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Test your basic knowledge |
USMLE GI
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Subjects
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health-sciences
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usmle
Instructions:
Answer 50 questions in 15 minutes.
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study here
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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 layer in the mucosa is responsible for absorption
Epithelium
Old men - arthralgias - cardiac and neuro sx
Gamma glutamyl transferase GGT
Conj/unconj - inc - nl to dec
2. What skin condition is associated with celiac sprue
Amylase
90%
Dermatitis herpetiformis
Zollinger Ellison - phenylalanine and tryptophan
3. What is the classic triad of hemochromatosis
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4. What are the treatmet options for crohns
Unconjugated - water insoluble
HPNCC
Corticosteroids - infliximab
Sister mary joseph nodule
5. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Esophageal cancer
NAV = nerve artery vein - venous near the penis (NAVEL)
Can lead to hematemesis - found in EtOHics and bulimics
All 3 gut layers outpouch as in Meckels
6. What is the cause of Barrett's and the assocaited complications
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Lubricate food (glycoprotiens)
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
3 waves/min
7. Between what structures do strong anastamoses exist
Celiac sprue
Decreased intercellular adhesion and increased proliferation
Pleomorphic adenoma
Left and right gastroepiploics - left and right gastrics
8. What is the frequency of basal electric rhythm of the ilieum
Duodenal atresia - Downs
8-9 waves/min
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Hyperpigmented mouth - lips - hands - genitalia
9. What is the rule of 2s for meckels
Fe2+ in the duod
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
10. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Obstruction of the common bile duct
Black - rotors syndrome
Elevated amylase - and lipase
Bleeding - penetration into pancreas - perforation - obstruction
11. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
HPNCC
Where hindgut meets ectoderm
Pertechnetate - study for uptake
Urobilin
12. What does the splenorenal ligament connect - and What does it contain
Spleen to posterior abdominal wall - splenic artery and vein
Esophageal carcinoma
Squamous - upper 1/3 - adeno - lower 1/3
GLUT 2
13. What do you treat Wilsons disease with and What is the inheritance
12 waves/min
US and cholecystectomy
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Penicillinamine - AR inheritance
14. What is the main symptom if a VIPoma
Failure of the processus vagainlis to close
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Omeprazole
Reye's syndrome
15. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Lamina propria
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
16. Cholecytsokinin - source - action - regulation
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
Colonic polyps
Inc risk of CRC and other visceral malignancies
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
17. what percentage of colonic polyps are non - neoplastic
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
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Decreased intercellular adhesion and increased proliferation
90%
18. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Epigastric abdominal pain radiating to back - anorexia - nausea
Hepatic steatosis
19. HCC is associated with what other conditions
2ndary biliary cirrhosis
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Old men - arthralgias - cardiac and neuro sx
GLUT 2
20. Where does crohns usually affect the GI tract
Redness and tenderness on palpation of extremities
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
Terminal ileum and colon
Redundant mesentary
21. What serum enzyme is elevated in acute pancreatitis and mumps
Amylase
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
22. At what level of the spine does the IM exit the aorta
90%
L3
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Conj/unconj - inc - nl to dec
23. What kind of pancreatitis is associated with EtOH and smoking
Turcot
Left gastric vein and esophogeal vein - esophagus
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Chronic calcifying pancreatitis - inc risk of panreatic cancer
24. Why are most diverticula considered false
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Necrotizing enterocolitis
25. What are the labs in acute pancreatitis
Epithelium
Glucose dependent insulinotropic peptide
Elevated amylase - and lipase
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
26. What causes nutmeg liver
Backup of blood into the liver - RHF - budd chiari
Copious diarrhea - non alpha - non beta cell pancreatic tumor
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Liver metabolizes 5HT
27. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Phenobarbital - inc liver enzyme synthesis
With albumin
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
FAP
28. Are single polyps malignant in peutz jehgers
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Hemosiderosis - hemochromatosis
Black - rotors syndrome
No
29. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Zollinger ellison - brunners glands
Decrease - weight gain
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
90%
30. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Lubricate food (glycoprotiens)
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Muscularis mucosae
Appendicitis
31. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Alcoholic cirrhosis
Alk phos
Duodenum - 2nd - 3rd and 4th parts
Cholesterol
32. What can hemochromatosis be secondary to...
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Uremia
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
33. What cells make pepsin - What does it do - and what regulates it
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Striated and smooth
Inc lower esphogeal tone leading to achalasia
Menetriers disease
34. What does a low flow rate mean for saliva
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Hypotonic because of more time to reabsorb NaCl
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Via the superior pancreaticduodenal
35. What kind of anemia is in Wilsons
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Inferior rectal nerve
Hemolytic anemia
Hernia
36. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Inc conj bilirubin - inc cholesterol - inc alk phos
37. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Virchow's node
Intussusception
External (superficial) ring only
38. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
When diffusely infiltrative - thickened rigid appearance like a leather bottle
GERD - may also present with nocturnal cough and dyspnea
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Appendicitis
39. Where are peyers patches found
Lipase
Decrease - weight gain
Lamina propora and submucosa
Liver metabolizes 5HT
40. Which patients have pigment stones
Glucouronate - water soluble (direct)
Trypsin - chymotrypsin - elastase - carboxypeptidases
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
41. milk intolerance
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
GLUT 2
Dissaccharidase def - most commonly lactase
AR
42. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
GLUT 2
Causes of gall stones
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
43. What structures feed into the common hepatic duct
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Right and left hepatic duct
Cirrhosis
44. What enzyme is necessary to create conjugated bilirubin
Krukenbergs tumor
Uridine glucuronyl transferase
Causes of gall stones
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
45. what kind of muscle is in the upper 1/3 of esophagus
Hydrocele
Striated
Inc - weight loss
US and cholecystectomy
46. Where is the deep inguinal ring relative to the inferior epigastric vessels
Lateral
Jaundice - fever - RUQ
Around the central vein (zone III)
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
47. Where are oligosaccharide hydrolases and What do they do
Gut bacteria
Brush border of intestine - produce monosaccharides from oligo and di
Inc - weight loss
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
48. Where is folate absorbed
Zollinger Ellison - phenylalanine and tryptophan
Squamous - upper 1/3 - adeno - lower 1/3
The jejunum
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
49. What is the prognosis of adenocarcinoma
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Averages 6 months - very aggressive - usually already metastasized at presentation
Gut bacteria
External (superficial) ring only
50. What is the omphalomesenteric cyst
Cigarettes and chronic pancreatitis - not EtOH
Cystic dilation of the viteline duct
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Barrett's esophagus
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