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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 a positive murphy's sign
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Osmotic
Inspiratory arrest on deep palpation due to pain

2. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Epigastric abdominal pain radiating to back - anorexia - nausea
The proximal small bowel
Alfatoxin in peanuts
Esophageal varices

3. trypsinogen is converted to trypsin via what enzyme
Lubricate food (glycoprotiens)
Causes of gall stones
Enterokinase/enteropeptidase from the duodenal mucosa
Inc smooth muscle relaxation - including lower esophageal sphincter

4. What is the risk with peutz jehgers
Primarly through ECL leading to histamine release
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
Lateral to the inferior epigastric artery
Inc risk of CRC and other visceral malignancies

5. Where is IgA shuttled
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Where hindgut meets ectoderm
Internal thoracic to superior epigastric to inferior epigastric
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

6. Esophagitis can result From which 3 infectious agents - or chemical ingestion
M3 - Gq - inc IP3/Ca
HSV-1 - CMV - Candida
Unconjugated - water insoluble
Hypotonic because of more time to reabsorb NaCl

7. If the hemochromatosis is primary - What is the pattern of inheritance
Inc - weight loss
Zenkers - halitosis - dysphagia and obstruction
AR
Splenic flexure

8. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Unconj - absent (acholuria) - inc
Falciform - ligamentum teres - fetal umbilical vein

9. somatostatin - source - action - regulation
Jewish and African American men
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Unconjugated - water insoluble

10. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Unconj - absent (acholuria) - inc
HPNCC
Unconjugated - water insoluble

11. Failure of relaxation of lower esophageal sphincter - Name and etiology
Elevated amylase - and lipase
Dissaccharidase def - most commonly lactase
Redness and tenderness on palpation of extremities
Achalasia due to loss of myenteric plexus (auberach)

12. How does hirschsprung present and appear on imaging
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
Epigastric abdominal pain radiating to back - anorexia - nausea
Zollinger Ellison - phenylalanine and tryptophan
In the ileum with bile acids - requires IF

13. Where is B12 absorbed
IBS at least 2 with recurrent abdominal pain
Adhesion
In the ileum with bile acids - requires IF
Failure of neural crest migration

14. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Unconjugated - water insoluble
Smooth
VZV and influenza B treated with salicylates
Above

15. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Black - rotors syndrome
Achalasia due to loss of myenteric plexus (auberach)
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Duodenum - 2nd - 3rd and 4th parts

16. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Peyers patches
Can lead to hematemesis - found in EtOHics and bulimics
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Increase tumorigenesis

17. What is the action of NO as a GI hormone
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Amylase
Inc smooth muscle relaxation - including lower esophageal sphincter
Colovesical leading to pneumaturia

18. What pancreatic enzymes are responsible for fat digestion
Bleeding - penetration into pancreas - perforation - obstruction
Hypercoaguability - polycythemia vera - pregnancy - HCC
Serous on the sides parotids - mucinous in the middle sublingual
Lipase - phospholipase A - colipase

19. What carcinogens are associated with HCC
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Alfatoxin in peanuts
...

20. With caput medusaw - between what vessels is the anastomoses and Where is it
Crohns = noncaseating granulomas - UC = crypt abscesses
Alpha amylase
Paraumbilical and superficial and inferior epigastric - umbilicus
Unconj - absent (acholuria) - inc

21. How do villi appear in disaccharidease def
Hypercoaguability - polycythemia vera - pregnancy - HCC
NAV = nerve artery vein - venous near the penis (NAVEL)
Increase tumorigenesis
Normal

22. is meckels a true diverticulum and how common is it
Dense core bodies
True and most common congenital anomoly of GI tract
Hydrocele
T cell lymphoma

23. absent UDPGT - presents early in life - early mortality
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Crigler - najjar type 1
Hemosiderosis - hemochromatosis
Phototherapy

24. Which patients have pigment stones
Stercobilin
Muscularis mucosae
Oral glucose
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn

25. What is the frequency of basal electric rhythm in the duodenum
12 waves/min
Gardner's syndrome
Celiac sprue
Hepatic steatosis

26. inflammatino of gallbadder
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Pancreatic and bile
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Zollinger Ellison - phenylalanine and tryptophan

27. What kind of cancer to celiac sprue put you as inc risk for
Cholesterol
Normal
Increase tumorigenesis
T cell lymphoma

28. What gives stool its characteristic color
Liver metabolizes 5HT
Stercobilin
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Trypsin - chymotrypsin - elastase - carboxypeptidases

29. How are all 3 monosaccharides transported to the blood
GLUT 2
Gastrohepatic ligament
Around the central vein (zone III)
Stimulate intestinal persistalsis

30. In PUD with a duodenal ulcer does pain inc or dec with meals
Decrease - weight gain
Crohns = noncaseating granulomas - UC = crypt abscesses
Omeprazole
Cholesterol - 10-20% opaque due to calcifications

31. What causes nutmeg liver
Chronic gastritis and pernicious anemia
Backup of blood into the liver - RHF - budd chiari
Hernia
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

32. What is the mechanism for reyes syndrome
Normal
Poor anastamoses
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

33. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Striated and smooth
Juvenille polyps - no risk if single
Alk pho
Brunners

34. What kind of anemia is in Wilsons
Hemolytic anemia
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Where hindgut meets ectoderm
Pertechnetate - study for uptake

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

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36. What cells secrete bicarb - What does it do - and what regulates it
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Oligosaccharide digestion
HSV-1 - CMV - Candida
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

37. Where are peyers patches found
Lamina propora and submucosa
Gardner's syndrome
The jejunum
Hernia

38. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Hyperpigmented mouth - lips - hands - genitalia
Dissaccharidase def - most commonly lactase
Meckels
Intussusception

39. in budd chiari syndrome - Where is the congestion and necrosis
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Failure of neural crest migration
Centrilobular leading to congestive liver disease
Pancreatic head causing obstructive jaundice

40. in carcinoid tumors - What is seen on EM
Dubin johnson
Dense core bodies
CEA - CA-19-9
Right and left hepatic duct

41. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Mucosa - submucosa - muscularis externa - serosa/adventitia
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Erosive - disruption of mucosal barrier leading to inflammation
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

42. why infxn is implicated in duodenal PUD
The gastroduodenal
Uremia
H pylori (almost 100%)
Stimulate the H/K ATPase

43. What is the most common cause of gallstones
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Alpha1 antitrypsin def - codominant trait
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Begins starch digestion - inactivated by low pH upon reaching the stomach

44. What layer in the mucosa is responsible for support
Lamina propria
Parietal cells in the stomach - B12 binding protein
Duodenum - 2nd - 3rd and 4th parts
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

45. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Pleuroperitoneal
Gallbladder
Alcoholic cirrhosis
Unconj - absent (acholuria) - inc

46. What congenital birth defect is associated with Hirschsprung
Female - fat - fertile - forty
Lateral
Downs
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

47. Where is there sclerosis in alcoholic cirrohosis
H pylori (almost 100%)
Around the central vein (zone III)
Peutz jeghers
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

48. Who is at risk for pancreatic adenocarcinoma
Obstruction of the common bile duct
Jewish and African American men
Lipase
Juvenille polyps - no risk if single

49. What is the sphincter of the pancreatic duct
Sphincter of oddi
Causes of gall stones
Inguninal ligament - sartorius muscle - adductor longus
AR

50. What do you treat Wilsons disease with and What is the inheritance
Female - fat - fertile - forty
Penicillinamine - AR inheritance
Epigastric abdominal pain radiating to back - anorexia - nausea
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics