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. Gastrin - source - action - regulation
Budd chiari syndrome
Colonic polyps
Source - G cells in the antrum - action - inc gastric H+ secretion - inc growth of gastric mucosa - and inc gastric motility - regulation - inc by stomach distention/alkalinaztion - amino acids - peptides - vagal stimulation - dec by stomach pH < 1.5
Around the central vein (zone III)

2. 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

3. What is the sphincter of the pancreatic duct
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Sphincter of oddi
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

4. What is the most common cause of gallstones
Crigler - najjar type 1
Inc lower esphogeal tone leading to achalasia
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Juvenile polyposis syndrome - inc risk of adenocarcinoma

5. What does alpha amylase do and what inactivates it
Osmotic
Begins starch digestion - inactivated by low pH upon reaching the stomach
Volvulus
Crypts but not villi

6. somatostatin - source - action - regulation
Jaundice - fever - RUQ
Peutz jeghers
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
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

7. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Can lead to hematemesis - found in EtOHics and bulimics
Crohns = maybe - UC= always
Oligosaccharide digestion

8. Which kind of hemorrhoids are painful and why
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Chronic calcifying pancreatitis - inc risk of panreatic cancer
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

9. What are the complications of chronic pancreatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Heme metabolism
Lamina propria

10. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Meckels
Punched out - clean margins - carcinoma =raised irregular margins
Common hepatic - splenic - left gastric - main blood supply for stomach
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM

11. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Below
Duodenal atresia - Downs
Conj - inc - dec
Left gastric vein and esophogeal vein - esophagus

12. Is there any structural abnl with IBS - What is the course of disease and presentation
Below
H2 receptor - inc cAMP
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
No - chronic - can present with diarrhea or constipation or alternation - treat sx

13. What is diverticulosis
Pertechnetate - study for uptake
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Centrilobular congestion and necrosis - cardiac cirrhosis
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

14. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Decrease - weight gain
Falciform - ligamentum teres - fetal umbilical vein
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

15. How does CRC present in the distal and proximal colon
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Gastric glands
IBS at least 2 with recurrent abdominal pain

16. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Diverticulum
Lactase is located at the tips of intestinal villi
Inc conj bilirubin - inc cholesterol - inc alk phos
Lipase - phospholipase A - colipase

17. What do tumors that arise in the head of the pancreas cause
Esophageal varices
Obstruction of the common bile duct
Dilated esophagus with an area of distal stenosis - birds beak
Penicillinamine - AR inheritance

18. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Terminal ileum and colon
Volvulus
Dissaccharidase def - most commonly lactase

19. What is the omphalomesenteric cyst
Parietal cells in the stomach - B12 binding protein
Peyers patches
Primary sclerosing cholangitis
Cystic dilation of the viteline duct

20. What are the layers of the gut wall from inside out
HPNCC
Gut bacteria
External (superficial) ring only
Mucosa - submucosa - muscularis externa - serosa/adventitia

21. What is contained within the submucosa

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

22. What receptors does ACH bind on the parietal cells and What does it activate
M3 - Gq - inc IP3/Ca
Adhesion
Backup of blood into the liver - RHF - budd chiari
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

23. Where are oligosaccharide hydrolases and What do they do
Oligosaccharide digestion
Brush border of intestine - produce monosaccharides from oligo and di
L4
Left gastric vein and esophogeal vein - esophagus

24. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
HPNCC
8-9 waves/min
T12
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

25. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Krukenbergs tumor
Diverticulum
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Peutz jeghers

26. What is the HLA association and treatment for hemochromatosis
Repeated phlebotomy - deferoxamine - HLA- A3
Acute pancreatitis
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Backup of blood into the liver - RHF - budd chiari

27. Bilirubin is the product of what?
Heme metabolism
8-9 waves/min
Diverticulum
Lamina propora and submucosa

28. How does hirschsprung present and appear on imaging
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Femoral hernia
Intussusception
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

29. What are the histological findings in the jejunum
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
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
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

30. What does bicarb do in the duodenum
Dense core bodies
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

31. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
L2
Small intestine
Conj - inc - dec
Esophageal cancer

32. What separates the right greater and lesser sacs
GERD - may also present with nocturnal cough and dyspnea
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Gastrohepatic ligament
Sister mary joseph nodule

33. How does brain injury lead to acute gastritis and What is it called
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Adhesion
T12

34. conjugated hyperbilirubinemia due to defective liver excretion
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Small intestine
Dubin johnson
Can lead to hematemesis - found in EtOHics and bulimics

35. With caput medusaw - between what vessels is the anastomoses and Where is it
Paraumbilical and superficial and inferior epigastric - umbilicus
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Uremia

36. What are the treatment options for uclerative colitis
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
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
Spleen to posterior abdominal wall - splenic artery and vein
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

37. What are the midgut structures and what supplies their blood and PANS innervation
Esophageal carcinoma
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Lateral to the inferior epigastric artery
Paraumbilical and superficial and inferior epigastric - umbilicus

38. signet ring cells - acanthosis nigracans - dz - character/association - spread
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Spleen to posterior abdominal wall - splenic artery and vein
Esophageal cancer
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

39. How is bilirubin carried in the blood
Omeprazole
With albumin
HSV-1 - CMV - Candida
Ischemic colitis

40. What is the presentation of pancreatic adenocarcinoma
Internal thoracic to superior epigastric to inferior epigastric
All 3 gut layers outpouch as in Meckels
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Copious diarrhea - non alpha - non beta cell pancreatic tumor

41. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Hypercoaguability - polycythemia vera - pregnancy - HCC
Common hepatic - splenic - left gastric - main blood supply for stomach
Zenkers - halitosis - dysphagia and obstruction

42. What does autoimmune destruction of parietal cells lead to...
Hirschsprungs
Chronic gastritis and pernicious anemia
In the mucus that covers the gastric epithelium
Tropical sprue

43. What structure is Not contained in the femoral sheath
Complications of UC
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Backup of blood into the liver - RHF - budd chiari
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

44. Which area of the hindgut is a watershed area
Splenic flexure
Gut bacteria
Unconjugated - water insoluble
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

45. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Complications of crohns
Angiodysplasia
Lactase is located at the tips of intestinal villi
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

46. What pancreatic proteases are secreted as zymogens
Dilated esophagus with an area of distal stenosis - birds beak
CEA - CA-19-9
The proximal small bowel
Trypsin - chymotrypsin - elastase - carboxypeptidases

47. 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

48. Why does carcinoid syndrome not occur if tumor is confined to GI system
Barrett's esophagus
Liver metabolizes 5HT
Source - G cells in the antrum - action - inc gastric H+ secretion - inc growth of gastric mucosa - and inc gastric motility - regulation - inc by stomach distention/alkalinaztion - amino acids - peptides - vagal stimulation - dec by stomach pH < 1.5
Brush border of intestine - produce monosaccharides from oligo and di

49. What causes hirschsprungs
All 3 gut layers outpouch as in Meckels
Alcoholic cirrhosis
Failure of neural crest migration
EtOH

50. A protrusion of peritoneum through an opening - usually a site of weakness
Hernia
EtOH
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Omeprazole