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USMLE GI

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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. Transmural esophageal rupture due to violent retching

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2. Which IBD is autoimmune and which may be a disordered response to bacteria
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Inc smooth muscle relaxation - including lower esophageal sphincter

3. What drug blocks the H2R
Cimetidine
US and cholecystectomy
External (superficial) ring only
Fasting and stress

4. What source of salivary secretion is the most serous and What is the most mucinous
Serous on the sides parotids - mucinous in the middle sublingual
Positive
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Inspiratory arrest on deep palpation due to pain

5. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Alpha amylase
...
Volvulus
Duodenal atresia - Downs

6. Acute gastritis is caused By what process
The entire
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Decrease - weight gain
Erosive - disruption of mucosal barrier leading to inflammation

7. What are the ABCDEF of esophageal cancer
Begins starch digestion - inactivated by low pH upon reaching the stomach
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Pertechnetate - study for uptake

8. What factors increase risk of malignancy of adenomatous polyps
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
HPNCC
Lipase - phospholipase A - colipase
Gardner's syndrome

9. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

10. signet ring cells - acanthosis nigracans - dz - character/association - spread
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Glucouronate - water soluble (direct)
Gamma glutamyl transferase GGT

11. What is the frequency of basal electric rhythm of the stomach
Crohns = maybe - UC= always
Upregulated intracellular signal transduction
3 waves/min
The entire

12. Where are peyers patches found
Brush border of intestine - produce monosaccharides from oligo and di
Lamina propora and submucosa
Necrotizing enterocolitis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

13. What commonly leads to appendicity in kids vs adults
Brush border of intestine - produce monosaccharides from oligo and di
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Glucose dependent insulinotropic peptide
US and cholecystectomy

14. What layer in the mucosa is repsonsible for motility
Muscularis mucosae
Hyperplastic
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn

15. what percentage of colonic polyps are non - neoplastic
90%
Volvulus
AST
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

16. What is the leading cause of bowel incarceration
Upregulated intracellular signal transduction
Femoral hernia
Pancreatic and bile
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

17. What is Trousseau's sign
Redness and tenderness on palpation of extremities
Esophageal varices
Squamous - upper 1/3 - adeno - lower 1/3
Dec PGE2 leading to dec gastric mucosa protection

18. What happens to the short gastics if the splenic artery is blocked
Femoral hernia
Around the central vein (zone III)
Poor anastamoses
Common hepatic - splenic - left gastric - main blood supply for stomach

19. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Colonic polyps
Left gastric vein and esophogeal vein - esophagus
Serous on the sides parotids - mucinous in the middle sublingual
Tropical sprue

20. What does histo show for alpha1 antitrypsin def
Hemolytic anemia
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
PAS- positive globules in liver -

21. What does extrahepatic biliary obstruction cause
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Ceruplasmin
Lactase is located at the tips of intestinal villi
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

22. Scleroderma is associated with what kind of esophageal dysmotility
Lye ingestion and acid reflux
Low pressure proximal to LES
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Warthins' tumor

23. Where are oligosaccharide hydrolases and What do they do
Unconjugated - water insoluble
Skip lesions =crohns - colon = UC
Brush border of intestine - produce monosaccharides from oligo and di
M3 - Gq - inc IP3/Ca

24. What kind of anemia is in Wilsons
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Hemolytic anemia
Krukenbergs tumor
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

25. What are the histological findings in the jejunum
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Meckels
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Upregulated intracellular signal transduction

26. What is the prognosis of adenocarcinoma
Averages 6 months - very aggressive - usually already metastasized at presentation
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Pleuroperitoneal
Lack or have an attenuated muscularis externa - often in the sigmoid colon

27. What are the midgut structures and what supplies their blood and PANS innervation
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
AST >ALT - ration is usually 1.5
Boerhaave's Syndrome - Been heaving syndrome
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

28. If the abdominal aorta is blocked - How does blood get to the left colic artery
Pancreatic and bile
Via the middle colic
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

29. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Celiac sprue
Crohns = noncaseating granulomas - UC = crypt abscesses
Failure of neural crest migration
Alcoholic cirrhosis

30. What congenital birth defect is associated with Hirschsprung
Dermatitis herpetiformis
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Positive
Downs

31. What are the complications of acute pancreatitis
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Downs

32. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Achalasia due to loss of myenteric plexus (auberach)
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
Splenic flexure

33. What skin condition is associated with celiac sprue
Dermatitis herpetiformis
EtOH
The gastroduodenal
Hemosiderosis - hemochromatosis

34. What can fistula between the gallbladder and small intestine create and how can you tell
GERD - may also present with nocturnal cough and dyspnea
Alcoholic cirrhosis
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

35. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Via the superior pancreaticduodenal
The submucosal nerve plexus - meissner's
L2
Pleomorphic adenoma

36. What receptors does ACH bind on the parietal cells and What does it activate
Hypercoaguability - polycythemia vera - pregnancy - HCC
M3 - Gq - inc IP3/Ca
Primarly through ECL leading to histamine release
Epithelium

37. To what substance is bilirubin conjugated and why
Pyoderma gangrenosum - primary sclerosing cholangitis
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Glucouronate - water soluble (direct)
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

38. What kind of muscle is in the middle 1/3 of esophagus
Primary sclerosing cholangitis
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Hyperplastic
Striated and smooth

39. What transforms conjugated bilirubin to urobilinogen
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Gut bacteria
Superior rectal and middle and inferior rectal - rectum
ALT>AST

40. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Above
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Superior rectal
Hepatic steatosis

41. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
2ndary biliary cirrhosis
External (superficial) ring only
Pancreatic and bile

42. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Barrett's esophagus
Internal thoracic to superior epigastric to inferior epigastric
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

43. What parts of the small bowel can tropical sprue effect
Diverticulitis in elderly - ectopic pregs use hCG to rule out
The entire
Chronic gastritis and pernicious anemia
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

44. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Hyperplastic
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

45. What is the lumen of the pancreatic duct
Hemosiderosis - hemochromatosis
Ampulla of vater
Positive urease test
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

46. What is the most common esophageal cancer worldwide and in the US
Worldwide - SC - US - adeno
H2 receptor - inc cAMP
Skip lesions =crohns - colon = UC
8-9 waves/min

47. What test and result confirms H pylori infxn
GLUT 2
Positive urease test
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Juvenille polyps - no risk if single

48. What separates the right greater and lesser sacs
Conj/unconj - inc - nl to dec
External spermatic fascia only
Gastrohepatic ligament
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

49. Diaphragmatic hernias occur in infants because of defective development of which membrane
Where hindgut meets ectoderm
Female - fat - fertile - forty
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Pleuroperitoneal

50. When do you see hypertrophy of brunners glands
Esophageal varices
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Hyperplastic
Peptic ulcer disease