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USMLE GI
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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. Autodigestion of pancreas by pancreatic enzymes
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Gastric glands
Acute pancreatitis
Ischemic colitis
2. If the abdominal aorta is blocked - How does blood get to the left colic artery
Via the middle colic
Terminal ileum and colon
Ischemic colitis
Jaundice - fever - RUQ
3. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Omeprazole
Dec PGE2 leading to dec gastric mucosa protection
Lactase is located at the tips of intestinal villi
Pleomorphic adenoma
4. What layer of fascia covers a direct inguinal hernia
Hypercoaguability - polycythemia vera - pregnancy - HCC
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Decrease - weight gain
External spermatic fascia only
5. Where does copper accumulate in Wilsons and What are ABCD
The submucosal nerve plexus - meissner's
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
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
In the mucus that covers the gastric epithelium
6. What cells secrete bicarb - What does it do - and what regulates it
Erosive - disruption of mucosal barrier leading to inflammation
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
12 waves/min
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
7. What is pancreatic adenocarcinoma associated with
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Cigarettes and chronic pancreatitis - not EtOH
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
Colovesical leading to pneumaturia
8. conjugated hyperbilirubinemia due to defective liver excretion
Dense core bodies
Dissaccharidase def - most commonly lactase
Dermatitis herpetiformis
Dubin johnson
9. What is the most common cause of gallstones
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Neural muscarinic pathways
Via the superior pancreaticduodenal
Celiac sprue
10. Where does crohns usually affect the GI tract
Diverticulum
Terminal ileum and colon
Penicillinamine - AR inheritance
Neural muscarinic pathways
11. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
AST>ALT
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Cholesterol - 10-20% opaque due to calcifications
Juvenille polyps - no risk if single
12. When and How does Abetalipoproteinemia present
Inc risk of CRC and other visceral malignancies
Early childhood - neuro sx and malabsorption
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
13. Failure of relaxation of lower esophageal sphincter - Name and etiology
Alpha1 antitrypsin def - codominant trait
Parietal cells in the stomach - B12 binding protein
Achalasia due to loss of myenteric plexus (auberach)
Fasting and stress
14. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
IBS at least 2 with recurrent abdominal pain
Antrum - H.pylori - inc risk of MALT lymphoma
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
15. What is the path of an indirect inguinal hernia
Lye ingestion and acid reflux
Inspiratory arrest on deep palpation due to pain
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Diarrhea - steatorrhea - weight loss - weakness
16. What do tumors that arise in the head of the pancreas cause
Pleomorphic adenoma
Menetriers disease
Obstruction of the common bile duct
Stimulate the H/K ATPase
17. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Upregulated intracellular signal transduction
Celiac sprue
Crohns = noncaseating granulomas - UC = crypt abscesses
Superior rectal
18. What are the main components of bile
Acute pancreatitis
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Tropical sprue
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
19. Bilirubin is the product of what?
Dissaccharidase def - most commonly lactase
Heme metabolism
Dense core bodies
Common hepatic - splenic - left gastric - main blood supply for stomach
20. What causes primary biliary cirrhosis
EtOH
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
The jejunum
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
21. What does extrahepatic biliary obstruction cause
Tropical sprue
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Positive
22. What nerve innervates the external hemorrhoids
GERD - may also present with nocturnal cough and dyspnea
Inferior rectal nerve
Positive
M3 - Gq - inc IP3/Ca
23. What is the triad of Plummer - Vinson syndrome
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Turcot
No
Cigarettes and chronic pancreatitis - not EtOH
24. What reaction does salivary amylase catalyze
Enterokinase/enteropeptidase from the duodenal mucosa
Oligosaccharide digestion
Phenobarbital - inc liver enzyme synthesis
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
25. crigler - najjar type II responds to which therapy and How does it work
Backup of blood into the liver - RHF - budd chiari
Phenobarbital - inc liver enzyme synthesis
Ischemic colitis
FAP
26. Which IBD is autoimmune and which may be a disordered response to bacteria
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
12 waves/min
The submucosal nerve plexus - meissner's
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
27. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Centrilobular leading to congestive liver disease
Crohns = noncaseating granulomas - UC = crypt abscesses
Omeprazole
2ndary biliary cirrhosis
28. What are the two molecular pathways that lead to CRC
Conj/unconj - inc - nl to dec
MSI (15%) and APC/beta catenin chromosomal instability (85%)
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Omeprazole
29. How are all 3 monosaccharides transported to the blood
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Intussusception
Goes through deep inguinal ring - external inguinal ring and into the scrotum
GLUT 2
30. What cell produces IF and What does it do
AST>ALT
Common hepatic - splenic - left gastric - main blood supply for stomach
Parietal cells in the stomach - B12 binding protein
Zenkers - halitosis - dysphagia and obstruction
31. What pancreatic enzymes are responsible for fat digestion
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Pertechnetate - study for uptake
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
Lipase - phospholipase A - colipase
32. List the clinical findings of HCC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Dense core bodies
Juvenille polyps - no risk if single
12 waves/min
33. What do mucins do?
Pertechnetate - study for uptake
Alcoholic hepatitis
Pancreatic and bile
Lubricate food (glycoprotiens)
34. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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35. What artery passes around the duodenum
Trypsin - chymotrypsin - elastase - carboxypeptidases
The gastroduodenal
Neutralizes oral bacertial acids and maintains dental health
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
36. What are the histological findings in the duodenum
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37. Who is at risk for pancreatic adenocarcinoma
Older patients
Repeated phlebotomy - deferoxamine - HLA- A3
Jewish and African American men
Uridine glucuronyl transferase
38. Where and How is iron absorbed
Fe2+ in the duod
Superior rectal and middle and inferior rectal - rectum
HSV-1 - CMV - Candida
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
39. What source of salivary secretion is the most serous and What is the most mucinous
Chronic gastritis and pernicious anemia
Serous on the sides parotids - mucinous in the middle sublingual
Decreased intercellular adhesion and increased proliferation
Ceruplasmin
40. What do you treat Wilsons disease with and What is the inheritance
Penicillinamine - AR inheritance
Krukenbergs tumor
Lactase is located at the tips of intestinal villi
Cirrhosis
41. How is salivary secretion stimulated
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
HPNCC
Around the central vein (zone III)
42. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Low pressure proximal to LES
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Brunners
43. what kind of muscle is in the upper 1/3 of esophagus
No
Striated
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
In the mucus that covers the gastric epithelium
44. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Uridine glucuronyl transferase
External spermatic fascia only
Punched out - clean margins - carcinoma =raised irregular margins
Alk pho
45. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
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
ALT>AST
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Zollinger Ellison - phenylalanine and tryptophan
46. Where are carcinoid tumors most commonly malignant
Dermatitis herpetiformis
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Small intestine
47. What are the histological findings of the colon
Complications of UC
Alpha amylase
Crypts but not villi
Copious diarrhea - non alpha - non beta cell pancreatic tumor
48. What portion of the bowel does sprue effect
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Muscularis mucosae
The proximal small bowel
Diverticulum
49. What is the cause of Barrett's and the assocaited complications
Hyperplastic
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Around the central vein (zone III)
50. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Failure of the processus vagainlis to close
Gardner's syndrome
Femoral hernia
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Sorry!:) No result found.
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