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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 causes hirschsprungs
AST>ALT
Failure of neural crest migration
Fasting and stress
Unconj - absent (acholuria) - inc
2. Diaphragmatic hernias occur in infants because of defective development of which membrane
Urobilin
Esophageal cancer
Pleuroperitoneal
Early childhood - neuro sx and malabsorption
3. What parts of the small bowel can tropical sprue effect
Hypotonic because of more time to reabsorb NaCl
Causes of gall stones
The entire
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
4. What portion of the bowel does sprue effect
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
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
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
The proximal small bowel
5. What does histo show for alpha1 antitrypsin def
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Gastric glands
PAS- positive globules in liver -
Complications of UC
6. What receptor does histamine bind on the parietal cell and What does it activate
Pertechnetate - study for uptake
H2 receptor - inc cAMP
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Uremia
7. What are the extraintestinal manifestations of ulcerative colitis
...
Pyoderma gangrenosum - primary sclerosing cholangitis
Stimulate the H/K ATPase
Common hepatic - splenic - left gastric - main blood supply for stomach
8. subQ peribumbilical metastasis
Sister mary joseph nodule
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Centrilobular congestion and necrosis - cardiac cirrhosis
Hyperplastic
9. What do you treat Wilsons disease with and What is the inheritance
Penicillinamine - AR inheritance
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
Zenkers - halitosis - dysphagia and obstruction
Spleen to posterior abdominal wall - splenic artery and vein
10. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Pleomorphic adenoma
Copious diarrhea - non alpha - non beta cell pancreatic tumor
US and cholecystectomy
In the mucus that covers the gastric epithelium
11. A protrusion of peritoneum through an opening - usually a site of weakness
Hernia
All 3 gut layers outpouch as in Meckels
Gastric glands
Glucouronate - water soluble (direct)
12. What are the complications of duodenal PUD
Parietal cells in the stomach - B12 binding protein
8-9 waves/min
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Bleeding - penetration into pancreas - perforation - obstruction
13. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Mallory bodies
2ndary biliary cirrhosis
PAS- positive globules in liver -
Budd chiari syndrome
14. If trypsin activates more trypsinogen - what kind of feedback loop is established
Positive
Chagas disease
Zollinger Ellison - phenylalanine and tryptophan
Glucose dependent insulinotropic peptide
15. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Upregulated intracellular signal transduction
With albumin
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Glucouronate - water soluble (direct)
16. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
HSV-1 - CMV - Candida
Hepatic steatosis
Cimetidine
Fe2+ in the duod
17. What structures feed into the common hepatic duct
Gut bacteria
Right and left hepatic duct
Uremia
Female - fat - fertile - forty
18. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
FAP
Hypotonic because of more time to reabsorb NaCl
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
19. What does the splenorenal ligament connect - and What does it contain
Crypts but not villi
Spleen to posterior abdominal wall - splenic artery and vein
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
PAS- positive globules in liver -
20. What is the classic triad of hemochromatosis
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21. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Colovesical leading to pneumaturia
Crohns = maybe - UC= always
The entire
22. In viral hepatitis - which liver enzyme is higher
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Female - fat - fertile - forty
ALT>AST
Uridine glucuronyl transferase
23. What receptors does gastrin bind on the parietal cell and What does it activate
CCK8 receptor - Gq inc IP3/Ca
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
12 waves/min
Unconjugated - water insoluble
24. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Menetriers disease
The submucosal nerve plexus - meissner's
In the mucus that covers the gastric epithelium
Oral glucose
25. inflammatino of gallbadder
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Krukenbergs tumor
Barrett's esophagus
12 waves/min
26. What are the common causes of gastric ulcers - What causes gastric ulcer
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
External spermatic fascia only
Skip lesions =crohns - colon = UC
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
27. What are the labs in acute pancreatitis
Elevated amylase - and lipase
Meckels
Via the superior pancreaticduodenal
Peptic ulcer disease
28. What are the histological findings of the colon
Crypts but not villi
The gastroduodenal
Pleuroperitoneal
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
29. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Epithelium
Alpha amylase
Budd chiari syndrome
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
30. FAP + osseous and soft tissue tumors - retinal hyperplasia
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31. What does extrahepatic biliary obstruction cause
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Antrum - H.pylori - inc risk of MALT lymphoma
The jejunum
Complications of UC
32. What cell produces IF and What does it do
Parietal cells in the stomach - B12 binding protein
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Decreased intercellular adhesion and increased proliferation
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
33. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Causes of gall stones
Appendicitis
Meckels
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
34. How does hirschsprung present and appear on imaging
Gardner's syndrome
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
Worldwide - SC - US - adeno
AST
35. What happens to the short gastics if the splenic artery is blocked
Poor anastamoses
Decrease - weight gain
Amylase
Neutralizes gastric acid allowing pancreatic enzymes to fxn
36. secretin - source - action - regulation
Falciform - ligamentum teres - fetal umbilical vein
Splenic flexure
No
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
37. Which is used more quickly - an oral glucose load - or that by IV
Muscularis mucosae
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Zollinger ellison - brunners glands
Oral glucose
38. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Striated and smooth
Fasting and stress
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Lactase is located at the tips of intestinal villi
39. Gastrin - source - action - regulation
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
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
Hirschsprungs
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
40. Where is there sclerosis in alcoholic cirrohosis
Sphincter of oddi
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Around the central vein (zone III)
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
41. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
L2
Closer to isotonic because of less time to reabsorb NaCl
True and most common congenital anomoly of GI tract
42. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Crohns = noncaseating granulomas - UC = crypt abscesses
Omeprazole
Angiodysplasia
Below
43. Why does carcinoid syndrome not occur if tumor is confined to GI system
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
NAV = nerve artery vein - venous near the penis (NAVEL)
Liver metabolizes 5HT
Alfatoxin in peanuts
44. why infxn is implicated in duodenal PUD
So hypertrophied they look like brain gyri
H pylori (almost 100%)
Nonkeritinized stratified sqamous epithelium
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
45. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Sphincter of oddi
Brunners
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Chronic gastritis and pernicious anemia
46. Scleroderma is associated with what kind of esophageal dysmotility
Nonkeritinized stratified sqamous epithelium
Low pressure proximal to LES
Failure of the processus vagainlis to close
Centrilobular leading to congestive liver disease
47. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Gardner's syndrome
Zenkers - halitosis - dysphagia and obstruction
T12
Alcoholic cirrhosis
48. What is the presenting course for appendicity
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49. What kind of lesions are characteristic of duodenal PUD vs cancer
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Punched out - clean margins - carcinoma =raised irregular margins
50. If the hemochromatosis is primary - What is the pattern of inheritance
Alk phos
AR
Hypercoaguability - polycythemia vera - pregnancy - HCC
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum