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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. Between what structures do strong anastamoses exist
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
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
Left and right gastroepiploics - left and right gastrics
All 3
2. What drug blocks the H2R
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Hemolytic anemia
Cimetidine
Epigastric abdominal pain radiating to back - anorexia - nausea
3. How does brain injury lead to acute gastritis and What is it called
Lipase
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
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)
4. Where does type A chronic gastritis occur and What causes it
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Hirschsprungs
Unconjugated - water insoluble
Stimulate intestinal persistalsis
5. What does loss of APC cause
Decreased intercellular adhesion and increased proliferation
Phenobarbital - inc liver enzyme synthesis
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Lactase is located at the tips of intestinal villi
6. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Celiac sprue
Above
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Cholesterol
7. What layer in the mucosa is responsible for support
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
Failure of the processus vagainlis to close
Lamina propria
Brunners
8. most common malignant salivary gland tumor
Peyers patches
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Mucoepidermoid carcinoma
9. What converts inactive pepsinogen to pepsin
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker
H+
10. What separates the right greater and lesser sacs
Gastrohepatic ligament
Older patients
CHF and inc risk of HCC
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
11. What serum enzyme is elevated in acute pancreatitis and mumps
Amylase
Neural muscarinic pathways
US and cholecystectomy
Obstruction of the common bile duct
12. What nerve innervates the external hemorrhoids
Liver metabolizes 5HT
Inferior rectal nerve
All 3 gut layers outpouch as in Meckels
Duodenal atresia - Downs
13. What type of insults result in micronodular cirrhosis
Esophageal varices
H+
Inc - weight loss
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
14. What are the signs of peutz jehgers
With albumin
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Hyperpigmented mouth - lips - hands - genitalia
H pylori (almost 100%)
15. in budd chiari syndrome - Where is the congestion and necrosis
Centrilobular leading to congestive liver disease
Hepatic steatosis
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Juvenille polyps - no risk if single
16. bilateral mets to ovaries with abundant mucus - signet ring cells
2ndary biliary cirrhosis
Uridine glucuronyl transferase
Elevated amylase - and lipase
Krukenbergs tumor
17. What are the foregut structures and what supplies their blood and PANS innvervation
AST>ALT
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Dissaccharidase def - most commonly lactase
18. What are the histological findings in the ileum
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19. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Mallory bodies
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Volvulus
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
20. What are the histological findings in the duodenum
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21. milk intolerance
Inspiratory arrest on deep palpation due to pain
Hyperpigmented mouth - lips - hands - genitalia
Dissaccharidase def - most commonly lactase
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
22. To what substance is bilirubin conjugated and why
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Glucouronate - water soluble (direct)
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Pleuroperitoneal
23. absent UDPGT - presents early in life - early mortality
Muscularis mucosae
Crigler - najjar type 1
Ceruplasmin
Osmotic
24. Malabsorption syndromes have what common clinical presentation
Diarrhea - steatorrhea - weight loss - weakness
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Poor anastamoses
CHF and inc risk of HCC
25. what percentage of colonic polyps are non - neoplastic
Amylase
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
90%
Female - fat - fertile - forty
26. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Esophageal cancer
Alcoholic cirrhosis
Liver metabolizes 5HT
Terminal ileum and colon
27. What kind of diarrhea is produced from a disaccharide def
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
AST>ALT
Osmotic
28. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Diverticulitis in elderly - ectopic pregs use hCG to rule out
2ndary biliary cirrhosis
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
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
29. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Averages 6 months - very aggressive - usually already metastasized at presentation
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Esophageal cancer
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
30. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Hemolytic anemia
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Hydrocele
Parietal cells in the stomach - B12 binding protein
31. What are the main components of bile
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Reye's syndrome
Inc smooth muscle relaxation - including lower esophageal sphincter
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
32. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Diarrhea - steatorrhea - weight loss - weakness
2ndary biliary cirrhosis
Hemolytic anemia
Fasting and stress
33. What is the leading cause of bowel incarceration
CEA - CA-19-9
Femoral hernia
Backup of blood into the liver - RHF - budd chiari
Boerhaave's Syndrome - Been heaving syndrome
34. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Hirschsprungs
Celiac sprue
Alpha amylase
Common hepatic - splenic - left gastric - main blood supply for stomach
35. At what spinal level does the is the bifurcation of aorta
Punched out - clean margins - carcinoma =raised irregular margins
Cystic dilation of the viteline duct
L4
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
36. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Alpha1 antitrypsin def - codominant trait
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Alpha amylase
Small intestine
37. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Crohns = maybe - UC= always
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
VZV and influenza B treated with salicylates
38. What infection causes Whipple disease and What can you see on LM
Adhesion
Short gastrics - left greater and lesser
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
T cell lymphoma
39. Where is the pectinate line
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Via the superior pancreaticduodenal
Where hindgut meets ectoderm
Positive
40. 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
Around the central vein (zone III)
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
T cell lymphoma
41. What cells make pepsin - What does it do - and what regulates it
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Cystic duct and common hepatic duct
Enterokinase/enteropeptidase from the duodenal mucosa
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
42. What are the extraintestinal manifestations of crohns
PAS- positive globules in liver -
Peutz jeghers
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
L2
43. What can fistula between the gallbladder and small intestine create and how can you tell
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Peptic ulcer disease
Common hepatic - splenic - left gastric - main blood supply for stomach
T cell lymphoma
44. What is the path of an indirect inguinal hernia
Increase tumorigenesis
The jejunum
Dubin johnson
Goes through deep inguinal ring - external inguinal ring and into the scrotum
45. Scleroderma is associated with what kind of esophageal dysmotility
IBS at least 2 with recurrent abdominal pain
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Low pressure proximal to LES
Upregulated intracellular signal transduction
46. What happens to the short gastics if the splenic artery is blocked
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Poor anastamoses
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Crohns = noncaseating granulomas - UC = crypt abscesses
47. What is the presentation of pancreatic adenocarcinoma
Positive urease test
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
48. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Cirrhosis
Hernia
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Lack or have an attenuated muscularis externa - often in the sigmoid colon
49. Are single polyps malignant in peutz jehgers
Increase tumorigenesis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Right and left hepatic duct
No
50. What complication can arise from indirect inguinal hernias
Pleomorphic adenoma
Dubin johnson
Reye's syndrome
Hydrocele