SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
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 kind of pathways do CCK act on to cause pancreatic secretion
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Cystic dilation of the viteline duct
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Neural muscarinic pathways
2. Malabsorption syndromes have what common clinical presentation
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Diarrhea - steatorrhea - weight loss - weakness
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
3. What is the other name for GIP (gastric inhibitory peptide)
Glucose dependent insulinotropic peptide
M3 - Gq - inc IP3/Ca
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
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
4. What are the treatment options for uclerative colitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Skip lesions =crohns - colon = UC
Menetriers disease
Punched out - clean margins - carcinoma =raised irregular margins
5. What layer in the mucosa is responsible for absorption
Can lead to hematemesis - found in EtOHics and bulimics
Pleuroperitoneal
Epithelium
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
6. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Sister mary joseph nodule
Zollinger Ellison - phenylalanine and tryptophan
Peyers patches
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
7. What is the arterial supply and venous drainage below pectinate line
The entire
Inguninal ligament - sartorius muscle - adductor longus
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
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
8. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Uremia
Copious diarrhea - non alpha - non beta cell pancreatic tumor
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
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
9. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Oligosaccharide digestion
Esophageal cancer
Esophageal carcinoma
Left gastric vein and esophogeal vein - esophagus
10. What receptor does histamine bind on the parietal cell and What does it activate
H2 receptor - inc cAMP
The submucosal nerve plexus - meissner's
Hernia
Failure of the processus vagainlis to close
11. What kind of muscle is in the middle 1/3 of esophagus
The gastroduodenal
Muscularis mucosae
Striated and smooth
Antrum - H.pylori - inc risk of MALT lymphoma
12. What artery passes around the duodenum
The gastroduodenal
Juvenile polyposis syndrome - inc risk of adenocarcinoma
In the ileum with bile acids - requires IF
Inc conj bilirubin - inc cholesterol - inc alk phos
13. What are the branches of the celiac trunk and What do they supply
Inc lower esphogeal tone leading to achalasia
Inguninal ligament - sartorius muscle - adductor longus
Common hepatic - splenic - left gastric - main blood supply for stomach
Lack or have an attenuated muscularis externa - often in the sigmoid colon
14. What enzyme is necessary to create conjugated bilirubin
Failure of the processus vagainlis to close
Uridine glucuronyl transferase
Virchow's node
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
15. What gives urine its characteristic color
Lamina propria
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Urobilin
8-9 waves/min
16. Where is folate absorbed
The jejunum
Inc conj bilirubin - inc cholesterol - inc alk phos
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Alpha amylase
17. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Zollinger Ellison - phenylalanine and tryptophan
Adhesion
Cystic dilation of the viteline duct
Meconium ileus
18. What other condition can lead to acute gastritis - think renal
Redness and tenderness on palpation of extremities
The entire
Hemolytic anemia
Uremia
19. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Causes of gall stones
Paraumbilical and superficial and inferior epigastric - umbilicus
No
8-9 waves/min
20. What do you treat Wilsons disease with and What is the inheritance
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Stimulate intestinal persistalsis
Penicillinamine - AR inheritance
Jaundice - fever - RUQ
21. Where does an indirect inguinal hernia enter the deep inguinal ring
HPNCC
L2
Below
Lateral to the inferior epigastric artery
22. concentric onion skin bile duct fibrosis
Primary sclerosing cholangitis
Corticosteroids - infliximab
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Gardner's syndrome
23. What are the two molecular pathways that lead to CRC
Poor anastamoses
Alcoholic cirrhosis
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Averages 6 months - very aggressive - usually already metastasized at presentation
24. What causes carcinoid syndrome amd What are the symptoms
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
True and most common congenital anomoly of GI tract
25. absent UDPGT - presents early in life - early mortality
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Crigler - najjar type 1
The gastroduodenal
All 3 gut layers outpouch as in Meckels
26. What kind of diarrhea is produced from a disaccharide def
Esophageal carcinoma
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Stimulate intestinal persistalsis
Osmotic
27. How does brain injury lead to acute gastritis and What is it called
12 waves/min
Erosive - disruption of mucosal barrier leading to inflammation
Mucoepidermoid carcinoma
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
28. At what spinal level does the celiac trunk exit
CHF and inc risk of HCC
T12
Lateral
Brunners
29. At what spinal level does the SMA exit
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Stimulate intestinal persistalsis
Repeated phlebotomy - deferoxamine - HLA- A3
L1
30. What kind of insults results in macronodular cirrhosis
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Glucouronate - water soluble (direct)
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
31. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Backup of blood into the liver - RHF - budd chiari
Around the central vein (zone III)
2ndary biliary cirrhosis
32. Achalasia increases the risk For what complication
Esophageal carcinoma
Crypts but not villi
Cirrhosis
Complications of crohns
33. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Omeprazole
8-9 waves/min
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
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
34. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Falciform - ligamentum teres - fetal umbilical vein
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
35. When do you see hypertrophy of brunners glands
Peptic ulcer disease
Worldwide - SC - US - adeno
Serous on the sides parotids - mucinous in the middle sublingual
With albumin
36. What is indirect bilirubin
Unconjugated - water insoluble
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
The gastroduodenal
Nonkeritinized stratified sqamous epithelium
37. Where is the deep inguinal ring relative to the inferior epigastric vessels
Lateral
Black - rotors syndrome
Trypsin - chymotrypsin - elastase - carboxypeptidases
Meconium ileus
38. What causes hirschsprungs
Failure of neural crest migration
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Via the middle colic
Nonkeritinized stratified sqamous epithelium
39. If trypsin activates more trypsinogen - what kind of feedback loop is established
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
Adhesion
Positive
Gallbladder
40. What layer of fascia covers a direct inguinal hernia
Terminal ileum and colon
NAV = nerve artery vein - venous near the penis (NAVEL)
Esophageal varices
External spermatic fascia only
41. Scleroderma is associated with what kind of esophageal dysmotility
Unconjugated - water insoluble
Crohns = noncaseating granulomas - UC = crypt abscesses
Low pressure proximal to LES
Hernia
42. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
In the mucus that covers the gastric epithelium
Above
GERD - may also present with nocturnal cough and dyspnea
Upregulated intracellular signal transduction
43. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Myenteric nerve plexus - aurbach
44. What do you use to diagnose meckels
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Pertechnetate - study for uptake
Crohns = maybe - UC= always
Corticosteroids - infliximab
45. In alchoholic hepatitis which liver enzyme is higher
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
AST>ALT
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
46. What source of salivary secretion is the most serous and What is the most mucinous
Positive urease test
Serous on the sides parotids - mucinous in the middle sublingual
Cirrhosis
L1
47. What is the most common diaphragmatic hernia and What are the two types
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Smooth
Centrilobular congestion and necrosis - cardiac cirrhosis
48. What are the complications of chronic pancreatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Inc smooth muscle relaxation - including lower esophageal sphincter
49. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Short gastrics - left greater and lesser
Meconium ileus
Alk pho
Cystic duct and common hepatic duct
50. What is the most common esophageal cancer worldwide and in the US
Worldwide - SC - US - adeno
Splenic flexure
All 3
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial