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USMLE GI
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Subjects
:
health-sciences
,
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. What does extrahepatic biliary obstruction cause
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Colovesical leading to pneumaturia
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Gamma glutamyl transferase GGT
2. What are the structures of the femoral triangle and how are they organized
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
NAV = nerve artery vein - venous near the penis (NAVEL)
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Female - fat - fertile - forty
3. What are the results of hemochromatosis
CHF and inc risk of HCC
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Failure of the processus vagainlis to close
Gamma glutamyl transferase GGT
4. What gives urine its characteristic color
Virchow's node
Squamous - upper 1/3 - adeno - lower 1/3
Esophageal varices
Urobilin
5. Are single polyps malignant in peutz jehgers
Corticosteroids - infliximab
The jejunum
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
No
6. Where is bicarb trapped
Ampulla of vater
Esophageal cancer
In the mucus that covers the gastric epithelium
H2 receptor - inc cAMP
7. What are the extraintestinal manifestations of ulcerative colitis
AST
Pyoderma gangrenosum - primary sclerosing cholangitis
Juvenile polyposis syndrome - inc risk of adenocarcinoma
All 3
8. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Hepatic steatosis
Enterokinase/enteropeptidase from the duodenal mucosa
Liver metabolizes 5HT
Dissaccharidase def - most commonly lactase
9. At what level do the testicular/ovarian arteries exit the aorta
Common hepatic - splenic - left gastric - main blood supply for stomach
Hyperplastic
L2
All 3
10. Malabsorption syndromes have what common clinical presentation
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Muscularis mucosae
Appendicitis
Diarrhea - steatorrhea - weight loss - weakness
11. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Gut bacteria
Lactase is located at the tips of intestinal villi
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Hydrocele
12. What are the borders of Hesselbach's triangle
Glucouronate - water soluble (direct)
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Pertechnetate - study for uptake
CEA - CA-19-9
13. How is bilirubin carried in the blood
No
With albumin
Repeated phlebotomy - deferoxamine - HLA- A3
Ceruplasmin
14. What kind of pancreatitis is associated with EtOH and smoking
Worldwide - SC - US - adeno
Hepatic steatosis
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Jaundice - fever - RUQ
15. subQ peribumbilical metastasis
Alpha1 antitrypsin def - codominant trait
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Sister mary joseph nodule
External spermatic fascia only
16. What commonly leads to appendicity in kids vs adults
Superior rectal
Chronic gastritis and pernicious anemia
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Adhesion
17. What source of salivary secretion is the most serous and What is the most mucinous
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Serous on the sides parotids - mucinous in the middle sublingual
3 waves/min
18. Which area of the hindgut is a watershed area
Splenic flexure
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
Inc conj bilirubin - inc cholesterol - inc alk phos
12 waves/min
19. in budd chiari syndrome - Where is the congestion and necrosis
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
3 waves/min
Centrilobular leading to congestive liver disease
Pleomorphic adenoma
20. What serum enzyme is elevated in acute pancreatitis and mumps
L/R renal artery around L1
8-9 waves/min
Splenic flexure
Amylase
21. What are motilin receptor agonists used for clinically
Portal HTN
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Stimulate intestinal persistalsis
Fe2+ in the duod
22. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Alfatoxin in peanuts
Juvenille polyps - no risk if single
Lamina propora and submucosa
23. In viral hepatitis - which liver enzyme is higher
Antrum - H.pylori - inc risk of MALT lymphoma
ALT>AST
Cystic dilation of the viteline duct
Centrilobular leading to congestive liver disease
24. What kind of muscle is in the lower 1/3 of the esophagus
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Where hindgut meets ectoderm
Stercobilin
Smooth
25. What are the tumor markers for pancreatic adenocarcinoma
Phenobarbital - inc liver enzyme synthesis
Omeprazole
CEA - CA-19-9
Lamina propora and submucosa
26. What are the effects of atropine on parietal cells and G cells
The entire
Sphincter of oddi
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Hypotonic because of more time to reabsorb NaCl
27. What test and result confirms H pylori infxn
Positive urease test
ALT>AST
Trypsin - chymotrypsin - elastase - carboxypeptidases
MSI (15%) and APC/beta catenin chromosomal instability (85%)
28. Failure of relaxation of lower esophageal sphincter - Name and etiology
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Achalasia due to loss of myenteric plexus (auberach)
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
29. Where is B12 absorbed
In the ileum with bile acids - requires IF
Bleeding - penetration into pancreas - perforation - obstruction
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Unconj - absent (acholuria) - inc
30. What is the characteristic histo finding in alcoholic hepatitis
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Gardner's syndrome
Mallory bodies
31. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Stimulate intestinal persistalsis
Pleuroperitoneal
32. What are the foregut structures and what supplies their blood and PANS innvervation
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Penicillinamine - AR inheritance
Lipase - phospholipase A - colipase
Stercobilin
33. With caput medusaw - between what vessels is the anastomoses and Where is it
Crypts but not villi
Paraumbilical and superficial and inferior epigastric - umbilicus
Warthins' tumor
Primary sclerosing cholangitis
34. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Crohns = maybe - UC= always
Alk phos
Diarrhea - steatorrhea - weight loss - weakness
Amylase
35. What does GET SMASHED stand for in acute pancreatitis
The proximal small bowel
Esophageal varices
Failure of neural crest migration
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
36. What is contained within the muscularis externa
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Downs
Stimulate intestinal persistalsis
Myenteric nerve plexus - aurbach
37. What do you use to diagnose meckels
Terminal ileum and colon
AR
Inc lower esphogeal tone leading to achalasia
Pertechnetate - study for uptake
38. People of what decent are associated with celiac sprue and what findings/antibodies are present
Brunners
Inguninal ligament - sartorius muscle - adductor longus
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Inc smooth muscle relaxation - including lower esophageal sphincter
39. Bile is critical for exrection of what substance
Cholesterol
Inc risk of CRC and other visceral malignancies
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Centrilobular congestion and necrosis - cardiac cirrhosis
40. What is the cause of Barrett's and the assocaited complications
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Low pressure proximal to LES
Above
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
41. Achalasia increases the risk For what complication
Esophageal carcinoma
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
L1
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
42. 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
Omeprazole
Via the middle colic
All 3 gut layers outpouch as in Meckels
43. Through which aspect of the inguinal canal does a direct inguinal go
Esophageal varices
Positive
Warthins' tumor
External (superficial) ring only
44. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
2ndary biliary cirrhosis
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
12 waves/min
45. What histological findings are present in the esophagus
Nonkeritinized stratified sqamous epithelium
Hepatic steatosis
Below
Dissaccharidase def - most commonly lactase
46. What does K- ras mutation cause
Upregulated intracellular signal transduction
Pyoderma gangrenosum - primary sclerosing cholangitis
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Carcinoid syndrome
47. What is the frequency of basal electric rhythm of the ilieum
Phenobarbital - inc liver enzyme synthesis
8-9 waves/min
Small intestine
Elevated amylase - and lipase
48. Between what structures do strong anastamoses exist
Elevated amylase - and lipase
Repeated phlebotomy - deferoxamine - HLA- A3
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Left and right gastroepiploics - left and right gastrics
49. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Alcoholic cirrhosis
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Menetriers disease
50. Where are tumors commonly in pancreatic adenocarcinoma
Squamous - upper 1/3 - adeno - lower 1/3
Pancreatic head causing obstructive jaundice
Unconjugated - water insoluble
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Sorry!:) No result found.
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