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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. Liver cell failure can lead to multisystem signs including
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Trypsin - chymotrypsin - elastase - carboxypeptidases
Gallbladder
External (superficial) ring only
2. What is the cause of Barrett's and the assocaited complications
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
NAV = nerve artery vein - venous near the penis (NAVEL)
Peptic ulcer disease
Zollinger ellison - brunners glands
3. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Redundant mesentary
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
L2
Superior rectal
4. What is the TX of physiologic neonatal jaundice
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Phototherapy
Brunners
Increase tumorigenesis
5. What is the classic triad of hemochromatosis
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6. most common non - neoplastic polyp in colon
Epithelium
Pancreatic head causing obstructive jaundice
Lactase is located at the tips of intestinal villi
Hyperplastic
7. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
No
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Alpha1 antitrypsin def - codominant trait
Tropical sprue
8. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Causes of gall stones
Alcoholic cirrhosis
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
...
9. What receptors does gastrin bind on the parietal cell and What does it activate
In the ileum with bile acids - requires IF
Sphincter of oddi
Zollinger Ellison - phenylalanine and tryptophan
CCK8 receptor - Gq inc IP3/Ca
10. What drug blocks the H2R
Cimetidine
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
FAP
No
11. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Adhesion
Alk pho
GERD - may also present with nocturnal cough and dyspnea
Esophageal cancer
12. Where are peyers patches found
Lamina propora and submucosa
L1
VZV and influenza B treated with salicylates
Pyoderma gangrenosum - primary sclerosing cholangitis
13. What are the effects of atropine on parietal cells and G cells
Stimulate intestinal persistalsis
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Tropical sprue
14. What does TOASTED with alcoholic hepatitis stand for
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Elevated amylase - and lipase
AST >ALT - ration is usually 1.5
Pertechnetate - study for uptake
15. rare - often fatal childhood hepatoencephalopathy
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16. Where is the pectinate line
Stimulate intestinal persistalsis
Where hindgut meets ectoderm
Dense core bodies
Acute pancreatitis
17. Is there any structural abnl with IBS - What is the course of disease and presentation
Cholesterol - 10-20% opaque due to calcifications
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
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Barrett's esophagus
18. What drug inhibits the H/K ATPase
Pancreatic and bile
Omeprazole
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
In the mucus that covers the gastric epithelium
19. What is the frequency of basal electric rhythm of the stomach
ALT>AST
US and cholecystectomy
Dense core bodies
3 waves/min
20. What source of salivary secretion is the most serous and What is the most mucinous
Serous on the sides parotids - mucinous in the middle sublingual
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
FAP
Adhesion
21. What kind of muscle is in the middle 1/3 of esophagus
Myenteric nerve plexus - aurbach
Striated and smooth
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Krukenbergs tumor
22. What serum enzyme is elevated inacute pancreatitis
Lipase
Via the superior pancreaticduodenal
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Hemosiderosis - hemochromatosis
23. Which serum enzyme increases with heavy EtOH consumption
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Gamma glutamyl transferase GGT
Superior rectal and middle and inferior rectal - rectum
Gastric glands
24. What kind of anemia is in Wilsons
AR
Hemolytic anemia
Decreased intercellular adhesion and increased proliferation
Complications of UC
25. Gq and inc cAMP both work to do what in parietal cells
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Portal HTN
L3
Stimulate the H/K ATPase
26. What layer of fascia covers a direct inguinal hernia
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
Pancreatic and bile
External spermatic fascia only
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
27. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Unconj - absent (acholuria) - inc
Lipase - phospholipase A - colipase
Hydrocele
28. Transmural esophageal rupture due to violent retching
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29. somatostatin - source - action - regulation
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
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
30. What do you use to diagnose meckels
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Alpha amylase
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Pertechnetate - study for uptake
31. Diaphragmatic hernias occur in infants because of defective development of which membrane
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
So hypertrophied they look like brain gyri
Pleuroperitoneal
32. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Boerhaave's Syndrome - Been heaving syndrome
Complications of crohns
Dilated esophagus with an area of distal stenosis - birds beak
Urobilin
33. Progressive dyshphage beginning with solids and moving to liquids and weight loss
External spermatic fascia only
Repeated phlebotomy - deferoxamine - HLA- A3
Esophageal cancer
Cholesterol
34. What kind of insults results in macronodular cirrhosis
Esophageal carcinoma
Appendicitis
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Primary sclerosing cholangitis
35. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Via the superior pancreaticduodenal
Diverticulum
Failure of neural crest migration
Reye's syndrome
36. What are the four Fs of gallstones
Female - fat - fertile - forty
Gallbladder
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Necrotizing enterocolitis
37. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Cirrhosis
Hernia
38. Where are tumors commonly in pancreatic adenocarcinoma
Lamina propora and submucosa
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Pancreatic head causing obstructive jaundice
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
39. How do you DX and TX gallstones
Peptic ulcer disease
Hypercoaguability - polycythemia vera - pregnancy - HCC
Carcinoid syndrome
US and cholecystectomy
40. What is the cause of physiologic neonatal jaundice
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
41. How does loss of NO secretion affect the esophagus and what results
Inc lower esphogeal tone leading to achalasia
Punched out - clean margins - carcinoma =raised irregular margins
Downs
Adhesion
42. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Celiac sprue
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Volvulus
43. What reaction does salivary amylase catalyze
Conj/unconj - inc - nl to dec
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Positive urease test
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
44. Why are most diverticula considered false
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
The submucosal nerve plexus - meissner's
45. Where is bicarb trapped
In the mucus that covers the gastric epithelium
Barrett's esophagus
Duodenal atresia - Downs
Budd chiari syndrome
46. What layer in the mucosa is responsible for absorption
FAP
Diverticulum
Alpha amylase
Epithelium
47. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Dubin johnson
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Gastrohepatic ligament
48. What is the risk with peutz jehgers
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
IBS at least 2 with recurrent abdominal pain
Portal HTN
Inc risk of CRC and other visceral malignancies
49. What happens to the short gastics if the splenic artery is blocked
Where hindgut meets ectoderm
Poor anastamoses
Glucouronate - water soluble (direct)
Upregulated intracellular signal transduction
50. What intervention will intervention will relieve portal HTN
GLUT 2
Krukenbergs tumor
Lateral to the inferior epigastric artery
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
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