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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. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Gilbert's
Volvulus
External spermatic fascia only
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

2. What is the frequency of basal electric rhythm of the stomach
3 waves/min
No
Centrilobular congestion and necrosis - cardiac cirrhosis
GERD - may also present with nocturnal cough and dyspnea

3. In what scenarios do pts with gilberts have inc bili
Via the superior pancreaticduodenal
Cimetidine
L4
Fasting and stress

4. To what substance is bilirubin conjugated and why
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Nonkeritinized stratified sqamous epithelium
Zollinger Ellison - phenylalanine and tryptophan
Glucouronate - water soluble (direct)

5. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
With albumin

6. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Centrilobular leading to congestive liver disease
Duodenal atresia - Downs
Upregulated intracellular signal transduction

7. What source of salivary secretion is the most serous and What is the most mucinous
Celiac sprue
Superior rectal and middle and inferior rectal - rectum
Smooth
Serous on the sides parotids - mucinous in the middle sublingual

8. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Zollinger ellison - brunners glands
Alcoholic hepatitis
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

9. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Left gastric vein and esophogeal vein - esophagus
Chagas disease
Crigler - najjar type 1
Esophageal cancer

10. Where is B12 absorbed
Striated
NAV = nerve artery vein - venous near the penis (NAVEL)
Crohns = maybe - UC= always
In the ileum with bile acids - requires IF

11. What drug inhibits the H/K ATPase
Alcoholic cirrhosis
Decreased intercellular adhesion and increased proliferation
Omeprazole
Via the superior pancreaticduodenal

12. In viral hepatitis - which liver enzyme is higher
ALT>AST
Decreased intercellular adhesion and increased proliferation
Upregulated intracellular signal transduction
Can lead to hematemesis - found in EtOHics and bulimics

13. Bilirubin is the product of what?
Inc - weight loss
Heme metabolism
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Hirschsprungs

14. Dysphagia in achalasia results from
Superior rectal and middle and inferior rectal - rectum
Redundant mesentary
Neutralizes oral bacertial acids and maintains dental health
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

15. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue

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16. What does extrahepatic biliary obstruction cause
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Hyperpigmented mouth - lips - hands - genitalia

17. Achalasia increases the risk For what complication
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
Esophageal carcinoma
Budd chiari syndrome
Zollinger ellison - brunners glands

18. What structures feed into the cystic duct
Positive
Alcoholic hepatitis
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Gallbladder

19. What infection causes Whipple disease and What can you see on LM
Pancreatic head causing obstructive jaundice
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Enterokinase/enteropeptidase from the duodenal mucosa

20. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Decreased intercellular adhesion and increased proliferation
Lateral
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
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

21. What receptor does histamine bind on the parietal cell and What does it activate
H2 receptor - inc cAMP
Crohns = noncaseating granulomas - UC = crypt abscesses
Alk phos
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

22. Liver cell failure can lead to multisystem signs including
Sphincter of oddi
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Gastrohepatic ligament
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

23. What artery passes around the duodenum
Enterokinase/enteropeptidase from the duodenal mucosa
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
The gastroduodenal
The submucosal nerve plexus - meissner's

24. What kind of digestion is bile needed for
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Low pressure proximal to LES

25. What does primary sclerosing cholangitis lead to...
Pancreatic and bile
8-9 waves/min
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

26. What is the prognosis of adenocarcinoma
90%
Averages 6 months - very aggressive - usually already metastasized at presentation
The proximal small bowel
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

27. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Inc lower esphogeal tone leading to achalasia
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Diverticulum

28. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Necrotizing enterocolitis
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
Superior rectal
Myenteric nerve plexus - aurbach

29. What are the histological findings in the duodenum

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30. What is the arterial supply and venous drainage below pectinate line
Liver metabolizes 5HT
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
L/R renal artery around L1

31. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Volvulus
Penicillinamine - AR inheritance
Serous on the sides parotids - mucinous in the middle sublingual
Carcinoid syndrome

32. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Normal
Peutz jeghers
GLUT 2
Via the middle colic

33. In PUD with a duodenal ulcer does pain inc or dec with meals
2ndary biliary cirrhosis
CHF and inc risk of HCC
Decrease - weight gain
Esophageal varices

34. Through which aspect of the inguinal canal does a direct inguinal go
Peptic ulcer disease
External (superficial) ring only
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

35. What is the rule of 2s for meckels
Left gastric vein and esophogeal vein - esophagus
Centrilobular leading to congestive liver disease
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Oral glucose

36. How is bilirubin carried in the blood
Complications of UC
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
With albumin
Alpha amylase

37. What is the presenting course for appendicity

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38. somatostatin - source - action - regulation
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
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
Fasting and stress
Increase tumorigenesis

39. Gallstones that reach the common channel at ampulla can block which two ducts
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Pancreatic and bile
Tropical sprue
MSI (15%) and APC/beta catenin chromosomal instability (85%)

40. What is the mechanism for reyes syndrome
Lactase is located at the tips of intestinal villi
Dubin johnson
Penicillinamine - AR inheritance
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

41. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Diarrhea - steatorrhea - weight loss - weakness
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Dysphagia (due to esophageal web) - glossitis - iron def anemia
The entire

42. What are the results of hemochromatosis
CHF and inc risk of HCC
Liver metabolizes 5HT
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
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

43. What is the sphincter of the pancreatic duct
Hypotonic because of more time to reabsorb NaCl
Alfatoxin in peanuts
Sphincter of oddi
Via the superior pancreaticduodenal

44. What does high flow rate mean
Closer to isotonic because of less time to reabsorb NaCl
AST >ALT - ration is usually 1.5
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

45. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Conj - inc - dec
HSV-1 - CMV - Candida
Femoral hernia

46. What is the action of NO as a GI hormone
Inc smooth muscle relaxation - including lower esophageal sphincter
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Gut bacteria
Copious diarrhea - non alpha - non beta cell pancreatic tumor

47. malnutrition - toxic megacolon - colorectal carcinoma
Complications of UC
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Conj - inc - dec

48. What is the leading cause of bowel incarceration
Below
Femoral hernia
Positive
EtOH

49. What is contained within the muscularis externa
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
H pylori (almost 100%)
Hemosiderosis - hemochromatosis
Myenteric nerve plexus - aurbach

50. What is the most important mechanism in gastric acid secretion
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
In the mucus that covers the gastric epithelium
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Common hepatic - splenic - left gastric - main blood supply for stomach