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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 results of hemochromatosis
CHF and inc risk of HCC
Small intestine
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Upregulated intracellular signal transduction
2. If the abdominal aorta is blocked - How does blood get to the left colic artery
Via the middle colic
Celiac sprue
Crigler - najjar type 1
Old men - arthralgias - cardiac and neuro sx
3. Bile is critical for exrection of what substance
Cholesterol
Bleeding - intussusception - volvulus - obstruction near terminal ileum
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Osmotic
4. HCC is associated with what other conditions
Begins starch digestion - inactivated by low pH upon reaching the stomach
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
5. motilin - source - action - regulation
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Adhesion
Gallbladder
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
6. What structures feed into the common bile duct
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Dilated esophagus with an area of distal stenosis - birds beak
Cystic duct and common hepatic duct
No
7. trypsinogen is converted to trypsin via what enzyme
Left and right gastroepiploics - left and right gastrics
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Phenobarbital - inc liver enzyme synthesis
Enterokinase/enteropeptidase from the duodenal mucosa
8. What is the rule of 2s for meckels
Fe2+ in the duod
Uremia
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Neural muscarinic pathways
9. What is the clinical presentation of acute pancreatitis
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Epigastric abdominal pain radiating to back - anorexia - nausea
10. What is biliary colic
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Falciform - ligamentum teres - fetal umbilical vein
CCK8 receptor - Gq inc IP3/Ca
11. What layer of fascia covers a direct inguinal hernia
External spermatic fascia only
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Dilated esophagus with an area of distal stenosis - birds beak
Pancreatic head causing obstructive jaundice
12. Between what structures do strong anastamoses exist
Failure of the processus vagainlis to close
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Zollinger ellison - brunners glands
Left and right gastroepiploics - left and right gastrics
13. vasoactive intestinal polypeptide (VIP) - source - action - regulation
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
Upregulated intracellular signal transduction
Spleen to posterior abdominal wall - splenic artery and vein
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
14. What is the leading cause of bowel incarceration
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Alk phos
Femoral hernia
Lateral
15. What does TOASTED with alcoholic hepatitis stand for
Diarrhea - steatorrhea - weight loss - weakness
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Enterokinase/enteropeptidase from the duodenal mucosa
AST >ALT - ration is usually 1.5
16. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Esophageal carcinoma
US and cholecystectomy
Conj/unconj - inc - nl to dec
Heme metabolism
17. multiple juvenil polyps in GI tract - risk
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Juvenile polyposis syndrome - inc risk of adenocarcinoma
L/R renal artery around L1
18. Where does an indirect inguinal hernia enter the deep inguinal ring
Urobilin
Lateral to the inferior epigastric artery
Begins starch digestion - inactivated by low pH upon reaching the stomach
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
19. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
GERD - may also present with nocturnal cough and dyspnea
Cirrhosis
Zollinger ellison - brunners glands
20. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Mucoepidermoid carcinoma
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
Dissaccharidase def - most commonly lactase
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
21. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
AST >ALT - ration is usually 1.5
The jejunum
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
US and cholecystectomy
22. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Meconium ileus
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
Brunners
Elevated amylase - and lipase
23. What receptors does ACH bind on the parietal cells and What does it activate
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Averages 6 months - very aggressive - usually already metastasized at presentation
Pleuroperitoneal
M3 - Gq - inc IP3/Ca
24. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Lipase
25. somatostatin - source - action - regulation
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
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Inc risk of CRC and other visceral malignancies
Penicillinamine - AR inheritance
26. What is the ddx associated with appendicitis
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Warthins' tumor
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Diverticulitis in elderly - ectopic pregs use hCG to rule out
27. most common non - neoplastic polyp in colon
90%
Failure of neural crest migration
Hyperplastic
Hydrocele
28. What kind of lesions are characteristic of duodenal PUD vs cancer
Punched out - clean margins - carcinoma =raised irregular margins
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Intussusception
Esophageal cancer
29. What enzyme is necessary to create conjugated bilirubin
Decreased intercellular adhesion and increased proliferation
Uridine glucuronyl transferase
Pyoderma gangrenosum - primary sclerosing cholangitis
PAS- positive globules in liver -
30. What does a gastrinoma cause
Where hindgut meets ectoderm
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
31. What are the signs of peutz jehgers
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Dec PGE2 leading to dec gastric mucosa protection
Hyperpigmented mouth - lips - hands - genitalia
Increase tumorigenesis
32. involvement of left supraclavicular node by mets from stomach
33. How does hirschsprung present and appear on imaging
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
Superior rectal
Short gastrics - left greater and lesser
Dilated esophagus with an area of distal stenosis - birds beak
34. Where and How is iron absorbed
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Fe2+ in the duod
8-9 waves/min
Erosive - disruption of mucosal barrier leading to inflammation
35. What receptor does histamine bind on the parietal cell and What does it activate
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
H2 receptor - inc cAMP
Dense core bodies
Sphincter of oddi
36. malnutrition - toxic megacolon - colorectal carcinoma
Portal HTN
Via the middle colic
Complications of UC
Penicillinamine - AR inheritance
37. How is salivary secretion stimulated
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Unconj - absent (acholuria) - inc
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Mitochondrial abnl - fatty liver - hypoglycemia - coma
38. How do villi appear in disaccharidease def
Lamina propria
Normal
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
No
39. Gallstones that reach the common channel at ampulla can block which two ducts
Pancreatic and bile
Neutralizes gastric acid allowing pancreatic enzymes to fxn
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Boerhaave's Syndrome - Been heaving syndrome
40. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Lipase - phospholipase A - colipase
Via the superior pancreaticduodenal
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
41. What intervention will intervention will relieve portal HTN
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Lamina propria
Meckels
Erosive - disruption of mucosal barrier leading to inflammation
42. FAP + osseous and soft tissue tumors - retinal hyperplasia
43. Where are peyers patches found
Lamina propora and submucosa
Crigler - najjar type 1
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Internal thoracic to superior epigastric to inferior epigastric
44. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Esophageal cancer
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
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
45. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
2ndary biliary cirrhosis
Portal HTN
EtOH
Left and right gastroepiploics - left and right gastrics
46. What is the action of NO as a GI hormone
Cystic duct and common hepatic duct
Inc smooth muscle relaxation - including lower esophageal sphincter
Causes of gall stones
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
47. What skin condition is associated with celiac sprue
Redundant mesentary
Left and right gastroepiploics - left and right gastrics
Dermatitis herpetiformis
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
48. How do burns cause acute gastritis and What is it called
49. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Stercobilin
Pancreatic and bile
Hemosiderosis - hemochromatosis
Gallbladder
50. With internal hemorrhoids Where is the anastomoses and Where is it
So hypertrophied they look like brain gyri
Superior rectal and middle and inferior rectal - rectum
Antrum - H.pylori - inc risk of MALT lymphoma
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament