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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. A protrusion of peritoneum through an opening - usually a site of weakness
Causes of gall stones
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Uremia
Hernia
2. Acute gastritis is caused By what process
All 3 gut layers outpouch as in Meckels
Dermatitis herpetiformis
Erosive - disruption of mucosal barrier leading to inflammation
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
3. What type of insults result in micronodular cirrhosis
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Alpha1 antitrypsin def - codominant trait
Normal
4. what percentage of colonic polyps are non - neoplastic
Paraumbilical and superficial and inferior epigastric - umbilicus
90%
Lactase is located at the tips of intestinal villi
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
5. in carcinoid tumors - What is seen on EM
Dense core bodies
Chronic calcifying pancreatitis - inc risk of panreatic cancer
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Poor anastamoses
6. What are the common causes of gastric ulcers - What causes gastric ulcer
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Lack or have an attenuated muscularis externa - often in the sigmoid colon
L/R renal artery around L1
Alfatoxin in peanuts
7. what kind of fistula is associated with diverticulitis
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Colovesical leading to pneumaturia
In the mucus that covers the gastric epithelium
8. Why does volvulus occur more at cecum and sigmoid colon
Female - fat - fertile - forty
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Redundant mesentary
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
9. What is the cause of Barrett's and the assocaited complications
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Alpha amylase
Uridine glucuronyl transferase
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
10. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Alpha amylase
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
All 3 gut layers outpouch as in Meckels
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
11. List the clinical findings of HCC
Barrett's esophagus
Uremia
L1
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
12. trypsinogen is converted to trypsin via what enzyme
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Enterokinase/enteropeptidase from the duodenal mucosa
External spermatic fascia only
Mallory bodies
13. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
2ndary biliary cirrhosis
Colovesical leading to pneumaturia
Stimulate intestinal persistalsis
Inc smooth muscle relaxation - including lower esophageal sphincter
14. What structures feed into the common hepatic duct
Splenic flexure
Right and left hepatic duct
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
15. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Carcinoid syndrome
Obstruction of the common bile duct
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Elevated amylase - and lipase
16. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
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
Zollinger Ellison - phenylalanine and tryptophan
Lubricate food (glycoprotiens)
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
17. Malabsorption syndromes have what common clinical presentation
IBS at least 2 with recurrent abdominal pain
Primarly through ECL leading to histamine release
Diarrhea - steatorrhea - weight loss - weakness
Serous on the sides parotids - mucinous in the middle sublingual
18. in budd chiari syndrome - Where is the congestion and necrosis
Striated and smooth
Unconj - absent (acholuria) - inc
Lubricate food (glycoprotiens)
Centrilobular leading to congestive liver disease
19. When and How does Abetalipoproteinemia present
Centrilobular congestion and necrosis - cardiac cirrhosis
Cigarettes and chronic pancreatitis - not EtOH
So hypertrophied they look like brain gyri
Early childhood - neuro sx and malabsorption
20. What does the splenorenal ligament connect - and What does it contain
Spleen to posterior abdominal wall - splenic artery and vein
Zenkers - halitosis - dysphagia and obstruction
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Cystic dilation of the viteline duct
21. What pancreatic enzymes are responsible for fat digestion
Alk phos
Low pressure proximal to LES
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
Lipase - phospholipase A - colipase
22. What does a low flow rate mean for saliva
Hypotonic because of more time to reabsorb NaCl
The entire
Serous on the sides parotids - mucinous in the middle sublingual
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
23. At what spinal level does the SMA exit
L1
CHF and inc risk of HCC
Pancreatic head causing obstructive jaundice
Splenic flexure
24. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Upregulated intracellular signal transduction
Crigler - najjar type 1
Crohns = noncaseating granulomas - UC = crypt abscesses
No - chronic - can present with diarrhea or constipation or alternation - treat sx
25. What causes nutmeg liver
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Warthins' tumor
Hypercoaguability - polycythemia vera - pregnancy - HCC
Backup of blood into the liver - RHF - budd chiari
26. What serum enzyme is elevated inacute pancreatitis
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Lipase
Muscularis mucosae
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
27. What are the histological findings in the duodenum
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28. What does bicab do in the mouth
Amylase
Heme metabolism
Bleeding - penetration into pancreas - perforation - obstruction
Neutralizes oral bacertial acids and maintains dental health
29. What is biliary colic
Alpha1 antitrypsin def - codominant trait
Gut bacteria
Left and right gastroepiploics - left and right gastrics
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
30. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Lactase is located at the tips of intestinal villi
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Dec PGE2 leading to dec gastric mucosa protection
31. Where is the deep inguinal ring relative to the inferior epigastric vessels
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Lateral
Enterokinase/enteropeptidase from the duodenal mucosa
Gallbladder
32. What causes hirschsprungs
ALT>AST
Oral glucose
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Failure of neural crest migration
33. What is indirect bilirubin
Closer to isotonic because of less time to reabsorb NaCl
Menetriers disease
Unconjugated - water insoluble
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
34. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Black - rotors syndrome
Terminal ileum and colon
The gastroduodenal
35. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Hepatic steatosis
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Juvenile polyposis syndrome - inc risk of adenocarcinoma
36. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Gallbladder
Myenteric nerve plexus - aurbach
Internal thoracic to superior epigastric to inferior epigastric
Complications of crohns
37. How many layers of spermatic fascia are covers an indirect inguinal hernia
Crypts but not villi
Menetriers disease
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
All 3
38. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Duodenal atresia - Downs
Backup of blood into the liver - RHF - budd chiari
The proximal small bowel
Alcoholic hepatitis
39. Where does an indirect inguinal hernia enter the deep inguinal ring
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Lateral to the inferior epigastric artery
AST
Lactase is located at the tips of intestinal villi
40. malnutrition - toxic megacolon - colorectal carcinoma
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Complications of UC
41. Where is folate absorbed
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Failure of the processus vagainlis to close
Hirschsprungs
The jejunum
42. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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43. What serum enzyme is elevated in acute pancreatitis and mumps
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Amylase
Oligosaccharide digestion
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
44. What serum enzyme is decreased in wilsons disease
Acute pancreatitis
Ceruplasmin
Unconj - absent (acholuria) - inc
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
45. Who gets gastric ulcers
Glucose dependent insulinotropic peptide
Decrease - weight gain
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Older patients
46. What structures feed into the common bile duct
Cystic duct and common hepatic duct
Glucose dependent insulinotropic peptide
Peptic ulcer disease
Left gastric vein and esophogeal vein - esophagus
47. What is the most common diaphragmatic hernia and What are the two types
Splenic flexure
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
48. What are the four Fs of gallstones
Omeprazole
Female - fat - fertile - forty
Crohns = maybe - UC= always
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
49. What does primary sclerosing cholangitis lead to...
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
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Early childhood - neuro sx and malabsorption
50. What parts of the small bowel can tropical sprue effect
Paraumbilical and superficial and inferior epigastric - umbilicus
Alk phos
The entire
H pylori (almost 100%)