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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. Between what structures do strong anastamoses exist
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
FAP
Lye ingestion and acid reflux
Left and right gastroepiploics - left and right gastrics
2. What do mucins do?
Lubricate food (glycoprotiens)
Boerhaave's Syndrome - Been heaving syndrome
Juvenille polyps - no risk if single
Positive
3. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
Crohns = transmural (cobblestone mucosa - creeping fat - string sign - linear ulcers fissures - fistulas) UC = mucosal and submucosal (friable mucosal pseudopolyps with freely hanging mesentary - loss of haustra - lead pipe appearance on imaging
Diverticulum
2ndary biliary cirrhosis
4. HCC is associated with what other conditions
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Mitochondrial abnl - fatty liver - hypoglycemia - coma
GERD - may also present with nocturnal cough and dyspnea
Lye ingestion and acid reflux
5. What serum enzyme is elevated in acute pancreatitis and mumps
Pleomorphic adenoma
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Esophageal cancer
Amylase
6. B cells stimuated in the germinal centers of peyers patches differentiate into what?
IgA secreting plasma cells - ultimately reside in the lamina proporia
Lateral
Low pressure proximal to LES
Begins starch digestion - inactivated by low pH upon reaching the stomach
7. What does GET SMASHED stand for in acute pancreatitis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
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
Gardner's syndrome
Complications of crohns
8. Are single polyps malignant in peutz jehgers
H2 receptor - inc cAMP
No
Complications of crohns
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
9. What does TOASTED with alcoholic hepatitis stand for
NAV = nerve artery vein - venous near the penis (NAVEL)
Female - fat - fertile - forty
AST >ALT - ration is usually 1.5
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
10. Where is there sclerosis in alcoholic cirrohosis
Inc risk of CRC and other visceral malignancies
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Around the central vein (zone III)
Fasting and stress
11. Where is B12 absorbed
In the ileum with bile acids - requires IF
M3 - Gq - inc IP3/Ca
Brush border of intestine - produce monosaccharides from oligo and di
Cimetidine
12. Autodigestion of pancreas by pancreatic enzymes
Uridine glucuronyl transferase
Common hepatic - splenic - left gastric - main blood supply for stomach
Acute pancreatitis
Dubin johnson
13. In PUD - with gastric ulcers - does pain inc or dec with meals?
Necrotizing enterocolitis
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Inc - weight loss
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
14. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Crohns = transmural (cobblestone mucosa - creeping fat - string sign - linear ulcers fissures - fistulas) UC = mucosal and submucosal (friable mucosal pseudopolyps with freely hanging mesentary - loss of haustra - lead pipe appearance on imaging
Repeated phlebotomy - deferoxamine - HLA- A3
Fe2+ in the duod
External spermatic fascia only
15. How does CRC present in the distal and proximal colon
Muscularis mucosae
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Around the central vein (zone III)
Dec PGE2 leading to dec gastric mucosa protection
16. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Alpha1 antitrypsin def - codominant trait
Elevated amylase - and lipase
Lye ingestion and acid reflux
17. what percentage of colonic polyps are non - neoplastic
Hirschsprungs
Alpha1 antitrypsin def - codominant trait
90%
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
18. What does extrahepatic biliary obstruction cause
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
ALT>AST
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Lipase - phospholipase A - colipase
19. What serum markers increase in cholecystitis with bile duct involvement
Primarly through ECL leading to histamine release
L/R renal artery around L1
Duodenal atresia - Downs
Alk phos
20. What are causes of extrahepatic biliary obstruction
Striated and smooth
Pleomorphic adenoma
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
21. crigler - najjar type II responds to which therapy and How does it work
Erosive - disruption of mucosal barrier leading to inflammation
Inc smooth muscle relaxation - including lower esophageal sphincter
Phenobarbital - inc liver enzyme synthesis
Peutz jeghers
22. What are the histological findings of the colon
Inc smooth muscle relaxation - including lower esophageal sphincter
Crypts but not villi
Repeated phlebotomy - deferoxamine - HLA- A3
IgA secreting plasma cells - ultimately reside in the lamina proporia
23. Who is at risk for pancreatic adenocarcinoma
Cystic duct and common hepatic duct
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Brush border of intestine - produce monosaccharides from oligo and di
Jewish and African American men
24. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Black - rotors syndrome
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Diverticulum
Inc conj bilirubin - inc cholesterol - inc alk phos
25. What cells make pepsin - What does it do - and what regulates it
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Dense core bodies
Esophageal varices
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
26. What causes primary biliary cirrhosis
Lactase is located at the tips of intestinal villi
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
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
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
27. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Decrease - weight gain
Volvulus
Portal HTN
Elevated amylase - and lipase
28. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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29. What drug inhibits the H/K ATPase
T12
Crohns = maybe - UC= always
Omeprazole
Dermatitis herpetiformis
30. What happens to the short gastics if the splenic artery is blocked
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Poor anastamoses
H2 receptor - inc cAMP
Jewish and African American men
31. somatostatin - source - action - regulation
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
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
32. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Parietal cells in the stomach - B12 binding protein
Uremia
L1
Carcinoid syndrome
33. likely infectious form of malabsorption - responds to antibiotics
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Conj - inc - dec
Tropical sprue
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
34. What can hemochromatosis be secondary to...
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Stimulate intestinal persistalsis
Cystic dilation of the viteline duct
Celiac sprue
35. What do you use to diagnose meckels
Unconjugated - water insoluble
Pertechnetate - study for uptake
Cystic duct and common hepatic duct
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
36. why infxn is implicated in duodenal PUD
Inspiratory arrest on deep palpation due to pain
H pylori (almost 100%)
L/R renal artery around L1
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
37. absent UDPGT - presents early in life - early mortality
Crigler - najjar type 1
Fe2+ in the duod
Lateral to the inferior epigastric artery
Above
38. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Jewish and African American men
Early childhood - neuro sx and malabsorption
39. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Downs
Crohns = noncaseating granulomas - UC = crypt abscesses
Angiodysplasia
40. In PUD with a duodenal ulcer does pain inc or dec with meals
Decrease - weight gain
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Downs
41. What layer in the mucosa is responsible for support
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Lamina propria
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
L/R renal artery around L1
42. What are the complications of chronic pancreatitis
Punched out - clean margins - carcinoma =raised irregular margins
Conj/unconj - inc - nl to dec
Epigastric abdominal pain radiating to back - anorexia - nausea
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
43. At what level of the spine does the IM exit the aorta
Ampulla of vater
Above
L3
Failure of neural crest migration
44. multiple juvenil polyps in GI tract - risk
Poor anastamoses
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
2ndary biliary cirrhosis
Juvenile polyposis syndrome - inc risk of adenocarcinoma
45. How does loss of NO secretion affect the esophagus and what results
Inc lower esphogeal tone leading to achalasia
Angiodysplasia
Chagas disease
Decrease - weight gain
46. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Colovesical leading to pneumaturia
Splenic flexure
Tropical sprue
Menetriers disease
47. Where are peyers patches found
Epithelium
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Lamina propora and submucosa
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
48. What test and result confirms H pylori infxn
L3
Positive urease test
Heme metabolism
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
49. At what level do the testicular/ovarian arteries exit the aorta
The jejunum
Mallory bodies
L2
...
50. Where are oligosaccharide hydrolases and What do they do
Brush border of intestine - produce monosaccharides from oligo and di
Averages 6 months - very aggressive - usually already metastasized at presentation
Hyperpigmented mouth - lips - hands - genitalia
Meckels
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