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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. Where is bicarb trapped
Mucoepidermoid carcinoma
In the mucus that covers the gastric epithelium
Mallory bodies
Chronic calcifying pancreatitis - inc risk of panreatic cancer
2. People of what decent are associated with celiac sprue and what findings/antibodies are present
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Pleuroperitoneal
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
3. What are the signs of peutz jehgers
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Krukenbergs tumor
Liver metabolizes 5HT
Hyperpigmented mouth - lips - hands - genitalia
4. Gallstones that reach the common channel at ampulla can block which two ducts
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Epigastric abdominal pain radiating to back - anorexia - nausea
Pancreatic and bile
Redness and tenderness on palpation of extremities
5. What is the action of NO as a GI hormone
Inc smooth muscle relaxation - including lower esophageal sphincter
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
CEA - CA-19-9
6. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
So hypertrophied they look like brain gyri
Black - rotors syndrome
Uridine glucuronyl transferase
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
7. Who gets gastric ulcers
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
Phototherapy
Older patients
Primary sclerosing cholangitis
8. What structures feed into the common hepatic duct
Chagas disease
Fe2+ in the duod
Short gastrics - left greater and lesser
Right and left hepatic duct
9. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Primary sclerosing cholangitis
Small intestine
Pleomorphic adenoma
Zollinger Ellison - phenylalanine and tryptophan
10. If trypsin activates more trypsinogen - what kind of feedback loop is established
Brunners
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
T12
Positive
11. What are the structures of the femoral triangle and how are they organized
Superior rectal and middle and inferior rectal - rectum
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
NAV = nerve artery vein - venous near the penis (NAVEL)
12. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
L2
Brush border of intestine - produce monosaccharides from oligo and di
Complications of crohns
Mitochondrial abnl - fatty liver - hypoglycemia - coma
13. What is diverticulosis
Dec PGE2 leading to dec gastric mucosa protection
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
The gastroduodenal
Alk phos
14. What do you use to diagnose meckels
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Pertechnetate - study for uptake
EtOH
15. Where is folate absorbed
Stimulate the H/K ATPase
The jejunum
Enterokinase/enteropeptidase from the duodenal mucosa
GLUT 2
16. In what scenarios do pts with gilberts have inc bili
Alpha amylase
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Fasting and stress
17. How does brain injury lead to acute gastritis and What is it called
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
VZV and influenza B treated with salicylates
18. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Conj - inc - dec
Sister mary joseph nodule
Goes through deep inguinal ring - external inguinal ring and into the scrotum
19. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Pleomorphic adenoma
Inc - weight loss
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Conj - inc - dec
20. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Esophageal varices
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Crigler - najjar type 1
21. is meckels a true diverticulum and how common is it
Nonkeritinized stratified sqamous epithelium
Hyperplastic
Alcoholic cirrhosis
True and most common congenital anomoly of GI tract
22. What source of salivary secretion is the most serous and What is the most mucinous
EtOH
Serous on the sides parotids - mucinous in the middle sublingual
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
Necrotizing enterocolitis
23. In alchoholic hepatitis which liver enzyme is higher
Diarrhea - steatorrhea - weight loss - weakness
AST>ALT
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
GLUT 2
24. What does GET SMASHED stand for in acute pancreatitis
Crigler - najjar type 1
Fasting and stress
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Via the middle colic
25. What is the risk with peutz jehgers
Esophageal varices
Closer to isotonic because of less time to reabsorb NaCl
Failure of neural crest migration
Inc risk of CRC and other visceral malignancies
26. What are motilin receptor agonists used for clinically
Stimulate intestinal persistalsis
Duodenum - 2nd - 3rd and 4th parts
Ischemic colitis
All 3 gut layers outpouch as in Meckels
27. What are the extraintestinal manifestations of ulcerative colitis
Pyoderma gangrenosum - primary sclerosing cholangitis
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
NAV = nerve artery vein - venous near the penis (NAVEL)
Angiodysplasia
28. What is the main symptom if a VIPoma
Celiac sprue
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Complications of crohns
Copious diarrhea - non alpha - non beta cell pancreatic tumor
29. What kind of lesions are characteristic of duodenal PUD vs cancer
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Hernia
Punched out - clean margins - carcinoma =raised irregular margins
30. FAP + osseous and soft tissue tumors - retinal hyperplasia
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31. Why does volvulus occur more at cecum and sigmoid colon
Redundant mesentary
Dubin johnson
Alcoholic hepatitis
Goes through deep inguinal ring - external inguinal ring and into the scrotum
32. Scleroderma is associated with what kind of esophageal dysmotility
L/R renal artery around L1
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Low pressure proximal to LES
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
33. What drug blocks the H2R
Cimetidine
Mucoepidermoid carcinoma
Zenkers - halitosis - dysphagia and obstruction
Centrilobular leading to congestive liver disease
34. What enzyme is necessary to create conjugated bilirubin
Uridine glucuronyl transferase
Erosive - disruption of mucosal barrier leading to inflammation
Obstruction of the common bile duct
Esophageal carcinoma
35. What does a gastrinoma cause
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Cholesterol - 10-20% opaque due to calcifications
Fasting and stress
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
36. 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
Volvulus
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Hypotonic because of more time to reabsorb NaCl
Skip lesions =crohns - colon = UC
37. 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
The jejunum
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Where hindgut meets ectoderm
38. Diaphragmatic hernias occur in infants because of defective development of which membrane
Pleuroperitoneal
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Upregulated intracellular signal transduction
Superior rectal
39. Abuse of what substance leads to acute gastritis
EtOH
Alcoholic cirrhosis
All 3
Left gastric vein and esophogeal vein - esophagus
40. What pancreatic enzymes are responsible for fat digestion
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Lipase - phospholipase A - colipase
Ischemic colitis
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
41. Gq and inc cAMP both work to do what in parietal cells
In the ileum with bile acids - requires IF
Gastric glands
Cigarettes and chronic pancreatitis - not EtOH
Stimulate the H/K ATPase
42. What are the signs and symptoms of budd chiari
Peutz jeghers
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Pyoderma gangrenosum - primary sclerosing cholangitis
Cirrhosis
43. What receptors does gastrin bind on the parietal cell and What does it activate
Via the middle colic
12 waves/min
CCK8 receptor - Gq inc IP3/Ca
Gastric glands
44. What kind of pancreatitis is associated with EtOH and smoking
Necrotizing enterocolitis
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Pancreatic head causing obstructive jaundice
Dysphagia (due to esophageal web) - glossitis - iron def anemia
45. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Superior rectal
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Hypotonic because of more time to reabsorb NaCl
Fe2+ in the duod
46. What serum markers increase in cholecystitis with bile duct involvement
Alk phos
Falciform - ligamentum teres - fetal umbilical vein
Alfatoxin in peanuts
Upregulated intracellular signal transduction
47. How does gastrin increase acid secretion?
Lateral to the inferior epigastric artery
Elevated amylase - and lipase
Skip lesions =crohns - colon = UC
Primarly through ECL leading to histamine release
48. Bile is critical for exrection of what substance
Cholesterol
H pylori (almost 100%)
Esophageal carcinoma
AR
49. trypsinogen is converted to trypsin via what enzyme
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
Enterokinase/enteropeptidase from the duodenal mucosa
Alk pho
Liver metabolizes 5HT
50. What structure is Not contained in the femoral sheath
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Falciform - ligamentum teres - fetal umbilical vein
Gardner's syndrome
Esophageal cancer
Sorry!:) No result found.
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