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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 causes pancreatic insuff and What does it cause
Intussusception
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Cigarettes and chronic pancreatitis - not EtOH

2. Which kind of hemorrhoids are painful and why
Sphincter of oddi
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
L4
Intussusception

3. How does hirschsprung present and appear on imaging
Pancreatic and bile
L4
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
L/R renal artery around L1

4. inflammatino of gallbadder
Where hindgut meets ectoderm
Averages 6 months - very aggressive - usually already metastasized at presentation
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Lubricate food (glycoprotiens)

5. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Alpha amylase
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Lye ingestion and acid reflux

6. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Chronic gastritis and pernicious anemia
Conj - inc - dec
Obstruction of the common bile duct
Skip lesions =crohns - colon = UC

7. What layer in the mucosa is responsible for absorption
Begins starch digestion - inactivated by low pH upon reaching the stomach
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Epithelium

8. Where and How is iron absorbed
Budd chiari syndrome
Sphincter of oddi
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Fe2+ in the duod

9. How does abetalipoproteinemia lead to malabsorption
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Crohns = maybe - UC= always
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

10. most common malignant salivary gland tumor
Gamma glutamyl transferase GGT
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Mucoepidermoid carcinoma
Cystic dilation of the viteline duct

11. What causes carcinoid syndrome amd What are the symptoms
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Bleeding - penetration into pancreas - perforation - obstruction
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

12. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Early childhood - neuro sx and malabsorption
Pancreatic head causing obstructive jaundice
Adhesion

13. If trypsin activates more trypsinogen - what kind of feedback loop is established
Hemolytic anemia
L1
Positive
CEA - CA-19-9

14. Diaphragmatic hernias occur in infants because of defective development of which membrane
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Pleuroperitoneal
Zollinger ellison - brunners glands
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

15. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Chagas disease
Internal thoracic to superior epigastric to inferior epigastric
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

16. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Paraumbilical and superficial and inferior epigastric - umbilicus
VZV and influenza B treated with salicylates
Falciform - ligamentum teres - fetal umbilical vein

17. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Hemosiderosis - hemochromatosis
Erosive - disruption of mucosal barrier leading to inflammation
Inc risk of CRC and other visceral malignancies

18. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Carcinoid syndrome
True and most common congenital anomoly of GI tract
Meckels
Bleeding - intussusception - volvulus - obstruction near terminal ileum

19. What gives urine its characteristic color
Zenkers - halitosis - dysphagia and obstruction
Urobilin
Squamous - upper 1/3 - adeno - lower 1/3
Achalasia due to loss of myenteric plexus (auberach)

20. What are the results of hemochromatosis
Right and left hepatic duct
External (superficial) ring only
CHF and inc risk of HCC
Inc smooth muscle relaxation - including lower esophageal sphincter

21. What are the histological findings of the colon
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
Crypts but not villi
Oligosaccharide digestion
The proximal small bowel

22. What percentage of gall stones are cholesterol stones and What are the associations
Inguninal ligament - sartorius muscle - adductor longus
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
T cell lymphoma

23. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Alcoholic cirrhosis
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
With albumin
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

24. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Inc conj bilirubin - inc cholesterol - inc alk phos
Achalasia due to loss of myenteric plexus (auberach)
Hemolytic anemia
Paraumbilical and superficial and inferior epigastric - umbilicus

25. What arteries exit just below the SMA
Gilbert's
L/R renal artery around L1
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
Lateral to the inferior epigastric artery

26. Where does type A chronic gastritis occur and What causes it
Cystic dilation of the viteline duct
Colonic polyps
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Glucouronate - water soluble (direct)

27. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Decrease - weight gain
Peyers patches
Right and left hepatic duct
Unconj - absent (acholuria) - inc

28. What is the HLA association and treatment for hemochromatosis
Brush border of intestine - produce monosaccharides from oligo and di
Redundant mesentary
Repeated phlebotomy - deferoxamine - HLA- A3
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

29. What kind of digestion is bile needed for
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Cholesterol
Inc smooth muscle relaxation - including lower esophageal sphincter

30. How do villi appear in disaccharidease def
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Gamma glutamyl transferase GGT
Carcinoid syndrome
Normal

31. What kind of muscle is in the middle 1/3 of esophagus
Mucosa - submucosa - muscularis externa - serosa/adventitia
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Centrilobular leading to congestive liver disease
Striated and smooth

32. What serum enzyme is elevated in acute pancreatitis and mumps
Nonkeritinized stratified sqamous epithelium
Hepatic steatosis
Complications of UC
Amylase

33. What kind of muscle is in the lower 1/3 of the esophagus
H+
Smooth
Zenkers - halitosis - dysphagia and obstruction
Worldwide - SC - US - adeno

34. How many layers of spermatic fascia are covers an indirect inguinal hernia
The gastroduodenal
All 3
Pertechnetate - study for uptake
Gamma glutamyl transferase GGT

35. How does CRC present in the distal and proximal colon
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Cholesterol - 10-20% opaque due to calcifications
Complications of crohns
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

36. What is the clinical presentation of acute pancreatitis
Duodenum - 2nd - 3rd and 4th parts
90%
Epigastric abdominal pain radiating to back - anorexia - nausea
Inc - weight loss

37. What structures feed into the common hepatic duct
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Gut bacteria
Right and left hepatic duct
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

38. involvement of left supraclavicular node by mets from stomach

39. What does the splenorenal ligament connect - and What does it contain
Spleen to posterior abdominal wall - splenic artery and vein
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
IBS at least 2 with recurrent abdominal pain
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

40. In what clinical scenarior do you see portosystemic anastomoses
Gardner's syndrome
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Portal HTN
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

41. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
CHF and inc risk of HCC
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
The proximal small bowel

42. What test and result confirms H pylori infxn
EtOH
Lubricate food (glycoprotiens)
Positive urease test
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

43. What is the ddx associated with appendicitis
Peutz jeghers
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Diverticulitis in elderly - ectopic pregs use hCG to rule out
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

44. What does primary sclerosing cholangitis lead to...
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
AST
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

45. Gastrin - source - action - regulation
The submucosal nerve plexus - meissner's
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
Adhesion
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

46. What is indirect bilirubin
Hydrocele
Right and left hepatic duct
GERD - may also present with nocturnal cough and dyspnea
Unconjugated - water insoluble

47. What cells secrete bicarb - What does it do - and what regulates it
L2
T12
Peutz jeghers
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

48. bilateral mets to ovaries with abundant mucus - signet ring cells
Warthins' tumor
Ampulla of vater
Krukenbergs tumor
Right and left hepatic duct

49. What is the sphincter of the pancreatic duct
Sphincter of oddi
Neutralizes oral bacertial acids and maintains dental health
Carcinoid syndrome
Oligosaccharide digestion

50. What is contained within the submucosa