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. GIP - source - action regulation
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Superior rectal
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Hemosiderosis - hemochromatosis

2. What structures feed into the cystic duct
Gallbladder
Parietal cells in the stomach - B12 binding protein
Failure of neural crest migration
L4

3. With internal hemorrhoids Where is the anastomoses and Where is it
Closer to isotonic because of less time to reabsorb NaCl
Superior rectal and middle and inferior rectal - rectum
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

4. What are the hindgut structures and what supplies their blood and PANS innvervation
Cimetidine
The gastroduodenal
Positive urease test
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

5. What are the ABCDEF of esophageal cancer
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Diverticulitis in elderly - ectopic pregs use hCG to rule out

6. In an MI - which liver enzyme is elevated
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
AST
Menetriers disease
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

7. What is the rule of 2s for meckels
Causes of gall stones
Trypsin - chymotrypsin - elastase - carboxypeptidases
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

8. How is salivary secretion stimulated
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Mucosa - submucosa - muscularis externa - serosa/adventitia
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

9. what kind of muscle is in the upper 1/3 of esophagus
Liver metabolizes 5HT
Oral glucose
Corticosteroids - infliximab
Striated

10. What does extrahepatic biliary obstruction cause
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Chagas disease
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
Amylase

11. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
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
Crigler - najjar type 1
Via the middle colic
Meckels

12. Is there any structural abnl with IBS - What is the course of disease and presentation
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Inguninal ligament - sartorius muscle - adductor longus
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
No - chronic - can present with diarrhea or constipation or alternation - treat sx

13. In alchoholic hepatitis which liver enzyme is higher
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
L1
Urobilin
AST>ALT

14. What is the sphincter of the pancreatic duct
Liver metabolizes 5HT
Diverticulum
Sphincter of oddi
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

15. Where does an indirect inguinal hernia enter the deep inguinal ring
Dilated esophagus with an area of distal stenosis - birds beak
Lateral to the inferior epigastric artery
Pertechnetate - study for uptake
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

16. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Where hindgut meets ectoderm
Internal thoracic to superior epigastric to inferior epigastric
Gastric glands
Peyers patches

17. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

18. How do you DX and TX gallstones
Paraumbilical and superficial and inferior epigastric - umbilicus
US and cholecystectomy
Gastrohepatic ligament
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

19. milk intolerance
Failure of neural crest migration
Angiodysplasia
Dissaccharidase def - most commonly lactase
Chagas disease

20. What artery passes around the duodenum
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Omeprazole
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
The gastroduodenal

21. What serum enzyme is elevated in acute pancreatitis and mumps
Amylase
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Bleeding - penetration into pancreas - perforation - obstruction
Hydrocele

22. What is the epi for CRC
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
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
Corticosteroids - infliximab
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

23. What is the omphalomesenteric cyst
Cystic dilation of the viteline duct
Paraumbilical and superficial and inferior epigastric - umbilicus
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

24. What is the lumen of the pancreatic duct
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Ampulla of vater
Striated
Lactase is located at the tips of intestinal villi

25. Where is bicarb trapped
True and most common congenital anomoly of GI tract
In the mucus that covers the gastric epithelium
Downs
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

26. What are the borders of Hesselbach's triangle
Mucoepidermoid carcinoma
Alk pho
Left and right gastroepiploics - left and right gastrics
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

27. Where is IgA shuttled
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Femoral hernia
Inguninal ligament - sartorius muscle - adductor longus
Unconj - absent (acholuria) - inc

28. How do burns cause acute gastritis and What is it called

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

29. What layer in the mucosa is responsible for support
Krukenbergs tumor
Lamina propria
US and cholecystectomy
Sister mary joseph nodule

30. What is the frequency of basal electric rhythm in the duodenum
Cholesterol
12 waves/min
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Neutralizes gastric acid allowing pancreatic enzymes to fxn

31. what kind of fistula is associated with diverticulitis
Barrett's esophagus
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Colovesical leading to pneumaturia

32. What gives urine its characteristic color
Meconium ileus
Complications of crohns
Urobilin
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

33. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Centrilobular congestion and necrosis - cardiac cirrhosis
Alpha amylase
Phototherapy
Jaundice - fever - RUQ

34. rare - often fatal childhood hepatoencephalopathy

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

35. What is the cause of physiologic neonatal jaundice
Amylase
Omeprazole
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

36. What does high flow rate mean
Lateral
Lipase - phospholipase A - colipase
Closer to isotonic because of less time to reabsorb NaCl
Crohns = maybe - UC= always

37. What is the most common indication of emergent abdominal surgery in children
Redundant mesentary
Pleomorphic adenoma
Appendicitis
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

38. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Muscularis mucosae
Cystic dilation of the viteline duct
Stimulate the H/K ATPase
Esophageal varices

39. What does loss of APC cause
Decreased intercellular adhesion and increased proliferation
Barrett's esophagus
Lactase is located at the tips of intestinal villi
3 waves/min

40. What does autoimmune destruction of parietal cells lead to...
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Esophageal cancer
Chronic gastritis and pernicious anemia
Inc lower esphogeal tone leading to achalasia

41. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Complications of crohns
The entire
Lamina propora and submucosa
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

42. What are additional risk factors for CRC
Colovesical leading to pneumaturia
2ndary biliary cirrhosis
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Ampulla of vater

43. When and why is stomach cancer termed linitis plastica
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Bleeding - intussusception - volvulus - obstruction near terminal ileum
12 waves/min
Via the superior pancreaticduodenal

44. To what substance is bilirubin conjugated and why
Obstruction of the common bile duct
Glucouronate - water soluble (direct)
Zollinger ellison - brunners glands
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

45. What is the rate limiting step of carbohydrate digestion
Inc conj bilirubin - inc cholesterol - inc alk phos
Juvenille polyps - no risk if single
Duodenal atresia - Downs
Oligosaccharide digestion

46. What is the most important mechanism in gastric acid secretion
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Normal
Splenic flexure
Antrum - H.pylori - inc risk of MALT lymphoma

47. What drug blocks the H2R
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Striated
Cimetidine
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

48. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Esophageal cancer
Sister mary joseph nodule
Trypsin - chymotrypsin - elastase - carboxypeptidases
Cigarettes and chronic pancreatitis - not EtOH

49. What pancreatic enzymes are responsible for fat digestion
Inc - weight loss
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Heme metabolism
Lipase - phospholipase A - colipase

50. What kind of lesions are characteristic of duodenal PUD vs cancer
Punched out - clean margins - carcinoma =raised irregular margins
Cigarettes and chronic pancreatitis - not EtOH
VZV and influenza B treated with salicylates
Primarly through ECL leading to histamine release