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Test your basic knowledge |
USMLE GI
Start Test
Study First
Subjects
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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. Through which aspect of the inguinal canal does a direct inguinal go
Lubricate food (glycoprotiens)
Alcoholic cirrhosis
External (superficial) ring only
Internal thoracic to superior epigastric to inferior epigastric
2. What does K- ras mutation cause
Upregulated intracellular signal transduction
Mucosa - submucosa - muscularis externa - serosa/adventitia
Cholesterol
Inferior rectal nerve
3. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Backup of blood into the liver - RHF - budd chiari
Crohns = noncaseating granulomas - UC = crypt abscesses
Striated and smooth
4. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Decreased intercellular adhesion and increased proliferation
Black - rotors syndrome
NAV = nerve artery vein - venous near the penis (NAVEL)
5. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
EtOH
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Pleomorphic adenoma
6. Achalasia increases the risk For what complication
CHF and inc risk of HCC
Crohns = maybe - UC= always
Unconjugated - water insoluble
Esophageal carcinoma
7. When and How does Abetalipoproteinemia present
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Causes of gall stones
Early childhood - neuro sx and malabsorption
3 waves/min
8. What is the sphincter of the pancreatic duct
Sphincter of oddi
Left gastric vein and esophogeal vein - esophagus
Gallbladder
Virchow's node
9. What is the most common cause of gallstones
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
The proximal small bowel
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
10. What are the ABCDEF of esophageal cancer
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Female - fat - fertile - forty
Pancreatic and bile
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
11. What drug blocks the H2R
Cimetidine
Spleen to posterior abdominal wall - splenic artery and vein
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
12. concentric onion skin bile duct fibrosis
Dubin johnson
Liver metabolizes 5HT
Primary sclerosing cholangitis
IBS at least 2 with recurrent abdominal pain
13. absent UDPGT - presents early in life - early mortality
Mallory bodies
Crigler - najjar type 1
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
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
14. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Crigler - najjar type 1
FAP
Crohns = maybe - UC= always
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
15. Which area of the hindgut is a watershed area
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Splenic flexure
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Inc conj bilirubin - inc cholesterol - inc alk phos
16. What transforms conjugated bilirubin to urobilinogen
Gut bacteria
Omeprazole
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
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
17. What is contained within the muscularis externa
Angiodysplasia
Repeated phlebotomy - deferoxamine - HLA- A3
L4
Myenteric nerve plexus - aurbach
18. multiple juvenil polyps in GI tract - risk
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Fasting and stress
All 3
Juvenile polyposis syndrome - inc risk of adenocarcinoma
19. What do mucins do?
Brunners
Lubricate food (glycoprotiens)
Backup of blood into the liver - RHF - budd chiari
Mucoepidermoid carcinoma
20. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Hyperpigmented mouth - lips - hands - genitalia
Esophageal cancer
Skip lesions =crohns - colon = UC
Cholesterol - 10-20% opaque due to calcifications
21. What enzyme is necessary to create conjugated bilirubin
H+
Uridine glucuronyl transferase
Hernia
Primary sclerosing cholangitis
22. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Hemosiderosis - hemochromatosis
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Zenkers - halitosis - dysphagia and obstruction
Hyperplastic
23. what kind of muscle is in the upper 1/3 of esophagus
Striated
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Superior rectal
Redness and tenderness on palpation of extremities
24. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Diarrhea - steatorrhea - weight loss - weakness
Conj/unconj - inc - nl to dec
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
25. What kind of lesions are characteristic of duodenal PUD vs cancer
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Punched out - clean margins - carcinoma =raised irregular margins
Female - fat - fertile - forty
Inguninal ligament - sartorius muscle - adductor longus
26. Where does an indirect inguinal hernia enter the deep inguinal ring
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
The proximal small bowel
Lateral to the inferior epigastric artery
Pancreatic head causing obstructive jaundice
27. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Colonic polyps
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
28. How is salivary secretion stimulated
Internal thoracic to superior epigastric to inferior epigastric
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Glucose dependent insulinotropic peptide
29. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
HPNCC
T12
Enterokinase/enteropeptidase from the duodenal mucosa
Upregulated intracellular signal transduction
30. What is the ddx associated with appendicitis
Normal
Upregulated intracellular signal transduction
Repeated phlebotomy - deferoxamine - HLA- A3
Diverticulitis in elderly - ectopic pregs use hCG to rule out
31. Who gets gastric ulcers
Older patients
L3
Unconj - absent (acholuria) - inc
Trypsin - chymotrypsin - elastase - carboxypeptidases
32. What are the borders of Hesselbach's triangle
Enterokinase/enteropeptidase from the duodenal mucosa
T12
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Dubin johnson
33. What are the structures of the femoral triangle and how are they organized
Gamma glutamyl transferase GGT
NAV = nerve artery vein - venous near the penis (NAVEL)
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Alpha1 antitrypsin def - codominant trait
34. inflammatino of gallbadder
Gastric glands
Ampulla of vater
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Esophageal carcinoma
35. What are the signs of peutz jehgers
Crypts but not villi
Primary sclerosing cholangitis
Hyperpigmented mouth - lips - hands - genitalia
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
36. What intervention will intervention will relieve portal HTN
2ndary biliary cirrhosis
Pertechnetate - study for uptake
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
37. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Unconj - absent (acholuria) - inc
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Juvenile polyposis syndrome - inc risk of adenocarcinoma
L/R renal artery around L1
38. bilateral mets to ovaries with abundant mucus - signet ring cells
Fe2+ in the duod
Krukenbergs tumor
Punched out - clean margins - carcinoma =raised irregular margins
Pleomorphic adenoma
39. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Duodenal atresia - Downs
Stimulate the H/K ATPase
Mucosa - submucosa - muscularis externa - serosa/adventitia
Redundant mesentary
40. Where does type A chronic gastritis occur and What causes it
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Centrilobular leading to congestive liver disease
Intussusception
PAS- positive globules in liver -
41. what percentage of colonic polyps are non - neoplastic
Esophageal cancer
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Unconjugated - water insoluble
90%
42. What source of salivary secretion is the most serous and What is the most mucinous
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
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Serous on the sides parotids - mucinous in the middle sublingual
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
43. Which serum enzyme increases with heavy EtOH consumption
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Gamma glutamyl transferase GGT
GERD - may also present with nocturnal cough and dyspnea
Portal HTN
44. Autodigestion of pancreas by pancreatic enzymes
Acute pancreatitis
Alk pho
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Mucoepidermoid carcinoma
45. What kind of digestion is bile needed for
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Turcot
46. How does CRC present in the distal and proximal colon
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Cystic duct and common hepatic duct
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
47. subQ peribumbilical metastasis
Ceruplasmin
Sister mary joseph nodule
Left gastric vein and esophogeal vein - esophagus
No - chronic - can present with diarrhea or constipation or alternation - treat sx
48. What conditions are associated with budd chiari
Decrease - weight gain
Hypercoaguability - polycythemia vera - pregnancy - HCC
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
So hypertrophied they look like brain gyri
49. occlusion of IVC or hepatic veins
Cimetidine
Liver metabolizes 5HT
Budd chiari syndrome
Internal thoracic to superior epigastric to inferior epigastric
50. What causes carcinoid syndrome amd What are the symptoms
H2 receptor - inc cAMP
Penicillinamine - AR inheritance
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -