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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 are the two molecular pathways that lead to CRC
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Inc smooth muscle relaxation - including lower esophageal sphincter
Gastrohepatic ligament
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
2. What are the hindgut structures and what supplies their blood and PANS innvervation
Glucose dependent insulinotropic peptide
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Appendicitis
Inspiratory arrest on deep palpation due to pain
3. What are the extraintestinal manifestations of ulcerative colitis
True and most common congenital anomoly of GI tract
PAS- positive globules in liver -
Lateral to the inferior epigastric artery
Pyoderma gangrenosum - primary sclerosing cholangitis
4. Where is the deep inguinal ring relative to the inferior epigastric vessels
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
Neural muscarinic pathways
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Lateral
5. What does the splenorenal ligament connect - and What does it contain
Spleen to posterior abdominal wall - splenic artery and vein
Dilated esophagus with an area of distal stenosis - birds beak
Failure of the processus vagainlis to close
H pylori (almost 100%)
6. What skin condition is associated with celiac sprue
Failure of the processus vagainlis to close
Lateral to the inferior epigastric artery
AST
Dermatitis herpetiformis
7. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
All 3 gut layers outpouch as in Meckels
Meckels
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Angiodysplasia
8. What are the results of hemochromatosis
Carcinoid syndrome
CHF and inc risk of HCC
In the ileum with bile acids - requires IF
Below
9. If the abdominal aorta is blocked - How does blood get to the left colic artery
Myenteric nerve plexus - aurbach
Via the middle colic
The gastroduodenal
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
10. How are all 3 monosaccharides transported to the blood
GLUT 2
Nonkeritinized stratified sqamous epithelium
AST >ALT - ration is usually 1.5
Dermatitis herpetiformis
11. What does bicarb do in the duodenum
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Terminal ileum and colon
Adhesion
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
12. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Inc lower esphogeal tone leading to achalasia
IgA secreting plasma cells - ultimately reside in the lamina proporia
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Barrett's esophagus
13. What is the TX of physiologic neonatal jaundice
Mallory bodies
Acute pancreatitis
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Phototherapy
14. What is the ddx associated with appendicitis
L1
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Superior rectal and middle and inferior rectal - rectum
Via the superior pancreaticduodenal
15. What is biliary colic
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Amylase
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
16. What is indirect bilirubin
Unconjugated - water insoluble
Esophageal cancer
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
17. What commonly leads to appendicity in kids vs adults
Inc smooth muscle relaxation - including lower esophageal sphincter
Cystic duct and common hepatic duct
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Worldwide - SC - US - adeno
18. What serum enzyme is elevated in acute pancreatitis and mumps
Peyers patches
Amylase
Left gastric vein and esophogeal vein - esophagus
Smooth
19. What causes pancreatic insuff and What does it cause
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Below
Hepatic steatosis
Necrotizing enterocolitis
20. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
NAV = nerve artery vein - venous near the penis (NAVEL)
Diverticulum
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Ischemic colitis
21. Scleroderma is associated with what kind of esophageal dysmotility
Closer to isotonic because of less time to reabsorb NaCl
Via the middle colic
Alk phos
Low pressure proximal to LES
22. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Positive
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Serous on the sides parotids - mucinous in the middle sublingual
Cirrhosis
23. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Early childhood - neuro sx and malabsorption
Nonkeritinized stratified sqamous epithelium
Redness and tenderness on palpation of extremities
24. trypsinogen is converted to trypsin via what enzyme
Enterokinase/enteropeptidase from the duodenal mucosa
EtOH
Where hindgut meets ectoderm
GLUT 2
25. At what spinal level does the SMA exit
Duodenum - 2nd - 3rd and 4th parts
Hirschsprungs
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
L1
26. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Diarrhea - steatorrhea - weight loss - weakness
Above
27. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Conj - inc - dec
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Epigastric abdominal pain radiating to back - anorexia - nausea
Inc smooth muscle relaxation - including lower esophageal sphincter
28. What are the histological findings in the duodenum
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29. Where are oligosaccharide hydrolases and What do they do
Liver metabolizes 5HT
No - chronic - can present with diarrhea or constipation or alternation - treat sx
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
Brush border of intestine - produce monosaccharides from oligo and di
30. 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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31. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Crohns = noncaseating granulomas - UC = crypt abscesses
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Conj - inc - dec
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
32. At what level do the testicular/ovarian arteries exit the aorta
Meckels
L2
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Begins starch digestion - inactivated by low pH upon reaching the stomach
33. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Alk pho
Amylase
FAP
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
34. What are the extraintestinal manifestations of crohns
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
M3 - Gq - inc IP3/Ca
Oligosaccharide digestion
Bleeding - intussusception - volvulus - obstruction near terminal ileum
35. Where is the arterial supply from above the pectinate line - and What is the venous drainage
2ndary biliary cirrhosis
Glucouronate - water soluble (direct)
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Below
36. What are the structures of the femoral triangle and how are they organized
Centrilobular congestion and necrosis - cardiac cirrhosis
NAV = nerve artery vein - venous near the penis (NAVEL)
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Dec PGE2 leading to dec gastric mucosa protection
37. somatostatin - source - action - regulation
Left and right gastroepiploics - left and right gastrics
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Bleeding - intussusception - volvulus - obstruction near terminal ileum
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
38. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Peptic ulcer disease
Repeated phlebotomy - deferoxamine - HLA- A3
Adhesion
Spleen to posterior abdominal wall - splenic artery and vein
39. What are the histological findings in the ileum
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40. What is the classic triad of hemochromatosis
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41. in budd chiari syndrome - Where is the congestion and necrosis
Ampulla of vater
The jejunum
Centrilobular leading to congestive liver disease
Enterokinase/enteropeptidase from the duodenal mucosa
42. What is the most common esophageal cancer worldwide and in the US
Osmotic
L/R renal artery around L1
Worldwide - SC - US - adeno
3 waves/min
43. What complication can arise from indirect inguinal hernias
Muscularis mucosae
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Hydrocele
44. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Chagas disease
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Duodenal atresia - Downs
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
45. What is the most common indication of emergent abdominal surgery in children
Appendicitis
Myenteric nerve plexus - aurbach
Krukenbergs tumor
Striated and smooth
46. What serum markers increase in cholecystitis with bile duct involvement
Uremia
Bleeding - penetration into pancreas - perforation - obstruction
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Alk phos
47. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Pertechnetate - study for uptake
Crohns = maybe - UC= always
48. What is the most common cause of gallstones
Dubin johnson
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
49. In an MI - which liver enzyme is elevated
Increase tumorigenesis
L4
AST
Colonic polyps
50. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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