USMLE GI

Instructions:

• Answer 50 questions in 15 minutes.
• If you are not ready to take this test, you can study here.
• 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 is the frequency of basal electric rhythm of the stomach
Crohns = noncaseating granulomas - UC = crypt abscesses
3 waves/min
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation


2. What is the rate limiting step of carbohydrate digestion
8-9 waves/min
GERD - may also present with nocturnal cough and dyspnea
Duodenal atresia - Downs
Oligosaccharide digestion


3. What drug inhibits the H/K ATPase
Omeprazole
Chronic calcifying pancreatitis - inc risk of panreatic cancer
HSV-1 - CMV - Candida
Gilbert's


4. What is the presenting course for appendicity

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5. why infxn is implicated in duodenal PUD
H pylori (almost 100%)
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Elevated amylase - and lipase


6. What makes a true diverticula
All 3 gut layers outpouch as in Meckels
H pylori (almost 100%)
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Splenic flexure


7. Why does volvulus occur more at cecum and sigmoid colon
Redundant mesentary
Dec PGE2 leading to dec gastric mucosa protection
Neutralizes oral bacertial acids and maintains dental health
Uremia


8. What are causes of extrahepatic biliary obstruction
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Jaundice - fever - RUQ


9. What do you treat Wilsons disease with and What is the inheritance
Conj - inc - dec
Penicillinamine - AR inheritance
Primary sclerosing cholangitis
Juvenille polyps - no risk if single


10. What gives urine its characteristic color
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Dense core bodies
Urobilin
Ampulla of vater


11. What are the histological findings in the jejunum
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
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
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn


12. What are the borders of Hesselbach's triangle
Boerhaave's Syndrome - Been heaving syndrome
Positive urease test
Duodenum - 2nd - 3rd and 4th parts
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament


13. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Peutz jeghers
Jaundice - fever - RUQ
Internal thoracic to superior epigastric to inferior epigastric
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)


14. Transmural esophageal rupture due to violent retching

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15. What is the classic triad of hemochromatosis

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16. What is the most common diaphragmatic hernia and What are the two types
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Paraumbilical and superficial and inferior epigastric - umbilicus
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus


17. What are the foregut structures and what supplies their blood and PANS innvervation
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Below
Old men - arthralgias - cardiac and neuro sx
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome


18. Scleroderma is associated with what kind of esophageal dysmotility
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Low pressure proximal to LES
Common hepatic - splenic - left gastric - main blood supply for stomach
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates


19. What does histo show for alpha1 antitrypsin def
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Alpha1 antitrypsin def - codominant trait
Diverticulitis in elderly - ectopic pregs use hCG to rule out
PAS- positive globules in liver -


20. Who gets gastric ulcers
Hypercoaguability - polycythemia vera - pregnancy - HCC
Older patients
L/R renal artery around L1
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates


21. What are esophageal strictures associated with
Mucoepidermoid carcinoma
Lye ingestion and acid reflux
In the ileum with bile acids - requires IF
Crohns = maybe - UC= always


22. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Epigastric abdominal pain radiating to back - anorexia - nausea
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Redness and tenderness on palpation of extremities
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly


23. How do burns cause acute gastritis and What is it called

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24. What are the barium swallow findings of achalasia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Sphincter of oddi
Dilated esophagus with an area of distal stenosis - birds beak
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn


25. What are the extraintestinal manifestations of ulcerative colitis
Alpha amylase
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Crohns = noncaseating granulomas - UC = crypt abscesses
Pyoderma gangrenosum - primary sclerosing cholangitis


26. subQ peribumbilical metastasis
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Sister mary joseph nodule
Ceruplasmin
Goes through deep inguinal ring - external inguinal ring and into the scrotum


27. In PUD with a duodenal ulcer does pain inc or dec with meals
Decrease - weight gain
Backup of blood into the liver - RHF - budd chiari
All 3
H pylori (almost 100%)


28. How is salivary secretion stimulated
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Above
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Dermatitis herpetiformis


29. Gq and inc cAMP both work to do what in parietal cells
Lateral
Complications of UC
Meckels
Stimulate the H/K ATPase


30. is meckels a true diverticulum and how common is it
Jewish and African American men
Bleeding - penetration into pancreas - perforation - obstruction
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
True and most common congenital anomoly of GI tract


31. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Alpha amylase
External spermatic fascia only
Antrum - H.pylori - inc risk of MALT lymphoma


32. What is charcot triad of cholangitis
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
Jaundice - fever - RUQ
Paraumbilical and superficial and inferior epigastric - umbilicus
No


33. What separates the right greater and lesser sacs
Brush border of intestine - produce monosaccharides from oligo and di
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Gastrohepatic ligament
HPNCC


34. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Failure of neural crest migration
Cystic duct and common hepatic duct
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Alpha1 antitrypsin def - codominant trait


35. What layer in the mucosa is repsonsible for motility
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Erosive - disruption of mucosal barrier leading to inflammation
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Muscularis mucosae


36. What structures feed into the cystic duct
Gallbladder
90%
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Failure of the processus vagainlis to close


37. What structures feed into the common hepatic duct
AR
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Right and left hepatic duct
Downs


38. What is the clinical presentation of acute pancreatitis
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
Gallbladder
Epigastric abdominal pain radiating to back - anorexia - nausea
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid


39. What are the complications of acute pancreatitis
No
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Myenteric nerve plexus - aurbach


40. What is the mechanism for reyes syndrome
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Turcot
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Inc conj bilirubin - inc cholesterol - inc alk phos


41. Abuse of what substance leads to acute gastritis
EtOH
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes


42. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Cirrhosis
Hemosiderosis - hemochromatosis
Alfatoxin in peanuts
Mitochondrial abnl - fatty liver - hypoglycemia - coma


43. What are the histological findings in the duodenum

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44. crigler - najjar type II responds to which therapy and How does it work
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Zollinger ellison - brunners glands
Increase tumorigenesis
Phenobarbital - inc liver enzyme synthesis


45. Achalasia can be secondary to what infectious disease common in South America
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Internal thoracic to superior epigastric to inferior epigastric
Left and right gastroepiploics - left and right gastrics
Chagas disease


46. What layer in the mucosa is responsible for absorption
Hemolytic anemia
Barrett's esophagus
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Epithelium


47. Is there any structural abnl with IBS - What is the course of disease and presentation
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
Alk phos
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Pleomorphic adenoma


48. inflammatino of gallbadder
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Inc lower esphogeal tone leading to achalasia
Phenobarbital - inc liver enzyme synthesis
Left and right gastroepiploics - left and right gastrics


49. trypsinogen is converted to trypsin via what enzyme
Phenobarbital - inc liver enzyme synthesis
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Cimetidine
Enterokinase/enteropeptidase from the duodenal mucosa


50. most common malignant salivary gland tumor
Mucoepidermoid carcinoma
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Ampulla of vater