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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. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Skip lesions =crohns - colon = UC
2. Why are most diverticula considered false
Lack or have an attenuated muscularis externa - often in the sigmoid colon
H2 receptor - inc cAMP
Complications of crohns
Falciform - ligamentum teres - fetal umbilical vein
3. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Lateral to the inferior epigastric artery
4. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Causes of gall stones
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Volvulus
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
5. What are the main components of bile
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
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
Esophageal varices
6. What receptors does ACH bind on the parietal cells and What does it activate
90%
Conj/unconj - inc - nl to dec
Dissaccharidase def - most commonly lactase
M3 - Gq - inc IP3/Ca
7. What does primary sclerosing cholangitis lead to...
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Squamous - upper 1/3 - adeno - lower 1/3
Epithelium
8. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Phototherapy
Peutz jeghers
Oral glucose
Duodenal atresia - Downs
9. What percentage of gall stones are cholesterol stones and What are the associations
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Angiodysplasia
10. What are the signs and symptoms of budd chiari
Esophageal varices
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
11. what percentage of colonic polyps are non - neoplastic
90%
Ceruplasmin
Obstruction of the common bile duct
Pleuroperitoneal
12. What are the histological findings in the jejunum
Crigler - najjar type 1
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Complications of UC
Complications of crohns
13. What are the histological findings in the duodenum
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14. What is the clinical presentation of acute pancreatitis
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
Inspiratory arrest on deep palpation due to pain
Epigastric abdominal pain radiating to back - anorexia - nausea
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
15. Gastrin - source - action - regulation
Begins starch digestion - inactivated by low pH upon reaching the stomach
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Pleomorphic adenoma
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
16. What is the most common esophageal cancer worldwide and in the US
Lactase is located at the tips of intestinal villi
Worldwide - SC - US - adeno
VZV and influenza B treated with salicylates
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
17. Autoantibodies to gluten (gliadin) in wheat and other grains
Celiac sprue
Uremia
Gallbladder
Common hepatic - splenic - left gastric - main blood supply for stomach
18. What kind of pathways do CCK act on to cause pancreatic secretion
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
HSV-1 - CMV - Candida
Neural muscarinic pathways
Trypsin - chymotrypsin - elastase - carboxypeptidases
19. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Carcinoid syndrome
AST >ALT - ration is usually 1.5
Alpha1 antitrypsin def - codominant trait
Hepatic steatosis
20. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Complications of crohns
Goes through deep inguinal ring - external inguinal ring and into the scrotum
No
Juvenile polyposis syndrome - inc risk of adenocarcinoma
21. What are the histological findings in the ileum
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22. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
AST
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Averages 6 months - very aggressive - usually already metastasized at presentation
Increase tumorigenesis
23. Who gets gastric ulcers
Older patients
Dissaccharidase def - most commonly lactase
Uridine glucuronyl transferase
Fasting and stress
24. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Via the superior pancreaticduodenal
Worldwide - SC - US - adeno
Pancreatic and bile
Budd chiari syndrome
25. What structures feed into the common bile duct
Cirrhosis
Conj/unconj - inc - nl to dec
T12
Cystic duct and common hepatic duct
26. Where is folate absorbed
Stimulate intestinal persistalsis
Parietal cells in the stomach - B12 binding protein
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
The jejunum
27. What kind of cancer to celiac sprue put you as inc risk for
Adhesion
T cell lymphoma
Ampulla of vater
H pylori (almost 100%)
28. What is the rate limiting step of carbohydrate digestion
Penicillinamine - AR inheritance
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Pyoderma gangrenosum - primary sclerosing cholangitis
Oligosaccharide digestion
29. What is the arterial supply and venous drainage below pectinate line
Femoral hernia
Tropical sprue
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
T12
30. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Diverticulitis in elderly - ectopic pregs use hCG to rule out
CEA - CA-19-9
Uridine glucuronyl transferase
IgA secreting plasma cells - ultimately reside in the lamina proporia
31. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
IBS at least 2 with recurrent abdominal pain
Zollinger Ellison - phenylalanine and tryptophan
Duodenum - 2nd - 3rd and 4th parts
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
32. How do burns cause acute gastritis and What is it called
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33. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Omeprazole
Downs
Lubricate food (glycoprotiens)
Pleomorphic adenoma
34. What does K- ras mutation cause
All 3 gut layers outpouch as in Meckels
Pleuroperitoneal
Positive urease test
Upregulated intracellular signal transduction
35. What is contained within the muscularis externa
Myenteric nerve plexus - aurbach
Boerhaave's Syndrome - Been heaving syndrome
Cigarettes and chronic pancreatitis - not EtOH
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
36. A protrusion of peritoneum through an opening - usually a site of weakness
Failure of the processus vagainlis to close
Hypotonic because of more time to reabsorb NaCl
Hernia
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
37. In alchoholic hepatitis which liver enzyme is higher
Hemosiderosis - hemochromatosis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
AST>ALT
Reye's syndrome
38. In what clinical scenarior do you see portosystemic anastomoses
Pleomorphic adenoma
Portal HTN
Pancreatic and bile
GERD - may also present with nocturnal cough and dyspnea
39. What parts of the small bowel can tropical sprue effect
Redundant mesentary
Intussusception
The entire
90%
40. Where is the pectinate line
Centrilobular congestion and necrosis - cardiac cirrhosis
Where hindgut meets ectoderm
Crigler - najjar type 1
IgA secreting plasma cells - ultimately reside in the lamina proporia
41. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Hepatic steatosis
Juvenille polyps - no risk if single
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Cimetidine
42. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Black - rotors syndrome
Fasting and stress
Appendicitis
Internal thoracic to superior epigastric to inferior epigastric
43. What is the most common diaphragmatic hernia and What are the two types
Cholesterol
Meconium ileus
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Begins starch digestion - inactivated by low pH upon reaching the stomach
44. Abuse of what substance leads to acute gastritis
Duodenal atresia - Downs
EtOH
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
45. What can fistula between the gallbladder and small intestine create and how can you tell
AR
Decreased intercellular adhesion and increased proliferation
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Dense core bodies
46. What is contained in the gastrosplenic and What areas does it separate
AST >ALT - ration is usually 1.5
Alcoholic hepatitis
Short gastrics - left greater and lesser
Black - rotors syndrome
47. Who gets Whipple disease and How do they present
Phenobarbital - inc liver enzyme synthesis
Old men - arthralgias - cardiac and neuro sx
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Virchow's node
48. malnutrition - toxic megacolon - colorectal carcinoma
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Complications of UC
Bleeding - intussusception - volvulus - obstruction near terminal ileum
CCK8 receptor - Gq inc IP3/Ca
49. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
M3 - Gq - inc IP3/Ca
Peyers patches
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
50. What are the foregut structures and what supplies their blood and PANS innvervation
External (superficial) ring only
Antrum - H.pylori - inc risk of MALT lymphoma
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia