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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. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Decrease - weight gain
Spleen to posterior abdominal wall - splenic artery and vein
Lactase is located at the tips of intestinal villi
Paraumbilical and superficial and inferior epigastric - umbilicus
2. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Duodenal atresia - Downs
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Meconium ileus
Lamina propria
3. What is charcot triad of cholangitis
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Jaundice - fever - RUQ
4. What does loss of APC cause
Phototherapy
Decreased intercellular adhesion and increased proliferation
Positive urease test
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
5. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
Hepatic steatosis
GLUT 2
Antrum - H.pylori - inc risk of MALT lymphoma
6. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Inc conj bilirubin - inc cholesterol - inc alk phos
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Lactase is located at the tips of intestinal villi
Inspiratory arrest on deep palpation due to pain
7. What serum enzyme is elevated inacute pancreatitis
Via the superior pancreaticduodenal
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Lipase
Striated and smooth
8. What is the omphalomesenteric cyst
Terminal ileum and colon
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
Colonic polyps
Cystic dilation of the viteline duct
9. What skin condition is associated with celiac sprue
CHF and inc risk of HCC
Downs
Dermatitis herpetiformis
Smooth
10. How do you DX and TX gallstones
US and cholecystectomy
Failure of the processus vagainlis to close
Begins starch digestion - inactivated by low pH upon reaching the stomach
T cell lymphoma
11. Where are tumors commonly in pancreatic adenocarcinoma
Krukenbergs tumor
Appendicitis
Pancreatic head causing obstructive jaundice
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
12. Acute gastritis is caused By what process
Enterokinase/enteropeptidase from the duodenal mucosa
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Erosive - disruption of mucosal barrier leading to inflammation
Cholesterol
13. What is the most common indication of emergent abdominal surgery in children
Decrease - weight gain
Chronic gastritis and pernicious anemia
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Appendicitis
14. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Punched out - clean margins - carcinoma =raised irregular margins
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Failure of the processus vagainlis to close
Hepatic steatosis
15. At what level of the spine does the IM exit the aorta
Cystic duct and common hepatic duct
Inc risk of CRC and other visceral malignancies
L3
Appendicitis
16. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue
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17. Who is at risk for pancreatic adenocarcinoma
Alk phos
Jewish and African American men
Superior rectal
Duodenal atresia - Downs
18. What congenital birth defect is associated with Hirschsprung
Complications of UC
Lye ingestion and acid reflux
Cigarettes and chronic pancreatitis - not EtOH
Downs
19. What layer in the mucosa is repsonsible for motility
Muscularis mucosae
Black - rotors syndrome
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Acute pancreatitis
20. What structures feed into the common hepatic duct
Mucoepidermoid carcinoma
Right and left hepatic duct
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Centrilobular leading to congestive liver disease
21. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Hemosiderosis - hemochromatosis
Spleen to posterior abdominal wall - splenic artery and vein
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Inspiratory arrest on deep palpation due to pain
22. Where is there sclerosis in alcoholic cirrohosis
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Nonkeritinized stratified sqamous epithelium
Around the central vein (zone III)
23. What is the characteristic histo finding in alcoholic hepatitis
Inguninal ligament - sartorius muscle - adductor longus
Gamma glutamyl transferase GGT
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Mallory bodies
24. Why are most diverticula considered false
Juvenille polyps - no risk if single
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Ischemic colitis
25. What kind of muscle is in the lower 1/3 of the esophagus
Smooth
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Muscularis mucosae
26. Who gets Whipple disease and How do they present
HPNCC
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
Old men - arthralgias - cardiac and neuro sx
In the ileum with bile acids - requires IF
27. In alchoholic hepatitis which liver enzyme is higher
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
L4
Penicillinamine - AR inheritance
AST>ALT
28. What does high flow rate mean
Mallory bodies
Pleuroperitoneal
Peyers patches
Closer to isotonic because of less time to reabsorb NaCl
29. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Paraumbilical and superficial and inferior epigastric - umbilicus
Budd chiari syndrome
Zollinger ellison - brunners glands
30. Abuse of what substance leads to acute gastritis
The jejunum
Uridine glucuronyl transferase
Portal HTN
EtOH
31. What cell produces IF and What does it do
Parietal cells in the stomach - B12 binding protein
Spleen to posterior abdominal wall - splenic artery and vein
EtOH
Krukenbergs tumor
32. What is the clinical presentation of acute pancreatitis
Omeprazole
VZV and influenza B treated with salicylates
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Epigastric abdominal pain radiating to back - anorexia - nausea
33. What are motilin receptor agonists used for clinically
Stimulate intestinal persistalsis
Begins starch digestion - inactivated by low pH upon reaching the stomach
Celiac sprue
Angiodysplasia
34. What layer in the mucosa is responsible for support
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
The entire
Jewish and African American men
Lamina propria
35. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Zenkers - halitosis - dysphagia and obstruction
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Menetriers disease
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
36. What are the complications of acute pancreatitis
Lipase
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Superior rectal and middle and inferior rectal - rectum
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
37. concentric onion skin bile duct fibrosis
Primary sclerosing cholangitis
M3 - Gq - inc IP3/Ca
Muscularis mucosae
Lateral to the inferior epigastric artery
38. What drug blocks the H2R
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Cimetidine
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Gut bacteria
39. What receptors does ACH bind on the parietal cells and What does it activate
Zollinger Ellison - phenylalanine and tryptophan
M3 - Gq - inc IP3/Ca
Around the central vein (zone III)
Dissaccharidase def - most commonly lactase
40. How is bilirubin carried in the blood
With albumin
Fasting and stress
Zollinger ellison - brunners glands
L/R renal artery around L1
41. What pancreatic proteases are secreted as zymogens
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Trypsin - chymotrypsin - elastase - carboxypeptidases
Dense core bodies
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
42. What are the layers of the gut wall from inside out
8-9 waves/min
Chagas disease
Krukenbergs tumor
Mucosa - submucosa - muscularis externa - serosa/adventitia
43. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Inguninal ligament - sartorius muscle - adductor longus
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Angiodysplasia
44. What are the tumor markers for pancreatic adenocarcinoma
The entire
Portal HTN
CEA - CA-19-9
Conj - inc - dec
45. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Peyers patches
90%
Enterokinase/enteropeptidase from the duodenal mucosa
Superior rectal and middle and inferior rectal - rectum
46. Which serum enzyme increases with heavy EtOH consumption
Redness and tenderness on palpation of extremities
Gamma glutamyl transferase GGT
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
47. What kind of diarrhea is produced from a disaccharide def
90%
Dermatitis herpetiformis
Punched out - clean margins - carcinoma =raised irregular margins
Osmotic
48. What is the TX of physiologic neonatal jaundice
Phototherapy
12 waves/min
Backup of blood into the liver - RHF - budd chiari
Left and right gastroepiploics - left and right gastrics
49. What histological findings are present in the esophagus
3 waves/min
Osmotic
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Nonkeritinized stratified sqamous epithelium
50. Where is the deep inguinal ring relative to the inferior epigastric vessels
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Boerhaave's Syndrome - Been heaving syndrome
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Lateral