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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. in carcinoid tumors - What is seen on EM
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
CCK8 receptor - Gq inc IP3/Ca
GERD - may also present with nocturnal cough and dyspnea
Dense core bodies
2. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Obstruction of the common bile duct
Myenteric nerve plexus - aurbach
Pleomorphic adenoma
Esophageal cancer
3. subQ peribumbilical metastasis
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Alk pho
Backup of blood into the liver - RHF - budd chiari
Sister mary joseph nodule
4. How do burns cause acute gastritis and What is it called
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5. What receptor does histamine bind on the parietal cell and What does it activate
In the mucus that covers the gastric epithelium
Hydrocele
H2 receptor - inc cAMP
Dysphagia (due to esophageal web) - glossitis - iron def anemia
6. bilateral mets to ovaries with abundant mucus - signet ring cells
Krukenbergs tumor
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Dubin johnson
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
7. What does autoimmune destruction of parietal cells lead to...
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Chronic gastritis and pernicious anemia
Cystic duct and common hepatic duct
8. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Glucose dependent insulinotropic peptide
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Juvenille polyps - no risk if single
Pancreatic head causing obstructive jaundice
9. involvement of left supraclavicular node by mets from stomach
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10. In viral hepatitis - which liver enzyme is higher
Penicillinamine - AR inheritance
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
ALT>AST
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
11. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Inc conj bilirubin - inc cholesterol - inc alk phos
Fe2+ in the duod
Nonkeritinized stratified sqamous epithelium
12. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Positive
Hypercoaguability - polycythemia vera - pregnancy - HCC
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Neutralizes gastric acid allowing pancreatic enzymes to fxn
13. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Internal thoracic to superior epigastric to inferior epigastric
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
IgA secreting plasma cells - ultimately reside in the lamina proporia
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
14. What kind of pathways do CCK act on to cause pancreatic secretion
Ampulla of vater
Neural muscarinic pathways
Failure of neural crest migration
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
15. What are the complications of chronic pancreatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Urobilin
IgA secreting plasma cells - ultimately reside in the lamina proporia
Redness and tenderness on palpation of extremities
16. What is the presentation of pancreatic adenocarcinoma
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Meckels
Penicillinamine - AR inheritance
Inc conj bilirubin - inc cholesterol - inc alk phos
17. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Lipase - phospholipase A - colipase
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Menetriers disease
Boerhaave's Syndrome - Been heaving syndrome
18. What layer in the mucosa is responsible for absorption
Ischemic colitis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Epithelium
19. If the hemochromatosis is primary - What is the pattern of inheritance
Liver metabolizes 5HT
Upregulated intracellular signal transduction
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
AR
20. What histological findings are present in the stomach
...
AST>ALT
Urobilin
Gastric glands
21. What histological findings are present in the esophagus
Nonkeritinized stratified sqamous epithelium
Primary sclerosing cholangitis
Centrilobular congestion and necrosis - cardiac cirrhosis
Uridine glucuronyl transferase
22. What is the triad of Plummer - Vinson syndrome
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Spleen to posterior abdominal wall - splenic artery and vein
Crohns = noncaseating granulomas - UC = crypt abscesses
Lipase
23. What are the four Fs of gallstones
Female - fat - fertile - forty
The proximal small bowel
Liver metabolizes 5HT
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
24. What is the frequency of basal electric rhythm of the ilieum
8-9 waves/min
Lamina propria
CCK8 receptor - Gq inc IP3/Ca
HSV-1 - CMV - Candida
25. Autoantibodies to gluten (gliadin) in wheat and other grains
T cell lymphoma
Omeprazole
Pertechnetate - study for uptake
Celiac sprue
26. What are motilin receptor agonists used for clinically
L4
L/R renal artery around L1
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Stimulate intestinal persistalsis
27. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Redness and tenderness on palpation of extremities
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
28. secretin - source - action - regulation
Esophageal cancer
Increase tumorigenesis
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Source - S cells (duod) - action - inc pancreatic bicarb secretion - dec gastric acid secretin - inc bile secretion - regulation - inc by acid - fatty acids in lumen of duod
29. What are the extraintestinal manifestations of crohns
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Common hepatic - splenic - left gastric - main blood supply for stomach
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Ampulla of vater
30. What is the action of NO as a GI hormone
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Inc smooth muscle relaxation - including lower esophageal sphincter
Liver metabolizes 5HT
Amylase
31. At what spinal level does the SMA exit
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
L1
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Meconium ileus
32. What are the histological findings in the duodenum
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33. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Hepatic steatosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Appendicitis
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
34. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Fasting and stress
Cirrhosis
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
35. What drug inhibits the H/K ATPase
Duodenum - 2nd - 3rd and 4th parts
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Omeprazole
H2 receptor - inc cAMP
36. Achalasia increases the risk For what complication
Superior rectal and middle and inferior rectal - rectum
Esophageal carcinoma
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Upregulated intracellular signal transduction
37. Where does copper accumulate in Wilsons and What are ABCD
Mallory bodies
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
External spermatic fascia only
38. in budd chiari syndrome - Where is the congestion and necrosis
Primarly through ECL leading to histamine release
Gallbladder
Inc smooth muscle relaxation - including lower esophageal sphincter
Centrilobular leading to congestive liver disease
39. Through which aspect of the inguinal canal does a direct inguinal go
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Corticosteroids - infliximab
Acute pancreatitis
External (superficial) ring only
40. What are the ABCDEF of esophageal cancer
NAV = nerve artery vein - venous near the penis (NAVEL)
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
T cell lymphoma
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
41. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Unconjugated - water insoluble
Can lead to hematemesis - found in EtOHics and bulimics
Stercobilin
Trypsin - chymotrypsin - elastase - carboxypeptidases
42. How does hirschsprung present and appear on imaging
Pleuroperitoneal
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Krukenbergs tumor
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
43. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Mucoepidermoid carcinoma
Colovesical leading to pneumaturia
Parietal cells in the stomach - B12 binding protein
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
44. What are the histological findings in the ileum
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45. What causes pancreatic insuff and What does it cause
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Appendicitis
AST>ALT
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
46. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Causes of gall stones
Meckels
Phenobarbital - inc liver enzyme synthesis
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
47. What are the complications of duodenal PUD
The gastroduodenal
Bleeding - penetration into pancreas - perforation - obstruction
GLUT 2
Gallbladder
48. What portion of the bowel does sprue effect
Glucouronate - water soluble (direct)
Cystic duct and common hepatic duct
Female - fat - fertile - forty
The proximal small bowel
49. How does gastrin increase acid secretion?
Urobilin
Punched out - clean margins - carcinoma =raised irregular margins
Primarly through ECL leading to histamine release
GLUT 2
50. What is one potential precipitating factor for intussusception
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Hypercoaguability - polycythemia vera - pregnancy - HCC