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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. Where does crohns usually affect the GI tract
Terminal ileum and colon
Bleeding - penetration into pancreas - perforation - obstruction
Female - fat - fertile - forty
Epigastric abdominal pain radiating to back - anorexia - nausea
2. Acute gastritis is caused By what process
Turcot
Inc smooth muscle relaxation - including lower esophageal sphincter
Hemosiderosis - hemochromatosis
Erosive - disruption of mucosal barrier leading to inflammation
3. What are the complications of chronic pancreatitis
Black - rotors syndrome
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Diarrhea - steatorrhea - weight loss - weakness
Positive
4. What are the two molecular pathways that lead to CRC
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Turcot
Mucoepidermoid carcinoma
Alcoholic cirrhosis
5. How does CRC present in the distal and proximal colon
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Closer to isotonic because of less time to reabsorb NaCl
Upregulated intracellular signal transduction
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
6. Which patients have pigment stones
Failure of neural crest migration
Lipase - phospholipase A - colipase
Closer to isotonic because of less time to reabsorb NaCl
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
7. What histological findings are present in the esophagus
NAV = nerve artery vein - venous near the penis (NAVEL)
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Juvenille polyps - no risk if single
Nonkeritinized stratified sqamous epithelium
8. When and why is stomach cancer termed linitis plastica
Glucose dependent insulinotropic peptide
When diffusely infiltrative - thickened rigid appearance like a leather bottle
GLUT 2
Hypotonic because of more time to reabsorb NaCl
9. Which is used more quickly - an oral glucose load - or that by IV
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Oral glucose
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Glucose dependent insulinotropic peptide
10. What are the labs in acute pancreatitis
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
IBS at least 2 with recurrent abdominal pain
Elevated amylase - and lipase
IgA secreting plasma cells - ultimately reside in the lamina proporia
11. Where is folate absorbed
...
The jejunum
M3 - Gq - inc IP3/Ca
Antrum - H.pylori - inc risk of MALT lymphoma
12. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Lye ingestion and acid reflux
Alpha amylase
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Colonic polyps
13. What kind of digestion is bile needed for
Superior rectal
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
NAV = nerve artery vein - venous near the penis (NAVEL)
14. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
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
Peutz jeghers
Hemosiderosis - hemochromatosis
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
15. What does high flow rate mean
Parietal cells in the stomach - B12 binding protein
Cholesterol
Cystic duct and common hepatic duct
Closer to isotonic because of less time to reabsorb NaCl
16. What does the splenorenal ligament connect - and What does it contain
Spleen to posterior abdominal wall - splenic artery and vein
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Lipase
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
17. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
NAV = nerve artery vein - venous near the penis (NAVEL)
Cystic duct and common hepatic duct
Phototherapy
18. What is the ddx associated with appendicitis
Gamma glutamyl transferase GGT
Duodenum - 2nd - 3rd and 4th parts
Diverticulitis in elderly - ectopic pregs use hCG to rule out
External spermatic fascia only
19. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Alk pho
ALT>AST
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
20. At what spinal level does the is the bifurcation of aorta
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
L4
Pancreatic head causing obstructive jaundice
The entire
21. most common non - neoplastic polyp in colon
Can lead to hematemesis - found in EtOHics and bulimics
Short gastrics - left greater and lesser
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
Hyperplastic
22. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Gastrohepatic ligament
Lactase is located at the tips of intestinal villi
Intussusception
Causes of gall stones
23. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Alpha amylase
2ndary biliary cirrhosis
Peutz jeghers
Repeated phlebotomy - deferoxamine - HLA- A3
24. What are the extraintestinal manifestations of ulcerative colitis
Upregulated intracellular signal transduction
Pyoderma gangrenosum - primary sclerosing cholangitis
Hyperpigmented mouth - lips - hands - genitalia
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
25. milk intolerance
IgA secreting plasma cells - ultimately reside in the lamina proporia
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
Dissaccharidase def - most commonly lactase
Dense core bodies
26. What percentage of gall stones are cholesterol stones and What are the associations
Mucosa - submucosa - muscularis externa - serosa/adventitia
Ischemic colitis
Pancreatic and bile
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
27. Dysphagia in achalasia results from
Redness and tenderness on palpation of extremities
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Normal
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
28. What is contained within the muscularis externa
Black - rotors syndrome
Warthins' tumor
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Myenteric nerve plexus - aurbach
29. In alchoholic hepatitis which liver enzyme is higher
Meckels
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
AST>ALT
Lye ingestion and acid reflux
30. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Alcoholic hepatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
31. What histological findings are present in the stomach
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Chagas disease
Diverticulum
Gastric glands
32. What are the complications of Meckels
Osmotic
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Gardner's syndrome
Redundant mesentary
33. Achalasia can be secondary to what infectious disease common in South America
Chagas disease
With albumin
Lipase - phospholipase A - colipase
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
34. Autodigestion of pancreas by pancreatic enzymes
Repeated phlebotomy - deferoxamine - HLA- A3
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
Centrilobular leading to congestive liver disease
Acute pancreatitis
35. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Zenkers - halitosis - dysphagia and obstruction
Duodenum - 2nd - 3rd and 4th parts
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
36. What does a gastrinoma cause
Appendicitis
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Lamina propria
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
37. How is bilirubin carried in the blood
With albumin
H pylori (almost 100%)
Fasting and stress
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
38. What cells secrete bicarb - What does it do - and what regulates it
Adhesion
Alpha1 antitrypsin def - codominant trait
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
39. What are the longterm sequelae of nutmeg liver
Falciform - ligamentum teres - fetal umbilical vein
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
Centrilobular congestion and necrosis - cardiac cirrhosis
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
40. People of what decent are associated with celiac sprue and what findings/antibodies are present
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Liver metabolizes 5HT
41. At what spinal level does the SMA exit
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
L1
Ischemic colitis
Pertechnetate - study for uptake
42. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Cholesterol - 10-20% opaque due to calcifications
Hepatic steatosis
Left and right gastroepiploics - left and right gastrics
43. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Ceruplasmin
Volvulus
Hypotonic because of more time to reabsorb NaCl
Pleuroperitoneal
44. What is indirect bilirubin
Meconium ileus
Cimetidine
Unconjugated - water insoluble
AST >ALT - ration is usually 1.5
45. inflammatino of gallbadder
Inc smooth muscle relaxation - including lower esophageal sphincter
Fe2+ in the duod
Failure of the processus vagainlis to close
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
46. Which serum enzyme increases with heavy EtOH consumption
12 waves/min
Alfatoxin in peanuts
Gamma glutamyl transferase GGT
Lamina propora and submucosa
47. What carcinogens are associated with HCC
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Inspiratory arrest on deep palpation due to pain
Intussusception
Alfatoxin in peanuts
48. Where is the pectinate line
Hemolytic anemia
Common hepatic - splenic - left gastric - main blood supply for stomach
Where hindgut meets ectoderm
Zenkers - halitosis - dysphagia and obstruction
49. Where does type A chronic gastritis occur and What causes it
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
External spermatic fascia only
Primary sclerosing cholangitis
Osmotic
50. Malabsorption syndromes have what common clinical presentation
Mucoepidermoid carcinoma
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
The proximal small bowel
Diarrhea - steatorrhea - weight loss - weakness