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 kind of fistula is associated with diverticulitis
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Colovesical leading to pneumaturia
Gastrohepatic ligament

2. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Zollinger ellison - brunners glands
The entire
Budd chiari syndrome
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer

3. What do mucins do?
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
External spermatic fascia only
Glucose dependent insulinotropic peptide
Lubricate food (glycoprotiens)

4. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
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
Enterokinase/enteropeptidase from the duodenal mucosa
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Mallory bodies

5. What causes pancreatic insuff and What does it cause
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Colonic polyps
Acute pancreatitis

6. What are the labs in acute pancreatitis
Nonkeritinized stratified sqamous epithelium
Epigastric abdominal pain radiating to back - anorexia - nausea
Elevated amylase - and lipase
Sister mary joseph nodule

7. Liver cell failure can lead to multisystem signs including
PAS- positive globules in liver -
Lamina propora and submucosa
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Where hindgut meets ectoderm

8. What cells secrete bicarb - What does it do - and what regulates it
Striated
Early childhood - neuro sx and malabsorption
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
IBS at least 2 with recurrent abdominal pain

9. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Cholesterol - 10-20% opaque due to calcifications
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

10. What are the hindgut structures and what supplies their blood and PANS innvervation
Glucose dependent insulinotropic peptide
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Alpha amylase
Inc smooth muscle relaxation - including lower esophageal sphincter

11. What kind of insults results in macronodular cirrhosis
CHF and inc risk of HCC
Centrilobular leading to congestive liver disease
Peptic ulcer disease
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

12. What are the two molecular pathways that lead to CRC
Low pressure proximal to LES
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Adhesion

13. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
...
The proximal small bowel
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

14. What is the mechanism for reyes syndrome
CHF and inc risk of HCC
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Dissaccharidase def - most commonly lactase

15. Acute gastritis is caused By what process
Failure of the processus vagainlis to close
Erosive - disruption of mucosal barrier leading to inflammation
Fasting and stress
Peutz jeghers

16. What drug blocks the H2R
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Cimetidine
Virchow's node
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

17. What does extrahepatic biliary obstruction cause
T cell lymphoma
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Inc smooth muscle relaxation - including lower esophageal sphincter
Obstruction of the common bile duct

18. What type of insults result in micronodular cirrhosis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Epithelium
The gastroduodenal

19. How does brain injury lead to acute gastritis and What is it called
Dysphagia (due to esophageal web) - glossitis - iron def anemia
H+
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

20. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Liver metabolizes 5HT
Esophageal varices
Worldwide - SC - US - adeno
Conj - inc - dec

21. Where is IgA shuttled
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Celiac sprue

22. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
In the mucus that covers the gastric epithelium
Above
Crohns = noncaseating granulomas - UC = crypt abscesses
All 3 gut layers outpouch as in Meckels

23. What factors increase risk of malignancy of adenomatous polyps
Left and right gastroepiploics - left and right gastrics
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Paraumbilical and superficial and inferior epigastric - umbilicus
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

24. milk intolerance
Crohns = noncaseating granulomas - UC = crypt abscesses
Can lead to hematemesis - found in EtOHics and bulimics
Dissaccharidase def - most commonly lactase
Phenobarbital - inc liver enzyme synthesis

25. What are the results of hemochromatosis
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
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
Celiac sprue
CHF and inc risk of HCC

26. HCC is associated with what other conditions
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Lubricate food (glycoprotiens)
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Alpha1 antitrypsin def - codominant trait

27. What are the complications of chronic pancreatitis
Hyperplastic
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Where hindgut meets ectoderm
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM

28. signet ring cells - acanthosis nigracans - dz - character/association - spread
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
HSV-1 - CMV - Candida
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

29. most common non - neoplastic polyp in colon
IgA secreting plasma cells - ultimately reside in the lamina proporia
Hyperplastic
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Downs

30. What retroperitoneal structure flanks both sides of the pancreas on CT
H2 receptor - inc cAMP
Duodenum - 2nd - 3rd and 4th parts
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Alpha amylase

31. What is the most common diaphragmatic hernia and What are the two types
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Inc risk of CRC and other visceral malignancies
Pyoderma gangrenosum - primary sclerosing cholangitis

32. What is the arterial supply and venous drainage below pectinate line
Hypercoaguability - polycythemia vera - pregnancy - HCC
Begins starch digestion - inactivated by low pH upon reaching the stomach
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Tropical sprue

33. What is Trousseau's sign
Redness and tenderness on palpation of extremities
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Oligosaccharide digestion
Centrilobular congestion and necrosis - cardiac cirrhosis

34. In what scenarios do pts with gilberts have inc bili
Alpha1 antitrypsin def - codominant trait
Carcinoid syndrome
Hypercoaguability - polycythemia vera - pregnancy - HCC
Fasting and stress

35. What kind of cancer to celiac sprue put you as inc risk for
Parietal cells in the stomach - B12 binding protein
T cell lymphoma
Budd chiari syndrome
NAV = nerve artery vein - venous near the penis (NAVEL)

36. What kind of muscle is in the lower 1/3 of the esophagus
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Smooth
Poor anastamoses
Conj/unconj - inc - nl to dec

37. People of what decent are associated with celiac sprue and what findings/antibodies are present
Peyers patches
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Decrease - weight gain

38. What are the common causes of gastric ulcers - What causes gastric ulcer
Positive
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

39. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Normal
Left and right gastroepiploics - left and right gastrics
Alpha amylase

40. involvement of left supraclavicular node by mets from stomach

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

41. What can fistula between the gallbladder and small intestine create and how can you tell
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Osmotic
Downs
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

42. What is the sphincter of the pancreatic duct
Failure of the processus vagainlis to close
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Sphincter of oddi
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

43. Autoantibodies to gluten (gliadin) in wheat and other grains
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Barrett's esophagus
Celiac sprue
CCK8 receptor - Gq inc IP3/Ca

44. What enzyme is necessary to create conjugated bilirubin
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Uridine glucuronyl transferase
Bleeding - intussusception - volvulus - obstruction near terminal ileum

45. What serum markers increase in cholecystitis with bile duct involvement
Splenic flexure
Jewish and African American men
Alk phos
Cigarettes and chronic pancreatitis - not EtOH

46. How does CRC present in the distal and proximal colon
All 3 gut layers outpouch as in Meckels
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Gallbladder
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

47. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
Enterokinase/enteropeptidase from the duodenal mucosa
Crigler - najjar type 1
Old men - arthralgias - cardiac and neuro sx

48. When do you see hypertrophy of brunners glands
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Gastrohepatic ligament
Boerhaave's Syndrome - Been heaving syndrome
Peptic ulcer disease

49. What receptors does ACH bind on the parietal cells and What does it activate
Complications of crohns
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
So hypertrophied they look like brain gyri
M3 - Gq - inc IP3/Ca

50. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Increase tumorigenesis
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides