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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. What causes hirschsprungs
Bleeding - penetration into pancreas - perforation - obstruction
Heme metabolism
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Failure of neural crest migration

2. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Primarly through ECL leading to histamine release
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

3. What kind of muscle is in the middle 1/3 of esophagus
Striated and smooth
Where hindgut meets ectoderm
Inguninal ligament - sartorius muscle - adductor longus
AST>ALT

4. What are the histological findings in the duodenum

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5. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Chagas disease
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Inc risk of CRC and other visceral malignancies
Lactase is located at the tips of intestinal villi

6. Where is there sclerosis in alcoholic cirrohosis
Redundant mesentary
Inspiratory arrest on deep palpation due to pain
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Around the central vein (zone III)

7. What is the other name for GIP (gastric inhibitory peptide)
Small intestine
Positive
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Glucose dependent insulinotropic peptide

8. What are the hindgut structures and what supplies their blood and PANS innvervation
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Causes of gall stones
All 3

9. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis

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10. What are the treatmet options for crohns
Lamina propora and submucosa
Corticosteroids - infliximab
Cystic dilation of the viteline duct
Right and left hepatic duct

11. What is the leading cause of bowel incarceration
Femoral hernia
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Myenteric nerve plexus - aurbach
Oligosaccharide digestion

12. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
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
Urobilin
Amylase
Superior rectal

13. What reaction does salivary amylase catalyze
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Unconj - absent (acholuria) - inc
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

14. What layer of fascia covers a direct inguinal hernia
External spermatic fascia only
Punched out - clean margins - carcinoma =raised irregular margins
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

15. Where is the pectinate line
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Peptic ulcer disease
Where hindgut meets ectoderm
Striated

16. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
FAP
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
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Pancreatic head causing obstructive jaundice

17. Where are oligosaccharide hydrolases and What do they do
Brush border of intestine - produce monosaccharides from oligo and di
Angiodysplasia
Carcinoid syndrome
Superior rectal and middle and inferior rectal - rectum

18. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Below
CHF and inc risk of HCC
Downs

19. what percentage of colonic polyps are non - neoplastic
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Internal thoracic to superior epigastric to inferior epigastric
Unconj - absent (acholuria) - inc
90%

20. What is a positive murphy's sign
AST >ALT - ration is usually 1.5
Inspiratory arrest on deep palpation due to pain
Centrilobular leading to congestive liver disease
Crigler - najjar type 1

21. What congenital birth defect is associated with Hirschsprung
Spleen to posterior abdominal wall - splenic artery and vein
Downs
So hypertrophied they look like brain gyri
Lipase

22. What does TOASTED with alcoholic hepatitis stand for
AST >ALT - ration is usually 1.5
Inc risk of CRC and other visceral malignancies
Stercobilin
L/R renal artery around L1

23. What conditions are associated with budd chiari
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Hypercoaguability - polycythemia vera - pregnancy - HCC
Glucose dependent insulinotropic peptide
Neutralizes oral bacertial acids and maintains dental health

24. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Increase tumorigenesis
Menetriers disease
Liver metabolizes 5HT
Lubricate food (glycoprotiens)

25. What test and result confirms H pylori infxn
External (superficial) ring only
H2 receptor - inc cAMP
Glucouronate - water soluble (direct)
Positive urease test

26. What are the layers of the gut wall from inside out
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Inc conj bilirubin - inc cholesterol - inc alk phos
Appendicitis
Mucosa - submucosa - muscularis externa - serosa/adventitia

27. What histological findings are present in the esophagus
Meckels
Nonkeritinized stratified sqamous epithelium
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
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

28. What is the frequency of basal electric rhythm of the stomach
Alcoholic cirrhosis
3 waves/min
Early childhood - neuro sx and malabsorption
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

29. What are causes of extrahepatic biliary obstruction
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Antrum - H.pylori - inc risk of MALT lymphoma
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

30. FAP + malignant CNS tumor
Normal
Right and left hepatic duct
Acute pancreatitis
Turcot

31. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Cholesterol - 10-20% opaque due to calcifications
HPNCC
Epithelium
Juvenille polyps - no risk if single

32. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Pancreatic and bile
Hemosiderosis - hemochromatosis
Carcinoid syndrome
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

33. Where and How is iron absorbed
HSV-1 - CMV - Candida
Cystic dilation of the viteline duct
Fe2+ in the duod
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

34. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Colovesical leading to pneumaturia
IgA secreting plasma cells - ultimately reside in the lamina proporia
Gallbladder
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

35. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Meconium ileus
Inguninal ligament - sartorius muscle - adductor longus
L2
Femoral hernia

36. What kind of anemia is in Wilsons
Hemolytic anemia
90%
Antrum - H.pylori - inc risk of MALT lymphoma
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

37. What is the epi for CRC
Unconj - absent (acholuria) - inc
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Hernia
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

38. What are the extraintestinal manifestations of crohns
Lipase
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Inc risk of CRC and other visceral malignancies
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

39. What structures feed into the cystic duct
Hemolytic anemia
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Averages 6 months - very aggressive - usually already metastasized at presentation
Gallbladder

40. What drug inhibits the H/K ATPase
Omeprazole
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Old men - arthralgias - cardiac and neuro sx
Begins starch digestion - inactivated by low pH upon reaching the stomach

41. What are the histological findings in the jejunum
H+
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Antrum - H.pylori - inc risk of MALT lymphoma

42. What is the characteristic histo finding in alcoholic hepatitis
Brush border of intestine - produce monosaccharides from oligo and di
Pancreatic and bile
No
Mallory bodies

43. What do mucins do?
All 3
Gastrohepatic ligament
Lubricate food (glycoprotiens)
The submucosal nerve plexus - meissner's

44. How does CRC present in the distal and proximal colon
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
External spermatic fascia only
H+
Colonic polyps

45. What are the signs and symptoms of budd chiari
Gastrohepatic ligament
Adhesion
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

46. What do you use to diagnose meckels
Krukenbergs tumor
T12
Pertechnetate - study for uptake
Hypotonic because of more time to reabsorb NaCl

47. Autodigestion of pancreas by pancreatic enzymes
Sister mary joseph nodule
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Acute pancreatitis
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

48. What is the main symptom if a VIPoma
External spermatic fascia only
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Older patients
Obstruction of the common bile duct

49. Which kind of hemorrhoids are painful and why
Cystic dilation of the viteline duct
Cystic duct and common hepatic duct
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

50. concentric onion skin bile duct fibrosis
Uremia
Primary sclerosing cholangitis
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Gastrohepatic ligament