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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 layer in the mucosa is responsible for support
Lamina propria
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
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Alpha amylase
2. What serum markers increase in cholecystitis with bile duct involvement
Alk phos
Muscularis mucosae
Uremia
Mitochondrial abnl - fatty liver - hypoglycemia - coma
3. What does loss of p53 cause
NAV = nerve artery vein - venous near the penis (NAVEL)
Hyperpigmented mouth - lips - hands - genitalia
Increase tumorigenesis
Lipase
4. At what level of the spine does the IM exit the aorta
Low pressure proximal to LES
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
L3
Trypsin - chymotrypsin - elastase - carboxypeptidases
5. How does brain injury lead to acute gastritis and What is it called
Female - fat - fertile - forty
Tropical sprue
HSV-1 - CMV - Candida
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
6. What gives urine its characteristic color
Primary sclerosing cholangitis
Urobilin
Complications of UC
Epigastric abdominal pain radiating to back - anorexia - nausea
7. What layer of fascia covers a direct inguinal hernia
Averages 6 months - very aggressive - usually already metastasized at presentation
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
External spermatic fascia only
Spleen to posterior abdominal wall - splenic artery and vein
8. Achalasia increases the risk For what complication
Hyperpigmented mouth - lips - hands - genitalia
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Esophageal carcinoma
CCK8 receptor - Gq inc IP3/Ca
9. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Adhesion
IBS at least 2 with recurrent abdominal pain
Mucoepidermoid carcinoma
FAP
10. What is the rate limiting step of carbohydrate digestion
Left and right gastroepiploics - left and right gastrics
L3
Epithelium
Oligosaccharide digestion
11. What parts of the small bowel can tropical sprue effect
Urobilin
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
The entire
Failure of the processus vagainlis to close
12. What kind of muscle is in the middle 1/3 of esophagus
Striated and smooth
Penicillinamine - AR inheritance
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Alpha1 antitrypsin def - codominant trait
13. What happens to the short gastics if the splenic artery is blocked
Cirrhosis
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Failure of the processus vagainlis to close
Poor anastamoses
14. What layer in the mucosa is repsonsible for motility
FAP
8-9 waves/min
Muscularis mucosae
Phototherapy
15. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
AST
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Internal thoracic to superior epigastric to inferior epigastric
Repeated phlebotomy - deferoxamine - HLA- A3
16. What reaction does salivary amylase catalyze
Appendicitis
Normal
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
17. Where is the deep inguinal ring relative to the inferior epigastric vessels
Lateral
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
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
Pertechnetate - study for uptake
18. Dysphagia in achalasia results from
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Tropical sprue
Skip lesions =crohns - colon = UC
19. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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20. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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21. What are the extraintestinal manifestations of crohns
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Meckels
M3 - Gq - inc IP3/Ca
Alfatoxin in peanuts
22. When do you see hypertrophy of brunners glands
Peptic ulcer disease
Barrett's esophagus
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
23. Where does copper accumulate in Wilsons and What are ABCD
Decreased intercellular adhesion and increased proliferation
Trypsin - chymotrypsin - elastase - carboxypeptidases
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
24. What are the complications of acute pancreatitis
Lateral to the inferior epigastric artery
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Neural muscarinic pathways
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
25. What percentage of gall stones are cholesterol stones and What are the associations
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
HPNCC
26. involvement of left supraclavicular node by mets from stomach
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27. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Striated and smooth
Inspiratory arrest on deep palpation due to pain
AST>ALT
Falciform - ligamentum teres - fetal umbilical vein
28. FAP + osseous and soft tissue tumors - retinal hyperplasia
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29. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Intussusception
T12
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
External (superficial) ring only
30. in budd chiari syndrome - Where is the congestion and necrosis
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Centrilobular leading to congestive liver disease
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Complications of UC
31. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Carcinoid syndrome
Hepatic steatosis
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Mucosa - submucosa - muscularis externa - serosa/adventitia
32. In alchoholic hepatitis which liver enzyme is higher
Hemosiderosis - hemochromatosis
Hernia
Parietal cells in the stomach - B12 binding protein
AST>ALT
33. Why does volvulus occur more at cecum and sigmoid colon
Redundant mesentary
Alpha amylase
Skip lesions =crohns - colon = UC
Positive
34. Acute gastritis is caused By what process
Erosive - disruption of mucosal barrier leading to inflammation
Fe2+ in the duod
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Zenkers - halitosis - dysphagia and obstruction
35. Which kind of hemorrhoids are painful and why
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Diverticulum
Inguninal ligament - sartorius muscle - adductor longus
Failure of the processus vagainlis to close
36. Who gets gastric ulcers
T cell lymphoma
Older patients
Worldwide - SC - US - adeno
All 3 gut layers outpouch as in Meckels
37. What are the foregut structures and what supplies their blood and PANS innvervation
Cimetidine
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Femoral hernia
Neural muscarinic pathways
38. What is the lumen of the pancreatic duct
Ampulla of vater
Conj - inc - dec
Bleeding - penetration into pancreas - perforation - obstruction
AR
39. What causes nutmeg liver
Backup of blood into the liver - RHF - budd chiari
Ceruplasmin
Crohns = noncaseating granulomas - UC = crypt abscesses
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
40. What receptors does ACH bind on the parietal cells and What does it activate
M3 - Gq - inc IP3/Ca
Glucose dependent insulinotropic peptide
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Epithelium
41. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Small intestine
Carcinoid syndrome
Zollinger ellison - brunners glands
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
42. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Carcinoid syndrome
HPNCC
Falciform - ligamentum teres - fetal umbilical vein
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
43. likely infectious form of malabsorption - responds to antibiotics
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Tropical sprue
Lubricate food (glycoprotiens)
Peutz jeghers
44. What receptors does gastrin bind on the parietal cell and What does it activate
CCK8 receptor - Gq inc IP3/Ca
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Myenteric nerve plexus - aurbach
Cholesterol - 10-20% opaque due to calcifications
45. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Sister mary joseph nodule
Conj/unconj - inc - nl to dec
EtOH
T cell lymphoma
46. Where does crohns usually affect the GI tract
Brunners
Terminal ileum and colon
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Alfatoxin in peanuts
47. What do tumors that arise in the head of the pancreas cause
The gastroduodenal
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Obstruction of the common bile duct
Old men - arthralgias - cardiac and neuro sx
48. What is the epi for CRC
Right and left hepatic duct
Epithelium
Closer to isotonic because of less time to reabsorb NaCl
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
49. What structures feed into the cystic duct
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Glucose dependent insulinotropic peptide
Gallbladder
VZV and influenza B treated with salicylates
50. How does loss of NO secretion affect the esophagus and what results
Inc lower esphogeal tone leading to achalasia
Femoral hernia
Crohns = maybe - UC= always
Averages 6 months - very aggressive - usually already metastasized at presentation