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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. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Positive urease test
Superior rectal
Common hepatic - splenic - left gastric - main blood supply for stomach
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
2. What is the frequency of basal electric rhythm of the ilieum
8-9 waves/min
Centrilobular congestion and necrosis - cardiac cirrhosis
Neural muscarinic pathways
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
3. What is indirect bilirubin
Worldwide - SC - US - adeno
H+
Unconjugated - water insoluble
Via the middle colic
4. Where is IgA shuttled
Left and right gastroepiploics - left and right gastrics
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Peyers patches
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
5. occlusion of IVC or hepatic veins
Hydrocele
Begins starch digestion - inactivated by low pH upon reaching the stomach
Budd chiari syndrome
Dissaccharidase def - most commonly lactase
6. Between what structures do strong anastamoses exist
AST>ALT
Lateral
Left and right gastroepiploics - left and right gastrics
Hyperplastic
7. What is the most common esophageal cancer worldwide and in the US
Worldwide - SC - US - adeno
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Inc conj bilirubin - inc cholesterol - inc alk phos
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
8. in budd chiari syndrome - Where is the congestion and necrosis
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Centrilobular leading to congestive liver disease
Positive urease test
Meconium ileus
9. signet ring cells - acanthosis nigracans - dz - character/association - spread
Inc smooth muscle relaxation - including lower esophageal sphincter
Zenkers - halitosis - dysphagia and obstruction
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
10. malnutrition - toxic megacolon - colorectal carcinoma
Via the middle colic
Complications of UC
In the ileum with bile acids - requires IF
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
11. When do you see hypertrophy of brunners glands
Peptic ulcer disease
Pancreatic and bile
Upregulated intracellular signal transduction
Skip lesions =crohns - colon = UC
12. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
HPNCC
Unconjugated - water insoluble
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Alfatoxin in peanuts
13. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Splenic flexure
Hypercoaguability - polycythemia vera - pregnancy - HCC
IgA secreting plasma cells - ultimately reside in the lamina proporia
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
14. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Crohns = noncaseating granulomas - UC = crypt abscesses
Terminal ileum and colon
Gilbert's
15. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Complications of crohns
16. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Cirrhosis
Superior rectal and middle and inferior rectal - rectum
Neural muscarinic pathways
Inferior rectal nerve
17. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Osmotic
Alcoholic cirrhosis
Pleomorphic adenoma
Downs
18. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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19. What is diverticulosis
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Gastric glands
Inc lower esphogeal tone leading to achalasia
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
20. most common non - neoplastic polyp in colon
Unconj - absent (acholuria) - inc
Striated and smooth
Hyperplastic
Lamina propora and submucosa
21. Where is the arterial supply from above the pectinate line - and What is the venous drainage
8-9 waves/min
Left and right gastroepiploics - left and right gastrics
Stimulate the H/K ATPase
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
22. What carcinogens are associated with HCC
Virchow's node
Lateral
Alfatoxin in peanuts
Zollinger ellison - brunners glands
23. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Nonkeritinized stratified sqamous epithelium
Esophageal cancer
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
24. What histological findings are present in the esophagus
Nonkeritinized stratified sqamous epithelium
Oral glucose
Ampulla of vater
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
25. Achalasia can be secondary to what infectious disease common in South America
All 3
Chagas disease
Heme metabolism
Antrum - H.pylori - inc risk of MALT lymphoma
26. What makes a true diverticula
Pleuroperitoneal
All 3 gut layers outpouch as in Meckels
Complications of crohns
Duodenum - 2nd - 3rd and 4th parts
27. When and How does Abetalipoproteinemia present
Early childhood - neuro sx and malabsorption
Hyperplastic
T12
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
28. How does gastrin increase acid secretion?
Primarly through ECL leading to histamine release
Lateral to the inferior epigastric artery
...
Around the central vein (zone III)
29. What causes hirschsprungs
Pleuroperitoneal
Failure of neural crest migration
Hirschsprungs
Early childhood - neuro sx and malabsorption
30. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Early childhood - neuro sx and malabsorption
Conj/unconj - inc - nl to dec
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Neutralizes oral bacertial acids and maintains dental health
31. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Necrotizing enterocolitis
Neural muscarinic pathways
Chronic gastritis and pernicious anemia
32. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
With albumin
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Trypsin - chymotrypsin - elastase - carboxypeptidases
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
33. What are the signs and symptoms of budd chiari
H pylori (almost 100%)
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Dissaccharidase def - most commonly lactase
Lamina propora and submucosa
34. What is the most common cause of gallstones
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
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Failure of the processus vagainlis to close
35. What is the most common indication of emergent abdominal surgery in children
GERD - may also present with nocturnal cough and dyspnea
CHF and inc risk of HCC
Paraumbilical and superficial and inferior epigastric - umbilicus
Appendicitis
36. What is the arterial supply and venous drainage below pectinate line
In the mucus that covers the gastric epithelium
Alk phos
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
37. Where does type A chronic gastritis occur and What causes it
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Peutz jeghers
Bleeding - penetration into pancreas - perforation - obstruction
H2 receptor - inc cAMP
38. What is the TX of physiologic neonatal jaundice
Phototherapy
Low pressure proximal to LES
Adhesion
Ischemic colitis
39. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Conj - inc - dec
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
40. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
L1
The proximal small bowel
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Gallbladder
41. What is the main symptom if a VIPoma
Trypsin - chymotrypsin - elastase - carboxypeptidases
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Neutralizes oral bacertial acids and maintains dental health
Boerhaave's Syndrome - Been heaving syndrome
42. What skin condition is associated with celiac sprue
Dermatitis herpetiformis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
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 is the pancreatic enzyme concentration highest and what reaction does it catalyze
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Paraumbilical and superficial and inferior epigastric - umbilicus
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Gallbladder
44. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Duodenum - 2nd - 3rd and 4th parts
Around the central vein (zone III)
Paraumbilical and superficial and inferior epigastric - umbilicus
Crohns = maybe - UC= always
45. What infection causes Whipple disease and What can you see on LM
Liver metabolizes 5HT
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Glucose dependent insulinotropic peptide
Diarrhea - steatorrhea - weight loss - weakness
46. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Old men - arthralgias - cardiac and neuro sx
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Reye's syndrome
47. What are motilin receptor agonists used for clinically
Stimulate intestinal persistalsis
Positive
Cystic dilation of the viteline duct
FAP
48. What are esophageal strictures associated with
AST>ALT
So hypertrophied they look like brain gyri
Lye ingestion and acid reflux
Chronic gastritis and pernicious anemia
49. What are the extraintestinal manifestations of ulcerative colitis
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Pyoderma gangrenosum - primary sclerosing cholangitis
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
50. What receptor does histamine bind on the parietal cell and What does it activate
PAS- positive globules in liver -
H2 receptor - inc cAMP
Hirschsprungs
Sphincter of oddi