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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. Where are peyers patches found
Lamina propora and submucosa
HSV-1 - CMV - Candida
Inc lower esphogeal tone leading to achalasia
Achalasia due to loss of myenteric plexus (auberach)
2. What causes carcinoid syndrome amd What are the symptoms
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Stimulate the H/K ATPase
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Zenkers - halitosis - dysphagia and obstruction
3. What is the arterial supply and venous drainage below pectinate line
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Femoral hernia
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Cystic duct and common hepatic duct
4. What is the epi for CRC
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Gallbladder
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Poor anastamoses
5. Who gets Whipple disease and How do they present
Jewish and African American men
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
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Old men - arthralgias - cardiac and neuro sx
6. How is the diagonsis of CRC made
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
Boerhaave's Syndrome - Been heaving syndrome
Oral glucose
Duodenum - 2nd - 3rd and 4th parts
7. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
HSV-1 - CMV - Candida
Hypotonic because of more time to reabsorb NaCl
Conj - inc - dec
8. What are the four Fs of gallstones
Small intestine
Oral glucose
Female - fat - fertile - forty
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
9. What can fistula between the gallbladder and small intestine create and how can you tell
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Cholesterol - 10-20% opaque due to calcifications
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
10. Which IBD is autoimmune and which may be a disordered response to bacteria
Trypsin - chymotrypsin - elastase - carboxypeptidases
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Colovesical leading to pneumaturia
Cirrhosis
11. FAP + malignant CNS tumor
Jewish and African American men
Serous on the sides parotids - mucinous in the middle sublingual
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Turcot
12. What are the structures of the femoral triangle and how are they organized
Diverticulum
NAV = nerve artery vein - venous near the penis (NAVEL)
Zollinger Ellison - phenylalanine and tryptophan
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
13. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Pancreatic head causing obstructive jaundice
Uremia
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Begins starch digestion - inactivated by low pH upon reaching the stomach
14. likely infectious form of malabsorption - responds to antibiotics
HPNCC
Tropical sprue
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Crigler - najjar type 1
15. Malabsorption syndromes have what common clinical presentation
Diarrhea - steatorrhea - weight loss - weakness
Lye ingestion and acid reflux
Erosive - disruption of mucosal barrier leading to inflammation
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
16. People of what decent are associated with celiac sprue and what findings/antibodies are present
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
AST>ALT
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Worldwide - SC - US - adeno
17. What can hemochromatosis be secondary to...
The submucosal nerve plexus - meissner's
Inspiratory arrest on deep palpation due to pain
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Krukenbergs tumor
18. What are the layers of the gut wall from inside out
Stercobilin
Mucosa - submucosa - muscularis externa - serosa/adventitia
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
IgA secreting plasma cells - ultimately reside in the lamina proporia
19. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Hemosiderosis - hemochromatosis
Nonkeritinized stratified sqamous epithelium
Inc - weight loss
20. What is the cause of Barrett's and the assocaited complications
Chronic gastritis and pernicious anemia
Hyperpigmented mouth - lips - hands - genitalia
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Black - rotors syndrome
21. What layer in the mucosa is responsible for absorption
Liver metabolizes 5HT
Pyoderma gangrenosum - primary sclerosing cholangitis
Alfatoxin in peanuts
Epithelium
22. What are the barium swallow findings of achalasia
Dilated esophagus with an area of distal stenosis - birds beak
Begins starch digestion - inactivated by low pH upon reaching the stomach
Positive urease test
Gamma glutamyl transferase GGT
23. In alchoholic hepatitis which liver enzyme is higher
AST>ALT
Turcot
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Meckels
24. What findings are associated with reyes
Cirrhosis
Mitochondrial abnl - fatty liver - hypoglycemia - coma
EtOH
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
25. What does primary sclerosing cholangitis lead to...
Femoral hernia
Striated
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Alcoholic hepatitis
26. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Tropical sprue
Punched out - clean margins - carcinoma =raised irregular margins
Alpha amylase
AR
27. HCC is associated with what other conditions
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Gastrohepatic ligament
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
28. What parts of the small bowel can tropical sprue effect
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Normal
The entire
Muscularis mucosae
29. What kind of muscle is in the middle 1/3 of esophagus
Striated and smooth
Alk phos
In the ileum with bile acids - requires IF
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
30. Where is the pectinate line
Downs
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Where hindgut meets ectoderm
Female - fat - fertile - forty
31. Which serum enzyme increases with heavy EtOH consumption
Lateral to the inferior epigastric artery
Myenteric nerve plexus - aurbach
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Gamma glutamyl transferase GGT
32. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Poor anastamoses
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
33. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Duodenal atresia - Downs
Celiac sprue
Pleuroperitoneal
34. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Ampulla of vater
Cirrhosis
Volvulus
Alfatoxin in peanuts
35. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Lactase is located at the tips of intestinal villi
Dense core bodies
Diverticulum
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
36. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Conj/unconj - inc - nl to dec
Zollinger Ellison - phenylalanine and tryptophan
IBS at least 2 with recurrent abdominal pain
37. Which area of the hindgut is a watershed area
Penicillinamine - AR inheritance
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Splenic flexure
Closer to isotonic because of less time to reabsorb NaCl
38. What is contained in the gastrosplenic and What areas does it separate
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Alcoholic cirrhosis
Short gastrics - left greater and lesser
Brush border of intestine - produce monosaccharides from oligo and di
39. Where does crohns usually affect the GI tract
AST >ALT - ration is usually 1.5
Terminal ileum and colon
Barrett's esophagus
CEA - CA-19-9
40. What is the frequency of basal electric rhythm of the ilieum
Esophageal carcinoma
8-9 waves/min
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
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
41. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Hypotonic because of more time to reabsorb NaCl
Via the superior pancreaticduodenal
Worldwide - SC - US - adeno
Lamina propria
42. What gives stool its characteristic color
Esophageal varices
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Stercobilin
US and cholecystectomy
43. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
HPNCC
Angiodysplasia
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Epigastric abdominal pain radiating to back - anorexia - nausea
44. Which kind of hemorrhoids are painful and why
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Amylase
In the ileum with bile acids - requires IF
Inc risk of CRC and other visceral malignancies
45. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Dense core bodies
Carcinoid syndrome
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Dissaccharidase def - most commonly lactase
46. How does gastrin increase acid secretion?
Positive urease test
Primarly through ECL leading to histamine release
NAV = nerve artery vein - venous near the penis (NAVEL)
Trypsin - chymotrypsin - elastase - carboxypeptidases
47. What is the prognosis of adenocarcinoma
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Averages 6 months - very aggressive - usually already metastasized at presentation
48. What retroperitoneal structure flanks both sides of the pancreas on CT
M3 - Gq - inc IP3/Ca
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Duodenum - 2nd - 3rd and 4th parts
Urobilin
49. Where and How is iron absorbed
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Fe2+ in the duod
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
50. What are the signs of peutz jehgers
Hyperpigmented mouth - lips - hands - genitalia
Lack or have an attenuated muscularis externa - often in the sigmoid colon
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
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