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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 serum enzyme is elevated inacute pancreatitis
Failure of the processus vagainlis to close
Lipase
Cirrhosis
Diarrhea - steatorrhea - weight loss - weakness
2. occlusion of IVC or hepatic veins
Budd chiari syndrome
3 waves/min
Around the central vein (zone III)
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
3. What cells secrete bicarb - What does it do - and what regulates it
Centrilobular leading to congestive liver disease
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
MSI (15%) and APC/beta catenin chromosomal instability (85%)
4. When and How does Abetalipoproteinemia present
Ischemic colitis
Downs
Early childhood - neuro sx and malabsorption
Conj - inc - dec
5. what kind of fistula is associated with diverticulitis
Colovesical leading to pneumaturia
L2
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Phenobarbital - inc liver enzyme synthesis
6. secretin - source - action - regulation
Urobilin
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
Krukenbergs tumor
Via the middle colic
7. trypsinogen is converted to trypsin via what enzyme
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Enterokinase/enteropeptidase from the duodenal mucosa
T cell lymphoma
AST>ALT
8. conjugated hyperbilirubinemia due to defective liver excretion
Internal thoracic to superior epigastric to inferior epigastric
Esophageal carcinoma
Trypsin - chymotrypsin - elastase - carboxypeptidases
Dubin johnson
9. What are the branches of the celiac trunk and What do they supply
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Common hepatic - splenic - left gastric - main blood supply for stomach
Pleomorphic adenoma
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
10. Why does carcinoid syndrome not occur if tumor is confined to GI system
Liver metabolizes 5HT
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
11. What structures feed into the common bile duct
Stercobilin
Cystic duct and common hepatic duct
Short gastrics - left greater and lesser
L2
12. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
Redness and tenderness on palpation of extremities
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
...
Punched out - clean margins - carcinoma =raised irregular margins
13. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Warthins' tumor
Right and left hepatic duct
Conj/unconj - inc - nl to dec
T12
14. concentric onion skin bile duct fibrosis
Closer to isotonic because of less time to reabsorb NaCl
Primary sclerosing cholangitis
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Obstruction of the common bile duct
15. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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16. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Gallbladder
Cirrhosis
Portal HTN
Alk pho
17. What can fistula between the gallbladder and small intestine create and how can you tell
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
GERD - may also present with nocturnal cough and dyspnea
Parietal cells in the stomach - B12 binding protein
Complications of UC
18. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Downs
Causes of gall stones
Glucouronate - water soluble (direct)
Left and right gastroepiploics - left and right gastrics
19. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Esophageal varices
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Backup of blood into the liver - RHF - budd chiari
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
20. What is the triad of Plummer - Vinson syndrome
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Dysphagia (due to esophageal web) - glossitis - iron def anemia
CEA - CA-19-9
Dense core bodies
21. What causes pancreatic insuff and What does it cause
Trypsin - chymotrypsin - elastase - carboxypeptidases
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Hypotonic because of more time to reabsorb NaCl
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
22. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Striated and smooth
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Closer to isotonic because of less time to reabsorb NaCl
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
23. FAP + osseous and soft tissue tumors - retinal hyperplasia
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24. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Jewish and African American men
Meconium ileus
Meckels
Peutz jeghers
25. What nerve innervates the external hemorrhoids
Above
90%
Inferior rectal nerve
CHF and inc risk of HCC
26. Which viral infxns/treatments are associated with reyes syndrome
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Colovesical leading to pneumaturia
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
VZV and influenza B treated with salicylates
27. How do NSAIDs cause acute gastritis
Female - fat - fertile - forty
Dec PGE2 leading to dec gastric mucosa protection
Inc conj bilirubin - inc cholesterol - inc alk phos
Inguninal ligament - sartorius muscle - adductor longus
28. At what level of the spine does the IM exit the aorta
Lipase
L3
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
29. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Brush border of intestine - produce monosaccharides from oligo and di
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Cholesterol - 10-20% opaque due to calcifications
30. Where is B12 absorbed
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Lamina propora and submucosa
Low pressure proximal to LES
In the ileum with bile acids - requires IF
31. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Zollinger Ellison - phenylalanine and tryptophan
Striated
All 3
Normal
32. What kind of pathways do CCK act on to cause pancreatic secretion
Neural muscarinic pathways
H2 receptor - inc cAMP
Celiac sprue
Internal thoracic to superior epigastric to inferior epigastric
33. subQ peribumbilical metastasis
Turcot
Gastric glands
Sister mary joseph nodule
Hepatic steatosis
34. What do the rugae of stomach look like in menetriers disease
Normal
Phenobarbital - inc liver enzyme synthesis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
So hypertrophied they look like brain gyri
35. motilin - source - action - regulation
Averages 6 months - very aggressive - usually already metastasized at presentation
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Oligosaccharide digestion
Dissaccharidase def - most commonly lactase
36. What are the extraintestinal manifestations of ulcerative colitis
VZV and influenza B treated with salicylates
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Pyoderma gangrenosum - primary sclerosing cholangitis
H+
37. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Peyers patches
Right and left hepatic duct
Liver metabolizes 5HT
EtOH
38. What is charcot triad of cholangitis
External (superficial) ring only
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Jaundice - fever - RUQ
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
39. What are the midgut structures and what supplies their blood and PANS innervation
Pleomorphic adenoma
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Hyperpigmented mouth - lips - hands - genitalia
Pleuroperitoneal
40. What are the ABCDEF of esophageal cancer
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Diverticulum
41. Where are tumors commonly in pancreatic adenocarcinoma
Bleeding - penetration into pancreas - perforation - obstruction
Pancreatic head causing obstructive jaundice
Corticosteroids - infliximab
Gamma glutamyl transferase GGT
42. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
External (superficial) ring only
Gut bacteria
Budd chiari syndrome
Alcoholic cirrhosis
43. What is the rate limiting step of carbohydrate digestion
2ndary biliary cirrhosis
Hemosiderosis - hemochromatosis
Oligosaccharide digestion
VZV and influenza B treated with salicylates
44. What cell produces IF and What does it do
Parietal cells in the stomach - B12 binding protein
Left gastric vein and esophogeal vein - esophagus
Lubricate food (glycoprotiens)
L4
45. What structure is Not contained in the femoral sheath
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
No
46. Where is the deep inguinal ring relative to the inferior epigastric vessels
Achalasia due to loss of myenteric plexus (auberach)
Lateral
Older patients
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
47. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
With albumin
Left gastric vein and esophogeal vein - esophagus
Lye ingestion and acid reflux
Chagas disease
48. involvement of left supraclavicular node by mets from stomach
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49. What layer in the mucosa is responsible for support
Alpha amylase
Lamina propria
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Right and left hepatic duct
50. What causes primary biliary cirrhosis
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Sphincter of oddi
Early childhood - neuro sx and malabsorption