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Test your basic knowledge |
USMLE GI
Start Test
Study First
Subjects
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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 the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Failure of neural crest migration
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Hemosiderosis - hemochromatosis
2. What histological findings are present in the stomach
Gastric glands
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Duodenal atresia - Downs
Corticosteroids - infliximab
3. What is contained in the gastrosplenic and What areas does it separate
EtOH
H2 receptor - inc cAMP
Short gastrics - left greater and lesser
Gastric glands
4. What histological findings are present in the esophagus
Conj - inc - dec
Nonkeritinized stratified sqamous epithelium
With albumin
Averages 6 months - very aggressive - usually already metastasized at presentation
5. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Pertechnetate - study for uptake
Esophageal cancer
T cell lymphoma
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
6. absent UDPGT - presents early in life - early mortality
Esophageal varices
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Crigler - najjar type 1
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
7. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Pertechnetate - study for uptake
M3 - Gq - inc IP3/Ca
Esophageal carcinoma
8. What are the structures of the femoral triangle and how are they organized
Pleuroperitoneal
NAV = nerve artery vein - venous near the penis (NAVEL)
Decreased intercellular adhesion and increased proliferation
Spleen to posterior abdominal wall - splenic artery and vein
9. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
HPNCC
Hirschsprungs
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Pancreatic and bile
10. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Inc conj bilirubin - inc cholesterol - inc alk phos
L4
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Cystic dilation of the viteline duct
11. vasoactive intestinal polypeptide (VIP) - source - action - regulation
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
Causes of gall stones
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Peyers patches
12. Gallstones that reach the common channel at ampulla can block which two ducts
Failure of neural crest migration
Increase tumorigenesis
Pancreatic and bile
Unconjugated - water insoluble
13. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Achalasia due to loss of myenteric plexus (auberach)
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
US and cholecystectomy
Carcinoid syndrome
14. Bilirubin is the product of what?
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Heme metabolism
Volvulus
15. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
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
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
16. When and why is stomach cancer termed linitis plastica
Meckels
EtOH
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Spleen to posterior abdominal wall - splenic artery and vein
17. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Below
Corticosteroids - infliximab
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
Above
18. What are motilin receptor agonists used for clinically
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
12 waves/min
Stimulate intestinal persistalsis
Mucosa - submucosa - muscularis externa - serosa/adventitia
19. What is contained within the muscularis externa
Chronic gastritis and pernicious anemia
Myenteric nerve plexus - aurbach
Gut bacteria
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
20. How is bilirubin carried in the blood
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
With albumin
Alfatoxin in peanuts
IgA secreting plasma cells - ultimately reside in the lamina proporia
21. What does alpha amylase do and what inactivates it
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Begins starch digestion - inactivated by low pH upon reaching the stomach
L1
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
22. is meckels a true diverticulum and how common is it
Unconj - absent (acholuria) - inc
Hernia
AST >ALT - ration is usually 1.5
True and most common congenital anomoly of GI tract
23. somatostatin - source - action - regulation
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
Parietal cells in the stomach - B12 binding protein
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Zollinger ellison - brunners glands
24. What does primary sclerosing cholangitis lead to...
All 3
AST>ALT
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
25. bilateral mets to ovaries with abundant mucus - signet ring cells
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Virchow's node
Krukenbergs tumor
26. what kind of muscle is in the upper 1/3 of esophagus
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Causes of gall stones
Striated
Hyperplastic
27. What carcinogens are associated with HCC
Myenteric nerve plexus - aurbach
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Alfatoxin in peanuts
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
28. most common malignant salivary gland tumor
GERD - may also present with nocturnal cough and dyspnea
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Mucoepidermoid carcinoma
HPNCC
29. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Alpha amylase
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
30. In alchoholic hepatitis which liver enzyme is higher
Osmotic
Hernia
AST>ALT
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
31. Diaphragmatic hernias occur in infants because of defective development of which membrane
Positive
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Pleuroperitoneal
Older patients
32. Where is folate absorbed
Cholesterol - 10-20% opaque due to calcifications
The jejunum
3 waves/min
8-9 waves/min
33. What layer in the mucosa is repsonsible for motility
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Above
Muscularis mucosae
34. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Dense core bodies
Zollinger Ellison - phenylalanine and tryptophan
Nonkeritinized stratified sqamous epithelium
CEA - CA-19-9
35. Malabsorption syndromes have what common clinical presentation
Duodenum - 2nd - 3rd and 4th parts
External spermatic fascia only
Jewish and African American men
Diarrhea - steatorrhea - weight loss - weakness
36. What is the leading cause of bowel incarceration
Barrett's esophagus
NAV = nerve artery vein - venous near the penis (NAVEL)
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Femoral hernia
37. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Ceruplasmin
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Backup of blood into the liver - RHF - budd chiari
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
38. In PUD with a duodenal ulcer does pain inc or dec with meals
Decrease - weight gain
Backup of blood into the liver - RHF - budd chiari
Upregulated intracellular signal transduction
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
39. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
US and cholecystectomy
Mucosa - submucosa - muscularis externa - serosa/adventitia
Colonic polyps
Alpha amylase
40. What does extrahepatic biliary obstruction cause
Omeprazole
Trypsin - chymotrypsin - elastase - carboxypeptidases
H pylori (almost 100%)
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
41. What drug blocks the H2R
Hirschsprungs
Cimetidine
Hemosiderosis - hemochromatosis
External spermatic fascia only
42. What are the signs and symptoms of budd chiari
Conj - inc - dec
The entire
Dermatitis herpetiformis
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
43. What is the risk with peutz jehgers
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Inc risk of CRC and other visceral malignancies
Poor anastamoses
Punched out - clean margins - carcinoma =raised irregular margins
44. What are the complications of duodenal PUD
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Bleeding - penetration into pancreas - perforation - obstruction
Lipase
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
45. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Acute pancreatitis
GERD - may also present with nocturnal cough and dyspnea
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Phototherapy
46. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Lateral to the inferior epigastric artery
Uremia
Via the superior pancreaticduodenal
Conj/unconj - inc - nl to dec
47. Are single polyps malignant in peutz jehgers
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Esophageal varices
No
ALT>AST
48. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Superior rectal and middle and inferior rectal - rectum
49. What does histo show for alpha1 antitrypsin def
PAS- positive globules in liver -
Meconium ileus
Serous on the sides parotids - mucinous in the middle sublingual
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
50. If trypsin activates more trypsinogen - what kind of feedback loop is established
Positive
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Older patients
Inguninal ligament - sartorius muscle - adductor longus