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Test your basic knowledge |
USMLE GI
Start Test
Study First
Subjects
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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. Acute gastritis is caused By what process
Erosive - disruption of mucosal barrier leading to inflammation
Gastrohepatic ligament
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
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
2. What is the most common esophageal cancer worldwide and in the US
Achalasia due to loss of myenteric plexus (auberach)
Worldwide - SC - US - adeno
Primary sclerosing cholangitis
Hemolytic anemia
3. What factors increase risk of malignancy of adenomatous polyps
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
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
4. When and How does Abetalipoproteinemia present
Early childhood - neuro sx and malabsorption
Lactase is located at the tips of intestinal villi
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
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
5. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Stimulate intestinal persistalsis
Alpha amylase
Via the superior pancreaticduodenal
6. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Around the central vein (zone III)
Meconium ileus
Terminal ileum and colon
7. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Hirschsprungs
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Alcoholic hepatitis
Volvulus
8. What are the labs in acute pancreatitis
Elevated amylase - and lipase
Peyers patches
Decrease - weight gain
No - chronic - can present with diarrhea or constipation or alternation - treat sx
9. What kind of muscle is in the lower 1/3 of the esophagus
Splenic flexure
Older patients
Glucose dependent insulinotropic peptide
Smooth
10. What does a gastrinoma cause
Jaundice - fever - RUQ
Inc conj bilirubin - inc cholesterol - inc alk phos
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
11. What is the most common cause of gallstones
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Acute pancreatitis
Lamina propria
12. What do the rugae of stomach look like in menetriers disease
Inc - weight loss
Carcinoid syndrome
Pancreatic head causing obstructive jaundice
So hypertrophied they look like brain gyri
13. Dysphagia in achalasia results from
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Esophageal carcinoma
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
14. How do villi appear in disaccharidease def
Dissaccharidase def - most commonly lactase
IBS at least 2 with recurrent abdominal pain
Normal
Cystic dilation of the viteline duct
15. Transmural esophageal rupture due to violent retching
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16. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Liver metabolizes 5HT
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
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
IgA secreting plasma cells - ultimately reside in the lamina proporia
17. Where is the deep inguinal ring relative to the inferior epigastric vessels
Phototherapy
True and most common congenital anomoly of GI tract
Lateral
Amylase
18. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Peutz jeghers
Meckels
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Complications of crohns
19. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Poor anastamoses
8-9 waves/min
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
20. What is the main symptom if a VIPoma
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Crohns = noncaseating granulomas - UC = crypt abscesses
21. Where does crohns usually affect the GI tract
Lactase is located at the tips of intestinal villi
Duodenal atresia - Downs
Terminal ileum and colon
Colovesical leading to pneumaturia
22. What is one potential precipitating factor for intussusception
Alk pho
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Reye's syndrome
Angiodysplasia
23. What does a low flow rate mean for saliva
Crigler - najjar type 1
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Uridine glucuronyl transferase
Hypotonic because of more time to reabsorb NaCl
24. If trypsin activates more trypsinogen - what kind of feedback loop is established
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Positive
Punched out - clean margins - carcinoma =raised irregular margins
25. Malabsorption syndromes have what common clinical presentation
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Diarrhea - steatorrhea - weight loss - weakness
Pancreatic and bile
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
26. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Bleeding - penetration into pancreas - perforation - obstruction
Carcinoid syndrome
Myenteric nerve plexus - aurbach
Jaundice - fever - RUQ
27. Where are tumors commonly in pancreatic adenocarcinoma
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Pertechnetate - study for uptake
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Pancreatic head causing obstructive jaundice
28. What artery passes around the duodenum
Hyperplastic
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Alcoholic cirrhosis
The gastroduodenal
29. What causes primary biliary cirrhosis
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
8-9 waves/min
T12
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
30. What are the treatment options for uclerative colitis
Crigler - najjar type 1
Cystic duct and common hepatic duct
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Stimulate the H/K ATPase
31. What is the triad of Plummer - Vinson syndrome
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Jaundice - fever - RUQ
Dysphagia (due to esophageal web) - glossitis - iron def anemia
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
32. What causes hirschsprungs
Hirschsprungs
Peutz jeghers
With albumin
Failure of neural crest migration
33. What kind of cancer to celiac sprue put you as inc risk for
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Peyers patches
T cell lymphoma
Splenic flexure
34. What cells make pepsin - What does it do - and what regulates it
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
35. Achalasia can be secondary to what infectious disease common in South America
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Osmotic
Chagas disease
36. 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
AST >ALT - ration is usually 1.5
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Mucosa - submucosa - muscularis externa - serosa/adventitia
37. How is salivary secretion stimulated
Dense core bodies
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Boerhaave's Syndrome - Been heaving syndrome
38. What are causes of extrahepatic biliary obstruction
Elevated amylase - and lipase
Jaundice - fever - RUQ
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Skip lesions =crohns - colon = UC
39. At what level of the spine does the IM exit the aorta
Conj/unconj - inc - nl to dec
Dissaccharidase def - most commonly lactase
Tropical sprue
L3
40. most common malignant salivary gland tumor
Stercobilin
Mucoepidermoid carcinoma
Portal HTN
Ceruplasmin
41. What is the mechanism for reyes syndrome
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Source - S cells (duod) - action - inc pancreatic bicarb secretion - dec gastric acid secretin - inc bile secretion - regulation - inc by acid - fatty acids in lumen of duod
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
42. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Can lead to hematemesis - found in EtOHics and bulimics
Achalasia due to loss of myenteric plexus (auberach)
Inferior rectal nerve
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
43. motilin - source - action - regulation
Decrease - weight gain
Duodenal atresia - Downs
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
IBS at least 2 with recurrent abdominal pain
44. Where does type A chronic gastritis occur and What causes it
Neural muscarinic pathways
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
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Liver metabolizes 5HT
45. What is the most common diaphragmatic hernia and What are the two types
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Appendicitis
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
46. How does abetalipoproteinemia lead to malabsorption
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
EtOH
Portal HTN
AST >ALT - ration is usually 1.5
47. What kind of muscle is in the middle 1/3 of esophagus
Striated and smooth
Unconj - absent (acholuria) - inc
Ischemic colitis
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
48. Gastrin - source - action - regulation
Meconium ileus
Hyperplastic
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
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
49. Between what structures do strong anastamoses exist
Stimulate intestinal persistalsis
Failure of the processus vagainlis to close
Left and right gastroepiploics - left and right gastrics
Amylase
50. What skin condition is associated with celiac sprue
Dermatitis herpetiformis
GERD - may also present with nocturnal cough and dyspnea
Complications of crohns
H+