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 NSAIDs cause acute gastritis
Alk pho
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Dec PGE2 leading to dec gastric mucosa protection
Inguninal ligament - sartorius muscle - adductor longus

2. In PUD with a duodenal ulcer does pain inc or dec with meals
Superior rectal and middle and inferior rectal - rectum
Acute pancreatitis
Decrease - weight gain
Femoral hernia

3. What is the frequency of basal electric rhythm of the ilieum
Alfatoxin in peanuts
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
8-9 waves/min
Falciform - ligamentum teres - fetal umbilical vein

4. What are additional risk factors for CRC
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
VZV and influenza B treated with salicylates
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

5. What are the effects of atropine on parietal cells and G cells
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Inc risk of CRC and other visceral malignancies
...

6. What do you treat Wilsons disease with and What is the inheritance
The proximal small bowel
Alpha1 antitrypsin def - codominant trait
H+
Penicillinamine - AR inheritance

7. What are the labs in acute pancreatitis
Bleeding - penetration into pancreas - perforation - obstruction
Epigastric abdominal pain radiating to back - anorexia - nausea
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
Elevated amylase - and lipase

8. What other condition can lead to acute gastritis - think renal
Pertechnetate - study for uptake
Uremia
2ndary biliary cirrhosis
The jejunum

9. What does K- ras mutation cause
Elevated amylase - and lipase
Upregulated intracellular signal transduction
Stimulate the H/K ATPase
L3

10. What drug blocks the H2R
Inferior rectal nerve
Decreased intercellular adhesion and increased proliferation
Cimetidine
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

11. Malabsorption syndromes have what common clinical presentation
Portal HTN
Epithelium
Diarrhea - steatorrhea - weight loss - weakness
H pylori (almost 100%)

12. List the clinical findings of HCC
Positive
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Downs
Can lead to hematemesis - found in EtOHics and bulimics

13. What reaction does salivary amylase catalyze
Lye ingestion and acid reflux
Repeated phlebotomy - deferoxamine - HLA- A3
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Right and left hepatic duct

14. What is the other name for GIP (gastric inhibitory peptide)
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Glucose dependent insulinotropic peptide
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Below

15. Why does carcinoid syndrome not occur if tumor is confined to GI system
Liver metabolizes 5HT
Lamina propora and submucosa
Dilated esophagus with an area of distal stenosis - birds beak
Complications of UC

16. What is charcot triad of cholangitis
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Jaundice - fever - RUQ
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

17. 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
H+
H pylori (almost 100%)
Dissaccharidase def - most commonly lactase

18. FAP + osseous and soft tissue tumors - retinal hyperplasia

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

19. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Low pressure proximal to LES
Carcinoid syndrome
PAS- positive globules in liver -
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

20. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Uridine glucuronyl transferase
Falciform - ligamentum teres - fetal umbilical vein
Heme metabolism
Terminal ileum and colon

21. What is the sphincter of the pancreatic duct
Hyperpigmented mouth - lips - hands - genitalia
Sphincter of oddi
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Small intestine

22. What does the splenorenal ligament connect - and What does it contain
L3
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
GERD - may also present with nocturnal cough and dyspnea
Spleen to posterior abdominal wall - splenic artery and vein

23. What is the clinical presentation of acute pancreatitis
Cigarettes and chronic pancreatitis - not EtOH
Oligosaccharide digestion
Epigastric abdominal pain radiating to back - anorexia - nausea
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

24. What does autoimmune destruction of parietal cells lead to...
Mallory bodies
Esophageal carcinoma
Hernia
Chronic gastritis and pernicious anemia

25. Which viral infxns/treatments are associated with reyes syndrome
8-9 waves/min
VZV and influenza B treated with salicylates
Juvenille polyps - no risk if single
Hyperplastic

26. What arteries exit just below the SMA
L/R renal artery around L1
Angiodysplasia
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Duodenal atresia - Downs

27. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Lactase is located at the tips of intestinal villi
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

28. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Splenic flexure
Esophageal varices
Ischemic colitis
Striated and smooth

29. To what substance is bilirubin conjugated and why
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
Upregulated intracellular signal transduction
Glucouronate - water soluble (direct)
90%

30. Achalasia increases the risk For what complication
Esophageal carcinoma
VZV and influenza B treated with salicylates
Internal thoracic to superior epigastric to inferior epigastric
Alfatoxin in peanuts

31. What does high flow rate mean
Brush border of intestine - produce monosaccharides from oligo and di
Closer to isotonic because of less time to reabsorb NaCl
Phenobarbital - inc liver enzyme synthesis
Terminal ileum and colon

32. What is indirect bilirubin
Unconjugated - water insoluble
3 waves/min
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Juvenile polyposis syndrome - inc risk of adenocarcinoma

33. Who gets Whipple disease and How do they present
Black - rotors syndrome
Gilbert's
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Old men - arthralgias - cardiac and neuro sx

34. What are the foregut structures and what supplies their blood and PANS innvervation
Urobilin
Dermatitis herpetiformis
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Older patients

35. Autoantibodies to gluten (gliadin) in wheat and other grains
Celiac sprue
Worldwide - SC - US - adeno
Intussusception
Zollinger ellison - brunners glands

36. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
FAP
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Inc - weight loss
Alk pho

37. What does bicarb do in the duodenum
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Trypsin - chymotrypsin - elastase - carboxypeptidases
Pleuroperitoneal
Neutralizes gastric acid allowing pancreatic enzymes to fxn

38. What are the longterm sequelae of nutmeg liver
Brunners
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Meconium ileus
Centrilobular congestion and necrosis - cardiac cirrhosis

39. What are the borders of the femoral triangle
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Inguninal ligament - sartorius muscle - adductor longus
Inc conj bilirubin - inc cholesterol - inc alk phos

40. How does hirschsprung present and appear on imaging
Myenteric nerve plexus - aurbach
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Krukenbergs tumor
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

41. What type of insults result in micronodular cirrhosis
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Osmotic
Below

42. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Alfatoxin in peanuts
H+
IgA secreting plasma cells - ultimately reside in the lamina proporia
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

43. What layer of fascia covers a direct inguinal hernia
Mucoepidermoid carcinoma
Hydrocele
Internal thoracic to superior epigastric to inferior epigastric
External spermatic fascia only

44. What enzyme is necessary to create conjugated bilirubin
Uridine glucuronyl transferase
Dilated esophagus with an area of distal stenosis - birds beak
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Conj/unconj - inc - nl to dec

45. is meckels a true diverticulum and how common is it
Via the middle colic
True and most common congenital anomoly of GI tract
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Primary sclerosing cholangitis

46. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Parietal cells in the stomach - B12 binding protein

47. At what spinal level does the SMA exit
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
L1
Angiodysplasia
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

48. What are the complications of duodenal PUD
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Squamous - upper 1/3 - adeno - lower 1/3
Bleeding - penetration into pancreas - perforation - obstruction
Dissaccharidase def - most commonly lactase

49. What are causes of extrahepatic biliary obstruction
Chronic gastritis and pernicious anemia
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Diverticulum

50. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Urobilin
Primary sclerosing cholangitis
Volvulus
Inc risk of CRC and other visceral malignancies