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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. What is the most common cause of gallstones
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
The entire
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

2. Progressive dyshphage beginning with solids and moving to liquids and weight loss
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
Esophageal cancer
Gamma glutamyl transferase GGT
H pylori (almost 100%)

3. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Superior rectal
Alpha amylase
Unconjugated - water insoluble
All 3

4. What causes primary biliary cirrhosis
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Alk pho
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Right and left hepatic duct

5. With internal hemorrhoids Where is the anastomoses and Where is it
Superior rectal and middle and inferior rectal - rectum
Alfatoxin in peanuts
Where hindgut meets ectoderm
Juvenille polyps - no risk if single

6. What intervention will intervention will relieve portal HTN
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Smooth
The gastroduodenal
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

7. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Peutz jeghers
Poor anastamoses
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Lamina propria

8. malnutrition - toxic megacolon - colorectal carcinoma
Lateral to the inferior epigastric artery
Complications of UC
90%
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

9. What kind of pancreatitis is associated with EtOH and smoking
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Gut bacteria
90%
Chronic calcifying pancreatitis - inc risk of panreatic cancer

10. What does autoimmune destruction of parietal cells lead to...
Chronic gastritis and pernicious anemia
Alpha amylase
Gardner's syndrome
90%

11. Acute gastritis is caused By what process
Penicillinamine - AR inheritance
GERD - may also present with nocturnal cough and dyspnea
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Erosive - disruption of mucosal barrier leading to inflammation

12. Which area of the hindgut is a watershed area
Alcoholic hepatitis
External (superficial) ring only
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
Splenic flexure

13. What are the histological findings in the ileum

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14. What source of salivary secretion is the most serous and What is the most mucinous
Turcot
Serous on the sides parotids - mucinous in the middle sublingual
Oral glucose
Budd chiari syndrome

15. What parts of the small bowel can tropical sprue effect
Lubricate food (glycoprotiens)
The entire
Above
Muscularis mucosae

16. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Esophageal varices
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
CCK8 receptor - Gq inc IP3/Ca

17. What can hemochromatosis be secondary to...
Osmotic
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Oligosaccharide digestion
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

18. Where is there sclerosis in alcoholic cirrohosis
Peptic ulcer disease
T12
Around the central vein (zone III)
Muscularis mucosae

19. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
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
Cigarettes and chronic pancreatitis - not EtOH
IBS at least 2 with recurrent abdominal pain
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

20. Is there any structural abnl with IBS - What is the course of disease and presentation
Cystic dilation of the viteline duct
Uridine glucuronyl transferase
No - chronic - can present with diarrhea or constipation or alternation - treat sx
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

21. What receptor does histamine bind on the parietal cell and What does it activate
8-9 waves/min
Copious diarrhea - non alpha - non beta cell pancreatic tumor
H2 receptor - inc cAMP
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

22. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Paraumbilical and superficial and inferior epigastric - umbilicus
Intussusception
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

23. When and why is stomach cancer termed linitis plastica
When diffusely infiltrative - thickened rigid appearance like a leather bottle
NAV = nerve artery vein - venous near the penis (NAVEL)
Ampulla of vater
Common hepatic - splenic - left gastric - main blood supply for stomach

24. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Diarrhea - steatorrhea - weight loss - weakness
Inc - weight loss
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

25. What happens to the short gastics if the splenic artery is blocked
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Poor anastamoses

26. What is the frequency of basal electric rhythm of the stomach
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
Duodenal atresia - Downs
3 waves/min
Upregulated intracellular signal transduction

27. What are the four Fs of gallstones
Female - fat - fertile - forty
Phenobarbital - inc liver enzyme synthesis
Lubricate food (glycoprotiens)
Cimetidine

28. What separates the right greater and lesser sacs
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Appendicitis
Gastrohepatic ligament
Volvulus

29. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
Pancreatic head causing obstructive jaundice
Can lead to hematemesis - found in EtOHics and bulimics
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

30. What is the lumen of the pancreatic duct
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Penicillinamine - AR inheritance
Ampulla of vater
The entire

31. What conditions are associated with budd chiari
Causes of gall stones
Acute pancreatitis
Hypercoaguability - polycythemia vera - pregnancy - HCC
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

32. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Hemosiderosis - hemochromatosis
2ndary biliary cirrhosis
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Bleeding - intussusception - volvulus - obstruction near terminal ileum

33. Where are peyers patches found
Lamina propora and submucosa
Meconium ileus
Closer to isotonic because of less time to reabsorb NaCl
Alk pho

34. most common non - neoplastic polyp in colon
Hyperplastic
Portal HTN
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
Lipase - phospholipase A - colipase

35. What gives urine its characteristic color
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Unconj - absent (acholuria) - inc
Urobilin

36. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Alpha1 antitrypsin def - codominant trait
Squamous - upper 1/3 - adeno - lower 1/3
CHF and inc risk of HCC

37. What is the most common indication of emergent abdominal surgery in children
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Dubin johnson
Appendicitis
Cimetidine

38. somatostatin - source - action - regulation
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
Dense core bodies
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Portal HTN

39. What are the signs and symptoms of budd chiari
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Appendicitis
True and most common congenital anomoly of GI tract
Duodenal atresia - Downs

40. What is the prognosis of adenocarcinoma
Averages 6 months - very aggressive - usually already metastasized at presentation
Striated
Bleeding - penetration into pancreas - perforation - obstruction
Brunners

41. What is one potential precipitating factor for intussusception
Inc risk of CRC and other visceral malignancies
Barrett's esophagus
All 3
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

42. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Alk pho
Where hindgut meets ectoderm
Tropical sprue
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

43. HCC is associated with what other conditions
Striated
Pertechnetate - study for uptake
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

44. Where are oligosaccharide hydrolases and What do they do
Hyperplastic
Lubricate food (glycoprotiens)
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Brush border of intestine - produce monosaccharides from oligo and di

45. What layer in the mucosa is repsonsible for motility
Pyoderma gangrenosum - primary sclerosing cholangitis
Positive urease test
Muscularis mucosae
Juvenille polyps - no risk if single

46. Why does indirect inguinal hernia happen in infacnts
Lubricate food (glycoprotiens)
Failure of the processus vagainlis to close
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
All 3

47. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Zenkers - halitosis - dysphagia and obstruction
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Crohns = noncaseating granulomas - UC = crypt abscesses
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

48. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery

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49. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
NAV = nerve artery vein - venous near the penis (NAVEL)

50. Who is at risk for pancreatic adenocarcinoma
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Jewish and African American men
Oral glucose
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure