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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 drug inhibits the H/K ATPase
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Omeprazole
Fe2+ in the duod
Crohns = transmural (cobblestone mucosa - creeping fat - string sign - linear ulcers fissures - fistulas) UC = mucosal and submucosal (friable mucosal pseudopolyps with freely hanging mesentary - loss of haustra - lead pipe appearance on imaging
2. Where are carcinoid tumors most commonly malignant
AST >ALT - ration is usually 1.5
Duodenum - 2nd - 3rd and 4th parts
Small intestine
Hyperpigmented mouth - lips - hands - genitalia
3. concentric onion skin bile duct fibrosis
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Inc conj bilirubin - inc cholesterol - inc alk phos
Primary sclerosing cholangitis
Sphincter of oddi
4. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue
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5. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Colonic polyps
Below
Esophageal varices
6. What are the treatment options for uclerative colitis
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
HSV-1 - CMV - Candida
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
7. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Gamma glutamyl transferase GGT
Hemolytic anemia
IBS at least 2 with recurrent abdominal pain
Sister mary joseph nodule
8. What does histo show for alpha1 antitrypsin def
Meconium ileus
NAV = nerve artery vein - venous near the penis (NAVEL)
PAS- positive globules in liver -
Striated
9. What serum enzyme is elevated in acute pancreatitis and mumps
Amylase
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Causes of gall stones
10. What are the treatmet options for crohns
Corticosteroids - infliximab
Cystic dilation of the viteline duct
Pancreatic head causing obstructive jaundice
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
11. What does K- ras mutation cause
Phenobarbital - inc liver enzyme synthesis
Glucose dependent insulinotropic peptide
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Upregulated intracellular signal transduction
12. What kind of digestion is bile needed for
Budd chiari syndrome
Inc risk of CRC and other visceral malignancies
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
13. What does primary sclerosing cholangitis lead to...
Right and left hepatic duct
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Esophageal varices
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
14. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Falciform - ligamentum teres - fetal umbilical vein
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Inc lower esphogeal tone leading to achalasia
15. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Glucose dependent insulinotropic peptide
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Complications of crohns
16. What is the leading cause of bowel incarceration
Mallory bodies
Falciform - ligamentum teres - fetal umbilical vein
Femoral hernia
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
17. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
Glucose dependent insulinotropic peptide
Esophageal varices
Heme metabolism
Skip lesions =crohns - colon = UC
18. Which area of the hindgut is a watershed area
Splenic flexure
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
M3 - Gq - inc IP3/Ca
Jewish and African American men
19. In an MI - which liver enzyme is elevated
L4
Zenkers - halitosis - dysphagia and obstruction
AST
Virchow's node
20. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
Lateral to the inferior epigastric artery
Complications of crohns
Mucoepidermoid carcinoma
21. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Upregulated intracellular signal transduction
Colonic polyps
Backup of blood into the liver - RHF - budd chiari
Crohns = maybe - UC= always
22. 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
Alk pho
Gastrohepatic ligament
Superior rectal
23. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Zollinger ellison - brunners glands
Dense core bodies
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
The submucosal nerve plexus - meissner's
24. Is there any structural abnl with IBS - What is the course of disease and presentation
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Duodenal atresia - Downs
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Crigler - najjar type 1
25. How do NSAIDs cause acute gastritis
Dec PGE2 leading to dec gastric mucosa protection
Diarrhea - steatorrhea - weight loss - weakness
Obstruction of the common bile duct
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
26. What can hemochromatosis be secondary to...
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Alcoholic hepatitis
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
27. How does hirschsprung present and appear on imaging
Striated
Lactase is located at the tips of intestinal villi
No - chronic - can present with diarrhea or constipation or alternation - treat sx
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
28. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Glucose dependent insulinotropic peptide
Alpha amylase
29. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Cystic duct and common hepatic duct
12 waves/min
L2
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
30. What happens to the short gastics if the splenic artery is blocked
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Poor anastamoses
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Alcoholic cirrhosis
31. signet ring cells - acanthosis nigracans - dz - character/association - spread
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
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Brush border of intestine - produce monosaccharides from oligo and di
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
32. What are the four Fs of gallstones
So hypertrophied they look like brain gyri
In the mucus that covers the gastric epithelium
Female - fat - fertile - forty
Cystic duct and common hepatic duct
33. What do you treat Wilsons disease with and What is the inheritance
Penicillinamine - AR inheritance
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Zollinger Ellison - phenylalanine and tryptophan
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
34. What is the cause of physiologic neonatal jaundice
M3 - Gq - inc IP3/Ca
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
No
35. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Left and right gastroepiploics - left and right gastrics
Dermatitis herpetiformis
Erosive - disruption of mucosal barrier leading to inflammation
36. What is the frequency of basal electric rhythm of the ilieum
Intussusception
AR
8-9 waves/min
L1
37. In alchoholic hepatitis which liver enzyme is higher
So hypertrophied they look like brain gyri
AST>ALT
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
Closer to isotonic because of less time to reabsorb NaCl
38. Which kind of hemorrhoids are painful and why
Crohns = noncaseating granulomas - UC = crypt abscesses
Gardner's syndrome
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
39. What receptor does histamine bind on the parietal cell and What does it activate
L2
Lactase is located at the tips of intestinal villi
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
H2 receptor - inc cAMP
40. What is the frequency of basal electric rhythm of the stomach
3 waves/min
Inc lower esphogeal tone leading to achalasia
Glucose dependent insulinotropic peptide
Diarrhea - steatorrhea - weight loss - weakness
41. What causes primary biliary cirrhosis
Source - parasympathetic ganglion in sphincters - gallbladder - small intestine - action - inc intestinal water and electrolyte secretion - inc relaxation of intestinal smooth muscle and sphincters - regulation - inc by distention and vagal stimulati
Superior rectal and middle and inferior rectal - rectum
Cholesterol - 10-20% opaque due to calcifications
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
42. Diaphragmatic hernias occur in infants because of defective development of which membrane
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Urobilin
Pleuroperitoneal
43. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Muscularis mucosae
Jaundice - fever - RUQ
Intussusception
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
44. Dysphagia in achalasia results from
Pertechnetate - study for uptake
Phototherapy
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Closer to isotonic because of less time to reabsorb NaCl
45. How are all 3 monosaccharides transported to the blood
Penicillinamine - AR inheritance
Dysphagia (due to esophageal web) - glossitis - iron def anemia
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
GLUT 2
46. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Mitochondrial abnl - fatty liver - hypoglycemia - coma
L/R renal artery around L1
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
47. What artery passes around the duodenum
Lamina propria
Cirrhosis
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
The gastroduodenal
48. What are motilin receptor agonists used for clinically
Diverticulitis in elderly - ectopic pregs use hCG to rule out
L2
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Stimulate intestinal persistalsis
49. What are the histological findings in the duodenum
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50. Why are most diverticula considered false
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Chronic calcifying pancreatitis - inc risk of panreatic cancer
CCK8 receptor - Gq inc IP3/Ca
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders