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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 rate limiting step of carbohydrate digestion
L2
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Oligosaccharide digestion
Cigarettes and chronic pancreatitis - not EtOH
2. Which is used more quickly - an oral glucose load - or that by IV
L2
Oral glucose
Phototherapy
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
3. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Conj/unconj - inc - nl to dec
Omeprazole
Backup of blood into the liver - RHF - budd chiari
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
4. Where is the pectinate line
External spermatic fascia only
VZV and influenza B treated with salicylates
Where hindgut meets ectoderm
Fasting and stress
5. bilateral mets to ovaries with abundant mucus - signet ring cells
Krukenbergs tumor
Worldwide - SC - US - adeno
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
AST>ALT
6. What are the common causes of gastric ulcers - What causes gastric ulcer
Stimulate the H/K ATPase
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
7. What drug inhibits the H/K ATPase
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
8-9 waves/min
Omeprazole
Appendicitis
8. What are the four Fs of gallstones
Source - G cells in the antrum - action - inc gastric H+ secretion - inc growth of gastric mucosa - and inc gastric motility - regulation - inc by stomach distention/alkalinaztion - amino acids - peptides - vagal stimulation - dec by stomach pH < 1.5
Appendicitis
Female - fat - fertile - forty
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
9. Why does volvulus occur more at cecum and sigmoid colon
Stimulate intestinal persistalsis
Redundant mesentary
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Angiodysplasia
10. What are the signs of peutz jehgers
Alk phos
Hyperpigmented mouth - lips - hands - genitalia
Via the superior pancreaticduodenal
Brunners
11. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Peyers patches
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Conj - inc - dec
12. What is the frequency of basal electric rhythm of the ilieum
8-9 waves/min
Meconium ileus
Antrum - H.pylori - inc risk of MALT lymphoma
Diarrhea - steatorrhea - weight loss - weakness
13. Where does copper accumulate in Wilsons and What are ABCD
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Glucouronate - water soluble (direct)
HSV-1 - CMV - Candida
14. Dysphagia in achalasia results from
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Cirrhosis
Copious diarrhea - non alpha - non beta cell pancreatic tumor
15. What infection causes Whipple disease and What can you see on LM
Myenteric nerve plexus - aurbach
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
...
Stercobilin
16. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
8-9 waves/min
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Zenkers - halitosis - dysphagia and obstruction
AST >ALT - ration is usually 1.5
17. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Small intestine
Where hindgut meets ectoderm
Dubin johnson
Meckels
18. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
L/R renal artery around L1
Centrilobular congestion and necrosis - cardiac cirrhosis
Skip lesions =crohns - colon = UC
2ndary biliary cirrhosis
19. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Alk pho
Menetriers disease
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
20. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Pleomorphic adenoma
Erosive - disruption of mucosal barrier leading to inflammation
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Smooth
21. What does bicab do in the mouth
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Neutralizes oral bacertial acids and maintains dental health
M3 - Gq - inc IP3/Ca
Left gastric vein and esophogeal vein - esophagus
22. If trypsin activates more trypsinogen - what kind of feedback loop is established
Around the central vein (zone III)
Positive
Skip lesions =crohns - colon = UC
Unconj - absent (acholuria) - inc
23. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Duodenal atresia - Downs
Via the middle colic
Diarrhea - steatorrhea - weight loss - weakness
24. In an MI - which liver enzyme is elevated
Mucoepidermoid carcinoma
Upregulated intracellular signal transduction
Jewish and African American men
AST
25. Gastrin - source - action - regulation
Small intestine
Source - G cells in the antrum - action - inc gastric H+ secretion - inc growth of gastric mucosa - and inc gastric motility - regulation - inc by stomach distention/alkalinaztion - amino acids - peptides - vagal stimulation - dec by stomach pH < 1.5
Duodenum - 2nd - 3rd and 4th parts
Cystic duct and common hepatic duct
26. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Lipase
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Gut bacteria
27. Why does indirect inguinal hernia happen in infacnts
The proximal small bowel
Failure of the processus vagainlis to close
Inferior rectal nerve
Gastrohepatic ligament
28. What are the histological findings in the jejunum
Complications of UC
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
External (superficial) ring only
29. inflammatino of gallbadder
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Source - G cells in the antrum - action - inc gastric H+ secretion - inc growth of gastric mucosa - and inc gastric motility - regulation - inc by stomach distention/alkalinaztion - amino acids - peptides - vagal stimulation - dec by stomach pH < 1.5
Peptic ulcer disease
Alcoholic cirrhosis
30. signet ring cells - acanthosis nigracans - dz - character/association - spread
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
The entire
Gut bacteria
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
31. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
CCK8 receptor - Gq inc IP3/Ca
Necrotizing enterocolitis
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
IgA secreting plasma cells - ultimately reside in the lamina proporia
32. What are the complications of duodenal PUD
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Common hepatic - splenic - left gastric - main blood supply for stomach
Bleeding - penetration into pancreas - perforation - obstruction
12 waves/min
33. What are the branches of the celiac trunk and What do they supply
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Common hepatic - splenic - left gastric - main blood supply for stomach
Inguninal ligament - sartorius muscle - adductor longus
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
34. occlusion of IVC or hepatic veins
Ampulla of vater
Budd chiari syndrome
L2
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
35. What can hemochromatosis be secondary to...
Glucouronate - water soluble (direct)
Older patients
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Cimetidine
36. What pancreatic enzymes are responsible for fat digestion
AST
Gastric glands
Lipase - phospholipase A - colipase
Alfatoxin in peanuts
37. Where does type B chronic gastritis occur and What causes it
Esophageal varices
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Redundant mesentary
Antrum - H.pylori - inc risk of MALT lymphoma
38. What arteries exit just below the SMA
Hypotonic because of more time to reabsorb NaCl
L/R renal artery around L1
Uridine glucuronyl transferase
Squamous - upper 1/3 - adeno - lower 1/3
39. What is the triad of Plummer - Vinson syndrome
Warthins' tumor
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Krukenbergs tumor
Esophageal carcinoma
40. What kind of diarrhea is produced from a disaccharide def
Osmotic
Causes of gall stones
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Neutralizes gastric acid allowing pancreatic enzymes to fxn
41. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Meconium ileus
Internal thoracic to superior epigastric to inferior epigastric
Primarly through ECL leading to histamine release
42. Who is at risk for pancreatic adenocarcinoma
Jewish and African American men
Punched out - clean margins - carcinoma =raised irregular margins
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Worldwide - SC - US - adeno
43. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Carcinoid syndrome
All 3 gut layers outpouch as in Meckels
Alpha amylase
AST
44. Where does type A chronic gastritis occur and What causes it
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Esophageal carcinoma
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
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
45. What pancreatic proteases are secreted as zymogens
Alpha1 antitrypsin def - codominant trait
Gamma glutamyl transferase GGT
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
Trypsin - chymotrypsin - elastase - carboxypeptidases
46. What are motilin receptor agonists used for clinically
Stimulate intestinal persistalsis
Hemosiderosis - hemochromatosis
External (superficial) ring only
Terminal ileum and colon
47. What factors increase risk of malignancy of adenomatous polyps
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Gastrohepatic ligament
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
48. What layer in the mucosa is responsible for support
Mallory bodies
Lamina propria
Menetriers disease
Glucose dependent insulinotropic peptide
49. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Menetriers disease
The jejunum
Via the superior pancreaticduodenal
M3 - Gq - inc IP3/Ca
50. is meckels a true diverticulum and how common is it
Pertechnetate - study for uptake
Inferior rectal nerve
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
True and most common congenital anomoly of GI tract