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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 gives stool its characteristic color
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Pancreatic head causing obstructive jaundice
2ndary biliary cirrhosis
Stercobilin
2. What is Trousseau's sign
Hypercoaguability - polycythemia vera - pregnancy - HCC
Redness and tenderness on palpation of extremities
3 waves/min
Below
3. What transforms conjugated bilirubin to urobilinogen
Cirrhosis
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
PAS- positive globules in liver -
Gut bacteria
4. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Goes through deep inguinal ring - external inguinal ring and into the scrotum
GLUT 2
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Inc conj bilirubin - inc cholesterol - inc alk phos
5. In alchoholic hepatitis which liver enzyme is higher
Hirschsprungs
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
AST>ALT
Striated and smooth
6. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Short gastrics - left greater and lesser
Stimulate intestinal persistalsis
2ndary biliary cirrhosis
7. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Barrett's esophagus
Omeprazole
Terminal ileum and colon
Necrotizing enterocolitis
8. What kind of muscle is in the lower 1/3 of the esophagus
Smooth
Paraumbilical and superficial and inferior epigastric - umbilicus
Krukenbergs tumor
Older patients
9. What findings are associated with reyes
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Amylase
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
10. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
In the ileum with bile acids - requires IF
Can lead to hematemesis - found in EtOHics and bulimics
Neutralizes gastric acid allowing pancreatic enzymes to fxn
...
11. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Paraumbilical and superficial and inferior epigastric - umbilicus
Lactase is located at the tips of intestinal villi
Upregulated intracellular signal transduction
CEA - CA-19-9
12. To what substance is bilirubin conjugated and why
Glucouronate - water soluble (direct)
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
AST >ALT - ration is usually 1.5
Lubricate food (glycoprotiens)
13. What commonly leads to appendicity in kids vs adults
Lactase is located at the tips of intestinal villi
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
14. What are the branches of the celiac trunk and What do they supply
Common hepatic - splenic - left gastric - main blood supply for stomach
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Esophageal cancer
Lateral to the inferior epigastric artery
15. What are the complications of acute pancreatitis
Crohns = maybe - UC= always
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Hemosiderosis - hemochromatosis
Bleeding - penetration into pancreas - perforation - obstruction
16. What drug blocks the H2R
Cimetidine
Internal thoracic to superior epigastric to inferior epigastric
Gamma glutamyl transferase GGT
Hirschsprungs
17. What is the HLA association and treatment for hemochromatosis
Meconium ileus
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Repeated phlebotomy - deferoxamine - HLA- A3
18. What are the barium swallow findings of achalasia
Early childhood - neuro sx and malabsorption
Intussusception
Dilated esophagus with an area of distal stenosis - birds beak
Bleeding - intussusception - volvulus - obstruction near terminal ileum
19. Where are oligosaccharide hydrolases and What do they do
Gamma glutamyl transferase GGT
Brush border of intestine - produce monosaccharides from oligo and di
External spermatic fascia only
Internal thoracic to superior epigastric to inferior epigastric
20. Where is the deep inguinal ring relative to the inferior epigastric vessels
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
The proximal small bowel
Lateral
...
21. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
Via the superior pancreaticduodenal
All 3
Reye's syndrome
22. What are the effects of atropine on parietal cells and G cells
Barrett's esophagus
Common hepatic - splenic - left gastric - main blood supply for stomach
Hemolytic anemia
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
23. What type of insults result in micronodular cirrhosis
Krukenbergs tumor
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
24. What is the TX of physiologic neonatal jaundice
Early childhood - neuro sx and malabsorption
Obstruction of the common bile duct
Phototherapy
Stimulate the H/K ATPase
25. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
L2
Crohns = maybe - UC= always
Gamma glutamyl transferase GGT
26. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
CCK8 receptor - Gq inc IP3/Ca
Redundant mesentary
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
27. What kind of insults results in macronodular cirrhosis
Lateral
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
28. What artery passes around the duodenum
The gastroduodenal
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
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Cystic duct and common hepatic duct
29. What does a gastrinoma cause
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
AST>ALT
Dense core bodies
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
30. What skin condition is associated with celiac sprue
Muscularis mucosae
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Via the middle colic
Dermatitis herpetiformis
31. What makes a true diverticula
Hyperplastic
Parietal cells in the stomach - B12 binding protein
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
All 3 gut layers outpouch as in Meckels
32. FAP + malignant CNS tumor
Turcot
Zollinger ellison - brunners glands
Juvenille polyps - no risk if single
T cell lymphoma
33. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Zollinger Ellison - phenylalanine and tryptophan
Lactase is located at the tips of intestinal villi
True and most common congenital anomoly of GI tract
34. Which viral infxns/treatments are associated with reyes syndrome
VZV and influenza B treated with salicylates
Boerhaave's Syndrome - Been heaving syndrome
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Jewish and African American men
35. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Osmotic
The entire
L4
36. What are the histological findings in the duodenum
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37. What are the treatmet options for crohns
Corticosteroids - infliximab
Via the middle colic
Esophageal varices
Uridine glucuronyl transferase
38. What is the action of NO as a GI hormone
Inc - weight loss
Inc smooth muscle relaxation - including lower esophageal sphincter
Normal
Trypsin - chymotrypsin - elastase - carboxypeptidases
39. what percentage of colonic polyps are non - neoplastic
Squamous - upper 1/3 - adeno - lower 1/3
90%
8-9 waves/min
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
40. What receptors does ACH bind on the parietal cells and What does it activate
M3 - Gq - inc IP3/Ca
Heme metabolism
Superior rectal
Cholesterol - 10-20% opaque due to calcifications
41. What does bicab do in the mouth
Neutralizes oral bacertial acids and maintains dental health
Jaundice - fever - RUQ
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Black - rotors syndrome
42. What are the foregut structures and what supplies their blood and PANS innvervation
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Omeprazole
In the mucus that covers the gastric epithelium
Urobilin
43. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Adhesion
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Mucosa - submucosa - muscularis externa - serosa/adventitia
H+
44. What is the rate limiting step of carbohydrate digestion
Lipase
Lamina propria
Oligosaccharide digestion
Cystic dilation of the viteline duct
45. What are the main components of bile
Stimulate the H/K ATPase
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Achalasia due to loss of myenteric plexus (auberach)
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
46. Why does volvulus occur more at cecum and sigmoid colon
Hirschsprungs
Falciform - ligamentum teres - fetal umbilical vein
Unconj - absent (acholuria) - inc
Redundant mesentary
47. Which serum enzyme increases with heavy EtOH consumption
CCK8 receptor - Gq inc IP3/Ca
Gamma glutamyl transferase GGT
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
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
48. milk intolerance
Dissaccharidase def - most commonly lactase
Via the superior pancreaticduodenal
Female - fat - fertile - forty
Gut bacteria
49. most common non - neoplastic polyp in colon
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Hyperplastic
Worldwide - SC - US - adeno
Around the central vein (zone III)
50. crigler - najjar type II responds to which therapy and How does it work
Cirrhosis
Phenobarbital - inc liver enzyme synthesis
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
L1