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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. In what clinical scenarior do you see portosystemic anastomoses
Portal HTN
Hypotonic because of more time to reabsorb NaCl
Inc lower esphogeal tone leading to achalasia
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
2. At what level of the spine does the IM exit the aorta
Myenteric nerve plexus - aurbach
Redundant mesentary
L3
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
3. What kind of insults results in macronodular cirrhosis
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Diverticulum
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Tropical sprue
4. Failure of relaxation of lower esophageal sphincter - Name and etiology
Inspiratory arrest on deep palpation due to pain
The jejunum
Achalasia due to loss of myenteric plexus (auberach)
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
5. malnutrition - toxic megacolon - colorectal carcinoma
Complications of UC
Averages 6 months - very aggressive - usually already metastasized at presentation
Lamina propria
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
6. What is the other name for GIP (gastric inhibitory peptide)
Glucose dependent insulinotropic peptide
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
L/R renal artery around L1
7. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
L2
HPNCC
Complications of UC
Crohns = maybe - UC= always
8. How is salivary secretion stimulated
Oral glucose
Angiodysplasia
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
No - chronic - can present with diarrhea or constipation or alternation - treat sx
9. What are the borders of the femoral triangle
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Superior rectal
Inguninal ligament - sartorius muscle - adductor longus
Muscularis mucosae
10. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Increase tumorigenesis
Older patients
Alk phos
GERD - may also present with nocturnal cough and dyspnea
11. What receptors does ACH bind on the parietal cells and What does it activate
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Juvenile polyposis syndrome - inc risk of adenocarcinoma
M3 - Gq - inc IP3/Ca
Femoral hernia
12. If the abdominal aorta is blocked - How does blood get to the left colic artery
Left and right gastroepiploics - left and right gastrics
Crypts but not villi
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Via the middle colic
13. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus
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14. motilin - source - action - regulation
Penicillinamine - AR inheritance
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Meckels
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
15. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
T12
Closer to isotonic because of less time to reabsorb NaCl
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Chagas disease
16. GIP - source - action regulation
Brush border of intestine - produce monosaccharides from oligo and di
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
All 3 gut layers outpouch as in Meckels
17. What retroperitoneal structure flanks both sides of the pancreas on CT
Alpha1 antitrypsin def - codominant trait
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Duodenum - 2nd - 3rd and 4th parts
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
18. What are the complications of chronic pancreatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
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
Mucoepidermoid carcinoma
Copious diarrhea - non alpha - non beta cell pancreatic tumor
19. What does TOASTED with alcoholic hepatitis stand for
Oligosaccharide digestion
With albumin
AST >ALT - ration is usually 1.5
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
20. What are the main components of bile
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Portal HTN
Inc - weight loss
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
21. What kind of muscle is in the middle 1/3 of esophagus
Striated and smooth
Primary sclerosing cholangitis
Stimulate the H/K ATPase
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
22. What are the common causes of gastric ulcers - What causes gastric ulcer
Falciform - ligamentum teres - fetal umbilical vein
Duodenal atresia - Downs
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Appendicitis
23. What can fistula between the gallbladder and small intestine create and how can you tell
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Hirschsprungs
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
Hepatic steatosis
24. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
PAS- positive globules in liver -
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Zollinger ellison - brunners glands
25. Which kind of hemorrhoids are painful and why
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
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
Virchow's node
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
26. What does a gastrinoma cause
The jejunum
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
27. What kind of pancreatitis is associated with EtOH and smoking
Portal HTN
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Turcot
Begins starch digestion - inactivated by low pH upon reaching the stomach
28. most common malignant salivary gland tumor
Corticosteroids - infliximab
Mucoepidermoid carcinoma
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
29. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Left gastric vein and esophogeal vein - esophagus
Intussusception
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Centrilobular congestion and necrosis - cardiac cirrhosis
30. How do you DX and TX gallstones
Uridine glucuronyl transferase
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Adhesion
US and cholecystectomy
31. What is Trousseau's sign
Redness and tenderness on palpation of extremities
Acute pancreatitis
Femoral hernia
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
32. What are the complications of acute pancreatitis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Myenteric nerve plexus - aurbach
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Cirrhosis
33. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
L1
Jewish and African American men
Failure of the processus vagainlis to close
2ndary biliary cirrhosis
34. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Hemolytic anemia
Duodenal atresia - Downs
35. What is biliary colic
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Conj/unconj - inc - nl to dec
Gardner's syndrome
Pancreatic head causing obstructive jaundice
36. How does hirschsprung present and appear on imaging
Inc risk of CRC and other visceral malignancies
Jewish and African American men
Barrett's esophagus
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
37. What source of salivary secretion is the most serous and What is the most mucinous
Left and right gastroepiploics - left and right gastrics
Serous on the sides parotids - mucinous in the middle sublingual
Primarly through ECL leading to histamine release
Where hindgut meets ectoderm
38. milk intolerance
Crypts but not villi
Unconj - absent (acholuria) - inc
Glucose dependent insulinotropic peptide
Dissaccharidase def - most commonly lactase
39. Autodigestion of pancreas by pancreatic enzymes
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Acute pancreatitis
Trypsin - chymotrypsin - elastase - carboxypeptidases
Ischemic colitis
40. Gq and inc cAMP both work to do what in parietal cells
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Diverticulum
Stimulate the H/K ATPase
41. What pancreatic proteases are secreted as zymogens
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Brunners
Trypsin - chymotrypsin - elastase - carboxypeptidases
Nonkeritinized stratified sqamous epithelium
42. What is the most common cause of gallstones
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
The gastroduodenal
Lateral to the inferior epigastric artery
43. What does the splenorenal ligament connect - and What does it contain
The entire
Spleen to posterior abdominal wall - splenic artery and vein
Peptic ulcer disease
Neural muscarinic pathways
44. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Gut bacteria
Serous on the sides parotids - mucinous in the middle sublingual
Conj/unconj - inc - nl to dec
Meckels
45. Who gets Whipple disease and How do they present
External (superficial) ring only
Old men - arthralgias - cardiac and neuro sx
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Cholesterol - 10-20% opaque due to calcifications
46. What is the cause of physiologic neonatal jaundice
Dec PGE2 leading to dec gastric mucosa protection
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Reye's syndrome
Lamina propora and submucosa
47. What is the arterial supply and venous drainage below pectinate line
Averages 6 months - very aggressive - usually already metastasized at presentation
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
All 3
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
48. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Decrease - weight gain
Unconj - absent (acholuria) - inc
Above
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
49. likely infectious form of malabsorption - responds to antibiotics
Around the central vein (zone III)
L4
Tropical sprue
Fe2+ in the duod
50. What type of insults result in micronodular cirrhosis
Lipase
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
GLUT 2
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
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