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. What infection causes Whipple disease and What can you see on LM
Failure of the processus vagainlis to close
Appendicitis
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Inc - weight loss

2. What receptors does ACH bind on the parietal cells and What does it activate
M3 - Gq - inc IP3/Ca
External (superficial) ring only
Old men - arthralgias - cardiac and neuro sx
Boerhaave's Syndrome - Been heaving syndrome

3. Why does volvulus occur more at cecum and sigmoid colon
Redundant mesentary
Peptic ulcer disease
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Goes through deep inguinal ring - external inguinal ring and into the scrotum

4. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
FAP
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
IBS at least 2 with recurrent abdominal pain
Alfatoxin in peanuts

5. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Hypercoaguability - polycythemia vera - pregnancy - HCC
Volvulus
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
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

6. What is the mechanism for reyes syndrome
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Necrotizing enterocolitis
Increase tumorigenesis
Volvulus

7. What are the complications of chronic pancreatitis
Celiac sprue
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Bleeding - penetration into pancreas - perforation - obstruction
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM

8. what kind of fistula is associated with diverticulitis
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Urobilin
Angiodysplasia
Colovesical leading to pneumaturia

9. 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

10. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Zollinger ellison - brunners glands
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Inc - weight loss
Hirschsprungs

11. What kind of diarrhea is produced from a disaccharide def
Tropical sprue
Osmotic
Centrilobular leading to congestive liver disease
Glucouronate - water soluble (direct)

12. What factors increase risk of malignancy of adenomatous polyps
Pleomorphic adenoma
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn

13. What is one potential precipitating factor for intussusception
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Duodenum - 2nd - 3rd and 4th parts
Stercobilin
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

14. What does loss of p53 cause
Peutz jeghers
Zenkers - halitosis - dysphagia and obstruction
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Increase tumorigenesis

15. Autoantibodies to gluten (gliadin) in wheat and other grains
Celiac sprue
Cholesterol - 10-20% opaque due to calcifications
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Urobilin

16. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Common hepatic - splenic - left gastric - main blood supply for stomach
CCK8 receptor - Gq inc IP3/Ca
Elevated amylase - and lipase
Via the superior pancreaticduodenal

17. What separates the right greater and lesser sacs
Short gastrics - left greater and lesser
Cigarettes and chronic pancreatitis - not EtOH
Inguninal ligament - sartorius muscle - adductor longus
Gastrohepatic ligament

18. What pancreatic enzymes are responsible for fat digestion
Inc conj bilirubin - inc cholesterol - inc alk phos
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Inc lower esphogeal tone leading to achalasia
Lipase - phospholipase A - colipase

19. What can hemochromatosis be secondary to...
Splenic flexure
GERD - may also present with nocturnal cough and dyspnea
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Poor anastamoses

20. What causes primary biliary cirrhosis
Left gastric vein and esophogeal vein - esophagus
Right and left hepatic duct
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Trypsin - chymotrypsin - elastase - carboxypeptidases

21. vasoactive intestinal polypeptide (VIP) - source - action - regulation
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
Necrotizing enterocolitis
Lateral to the inferior epigastric artery
8-9 waves/min

22. What structures feed into the common bile duct
Celiac sprue
Cystic duct and common hepatic duct
H2 receptor - inc cAMP
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

23. How do villi appear in disaccharidease def
GERD - may also present with nocturnal cough and dyspnea
Conj/unconj - inc - nl to dec
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Normal

24. At what spinal level does the SMA exit
L1
Gilbert's
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
...

25. What do tumors that arise in the head of the pancreas cause
Obstruction of the common bile duct
Lateral
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Amylase

26. HCC is associated with what other conditions
Diarrhea - steatorrhea - weight loss - weakness
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Complications of UC
Splenic flexure

27. What layer in the mucosa is responsible for support
Lamina propria
Stercobilin
Alk phos
Pancreatic and bile

28. Where is bicarb trapped
In the mucus that covers the gastric epithelium
Phenobarbital - inc liver enzyme synthesis
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
CCK8 receptor - Gq inc IP3/Ca

29. What is biliary colic
Parietal cells in the stomach - B12 binding protein
Fasting and stress
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

30. Diaphragmatic hernias occur in infants because of defective development of which membrane
Pleuroperitoneal
Celiac sprue
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

31. What is the presentation of pancreatic adenocarcinoma
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Urobilin
2ndary biliary cirrhosis
Normal

32. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
T12
Osmotic
Celiac sprue
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

33. What are the effects of atropine on parietal cells and G cells
Unconjugated - water insoluble
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Crohns = maybe - UC= always
Goes through deep inguinal ring - external inguinal ring and into the scrotum

34. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Unconj - absent (acholuria) - inc
Serous on the sides parotids - mucinous in the middle sublingual
Striated and smooth
Colonic polyps

35. What does high flow rate mean
Cirrhosis
Closer to isotonic because of less time to reabsorb NaCl
Cholesterol
Stimulate intestinal persistalsis

36. Gq and inc cAMP both work to do what in parietal cells
Amylase
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Myenteric nerve plexus - aurbach
Stimulate the H/K ATPase

37. subQ peribumbilical metastasis
Decreased intercellular adhesion and increased proliferation
Sister mary joseph nodule
Alcoholic hepatitis
Hyperplastic

38. With internal hemorrhoids Where is the anastomoses and Where is it
Turcot
Femoral hernia
Superior rectal and middle and inferior rectal - rectum
Downs

39. What nerve innervates the external hemorrhoids
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Inferior rectal nerve
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
Budd chiari syndrome

40. What causes hirschsprungs
Failure of neural crest migration
Left and right gastroepiploics - left and right gastrics
Heme metabolism
Poor anastamoses

41. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Brunners
CCK8 receptor - Gq inc IP3/Ca
AR
Zollinger Ellison - phenylalanine and tryptophan

42. What does a gastrinoma cause
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Complications of UC
Antrum - H.pylori - inc risk of MALT lymphoma
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

43. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Right and left hepatic duct
Meconium ileus
Mucosa - submucosa - muscularis externa - serosa/adventitia
Paraumbilical and superficial and inferior epigastric - umbilicus

44. What commonly leads to appendicity in kids vs adults
Smooth
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
Sphincter of oddi
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

45. What drug inhibits the H/K ATPase
Omeprazole
True and most common congenital anomoly of GI tract
Hepatic steatosis
Neutralizes oral bacertial acids and maintains dental health

46. What receptor does histamine bind on the parietal cell and What does it activate
Gamma glutamyl transferase GGT
H2 receptor - inc cAMP
Repeated phlebotomy - deferoxamine - HLA- A3
Lactase is located at the tips of intestinal villi

47. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Phenobarbital - inc liver enzyme synthesis
Hernia
IBS at least 2 with recurrent abdominal pain
Myenteric nerve plexus - aurbach

48. involvement of left supraclavicular node by mets from stomach

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

49. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Repeated phlebotomy - deferoxamine - HLA- A3
Diverticulum
Alfatoxin in peanuts
Alpha amylase

50. What causes carcinoid syndrome amd What are the symptoms
Esophageal carcinoma
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Hypercoaguability - polycythemia vera - pregnancy - HCC
Chronic calcifying pancreatitis - inc risk of panreatic cancer