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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 serum enzyme is elevated in acute pancreatitis and mumps
Crypts but not villi
Gut bacteria
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Amylase
2. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Hemosiderosis - hemochromatosis
Intussusception
AST >ALT - ration is usually 1.5
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
3. conjugated hyperbilirubinemia due to defective liver excretion
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
NAV = nerve artery vein - venous near the penis (NAVEL)
Dubin johnson
4. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Elevated amylase - and lipase
IgA secreting plasma cells - ultimately reside in the lamina proporia
Zollinger ellison - brunners glands
Inguninal ligament - sartorius muscle - adductor longus
5. What skin condition is associated with celiac sprue
Dermatitis herpetiformis
Epigastric abdominal pain radiating to back - anorexia - nausea
Volvulus
Via the middle colic
6. In PUD - with gastric ulcers - does pain inc or dec with meals?
Inc - weight loss
Carcinoid syndrome
Alpha1 antitrypsin def - codominant trait
Centrilobular leading to congestive liver disease
7. What kind of anemia is in Wilsons
Falciform - ligamentum teres - fetal umbilical vein
L1
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Hemolytic anemia
8. What is the presenting course for appendicity
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9. Why does volvulus occur more at cecum and sigmoid colon
Redundant mesentary
Old men - arthralgias - cardiac and neuro sx
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Sister mary joseph nodule
10. In what scenarios do pts with gilberts have inc bili
Heme metabolism
Fasting and stress
Meconium ileus
HSV-1 - CMV - Candida
11. What are the foregut structures and what supplies their blood and PANS innvervation
Reye's syndrome
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
H+
L2
12. At what level do the testicular/ovarian arteries exit the aorta
Decrease - weight gain
Inc smooth muscle relaxation - including lower esophageal sphincter
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
L2
13. How does brain injury lead to acute gastritis and What is it called
Gastrohepatic ligament
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Oligosaccharide digestion
Falciform - ligamentum teres - fetal umbilical vein
14. Bile is critical for exrection of what substance
Liver metabolizes 5HT
Neural muscarinic pathways
Acute pancreatitis
Cholesterol
15. likely infectious form of malabsorption - responds to antibiotics
Tropical sprue
Boerhaave's Syndrome - Been heaving syndrome
Left and right gastroepiploics - left and right gastrics
Obstruction of the common bile duct
16. What are the results of hemochromatosis
CHF and inc risk of HCC
Phototherapy
Cigarettes and chronic pancreatitis - not EtOH
Uridine glucuronyl transferase
17. What is the TX of physiologic neonatal jaundice
Phototherapy
Centrilobular leading to congestive liver disease
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Striated and smooth
18. What structures feed into the common bile duct
AST
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Virchow's node
Cystic duct and common hepatic duct
19. Who gets Whipple disease and How do they present
Via the superior pancreaticduodenal
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Peyers patches
Old men - arthralgias - cardiac and neuro sx
20. What kind of diarrhea is produced from a disaccharide def
Osmotic
Acute pancreatitis
Dec PGE2 leading to dec gastric mucosa protection
Ampulla of vater
21. What layer in the mucosa is responsible for support
Barrett's esophagus
Lamina propria
Epithelium
Bleeding - intussusception - volvulus - obstruction near terminal ileum
22. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Above
Redness and tenderness on palpation of extremities
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Female - fat - fertile - forty
23. milk intolerance
Lipase - phospholipase A - colipase
Dissaccharidase def - most commonly lactase
Splenic flexure
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
24. Where is the arterial supply from above the pectinate line - and What is the venous drainage
In the mucus that covers the gastric epithelium
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Dec PGE2 leading to dec gastric mucosa protection
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
25. Where and How is iron absorbed
Black - rotors syndrome
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
GLUT 2
Fe2+ in the duod
26. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
8-9 waves/min
Fasting and stress
Brunners
Warthins' tumor
27. What histological findings are present in the esophagus
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Glucouronate - water soluble (direct)
Nonkeritinized stratified sqamous epithelium
28. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Poor anastamoses
True and most common congenital anomoly of GI tract
Superior rectal
Left gastric vein and esophogeal vein - esophagus
29. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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30. What factors increase risk of malignancy of adenomatous polyps
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Pancreatic head causing obstructive jaundice
Female - fat - fertile - forty
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
31. With internal hemorrhoids Where is the anastomoses and Where is it
Internal thoracic to superior epigastric to inferior epigastric
Striated and smooth
Falciform - ligamentum teres - fetal umbilical vein
Superior rectal and middle and inferior rectal - rectum
32. Where is the pectinate line
Alpha1 antitrypsin def - codominant trait
Esophageal cancer
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Where hindgut meets ectoderm
33. What is the most important mechanism in gastric acid secretion
Lateral
Hepatic steatosis
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
34. How is the diagonsis of CRC made
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
Pleomorphic adenoma
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Crigler - najjar type 1
35. subQ peribumbilical metastasis
Normal
Volvulus
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Sister mary joseph nodule
36. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
Dec PGE2 leading to dec gastric mucosa protection
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Gilbert's
37. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Complications of UC
Alcoholic hepatitis
L1
EtOH
38. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Zollinger ellison - brunners glands
Splenic flexure
Pertechnetate - study for uptake
Conj - inc - dec
39. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Carcinoid syndrome
Poor anastamoses
Alk phos
40. How is salivary secretion stimulated
Angiodysplasia
90%
Hemosiderosis - hemochromatosis
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
41. What is the prognosis of adenocarcinoma
Sphincter of oddi
Averages 6 months - very aggressive - usually already metastasized at presentation
Budd chiari syndrome
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
42. If trypsin activates more trypsinogen - what kind of feedback loop is established
Neural muscarinic pathways
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Parietal cells in the stomach - B12 binding protein
Positive
43. When do you see hypertrophy of brunners glands
Falciform - ligamentum teres - fetal umbilical vein
Dense core bodies
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Peptic ulcer disease
44. What congenital birth defect is associated with Hirschsprung
Duodenum - 2nd - 3rd and 4th parts
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
Downs
GERD - may also present with nocturnal cough and dyspnea
45. What layer in the mucosa is repsonsible for motility
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Muscularis mucosae
Obstruction of the common bile duct
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
46. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Erosive - disruption of mucosal barrier leading to inflammation
Inc conj bilirubin - inc cholesterol - inc alk phos
47. What source of salivary secretion is the most serous and What is the most mucinous
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Brunners
Serous on the sides parotids - mucinous in the middle sublingual
Lack or have an attenuated muscularis externa - often in the sigmoid colon
48. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue
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49. What structures feed into the common hepatic duct
Right and left hepatic duct
Angiodysplasia
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Esophageal cancer
50. What pancreatic proteases are secreted as zymogens
External spermatic fascia only
Trypsin - chymotrypsin - elastase - carboxypeptidases
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus