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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. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Oral glucose
Carcinoid syndrome
Alcoholic cirrhosis
Early childhood - neuro sx and malabsorption
2. 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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3. Which viral infxns/treatments are associated with reyes syndrome
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Parietal cells in the stomach - B12 binding protein
Crigler - najjar type 1
VZV and influenza B treated with salicylates
4. HCC is associated with what other conditions
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
3 waves/min
All 3 gut layers outpouch as in Meckels
HSV-1 - CMV - Candida
5. What causes pancreatic insuff and What does it cause
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Osmotic
Striated and smooth
6. involvement of left supraclavicular node by mets from stomach
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7. Failure of relaxation of lower esophageal sphincter - Name and etiology
Brush border of intestine - produce monosaccharides from oligo and di
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Achalasia due to loss of myenteric plexus (auberach)
8. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Glucose dependent insulinotropic peptide
Ischemic colitis
Conj/unconj - inc - nl to dec
Appendicitis
9. In an MI - which liver enzyme is elevated
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
Jaundice - fever - RUQ
Zenkers - halitosis - dysphagia and obstruction
AST
10. What nerve innervates the external hemorrhoids
Enterokinase/enteropeptidase from the duodenal mucosa
Warthins' tumor
True and most common congenital anomoly of GI tract
Inferior rectal nerve
11. What is the most important mechanism in gastric acid secretion
Failure of neural crest migration
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Backup of blood into the liver - RHF - budd chiari
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
12. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Alpha1 antitrypsin def - codominant trait
The entire
Above
Gilbert's
13. FAP + osseous and soft tissue tumors - retinal hyperplasia
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14. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
3 waves/min
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
Dec PGE2 leading to dec gastric mucosa protection
Hirschsprungs
15. why infxn is implicated in duodenal PUD
Cimetidine
Chagas disease
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
H pylori (almost 100%)
16. What converts inactive pepsinogen to pepsin
H+
Uremia
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
Uridine glucuronyl transferase
17. What is contained within the muscularis externa
Myenteric nerve plexus - aurbach
Alk pho
Diverticulum
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
18. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Via the superior pancreaticduodenal
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Cigarettes and chronic pancreatitis - not EtOH
19. What are the main components of bile
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
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
Complications of UC
20. At what spinal level does the is the bifurcation of aorta
L4
GLUT 2
Cystic duct and common hepatic 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
21. in budd chiari syndrome - Where is the congestion and necrosis
Downs
Decrease - weight gain
Centrilobular leading to congestive liver disease
L2
22. What is the cause of Barrett's and the assocaited complications
Warthins' tumor
Turcot
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Gut bacteria
23. Where are tumors commonly in pancreatic adenocarcinoma
Antrum - H.pylori - inc risk of MALT lymphoma
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Pancreatic head causing obstructive jaundice
Below
24. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
HPNCC
H2 receptor - inc cAMP
25. What serum enzyme is elevated inacute pancreatitis
Lipase
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Where hindgut meets ectoderm
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
26. Are single polyps malignant in peutz jehgers
The proximal small bowel
No
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
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
27. When do you see hypertrophy of brunners glands
Tropical sprue
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Peptic ulcer disease
Alk phos
28. At what spinal level does the celiac trunk exit
Trypsin - chymotrypsin - elastase - carboxypeptidases
Osmotic
Liver metabolizes 5HT
T12
29. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Cirrhosis
Repeated phlebotomy - deferoxamine - HLA- A3
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
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
30. 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
Unconjugated - water insoluble
Lateral
Splenic flexure
31. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Unconj - absent (acholuria) - inc
Appendicitis
Right and left hepatic duct
Chronic gastritis and pernicious anemia
32. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Paraumbilical and superficial and inferior epigastric - umbilicus
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
M3 - Gq - inc IP3/Ca
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
33. What complication can arise from indirect inguinal hernias
Crigler - najjar type 1
T cell lymphoma
Hydrocele
Neutralizes gastric acid allowing pancreatic enzymes to fxn
34. What is the main symptom if a VIPoma
Upregulated intracellular signal transduction
IBS at least 2 with recurrent abdominal pain
Short gastrics - left greater and lesser
Copious diarrhea - non alpha - non beta cell pancreatic tumor
35. What do mucins do?
Lubricate food (glycoprotiens)
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
Neural muscarinic pathways
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
36. subQ peribumbilical metastasis
Sister mary joseph nodule
Crigler - najjar type 1
Complications of crohns
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
37. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Necrotizing enterocolitis
Cholesterol
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
38. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
HPNCC
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Zenkers - halitosis - dysphagia and obstruction
39. What enzyme is necessary to create conjugated bilirubin
EtOH
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Uridine glucuronyl transferase
Via the superior pancreaticduodenal
40. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Squamous - upper 1/3 - adeno - lower 1/3
Phototherapy
Lack or have an attenuated muscularis externa - often in the sigmoid colon
41. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Meckels
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
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 smooth muscle relaxation - including lower esophageal sphincter
42. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Serous on the sides parotids - mucinous in the middle sublingual
Causes of gall stones
The jejunum
The entire
43. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Ampulla of vater
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Superior rectal
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
44. Which area of the hindgut is a watershed area
Achalasia due to loss of myenteric plexus (auberach)
Splenic flexure
Acute pancreatitis
Striated
45. signet ring cells - acanthosis nigracans - dz - character/association - spread
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Myenteric nerve plexus - aurbach
46. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Pleomorphic adenoma
Carcinoid syndrome
Femoral hernia
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
47. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
...
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Normal
48. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Primarly through ECL leading to histamine release
Lamina propria
Crohns = maybe - UC= always
Repeated phlebotomy - deferoxamine - HLA- A3
49. What receptor does histamine bind on the parietal cell and What does it activate
H2 receptor - inc cAMP
Oral glucose
Carcinoid syndrome
Hydrocele
50. What causes hirschsprungs
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Epithelium
Pyoderma gangrenosum - primary sclerosing cholangitis
Failure of neural crest migration