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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 layer in the mucosa is responsible for absorption
AST
Epithelium
Hirschsprungs
Alcoholic cirrhosis
2. What portion of the bowel does sprue effect
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
Menetriers disease
The proximal small bowel
Via the middle colic
3. What is the cause of physiologic neonatal jaundice
Lactase is located at the tips of intestinal villi
Primarly through ECL leading to histamine release
Worldwide - SC - US - adeno
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
4. What is the arterial supply and venous drainage below pectinate line
Conj/unconj - inc - nl to dec
Stimulate the H/K ATPase
Fe2+ in the duod
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
5. What are the histological findings in the jejunum
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
ALT>AST
Crigler - najjar type 1
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
6. What test and result confirms H pylori infxn
Repeated phlebotomy - deferoxamine - HLA- A3
T12
Positive urease test
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
7. What are the ABCDEF of esophageal cancer
Fasting and stress
Begins starch digestion - inactivated by low pH upon reaching the stomach
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Jaundice - fever - RUQ
8. Transmural esophageal rupture due to violent retching
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9. What receptors does ACH bind on the parietal cells and What does it activate
Hirschsprungs
M3 - Gq - inc IP3/Ca
Trypsin - chymotrypsin - elastase - carboxypeptidases
AR
10. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Sphincter of oddi
So hypertrophied they look like brain gyri
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Menetriers disease
11. What serum markers increase in cholecystitis with bile duct involvement
Oral glucose
PAS- positive globules in liver -
Alk phos
Colonic polyps
12. What kind of insults results in macronodular cirrhosis
Cholesterol
Can lead to hematemesis - found in EtOHics and bulimics
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Celiac sprue
13. Is there any structural abnl with IBS - What is the course of disease and presentation
VZV and influenza B treated with salicylates
L4
Intussusception
No - chronic - can present with diarrhea or constipation or alternation - treat sx
14. What is Trousseau's sign
Meckels
Centrilobular leading to congestive liver disease
Redness and tenderness on palpation of extremities
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
15. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
T12
All 3 gut layers outpouch as in Meckels
16. Why are most diverticula considered false
Achalasia due to loss of myenteric plexus (auberach)
Skip lesions =crohns - colon = UC
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Dense core bodies
17. occlusion of IVC or hepatic veins
Budd chiari syndrome
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Splenic flexure
Small intestine
18. If the abdominal aorta is blocked - How does blood get to the left colic artery
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Brush border of intestine - produce monosaccharides from oligo and di
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Via the middle colic
19. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
12 waves/min
Closer to isotonic because of less time to reabsorb NaCl
US and cholecystectomy
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
20. What serum enzyme is decreased in wilsons disease
Ceruplasmin
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
Unconjugated - water insoluble
90%
21. most common non - neoplastic polyp in colon
Hyperplastic
Decreased intercellular adhesion and increased proliferation
Dilated esophagus with an area of distal stenosis - birds beak
Sister mary joseph nodule
22. What are the midgut structures and what supplies their blood and PANS innervation
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Muscularis mucosae
Alcoholic hepatitis
23. What does extrahepatic biliary obstruction cause
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
M3 - Gq - inc IP3/Ca
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
24. What does TOASTED with alcoholic hepatitis stand for
Dissaccharidase def - most commonly lactase
Duodenum - 2nd - 3rd and 4th parts
AST >ALT - ration is usually 1.5
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
25. most common malignant salivary gland tumor
Crohns = maybe - UC= always
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Mucoepidermoid carcinoma
Ampulla of vater
26. What are the complications of Meckels
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Averages 6 months - very aggressive - usually already metastasized at presentation
Lubricate food (glycoprotiens)
27. What structures feed into the cystic duct
Crohns = maybe - UC= always
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
Gallbladder
Crypts but not villi
28. What is the most common diaphragmatic hernia and What are the two types
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
H pylori (almost 100%)
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Hepatic steatosis
29. What layer in the mucosa is repsonsible for motility
Conj - inc - dec
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
HPNCC
Muscularis mucosae
30. What kind of muscle is in the middle 1/3 of esophagus
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Striated and smooth
Osmotic
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
31. Esophagitis can result From which 3 infectious agents - or chemical ingestion
HSV-1 - CMV - Candida
Fasting and stress
Jewish and African American men
Pancreatic head causing obstructive jaundice
32. What does primary sclerosing cholangitis lead to...
Lamina propora and submucosa
Paraumbilical and superficial and inferior epigastric - umbilicus
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Hirschsprungs
33. List the clinical findings of HCC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Lamina propria
CCK8 receptor - Gq inc IP3/Ca
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
34. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Unconj - absent (acholuria) - inc
Normal
ALT>AST
Short gastrics - left greater and lesser
35. Where does type B chronic gastritis occur and What causes it
Cimetidine
Splenic flexure
Antrum - H.pylori - inc risk of MALT lymphoma
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
36. What are the branches of the celiac trunk and What do they supply
Barrett's esophagus
AST >ALT - ration is usually 1.5
Common hepatic - splenic - left gastric - main blood supply for stomach
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
37. What intervention will intervention will relieve portal HTN
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Internal thoracic to superior epigastric to inferior epigastric
L4
3 waves/min
38. What congenital birth defect is associated with Hirschsprung
Downs
Uridine glucuronyl transferase
Peyers patches
Squamous - upper 1/3 - adeno - lower 1/3
39. Where is B12 absorbed
Smooth
In the ileum with bile acids - requires IF
GLUT 2
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
40. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Diverticulum
Cimetidine
Positive
41. What do you treat Wilsons disease with and What is the inheritance
Gut bacteria
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Penicillinamine - AR inheritance
42. What are the main components of bile
CHF and inc risk of HCC
Achalasia due to loss of myenteric plexus (auberach)
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
NAV = nerve artery vein - venous near the penis (NAVEL)
43. What serum enzyme is elevated inacute pancreatitis
The entire
Lipase
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Parietal cells in the stomach - B12 binding protein
44. secretin - source - action - regulation
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Sister mary joseph nodule
Pleuroperitoneal
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
45. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
L/R renal artery around L1
When diffusely infiltrative - thickened rigid appearance like a leather bottle
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
46. What receptors does gastrin bind on the parietal cell and What does it activate
CCK8 receptor - Gq inc IP3/Ca
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Punched out - clean margins - carcinoma =raised irregular margins
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
47. At what level do the testicular/ovarian arteries exit the aorta
Repeated phlebotomy - deferoxamine - HLA- A3
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
L2
48. What is the sphincter of the pancreatic duct
Lipase
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Gastrohepatic ligament
Sphincter of oddi
49. Where are tumors commonly in pancreatic adenocarcinoma
Short gastrics - left greater and lesser
Falciform - ligamentum teres - fetal umbilical vein
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Pancreatic head causing obstructive jaundice
50. What pancreatic proteases are secreted as zymogens
Gardner's syndrome
Trypsin - chymotrypsin - elastase - carboxypeptidases
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders