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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 indirect bilirubin
Jaundice - fever - RUQ
Zollinger ellison - brunners glands
Unconjugated - water insoluble
No

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

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3. FAP + malignant CNS tumor
Lubricate food (glycoprotiens)
Alk phos
Turcot
Mucoepidermoid carcinoma

4. What are the histological findings in the jejunum
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
Pleomorphic adenoma
Striated

5. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
HPNCC
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

6. Where is B12 absorbed
Gastrohepatic ligament
Pleomorphic adenoma
HSV-1 - CMV - Candida
In the ileum with bile acids - requires IF

7. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
Juvenille polyps - no risk if single
Smooth
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

8. In PUD - with gastric ulcers - does pain inc or dec with meals?
US and cholecystectomy
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Inc - weight loss
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

9. What is the frequency of basal electric rhythm of the stomach
Esophageal cancer
Centrilobular congestion and necrosis - cardiac cirrhosis
3 waves/min
Primarly through ECL leading to histamine release

10. What is the TX of physiologic neonatal jaundice
Redundant mesentary
Phototherapy
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
H+

11. What is the path of an indirect inguinal hernia
Hemolytic anemia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Hemosiderosis - hemochromatosis
Omeprazole

12. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
L/R renal artery around L1
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Mitochondrial abnl - fatty liver - hypoglycemia - coma

13. What is the triad of Plummer - Vinson syndrome
Dec PGE2 leading to dec gastric mucosa protection
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Hypercoaguability - polycythemia vera - pregnancy - HCC
Dysphagia (due to esophageal web) - glossitis - iron def anemia

14. A protrusion of peritoneum through an opening - usually a site of weakness
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
L/R renal artery around L1
Hernia
Via the superior pancreaticduodenal

15. What are the ABCDEF of esophageal cancer
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Glucouronate - water soluble (direct)
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Black - rotors syndrome

16. What are the labs in acute pancreatitis
Via the superior pancreaticduodenal
All 3 gut layers outpouch as in Meckels
Elevated amylase - and lipase
Hernia

17. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Unconj - absent (acholuria) - inc
US and cholecystectomy
Lubricate food (glycoprotiens)
M3 - Gq - inc IP3/Ca

18. B cells stimuated in the germinal centers of peyers patches differentiate into what?
IgA secreting plasma cells - ultimately reside in the lamina proporia
Colovesical leading to pneumaturia
90%
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

19. What receptor does histamine bind on the parietal cell and What does it activate
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Mucoepidermoid carcinoma
Primary sclerosing cholangitis
H2 receptor - inc cAMP

20. Through which aspect of the inguinal canal does a direct inguinal go
Chagas disease
Inc - weight loss
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
External (superficial) ring only

21. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Left gastric vein and esophogeal vein - esophagus
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

22. What structures feed into the common hepatic duct
Right and left hepatic duct
Cigarettes and chronic pancreatitis - not EtOH
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

23. Dysphagia in achalasia results from
Skip lesions =crohns - colon = UC
Gamma glutamyl transferase GGT
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
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

24. multiple juvenil polyps in GI tract - risk
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Pyoderma gangrenosum - primary sclerosing cholangitis
Alpha amylase
Duodenal atresia - Downs

25. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Meckels
Angiodysplasia
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Obstruction of the common bile duct

26. What are the histological findings of the colon
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Crypts but not villi
Necrotizing enterocolitis
Internal thoracic to superior epigastric to inferior epigastric

27. With caput medusaw - between what vessels is the anastomoses and Where is it
Paraumbilical and superficial and inferior epigastric - umbilicus
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
Dermatitis herpetiformis
In the ileum with bile acids - requires IF

28. Which serum enzyme increases with heavy EtOH consumption
Centrilobular congestion and necrosis - cardiac cirrhosis
Gamma glutamyl transferase GGT
Inferior rectal nerve
Diverticulum

29. What is the most common diaphragmatic hernia and What are the two types
Conj/unconj - inc - nl to dec
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
The jejunum

30. What percentage of gall stones are cholesterol stones and What are the associations
L3
Pleomorphic adenoma
Positive urease test
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

31. What are additional risk factors for CRC
8-9 waves/min
Neural muscarinic pathways
MSI (15%) and APC/beta catenin chromosomal instability (85%)
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

32. What does histo show for alpha1 antitrypsin def
No - chronic - can present with diarrhea or constipation or alternation - treat sx
PAS- positive globules in liver -
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Inc - weight loss

33. Abuse of what substance leads to acute gastritis
The gastroduodenal
EtOH
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
H+

34. What is the HLA association and treatment for hemochromatosis
Failure of the processus vagainlis to close
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Repeated phlebotomy - deferoxamine - HLA- A3
Meconium ileus

35. What causes primary biliary cirrhosis
Upregulated intracellular signal transduction
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

36. What is the risk with peutz jehgers
Cigarettes and chronic pancreatitis - not EtOH
Closer to isotonic because of less time to reabsorb NaCl
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Inc risk of CRC and other visceral malignancies

37. What serum enzyme is elevated inacute pancreatitis
L1
Lipase
Hernia
Female - fat - fertile - forty

38. What kind of cancer to celiac sprue put you as inc risk for
8-9 waves/min
L3
Backup of blood into the liver - RHF - budd chiari
T cell lymphoma

39. What does high flow rate mean
Heme metabolism
Bleeding - penetration into pancreas - perforation - obstruction
H pylori (almost 100%)
Closer to isotonic because of less time to reabsorb NaCl

40. What pancreatic proteases are secreted as zymogens
Dec PGE2 leading to dec gastric mucosa protection
H2 receptor - inc cAMP
Trypsin - chymotrypsin - elastase - carboxypeptidases
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

41. What serum markers increase in cholecystitis with bile duct involvement
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Alk phos
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

42. occlusion of IVC or hepatic veins
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Neural muscarinic pathways
Budd chiari syndrome
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

43. What findings are associated with reyes
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Chagas disease
Pleomorphic adenoma

44. Where is there sclerosis in alcoholic cirrohosis
AST>ALT
3 waves/min
Around the central vein (zone III)
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

45. At what spinal level does the is the bifurcation of aorta
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Inc lower esphogeal tone leading to achalasia
L4
Via the superior pancreaticduodenal

46. What layer in the mucosa is repsonsible for motility
Brunners
Repeated phlebotomy - deferoxamine - HLA- A3
US and cholecystectomy
Muscularis mucosae

47. 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
Early childhood - neuro sx and malabsorption
Esophageal carcinoma
Alk pho

48. What structures feed into the common bile duct
Krukenbergs tumor
Lactase is located at the tips of intestinal villi
Cystic duct and common hepatic duct
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

49. What makes a true diverticula
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
8-9 waves/min
All 3 gut layers outpouch as in Meckels
Epigastric abdominal pain radiating to back - anorexia - nausea

50. What are the main components of bile
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Centrilobular leading to congestive liver disease
Short gastrics - left greater and lesser
Neutralizes oral bacertial acids and maintains dental health