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Test your basic knowledge |
USMLE GI
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Subjects
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health-sciences
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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. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Esophageal varices
External (superficial) ring only
FAP
Alpha1 antitrypsin def - codominant trait
2. involvement of left supraclavicular node by mets from stomach
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3. What kind of muscle is in the middle 1/3 of esophagus
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
Esophageal carcinoma
Pleuroperitoneal
Striated and smooth
4. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Increase tumorigenesis
Unconj - absent (acholuria) - inc
Cigarettes and chronic pancreatitis - not EtOH
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
5. What do the rugae of stomach look like in menetriers disease
Bleeding - penetration into pancreas - perforation - obstruction
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
So hypertrophied they look like brain gyri
Boerhaave's Syndrome - Been heaving syndrome
6. Acute gastritis is caused By what process
Primarly through ECL leading to histamine release
Small intestine
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Erosive - disruption of mucosal barrier leading to inflammation
7. What are the main components of bile
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
8. If the hemochromatosis is primary - What is the pattern of inheritance
Sister mary joseph nodule
Intussusception
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
AR
9. What kind of insults results in macronodular cirrhosis
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Duodenum - 2nd - 3rd and 4th parts
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Angiodysplasia
10. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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11. Which IBD is autoimmune and which may be a disordered response to bacteria
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Necrotizing enterocolitis
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
12. What does K- ras mutation cause
Warthins' tumor
M3 - Gq - inc IP3/Ca
Oral glucose
Upregulated intracellular signal transduction
13. What is the triad of Plummer - Vinson syndrome
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
14. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Primarly through ECL leading to histamine release
CEA - CA-19-9
Striated and smooth
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
15. In what clinical scenarior do you see portosystemic anastomoses
Hydrocele
Portal HTN
Squamous - upper 1/3 - adeno - lower 1/3
AST>ALT
16. 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
Omeprazole
Short gastrics - left greater and lesser
Alpha1 antitrypsin def - codominant trait
17. What are the common causes of gastric ulcers - What causes gastric ulcer
Neutralizes gastric acid allowing pancreatic enzymes to fxn
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Failure of the processus vagainlis to close
18. What enzyme is necessary to create conjugated bilirubin
The entire
Uridine glucuronyl transferase
Peyers patches
Hirschsprungs
19. How does CRC present in the distal and proximal colon
Terminal ileum and colon
Esophageal carcinoma
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
20. concentric onion skin bile duct fibrosis
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Can lead to hematemesis - found in EtOHics and bulimics
Primary sclerosing cholangitis
Neural muscarinic pathways
21. What other condition can lead to acute gastritis - think renal
Crigler - najjar type 1
Uremia
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
22. At what spinal level does the SMA exit
Amylase
L1
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Reye's syndrome
23. What kind of pathways do CCK act on to cause pancreatic secretion
Above
Heme metabolism
Neural muscarinic pathways
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
24. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Chronic gastritis and pernicious anemia
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Trypsin - chymotrypsin - elastase - carboxypeptidases
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
25. crigler - najjar type II responds to which therapy and How does it work
Phenobarbital - inc liver enzyme synthesis
2ndary biliary cirrhosis
L2
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
26. What receptors does ACH bind on the parietal cells and What does it activate
Meconium ileus
2ndary biliary cirrhosis
M3 - Gq - inc IP3/Ca
Striated
27. What converts inactive pepsinogen to pepsin
Alcoholic cirrhosis
H+
Lateral
Bleeding - intussusception - volvulus - obstruction near terminal ileum
28. What does bicab do in the mouth
Neutralizes oral bacertial acids and maintains dental health
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
All 3 gut layers outpouch as in Meckels
HSV-1 - CMV - Candida
29. secretin - source - action - regulation
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
Corticosteroids - infliximab
Left and right gastroepiploics - left and right gastrics
Turcot
30. What is contained within the submucosa
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31. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Peyers patches
In the ileum with bile acids - requires IF
Stimulate the H/K ATPase
Causes of gall stones
32. What skin condition is associated with celiac sprue
Dilated esophagus with an area of distal stenosis - birds beak
Dermatitis herpetiformis
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
The submucosal nerve plexus - meissner's
33. What receptor does histamine bind on the parietal cell and What does it activate
T cell lymphoma
Hirschsprungs
H2 receptor - inc cAMP
Above
34. Who is at risk for pancreatic adenocarcinoma
Angiodysplasia
Heme metabolism
Jewish and African American men
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
35. Autodigestion of pancreas by pancreatic enzymes
Hirschsprungs
Acute pancreatitis
Complications of crohns
Gilbert's
36. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Pleomorphic adenoma
PAS- positive globules in liver -
Superior rectal and middle and inferior rectal - rectum
37. What is the leading cause of bowel incarceration
FAP
Budd chiari syndrome
Hemolytic anemia
Femoral hernia
38. What are the layers of the gut wall from inside out
Mucosa - submucosa - muscularis externa - serosa/adventitia
Lateral
Colovesical leading to pneumaturia
Above
39. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Squamous - upper 1/3 - adeno - lower 1/3
Hemolytic anemia
CHF and inc risk of HCC
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
40. In PUD with a duodenal ulcer does pain inc or dec with meals
Epigastric abdominal pain radiating to back - anorexia - nausea
Decrease - weight gain
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
In the mucus that covers the gastric epithelium
41. What does extrahepatic biliary obstruction cause
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Older patients
Duodenum - 2nd - 3rd and 4th parts
Brush border of intestine - produce monosaccharides from oligo and di
42. What findings are associated with reyes
Centrilobular congestion and necrosis - cardiac cirrhosis
Falciform - ligamentum teres - fetal umbilical vein
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Colonic polyps
43. What can hemochromatosis be secondary to...
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Cholesterol - 10-20% opaque due to calcifications
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Hypotonic because of more time to reabsorb NaCl
44. In what scenarios do pts with gilberts have inc bili
Fasting and stress
H+
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
45. Achalasia can be secondary to what infectious disease common in South America
Chagas disease
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Paraumbilical and superficial and inferior epigastric - umbilicus
Ceruplasmin
46. What artery passes around the duodenum
The gastroduodenal
Crohns = maybe - UC= always
Positive
Zollinger Ellison - phenylalanine and tryptophan
47. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Acute pancreatitis
Above
So hypertrophied they look like brain gyri
Falciform - ligamentum teres - fetal umbilical vein
48. 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
EtOH
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Epigastric abdominal pain radiating to back - anorexia - nausea
49. What are the extraintestinal manifestations of crohns
ALT>AST
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
50. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Where hindgut meets ectoderm
Mallory bodies
Gamma glutamyl transferase GGT
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
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