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 is the other name for GIP (gastric inhibitory peptide)
Redundant mesentary
Sister mary joseph nodule
Glucose dependent insulinotropic peptide
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

2. is meckels a true diverticulum and how common is it
Heme metabolism
CCK8 receptor - Gq inc IP3/Ca
Upregulated intracellular signal transduction
True and most common congenital anomoly of GI tract

3. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
T cell lymphoma
Brush border of intestine - produce monosaccharides from oligo and di
Angiodysplasia
2ndary biliary cirrhosis

4. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
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
Internal thoracic to superior epigastric to inferior epigastric
Barrett's esophagus
Fe2+ in the duod

5. At what level do the testicular/ovarian arteries exit the aorta
L2
...
Diarrhea - steatorrhea - weight loss - weakness
Lamina propria

6. What is the cause of physiologic neonatal jaundice
Fasting and stress
External (superficial) ring only
Uremia
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

7. If the abdominal aorta is blocked - How does blood get to the left colic artery
Esophageal varices
Around the central vein (zone III)
Closer to isotonic because of less time to reabsorb NaCl
Via the middle colic

8. 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

9. What is the ddx associated with appendicitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Parietal cells in the stomach - B12 binding protein

10. What kind of anemia is in Wilsons
Cigarettes and chronic pancreatitis - not EtOH
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Hemolytic anemia
Hernia

11. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Below
Zollinger Ellison - phenylalanine and tryptophan
Ceruplasmin
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

12. What is the leading cause of bowel incarceration
Gut bacteria
Liver metabolizes 5HT
Femoral hernia
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

13. What is the epi for CRC
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Redundant mesentary

14. Where is bicarb trapped
Positive
In the mucus that covers the gastric epithelium
Low pressure proximal to LES
Pyoderma gangrenosum - primary sclerosing cholangitis

15. What kind of lesions are characteristic of duodenal PUD vs cancer
Punched out - clean margins - carcinoma =raised irregular margins
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
Around the central vein (zone III)
Normal

16. Is there any structural abnl with IBS - What is the course of disease and presentation
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
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Hyperpigmented mouth - lips - hands - genitalia
No - chronic - can present with diarrhea or constipation or alternation - treat sx

17. What is the lumen of the pancreatic duct
H2 receptor - inc cAMP
No
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Ampulla of vater

18. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Inc lower esphogeal tone leading to achalasia
VZV and influenza B treated with salicylates
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Gut bacteria

19. What are causes of extrahepatic biliary obstruction
Enterokinase/enteropeptidase from the duodenal mucosa
Redundant mesentary
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

20. What cells make pepsin - What does it do - and what regulates it
Sister mary joseph nodule
Zollinger ellison - brunners glands
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Heme metabolism

21. Which is used more quickly - an oral glucose load - or that by IV
Oral glucose
Osmotic
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
With albumin

22. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery

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

23. Where is there sclerosis in alcoholic cirrohosis
Gastric glands
Around the central vein (zone III)
Hemolytic anemia
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

24. What is the risk with peutz jehgers
Obstruction of the common bile duct
Inc risk of CRC and other visceral malignancies
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Amylase

25. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Low pressure proximal to LES
Complications of crohns
Juvenille polyps - no risk if single
Can lead to hematemesis - found in EtOHics and bulimics

26. What does loss of p53 cause
Femoral hernia
Increase tumorigenesis
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Superior rectal

27. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Juvenille polyps - no risk if single
Stimulate the H/K ATPase
Alk phos
IgA secreting plasma cells - ultimately reside in the lamina proporia

28. How does CRC present in the distal and proximal colon
Gamma glutamyl transferase GGT
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Crypts but not villi
Crigler - najjar type 1

29. What is the most common cause of gallstones
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Squamous - upper 1/3 - adeno - lower 1/3
Uridine glucuronyl transferase

30. What is the frequency of basal electric rhythm of the ilieum
In the mucus that covers the gastric epithelium
8-9 waves/min
The entire
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

31. What is indirect bilirubin
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Unconjugated - water insoluble
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Gastric glands

32. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Gallbladder
Uremia
Short gastrics - left greater and lesser
IBS at least 2 with recurrent abdominal pain

33. 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

34. What do you treat Wilsons disease with and What is the inheritance
Penicillinamine - AR inheritance
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
So hypertrophied they look like brain gyri
Gilbert's

35. What skin condition is associated with celiac sprue
Lubricate food (glycoprotiens)
Dermatitis herpetiformis
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Striated and smooth

36. likely infectious form of malabsorption - responds to antibiotics
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Tropical sprue
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Alk phos

37. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Lye ingestion and acid reflux
IgA secreting plasma cells - ultimately reside in the lamina proporia
Alcoholic cirrhosis
Zenkers - halitosis - dysphagia and obstruction

38. What is a positive murphy's sign
Inspiratory arrest on deep palpation due to pain
M3 - Gq - inc IP3/Ca
EtOH
Pleomorphic adenoma

39. What does bicarb do in the duodenum
Dermatitis herpetiformis
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Pyoderma gangrenosum - primary sclerosing cholangitis
Brunners

40. When and How does Abetalipoproteinemia present
Diverticulitis in elderly - ectopic pregs use hCG to rule out
PAS- positive globules in liver -
Early childhood - neuro sx and malabsorption
Epithelium

41. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
2ndary biliary cirrhosis
...
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

42. What are the common causes of gastric ulcers - What causes gastric ulcer
Bleeding - intussusception - volvulus - obstruction near terminal ileum
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Normal
Colonic polyps

43. What kind of muscle is in the middle 1/3 of esophagus
Inc risk of CRC and other visceral malignancies
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
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Striated and smooth

44. What are the histological findings in the duodenum

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

45. What are the four Fs of gallstones
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Smooth
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Female - fat - fertile - forty

46. What are the treatment options for uclerative colitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
The submucosal nerve plexus - meissner's
Closer to isotonic because of less time to reabsorb NaCl
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

47. What are the labs in acute pancreatitis
Alpha1 antitrypsin def - codominant trait
Elevated amylase - and lipase
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
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

48. What is the arterial supply and venous drainage below pectinate line
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Omeprazole
Can lead to hematemesis - found in EtOHics and bulimics

49. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
The submucosal nerve plexus - meissner's
External (superficial) ring only
Meckels
Epigastric abdominal pain radiating to back - anorexia - nausea

50. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Zollinger ellison - brunners glands
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Alcoholic cirrhosis
Liver metabolizes 5HT