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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 findings are associated with reyes
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Antrum - H.pylori - inc risk of MALT lymphoma
Stimulate the H/K ATPase
2. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Meconium ileus
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Causes of gall stones
3. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
L1
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Urobilin
4. If the hemochromatosis is primary - What is the pattern of inheritance
Intussusception
AR
Menetriers disease
All 3 gut layers outpouch as in Meckels
5. What percentage of gall stones are cholesterol stones and What are the associations
Paraumbilical and superficial and inferior epigastric - umbilicus
Averages 6 months - very aggressive - usually already metastasized at presentation
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
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
6. What is a positive murphy's sign
L3
Smooth
Inspiratory arrest on deep palpation due to pain
Boerhaave's Syndrome - Been heaving syndrome
7. concentric onion skin bile duct fibrosis
Chronic gastritis and pernicious anemia
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Primary sclerosing cholangitis
8. Through which aspect of the inguinal canal does a direct inguinal go
AST
12 waves/min
H2 receptor - inc cAMP
External (superficial) ring only
9. Diaphragmatic hernias occur in infants because of defective development of which membrane
Phototherapy
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Pleuroperitoneal
Phenobarbital - inc liver enzyme synthesis
10. What does bicarb do in the duodenum
Dec PGE2 leading to dec gastric mucosa protection
Neutralizes gastric acid allowing pancreatic enzymes to fxn
L3
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
11. is meckels a true diverticulum and how common is it
Dense core bodies
True and most common congenital anomoly of GI tract
Erosive - disruption of mucosal barrier leading to inflammation
Unconjugated - water insoluble
12. What kind of pancreatitis is associated with EtOH and smoking
All 3
Right and left hepatic duct
Chronic calcifying pancreatitis - inc risk of panreatic cancer
L3
13. Which kind of hemorrhoids are painful and why
Mallory bodies
Begins starch digestion - inactivated by low pH upon reaching the stomach
Erosive - disruption of mucosal barrier leading to inflammation
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
14. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Adhesion
Zollinger ellison - brunners glands
H pylori (almost 100%)
Dec PGE2 leading to dec gastric mucosa protection
15. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Internal thoracic to superior epigastric to inferior epigastric
16. What does histo show for alpha1 antitrypsin def
Crohns = maybe - UC= always
PAS- positive globules in liver -
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
GLUT 2
17. How does CRC present in the distal and proximal colon
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Inspiratory arrest on deep palpation due to pain
Inc lower esphogeal tone leading to achalasia
Unconj - absent (acholuria) - inc
18. What are causes of extrahepatic biliary obstruction
AR
Omeprazole
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Meconium ileus
19. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Skip lesions =crohns - colon = UC
Lateral to the inferior epigastric artery
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Lactase is located at the tips of intestinal villi
20. What is the presenting course for appendicity
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21. What serum markers increase in cholecystitis with bile duct involvement
Alk phos
90%
Elevated amylase - and lipase
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
22. At what level do the testicular/ovarian arteries exit the aorta
L2
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Portal HTN
Cigarettes and chronic pancreatitis - not EtOH
23. With internal hemorrhoids Where is the anastomoses and Where is it
Hemosiderosis - hemochromatosis
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Superior rectal and middle and inferior rectal - rectum
Cholesterol
24. Progressive dyshphage beginning with solids and moving to liquids and weight loss
No
Esophageal cancer
Pancreatic head causing obstructive jaundice
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
25. What are the hindgut structures and what supplies their blood and PANS innvervation
Epithelium
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Smooth
Crypts but not villi
26. What is the rule of 2s for meckels
Dubin johnson
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
All 3
27. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
The jejunum
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Hirschsprungs
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
28. How is the diagonsis of CRC made
Crigler - najjar type 1
ALT>AST
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
Common hepatic - splenic - left gastric - main blood supply for stomach
29. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
Esophageal carcinoma
Boerhaave's Syndrome - Been heaving syndrome
Hemosiderosis - hemochromatosis
30. What is the classic triad of hemochromatosis
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31. Autodigestion of pancreas by pancreatic enzymes
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Erosive - disruption of mucosal barrier leading to inflammation
Acute pancreatitis
H pylori (almost 100%)
32. In viral hepatitis - which liver enzyme is higher
Cirrhosis
Achalasia due to loss of myenteric plexus (auberach)
ALT>AST
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
33. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Common hepatic - splenic - left gastric - main blood supply for stomach
Cirrhosis
Appendicitis
34. Why does volvulus occur more at cecum and sigmoid colon
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Redundant mesentary
Achalasia due to loss of myenteric plexus (auberach)
Low pressure proximal to LES
35. What are the complications of chronic pancreatitis
Pertechnetate - study for uptake
Around the central vein (zone III)
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
MSI (15%) and APC/beta catenin chromosomal instability (85%)
36. If trypsin activates more trypsinogen - what kind of feedback loop is established
Appendicitis
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Positive
Inspiratory arrest on deep palpation due to pain
37. Which serum enzyme increases with heavy EtOH consumption
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Gamma glutamyl transferase GGT
US and cholecystectomy
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
38. What commonly leads to appendicity in kids vs adults
Nonkeritinized stratified sqamous epithelium
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
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
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
39. What causes hirschsprungs
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Failure of neural crest migration
Lye ingestion and acid reflux
Smooth
40. What factors increase risk of malignancy of adenomatous polyps
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Pyoderma gangrenosum - primary sclerosing cholangitis
PAS- positive globules in liver -
Achalasia due to loss of myenteric plexus (auberach)
41. What type of insults result in micronodular cirrhosis
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Uridine glucuronyl transferase
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Cholesterol
42. somatostatin - source - action - regulation
Adhesion
Turcot
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
Repeated phlebotomy - deferoxamine - HLA- A3
43. What kind of pathways do CCK act on to cause pancreatic secretion
Centrilobular leading to congestive liver disease
FAP
Neural muscarinic pathways
Inc - weight loss
44. What are the borders of the femoral triangle
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Inguninal ligament - sartorius muscle - adductor longus
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
US and cholecystectomy
45. What happens to the short gastics if the splenic artery is blocked
Hyperpigmented mouth - lips - hands - genitalia
Hyperplastic
Pleuroperitoneal
Poor anastamoses
46. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Uremia
Alcoholic cirrhosis
Internal thoracic to superior epigastric to inferior epigastric
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
47. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Hyperpigmented mouth - lips - hands - genitalia
Via the superior pancreaticduodenal
Alk pho
Left and right gastroepiploics - left and right gastrics
48. 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
Skip lesions =crohns - colon = UC
Short gastrics - left greater and lesser
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
49. Why does carcinoid syndrome not occur if tumor is confined to GI system
The entire
Inc - weight loss
Liver metabolizes 5HT
Superior rectal and middle and inferior rectal - rectum
50. How does gastrin increase acid secretion?
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Primarly through ECL leading to histamine release
Budd chiari syndrome
Cholesterol
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