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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. Where are tumors commonly in pancreatic adenocarcinoma
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Pancreatic head causing obstructive jaundice
Phenobarbital - inc liver enzyme synthesis
2. What gives stool its characteristic color
Osmotic
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Stercobilin
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
3. Autodigestion of pancreas by pancreatic enzymes
Skip lesions =crohns - colon = UC
Acute pancreatitis
The entire
Lateral to the inferior epigastric artery
4. In viral hepatitis - which liver enzyme is higher
AST>ALT
Antrum - H.pylori - inc risk of MALT lymphoma
Gamma glutamyl transferase GGT
ALT>AST
5. What are the histological findings in the duodenum
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6. Bilirubin is the product of what?
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Inc conj bilirubin - inc cholesterol - inc alk phos
PAS- positive globules in liver -
Heme metabolism
7. What cells secrete bicarb - What does it do - and what regulates it
Liver metabolizes 5HT
Peptic ulcer disease
Oligosaccharide digestion
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
8. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Inspiratory arrest on deep palpation due to pain
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Necrotizing enterocolitis
Penicillinamine - AR inheritance
9. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Cystic dilation of the viteline duct
Conj/unconj - inc - nl to dec
Alfatoxin in peanuts
Neutralizes gastric acid allowing pancreatic enzymes to fxn
10. absent UDPGT - presents early in life - early mortality
Cirrhosis
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
Enterokinase/enteropeptidase from the duodenal mucosa
Crigler - najjar type 1
11. What are motilin receptor agonists used for clinically
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Stimulate intestinal persistalsis
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Common hepatic - splenic - left gastric - main blood supply for stomach
12. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Alk pho
Carcinoid syndrome
Menetriers disease
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
13. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Complications of crohns
IgA secreting plasma cells - ultimately reside in the lamina proporia
14. HCC is associated with what other conditions
Old men - arthralgias - cardiac and neuro sx
Oligosaccharide digestion
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
No
15. Gastrin - source - action - regulation
Lactase is located at the tips of intestinal villi
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
Via the superior pancreaticduodenal
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
16. What do the rugae of stomach look like in menetriers disease
So hypertrophied they look like brain gyri
Gilbert's
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
17. How does abetalipoproteinemia lead to malabsorption
Decrease - weight gain
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Cigarettes and chronic pancreatitis - not EtOH
No
18. How does loss of NO secretion affect the esophagus and what results
Intussusception
Acute pancreatitis
Meconium ileus
Inc lower esphogeal tone leading to achalasia
19. What are esophageal strictures associated with
Lye ingestion and acid reflux
Pleomorphic adenoma
IgA secreting plasma cells - ultimately reside in the lamina proporia
Lateral to the inferior epigastric artery
20. What are the treatmet options for crohns
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Oral glucose
Corticosteroids - infliximab
21. How many layers of spermatic fascia are covers an indirect inguinal hernia
Hernia
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Falciform - ligamentum teres - fetal umbilical vein
All 3
22. What is the presentation of pancreatic adenocarcinoma
Fe2+ in the duod
Barrett's esophagus
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Appendicitis
23. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Pancreatic head causing obstructive jaundice
Skip lesions =crohns - colon = UC
ALT>AST
24. What pancreatic proteases are secreted as zymogens
Jewish and African American men
Warthins' tumor
Superior rectal and middle and inferior rectal - rectum
Trypsin - chymotrypsin - elastase - carboxypeptidases
25. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Zollinger ellison - brunners glands
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Complications of crohns
26. What is Trousseau's sign
Uridine glucuronyl transferase
CEA - CA-19-9
No
Redness and tenderness on palpation of extremities
27. What are the histological findings in the ileum
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28. malnutrition - toxic megacolon - colorectal carcinoma
IBS at least 2 with recurrent abdominal pain
Complications of UC
Centrilobular congestion and necrosis - cardiac cirrhosis
Nonkeritinized stratified sqamous epithelium
29. What are the ABCDEF of esophageal cancer
Downs
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Positive urease test
Early childhood - neuro sx and malabsorption
30. What receptor does histamine bind on the parietal cell and What does it activate
HSV-1 - CMV - Candida
H2 receptor - inc cAMP
Black - rotors syndrome
Hemosiderosis - hemochromatosis
31. Abuse of what substance leads to acute gastritis
EtOH
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
US and cholecystectomy
Mallory bodies
32. multiple juvenil polyps in GI tract - risk
Low pressure proximal to LES
Juvenile polyposis syndrome - inc risk of adenocarcinoma
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
33. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Boerhaave's Syndrome - Been heaving syndrome
Crohns = maybe - UC= always
Downs
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
34. Where and How is iron absorbed
Fe2+ in the duod
Can lead to hematemesis - found in EtOHics and bulimics
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Pleuroperitoneal
35. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Meckels
Downs
No - chronic - can present with diarrhea or constipation or alternation - treat sx
36. What is the triad of Plummer - Vinson syndrome
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Hypotonic because of more time to reabsorb NaCl
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Primarly through ECL leading to histamine release
37. What are the complications of duodenal PUD
Bleeding - penetration into pancreas - perforation - obstruction
Mallory bodies
L3
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
38. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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39. What does GET SMASHED stand for in acute pancreatitis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Conj - inc - dec
Alk phos
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
40. What reaction does salivary amylase catalyze
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Worldwide - SC - US - adeno
Failure of the processus vagainlis to close
41. What does loss of p53 cause
Increase tumorigenesis
Falciform - ligamentum teres - fetal umbilical vein
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Gastrohepatic ligament
42. What does primary sclerosing cholangitis lead to...
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Common hepatic - splenic - left gastric - main blood supply for stomach
Conj/unconj - inc - nl to dec
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
43. Where are peyers patches found
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Lamina propora and submucosa
Penicillinamine - AR inheritance
HSV-1 - CMV - Candida
44. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Gut bacteria
Black - rotors syndrome
Crohns = maybe - UC= always
Falciform - ligamentum teres - fetal umbilical vein
45. What is the ddx associated with appendicitis
90%
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
External (superficial) ring only
46. What does alpha amylase do and what inactivates it
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
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
Begins starch digestion - inactivated by low pH upon reaching the stomach
Pleuroperitoneal
47. What is the TX of physiologic neonatal jaundice
All 3 gut layers outpouch as in Meckels
L2
Phototherapy
Downs
48. Which serum enzyme increases with heavy EtOH consumption
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Gamma glutamyl transferase GGT
Via the superior pancreaticduodenal
Striated
49. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Unconjugated - water insoluble
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
50. What are the foregut structures and what supplies their blood and PANS innvervation
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Internal thoracic to superior epigastric to inferior epigastric
Short gastrics - left greater and lesser
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus