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Test your basic knowledge |
USMLE GI
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Subjects
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health-sciences
,
usmle
Instructions:
Answer 50 questions in 15 minutes.
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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 is the frequency of basal electric rhythm of the ilieum
Achalasia due to loss of myenteric plexus (auberach)
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Dissaccharidase def - most commonly lactase
8-9 waves/min
2. In what scenarios do pts with gilberts have inc bili
Backup of blood into the liver - RHF - budd chiari
Liver metabolizes 5HT
Fasting and stress
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
3. Gastrin - source - action - regulation
Oligosaccharide digestion
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
Glucouronate - water soluble (direct)
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
4. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
3 waves/min
Ischemic colitis
Dense core bodies
Causes of gall stones
5. What serum enzyme is elevated inacute pancreatitis
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Lipase
Short gastrics - left greater and lesser
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
6. What serum markers increase in cholecystitis with bile duct involvement
Ischemic colitis
Acute pancreatitis
Alk phos
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
7. What is the presenting course for appendicity
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8. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Colonic polyps
Squamous - upper 1/3 - adeno - lower 1/3
Decrease - weight gain
9. What structures feed into the common bile duct
Cystic duct and common hepatic duct
Enterokinase/enteropeptidase from the duodenal mucosa
Osmotic
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
10. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Alpha amylase
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Volvulus
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
11. What does alpha amylase do and what inactivates it
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Begins starch digestion - inactivated by low pH upon reaching the stomach
Gardner's syndrome
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
12. Who is at risk for pancreatic adenocarcinoma
Serous on the sides parotids - mucinous in the middle sublingual
Dissaccharidase def - most commonly lactase
Jewish and African American men
PAS- positive globules in liver -
13. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Inc conj bilirubin - inc cholesterol - inc alk phos
VZV and influenza B treated with salicylates
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Chagas disease
14. Where is folate absorbed
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Celiac sprue
The jejunum
Phenobarbital - inc liver enzyme synthesis
15. Where does type A chronic gastritis occur and What causes it
Mucosa - submucosa - muscularis externa - serosa/adventitia
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Phenobarbital - inc liver enzyme synthesis
Glucouronate - water soluble (direct)
16. What are the foregut structures and what supplies their blood and PANS innvervation
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Oral glucose
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
L1
17. What are the four Fs of gallstones
Erosive - disruption of mucosal barrier leading to inflammation
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Female - fat - fertile - forty
T12
18. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Bleeding - penetration into pancreas - perforation - obstruction
19. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Complications of UC
Alpha amylase
...
Reye's syndrome
20. most common malignant salivary gland tumor
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Mucoepidermoid carcinoma
Uremia
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
21. What carcinogens are associated with HCC
Primarly through ECL leading to histamine release
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Alfatoxin in peanuts
Alk pho
22. What is biliary colic
Bleeding - penetration into pancreas - perforation - obstruction
Spleen to posterior abdominal wall - splenic artery and vein
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Achalasia due to loss of myenteric plexus (auberach)
23. What is one potential precipitating factor for intussusception
Duodenum - 2nd - 3rd and 4th parts
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Amylase
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
24. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Corticosteroids - infliximab
Hepatic steatosis
Cholesterol - 10-20% opaque due to calcifications
T12
25. What reaction does salivary amylase catalyze
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Stimulate intestinal persistalsis
H+
Alfatoxin in peanuts
26. In an MI - which liver enzyme is elevated
Zollinger ellison - brunners glands
Juvenile polyposis syndrome - inc risk of adenocarcinoma
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
AST
27. What are the structures of the femoral triangle and how are they organized
T12
Gut bacteria
NAV = nerve artery vein - venous near the penis (NAVEL)
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
28. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
L1
Female - fat - fertile - forty
H2 receptor - inc cAMP
Unconj - absent (acholuria) - inc
29. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Bleeding - penetration into pancreas - perforation - obstruction
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Splenic flexure
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
30. What is the clinical presentation of acute pancreatitis
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Epigastric abdominal pain radiating to back - anorexia - nausea
Falciform - ligamentum teres - fetal umbilical vein
IgA secreting plasma cells - ultimately reside in the lamina proporia
31. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Redundant mesentary
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Cystic dilation of the viteline duct
32. What pancreatic proteases are secreted as zymogens
Diarrhea - steatorrhea - weight loss - weakness
Achalasia due to loss of myenteric plexus (auberach)
Duodenal atresia - Downs
Trypsin - chymotrypsin - elastase - carboxypeptidases
33. What kind of pathways do CCK act on to cause pancreatic secretion
Centrilobular leading to congestive liver disease
Neural muscarinic pathways
Crigler - najjar type 1
CEA - CA-19-9
34. What histological findings are present in the esophagus
The proximal small bowel
Pyoderma gangrenosum - primary sclerosing cholangitis
Nonkeritinized stratified sqamous epithelium
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
35. At what spinal level does the is the bifurcation of aorta
Redundant mesentary
Heme metabolism
L4
Older patients
36. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
ALT>AST
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
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
Via the superior pancreaticduodenal
37. Where is IgA shuttled
Closer to isotonic because of less time to reabsorb NaCl
Inc - weight loss
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Skip lesions =crohns - colon = UC
38. How do villi appear in disaccharidease def
Normal
Short gastrics - left greater and lesser
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
L2
39. What nerve innervates the external hemorrhoids
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Inferior rectal nerve
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Budd chiari syndrome
40. most common non - neoplastic polyp in colon
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Positive urease test
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Hyperplastic
41. What gives stool its characteristic color
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Left and right gastroepiploics - left and right gastrics
Stercobilin
42. Dysphagia in achalasia results from
The proximal small bowel
Pertechnetate - study for uptake
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
43. If the hemochromatosis is primary - What is the pattern of inheritance
Oligosaccharide digestion
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Older patients
AR
44. What is the HLA association and treatment for hemochromatosis
Repeated phlebotomy - deferoxamine - HLA- A3
Diarrhea - steatorrhea - weight loss - weakness
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
45. Which kind of hemorrhoids are painful and why
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Glucose dependent insulinotropic peptide
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
46. At what spinal level does the celiac trunk exit
Crohns = noncaseating granulomas - UC = crypt abscesses
T12
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Glucose dependent insulinotropic peptide
47. FAP + osseous and soft tissue tumors - retinal hyperplasia
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48. What cells secrete bicarb - What does it do - and what regulates it
Crigler - najjar type 1
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Hyperplastic
49. Is there any structural abnl with IBS - What is the course of disease and presentation
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Boerhaave's Syndrome - Been heaving syndrome
...
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
50. What findings are associated with reyes
Femoral hernia
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Dubin johnson
Ischemic colitis
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