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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 arteries exit just below the SMA
Penicillinamine - AR inheritance
Serous on the sides parotids - mucinous in the middle sublingual
L/R renal artery around L1
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

2. What are additional risk factors for CRC
Gut bacteria
Conj - inc - dec
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
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

3. How does CRC present in the distal and proximal colon
Boerhaave's Syndrome - Been heaving syndrome
Low pressure proximal to LES
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

4. What nerve innervates the external hemorrhoids
Inferior rectal nerve
Can lead to hematemesis - found in EtOHics and bulimics
Brunners
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn

5. What pancreatic proteases are secreted as zymogens
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Trypsin - chymotrypsin - elastase - carboxypeptidases
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
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

6. What cells secrete bicarb - What does it do - and what regulates it
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Mucoepidermoid carcinoma

7. How is the diagonsis of CRC made
Short gastrics - left greater and lesser
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
External spermatic fascia only
No - chronic - can present with diarrhea or constipation or alternation - treat sx

8. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Diverticulum
Adhesion
Worldwide - SC - US - adeno
Left and right gastroepiploics - left and right gastrics

9. In alchoholic hepatitis which liver enzyme is higher
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
AR
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
AST>ALT

10. Where is the pectinate line
L/R renal artery around L1
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Where hindgut meets ectoderm
When diffusely infiltrative - thickened rigid appearance like a leather bottle

11. secretin - source - action - regulation
L/R renal artery around L1
Internal thoracic to superior epigastric to inferior epigastric
Cirrhosis
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

12. absent UDPGT - presents early in life - early mortality
Budd chiari syndrome
Early childhood - neuro sx and malabsorption
Primary sclerosing cholangitis
Crigler - najjar type 1

13. What cell produces IF and What does it do
Parietal cells in the stomach - B12 binding protein
Pleomorphic adenoma
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Lipase

14. What is the frequency of basal electric rhythm in the duodenum
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Carcinoid syndrome
Mucosa - submucosa - muscularis externa - serosa/adventitia
12 waves/min

15. At what spinal level does the celiac trunk exit
Striated and smooth
Gallbladder
T12
H pylori (almost 100%)

16. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Esophageal cancer
Crohns = maybe - UC= always
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
90%

17. What is contained in the gastrosplenic and What areas does it separate
Short gastrics - left greater and lesser
True and most common congenital anomoly of GI tract
The gastroduodenal
Above

18. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Paraumbilical and superficial and inferior epigastric - umbilicus
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

19. With internal hemorrhoids Where is the anastomoses and Where is it
Superior rectal and middle and inferior rectal - rectum
Warthins' tumor
Mucosa - submucosa - muscularis externa - serosa/adventitia
Cystic duct and common hepatic duct

20. motilin - source - action - regulation
Adhesion
Cholesterol - 10-20% opaque due to calcifications
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

21. somatostatin - source - action - regulation
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
Ischemic colitis
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Fe2+ in the duod

22. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Phototherapy
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Alk pho

23. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Alk pho
Gallbladder
The submucosal nerve plexus - meissner's
FAP

24. What is the rule of 2s for meckels
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Celiac sprue
Paraumbilical and superficial and inferior epigastric - umbilicus

25. What receptors does ACH bind on the parietal cells and What does it activate
Cimetidine
M3 - Gq - inc IP3/Ca
Crohns = noncaseating granulomas - UC = crypt abscesses
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

26. Why does volvulus occur more at cecum and sigmoid colon
Fasting and stress
Redundant mesentary
Normal
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

27. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Serous on the sides parotids - mucinous in the middle sublingual
CEA - CA-19-9
Lamina propria
Squamous - upper 1/3 - adeno - lower 1/3

28. What happens to the short gastics if the splenic artery is blocked
Poor anastamoses
3 waves/min
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
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

29. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Inspiratory arrest on deep palpation due to pain
Inc smooth muscle relaxation - including lower esophageal sphincter
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Esophageal varices

30. Where does an indirect inguinal hernia enter the deep inguinal ring
Lateral to the inferior epigastric artery
Upregulated intracellular signal transduction
GERD - may also present with nocturnal cough and dyspnea
Antrum - H.pylori - inc risk of MALT lymphoma

31. What is biliary colic
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Enterokinase/enteropeptidase from the duodenal mucosa
Inguninal ligament - sartorius muscle - adductor longus
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

32. Where does copper accumulate in Wilsons and What are ABCD
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Gastrohepatic ligament
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Pertechnetate - study for uptake

33. What are the histological findings in the jejunum
Gallbladder
The gastroduodenal
Zenkers - halitosis - dysphagia and obstruction
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

34. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Ischemic colitis
Mallory bodies
Zollinger ellison - brunners glands
AST>ALT

35. What are the two molecular pathways that lead to CRC
IgA secreting plasma cells - ultimately reside in the lamina proporia
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Dubin johnson
Inc conj bilirubin - inc cholesterol - inc alk phos

36. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Peutz jeghers
Sister mary joseph nodule
GERD - may also present with nocturnal cough and dyspnea
Repeated phlebotomy - deferoxamine - HLA- A3

37. What enzyme is necessary to create conjugated bilirubin
Colovesical leading to pneumaturia
Uridine glucuronyl transferase
Juvenille polyps - no risk if single
Penicillinamine - AR inheritance

38. Gallstones that reach the common channel at ampulla can block which two ducts
Pancreatic and bile
Striated and smooth
True and most common congenital anomoly of GI tract
Begins starch digestion - inactivated by low pH upon reaching the stomach

39. What does GET SMASHED stand for in acute pancreatitis
True and most common congenital anomoly of GI tract
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
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Cystic duct and common hepatic duct

40. What causes hirschsprungs
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Pertechnetate - study for uptake
Below
Failure of neural crest migration

41. What is the prognosis of adenocarcinoma
Inc - weight loss
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Averages 6 months - very aggressive - usually already metastasized at presentation
Gilbert's

42. People of what decent are associated with celiac sprue and what findings/antibodies are present
Acute pancreatitis
Positive
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

43. What are the effects of atropine on parietal cells and G cells
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
All 3 gut layers outpouch as in Meckels
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
L4

44. What infection causes Whipple disease and What can you see on LM
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
90%
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

45. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
External spermatic fascia only
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Necrotizing enterocolitis
The proximal small bowel

46. why infxn is implicated in duodenal PUD
H pylori (almost 100%)
Older patients
Primary sclerosing cholangitis
Positive

47. Where is there sclerosis in alcoholic cirrohosis
Around the central vein (zone III)
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Corticosteroids - infliximab
Ampulla of vater

48. What can fistula between the gallbladder and small intestine create and how can you tell
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Gamma glutamyl transferase GGT
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Cimetidine

49. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
In the mucus that covers the gastric epithelium
Pleomorphic adenoma
Stercobilin
The proximal small bowel

50. FAP + malignant CNS tumor
NAV = nerve artery vein - venous near the penis (NAVEL)
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
Turcot
Copious diarrhea - non alpha - non beta cell pancreatic tumor