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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 does bicab do in the mouth
Jewish and African American men
Neutralizes oral bacertial acids and maintains dental health
Colovesical leading to pneumaturia
L3
2. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Turcot
Bleeding - penetration into pancreas - perforation - obstruction
Alk pho
Amylase
3. likely infectious form of malabsorption - responds to antibiotics
Tropical sprue
Above
Liver metabolizes 5HT
The entire
4. What do mucins do?
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Lubricate food (glycoprotiens)
5. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
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
CEA - CA-19-9
Carcinoid syndrome
Closer to isotonic because of less time to reabsorb NaCl
6. How are all 3 monosaccharides transported to the blood
Penicillinamine - AR inheritance
AR
GLUT 2
Intussusception
7. What are the histological findings of the colon
True and most common congenital anomoly of GI tract
Crypts but not villi
Alpha amylase
CHF and inc risk of HCC
8. Liver cell failure can lead to multisystem signs including
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Lateral
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
9. What does loss of p53 cause
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Increase tumorigenesis
Below
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
10. How is salivary secretion stimulated
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Uremia
Necrotizing enterocolitis
Carcinoid syndrome
11. What gives urine its characteristic color
Short gastrics - left greater and lesser
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Urobilin
Penicillinamine - AR inheritance
12. What does K- ras mutation cause
Peutz jeghers
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Upregulated intracellular signal transduction
Inc - weight loss
13. What is the main symptom if a VIPoma
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Smooth
Inc lower esphogeal tone leading to achalasia
14. Where are tumors commonly in pancreatic adenocarcinoma
Pancreatic head causing obstructive jaundice
Esophageal varices
Dilated esophagus with an area of distal stenosis - birds beak
Serous on the sides parotids - mucinous in the middle sublingual
15. What are the effects of atropine on parietal cells and G cells
Lateral to the inferior epigastric artery
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Crohns = maybe - UC= always
All 3 gut layers outpouch as in Meckels
16. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
Neutralizes oral bacertial acids and maintains dental health
Crypts but not villi
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
17. What are the complications of acute pancreatitis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Acute pancreatitis
Stercobilin
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
18. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Skip lesions =crohns - colon = UC
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Splenic flexure
Internal thoracic to superior epigastric to inferior epigastric
19. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Paraumbilical and superficial and inferior epigastric - umbilicus
Alpha amylase
Failure of neural crest migration
Low pressure proximal to LES
20. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Chronic gastritis and pernicious anemia
Dilated esophagus with an area of distal stenosis - birds beak
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
GLUT 2
21. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Oral glucose
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Striated and smooth
Peutz jeghers
22. What does loss of APC cause
Decreased intercellular adhesion and increased proliferation
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
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Inc lower esphogeal tone leading to achalasia
23. In PUD - with gastric ulcers - does pain inc or dec with meals?
Inc - weight loss
Epithelium
Terminal ileum and colon
Trypsin - chymotrypsin - elastase - carboxypeptidases
24. What are the layers of the gut wall from inside out
Sphincter of oddi
Mucosa - submucosa - muscularis externa - serosa/adventitia
Lamina propora and submucosa
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
25. involvement of left supraclavicular node by mets from stomach
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26. somatostatin - source - action - regulation
Amylase
CHF and inc risk of HCC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
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
27. What cell produces IF and What does it do
Parietal cells in the stomach - B12 binding protein
Lye ingestion and acid reflux
Colovesical leading to pneumaturia
Unconjugated - water insoluble
28. What do the rugae of stomach look like in menetriers disease
Epigastric abdominal pain radiating to back - anorexia - nausea
So hypertrophied they look like brain gyri
Crohns = noncaseating granulomas - UC = crypt abscesses
Skip lesions =crohns - colon = UC
29. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Causes of gall stones
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Crohns = maybe - UC= always
30. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
3 waves/min
Sister mary joseph nodule
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
31. What converts inactive pepsinogen to pepsin
Stimulate intestinal persistalsis
Stimulate the H/K ATPase
H+
Corticosteroids - infliximab
32. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
The entire
Neutralizes oral bacertial acids and maintains dental health
H+
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
33. What transforms conjugated bilirubin to urobilinogen
Neural muscarinic pathways
Conj/unconj - inc - nl to dec
Diverticulum
Gut bacteria
34. Where does type A chronic gastritis occur and What causes it
90%
Hyperpigmented mouth - lips - hands - genitalia
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
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
35. What does a low flow rate mean for saliva
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Hypotonic because of more time to reabsorb NaCl
HPNCC
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
36. What does TOASTED with alcoholic hepatitis stand for
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
Hydrocele
AST >ALT - ration is usually 1.5
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
37. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Inc conj bilirubin - inc cholesterol - inc alk phos
Small intestine
Smooth
Ceruplasmin
38. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
IBS at least 2 with recurrent abdominal pain
Sister mary joseph nodule
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
39. What is a positive murphy's sign
Epithelium
Inc risk of CRC and other visceral malignancies
Omeprazole
Inspiratory arrest on deep palpation due to pain
40. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Heme metabolism
Superior rectal
Jewish and African American men
Unconj - absent (acholuria) - inc
41. What arteries exit just below the SMA
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Punched out - clean margins - carcinoma =raised irregular margins
Nonkeritinized stratified sqamous epithelium
L/R renal artery around L1
42. Which viral infxns/treatments are associated with reyes syndrome
Penicillinamine - AR inheritance
VZV and influenza B treated with salicylates
Peptic ulcer disease
Begins starch digestion - inactivated by low pH upon reaching the stomach
43. What are the structures of the femoral triangle and how are they organized
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Internal thoracic to superior epigastric to inferior epigastric
NAV = nerve artery vein - venous near the penis (NAVEL)
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
44. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
IBS at least 2 with recurrent abdominal pain
Repeated phlebotomy - deferoxamine - HLA- A3
Falciform - ligamentum teres - fetal umbilical vein
45. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
The jejunum
Volvulus
46. What is the arterial supply and venous drainage below pectinate line
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Zenkers - halitosis - dysphagia and obstruction
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
47. Between what structures do strong anastamoses exist
Left and right gastroepiploics - left and right gastrics
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Penicillinamine - AR inheritance
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
48. What pancreatic enzymes are responsible for fat digestion
Crypts but not villi
With albumin
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Lipase - phospholipase A - colipase
49. 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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50. What is charcot triad of cholangitis
True and most common congenital anomoly of GI tract
Jaundice - fever - RUQ
Inferior rectal nerve
Osmotic