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Test your basic knowledge |
USMLE GI
Start Test
Study First
Subjects
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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. 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
Skip lesions =crohns - colon = UC
Stimulate the H/K ATPase
The entire
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
2. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
FAP
Can lead to hematemesis - found in EtOHics and bulimics
Pleomorphic adenoma
Causes of gall stones
3. Who gets gastric ulcers
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Lactase is located at the tips of intestinal villi
Older patients
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
4. somatostatin - source - action - regulation
Around the central vein (zone III)
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
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
5. What receptor does histamine bind on the parietal cell and What does it activate
T12
Krukenbergs tumor
H2 receptor - inc cAMP
Epithelium
6. What kind of anemia is in Wilsons
The entire
Hemolytic anemia
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Heme metabolism
7. What cells make pepsin - What does it do - and what regulates it
Neutralizes oral bacertial acids and maintains dental health
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
VZV and influenza B treated with salicylates
Duodenum - 2nd - 3rd and 4th parts
8. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Acute pancreatitis
Crohns = noncaseating granulomas - UC = crypt abscesses
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
9. What is the ddx associated with appendicitis
Crigler - najjar type 1
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Mucosa - submucosa - muscularis externa - serosa/adventitia
10. What kind of pancreatitis is associated with EtOH and smoking
Lactase is located at the tips of intestinal villi
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Positive urease test
Hepatic steatosis
11. Liver cell failure can lead to multisystem signs including
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Mucosa - submucosa - muscularis externa - serosa/adventitia
Gut bacteria
12. What is the risk with peutz jehgers
Inc risk of CRC and other visceral malignancies
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Superior rectal and middle and inferior rectal - rectum
Hirschsprungs
13. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Below
Fe2+ in the duod
Duodenal atresia - Downs
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
14. What are the branches of the celiac trunk and What do they supply
Alpha amylase
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Phenobarbital - inc liver enzyme synthesis
Common hepatic - splenic - left gastric - main blood supply for stomach
15. What kind of cancer to celiac sprue put you as inc risk for
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
T cell lymphoma
Epithelium
Gastric glands
16. What is the arterial supply and venous drainage below pectinate line
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Hemosiderosis - hemochromatosis
Cirrhosis
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
17. What cell produces IF and What does it do
Sphincter of oddi
AST
Elevated amylase - and lipase
Parietal cells in the stomach - B12 binding protein
18. What commonly leads to appendicity in kids vs adults
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
M3 - Gq - inc IP3/Ca
Bleeding - penetration into pancreas - perforation - obstruction
Colovesical leading to pneumaturia
19. What are the histological findings in the duodenum
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20. Where are oligosaccharide hydrolases and What do they do
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Worldwide - SC - US - adeno
Brush border of intestine - produce monosaccharides from oligo and di
Obstruction of the common bile duct
21. In what clinical scenarior do you see portosystemic anastomoses
Duodenal atresia - Downs
Portal HTN
Ampulla of vater
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
22. What serum markers increase in cholecystitis with bile duct involvement
Alk phos
HSV-1 - CMV - Candida
Backup of blood into the liver - RHF - budd chiari
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
23. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Centrilobular leading to congestive liver disease
CCK8 receptor - Gq inc IP3/Ca
24. To what substance is bilirubin conjugated and why
Glucouronate - water soluble (direct)
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Cystic dilation of the viteline duct
Lack or have an attenuated muscularis externa - often in the sigmoid colon
25. Where does type B chronic gastritis occur and What causes it
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Antrum - H.pylori - inc risk of MALT lymphoma
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Hemosiderosis - hemochromatosis
26. most common non - neoplastic polyp in colon
Poor anastamoses
Hyperplastic
Gallbladder
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
27. What is the classic triad of hemochromatosis
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28. What causes hirschsprungs
Failure of neural crest migration
Pleomorphic adenoma
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Diverticulitis in elderly - ectopic pregs use hCG to rule out
29. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
The submucosal nerve plexus - meissner's
Alpha amylase
Volvulus
Closer to isotonic because of less time to reabsorb NaCl
30. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Esophageal varices
Celiac sprue
Juvenille polyps - no risk if single
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
31. How are all 3 monosaccharides transported to the blood
External spermatic fascia only
T12
GLUT 2
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
32. What does TOASTED with alcoholic hepatitis stand for
Elevated amylase - and lipase
Hemolytic anemia
AST >ALT - ration is usually 1.5
Volvulus
33. How do villi appear in disaccharidease def
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Acute pancreatitis
Normal
34. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Inc smooth muscle relaxation - including lower esophageal sphincter
Hepatic steatosis
Mallory bodies
Muscularis mucosae
35. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Unconj - absent (acholuria) - inc
Erosive - disruption of mucosal barrier leading to inflammation
36. What is the main symptom if a VIPoma
CCK8 receptor - Gq inc IP3/Ca
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Hypotonic because of more time to reabsorb NaCl
Cholesterol - 10-20% opaque due to calcifications
37. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Can lead to hematemesis - found in EtOHics and bulimics
VZV and influenza B treated with salicylates
Portal HTN
Zenkers - halitosis - dysphagia and obstruction
38. What reaction does salivary amylase catalyze
H+
Hypercoaguability - polycythemia vera - pregnancy - HCC
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
39. What is the characteristic histo finding in alcoholic hepatitis
Peyers patches
AST
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
Mallory bodies
40. What factors increase risk of malignancy of adenomatous polyps
Neural muscarinic pathways
Stimulate the H/K ATPase
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
41. What converts inactive pepsinogen to pepsin
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Averages 6 months - very aggressive - usually already metastasized at presentation
Carcinoid syndrome
H+
42. In viral hepatitis - which liver enzyme is higher
ALT>AST
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
Fasting and stress
With albumin
43. What is the TX of physiologic neonatal jaundice
In the mucus that covers the gastric epithelium
Cimetidine
Phototherapy
Hypotonic because of more time to reabsorb NaCl
44. What are the common causes of gastric ulcers - What causes gastric ulcer
In the mucus that covers the gastric epithelium
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Trypsin - chymotrypsin - elastase - carboxypeptidases
45. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Gardner's syndrome
Cystic duct and common hepatic duct
Alcoholic cirrhosis
46. What are the labs in acute pancreatitis
Unconjugated - water insoluble
Elevated amylase - and lipase
Small intestine
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
47. With caput medusaw - between what vessels is the anastomoses and Where is it
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Uremia
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Paraumbilical and superficial and inferior epigastric - umbilicus
48. Bile is critical for exrection of what substance
Ceruplasmin
Intussusception
Cholesterol
Peyers patches
49. What is the action of NO as a GI hormone
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
With albumin
Achalasia due to loss of myenteric plexus (auberach)
50. Through which aspect of the inguinal canal does a direct inguinal go
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Virchow's node
External (superficial) ring only
Unconjugated - water insoluble