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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. trypsinogen is converted to trypsin via what enzyme
Enterokinase/enteropeptidase from the duodenal mucosa
Krukenbergs tumor
Meckels
Barrett's esophagus
2. Which IBD is autoimmune and which may be a disordered response to bacteria
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Increase tumorigenesis
8-9 waves/min
2ndary biliary cirrhosis
3. What does bicarb do in the duodenum
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Adhesion
Spleen to posterior abdominal wall - splenic artery and vein
Angiodysplasia
4. At what spinal level does the celiac trunk exit
Alpha1 antitrypsin def - codominant trait
Cholesterol
Reye's syndrome
T12
5. What is Trousseau's sign
ALT>AST
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Redness and tenderness on palpation of extremities
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
6. What are the complications of chronic pancreatitis
Enterokinase/enteropeptidase from the duodenal mucosa
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
HPNCC
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
7. Are single polyps malignant in peutz jehgers
No
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
All 3
Primarly through ECL leading to histamine release
8. What are the longterm sequelae of nutmeg liver
Centrilobular congestion and necrosis - cardiac cirrhosis
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Superior rectal and middle and inferior rectal - rectum
Ampulla of vater
9. Which area of the hindgut is a watershed area
Esophageal cancer
Splenic flexure
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
10. What complication can arise from indirect inguinal hernias
Closer to isotonic because of less time to reabsorb NaCl
Hydrocele
Old men - arthralgias - cardiac and neuro sx
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
11. subQ peribumbilical metastasis
Closer to isotonic because of less time to reabsorb NaCl
3 waves/min
Sister mary joseph nodule
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
12. What cells secrete bicarb - What does it do - and what regulates it
In the ileum with bile acids - requires IF
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
13. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Portal HTN
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Achalasia due to loss of myenteric plexus (auberach)
14. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Esophageal varices
Colonic polyps
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
15. What structures feed into the common hepatic duct
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Right and left hepatic duct
...
All 3 gut layers outpouch as in Meckels
16. crigler - najjar type II responds to which therapy and How does it work
Ampulla of vater
Phenobarbital - inc liver enzyme synthesis
T12
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
17. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
CEA - CA-19-9
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
18. Where does an indirect inguinal hernia enter the deep inguinal ring
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Bleeding - penetration into pancreas - perforation - obstruction
In the mucus that covers the gastric epithelium
Lateral to the inferior epigastric artery
19. What is contained within the muscularis externa
Hypercoaguability - polycythemia vera - pregnancy - HCC
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Myenteric nerve plexus - aurbach
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
20. somatostatin - source - action - regulation
Decreased intercellular adhesion and increased proliferation
Tropical sprue
Crypts but not villi
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
21. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Ceruplasmin
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Alpha1 antitrypsin def - codominant trait
22. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Uremia
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Complications of crohns
23. What artery passes around the duodenum
The gastroduodenal
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
So hypertrophied they look like brain gyri
T cell lymphoma
24. How is salivary secretion stimulated
Stercobilin
Hyperplastic
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Diverticulitis in elderly - ectopic pregs use hCG to rule out
25. What is the epi for CRC
Cystic dilation of the viteline duct
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
26. What test and result confirms H pylori infxn
Dubin johnson
Positive urease test
Epithelium
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
27. What are the branches of the celiac trunk and What do they supply
Pleomorphic adenoma
Common hepatic - splenic - left gastric - main blood supply for stomach
Brush border of intestine - produce monosaccharides from oligo and di
HSV-1 - CMV - Candida
28. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
All 3 gut layers outpouch as in Meckels
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Hypercoaguability - polycythemia vera - pregnancy - HCC
Zollinger Ellison - phenylalanine and tryptophan
29. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
The entire
Crohns = maybe - UC= always
Repeated phlebotomy - deferoxamine - HLA- A3
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
30. Where does type B chronic gastritis occur and What causes it
Antrum - H.pylori - inc risk of MALT lymphoma
Jewish and African American men
Crohns = noncaseating granulomas - UC = crypt abscesses
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
31. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Zollinger Ellison - phenylalanine and tryptophan
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Copious diarrhea - non alpha - non beta cell pancreatic tumor
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
32. At what spinal level does the is the bifurcation of aorta
L4
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Zollinger Ellison - phenylalanine and tryptophan
Copious diarrhea - non alpha - non beta cell pancreatic tumor
33. What kind of lesions are characteristic of duodenal PUD vs cancer
Unconj - absent (acholuria) - inc
Punched out - clean margins - carcinoma =raised irregular margins
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Positive urease test
34. What does loss of p53 cause
Lateral
Cirrhosis
Via the superior pancreaticduodenal
Increase tumorigenesis
35. What are the complications of Meckels
Osmotic
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Terminal ileum and colon
36. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
...
Below
Phenobarbital - inc liver enzyme synthesis
Older patients
37. What factors increase risk of malignancy of adenomatous polyps
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Inguninal ligament - sartorius muscle - adductor longus
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Fe2+ in the duod
38. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
H2 receptor - inc cAMP
Inc conj bilirubin - inc cholesterol - inc alk phos
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
PAS- positive globules in liver -
39. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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40. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
Normal
Skip lesions =crohns - colon = UC
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Hypercoaguability - polycythemia vera - pregnancy - HCC
41. What gives stool its characteristic color
Erosive - disruption of mucosal barrier leading to inflammation
Stercobilin
Epithelium
Worldwide - SC - US - adeno
42. Autodigestion of pancreas by pancreatic enzymes
Alk pho
Where hindgut meets ectoderm
Acute pancreatitis
T12
43. Gallstones that reach the common channel at ampulla can block which two ducts
Pancreatic and bile
Menetriers disease
FAP
CCK8 receptor - Gq inc IP3/Ca
44. What intervention will intervention will relieve portal HTN
Terminal ileum and colon
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Below
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
45. What is the risk with peutz jehgers
Amylase
Inc risk of CRC and other visceral malignancies
Glucouronate - water soluble (direct)
Lack or have an attenuated muscularis externa - often in the sigmoid colon
46. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Below
So hypertrophied they look like brain gyri
Conj/unconj - inc - nl to dec
47. Where is the pectinate line
So hypertrophied they look like brain gyri
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Where hindgut meets ectoderm
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
48. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Peptic ulcer disease
The submucosal nerve plexus - meissner's
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Esophageal varices
49. What is a positive murphy's sign
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Serous on the sides parotids - mucinous in the middle sublingual
CCK8 receptor - Gq inc IP3/Ca
Inspiratory arrest on deep palpation due to pain
50. What is pancreatic adenocarcinoma associated with
Hepatic steatosis
Cigarettes and chronic pancreatitis - not EtOH
No - chronic - can present with diarrhea or constipation or alternation - treat sx
IBS at least 2 with recurrent abdominal pain