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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. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Downs
Black - rotors syndrome
2ndary biliary cirrhosis
GERD - may also present with nocturnal cough and dyspnea
2. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Falciform - ligamentum teres - fetal umbilical vein
Crohns = noncaseating granulomas - UC = crypt abscesses
Right and left hepatic duct
Brush border of intestine - produce monosaccharides from oligo and di
3. HCC is associated with what other conditions
In the mucus that covers the gastric epithelium
Zollinger ellison - brunners glands
Juvenille polyps - no risk if single
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
4. Which area of the hindgut is a watershed area
Failure of neural crest migration
Gastrohepatic ligament
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Splenic flexure
5. People of what decent are associated with celiac sprue and what findings/antibodies are present
Dissaccharidase def - most commonly lactase
Colonic polyps
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Failure of neural crest migration
6. What are the complications of duodenal PUD
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Bleeding - penetration into pancreas - perforation - obstruction
Lipase - phospholipase A - colipase
Krukenbergs tumor
7. What are the histological findings in the jejunum
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Causes of gall stones
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
8. What are the treatmet options for crohns
Hemolytic anemia
Juvenille polyps - no risk if single
Heme metabolism
Corticosteroids - infliximab
9. Where are tumors commonly in pancreatic adenocarcinoma
L2
AST
Pancreatic head causing obstructive jaundice
Mallory bodies
10. What are the structures of the femoral triangle and how are they organized
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Striated and smooth
Jewish and African American men
NAV = nerve artery vein - venous near the penis (NAVEL)
11. What conditions are associated with budd chiari
Stimulate the H/K ATPase
Glucouronate - water soluble (direct)
Hypercoaguability - polycythemia vera - pregnancy - HCC
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
12. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Jewish and African American men
L1
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Cystic duct and common hepatic duct
13. What kind of anemia is in Wilsons
Gallbladder
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Hemolytic anemia
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
14. absent UDPGT - presents early in life - early mortality
Crigler - najjar type 1
Alk pho
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
IgA secreting plasma cells - ultimately reside in the lamina proporia
15. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
HPNCC
12 waves/min
Older patients
Inferior rectal nerve
16. What nerve innervates the external hemorrhoids
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Pertechnetate - study for uptake
PAS- positive globules in liver -
Inferior rectal nerve
17. What is the leading cause of bowel incarceration
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Lipase - phospholipase A - colipase
Femoral hernia
Worldwide - SC - US - adeno
18. What is indirect bilirubin
Via the middle colic
Unconjugated - water insoluble
Stimulate intestinal persistalsis
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
19. What separates the right greater and lesser sacs
Adhesion
Colonic polyps
Uridine glucuronyl transferase
Gastrohepatic ligament
20. What cell produces IF and What does it do
Hepatic steatosis
Parietal cells in the stomach - B12 binding protein
ALT>AST
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
21. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Left gastric vein and esophogeal vein - esophagus
Fasting and stress
Diverticulum
Boerhaave's Syndrome - Been heaving syndrome
22. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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23. What intervention will intervention will relieve portal HTN
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
With albumin
Carcinoid syndrome
Adhesion
24. somatostatin - source - action - regulation
Alcoholic hepatitis
Peutz jeghers
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
Cigarettes and chronic pancreatitis - not EtOH
25. What commonly leads to appendicity in kids vs adults
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Lye ingestion and acid reflux
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Boerhaave's Syndrome - Been heaving syndrome
26. What are the complications of Meckels
Acute pancreatitis
Conj - inc - dec
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Bleeding - intussusception - volvulus - obstruction near terminal ileum
27. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Stimulate the H/K ATPase
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Superior rectal and middle and inferior rectal - rectum
28. concentric onion skin bile duct fibrosis
Primary sclerosing cholangitis
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Achalasia due to loss of myenteric plexus (auberach)
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
29. What is the most common cause of gallstones
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
AST
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
30. What layer in the mucosa is responsible for support
Lamina propria
Enterokinase/enteropeptidase from the duodenal mucosa
True and most common congenital anomoly of GI tract
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
31. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Boerhaave's Syndrome - Been heaving syndrome
2ndary biliary cirrhosis
Left and right gastroepiploics - left and right gastrics
IBS at least 2 with recurrent abdominal pain
32. What layer in the mucosa is repsonsible for motility
Left gastric vein and esophogeal vein - esophagus
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Muscularis mucosae
33. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Alcoholic cirrhosis
Stimulate intestinal persistalsis
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
Meckels
34. What are the labs in acute pancreatitis
Elevated amylase - and lipase
Inc conj bilirubin - inc cholesterol - inc alk phos
Sister mary joseph nodule
Upregulated intracellular signal transduction
35. What is the rule of 2s for meckels
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Lipase - phospholipase A - colipase
CHF and inc risk of HCC
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
36. In what scenarios do pts with gilberts have inc bili
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Fasting and stress
Amylase
Copious diarrhea - non alpha - non beta cell pancreatic tumor
37. What is the main symptom if a VIPoma
Copious diarrhea - non alpha - non beta cell pancreatic tumor
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
Gamma glutamyl transferase GGT
Poor anastamoses
38. involvement of left supraclavicular node by mets from stomach
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39. What kind of muscle is in the middle 1/3 of esophagus
Femoral hernia
Normal
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Striated and smooth
40. What skin condition is associated with celiac sprue
Epithelium
All 3 gut layers outpouch as in Meckels
Dermatitis herpetiformis
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
41. Through which aspect of the inguinal canal does a direct inguinal go
Epigastric abdominal pain radiating to back - anorexia - nausea
Cystic duct and common hepatic duct
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
External (superficial) ring only
42. motilin - source - action - regulation
Repeated phlebotomy - deferoxamine - HLA- A3
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
L3
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
43. What is the arterial supply and venous drainage below pectinate line
Inc risk of CRC and other visceral malignancies
Cigarettes and chronic pancreatitis - not EtOH
Ischemic colitis
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
44. Transmural esophageal rupture due to violent retching
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45. What does alpha amylase do and what inactivates it
Gastrohepatic ligament
Lamina propria
Begins starch digestion - inactivated by low pH upon reaching the stomach
True and most common congenital anomoly of GI tract
46. What does a low flow rate mean for saliva
Peyers patches
External spermatic fascia only
Via the superior pancreaticduodenal
Hypotonic because of more time to reabsorb NaCl
47. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Causes of gall stones
Cystic duct and common hepatic duct
Intussusception
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
48. How is the diagonsis of CRC made
Inc conj bilirubin - inc cholesterol - inc alk phos
Portal HTN
Fe2+ in the duod
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
49. In viral hepatitis - which liver enzyme is higher
Colonic polyps
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
ALT>AST
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
50. What are the main components of bile
Jewish and African American men
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
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