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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. absent UDPGT - presents early in life - early mortality
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Poor anastamoses
AST >ALT - ration is usually 1.5
Crigler - najjar type 1
2. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Inc smooth muscle relaxation - including lower esophageal sphincter
Menetriers disease
Above
Trypsin - chymotrypsin - elastase - carboxypeptidases
3. What is the path of an indirect inguinal hernia
Inspiratory arrest on deep palpation due to pain
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Stercobilin
Inferior rectal nerve
4. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Peutz jeghers
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
So hypertrophied they look like brain gyri
Alpha1 antitrypsin def - codominant trait
5. What nerve innervates the external hemorrhoids
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Hyperpigmented mouth - lips - hands - genitalia
Inferior rectal nerve
Boerhaave's Syndrome - Been heaving syndrome
6. What type of insults result in micronodular cirrhosis
MSI (15%) and APC/beta catenin chromosomal instability (85%)
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Meckels
7. Transmural esophageal rupture due to violent retching
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8. Where is folate absorbed
The jejunum
Below
H+
Inc risk of CRC and other visceral malignancies
9. bilateral mets to ovaries with abundant mucus - signet ring cells
Pyoderma gangrenosum - primary sclerosing cholangitis
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Krukenbergs tumor
Dec PGE2 leading to dec gastric mucosa protection
10. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue
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11. What kind of muscle is in the middle 1/3 of esophagus
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Striated and smooth
Cystic dilation of the viteline duct
US and cholecystectomy
12. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Hirschsprungs
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Black - rotors syndrome
Esophageal cancer
13. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
All 3
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
14. What structures feed into the common bile duct
Via the middle colic
Hyperpigmented mouth - lips - hands - genitalia
L/R renal artery around L1
Cystic duct and common hepatic duct
15. What receptor does histamine bind on the parietal cell and What does it activate
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Lye ingestion and acid reflux
H2 receptor - inc cAMP
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
16. HCC is associated with what other conditions
Conj/unconj - inc - nl to dec
The gastroduodenal
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Punched out - clean margins - carcinoma =raised irregular margins
17. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
The submucosal nerve plexus - meissner's
Hepatic steatosis
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
18. What does bicab do in the mouth
Chronic gastritis and pernicious anemia
Left and right gastroepiploics - left and right gastrics
AST
Neutralizes oral bacertial acids and maintains dental health
19. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Superior rectal
Neutralizes gastric acid allowing pancreatic enzymes to fxn
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
AST >ALT - ration is usually 1.5
20. What is the frequency of basal electric rhythm of the stomach
Uremia
L4
Skip lesions =crohns - colon = UC
3 waves/min
21. When do you see hypertrophy of brunners glands
Peptic ulcer disease
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
FAP
Necrotizing enterocolitis
22. What kind of insults results in macronodular cirrhosis
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Mallory bodies
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
23. occlusion of IVC or hepatic veins
Nonkeritinized stratified sqamous epithelium
Budd chiari syndrome
Turcot
Terminal ileum and colon
24. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Positive urease test
Redundant mesentary
Lamina propria
Zollinger Ellison - phenylalanine and tryptophan
25. Which serum enzyme increases with heavy EtOH consumption
Budd chiari syndrome
Hyperplastic
Hydrocele
Gamma glutamyl transferase GGT
26. What are the complications of duodenal PUD
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Bleeding - penetration into pancreas - perforation - obstruction
When diffusely infiltrative - thickened rigid appearance like a leather bottle
AST
27. FAP + osseous and soft tissue tumors - retinal hyperplasia
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28. Acute gastritis is caused By what process
Ampulla of vater
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
M3 - Gq - inc IP3/Ca
Erosive - disruption of mucosal barrier leading to inflammation
29. What is the epi for CRC
Cholesterol
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
30. List the clinical findings of HCC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
All 3 gut layers outpouch as in Meckels
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
31. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Superior rectal and middle and inferior rectal - rectum
Juvenille polyps - no risk if single
2ndary biliary cirrhosis
L1
32. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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33. How do villi appear in disaccharidease def
IBS at least 2 with recurrent abdominal pain
Krukenbergs tumor
Normal
Turcot
34. What serum markers increase in cholecystitis with bile duct involvement
Esophageal cancer
Cimetidine
Alk phos
Stimulate intestinal persistalsis
35. most common malignant salivary gland tumor
3 waves/min
Mucoepidermoid carcinoma
T cell lymphoma
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
36. Scleroderma is associated with what kind of esophageal dysmotility
Turcot
Uremia
Low pressure proximal to LES
Lye ingestion and acid reflux
37. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Small intestine
Cystic duct and common hepatic duct
Ischemic colitis
Femoral hernia
38. What is the cause of physiologic neonatal jaundice
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Antrum - H.pylori - inc risk of MALT lymphoma
...
The jejunum
39. If the hemochromatosis is primary - What is the pattern of inheritance
Common hepatic - splenic - left gastric - main blood supply for stomach
AST>ALT
AR
Dilated esophagus with an area of distal stenosis - birds beak
40. What are causes of extrahepatic biliary obstruction
Achalasia due to loss of myenteric plexus (auberach)
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Where hindgut meets ectoderm
Upregulated intracellular signal transduction
41. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Alk pho
2ndary biliary cirrhosis
Female - fat - fertile - forty
GERD - may also present with nocturnal cough and dyspnea
42. What does alpha amylase do and what inactivates it
Begins starch digestion - inactivated by low pH upon reaching the stomach
Lipase
Low pressure proximal to LES
Decreased intercellular adhesion and increased proliferation
43. What does bicarb do in the duodenum
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Decrease - weight gain
Neutralizes oral bacertial acids and maintains dental health
Neutralizes gastric acid allowing pancreatic enzymes to fxn
44. In what clinical scenarior do you see portosystemic anastomoses
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Dilated esophagus with an area of distal stenosis - birds beak
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Portal HTN
45. What is the frequency of basal electric rhythm of the ilieum
Mucosa - submucosa - muscularis externa - serosa/adventitia
Muscularis mucosae
AST
8-9 waves/min
46. Bilirubin is the product of what?
Dilated esophagus with an area of distal stenosis - birds beak
FAP
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Heme metabolism
47. When and How does Abetalipoproteinemia present
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Early childhood - neuro sx and malabsorption
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Alpha amylase
48. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Below
Gastrohepatic ligament
Causes of gall stones
49. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
Jewish and African American men
Gut bacteria
Fe2+ in the duod
50. What causes primary biliary cirrhosis
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Fe2+ in the duod
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Dermatitis herpetiformis
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