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Test your basic knowledge |
USMLE GI
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Subjects
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health-sciences
,
usmle
Instructions:
Answer 50 questions in 15 minutes.
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study here
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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 is the TX of physiologic neonatal jaundice
Phototherapy
Smooth
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
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
2. trypsinogen is converted to trypsin via what enzyme
Enterokinase/enteropeptidase from the duodenal mucosa
Osmotic
Upregulated intracellular signal transduction
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
3. What does histo show for alpha1 antitrypsin def
Jaundice - fever - RUQ
PAS- positive globules in liver -
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Cimetidine
4. What is the most common diaphragmatic hernia and What are the two types
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Celiac sprue
5. How is bilirubin carried in the blood
With albumin
Inferior rectal nerve
Antrum - H.pylori - inc risk of MALT lymphoma
Inc - weight loss
6. What is contained within the muscularis externa
Myenteric nerve plexus - aurbach
IBS at least 2 with recurrent abdominal pain
Primarly through ECL leading to histamine release
EtOH
7. What is one potential precipitating factor for intussusception
Worldwide - SC - US - adeno
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Esophageal varices
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
8. How does gastrin increase acid secretion?
Gastric glands
Peptic ulcer disease
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Primarly through ECL leading to histamine release
9. To what substance is bilirubin conjugated and why
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Glucouronate - water soluble (direct)
Zenkers - halitosis - dysphagia and obstruction
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
10. Where are oligosaccharide hydrolases and What do they do
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Brush border of intestine - produce monosaccharides from oligo and di
11. inflammatino of gallbadder
Lateral
Achalasia due to loss of myenteric plexus (auberach)
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
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
12. malnutrition - toxic megacolon - colorectal carcinoma
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
Complications of UC
Gastric glands
Dilated esophagus with an area of distal stenosis - birds beak
13. FAP + malignant CNS tumor
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Turcot
Esophageal varices
L3
14. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
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
Around the central vein (zone III)
Complications of crohns
15. What histological findings are present in the esophagus
Nonkeritinized stratified sqamous epithelium
Chagas disease
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Positive
16. What does loss of p53 cause
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Dermatitis herpetiformis
Increase tumorigenesis
Worldwide - SC - US - adeno
17. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Mucosa - submucosa - muscularis externa - serosa/adventitia
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Striated and smooth
Gardner's syndrome
18. What histological findings are present in the stomach
Gastric glands
Meconium ileus
Stercobilin
Centrilobular leading to congestive liver disease
19. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Pancreatic and bile
Ceruplasmin
Pleuroperitoneal
Esophageal cancer
20. What can hemochromatosis be secondary to...
Trypsin - chymotrypsin - elastase - carboxypeptidases
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
L1
21. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Internal thoracic to superior epigastric to inferior epigastric
Smooth
Chronic calcifying pancreatitis - inc risk of panreatic cancer
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
22. what percentage of colonic polyps are non - neoplastic
Erosive - disruption of mucosal barrier leading to inflammation
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Sphincter of oddi
90%
23. What is the leading cause of bowel incarceration
Jaundice - fever - RUQ
When diffusely infiltrative - thickened rigid appearance like a leather bottle
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Femoral hernia
24. What are the longterm sequelae of nutmeg liver
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Obstruction of the common bile duct
Centrilobular congestion and necrosis - cardiac cirrhosis
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
25. What is the frequency of basal electric rhythm of the stomach
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Pleomorphic adenoma
3 waves/min
Lipase - phospholipase A - colipase
26. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
...
Dense core bodies
AST
Alcoholic cirrhosis
27. At what spinal level does the celiac trunk exit
Duodenum - 2nd - 3rd and 4th parts
Centrilobular leading to congestive liver disease
Downs
T12
28. What retroperitoneal structure flanks both sides of the pancreas on CT
The submucosal nerve plexus - meissner's
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Duodenum - 2nd - 3rd and 4th parts
L4
29. secretin - source - action - regulation
Dubin johnson
Enterokinase/enteropeptidase from the duodenal mucosa
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
With albumin
30. What is indirect bilirubin
CHF and inc risk of HCC
Unconjugated - water insoluble
T cell lymphoma
Older patients
31. motilin - source - action - regulation
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Female - fat - fertile - forty
Paraumbilical and superficial and inferior epigastric - umbilicus
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
32. Where are peyers patches found
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Necrotizing enterocolitis
Lamina propora and submucosa
Ceruplasmin
33. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Zollinger ellison - brunners glands
Via the superior pancreaticduodenal
Gastrohepatic ligament
Cholesterol - 10-20% opaque due to calcifications
34. How do you DX and TX gallstones
Dissaccharidase def - most commonly lactase
US and cholecystectomy
Intussusception
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
35. Why does volvulus occur more at cecum and sigmoid colon
Redundant mesentary
L4
HPNCC
Ampulla of vater
36. What are the complications of chronic pancreatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Stimulate intestinal persistalsis
Positive urease test
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
37. Where is the deep inguinal ring relative to the inferior epigastric vessels
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Where hindgut meets ectoderm
Lateral
38. Which IBD is autoimmune and which may be a disordered response to bacteria
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Ampulla of vater
Superior rectal
Reye's syndrome
39. What structures feed into the cystic duct
Paraumbilical and superficial and inferior epigastric - umbilicus
Worldwide - SC - US - adeno
Early childhood - neuro sx and malabsorption
Gallbladder
40. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Dec PGE2 leading to dec gastric mucosa protection
Hypotonic because of more time to reabsorb NaCl
Above
No - chronic - can present with diarrhea or constipation or alternation - treat sx
41. What kind of muscle is in the middle 1/3 of esophagus
Positive urease test
Failure of neural crest migration
Striated and smooth
Terminal ileum and colon
42. What separates the right greater and lesser sacs
Epigastric abdominal pain radiating to back - anorexia - nausea
Gastrohepatic ligament
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Positive
43. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Uridine glucuronyl transferase
Inc conj bilirubin - inc cholesterol - inc alk phos
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
44. What is the HLA association and treatment for hemochromatosis
Repeated phlebotomy - deferoxamine - HLA- A3
With albumin
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Lipase - phospholipase A - colipase
45. What are the histological findings of the colon
Crypts but not villi
Erosive - disruption of mucosal barrier leading to inflammation
Appendicitis
Trypsin - chymotrypsin - elastase - carboxypeptidases
46. Transmural esophageal rupture due to violent retching
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47. What conditions are associated with budd chiari
Zollinger Ellison - phenylalanine and tryptophan
Hypercoaguability - polycythemia vera - pregnancy - HCC
T12
Gut bacteria
48. What structure is Not contained in the femoral sheath
Cholesterol - 10-20% opaque due to calcifications
MSI (15%) and APC/beta catenin chromosomal instability (85%)
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Primarly through ECL leading to histamine release
49. What are the histological findings in the ileum
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50. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Dissaccharidase def - most commonly lactase
Hernia
Pleomorphic adenoma
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