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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. subQ peribumbilical metastasis
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Decrease - weight gain
Hemolytic anemia
Sister mary joseph nodule
2. Where is IgA shuttled
GLUT 2
Closer to isotonic because of less time to reabsorb NaCl
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Superior rectal and middle and inferior rectal - rectum
3. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
L1
Carcinoid syndrome
Chronic gastritis and pernicious anemia
4. What does loss of APC cause
Decreased intercellular adhesion and increased proliferation
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Warthins' tumor
5. Where are oligosaccharide hydrolases and What do they do
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Alpha amylase
Brush border of intestine - produce monosaccharides from oligo and di
6. What is the lumen of the pancreatic duct
Cigarettes and chronic pancreatitis - not EtOH
HPNCC
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Ampulla of vater
7. How do burns cause acute gastritis and What is it called
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8. In alchoholic hepatitis which liver enzyme is higher
CCK8 receptor - Gq inc IP3/Ca
AST>ALT
Phototherapy
Warthins' tumor
9. What kind of digestion is bile needed for
Esophageal carcinoma
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Dermatitis herpetiformis
Primarly through ECL leading to histamine release
10. Which kind of hemorrhoids are painful and why
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Decreased intercellular adhesion and increased proliferation
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
11. trypsinogen is converted to trypsin via what enzyme
Alcoholic cirrhosis
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Enterokinase/enteropeptidase from the duodenal mucosa
Omeprazole
12. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Inguninal ligament - sartorius muscle - adductor longus
Jaundice - fever - RUQ
Hemosiderosis - hemochromatosis
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
13. What are the histological findings in the duodenum
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14. Where does an indirect inguinal hernia enter the deep inguinal ring
Dilated esophagus with an area of distal stenosis - birds beak
Mucosa - submucosa - muscularis externa - serosa/adventitia
Lateral to the inferior epigastric artery
AST>ALT
15. What layer in the mucosa is repsonsible for motility
Muscularis mucosae
Elevated amylase - and lipase
T12
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
16. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Black - rotors syndrome
Epithelium
When diffusely infiltrative - thickened rigid appearance like a leather bottle
2ndary biliary cirrhosis
17. What is the presenting course for appendicity
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18. What are the extraintestinal manifestations of ulcerative colitis
Corticosteroids - infliximab
Fasting and stress
Pyoderma gangrenosum - primary sclerosing cholangitis
Repeated phlebotomy - deferoxamine - HLA- A3
19. What does high flow rate mean
Dec PGE2 leading to dec gastric mucosa protection
Dermatitis herpetiformis
Closer to isotonic because of less time to reabsorb NaCl
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
20. How many layers of spermatic fascia are covers an indirect inguinal hernia
All 3
Below
Muscularis mucosae
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
21. At what spinal level does the is the bifurcation of aorta
No
L4
Gilbert's
Unconjugated - water insoluble
22. 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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23. What do you use to diagnose meckels
Epigastric abdominal pain radiating to back - anorexia - nausea
Pertechnetate - study for uptake
Hemolytic anemia
Internal thoracic to superior epigastric to inferior epigastric
24. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Zollinger Ellison - phenylalanine and tryptophan
FAP
With albumin
Serous on the sides parotids - mucinous in the middle sublingual
25. What does extrahepatic biliary obstruction cause
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Around the central vein (zone III)
Chronic gastritis and pernicious anemia
Muscularis mucosae
26. Is there any structural abnl with IBS - What is the course of disease and presentation
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Carcinoid syndrome
27. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Unconjugated - water insoluble
Below
Serous on the sides parotids - mucinous in the middle sublingual
Necrotizing enterocolitis
28. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
H pylori (almost 100%)
Worldwide - SC - US - adeno
Femoral hernia
Meckels
29. Which viral infxns/treatments are associated with reyes syndrome
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
The submucosal nerve plexus - meissner's
No
VZV and influenza B treated with salicylates
30. What retroperitoneal structure flanks both sides of the pancreas on CT
Alpha1 antitrypsin def - codominant trait
Duodenum - 2nd - 3rd and 4th parts
AST >ALT - ration is usually 1.5
MSI (15%) and APC/beta catenin chromosomal instability (85%)
31. How do NSAIDs cause acute gastritis
Lactase is located at the tips of intestinal villi
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Dec PGE2 leading to dec gastric mucosa protection
32. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Via the middle colic
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Dense core bodies
Colonic polyps
33. What causes carcinoid syndrome amd What are the symptoms
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
EtOH
Hyperplastic
34. How is the diagonsis of CRC made
Virchow's node
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker
...
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
35. What is the most common cause of gallstones
All 3
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Uridine glucuronyl transferase
External spermatic fascia only
36. In an MI - which liver enzyme is elevated
AST
MSI (15%) and APC/beta catenin chromosomal instability (85%)
All 3 gut layers outpouch as in Meckels
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
37. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Hepatic steatosis
So hypertrophied they look like brain gyri
Ceruplasmin
IgA secreting plasma cells - ultimately reside in the lamina proporia
38. What intervention will intervention will relieve portal HTN
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Decrease - weight gain
Colonic polyps
Left gastric vein and esophogeal vein - esophagus
39. What causes primary biliary cirrhosis
The jejunum
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Squamous - upper 1/3 - adeno - lower 1/3
Obstruction of the common bile duct
40. What is the rate limiting step of carbohydrate digestion
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Oligosaccharide digestion
Ampulla of vater
Juvenile polyposis syndrome - inc risk of adenocarcinoma
41. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Can lead to hematemesis - found in EtOHics and bulimics
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Fasting and stress
Lipase
42. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
HPNCC
Causes of gall stones
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
HSV-1 - CMV - Candida
43. Where is bicarb trapped
Esophageal cancer
Enterokinase/enteropeptidase from the duodenal mucosa
External spermatic fascia only
In the mucus that covers the gastric epithelium
44. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Decreased intercellular adhesion and increased proliferation
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Internal thoracic to superior epigastric to inferior epigastric
Falciform - ligamentum teres - fetal umbilical vein
45. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
All 3 gut layers outpouch as in Meckels
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
L3
GERD - may also present with nocturnal cough and dyspnea
46. What nerve innervates the external hemorrhoids
Inferior rectal nerve
Primarly through ECL leading to histamine release
Stimulate intestinal persistalsis
Gastrohepatic ligament
47. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Pleuroperitoneal
Hepatic steatosis
Alk pho
L/R renal artery around L1
48. what percentage of colonic polyps are non - neoplastic
Amylase
90%
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Positive urease test
49. What is the path of an indirect inguinal hernia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
CEA - CA-19-9
Cystic dilation of the viteline duct
50. why infxn is implicated in duodenal PUD
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Diarrhea - steatorrhea - weight loss - weakness
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
H pylori (almost 100%)
Sorry!:) No result found.
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