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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 can hemochromatosis be secondary to...
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Splenic flexure
Krukenbergs tumor
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
2. In viral hepatitis - which liver enzyme is higher
Peyers patches
ALT>AST
HPNCC
Causes of gall stones
3. How does hirschsprung present and appear on imaging
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Myenteric nerve plexus - aurbach
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
Warthins' tumor
4. What is charcot triad of cholangitis
Portal HTN
Hepatic steatosis
Jaundice - fever - RUQ
M3 - Gq - inc IP3/Ca
5. What makes a true diverticula
Stercobilin
All 3 gut layers outpouch as in Meckels
Repeated phlebotomy - deferoxamine - HLA- A3
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
6. What does a gastrinoma cause
Left gastric vein and esophogeal vein - esophagus
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Femoral hernia
Complications of crohns
7. What gives urine its characteristic color
Cystic duct and common hepatic duct
Lateral to the inferior epigastric artery
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Urobilin
8. Bilirubin is the product of what?
Lactase is located at the tips of intestinal villi
Heme metabolism
Carcinoid syndrome
The jejunum
9. What does K- ras mutation cause
Inc risk of CRC and other visceral malignancies
Hyperplastic
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
Upregulated intracellular signal transduction
10. What are the common causes of gastric ulcers - What causes gastric ulcer
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Necrotizing enterocolitis
Pancreatic and bile
Redness and tenderness on palpation of extremities
11. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
Stercobilin
Skip lesions =crohns - colon = UC
Intussusception
Via the middle colic
12. In what clinical scenarior do you see portosystemic anastomoses
Small intestine
Portal HTN
Bleeding - penetration into pancreas - perforation - obstruction
Begins starch digestion - inactivated by low pH upon reaching the stomach
13. absent UDPGT - presents early in life - early mortality
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Crigler - najjar type 1
Trypsin - chymotrypsin - elastase - carboxypeptidases
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
14. What do tumors that arise in the head of the pancreas cause
Barrett's esophagus
Inc - weight loss
Obstruction of the common bile duct
Lactase is located at the tips of intestinal villi
15. What are the extraintestinal manifestations of crohns
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Heme metabolism
16. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Complications of crohns
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
17. At what spinal level does the is the bifurcation of aorta
Inferior rectal nerve
L4
Redness and tenderness on palpation of extremities
CCK8 receptor - Gq inc IP3/Ca
18. what percentage of colonic polyps are non - neoplastic
Mucoepidermoid carcinoma
90%
With albumin
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
19. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Meckels
Downs
Epigastric abdominal pain radiating to back - anorexia - nausea
H+
20. List the clinical findings of HCC
L2
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Alcoholic hepatitis
Turcot
21. What do mucins do?
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
Lubricate food (glycoprotiens)
Where hindgut meets ectoderm
22. Where does type A chronic gastritis occur and What causes it
Redundant mesentary
Internal thoracic to superior epigastric to inferior epigastric
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
23. Bile is critical for exrection of what substance
Gastric glands
Alpha1 antitrypsin def - codominant trait
Jewish and African American men
Cholesterol
24. Where is there sclerosis in alcoholic cirrohosis
Averages 6 months - very aggressive - usually already metastasized at presentation
Duodenum - 2nd - 3rd and 4th parts
Around the central vein (zone III)
Uridine glucuronyl transferase
25. Where does an indirect inguinal hernia enter the deep inguinal ring
Can lead to hematemesis - found in EtOHics and bulimics
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Lateral to the inferior epigastric artery
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
26. Where is folate absorbed
The jejunum
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Striated
27. Which is used more quickly - an oral glucose load - or that by IV
Alcoholic cirrhosis
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Oral glucose
28. Dysphagia in achalasia results from
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
H2 receptor - inc cAMP
Pyoderma gangrenosum - primary sclerosing cholangitis
29. What does alpha amylase do and what inactivates it
Dysphagia (due to esophageal web) - glossitis - iron def anemia
External spermatic fascia only
Begins starch digestion - inactivated by low pH upon reaching the stomach
Smooth
30. What layer in the mucosa is repsonsible for motility
Muscularis mucosae
US and cholecystectomy
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Ischemic colitis
31. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Inc conj bilirubin - inc cholesterol - inc alk phos
Turcot
Erosive - disruption of mucosal barrier leading to inflammation
The submucosal nerve plexus - meissner's
32. secretin - source - action - regulation
Tropical sprue
CHF and inc risk of HCC
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
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
33. Achalasia increases the risk For what complication
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Esophageal carcinoma
In the mucus that covers the gastric epithelium
34. What structure is Not contained in the femoral sheath
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Turcot
35. What kind of lesions are characteristic of duodenal PUD vs cancer
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Punched out - clean margins - carcinoma =raised irregular margins
Hernia
Hemosiderosis - hemochromatosis
36. At what level do the testicular/ovarian arteries exit the aorta
Femoral hernia
L2
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Dubin johnson
37. What are the histological findings in the ileum
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38. What transforms conjugated bilirubin to urobilinogen
Gut bacteria
Skip lesions =crohns - colon = UC
Female - fat - fertile - forty
CCK8 receptor - Gq inc IP3/Ca
39. People of what decent are associated with celiac sprue and what findings/antibodies are present
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Intussusception
40. Where are tumors commonly in pancreatic adenocarcinoma
Pancreatic head causing obstructive jaundice
Averages 6 months - very aggressive - usually already metastasized at presentation
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Inferior rectal nerve
41. conjugated hyperbilirubinemia due to defective liver excretion
Nonkeritinized stratified sqamous epithelium
Dubin johnson
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
When diffusely infiltrative - thickened rigid appearance like a leather bottle
42. What is the lumen of the pancreatic duct
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Smooth
Ampulla of vater
Urobilin
43. Which serum enzyme increases with heavy EtOH consumption
Angiodysplasia
Juvenille polyps - no risk if single
Gamma glutamyl transferase GGT
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
44. What are the histological findings in the duodenum
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45. Where are oligosaccharide hydrolases and What do they do
Common hepatic - splenic - left gastric - main blood supply for stomach
Cigarettes and chronic pancreatitis - not EtOH
Brush border of intestine - produce monosaccharides from oligo and di
Parietal cells in the stomach - B12 binding protein
46. What percentage of gall stones are cholesterol stones and What are the associations
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Mitochondrial abnl - fatty liver - hypoglycemia - coma
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
47. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Peutz jeghers
H pylori (almost 100%)
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Warthins' tumor
48. in carcinoid tumors - What is seen on EM
Neural muscarinic pathways
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Dense core bodies
Neutralizes gastric acid allowing pancreatic enzymes to fxn
49. What separates the right greater and lesser sacs
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Neutralizes oral bacertial acids and maintains dental health
Gastrohepatic ligament
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
50. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Superior rectal
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Lamina propora and submucosa
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