SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
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 bicarb trapped
In the mucus that covers the gastric epithelium
Phototherapy
Celiac sprue
Upregulated intracellular signal transduction
2. Where is IgA shuttled
Small intestine
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Lactase is located at the tips of intestinal villi
The gastroduodenal
3. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Appendicitis
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
4. Where is folate absorbed
Mallory bodies
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Punched out - clean margins - carcinoma =raised irregular margins
The jejunum
5. What serum markers increase in cholecystitis with bile duct involvement
Smooth
Alk phos
Hernia
Myenteric nerve plexus - aurbach
6. What histological findings are present in the stomach
Smooth
Gastric glands
Ischemic colitis
Above
7. What parts of the small bowel can tropical sprue effect
Barrett's esophagus
The entire
Budd chiari syndrome
When diffusely infiltrative - thickened rigid appearance like a leather bottle
8. What pancreatic proteases are secreted as zymogens
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Trypsin - chymotrypsin - elastase - carboxypeptidases
Brush border of intestine - produce monosaccharides from oligo and di
Jaundice - fever - RUQ
9. What do you use to diagnose meckels
H2 receptor - inc cAMP
Ceruplasmin
Poor anastamoses
Pertechnetate - study for uptake
10. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Inc risk of CRC and other visceral malignancies
Zenkers - halitosis - dysphagia and obstruction
Brunners
H2 receptor - inc cAMP
11. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Oligosaccharide digestion
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Small intestine
Gilbert's
12. Who gets gastric ulcers
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Older patients
Conj - inc - dec
The submucosal nerve plexus - meissner's
13. How does gastrin increase acid secretion?
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Gardner's syndrome
Epithelium
Primarly through ECL leading to histamine release
14. Which serum enzyme increases with heavy EtOH consumption
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Gamma glutamyl transferase GGT
Meconium ileus
Neutralizes oral bacertial acids and maintains dental health
15. Where is the pectinate line
Causes of gall stones
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Meckels
Where hindgut meets ectoderm
16. What is the risk with peutz jehgers
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
L1
Inc risk of CRC and other visceral malignancies
Meconium ileus
17. What is the most important mechanism in gastric acid secretion
Increase tumorigenesis
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
True and most common congenital anomoly of GI tract
Black - rotors syndrome
18. conjugated hyperbilirubinemia due to defective liver excretion
Primary sclerosing cholangitis
Dubin johnson
IgA secreting plasma cells - ultimately reside in the lamina proporia
Alcoholic hepatitis
19. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Worldwide - SC - US - adeno
Alpha1 antitrypsin def - codominant trait
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Muscularis mucosae
20. How does CRC present in the distal and proximal colon
HSV-1 - CMV - Candida
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Lubricate food (glycoprotiens)
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
21. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Source - parasympathetic ganglion in sphincters - gallbladder - small intestine - action - inc intestinal water and electrolyte secretion - inc relaxation of intestinal smooth muscle and sphincters - regulation - inc by distention and vagal stimulati
Unconj - absent (acholuria) - inc
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Zollinger ellison - brunners glands
22. What does autoimmune destruction of parietal cells lead to...
Chronic gastritis and pernicious anemia
Bleeding - penetration into pancreas - perforation - obstruction
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Around the central vein (zone III)
23. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
L/R renal artery around L1
Conj - inc - dec
Juvenille polyps - no risk if single
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
24. What does a gastrinoma cause
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Elevated amylase - and lipase
Chagas disease
25. If the abdominal aorta is blocked - How does blood get to the left colic artery
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Via the middle colic
Crigler - najjar type 1
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
26. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Redness and tenderness on palpation of extremities
Internal thoracic to superior epigastric to inferior epigastric
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
27. What findings are associated with reyes
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Mallory bodies
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
28. Where are carcinoid tumors most commonly malignant
Hepatic steatosis
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Small intestine
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
29. signet ring cells - acanthosis nigracans - dz - character/association - spread
Primary sclerosing cholangitis
Crypts but not villi
Unconjugated - water insoluble
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
30. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Juvenille polyps - no risk if single
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Alk pho
31. Achalasia can be secondary to what infectious disease common in South America
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Chagas disease
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Hemosiderosis - hemochromatosis
32. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
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
Colonic polyps
Femoral hernia
Crohns = noncaseating granulomas - UC = crypt abscesses
33. Where are tumors commonly in pancreatic adenocarcinoma
Pancreatic head causing obstructive jaundice
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Antrum - H.pylori - inc risk of MALT lymphoma
34. In PUD with a duodenal ulcer does pain inc or dec with meals
Decrease - weight gain
Brush border of intestine - produce monosaccharides from oligo and di
True and most common congenital anomoly of GI tract
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
35. What layer in the mucosa is responsible for absorption
Can lead to hematemesis - found in EtOHics and bulimics
Alpha amylase
Epithelium
Inferior rectal nerve
36. What are the labs in acute pancreatitis
Colovesical leading to pneumaturia
Elevated amylase - and lipase
Inc risk of CRC and other visceral malignancies
Hirschsprungs
37. What congenital birth defect is associated with Hirschsprung
Left gastric vein and esophogeal vein - esophagus
Downs
Inc risk of CRC and other visceral malignancies
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
38. What are the four Fs of gallstones
Lactase is located at the tips of intestinal villi
Skip lesions =crohns - colon = UC
Inguninal ligament - sartorius muscle - adductor longus
Female - fat - fertile - forty
39. What commonly leads to appendicity in kids vs adults
With albumin
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Cirrhosis
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
40. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Lactase is located at the tips of intestinal villi
Cirrhosis
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Antrum - H.pylori - inc risk of MALT lymphoma
41. How does abetalipoproteinemia lead to malabsorption
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Redness and tenderness on palpation of extremities
Early childhood - neuro sx and malabsorption
Causes of gall stones
42. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Hirschsprungs
Hepatic steatosis
Low pressure proximal to LES
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
43. What does K- ras mutation cause
Upregulated intracellular signal transduction
Adhesion
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Redness and tenderness on palpation of extremities
44. What are the midgut structures and what supplies their blood and PANS innervation
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Jaundice - fever - RUQ
Centrilobular congestion and necrosis - cardiac cirrhosis
Diverticulum
45. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Meckels
46. What does alpha amylase do and what inactivates it
H2 receptor - inc cAMP
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Begins starch digestion - inactivated by low pH upon reaching the stomach
Dense core bodies
47. Where does crohns usually affect the GI tract
Terminal ileum and colon
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
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Mucoepidermoid carcinoma
48. What causes primary biliary cirrhosis
Hemosiderosis - hemochromatosis
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Primarly through ECL leading to histamine release
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
49. B cells stimuated in the germinal centers of peyers patches differentiate into what?
GERD - may also present with nocturnal cough and dyspnea
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
IgA secreting plasma cells - ultimately reside in the lamina proporia
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
50. What infection causes Whipple disease and What can you see on LM
Turcot
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Stercobilin