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Test your basic knowledge |
USMLE GI
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Subjects
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health-sciences
,
usmle
Instructions:
Answer 50 questions in 15 minutes.
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study here
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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 arteries exit just below the SMA
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Dermatitis herpetiformis
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
L/R renal artery around L1
2. Where is the pectinate line
Mucoepidermoid carcinoma
Where hindgut meets ectoderm
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Amylase
3. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Krukenbergs tumor
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Omeprazole
4. What makes a true diverticula
In the ileum with bile acids - requires IF
All 3 gut layers outpouch as in Meckels
AST >ALT - ration is usually 1.5
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
5. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Hirschsprungs
6. Why are most diverticula considered false
Cimetidine
90%
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Dermatitis herpetiformis
7. What kind of insults results in macronodular cirrhosis
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Splenic flexure
Failure of neural crest migration
Via the superior pancreaticduodenal
8. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Meckels
Lactase is located at the tips of intestinal villi
Squamous - upper 1/3 - adeno - lower 1/3
Lipase - phospholipase A - colipase
9. What separates the right greater and lesser sacs
Cholesterol
Gastrohepatic ligament
Paraumbilical and superficial and inferior epigastric - umbilicus
Zollinger ellison - brunners glands
10. Where and How is iron absorbed
Fe2+ in the duod
Meckels
L2
Lactase is located at the tips of intestinal villi
11. Dysphagia in achalasia results from
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Meckels
Normal
CHF and inc risk of HCC
12. What does GET SMASHED stand for in acute pancreatitis
Spleen to posterior abdominal wall - splenic artery and vein
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Via the superior pancreaticduodenal
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
13. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Lipase - phospholipase A - colipase
Esophageal cancer
Esophageal varices
Crohns = maybe - UC= always
14. What are the labs in acute pancreatitis
Old men - arthralgias - cardiac and neuro sx
Lye ingestion and acid reflux
Complications of crohns
Elevated amylase - and lipase
15. What retroperitoneal structure flanks both sides of the pancreas on CT
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Duodenum - 2nd - 3rd and 4th parts
Hyperplastic
16. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Female - fat - fertile - forty
Adhesion
17. What kind of digestion is bile needed for
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
External (superficial) ring only
Upregulated intracellular signal transduction
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
18. How do villi appear in disaccharidease def
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Increase tumorigenesis
Normal
Via the middle colic
19. What does autoimmune destruction of parietal cells lead to...
Omeprazole
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Chronic gastritis and pernicious anemia
20. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Colonic polyps
Nonkeritinized stratified sqamous epithelium
Antrum - H.pylori - inc risk of MALT lymphoma
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
21. Where is bicarb trapped
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
In the mucus that covers the gastric epithelium
Hyperpigmented mouth - lips - hands - genitalia
Diverticulitis in elderly - ectopic pregs use hCG to rule out
22. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
Femoral hernia
FAP
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
23. What percentage of gall stones are cholesterol stones and What are the associations
Lactase is located at the tips of intestinal villi
Complications of UC
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Copious diarrhea - non alpha - non beta cell pancreatic tumor
24. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus
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25. What does histo show for alpha1 antitrypsin def
Left gastric vein and esophogeal vein - esophagus
PAS- positive globules in liver -
Normal
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
26. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Esophageal varices
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
27. What does high flow rate mean
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Closer to isotonic because of less time to reabsorb NaCl
T cell lymphoma
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
28. What are the signs of peutz jehgers
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Meconium ileus
Hyperpigmented mouth - lips - hands - genitalia
29. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Enterokinase/enteropeptidase from the duodenal mucosa
Omeprazole
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Inc conj bilirubin - inc cholesterol - inc alk phos
30. absent UDPGT - presents early in life - early mortality
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Crigler - najjar type 1
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Duodenum - 2nd - 3rd and 4th parts
31. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Inguninal ligament - sartorius muscle - adductor longus
32. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue
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33. What congenital birth defect is associated with Hirschsprung
Downs
Meconium ileus
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Stimulate intestinal persistalsis
34. At what level do the testicular/ovarian arteries exit the aorta
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Femoral hernia
Angiodysplasia
L2
35. Where are oligosaccharide hydrolases and What do they do
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Short gastrics - left greater and lesser
L3
Brush border of intestine - produce monosaccharides from oligo and di
36. FAP + malignant CNS tumor
Turcot
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Centrilobular leading to congestive liver disease
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
37. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
H+
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Below
38. What causes primary biliary cirrhosis
Myenteric nerve plexus - aurbach
Uremia
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
39. What is the action of NO as a GI hormone
Lipase - phospholipase A - colipase
Older patients
Oligosaccharide digestion
Inc smooth muscle relaxation - including lower esophageal sphincter
40. Achalasia can be secondary to what infectious disease common in South America
12 waves/min
HSV-1 - CMV - Candida
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Chagas disease
41. At what spinal level does the is the bifurcation of aorta
External (superficial) ring only
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
L4
42. Gq and inc cAMP both work to do what in parietal cells
90%
Phototherapy
Stimulate the H/K ATPase
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
43. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Crohns = noncaseating granulomas - UC = crypt abscesses
CEA - CA-19-9
Meconium ileus
Inguninal ligament - sartorius muscle - adductor longus
44. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Pyoderma gangrenosum - primary sclerosing cholangitis
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Muscularis mucosae
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
45. What histological findings are present in the esophagus
Complications of crohns
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Alk phos
Nonkeritinized stratified sqamous epithelium
46. Esophagitis can result From which 3 infectious agents - or chemical ingestion
So hypertrophied they look like brain gyri
Adhesion
HSV-1 - CMV - Candida
Superior rectal and middle and inferior rectal - rectum
47. What kind of lesions are characteristic of duodenal PUD vs cancer
Lamina propria
Punched out - clean margins - carcinoma =raised irregular margins
Redundant mesentary
Unconj - absent (acholuria) - inc
48. What kind of anemia is in Wilsons
Antrum - H.pylori - inc risk of MALT lymphoma
Hemolytic anemia
Dec PGE2 leading to dec gastric mucosa protection
Inc conj bilirubin - inc cholesterol - inc alk phos
49. What serum enzyme is elevated in acute pancreatitis and mumps
Amylase
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
L4
T cell lymphoma
50. What are the common causes of gastric ulcers - What causes gastric ulcer
Right and left hepatic duct
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Serous on the sides parotids - mucinous in the middle sublingual
Primarly through ECL leading to histamine release
Sorry!:) No result found.
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