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. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Gastrohepatic ligament
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Esophageal cancer

2. What is a positive murphy's sign
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Volvulus
Early childhood - neuro sx and malabsorption
Inspiratory arrest on deep palpation due to pain

3. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Peptic ulcer disease
Cystic duct and common hepatic duct
Ampulla of vater
Diverticulum

4. What does a gastrinoma cause
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Turcot
Positive
Cirrhosis

5. What does bicarb do in the duodenum
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Downs
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Splenic flexure

6. absent UDPGT - presents early in life - early mortality
Brush border of intestine - produce monosaccharides from oligo and di
Crigler - najjar type 1
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Erosive - disruption of mucosal barrier leading to inflammation

7. What is biliary colic
Lye ingestion and acid reflux
Paraumbilical and superficial and inferior epigastric - umbilicus
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Gilbert's

8. What nerve innervates the external hemorrhoids
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Nonkeritinized stratified sqamous epithelium
Inferior rectal nerve
Lateral to the inferior epigastric artery

9. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Centrilobular leading to congestive liver disease
Juvenile polyposis syndrome - inc risk of adenocarcinoma
MSI (15%) and APC/beta catenin chromosomal instability (85%)
HPNCC

10. inflammatino of gallbadder
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
VZV and influenza B treated with salicylates
Trypsin - chymotrypsin - elastase - carboxypeptidases
Phenobarbital - inc liver enzyme synthesis

11. HCC is associated with what other conditions
Above
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Esophageal cancer
Colonic polyps

12. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Crohns = noncaseating granulomas - UC = crypt abscesses
Gastric glands
Hyperpigmented mouth - lips - hands - genitalia
Colonic polyps

13. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
IBS at least 2 with recurrent abdominal pain
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Alpha amylase
Carcinoid syndrome

14. What is the cause of physiologic neonatal jaundice
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Achalasia due to loss of myenteric plexus (auberach)
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Gallbladder

15. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Small intestine
Sphincter of oddi
Can lead to hematemesis - found in EtOHics and bulimics
Female - fat - fertile - forty

16. What complication can arise from indirect inguinal hernias
NAV = nerve artery vein - venous near the penis (NAVEL)
Inguninal ligament - sartorius muscle - adductor longus
Hydrocele
In the ileum with bile acids - requires IF

17. What does the splenorenal ligament connect - and What does it contain
Sister mary joseph nodule
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Spleen to posterior abdominal wall - splenic artery and vein

18. What kind of insults results in macronodular cirrhosis
Right and left hepatic duct
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Fasting and stress
Enterokinase/enteropeptidase from the duodenal mucosa

19. What is contained within the muscularis externa
Goes through deep inguinal ring - external inguinal ring and into the scrotum
L1
IBS at least 2 with recurrent abdominal pain
Myenteric nerve plexus - aurbach

20. How do NSAIDs cause acute gastritis
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Hypotonic because of more time to reabsorb NaCl
Dec PGE2 leading to dec gastric mucosa protection
In the mucus that covers the gastric epithelium

21. crigler - najjar type II responds to which therapy and How does it work
L/R renal artery around L1
Heme metabolism
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Phenobarbital - inc liver enzyme synthesis

22. What is the clinical presentation of acute pancreatitis
Alcoholic cirrhosis
Reye's syndrome
Epigastric abdominal pain radiating to back - anorexia - nausea
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

23. malnutrition - toxic megacolon - colorectal carcinoma
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Complications of UC
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

24. What are the foregut structures and what supplies their blood and PANS innvervation
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Lipase
CHF and inc risk of HCC
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

25. bilateral mets to ovaries with abundant mucus - signet ring cells
Mallory bodies
AST>ALT
Krukenbergs tumor
Menetriers disease

26. What are the complications of Meckels
Hypotonic because of more time to reabsorb NaCl
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Bleeding - intussusception - volvulus - obstruction near terminal ileum

27. What parts of the small bowel can tropical sprue effect
Squamous - upper 1/3 - adeno - lower 1/3
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
The entire
Primarly through ECL leading to histamine release

28. What are motilin receptor agonists used for clinically
Downs
Stimulate intestinal persistalsis
Cimetidine
Averages 6 months - very aggressive - usually already metastasized at presentation

29. somatostatin - source - action - regulation
Cirrhosis
Hypotonic because of more time to reabsorb NaCl
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

30. Diaphragmatic hernias occur in infants because of defective development of which membrane
Lipase - phospholipase A - colipase
Pleuroperitoneal
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

31. Where is folate absorbed
Left and right gastroepiploics - left and right gastrics
The jejunum
Stimulate the H/K ATPase
True and most common congenital anomoly of GI tract

32. What is the sphincter of the pancreatic duct
Sphincter of oddi
Conj/unconj - inc - nl to dec
HPNCC
Oligosaccharide digestion

33. What gives stool its characteristic color
H+
Short gastrics - left greater and lesser
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Stercobilin

34. What are the extraintestinal manifestations of ulcerative colitis
Ampulla of vater
Pyoderma gangrenosum - primary sclerosing cholangitis
Lipase
Backup of blood into the liver - RHF - budd chiari

35. 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
Zenkers - halitosis - dysphagia and obstruction
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
90%

36. When do you see hypertrophy of brunners glands
Peptic ulcer disease
Mucoepidermoid carcinoma
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

37. FAP + malignant CNS tumor
Adhesion
All 3 gut layers outpouch as in Meckels
Lipase
Turcot

38. What serum markers increase in cholecystitis with bile duct involvement
Conj - inc - dec
Liver metabolizes 5HT
Alk phos
Stimulate the H/K ATPase

39. What can fistula between the gallbladder and small intestine create and how can you tell
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Enterokinase/enteropeptidase from the duodenal mucosa
In the mucus that covers the gastric epithelium
HPNCC

40. What histological findings are present in the esophagus
Older patients
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Nonkeritinized stratified sqamous epithelium
Lamina propria

41. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Black - rotors syndrome
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

42. Malabsorption syndromes have what common clinical presentation
Glucose dependent insulinotropic peptide
Diarrhea - steatorrhea - weight loss - weakness
Ampulla of vater
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

43. What are the tumor markers for pancreatic adenocarcinoma
CEA - CA-19-9
Averages 6 months - very aggressive - usually already metastasized at presentation
Lubricate food (glycoprotiens)
3 waves/min

44. 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

45. Bile is critical for exrection of what substance
Left and right gastroepiploics - left and right gastrics
Cimetidine
Hyperpigmented mouth - lips - hands - genitalia
Cholesterol

46. What are the ABCDEF of esophageal cancer
Oral glucose
Myenteric nerve plexus - aurbach
Enterokinase/enteropeptidase from the duodenal mucosa
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

47. What is the path of an indirect inguinal hernia
Oral glucose
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
Brush border of intestine - produce monosaccharides from oligo and di
Goes through deep inguinal ring - external inguinal ring and into the scrotum

48. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis

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

49. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Crohns = noncaseating granulomas - UC = crypt abscesses
GERD - may also present with nocturnal cough and dyspnea
L2
Stimulate intestinal persistalsis

50. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Epithelium
Cholesterol - 10-20% opaque due to calcifications