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. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
With albumin
Zollinger Ellison - phenylalanine and tryptophan
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

2. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Turcot
Causes of gall stones
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Appendicitis

3. What kind of anemia is in Wilsons
Hemolytic anemia
L3
Phototherapy
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

4. What does a low flow rate mean for saliva
The jejunum
Hypotonic because of more time to reabsorb NaCl
Unconjugated - water insoluble
Unconj - absent (acholuria) - inc

5. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
GLUT 2
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
True and most common congenital anomoly of GI tract
Angiodysplasia

6. At what level do the testicular/ovarian arteries exit the aorta
Inc risk of CRC and other visceral malignancies
Uremia
Lateral
L2

7. in carcinoid tumors - What is seen on EM
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
VZV and influenza B treated with salicylates
Stercobilin
Dense core bodies

8. crigler - najjar type II responds to which therapy and How does it work
Phenobarbital - inc liver enzyme synthesis
Downs
Menetriers disease
Hypercoaguability - polycythemia vera - pregnancy - HCC

9. Between what structures do strong anastamoses exist
Left and right gastroepiploics - left and right gastrics
Zollinger Ellison - phenylalanine and tryptophan
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Peutz jeghers

10. Where is the arterial supply from above the pectinate line - and What is the venous drainage
CHF and inc risk of HCC
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

11. What does loss of APC cause
Worldwide - SC - US - adeno
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Redness and tenderness on palpation of extremities
Decreased intercellular adhesion and increased proliferation

12. How does abetalipoproteinemia lead to malabsorption
The entire
Lamina propora and submucosa
Dermatitis herpetiformis
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

13. What is Trousseau's sign
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Redness and tenderness on palpation of extremities
Stercobilin

14. What are the histological findings in the jejunum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Duodenum - 2nd - 3rd and 4th parts
Hemosiderosis - hemochromatosis

15. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Femoral hernia
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Myenteric nerve plexus - aurbach
Ischemic colitis

16. What does primary sclerosing cholangitis lead to...
Menetriers disease
VZV and influenza B treated with salicylates
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

17. Why are most diverticula considered false
Squamous - upper 1/3 - adeno - lower 1/3
All 3
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

18. What layer in the mucosa is repsonsible for motility
Phototherapy
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Lye ingestion and acid reflux
Muscularis mucosae

19. What is the most common cause of gallstones
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Hypotonic because of more time to reabsorb NaCl
Left gastric vein and esophogeal vein - esophagus
Cystic duct and common hepatic duct

20. What does autoimmune destruction of parietal cells lead to...
Chronic gastritis and pernicious anemia
Hernia
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
So hypertrophied they look like brain gyri

21. What is the triad of Plummer - Vinson syndrome
Begins starch digestion - inactivated by low pH upon reaching the stomach
Dysphagia (due to esophageal web) - glossitis - iron def anemia
In the mucus that covers the gastric epithelium
Paraumbilical and superficial and inferior epigastric - umbilicus

22. At what spinal level does the celiac trunk exit
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
All 3 gut layers outpouch as in Meckels
90%
T12

23. 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
Paraumbilical and superficial and inferior epigastric - umbilicus
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Pertechnetate - study for uptake

24. What is the presentation of pancreatic adenocarcinoma
Dubin johnson
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
Adhesion
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

25. What are the histological findings in the ileum

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

26. What parts of the small bowel can tropical sprue effect
The entire
HSV-1 - CMV - Candida
Common hepatic - splenic - left gastric - main blood supply for stomach
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

27. What are the midgut structures and what supplies their blood and PANS innervation
Budd chiari syndrome
Gardner's syndrome
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Antrum - H.pylori - inc risk of MALT lymphoma

28. Scleroderma is associated with what kind of esophageal dysmotility
Conj/unconj - inc - nl to dec
Low pressure proximal to LES
Unconjugated - water insoluble
Dubin johnson

29. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Inspiratory arrest on deep palpation due to pain
Superior rectal
Decreased intercellular adhesion and increased proliferation
Necrotizing enterocolitis

30. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Conj/unconj - inc - nl to dec
Squamous - upper 1/3 - adeno - lower 1/3
Cholesterol
Alcoholic hepatitis

31. 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

32. What are the hindgut structures and what supplies their blood and PANS innvervation
L1
Crigler - najjar type 1
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Older patients

33. What intervention will intervention will relieve portal HTN
Begins starch digestion - inactivated by low pH upon reaching the stomach
Gut bacteria
Ampulla of vater
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

34. What are causes of extrahepatic biliary obstruction
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Hepatic steatosis
Ampulla of vater
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

35. Liver cell failure can lead to multisystem signs including
Mucoepidermoid carcinoma
Squamous - upper 1/3 - adeno - lower 1/3
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

36. Achalasia increases the risk For what complication
Angiodysplasia
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
With albumin
Esophageal carcinoma

37. What makes a true diverticula
All 3 gut layers outpouch as in Meckels
AST >ALT - ration is usually 1.5
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
Glucouronate - water soluble (direct)

38. What kind of pancreatitis is associated with EtOH and smoking
Oligosaccharide digestion
12 waves/min
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Chronic calcifying pancreatitis - inc risk of panreatic cancer

39. How does hirschsprung present and appear on imaging
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
VZV and influenza B treated with salicylates
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
L3

40. What does extrahepatic biliary obstruction cause
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Sphincter of oddi
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Neural muscarinic pathways

41. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Left gastric vein and esophogeal vein - esophagus
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Duodenal atresia - Downs
Angiodysplasia

42. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
The submucosal nerve plexus - meissner's
Dec PGE2 leading to dec gastric mucosa protection
Peyers patches
Sister mary joseph nodule

43. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Colonic polyps
Femoral hernia

44. What is the other name for GIP (gastric inhibitory peptide)
Dubin johnson
Glucose dependent insulinotropic peptide
Mucosa - submucosa - muscularis externa - serosa/adventitia
Alk pho

45. What is diverticulosis
Around the central vein (zone III)
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Cimetidine
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

46. signet ring cells - acanthosis nigracans - dz - character/association - spread
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Alk phos
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

47. Where are tumors commonly in pancreatic adenocarcinoma
No
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Pancreatic head causing obstructive jaundice
Amylase

48. In PUD with a duodenal ulcer does pain inc or dec with meals
In the ileum with bile acids - requires IF
Tropical sprue
Decrease - weight gain
12 waves/min

49. What are the complications of acute pancreatitis
Positive
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
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
Bleeding - intussusception - volvulus - obstruction near terminal ileum

50. What kind of cancer to celiac sprue put you as inc risk for
T cell lymphoma
Esophageal cancer
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Lamina propora and submucosa