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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. How does gastrin increase acid secretion?
Primarly through ECL leading to histamine release
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Cimetidine
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

2. What do you use to diagnose meckels
Pertechnetate - study for uptake
Causes of gall stones
Where hindgut meets ectoderm
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

3. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Peyers patches
Spleen to posterior abdominal wall - splenic artery and vein
Colonic polyps
Older patients

4. What kind of insults results in macronodular cirrhosis
Above
Elevated amylase - and lipase
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Hyperplastic

5. What are the histological findings in the duodenum

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6. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
GERD - may also present with nocturnal cough and dyspnea
Squamous - upper 1/3 - adeno - lower 1/3

7. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Below
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Crohns = maybe - UC= always

8. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
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
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Hyperpigmented mouth - lips - hands - genitalia
Volvulus

9. Through which aspect of the inguinal canal does a direct inguinal go
Gilbert's
External (superficial) ring only
Averages 6 months - very aggressive - usually already metastasized at presentation
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

10. What are the branches of the celiac trunk and What do they supply
Falciform - ligamentum teres - fetal umbilical vein
Crypts but not villi
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Common hepatic - splenic - left gastric - main blood supply for stomach

11. Where are carcinoid tumors most commonly malignant
Small intestine
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
HPNCC
Upregulated intracellular signal transduction

12. Where is the pectinate line
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
Spleen to posterior abdominal wall - splenic artery and vein
Failure of neural crest migration
Where hindgut meets ectoderm

13. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Internal thoracic to superior epigastric to inferior epigastric
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Erosive - disruption of mucosal barrier leading to inflammation
Dilated esophagus with an area of distal stenosis - birds beak

14. With internal hemorrhoids Where is the anastomoses and Where is it
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Lateral
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Superior rectal and middle and inferior rectal - rectum

15. What serum enzyme is decreased in wilsons disease
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Ceruplasmin
Celiac sprue
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

16. What converts inactive pepsinogen to pepsin
H+
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Lateral
Peptic ulcer disease

17. concentric onion skin bile duct fibrosis
Right and left hepatic duct
Crohns = maybe - UC= always
All 3
Primary sclerosing cholangitis

18. At what spinal level does the is the bifurcation of aorta
AST>ALT
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
L4
Via the superior pancreaticduodenal

19. Are single polyps malignant in peutz jehgers
Zollinger ellison - brunners glands
Femoral hernia
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
No

20. conjugated hyperbilirubinemia due to defective liver excretion
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Dermatitis herpetiformis
Dubin johnson
Hemosiderosis - hemochromatosis

21. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Parietal cells in the stomach - B12 binding protein
Spleen to posterior abdominal wall - splenic artery and vein
Inc conj bilirubin - inc cholesterol - inc alk phos
Crohns = maybe - UC= always

22. What causes primary biliary cirrhosis
H2 receptor - inc cAMP
In the ileum with bile acids - requires IF
AST
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

23. Where are oligosaccharide hydrolases and What do they do
Causes of gall stones
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Brush border of intestine - produce monosaccharides from oligo and di
Alpha1 antitrypsin def - codominant trait

24. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
L3
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Upregulated intracellular signal transduction
Tropical sprue

25. Where is B12 absorbed
Early childhood - neuro sx and malabsorption
In the ileum with bile acids - requires IF
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
Upregulated intracellular signal transduction

26. What is indirect bilirubin
Unconjugated - water insoluble
The submucosal nerve plexus - meissner's
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

27. What intervention will intervention will relieve portal HTN
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Nonkeritinized stratified sqamous epithelium
The jejunum
Ceruplasmin

28. A protrusion of peritoneum through an opening - usually a site of weakness
Superior rectal and middle and inferior rectal - rectum
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Hernia
Celiac sprue

29. How does CRC present in the distal and proximal colon
Myenteric nerve plexus - aurbach
Decrease - weight gain
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Esophageal carcinoma

30. What cells make pepsin - What does it do - and what regulates it
AST>ALT
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
90%
Superior rectal and middle and inferior rectal - rectum

31. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Amylase
Meckels
Crigler - najjar type 1
Cystic duct and common hepatic duct

32. What are the tumor markers for pancreatic adenocarcinoma
Punched out - clean margins - carcinoma =raised irregular margins
Superior rectal
Mallory bodies
CEA - CA-19-9

33. At what level of the spine does the IM exit the aorta
L3
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Positive urease test
Poor anastamoses

34. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Alcoholic cirrhosis
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

35. What are the borders of the femoral triangle
Inguninal ligament - sartorius muscle - adductor longus
Failure of the processus vagainlis to close
Lateral
Colovesical leading to pneumaturia

36. What causes hirschsprungs
External (superficial) ring only
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Failure of neural crest migration
GERD - may also present with nocturnal cough and dyspnea

37. What are the extraintestinal manifestations of ulcerative colitis
Hydrocele
CHF and inc risk of HCC
Pyoderma gangrenosum - primary sclerosing cholangitis
3 waves/min

38. crigler - najjar type II responds to which therapy and How does it work
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Phenobarbital - inc liver enzyme synthesis
Hydrocele

39. What gives stool its characteristic color
Lateral
Stercobilin
Trypsin - chymotrypsin - elastase - carboxypeptidases
GERD - may also present with nocturnal cough and dyspnea

40. What is the most common indication of emergent abdominal surgery in children
Gastrohepatic ligament
Appendicitis
Left gastric vein and esophogeal vein - esophagus
Phototherapy

41. What do the rugae of stomach look like in menetriers disease
Crigler - najjar type 1
Ceruplasmin
Dense core bodies
So hypertrophied they look like brain gyri

42. What kind of lesions are characteristic of duodenal PUD vs cancer
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Liver metabolizes 5HT
Gallbladder
Punched out - clean margins - carcinoma =raised irregular margins

43. What are the structures of the femoral triangle and how are they organized
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Dermatitis herpetiformis
NAV = nerve artery vein - venous near the penis (NAVEL)

44. What kind of cancer to celiac sprue put you as inc risk for
T cell lymphoma
L/R renal artery around L1
Heme metabolism
Pyoderma gangrenosum - primary sclerosing cholangitis

45. What does GET SMASHED stand for in acute pancreatitis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Stimulate the H/K ATPase
Primary sclerosing cholangitis
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

46. Bilirubin is the product of what?
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Heme metabolism
External (superficial) ring only
Primary sclerosing cholangitis

47. Gq and inc cAMP both work to do what in parietal cells
Esophageal varices
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Intussusception
Stimulate the H/K ATPase

48. What is the frequency of basal electric rhythm of the stomach
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
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
Gut bacteria
3 waves/min

49. In an MI - which liver enzyme is elevated
AST
Gallbladder
Dubin johnson
Peptic ulcer disease

50. What are the main components of bile
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Cholesterol
Ceruplasmin
Terminal ileum and colon