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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 the action of NO as a GI hormone
Redundant mesentary
Crypts but not villi
Complications of crohns
Inc smooth muscle relaxation - including lower esophageal sphincter
2. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Cirrhosis
Via the middle colic
Alpha1 antitrypsin def - codominant trait
Juvenille polyps - no risk if single
3. What does bicab do in the mouth
All 3 gut layers outpouch as in Meckels
PAS- positive globules in liver -
Neutralizes oral bacertial acids and maintains dental health
Adhesion
4. At what spinal level does the SMA exit
L1
Causes of gall stones
Unconjugated - water insoluble
Downs
5. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Alfatoxin in peanuts
6. What receptors does gastrin bind on the parietal cell and What does it activate
CCK8 receptor - Gq inc IP3/Ca
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Cholesterol - 10-20% opaque due to calcifications
Closer to isotonic because of less time to reabsorb NaCl
7. What does alpha amylase do and what inactivates it
IBS at least 2 with recurrent abdominal pain
Begins starch digestion - inactivated by low pH upon reaching the stomach
Superior rectal and middle and inferior rectal - rectum
Epithelium
8. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Inferior rectal nerve
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
9. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Below
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
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
10. What is the clinical presentation of acute pancreatitis
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Hemosiderosis - hemochromatosis
Epigastric abdominal pain radiating to back - anorexia - nausea
Myenteric nerve plexus - aurbach
11. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Meckels
Dubin johnson
Uridine glucuronyl transferase
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
12. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
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
Pyoderma gangrenosum - primary sclerosing cholangitis
Necrotizing enterocolitis
Oligosaccharide digestion
13. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Alfatoxin in peanuts
Dysphagia (due to esophageal web) - glossitis - iron def anemia
FAP
Angiodysplasia
14. What are the signs of peutz jehgers
Female - fat - fertile - forty
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Hyperpigmented mouth - lips - hands - genitalia
Lateral to the inferior epigastric artery
15. What pancreatic enzymes are responsible for fat digestion
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
External spermatic fascia only
Lipase - phospholipase A - colipase
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
16. What enzyme is necessary to create conjugated bilirubin
Uridine glucuronyl transferase
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Esophageal carcinoma
Decreased intercellular adhesion and increased proliferation
17. What is the path of an indirect inguinal hernia
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Inguninal ligament - sartorius muscle - adductor longus
L1
Goes through deep inguinal ring - external inguinal ring and into the scrotum
18. What is Trousseau's sign
Gastrohepatic ligament
Redness and tenderness on palpation of extremities
Alk pho
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
19. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Esophageal varices
90%
20. What is the most common diaphragmatic hernia and What are the two types
Appendicitis
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Crigler - najjar type 1
21. What are the hindgut structures and what supplies their blood and PANS innvervation
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Alcoholic hepatitis
Volvulus
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
22. What are additional risk factors for CRC
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Gut bacteria
Penicillinamine - AR inheritance
L1
23. Between what structures do strong anastamoses exist
Omeprazole
Left and right gastroepiploics - left and right gastrics
Normal
Primary sclerosing cholangitis
24. What conditions are associated with budd chiari
Hypercoaguability - polycythemia vera - pregnancy - HCC
Can lead to hematemesis - found in EtOHics and bulimics
Centrilobular congestion and necrosis - cardiac cirrhosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
25. Where is folate absorbed
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Neural muscarinic pathways
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
The jejunum
26. What are the histological findings in the jejunum
Closer to isotonic because of less time to reabsorb NaCl
Inferior rectal nerve
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Oral glucose
27. What are the histological findings of the colon
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Crypts but not villi
Mucoepidermoid carcinoma
Gallbladder
28. What are the extraintestinal manifestations of crohns
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Hyperpigmented mouth - lips - hands - genitalia
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
29. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
IgA secreting plasma cells - ultimately reside in the lamina proporia
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Volvulus
30. Where does an indirect inguinal hernia enter the deep inguinal ring
US and cholecystectomy
Lateral to the inferior epigastric artery
Around the central vein (zone III)
Meconium ileus
31. How is bilirubin carried in the blood
Ischemic colitis
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Necrotizing enterocolitis
With albumin
32. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
3 waves/min
Positive urease test
Angiodysplasia
33. What retroperitoneal structure flanks both sides of the pancreas on CT
Internal thoracic to superior epigastric to inferior epigastric
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Pertechnetate - study for uptake
Duodenum - 2nd - 3rd and 4th parts
34. What are the two molecular pathways that lead to CRC
In the ileum with bile acids - requires IF
Superior rectal and middle and inferior rectal - rectum
Trypsin - chymotrypsin - elastase - carboxypeptidases
MSI (15%) and APC/beta catenin chromosomal instability (85%)
35. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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36. Where are tumors commonly in pancreatic adenocarcinoma
Inc lower esphogeal tone leading to achalasia
Pancreatic head causing obstructive jaundice
Alk phos
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
37. In PUD - with gastric ulcers - does pain inc or dec with meals?
Heme metabolism
Inc - weight loss
Cystic dilation of the viteline duct
Peyers patches
38. What is the other name for GIP (gastric inhibitory peptide)
H pylori (almost 100%)
Turcot
L2
Glucose dependent insulinotropic peptide
39. What is the omphalomesenteric cyst
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Striated
Cystic dilation of the viteline duct
Cholesterol
40. What is the main symptom if a VIPoma
Smooth
Inc smooth muscle relaxation - including lower esophageal sphincter
Normal
Copious diarrhea - non alpha - non beta cell pancreatic tumor
41. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Ischemic colitis
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Lipase
42. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Femoral hernia
Conj/unconj - inc - nl to dec
Penicillinamine - AR inheritance
Esophageal carcinoma
43. What cell produces IF and What does it do
The entire
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Decrease - weight gain
Parietal cells in the stomach - B12 binding protein
44. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
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
Duodenal atresia - Downs
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
Gut bacteria
45. What are the common causes of gastric ulcers - What causes gastric ulcer
Stercobilin
Urobilin
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
In the ileum with bile acids - requires IF
46. What drug blocks the H2R
Cimetidine
Centrilobular congestion and necrosis - cardiac cirrhosis
Achalasia due to loss of myenteric plexus (auberach)
Celiac sprue
47. With internal hemorrhoids Where is the anastomoses and Where is it
H+
Phenobarbital - inc liver enzyme synthesis
Superior rectal and middle and inferior rectal - rectum
Dense core bodies
48. What can hemochromatosis be secondary to...
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
3 waves/min
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
AST>ALT
49. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Serous on the sides parotids - mucinous in the middle sublingual
L/R renal artery around L1
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
Low pressure proximal to LES
50. What is contained within the muscularis externa
Diarrhea - steatorrhea - weight loss - weakness
Myenteric nerve plexus - aurbach
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Left gastric vein and esophogeal vein - esophagus