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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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study here
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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. absent UDPGT - presents early in life - early mortality
Increase tumorigenesis
Lipase - phospholipase A - colipase
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Crigler - najjar type 1
2. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Sister mary joseph nodule
HPNCC
3. What are the complications of chronic pancreatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
GLUT 2
FAP
Pyoderma gangrenosum - primary sclerosing cholangitis
4. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Alcoholic cirrhosis
Angiodysplasia
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
Crohns = noncaseating granulomas - UC = crypt abscesses
5. Bilirubin is the product of what?
Heme metabolism
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Complications of UC
Gut bacteria
6. What is contained within the submucosa
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7. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Left gastric vein and esophogeal vein - esophagus
Pyoderma gangrenosum - primary sclerosing cholangitis
Hyperpigmented mouth - lips - hands - genitalia
8. What does autoimmune destruction of parietal cells lead to...
Diverticulum
Chronic gastritis and pernicious anemia
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
9. What receptors does ACH bind on the parietal cells and What does it activate
M3 - Gq - inc IP3/Ca
Alcoholic cirrhosis
Decrease - weight gain
Reye's syndrome
10. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
HSV-1 - CMV - Candida
Crohns = noncaseating granulomas - UC = crypt abscesses
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
11. Where does type B chronic gastritis occur and What causes it
Positive
Portal HTN
Inspiratory arrest on deep palpation due to pain
Antrum - H.pylori - inc risk of MALT lymphoma
12. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
GERD - may also present with nocturnal cough and dyspnea
Complications of crohns
Necrotizing enterocolitis
13. Where does copper accumulate in Wilsons and What are ABCD
CEA - CA-19-9
Mucosa - submucosa - muscularis externa - serosa/adventitia
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
14. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
The gastroduodenal
Above
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Alk pho
15. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Carcinoid syndrome
Ischemic colitis
16. In viral hepatitis - which liver enzyme is higher
Stimulate the H/K ATPase
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
T cell lymphoma
ALT>AST
17. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Squamous - upper 1/3 - adeno - lower 1/3
HSV-1 - CMV - Candida
Portal HTN
Dermatitis herpetiformis
18. What congenital birth defect is associated with Hirschsprung
Cigarettes and chronic pancreatitis - not EtOH
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Downs
Via the superior pancreaticduodenal
19. What makes a true diverticula
Peyers patches
Centrilobular leading to congestive liver disease
All 3 gut layers outpouch as in Meckels
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
20. What does GET SMASHED stand for in acute pancreatitis
Lipase
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Hydrocele
8-9 waves/min
21. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus
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22. What type of insults result in micronodular cirrhosis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Alcoholic cirrhosis
Early childhood - neuro sx and malabsorption
23. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Diverticulum
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Right and left hepatic duct
24. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Gilbert's
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
FAP
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
25. Abuse of what substance leads to acute gastritis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Around the central vein (zone III)
EtOH
26. What kind of lesions are characteristic of duodenal PUD vs cancer
The proximal small bowel
Gardner's syndrome
Striated
Punched out - clean margins - carcinoma =raised irregular margins
27. What is pancreatic adenocarcinoma associated with
Via the middle colic
Gardner's syndrome
Hirschsprungs
Cigarettes and chronic pancreatitis - not EtOH
28. To what substance is bilirubin conjugated and why
Amylase
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Glucouronate - water soluble (direct)
Menetriers disease
29. Dysphagia in achalasia results from
Crohns = maybe - UC= always
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Sphincter of oddi
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
30. What is the cause of Barrett's and the assocaited complications
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Lubricate food (glycoprotiens)
Crohns = maybe - UC= always
31. What are the branches of the celiac trunk and What do they supply
Reye's syndrome
VZV and influenza B treated with salicylates
Common hepatic - splenic - left gastric - main blood supply for stomach
Splenic flexure
32. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
FAP
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
CCK8 receptor - Gq inc IP3/Ca
Black - rotors syndrome
33. What are the complications of Meckels
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Appendicitis
Sphincter of oddi
Bleeding - intussusception - volvulus - obstruction near terminal ileum
34. What gives urine its characteristic color
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Urobilin
35. likely infectious form of malabsorption - responds to antibiotics
Can lead to hematemesis - found in EtOHics and bulimics
Tropical sprue
Stimulate the H/K ATPase
Smooth
36. Which area of the hindgut is a watershed area
Osmotic
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Superior rectal
Splenic flexure
37. What is the most common esophageal cancer worldwide and in the US
M3 - Gq - inc IP3/Ca
Worldwide - SC - US - adeno
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Peptic ulcer disease
38. 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
HSV-1 - CMV - Candida
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
39. What is the mechanism for reyes syndrome
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Crohns = maybe - UC= always
40. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
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
Heme metabolism
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
41. What cell produces IF and What does it do
Punched out - clean margins - carcinoma =raised irregular margins
The proximal small bowel
Parietal cells in the stomach - B12 binding protein
Splenic flexure
42. What cells secrete bicarb - What does it do - and what regulates it
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Ceruplasmin
Trypsin - chymotrypsin - elastase - carboxypeptidases
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
43. What layer in the mucosa is responsible for absorption
Esophageal carcinoma
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Epithelium
44. Which IBD is autoimmune and which may be a disordered response to bacteria
Via the middle colic
Mucosa - submucosa - muscularis externa - serosa/adventitia
Meconium ileus
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
45. What are the hindgut structures and what supplies their blood and PANS innvervation
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Ampulla of vater
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
46. Why does volvulus occur more at cecum and sigmoid colon
The gastroduodenal
Small intestine
Redundant mesentary
Paraumbilical and superficial and inferior epigastric - umbilicus
47. Achalasia increases the risk For what complication
Esophageal carcinoma
Normal
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Splenic flexure
48. What reaction does salivary amylase catalyze
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Inc smooth muscle relaxation - including lower esophageal sphincter
Boerhaave's Syndrome - Been heaving syndrome
Lye ingestion and acid reflux
49. What happens to the short gastics if the splenic artery is blocked
Unconjugated - water insoluble
EtOH
Poor anastamoses
Gastrohepatic ligament
50. What do you treat Wilsons disease with and What is the inheritance
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Crypts but not villi
Penicillinamine - AR inheritance
Appendicitis
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