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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. What is contained within the submucosa
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2. What do tumors that arise in the head of the pancreas cause
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Gardner's syndrome
Femoral hernia
Obstruction of the common bile duct
3. Where is the pectinate line
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Necrotizing enterocolitis
3 waves/min
Where hindgut meets ectoderm
4. what kind of fistula is associated with diverticulitis
Inspiratory arrest on deep palpation due to pain
Black - rotors syndrome
Colovesical leading to pneumaturia
Normal
5. What is the HLA association and treatment for hemochromatosis
Alpha1 antitrypsin def - codominant trait
Pleomorphic adenoma
Repeated phlebotomy - deferoxamine - HLA- A3
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
6. What causes nutmeg liver
Black - rotors syndrome
Backup of blood into the liver - RHF - budd chiari
Inc smooth muscle relaxation - including lower esophageal sphincter
EtOH
7. What arteries exit just below the SMA
L/R renal artery around L1
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Falciform - ligamentum teres - fetal umbilical vein
Lipase
8. FAP + malignant CNS tumor
Averages 6 months - very aggressive - usually already metastasized at presentation
The entire
Turcot
Hyperplastic
9. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Complications of UC
GERD - may also present with nocturnal cough and dyspnea
Via the middle colic
Unconjugated - water insoluble
10. Through which aspect of the inguinal canal does a direct inguinal go
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
External (superficial) ring only
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Heme metabolism
11. What are the results of hemochromatosis
CHF and inc risk of HCC
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Inc - weight loss
Inc smooth muscle relaxation - including lower esophageal sphincter
12. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Liver metabolizes 5HT
Crohns = noncaseating granulomas - UC = crypt abscesses
Alpha amylase
13. vasoactive intestinal polypeptide (VIP) - source - action - regulation
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
VZV and influenza B treated with salicylates
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Barrett's esophagus
14. What structures feed into the cystic duct
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
Neural muscarinic pathways
Epithelium
Gallbladder
15. What type of insults result in micronodular cirrhosis
Redundant mesentary
Decrease - weight gain
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Dilated esophagus with an area of distal stenosis - birds beak
16. What are the two molecular pathways that lead to CRC
Juvenille polyps - no risk if single
Oligosaccharide digestion
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Myenteric nerve plexus - aurbach
17. What are causes of extrahepatic biliary obstruction
Backup of blood into the liver - RHF - budd chiari
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Splenic flexure
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
18. If trypsin activates more trypsinogen - what kind of feedback loop is established
12 waves/min
Punched out - clean margins - carcinoma =raised irregular margins
Positive
Barrett's esophagus
19. bilateral mets to ovaries with abundant mucus - signet ring cells
Sphincter of oddi
Krukenbergs tumor
Budd chiari syndrome
3 waves/min
20. What are the main components of bile
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Heme metabolism
Neutralizes gastric acid allowing pancreatic enzymes to fxn
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
21. People of what decent are associated with celiac sprue and what findings/antibodies are present
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
CEA - CA-19-9
Inc smooth muscle relaxation - including lower esophageal sphincter
Copious diarrhea - non alpha - non beta cell pancreatic tumor
22. What histological findings are present in the stomach
Gastric glands
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
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
Common hepatic - splenic - left gastric - main blood supply for stomach
23. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Inc conj bilirubin - inc cholesterol - inc alk phos
Uridine glucuronyl transferase
Sphincter of oddi
Angiodysplasia
24. Where are oligosaccharide hydrolases and What do they do
Worldwide - SC - US - adeno
Turcot
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Brush border of intestine - produce monosaccharides from oligo and di
25. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
Boerhaave's Syndrome - Been heaving syndrome
External spermatic fascia only
Zenkers - halitosis - dysphagia and obstruction
26. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Neural muscarinic pathways
Closer to isotonic because of less time to reabsorb NaCl
Cholesterol - 10-20% opaque due to calcifications
Alfatoxin in peanuts
27. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Alcoholic hepatitis
Small intestine
Menetriers disease
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
28. What do you treat Wilsons disease with and What is the inheritance
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Penicillinamine - AR inheritance
Conj/unconj - inc - nl to dec
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
29. What is the clinical presentation of acute pancreatitis
Epigastric abdominal pain radiating to back - anorexia - nausea
Smooth
Nonkeritinized stratified sqamous epithelium
Skip lesions =crohns - colon = UC
30. How do burns cause acute gastritis and What is it called
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31. What causes hirschsprungs
Myenteric nerve plexus - aurbach
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Virchow's node
Failure of neural crest migration
32. Which viral infxns/treatments are associated with reyes syndrome
Amylase
VZV and influenza B treated with salicylates
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Sphincter of oddi
33. What factors increase risk of malignancy of adenomatous polyps
Via the middle colic
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Pyoderma gangrenosum - primary sclerosing cholangitis
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
34. what percentage of colonic polyps are non - neoplastic
Inspiratory arrest on deep palpation due to pain
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Cigarettes and chronic pancreatitis - not EtOH
90%
35. Cholecytsokinin - source - action - regulation
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
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Crohns = maybe - UC= always
Cholesterol - 10-20% opaque due to calcifications
36. To what substance is bilirubin conjugated and why
Erosive - disruption of mucosal barrier leading to inflammation
Glucouronate - water soluble (direct)
Pyoderma gangrenosum - primary sclerosing cholangitis
Trypsin - chymotrypsin - elastase - carboxypeptidases
37. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Hemosiderosis - hemochromatosis
Falciform - ligamentum teres - fetal umbilical vein
Erosive - disruption of mucosal barrier leading to inflammation
Unconjugated - water insoluble
38. What retroperitoneal structure flanks both sides of the pancreas on CT
Antrum - H.pylori - inc risk of MALT lymphoma
Duodenum - 2nd - 3rd and 4th parts
Internal thoracic to superior epigastric to inferior epigastric
Intussusception
39. What carcinogens are associated with HCC
Alfatoxin in peanuts
Acute pancreatitis
Centrilobular leading to congestive liver disease
External (superficial) ring only
40. What is one potential precipitating factor for intussusception
Alcoholic cirrhosis
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Causes of gall stones
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
41. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Carcinoid syndrome
Gardner's syndrome
Female - fat - fertile - forty
Neutralizes gastric acid allowing pancreatic enzymes to fxn
42. What are the treatmet options for crohns
Alk phos
Corticosteroids - infliximab
L3
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
43. is meckels a true diverticulum and how common is it
Oligosaccharide digestion
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
True and most common congenital anomoly of GI tract
Peutz jeghers
44. What source of salivary secretion is the most serous and What is the most mucinous
No
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Upregulated intracellular signal transduction
Serous on the sides parotids - mucinous in the middle sublingual
45. How does loss of NO secretion affect the esophagus and what results
Sphincter of oddi
Inc lower esphogeal tone leading to achalasia
AST>ALT
Dissaccharidase def - most commonly lactase
46. When do you see hypertrophy of brunners glands
Peptic ulcer disease
EtOH
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
47. What test and result confirms H pylori infxn
Diverticulum
Positive urease test
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Inc lower esphogeal tone leading to achalasia
48. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Black - rotors syndrome
Centrilobular leading to congestive liver disease
Hyperpigmented mouth - lips - hands - genitalia
Diverticulitis in elderly - ectopic pregs use hCG to rule out
49. At what level of the spine does the IM exit the aorta
L3
Epigastric abdominal pain radiating to back - anorexia - nausea
Spleen to posterior abdominal wall - splenic artery and vein
Alcoholic cirrhosis
50. When and why is stomach cancer termed linitis plastica
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
The entire
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Budd chiari syndrome