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Test your basic knowledge |
USMLE GI
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Subjects
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health-sciences
,
usmle
Instructions:
Answer 50 questions in 15 minutes.
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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. likely infectious form of malabsorption - responds to antibiotics
US and cholecystectomy
Tropical sprue
NAV = nerve artery vein - venous near the penis (NAVEL)
All 3 gut layers outpouch as in Meckels
2. At what spinal level does the is the bifurcation of aorta
Squamous - upper 1/3 - adeno - lower 1/3
Black - rotors syndrome
Short gastrics - left greater and lesser
L4
3. Bilirubin is the product of what?
Oral glucose
Heme metabolism
Unconj - absent (acholuria) - inc
Jaundice - fever - RUQ
4. What kind of pathways do CCK act on to cause pancreatic secretion
Common hepatic - splenic - left gastric - main blood supply for stomach
Neural muscarinic pathways
Boerhaave's Syndrome - Been heaving syndrome
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
5. FAP + malignant CNS tumor
Dec PGE2 leading to dec gastric mucosa protection
Turcot
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
No - chronic - can present with diarrhea or constipation or alternation - treat sx
6. Malabsorption syndromes have what common clinical presentation
The gastroduodenal
Duodenum - 2nd - 3rd and 4th parts
Gut bacteria
Diarrhea - steatorrhea - weight loss - weakness
7. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Adhesion
Primary sclerosing cholangitis
Duodenum - 2nd - 3rd and 4th parts
Inc conj bilirubin - inc cholesterol - inc alk phos
8. What are the effects of atropine on parietal cells and G cells
Superior rectal
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Stimulate intestinal persistalsis
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
9. Acute gastritis is caused By what process
Erosive - disruption of mucosal barrier leading to inflammation
Enterokinase/enteropeptidase from the duodenal mucosa
True and most common congenital anomoly of GI tract
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
10. What is the classic triad of hemochromatosis
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11. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Inspiratory arrest on deep palpation due to pain
Internal thoracic to superior epigastric to inferior epigastric
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Boerhaave's Syndrome - Been heaving syndrome
12. motilin - source - action - regulation
Spleen to posterior abdominal wall - splenic artery and vein
Neutralizes oral bacertial acids and maintains dental health
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Lamina propora and submucosa
13. What serum markers increase in cholecystitis with bile duct involvement
Alk phos
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
14. What is the cause of physiologic neonatal jaundice
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
T cell lymphoma
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
15. What are the common causes of gastric ulcers - What causes gastric ulcer
Fasting and stress
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Hypercoaguability - polycythemia vera - pregnancy - HCC
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
16. Where and How is iron absorbed
AST >ALT - ration is usually 1.5
Superior rectal
Uridine glucuronyl transferase
Fe2+ in the duod
17. What serum enzyme is elevated in acute pancreatitis and mumps
Hepatic steatosis
Positive urease test
Hyperplastic
Amylase
18. 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
CHF and inc risk of HCC
Lateral to the inferior epigastric artery
Skip lesions =crohns - colon = UC
19. Scleroderma is associated with what kind of esophageal dysmotility
Hypercoaguability - polycythemia vera - pregnancy - HCC
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Low pressure proximal to LES
20. When do you see hypertrophy of brunners glands
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Gamma glutamyl transferase GGT
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Peptic ulcer disease
21. What factors increase risk of malignancy of adenomatous polyps
Peptic ulcer disease
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Primarly through ECL leading to histamine release
22. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Black - rotors syndrome
Virchow's node
Sphincter of oddi
Hepatic steatosis
23. What are the histological findings in the duodenum
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24. How are all 3 monosaccharides transported to the blood
GLUT 2
Jewish and African American men
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
Epithelium
25. What intervention will intervention will relieve portal HTN
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Zollinger Ellison - phenylalanine and tryptophan
26. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Peutz jeghers
Causes of gall stones
The entire
27. In what clinical scenarior do you see portosystemic anastomoses
Portal HTN
Smooth
Esophageal varices
Necrotizing enterocolitis
28. A protrusion of peritoneum through an opening - usually a site of weakness
External (superficial) ring only
GLUT 2
Lipase
Hernia
29. Why does indirect inguinal hernia happen in infacnts
Centrilobular congestion and necrosis - cardiac cirrhosis
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Hepatic steatosis
Failure of the processus vagainlis to close
30. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Esophageal cancer
Menetriers disease
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
31. Where does type B chronic gastritis occur and What causes it
Lye ingestion and acid reflux
Punched out - clean margins - carcinoma =raised irregular margins
Antrum - H.pylori - inc risk of MALT lymphoma
Neutralizes oral bacertial acids and maintains dental health
32. How many layers of spermatic fascia are covers an indirect inguinal hernia
Lubricate food (glycoprotiens)
Unconj - absent (acholuria) - inc
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
All 3
33. What kind of insults results in macronodular cirrhosis
Hypercoaguability - polycythemia vera - pregnancy - HCC
Crohns = maybe - UC= always
CHF and inc risk of HCC
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
34. What can hemochromatosis be secondary to...
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
HSV-1 - CMV - Candida
Right and left hepatic duct
35. What does loss of APC cause
Decreased intercellular adhesion and increased proliferation
Redundant mesentary
FAP
Esophageal cancer
36. With internal hemorrhoids Where is the anastomoses and Where is it
Chagas disease
Superior rectal and middle and inferior rectal - rectum
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Glucouronate - water soluble (direct)
37. What conditions are associated with budd chiari
Warthins' tumor
Gastric glands
Hypercoaguability - polycythemia vera - pregnancy - HCC
Obstruction of the common bile duct
38. What are the treatment options for uclerative colitis
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Carcinoid syndrome
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
39. Where is the pectinate line
Lateral
Where hindgut meets ectoderm
Lipase - phospholipase A - colipase
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
40. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Poor anastamoses
Cirrhosis
90%
Esophageal varices
41. How do burns cause acute gastritis and What is it called
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42. Which kind of hemorrhoids are painful and why
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Hyperplastic
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Peyers patches
43. What happens to the short gastics if the splenic artery is blocked
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Poor anastamoses
Black - rotors syndrome
Striated
44. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
T cell lymphoma
Zenkers - halitosis - dysphagia and obstruction
Hyperpigmented mouth - lips - hands - genitalia
45. Between what structures do strong anastamoses exist
Left and right gastroepiploics - left and right gastrics
Punched out - clean margins - carcinoma =raised irregular margins
Jaundice - fever - RUQ
Female - fat - fertile - forty
46. With caput medusaw - between what vessels is the anastomoses and Where is it
Paraumbilical and superficial and inferior epigastric - umbilicus
Worldwide - SC - US - adeno
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Diverticulum
47. How do villi appear in disaccharidease def
Increase tumorigenesis
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Normal
HSV-1 - CMV - Candida
48. Who gets gastric ulcers
Esophageal carcinoma
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
Older patients
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
49. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
T cell lymphoma
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
PAS- positive globules in liver -
Juvenille polyps - no risk if single
50. What do the rugae of stomach look like in menetriers disease
So hypertrophied they look like brain gyri
Redness and tenderness on palpation of extremities
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Sorry!:) No result found.
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