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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. Gastrin - source - action - regulation
Dissaccharidase def - most commonly lactase
Skip lesions =crohns - colon = UC
Reye's syndrome
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
2. In PUD - with gastric ulcers - does pain inc or dec with meals?
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Small intestine
Inc - weight loss
The gastroduodenal
3. A protrusion of peritoneum through an opening - usually a site of weakness
Juvenille polyps - no risk if single
Hernia
Esophageal cancer
Punched out - clean margins - carcinoma =raised irregular margins
4. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Intussusception
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Crohns = noncaseating granulomas - UC = crypt abscesses
Lateral
5. In an MI - which liver enzyme is elevated
Achalasia due to loss of myenteric plexus (auberach)
Female - fat - fertile - forty
AST
L4
6. What is the path of an indirect inguinal hernia
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
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Spleen to posterior abdominal wall - splenic artery and vein
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
7. What transforms conjugated bilirubin to urobilinogen
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Gut bacteria
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
8. What are motilin receptor agonists used for clinically
Cigarettes and chronic pancreatitis - not EtOH
Alcoholic cirrhosis
Stimulate intestinal persistalsis
H+
9. What are the hindgut structures and what supplies their blood and PANS innvervation
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Volvulus
Positive urease test
10. What cells secrete bicarb - What does it do - and what regulates it
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Can lead to hematemesis - found in EtOHics and bulimics
Chagas disease
11. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Internal thoracic to superior epigastric to inferior epigastric
Zollinger Ellison - phenylalanine and tryptophan
12. What is the prognosis of adenocarcinoma
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Early childhood - neuro sx and malabsorption
Averages 6 months - very aggressive - usually already metastasized at presentation
CHF and inc risk of HCC
13. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Elevated amylase - and lipase
Alcoholic hepatitis
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
14. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Black - rotors syndrome
Dense core bodies
Superior rectal
Epithelium
15. What kind of lesions are characteristic of duodenal PUD vs cancer
Lamina propora and submucosa
Punched out - clean margins - carcinoma =raised irregular margins
Meconium ileus
Serous on the sides parotids - mucinous in the middle sublingual
16. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Antrum - H.pylori - inc risk of MALT lymphoma
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Inc - weight loss
Cirrhosis
17. How are all 3 monosaccharides transported to the blood
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
GLUT 2
Epithelium
Short gastrics - left greater and lesser
18. What kind of muscle is in the lower 1/3 of the esophagus
Lateral
Glucose dependent insulinotropic peptide
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Smooth
19. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Lateral to the inferior epigastric artery
Decreased intercellular adhesion and increased proliferation
Diarrhea - steatorrhea - weight loss - weakness
Esophageal varices
20. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Peptic ulcer disease
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Hirschsprungs
Carcinoid syndrome
21. What is the most common esophageal cancer worldwide and in the US
Can lead to hematemesis - found in EtOHics and bulimics
Worldwide - SC - US - adeno
Hypercoaguability - polycythemia vera - pregnancy - HCC
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
22. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Squamous - upper 1/3 - adeno - lower 1/3
Via the middle colic
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
23. Where is the pectinate line
Hepatic steatosis
Where hindgut meets ectoderm
Backup of blood into the liver - RHF - budd chiari
Falciform - ligamentum teres - fetal umbilical vein
24. FAP + malignant CNS tumor
Turcot
Redness and tenderness on palpation of extremities
Portal HTN
Lack or have an attenuated muscularis externa - often in the sigmoid colon
25. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Peyers patches
Meckels
US and cholecystectomy
Via the superior pancreaticduodenal
26. What are the midgut structures and what supplies their blood and PANS innervation
Alcoholic hepatitis
Conj/unconj - inc - nl to dec
So hypertrophied they look like brain gyri
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
27. Where are carcinoid tumors most commonly malignant
Causes of gall stones
Worldwide - SC - US - adeno
NAV = nerve artery vein - venous near the penis (NAVEL)
Small intestine
28. What pancreatic enzymes are responsible for fat digestion
Primarly through ECL leading to histamine release
Colovesical leading to pneumaturia
GERD - may also present with nocturnal cough and dyspnea
Lipase - phospholipase A - colipase
29. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Alpha amylase
GLUT 2
12 waves/min
Zollinger ellison - brunners glands
30. Who is at risk for pancreatic adenocarcinoma
Worldwide - SC - US - adeno
Jewish and African American men
Trypsin - chymotrypsin - elastase - carboxypeptidases
Where hindgut meets ectoderm
31. What are the complications of acute pancreatitis
Hernia
Around the central vein (zone III)
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Hemosiderosis - hemochromatosis
32. When and How does Abetalipoproteinemia present
Punched out - clean margins - carcinoma =raised irregular margins
Femoral hernia
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Early childhood - neuro sx and malabsorption
33. Where are peyers patches found
Redundant mesentary
Lamina propora and submucosa
Dermatitis herpetiformis
Neutralizes gastric acid allowing pancreatic enzymes to fxn
34. How do you DX and TX gallstones
...
Mitochondrial abnl - fatty liver - hypoglycemia - coma
US and cholecystectomy
Glucouronate - water soluble (direct)
35. What are the signs and symptoms of budd chiari
Superior rectal
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
36. What are the extraintestinal manifestations of crohns
NAV = nerve artery vein - venous near the penis (NAVEL)
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Left gastric vein and esophogeal vein - esophagus
ALT>AST
37. What is the action of NO as a GI hormone
Colovesical leading to pneumaturia
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Inc smooth muscle relaxation - including lower esophageal sphincter
Failure of neural crest migration
38. What are the tumor markers for pancreatic adenocarcinoma
Omeprazole
CEA - CA-19-9
2ndary biliary cirrhosis
Redundant mesentary
39. Malabsorption syndromes have what common clinical presentation
Falciform - ligamentum teres - fetal umbilical vein
Diarrhea - steatorrhea - weight loss - weakness
Hernia
EtOH
40. What is the main symptom if a VIPoma
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Meconium ileus
FAP
41. Transmural esophageal rupture due to violent retching
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42. What does loss of p53 cause
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Dissaccharidase def - most commonly lactase
Increase tumorigenesis
Cigarettes and chronic pancreatitis - not EtOH
43. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Failure of the processus vagainlis to close
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
44. Liver cell failure can lead to multisystem signs including
Volvulus
Inc lower esphogeal tone leading to achalasia
Necrotizing enterocolitis
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
45. What do you use to diagnose meckels
Ischemic colitis
Hypercoaguability - polycythemia vera - pregnancy - HCC
Zollinger ellison - brunners glands
Pertechnetate - study for uptake
46. Why does indirect inguinal hernia happen in infacnts
Acute pancreatitis
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Failure of the processus vagainlis to close
Paraumbilical and superficial and inferior epigastric - umbilicus
47. How is bilirubin carried in the blood
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
With albumin
AR
NAV = nerve artery vein - venous near the penis (NAVEL)
48. 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
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
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
CCK8 receptor - Gq inc IP3/Ca
49. Cholecytsokinin - source - action - regulation
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
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Skip lesions =crohns - colon = UC
Juvenille polyps - no risk if single
50. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
FAP
Esophageal varices
In the ileum with bile acids - requires IF
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus