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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. rare - often fatal childhood hepatoencephalopathy

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2. Acute gastritis is caused By what process
Elevated amylase - and lipase
Meckels
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Erosive - disruption of mucosal barrier leading to inflammation

3. What is the presenting course for appendicity

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4. What is the most common indication of emergent abdominal surgery in children
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Ischemic colitis
Appendicitis
Cigarettes and chronic pancreatitis - not EtOH

5. trypsinogen is converted to trypsin via what enzyme
Enterokinase/enteropeptidase from the duodenal mucosa
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Jaundice - fever - RUQ

6. What does TOASTED with alcoholic hepatitis stand for
Terminal ileum and colon
AST >ALT - ration is usually 1.5
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

7. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
AST
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Crigler - najjar type 1
FAP

8. If the hemochromatosis is primary - What is the pattern of inheritance
AR
Cigarettes and chronic pancreatitis - not EtOH
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
AST

9. What kind of anemia is in Wilsons
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
L1
Hemolytic anemia

10. What happens to the short gastics if the splenic artery is blocked
Poor anastamoses
Lipase - phospholipase A - colipase
Pleomorphic adenoma
Dubin johnson

11. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Peutz jeghers
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
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Spleen to posterior abdominal wall - splenic artery and vein

12. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
3 waves/min
Early childhood - neuro sx and malabsorption
IBS at least 2 with recurrent abdominal pain
No

13. What is the other name for GIP (gastric inhibitory peptide)
Hyperpigmented mouth - lips - hands - genitalia
AR
Glucose dependent insulinotropic peptide
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

14. blind pouch protruding from alimentary tract that communicates with lumen of the gut
With albumin
Diverticulum
AST >ALT - ration is usually 1.5
Juvenile polyposis syndrome - inc risk of adenocarcinoma

15. How is salivary secretion stimulated
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Trypsin - chymotrypsin - elastase - carboxypeptidases
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Adhesion

16. How many layers of spermatic fascia are covers an indirect inguinal hernia
Pleuroperitoneal
All 3
NAV = nerve artery vein - venous near the penis (NAVEL)
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

17. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Left gastric vein and esophogeal vein - esophagus
Hypotonic because of more time to reabsorb NaCl
Alcoholic cirrhosis

18. What does bicab do in the mouth
Lamina propria
Neutralizes oral bacertial acids and maintains dental health
Centrilobular congestion and necrosis - cardiac cirrhosis
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

19. How are all 3 monosaccharides transported to the blood
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
GLUT 2
Below
Stimulate intestinal persistalsis

20. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Inc conj bilirubin - inc cholesterol - inc alk phos
Barrett's esophagus
Uremia

21. Who gets gastric ulcers
Inc smooth muscle relaxation - including lower esophageal sphincter
Older patients
Dermatitis herpetiformis
8-9 waves/min

22. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Zollinger ellison - brunners glands
Smooth
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

23. why infxn is implicated in duodenal PUD
Esophageal varices
Glucouronate - water soluble (direct)
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
H pylori (almost 100%)

24. What does primary sclerosing cholangitis lead to...
Cystic duct and common hepatic duct
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Centrilobular leading to congestive liver disease
Corticosteroids - infliximab

25. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Diarrhea - steatorrhea - weight loss - weakness
Adhesion
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Trypsin - chymotrypsin - elastase - carboxypeptidases

26. What is the TX of physiologic neonatal jaundice
Phototherapy
H pylori (almost 100%)
Esophageal varices
External spermatic fascia only

27. Where does copper accumulate in Wilsons and What are ABCD
Hyperplastic
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Jaundice - fever - RUQ
Diverticulum

28. What is Trousseau's sign
Dissaccharidase def - most commonly lactase
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Redness and tenderness on palpation of extremities
Mucosa - submucosa - muscularis externa - serosa/adventitia

29. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Conj - inc - dec
Phenobarbital - inc liver enzyme synthesis
Hirschsprungs

30. What is the rate limiting step of carbohydrate digestion
Brush border of intestine - produce monosaccharides from oligo and di
Crypts but not villi
Oligosaccharide digestion
Budd chiari syndrome

31. what kind of muscle is in the upper 1/3 of esophagus
Volvulus
Crohns = noncaseating granulomas - UC = crypt abscesses
AST
Striated

32. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
US and cholecystectomy
Complications of crohns
Alpha amylase
Carcinoid syndrome

33. What kind of lesions are characteristic of duodenal PUD vs cancer
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Punched out - clean margins - carcinoma =raised irregular margins
Pancreatic head causing obstructive jaundice

34. What are the labs in acute pancreatitis
External spermatic fascia only
Gastric glands
Osmotic
Elevated amylase - and lipase

35. 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
HPNCC
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
True and most common congenital anomoly of GI tract

36. What is diverticulosis
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Repeated phlebotomy - deferoxamine - HLA- A3
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

37. What causes pancreatic insuff and What does it cause
AR
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Old men - arthralgias - cardiac and neuro sx

38. What are the ABCDEF of esophageal cancer
Stimulate intestinal persistalsis
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
T cell lymphoma
When diffusely infiltrative - thickened rigid appearance like a leather bottle

39. Where is folate absorbed
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
Hemosiderosis - hemochromatosis
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

40. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Esophageal cancer
Boerhaave's Syndrome - Been heaving syndrome
Turcot
Acute pancreatitis

41. milk intolerance
Black - rotors syndrome
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Dissaccharidase def - most commonly lactase
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

42. What are the complications of Meckels
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Pancreatic and bile
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Jewish and African American men

43. What kind of cancer to celiac sprue put you as inc risk for
Stimulate the H/K ATPase
Ceruplasmin
Myenteric nerve plexus - aurbach
T cell lymphoma

44. What are the four Fs of gallstones
IBS at least 2 with recurrent abdominal pain
Myenteric nerve plexus - aurbach
Spleen to posterior abdominal wall - splenic artery and vein
Female - fat - fertile - forty

45. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Alpha1 antitrypsin def - codominant trait
Dense core bodies
Begins starch digestion - inactivated by low pH upon reaching the stomach
Juvenille polyps - no risk if single

46. What can fistula between the gallbladder and small intestine create and how can you tell
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Inc - weight loss
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

47. Where does type B chronic gastritis occur and What causes it
Dissaccharidase def - most commonly lactase
Zollinger Ellison - phenylalanine and tryptophan
Antrum - H.pylori - inc risk of MALT lymphoma
Turcot

48. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
AST>ALT
Omeprazole
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

49. What is the triad of Plummer - Vinson syndrome
L4
Internal thoracic to superior epigastric to inferior epigastric
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Gastric glands

50. What is the cause of Barrett's and the assocaited complications
Complications of UC
Mucoepidermoid carcinoma
Mucosa - submucosa - muscularis externa - serosa/adventitia
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer