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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. In viral hepatitis - which liver enzyme is higher
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
ALT>AST
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
External spermatic fascia only
2. Where is IgA shuttled
Lubricate food (glycoprotiens)
Failure of the processus vagainlis to close
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Nonkeritinized stratified sqamous epithelium
3. Which viral infxns/treatments are associated with reyes syndrome
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
GLUT 2
Oligosaccharide digestion
VZV and influenza B treated with salicylates
4. What does bicarb do in the duodenum
Osmotic
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Pyoderma gangrenosum - primary sclerosing cholangitis
5. What can hemochromatosis be secondary to...
Inguninal ligament - sartorius muscle - adductor longus
Zenkers - halitosis - dysphagia and obstruction
T12
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
6. What can fistula between the gallbladder and small intestine create and how can you tell
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Cholesterol
Brunners
7. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Hirschsprungs
Peutz jeghers
Hyperplastic
Intussusception
8. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
Early childhood - neuro sx and malabsorption
Crypts but not villi
Mucoepidermoid carcinoma
9. What is contained within the submucosa
10. What is the cause of Barrett's and the assocaited complications
Spleen to posterior abdominal wall - splenic artery and vein
L1
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
11. What is one potential precipitating factor for intussusception
Zollinger ellison - brunners glands
T12
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Tropical sprue
12. inflammatino of gallbadder
Mallory bodies
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
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
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
13. What are motilin receptor agonists used for clinically
Colovesical leading to pneumaturia
Stimulate intestinal persistalsis
Alpha1 antitrypsin def - codominant trait
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
14. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
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
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Krukenbergs tumor
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
15. Cholecytsokinin - source - action - regulation
Juvenile polyposis syndrome - inc risk of adenocarcinoma
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
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
16. What causes carcinoid syndrome amd What are the symptoms
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Lye ingestion and acid reflux
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
17. What is the presenting course for appendicity
18. What conditions are associated with budd chiari
Via the superior pancreaticduodenal
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Hypercoaguability - polycythemia vera - pregnancy - HCC
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
19. Which serum enzyme increases with heavy EtOH consumption
Gamma glutamyl transferase GGT
Paraumbilical and superficial and inferior epigastric - umbilicus
L1
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
20. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Downs
Complications of crohns
Uridine glucuronyl transferase
21. What converts inactive pepsinogen to pepsin
Begins starch digestion - inactivated by low pH upon reaching the stomach
L/R renal artery around L1
Boerhaave's Syndrome - Been heaving syndrome
H+
22. Liver cell failure can lead to multisystem signs including
Acute pancreatitis
Alpha1 antitrypsin def - codominant trait
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
23. What is the presentation of pancreatic adenocarcinoma
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Splenic flexure
In the ileum with bile acids - requires IF
24. Why does indirect inguinal hernia happen in infacnts
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Failure of the processus vagainlis to close
CHF and inc risk of HCC
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
25. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
L3
Crohns = maybe - UC= always
AST>ALT
AST >ALT - ration is usually 1.5
26. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Esophageal cancer
Zollinger ellison - brunners glands
Dermatitis herpetiformis
27. What are esophageal strictures associated with
Old men - arthralgias - cardiac and neuro sx
Alpha amylase
Poor anastamoses
Lye ingestion and acid reflux
28. What is the main symptom if a VIPoma
Fe2+ in the duod
Cimetidine
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Copious diarrhea - non alpha - non beta cell pancreatic tumor
29. What kind of muscle is in the middle 1/3 of esophagus
Lamina propria
Striated and smooth
Enterokinase/enteropeptidase from the duodenal mucosa
Crigler - najjar type 1
30. involvement of left supraclavicular node by mets from stomach
31. What is the other name for GIP (gastric inhibitory peptide)
Glucose dependent insulinotropic peptide
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Pancreatic head causing obstructive jaundice
Dubin johnson
32. What histological findings are present in the stomach
Cirrhosis
Gastric glands
Myenteric nerve plexus - aurbach
Serous on the sides parotids - mucinous in the middle sublingual
33. What transforms conjugated bilirubin to urobilinogen
Pancreatic head causing obstructive jaundice
Gut bacteria
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Heme metabolism
34. Gq and inc cAMP both work to do what in parietal cells
Cystic dilation of the viteline duct
Lipase - phospholipase A - colipase
Stimulate the H/K ATPase
Uridine glucuronyl transferase
35. What gives urine its characteristic color
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Glucose dependent insulinotropic peptide
Urobilin
Crohns = maybe - UC= always
36. What kind of insults results in macronodular cirrhosis
Glucose dependent insulinotropic peptide
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Terminal ileum and colon
37. What are the structures of the femoral triangle and how are they organized
Zenkers - halitosis - dysphagia and obstruction
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
NAV = nerve artery vein - venous near the penis (NAVEL)
Chagas disease
38. Which area of the hindgut is a watershed area
Striated
Reye's syndrome
Krukenbergs tumor
Splenic flexure
39. In an MI - which liver enzyme is elevated
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Zollinger ellison - brunners glands
AST
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
40. How do burns cause acute gastritis and What is it called
41. Where are tumors commonly in pancreatic adenocarcinoma
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Pancreatic head causing obstructive jaundice
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
42. What artery passes around the duodenum
The gastroduodenal
Mucoepidermoid carcinoma
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
43. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Zenkers - halitosis - dysphagia and obstruction
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Ceruplasmin
HSV-1 - CMV - Candida
44. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Turcot
So hypertrophied they look like brain gyri
ALT>AST
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
45. What findings are associated with reyes
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Epithelium
Gastrohepatic ligament
Pancreatic head causing obstructive jaundice
46. What is the HLA association and treatment for hemochromatosis
Dec PGE2 leading to dec gastric mucosa protection
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Mucoepidermoid carcinoma
Repeated phlebotomy - deferoxamine - HLA- A3
47. What are the treatment options for uclerative colitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Superior rectal
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
48. What kind of pathways do CCK act on to cause pancreatic secretion
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Redness and tenderness on palpation of extremities
Skip lesions =crohns - colon = UC
Neural muscarinic pathways
49. What are the borders of the femoral triangle
Inguninal ligament - sartorius muscle - adductor longus
Lateral to the inferior epigastric artery
Inc risk of CRC and other visceral malignancies
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
50. FAP + osseous and soft tissue tumors - retinal hyperplasia