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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. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Cirrhosis
Female - fat - fertile - forty
External spermatic fascia only
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
2. What are the hindgut structures and what supplies their blood and PANS innvervation
IgA secreting plasma cells - ultimately reside in the lamina proporia
Turcot
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Hemosiderosis - hemochromatosis
3. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Volvulus
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Cholesterol - 10-20% opaque due to calcifications
4. What are the extraintestinal manifestations of crohns
Urobilin
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
T12
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
5. What does GET SMASHED stand for in acute pancreatitis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Lye ingestion and acid reflux
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
6. What are additional risk factors for CRC
Colonic polyps
IgA secreting plasma cells - ultimately reside in the lamina proporia
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Failure of the processus vagainlis to close
7. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Lamina propria
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Gastric glands
8. What kind of lesions are characteristic of duodenal PUD vs cancer
Myenteric nerve plexus - aurbach
Low pressure proximal to LES
HPNCC
Punched out - clean margins - carcinoma =raised irregular margins
9. What transforms conjugated bilirubin to urobilinogen
L1
Gut bacteria
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Trypsin - chymotrypsin - elastase - carboxypeptidases
10. What drug blocks the H2R
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
PAS- positive globules in liver -
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Cimetidine
11. At what level do the testicular/ovarian arteries exit the aorta
L2
Begins starch digestion - inactivated by low pH upon reaching the stomach
Conj/unconj - inc - nl to dec
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
12. Failure of relaxation of lower esophageal sphincter - Name and etiology
Achalasia due to loss of myenteric plexus (auberach)
Redundant mesentary
CHF and inc risk of HCC
Gastric glands
13. What test and result confirms H pylori infxn
Low pressure proximal to LES
Centrilobular leading to congestive liver disease
Positive urease test
Chronic calcifying pancreatitis - inc risk of panreatic cancer
14. What can hemochromatosis be secondary to...
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Squamous - upper 1/3 - adeno - lower 1/3
Epigastric abdominal pain radiating to back - anorexia - nausea
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
15. What portion of the bowel does sprue effect
The proximal small bowel
Alpha1 antitrypsin def - codominant trait
Crypts but not villi
Stercobilin
16. Which is used more quickly - an oral glucose load - or that by IV
Brush border of intestine - produce monosaccharides from oligo and di
Oral glucose
The jejunum
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
17. What are the tumor markers for pancreatic adenocarcinoma
Alk phos
Antrum - H.pylori - inc risk of MALT lymphoma
Cirrhosis
CEA - CA-19-9
18. 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
Zenkers - halitosis - dysphagia and obstruction
Pancreatic and bile
Unconj - absent (acholuria) - inc
19. How does gastrin increase acid secretion?
Around the central vein (zone III)
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
So hypertrophied they look like brain gyri
Primarly through ECL leading to histamine release
20. What is a positive murphy's sign
L3
Inspiratory arrest on deep palpation due to pain
Lipase - phospholipase A - colipase
All 3 gut layers outpouch as in Meckels
21. How do you DX and TX gallstones
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
US and cholecystectomy
Antrum - H.pylori - inc risk of MALT lymphoma
Decrease - weight gain
22. What do the rugae of stomach look like in menetriers disease
Source - G cells in the antrum - action - inc gastric H+ secretion - inc growth of gastric mucosa - and inc gastric motility - regulation - inc by stomach distention/alkalinaztion - amino acids - peptides - vagal stimulation - dec by stomach pH < 1.5
Averages 6 months - very aggressive - usually already metastasized at presentation
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
So hypertrophied they look like brain gyri
23. Bile is critical for exrection of what substance
Antrum - H.pylori - inc risk of MALT lymphoma
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Cholesterol
PAS- positive globules in liver -
24. What do you use to diagnose meckels
Hydrocele
Centrilobular congestion and necrosis - cardiac cirrhosis
Pertechnetate - study for uptake
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
25. Achalasia increases the risk For what complication
Conj/unconj - inc - nl to dec
Esophageal carcinoma
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Pleomorphic adenoma
26. Why does volvulus occur more at cecum and sigmoid colon
Positive urease test
Lipase - phospholipase A - colipase
Cystic duct and common hepatic duct
Redundant mesentary
27. 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
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
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Bleeding - intussusception - volvulus - obstruction near terminal ileum
28. What happens to the short gastics if the splenic artery is blocked
Poor anastamoses
Peyers patches
Cimetidine
Below
29. What is the classic triad of hemochromatosis
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30. What is the omphalomesenteric cyst
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Cystic dilation of the viteline duct
Failure of the processus vagainlis to close
Osmotic
31. What causes carcinoid syndrome amd What are the symptoms
Lateral
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Crohns = maybe - UC= always
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
32. What are the main components of bile
Complications of crohns
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Krukenbergs tumor
MSI (15%) and APC/beta catenin chromosomal instability (85%)
33. Where is IgA shuttled
Fasting and stress
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
VZV and influenza B treated with salicylates
Necrotizing enterocolitis
34. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
IBS at least 2 with recurrent abdominal pain
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Peyers patches
The submucosal nerve plexus - meissner's
35. Where does crohns usually affect the GI tract
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Worldwide - SC - US - adeno
Terminal ileum and colon
Dissaccharidase def - most commonly lactase
36. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Skip lesions =crohns - colon = UC
Epigastric abdominal pain radiating to back - anorexia - nausea
Glucouronate - water soluble (direct)
37. What receptors does ACH bind on the parietal cells and What does it activate
Epithelium
M3 - Gq - inc IP3/Ca
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
When diffusely infiltrative - thickened rigid appearance like a leather bottle
38. What histological findings are present in the stomach
Corticosteroids - infliximab
Pleomorphic adenoma
Peyers patches
Gastric glands
39. what kind of fistula is associated with diverticulitis
CHF and inc risk of HCC
Lamina propria
Lye ingestion and acid reflux
Colovesical leading to pneumaturia
40. inflammatino of gallbadder
Pyoderma gangrenosum - primary sclerosing cholangitis
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Epithelium
Phototherapy
41. What are the two molecular pathways that lead to CRC
Gallbladder
Hyperplastic
MSI (15%) and APC/beta catenin chromosomal instability (85%)
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
42. What is the TX of physiologic neonatal jaundice
Alfatoxin in peanuts
Phototherapy
Juvenille polyps - no risk if single
Crohns = maybe - UC= always
43. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Alk pho
FAP
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Superior rectal
44. What are the histological findings of the colon
Crypts but not villi
Meconium ileus
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Copious diarrhea - non alpha - non beta cell pancreatic tumor
45. Where is the pectinate line
Meckels
Where hindgut meets ectoderm
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Carcinoid syndrome
46. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Glucose dependent insulinotropic peptide
Fasting and stress
Conj - inc - dec
47. Which IBD is autoimmune and which may be a disordered response to bacteria
Oligosaccharide digestion
Left gastric vein and esophogeal vein - esophagus
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
48. Gallstones that reach the common channel at ampulla can block which two ducts
Crigler - najjar type 1
Meckels
Pancreatic and bile
Serous on the sides parotids - mucinous in the middle sublingual
49. Are single polyps malignant in peutz jehgers
No
Neutralizes oral bacertial acids and maintains dental health
L4
Inc smooth muscle relaxation - including lower esophageal sphincter
50. What serum enzyme is elevated inacute pancreatitis
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Peyers patches
Lipase
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid