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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. Where and How is iron absorbed
Pancreatic head causing obstructive jaundice
Fe2+ in the duod
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Warthins' tumor

2. What does GET SMASHED stand for in acute pancreatitis
Inc lower esphogeal tone leading to achalasia
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
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
Averages 6 months - very aggressive - usually already metastasized at presentation

3. What kind of lesions are characteristic of duodenal PUD vs cancer
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
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
Punched out - clean margins - carcinoma =raised irregular margins
Dysphagia (due to esophageal web) - glossitis - iron def anemia

4. What are the histological findings in the ileum

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5. How do NSAIDs cause acute gastritis
Smooth
Brush border of intestine - produce monosaccharides from oligo and di
Dec PGE2 leading to dec gastric mucosa protection
HPNCC

6. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
AST>ALT
AST
Serous on the sides parotids - mucinous in the middle sublingual
Hepatic steatosis

7. multiple juvenil polyps in GI tract - risk
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Hepatic steatosis

8. If trypsin activates more trypsinogen - what kind of feedback loop is established
Positive
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Causes of gall stones
Poor anastamoses

9. What are the foregut structures and what supplies their blood and PANS innvervation
Skip lesions =crohns - colon = UC
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Decreased intercellular adhesion and increased proliferation
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

10. What nerve innervates the external hemorrhoids
Alcoholic cirrhosis
Epithelium
Inferior rectal nerve
Carcinoid syndrome

11. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Duodenum - 2nd - 3rd and 4th parts
Complications of crohns
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Esophageal cancer

12. What does loss of p53 cause
Heme metabolism
Dubin johnson
Increase tumorigenesis
Inc smooth muscle relaxation - including lower esophageal sphincter

13. What causes carcinoid syndrome amd What are the symptoms
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Pancreatic and bile
H pylori (almost 100%)
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

14. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Striated and smooth
Complications of crohns
Alcoholic cirrhosis
Alpha amylase

15. Which area of the hindgut is a watershed area
Via the middle colic
Splenic flexure
The jejunum
Below

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

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17. What causes pancreatic insuff and What does it cause
Positive
Redundant mesentary
Redness and tenderness on palpation of extremities
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

18. What layer in the mucosa is responsible for support
Brunners
Inc conj bilirubin - inc cholesterol - inc alk phos
Lamina propria
Inferior rectal nerve

19. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Brunners
VZV and influenza B treated with salicylates
Complications of crohns
90%

20. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Penicillinamine - AR inheritance
L4
Unconjugated - water insoluble
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

21. What is the frequency of basal electric rhythm of the stomach
Dubin johnson
Mitochondrial abnl - fatty liver - hypoglycemia - coma
3 waves/min
Averages 6 months - very aggressive - usually already metastasized at presentation

22. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Hyperplastic
Celiac sprue
Crohns = maybe - UC= always
CHF and inc risk of HCC

23. What are the barium swallow findings of achalasia
Around the central vein (zone III)
CEA - CA-19-9
Crypts but not villi
Dilated esophagus with an area of distal stenosis - birds beak

24. What causes primary biliary cirrhosis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Budd chiari syndrome
Phenobarbital - inc liver enzyme synthesis
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

25. inflammatino of gallbadder
Glucouronate - water soluble (direct)
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Hirschsprungs
AST>ALT

26. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Cystic duct and common hepatic duct
12 waves/min
Warthins' tumor

27. How many layers of spermatic fascia are covers an indirect inguinal hernia
All 3
L1
Urobilin
No

28. If the abdominal aorta is blocked - How does blood get to the left colic artery
Via the middle colic
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Black - rotors syndrome
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

29. How is salivary secretion stimulated
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Meckels
Gut bacteria

30. What are the structures of the femoral triangle and how are they organized
NAV = nerve artery vein - venous near the penis (NAVEL)
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
GLUT 2
Fasting and stress

31. What is contained within the submucosa

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32. rare - often fatal childhood hepatoencephalopathy

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33. What cell produces IF and What does it do
Redundant mesentary
Parietal cells in the stomach - B12 binding protein
Alfatoxin in peanuts
Krukenbergs tumor

34. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
The proximal small bowel
VZV and influenza B treated with salicylates
Repeated phlebotomy - deferoxamine - HLA- A3
2ndary biliary cirrhosis

35. What receptor does histamine bind on the parietal cell and What does it activate
H2 receptor - inc cAMP
Common hepatic - splenic - left gastric - main blood supply for stomach
Dysphagia (due to esophageal web) - glossitis - iron def anemia
The entire

36. What is the risk with peutz jehgers
3 waves/min
Pancreatic head causing obstructive jaundice
Conj/unconj - inc - nl to dec
Inc risk of CRC and other visceral malignancies

37. What is the epi for CRC
US and cholecystectomy
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
HPNCC
Hydrocele

38. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Conj/unconj - inc - nl to dec
Alk pho
AR

39. most common non - neoplastic polyp in colon
Hyperplastic
Intussusception
IBS at least 2 with recurrent abdominal pain
Stimulate the H/K ATPase

40. What kind of insults results in macronodular cirrhosis
Complications of UC
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Hydrocele
2ndary biliary cirrhosis

41. What is the ddx associated with appendicitis
True and most common congenital anomoly of GI tract
Dissaccharidase def - most commonly lactase
M3 - Gq - inc IP3/Ca
Diverticulitis in elderly - ectopic pregs use hCG to rule out

42. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Inferior rectal nerve
GERD - may also present with nocturnal cough and dyspnea
Alfatoxin in peanuts
Peutz jeghers

43. What are the tumor markers for pancreatic adenocarcinoma
CEA - CA-19-9
Glucouronate - water soluble (direct)
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
All 3 gut layers outpouch as in Meckels

44. What are the signs of peutz jehgers
Barrett's esophagus
Hyperpigmented mouth - lips - hands - genitalia
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Oligosaccharide digestion

45. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Hypotonic because of more time to reabsorb NaCl
Ischemic colitis
Necrotizing enterocolitis
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

46. bilateral mets to ovaries with abundant mucus - signet ring cells
Downs
Peptic ulcer disease
Krukenbergs tumor
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

47. Where is folate absorbed
The jejunum
Falciform - ligamentum teres - fetal umbilical vein
Colovesical leading to pneumaturia
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa

48. What does histo show for alpha1 antitrypsin def
PAS- positive globules in liver -
Brunners
Zenkers - halitosis - dysphagia and obstruction
Hemolytic anemia

49. In alchoholic hepatitis which liver enzyme is higher
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Pertechnetate - study for uptake
AST>ALT

50. What is the lumen of the pancreatic duct
Jaundice - fever - RUQ
Primary sclerosing cholangitis
Dilated esophagus with an area of distal stenosis - birds beak
Ampulla of vater