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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. Is there any structural abnl with IBS - What is the course of disease and presentation
Sphincter of oddi
Redundant mesentary
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Pertechnetate - study for uptake

2. What are the signs and symptoms of budd chiari
Striated
Closer to isotonic because of less time to reabsorb NaCl
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Pyoderma gangrenosum - primary sclerosing cholangitis

3. What are the complications of acute pancreatitis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Phenobarbital - inc liver enzyme synthesis
Pancreatic head causing obstructive jaundice
L/R renal artery around L1

4. How does brain injury lead to acute gastritis and What is it called
Stercobilin
Alk phos
Striated and smooth
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

5. What is the path of an indirect inguinal hernia
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Alpha amylase
Goes through deep inguinal ring - external inguinal ring and into the scrotum

6. most common malignant salivary gland tumor
Hemosiderosis - hemochromatosis
Mucoepidermoid carcinoma
Pertechnetate - study for uptake
Fe2+ in the duod

7. What do tumors that arise in the head of the pancreas cause
Obstruction of the common bile duct
Squamous - upper 1/3 - adeno - lower 1/3
Alfatoxin in peanuts
Jaundice - fever - RUQ

8. What is Trousseau's sign
Redness and tenderness on palpation of extremities
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Inc smooth muscle relaxation - including lower esophageal sphincter
MSI (15%) and APC/beta catenin chromosomal instability (85%)

9. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Peptic ulcer disease
Can lead to hematemesis - found in EtOHics and bulimics

10. absent UDPGT - presents early in life - early mortality
Penicillinamine - AR inheritance
Squamous - upper 1/3 - adeno - lower 1/3
Crigler - najjar type 1
Antrum - H.pylori - inc risk of MALT lymphoma

11. What retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
Diarrhea - steatorrhea - weight loss - weakness
Positive urease test
Gut bacteria

12. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Inc conj bilirubin - inc cholesterol - inc alk phos
Crigler - najjar type 1

13. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Hydrocele
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Uremia

14. What is the frequency of basal electric rhythm in the duodenum
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
12 waves/min
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

15. What are the effects of atropine on parietal cells and G cells
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Peutz jeghers
Inspiratory arrest on deep palpation due to pain
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

16. What are causes of extrahepatic biliary obstruction
Below
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
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
Unconj - absent (acholuria) - inc

17. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Parietal cells in the stomach - B12 binding protein
HSV-1 - CMV - Candida
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

18. What does K- ras mutation cause
Upregulated intracellular signal transduction
Common hepatic - splenic - left gastric - main blood supply for stomach
Cystic dilation of the viteline duct
12 waves/min

19. How is bilirubin carried in the blood
With albumin
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Alk phos
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

20. What makes a true diverticula
All 3 gut layers outpouch as in Meckels
Gastrohepatic ligament
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Virchow's node

21. occlusion of IVC or hepatic veins
Budd chiari syndrome
L/R renal artery around L1
Dermatitis herpetiformis
ALT>AST

22. Achalasia increases the risk For what complication
Hyperplastic
Esophageal carcinoma
NAV = nerve artery vein - venous near the penis (NAVEL)
Lateral to the inferior epigastric artery

23. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
L1
Inc lower esphogeal tone leading to achalasia

24. Who is at risk for pancreatic adenocarcinoma
Jewish and African American men
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
8-9 waves/min
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

25. Why does carcinoid syndrome not occur if tumor is confined to GI system
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Liver metabolizes 5HT
External spermatic fascia only
IBS at least 2 with recurrent abdominal pain

26. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
Bleeding - penetration into pancreas - perforation - obstruction
Lamina propora and submucosa
Hemosiderosis - hemochromatosis

27. What cell produces IF and What does it do
Zenkers - halitosis - dysphagia and obstruction
Older patients
Dubin johnson
Parietal cells in the stomach - B12 binding protein

28. What carcinogens are associated with HCC
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Parietal cells in the stomach - B12 binding protein
Alfatoxin in peanuts
Via the superior pancreaticduodenal

29. How many layers of spermatic fascia are covers an indirect inguinal hernia
Skip lesions =crohns - colon = UC
Inc risk of CRC and other visceral malignancies
Phototherapy
All 3

30. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Esophageal carcinoma
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Carcinoid syndrome

31. Where is bicarb trapped
Early childhood - neuro sx and malabsorption
L1
In the mucus that covers the gastric epithelium
Poor anastamoses

32. What is indirect bilirubin
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Colonic polyps
Unconjugated - water insoluble

33. A protrusion of peritoneum through an opening - usually a site of weakness
Paraumbilical and superficial and inferior epigastric - umbilicus
AST >ALT - ration is usually 1.5
Hernia
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

34. What kind of cancer to celiac sprue put you as inc risk for
Where hindgut meets ectoderm
Epigastric abdominal pain radiating to back - anorexia - nausea
T cell lymphoma
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

35. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Esophageal cancer
Neural muscarinic pathways
Crohns = noncaseating granulomas - UC = crypt abscesses
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

36. When do you see hypertrophy of brunners glands
Repeated phlebotomy - deferoxamine - HLA- A3
Below
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Peptic ulcer disease

37. why infxn is implicated in duodenal PUD
H pylori (almost 100%)
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Gastric glands
Increase tumorigenesis

38. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
The proximal small bowel
Fe2+ in the duod
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

39. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Volvulus
Dilated esophagus with an area of distal stenosis - birds beak
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Inc risk of CRC and other visceral malignancies

40. What are the treatmet options for crohns
Dermatitis herpetiformis
Corticosteroids - infliximab
Chronic gastritis and pernicious anemia
T cell lymphoma

41. What serum enzyme is elevated in acute pancreatitis and mumps
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Chagas disease
Amylase
Portal HTN

42. How do NSAIDs cause acute gastritis
Pancreatic head causing obstructive jaundice
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Dec PGE2 leading to dec gastric mucosa protection
Common hepatic - splenic - left gastric - main blood supply for stomach

43. What are the common causes of gastric ulcers - What causes gastric ulcer
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Menetriers disease
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
L1

44. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Failure of the processus vagainlis to close
Meckels
Dilated esophagus with an area of distal stenosis - birds beak
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

45. Which kind of hemorrhoids are painful and why
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Pertechnetate - study for uptake
Mallory bodies

46. What commonly leads to appendicity in kids vs adults
L4
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Mallory bodies
NAV = nerve artery vein - venous near the penis (NAVEL)

47. What does TOASTED with alcoholic hepatitis stand for
Crohns = maybe - UC= always
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
AST >ALT - ration is usually 1.5

48. Where is IgA shuttled
Liver metabolizes 5HT
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Common hepatic - splenic - left gastric - main blood supply for stomach

49. What drug blocks the H2R
Cimetidine
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
...

50. What are the treatment options for uclerative colitis
Upregulated intracellular signal transduction
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis