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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 kind of diarrhea is produced from a disaccharide def
Enterokinase/enteropeptidase from the duodenal mucosa
External (superficial) ring only
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Osmotic
2. What kind of pancreatitis is associated with EtOH and smoking
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Fasting and stress
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
3. What are the borders of the femoral triangle
3 waves/min
Inguninal ligament - sartorius muscle - adductor longus
Alpha1 antitrypsin def - codominant trait
Lateral to the inferior epigastric artery
4. What are the labs in acute pancreatitis
Lamina propria
Female - fat - fertile - forty
Dec PGE2 leading to dec gastric mucosa protection
Elevated amylase - and lipase
5. What findings are associated with reyes
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Mitochondrial abnl - fatty liver - hypoglycemia - coma
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Heme metabolism
6. Where are carcinoid tumors most commonly malignant
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Small intestine
External spermatic fascia only
Crohns = maybe - UC= always
7. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
AST
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Serous on the sides parotids - mucinous in the middle sublingual
Cigarettes and chronic pancreatitis - not EtOH
8. Which viral infxns/treatments are associated with reyes syndrome
Dilated esophagus with an area of distal stenosis - birds beak
Lipase
VZV and influenza B treated with salicylates
Glucose dependent insulinotropic peptide
9. What are the results of hemochromatosis
Gilbert's
CHF and inc risk of HCC
HSV-1 - CMV - Candida
IBS at least 2 with recurrent abdominal pain
10. What is the frequency of basal electric rhythm of the stomach
3 waves/min
H+
Hyperpigmented mouth - lips - hands - genitalia
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
11. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Left gastric vein and esophogeal vein - esophagus
US and cholecystectomy
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Crypts but not villi
12. What carcinogens are associated with HCC
CEA - CA-19-9
Urobilin
Redundant mesentary
Alfatoxin in peanuts
13. crigler - najjar type II responds to which therapy and How does it work
Striated
Ischemic colitis
Phenobarbital - inc liver enzyme synthesis
Cystic dilation of the viteline duct
14. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Lamina propria
Gamma glutamyl transferase GGT
Via the superior pancreaticduodenal
Urobilin
15. In alchoholic hepatitis which liver enzyme is higher
AST>ALT
Turcot
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Gut bacteria
16. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Positive urease test
Duodenal atresia - Downs
Glucouronate - water soluble (direct)
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
17. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Bleeding - penetration into pancreas - perforation - obstruction
Colonic polyps
Conj - inc - dec
18. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Primarly through ECL leading to histamine release
19. What is the prognosis of adenocarcinoma
Achalasia due to loss of myenteric plexus (auberach)
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Averages 6 months - very aggressive - usually already metastasized at presentation
Early childhood - neuro sx and malabsorption
20. What pancreatic enzymes are responsible for fat digestion
CHF and inc risk of HCC
Cigarettes and chronic pancreatitis - not EtOH
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Lipase - phospholipase A - colipase
21. What is the clinical presentation of acute pancreatitis
Epigastric abdominal pain radiating to back - anorexia - nausea
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Centrilobular leading to congestive liver disease
Inc - weight loss
22. Where is the pectinate line
Trypsin - chymotrypsin - elastase - carboxypeptidases
Where hindgut meets ectoderm
Esophageal cancer
HSV-1 - CMV - Candida
23. What histological findings are present in the esophagus
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Nonkeritinized stratified sqamous epithelium
Terminal ileum and colon
24. What does histo show for alpha1 antitrypsin def
PAS- positive globules in liver -
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Appendicitis
L4
25. What is the cause of physiologic neonatal jaundice
Poor anastamoses
Early childhood - neuro sx and malabsorption
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
26. What is the path of an indirect inguinal hernia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Inguninal ligament - sartorius muscle - adductor longus
When diffusely infiltrative - thickened rigid appearance like a leather bottle
M3 - Gq - inc IP3/Ca
27. What is biliary colic
Hypotonic because of more time to reabsorb NaCl
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
Duodenum - 2nd - 3rd and 4th parts
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
28. Who gets Whipple disease and How do they present
Old men - arthralgias - cardiac and neuro sx
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Volvulus
Centrilobular leading to congestive liver disease
29. What are the branches of the celiac trunk and What do they supply
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Superior rectal and middle and inferior rectal - rectum
Common hepatic - splenic - left gastric - main blood supply for stomach
Lateral to the inferior epigastric artery
30. what kind of fistula is associated with diverticulitis
L/R renal artery around L1
Colovesical leading to pneumaturia
GERD - may also present with nocturnal cough and dyspnea
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
31. Where are peyers patches found
12 waves/min
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
Lamina propora and submucosa
Inc - weight loss
32. Where does an indirect inguinal hernia enter the deep inguinal ring
Lateral to the inferior epigastric artery
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
33. What is the mechanism for reyes syndrome
Enterokinase/enteropeptidase from the duodenal mucosa
Hernia
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
34. What is the most common diaphragmatic hernia and What are the two types
Esophageal varices
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Mucosa - submucosa - muscularis externa - serosa/adventitia
US and cholecystectomy
35. What are causes of extrahepatic biliary obstruction
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Inspiratory arrest on deep palpation due to pain
FAP
36. What gives urine its characteristic color
NAV = nerve artery vein - venous near the penis (NAVEL)
Gastric glands
Hypotonic because of more time to reabsorb NaCl
Urobilin
37. What other condition can lead to acute gastritis - think renal
Uremia
Diarrhea - steatorrhea - weight loss - weakness
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Glucouronate - water soluble (direct)
38. What serum enzyme is elevated inacute pancreatitis
Lipase
Hypercoaguability - polycythemia vera - pregnancy - HCC
Mucoepidermoid carcinoma
HPNCC
39. How do villi appear in disaccharidease def
The entire
L1
Normal
True and most common congenital anomoly of GI tract
40. What does GET SMASHED stand for in acute pancreatitis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Pleomorphic adenoma
Striated
41. What is contained within the muscularis externa
Esophageal carcinoma
Failure of the processus vagainlis to close
Ceruplasmin
Myenteric nerve plexus - aurbach
42. What can fistula between the gallbladder and small intestine create and how can you tell
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Stimulate intestinal persistalsis
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Hepatic steatosis
43. What does loss of APC cause
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Decreased intercellular adhesion and increased proliferation
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
44. How are all 3 monosaccharides transported to the blood
Early childhood - neuro sx and malabsorption
GLUT 2
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Mallory bodies
45. In an MI - which liver enzyme is elevated
AST >ALT - ration is usually 1.5
Jaundice - fever - RUQ
AST
ALT>AST
46. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Alpha amylase
Chagas disease
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Sister mary joseph nodule
47. What is the frequency of basal electric rhythm of the ilieum
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
8-9 waves/min
Hirschsprungs
Striated and smooth
48. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Complications of crohns
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Inspiratory arrest on deep palpation due to pain
Myenteric nerve plexus - aurbach
49. Where is IgA shuttled
Dense core bodies
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Stercobilin
Lye ingestion and acid reflux
50. What is one potential precipitating factor for intussusception
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Causes of gall stones
Below
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