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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. likely infectious form of malabsorption - responds to antibiotics
In the ileum with bile acids - requires IF
Black - rotors syndrome
Internal thoracic to superior epigastric to inferior epigastric
Tropical sprue
2. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Intussusception
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
EtOH
Nonkeritinized stratified sqamous epithelium
3. What are the histological findings in the ileum
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4. When and How does Abetalipoproteinemia present
L4
Omeprazole
Early childhood - neuro sx and malabsorption
Positive
5. What does primary sclerosing cholangitis lead to...
AST>ALT
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Inc lower esphogeal tone leading to achalasia
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
6. What cells secrete bicarb - What does it do - and what regulates it
Diarrhea - steatorrhea - weight loss - weakness
Ischemic colitis
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
7. What transforms conjugated bilirubin to urobilinogen
Gut bacteria
In the ileum with bile acids - requires IF
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
8. What reaction does salivary amylase catalyze
Lateral
T cell lymphoma
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Bleeding - penetration into pancreas - perforation - obstruction
9. What is the rate limiting step of carbohydrate digestion
Inguninal ligament - sartorius muscle - adductor longus
Pleomorphic adenoma
Oligosaccharide digestion
Goes through deep inguinal ring - external inguinal ring and into the scrotum
10. In PUD with a duodenal ulcer does pain inc or dec with meals
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Decrease - weight gain
Diverticulitis in elderly - ectopic pregs use hCG to rule out
11. What converts inactive pepsinogen to pepsin
H+
Colovesical leading to pneumaturia
Upregulated intracellular signal transduction
Cirrhosis
12. What is the other name for GIP (gastric inhibitory peptide)
Zollinger ellison - brunners glands
Glucose dependent insulinotropic peptide
Crypts but not villi
Female - fat - fertile - forty
13. How does loss of NO secretion affect the esophagus and what results
AR
Inc lower esphogeal tone leading to achalasia
FAP
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
14. What gives stool its characteristic color
Dense core bodies
Conj/unconj - inc - nl to dec
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Stercobilin
15. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Hypotonic because of more time to reabsorb NaCl
Redundant mesentary
FAP
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
16. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Causes of gall stones
Esophageal varices
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
17. Between what structures do strong anastamoses exist
Primary sclerosing cholangitis
Fasting and stress
Left and right gastroepiploics - left and right gastrics
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
18. What kind of lesions are characteristic of duodenal PUD vs cancer
Punched out - clean margins - carcinoma =raised irregular margins
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
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
Penicillinamine - AR inheritance
19. Where and How is iron absorbed
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Menetriers disease
Fe2+ in the duod
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
20. Abuse of what substance leads to acute gastritis
All 3 gut layers outpouch as in Meckels
EtOH
Lubricate food (glycoprotiens)
Gamma glutamyl transferase GGT
21. Where are oligosaccharide hydrolases and What do they do
Peyers patches
Brush border of intestine - produce monosaccharides from oligo and di
Primarly through ECL leading to histamine release
Hydrocele
22. Achalasia increases the risk For what complication
Mallory bodies
Backup of blood into the liver - RHF - budd chiari
Esophageal carcinoma
Acute pancreatitis
23. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Duodenal atresia - Downs
Dec PGE2 leading to dec gastric mucosa protection
H pylori (almost 100%)
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
24. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus
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25. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Gilbert's
HSV-1 - CMV - Candida
NAV = nerve artery vein - venous near the penis (NAVEL)
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker
26. How is bilirubin carried in the blood
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Gamma glutamyl transferase GGT
AST
With albumin
27. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Squamous - upper 1/3 - adeno - lower 1/3
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
IBS at least 2 with recurrent abdominal pain
Colonic polyps
28. What is the clinical presentation of acute pancreatitis
Epigastric abdominal pain radiating to back - anorexia - nausea
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Dec PGE2 leading to dec gastric mucosa protection
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
29. What are the treatmet options for crohns
Corticosteroids - infliximab
PAS- positive globules in liver -
Esophageal carcinoma
Hernia
30. subQ peribumbilical metastasis
Centrilobular congestion and necrosis - cardiac cirrhosis
Sister mary joseph nodule
Short gastrics - left greater and lesser
Bleeding - penetration into pancreas - perforation - obstruction
31. What other condition can lead to acute gastritis - think renal
Uremia
Intussusception
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
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
32. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Internal thoracic to superior epigastric to inferior epigastric
Dilated esophagus with an area of distal stenosis - birds beak
US and cholecystectomy
Superior rectal
33. In an MI - which liver enzyme is elevated
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Internal thoracic to superior epigastric to inferior epigastric
Meconium ileus
AST
34. What are the labs in acute pancreatitis
Elevated amylase - and lipase
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
GERD - may also present with nocturnal cough and dyspnea
35. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Mitochondrial abnl - fatty liver - hypoglycemia - coma
HPNCC
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Primarly through ECL leading to histamine release
36. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Cholesterol
Zenkers - halitosis - dysphagia and obstruction
Squamous - upper 1/3 - adeno - lower 1/3
Normal
37. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Left gastric vein and esophogeal vein - esophagus
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
ALT>AST
38. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
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
Lactase is located at the tips of intestinal villi
Myenteric nerve plexus - aurbach
Complications of crohns
39. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Hirschsprungs
Dysphagia (due to esophageal web) - glossitis - iron def anemia
AST
All 3 gut layers outpouch as in Meckels
40. What is diverticulosis
Complications of crohns
Decrease - weight gain
GERD - may also present with nocturnal cough and dyspnea
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
41. Why does volvulus occur more at cecum and sigmoid colon
T cell lymphoma
Redundant mesentary
Squamous - upper 1/3 - adeno - lower 1/3
Downs
42. What findings are associated with reyes
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Volvulus
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Female - fat - fertile - forty
43. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
HSV-1 - CMV - Candida
Oral glucose
8-9 waves/min
Conj - inc - dec
44. FAP + osseous and soft tissue tumors - retinal hyperplasia
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45. Why are most diverticula considered false
Lack or have an attenuated muscularis externa - often in the sigmoid colon
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Unconjugated - water insoluble
Decrease - weight gain
46. milk intolerance
Dissaccharidase def - most commonly lactase
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Superior rectal
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
47. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Normal
Intussusception
Ischemic colitis
48. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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49. What drug inhibits the H/K ATPase
Omeprazole
Superior rectal and middle and inferior rectal - rectum
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Brush border of intestine - produce monosaccharides from oligo and di
50. What kind of muscle is in the middle 1/3 of esophagus
Striated and smooth
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
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Where hindgut meets ectoderm