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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. How does brain injury lead to acute gastritis and What is it called
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
EtOH

2. What happens to the short gastics if the splenic artery is blocked
Diarrhea - steatorrhea - weight loss - weakness
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Chronic constipation early in life with dilated portion of the colon proximal to the aganglionic segment resulting in a transition zone - involves rectum - usually a failure to pass meconium
Poor anastamoses

3. Where does type B chronic gastritis occur and What causes it
Stercobilin
Antrum - H.pylori - inc risk of MALT lymphoma
Muscularis mucosae
Intussusception

4. What is the lumen of the pancreatic duct
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
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Turcot
Ampulla of vater

5. What does a gastrinoma cause
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Warthins' tumor
External (superficial) ring only
Old men - arthralgias - cardiac and neuro sx

6. what percentage of colonic polyps are non - neoplastic
EtOH
Muscularis mucosae
90%
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

7. What are the signs and symptoms of budd chiari
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Centrilobular leading to congestive liver disease

8. What cell produces IF and What does it do
Parietal cells in the stomach - B12 binding protein
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
NAV = nerve artery vein - venous near the penis (NAVEL)
Oligosaccharide digestion

9. What layer in the mucosa is responsible for absorption
AST
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Epithelium
Striated

10. Which is used more quickly - an oral glucose load - or that by IV
Colovesical leading to pneumaturia
Hernia
Oral glucose
Neutralizes gastric acid allowing pancreatic enzymes to fxn

11. If the abdominal aorta is blocked - How does blood get to the left colic artery
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Appendicitis
Downs
Via the middle colic

12. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Failure of neural crest migration
External spermatic fascia only

13. What are the foregut structures and what supplies their blood and PANS innvervation
HPNCC
All 3 gut layers outpouch as in Meckels
Common hepatic - splenic - left gastric - main blood supply for stomach
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

14. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Gastric glands
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Conj - inc - dec
Increase tumorigenesis

15. What is the frequency of basal electric rhythm of the ilieum
8-9 waves/min
Crigler - najjar type 1
Alpha amylase
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

16. trypsinogen is converted to trypsin via what enzyme
Right and left hepatic duct
Hernia
Enterokinase/enteropeptidase from the duodenal mucosa
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

17. What serum markers increase in cholecystitis with bile duct involvement
In the mucus that covers the gastric epithelium
Ampulla of vater
Dilated esophagus with an area of distal stenosis - birds beak
Alk phos

18. What is indirect bilirubin
Unconjugated - water insoluble
T cell lymphoma
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Positive urease test

19. Why are most diverticula considered false
The jejunum
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Striated
Lack or have an attenuated muscularis externa - often in the sigmoid colon

20. What source of salivary secretion is the most serous and What is the most mucinous
Serous on the sides parotids - mucinous in the middle sublingual
Punched out - clean margins - carcinoma =raised irregular margins
Budd chiari syndrome
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

21. Where does copper accumulate in Wilsons and What are ABCD
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Osmotic
Dilated esophagus with an area of distal stenosis - birds beak
Enterokinase/enteropeptidase from the duodenal mucosa

22. Where is B12 absorbed
Crohns = maybe - UC= always
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
In the ileum with bile acids - requires IF
Inc smooth muscle relaxation - including lower esophageal sphincter

23. What layer in the mucosa is repsonsible for motility
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
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
T12
Muscularis mucosae

24. How does gastrin increase acid secretion?
Hepatic steatosis
Meconium ileus
Primarly through ECL leading to histamine release
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

25. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Hepatic steatosis
Poor anastamoses
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
3 waves/min

26. How is salivary secretion stimulated
Low pressure proximal to LES
Crohns = transmural (cobblestone mucosa - creeping fat - string sign - linear ulcers fissures - fistulas) UC = mucosal and submucosal (friable mucosal pseudopolyps with freely hanging mesentary - loss of haustra - lead pipe appearance on imaging
Alfatoxin in peanuts
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

27. People of what decent are associated with celiac sprue and what findings/antibodies are present
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Celiac sprue
Primarly through ECL leading to histamine release
AST

28. Where are oligosaccharide hydrolases and What do they do
Brush border of intestine - produce monosaccharides from oligo and di
Dense core bodies
Muscularis mucosae
Necrotizing enterocolitis

29. What is the action of NO as a GI hormone
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Inc smooth muscle relaxation - including lower esophageal sphincter
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Paraumbilical and superficial and inferior epigastric - umbilicus

30. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Conj - inc - dec
Intussusception
Zollinger Ellison - phenylalanine and tryptophan
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

31. How do NSAIDs cause acute gastritis
Neutralizes oral bacertial acids and maintains dental health
Krukenbergs tumor
Dec PGE2 leading to dec gastric mucosa protection
Ampulla of vater

32. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Alpha1 antitrypsin def - codominant trait
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
All 3
Barrett's esophagus

33. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Diarrhea - steatorrhea - weight loss - weakness
Hypercoaguability - polycythemia vera - pregnancy - HCC
Obstruction of the common bile duct
Duodenal atresia - Downs

34. How do you DX and TX gallstones
Cholesterol
Pertechnetate - study for uptake
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
US and cholecystectomy

35. What is contained within the muscularis externa
Oral glucose
Myenteric nerve plexus - aurbach
Via the superior pancreaticduodenal
Fasting and stress

36. What is the frequency of basal electric rhythm in the duodenum
ALT>AST
12 waves/min
Lipase
Corticosteroids - infliximab

37. What portion of the bowel does sprue effect
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Celiac sprue
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
The proximal small bowel

38. Malabsorption syndromes have what common clinical presentation
Diarrhea - steatorrhea - weight loss - weakness
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Glucouronate - water soluble (direct)
Lateral

39. In PUD with a duodenal ulcer does pain inc or dec with meals
Fasting and stress
Decrease - weight gain
Meconium ileus
Barrett's esophagus

40. What serum enzyme is decreased in wilsons disease
Peptic ulcer disease
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Cigarettes and chronic pancreatitis - not EtOH
Ceruplasmin

41. What intervention will intervention will relieve portal HTN
Worldwide - SC - US - adeno
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Cigarettes and chronic pancreatitis - not EtOH

42. What conditions are associated with budd chiari
L3
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Cholesterol - 10-20% opaque due to calcifications
Hypercoaguability - polycythemia vera - pregnancy - HCC

43. What is the mechanism for reyes syndrome
Lateral to the inferior epigastric artery
Dilated esophagus with an area of distal stenosis - birds beak
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

44. What findings are associated with reyes
IgA secreting plasma cells - ultimately reside in the lamina proporia
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Early childhood - neuro sx and malabsorption
Inc risk of CRC and other visceral malignancies

45. What are the complications of duodenal PUD
AST >ALT - ration is usually 1.5
Femoral hernia
Intussusception
Bleeding - penetration into pancreas - perforation - obstruction

46. What factors increase risk of malignancy of adenomatous polyps
GLUT 2
Redundant mesentary
Peptic ulcer disease
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

47. multiple juvenil polyps in GI tract - risk
Falciform - ligamentum teres - fetal umbilical vein
Complications of crohns
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Juvenile polyposis syndrome - inc risk of adenocarcinoma

48. What infection causes Whipple disease and What can you see on LM
Uremia
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
L3
Dermatitis herpetiformis

49. What is charcot triad of cholangitis
Muscularis mucosae
Striated and smooth
Decreased intercellular adhesion and increased proliferation
Jaundice - fever - RUQ

50. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Inc - weight loss
Urobilin
Juvenille polyps - no risk if single
Hirschsprungs