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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. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Jewish and African American men
Duodenal atresia - Downs
2. What is the frequency of basal electric rhythm of the stomach
Obstruction of the common bile duct
IBS at least 2 with recurrent abdominal pain
3 waves/min
Epithelium
3. Which IBD is autoimmune and which may be a disordered response to bacteria
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Hydrocele
Primarly through ECL leading to histamine release
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
4. what percentage of colonic polyps are non - neoplastic
Alpha1 antitrypsin def - codominant trait
90%
Mucoepidermoid carcinoma
Volvulus
5. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue
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6. What are the histological findings in the duodenum
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7. What other condition can lead to acute gastritis - think renal
Worldwide - SC - US - adeno
Uremia
Brush border of intestine - produce monosaccharides from oligo and di
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
8. What receptors does ACH bind on the parietal cells and What does it activate
Neutralizes oral bacertial acids and maintains dental health
Pleomorphic adenoma
M3 - Gq - inc IP3/Ca
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
9. What kind of muscle is in the lower 1/3 of the esophagus
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Smooth
Osmotic
10. What does autoimmune destruction of parietal cells lead to...
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
GERD - may also present with nocturnal cough and dyspnea
Chronic gastritis and pernicious anemia
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
11. 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
Dubin johnson
Stimulate intestinal persistalsis
Esophageal carcinoma
12. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
Mucosa - submucosa - muscularis externa - serosa/adventitia
Colonic polyps
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
13. What cells secrete bicarb - What does it do - and what regulates it
Glucose dependent insulinotropic peptide
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Virchow's node
Hernia
14. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Hemolytic anemia
Unconjugated - water insoluble
Brunners
Chagas disease
15. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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16. What serum enzyme is decreased in wilsons disease
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
Adhesion
The entire
Ceruplasmin
17. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
VZV and influenza B treated with salicylates
Via the superior pancreaticduodenal
In the ileum with bile acids - requires IF
8-9 waves/min
18. At what spinal level does the is the bifurcation of aorta
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Small intestine
Inc conj bilirubin - inc cholesterol - inc alk phos
L4
19. secretin - source - action - regulation
Around the central vein (zone III)
Failure of neural crest migration
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
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
20. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Zollinger ellison - brunners glands
Diarrhea - steatorrhea - weight loss - weakness
Gallbladder
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
21. Where are oligosaccharide hydrolases and What do they do
Stimulate intestinal persistalsis
Neutralizes oral bacertial acids and maintains dental health
H2 receptor - inc cAMP
Brush border of intestine - produce monosaccharides from oligo and di
22. What reaction does salivary amylase catalyze
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Lamina propria
CEA - CA-19-9
23. What are the branches of the celiac trunk and What do they supply
L2
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Common hepatic - splenic - left gastric - main blood supply for stomach
24. What are the structures of the femoral triangle and how are they organized
Dissaccharidase def - most commonly lactase
NAV = nerve artery vein - venous near the penis (NAVEL)
Nonkeritinized stratified sqamous epithelium
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
25. Achalasia increases the risk For what complication
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Esophageal carcinoma
T12
Dermatitis herpetiformis
26. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Penicillinamine - AR inheritance
Alk pho
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
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
27. Where is folate absorbed
Warthins' tumor
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
The jejunum
28. What layer in the mucosa is responsible for support
Alfatoxin in peanuts
Uridine glucuronyl transferase
Lamina propria
Cigarettes and chronic pancreatitis - not EtOH
29. What transforms conjugated bilirubin to urobilinogen
Failure of the processus vagainlis to close
Gamma glutamyl transferase GGT
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Gut bacteria
30. What does bicab do in the mouth
Neutralizes oral bacertial acids and maintains dental health
Normal
Hypercoaguability - polycythemia vera - pregnancy - HCC
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
31. What serum enzyme is elevated inacute pancreatitis
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Lipase
Obstruction of the common bile duct
32. What does a gastrinoma cause
Failure of neural crest migration
Brunners
Stimulate intestinal persistalsis
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
33. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
Older patients
Neutralizes oral bacertial acids and maintains dental health
12 waves/min
34. Are single polyps malignant in peutz jehgers
No
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Inc risk of CRC and other visceral malignancies
Superior rectal and middle and inferior rectal - rectum
35. What does alpha amylase do and what inactivates it
Phototherapy
CEA - CA-19-9
In the ileum with bile acids - requires IF
Begins starch digestion - inactivated by low pH upon reaching the stomach
36. At what level do the testicular/ovarian arteries exit the aorta
Bleeding - intussusception - volvulus - obstruction near terminal ileum
L2
Inguninal ligament - sartorius muscle - adductor longus
Dense core bodies
37. What are the layers of the gut wall from inside out
Low pressure proximal to LES
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Liver metabolizes 5HT
Mucosa - submucosa - muscularis externa - serosa/adventitia
38. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Zenkers - halitosis - dysphagia and obstruction
Cystic duct and common hepatic duct
8-9 waves/min
39. Who is at risk for pancreatic adenocarcinoma
Normal
Jewish and African American men
Cigarettes and chronic pancreatitis - not EtOH
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
40. What layer of fascia covers a direct inguinal hernia
External spermatic fascia only
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Inc risk of CRC and other visceral malignancies
The proximal small bowel
41. What are the four Fs of gallstones
Cystic duct and common hepatic duct
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Elevated amylase - and lipase
Female - fat - fertile - forty
42. occlusion of IVC or hepatic veins
Budd chiari syndrome
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Falciform - ligamentum teres - fetal umbilical vein
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
43. What does histo show for alpha1 antitrypsin def
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Juvenile polyposis syndrome - inc risk of adenocarcinoma
PAS- positive globules in liver -
Downs
44. What kind of pathways do CCK act on to cause pancreatic secretion
Adhesion
Neural muscarinic pathways
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
45. What do mucins do?
Jaundice - fever - RUQ
Lubricate food (glycoprotiens)
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Dissaccharidase def - most commonly lactase
46. When do you see hypertrophy of brunners glands
The jejunum
Peptic ulcer disease
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
47. what kind of muscle is in the upper 1/3 of esophagus
Epigastric abdominal pain radiating to back - anorexia - nausea
Striated
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Mallory bodies
48. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Volvulus
AST
Black - rotors syndrome
8-9 waves/min
49. What causes carcinoid syndrome amd What are the symptoms
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Dermatitis herpetiformis
Punched out - clean margins - carcinoma =raised irregular margins
Barrett's esophagus
50. trypsinogen is converted to trypsin via what enzyme
Alk phos
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Enterokinase/enteropeptidase from the duodenal mucosa
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis