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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. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Below
Uremia
H2 receptor - inc cAMP
Normal

2. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Esophageal varices
Fe2+ in the duod
Via the superior pancreaticduodenal
Alcoholic hepatitis

3. What receptor does histamine bind on the parietal cell and What does it activate
EtOH
Nonkeritinized stratified sqamous epithelium
H2 receptor - inc cAMP
Appendicitis

4. What are the histological findings in the duodenum

5. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Adhesion
US and cholecystectomy
Angiodysplasia

6. What kind of muscle is in the lower 1/3 of the esophagus
HSV-1 - CMV - Candida
Smooth
Hydrocele
Colovesical leading to pneumaturia

7. What converts inactive pepsinogen to pepsin
Gallbladder
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
H+
Failure of neural crest migration

8. What is the TX of physiologic neonatal jaundice
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Phototherapy
Skip lesions =crohns - colon = UC
Warthins' tumor

9. What is the cause of Barrett's and the assocaited complications
Mitochondrial abnl - fatty liver - hypoglycemia - coma
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
The entire

10. in budd chiari syndrome - Where is the congestion and necrosis
Barrett's esophagus
Centrilobular leading to congestive liver disease
Inguninal ligament - sartorius muscle - adductor longus
Lateral

11. List the clinical findings of HCC
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Krukenbergs tumor
Neutralizes gastric acid allowing pancreatic enzymes to fxn

12. What is biliary colic
Amylase
HPNCC
Inc lower esphogeal tone leading to achalasia
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

13. Bilirubin is the product of what?
Stimulate the H/K ATPase
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Duodenal atresia - Downs
Heme metabolism

14. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Increase tumorigenesis
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Carcinoid syndrome

15. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
CCK8 receptor - Gq inc IP3/Ca
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

16. What does loss of p53 cause
Barrett's esophagus
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Increase tumorigenesis
Pancreatic and bile

17. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Fasting and stress
Alk pho
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Primary sclerosing cholangitis

18. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Inferior rectal nerve
Decreased intercellular adhesion and increased proliferation
Meckels
Cimetidine

19. What causes nutmeg liver
Short gastrics - left greater and lesser
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Backup of blood into the liver - RHF - budd chiari

20. malnutrition - toxic megacolon - colorectal carcinoma
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
AST
Diarrhea - steatorrhea - weight loss - weakness
Complications of UC

21. What does extrahepatic biliary obstruction cause
Normal
Uremia
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
L4

22. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
Obstruction of the common bile duct
Gallbladder
Celiac sprue

23. What does K- ras mutation cause
IBS at least 2 with recurrent abdominal pain
Upregulated intracellular signal transduction
Esophageal carcinoma
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

24. What layer in the mucosa is responsible for support
Inc conj bilirubin - inc cholesterol - inc alk phos
Uremia
Lamina propria
Epigastric abdominal pain radiating to back - anorexia - nausea

25. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Lubricate food (glycoprotiens)
Necrotizing enterocolitis
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn

26. Where are carcinoid tumors most commonly malignant
Small intestine
Cimetidine
Pyoderma gangrenosum - primary sclerosing cholangitis
Gastrohepatic ligament

27. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Esophageal varices
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
L1
Tropical sprue

28. When and why is stomach cancer termed linitis plastica
Femoral hernia
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Left and right gastroepiploics - left and right gastrics

29. Achalasia increases the risk For what complication
L2
Esophageal carcinoma
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Striated and smooth

30. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
2ndary biliary cirrhosis
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM

31. What is the most common indication of emergent abdominal surgery in children
Obstruction of the common bile duct
Appendicitis
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
No

32. What commonly leads to appendicity in kids vs adults
CEA - CA-19-9
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Antrum - H.pylori - inc risk of MALT lymphoma
Angiodysplasia

33. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Inferior rectal nerve
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Pancreatic head causing obstructive jaundice
Volvulus

34. Bile is critical for exrection of what substance
Cholesterol
Erosive - disruption of mucosal barrier leading to inflammation
Jaundice - fever - RUQ
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

35. What are the signs of peutz jehgers
Meckels
Omeprazole
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Hyperpigmented mouth - lips - hands - genitalia

36. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
L2
Cirrhosis
Corticosteroids - infliximab
Phototherapy

37. What layer in the mucosa is repsonsible for motility
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Amylase
The submucosal nerve plexus - meissner's
Muscularis mucosae

38. What are the foregut structures and what supplies their blood and PANS innvervation
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

39. What is the frequency of basal electric rhythm of the ilieum
8-9 waves/min
Urobilin
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Neutralizes oral bacertial acids and maintains dental health

40. Where is the pectinate line
Neural muscarinic pathways
Warthins' tumor
EtOH
Where hindgut meets ectoderm

41. What are the complications of Meckels
Dysphagia (due to esophageal web) - glossitis - iron def anemia
US and cholecystectomy
GLUT 2
Bleeding - intussusception - volvulus - obstruction near terminal ileum

42. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Oral glucose
Alfatoxin in peanuts
AST>ALT
Hepatic steatosis

43. Is there any structural abnl with IBS - What is the course of disease and presentation
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Colovesical leading to pneumaturia
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Barrett's esophagus

44. What serum enzyme is elevated in acute pancreatitis and mumps
Fe2+ in the duod
Amylase
Warthins' tumor
Inc risk of CRC and other visceral malignancies

45. What is the arterial supply and venous drainage below pectinate line
Left and right gastroepiploics - left and right gastrics
Meconium ileus
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

46. most common malignant salivary gland tumor
Mucoepidermoid carcinoma
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Zollinger Ellison - phenylalanine and tryptophan
Redundant mesentary

47. rare - often fatal childhood hepatoencephalopathy

48. What does high flow rate mean
So hypertrophied they look like brain gyri
Neutralizes oral bacertial acids and maintains dental health
Closer to isotonic because of less time to reabsorb NaCl
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

49. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Acute pancreatitis
Superior rectal
Lamina propria
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

50. most common non - neoplastic polyp in colon
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Hyperplastic
Low pressure proximal to LES
Centrilobular congestion and necrosis - cardiac cirrhosis