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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 structures feed into the common bile duct
T cell lymphoma
Cystic duct and common hepatic duct
Achalasia due to loss of myenteric plexus (auberach)
Bleeding - penetration into pancreas - perforation - obstruction
2. What artery passes around the duodenum
Neutralizes oral bacertial acids and maintains dental health
L1
Bleeding - penetration into pancreas - perforation - obstruction
The gastroduodenal
3. 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
Failure of the processus vagainlis to close
Striated
Striated and smooth
4. What commonly leads to appendicity in kids vs adults
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Internal thoracic to superior epigastric to inferior epigastric
Short gastrics - left greater and lesser
5. What does bicab do in the mouth
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Gastric glands
Neutralizes oral bacertial acids and maintains dental health
Conj/unconj - inc - nl to dec
6. Where is IgA shuttled
Female - fat - fertile - forty
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Punched out - clean margins - carcinoma =raised irregular margins
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
7. Achalasia increases the risk For what complication
Esophageal carcinoma
In the ileum with bile acids - requires IF
Hirschsprungs
...
8. What are the complications of duodenal PUD
Bleeding - penetration into pancreas - perforation - obstruction
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Hemosiderosis - hemochromatosis
Cystic dilation of the viteline duct
9. What does autoimmune destruction of parietal cells lead to...
External spermatic fascia only
H pylori (almost 100%)
Chronic gastritis and pernicious anemia
Heme metabolism
10. what percentage of colonic polyps are non - neoplastic
Gut bacteria
Duodenum - 2nd - 3rd and 4th parts
GLUT 2
90%
11. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Lateral
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
12. What causes pancreatic insuff and What does it cause
Failure of the processus vagainlis to close
Heme metabolism
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Inc - weight loss
13. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Heme metabolism
Diverticulum
Intussusception
14. What does GET SMASHED stand for in acute pancreatitis
Punched out - clean margins - carcinoma =raised irregular margins
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Early childhood - neuro sx and malabsorption
15. What layer of fascia covers a direct inguinal hernia
Antrum - H.pylori - inc risk of MALT lymphoma
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
External spermatic fascia only
All 3 gut layers outpouch as in Meckels
16. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Carcinoid syndrome
Inspiratory arrest on deep palpation due to pain
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Gamma glutamyl transferase GGT
17. What separates the right greater and lesser sacs
Gastrohepatic ligament
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
External (superficial) ring only
Mitochondrial abnl - fatty liver - hypoglycemia - coma
18. If trypsin activates more trypsinogen - what kind of feedback loop is established
Hernia
Zollinger ellison - brunners glands
Gilbert's
Positive
19. Why does indirect inguinal hernia happen in infacnts
Failure of the processus vagainlis to close
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Worldwide - SC - US - adeno
20. What are the extraintestinal manifestations of ulcerative colitis
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
L2
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Pyoderma gangrenosum - primary sclerosing cholangitis
21. Which serum enzyme increases with heavy EtOH consumption
Gamma glutamyl transferase GGT
HPNCC
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Centrilobular leading to congestive liver disease
22. Are single polyps malignant in peutz jehgers
Neural muscarinic pathways
Fe2+ in the duod
Cirrhosis
No
23. What is the arterial supply and venous drainage below pectinate line
Zenkers - halitosis - dysphagia and obstruction
Can lead to hematemesis - found in EtOHics and bulimics
Hernia
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
24. Gallstones that reach the common channel at ampulla can block which two ducts
Pancreatic and bile
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Alfatoxin in peanuts
Neural muscarinic pathways
25. What kind of digestion is bile needed for
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Duodenal atresia - Downs
26. What retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
L/R renal artery around L1
Paraumbilical and superficial and inferior epigastric - umbilicus
Unconj - absent (acholuria) - inc
27. What cells make pepsin - What does it do - and what regulates it
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Esophageal cancer
28. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Crohns = noncaseating granulomas - UC = crypt abscesses
Dec PGE2 leading to dec gastric mucosa protection
Hypotonic because of more time to reabsorb NaCl
Zenkers - halitosis - dysphagia and obstruction
29. What makes a true diverticula
Complications of crohns
NAV = nerve artery vein - venous near the penis (NAVEL)
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
All 3 gut layers outpouch as in Meckels
30. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Striated
Zollinger Ellison - phenylalanine and tryptophan
Alcoholic hepatitis
Appendicitis
31. What drug inhibits the H/K ATPase
Alfatoxin in peanuts
Brunners
Omeprazole
Early childhood - neuro sx and malabsorption
32. What are the structures of the femoral triangle and how are they organized
Oligosaccharide digestion
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Primarly through ECL leading to histamine release
NAV = nerve artery vein - venous near the penis (NAVEL)
33. What nerve innervates the external hemorrhoids
The jejunum
Inferior rectal nerve
Conj/unconj - inc - nl to dec
Parietal cells in the stomach - B12 binding protein
34. Transmural esophageal rupture due to violent retching
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35. Where are carcinoid tumors most commonly malignant
AST>ALT
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Zenkers - halitosis - dysphagia and obstruction
Small intestine
36. How do burns cause acute gastritis and What is it called
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37. In an MI - which liver enzyme is elevated
Lipase
Hepatic steatosis
Gamma glutamyl transferase GGT
AST
38. What does high flow rate mean
Omeprazole
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Angiodysplasia
Closer to isotonic because of less time to reabsorb NaCl
39. Which IBD is autoimmune and which may be a disordered response to bacteria
Failure of neural crest migration
Juvenille polyps - no risk if single
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Glucose dependent insulinotropic peptide
40. subQ peribumbilical metastasis
...
Heme metabolism
Alcoholic cirrhosis
Sister mary joseph nodule
41. What are the signs of peutz jehgers
Tropical sprue
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Hyperpigmented mouth - lips - hands - genitalia
CCK8 receptor - Gq inc IP3/Ca
42. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Gastric glands
Femoral hernia
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Crohns = maybe - UC= always
43. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Corticosteroids - infliximab
Brunners
ALT>AST
EtOH
44. How many layers of spermatic fascia are covers an indirect inguinal hernia
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Pleuroperitoneal
Causes of gall stones
All 3
45. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
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
Meckels
Decreased intercellular adhesion and increased proliferation
Causes of gall stones
46. in budd chiari syndrome - Where is the congestion and necrosis
T cell lymphoma
Early childhood - neuro sx and malabsorption
Centrilobular leading to congestive liver disease
IgA secreting plasma cells - ultimately reside in the lamina proporia
47. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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48. What are the borders of Hesselbach's triangle
CCK8 receptor - Gq inc IP3/Ca
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Parietal cells in the stomach - B12 binding protein
Neural muscarinic pathways
49. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Alpha1 antitrypsin def - codominant trait
Hemosiderosis - hemochromatosis
50. inflammatino of gallbadder
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
AST >ALT - ration is usually 1.5
IgA secreting plasma cells - ultimately reside in the lamina proporia