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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 IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Dec PGE2 leading to dec gastric mucosa protection
Below
Pertechnetate - study for uptake
Crohns = noncaseating granulomas - UC = crypt abscesses

2. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
L4
Dilated esophagus with an area of distal stenosis - birds beak
Juvenille polyps - no risk if single
Internal thoracic to superior epigastric to inferior epigastric

3. What gives stool its characteristic color
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Stercobilin
The entire
The gastroduodenal

4. What are the complications of Meckels
Alfatoxin in peanuts
Around the central vein (zone III)
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Peptic ulcer disease

5. What are the midgut structures and what supplies their blood and PANS innervation
Centrilobular congestion and necrosis - cardiac cirrhosis
FAP
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
With albumin

6. In viral hepatitis - which liver enzyme is higher
ALT>AST
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
L1
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

7. What are the layers of the gut wall from inside out
Mucosa - submucosa - muscularis externa - serosa/adventitia
Lateral to the inferior epigastric artery
Hernia
H pylori (almost 100%)

8. Which area of the hindgut is a watershed area
Splenic flexure
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

9. What histological findings are present in the stomach
IBS at least 2 with recurrent abdominal pain
Gastric glands
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Parietal cells in the stomach - B12 binding protein

10. What do you treat Wilsons disease with and What is the inheritance
Positive urease test
Volvulus
Penicillinamine - AR inheritance
Gilbert's

11. How does abetalipoproteinemia lead to malabsorption
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Neutralizes oral bacertial acids and maintains dental health
Lipase - phospholipase A - colipase

12. Where is bicarb trapped
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Dilated esophagus with an area of distal stenosis - birds beak
Dec PGE2 leading to dec gastric mucosa protection
In the mucus that covers the gastric epithelium

13. How many layers of spermatic fascia are covers an indirect inguinal hernia
Alfatoxin in peanuts
Angiodysplasia
All 3
Decrease - weight gain

14. What is the arterial supply and venous drainage below pectinate line
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
Unconj - absent (acholuria) - inc
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Osmotic

15. Which IBD is autoimmune and which may be a disordered response to bacteria
Common hepatic - splenic - left gastric - main blood supply for stomach
Mucosa - submucosa - muscularis externa - serosa/adventitia
Striated and smooth
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

16. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
Cirrhosis
Inc - weight loss
Averages 6 months - very aggressive - usually already metastasized at presentation

17. What are the four Fs of gallstones
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
FAP
Female - fat - fertile - forty
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

18. Gq and inc cAMP both work to do what in parietal cells
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
2ndary biliary cirrhosis
Stimulate the H/K ATPase
Common hepatic - splenic - left gastric - main blood supply for stomach

19. What conditions are associated with budd chiari
Chronic gastritis and pernicious anemia
Common hepatic - splenic - left gastric - main blood supply for stomach
Hypercoaguability - polycythemia vera - pregnancy - HCC
The submucosal nerve plexus - meissner's

20. What does the splenorenal ligament connect - and What does it contain
Spleen to posterior abdominal wall - splenic artery and vein
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Crohns = maybe - UC= always

21. How does hirschsprung present and appear on imaging
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
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
Elevated amylase - and lipase
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

22. What kind of anemia is in Wilsons
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Cystic dilation of the viteline duct
Amylase
Hemolytic anemia

23. What transforms conjugated bilirubin to urobilinogen
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Gut bacteria
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

24. What does extrahepatic biliary obstruction cause
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
All 3
FAP
With albumin

25. why infxn is implicated in duodenal PUD
Hyperplastic
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
H pylori (almost 100%)
AST >ALT - ration is usually 1.5

26. What infection causes Whipple disease and What can you see on LM
90%
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

27. What are the results of hemochromatosis
Erosive - disruption of mucosal barrier leading to inflammation
CHF and inc risk of HCC
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
In the ileum with bile acids - requires IF

28. Where are peyers patches found
Paraumbilical and superficial and inferior epigastric - umbilicus
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
AR
Lamina propora and submucosa

29. Where is there sclerosis in alcoholic cirrohosis
8-9 waves/min
Around the central vein (zone III)
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
L4

30. Bile is critical for exrection of what substance
Cholesterol
Jewish and African American men
Jaundice - fever - RUQ
Positive

31. What do mucins do?
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Phototherapy
The submucosal nerve plexus - meissner's
Lubricate food (glycoprotiens)

32. What are the longterm sequelae of nutmeg liver
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Fasting and stress
Phototherapy
Centrilobular congestion and necrosis - cardiac cirrhosis

33. What cells make pepsin - What does it do - and what regulates it
Alfatoxin in peanuts
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

34. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Zollinger ellison - brunners glands
Gilbert's
HPNCC
Inspiratory arrest on deep palpation due to pain

35. Where does copper accumulate in Wilsons and What are ABCD
Obstruction of the common bile duct
Virchow's node
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

36. Gallstones that reach the common channel at ampulla can block which two ducts
L1
Pancreatic and bile
Where hindgut meets ectoderm
Splenic flexure

37. What is contained within the submucosa

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38. What are the main components of bile
Old men - arthralgias - cardiac and neuro sx
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Positive urease test
AST

39. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Via the superior pancreaticduodenal
Below
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Common hepatic - splenic - left gastric - main blood supply for stomach

40. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Esophageal cancer
Via the superior pancreaticduodenal
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Amylase

41. What structure is Not contained in the femoral sheath
External (superficial) ring only
Dubin johnson
Dysphagia (due to esophageal web) - glossitis - iron def anemia
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

42. What serum enzyme is elevated inacute pancreatitis
Unconj - absent (acholuria) - inc
Repeated phlebotomy - deferoxamine - HLA- A3
HSV-1 - CMV - Candida
Lipase

43. What causes primary biliary cirrhosis
M3 - Gq - inc IP3/Ca
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Lubricate food (glycoprotiens)
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

44. What are the effects of atropine on parietal cells and G cells
Zollinger ellison - brunners glands
Hyperplastic
Glucouronate - water soluble (direct)
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

45. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Below
Via the middle colic
Complications of crohns
Older patients

46. trypsinogen is converted to trypsin via what enzyme
Closer to isotonic because of less time to reabsorb NaCl
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Adhesion
Enterokinase/enteropeptidase from the duodenal mucosa

47. What receptors does ACH bind on the parietal cells and What does it activate
M3 - Gq - inc IP3/Ca
Redundant mesentary
Krukenbergs tumor
Conj - inc - dec

48. In what scenarios do pts with gilberts have inc bili
Mucosa - submucosa - muscularis externa - serosa/adventitia
Fasting and stress
Glucouronate - water soluble (direct)
Alcoholic hepatitis

49. What kind of pancreatitis is associated with EtOH and smoking
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Paraumbilical and superficial and inferior epigastric - umbilicus
NAV = nerve artery vein - venous near the penis (NAVEL)
Chronic calcifying pancreatitis - inc risk of panreatic cancer

50. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
2ndary biliary cirrhosis
Gastric glands
Below
Alcoholic hepatitis