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
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Esophageal cancer
Mallory bodies
Lateral to the inferior epigastric artery

2. What is the mechanism for reyes syndrome
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Complications of UC
HPNCC

3. What does histo show for alpha1 antitrypsin def
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Unconjugated - water insoluble
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
PAS- positive globules in liver -

4. bilateral mets to ovaries with abundant mucus - signet ring cells
Colonic polyps
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Hirschsprungs
Krukenbergs tumor

5. What are causes of extrahepatic biliary obstruction
Colonic polyps
Oral glucose
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

6. What do the rugae of stomach look like in menetriers disease
So hypertrophied they look like brain gyri
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Krukenbergs tumor

7. Where does crohns usually affect the GI tract
Inguninal ligament - sartorius muscle - adductor longus
Older patients
Terminal ileum and colon
Duodenal atresia - Downs

8. People of what decent are associated with celiac sprue and what findings/antibodies are present
H+
In the ileum with bile acids - requires IF
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
External spermatic fascia only

9. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Inc conj bilirubin - inc cholesterol - inc alk phos
HSV-1 - CMV - Candida
Brunners
Gastric glands

10. What does high flow rate mean
Mucoepidermoid carcinoma
Closer to isotonic because of less time to reabsorb NaCl
Conj - inc - dec
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

11. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
Elevated amylase - and lipase
Omeprazole
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

12. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Complications of UC
Black - rotors syndrome
Cirrhosis
Old men - arthralgias - cardiac and neuro sx

13. Are single polyps malignant in peutz jehgers
Via the superior pancreaticduodenal
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
T cell lymphoma
No

14. Malabsorption syndromes have what common clinical presentation
Diarrhea - steatorrhea - weight loss - weakness
Left gastric vein and esophogeal vein - esophagus
Superior rectal
Portal HTN

15. What drug blocks the H2R
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
Downs
Cimetidine
US and cholecystectomy

16. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Cigarettes and chronic pancreatitis - not EtOH
Smooth
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Menetriers disease

17. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Stercobilin
H+
Alcoholic hepatitis
HSV-1 - CMV - Candida

18. What is the frequency of basal electric rhythm of the ilieum
8-9 waves/min
L2
Corticosteroids - infliximab
Begins starch digestion - inactivated by low pH upon reaching the stomach

19. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Omeprazole
Alk pho
Portal HTN
GERD - may also present with nocturnal cough and dyspnea

20. How is the diagonsis of CRC made
Trypsin - chymotrypsin - elastase - carboxypeptidases
Chronic calcifying pancreatitis - inc risk of panreatic cancer
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
HSV-1 - CMV - Candida

21. What is the path of an indirect inguinal hernia
Worldwide - SC - US - adeno
Crypts but not villi
Goes through deep inguinal ring - external inguinal ring and into the scrotum
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

22. What infection causes Whipple disease and What can you see on LM
HPNCC
Lateral
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Appendicitis

23. Where does type B chronic gastritis occur and What causes it
Striated
Appendicitis
Gilbert's
Antrum - H.pylori - inc risk of MALT lymphoma

24. What is the presentation of pancreatic adenocarcinoma
Pancreatic head causing obstructive jaundice
IBS at least 2 with recurrent abdominal pain
Alk pho
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

25. What pancreatic enzymes are responsible for fat digestion
Liver metabolizes 5HT
8-9 waves/min
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Lipase - phospholipase A - colipase

26. What causes hirschsprungs
Unconj - absent (acholuria) - inc
Failure of neural crest migration
Inc lower esphogeal tone leading to achalasia
Jaundice - fever - RUQ

27. 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

28. What congenital birth defect is associated with Hirschsprung
Phototherapy
Downs
Parietal cells in the stomach - B12 binding protein
VZV and influenza B treated with salicylates

29. What are the treatment options for uclerative colitis
Inferior rectal nerve
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Esophageal cancer
Splenic flexure

30. Acute gastritis is caused By what process
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Erosive - disruption of mucosal barrier leading to inflammation
Portal HTN
Centrilobular leading to congestive liver disease

31. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Inc conj bilirubin - inc cholesterol - inc alk phos
Meconium ileus
Epigastric abdominal pain radiating to back - anorexia - nausea
T12

32. Where does type A chronic gastritis occur and What causes it
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Antrum - H.pylori - inc risk of MALT lymphoma
Portal HTN
Glucose dependent insulinotropic peptide

33. What is contained in the gastrosplenic and What areas does it separate
Short gastrics - left greater and lesser
Osmotic
Fe2+ in the duod
Heme metabolism

34. To what substance is bilirubin conjugated and why
Glucouronate - water soluble (direct)
Increase tumorigenesis
Positive
Urobilin

35. What are the complications of acute pancreatitis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
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
Pancreatic and bile
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

36. What is a positive murphy's sign
Inspiratory arrest on deep palpation due to pain
Celiac sprue
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

37. If trypsin activates more trypsinogen - what kind of feedback loop is established
Positive
L3
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
US and cholecystectomy

38. What does loss of APC cause
Decreased intercellular adhesion and increased proliferation
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Hemosiderosis - hemochromatosis
Where hindgut meets ectoderm

39. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Alcoholic cirrhosis
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Carcinoid syndrome

40. What histological findings are present in the stomach
Gastric glands
Splenic flexure
Spleen to posterior abdominal wall - splenic artery and vein
Centrilobular leading to congestive liver disease

41. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Budd chiari syndrome
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Oral glucose
Inc conj bilirubin - inc cholesterol - inc alk phos

42. concentric onion skin bile duct fibrosis
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Primary sclerosing cholangitis
Pyoderma gangrenosum - primary sclerosing cholangitis

43. 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

44. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Mucoepidermoid carcinoma
Colonic polyps
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Ischemic colitis

45. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Lactase is located at the tips of intestinal villi
Crigler - najjar type 1
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Striated and smooth

46. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Esophageal varices
IgA secreting plasma cells - ultimately reside in the lamina proporia
Low pressure proximal to LES
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

47. What makes a true diverticula
Old men - arthralgias - cardiac and neuro sx
All 3 gut layers outpouch as in Meckels
Gut bacteria
...

48. What is the HLA association and treatment for hemochromatosis
Inspiratory arrest on deep palpation due to pain
Repeated phlebotomy - deferoxamine - HLA- A3
Osmotic
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

49. What serum enzyme is elevated in acute pancreatitis and mumps
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Amylase
Cholesterol
Krukenbergs tumor

50. How does hirschsprung present and appear on imaging
Cigarettes and chronic pancreatitis - not EtOH
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
Acute pancreatitis
Crigler - najjar type 1