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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 is one potential precipitating factor for intussusception
In the mucus that covers the gastric epithelium
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
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
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
2. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Backup of blood into the liver - RHF - budd chiari
So hypertrophied they look like brain gyri
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Diverticulitis in elderly - ectopic pregs use hCG to rule out
3. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Decreased intercellular adhesion and increased proliferation
Hepatic steatosis
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
4. Who is at risk for pancreatic adenocarcinoma
AST
Uridine glucuronyl transferase
Boerhaave's Syndrome - Been heaving syndrome
Jewish and African American men
5. What is contained in the gastrosplenic and What areas does it separate
Inc smooth muscle relaxation - including lower esophageal sphincter
Poor anastamoses
Short gastrics - left greater and lesser
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
6. Who gets Whipple disease and How do they present
Old men - arthralgias - cardiac and neuro sx
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Brunners
HSV-1 - CMV - Candida
7. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Pleuroperitoneal
IBS at least 2 with recurrent abdominal pain
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Menetriers disease
8. what percentage of colonic polyps are non - neoplastic
Lateral to the inferior epigastric artery
Source - parasympathetic ganglion in sphincters - gallbladder - small intestine - action - inc intestinal water and electrolyte secretion - inc relaxation of intestinal smooth muscle and sphincters - regulation - inc by distention and vagal stimulati
90%
Lateral
9. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Muscularis mucosae
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Peyers patches
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
10. What is the rate limiting step of carbohydrate digestion
GERD - may also present with nocturnal cough and dyspnea
Oligosaccharide digestion
Intussusception
Adhesion
11. what kind of muscle is in the upper 1/3 of esophagus
Striated
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
The submucosal nerve plexus - meissner's
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
12. What do the rugae of stomach look like in menetriers disease
The entire
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
So hypertrophied they look like brain gyri
Mucoepidermoid carcinoma
13. What does loss of APC cause
Lipase - phospholipase A - colipase
GERD - may also present with nocturnal cough and dyspnea
Adhesion
Decreased intercellular adhesion and increased proliferation
14. What is the main symptom if a VIPoma
NAV = nerve artery vein - venous near the penis (NAVEL)
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Brunners
Hydrocele
15. What are the treatmet options for crohns
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
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
Paraumbilical and superficial and inferior epigastric - umbilicus
Corticosteroids - infliximab
16. What is contained within the submucosa
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17. What are the histological findings in the duodenum
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18. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
3 waves/min
Colonic polyps
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
19. Which area of the hindgut is a watershed area
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Muscularis mucosae
Conj - inc - dec
Splenic flexure
20. What complication can arise from indirect inguinal hernias
Increase tumorigenesis
12 waves/min
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Hydrocele
21. A protrusion of peritoneum through an opening - usually a site of weakness
Positive urease test
Hernia
Uremia
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
22. What is contained within the muscularis externa
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Myenteric nerve plexus - aurbach
Closer to isotonic because of less time to reabsorb NaCl
Inc lower esphogeal tone leading to achalasia
23. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Inc smooth muscle relaxation - including lower esophageal sphincter
Redundant mesentary
24. In PUD - with gastric ulcers - does pain inc or dec with meals?
Cirrhosis
Colonic polyps
Inc - weight loss
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
25. What do tumors that arise in the head of the pancreas cause
Obstruction of the common bile duct
Skip lesions =crohns - colon = UC
US and cholecystectomy
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
26. People of what decent are associated with celiac sprue and what findings/antibodies are present
H+
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
So hypertrophied they look like brain gyri
27. What other condition can lead to acute gastritis - think renal
IBS at least 2 with recurrent abdominal pain
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Uremia
Pleomorphic adenoma
28. Where does copper accumulate in Wilsons and What are ABCD
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Black - rotors syndrome
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
29. What causes carcinoid syndrome amd What are the symptoms
VZV and influenza B treated with salicylates
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Inferior rectal nerve
Diarrhea - steatorrhea - weight loss - weakness
30. What is a positive murphy's sign
So hypertrophied they look like brain gyri
Inc - weight loss
Inspiratory arrest on deep palpation due to pain
Inc risk of CRC and other visceral malignancies
31. In what scenarios do pts with gilberts have inc bili
FAP
Fasting and stress
Alk phos
Striated
32. At what spinal level does the SMA exit
Above
Cystic dilation of the viteline duct
L1
Brunners
33. In PUD with a duodenal ulcer does pain inc or dec with meals
Pyoderma gangrenosum - primary sclerosing cholangitis
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Decrease - weight gain
Liver metabolizes 5HT
34. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
True and most common congenital anomoly of GI tract
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Carcinoid syndrome
Pleuroperitoneal
35. signet ring cells - acanthosis nigracans - dz - character/association - spread
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Duodenum - 2nd - 3rd and 4th parts
Gamma glutamyl transferase GGT
H+
36. What receptor does histamine bind on the parietal cell and What does it activate
H2 receptor - inc cAMP
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Hirschsprungs
37. What retroperitoneal structure flanks both sides of the pancreas on CT
HSV-1 - CMV - Candida
Muscularis mucosae
Duodenum - 2nd - 3rd and 4th parts
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
38. What are the borders of Hesselbach's triangle
The proximal small bowel
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
39. What findings are associated with reyes
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Mucoepidermoid carcinoma
Mitochondrial abnl - fatty liver - hypoglycemia - coma
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
40. What does primary sclerosing cholangitis lead to...
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Gastric glands
Conj/unconj - inc - nl to dec
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
41. What drug inhibits the H/K ATPase
Omeprazole
Smooth
Appendicitis
Conj/unconj - inc - nl to dec
42. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Splenic flexure
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Source - parasympathetic ganglion in sphincters - gallbladder - small intestine - action - inc intestinal water and electrolyte secretion - inc relaxation of intestinal smooth muscle and sphincters - regulation - inc by distention and vagal stimulati
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
43. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Trypsin - chymotrypsin - elastase - carboxypeptidases
Cirrhosis
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Esophageal cancer
44. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue
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45. What can hemochromatosis be secondary to...
Cigarettes and chronic pancreatitis - not EtOH
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
In the mucus that covers the gastric epithelium
46. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Glucose dependent insulinotropic peptide
Pleomorphic adenoma
Hyperpigmented mouth - lips - hands - genitalia
Osmotic
47. What are the four Fs of gallstones
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Female - fat - fertile - forty
Falciform - ligamentum teres - fetal umbilical vein
Via the superior pancreaticduodenal
48. What infection causes Whipple disease and What can you see on LM
Esophageal varices
Primarly through ECL leading to histamine release
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
49. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Esophageal cancer
Juvenille polyps - no risk if single
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Hypercoaguability - polycythemia vera - pregnancy - HCC
50. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Lactase is located at the tips of intestinal villi
Low pressure proximal to LES
Inc smooth muscle relaxation - including lower esophageal sphincter
12 waves/min