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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. How are all 3 monosaccharides transported to the blood
Complications of crohns
Cimetidine
Dec PGE2 leading to dec gastric mucosa protection
GLUT 2
2. What histological findings are present in the esophagus
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Short gastrics - left greater and lesser
Reye's syndrome
Nonkeritinized stratified sqamous epithelium
3. At what spinal level does the SMA exit
L1
CHF and inc risk of HCC
AST
Lipase
4. What does histo show for alpha1 antitrypsin def
PAS- positive globules in liver -
Omeprazole
EtOH
Lamina propria
5. subQ peribumbilical metastasis
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Sister mary joseph nodule
Pyoderma gangrenosum - primary sclerosing cholangitis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
6. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
Skip lesions =crohns - colon = UC
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
GLUT 2
Lamina propria
7. What causes carcinoid syndrome amd What are the symptoms
Below
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Juvenile polyposis syndrome - inc risk of adenocarcinoma
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
8. Where is there sclerosis in alcoholic cirrohosis
Below
Around the central vein (zone III)
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Hepatic steatosis
9. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Inc conj bilirubin - inc cholesterol - inc alk phos
Around the central vein (zone III)
Averages 6 months - very aggressive - usually already metastasized at presentation
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
10. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
Stercobilin
Redundant mesentary
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
...
11. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Smooth
Old men - arthralgias - cardiac and neuro sx
Above
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
12. Esophagitis can result From which 3 infectious agents - or chemical ingestion
HSV-1 - CMV - Candida
Left and right gastroepiploics - left and right gastrics
Brush border of intestine - produce monosaccharides from oligo and di
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
13. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Superior rectal
L4
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Lamina propora and submucosa
14. Which serum enzyme increases with heavy EtOH consumption
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Gamma glutamyl transferase GGT
Pertechnetate - study for uptake
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
15. What is biliary colic
H+
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
16. Abuse of what substance leads to acute gastritis
EtOH
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Lipase
17. most common non - neoplastic polyp in colon
Hyperplastic
Diarrhea - steatorrhea - weight loss - weakness
Upregulated intracellular signal transduction
Colonic polyps
18. What histological findings are present in the stomach
Small intestine
Gastric glands
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Esophageal varices
19. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Primary sclerosing cholangitis
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Early childhood - neuro sx and malabsorption
Below
20. With internal hemorrhoids Where is the anastomoses and Where is it
H2 receptor - inc cAMP
Superior rectal and middle and inferior rectal - rectum
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Alpha1 antitrypsin def - codominant trait
21. What are causes of extrahepatic biliary obstruction
Conj - inc - dec
T12
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
22. Gastrin - source - action - regulation
Right and left hepatic duct
Jewish and African American men
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
EtOH
23. Dysphagia in achalasia results from
Crohns = maybe - UC= always
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Female - fat - fertile - forty
Decreased intercellular adhesion and increased proliferation
24. What pancreatic enzymes are responsible for fat digestion
Jaundice - fever - RUQ
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Lipase - phospholipase A - colipase
Hydrocele
25. occlusion of IVC or hepatic veins
Budd chiari syndrome
Alpha amylase
The gastroduodenal
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
26. If the abdominal aorta is blocked - How does blood get to the left colic artery
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Via the middle colic
Pancreatic and bile
Corticosteroids - infliximab
27. What complication can arise from indirect inguinal hernias
Falciform - ligamentum teres - fetal umbilical vein
Where hindgut meets ectoderm
Dermatitis herpetiformis
Hydrocele
28. What do you use to diagnose meckels
Duodenal atresia - Downs
Sphincter of oddi
Alcoholic hepatitis
Pertechnetate - study for uptake
29. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Appendicitis
Brunners
Stimulate the H/K ATPase
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
30. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
PAS- positive globules in liver -
Peyers patches
Dec PGE2 leading to dec gastric mucosa protection
31. What is Trousseau's sign
Hyperpigmented mouth - lips - hands - genitalia
Redness and tenderness on palpation of extremities
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
32. In an MI - which liver enzyme is elevated
T12
Crigler - najjar type 1
Myenteric nerve plexus - aurbach
AST
33. How is salivary secretion stimulated
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Necrotizing enterocolitis
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
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
34. rare - often fatal childhood hepatoencephalopathy
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35. What are the histological findings in the ileum
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36. What receptors does ACH bind on the parietal cells and What does it activate
Lubricate food (glycoprotiens)
Inferior rectal nerve
M3 - Gq - inc IP3/Ca
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
37. What kind of muscle is in the middle 1/3 of esophagus
Cystic duct and common hepatic duct
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Striated and smooth
38. Where is the deep inguinal ring relative to the inferior epigastric vessels
Alk phos
Lateral
Paraumbilical and superficial and inferior epigastric - umbilicus
Pleomorphic adenoma
39. How is bilirubin carried in the blood
With albumin
Cystic duct and common hepatic duct
M3 - Gq - inc IP3/Ca
Dysphagia (due to esophageal web) - glossitis - iron def anemia
40. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Peutz jeghers
Causes of gall stones
Striated and smooth
Crohns = noncaseating granulomas - UC = crypt abscesses
41. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Esophageal varices
Boerhaave's Syndrome - Been heaving syndrome
Pyoderma gangrenosum - primary sclerosing cholangitis
Downs
42. What layer in the mucosa is responsible for support
Lamina propria
HPNCC
Dense core bodies
External spermatic fascia only
43. What kind of lesions are characteristic of duodenal PUD vs cancer
Pertechnetate - study for uptake
Begins starch digestion - inactivated by low pH upon reaching the stomach
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Punched out - clean margins - carcinoma =raised irregular margins
44. How many layers of spermatic fascia are covers an indirect inguinal hernia
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
All 3
Primary sclerosing cholangitis
45. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Hypercoaguability - polycythemia vera - pregnancy - HCC
Falciform - ligamentum teres - fetal umbilical vein
46. What causes hirschsprungs
Failure of neural crest migration
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Elevated amylase - and lipase
Pyoderma gangrenosum - primary sclerosing cholangitis
47. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Inc smooth muscle relaxation - including lower esophageal sphincter
Warthins' tumor
Can lead to hematemesis - found in EtOHics and bulimics
Zenkers - halitosis - dysphagia and obstruction
48. What makes a true diverticula
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Older patients
All 3 gut layers outpouch as in Meckels
49. What is the arterial supply and venous drainage below pectinate line
In the ileum with bile acids - requires IF
Alcoholic hepatitis
Trypsin - chymotrypsin - elastase - carboxypeptidases
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
50. What is the leading cause of bowel incarceration
Femoral hernia
Crohns = noncaseating granulomas - UC = crypt abscesses
Worldwide - SC - US - adeno
Sister mary joseph nodule