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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. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Begins starch digestion - inactivated by low pH upon reaching the stomach
HPNCC
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Virchow's node
2. What is the mechanism for reyes syndrome
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
NAV = nerve artery vein - venous near the penis (NAVEL)
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
3. Where is the deep inguinal ring relative to the inferior epigastric vessels
Below
Lateral
US and cholecystectomy
Gardner's syndrome
4. Where does an indirect inguinal hernia enter the deep inguinal ring
Complications of UC
Erosive - disruption of mucosal barrier leading to inflammation
Meckels
Lateral to the inferior epigastric artery
5. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Colonic polyps
Alk phos
Gut bacteria
Chagas disease
6. What drug blocks the H2R
Repeated phlebotomy - deferoxamine - HLA- A3
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
M3 - Gq - inc IP3/Ca
Cimetidine
7. What layer in the mucosa is responsible for support
Lamina propria
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Liver metabolizes 5HT
Femoral hernia
8. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Alcoholic cirrhosis
Gastrohepatic ligament
Decrease - weight gain
The entire
9. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Carcinoid syndrome
Upregulated intracellular signal transduction
Smooth
...
10. What is the characteristic histo finding in alcoholic hepatitis
Mallory bodies
Failure of neural crest migration
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
Inc lower esphogeal tone leading to achalasia
11. Where is there sclerosis in alcoholic cirrohosis
Around the central vein (zone III)
T cell lymphoma
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
Antrum - H.pylori - inc risk of MALT lymphoma
12. Bilirubin is the product of what?
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
Mucosa - submucosa - muscularis externa - serosa/adventitia
Heme metabolism
In the ileum with bile acids - requires IF
13. What does extrahepatic biliary obstruction cause
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Ceruplasmin
Around the central vein (zone III)
Dissaccharidase def - most commonly lactase
14. What is the lumen of the pancreatic duct
Worldwide - SC - US - adeno
Ampulla of vater
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Juvenile polyposis syndrome - inc risk of adenocarcinoma
15. What is contained within the submucosa
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16. what kind of fistula is associated with diverticulitis
Colovesical leading to pneumaturia
Dec PGE2 leading to dec gastric mucosa protection
Esophageal varices
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
17. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
CEA - CA-19-9
Zenkers - halitosis - dysphagia and obstruction
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
18. What serum enzyme is elevated inacute pancreatitis
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Bleeding - penetration into pancreas - perforation - obstruction
Lipase
19. Where is folate absorbed
The jejunum
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Primary sclerosing cholangitis
US and cholecystectomy
20. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Crohns = noncaseating granulomas - UC = crypt abscesses
Krukenbergs tumor
Pancreatic head causing obstructive jaundice
Myenteric nerve plexus - aurbach
21. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Complications of crohns
Gilbert's
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
22. What are the common causes of gastric ulcers - What causes gastric ulcer
Lamina propora and submucosa
In the mucus that covers the gastric epithelium
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Above
23. What are esophageal strictures associated with
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Esophageal cancer
Lye ingestion and acid reflux
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
24. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Lipase - phospholipase A - colipase
3 waves/min
Inc conj bilirubin - inc cholesterol - inc alk phos
Crypts but not villi
25. What is the cause of Barrett's and the assocaited complications
Gut bacteria
Neural muscarinic pathways
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
26. Where does type A chronic gastritis occur and What causes it
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Amylase
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Sister mary joseph nodule
27. Who is at risk for pancreatic adenocarcinoma
Jewish and African American men
AST
Obstruction of the common bile duct
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
28. occlusion of IVC or hepatic veins
PAS- positive globules in liver -
External (superficial) ring only
Cholesterol - 10-20% opaque due to calcifications
Budd chiari syndrome
29. What retroperitoneal structure flanks both sides of the pancreas on CT
Above
Cigarettes and chronic pancreatitis - not EtOH
Duodenum - 2nd - 3rd and 4th parts
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
30. What is the most common indication of emergent abdominal surgery in children
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Appendicitis
Peptic ulcer disease
Duodenal atresia - Downs
31. multiple juvenil polyps in GI tract - risk
Juvenile polyposis syndrome - inc risk of adenocarcinoma
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
IgA secreting plasma cells - ultimately reside in the lamina proporia
Hypotonic because of more time to reabsorb NaCl
32. What does TOASTED with alcoholic hepatitis stand for
12 waves/min
Backup of blood into the liver - RHF - budd chiari
AST >ALT - ration is usually 1.5
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
33. What causes nutmeg liver
AST>ALT
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Backup of blood into the liver - RHF - budd chiari
Dilated esophagus with an area of distal stenosis - birds beak
34. What is the rule of 2s for meckels
Meconium ileus
Heme metabolism
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
All 3 gut layers outpouch as in Meckels
35. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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36. What is the main symptom if a VIPoma
L4
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
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Inc conj bilirubin - inc cholesterol - inc alk phos
37. What enzyme is necessary to create conjugated bilirubin
Decrease - weight gain
Neutralizes oral bacertial acids and maintains dental health
Inc - weight loss
Uridine glucuronyl transferase
38. Between what structures do strong anastamoses exist
Jewish and African American men
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
Alcoholic hepatitis
Left and right gastroepiploics - left and right gastrics
39. What are the barium swallow findings of achalasia
Dilated esophagus with an area of distal stenosis - birds beak
External spermatic fascia only
The gastroduodenal
Failure of the processus vagainlis to close
40. What is the frequency of basal electric rhythm of the ilieum
Cirrhosis
8-9 waves/min
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Downs
41. What are the histological findings of the colon
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Brunners
Redness and tenderness on palpation of extremities
Crypts but not villi
42. What is the presentation of pancreatic adenocarcinoma
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Elevated amylase - and lipase
Lateral to the inferior epigastric artery
Cholesterol
43. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Glucouronate - water soluble (direct)
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Inc lower esphogeal tone leading to achalasia
Menetriers disease
44. FAP + osseous and soft tissue tumors - retinal hyperplasia
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45. What are the histological findings in the ileum
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46. What portion of the bowel does sprue effect
The proximal small bowel
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Turcot
Portal HTN
47. Where are oligosaccharide hydrolases and What do they do
Alk phos
Brush border of intestine - produce monosaccharides from oligo and di
Closer to isotonic because of less time to reabsorb NaCl
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
48. What do you treat Wilsons disease with and What is the inheritance
Heme metabolism
Antrum - H.pylori - inc risk of MALT lymphoma
Penicillinamine - AR inheritance
H2 receptor - inc cAMP
49. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
H pylori (almost 100%)
Dense core bodies
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
50. Why are most diverticula considered false
Elevated amylase - and lipase
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Lack or have an attenuated muscularis externa - often in the sigmoid colon
The gastroduodenal