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Test your basic knowledge |
USMLE GI
Start Test
Study First
Subjects
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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 are the four Fs of gallstones
Gardner's syndrome
Female - fat - fertile - forty
Redness and tenderness on palpation of extremities
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
2. What kind of digestion is bile needed for
T cell lymphoma
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
3. what kind of muscle is in the upper 1/3 of esophagus
Failure of neural crest migration
Begins starch digestion - inactivated by low pH upon reaching the stomach
Obstruction of the common bile duct
Striated
4. crigler - najjar type II responds to which therapy and How does it work
Phenobarbital - inc liver enzyme synthesis
Hirschsprungs
The entire
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
5. Where is there sclerosis in alcoholic cirrohosis
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Glucouronate - water soluble (direct)
Failure of neural crest migration
Around the central vein (zone III)
6. Where is the deep inguinal ring relative to the inferior epigastric vessels
Dermatitis herpetiformis
Lateral
Tropical sprue
Menetriers disease
7. Where is the pectinate line
H pylori (almost 100%)
Where hindgut meets ectoderm
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Primarly through ECL leading to histamine release
8. What are the complications of acute pancreatitis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Zollinger ellison - brunners glands
Juvenile polyposis syndrome - inc risk of adenocarcinoma
The jejunum
9. Bilirubin is the product of what?
Heme metabolism
Dubin johnson
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
10. What infection causes Whipple disease and What can you see on LM
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Gastric glands
Dubin johnson
Conj - inc - dec
11. HCC is associated with what other conditions
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Left gastric vein and esophogeal vein - esophagus
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
12. What do the rugae of stomach look like in menetriers disease
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
So hypertrophied they look like brain gyri
Osmotic
Alcoholic cirrhosis
13. Where are tumors commonly in pancreatic adenocarcinoma
Dubin johnson
Pancreatic head causing obstructive jaundice
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Amylase
14. What is the mechanism for reyes syndrome
M3 - Gq - inc IP3/Ca
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Inc - weight loss
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
15. What do you treat Wilsons disease with and What is the inheritance
Penicillinamine - AR inheritance
Carcinoid syndrome
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Unconj - absent (acholuria) - inc
16. secretin - source - action - regulation
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
Cimetidine
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
The gastroduodenal
17. most common malignant salivary gland tumor
Mucoepidermoid carcinoma
Hydrocele
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
In the ileum with bile acids - requires IF
18. Gallstones that reach the common channel at ampulla can block which two ducts
Peyers patches
Dilated esophagus with an area of distal stenosis - birds beak
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Pancreatic and bile
19. What layer in the mucosa is responsible for support
Lamina propria
CHF and inc risk of HCC
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Terminal ileum and colon
20. What is the TX of physiologic neonatal jaundice
Phototherapy
Lateral
Ischemic colitis
HPNCC
21. Where does type A chronic gastritis occur and What causes it
Gardner's syndrome
Complications of UC
Crigler - najjar type 1
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
22. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Hemosiderosis - hemochromatosis
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
GLUT 2
Inc conj bilirubin - inc cholesterol - inc alk phos
23. What is the cause of physiologic neonatal jaundice
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Stimulate intestinal persistalsis
Lubricate food (glycoprotiens)
Gastrohepatic ligament
24. subQ peribumbilical metastasis
L/R renal artery around L1
Sister mary joseph nodule
Neural muscarinic pathways
Diverticulum
25. What can hemochromatosis be secondary to...
Uremia
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Liver metabolizes 5HT
Via the middle colic
26. Where are carcinoid tumors most commonly malignant
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
The proximal small bowel
Small intestine
Poor anastamoses
27. What pancreatic enzymes are responsible for fat digestion
Right and left hepatic duct
Meconium ileus
Lipase - phospholipase A - colipase
Crohns = maybe - UC= always
28. What gives stool its characteristic color
Lipase
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Stercobilin
Phototherapy
29. occlusion of IVC or hepatic veins
Alpha amylase
Budd chiari syndrome
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Crohns = maybe - UC= always
30. With caput medusaw - between what vessels is the anastomoses and Where is it
Paraumbilical and superficial and inferior epigastric - umbilicus
Small intestine
Phenobarbital - inc liver enzyme synthesis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
31. Where does an indirect inguinal hernia enter the deep inguinal ring
AST
Fe2+ in the duod
Cystic duct and common hepatic duct
Lateral to the inferior epigastric artery
32. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Virchow's node
Dec PGE2 leading to dec gastric mucosa protection
33. likely infectious form of malabsorption - responds to antibiotics
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Tropical sprue
Adhesion
Corticosteroids - infliximab
34. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Gastrohepatic ligament
Adhesion
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Upregulated intracellular signal transduction
35. What does histo show for alpha1 antitrypsin def
PAS- positive globules in liver -
The jejunum
Gardner's syndrome
Gamma glutamyl transferase GGT
36. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Can lead to hematemesis - found in EtOHics and bulimics
The submucosal nerve plexus - meissner's
Low pressure proximal to LES
Jaundice - fever - RUQ
37. What receptor does histamine bind on the parietal cell and What does it activate
Myenteric nerve plexus - aurbach
Phenobarbital - inc liver enzyme synthesis
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
H2 receptor - inc cAMP
38. If the abdominal aorta is blocked - How does blood get to the left colic artery
AST >ALT - ration is usually 1.5
Via the middle colic
Colovesical leading to pneumaturia
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
39. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Esophageal carcinoma
Urobilin
Conj/unconj - inc - nl to dec
40. To what substance is bilirubin conjugated and why
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Positive
Glucouronate - water soluble (direct)
41. What are the ABCDEF of esophageal cancer
Esophageal carcinoma
Budd chiari syndrome
Liver metabolizes 5HT
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
42. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Duodenal atresia - Downs
Cholesterol
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
L1
43. What is biliary colic
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Conj - inc - dec
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
L/R renal artery around L1
44. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Gastric glands
Gut bacteria
Hirschsprungs
Colonic polyps
45. Which is used more quickly - an oral glucose load - or that by IV
Warthins' tumor
Oral glucose
Fasting and stress
Dec PGE2 leading to dec gastric mucosa protection
46. What is the rule of 2s for meckels
Peyers patches
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
47. How is the diagonsis of CRC made
Gut bacteria
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker
48. People of what decent are associated with celiac sprue and what findings/antibodies are present
Esophageal varices
Conj - inc - dec
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Crigler - najjar type 1
49. Acute gastritis is caused By what process
Lateral to the inferior epigastric artery
L1
Erosive - disruption of mucosal barrier leading to inflammation
Increase tumorigenesis
50. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Alcoholic hepatitis
Unconj - absent (acholuria) - inc
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Crypts but not villi