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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. Which kind of hemorrhoids are painful and why
L4
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
The jejunum
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
2. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Lactase is located at the tips of intestinal villi
The entire
Gamma glutamyl transferase GGT
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
3. What findings are associated with reyes
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Common hepatic - splenic - left gastric - main blood supply for stomach
Worldwide - SC - US - adeno
Small intestine
4. What is the leading cause of bowel incarceration
Femoral hernia
Oligosaccharide digestion
All 3 gut layers outpouch as in Meckels
Alk phos
5. What cells make pepsin - What does it do - and what regulates it
Hypercoaguability - polycythemia vera - pregnancy - HCC
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Dilated esophagus with an area of distal stenosis - birds beak
6. What test and result confirms H pylori infxn
Worldwide - SC - US - adeno
Juvenille polyps - no risk if single
Left gastric vein and esophogeal vein - esophagus
Positive urease test
7. What is the most common cause of gallstones
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Downs
8. What does K- ras mutation cause
Achalasia due to loss of myenteric plexus (auberach)
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Upregulated intracellular signal transduction
9. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
Antrum - H.pylori - inc risk of MALT lymphoma
Inferior rectal nerve
Budd chiari syndrome
...
10. What do you use to diagnose meckels
Lipase
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Gut bacteria
Pertechnetate - study for uptake
11. Is there any structural abnl with IBS - What is the course of disease and presentation
No - chronic - can present with diarrhea or constipation or alternation - treat sx
HPNCC
Zollinger Ellison - phenylalanine and tryptophan
Alfatoxin in peanuts
12. Bilirubin is the product of what?
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
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
Heme metabolism
Below
13. What artery passes around the duodenum
The gastroduodenal
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Epithelium
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
14. What is the risk with peutz jehgers
Unconj - absent (acholuria) - inc
Bleeding - penetration into pancreas - perforation - obstruction
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Inc risk of CRC and other visceral malignancies
15. What is the clinical presentation of acute pancreatitis
Redness and tenderness on palpation of extremities
Epigastric abdominal pain radiating to back - anorexia - nausea
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Early childhood - neuro sx and malabsorption
16. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Complications of crohns
Lye ingestion and acid reflux
Hepatic steatosis
Dec PGE2 leading to dec gastric mucosa protection
17. bilateral mets to ovaries with abundant mucus - signet ring cells
Hirschsprungs
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Krukenbergs tumor
18. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Brunners
Stercobilin
Brush border of intestine - produce monosaccharides from oligo and di
19. Achalasia can be secondary to what infectious disease common in South America
Lye ingestion and acid reflux
Chagas disease
Volvulus
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
20. What can fistula between the gallbladder and small intestine create and how can you tell
Phenobarbital - inc liver enzyme synthesis
Hirschsprungs
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
2ndary biliary cirrhosis
21. Which IBD is autoimmune and which may be a disordered response to bacteria
Crypts but not villi
Upregulated intracellular signal transduction
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Antrum - H.pylori - inc risk of MALT lymphoma
22. What causes pancreatic insuff and What does it cause
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
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
L/R renal artery around L1
HSV-1 - CMV - Candida
23. what percentage of colonic polyps are non - neoplastic
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
90%
Lye ingestion and acid reflux
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
24. in budd chiari syndrome - Where is the congestion and necrosis
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Gamma glutamyl transferase GGT
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Centrilobular leading to congestive liver disease
25. What is a positive murphy's sign
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Inspiratory arrest on deep palpation due to pain
Cimetidine
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
26. What factors increase risk of malignancy of adenomatous polyps
Intussusception
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
H2 receptor - inc cAMP
Spleen to posterior abdominal wall - splenic artery and vein
27. At what spinal level does the SMA exit
Elevated amylase - and lipase
L1
Conj/unconj - inc - nl to dec
Goes through deep inguinal ring - external inguinal ring and into the scrotum
28. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Colonic polyps
Left and right gastroepiploics - left and right gastrics
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Mallory bodies
29. What is the other name for GIP (gastric inhibitory peptide)
IgA secreting plasma cells - ultimately reside in the lamina proporia
Glucose dependent insulinotropic peptide
Colonic polyps
VZV and influenza B treated with salicylates
30. What are the complications of chronic pancreatitis
Stercobilin
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Stimulate intestinal persistalsis
31. signet ring cells - acanthosis nigracans - dz - character/association - spread
All 3 gut layers outpouch as in Meckels
NAV = nerve artery vein - venous near the penis (NAVEL)
Fe2+ in the duod
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
32. What are the two molecular pathways that lead to CRC
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Dubin johnson
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Alk phos
33. How does loss of NO secretion affect the esophagus and what results
Celiac sprue
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Inc lower esphogeal tone leading to achalasia
Lye ingestion and acid reflux
34. crigler - najjar type II responds to which therapy and How does it work
M3 - Gq - inc IP3/Ca
Goes through deep inguinal ring - external inguinal ring and into the scrotum
8-9 waves/min
Phenobarbital - inc liver enzyme synthesis
35. Where and How is iron absorbed
Fe2+ in the duod
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Complications of crohns
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
36. What complication can arise from indirect inguinal hernias
Above
Superior rectal
Hydrocele
Turcot
37. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Begins starch digestion - inactivated by low pH upon reaching the stomach
Crohns = noncaseating granulomas - UC = crypt abscesses
Fe2+ in the duod
Gastrohepatic ligament
38. What kind of muscle is in the lower 1/3 of the esophagus
Smooth
Dense core bodies
Poor anastamoses
Dilated esophagus with an area of distal stenosis - birds beak
39. How are all 3 monosaccharides transported to the blood
GLUT 2
Upregulated intracellular signal transduction
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Muscularis mucosae
40. Achalasia increases the risk For what complication
Glucose dependent insulinotropic peptide
Barrett's esophagus
Esophageal carcinoma
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
41. What is the characteristic histo finding in alcoholic hepatitis
T cell lymphoma
Dense core bodies
AR
Mallory bodies
42. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Zollinger ellison - brunners glands
Adhesion
Alpha1 antitrypsin def - codominant trait
43. What does a low flow rate mean for saliva
Hypotonic because of more time to reabsorb NaCl
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Oligosaccharide digestion
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
44. What is the omphalomesenteric cyst
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Cystic dilation of the viteline duct
Where hindgut meets ectoderm
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
45. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
HPNCC
Lipase
Jewish and African American men
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
46. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Hirschsprungs
Esophageal varices
HPNCC
External spermatic fascia only
47. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Zenkers - halitosis - dysphagia and obstruction
US and cholecystectomy
Stimulate the H/K ATPase
Complications of crohns
48. What receptor does histamine bind on the parietal cell and What does it activate
Stimulate the H/K ATPase
H2 receptor - inc cAMP
Mallory bodies
Chronic gastritis and pernicious anemia
49. What are the effects of atropine on parietal cells and G cells
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Can lead to hematemesis - found in EtOHics and bulimics
The jejunum
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
50. Gallstones that reach the common channel at ampulla can block which two ducts
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Hypercoaguability - polycythemia vera - pregnancy - HCC
Pancreatic and bile
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum