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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. most common malignant salivary gland tumor
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Mucoepidermoid carcinoma
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Backup of blood into the liver - RHF - budd chiari
2. bilateral mets to ovaries with abundant mucus - signet ring cells
Krukenbergs tumor
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Decrease - weight gain
3. What are the four Fs of gallstones
AST
Failure of neural crest migration
Female - fat - fertile - forty
Chagas disease
4. Which area of the hindgut is a watershed area
No
Splenic flexure
Trypsin - chymotrypsin - elastase - carboxypeptidases
Unconj - absent (acholuria) - inc
5. At what spinal level does the is the bifurcation of aorta
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
The jejunum
L4
Pancreatic head causing obstructive jaundice
6. What does bicab do in the mouth
The entire
Parietal cells in the stomach - B12 binding protein
Neutralizes oral bacertial acids and maintains dental health
L3
7. When and How does Abetalipoproteinemia present
Falciform - ligamentum teres - fetal umbilical vein
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Early childhood - neuro sx and malabsorption
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
8. What does loss of APC cause
Decreased intercellular adhesion and increased proliferation
The submucosal nerve plexus - meissner's
M3 - Gq - inc IP3/Ca
Black - rotors syndrome
9. How do NSAIDs cause acute gastritis
Dec PGE2 leading to dec gastric mucosa protection
Inferior rectal nerve
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Duodenum - 2nd - 3rd and 4th parts
10. What is the most common indication of emergent abdominal surgery in children
Inferior rectal nerve
Pleomorphic adenoma
Appendicitis
Alcoholic hepatitis
11. Which viral infxns/treatments are associated with reyes syndrome
VZV and influenza B treated with salicylates
Primarly through ECL leading to histamine release
Trypsin - chymotrypsin - elastase - carboxypeptidases
Alcoholic hepatitis
12. In PUD with a duodenal ulcer does pain inc or dec with meals
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Appendicitis
Decrease - weight gain
13. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Inc risk of CRC and other visceral malignancies
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Hemosiderosis - hemochromatosis
Internal thoracic to superior epigastric to inferior epigastric
14. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Lubricate food (glycoprotiens)
Budd chiari syndrome
Gamma glutamyl transferase GGT
Superior rectal
15. How are all 3 monosaccharides transported to the blood
Positive urease test
GLUT 2
Alfatoxin in peanuts
Ceruplasmin
16. What is the HLA association and treatment for hemochromatosis
Smooth
Repeated phlebotomy - deferoxamine - HLA- A3
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Cholesterol
17. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Femoral hernia
Chronic gastritis and pernicious anemia
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Failure of neural crest migration
18. What is the action of NO as a GI hormone
Redundant mesentary
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Inc smooth muscle relaxation - including lower esophageal sphincter
Lubricate food (glycoprotiens)
19. What complication can arise from indirect inguinal hernias
Adhesion
True and most common congenital anomoly of GI tract
Hydrocele
Alcoholic hepatitis
20. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
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
Necrotizing enterocolitis
PAS- positive globules in liver -
Terminal ileum and colon
21. At what spinal level does the celiac trunk exit
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Worldwide - SC - US - adeno
Alcoholic cirrhosis
T12
22. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
Skip lesions =crohns - colon = UC
Decreased intercellular adhesion and increased proliferation
Pancreatic head causing obstructive jaundice
Striated and smooth
23. What are the labs in acute pancreatitis
Stimulate the H/K ATPase
Fasting and stress
Elevated amylase - and lipase
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
24. Acute gastritis is caused By what process
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Splenic flexure
Erosive - disruption of mucosal barrier leading to inflammation
25. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Cholesterol - 10-20% opaque due to calcifications
Dubin johnson
Alk phos
No
26. What is the frequency of basal electric rhythm in the duodenum
12 waves/min
Appendicitis
L1
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
27. What receptors does gastrin bind on the parietal cell and What does it activate
Alpha1 antitrypsin def - codominant trait
CCK8 receptor - Gq inc IP3/Ca
Redness and tenderness on palpation of extremities
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
28. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Dermatitis herpetiformis
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Uremia
Below
29. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Conj/unconj - inc - nl to dec
Muscularis mucosae
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
30. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Urobilin
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
L3
31. why infxn is implicated in duodenal PUD
H pylori (almost 100%)
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
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
32. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Dilated esophagus with an area of distal stenosis - birds beak
Complications of crohns
Alk phos
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
33. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
The gastroduodenal
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
So hypertrophied they look like brain gyri
HPNCC
34. Where is the pectinate line
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Downs
Lamina propria
Where hindgut meets ectoderm
35. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Brush border of intestine - produce monosaccharides from oligo and di
Intussusception
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
36. Abuse of what substance leads to acute gastritis
Poor anastamoses
Begins starch digestion - inactivated by low pH upon reaching the stomach
2ndary biliary cirrhosis
EtOH
37. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Can lead to hematemesis - found in EtOHics and bulimics
Where hindgut meets ectoderm
Lipase
Hypercoaguability - polycythemia vera - pregnancy - HCC
38. What cell produces IF and What does it do
Skip lesions =crohns - colon = UC
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Appendicitis
Parietal cells in the stomach - B12 binding protein
39. When do you see hypertrophy of brunners glands
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Myenteric nerve plexus - aurbach
Adhesion
Peptic ulcer disease
40. What are the layers of the gut wall from inside out
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Erosive - disruption of mucosal barrier leading to inflammation
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Mucosa - submucosa - muscularis externa - serosa/adventitia
41. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Poor anastamoses
Diverticulum
Alk phos
Decrease - weight gain
42. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Adhesion
Alcoholic cirrhosis
Short gastrics - left greater and lesser
43. Where is bicarb trapped
Trypsin - chymotrypsin - elastase - carboxypeptidases
Conj - inc - dec
Stercobilin
In the mucus that covers the gastric epithelium
44. Why are most diverticula considered false
Lack or have an attenuated muscularis externa - often in the sigmoid colon
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Gut bacteria
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
45. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Hyperpigmented mouth - lips - hands - genitalia
Zollinger Ellison - phenylalanine and tryptophan
Complications of crohns
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
46. FAP + malignant CNS tumor
Zollinger ellison - brunners glands
Dermatitis herpetiformis
Enterokinase/enteropeptidase from the duodenal mucosa
Turcot
47. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
CHF and inc risk of HCC
FAP
Gastric glands
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
48. in carcinoid tumors - What is seen on EM
Primarly through ECL leading to histamine release
Redundant mesentary
Pertechnetate - study for uptake
Dense core bodies
49. A protrusion of peritoneum through an opening - usually a site of weakness
So hypertrophied they look like brain gyri
Hernia
Can lead to hematemesis - found in EtOHics and bulimics
Splenic flexure
50. What are additional risk factors for CRC
All 3
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
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
Enterokinase/enteropeptidase from the duodenal mucosa