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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. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Carcinoid syndrome
Liver metabolizes 5HT
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Amylase
2. Progressive dyshphage beginning with solids and moving to liquids and weight loss
L2
Esophageal cancer
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Dilated esophagus with an area of distal stenosis - birds beak
3. somatostatin - source - action - regulation
Downs
US and cholecystectomy
Crohns = noncaseating granulomas - UC = crypt abscesses
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
4. What arteries exit just below the SMA
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Zollinger Ellison - phenylalanine and tryptophan
Lactase is located at the tips of intestinal villi
L/R renal artery around L1
5. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Striated and smooth
Decrease - weight gain
Alpha amylase
Inguninal ligament - sartorius muscle - adductor longus
6. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Conj - inc - dec
Brunners
Angiodysplasia
Reye's syndrome
7. Where and How is iron absorbed
Fe2+ in the duod
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Spleen to posterior abdominal wall - splenic artery and vein
8. What are the labs in acute pancreatitis
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
L/R renal artery around L1
Female - fat - fertile - forty
Elevated amylase - and lipase
9. most common non - neoplastic polyp in colon
Lateral
Left and right gastroepiploics - left and right gastrics
Hyperplastic
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
10. What drug inhibits the H/K ATPase
The proximal small bowel
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
H2 receptor - inc cAMP
Omeprazole
11. What are the tumor markers for pancreatic adenocarcinoma
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Neutralizes oral bacertial acids and maintains dental health
CEA - CA-19-9
Peyers patches
12. People of what decent are associated with celiac sprue and what findings/antibodies are present
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Brush border of intestine - produce monosaccharides from oligo and di
NAV = nerve artery vein - venous near the penis (NAVEL)
13. What converts inactive pepsinogen to pepsin
H+
Sister mary joseph nodule
Failure of the processus vagainlis to close
Diverticulum
14. Achalasia increases the risk For what complication
Lamina propora and submucosa
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Esophageal carcinoma
Closer to isotonic because of less time to reabsorb NaCl
15. At what spinal level does the SMA exit
L1
Ampulla of vater
Brush border of intestine - produce monosaccharides from oligo and di
Dissaccharidase def - most commonly lactase
16. What does extrahepatic biliary obstruction cause
HSV-1 - CMV - Candida
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Neutralizes oral bacertial acids and maintains dental health
17. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Duodenal atresia - Downs
Urobilin
True and most common congenital anomoly of GI tract
Stimulate intestinal persistalsis
18. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Peutz jeghers
Superior rectal
Krukenbergs tumor
Lactase is located at the tips of intestinal villi
19. concentric onion skin bile duct fibrosis
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Primary sclerosing cholangitis
Lamina propora and submucosa
20. What is the frequency of basal electric rhythm of the ilieum
Low pressure proximal to LES
Centrilobular congestion and necrosis - cardiac cirrhosis
8-9 waves/min
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
21. What cell produces IF and What does it do
Parietal cells in the stomach - B12 binding protein
Lack or have an attenuated muscularis externa - often in the sigmoid colon
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
EtOH
22. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
23. What are the ABCDEF of esophageal cancer
Causes of gall stones
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
24. What structures feed into the cystic duct
Achalasia due to loss of myenteric plexus (auberach)
Trypsin - chymotrypsin - elastase - carboxypeptidases
Warthins' tumor
Gallbladder
25. What is the most common cause of gallstones
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Serous on the sides parotids - mucinous in the middle sublingual
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
26. Which kind of hemorrhoids are painful and why
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Chronic gastritis and pernicious anemia
Chronic calcifying pancreatitis - inc risk of panreatic cancer
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
27. What receptors does gastrin bind on the parietal cell and What does it activate
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Alpha amylase
Omeprazole
CCK8 receptor - Gq inc IP3/Ca
28. How does CRC present in the distal and proximal colon
So hypertrophied they look like brain gyri
Hydrocele
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
29. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Above
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
Oral glucose
30. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Around the central vein (zone III)
Diverticulum
Hemosiderosis - hemochromatosis
Hepatic steatosis
31. What is the rule of 2s for meckels
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Averages 6 months - very aggressive - usually already metastasized at presentation
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Inguninal ligament - sartorius muscle - adductor longus
32. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Sister mary joseph nodule
Begins starch digestion - inactivated by low pH upon reaching the stomach
Intussusception
Small intestine
33. What are the barium swallow findings of achalasia
Necrotizing enterocolitis
Dilated esophagus with an area of distal stenosis - birds beak
Femoral hernia
Worldwide - SC - US - adeno
34. secretin - source - action - regulation
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
Glucouronate - water soluble (direct)
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Splenic flexure
35. What is charcot triad of cholangitis
Positive urease test
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Downs
Jaundice - fever - RUQ
36. bilateral mets to ovaries with abundant mucus - signet ring cells
Krukenbergs tumor
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Femoral hernia
L4
37. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
Squamous - upper 1/3 - adeno - lower 1/3
AST
Amylase
38. What layer in the mucosa is repsonsible for motility
L1
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
Begins starch digestion - inactivated by low pH upon reaching the stomach
Muscularis mucosae
39. What drug blocks the H2R
Nonkeritinized stratified sqamous epithelium
Cimetidine
The jejunum
Diverticulitis in elderly - ectopic pregs use hCG to rule out
40. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Dense core bodies
Turcot
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Zollinger Ellison - phenylalanine and tryptophan
41. What cells make pepsin - What does it do - and what regulates it
Hepatic steatosis
Lactase is located at the tips of intestinal villi
L1
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
42. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Colonic polyps
AST
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
43. 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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44. Who gets Whipple disease and How do they present
Common hepatic - splenic - left gastric - main blood supply for stomach
Hirschsprungs
Old men - arthralgias - cardiac and neuro sx
Terminal ileum and colon
45. What are the borders of the femoral triangle
Pleuroperitoneal
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Inguninal ligament - sartorius muscle - adductor longus
Peyers patches
46. In what clinical scenarior do you see portosystemic anastomoses
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Alpha amylase
Portal HTN
Duodenal atresia - Downs
47. What serum enzyme is decreased in wilsons disease
Striated
Hemosiderosis - hemochromatosis
Meconium ileus
Ceruplasmin
48. What does histo show for alpha1 antitrypsin def
PAS- positive globules in liver -
Femoral hernia
Lactase is located at the tips of intestinal villi
Myenteric nerve plexus - aurbach
49. What are the main components of bile
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Volvulus
Small intestine
50. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Falciform - ligamentum teres - fetal umbilical vein
Oligosaccharide digestion
90%