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 are the treatment options for uclerative colitis
Crigler - najjar type 1
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Muscularis mucosae

2. GIP - source - action regulation
Primary sclerosing cholangitis
Decreased intercellular adhesion and increased proliferation
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
The proximal small bowel

3. What is the path of an indirect inguinal hernia
Splenic flexure
Positive
HPNCC
Goes through deep inguinal ring - external inguinal ring and into the scrotum

4. Esophagitis can result From which 3 infectious agents - or chemical ingestion
The proximal small bowel
HSV-1 - CMV - Candida
Volvulus
Repeated phlebotomy - deferoxamine - HLA- A3

5. What kind of cancer to celiac sprue put you as inc risk for
T cell lymphoma
Gardner's syndrome
AR
Boerhaave's Syndrome - Been heaving syndrome

6. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Pleomorphic adenoma
Can lead to hematemesis - found in EtOHics and bulimics
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
...

7. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Stercobilin
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Right and left hepatic duct
GERD - may also present with nocturnal cough and dyspnea

8. In what scenarios do pts with gilberts have inc bili
Inc conj bilirubin - inc cholesterol - inc alk phos
T cell lymphoma
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Fasting and stress

9. Where does an indirect inguinal hernia enter the deep inguinal ring
Penicillinamine - AR inheritance
Lateral to the inferior epigastric artery
Decreased intercellular adhesion and increased proliferation
Ischemic colitis

10. What kind of muscle is in the lower 1/3 of the esophagus
Uremia
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
Smooth
Poor anastamoses

11. What is biliary colic
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
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
External (superficial) ring only
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

12. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
T12

13. What are the four Fs of gallstones
Female - fat - fertile - forty
In the mucus that covers the gastric epithelium
Juvenille polyps - no risk if single
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

14. What are the effects of atropine on parietal cells and G cells
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Hernia
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

15. What are the branches of the celiac trunk and What do they supply
In the mucus that covers the gastric epithelium
Common hepatic - splenic - left gastric - main blood supply for stomach
PAS- positive globules in liver -
Increase tumorigenesis

16. What is charcot triad of cholangitis
Jaundice - fever - RUQ
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Acute pancreatitis
Goes through deep inguinal ring - external inguinal ring and into the scrotum

17. What serum enzyme is decreased in wilsons disease
Inc conj bilirubin - inc cholesterol - inc alk phos
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Ceruplasmin
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

18. What structures feed into the common bile duct
Volvulus
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
Cystic duct and common hepatic duct
H+

19. What commonly leads to appendicity in kids vs adults
Cholesterol - 10-20% opaque due to calcifications
Acute pancreatitis
VZV and influenza B treated with salicylates
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

20. What is the most common indication of emergent abdominal surgery in children
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
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
Appendicitis
Old men - arthralgias - cardiac and neuro sx

21. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Below
Alcoholic hepatitis
Complications of crohns
Worldwide - SC - US - adeno

22. What is the leading cause of bowel incarceration
Femoral hernia
L1
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

23. 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

24. What makes a true diverticula
Crigler - najjar type 1
All 3 gut layers outpouch as in Meckels
Sister mary joseph nodule
Stercobilin

25. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Juvenille polyps - no risk if single
Fe2+ in the duod
Neural muscarinic pathways
Hydrocele

26. What is the most common esophageal cancer worldwide and in the US
Worldwide - SC - US - adeno
Cirrhosis
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Duodenal atresia - Downs

27. What does bicab do in the mouth
Crohns = maybe - UC= always
Sister mary joseph nodule
Neutralizes oral bacertial acids and maintains dental health
Small intestine

28. What parts of the small bowel can tropical sprue effect
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
The entire

29. What does primary sclerosing cholangitis lead to...
Early childhood - neuro sx and malabsorption
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
The entire
AST >ALT - ration is usually 1.5

30. What are the ABCDEF of esophageal cancer
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Diarrhea - steatorrhea - weight loss - weakness
Old men - arthralgias - cardiac and neuro sx
Centrilobular congestion and necrosis - cardiac cirrhosis

31. What is the frequency of basal electric rhythm of the ilieum
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
8-9 waves/min
Intussusception
Heme metabolism

32. What reaction does salivary amylase catalyze
Worldwide - SC - US - adeno
IBS at least 2 with recurrent abdominal pain
Necrotizing enterocolitis
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

33. What are the complications of chronic pancreatitis
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Crohns = noncaseating granulomas - UC = crypt abscesses
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Hyperpigmented mouth - lips - hands - genitalia

34. How does hirschsprung present and appear on imaging
Muscularis mucosae
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
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
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

35. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Ampulla of vater
Normal
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Zollinger Ellison - phenylalanine and tryptophan

36. What is a positive murphy's sign
Cimetidine
Terminal ileum and colon
Inspiratory arrest on deep palpation due to pain
The proximal small bowel

37. What are the borders of Hesselbach's triangle
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Zenkers - halitosis - dysphagia and obstruction
Gut bacteria

38. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Hirschsprungs
Esophageal varices
Superior rectal and middle and inferior rectal - rectum
HPNCC

39. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Zenkers - halitosis - dysphagia and obstruction
Centrilobular congestion and necrosis - cardiac cirrhosis
Boerhaave's Syndrome - Been heaving syndrome
Complications of crohns

40. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Splenic flexure
Conj/unconj - inc - nl to dec
Squamous - upper 1/3 - adeno - lower 1/3
Stercobilin

41. At what level do the testicular/ovarian arteries exit the aorta
Celiac sprue
No
L2
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

42. 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

43. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
H pylori (almost 100%)
Lipase
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
L3

44. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Normal
Brunners

45. What type of insults result in micronodular cirrhosis
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Lipase
2ndary biliary cirrhosis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

46. Why does indirect inguinal hernia happen in infacnts
Budd chiari syndrome
Failure of the processus vagainlis to close
Dilated esophagus with an area of distal stenosis - birds beak
Decreased intercellular adhesion and increased proliferation

47. What does alpha amylase do and what inactivates it
The entire
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Left gastric vein and esophogeal vein - esophagus
Begins starch digestion - inactivated by low pH upon reaching the stomach

48. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Old men - arthralgias - cardiac and neuro sx
Below
H pylori (almost 100%)
Appendicitis

49. What is the lumen of the pancreatic duct
Ampulla of vater
Colovesical leading to pneumaturia
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
GERD - may also present with nocturnal cough and dyspnea

50. What histological findings are present in the stomach
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Low pressure proximal to LES
Gastric glands
...