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USMLE GI

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 test and result confirms H pylori infxn
90%
Fasting and stress
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Positive urease test

2. What serum enzyme is elevated inacute pancreatitis
Superior rectal and middle and inferior rectal - rectum
Below
T cell lymphoma
Lipase

3. Who gets Whipple disease and How do they present
Old men - arthralgias - cardiac and neuro sx
Internal thoracic to superior epigastric to inferior epigastric
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Alcoholic cirrhosis

4. Why are most diverticula considered false
Gastrohepatic ligament
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Punched out - clean margins - carcinoma =raised irregular margins

5. What receptor does histamine bind on the parietal cell and What does it activate
Skip lesions =crohns - colon = UC
H2 receptor - inc cAMP
Jewish and African American men
Normal

6. what kind of muscle is in the upper 1/3 of esophagus
Juvenille polyps - no risk if single
Primarly through ECL leading to histamine release
Striated
Crigler - najjar type 1

7. trypsinogen is converted to trypsin via what enzyme
Begins starch digestion - inactivated by low pH upon reaching the stomach
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Enterokinase/enteropeptidase from the duodenal mucosa
ALT>AST

8. What does extrahepatic biliary obstruction cause
Inc smooth muscle relaxation - including lower esophageal sphincter
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

9. What is diverticulosis
Serous on the sides parotids - mucinous in the middle sublingual
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Right and left hepatic duct
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

10. Where does type B chronic gastritis occur and What causes it
Duodenal atresia - Downs
Antrum - H.pylori - inc risk of MALT lymphoma
External spermatic fascia only
Obstruction of the common bile duct

11. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Centrilobular congestion and necrosis - cardiac cirrhosis
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Conj - inc - dec

12. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker
Adhesion
12 waves/min
Tropical sprue

13. What does autoimmune destruction of parietal cells lead to...
Pyoderma gangrenosum - primary sclerosing cholangitis
Chronic gastritis and pernicious anemia
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Epithelium

14. What are the two molecular pathways that lead to CRC
Peyers patches
Stimulate intestinal persistalsis
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Serous on the sides parotids - mucinous in the middle sublingual

15. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Via the middle colic
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Alcoholic cirrhosis

16. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Meconium ileus
Lateral to the inferior epigastric artery
Virchow's node
AST

17. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
IBS at least 2 with recurrent abdominal pain
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Left and right gastroepiploics - left and right gastrics
No - chronic - can present with diarrhea or constipation or alternation - treat sx

18. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
AST
Hemosiderosis - hemochromatosis
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

19. How is salivary secretion stimulated
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Primary sclerosing cholangitis
Positive
Internal thoracic to superior epigastric to inferior epigastric

20. Abuse of what substance leads to acute gastritis
EtOH
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Backup of blood into the liver - RHF - budd chiari

21. is meckels a true diverticulum and how common is it
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Hypercoaguability - polycythemia vera - pregnancy - HCC
True and most common congenital anomoly of GI tract
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

22. Through which aspect of the inguinal canal does a direct inguinal go
HSV-1 - CMV - Candida
External (superficial) ring only
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Zollinger Ellison - phenylalanine and tryptophan

23. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Inc conj bilirubin - inc cholesterol - inc alk phos
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

24. In PUD - with gastric ulcers - does pain inc or dec with meals?
Where hindgut meets ectoderm
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Inc - weight loss
Around the central vein (zone III)

25. In what scenarios do pts with gilberts have inc bili
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
Fasting and stress
Chronic gastritis and pernicious anemia
Achalasia due to loss of myenteric plexus (auberach)

26. What are the histological findings in the duodenum

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27. motilin - source - action - regulation
Positive urease test
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

28. What skin condition is associated with celiac sprue
Neural muscarinic pathways
Dermatitis herpetiformis
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
Duodenum - 2nd - 3rd and 4th parts

29. What parts of the small bowel can tropical sprue effect
Redness and tenderness on palpation of extremities
The entire
Smooth
Positive

30. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Duodenum - 2nd - 3rd and 4th parts
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Carcinoid syndrome
In the mucus that covers the gastric epithelium

31. At what level of the spine does the IM exit the aorta
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker
L3
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

32. How many layers of spermatic fascia are covers an indirect inguinal hernia
Dilated esophagus with an area of distal stenosis - birds beak
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Hirschsprungs
All 3

33. What is the path of an indirect inguinal hernia
Old men - arthralgias - cardiac and neuro sx
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Superior rectal
Uremia

34. What is the clinical presentation of acute pancreatitis
Epigastric abdominal pain radiating to back - anorexia - nausea
Redundant mesentary
Femoral hernia
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

35. What happens to the short gastics if the splenic artery is blocked
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
In the mucus that covers the gastric epithelium
Poor anastamoses

36. What pancreatic proteases are secreted as zymogens
AR
Averages 6 months - very aggressive - usually already metastasized at presentation
Trypsin - chymotrypsin - elastase - carboxypeptidases
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

37. What structure is Not contained in the femoral sheath
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

38. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Alpha1 antitrypsin def - codominant trait
Gamma glutamyl transferase GGT
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

39. Where is IgA shuttled
True and most common congenital anomoly of GI tract
Terminal ileum and colon
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Penicillinamine - AR inheritance

40. What is the presenting course for appendicity

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41. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Common hepatic - splenic - left gastric - main blood supply for stomach

42. conjugated hyperbilirubinemia due to defective liver excretion
Upregulated intracellular signal transduction
Reye's syndrome
Dubin johnson
Conj/unconj - inc - nl to dec

43. What do you use to diagnose meckels
Older patients
Pertechnetate - study for uptake
Hemosiderosis - hemochromatosis
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

44. What is the rule of 2s for meckels
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Obstruction of the common bile duct
Peyers patches

45. What is the ddx associated with appendicitis
H2 receptor - inc cAMP
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

46. In what clinical scenarior do you see portosystemic anastomoses
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Portal HTN
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
IBS at least 2 with recurrent abdominal pain

47. What is the leading cause of bowel incarceration
Increase tumorigenesis
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Femoral hernia
Epigastric abdominal pain radiating to back - anorexia - nausea

48. What are the extraintestinal manifestations of ulcerative colitis
L/R renal artery around L1
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Inc - weight loss
Pyoderma gangrenosum - primary sclerosing cholangitis

49. How does hirschsprung present and appear on imaging
Heme metabolism
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
Acute pancreatitis
The jejunum

50. What causes pancreatic insuff and What does it cause
Via the superior pancreaticduodenal
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Unconjugated - water insoluble
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

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USMLE GI

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