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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 intervention will intervention will relieve portal HTN
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Hypotonic because of more time to reabsorb NaCl
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
2. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland 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
The proximal small bowel
Meconium ileus
Pleomorphic adenoma
3. How does brain injury lead to acute gastritis and What is it called
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Cystic dilation of the viteline duct
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Fe2+ in the duod
4. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Hemolytic anemia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
5. FAP + malignant CNS tumor
Antrum - H.pylori - inc risk of MALT lymphoma
Turcot
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Alpha amylase
6. What is the frequency of basal electric rhythm in the duodenum
12 waves/min
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Redundant mesentary
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
7. What is the prognosis of adenocarcinoma
Superior rectal and middle and inferior rectal - rectum
Averages 6 months - very aggressive - usually already metastasized at presentation
...
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
8. What congenital birth defect is associated with Hirschsprung
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Heme metabolism
Black - rotors syndrome
Downs
9. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
10. What is the ddx associated with appendicitis
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Pertechnetate - study for uptake
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
11. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
VZV and influenza B treated with salicylates
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
12. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Black - rotors syndrome
Cirrhosis
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
13. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Zollinger Ellison - phenylalanine and tryptophan
Superior rectal and middle and inferior rectal - rectum
14. Which kind of hemorrhoids are painful and why
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Uremia
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
15. Through which aspect of the inguinal canal does a direct inguinal go
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Diverticulitis in elderly - ectopic pregs use hCG to rule out
External (superficial) ring only
Decreased intercellular adhesion and increased proliferation
16. Diaphragmatic hernias occur in infants because of defective development of which membrane
HSV-1 - CMV - Candida
Pancreatic and bile
Pleuroperitoneal
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
17. Transmural esophageal rupture due to violent retching
18. What structures feed into the cystic duct
Gallbladder
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
19. What kind of muscle is in the lower 1/3 of the esophagus
All 3
Smooth
Internal thoracic to superior epigastric to inferior epigastric
Centrilobular leading to congestive liver disease
20. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
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
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Krukenbergs tumor
21. What is the most important mechanism in gastric acid secretion
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Fasting and stress
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
22. Scleroderma is associated with what kind of esophageal dysmotility
Low pressure proximal to LES
Stimulate the H/K ATPase
Superior rectal
Black - rotors syndrome
23. Abuse of what substance leads to acute gastritis
EtOH
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Acute pancreatitis
24. What does high flow rate mean
Portal HTN
Closer to isotonic because of less time to reabsorb NaCl
Meconium ileus
Colovesical leading to pneumaturia
25. What are the histological findings in the duodenum
26. What are esophageal strictures associated with
Hydrocele
Neural muscarinic pathways
Skip lesions =crohns - colon = UC
Lye ingestion and acid reflux
27. What is the rule of 2s for meckels
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Unconj - absent (acholuria) - inc
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Lubricate food (glycoprotiens)
28. What causes pancreatic insuff and What does it cause
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Decreased intercellular adhesion and increased proliferation
Alcoholic cirrhosis
Normal
29. Where does type A chronic gastritis occur and What causes it
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Acute pancreatitis
Worldwide - SC - US - adeno
Portal HTN
30. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Cholesterol - 10-20% opaque due to calcifications
Alcoholic hepatitis
Lipase
Failure of the processus vagainlis to close
31. What is the main symptom if a VIPoma
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Erosive - disruption of mucosal barrier leading to inflammation
Bleeding - penetration into pancreas - perforation - obstruction
Right and left hepatic duct
32. What happens to the short gastics if the splenic artery is blocked
Poor anastamoses
Krukenbergs tumor
H pylori (almost 100%)
Stimulate intestinal persistalsis
33. What retroperitoneal structure flanks both sides of the pancreas on CT
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Duodenum - 2nd - 3rd and 4th parts
H pylori (almost 100%)
Source - I cells (duod - jej - action - inc pancreative secretion - inc gallbladder contraction - dec gastric emptying - sphincter of Oddi relaxation - regulation - inc by fatty acids and amino acids
34. What kind of muscle is in the middle 1/3 of esophagus
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Unconj - absent (acholuria) - inc
External (superficial) ring only
Striated and smooth
35. What does K- ras mutation cause
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Upregulated intracellular signal transduction
The gastroduodenal
Glucouronate - water soluble (direct)
36. What receptor does histamine bind on the parietal cell and What does it activate
H2 receptor - inc cAMP
T cell lymphoma
Corticosteroids - infliximab
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
37. In viral hepatitis - which liver enzyme is higher
Below
Neural muscarinic pathways
Falciform - ligamentum teres - fetal umbilical vein
ALT>AST
38. What source of salivary secretion is the most serous and What is the most mucinous
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
Serous on the sides parotids - mucinous in the middle sublingual
All 3 gut layers outpouch as in Meckels
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
39. Malabsorption syndromes have what common clinical presentation
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
M3 - Gq - inc IP3/Ca
Diarrhea - steatorrhea - weight loss - weakness
40. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Omeprazole
Brunners
Inspiratory arrest on deep palpation due to pain
Uremia
41. What can fistula between the gallbladder and small intestine create and how can you tell
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
The gastroduodenal
Peyers patches
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
42. Between what structures do strong anastamoses exist
Left and right gastroepiploics - left and right gastrics
Hepatic steatosis
Brunners
Positive
43. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Warthins' tumor
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
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Necrotizing enterocolitis
44. People of what decent are associated with celiac sprue and what findings/antibodies are present
Osmotic
Internal thoracic to superior epigastric to inferior epigastric
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
45. What is the clinical presentation of acute pancreatitis
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Worldwide - SC - US - adeno
Epigastric abdominal pain radiating to back - anorexia - nausea
46. What can hemochromatosis be secondary to...
Zollinger Ellison - phenylalanine and tryptophan
Where hindgut meets ectoderm
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Krukenbergs tumor
47. Why are most diverticula considered false
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Uridine glucuronyl transferase
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Punched out - clean margins - carcinoma =raised irregular margins
48. What kind of pathways do CCK act on to cause pancreatic secretion
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
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Neural muscarinic pathways
Dissaccharidase def - most commonly lactase
49. What pancreatic enzymes are responsible for fat digestion
Lipase - phospholipase A - colipase
US and cholecystectomy
Crigler - najjar type 1
Goes through deep inguinal ring - external inguinal ring and into the scrotum
50. What are the effects of atropine on parietal cells and G cells
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Ischemic colitis
AST>ALT