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Test your basic knowledge |
USMLE GI
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Subjects
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health-sciences
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usmle
Instructions:
Answer 50 questions in 15 minutes.
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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 does bicab do in the mouth
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Phenobarbital - inc liver enzyme synthesis
Neutralizes oral bacertial acids and maintains dental health
The entire
2. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Zenkers - halitosis - dysphagia and obstruction
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Centrilobular leading to congestive liver disease
Meckels
3. At what spinal level does the celiac trunk exit
Crigler - najjar type 1
Mallory bodies
Juvenille polyps - no risk if single
T12
4. What are the complications of acute pancreatitis
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Gallbladder
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Peutz jeghers
5. What causes pancreatic insuff and What does it cause
Pleomorphic adenoma
Conj - inc - dec
Budd chiari syndrome
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
6. If the abdominal aorta is blocked - How does blood get to the left colic artery
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Via the middle colic
Conj/unconj - inc - nl to dec
Uremia
7. What do you use to diagnose meckels
Older patients
CHF and inc risk of HCC
Pertechnetate - study for uptake
Conj/unconj - inc - nl to dec
8. What histological findings are present in the esophagus
Lateral
Nonkeritinized stratified sqamous epithelium
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Terminal ileum and colon
9. When and How does Abetalipoproteinemia present
Repeated phlebotomy - deferoxamine - HLA- A3
Early childhood - neuro sx and malabsorption
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Ceruplasmin
10. What intervention will intervention will relieve portal HTN
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
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
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Enterokinase/enteropeptidase from the duodenal mucosa
11. What are the ABCDEF of esophageal cancer
Uridine glucuronyl transferase
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Inc lower esphogeal tone leading to achalasia
Redness and tenderness on palpation of extremities
12. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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13. Achalasia can be secondary to what infectious disease common in South America
Ischemic colitis
Chagas disease
Diverticulum
IBS at least 2 with recurrent abdominal pain
14. How does abetalipoproteinemia lead to malabsorption
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Meconium ileus
Hepatic steatosis
15. Which IBD is autoimmune and which may be a disordered response to bacteria
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Chronic gastritis and pernicious anemia
Carcinoid syndrome
Peyers patches
16. What receptors does gastrin bind on the parietal cell and What does it activate
CCK8 receptor - Gq inc IP3/Ca
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Spleen to posterior abdominal wall - splenic artery and vein
Corticosteroids - infliximab
17. somatostatin - source - action - regulation
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
H+
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
18. trypsinogen is converted to trypsin via what enzyme
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Enterokinase/enteropeptidase from the duodenal mucosa
Right and left hepatic duct
19. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Crohns = maybe - UC= always
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Below
20. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Dissaccharidase def - most commonly lactase
Averages 6 months - very aggressive - usually already metastasized at presentation
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Ischemic colitis
21. What are the barium swallow findings of achalasia
Squamous - upper 1/3 - adeno - lower 1/3
Cystic dilation of the viteline duct
Conj - inc - dec
Dilated esophagus with an area of distal stenosis - birds beak
22. What does a low flow rate mean for saliva
AR
Diverticulum
Striated and smooth
Hypotonic because of more time to reabsorb NaCl
23. What is one potential precipitating factor for intussusception
Alpha1 antitrypsin def - codominant trait
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Hydrocele
AST>ALT
24. occlusion of IVC or hepatic veins
Oligosaccharide digestion
Conj/unconj - inc - nl to dec
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Budd chiari syndrome
25. What kind of anemia is in Wilsons
Hemolytic anemia
Inc smooth muscle relaxation - including lower esophageal sphincter
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
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
26. Where and How is iron absorbed
Fe2+ in the duod
AST
Complications of crohns
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
27. What is the presentation of pancreatic adenocarcinoma
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Dubin johnson
M3 - Gq - inc IP3/Ca
Krukenbergs tumor
28. What does TOASTED with alcoholic hepatitis stand for
Duodenum - 2nd - 3rd and 4th parts
AST >ALT - ration is usually 1.5
Warthins' tumor
Old men - arthralgias - cardiac and neuro sx
29. Where does crohns usually affect the GI tract
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Duodenum - 2nd - 3rd and 4th parts
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Terminal ileum and colon
30. How does CRC present in the distal and proximal colon
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Averages 6 months - very aggressive - usually already metastasized at presentation
31. What is pancreatic adenocarcinoma associated with
Sphincter of oddi
Female - fat - fertile - forty
Cigarettes and chronic pancreatitis - not EtOH
Striated and smooth
32. What is the path of an indirect inguinal hernia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Adhesion
Warthins' tumor
Dubin johnson
33. What is Trousseau's sign
Redness and tenderness on palpation of extremities
Hypotonic because of more time to reabsorb NaCl
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Mitochondrial abnl - fatty liver - hypoglycemia - coma
34. In PUD with a duodenal ulcer does pain inc or dec with meals
Gamma glutamyl transferase GGT
Striated and smooth
Decrease - weight gain
Brunners
35. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
Peutz jeghers
Reye's syndrome
Alfatoxin in peanuts
...
36. What serum enzyme is elevated inacute pancreatitis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Lipase
Decreased intercellular adhesion and increased proliferation
Serous on the sides parotids - mucinous in the middle sublingual
37. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Turcot
38. What is the TX of physiologic neonatal jaundice
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
HSV-1 - CMV - Candida
Phototherapy
Chagas disease
39. What makes a true diverticula
L2
All 3 gut layers outpouch as in Meckels
Lubricate food (glycoprotiens)
In the mucus that covers the gastric epithelium
40. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
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
Alcoholic hepatitis
Inc lower esphogeal tone leading to achalasia
Uridine glucuronyl transferase
41. What causes nutmeg liver
Backup of blood into the liver - RHF - budd chiari
Female - fat - fertile - forty
Zollinger ellison - brunners glands
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
42. What does autoimmune destruction of parietal cells lead to...
Dubin johnson
Dissaccharidase def - most commonly lactase
Alfatoxin in peanuts
Chronic gastritis and pernicious anemia
43. Are single polyps malignant in peutz jehgers
No
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
True and most common congenital anomoly of GI tract
Causes of gall stones
44. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
45. Which is used more quickly - an oral glucose load - or that by IV
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Hydrocele
Oral glucose
46. in CF - meconium plug obstructs intestine - preventing stool passage at birth
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
Primarly through ECL leading to histamine release
Carcinoid syndrome
Meconium ileus
47. 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
Fe2+ in the duod
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Inc - weight loss
48. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Lamina propora and submucosa
GERD - may also present with nocturnal cough and dyspnea
ALT>AST
49. What are the signs and symptoms of budd chiari
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Peutz jeghers
50. What is the cause of physiologic neonatal jaundice
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Worldwide - SC - US - adeno
Conj/unconj - inc - nl to dec
Uridine glucuronyl transferase
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