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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. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Inferior rectal nerve
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Volvulus
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
2. What can hemochromatosis be secondary to...
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
AST
Stercobilin
3. What kind of pancreatitis is associated with EtOH and smoking
Serous on the sides parotids - mucinous in the middle sublingual
Chronic calcifying pancreatitis - inc risk of panreatic cancer
The submucosal nerve plexus - meissner's
Early childhood - neuro sx and malabsorption
4. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Angiodysplasia
5. motilin - source - action - regulation
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
VZV and influenza B treated with salicylates
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
6. How is salivary secretion stimulated
True and most common congenital anomoly of GI tract
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Sphincter of oddi
Gut bacteria
7. What is the omphalomesenteric cyst
In the mucus that covers the gastric epithelium
Cystic dilation of the viteline duct
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Oral glucose
8. What causes hirschsprungs
Oral glucose
Primarly through ECL leading to histamine release
Inguninal ligament - sartorius muscle - adductor longus
Failure of neural crest migration
9. What receptors does gastrin bind on the parietal cell and What does it activate
CCK8 receptor - Gq inc IP3/Ca
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
PAS- positive globules in liver -
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
10. Cholecytsokinin - source - action - regulation
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Brunners
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
Osmotic
11. in budd chiari syndrome - Where is the congestion and necrosis
Superior rectal
Decrease - weight gain
Centrilobular leading to congestive liver disease
EtOH
12. What factors increase risk of malignancy of adenomatous polyps
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Lateral
HSV-1 - CMV - Candida
Poor anastamoses
13. Are single polyps malignant in peutz jehgers
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Alpha1 antitrypsin def - codominant trait
No
Jewish and African American men
14. 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
L3
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Skip lesions =crohns - colon = UC
In the ileum with bile acids - requires IF
15. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Sphincter of oddi
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
3 waves/min
Colonic polyps
16. What serum markers increase in cholecystitis with bile duct involvement
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Gastrohepatic ligament
Positive urease test
Alk phos
17. What are the extraintestinal manifestations of crohns
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Liver metabolizes 5HT
Averages 6 months - very aggressive - usually already metastasized at presentation
All 3 gut layers outpouch as in Meckels
18. What are the labs in acute pancreatitis
Elevated amylase - and lipase
IgA secreting plasma cells - ultimately reside in the lamina proporia
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
HPNCC
19. What is the prognosis of adenocarcinoma
Increase tumorigenesis
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Ceruplasmin
Averages 6 months - very aggressive - usually already metastasized at presentation
20. What serum enzyme is elevated inacute pancreatitis
HPNCC
Lipase
Jaundice - fever - RUQ
Pyoderma gangrenosum - primary sclerosing cholangitis
21. What are the longterm sequelae of nutmeg liver
Centrilobular congestion and necrosis - cardiac cirrhosis
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
NAV = nerve artery vein - venous near the penis (NAVEL)
H pylori (almost 100%)
22. Where does an indirect inguinal hernia enter the deep inguinal ring
Inferior rectal nerve
Centrilobular leading to congestive liver disease
Lateral to the inferior epigastric artery
Corticosteroids - infliximab
23. blind pouch protruding from alimentary tract that communicates with lumen of the gut
External (superficial) ring only
Female - fat - fertile - forty
HSV-1 - CMV - Candida
Diverticulum
24. What kind of pathways do CCK act on to cause pancreatic secretion
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
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
Dubin johnson
Neural muscarinic pathways
25. What is the most common cause of gallstones
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Striated and smooth
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Chagas disease
26. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Falciform - ligamentum teres - fetal umbilical vein
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Meconium ileus
Epithelium
27. most common malignant salivary gland tumor
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Alpha1 antitrypsin def - codominant trait
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Mucoepidermoid carcinoma
28. What is pancreatic adenocarcinoma associated with
Cystic duct and common hepatic duct
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Cigarettes and chronic pancreatitis - not EtOH
Hyperpigmented mouth - lips - hands - genitalia
29. When do you see hypertrophy of brunners glands
Peptic ulcer disease
Centrilobular congestion and necrosis - cardiac cirrhosis
Gilbert's
Hydrocele
30. What do you treat Wilsons disease with and What is the inheritance
Low pressure proximal to LES
Dense core bodies
Penicillinamine - AR inheritance
Crigler - najjar type 1
31. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
NAV = nerve artery vein - venous near the penis (NAVEL)
Meckels
Esophageal varices
CCK8 receptor - Gq inc IP3/Ca
32. What are causes of extrahepatic biliary obstruction
Brush border of intestine - produce monosaccharides from oligo and di
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
33. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
12 waves/min
Necrotizing enterocolitis
Cystic dilation of the viteline duct
3 waves/min
34. Esophagitis can result From which 3 infectious agents - or chemical ingestion
H+
H pylori (almost 100%)
Striated
HSV-1 - CMV - Candida
35. When and How does Abetalipoproteinemia present
Neural muscarinic pathways
Early childhood - neuro sx and malabsorption
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Glucouronate - water soluble (direct)
36. In an MI - which liver enzyme is elevated
Parietal cells in the stomach - B12 binding protein
AST
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Short gastrics - left greater and lesser
37. What causes primary biliary cirrhosis
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
In the ileum with bile acids - requires IF
AR
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
38. What are the midgut structures and what supplies their blood and PANS innervation
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Lateral
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
39. Which IBD is autoimmune and which may be a disordered response to bacteria
Peptic ulcer disease
Left gastric vein and esophogeal vein - esophagus
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Pyoderma gangrenosum - primary sclerosing cholangitis
40. GIP - source - action regulation
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Causes of gall stones
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
41. what kind of muscle is in the upper 1/3 of esophagus
Low pressure proximal to LES
L/R renal artery around L1
Inferior rectal nerve
Striated
42. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Fasting and stress
Below
Normal
Conj/unconj - inc - nl to dec
43. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Pleomorphic adenoma
Above
Inferior rectal nerve
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
44. What is the triad of Plummer - Vinson syndrome
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Dense core bodies
Mucosa - submucosa - muscularis externa - serosa/adventitia
MSI (15%) and APC/beta catenin chromosomal instability (85%)
45. Why would a self - limited lactase def occur following an injury (viral diarrhea)
No
Old men - arthralgias - cardiac and neuro sx
Hemosiderosis - hemochromatosis
Lactase is located at the tips of intestinal villi
46. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Amylase
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Chagas disease
GERD - may also present with nocturnal cough and dyspnea
47. What is charcot triad of cholangitis
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
Jaundice - fever - RUQ
Meconium ileus
Backup of blood into the liver - RHF - budd chiari
48. How is the diagonsis of CRC made
Female - fat - fertile - forty
Diverticulum
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker
Pancreatic head causing obstructive jaundice
49. In PUD - with gastric ulcers - does pain inc or dec with meals?
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Inc - weight loss
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Glucose dependent insulinotropic peptide
50. HCC is associated with what other conditions
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
EtOH
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Glucouronate - water soluble (direct)
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