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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. Between what structures do strong anastamoses exist
Worldwide - SC - US - adeno
Lubricate food (glycoprotiens)
Meconium ileus
Left and right gastroepiploics - left and right gastrics
2. What layer in the mucosa is responsible for absorption
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Epithelium
Chronic gastritis and pernicious anemia
3. How does abetalipoproteinemia lead to malabsorption
The proximal small bowel
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Upregulated intracellular signal transduction
4. What are the common causes of gastric ulcers - What causes gastric ulcer
Uridine glucuronyl transferase
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Primarly through ECL leading to histamine release
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
5. What is the path of an indirect inguinal hernia
Falciform - ligamentum teres - fetal umbilical vein
Jaundice - fever - RUQ
Uremia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
6. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Unconj - absent (acholuria) - inc
Alk phos
Chagas disease
Stimulate intestinal persistalsis
7. Which kind of hemorrhoids are painful and why
The jejunum
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
The entire
Crypts but not villi
8. Which viral infxns/treatments are associated with reyes syndrome
Juvenille polyps - no risk if single
Mucosa - submucosa - muscularis externa - serosa/adventitia
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
VZV and influenza B treated with salicylates
9. What is the HLA association and treatment for hemochromatosis
Glucose dependent insulinotropic peptide
Repeated phlebotomy - deferoxamine - HLA- A3
Fe2+ in the duod
The proximal small bowel
10. Dysphagia in achalasia results from
Inguninal ligament - sartorius muscle - adductor longus
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
11. What histological findings are present in the stomach
Diarrhea - steatorrhea - weight loss - weakness
Terminal ileum and colon
Gastric glands
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
12. 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
Skip lesions =crohns - colon = UC
External (superficial) ring only
Worldwide - SC - US - adeno
Meconium ileus
13. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Juvenille polyps - no risk if single
90%
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Carcinoid syndrome
14. What does a low flow rate mean for saliva
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Hypotonic because of more time to reabsorb NaCl
Chagas disease
Inc conj bilirubin - inc cholesterol - inc alk phos
15. In PUD with a duodenal ulcer does pain inc or dec with meals
Serous on the sides parotids - mucinous in the middle sublingual
Penicillinamine - AR inheritance
Decrease - weight gain
Neural muscarinic pathways
16. What do tumors that arise in the head of the pancreas cause
Spleen to posterior abdominal wall - splenic artery and vein
Obstruction of the common bile duct
...
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
17. What is the clinical presentation of acute pancreatitis
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
Conj/unconj - inc - nl to dec
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
Epigastric abdominal pain radiating to back - anorexia - nausea
18. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Lactase is located at the tips of intestinal villi
Lipase
CEA - CA-19-9
Skip lesions =crohns - colon = UC
19. What does extrahepatic biliary obstruction cause
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Paraumbilical and superficial and inferior epigastric - umbilicus
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
20. What skin condition is associated with celiac sprue
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Left gastric vein and esophogeal vein - esophagus
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Dermatitis herpetiformis
21. What is the cause of physiologic neonatal jaundice
Colonic polyps
GERD - may also present with nocturnal cough and dyspnea
Neural muscarinic pathways
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
22. What is contained in the gastrosplenic and What areas does it separate
Small intestine
Lubricate food (glycoprotiens)
Sister mary joseph nodule
Short gastrics - left greater and lesser
23. What receptors does ACH bind on the parietal cells and What does it activate
Penicillinamine - AR inheritance
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Bleeding - intussusception - volvulus - obstruction near terminal ileum
M3 - Gq - inc IP3/Ca
24. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Dilated esophagus with an area of distal stenosis - birds beak
Below
Liver metabolizes 5HT
IBS at least 2 with recurrent abdominal pain
25. Where is folate absorbed
Pleuroperitoneal
The jejunum
Lye ingestion and acid reflux
Urobilin
26. what kind of muscle is in the upper 1/3 of esophagus
Striated
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Liver metabolizes 5HT
27. How is salivary secretion stimulated
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Positive
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
Begins starch digestion - inactivated by low pH upon reaching the stomach
28. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Stercobilin
Punched out - clean margins - carcinoma =raised irregular margins
Ischemic colitis
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
29. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Poor anastamoses
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
Older patients
Intussusception
30. What are the longterm sequelae of nutmeg liver
Alk pho
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
Centrilobular congestion and necrosis - cardiac cirrhosis
Around the central vein (zone III)
31. What is the most common cause of gallstones
Pancreatic and bile
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
The gastroduodenal
Old men - arthralgias - cardiac and neuro sx
32. What are the four Fs of gallstones
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Small intestine
Female - fat - fertile - forty
Diverticulitis in elderly - ectopic pregs use hCG to rule out
33. What layer in the mucosa is repsonsible for motility
Decreased intercellular adhesion and increased proliferation
Lateral to the inferior epigastric artery
Muscularis mucosae
Trypsin - chymotrypsin - elastase - carboxypeptidases
34. What is the frequency of basal electric rhythm of the ilieum
Diverticulum
Epigastric abdominal pain radiating to back - anorexia - nausea
8-9 waves/min
Duodenal atresia - Downs
35. What gives urine its characteristic color
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Gilbert's
Striated and smooth
Urobilin
36. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
37. What are the extraintestinal manifestations of ulcerative colitis
Inguninal ligament - sartorius muscle - adductor longus
AR
Pyoderma gangrenosum - primary sclerosing cholangitis
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
38. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Decreased intercellular adhesion and increased proliferation
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Complications of crohns
Hydrocele
39. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Cholesterol - 10-20% opaque due to calcifications
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Inguninal ligament - sartorius muscle - adductor longus
Budd chiari syndrome
40. What do mucins do?
True and most common congenital anomoly of GI tract
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Lubricate food (glycoprotiens)
The submucosal nerve plexus - meissner's
41. Where are tumors commonly in pancreatic adenocarcinoma
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
Pleomorphic adenoma
Pancreatic head causing obstructive jaundice
Corticosteroids - infliximab
42. What are the two molecular pathways that lead to CRC
The jejunum
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Heme metabolism
In the ileum with bile acids - requires IF
43. motilin - source - action - regulation
Normal
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
44. What is the most important mechanism in gastric acid secretion
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Diarrhea - steatorrhea - weight loss - weakness
45. Where does type A chronic gastritis occur and What causes it
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Liver metabolizes 5HT
CCK8 receptor - Gq inc IP3/Ca
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
46. rare - often fatal childhood hepatoencephalopathy
47. What happens to the short gastics if the splenic artery is blocked
Ceruplasmin
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Hyperplastic
Poor anastamoses
48. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
49. What are the histological findings in the duodenum
50. What kind of lesions are characteristic of duodenal PUD vs cancer
Necrotizing enterocolitis
Inferior rectal nerve
Small intestine
Punched out - clean margins - carcinoma =raised irregular margins