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 congenital birth defect is associated with Hirschsprung
AST
Downs
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
AR

2. What are additional risk factors for CRC
Zollinger Ellison - phenylalanine and tryptophan
In the ileum with bile acids - requires IF
Centrilobular congestion and necrosis - cardiac cirrhosis
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

3. What is the frequency of basal electric rhythm of the ilieum
8-9 waves/min
No
Hydrocele
Averages 6 months - very aggressive - usually already metastasized at presentation

4. what kind of fistula is associated with diverticulitis
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
Brush border of intestine - produce monosaccharides from oligo and di
Colovesical leading to pneumaturia
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

5. At what spinal level does the SMA exit
Primary sclerosing cholangitis
8-9 waves/min
L1
Via the superior pancreaticduodenal

6. Where are tumors commonly in pancreatic adenocarcinoma
Liver metabolizes 5HT
L4
Pancreatic head causing obstructive jaundice
Positive

7. Who gets gastric ulcers
Cholesterol - 10-20% opaque due to calcifications
90%
Older patients
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

8. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Serous on the sides parotids - mucinous in the middle sublingual

9. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Pyoderma gangrenosum - primary sclerosing cholangitis
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
So hypertrophied they look like brain gyri
Short gastrics - left greater and lesser

10. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Menetriers disease
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Ischemic colitis
Esophageal carcinoma

11. 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

12. FAP + malignant CNS tumor
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Turcot
EtOH
Intussusception

13. What does bicab do in the mouth
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Splenic flexure
Neutralizes oral bacertial acids and maintains dental health
Crypts but not villi

14. What is the triad of Plummer - Vinson syndrome
Alk pho
L/R renal artery around L1
Below
Dysphagia (due to esophageal web) - glossitis - iron def anemia

15. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Alfatoxin in peanuts
Budd chiari syndrome
Achalasia due to loss of myenteric plexus (auberach)

16. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Colonic polyps
Positive urease test
Antrum - H.pylori - inc risk of MALT lymphoma
HSV-1 - CMV - Candida

17. motilin - source - action - regulation
Uridine glucuronyl transferase
Decrease - weight gain
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Cholesterol

18. Autoantibodies to gluten (gliadin) in wheat and other grains
Skip lesions =crohns - colon = UC
Celiac sprue
Brush border of intestine - produce monosaccharides from oligo and di
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

19. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Jewish and African American men
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Sister mary joseph nodule

20. What is the epi for CRC
Lateral
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Hernia
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

21. is meckels a true diverticulum and how common is it
Inc smooth muscle relaxation - including lower esophageal sphincter
True and most common congenital anomoly of GI tract
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

22. What is indirect bilirubin
Krukenbergs tumor
L2
Unconjugated - water insoluble
Carcinoid syndrome

23. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Hirschsprungs
Lactase is located at the tips of intestinal villi
Duodenal atresia - Downs
Peutz jeghers

24. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Brunners
Epigastric abdominal pain radiating to back - anorexia - nausea
L3
Esophageal cancer

25. Which kind of hemorrhoids are painful and why
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Unconjugated - water insoluble
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa

26. What kind of insults results in macronodular cirrhosis
3 waves/min
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Terminal ileum and colon
Lateral

27. Where does crohns usually affect the GI tract
Femoral hernia
Bleeding - penetration into pancreas - perforation - obstruction
Terminal ileum and colon
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

28. Achalasia can be secondary to what infectious disease common in South America
12 waves/min
Dense core bodies
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Chagas disease

29. what kind of muscle is in the upper 1/3 of esophagus
Striated
Intussusception
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
T cell lymphoma

30. What is biliary colic
Juvenile polyposis syndrome - inc risk of adenocarcinoma
H pylori (almost 100%)
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Cystic dilation of the viteline duct

31. At what spinal level does the celiac trunk exit
Pleomorphic adenoma
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Chronic calcifying pancreatitis - inc risk of panreatic cancer
T12

32. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Above
Glucose dependent insulinotropic peptide

33. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
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
No
Causes of gall stones
Diverticulum

34. What causes nutmeg liver
Complications of UC
Krukenbergs tumor
Where hindgut meets ectoderm
Backup of blood into the liver - RHF - budd chiari

35. What cells secrete bicarb - What does it do - and what regulates it
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Via the superior pancreaticduodenal
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

36. What are the borders of Hesselbach's triangle
Left and right gastroepiploics - left and right gastrics
Omeprazole
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

37. Who gets Whipple disease and How do they present
Old men - arthralgias - cardiac and neuro sx
Portal HTN
Epigastric abdominal pain radiating to back - anorexia - nausea
Esophageal varices

38. What histological findings are present in the esophagus
Nonkeritinized stratified sqamous epithelium
Achalasia due to loss of myenteric plexus (auberach)
Bleeding - penetration into pancreas - perforation - obstruction
Juvenile polyposis syndrome - inc risk of adenocarcinoma

39. What does autoimmune destruction of parietal cells lead to...
90%
Chronic gastritis and pernicious anemia
Downs
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

40. What carcinogens are associated with HCC
Alfatoxin in peanuts
In the mucus that covers the gastric epithelium
HPNCC
Amylase

41. How do you DX and TX gallstones
Meckels
US and cholecystectomy
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
L3

42. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Gallbladder
PAS- positive globules in liver -
Squamous - upper 1/3 - adeno - lower 1/3
Alpha amylase

43. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

44. What kind of muscle is in the lower 1/3 of the esophagus
Conj/unconj - inc - nl to dec
H+
L3
Smooth

45. What is contained within the muscularis externa
Myenteric nerve plexus - aurbach
Jaundice - fever - RUQ
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Stercobilin

46. What are the structures of the femoral triangle and how are they organized
Internal thoracic to superior epigastric to inferior epigastric
NAV = nerve artery vein - venous near the penis (NAVEL)
Ceruplasmin
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

47. Where are oligosaccharide hydrolases and What do they do
Brush border of intestine - produce monosaccharides from oligo and di
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

48. What is pancreatic adenocarcinoma associated with
HSV-1 - CMV - Candida
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Cigarettes and chronic pancreatitis - not EtOH
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

49. What is contained within the submucosa

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

50. Autodigestion of pancreas by pancreatic enzymes
Below
All 3 gut layers outpouch as in Meckels
Acute pancreatitis
Lamina propora and submucosa