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Test your basic knowledge |
USMLE GI
Start Test
Study First
Subjects
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health-sciences
,
usmle
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
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 does an indirect inguinal hernia enter the deep inguinal ring
All 3 gut layers outpouch as in Meckels
Chronic gastritis and pernicious anemia
Lateral to the inferior epigastric artery
Early childhood - neuro sx and malabsorption
2. What kind of lesions are characteristic of duodenal PUD vs cancer
Esophageal carcinoma
Pertechnetate - study for uptake
Internal thoracic to superior epigastric to inferior epigastric
Punched out - clean margins - carcinoma =raised irregular margins
3. Which IBD is autoimmune and which may be a disordered response to bacteria
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Hernia
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
4. What structures feed into the cystic duct
Gallbladder
Mucoepidermoid carcinoma
T12
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
5. What are the four Fs of gallstones
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Dense core bodies
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Female - fat - fertile - forty
6. What kind of cancer to celiac sprue put you as inc risk for
Averages 6 months - very aggressive - usually already metastasized at presentation
T cell lymphoma
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
7. What are the histological findings in the jejunum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Early childhood - neuro sx and malabsorption
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
8. What is the frequency of basal electric rhythm of the ilieum
Complications of UC
Zollinger ellison - brunners glands
The entire
8-9 waves/min
9. What source of salivary secretion is the most serous and What is the most mucinous
The gastroduodenal
Via the middle colic
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Serous on the sides parotids - mucinous in the middle sublingual
10. What kind of insults results in macronodular cirrhosis
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Upregulated intracellular signal transduction
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Cholesterol
11. What are the main components of bile
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Phenobarbital - inc liver enzyme synthesis
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
12. What are the ABCDEF of esophageal cancer
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
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Internal thoracic to superior epigastric to inferior epigastric
Phototherapy
13. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Epithelium
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Epigastric abdominal pain radiating to back - anorexia - nausea
Hepatic steatosis
14. What does histo show for alpha1 antitrypsin def
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
PAS- positive globules in liver -
CCK8 receptor - Gq inc IP3/Ca
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
15. How are all 3 monosaccharides transported to the blood
Cholesterol - 10-20% opaque due to calcifications
The proximal small bowel
Causes of gall stones
GLUT 2
16. Where is there sclerosis in alcoholic cirrohosis
Female - fat - fertile - forty
Inc lower esphogeal tone leading to achalasia
Femoral hernia
Around the central vein (zone III)
17. What does loss of p53 cause
Pleuroperitoneal
Increase tumorigenesis
Celiac sprue
12 waves/min
18. What are the labs in acute pancreatitis
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Superior rectal
Elevated amylase - and lipase
Failure of neural crest migration
19. Where does type B chronic gastritis occur and What causes it
Duodenum - 2nd - 3rd and 4th parts
Obstruction of the common bile duct
Complications of UC
Antrum - H.pylori - inc risk of MALT lymphoma
20. What are the two molecular pathways that lead to CRC
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Omeprazole
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
MSI (15%) and APC/beta catenin chromosomal instability (85%)
21. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Backup of blood into the liver - RHF - budd chiari
Unconjugated - water insoluble
Dissaccharidase def - most commonly lactase
22. What receptors does ACH bind on the parietal cells and What does it activate
Phenobarbital - inc liver enzyme synthesis
Lamina propria
When diffusely infiltrative - thickened rigid appearance like a leather bottle
M3 - Gq - inc IP3/Ca
23. With caput medusaw - between what vessels is the anastomoses and Where is it
Esophageal varices
Lamina propria
Paraumbilical and superficial and inferior epigastric - umbilicus
Redness and tenderness on palpation of extremities
24. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Stimulate the H/K ATPase
Peutz jeghers
Krukenbergs tumor
IgA secreting plasma cells - ultimately reside in the lamina proporia
25. Liver cell failure can lead to multisystem signs including
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
12 waves/min
Closer to isotonic because of less time to reabsorb NaCl
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
26. List the clinical findings of HCC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Warthins' tumor
Cystic duct and common hepatic duct
Meckels
27. What kind of diarrhea is produced from a disaccharide def
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Osmotic
Centrilobular congestion and necrosis - cardiac cirrhosis
28. involvement of left supraclavicular node by mets from stomach
29. Malabsorption syndromes have what common clinical presentation
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Diarrhea - steatorrhea - weight loss - weakness
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
US and cholecystectomy
30. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Serous on the sides parotids - mucinous in the middle sublingual
Parietal cells in the stomach - B12 binding protein
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
31. What artery passes around the duodenum
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Glucouronate - water soluble (direct)
The gastroduodenal
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
32. Where and How is iron absorbed
Repeated phlebotomy - deferoxamine - HLA- A3
Fe2+ in the duod
Lateral to the inferior epigastric artery
Juvenile polyposis syndrome - inc risk of adenocarcinoma
33. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Conj - inc - dec
Esophageal varices
34. What is one potential precipitating factor for intussusception
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Uremia
Fasting and stress
Female - fat - fertile - forty
35. What are the treatment options for uclerative colitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Neutralizes oral bacertial acids and maintains dental health
Complications of UC
36. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Inc conj bilirubin - inc cholesterol - inc alk phos
Lactase is located at the tips of intestinal villi
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Duodenal atresia - Downs
37. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
Fe2+ in the duod
Hemosiderosis - hemochromatosis
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
38. secretin - source - action - regulation
Amylase
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
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
39. What is charcot triad of cholangitis
Ischemic colitis
Dense core bodies
Jaundice - fever - RUQ
Inc risk of CRC and other visceral malignancies
40. Acute gastritis is caused By what process
Omeprazole
Erosive - disruption of mucosal barrier leading to inflammation
Juvenille polyps - no risk if single
US and cholecystectomy
41. What test and result confirms H pylori infxn
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Positive urease test
Lipase - phospholipase A - colipase
Peptic ulcer disease
42. What are the structures of the femoral triangle and how are they organized
Oligosaccharide digestion
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
NAV = nerve artery vein - venous near the penis (NAVEL)
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
43. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Early childhood - neuro sx and malabsorption
Penicillinamine - AR inheritance
All 3 gut layers outpouch as in Meckels
Left gastric vein and esophogeal vein - esophagus
44. What are the barium swallow findings of achalasia
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Hyperplastic
Celiac sprue
Dilated esophagus with an area of distal stenosis - birds beak
45. bilateral mets to ovaries with abundant mucus - signet ring cells
Worldwide - SC - US - adeno
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
All 3 gut layers outpouch as in Meckels
Krukenbergs tumor
46. In what scenarios do pts with gilberts have inc bili
Cigarettes and chronic pancreatitis - not EtOH
Inc - weight loss
Fasting and stress
Duodenal atresia - Downs
47. What serum enzyme is elevated inacute pancreatitis
Lipase
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Tropical sprue
48. most common malignant salivary gland tumor
Chronic gastritis and pernicious anemia
The gastroduodenal
Mucoepidermoid carcinoma
Early childhood - neuro sx and malabsorption
49. What cell produces IF and What does it do
Uremia
Inguninal ligament - sartorius muscle - adductor longus
Parietal cells in the stomach - B12 binding protein
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
50. What carcinogens are associated with HCC
Alpha amylase
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Alfatoxin in peanuts