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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. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Crigler - najjar type 1
Intussusception
Zenkers - halitosis - dysphagia and obstruction
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
2. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
3 waves/min
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Cirrhosis
3. What source of salivary secretion is the most serous and What is the most mucinous
Serous on the sides parotids - mucinous in the middle sublingual
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Goes through deep inguinal ring - external inguinal ring and into the scrotum
4. Achalasia increases the risk For what complication
Jewish and African American men
Turcot
Esophageal carcinoma
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
5. How do burns cause acute gastritis and What is it called
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6. Where are peyers patches found
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Cholesterol
Lamina propora and submucosa
7. Where are tumors commonly in pancreatic adenocarcinoma
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Pancreatic head causing obstructive jaundice
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
L1
8. What is the presentation of pancreatic adenocarcinoma
Colonic polyps
HSV-1 - CMV - Candida
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
9. Which patients have pigment stones
Tropical sprue
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Alpha amylase
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
10. What complication can arise from indirect inguinal hernias
Hydrocele
90%
Pyoderma gangrenosum - primary sclerosing cholangitis
Lubricate food (glycoprotiens)
11. Abuse of what substance leads to acute gastritis
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
EtOH
Crohns = noncaseating granulomas - UC = crypt abscesses
Low pressure proximal to LES
12. What is the cause of physiologic neonatal jaundice
Bleeding - penetration into pancreas - perforation - obstruction
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
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
13. In alchoholic hepatitis which liver enzyme is higher
GLUT 2
AST>ALT
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
14. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Common hepatic - splenic - left gastric - main blood supply for stomach
Pancreatic and bile
Pertechnetate - study for uptake
Juvenille polyps - no risk if single
15. What are the four Fs of gallstones
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Lubricate food (glycoprotiens)
Female - fat - fertile - forty
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
16. In what scenarios do pts with gilberts have inc bili
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Fasting and stress
GLUT 2
17. What retroperitoneal structure flanks both sides of the pancreas on CT
Older patients
Meconium ileus
Duodenum - 2nd - 3rd and 4th parts
PAS- positive globules in liver -
18. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Pertechnetate - study for uptake
Causes of gall stones
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Enterokinase/enteropeptidase from the duodenal mucosa
19. How does hirschsprung present and appear on imaging
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Neural muscarinic pathways
Failure of neural crest migration
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
20. To what substance is bilirubin conjugated and why
Gastrohepatic ligament
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Gilbert's
Glucouronate - water soluble (direct)
21. Which kind of hemorrhoids are painful and why
Menetriers disease
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
22. At what level of the spine does the IM exit the aorta
L3
Mallory bodies
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Reye's syndrome
23. What type of insults result in micronodular cirrhosis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Dilated esophagus with an area of distal stenosis - birds beak
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
24. What are causes of extrahepatic biliary obstruction
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Dense core bodies
Heme metabolism
Left and right gastroepiploics - left and right gastrics
25. What conditions are associated with budd chiari
Hypercoaguability - polycythemia vera - pregnancy - HCC
GLUT 2
...
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
26. What are the histological findings in the ileum
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27. occlusion of IVC or hepatic veins
GLUT 2
Inguninal ligament - sartorius muscle - adductor longus
Budd chiari syndrome
Punched out - clean margins - carcinoma =raised irregular margins
28. What happens to the short gastics if the splenic artery is blocked
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Poor anastamoses
Hemosiderosis - hemochromatosis
Alcoholic hepatitis
29. What kind of muscle is in the lower 1/3 of the esophagus
AR
Downs
VZV and influenza B treated with salicylates
Smooth
30. What kind of muscle is in the middle 1/3 of esophagus
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Striated and smooth
Cystic duct and common hepatic duct
31. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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32. What does extrahepatic biliary obstruction cause
HSV-1 - CMV - Candida
Ischemic colitis
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
33. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Femoral hernia
Conj/unconj - inc - nl to dec
Smooth
34. When and why is stomach cancer termed linitis plastica
When diffusely infiltrative - thickened rigid appearance like a leather bottle
All 3 gut layers outpouch as in Meckels
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Crypts but not villi
35. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Left gastric vein and esophogeal vein - esophagus
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Inguninal ligament - sartorius muscle - adductor longus
Tropical sprue
36. in carcinoid tumors - What is seen on EM
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Dense core bodies
Decreased intercellular adhesion and increased proliferation
Brunners
37. What skin condition is associated with celiac sprue
Dermatitis herpetiformis
AST >ALT - ration is usually 1.5
EtOH
Lipase - phospholipase A - colipase
38. Where are oligosaccharide hydrolases and What do they do
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Brush border of intestine - produce monosaccharides from oligo and di
T cell lymphoma
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
39. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Diverticulum
Lateral to the inferior epigastric artery
Alk pho
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
40. What do you use to diagnose meckels
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Glucose dependent insulinotropic peptide
Pertechnetate - study for uptake
41. What kind of diarrhea is produced from a disaccharide def
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Short gastrics - left greater and lesser
Osmotic
42. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Black - rotors syndrome
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
43. What are esophageal strictures associated with
Inc risk of CRC and other visceral malignancies
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Lye ingestion and acid reflux
44. What is diverticulosis
90%
Worldwide - SC - US - adeno
Intussusception
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
45. what kind of muscle is in the upper 1/3 of esophagus
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Striated
Superior rectal and middle and inferior rectal - rectum
Carcinoid syndrome
46. Through which aspect of the inguinal canal does a direct inguinal go
Neural muscarinic pathways
External (superficial) ring only
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Spleen to posterior abdominal wall - splenic artery and vein
47. What parts of the small bowel can tropical sprue effect
Normal
The entire
Hypotonic because of more time to reabsorb NaCl
When diffusely infiltrative - thickened rigid appearance like a leather bottle
48. What receptor does histamine bind on the parietal cell and What does it activate
MSI (15%) and APC/beta catenin chromosomal instability (85%)
L4
Celiac sprue
H2 receptor - inc cAMP
49. What are the complications of duodenal PUD
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Oral glucose
Bleeding - penetration into pancreas - perforation - obstruction
Common hepatic - splenic - left gastric - main blood supply for stomach
50. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Crigler - najjar type 1
Ischemic colitis
Chagas disease