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Test your basic knowledge |
USMLE GI
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Subjects
:
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 is the main symptom if a VIPoma
Bleeding - penetration into pancreas - perforation - obstruction
The gastroduodenal
Turcot
Copious diarrhea - non alpha - non beta cell pancreatic tumor
2. What are the tumor markers for pancreatic adenocarcinoma
CEA - CA-19-9
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Angiodysplasia
Dec PGE2 leading to dec gastric mucosa protection
3. Where are peyers patches found
Lamina propora and submucosa
Chronic calcifying pancreatitis - inc risk of panreatic cancer
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
Ischemic colitis
4. What is the sphincter of the pancreatic duct
Sphincter of oddi
Boerhaave's Syndrome - Been heaving syndrome
All 3 gut layers outpouch as in Meckels
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
5. What are the histological findings in the ileum
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6. What are the histological findings of the colon
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
CHF and inc risk of HCC
Crypts but not villi
Acute pancreatitis
7. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Hepatic steatosis
8. What does a low flow rate mean for saliva
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Hypotonic because of more time to reabsorb NaCl
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
90%
9. Between what structures do strong anastamoses exist
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Left and right gastroepiploics - left and right gastrics
Downs
Diverticulitis in elderly - ectopic pregs use hCG to rule out
10. motilin - source - action - regulation
Elevated amylase - and lipase
Warthins' tumor
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
...
11. secretin - source - action - regulation
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Juvenille polyps - no risk if single
Barrett's esophagus
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
12. Which area of the hindgut is a watershed area
Splenic flexure
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Internal thoracic to superior epigastric to inferior epigastric
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
13. what kind of muscle is in the upper 1/3 of esophagus
Trypsin - chymotrypsin - elastase - carboxypeptidases
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Striated
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
14. What cells make pepsin - What does it do - and what regulates it
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Crohns = maybe - UC= always
15. What does loss of p53 cause
Striated and smooth
No
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Increase tumorigenesis
16. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Alk pho
Peutz jeghers
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
17. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Menetriers disease
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Gamma glutamyl transferase GGT
18. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Volvulus
Old men - arthralgias - cardiac and neuro sx
Can lead to hematemesis - found in EtOHics and bulimics
Cholesterol
19. What infection causes Whipple disease and What can you see on LM
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Lateral
M3 - Gq - inc IP3/Ca
20. What intervention will intervention will relieve portal HTN
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
CEA - CA-19-9
Epithelium
21. Dysphagia in achalasia results from
Carcinoid syndrome
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Gallbladder
Brunners
22. What are the complications of chronic pancreatitis
Penicillinamine - AR inheritance
Normal
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
True and most common congenital anomoly of GI tract
23. What cell produces IF and What does it do
Parietal cells in the stomach - B12 binding protein
Averages 6 months - very aggressive - usually already metastasized at presentation
Via the superior pancreaticduodenal
CHF and inc risk of HCC
24. What is the frequency of basal electric rhythm of the stomach
Smooth
3 waves/min
Bleeding - intussusception - volvulus - obstruction near terminal ileum
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
25. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
GERD - may also present with nocturnal cough and dyspnea
Striated
Alcoholic hepatitis
Positive
26. What are causes of extrahepatic biliary obstruction
Peyers patches
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
AST>ALT
HPNCC
27. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Decreased intercellular adhesion and increased proliferation
Superior rectal
Uridine glucuronyl transferase
Hyperplastic
28. What are the complications of Meckels
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Positive urease test
Bleeding - intussusception - volvulus - obstruction near terminal ileum
External spermatic fascia only
29. HCC is associated with what other conditions
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Early childhood - neuro sx and malabsorption
Decrease - weight gain
30. Where does crohns usually affect the GI tract
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Terminal ileum and colon
Warthins' tumor
Alk phos
31. What kind of muscle is in the middle 1/3 of esophagus
L2
Low pressure proximal to LES
Dense core bodies
Striated and smooth
32. What are the common causes of gastric ulcers - What causes gastric ulcer
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Bleeding - penetration into pancreas - perforation - obstruction
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Budd chiari syndrome
33. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
GLUT 2
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Upregulated intracellular signal transduction
Juvenile polyposis syndrome - inc risk of adenocarcinoma
34. How is bilirubin carried in the blood
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
With albumin
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
No
35. How many layers of spermatic fascia are covers an indirect inguinal hernia
L/R renal artery around L1
Pancreatic and bile
All 3
Gut bacteria
36. In alchoholic hepatitis which liver enzyme is higher
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
AST>ALT
Low pressure proximal to LES
Parietal cells in the stomach - B12 binding protein
37. What kind of diarrhea is produced from a disaccharide def
Osmotic
Epigastric abdominal pain radiating to back - anorexia - nausea
Nonkeritinized stratified sqamous epithelium
Small intestine
38. What are the borders of Hesselbach's triangle
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Gallbladder
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
8-9 waves/min
39. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Crohns = maybe - UC= always
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Angiodysplasia
Cystic duct and common hepatic duct
40. Gq and inc cAMP both work to do what in parietal cells
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Inc - weight loss
Striated and smooth
Stimulate the H/K ATPase
41. Who gets Whipple disease and How do they present
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Esophageal cancer
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Old men - arthralgias - cardiac and neuro sx
42. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Crohns = noncaseating granulomas - UC = crypt abscesses
Peyers patches
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Brunners
43. What is biliary colic
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Neutralizes oral bacertial acids and maintains dental health
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
T cell lymphoma
44. What are the extraintestinal manifestations of crohns
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Cirrhosis
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
45. Where is bicarb trapped
In the mucus that covers the gastric epithelium
Inc risk of CRC and other visceral malignancies
Esophageal cancer
US and cholecystectomy
46. What causes hirschsprungs
Tropical sprue
Failure of neural crest migration
L3
3 waves/min
47. Which IBD is autoimmune and which may be a disordered response to bacteria
Zollinger ellison - brunners glands
Gilbert's
Short gastrics - left greater and lesser
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
48. What are the four Fs of gallstones
Lubricate food (glycoprotiens)
EtOH
Can lead to hematemesis - found in EtOHics and bulimics
Female - fat - fertile - forty
49. GIP - source - action regulation
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Gilbert's
Diverticulum
Older patients
50. Where is IgA shuttled
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Lubricate food (glycoprotiens)
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Sorry!:) No result found.
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