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USMLE GI

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What gives stool its characteristic color
Stercobilin
Menetriers disease
3 waves/min
12 waves/min

2. Through which aspect of the inguinal canal does a direct inguinal go
Oral glucose
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Striated
External (superficial) ring only

3. How does CRC present in the distal and proximal colon
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Glucose dependent insulinotropic peptide
Paraumbilical and superficial and inferior epigastric - umbilicus
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

4. Is there any structural abnl with IBS - What is the course of disease and presentation
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
T12
Cystic duct and common hepatic duct

5. What percentage of gall stones are cholesterol stones and What are the associations
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Black - rotors syndrome
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
All 3

6. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Bleeding - penetration into pancreas - perforation - obstruction
Antrum - H.pylori - inc risk of MALT lymphoma
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

7. What are the labs in acute pancreatitis
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Worldwide - SC - US - adeno
3 waves/min
Elevated amylase - and lipase

8. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Chronic gastritis and pernicious anemia
Cimetidine
HSV-1 - CMV - Candida
When diffusely infiltrative - thickened rigid appearance like a leather bottle

9. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Mallory bodies
True and most common congenital anomoly of GI tract
Conj - inc - dec

10. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus

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11. What are the signs and symptoms of budd chiari
L4
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Centrilobular congestion and necrosis - cardiac cirrhosis

12. Which is used more quickly - an oral glucose load - or that by IV
Acute pancreatitis
Parietal cells in the stomach - B12 binding protein
Dense core bodies
Oral glucose

13. What serum markers increase in cholecystitis with bile duct involvement
Gamma glutamyl transferase GGT
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Alk phos
Superior rectal and middle and inferior rectal - rectum

14. What layer in the mucosa is repsonsible for motility
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Chagas disease
Muscularis mucosae
Pleomorphic adenoma

15. Progressive dyshphage beginning with solids and moving to liquids and weight loss
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Esophageal cancer
Volvulus
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn

16. What do the rugae of stomach look like in menetriers disease
Colonic polyps
So hypertrophied they look like brain gyri
Ceruplasmin
The submucosal nerve plexus - meissner's

17. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Primary sclerosing cholangitis
Esophageal cancer
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
IBS at least 2 with recurrent abdominal pain

18. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
IgA secreting plasma cells - ultimately reside in the lamina proporia
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Celiac sprue

19. What are the extraintestinal manifestations of ulcerative colitis
With albumin
Pyoderma gangrenosum - primary sclerosing cholangitis
Unconj - absent (acholuria) - inc
Chagas disease

20. Gastrin - source - action - regulation
Colovesical leading to pneumaturia
Achalasia due to loss of myenteric plexus (auberach)
Source - G cells in the antrum - action - inc gastric H+ secretion - inc growth of gastric mucosa - and inc gastric motility - regulation - inc by stomach distention/alkalinaztion - amino acids - peptides - vagal stimulation - dec by stomach pH < 1.5
Left and right gastroepiploics - left and right gastrics

21. What are esophageal strictures associated with
Lye ingestion and acid reflux
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Closer to isotonic because of less time to reabsorb NaCl
Below

22. What layer of fascia covers a direct inguinal hernia
External spermatic fascia only
Unconjugated - water insoluble
Neutralizes oral bacertial acids and maintains dental health
Redundant mesentary

23. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Skip lesions =crohns - colon = UC
Fe2+ in the duod
Ischemic colitis
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

24. Why does carcinoid syndrome not occur if tumor is confined to GI system
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Common hepatic - splenic - left gastric - main blood supply for stomach
Hernia
Liver metabolizes 5HT

25. Achalasia increases the risk For what complication
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Common hepatic - splenic - left gastric - main blood supply for stomach
Esophageal carcinoma
Hepatic steatosis

26. What is the most common cause of gallstones
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Pertechnetate - study for uptake
Terminal ileum and colon

27. How is salivary secretion stimulated
L2
Hirschsprungs
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Cirrhosis

28. With caput medusaw - between what vessels is the anastomoses and Where is it
In the mucus that covers the gastric epithelium
Paraumbilical and superficial and inferior epigastric - umbilicus
Stimulate intestinal persistalsis
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

29. What drug blocks the H2R
Lactase is located at the tips of intestinal villi
Lubricate food (glycoprotiens)
Peutz jeghers
Cimetidine

30. Autodigestion of pancreas by pancreatic enzymes
Esophageal varices
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Menetriers disease
Acute pancreatitis

31. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue

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32. What are the histological findings in the duodenum

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33. Where does an indirect inguinal hernia enter the deep inguinal ring
Alpha1 antitrypsin def - codominant trait
Corticosteroids - infliximab
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Lateral to the inferior epigastric artery

34. What makes a true diverticula
In the ileum with bile acids - requires IF
All 3 gut layers outpouch as in Meckels
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Brunners

35. what percentage of colonic polyps are non - neoplastic
Hirschsprungs
Warthins' tumor
90%
Osmotic

36. What do tumors that arise in the head of the pancreas cause
Obstruction of the common bile duct
Gamma glutamyl transferase GGT
Tropical sprue
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

37. Who gets Whipple disease and How do they present
Old men - arthralgias - cardiac and neuro sx
Lubricate food (glycoprotiens)
Hernia
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

38. Gallstones that reach the common channel at ampulla can block which two ducts
Myenteric nerve plexus - aurbach
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Pancreatic and bile
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

39. What does loss of p53 cause
Squamous - upper 1/3 - adeno - lower 1/3
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker
Increase tumorigenesis
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

40. In alchoholic hepatitis which liver enzyme is higher
FAP
AST>ALT
Fasting and stress
Cystic duct and common hepatic duct

41. With internal hemorrhoids Where is the anastomoses and Where is it
Superior rectal and middle and inferior rectal - rectum
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Reye's syndrome
Above

42. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Meconium ileus
All 3 gut layers outpouch as in Meckels
Above
Small intestine

43. What are the results of hemochromatosis
Enterokinase/enteropeptidase from the duodenal mucosa
CHF and inc risk of HCC
Myenteric nerve plexus - aurbach
Positive urease test

44. What is the action of NO as a GI hormone
Alcoholic cirrhosis
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Inc smooth muscle relaxation - including lower esophageal sphincter

45. most common non - neoplastic polyp in colon
Hyperplastic
Paraumbilical and superficial and inferior epigastric - umbilicus
Warthins' tumor
Juvenille polyps - no risk if single

46. what kind of fistula is associated with diverticulitis
Colovesical leading to pneumaturia
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Zollinger ellison - brunners glands
Positive urease test

47. Liver cell failure can lead to multisystem signs including
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
L/R renal artery around L1
Via the middle colic
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

48. What does primary sclerosing cholangitis lead to...
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Chagas disease
Oligosaccharide digestion

49. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Backup of blood into the liver - RHF - budd chiari
Gilbert's
Conj/unconj - inc - nl to dec
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

50. What kind of pathways do CCK act on to cause pancreatic secretion
Amylase
Jewish and African American men
Neural muscarinic pathways
Primarly through ECL leading to histamine release