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Test your basic knowledge |
USMLE GI
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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. With internal hemorrhoids Where is the anastomoses and Where is it
Angiodysplasia
When diffusely infiltrative - thickened rigid appearance like a leather bottle
In the mucus that covers the gastric epithelium
Superior rectal and middle and inferior rectal - rectum
2. What are additional risk factors for CRC
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Older patients
Jewish and African American men
3. How does CRC present in the distal and proximal colon
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Phototherapy
Can lead to hematemesis - found in EtOHics and bulimics
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
4. What is contained within the submucosa
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5. Autoantibodies to gluten (gliadin) in wheat and other grains
Squamous - upper 1/3 - adeno - lower 1/3
Celiac sprue
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Begins starch digestion - inactivated by low pH upon reaching the stomach
6. At what spinal level does the SMA exit
Amylase
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
L1
Hypercoaguability - polycythemia vera - pregnancy - HCC
7. Where does crohns usually affect the GI tract
Terminal ileum and colon
CCK8 receptor - Gq inc IP3/Ca
Dissaccharidase def - most commonly lactase
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
8. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Pancreatic and bile
Gastric glands
9. What separates the right greater and lesser sacs
Achalasia due to loss of myenteric plexus (auberach)
L3
Gastrohepatic ligament
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
10. What layer in the mucosa is repsonsible for motility
Smooth
Muscularis mucosae
Inguninal ligament - sartorius muscle - adductor longus
The gastroduodenal
11. what percentage of colonic polyps are non - neoplastic
Meckels
HPNCC
Smooth
90%
12. What are the histological findings in the jejunum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
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
Spleen to posterior abdominal wall - splenic artery and vein
Alpha amylase
13. How is the diagonsis of CRC made
Superior rectal
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
Inc - weight loss
Corticosteroids - infliximab
14. What does loss of p53 cause
Corticosteroids - infliximab
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Increase tumorigenesis
90%
15. What is biliary colic
Failure of the processus vagainlis to close
Glucouronate - water soluble (direct)
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
16. What is pancreatic adenocarcinoma associated with
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
...
Cigarettes and chronic pancreatitis - not EtOH
Acute pancreatitis
17. What is the ddx associated with appendicitis
L/R renal artery around L1
Pancreatic head causing obstructive jaundice
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
18. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Brunners
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Esophageal cancer
Jewish and African American men
19. What layer in the mucosa is responsible for support
Lamina propria
Pyoderma gangrenosum - primary sclerosing cholangitis
Inc lower esphogeal tone leading to achalasia
Striated
20. trypsinogen is converted to trypsin via what enzyme
Enterokinase/enteropeptidase from the duodenal mucosa
H2 receptor - inc cAMP
Hypercoaguability - polycythemia vera - pregnancy - HCC
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
21. subQ peribumbilical metastasis
Hypotonic because of more time to reabsorb NaCl
L4
Colovesical leading to pneumaturia
Sister mary joseph nodule
22. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Crohns = maybe - UC= always
Zollinger Ellison - phenylalanine and tryptophan
Lipase - phospholipase A - colipase
H2 receptor - inc cAMP
23. What kind of pathways do CCK act on to cause pancreatic secretion
Neural muscarinic pathways
Pleuroperitoneal
Uridine glucuronyl transferase
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
24. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
So hypertrophied they look like brain gyri
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Pyoderma gangrenosum - primary sclerosing cholangitis
Serous on the sides parotids - mucinous in the middle sublingual
25. malnutrition - toxic megacolon - colorectal carcinoma
Normal
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
NAV = nerve artery vein - venous near the penis (NAVEL)
Complications of UC
26. What is the epi for CRC
Gamma glutamyl transferase GGT
Esophageal carcinoma
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Hypercoaguability - polycythemia vera - pregnancy - HCC
27. What do you use to diagnose meckels
Cystic duct and common hepatic duct
Hyperplastic
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Pertechnetate - study for uptake
28. What are the barium swallow findings of achalasia
Primarly through ECL leading to histamine release
Dilated esophagus with an area of distal stenosis - birds beak
Smooth
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
29. What does high flow rate mean
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
In the mucus that covers the gastric epithelium
Phototherapy
Closer to isotonic because of less time to reabsorb NaCl
30. What are the common causes of gastric ulcers - What causes gastric ulcer
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Inspiratory arrest on deep palpation due to pain
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Hemolytic anemia
31. What is the most common diaphragmatic hernia and What are the two types
With albumin
Chronic calcifying pancreatitis - inc risk of panreatic cancer
External (superficial) ring only
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
32. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
IgA secreting plasma cells - ultimately reside in the lamina proporia
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
33. What layer in the mucosa is responsible for absorption
Left gastric vein and esophogeal vein - esophagus
Stercobilin
Older patients
Epithelium
34. What portion of the bowel does sprue effect
The proximal small bowel
L4
Alk phos
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
35. Gallstones that reach the common channel at ampulla can block which two ducts
IgA secreting plasma cells - ultimately reside in the lamina proporia
Pancreatic and bile
Epithelium
Cystic dilation of the viteline duct
36. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Unconjugated - water insoluble
Uremia
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Conj/unconj - inc - nl to dec
37. Through which aspect of the inguinal canal does a direct inguinal go
Ischemic colitis
External (superficial) ring only
Alpha1 antitrypsin def - codominant trait
AST>ALT
38. Where are peyers patches found
Conj/unconj - inc - nl to dec
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Smooth
Lamina propora and submucosa
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. What do tumors that arise in the head of the pancreas cause
Boerhaave's Syndrome - Been heaving syndrome
Above
Skip lesions =crohns - colon = UC
Obstruction of the common bile duct
41. What is contained in the gastrosplenic and What areas does it separate
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Short gastrics - left greater and lesser
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Adhesion
42. Transmural esophageal rupture due to violent retching
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43. What serum enzyme is elevated in acute pancreatitis and mumps
Lye ingestion and acid reflux
Pyoderma gangrenosum - primary sclerosing cholangitis
Amylase
Nonkeritinized stratified sqamous epithelium
44. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Peyers patches
The proximal small bowel
Cimetidine
Adhesion
45. What histological findings are present in the esophagus
Failure of the processus vagainlis to close
Nonkeritinized stratified sqamous epithelium
Superior rectal
Lye ingestion and acid reflux
46. signet ring cells - acanthosis nigracans - dz - character/association - spread
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
H2 receptor - inc cAMP
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Inc - weight loss
47. What are the layers of the gut wall from inside out
Acute pancreatitis
Mucosa - submucosa - muscularis externa - serosa/adventitia
Where hindgut meets ectoderm
Virchow's node
48. What is the cause of Barrett's and the assocaited complications
Elevated amylase - and lipase
Hepatic steatosis
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
49. What is the sphincter of the pancreatic duct
Sphincter of oddi
Jewish and African American men
Cholesterol
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
50. GIP - source - action regulation
Appendicitis
Corticosteroids - infliximab
Positive
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Sorry!:) No result found.
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