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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 serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Redness and tenderness on palpation of extremities
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Inc lower esphogeal tone leading to achalasia
Splenic flexure
2. What does extrahepatic biliary obstruction cause
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
The gastroduodenal
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Spleen to posterior abdominal wall - splenic artery and vein
3. What does TOASTED with alcoholic hepatitis stand for
Gastric glands
H+
The proximal small bowel
AST >ALT - ration is usually 1.5
4. in carcinoid tumors - What is seen on EM
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
VZV and influenza B treated with salicylates
Dense core bodies
5. signet ring cells - acanthosis nigracans - dz - character/association - spread
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
ALT>AST
Via the superior pancreaticduodenal
6. What are the layers of the gut wall from inside out
Primarly through ECL leading to histamine release
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Mucosa - submucosa - muscularis externa - serosa/adventitia
7. What are the two molecular pathways that lead to CRC
Repeated phlebotomy - deferoxamine - HLA- A3
MSI (15%) and APC/beta catenin chromosomal instability (85%)
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Femoral hernia
8. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
The submucosal nerve plexus - meissner's
Left gastric vein and esophogeal vein - esophagus
Conj/unconj - inc - nl to dec
Juvenille polyps - no risk if single
9. What are the borders of Hesselbach's triangle
Nonkeritinized stratified sqamous epithelium
Terminal ileum and colon
Hemolytic anemia
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
10. Where does copper accumulate in Wilsons and What are ABCD
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Lipase - phospholipase A - colipase
Fe2+ in the duod
T cell lymphoma
11. What are esophageal strictures associated with
Lye ingestion and acid reflux
Jaundice - fever - RUQ
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Duodenum - 2nd - 3rd and 4th parts
12. What transforms conjugated bilirubin to urobilinogen
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Gut bacteria
Pleuroperitoneal
13. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Inc smooth muscle relaxation - including lower esophageal sphincter
Superior rectal and middle and inferior rectal - rectum
Carcinoid syndrome
Alcoholic hepatitis
14. What are the treatment options for uclerative colitis
Inc conj bilirubin - inc cholesterol - inc alk phos
All 3
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
15. What parts of the small bowel can tropical sprue effect
Carcinoid syndrome
The entire
Redundant mesentary
Antrum - H.pylori - inc risk of MALT lymphoma
16. At what spinal level does the is the bifurcation of aorta
Boerhaave's Syndrome - Been heaving syndrome
L4
L3
Inc smooth muscle relaxation - including lower esophageal sphincter
17. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Lateral
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
Normal
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
18. What drug blocks the H2R
Peptic ulcer disease
Cimetidine
Positive
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
19. What is the main symptom if a VIPoma
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Obstruction of the common bile duct
20. What do you use to diagnose meckels
Splenic flexure
Pertechnetate - study for uptake
Hydrocele
AST
21. GIP - source - action regulation
Conj/unconj - inc - nl to dec
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Lipase - phospholipase A - colipase
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
22. What is the TX of physiologic neonatal jaundice
Cystic dilation of the viteline duct
Epithelium
Where hindgut meets ectoderm
Phototherapy
23. Achalasia can be secondary to what infectious disease common in South America
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Chagas disease
Elevated amylase - and lipase
Meckels
24. rare - often fatal childhood hepatoencephalopathy
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25. Why does carcinoid syndrome not occur if tumor is confined to GI system
Liver metabolizes 5HT
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Epithelium
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
26. What does K- ras mutation cause
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Upregulated intracellular signal transduction
Jaundice - fever - RUQ
Striated and smooth
27. what kind of muscle is in the upper 1/3 of esophagus
Decreased intercellular adhesion and increased proliferation
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Striated
Boerhaave's Syndrome - Been heaving syndrome
28. What is indirect bilirubin
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Oral glucose
Unconjugated - water insoluble
29. What is the clinical presentation of acute pancreatitis
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
Carcinoid syndrome
Epigastric abdominal pain radiating to back - anorexia - nausea
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
30. How does brain injury lead to acute gastritis and What is it called
Warthins' tumor
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Peutz jeghers
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
31. How do burns cause acute gastritis and What is it called
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32. What is the arterial supply and venous drainage below pectinate line
Lye ingestion and acid reflux
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Pancreatic and bile
Inc smooth muscle relaxation - including lower esophageal sphincter
33. What is the HLA association and treatment for hemochromatosis
Repeated phlebotomy - deferoxamine - HLA- A3
Diarrhea - steatorrhea - weight loss - weakness
Uridine glucuronyl transferase
Alk phos
34. What converts inactive pepsinogen to pepsin
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
NAV = nerve artery vein - venous near the penis (NAVEL)
Uremia
H+
35. What are the four Fs of gallstones
True and most common congenital anomoly of GI tract
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Female - fat - fertile - forty
Enterokinase/enteropeptidase from the duodenal mucosa
36. What does histo show for alpha1 antitrypsin def
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
PAS- positive globules in liver -
Dermatitis herpetiformis
The proximal small bowel
37. What are the midgut structures and what supplies their blood and PANS innervation
Pleuroperitoneal
The jejunum
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
38. What drug inhibits the H/K ATPase
Omeprazole
Smooth
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
39. With caput medusaw - between what vessels is the anastomoses and Where is it
Turcot
IBS at least 2 with recurrent abdominal pain
Unconjugated - water insoluble
Paraumbilical and superficial and inferior epigastric - umbilicus
40. If the abdominal aorta is blocked - How does blood get to the left colic artery
Alpha1 antitrypsin def - codominant trait
Warthins' tumor
Via the middle colic
Hemolytic anemia
41. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Pyoderma gangrenosum - primary sclerosing cholangitis
HPNCC
Hydrocele
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
42. In PUD with a duodenal ulcer does pain inc or dec with meals
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Decrease - weight gain
Gallbladder
The entire
43. What are the complications of chronic pancreatitis
Hemosiderosis - hemochromatosis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Unconjugated - water insoluble
H2 receptor - inc cAMP
44. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
AST>ALT
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Colonic polyps
Pyoderma gangrenosum - primary sclerosing cholangitis
45. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Dermatitis herpetiformis
Hyperplastic
AST
46. What receptors does ACH bind on the parietal cells and What does it activate
Crypts but not villi
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
M3 - Gq - inc IP3/Ca
Lateral
47. What can hemochromatosis be secondary to...
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Lipase - phospholipase A - colipase
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
48. What is the presentation of pancreatic adenocarcinoma
Cimetidine
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Short gastrics - left greater and lesser
AST
49. Where does type B chronic gastritis occur and What causes it
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Causes of gall stones
Antrum - H.pylori - inc risk of MALT lymphoma
Squamous - upper 1/3 - adeno - lower 1/3
50. What does bicab do in the mouth
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Osmotic
Neutralizes oral bacertial acids and maintains dental health
Primary sclerosing cholangitis