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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. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Inferior rectal nerve
Necrotizing enterocolitis
Esophageal varices

2. What is contained within the muscularis externa
Myenteric nerve plexus - aurbach
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Antrum - H.pylori - inc risk of MALT lymphoma
Dermatitis herpetiformis

3. Where is bicarb trapped
Neutralizes gastric acid allowing pancreatic enzymes to fxn
In the mucus that covers the gastric epithelium
Stimulate the H/K ATPase
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

4. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Small intestine
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
Lamina propria
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

5. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Gardner's syndrome
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

6. To what substance is bilirubin conjugated and why
Erosive - disruption of mucosal barrier leading to inflammation
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Glucouronate - water soluble (direct)
Uridine glucuronyl transferase

7. What are the branches of the celiac trunk and What do they supply
Ampulla of vater
Failure of neural crest migration
Common hepatic - splenic - left gastric - main blood supply for stomach
Increase tumorigenesis

8. What causes primary biliary cirrhosis
M3 - Gq - inc IP3/Ca
Lamina propria
Pleomorphic adenoma
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

9. Who is at risk for pancreatic adenocarcinoma
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
Dermatitis herpetiformis
Striated and smooth
Jewish and African American men

10. What makes a true diverticula
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
L/R renal artery around L1
All 3 gut layers outpouch as in Meckels
Zenkers - halitosis - dysphagia and obstruction

11. Dysphagia in achalasia results from
FAP
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
With albumin

12. in carcinoid tumors - What is seen on EM
Bleeding - penetration into pancreas - perforation - obstruction
Splenic flexure
Pancreatic and bile
Dense core bodies

13. Where are oligosaccharide hydrolases and What do they do
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
CCK8 receptor - Gq inc IP3/Ca
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Brush border of intestine - produce monosaccharides from oligo and di

14. What are the complications of duodenal PUD
Complications of crohns
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Striated
Bleeding - penetration into pancreas - perforation - obstruction

15. What does a gastrinoma cause
Enterokinase/enteropeptidase from the duodenal mucosa
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
US and cholecystectomy
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

16. Why does indirect inguinal hernia happen in infacnts
Failure of the processus vagainlis to close
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Pancreatic and bile
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

17. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Duodenal atresia - Downs

18. Between what structures do strong anastamoses exist
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Inc lower esphogeal tone leading to achalasia
Left and right gastroepiploics - left and right gastrics
Lubricate food (glycoprotiens)

19. What serum enzyme is decreased in wilsons disease
3 waves/min
The submucosal nerve plexus - meissner's
Inferior rectal nerve
Ceruplasmin

20. Bilirubin is the product of what?
Heme metabolism
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

21. Where does copper accumulate in Wilsons and What are ABCD
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Older patients
Fasting and stress

22. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
US and cholecystectomy
Crohns = noncaseating granulomas - UC = crypt abscesses
Striated and smooth
Peptic ulcer disease

23. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Low pressure proximal to LES
Ischemic colitis
In the ileum with bile acids - requires IF
Zollinger ellison - brunners glands

24. What is the cause of physiologic neonatal jaundice
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Epithelium
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
The entire

25. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Alk pho
Krukenbergs tumor
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

26. What does histo show for alpha1 antitrypsin def
Esophageal cancer
PAS- positive globules in liver -
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

27. What does bicarb do in the duodenum
Hydrocele
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Via the middle colic
Positive urease test

28. How are all 3 monosaccharides transported to the blood
GLUT 2
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Hemolytic anemia
Peptic ulcer disease

29. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Decreased intercellular adhesion and increased proliferation
Menetriers disease
Fasting and stress

30. What is the cause of Barrett's and the assocaited complications
Redundant mesentary
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
PAS- positive globules in liver -
External spermatic fascia only

31. Malabsorption syndromes have what common clinical presentation
Crohns = noncaseating granulomas - UC = crypt abscesses
Parietal cells in the stomach - B12 binding protein
Diarrhea - steatorrhea - weight loss - weakness
Source - I cells (duod - jej - action - inc pancreative secretion - inc gallbladder contraction - dec gastric emptying - sphincter of Oddi relaxation - regulation - inc by fatty acids and amino acids

32. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Pyoderma gangrenosum - primary sclerosing cholangitis
Colonic polyps
Hemosiderosis - hemochromatosis
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

33. Diaphragmatic hernias occur in infants because of defective development of which membrane
Esophageal cancer
Pleuroperitoneal
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Dermatitis herpetiformis

34. What serum enzyme is elevated inacute pancreatitis
Lipase
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Where hindgut meets ectoderm
Centrilobular congestion and necrosis - cardiac cirrhosis

35. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Omeprazole
NAV = nerve artery vein - venous near the penis (NAVEL)
Falciform - ligamentum teres - fetal umbilical vein
Below

36. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Alpha1 antitrypsin def - codominant trait
Hemolytic anemia
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
Jewish and African American men

37. How do you DX and TX gallstones
Cirrhosis
US and cholecystectomy
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

38. Where is the pectinate line
Elevated amylase - and lipase
Where hindgut meets ectoderm
Celiac sprue
Redundant mesentary

39. Which kind of hemorrhoids are painful and why
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Hemosiderosis - hemochromatosis
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Tropical sprue

40. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Pancreatic and bile
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Trypsin - chymotrypsin - elastase - carboxypeptidases
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

41. What is the leading cause of bowel incarceration
Hemolytic anemia
Dermatitis herpetiformis
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Femoral hernia

42. What are the complications of chronic pancreatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Paraumbilical and superficial and inferior epigastric - umbilicus

43. What is the most common indication of emergent abdominal surgery in children
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Appendicitis
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

44. Autoantibodies to gluten (gliadin) in wheat and other grains
Oligosaccharide digestion
Gastrohepatic ligament
12 waves/min
Celiac sprue

45. What are the results of hemochromatosis
Angiodysplasia
Obstruction of the common bile duct
CHF and inc risk of HCC
Chronic calcifying pancreatitis - inc risk of panreatic cancer

46. In PUD with a duodenal ulcer does pain inc or dec with meals
Decrease - weight gain
Cimetidine
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Mucosa - submucosa - muscularis externa - serosa/adventitia

47. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
12 waves/min
Striated and smooth
Oral glucose
Zollinger ellison - brunners glands

48. If the hemochromatosis is primary - What is the pattern of inheritance
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
AR
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

49. trypsinogen is converted to trypsin via what enzyme
Enterokinase/enteropeptidase from the duodenal mucosa
ALT>AST
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
Spleen to posterior abdominal wall - splenic artery and vein

50. What is the TX of physiologic neonatal jaundice
Phototherapy
Obstruction of the common bile duct
Virchow's node
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith