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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 diaphragmatic hernia and What are the two types
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Can lead to hematemesis - found in EtOHics and bulimics
Repeated phlebotomy - deferoxamine - HLA- A3
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

2. What is contained within the submucosa

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3. What causes primary biliary cirrhosis
Portal HTN
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Brush border of intestine - produce monosaccharides from oligo and di

4. What are the histological findings in the jejunum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
H+
Begins starch digestion - inactivated by low pH upon reaching the stomach

5. What drug blocks the H2R
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Cimetidine
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Dense core bodies

6. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Unconj - absent (acholuria) - inc
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Diarrhea - steatorrhea - weight loss - weakness
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

7. What intervention will intervention will relieve portal HTN
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Crohns = maybe - UC= always
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Corticosteroids - infliximab

8. How does CRC present in the distal and proximal colon
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Fe2+ in the duod
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Pancreatic head causing obstructive jaundice

9. What converts inactive pepsinogen to pepsin
H+
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
CEA - CA-19-9
Averages 6 months - very aggressive - usually already metastasized at presentation

10. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Warthins' tumor
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Superior rectal
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

11. What congenital birth defect is associated with Hirschsprung
Stercobilin
Downs
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Female - fat - fertile - forty

12. inflammatino of gallbadder
Neural muscarinic pathways
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Smooth
Adhesion

13. What artery passes around the duodenum
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Around the central vein (zone III)
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
The gastroduodenal

14. What kind of muscle is in the lower 1/3 of the esophagus
L3
IBS at least 2 with recurrent abdominal pain
Smooth
90%

15. What are the longterm sequelae of nutmeg liver
Centrilobular congestion and necrosis - cardiac cirrhosis
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Causes of gall stones
Brunners

16. What is diverticulosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Colovesical leading to pneumaturia
Crohns = noncaseating granulomas - UC = crypt abscesses

17. What does a low flow rate mean for saliva
Hypotonic because of more time to reabsorb NaCl
Krukenbergs tumor
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

18. What receptors does gastrin bind on the parietal cell and What does it activate
CCK8 receptor - Gq inc IP3/Ca
Lateral to the inferior epigastric artery
Lye ingestion and acid reflux
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

19. In PUD with a duodenal ulcer does pain inc or dec with meals
Myenteric nerve plexus - aurbach
Adhesion
Glucose dependent insulinotropic peptide
Decrease - weight gain

20. What receptors does ACH bind on the parietal cells and What does it activate
Zenkers - halitosis - dysphagia and obstruction
L2
M3 - Gq - inc IP3/Ca
Colovesical leading to pneumaturia

21. What are the borders of Hesselbach's triangle
Conj/unconj - inc - nl to dec
Crypts but not villi
Conj - inc - dec
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

22. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Pancreatic and bile
Dense core bodies
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

23. What is contained within the muscularis externa
Myenteric nerve plexus - aurbach
Inc risk of CRC and other visceral malignancies
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
L3

24. How do you DX and TX gallstones
Falciform - ligamentum teres - fetal umbilical vein
US and cholecystectomy
Gut bacteria
ALT>AST

25. A protrusion of peritoneum through an opening - usually a site of weakness
Worldwide - SC - US - adeno
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Hernia
Female - fat - fertile - forty

26. GIP - source - action regulation
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Superior rectal
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

27. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Left and right gastroepiploics - left and right gastrics
Alpha1 antitrypsin def - codominant trait
Peptic ulcer disease
MSI (15%) and APC/beta catenin chromosomal instability (85%)

28. What do tumors that arise in the head of the pancreas cause
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Urobilin
Increase tumorigenesis
Obstruction of the common bile duct

29. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Virchow's node
Zollinger ellison - brunners glands
Crohns = maybe - UC= always
Esophageal carcinoma

30. What are the effects of atropine on parietal cells and G cells
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Left gastric vein and esophogeal vein - esophagus
PAS- positive globules in liver -

31. malnutrition - toxic megacolon - colorectal carcinoma
Volvulus
Complications of UC
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Paraumbilical and superficial and inferior epigastric - umbilicus

32. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Osmotic
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Striated and smooth
Left gastric vein and esophogeal vein - esophagus

33. What does a gastrinoma cause
Mucoepidermoid carcinoma
GERD - may also present with nocturnal cough and dyspnea
3 waves/min
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

34. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
No - chronic - can present with diarrhea or constipation or alternation - treat sx
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Brunners
Via the middle colic

35. Why does indirect inguinal hernia happen in infacnts
Turcot
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Gilbert's
Failure of the processus vagainlis to close

36. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Upregulated intracellular signal transduction
Colonic polyps
Conj/unconj - inc - nl to dec
Mitochondrial abnl - fatty liver - hypoglycemia - coma

37. What is the other name for GIP (gastric inhibitory peptide)
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Glucose dependent insulinotropic peptide
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

38. FAP + osseous and soft tissue tumors - retinal hyperplasia

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39. Which is used more quickly - an oral glucose load - or that by IV
Oral glucose
Failure of neural crest migration
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Backup of blood into the liver - RHF - budd chiari

40. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis

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41. why infxn is implicated in duodenal PUD
H pylori (almost 100%)
Begins starch digestion - inactivated by low pH upon reaching the stomach
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Alpha amylase

42. What receptor does histamine bind on the parietal cell and What does it activate
Phenobarbital - inc liver enzyme synthesis
H2 receptor - inc cAMP
Volvulus
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

43. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
Pertechnetate - study for uptake
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

44. what percentage of colonic polyps are non - neoplastic
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Fe2+ in the duod
90%
Myenteric nerve plexus - aurbach

45. How does gastrin increase acid secretion?
With albumin
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Primarly through ECL leading to histamine release

46. Who gets Whipple disease and How do they present
Old men - arthralgias - cardiac and neuro sx
Cystic dilation of the viteline duct
Where hindgut meets ectoderm
Mucosa - submucosa - muscularis externa - serosa/adventitia

47. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Alpha1 antitrypsin def - codominant trait
Gardner's syndrome
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Esophageal cancer

48. What kind of muscle is in the middle 1/3 of esophagus
Striated and smooth
Pancreatic head causing obstructive jaundice
L2
Primary sclerosing cholangitis

49. In what scenarios do pts with gilberts have inc bili
Fasting and stress
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

50. What are the complications of duodenal PUD
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Bleeding - penetration into pancreas - perforation - obstruction
Gastrohepatic ligament