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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 retroperitoneal structure flanks both sides of the pancreas on CT
Striated
Dissaccharidase def - most commonly lactase
Duodenum - 2nd - 3rd and 4th parts
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
2. what kind of muscle is in the upper 1/3 of esophagus
Striated
Centrilobular congestion and necrosis - cardiac cirrhosis
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Inc risk of CRC and other visceral malignancies
3. most common non - neoplastic polyp in colon
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Backup of blood into the liver - RHF - budd chiari
Hyperplastic
Alk phos
4. What is the sphincter of the pancreatic duct
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Jewish and African American men
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Sphincter of oddi
5. What causes pancreatic insuff and What does it cause
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Mucosa - submucosa - muscularis externa - serosa/adventitia
6. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
L1
Begins starch digestion - inactivated by low pH upon reaching the stomach
Menetriers disease
Lipase - phospholipase A - colipase
7. What layer in the mucosa is responsible for absorption
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Epithelium
Glucouronate - water soluble (direct)
8. likely infectious form of malabsorption - responds to antibiotics
Tropical sprue
In the mucus that covers the gastric epithelium
Complications of UC
AR
9. FAP + osseous and soft tissue tumors - retinal hyperplasia
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10. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
GLUT 2
Conj/unconj - inc - nl to dec
Necrotizing enterocolitis
90%
11. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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12. What pancreatic proteases are secreted as zymogens
Trypsin - chymotrypsin - elastase - carboxypeptidases
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Boerhaave's Syndrome - Been heaving syndrome
Failure of neural crest migration
13. What conditions are associated with budd chiari
Hypercoaguability - polycythemia vera - pregnancy - HCC
Centrilobular congestion and necrosis - cardiac cirrhosis
Nonkeritinized stratified sqamous epithelium
Lipase - phospholipase A - colipase
14. What can fistula between the gallbladder and small intestine create and how can you tell
Cystic dilation of the viteline duct
Gastric glands
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
L1
15. Where does an indirect inguinal hernia enter the deep inguinal ring
2ndary biliary cirrhosis
Celiac sprue
Lateral to the inferior epigastric artery
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
16. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Diverticulum
Positive urease test
Esophageal varices
Volvulus
17. Gq and inc cAMP both work to do what in parietal cells
Peutz jeghers
So hypertrophied they look like brain gyri
Colovesical leading to pneumaturia
Stimulate the H/K ATPase
18. crigler - najjar type II responds to which therapy and How does it work
Phenobarbital - inc liver enzyme synthesis
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Normal
19. What kind of diarrhea is produced from a disaccharide def
Osmotic
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Failure of neural crest migration
Menetriers disease
20. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Hemosiderosis - hemochromatosis
Duodenal atresia - Downs
Zollinger ellison - brunners glands
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
21. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Glucouronate - water soluble (direct)
Left gastric vein and esophogeal vein - esophagus
Pleuroperitoneal
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
22. How does hirschsprung present and appear on imaging
Oral glucose
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
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
Early childhood - neuro sx and malabsorption
23. inflammatino of gallbadder
Unconjugated - water insoluble
Lamina propria
All 3
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
24. At what level do the testicular/ovarian arteries exit the aorta
L2
M3 - Gq - inc IP3/Ca
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Complications of UC
25. When and How does Abetalipoproteinemia present
Hydrocele
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
Early childhood - neuro sx and malabsorption
Neural muscarinic pathways
26. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Meckels
Dense core bodies
Inc - weight loss
Hypercoaguability - polycythemia vera - pregnancy - HCC
27. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Zenkers - halitosis - dysphagia and obstruction
Via the superior pancreaticduodenal
Conj/unconj - inc - nl to dec
28. What are the borders of Hesselbach's triangle
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Phototherapy
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
29. What are the complications of duodenal PUD
Small intestine
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Bleeding - penetration into pancreas - perforation - obstruction
AR
30. is meckels a true diverticulum and how common is it
Centrilobular leading to congestive liver disease
Hemolytic anemia
Juvenille polyps - no risk if single
True and most common congenital anomoly of GI tract
31. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
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
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
32. 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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33. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Zenkers - halitosis - dysphagia and obstruction
Hyperpigmented mouth - lips - hands - genitalia
L1
Zollinger Ellison - phenylalanine and tryptophan
34. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Cirrhosis
35. FAP + malignant CNS tumor
Spleen to posterior abdominal wall - splenic artery and vein
Turcot
Small intestine
Gallbladder
36. What kind of anemia is in Wilsons
Pancreatic head causing obstructive 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
Hemolytic anemia
Inspiratory arrest on deep palpation due to pain
37. What is the presenting course for appendicity
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38. What reaction does salivary amylase catalyze
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
All 3 gut layers outpouch as in Meckels
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
EtOH
39. Failure of relaxation of lower esophageal sphincter - Name and etiology
PAS- positive globules in liver -
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
Achalasia due to loss of myenteric plexus (auberach)
H pylori (almost 100%)
40. What pancreatic enzymes are responsible for fat digestion
Diverticulum
Lipase - phospholipase A - colipase
Inguninal ligament - sartorius muscle - adductor longus
Inc risk of CRC and other visceral malignancies
41. What is the rule of 2s for meckels
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Epigastric abdominal pain radiating to back - anorexia - nausea
The jejunum
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
42. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Alpha1 antitrypsin def - codominant trait
Below
Parietal cells in the stomach - B12 binding protein
43. What is contained within the muscularis externa
Myenteric nerve plexus - aurbach
Acute pancreatitis
T12
Lateral to the inferior epigastric artery
44. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Closer to isotonic because of less time to reabsorb NaCl
Above
Alcoholic cirrhosis
Femoral hernia
45. What cell produces IF and What does it do
Parietal cells in the stomach - B12 binding protein
The proximal small bowel
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
L/R renal artery around L1
46. What layer in the mucosa is repsonsible for motility
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Muscularis mucosae
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Below
47. What gives stool its characteristic color
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
Stercobilin
Osmotic
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
48. What is the other name for GIP (gastric inhibitory peptide)
Female - fat - fertile - forty
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Glucose dependent insulinotropic peptide
Enterokinase/enteropeptidase from the duodenal mucosa
49. What kind of digestion is bile needed for
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Budd chiari syndrome
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
H pylori (almost 100%)
50. If trypsin activates more trypsinogen - what kind of feedback loop is established
Pancreatic head causing obstructive jaundice
L2
Cholesterol
Positive