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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. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Gut bacteria
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Volvulus
2. What is the leading cause of bowel incarceration
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Femoral hernia
Appendicitis
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
3. Esophagitis can result From which 3 infectious agents - or chemical ingestion
HSV-1 - CMV - Candida
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Left and right gastroepiploics - left and right gastrics
Appendicitis
4. What is the frequency of basal electric rhythm in the duodenum
Myenteric nerve plexus - aurbach
12 waves/min
Where hindgut meets ectoderm
Reye's syndrome
5. What other condition can lead to acute gastritis - think renal
Hypotonic because of more time to reabsorb NaCl
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Uremia
VZV and influenza B treated with salicylates
6. What does high flow rate mean
Complications of UC
Closer to isotonic because of less time to reabsorb NaCl
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
GERD - may also present with nocturnal cough and dyspnea
7. blind pouch protruding from alimentary tract that communicates with lumen of the gut
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
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
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Diverticulum
8. Transmural esophageal rupture due to violent retching
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9. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Sphincter of oddi
Glucouronate - water soluble (direct)
Unconj - absent (acholuria) - inc
10. 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
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Jewish and African American men
T cell lymphoma
11. What is the ddx associated with appendicitis
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Alcoholic hepatitis
Right and left hepatic duct
12. What does histo show for alpha1 antitrypsin def
Gamma glutamyl transferase GGT
PAS- positive globules in liver -
Redundant mesentary
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
13. signet ring cells - acanthosis nigracans - dz - character/association - spread
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Inferior rectal nerve
Amylase
14. what kind of fistula is associated with diverticulitis
Colovesical leading to pneumaturia
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Dec PGE2 leading to dec gastric mucosa protection
Alcoholic hepatitis
15. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Ceruplasmin
Intussusception
Hepatic steatosis
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
16. What is the cause of Barrett's and the assocaited complications
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Stimulate the H/K ATPase
Small intestine
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
17. What does alpha amylase do and what inactivates it
Hypotonic because of more time to reabsorb NaCl
Glucouronate - water soluble (direct)
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Begins starch digestion - inactivated by low pH upon reaching the stomach
18. What serum enzyme is elevated inacute pancreatitis
Lipase
Punched out - clean margins - carcinoma =raised irregular margins
12 waves/min
Glucose dependent insulinotropic peptide
19. Autodigestion of pancreas by pancreatic enzymes
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Acute pancreatitis
20. What do tumors that arise in the head of the pancreas cause
Obstruction of the common bile duct
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Centrilobular leading to congestive liver disease
AST
21. A protrusion of peritoneum through an opening - usually a site of weakness
Dubin johnson
Chronic gastritis and pernicious anemia
Hernia
Cystic duct and common hepatic duct
22. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Hypotonic because of more time to reabsorb NaCl
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
Warthins' tumor
Left gastric vein and esophogeal vein - esophagus
23. What are the foregut structures and what supplies their blood and PANS innvervation
CCK8 receptor - Gq inc IP3/Ca
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Skip lesions =crohns - colon = UC
24. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Menetriers disease
Esophageal varices
The gastroduodenal
25. What does the splenorenal ligament connect - and What does it contain
Spleen to posterior abdominal wall - splenic artery and vein
GLUT 2
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Lactase is located at the tips of intestinal villi
26. What are the two molecular pathways that lead to CRC
ALT>AST
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Dermatitis herpetiformis
Low pressure proximal to LES
27. What reaction does salivary amylase catalyze
Urobilin
Primarly through ECL leading to histamine release
Lipase - phospholipase A - colipase
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
28. When and How does Abetalipoproteinemia present
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Where hindgut meets ectoderm
Liver metabolizes 5HT
Early childhood - neuro sx and malabsorption
29. 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
Tropical sprue
Lactase is located at the tips of intestinal villi
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Skip lesions =crohns - colon = UC
30. Malabsorption syndromes have what common clinical presentation
Elevated amylase - and lipase
Femoral hernia
Diarrhea - steatorrhea - weight loss - weakness
Hypotonic because of more time to reabsorb NaCl
31. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Female - fat - fertile - forty
So hypertrophied they look like brain gyri
32. If trypsin activates more trypsinogen - what kind of feedback loop is established
Centrilobular leading to congestive liver disease
Positive
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
Gallbladder
33. likely infectious form of malabsorption - responds to antibiotics
Tropical sprue
Zollinger ellison - brunners glands
Alk phos
Appendicitis
34. If the hemochromatosis is primary - What is the pattern of inheritance
Enterokinase/enteropeptidase from the duodenal mucosa
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Oral glucose
AR
35. What retroperitoneal structure flanks both sides of the pancreas on CT
Dissaccharidase def - most commonly lactase
H2 receptor - inc cAMP
Duodenum - 2nd - 3rd and 4th parts
Hernia
36. Cholecytsokinin - source - action - regulation
External (superficial) ring only
CEA - CA-19-9
NAV = nerve artery vein - venous near the penis (NAVEL)
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
37. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Dysphagia (due to esophageal web) - glossitis - iron def anemia
GERD - may also present with nocturnal cough and dyspnea
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
H pylori (almost 100%)
38. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
All 3
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Necrotizing enterocolitis
Hernia
39. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
40. In PUD - with gastric ulcers - does pain inc or dec with meals?
Inc - weight loss
Oral glucose
Smooth
Averages 6 months - very aggressive - usually already metastasized at presentation
41. What are the complications of chronic pancreatitis
Causes of gall stones
Inferior rectal nerve
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Smooth
42. What is the prognosis of adenocarcinoma
Averages 6 months - very aggressive - usually already metastasized at presentation
The jejunum
Angiodysplasia
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
43. What do you use to diagnose meckels
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Pertechnetate - study for uptake
The entire
Femoral hernia
44. trypsinogen is converted to trypsin via what enzyme
Old men - arthralgias - cardiac and neuro sx
Enterokinase/enteropeptidase from the duodenal mucosa
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Budd chiari syndrome
45. In an MI - which liver enzyme is elevated
Common hepatic - splenic - left gastric - main blood supply for stomach
Striated and smooth
AST
Barrett's esophagus
46. most common malignant salivary gland tumor
2ndary biliary cirrhosis
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Pleuroperitoneal
Mucoepidermoid carcinoma
47. How do NSAIDs cause acute gastritis
Duodenal atresia - Downs
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
ALT>AST
Dec PGE2 leading to dec gastric mucosa protection
48. What are the complications of duodenal PUD
Epigastric abdominal pain radiating to back - anorexia - nausea
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Inc smooth muscle relaxation - including lower esophageal sphincter
Bleeding - penetration into pancreas - perforation - obstruction
49. What structures feed into the common bile duct
Cystic duct and common hepatic duct
Volvulus
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Muscularis mucosae
50. How do villi appear in disaccharidease def
Can lead to hematemesis - found in EtOHics and bulimics
Normal
Liver metabolizes 5HT
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia