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. What transforms conjugated bilirubin to urobilinogen
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Reye's syndrome
Gut bacteria
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa


2. What are the complications of acute pancreatitis
L2
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
In the mucus that covers the gastric epithelium
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion


3. In alchoholic hepatitis which liver enzyme is higher
AST>ALT
Jaundice - fever - RUQ
FAP
Ampulla of vater


4. Which patients have pigment stones
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Low pressure proximal to LES
The submucosal nerve plexus - meissner's


5. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Reye's syndrome
Intussusception
Fe2+ in the duod
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC


6. What is the most common indication of emergent abdominal surgery in children
Backup of blood into the liver - RHF - budd chiari
Appendicitis
Urobilin
Meconium ileus


7. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
H2 receptor - inc cAMP
Superior rectal
Via the middle colic
Spleen to posterior abdominal wall - splenic artery and vein


8. What does primary sclerosing cholangitis lead to...
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Trypsin - chymotrypsin - elastase - carboxypeptidases
Splenic flexure
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP


9. What is the triad of Plummer - Vinson syndrome
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Worldwide - SC - US - adeno
Hyperplastic
Dysphagia (due to esophageal web) - glossitis - iron def anemia


10. Gallstones that reach the common channel at ampulla can block which two ducts
Pancreatic and bile
Mucoepidermoid carcinoma
External spermatic fascia only
Juvenille polyps - no risk if single


11. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Dissaccharidase def - most commonly lactase
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Decrease - weight gain
Alk pho


12. Are single polyps malignant in peutz jehgers
No
Alk pho
Zollinger Ellison - phenylalanine and tryptophan
Redness and tenderness on palpation of extremities


13. What are the histological findings in the duodenum

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14. How many layers of spermatic fascia are covers an indirect inguinal hernia
Hyperplastic
Right and left hepatic duct
All 3
Pain associated with cholecystitis and galls stones - diabetics may not present with pain


15. Where and How is iron absorbed
Backup of blood into the liver - RHF - budd chiari
Fe2+ in the duod
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC


16. inflammatino of gallbadder
Peptic ulcer disease
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
H+
IgA receives protective secretory component and is then transported across the epithelium to gut lumen


17. What are the histological findings in the ileum

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18. What is the characteristic histo finding in alcoholic hepatitis
Alpha1 antitrypsin def - codominant trait
Cigarettes and chronic pancreatitis - not EtOH
Mallory bodies
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn


19. When do you see hypertrophy of brunners glands
Peptic ulcer disease
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Myenteric nerve plexus - aurbach
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood


20. What is diverticulosis
Older patients
Amylase
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall


21. What are the foregut structures and what supplies their blood and PANS innvervation
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Achalasia due to loss of myenteric plexus (auberach)
Paraumbilical and superficial and inferior epigastric - umbilicus
Brush border of intestine - produce monosaccharides from oligo and di


22. Which IBD is autoimmune and which may be a disordered response to bacteria
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Superior rectal and middle and inferior rectal - rectum
Ceruplasmin
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation


23. What are additional risk factors for CRC
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Hepatic steatosis
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome


24. What pancreatic proteases are secreted as zymogens
Inc conj bilirubin - inc cholesterol - inc alk phos
Trypsin - chymotrypsin - elastase - carboxypeptidases
Crohns = maybe - UC= always
Diverticulum


25. signet ring cells - acanthosis nigracans - dz - character/association - spread
Gastrohepatic ligament
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Antrum - H.pylori - inc risk of MALT lymphoma


26. Where does type A chronic gastritis occur and What causes it
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Pyoderma gangrenosum - primary sclerosing cholangitis
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Poor anastamoses


27. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus

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28. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Glucose dependent insulinotropic peptide
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Punched out - clean margins - carcinoma =raised irregular margins
Esophageal cancer


29. If the abdominal aorta is blocked - How does blood get to the left colic artery
Meckels
AST>ALT
Via the middle colic
Cystic dilation of the viteline duct


30. What causes nutmeg liver
Celiac sprue
Backup of blood into the liver - RHF - budd chiari
Antrum - H.pylori - inc risk of MALT lymphoma
Phenobarbital - inc liver enzyme synthesis


31. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Hypercoaguability - polycythemia vera - pregnancy - HCC
Lateral
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
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


32. What receptors does gastrin bind on the parietal cell and What does it activate
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
Positive urease test
CCK8 receptor - Gq inc IP3/Ca
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC


33. What is the HLA association and treatment for hemochromatosis
The submucosal nerve plexus - meissner's
Duodenal atresia - Downs
Portal HTN
Repeated phlebotomy - deferoxamine - HLA- A3


34. Where does an indirect inguinal hernia enter the deep inguinal ring
Glucose dependent insulinotropic peptide
NAV = nerve artery vein - venous near the penis (NAVEL)
Lateral to the inferior epigastric artery
Failure of the processus vagainlis to close


35. What is the frequency of basal electric rhythm of the stomach
3 waves/min
Decreased intercellular adhesion and increased proliferation
Zollinger ellison - brunners glands
Crypts but not villi


36. What are the labs in acute pancreatitis
AST >ALT - ration is usually 1.5
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Elevated amylase - and lipase
Averages 6 months - very aggressive - usually already metastasized at presentation


37. rare - often fatal childhood hepatoencephalopathy

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38. What happens to the short gastics if the splenic artery is blocked
Glucouronate - water soluble (direct)
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Poor anastamoses


39. What kind of diarrhea is produced from a disaccharide def
Oligosaccharide digestion
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Osmotic


40. What portion of the bowel does sprue effect
Striated and smooth
Squamous - upper 1/3 - adeno - lower 1/3
Dysphagia (due to esophageal web) - glossitis - iron def anemia
The proximal small bowel


41. What is the presentation of pancreatic adenocarcinoma
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Alk phos
AST>ALT
Jaundice - fever - RUQ


42. Who gets gastric ulcers
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
The entire
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
Older patients


43. Where is the deep inguinal ring relative to the inferior epigastric vessels
Lateral
Hirschsprungs
Erosive - disruption of mucosal barrier leading to inflammation
FAP


44. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Superior rectal and middle and inferior rectal - rectum
Obstruction of the common bile duct
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Diverticulum


45. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Superior rectal and middle and inferior rectal - rectum
Older patients
GLUT 2
Via the superior pancreaticduodenal


46. What is the classic triad of hemochromatosis

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47. What is the prognosis of adenocarcinoma
Corticosteroids - infliximab
Striated and smooth
Averages 6 months - very aggressive - usually already metastasized at presentation
Female - fat - fertile - forty


48. What structures feed into the common bile duct
Cystic duct and common hepatic duct
Hemolytic anemia
Osmotic
Budd chiari syndrome


49. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Upregulated intracellular signal transduction
Boerhaave's Syndrome - Been heaving syndrome
Oral glucose
Hemosiderosis - hemochromatosis


50. Where are carcinoid tumors most commonly malignant
Small intestine
Pancreatic and bile
Cigarettes and chronic pancreatitis - not EtOH
HSV-1 - CMV - Candida