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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 source of salivary secretion is the most serous and What is the most mucinous
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Serous on the sides parotids - mucinous in the middle sublingual
Hepatic steatosis
Dissaccharidase def - most commonly lactase
2. Between what structures do strong anastamoses exist
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Hypercoaguability - polycythemia vera - pregnancy - HCC
Meckels
Left and right gastroepiploics - left and right gastrics
3. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Hirschsprungs
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Diverticulum
Alfatoxin in peanuts
4. When and How does Abetalipoproteinemia present
L3
Esophageal varices
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Early childhood - neuro sx and malabsorption
5. What does loss of p53 cause
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Increase tumorigenesis
Jewish and African American men
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
6. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Complications of UC
Zenkers - halitosis - dysphagia and obstruction
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
7. What does bicab do in the mouth
Hemolytic anemia
Neutralizes oral bacertial acids and maintains dental health
The entire
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
8. involvement of left supraclavicular node by mets from stomach
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9. What histological findings are present in the stomach
Inguninal ligament - sartorius muscle - adductor longus
Lye ingestion and acid reflux
Gastric glands
Hernia
10. What layer in the mucosa is repsonsible for motility
Muscularis mucosae
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Lipase - phospholipase A - colipase
Small intestine
11. What is the frequency of basal electric rhythm of the stomach
Inguninal ligament - sartorius muscle - adductor longus
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
3 waves/min
12. What do tumors that arise in the head of the pancreas cause
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
VZV and influenza B treated with salicylates
Obstruction of the common bile duct
13. In alchoholic hepatitis which liver enzyme is higher
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Enterokinase/enteropeptidase from the duodenal mucosa
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
AST>ALT
14. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Can lead to hematemesis - found in EtOHics and bulimics
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Osmotic
15. What is the prognosis of adenocarcinoma
Esophageal cancer
H pylori (almost 100%)
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Averages 6 months - very aggressive - usually already metastasized at presentation
16. What portion of the bowel does sprue effect
Goes through deep inguinal ring - external inguinal ring and into the scrotum
The proximal small bowel
Meckels
Fe2+ in the duod
17. What structure is Not contained in the femoral sheath
CCK8 receptor - Gq inc IP3/Ca
Alk pho
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Uremia
18. How do you DX and TX gallstones
US and cholecystectomy
Intussusception
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Normal
19. How does CRC present in the distal and proximal colon
CCK8 receptor - Gq inc IP3/Ca
Primary sclerosing cholangitis
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
The jejunum
20. Where are peyers patches found
Antrum - H.pylori - inc risk of MALT lymphoma
Lamina propora and submucosa
Lipase
Cimetidine
21. in carcinoid tumors - What is seen on EM
Chagas disease
L4
Dense core bodies
Cirrhosis
22. FAP + malignant CNS tumor
Turcot
90%
Cimetidine
Gut bacteria
23. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Jewish and African American men
Tropical sprue
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
24. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Unconjugated - water insoluble
Heme metabolism
Crohns = maybe - UC= always
Oligosaccharide digestion
25. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Pleomorphic adenoma
AR
Juvenille polyps - no risk if single
Necrotizing enterocolitis
26. What are the two molecular pathways that lead to CRC
Fe2+ in the duod
US and cholecystectomy
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Uremia
27. What test and result confirms H pylori infxn
Stimulate the H/K ATPase
Jaundice - fever - RUQ
Positive urease test
In the ileum with bile acids - requires IF
28. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Causes of gall stones
Duodenum - 2nd - 3rd and 4th parts
Dysphagia (due to esophageal web) - glossitis - iron def anemia
29. What causes nutmeg liver
Redundant mesentary
Backup of blood into the liver - RHF - budd chiari
Pancreatic and bile
Hernia
30. Malabsorption syndromes have what common clinical presentation
Osmotic
L3
Diarrhea - steatorrhea - weight loss - weakness
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
31. What are the borders of Hesselbach's triangle
Decrease - weight gain
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
32. What are the signs and symptoms of budd chiari
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Angiodysplasia
Striated
33. Transmural esophageal rupture due to violent retching
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34. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Hypotonic because of more time to reabsorb NaCl
Phenobarbital - inc liver enzyme synthesis
HPNCC
35. What are the foregut structures and what supplies their blood and PANS innvervation
Portal HTN
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Sphincter of oddi
36. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Decreased intercellular adhesion and increased proliferation
Hirschsprungs
MSI (15%) and APC/beta catenin chromosomal instability (85%)
IBS at least 2 with recurrent abdominal pain
37. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Brunners
Peptic ulcer disease
GERD - may also present with nocturnal cough and dyspnea
Averages 6 months - very aggressive - usually already metastasized at presentation
38. What kind of pathways do CCK act on to cause pancreatic secretion
Neural muscarinic pathways
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
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
3 waves/min
39. What artery passes around the duodenum
The gastroduodenal
Sphincter of oddi
Can lead to hematemesis - found in EtOHics and bulimics
EtOH
40. What is the presenting course for appendicity
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41. vasoactive intestinal polypeptide (VIP) - source - action - regulation
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Causes of gall stones
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
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
42. Through which aspect of the inguinal canal does a direct inguinal go
Hyperpigmented mouth - lips - hands - genitalia
Pleomorphic adenoma
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
External (superficial) ring only
43. What are motilin receptor agonists used for clinically
Ceruplasmin
Stimulate intestinal persistalsis
Urobilin
Gut bacteria
44. With internal hemorrhoids Where is the anastomoses and Where is it
Peptic ulcer disease
Hypotonic because of more time to reabsorb NaCl
Superior rectal and middle and inferior rectal - rectum
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
45. Dysphagia in achalasia results from
Left gastric vein and esophogeal vein - esophagus
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
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
ALT>AST
46. What are the barium swallow findings of achalasia
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Dilated esophagus with an area of distal stenosis - birds beak
Conj - inc - dec
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
47. What factors increase risk of malignancy of adenomatous polyps
Muscularis mucosae
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Primary sclerosing cholangitis
48. Which IBD is autoimmune and which may be a disordered response to bacteria
Peutz jeghers
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Muscularis mucosae
Enterokinase/enteropeptidase from the duodenal mucosa
49. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Hypercoaguability - polycythemia vera - pregnancy - HCC
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Uridine glucuronyl transferase
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
50. What skin condition is associated with celiac sprue
Dermatitis herpetiformis
Gallbladder
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Colonic polyps