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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 are the ABCDEF of esophageal cancer
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Below
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Urobilin
2. How do villi appear in disaccharidease def
Krukenbergs tumor
Normal
Stercobilin
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
3. What are the treatment options for uclerative colitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Budd chiari syndrome
Uridine glucuronyl transferase
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
4. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Esophageal varices
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
5. Who is at risk for pancreatic adenocarcinoma
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Jewish and African American men
Lye ingestion and acid reflux
6. What is the most common indication of emergent abdominal surgery in children
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Begins starch digestion - inactivated by low pH upon reaching the stomach
NAV = nerve artery vein - venous near the penis (NAVEL)
Appendicitis
7. What test and result confirms H pylori infxn
Positive urease test
Normal
With albumin
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
8. What kind of pancreatitis is associated with EtOH and smoking
The submucosal nerve plexus - meissner's
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Dubin johnson
Chronic calcifying pancreatitis - inc risk of panreatic cancer
9. 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
Around the central vein (zone III)
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Begins starch digestion - inactivated by low pH upon reaching the stomach
10. What arteries exit just below the SMA
L2
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
L/R renal artery around L1
Liver metabolizes 5HT
11. crigler - najjar type II responds to which therapy and How does it work
Phenobarbital - inc liver enzyme synthesis
Redness and tenderness on palpation of extremities
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
Repeated phlebotomy - deferoxamine - HLA- A3
12. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
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
Phenobarbital - inc liver enzyme synthesis
Alpha1 antitrypsin def - codominant trait
Hyperpigmented mouth - lips - hands - genitalia
13. what kind of muscle is in the upper 1/3 of esophagus
Femoral hernia
Hyperplastic
Striated
HSV-1 - CMV - Candida
14. What are the histological findings of the colon
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Celiac sprue
Crypts but not villi
Colovesical leading to pneumaturia
15. What do mucins do?
The entire
Pleuroperitoneal
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Lubricate food (glycoprotiens)
16. What kind of muscle is in the middle 1/3 of esophagus
Carcinoid syndrome
Striated and smooth
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Jaundice - fever - RUQ
17. In PUD - with gastric ulcers - does pain inc or dec with meals?
Mallory bodies
Inc - weight loss
Nonkeritinized stratified sqamous epithelium
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
18. What is the most common cause of gallstones
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Pleomorphic adenoma
Where hindgut meets ectoderm
19. What are the structures of the femoral triangle and how are they organized
Crohns = noncaseating granulomas - UC = crypt abscesses
EtOH
NAV = nerve artery vein - venous near the penis (NAVEL)
Early childhood - neuro sx and malabsorption
20. When and why is stomach cancer termed linitis plastica
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
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
Dilated esophagus with an area of distal stenosis - birds beak
21. why infxn is implicated in duodenal PUD
In the ileum with bile acids - requires IF
Colovesical leading to pneumaturia
H pylori (almost 100%)
Hemosiderosis - hemochromatosis
22. Autoantibodies to gluten (gliadin) in wheat and other grains
AR
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Unconjugated - water insoluble
Celiac sprue
23. What structure is Not contained in the femoral sheath
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Pleuroperitoneal
24. Diaphragmatic hernias occur in infants because of defective development of which membrane
CCK8 receptor - Gq inc IP3/Ca
AST>ALT
Poor anastamoses
Pleuroperitoneal
25. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Where hindgut meets ectoderm
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Gilbert's
Complications of UC
26. What are esophageal strictures associated with
Lye ingestion and acid reflux
In the mucus that covers the gastric epithelium
Gastric glands
Positive
27. Which kind of hemorrhoids are painful and why
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Chagas disease
Ischemic colitis
Inc lower esphogeal tone leading to achalasia
28. What drug inhibits the H/K ATPase
Omeprazole
Pleuroperitoneal
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
ALT>AST
29. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Alk pho
Peutz jeghers
Penicillinamine - AR inheritance
90%
30. What is the presentation of pancreatic adenocarcinoma
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Complications of UC
Striated
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
31. How do you DX and TX gallstones
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Superior rectal and middle and inferior rectal - rectum
US and cholecystectomy
No
32. What is Trousseau's sign
Redness and tenderness on palpation of extremities
Serous on the sides parotids - mucinous in the middle sublingual
Cystic dilation of the viteline duct
Cystic duct and common hepatic duct
33. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Decreased intercellular adhesion and increased proliferation
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Pyoderma gangrenosum - primary sclerosing cholangitis
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
34. If trypsin activates more trypsinogen - what kind of feedback loop is established
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
3 waves/min
Positive
Female - fat - fertile - forty
35. What does autoimmune destruction of parietal cells lead to...
Can lead to hematemesis - found in EtOHics and bulimics
External spermatic fascia only
Lye ingestion and acid reflux
Chronic gastritis and pernicious anemia
36. How is bilirubin carried in the blood
With albumin
Liver metabolizes 5HT
Striated
Unconj - absent (acholuria) - inc
37. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Can lead to hematemesis - found in EtOHics and bulimics
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Lactase is located at the tips of intestinal villi
L2
38. HCC is associated with what other conditions
Can lead to hematemesis - found in EtOHics and bulimics
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Necrotizing enterocolitis
Esophageal carcinoma
39. What is pancreatic adenocarcinoma associated with
Menetriers disease
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Cigarettes and chronic pancreatitis - not EtOH
Spleen to posterior abdominal wall - splenic artery and vein
40. What kind of muscle is in the lower 1/3 of the esophagus
Smooth
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Gallbladder
Heme metabolism
41. What is the cause of Barrett's and the assocaited complications
Complications of UC
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Brush border of intestine - produce monosaccharides from oligo and di
Black - rotors syndrome
42. milk intolerance
Alfatoxin in peanuts
Stimulate the H/K ATPase
Neural muscarinic pathways
Dissaccharidase def - most commonly lactase
43. In viral hepatitis - which liver enzyme is higher
Lamina propria
CCK8 receptor - Gq inc IP3/Ca
Juvenille polyps - no risk if single
ALT>AST
44. What serum enzyme is decreased in wilsons disease
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Ceruplasmin
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Smooth
45. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Jewish and African American men
All 3 gut layers outpouch as in Meckels
Pleomorphic adenoma
Alcoholic cirrhosis
46. What type of insults result in micronodular cirrhosis
Zollinger ellison - brunners glands
Neutralizes gastric acid allowing pancreatic enzymes to fxn
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Corticosteroids - infliximab
47. What does K- ras mutation cause
Esophageal cancer
Worldwide - SC - US - adeno
Upregulated intracellular signal transduction
Intussusception
48. What is the action of NO as a GI hormone
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
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Inc smooth muscle relaxation - including lower esophageal sphincter
49. Where is there sclerosis in alcoholic cirrohosis
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
VZV and influenza B treated with salicylates
Around the central vein (zone III)
Crohns = maybe - UC= always
50. Where is the deep inguinal ring relative to the inferior epigastric vessels
Uridine glucuronyl transferase
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Lateral
Peyers patches