USMLE GI

Instructions:

• Answer 50 questions in 15 minutes.
• If you are not ready to take this test, you can study here.
• 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. Autoantibodies to gluten (gliadin) in wheat and other grains
Backup of blood into the liver - RHF - budd chiari
Celiac sprue
Gallbladder
Low pressure proximal to LES


2. Where are peyers patches found
Lamina propora and submucosa
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Cimetidine
Primary sclerosing cholangitis


3. What drug blocks the H2R
Cimetidine
IBS at least 2 with recurrent abdominal pain
Celiac sprue
Volvulus


4. What is the most common indication of emergent abdominal surgery in children
Hypercoaguability - polycythemia vera - pregnancy - HCC
Appendicitis
Femoral hernia
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn


5. Where are carcinoid tumors most commonly malignant
Neural muscarinic pathways
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Small intestine
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics


6. With internal hemorrhoids Where is the anastomoses and Where is it
With albumin
Mucoepidermoid carcinoma
Parietal cells in the stomach - B12 binding protein
Superior rectal and middle and inferior rectal - rectum


7. What commonly leads to appendicity in kids vs adults
Fe2+ in the duod
H2 receptor - inc cAMP
Pleuroperitoneal
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith


8. What pancreatic proteases are secreted as zymogens
Cystic dilation of the viteline duct
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Trypsin - chymotrypsin - elastase - carboxypeptidases
Falciform - ligamentum teres - fetal umbilical vein


9. Where is the pectinate line
Chagas disease
Zollinger ellison - brunners glands
Where hindgut meets ectoderm
Increase tumorigenesis


10. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Black - rotors syndrome
Fasting and stress
Cystic dilation of the viteline duct
Stimulate intestinal persistalsis


11. What artery passes around the duodenum
Antrum - H.pylori - inc risk of MALT lymphoma
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
The gastroduodenal
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament


12. What is the most common esophageal cancer worldwide and in the US
External (superficial) ring only
Lateral
Gut bacteria
Worldwide - SC - US - adeno


13. occlusion of IVC or hepatic veins
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Left gastric vein and esophogeal vein - esophagus
Striated
Budd chiari syndrome


14. How is the diagonsis of CRC made
Paraumbilical and superficial and inferior epigastric - umbilicus
Gut bacteria
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
Inguninal ligament - sartorius muscle - adductor longus


15. What do you treat Wilsons disease with and What is the inheritance
Inc conj bilirubin - inc cholesterol - inc alk phos
Penicillinamine - AR inheritance
Esophageal varices
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum


16. What is the risk with peutz jehgers
Inc risk of CRC and other visceral malignancies
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Barrett's esophagus
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


17. What are the borders of Hesselbach's triangle
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
EtOH
Lamina propria
Alk pho


18. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
NAV = nerve artery vein - venous near the penis (NAVEL)
Duodenal atresia - Downs
Below
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)


19. Why does indirect inguinal hernia happen in infacnts
Dilated esophagus with an area of distal stenosis - birds beak
Gastric glands
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Failure of the processus vagainlis to close


20. Which patients have pigment stones
Necrotizing enterocolitis
Intussusception
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
L4


21. Which area of the hindgut is a watershed area
Splenic flexure
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Carcinoid syndrome


22. What kind of muscle is in the middle 1/3 of esophagus
Striated and smooth
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Angiodysplasia


23. What is the action of NO as a GI hormone
Inc smooth muscle relaxation - including lower esophageal sphincter
Closer to isotonic because of less time to reabsorb NaCl
Gut bacteria
Chronic gastritis and pernicious anemia


24. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Alpha amylase
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Decrease - weight gain
Dermatitis herpetiformis


25. What is the sphincter of the pancreatic duct
Upregulated intracellular signal transduction
Sphincter of oddi
Internal thoracic to superior epigastric to inferior epigastric
Uridine glucuronyl transferase


26. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Inc conj bilirubin - inc cholesterol - inc alk phos
In the ileum with bile acids - requires IF
Complications of crohns


27. What is the most important mechanism in gastric acid secretion
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Cholesterol
Centrilobular leading to congestive liver disease
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC


28. What layer in the mucosa is repsonsible for motility
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Muscularis mucosae
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
True and most common congenital anomoly of GI tract


29. inflammatino of gallbadder
Causes of gall stones
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
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
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)


30. HCC is associated with what other conditions
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Ceruplasmin
Uremia
True and most common congenital anomoly of GI tract


31. In alchoholic hepatitis which liver enzyme is higher
Inc risk of CRC and other visceral malignancies
AST>ALT
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Diarrhea - steatorrhea - weight loss - weakness


32. Which kind of hemorrhoids are painful and why
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Uridine glucuronyl transferase
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells


33. What do you use to diagnose meckels
Averages 6 months - very aggressive - usually already metastasized at presentation
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Pertechnetate - study for uptake
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia


34. Where is B12 absorbed
In the ileum with bile acids - requires IF
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
All 3 gut layers outpouch as in Meckels
Heme metabolism


35. What is the presenting course for appendicity


36. How do NSAIDs cause acute gastritis
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Mallory bodies
Short gastrics - left greater and lesser
Dec PGE2 leading to dec gastric mucosa protection


37. What is the other name for GIP (gastric inhibitory peptide)
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Glucose dependent insulinotropic peptide
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Short gastrics - left greater and lesser


38. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
GERD - may also present with nocturnal cough and dyspnea
In the mucus that covers the gastric epithelium
Zollinger ellison - brunners glands


39. What are the layers of the gut wall from inside out
Can lead to hematemesis - found in EtOHics and bulimics
Below
Mucosa - submucosa - muscularis externa - serosa/adventitia
90%


40. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Low pressure proximal to LES
AST
Gilbert's
IBS at least 2 with recurrent abdominal pain


41. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Esophageal varices
Parietal cells in the stomach - B12 binding protein
...
Angiodysplasia


42. In an MI - which liver enzyme is elevated
Reye's syndrome
Pancreatic and bile
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
AST


43. What are the complications of Meckels
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Serous on the sides parotids - mucinous in the middle sublingual
Downs
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine


44. Cholecytsokinin - source - action - regulation
Via the superior pancreaticduodenal
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
Smooth
Autoimmune= ulcerative colitis - disordered response to bactere = crohns


45. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Elevated amylase - and lipase
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Unconj - absent (acholuria) - inc
Dysphagia (due to esophageal web) - glossitis - iron def anemia


46. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Failure of the processus vagainlis to close
Hypercoaguability - polycythemia vera - pregnancy - HCC
Upregulated intracellular signal transduction
Hepatic steatosis


47. Where is IgA shuttled
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
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
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
No


48. What does bicarb do in the duodenum
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Superior rectal and middle and inferior rectal - rectum


49. What gives stool its characteristic color
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Hypotonic because of more time to reabsorb NaCl
Volvulus
Stercobilin


50. Why does volvulus occur more at cecum and sigmoid colon
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Redundant mesentary
Hyperpigmented mouth - lips - hands - genitalia
Centrilobular congestion and necrosis - cardiac cirrhosis