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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. Autoantibodies to gluten (gliadin) in wheat and other grains
No
Poor anastamoses
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Celiac sprue

2. What are the common causes of gastric ulcers - What causes gastric ulcer
Pertechnetate - study for uptake
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Cholesterol - 10-20% opaque due to calcifications

3. What is the other name for GIP (gastric inhibitory peptide)
Antrum - H.pylori - inc risk of MALT lymphoma
Smooth
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Glucose dependent insulinotropic peptide

4. Where are oligosaccharide hydrolases and What do they do
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
Virchow's node
Brush border of intestine - produce monosaccharides from oligo and di
Osmotic

5. What does a gastrinoma cause
Gut bacteria
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
In the ileum with bile acids - requires IF
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

6. What are motilin receptor agonists used for clinically
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
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
Stimulate intestinal persistalsis

7. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Peyers patches
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
AST >ALT - ration is usually 1.5
Elevated amylase - and lipase

8. What are the tumor markers for pancreatic adenocarcinoma
CEA - CA-19-9
Gut bacteria
Inc conj bilirubin - inc cholesterol - inc alk phos
Carcinoid syndrome

9. What histological findings are present in the esophagus
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Nonkeritinized stratified sqamous epithelium
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

10. what kind of fistula is associated with diverticulitis
Colovesical leading to pneumaturia
Hernia
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Via the middle colic

11. What is the most common esophageal cancer worldwide and in the US
FAP
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Redundant mesentary
Worldwide - SC - US - adeno

12. What artery passes around the duodenum
Inferior rectal nerve
The gastroduodenal
FAP
Redness and tenderness on palpation of extremities

13. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Internal thoracic to superior epigastric to inferior epigastric
Failure of the processus vagainlis to close
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Right and left hepatic duct

14. Which IBD is autoimmune and which may be a disordered response to bacteria
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Lamina propria
Menetriers disease
Positive urease test

15. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Celiac sprue
Lamina propora and submucosa
Alpha amylase
When diffusely infiltrative - thickened rigid appearance like a leather bottle

16. How does abetalipoproteinemia lead to malabsorption
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Splenic flexure
Brush border of intestine - produce monosaccharides from oligo and di
Lye ingestion and acid reflux

17. Between what structures do strong anastamoses exist
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Ischemic colitis
Left and right gastroepiploics - left and right gastrics
Osmotic

18. somatostatin - source - action - regulation
M3 - Gq - inc IP3/Ca
Phototherapy
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
Peptic ulcer disease

19. How does loss of NO secretion affect the esophagus and what results
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
All 3
Diarrhea - steatorrhea - weight loss - weakness
Inc lower esphogeal tone leading to achalasia

20. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Budd chiari syndrome
Peutz jeghers
Turcot
T cell lymphoma

21. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Repeated phlebotomy - deferoxamine - HLA- A3
Alpha amylase
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Intussusception

22. What kind of cancer to celiac sprue put you as inc risk for
Splenic flexure
Striated
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
T cell lymphoma

23. Cholecytsokinin - source - action - regulation
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
Alcoholic cirrhosis
Phototherapy
MSI (15%) and APC/beta catenin chromosomal instability (85%)

24. What is the HLA association and treatment for hemochromatosis
Repeated phlebotomy - deferoxamine - HLA- A3
Epigastric abdominal pain radiating to back - anorexia - nausea
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

25. What does bicarb do in the duodenum
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Mucosa - submucosa - muscularis externa - serosa/adventitia
Hirschsprungs
Cystic duct and common hepatic duct

26. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Via the superior pancreaticduodenal
Unconjugated - water insoluble
Striated and smooth
Worldwide - SC - US - adeno

27. What structure is Not contained in the femoral sheath
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Duodenal atresia - Downs
Gut bacteria

28. What are the complications of duodenal PUD
Bleeding - penetration into pancreas - perforation - obstruction
Hyperpigmented mouth - lips - hands - genitalia
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Stimulate the H/K ATPase

29. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Cystic dilation of the viteline duct
Hepatic steatosis
True and most common congenital anomoly of GI tract
Gamma glutamyl transferase GGT

30. What are the effects of atropine on parietal cells and G cells
Falciform - ligamentum teres - fetal umbilical vein
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
90%
Oligosaccharide digestion

31. rare - often fatal childhood hepatoencephalopathy

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32. What are the extraintestinal manifestations of crohns
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
External (superficial) ring only
M3 - Gq - inc IP3/Ca

33. Where does copper accumulate in Wilsons and What are ABCD
Left gastric vein and esophogeal vein - esophagus
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
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
AR

34. How does brain injury lead to acute gastritis and What is it called
Failure of neural crest migration
T cell lymphoma
Meconium ileus
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

35. secretin - source - action - regulation
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
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
Normal

36. What drug blocks the H2R
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Cimetidine
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Pertechnetate - study for uptake

37. vasoactive intestinal polypeptide (VIP) - source - action - regulation
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
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
In the ileum with bile acids - requires IF
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

38. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Conj/unconj - inc - nl to dec
So hypertrophied they look like brain gyri
Barrett's esophagus
Hirschsprungs

39. When do you see hypertrophy of brunners glands
Duodenal atresia - Downs
Phenobarbital - inc liver enzyme synthesis
Osmotic
Peptic ulcer disease

40. What complication can arise from indirect inguinal hernias
AR
Chronic calcifying pancreatitis - inc risk of panreatic cancer
2ndary biliary cirrhosis
Hydrocele

41. conjugated hyperbilirubinemia due to defective liver excretion
Punched out - clean margins - carcinoma =raised irregular margins
Dubin johnson
Necrotizing enterocolitis
Hypotonic because of more time to reabsorb NaCl

42. What are additional risk factors for CRC
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Early childhood - neuro sx and malabsorption
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Fe2+ in the duod

43. With internal hemorrhoids Where is the anastomoses and Where is it
Superior rectal and middle and inferior rectal - rectum
Gallbladder
Sphincter of oddi
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

44. Where does type B chronic gastritis occur and What causes it
Antrum - H.pylori - inc risk of MALT lymphoma
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

45. How does gastrin increase acid secretion?
Primarly through ECL leading to histamine release
Parietal cells in the stomach - B12 binding protein
L/R renal artery around L1
Lamina propora and submucosa

46. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Lateral to the inferior epigastric artery
Crohns = noncaseating granulomas - UC = crypt abscesses

47. What are the labs in acute pancreatitis
Elevated amylase - and lipase
Budd chiari syndrome
Pertechnetate - study for uptake
Positive urease test

48. What transforms conjugated bilirubin to urobilinogen
H pylori (almost 100%)
Gut bacteria
Peyers patches
L1

49. What is the rate limiting step of carbohydrate digestion
Uridine glucuronyl transferase
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Gamma glutamyl transferase GGT
Oligosaccharide digestion

50. Which area of the hindgut is a watershed area
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Splenic flexure
Crohns = maybe - UC= always
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes