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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 separates the right greater and lesser sacs
Gallbladder
Gastrohepatic ligament
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
When diffusely infiltrative - thickened rigid appearance like a leather bottle

2. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
...
Dermatitis herpetiformis
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

3. What are the borders of the femoral triangle
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Inguninal ligament - sartorius muscle - adductor longus
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

4. Where are peyers patches found
Alk pho
Lamina propora and submucosa
Redness and tenderness on palpation of extremities
Dec PGE2 leading to dec gastric mucosa protection

5. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Epithelium
Falciform - ligamentum teres - fetal umbilical vein
Jewish and African American men
Hemosiderosis - hemochromatosis

6. Which IBD is autoimmune and which may be a disordered response to bacteria
Nonkeritinized stratified sqamous epithelium
Chronic gastritis and pernicious anemia
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Cholesterol

7. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Poor anastamoses
Dilated esophagus with an area of distal stenosis - birds beak
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

8. What is the lumen of the pancreatic duct
Lactase is located at the tips of intestinal villi
Ampulla of vater
GLUT 2
Glucose dependent insulinotropic peptide

9. B cells stimuated in the germinal centers of peyers patches differentiate into what?
IgA secreting plasma cells - ultimately reside in the lamina proporia
Necrotizing enterocolitis
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

10. What kind of lesions are characteristic of duodenal PUD vs cancer
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Alfatoxin in peanuts
Punched out - clean margins - carcinoma =raised irregular margins
Hemosiderosis - hemochromatosis

11. Which area of the hindgut is a watershed area
Urobilin
Splenic flexure
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Short gastrics - left greater and lesser

12. Cholecytsokinin - source - action - regulation
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
Redness and tenderness on palpation of extremities
Cirrhosis
Ampulla of vater

13. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Crohns = noncaseating granulomas - UC = crypt abscesses
Cirrhosis
Achalasia due to loss of myenteric plexus (auberach)
Menetriers disease

14. What are the signs and symptoms of budd chiari
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Inspiratory arrest on deep palpation due to pain
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD

15. What does the splenorenal ligament connect - and What does it contain
Hernia
Gilbert's
Epithelium
Spleen to posterior abdominal wall - splenic artery and vein

16. What are the extraintestinal manifestations of ulcerative colitis
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
ALT>AST
Pyoderma gangrenosum - primary sclerosing cholangitis
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

17. What structures feed into the cystic duct
Gallbladder
PAS- positive globules in liver -
Brunners
Cystic dilation of the viteline duct

18. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Esophageal cancer

19. likely infectious form of malabsorption - responds to antibiotics
Tropical sprue
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Alk pho
Lateral to the inferior epigastric artery

20. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Striated and smooth
Conj - inc - dec
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

21. What is the HLA association and treatment for hemochromatosis
Superior rectal
Enterokinase/enteropeptidase from the duodenal mucosa
In the mucus that covers the gastric epithelium
Repeated phlebotomy - deferoxamine - HLA- A3

22. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
HPNCC
Gallbladder
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Hirschsprungs

23. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Epigastric abdominal pain radiating to back - anorexia - nausea
Intussusception
2ndary biliary cirrhosis

24. What can fistula between the gallbladder and small intestine create and how can you tell
Hypercoaguability - polycythemia vera - pregnancy - HCC
Redness and tenderness on palpation of extremities
Complications of UC
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

25. How does CRC present in the distal and proximal colon
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Hirschsprungs
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
US and cholecystectomy

26. 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
Erosive - disruption of mucosal barrier leading to inflammation
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Decreased intercellular adhesion and increased proliferation

27. With caput medusaw - between what vessels is the anastomoses and Where is it
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
True and most common congenital anomoly of GI tract
Paraumbilical and superficial and inferior epigastric - umbilicus
Myenteric nerve plexus - aurbach

28. What does histo show for alpha1 antitrypsin def
Via the superior pancreaticduodenal
PAS- positive globules in liver -
Neural muscarinic pathways
Punched out - clean margins - carcinoma =raised irregular margins

29. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Ampulla of vater
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Meconium ileus
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

30. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Gut bacteria
2ndary biliary cirrhosis
Esophageal cancer
AR

31. What are the common causes of gastric ulcers - What causes gastric ulcer
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
US and cholecystectomy
Zollinger ellison - brunners glands
With albumin

32. Which viral infxns/treatments are associated with reyes syndrome
In the mucus that covers the gastric epithelium
VZV and influenza B treated with salicylates
Around the central vein (zone III)
Uremia

33. Where does type B chronic gastritis occur and What causes it
Hyperplastic
Zenkers - halitosis - dysphagia and obstruction
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Antrum - H.pylori - inc risk of MALT lymphoma

34. What arteries exit just below the SMA
Colonic polyps
Mucoepidermoid carcinoma
Cholesterol - 10-20% opaque due to calcifications
L/R renal artery around L1

35. What complication can arise from indirect inguinal hernias
Hypercoaguability - polycythemia vera - pregnancy - HCC
Hydrocele
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Bleeding - penetration into pancreas - perforation - obstruction

36. What are the histological findings in the ileum

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37. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
Cholesterol
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Liver metabolizes 5HT

38. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Acute pancreatitis
Alpha amylase
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Trypsin - chymotrypsin - elastase - carboxypeptidases

39. What test and result confirms H pylori infxn
Positive urease test
Worldwide - SC - US - adeno
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Lamina propria

40. Why does volvulus occur more at cecum and sigmoid colon
Redundant mesentary
Lamina propria
Esophageal cancer
Chronic gastritis and pernicious anemia

41. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
90%
Inc conj bilirubin - inc cholesterol - inc alk phos
Superior rectal

42. What layer of fascia covers a direct inguinal hernia
Celiac sprue
Cholesterol - 10-20% opaque due to calcifications
External spermatic fascia only
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

43. What makes a true diverticula
All 3 gut layers outpouch as in Meckels
Erosive - disruption of mucosal barrier leading to inflammation
Osmotic
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

44. What is the epi for CRC
AR
Cimetidine
Cirrhosis
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

45. Who gets gastric ulcers
Omeprazole
Older patients
Inc lower esphogeal tone leading to achalasia
Positive

46. What are the foregut structures and what supplies their blood and PANS innvervation
AST>ALT
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Alcoholic hepatitis

47. Where is there sclerosis in alcoholic cirrohosis
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Hirschsprungs
In the mucus that covers the gastric epithelium
Around the central vein (zone III)

48. Who is at risk for pancreatic adenocarcinoma
Diarrhea - steatorrhea - weight loss - weakness
Low pressure proximal to LES
EtOH
Jewish and African American men

49. What infection causes Whipple disease and What can you see on LM
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Lipase - phospholipase A - colipase

50. trypsinogen is converted to trypsin via what enzyme
Parietal cells in the stomach - B12 binding protein
Enterokinase/enteropeptidase from the duodenal mucosa
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Inc - weight loss