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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. Why are most diverticula considered false
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Cholesterol
Lack or have an attenuated muscularis externa - often in the sigmoid colon
IgA secreting plasma cells - ultimately reside in the lamina proporia
2. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Via the superior pancreaticduodenal
Hyperplastic
AST >ALT - ration is usually 1.5
Old men - arthralgias - cardiac and neuro sx
3. Gq and inc cAMP both work to do what in parietal cells
Phototherapy
Stimulate the H/K ATPase
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Juvenile polyposis syndrome - inc risk of adenocarcinoma
4. Where does crohns usually affect the GI tract
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Terminal ileum and colon
Osmotic
All 3
5. What are esophageal strictures associated with
Gilbert's
Causes of gall stones
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Lye ingestion and acid reflux
6. Failure of relaxation of lower esophageal sphincter - Name and etiology
Achalasia due to loss of myenteric plexus (auberach)
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
7. What is the other name for GIP (gastric inhibitory peptide)
Superior rectal
Gastric glands
Begins starch digestion - inactivated by low pH upon reaching the stomach
Glucose dependent insulinotropic peptide
8. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Crypts but not villi
Zollinger ellison - brunners glands
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Omeprazole
9. What are motilin receptor agonists used for clinically
Stimulate intestinal persistalsis
Urobilin
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Jaundice - fever - RUQ
10. What are the longterm sequelae of nutmeg liver
AST >ALT - ration is usually 1.5
Centrilobular congestion and necrosis - cardiac cirrhosis
Cirrhosis
Erosive - disruption of mucosal barrier leading to inflammation
11. What kind of lesions are characteristic of duodenal PUD vs cancer
H2 receptor - inc cAMP
Punched out - clean margins - carcinoma =raised irregular margins
Hirschsprungs
...
12. What does histo show for alpha1 antitrypsin def
Mucosa - submucosa - muscularis externa - serosa/adventitia
All 3
PAS- positive globules in liver -
Small intestine
13. What do tumors that arise in the head of the pancreas cause
Primary sclerosing cholangitis
Angiodysplasia
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Obstruction of the common bile duct
14. What do the rugae of stomach look like in menetriers disease
Lubricate food (glycoprotiens)
12 waves/min
So hypertrophied they look like brain gyri
Peptic ulcer disease
15. What are the layers of the gut wall from inside out
L2
Mucosa - submucosa - muscularis externa - serosa/adventitia
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Inc - weight loss
16. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Cimetidine
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Zollinger Ellison - phenylalanine and tryptophan
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
17. What do you treat Wilsons disease with and What is the inheritance
Primary sclerosing cholangitis
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Penicillinamine - AR inheritance
Inspiratory arrest on deep palpation due to pain
18. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
All 3
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Peutz jeghers
Mucoepidermoid carcinoma
19. What is biliary colic
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
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
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
Dissaccharidase def - most commonly lactase
20. What are the hindgut structures and what supplies their blood and PANS innvervation
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Falciform - ligamentum teres - fetal umbilical vein
21. What are the treatment options for uclerative colitis
Common hepatic - splenic - left gastric - main blood supply for stomach
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
Dense core bodies
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
22. Bilirubin is the product of what?
Below
Heme metabolism
Hyperpigmented mouth - lips - hands - genitalia
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
23. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
L4
Intussusception
Budd chiari syndrome
24. What other condition can lead to acute gastritis - think renal
Left and right gastroepiploics - left and right gastrics
The entire
Ceruplasmin
Uremia
25. Where is the deep inguinal ring relative to the inferior epigastric vessels
Sphincter of oddi
Lateral
Inc risk of CRC and other visceral malignancies
H2 receptor - inc cAMP
26. What is the clinical presentation of acute pancreatitis
GLUT 2
Enterokinase/enteropeptidase from the duodenal mucosa
Epigastric abdominal pain radiating to back - anorexia - nausea
Pyoderma gangrenosum - primary sclerosing cholangitis
27. bilateral mets to ovaries with abundant mucus - signet ring cells
Colonic polyps
Krukenbergs tumor
Boerhaave's Syndrome - Been heaving syndrome
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
28. What are the extraintestinal manifestations of ulcerative colitis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Pyoderma gangrenosum - primary sclerosing cholangitis
Hyperplastic
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
29. What are causes of extrahepatic biliary obstruction
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
In the ileum with bile acids - requires IF
Boerhaave's Syndrome - Been heaving syndrome
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
30. What are the complications of duodenal PUD
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
In the ileum with bile acids - requires IF
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Bleeding - penetration into pancreas - perforation - obstruction
31. Why does carcinoid syndrome not occur if tumor is confined to GI system
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Liver metabolizes 5HT
32. What artery passes around the duodenum
The gastroduodenal
Small intestine
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
M3 - Gq - inc IP3/Ca
33. What causes pancreatic insuff and What does it cause
Stercobilin
Boerhaave's Syndrome - Been heaving syndrome
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
34. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
In the ileum with bile acids - requires IF
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Carcinoid syndrome
Backup of blood into the liver - RHF - budd chiari
35. What is the most important mechanism in gastric acid secretion
Inc risk of CRC and other visceral malignancies
Enterokinase/enteropeptidase from the duodenal mucosa
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
36. somatostatin - source - action - regulation
Esophageal cancer
Alk phos
Portal HTN
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
37. With internal hemorrhoids Where is the anastomoses and Where is it
Poor anastamoses
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Superior rectal and middle and inferior rectal - rectum
Neutralizes gastric acid allowing pancreatic enzymes to fxn
38. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Epigastric abdominal pain radiating to back - anorexia - nausea
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
39. What gives urine its characteristic color
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Urobilin
Dissaccharidase def - most commonly lactase
So hypertrophied they look like brain gyri
40. Where is there sclerosis in alcoholic cirrohosis
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Budd chiari syndrome
Around the central vein (zone III)
41. What factors increase risk of malignancy of adenomatous polyps
Redundant mesentary
Mucosa - submucosa - muscularis externa - serosa/adventitia
Jewish and African American men
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
42. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Hypotonic because of more time to reabsorb NaCl
Cholesterol - 10-20% opaque due to calcifications
Peyers patches
43. What type of insults result in micronodular cirrhosis
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Uremia
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Pleuroperitoneal
44. What causes hirschsprungs
Failure of neural crest migration
Jaundice - fever - RUQ
Warthins' tumor
Esophageal carcinoma
45. What parts of the small bowel can tropical sprue effect
The entire
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
External (superficial) ring only
FAP
46. likely infectious form of malabsorption - responds to antibiotics
Jewish and African American men
Glucose dependent insulinotropic peptide
Tropical sprue
Inc conj bilirubin - inc cholesterol - inc alk phos
47. What kind of digestion is bile needed for
Elevated amylase - and lipase
Peyers patches
Juvenille polyps - no risk if single
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
48. What serum markers increase in cholecystitis with bile duct involvement
Alk phos
Chagas disease
Hyperplastic
Short gastrics - left greater and lesser
49. What structure is Not contained in the femoral sheath
Reye's syndrome
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Colovesical leading to pneumaturia
Stimulate intestinal persistalsis
50. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Hirschsprungs
Menetriers disease
Femoral hernia
Uridine glucuronyl transferase
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