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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 kind of cancer to celiac sprue put you as inc risk for
VZV and influenza B treated with salicylates
Crypts but not villi
T cell lymphoma
The proximal small bowel

2. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Jewish and African American men
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Menetriers disease
Tropical sprue

3. In what clinical scenarior do you see portosystemic anastomoses
Superior rectal
US and cholecystectomy
Hypercoaguability - polycythemia vera - pregnancy - HCC
Portal HTN

4. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Alpha amylase
Pleuroperitoneal
8-9 waves/min
Barrett's esophagus

5. Where are tumors commonly in pancreatic adenocarcinoma
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Pancreatic head causing obstructive jaundice
Hydrocele
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

6. Where is bicarb trapped
Short gastrics - left greater and lesser
In the mucus that covers the gastric epithelium
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
Antrum - H.pylori - inc risk of MALT lymphoma

7. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Left and right gastroepiploics - left and right gastrics
Osmotic
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

8. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Zollinger Ellison - phenylalanine and tryptophan
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Alcoholic cirrhosis
Bleeding - intussusception - volvulus - obstruction near terminal ileum

9. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Colonic polyps
Alcoholic hepatitis
Pancreatic and bile
Squamous - upper 1/3 - adeno - lower 1/3

10. is meckels a true diverticulum and how common is it
Above
Peyers patches
Uremia
True and most common congenital anomoly of GI tract

11. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Pertechnetate - study for uptake
Cirrhosis
The submucosal nerve plexus - meissner's
Diverticulitis in elderly - ectopic pregs use hCG to rule out

12. Which patients have pigment stones
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Sister mary joseph nodule
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn

13. Where does copper accumulate in Wilsons and What are ABCD
Mucoepidermoid carcinoma
Fe2+ in the duod
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

14. Which kind of hemorrhoids are painful and why
Primary sclerosing cholangitis
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Inc risk of CRC and other visceral malignancies

15. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Meconium ileus
Gallbladder
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

16. What drug inhibits the H/K ATPase
L4
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Omeprazole
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

17. What does high flow rate mean
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Closer to isotonic because of less time to reabsorb NaCl
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
FAP

18. What is charcot triad of cholangitis
Glucose dependent insulinotropic peptide
Ceruplasmin
Jaundice - fever - RUQ
...

19. Gallstones that reach the common channel at ampulla can block which two ducts
Pancreatic and bile
Positive urease test
Gamma glutamyl transferase GGT
Centrilobular congestion and necrosis - cardiac cirrhosis

20. in carcinoid tumors - What is seen on EM
No
Reye's syndrome
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Dense core bodies

21. People of what decent are associated with celiac sprue and what findings/antibodies are present
Old men - arthralgias - cardiac and neuro sx
Neural muscarinic pathways
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Via the superior pancreaticduodenal

22. When do you see hypertrophy of brunners glands
Lactase is located at the tips of intestinal villi
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Peptic ulcer disease
Bleeding - penetration into pancreas - perforation - obstruction

23. What cells secrete bicarb - What does it do - and what regulates it
External (superficial) ring only
Internal thoracic to superior epigastric to inferior epigastric
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Hernia

24. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Downs
Left gastric vein and esophogeal vein - esophagus
12 waves/min

25. What are the treatmet options for crohns
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Striated and smooth
Short gastrics - left greater and lesser
Corticosteroids - infliximab

26. What factors increase risk of malignancy of adenomatous polyps
T12
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
In the mucus that covers the gastric epithelium
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

27. What is the cause of Barrett's and the assocaited complications
Gastric glands
Unconjugated - water insoluble
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Meconium ileus

28. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Centrilobular leading to congestive liver disease
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
Alcoholic hepatitis
The submucosal nerve plexus - meissner's

29. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Krukenbergs tumor
L1
2ndary biliary cirrhosis
Glucouronate - water soluble (direct)

30. What is the most common indication of emergent abdominal surgery in children
Skip lesions =crohns - colon = UC
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
2ndary biliary cirrhosis
Appendicitis

31. What is the presenting course for appendicity

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32. What is the rate limiting step of carbohydrate digestion
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Pyoderma gangrenosum - primary sclerosing cholangitis
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Oligosaccharide digestion

33. What are the four Fs of gallstones
Centrilobular leading to congestive liver disease
Female - fat - fertile - forty
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Zenkers - halitosis - dysphagia and obstruction

34. What is contained within the submucosa

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35. What layer in the mucosa is responsible for absorption
Low pressure proximal to LES
Epithelium
Hernia
Unconj - absent (acholuria) - inc

36. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Brunners
Cigarettes and chronic pancreatitis - not EtOH
Goes through deep inguinal ring - external inguinal ring and into the scrotum

37. What percentage of gall stones are cholesterol stones and What are the associations
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
Inspiratory arrest on deep palpation due to pain
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
CHF and inc risk of HCC

38. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Meckels
EtOH
L4

39. What are the histological findings in the ileum

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40. Are single polyps malignant in peutz jehgers
Inc lower esphogeal tone leading to achalasia
Epithelium
No
Carcinoid syndrome

41. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Early childhood - neuro sx and malabsorption
H+
FAP
Via the middle colic

42. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Ampulla of vater
Inc smooth muscle relaxation - including lower esophageal sphincter
Alk pho
L4

43. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
All 3 gut layers outpouch as in Meckels
Superior rectal

44. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Zollinger ellison - brunners glands
Downs
Hirschsprungs
Lactase is located at the tips of intestinal villi

45. How is salivary secretion stimulated
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Left and right gastroepiploics - left and right gastrics
Causes of gall stones

46. What artery passes around the duodenum
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Acute pancreatitis
The gastroduodenal

47. How do you DX and TX gallstones
Gastrohepatic ligament
Cigarettes and chronic pancreatitis - not EtOH
Ceruplasmin
US and cholecystectomy

48. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Hemolytic anemia
Below
Primarly through ECL leading to histamine release
Warthins' tumor

49. Where is there sclerosis in alcoholic cirrohosis
Around the central vein (zone III)
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
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

50. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Dermatitis herpetiformis
Esophageal varices
Hydrocele
IgA receives protective secretory component and is then transported across the epithelium to gut lumen