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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. subQ peribumbilical metastasis
Enterokinase/enteropeptidase from the duodenal mucosa
In the ileum with bile acids - requires IF
Sister mary joseph nodule
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
2. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Via the middle colic
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
3. What are the four Fs of gallstones
Pyoderma gangrenosum - primary sclerosing cholangitis
Gastric glands
Redundant mesentary
Female - fat - fertile - forty
4. What are the barium swallow findings of achalasia
Mucoepidermoid carcinoma
Dilated esophagus with an area of distal stenosis - birds beak
Worldwide - SC - US - adeno
Portal HTN
5. What does bicab do in the mouth
Tropical sprue
Hirschsprungs
Neutralizes oral bacertial acids and maintains dental health
Cholesterol - 10-20% opaque due to calcifications
6. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Mucoepidermoid carcinoma
Reye's syndrome
Smooth
7. How is the diagonsis of CRC made
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
Begins starch digestion - inactivated by low pH upon reaching the stomach
Lipase - phospholipase A - colipase
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
8. How is salivary secretion stimulated
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Hyperpigmented mouth - lips - hands - genitalia
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Lubricate food (glycoprotiens)
9. How does abetalipoproteinemia lead to malabsorption
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Duodenum - 2nd - 3rd and 4th parts
Appendicitis
GERD - may also present with nocturnal cough and dyspnea
10. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Zollinger ellison - brunners glands
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
GERD - may also present with nocturnal cough and dyspnea
8-9 waves/min
11. crigler - najjar type II responds to which therapy and How does it work
Lamina propora and submucosa
Phenobarbital - inc liver enzyme synthesis
Fe2+ in the duod
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
12. Which patients have pigment stones
Hypotonic because of more time to reabsorb NaCl
Alpha amylase
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Colovesical leading to pneumaturia
13. What layer in the mucosa is responsible for support
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
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
Lamina propria
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
14. What does K- ras mutation cause
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
Causes of gall stones
Cystic duct and common hepatic duct
Upregulated intracellular signal transduction
15. What nerve innervates the external hemorrhoids
Erosive - disruption of mucosal barrier leading to inflammation
Inferior rectal nerve
True and most common congenital anomoly of GI tract
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
16. What is the other name for GIP (gastric inhibitory peptide)
AST
AST>ALT
Glucose dependent insulinotropic peptide
Increase tumorigenesis
17. What structures feed into the cystic duct
Gamma glutamyl transferase GGT
Gallbladder
Lateral to the inferior epigastric artery
Appendicitis
18. What are the signs and symptoms of budd chiari
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Fe2+ in the duod
19. What congenital birth defect is associated with Hirschsprung
Internal thoracic to superior epigastric to inferior epigastric
Downs
Conj/unconj - inc - nl to dec
T12
20. What are the histological findings of the colon
Crypts but not villi
Closer to isotonic because of less time to reabsorb NaCl
Centrilobular congestion and necrosis - cardiac cirrhosis
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
21. What is diverticulosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Dense core bodies
Intussusception
Cirrhosis
22. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Via the superior pancreaticduodenal
Epithelium
Angiodysplasia
True and most common congenital anomoly of GI tract
23. Who gets Whipple disease and How do they present
CCK8 receptor - Gq inc IP3/Ca
Primarly through ECL leading to histamine release
Old men - arthralgias - cardiac and neuro sx
Cimetidine
24. At what spinal level does the SMA exit
Superior rectal
CEA - CA-19-9
L1
Esophageal varices
25. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Peyers patches
Cystic dilation of the viteline duct
Reye's syndrome
26. What pancreatic enzymes are responsible for fat digestion
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Zollinger ellison - brunners glands
Menetriers disease
Lipase - phospholipase A - colipase
27. What kind of muscle is in the middle 1/3 of esophagus
Striated and smooth
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Sister mary joseph nodule
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
28. What receptor does histamine bind on the parietal cell and What does it activate
CEA - CA-19-9
H2 receptor - inc cAMP
The entire
Cigarettes and chronic pancreatitis - not EtOH
29. What happens to the short gastics if the splenic artery is blocked
M3 - Gq - inc IP3/Ca
Poor anastamoses
With albumin
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
30. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Brush border of intestine - produce monosaccharides from oligo and di
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Alpha amylase
Sister mary joseph nodule
31. What retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
Falciform - ligamentum teres - fetal umbilical vein
Repeated phlebotomy - deferoxamine - HLA- A3
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
32. milk intolerance
Volvulus
AR
Dissaccharidase def - most commonly lactase
Hypercoaguability - polycythemia vera - pregnancy - HCC
33. likely infectious form of malabsorption - responds to antibiotics
Tropical sprue
Fe2+ in the duod
Pleuroperitoneal
Paraumbilical and superficial and inferior epigastric - umbilicus
34. Malabsorption syndromes have what common clinical presentation
Peyers patches
Causes of gall stones
Antrum - H.pylori - inc risk of MALT lymphoma
Diarrhea - steatorrhea - weight loss - weakness
35. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Meckels
36. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
Meckels
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Averages 6 months - very aggressive - usually already metastasized at presentation
37. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Small intestine
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Ischemic colitis
Diverticulum
38. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Above
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Crigler - najjar type 1
Dysphagia (due to esophageal web) - glossitis - iron def anemia
39. What pancreatic proteases are secreted as zymogens
Trypsin - chymotrypsin - elastase - carboxypeptidases
L1
CHF and inc risk of HCC
Hypercoaguability - polycythemia vera - pregnancy - HCC
40. In alchoholic hepatitis which liver enzyme is higher
HSV-1 - CMV - Candida
Gastrohepatic ligament
AST>ALT
Parietal cells in the stomach - B12 binding protein
41. FAP + osseous and soft tissue tumors - retinal hyperplasia
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42. What are the common causes of gastric ulcers - What causes gastric ulcer
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Menetriers disease
Adhesion
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
43. What kind of pathways do CCK act on to cause pancreatic secretion
Juvenille polyps - no risk if single
Dubin johnson
Neural muscarinic pathways
Hernia
44. When do you see hypertrophy of brunners glands
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Peptic ulcer disease
Celiac sprue
Backup of blood into the liver - RHF - budd chiari
45. Abuse of what substance leads to acute gastritis
EtOH
Via the superior pancreaticduodenal
Below
Striated and smooth
46. What kind of lesions are characteristic of duodenal PUD vs cancer
Short gastrics - left greater and lesser
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Turcot
Punched out - clean margins - carcinoma =raised irregular margins
47. Where does type B chronic gastritis occur and What causes it
Backup of blood into the liver - RHF - budd chiari
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
GERD - may also present with nocturnal cough and dyspnea
Antrum - H.pylori - inc risk of MALT lymphoma
48. What is the most common esophageal cancer worldwide and in the US
Worldwide - SC - US - adeno
Punched out - clean margins - carcinoma =raised irregular margins
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Neutralizes gastric acid allowing pancreatic enzymes to fxn
49. In what scenarios do pts with gilberts have inc bili
Alk phos
Common hepatic - splenic - left gastric - main blood supply for stomach
Fasting and stress
Bleeding - intussusception - volvulus - obstruction near terminal ileum
50. What layer in the mucosa is responsible for absorption
Epithelium
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Unconjugated - water insoluble
Juvenille polyps - no risk if single