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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. What is the path of an indirect inguinal hernia
Peutz jeghers
With albumin
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Meconium ileus
2. Transmural esophageal rupture due to violent retching
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3. multiple juvenil polyps in GI tract - risk
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
4. What is the most common diaphragmatic hernia and What are the two types
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Above
Colovesical leading to pneumaturia
Complications of crohns
5. What type of insults result in micronodular cirrhosis
Superior rectal
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
6. What is the characteristic histo finding in alcoholic hepatitis
Inc lower esphogeal tone leading to achalasia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Mallory bodies
Esophageal varices
7. Diaphragmatic hernias occur in infants because of defective development of which membrane
Pertechnetate - study for uptake
AST
Averages 6 months - very aggressive - usually already metastasized at presentation
Pleuroperitoneal
8. What is one potential precipitating factor for intussusception
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Lubricate food (glycoprotiens)
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
8-9 waves/min
9. What is the rule of 2s for meckels
Jewish and African American men
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Inc smooth muscle relaxation - including lower esophageal sphincter
Lateral
10. Achalasia increases the risk For what complication
Alk pho
Esophageal carcinoma
Diarrhea - steatorrhea - weight loss - weakness
H2 receptor - inc cAMP
11. What is the most common esophageal cancer worldwide and in the US
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Worldwide - SC - US - adeno
No
12. A protrusion of peritoneum through an opening - usually a site of weakness
Positive
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Poor anastamoses
Hernia
13. Acute gastritis is caused By what process
Erosive - disruption of mucosal barrier leading to inflammation
Gilbert's
Amylase
Achalasia due to loss of myenteric plexus (auberach)
14. What does bicab do in the mouth
Menetriers disease
Neutralizes oral bacertial acids and maintains dental health
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
8-9 waves/min
15. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Inc conj bilirubin - inc cholesterol - inc alk phos
Diarrhea - steatorrhea - weight loss - weakness
Alcoholic hepatitis
Crohns = maybe - UC= always
16. What kind of pathways do CCK act on to cause pancreatic secretion
Neural muscarinic pathways
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Above
Gut bacteria
17. What is the HLA association and treatment for hemochromatosis
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Repeated phlebotomy - deferoxamine - HLA- A3
Dubin johnson
Amylase
18. Which is used more quickly - an oral glucose load - or that by IV
Oral glucose
CHF and inc risk of HCC
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
CCK8 receptor - Gq inc IP3/Ca
19. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Reye's syndrome
Carcinoid syndrome
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
20. Where are peyers patches found
Lamina propora and submucosa
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Left gastric vein and esophogeal vein - esophagus
Internal thoracic to superior epigastric to inferior epigastric
21. Which area of the hindgut is a watershed area
Splenic flexure
Hirschsprungs
Where hindgut meets ectoderm
Cholesterol
22. What does TOASTED with alcoholic hepatitis stand for
AST >ALT - ration is usually 1.5
Hypotonic because of more time to reabsorb NaCl
L1
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
23. 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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24. What are additional risk factors for CRC
Angiodysplasia
Inc risk of CRC and other visceral malignancies
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Closer to isotonic because of less time to reabsorb NaCl
25. What kind of anemia is in Wilsons
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Hemolytic anemia
Uremia
Zollinger ellison - brunners glands
26. What are the histological findings of the colon
T cell lymphoma
8-9 waves/min
Mallory bodies
Crypts but not villi
27. secretin - source - action - regulation
Jaundice - fever - RUQ
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
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
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
28. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
Mucoepidermoid carcinoma
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
...
Centrilobular leading to congestive liver disease
29. in carcinoid tumors - What is seen on EM
3 waves/min
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Dense core bodies
Bleeding - intussusception - volvulus - obstruction near terminal ileum
30. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Sphincter of oddi
Obstruction of the common bile duct
Dilated esophagus with an area of distal stenosis - birds beak
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
31. At what spinal level does the is the bifurcation of aorta
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
L4
Alk pho
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
32. People of what decent are associated with celiac sprue and what findings/antibodies are present
Unconjugated - water insoluble
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
33. What is the most common indication of emergent abdominal surgery in children
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Adhesion
Appendicitis
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
34. Which kind of hemorrhoids are painful and why
H2 receptor - inc cAMP
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Crigler - najjar type 1
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
35. In an MI - which liver enzyme is elevated
Jaundice - fever - RUQ
Unconjugated - water insoluble
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
AST
36. Between what structures do strong anastamoses exist
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Left and right gastroepiploics - left and right gastrics
Complications of crohns
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
37. What is the main symptom if a VIPoma
Begins starch digestion - inactivated by low pH upon reaching the stomach
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Tropical sprue
38. Where does type A chronic gastritis occur and What causes it
Phototherapy
L1
The proximal small bowel
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
39. Why does volvulus occur more at cecum and sigmoid colon
Can lead to hematemesis - found in EtOHics and bulimics
Redundant mesentary
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Erosive - disruption of mucosal barrier leading to inflammation
40. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Older patients
Complications of crohns
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Trypsin - chymotrypsin - elastase - carboxypeptidases
41. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Conj - inc - dec
Fasting and stress
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
T cell lymphoma
42. What arteries exit just below the SMA
Mucoepidermoid carcinoma
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
L/R renal artery around L1
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
43. Where are tumors commonly in pancreatic adenocarcinoma
Hyperplastic
Cholesterol
Pancreatic head causing obstructive jaundice
The proximal small bowel
44. What pancreatic enzymes are responsible for fat digestion
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Lipase - phospholipase A - colipase
Fe2+ in the duod
45. What gives stool its characteristic color
Angiodysplasia
Stercobilin
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Downs
46. What are the labs in acute pancreatitis
Elevated amylase - and lipase
3 waves/min
Inc risk of CRC and other visceral malignancies
Juvenile polyposis syndrome - inc risk of adenocarcinoma
47. What are motilin receptor agonists used for clinically
Alk phos
Stimulate intestinal persistalsis
Primary sclerosing cholangitis
Inferior rectal nerve
48. What are the two molecular pathways that lead to CRC
Gardner's syndrome
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Angiodysplasia
49. What are the tumor markers for pancreatic adenocarcinoma
CEA - CA-19-9
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
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
AST>ALT
50. Malabsorption syndromes have what common clinical presentation
Diarrhea - steatorrhea - weight loss - weakness
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Above