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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 kind of muscle is in the lower 1/3 of the esophagus
Jaundice - fever - RUQ
Smooth
Lipase
Nonkeritinized stratified sqamous epithelium
2. What is indirect bilirubin
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Unconjugated - water insoluble
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
3. How does brain injury lead to acute gastritis and What is it called
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Inc - weight loss
4. What are the foregut structures and what supplies their blood and PANS innvervation
Sister mary joseph nodule
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Alcoholic hepatitis
5. What receptor does histamine bind on the parietal cell and What does it activate
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Crypts but not villi
Achalasia due to loss of myenteric plexus (auberach)
H2 receptor - inc cAMP
6. What are the barium swallow findings of achalasia
Inc - weight loss
NAV = nerve artery vein - venous near the penis (NAVEL)
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Dilated esophagus with an area of distal stenosis - birds beak
7. Where are peyers patches found
Diverticulum
Lamina propora and submucosa
Adhesion
Fasting and stress
8. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Menetriers disease
Hepatic steatosis
Short gastrics - left greater and lesser
Redundant mesentary
9. What enzyme is necessary to create conjugated bilirubin
Uridine glucuronyl transferase
Duodenal atresia - Downs
T12
Primarly through ECL leading to histamine release
10. What is the triad of Plummer - Vinson syndrome
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Ceruplasmin
Normal
Dysphagia (due to esophageal web) - glossitis - iron def anemia
11. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
12. What does the splenorenal ligament connect - and What does it contain
Spleen to posterior abdominal wall - splenic artery and vein
Osmotic
Colonic polyps
Complications of crohns
13. What causes nutmeg liver
Mallory bodies
Lamina propora and submucosa
Backup of blood into the liver - RHF - budd chiari
Alpha amylase
14. What are the hindgut structures and what supplies their blood and PANS innvervation
Downs
Striated and smooth
Boerhaave's Syndrome - Been heaving syndrome
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
15. What serum enzyme is elevated in acute pancreatitis and mumps
Gilbert's
Left and right gastroepiploics - left and right gastrics
Via the superior pancreaticduodenal
Amylase
16. what kind of fistula is associated with diverticulitis
Colovesical leading to pneumaturia
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Inguninal ligament - sartorius muscle - adductor longus
Boerhaave's Syndrome - Been heaving syndrome
17. What nerve innervates the external hemorrhoids
Inferior rectal nerve
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Conj - inc - dec
Positive
18. What structures feed into the cystic duct
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Increase tumorigenesis
Gallbladder
Alcoholic cirrhosis
19. What does extrahepatic biliary obstruction cause
Boerhaave's Syndrome - Been heaving syndrome
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Jewish and African American men
Stercobilin
20. What serum markers increase in cholecystitis with bile duct involvement
L/R renal artery around L1
T cell lymphoma
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Alk phos
21. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Elevated amylase - and lipase
Oligosaccharide digestion
22. Where is the deep inguinal ring relative to the inferior epigastric vessels
AR
Omeprazole
Lateral
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
23. What separates the right greater and lesser sacs
Gastrohepatic ligament
Stimulate intestinal persistalsis
Spleen to posterior abdominal wall - splenic artery and vein
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
24. what kind of muscle is in the upper 1/3 of esophagus
The entire
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Adhesion
Striated
25. trypsinogen is converted to trypsin via what enzyme
Jaundice - fever - RUQ
Enterokinase/enteropeptidase from the duodenal mucosa
Worldwide - SC - US - adeno
Spleen to posterior abdominal wall - splenic artery and vein
26. Gq and inc cAMP both work to do what in parietal cells
Virchow's node
Positive urease test
Stimulate the H/K ATPase
HSV-1 - CMV - Candida
27. What does bicarb do in the duodenum
Left and right gastroepiploics - left and right gastrics
Lipase - phospholipase A - colipase
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Where hindgut meets ectoderm
28. What are the treatment options for uclerative colitis
Brunners
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
29. What kind of pancreatitis is associated with EtOH and smoking
Chronic calcifying pancreatitis - inc risk of panreatic cancer
H pylori (almost 100%)
Failure of neural crest migration
Neural muscarinic pathways
30. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Osmotic
Squamous - upper 1/3 - adeno - lower 1/3
Lipase - phospholipase A - colipase
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
31. How do you DX and TX gallstones
Begins starch digestion - inactivated by low pH upon reaching the stomach
Conj - inc - dec
Stercobilin
US and cholecystectomy
32. What cells secrete bicarb - What does it do - and what regulates it
Low pressure proximal to LES
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Hypercoaguability - polycythemia vera - pregnancy - HCC
Mucoepidermoid carcinoma
33. Where is bicarb trapped
Neural muscarinic pathways
Ischemic colitis
Lye ingestion and acid reflux
In the mucus that covers the gastric epithelium
34. What does histo show for alpha1 antitrypsin def
PAS- positive globules in liver -
True and most common congenital anomoly of GI tract
Enterokinase/enteropeptidase from the duodenal mucosa
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
35. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Trypsin - chymotrypsin - elastase - carboxypeptidases
Juvenille polyps - no risk if single
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Inc smooth muscle relaxation - including lower esophageal sphincter
36. What is contained within the muscularis externa
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
The jejunum
Myenteric nerve plexus - aurbach
37. What histological findings are present in the stomach
Duodenal atresia - Downs
Hyperplastic
Gastric glands
Glucose dependent insulinotropic peptide
38. In alchoholic hepatitis which liver enzyme is higher
Lactase is located at the tips of intestinal villi
AST>ALT
Hyperpigmented mouth - lips - hands - genitalia
Dilated esophagus with an area of distal stenosis - birds beak
39. What structure is Not contained in the femoral sheath
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Mucoepidermoid carcinoma
Gut bacteria
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
40. What converts inactive pepsinogen to pepsin
H+
Reye's syndrome
Achalasia due to loss of myenteric plexus (auberach)
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
41. Where is B12 absorbed
In the ileum with bile acids - requires IF
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Jewish and African American men
Normal
42. is meckels a true diverticulum and how common is it
Serous on the sides parotids - mucinous in the middle sublingual
True and most common congenital anomoly of GI tract
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Cirrhosis
43. What does loss of APC cause
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Decreased intercellular adhesion and increased proliferation
Inspiratory arrest on deep palpation due to pain
44. What causes hirschsprungs
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
90%
Failure of neural crest migration
Hernia
45. What is the most common indication of emergent abdominal surgery in children
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Appendicitis
Meconium ileus
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
46. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Smooth
Alk pho
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Glucose dependent insulinotropic peptide
47. Autodigestion of pancreas by pancreatic enzymes
T12
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Acute pancreatitis
Neural muscarinic pathways
48. How does abetalipoproteinemia lead to malabsorption
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
...
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Can lead to hematemesis - found in EtOHics and bulimics
49. How does gastrin increase acid secretion?
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Crigler - najjar type 1
Primarly through ECL leading to histamine release
PAS- positive globules in liver -
50. Achalasia can be secondary to what infectious disease common in South America
Chagas disease
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
Mucosa - submucosa - muscularis externa - serosa/adventitia
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells