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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. How are all 3 monosaccharides transported to the blood
Turcot
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Cystic dilation of the viteline duct
GLUT 2
2. What are the histological findings in the ileum
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3. What is the most common diaphragmatic hernia and What are the two types
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Necrotizing enterocolitis
Complications of UC
4. Which is used more quickly - an oral glucose load - or that by IV
Hyperpigmented mouth - lips - hands - genitalia
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Meckels
Oral glucose
5. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
True and most common congenital anomoly of GI tract
Myenteric nerve plexus - aurbach
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
6. in budd chiari syndrome - Where is the congestion and necrosis
L1
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Centrilobular leading to congestive liver disease
Juvenille polyps - no risk if single
7. Autodigestion of pancreas by pancreatic enzymes
Acute pancreatitis
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
L3
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
8. How does gastrin increase acid secretion?
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Erosive - disruption of mucosal barrier leading to inflammation
Primarly through ECL leading to histamine release
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
9. absent UDPGT - presents early in life - early mortality
Decreased intercellular adhesion and increased proliferation
Centrilobular leading to congestive liver disease
Crigler - najjar type 1
Pertechnetate - study for uptake
10. What arteries exit just below the SMA
Hirschsprungs
Menetriers disease
L/R renal artery around L1
Source - G cells in the antrum - action - inc gastric H+ secretion - inc growth of gastric mucosa - and inc gastric motility - regulation - inc by stomach distention/alkalinaztion - amino acids - peptides - vagal stimulation - dec by stomach pH < 1.5
11. What is indirect bilirubin
Lateral
90%
Diverticulum
Unconjugated - water insoluble
12. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
All 3
Volvulus
Dissaccharidase def - most commonly lactase
Hepatic steatosis
13. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Cholesterol - 10-20% opaque due to calcifications
Uremia
Acute pancreatitis
Cholesterol
14. What infection causes Whipple disease and What can you see on LM
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Epigastric abdominal pain radiating to back - anorexia - nausea
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Oral glucose
15. What structures feed into the cystic duct
Neural muscarinic pathways
12 waves/min
Gallbladder
L/R renal artery around L1
16. Gastrin - source - action - regulation
Penicillinamine - AR inheritance
Source - G cells in the antrum - action - inc gastric H+ secretion - inc growth of gastric mucosa - and inc gastric motility - regulation - inc by stomach distention/alkalinaztion - amino acids - peptides - vagal stimulation - dec by stomach pH < 1.5
PAS- positive globules in liver -
The jejunum
17. How do you DX and TX gallstones
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
US and cholecystectomy
Tropical sprue
HPNCC
18. What does a gastrinoma cause
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Lye ingestion and acid reflux
Female - fat - fertile - forty
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
19. signet ring cells - acanthosis nigracans - dz - character/association - spread
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
CCK8 receptor - Gq inc IP3/Ca
HSV-1 - CMV - Candida
20. What is the most important mechanism in gastric acid secretion
Stercobilin
Myenteric nerve plexus - aurbach
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Elevated amylase - and lipase
21. What receptors does ACH bind on the parietal cells and What does it activate
Turcot
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Superior rectal and middle and inferior rectal - rectum
M3 - Gq - inc IP3/Ca
22. rare - often fatal childhood hepatoencephalopathy
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23. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Peyers patches
Chagas disease
Heme metabolism
Inc risk of CRC and other visceral malignancies
24. Where is IgA shuttled
Appendicitis
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Hypercoaguability - polycythemia vera - pregnancy - HCC
In the ileum with bile acids - requires IF
25. what kind of muscle is in the upper 1/3 of esophagus
Striated
GLUT 2
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Appendicitis
26. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Lamina propora and submucosa
Conj - inc - dec
ALT>AST
27. What is the classic triad of hemochromatosis
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28. What is the presentation of pancreatic adenocarcinoma
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Around the central vein (zone III)
Gastrohepatic ligament
Primarly through ECL leading to histamine release
29. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
External spermatic fascia only
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Myenteric nerve plexus - aurbach
30. What layer in the mucosa is responsible for support
Lamina propria
Hemolytic anemia
ALT>AST
Colonic polyps
31. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Positive
Pancreatic and bile
Alcoholic cirrhosis
Zenkers - halitosis - dysphagia and obstruction
32. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Meckels
Right and left hepatic duct
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Ampulla of vater
33. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Colonic polyps
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Menetriers disease
Duodenum - 2nd - 3rd and 4th parts
34. Achalasia can be secondary to what infectious disease common in South America
Stimulate the H/K ATPase
Superior rectal
Chagas disease
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
35. Bilirubin is the product of what?
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Heme metabolism
Cimetidine
M3 - Gq - inc IP3/Ca
36. What layer in the mucosa is responsible for absorption
Epithelium
Cirrhosis
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
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
37. When do you see hypertrophy of brunners glands
With albumin
Mucosa - submucosa - muscularis externa - serosa/adventitia
Peptic ulcer disease
Budd chiari syndrome
38. subQ peribumbilical metastasis
Stimulate intestinal persistalsis
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Sister mary joseph nodule
GERD - may also present with nocturnal cough and dyspnea
39. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Esophageal cancer
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
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
40. 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
Barrett's esophagus
All 3 gut layers outpouch as in Meckels
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
41. What layer in the mucosa is repsonsible for motility
Normal
Repeated phlebotomy - deferoxamine - HLA- A3
Angiodysplasia
Muscularis mucosae
42. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Peyers patches
AST
43. involvement of left supraclavicular node by mets from stomach
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44. Is there any structural abnl with IBS - What is the course of disease and presentation
Acute pancreatitis
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
No - chronic - can present with diarrhea or constipation or alternation - treat sx
45. How is bilirubin carried in the blood
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Above
Duodenum - 2nd - 3rd and 4th parts
With albumin
46. Which serum enzyme increases with heavy EtOH consumption
Hernia
Dissaccharidase def - most commonly lactase
Lamina propora and submucosa
Gamma glutamyl transferase GGT
47. What are causes of extrahepatic biliary obstruction
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
PAS- positive globules in liver -
Redness and tenderness on palpation of extremities
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
48. How does loss of NO secretion affect the esophagus and what results
Adhesion
Meckels
Dissaccharidase def - most commonly lactase
Inc lower esphogeal tone leading to achalasia
49. What are the two molecular pathways that lead to CRC
Alfatoxin in peanuts
Hypotonic because of more time to reabsorb NaCl
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
50. What does GET SMASHED stand for in acute pancreatitis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Crypts but not villi
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
T12