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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. HCC is associated with what other conditions
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
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
2. What are the effects of atropine on parietal cells and G cells
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
3. What pancreatic enzymes are responsible for fat digestion
Lipase - phospholipase A - colipase
Poor anastamoses
3 waves/min
Oral glucose
4. Which serum enzyme increases with heavy EtOH consumption
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Oligosaccharide digestion
Gamma glutamyl transferase GGT
Esophageal carcinoma
5. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Cholesterol - 10-20% opaque due to calcifications
Duodenal atresia - Downs
Decrease - weight gain
Appendicitis
6. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Glucouronate - water soluble (direct)
Punched out - clean margins - carcinoma =raised irregular margins
Conj/unconj - inc - nl to dec
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
7. Which is used more quickly - an oral glucose load - or that by IV
Oral glucose
Mallory bodies
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Increase tumorigenesis
8. Liver cell failure can lead to multisystem signs including
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Jaundice - fever - RUQ
Cystic duct and common hepatic duct
Glucose dependent insulinotropic peptide
9. In what clinical scenarior do you see portosystemic anastomoses
Portal HTN
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
Epithelium
Crohns = maybe - UC= always
10. subQ peribumbilical metastasis
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Upregulated intracellular signal transduction
Sister mary joseph nodule
GLUT 2
11. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Inc conj bilirubin - inc cholesterol - inc alk phos
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
NAV = nerve artery vein - venous near the penis (NAVEL)
12. Where does type A chronic gastritis occur and What causes it
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Diarrhea - steatorrhea - weight loss - weakness
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
13. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
GERD - may also present with nocturnal cough and dyspnea
Necrotizing enterocolitis
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Peyers patches
14. How do villi appear in disaccharidease def
Normal
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Muscularis mucosae
Juvenille polyps - no risk if single
15. What happens to the short gastics if the splenic artery is blocked
External spermatic fascia only
Crohns = noncaseating granulomas - UC = crypt abscesses
Poor anastamoses
Complications of UC
16. A protrusion of peritoneum through an opening - usually a site of weakness
L2
Hernia
Left and right gastroepiploics - left and right gastrics
H+
17. What do you treat Wilsons disease with and What is the inheritance
Sphincter of oddi
CEA - CA-19-9
Penicillinamine - AR inheritance
Can lead to hematemesis - found in EtOHics and bulimics
18. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus
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19. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
L1
Conj/unconj - inc - nl to dec
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Superior rectal and middle and inferior rectal - rectum
20. If the abdominal aorta is blocked - How does blood get to the left colic artery
Falciform - ligamentum teres - fetal umbilical vein
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Necrotizing enterocolitis
Via the middle colic
21. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Inc lower esphogeal tone leading to achalasia
Short gastrics - left greater and lesser
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
2ndary biliary cirrhosis
22. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Alcoholic hepatitis
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Backup of blood into the liver - RHF - budd chiari
23. What causes hirschsprungs
Upregulated intracellular signal transduction
IgA secreting plasma cells - ultimately reside in the lamina proporia
Failure of neural crest migration
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
24. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Intussusception
The gastroduodenal
25. Where is bicarb trapped
Via the middle colic
EtOH
Gardner's syndrome
In the mucus that covers the gastric epithelium
26. Transmural esophageal rupture due to violent retching
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27. What converts inactive pepsinogen to pepsin
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
AST >ALT - ration is usually 1.5
Crohns = noncaseating granulomas - UC = crypt abscesses
H+
28. How does abetalipoproteinemia lead to malabsorption
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Budd chiari syndrome
Inferior rectal nerve
Juvenile polyposis syndrome - inc risk of adenocarcinoma
29. What is a positive murphy's sign
Positive
Krukenbergs tumor
Intussusception
Inspiratory arrest on deep palpation due to pain
30. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Goes through deep inguinal ring - external inguinal ring and into the scrotum
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
Alpha1 antitrypsin def - codominant trait
31. what percentage of colonic polyps are non - neoplastic
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
90%
32. Why does carcinoid syndrome not occur if tumor is confined to GI system
Adhesion
Liver metabolizes 5HT
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Fe2+ in the duod
33. What receptors does gastrin bind on the parietal cell and What does it activate
Hyperplastic
Dissaccharidase def - most commonly lactase
Conj/unconj - inc - nl to dec
CCK8 receptor - Gq inc IP3/Ca
34. What causes nutmeg liver
Hyperpigmented mouth - lips - hands - genitalia
Backup of blood into the liver - RHF - budd chiari
Early childhood - neuro sx and malabsorption
Hirschsprungs
35. What factors increase risk of malignancy of adenomatous polyps
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Sister mary joseph nodule
Unconjugated - water insoluble
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
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
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Corticosteroids - infliximab
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
37. What does histo show for alpha1 antitrypsin def
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
PAS- positive globules in liver -
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Hemolytic anemia
38. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Where hindgut meets ectoderm
Above
Oral glucose
Cirrhosis
39. In what scenarios do pts with gilberts have inc bili
Omeprazole
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Duodenal atresia - Downs
Fasting and stress
40. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Celiac sprue
Inc conj bilirubin - inc cholesterol - inc alk phos
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
41. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Hypotonic because of more time to reabsorb NaCl
Gut bacteria
Liver metabolizes 5HT
Left gastric vein and esophogeal vein - esophagus
42. Why are most diverticula considered false
Increase tumorigenesis
Necrotizing enterocolitis
The proximal small bowel
Lack or have an attenuated muscularis externa - often in the sigmoid colon
43. What are the ABCDEF of esophageal cancer
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Zenkers - halitosis - dysphagia and obstruction
Upregulated intracellular signal transduction
44. Which kind of hemorrhoids are painful and why
Pleuroperitoneal
Lubricate food (glycoprotiens)
Barrett's esophagus
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
45. What is pancreatic adenocarcinoma associated with
Cigarettes and chronic pancreatitis - not EtOH
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Virchow's node
46. trypsinogen is converted to trypsin via what enzyme
Decrease - weight gain
Diverticulum
Esophageal carcinoma
Enterokinase/enteropeptidase from the duodenal mucosa
47. What are the borders of the femoral triangle
Neural muscarinic pathways
Barrett's esophagus
AST
Inguninal ligament - sartorius muscle - adductor longus
48. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Lactase is located at the tips of intestinal villi
Esophageal cancer
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
...
49. What do you use to diagnose meckels
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
Pertechnetate - study for uptake
Alk pho
Boerhaave's Syndrome - Been heaving syndrome
50. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Unconj - absent (acholuria) - inc
Bleeding - penetration into pancreas - perforation - obstruction
3 waves/min
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