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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. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Ampulla of vater
Esophageal cancer
Pleuroperitoneal
Obstruction of the common bile duct
2. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Alpha amylase
Bleeding - penetration into pancreas - perforation - obstruction
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Virchow's node
3. What is the frequency of basal electric rhythm of the ilieum
Inc - weight loss
8-9 waves/min
Pyoderma gangrenosum - primary sclerosing cholangitis
Redundant mesentary
4. 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
Lactase is located at the tips of intestinal villi
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
CCK8 receptor - Gq inc IP3/Ca
5. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Superior rectal
Conj/unconj - inc - nl to dec
Gilbert's
6. What is the action of NO as a GI hormone
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Serous on the sides parotids - mucinous in the middle sublingual
Cirrhosis
Inc smooth muscle relaxation - including lower esophageal sphincter
7. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Corticosteroids - infliximab
Adhesion
H2 receptor - inc cAMP
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
8. Bilirubin is the product of what?
Heme metabolism
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
9. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Falciform - ligamentum teres - fetal umbilical vein
Duodenal atresia - Downs
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
10. What drug inhibits the H/K ATPase
Tropical sprue
CHF and inc risk of HCC
Omeprazole
PAS- positive globules in liver -
11. What are the complications of acute pancreatitis
Zollinger Ellison - phenylalanine and tryptophan
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Alk phos
Sphincter of oddi
12. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Decreased intercellular adhesion and increased proliferation
Hirschsprungs
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Appendicitis
13. What does autoimmune destruction of parietal cells lead to...
Conj/unconj - inc - nl to dec
Portal HTN
Chronic gastritis and pernicious anemia
Squamous - upper 1/3 - adeno - lower 1/3
14. 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
Myenteric nerve plexus - aurbach
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Skip lesions =crohns - colon = UC
Budd chiari syndrome
15. What is the other name for GIP (gastric inhibitory peptide)
Esophageal carcinoma
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Glucose dependent insulinotropic peptide
16. In what scenarios do pts with gilberts have inc bili
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Erosive - disruption of mucosal barrier leading to inflammation
Ischemic colitis
Fasting and stress
17. How many layers of spermatic fascia are covers an indirect inguinal hernia
All 3
L4
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Antrum - H.pylori - inc risk of MALT lymphoma
18. What are the extraintestinal manifestations of crohns
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Cholesterol - 10-20% opaque due to calcifications
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
3 waves/min
19. involvement of left supraclavicular node by mets from stomach
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20. 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
Epithelium
Alcoholic hepatitis
When diffusely infiltrative - thickened rigid appearance like a leather bottle
21. What are the results of hemochromatosis
Failure of neural crest migration
Cholesterol - 10-20% opaque due to calcifications
Redness and tenderness on palpation of extremities
CHF and inc risk of HCC
22. what percentage of colonic polyps are non - neoplastic
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Hypercoaguability - polycythemia vera - pregnancy - HCC
True and most common congenital anomoly of GI tract
90%
23. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Hernia
Where hindgut meets ectoderm
Hepatic steatosis
Superior rectal
24. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Inc conj bilirubin - inc cholesterol - inc alk phos
AST
Redundant mesentary
Averages 6 months - very aggressive - usually already metastasized at presentation
25. What does high flow rate mean
Smooth
Closer to isotonic because of less time to reabsorb NaCl
Via the superior pancreaticduodenal
Alk phos
26. What do you treat Wilsons disease with and What is the inheritance
Pyoderma gangrenosum - primary sclerosing cholangitis
PAS- positive globules in liver -
Penicillinamine - AR inheritance
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
27. concentric onion skin bile duct fibrosis
FAP
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Primary sclerosing cholangitis
Conj/unconj - inc - nl to dec
28. What is the path of an indirect inguinal hernia
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Oral glucose
Complications of crohns
Goes through deep inguinal ring - external inguinal ring and into the scrotum
29. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Duodenal atresia - Downs
Increase tumorigenesis
Gastric glands
30. Which area of the hindgut is a watershed area
Mallory bodies
Lamina propria
Parietal cells in the stomach - B12 binding protein
Splenic flexure
31. Gq and inc cAMP both work to do what in parietal cells
Striated
Below
Stimulate the H/K ATPase
Lack or have an attenuated muscularis externa - often in the sigmoid colon
32. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Jewish and African American men
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Hydrocele
Lactase is located at the tips of intestinal villi
33. What are the signs of peutz jehgers
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Hyperpigmented mouth - lips - hands - genitalia
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
34. most common malignant salivary gland tumor
Mucoepidermoid carcinoma
Alfatoxin in peanuts
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Epigastric abdominal pain radiating to back - anorexia - nausea
35. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Internal thoracic to superior epigastric to inferior epigastric
Female - fat - fertile - forty
Unconj - absent (acholuria) - inc
Chronic gastritis and pernicious anemia
36. rare - often fatal childhood hepatoencephalopathy
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37. What are the complications of duodenal PUD
Bleeding - penetration into pancreas - perforation - obstruction
GLUT 2
Inc - weight loss
Cystic dilation of the viteline duct
38. Are single polyps malignant in peutz jehgers
Krukenbergs tumor
Peyers patches
No
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
39. Where does type A chronic gastritis occur and What causes it
Alcoholic hepatitis
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
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
40. What enzyme is necessary to create conjugated bilirubin
Ampulla of vater
Uridine glucuronyl transferase
Left and right gastroepiploics - left and right gastrics
Menetriers disease
41. Esophagitis can result From which 3 infectious agents - or chemical ingestion
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Inspiratory arrest on deep palpation due to pain
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
HSV-1 - CMV - Candida
42. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Squamous - upper 1/3 - adeno - lower 1/3
43. Why does indirect inguinal hernia happen in infacnts
Repeated phlebotomy - deferoxamine - HLA- A3
Lactase is located at the tips of intestinal villi
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Failure of the processus vagainlis to close
44. What is the most common cause of gallstones
Superior rectal
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
45. What are the barium swallow findings of achalasia
Pancreatic and bile
Dilated esophagus with an area of distal stenosis - birds beak
Tropical sprue
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
46. If trypsin activates more trypsinogen - what kind of feedback loop is established
So hypertrophied they look like brain gyri
Fe2+ in the duod
Diverticulum
Positive
47. Where are peyers patches found
Lamina propora and submucosa
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
3 waves/min
48. What can hemochromatosis be secondary to...
Inc - weight loss
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Downs
49. If the abdominal aorta is blocked - How does blood get to the left colic artery
CHF and inc risk of HCC
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Via the middle colic
Hepatic steatosis
50. Abuse of what substance leads to acute gastritis
EtOH
Poor anastamoses
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
Krukenbergs tumor