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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. What is the most common esophageal cancer worldwide and in the US
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Duodenum - 2nd - 3rd and 4th parts
CHF and inc risk of HCC
Worldwide - SC - US - adeno
2. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
All 3
Celiac sprue
Conj - inc - dec
T cell lymphoma
3. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Boerhaave's Syndrome - Been heaving syndrome
Hepatic steatosis
Splenic flexure
Peyers patches
4. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Crohns = maybe - UC= always
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Gardner's syndrome
Peptic ulcer disease
5. What causes hirschsprungs
Failure of neural crest migration
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Mallory bodies
Alfatoxin in peanuts
6. What is the frequency of basal electric rhythm of the ilieum
Hypercoaguability - polycythemia vera - pregnancy - HCC
8-9 waves/min
Smooth
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
7. What happens to the short gastics if the splenic artery is blocked
External spermatic fascia only
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
Splenic flexure
Poor anastamoses
8. What kind of muscle is in the middle 1/3 of esophagus
The proximal small bowel
Striated and smooth
Esophageal cancer
Lateral to the inferior epigastric artery
9. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Serous on the sides parotids - mucinous in the middle sublingual
Carcinoid syndrome
Corticosteroids - infliximab
10. Which IBD is autoimmune and which may be a disordered response to bacteria
Virchow's node
Conj - inc - dec
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Crohns = transmural (cobblestone mucosa - creeping fat - string sign - linear ulcers fissures - fistulas) UC = mucosal and submucosal (friable mucosal pseudopolyps with freely hanging mesentary - loss of haustra - lead pipe appearance on imaging
11. Cholecytsokinin - source - action - regulation
Lubricate food (glycoprotiens)
Warthins' 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
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
12. What do the rugae of stomach look like in menetriers disease
Zenkers - halitosis - dysphagia and obstruction
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
So hypertrophied they look like brain gyri
Smooth
13. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
The entire
Crohns = maybe - UC= always
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
14. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
EtOH
Left gastric vein and esophogeal vein - esophagus
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
15. What is the path of an indirect inguinal hernia
In the ileum with bile acids - requires IF
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
16. Acute gastritis is caused By what process
Erosive - disruption of mucosal barrier leading to inflammation
External (superficial) ring only
Punched out - clean margins - carcinoma =raised irregular margins
Lateral to the inferior epigastric artery
17. What are the signs of peutz jehgers
L1
Krukenbergs tumor
Hyperpigmented mouth - lips - hands - genitalia
Primarly through ECL leading to histamine release
18. What serum markers increase in cholecystitis with bile duct involvement
Alk phos
In the mucus that covers the gastric epithelium
Gut bacteria
Phototherapy
19. What arteries exit just below the SMA
Diverticulum
L/R renal artery around L1
Crohns = noncaseating granulomas - UC = crypt abscesses
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
20. Where is the pectinate line
Where hindgut meets ectoderm
Below
IgA secreting plasma cells - ultimately reside in the lamina proporia
Splenic flexure
21. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Volvulus
Low pressure proximal to LES
Glucouronate - water soluble (direct)
VZV and influenza B treated with salicylates
22. In what scenarios do pts with gilberts have inc bili
H pylori (almost 100%)
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Fasting and stress
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
23. What causes pancreatic insuff and What does it cause
Colovesical leading to pneumaturia
Conj - inc - dec
Splenic flexure
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
24. What are the common causes of gastric ulcers - What causes gastric ulcer
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Superior rectal and middle and inferior rectal - rectum
Common hepatic - splenic - left gastric - main blood supply for stomach
L/R renal artery around L1
25. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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26. What separates the right greater and lesser sacs
Diarrhea - steatorrhea - weight loss - weakness
Gastrohepatic ligament
Brush border of intestine - produce monosaccharides from oligo and di
Ischemic colitis
27. what percentage of colonic polyps are non - neoplastic
90%
The jejunum
Inferior rectal nerve
Penicillinamine - AR inheritance
28. what kind of muscle is in the upper 1/3 of esophagus
Striated
Stimulate intestinal persistalsis
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Barrett's esophagus
29. What is the mechanism for reyes syndrome
Positive urease test
True and most common congenital anomoly of GI tract
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Gilbert's
30. What are the borders of Hesselbach's triangle
Adhesion
Decrease - weight gain
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
31. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Alk pho
Phenobarbital - inc liver enzyme synthesis
Upregulated intracellular signal transduction
Juvenile polyposis syndrome - inc risk of adenocarcinoma
32. Which area of the hindgut is a watershed area
Alcoholic cirrhosis
Splenic flexure
Black - rotors syndrome
Dilated esophagus with an area of distal stenosis - birds beak
33. Which patients have pigment stones
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Zenkers - halitosis - dysphagia and obstruction
Mucoepidermoid carcinoma
Erosive - disruption of mucosal barrier leading to inflammation
34. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Cholesterol - 10-20% opaque due to calcifications
Intussusception
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Epigastric abdominal pain radiating to back - anorexia - nausea
35. How are all 3 monosaccharides transported to the blood
FAP
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
GLUT 2
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
36. How does brain injury lead to acute gastritis and What is it called
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Unconj - absent (acholuria) - inc
Warthins' tumor
37. milk intolerance
Appendicitis
Dissaccharidase def - most commonly lactase
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Above
38. absent UDPGT - presents early in life - early mortality
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Crigler - najjar type 1
Gardner's syndrome
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
39. What is indirect bilirubin
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Unconjugated - water insoluble
40. What cell produces IF and What does it do
Amylase
12 waves/min
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Parietal cells in the stomach - B12 binding protein
41. Scleroderma is associated with what kind of esophageal dysmotility
Oligosaccharide digestion
Ischemic colitis
Low pressure proximal to LES
GERD - may also present with nocturnal cough and dyspnea
42. What are causes of extrahepatic biliary obstruction
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
MSI (15%) and APC/beta catenin chromosomal instability (85%)
43. What are the four Fs of gallstones
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Where hindgut meets ectoderm
Peutz jeghers
Female - fat - fertile - forty
44. Who gets gastric ulcers
Older patients
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Squamous - upper 1/3 - adeno - lower 1/3
Fasting and stress
45. What reaction does salivary amylase catalyze
Conj - inc - dec
Redundant mesentary
L3
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
46. What can hemochromatosis be secondary to...
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Oligosaccharide digestion
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
47. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Paraumbilical and superficial and inferior epigastric - umbilicus
Barrett's esophagus
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
48. What are the histological findings in the jejunum
12 waves/min
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
CEA - CA-19-9
Lye ingestion and acid reflux
49. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Crohns = noncaseating granulomas - UC = crypt abscesses
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
50. How does loss of NO secretion affect the esophagus and what results
GLUT 2
US and cholecystectomy
Inc lower esphogeal tone leading to achalasia
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Sorry!:) No result found.
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