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Test your basic knowledge |
USMLE GI
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Subjects
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health-sciences
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usmle
Instructions:
Answer 50 questions in 15 minutes.
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study here
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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. Achalasia increases the risk For what complication
Femoral hernia
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Esophageal carcinoma
Stercobilin
2. Where is the deep inguinal ring relative to the inferior epigastric vessels
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Celiac sprue
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Lateral
3. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Alk phos
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Celiac sprue
Falciform - ligamentum teres - fetal umbilical vein
4. What does alpha amylase do and what inactivates it
Pleuroperitoneal
Begins starch digestion - inactivated by low pH upon reaching the stomach
Dermatitis herpetiformis
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
5. What type of insults result in micronodular cirrhosis
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Glucouronate - water soluble (direct)
6. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Black - rotors syndrome
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
7. What kind of cancer to celiac sprue put you as inc risk for
Penicillinamine - AR inheritance
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Virchow's node
T cell lymphoma
8. What is the risk with peutz jehgers
Appendicitis
Spleen to posterior abdominal wall - splenic artery and vein
IgA secreting plasma cells - ultimately reside in the lamina proporia
Inc risk of CRC and other visceral malignancies
9. What is the classic triad of hemochromatosis
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10. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
Inc - weight loss
Neural muscarinic pathways
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
11. Where does type A chronic gastritis occur and What causes it
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
HSV-1 - CMV - Candida
12. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Mucoepidermoid carcinoma
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Cirrhosis
In the mucus that covers the gastric epithelium
13. what kind of muscle is in the upper 1/3 of esophagus
L/R renal artery around L1
Jaundice - fever - RUQ
H+
Striated
14. How many layers of spermatic fascia are covers an indirect inguinal hernia
Neutralizes gastric acid allowing pancreatic enzymes to fxn
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Menetriers disease
All 3
15. Which area of the hindgut is a watershed area
Old men - arthralgias - cardiac and neuro sx
8-9 waves/min
Splenic flexure
Pleuroperitoneal
16. What receptors does gastrin bind on the parietal cell and What does it activate
Hirschsprungs
CCK8 receptor - Gq inc IP3/Ca
NAV = nerve artery vein - venous near the penis (NAVEL)
Can lead to hematemesis - found in EtOHics and bulimics
17. subQ peribumbilical metastasis
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Left gastric vein and esophogeal vein - esophagus
Sister mary joseph nodule
Amylase
18. What is the cause of physiologic neonatal jaundice
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Dubin johnson
All 3
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
19. What can hemochromatosis be secondary to...
Dubin johnson
Unconj - absent (acholuria) - inc
Hepatic steatosis
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
20. Where is there sclerosis in alcoholic cirrohosis
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Around the central vein (zone III)
3 waves/min
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
21. What do tumors that arise in the head of the pancreas cause
Obstruction of the common bile duct
IgA secreting plasma cells - ultimately reside in the lamina proporia
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Crohns = noncaseating granulomas - UC = crypt abscesses
22. What congenital birth defect is associated with Hirschsprung
Dec PGE2 leading to dec gastric mucosa protection
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Ceruplasmin
Downs
23. rare - often fatal childhood hepatoencephalopathy
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24. What is charcot triad of cholangitis
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Jaundice - fever - RUQ
So hypertrophied they look like brain gyri
25. Where are peyers patches found
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Upregulated intracellular signal transduction
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Lamina propora and submucosa
26. What findings are associated with reyes
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
27. What kind of digestion is bile needed for
Oligosaccharide digestion
Lipase - phospholipase A - colipase
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
With albumin
28. What is contained in the gastrosplenic and What areas does it separate
Striated and smooth
Short gastrics - left greater and lesser
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
H+
29. Gastrin - source - action - regulation
H2 receptor - inc cAMP
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
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Liver metabolizes 5HT
30. What serum enzyme is decreased in wilsons disease
In the ileum with bile acids - requires IF
Ceruplasmin
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Crohns = maybe - UC= always
31. Where and How is iron absorbed
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Fe2+ in the duod
Mucoepidermoid carcinoma
Peutz jeghers
32. What is the presenting course for appendicity
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33. How does hirschsprung present and appear on imaging
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
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
Virchow's node
34. What can fistula between the gallbladder and small intestine create and how can you tell
Carcinoid syndrome
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
35. What test and result confirms H pylori infxn
Peptic ulcer disease
Positive urease test
Mucoepidermoid carcinoma
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
36. What serum enzyme is elevated inacute pancreatitis
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Causes of gall stones
Neural muscarinic pathways
Lipase
37. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Via the superior pancreaticduodenal
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
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Alk pho
38. What does bicab do in the mouth
Neutralizes oral bacertial acids and maintains dental health
Poor anastamoses
Meckels
Antrum - H.pylori - inc risk of MALT lymphoma
39. How does abetalipoproteinemia lead to malabsorption
Phenobarbital - inc liver enzyme synthesis
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Jewish and African American men
40. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Intussusception
Neural muscarinic pathways
Skip lesions =crohns - colon = UC
Falciform - ligamentum teres - fetal umbilical vein
41. What is the cause of Barrett's and the assocaited complications
Downs
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
The proximal small bowel
Gastric glands
42. What other condition can lead to acute gastritis - think renal
AR
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Uremia
AST>ALT
43. absent UDPGT - presents early in life - early mortality
Colonic polyps
Menetriers disease
Crigler - najjar type 1
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
44. What artery passes around the duodenum
Carcinoid syndrome
Brunners
The gastroduodenal
Penicillinamine - AR inheritance
45. Which viral infxns/treatments are associated with reyes syndrome
12 waves/min
VZV and influenza B treated with salicylates
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Failure of neural crest migration
46. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Peptic ulcer disease
Esophageal varices
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Peyers patches
47. What kind of muscle is in the lower 1/3 of the esophagus
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Hirschsprungs
Smooth
48. What kind of lesions are characteristic of duodenal PUD vs cancer
Averages 6 months - very aggressive - usually already metastasized at presentation
Punched out - clean margins - carcinoma =raised irregular margins
Crigler - najjar type 1
Upregulated intracellular signal transduction
49. What does extrahepatic biliary obstruction cause
CHF and inc risk of HCC
Carcinoid syndrome
Heme metabolism
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
50. Where is B12 absorbed
Superior rectal and middle and inferior rectal - rectum
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Left gastric vein and esophogeal vein - esophagus
In the ileum with bile acids - requires IF
Sorry!:) No result found.
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