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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. Abuse of what substance leads to acute gastritis
External spermatic fascia only
EtOH
The proximal small bowel
NAV = nerve artery vein - venous near the penis (NAVEL)
2. What do mucins do?
Lubricate food (glycoprotiens)
GERD - may also present with nocturnal cough and dyspnea
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
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
3. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Lactase is located at the tips of intestinal villi
Cholesterol - 10-20% opaque due to calcifications
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Intussusception
4. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Alcoholic cirrhosis
Uridine glucuronyl transferase
Backup of blood into the liver - RHF - budd chiari
Osmotic
5. What is the risk with peutz jehgers
Duodenum - 2nd - 3rd and 4th parts
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Inc risk of CRC and other visceral malignancies
MSI (15%) and APC/beta catenin chromosomal instability (85%)
6. What layer in the mucosa is responsible for absorption
Crohns = noncaseating granulomas - UC = crypt abscesses
Epithelium
In the ileum with bile acids - requires IF
Small intestine
7. What does loss of p53 cause
Small intestine
Increase tumorigenesis
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Via the superior pancreaticduodenal
8. FAP + malignant CNS tumor
Pyoderma gangrenosum - primary sclerosing cholangitis
All 3 gut layers outpouch as in Meckels
Glucose dependent insulinotropic peptide
Turcot
9. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Dissaccharidase def - most commonly lactase
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Lack or have an attenuated muscularis externa - often in the sigmoid colon
10. How does gastrin increase acid secretion?
Inc conj bilirubin - inc cholesterol - inc alk phos
Sphincter of oddi
Primarly through ECL leading to histamine release
Squamous - upper 1/3 - adeno - lower 1/3
11. What are the complications of Meckels
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Alcoholic cirrhosis
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Right and left hepatic duct
12. What causes hirschsprungs
Via the superior pancreaticduodenal
Via the middle colic
Averages 6 months - very aggressive - usually already metastasized at presentation
Failure of neural crest migration
13. What structure is Not contained in the femoral sheath
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Lubricate food (glycoprotiens)
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Normal
14. At what level of the spine does the IM exit the aorta
Cholesterol - 10-20% opaque due to calcifications
L3
HPNCC
Causes of gall stones
15. In PUD - with gastric ulcers - does pain inc or dec with meals?
Inc - weight loss
8-9 waves/min
Adhesion
Jewish and African American men
16. what kind of muscle is in the upper 1/3 of esophagus
Cirrhosis
Striated
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
17. What does histo show for alpha1 antitrypsin def
PAS- positive globules in liver -
Budd chiari syndrome
Mallory bodies
Serous on the sides parotids - mucinous in the middle sublingual
18. Bile is critical for exrection of what substance
Neutralizes oral bacertial acids and maintains dental health
Cholesterol
The gastroduodenal
Dense core bodies
19. Where is the deep inguinal ring relative to the inferior epigastric vessels
Inc - weight loss
Hemosiderosis - hemochromatosis
Lateral
Black - rotors syndrome
20. In an MI - which liver enzyme is elevated
AST
Gut bacteria
Lubricate food (glycoprotiens)
Juvenile polyposis syndrome - inc risk of adenocarcinoma
21. What are the foregut structures and what supplies their blood and PANS innvervation
Inc lower esphogeal tone leading to achalasia
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Phototherapy
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
22. What kind of pancreatitis is associated with EtOH and smoking
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Lipase - phospholipase A - colipase
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
23. in budd chiari syndrome - Where is the congestion and necrosis
Splenic flexure
Centrilobular leading to congestive liver disease
The submucosal nerve plexus - meissner's
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
24. most common non - neoplastic polyp in colon
Hyperplastic
H2 receptor - inc cAMP
Inc smooth muscle relaxation - including lower esophageal sphincter
MSI (15%) and APC/beta catenin chromosomal instability (85%)
25. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
HSV-1 - CMV - Candida
Alpha1 antitrypsin def - codominant trait
Enterokinase/enteropeptidase from the duodenal mucosa
Duodenal atresia - Downs
26. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Complications of crohns
Closer to isotonic because of less time to reabsorb NaCl
Pleuroperitoneal
27. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Inc - weight loss
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Pancreatic head causing obstructive jaundice
28. What does bicab do in the mouth
Gastrohepatic ligament
T cell lymphoma
Neutralizes oral bacertial acids and maintains dental health
Gilbert's
29. What infection causes Whipple disease and What can you see on LM
Penicillinamine - AR inheritance
AST>ALT
Paraumbilical and superficial and inferior epigastric - umbilicus
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
30. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
L4
Hemosiderosis - hemochromatosis
Oligosaccharide digestion
External spermatic fascia only
31. When do you see hypertrophy of brunners glands
In the ileum with bile acids - requires IF
AST >ALT - ration is usually 1.5
Peptic ulcer disease
Lactase is located at the tips of intestinal villi
32. What do you use to diagnose meckels
Adhesion
Pertechnetate - study for uptake
Zenkers - halitosis - dysphagia and obstruction
Fe2+ in the duod
33. Where is B12 absorbed
In the ileum with bile acids - requires IF
Dense core bodies
T cell lymphoma
CEA - CA-19-9
34. What percentage of gall stones are cholesterol stones and What are the associations
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Meckels
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
35. What drug inhibits the H/K ATPase
Superior rectal
Omeprazole
Liver metabolizes 5HT
Pleuroperitoneal
36. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Hirschsprungs
CEA - CA-19-9
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Positive
37. What arteries exit just below the SMA
Peptic ulcer disease
L/R renal artery around L1
Redness and tenderness on palpation of extremities
Adhesion
38. What is the cause of physiologic neonatal jaundice
Phenobarbital - inc liver enzyme synthesis
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Inc - weight loss
Peyers patches
39. somatostatin - source - action - regulation
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
Pancreatic head causing obstructive jaundice
The proximal small bowel
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
40. How do NSAIDs cause acute gastritis
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Conj - inc - dec
Dec PGE2 leading to dec gastric mucosa protection
41. What nerve innervates the external hemorrhoids
Inferior rectal nerve
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
In the mucus that covers the gastric epithelium
Punched out - clean margins - carcinoma =raised irregular margins
42. What retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
In the ileum with bile acids - requires IF
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Urobilin
43. in carcinoid tumors - What is seen on EM
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Around the central vein (zone III)
Can lead to hematemesis - found in EtOHics and bulimics
Dense core bodies
44. What findings are associated with reyes
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Sphincter of oddi
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
45. What does alpha amylase do and what inactivates it
Volvulus
Spleen to posterior abdominal wall - splenic artery and vein
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Begins starch digestion - inactivated by low pH upon reaching the stomach
46. What does TOASTED with alcoholic hepatitis stand for
Hirschsprungs
Colovesical leading to pneumaturia
Chronic gastritis and pernicious anemia
AST >ALT - ration is usually 1.5
47. If the hemochromatosis is primary - What is the pattern of inheritance
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Normal
AR
48. What are the histological findings in the jejunum
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Juvenille polyps - no risk if single
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Meckels
49. What are the complications of duodenal PUD
Conj/unconj - inc - nl to dec
Bleeding - penetration into pancreas - perforation - obstruction
Inguninal ligament - sartorius muscle - adductor longus
Zollinger ellison - brunners glands
50. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Crohns = maybe - UC= always
Cirrhosis
Positive urease test
Paraumbilical and superficial and inferior epigastric - umbilicus
Sorry!:) No result found.
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