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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. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Jaundice - fever - RUQ
Hyperpigmented mouth - lips - hands - genitalia
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
2. Who is at risk for pancreatic adenocarcinoma
AST >ALT - ration is usually 1.5
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Meckels
Jewish and African American men
3. Dysphagia in achalasia results from
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
...
4. Where and How is iron absorbed
IBS at least 2 with recurrent abdominal pain
Hirschsprungs
Gut bacteria
Fe2+ in the duod
5. What complication can arise from indirect inguinal hernias
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Hydrocele
No - chronic - can present with diarrhea or constipation or alternation - treat sx
12 waves/min
6. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Above
EtOH
Epithelium
Brunners
7. What structures feed into the cystic duct
Duodenum - 2nd - 3rd and 4th parts
Budd chiari syndrome
Gallbladder
Alk phos
8. most common non - neoplastic polyp in colon
Oral glucose
Esophageal varices
Hyperplastic
Dec PGE2 leading to dec gastric mucosa protection
9. Where is the deep inguinal ring relative to the inferior epigastric vessels
Lateral
Warthins' tumor
Closer to isotonic because of less time to reabsorb NaCl
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
10. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Pleomorphic adenoma
The submucosal nerve plexus - meissner's
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
11. What is charcot triad of cholangitis
Lateral to the inferior epigastric artery
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Jaundice - fever - RUQ
Superior rectal and middle and inferior rectal - rectum
12. What can hemochromatosis be secondary to...
Bleeding - penetration into pancreas - perforation - obstruction
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Complications of UC
GERD - may also present with nocturnal cough and dyspnea
13. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Zollinger ellison - brunners glands
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Mallory bodies
Neutralizes gastric acid allowing pancreatic enzymes to fxn
14. 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
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
GERD - may also present with nocturnal cough and dyspnea
15. What are the branches of the celiac trunk and What do they supply
Reye's syndrome
Lye ingestion and acid reflux
Common hepatic - splenic - left gastric - main blood supply for stomach
Juvenille polyps - no risk if single
16. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Meckels
Alcoholic hepatitis
Ischemic colitis
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
17. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Mucosa - submucosa - muscularis externa - serosa/adventitia
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
18. Bilirubin is the product of what?
So hypertrophied they look like brain gyri
Cigarettes and chronic pancreatitis - not EtOH
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Heme metabolism
19. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Around the central vein (zone III)
Alk pho
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
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
20. What congenital birth defect is associated with Hirschsprung
Centrilobular leading to congestive liver disease
Appendicitis
Right and left hepatic duct
Downs
21. What are the histological findings in the jejunum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
AST>ALT
Menetriers disease
Inc risk of CRC and other visceral malignancies
22. How is salivary secretion stimulated
Short gastrics - left greater and lesser
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
23. What does alpha amylase do and what inactivates it
Dissaccharidase def - most commonly lactase
Acute pancreatitis
Begins starch digestion - inactivated by low pH upon reaching the stomach
Hernia
24. How does brain injury lead to acute gastritis and What is it called
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
AR
T cell lymphoma
25. How does gastrin increase acid secretion?
Jaundice - fever - RUQ
12 waves/min
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Primarly through ECL leading to histamine release
26. What is indirect bilirubin
Mucosa - submucosa - muscularis externa - serosa/adventitia
Superior rectal
Unconjugated - water insoluble
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
27. At what spinal level does the celiac trunk exit
Cholesterol - 10-20% opaque due to calcifications
Virchow's node
CHF and inc risk of HCC
T12
28. What is the prognosis of adenocarcinoma
Right and left hepatic duct
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Averages 6 months - very aggressive - usually already metastasized at presentation
Closer to isotonic because of less time to reabsorb NaCl
29. What do tumors that arise in the head of the pancreas cause
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Intussusception
Urobilin
Obstruction of the common bile duct
30. What artery passes around the duodenum
Parietal cells in the stomach - B12 binding protein
Cimetidine
Falciform - ligamentum teres - fetal umbilical vein
The gastroduodenal
31. What causes carcinoid syndrome amd What are the symptoms
Lipase - phospholipase A - colipase
Inspiratory arrest on deep palpation due to pain
Penicillinamine - AR inheritance
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
32. subQ peribumbilical metastasis
Sister mary joseph nodule
Gastric glands
Colovesical leading to pneumaturia
Alfatoxin in peanuts
33. Are single polyps malignant in peutz jehgers
No
Lactase is located at the tips of intestinal villi
Hemolytic anemia
Lateral
34. What drug inhibits the H/K ATPase
Hirschsprungs
Omeprazole
The submucosal nerve plexus - meissner's
Virchow's node
35. What is the ddx associated with appendicitis
Trypsin - chymotrypsin - elastase - carboxypeptidases
Lamina propora and submucosa
Diverticulitis in elderly - ectopic pregs use hCG to rule out
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
36. in CF - meconium plug obstructs intestine - preventing stool passage at birth
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
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Meconium ileus
Inc risk of CRC and other visceral malignancies
37. Where is IgA shuttled
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Failure of neural crest migration
Acute pancreatitis
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
38. How do villi appear in disaccharidease def
Serous on the sides parotids - mucinous in the middle sublingual
90%
Pleomorphic adenoma
Normal
39. Where does crohns usually affect the GI tract
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Paraumbilical and superficial and inferior epigastric - umbilicus
Terminal ileum and colon
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
40. GIP - source - action regulation
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Hydrocele
All 3
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
41. What carcinogens are associated with HCC
Inspiratory arrest on deep palpation due to pain
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Gamma glutamyl transferase GGT
Alfatoxin in peanuts
42. List the clinical findings of HCC
Dec PGE2 leading to dec gastric mucosa protection
Femoral hernia
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
43. What portion of the bowel does sprue effect
Downs
The proximal small bowel
EtOH
Peptic ulcer disease
44. Which area of the hindgut is a watershed area
IgA secreting plasma cells - ultimately reside in the lamina proporia
Heme metabolism
Splenic flexure
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
45. What do mucins do?
Striated
Inferior rectal nerve
Lubricate food (glycoprotiens)
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
46. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Crohns = maybe - UC= always
The gastroduodenal
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Esophageal cancer
47. What is a positive murphy's sign
Internal thoracic to superior epigastric to inferior epigastric
Stimulate the H/K ATPase
PAS- positive globules in liver -
Inspiratory arrest on deep palpation due to pain
48. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Hirschsprungs
Inguninal ligament - sartorius muscle - adductor longus
Corticosteroids - infliximab
HPNCC
49. When do you see hypertrophy of brunners glands
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Centrilobular congestion and necrosis - cardiac cirrhosis
Zenkers - halitosis - dysphagia and obstruction
Peptic ulcer disease
50. What is the sphincter of the pancreatic duct
Centrilobular leading to congestive liver disease
Sphincter of oddi
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
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