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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. What does histo show for alpha1 antitrypsin def
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
PAS- positive globules in liver -
2. crigler - najjar type II responds to which therapy and How does it work
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Phenobarbital - inc liver enzyme synthesis
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
3. What causes hirschsprungs
Failure of neural crest migration
Left gastric vein and esophogeal vein - esophagus
Myenteric nerve plexus - aurbach
With albumin
4. What is the other name for GIP (gastric inhibitory peptide)
Glucose dependent insulinotropic peptide
Portal HTN
Amylase
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
5. What causes pancreatic insuff and What does it cause
Inspiratory arrest on deep palpation due to pain
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
6. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
H+
Short gastrics - left greater and lesser
Peyers patches
Juvenille polyps - no risk if single
7. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
Downs
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Mucosa - submucosa - muscularis externa - serosa/adventitia
...
8. Where and How is iron absorbed
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Fe2+ in the duod
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Via the superior pancreaticduodenal
9. What kind of diarrhea is produced from a disaccharide def
Phototherapy
Reye's syndrome
Osmotic
Jaundice - fever - RUQ
10. what percentage of colonic polyps are non - neoplastic
Gamma glutamyl transferase GGT
90%
Juvenille polyps - no risk if single
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
11. What causes primary biliary cirrhosis
Alcoholic hepatitis
Neural muscarinic pathways
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Omeprazole
12. With caput medusaw - between what vessels is the anastomoses and Where is it
Mallory bodies
Paraumbilical and superficial and inferior epigastric - umbilicus
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Right and left hepatic duct
13. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
ALT>AST
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Terminal ileum and colon
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
14. What is one potential precipitating factor for intussusception
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Cystic dilation of the viteline duct
Cholesterol
Backup of blood into the liver - RHF - budd chiari
15. What does TOASTED with alcoholic hepatitis stand for
Pleuroperitoneal
External spermatic fascia only
AR
AST >ALT - ration is usually 1.5
16. Gallstones that reach the common channel at ampulla can block which two ducts
Pancreatic and bile
Krukenbergs tumor
Celiac sprue
The submucosal nerve plexus - meissner's
17. What serum enzyme is elevated in acute pancreatitis and mumps
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
HSV-1 - CMV - Candida
Amylase
Mucoepidermoid carcinoma
18. Why does indirect inguinal hernia happen in infacnts
Failure of the processus vagainlis to close
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Skip lesions =crohns - colon = UC
Turcot
19. What pancreatic proteases are secreted as zymogens
Esophageal carcinoma
Trypsin - chymotrypsin - elastase - carboxypeptidases
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Lipase - phospholipase A - colipase
20. occlusion of IVC or hepatic veins
Conj/unconj - inc - nl to dec
Ampulla of vater
Budd chiari syndrome
Normal
21. What are the labs in acute pancreatitis
Elevated amylase - and lipase
The proximal small bowel
Neutralizes oral bacertial acids and maintains dental health
2ndary biliary cirrhosis
22. What are the hindgut structures and what supplies their blood and PANS innvervation
Positive urease test
So hypertrophied they look like brain gyri
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
23. Are single polyps malignant in peutz jehgers
Pancreatic head causing obstructive jaundice
AST
Mucosa - submucosa - muscularis externa - serosa/adventitia
No
24. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Alcoholic hepatitis
Below
MSI (15%) and APC/beta catenin chromosomal instability (85%)
25. concentric onion skin bile duct fibrosis
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Primary sclerosing cholangitis
In the ileum with bile acids - requires IF
26. What transforms conjugated bilirubin to urobilinogen
Gut bacteria
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Dilated esophagus with an area of distal stenosis - birds beak
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
27. What is the clinical presentation of acute pancreatitis
Dissaccharidase def - most commonly lactase
2ndary biliary cirrhosis
Epigastric abdominal pain radiating to back - anorexia - nausea
Brunners
28. How is the diagonsis of CRC made
Pertechnetate - study for uptake
Positive
Cystic dilation of the viteline duct
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
29. What are the ABCDEF of esophageal cancer
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
No
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Penicillinamine - AR inheritance
30. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Alk phos
Dubin johnson
Heme metabolism
31. What findings are associated with reyes
Centrilobular leading to congestive liver disease
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
32. What layer of fascia covers a direct inguinal hernia
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Zenkers - halitosis - dysphagia and obstruction
Uremia
External spermatic fascia only
33. absent UDPGT - presents early in life - early mortality
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Common hepatic - splenic - left gastric - main blood supply for stomach
Lipase - phospholipase A - colipase
Crigler - najjar type 1
34. What are the complications of acute pancreatitis
Hydrocele
HSV-1 - CMV - Candida
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
35. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Squamous - upper 1/3 - adeno - lower 1/3
Positive
Alpha amylase
36. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Serous on the sides parotids - mucinous in the middle sublingual
Spleen to posterior abdominal wall - splenic artery and vein
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Zollinger ellison - brunners glands
37. What is the frequency of basal electric rhythm of the ilieum
Normal
No
Erosive - disruption of mucosal barrier leading to inflammation
8-9 waves/min
38. What does GET SMASHED stand for in acute pancreatitis
Diarrhea - steatorrhea - weight loss - weakness
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
39. At what spinal level does the SMA exit
Low pressure proximal to LES
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Pyoderma gangrenosum - primary sclerosing cholangitis
L1
40. What is the main symptom if a VIPoma
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Gut bacteria
41. What does a gastrinoma cause
Dense core bodies
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Hypotonic because of more time to reabsorb NaCl
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
42. What structures feed into the common bile duct
Dec PGE2 leading to dec gastric mucosa protection
Dilated esophagus with an area of distal stenosis - birds beak
L4
Cystic duct and common hepatic duct
43. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
8-9 waves/min
Meckels
Intussusception
Penicillinamine - AR inheritance
44. malnutrition - toxic megacolon - colorectal carcinoma
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Complications of UC
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Bleeding - intussusception - volvulus - obstruction near terminal ileum
45. What do tumors that arise in the head of the pancreas cause
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Failure of the processus vagainlis to close
Obstruction of the common bile duct
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
46. What is the rate limiting step of carbohydrate digestion
Oligosaccharide digestion
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Diverticulum
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
47. What pancreatic enzymes are responsible for fat digestion
Hemosiderosis - hemochromatosis
Lipase - phospholipase A - colipase
Decreased intercellular adhesion and increased proliferation
Bleeding - intussusception - volvulus - obstruction near terminal ileum
48. What portion of the bowel does sprue effect
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Failure of the processus vagainlis to close
The proximal small bowel
Causes of gall stones
49. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Uridine glucuronyl transferase
12 waves/min
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Black - rotors syndrome
50. Which IBD is autoimmune and which may be a disordered response to bacteria
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Begins starch digestion - inactivated by low pH upon reaching the stomach
Can lead to hematemesis - found in EtOHics and bulimics
Jaundice - fever - RUQ