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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. What are esophageal strictures associated with
Alpha1 antitrypsin def - codominant trait
Lipase
Lye ingestion and acid reflux
Inc risk of CRC and other visceral malignancies
2. What kind of muscle is in the middle 1/3 of esophagus
Poor anastamoses
Turcot
Striated and smooth
L/R renal artery around L1
3. What are the extraintestinal manifestations of ulcerative colitis
Via the middle colic
Diarrhea - steatorrhea - weight loss - weakness
Pyoderma gangrenosum - primary sclerosing cholangitis
Necrotizing enterocolitis
4. What is a positive murphy's sign
Inspiratory arrest on deep palpation due to pain
Older patients
The submucosal nerve plexus - meissner's
Low pressure proximal to LES
5. What infection causes Whipple disease and What can you see on LM
Left and right gastroepiploics - left and right gastrics
IBS at least 2 with recurrent abdominal pain
Right and left hepatic duct
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
6. Where is folate absorbed
When diffusely infiltrative - thickened rigid appearance like a leather bottle
All 3 gut layers outpouch as in Meckels
Neutralizes gastric acid allowing pancreatic enzymes to fxn
The jejunum
7. What can fistula between the gallbladder and small intestine create and how can you tell
Superior rectal and middle and inferior rectal - rectum
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
8. If the abdominal aorta is blocked - How does blood get to the left colic artery
Via the middle colic
Penicillinamine - AR inheritance
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
T cell lymphoma
9. What receptors does gastrin bind on the parietal cell and What does it activate
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Unconjugated - water insoluble
Celiac sprue
CCK8 receptor - Gq inc IP3/Ca
10. What congenital birth defect is associated with Hirschsprung
Osmotic
Downs
Hydrocele
Superior rectal and middle and inferior rectal - rectum
11. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Diverticulum
Lateral to the inferior epigastric artery
2ndary biliary cirrhosis
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
12. Where does type B chronic gastritis occur and What causes it
Liver metabolizes 5HT
Antrum - H.pylori - inc risk of MALT lymphoma
Left gastric vein and esophogeal vein - esophagus
Centrilobular congestion and necrosis - cardiac cirrhosis
13. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Erosive - disruption of mucosal barrier leading to inflammation
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
Oral glucose
14. What serum enzyme is elevated inacute pancreatitis
All 3 gut layers outpouch as in Meckels
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Glucouronate - water soluble (direct)
Lipase
15. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Cirrhosis
Duodenum - 2nd - 3rd and 4th parts
AST
Primarly through ECL leading to histamine release
16. What other condition can lead to acute gastritis - think renal
Uremia
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Left and right gastroepiploics - left and right gastrics
Superior rectal
17. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
External spermatic fascia only
Intussusception
Copious diarrhea - non alpha - non beta cell pancreatic tumor
18. why infxn is implicated in duodenal PUD
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Lactase is located at the tips of intestinal villi
H pylori (almost 100%)
IBS at least 2 with recurrent abdominal pain
19. secretin - source - action - regulation
Alpha amylase
Spleen to posterior abdominal wall - splenic artery and vein
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
Bleeding - intussusception - volvulus - obstruction near terminal ileum
20. What happens to the short gastics if the splenic artery is blocked
90%
Poor anastamoses
Dissaccharidase def - most commonly lactase
Hydrocele
21. What do tumors that arise in the head of the pancreas cause
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Obstruction of the common bile duct
T cell lymphoma
Cirrhosis
22. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Ampulla of vater
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Small intestine
3 waves/min
23. How do NSAIDs cause acute gastritis
Mucosa - submucosa - muscularis externa - serosa/adventitia
Epithelium
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Dec PGE2 leading to dec gastric mucosa protection
24. What are the structures of the femoral triangle and how are they organized
Fasting and stress
Failure of the processus vagainlis to close
NAV = nerve artery vein - venous near the penis (NAVEL)
Esophageal cancer
25. What are the foregut structures and what supplies their blood and PANS innvervation
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
AR
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
M3 - Gq - inc IP3/Ca
26. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Intussusception
T cell lymphoma
Inc conj bilirubin - inc cholesterol - inc alk phos
27. Who is at risk for pancreatic adenocarcinoma
Cimetidine
Jewish and African American men
Hydrocele
Liver metabolizes 5HT
28. In PUD - with gastric ulcers - does pain inc or dec with meals?
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Inc - weight loss
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Internal thoracic to superior epigastric to inferior epigastric
29. Why does indirect inguinal hernia happen in infacnts
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Portal HTN
Failure of the processus vagainlis to close
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
30. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
GERD - may also present with nocturnal cough and dyspnea
Dilated esophagus with an area of distal stenosis - birds beak
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
31. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Alpha amylase
H+
32. What is the presenting course for appendicity
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33. How do villi appear in disaccharidease def
Amylase
Normal
Pleomorphic adenoma
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
34. What is the arterial supply and venous drainage below pectinate line
Zenkers - halitosis - dysphagia and obstruction
Via the middle colic
Esophageal carcinoma
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
35. What does high flow rate mean
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Closer to isotonic because of less time to reabsorb NaCl
...
Heme metabolism
36. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Jaundice - fever - RUQ
Backup of blood into the liver - RHF - budd chiari
Inferior rectal nerve
Crohns = maybe - UC= always
37. What does a gastrinoma cause
Where hindgut meets ectoderm
Pancreatic head causing obstructive jaundice
Hyperplastic
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
38. What are the treatmet options for crohns
Corticosteroids - infliximab
Complications of crohns
Urobilin
Acute pancreatitis
39. What cells secrete bicarb - What does it do - and what regulates it
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Glucouronate - water soluble (direct)
Tropical sprue
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
40. What are the labs in acute pancreatitis
Glucose dependent insulinotropic peptide
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Elevated amylase - and lipase
Copious diarrhea - non alpha - non beta cell pancreatic tumor
41. Gq and inc cAMP both work to do what in parietal cells
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Pleomorphic adenoma
Stimulate the H/K ATPase
Conj - inc - dec
42. In an MI - which liver enzyme is elevated
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
AST
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
43. What kind of anemia is in Wilsons
Hemolytic anemia
AST >ALT - ration is usually 1.5
Gut bacteria
Worldwide - SC - US - adeno
44. What is the most common diaphragmatic hernia and What are the two types
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Cystic dilation of the viteline duct
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Bleeding - penetration into pancreas - perforation - obstruction
45. GIP - source - action regulation
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Nonkeritinized stratified sqamous epithelium
46. What kind of muscle is in the lower 1/3 of the esophagus
The submucosal nerve plexus - meissner's
Smooth
Penicillinamine - AR inheritance
No - chronic - can present with diarrhea or constipation or alternation - treat sx
47. What factors increase risk of malignancy of adenomatous polyps
L1
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
H pylori (almost 100%)
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
48. Why does carcinoid syndrome not occur if tumor is confined to GI system
Liver metabolizes 5HT
Female - fat - fertile - forty
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
49. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Causes of gall stones
Conj/unconj - inc - nl to dec
Sphincter of oddi
50. What is the presentation of pancreatic adenocarcinoma
Corticosteroids - infliximab
Terminal ileum and colon
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
GERD - may also present with nocturnal cough and dyspnea