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. List the clinical findings of HCC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Complications of UC
ALT>AST
L/R renal artery around L1

2. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Internal thoracic to superior epigastric to inferior epigastric
Ischemic colitis
Reye's syndrome
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

3. What causes hirschsprungs
Failure of neural crest migration
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Volvulus
Old men - arthralgias - cardiac and neuro sx

4. What intervention will intervention will relieve portal HTN
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Boerhaave's Syndrome - Been heaving syndrome
Chronic gastritis and pernicious anemia
Carcinoid syndrome

5. What layer in the mucosa is repsonsible for motility
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Alpha amylase
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
Muscularis mucosae

6. What is the triad of Plummer - Vinson syndrome
Brush border of intestine - produce monosaccharides from oligo and di
Decreased intercellular adhesion and increased proliferation
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Hemolytic anemia

7. What does K- ras mutation cause
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Antrum - H.pylori - inc risk of MALT lymphoma
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Upregulated intracellular signal transduction

8. How is bilirubin carried in the blood
Goes through deep inguinal ring - external inguinal ring and into the scrotum
With albumin
Urobilin
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

9. What are the borders of Hesselbach's triangle
Esophageal cancer
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

10. What is the clinical presentation of acute pancreatitis
Crohns = maybe - UC= always
In the ileum with bile acids - requires IF
Esophageal carcinoma
Epigastric abdominal pain radiating to back - anorexia - nausea

11. What are the histological findings in the jejunum
FAP
T12
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Gamma glutamyl transferase GGT

12. With internal hemorrhoids Where is the anastomoses and Where is it
Superior rectal and middle and inferior rectal - rectum
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Ischemic colitis
Stercobilin

13. What happens to the short gastics if the splenic artery is blocked
Mallory bodies
Barrett's esophagus
Esophageal cancer
Poor anastamoses

14. If trypsin activates more trypsinogen - what kind of feedback loop is established
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Positive
Mucoepidermoid carcinoma
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn

15. What are the extraintestinal manifestations of ulcerative colitis
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Reye's syndrome
No
Pyoderma gangrenosum - primary sclerosing cholangitis

16. What is the presenting course for appendicity

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

17. What is charcot triad of cholangitis
True and most common congenital anomoly of GI tract
Jaundice - fever - RUQ
Crohns = noncaseating granulomas - UC = crypt abscesses
Gallbladder

18. What is the most important mechanism in gastric acid secretion
12 waves/min
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Bleeding - penetration into pancreas - perforation - obstruction
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

19. How do villi appear in disaccharidease def
Normal
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Conj/unconj - inc - nl to dec
Uridine glucuronyl transferase

20. What are the barium swallow findings of achalasia
Dilated esophagus with an area of distal stenosis - birds beak
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
12 waves/min
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

21. What does histo show for alpha1 antitrypsin def
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Epithelium
Falciform - ligamentum teres - fetal umbilical vein
PAS- positive globules in liver -

22. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Cimetidine
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Superior rectal and middle and inferior rectal - rectum
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

23. What gives urine its characteristic color
Hyperpigmented mouth - lips - hands - genitalia
Urobilin
AR
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

24. What is the frequency of basal electric rhythm in the duodenum
Normal
12 waves/min
Phototherapy
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

25. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
NAV = nerve artery vein - venous near the penis (NAVEL)
Colovesical leading to pneumaturia
Esophageal carcinoma
Duodenal atresia - Downs

26. What kind of diarrhea is produced from a disaccharide def
Chagas disease
Centrilobular leading to congestive liver disease
Osmotic
HSV-1 - CMV - Candida

27. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
2ndary biliary cirrhosis
M3 - Gq - inc IP3/Ca
Crohns = noncaseating granulomas - UC = crypt abscesses
Barrett's esophagus

28. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery

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

29. What conditions are associated with budd chiari
Brush border of intestine - produce monosaccharides from oligo and di
Juvenille polyps - no risk if single
Hypercoaguability - polycythemia vera - pregnancy - HCC
CEA - CA-19-9

30. What is the characteristic histo finding in alcoholic hepatitis
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
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
Mallory bodies
Lamina propora and submucosa

31. What is Trousseau's sign
Redness and tenderness on palpation of extremities
Neutralizes oral bacertial acids and maintains dental health
Increase tumorigenesis
Diverticulum

32. What causes carcinoid syndrome amd What are the symptoms
NAV = nerve artery vein - venous near the penis (NAVEL)
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Lack or have an attenuated muscularis externa - often in the sigmoid colon
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

33. multiple juvenil polyps in GI tract - risk
Jewish and African American men
Via the superior pancreaticduodenal
Pleomorphic adenoma
Juvenile polyposis syndrome - inc risk of adenocarcinoma

34. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Cholesterol - 10-20% opaque due to calcifications
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
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
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

35. What receptor does histamine bind on the parietal cell and What does it activate
H2 receptor - inc cAMP
Alfatoxin in peanuts
Punched out - clean margins - carcinoma =raised irregular margins
Brunners

36. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Hemosiderosis - hemochromatosis
Omeprazole
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Angiodysplasia

37. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Spleen to posterior abdominal wall - splenic artery and vein
Peyers patches
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
2ndary biliary cirrhosis

38. What does high flow rate mean
Closer to isotonic because of less time to reabsorb NaCl
Around the central vein (zone III)
Zollinger Ellison - phenylalanine and tryptophan
Portal HTN

39. At what spinal level does the is the bifurcation of aorta
Backup of blood into the liver - RHF - budd chiari
Inguninal ligament - sartorius muscle - adductor longus
L4
Dec PGE2 leading to dec gastric mucosa protection

40. What is the path of an indirect inguinal hernia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Chronic gastritis and pernicious anemia
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Gallbladder

41. What are motilin receptor agonists used for clinically
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Pleomorphic adenoma
Achalasia due to loss of myenteric plexus (auberach)
Stimulate intestinal persistalsis

42. What is the rule of 2s for meckels
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Myenteric nerve plexus - aurbach
PAS- positive globules in liver -
Pleomorphic adenoma

43. FAP + osseous and soft tissue tumors - retinal hyperplasia

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

44. Gq and inc cAMP both work to do what in parietal cells
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Unconjugated - water insoluble
CCK8 receptor - Gq inc IP3/Ca
Stimulate the H/K ATPase

45. What kind of pancreatitis is associated with EtOH and smoking
Bleeding - penetration into pancreas - perforation - obstruction
Dec PGE2 leading to dec gastric mucosa protection
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Chronic calcifying pancreatitis - inc risk of panreatic cancer

46. What is the lumen of the pancreatic duct
Menetriers disease
Phototherapy
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Ampulla of vater

47. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Right and left hepatic duct
Pancreatic head causing obstructive jaundice
Smooth
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

48. What cells secrete bicarb - What does it do - and what regulates it
Crohns = noncaseating granulomas - UC = crypt abscesses
With albumin
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
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

49. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Paraumbilical and superficial and inferior epigastric - umbilicus
Brush border of intestine - produce monosaccharides from oligo and di
HSV-1 - CMV - Candida

50. What are the treatmet options for crohns
Corticosteroids - infliximab
Uridine glucuronyl transferase
Menetriers disease
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