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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. At what spinal level does the SMA exit
Alk phos
Via the middle colic
L1
Esophageal varices
2. Gastrin - source - action - regulation
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
Stimulate intestinal persistalsis
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Inc - weight loss
3. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Inc conj bilirubin - inc cholesterol - inc alk phos
Alk pho
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Crigler - najjar type 1
4. Through which aspect of the inguinal canal does a direct inguinal go
Juvenile polyposis syndrome - inc risk of adenocarcinoma
All 3
Lubricate food (glycoprotiens)
External (superficial) ring only
5. What kind of lesions are characteristic of duodenal PUD vs cancer
Punched out - clean margins - carcinoma =raised irregular margins
Ischemic colitis
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Repeated phlebotomy - deferoxamine - HLA- A3
6. At what level do the testicular/ovarian arteries exit the aorta
Crohns = maybe - UC= always
L2
Hemosiderosis - hemochromatosis
Elevated amylase - and lipase
7. What are esophageal strictures associated with
Lye ingestion and acid reflux
CCK8 receptor - Gq inc IP3/Ca
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
8. Where is IgA shuttled
Krukenbergs tumor
Esophageal carcinoma
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
9. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Poor anastamoses
Carcinoid syndrome
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Adhesion
10. What is the characteristic histo finding in alcoholic hepatitis
PAS- positive globules in liver -
Lye ingestion and acid reflux
Mallory bodies
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
11. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Boerhaave's Syndrome - Been heaving syndrome
Fe2+ in the duod
Bleeding - penetration into pancreas - perforation - obstruction
Necrotizing enterocolitis
12. 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
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Skip lesions =crohns - colon = UC
Ampulla of vater
13. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Femoral hernia
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
HPNCC
Above
14. What kind of diarrhea is produced from a disaccharide def
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Osmotic
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Antrum - H.pylori - inc risk of MALT lymphoma
15. What is the sphincter of the pancreatic duct
Hyperpigmented mouth - lips - hands - genitalia
Liver metabolizes 5HT
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Sphincter of oddi
16. trypsinogen is converted to trypsin via what enzyme
Hypercoaguability - polycythemia vera - pregnancy - HCC
All 3
Enterokinase/enteropeptidase from the duodenal mucosa
Conj/unconj - inc - nl to dec
17. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Esophageal cancer
Peutz jeghers
Oral glucose
18. What skin condition is associated with celiac sprue
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Dermatitis herpetiformis
Tropical sprue
19. How does loss of NO secretion affect the esophagus and what results
GERD - may also present with nocturnal cough and dyspnea
Stimulate intestinal persistalsis
Inc lower esphogeal tone leading to achalasia
Hernia
20. What is the ddx associated with appendicitis
Phototherapy
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Skip lesions =crohns - colon = UC
AR
21. How are all 3 monosaccharides transported to the blood
Reye's syndrome
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Causes of gall stones
GLUT 2
22. What histological findings are present in the stomach
Gastric glands
The gastroduodenal
External (superficial) ring only
Jewish and African American men
23. What are the treatmet options for crohns
Early childhood - neuro sx and malabsorption
The proximal small bowel
Corticosteroids - infliximab
Omeprazole
24. What are the barium swallow findings of achalasia
Redness and tenderness on palpation of extremities
Dilated esophagus with an area of distal stenosis - birds beak
Oligosaccharide digestion
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
25. What are the extraintestinal manifestations of ulcerative colitis
Gastric glands
Positive
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Pyoderma gangrenosum - primary sclerosing cholangitis
26. What are the histological findings in the jejunum
Upregulated intracellular signal transduction
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Positive urease test
Primary sclerosing cholangitis
27. What serum enzyme is elevated in acute pancreatitis and mumps
Amylase
Right and left hepatic duct
Black - rotors syndrome
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
28. How do villi appear in disaccharidease def
Primary sclerosing cholangitis
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Normal
29. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Peutz jeghers
3 waves/min
Necrotizing enterocolitis
30. What are the treatment options for uclerative colitis
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Stimulate intestinal persistalsis
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
31. What artery passes around the duodenum
L2
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Myenteric nerve plexus - aurbach
The gastroduodenal
32. What does alpha amylase do and what inactivates it
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Inc lower esphogeal tone leading to achalasia
Begins starch digestion - inactivated by low pH upon reaching the stomach
33. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Internal thoracic to superior epigastric to inferior epigastric
Peutz jeghers
Alcoholic hepatitis
...
34. 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
GERD - may also present with nocturnal cough and dyspnea
Acute pancreatitis
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
35. somatostatin - source - action - regulation
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
AST >ALT - ration is usually 1.5
Boerhaave's Syndrome - Been heaving syndrome
Mallory bodies
36. What kind of pancreatitis is associated with EtOH and smoking
Osmotic
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Ampulla of vater
Via the superior pancreaticduodenal
37. What is the most common diaphragmatic hernia and What are the two types
Meckels
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
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
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
38. What are motilin receptor agonists used for clinically
Glucouronate - water soluble (direct)
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Alk phos
Stimulate intestinal persistalsis
39. What kind of pathways do CCK act on to cause pancreatic secretion
Crohns = noncaseating granulomas - UC = crypt abscesses
CEA - CA-19-9
Acute pancreatitis
Neural muscarinic pathways
40. What are additional risk factors for CRC
Menetriers disease
Inspiratory arrest on deep palpation due to pain
Barrett's esophagus
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
41. In PUD - with gastric ulcers - does pain inc or dec with meals?
Can lead to hematemesis - found in EtOHics and bulimics
Inc - weight loss
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Spleen to posterior abdominal wall - splenic artery and vein
42. What drug inhibits the H/K ATPase
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Omeprazole
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
43. milk intolerance
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Lactase is located at the tips of intestinal villi
Hypercoaguability - polycythemia vera - pregnancy - HCC
Dissaccharidase def - most commonly lactase
44. What other condition can lead to acute gastritis - think renal
8-9 waves/min
Uremia
Nonkeritinized stratified sqamous epithelium
Chagas disease
45. Where does type A chronic gastritis occur and What causes it
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Inguninal ligament - sartorius muscle - adductor longus
Mallory bodies
Esophageal carcinoma
46. What is charcot triad of cholangitis
Volvulus
Jaundice - fever - RUQ
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Hypercoaguability - polycythemia vera - pregnancy - HCC
47. Achalasia can be secondary to what infectious disease common in South America
Chagas disease
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Portal HTN
Decreased intercellular adhesion and increased proliferation
48. Where is bicarb trapped
Mucosa - submucosa - muscularis externa - serosa/adventitia
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Alpha1 antitrypsin def - codominant trait
In the mucus that covers the gastric epithelium
49. What kind of cancer to celiac sprue put you as inc risk for
Alcoholic hepatitis
Can lead to hematemesis - found in EtOHics and bulimics
T cell lymphoma
Redness and tenderness on palpation of extremities
50. why infxn is implicated in duodenal PUD
Gastric glands
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Superior rectal and middle and inferior rectal - rectum
H pylori (almost 100%)