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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. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Centrilobular congestion and necrosis - cardiac cirrhosis
Below
Peutz jeghers
NAV = nerve artery vein - venous near the penis (NAVEL)
2. Diaphragmatic hernias occur in infants because of defective development of which membrane
Normal
12 waves/min
Pleuroperitoneal
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
3. At what spinal level does the SMA exit
L1
Short gastrics - left greater and lesser
Appendicitis
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
4. Where does type B chronic gastritis occur and What causes it
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Antrum - H.pylori - inc risk of MALT lymphoma
Lactase is located at the tips of intestinal villi
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
5. What findings are associated with reyes
Esophageal cancer
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
6. involvement of left supraclavicular node by mets from stomach
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7. What layer in the mucosa is responsible for support
Lateral
Redundant mesentary
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Lamina propria
8. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Warthins' tumor
Meckels
Esophageal carcinoma
Stercobilin
9. How do NSAIDs cause acute gastritis
Pyoderma gangrenosum - primary sclerosing cholangitis
Nonkeritinized stratified sqamous epithelium
Dec PGE2 leading to dec gastric mucosa protection
Lipase
10. What is the most common indication of emergent abdominal surgery in children
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Appendicitis
Obstruction of the common bile duct
External (superficial) ring only
11. Where and How is iron absorbed
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Internal thoracic to superior epigastric to inferior epigastric
Fe2+ in the duod
Failure of the processus vagainlis to close
12. What kind of muscle is in the lower 1/3 of the esophagus
Tropical sprue
Smooth
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Gardner's syndrome
13. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
IBS at least 2 with recurrent abdominal pain
The gastroduodenal
Necrotizing enterocolitis
14. What type of insults result in micronodular cirrhosis
Conj - inc - dec
Hyperplastic
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Causes of gall stones
15. What does alpha amylase do and what inactivates it
Unconj - absent (acholuria) - inc
Begins starch digestion - inactivated by low pH upon reaching the stomach
EtOH
Striated and smooth
16. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Phenobarbital - inc liver enzyme synthesis
All 3
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Peyers patches
17. How do villi appear in disaccharidease def
Normal
Black - rotors syndrome
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
Krukenbergs tumor
18. What is the most common cause of gallstones
HPNCC
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Inferior rectal nerve
Begins starch digestion - inactivated by low pH upon reaching the stomach
19. HCC is associated with what other conditions
Penicillinamine - AR inheritance
Hypercoaguability - polycythemia vera - pregnancy - HCC
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
20. What is a positive murphy's sign
Chagas disease
Virchow's node
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Inspiratory arrest on deep palpation due to pain
21. Why are most diverticula considered false
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Pancreatic head causing obstructive jaundice
H2 receptor - inc cAMP
Enterokinase/enteropeptidase from the duodenal mucosa
22. What is the most common esophageal cancer worldwide and in the US
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
PAS- positive globules in liver -
Worldwide - SC - US - adeno
Liver metabolizes 5HT
23. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
The proximal small bowel
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Conj/unconj - inc - nl to dec
Worldwide - SC - US - adeno
24. What cells secrete bicarb - What does it do - and what regulates it
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Failure of neural crest migration
Esophageal varices
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
25. What are the borders of the femoral triangle
Skip lesions =crohns - colon = UC
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Inferior rectal nerve
Inguninal ligament - sartorius muscle - adductor longus
26. How does CRC present in the distal and proximal colon
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Common hepatic - splenic - left gastric - main blood supply for stomach
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
27. What are the tumor markers for pancreatic adenocarcinoma
Diverticulitis in elderly - ectopic pregs use hCG to rule out
CEA - CA-19-9
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Alcoholic cirrhosis
28. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
When diffusely infiltrative - thickened rigid appearance like a leather bottle
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
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
29. Who gets gastric ulcers
Older patients
Cigarettes and chronic pancreatitis - not EtOH
Chagas disease
AST
30. Where are peyers patches found
Lubricate food (glycoprotiens)
Lamina propora and submucosa
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Inguninal ligament - sartorius muscle - adductor longus
31. How do you DX and TX gallstones
Black - rotors syndrome
Lactase is located at the tips of intestinal villi
Via the superior pancreaticduodenal
US and cholecystectomy
32. Between what structures do strong anastamoses exist
Budd chiari syndrome
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Left and right gastroepiploics - left and right gastrics
Striated
33. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Peutz jeghers
34. Where is there sclerosis in alcoholic cirrohosis
Gamma glutamyl transferase GGT
Superior rectal
Older patients
Around the central vein (zone III)
35. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Superior rectal
Short gastrics - left greater and lesser
External (superficial) ring only
Inc smooth muscle relaxation - including lower esophageal sphincter
36. What kind of lesions are characteristic of duodenal PUD vs cancer
Backup of blood into the liver - RHF - budd chiari
L2
Positive
Punched out - clean margins - carcinoma =raised irregular margins
37. Achalasia can be secondary to what infectious disease common in South America
Dec PGE2 leading to dec gastric mucosa protection
Chagas disease
Increase tumorigenesis
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
38. What gives urine its characteristic color
90%
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Urobilin
L/R renal artery around L1
39. What is diverticulosis
Neural muscarinic pathways
Small intestine
Alcoholic hepatitis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
40. Which viral infxns/treatments are associated with reyes syndrome
Redundant mesentary
VZV and influenza B treated with salicylates
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Erosive - disruption of mucosal barrier leading to inflammation
41. How do burns cause acute gastritis and What is it called
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42. What causes nutmeg liver
Backup of blood into the liver - RHF - budd chiari
Lamina propora and submucosa
Adhesion
Meconium ileus
43. How is the diagonsis of CRC made
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
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
44. What complication can arise from indirect inguinal hernias
Hydrocele
L4
Spleen to posterior abdominal wall - splenic artery and vein
Peyers patches
45. Abuse of what substance leads to acute gastritis
Alk phos
Via the superior pancreaticduodenal
EtOH
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
46. What is the frequency of basal electric rhythm of the stomach
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Brush border of intestine - produce monosaccharides from oligo and di
3 waves/min
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
47. When do you see hypertrophy of brunners glands
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Complications of crohns
Peptic ulcer disease
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
48. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
L4
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
49. malnutrition - toxic megacolon - colorectal carcinoma
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Bleeding - penetration into pancreas - perforation - obstruction
Complications of UC
50. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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