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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. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Conj/unconj - inc - nl to dec
Squamous - upper 1/3 - adeno - lower 1/3
Muscularis mucosae
Budd chiari syndrome
2. Which serum enzyme increases with heavy EtOH consumption
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Redundant mesentary
Repeated phlebotomy - deferoxamine - HLA- A3
Gamma glutamyl transferase GGT
3. What are the tumor markers for pancreatic adenocarcinoma
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Neural muscarinic pathways
CEA - CA-19-9
4. What is the most common esophageal cancer worldwide and in the US
Source - S cells (duod) - action - inc pancreatic bicarb secretion - dec gastric acid secretin - inc bile secretion - regulation - inc by acid - fatty acids in lumen of duod
Worldwide - SC - US - adeno
Appendicitis
Redness and tenderness on palpation of extremities
5. Autoantibodies to gluten (gliadin) in wheat and other grains
Brush border of intestine - produce monosaccharides from oligo and di
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Celiac sprue
All 3
6. subQ peribumbilical metastasis
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Low pressure proximal to LES
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Sister mary joseph nodule
7. What is Trousseau's sign
Dermatitis herpetiformis
Redness and tenderness on palpation of extremities
Stercobilin
H+
8. Where does type A chronic gastritis occur and What causes it
HPNCC
Peutz jeghers
Peptic ulcer disease
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
9. rare - often fatal childhood hepatoencephalopathy
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10. What separates the right greater and lesser sacs
Positive
Gastrohepatic ligament
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Pancreatic and bile
11. What kind of anemia is in Wilsons
Hemolytic anemia
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Reye's syndrome
12. Where does crohns usually affect the GI tract
Terminal ileum and colon
Celiac sprue
ALT>AST
Bleeding - intussusception - volvulus - obstruction near terminal ileum
13. In viral hepatitis - which liver enzyme is higher
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Hydrocele
ALT>AST
Peptic ulcer disease
14. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Oral glucose
Brunners
CEA - CA-19-9
15. What is the most common indication of emergent abdominal surgery in children
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Urobilin
Appendicitis
Erosive - disruption of mucosal barrier leading to inflammation
16. What does the splenorenal ligament connect - and What does it contain
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Backup of blood into the liver - RHF - budd chiari
Spleen to posterior abdominal wall - splenic artery and vein
Repeated phlebotomy - deferoxamine - HLA- A3
17. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Via the middle colic
Inc risk of CRC and other visceral malignancies
Black - rotors syndrome
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
18. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
External (superficial) ring only
Alcoholic hepatitis
Esophageal carcinoma
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
19. How do you DX and TX gallstones
Pancreatic head causing obstructive jaundice
US and cholecystectomy
Dense core bodies
Worldwide - SC - US - adeno
20. In an MI - which liver enzyme is elevated
AST
Enterokinase/enteropeptidase from the duodenal mucosa
Superior rectal
Glucouronate - water soluble (direct)
21. What parts of the small bowel can tropical sprue effect
The entire
Gut bacteria
So hypertrophied they look like brain gyri
Normal
22. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Mucoepidermoid carcinoma
Crohns = maybe - UC= always
Necrotizing enterocolitis
23. In PUD - with gastric ulcers - does pain inc or dec with meals?
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Inc - weight loss
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
24. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
Punched out - clean margins - carcinoma =raised irregular margins
...
Peutz jeghers
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
25. If trypsin activates more trypsinogen - what kind of feedback loop is established
The proximal small bowel
Positive
Phototherapy
Meckels
26. What is the classic triad of hemochromatosis
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27. 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
Crypts but not villi
Cystic dilation of the viteline duct
Skip lesions =crohns - colon = UC
Hyperplastic
28. What are motilin receptor agonists used for clinically
Stimulate intestinal persistalsis
Splenic flexure
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Averages 6 months - very aggressive - usually already metastasized at presentation
29. What infection causes Whipple disease and What can you see on LM
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
IBS at least 2 with recurrent abdominal pain
Crohns = noncaseating granulomas - UC = crypt abscesses
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
30. FAP + osseous and soft tissue tumors - retinal hyperplasia
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31. What is pancreatic adenocarcinoma associated with
Parietal cells in the stomach - B12 binding protein
Elevated amylase - and lipase
Cigarettes and chronic pancreatitis - not EtOH
Superior rectal and middle and inferior rectal - rectum
32. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Oligosaccharide digestion
Corticosteroids - infliximab
33. What artery passes around the duodenum
Sphincter of oddi
Lateral to the inferior epigastric artery
The gastroduodenal
Downs
34. What is the most common diaphragmatic hernia and What are the two types
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Gut bacteria
Upregulated intracellular signal transduction
Skip lesions =crohns - colon = UC
35. What does loss of p53 cause
Striated and smooth
Myenteric nerve plexus - aurbach
Above
Increase tumorigenesis
36. What are the structures of the femoral triangle and how are they organized
Inguninal ligament - sartorius muscle - adductor longus
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
NAV = nerve artery vein - venous near the penis (NAVEL)
Inc - weight loss
37. What is the rate limiting step of carbohydrate digestion
Myenteric nerve plexus - aurbach
Oligosaccharide digestion
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
38. most common non - neoplastic polyp in colon
Epigastric abdominal pain radiating to back - anorexia - nausea
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Hyperplastic
Inguninal ligament - sartorius muscle - adductor longus
39. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Adhesion
Causes of gall stones
Alpha amylase
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
40. When do you see hypertrophy of brunners glands
Peptic ulcer disease
The proximal small bowel
Lipase - phospholipase A - colipase
HPNCC
41. What complication can arise from indirect inguinal hernias
Carcinoid syndrome
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Hydrocele
42. What arteries exit just below the SMA
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Neutralizes oral bacertial acids and maintains dental health
L/R renal artery around L1
IBS at least 2 with recurrent abdominal pain
43. What does a gastrinoma cause
The jejunum
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
44. How do burns cause acute gastritis and What is it called
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45. What histological findings are present in the stomach
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Gastric glands
Menetriers disease
Crohns = maybe - UC= always
46. What source of salivary secretion is the most serous and What is the most mucinous
Serous on the sides parotids - mucinous in the middle sublingual
AST >ALT - ration is usually 1.5
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
47. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Striated and smooth
IBS at least 2 with recurrent abdominal pain
Internal thoracic to superior epigastric to inferior epigastric
Pleomorphic adenoma
48. what percentage of colonic polyps are non - neoplastic
Left and right gastroepiploics - left and right gastrics
90%
L3
Hyperpigmented mouth - lips - hands - genitalia
49. What are the layers of the gut wall from inside out
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Mucosa - submucosa - muscularis externa - serosa/adventitia
Inc smooth muscle relaxation - including lower esophageal sphincter
So hypertrophied they look like brain gyri
50. What can hemochromatosis be secondary to...
Hemolytic anemia
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Squamous - upper 1/3 - adeno - lower 1/3