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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 is the rate limiting step of carbohydrate digestion
8-9 waves/min
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Oligosaccharide digestion
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
2. Which patients have pigment stones
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
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
Smooth
Increase tumorigenesis
3. What is one potential precipitating factor for intussusception
Acute pancreatitis
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
All 3
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
4. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Falciform - ligamentum teres - fetal umbilical vein
Dysphagia (due to esophageal web) - glossitis - iron def anemia
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Gastric glands
5. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Short gastrics - left greater and lesser
Volvulus
Sister mary joseph nodule
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
6. What are the signs of peutz jehgers
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Hyperpigmented mouth - lips - hands - genitalia
Dissaccharidase def - most commonly lactase
Repeated phlebotomy - deferoxamine - HLA- A3
7. Where does copper accumulate in Wilsons and What are ABCD
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
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
Cystic dilation of the viteline duct
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
8. How does gastrin increase acid secretion?
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Primarly through ECL leading to histamine release
Causes of gall stones
Pyoderma gangrenosum - primary sclerosing cholangitis
9. People of what decent are associated with celiac sprue and what findings/antibodies are present
L4
Hypotonic because of more time to reabsorb NaCl
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
10. What is the frequency of basal electric rhythm of the ilieum
Worldwide - SC - US - adeno
8-9 waves/min
Decreased intercellular adhesion and increased proliferation
Trypsin - chymotrypsin - elastase - carboxypeptidases
11. What is the presenting course for appendicity
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12. What structures feed into the common hepatic duct
Right and left hepatic duct
Muscularis mucosae
Chronic gastritis and pernicious anemia
L3
13. Achalasia increases the risk For what complication
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Esophageal carcinoma
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
14. Why does volvulus occur more at cecum and sigmoid colon
Around the central vein (zone III)
Stercobilin
Redundant mesentary
Pancreatic head causing obstructive jaundice
15. What is the cause of Barrett's and the assocaited complications
Peyers patches
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Where hindgut meets ectoderm
Backup of blood into the liver - RHF - budd chiari
16. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Menetriers disease
Backup of blood into the liver - RHF - budd chiari
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Inc smooth muscle relaxation - including lower esophageal sphincter
17. most common non - neoplastic polyp in colon
Gallbladder
Crohns = noncaseating granulomas - UC = crypt abscesses
Bleeding - penetration into pancreas - perforation - obstruction
Hyperplastic
18. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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19. What are the ABCDEF of esophageal cancer
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Skip lesions =crohns - colon = UC
Chagas disease
20. Abuse of what substance leads to acute gastritis
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
EtOH
Epithelium
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
21. Where does crohns usually affect the GI tract
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Lamina propora and submucosa
Terminal ileum and colon
H pylori (almost 100%)
22. What is contained within the muscularis externa
Myenteric nerve plexus - aurbach
Backup of blood into the liver - RHF - budd chiari
Mitochondrial abnl - fatty liver - hypoglycemia - coma
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
23. Where is there sclerosis in alcoholic cirrohosis
Dilated esophagus with an area of distal stenosis - birds beak
Around the central vein (zone III)
Cimetidine
Crypts but not villi
24. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Ampulla of vater
GERD - may also present with nocturnal cough and dyspnea
Meckels
Colonic polyps
25. What test and result confirms H pylori infxn
US and cholecystectomy
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
8-9 waves/min
Positive urease test
26. What is the most important mechanism in gastric acid secretion
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Myenteric nerve plexus - aurbach
27. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Hypotonic because of more time to reabsorb NaCl
H+
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Alpha amylase
28. What are the histological findings in the duodenum
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29. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Adhesion
Ceruplasmin
Worldwide - SC - US - adeno
Crypts but not villi
30. What does K- ras mutation cause
Alpha1 antitrypsin def - codominant trait
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Positive
Upregulated intracellular signal transduction
31. Which is used more quickly - an oral glucose load - or that by IV
Oral glucose
Trypsin - chymotrypsin - elastase - carboxypeptidases
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Left gastric vein and esophogeal vein - esophagus
32. Where is IgA shuttled
Inc - weight loss
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Low pressure proximal to LES
33. What can fistula between the gallbladder and small intestine create and how can you tell
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Meckels
34. What cells secrete bicarb - What does it do - and what regulates it
Dense core bodies
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Gamma glutamyl transferase GGT
35. What is the TX of physiologic neonatal jaundice
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Failure of the processus vagainlis to close
Phototherapy
36. What are the complications of acute pancreatitis
L3
Normal
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
37. subQ peribumbilical metastasis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Sister mary joseph nodule
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Stercobilin
38. What does GET SMASHED stand for in acute pancreatitis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Gastric glands
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Alcoholic hepatitis
39. What artery passes around the duodenum
Pancreatic head causing obstructive jaundice
Gallbladder
The gastroduodenal
L4
40. inflammatino of gallbadder
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Inspiratory arrest on deep palpation due to pain
Dilated esophagus with an area of distal stenosis - birds beak
Mucoepidermoid carcinoma
41. Where does type B chronic gastritis occur and What causes it
Brush border of intestine - produce monosaccharides from oligo and di
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Striated
Antrum - H.pylori - inc risk of MALT lymphoma
42. In PUD with a duodenal ulcer does pain inc or dec with meals
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Decrease - weight gain
Gastric glands
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
43. Where is B12 absorbed
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Chronic calcifying pancreatitis - inc risk of panreatic cancer
In the ileum with bile acids - requires IF
Cimetidine
44. What does loss of p53 cause
Increase tumorigenesis
Colovesical leading to pneumaturia
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Cimetidine
45. likely infectious form of malabsorption - responds to antibiotics
Tropical sprue
Phenobarbital - inc liver enzyme synthesis
Portal HTN
2ndary biliary cirrhosis
46. What are the branches of the celiac trunk and What do they supply
Jewish and African American men
Erosive - disruption of mucosal barrier leading to inflammation
Redness and tenderness on palpation of extremities
Common hepatic - splenic - left gastric - main blood supply for stomach
47. Which area of the hindgut is a watershed area
Lye ingestion and acid reflux
Splenic flexure
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Centrilobular congestion and necrosis - cardiac cirrhosis
48. What are the four Fs of gallstones
Necrotizing enterocolitis
Female - fat - fertile - forty
Ischemic colitis
Adhesion
49. Where does an indirect inguinal hernia enter the deep inguinal ring
Dissaccharidase def - most commonly lactase
Chagas disease
Lateral to the inferior epigastric artery
Omeprazole
50. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Lamina propora and submucosa
Duodenal atresia - Downs
Amylase
No