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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 are additional risk factors for CRC
Sphincter of oddi
Phenobarbital - inc liver enzyme synthesis
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
2. What gives stool its characteristic color
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
CHF and inc risk of HCC
Stercobilin
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
3. What is the most common cause of gallstones
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Worldwide - SC - US - adeno
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
4. What kind of anemia is in Wilsons
Superior rectal and middle and inferior rectal - rectum
Hemolytic anemia
Lye ingestion and acid reflux
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
5. What makes a true diverticula
Gilbert's
All 3 gut layers outpouch as in Meckels
Hypercoaguability - polycythemia vera - pregnancy - HCC
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
6. What receptor does histamine bind on the parietal cell and What does it activate
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
H2 receptor - inc cAMP
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Uremia
7. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
The entire
Adhesion
Small intestine
Zenkers - halitosis - dysphagia and obstruction
8. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Cholesterol - 10-20% opaque due to calcifications
Zollinger ellison - brunners glands
Inc lower esphogeal tone leading to achalasia
Peyers patches
9. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Crohns = noncaseating granulomas - UC = crypt abscesses
Unconjugated - water insoluble
H pylori (almost 100%)
Worldwide - SC - US - adeno
10. Cholecytsokinin - source - action - regulation
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
L1
Neutralizes oral bacertial acids and maintains dental health
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
11. Where is B12 absorbed
In the ileum with bile acids - requires IF
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Old men - arthralgias - cardiac and neuro sx
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
12. most common malignant salivary gland tumor
IgA secreting plasma cells - ultimately reside in the lamina proporia
Neutralizes oral bacertial acids and maintains dental health
...
Mucoepidermoid carcinoma
13. occlusion of IVC or hepatic veins
Budd chiari syndrome
Alk phos
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Decreased intercellular adhesion and increased proliferation
14. Where is there sclerosis in alcoholic cirrohosis
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Around the central vein (zone III)
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Conj - inc - dec
15. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Cirrhosis
Older patients
CCK8 receptor - Gq inc IP3/Ca
Alcoholic hepatitis
16. What is the action of NO as a GI hormone
Jewish and African American men
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Inc smooth muscle relaxation - including lower esophageal sphincter
Dec PGE2 leading to dec gastric mucosa protection
17. At what spinal level does the SMA exit
3 waves/min
Stercobilin
L1
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
18. What are the histological findings in the jejunum
External (superficial) ring only
Inferior rectal nerve
Diarrhea - steatorrhea - weight loss - weakness
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
19. What layer of fascia covers a direct inguinal hernia
Old men - arthralgias - cardiac and neuro sx
External spermatic fascia only
Inc risk of CRC and other visceral malignancies
CCK8 receptor - Gq inc IP3/Ca
20. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
The submucosal nerve plexus - meissner's
Above
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Gallbladder
21. subQ peribumbilical metastasis
Uridine glucuronyl transferase
Sister mary joseph nodule
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
Lipase - phospholipase A - colipase
22. At what level do the testicular/ovarian arteries exit the aorta
L2
Osmotic
Femoral hernia
Zollinger Ellison - phenylalanine and tryptophan
23. What are the extraintestinal manifestations of ulcerative colitis
Gamma glutamyl transferase GGT
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
Serous on the sides parotids - mucinous in the middle sublingual
Pyoderma gangrenosum - primary sclerosing cholangitis
24. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Krukenbergs tumor
25. What cells secrete bicarb - What does it do - and what regulates it
Common hepatic - splenic - left gastric - main blood supply for stomach
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Epigastric abdominal pain radiating to back - anorexia - nausea
Early childhood - neuro sx and malabsorption
26. What percentage of gall stones are cholesterol stones and What are the associations
Positive urease test
Crypts but not villi
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
27. What are the structures of the femoral triangle and how are they organized
GLUT 2
Positive urease test
So hypertrophied they look like brain gyri
NAV = nerve artery vein - venous near the penis (NAVEL)
28. What is the leading cause of bowel incarceration
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Centrilobular leading to congestive liver disease
Punched out - clean margins - carcinoma =raised irregular margins
Femoral hernia
29. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Mucosa - submucosa - muscularis externa - serosa/adventitia
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Complications of crohns
Alpha1 antitrypsin def - codominant trait
30. Where is the pectinate line
Urobilin
Neural muscarinic pathways
Where hindgut meets ectoderm
Obstruction of the common bile duct
31. What is Trousseau's sign
Meckels
Oral glucose
Redness and tenderness on palpation of extremities
Pleuroperitoneal
32. What does alpha amylase do and what inactivates it
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Begins starch digestion - inactivated by low pH upon reaching the stomach
Bleeding - intussusception - volvulus - obstruction near terminal ileum
33. What is contained in the gastrosplenic and What areas does it separate
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Short gastrics - left greater and lesser
34. What drug blocks the H2R
All 3 gut layers outpouch as in Meckels
Punched out - clean margins - carcinoma =raised irregular margins
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
Cimetidine
35. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Cholesterol
Dense core bodies
36. What are the complications of duodenal PUD
Female - fat - fertile - forty
Gut bacteria
CCK8 receptor - Gq inc IP3/Ca
Bleeding - penetration into pancreas - perforation - obstruction
37. What is the sphincter of the pancreatic duct
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Alk pho
Esophageal cancer
Sphincter of oddi
38. FAP + malignant CNS tumor
Gamma glutamyl transferase GGT
Common hepatic - splenic - left gastric - main blood supply for stomach
Around the central vein (zone III)
Turcot
39. 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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40. If trypsin activates more trypsinogen - what kind of feedback loop is established
Positive
Nonkeritinized stratified sqamous epithelium
H pylori (almost 100%)
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
41. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
No
Femoral hernia
Conj/unconj - inc - nl to dec
AST >ALT - ration is usually 1.5
42. What is the omphalomesenteric cyst
Krukenbergs tumor
Cystic dilation of the viteline duct
AR
Punched out - clean margins - carcinoma =raised irregular margins
43. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Esophageal carcinoma
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Zollinger Ellison - phenylalanine and tryptophan
Colonic polyps
44. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Bleeding - penetration into pancreas - perforation - obstruction
Inc lower esphogeal tone leading to achalasia
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Lactase is located at the tips of intestinal villi
45. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
All 3 gut layers outpouch as in Meckels
Dubin johnson
Duodenal atresia - Downs
46. What nerve innervates the external hemorrhoids
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Inferior rectal nerve
...
Glucose dependent insulinotropic peptide
47. What is the most important mechanism in gastric acid secretion
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
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
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
48. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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49. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
H2 receptor - inc cAMP
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
External spermatic fascia only
Zollinger ellison - brunners glands
50. most common non - neoplastic polyp in colon
Hyperplastic
Superior rectal
Downs
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin