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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 is the presenting course for appendicity
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2. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Superior rectal
Omeprazole
3. What are the complications of acute pancreatitis
Neutralizes oral bacertial acids and maintains dental health
Primary sclerosing cholangitis
Hyperplastic
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
4. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Jewish and African American men
Alfatoxin in peanuts
Celiac sprue
Squamous - upper 1/3 - adeno - lower 1/3
5. Where is there sclerosis in alcoholic cirrohosis
Redness and tenderness on palpation of extremities
AST>ALT
FAP
Around the central vein (zone III)
6. What does a gastrinoma cause
Complications of crohns
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Brush border of intestine - produce monosaccharides from oligo and di
Pleomorphic adenoma
7. GIP - source - action regulation
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Centrilobular congestion and necrosis - cardiac cirrhosis
L/R renal artery around L1
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
8. What are the complications of duodenal PUD
CHF and inc risk of HCC
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Redness and tenderness on palpation of extremities
Bleeding - penetration into pancreas - perforation - obstruction
9. At what level of the spine does the IM exit the aorta
L3
Dubin johnson
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Parietal cells in the stomach - B12 binding protein
10. How do you DX and TX gallstones
Ceruplasmin
US and cholecystectomy
AST >ALT - ration is usually 1.5
Redness and tenderness on palpation of extremities
11. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Ampulla of vater
Alcoholic hepatitis
Cimetidine
3 waves/min
12. why infxn is implicated in duodenal PUD
AST >ALT - ration is usually 1.5
Duodenal atresia - Downs
H pylori (almost 100%)
Lipase
13. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Pertechnetate - study for uptake
HPNCC
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
14. Where does type A chronic gastritis occur and What causes it
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Gastrohepatic ligament
15. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Omeprazole
Meckels
In the mucus that covers the gastric epithelium
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
16. What nerve innervates the external hemorrhoids
The gastroduodenal
Hyperpigmented mouth - lips - hands - genitalia
Inferior rectal nerve
Necrotizing enterocolitis
17. What is contained within the submucosa
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18. What receptor does histamine bind on the parietal cell and What does it activate
H2 receptor - inc cAMP
Positive urease test
FAP
Warthins' tumor
19. What percentage of gall stones are cholesterol stones and What are the associations
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Acute pancreatitis
HPNCC
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
20. What causes carcinoid syndrome amd What are the symptoms
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
The entire
H2 receptor - inc cAMP
Can lead to hematemesis - found in EtOHics and bulimics
21. in budd chiari syndrome - Where is the congestion and necrosis
Centrilobular leading to congestive liver disease
Backup of blood into the liver - RHF - budd chiari
Intussusception
Volvulus
22. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
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
Unconj - absent (acholuria) - inc
The submucosal nerve plexus - meissner's
Angiodysplasia
23. How does loss of NO secretion affect the esophagus and what results
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
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
Inc lower esphogeal tone leading to achalasia
Phototherapy
24. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
HSV-1 - CMV - Candida
Via the superior pancreaticduodenal
T12
25. Where is the pectinate line
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Jaundice - fever - RUQ
Where hindgut meets ectoderm
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
26. What findings are associated with reyes
Mitochondrial abnl - fatty liver - hypoglycemia - coma
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Trypsin - chymotrypsin - elastase - carboxypeptidases
Ampulla of vater
27. What is the cause of physiologic neonatal jaundice
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Pancreatic head causing obstructive jaundice
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
28. subQ peribumbilical metastasis
Fe2+ in the duod
Sister mary joseph nodule
Oligosaccharide digestion
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
29. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Juvenille polyps - no risk if single
Corticosteroids - infliximab
Cholesterol - 10-20% opaque due to calcifications
Zollinger ellison - brunners glands
30. With internal hemorrhoids Where is the anastomoses and Where is it
Pleuroperitoneal
Superior rectal and middle and inferior rectal - rectum
L3
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
31. secretin - source - action - regulation
Penicillinamine - AR inheritance
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Trypsin - chymotrypsin - elastase - carboxypeptidases
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
32. What are the results of hemochromatosis
Alpha amylase
Decreased intercellular adhesion and increased proliferation
In the ileum with bile acids - requires IF
CHF and inc risk of HCC
33. List the clinical findings of HCC
Can lead to hematemesis - found in EtOHics and bulimics
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Erosive - disruption of mucosal barrier leading to inflammation
Alcoholic hepatitis
34. What are the ABCDEF of esophageal cancer
Enterokinase/enteropeptidase from the duodenal mucosa
Duodenal atresia - Downs
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
35. What do the rugae of stomach look like in menetriers disease
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
IgA secreting plasma cells - ultimately reside in the lamina proporia
So hypertrophied they look like brain gyri
Failure of neural crest migration
36. What cells make pepsin - What does it do - and what regulates it
Angiodysplasia
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
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
Esophageal varices
37. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Peyers patches
Alk phos
Ceruplasmin
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
38. Why are most diverticula considered false
All 3 gut layers outpouch as in Meckels
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Meckels
Diverticulitis in elderly - ectopic pregs use hCG to rule out
39. What are the borders of Hesselbach's triangle
Early childhood - neuro sx and malabsorption
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Alcoholic hepatitis
40. What layer in the mucosa is repsonsible for motility
Muscularis mucosae
Phenobarbital - inc liver enzyme synthesis
Sister mary joseph nodule
Myenteric nerve plexus - aurbach
41. What are the treatment options for uclerative colitis
Can lead to hematemesis - found in EtOHics and bulimics
Decrease - weight gain
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Pyoderma gangrenosum - primary sclerosing cholangitis
42. At what spinal level does the is the bifurcation of aorta
GLUT 2
Tropical sprue
8-9 waves/min
L4
43. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Peptic ulcer disease
Can lead to hematemesis - found in EtOHics and bulimics
Primary sclerosing cholangitis
44. What factors increase risk of malignancy of adenomatous polyps
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Esophageal carcinoma
45. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Tropical sprue
Zenkers - halitosis - dysphagia and obstruction
46. Which viral infxns/treatments are associated with reyes syndrome
VZV and influenza B treated with salicylates
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Redundant mesentary
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
47. What are the common causes of gastric ulcers - What causes gastric ulcer
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
The submucosal nerve plexus - meissner's
Pertechnetate - study for uptake
Duodenum - 2nd - 3rd and 4th parts
48. What are the extraintestinal manifestations of crohns
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Pancreatic head causing obstructive jaundice
Fe2+ in the duod
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
49. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Phototherapy
L2
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Unconj - absent (acholuria) - inc
50. What artery passes around the duodenum
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Boerhaave's Syndrome - Been heaving syndrome
FAP
The gastroduodenal