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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 infection causes Whipple disease and What can you see on LM
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Uridine glucuronyl transferase
H2 receptor - inc cAMP
Elevated amylase - and lipase
2. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Gut bacteria
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Jaundice - fever - RUQ
Begins starch digestion - inactivated by low pH upon reaching the stomach
3. What are the two molecular pathways that lead to CRC
MSI (15%) and APC/beta catenin chromosomal instability (85%)
H2 receptor - inc cAMP
Internal thoracic to superior epigastric to inferior epigastric
Uridine glucuronyl transferase
4. What is the triad of Plummer - Vinson syndrome
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Epithelium
Intussusception
Dysphagia (due to esophageal web) - glossitis - iron def anemia
5. What is the clinical presentation of acute pancreatitis
Epigastric abdominal pain radiating to back - anorexia - nausea
All 3
Lateral
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
6. What nerve innervates the external hemorrhoids
Inferior rectal nerve
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Downs
Carcinoid syndrome
7. What receptor does histamine bind on the parietal cell and What does it activate
H2 receptor - inc cAMP
H pylori (almost 100%)
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
8. At what spinal level does the is the bifurcation of aorta
Inferior rectal nerve
Conj - inc - dec
L4
Virchow's node
9. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Hernia
Intussusception
Short gastrics - left greater and lesser
Glucouronate - water soluble (direct)
10. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Omeprazole
Pertechnetate - study for uptake
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
11. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Krukenbergs tumor
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
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
12. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Pleomorphic adenoma
US and cholecystectomy
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Cholesterol - 10-20% opaque due to calcifications
13. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Alpha1 antitrypsin def - codominant trait
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Epithelium
14. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Chagas disease
Phenobarbital - inc liver enzyme synthesis
Increase tumorigenesis
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
15. Where are carcinoid tumors most commonly malignant
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Stimulate the H/K ATPase
Low pressure proximal to LES
Small intestine
16. What layer of fascia covers a direct inguinal hernia
External spermatic fascia only
8-9 waves/min
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
Gastrohepatic ligament
17. Gallstones that reach the common channel at ampulla can block which two ducts
Diverticulum
Lipase
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Pancreatic and bile
18. How do villi appear in disaccharidease def
Gilbert's
Superior rectal and middle and inferior rectal - rectum
Lubricate food (glycoprotiens)
Normal
19. What layer in the mucosa is responsible for support
Older patients
Lamina propria
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
20. What are the complications of Meckels
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Older patients
Dec PGE2 leading to dec gastric mucosa protection
Black - rotors syndrome
21. Where is there sclerosis in alcoholic cirrohosis
Around the central vein (zone III)
Left gastric vein and esophogeal vein - esophagus
Hernia
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
22. How is salivary secretion stimulated
Achalasia due to loss of myenteric plexus (auberach)
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
L2
Pancreatic and bile
23. what kind of fistula is associated with diverticulitis
Colovesical leading to pneumaturia
Downs
Hypotonic because of more time to reabsorb NaCl
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
24. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Glucose dependent insulinotropic peptide
Hernia
25. What are causes of extrahepatic biliary obstruction
Decreased intercellular adhesion and increased proliferation
Failure of neural crest migration
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Complications of UC
26. People of what decent are associated with celiac sprue and what findings/antibodies are present
ALT>AST
Squamous - upper 1/3 - adeno - lower 1/3
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Pleomorphic adenoma
27. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Barrett's esophagus
HPNCC
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Glucouronate - water soluble (direct)
28. What is the rate limiting step of carbohydrate digestion
Cirrhosis
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Oligosaccharide digestion
Krukenbergs tumor
29. In alchoholic hepatitis which liver enzyme is higher
Diverticulum
AST>ALT
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Meconium ileus
30. What do tumors that arise in the head of the pancreas cause
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Black - rotors syndrome
Obstruction of the common bile duct
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
31. What does GET SMASHED stand for in acute pancreatitis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Small intestine
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Glucose dependent insulinotropic peptide
32. malnutrition - toxic megacolon - colorectal carcinoma
Conj - inc - dec
Corticosteroids - infliximab
Uremia
Complications of UC
33. Which patients have pigment stones
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Liver metabolizes 5HT
Crypts but not villi
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
34. What are the structures of the femoral triangle and how are they organized
Alk phos
PAS- positive globules in liver -
Omeprazole
NAV = nerve artery vein - venous near the penis (NAVEL)
35. What are motilin receptor agonists used for clinically
Conj - inc - dec
Stimulate intestinal persistalsis
Dec PGE2 leading to dec gastric mucosa protection
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
36. Where are oligosaccharide hydrolases and What do they do
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Brush border of intestine - produce monosaccharides from oligo and di
Serous on the sides parotids - mucinous in the middle sublingual
Repeated phlebotomy - deferoxamine - HLA- A3
37. What is contained in the gastrosplenic and What areas does it separate
Glucouronate - water soluble (direct)
Alcoholic cirrhosis
Corticosteroids - infliximab
Short gastrics - left greater and lesser
38. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Lipase - phospholipase A - colipase
FAP
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
39. What is Trousseau's sign
Worldwide - SC - US - adeno
Redness and tenderness on palpation of extremities
Esophageal carcinoma
Gallbladder
40. Achalasia increases the risk For what complication
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
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
Esophageal carcinoma
Corticosteroids - infliximab
41. What layer in the mucosa is responsible for absorption
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
Gardner's syndrome
Epithelium
Crohns = noncaseating granulomas - UC = crypt abscesses
42. What does the splenorenal ligament connect - and What does it contain
L1
Spleen to posterior abdominal wall - splenic artery and vein
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
43. How does gastrin increase acid secretion?
Hernia
Old men - arthralgias - cardiac and neuro sx
Neutralizes oral bacertial acids and maintains dental health
Primarly through ECL leading to histamine release
44. What cell produces IF and What does it do
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Mucoepidermoid carcinoma
Parietal cells in the stomach - B12 binding protein
Warthins' tumor
45. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Phenobarbital - inc liver enzyme synthesis
Angiodysplasia
Intussusception
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
46. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Mallory bodies
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Myenteric nerve plexus - aurbach
47. What are esophageal strictures associated with
Lye ingestion and acid reflux
Cirrhosis
Striated and smooth
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
48. Where are tumors commonly in pancreatic adenocarcinoma
AST
Pancreatic head causing obstructive jaundice
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
49. How does abetalipoproteinemia lead to malabsorption
CEA - CA-19-9
Black - rotors syndrome
Early childhood - neuro sx and malabsorption
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
50. What cells make pepsin - What does it do - and what regulates it
Alk pho
Glucouronate - water soluble (direct)
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Causes of gall stones