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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. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Skip lesions =crohns - colon = UC
Femoral hernia
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Complications of crohns
2. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Femoral hernia
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Amylase
3. Why does carcinoid syndrome not occur if tumor is confined to GI system
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
Lye ingestion and acid reflux
Liver metabolizes 5HT
Omeprazole
4. What receptors does gastrin bind on the parietal cell and What does it activate
Inspiratory arrest on deep palpation due to pain
Turcot
FAP
CCK8 receptor - Gq inc IP3/Ca
5. What are the two molecular pathways that lead to CRC
Paraumbilical and superficial and inferior epigastric - umbilicus
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
6. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Cystic dilation of the viteline duct
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Lateral to the inferior epigastric artery
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
7. What does alpha amylase do and what inactivates it
GLUT 2
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Begins starch digestion - inactivated by low pH upon reaching the stomach
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
8. What do you use to diagnose meckels
L/R renal artery around L1
Pertechnetate - study for uptake
Chronic gastritis and pernicious anemia
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
9. What are the histological findings in the jejunum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Alpha amylase
All 3 gut layers outpouch as in Meckels
10. What converts inactive pepsinogen to pepsin
In the ileum with bile acids - requires IF
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
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
H+
11. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
T12
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
FAP
12. What drug blocks the H2R
Zenkers - halitosis - dysphagia and obstruction
Cimetidine
US and cholecystectomy
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
13. What structure is Not contained in the femoral sheath
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
12 waves/min
Erosive - disruption of mucosal barrier leading to inflammation
Heme metabolism
14. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Complications of UC
Via the middle colic
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Pertechnetate - study for uptake
15. Between what structures do strong anastamoses exist
Right and left hepatic duct
Closer to isotonic because of less time to reabsorb NaCl
Left and right gastroepiploics - left and right gastrics
Dubin johnson
16. If the hemochromatosis is primary - What is the pattern of inheritance
Female - fat - fertile - forty
AR
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
17. Where is the deep inguinal ring relative to the inferior epigastric vessels
Brunners
Lateral
Downs
...
18. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
US and cholecystectomy
Unconj - absent (acholuria) - inc
Left gastric vein and esophogeal vein - esophagus
Lateral to the inferior epigastric artery
19. What type of insults result in micronodular cirrhosis
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Hypercoaguability - polycythemia vera - pregnancy - HCC
Increase tumorigenesis
20. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Pleomorphic adenoma
Erosive - disruption of mucosal barrier leading to inflammation
Positive
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
21. What is one potential precipitating factor for intussusception
Centrilobular congestion and necrosis - cardiac cirrhosis
Meckels
8-9 waves/min
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
22. What is a positive murphy's sign
Inspiratory arrest on deep palpation due to pain
Backup of blood into the liver - RHF - budd chiari
Positive urease test
Hyperpigmented mouth - lips - hands - genitalia
23. What does loss of p53 cause
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Cholesterol
True and most common congenital anomoly of GI tract
Increase tumorigenesis
24. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
PAS- positive globules in liver -
No
Skip lesions =crohns - colon = UC
25. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Carcinoid syndrome
FAP
Via the middle colic
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
26. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Uremia
Lactase is located at the tips of intestinal villi
Intussusception
Splenic flexure
27. malnutrition - toxic megacolon - colorectal carcinoma
H pylori (almost 100%)
Smooth
Complications of UC
Erosive - disruption of mucosal barrier leading to inflammation
28. What causes pancreatic insuff and What does it cause
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Low pressure proximal to LES
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
29. What is Trousseau's sign
Redness and tenderness on palpation of extremities
Low pressure proximal to LES
Superior rectal
Budd chiari syndrome
30. Which serum enzyme increases with heavy EtOH consumption
All 3
Gamma glutamyl transferase GGT
Increase tumorigenesis
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
31. What retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Averages 6 months - very aggressive - usually already metastasized at presentation
Inc lower esphogeal tone leading to achalasia
32. What is the ddx associated with appendicitis
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Left and right gastroepiploics - left and right gastrics
All 3 gut layers outpouch as in Meckels
33. in CF - meconium plug obstructs intestine - preventing stool passage at birth
...
Lamina propora and submucosa
Oligosaccharide digestion
Meconium ileus
34. what kind of fistula is associated with diverticulitis
Cirrhosis
Colovesical leading to pneumaturia
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
35. What intervention will intervention will relieve portal HTN
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
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Hirschsprungs
AST >ALT - ration is usually 1.5
36. What is the cause of Barrett's and the assocaited complications
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Complications of UC
Tropical sprue
Dubin johnson
37. What pancreatic enzymes are responsible for fat digestion
Lipase - phospholipase A - colipase
Smooth
Right and left hepatic duct
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
38. What is the presentation of pancreatic adenocarcinoma
FAP
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Worldwide - SC - US - adeno
Warthins' tumor
39. What can hemochromatosis be secondary to...
The gastroduodenal
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
GERD - may also present with nocturnal cough and dyspnea
40. What complication can arise from indirect inguinal hernias
Hydrocele
Black - rotors syndrome
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Crypts but not villi
41. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Esophageal cancer
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
90%
Squamous - upper 1/3 - adeno - lower 1/3
42. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
ALT>AST
Corticosteroids - infliximab
Hemosiderosis - hemochromatosis
Diarrhea - steatorrhea - weight loss - weakness
43. At what spinal level does the SMA exit
L1
Squamous - upper 1/3 - adeno - lower 1/3
EtOH
The entire
44. Why does indirect inguinal hernia happen in infacnts
Juvenille polyps - no risk if single
Enterokinase/enteropeptidase from the duodenal mucosa
Failure of the processus vagainlis to close
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
45. Who gets gastric ulcers
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Cholesterol
Stercobilin
Older patients
46. What are the longterm sequelae of nutmeg liver
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Krukenbergs tumor
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Centrilobular congestion and necrosis - cardiac cirrhosis
47. likely infectious form of malabsorption - responds to antibiotics
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Tropical sprue
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Corticosteroids - infliximab
48. Which area of the hindgut is a watershed area
Oligosaccharide digestion
Oral glucose
Splenic flexure
Inferior rectal nerve
49. At what level of the spine does the IM exit the aorta
Older patients
Backup of blood into the liver - RHF - budd chiari
Poor anastamoses
L3
50. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Cirrhosis
Superior rectal
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
T12