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Test your basic knowledge |
USMLE GI
Start Test
Study First
Subjects
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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. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Alpha amylase
Positive urease test
HPNCC
Gallbladder
2. How does gastrin increase acid secretion?
Redness and tenderness on palpation of extremities
3 waves/min
Primarly through ECL leading to histamine release
Brush border of intestine - produce monosaccharides from oligo and di
3. What receptors does ACH bind on the parietal cells and What does it activate
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
2ndary biliary cirrhosis
Low pressure proximal to LES
M3 - Gq - inc IP3/Ca
4. In viral hepatitis - which liver enzyme is higher
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
Hyperplastic
Adhesion
ALT>AST
5. Autodigestion of pancreas by pancreatic enzymes
Erosive - disruption of mucosal barrier leading to inflammation
Fe2+ in the duod
Inc risk of CRC and other visceral malignancies
Acute pancreatitis
6. In what clinical scenarior do you see portosystemic anastomoses
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
Portal HTN
Alcoholic cirrhosis
Pleuroperitoneal
7. Where is there sclerosis in alcoholic cirrohosis
External (superficial) ring only
Around the central vein (zone III)
Increase tumorigenesis
Left gastric vein and esophogeal vein - esophagus
8. what kind of fistula is associated with diverticulitis
Serous on the sides parotids - mucinous in the middle sublingual
GLUT 2
Left and right gastroepiploics - left and right gastrics
Colovesical leading to pneumaturia
9. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Internal thoracic to superior epigastric to inferior epigastric
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Adhesion
10. Where does copper accumulate in Wilsons and What are ABCD
Primarly through ECL leading to histamine release
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
Osmotic
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
11. What kind of pathways do CCK act on to cause pancreatic secretion
Dissaccharidase def - most commonly lactase
Pancreatic head causing obstructive jaundice
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Neural muscarinic pathways
12. What is the most common diaphragmatic hernia and What are the two types
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Erosive - disruption of mucosal barrier leading to inflammation
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
13. How do burns cause acute gastritis and What is it called
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14. What are the longterm sequelae of nutmeg liver
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
AST
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Centrilobular congestion and necrosis - cardiac cirrhosis
15. What is the frequency of basal electric rhythm of the stomach
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
H2 receptor - inc cAMP
3 waves/min
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
16. What is the rule of 2s for meckels
L1
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
17. signet ring cells - acanthosis nigracans - dz - character/association - spread
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Downs
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
18. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Alpha amylase
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Cimetidine
Smooth
19. What are the complications of acute pancreatitis
Inc smooth muscle relaxation - including lower esophageal sphincter
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Striated and smooth
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
20. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Ampulla of vater
Esophageal varices
Via the superior pancreaticduodenal
21. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Diverticulum
True and most common congenital anomoly of GI tract
Causes of gall stones
22. What congenital birth defect is associated with Hirschsprung
Downs
Muscularis mucosae
Lateral to the inferior epigastric artery
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
23. If the abdominal aorta is blocked - How does blood get to the left colic artery
With albumin
Via the middle colic
Redness and tenderness on palpation of extremities
Stimulate the H/K ATPase
24. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Internal thoracic to superior epigastric to inferior epigastric
Carcinoid syndrome
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Dermatitis herpetiformis
25. What gives stool its characteristic color
Stercobilin
Small intestine
Below
Lipase - phospholipase A - colipase
26. What converts inactive pepsinogen to pepsin
H+
Conj/unconj - inc - nl to dec
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Amylase
27. What is one potential precipitating factor for intussusception
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Chronic calcifying pancreatitis - inc risk of panreatic cancer
External spermatic fascia only
28. 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
Tropical sprue
AST
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
29. What are the treatmet options for crohns
Corticosteroids - infliximab
Sister mary joseph nodule
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
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
30. What does the splenorenal ligament connect - and What does it contain
L4
Spleen to posterior abdominal wall - splenic artery and vein
Female - fat - fertile - forty
Dubin johnson
31. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Old men - arthralgias - cardiac and neuro sx
Carcinoid syndrome
When diffusely infiltrative - thickened rigid appearance like a leather bottle
L2
32. Which IBD is autoimmune and which may be a disordered response to bacteria
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Inc lower esphogeal tone leading to achalasia
Crigler - najjar type 1
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
33. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Crypts but not villi
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
L2
Gamma glutamyl transferase GGT
34. What receptor does histamine bind on the parietal cell and What does it activate
Boerhaave's Syndrome - Been heaving syndrome
H2 receptor - inc cAMP
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Punched out - clean margins - carcinoma =raised irregular margins
35. When do you see hypertrophy of brunners glands
Lateral
Peptic ulcer disease
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Goes through deep inguinal ring - external inguinal ring and into the scrotum
36. What transforms conjugated bilirubin to urobilinogen
Pleuroperitoneal
Hemolytic anemia
Brunners
Gut bacteria
37. What layer of fascia covers a direct inguinal hernia
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Inc risk of CRC and other visceral malignancies
External spermatic fascia only
Common hepatic - splenic - left gastric - main blood supply for stomach
38. How do villi appear in disaccharidease def
Primarly through ECL leading to histamine release
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Normal
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
39. What are the complications of chronic pancreatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
HSV-1 - CMV - Candida
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
40. Transmural esophageal rupture due to violent retching
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41. Why does volvulus occur more at cecum and sigmoid colon
Jaundice - fever - RUQ
Mucosa - submucosa - muscularis externa - serosa/adventitia
Redundant mesentary
IBS at least 2 with recurrent abdominal pain
42. What carcinogens are associated with HCC
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
8-9 waves/min
Alfatoxin in peanuts
Reye's syndrome
43. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Positive
Superior rectal
Diverticulum
HPNCC
44. 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
Paraumbilical and superficial and inferior epigastric - umbilicus
The submucosal nerve plexus - meissner's
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Skip lesions =crohns - colon = UC
45. What type of insults result in micronodular cirrhosis
Mucoepidermoid carcinoma
Stimulate intestinal persistalsis
Chagas disease
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
46. What does bicab do in the mouth
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Achalasia due to loss of myenteric plexus (auberach)
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
Neutralizes oral bacertial acids and maintains dental health
47. subQ peribumbilical metastasis
Gallbladder
PAS- positive globules in liver -
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Sister mary joseph nodule
48. What serum enzyme is elevated in acute pancreatitis and mumps
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
Erosive - disruption of mucosal barrier leading to inflammation
Portal HTN
Amylase
49. What serum markers increase in cholecystitis with bile duct involvement
Alk phos
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Stimulate intestinal persistalsis
50. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Uremia
Inc - weight loss
Zollinger Ellison - phenylalanine and tryptophan
With albumin