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USMLE GI

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 kind of muscle is in the upper 1/3 of esophagus
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Striated
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Where hindgut meets ectoderm

2. What are the barium swallow findings of achalasia
No
US and cholecystectomy
Dilated esophagus with an area of distal stenosis - birds beak
Female - fat - fertile - forty

3. Where are oligosaccharide hydrolases and What do they do
Brush border of intestine - produce monosaccharides from oligo and di
Peyers patches
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Pleomorphic adenoma

4. What does GET SMASHED stand for in acute pancreatitis
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
AST >ALT - ration is usually 1.5
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Mucosa - submucosa - muscularis externa - serosa/adventitia

5. What do the rugae of stomach look like in menetriers disease
Dec PGE2 leading to dec gastric mucosa protection
90%
All 3 gut layers outpouch as in Meckels
So hypertrophied they look like brain gyri

6. How does brain injury lead to acute gastritis and What is it called
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Colonic polyps
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

7. milk intolerance
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Increase tumorigenesis
Small intestine
Dissaccharidase def - most commonly lactase

8. Is there any structural abnl with IBS - What is the course of disease and presentation
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
L1

9. What are the extraintestinal manifestations of ulcerative colitis
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
Pyoderma gangrenosum - primary sclerosing cholangitis
Alpha1 antitrypsin def - codominant trait
Zenkers - halitosis - dysphagia and obstruction

10. What receptor does histamine bind on the parietal cell and What does it activate
Punched out - clean margins - carcinoma =raised irregular margins
Copious diarrhea - non alpha - non beta cell pancreatic tumor
H2 receptor - inc cAMP
Above

11. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Conj/unconj - inc - nl to dec
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Upregulated intracellular signal transduction

12. What are esophageal strictures associated with
Lye ingestion and acid reflux
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
IgA secreting plasma cells - ultimately reside in the lamina proporia
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

13. What is the triad of Plummer - Vinson syndrome
Zollinger ellison - brunners glands
2ndary biliary cirrhosis
Epithelium
Dysphagia (due to esophageal web) - glossitis - iron def anemia

14. Bilirubin is the product of what?
Krukenbergs tumor
Oligosaccharide digestion
Heme metabolism
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

15. Why does indirect inguinal hernia happen in infacnts
Failure of the processus vagainlis to close
The proximal small bowel
Fasting and stress
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

16. signet ring cells - acanthosis nigracans - dz - character/association - spread
Bleeding - penetration into pancreas - perforation - obstruction
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Colonic polyps
Bleeding - intussusception - volvulus - obstruction near terminal ileum

17. What is a positive murphy's sign
Ceruplasmin
Antrum - H.pylori - inc risk of MALT lymphoma
Inspiratory arrest on deep palpation due to pain
Zenkers - halitosis - dysphagia and obstruction

18. What are the hindgut structures and what supplies their blood and PANS innvervation
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Reye's syndrome
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Splenic flexure

19. What gives urine its characteristic color
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Unconj - absent (acholuria) - inc
H pylori (almost 100%)
Urobilin

20. absent UDPGT - presents early in life - early mortality
2ndary biliary cirrhosis
Amylase
Crigler - najjar type 1
Cimetidine

21. occlusion of IVC or hepatic veins
Averages 6 months - very aggressive - usually already metastasized at presentation
Budd chiari syndrome
Begins starch digestion - inactivated by low pH upon reaching the stomach
Dissaccharidase def - most commonly lactase

22. What are motilin receptor agonists used for clinically
Stimulate intestinal persistalsis
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Achalasia due to loss of myenteric plexus (auberach)
Backup of blood into the liver - RHF - budd chiari

23. How does CRC present in the distal and proximal colon
L/R renal artery around L1
Old men - arthralgias - cardiac and neuro sx
Repeated phlebotomy - deferoxamine - HLA- A3
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

24. Which IBD is autoimmune and which may be a disordered response to bacteria
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Diverticulum
Alfatoxin in peanuts
Superior rectal

25. likely infectious form of malabsorption - responds to antibiotics
Striated
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Tropical sprue
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

26. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Inspiratory arrest on deep palpation due to pain
Around the central vein (zone III)

27. What retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
With albumin
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Mucoepidermoid carcinoma

28. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Jaundice - fever - RUQ
Dilated esophagus with an area of distal stenosis - birds beak
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Crohns = noncaseating granulomas - UC = crypt abscesses

29. What structures feed into the common bile duct
EtOH
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Cystic duct and common hepatic duct
Pertechnetate - study for uptake

30. GIP - source - action regulation
Cimetidine
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
...
Nonkeritinized stratified sqamous epithelium

31. what kind of fistula is associated with diverticulitis
Colovesical leading to pneumaturia
Begins starch digestion - inactivated by low pH upon reaching the stomach
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Falciform - ligamentum teres - fetal umbilical vein

32. Esophagitis can result From which 3 infectious agents - or chemical ingestion
HSV-1 - CMV - Candida
Liver metabolizes 5HT
Inc lower esphogeal tone leading to achalasia
Redness and tenderness on palpation of extremities

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

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34. What does a low flow rate mean for saliva
Low pressure proximal to LES
AST
Diarrhea - steatorrhea - weight loss - weakness
Hypotonic because of more time to reabsorb NaCl

35. Which patients have pigment stones
Muscularis mucosae
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Urobilin

36. What is diverticulosis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Trypsin - chymotrypsin - elastase - carboxypeptidases
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Lateral

37. What is the omphalomesenteric cyst
Mucoepidermoid carcinoma
Cystic dilation of the viteline duct
Diverticulum
Sphincter of oddi

38. What are the four Fs of gallstones
Female - fat - fertile - forty
Mallory bodies
Amylase
Cholesterol

39. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Normal
Centrilobular leading to congestive liver disease
IgA secreting plasma cells - ultimately reside in the lamina proporia
Sister mary joseph nodule

40. What are the longterm sequelae of nutmeg liver
Inspiratory arrest on deep palpation due to pain
Appendicitis
Brunners
Centrilobular congestion and necrosis - cardiac cirrhosis

41. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Hirschsprungs
Urobilin
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Crohns = maybe - UC= always

42. What are the effects of atropine on parietal cells and G cells
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
CHF and inc risk of HCC
H+
Downs

43. What are the histological findings in the duodenum

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44. How do NSAIDs cause acute gastritis
H2 receptor - inc cAMP
Mucoepidermoid carcinoma
Inc risk of CRC and other visceral malignancies
Dec PGE2 leading to dec gastric mucosa protection

45. What is the characteristic histo finding in alcoholic hepatitis
Striated
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Mallory bodies
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

46. Abuse of what substance leads to acute gastritis
Menetriers disease
Glucose dependent insulinotropic peptide
When diffusely infiltrative - thickened rigid appearance like a leather bottle
EtOH

47. Which area of the hindgut is a watershed area
Centrilobular leading to congestive liver disease
Primarly through ECL leading to histamine release
Lactase is located at the tips of intestinal villi
Splenic flexure

48. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Alcoholic cirrhosis
AR
Primarly through ECL leading to histamine release
Increase tumorigenesis

49. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Intussusception
Hemolytic anemia
Early childhood - neuro sx and malabsorption

50. How are all 3 monosaccharides transported to the blood
Volvulus
GLUT 2
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Left and right gastroepiploics - left and right gastrics

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USMLE GI

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