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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. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Duodenum - 2nd - 3rd and 4th parts
Dense core bodies
Juvenille polyps - no risk if single
2. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Enterokinase/enteropeptidase from the duodenal mucosa
Uridine glucuronyl transferase
Complications of crohns
2ndary biliary cirrhosis
3. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Parietal cells in the stomach - B12 binding protein
GERD - may also present with nocturnal cough and dyspnea
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Around the central vein (zone III)
4. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Conj - inc - dec
CHF and inc risk of HCC
Barrett's esophagus
Nonkeritinized stratified sqamous epithelium
5. What transforms conjugated bilirubin to urobilinogen
Alpha amylase
IgA secreting plasma cells - ultimately reside in the lamina proporia
Inguninal ligament - sartorius muscle - adductor longus
Gut bacteria
6. What factors increase risk of malignancy of adenomatous polyps
Dec PGE2 leading to dec gastric mucosa protection
Cystic dilation of the viteline duct
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Centrilobular congestion and necrosis - cardiac cirrhosis
7. Achalasia can be secondary to what infectious disease common in South America
Erosive - disruption of mucosal barrier leading to inflammation
Chagas disease
Esophageal carcinoma
No - chronic - can present with diarrhea or constipation or alternation - treat sx
8. Through which aspect of the inguinal canal does a direct inguinal go
Closer to isotonic because of less time to reabsorb NaCl
Dissaccharidase def - most commonly lactase
External (superficial) ring only
L4
9. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Angiodysplasia
Achalasia due to loss of myenteric plexus (auberach)
Penicillinamine - AR inheritance
Cirrhosis
10. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Hemosiderosis - hemochromatosis
Hydrocele
HSV-1 - CMV - Candida
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
11. What causes pancreatic insuff and What does it cause
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Alpha1 antitrypsin def - codominant trait
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
12. What is the omphalomesenteric cyst
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Lamina propora and submucosa
Cystic dilation of the viteline duct
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
13. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Hypotonic because of more time to reabsorb NaCl
Amylase
Volvulus
Pleomorphic adenoma
14. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Osmotic
Alcoholic cirrhosis
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
15. Acute gastritis is caused By what process
Erosive - disruption of mucosal barrier leading to inflammation
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
Striated
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
16. What do tumors that arise in the head of the pancreas cause
Gardner's syndrome
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Barrett's esophagus
Obstruction of the common bile duct
17. How is salivary secretion stimulated
Lipase - phospholipase A - colipase
Uridine glucuronyl transferase
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
18. What artery passes around the duodenum
The gastroduodenal
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Bleeding - penetration into pancreas - perforation - obstruction
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
19. What is the TX of physiologic neonatal jaundice
Phototherapy
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
The gastroduodenal
20. What does bicarb do in the duodenum
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Turcot
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Above
21. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
The submucosal nerve plexus - meissner's
Superior rectal
Omeprazole
Duodenal atresia - Downs
22. What portion of the bowel does sprue effect
The proximal small bowel
Crigler - najjar type 1
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
12 waves/min
23. In PUD with a duodenal ulcer does pain inc or dec with meals
Decrease - weight gain
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
ALT>AST
Common hepatic - splenic - left gastric - main blood supply for stomach
24. At what spinal level does the SMA exit
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Amylase
Copious diarrhea - non alpha - non beta cell pancreatic tumor
L1
25. What are the main components of bile
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Averages 6 months - very aggressive - usually already metastasized at presentation
Tropical sprue
Intussusception
26. most common malignant salivary gland tumor
Brunners
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Mucoepidermoid carcinoma
27. Is there any structural abnl with IBS - What is the course of disease and presentation
CEA - CA-19-9
Omeprazole
Low pressure proximal to LES
No - chronic - can present with diarrhea or constipation or alternation - treat sx
28. What intervention will intervention will relieve portal HTN
Left gastric vein and esophogeal vein - esophagus
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Omeprazole
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
29. What are the foregut structures and what supplies their blood and PANS innvervation
Left and right gastroepiploics - left and right gastrics
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
AST >ALT - ration is usually 1.5
Peptic ulcer disease
30. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
PAS- positive globules in liver -
Backup of blood into the liver - RHF - budd chiari
Angiodysplasia
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
31. crigler - najjar type II responds to which therapy and How does it work
Phenobarbital - inc liver enzyme synthesis
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
H2 receptor - inc cAMP
Sphincter of oddi
32. What serum enzyme is elevated inacute pancreatitis
ALT>AST
The entire
Epigastric abdominal pain radiating to back - anorexia - nausea
Lipase
33. Malabsorption syndromes have what common clinical presentation
Diarrhea - steatorrhea - weight loss - weakness
Stimulate the H/K ATPase
Hernia
Pleomorphic adenoma
34. What is the presentation of pancreatic adenocarcinoma
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
GERD - may also present with nocturnal cough and dyspnea
Colovesical leading to pneumaturia
35. What kind of insults results in macronodular cirrhosis
Downs
All 3 gut layers outpouch as in Meckels
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
36. What does alpha amylase do and what inactivates it
Ampulla of vater
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Begins starch digestion - inactivated by low pH upon reaching the stomach
Low pressure proximal to LES
37. What structures feed into the cystic duct
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Gallbladder
Peyers patches
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
38. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Meckels
Uremia
Diverticulum
Fasting and stress
39. Failure of relaxation of lower esophageal sphincter - Name and etiology
Hyperpigmented mouth - lips - hands - genitalia
Achalasia due to loss of myenteric plexus (auberach)
Zollinger ellison - brunners glands
Small intestine
40. If trypsin activates more trypsinogen - what kind of feedback loop is established
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Positive
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
41. What reaction does salivary amylase catalyze
Worldwide - SC - US - adeno
L/R renal artery around L1
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
42. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Chagas disease
Glucose dependent insulinotropic peptide
Zenkers - halitosis - dysphagia and obstruction
All 3 gut layers outpouch as in Meckels
43. What is the presenting course for appendicity
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44. What are the results of hemochromatosis
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
VZV and influenza B treated with salicylates
CHF and inc risk of HCC
45. How do burns cause acute gastritis and What is it called
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46. What are the effects of atropine on parietal cells and G cells
H+
Tropical sprue
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Diverticulitis in elderly - ectopic pregs use hCG to rule out
47. Liver cell failure can lead to multisystem signs including
Old men - arthralgias - cardiac and neuro sx
Glucose dependent insulinotropic peptide
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
48. What are the histological findings in the duodenum
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49. trypsinogen is converted to trypsin via what enzyme
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Dec PGE2 leading to dec gastric mucosa protection
Hirschsprungs
Enterokinase/enteropeptidase from the duodenal mucosa
50. What is biliary colic
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
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Obstruction of the common bile duct
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