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 is the omphalomesenteric cyst
Duodenal atresia - Downs
Cystic dilation of the viteline duct
In the mucus that covers the gastric epithelium
Phototherapy

2. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Ceruplasmin
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Centrilobular leading to congestive liver disease

3. What layer in the mucosa is responsible for support
Lamina propria
Appendicitis
Cimetidine
L/R renal artery around L1

4. What are the effects of atropine on parietal cells and G cells
Peutz jeghers
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
CHF and inc risk of HCC
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

5. In PUD with a duodenal ulcer does pain inc or dec with meals
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Decrease - weight gain
AST>ALT
Early childhood - neuro sx and malabsorption

6. What is the frequency of basal electric rhythm of the stomach
Esophageal varices
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
3 waves/min
Enterokinase/enteropeptidase from the duodenal mucosa

7. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
2ndary biliary cirrhosis
Carcinoid syndrome
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn

8. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Superior rectal
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Short gastrics - left greater and lesser
Cimetidine

9. Scleroderma is associated with what kind of esophageal dysmotility
Spleen to posterior abdominal wall - splenic artery and vein
HPNCC
IgA secreting plasma cells - ultimately reside in the lamina proporia
Low pressure proximal to LES

10. What does the splenorenal ligament connect - and What does it contain
H2 receptor - inc cAMP
Can lead to hematemesis - found in EtOHics and bulimics
Spleen to posterior abdominal wall - splenic artery and vein
Backup of blood into the liver - RHF - budd chiari

11. What is the action of NO as a GI hormone
Penicillinamine - AR inheritance
Hepatic steatosis
Inc smooth muscle relaxation - including lower esophageal sphincter
Juvenille polyps - no risk if single

12. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Conj - inc - dec
Hyperpigmented mouth - lips - hands - genitalia
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Esophageal cancer

13. What does TOASTED with alcoholic hepatitis stand for
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Boerhaave's Syndrome - Been heaving syndrome
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
AST >ALT - ration is usually 1.5

14. trypsinogen is converted to trypsin via what enzyme
GERD - may also present with nocturnal cough and dyspnea
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Enterokinase/enteropeptidase from the duodenal mucosa

15. What is pancreatic adenocarcinoma associated with
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Cigarettes and chronic pancreatitis - not EtOH
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

16. secretin - source - action - regulation
Corticosteroids - infliximab
True and most common congenital anomoly of GI tract
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
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

17. What are the signs of peutz jehgers
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Hyperpigmented mouth - lips - hands - genitalia
Striated and smooth
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

18. Autodigestion of pancreas by pancreatic enzymes
Peutz jeghers
Acute pancreatitis
Alcoholic hepatitis
Barrett's esophagus

19. Why does carcinoid syndrome not occur if tumor is confined to GI system
H2 receptor - inc cAMP
Liver metabolizes 5HT
2ndary biliary cirrhosis
True and most common congenital anomoly of GI tract

20. What is indirect bilirubin
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Normal
Unconjugated - water insoluble
Zollinger ellison - brunners glands

21. What histological findings are present in the esophagus
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Squamous - upper 1/3 - adeno - lower 1/3
Nonkeritinized stratified sqamous epithelium
Alpha amylase

22. What is the frequency of basal electric rhythm in the duodenum
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
12 waves/min
Inc - weight loss
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

23. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Squamous - upper 1/3 - adeno - lower 1/3
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

24. Why does volvulus occur more at cecum and sigmoid colon
Warthins' tumor
Redundant mesentary
H pylori (almost 100%)
Hydrocele

25. What are the complications of chronic pancreatitis
Pleuroperitoneal
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Gastric glands
Old men - arthralgias - cardiac and neuro sx

26. A protrusion of peritoneum through an opening - usually a site of weakness
Hernia
Osmotic
Mucoepidermoid carcinoma
Elevated amylase - and lipase

27. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery

28. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Redness and tenderness on palpation of extremities
Duodenal atresia - Downs
Budd chiari syndrome

29. What is the most important mechanism in gastric acid secretion
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
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
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

30. What is the cause of physiologic neonatal jaundice
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Acute pancreatitis
Internal thoracic to superior epigastric to inferior epigastric
Erosive - disruption of mucosal barrier leading to inflammation

31. What are esophageal strictures associated with
Oral glucose
Lye ingestion and acid reflux
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
The gastroduodenal

32. Where are peyers patches found
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Lamina propora and submucosa
Dec PGE2 leading to dec gastric mucosa protection
Crohns = noncaseating granulomas - UC = crypt abscesses

33. What structures feed into the common hepatic duct
VZV and influenza B treated with salicylates
Right and left hepatic duct
Crypts but not villi
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

34. What are the hindgut structures and what supplies their blood and PANS innvervation
Trypsin - chymotrypsin - elastase - carboxypeptidases
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
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Mucoepidermoid carcinoma

35. Where is B12 absorbed
Repeated phlebotomy - deferoxamine - HLA- A3
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Peptic ulcer disease
In the ileum with bile acids - requires IF

36. How do villi appear in disaccharidease def
Normal
Hemosiderosis - hemochromatosis
Epithelium
Meconium ileus

37. What are the complications of Meckels
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Zollinger Ellison - phenylalanine and tryptophan
Liver metabolizes 5HT
Redness and tenderness on palpation of extremities

38. What are motilin receptor agonists used for clinically
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
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Stimulate intestinal persistalsis

39. Why does indirect inguinal hernia happen in infacnts
Mucosa - submucosa - muscularis externa - serosa/adventitia
Superior rectal and middle and inferior rectal - rectum
Failure of the processus vagainlis to close
Mallory bodies

40. Dysphagia in achalasia results from
Femoral hernia
Crohns = maybe - UC= always
Where hindgut meets ectoderm
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

41. Gallstones that reach the common channel at ampulla can block which two ducts
Pertechnetate - study for uptake
Antrum - H.pylori - inc risk of MALT lymphoma
Pancreatic and bile
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

42. What retroperitoneal structure flanks both sides of the pancreas on CT
Primary sclerosing cholangitis
Via the superior pancreaticduodenal
The jejunum
Duodenum - 2nd - 3rd and 4th parts

43. What are the labs in acute pancreatitis
No
Normal
Mallory bodies
Elevated amylase - and lipase

44. What are the complications of duodenal PUD
Reye's syndrome
Dissaccharidase def - most commonly lactase
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Bleeding - penetration into pancreas - perforation - obstruction

45. What is the classic triad of hemochromatosis

46. What receptors does gastrin bind on the parietal cell and What does it activate
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
CCK8 receptor - Gq inc IP3/Ca
Peutz jeghers
Barrett's esophagus

47. What are the histological findings in the jejunum
Menetriers disease
ALT>AST
Gastrohepatic ligament
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

48. What causes hirschsprungs
Failure of neural crest migration
IBS at least 2 with recurrent abdominal pain
Inc - weight loss
Old men - arthralgias - cardiac and neuro sx

49. What does primary sclerosing cholangitis lead to...
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Colovesical leading to pneumaturia
Complications of UC
Corticosteroids - infliximab

50. At what level do the testicular/ovarian arteries exit the aorta
Turcot
L2
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin