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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 do mucins do?
Goes through deep inguinal ring - external inguinal ring and into the scrotum
The entire
Internal thoracic to superior epigastric to inferior epigastric
Lubricate food (glycoprotiens)
2. What can fistula between the gallbladder and small intestine create and how can you tell
Inguninal ligament - sartorius muscle - adductor longus
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Averages 6 months - very aggressive - usually already metastasized at presentation
Mitochondrial abnl - fatty liver - hypoglycemia - coma
3. What are the tumor markers for pancreatic adenocarcinoma
Lubricate food (glycoprotiens)
Alfatoxin in peanuts
CEA - CA-19-9
Cholesterol - 10-20% opaque due to calcifications
4. What complication can arise from indirect inguinal hernias
H2 receptor - inc cAMP
GERD - may also present with nocturnal cough and dyspnea
Complications of crohns
Hydrocele
5. What is the most common esophageal cancer worldwide and in the US
Dilated esophagus with an area of distal stenosis - birds beak
Virchow's node
Worldwide - SC - US - adeno
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
6. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Zenkers - halitosis - dysphagia and obstruction
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Crohns = maybe - UC= always
Trypsin - chymotrypsin - elastase - carboxypeptidases
7. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Conj/unconj - inc - nl to dec
Dermatitis herpetiformis
Muscularis mucosae
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
8. What are the foregut structures and what supplies their blood and PANS innvervation
Crypts but not villi
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Cystic dilation of the viteline duct
Hepatic steatosis
9. What structures feed into the cystic duct
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Left and right gastroepiploics - left and right gastrics
Gallbladder
L3
10. When do you see hypertrophy of brunners glands
Peptic ulcer disease
Mallory bodies
Bleeding - intussusception - volvulus - obstruction near terminal ileum
When diffusely infiltrative - thickened rigid appearance like a leather bottle
11. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
12. inflammatino of gallbadder
AR
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Closer to isotonic because of less time to reabsorb NaCl
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
13. trypsinogen is converted to trypsin via what enzyme
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Lye ingestion and acid reflux
Enterokinase/enteropeptidase from the duodenal mucosa
14. How is bilirubin carried in the blood
With albumin
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Small intestine
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
15. What test and result confirms H pylori infxn
The submucosal nerve plexus - meissner's
Bleeding - penetration into pancreas - perforation - obstruction
Gardner's syndrome
Positive urease test
16. is meckels a true diverticulum and how common is it
Pyoderma gangrenosum - primary sclerosing cholangitis
True and most common congenital anomoly of GI tract
Conj/unconj - inc - nl to dec
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
17. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Squamous - upper 1/3 - adeno - lower 1/3
Angiodysplasia
Alpha1 antitrypsin def - codominant trait
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
18. What arteries exit just below the SMA
L/R renal artery around L1
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Omeprazole
19. Where are tumors commonly in pancreatic adenocarcinoma
Pancreatic head causing obstructive jaundice
2ndary biliary cirrhosis
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Peyers patches
20. What parts of the small bowel can tropical sprue effect
Normal
Barrett's esophagus
The entire
IgA secreting plasma cells - ultimately reside in the lamina proporia
21. What does loss of APC cause
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Amylase
Decreased intercellular adhesion and increased proliferation
Peptic ulcer disease
22. What does bicab do in the mouth
Backup of blood into the liver - RHF - budd chiari
Unconjugated - water insoluble
Neutralizes oral bacertial acids and maintains dental health
Alpha1 antitrypsin def - codominant trait
23. What are the borders of Hesselbach's triangle
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Alcoholic hepatitis
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Liver metabolizes 5HT
24. Where does type B chronic gastritis occur and What causes it
Centrilobular leading to congestive liver disease
Black - rotors syndrome
3 waves/min
Antrum - H.pylori - inc risk of MALT lymphoma
25. A protrusion of peritoneum through an opening - usually a site of weakness
Carcinoid syndrome
PAS- positive globules in liver -
The submucosal nerve plexus - meissner's
Hernia
26. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
...
Left gastric vein and esophogeal vein - esophagus
Inc conj bilirubin - inc cholesterol - inc alk phos
27. What are the two molecular pathways that lead to CRC
MSI (15%) and APC/beta catenin chromosomal instability (85%)
H pylori (almost 100%)
Primary sclerosing cholangitis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
28. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Cholesterol - 10-20% opaque due to calcifications
CCK8 receptor - Gq inc IP3/Ca
Osmotic
Jaundice - fever - RUQ
29. vasoactive intestinal polypeptide (VIP) - source - action - regulation
The submucosal nerve plexus - meissner's
FAP
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
Alcoholic hepatitis
30. crigler - najjar type II responds to which therapy and How does it work
Phenobarbital - inc liver enzyme synthesis
Antrum - H.pylori - inc risk of MALT lymphoma
Gastrohepatic ligament
Achalasia due to loss of myenteric plexus (auberach)
31. What are the histological findings in the jejunum
Crigler - najjar type 1
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Increase tumorigenesis
Gardner's syndrome
32. absent UDPGT - presents early in life - early mortality
Obstruction of the common bile duct
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Amylase
Crigler - najjar type 1
33. What kind of pathways do CCK act on to cause pancreatic secretion
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Neural muscarinic pathways
Female - fat - fertile - forty
Alk pho
34. Where is the pectinate line
Left gastric vein and esophogeal vein - esophagus
Brush border of intestine - produce monosaccharides from oligo and di
Where hindgut meets ectoderm
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
35. What is the sphincter of the pancreatic duct
Oligosaccharide digestion
Sphincter of oddi
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Diverticulum
36. What drug blocks the H2R
Via the middle colic
Cimetidine
Epigastric abdominal pain radiating to back - anorexia - nausea
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
37. What are the structures of the femoral triangle and how are they organized
Where hindgut meets ectoderm
NAV = nerve artery vein - venous near the penis (NAVEL)
Menetriers disease
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
38. What does alpha amylase do and what inactivates it
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
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Old men - arthralgias - cardiac and neuro sx
Begins starch digestion - inactivated by low pH upon reaching the stomach
39. What are the borders of the femoral triangle
Duodenum - 2nd - 3rd and 4th parts
Inguninal ligament - sartorius muscle - adductor longus
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Dysphagia (due to esophageal web) - glossitis - iron def anemia
40. In what scenarios do pts with gilberts have inc bili
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Complications of UC
Uremia
Fasting and stress
41. What is the most common cause of gallstones
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Meconium ileus
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
42. How many layers of spermatic fascia are covers an indirect inguinal hernia
Inc smooth muscle relaxation - including lower esophageal sphincter
All 3
Lactase is located at the tips of intestinal villi
Zenkers - halitosis - dysphagia and obstruction
43. milk intolerance
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Dissaccharidase def - most commonly lactase
Muscularis mucosae
Hemolytic anemia
44. most common malignant salivary gland tumor
Older patients
Mucoepidermoid carcinoma
Right and left hepatic duct
Glucose dependent insulinotropic peptide
45. malnutrition - toxic megacolon - colorectal carcinoma
Complications of UC
Elevated amylase - and lipase
Gastric glands
Inc conj bilirubin - inc cholesterol - inc alk phos
46. What is a positive murphy's sign
Inspiratory arrest on deep palpation due to pain
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Stimulate the H/K ATPase
Portal HTN
47. multiple juvenil polyps in GI tract - risk
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Liver metabolizes 5HT
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
48. What structures feed into the common hepatic duct
Right and left hepatic duct
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
External spermatic fascia only
Primary sclerosing cholangitis
49. What are the histological findings of the colon
Crypts but not villi
Hepatic steatosis
Intussusception
Osmotic
50. Diaphragmatic hernias occur in infants because of defective development of which membrane
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Hypotonic because of more time to reabsorb NaCl
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Pleuroperitoneal