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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 histological findings in the duodenum
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2. What are the borders of the femoral triangle
Inguninal ligament - sartorius muscle - adductor longus
Pancreatic and bile
So hypertrophied they look like brain gyri
Stimulate the H/K ATPase
3. What serum markers increase in cholecystitis with bile duct involvement
Alk phos
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Epigastric abdominal pain radiating to back - anorexia - nausea
4. What serum enzyme is decreased in wilsons disease
Ceruplasmin
T cell lymphoma
Brunners
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
5. Which kind of hemorrhoids are painful and why
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
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Causes of gall stones
Chronic gastritis and pernicious anemia
6. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
In the ileum with bile acids - requires IF
Peyers patches
Peutz jeghers
Duodenal atresia - Downs
7. What nerve innervates the external hemorrhoids
Inferior rectal nerve
Diarrhea - steatorrhea - weight loss - weakness
Hirschsprungs
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
8. Gallstones that reach the common channel at ampulla can block which two ducts
Alcoholic cirrhosis
All 3 gut layers outpouch as in Meckels
Backup of blood into the liver - RHF - budd chiari
Pancreatic and bile
9. What converts inactive pepsinogen to pepsin
Cystic dilation of the viteline duct
Epigastric abdominal pain radiating to back - anorexia - nausea
H+
Krukenbergs tumor
10. Achalasia can be secondary to what infectious disease common in South America
Chagas disease
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Urobilin
Falciform - ligamentum teres - fetal umbilical vein
11. What is the most common indication of emergent abdominal surgery in children
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Appendicitis
H+
12. What is the most important mechanism in gastric acid secretion
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Phenobarbital - inc liver enzyme synthesis
Worldwide - SC - US - adeno
13. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Crypts but not villi
Esophageal cancer
Punched out - clean margins - carcinoma =raised irregular margins
Sister mary joseph nodule
14. Where is the deep inguinal ring relative to the inferior epigastric vessels
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Superior rectal and middle and inferior rectal - rectum
Lateral
Hypotonic because of more time to reabsorb NaCl
15. What is a positive murphy's sign
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Downs
Jewish and African American men
Inspiratory arrest on deep palpation due to pain
16. How do NSAIDs cause acute gastritis
Dec PGE2 leading to dec gastric mucosa protection
Chronic gastritis and pernicious anemia
Inc smooth muscle relaxation - including lower esophageal sphincter
3 waves/min
17. What is the most common diaphragmatic hernia and What are the two types
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Turcot
18. What is the presentation of pancreatic adenocarcinoma
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Common hepatic - splenic - left gastric - main blood supply for stomach
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
19. In alchoholic hepatitis which liver enzyme is higher
Dense core bodies
Mucoepidermoid carcinoma
Can lead to hematemesis - found in EtOHics and bulimics
AST>ALT
20. What is the most common esophageal cancer worldwide and in the US
Worldwide - SC - US - adeno
Gastric glands
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Bleeding - intussusception - volvulus - obstruction near terminal ileum
21. What structures feed into the common hepatic duct
Warthins' tumor
Right and left hepatic duct
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
HPNCC
22. What is the rule of 2s for meckels
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Ceruplasmin
Lactase is located at the tips of intestinal villi
Chronic calcifying pancreatitis - inc risk of panreatic cancer
23. What histological findings are present in the stomach
Bleeding - penetration into pancreas - perforation - obstruction
L2
Gastric glands
Virchow's node
24. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Striated
Virchow's node
L4
Alpha amylase
25. What is biliary colic
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Striated and smooth
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Unconj - absent (acholuria) - inc
26. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
H pylori (almost 100%)
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
AST >ALT - ration is usually 1.5
27. What receptor does histamine bind on the parietal cell and What does it activate
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
H2 receptor - inc cAMP
Epithelium
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
28. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Dermatitis herpetiformis
Falciform - ligamentum teres - fetal umbilical vein
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
29. What commonly leads to appendicity in kids vs adults
Causes of gall stones
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
AST >ALT - ration is usually 1.5
30. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Dysphagia (due to esophageal web) - glossitis - iron def anemia
CEA - CA-19-9
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
31. What does loss of p53 cause
Increase tumorigenesis
Primarly through ECL leading to histamine release
Punched out - clean margins - carcinoma =raised irregular margins
Alk pho
32. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Crohns = maybe - UC= always
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Volvulus
Splenic flexure
33. How does hirschsprung present and appear on imaging
Meconium ileus
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
2ndary biliary cirrhosis
Inc risk of CRC and other visceral malignancies
34. How do villi appear in disaccharidease def
Normal
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
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
Gardner's syndrome
35. What cells secrete bicarb - What does it do - and what regulates it
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Heme metabolism
...
Meconium ileus
36. likely infectious form of malabsorption - responds to antibiotics
Cimetidine
Adhesion
Mallory bodies
Tropical sprue
37. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Alk pho
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Striated
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
38. What layer of fascia covers a direct inguinal hernia
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
External spermatic fascia only
Closer to isotonic because of less time to reabsorb NaCl
With albumin
39. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Enterokinase/enteropeptidase from the duodenal mucosa
Stercobilin
Alcoholic hepatitis
40. What are motilin receptor agonists used for clinically
Myenteric nerve plexus - aurbach
Stimulate intestinal persistalsis
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
41. What enzyme is necessary to create conjugated bilirubin
L3
No
Inc smooth muscle relaxation - including lower esophageal sphincter
Uridine glucuronyl transferase
42. What is the clinical presentation of acute pancreatitis
Femoral hernia
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Cholesterol
Epigastric abdominal pain radiating to back - anorexia - nausea
43. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Pleomorphic adenoma
Can lead to hematemesis - found in EtOHics and bulimics
L4
Normal
44. What do you treat Wilsons disease with and What is the inheritance
Causes of gall stones
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Superior rectal and middle and inferior rectal - rectum
Penicillinamine - AR inheritance
45. What are the histological findings in the ileum
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46. What causes primary biliary cirrhosis
EtOH
Squamous - upper 1/3 - adeno - lower 1/3
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
47. What are the complications of chronic pancreatitis
Decrease - weight gain
Lipase
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
48. Autodigestion of pancreas by pancreatic enzymes
Hemolytic anemia
Lateral
Acute pancreatitis
Esophageal carcinoma
49. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Neutralizes oral bacertial acids and maintains dental health
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Enterokinase/enteropeptidase from the duodenal mucosa
Hirschsprungs
50. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Boerhaave's Syndrome - Been heaving syndrome
Poor anastamoses
Causes of gall stones
With albumin