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Test your basic knowledge |
USMLE GI
Start Test
Study First
Subjects
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health-sciences
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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. GIP - source - action regulation
Carcinoid syndrome
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Portal HTN
2. What does K- ras mutation cause
Upregulated intracellular signal transduction
Nonkeritinized stratified sqamous epithelium
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Antrum - H.pylori - inc risk of MALT lymphoma
3. in budd chiari syndrome - Where is the congestion and necrosis
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Pancreatic and bile
Centrilobular leading to congestive liver disease
Hyperplastic
4. What are the extraintestinal manifestations of crohns
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Gastric glands
5. When do you see hypertrophy of brunners glands
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Peptic ulcer disease
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
MSI (15%) and APC/beta catenin chromosomal instability (85%)
6. What is the action of NO as a GI hormone
Inc risk of CRC and other visceral malignancies
Inc smooth muscle relaxation - including lower esophageal sphincter
Glucouronate - water soluble (direct)
AST>ALT
7. What are the signs of peutz jehgers
8-9 waves/min
Hyperpigmented mouth - lips - hands - genitalia
VZV and influenza B treated with salicylates
Pyoderma gangrenosum - primary sclerosing cholangitis
8. What cell produces IF and What does it do
Parietal cells in the stomach - B12 binding protein
Lye ingestion and acid reflux
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Internal thoracic to superior epigastric to inferior epigastric
9. What percentage of gall stones are cholesterol stones and What are the associations
Black - rotors syndrome
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Gastrohepatic ligament
10. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Lubricate food (glycoprotiens)
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
11. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Uridine glucuronyl transferase
Conj/unconj - inc - nl to dec
Omeprazole
Duodenal atresia - Downs
12. What is the HLA association and treatment for hemochromatosis
Repeated phlebotomy - deferoxamine - HLA- A3
Colovesical leading to pneumaturia
Older patients
Pyoderma gangrenosum - primary sclerosing cholangitis
13. What does extrahepatic biliary obstruction cause
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Squamous - upper 1/3 - adeno - lower 1/3
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Oligosaccharide digestion
14. Which serum enzyme increases with heavy EtOH consumption
Gamma glutamyl transferase GGT
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
Pyoderma gangrenosum - primary sclerosing cholangitis
Old men - arthralgias - cardiac and neuro sx
15. What layer in the mucosa is responsible for absorption
No
Antrum - H.pylori - inc risk of MALT lymphoma
Hemosiderosis - hemochromatosis
Epithelium
16. What is the prognosis of adenocarcinoma
Inc - weight loss
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Averages 6 months - very aggressive - usually already metastasized at presentation
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
17. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Superior rectal
Krukenbergs tumor
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
18. What is indirect bilirubin
Normal
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Uridine glucuronyl transferase
Unconjugated - water insoluble
19. What serum markers increase in cholecystitis with bile duct involvement
Decrease - weight gain
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Alk phos
Diverticulum
20. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Gardner's syndrome
Menetriers disease
Cholesterol
Osmotic
21. malnutrition - toxic megacolon - colorectal carcinoma
EtOH
Complications of UC
Alpha amylase
Peptic ulcer disease
22. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
IBS at least 2 with recurrent abdominal pain
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Gastrohepatic ligament
Cimetidine
23. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Meconium ileus
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Penicillinamine - AR inheritance
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
24. What kind of muscle is in the middle 1/3 of esophagus
Striated and smooth
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Begins starch digestion - inactivated by low pH upon reaching the stomach
IgA secreting plasma cells - ultimately reside in the lamina proporia
25. Who gets gastric ulcers
Gut bacteria
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Zollinger ellison - brunners glands
Older patients
26. What are the effects of atropine on parietal cells and G cells
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Stimulate the H/K ATPase
27. What are the longterm sequelae of nutmeg liver
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Centrilobular congestion and necrosis - cardiac cirrhosis
28. What is the sphincter of the pancreatic duct
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Alpha amylase
Sphincter of oddi
29. Dysphagia in achalasia results from
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
So hypertrophied they look like brain gyri
Hemosiderosis - hemochromatosis
Cholesterol
30. What are the complications of duodenal PUD
Osmotic
Budd chiari syndrome
Bleeding - penetration into pancreas - perforation - obstruction
Inguninal ligament - sartorius muscle - adductor longus
31. At what level do the testicular/ovarian arteries exit the aorta
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
L2
Celiac sprue
32. Achalasia increases the risk For what complication
Mucosa - submucosa - muscularis externa - serosa/adventitia
Esophageal carcinoma
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
33. What is contained within the muscularis externa
Brunners
Myenteric nerve plexus - aurbach
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Early childhood - neuro sx and malabsorption
34. Diaphragmatic hernias occur in infants because of defective development of which membrane
Tropical sprue
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Pleuroperitoneal
Jaundice - fever - RUQ
35. What kind of cancer to celiac sprue put you as inc risk for
T cell lymphoma
Jewish and African American men
Alk pho
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
36. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
H pylori (almost 100%)
Positive
37. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Where hindgut meets ectoderm
In the ileum with bile acids - requires IF
Carcinoid syndrome
Menetriers disease
38. What are the borders of Hesselbach's triangle
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
M3 - Gq - inc IP3/Ca
Dissaccharidase def - most commonly lactase
39. A protrusion of peritoneum through an opening - usually a site of weakness
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Hernia
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Erosive - disruption of mucosal barrier leading to inflammation
40. How many layers of spermatic fascia are covers an indirect inguinal hernia
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
All 3
Gastrohepatic ligament
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
41. In an MI - which liver enzyme is elevated
Positive urease test
AST
The proximal small bowel
Alcoholic hepatitis
42. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Diverticulum
Unconj - absent (acholuria) - inc
Worldwide - SC - US - adeno
Phototherapy
43. What kind of pathways do CCK act on to cause pancreatic secretion
Juvenille polyps - no risk if single
Left gastric vein and esophogeal vein - esophagus
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Neural muscarinic pathways
44. How do NSAIDs cause acute gastritis
Peyers patches
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Dec PGE2 leading to dec gastric mucosa protection
Lack or have an attenuated muscularis externa - often in the sigmoid colon
45. What is diverticulosis
Upregulated intracellular signal transduction
Chronic gastritis and pernicious anemia
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
AST
46. What reaction does salivary amylase catalyze
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
L2
47. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
Repeated phlebotomy - deferoxamine - HLA- A3
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Neutralizes oral bacertial acids and maintains dental health
48. What portion of the bowel does sprue effect
Alpha1 antitrypsin def - codominant trait
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
The proximal small bowel
Redundant mesentary
49. With internal hemorrhoids Where is the anastomoses and Where is it
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Low pressure proximal to LES
Superior rectal and middle and inferior rectal - rectum
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
50. What cells secrete bicarb - What does it do - and what regulates it
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
L1
Obstruction of the common bile duct
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx