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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 pancreatic enzymes are responsible for fat digestion
Warthins' tumor
True and most common congenital anomoly of GI tract
Penicillinamine - AR inheritance
Lipase - phospholipase A - colipase
2. What are the foregut structures and what supplies their blood and PANS innvervation
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Via the middle colic
Zenkers - halitosis - dysphagia and obstruction
Neutralizes gastric acid allowing pancreatic enzymes to fxn
3. What is the sphincter of the pancreatic duct
Sphincter of oddi
Lubricate food (glycoprotiens)
Unconjugated - water insoluble
Punched out - clean margins - carcinoma =raised irregular margins
4. 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
The proximal small bowel
Virchow's node
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
5. Which IBD is autoimmune and which may be a disordered response to bacteria
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Stimulate intestinal persistalsis
Common hepatic - splenic - left gastric - main blood supply for stomach
6. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Pleomorphic adenoma
Early childhood - neuro sx and malabsorption
Duodenal atresia - Downs
90%
7. Where is there sclerosis in alcoholic cirrohosis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Around the central vein (zone III)
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Chronic gastritis and pernicious anemia
8. What causes nutmeg liver
Gastric glands
Backup of blood into the liver - RHF - budd chiari
Erosive - disruption of mucosal barrier leading to inflammation
Cystic dilation of the viteline duct
9. How does loss of NO secretion affect the esophagus and what results
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Inc lower esphogeal tone leading to achalasia
Hyperpigmented mouth - lips - hands - genitalia
10. Who is at risk for pancreatic adenocarcinoma
Antrum - H.pylori - inc risk of MALT lymphoma
Virchow's node
Diarrhea - steatorrhea - weight loss - weakness
Jewish and African American men
11. What do mucins do?
Internal thoracic to superior epigastric to inferior epigastric
Lubricate food (glycoprotiens)
Appendicitis
Conj - inc - dec
12. B cells stimuated in the germinal centers of peyers patches differentiate into what?
L2
L/R renal artery around L1
In the mucus that covers the gastric epithelium
IgA secreting plasma cells - ultimately reside in the lamina proporia
13. Achalasia can be secondary to what infectious disease common in South America
Splenic flexure
Angiodysplasia
Menetriers disease
Chagas disease
14. What reaction does salivary amylase catalyze
Conj - inc - dec
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Smooth
Complications of UC
15. At what spinal level does the SMA exit
Oral glucose
MSI (15%) and APC/beta catenin chromosomal instability (85%)
L1
Glucouronate - water soluble (direct)
16. How are all 3 monosaccharides transported to the blood
Complications of crohns
GLUT 2
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
AST
17. In viral hepatitis - which liver enzyme is higher
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
HPNCC
ALT>AST
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
18. What serum enzyme is decreased in wilsons disease
Dense core bodies
Ceruplasmin
Lye ingestion and acid reflux
Zollinger ellison - brunners glands
19. likely infectious form of malabsorption - responds to antibiotics
Crigler - najjar type 1
Tropical sprue
Cirrhosis
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
20. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Pancreatic head causing obstructive jaundice
Volvulus
L4
Cirrhosis
21. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Chagas disease
22. Where are tumors commonly in pancreatic adenocarcinoma
Pancreatic head causing obstructive jaundice
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Meckels
Black - rotors syndrome
23. What is the main symptom if a VIPoma
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Upregulated intracellular signal transduction
EtOH
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
24. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Superior rectal and middle and inferior rectal - rectum
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Corticosteroids - infliximab
Via the superior pancreaticduodenal
25. What commonly leads to appendicity in kids vs adults
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Krukenbergs tumor
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
VZV and influenza B treated with salicylates
26. What gives stool its characteristic color
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Decreased intercellular adhesion and increased proliferation
Trypsin - chymotrypsin - elastase - carboxypeptidases
Stercobilin
27. At what spinal level does the celiac trunk exit
T12
Colonic polyps
Gallbladder
Skip lesions =crohns - colon = UC
28. What are the effects of atropine on parietal cells and G cells
Menetriers disease
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
29. In what clinical scenarior do you see portosystemic anastomoses
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Fasting and stress
Bleeding - penetration into pancreas - perforation - obstruction
Portal HTN
30. How do burns cause acute gastritis and What is it called
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31. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
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
Paraumbilical and superficial and inferior epigastric - umbilicus
Where hindgut meets ectoderm
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
32. Where is folate absorbed
Cigarettes and chronic pancreatitis - not EtOH
The jejunum
External (superficial) ring only
Female - fat - fertile - forty
33. What layer in the mucosa is responsible for absorption
Epithelium
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Inc - weight loss
Mucoepidermoid carcinoma
34. What are the borders of the femoral triangle
Omeprazole
Fe2+ in the duod
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Inguninal ligament - sartorius muscle - adductor longus
35. What is the prognosis of adenocarcinoma
Corticosteroids - infliximab
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Inferior rectal nerve
Averages 6 months - very aggressive - usually already metastasized at presentation
36. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
M3 - Gq - inc IP3/Ca
Gut bacteria
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
37. Is there any structural abnl with IBS - What is the course of disease and presentation
Zollinger Ellison - phenylalanine and tryptophan
Pleuroperitoneal
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Alcoholic hepatitis
38. What are the signs of peutz jehgers
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
T cell lymphoma
Stimulate the H/K ATPase
Hyperpigmented mouth - lips - hands - genitalia
39. What are the common causes of gastric ulcers - What causes gastric ulcer
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
The jejunum
Primary sclerosing cholangitis
Intussusception
40. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Esophageal varices
Hemosiderosis - hemochromatosis
Duodenal atresia - Downs
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
41. What are the histological findings in the duodenum
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42. What is contained within the submucosa
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43. How many layers of spermatic fascia are covers an indirect inguinal hernia
Phenobarbital - inc liver enzyme synthesis
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
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
All 3
44. What receptors does gastrin bind on the parietal cell and What does it activate
Juvenile polyposis syndrome - inc risk of adenocarcinoma
CCK8 receptor - Gq inc IP3/Ca
Enterokinase/enteropeptidase from the duodenal mucosa
Ischemic colitis
45. malnutrition - toxic megacolon - colorectal carcinoma
Complications of UC
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Terminal ileum and colon
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
46. What layer in the mucosa is responsible for support
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Muscularis mucosae
Lamina propria
47. Which viral infxns/treatments are associated with reyes syndrome
VZV and influenza B treated with salicylates
Zenkers - halitosis - dysphagia and obstruction
Low pressure proximal to LES
Sister mary joseph nodule
48. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
Complications of crohns
The submucosal nerve plexus - meissner's
...
Alpha amylase
49. in carcinoid tumors - What is seen on EM
Adhesion
Dense core bodies
Left gastric vein and esophogeal vein - esophagus
Complications of crohns
50. What is the clinical presentation of acute pancreatitis
Epigastric abdominal pain radiating to back - anorexia - nausea
Begins starch digestion - inactivated by low pH upon reaching the stomach
Glucouronate - water soluble (direct)
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus