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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. People of what decent are associated with celiac sprue and what findings/antibodies are present
Tropical sprue
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Dec PGE2 leading to dec gastric mucosa protection
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
2. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Peutz jeghers
Redness and tenderness on palpation of extremities
Hypotonic because of more time to reabsorb NaCl
3. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Virchow's node
Lactase is located at the tips of intestinal villi
Inspiratory arrest on deep palpation due to pain
IgA secreting plasma cells - ultimately reside in the lamina proporia
4. What is the most common esophageal cancer worldwide and in the US
Neutralizes oral bacertial acids and maintains dental health
Esophageal carcinoma
Worldwide - SC - US - adeno
Elevated amylase - and lipase
5. Why does carcinoid syndrome not occur if tumor is confined to GI system
Crohns = noncaseating granulomas - UC = crypt abscesses
Liver metabolizes 5HT
Colovesical leading to pneumaturia
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
6. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Above
Myenteric nerve plexus - aurbach
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Complications of crohns
7. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Hypercoaguability - polycythemia vera - pregnancy - HCC
Increase tumorigenesis
Esophageal cancer
Mucosa - submucosa - muscularis externa - serosa/adventitia
8. FAP + malignant CNS tumor
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Turcot
Cimetidine
Smooth
9. In PUD - with gastric ulcers - does pain inc or dec with meals?
Virchow's node
Ischemic colitis
Inc - weight loss
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
10. What is the presentation of pancreatic adenocarcinoma
Esophageal varices
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Krukenbergs tumor
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
11. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Early childhood - neuro sx and malabsorption
The gastroduodenal
Bleeding - penetration into pancreas - perforation - obstruction
Inc conj bilirubin - inc cholesterol - inc alk phos
12. How does hirschsprung present and appear on imaging
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
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
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Urobilin
13. What layer in the mucosa is responsible for absorption
Can lead to hematemesis - found in EtOHics and bulimics
Epithelium
Hydrocele
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
14. blind pouch protruding from alimentary tract that communicates with lumen of the gut
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
Diverticulum
Peyers patches
Unconj - absent (acholuria) - inc
15. most common non - neoplastic polyp in colon
Striated
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Lye ingestion and acid reflux
Hyperplastic
16. what kind of muscle is in the upper 1/3 of esophagus
Dubin johnson
Striated
Mucoepidermoid carcinoma
Hypotonic because of more time to reabsorb NaCl
17. What are the labs in acute pancreatitis
Elevated amylase - and lipase
Where hindgut meets ectoderm
The gastroduodenal
Small intestine
18. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Dermatitis herpetiformis
Hypotonic because of more time to reabsorb NaCl
Intussusception
Conj/unconj - inc - nl to dec
19. Where and How is iron absorbed
Volvulus
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Fe2+ in the duod
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
20. What type of insults result in micronodular cirrhosis
Hirschsprungs
Dermatitis herpetiformis
Reye's syndrome
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
21. What skin condition is associated with celiac sprue
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Splenic flexure
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Dermatitis herpetiformis
22. Who is at risk for pancreatic adenocarcinoma
Jewish and African American men
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Redundant mesentary
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
23. In viral hepatitis - which liver enzyme is higher
ALT>AST
Positive
Warthins' tumor
Juvenile polyposis syndrome - inc risk of adenocarcinoma
24. Where is the pectinate line
Where hindgut meets ectoderm
Positive urease test
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
25. What does TOASTED with alcoholic hepatitis stand for
Pancreatic and bile
AST >ALT - ration is usually 1.5
Carcinoid syndrome
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
26. How do NSAIDs cause acute gastritis
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Copious diarrhea - non alpha - non beta cell pancreatic tumor
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Dec PGE2 leading to dec gastric mucosa protection
27. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Enterokinase/enteropeptidase from the duodenal mucosa
Esophageal varices
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
28. What can fistula between the gallbladder and small intestine create and how can you tell
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Phototherapy
Punched out - clean margins - carcinoma =raised irregular margins
29. Dysphagia in achalasia results from
Normal
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Hemolytic anemia
All 3 gut layers outpouch as in Meckels
30. What is the most common indication of emergent abdominal surgery in children
Black - rotors syndrome
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Appendicitis
31. What causes carcinoid syndrome amd What are the symptoms
Peyers patches
Can lead to hematemesis - found in EtOHics and bulimics
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Inc conj bilirubin - inc cholesterol - inc alk phos
32. When and why is stomach cancer termed linitis plastica
Small intestine
Volvulus
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
33. What converts inactive pepsinogen to pepsin
Sphincter of oddi
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Adhesion
H+
34. What are the layers of the gut wall from inside out
Centrilobular congestion and necrosis - cardiac cirrhosis
In the ileum with bile acids - requires IF
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Mucosa - submucosa - muscularis externa - serosa/adventitia
35. What percentage of gall stones are cholesterol stones and What are the associations
CEA - CA-19-9
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
HPNCC
36. What source of salivary secretion is the most serous and What is the most mucinous
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
Krukenbergs tumor
Appendicitis
Serous on the sides parotids - mucinous in the middle sublingual
37. How is the diagonsis of CRC made
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Normal
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
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
38. In an MI - which liver enzyme is elevated
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
Diverticulum
L2
AST
39. What does histo show for alpha1 antitrypsin def
Krukenbergs tumor
All 3
PAS- positive globules in liver -
Failure of neural crest migration
40. What cells secrete bicarb - What does it do - and what regulates it
Achalasia due to loss of myenteric plexus (auberach)
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Crohns = maybe - UC= always
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
41. What is charcot triad of cholangitis
Turcot
Elevated amylase - and lipase
GERD - may also present with nocturnal cough and dyspnea
Jaundice - fever - RUQ
42. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Trypsin - chymotrypsin - elastase - carboxypeptidases
Small intestine
Unconj - absent (acholuria) - inc
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
43. What is the lumen of the pancreatic duct
Left gastric vein and esophogeal vein - esophagus
Elevated amylase - and lipase
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Ampulla of vater
44. Bilirubin is the product of what?
The entire
Alfatoxin in peanuts
Heme metabolism
Peutz jeghers
45. What is contained within the submucosa
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46. How is bilirubin carried in the blood
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Alcoholic cirrhosis
With albumin
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
47. At what spinal level does the celiac trunk exit
T12
3 waves/min
Centrilobular leading to congestive liver disease
Bleeding - intussusception - volvulus - obstruction near terminal ileum
48. in carcinoid tumors - What is seen on EM
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Low pressure proximal to LES
Dense core bodies
Pleomorphic adenoma
49. Where is folate absorbed
Diverticulitis in elderly - ectopic pregs use hCG to rule out
90%
The jejunum
Lamina propora and submucosa
50. Cholecytsokinin - source - action - regulation
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
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Inspiratory arrest on deep palpation due to pain
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia