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. in budd chiari syndrome - Where is the congestion and necrosis
Lateral
Amylase
Femoral hernia
Centrilobular leading to congestive liver disease

2. What does TOASTED with alcoholic hepatitis stand for
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
AST >ALT - ration is usually 1.5
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Intussusception

3. Which serum enzyme increases with heavy EtOH consumption
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Unconj - absent (acholuria) - inc
Gamma glutamyl transferase GGT
Splenic flexure

4. Who is at risk for pancreatic adenocarcinoma
Zenkers - halitosis - dysphagia and obstruction
Budd chiari syndrome
Jewish and African American men
Above

5. What is the frequency of basal electric rhythm of the stomach
3 waves/min
Stimulate intestinal persistalsis
Meconium ileus
Budd chiari syndrome

6. How is the diagonsis of CRC made
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Below
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

7. What are the layers of the gut wall from inside out
Mucosa - submucosa - muscularis externa - serosa/adventitia
L2
12 waves/min
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

8. What causes primary biliary cirrhosis
Crigler - najjar type 1
Via the superior pancreaticduodenal
Falciform - ligamentum teres - fetal umbilical vein
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

9. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Falciform - ligamentum teres - fetal umbilical vein
Dysphagia (due to esophageal web) - glossitis - iron def anemia

10. What gives stool its characteristic color
Serous on the sides parotids - mucinous in the middle sublingual
Via the superior pancreaticduodenal
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Stercobilin

11. Is there any structural abnl with IBS - What is the course of disease and presentation
Centrilobular congestion and necrosis - cardiac cirrhosis
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Sister mary joseph nodule
Cystic duct and common hepatic duct

12. In what scenarios do pts with gilberts have inc bili
Cystic duct and common hepatic duct
Hyperpigmented mouth - lips - hands - genitalia
Gilbert's
Fasting and stress

13. Gastrin - source - action - regulation
Hemolytic anemia
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
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
Black - rotors syndrome

14. What pancreatic enzymes are responsible for fat digestion
Repeated phlebotomy - deferoxamine - HLA- A3
Lipase - phospholipase A - colipase
Alfatoxin in peanuts
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

15. in carcinoid tumors - What is seen on EM
Boerhaave's Syndrome - Been heaving syndrome
Dense core bodies
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Uremia

16. People of what decent are associated with celiac sprue and what findings/antibodies are present
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Celiac sprue
Lactase is located at the tips of intestinal villi
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

17. What does bicab do in the mouth
Neutralizes oral bacertial acids and maintains dental health
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Cigarettes and chronic pancreatitis - not EtOH
Striated and smooth

18. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Alpha amylase
Lateral
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Alpha1 antitrypsin def - codominant trait

19. What factors increase risk of malignancy of adenomatous polyps
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Cystic dilation of the viteline duct
Jaundice - fever - RUQ
HSV-1 - CMV - Candida

20. What structures feed into the common bile duct
Cholesterol
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
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
Cystic duct and common hepatic duct

21. What is contained within the submucosa

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

22. What test and result confirms H pylori infxn
Neutralizes oral bacertial acids and maintains dental health
IBS at least 2 with recurrent abdominal pain
Positive urease test
Left gastric vein and esophogeal vein - esophagus

23. What causes hirschsprungs
Gastrohepatic ligament
Peyers patches
Failure of neural crest migration
Zenkers - halitosis - dysphagia and obstruction

24. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Elevated amylase - and lipase
Omeprazole
Crypts but not villi
Colonic polyps

25. What is the TX of physiologic neonatal jaundice
Decreased intercellular adhesion and increased proliferation
Phototherapy
Alcoholic cirrhosis
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

26. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Around the central vein (zone III)
GERD - may also present with nocturnal cough and dyspnea
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Glucouronate - water soluble (direct)

27. What structure is Not contained in the femoral sheath
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Phototherapy
Positive
Inc risk of CRC and other visceral malignancies

28. What are the tumor markers for pancreatic adenocarcinoma
Achalasia due to loss of myenteric plexus (auberach)
CEA - CA-19-9
Small intestine
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

29. What serum enzyme is elevated inacute pancreatitis
Epigastric abdominal pain radiating to back - anorexia - nausea
Peutz jeghers
Lipase
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

30. Which IBD is autoimmune and which may be a disordered response to bacteria
EtOH
Hypercoaguability - polycythemia vera - pregnancy - HCC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

31. What are the extraintestinal manifestations of crohns
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
IgA secreting plasma cells - ultimately reside in the lamina proporia
Hemosiderosis - hemochromatosis
Neutralizes gastric acid allowing pancreatic enzymes to fxn

32. What layer of fascia covers a direct inguinal hernia
External spermatic fascia only
Zollinger Ellison - phenylalanine and tryptophan
Alcoholic hepatitis
CEA - CA-19-9

33. 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
Increase tumorigenesis
Corticosteroids - infliximab
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

34. What skin condition is associated with celiac sprue
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Angiodysplasia
Dermatitis herpetiformis
GLUT 2

35. What is indirect bilirubin
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Sphincter of oddi
IgA secreting plasma cells - ultimately reside in the lamina proporia
Unconjugated - water insoluble

36. What cells make pepsin - What does it do - and what regulates it
PAS- positive globules in liver -
L2
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

37. 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

38. somatostatin - source - action - regulation
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
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
Normal
Cimetidine

39. What are the borders of Hesselbach's triangle
Mallory bodies
Jewish and African American men
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Serous on the sides parotids - mucinous in the middle sublingual

40. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
2ndary biliary cirrhosis
Acute pancreatitis
Serous on the sides parotids - mucinous in the middle sublingual

41. malnutrition - toxic megacolon - colorectal carcinoma
Glucose dependent insulinotropic peptide
Crohns = noncaseating granulomas - UC = crypt abscesses
Chronic gastritis and pernicious anemia
Complications of UC

42. What artery passes around the duodenum
Boerhaave's Syndrome - Been heaving syndrome
Adhesion
The gastroduodenal
Peyers patches

43. What makes a true diverticula
Lactase is located at the tips of intestinal villi
H pylori (almost 100%)
All 3 gut layers outpouch as in Meckels
Femoral hernia

44. What kind of diarrhea is produced from a disaccharide def
Common hepatic - splenic - left gastric - main blood supply for stomach
Osmotic
Peutz jeghers
CCK8 receptor - Gq inc IP3/Ca

45. With internal hemorrhoids Where is the anastomoses and Where is it
Esophageal varices
Superior rectal and middle and inferior rectal - rectum
Cimetidine
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

46. Where is the deep inguinal ring relative to the inferior epigastric vessels
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Lateral
Hemosiderosis - hemochromatosis

47. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Superior rectal and middle and inferior rectal - rectum
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
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

48. What carcinogens are associated with HCC
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
HPNCC
Alfatoxin in peanuts
Pleomorphic adenoma

49. Autodigestion of pancreas by pancreatic enzymes
Gastric glands
Conj - inc - dec
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Acute pancreatitis

50. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Alk phos
Crigler - najjar type 1
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
IgA secreting plasma cells - ultimately reside in the lamina proporia