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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 causes pancreatic insuff and What does it cause
Hepatic steatosis
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
AR
2. rare - often fatal childhood hepatoencephalopathy
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3. What causes nutmeg liver
CCK8 receptor - Gq inc IP3/Ca
2ndary biliary cirrhosis
Adhesion
Backup of blood into the liver - RHF - budd chiari
4. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Peutz jeghers
Upregulated intracellular signal transduction
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
5. Which patients have pigment stones
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Bleeding - penetration into pancreas - perforation - obstruction
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
6. What are the tumor markers for pancreatic adenocarcinoma
Lipase - phospholipase A - colipase
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
CEA - CA-19-9
Cystic duct and common hepatic duct
7. FAP + osseous and soft tissue tumors - retinal hyperplasia
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8. What kind of muscle is in the lower 1/3 of the esophagus
Smooth
Celiac sprue
AST>ALT
Gastrohepatic ligament
9. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Paraumbilical and superficial and inferior epigastric - umbilicus
Phototherapy
Inc conj bilirubin - inc cholesterol - inc alk phos
Mucosa - submucosa - muscularis externa - serosa/adventitia
10. What is the cause of Barrett's and the assocaited complications
Budd chiari syndrome
ALT>AST
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
11. What do the rugae of stomach look like in menetriers disease
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
So hypertrophied they look like brain gyri
Budd chiari syndrome
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
12. What are the longterm sequelae of nutmeg liver
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Juvenille polyps - no risk if single
Centrilobular congestion and necrosis - cardiac cirrhosis
13. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Budd chiari syndrome
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Ceruplasmin
Cystic duct and common hepatic duct
14. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Crohns = noncaseating granulomas - UC = crypt abscesses
Via the superior pancreaticduodenal
Ischemic colitis
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
15. multiple juvenil polyps in GI tract - risk
Hyperpigmented mouth - lips - hands - genitalia
Juvenile polyposis syndrome - inc risk of adenocarcinoma
L/R renal artery around L1
Squamous - upper 1/3 - adeno - lower 1/3
16. What is the clinical presentation of acute pancreatitis
Epigastric abdominal pain radiating to back - anorexia - nausea
Lactase is located at the tips of intestinal villi
Below
Oligosaccharide digestion
17. What is the rule of 2s for meckels
Neutralizes oral bacertial acids and maintains dental health
Pancreatic and bile
Lateral to the inferior epigastric artery
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
18. If the abdominal aorta is blocked - How does blood get to the left colic artery
Via the middle colic
Redness and tenderness on palpation of extremities
Stimulate the H/K ATPase
Alk pho
19. At what spinal level does the SMA exit
Duodenal atresia - Downs
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Epithelium
L1
20. Where are peyers patches found
Lamina propora and submucosa
Brunners
Ceruplasmin
So hypertrophied they look like brain gyri
21. What conditions are associated with budd chiari
Hypercoaguability - polycythemia vera - pregnancy - HCC
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
Neutralizes gastric acid allowing pancreatic enzymes to fxn
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
22. What transforms conjugated bilirubin to urobilinogen
Gardner's syndrome
Alpha1 antitrypsin def - codominant trait
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Gut bacteria
23. What drug inhibits the H/K ATPase
Lateral to the inferior epigastric artery
Backup of blood into the liver - RHF - budd chiari
Omeprazole
Inc risk of CRC and other visceral malignancies
24. milk intolerance
Dissaccharidase def - most commonly lactase
The gastroduodenal
Centrilobular leading to congestive liver disease
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
25. How does gastrin increase acid secretion?
Primarly through ECL leading to histamine release
Paraumbilical and superficial and inferior epigastric - umbilicus
Failure of neural crest migration
Ceruplasmin
26. What kind of insults results in macronodular cirrhosis
90%
Duodenum - 2nd - 3rd and 4th parts
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Gilbert's
27. What are the layers of the gut wall from inside out
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Appendicitis
Around the central vein (zone III)
Mucosa - submucosa - muscularis externa - serosa/adventitia
28. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
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
Inc lower esphogeal tone leading to achalasia
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
Causes of gall stones
29. Autoantibodies to gluten (gliadin) in wheat and other grains
Below
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Celiac sprue
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
30. Where is the pectinate line
So hypertrophied they look like brain gyri
Fe2+ in the duod
Muscularis mucosae
Where hindgut meets ectoderm
31. Bilirubin is the product of what?
Heme metabolism
Inspiratory arrest on deep palpation due to pain
Inc risk of CRC and other visceral malignancies
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
32. is meckels a true diverticulum and how common is it
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
True and most common congenital anomoly of GI tract
Necrotizing enterocolitis
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
33. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Carcinoid syndrome
Inc smooth muscle relaxation - including lower esophageal sphincter
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
34. What structures feed into the cystic duct
Gallbladder
Inferior rectal nerve
External (superficial) ring only
Lateral to the inferior epigastric artery
35. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Normal
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Inspiratory arrest on deep palpation due to pain
36. motilin - source - action - regulation
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Hepatic steatosis
...
37. What structures feed into the common bile duct
Cystic duct and common hepatic duct
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Barrett's esophagus
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
38. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Peyers patches
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Alpha amylase
39. Autodigestion of pancreas by pancreatic enzymes
2ndary biliary cirrhosis
Dissaccharidase def - most commonly lactase
Acute pancreatitis
Via the middle colic
40. B cells stimuated in the germinal centers of peyers patches differentiate into what?
IgA secreting plasma cells - ultimately reside in the lamina proporia
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Bleeding - penetration into pancreas - perforation - obstruction
US and cholecystectomy
41. What is the main symptom if a VIPoma
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Boerhaave's Syndrome - Been heaving syndrome
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Cirrhosis
42. Malabsorption syndromes have what common clinical presentation
Black - rotors syndrome
Common hepatic - splenic - left gastric - main blood supply for stomach
Diarrhea - steatorrhea - weight loss - weakness
Left and right gastroepiploics - left and right gastrics
43. What is the frequency of basal electric rhythm of the ilieum
With albumin
Glucouronate - water soluble (direct)
Dense core bodies
8-9 waves/min
44. occlusion of IVC or hepatic veins
Budd chiari syndrome
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Neutralizes gastric acid allowing pancreatic enzymes to fxn
45. What reaction does salivary amylase catalyze
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Below
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Failure of the processus vagainlis to close
46. How do you DX and TX gallstones
M3 - Gq - inc IP3/Ca
US and cholecystectomy
Low pressure proximal to LES
Diverticulum
47. What are the borders of Hesselbach's triangle
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Oral glucose
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Zollinger Ellison - phenylalanine and tryptophan
48. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Striated and smooth
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
49. What does the splenorenal ligament connect - and What does it contain
3 waves/min
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Spleen to posterior abdominal wall - splenic artery and vein
Hepatic steatosis
50. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
90%
Colonic polyps
Cimetidine
Tropical sprue