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Test your basic knowledge |
USMLE GI
Start Test
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. What is the frequency of basal electric rhythm of the ilieum
Dissaccharidase def - most commonly lactase
8-9 waves/min
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Omeprazole
2. occlusion of IVC or hepatic veins
Hypotonic because of more time to reabsorb NaCl
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Budd chiari syndrome
Inc smooth muscle relaxation - including lower esophageal sphincter
3. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Failure of neural crest migration
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Zollinger Ellison - phenylalanine and tryptophan
4. What serum enzyme is elevated inacute pancreatitis
Worldwide - SC - US - adeno
Primarly through ECL leading to histamine release
Lipase
Dec PGE2 leading to dec gastric mucosa protection
5. what kind of fistula is associated with diverticulitis
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Colovesical leading to pneumaturia
Gallbladder
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
6. involvement of left supraclavicular node by mets from stomach
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7. Why does volvulus occur more at cecum and sigmoid colon
Tropical sprue
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Conj - inc - dec
Redundant mesentary
8. How do you DX and TX gallstones
Turcot
Virchow's node
US and cholecystectomy
Decreased intercellular adhesion and increased proliferation
9. What does a gastrinoma cause
Dermatitis herpetiformis
Glucouronate - water soluble (direct)
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
10. What are the borders of Hesselbach's triangle
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Smooth
Nonkeritinized stratified sqamous epithelium
Fe2+ in the duod
11. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Esophageal cancer
Smooth
Positive
Unconjugated - water insoluble
12. What histological findings are present in the esophagus
Stimulate intestinal persistalsis
Liver metabolizes 5HT
The jejunum
Nonkeritinized stratified sqamous epithelium
13. What can hemochromatosis be secondary to...
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
HPNCC
Esophageal cancer
Diarrhea - steatorrhea - weight loss - weakness
14. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Causes of gall stones
Alpha amylase
Oligosaccharide digestion
Elevated amylase - and lipase
15. What do you use to diagnose meckels
Zenkers - halitosis - dysphagia and obstruction
Spleen to posterior abdominal wall - splenic artery and vein
Left and right gastroepiploics - left and right gastrics
Pertechnetate - study for uptake
16. What causes primary biliary cirrhosis
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
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Barrett's esophagus
Mallory bodies
17. What are the longterm sequelae of nutmeg liver
Centrilobular congestion and necrosis - cardiac cirrhosis
Decrease - weight gain
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Alpha amylase
18. What reaction does salivary amylase catalyze
Femoral hernia
Pleomorphic adenoma
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
19. What enzyme is necessary to create conjugated bilirubin
Uridine glucuronyl transferase
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Hyperplastic
Spleen to posterior abdominal wall - splenic artery and vein
20. What are the histological findings of the colon
Hyperplastic
Left gastric vein and esophogeal vein - esophagus
GLUT 2
Crypts but not villi
21. What is the most common cause of gallstones
CHF and inc risk of HCC
Inferior rectal nerve
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Myenteric nerve plexus - aurbach
22. What causes pancreatic insuff and What does it cause
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Hypercoaguability - polycythemia vera - pregnancy - HCC
Crypts but not villi
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
23. What is Trousseau's sign
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Amylase
External (superficial) ring only
Redness and tenderness on palpation of extremities
24. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Pancreatic and bile
Alcoholic hepatitis
Meckels
Dissaccharidase def - most commonly lactase
25. What retroperitoneal structure flanks both sides of the pancreas on CT
Pancreatic head causing obstructive jaundice
Duodenum - 2nd - 3rd and 4th parts
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Alcoholic cirrhosis
26. Diaphragmatic hernias occur in infants because of defective development of which membrane
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Pleuroperitoneal
PAS- positive globules in liver -
27. What is the other name for GIP (gastric inhibitory peptide)
L3
Glucose dependent insulinotropic peptide
Epithelium
Pertechnetate - study for uptake
28. Where is bicarb trapped
In the mucus that covers the gastric epithelium
Krukenbergs tumor
ALT>AST
Lye ingestion and acid reflux
29. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Achalasia due to loss of myenteric plexus (auberach)
No - chronic - can present with diarrhea or constipation or alternation - treat sx
GERD - may also present with nocturnal cough and dyspnea
Lubricate food (glycoprotiens)
30. Failure of relaxation of lower esophageal sphincter - Name and etiology
Dilated esophagus with an area of distal stenosis - birds beak
Achalasia due to loss of myenteric plexus (auberach)
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Portal HTN
31. What are causes of extrahepatic biliary obstruction
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Right and left hepatic duct
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
32. When do you see hypertrophy of brunners glands
Mucosa - submucosa - muscularis externa - serosa/adventitia
Femoral hernia
Peptic ulcer disease
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
33. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Via the superior pancreaticduodenal
Cholesterol - 10-20% opaque due to calcifications
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Adhesion
34. Where are oligosaccharide hydrolases and What do they do
Uridine glucuronyl transferase
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Brush border of intestine - produce monosaccharides from oligo and di
Ischemic colitis
35. What is contained in the gastrosplenic and What areas does it separate
Superior rectal
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Where hindgut meets ectoderm
Short gastrics - left greater and lesser
36. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Inc conj bilirubin - inc cholesterol - inc alk phos
Angiodysplasia
AR
37. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Crohns = maybe - UC= always
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
38. What is the lumen of the pancreatic duct
Ampulla of vater
Warthins' tumor
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
39. Where does type A chronic gastritis occur and What causes it
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Punched out - clean margins - carcinoma =raised irregular margins
US and cholecystectomy
40. What structures feed into the cystic duct
Lamina propria
Gallbladder
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Nonkeritinized stratified sqamous epithelium
41. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Hirschsprungs
Acute pancreatitis
42. What are the foregut structures and what supplies their blood and PANS innvervation
Common hepatic - splenic - left gastric - main blood supply for stomach
Neural muscarinic pathways
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
43. What histological findings are present in the stomach
Gastric glands
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Lamina propria
Meckels
44. Where is folate absorbed
Zollinger ellison - brunners glands
The jejunum
Early childhood - neuro sx and malabsorption
Complications of UC
45. What are the histological findings in the ileum
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46. What portion of the bowel does sprue effect
Inspiratory arrest on deep palpation due to pain
Early childhood - neuro sx and malabsorption
The proximal small bowel
Crypts but not villi
47. Why does indirect inguinal hernia happen in infacnts
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Closer to isotonic because of less time to reabsorb NaCl
Smooth
Failure of the processus vagainlis to close
48. What are the branches of the celiac trunk and What do they supply
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
The proximal small bowel
Common hepatic - splenic - left gastric - main blood supply for stomach
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
49. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Unconj - absent (acholuria) - inc
Pancreatic and bile
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
Worldwide - SC - US - adeno
50. What cells secrete bicarb - What does it do - and what regulates it
Lipase
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
H2 receptor - inc cAMP