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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 many layers of spermatic fascia are covers an indirect inguinal hernia
Lipase
All 3
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
Myenteric nerve plexus - aurbach

2. Where is B12 absorbed
Failure of the processus vagainlis to close
Source - G cells in the antrum - action - inc gastric H+ secretion - inc growth of gastric mucosa - and inc gastric motility - regulation - inc by stomach distention/alkalinaztion - amino acids - peptides - vagal stimulation - dec by stomach pH < 1.5
Virchow's node
In the ileum with bile acids - requires IF

3. What are the complications of Meckels
T12
Bleeding - intussusception - volvulus - obstruction near terminal ileum
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Unconjugated - water insoluble

4. inflammatino of gallbadder
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Gastrohepatic ligament
Hemolytic anemia

5. Abuse of what substance leads to acute gastritis
EtOH
H pylori (almost 100%)
Bleeding - intussusception - volvulus - obstruction near terminal ileum
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

6. What does histo show for alpha1 antitrypsin def
Via the superior pancreaticduodenal
PAS- positive globules in liver -
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

7. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Juvenille polyps - no risk if single
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
All 3
Gamma glutamyl transferase GGT

8. GIP - source - action regulation
Decreased intercellular adhesion and increased proliferation
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Dense core bodies
Gut bacteria

9. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Carcinoid syndrome
Epigastric abdominal pain radiating to back - anorexia - nausea
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Above

10. What portion of the bowel does sprue effect
The proximal small bowel
Source - G cells in the antrum - action - inc gastric H+ secretion - inc growth of gastric mucosa - and inc gastric motility - regulation - inc by stomach distention/alkalinaztion - amino acids - peptides - vagal stimulation - dec by stomach pH < 1.5
Menetriers disease
The jejunum

11. Bilirubin is the product of what?
Duodenum - 2nd - 3rd and 4th parts
Heme metabolism
Hemosiderosis - hemochromatosis
Inferior rectal nerve

12. How is bilirubin carried in the blood
Left gastric vein and esophogeal vein - esophagus
With albumin
Short gastrics - left greater and lesser
L4

13. What histological findings are present in the esophagus
Dec PGE2 leading to dec gastric mucosa protection
Nonkeritinized stratified sqamous epithelium
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Primarly through ECL leading to histamine release

14. Why does indirect inguinal hernia happen in infacnts
Glucose dependent insulinotropic peptide
Peptic ulcer disease
Failure of the processus vagainlis to close
Inc conj bilirubin - inc cholesterol - inc alk phos

15. What is the most common diaphragmatic hernia and What are the two types
Complications of crohns
Fasting and stress
Boerhaave's Syndrome - Been heaving syndrome
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

16. Where is the deep inguinal ring relative to the inferior epigastric vessels
Old men - arthralgias - cardiac and neuro sx
Squamous - upper 1/3 - adeno - lower 1/3
Lateral
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

17. What is the clinical presentation of acute pancreatitis
Skip lesions =crohns - colon = UC
Esophageal carcinoma
Epigastric abdominal pain radiating to back - anorexia - nausea
Fasting and stress

18. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
IBS at least 2 with recurrent abdominal pain
Crypts but not villi
H+
Juvenille polyps - no risk if single

19. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Chronic gastritis and pernicious anemia
Inc conj bilirubin - inc cholesterol - inc alk phos
When diffusely infiltrative - thickened rigid appearance like a leather bottle

20. What are the barium swallow findings of achalasia
Superior rectal
M3 - Gq - inc IP3/Ca
Crypts but not villi
Dilated esophagus with an area of distal stenosis - birds beak

21. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Crohns = noncaseating granulomas - UC = crypt abscesses
Mallory bodies
Esophageal cancer
Meckels

22. How is the diagonsis of CRC made
Stimulate the H/K ATPase
Diverticulitis in elderly - ectopic pregs use hCG to rule out
No - chronic - can present with diarrhea or constipation or alternation - treat sx
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

23. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
Internal thoracic to superior epigastric to inferior epigastric
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
L2
Skip lesions =crohns - colon = UC

24. Where does crohns usually affect the GI tract
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Duodenum - 2nd - 3rd and 4th parts
Terminal ileum and colon

25. Where is folate absorbed
Zollinger Ellison - phenylalanine and tryptophan
The jejunum
Inc smooth muscle relaxation - including lower esophageal sphincter
True and most common congenital anomoly of GI tract

26. What are the results of hemochromatosis
Krukenbergs tumor
Copious diarrhea - non alpha - non beta cell pancreatic tumor
CHF and inc risk of HCC
Lack or have an attenuated muscularis externa - often in the sigmoid colon

27. What conditions are associated with budd chiari
Hemolytic anemia
Right and left hepatic duct
Hypercoaguability - polycythemia vera - pregnancy - HCC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

28. Which viral infxns/treatments are associated with reyes syndrome
Stimulate the H/K ATPase
Boerhaave's Syndrome - Been heaving syndrome
VZV and influenza B treated with salicylates
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

29. What are the complications of acute pancreatitis
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Lactase is located at the tips of intestinal villi
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

30. What does TOASTED with alcoholic hepatitis stand for
Menetriers disease
Meconium ileus
Hernia
AST >ALT - ration is usually 1.5

31. To what substance is bilirubin conjugated and why
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Dermatitis herpetiformis
Glucouronate - water soluble (direct)
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

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

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33. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Duodenal atresia - Downs
Short gastrics - left greater and lesser
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Adhesion

34. What does K- ras mutation cause
Upregulated intracellular signal transduction
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Pancreatic head causing obstructive jaundice
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

35. Autodigestion of pancreas by pancreatic enzymes
Positive
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Glucouronate - water soluble (direct)
Acute pancreatitis

36. What are the histological findings in the duodenum

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37. What kind of diarrhea is produced from a disaccharide def
Osmotic
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
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Downs

38. trypsinogen is converted to trypsin via what enzyme
Volvulus
Femoral hernia
T cell lymphoma
Enterokinase/enteropeptidase from the duodenal mucosa

39. What is biliary colic
True and most common congenital anomoly of GI tract
Dec PGE2 leading to dec gastric mucosa protection
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Begins starch digestion - inactivated by low pH upon reaching the stomach

40. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
Positive
Hepatic steatosis
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

41. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
FAP
Zollinger Ellison - phenylalanine and tryptophan
Glucose dependent insulinotropic peptide
Ischemic colitis

42. What are the complications of chronic pancreatitis
Brunners
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Dilated esophagus with an area of distal stenosis - birds beak
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

43. How does loss of NO secretion affect the esophagus and what results
Pertechnetate - study for uptake
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Inc lower esphogeal tone leading to achalasia
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

44. concentric onion skin bile duct fibrosis
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Primary sclerosing cholangitis
Failure of neural crest migration
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

45. crigler - najjar type II responds to which therapy and How does it work
Primarly through ECL leading to histamine release
Phenobarbital - inc liver enzyme synthesis
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

46. How does hirschsprung present and appear on imaging
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
Esophageal carcinoma
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Low pressure proximal to LES

47. HCC is associated with what other conditions
Mitochondrial abnl - fatty liver - hypoglycemia - coma
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Hemolytic anemia

48. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Glucose dependent insulinotropic peptide
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
...
Duodenal atresia - Downs

49. What is the presenting course for appendicity

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50. rare - often fatal childhood hepatoencephalopathy

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