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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 are the treatment options for uclerative colitis
Epithelium
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Alk phos
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
2. At what level of the spine does the IM exit the aorta
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
No
L3
Uremia
3. What enzyme is necessary to create conjugated bilirubin
Budd chiari syndrome
Uridine glucuronyl transferase
Gastrohepatic ligament
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
4. secretin - source - action - regulation
Lipase - phospholipase A - colipase
Gardner's syndrome
HSV-1 - CMV - Candida
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
5. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Chronic gastritis and pernicious anemia
Redundant mesentary
Pleomorphic adenoma
Ceruplasmin
6. What are the signs and symptoms of budd chiari
Heme metabolism
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Hernia
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
7. How do villi appear in disaccharidease def
Mucosa - submucosa - muscularis externa - serosa/adventitia
Mucoepidermoid carcinoma
Intussusception
Normal
8. What drug blocks the H2R
Cimetidine
Fe2+ in the duod
Reye's syndrome
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
9. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Acute pancreatitis
Hirschsprungs
10. What is the prognosis of adenocarcinoma
Lactase is located at the tips of intestinal villi
Inguninal ligament - sartorius muscle - adductor longus
Alk pho
Averages 6 months - very aggressive - usually already metastasized at presentation
11. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Virchow's node
In the ileum with bile acids - requires IF
Left gastric vein and esophogeal vein - esophagus
12. What commonly leads to appendicity in kids vs adults
Jaundice - fever - RUQ
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Angiodysplasia
13. What does TOASTED with alcoholic hepatitis stand for
Cholesterol - 10-20% opaque due to calcifications
Liver metabolizes 5HT
AST >ALT - ration is usually 1.5
Spleen to posterior abdominal wall - splenic artery and vein
14. What receptors does ACH bind on the parietal cells and What does it activate
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
M3 - Gq - inc IP3/Ca
Primary sclerosing cholangitis
Hypercoaguability - polycythemia vera - pregnancy - HCC
15. What kind of lesions are characteristic of duodenal PUD vs cancer
HSV-1 - CMV - Candida
Punched out - clean margins - carcinoma =raised irregular margins
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
16. What are the barium swallow findings of achalasia
Backup of blood into the liver - RHF - budd chiari
Dilated esophagus with an area of distal stenosis - birds beak
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
17. What can hemochromatosis be secondary to...
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
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
T12
18. What converts inactive pepsinogen to pepsin
H+
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Inc risk of CRC and other visceral malignancies
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
19. Dysphagia in achalasia results from
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Celiac sprue
Redness and tenderness on palpation of extremities
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
20. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
CHF and inc risk of HCC
Pancreatic and bile
Above
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
21. Between what structures do strong anastamoses exist
Left and right gastroepiploics - left and right gastrics
Conj/unconj - inc - nl to dec
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
22. What retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
Duodenal atresia - Downs
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Cholesterol - 10-20% opaque due to calcifications
23. What cell produces IF and What does it do
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Neural muscarinic pathways
Parietal cells in the stomach - B12 binding protein
Achalasia due to loss of myenteric plexus (auberach)
24. What factors increase risk of malignancy of adenomatous polyps
Alcoholic cirrhosis
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
The entire
25. rare - often fatal childhood hepatoencephalopathy
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26. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Femoral hernia
Bleeding - penetration into pancreas - perforation - obstruction
Pancreatic head causing obstructive jaundice
IBS at least 2 with recurrent abdominal pain
27. What kind of insults results in macronodular cirrhosis
Penicillinamine - AR inheritance
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Redundant mesentary
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
28. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Downs
Zenkers - halitosis - dysphagia and obstruction
Left and right gastroepiploics - left and right gastrics
29. What is the most important mechanism in gastric acid secretion
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Chagas disease
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Pyoderma gangrenosum - primary sclerosing cholangitis
30. What is the TX of physiologic neonatal jaundice
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Phototherapy
Spleen to posterior abdominal wall - splenic artery and vein
31. HCC is associated with what other conditions
Conj - inc - dec
Inc lower esphogeal tone leading to achalasia
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
32. What are the complications of acute pancreatitis
Carcinoid syndrome
In the mucus that covers the gastric epithelium
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Sphincter of oddi
33. Who gets Whipple disease and How do they present
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Gastric glands
Hyperpigmented mouth - lips - hands - genitalia
Old men - arthralgias - cardiac and neuro sx
34. What are the structures of the femoral triangle and how are they organized
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
NAV = nerve artery vein - venous near the penis (NAVEL)
Penicillinamine - AR inheritance
Complications of crohns
35. Achalasia increases the risk For what complication
Pleomorphic adenoma
Esophageal carcinoma
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
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
36. Which is used more quickly - an oral glucose load - or that by IV
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Above
Oral glucose
Female - fat - fertile - forty
37. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Superior rectal
Urobilin
Hyperplastic
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
38. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Complications of UC
Antrum - H.pylori - inc risk of MALT lymphoma
Gallbladder
Hirschsprungs
39. What pancreatic enzymes are responsible for fat digestion
Tropical sprue
Lipase - phospholipase A - colipase
Dubin johnson
MSI (15%) and APC/beta catenin chromosomal instability (85%)
40. What can fistula between the gallbladder and small intestine create and how can you tell
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Intussusception
Cholesterol
90%
41. What is Trousseau's sign
Hyperpigmented mouth - lips - hands - genitalia
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Redness and tenderness on palpation of extremities
T12
42. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
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
Zollinger ellison - brunners glands
Left gastric vein and esophogeal vein - esophagus
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
43. In PUD with a duodenal ulcer does pain inc or dec with meals
Ceruplasmin
Hemosiderosis - hemochromatosis
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Decrease - weight gain
44. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
T12
Crohns = noncaseating granulomas - UC = crypt abscesses
Downs
Antrum - H.pylori - inc risk of MALT lymphoma
45. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
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
GERD - may also present with nocturnal cough and dyspnea
46. What serum enzyme is elevated in acute pancreatitis and mumps
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Amylase
Dermatitis herpetiformis
All 3 gut layers outpouch as in Meckels
47. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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48. What kind of muscle is in the middle 1/3 of esophagus
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Sphincter of oddi
Boerhaave's Syndrome - Been heaving syndrome
Striated and smooth
49. What is a positive murphy's sign
Epithelium
Meconium ileus
Squamous - upper 1/3 - adeno - lower 1/3
Inspiratory arrest on deep palpation due to pain
50. What intervention will intervention will relieve portal HTN
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Conj/unconj - inc - nl to dec
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation