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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. Bilirubin is the product of what?
Boerhaave's Syndrome - Been heaving syndrome
H+
Heme metabolism
Cholesterol - 10-20% opaque due to calcifications
2. What is contained within the muscularis externa
Positive urease test
Myenteric nerve plexus - aurbach
Failure of the processus vagainlis to close
Positive
3. What does extrahepatic biliary obstruction cause
Cholesterol
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Crigler - najjar type 1
Meconium ileus
4. What percentage of gall stones are cholesterol stones and What are the associations
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Brush border of intestine - produce monosaccharides from oligo and di
No
Dilated esophagus with an area of distal stenosis - birds beak
5. What kind of cancer to celiac sprue put you as inc risk for
T cell lymphoma
Turcot
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Cimetidine
6. Why does carcinoid syndrome not occur if tumor is confined to GI system
GERD - may also present with nocturnal cough and dyspnea
Below
So hypertrophied they look like brain gyri
Liver metabolizes 5HT
7. malnutrition - toxic megacolon - colorectal carcinoma
Complications of UC
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Backup of blood into the liver - RHF - budd chiari
Inc - weight loss
8. If trypsin activates more trypsinogen - what kind of feedback loop is established
Positive
Adhesion
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
L3
9. What is diverticulosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Stercobilin
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Striated and smooth
10. Which IBD is autoimmune and which may be a disordered response to bacteria
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Krukenbergs tumor
Alk phos
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
11. Where is the deep inguinal ring relative to the inferior epigastric vessels
The jejunum
Lateral
Zollinger ellison - brunners glands
AR
12. What are the signs and symptoms of budd chiari
AST>ALT
Colovesical leading to pneumaturia
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Above
13. What causes primary biliary cirrhosis
Repeated phlebotomy - deferoxamine - HLA- A3
Reye's syndrome
Ampulla of vater
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
14. HCC is associated with what other conditions
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Conj/unconj - inc - nl to dec
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
VZV and influenza B treated with salicylates
15. Failure of relaxation of lower esophageal sphincter - Name and etiology
So hypertrophied they look like brain gyri
Achalasia due to loss of myenteric plexus (auberach)
HPNCC
Short gastrics - left greater and lesser
16. What is contained within the submucosa
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17. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Hirschsprungs
Normal
18. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Via the superior pancreaticduodenal
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Upregulated intracellular signal transduction
Intussusception
19. What are the four Fs of gallstones
Acute pancreatitis
Female - fat - fertile - forty
Via the superior pancreaticduodenal
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
20. subQ peribumbilical metastasis
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Sister mary joseph nodule
Normal
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
21. Which area of the hindgut is a watershed area
Turcot
Epigastric abdominal pain radiating to back - anorexia - nausea
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Splenic flexure
22. What is the risk with peutz jehgers
Nonkeritinized stratified sqamous epithelium
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Inc risk of CRC and other visceral malignancies
Barrett's esophagus
23. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Stercobilin
Menetriers disease
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Femoral hernia
24. What receptor does histamine bind on the parietal cell and What does it activate
Crohns = noncaseating granulomas - UC = crypt abscesses
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
H2 receptor - inc cAMP
Intussusception
25. Scleroderma is associated with what kind of esophageal dysmotility
Low pressure proximal to LES
Diverticulum
Brush border of intestine - produce monosaccharides from oligo and di
Neutralizes gastric acid allowing pancreatic enzymes to fxn
26. What do tumors that arise in the head of the pancreas cause
Hydrocele
Chronic gastritis and pernicious anemia
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Obstruction of the common bile duct
27. FAP + malignant CNS tumor
Stimulate the H/K ATPase
Striated and smooth
Turcot
Hypotonic because of more time to reabsorb NaCl
28. What are esophageal strictures associated with
Gamma glutamyl transferase GGT
Where hindgut meets ectoderm
Lye ingestion and acid reflux
Femoral hernia
29. What does TOASTED with alcoholic hepatitis stand for
Diverticulum
In the mucus that covers the gastric epithelium
AST >ALT - ration is usually 1.5
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
30. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
All 3
Ampulla of vater
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
31. Where are oligosaccharide hydrolases and What do they do
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Brush border of intestine - produce monosaccharides from oligo and di
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Enterokinase/enteropeptidase from the duodenal mucosa
32. Where does type B chronic gastritis occur and What causes it
Mucoepidermoid carcinoma
Lye ingestion and acid reflux
Antrum - H.pylori - inc risk of MALT lymphoma
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
33. What is the most common esophageal cancer worldwide and in the US
Worldwide - SC - US - adeno
Hyperplastic
Increase tumorigenesis
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
34. 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
Failure of neural crest migration
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Inspiratory arrest on deep palpation due to pain
35. What does high flow rate mean
CCK8 receptor - Gq inc IP3/Ca
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
8-9 waves/min
Closer to isotonic because of less time to reabsorb NaCl
36. What do the rugae of stomach look like in menetriers disease
Mitochondrial abnl - fatty liver - hypoglycemia - coma
So hypertrophied they look like brain gyri
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
37. Where and How is iron absorbed
Above
Boerhaave's Syndrome - Been heaving syndrome
Fe2+ in the duod
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
38. What transforms conjugated bilirubin to urobilinogen
Gastric glands
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Gut bacteria
IBS at least 2 with recurrent abdominal pain
39. What findings are associated with reyes
Enterokinase/enteropeptidase from the duodenal mucosa
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
L3
40. With caput medusaw - between what vessels is the anastomoses and Where is it
Liver metabolizes 5HT
Amylase
Paraumbilical and superficial and inferior epigastric - umbilicus
Penicillinamine - AR inheritance
41. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Oligosaccharide digestion
L3
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
42. What is contained in the gastrosplenic and What areas does it separate
Short gastrics - left greater and lesser
Skip lesions =crohns - colon = UC
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Mallory bodies
43. crigler - najjar type II responds to which therapy and How does it work
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Portal HTN
IBS at least 2 with recurrent abdominal pain
Phenobarbital - inc liver enzyme synthesis
44. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Left and right gastroepiploics - left and right gastrics
Old men - arthralgias - cardiac and neuro sx
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
45. With internal hemorrhoids Where is the anastomoses and Where is it
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
EtOH
Superior rectal and middle and inferior rectal - rectum
46. what kind of fistula is associated with diverticulitis
AST>ALT
L2
Colovesical leading to pneumaturia
Pleuroperitoneal
47. Where are carcinoid tumors most commonly malignant
Dissaccharidase def - most commonly lactase
Centrilobular congestion and necrosis - cardiac cirrhosis
Small intestine
Appendicitis
48. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Pleomorphic adenoma
Via the superior pancreaticduodenal
Alcoholic hepatitis
49. What makes a true diverticula
T12
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
All 3 gut layers outpouch as in Meckels
50. inflammatino of gallbadder
Positive urease test
Portal HTN
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure