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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 is a positive murphy's sign
Inspiratory arrest on deep palpation due to pain
Phenobarbital - inc liver enzyme synthesis
Alfatoxin in peanuts
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
2. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Worldwide - SC - US - adeno
Lipase - phospholipase A - colipase
Lactase is located at the tips of intestinal villi
Lateral to the inferior epigastric artery
3. What transforms conjugated bilirubin to urobilinogen
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Hypercoaguability - polycythemia vera - pregnancy - HCC
Gut bacteria
Superior rectal
4. Abuse of what substance leads to acute gastritis
External (superficial) ring only
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
EtOH
Cimetidine
5. trypsinogen is converted to trypsin via what enzyme
The proximal small bowel
Oligosaccharide digestion
Phenobarbital - inc liver enzyme synthesis
Enterokinase/enteropeptidase from the duodenal mucosa
6. What are the longterm sequelae of nutmeg liver
Centrilobular congestion and necrosis - cardiac cirrhosis
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
Pertechnetate - study for uptake
Alpha amylase
7. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
Reye's syndrome
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Pertechnetate - study for uptake
8. What are the signs of peutz jehgers
Acute pancreatitis
Centrilobular congestion and necrosis - cardiac cirrhosis
Hyperpigmented mouth - lips - hands - genitalia
Lipase - phospholipase A - colipase
9. At what level do the testicular/ovarian arteries exit the aorta
L2
Hemolytic anemia
Can lead to hematemesis - found in EtOHics and bulimics
The proximal small bowel
10. Which patients have pigment stones
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Stercobilin
In the mucus that covers the gastric epithelium
11. What drug blocks the H2R
Hydrocele
Cimetidine
Esophageal carcinoma
Striated and smooth
12. What structures feed into the cystic duct
Lateral
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Gallbladder
Elevated amylase - and lipase
13. What cells make pepsin - What does it do - and what regulates it
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Gastric glands
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Upregulated intracellular signal transduction
14. in carcinoid tumors - What is seen on EM
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Hemosiderosis - hemochromatosis
Dense core bodies
In the mucus that covers the gastric epithelium
15. crigler - najjar type II responds to which therapy and How does it work
Inc conj bilirubin - inc cholesterol - inc alk phos
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Hydrocele
Phenobarbital - inc liver enzyme synthesis
16. bilateral mets to ovaries with abundant mucus - signet ring cells
Krukenbergs tumor
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Inferior rectal nerve
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
17. What are esophageal strictures associated with
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Lye ingestion and acid reflux
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
18. What cells secrete bicarb - What does it do - and what regulates it
The gastroduodenal
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
HPNCC
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
19. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Crohns = noncaseating granulomas - UC = crypt abscesses
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Normal
Parietal cells in the stomach - B12 binding protein
20. What are the results of hemochromatosis
Carcinoid syndrome
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
CHF and inc risk of HCC
Causes of gall stones
21. What does the splenorenal ligament connect - and What does it contain
Lamina propria
Spleen to posterior abdominal wall - splenic artery and vein
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
22. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Hemosiderosis - hemochromatosis
Cholesterol
Krukenbergs tumor
IBS at least 2 with recurrent abdominal pain
23. Where is B12 absorbed
In the ileum with bile acids - requires IF
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Inc smooth muscle relaxation - including lower esophageal sphincter
24. Which area of the hindgut is a watershed area
Splenic flexure
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Intussusception
Paraumbilical and superficial and inferior epigastric - umbilicus
25. Where does crohns usually affect the GI tract
Terminal ileum and colon
Fasting and stress
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
Gallbladder
26. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Fasting and stress
Punched out - clean margins - carcinoma =raised irregular margins
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Angiodysplasia
27. What complication can arise from indirect inguinal hernias
T cell lymphoma
Hydrocele
VZV and influenza B treated with salicylates
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
28. What pancreatic enzymes are responsible for fat digestion
Lipase - phospholipase A - colipase
Colovesical leading to pneumaturia
Turcot
Lubricate food (glycoprotiens)
29. How does brain injury lead to acute gastritis and What is it called
Lye ingestion and acid reflux
The jejunum
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Small intestine
30. What layer in the mucosa is responsible for support
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Lamina propria
Hirschsprungs
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
31. What are causes of extrahepatic biliary obstruction
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Positive urease test
Jaundice - fever - RUQ
32. What enzyme is necessary to create conjugated bilirubin
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Duodenal atresia - Downs
Hirschsprungs
Uridine glucuronyl transferase
33. Where is IgA shuttled
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Crohns = maybe - UC= always
Appendicitis
Gallbladder
34. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Carcinoid syndrome
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Alk pho
Appendicitis
35. What kind of diarrhea is produced from a disaccharide def
Osmotic
Redundant mesentary
Common hepatic - splenic - left gastric - main blood supply for stomach
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
36. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Chronic calcifying pancreatitis - inc risk of panreatic cancer
IgA secreting plasma cells - ultimately reside in the lamina proporia
Upregulated intracellular signal transduction
Small intestine
37. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Duodenal atresia - Downs
Small intestine
Internal thoracic to superior epigastric to inferior epigastric
Via the middle colic
38. What kind of pathways do CCK act on to cause pancreatic secretion
Small intestine
Neural muscarinic pathways
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
90%
39. What is the main symptom if a VIPoma
Copious diarrhea - non alpha - non beta cell pancreatic tumor
IBS at least 2 with recurrent abdominal pain
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
40. Where are tumors commonly in pancreatic adenocarcinoma
Pancreatic head causing obstructive jaundice
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Left and right gastroepiploics - left and right gastrics
Hemosiderosis - hemochromatosis
41. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
HPNCC
Chronic gastritis and pernicious anemia
Stimulate the H/K ATPase
42. What is the cause of Barrett's and the assocaited complications
No
Fe2+ in the duod
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Erosive - disruption of mucosal barrier leading to inflammation
43. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
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
Conj - inc - dec
Cholesterol - 10-20% opaque due to calcifications
Esophageal carcinoma
44. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Necrotizing enterocolitis
Squamous - upper 1/3 - adeno - lower 1/3
L4
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
45. likely infectious form of malabsorption - responds to antibiotics
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Neural muscarinic pathways
Angiodysplasia
Tropical sprue
46. What does bicab do in the mouth
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Neural muscarinic pathways
Left gastric vein and esophogeal vein - esophagus
Neutralizes oral bacertial acids and maintains dental health
47. Gastrin - source - action - regulation
Complications of UC
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Lamina propria
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
48. Acute gastritis is caused By what process
Complications of UC
Above
Inspiratory arrest on deep palpation due to pain
Erosive - disruption of mucosal barrier leading to inflammation
49. What conditions are associated with budd chiari
Neutralizes oral bacertial acids and maintains dental health
Hypercoaguability - polycythemia vera - pregnancy - HCC
Dense core bodies
So hypertrophied they look like brain gyri
50. What is the rate limiting step of carbohydrate digestion
M3 - Gq - inc IP3/Ca
Crigler - najjar type 1
Oligosaccharide digestion
HSV-1 - CMV - Candida