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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 is the presenting course for appendicity
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2. rare - often fatal childhood hepatoencephalopathy
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3. Where does an indirect inguinal hernia enter the deep inguinal ring
H2 receptor - inc cAMP
Lateral to the inferior epigastric artery
Alpha amylase
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
4. What kind of muscle is in the lower 1/3 of the esophagus
Gastric glands
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Smooth
Early childhood - neuro sx and malabsorption
5. 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
Cimetidine
Skip lesions =crohns - colon = UC
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
6. Gq and inc cAMP both work to do what in parietal cells
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Stimulate the H/K ATPase
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Worldwide - SC - US - adeno
7. What are the signs of peutz jehgers
EtOH
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Hyperpigmented mouth - lips - hands - genitalia
8. What kind of anemia is in Wilsons
Hemolytic anemia
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Urobilin
Old men - arthralgias - cardiac and neuro sx
9. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Stercobilin
10. Where is bicarb trapped
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
In the mucus that covers the gastric epithelium
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
11. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
US and cholecystectomy
Black - rotors syndrome
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
12. What gives stool its characteristic color
Hydrocele
Dilated esophagus with an area of distal stenosis - birds beak
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Stercobilin
13. At what spinal level does the SMA exit
Alcoholic hepatitis
Antrum - H.pylori - inc risk of MALT lymphoma
Begins starch digestion - inactivated by low pH upon reaching the stomach
L1
14. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Unconj - absent (acholuria) - inc
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Necrotizing enterocolitis
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
15. What layer of fascia covers a direct inguinal hernia
External spermatic fascia only
Older patients
Elevated amylase - and lipase
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
16. If the abdominal aorta is blocked - How does blood get to the left colic artery
Via the middle colic
Portal HTN
Terminal ileum and colon
Positive urease test
17. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Barrett's esophagus
Decreased intercellular adhesion and increased proliferation
Where hindgut meets ectoderm
Ischemic colitis
18. subQ peribumbilical metastasis
All 3
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Sister mary joseph nodule
19. What infection causes Whipple disease and What can you see on LM
Lubricate food (glycoprotiens)
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Inc conj bilirubin - inc cholesterol - inc alk phos
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
20. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Complications of UC
Left gastric vein and esophogeal vein - esophagus
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Enterokinase/enteropeptidase from the duodenal mucosa
21. What are the four Fs of gallstones
Small intestine
Female - fat - fertile - forty
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
22. in budd chiari syndrome - Where is the congestion and necrosis
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Centrilobular leading to congestive liver disease
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Hepatic steatosis
23. What does alpha amylase do and what inactivates it
Begins starch digestion - inactivated by low pH upon reaching the stomach
Elevated amylase - and lipase
Redundant mesentary
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
24. Liver cell failure can lead to multisystem signs including
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Osmotic
Lateral to the inferior epigastric artery
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
25. What serum enzyme is elevated in acute pancreatitis and mumps
Amylase
Dysphagia (due to esophageal web) - glossitis - iron def anemia
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
All 3 gut layers outpouch as in Meckels
26. GIP - source - action regulation
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Nonkeritinized stratified sqamous epithelium
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
27. Why does carcinoid syndrome not occur if tumor is confined to GI system
L2
The submucosal nerve plexus - meissner's
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Liver metabolizes 5HT
28. What is the mechanism for reyes syndrome
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Sphincter of oddi
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
29. How does CRC present in the distal and proximal colon
Inc - weight loss
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Hernia
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
30. What can fistula between the gallbladder and small intestine create and how can you tell
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Dilated esophagus with an area of distal stenosis - birds beak
Splenic flexure
Parietal cells in the stomach - B12 binding protein
31. In what scenarios do pts with gilberts have inc bili
The submucosal nerve plexus - meissner's
Hernia
Fasting and stress
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
32. Dysphagia in achalasia results from
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Barrett's esophagus
8-9 waves/min
Boerhaave's Syndrome - Been heaving syndrome
33. Why does indirect inguinal hernia happen in infacnts
Complications of UC
Failure of the processus vagainlis to close
Muscularis mucosae
FAP
34. If the hemochromatosis is primary - What is the pattern of inheritance
Inferior rectal nerve
12 waves/min
AR
Omeprazole
35. Where are carcinoid tumors most commonly malignant
Failure of the processus vagainlis to close
Small intestine
Bleeding - penetration into pancreas - perforation - obstruction
H2 receptor - inc cAMP
36. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Meckels
Inc lower esphogeal tone leading to achalasia
Left and right gastroepiploics - left and right gastrics
Gut bacteria
37. What are the treatment options for uclerative colitis
H2 receptor - inc cAMP
Chronic calcifying pancreatitis - inc risk of panreatic cancer
The gastroduodenal
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
38. What is contained in the gastrosplenic and What areas does it separate
Falciform - ligamentum teres - fetal umbilical vein
Peptic ulcer disease
Short gastrics - left greater and lesser
The proximal small bowel
39. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Pancreatic head causing obstructive jaundice
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Carcinoid syndrome
Goes through deep inguinal ring - external inguinal ring and into the scrotum
40. What are the treatmet options for crohns
Corticosteroids - infliximab
H pylori (almost 100%)
Barrett's esophagus
Inguninal ligament - sartorius muscle - adductor longus
41. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
GERD - may also present with nocturnal cough and dyspnea
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
All 3 gut layers outpouch as in Meckels
42. What do mucins do?
Dermatitis herpetiformis
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
Lubricate food (glycoprotiens)
Short gastrics - left greater and lesser
43. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Angiodysplasia
Mallory bodies
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Colonic polyps
44. Why would a self - limited lactase def occur following an injury (viral diarrhea)
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Lactase is located at the tips of intestinal villi
L4
Pancreatic and bile
45. What do tumors that arise in the head of the pancreas cause
Obstruction of the common bile duct
Gallbladder
AR
So hypertrophied they look like brain gyri
46. What are the effects of atropine on parietal cells and G cells
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Centrilobular leading to congestive liver disease
47. What is the action of NO as a GI hormone
Female - fat - fertile - forty
Inc smooth muscle relaxation - including lower esophageal sphincter
ALT>AST
Alpha amylase
48. Between what structures do strong anastamoses exist
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Left and right gastroepiploics - left and right gastrics
In the mucus that covers the gastric epithelium
Cystic dilation of the viteline duct
49. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Peyers patches
Esophageal cancer
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Complications of UC
50. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Lye ingestion and acid reflux
Zollinger Ellison - phenylalanine and tryptophan