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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
.
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. How is the diagonsis of CRC made
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker
Chronic constipation early in life with dilated portion of the colon proximal to the aganglionic segment resulting in a transition zone - involves rectum - usually a failure to pass meconium
Pleomorphic adenoma
Diverticulum
2. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Cirrhosis
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Oral glucose
Inc risk of CRC and other visceral malignancies
3. Which viral infxns/treatments are associated with reyes syndrome
VZV and influenza B treated with salicylates
L1
Amylase
Jaundice - fever - RUQ
4. At what spinal level does the celiac trunk exit
Ampulla of vater
Around the central vein (zone III)
T12
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
5. What retroperitoneal structure flanks both sides of the pancreas on CT
Meckels
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Duodenum - 2nd - 3rd and 4th parts
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
6. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Unconj - absent (acholuria) - inc
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Striated and smooth
7. What do tumors that arise in the head of the pancreas cause
Acute pancreatitis
Boerhaave's Syndrome - Been heaving syndrome
Obstruction of the common bile duct
Adhesion
8. What serum enzyme is elevated in acute pancreatitis and mumps
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Amylase
Jaundice - fever - RUQ
Neutralizes gastric acid allowing pancreatic enzymes to fxn
9. What is charcot triad of cholangitis
AR
Jaundice - fever - RUQ
H pylori (almost 100%)
Primarly through ECL leading to histamine release
10. What is the most common esophageal cancer worldwide and in the US
Alk pho
Lateral to the inferior epigastric artery
Worldwide - SC - US - adeno
Splenic flexure
11. crigler - najjar type II responds to which therapy and How does it work
Phenobarbital - inc liver enzyme synthesis
L3
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
Internal thoracic to superior epigastric to inferior epigastric
12. What is the omphalomesenteric cyst
Inc - weight loss
Liver metabolizes 5HT
Decreased intercellular adhesion and increased proliferation
Cystic dilation of the viteline duct
13. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Inc - weight loss
Zenkers - halitosis - dysphagia and obstruction
Ischemic colitis
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
14. What are the tumor markers for pancreatic adenocarcinoma
Lubricate food (glycoprotiens)
Hemosiderosis - hemochromatosis
CEA - CA-19-9
Cystic duct and common hepatic duct
15. vasoactive intestinal polypeptide (VIP) - source - action - regulation
8-9 waves/min
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
Erosive - disruption of mucosal barrier leading to inflammation
With albumin
16. Where is the pectinate line
Where hindgut meets ectoderm
AST >ALT - ration is usually 1.5
Mallory bodies
Hyperpigmented mouth - lips - hands - genitalia
17. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
FAP
Uremia
Internal thoracic to superior epigastric to inferior epigastric
Pleomorphic adenoma
18. What is the epi for CRC
Female - fat - fertile - forty
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
HSV-1 - CMV - Candida
Downs
19. Where is there sclerosis in alcoholic cirrohosis
Hemosiderosis - hemochromatosis
VZV and influenza B treated with salicylates
Around the central vein (zone III)
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
20. Where does an indirect inguinal hernia enter the deep inguinal ring
Punched out - clean margins - carcinoma =raised irregular margins
Can lead to hematemesis - found in EtOHics and bulimics
Lateral to the inferior epigastric artery
Myenteric nerve plexus - aurbach
21. What is the rate limiting step of carbohydrate digestion
Low pressure proximal to LES
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Oligosaccharide digestion
22. FAP + osseous and soft tissue tumors - retinal hyperplasia
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23. When do you see hypertrophy of brunners glands
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Peptic ulcer disease
Smooth
Acute pancreatitis
24. What layer of fascia covers a direct inguinal hernia
Gamma glutamyl transferase GGT
External spermatic fascia only
Above
GLUT 2
25. Where does type B chronic gastritis occur and What causes it
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Antrum - H.pylori - inc risk of MALT lymphoma
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
26. What kind of muscle is in the middle 1/3 of esophagus
ALT>AST
Striated and smooth
VZV and influenza B treated with salicylates
The entire
27. What conditions are associated with budd chiari
Hypercoaguability - polycythemia vera - pregnancy - HCC
Bleeding - penetration into pancreas - perforation - obstruction
Inc - weight loss
MSI (15%) and APC/beta catenin chromosomal instability (85%)
28. What is the rule of 2s for meckels
Dense core bodies
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Neutralizes oral bacertial acids and maintains dental health
29. What are the treatment options for uclerative colitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Bleeding - intussusception - volvulus - obstruction near terminal ileum
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Epithelium
30. malnutrition - toxic megacolon - colorectal carcinoma
Reye's syndrome
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Complications of UC
31. What gives urine its characteristic color
Complications of UC
Urobilin
Peyers patches
Antrum - H.pylori - inc risk of MALT lymphoma
32. Where is bicarb trapped
In the mucus that covers the gastric epithelium
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Intussusception
Crohns = noncaseating granulomas - UC = crypt abscesses
33. What nerve innervates the external hemorrhoids
Inferior rectal nerve
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Juvenille polyps - no risk if single
In the mucus that covers the gastric epithelium
34. What histological findings are present in the stomach
Short gastrics - left greater and lesser
Gastric glands
Cystic duct and common hepatic duct
2ndary biliary cirrhosis
35. What does TOASTED with alcoholic hepatitis stand for
AST >ALT - ration is usually 1.5
Decrease - weight gain
Lamina propria
Positive
36. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Small intestine
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
GERD - may also present with nocturnal cough and dyspnea
Intussusception
37. Where are peyers patches found
Lamina propora and submucosa
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Spleen to posterior abdominal wall - splenic artery and vein
Mallory bodies
38. What do mucins do?
Lubricate food (glycoprotiens)
Mallory bodies
Oral glucose
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
39. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Antrum - H.pylori - inc risk of MALT lymphoma
Hemosiderosis - hemochromatosis
40. What causes pancreatic insuff and What does it cause
Skip lesions =crohns - colon = UC
Adhesion
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Redundant mesentary
41. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Esophageal cancer
Via the superior pancreaticduodenal
Cholesterol - 10-20% opaque due to calcifications
Chronic gastritis and pernicious anemia
42. What portion of the bowel does sprue effect
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
The proximal small bowel
Jewish and African American men
Cimetidine
43. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Decrease - weight gain
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Hirschsprungs
In the mucus that covers the gastric epithelium
44. With caput medusaw - between what vessels is the anastomoses and Where is it
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Brush border of intestine - produce monosaccharides from oligo and di
Alcoholic cirrhosis
Paraumbilical and superficial and inferior epigastric - umbilicus
45. What is the clinical presentation of acute pancreatitis
Duodenum - 2nd - 3rd and 4th parts
Mallory bodies
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Epigastric abdominal pain radiating to back - anorexia - nausea
46. What kind of pathways do CCK act on to cause pancreatic secretion
Neural muscarinic pathways
Duodenum - 2nd - 3rd and 4th parts
Lubricate food (glycoprotiens)
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
47. in CF - meconium plug obstructs intestine - preventing stool passage at birth
L2
Inc - weight loss
Crigler - najjar type 1
Meconium ileus
48. What are the borders of Hesselbach's triangle
Cholesterol
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Colonic polyps
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
49. What parts of the small bowel can tropical sprue effect
Lye ingestion and acid reflux
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
The entire
Centrilobular leading to congestive liver disease
50. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Cholesterol - 10-20% opaque due to calcifications
IgA secreting plasma cells - ultimately reside in the lamina proporia
No
L4
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