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. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Brush border of intestine - produce monosaccharides from oligo and di
Hirschsprungs

2. What do the rugae of stomach look like in menetriers disease
So hypertrophied they look like brain gyri
Paraumbilical and superficial and inferior epigastric - umbilicus
Begins starch digestion - inactivated by low pH upon reaching the stomach
Necrotizing enterocolitis

3. What nerve innervates the external hemorrhoids
L3
Dubin johnson
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Inferior rectal nerve

4. What is the most common diaphragmatic hernia and What are the two types
No
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Via the middle colic
Antrum - H.pylori - inc risk of MALT lymphoma

5. What is the triad of Plummer - Vinson syndrome
Pleuroperitoneal
Dysphagia (due to esophageal web) - glossitis - iron def anemia
FAP
Cirrhosis

6. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Pancreatic and bile
No
Volvulus
Cholesterol

7. What causes carcinoid syndrome amd What are the symptoms
Redness and tenderness on palpation of extremities
Carcinoid syndrome
FAP
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

8. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Backup of blood into the liver - RHF - budd chiari
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

9. What are the common causes of gastric ulcers - What causes gastric ulcer
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Neutralizes gastric acid allowing pancreatic enzymes to fxn
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

10. What are the layers of the gut wall from inside out
Averages 6 months - very aggressive - usually already metastasized at presentation
Brush border of intestine - produce monosaccharides from oligo and di
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Mucosa - submucosa - muscularis externa - serosa/adventitia

11. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
Decreased intercellular adhesion and increased proliferation
L/R renal artery around L1
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
...

12. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Averages 6 months - very aggressive - usually already metastasized at presentation
Low pressure proximal to LES
Cirrhosis

13. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Inc risk of CRC and other visceral malignancies
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
The entire
Falciform - ligamentum teres - fetal umbilical vein

14. List the clinical findings of HCC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Jewish and African American men
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
Skip lesions =crohns - colon = UC

15. What is the cause of physiologic neonatal jaundice
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Osmotic
Causes of gall stones

16. In PUD with a duodenal ulcer does pain inc or dec with meals
Decrease - weight gain
Short gastrics - left greater and lesser
Via the middle colic
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

17. rare - often fatal childhood hepatoencephalopathy

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

18. What factors increase risk of malignancy of adenomatous polyps
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
VZV and influenza B treated with salicylates
US and cholecystectomy

19. Which serum enzyme increases with heavy EtOH consumption
Failure of the processus vagainlis to close
Phenobarbital - inc liver enzyme synthesis
Paraumbilical and superficial and inferior epigastric - umbilicus
Gamma glutamyl transferase GGT

20. What are motilin receptor agonists used for clinically
Omeprazole
All 3 gut layers outpouch as in Meckels
Stimulate intestinal persistalsis
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

21. In viral hepatitis - which liver enzyme is higher
Osmotic
Common hepatic - splenic - left gastric - main blood supply for stomach
ALT>AST
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

22. What is the leading cause of bowel incarceration
Female - fat - fertile - forty
L/R renal artery around L1
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Femoral hernia

23. What are esophageal strictures associated with
Superior rectal
Chagas disease
Liver metabolizes 5HT
Lye ingestion and acid reflux

24. What is the main symptom if a VIPoma
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
The jejunum
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Chagas disease

25. What structures feed into the common bile duct
Cystic duct and common hepatic duct
Can lead to hematemesis - found in EtOHics and bulimics
Neural muscarinic pathways
MSI (15%) and APC/beta catenin chromosomal instability (85%)

26. What does the splenorenal ligament connect - and What does it contain
Spleen to posterior abdominal wall - splenic artery and vein
Tropical sprue
Via the superior pancreaticduodenal
Inferior rectal nerve

27. What portion of the bowel does sprue effect
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
The proximal small bowel
Above
Conj - inc - dec

28. What is a positive murphy's sign
Via the superior pancreaticduodenal
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Pertechnetate - study for uptake
Inspiratory arrest on deep palpation due to pain

29. In what scenarios do pts with gilberts have inc bili
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Fasting and stress
Squamous - upper 1/3 - adeno - lower 1/3

30. How do burns cause acute gastritis and What is it called

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

31. What serum enzyme is elevated inacute pancreatitis
Lipase
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Low pressure proximal to LES
Enterokinase/enteropeptidase from the duodenal mucosa

32. How does CRC present in the distal and proximal colon
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Carcinoid syndrome
Superior rectal
Lack or have an attenuated muscularis externa - often in the sigmoid colon

33. What converts inactive pepsinogen to pepsin
Dec PGE2 leading to dec gastric mucosa protection
H+
US and cholecystectomy
FAP

34. What are the extraintestinal manifestations of ulcerative colitis
CCK8 receptor - Gq inc IP3/Ca
Pyoderma gangrenosum - primary sclerosing cholangitis
Bleeding - penetration into pancreas - perforation - obstruction
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

35. How does brain injury lead to acute gastritis and What is it called
The entire
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
Hyperpigmented mouth - lips - hands - genitalia
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

36. What are the hindgut structures and what supplies their blood and PANS innvervation
Esophageal varices
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Increase tumorigenesis
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

37. What are causes of extrahepatic biliary obstruction
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
8-9 waves/min
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Liver metabolizes 5HT

38. 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

39. What gives stool its characteristic color
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
Stercobilin

40. Where does type A chronic gastritis occur and What causes it
Menetriers disease
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Around the central vein (zone III)
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

41. Which viral infxns/treatments are associated with reyes syndrome
Low pressure proximal to LES
VZV and influenza B treated with salicylates
H2 receptor - inc cAMP
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

42. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Alpha1 antitrypsin def - codominant trait
Lipase - phospholipase A - colipase
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

43. concentric onion skin bile duct fibrosis
Skip lesions =crohns - colon = UC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Necrotizing enterocolitis
Primary sclerosing cholangitis

44. What structure is Not contained in the femoral sheath
Carcinoid syndrome
Pancreatic head causing obstructive jaundice
Phenobarbital - inc liver enzyme synthesis
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

45. Who gets gastric ulcers
L3
Older patients
Obstruction of the common bile duct
Goes through deep inguinal ring - external inguinal ring and into the scrotum

46. multiple juvenil polyps in GI tract - risk
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Averages 6 months - very aggressive - usually already metastasized at presentation
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

47. What does loss of p53 cause
Increase tumorigenesis
Alfatoxin in peanuts
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

48. What percentage of gall stones are cholesterol stones and What are the associations
Pleuroperitoneal
Acute pancreatitis
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

49. Where is the deep inguinal ring relative to the inferior epigastric vessels
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
NAV = nerve artery vein - venous near the penis (NAVEL)
Enterokinase/enteropeptidase from the duodenal mucosa
Lateral

50. What are the signs and symptoms of budd chiari
Older patients
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation