SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
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. What drug inhibits the H/K ATPase
Omeprazole
Hypercoaguability - polycythemia vera - pregnancy - HCC
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
2. malnutrition - toxic megacolon - colorectal carcinoma
Complications of UC
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
CEA - CA-19-9
Chagas disease
3. What reaction does salivary amylase catalyze
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Sphincter of oddi
4. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Zollinger Ellison - phenylalanine and tryptophan
Inferior rectal nerve
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
CCK8 receptor - Gq inc IP3/Ca
5. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Duodenal atresia - Downs
Lactase is located at the tips of intestinal villi
6. Acute gastritis is caused By what process
Erosive - disruption of mucosal barrier leading to inflammation
Esophageal cancer
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
GERD - may also present with nocturnal cough and dyspnea
7. What does K- ras mutation cause
Gastric glands
Upregulated intracellular signal transduction
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
EtOH
8. What are the treatment options for uclerative colitis
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Can lead to hematemesis - found in EtOHics and bulimics
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Dissaccharidase def - most commonly lactase
9. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
L/R renal artery around L1
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Ceruplasmin
10. What test and result confirms H pylori infxn
Esophageal carcinoma
L2
Positive urease test
Cigarettes and chronic pancreatitis - not EtOH
11. How does hirschsprung present and appear on imaging
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
Striated
Reye's syndrome
Brunners
12. What does TOASTED with alcoholic hepatitis stand for
Cigarettes and chronic pancreatitis - not EtOH
Alk pho
Decrease - weight gain
AST >ALT - ration is usually 1.5
13. Gastrin - source - action - regulation
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
Turcot
Neural muscarinic pathways
Lamina propria
14. Why does carcinoid syndrome not occur if tumor is confined to GI system
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Esophageal cancer
H+
Liver metabolizes 5HT
15. Where is the pectinate line
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Alpha1 antitrypsin def - codominant trait
Where hindgut meets ectoderm
Lipase
16. most common non - neoplastic polyp in colon
Mitochondrial abnl - fatty liver - hypoglycemia - coma
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Hyperplastic
Stercobilin
17. To what substance is bilirubin conjugated and why
Glucouronate - water soluble (direct)
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Crohns = maybe - UC= always
18. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
Cirrhosis
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Muscularis mucosae
19. What does a low flow rate mean for saliva
Heme metabolism
Ampulla of vater
Hypotonic because of more time to reabsorb NaCl
Conj - inc - dec
20. What are the borders of Hesselbach's triangle
Lactase is located at the tips of intestinal villi
Alk phos
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
21. what kind of muscle is in the upper 1/3 of esophagus
HSV-1 - CMV - Candida
Striated
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
22. What receptor does histamine bind on the parietal cell and What does it activate
Centrilobular leading to congestive liver disease
Esophageal varices
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
H2 receptor - inc cAMP
23. What is the HLA association and treatment for hemochromatosis
Peyers patches
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Repeated phlebotomy - deferoxamine - HLA- A3
Pleuroperitoneal
24. What are the histological findings in the jejunum
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Striated
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
25. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Primary sclerosing cholangitis
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Terminal ileum and colon
26. What percentage of gall stones are cholesterol stones and What are the associations
Menetriers disease
EtOH
AST>ALT
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
27. What is the lumen of the pancreatic duct
Decrease - weight gain
The gastroduodenal
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
Ampulla of vater
28. Autodigestion of pancreas by pancreatic enzymes
Causes of gall stones
Bleeding - penetration into pancreas - perforation - obstruction
Acute pancreatitis
Cholesterol - 10-20% opaque due to calcifications
29. What causes hirschsprungs
Failure of neural crest migration
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Paraumbilical and superficial and inferior epigastric - umbilicus
Lamina propria
30. What is the leading cause of bowel incarceration
Enterokinase/enteropeptidase from the duodenal mucosa
Femoral hernia
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Heme metabolism
31. Why does indirect inguinal hernia happen in infacnts
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Failure of the processus vagainlis to close
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
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
32. What causes pancreatic insuff and What does it cause
Can lead to hematemesis - found in EtOHics and bulimics
Smooth
Lubricate food (glycoprotiens)
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
33. What are causes of extrahepatic biliary obstruction
Cigarettes and chronic pancreatitis - not EtOH
Trypsin - chymotrypsin - elastase - carboxypeptidases
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Reye's syndrome
34. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Normal
In the ileum with bile acids - requires IF
Pancreatic and bile
35. How does CRC present in the distal and proximal colon
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Hyperpigmented mouth - lips - hands - genitalia
Crigler - najjar type 1
36. What kind of diarrhea is produced from a disaccharide def
Osmotic
Oral glucose
Serous on the sides parotids - mucinous in the middle sublingual
Short gastrics - left greater and lesser
37. What conditions are associated with budd chiari
Hypercoaguability - polycythemia vera - pregnancy - HCC
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Warthins' tumor
38. What type of insults result in micronodular cirrhosis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Serous on the sides parotids - mucinous in the middle sublingual
When diffusely infiltrative - thickened rigid appearance like a leather bottle
M3 - Gq - inc IP3/Ca
39. Bilirubin is the product of what?
Heme metabolism
Hydrocele
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
GERD - may also present with nocturnal cough and dyspnea
40. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Duodenum - 2nd - 3rd and 4th parts
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Ampulla of vater
41. What is biliary colic
Neural muscarinic pathways
Reye's syndrome
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Via the superior pancreaticduodenal
42. Where does copper accumulate in Wilsons and What are ABCD
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
IBS at least 2 with recurrent abdominal pain
Dec PGE2 leading to dec gastric mucosa protection
43. What are the tumor markers for pancreatic adenocarcinoma
The proximal small bowel
CEA - CA-19-9
EtOH
Fasting and stress
44. 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
Gut bacteria
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Tropical sprue
45. What does alpha amylase do and what inactivates it
Begins starch digestion - inactivated by low pH upon reaching the stomach
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Cystic dilation of the viteline duct
Lateral to the inferior epigastric artery
46. What do the rugae of stomach look like in menetriers disease
Mucosa - submucosa - muscularis externa - serosa/adventitia
Pleomorphic adenoma
So hypertrophied they look like brain gyri
Zollinger ellison - brunners glands
47. What causes carcinoid syndrome amd What are the symptoms
Warthins' tumor
Spleen to posterior abdominal wall - splenic artery and vein
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Turcot
48. subQ peribumbilical metastasis
Averages 6 months - very aggressive - usually already metastasized at presentation
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Sister mary joseph nodule
49. trypsinogen is converted to trypsin via what enzyme
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Enterokinase/enteropeptidase from the duodenal mucosa
Stimulate intestinal persistalsis
Worldwide - SC - US - adeno
50. Where are oligosaccharide hydrolases and What do they do
Crypts but not villi
Decreased intercellular adhesion and increased proliferation
Brush border of intestine - produce monosaccharides from oligo and di
Gardner's syndrome