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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. What serum enzyme is elevated in acute pancreatitis and mumps
With albumin
Amylase
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
So hypertrophied they look like brain gyri
2. If the abdominal aorta is blocked - How does blood get to the left colic artery
Complications of UC
Obstruction of the common bile duct
Via the middle colic
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
3. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Hypercoaguability - polycythemia vera - pregnancy - HCC
Chronic gastritis and pernicious anemia
Necrotizing enterocolitis
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
4. What does bicab do in the mouth
Failure of the processus vagainlis to close
Decreased intercellular adhesion and increased proliferation
Muscularis mucosae
Neutralizes oral bacertial acids and maintains dental health
5. What do you use to diagnose meckels
Hemolytic anemia
With albumin
Pertechnetate - study for uptake
Via the superior pancreaticduodenal
6. What does a low flow rate mean for saliva
Stimulate intestinal persistalsis
Antrum - H.pylori - inc risk of MALT lymphoma
Repeated phlebotomy - deferoxamine - HLA- A3
Hypotonic because of more time to reabsorb NaCl
7. What are the common causes of gastric ulcers - What causes gastric ulcer
Lipase
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Parietal cells in the stomach - B12 binding protein
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
8. What does TOASTED with alcoholic hepatitis stand for
Hydrocele
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
AST >ALT - ration is usually 1.5
Above
9. crigler - najjar type II responds to which therapy and How does it work
Closer to isotonic because of less time to reabsorb NaCl
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Phenobarbital - inc liver enzyme synthesis
Older patients
10. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Right and left hepatic duct
Boerhaave's Syndrome - Been heaving syndrome
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Hirschsprungs
11. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Pancreatic and bile
CHF and inc risk of HCC
Via the middle colic
Zollinger ellison - brunners glands
12. What nerve innervates the external hemorrhoids
Hyperpigmented mouth - lips - hands - genitalia
Mucosa - submucosa - muscularis externa - serosa/adventitia
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Inferior rectal nerve
13. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Black - rotors syndrome
Lipase
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
14. What is the frequency of basal electric rhythm of the stomach
Zollinger Ellison - phenylalanine and tryptophan
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
3 waves/min
15. What drug blocks the H2R
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
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
Osmotic
Cimetidine
16. What does bicarb do in the duodenum
EtOH
Epigastric abdominal pain radiating to back - anorexia - nausea
Neutralizes gastric acid allowing pancreatic enzymes to fxn
MSI (15%) and APC/beta catenin chromosomal instability (85%)
17. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Inc lower esphogeal tone leading to achalasia
Barrett's esophagus
Peyers patches
EtOH
18. Where is the arterial supply from above the pectinate line - and What is the venous drainage
CHF and inc risk of HCC
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
19. What cells secrete bicarb - What does it do - and what regulates it
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Internal thoracic to superior epigastric to inferior epigastric
Gilbert's
Pancreatic head causing obstructive jaundice
20. What do you treat Wilsons disease with and What is the inheritance
Striated
Oral glucose
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Penicillinamine - AR inheritance
21. What is contained in the gastrosplenic and What areas does it separate
Short gastrics - left greater and lesser
Diarrhea - steatorrhea - weight loss - weakness
AST
Necrotizing enterocolitis
22. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Obstruction of the common bile duct
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Uridine glucuronyl transferase
Brush border of intestine - produce monosaccharides from oligo and di
23. What is the mechanism for reyes syndrome
Epithelium
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
EtOH
24. How does CRC present in the distal and proximal colon
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Causes of gall stones
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
25. How does brain injury lead to acute gastritis and What is it called
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Primarly through ECL leading to histamine release
Terminal ileum and colon
Via the middle colic
26. What histological findings are present in the stomach
Uridine glucuronyl transferase
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Gastric glands
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
27. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
L1
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
T cell lymphoma
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
28. in budd chiari syndrome - Where is the congestion and necrosis
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Centrilobular leading to congestive liver disease
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
29. What does histo show for alpha1 antitrypsin def
Uridine glucuronyl transferase
All 3 gut layers outpouch as in Meckels
PAS- positive globules in liver -
L3
30. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Lipase
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
Superior rectal
31. subQ peribumbilical metastasis
Sister mary joseph nodule
Below
Duodenal atresia - Downs
Chronic calcifying pancreatitis - inc risk of panreatic cancer
32. What retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
Cirrhosis
Chagas disease
Boerhaave's Syndrome - Been heaving syndrome
33. What is the most common cause of gallstones
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Averages 6 months - very aggressive - usually already metastasized at presentation
Right and left hepatic duct
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
34. Where does crohns usually affect the GI tract
Terminal ileum and colon
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
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
Inspiratory arrest on deep palpation due to pain
35. Where does type A chronic gastritis occur and What causes it
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Worldwide - SC - US - adeno
CEA - CA-19-9
36. Which is used more quickly - an oral glucose load - or that by IV
Uridine glucuronyl transferase
Oral glucose
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Zollinger Ellison - phenylalanine and tryptophan
37. Malabsorption syndromes have what common clinical presentation
Diarrhea - steatorrhea - weight loss - weakness
Ampulla of vater
Spleen to posterior abdominal wall - splenic artery and vein
Hypercoaguability - polycythemia vera - pregnancy - HCC
38. motilin - source - action - regulation
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Alk phos
Primary sclerosing cholangitis
FAP
39. How do NSAIDs cause acute gastritis
Dec PGE2 leading to dec gastric mucosa protection
Closer to isotonic because of less time to reabsorb NaCl
Penicillinamine - AR inheritance
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
40. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Pertechnetate - study for uptake
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Alk pho
FAP
41. What is contained within the submucosa
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42. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
PAS- positive globules in liver -
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Epigastric abdominal pain radiating to back - anorexia - nausea
Unconj - absent (acholuria) - inc
43. What separates the right greater and lesser sacs
Gastrohepatic ligament
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Pyoderma gangrenosum - primary sclerosing cholangitis
Mucoepidermoid carcinoma
44. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Oligosaccharide digestion
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
HSV-1 - CMV - Candida
Juvenille polyps - no risk if single
45. somatostatin - source - action - regulation
Urobilin
Hypercoaguability - polycythemia vera - pregnancy - HCC
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
L2
46. Where are oligosaccharide hydrolases and What do they do
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Brush border of intestine - produce monosaccharides from oligo and di
The proximal small bowel
Conj/unconj - inc - nl to dec
47. What congenital birth defect is associated with Hirschsprung
Downs
Neutralizes oral bacertial acids and maintains dental health
Early childhood - neuro sx and malabsorption
Diverticulitis in elderly - ectopic pregs use hCG to rule out
48. What is the ddx associated with appendicitis
Chronic gastritis and pernicious anemia
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Pertechnetate - study for uptake
Diverticulitis in elderly - ectopic pregs use hCG to rule out
49. What happens to the short gastics if the splenic artery is blocked
Crypts but not villi
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Duodenal atresia - Downs
Poor anastamoses
50. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Goes through deep inguinal ring - external inguinal ring and into the scrotum
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
Mallory bodies
Poor anastamoses
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