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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 is the rule of 2s for meckels
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Inc conj bilirubin - inc cholesterol - inc alk phos
2. What serum enzyme is elevated in acute pancreatitis and mumps
Amylase
Cimetidine
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Myenteric nerve plexus - aurbach
3. What infection causes Whipple disease and What can you see on LM
L3
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Alk phos
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
4. What kind of cancer to celiac sprue put you as inc risk for
Menetriers disease
Neutralizes gastric acid allowing pancreatic enzymes to fxn
T cell lymphoma
Complications of UC
5. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Lateral to the inferior epigastric artery
Common hepatic - splenic - left gastric - main blood supply for stomach
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
6. What is the classic triad of hemochromatosis
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7. What do tumors that arise in the head of the pancreas cause
Spleen to posterior abdominal wall - splenic artery and vein
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Female - fat - fertile - forty
Obstruction of the common bile duct
8. What is the characteristic histo finding in alcoholic hepatitis
CHF and inc risk of HCC
Mallory bodies
Smooth
Angiodysplasia
9. What is the frequency of basal electric rhythm of the stomach
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
Inc smooth muscle relaxation - including lower esophageal sphincter
Hypercoaguability - polycythemia vera - pregnancy - HCC
3 waves/min
10. What do you use to diagnose meckels
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Pertechnetate - study for uptake
Ischemic colitis
11. With internal hemorrhoids Where is the anastomoses and Where is it
Pleomorphic adenoma
Positive urease test
Superior rectal and middle and inferior rectal - rectum
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
12. What structures feed into the common bile duct
Alpha1 antitrypsin def - codominant trait
Small intestine
8-9 waves/min
Cystic duct and common hepatic duct
13. What do mucins do?
Lubricate food (glycoprotiens)
With albumin
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Alpha amylase
14. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Gardner's syndrome
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Colonic polyps
CCK8 receptor - Gq inc IP3/Ca
15. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Esophageal varices
Smooth
Lipase - phospholipase A - colipase
Dubin johnson
16. What structure is Not contained in the femoral sheath
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Dubin johnson
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Unconjugated - water insoluble
17. milk intolerance
Complications of UC
Dissaccharidase def - most commonly lactase
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Normal
18. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
...
Ischemic colitis
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
19. Through which aspect of the inguinal canal does a direct inguinal go
External (superficial) ring only
Angiodysplasia
Portal HTN
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
20. Where does an indirect inguinal hernia enter the deep inguinal ring
Omeprazole
Amylase
Turcot
Lateral to the inferior epigastric artery
21. Autoantibodies to gluten (gliadin) in wheat and other grains
Phototherapy
Celiac sprue
Ampulla of vater
Glucouronate - water soluble (direct)
22. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Black - rotors syndrome
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Oligosaccharide digestion
Volvulus
23. What is contained within the submucosa
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24. What receptor does histamine bind on the parietal cell and What does it activate
Peptic ulcer disease
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Normal
H2 receptor - inc cAMP
25. What are the histological findings in the jejunum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
L/R renal artery around L1
Intussusception
26. Malabsorption syndromes have what common clinical presentation
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Duodenal atresia - Downs
Diarrhea - steatorrhea - weight loss - weakness
Hypotonic because of more time to reabsorb NaCl
27. How does CRC present in the distal and proximal colon
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Peyers patches
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
28. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Brunners
Stimulate intestinal persistalsis
Inc smooth muscle relaxation - including lower esophageal sphincter
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
29. How are all 3 monosaccharides transported to the blood
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Lactase is located at the tips of intestinal villi
Hemolytic anemia
GLUT 2
30. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Meconium ileus
HSV-1 - CMV - Candida
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Paraumbilical and superficial and inferior epigastric - umbilicus
31. When do you see hypertrophy of brunners glands
Nonkeritinized stratified sqamous epithelium
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Esophageal carcinoma
Peptic ulcer disease
32. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Lye ingestion and acid reflux
FAP
Volvulus
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
33. What are the barium swallow findings of achalasia
Zollinger Ellison - phenylalanine and tryptophan
Esophageal cancer
Dilated esophagus with an area of distal stenosis - birds beak
EtOH
34. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
2ndary biliary cirrhosis
Punched out - clean margins - carcinoma =raised irregular margins
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
35. If the hemochromatosis is primary - What is the pattern of inheritance
Muscularis mucosae
Diverticulum
Spleen to posterior abdominal wall - splenic artery and vein
AR
36. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus
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37. What is the frequency of basal electric rhythm of the ilieum
8-9 waves/min
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Above
38. in carcinoid tumors - What is seen on EM
Dense core bodies
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Juvenile polyposis syndrome - inc risk of adenocarcinoma
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
39. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Lamina propora and submucosa
Superior rectal
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Internal thoracic to superior epigastric to inferior epigastric
40. Achalasia increases the risk For what complication
Esophageal carcinoma
Redness and tenderness on palpation of extremities
Superior rectal and middle and inferior rectal - rectum
Peyers patches
41. Which viral infxns/treatments are associated with reyes syndrome
Chagas disease
Colovesical leading to pneumaturia
Cimetidine
VZV and influenza B treated with salicylates
42. What reaction does salivary amylase catalyze
Crigler - najjar type 1
Glucouronate - water soluble (direct)
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Via the middle colic
43. Where does copper accumulate in Wilsons and What are ABCD
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Peyers patches
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Hirschsprungs
44. What is indirect bilirubin
AST >ALT - ration is usually 1.5
Osmotic
Unconjugated - water insoluble
Reye's syndrome
45. What are the structures of the femoral triangle and how are they organized
NAV = nerve artery vein - venous near the penis (NAVEL)
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Zollinger Ellison - phenylalanine and tryptophan
46. Where and How is iron absorbed
Pancreatic head causing obstructive jaundice
Meconium ileus
Fe2+ in the duod
Older patients
47. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Alpha1 antitrypsin def - codominant trait
L3
Striated and smooth
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
48. What do the rugae of stomach look like in menetriers disease
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
So hypertrophied they look like brain gyri
M3 - Gq - inc IP3/Ca
49. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Cystic duct and common hepatic duct
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Meconium ileus
50. What enzyme is necessary to create conjugated bilirubin
Uridine glucuronyl transferase
Early childhood - neuro sx and malabsorption
M3 - Gq - inc IP3/Ca
Around the central vein (zone III)