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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. Where does an indirect inguinal hernia enter the deep inguinal ring
In the ileum with bile acids - requires IF
Lateral to the inferior epigastric artery
Crohns = noncaseating granulomas - UC = crypt abscesses
L4
2. What kind of diarrhea is produced from a disaccharide def
Osmotic
Pleuroperitoneal
Striated and smooth
Neutralizes gastric acid allowing pancreatic enzymes to fxn
3. What kind of pancreatitis is associated with EtOH and smoking
Chronic calcifying pancreatitis - inc risk of panreatic cancer
GLUT 2
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
4. If the hemochromatosis is primary - What is the pattern of inheritance
Corticosteroids - infliximab
Hernia
AR
Reye's syndrome
5. What is the frequency of basal electric rhythm of the ilieum
8-9 waves/min
Esophageal varices
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
6. What are the borders of the femoral triangle
Jewish and African American men
Inguninal ligament - sartorius muscle - adductor longus
Stimulate intestinal persistalsis
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
7. What are the histological findings in the ileum
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8. What does the splenorenal ligament connect - and What does it contain
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Portal HTN
Spleen to posterior abdominal wall - splenic artery and vein
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
9. What is the most common diaphragmatic hernia and What are the two types
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Inc risk of CRC and other visceral malignancies
Failure of neural crest migration
10. What layer in the mucosa is responsible for support
Complications of crohns
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Lamina propria
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
11. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Conj/unconj - inc - nl to dec
Nonkeritinized stratified sqamous epithelium
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Positive
12. Gastrin - source - action - regulation
Complications of crohns
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
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
Can lead to hematemesis - found in EtOHics and bulimics
13. What are the results of hemochromatosis
T cell lymphoma
L/R renal artery around L1
CHF and inc risk of HCC
12 waves/min
14. What does extrahepatic biliary obstruction cause
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Conj/unconj - inc - nl to dec
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
15. signet ring cells - acanthosis nigracans - dz - character/association - spread
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Stimulate intestinal persistalsis
Alcoholic hepatitis
16. What are the structures of the femoral triangle and how are they organized
Conj - inc - dec
NAV = nerve artery vein - venous near the penis (NAVEL)
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
Osmotic
17. What is pancreatic adenocarcinoma associated with
Black - rotors syndrome
Antrum - H.pylori - inc risk of MALT lymphoma
Cigarettes and chronic pancreatitis - not EtOH
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
18. Autodigestion of pancreas by pancreatic enzymes
Uridine glucuronyl transferase
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Acute pancreatitis
19. What does histo show for alpha1 antitrypsin def
Gastrohepatic ligament
Cirrhosis
PAS- positive globules in liver -
AR
20. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Alk pho
Hydrocele
Ischemic colitis
21. What is the risk with peutz jehgers
Intussusception
Erosive - disruption of mucosal barrier leading to inflammation
Alk phos
Inc risk of CRC and other visceral malignancies
22. What transforms conjugated bilirubin to urobilinogen
Gut bacteria
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Neutralizes oral bacertial acids and maintains dental health
Lamina propria
23. What test and result confirms H pylori infxn
Obstruction of the common bile duct
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Positive urease test
Splenic flexure
24. What are the complications of Meckels
Mucoepidermoid carcinoma
Colonic polyps
12 waves/min
Bleeding - intussusception - volvulus - obstruction near terminal ileum
25. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Uridine glucuronyl transferase
Zollinger ellison - brunners glands
Lactase is located at the tips of intestinal villi
26. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
T cell lymphoma
Peyers patches
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Crohns = noncaseating granulomas - UC = crypt abscesses
27. What structures feed into the common hepatic duct
Esophageal cancer
All 3 gut layers outpouch as in Meckels
Right and left hepatic duct
EtOH
28. 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
Glucouronate - water soluble (direct)
T cell lymphoma
HSV-1 - CMV - Candida
29. Liver cell failure can lead to multisystem signs including
Parietal cells in the stomach - B12 binding protein
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Left gastric vein and esophogeal vein - esophagus
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
30. What artery passes around the duodenum
The gastroduodenal
Juvenille polyps - no risk if single
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
31. What are the effects of atropine on parietal cells and G cells
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Gardner's syndrome
32. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Lactase is located at the tips of intestinal villi
Averages 6 months - very aggressive - usually already metastasized at presentation
Diarrhea - steatorrhea - weight loss - weakness
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
33. What does bicarb do in the duodenum
Neutralizes gastric acid allowing pancreatic enzymes to fxn
L4
Sphincter of oddi
Via the middle colic
34. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
FAP
Erosive - disruption of mucosal barrier leading to inflammation
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Early childhood - neuro sx and malabsorption
35. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
AST>ALT
IBS at least 2 with recurrent abdominal pain
Crohns = noncaseating granulomas - UC = crypt abscesses
Gastric glands
36. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Cystic dilation of the viteline duct
Lipase
Intussusception
Hirschsprungs
37. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Female - fat - fertile - forty
Duodenal atresia - Downs
Bleeding - penetration into pancreas - perforation - obstruction
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
38. Through which aspect of the inguinal canal does a direct inguinal go
Lipase
External (superficial) ring only
Esophageal carcinoma
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
39. Transmural esophageal rupture due to violent retching
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40. What is the arterial supply and venous drainage below pectinate line
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
NAV = nerve artery vein - venous near the penis (NAVEL)
41. What is the frequency of basal electric rhythm of the stomach
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Trypsin - chymotrypsin - elastase - carboxypeptidases
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
3 waves/min
42. What layer in the mucosa is repsonsible for motility
Hirschsprungs
Inspiratory arrest on deep palpation due to pain
Fasting and stress
Muscularis mucosae
43. What are the labs in acute pancreatitis
Elevated amylase - and lipase
Conj/unconj - inc - nl to dec
Krukenbergs tumor
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
44. What are the longterm sequelae of nutmeg liver
Centrilobular congestion and necrosis - cardiac cirrhosis
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Alcoholic hepatitis
Uremia
45. why infxn is implicated in duodenal PUD
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
H pylori (almost 100%)
Striated and smooth
46. In alchoholic hepatitis which liver enzyme is higher
Conj/unconj - inc - nl to dec
Terminal ileum and colon
AST>ALT
Juvenile polyposis syndrome - inc risk of adenocarcinoma
47. A protrusion of peritoneum through an opening - usually a site of weakness
Hernia
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Antrum - H.pylori - inc risk of MALT lymphoma
Phenobarbital - inc liver enzyme synthesis
48. Why does volvulus occur more at cecum and sigmoid colon
Redundant mesentary
L/R renal artery around L1
Urobilin
Osmotic
49. Where are oligosaccharide hydrolases and What do they do
Brush border of intestine - produce monosaccharides from oligo and di
Duodenum - 2nd - 3rd and 4th parts
Hydrocele
Zollinger Ellison - phenylalanine and tryptophan
50. What is the leading cause of bowel incarceration
Femoral hernia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Meckels
Dubin johnson