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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 contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Muscularis mucosae
Pyoderma gangrenosum - primary sclerosing cholangitis
2. Achalasia increases the risk For what complication
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
Esophageal carcinoma
M3 - Gq - inc IP3/Ca
Colonic polyps
3. In PUD with a duodenal ulcer does pain inc or dec with meals
Alcoholic hepatitis
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Decrease - weight gain
Cystic duct and common hepatic duct
4. what kind of muscle is in the upper 1/3 of esophagus
Meckels
Lubricate food (glycoprotiens)
Ceruplasmin
Striated
5. What is a positive murphy's sign
Bleeding - penetration into pancreas - perforation - obstruction
Inspiratory arrest on deep palpation due to pain
AST >ALT - ration is usually 1.5
Increase tumorigenesis
6. Where does an indirect inguinal hernia enter the deep inguinal ring
Falciform - ligamentum teres - fetal umbilical vein
T12
Lateral to the inferior epigastric artery
Hemosiderosis - hemochromatosis
7. How does loss of NO secretion affect the esophagus and what results
Gastric glands
Inc lower esphogeal tone leading to achalasia
Punched out - clean margins - carcinoma =raised irregular margins
Falciform - ligamentum teres - fetal umbilical vein
8. Who gets gastric ulcers
Older patients
Corticosteroids - infliximab
Smooth
AST>ALT
9. most common malignant salivary gland tumor
Phenobarbital - inc liver enzyme synthesis
Backup of blood into the liver - RHF - budd chiari
Short gastrics - left greater and lesser
Mucoepidermoid carcinoma
10. What kind of insults results in macronodular cirrhosis
All 3
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Superior rectal
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
11. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Glucose dependent insulinotropic peptide
Punched out - clean margins - carcinoma =raised irregular margins
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
GLUT 2
12. What histological findings are present in the stomach
Positive
Lye ingestion and acid reflux
Gastric glands
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
13. trypsinogen is converted to trypsin via what enzyme
Centrilobular congestion and necrosis - cardiac cirrhosis
Acute pancreatitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Enterokinase/enteropeptidase from the duodenal mucosa
14. How do NSAIDs cause acute gastritis
Squamous - upper 1/3 - adeno - lower 1/3
Dec PGE2 leading to dec gastric mucosa protection
8-9 waves/min
Source - parasympathetic ganglion in sphincters - gallbladder - small intestine - action - inc intestinal water and electrolyte secretion - inc relaxation of intestinal smooth muscle and sphincters - regulation - inc by distention and vagal stimulati
15. most common non - neoplastic polyp in colon
Hyperplastic
Early childhood - neuro sx and malabsorption
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
16. What are the four Fs of gallstones
3 waves/min
Decrease - weight gain
Hypercoaguability - polycythemia vera - pregnancy - HCC
Female - fat - fertile - forty
17. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
All 3
Duodenal atresia - Downs
Glucose dependent insulinotropic peptide
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
18. What is Trousseau's sign
Short gastrics - left greater and lesser
Redness and tenderness on palpation of extremities
Terminal ileum and colon
Myenteric nerve plexus - aurbach
19. What is the other name for GIP (gastric inhibitory peptide)
Diverticulum
Glucose dependent insulinotropic peptide
Left and right gastroepiploics - left and right gastrics
Nonkeritinized stratified sqamous epithelium
20. What are the tumor markers for pancreatic adenocarcinoma
CEA - CA-19-9
Stimulate intestinal persistalsis
H pylori (almost 100%)
Paraumbilical and superficial and inferior epigastric - umbilicus
21. What structures feed into the common bile duct
Positive
Cystic duct and common hepatic duct
Dermatitis herpetiformis
Sphincter of oddi
22. What is the leading cause of bowel incarceration
Inguninal ligament - sartorius muscle - adductor longus
Pancreatic and bile
Femoral hernia
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
23. What receptor does histamine bind on the parietal cell and What does it activate
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
H2 receptor - inc cAMP
Bleeding - penetration into pancreas - perforation - obstruction
Crohns = noncaseating granulomas - UC = crypt abscesses
24. in budd chiari syndrome - Where is the congestion and necrosis
Hepatic steatosis
Amylase
L4
Centrilobular leading to congestive liver disease
25. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Colonic polyps
Causes of gall stones
All 3 gut layers outpouch as in Meckels
26. subQ peribumbilical metastasis
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Sister mary joseph nodule
Turcot
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
27. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Inc conj bilirubin - inc cholesterol - inc alk phos
Spleen to posterior abdominal wall - splenic artery and vein
T cell lymphoma
Older patients
28. Autodigestion of pancreas by pancreatic enzymes
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Backup of blood into the liver - RHF - budd chiari
Acute pancreatitis
IgA secreting plasma cells - ultimately reside in the lamina proporia
29. What is the presenting course for appendicity
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30. What are the two molecular pathways that lead to CRC
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Hypercoaguability - polycythemia vera - pregnancy - HCC
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
31. If the hemochromatosis is primary - What is the pattern of inheritance
Tropical sprue
AR
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
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
32. What are additional risk factors for CRC
Repeated phlebotomy - deferoxamine - HLA- A3
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
H+
33. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Uremia
Backup of blood into the liver - RHF - budd chiari
34. secretin - source - action - regulation
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Intussusception
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
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
35. What are the common causes of gastric ulcers - What causes gastric ulcer
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Alpha1 antitrypsin def - codominant trait
Poor anastamoses
Antrum - H.pylori - inc risk of MALT lymphoma
36. What can fistula between the gallbladder and small intestine create and how can you tell
Ampulla of vater
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
37. What are the signs and symptoms of budd chiari
Hirschsprungs
Neural muscarinic pathways
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
All 3 gut layers outpouch as in Meckels
38. When and How does Abetalipoproteinemia present
Early childhood - neuro sx and malabsorption
All 3 gut layers outpouch as in Meckels
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
So hypertrophied they look like brain gyri
39. What is the cause of physiologic neonatal jaundice
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Left and right gastroepiploics - left and right gastrics
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
40. Which IBD is autoimmune and which may be a disordered response to bacteria
H pylori (almost 100%)
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Meckels
Primary sclerosing cholangitis
41. In viral hepatitis - which liver enzyme is higher
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Early childhood - neuro sx and malabsorption
ALT>AST
42. When and why is stomach cancer termed linitis plastica
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Source - parasympathetic ganglion in sphincters - gallbladder - small intestine - action - inc intestinal water and electrolyte secretion - inc relaxation of intestinal smooth muscle and sphincters - regulation - inc by distention and vagal stimulati
Pertechnetate - study for uptake
Alpha amylase
43. motilin - source - action - regulation
T12
Corticosteroids - infliximab
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
44. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
The gastroduodenal
Inspiratory arrest on deep palpation due to pain
Centrilobular leading to congestive liver disease
Above
45. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
External (superficial) ring only
Boerhaave's Syndrome - Been heaving syndrome
Antrum - H.pylori - inc risk of MALT lymphoma
46. What is the arterial supply and venous drainage below pectinate line
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Gastric glands
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
47. What do mucins do?
Lubricate food (glycoprotiens)
Neutralizes oral bacertial acids and maintains dental health
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
48. What drug blocks the H2R
Downs
Stimulate intestinal persistalsis
Pancreatic head causing obstructive jaundice
Cimetidine
49. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Zollinger ellison - brunners glands
Poor anastamoses
Oligosaccharide digestion
50. inflammatino of gallbadder
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Femoral hernia