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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 is diverticulosis
AST
Conj/unconj - inc - nl to dec
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Backup of blood into the liver - RHF - budd chiari
2. likely infectious form of malabsorption - responds to antibiotics
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
The gastroduodenal
Tropical sprue
Inguninal ligament - sartorius muscle - adductor longus
3. Which IBD is autoimmune and which may be a disordered response to bacteria
VZV and influenza B treated with salicylates
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Failure of the processus vagainlis to close
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
4. What does autoimmune destruction of parietal cells lead to...
Splenic flexure
Chronic gastritis and pernicious anemia
Ceruplasmin
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
5. What does histo show for alpha1 antitrypsin def
Dilated esophagus with an area of distal stenosis - birds beak
PAS- positive globules in liver -
Sphincter of oddi
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
6. If the abdominal aorta is blocked - How does blood get to the left colic artery
Unconj - absent (acholuria) - inc
Centrilobular congestion and necrosis - cardiac cirrhosis
Via the middle colic
Chagas disease
7. What are the midgut structures and what supplies their blood and PANS innervation
Stercobilin
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
L2
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
8. What are the branches of the celiac trunk and What do they supply
ALT>AST
Left and right gastroepiploics - left and right gastrics
EtOH
Common hepatic - splenic - left gastric - main blood supply for stomach
9. what kind of muscle is in the upper 1/3 of esophagus
Below
Positive urease test
Striated
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
10. FAP + osseous and soft tissue tumors - retinal hyperplasia
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11. What are the histological findings in the jejunum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Old men - arthralgias - cardiac and neuro sx
Redness and tenderness on palpation of extremities
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
12. What is the other name for GIP (gastric inhibitory peptide)
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Esophageal cancer
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Glucose dependent insulinotropic peptide
13. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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14. What serum enzyme is elevated inacute pancreatitis
Crohns = maybe - UC= always
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Inc - weight loss
Lipase
15. What are the histological findings of the colon
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Striated and smooth
Crypts but not villi
ALT>AST
16. What are the two molecular pathways that lead to CRC
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Obstruction of the common bile duct
MSI (15%) and APC/beta catenin chromosomal instability (85%)
90%
17. What are the tumor markers for pancreatic adenocarcinoma
Penicillinamine - AR inheritance
CEA - CA-19-9
Pancreatic and bile
Lateral to the inferior epigastric artery
18. most common malignant salivary gland tumor
Warthins' tumor
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Mucoepidermoid carcinoma
19. In what scenarios do pts with gilberts have inc bili
Pyoderma gangrenosum - primary sclerosing cholangitis
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Fasting and stress
Sphincter of oddi
20. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Alk pho
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Crigler - najjar type 1
21. What kind of pathways do CCK act on to cause pancreatic secretion
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Neural muscarinic pathways
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
22. What layer in the mucosa is repsonsible for motility
Where hindgut meets ectoderm
Above
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Muscularis mucosae
23. What is the frequency of basal electric rhythm of the stomach
Stimulate the H/K ATPase
Hirschsprungs
Primarly through ECL leading to histamine release
3 waves/min
24. Gq and inc cAMP both work to do what in parietal cells
Via the superior pancreaticduodenal
US and cholecystectomy
Stimulate the H/K ATPase
Peutz jeghers
25. What gives stool its characteristic color
In the mucus that covers the gastric epithelium
Sphincter of oddi
Centrilobular congestion and necrosis - cardiac cirrhosis
Stercobilin
26. What is the sphincter of the pancreatic duct
Inc lower esphogeal tone leading to achalasia
Esophageal varices
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Sphincter of oddi
27. Which is used more quickly - an oral glucose load - or that by IV
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Oral glucose
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
28. What does bicarb do in the duodenum
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Squamous - upper 1/3 - adeno - lower 1/3
Via the middle colic
Heme metabolism
29. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Dissaccharidase def - most commonly lactase
IgA secreting plasma cells - ultimately reside in the lamina proporia
Causes of gall stones
Volvulus
30. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Glucose dependent insulinotropic peptide
Fe2+ in the duod
31. What do you treat Wilsons disease with and What is the inheritance
Gastric glands
Penicillinamine - AR inheritance
Glucouronate - water soluble (direct)
Angiodysplasia
32. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
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
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Pleomorphic adenoma
33. What findings are associated with reyes
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Skip lesions =crohns - colon = UC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Mitochondrial abnl - fatty liver - hypoglycemia - coma
34. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Menetriers disease
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Internal thoracic to superior epigastric to inferior epigastric
Zenkers - halitosis - dysphagia and obstruction
35. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Complications of UC
Unconj - absent (acholuria) - inc
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
AST >ALT - ration is usually 1.5
36. What histological findings are present in the stomach
Celiac sprue
Gastric glands
L/R renal artery around L1
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
37. Which viral infxns/treatments are associated with reyes syndrome
VZV and influenza B treated with salicylates
Averages 6 months - very aggressive - usually already metastasized at presentation
Pertechnetate - study for uptake
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
38. What is a positive murphy's sign
Inspiratory arrest on deep palpation due to pain
Colonic polyps
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
39. What are the foregut structures and what supplies their blood and PANS innvervation
Gilbert's
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Inc risk of CRC and other visceral malignancies
Esophageal cancer
40. Where is the arterial supply from above the pectinate line - and What is the venous drainage
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
FAP
Lamina propora and submucosa
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
41. What kind of anemia is in Wilsons
Hemolytic anemia
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Alcoholic hepatitis
Corticosteroids - infliximab
42. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Smooth
T cell lymphoma
Inc conj bilirubin - inc cholesterol - inc alk phos
Virchow's node
43. in carcinoid tumors - What is seen on EM
AST>ALT
Inc conj bilirubin - inc cholesterol - inc alk phos
Dense core bodies
All 3 gut layers outpouch as in Meckels
44. what percentage of colonic polyps are non - neoplastic
Intussusception
90%
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
45. How is the diagonsis of CRC made
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
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
46. What is the HLA association and treatment for hemochromatosis
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
T12
Repeated phlebotomy - deferoxamine - HLA- A3
3 waves/min
47. What nerve innervates the external hemorrhoids
Left gastric vein and esophogeal vein - esophagus
Achalasia due to loss of myenteric plexus (auberach)
Inferior rectal nerve
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
48. In PUD with a duodenal ulcer does pain inc or dec with meals
Positive
Oral glucose
Decrease - weight gain
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
49. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Via the middle colic
Pancreatic and bile
Zollinger Ellison - phenylalanine and tryptophan
50. Abuse of what substance leads to acute gastritis
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
EtOH
Splenic flexure
Centrilobular congestion and necrosis - cardiac cirrhosis
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