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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. What kind of pancreatitis is associated with EtOH and smoking
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
The submucosal nerve plexus - meissner's
Gut bacteria
Chronic calcifying pancreatitis - inc risk of panreatic cancer
2. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
H2 receptor - inc cAMP
3. What congenital birth defect is associated with Hirschsprung
Downs
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Erosive - disruption of mucosal barrier leading to inflammation
Alk phos
4. What do you use to diagnose meckels
90%
Pertechnetate - study for uptake
Hyperplastic
Unconj - absent (acholuria) - inc
5. is meckels a true diverticulum and how common is it
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Meckels
True and most common congenital anomoly of GI tract
Neutralizes gastric acid allowing pancreatic enzymes to fxn
6. What are the histological findings in the ileum
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7. What does extrahepatic biliary obstruction cause
Glucouronate - water soluble (direct)
Common hepatic - splenic - left gastric - main blood supply for stomach
Dubin johnson
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
8. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Colonic polyps
The submucosal nerve plexus - meissner's
Short gastrics - left greater and lesser
9. crigler - najjar type II responds to which therapy and How does it work
PAS- positive globules in liver -
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
Phenobarbital - inc liver enzyme synthesis
Older patients
10. Which kind of hemorrhoids are painful and why
Mallory bodies
Repeated phlebotomy - deferoxamine - HLA- A3
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Internal thoracic to superior epigastric to inferior epigastric
11. absent UDPGT - presents early in life - early mortality
Crigler - najjar type 1
ALT>AST
Pleuroperitoneal
L/R renal artery around L1
12. Between what structures do strong anastamoses exist
Smooth
Left and right gastroepiploics - left and right gastrics
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
13. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Pancreatic and bile
AST >ALT - ration is usually 1.5
Conj/unconj - inc - nl to dec
Can lead to hematemesis - found in EtOHics and bulimics
14. 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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15. conjugated hyperbilirubinemia due to defective liver excretion
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Dubin johnson
Old men - arthralgias - cardiac and neuro sx
Phenobarbital - inc liver enzyme synthesis
16. In what scenarios do pts with gilberts have inc bili
Fasting and stress
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Crohns = maybe - UC= always
Nonkeritinized stratified sqamous epithelium
17. What reaction does salivary amylase catalyze
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Nonkeritinized stratified sqamous epithelium
Esophageal carcinoma
18. Where does type B chronic gastritis occur and What causes it
Inc smooth muscle relaxation - including lower esophageal sphincter
Brunners
Antrum - H.pylori - inc risk of MALT lymphoma
Virchow's node
19. What are motilin receptor agonists used for clinically
Smooth
Redness and tenderness on palpation of extremities
Stimulate intestinal persistalsis
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
20. why infxn is implicated in duodenal PUD
Repeated phlebotomy - deferoxamine - HLA- A3
Glucouronate - water soluble (direct)
H pylori (almost 100%)
Diverticulum
21. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Muscularis mucosae
Alcoholic hepatitis
Cholesterol - 10-20% opaque due to calcifications
CHF and inc risk of HCC
22. Which IBD is autoimmune and which may be a disordered response to bacteria
Inc smooth muscle relaxation - including lower esophageal sphincter
GLUT 2
Dec PGE2 leading to dec gastric mucosa protection
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
23. What happens to the short gastics if the splenic artery is blocked
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Poor anastamoses
Budd chiari syndrome
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
24. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Adhesion
Dissaccharidase def - most commonly lactase
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
25. What does the splenorenal ligament connect - and What does it contain
Left and right gastroepiploics - left and right gastrics
Ampulla of vater
Spleen to posterior abdominal wall - splenic artery and vein
Hemolytic anemia
26. What is the main symptom if a VIPoma
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Jewish and African American men
Zenkers - halitosis - dysphagia and obstruction
Gastric glands
27. If trypsin activates more trypsinogen - what kind of feedback loop is established
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Positive
Gardner's syndrome
Alfatoxin in peanuts
28. What do tumors that arise in the head of the pancreas cause
Obstruction of the common bile duct
Ampulla of vater
External (superficial) ring only
Gastric glands
29. What is the prognosis of adenocarcinoma
Averages 6 months - very aggressive - usually already metastasized at presentation
Duodenal atresia - Downs
H2 receptor - inc cAMP
Obstruction of the common bile duct
30. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
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
L3
...
Dermatitis herpetiformis
31. What kind of muscle is in the middle 1/3 of esophagus
Striated and smooth
Zollinger ellison - brunners glands
Downs
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
32. What is the lumen of the pancreatic duct
Enterokinase/enteropeptidase from the duodenal mucosa
Inc smooth muscle relaxation - including lower esophageal sphincter
Ampulla of vater
Low pressure proximal to LES
33. What skin condition is associated with celiac sprue
Heme metabolism
Gardner's syndrome
Dermatitis herpetiformis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
34. Where is there sclerosis in alcoholic cirrohosis
Around the central vein (zone III)
In the mucus that covers the gastric epithelium
Positive urease test
Neutralizes oral bacertial acids and maintains dental health
35. What is the risk with peutz jehgers
Inc risk of CRC and other visceral malignancies
VZV and influenza B treated with salicylates
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Meckels
36. What do you treat Wilsons disease with and What is the inheritance
Penicillinamine - AR inheritance
Lateral
90%
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
37. What is charcot triad of cholangitis
With albumin
Positive
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Jaundice - fever - RUQ
38. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Gallbladder
Urobilin
Alcoholic cirrhosis
Phenobarbital - inc liver enzyme synthesis
39. How does loss of NO secretion affect the esophagus and what results
Cimetidine
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Inc lower esphogeal tone leading to achalasia
Peutz jeghers
40. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
90%
Black - rotors syndrome
Achalasia due to loss of myenteric plexus (auberach)
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
41. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
CEA - CA-19-9
Necrotizing enterocolitis
Esophageal carcinoma
42. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Inc - weight loss
IBS at least 2 with recurrent abdominal pain
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
43. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Black - rotors syndrome
Epithelium
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Bleeding - intussusception - volvulus - obstruction near terminal ileum
44. What layer in the mucosa is repsonsible for motility
Diarrhea - steatorrhea - weight loss - weakness
Cystic duct and common hepatic duct
Mucosa - submucosa - muscularis externa - serosa/adventitia
Muscularis mucosae
45. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Lateral to the inferior epigastric artery
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Carcinoid syndrome
46. What is the frequency of basal electric rhythm in the duodenum
Budd chiari syndrome
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Around the central vein (zone III)
12 waves/min
47. What retroperitoneal structure flanks both sides of the pancreas on CT
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
T12
Hemosiderosis - hemochromatosis
Duodenum - 2nd - 3rd and 4th parts
48. Why does indirect inguinal hernia happen in infacnts
Nonkeritinized stratified sqamous epithelium
Failure of the processus vagainlis to close
Zollinger Ellison - phenylalanine and tryptophan
GERD - may also present with nocturnal cough and dyspnea
49. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
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
Can lead to hematemesis - found in EtOHics and bulimics
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
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
50. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Phenobarbital - inc liver enzyme synthesis
Brush border of intestine - produce monosaccharides from oligo and di
Closer to isotonic because of less time to reabsorb NaCl
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates