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Test your basic knowledge |
USMLE GI
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Subjects
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health-sciences
,
usmle
Instructions:
Answer 50 questions in 15 minutes.
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study here
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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 presentation of pancreatic adenocarcinoma
Worldwide - SC - US - adeno
Nonkeritinized stratified sqamous epithelium
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Striated and smooth
2. Who gets Whipple disease and How do they present
Crigler - najjar type 1
Liver metabolizes 5HT
Old men - arthralgias - cardiac and neuro sx
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
3. How does CRC present in the distal and proximal colon
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
90%
Carcinoid syndrome
Oligosaccharide digestion
4. What is one potential precipitating factor for intussusception
Crigler - najjar type 1
Primary sclerosing cholangitis
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
5. What are the extraintestinal manifestations of crohns
Cystic duct and common hepatic duct
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Lipase
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
6. What skin condition is associated with celiac sprue
Around the central vein (zone III)
Hypercoaguability - polycythemia vera - pregnancy - HCC
Primarly through ECL leading to histamine release
Dermatitis herpetiformis
7. Where is B12 absorbed
Serous on the sides parotids - mucinous in the middle sublingual
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
In the ileum with bile acids - requires IF
Can lead to hematemesis - found in EtOHics and bulimics
8. At what level do the testicular/ovarian arteries exit the aorta
L2
External (superficial) ring only
Crohns = maybe - UC= always
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
9. Where are oligosaccharide hydrolases and What do they do
Positive urease test
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Brush border of intestine - produce monosaccharides from oligo and di
Complications of crohns
10. Who is at risk for pancreatic adenocarcinoma
Jewish and African American men
Liver metabolizes 5HT
Muscularis mucosae
Unconjugated - water insoluble
11. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue
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12. How is the diagonsis of CRC made
Jewish and African American men
Phototherapy
8-9 waves/min
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
13. Where does an indirect inguinal hernia enter the deep inguinal ring
Lateral to the inferior epigastric artery
Repeated phlebotomy - deferoxamine - HLA- A3
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Gardner's syndrome
14. With caput medusaw - between what vessels is the anastomoses and Where is it
Paraumbilical and superficial and inferior epigastric - umbilicus
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Bleeding - intussusception - volvulus - obstruction near terminal ileum
15. in budd chiari syndrome - Where is the congestion and necrosis
T cell lymphoma
Punched out - clean margins - carcinoma =raised irregular margins
Meckels
Centrilobular leading to congestive liver disease
16. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Alcoholic cirrhosis
Goes through deep inguinal ring - external inguinal ring and into the scrotum
17. is meckels a true diverticulum and how common is it
Dense core bodies
Lye ingestion and acid reflux
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
True and most common congenital anomoly of GI tract
18. Scleroderma is associated with what kind of esophageal dysmotility
Lipase - phospholipase A - colipase
Low pressure proximal to LES
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Lamina propria
19. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Cystic duct and common hepatic duct
Uremia
Conj - inc - dec
20. What is the cause of Barrett's and the assocaited complications
Enterokinase/enteropeptidase from the duodenal mucosa
Positive
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Alcoholic hepatitis
21. What is the lumen of the pancreatic duct
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Ampulla of vater
GERD - may also present with nocturnal cough and dyspnea
22. What are the complications of Meckels
Necrotizing enterocolitis
Right and left hepatic duct
In the ileum with bile acids - requires IF
Bleeding - intussusception - volvulus - obstruction near terminal ileum
23. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Cholesterol - 10-20% opaque due to calcifications
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
FAP
Pyoderma gangrenosum - primary sclerosing cholangitis
24. What parts of the small bowel can tropical sprue effect
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
The entire
25. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Via the middle colic
Unconj - absent (acholuria) - inc
Backup of blood into the liver - RHF - budd chiari
Warthins' tumor
26. What enzyme is necessary to create conjugated bilirubin
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Primarly through ECL leading to histamine release
CHF and inc risk of HCC
Uridine glucuronyl transferase
27. What are the structures of the femoral triangle and how are they organized
Unconjugated - water insoluble
NAV = nerve artery vein - venous near the penis (NAVEL)
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Juvenile polyposis syndrome - inc risk of adenocarcinoma
28. When and How does Abetalipoproteinemia present
Early childhood - neuro sx and malabsorption
Cimetidine
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Old men - arthralgias - cardiac and neuro sx
29. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Portal HTN
Hypercoaguability - polycythemia vera - pregnancy - HCC
AST
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
30. somatostatin - source - action - regulation
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
Decrease - weight gain
Downs
Terminal ileum and colon
31. How do villi appear in disaccharidease def
Omeprazole
Normal
Acute pancreatitis
Inguninal ligament - sartorius muscle - adductor longus
32. What kind of insults results in macronodular cirrhosis
Obstruction of the common bile duct
ALT>AST
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Alk pho
33. What is the most common cause of gallstones
The gastroduodenal
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Lipase - phospholipase A - colipase
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
34. What transforms conjugated bilirubin to urobilinogen
H2 receptor - inc cAMP
Pyoderma gangrenosum - primary sclerosing cholangitis
Gut bacteria
Urobilin
35. What causes pancreatic insuff and What does it cause
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Tropical sprue
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
36. Where does type A chronic gastritis occur and What causes it
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
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Crohns = noncaseating granulomas - UC = crypt abscesses
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
37. What cells make pepsin - What does it do - and what regulates it
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Dec PGE2 leading to dec gastric mucosa protection
Uridine glucuronyl transferase
Lactase is located at the tips of intestinal villi
38. What is the most common esophageal cancer worldwide and in the US
Worldwide - SC - US - adeno
Glucouronate - water soluble (direct)
Smooth
Chagas disease
39. What are the signs of peutz jehgers
Boerhaave's Syndrome - Been heaving syndrome
Duodenum - 2nd - 3rd and 4th parts
Hyperpigmented mouth - lips - hands - genitalia
Gamma glutamyl transferase GGT
40. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Unconjugated - water insoluble
Zollinger Ellison - phenylalanine and tryptophan
L1
41. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
T cell lymphoma
Peptic ulcer disease
Colonic polyps
Gut bacteria
42. What findings are associated with reyes
AST
Serous on the sides parotids - mucinous in the middle sublingual
Oligosaccharide digestion
Mitochondrial abnl - fatty liver - hypoglycemia - coma
43. What does TOASTED with alcoholic hepatitis stand for
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
AST >ALT - ration is usually 1.5
Failure of neural crest migration
Alcoholic cirrhosis
44. In an MI - which liver enzyme is elevated
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
External (superficial) ring only
AST
Spleen to posterior abdominal wall - splenic artery and vein
45. What receptor does histamine bind on the parietal cell and What does it activate
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
The jejunum
H2 receptor - inc cAMP
Neutralizes gastric acid allowing pancreatic enzymes to fxn
46. bilateral mets to ovaries with abundant mucus - signet ring cells
IgA secreting plasma cells - ultimately reside in the lamina proporia
Inc lower esphogeal tone leading to achalasia
Zollinger ellison - brunners glands
Krukenbergs tumor
47. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Fe2+ in the duod
Cholesterol - 10-20% opaque due to calcifications
Peutz jeghers
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
48. What is the characteristic histo finding in alcoholic hepatitis
GERD - may also present with nocturnal cough and dyspnea
Pertechnetate - study for uptake
Complications of UC
Mallory bodies
49. malnutrition - toxic megacolon - colorectal carcinoma
Neutralizes oral bacertial acids and maintains dental health
Virchow's node
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Complications of UC
50. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Gilbert's
No
HPNCC
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
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