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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. What is one potential precipitating factor for intussusception
Decreased intercellular adhesion and increased proliferation
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Obstruction of the common bile duct
2. Gastrin - source - action - regulation
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Source - G cells in the antrum - action - inc gastric H+ secretion - inc growth of gastric mucosa - and inc gastric motility - regulation - inc by stomach distention/alkalinaztion - amino acids - peptides - vagal stimulation - dec by stomach pH < 1.5
Conj/unconj - inc - nl to dec
Lamina propora and submucosa
3. What are the histological findings in the jejunum
Left gastric vein and esophogeal vein - esophagus
Gastric glands
PAS- positive globules in liver -
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
4. What are the labs in acute pancreatitis
Hepatic steatosis
Elevated amylase - and lipase
Peutz jeghers
AST
5. Which viral infxns/treatments are associated with reyes syndrome
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
EtOH
VZV and influenza B treated with salicylates
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
6. What is contained in the gastrosplenic and What areas does it separate
Esophageal cancer
Short gastrics - left greater and lesser
Colonic polyps
Corticosteroids - infliximab
7. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Menetriers disease
IgA secreting plasma cells - ultimately reside in the lamina proporia
Dysphagia (due to esophageal web) - glossitis - iron def anemia
8. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Budd chiari syndrome
Failure of neural crest migration
Peutz jeghers
9. Who gets gastric ulcers
Older patients
Parietal cells in the stomach - B12 binding protein
Terminal ileum and colon
Gastric glands
10. Who gets Whipple disease and How do they present
Old men - arthralgias - cardiac and neuro sx
8-9 waves/min
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Copious diarrhea - non alpha - non beta cell pancreatic tumor
11. motilin - source - action - regulation
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
FAP
Portal HTN
IgA secreting plasma cells - ultimately reside in the lamina proporia
12. What does the splenorenal ligament connect - and What does it contain
Ischemic colitis
Spleen to posterior abdominal wall - splenic artery and vein
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Zollinger ellison - brunners glands
13. What histological findings are present in the esophagus
Ceruplasmin
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
CCK8 receptor - Gq inc IP3/Ca
Nonkeritinized stratified sqamous epithelium
14. How does CRC present in the distal and proximal colon
Budd chiari syndrome
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Causes of gall stones
Crigler - najjar type 1
15. What kind of pancreatitis is associated with EtOH and smoking
HPNCC
Primary sclerosing cholangitis
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Chronic calcifying pancreatitis - inc risk of panreatic cancer
16. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Female - fat - fertile - forty
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
Ischemic colitis
Older patients
17. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
The proximal small bowel
With albumin
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
18. What causes hirschsprungs
Mallory bodies
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Begins starch digestion - inactivated by low pH upon reaching the stomach
Failure of neural crest migration
19. What are the tumor markers for pancreatic adenocarcinoma
Serous on the sides parotids - mucinous in the middle sublingual
CEA - CA-19-9
Inc - weight loss
Juvenile polyposis syndrome - inc risk of adenocarcinoma
20. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Cystic duct and common hepatic duct
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Diverticulum
Complications of crohns
21. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
All 3
...
Uridine glucuronyl transferase
Complications of UC
22. What is the most common diaphragmatic hernia and What are the two types
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Zenkers - halitosis - dysphagia and obstruction
23. 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
Hypercoaguability - polycythemia vera - pregnancy - HCC
T cell lymphoma
Hydrocele
24. What receptor does histamine bind on the parietal cell and What does it activate
H2 receptor - inc cAMP
No
Failure of neural crest migration
Pancreatic head causing obstructive jaundice
25. What gives urine its characteristic color
H+
L4
Urobilin
Crigler - najjar type 1
26. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Diverticulum
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Gamma glutamyl transferase GGT
Above
27. What kind of digestion is bile needed for
Cimetidine
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
28. Gallstones that reach the common channel at ampulla can block which two ducts
External spermatic fascia only
Pancreatic and bile
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Parietal cells in the stomach - B12 binding protein
29. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Heme metabolism
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Below
Source - G cells in the antrum - action - inc gastric H+ secretion - inc growth of gastric mucosa - and inc gastric motility - regulation - inc by stomach distention/alkalinaztion - amino acids - peptides - vagal stimulation - dec by stomach pH < 1.5
30. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Increase tumorigenesis
Celiac sprue
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Worldwide - SC - US - adeno
31. bilateral mets to ovaries with abundant mucus - signet ring cells
Krukenbergs tumor
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Inc conj bilirubin - inc cholesterol - inc alk phos
32. 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
Internal thoracic to superior epigastric to inferior epigastric
Begins starch digestion - inactivated by low pH upon reaching the stomach
Osmotic
33. signet ring cells - acanthosis nigracans - dz - character/association - spread
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Colonic polyps
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
34. What serum enzyme is elevated in acute pancreatitis and mumps
HPNCC
Redness and tenderness on palpation of extremities
The submucosal nerve plexus - meissner's
Amylase
35. secretin - source - action - regulation
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
Repeated phlebotomy - deferoxamine - HLA- A3
Inc lower esphogeal tone leading to achalasia
Early childhood - neuro sx and malabsorption
36. What are the borders of the femoral triangle
Inguninal ligament - sartorius muscle - adductor longus
90%
T12
Below
37. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Warthins' tumor
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
IgA secreting plasma cells - ultimately reside in the lamina proporia
38. Which serum enzyme increases with heavy EtOH consumption
True and most common congenital anomoly of GI tract
Erosive - disruption of mucosal barrier leading to inflammation
Crohns = noncaseating granulomas - UC = crypt abscesses
Gamma glutamyl transferase GGT
39. What is the rate limiting step of carbohydrate digestion
M3 - Gq - inc IP3/Ca
Colovesical leading to pneumaturia
Oligosaccharide digestion
Inspiratory arrest on deep palpation due to pain
40. What cells make pepsin - What does it do - and what regulates it
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Smooth
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
41. Where is IgA shuttled
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
2ndary biliary cirrhosis
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Brush border of intestine - produce monosaccharides from oligo and di
42. Where are tumors commonly in pancreatic adenocarcinoma
Pancreatic head causing obstructive jaundice
Copious diarrhea - non alpha - non beta cell pancreatic tumor
AST
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
43. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
...
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Stercobilin
PAS- positive globules in liver -
44. In what clinical scenarior do you see portosystemic anastomoses
Primarly through ECL leading to histamine release
Antrum - H.pylori - inc risk of MALT lymphoma
Lateral
Portal HTN
45. What is the rule of 2s for meckels
Lamina propria
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Lye ingestion and acid reflux
46. What infection causes Whipple disease and What can you see on LM
Downs
Averages 6 months - very aggressive - usually already metastasized at presentation
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
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
47. what kind of fistula is associated with diverticulitis
IBS at least 2 with recurrent abdominal pain
Paraumbilical and superficial and inferior epigastric - umbilicus
Colovesical leading to pneumaturia
Normal
48. What do you treat Wilsons disease with and What is the inheritance
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Hyperpigmented mouth - lips - hands - genitalia
Penicillinamine - AR inheritance
Warthins' tumor
49. How does loss of NO secretion affect the esophagus and what results
Inc lower esphogeal tone leading to achalasia
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Decreased intercellular adhesion and increased proliferation
Osmotic
50. 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
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Female - fat - fertile - forty
Can you answer 50 questions in 15 minutes?
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