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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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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 TX of physiologic neonatal jaundice
Phototherapy
Alcoholic hepatitis
Femoral hernia
Redness and tenderness on palpation of extremities
2. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Intussusception
Unconjugated - water insoluble
Conj - inc - dec
3. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
True and most common congenital anomoly of GI tract
Pleomorphic adenoma
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Achalasia due to loss of myenteric plexus (auberach)
4. What cell produces IF and What does it do
Via the middle colic
Bleeding - penetration into pancreas - perforation - obstruction
Hyperpigmented mouth - lips - hands - genitalia
Parietal cells in the stomach - B12 binding protein
5. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Poor anastamoses
Cirrhosis
Angiodysplasia
Peutz jeghers
6. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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7. What is contained in the gastrosplenic and What areas does it separate
Omeprazole
Short gastrics - left greater and lesser
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Positive urease test
8. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Zollinger Ellison - phenylalanine and tryptophan
Alcoholic cirrhosis
Enterokinase/enteropeptidase from the duodenal mucosa
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
9. What gives urine its characteristic color
Dense core bodies
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Urobilin
The jejunum
10. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Averages 6 months - very aggressive - usually already metastasized at presentation
Splenic flexure
Crohns = maybe - UC= always
Crigler - najjar type 1
11. What are the longterm sequelae of nutmeg liver
H+
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
8-9 waves/min
Centrilobular congestion and necrosis - cardiac cirrhosis
12. What kind of pancreatitis is associated with EtOH and smoking
L2
Chronic calcifying pancreatitis - inc risk of panreatic cancer
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
3 waves/min
13. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Gut bacteria
Fe2+ in the duod
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Cholesterol - 10-20% opaque due to calcifications
14. In what clinical scenarior do you see portosystemic anastomoses
Inc lower esphogeal tone leading to achalasia
Crigler - najjar type 1
Portal HTN
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
15. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Celiac sprue
Lactase is located at the tips of intestinal villi
Achalasia due to loss of myenteric plexus (auberach)
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
16. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
HSV-1 - CMV - Candida
Inspiratory arrest on deep palpation due to pain
Amylase
Menetriers disease
17. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Unconjugated - water insoluble
Inguninal ligament - sartorius muscle - adductor longus
Ischemic colitis
Left gastric vein and esophogeal vein - esophagus
18. What parts of the small bowel can tropical sprue effect
Alpha amylase
Stercobilin
Pertechnetate - study for uptake
The entire
19. What retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
NAV = nerve artery vein - venous near the penis (NAVEL)
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
20. Where does crohns usually affect the GI tract
Terminal ileum and colon
Inc conj bilirubin - inc cholesterol - inc alk phos
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
21. What kind of digestion is bile needed for
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
Primary sclerosing cholangitis
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Positive urease test
22. How do villi appear in disaccharidease def
Averages 6 months - very aggressive - usually already metastasized at presentation
Epigastric abdominal pain radiating to back - anorexia - nausea
Normal
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
23. What gives stool its characteristic color
Fe2+ in the duod
Stercobilin
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
So hypertrophied they look like brain gyri
24. What are the borders of the femoral triangle
Inguninal ligament - sartorius muscle - adductor longus
Chronic gastritis and pernicious anemia
Portal HTN
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
25. What does histo show for alpha1 antitrypsin def
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Decreased intercellular adhesion and increased proliferation
PAS- positive globules in liver -
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
26. In alchoholic hepatitis which liver enzyme is higher
Lateral to the inferior epigastric artery
Lipase
AST>ALT
Glucouronate - water soluble (direct)
27. What are the complications of Meckels
Where hindgut meets ectoderm
Increase tumorigenesis
Bleeding - intussusception - volvulus - obstruction near terminal ileum
When diffusely infiltrative - thickened rigid appearance like a leather bottle
28. Where is there sclerosis in alcoholic cirrohosis
Positive
Cholesterol
Barrett's esophagus
Around the central vein (zone III)
29. GIP - source - action regulation
Lipase - phospholipase A - colipase
Via the superior pancreaticduodenal
IBS at least 2 with recurrent abdominal pain
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
30. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
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
...
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
31. In PUD with a duodenal ulcer does pain inc or dec with meals
Decrease - weight gain
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Pertechnetate - study for uptake
32. What makes a true diverticula
All 3 gut layers outpouch as in Meckels
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Ischemic colitis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
33. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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34. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Splenic flexure
H2 receptor - inc cAMP
Esophageal varices
Redness and tenderness on palpation of extremities
35. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Adhesion
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Myenteric nerve plexus - aurbach
Backup of blood into the liver - RHF - budd chiari
36. Where does copper accumulate in Wilsons and What are ABCD
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
12 waves/min
37. What is the most common indication of emergent abdominal surgery in children
90%
H+
Appendicitis
Hemolytic anemia
38. How does hirschsprung present and appear on imaging
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
Averages 6 months - very aggressive - usually already metastasized at presentation
Below
AST >ALT - ration is usually 1.5
39. Gastrin - source - action - regulation
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
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
Angiodysplasia
Menetriers disease
40. In an MI - which liver enzyme is elevated
AST
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Paraumbilical and superficial and inferior epigastric - umbilicus
Cystic dilation of the viteline duct
41. What is the frequency of basal electric rhythm of the stomach
3 waves/min
Terminal ileum and colon
L/R renal artery around L1
Begins starch digestion - inactivated by low pH upon reaching the stomach
42. Malabsorption syndromes have what common clinical presentation
Diarrhea - steatorrhea - weight loss - weakness
No
Osmotic
Celiac sprue
43. motilin - source - action - regulation
Neural muscarinic pathways
Budd chiari syndrome
Striated
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
44. What are the signs of peutz jehgers
Gardner's syndrome
Lactase is located at the tips of intestinal villi
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Hyperpigmented mouth - lips - hands - genitalia
45. What are the treatment options for uclerative colitis
Inc smooth muscle relaxation - including lower esophageal sphincter
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
46. What are the results of hemochromatosis
IgA secreting plasma cells - ultimately reside in the lamina proporia
CHF and inc risk of HCC
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
47. Where are oligosaccharide hydrolases and What do they do
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Brush border of intestine - produce monosaccharides from oligo and di
Celiac sprue
Oligosaccharide digestion
48. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Black - rotors syndrome
49. What are the main components of bile
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Juvenile polyposis syndrome - inc risk of adenocarcinoma
50. Which patients have pigment stones
True and most common congenital anomoly of GI tract
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Skip lesions =crohns - colon = UC
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