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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 are the ABCDEF of esophageal cancer
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Small intestine

2. Between what structures do strong anastamoses exist
Gastric glands
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Left and right gastroepiploics - left and right gastrics
No

3. What are the signs and symptoms of budd chiari
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Old men - arthralgias - cardiac and neuro sx
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

4. What kind of digestion is bile needed for
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Peptic ulcer disease
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Pancreatic and bile

5. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Unconj - absent (acholuria) - inc
Superior rectal
Juvenille polyps - no risk if single
Stercobilin

6. What is the classic triad of hemochromatosis

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7. Where and How is iron absorbed
Lipase - phospholipase A - colipase
Fe2+ in the duod
Appendicitis
L2

8. What are the barium swallow findings of achalasia
Osmotic
Dilated esophagus with an area of distal stenosis - birds beak
Old men - arthralgias - cardiac and neuro sx
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

9. What does TOASTED with alcoholic hepatitis stand for
Neural muscarinic pathways
AST >ALT - ration is usually 1.5
Spleen to posterior abdominal wall - splenic artery and vein
Adhesion

10. What are the extraintestinal manifestations of crohns
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Unconjugated - water insoluble
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

11. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Dubin johnson
Epithelium
Neutralizes oral bacertial acids and maintains dental health
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

12. How is bilirubin carried in the blood
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Unconj - absent (acholuria) - inc
With albumin
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

13. Where does type A chronic gastritis occur and What causes it
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Uridine glucuronyl transferase
Parietal cells in the stomach - B12 binding protein
Ceruplasmin

14. How many layers of spermatic fascia are covers an indirect inguinal hernia
All 3
Bleeding - penetration into pancreas - perforation - obstruction
Repeated phlebotomy - deferoxamine - HLA- A3
Redness and tenderness on palpation of extremities

15. concentric onion skin bile duct fibrosis
Brunners
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Averages 6 months - very aggressive - usually already metastasized at presentation
Primary sclerosing cholangitis

16. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Chagas disease
Peutz jeghers
Left and right gastroepiploics - left and right gastrics
Alcoholic cirrhosis

17. What is the most important mechanism in gastric acid secretion
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
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
Phenobarbital - inc liver enzyme synthesis
90%

18. When and why is stomach cancer termed linitis plastica
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
When diffusely infiltrative - thickened rigid appearance like a leather bottle
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

19. What is the frequency of basal electric rhythm in the duodenum
12 waves/min
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
IBS at least 2 with recurrent abdominal pain
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

20. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Lubricate food (glycoprotiens)
Unconjugated - water insoluble
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Above

21. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
L4
Colonic polyps
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
T cell lymphoma

22. What carcinogens are associated with HCC
Inguninal ligament - sartorius muscle - adductor longus
Inferior rectal nerve
Alfatoxin in peanuts
Increase tumorigenesis

23. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Achalasia due to loss of myenteric plexus (auberach)
Gardner's syndrome
Alk pho

24. What are esophageal strictures associated with
Mucosa - submucosa - muscularis externa - serosa/adventitia
Lye ingestion and acid reflux
Budd chiari syndrome
AR

25. secretin - source - action - regulation
Trypsin - chymotrypsin - elastase - carboxypeptidases
Ischemic colitis
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
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

26. What receptor does histamine bind on the parietal cell and What does it activate
H2 receptor - inc cAMP
Cirrhosis
Complications of crohns
Lamina propora and submucosa

27. What are the tumor markers for pancreatic adenocarcinoma
CEA - CA-19-9
Oligosaccharide digestion
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Begins starch digestion - inactivated by low pH upon reaching the stomach

28. What is the path of an indirect inguinal hernia
Can lead to hematemesis - found in EtOHics and bulimics
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Ischemic colitis
Left gastric vein and esophogeal vein - esophagus

29. What does bicarb do in the duodenum
Neutralizes gastric acid allowing pancreatic enzymes to fxn
IgA secreting plasma cells - ultimately reside in the lamina proporia
8-9 waves/min
Penicillinamine - AR inheritance

30. What are the histological findings in the jejunum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Peptic ulcer disease
Urobilin
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

31. What does primary sclerosing cholangitis lead to...
IgA secreting plasma cells - ultimately reside in the lamina proporia
Tropical sprue
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Trypsin - chymotrypsin - elastase - carboxypeptidases

32. What are the common causes of gastric ulcers - What causes gastric ulcer
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Inc conj bilirubin - inc cholesterol - inc alk phos
Backup of blood into the liver - RHF - budd chiari

33. Who gets gastric ulcers
Small intestine
Older patients
Primary sclerosing cholangitis
Fasting and stress

34. What are the four Fs of gallstones
Dec PGE2 leading to dec gastric mucosa protection
Brush border of intestine - produce monosaccharides from oligo and di
Female - fat - fertile - forty
Liver metabolizes 5HT

35. What skin condition is associated with celiac sprue
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Gardner's syndrome
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Dermatitis herpetiformis

36. A protrusion of peritoneum through an opening - usually a site of weakness
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Hernia
Inc conj bilirubin - inc cholesterol - inc alk phos
Angiodysplasia

37. Gastrin - source - action - regulation
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
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Can lead to hematemesis - found in EtOHics and bulimics
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

38. What is pancreatic adenocarcinoma associated with
Spleen to posterior abdominal wall - splenic artery and vein
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
90%
Cigarettes and chronic pancreatitis - not EtOH

39. What does bicab do in the mouth
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Neutralizes oral bacertial acids and maintains dental health
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Right and left hepatic duct

40. With internal hemorrhoids Where is the anastomoses and Where is it
The gastroduodenal
Inc conj bilirubin - inc cholesterol - inc alk phos
True and most common congenital anomoly of GI tract
Superior rectal and middle and inferior rectal - rectum

41. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Zollinger Ellison - phenylalanine and tryptophan
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
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
AST >ALT - ration is usually 1.5

42. What type of insults result in micronodular cirrhosis
Oligosaccharide digestion
Cholesterol
Omeprazole
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

43. What percentage of gall stones are cholesterol stones and What are the associations
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
AR
Mallory bodies
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

44. involvement of left supraclavicular node by mets from stomach

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45. multiple juvenil polyps in GI tract - risk
Striated and smooth
Cholesterol - 10-20% opaque due to calcifications
AST>ALT
Juvenile polyposis syndrome - inc risk of adenocarcinoma

46. What is the epi for CRC
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Zenkers - halitosis - dysphagia and obstruction

47. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Carcinoid syndrome
Female - fat - fertile - forty
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
GERD - may also present with nocturnal cough and dyspnea

48. What test and result confirms H pylori infxn
Conj/unconj - inc - nl to dec
Alk pho
L2
Positive urease test

49. What causes hirschsprungs
Fe2+ in the duod
Decreased intercellular adhesion and increased proliferation
Failure of neural crest migration
Meconium ileus

50. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Left gastric vein and esophogeal vein - esophagus
Cystic dilation of the viteline duct
Hypercoaguability - polycythemia vera - pregnancy - HCC
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue