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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 pancreatic proteases are secreted as zymogens
Trypsin - chymotrypsin - elastase - carboxypeptidases
T cell lymphoma
AST>ALT
Phenobarbital - inc liver enzyme synthesis
2. What layer in the mucosa is responsible for absorption
Epithelium
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Striated
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
3. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Via the superior pancreaticduodenal
Crohns = maybe - UC= always
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
4. What are the layers of the gut wall from inside out
Mucosa - submucosa - muscularis externa - serosa/adventitia
Gardner's syndrome
Mallory bodies
Cholesterol
5. What layer in the mucosa is responsible for support
Lamina propria
Alk pho
Glucouronate - water soluble (direct)
Zenkers - halitosis - dysphagia and obstruction
6. What does autoimmune destruction of parietal cells lead to...
Glucose dependent insulinotropic peptide
Chronic gastritis and pernicious anemia
Cystic duct and common hepatic duct
Dysphagia (due to esophageal web) - glossitis - iron def anemia
7. What is the path of an indirect inguinal hernia
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Alk phos
Falciform - ligamentum teres - fetal umbilical vein
8. 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
L4
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Hydrocele
9. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
L1
Hyperplastic
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
10. A protrusion of peritoneum through an opening - usually a site of weakness
PAS- positive globules in liver -
Crypts but not villi
Hernia
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
11. What is the sphincter of the pancreatic duct
Older patients
Mallory bodies
Spleen to posterior abdominal wall - splenic artery and vein
Sphincter of oddi
12. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Liver metabolizes 5HT
Skip lesions =crohns - colon = UC
Alcoholic hepatitis
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
13. What layer in the mucosa is repsonsible for motility
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Muscularis mucosae
Gut bacteria
Stimulate the H/K ATPase
14. conjugated hyperbilirubinemia due to defective liver excretion
Liver metabolizes 5HT
Epithelium
Paraumbilical and superficial and inferior epigastric - umbilicus
Dubin johnson
15. What is pancreatic adenocarcinoma associated with
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Cigarettes and chronic pancreatitis - not EtOH
Lamina propria
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
16. What is the main symptom if a VIPoma
Inc conj bilirubin - inc cholesterol - inc alk phos
Copious diarrhea - non alpha - non beta cell pancreatic tumor
L4
Decrease - weight gain
17. What does a low flow rate mean for saliva
Uridine glucuronyl transferase
Squamous - upper 1/3 - adeno - lower 1/3
Hypotonic because of more time to reabsorb NaCl
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
18. What is diverticulosis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Intussusception
Juvenille polyps - no risk if single
19. With internal hemorrhoids Where is the anastomoses and Where is it
Jaundice - fever - RUQ
Superior rectal and middle and inferior rectal - rectum
12 waves/min
Ampulla of vater
20. somatostatin - source - action - regulation
L3
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
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
Epithelium
21. What parts of the small bowel can tropical sprue effect
Increase tumorigenesis
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
The entire
Gallbladder
22. What are the signs and symptoms of budd chiari
Dec PGE2 leading to dec gastric mucosa protection
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Redness and tenderness on palpation of extremities
True and most common congenital anomoly of GI tract
23. concentric onion skin bile duct fibrosis
Primary sclerosing cholangitis
Pleomorphic adenoma
IgA secreting plasma cells - ultimately reside in the lamina proporia
Older patients
24. What receptors does ACH bind on the parietal cells and What does it activate
M3 - Gq - inc IP3/Ca
Lubricate food (glycoprotiens)
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
25. When do you see hypertrophy of brunners glands
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Peptic ulcer disease
Epigastric abdominal pain radiating to back - anorexia - nausea
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
26. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
AST
Squamous - upper 1/3 - adeno - lower 1/3
Falciform - ligamentum teres - fetal umbilical vein
Oligosaccharide digestion
27. What are motilin receptor agonists used for clinically
FAP
Falciform - ligamentum teres - fetal umbilical vein
Jaundice - fever - RUQ
Stimulate intestinal persistalsis
28. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus
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29. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Pancreatic head causing obstructive jaundice
Oral glucose
AST>ALT
Internal thoracic to superior epigastric to inferior epigastric
30. What kind of pancreatitis is associated with EtOH and smoking
Duodenal atresia - Downs
Chronic calcifying pancreatitis - inc risk of panreatic cancer
The jejunum
Crohns = noncaseating granulomas - UC = crypt abscesses
31. likely infectious form of malabsorption - responds to antibiotics
Pleuroperitoneal
External spermatic fascia only
Tropical sprue
Short gastrics - left greater and lesser
32. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Poor anastamoses
Lipase - phospholipase A - colipase
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Peutz jeghers
33. At what level do the testicular/ovarian arteries exit the aorta
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Sphincter of oddi
Epigastric abdominal pain radiating to back - anorexia - nausea
L2
34. What pancreatic enzymes are responsible for fat digestion
Lipase - phospholipase A - colipase
Increase tumorigenesis
Chagas disease
Dec PGE2 leading to dec gastric mucosa protection
35. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Internal thoracic to superior epigastric to inferior epigastric
Right and left hepatic duct
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
36. What does loss of p53 cause
Increase tumorigenesis
Esophageal carcinoma
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
H2 receptor - inc cAMP
37. What does primary sclerosing cholangitis lead to...
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Punched out - clean margins - carcinoma =raised irregular margins
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Trypsin - chymotrypsin - elastase - carboxypeptidases
38. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Oligosaccharide digestion
Early childhood - neuro sx and malabsorption
Complications of crohns
Reye's syndrome
39. If trypsin activates more trypsinogen - what kind of feedback loop is established
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Enterokinase/enteropeptidase from the duodenal mucosa
Positive
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
40. What is the leading cause of bowel incarceration
Femoral hernia
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Gastrohepatic ligament
Right and left hepatic duct
41. What is the arterial supply and venous drainage below pectinate line
Acute pancreatitis
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
AST
Bleeding - penetration into pancreas - perforation - obstruction
42. What do you use to diagnose meckels
Carcinoid syndrome
Pertechnetate - study for uptake
Enterokinase/enteropeptidase from the duodenal mucosa
Fasting and stress
43. blind pouch protruding from alimentary tract that communicates with lumen of the gut
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
True and most common congenital anomoly of GI tract
Liver metabolizes 5HT
Diverticulum
44. Where does type B chronic gastritis occur and What causes it
Antrum - H.pylori - inc risk of MALT lymphoma
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Where hindgut meets ectoderm
45. What does histo show for alpha1 antitrypsin def
Peyers patches
Oligosaccharide digestion
PAS- positive globules in liver -
Common hepatic - splenic - left gastric - main blood supply for stomach
46. Where does crohns usually affect the GI tract
CEA - CA-19-9
Gamma glutamyl transferase GGT
Terminal ileum and colon
Hernia
47. Malabsorption syndromes have what common clinical presentation
Pancreatic and bile
Diarrhea - steatorrhea - weight loss - weakness
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
48. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Sphincter of oddi
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Short gastrics - left greater and lesser
49. What makes a true diverticula
When diffusely infiltrative - thickened rigid appearance like a leather bottle
All 3 gut layers outpouch as in Meckels
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
CHF and inc risk of HCC
50. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
AST
Conj/unconj - inc - nl to dec
IgA secreting plasma cells - ultimately reside in the lamina proporia
Hyrdolyzes alpha 1-4 linkages to yield disaccharides