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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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study here
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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 is Trousseau's sign
Redness and tenderness on palpation of extremities
Older patients
The entire
Portal HTN
2. What does high flow rate mean
Closer to isotonic because of less time to reabsorb NaCl
Right and left hepatic duct
Intussusception
Colovesical leading to pneumaturia
3. What is the rate limiting step of carbohydrate digestion
Inferior rectal nerve
Oligosaccharide digestion
Inc smooth muscle relaxation - including lower esophageal sphincter
Dubin johnson
4. motilin - source - action - regulation
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
5. What does the splenorenal ligament connect - and What does it contain
Enterokinase/enteropeptidase from the duodenal mucosa
Crypts but not villi
Spleen to posterior abdominal wall - splenic artery and vein
Bleeding - penetration into pancreas - perforation - obstruction
6. What is the characteristic histo finding in alcoholic hepatitis
Mallory bodies
Punched out - clean margins - carcinoma =raised irregular margins
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Neutralizes oral bacertial acids and maintains dental health
7. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Crigler - najjar type 1
Paraumbilical and superficial and inferior epigastric - umbilicus
Antrum - H.pylori - inc risk of MALT lymphoma
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
8. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Peyers patches
Angiodysplasia
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
CEA - CA-19-9
9. In what clinical scenarior do you see portosystemic anastomoses
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Portal HTN
H+
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
10. What is the action of NO as a GI hormone
Inc smooth muscle relaxation - including lower esophageal sphincter
Inc - weight loss
Falciform - ligamentum teres - fetal umbilical vein
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
11. Where is B12 absorbed
Inc conj bilirubin - inc cholesterol - inc alk phos
In the ileum with bile acids - requires IF
Phototherapy
Bleeding - intussusception - volvulus - obstruction near terminal ileum
12. What is the most common diaphragmatic hernia and What are the two types
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Hypercoaguability - polycythemia vera - pregnancy - HCC
13. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Alcoholic cirrhosis
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
The jejunum
14. what percentage of colonic polyps are non - neoplastic
External spermatic fascia only
90%
Mallory bodies
Cystic dilation of the viteline duct
15. GIP - source - action regulation
CEA - CA-19-9
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Hydrocele
L4
16. What happens to the short gastics if the splenic artery is blocked
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Jewish and African American men
Poor anastamoses
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
17. What gives urine its characteristic color
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Volvulus
Cholesterol
Urobilin
18. What causes primary biliary cirrhosis
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Paraumbilical and superficial and inferior epigastric - umbilicus
Necrotizing enterocolitis
19. is meckels a true diverticulum and how common is it
Esophageal cancer
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Glucose dependent insulinotropic peptide
True and most common congenital anomoly of GI tract
20. What is the lumen of the pancreatic duct
Tropical sprue
Lye ingestion and acid reflux
Skip lesions =crohns - colon = UC
Ampulla of vater
21. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Carcinoid syndrome
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
22. What is a positive murphy's sign
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Inspiratory arrest on deep palpation due to pain
CCK8 receptor - Gq inc IP3/Ca
Striated and smooth
23. What structures feed into the cystic duct
GERD - may also present with nocturnal cough and dyspnea
Hirschsprungs
Gallbladder
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
24. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Crypts but not villi
Left gastric vein and esophogeal vein - esophagus
Backup of blood into the liver - RHF - budd chiari
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
25. multiple juvenil polyps in GI tract - risk
Menetriers disease
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Mucosa - submucosa - muscularis externa - serosa/adventitia
26. Transmural esophageal rupture due to violent retching
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27. Where does type B chronic gastritis occur and What causes it
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Terminal ileum and colon
Antrum - H.pylori - inc risk of MALT lymphoma
3 waves/min
28. When and How does Abetalipoproteinemia present
FAP
Zollinger ellison - brunners glands
Early childhood - neuro sx and malabsorption
The entire
29. How does hirschsprung present and appear on imaging
Femoral hernia
Elevated amylase - and lipase
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
The gastroduodenal
30. What is the most common esophageal cancer worldwide and in the US
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
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
Worldwide - SC - US - adeno
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
31. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Duodenal atresia - Downs
Conj/unconj - inc - nl to dec
Punched out - clean margins - carcinoma =raised irregular margins
Hyperpigmented mouth - lips - hands - genitalia
32. Which serum enzyme increases with heavy EtOH consumption
Where hindgut meets ectoderm
Cholesterol - 10-20% opaque due to calcifications
Short gastrics - left greater and lesser
Gamma glutamyl transferase GGT
33. Achalasia can be secondary to what infectious disease common in South America
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Chagas disease
M3 - Gq - inc IP3/Ca
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
34. What is the ddx associated with appendicitis
Zollinger Ellison - phenylalanine and tryptophan
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Dissaccharidase def - most commonly lactase
35. How do NSAIDs cause acute gastritis
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Dec PGE2 leading to dec gastric mucosa protection
AST
Redness and tenderness on palpation of extremities
36. What artery passes around the duodenum
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Pancreatic and bile
Unconj - absent (acholuria) - inc
The gastroduodenal
37. What is pancreatic adenocarcinoma associated with
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Cigarettes and chronic pancreatitis - not EtOH
EtOH
Lipase - phospholipase A - colipase
38. What are the treatment options for uclerative colitis
Gallbladder
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Colonic polyps
Splenic flexure
39. When and why is stomach cancer termed linitis plastica
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Oral glucose
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Mallory bodies
40. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Skip lesions =crohns - colon = UC
Myenteric nerve plexus - aurbach
L/R renal artery around L1
Esophageal cancer
41. What layer in the mucosa is responsible for support
Skip lesions =crohns - colon = UC
Cystic duct and common hepatic duct
Lamina propria
H+
42. What is the arterial supply and venous drainage below pectinate line
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Squamous - upper 1/3 - adeno - lower 1/3
43. somatostatin - source - action - regulation
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
8-9 waves/min
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
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
44. absent UDPGT - presents early in life - early mortality
Pertechnetate - study for uptake
Downs
Crigler - najjar type 1
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
45. How do burns cause acute gastritis and What is it called
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46. If the hemochromatosis is primary - What is the pattern of inheritance
Alk pho
Poor anastamoses
AR
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
47. What congenital birth defect is associated with Hirschsprung
Striated
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
VZV and influenza B treated with salicylates
Downs
48. Is there any structural abnl with IBS - What is the course of disease and presentation
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
True and most common congenital anomoly of GI tract
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Primarly through ECL leading to histamine release
49. What receptors does gastrin bind on the parietal cell and What does it activate
CCK8 receptor - Gq inc IP3/Ca
Epithelium
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Stercobilin
50. What are the foregut structures and what supplies their blood and PANS innvervation
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Stimulate intestinal persistalsis
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Backup of blood into the liver - RHF - budd chiari
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