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Test your basic knowledge |
USMLE GI
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Subjects
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health-sciences
,
usmle
Instructions:
Answer 50 questions in 15 minutes.
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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 leading cause of bowel incarceration
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
HPNCC
So hypertrophied they look like brain gyri
Femoral hernia
2. What complication can arise from indirect inguinal hernias
The proximal small bowel
L/R renal artery around L1
Hydrocele
Mucoepidermoid carcinoma
3. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Internal thoracic to superior epigastric to inferior epigastric
Sister mary joseph nodule
GERD - may also present with nocturnal cough and dyspnea
Above
4. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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5. What is the most common esophageal cancer worldwide and in the US
Dermatitis herpetiformis
Worldwide - SC - US - adeno
Reye's syndrome
VZV and influenza B treated with salicylates
6. what kind of muscle is in the upper 1/3 of esophagus
Diverticulum
Striated
Fe2+ in the duod
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
7. What are the borders of Hesselbach's triangle
IBS at least 2 with recurrent abdominal pain
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Celiac sprue
8. What gives stool its characteristic color
Stercobilin
Old men - arthralgias - cardiac and neuro sx
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Decrease - weight gain
9. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus
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10. What structure is Not contained in the femoral sheath
Krukenbergs tumor
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
IBS at least 2 with recurrent abdominal pain
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
11. What structures feed into the common bile duct
...
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Cystic duct and common hepatic duct
Juvenille polyps - no risk if single
12. To what substance is bilirubin conjugated and why
Glucouronate - water soluble (direct)
Urobilin
Stimulate the H/K ATPase
Zenkers - halitosis - dysphagia and obstruction
13. At what spinal level does the is the bifurcation of aorta
Upregulated intracellular signal transduction
Uremia
L4
Zollinger Ellison - phenylalanine and tryptophan
14. What portion of the bowel does sprue effect
The proximal small bowel
Centrilobular congestion and necrosis - cardiac cirrhosis
Inguninal ligament - sartorius muscle - adductor longus
Muscularis mucosae
15. With internal hemorrhoids Where is the anastomoses and Where is it
T cell lymphoma
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Gastrohepatic ligament
Superior rectal and middle and inferior rectal - rectum
16. in budd chiari syndrome - Where is the congestion and necrosis
Urobilin
Hemosiderosis - hemochromatosis
Centrilobular leading to congestive liver disease
Redundant mesentary
17. What is the cause of physiologic neonatal jaundice
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
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Meckels
Heme metabolism
18. What is the characteristic histo finding in alcoholic hepatitis
Left gastric vein and esophogeal vein - esophagus
Mallory bodies
Normal
Cimetidine
19. What are motilin receptor agonists used for clinically
Urobilin
...
Upregulated intracellular signal transduction
Stimulate intestinal persistalsis
20. What are the complications of chronic pancreatitis
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Menetriers disease
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
21. What is the most common cause of gallstones
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Common hepatic - splenic - left gastric - main blood supply for stomach
Alk pho
22. What are the four Fs of gallstones
Positive urease test
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Elevated amylase - and lipase
Female - fat - fertile - forty
23. What do you treat Wilsons disease with and What is the inheritance
H2 receptor - inc cAMP
Crypts but not villi
Penicillinamine - AR inheritance
Decreased intercellular adhesion and increased proliferation
24. What serum enzyme is elevated in acute pancreatitis and mumps
Gardner's syndrome
Amylase
2ndary biliary cirrhosis
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
25. What are the histological findings of the colon
Hypercoaguability - polycythemia vera - pregnancy - HCC
Crohns = transmural (cobblestone mucosa - creeping fat - string sign - linear ulcers fissures - fistulas) UC = mucosal and submucosal (friable mucosal pseudopolyps with freely hanging mesentary - loss of haustra - lead pipe appearance on imaging
Portal HTN
Crypts but not villi
26. What does the splenorenal ligament connect - and What does it contain
Lipase
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Spleen to posterior abdominal wall - splenic artery and vein
In the ileum with bile acids - requires IF
27. In PUD - with gastric ulcers - does pain inc or dec with meals?
Striated
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
8-9 waves/min
Inc - weight loss
28. Gastrin - source - action - regulation
Heme metabolism
AST >ALT - ration is usually 1.5
Source - G cells in the antrum - action - inc gastric H+ secretion - inc growth of gastric mucosa - and inc gastric motility - regulation - inc by stomach distention/alkalinaztion - amino acids - peptides - vagal stimulation - dec by stomach pH < 1.5
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
29. What test and result confirms H pylori infxn
Dec PGE2 leading to dec gastric mucosa protection
Colonic polyps
Positive urease test
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
30. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue
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31. What are the signs of peutz jehgers
NAV = nerve artery vein - venous near the penis (NAVEL)
...
Hyperpigmented mouth - lips - hands - genitalia
Failure of neural crest migration
32. What structures feed into the cystic duct
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Nonkeritinized stratified sqamous epithelium
Gallbladder
Duodenal atresia - Downs
33. What does loss of p53 cause
Gastrohepatic ligament
The entire
Celiac sprue
Increase tumorigenesis
34. What are the layers of the gut wall from inside out
Repeated phlebotomy - deferoxamine - HLA- A3
Pancreatic and bile
Mucosa - submucosa - muscularis externa - serosa/adventitia
Superior rectal and middle and inferior rectal - rectum
35. Are single polyps malignant in peutz jehgers
Barrett's esophagus
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Cigarettes and chronic pancreatitis - not EtOH
No
36. inflammatino of gallbadder
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Cystic dilation of the viteline duct
Penicillinamine - AR inheritance
37. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Phenobarbital - inc liver enzyme synthesis
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
HPNCC
Diarrhea - steatorrhea - weight loss - weakness
38. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Gastric glands
Complications of UC
Gastrohepatic ligament
Necrotizing enterocolitis
39. Where are peyers patches found
Complications of crohns
In the ileum with bile acids - requires IF
Lamina propora and submucosa
Urobilin
40. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Left gastric vein and esophogeal vein - esophagus
Hyperpigmented mouth - lips - hands - genitalia
Via the superior pancreaticduodenal
Small intestine
41. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
Chronic gastritis and pernicious anemia
ALT>AST
Lipase
42. Malabsorption syndromes have what common clinical presentation
Obstruction of the common bile duct
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Via the middle colic
Diarrhea - steatorrhea - weight loss - weakness
43. What layer of fascia covers a direct inguinal hernia
External spermatic fascia only
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Elevated amylase - and lipase
Primarly through ECL leading to histamine release
44. What structures feed into the common hepatic duct
Right and left hepatic duct
Corticosteroids - infliximab
Elevated amylase - and lipase
Hypercoaguability - polycythemia vera - pregnancy - HCC
45. What are causes of extrahepatic biliary obstruction
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Esophageal cancer
L4
Alcoholic cirrhosis
46. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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47. What is the most common indication of emergent abdominal surgery in children
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Appendicitis
The gastroduodenal
Worldwide - SC - US - adeno
48. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Alpha amylase
Alpha1 antitrypsin def - codominant trait
Primary sclerosing cholangitis
Normal
49. What are additional risk factors for CRC
Osmotic
Averages 6 months - very aggressive - usually already metastasized at presentation
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
50. What parts of the small bowel can tropical sprue effect
Centrilobular leading to congestive liver disease
Punched out - clean margins - carcinoma =raised irregular margins
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
The entire
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