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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. At what level of the spine does the IM exit the aorta
L3
The entire
Myenteric nerve plexus - aurbach
Mucoepidermoid carcinoma
2. motilin - source - action - regulation
Ceruplasmin
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Complications of crohns
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
3. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Virchow's node
L/R renal artery around L1
Black - rotors syndrome
3 waves/min
4. What gives urine its characteristic color
Backup of blood into the liver - RHF - budd chiari
Urobilin
Crohns = noncaseating granulomas - UC = crypt abscesses
Intussusception
5. What intervention will intervention will relieve portal HTN
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Duodenal atresia - Downs
6. What are the complications of duodenal PUD
Bleeding - penetration into pancreas - perforation - obstruction
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Lamina propora and submucosa
7. Failure of relaxation of lower esophageal sphincter - Name and etiology
Mucosa - submucosa - muscularis externa - serosa/adventitia
Failure of the processus vagainlis to close
Inc conj bilirubin - inc cholesterol - inc alk phos
Achalasia due to loss of myenteric plexus (auberach)
8. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
GLUT 2
Alcoholic cirrhosis
Intussusception
Gut bacteria
9. What nerve innervates the external hemorrhoids
Tropical sprue
Angiodysplasia
Low pressure proximal to LES
Inferior rectal nerve
10. What kind of pathways do CCK act on to cause pancreatic secretion
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Neural muscarinic pathways
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Mucosa - submucosa - muscularis externa - serosa/adventitia
11. What is the most common diaphragmatic hernia and What are the two types
Inc - weight loss
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
H+
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
12. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Hirschsprungs
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Lateral
13. How does loss of NO secretion affect the esophagus and what results
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Inc lower esphogeal tone leading to achalasia
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Decrease - weight gain
14. What is indirect bilirubin
Zollinger Ellison - phenylalanine and tryptophan
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
Failure of neural crest migration
Unconjugated - water insoluble
15. What serum enzyme is decreased in wilsons disease
Conj/unconj - inc - nl to dec
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Ceruplasmin
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
16. What are the histological findings in the jejunum
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Conj/unconj - inc - nl to dec
Cystic dilation of the viteline duct
17. What are the layers of the gut wall from inside out
Mucosa - submucosa - muscularis externa - serosa/adventitia
Dissaccharidase def - most commonly lactase
GLUT 2
CCK8 receptor - Gq inc IP3/Ca
18. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Esophageal cancer
EtOH
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
19. Which patients have pigment stones
Hyperplastic
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Short gastrics - left greater and lesser
Krukenbergs tumor
20. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Crohns = maybe - UC= always
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Cystic dilation of the viteline duct
21. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Carcinoid syndrome
Hemosiderosis - hemochromatosis
Can lead to hematemesis - found in EtOHics and bulimics
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
22. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Peutz jeghers
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
No - chronic - can present with diarrhea or constipation or alternation - treat sx
23. What is the action of NO as a GI hormone
Inc smooth muscle relaxation - including lower esophageal sphincter
Angiodysplasia
PAS- positive globules in liver -
VZV and influenza B treated with salicylates
24. What are the main components of bile
Alk pho
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Pyoderma gangrenosum - primary sclerosing cholangitis
25. Why does carcinoid syndrome not occur if tumor is confined to GI system
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Begins starch digestion - inactivated by low pH upon reaching the stomach
Liver metabolizes 5HT
Lipase
26. What is the cause of physiologic neonatal jaundice
Via the middle colic
Elevated amylase - and lipase
Hypotonic because of more time to reabsorb NaCl
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
27. If the abdominal aorta is blocked - How does blood get to the left colic artery
CHF and inc risk of HCC
2ndary biliary cirrhosis
Unconjugated - water insoluble
Via the middle colic
28. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Peutz jeghers
Zenkers - halitosis - dysphagia and obstruction
Brush border of intestine - produce monosaccharides from oligo and di
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
29. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Striated and smooth
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
HSV-1 - CMV - Candida
Trypsin - chymotrypsin - elastase - carboxypeptidases
30. What are the longterm sequelae of nutmeg liver
Barrett's esophagus
Centrilobular congestion and necrosis - cardiac cirrhosis
Skip lesions =crohns - colon = UC
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
31. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Inc conj bilirubin - inc cholesterol - inc alk phos
Gilbert's
Alcoholic cirrhosis
Necrotizing enterocolitis
32. What do tumors that arise in the head of the pancreas cause
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Obstruction of the common bile duct
Meckels
Tropical sprue
33. What do the rugae of stomach look like in menetriers disease
So hypertrophied they look like brain gyri
Serous on the sides parotids - mucinous in the middle sublingual
Sphincter of oddi
Phenobarbital - inc liver enzyme synthesis
34. What drug blocks the H2R
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
Cimetidine
Angiodysplasia
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
35. In PUD with a duodenal ulcer does pain inc or dec with meals
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Small intestine
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Decrease - weight gain
36. Which area of the hindgut is a watershed area
Cystic duct and common hepatic duct
Obstruction of the common bile duct
Splenic flexure
Glucouronate - water soluble (direct)
37. What retroperitoneal structure flanks both sides of the pancreas on CT
Peptic ulcer disease
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
Crohns = maybe - UC= always
Duodenum - 2nd - 3rd and 4th parts
38. Who gets Whipple disease and How do they present
Cystic dilation of the viteline duct
Ceruplasmin
Old men - arthralgias - cardiac and neuro sx
Achalasia due to loss of myenteric plexus (auberach)
39. Where is there sclerosis in alcoholic cirrohosis
Hyperpigmented mouth - lips - hands - genitalia
Around the central vein (zone III)
Virchow's node
Cystic dilation of the viteline duct
40. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
IBS at least 2 with recurrent abdominal pain
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Meconium ileus
41. What is the main symptom if a VIPoma
Upregulated intracellular signal transduction
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Copious diarrhea - non alpha - non beta cell pancreatic tumor
42. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Dilated esophagus with an area of distal stenosis - birds beak
Reye's syndrome
Alk pho
Alcoholic hepatitis
43. somatostatin - source - action - regulation
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
Hepatic steatosis
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Elevated amylase - and lipase
44. What drug inhibits the H/K ATPase
Omeprazole
Upregulated intracellular signal transduction
Alpha amylase
T cell lymphoma
45. What are the extraintestinal manifestations of crohns
Acute pancreatitis
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Hemosiderosis - hemochromatosis
46. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Centrilobular leading to congestive liver disease
Alpha1 antitrypsin def - codominant trait
Terminal ileum and colon
Inc - weight loss
47. What is the most important mechanism in gastric acid secretion
Gardner's syndrome
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
48. Which kind of hemorrhoids are painful and why
Phototherapy
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Upregulated intracellular signal transduction
Ampulla of vater
49. What pancreatic enzymes are responsible for fat digestion
HSV-1 - CMV - Candida
Obstruction of the common bile duct
Lipase - phospholipase A - colipase
Elevated amylase - and lipase
50. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Barrett's esophagus
Esophageal cancer
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Autoimmune= ulcerative colitis - disordered response to bactere = crohns