Test your basic knowledge |

USMLE GI

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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 kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Pancreatic and bile
Cholesterol - 10-20% opaque due to calcifications
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

2. Which serum enzyme increases with heavy EtOH consumption
Alcoholic cirrhosis
Gamma glutamyl transferase GGT
Complications of crohns
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

3. why infxn is implicated in duodenal PUD
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
H pylori (almost 100%)
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
90%

4. What is pancreatic adenocarcinoma associated with
Bleeding - penetration into pancreas - perforation - obstruction
Cigarettes and chronic pancreatitis - not EtOH
Superior rectal and middle and inferior rectal - rectum
Jewish and African American men

5. What is the rate limiting step of carbohydrate digestion
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Oligosaccharide digestion
With albumin

6. Gastrin - source - action - regulation
Increase tumorigenesis
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
Cimetidine
Worldwide - SC - US - adeno

7. Progressive dyshphage beginning with solids and moving to liquids and weight loss
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Menetriers disease
Esophageal cancer
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

8. How is bilirubin carried in the blood
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
With albumin
12 waves/min
Inspiratory arrest on deep palpation due to pain

9. What are the extraintestinal manifestations of ulcerative colitis
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Lamina propria
Pyoderma gangrenosum - primary sclerosing cholangitis

10. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Alk pho
Hemosiderosis - hemochromatosis
Black - rotors syndrome

11. What is the most common indication of emergent abdominal surgery in children
Primarly through ECL leading to histamine release
Appendicitis
AST
Warthins' tumor

12. To what substance is bilirubin conjugated and why
H pylori (almost 100%)
Glucouronate - water soluble (direct)
Conj - inc - dec
Chagas disease

13. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Hypercoaguability - polycythemia vera - pregnancy - HCC
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

14. Who gets gastric ulcers
Older patients
Downs
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Reye's syndrome

15. What does a low flow rate mean for saliva
Cystic dilation of the viteline duct
Hypotonic because of more time to reabsorb NaCl
Gallbladder
Esophageal cancer

16. Why does indirect inguinal hernia happen in infacnts
Redundant mesentary
The submucosal nerve plexus - meissner's
Failure of the processus vagainlis to close
Peyers patches

17. subQ peribumbilical metastasis
Internal thoracic to superior epigastric to inferior epigastric
Sister mary joseph nodule
Alk phos
Backup of blood into the liver - RHF - budd chiari

18. conjugated hyperbilirubinemia due to defective liver excretion
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Pertechnetate - study for uptake
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Dubin johnson

19. What other condition can lead to acute gastritis - think renal
Uremia
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
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

20. What structures feed into the cystic duct
Terminal ileum and colon
Gallbladder
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

21. What is contained in the gastrosplenic and What areas does it separate
Short gastrics - left greater and lesser
Inc lower esphogeal tone leading to achalasia
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Urobilin

22. What kind of anemia is in Wilsons
All 3
Colonic polyps
Hemolytic anemia
Left and right gastroepiploics - left and right gastrics

23. How do villi appear in disaccharidease def
Older patients
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Normal
HSV-1 - CMV - Candida

24. What serum enzyme is elevated in acute pancreatitis and mumps
VZV and influenza B treated with salicylates
Amylase
Cholesterol - 10-20% opaque due to calcifications
The entire

25. Achalasia can be secondary to what infectious disease common in South America
Complications of crohns
Chagas disease
So hypertrophied they look like brain gyri
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

26. What are additional risk factors for CRC
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
GLUT 2
Stercobilin
GERD - may also present with nocturnal cough and dyspnea

27. involvement of left supraclavicular node by mets from stomach

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

28. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Oral glucose
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
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

29. What are the effects of atropine on parietal cells and G cells
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
T12
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
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

30. Is there any structural abnl with IBS - What is the course of disease and presentation
Fe2+ in the duod
L3
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Acute pancreatitis

31. Which kind of hemorrhoids are painful and why
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Right and left hepatic duct
Black - rotors syndrome
Skip lesions =crohns - colon = UC

32. Where does type A chronic gastritis occur and What causes it
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
Zollinger ellison - brunners glands
Boerhaave's Syndrome - Been heaving syndrome
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

33. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
3 waves/min
Below
Hemosiderosis - hemochromatosis
Causes of gall stones

34. What are the ABCDEF of esophageal cancer
Muscularis mucosae
H2 receptor - inc cAMP
Left gastric vein and esophogeal vein - esophagus
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

35. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Hirschsprungs
NAV = nerve artery vein - venous near the penis (NAVEL)
Terminal ileum and colon
Hypotonic because of more time to reabsorb NaCl

36. What is Trousseau's sign
Brunners
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Redness and tenderness on palpation of extremities

37. What does primary sclerosing cholangitis lead to...
Alk phos
Diverticulum
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Dense core bodies

38. What is contained within the submucosa

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

39. What are the signs and symptoms of budd chiari
Gardner's syndrome
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
Serous on the sides parotids - mucinous in the middle sublingual
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD

40. When and How does Abetalipoproteinemia present
Begins starch digestion - inactivated by low pH upon reaching the stomach
Early childhood - neuro sx and malabsorption
HPNCC
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

41. Where does copper accumulate in Wilsons and What are ABCD
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Phenobarbital - inc liver enzyme synthesis
Dilated esophagus with an area of distal stenosis - birds beak
Bleeding - intussusception - volvulus - obstruction near terminal ileum

42. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Common hepatic - splenic - left gastric - main blood supply for stomach
HSV-1 - CMV - Candida
Intussusception

43. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Conj - inc - dec
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
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

44. How does hirschsprung present and appear on imaging
Alfatoxin in peanuts
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
CHF and inc risk of HCC
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

45. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Dilated esophagus with an area of distal stenosis - birds beak
...
Gamma glutamyl transferase GGT
Zollinger ellison - brunners glands

46. Which viral infxns/treatments are associated with reyes syndrome
Fe2+ in the duod
Dermatitis herpetiformis
Pertechnetate - study for uptake
VZV and influenza B treated with salicylates

47. Dysphagia in achalasia results from
Chronic gastritis and pernicious anemia
Krukenbergs tumor
Cirrhosis
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

48. What are the midgut structures and what supplies their blood and PANS innervation
Inc lower esphogeal tone leading to achalasia
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Enterokinase/enteropeptidase from the duodenal mucosa
Sister mary joseph nodule

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

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

50. If the abdominal aorta is blocked - How does blood get to the left colic artery
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Neural muscarinic pathways
Gastrohepatic ligament
Via the middle colic