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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. What is the risk with peutz jehgers
Common hepatic - splenic - left gastric - main blood supply for stomach
Chagas disease
Inc risk of CRC and other visceral malignancies
Meconium ileus
2. What is contained in the gastrosplenic and What areas does it separate
Worldwide - SC - US - adeno
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Short gastrics - left greater and lesser
Inc smooth muscle relaxation - including lower esophageal sphincter
3. What infection causes Whipple disease and What can you see on LM
Barrett's esophagus
PAS- positive globules in liver -
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Duodenum - 2nd - 3rd and 4th parts
4. What kind of muscle is in the lower 1/3 of the esophagus
Smooth
M3 - Gq - inc IP3/Ca
Cystic duct and common hepatic duct
Mallory bodies
5. What are the histological findings of the colon
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Crypts but not villi
AST>ALT
Cholesterol - 10-20% opaque due to calcifications
6. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Old men - arthralgias - cardiac and neuro sx
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
7. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Esophageal cancer
Oral glucose
Ischemic colitis
8. What transforms conjugated bilirubin to urobilinogen
Punched out - clean margins - carcinoma =raised irregular margins
Hernia
Gut bacteria
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
9. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Hirschsprungs
Peutz jeghers
Antrum - H.pylori - inc risk of MALT lymphoma
T12
10. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
So hypertrophied they look like brain gyri
Zollinger Ellison - phenylalanine and tryptophan
Duodenal atresia - Downs
11. What does GET SMASHED stand for in acute pancreatitis
Sphincter of oddi
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Crigler - najjar type 1
Diverticulum
12. With internal hemorrhoids Where is the anastomoses and Where is it
External spermatic fascia only
Superior rectal and middle and inferior rectal - rectum
In the ileum with bile acids - requires IF
Parietal cells in the stomach - B12 binding protein
13. What are the effects of atropine on parietal cells and G cells
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
Gastric glands
14. How does hirschsprung present and appear on imaging
Chronic constipation early in life with dilated portion of the colon proximal to the aganglionic segment resulting in a transition zone - involves rectum - usually a failure to pass meconium
Colovesical leading to pneumaturia
Mucoepidermoid carcinoma
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
15. Where and How is iron absorbed
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Fe2+ in the duod
Centrilobular congestion and necrosis - cardiac cirrhosis
Epithelium
16. What does the splenorenal ligament connect - and What does it contain
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Epithelium
Spleen to posterior abdominal wall - splenic artery and vein
17. What is diverticulosis
Osmotic
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Hyperpigmented mouth - lips - hands - genitalia
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
18. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Colonic polyps
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Cimetidine
Parietal cells in the stomach - B12 binding protein
19. blind pouch protruding from alimentary tract that communicates with lumen of the gut
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Redundant mesentary
Diverticulum
The proximal small bowel
20. What does alpha amylase do and what inactivates it
Begins starch digestion - inactivated by low pH upon reaching the stomach
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
M3 - Gq - inc IP3/Ca
The jejunum
21. What other condition can lead to acute gastritis - think renal
T12
Uremia
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
22. Which serum enzyme increases with heavy EtOH consumption
Positive
Falciform - ligamentum teres - fetal umbilical vein
Gamma glutamyl transferase GGT
Primarly through ECL leading to histamine release
23. What kind of insults results in macronodular cirrhosis
AR
Left gastric vein and esophogeal vein - esophagus
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Peutz jeghers
24. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Neural muscarinic pathways
Duodenal atresia - Downs
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
25. What are the two molecular pathways that lead to CRC
H2 receptor - inc cAMP
Hernia
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
MSI (15%) and APC/beta catenin chromosomal instability (85%)
26. What does high flow rate mean
Small intestine
Stimulate the H/K ATPase
Dec PGE2 leading to dec gastric mucosa protection
Closer to isotonic because of less time to reabsorb NaCl
27. What are the ABCDEF of esophageal cancer
Short gastrics - left greater and lesser
Amylase
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
28. bilateral mets to ovaries with abundant mucus - signet ring cells
Bleeding - penetration into pancreas - perforation - obstruction
Esophageal varices
Krukenbergs tumor
Via the middle colic
29. What is Trousseau's sign
Cholesterol
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Redness and tenderness on palpation of extremities
Budd chiari syndrome
30. What is the lumen of the pancreatic duct
Dermatitis herpetiformis
External (superficial) ring only
Ampulla of vater
Right and left hepatic duct
31. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Enterokinase/enteropeptidase from the duodenal mucosa
Early childhood - neuro sx and malabsorption
Gamma glutamyl transferase GGT
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
32. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
H+
Cirrhosis
No - chronic - can present with diarrhea or constipation or alternation - treat sx
33. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Inc smooth muscle relaxation - including lower esophageal sphincter
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Juvenile polyposis syndrome - inc risk of adenocarcinoma
34. Autodigestion of pancreas by pancreatic enzymes
Begins starch digestion - inactivated by low pH upon reaching the stomach
Acute pancreatitis
Cimetidine
Ceruplasmin
35. What are the labs in acute pancreatitis
Elevated amylase - and lipase
Heme metabolism
Urobilin
Dilated esophagus with an area of distal stenosis - birds beak
36. occlusion of IVC or hepatic veins
Hirschsprungs
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Budd chiari syndrome
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
37. If trypsin activates more trypsinogen - what kind of feedback loop is established
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Phenobarbital - inc liver enzyme synthesis
Positive
Duodenal atresia - Downs
38. What layer in the mucosa is responsible for support
Dec PGE2 leading to dec gastric mucosa protection
Short gastrics - left greater and lesser
Lamina propria
Skip lesions =crohns - colon = UC
39. multiple juvenil polyps in GI tract - risk
Meconium ileus
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Short gastrics - left greater and lesser
T12
40. What gives stool its characteristic color
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
L4
Stercobilin
In the mucus that covers the gastric epithelium
41. How does loss of NO secretion affect the esophagus and what results
Alk pho
Gamma glutamyl transferase GGT
Inc lower esphogeal tone leading to achalasia
AST
42. What are the extraintestinal manifestations of ulcerative colitis
Pyoderma gangrenosum - primary sclerosing cholangitis
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Increase tumorigenesis
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
43. What are the treatment options for uclerative colitis
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
3 waves/min
Erosive - disruption of mucosal barrier leading to inflammation
44. In PUD - with gastric ulcers - does pain inc or dec with meals?
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Inc - weight loss
Terminal ileum and colon
T cell lymphoma
45. What nerve innervates the external hemorrhoids
Inferior rectal nerve
Jaundice - fever - RUQ
Skip lesions =crohns - colon = UC
Tropical sprue
46. What serum enzyme is elevated inacute pancreatitis
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Lipase
Hyperpigmented mouth - lips - hands - genitalia
47. At what spinal level does the is the bifurcation of aorta
L4
Celiac sprue
True and most common congenital anomoly of GI tract
Early childhood - neuro sx and malabsorption
48. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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49. What kind of diarrhea is produced from a disaccharide def
Obstruction of the common bile duct
HSV-1 - CMV - Candida
Low pressure proximal to LES
Osmotic
50. What do tumors that arise in the head of the pancreas cause
Cigarettes and chronic pancreatitis - not EtOH
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Obstruction of the common bile duct