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. How do villi appear in disaccharidease def
Normal
Carcinoid syndrome
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Closer to isotonic because of less time to reabsorb NaCl

2. What does histo show for alpha1 antitrypsin def
Inguninal ligament - sartorius muscle - adductor longus
The submucosal nerve plexus - meissner's
PAS- positive globules in liver -
Heme metabolism

3. What histological findings are present in the stomach
Gastric glands
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
VZV and influenza B treated with salicylates
Nonkeritinized stratified sqamous epithelium

4. What cells secrete bicarb - What does it do - and what regulates it
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Mucosa - submucosa - muscularis externa - serosa/adventitia
Inc lower esphogeal tone leading to achalasia
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

5. What kind of cancer to celiac sprue put you as inc risk for
Colonic polyps
T cell lymphoma
Zollinger Ellison - phenylalanine and tryptophan
Hypercoaguability - polycythemia vera - pregnancy - HCC

6. In PUD - with gastric ulcers - does pain inc or dec with meals?
Alcoholic hepatitis
Common hepatic - splenic - left gastric - main blood supply for stomach
Inc - weight loss
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

7. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Muscularis mucosae
Black - rotors syndrome
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

8. With caput medusaw - between what vessels is the anastomoses and Where is it
Osmotic
Colonic polyps
Paraumbilical and superficial and inferior epigastric - umbilicus
Crohns = maybe - UC= always

9. Abuse of what substance leads to acute gastritis
Cigarettes and chronic pancreatitis - not EtOH
Dubin johnson
Hemosiderosis - hemochromatosis
EtOH

10. why infxn is implicated in duodenal PUD
H pylori (almost 100%)
Alpha amylase
Ceruplasmin
Dissaccharidase def - most commonly lactase

11. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Lipase - phospholipase A - colipase
Esophageal cancer
Inc lower esphogeal tone leading to achalasia
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

12. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Splenic flexure
Crohns = noncaseating granulomas - UC = crypt abscesses
Crohns = maybe - UC= always
Budd chiari syndrome

13. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Adhesion
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

14. Malabsorption syndromes have what common clinical presentation
Inc smooth muscle relaxation - including lower esophageal sphincter
Cystic dilation of the viteline duct
The gastroduodenal
Diarrhea - steatorrhea - weight loss - weakness

15. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Tropical sprue
Via the superior pancreaticduodenal
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

16. What are the results of hemochromatosis
Krukenbergs tumor
Budd chiari syndrome
IBS at least 2 with recurrent abdominal pain
CHF and inc risk of HCC

17. What carcinogens are associated with HCC
Intussusception
Zollinger Ellison - phenylalanine and tryptophan
Alfatoxin in peanuts
Celiac sprue

18. What is Trousseau's sign
Crypts but not villi
Redness and tenderness on palpation of extremities
The submucosal nerve plexus - meissner's
Squamous - upper 1/3 - adeno - lower 1/3

19. 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

20. 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

21. Autoantibodies to gluten (gliadin) in wheat and other grains
Lactase is located at the tips of intestinal villi
Celiac sprue
Gardner's syndrome
H2 receptor - inc cAMP

22. Transmural esophageal rupture due to violent retching

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

23. What retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Below
NAV = nerve artery vein - venous near the penis (NAVEL)

24. What do you treat Wilsons disease with and What is the inheritance
Penicillinamine - AR inheritance
Amylase
Black - rotors syndrome
Small intestine

25. What are motilin receptor agonists used for clinically
Hirschsprungs
Hemolytic anemia
Lateral
Stimulate intestinal persistalsis

26. What infection causes Whipple disease and What can you see on LM
Short gastrics - left greater and lesser
Lactase is located at the tips of intestinal villi
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Oligosaccharide digestion

27. What is contained within the submucosa

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

28. malnutrition - toxic megacolon - colorectal carcinoma
Hemosiderosis - hemochromatosis
Complications of UC
Duodenal atresia - Downs
L1

29. What layer in the mucosa is repsonsible for motility
Muscularis mucosae
Falciform - ligamentum teres - fetal umbilical vein
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
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

30. What are the main components of bile
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Old men - arthralgias - cardiac and neuro sx
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Nonkeritinized stratified sqamous epithelium

31. What are the midgut structures and what supplies their blood and PANS innervation
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
T12
Dec PGE2 leading to dec gastric mucosa protection

32. What artery passes around the duodenum
Pancreatic and bile
The gastroduodenal
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Hemosiderosis - hemochromatosis

33. With internal hemorrhoids Where is the anastomoses and Where is it
Black - rotors syndrome
Superior rectal and middle and inferior rectal - rectum
In the mucus that covers the gastric epithelium
Paraumbilical and superficial and inferior epigastric - umbilicus

34. secretin - source - action - regulation
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
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
AST>ALT
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

35. What conditions are associated with budd chiari
Averages 6 months - very aggressive - usually already metastasized at presentation
All 3 gut layers outpouch as in Meckels
True and most common congenital anomoly of GI tract
Hypercoaguability - polycythemia vera - pregnancy - HCC

36. What are the common causes of gastric ulcers - What causes gastric ulcer
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Older patients
Early childhood - neuro sx and malabsorption
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

37. What is the lumen of the pancreatic duct
Can lead to hematemesis - found in EtOHics and bulimics
Complications of UC
Ampulla of vater
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

38. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Necrotizing enterocolitis
Urobilin

39. How does loss of NO secretion affect the esophagus and what results
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
H+
Primary sclerosing cholangitis
Inc lower esphogeal tone leading to achalasia

40. Acute gastritis is caused By what process
Fasting and stress
Erosive - disruption of mucosal barrier leading to inflammation
Conj - inc - dec
Decreased intercellular adhesion and increased proliferation

41. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Older patients
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Alpha amylase
Primarly through ECL leading to histamine release

42. Bilirubin is the product of what?
Upregulated intracellular signal transduction
Heme metabolism
Where hindgut meets ectoderm
Low pressure proximal to LES

43. At what spinal level does the celiac trunk exit
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Zenkers - halitosis - dysphagia and obstruction
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
T12

44. When and How does Abetalipoproteinemia present
Hydrocele
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Elevated amylase - and lipase
Early childhood - neuro sx and malabsorption

45. What is contained within the muscularis externa
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
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Ceruplasmin
Myenteric nerve plexus - aurbach

46. in carcinoid tumors - What is seen on EM
Dense core bodies
Hemosiderosis - hemochromatosis
Right and left hepatic duct
Hyperplastic

47. Which area of the hindgut is a watershed area
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Gastric glands
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Splenic flexure

48. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

49. Failure of relaxation of lower esophageal sphincter - Name and etiology
Achalasia due to loss of myenteric plexus (auberach)
Normal
L1
Warthins' tumor

50. What are the four Fs of gallstones
Female - fat - fertile - forty
Elevated amylase - and lipase
Older patients
Dermatitis herpetiformis