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Test your basic knowledge |
USMLE GI
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Subjects
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health-sciences
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usmle
Instructions:
Answer 50 questions in 15 minutes.
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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. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
VZV and influenza B treated with salicylates
All 3
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
2. What does TOASTED with alcoholic hepatitis stand for
AST >ALT - ration is usually 1.5
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Backup of blood into the liver - RHF - budd chiari
H2 receptor - inc cAMP
3. likely infectious form of malabsorption - responds to antibiotics
US and cholecystectomy
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Inc smooth muscle relaxation - including lower esophageal sphincter
Tropical sprue
4. What are the histological findings in the ileum
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5. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Alk pho
GERD - may also present with nocturnal cough and dyspnea
Volvulus
6. What is the path of an indirect inguinal hernia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
H pylori (almost 100%)
Left and right gastroepiploics - left and right gastrics
AST
7. What is the leading cause of bowel incarceration
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Femoral hernia
Barrett's esophagus
Downs
8. What are the treatment options for uclerative colitis
Cigarettes and chronic pancreatitis - not EtOH
Superior rectal
Duodenum - 2nd - 3rd and 4th parts
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
9. What is the most important mechanism in gastric acid secretion
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Inc lower esphogeal tone leading to achalasia
External spermatic fascia only
Left gastric vein and esophogeal vein - esophagus
10. How do NSAIDs cause acute gastritis
PAS- positive globules in liver -
Superior rectal
Mucosa - submucosa - muscularis externa - serosa/adventitia
Dec PGE2 leading to dec gastric mucosa protection
11. What are the four Fs of gallstones
Common hepatic - splenic - left gastric - main blood supply for stomach
Female - fat - fertile - forty
Redundant mesentary
AST
12. What does primary sclerosing cholangitis lead to...
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Squamous - upper 1/3 - adeno - lower 1/3
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Bleeding - penetration into pancreas - perforation - obstruction
13. What complication can arise from indirect inguinal hernias
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Hydrocele
The submucosal nerve plexus - meissner's
Penicillinamine - AR inheritance
14. What is the clinical presentation of acute pancreatitis
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
L1
Jewish and African American men
Epigastric abdominal pain radiating to back - anorexia - nausea
15. What are the two molecular pathways that lead to CRC
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
H2 receptor - inc cAMP
MSI (15%) and APC/beta catenin chromosomal instability (85%)
16. What happens to the short gastics if the splenic artery is blocked
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Poor anastamoses
IBS at least 2 with recurrent abdominal pain
Primarly through ECL leading to histamine release
17. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Hemolytic anemia
Hemosiderosis - hemochromatosis
Upregulated intracellular signal transduction
18. What is the risk with peutz jehgers
Conj - inc - dec
Inc risk of CRC and other visceral malignancies
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Complications of crohns
19. What kind of pathways do CCK act on to cause pancreatic secretion
Reye's syndrome
Bleeding - penetration into pancreas - perforation - obstruction
Penicillinamine - AR inheritance
Neural muscarinic pathways
20. What are the ABCDEF of esophageal cancer
Common hepatic - splenic - left gastric - main blood supply for stomach
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Punched out - clean margins - carcinoma =raised irregular margins
Epithelium
21. How is bilirubin carried in the blood
Achalasia due to loss of myenteric plexus (auberach)
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
With albumin
Crohns = maybe - UC= always
22. What transforms conjugated bilirubin to urobilinogen
Increase tumorigenesis
Gut bacteria
Turcot
AST >ALT - ration is usually 1.5
23. If the abdominal aorta is blocked - How does blood get to the left colic artery
Where hindgut meets ectoderm
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Via the middle colic
Cimetidine
24. What are the histological findings of the colon
Low pressure proximal to LES
Crypts but not villi
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Smooth
25. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Hemosiderosis - hemochromatosis
Causes of gall stones
HSV-1 - CMV - Candida
Unconj - absent (acholuria) - inc
26. Who is at risk for pancreatic adenocarcinoma
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Jewish and African American men
27. Which IBD is autoimmune and which may be a disordered response to bacteria
Dec PGE2 leading to dec gastric mucosa protection
Neutralizes oral bacertial acids and maintains dental health
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Spleen to posterior abdominal wall - splenic artery and vein
28. What kind of muscle is in the middle 1/3 of esophagus
Striated and smooth
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Trypsin - chymotrypsin - elastase - carboxypeptidases
29. What is the most common cause of gallstones
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Right and left hepatic duct
Epigastric abdominal pain radiating to back - anorexia - nausea
2ndary biliary cirrhosis
30. What drug blocks the H2R
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Cimetidine
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
Virchow's node
31. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Angiodysplasia
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
32. What does loss of APC cause
Crohns = maybe - UC= always
Decreased intercellular adhesion and increased proliferation
NAV = nerve artery vein - venous near the penis (NAVEL)
Necrotizing enterocolitis
33. What are causes of extrahepatic biliary obstruction
Alpha1 antitrypsin def - codominant trait
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Older patients
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
34. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Ceruplasmin
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Can lead to hematemesis - found in EtOHics and bulimics
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
35. What is contained within the muscularis externa
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Hemosiderosis - hemochromatosis
Myenteric nerve plexus - aurbach
Conj - inc - dec
36. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Lye ingestion and acid reflux
Hydrocele
Esophageal varices
37. What pancreatic proteases are secreted as zymogens
Pancreatic head causing obstructive jaundice
The gastroduodenal
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Trypsin - chymotrypsin - elastase - carboxypeptidases
38. Where and How is iron absorbed
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Spleen to posterior abdominal wall - splenic artery and vein
Fe2+ in the duod
39. Where is IgA shuttled
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Osmotic
Dubin johnson
40. What test and result confirms H pylori infxn
Positive urease test
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Urobilin
PAS- positive globules in liver -
41. What are the signs and symptoms of budd chiari
FAP
Lamina propora and submucosa
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Conj - inc - dec
42. What are the complications of acute pancreatitis
Inc conj bilirubin - inc cholesterol - inc alk phos
Pancreatic head causing obstructive jaundice
Appendicitis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
43. What gives urine its characteristic color
Urobilin
Above
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
Stimulate intestinal persistalsis
44. What receptor does histamine bind on the parietal cell and What does it activate
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
M3 - Gq - inc IP3/Ca
H2 receptor - inc cAMP
H+
45. Between what structures do strong anastamoses exist
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
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
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
Left and right gastroepiploics - left and right gastrics
46. What findings are associated with reyes
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
47. What is the main symptom if a VIPoma
Left gastric vein and esophogeal vein - esophagus
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Copious diarrhea - non alpha - non beta cell pancreatic tumor
H+
48. What source of salivary secretion is the most serous and What is the most mucinous
8-9 waves/min
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Serous on the sides parotids - mucinous in the middle sublingual
Hirschsprungs
49. What kind of insults results in macronodular cirrhosis
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Colovesical leading to pneumaturia
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
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
50. Where are oligosaccharide hydrolases and What do they do
Brush border of intestine - produce monosaccharides from oligo and di
Redundant mesentary
L4
H+
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