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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 is pancreatic adenocarcinoma associated with
Alk pho
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Cigarettes and chronic pancreatitis - not EtOH

2. trypsinogen is converted to trypsin via what enzyme
Enterokinase/enteropeptidase from the duodenal mucosa
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Via the middle colic
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

3. In what scenarios do pts with gilberts have inc bili
Right and left hepatic duct
Celiac sprue
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Fasting and stress

4. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Reye's syndrome
CHF and inc risk of HCC
Alcoholic hepatitis

5. Why does indirect inguinal hernia happen in infacnts
Low pressure proximal to LES
Failure of the processus vagainlis to close
EtOH
Lactase is located at the tips of intestinal villi

6. What are esophageal strictures associated with
Phototherapy
Omeprazole
Lye ingestion and acid reflux
Pancreatic and bile

7. What does autoimmune destruction of parietal cells lead to...
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Left and right gastroepiploics - left and right gastrics
Chronic gastritis and pernicious anemia
Worldwide - SC - US - adeno

8. Is there any structural abnl with IBS - What is the course of disease and presentation
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Esophageal carcinoma
Peyers patches
No - chronic - can present with diarrhea or constipation or alternation - treat sx

9. How is bilirubin carried in the blood
Peyers patches
Gamma glutamyl transferase GGT
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
With albumin

10. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Diverticulum
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Pancreatic head causing obstructive jaundice

11. What cell produces IF and What does it do
Parietal cells in the stomach - B12 binding protein
Fasting and stress
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

12. What are the hindgut structures and what supplies their blood and PANS innvervation
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Can lead to hematemesis - found in EtOHics and bulimics
Celiac sprue

13. Where are carcinoid tumors most commonly malignant
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
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
The jejunum
Small intestine

14. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
L1

15. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Inc - weight loss
Cirrhosis
Adhesion

16. Where is the deep inguinal ring relative to the inferior epigastric vessels
No
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Lateral
Lack or have an attenuated muscularis externa - often in the sigmoid colon

17. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
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
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

18. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Peyers patches
Neutralizes oral bacertial acids and maintains dental health
Primary sclerosing cholangitis
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

19. Which IBD is autoimmune and which may be a disordered response to bacteria
Phototherapy
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Poor anastamoses

20. Malabsorption syndromes have what common clinical presentation
Diarrhea - steatorrhea - weight loss - weakness
Cystic dilation of the viteline duct
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Cimetidine

21. What is the action of NO as a GI hormone
Oligosaccharide digestion
Inc smooth muscle relaxation - including lower esophageal sphincter
Cigarettes and chronic pancreatitis - not EtOH
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

22. What are the longterm sequelae of nutmeg liver
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Centrilobular congestion and necrosis - cardiac cirrhosis
EtOH
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

23. What are the effects of atropine on parietal cells and G cells
Can lead to hematemesis - found in EtOHics and bulimics
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

24. Are single polyps malignant in peutz jehgers
Portal HTN
Serous on the sides parotids - mucinous in the middle sublingual
Alk pho
No

25. At what level do the testicular/ovarian arteries exit the aorta
Lateral to the inferior epigastric artery
Stercobilin
Stimulate the H/K ATPase
L2

26. bilateral mets to ovaries with abundant mucus - signet ring cells
Krukenbergs tumor
Crohns = maybe - UC= always
Neural muscarinic pathways
Virchow's node

27. What gives stool its characteristic color
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Stercobilin
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
NAV = nerve artery vein - venous near the penis (NAVEL)

28. Liver cell failure can lead to multisystem signs including
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Causes of gall stones
Cystic dilation of the viteline duct

29. What are the complications of duodenal PUD
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Repeated phlebotomy - deferoxamine - HLA- A3
Hyperplastic
Bleeding - penetration into pancreas - perforation - obstruction

30. What percentage of gall stones are cholesterol stones and What are the associations
HPNCC
Hypercoaguability - polycythemia vera - pregnancy - HCC
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Cystic duct and common hepatic duct

31. What serum enzyme is elevated in acute pancreatitis and mumps
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
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
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Amylase

32. What does a gastrinoma cause
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
So hypertrophied they look like brain gyri
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
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

33. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Unconj - absent (acholuria) - inc
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Tropical sprue
Complications of crohns

34. People of what decent are associated with celiac sprue and what findings/antibodies are present
With albumin
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Inferior rectal nerve
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

35. What is the most common cause of gallstones
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
GLUT 2
Diverticulum

36. How is salivary secretion stimulated
Omeprazole
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Colonic polyps
Hernia

37. When and How does Abetalipoproteinemia present
Early childhood - neuro sx and malabsorption
Gardner's syndrome
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Hemolytic anemia

38. What separates the right greater and lesser sacs
Pleuroperitoneal
Gastrohepatic ligament
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Sphincter of oddi

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

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40. What does loss of p53 cause
Averages 6 months - very aggressive - usually already metastasized at presentation
Increase tumorigenesis
Decreased intercellular adhesion and increased proliferation
AST

41. Which kind of hemorrhoids are painful and why
3 waves/min
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
In the mucus that covers the gastric epithelium
True and most common congenital anomoly of GI tract

42. in budd chiari syndrome - Where is the congestion and necrosis
External spermatic fascia only
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Centrilobular leading to congestive liver disease
Gilbert's

43. Which area of the hindgut is a watershed area
Gardner's syndrome
Uremia
The gastroduodenal
Splenic flexure

44. What is the most common diaphragmatic hernia and What are the two types
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Internal thoracic to superior epigastric to inferior epigastric
Reye's syndrome
Conj/unconj - inc - nl to dec

45. What converts inactive pepsinogen to pepsin
Gardner's syndrome
Corticosteroids - infliximab
H+
FAP

46. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Pyoderma gangrenosum - primary sclerosing cholangitis
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Superior rectal

47. Bile is critical for exrection of what substance
Obstruction of the common bile duct
Phenobarbital - inc liver enzyme synthesis
Trypsin - chymotrypsin - elastase - carboxypeptidases
Cholesterol

48. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Glucose dependent insulinotropic peptide
Epithelium
Superior rectal and middle and inferior rectal - rectum
Juvenille polyps - no risk if single

49. Scleroderma is associated with what kind of esophageal dysmotility
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Low pressure proximal to LES

50. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Enterokinase/enteropeptidase from the duodenal mucosa
Peptic ulcer disease
Angiodysplasia