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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. Where is bicarb trapped
In the mucus that covers the gastric epithelium
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Below
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
2. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Menetriers disease
Crigler - najjar type 1
...
Dense core bodies
3. Where does crohns usually affect the GI tract
Inc - weight loss
Fasting and stress
Angiodysplasia
Terminal ileum and colon
4. What is pancreatic adenocarcinoma associated with
Cigarettes and chronic pancreatitis - not EtOH
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
5. Transmural esophageal rupture due to violent retching
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6. Cholecytsokinin - source - action - regulation
Female - fat - fertile - forty
Left and right gastroepiploics - left and right gastrics
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
Falciform - ligamentum teres - fetal umbilical vein
7. In an MI - which liver enzyme is elevated
AST
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Lye ingestion and acid reflux
Phototherapy
8. What does bicarb do in the duodenum
Juvenile polyposis syndrome - inc risk of adenocarcinoma
VZV and influenza B treated with salicylates
The submucosal nerve plexus - meissner's
Neutralizes gastric acid allowing pancreatic enzymes to fxn
9. What does TOASTED with alcoholic hepatitis stand for
Lubricate food (glycoprotiens)
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
US and cholecystectomy
AST >ALT - ration is usually 1.5
10. Where does an indirect inguinal hernia enter the deep inguinal ring
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Lateral to the inferior epigastric artery
Inc smooth muscle relaxation - including lower esophageal sphincter
Chronic gastritis and pernicious anemia
11. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Lactase is located at the tips of intestinal villi
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Nonkeritinized stratified sqamous epithelium
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
12. B cells stimuated in the germinal centers of peyers patches differentiate into what?
IgA secreting plasma cells - ultimately reside in the lamina proporia
Peptic ulcer disease
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Chronic gastritis and pernicious anemia
13. Who is at risk for pancreatic adenocarcinoma
Poor anastamoses
Uridine glucuronyl transferase
Jewish and African American men
Superior rectal and middle and inferior rectal - rectum
14. In PUD with a duodenal ulcer does pain inc or dec with meals
2ndary biliary cirrhosis
Decrease - weight gain
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
15. When and How does Abetalipoproteinemia present
Early childhood - neuro sx and malabsorption
Esophageal carcinoma
Averages 6 months - very aggressive - usually already metastasized at presentation
Celiac sprue
16. What causes carcinoid syndrome amd What are the symptoms
Virchow's node
Oral glucose
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
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
17. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Black - rotors syndrome
Splenic flexure
Corticosteroids - infliximab
Enterokinase/enteropeptidase from the duodenal mucosa
18. in budd chiari syndrome - Where is the congestion and necrosis
90%
Skip lesions =crohns - colon = UC
Centrilobular leading to congestive liver disease
Warthins' tumor
19. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
PAS- positive globules in liver -
Low pressure proximal to LES
Complications of crohns
Pleuroperitoneal
20. What kind of insults results in macronodular cirrhosis
Alfatoxin in peanuts
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
21. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Inferior rectal nerve
Unconj - absent (acholuria) - inc
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
22. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Early childhood - neuro sx and malabsorption
Peutz jeghers
Esophageal carcinoma
23. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Angiodysplasia
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Adhesion
24. What is charcot triad of cholangitis
Jaundice - fever - RUQ
Urobilin
HPNCC
All 3
25. Where does copper accumulate in Wilsons and What are ABCD
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Erosive - disruption of mucosal barrier leading to inflammation
Trypsin - chymotrypsin - elastase - carboxypeptidases
Goes through deep inguinal ring - external inguinal ring and into the scrotum
26. inflammatino of gallbadder
Common hepatic - splenic - left gastric - main blood supply for stomach
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Backup of blood into the liver - RHF - budd chiari
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
27. What serum enzyme is elevated inacute pancreatitis
H pylori (almost 100%)
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Lipase
Pyoderma gangrenosum - primary sclerosing cholangitis
28. What is contained within the muscularis externa
Myenteric nerve plexus - aurbach
Ischemic colitis
Mitochondrial abnl - fatty liver - hypoglycemia - coma
CEA - CA-19-9
29. What factors increase risk of malignancy of adenomatous polyps
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Via the middle colic
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
30. Failure of relaxation of lower esophageal sphincter - Name and etiology
Cimetidine
Old men - arthralgias - cardiac and neuro sx
Serous on the sides parotids - mucinous in the middle sublingual
Achalasia due to loss of myenteric plexus (auberach)
31. crigler - najjar type II responds to which therapy and How does it work
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Phenobarbital - inc liver enzyme synthesis
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Peptic ulcer disease
32. What transforms conjugated bilirubin to urobilinogen
Gut bacteria
Striated and smooth
Brunners
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
33. What are the extraintestinal manifestations of ulcerative colitis
Hypercoaguability - polycythemia vera - pregnancy - HCC
Pyoderma gangrenosum - primary sclerosing cholangitis
8-9 waves/min
Mucosa - submucosa - muscularis externa - serosa/adventitia
34. rare - often fatal childhood hepatoencephalopathy
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35. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Positive
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
Gilbert's
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
36. Achalasia can be secondary to what infectious disease common in South America
Heme metabolism
Phenobarbital - inc liver enzyme synthesis
Chagas disease
Mitochondrial abnl - fatty liver - hypoglycemia - coma
37. What are the structures of the femoral triangle and how are they organized
Pleomorphic adenoma
Hirschsprungs
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
NAV = nerve artery vein - venous near the penis (NAVEL)
38. What are the extraintestinal manifestations of crohns
Inc risk of CRC and other visceral malignancies
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Adhesion
Crohns = noncaseating granulomas - UC = crypt abscesses
39. What is the arterial supply and venous drainage below pectinate line
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Budd chiari syndrome
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Alk pho
40. What are the histological findings in the duodenum
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41. What causes nutmeg liver
Necrotizing enterocolitis
Backup of blood into the liver - RHF - budd chiari
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
No
42. If trypsin activates more trypsinogen - what kind of feedback loop is established
Alk phos
Positive
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
43. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Stimulate intestinal persistalsis
L1
Terminal ileum and colon
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
44. What retroperitoneal structure flanks both sides of the pancreas on CT
Hyperplastic
HSV-1 - CMV - Candida
Jewish and African American men
Duodenum - 2nd - 3rd and 4th parts
45. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Gilbert's
Hernia
L4
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
46. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
GERD - may also present with nocturnal cough and dyspnea
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
NAV = nerve artery vein - venous near the penis (NAVEL)
Positive urease test
47. What do the rugae of stomach look like in menetriers disease
Chronic gastritis and pernicious anemia
Inferior rectal nerve
So hypertrophied they look like brain gyri
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
48. most common non - neoplastic polyp in colon
Hyperplastic
Around the central vein (zone III)
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
49. Why does indirect inguinal hernia happen in infacnts
Warthins' tumor
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Boerhaave's Syndrome - Been heaving syndrome
Failure of the processus vagainlis to close
50. With internal hemorrhoids Where is the anastomoses and Where is it
Low pressure proximal to LES
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Superior rectal and middle and inferior rectal - rectum
Pleomorphic adenoma