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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...
Nonkeritinized stratified sqamous epithelium
Inferior rectal nerve
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

2. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
GERD - may also present with nocturnal cough and dyspnea
The jejunum
Primary sclerosing cholangitis

3. What are the common causes of gastric ulcers - What causes gastric ulcer
Diverticulum
In the mucus that covers the gastric epithelium
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
...

4. What is the most common cause of gallstones
Splenic flexure
Chagas disease
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Trypsin - chymotrypsin - elastase - carboxypeptidases

5. What kind of digestion is bile needed for
Striated
Jaundice - fever - RUQ
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

6. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
GERD - may also present with nocturnal cough and dyspnea
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Acute pancreatitis

7. What is the path of an indirect inguinal hernia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Cholesterol
Hepatic steatosis

8. What are the foregut structures and what supplies their blood and PANS innvervation
H pylori (almost 100%)
Warthins' tumor
Begins starch digestion - inactivated by low pH upon reaching the stomach
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

9. What commonly leads to appendicity in kids vs adults
Via the middle colic
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Cimetidine

10. What kind of pathways do CCK act on to cause pancreatic secretion
Redundant mesentary
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Via the superior pancreaticduodenal
Neural muscarinic pathways

11. What is diverticulosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Fasting and stress
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Averages 6 months - very aggressive - usually already metastasized at presentation

12. What does bicab do in the mouth
Neutralizes oral bacertial acids and maintains dental health
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Striated

13. At what spinal level does the SMA exit
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Superior rectal
L1

14. What does loss of p53 cause
Increase tumorigenesis
2ndary biliary cirrhosis
Volvulus
Corticosteroids - infliximab

15. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Alcoholic hepatitis
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Esophageal varices
Repeated phlebotomy - deferoxamine - HLA- A3

16. Where is bicarb trapped
Lye ingestion and acid reflux
In the mucus that covers the gastric epithelium
Above
Esophageal carcinoma

17. What is the rule of 2s for meckels
Above
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Turcot
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

18. What type of insults result in micronodular cirrhosis
Right and left hepatic duct
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Hemolytic anemia
Mucoepidermoid carcinoma

19. What are the signs of peutz jehgers
Alpha1 antitrypsin def - codominant trait
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
T12
Hyperpigmented mouth - lips - hands - genitalia

20. What are the complications of chronic pancreatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Via the superior pancreaticduodenal
Enterokinase/enteropeptidase from the duodenal mucosa

21. motilin - source - action - regulation
Pertechnetate - study for uptake
Muscularis mucosae
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Chronic constipation early in life with dilated portion of the colon proximal to the aganglionic segment resulting in a transition zone - involves rectum - usually a failure to pass meconium

22. What does extrahepatic biliary obstruction cause
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Mallory bodies

23. What does primary sclerosing cholangitis lead to...
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Cirrhosis
Bleeding - penetration into pancreas - perforation - obstruction
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

24. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Cholesterol
Superior rectal
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Left gastric vein and esophogeal vein - esophagus

25. What does autoimmune destruction of parietal cells lead to...
Black - rotors syndrome
Cigarettes and chronic pancreatitis - not EtOH
Chronic gastritis and pernicious anemia
CCK8 receptor - Gq inc IP3/Ca

26. what percentage of colonic polyps are non - neoplastic
Stimulate intestinal persistalsis
Lamina propora and submucosa
90%
True and most common congenital anomoly of GI tract

27. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Meckels
Jewish and African American men
Inspiratory arrest on deep palpation due to pain
Failure of neural crest migration

28. signet ring cells - acanthosis nigracans - dz - character/association - spread
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Decreased intercellular adhesion and increased proliferation

29. How does CRC present in the distal and proximal colon
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Amylase
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

30. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Barrett's esophagus
Below
L3
Portal HTN

31. What drug blocks the H2R
Lactase is located at the tips of intestinal villi
Cimetidine
Inc smooth muscle relaxation - including lower esophageal sphincter
Neutralizes gastric acid allowing pancreatic enzymes to fxn

32. What does high flow rate mean
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Closer to isotonic because of less time to reabsorb NaCl
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

33. Cholecytsokinin - source - action - regulation
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
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

34. What are esophageal strictures associated with
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Lye ingestion and acid reflux
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Failure of neural crest migration

35. How does brain injury lead to acute gastritis and What is it called
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Left and right gastroepiploics - left and right gastrics

36. Where is IgA shuttled
Failure of neural crest migration
Celiac sprue
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Falciform - ligamentum teres - fetal umbilical vein

37. What layer in the mucosa is responsible for support
Cirrhosis
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Lamina propria
Punched out - clean margins - carcinoma =raised irregular margins

38. What are the extraintestinal manifestations of ulcerative colitis
Chronic gastritis and pernicious anemia
Pyoderma gangrenosum - primary sclerosing cholangitis
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Portal HTN

39. What congenital birth defect is associated with Hirschsprung
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Downs
All 3 gut layers outpouch as in Meckels
Adhesion

40. What does a low flow rate mean for saliva
Hypotonic because of more time to reabsorb NaCl
CEA - CA-19-9
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Fasting and stress

41. What kind of cancer to celiac sprue put you as inc risk for
IgA secreting plasma cells - ultimately reside in the lamina proporia
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
T cell lymphoma
Cimetidine

42. In PUD - with gastric ulcers - does pain inc or dec with meals?
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Antrum - H.pylori - inc risk of MALT lymphoma
Inc - weight loss
Menetriers disease

43. How does gastrin increase acid secretion?
Primarly through ECL leading to histamine release
Pyoderma gangrenosum - primary sclerosing cholangitis
Parietal cells in the stomach - B12 binding protein
Pleomorphic adenoma

44. At what level do the testicular/ovarian arteries exit the aorta
L2
Peyers patches
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

45. What causes hirschsprungs
Failure of neural crest migration
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Oligosaccharide digestion
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

46. What layer in the mucosa is repsonsible for motility
Dense core bodies
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
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Muscularis mucosae

47. What does TOASTED with alcoholic hepatitis stand for
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
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
Paraumbilical and superficial and inferior epigastric - umbilicus
AST >ALT - ration is usually 1.5

48. Why are most diverticula considered false
Menetriers disease
Hyperpigmented mouth - lips - hands - genitalia
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Lack or have an attenuated muscularis externa - often in the sigmoid colon

49. what kind of muscle is in the upper 1/3 of esophagus
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Hemosiderosis - hemochromatosis
Pyoderma gangrenosum - primary sclerosing cholangitis
Striated

50. Bilirubin is the product of what?
Normal
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Heme metabolism
Above