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Test your basic knowledge |
USMLE GI
Start Test
Study First
Subjects
:
health-sciences
,
usmle
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. How does hirschsprung present and appear on imaging
Crigler - najjar type 1
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Copious diarrhea - non alpha - non beta cell pancreatic tumor
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
2. What is the lumen of the pancreatic duct
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Alfatoxin in peanuts
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Ampulla of vater
3. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Lactase is located at the tips of intestinal villi
Inc lower esphogeal tone leading to achalasia
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
4. How do villi appear in disaccharidease def
Normal
Low pressure proximal to LES
Conj/unconj - inc - nl to dec
GLUT 2
5. At what level do the testicular/ovarian arteries exit the aorta
Inspiratory arrest on deep palpation due to pain
Gastrohepatic ligament
L2
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
6. What is the path of an indirect inguinal hernia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Jaundice - fever - RUQ
L3
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
7. What is pancreatic adenocarcinoma associated with
Angiodysplasia
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Cigarettes and chronic pancreatitis - not EtOH
Gastrohepatic ligament
8. If the abdominal aorta is blocked - How does blood get to the left colic artery
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Via the middle colic
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
9. When do you see hypertrophy of brunners glands
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Pancreatic head causing obstructive jaundice
Peptic ulcer disease
10. What complication can arise from indirect inguinal hernias
Cirrhosis
Hydrocele
AR
Stercobilin
11. In alchoholic hepatitis which liver enzyme is higher
AST>ALT
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Serous on the sides parotids - mucinous in the middle sublingual
Unconjugated - water insoluble
12. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Erosive - disruption of mucosal barrier leading to inflammation
Meconium ileus
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
13. What separates the right greater and lesser sacs
Gastrohepatic ligament
Gallbladder
Inc conj bilirubin - inc cholesterol - inc alk phos
Glucouronate - water soluble (direct)
14. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Begins starch digestion - inactivated by low pH upon reaching the stomach
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Short gastrics - left greater and lesser
Brunners
15. What does bicarb do in the duodenum
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Dermatitis herpetiformis
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Warthins' tumor
16. Who gets Whipple disease and How do they present
Mucosa - submucosa - muscularis externa - serosa/adventitia
Necrotizing enterocolitis
Mallory bodies
Old men - arthralgias - cardiac and neuro sx
17. How does loss of NO secretion affect the esophagus and what results
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
ALT>AST
Older patients
Inc lower esphogeal tone leading to achalasia
18. What are the longterm sequelae of nutmeg liver
Centrilobular congestion and necrosis - cardiac cirrhosis
Zollinger Ellison - phenylalanine and tryptophan
IBS at least 2 with recurrent abdominal pain
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
19. What reaction does salivary amylase catalyze
Peyers patches
Superior rectal
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Dense core bodies
20. Gq and inc cAMP both work to do what in parietal cells
Diverticulum
Hirschsprungs
Stimulate the H/K ATPase
Gardner's syndrome
21. What receptor does histamine bind on the parietal cell and What does it activate
H2 receptor - inc cAMP
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Pleomorphic adenoma
Krukenbergs tumor
22. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
IBS at least 2 with recurrent abdominal pain
Osmotic
Hemosiderosis - hemochromatosis
Terminal ileum and colon
23. What kind of lesions are characteristic of duodenal PUD vs cancer
Appendicitis
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Punched out - clean margins - carcinoma =raised irregular margins
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
24. What drug inhibits the H/K ATPase
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
Older patients
90%
Omeprazole
25. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Gamma glutamyl transferase GGT
Superior rectal
Neural muscarinic pathways
Turcot
26. What causes carcinoid syndrome amd What are the symptoms
Angiodysplasia
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Gamma glutamyl transferase GGT
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
27. What receptors does gastrin bind on the parietal cell and What does it activate
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
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
Volvulus
CCK8 receptor - Gq inc IP3/Ca
28. What is diverticulosis
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Budd chiari syndrome
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
29. What retroperitoneal structure flanks both sides of the pancreas on CT
Reye's syndrome
Centrilobular leading to congestive liver disease
Duodenum - 2nd - 3rd and 4th parts
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
30. With internal hemorrhoids Where is the anastomoses and Where is it
Superior rectal and middle and inferior rectal - rectum
Hyperplastic
Oral glucose
Omeprazole
31. What gives stool its characteristic color
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Superior rectal and middle and inferior rectal - rectum
Stercobilin
Glucouronate - water soluble (direct)
32. What does loss of APC cause
Decreased intercellular adhesion and increased proliferation
L/R renal artery around L1
Peyers patches
Mucosa - submucosa - muscularis externa - serosa/adventitia
33. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Colonic polyps
Hirschsprungs
Stercobilin
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
34. What are the extraintestinal manifestations of crohns
Dubin johnson
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Splenic flexure
Erosive - disruption of mucosal barrier leading to inflammation
35. What are the histological findings in the duodenum
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36. Acute gastritis is caused By what process
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Lactase is located at the tips of intestinal villi
Erosive - disruption of mucosal barrier leading to inflammation
All 3 gut layers outpouch as in Meckels
37. What is biliary colic
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
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
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Jaundice - fever - RUQ
38. What are the complications of duodenal PUD
Failure of neural crest migration
Bleeding - penetration into pancreas - perforation - obstruction
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Femoral hernia
39. How are all 3 monosaccharides transported to the blood
Lubricate food (glycoprotiens)
GLUT 2
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
40. concentric onion skin bile duct fibrosis
Complications of UC
Primary sclerosing cholangitis
Internal thoracic to superior epigastric to inferior epigastric
Diverticulitis in elderly - ectopic pregs use hCG to rule out
41. What is the risk with peutz jehgers
Redundant mesentary
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Inc risk of CRC and other visceral malignancies
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
42. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Brunners
Gallbladder
Esophageal varices
Tropical sprue
43. What causes hirschsprungs
Trypsin - chymotrypsin - elastase - carboxypeptidases
Failure of neural crest migration
Carcinoid syndrome
Diverticulitis in elderly - ectopic pregs use hCG to rule out
44. What is the presentation of pancreatic adenocarcinoma
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
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
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
45. Which viral infxns/treatments are associated with reyes syndrome
Redundant mesentary
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
VZV and influenza B treated with salicylates
46. What type of insults result in micronodular cirrhosis
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Portal HTN
H+
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
47. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Peutz jeghers
Carcinoid syndrome
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Failure of the processus vagainlis to close
48. How do you DX and TX gallstones
US and cholecystectomy
AR
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
Brush border of intestine - produce monosaccharides from oligo and di
49. What are the histological findings in the ileum
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50. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Stimulate the H/K ATPase
Nonkeritinized stratified sqamous epithelium
Portal HTN
Below