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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. Which kind of hemorrhoids are painful and why
Dermatitis herpetiformis
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
The proximal small bowel
With albumin
2. HCC is associated with what other conditions
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
3. With internal hemorrhoids Where is the anastomoses and Where is it
So hypertrophied they look like brain gyri
Superior rectal and middle and inferior rectal - rectum
Dec PGE2 leading to dec gastric mucosa protection
Ischemic colitis
4. Who gets gastric ulcers
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
In the mucus that covers the gastric epithelium
Older patients
5. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Primarly through ECL leading to histamine release
Intussusception
In the ileum with bile acids - requires IF
Old men - arthralgias - cardiac and neuro sx
6. What are the signs of peutz jehgers
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Inc smooth muscle relaxation - including lower esophageal sphincter
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Hyperpigmented mouth - lips - hands - genitalia
7. What are the longterm sequelae of nutmeg liver
Juvenille polyps - no risk if single
Centrilobular congestion and necrosis - cardiac cirrhosis
The entire
Poor anastamoses
8. Who is at risk for pancreatic adenocarcinoma
Positive urease test
Jewish and African American men
Lye ingestion and acid reflux
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
9. In PUD - with gastric ulcers - does pain inc or dec with meals?
Inc - weight loss
Source - I cells (duod - jej - action - inc pancreative secretion - inc gallbladder contraction - dec gastric emptying - sphincter of Oddi relaxation - regulation - inc by fatty acids and amino acids
Cimetidine
No - chronic - can present with diarrhea or constipation or alternation - treat sx
10. What does extrahepatic biliary obstruction cause
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
GERD - may also present with nocturnal cough and dyspnea
Alpha amylase
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
11. Which serum enzyme increases with heavy EtOH consumption
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
External (superficial) ring only
Gamma glutamyl transferase GGT
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
12. Gastrin - source - action - regulation
Internal thoracic to superior epigastric to inferior epigastric
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
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Urobilin
13. What do you treat Wilsons disease with and What is the inheritance
Ampulla of vater
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
In the mucus that covers the gastric epithelium
Penicillinamine - AR inheritance
14. How do NSAIDs cause acute gastritis
L1
Inc - weight loss
Meconium ileus
Dec PGE2 leading to dec gastric mucosa protection
15. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
CHF and inc risk of HCC
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
Necrotizing enterocolitis
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
16. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Hydrocele
Positive
Crohns = noncaseating granulomas - UC = crypt abscesses
Mitochondrial abnl - fatty liver - hypoglycemia - coma
17. People of what decent are associated with celiac sprue and what findings/antibodies are present
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Positive urease test
Brunners
Alk pho
18. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Cystic dilation of the viteline duct
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Spleen to posterior abdominal wall - splenic artery and vein
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
19. 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
Neutralizes gastric acid allowing pancreatic enzymes to fxn
L1
Skip lesions =crohns - colon = UC
Crigler - najjar type 1
20. FAP + malignant CNS tumor
Turcot
3 waves/min
L4
Early childhood - neuro sx and malabsorption
21. What is the triad of Plummer - Vinson syndrome
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Glucose dependent insulinotropic peptide
22. Which IBD is autoimmune and which may be a disordered response to bacteria
The proximal small bowel
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Lye ingestion and acid reflux
23. what kind of muscle is in the upper 1/3 of esophagus
Smooth
Striated
Inc risk of CRC and other visceral malignancies
Dysphagia (due to esophageal web) - glossitis - iron def anemia
24. Where and How is iron absorbed
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Fe2+ in the duod
Gut bacteria
Normal
25. How does hirschsprung present and appear on imaging
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Chronic gastritis and pernicious anemia
Hyperpigmented mouth - lips - hands - genitalia
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
26. What structure is Not contained in the femoral sheath
Conj/unconj - inc - nl to dec
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Peptic ulcer disease
27. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Redness and tenderness on palpation of extremities
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Alk pho
Gallbladder
28. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Complications of crohns
Repeated phlebotomy - deferoxamine - HLA- A3
GERD - may also present with nocturnal cough and dyspnea
Warthins' tumor
29. Between what structures do strong anastamoses exist
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Left and right gastroepiploics - left and right gastrics
HSV-1 - CMV - Candida
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
30. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Brush border of intestine - produce monosaccharides from oligo and di
Punched out - clean margins - carcinoma =raised irregular margins
Zollinger ellison - brunners glands
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
31. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Decreased intercellular adhesion and increased proliferation
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Stimulate the H/K ATPase
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
32. What is the characteristic histo finding in alcoholic hepatitis
The proximal small bowel
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Mallory bodies
In the mucus that covers the gastric epithelium
33. What is the other name for GIP (gastric inhibitory peptide)
Hyperpigmented mouth - lips - hands - genitalia
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Glucose dependent insulinotropic peptide
VZV and influenza B treated with salicylates
34. Where does crohns usually affect the GI tract
Inc lower esphogeal tone leading to achalasia
Terminal ileum and colon
CEA - CA-19-9
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
35. Where is folate absorbed
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
The jejunum
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
36. What gives stool its characteristic color
Corticosteroids - infliximab
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
Stercobilin
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
37. What factors increase risk of malignancy of adenomatous polyps
Urobilin
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Colovesical leading to pneumaturia
38. What is the cause of Barrett's and the assocaited complications
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Parietal cells in the stomach - B12 binding protein
M3 - Gq - inc IP3/Ca
39. Why does volvulus occur more at cecum and sigmoid colon
Peutz jeghers
3 waves/min
External spermatic fascia only
Redundant mesentary
40. At what level of the spine does the IM exit the aorta
H2 receptor - inc cAMP
Copious diarrhea - non alpha - non beta cell pancreatic tumor
L3
3 waves/min
41. Are single polyps malignant in peutz jehgers
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
No
Oral glucose
Left and right gastroepiploics - left and right gastrics
42. Which area of the hindgut is a watershed area
Splenic flexure
Striated
Stimulate the H/K ATPase
Mucoepidermoid carcinoma
43. What is the ddx associated with appendicitis
12 waves/min
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
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Failure of neural crest migration
44. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
The proximal small bowel
Crypts but not villi
GERD - may also present with nocturnal cough and dyspnea
Gut bacteria
45. What are the histological findings in the jejunum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Centrilobular congestion and necrosis - cardiac cirrhosis
Averages 6 months - very aggressive - usually already metastasized at presentation
Gastric glands
46. What are the four Fs of gallstones
Chagas disease
Female - fat - fertile - forty
Superior rectal
Alpha1 antitrypsin def - codominant trait
47. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Failure of neural crest migration
Brunners
Cystic duct and common hepatic duct
Omeprazole
48. What layer in the mucosa is responsible for absorption
Via the superior pancreaticduodenal
Esophageal varices
Epithelium
Turcot
49. What nerve innervates the external hemorrhoids
Chronic gastritis and pernicious anemia
Inferior rectal nerve
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
12 waves/min
50. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Hepatic steatosis
Urobilin
Jewish and African American men
Pyoderma gangrenosum - primary sclerosing cholangitis