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. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
IBS at least 2 with recurrent abdominal pain
Inc smooth muscle relaxation - including lower esophageal sphincter
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Esophageal varices

2. what kind of fistula is associated with diverticulitis
Achalasia due to loss of myenteric plexus (auberach)
With albumin
Colovesical leading to pneumaturia
Pyoderma gangrenosum - primary sclerosing cholangitis

3. What are the ABCDEF of esophageal cancer
Pyoderma gangrenosum - primary sclerosing cholangitis
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

4. What are the branches of the celiac trunk and What do they supply
Amylase
Downs
Normal
Common hepatic - splenic - left gastric - main blood supply for stomach

5. What do mucins do?
Lubricate food (glycoprotiens)
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
H+
Acute pancreatitis

6. subQ peribumbilical metastasis
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Amylase
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Sister mary joseph nodule

7. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Alk pho
Falciform - ligamentum teres - fetal umbilical vein
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
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

8. What happens to the short gastics if the splenic artery is blocked
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Poor anastamoses
Dense core bodies
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

9. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Fe2+ in the duod
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Cimetidine

10. Where are oligosaccharide hydrolases and What do they do
Female - fat - fertile - forty
Necrotizing enterocolitis
Brush border of intestine - produce monosaccharides from oligo and di
Short gastrics - left greater and lesser

11. What do the rugae of stomach look like in menetriers disease
The entire
Neutralizes gastric acid allowing pancreatic enzymes to fxn
So hypertrophied they look like brain gyri
Myenteric nerve plexus - aurbach

12. How does CRC present in the distal and proximal colon
Peptic ulcer disease
Mallory bodies
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
CEA - CA-19-9

13. What receptors does gastrin bind on the parietal cell and What does it activate
CCK8 receptor - Gq inc IP3/Ca
NAV = nerve artery vein - venous near the penis (NAVEL)
Diarrhea - steatorrhea - weight loss - weakness
Lye ingestion and acid reflux

14. crigler - najjar type II responds to which therapy and How does it work
Common hepatic - splenic - left gastric - main blood supply for stomach
Hyperpigmented mouth - lips - hands - genitalia
Phenobarbital - inc liver enzyme synthesis
MSI (15%) and APC/beta catenin chromosomal instability (85%)

15. What kind of lesions are characteristic of duodenal PUD vs cancer
External spermatic fascia only
Punched out - clean margins - carcinoma =raised irregular margins
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Lipase - phospholipase A - colipase

16. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Lipase - phospholipase A - colipase
Esophageal carcinoma

17. most common non - neoplastic polyp in colon
Phenobarbital - inc liver enzyme synthesis
Angiodysplasia
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Hyperplastic

18. Why does indirect inguinal hernia happen in infacnts
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Decrease - weight gain
Failure of the processus vagainlis to close
Crigler - najjar type 1

19. What does primary sclerosing cholangitis lead to...
Primary sclerosing cholangitis
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Via the middle colic
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

20. What does autoimmune destruction of parietal cells lead to...
Chronic gastritis and pernicious anemia
Volvulus
Striated
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

21. What is the most important mechanism in gastric acid secretion
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Alfatoxin in peanuts
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

22. What does loss of p53 cause
Hypotonic because of more time to reabsorb NaCl
GLUT 2
Increase tumorigenesis
Redness and tenderness on palpation of extremities

23. Bilirubin is the product of what?
L1
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Heme metabolism
Cholesterol

24. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Epithelium
Gastric glands
Backup of blood into the liver - RHF - budd chiari
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

25. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Can lead to hematemesis - found in EtOHics and bulimics
Begins starch digestion - inactivated by low pH upon reaching the stomach
Inguninal ligament - sartorius muscle - adductor longus
Pertechnetate - study for uptake

26. In PUD with a duodenal ulcer does pain inc or dec with meals
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Centrilobular leading to congestive liver disease
Decrease - weight gain
GLUT 2

27. Are single polyps malignant in peutz jehgers
No
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Hepatic steatosis
Obstruction of the common bile duct

28. Where is IgA shuttled
Liver metabolizes 5HT
Spleen to posterior abdominal wall - splenic artery and vein
Above
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

29. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Achalasia due to loss of myenteric plexus (auberach)
Poor anastamoses
Ischemic colitis
Crohns = noncaseating granulomas - UC = crypt abscesses

30. Why are most diverticula considered false
Lack or have an attenuated muscularis externa - often in the sigmoid colon
US and cholecystectomy
Lye ingestion and acid reflux
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

31. What structure is Not contained in the femoral sheath
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Crigler - najjar type 1
Repeated phlebotomy - deferoxamine - HLA- A3
Pyoderma gangrenosum - primary sclerosing cholangitis

32. Between what structures do strong anastamoses exist
Left and right gastroepiploics - left and right gastrics
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Cigarettes and chronic pancreatitis - not EtOH
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

33. How is bilirubin carried in the blood
Celiac sprue
Lipase
Cirrhosis
With albumin

34. What is the cause of physiologic neonatal jaundice
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Hydrocele
Inspiratory arrest on deep palpation due to pain

35. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Intussusception
Pertechnetate - study for uptake
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Corticosteroids - infliximab

36. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Inc conj bilirubin - inc cholesterol - inc alk phos
Ceruplasmin
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

37. What do you use to diagnose meckels
Intussusception
IgA secreting plasma cells - ultimately reside in the lamina proporia
Pertechnetate - study for uptake
Reye's syndrome

38. What conditions are associated with budd chiari
Peyers patches
Alcoholic cirrhosis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Hypercoaguability - polycythemia vera - pregnancy - HCC

39. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
L2
Black - rotors syndrome
12 waves/min
Hernia

40. What gives stool its characteristic color
Stercobilin
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Closer to isotonic because of less time to reabsorb NaCl

41. What layer in the mucosa is responsible for support
Centrilobular congestion and necrosis - cardiac cirrhosis
Volvulus
FAP
Lamina propria

42. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
L1
Zollinger ellison - brunners glands
Inc conj bilirubin - inc cholesterol - inc alk phos
Menetriers disease

43. What receptors does ACH bind on the parietal cells and What does it activate
Penicillinamine - AR inheritance
Via the superior pancreaticduodenal
M3 - Gq - inc IP3/Ca
Sister mary joseph nodule

44. What are the complications of acute pancreatitis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
2ndary biliary cirrhosis
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Crohns = noncaseating granulomas - UC = crypt abscesses

45. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Heme metabolism
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Cirrhosis
Alpha1 antitrypsin def - codominant trait

46. Autoantibodies to gluten (gliadin) in wheat and other grains
Celiac sprue
Cimetidine
Warthins' tumor
Glucouronate - water soluble (direct)

47. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Lamina propora and submucosa
Virchow's node
Chagas disease

48. Gastrin - source - action - regulation
Alpha1 antitrypsin def - codominant trait
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
Fasting and stress
Female - fat - fertile - forty

49. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
IBS at least 2 with recurrent abdominal pain
Positive
Obstruction of the common bile duct
All 3 gut layers outpouch as in Meckels

50. What is the most common indication of emergent abdominal surgery in children
Dissaccharidase def - most commonly lactase
Begins starch digestion - inactivated by low pH upon reaching the stomach
Appendicitis
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions