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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 kind of cancer to celiac sprue put you as inc risk for
External (superficial) ring only
T cell lymphoma
Ampulla of vater
3 waves/min
2. malnutrition - toxic megacolon - colorectal carcinoma
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Complications of UC
Portal HTN
The jejunum
3. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Lipase - phospholipase A - colipase
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Inferior rectal nerve
4. What histological findings are present in the stomach
All 3 gut layers outpouch as in Meckels
2ndary biliary cirrhosis
Crohns = noncaseating granulomas - UC = crypt abscesses
Gastric glands
5. Where is IgA shuttled
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Hypotonic because of more time to reabsorb NaCl
Unconjugated - water insoluble
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
6. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Squamous - upper 1/3 - adeno - lower 1/3
Inc risk of CRC and other visceral malignancies
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
7. What serum markers increase in cholecystitis with bile duct involvement
Alk phos
Esophageal cancer
Brush border of intestine - produce monosaccharides from oligo and di
Inc risk of CRC and other visceral malignancies
8. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Sphincter of oddi
Omeprazole
Hemosiderosis - hemochromatosis
Can lead to hematemesis - found in EtOHics and bulimics
9. What are the signs and symptoms of budd chiari
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Femoral hernia
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Epigastric abdominal pain radiating to back - anorexia - nausea
10. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Hyperplastic
Nonkeritinized stratified sqamous epithelium
Brush border of intestine - produce monosaccharides from oligo and di
11. What can fistula between the gallbladder and small intestine create and how can you tell
Above
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Can lead to hematemesis - found in EtOHics and bulimics
Neural muscarinic pathways
12. what percentage of colonic polyps are non - neoplastic
Penicillinamine - AR inheritance
L4
90%
Inguninal ligament - sartorius muscle - adductor longus
13. Where is folate absorbed
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
The jejunum
AST >ALT - ration is usually 1.5
14. Where does type B chronic gastritis occur and What causes it
Via the superior pancreaticduodenal
Antrum - H.pylori - inc risk of MALT lymphoma
...
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
15. What gives stool its characteristic color
Left and right gastroepiploics - left and right gastrics
Juvenille polyps - no risk if single
L2
Stercobilin
16. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Amylase
Punched out - clean margins - carcinoma =raised irregular margins
Older patients
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
17. How do you DX and TX gallstones
Menetriers disease
Appendicitis
US and cholecystectomy
Pleuroperitoneal
18. When and How does Abetalipoproteinemia present
Common hepatic - splenic - left gastric - main blood supply for stomach
Early childhood - neuro sx and malabsorption
8-9 waves/min
Hypotonic because of more time to reabsorb NaCl
19. In alchoholic hepatitis which liver enzyme is higher
AST>ALT
Primarly through ECL leading to histamine release
No - chronic - can present with diarrhea or constipation or alternation - treat sx
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
20. What parts of the small bowel can tropical sprue effect
The entire
Crigler - najjar type 1
Gamma glutamyl transferase GGT
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
21. What are the midgut structures and what supplies their blood and PANS innervation
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
22. What receptors does ACH bind on the parietal cells and What does it activate
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Alpha amylase
M3 - Gq - inc IP3/Ca
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
23. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Superior rectal
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Above
AST
24. How does CRC present in the distal and proximal colon
Chronic gastritis and pernicious anemia
Brush border of intestine - produce monosaccharides from oligo and di
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Myenteric nerve plexus - aurbach
25. What is the clinical presentation of acute pancreatitis
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Epigastric abdominal pain radiating to back - anorexia - nausea
Fasting and stress
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
26. What is the TX of physiologic neonatal jaundice
Esophageal varices
Phototherapy
Striated
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
27. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
HPNCC
Fasting and stress
Complications of UC
Obstruction of the common bile duct
28. Dysphagia in achalasia results from
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Internal thoracic to superior epigastric to inferior epigastric
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Positive
29. What are the borders of Hesselbach's triangle
Lubricate food (glycoprotiens)
Backup of blood into the liver - RHF - budd chiari
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Appendicitis
30. What are the complications of Meckels
Peyers patches
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Bleeding - intussusception - volvulus - obstruction near terminal ileum
No - chronic - can present with diarrhea or constipation or alternation - treat sx
31. Who gets gastric ulcers
Phototherapy
Chronic gastritis and pernicious anemia
Primarly through ECL leading to histamine release
Older patients
32. Bile is critical for exrection of what substance
Low pressure proximal to LES
Cholesterol
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Enterokinase/enteropeptidase from the duodenal mucosa
33. What are the treatment options for uclerative colitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Muscularis mucosae
Alpha amylase
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
34. concentric onion skin bile duct fibrosis
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Inguninal ligament - sartorius muscle - adductor longus
Primary sclerosing cholangitis
Below
35. What layer in the mucosa is responsible for support
HPNCC
Uridine glucuronyl transferase
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Lamina propria
36. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
AR
Skip lesions =crohns - colon = UC
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Antrum - H.pylori - inc risk of MALT lymphoma
37. With caput medusaw - between what vessels is the anastomoses and Where is it
H pylori (almost 100%)
Paraumbilical and superficial and inferior epigastric - umbilicus
No
AST>ALT
38. What are esophageal strictures associated with
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
US and cholecystectomy
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Lye ingestion and acid reflux
39. What are the barium swallow findings of achalasia
Zollinger Ellison - phenylalanine and tryptophan
Epithelium
Dilated esophagus with an area of distal stenosis - birds beak
Menetriers disease
40. What is Trousseau's sign
With albumin
Redness and tenderness on palpation of extremities
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
41. What is the action of NO as a GI hormone
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Inc smooth muscle relaxation - including lower esophageal sphincter
Warthins' tumor
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
42. likely infectious form of malabsorption - responds to antibiotics
Tropical sprue
Downs
Peutz jeghers
Conj/unconj - inc - nl to dec
43. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
GLUT 2
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
FAP
44. In an MI - which liver enzyme is elevated
AST
Uremia
The jejunum
Glucouronate - water soluble (direct)
45. What type of insults result in micronodular cirrhosis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Zenkers - halitosis - dysphagia and obstruction
Cholesterol - 10-20% opaque due to calcifications
46. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Inc conj bilirubin - inc cholesterol - inc alk phos
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Meckels
Complications of UC
47. What are the four Fs of gallstones
Can lead to hematemesis - found in EtOHics and bulimics
Fasting and stress
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Female - fat - fertile - forty
48. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Hernia
Peutz jeghers
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Warthins' tumor
49. What is the most important mechanism in gastric acid secretion
The proximal small bowel
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
12 waves/min
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
50. What transforms conjugated bilirubin to urobilinogen
Esophageal carcinoma
Via the middle colic
Gut bacteria
Female - fat - fertile - forty