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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 does GET SMASHED stand for in acute pancreatitis
Lipase
Superior rectal and middle and inferior rectal - rectum
Pleuroperitoneal
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

2. What are the longterm sequelae of nutmeg liver
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Gut bacteria
2ndary biliary cirrhosis
Centrilobular congestion and necrosis - cardiac cirrhosis

3. What complication can arise from indirect inguinal hernias
Hydrocele
Alk pho
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

4. rare - often fatal childhood hepatoencephalopathy

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5. What is the triad of Plummer - Vinson syndrome
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Closer to isotonic because of less time to reabsorb NaCl
Dysphagia (due to esophageal web) - glossitis - iron def anemia

6. What are esophageal strictures associated with
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Above
Lye ingestion and acid reflux
Carcinoid syndrome

7. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Lateral
Hydrocele
Meconium ileus
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM

8. Transmural esophageal rupture due to violent retching

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9. concentric onion skin bile duct fibrosis
Muscularis mucosae
Primary sclerosing cholangitis
Pancreatic head causing obstructive jaundice
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

10. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Dermatitis herpetiformis
Can lead to hematemesis - found in EtOHics and bulimics
Meconium ileus
Early childhood - neuro sx and malabsorption

11. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus

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12. What causes primary biliary cirrhosis
Oral glucose
Esophageal cancer
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Gastric glands

13. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Erosive - disruption of mucosal barrier leading to inflammation
Hemosiderosis - hemochromatosis
Above
Older patients

14. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Diarrhea - steatorrhea - weight loss - weakness
Epigastric abdominal pain radiating to back - anorexia - nausea
HSV-1 - CMV - Candida
In the ileum with bile acids - requires IF

15. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Ischemic colitis
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

16. What are the main components of bile
Primarly through ECL leading to histamine release
IgA secreting plasma cells - ultimately reside in the lamina proporia
Failure of the processus vagainlis to close
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

17. What does TOASTED with alcoholic hepatitis stand for
Obstruction of the common bile duct
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
AST >ALT - ration is usually 1.5

18. What causes carcinoid syndrome amd What are the symptoms
Female - fat - fertile - forty
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Achalasia due to loss of myenteric plexus (auberach)

19. How many layers of spermatic fascia are covers an indirect inguinal hernia
Averages 6 months - very aggressive - usually already metastasized at presentation
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
All 3
Lipase

20. Which kind of hemorrhoids are painful and why
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Punched out - clean margins - carcinoma =raised irregular margins
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Alfatoxin in peanuts

21. In PUD - with gastric ulcers - does pain inc or dec with meals?
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Lubricate food (glycoprotiens)
Inc - weight loss
Pancreatic head causing obstructive jaundice

22. What is one potential precipitating factor for intussusception
Below
Paraumbilical and superficial and inferior epigastric - umbilicus
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Squamous - upper 1/3 - adeno - lower 1/3

23. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Inc lower esphogeal tone leading to achalasia
Gut bacteria
Corticosteroids - infliximab
Black - rotors syndrome

24. What does autoimmune destruction of parietal cells lead to...
Alk pho
ALT>AST
Chronic gastritis and pernicious anemia
Fe2+ in the duod

25. What is the risk with peutz jehgers
H pylori (almost 100%)
Inc risk of CRC and other visceral malignancies
Failure of the processus vagainlis to close
Alpha1 antitrypsin def - codominant trait

26. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Unconj - absent (acholuria) - inc
Myenteric nerve plexus - aurbach
Ischemic colitis
Alpha amylase

27. What are the two molecular pathways that lead to CRC
L1
Mucosa - submucosa - muscularis externa - serosa/adventitia
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
MSI (15%) and APC/beta catenin chromosomal instability (85%)

28. How do you DX and TX gallstones
Lye ingestion and acid reflux
The gastroduodenal
US and cholecystectomy
Boerhaave's Syndrome - Been heaving syndrome

29. What are the tumor markers for pancreatic adenocarcinoma
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
CEA - CA-19-9
L2

30. what percentage of colonic polyps are non - neoplastic
Boerhaave's Syndrome - Been heaving syndrome
90%
Older patients
Primary sclerosing cholangitis

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

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32. What percentage of gall stones are cholesterol stones and What are the associations
Trypsin - chymotrypsin - elastase - carboxypeptidases
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
Phenobarbital - inc liver enzyme synthesis

33. What are the midgut structures and what supplies their blood and PANS innervation
Barrett's esophagus
So hypertrophied they look like brain gyri
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Early childhood - neuro sx and malabsorption

34. What kind of anemia is in Wilsons
Hemolytic anemia
Stimulate intestinal persistalsis
Enterokinase/enteropeptidase from the duodenal mucosa
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

35. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
No - chronic - can present with diarrhea or constipation or alternation - treat sx
...
Oral glucose
PAS- positive globules in liver -

36. What are the borders of the femoral triangle
Fasting and stress
Heme metabolism
Neutralizes oral bacertial acids and maintains dental health
Inguninal ligament - sartorius muscle - adductor longus

37. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
AST>ALT
Barrett's esophagus
The proximal small bowel

38. What is the rule of 2s for meckels
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Uridine glucuronyl transferase
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

39. What is a positive murphy's sign
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Squamous - upper 1/3 - adeno - lower 1/3
Inspiratory arrest on deep palpation due to pain

40. What is the rate limiting step of carbohydrate digestion
Oligosaccharide digestion
All 3 gut layers outpouch as in Meckels
Volvulus
Black - rotors syndrome

41. Cholecytsokinin - source - action - regulation
Primary sclerosing cholangitis
Gallbladder
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
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

42. in budd chiari syndrome - Where is the congestion and necrosis
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Centrilobular leading to congestive liver disease
In the ileum with bile acids - requires IF
Gardner's syndrome

43. Autoantibodies to gluten (gliadin) in wheat and other grains
Crypts but not villi
Phenobarbital - inc liver enzyme synthesis
Celiac sprue
The entire

44. What is the cause of Barrett's and the assocaited complications
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

45. What layer in the mucosa is responsible for support
Urobilin
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
Above
Lamina propria

46. bilateral mets to ovaries with abundant mucus - signet ring cells
Krukenbergs tumor
Normal
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
US and cholecystectomy

47. Where are oligosaccharide hydrolases and What do they do
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
Amylase
PAS- positive globules in liver -
Brush border of intestine - produce monosaccharides from oligo and di

48. Liver cell failure can lead to multisystem signs including
Hydrocele
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Hepatic steatosis
Lack or have an attenuated muscularis externa - often in the sigmoid colon

49. most common non - neoplastic polyp in colon
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
H+
Hyperplastic
Around the central vein (zone III)

50. What histological findings are present in the esophagus
Omeprazole
Cholesterol - 10-20% opaque due to calcifications
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Nonkeritinized stratified sqamous epithelium