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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. signet ring cells - acanthosis nigracans - dz - character/association - spread
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Uremia
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

2. If trypsin activates more trypsinogen - what kind of feedback loop is established
Short gastrics - left greater and lesser
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Esophageal cancer
Positive

3. FAP + osseous and soft tissue tumors - retinal hyperplasia

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4. What is the lumen of the pancreatic duct
Pancreatic head causing obstructive jaundice
Ampulla of vater
Inc risk of CRC and other visceral malignancies
2ndary biliary cirrhosis

5. At what level do the testicular/ovarian arteries exit the aorta
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Pertechnetate - study for uptake
Myenteric nerve plexus - aurbach
L2

6. What portion of the bowel does sprue effect
True and most common congenital anomoly of GI tract
Redundant mesentary
Juvenile polyposis syndrome - inc risk of adenocarcinoma
The proximal small bowel

7. Gastrin - source - action - regulation
Repeated phlebotomy - deferoxamine - HLA- A3
Gardner's syndrome
Older patients
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

8. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Low pressure proximal to LES
Meconium ileus
Sister mary joseph nodule

9. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Menetriers disease
Penicillinamine - AR inheritance
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

10. 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
The gastroduodenal
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

11. In viral hepatitis - which liver enzyme is higher
AST
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
ALT>AST
Ischemic colitis

12. inflammatino of gallbadder
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Meconium ileus
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

13. Is there any structural abnl with IBS - What is the course of disease and presentation
Positive
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

14. What are the results of hemochromatosis
Short gastrics - left greater and lesser
CHF and inc risk of HCC
The submucosal nerve plexus - meissner's
Esophageal varices

15. What are the complications of Meckels
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Normal

16. What serum enzyme is decreased in wilsons disease
Pertechnetate - study for uptake
Dense core bodies
True and most common congenital anomoly of GI tract
Ceruplasmin

17. most common malignant salivary gland tumor
Mucoepidermoid carcinoma
Inc - weight loss
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
MSI (15%) and APC/beta catenin chromosomal instability (85%)

18. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
NAV = nerve artery vein - venous near the penis (NAVEL)
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Crohns = noncaseating granulomas - UC = crypt abscesses
Phenobarbital - inc liver enzyme synthesis

19. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Causes of gall stones
Urobilin
Muscularis mucosae
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

20. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Adhesion
Inc risk of CRC and other visceral malignancies
Fasting and stress

21. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Dilated esophagus with an area of distal stenosis - birds beak
Necrotizing enterocolitis
Ampulla of vater
Esophageal varices

22. What is contained within the submucosa

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23. What are the extraintestinal manifestations of ulcerative colitis
Lye ingestion and acid reflux
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Pyoderma gangrenosum - primary sclerosing cholangitis
External (superficial) ring only

24. What is the classic triad of hemochromatosis

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25. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Failure of neural crest migration
CHF and inc risk of HCC
Complications of crohns
Adhesion

26. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Cholesterol - 10-20% opaque due to calcifications
Hirschsprungs
Via the superior pancreaticduodenal
8-9 waves/min

27. What kind of muscle is in the lower 1/3 of the esophagus
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Smooth
Pancreatic and bile
AST>ALT

28. rare - often fatal childhood hepatoencephalopathy

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29. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Redundant mesentary
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Brunners

30. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
Urobilin
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Volvulus

31. What are the labs in acute pancreatitis
Smooth
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Elevated amylase - and lipase
Urobilin

32. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Nonkeritinized stratified sqamous epithelium
Hemosiderosis - hemochromatosis
Pancreatic head causing obstructive jaundice
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

33. what percentage of colonic polyps are non - neoplastic
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
H2 receptor - inc cAMP
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
90%

34. What do you use to diagnose meckels
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Pertechnetate - study for uptake
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Goes through deep inguinal ring - external inguinal ring and into the scrotum

35. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
T12
Inguninal ligament - sartorius muscle - adductor longus
Peutz jeghers
IBS at least 2 with recurrent abdominal pain

36. What is the characteristic histo finding in alcoholic hepatitis
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Fasting and stress
Jewish and African American men
Mallory bodies

37. What are the borders of the femoral triangle
Inguninal ligament - sartorius muscle - adductor longus
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Hyperplastic

38. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Superior rectal
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Zenkers - halitosis - dysphagia and obstruction
Falciform - ligamentum teres - fetal umbilical vein

39. crigler - najjar type II responds to which therapy and How does it work
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Backup of blood into the liver - RHF - budd chiari
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Phenobarbital - inc liver enzyme synthesis

40. Diaphragmatic hernias occur in infants because of defective development of which membrane
Pleomorphic adenoma
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Pleuroperitoneal
In the mucus that covers the gastric epithelium

41. What are the histological findings of the colon
Crypts but not villi
Decreased intercellular adhesion and increased proliferation
Zollinger Ellison - phenylalanine and tryptophan
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

42. What do you treat Wilsons disease with and What is the inheritance
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
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Penicillinamine - AR inheritance
L1

43. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
FAP
Stimulate intestinal persistalsis
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
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

44. Why does carcinoid syndrome not occur if tumor is confined to GI system
External spermatic fascia only
Liver metabolizes 5HT
Lateral to the inferior epigastric artery
In the mucus that covers the gastric epithelium

45. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Smooth
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Cirrhosis

46. What is the cause of physiologic neonatal jaundice
Hypercoaguability - polycythemia vera - pregnancy - HCC
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Begins starch digestion - inactivated by low pH upon reaching the stomach
Primary sclerosing cholangitis

47. What is the path of an indirect inguinal hernia
Inferior rectal nerve
3 waves/min
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Early childhood - neuro sx and malabsorption

48. What is the arterial supply and venous drainage below pectinate line
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Pleomorphic adenoma
Esophageal varices
Decrease - weight gain

49. What are the barium swallow findings of achalasia
Inferior rectal nerve
Adhesion
Phenobarbital - inc liver enzyme synthesis
Dilated esophagus with an area of distal stenosis - birds beak

50. What cells make pepsin - What does it do - and what regulates it
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Lateral to the inferior epigastric artery
Fasting and stress
Old men - arthralgias - cardiac and neuro sx