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Test your basic knowledge |
USMLE GI
Start Test
Study First
Subjects
:
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. What does GET SMASHED stand for in acute pancreatitis
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Osmotic
Gastrohepatic ligament
2. At what spinal level does the celiac trunk exit
T12
Backup of blood into the liver - RHF - budd chiari
Right and left hepatic duct
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
3. What nerve innervates the external hemorrhoids
Inferior rectal nerve
Hemolytic anemia
Upregulated intracellular signal transduction
Old men - arthralgias - cardiac and neuro sx
4. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Crohns = maybe - UC= always
Conj/unconj - inc - nl to dec
Primarly through ECL leading to histamine release
Elevated amylase - and lipase
5. What are the branches of the celiac trunk and What do they supply
Uremia
Common hepatic - splenic - left gastric - main blood supply for stomach
Fasting and stress
Around the central vein (zone III)
6. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Inc conj bilirubin - inc cholesterol - inc alk phos
Amylase
Unconj - absent (acholuria) - inc
Corticosteroids - infliximab
7. what kind of fistula is associated with diverticulitis
Colovesical leading to pneumaturia
Right and left hepatic duct
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Backup of blood into the liver - RHF - budd chiari
8. What transforms conjugated bilirubin to urobilinogen
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Pancreatic head causing obstructive jaundice
Gut bacteria
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
9. What commonly leads to appendicity in kids vs adults
NAV = nerve artery vein - venous near the penis (NAVEL)
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
12 waves/min
10. What makes a true diverticula
All 3 gut layers outpouch as in Meckels
T cell lymphoma
Small intestine
90%
11. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
12. What drug inhibits the H/K ATPase
Omeprazole
Common hepatic - splenic - left gastric - main blood supply for stomach
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Urobilin
13. What is the triad of Plummer - Vinson syndrome
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Erosive - disruption of mucosal barrier leading to inflammation
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Enterokinase/enteropeptidase from the duodenal mucosa
14. involvement of left supraclavicular node by mets from stomach
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15. Who is at risk for pancreatic adenocarcinoma
Jewish and African American men
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Unconj - absent (acholuria) - inc
M3 - Gq - inc IP3/Ca
16. What does loss of p53 cause
Hyperplastic
Sphincter of oddi
Increase tumorigenesis
Inferior rectal nerve
17. What cell produces IF and What does it do
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Parietal cells in the stomach - B12 binding protein
Cystic duct and common hepatic duct
External (superficial) ring only
18. What portion of the bowel does sprue effect
The proximal small bowel
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Portal HTN
19. How do villi appear in disaccharidease def
Cimetidine
Normal
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Old men - arthralgias - cardiac and neuro sx
20. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Ampulla of vater
Oral glucose
Lateral to the inferior epigastric artery
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
21. What is the lumen of the pancreatic duct
Backup of blood into the liver - RHF - budd chiari
Ampulla of vater
Lateral to the inferior epigastric artery
Via the middle colic
22. What kind of lesions are characteristic of duodenal PUD vs cancer
Punched out - clean margins - carcinoma =raised irregular margins
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Can lead to hematemesis - found in EtOHics and bulimics
23. What infection causes Whipple disease and What can you see on LM
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Inguninal ligament - sartorius muscle - adductor longus
24. If trypsin activates more trypsinogen - what kind of feedback loop is established
Positive
Esophageal cancer
Superior rectal and middle and inferior rectal - rectum
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
25. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
L2
Positive
Volvulus
Cholesterol - 10-20% opaque due to calcifications
26. What causes hirschsprungs
Failure of neural crest migration
In the ileum with bile acids - requires IF
Mucosa - submucosa - muscularis externa - serosa/adventitia
Hydrocele
27. What are the foregut structures and what supplies their blood and PANS innvervation
Lateral to the inferior epigastric artery
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Boerhaave's Syndrome - Been heaving syndrome
28. What is the TX of physiologic neonatal jaundice
Uremia
Phototherapy
Ceruplasmin
The submucosal nerve plexus - meissner's
29. Where is IgA shuttled
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Inc risk of CRC and other visceral malignancies
Stimulate the H/K ATPase
Increase tumorigenesis
30. What is contained in the gastrosplenic and What areas does it separate
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
MSI (15%) and APC/beta catenin chromosomal instability (85%)
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Short gastrics - left greater and lesser
31. What pancreatic proteases are secreted as zymogens
L3
Trypsin - chymotrypsin - elastase - carboxypeptidases
Epithelium
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
32. A protrusion of peritoneum through an opening - usually a site of weakness
Low pressure proximal to LES
Peutz jeghers
Hernia
Oligosaccharide digestion
33. What drug blocks the H2R
Epigastric abdominal pain radiating to back - anorexia - nausea
Ampulla of vater
Cimetidine
Elevated amylase - and lipase
34. What is indirect bilirubin
In the ileum with bile acids - requires IF
Smooth
Unconjugated - water insoluble
Inc risk of CRC and other visceral malignancies
35. What are the treatment options for uclerative colitis
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
All 3 gut layers outpouch as in Meckels
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
36. Who gets Whipple disease and How do they present
Stimulate intestinal persistalsis
Short gastrics - left greater and lesser
Old men - arthralgias - cardiac and neuro sx
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
37. What is the most common esophageal cancer worldwide and in the US
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
External (superficial) ring only
Worldwide - SC - US - adeno
Increase tumorigenesis
38. In PUD with a duodenal ulcer does pain inc or dec with meals
In the ileum with bile acids - requires IF
Decrease - weight gain
The jejunum
...
39. What are the treatmet options for crohns
Corticosteroids - infliximab
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
40. absent UDPGT - presents early in life - early mortality
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Crigler - najjar type 1
Necrotizing enterocolitis
Turcot
41. Which area of the hindgut is a watershed area
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Omeprazole
Splenic flexure
T12
42. Bilirubin is the product of what?
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Heme metabolism
43. At what level do the testicular/ovarian arteries exit the aorta
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
Zollinger Ellison - phenylalanine and tryptophan
L2
Glucose dependent insulinotropic peptide
44. How does hirschsprung present and appear on imaging
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Via the superior pancreaticduodenal
Chronic constipation early in life with dilated portion of the colon proximal to the aganglionic segment resulting in a transition zone - involves rectum - usually a failure to pass meconium
Early childhood - neuro sx and malabsorption
45. What arteries exit just below the SMA
Internal thoracic to superior epigastric to inferior epigastric
Diverticulitis in elderly - ectopic pregs use hCG to rule out
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
L/R renal artery around L1
46. In viral hepatitis - which liver enzyme is higher
ALT>AST
Neutralizes oral bacertial acids and maintains dental health
External (superficial) ring only
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
47. Why does indirect inguinal hernia happen in infacnts
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Cystic duct and common hepatic duct
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Failure of the processus vagainlis to close
48. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Dense core bodies
Unconjugated - water insoluble
With albumin
Alk pho
49. conjugated hyperbilirubinemia due to defective liver excretion
Alcoholic hepatitis
The jejunum
GERD - may also present with nocturnal cough and dyspnea
Dubin johnson
50. What cells secrete bicarb - What does it do - and what regulates it
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Causes of gall stones
Femoral hernia
Hirschsprungs