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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. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Skip lesions =crohns - colon = UC
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Decrease - weight gain
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

2. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Gamma glutamyl transferase GGT
Punched out - clean margins - carcinoma =raised irregular margins
Conj - inc - dec
CHF and inc risk of HCC

3. In alchoholic hepatitis which liver enzyme is higher
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
Angiodysplasia
Crigler - najjar type 1
AST>ALT

4. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Crigler - najjar type 1
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Cystic dilation of the viteline duct
Juvenille polyps - no risk if single

5. What drug blocks the H2R
The proximal small bowel
HSV-1 - CMV - Candida
Cimetidine
Lateral

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

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7. What causes nutmeg liver
Pancreatic head causing obstructive jaundice
Epigastric abdominal pain radiating to back - anorexia - nausea
In the ileum with bile acids - requires IF
Backup of blood into the liver - RHF - budd chiari

8. 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
Jaundice - fever - RUQ
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
Skip lesions =crohns - colon = UC
The submucosal nerve plexus - meissner's

9. What does primary sclerosing cholangitis lead to...
Lactase is located at the tips of intestinal villi
Striated and smooth
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Dubin johnson

10. Where and How is iron absorbed
Stercobilin
Fe2+ in the duod
Antrum - H.pylori - inc risk of MALT lymphoma
Reye's syndrome

11. What kind of diarrhea is produced from a disaccharide def
Osmotic
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Inc risk of CRC and other visceral malignancies
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

12. What are the signs and symptoms of budd chiari
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Neutralizes oral bacertial acids and maintains dental health
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

13. What other condition can lead to acute gastritis - think renal
Amylase
Early childhood - neuro sx and malabsorption
Uremia
Brush border of intestine - produce monosaccharides from oligo and di

14. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Menetriers disease
Neutralizes oral bacertial acids and maintains dental health

15. What is the presentation of pancreatic adenocarcinoma
The entire
Achalasia due to loss of myenteric plexus (auberach)
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
M3 - Gq - inc IP3/Ca

16. concentric onion skin bile duct fibrosis
Begins starch digestion - inactivated by low pH upon reaching the stomach
Necrotizing enterocolitis
Lamina propora and submucosa
Primary sclerosing cholangitis

17. Liver cell failure can lead to multisystem signs including
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
L4
Alpha1 antitrypsin def - codominant trait
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

18. What do the rugae of stomach look like in menetriers disease
So hypertrophied they look like brain gyri
Peutz jeghers
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
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

19. What is the path of an indirect inguinal hernia
12 waves/min
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Terminal ileum and colon

20. What causes hirschsprungs
Barrett's esophagus
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
12 waves/min
Failure of neural crest migration

21. What are the longterm sequelae of nutmeg liver
Centrilobular congestion and necrosis - cardiac cirrhosis
Alcoholic cirrhosis
Ischemic colitis
Dermatitis herpetiformis

22. What does alpha amylase do and what inactivates it
Begins starch digestion - inactivated by low pH upon reaching the stomach
Duodenum - 2nd - 3rd and 4th parts
Worldwide - SC - US - adeno
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

23. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Carcinoid syndrome
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Osmotic
Phototherapy

24. bilateral mets to ovaries with abundant mucus - signet ring cells
Decrease - weight gain
Krukenbergs tumor
Low pressure proximal to LES
T12

25. What is the sphincter of the pancreatic duct
Amylase
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Sphincter of oddi
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

26. What is diverticulosis
Menetriers disease
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
US and cholecystectomy

27. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Lactase is located at the tips of intestinal villi
Reye's syndrome
Necrotizing enterocolitis
Hyperpigmented mouth - lips - hands - genitalia

28. What can fistula between the gallbladder and small intestine create and how can you tell
Pyoderma gangrenosum - primary sclerosing cholangitis
Duodenal atresia - Downs
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

29. what kind of muscle is in the upper 1/3 of esophagus
Brush border of intestine - produce monosaccharides from oligo and di
Ceruplasmin
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Striated

30. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
The entire
Uremia
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
...

31. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
So hypertrophied they look like brain gyri
Internal thoracic to superior epigastric to inferior epigastric
Ischemic colitis
Crypts but not villi

32. Dysphagia in achalasia results from
Gut bacteria
Closer to isotonic because of less time to reabsorb NaCl
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

33. What kind of digestion is bile needed for
Oligosaccharide digestion
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Erosive - disruption of mucosal barrier leading to inflammation

34. What is the ddx associated with appendicitis
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Stimulate intestinal persistalsis
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
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer

35. HCC is associated with what other conditions
Downs
Redundant mesentary
External (superficial) ring only
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

36. What intervention will intervention will relieve portal HTN
Cirrhosis
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Angiodysplasia

37. Which patients have pigment stones
Copious diarrhea - non alpha - non beta cell pancreatic tumor
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

38. What serum enzyme is elevated inacute pancreatitis
Stercobilin
Cholesterol
Lipase
Esophageal carcinoma

39. What receptors does gastrin bind on the parietal cell and What does it activate
Around the central vein (zone III)
When diffusely infiltrative - thickened rigid appearance like a leather bottle
CCK8 receptor - Gq inc IP3/Ca
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

40. Gastrin - source - action - regulation
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Complications of UC
Squamous - upper 1/3 - adeno - lower 1/3
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

41. signet ring cells - acanthosis nigracans - dz - character/association - spread
Turcot
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

42. How do burns cause acute gastritis and What is it called

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43. When do you see hypertrophy of brunners glands
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Peptic ulcer disease
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Repeated phlebotomy - deferoxamine - HLA- A3

44. What can hemochromatosis be secondary to...
Backup of blood into the liver - RHF - budd chiari
Left and right gastroepiploics - left and right gastrics
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Tropical sprue

45. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
When diffusely infiltrative - thickened rigid appearance like a leather bottle
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
Hepatic steatosis
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

46. What is the risk with peutz jehgers
Inc risk of CRC and other visceral malignancies
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Dermatitis herpetiformis
Esophageal cancer

47. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Colonic polyps
Alcoholic cirrhosis
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

48. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Hypotonic because of more time to reabsorb NaCl
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Epithelium
Cirrhosis

49. What is the mechanism for reyes syndrome
Cystic dilation of the viteline duct
Complications of crohns
Common hepatic - splenic - left gastric - main blood supply for stomach
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

50. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Inc lower esphogeal tone leading to achalasia
Crypts but not villi
Intussusception
All 3 gut layers outpouch as in Meckels