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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 are the treatment options for uclerative colitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Tropical sprue
Left and right gastroepiploics - left and right gastrics
2. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Liver metabolizes 5HT
Cimetidine
Inc conj bilirubin - inc cholesterol - inc alk phos
The gastroduodenal
3. What percentage of gall stones are cholesterol stones and What are the associations
Angiodysplasia
The proximal small bowel
Crohns = noncaseating granulomas - UC = crypt abscesses
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
4. Why does carcinoid syndrome not occur if tumor is confined to GI system
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Reye's syndrome
Liver metabolizes 5HT
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
5. What is a positive murphy's sign
Superior rectal and middle and inferior rectal - rectum
Inguninal ligament - sartorius muscle - adductor longus
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Inspiratory arrest on deep palpation due to pain
6. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Duodenum - 2nd - 3rd and 4th parts
Hirschsprungs
Striated
Redness and tenderness on palpation of extremities
7. inflammatino of gallbadder
Smooth
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
T cell lymphoma
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
8. What is charcot triad of cholangitis
Pancreatic head causing obstructive jaundice
Peutz jeghers
Jaundice - fever - RUQ
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
9. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Pertechnetate - study for uptake
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Brunners
Stercobilin
10. What reaction does salivary amylase catalyze
Upregulated intracellular signal transduction
Neutralizes oral bacertial acids and maintains dental health
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Hepatic steatosis
11. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Left and right gastroepiploics - left and right gastrics
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
Diverticulum
L1
12. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Lateral
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Internal thoracic to superior epigastric to inferior epigastric
13. What are the treatmet options for crohns
Via the superior pancreaticduodenal
Corticosteroids - infliximab
Gardner's syndrome
Stimulate intestinal persistalsis
14. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Via the superior pancreaticduodenal
HSV-1 - CMV - Candida
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Corticosteroids - infliximab
15. What are the common causes of gastric ulcers - What causes gastric ulcer
Penicillinamine - AR inheritance
H2 receptor - inc cAMP
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Elevated amylase - and lipase
16. What is the frequency of basal electric rhythm in the duodenum
Striated and smooth
Superior rectal and middle and inferior rectal - rectum
Old men - arthralgias - cardiac and neuro sx
12 waves/min
17. What serum markers increase in cholecystitis with bile duct involvement
Colonic polyps
Alk phos
H+
When diffusely infiltrative - thickened rigid appearance like a leather bottle
18. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Inc risk of CRC and other visceral malignancies
Cholesterol - 10-20% opaque due to calcifications
Hyperpigmented mouth - lips - hands - genitalia
19. What are the borders of Hesselbach's triangle
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
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Complications of UC
Hemosiderosis - hemochromatosis
20. What gives stool its characteristic color
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
Stercobilin
AR
Splenic flexure
21. Which is used more quickly - an oral glucose load - or that by IV
Oral glucose
Uridine glucuronyl transferase
Intussusception
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
22. Where is bicarb trapped
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
In the mucus that covers the gastric epithelium
Stimulate intestinal persistalsis
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
23. Where are oligosaccharide hydrolases and What do they do
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Brush border of intestine - produce monosaccharides from oligo and di
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
24. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
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
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Spleen to posterior abdominal wall - splenic artery and vein
25. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Squamous - upper 1/3 - adeno - lower 1/3
Peyers patches
Mucosa - submucosa - muscularis externa - serosa/adventitia
Turcot
26. How do villi appear in disaccharidease def
Warthins' tumor
HSV-1 - CMV - Candida
2ndary biliary cirrhosis
Normal
27. Where is the deep inguinal ring relative to the inferior epigastric vessels
Appendicitis
Paraumbilical and superficial and inferior epigastric - umbilicus
Brunners
Lateral
28. In what scenarios do pts with gilberts have inc bili
Ampulla of vater
Alk pho
Fasting and stress
Glucouronate - water soluble (direct)
29. What are the complications of acute pancreatitis
Gastrohepatic ligament
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Alpha amylase
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
30. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Causes of gall stones
Portal HTN
Crypts but not villi
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
31. How does abetalipoproteinemia lead to malabsorption
Positive
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
The entire
32. What is biliary colic
Inc - weight loss
Diarrhea - steatorrhea - weight loss - weakness
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Glucouronate - water soluble (direct)
33. most common non - neoplastic polyp in colon
Cigarettes and chronic pancreatitis - not EtOH
Hyperplastic
Amylase
Warthins' tumor
34. What layer of fascia covers a direct inguinal hernia
Hypotonic because of more time to reabsorb NaCl
External spermatic fascia only
Neural muscarinic pathways
Hemosiderosis - hemochromatosis
35. Who is at risk for pancreatic adenocarcinoma
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
GERD - may also present with nocturnal cough and dyspnea
Jewish and African American men
Failure of the processus vagainlis to close
36. How does CRC present in the distal and proximal colon
Splenic flexure
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Dermatitis herpetiformis
37. What conditions are associated with budd chiari
Hypercoaguability - polycythemia vera - pregnancy - HCC
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Early childhood - neuro sx and malabsorption
Ampulla of vater
38. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Pleomorphic adenoma
AST
Alcoholic hepatitis
Osmotic
39. Achalasia can be secondary to what infectious disease common in South America
Dec PGE2 leading to dec gastric mucosa protection
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Chagas disease
NAV = nerve artery vein - venous near the penis (NAVEL)
40. People of what decent are associated with celiac sprue and what findings/antibodies are present
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Lubricate food (glycoprotiens)
Failure of neural crest migration
41. what kind of muscle is in the upper 1/3 of esophagus
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
All 3
Striated
42. What are the complications of chronic pancreatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Inc conj bilirubin - inc cholesterol - inc alk phos
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
IgA secreting plasma cells - ultimately reside in the lamina proporia
43. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Gamma glutamyl transferase GGT
Hyperpigmented mouth - lips - hands - genitalia
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Can lead to hematemesis - found in EtOHics and bulimics
44. Dysphagia in achalasia results from
Obstruction of the common bile duct
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
FAP
45. multiple juvenil polyps in GI tract - risk
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Pertechnetate - study for uptake
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Muscularis mucosae
46. Achalasia increases the risk For what complication
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Esophageal carcinoma
T12
Dermatitis herpetiformis
47. What are the signs and symptoms of budd chiari
L2
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
The entire
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
48. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Decrease - weight gain
Causes of gall stones
Ischemic colitis
49. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Alpha1 antitrypsin def - codominant trait
50. What does bicab do in the mouth
Neutralizes oral bacertial acids and maintains dental health
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
L4
Ischemic colitis