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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. Autodigestion of pancreas by pancreatic enzymes
Skip lesions =crohns - colon = UC
Source - S cells (duod) - action - inc pancreatic bicarb secretion - dec gastric acid secretin - inc bile secretion - regulation - inc by acid - fatty acids in lumen of duod
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Acute pancreatitis

2. Transmural esophageal rupture due to violent retching

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3. What are the labs in acute pancreatitis
Elevated amylase - and lipase
Peyers patches
Dec PGE2 leading to dec gastric mucosa protection
Inc smooth muscle relaxation - including lower esophageal sphincter

4. likely infectious form of malabsorption - responds to antibiotics
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Barrett's esophagus
Tropical sprue
Black - rotors syndrome

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

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6. What complication can arise from indirect inguinal hernias
Inferior rectal nerve
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
FAP
Hydrocele

7. At what level of the spine does the IM exit the aorta
Pancreatic and bile
L3
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Skip lesions =crohns - colon = UC

8. What retroperitoneal structure flanks both sides of the pancreas on CT
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Via the superior pancreaticduodenal
Duodenum - 2nd - 3rd and 4th parts
L1

9. What receptors does gastrin bind on the parietal cell and What does it activate
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Lactase is located at the tips of intestinal villi
CCK8 receptor - Gq inc IP3/Ca

10. What does bicarb do in the duodenum
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
Virchow's node
Decreased intercellular adhesion and increased proliferation
Neutralizes gastric acid allowing pancreatic enzymes to fxn

11. What is the rule of 2s for meckels
Omeprazole
When diffusely infiltrative - thickened rigid appearance like a leather bottle
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

12. What are the main components of bile
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Left gastric vein and esophogeal vein - esophagus
Intussusception
GERD - may also present with nocturnal cough and dyspnea

13. Who gets gastric ulcers
Older patients
Closer to isotonic because of less time to reabsorb NaCl
Lateral
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD

14. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
FAP
HPNCC
Uremia
Brunners

15. In alchoholic hepatitis which liver enzyme is higher
AST>ALT
12 waves/min
In the ileum with bile acids - requires IF
Barrett's esophagus

16. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Serous on the sides parotids - mucinous in the middle sublingual
2ndary biliary cirrhosis
Inc risk of CRC and other visceral malignancies
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

17. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
CCK8 receptor - Gq inc IP3/Ca
Colovesical leading to pneumaturia
Black - rotors syndrome
...

18. What are additional risk factors for CRC
Complications of UC
HPNCC
Glucouronate - water soluble (direct)
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

19. What are the borders of Hesselbach's triangle
Liver metabolizes 5HT
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Repeated phlebotomy - deferoxamine - HLA- A3
Turcot

20. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Parietal cells in the stomach - B12 binding protein
EtOH
Necrotizing enterocolitis
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

21. What enzyme is necessary to create conjugated bilirubin
Neural muscarinic pathways
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Unconj - absent (acholuria) - inc
Uridine glucuronyl transferase

22. What is contained within the muscularis externa
Myenteric nerve plexus - aurbach
Complications of UC
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Alk phos

23. Where are oligosaccharide hydrolases and What do they do
CEA - CA-19-9
L2
Brush border of intestine - produce monosaccharides from oligo and di
Causes of gall stones

24. What are the complications of duodenal PUD
Bleeding - penetration into pancreas - perforation - obstruction
Where hindgut meets ectoderm
AST >ALT - ration is usually 1.5
AST>ALT

25. Where does crohns usually affect the GI tract
Brush border of intestine - produce monosaccharides from oligo and di
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
HPNCC
Terminal ileum and colon

26. What kind of pancreatitis is associated with EtOH and smoking
Mucoepidermoid carcinoma
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Neural muscarinic pathways

27. What kind of insults results in macronodular cirrhosis
No
In the mucus that covers the gastric epithelium
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

28. What is diverticulosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Left and right gastroepiploics - left and right gastrics
Epithelium

29. What commonly leads to appendicity in kids vs adults
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Left gastric vein and esophogeal vein - esophagus

30. How do you DX and TX gallstones
US and cholecystectomy
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
VZV and influenza B treated with salicylates
Gardner's syndrome

31. How does hirschsprung present and appear on imaging
Crigler - najjar type 1
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
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Primary sclerosing cholangitis

32. What is the characteristic histo finding in alcoholic hepatitis
Volvulus
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Mallory bodies

33. What is the presentation of pancreatic adenocarcinoma
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
3 waves/min
Intussusception
Pleomorphic adenoma

34. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Alpha1 antitrypsin def - codominant trait
Left and right gastroepiploics - left and right gastrics
Fasting and stress
Menetriers disease

35. What artery passes around the duodenum
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
The gastroduodenal
Cimetidine
External spermatic fascia only

36. What are the effects of atropine on parietal cells and G cells
Urobilin
Lamina propria
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

37. What serum enzyme is decreased in wilsons disease
Sister mary joseph nodule
Pertechnetate - study for uptake
Ceruplasmin
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

38. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Juvenille polyps - no risk if single
Crohns = noncaseating granulomas - UC = crypt abscesses
Angiodysplasia

39. What is the sphincter of the pancreatic duct
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Sphincter of oddi
True and most common congenital anomoly of GI tract
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

40. What are the histological findings of the colon
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Black - rotors syndrome
Crypts but not villi

41. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Adhesion

42. In an MI - which liver enzyme is elevated
The submucosal nerve plexus - meissner's
Adhesion
AST
Worldwide - SC - US - adeno

43. What do tumors that arise in the head of the pancreas cause
Obstruction of the common bile duct
Female - fat - fertile - forty
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
When diffusely infiltrative - thickened rigid appearance like a leather bottle

44. When and How does Abetalipoproteinemia present
Dense core bodies
Chagas disease
Early childhood - neuro sx and malabsorption
Gut bacteria

45. bilateral mets to ovaries with abundant mucus - signet ring cells
Lateral
Krukenbergs tumor
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Around the central vein (zone III)

46. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Begins starch digestion - inactivated by low pH upon reaching the stomach

47. subQ peribumbilical metastasis
Tropical sprue
Myenteric nerve plexus - aurbach
Alk pho
Sister mary joseph nodule

48. What kind of cancer to celiac sprue put you as inc risk for
Dysphagia (due to esophageal web) - glossitis - iron def anemia
T cell lymphoma
H pylori (almost 100%)
VZV and influenza B treated with salicylates

49. What do mucins do?
Lubricate food (glycoprotiens)
Urobilin
Carcinoid syndrome
Alcoholic cirrhosis

50. What is the TX of physiologic neonatal jaundice
Pleuroperitoneal
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Crohns = noncaseating granulomas - UC = crypt abscesses
Phototherapy