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Test your basic knowledge |
USMLE GI
Start Test
Study First
Subjects
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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 gives stool its characteristic color
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Falciform - ligamentum teres - fetal umbilical vein
Stercobilin
Bleeding - penetration into pancreas - perforation - obstruction
2. How does loss of NO secretion affect the esophagus and what results
Esophageal varices
Antrum - H.pylori - inc risk of MALT lymphoma
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Inc lower esphogeal tone leading to achalasia
3. What are the effects of atropine on parietal cells and G cells
Nonkeritinized stratified sqamous epithelium
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Failure of neural crest migration
4. What are the histological findings in the ileum
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5. What is the ddx associated with appendicitis
Pancreatic head causing obstructive jaundice
Diverticulitis in elderly - ectopic pregs use hCG to rule out
The proximal small bowel
Unconjugated - water insoluble
6. What drug inhibits the H/K ATPase
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Conj - inc - dec
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Omeprazole
7. Gq and inc cAMP both work to do what in parietal cells
Lipase - phospholipase A - colipase
Stimulate the H/K ATPase
Crohns = maybe - UC= always
L4
8. In PUD with a duodenal ulcer does pain inc or dec with meals
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Hernia
Pleomorphic adenoma
Decrease - weight gain
9. What does TOASTED with alcoholic hepatitis stand for
AST >ALT - ration is usually 1.5
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Via the middle colic
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
10. In what clinical scenarior do you see portosystemic anastomoses
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Lipase - phospholipase A - colipase
Meckels
Portal HTN
11. What structures feed into the common bile duct
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Cystic duct and common hepatic duct
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
12. What drug blocks the H2R
Repeated phlebotomy - deferoxamine - HLA- A3
ALT>AST
Cimetidine
Striated
13. What type of insults result in micronodular cirrhosis
AST >ALT - ration is usually 1.5
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Meckels
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
14. What does bicarb do in the duodenum
Hyperpigmented mouth - lips - hands - genitalia
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Volvulus
15. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
2ndary biliary cirrhosis
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
...
Cystic duct and common hepatic duct
16. What makes a true diverticula
All 3 gut layers outpouch as in Meckels
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Superior rectal
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
17. What is the most common diaphragmatic hernia and What are the two types
Female - fat - fertile - forty
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
18. Autodigestion of pancreas by pancreatic enzymes
Normal
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Backup of blood into the liver - RHF - budd chiari
Acute pancreatitis
19. What other condition can lead to acute gastritis - think renal
Mallory bodies
IBS at least 2 with recurrent abdominal pain
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Uremia
20. What transforms conjugated bilirubin to urobilinogen
Dec PGE2 leading to dec gastric mucosa protection
Pancreatic and bile
US and cholecystectomy
Gut bacteria
21. If the abdominal aorta is blocked - How does blood get to the left colic artery
Via the middle colic
NAV = nerve artery vein - venous near the penis (NAVEL)
Above
Conj/unconj - inc - nl to dec
22. What factors increase risk of malignancy of adenomatous polyps
Paraumbilical and superficial and inferior epigastric - umbilicus
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Tropical sprue
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
23. What portion of the bowel does sprue effect
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Failure of the processus vagainlis to close
VZV and influenza B treated with salicylates
The proximal small bowel
24. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Source - parasympathetic ganglion in sphincters - gallbladder - small intestine - action - inc intestinal water and electrolyte secretion - inc relaxation of intestinal smooth muscle and sphincters - regulation - inc by distention and vagal stimulati
Crigler - najjar type 1
Alcoholic hepatitis
Epithelium
25. What kind of digestion is bile needed for
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Causes of gall stones
Worldwide - SC - US - adeno
26. What are the complications of acute pancreatitis
Omeprazole
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Above
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
27. What carcinogens are associated with HCC
Alfatoxin in peanuts
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Hernia
28. Where does copper accumulate in Wilsons and What are ABCD
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Brunners
Femoral hernia
29. What is the cause of Barrett's and the assocaited complications
Punched out - clean margins - carcinoma =raised irregular margins
Duodenum - 2nd - 3rd and 4th parts
Redundant mesentary
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
30. GIP - source - action regulation
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
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Cystic dilation of the viteline duct
31. What are the main components of bile
Cystic duct and common hepatic duct
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Where hindgut meets ectoderm
Dysphagia (due to esophageal web) - glossitis - iron def anemia
32. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Alpha1 antitrypsin def - codominant trait
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Zollinger Ellison - phenylalanine and tryptophan
33. Bilirubin is the product of what?
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Heme metabolism
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
34. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Internal thoracic to superior epigastric to inferior epigastric
Begins starch digestion - inactivated by low pH upon reaching the stomach
Hydrocele
35. What are motilin receptor agonists used for clinically
Primary sclerosing cholangitis
Stimulate intestinal persistalsis
Inc smooth muscle relaxation - including lower esophageal sphincter
Trypsin - chymotrypsin - elastase - carboxypeptidases
36. What is the most common indication of emergent abdominal surgery in children
Increase tumorigenesis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Appendicitis
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
37. What are the barium swallow findings of achalasia
Dilated esophagus with an area of distal stenosis - birds beak
Small intestine
Esophageal cancer
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
38. What congenital birth defect is associated with Hirschsprung
Colovesical leading to pneumaturia
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Downs
Turcot
39. Why does carcinoid syndrome not occur if tumor is confined to GI system
Liver metabolizes 5HT
Lateral
12 waves/min
AST>ALT
40. Where is the pectinate line
T cell lymphoma
Where hindgut meets ectoderm
Splenic flexure
Mucoepidermoid carcinoma
41. What are the histological findings in the jejunum
Spleen to posterior abdominal wall - splenic artery and vein
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Stimulate the H/K ATPase
All 3 gut layers outpouch as in Meckels
42. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
External spermatic fascia only
Peyers patches
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Dubin johnson
43. What cells secrete bicarb - What does it do - and what regulates it
Superior rectal and middle and inferior rectal - rectum
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
44. inflammatino of gallbadder
Normal
Inc smooth muscle relaxation - including lower esophageal sphincter
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Hernia
45. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Adhesion
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
46. Autoantibodies to gluten (gliadin) in wheat and other grains
Urobilin
Celiac sprue
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Menetriers disease
47. What does K- ras mutation cause
AST
Menetriers disease
AR
Upregulated intracellular signal transduction
48. What cell produces IF and What does it do
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Parietal cells in the stomach - B12 binding protein
Gastrohepatic ligament
3 waves/min
49. What is the main symptom if a VIPoma
8-9 waves/min
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Inc conj bilirubin - inc cholesterol - inc alk phos
Copious diarrhea - non alpha - non beta cell pancreatic tumor
50. What reaction does salivary amylase catalyze
Mucosa - submucosa - muscularis externa - serosa/adventitia
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Enterokinase/enteropeptidase from the duodenal mucosa