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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 gives stool its characteristic color
Stercobilin
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Fe2+ in the duod
Mucoepidermoid carcinoma

2. GIP - source - action regulation
Normal
ALT>AST
Achalasia due to loss of myenteric plexus (auberach)
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

3. What kind of pancreatitis is associated with EtOH and smoking
All 3
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Virchow's node
IBS at least 2 with recurrent abdominal pain

4. likely infectious form of malabsorption - responds to antibiotics
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
HPNCC
Tropical sprue
Lye ingestion and acid reflux

5. What are the borders of Hesselbach's triangle
Black - rotors syndrome
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Bleeding - penetration into pancreas - perforation - obstruction
Superior rectal

6. What are the complications of acute pancreatitis
Serous on the sides parotids - mucinous in the middle sublingual
Primarly through ECL leading to histamine release
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

7. What does autoimmune destruction of parietal cells lead to...
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
AR
Downs
Chronic gastritis and pernicious anemia

8. What is diverticulosis
Lye ingestion and acid reflux
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Uremia
Low pressure proximal to LES

9. How is bilirubin carried in the blood
Ischemic colitis
With albumin
Zollinger ellison - brunners glands
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer

10. Acute gastritis is caused By what process
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Zenkers - halitosis - dysphagia and obstruction
Erosive - disruption of mucosal barrier leading to inflammation
Heme metabolism

11. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery

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12. What is contained within the submucosa

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13. Between what structures do strong anastamoses exist
Warthins' tumor
Left and right gastroepiploics - left and right gastrics
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Where hindgut meets ectoderm

14. What does TOASTED with alcoholic hepatitis stand for
Closer to isotonic because of less time to reabsorb NaCl
Heme metabolism
AST >ALT - ration is usually 1.5
Epithelium

15. HCC is associated with what other conditions
Peptic ulcer disease
Ischemic colitis
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Heme metabolism

16. occlusion of IVC or hepatic veins
Budd chiari syndrome
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
Pleuroperitoneal
2ndary biliary cirrhosis

17. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Gut bacteria
Parietal cells in the stomach - B12 binding protein
Above
The submucosal nerve plexus - meissner's

18. In viral hepatitis - which liver enzyme is higher
Dermatitis herpetiformis
VZV and influenza B treated with salicylates
ALT>AST
Backup of blood into the liver - RHF - budd chiari

19. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Failure of neural crest migration
Intussusception
Backup of blood into the liver - RHF - budd chiari
All 3 gut layers outpouch as in Meckels

20. What is the most important mechanism in gastric acid secretion
Sphincter of oddi
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

21. What kind of diarrhea is produced from a disaccharide def
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Smooth
Inc lower esphogeal tone leading to achalasia
Osmotic

22. Where is there sclerosis in alcoholic cirrohosis
Crohns = transmural (cobblestone mucosa - creeping fat - string sign - linear ulcers fissures - fistulas) UC = mucosal and submucosal (friable mucosal pseudopolyps with freely hanging mesentary - loss of haustra - lead pipe appearance on imaging
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Around the central vein (zone III)
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

23. What can hemochromatosis be secondary to...
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Virchow's node
Where hindgut meets ectoderm
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

24. How do burns cause acute gastritis and What is it called

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25. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Femoral hernia
Parietal cells in the stomach - B12 binding protein
Dermatitis herpetiformis
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

26. What kind of lesions are characteristic of duodenal PUD vs cancer
Celiac sprue
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Alcoholic hepatitis
Punched out - clean margins - carcinoma =raised irregular margins

27. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Around the central vein (zone III)
Low pressure proximal to LES
AR
Alcoholic cirrhosis

28. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
T12
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Volvulus
Chronic gastritis and pernicious anemia

29. What is the presentation of pancreatic adenocarcinoma
Phenobarbital - inc liver enzyme synthesis
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Alcoholic cirrhosis
Smooth

30. Are single polyps malignant in peutz jehgers
Black - rotors syndrome
Stercobilin
Virchow's node
No

31. What carcinogens are associated with HCC
Mallory bodies
Crohns = transmural (cobblestone mucosa - creeping fat - string sign - linear ulcers fissures - fistulas) UC = mucosal and submucosal (friable mucosal pseudopolyps with freely hanging mesentary - loss of haustra - lead pipe appearance on imaging
Sister mary joseph nodule
Alfatoxin in peanuts

32. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Squamous - upper 1/3 - adeno - lower 1/3
Penicillinamine - AR inheritance
Achalasia due to loss of myenteric plexus (auberach)
Zollinger Ellison - phenylalanine and tryptophan

33. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Duodenal atresia - Downs
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

34. What kind of pathways do CCK act on to cause pancreatic secretion
Celiac sprue
Pyoderma gangrenosum - primary sclerosing cholangitis
Neural muscarinic pathways
Spleen to posterior abdominal wall - splenic artery and vein

35. What serum enzyme is decreased in wilsons disease
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Decrease - weight gain
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Ceruplasmin

36. What is the most common diaphragmatic hernia and What are the two types
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

37. What drug inhibits the H/K ATPase
Omeprazole
Lipase
Old men - arthralgias - cardiac and neuro sx
Mitochondrial abnl - fatty liver - hypoglycemia - coma

38. What is the cause of Barrett's and the assocaited complications
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Volvulus
Lateral
Myenteric nerve plexus - aurbach

39. What is the epi for CRC
Omeprazole
Centrilobular congestion and necrosis - cardiac cirrhosis
Hyperplastic
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

40. What enzyme is necessary to create conjugated bilirubin
Uridine glucuronyl transferase
Pancreatic and bile
NAV = nerve artery vein - venous near the penis (NAVEL)
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

41. What histological findings are present in the stomach
HSV-1 - CMV - Candida
Amylase
Gastric glands
Bleeding - intussusception - volvulus - obstruction near terminal ileum

42. What kind of anemia is in Wilsons
EtOH
Hemolytic anemia
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Goes through deep inguinal ring - external inguinal ring and into the scrotum

43. Why are most diverticula considered false
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Nonkeritinized stratified sqamous epithelium
12 waves/min
Mucoepidermoid carcinoma

44. What are the common causes of gastric ulcers - What causes gastric ulcer
Pleuroperitoneal
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa

45. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Virchow's node
Necrotizing enterocolitis
Meconium ileus
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

46. What kind of cancer to celiac sprue put you as inc risk for
T cell lymphoma
Low pressure proximal to LES
Zollinger Ellison - phenylalanine and tryptophan
Krukenbergs tumor

47. What retroperitoneal structure flanks both sides of the pancreas on CT
Cirrhosis
HSV-1 - CMV - Candida
Portal HTN
Duodenum - 2nd - 3rd and 4th parts

48. What are the hindgut structures and what supplies their blood and PANS innvervation
Chagas disease
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Hemolytic anemia

49. How does gastrin increase acid secretion?
Corticosteroids - infliximab
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Primarly through ECL leading to histamine release

50. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
...
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Mucoepidermoid carcinoma
Around the central vein (zone III)