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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 does autoimmune destruction of parietal cells lead to...
Old men - arthralgias - cardiac and neuro sx
Heme metabolism
Chronic gastritis and pernicious anemia
Lipase
2. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus
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3. What causes nutmeg liver
Splenic flexure
Cirrhosis
Osmotic
Backup of blood into the liver - RHF - budd chiari
4. Where is folate absorbed
The jejunum
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Inc - weight loss
L1
5. What does TOASTED with alcoholic hepatitis stand for
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Dermatitis herpetiformis
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
AST >ALT - ration is usually 1.5
6. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Parietal cells in the stomach - B12 binding protein
Brunners
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
7. Abuse of what substance leads to acute gastritis
EtOH
Downs
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
8. What is a positive murphy's sign
Inspiratory arrest on deep palpation due to pain
So hypertrophied they look like brain gyri
Lipase - phospholipase A - colipase
Internal thoracic to superior epigastric to inferior epigastric
9. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Meconium ileus
Superior rectal
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Dubin johnson
10. What layer of fascia covers a direct inguinal hernia
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Hemosiderosis - hemochromatosis
Stercobilin
External spermatic fascia only
11. What causes primary biliary cirrhosis
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Goes through deep inguinal ring - external inguinal ring and into the scrotum
12. What are motilin receptor agonists used for clinically
Stimulate intestinal persistalsis
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Erosive - disruption of mucosal barrier leading to inflammation
Muscularis mucosae
13. Where are tumors commonly in pancreatic adenocarcinoma
All 3 gut layers outpouch as in Meckels
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Worldwide - SC - US - adeno
Pancreatic head causing obstructive jaundice
14. In an MI - which liver enzyme is elevated
AST
Pleomorphic adenoma
VZV and influenza B treated with salicylates
Female - fat - fertile - forty
15. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Alpha amylase
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Epigastric abdominal pain radiating to back - anorexia - nausea
Obstruction of the common bile duct
16. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Intussusception
IgA secreting plasma cells - ultimately reside in the lamina proporia
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Carcinoid syndrome
17. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Unconj - absent (acholuria) - inc
2ndary biliary cirrhosis
Angiodysplasia
Lipase
18. Achalasia increases the risk For what complication
Alk phos
Esophageal carcinoma
Heme metabolism
Poor anastamoses
19. What are esophageal strictures associated with
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Diverticulum
Lye ingestion and acid reflux
Menetriers disease
20. What is the clinical presentation of acute pancreatitis
Gilbert's
Epigastric abdominal pain radiating to back - anorexia - nausea
Superior rectal
Conj/unconj - inc - nl to dec
21. What is the most common cause of gallstones
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Colovesical leading to pneumaturia
Cigarettes and chronic pancreatitis - not EtOH
EtOH
22. Which IBD is autoimmune and which may be a disordered response to bacteria
Ceruplasmin
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Alk pho
Esophageal cancer
23. What cells make pepsin - What does it do - and what regulates it
Hyperpigmented mouth - lips - hands - genitalia
Short gastrics - left greater and lesser
Virchow's node
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
24. What are the complications of duodenal PUD
M3 - Gq - inc IP3/Ca
Bleeding - penetration into pancreas - perforation - obstruction
Menetriers disease
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
25. Which serum enzyme increases with heavy EtOH consumption
Gamma glutamyl transferase GGT
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Paraumbilical and superficial and inferior epigastric - umbilicus
Alk phos
26. What do tumors that arise in the head of the pancreas cause
Source - parasympathetic ganglion in sphincters - gallbladder - small intestine - action - inc intestinal water and electrolyte secretion - inc relaxation of intestinal smooth muscle and sphincters - regulation - inc by distention and vagal stimulati
Obstruction of the common bile duct
Hyperpigmented mouth - lips - hands - genitalia
Pancreatic head causing obstructive jaundice
27. What converts inactive pepsinogen to pepsin
Pertechnetate - study for uptake
Virchow's node
H+
Centrilobular leading to congestive liver disease
28. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
IBS at least 2 with recurrent abdominal pain
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Uridine glucuronyl transferase
2ndary biliary cirrhosis
29. What is the action of NO as a GI hormone
True and most common congenital anomoly of GI tract
PAS- positive globules in liver -
Can lead to hematemesis - found in EtOHics and bulimics
Inc smooth muscle relaxation - including lower esophageal sphincter
30. What are the branches of the celiac trunk and What do they supply
Common hepatic - splenic - left gastric - main blood supply for stomach
All 3
Gallbladder
Hemosiderosis - hemochromatosis
31. What test and result confirms H pylori infxn
Above
Hydrocele
Penicillinamine - AR inheritance
Positive urease test
32. What kind of muscle is in the middle 1/3 of esophagus
Penicillinamine - AR inheritance
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Striated and smooth
3 waves/min
33. What are the main components of bile
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Carcinoid syndrome
Hyperpigmented mouth - lips - hands - genitalia
MSI (15%) and APC/beta catenin chromosomal instability (85%)
34. Bile is critical for exrection of what substance
Ischemic colitis
Cirrhosis
Cholesterol
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
35. What kind of lesions are characteristic of duodenal PUD vs cancer
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Poor anastamoses
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Punched out - clean margins - carcinoma =raised irregular margins
36. What is Trousseau's sign
Cholesterol
Redness and tenderness on palpation of extremities
IBS at least 2 with recurrent abdominal pain
Elevated amylase - and lipase
37. 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
Skip lesions =crohns - colon = UC
Virchow's node
Cholesterol
Increase tumorigenesis
38. What percentage of gall stones are cholesterol stones and What are the associations
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Lack or have an attenuated muscularis externa - often in the sigmoid colon
39. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Esophageal varices
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
40. What does high flow rate mean
Closer to isotonic because of less time to reabsorb NaCl
Downs
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Tropical sprue
41. What is the presentation of pancreatic adenocarcinoma
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Diarrhea - steatorrhea - weight loss - weakness
Crypts but not villi
42. What portion of the bowel does sprue effect
The proximal small bowel
Nonkeritinized stratified sqamous epithelium
Meckels
Redundant mesentary
43. Where and How is iron absorbed
Inferior rectal nerve
Trypsin - chymotrypsin - elastase - carboxypeptidases
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Fe2+ in the duod
44. What are the extraintestinal manifestations of ulcerative colitis
Carcinoid syndrome
Penicillinamine - AR inheritance
Brush border of intestine - produce monosaccharides from oligo and di
Pyoderma gangrenosum - primary sclerosing cholangitis
45. What is contained in the gastrosplenic and What areas does it separate
Short gastrics - left greater and lesser
Gamma glutamyl transferase GGT
Erosive - disruption of mucosal barrier leading to inflammation
The gastroduodenal
46. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Mucosa - submucosa - muscularis externa - serosa/adventitia
Can lead to hematemesis - found in EtOHics and bulimics
Positive urease test
47. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Left and right gastroepiploics - left and right gastrics
Low pressure proximal to LES
Black - rotors syndrome
Mitochondrial abnl - fatty liver - hypoglycemia - coma
48. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
CHF and inc risk of HCC
CEA - CA-19-9
3 waves/min
49. Through which aspect of the inguinal canal does a direct inguinal go
External (superficial) ring only
Inspiratory arrest on deep palpation due to pain
Serous on the sides parotids - mucinous in the middle sublingual
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
50. Where is the deep inguinal ring relative to the inferior epigastric vessels
Via the superior pancreaticduodenal
Ampulla of vater
Lateral
Dermatitis herpetiformis