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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 kind of muscle is in the lower 1/3 of the esophagus
Smooth
T12
Jewish and African American men
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
2. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Liver metabolizes 5HT
3 waves/min
Juvenille polyps - no risk if single
H pylori (almost 100%)
3. What receptor does histamine bind on the parietal cell and What does it activate
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
H2 receptor - inc cAMP
Nonkeritinized stratified sqamous epithelium
Hepatic steatosis
4. What reaction does salivary amylase catalyze
Lipase
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
5. What are the structures of the femoral triangle and how are they organized
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Cystic dilation of the viteline duct
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
NAV = nerve artery vein - venous near the penis (NAVEL)
6. in budd chiari syndrome - Where is the congestion and necrosis
Meckels
T cell lymphoma
Centrilobular leading to congestive liver disease
Alk pho
7. How does abetalipoproteinemia lead to malabsorption
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
External (superficial) ring only
8. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Increase tumorigenesis
With albumin
HPNCC
9. What kind of pathways do CCK act on to cause pancreatic secretion
Spleen to posterior abdominal wall - splenic artery and vein
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Muscularis mucosae
Neural muscarinic pathways
10. What does a gastrinoma cause
Muscularis mucosae
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
...
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
11. Abuse of what substance leads to acute gastritis
EtOH
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Inc lower esphogeal tone leading to achalasia
12. What parts of the small bowel can tropical sprue effect
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Mucosa - submucosa - muscularis externa - serosa/adventitia
The entire
Decrease - weight gain
13. signet ring cells - acanthosis nigracans - dz - character/association - spread
Fasting and stress
Via the middle colic
In the ileum with bile acids - requires IF
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
14. What kind of anemia is in Wilsons
Hemolytic anemia
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Nonkeritinized stratified sqamous epithelium
15. What are additional risk factors for CRC
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Causes of gall stones
HSV-1 - CMV - Candida
Mallory bodies
16. Which viral infxns/treatments are associated with reyes syndrome
VZV and influenza B treated with salicylates
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
IBS at least 2 with recurrent abdominal pain
Unconjugated - water insoluble
17. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Inguninal ligament - sartorius muscle - adductor longus
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
2ndary biliary cirrhosis
Pertechnetate - study for uptake
18. What cells make pepsin - What does it do - and what regulates it
Positive
Lateral to the inferior epigastric artery
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Female - fat - fertile - forty
19. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Volvulus
With albumin
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Angiodysplasia
20. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Crohns = noncaseating granulomas - UC = crypt abscesses
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Pyoderma gangrenosum - primary sclerosing cholangitis
21. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Alfatoxin in peanuts
22. What does loss of p53 cause
Adhesion
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Redness and tenderness on palpation of extremities
Increase tumorigenesis
23. Where does type A chronic gastritis occur and What causes it
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Internal thoracic to superior epigastric to inferior epigastric
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Neural muscarinic pathways
24. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
US and cholecystectomy
Alcoholic cirrhosis
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
25. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
L/R renal artery around L1
Peutz jeghers
Conj - inc - dec
26. inflammatino of gallbadder
Closer to isotonic because of less time to reabsorb NaCl
Begins starch digestion - inactivated by low pH upon reaching the stomach
Ischemic colitis
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
27. What kind of pancreatitis is associated with EtOH and smoking
Cystic duct and common hepatic duct
Via the middle colic
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Dilated esophagus with an area of distal stenosis - birds beak
28. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Via the superior pancreaticduodenal
Inspiratory arrest on deep palpation due to pain
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
AST
29. Where is bicarb trapped
Conj - inc - dec
Boerhaave's Syndrome - Been heaving syndrome
Duodenum - 2nd - 3rd and 4th parts
In the mucus that covers the gastric epithelium
30. What kind of digestion is bile needed for
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Warthins' tumor
Cigarettes and chronic pancreatitis - not EtOH
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
31. In alchoholic hepatitis which liver enzyme is higher
Alk pho
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
AST>ALT
Gastrohepatic ligament
32. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
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
Dysphagia (due to esophageal web) - glossitis - iron def anemia
AST>ALT
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
33. How does loss of NO secretion affect the esophagus and what results
Small intestine
Brush border of intestine - produce monosaccharides from oligo and di
Turcot
Inc lower esphogeal tone leading to achalasia
34. subQ peribumbilical metastasis
Crohns = noncaseating granulomas - UC = crypt abscesses
Duodenal atresia - Downs
Sister mary joseph nodule
Phototherapy
35. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Conj - inc - dec
Repeated phlebotomy - deferoxamine - HLA- A3
Diverticulum
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
36. What does bicab do in the mouth
Neutralizes oral bacertial acids and maintains dental health
NAV = nerve artery vein - venous near the penis (NAVEL)
Primarly through ECL leading to histamine release
Crypts but not villi
37. With internal hemorrhoids Where is the anastomoses and Where is it
Superior rectal and middle and inferior rectal - rectum
Right and left hepatic duct
Uremia
VZV and influenza B treated with salicylates
38. Why does volvulus occur more at cecum and sigmoid colon
Peyers patches
Gut bacteria
Redundant mesentary
Omeprazole
39. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Short gastrics - left greater and lesser
Can lead to hematemesis - found in EtOHics and bulimics
2ndary biliary cirrhosis
Diarrhea - steatorrhea - weight loss - weakness
40. What transforms conjugated bilirubin to urobilinogen
Glucouronate - water soluble (direct)
Gut bacteria
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
41. What does TOASTED with alcoholic hepatitis stand for
FAP
ALT>AST
AST >ALT - ration is usually 1.5
Dec PGE2 leading to dec gastric mucosa protection
42. What are the layers of the gut wall from inside out
Striated and smooth
Esophageal cancer
Inc lower esphogeal tone leading to achalasia
Mucosa - submucosa - muscularis externa - serosa/adventitia
43. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Cimetidine
Lamina propora and submucosa
8-9 waves/min
Alk pho
44. What pancreatic proteases are secreted as zymogens
Trypsin - chymotrypsin - elastase - carboxypeptidases
L2
Cystic duct and common hepatic duct
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
45. What are the two molecular pathways that lead to CRC
Cholesterol - 10-20% opaque due to calcifications
MSI (15%) and APC/beta catenin chromosomal instability (85%)
2ndary biliary cirrhosis
Failure of the processus vagainlis to close
46. Why would a self - limited lactase def occur following an injury (viral diarrhea)
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Lactase is located at the tips of intestinal villi
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Portal HTN
47. What converts inactive pepsinogen to pepsin
Hemosiderosis - hemochromatosis
Ampulla of vater
H+
True and most common congenital anomoly of GI tract
48. How does CRC present in the distal and proximal colon
Mallory bodies
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Liver metabolizes 5HT
49. What does high flow rate mean
Paraumbilical and superficial and inferior epigastric - umbilicus
Closer to isotonic because of less time to reabsorb NaCl
Amylase
Brush border of intestine - produce monosaccharides from oligo and di
50. Transmural esophageal rupture due to violent retching