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Test your basic knowledge |
USMLE GI
Start Test
Study First
Subjects
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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 are the branches of the celiac trunk and What do they supply
Decreased intercellular adhesion and increased proliferation
Common hepatic - splenic - left gastric - main blood supply for stomach
Crohns = noncaseating granulomas - UC = crypt abscesses
Erosive - disruption of mucosal barrier leading to inflammation
2. What is diverticulosis
Inferior rectal nerve
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
The proximal small bowel
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
3. In an MI - which liver enzyme is elevated
AST
Where hindgut meets ectoderm
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Dense core bodies
4. What is the epi for CRC
Lamina propria
External (superficial) ring only
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
5. How is salivary secretion stimulated
EtOH
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Adhesion
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
6. With caput medusaw - between what vessels is the anastomoses and Where is it
Backup of blood into the liver - RHF - budd chiari
Paraumbilical and superficial and inferior epigastric - umbilicus
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
7. What is Trousseau's sign
Redness and tenderness on palpation of extremities
Superior rectal and middle and inferior rectal - rectum
Juvenille polyps - no risk if single
Neutralizes gastric acid allowing pancreatic enzymes to fxn
8. A protrusion of peritoneum through an opening - usually a site of weakness
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Liver metabolizes 5HT
Hernia
Causes of gall stones
9. What is the clinical presentation of acute pancreatitis
Hemosiderosis - hemochromatosis
Epigastric abdominal pain radiating to back - anorexia - nausea
Crypts but not villi
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
10. Achalasia can be secondary to what infectious disease common in South America
Chagas disease
Conj/unconj - inc - nl to dec
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
11. If the abdominal aorta is blocked - How does blood get to the left colic artery
Esophageal cancer
Via the middle colic
Around the central vein (zone III)
Gamma glutamyl transferase GGT
12. What do tumors that arise in the head of the pancreas cause
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Pertechnetate - study for uptake
Obstruction of the common bile duct
13. What is the HLA association and treatment for hemochromatosis
IBS at least 2 with recurrent abdominal pain
Failure of neural crest migration
Gamma glutamyl transferase GGT
Repeated phlebotomy - deferoxamine - HLA- A3
14. What does extrahepatic biliary obstruction cause
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
15. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Cirrhosis
GLUT 2
Boerhaave's Syndrome - Been heaving syndrome
Lye ingestion and acid reflux
16. How does abetalipoproteinemia lead to malabsorption
Closer to isotonic because of less time to reabsorb NaCl
Gallbladder
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
17. What is the rule of 2s for meckels
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Cigarettes and chronic pancreatitis - not EtOH
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
18. bilateral mets to ovaries with abundant mucus - signet ring cells
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Crigler - najjar type 1
Esophageal carcinoma
Krukenbergs tumor
19. What are the borders of Hesselbach's triangle
Elevated amylase - and lipase
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Cirrhosis
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
20. Where does crohns usually affect the GI tract
Elevated amylase - and lipase
Terminal ileum and colon
The entire
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
21. Why does indirect inguinal hernia happen in infacnts
Via the superior pancreaticduodenal
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Early childhood - neuro sx and malabsorption
Failure of the processus vagainlis to close
22. motilin - source - action - regulation
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Smooth
23. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Chagas disease
In the mucus that covers the gastric epithelium
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
24. What do the rugae of stomach look like in menetriers disease
So hypertrophied they look like brain gyri
External (superficial) ring only
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Lactase is located at the tips of intestinal villi
25. What is a positive murphy's sign
Inspiratory arrest on deep palpation due to pain
Phototherapy
Dermatitis herpetiformis
Antrum - H.pylori - inc risk of MALT lymphoma
26. Which patients have pigment stones
Superior rectal and middle and inferior rectal - rectum
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Brush border of intestine - produce monosaccharides from oligo and di
27. What are the extraintestinal manifestations of crohns
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Femoral hernia
Inc smooth muscle relaxation - including lower esophageal sphincter
28. What histological findings are present in the esophagus
Right and left hepatic duct
Inguninal ligament - sartorius muscle - adductor longus
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Nonkeritinized stratified sqamous epithelium
29. What type of insults result in micronodular cirrhosis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Carcinoid syndrome
Angiodysplasia
30. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
FAP
Duodenum - 2nd - 3rd and 4th parts
Parietal cells in the stomach - B12 binding protein
31. What does a low flow rate mean for saliva
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Hypotonic because of more time to reabsorb NaCl
Neutralizes oral bacertial acids and maintains dental health
Superior rectal
32. What is the frequency of basal electric rhythm of the stomach
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
3 waves/min
Via the middle colic
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
33. most common malignant salivary gland tumor
Redundant mesentary
Mucoepidermoid carcinoma
CEA - CA-19-9
Punched out - clean margins - carcinoma =raised irregular margins
34. 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
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Small intestine
Skip lesions =crohns - colon = UC
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
35. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Alpha amylase
Diverticulum
Closer to isotonic because of less time to reabsorb NaCl
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
36. in carcinoid tumors - What is seen on EM
H pylori (almost 100%)
Lipase
Dense core bodies
Complications of UC
37. Through which aspect of the inguinal canal does a direct inguinal go
External (superficial) ring only
Via the middle colic
AST>ALT
Pyoderma gangrenosum - primary sclerosing cholangitis
38. Bile is critical for exrection of what substance
Diverticulum
Cholesterol
Crypts but not villi
Peyers patches
39. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Esophageal varices
Esophageal carcinoma
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Hydrocele
40. What are the ABCDEF of esophageal cancer
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Mucosa - submucosa - muscularis externa - serosa/adventitia
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
41. absent UDPGT - presents early in life - early mortality
Crigler - najjar type 1
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Hyperplastic
Meconium ileus
42. Who gets gastric ulcers
Hypercoaguability - polycythemia vera - pregnancy - HCC
Oral glucose
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Older patients
43. What are causes of extrahepatic biliary obstruction
Sister mary joseph nodule
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
GERD - may also present with nocturnal cough and dyspnea
Budd chiari syndrome
44. What makes a true diverticula
All 3 gut layers outpouch as in Meckels
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Pancreatic head causing obstructive jaundice
Dermatitis herpetiformis
45. What causes pancreatic insuff and What does it cause
T12
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Dysphagia (due to esophageal web) - glossitis - iron def anemia
46. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Cystic duct and common hepatic duct
Brunners
2ndary biliary cirrhosis
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
47. What serum enzyme is elevated inacute pancreatitis
Pancreatic and bile
Phototherapy
Lipase
Cholesterol
48. What parts of the small bowel can tropical sprue effect
Obstruction of the common bile duct
Ceruplasmin
The entire
Warthins' tumor
49. What kind of cancer to celiac sprue put you as inc risk for
Spleen to posterior abdominal wall - splenic artery and vein
Colonic polyps
T cell lymphoma
Lamina propria
50. Which IBD is autoimmune and which may be a disordered response to bacteria
L2
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Antrum - H.pylori - inc risk of MALT lymphoma