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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. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Pyoderma gangrenosum - primary sclerosing cholangitis
AST >ALT - ration is usually 1.5
2. What drug inhibits the H/K ATPase
Portal HTN
Gamma glutamyl transferase GGT
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Omeprazole
3. What is Trousseau's sign
Neutralizes gastric acid allowing pancreatic enzymes to fxn
3 waves/min
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Redness and tenderness on palpation of extremities
4. What retroperitoneal structure flanks both sides of the pancreas on CT
FAP
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Duodenum - 2nd - 3rd and 4th parts
5. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Common hepatic - splenic - left gastric - main blood supply for stomach
Positive
Peutz jeghers
AR
6. How many layers of spermatic fascia are covers an indirect inguinal hernia
Superior rectal
Skip lesions =crohns - colon = UC
Crigler - najjar type 1
All 3
7. likely infectious form of malabsorption - responds to antibiotics
Tropical sprue
External spermatic fascia only
Virchow's node
Via the middle colic
8. When and why is stomach cancer termed linitis plastica
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Backup of blood into the liver - RHF - budd chiari
Old men - arthralgias - cardiac and neuro sx
Carcinoid syndrome
9. If the abdominal aorta is blocked - How does blood get to the left colic artery
Hyperpigmented mouth - lips - hands - genitalia
Downs
Via the middle colic
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
10. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
In the ileum with bile acids - requires IF
11. What causes primary biliary cirrhosis
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Dubin johnson
Hypotonic because of more time to reabsorb NaCl
12. Through which aspect of the inguinal canal does a direct inguinal go
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Heme metabolism
External (superficial) ring only
Epithelium
13. motilin - source - action - regulation
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Conj - inc - dec
Diverticulitis in elderly - ectopic pregs use hCG to rule out
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
14. What is the most common indication of emergent abdominal surgery in children
Common hepatic - splenic - left gastric - main blood supply for stomach
Appendicitis
Squamous - upper 1/3 - adeno - lower 1/3
Punched out - clean margins - carcinoma =raised irregular margins
15. trypsinogen is converted to trypsin via what enzyme
Stimulate the H/K ATPase
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Enterokinase/enteropeptidase from the duodenal mucosa
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
16. Why does indirect inguinal hernia happen in infacnts
Alfatoxin in peanuts
Failure of the processus vagainlis to close
AST>ALT
Appendicitis
17. What is the frequency of basal electric rhythm of the ilieum
Unconj - absent (acholuria) - inc
8-9 waves/min
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Primarly through ECL leading to histamine release
18. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Hemosiderosis - hemochromatosis
L/R renal artery around L1
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Left gastric vein and esophogeal vein - esophagus
19. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Sphincter of oddi
FAP
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Zenkers - halitosis - dysphagia and obstruction
20. What is the ddx associated with appendicitis
Diverticulitis in elderly - ectopic pregs use hCG to rule out
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Primarly through ECL leading to histamine release
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
21. At what spinal level does the is the bifurcation of aorta
Below
L4
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Mucoepidermoid carcinoma
22. What kind of anemia is in Wilsons
Hemolytic anemia
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
Hemosiderosis - hemochromatosis
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
23. Failure of relaxation of lower esophageal sphincter - Name and etiology
Achalasia due to loss of myenteric plexus (auberach)
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
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Lamina propria
24. Transmural esophageal rupture due to violent retching
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25. In PUD with a duodenal ulcer does pain inc or dec with meals
US and cholecystectomy
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Dec PGE2 leading to dec gastric mucosa protection
Decrease - weight gain
26. What is contained within the submucosa
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27. People of what decent are associated with celiac sprue and what findings/antibodies are present
All 3
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
CHF and inc risk of HCC
Lye ingestion and acid reflux
28. 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
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
90%
Sphincter of oddi
29. Where are tumors commonly in pancreatic adenocarcinoma
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
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
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Pancreatic head causing obstructive jaundice
30. What infection causes Whipple disease and What can you see on LM
2ndary biliary cirrhosis
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Lactase is located at the tips of intestinal villi
Adhesion
31. What is the main symptom if a VIPoma
Antrum - H.pylori - inc risk of MALT lymphoma
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Amylase
Unconj - absent (acholuria) - inc
32. What does histo show for alpha1 antitrypsin def
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Colonic polyps
PAS- positive globules in liver -
Hemosiderosis - hemochromatosis
33. At what spinal level does the SMA exit
Phototherapy
L1
Cystic duct and common hepatic duct
Gut bacteria
34. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Conj - inc - dec
Failure of the processus vagainlis to close
35. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
The jejunum
Centrilobular leading to congestive liver disease
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Inc conj bilirubin - inc cholesterol - inc alk phos
36. How does CRC present in the distal and proximal colon
Myenteric nerve plexus - aurbach
Complications of UC
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Ischemic colitis
37. How do villi appear in disaccharidease def
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Normal
Positive urease test
Penicillinamine - AR inheritance
38. At what level do the testicular/ovarian arteries exit the aorta
L2
Barrett's esophagus
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Menetriers disease
39. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Lamina propria
Ischemic colitis
Inguninal ligament - sartorius muscle - adductor longus
Older patients
40. Acute gastritis is caused By what process
Erosive - disruption of mucosal barrier leading to inflammation
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
L1
41. If trypsin activates more trypsinogen - what kind of feedback loop is established
Right and left hepatic duct
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
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
Positive
42. What are motilin receptor agonists used for clinically
Stimulate intestinal persistalsis
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Penicillinamine - AR inheritance
43. Autodigestion of pancreas by pancreatic enzymes
Reye's syndrome
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Acute pancreatitis
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
44. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Colonic polyps
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
L2
45. Why would a self - limited lactase def occur following an injury (viral diarrhea)
PAS- positive globules in liver -
Femoral hernia
Lactase is located at the tips of intestinal villi
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
46. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
HPNCC
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
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
Primarly through ECL leading to histamine release
47. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
H+
Cholesterol - 10-20% opaque due to calcifications
Epithelium
Above
48. What conditions are associated with budd chiari
Hypercoaguability - polycythemia vera - pregnancy - HCC
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Brunners
Inc conj bilirubin - inc cholesterol - inc alk phos
49. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Complications of UC
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Cirrhosis
Crohns = noncaseating granulomas - UC = crypt abscesses
50. Where are carcinoid tumors most commonly malignant
Ampulla of vater
NAV = nerve artery vein - venous near the penis (NAVEL)
Small intestine
Unconj - absent (acholuria) - inc