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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 serum markers increase in cholecystitis with bile duct involvement
The entire
Unconj - absent (acholuria) - inc
Alk phos
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
2. What kind of pathways do CCK act on to cause pancreatic secretion
Duodenum - 2nd - 3rd and 4th parts
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Neural muscarinic pathways
Chronic gastritis and pernicious anemia
3. What receptors does gastrin bind on the parietal cell and What does it activate
Diarrhea - steatorrhea - weight loss - weakness
Achalasia due to loss of myenteric plexus (auberach)
CCK8 receptor - Gq inc IP3/Ca
MSI (15%) and APC/beta catenin chromosomal instability (85%)
4. What cells secrete bicarb - What does it do - and what regulates it
Lamina propria
Left and right gastroepiploics - left and right gastrics
Duodenum - 2nd - 3rd and 4th parts
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
5. Where does copper accumulate in Wilsons and What are ABCD
Inc smooth muscle relaxation - including lower esophageal sphincter
Achalasia due to loss of myenteric plexus (auberach)
Conj/unconj - inc - nl to dec
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
6. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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7. What pancreatic enzymes are responsible for fat digestion
The gastroduodenal
Lipase - phospholipase A - colipase
So hypertrophied they look like brain gyri
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
8. Why does carcinoid syndrome not occur if tumor is confined to GI system
Liver metabolizes 5HT
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
FAP
9. Where are tumors commonly in pancreatic adenocarcinoma
Pancreatic head causing obstructive jaundice
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
10. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Meckels
Complications of UC
Virchow's node
11. Where and How is iron absorbed
Fe2+ in the duod
...
Serous on the sides parotids - mucinous in the middle sublingual
AST>ALT
12. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Duodenal atresia - Downs
Inferior rectal nerve
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
13. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Pleomorphic adenoma
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Dilated esophagus with an area of distal stenosis - birds beak
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
14. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
US and cholecystectomy
Paraumbilical and superficial and inferior epigastric - umbilicus
Alpha1 antitrypsin def - codominant trait
No - chronic - can present with diarrhea or constipation or alternation - treat sx
15. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Conj/unconj - inc - nl to dec
Mucoepidermoid carcinoma
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
16. Which area of the hindgut is a watershed area
Esophageal carcinoma
Splenic flexure
Low pressure proximal to LES
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
17. What is the HLA association and treatment for hemochromatosis
Positive urease test
90%
Complications of crohns
Repeated phlebotomy - deferoxamine - HLA- A3
18. Through which aspect of the inguinal canal does a direct inguinal go
External (superficial) ring only
Gastrohepatic ligament
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Intussusception
19. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Phototherapy
20. concentric onion skin bile duct fibrosis
Failure of neural crest migration
Zollinger ellison - brunners glands
Crohns = maybe - UC= always
Primary sclerosing cholangitis
21. rare - often fatal childhood hepatoencephalopathy
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22. What is the cause of Barrett's and the assocaited complications
Neural muscarinic pathways
Pancreatic head causing obstructive jaundice
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
T12
23. inflammatino of gallbadder
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Averages 6 months - very aggressive - usually already metastasized at presentation
Jaundice - fever - RUQ
Pertechnetate - study for uptake
24. likely infectious form of malabsorption - responds to antibiotics
Tropical sprue
Pyoderma gangrenosum - primary sclerosing cholangitis
When diffusely infiltrative - thickened rigid appearance like a leather bottle
No - chronic - can present with diarrhea or constipation or alternation - treat sx
25. malnutrition - toxic megacolon - colorectal carcinoma
Older patients
Lipase - phospholipase A - colipase
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Complications of UC
26. Autoantibodies to gluten (gliadin) in wheat and other grains
Crohns = noncaseating granulomas - UC = crypt abscesses
Celiac sprue
Dec PGE2 leading to dec gastric mucosa protection
Virchow's node
27. At what spinal level does the is the bifurcation of aorta
Terminal ileum and colon
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
L4
Punched out - clean margins - carcinoma =raised irregular margins
28. What causes primary biliary cirrhosis
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Turcot
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
29. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
US and cholecystectomy
Superior rectal
90%
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
30. How do villi appear in disaccharidease def
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
Conj/unconj - inc - nl to dec
Normal
Centrilobular leading to congestive liver disease
31. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
Alpha1 antitrypsin def - codominant trait
In the mucus that covers the gastric epithelium
Uridine glucuronyl transferase
32. Who gets gastric ulcers
Inc - weight loss
Older patients
Primarly through ECL leading to histamine release
Oral glucose
33. milk intolerance
Dissaccharidase def - most commonly lactase
Squamous - upper 1/3 - adeno - lower 1/3
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
34. What is the frequency of basal electric rhythm in the duodenum
EtOH
12 waves/min
Unconj - absent (acholuria) - inc
Worldwide - SC - US - adeno
35. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Inferior rectal nerve
Epithelium
Redness and tenderness on palpation of extremities
Peyers patches
36. When and why is stomach cancer termed linitis plastica
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
When diffusely infiltrative - thickened rigid appearance like a leather bottle
The jejunum
37. What is the TX of physiologic neonatal jaundice
Phototherapy
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Squamous - upper 1/3 - adeno - lower 1/3
38. How is bilirubin carried in the blood
With albumin
PAS- positive globules in liver -
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
39. What is the main symptom if a VIPoma
FAP
Inferior rectal nerve
Copious diarrhea - non alpha - non beta cell pancreatic tumor
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
40. What kind of pancreatitis is associated with EtOH and smoking
Alk pho
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
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Chronic calcifying pancreatitis - inc risk of panreatic cancer
41. With caput medusaw - between what vessels is the anastomoses and Where is it
Inguninal ligament - sartorius muscle - adductor longus
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
In the mucus that covers the gastric epithelium
Paraumbilical and superficial and inferior epigastric - umbilicus
42. What is the action of NO as a GI hormone
L3
Ischemic colitis
Inc smooth muscle relaxation - including lower esophageal sphincter
Brush border of intestine - produce monosaccharides from oligo and di
43. most common malignant salivary gland tumor
Mucoepidermoid carcinoma
All 3 gut layers outpouch as in Meckels
Duodenum - 2nd - 3rd and 4th parts
Gastrohepatic ligament
44. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Reye's syndrome
US and cholecystectomy
Mucosa - submucosa - muscularis externa - serosa/adventitia
Complications of crohns
45. How are all 3 monosaccharides transported to the blood
So hypertrophied they look like brain gyri
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
GLUT 2
Boerhaave's Syndrome - Been heaving syndrome
46. What converts inactive pepsinogen to pepsin
Oligosaccharide digestion
H+
Hemolytic anemia
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
47. What transforms conjugated bilirubin to urobilinogen
Gut bacteria
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Alpha amylase
Juvenille polyps - no risk if single
48. What does histo show for alpha1 antitrypsin def
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Antrum - H.pylori - inc risk of MALT lymphoma
PAS- positive globules in liver -
49. People of what decent are associated with celiac sprue and what findings/antibodies are present
Hepatic steatosis
Duodenal atresia - Downs
Crigler - najjar type 1
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
50. What is a positive murphy's sign
Inspiratory arrest on deep palpation due to pain
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Inc smooth muscle relaxation - including lower esophageal sphincter
L4