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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 do the rugae of stomach look like in menetriers disease
Esophageal carcinoma
So hypertrophied they look like brain gyri
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
L1
2. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Redness and tenderness on palpation of extremities
FAP
Pancreatic head causing obstructive jaundice
3. Autoantibodies to gluten (gliadin) in wheat and other grains
Celiac sprue
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Superior rectal and middle and inferior rectal - rectum
Older patients
4. What receptors does gastrin bind on the parietal cell and What does it activate
Diarrhea - steatorrhea - weight loss - weakness
CCK8 receptor - Gq inc IP3/Ca
Alpha amylase
L3
5. What causes nutmeg liver
HSV-1 - CMV - Candida
Backup of blood into the liver - RHF - budd chiari
Trypsin - chymotrypsin - elastase - carboxypeptidases
Gastrohepatic ligament
6. What factors increase risk of malignancy of adenomatous polyps
Intussusception
Fe2+ in the duod
Small intestine
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
7. Are single polyps malignant in peutz jehgers
H pylori (almost 100%)
PAS- positive globules in liver -
No
Juvenille polyps - no risk if single
8. What artery passes around the duodenum
Dysphagia (due to esophageal web) - glossitis - iron def anemia
The gastroduodenal
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Ischemic colitis
9. what percentage of colonic polyps are non - neoplastic
L/R renal artery around L1
90%
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Inc - weight loss
10. most common non - neoplastic polyp in colon
Downs
Hyperplastic
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
11. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
12 waves/min
Ischemic colitis
Unconj - absent (acholuria) - inc
Oral glucose
12. What retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
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
IgA secreting plasma cells - ultimately reside in the lamina proporia
Inc smooth muscle relaxation - including lower esophageal sphincter
13. What reaction does salivary amylase catalyze
Virchow's node
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Fasting and stress
Hirschsprungs
14. What skin condition is associated with celiac sprue
Reye's syndrome
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
So hypertrophied they look like brain gyri
Dermatitis herpetiformis
15. What is the presenting course for appendicity
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16. What are the midgut structures and what supplies their blood and PANS innervation
Inferior rectal nerve
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Stercobilin
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
17. What serum enzyme is elevated in acute pancreatitis and mumps
Uremia
Amylase
Dissaccharidase def - most commonly lactase
Alfatoxin in peanuts
18. 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
Phototherapy
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
GERD - may also present with nocturnal cough and dyspnea
19. What is biliary colic
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
External spermatic fascia only
Stimulate the H/K ATPase
20. What is the triad of Plummer - Vinson syndrome
Hirschsprungs
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Conj/unconj - inc - nl to dec
21. To what substance is bilirubin conjugated and why
Pleomorphic adenoma
Epigastric abdominal pain radiating to back - anorexia - nausea
Glucouronate - water soluble (direct)
Cystic duct and common hepatic duct
22. Where does crohns usually affect the GI tract
Zenkers - halitosis - dysphagia and obstruction
Terminal ileum and colon
Mucoepidermoid carcinoma
Lack or have an attenuated muscularis externa - often in the sigmoid colon
23. What are the extraintestinal manifestations of ulcerative colitis
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Pyoderma gangrenosum - primary sclerosing cholangitis
Muscularis mucosae
8-9 waves/min
24. What is the ddx associated with appendicitis
Gut bacteria
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Primary sclerosing cholangitis
Lipase - phospholipase A - colipase
25. What does loss of p53 cause
Increase tumorigenesis
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Crigler - najjar type 1
Epithelium
26. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
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
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Lamina propora and submucosa
AR
27. What commonly leads to appendicity in kids vs adults
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Brush border of intestine - produce monosaccharides from oligo and di
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Oligosaccharide digestion
28. malnutrition - toxic megacolon - colorectal carcinoma
Repeated phlebotomy - deferoxamine - HLA- A3
FAP
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Complications of UC
29. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Juvenille polyps - no risk if single
Adhesion
Inc lower esphogeal tone leading to achalasia
Decreased intercellular adhesion and increased proliferation
30. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Esophageal varices
Crigler - najjar type 1
Increase tumorigenesis
31. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Stimulate intestinal persistalsis
Necrotizing enterocolitis
Urobilin
Hypotonic because of more time to reabsorb NaCl
32. What does the splenorenal ligament connect - and What does it contain
Below
Spleen to posterior abdominal wall - splenic artery and vein
Right and left hepatic duct
Cigarettes and chronic pancreatitis - not EtOH
33. Esophagitis can result From which 3 infectious agents - or chemical ingestion
HSV-1 - CMV - Candida
Cholesterol
Neutralizes oral bacertial acids and maintains dental health
Carcinoid syndrome
34. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Serous on the sides parotids - mucinous in the middle sublingual
Internal thoracic to superior epigastric to inferior epigastric
Alk phos
35. What are the histological findings in the jejunum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
In the mucus that covers the gastric epithelium
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Hepatic steatosis
36. What is the omphalomesenteric cyst
Alcoholic hepatitis
Increase tumorigenesis
Cystic dilation of the viteline duct
Menetriers disease
37. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Esophageal varices
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
GERD - may also present with nocturnal cough and dyspnea
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
38. At what spinal level does the celiac trunk exit
T12
Paraumbilical and superficial and inferior epigastric - umbilicus
Hernia
Inc conj bilirubin - inc cholesterol - inc alk phos
39. What does TOASTED with alcoholic hepatitis stand for
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
AST >ALT - ration is usually 1.5
Superior rectal and middle and inferior rectal - rectum
40. Gallstones that reach the common channel at ampulla can block which two ducts
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Pancreatic and bile
Hirschsprungs
Antrum - H.pylori - inc risk of MALT lymphoma
41. What portion of the bowel does sprue effect
Esophageal cancer
The proximal small bowel
Duodenum - 2nd - 3rd and 4th parts
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
42. What are the longterm sequelae of nutmeg liver
Centrilobular congestion and necrosis - cardiac cirrhosis
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Bleeding - intussusception - volvulus - obstruction near terminal ileum
EtOH
43. At what spinal level does the SMA exit
L1
IgA secreting plasma cells - ultimately reside in the lamina proporia
Crypts but not villi
Small intestine
44. What makes a true diverticula
All 3 gut layers outpouch as in Meckels
External (superficial) ring only
Dubin johnson
Centrilobular leading to congestive liver disease
45. What can fistula between the gallbladder and small intestine create and how can you tell
Female - fat - fertile - forty
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Angiodysplasia
Hydrocele
46. What test and result confirms H pylori infxn
Positive urease test
Barrett's esophagus
Early childhood - neuro sx and malabsorption
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
47. How many layers of spermatic fascia are covers an indirect inguinal hernia
Nonkeritinized stratified sqamous epithelium
Increase tumorigenesis
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
All 3
48. How do burns cause acute gastritis and What is it called
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49. in budd chiari syndrome - Where is the congestion and necrosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Penicillinamine - AR inheritance
Centrilobular leading to congestive liver disease
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
50. Where is there sclerosis in alcoholic cirrohosis
Around the central vein (zone III)
Osmotic
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Hemosiderosis - hemochromatosis
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