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 rate limiting step of carbohydrate digestion
Duodenal atresia - Downs
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
Oligosaccharide digestion
Inc risk of CRC and other visceral malignancies

2. What is the classic triad of hemochromatosis

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

3. inflammatino of gallbadder
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
Unconj - absent (acholuria) - inc
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Lateral to the inferior epigastric artery

4. What is the frequency of basal electric rhythm in the duodenum
12 waves/min
Worldwide - SC - US - adeno
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Hirschsprungs

5. Where is B12 absorbed
In the ileum with bile acids - requires IF
Downs
Hepatic steatosis
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

6. What causes carcinoid syndrome amd What are the symptoms
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Hyperplastic
Closer to isotonic because of less time to reabsorb NaCl
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

7. Where is bicarb trapped
In the mucus that covers the gastric epithelium
Hydrocele
AST>ALT
Ischemic colitis

8. With internal hemorrhoids Where is the anastomoses and Where is it
Alk pho
Superior rectal and middle and inferior rectal - rectum
Elevated amylase - and lipase
Black - rotors syndrome

9. What causes pancreatic insuff and What does it cause
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Common hepatic - splenic - left gastric - main blood supply for stomach
Sphincter of oddi

10. What layer in the mucosa is responsible for absorption
Epithelium
Urobilin
Crohns = maybe - UC= always
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

11. Gq and inc cAMP both work to do what in parietal cells
Crohns = maybe - UC= always
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Stimulate the H/K ATPase

12. Which kind of hemorrhoids are painful and why
Failure of neural crest migration
Via the superior pancreaticduodenal
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Internal thoracic to superior epigastric to inferior epigastric

13. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Esophageal cancer
Ampulla of vater
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Where hindgut meets ectoderm

14. Cholecytsokinin - source - action - regulation
Positive
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
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Brunners

15. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Femoral hernia
GERD - may also present with nocturnal cough and dyspnea
Colovesical leading to pneumaturia
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

16. What does high flow rate mean
Neural muscarinic pathways
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Closer to isotonic because of less time to reabsorb NaCl

17. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Intussusception
Angiodysplasia
Upregulated intracellular signal transduction
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

18. What is the most common diaphragmatic hernia and What are the two types
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Upregulated intracellular signal transduction
Smooth
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

19. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Inc - weight loss
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Uremia

20. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Small intestine
Elevated amylase - and lipase
Lactase is located at the tips of intestinal villi
Glucouronate - water soluble (direct)

21. What is a positive murphy's sign
Ceruplasmin
Inspiratory arrest on deep palpation due to pain
Angiodysplasia
External (superficial) ring only

22. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
3 waves/min
Sphincter of oddi
H pylori (almost 100%)
Hemosiderosis - hemochromatosis

23. what percentage of colonic polyps are non - neoplastic
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Cystic duct and common hepatic duct
90%
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

24. What are the main components of bile
Left and right gastroepiploics - left and right gastrics
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

25. Which viral infxns/treatments are associated with reyes syndrome
VZV and influenza B treated with salicylates
Pertechnetate - study for uptake
Gamma glutamyl transferase GGT
Nonkeritinized stratified sqamous epithelium

26. What layer in the mucosa is responsible for support
Backup of blood into the liver - RHF - budd chiari
Inc lower esphogeal tone leading to achalasia
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Lamina propria

27. What can hemochromatosis be secondary to...
Primary sclerosing cholangitis
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Positive
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

28. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Necrotizing enterocolitis
Myenteric nerve plexus - aurbach
Elevated amylase - and lipase

29. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Zollinger ellison - brunners glands
L1
The entire

30. Which patients have pigment stones
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Dense core bodies
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

31. What are the complications of duodenal PUD
Bleeding - penetration into pancreas - perforation - obstruction
Conj/unconj - inc - nl to dec
HPNCC
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

32. 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
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Serous on the sides parotids - mucinous in the middle sublingual

33. Who is at risk for pancreatic adenocarcinoma
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Jewish and African American men
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Alpha amylase

34. What is diverticulosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Angiodysplasia
L/R renal artery around L1
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

35. What serum enzyme is decreased in wilsons disease
Ceruplasmin
Mucoepidermoid carcinoma
Inguninal ligament - sartorius muscle - adductor longus
Trypsin - chymotrypsin - elastase - carboxypeptidases

36. What do mucins do?
Lubricate food (glycoprotiens)
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
US and cholecystectomy
Esophageal carcinoma

37. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Superior rectal
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Normal
Peptic ulcer disease

38. What is the cause of Barrett's and the assocaited complications
Serous on the sides parotids - mucinous in the middle sublingual
Mucoepidermoid carcinoma
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Above

39. Diaphragmatic hernias occur in infants because of defective development of which membrane
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Pleuroperitoneal
Inc conj bilirubin - inc cholesterol - inc alk phos
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

40. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Lactase is located at the tips of intestinal villi
Lateral
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
...

41. What test and result confirms H pylori infxn
IgA secreting plasma cells - ultimately reside in the lamina proporia
Positive urease test
So hypertrophied they look like brain gyri
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

42. What are the borders of the femoral triangle
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Primarly through ECL leading to histamine release
Inguninal ligament - sartorius muscle - adductor longus

43. What do tumors that arise in the head of the pancreas cause
Meckels
Juvenille polyps - no risk if single
Obstruction of the common bile duct
Necrotizing enterocolitis

44. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
EtOH
Black - rotors syndrome
Barrett's esophagus

45. What is biliary colic
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Lye ingestion and acid reflux
Juvenille polyps - no risk if single
Hypercoaguability - polycythemia vera - pregnancy - HCC

46. What pancreatic proteases are secreted as zymogens
Liver metabolizes 5HT
FAP
Smooth
Trypsin - chymotrypsin - elastase - carboxypeptidases

47. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Penicillinamine - AR inheritance
Jewish and African American men
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
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 is the most common indication of emergent abdominal surgery in children
Hemosiderosis - hemochromatosis
Appendicitis
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
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

49. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Oligosaccharide digestion
Centrilobular leading to congestive liver disease
H2 receptor - inc cAMP
FAP

50. What is the mechanism for reyes syndrome
Hepatic steatosis
External (superficial) ring only
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN