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USMLE GI
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Subjects
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health-sciences
,
usmle
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
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 are the foregut structures and what supplies their blood and PANS innvervation
Gilbert's
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Crohns = maybe - UC= always
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
2. What gives urine its characteristic color
Punched out - clean margins - carcinoma =raised irregular margins
Urobilin
Myenteric nerve plexus - aurbach
Parietal cells in the stomach - B12 binding protein
3. What kind of insults results in macronodular cirrhosis
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Stimulate intestinal persistalsis
Decrease - weight gain
Dubin johnson
4. What happens to the short gastics if the splenic artery is blocked
Poor anastamoses
Dense core bodies
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
5. What factors increase risk of malignancy of adenomatous polyps
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
12 waves/min
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
6. Between what structures do strong anastamoses exist
Mucoepidermoid carcinoma
Nonkeritinized stratified sqamous epithelium
Left and right gastroepiploics - left and right gastrics
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
7. What are the borders of Hesselbach's triangle
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
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Smooth
L/R renal artery around L1
8. Where are oligosaccharide hydrolases and What do they do
Brush border of intestine - produce monosaccharides from oligo and di
Esophageal cancer
MSI (15%) and APC/beta catenin chromosomal instability (85%)
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
9. What retroperitoneal structure flanks both sides of the pancreas on CT
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Duodenum - 2nd - 3rd and 4th parts
Urobilin
10. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Virchow's node
Adhesion
Lateral to the inferior epigastric artery
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
11. What do you treat Wilsons disease with and What is the inheritance
Celiac sprue
Old men - arthralgias - cardiac and neuro sx
Penicillinamine - AR inheritance
Serous on the sides parotids - mucinous in the middle sublingual
12. milk intolerance
Dissaccharidase def - most commonly lactase
Conj/unconj - inc - nl to dec
Inc risk of CRC and other visceral malignancies
When diffusely infiltrative - thickened rigid appearance like a leather bottle
13. What kind of anemia is in Wilsons
Hemolytic anemia
Punched out - clean margins - carcinoma =raised irregular margins
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Right and left hepatic duct
14. What are the longterm sequelae of nutmeg liver
Centrilobular congestion and necrosis - cardiac cirrhosis
Crohns = noncaseating granulomas - UC = crypt abscesses
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Juvenile polyposis syndrome - inc risk of adenocarcinoma
15. What is the action of NO as a GI hormone
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
Redness and tenderness on palpation of extremities
Inc smooth muscle relaxation - including lower esophageal sphincter
Hemolytic anemia
16. What drug inhibits the H/K ATPase
Peyers patches
Neutralizes oral bacertial acids and maintains dental health
Gastrohepatic ligament
Omeprazole
17. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Alpha amylase
2ndary biliary cirrhosis
Dense core bodies
Alcoholic cirrhosis
18. What makes a true diverticula
All 3 gut layers outpouch as in Meckels
Zenkers - halitosis - dysphagia and obstruction
In the ileum with bile acids - requires IF
Neutralizes oral bacertial acids and maintains dental health
19. Where does copper accumulate in Wilsons and What are ABCD
AR
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Hyperplastic
Crohns = maybe - UC= always
20. What does a gastrinoma cause
12 waves/min
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
ALT>AST
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
21. Where is B12 absorbed
In the ileum with bile acids - requires IF
All 3 gut layers outpouch as in Meckels
The jejunum
L1
22. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Inc conj bilirubin - inc cholesterol - inc alk phos
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Oligosaccharide digestion
Causes of gall stones
23. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Hemosiderosis - hemochromatosis
24. What arteries exit just below the SMA
Around the central vein (zone III)
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
GERD - may also present with nocturnal cough and dyspnea
L/R renal artery around L1
25. What artery passes around the duodenum
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
The gastroduodenal
All 3
26. What are the common causes of gastric ulcers - What causes gastric ulcer
Striated
Conj - inc - dec
Can lead to hematemesis - found in EtOHics and bulimics
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
27. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
...
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Chronic gastritis and pernicious anemia
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
28. What is the arterial supply and venous drainage below pectinate line
Mucoepidermoid carcinoma
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Closer to isotonic because of less time to reabsorb NaCl
29. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Volvulus
Colovesical leading to pneumaturia
Hemolytic anemia
Skip lesions =crohns - colon = UC
30. What do tumors that arise in the head of the pancreas cause
Carcinoid syndrome
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
External spermatic fascia only
Obstruction of the common bile duct
31. What is contained within the muscularis externa
Sphincter of oddi
L2
Myenteric nerve plexus - aurbach
Chronic calcifying pancreatitis - inc risk of panreatic cancer
32. Esophagitis can result From which 3 infectious agents - or chemical ingestion
CEA - CA-19-9
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
HSV-1 - CMV - Candida
Dissaccharidase def - most commonly lactase
33. What layer in the mucosa is responsible for absorption
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Urobilin
Uridine glucuronyl transferase
Epithelium
34. What receptors does ACH bind on the parietal cells and What does it activate
L2
Boerhaave's Syndrome - Been heaving syndrome
Colonic polyps
M3 - Gq - inc IP3/Ca
35. What pancreatic proteases are secreted as zymogens
Bleeding - intussusception - volvulus - obstruction near terminal ileum
H+
Via the middle colic
Trypsin - chymotrypsin - elastase - carboxypeptidases
36. likely infectious form of malabsorption - responds to antibiotics
Tropical sprue
No
Chagas disease
Dissaccharidase def - most commonly lactase
37. How do you DX and TX gallstones
Via the superior pancreaticduodenal
So hypertrophied they look like brain gyri
US and cholecystectomy
Amylase
38. Which serum enzyme increases with heavy EtOH consumption
Inc smooth muscle relaxation - including lower esophageal sphincter
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Gamma glutamyl transferase GGT
Menetriers disease
39. What are the histological findings in the ileum
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40. How do villi appear in disaccharidease def
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Failure of neural crest migration
Normal
41. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Fasting and stress
Myenteric nerve plexus - aurbach
Mucoepidermoid carcinoma
Via the superior pancreaticduodenal
42. Which is used more quickly - an oral glucose load - or that by IV
Oral glucose
The gastroduodenal
Fasting and stress
True and most common congenital anomoly of GI tract
43. What are the four Fs of gallstones
Female - fat - fertile - forty
Carcinoid syndrome
Gastrohepatic ligament
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
44. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
GERD - may also present with nocturnal cough and dyspnea
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
No
Alk pho
45. What is the presentation of pancreatic adenocarcinoma
Oligosaccharide digestion
Lactase is located at the tips of intestinal villi
AST
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
46. Which patients have pigment stones
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Backup of blood into the liver - RHF - budd chiari
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
Centrilobular congestion and necrosis - cardiac cirrhosis
47. How are all 3 monosaccharides transported to the blood
Terminal ileum and colon
GLUT 2
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Serous on the sides parotids - mucinous in the middle sublingual
48. Where are carcinoid tumors most commonly malignant
Lamina propria
Can lead to hematemesis - found in EtOHics and bulimics
Complications of UC
Small intestine
49. What are the signs and symptoms of budd chiari
Zollinger ellison - brunners glands
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Paraumbilical and superficial and inferior epigastric - umbilicus
Fasting and stress
50. What gives stool its characteristic color
Sister mary joseph nodule
Pleuroperitoneal
Colovesical leading to pneumaturia
Stercobilin
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