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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. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Falciform - ligamentum teres - fetal umbilical vein
HPNCC
Via the superior pancreaticduodenal
External (superficial) ring only
2. Achalasia increases the risk For what complication
Low pressure proximal to LES
Juvenile polyposis syndrome - inc risk of adenocarcinoma
The jejunum
Esophageal carcinoma
3. What reaction does salivary amylase catalyze
Superior rectal and middle and inferior rectal - rectum
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Peyers patches
4. Diaphragmatic hernias occur in infants because of defective development of which membrane
Liver metabolizes 5HT
Pleuroperitoneal
Nonkeritinized stratified sqamous epithelium
Centrilobular leading to congestive liver disease
5. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Colonic polyps
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Complications of crohns
Complications of UC
6. What is the frequency of basal electric rhythm of the stomach
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
IgA secreting plasma cells - ultimately reside in the lamina proporia
Zollinger ellison - brunners glands
3 waves/min
7. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Terminal ileum and colon
Hepatic steatosis
Cirrhosis
AST >ALT - ration is usually 1.5
8. With internal hemorrhoids Where is the anastomoses and Where is it
Superior rectal and middle and inferior rectal - rectum
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Old men - arthralgias - cardiac and neuro sx
Black - rotors syndrome
9. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
With albumin
12 waves/min
Alk pho
10. What is indirect bilirubin
Necrotizing enterocolitis
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Unconjugated - water insoluble
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
11. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Epithelium
Zollinger ellison - brunners glands
Superior rectal
Alk phos
12. How is salivary secretion stimulated
The gastroduodenal
Repeated phlebotomy - deferoxamine - HLA- A3
Liver metabolizes 5HT
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
13. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Upregulated intracellular signal transduction
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Budd chiari syndrome
Redundant mesentary
14. What are the histological findings in the ileum
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15. What does alpha amylase do and what inactivates it
Fasting and stress
Begins starch digestion - inactivated by low pH upon reaching the stomach
Meconium ileus
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
16. What kind of cancer to celiac sprue put you as inc risk for
T cell lymphoma
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
The gastroduodenal
Centrilobular congestion and necrosis - cardiac cirrhosis
17. What happens to the short gastics if the splenic artery is blocked
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Poor anastamoses
18. What are the branches of the celiac trunk and What do they supply
Warthins' tumor
Common hepatic - splenic - left gastric - main blood supply for stomach
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Appendicitis
19. Why does volvulus occur more at cecum and sigmoid colon
Redundant mesentary
Punched out - clean margins - carcinoma =raised irregular margins
PAS- positive globules in liver -
Pleuroperitoneal
20. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Gallbladder
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Colovesical leading to pneumaturia
21. What are the four Fs of gallstones
Female - fat - fertile - forty
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Positive urease test
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
22. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Inc risk of CRC and other visceral malignancies
12 waves/min
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
The gastroduodenal
23. What are the extraintestinal manifestations of ulcerative colitis
Pyoderma gangrenosum - primary sclerosing cholangitis
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Cimetidine
Ampulla of vater
24. Between what structures do strong anastamoses exist
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Myenteric nerve plexus - aurbach
Left and right gastroepiploics - left and right gastrics
25. What kind of muscle is in the middle 1/3 of esophagus
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Striated and smooth
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
26. Acute gastritis is caused By what process
Lateral to the inferior epigastric artery
Unconj - absent (acholuria) - inc
Mucosa - submucosa - muscularis externa - serosa/adventitia
Erosive - disruption of mucosal barrier leading to inflammation
27. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Above
Oligosaccharide digestion
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Juvenile polyposis syndrome - inc risk of adenocarcinoma
28. What are motilin receptor agonists used for clinically
Female - fat - fertile - forty
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Stimulate intestinal persistalsis
Conj/unconj - inc - nl to dec
29. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Appendicitis
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Angiodysplasia
Superior rectal and middle and inferior rectal - rectum
30. What does bicab do in the mouth
Elevated amylase - and lipase
90%
Neutralizes oral bacertial acids and maintains dental health
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
31. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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32. What carcinogens are associated with HCC
Alfatoxin in peanuts
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Myenteric nerve plexus - aurbach
Early childhood - neuro sx and malabsorption
33. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Failure of neural crest migration
Striated
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
2ndary biliary cirrhosis
34. What retroperitoneal structure flanks both sides of the pancreas on CT
Portal HTN
Urobilin
Duodenum - 2nd - 3rd and 4th parts
Amylase
35. What commonly leads to appendicity in kids vs adults
In the ileum with bile acids - requires IF
Neutralizes oral bacertial acids and maintains dental health
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
36. What cell produces IF and What does it do
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Parietal cells in the stomach - B12 binding protein
Adhesion
37. What is the cause of Barrett's and the assocaited complications
L3
Bleeding - penetration into pancreas - perforation - obstruction
Adhesion
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
38. What is the clinical presentation of acute pancreatitis
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Corticosteroids - infliximab
Hepatic steatosis
Epigastric abdominal pain radiating to back - anorexia - nausea
39. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Cystic duct and common hepatic duct
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
Lactase is located at the tips of intestinal villi
Peyers patches
40. What is the frequency of basal electric rhythm of the ilieum
Heme metabolism
Primarly through ECL leading to histamine release
8-9 waves/min
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
41. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Via the middle colic
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Conj - inc - dec
42. Who gets gastric ulcers
Older patients
Striated
Gardner's syndrome
CHF and inc risk of HCC
43. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Cimetidine
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Alcoholic cirrhosis
Adhesion
44. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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45. What are the common causes of gastric ulcers - What causes gastric ulcer
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Gut bacteria
Neural muscarinic pathways
46. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Repeated phlebotomy - deferoxamine - HLA- A3
Zollinger Ellison - phenylalanine and tryptophan
Heme metabolism
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
47. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Zollinger Ellison - phenylalanine and tryptophan
Serous on the sides parotids - mucinous in the middle sublingual
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Centrilobular leading to congestive liver disease
48. What is the risk with peutz jehgers
Inc risk of CRC and other visceral malignancies
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Decreased intercellular adhesion and increased proliferation
Barrett's esophagus
49. How is bilirubin carried in the blood
Chronic calcifying pancreatitis - inc risk of panreatic cancer
With albumin
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
50. What does loss of APC cause
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Elevated amylase - and lipase
Decreased intercellular adhesion and increased proliferation