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. Which serum enzyme increases with heavy EtOH consumption
Stimulate the H/K ATPase
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Decreased intercellular adhesion and increased proliferation
Gamma glutamyl transferase GGT

2. To what substance is bilirubin conjugated and why
Glucouronate - water soluble (direct)
Around the central vein (zone III)
Neutralizes oral bacertial acids and maintains dental health
Dubin johnson

3. What is biliary colic
Boerhaave's Syndrome - Been heaving syndrome
Pleuroperitoneal
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Hyperplastic

4. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Lipase - phospholipase A - colipase
Complications of UC
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
L1

5. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Worldwide - SC - US - adeno
Pertechnetate - study for uptake
NAV = nerve artery vein - venous near the penis (NAVEL)
FAP

6. What infection causes Whipple disease and What can you see on LM
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Lamina propria
True and most common congenital anomoly of GI tract
Alk phos

7. What are the effects of atropine on parietal cells and G cells
Inguninal ligament - sartorius muscle - adductor longus
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
H pylori (almost 100%)
Poor anastamoses

8. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Intussusception
External (superficial) ring only
Striated
Obstruction of the common bile duct

9. 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
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Smooth
Neutralizes gastric acid allowing pancreatic enzymes to fxn

10. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Phenobarbital - inc liver enzyme synthesis
Krukenbergs tumor
HSV-1 - CMV - Candida
Smooth

11. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Hirschsprungs
Penicillinamine - AR inheritance
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Menetriers disease

12. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Uridine glucuronyl transferase
Positive
Hemosiderosis - hemochromatosis
Goes through deep inguinal ring - external inguinal ring and into the scrotum

13. Are single polyps malignant in peutz jehgers
GLUT 2
No
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Short gastrics - left greater and lesser

14. What are the longterm sequelae of nutmeg liver
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Backup of blood into the liver - RHF - budd chiari
Centrilobular congestion and necrosis - cardiac cirrhosis
Ceruplasmin

15. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
True and most common congenital anomoly of GI tract
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

16. What is the frequency of basal electric rhythm in the duodenum
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
12 waves/min
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

17. Who gets gastric ulcers
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Older patients
Neural muscarinic pathways
Crigler - najjar type 1

18. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
NAV = nerve artery vein - venous near the penis (NAVEL)
Boerhaave's Syndrome - Been heaving syndrome
IBS at least 2 with recurrent abdominal pain

19. What are the two molecular pathways that lead to CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
MSI (15%) and APC/beta catenin chromosomal instability (85%)

20. What causes carcinoid syndrome amd What are the symptoms
Unconjugated - water insoluble
Myenteric nerve plexus - aurbach
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Crigler - najjar type 1

21. In what scenarios do pts with gilberts have inc bili
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Fasting and stress
Short gastrics - left greater and lesser
GERD - may also present with nocturnal cough and dyspnea

22. What are motilin receptor agonists used for clinically
Stimulate intestinal persistalsis
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Conj - inc - dec
Reye's syndrome

23. How does CRC present in the distal and proximal colon
Heme metabolism
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Bleeding - intussusception - volvulus - obstruction near terminal ileum

24. What are the main components of bile
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Alcoholic hepatitis
Intussusception
With albumin

25. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Superior rectal
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Lipase - phospholipase A - colipase
Upregulated intracellular signal transduction

26. What does bicarb do in the duodenum
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Striated and smooth
Barrett's esophagus
Low pressure proximal to LES

27. With caput medusaw - between what vessels is the anastomoses and Where is it
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Paraumbilical and superficial and inferior epigastric - umbilicus
Worldwide - SC - US - adeno
EtOH

28. How do NSAIDs cause acute gastritis
Dec PGE2 leading to dec gastric mucosa protection
Gut bacteria
Cholesterol
3 waves/min

29. What does K- ras mutation cause
Neural muscarinic pathways
L1
Upregulated intracellular signal transduction
Positive urease test

30. What are the complications of Meckels
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Femoral hernia
Smooth
Sister mary joseph nodule

31. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus

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

32. what percentage of colonic polyps are non - neoplastic
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Ischemic colitis
90%
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

33. At what spinal level does the SMA exit
L1
L3
Zenkers - halitosis - dysphagia and obstruction
Crohns = noncaseating granulomas - UC = crypt abscesses

34. What converts inactive pepsinogen to pepsin
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Peptic ulcer disease
Virchow's node
H+

35. What is the clinical presentation of acute pancreatitis
Epigastric abdominal pain radiating to back - anorexia - nausea
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Cimetidine
Inferior rectal nerve

36. trypsinogen is converted to trypsin via what enzyme
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
GLUT 2
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Enterokinase/enteropeptidase from the duodenal mucosa

37. What test and result confirms H pylori infxn
Chagas disease
Positive urease test
Inc smooth muscle relaxation - including lower esophageal sphincter
Unconj - absent (acholuria) - inc

38. Who gets Whipple disease and How do they present
Unconj - absent (acholuria) - inc
Jewish and African American men
Ischemic colitis
Old men - arthralgias - cardiac and neuro sx

39. What percentage of gall stones are cholesterol stones and What are the associations
Striated
Common hepatic - splenic - left gastric - main blood supply for stomach
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Lipase - phospholipase A - colipase

40. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Glucouronate - water soluble (direct)
Trypsin - chymotrypsin - elastase - carboxypeptidases
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Peyers patches

41. in carcinoid tumors - What is seen on EM
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Cholesterol
T12
Dense core bodies

42. What is the most common esophageal cancer worldwide and in the US
Menetriers disease
Worldwide - SC - US - adeno
L2
Enterokinase/enteropeptidase from the duodenal mucosa

43. What kind of digestion is bile needed for
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Elevated amylase - and lipase
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

44. What is the TX of physiologic neonatal jaundice
L/R renal artery around L1
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
GLUT 2
Phototherapy

45. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Duodenal atresia - Downs
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Uremia
Around the central vein (zone III)

46. What layer in the mucosa is repsonsible for motility
Alfatoxin in peanuts
Muscularis mucosae
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
CCK8 receptor - Gq inc IP3/Ca

47. What kind of insults results in macronodular cirrhosis
IBS at least 2 with recurrent abdominal pain
Gilbert's
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Lateral to the inferior epigastric artery

48. Why are most diverticula considered false
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
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Lateral
Causes of gall stones

49. What commonly leads to appendicity in kids vs adults
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Jaundice - fever - RUQ
Nonkeritinized stratified sqamous epithelium
CHF and inc risk of HCC

50. motilin - source - action - regulation
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
L1
Via the middle colic