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. In an MI - which liver enzyme is elevated
Around the central vein (zone III)
AST
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Black - rotors syndrome

2. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Left gastric vein and esophogeal vein - esophagus
Falciform - ligamentum teres - fetal umbilical vein
Glucouronate - water soluble (direct)
Causes of gall stones

3. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Common hepatic - splenic - left gastric - main blood supply for stomach
Alpha amylase
Backup of blood into the liver - RHF - budd chiari
Lamina propria

4. Between what structures do strong anastamoses exist
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
The proximal small bowel
Left and right gastroepiploics - left and right gastrics
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

5. People of what decent are associated with celiac sprue and what findings/antibodies are present
Phenobarbital - inc liver enzyme synthesis
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Downs
Striated and smooth

6. conjugated hyperbilirubinemia due to defective liver excretion
Lubricate food (glycoprotiens)
Dubin johnson
Sphincter of oddi
Adhesion

7. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Carcinoid syndrome
Lipase - phospholipase A - colipase
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

8. What kind of pancreatitis is associated with EtOH and smoking
Falciform - ligamentum teres - fetal umbilical vein
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Parietal cells in the stomach - B12 binding protein
Chronic calcifying pancreatitis - inc risk of panreatic cancer

9. What makes a true diverticula
Necrotizing enterocolitis
Muscularis mucosae
All 3 gut layers outpouch as in Meckels
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

10. What is diverticulosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
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
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

11. What are the treatment options for uclerative colitis
Centrilobular leading to congestive liver disease
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Low pressure proximal to LES

12. What test and result confirms H pylori infxn
Left and right gastroepiploics - left and right gastrics
Hypercoaguability - polycythemia vera - pregnancy - HCC
Pancreatic head causing obstructive jaundice
Positive urease test

13. What is the presentation of pancreatic adenocarcinoma
Crohns = noncaseating granulomas - UC = crypt abscesses
Dissaccharidase def - most commonly lactase
Centrilobular congestion and necrosis - cardiac cirrhosis
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

14. What is the HLA association and treatment for hemochromatosis
Colovesical leading to pneumaturia
Repeated phlebotomy - deferoxamine - HLA- A3
Positive
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

15. What serum enzyme is decreased in wilsons disease
FAP
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Ceruplasmin
Diarrhea - steatorrhea - weight loss - weakness

16. How do villi appear in disaccharidease def
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Normal
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

17. motilin - source - action - regulation
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Mallory bodies
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
T cell lymphoma

18. Where does crohns usually affect the GI tract
Worldwide - SC - US - adeno
Terminal ileum and colon
Common hepatic - splenic - left gastric - main blood supply for stomach
Complications of UC

19. What is the frequency of basal electric rhythm in the duodenum
Alpha1 antitrypsin def - codominant trait
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Hernia
12 waves/min

20. What does extrahepatic biliary obstruction cause
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Elevated amylase - and lipase
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

21. What structure is Not contained in the femoral sheath
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Esophageal cancer
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

22. Where is IgA shuttled
2ndary biliary cirrhosis
Primary sclerosing cholangitis
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Boerhaave's Syndrome - Been heaving syndrome

23. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Barrett's esophagus
Older patients
Colonic polyps
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

24. What structures feed into the common hepatic duct
Right and left hepatic duct
Where hindgut meets ectoderm
Pertechnetate - study for uptake
Splenic flexure

25. What are the barium swallow findings of achalasia
HSV-1 - CMV - Candida
Boerhaave's Syndrome - Been heaving syndrome
Mucosa - submucosa - muscularis externa - serosa/adventitia
Dilated esophagus with an area of distal stenosis - birds beak

26. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Redundant mesentary
Via the superior pancreaticduodenal
Short gastrics - left greater and lesser

27. With caput medusaw - between what vessels is the anastomoses and Where is it
Diverticulum
Paraumbilical and superficial and inferior epigastric - umbilicus
Meckels
NAV = nerve artery vein - venous near the penis (NAVEL)

28. Scleroderma is associated with what kind of esophageal dysmotility
So hypertrophied they look like brain gyri
Low pressure proximal to LES
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
L/R renal artery around L1

29. What are the labs in acute pancreatitis
Zollinger Ellison - phenylalanine and tryptophan
Elevated amylase - and lipase
External (superficial) ring only
Heme metabolism

30. Transmural esophageal rupture due to violent retching

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

31. What are the main components of bile
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Uremia
Crohns = maybe - UC= always
Tropical sprue

32. Where does type B chronic gastritis occur and What causes it
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Gut bacteria
Barrett's esophagus
Antrum - H.pylori - inc risk of MALT lymphoma

33. Autoantibodies to gluten (gliadin) in wheat and other grains
Celiac sprue
Backup of blood into the liver - RHF - budd chiari
Antrum - H.pylori - inc risk of MALT lymphoma
Left and right gastroepiploics - left and right gastrics

34. Where are peyers patches found
Lamina propora and submucosa
Omeprazole
HSV-1 - CMV - Candida
Sister mary joseph nodule

35. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Paraumbilical and superficial and inferior epigastric - umbilicus
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Inferior rectal nerve
Necrotizing enterocolitis

36. Liver cell failure can lead to multisystem signs including
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Averages 6 months - very aggressive - usually already metastasized at presentation
Centrilobular leading to congestive liver disease
Penicillinamine - AR inheritance

37. What findings are associated with reyes
In the ileum with bile acids - requires IF
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
Peutz jeghers
Mitochondrial abnl - fatty liver - hypoglycemia - coma

38. What kind of anemia is in Wilsons
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Enterokinase/enteropeptidase from the duodenal mucosa
Gallbladder
Hemolytic anemia

39. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Crohns = noncaseating granulomas - UC = crypt abscesses
Appendicitis
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Dilated esophagus with an area of distal stenosis - birds beak

40. 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

41. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Peyers patches
Diarrhea - steatorrhea - weight loss - weakness
M3 - Gq - inc IP3/Ca
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

42. What are causes of extrahepatic biliary obstruction
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

43. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
L/R renal artery around L1
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Ischemic colitis

44. inflammatino of gallbadder
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
GLUT 2
Backup of blood into the liver - RHF - budd chiari
Inguninal ligament - sartorius muscle - adductor longus

45. why infxn is implicated in duodenal PUD
H pylori (almost 100%)
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Cystic dilation of the viteline duct
Short gastrics - left greater and lesser

46. What histological findings are present in the stomach
Barrett's esophagus
IBS at least 2 with recurrent abdominal pain
Gastric glands
Goes through deep inguinal ring - external inguinal ring and into the scrotum

47. What are the structures of the femoral triangle and how are they organized
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Decrease - weight gain
Lye ingestion and acid reflux
NAV = nerve artery vein - venous near the penis (NAVEL)

48. What is charcot triad of cholangitis
Boerhaave's Syndrome - Been heaving syndrome
Chagas disease
Jaundice - fever - RUQ
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

49. most common malignant salivary gland tumor
Mucoepidermoid carcinoma
Glucose dependent insulinotropic peptide
Ampulla of vater
GERD - may also present with nocturnal cough and dyspnea

50. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Carcinoid syndrome
Fasting and stress
In the ileum with bile acids - requires IF