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Test your basic knowledge |
USMLE GI
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Subjects
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health-sciences
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usmle
Instructions:
Answer 50 questions in 15 minutes.
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study here
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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 transforms conjugated bilirubin to urobilinogen
Hernia
NAV = nerve artery vein - venous near the penis (NAVEL)
Duodenum - 2nd - 3rd and 4th parts
Gut bacteria
2. What do tumors that arise in the head of the pancreas cause
Downs
Jaundice - fever - RUQ
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Obstruction of the common bile duct
3. How does abetalipoproteinemia lead to malabsorption
Gastric glands
Below
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Positive
4. What does autoimmune destruction of parietal cells lead to...
Chronic gastritis and pernicious anemia
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Where hindgut meets ectoderm
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
5. Gastrin - source - action - regulation
Normal
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
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
6. most common non - neoplastic polyp in colon
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Splenic flexure
Pancreatic head causing obstructive jaundice
Hyperplastic
7. What are esophageal strictures associated with
Internal thoracic to superior epigastric to inferior epigastric
So hypertrophied they look like brain gyri
Worldwide - SC - US - adeno
Lye ingestion and acid reflux
8. Where does an indirect inguinal hernia enter the deep inguinal ring
Zenkers - halitosis - dysphagia and obstruction
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Zollinger ellison - brunners glands
Lateral to the inferior epigastric artery
9. What drug inhibits the H/K ATPase
Omeprazole
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Heme metabolism
10. Autoantibodies to gluten (gliadin) in wheat and other grains
Oligosaccharide digestion
Celiac sprue
Hyperpigmented mouth - lips - hands - genitalia
Redundant mesentary
11. In an MI - which liver enzyme is elevated
Menetriers disease
Mallory bodies
AST
Omeprazole
12. What are the histological findings in the jejunum
Positive urease test
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
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
Hypotonic because of more time to reabsorb NaCl
13. concentric onion skin bile duct fibrosis
Neutralizes oral bacertial acids and maintains dental health
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Primary sclerosing cholangitis
14. What is the most common esophageal cancer worldwide and in the US
Cigarettes and chronic pancreatitis - not EtOH
Failure of the processus vagainlis to close
Worldwide - SC - US - adeno
Trypsin - chymotrypsin - elastase - carboxypeptidases
15. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Diverticulum
Bleeding - penetration into pancreas - perforation - obstruction
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
16. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
In the ileum with bile acids - requires IF
Hirschsprungs
Krukenbergs tumor
Zollinger ellison - brunners glands
17. What structures feed into the common hepatic duct
Right and left hepatic duct
Lateral to the inferior epigastric artery
Bleeding - penetration into pancreas - perforation - obstruction
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
18. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus
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19. What factors increase risk of malignancy of adenomatous polyps
L2
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
20. What conditions are associated with budd chiari
Hypercoaguability - polycythemia vera - pregnancy - HCC
Begins starch digestion - inactivated by low pH upon reaching the stomach
Redness and tenderness on palpation of extremities
Glucose dependent insulinotropic peptide
21. In PUD with a duodenal ulcer does pain inc or dec with meals
Fe2+ in the duod
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Decrease - weight gain
Uremia
22. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Black - rotors syndrome
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
The jejunum
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
23. HCC is associated with what other conditions
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Juvenille polyps - no risk if single
Ischemic colitis
24. What is the risk with peutz jehgers
Inc risk of CRC and other visceral malignancies
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Around the central vein (zone III)
Inc lower esphogeal tone leading to achalasia
25. What causes carcinoid syndrome amd What are the symptoms
Muscularis mucosae
Mucosa - submucosa - muscularis externa - serosa/adventitia
Epigastric abdominal pain radiating to back - anorexia - nausea
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
26. Failure of relaxation of lower esophageal sphincter - Name and etiology
Amylase
Pertechnetate - study for uptake
Dilated esophagus with an area of distal stenosis - birds beak
Achalasia due to loss of myenteric plexus (auberach)
27. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Crypts but not villi
Liver metabolizes 5HT
Zollinger Ellison - phenylalanine and tryptophan
28. Why are most diverticula considered false
Sphincter of oddi
Lack or have an attenuated muscularis externa - often in the sigmoid colon
L1
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
29. absent UDPGT - presents early in life - early mortality
AST >ALT - ration is usually 1.5
Crigler - najjar type 1
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
Femoral hernia
30. Why does indirect inguinal hernia happen in infacnts
Uremia
Duodenum - 2nd - 3rd and 4th parts
Failure of the processus vagainlis to close
12 waves/min
31. what percentage of colonic polyps are non - neoplastic
Falciform - ligamentum teres - fetal umbilical vein
Stimulate the H/K ATPase
Jaundice - fever - RUQ
90%
32. FAP + osseous and soft tissue tumors - retinal hyperplasia
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33. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Hydrocele
Menetriers disease
Unconj - absent (acholuria) - inc
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
34. trypsinogen is converted to trypsin via what enzyme
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Enterokinase/enteropeptidase from the duodenal mucosa
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
35. What are the results of hemochromatosis
Female - fat - fertile - forty
CHF and inc risk of HCC
Unconjugated - water insoluble
Dubin johnson
36. What does high flow rate mean
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Unconjugated - water insoluble
Closer to isotonic because of less time to reabsorb NaCl
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
37. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Ischemic colitis
Cimetidine
Hepatic steatosis
38. What kind of cancer to celiac sprue put you as inc risk for
Krukenbergs tumor
CHF and inc risk of HCC
T cell lymphoma
Diverticulitis in elderly - ectopic pregs use hCG to rule out
39. What is the rule of 2s for meckels
IgA secreting plasma cells - ultimately reside in the lamina proporia
Mucoepidermoid carcinoma
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Warthins' tumor
40. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
CCK8 receptor - Gq inc IP3/Ca
True and most common congenital anomoly of GI tract
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
41. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Lateral to the inferior epigastric artery
Hyperplastic
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
42. What histological findings are present in the stomach
Gastric glands
Erosive - disruption of mucosal barrier leading to inflammation
Smooth
Lamina propria
43. In what clinical scenarior do you see portosystemic anastomoses
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Portal HTN
In the ileum with bile acids - requires IF
Myenteric nerve plexus - aurbach
44. What is the omphalomesenteric cyst
Cystic dilation of the viteline duct
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Causes of gall stones
Goes through deep inguinal ring - external inguinal ring and into the scrotum
45. What are motilin receptor agonists used for clinically
Striated and smooth
Hemolytic anemia
Stimulate intestinal persistalsis
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
46. What do you use to diagnose meckels
Pertechnetate - study for uptake
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Dysphagia (due to esophageal web) - glossitis - iron def anemia
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
47. How do villi appear in disaccharidease def
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Normal
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
Tropical sprue
48. What does primary sclerosing cholangitis lead to...
Ischemic colitis
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Ampulla of vater
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
49. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Complications of crohns
Above
Inc conj bilirubin - inc cholesterol - inc alk phos
50. What are additional risk factors for CRC
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
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