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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. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Menetriers disease
Conj - inc - dec
Lactase is located at the tips of intestinal villi
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

2. Why does carcinoid syndrome not occur if tumor is confined to GI system
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Liver metabolizes 5HT
Inc conj bilirubin - inc cholesterol - inc alk phos
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

3. What is the ddx associated with appendicitis
Peptic ulcer disease
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Above
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

4. What serum enzyme is elevated in acute pancreatitis and mumps
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Striated and smooth
Muscularis mucosae
Amylase

5. What is the sphincter of the pancreatic duct
Hypotonic because of more time to reabsorb NaCl
Complications of crohns
Sphincter of oddi
Lamina propria

6. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Dubin johnson
Black - rotors syndrome
Amylase

7. What commonly leads to appendicity in kids vs adults
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
L4
Mucoepidermoid carcinoma

8. How is the diagonsis of CRC made
Small intestine
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
Peptic ulcer disease
Cholesterol

9. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Source - parasympathetic ganglion in sphincters - gallbladder - small intestine - action - inc intestinal water and electrolyte secretion - inc relaxation of intestinal smooth muscle and sphincters - regulation - inc by distention and vagal stimulati
Menetriers disease
H+
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

10. What is the omphalomesenteric cyst
IBS at least 2 with recurrent abdominal pain
AST
Worldwide - SC - US - adeno
Cystic dilation of the viteline duct

11. What are the complications of Meckels
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Stimulate the H/K ATPase
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Right and left hepatic duct

12. What kind of cancer to celiac sprue put you as inc risk for
Sister mary joseph nodule
...
Chagas disease
T cell lymphoma

13. What test and result confirms H pylori infxn
Positive urease test
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Neutralizes gastric acid allowing pancreatic enzymes to fxn

14. What are the structures of the femoral triangle and how are they organized
Inc smooth muscle relaxation - including lower esophageal sphincter
3 waves/min
NAV = nerve artery vein - venous near the penis (NAVEL)
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

15. What structure is Not contained in the femoral sheath
Hemosiderosis - hemochromatosis
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Hypotonic because of more time to reabsorb NaCl

16. Where are tumors commonly in pancreatic adenocarcinoma
Crohns = maybe - UC= always
Pancreatic head causing obstructive jaundice
Carcinoid syndrome
Where hindgut meets ectoderm

17. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
Angiodysplasia
Increase tumorigenesis
Complications of UC

18. What layer in the mucosa is repsonsible for motility
Muscularis mucosae
Lateral
Cystic dilation of the viteline duct
Oral glucose

19. What does a gastrinoma cause
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Begins starch digestion - inactivated by low pH upon reaching the stomach
Via the middle colic

20. Where are oligosaccharide hydrolases and What do they do
Brush border of intestine - produce monosaccharides from oligo and di
Epithelium
PAS- positive globules in liver -
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

21. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Zollinger Ellison - phenylalanine and tryptophan
Internal thoracic to superior epigastric to inferior epigastric
Can lead to hematemesis - found in EtOHics and bulimics
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

22. Cholecytsokinin - source - action - regulation
Crigler - najjar type 1
Mucoepidermoid carcinoma
Source - I cells (duod - jej - action - inc pancreative secretion - inc gallbladder contraction - dec gastric emptying - sphincter of Oddi relaxation - regulation - inc by fatty acids and amino acids
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

23. What is the rule of 2s for meckels
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
H pylori (almost 100%)
Inc conj bilirubin - inc cholesterol - inc alk phos
AR

24. signet ring cells - acanthosis nigracans - dz - character/association - spread
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Centrilobular congestion and necrosis - cardiac cirrhosis
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Epigastric abdominal pain radiating to back - anorexia - nausea

25. What are esophageal strictures associated with
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Begins starch digestion - inactivated by low pH upon reaching the stomach
Lye ingestion and acid reflux
Menetriers disease

26. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Oral glucose
Meckels
Left and right gastroepiploics - left and right gastrics
Upregulated intracellular signal transduction

27. Abuse of what substance leads to acute gastritis
Redness and tenderness on palpation of extremities
L3
Superior rectal
EtOH

28. What are the main components of bile
Alcoholic cirrhosis
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Uremia
Reye's syndrome

29. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Ischemic colitis
Stercobilin
Redness and tenderness on palpation of extremities

30. What is pancreatic adenocarcinoma associated with
Lye ingestion and acid reflux
Colonic polyps
Cigarettes and chronic pancreatitis - not EtOH
Dilated esophagus with an area of distal stenosis - birds beak

31. bilateral mets to ovaries with abundant mucus - signet ring cells
Krukenbergs tumor
Spleen to posterior abdominal wall - splenic artery and vein
Alk phos
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

32. What are the ABCDEF of esophageal cancer
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Via the middle colic
Esophageal carcinoma
NAV = nerve artery vein - venous near the penis (NAVEL)

33. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
US and cholecystectomy
Alcoholic hepatitis
Source - parasympathetic ganglion in sphincters - gallbladder - small intestine - action - inc intestinal water and electrolyte secretion - inc relaxation of intestinal smooth muscle and sphincters - regulation - inc by distention and vagal stimulati
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

34. How does brain injury lead to acute gastritis and What is it called
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Above
Closer to isotonic because of less time to reabsorb NaCl
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

35. What does histo show for alpha1 antitrypsin def
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
Early childhood - neuro sx and malabsorption
The proximal small bowel
PAS- positive globules in liver -

36. What conditions are associated with budd chiari
Hypercoaguability - polycythemia vera - pregnancy - HCC
Dilated esophagus with an area of distal stenosis - birds beak
Upregulated intracellular signal transduction
Right and left hepatic duct

37. What histological findings are present in the stomach
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Diverticulum
Gastric glands
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

38. Where is the deep inguinal ring relative to the inferior epigastric vessels
Mallory bodies
Pancreatic and bile
Lateral
Dissaccharidase def - most commonly lactase

39. What is the path of an indirect inguinal hernia
Esophageal cancer
Elevated amylase - and lipase
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

40. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Internal thoracic to superior epigastric to inferior epigastric
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Crohns = noncaseating granulomas - UC = crypt abscesses

41. What do mucins do?
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
NAV = nerve artery vein - venous near the penis (NAVEL)
Lubricate food (glycoprotiens)
Neutralizes oral bacertial acids and maintains dental health

42. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Virchow's node
Inc smooth muscle relaxation - including lower esophageal sphincter
Zenkers - halitosis - dysphagia and obstruction

43. What other condition can lead to acute gastritis - think renal
Penicillinamine - AR inheritance
Inc smooth muscle relaxation - including lower esophageal sphincter
Uremia
Uridine glucuronyl transferase

44. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
M3 - Gq - inc IP3/Ca
Crohns = noncaseating granulomas - UC = crypt abscesses
Lack or have an attenuated muscularis externa - often in the sigmoid colon
L1

45. What are the histological findings in the ileum

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46. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
FAP
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
No
Failure of neural crest migration

47. What is one potential precipitating factor for intussusception
Inc conj bilirubin - inc cholesterol - inc alk phos
Phenobarbital - inc liver enzyme synthesis
Tropical sprue
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

48. If the abdominal aorta is blocked - How does blood get to the left colic artery
Punched out - clean margins - carcinoma =raised irregular margins
L4
Via the middle colic
Decrease - weight gain

49. What is the most common indication of emergent abdominal surgery in children
Cystic duct and common hepatic duct
Appendicitis
Hydrocele
Skip lesions =crohns - colon = UC

50. What drug blocks the H2R
Crohns = maybe - UC= always
Cimetidine
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
L2