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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. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
PAS- positive globules in liver -
True and most common congenital anomoly of GI tract
8-9 waves/min
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
2. What is the path of an indirect inguinal hernia
With albumin
Complications of crohns
Cystic duct and common hepatic duct
Goes through deep inguinal ring - external inguinal ring and into the scrotum
3. Transmural esophageal rupture due to violent retching
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4. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Closer to isotonic because of less time to reabsorb NaCl
GERD - may also present with nocturnal cough and dyspnea
Epithelium
5. In PUD with a duodenal ulcer does pain inc or dec with meals
Old men - arthralgias - cardiac and neuro sx
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Decrease - weight gain
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
6. likely infectious form of malabsorption - responds to antibiotics
Zollinger ellison - brunners glands
Redness and tenderness on palpation of extremities
Tropical sprue
Achalasia due to loss of myenteric plexus (auberach)
7. most common malignant salivary gland tumor
Volvulus
Virchow's node
Mucoepidermoid carcinoma
Urobilin
8. Which serum enzyme increases with heavy EtOH consumption
Gamma glutamyl transferase GGT
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Inguninal ligament - sartorius muscle - adductor longus
9. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Myenteric nerve plexus - aurbach
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
90%
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
10. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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11. What serum markers increase in cholecystitis with bile duct involvement
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Alk phos
All 3 gut layers outpouch as in Meckels
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
12. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Lipase - phospholipase A - colipase
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Cystic duct and common hepatic duct
Unconj - absent (acholuria) - inc
13. What are the borders of Hesselbach's triangle
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Dissaccharidase def - most commonly lactase
Causes of gall stones
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
14. How does hirschsprung present and appear on imaging
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Inc - weight loss
Backup of blood into the liver - RHF - budd chiari
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
15. What is biliary colic
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Skip lesions =crohns - colon = UC
Goes through deep inguinal ring - external inguinal ring and into the scrotum
L/R renal artery around L1
16. Who is at risk for pancreatic adenocarcinoma
VZV and influenza B treated with salicylates
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Inguninal ligament - sartorius muscle - adductor longus
Jewish and African American men
17. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Zollinger Ellison - phenylalanine and tryptophan
AST
Meconium ileus
The proximal small bowel
18. What kind of pathways do CCK act on to cause pancreatic secretion
Decreased intercellular adhesion and increased proliferation
Where hindgut meets ectoderm
Volvulus
Neural muscarinic pathways
19. Autodigestion of pancreas by pancreatic enzymes
Acute pancreatitis
Repeated phlebotomy - deferoxamine - HLA- A3
Uridine glucuronyl transferase
IgA secreting plasma cells - ultimately reside in the lamina proporia
20. What are the histological findings in the duodenum
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21. Autoantibodies to gluten (gliadin) in wheat and other grains
Falciform - ligamentum teres - fetal umbilical vein
Barrett's esophagus
Celiac sprue
Oral glucose
22. What can hemochromatosis be secondary to...
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Chronic calcifying pancreatitis - inc risk of panreatic cancer
H pylori (almost 100%)
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
23. What is the most common esophageal cancer worldwide and in the US
Hirschsprungs
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Around the central vein (zone III)
Worldwide - SC - US - adeno
24. Why does indirect inguinal hernia happen in infacnts
Duodenum - 2nd - 3rd and 4th parts
Failure of the processus vagainlis to close
Crigler - najjar type 1
Zenkers - halitosis - dysphagia and obstruction
25. What receptors does gastrin bind on the parietal cell and What does it activate
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
CCK8 receptor - Gq inc IP3/Ca
Redundant mesentary
Cystic duct and common hepatic duct
26. What structures feed into the common hepatic duct
Right and left hepatic duct
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
EtOH
Cholesterol
27. How do burns cause acute gastritis and What is it called
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28. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
L1
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Budd chiari syndrome
Alcoholic cirrhosis
29. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Alk pho
H pylori (almost 100%)
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
The proximal small bowel
30. What is the rate limiting step of carbohydrate digestion
Corticosteroids - infliximab
Ischemic colitis
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Oligosaccharide digestion
31. What are the foregut structures and what supplies their blood and PANS innvervation
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Lye ingestion and acid reflux
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Right and left hepatic duct
32. Bile is critical for exrection of what substance
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Cholesterol
Normal
Stimulate intestinal persistalsis
33. Where does crohns usually affect the GI tract
Adhesion
Femoral hernia
Terminal ileum and colon
Source - I cells (duod - jej - action - inc pancreative secretion - inc gallbladder contraction - dec gastric emptying - sphincter of Oddi relaxation - regulation - inc by fatty acids and amino acids
34. What arteries exit just below the SMA
Lamina propora and submucosa
Peyers patches
Older patients
L/R renal artery around L1
35. Gq and inc cAMP both work to do what in parietal cells
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Downs
Epigastric abdominal pain radiating to back - anorexia - nausea
Stimulate the H/K ATPase
36. Who gets gastric ulcers
Conj - inc - dec
Barrett's esophagus
Older patients
Celiac sprue
37. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Lye ingestion and acid reflux
Falciform - ligamentum teres - fetal umbilical vein
Corticosteroids - infliximab
38. Failure of relaxation of lower esophageal sphincter - Name and etiology
Achalasia due to loss of myenteric plexus (auberach)
Smooth
Brush border of intestine - produce monosaccharides from oligo and di
Tropical sprue
39. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
CCK8 receptor - Gq inc IP3/Ca
Pleomorphic adenoma
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Normal
40. What are the histological findings of the colon
Crypts but not villi
Small intestine
Sister mary joseph nodule
Striated and smooth
41. What serum enzyme is elevated inacute pancreatitis
The jejunum
Lipase
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Failure of the processus vagainlis to close
42. What drug blocks the H2R
Cimetidine
Zollinger ellison - brunners glands
Inc smooth muscle relaxation - including lower esophageal sphincter
Lipase
43. in carcinoid tumors - What is seen on EM
Dense core bodies
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Old men - arthralgias - cardiac and neuro sx
Crigler - najjar type 1
44. Where is IgA shuttled
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
Alpha1 antitrypsin def - codominant trait
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Epithelium
45. Between what structures do strong anastamoses exist
Pertechnetate - study for uptake
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Left and right gastroepiploics - left and right gastrics
Lye ingestion and acid reflux
46. GIP - source - action regulation
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Above
47. Achalasia increases the risk For what complication
Inc smooth muscle relaxation - including lower esophageal sphincter
Striated
Esophageal carcinoma
Adhesion
48. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Paraumbilical and superficial and inferior epigastric - umbilicus
Chronic gastritis and pernicious anemia
Black - rotors syndrome
Lubricate food (glycoprotiens)
49. What is the cause of physiologic neonatal jaundice
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Gut bacteria
Older patients
Sphincter of oddi
50. bilateral mets to ovaries with abundant mucus - signet ring cells
Lipase
With albumin
Esophageal varices
Krukenbergs tumor
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