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 longterm sequelae of nutmeg liver
Meconium ileus
Centrilobular congestion and necrosis - cardiac cirrhosis
Pleomorphic adenoma
Liver metabolizes 5HT

2. Where are oligosaccharide hydrolases and What do they do
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Brush border of intestine - produce monosaccharides from oligo and di
Crypts but not villi

3. What findings are associated with reyes
Omeprazole
Mitochondrial abnl - fatty liver - hypoglycemia - coma
PAS- positive globules in liver -
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

4. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Conj/unconj - inc - nl to dec
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Portal HTN

5. What does GET SMASHED stand for in acute pancreatitis
Cimetidine
3 waves/min
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Alcoholic hepatitis

6. Scleroderma is associated with what kind of esophageal dysmotility
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Low pressure proximal to LES
Female - fat - fertile - forty
The gastroduodenal

7. What are the results of hemochromatosis
Repeated phlebotomy - deferoxamine - HLA- A3
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
CHF and inc risk of HCC

8. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
HSV-1 - CMV - Candida
FAP
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Old men - arthralgias - cardiac and neuro sx

9. At what spinal level does the is the bifurcation of aorta
2ndary biliary cirrhosis
Colovesical leading to pneumaturia
EtOH
L4

10. What factors increase risk of malignancy of adenomatous polyps
Repeated phlebotomy - deferoxamine - HLA- A3
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Sister mary joseph nodule
Gardner's syndrome

11. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
IBS at least 2 with recurrent abdominal pain
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Alpha amylase
Obstruction of the common bile duct

12. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Duodenum - 2nd - 3rd and 4th parts
Esophageal cancer
GLUT 2
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

13. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Left gastric vein and esophogeal vein - esophagus
Inc - weight loss
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

14. What are causes of extrahepatic biliary obstruction
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Worldwide - SC - US - adeno
Lateral
Acute pancreatitis

15. What happens to the short gastics if the splenic artery is blocked
Superior rectal
Poor anastamoses
Epigastric abdominal pain radiating to back - anorexia - nausea
Unconjugated - water insoluble

16. What source of salivary secretion is the most serous and What is the most mucinous
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Colovesical leading to pneumaturia
Virchow's node
Serous on the sides parotids - mucinous in the middle sublingual

17. What is the lumen of the pancreatic duct
True and most common congenital anomoly of GI tract
Ampulla of vater
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Lateral

18. What is the leading cause of bowel incarceration
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Femoral hernia
Ceruplasmin
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

19. What causes carcinoid syndrome amd What are the symptoms
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Meckels

20. what kind of fistula is associated with diverticulitis
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Colovesical leading to pneumaturia
Below
Cigarettes and chronic pancreatitis - not EtOH

21. What do you treat Wilsons disease with and What is the inheritance
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Dubin johnson
Glucouronate - water soluble (direct)
Penicillinamine - AR inheritance

22. Which kind of hemorrhoids are painful and why
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Upregulated intracellular signal transduction
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

23. How does hirschsprung present and appear on imaging
All 3 gut layers outpouch as in Meckels
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
Hemolytic anemia
So hypertrophied they look like brain gyri

24. What separates the right greater and lesser sacs
Gastrohepatic ligament
Normal
Duodenal atresia - Downs
Black - rotors syndrome

25. What infection causes Whipple disease and What can you see on LM
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Crohns = maybe - UC= always
Left gastric vein and esophogeal vein - esophagus

26. What is the frequency of basal electric rhythm of the stomach
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
3 waves/min
Smooth

27. How does CRC present in the distal and proximal colon
Dense core bodies
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Pleomorphic adenoma

28. most common malignant salivary gland tumor
Jaundice - fever - RUQ
Hypotonic because of more time to reabsorb NaCl
Mucoepidermoid carcinoma
Repeated phlebotomy - deferoxamine - HLA- A3

29. What are the signs of peutz jehgers
Bleeding - penetration into pancreas - perforation - obstruction
Esophageal carcinoma
Hyperpigmented mouth - lips - hands - genitalia
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

30. What is the mechanism for reyes syndrome
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Zollinger ellison - brunners glands
Female - fat - fertile - forty
Stimulate intestinal persistalsis

31. What can hemochromatosis be secondary to...
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Femoral hernia
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Via the middle colic

32. At what level of the spine does the IM exit the aorta
Primarly through ECL leading to histamine release
Reye's syndrome
L3
Diarrhea - steatorrhea - weight loss - weakness

33. What causes nutmeg liver
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Backup of blood into the liver - RHF - budd chiari
Brunners
Antrum - H.pylori - inc risk of MALT lymphoma

34. absent UDPGT - presents early in life - early mortality
L4
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Crigler - najjar type 1
Left gastric vein and esophogeal vein - esophagus

35. FAP + malignant CNS tumor
Where hindgut meets ectoderm
No
Turcot
Short gastrics - left greater and lesser

36. What is Trousseau's sign
Redness and tenderness on palpation of extremities
L4
Adhesion
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

37. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Adhesion
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Cigarettes and chronic pancreatitis - not EtOH

38. What is the rule of 2s for meckels
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Small intestine

39. In an MI - which liver enzyme is elevated
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
AST
Turcot
Female - fat - fertile - forty

40. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker
Hypotonic because of more time to reabsorb NaCl
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
Brunners

41. List the clinical findings of HCC
Dissaccharidase def - most commonly lactase
Glucose dependent insulinotropic peptide
Decreased intercellular adhesion and increased proliferation
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

42. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Early childhood - neuro sx and malabsorption
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
CHF and inc risk of HCC

43. What receptors does ACH bind on the parietal cells and What does it activate
M3 - Gq - inc IP3/Ca
Cholesterol - 10-20% opaque due to calcifications
Turcot
Lactase is located at the tips of intestinal villi

44. What are the layers of the gut wall from inside out
Mucosa - submucosa - muscularis externa - serosa/adventitia
The proximal small bowel
Menetriers disease
Conj/unconj - inc - nl to dec

45. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Turcot
Duodenal atresia - Downs
Stimulate intestinal persistalsis
Zollinger Ellison - phenylalanine and tryptophan

46. In viral hepatitis - which liver enzyme is higher
Below
Peutz jeghers
ALT>AST
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

47. Where are peyers patches found
In the ileum with bile acids - requires IF
Lamina propora and submucosa
No - chronic - can present with diarrhea or constipation or alternation - treat sx
The entire

48. What complication can arise from indirect inguinal hernias
Crohns = maybe - UC= always
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Hydrocele

49. rare - often fatal childhood hepatoencephalopathy

50. What are the histological findings in the ileum