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 IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Crohns = maybe - UC= always
Appendicitis
Crohns = noncaseating granulomas - UC = crypt abscesses
Dense core bodies

2. How does abetalipoproteinemia lead to malabsorption
Conj - inc - dec
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Achalasia due to loss of myenteric plexus (auberach)
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

3. What factors increase risk of malignancy of adenomatous polyps
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Phototherapy
Gardner's syndrome

4. What is the main symptom if a VIPoma
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
PAS- positive globules in liver -
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

5. What type of insults result in micronodular cirrhosis
Angiodysplasia
L2
Below
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

6. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Lactase is located at the tips of intestinal villi
Inc conj bilirubin - inc cholesterol - inc alk phos
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Carcinoid syndrome

7. What is the characteristic histo finding in alcoholic hepatitis
Mallory bodies
Gastrohepatic ligament
Punched out - clean margins - carcinoma =raised irregular margins
GERD - may also present with nocturnal cough and dyspnea

8. What are the complications of Meckels
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
AST
Bleeding - intussusception - volvulus - obstruction near terminal ileum

9. What do the rugae of stomach look like in menetriers disease
Lamina propria
Crigler - najjar type 1
So hypertrophied they look like brain gyri
Conj/unconj - inc - nl to dec

10. What are the extraintestinal manifestations of crohns
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Dec PGE2 leading to dec gastric mucosa protection
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
IgA secreting plasma cells - ultimately reside in the lamina proporia

11. What parts of the small bowel can tropical sprue effect
12 waves/min
The entire
CHF and inc risk of HCC
Mucoepidermoid carcinoma

12. What is the path of an indirect inguinal hernia
Inc - weight loss
Omeprazole
Goes through deep inguinal ring - external inguinal ring and into the scrotum
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

13. What are additional risk factors for CRC
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Low pressure proximal to LES
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Diverticulitis in elderly - ectopic pregs use hCG to rule out

14. What other condition can lead to acute gastritis - think renal
Uremia
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Pyoderma gangrenosum - primary sclerosing cholangitis
Chronic gastritis and pernicious anemia

15. What are the complications of acute pancreatitis
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Menetriers disease
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

16. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Diverticulum
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
AST
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

17. What are the midgut structures and what supplies their blood and PANS innervation
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Alfatoxin in peanuts
The entire
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

18. When do you see hypertrophy of brunners glands
Meckels
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Peptic ulcer disease
Below

19. occlusion of IVC or hepatic veins
Gallbladder
Budd chiari syndrome
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
90%

20. What is biliary colic
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Hepatic steatosis

21. At what spinal level does the celiac trunk exit
...
Alpha amylase
Cigarettes and chronic pancreatitis - not EtOH
T12

22. How is the diagonsis of CRC made
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
Appendicitis
Primarly through ECL leading to histamine release
Trypsin - chymotrypsin - elastase - carboxypeptidases

23. What converts inactive pepsinogen to pepsin
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Begins starch digestion - inactivated by low pH upon reaching the stomach
H+
No - chronic - can present with diarrhea or constipation or alternation - treat sx

24. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Falciform - ligamentum teres - fetal umbilical vein
CEA - CA-19-9
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

25. Who gets Whipple disease and How do they present
Falciform - ligamentum teres - fetal umbilical vein
AST
Gallbladder
Old men - arthralgias - cardiac and neuro sx

26. What causes primary biliary cirrhosis
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Lactase is located at the tips of intestinal villi
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
AST>ALT

27. What does loss of APC cause
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Decreased intercellular adhesion and increased proliferation
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Virchow's node

28. Failure of relaxation of lower esophageal sphincter - Name and etiology
Achalasia due to loss of myenteric plexus (auberach)
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Around the central vein (zone III)
MSI (15%) and APC/beta catenin chromosomal instability (85%)

29. rare - often fatal childhood hepatoencephalopathy

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

30. What are the complications of chronic pancreatitis
HPNCC
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

31. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Zollinger ellison - brunners glands
Menetriers disease

32. inflammatino of gallbadder
Conj/unconj - inc - nl to dec
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
The submucosal nerve plexus - meissner's
Acute pancreatitis

33. What is one potential precipitating factor for intussusception
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Redness and tenderness on palpation of extremities

34. What kind of pathways do CCK act on to cause pancreatic secretion
Tropical sprue
Conj/unconj - inc - nl to dec
H+
Neural muscarinic pathways

35. What is pancreatic adenocarcinoma associated with
Ceruplasmin
Cigarettes and chronic pancreatitis - not EtOH
Epigastric abdominal pain radiating to back - anorexia - nausea
Pancreatic and bile

36. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Internal thoracic to superior epigastric to inferior epigastric
Alk pho
H2 receptor - inc cAMP
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

37. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Uridine glucuronyl transferase
Via the superior pancreaticduodenal
Gut bacteria

38. What are the longterm sequelae of nutmeg liver
Diverticulum
Centrilobular congestion and necrosis - cardiac cirrhosis
Oligosaccharide digestion
Conj - inc - dec

39. What is the frequency of basal electric rhythm of the stomach
Glucouronate - water soluble (direct)
Virchow's node
Inc smooth muscle relaxation - including lower esophageal sphincter
3 waves/min

40. Where and How is iron absorbed
Fe2+ in the duod
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Above
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

41. What is the presentation of pancreatic adenocarcinoma
Hemolytic anemia
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Hepatic steatosis
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

42. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
HPNCC
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Falciform - ligamentum teres - fetal umbilical vein
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

43. What pancreatic proteases are secreted as zymogens
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Inc risk of CRC and other visceral malignancies
Trypsin - chymotrypsin - elastase - carboxypeptidases
Glucose dependent insulinotropic peptide

44. What are the histological findings of the colon
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Alpha amylase
Crypts but not villi
Lamina propora and submucosa

45. crigler - najjar type II responds to which therapy and How does it work
Alcoholic hepatitis
Conj/unconj - inc - nl to dec
Adhesion
Phenobarbital - inc liver enzyme synthesis

46. At what spinal level does the SMA exit
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
Achalasia due to loss of myenteric plexus (auberach)
Chronic calcifying pancreatitis - inc risk of panreatic cancer
L1

47. malnutrition - toxic megacolon - colorectal carcinoma
In the mucus that covers the gastric epithelium
Spleen to posterior abdominal wall - splenic artery and vein
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Complications of UC

48. What are the treatmet options for crohns
Corticosteroids - infliximab
Sphincter of oddi
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Fe2+ in the duod

49. What are the tumor markers for pancreatic adenocarcinoma
Acute pancreatitis
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
CEA - CA-19-9
EtOH

50. What do you use to diagnose meckels
Alpha1 antitrypsin def - codominant trait
Lipase - phospholipase A - colipase
Pertechnetate - study for uptake
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN