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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. Abuse of what substance leads to acute gastritis
EtOH
Inc - weight loss
GLUT 2
Warthins' tumor

2. what kind of muscle is in the upper 1/3 of esophagus
Chagas disease
Striated
Cirrhosis
Bleeding - intussusception - volvulus - obstruction near terminal ileum

3. What are the signs of peutz jehgers
Hyperpigmented mouth - lips - hands - genitalia
The gastroduodenal
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Crohns = noncaseating granulomas - UC = crypt abscesses

4. What is contained in the gastrosplenic and What areas does it separate
Short gastrics - left greater and lesser
CCK8 receptor - Gq inc IP3/Ca
L2
Gallbladder

5. How are all 3 monosaccharides transported to the blood
Downs
Serous on the sides parotids - mucinous in the middle sublingual
Zollinger Ellison - phenylalanine and tryptophan
GLUT 2

6. What is pancreatic adenocarcinoma associated with
Amylase
Skip lesions =crohns - colon = UC
Cigarettes and chronic pancreatitis - not EtOH
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

7. What percentage of gall stones are cholesterol stones and What are the associations
Skip lesions =crohns - colon = UC
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Glucouronate - water soluble (direct)

8. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
HSV-1 - CMV - Candida
Osmotic
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

9. Bilirubin is the product of what?
Left gastric vein and esophogeal vein - esophagus
Heme metabolism
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

10. What is the epi for CRC
Epithelium
Peyers patches
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

11. What are the two molecular pathways that lead to CRC
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Heme metabolism
MSI (15%) and APC/beta catenin chromosomal instability (85%)

12. motilin - source - action - regulation
Diverticulum
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Crohns = noncaseating granulomas - UC = crypt abscesses

13. What drug inhibits the H/K ATPase
Cystic duct and common hepatic duct
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Inc - weight loss
Omeprazole

14. multiple juvenil polyps in GI tract - risk
Spleen to posterior abdominal wall - splenic artery and vein
Juvenile polyposis syndrome - inc risk of adenocarcinoma
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
Can lead to hematemesis - found in EtOHics and bulimics

15. What is the lumen of the pancreatic duct
Neural muscarinic pathways
Spleen to posterior abdominal wall - splenic artery and vein
Cholesterol - 10-20% opaque due to calcifications
Ampulla of vater

16. What does loss of p53 cause
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Increase tumorigenesis
Nonkeritinized stratified sqamous epithelium
Neutralizes oral bacertial acids and maintains dental health

17. What is the other name for GIP (gastric inhibitory peptide)
Glucose dependent insulinotropic peptide
Inc conj bilirubin - inc cholesterol - inc alk phos
Jewish and African American men
Skip lesions =crohns - colon = UC

18. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Lamina propria
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Krukenbergs tumor
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM

19. Achalasia can be secondary to what infectious disease common in South America
Chagas disease
Older patients
Internal thoracic to superior epigastric to inferior epigastric
Oligosaccharide digestion

20. What is the prognosis of adenocarcinoma
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Crohns = noncaseating granulomas - UC = crypt abscesses
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Averages 6 months - very aggressive - usually already metastasized at presentation

21. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Older patients
Spleen to posterior abdominal wall - splenic artery and vein
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Cholesterol - 10-20% opaque due to calcifications

22. Why does carcinoid syndrome not occur if tumor is confined to GI system
Oral glucose
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Neutralizes oral bacertial acids and maintains dental health
Liver metabolizes 5HT

23. What nerve innervates the external hemorrhoids
8-9 waves/min
Ampulla of vater
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Inferior rectal nerve

24. subQ peribumbilical metastasis
Sister mary joseph nodule
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Mucoepidermoid carcinoma
EtOH

25. How does gastrin increase acid secretion?
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Lipase - phospholipase A - colipase
Primarly through ECL leading to histamine release
Splenic flexure

26. What are the effects of atropine on parietal cells and G cells
IgA secreting plasma cells - ultimately reside in the lamina proporia
Backup of blood into the liver - RHF - budd chiari
Normal
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

27. What kind of pathways do CCK act on to cause pancreatic secretion
Cystic duct and common hepatic duct
Neural muscarinic pathways
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
With albumin

28. How does brain injury lead to acute gastritis and What is it called
Meconium ileus
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
Old men - arthralgias - cardiac and neuro sx

29. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Lipase - phospholipase A - colipase
Uremia
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Early childhood - neuro sx and malabsorption

30. What is the most important mechanism in gastric acid secretion
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Fe2+ in the duod
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Goes through deep inguinal ring - external inguinal ring and into the scrotum

31. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Causes of gall stones
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

32. What serum enzyme is decreased in wilsons disease
Ceruplasmin
Conj - inc - dec
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Peptic ulcer disease

33. concentric onion skin bile duct fibrosis
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Gallbladder
Primary sclerosing cholangitis
Gamma glutamyl transferase GGT

34. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
Hyperpigmented mouth - lips - hands - genitalia
Backup of blood into the liver - RHF - budd chiari
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

35. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue

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36. What cells make pepsin - What does it do - and what regulates it
Mucosa - submucosa - muscularis externa - serosa/adventitia
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Dermatitis herpetiformis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM

37. What are motilin receptor agonists used for clinically
Stimulate intestinal persistalsis
Glucose dependent insulinotropic peptide
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Smooth

38. occlusion of IVC or hepatic veins
Budd chiari syndrome
Jaundice - fever - RUQ
90%
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

39. What artery passes around the duodenum
T12
The gastroduodenal
No
AST>ALT

40. What layer in the mucosa is repsonsible for motility
Colovesical leading to pneumaturia
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Hypotonic because of more time to reabsorb NaCl
Muscularis mucosae

41. How many layers of spermatic fascia are covers an indirect inguinal hernia
Appendicitis
All 3
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable 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

42. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
External (superficial) ring only
The jejunum
Juvenille polyps - no risk if single
Corticosteroids - infliximab

43. trypsinogen is converted to trypsin via what enzyme
Neutralizes oral bacertial acids and maintains dental health
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Enterokinase/enteropeptidase from the duodenal mucosa
Hydrocele

44. Where is bicarb trapped
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
In the mucus that covers the gastric epithelium
Older patients
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

45. What are the histological findings in the ileum

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46. What are the extraintestinal manifestations of ulcerative colitis
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Pyoderma gangrenosum - primary sclerosing cholangitis
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

47. What are the results of hemochromatosis
Spleen to posterior abdominal wall - splenic artery and vein
Peyers patches
Femoral hernia
CHF and inc risk of HCC

48. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Via the superior pancreaticduodenal
L2
Cirrhosis

49. How is bilirubin carried in the blood
Via the superior pancreaticduodenal
With albumin
Acute pancreatitis
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

50. What structure is Not contained in the femoral sheath
2ndary biliary cirrhosis
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
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