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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 does autoimmune destruction of parietal cells lead to...
Chronic gastritis and pernicious anemia
Cystic dilation of the viteline duct
Conj/unconj - inc - nl to dec
The proximal small bowel

2. What are the borders of the femoral triangle
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
M3 - Gq - inc IP3/Ca
Inguninal ligament - sartorius muscle - adductor longus
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

3. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Mitochondrial abnl - fatty liver - hypoglycemia - coma
...
Complications of crohns

4. Who is at risk for pancreatic adenocarcinoma
Via the superior pancreaticduodenal
Jewish and African American men
Diverticulitis in elderly - ectopic pregs use hCG to rule out
NAV = nerve artery vein - venous near the penis (NAVEL)

5. How do NSAIDs cause acute gastritis
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
External spermatic fascia only
3 waves/min
Dec PGE2 leading to dec gastric mucosa protection

6. What layer of fascia covers a direct inguinal hernia
External spermatic fascia only
Antrum - H.pylori - inc risk of MALT lymphoma
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Lamina propria

7. How does abetalipoproteinemia lead to malabsorption
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
CEA - CA-19-9
Positive urease test
Striated and smooth

8. When and How does Abetalipoproteinemia present
Early childhood - neuro sx and malabsorption
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
L1
Superior rectal

9. What is a positive murphy's sign
Early childhood - neuro sx and malabsorption
IgA secreting plasma cells - ultimately reside in the lamina proporia
Inspiratory arrest on deep palpation due to pain
Oligosaccharide digestion

10. Which kind of hemorrhoids are painful and why
M3 - Gq - inc IP3/Ca
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Appendicitis
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

11. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Krukenbergs tumor
Conj - inc - dec
Esophageal cancer

12. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Liver metabolizes 5HT
Cirrhosis
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Lactase is located at the tips of intestinal villi

13. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
GERD - may also present with nocturnal cough and dyspnea
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Achalasia due to loss of myenteric plexus (auberach)
Sphincter of oddi

14. What transforms conjugated bilirubin to urobilinogen
Hemosiderosis - hemochromatosis
Gut bacteria
Lamina propora and submucosa
Splenic flexure

15. What cells make pepsin - What does it do - and what regulates it
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Chagas disease
Zollinger Ellison - phenylalanine and tryptophan

16. What causes pancreatic insuff and What does it cause
Alk phos
Cholesterol
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

17. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
Skip lesions =crohns - colon = UC
Menetriers disease
Ceruplasmin
Lubricate food (glycoprotiens)

18. What can fistula between the gallbladder and small intestine create and how can you tell
Stercobilin
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Backup of blood into the liver - RHF - budd chiari
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

19. What is the most common esophageal cancer worldwide and in the US
Epithelium
Worldwide - SC - US - adeno
Zenkers - halitosis - dysphagia and obstruction
Carcinoid syndrome

20. GIP - source - action regulation
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Colovesical leading to pneumaturia
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Carcinoid syndrome

21. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Inc smooth muscle relaxation - including lower esophageal sphincter
Worldwide - SC - US - adeno

22. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Below
Duodenum - 2nd - 3rd and 4th parts
AST >ALT - ration is usually 1.5
Poor anastamoses

23. What is the triad of Plummer - Vinson syndrome
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
12 waves/min
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

24. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Left gastric vein and esophogeal vein - esophagus
Inspiratory arrest on deep palpation due to pain
Black - rotors syndrome

25. What is Trousseau's sign
Pleuroperitoneal
In the mucus that covers the gastric epithelium
Erosive - disruption of mucosal barrier leading to inflammation
Redness and tenderness on palpation of extremities

26. If trypsin activates more trypsinogen - what kind of feedback loop is established
Positive
Begins starch digestion - inactivated by low pH upon reaching the stomach
Dilated esophagus with an area of distal stenosis - birds beak
Mallory bodies

27. What are the midgut structures and what supplies their blood and PANS innervation
All 3 gut layers outpouch as in Meckels
Alfatoxin in peanuts
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

28. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Centrilobular leading to congestive liver disease
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Superior rectal
FAP

29. Where is there sclerosis in alcoholic cirrohosis
Around the central vein (zone III)
Jewish and African American men
Inferior rectal nerve
Centrilobular congestion and necrosis - cardiac cirrhosis

30. Abuse of what substance leads to acute gastritis
Hyperpigmented mouth - lips - hands - genitalia
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
EtOH

31. What kind of digestion is bile needed for
Paraumbilical and superficial and inferior epigastric - umbilicus
Older patients
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Conj/unconj - inc - nl to dec

32. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Colonic polyps
Sphincter of oddi
Trypsin - chymotrypsin - elastase - carboxypeptidases
Omeprazole

33. Where and How is iron absorbed
Fe2+ in the duod
Bleeding - intussusception - volvulus - obstruction near terminal ileum
The jejunum
In the mucus that covers the gastric epithelium

34. Gastrin - source - action - regulation
FAP
Zenkers - halitosis - dysphagia and obstruction
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
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

35. What are the signs and symptoms of budd chiari
Oral glucose
Zenkers - halitosis - dysphagia and obstruction
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Decrease - weight gain

36. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus

37. In what clinical scenarior do you see portosystemic anastomoses
Portal HTN
EtOH
Jaundice - fever - RUQ
Esophageal varices

38. What congenital birth defect is associated with Hirschsprung
Oral glucose
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Downs

39. Between what structures do strong anastamoses exist
All 3
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Left and right gastroepiploics - left and right gastrics

40. Gallstones that reach the common channel at ampulla can block which two ducts
Unconjugated - water insoluble
Femoral hernia
Pancreatic and bile
Mallory bodies

41. What is the lumen of the pancreatic duct
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Ampulla of vater
Adhesion
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

42. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Increase tumorigenesis
Menetriers disease
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

43. Which patients have pigment stones
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Pancreatic head causing obstructive jaundice
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

44. What causes hirschsprungs
Hernia
H2 receptor - inc cAMP
Alk phos
Failure of neural crest migration

45. How does hirschsprung present and appear on imaging
Phototherapy
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
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Lack or have an attenuated muscularis externa - often in the sigmoid colon

46. What are the two molecular pathways that lead to CRC
Dissaccharidase def - most commonly lactase
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Decrease - weight gain

47. concentric onion skin bile duct fibrosis
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Liver metabolizes 5HT
Primary sclerosing cholangitis
Chronic gastritis and pernicious anemia

48. What are the foregut structures and what supplies their blood and PANS innvervation
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Inc lower esphogeal tone leading to achalasia
Lactase is located at the tips of intestinal villi

49. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue

50. People of what decent are associated with celiac sprue and what findings/antibodies are present
Punched out - clean margins - carcinoma =raised irregular margins
Hydrocele
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Averages 6 months - very aggressive - usually already metastasized at presentation