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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. Bile is critical for exrection of what substance
Cholesterol - 10-20% opaque due to calcifications
Lamina propria
Cholesterol
Striated
2. Acute gastritis is caused By what process
Failure of the processus vagainlis to close
Erosive - disruption of mucosal barrier leading to inflammation
Stimulate the H/K ATPase
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
3. What are the histological findings in the jejunum
Normal
Pleomorphic adenoma
L4
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
4. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Mucoepidermoid carcinoma
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
IgA secreting plasma cells - ultimately reside in the lamina proporia
Causes of gall stones
5. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Ceruplasmin
Short gastrics - left greater and lesser
Crohns = noncaseating granulomas - UC = crypt abscesses
Glucose dependent insulinotropic peptide
6. conjugated hyperbilirubinemia due to defective liver excretion
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
L1
Peptic ulcer disease
Dubin johnson
7. What kind of anemia is in Wilsons
Krukenbergs tumor
Epigastric abdominal pain radiating to back - anorexia - nausea
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Hemolytic anemia
8. With internal hemorrhoids Where is the anastomoses and Where is it
Falciform - ligamentum teres - fetal umbilical vein
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Superior rectal and middle and inferior rectal - rectum
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
9. In viral hepatitis - which liver enzyme is higher
ALT>AST
Begins starch digestion - inactivated by low pH upon reaching the stomach
CHF and inc risk of HCC
Alfatoxin in peanuts
10. How does abetalipoproteinemia lead to malabsorption
Black - rotors syndrome
Dec PGE2 leading to dec gastric mucosa protection
Boerhaave's Syndrome - Been heaving syndrome
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
11. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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12. What is contained within the submucosa
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13. How does brain injury lead to acute gastritis and What is it called
Cimetidine
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
In the mucus that covers the gastric epithelium
Causes of gall stones
14. Liver cell failure can lead to multisystem signs including
Pleomorphic adenoma
Bleeding - penetration into pancreas - perforation - obstruction
In the mucus that covers the gastric epithelium
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
15. What cells make pepsin - What does it do - and what regulates it
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Failure of the processus vagainlis to close
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Chronic calcifying pancreatitis - inc risk of panreatic cancer
16. What is the frequency of basal electric rhythm of the ilieum
Sister mary joseph nodule
Can lead to hematemesis - found in EtOHics and bulimics
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
8-9 waves/min
17. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Diarrhea - steatorrhea - weight loss - weakness
Oral glucose
FAP
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
18. What kind of insults results in macronodular cirrhosis
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Inguninal ligament - sartorius muscle - adductor longus
GERD - may also present with nocturnal cough and dyspnea
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
19. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Alcoholic cirrhosis
AST>ALT
Intussusception
Phototherapy
20. When do you see hypertrophy of brunners glands
FAP
Peptic ulcer disease
Complications of UC
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
21. What are the complications of Meckels
Backup of blood into the liver - RHF - budd chiari
Bleeding - intussusception - volvulus - obstruction near terminal ileum
IgA secreting plasma cells - ultimately reside in the lamina proporia
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
22. What is the frequency of basal electric rhythm in the duodenum
Duodenal atresia - Downs
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
HSV-1 - CMV - Candida
12 waves/min
23. At what spinal level does the celiac trunk exit
T12
External (superficial) ring only
Lamina propria
US and cholecystectomy
24. What causes primary biliary cirrhosis
Alfatoxin in peanuts
Muscularis mucosae
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
25. How do villi appear in disaccharidease def
Bleeding - penetration into pancreas - perforation - obstruction
L2
Diverticulum
Normal
26. What type of insults result in micronodular cirrhosis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Krukenbergs tumor
Lubricate food (glycoprotiens)
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
27. What are the complications of acute pancreatitis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Alk phos
Skip lesions =crohns - colon = UC
Peptic ulcer disease
28. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Begins starch digestion - inactivated by low pH upon reaching the stomach
Meconium ileus
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Dermatitis herpetiformis
29. What nerve innervates the external hemorrhoids
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Via the superior pancreaticduodenal
In the ileum with bile acids - requires IF
Inferior rectal nerve
30. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Acute pancreatitis
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
90%
Peutz jeghers
31. What are the complications of chronic pancreatitis
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
32. Which area of the hindgut is a watershed area
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Splenic flexure
Gilbert's
33. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Terminal ileum and colon
Black - rotors syndrome
Spleen to posterior abdominal wall - splenic artery and vein
34. What are the histological findings in the ileum
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35. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
Celiac sprue
Femoral hernia
Lipase - phospholipase A - colipase
36. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Dermatitis herpetiformis
Zollinger Ellison - phenylalanine and tryptophan
Punched out - clean margins - carcinoma =raised irregular margins
Jewish and African American men
37. malnutrition - toxic megacolon - colorectal carcinoma
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Omeprazole
Complications of crohns
Complications of UC
38. B cells stimuated in the germinal centers of peyers patches differentiate into what?
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
IgA secreting plasma cells - ultimately reside in the lamina proporia
Krukenbergs tumor
39. What other condition can lead to acute gastritis - think renal
Uremia
Sister mary joseph nodule
Duodenum - 2nd - 3rd and 4th parts
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
40. Who gets Whipple disease and How do they present
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Old men - arthralgias - cardiac and neuro sx
Lactase is located at the tips of intestinal villi
Alk pho
41. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Alpha1 antitrypsin def - codominant trait
VZV and influenza B treated with salicylates
ALT>AST
Hepatic steatosis
42. Who gets gastric ulcers
Failure of neural crest migration
Mucosa - submucosa - muscularis externa - serosa/adventitia
Older patients
Left and right gastroepiploics - left and right gastrics
43. concentric onion skin bile duct fibrosis
CCK8 receptor - Gq inc IP3/Ca
Primary sclerosing cholangitis
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Omeprazole
44. How do burns cause acute gastritis and What is it called
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45. in budd chiari syndrome - Where is the congestion and necrosis
Early childhood - neuro sx and malabsorption
Centrilobular leading to congestive liver disease
Gastric glands
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
46. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Mitochondrial abnl - fatty liver - hypoglycemia - coma
L1
Inc - weight loss
Squamous - upper 1/3 - adeno - lower 1/3
47. What does K- ras mutation cause
Pancreatic and bile
Upregulated intracellular signal transduction
Primarly through ECL leading to histamine release
Paraumbilical and superficial and inferior epigastric - umbilicus
48. What does primary sclerosing cholangitis lead to...
Downs
Volvulus
Where hindgut meets ectoderm
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
49. What are the branches of the celiac trunk and What do they supply
Common hepatic - splenic - left gastric - main blood supply for stomach
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Female - fat - fertile - forty
Acute pancreatitis
50. What is diverticulosis
Centrilobular leading to congestive liver disease
Upregulated intracellular signal transduction
Peutz jeghers
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall