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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. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Intussusception
Fasting and stress

2. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Left gastric vein and esophogeal vein - esophagus
Hemosiderosis - hemochromatosis
Heme metabolism
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

3. Where does type A chronic gastritis occur and What causes it
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Warthins' tumor
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

4. What is the path of an indirect inguinal hernia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Hepatic steatosis
Lateral
Skip lesions =crohns - colon = UC

5. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Peyers patches
Pyoderma gangrenosum - primary sclerosing cholangitis
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

6. secretin - source - action - regulation
Myenteric nerve plexus - aurbach
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
External (superficial) ring only
Source - S cells (duod) - action - inc pancreatic bicarb secretion - dec gastric acid secretin - inc bile secretion - regulation - inc by acid - fatty acids in lumen of duod

7. Why does volvulus occur more at cecum and sigmoid colon
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Redundant mesentary
Hernia
Hypotonic because of more time to reabsorb NaCl

8. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Hirschsprungs
Backup of blood into the liver - RHF - budd chiari
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

9. What is the cause of Barrett's and the assocaited complications
Old men - arthralgias - cardiac and neuro sx
Below
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Hydrocele

10. Acute gastritis is caused By what process
Goes through deep inguinal ring - external inguinal ring and into the scrotum
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
Erosive - disruption of mucosal barrier leading to inflammation
Lamina propria

11. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Falciform - ligamentum teres - fetal umbilical vein
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Bleeding - penetration into pancreas - perforation - obstruction
Early childhood - neuro sx and malabsorption

12. What is Trousseau's sign
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Redness and tenderness on palpation of extremities
Complications of UC

13. What causes hirschsprungs
Celiac sprue
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
Via the superior pancreaticduodenal
Failure of neural crest migration

14. What does K- ras mutation cause
Colonic polyps
Liver metabolizes 5HT
Upregulated intracellular signal transduction
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

15. What kind of cancer to celiac sprue put you as inc risk for
T cell lymphoma
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Ceruplasmin
Inc conj bilirubin - inc cholesterol - inc alk phos

16. What serum enzyme is decreased in wilsons disease
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
Ceruplasmin
Juvenile polyposis syndrome - inc risk of adenocarcinoma
The entire

17. crigler - najjar type II responds to which therapy and How does it work
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Nonkeritinized stratified sqamous epithelium
Phenobarbital - inc liver enzyme synthesis
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

18. What are the main components of bile
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Pertechnetate - study for uptake
Cholesterol - 10-20% opaque due to calcifications
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

19. How do NSAIDs cause acute gastritis
Source - S cells (duod) - action - inc pancreatic bicarb secretion - dec gastric acid secretin - inc bile secretion - regulation - inc by acid - fatty acids in lumen of duod
Cigarettes and chronic pancreatitis - not EtOH
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Dec PGE2 leading to dec gastric mucosa protection

20. List the clinical findings of HCC
Pancreatic head causing obstructive jaundice
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
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Portal HTN

21. What skin condition is associated with celiac sprue
Dermatitis herpetiformis
Hernia
Closer to isotonic because of less time to reabsorb NaCl
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

22. Where is folate absorbed
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
The jejunum
Inferior rectal nerve
US and cholecystectomy

23. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
8-9 waves/min
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Liver metabolizes 5HT
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

24. What structures feed into the common hepatic duct
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Right and left hepatic duct

25. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
H pylori (almost 100%)
2ndary biliary cirrhosis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

26. What is the classic triad of hemochromatosis

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27. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Superior rectal
Juvenille polyps - no risk if single
Black - rotors syndrome
Amylase

28. What are the two molecular pathways that lead to CRC
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
H+
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Elevated amylase - and lipase

29. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
HPNCC
Stimulate intestinal persistalsis
Lipase

30. In PUD - with gastric ulcers - does pain inc or dec with meals?
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Celiac sprue
Cystic dilation of the viteline duct
Inc - weight loss

31. What is the triad of Plummer - Vinson syndrome
...
Repeated phlebotomy - deferoxamine - HLA- A3
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Lamina propora and submucosa

32. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Alpha amylase
Celiac sprue
Chagas disease

33. At what level do the testicular/ovarian arteries exit the aorta
L2
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
IBS at least 2 with recurrent abdominal pain
ALT>AST

34. Autodigestion of pancreas by pancreatic enzymes
Bleeding - penetration into pancreas - perforation - obstruction
Early childhood - neuro sx and malabsorption
Peyers patches
Acute pancreatitis

35. What carcinogens are associated with HCC
Alfatoxin in peanuts
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Appendicitis
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

36. What can hemochromatosis be secondary to...
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Alcoholic hepatitis
H pylori (almost 100%)

37. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Sphincter of oddi
Barrett's esophagus
GERD - may also present with nocturnal cough and dyspnea
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

38. milk intolerance
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Inc smooth muscle relaxation - including lower esophageal sphincter
Dissaccharidase def - most commonly lactase
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

39. What is the leading cause of bowel incarceration
Hemolytic anemia
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Femoral hernia
GERD - may also present with nocturnal cough and dyspnea

40. What congenital birth defect is associated with Hirschsprung
Complications of crohns
Dec PGE2 leading to dec gastric mucosa protection
Downs
Paraumbilical and superficial and inferior epigastric - umbilicus

41. How is salivary secretion stimulated
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Gallbladder
Conj - inc - dec
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

42. How do burns cause acute gastritis and What is it called

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43. What pancreatic proteases are secreted as zymogens
Trypsin - chymotrypsin - elastase - carboxypeptidases
Complications of UC
H+
Paraumbilical and superficial and inferior epigastric - umbilicus

44. What is one potential precipitating factor for intussusception
Lye ingestion and acid reflux
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Esophageal cancer

45. rare - often fatal childhood hepatoencephalopathy

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46. Where is IgA shuttled
T12
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Chagas disease
Hypotonic because of more time to reabsorb NaCl

47. What layer of fascia covers a direct inguinal hernia
H+
External spermatic fascia only
Boerhaave's Syndrome - Been heaving syndrome
Dysphagia (due to esophageal web) - glossitis - iron def anemia

48. What are the histological findings in the ileum

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49. Who is at risk for pancreatic adenocarcinoma
Jewish and African American men
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Erosive - disruption of mucosal barrier leading to inflammation
Downs

50. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Right and left hepatic duct
L1
Mallory bodies
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