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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.
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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 obstructive liver disease - bone disease and bile duct disease
Closer to isotonic because of less time to reabsorb NaCl
Hirschsprungs
Alk pho
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
2. What are the labs in acute pancreatitis
Causes of gall stones
Diverticulum
Elevated amylase - and lipase
MSI (15%) and APC/beta catenin chromosomal instability (85%)
3. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Gut bacteria
Chagas disease
Black - rotors syndrome
4. What is Trousseau's sign
Volvulus
L4
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Redness and tenderness on palpation of extremities
5. How does abetalipoproteinemia lead to malabsorption
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Lamina propria
Gilbert's
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
6. What are the complications of Meckels
Around the central vein (zone III)
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Unconj - absent (acholuria) - inc
Old men - arthralgias - cardiac and neuro sx
7. What congenital birth defect is associated with Hirschsprung
The jejunum
Downs
Crigler - najjar type 1
Pancreatic and bile
8. most common non - neoplastic polyp in colon
2ndary biliary cirrhosis
Erosive - disruption of mucosal barrier leading to inflammation
Hyperplastic
Inc risk of CRC and other visceral malignancies
9. What are the extraintestinal manifestations of crohns
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
When diffusely infiltrative - thickened rigid appearance like a leather bottle
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
10. What do the rugae of stomach look like in menetriers disease
So hypertrophied they look like brain gyri
Gallbladder
Inc conj bilirubin - inc cholesterol - inc alk phos
Elevated amylase - and lipase
11. What layer of fascia covers a direct inguinal hernia
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
External spermatic fascia only
Causes of gall stones
2ndary biliary cirrhosis
12. What findings are associated with reyes
Hirschsprungs
Mitochondrial abnl - fatty liver - hypoglycemia - coma
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
13. absent UDPGT - presents early in life - early mortality
Crigler - najjar type 1
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Ceruplasmin
Turcot
14. In PUD - with gastric ulcers - does pain inc or dec with meals?
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Gut bacteria
HPNCC
Inc - weight loss
15. What structure is Not contained in the femoral sheath
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
T12
Pyoderma gangrenosum - primary sclerosing cholangitis
Serous on the sides parotids - mucinous in the middle sublingual
16. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Gallbladder
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
2ndary biliary cirrhosis
Gamma glutamyl transferase GGT
17. conjugated hyperbilirubinemia due to defective liver excretion
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Dubin johnson
Zollinger ellison - brunners glands
18. What is the presentation of pancreatic adenocarcinoma
Juvenille polyps - no risk if single
Around the central vein (zone III)
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
19. What retroperitoneal structure flanks both sides of the pancreas on CT
Dilated esophagus with an area of distal stenosis - birds beak
Primary sclerosing cholangitis
Duodenum - 2nd - 3rd and 4th parts
Hyperplastic
20. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
GERD - may also present with nocturnal cough and dyspnea
3 waves/min
FAP
21. What source of salivary secretion is the most serous and What is the most mucinous
Serous on the sides parotids - mucinous in the middle sublingual
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Poor anastamoses
Dilated esophagus with an area of distal stenosis - birds beak
22. What is pancreatic adenocarcinoma associated with
8-9 waves/min
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Pleomorphic adenoma
Cigarettes and chronic pancreatitis - not EtOH
23. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
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
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
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
24. What is the rate limiting step of carbohydrate digestion
Penicillinamine - AR inheritance
Ischemic colitis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Oligosaccharide digestion
25. What layer in the mucosa is responsible for absorption
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Adhesion
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Epithelium
26. What are the borders of Hesselbach's triangle
Phototherapy
Hyperplastic
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
27. What does extrahepatic biliary obstruction cause
Failure of neural crest migration
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Lamina propria
Lipase
28. What is the action of NO as a GI hormone
Meconium ileus
Inc smooth muscle relaxation - including lower esophageal sphincter
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Epigastric abdominal pain radiating to back - anorexia - nausea
29. Bilirubin is the product of what?
Heme metabolism
Hemosiderosis - hemochromatosis
Stimulate intestinal persistalsis
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
30. Why does volvulus occur more at cecum and sigmoid colon
Decrease - weight gain
Redundant mesentary
L/R renal artery around L1
Pertechnetate - study for uptake
31. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Cystic duct and common hepatic duct
Older patients
Left and right gastroepiploics - left and right gastrics
Alpha amylase
32. B cells stimuated in the germinal centers of peyers patches differentiate into what?
So hypertrophied they look like brain gyri
IgA secreting plasma cells - ultimately reside in the lamina proporia
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
33. 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
Sister mary joseph nodule
NAV = nerve artery vein - venous near the penis (NAVEL)
Black - rotors syndrome
Skip lesions =crohns - colon = UC
34. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Achalasia due to loss of myenteric plexus (auberach)
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Stercobilin
35. What is the frequency of basal electric rhythm of the stomach
Centrilobular congestion and necrosis - cardiac cirrhosis
Intussusception
3 waves/min
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
36. What is the cause of physiologic neonatal jaundice
L/R renal artery around L1
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Sphincter of oddi
Lye ingestion and acid reflux
37. what percentage of colonic polyps are non - neoplastic
Antrum - H.pylori - inc risk of MALT lymphoma
90%
Punched out - clean margins - carcinoma =raised irregular margins
Lipase
38. What other condition can lead to acute gastritis - think renal
Inspiratory arrest on deep palpation due to pain
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Uremia
The entire
39. What are esophageal strictures associated with
The jejunum
...
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Lye ingestion and acid reflux
40. Where does type A chronic gastritis occur and What causes it
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
AST >ALT - ration is usually 1.5
IBS at least 2 with recurrent abdominal pain
Spleen to posterior abdominal wall - splenic artery and vein
41. How does brain injury lead to acute gastritis and What is it called
Pancreatic head causing obstructive jaundice
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Penicillinamine - AR inheritance
Gut bacteria
42. At what level of the spine does the IM exit the aorta
Cystic duct and common hepatic duct
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
L3
HSV-1 - CMV - Candida
43. What are the foregut structures and what supplies their blood and PANS innvervation
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Pertechnetate - study for uptake
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
44. If the hemochromatosis is primary - What is the pattern of inheritance
AR
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
45. Which patients have pigment stones
In the ileum with bile acids - requires IF
Gastrohepatic ligament
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
L4
46. What are the main components of bile
Lateral to the inferior epigastric artery
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Complications of UC
47. What transforms conjugated bilirubin to urobilinogen
Cigarettes and chronic pancreatitis - not EtOH
Right and left hepatic duct
Failure of the processus vagainlis to close
Gut bacteria
48. in budd chiari syndrome - Where is the congestion and necrosis
Centrilobular leading to congestive liver disease
Glucose dependent insulinotropic peptide
Urobilin
Turcot
49. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Angiodysplasia
In the mucus that covers the gastric epithelium
External spermatic fascia only
No
50. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Duodenal atresia - Downs
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Uridine glucuronyl transferase
NAV = nerve artery vein - venous near the penis (NAVEL)
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