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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. How do villi appear in disaccharidease def
Conj - inc - dec
Normal
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
2. milk intolerance
CEA - CA-19-9
Hirschsprungs
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Dissaccharidase def - most commonly lactase
3. What layer in the mucosa is responsible for absorption
PAS- positive globules in liver -
Positive urease test
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
Epithelium
4. What kind of diarrhea is produced from a disaccharide def
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Alfatoxin in peanuts
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Osmotic
5. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Inc conj bilirubin - inc cholesterol - inc alk phos
Inspiratory arrest on deep palpation due to pain
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Zenkers - halitosis - dysphagia and obstruction
6. trypsinogen is converted to trypsin via what enzyme
Enterokinase/enteropeptidase from the duodenal mucosa
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
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
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
7. What intervention will intervention will relieve portal HTN
Cystic duct and common hepatic duct
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Lye ingestion and acid reflux
8. What is the frequency of basal electric rhythm of the stomach
Diarrhea - steatorrhea - weight loss - weakness
3 waves/min
Inc risk of CRC and other visceral malignancies
Alk phos
9. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Redundant mesentary
Centrilobular leading to congestive liver disease
Meckels
10. What does loss of p53 cause
Increase tumorigenesis
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
Turcot
Alpha amylase
11. conjugated hyperbilirubinemia due to defective liver excretion
No - chronic - can present with diarrhea or constipation or alternation - treat sx
The entire
Dubin johnson
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
12. What causes nutmeg liver
Krukenbergs tumor
Obstruction of the common bile duct
Backup of blood into the liver - RHF - budd chiari
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
13. What is biliary colic
Ischemic colitis
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Stimulate the H/K ATPase
Jaundice - fever - RUQ
14. What are the signs of peutz jehgers
Stimulate the H/K ATPase
Hyperpigmented mouth - lips - hands - genitalia
Begins starch digestion - inactivated by low pH upon reaching the stomach
Gallbladder
15. People of what decent are associated with celiac sprue and what findings/antibodies are present
H+
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Uridine glucuronyl transferase
Fasting and stress
16. motilin - source - action - regulation
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Ampulla of vater
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Meconium ileus
17. What are the complications of chronic pancreatitis
Worldwide - SC - US - adeno
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
External spermatic fascia only
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
18. What is the prognosis of adenocarcinoma
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Averages 6 months - very aggressive - usually already metastasized at presentation
Myenteric nerve plexus - aurbach
Inspiratory arrest on deep palpation due to pain
19. What gives stool its characteristic color
Inc - weight loss
The jejunum
Stercobilin
Primary sclerosing cholangitis
20. What pancreatic proteases are secreted as zymogens
Jaundice - fever - RUQ
All 3 gut layers outpouch as in Meckels
Trypsin - chymotrypsin - elastase - carboxypeptidases
Budd chiari syndrome
21. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
True and most common congenital anomoly of GI tract
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
22. What do mucins do?
Stimulate the H/K ATPase
Lubricate food (glycoprotiens)
Increase tumorigenesis
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
23. What are the histological findings of the colon
Diarrhea - steatorrhea - weight loss - weakness
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Crypts but not villi
Esophageal carcinoma
24. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Volvulus
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
H pylori (almost 100%)
25. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Lactase is located at the tips of intestinal villi
Neutralizes oral bacertial acids and maintains dental health
Crohns = maybe - UC= always
26. What structures feed into the common bile duct
Cystic duct and common hepatic duct
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
27. In viral hepatitis - which liver enzyme is higher
ALT>AST
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
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
28. What is the cause of physiologic neonatal jaundice
Via the superior pancreaticduodenal
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Crohns = maybe - UC= always
Juvenille polyps - no risk if single
29. What is the presentation of pancreatic adenocarcinoma
Krukenbergs tumor
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Mallory bodies
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
30. Why does indirect inguinal hernia happen in infacnts
Failure of the processus vagainlis to close
Positive urease test
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Cirrhosis
31. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Inc lower esphogeal tone leading to achalasia
Alk pho
Esophageal varices
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
32. Between what structures do strong anastamoses exist
Left and right gastroepiploics - left and right gastrics
Gastric glands
Squamous - upper 1/3 - adeno - lower 1/3
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
33. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
Inc lower esphogeal tone leading to achalasia
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Right and left hepatic duct
34. What does alpha amylase do and what inactivates it
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Begins starch digestion - inactivated by low pH upon reaching the stomach
Zollinger Ellison - phenylalanine and tryptophan
Inc smooth muscle relaxation - including lower esophageal sphincter
35. What pancreatic enzymes are responsible for fat digestion
Glucose dependent insulinotropic peptide
Acute pancreatitis
Adhesion
Lipase - phospholipase A - colipase
36. What is the other name for GIP (gastric inhibitory peptide)
Esophageal varices
Carcinoid syndrome
Glucose dependent insulinotropic peptide
Lubricate food (glycoprotiens)
37. What do tumors that arise in the head of the pancreas cause
Acute pancreatitis
Superior rectal and middle and inferior rectal - rectum
Obstruction of the common bile duct
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
38. What receptors does gastrin bind on the parietal cell and What does it activate
Phenobarbital - inc liver enzyme synthesis
CCK8 receptor - Gq inc IP3/Ca
2ndary biliary cirrhosis
Via the superior pancreaticduodenal
39. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Internal thoracic to superior epigastric to inferior epigastric
Mallory bodies
Turcot
Mucosa - submucosa - muscularis externa - serosa/adventitia
40. How does gastrin increase acid secretion?
Sister mary joseph nodule
Primarly through ECL leading to histamine release
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Via the superior pancreaticduodenal
41. Why are most diverticula considered false
Inc - weight loss
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Epithelium
42. What kind of cancer to celiac sprue put you as inc risk for
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Inc smooth muscle relaxation - including lower esophageal sphincter
T cell lymphoma
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
43. What is the rate limiting step of carbohydrate digestion
Corticosteroids - infliximab
Oligosaccharide digestion
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Hyperpigmented mouth - lips - hands - genitalia
44. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
Alcoholic cirrhosis
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Urobilin
45. Where is folate absorbed
Bleeding - penetration into pancreas - perforation - obstruction
The jejunum
Adhesion
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
46. How is bilirubin carried in the blood
With albumin
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Muscularis mucosae
47. Autodigestion of pancreas by pancreatic enzymes
Reye's syndrome
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Gut bacteria
Acute pancreatitis
48. signet ring cells - acanthosis nigracans - dz - character/association - spread
H2 receptor - inc cAMP
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Phenobarbital - inc liver enzyme synthesis
49. Dysphagia in achalasia results from
AR
Glucouronate - water soluble (direct)
GLUT 2
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
50. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Hirschsprungs
The jejunum
Chagas disease
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis