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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. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Failure of the processus vagainlis to close
Squamous - upper 1/3 - adeno - lower 1/3
H pylori (almost 100%)
Hyperplastic
2. What cells make pepsin - What does it do - and what regulates it
Lamina propora and submucosa
Cigarettes and chronic pancreatitis - not EtOH
Alk pho
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
3. What is contained within the submucosa
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4. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Necrotizing enterocolitis
Oligosaccharide digestion
FAP
5. What is the HLA association and treatment for hemochromatosis
Repeated phlebotomy - deferoxamine - HLA- A3
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Lactase is located at the tips of intestinal villi
Older patients
6. 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
Gut bacteria
All 3 gut layers outpouch as in Meckels
Stercobilin
7. What do you treat Wilsons disease with and What is the inheritance
Penicillinamine - AR inheritance
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Hydrocele
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
8. What are esophageal strictures associated with
Lye ingestion and acid reflux
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Peptic ulcer disease
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
9. Diaphragmatic hernias occur in infants because of defective development of which membrane
Pleuroperitoneal
Dissaccharidase def - most commonly lactase
Alfatoxin in peanuts
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
10. motilin - source - action - regulation
Right and left hepatic duct
Brunners
Fe2+ in the duod
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
11. In what scenarios do pts with gilberts have inc bili
Fasting and stress
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Oligosaccharide digestion
Gut bacteria
12. What is the cause of Barrett's and the assocaited complications
Hepatic steatosis
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
13. What gives urine its characteristic color
Urobilin
Skip lesions =crohns - colon = UC
Cystic dilation of the viteline duct
Centrilobular leading to congestive liver disease
14. What is the prognosis of adenocarcinoma
Necrotizing enterocolitis
Obstruction of the common bile duct
Cirrhosis
Averages 6 months - very aggressive - usually already metastasized at presentation
15. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Adhesion
Phototherapy
Corticosteroids - infliximab
HSV-1 - CMV - Candida
16. Autodigestion of pancreas by pancreatic enzymes
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Acute pancreatitis
Lipase - phospholipase A - colipase
17. When and why is stomach cancer termed linitis plastica
Hypercoaguability - polycythemia vera - pregnancy - HCC
Source - parasympathetic ganglion in sphincters - gallbladder - small intestine - action - inc intestinal water and electrolyte secretion - inc relaxation of intestinal smooth muscle and sphincters - regulation - inc by distention and vagal stimulati
Glucouronate - water soluble (direct)
When diffusely infiltrative - thickened rigid appearance like a leather bottle
18. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Conj/unconj - inc - nl to dec
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Liver metabolizes 5HT
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
19. What causes nutmeg liver
Backup of blood into the liver - RHF - budd chiari
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Reye's syndrome
20. What are the borders of Hesselbach's triangle
Striated
Uridine glucuronyl transferase
Below
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
21. What does loss of APC cause
Alcoholic cirrhosis
Decreased intercellular adhesion and increased proliferation
Krukenbergs tumor
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
22. What is the presenting course for appendicity
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23. what percentage of colonic polyps are non - neoplastic
EtOH
90%
Phenobarbital - inc liver enzyme synthesis
Unconjugated - water insoluble
24. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Heme metabolism
Peyers patches
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
25. Achalasia increases the risk For what complication
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Portal HTN
Esophageal carcinoma
Juvenille polyps - no risk if single
26. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Lye ingestion and acid reflux
Brunners
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Pancreatic head causing obstructive jaundice
27. What are additional risk factors for CRC
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Cigarettes and chronic pancreatitis - not EtOH
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Heme metabolism
28. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Peutz jeghers
Splenic flexure
Ampulla of vater
29. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Below
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
30. What separates the right greater and lesser sacs
HSV-1 - CMV - Candida
Gastrohepatic ligament
Spleen to posterior abdominal wall - splenic artery and vein
Gamma glutamyl transferase GGT
31. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Epithelium
Fe2+ in the duod
Neural muscarinic pathways
Black - rotors syndrome
32. Where is folate absorbed
Peutz jeghers
The jejunum
Cystic duct and common hepatic duct
Where hindgut meets ectoderm
33. What is the frequency of basal electric rhythm in the duodenum
Sphincter of oddi
Alfatoxin in peanuts
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
12 waves/min
34. What cells secrete bicarb - What does it do - and what regulates it
12 waves/min
Primary sclerosing cholangitis
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
35. What kind of digestion is bile needed for
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
In the ileum with bile acids - requires IF
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
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
36. What does histo show for alpha1 antitrypsin def
Hemosiderosis - hemochromatosis
Lack or have an attenuated muscularis externa - often in the sigmoid colon
PAS- positive globules in liver -
Zenkers - halitosis - dysphagia and obstruction
37. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
FAP
Colonic polyps
Hypotonic because of more time to reabsorb NaCl
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
38. Which IBD is autoimmune and which may be a disordered response to bacteria
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
39. conjugated hyperbilirubinemia due to defective liver excretion
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Dubin johnson
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Intussusception
40. How does loss of NO secretion affect the esophagus and what results
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Appendicitis
...
Inc lower esphogeal tone leading to achalasia
41. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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42. inflammatino of gallbadder
Squamous - upper 1/3 - adeno - lower 1/3
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
VZV and influenza B treated with salicylates
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
43. Malabsorption syndromes have what common clinical presentation
Diarrhea - steatorrhea - weight loss - weakness
Elevated amylase - and lipase
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Closer to isotonic because of less time to reabsorb NaCl
44. What does autoimmune destruction of parietal cells lead to...
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Chronic gastritis and pernicious anemia
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
45. With caput medusaw - between what vessels is the anastomoses and Where is it
3 waves/min
Paraumbilical and superficial and inferior epigastric - umbilicus
Obstruction of the common bile duct
Tropical sprue
46. What is Trousseau's sign
Redness and tenderness on palpation of extremities
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Epigastric abdominal pain radiating to back - anorexia - nausea
47. Is there any structural abnl with IBS - What is the course of disease and presentation
Oligosaccharide digestion
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Hirschsprungs
No - chronic - can present with diarrhea or constipation or alternation - treat sx
48. What are the midgut structures and what supplies their blood and PANS innervation
Osmotic
Gastrohepatic ligament
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Sphincter of oddi
49. Which viral infxns/treatments are associated with reyes syndrome
Penicillinamine - AR inheritance
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Muscularis mucosae
VZV and influenza B treated with salicylates
50. Gastrin - source - action - regulation
Celiac sprue
Increase tumorigenesis
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
Early childhood - neuro sx and malabsorption