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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. Through which aspect of the inguinal canal does a direct inguinal go
Old men - arthralgias - cardiac and neuro sx
L4
Gut bacteria
External (superficial) ring only

2. Autoantibodies to gluten (gliadin) in wheat and other grains
Duodenum - 2nd - 3rd and 4th parts
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Hypercoaguability - polycythemia vera - pregnancy - HCC
Celiac sprue

3. What is the rate limiting step of carbohydrate digestion
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Oligosaccharide digestion
HSV-1 - CMV - Candida
Lateral

4. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
T12
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
External (superficial) ring only
Duodenal atresia - Downs

5. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
Alcoholic hepatitis
Cigarettes and chronic pancreatitis - not EtOH
Source - parasympathetic ganglion in sphincters - gallbladder - small intestine - action - inc intestinal water and electrolyte secretion - inc relaxation of intestinal smooth muscle and sphincters - regulation - inc by distention and vagal stimulati

6. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Dissaccharidase def - most commonly lactase
2ndary biliary cirrhosis
Erosive - disruption of mucosal barrier leading to inflammation
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

7. What receptor does histamine bind on the parietal cell and What does it activate
H+
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
H2 receptor - inc cAMP
L2

8. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Superior rectal
...

9. Acute gastritis is caused By what process
Smooth
Erosive - disruption of mucosal barrier leading to inflammation
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Esophageal varices

10. What layer of fascia covers a direct inguinal hernia
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
External spermatic fascia only
Black - rotors syndrome
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

11. What are additional risk factors for CRC
Virchow's node
Chagas disease
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

12. crigler - najjar type II responds to which therapy and How does it work
Phenobarbital - inc liver enzyme synthesis
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Parietal cells in the stomach - B12 binding protein
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

13. How does loss of NO secretion affect the esophagus and what results
Skip lesions =crohns - colon = UC
Erosive - disruption of mucosal barrier leading to inflammation
Inc lower esphogeal tone leading to achalasia
Esophageal cancer

14. in carcinoid tumors - What is seen on EM
H pylori (almost 100%)
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Redness and tenderness on palpation of extremities
Dense core bodies

15. What is contained within the muscularis externa
Failure of the processus vagainlis to close
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Myenteric nerve plexus - aurbach
Juvenile polyposis syndrome - inc risk of adenocarcinoma

16. What does a low flow rate mean for saliva
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Hypotonic because of more time to reabsorb NaCl
Osmotic
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

17. How is salivary secretion stimulated
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Femoral hernia
Glucouronate - water soluble (direct)
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

18. What does high flow rate mean
Closer to isotonic because of less time to reabsorb NaCl
Alfatoxin in peanuts
Oral glucose
Epigastric abdominal pain radiating to back - anorexia - nausea

19. What is the most common cause of gallstones
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Inspiratory arrest on deep palpation due to pain
GERD - may also present with nocturnal cough and dyspnea

20. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Cirrhosis
Hyperplastic
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

21. What transforms conjugated bilirubin to urobilinogen
Poor anastamoses
IgA secreting plasma cells - ultimately reside in the lamina proporia
Above
Gut bacteria

22. What do mucins do?
Lubricate food (glycoprotiens)
IBS at least 2 with recurrent abdominal pain
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Downs

23. Malabsorption syndromes have what common clinical presentation
Positive urease test
Diarrhea - steatorrhea - weight loss - weakness
Pertechnetate - study for uptake
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

24. Where are tumors commonly in pancreatic adenocarcinoma
Pancreatic head causing obstructive jaundice
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Cystic duct and common hepatic duct
Virchow's node

25. What are the common causes of gastric ulcers - What causes gastric ulcer
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Dense core bodies

26. What kind of pancreatitis is associated with EtOH and smoking
ALT>AST
Cholesterol - 10-20% opaque due to calcifications
Cimetidine
Chronic calcifying pancreatitis - inc risk of panreatic cancer

27. What are the four Fs of gallstones
Female - fat - fertile - forty
Short gastrics - left greater and lesser
L2
Ampulla of vater

28. What happens to the short gastics if the splenic artery is blocked
Inc smooth muscle relaxation - including lower esophageal sphincter
Poor anastamoses
Common hepatic - splenic - left gastric - main blood supply for stomach
The proximal small bowel

29. What source of salivary secretion is the most serous and What is the most mucinous
Jaundice - fever - RUQ
L3
Dilated esophagus with an area of distal stenosis - birds beak
Serous on the sides parotids - mucinous in the middle sublingual

30. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
Black - rotors syndrome
Adhesion
Phototherapy

31. What congenital birth defect is associated with Hirschsprung
Black - rotors syndrome
Inferior rectal nerve
Downs
Sphincter of oddi

32. What type of insults result in micronodular cirrhosis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
3 waves/min
Squamous - upper 1/3 - adeno - lower 1/3
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

33. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Krukenbergs tumor
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Hirschsprungs

34. People of what decent are associated with celiac sprue and what findings/antibodies are present
Low pressure proximal to LES
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Cirrhosis

35. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
IBS at least 2 with recurrent abdominal pain
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Crohns = maybe - UC= always

36. milk intolerance
Dissaccharidase def - most commonly lactase
Centrilobular congestion and necrosis - cardiac cirrhosis
Common hepatic - splenic - left gastric - main blood supply for stomach
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

37. Which kind of hemorrhoids are painful and why
Unconjugated - water insoluble
Obstruction of the common bile duct
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Esophageal carcinoma

38. What is the path of an indirect inguinal hernia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Esophageal varices
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Alfatoxin in peanuts

39. trypsinogen is converted to trypsin via what enzyme
US and cholecystectomy
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Enterokinase/enteropeptidase from the duodenal mucosa
L1

40. What do you treat Wilsons disease with and What is the inheritance
Penicillinamine - AR inheritance
All 3
No
Paraumbilical and superficial and inferior epigastric - umbilicus

41. 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
Cystic duct and common hepatic duct
Skip lesions =crohns - colon = UC
Hyperplastic
Superior rectal and middle and inferior rectal - rectum

42. Which area of the hindgut is a watershed area
Splenic flexure
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
L4
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

43. What are causes of extrahepatic biliary obstruction
Meckels
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Inc - weight loss
CEA - CA-19-9

44. A protrusion of peritoneum through an opening - usually a site of weakness
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Hernia
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

45. What does loss of APC cause
Diarrhea - steatorrhea - weight loss - weakness
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Decreased intercellular adhesion and increased proliferation
Superior rectal and middle and inferior rectal - rectum

46. To what substance is bilirubin conjugated and why
Glucouronate - water soluble (direct)
Worldwide - SC - US - adeno
Bleeding - intussusception - volvulus - obstruction near terminal ileum
So hypertrophied they look like brain gyri

47. malnutrition - toxic megacolon - colorectal carcinoma
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Complications of UC
Brunners
Lateral

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

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49. What does loss of p53 cause
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Increase tumorigenesis
Obstruction of the common bile duct
Angiodysplasia

50. How do NSAIDs cause acute gastritis
Inferior rectal nerve
Dec PGE2 leading to dec gastric mucosa protection
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
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