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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. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
HPNCC
Warthins' tumor
Inferior rectal nerve
Lipase - phospholipase A - colipase

2. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Can lead to hematemesis - found in EtOHics and bulimics
Mucoepidermoid carcinoma
Dilated esophagus with an area of distal stenosis - birds beak
Chagas disease

3. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Pancreatic and bile
Angiodysplasia
Peyers patches
Zollinger Ellison - phenylalanine and tryptophan

4. How does brain injury lead to acute gastritis and What is it called
AST >ALT - ration is usually 1.5
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Peutz jeghers
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

5. What causes primary biliary cirrhosis
Short gastrics - left greater and lesser
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Old men - arthralgias - cardiac and neuro sx
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

6. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
...
Stimulate intestinal persistalsis
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

7. involvement of left supraclavicular node by mets from stomach

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8. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Above
Boerhaave's Syndrome - Been heaving syndrome

9. In PUD with a duodenal ulcer does pain inc or dec with meals
Decrease - weight gain
Pleomorphic adenoma
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Barrett's esophagus

10. HCC is associated with what other conditions
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
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
Chronic gastritis and pernicious anemia
Jewish and African American men

11. What structures feed into the cystic duct
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Gallbladder

12. Which is used more quickly - an oral glucose load - or that by IV
Oral glucose
Primarly through ECL leading to histamine release
Portal HTN
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

13. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Adhesion
Primarly through ECL leading to histamine release
Ischemic colitis
Goes through deep inguinal ring - external inguinal ring and into the scrotum

14. What does high flow rate mean
Achalasia due to loss of myenteric plexus (auberach)
Closer to isotonic because of less time to reabsorb NaCl
AST >ALT - ration is usually 1.5
Repeated phlebotomy - deferoxamine - HLA- A3

15. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Pleomorphic adenoma
FAP
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Paraumbilical and superficial and inferior epigastric - umbilicus

16. What does histo show for alpha1 antitrypsin def
PAS- positive globules in liver -
Crohns = noncaseating granulomas - UC = crypt abscesses
Averages 6 months - very aggressive - usually already metastasized at presentation
Hirschsprungs

17. Which area of the hindgut is a watershed area
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Splenic flexure
Hemolytic anemia
Centrilobular congestion and necrosis - cardiac cirrhosis

18. Where are peyers patches found
Uridine glucuronyl transferase
Complications of crohns
Lamina propora and submucosa
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

19. How is bilirubin carried in the blood
Lye ingestion and acid reflux
Crigler - najjar type 1
With albumin
Enterokinase/enteropeptidase from the duodenal mucosa

20. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Smooth
Peutz jeghers
GLUT 2

21. Autoantibodies to gluten (gliadin) in wheat and other grains
Celiac sprue
Krukenbergs tumor
Dysphagia (due to esophageal web) - glossitis - iron def anemia
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

22. What kind of cancer to celiac sprue put you as inc risk for
T cell lymphoma
Muscularis mucosae
L2
Older patients

23. What cell produces IF and What does it do
Crohns = maybe - UC= always
AST
Gamma glutamyl transferase GGT
Parietal cells in the stomach - B12 binding protein

24. What are additional risk factors for CRC
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Positive
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

25. What layer of fascia covers a direct inguinal hernia
External spermatic fascia only
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Around the central vein (zone III)

26. Achalasia increases the risk For what complication
Cigarettes and chronic pancreatitis - not EtOH
Esophageal carcinoma
Lipase
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

27. At what spinal level does the SMA exit
Crigler - najjar type 1
L1
T cell lymphoma
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

28. What infection causes Whipple disease and What can you see on LM
Unconjugated - water insoluble
Heme metabolism
External spermatic fascia only
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

29. What is the classic triad of hemochromatosis

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30. Where is the deep inguinal ring relative to the inferior epigastric vessels
Lateral
Alcoholic cirrhosis
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

31. What are the signs of peutz jehgers
90%
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Stercobilin
Hyperpigmented mouth - lips - hands - genitalia

32. What type of insults result in micronodular cirrhosis
Intussusception
L/R renal artery around L1
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Virchow's node

33. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
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
T cell lymphoma
Gardner's syndrome
Female - fat - fertile - forty

34. somatostatin - source - action - regulation
Pleuroperitoneal
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Chagas disease
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

35. What is the main symptom if a VIPoma
Upregulated intracellular signal transduction
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Gallbladder
Smooth

36. Why does volvulus occur more at cecum and sigmoid colon
Colonic polyps
Esophageal cancer
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Redundant mesentary

37. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Adhesion
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
The proximal small bowel

38. In an MI - which liver enzyme is elevated
Serous on the sides parotids - mucinous in the middle sublingual
L/R renal artery around L1
Meconium ileus
AST

39. Where are oligosaccharide hydrolases and What do they do
Brush border of intestine - produce monosaccharides from oligo and di
Striated
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Sister mary joseph nodule

40. What conditions are associated with budd chiari
Normal
L1
Hypercoaguability - polycythemia vera - pregnancy - HCC
Inspiratory arrest on deep palpation due to pain

41. In PUD - with gastric ulcers - does pain inc or dec with meals?
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Inc - weight loss
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Glucose dependent insulinotropic peptide

42. What transforms conjugated bilirubin to urobilinogen
Duodenum - 2nd - 3rd and 4th parts
Gut bacteria
Virchow's node
Splenic flexure

43. What is the lumen of the pancreatic duct
US and cholecystectomy
Gilbert's
Unconjugated - water insoluble
Ampulla of vater

44. What layer in the mucosa is repsonsible for motility
Gardner's syndrome
Stimulate the H/K ATPase
Muscularis mucosae
Pyoderma gangrenosum - primary sclerosing cholangitis

45. What serum enzyme is elevated inacute pancreatitis
Gastrohepatic ligament
AR
Lipase
Mucoepidermoid carcinoma

46. What kind of digestion is bile needed for
Pancreatic and bile
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Cigarettes and chronic pancreatitis - not EtOH
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

47. What kind of pancreatitis is associated with EtOH and smoking
Hemolytic anemia
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
3 waves/min

48. How does loss of NO secretion affect the esophagus and what results
Gastric glands
Increase tumorigenesis
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Inc lower esphogeal tone leading to achalasia

49. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Parietal cells in the stomach - B12 binding protein
Hydrocele
Pleomorphic adenoma
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

50. What are the treatment options for uclerative colitis
Hyperpigmented mouth - lips - hands - genitalia
The proximal small bowel
Around the central vein (zone III)
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy