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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. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Gilbert's
Where hindgut meets ectoderm
Peutz jeghers
PAS- positive globules in liver -
2. How does CRC present in the distal and proximal colon
Lamina propria
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
AR
Hypercoaguability - polycythemia vera - pregnancy - HCC
3. HCC is associated with what other conditions
Nonkeritinized stratified sqamous epithelium
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Esophageal cancer
4. what kind of muscle is in the upper 1/3 of esophagus
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Hemosiderosis - hemochromatosis
Striated
Splenic flexure
5. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Cholesterol
Stimulate intestinal persistalsis
Dec PGE2 leading to dec gastric mucosa protection
6. Why are most diverticula considered false
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Hyperplastic
Neutralizes oral bacertial acids and maintains dental health
Lack or have an attenuated muscularis externa - often in the sigmoid colon
7. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
HPNCC
Gut bacteria
Pleuroperitoneal
8. What is the presenting course for appendicity
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9. What is the clinical presentation of acute pancreatitis
Increase tumorigenesis
Epigastric abdominal pain radiating to back - anorexia - nausea
Positive urease test
Pleomorphic adenoma
10. What layer of fascia covers a direct inguinal hernia
Crypts but not villi
External spermatic fascia only
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Cystic dilation of the viteline duct
11. What layer in the mucosa is responsible for absorption
Epithelium
Inc risk of CRC and other visceral malignancies
Causes of gall stones
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
12. What congenital birth defect is associated with Hirschsprung
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Ampulla of vater
Downs
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
13. Where is folate absorbed
Liver metabolizes 5HT
Elevated amylase - and lipase
The jejunum
Nonkeritinized stratified sqamous epithelium
14. Where are carcinoid tumors most commonly malignant
Around the central vein (zone III)
Duodenal atresia - Downs
Duodenum - 2nd - 3rd and 4th parts
Small intestine
15. What are the hindgut structures and what supplies their blood and PANS innvervation
CHF and inc risk of HCC
Right and left hepatic duct
Failure of neural crest migration
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
16. What is the cause of Barrett's and the assocaited complications
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Stimulate intestinal persistalsis
Inc - weight loss
Myenteric nerve plexus - aurbach
17. What structure is Not contained in the femoral sheath
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
VZV and influenza B treated with salicylates
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
18. What pancreatic enzymes are responsible for fat digestion
Phototherapy
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Lipase - phospholipase A - colipase
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
19. What artery passes around the duodenum
The gastroduodenal
CCK8 receptor - Gq inc IP3/Ca
GERD - may also present with nocturnal cough and dyspnea
Mucosa - submucosa - muscularis externa - serosa/adventitia
20. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Meconium ileus
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Downs
21. What does a gastrinoma cause
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
L2
12 waves/min
Gastric glands
22. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Krukenbergs tumor
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Pleomorphic adenoma
Paraumbilical and superficial and inferior epigastric - umbilicus
23. What retroperitoneal structure flanks both sides of the pancreas on CT
CHF and inc risk of HCC
Duodenum - 2nd - 3rd and 4th parts
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
The proximal small bowel
24. What findings are associated with reyes
Mallory bodies
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Striated
25. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Superior rectal
Amylase
26. If the abdominal aorta is blocked - How does blood get to the left colic artery
Inc conj bilirubin - inc cholesterol - inc alk phos
Cigarettes and chronic pancreatitis - not EtOH
Via the middle colic
Omeprazole
27. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus
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28. involvement of left supraclavicular node by mets from stomach
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29. Cholecytsokinin - source - action - regulation
Adhesion
Krukenbergs tumor
Source - I cells (duod - jej - action - inc pancreative secretion - inc gallbladder contraction - dec gastric emptying - sphincter of Oddi relaxation - regulation - inc by fatty acids and amino acids
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
30. What do the rugae of stomach look like in menetriers disease
Below
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
So hypertrophied they look like brain gyri
Neural muscarinic pathways
31. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
90%
In the mucus that covers the gastric epithelium
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
H+
32. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Dissaccharidase def - most commonly lactase
Budd chiari syndrome
Conj/unconj - inc - nl to dec
33. What is the classic triad of hemochromatosis
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34. Where does crohns usually affect the GI tract
Terminal ileum and colon
Alpha1 antitrypsin def - codominant trait
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Pancreatic and bile
35. Why does carcinoid syndrome not occur if tumor is confined to GI system
Liver metabolizes 5HT
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Uridine glucuronyl transferase
Cystic duct and common hepatic duct
36. Acute gastritis is caused By what process
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Erosive - disruption of mucosal barrier leading to inflammation
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
H+
37. absent UDPGT - presents early in life - early mortality
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Paraumbilical and superficial and inferior epigastric - umbilicus
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Crigler - najjar type 1
38. What does extrahepatic biliary obstruction cause
True and most common congenital anomoly of GI tract
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Celiac sprue
Sphincter of oddi
39. What complication can arise from indirect inguinal hernias
Early childhood - neuro sx and malabsorption
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Hydrocele
Bleeding - intussusception - volvulus - obstruction near terminal ileum
40. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Hypercoaguability - polycythemia vera - pregnancy - HCC
Left gastric vein and esophogeal vein - esophagus
Warthins' tumor
Where hindgut meets ectoderm
41. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
AST >ALT - ration is usually 1.5
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Inc conj bilirubin - inc cholesterol - inc alk phos
Lateral
42. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue
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43. What is contained within the muscularis externa
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
M3 - Gq - inc IP3/Ca
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
Myenteric nerve plexus - aurbach
44. Where and How is iron absorbed
Closer to isotonic because of less time to reabsorb NaCl
L1
The gastroduodenal
Fe2+ in the duod
45. Where does type A chronic gastritis occur and What causes it
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Complications of crohns
Early childhood - neuro sx and malabsorption
46. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
With albumin
Jewish and African American men
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Dysphagia (due to esophageal web) - glossitis - iron def anemia
47. What does alpha amylase do and what inactivates it
Decrease - weight gain
Terminal ileum and colon
Begins starch digestion - inactivated by low pH upon reaching the stomach
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
48. What pancreatic proteases are secreted as zymogens
Boerhaave's Syndrome - Been heaving syndrome
Trypsin - chymotrypsin - elastase - carboxypeptidases
Gastrohepatic ligament
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
49. What are the barium swallow findings of achalasia
Colovesical leading to pneumaturia
Dilated esophagus with an area of distal stenosis - birds beak
Enterokinase/enteropeptidase from the duodenal mucosa
ALT>AST
50. Which patients have pigment stones
Cigarettes and chronic pancreatitis - not EtOH
AST>ALT
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
M3 - Gq - inc IP3/Ca