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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 salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue
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2. What kind of insults results in macronodular cirrhosis
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Primarly through ECL leading to histamine release
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
3. what kind of muscle is in the upper 1/3 of esophagus
True and most common congenital anomoly of GI tract
Trypsin - chymotrypsin - elastase - carboxypeptidases
Striated
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
4. What kind of cancer to celiac sprue put you as inc risk for
Left and right gastroepiploics - left and right gastrics
T cell lymphoma
Nonkeritinized stratified sqamous epithelium
Lubricate food (glycoprotiens)
5. What is contained in the gastrosplenic and What areas does it separate
Boerhaave's Syndrome - Been heaving syndrome
Sister mary joseph nodule
Short gastrics - left greater and lesser
Primary sclerosing cholangitis
6. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Intussusception
Crypts but not villi
Muscularis mucosae
Brush border of intestine - produce monosaccharides from oligo and di
7. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
12 waves/min
GERD - may also present with nocturnal cough and dyspnea
No
Left gastric vein and esophogeal vein - esophagus
8. What are the hindgut structures and what supplies their blood and PANS innvervation
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Brunners
Dubin johnson
Left and right gastroepiploics - left and right gastrics
9. What are additional risk factors for CRC
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
GLUT 2
Angiodysplasia
Dubin johnson
10. What is the ddx associated with appendicitis
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Hepatic steatosis
Striated and smooth
11. FAP + osseous and soft tissue tumors - retinal hyperplasia
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12. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Lamina propora and submucosa
Erosive - disruption of mucosal barrier leading to inflammation
Cholesterol - 10-20% opaque due to calcifications
13. rare - often fatal childhood hepatoencephalopathy
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14. What structures feed into the cystic duct
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Gallbladder
Glucose dependent insulinotropic peptide
Ischemic colitis
15. What is the action of NO as a GI hormone
Colovesical leading to pneumaturia
Decreased intercellular adhesion and increased proliferation
Colonic polyps
Inc smooth muscle relaxation - including lower esophageal sphincter
16. What are the common causes of gastric ulcers - What causes gastric ulcer
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Muscularis mucosae
Alpha amylase
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
17. What gives urine its characteristic color
Small intestine
Cigarettes and chronic pancreatitis - not EtOH
Urobilin
H2 receptor - inc cAMP
18. occlusion of IVC or hepatic veins
Budd chiari syndrome
Urobilin
Crypts but not villi
Dilated esophagus with an area of distal stenosis - birds beak
19. What is the TX of physiologic neonatal jaundice
Phototherapy
Alk phos
Where hindgut meets ectoderm
Normal
20. Is there any structural abnl with IBS - What is the course of disease and presentation
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Glucouronate - water soluble (direct)
Falciform - ligamentum teres - fetal umbilical vein
Female - fat - fertile - forty
21. What layer in the mucosa is responsible for support
Lamina propria
Alpha1 antitrypsin def - codominant trait
Mallory bodies
Causes of gall stones
22. What is a positive murphy's sign
Inspiratory arrest on deep palpation due to pain
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Inc - weight loss
23. What are the effects of atropine on parietal cells and G cells
IgA secreting plasma cells - ultimately reside in the lamina proporia
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Diarrhea - steatorrhea - weight loss - weakness
Menetriers disease
24. What do mucins do?
No
Lubricate food (glycoprotiens)
Can lead to hematemesis - found in EtOHics and bulimics
Appendicitis
25. At what level do the testicular/ovarian arteries exit the aorta
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
L2
Obstruction of the common bile duct
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
26. What is the most common indication of emergent abdominal surgery in children
Unconj - absent (acholuria) - inc
Phenobarbital - inc liver enzyme synthesis
With albumin
Appendicitis
27. What complication can arise from indirect inguinal hernias
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Omeprazole
Hydrocele
28. Where are tumors commonly in pancreatic adenocarcinoma
Pancreatic head causing obstructive jaundice
Unconjugated - water insoluble
Pertechnetate - study for uptake
Squamous - upper 1/3 - adeno - lower 1/3
29. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Cirrhosis
H2 receptor - inc cAMP
Via the middle colic
Striated and smooth
30. What is the presentation of pancreatic adenocarcinoma
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Inc smooth muscle relaxation - including lower esophageal sphincter
Upregulated intracellular signal transduction
31. Where does type B chronic gastritis occur and What causes it
Antrum - H.pylori - inc risk of MALT lymphoma
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Centrilobular leading to congestive liver disease
No - chronic - can present with diarrhea or constipation or alternation - treat sx
32. How does abetalipoproteinemia lead to malabsorption
Via the middle colic
Ceruplasmin
Lipase - phospholipase A - colipase
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
33. Where is folate absorbed
Older patients
Hyperplastic
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
The jejunum
34. What histological findings are present in the esophagus
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Nonkeritinized stratified sqamous epithelium
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
ALT>AST
35. In an MI - which liver enzyme is elevated
Inferior rectal nerve
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
AST
36. Malabsorption syndromes have what common clinical presentation
Diarrhea - steatorrhea - weight loss - weakness
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
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
37. What does extrahepatic biliary obstruction cause
Celiac sprue
Lateral to the inferior epigastric artery
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
38. What findings are associated with reyes
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Colonic polyps
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
AR
39. What commonly leads to appendicity in kids vs adults
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
40. What do the rugae of stomach look like in menetriers disease
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
So hypertrophied they look like brain gyri
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
41. Where is bicarb trapped
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
In the mucus that covers the gastric epithelium
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Zollinger Ellison - phenylalanine and tryptophan
42. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Black - rotors syndrome
CCK8 receptor - Gq inc IP3/Ca
Early childhood - neuro sx and malabsorption
Esophageal cancer
43. What does high flow rate mean
Primarly through ECL leading to histamine release
Closer to isotonic because of less time to reabsorb NaCl
Barrett's esophagus
Appendicitis
44. What factors increase risk of malignancy of adenomatous polyps
90%
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Adhesion
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
45. What are the complications of Meckels
90%
Bleeding - intussusception - volvulus - obstruction near terminal ileum
2ndary biliary cirrhosis
Nonkeritinized stratified sqamous epithelium
46. What is indirect bilirubin
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
With albumin
Unconjugated - water insoluble
Left gastric vein and esophogeal vein - esophagus
47. What are the barium swallow findings of achalasia
Dilated esophagus with an area of distal stenosis - birds beak
CEA - CA-19-9
3 waves/min
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
48. How does loss of NO secretion affect the esophagus and what results
Old men - arthralgias - cardiac and neuro sx
Inc lower esphogeal tone leading to achalasia
Inc conj bilirubin - inc cholesterol - inc alk phos
Hepatic steatosis
49. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Decreased intercellular adhesion and increased proliferation
12 waves/min
Peutz jeghers
T cell lymphoma
50. What other condition can lead to acute gastritis - think renal
Uremia
Cystic duct and common hepatic duct
AR
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
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