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Test your basic knowledge |
USMLE GI
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Subjects
:
health-sciences
,
usmle
Instructions:
Answer 50 questions in 15 minutes.
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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 gives stool its characteristic color
Muscularis mucosae
Stercobilin
True and most common congenital anomoly of GI tract
Positive
2. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
T12
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Myenteric nerve plexus - aurbach
Esophageal varices
3. List the clinical findings of HCC
CEA - CA-19-9
Redness and tenderness on palpation of extremities
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
4. What is the lumen of the pancreatic duct
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Ampulla of vater
Zollinger Ellison - phenylalanine and tryptophan
Angiodysplasia
5. What are additional risk factors for CRC
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Smooth
Cimetidine
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
6. What kind of muscle is in the middle 1/3 of esophagus
Stercobilin
Mallory bodies
Striated and smooth
Glucose dependent insulinotropic peptide
7. What are the effects of atropine on parietal cells and G cells
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Brush border of intestine - produce monosaccharides from oligo and di
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Centrilobular leading to congestive liver disease
8. Which viral infxns/treatments are associated with reyes syndrome
Inc lower esphogeal tone leading to achalasia
Normal
Repeated phlebotomy - deferoxamine - HLA- A3
VZV and influenza B treated with salicylates
9. What are the extraintestinal manifestations of crohns
Esophageal carcinoma
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
10. What kind of digestion is bile needed for
Backup of blood into the liver - RHF - budd chiari
Common hepatic - splenic - left gastric - main blood supply for stomach
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Early childhood - neuro sx and malabsorption
11. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
H pylori (almost 100%)
Brunners
Zollinger Ellison - phenylalanine and tryptophan
Closer to isotonic because of less time to reabsorb NaCl
12. At what spinal level does the celiac trunk exit
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Brush border of intestine - produce monosaccharides from oligo and di
T12
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
13. What does a low flow rate mean for saliva
Hypotonic because of more time to reabsorb NaCl
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
90%
Below
14. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
The entire
The proximal small bowel
Black - rotors syndrome
Diverticulitis in elderly - ectopic pregs use hCG to rule out
15. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Cimetidine
Poor anastamoses
Above
Lye ingestion and acid reflux
16. What is the action of NO as a GI hormone
Volvulus
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Inc smooth muscle relaxation - including lower esophageal sphincter
Decreased intercellular adhesion and increased proliferation
17. Why are most diverticula considered false
Stimulate intestinal persistalsis
Lateral
Erosive - disruption of mucosal barrier leading to inflammation
Lack or have an attenuated muscularis externa - often in the sigmoid colon
18. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Meckels
Alcoholic hepatitis
Uremia
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
19. What conditions are associated with budd chiari
Muscularis mucosae
Appendicitis
Hypercoaguability - polycythemia vera - pregnancy - HCC
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
20. What are the borders of the femoral triangle
Mucoepidermoid carcinoma
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Penicillinamine - AR inheritance
Inguninal ligament - sartorius muscle - adductor longus
21. occlusion of IVC or hepatic veins
Skip lesions =crohns - colon = UC
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Budd chiari syndrome
Hypercoaguability - polycythemia vera - pregnancy - HCC
22. What are esophageal strictures associated with
Lateral to the inferior epigastric artery
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Lye ingestion and acid reflux
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
23. What does GET SMASHED stand for in acute pancreatitis
Necrotizing enterocolitis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
T12
2ndary biliary cirrhosis
24. Gastrin - source - action - regulation
Mallory bodies
Cigarettes and chronic pancreatitis - not EtOH
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
Trypsin - chymotrypsin - elastase - carboxypeptidases
25. Dysphagia in achalasia results from
EtOH
Tropical sprue
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Volvulus
26. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
External spermatic fascia only
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Angiodysplasia
27. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue
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28. What are the hindgut structures and what supplies their blood and PANS innvervation
Brunners
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Neutralizes gastric acid allowing pancreatic enzymes to fxn
29. What carcinogens are associated with HCC
Hyperpigmented mouth - lips - hands - genitalia
GERD - may also present with nocturnal cough and dyspnea
Alfatoxin in peanuts
Colovesical leading to pneumaturia
30. What is diverticulosis
Above
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Lamina propora and submucosa
Gardner's syndrome
31. What is the most common indication of emergent abdominal surgery in children
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
All 3 gut layers outpouch as in Meckels
Old men - arthralgias - cardiac and neuro sx
Appendicitis
32. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
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
Inc conj bilirubin - inc cholesterol - inc alk phos
Uremia
33. What are the borders of Hesselbach's triangle
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Inc lower esphogeal tone leading to achalasia
Epigastric abdominal pain radiating to back - anorexia - nausea
34. Scleroderma is associated with what kind of esophageal dysmotility
Myenteric nerve plexus - aurbach
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Black - rotors syndrome
Low pressure proximal to LES
35. most common malignant salivary gland tumor
Enterokinase/enteropeptidase from the duodenal mucosa
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Mucoepidermoid carcinoma
Tropical sprue
36. What is the classic triad of hemochromatosis
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37. What is the most important mechanism in gastric acid secretion
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Serous on the sides parotids - mucinous in the middle sublingual
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
38. Where are oligosaccharide hydrolases and What do they do
Terminal ileum and colon
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Brush border of intestine - produce monosaccharides from oligo and di
39. What makes a true diverticula
CEA - CA-19-9
All 3 gut layers outpouch as in Meckels
Crohns = maybe - UC= always
Striated
40. What enzyme is necessary to create conjugated bilirubin
Normal
Complications of crohns
Uridine glucuronyl transferase
Appendicitis
41. What are the main components of bile
Mucoepidermoid carcinoma
Smooth
Falciform - ligamentum teres - fetal umbilical vein
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
42. bilateral mets to ovaries with abundant mucus - signet ring cells
L/R renal artery around L1
Superior rectal and middle and inferior rectal - rectum
Krukenbergs tumor
Sphincter of oddi
43. What structures feed into the common hepatic duct
Stimulate the H/K ATPase
Phototherapy
Right and left hepatic duct
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
44. FAP + osseous and soft tissue tumors - retinal hyperplasia
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45. Where and How is iron absorbed
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Chronic gastritis and pernicious anemia
Fe2+ in the duod
46. involvement of left supraclavicular node by mets from stomach
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47. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
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
Peyers patches
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Skip lesions =crohns - colon = UC
48. Where is the pectinate line
Oligosaccharide digestion
Gallbladder
Where hindgut meets ectoderm
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
49. What artery passes around the duodenum
The gastroduodenal
Lubricate food (glycoprotiens)
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
AST>ALT
50. How do NSAIDs cause acute gastritis
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Chronic gastritis and pernicious anemia
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Dec PGE2 leading to dec gastric mucosa protection
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