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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. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Averages 6 months - very aggressive - usually already metastasized at presentation
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Sister mary joseph nodule
Esophageal varices
2. How many layers of spermatic fascia are covers an indirect inguinal hernia
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
All 3
Closer to isotonic because of less time to reabsorb NaCl
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
3. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Alcoholic hepatitis
Lipase - phospholipase A - colipase
Cholesterol - 10-20% opaque due to calcifications
Dec PGE2 leading to dec gastric mucosa protection
4. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Crohns = maybe - UC= always
AST>ALT
Punched out - clean margins - carcinoma =raised irregular margins
Failure of neural crest migration
5. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Turcot
Adhesion
Carcinoid syndrome
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
6. What receptors does gastrin bind on the parietal cell and What does it activate
L2
Esophageal carcinoma
Glucouronate - water soluble (direct)
CCK8 receptor - Gq inc IP3/Ca
7. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Zenkers - halitosis - dysphagia and obstruction
Dissaccharidase def - most commonly lactase
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
8. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Cimetidine
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
9. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Brunners
US and cholecystectomy
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Hirschsprungs
10. Why are most diverticula considered false
All 3
Esophageal cancer
Serous on the sides parotids - mucinous in the middle sublingual
Lack or have an attenuated muscularis externa - often in the sigmoid colon
11. What does autoimmune destruction of parietal cells lead to...
Pleomorphic adenoma
Chronic gastritis and pernicious anemia
Gilbert's
Brush border of intestine - produce monosaccharides from oligo and di
12. vasoactive intestinal polypeptide (VIP) - 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
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Jaundice - fever - RUQ
US and cholecystectomy
13. What is the frequency of basal electric rhythm of the ilieum
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
8-9 waves/min
Cigarettes and chronic pancreatitis - not EtOH
Fasting and stress
14. What does GET SMASHED stand for in acute pancreatitis
All 3
Reye's syndrome
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
15. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
L1
Glucose dependent insulinotropic peptide
Squamous - upper 1/3 - adeno - lower 1/3
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
16. What is the mechanism for reyes syndrome
No
In the ileum with bile acids - requires IF
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
17. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
GERD - may also present with nocturnal cough and dyspnea
Epithelium
Unconj - absent (acholuria) - inc
18. How does brain injury lead to acute gastritis and What is it called
Fe2+ in the duod
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Redness and tenderness on palpation of extremities
19. What does TOASTED with alcoholic hepatitis stand for
Lamina propria
Complications of UC
AST >ALT - ration is usually 1.5
Early childhood - neuro sx and malabsorption
20. How are all 3 monosaccharides transported to the blood
GERD - may also present with nocturnal cough and dyspnea
Antrum - H.pylori - inc risk of MALT lymphoma
GLUT 2
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
21. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Liver metabolizes 5HT
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Phototherapy
Inspiratory arrest on deep palpation due to pain
22. What does K- ras mutation cause
Via the middle colic
Upregulated intracellular signal transduction
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Gilbert's
23. Bilirubin is the product of what?
Angiodysplasia
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Heme metabolism
Punched out - clean margins - carcinoma =raised irregular margins
24. What kind of anemia is in Wilsons
Unconjugated - water insoluble
Hemolytic anemia
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Muscularis mucosae
25. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Terminal ileum and colon
Fasting and stress
Adhesion
Juvenille polyps - no risk if single
26. What are the extraintestinal manifestations of crohns
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Pyoderma gangrenosum - primary sclerosing cholangitis
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
27. What are the two molecular pathways that lead to CRC
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Myenteric nerve plexus - aurbach
28. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Early childhood - neuro sx and malabsorption
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Ceruplasmin
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
29. What kind of pancreatitis is associated with EtOH and smoking
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Glucouronate - water soluble (direct)
Around the central vein (zone III)
Femoral hernia
30. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Begins starch digestion - inactivated by low pH upon reaching the stomach
Redundant mesentary
Fe2+ in the duod
31. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Smooth
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Esophageal varices
Volvulus
32. What is the most important mechanism in gastric acid secretion
Early childhood - neuro sx and malabsorption
Superior rectal and middle and inferior rectal - rectum
M3 - Gq - inc IP3/Ca
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
33. Bile is critical for exrection of what substance
Cholesterol
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Mallory bodies
Meconium ileus
34. What pancreatic proteases are secreted as zymogens
Causes of gall stones
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Trypsin - chymotrypsin - elastase - carboxypeptidases
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
35. In what scenarios do pts with gilberts have inc bili
Fasting and stress
Angiodysplasia
Phenobarbital - inc liver enzyme synthesis
Elevated amylase - and lipase
36. involvement of left supraclavicular node by mets from stomach
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37. What is the rule of 2s for meckels
PAS- positive globules in liver -
Glucose dependent insulinotropic peptide
VZV and influenza B treated with salicylates
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
38. subQ peribumbilical metastasis
Lateral
Poor anastamoses
Stimulate intestinal persistalsis
Sister mary joseph nodule
39. What kind of lesions are characteristic of duodenal PUD vs cancer
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
US and cholecystectomy
Punched out - clean margins - carcinoma =raised irregular margins
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
40. milk intolerance
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Dissaccharidase def - most commonly lactase
Hepatic steatosis
Angiodysplasia
41. What separates the right greater and lesser sacs
Pertechnetate - study for uptake
Superior rectal and middle and inferior rectal - rectum
Gastrohepatic ligament
Lye ingestion and acid reflux
42. Where and How is iron absorbed
Zollinger ellison - brunners glands
Cystic duct and common hepatic duct
Erosive - disruption of mucosal barrier leading to inflammation
Fe2+ in the duod
43. What is the epi for CRC
GERD - may also present with nocturnal cough and dyspnea
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
IBS at least 2 with recurrent abdominal pain
Short gastrics - left greater and lesser
44. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Reye's syndrome
Meconium ileus
HPNCC
External spermatic fascia only
45. What are the branches of the celiac trunk and What do they supply
Achalasia due to loss of myenteric plexus (auberach)
Common hepatic - splenic - left gastric - main blood supply for stomach
Dense core bodies
Stimulate intestinal persistalsis
46. What does a gastrinoma cause
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
47. Where does an indirect inguinal hernia enter the deep inguinal ring
Decrease - weight gain
Oligosaccharide digestion
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Lateral to the inferior epigastric artery
48. somatostatin - source - action - regulation
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Old men - arthralgias - cardiac and neuro sx
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
Fasting and stress
49. What kind of muscle is in the middle 1/3 of esophagus
Punched out - clean margins - carcinoma =raised irregular margins
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Striated and smooth
50. What are additional risk factors for CRC
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Adhesion
Uremia
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