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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. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Positive urease test
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Fe2+ in the duod
Inc conj bilirubin - inc cholesterol - inc alk phos
2. What findings are associated with reyes
Barrett's esophagus
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Internal thoracic to superior epigastric to inferior epigastric
3. What causes carcinoid syndrome amd What are the symptoms
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Fe2+ in the duod
Ceruplasmin
4. What does GET SMASHED stand for in acute pancreatitis
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Downs
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
5. What are motilin receptor agonists used for clinically
The submucosal nerve plexus - meissner's
Zollinger Ellison - phenylalanine and tryptophan
Stimulate intestinal persistalsis
Chronic calcifying pancreatitis - inc risk of panreatic cancer
6. Which viral infxns/treatments are associated with reyes syndrome
Budd chiari syndrome
Brunners
VZV and influenza B treated with salicylates
Amylase
7. Where are oligosaccharide hydrolases and What do they do
Brush border of intestine - produce monosaccharides from oligo and di
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Barrett's esophagus
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
8. What factors increase risk of malignancy of adenomatous polyps
3 waves/min
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Peutz jeghers
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
9. What gives stool its characteristic color
Stercobilin
Internal thoracic to superior epigastric to inferior epigastric
Achalasia due to loss of myenteric plexus (auberach)
HSV-1 - CMV - Candida
10. What are the complications of duodenal PUD
Jewish and African American men
EtOH
Bleeding - penetration into pancreas - perforation - obstruction
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
11. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Squamous - upper 1/3 - adeno - lower 1/3
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Centrilobular congestion and necrosis - cardiac cirrhosis
Angiodysplasia
12. What is the path of an indirect inguinal hernia
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Falciform - ligamentum teres - fetal umbilical vein
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
13. What kind of diarrhea is produced from a disaccharide def
Alk pho
Osmotic
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Gut bacteria
14. What artery passes around the duodenum
The gastroduodenal
Phenobarbital - inc liver enzyme synthesis
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Internal thoracic to superior epigastric to inferior epigastric
15. Which kind of hemorrhoids are painful and why
Juvenile polyposis syndrome - inc risk of adenocarcinoma
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Stimulate intestinal persistalsis
Glucose dependent insulinotropic peptide
16. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Appendicitis
Meconium ileus
Alcoholic cirrhosis
Short gastrics - left greater and lesser
17. How is the diagonsis of CRC made
Osmotic
T12
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
GLUT 2
18. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Conj/unconj - inc - nl to dec
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Penicillinamine - AR inheritance
19. In an MI - which liver enzyme is elevated
AST
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Averages 6 months - very aggressive - usually already metastasized at presentation
External (superficial) ring only
20. What are the complications of acute pancreatitis
3 waves/min
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
T12
21. What causes primary biliary cirrhosis
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Via the superior pancreaticduodenal
Cystic dilation of the viteline duct
22. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
With albumin
Chagas disease
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
23. trypsinogen is converted to trypsin via what enzyme
Repeated phlebotomy - deferoxamine - HLA- A3
Gilbert's
Enterokinase/enteropeptidase from the duodenal mucosa
Phototherapy
24. Bile is critical for exrection of what substance
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
Phototherapy
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
Cholesterol
25. What is the mechanism for reyes syndrome
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Normal
IBS at least 2 with recurrent abdominal pain
26. What serum enzyme is elevated in acute pancreatitis and mumps
Amylase
Internal thoracic to superior epigastric to inferior epigastric
Alk phos
Punched out - clean margins - carcinoma =raised irregular margins
27. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Lipase - phospholipase A - colipase
All 3
Barrett's esophagus
Peutz jeghers
28. People of what decent are associated with celiac sprue and what findings/antibodies are present
Brush border of intestine - produce monosaccharides from oligo and di
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
29. What is the frequency of basal electric rhythm in the duodenum
12 waves/min
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
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Volvulus
30. What are the branches of the celiac trunk and What do they supply
Common hepatic - splenic - left gastric - main blood supply for stomach
Punched out - clean margins - carcinoma =raised irregular margins
Ampulla of vater
Lateral to the inferior epigastric artery
31. What are the ABCDEF of esophageal cancer
Portal HTN
Where hindgut meets ectoderm
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
32. At what level do the testicular/ovarian arteries exit the aorta
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Lamina propora and submucosa
L2
33. Scleroderma is associated with what kind of esophageal dysmotility
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Low pressure proximal to LES
Peyers patches
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
34. likely infectious form of malabsorption - responds to antibiotics
Gastrohepatic ligament
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
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Tropical sprue
35. What retroperitoneal structure flanks both sides of the pancreas on CT
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Ischemic colitis
Duodenum - 2nd - 3rd and 4th parts
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
36. What are the treatmet options for crohns
M3 - Gq - inc IP3/Ca
Hemolytic anemia
Inferior rectal nerve
Corticosteroids - infliximab
37. What gives urine its characteristic color
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Via the superior pancreaticduodenal
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Urobilin
38. What are the four Fs of gallstones
Decreased intercellular adhesion and increased proliferation
Hepatic steatosis
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Female - fat - fertile - forty
39. How do burns cause acute gastritis and What is it called
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40. What is the classic triad of hemochromatosis
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41. What kind of digestion is bile needed for
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Lipase - phospholipase A - colipase
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
42. What is the presentation of pancreatic adenocarcinoma
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Jaundice - fever - RUQ
Above
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
43. What causes hirschsprungs
Smooth
Squamous - upper 1/3 - adeno - lower 1/3
Complications of crohns
Failure of neural crest migration
44. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Dissaccharidase def - most commonly lactase
Carcinoid syndrome
45. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
IgA secreting plasma cells - ultimately reside in the lamina proporia
Hirschsprungs
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
46. In what clinical scenarior do you see portosystemic anastomoses
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Crohns = maybe - UC= always
Squamous - upper 1/3 - adeno - lower 1/3
Portal HTN
47. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Angiodysplasia
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Hirschsprungs
48. What do the rugae of stomach look like in menetriers disease
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
So hypertrophied they look like brain gyri
Dubin johnson
Corticosteroids - infliximab
49. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Causes of gall stones
Esophageal cancer
The submucosal nerve plexus - meissner's
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
50. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Colonic polyps
Crohns = maybe - UC= always
Intussusception
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum