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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. When and How does Abetalipoproteinemia present
Jewish and African American men
Oligosaccharide digestion
Enterokinase/enteropeptidase from the duodenal mucosa
Early childhood - neuro sx and malabsorption
2. What causes nutmeg liver
Angiodysplasia
Oral glucose
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Backup of blood into the liver - RHF - budd chiari
3. What are the histological findings of the colon
Hyperplastic
Stimulate intestinal persistalsis
Internal thoracic to superior epigastric to inferior epigastric
Crypts but not villi
4. What gives stool its characteristic color
Decreased intercellular adhesion and increased proliferation
Stercobilin
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Oligosaccharide digestion
5. Gallstones that reach the common channel at ampulla can block which two ducts
Inc risk of CRC and other visceral malignancies
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Pancreatic and bile
Glucouronate - water soluble (direct)
6. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Serous on the sides parotids - mucinous in the middle sublingual
Jewish and African American men
Left gastric vein and esophogeal vein - esophagus
Erosive - disruption of mucosal barrier leading to inflammation
7. What is biliary colic
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Can lead to hematemesis - found in EtOHics and bulimics
Hyperpigmented mouth - lips - hands - genitalia
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
8. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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9. involvement of left supraclavicular node by mets from stomach
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10. What is the cause of physiologic neonatal jaundice
Inc lower esphogeal tone leading to achalasia
Brunners
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Pancreatic and bile
11. What does K- ras mutation cause
Appendicitis
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
Upregulated intracellular signal transduction
The submucosal nerve plexus - meissner's
12. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Conj/unconj - inc - nl to dec
Averages 6 months - very aggressive - usually already metastasized at presentation
Ischemic colitis
13. Which serum enzyme increases with heavy EtOH consumption
Warthins' tumor
Gamma glutamyl transferase GGT
Serous on the sides parotids - mucinous in the middle sublingual
Neutralizes oral bacertial acids and maintains dental health
14. What are the treatmet options for crohns
Normal
Corticosteroids - infliximab
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
The entire
15. GIP - source - action regulation
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Turcot
Falciform - ligamentum teres - fetal umbilical vein
H2 receptor - inc cAMP
16. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
...
Esophageal cancer
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
17. What does GET SMASHED stand for in acute pancreatitis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
AST >ALT - ration is usually 1.5
Volvulus
Cystic duct and common hepatic duct
18. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Pleomorphic adenoma
Conj/unconj - inc - nl to dec
Goes through deep inguinal ring - external inguinal ring and into the scrotum
19. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Pancreatic head causing obstructive jaundice
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
T cell lymphoma
Glucouronate - water soluble (direct)
20. Through which aspect of the inguinal canal does a direct inguinal go
Lateral
FAP
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
External (superficial) ring only
21. what kind of fistula is associated with diverticulitis
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
T12
Colovesical leading to pneumaturia
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
22. What cells make pepsin - What does it do - and what regulates it
L3
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Alpha amylase
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
23. What does a low flow rate mean for saliva
Hypotonic because of more time to reabsorb NaCl
Paraumbilical and superficial and inferior epigastric - umbilicus
Decreased intercellular adhesion and increased proliferation
T12
24. What nerve innervates the external hemorrhoids
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Nonkeritinized stratified sqamous epithelium
Inferior rectal nerve
Elevated amylase - and lipase
25. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
L4
Trypsin - chymotrypsin - elastase - carboxypeptidases
FAP
Can lead to hematemesis - found in EtOHics and bulimics
26. What is the frequency of basal electric rhythm in the duodenum
12 waves/min
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
IgA secreting plasma cells - ultimately reside in the lamina proporia
Early childhood - neuro sx and malabsorption
27. HCC is associated with what other conditions
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Centrilobular congestion and necrosis - cardiac cirrhosis
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
28. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Inc conj bilirubin - inc cholesterol - inc alk phos
GERD - may also present with nocturnal cough and dyspnea
Stercobilin
Begins starch digestion - inactivated by low pH upon reaching the stomach
29. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Mallory bodies
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
Superior rectal and middle and inferior rectal - rectum
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
30. Between what structures do strong anastamoses exist
Left and right gastroepiploics - left and right gastrics
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Elevated amylase - and lipase
Redness and tenderness on palpation of extremities
31. What are the longterm sequelae of nutmeg liver
L/R renal artery around L1
Colovesical leading to pneumaturia
Centrilobular congestion and necrosis - cardiac cirrhosis
Glucouronate - water soluble (direct)
32. When and why is stomach cancer termed linitis plastica
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Left gastric vein and esophogeal vein - esophagus
Decrease - weight gain
When diffusely infiltrative - thickened rigid appearance like a leather bottle
33. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Zenkers - halitosis - dysphagia and obstruction
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
34. What happens to the short gastics if the splenic artery is blocked
Gamma glutamyl transferase GGT
Peyers patches
Poor anastamoses
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
35. How do burns cause acute gastritis and What is it called
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36. What receptors does gastrin bind on the parietal cell and What does it activate
Brush border of intestine - produce monosaccharides from oligo and di
CCK8 receptor - Gq inc IP3/Ca
T12
Superior rectal and middle and inferior rectal - rectum
37. What retroperitoneal structure flanks both sides of the pancreas on CT
H pylori (almost 100%)
Duodenum - 2nd - 3rd and 4th parts
Inc - weight loss
M3 - Gq - inc IP3/Ca
38. What is the arterial supply and venous drainage below pectinate line
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Amylase
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
39. What does alpha amylase do and what inactivates it
Begins starch digestion - inactivated by low pH upon reaching the stomach
T cell lymphoma
GLUT 2
Complications of crohns
40. milk intolerance
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Dissaccharidase def - most commonly lactase
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Celiac sprue
41. What can hemochromatosis be secondary to...
Inguninal ligament - sartorius muscle - adductor longus
Around the central vein (zone III)
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Crohns = maybe - UC= always
42. What structures feed into the common bile duct
No
Stercobilin
Necrotizing enterocolitis
Cystic duct and common hepatic duct
43. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Duodenal atresia - Downs
Mucoepidermoid carcinoma
Phenobarbital - inc liver enzyme synthesis
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
44. Transmural esophageal rupture due to violent retching
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45. What artery passes around the duodenum
The gastroduodenal
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Inc risk of CRC and other visceral malignancies
Positive urease test
46. What are motilin receptor agonists used for clinically
HSV-1 - CMV - Candida
Corticosteroids - infliximab
Stimulate intestinal persistalsis
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
47. Is there any structural abnl with IBS - What is the course of disease and presentation
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Juvenille polyps - no risk if single
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
No - chronic - can present with diarrhea or constipation or alternation - treat sx
48. What is the rule of 2s for meckels
HPNCC
Cigarettes and chronic pancreatitis - not EtOH
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Trypsin - chymotrypsin - elastase - carboxypeptidases
49. What kind of muscle is in the lower 1/3 of the esophagus
Smooth
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Cirrhosis
Pleuroperitoneal
50. What are the two molecular pathways that lead to CRC
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Esophageal carcinoma
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
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Can you answer 50 questions in 15 minutes?
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