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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. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
The proximal small bowel
L3
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
Female - fat - fertile - forty
2. What kind of insults results in macronodular cirrhosis
Epithelium
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Omeprazole
Inferior rectal nerve
3. What layer in the mucosa is responsible for support
Turcot
Lamina propria
Left and right gastroepiploics - left and right gastrics
Cystic duct and common hepatic duct
4. How do burns cause acute gastritis and What is it called
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5. concentric onion skin bile duct fibrosis
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Primary sclerosing cholangitis
Elevated amylase - and lipase
Centrilobular leading to congestive liver disease
6. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Pertechnetate - study for uptake
The gastroduodenal
IgA secreting plasma cells - ultimately reside in the lamina proporia
Lamina propria
7. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue
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8. What parts of the small bowel can tropical sprue effect
Worldwide - SC - US - adeno
Small intestine
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
The entire
9. What are the complications of acute pancreatitis
90%
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Colonic polyps
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
10. Where are tumors commonly in pancreatic adenocarcinoma
Failure of neural crest migration
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Pancreatic head causing obstructive jaundice
Femoral hernia
11. Why does carcinoid syndrome not occur if tumor is confined to GI system
Liver metabolizes 5HT
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
12 waves/min
Reye's syndrome
12. conjugated hyperbilirubinemia due to defective liver excretion
Liver metabolizes 5HT
Dubin johnson
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
13. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Esophageal varices
Gallbladder
H+
14. Where are peyers patches found
Glucouronate - water soluble (direct)
Left and right gastroepiploics - left and right gastrics
Lamina propora and submucosa
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
15. What drug blocks the H2R
Cimetidine
With albumin
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
16. What is the epi for CRC
Alcoholic cirrhosis
Increase tumorigenesis
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
17. in budd chiari syndrome - Where is the congestion and necrosis
Positive urease test
Centrilobular leading to congestive liver disease
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
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
18. What does autoimmune destruction of parietal cells lead to...
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Chronic gastritis and pernicious anemia
Hemosiderosis - hemochromatosis
Lateral
19. What are the ABCDEF of esophageal cancer
Hypotonic because of more time to reabsorb NaCl
Zenkers - halitosis - dysphagia and obstruction
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Peptic ulcer disease
20. In viral hepatitis - which liver enzyme is higher
Pleomorphic adenoma
ALT>AST
Pancreatic head causing obstructive jaundice
Unconjugated - water insoluble
21. People of what decent are associated with celiac sprue and what findings/antibodies are present
Peutz jeghers
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
CHF and inc risk of HCC
22. What are the branches of the celiac trunk and What do they supply
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Common hepatic - splenic - left gastric - main blood supply for stomach
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
23. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
The entire
Internal thoracic to superior epigastric to inferior epigastric
HPNCC
24. 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
Conj/unconj - inc - nl to dec
Inguninal ligament - sartorius muscle - adductor longus
Lye ingestion and acid reflux
25. What structure is Not contained in the femoral sheath
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
NAV = nerve artery vein - venous near the penis (NAVEL)
Increase tumorigenesis
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
26. How many layers of spermatic fascia are covers an indirect inguinal hernia
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Myenteric nerve plexus - aurbach
All 3
27. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Crigler - najjar type 1
Esophageal varices
Heme metabolism
Tropical sprue
28. What other condition can lead to acute gastritis - think renal
Skip lesions =crohns - colon = UC
Cimetidine
Uremia
Boerhaave's Syndrome - Been heaving syndrome
29. What is the leading cause of bowel incarceration
External (superficial) ring only
Femoral hernia
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
30. In what scenarios do pts with gilberts have inc bili
Reye's syndrome
Omeprazole
Fasting and stress
Uridine glucuronyl transferase
31. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Hydrocele
Alcoholic hepatitis
Antrum - H.pylori - inc risk of MALT lymphoma
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
32. What kind of digestion is bile needed for
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Chronic gastritis and pernicious anemia
Femoral hernia
33. What is the clinical presentation of acute pancreatitis
Dermatitis herpetiformis
Around the central vein (zone III)
US and cholecystectomy
Epigastric abdominal pain radiating to back - anorexia - nausea
34. malnutrition - toxic megacolon - colorectal carcinoma
Amylase
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Complications of UC
PAS- positive globules in liver -
35. What is the HLA association and treatment for hemochromatosis
Cystic dilation of the viteline duct
AST
Repeated phlebotomy - deferoxamine - HLA- A3
Muscularis mucosae
36. What structures feed into the common bile duct
Cystic duct and common hepatic duct
In the mucus that covers the gastric epithelium
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
The submucosal nerve plexus - meissner's
37. Achalasia increases the risk For what complication
Esophageal carcinoma
Meconium ileus
Inc - weight loss
Alcoholic hepatitis
38. What serum markers increase in cholecystitis with bile duct involvement
Left and right gastroepiploics - left and right gastrics
Alk phos
Pyoderma gangrenosum - primary sclerosing cholangitis
Stimulate intestinal persistalsis
39. What is contained within the muscularis externa
IgA secreting plasma cells - ultimately reside in the lamina proporia
Myenteric nerve plexus - aurbach
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
40. What is the omphalomesenteric cyst
Cystic dilation of the viteline duct
Trypsin - chymotrypsin - elastase - carboxypeptidases
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Dense core bodies
41. what kind of muscle is in the upper 1/3 of esophagus
Striated
Oral glucose
Closer to isotonic because of less time to reabsorb NaCl
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
42. Why are most diverticula considered false
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Alpha amylase
Femoral hernia
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
43. How does CRC present in the distal and proximal colon
Primary sclerosing cholangitis
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Peutz jeghers
...
44. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Upregulated intracellular signal transduction
Cirrhosis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
45. Bile is critical for exrection of what substance
Cholesterol
Crypts but not villi
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Omeprazole
46. What cell produces IF and What does it do
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Parietal cells in the stomach - B12 binding protein
All 3
3 waves/min
47. How is salivary secretion stimulated
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Alpha amylase
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
48. At what spinal level does the SMA exit
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Pancreatic head causing obstructive jaundice
Brunners
L1
49. How do villi appear in disaccharidease def
Striated and smooth
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Normal
Virchow's node
50. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Above
Colonic polyps
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Angiodysplasia