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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. Where does type B chronic gastritis occur and What causes it
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Diverticulum
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Antrum - H.pylori - inc risk of MALT lymphoma

2. What carcinogens are associated with HCC
Alfatoxin in peanuts
Crigler - najjar type 1
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Where hindgut meets ectoderm

3. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Can lead to hematemesis - found in EtOHics and bulimics
Inferior rectal nerve
Esophageal cancer

4. What is the ddx associated with appendicitis
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Urobilin
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
External spermatic fascia only

5. What are the two molecular pathways that lead to CRC
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Dermatitis herpetiformis
Below

6. Which kind of hemorrhoids are painful and why
Inc - weight loss
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Lamina propria
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

7. What does the splenorenal ligament connect - and What does it contain
US and cholecystectomy
Spleen to posterior abdominal wall - splenic artery and vein
Lamina propora and submucosa
Causes of gall stones

8. What are additional risk factors for CRC
Glucose dependent insulinotropic peptide
Averages 6 months - very aggressive - usually already metastasized at presentation
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
3 waves/min

9. What source of salivary secretion is the most serous and What is the most mucinous
Tropical sprue
Inguninal ligament - sartorius muscle - adductor longus
Serous on the sides parotids - mucinous in the middle sublingual
No - chronic - can present with diarrhea or constipation or alternation - treat sx

10. Where is the deep inguinal ring relative to the inferior epigastric vessels
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Brunners
Lateral
Falciform - ligamentum teres - fetal umbilical vein

11. secretin - source - action - regulation
Pertechnetate - study for uptake
Hyperplastic
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
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

12. What does K- ras mutation cause
Old men - arthralgias - cardiac and neuro sx
Upregulated intracellular signal transduction
Cystic duct and common hepatic duct
Paraumbilical and superficial and inferior epigastric - umbilicus

13. What do you treat Wilsons disease with and What is the inheritance
Penicillinamine - AR inheritance
Superior rectal
Left and right gastroepiploics - left and right gastrics
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

14. occlusion of IVC or hepatic veins
Brush border of intestine - produce monosaccharides from oligo and di
Crohns = noncaseating granulomas - UC = crypt abscesses
Hepatic steatosis
Budd chiari syndrome

15. What serum markers increase in cholecystitis with bile duct involvement
US and cholecystectomy
Alk phos
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Krukenbergs tumor

16. What are the complications of duodenal PUD
Hemosiderosis - hemochromatosis
T12
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Bleeding - penetration into pancreas - perforation - obstruction

17. Where does type A chronic gastritis occur and What causes it
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Pertechnetate - study for uptake
AR
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

18. What are the tumor markers for pancreatic adenocarcinoma
With albumin
Older patients
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
CEA - CA-19-9

19. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Low pressure proximal to LES
ALT>AST
Via the superior pancreaticduodenal
Amylase

20. What is pancreatic adenocarcinoma associated with
ALT>AST
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
Peptic ulcer disease
Cigarettes and chronic pancreatitis - not EtOH

21. How does CRC present in the distal and proximal colon
US and cholecystectomy
Celiac sprue
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Lack or have an attenuated muscularis externa - often in the sigmoid colon

22. What is the risk with peutz jehgers
GLUT 2
Gilbert's
Inc risk of CRC and other visceral malignancies
Cigarettes and chronic pancreatitis - not EtOH

23. What is the cause of physiologic neonatal jaundice
Hernia
Pancreatic head causing obstructive jaundice
Unconjugated - water insoluble
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

24. What kind of digestion is bile needed for
Uridine glucuronyl transferase
PAS- positive globules in liver -
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

25. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Downs
Crohns = maybe - UC= always
Decrease - weight gain
Antrum - H.pylori - inc risk of MALT lymphoma

26. What causes carcinoid syndrome amd What are the symptoms
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Crigler - najjar type 1
Complications of UC

27. What are causes of extrahepatic biliary obstruction
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Crohns = noncaseating granulomas - UC = crypt abscesses
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Cholesterol - 10-20% opaque due to calcifications

28. What are esophageal strictures associated with
Inc risk of CRC and other visceral malignancies
Colovesical leading to pneumaturia
Lye ingestion and acid reflux
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

29. What cells make pepsin - What does it do - and what regulates it
In the ileum with bile acids - requires IF
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

30. GIP - source - action regulation
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Old men - arthralgias - cardiac and neuro sx
Right and left hepatic duct
Jaundice - fever - RUQ

31. What serum enzyme is elevated in acute pancreatitis and mumps
Dissaccharidase def - most commonly lactase
Amylase
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Uridine glucuronyl transferase

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

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33. What cells secrete bicarb - What does it do - and what regulates it
Epithelium
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
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

34. What structures feed into the common bile duct
Striated
Dilated esophagus with an area of distal stenosis - birds beak
Cystic duct and common hepatic duct
Reye's syndrome

35. HCC is associated with what other conditions
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Primarly through ECL leading to histamine release
Cystic dilation of the viteline duct

36. People of what decent are associated with celiac sprue and what findings/antibodies are present
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Ampulla of vater
Sphincter of oddi
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

37. What is the most common diaphragmatic hernia and What are the two types
Epigastric abdominal pain radiating to back - anorexia - nausea
Ceruplasmin
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Colovesical leading to pneumaturia

38. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
EtOH
Crypts but not villi
Cigarettes and chronic pancreatitis - not EtOH

39. Autodigestion of pancreas by pancreatic enzymes
Esophageal varices
All 3 gut layers outpouch as in Meckels
Acute pancreatitis
Cigarettes and chronic pancreatitis - not EtOH

40. What is the most common indication of emergent abdominal surgery in children
Appendicitis
Complications of crohns
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
The entire

41. If trypsin activates more trypsinogen - what kind of feedback loop is established
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Inferior rectal nerve
Positive
Crohns = noncaseating granulomas - UC = crypt abscesses

42. What receptors does gastrin bind on the parietal cell and What does it activate
Conj/unconj - inc - nl to dec
Right and left hepatic duct
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
CCK8 receptor - Gq inc IP3/Ca

43. Which IBD is autoimmune and which may be a disordered response to bacteria
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Glucose dependent insulinotropic peptide
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Jewish and African American men

44. What do you use to diagnose meckels
Bleeding - penetration into pancreas - perforation - obstruction
Fasting and stress
Pancreatic and bile
Pertechnetate - study for uptake

45. What does histo show for alpha1 antitrypsin def
PAS- positive globules in liver -
Duodenum - 2nd - 3rd and 4th parts
Skip lesions =crohns - colon = UC
Alcoholic cirrhosis

46. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
IgA secreting plasma cells - ultimately reside in the lamina proporia
Jaundice - fever - RUQ
Adhesion
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

47. If the hemochromatosis is primary - What is the pattern of inheritance
Averages 6 months - very aggressive - usually already metastasized at presentation
Sister mary joseph nodule
AR
External (superficial) ring only

48. What are the hindgut structures and what supplies their blood and PANS innvervation
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Alk pho
Mucosa - submucosa - muscularis externa - serosa/adventitia
...

49. Where is B12 absorbed
In the ileum with bile acids - requires IF
Appendicitis
Gilbert's
Striated

50. What is the classic triad of hemochromatosis

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