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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 layer in the mucosa is responsible for support
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Lamina propria
2. What is the cause of physiologic neonatal jaundice
Cystic dilation of the viteline duct
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Lamina propora and submucosa
3. What cell produces IF and What does it do
Reye's syndrome
Dense core bodies
Parietal cells in the stomach - B12 binding protein
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
4. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Superior rectal
Lateral
H2 receptor - inc cAMP
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
5. What is contained in the gastrosplenic and What areas does it separate
EtOH
Short gastrics - left greater and lesser
Dubin johnson
Angiodysplasia
6. motilin - source - action - regulation
Positive urease test
NAV = nerve artery vein - venous near the penis (NAVEL)
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Esophageal carcinoma
7. in carcinoid tumors - What is seen on EM
H2 receptor - inc cAMP
Can lead to hematemesis - found in EtOHics and bulimics
Dense core bodies
Inferior rectal nerve
8. What is the leading cause of bowel incarceration
Elevated amylase - and lipase
Femoral hernia
External spermatic fascia only
Portal HTN
9. What is a positive murphy's sign
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
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Inspiratory arrest on deep palpation due to pain
Peyers patches
10. What are the histological findings in the jejunum
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Cigarettes and chronic pancreatitis - not EtOH
Adhesion
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
11. How do burns cause acute gastritis and What is it called
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12. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Via the superior pancreaticduodenal
Colonic polyps
Ischemic colitis
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
13. 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
M3 - Gq - inc IP3/Ca
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Redness and tenderness on palpation of extremities
14. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Alfatoxin in peanuts
Gilbert's
Peyers patches
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
15. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
HSV-1 - CMV - Candida
External (superficial) ring only
Bleeding - intussusception - volvulus - obstruction near terminal ileum
16. Where are peyers patches found
Lamina propora and submucosa
Duodenal atresia - Downs
Oligosaccharide digestion
Boerhaave's Syndrome - Been heaving syndrome
17. What is the omphalomesenteric cyst
Cystic dilation of the viteline duct
Hirschsprungs
Primary sclerosing cholangitis
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
18. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
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
Hepatic steatosis
L1
Duodenal atresia - Downs
19. What do you treat Wilsons disease with and What is the inheritance
Neutralizes oral bacertial acids and maintains dental health
Backup of blood into the liver - RHF - budd chiari
Penicillinamine - AR inheritance
Mallory bodies
20. At what spinal level does the SMA exit
Short gastrics - left greater and lesser
Chagas disease
L1
Brunners
21. People of what decent are associated with celiac sprue and what findings/antibodies are present
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Nonkeritinized stratified sqamous epithelium
Causes of gall stones
22. Which is used more quickly - an oral glucose load - or that by IV
Warthins' tumor
Oral glucose
Amylase
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
23. Where does type B chronic gastritis occur and What causes it
Antrum - H.pylori - inc risk of MALT lymphoma
VZV and influenza B treated with salicylates
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Redundant mesentary
24. What happens to the short gastics if the splenic artery is blocked
3 waves/min
Poor anastamoses
Fasting and stress
Cystic dilation of the viteline duct
25. What conditions are associated with budd chiari
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Hypercoaguability - polycythemia vera - pregnancy - HCC
Cholesterol
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
26. Acute gastritis is caused By what process
Crigler - najjar type 1
Celiac sprue
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Erosive - disruption of mucosal barrier leading to inflammation
27. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis
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28. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
Positive urease test
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Sphincter of oddi
29. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Cystic duct and common hepatic duct
IgA secreting plasma cells - ultimately reside in the lamina proporia
Adhesion
Volvulus
30. inflammatino of gallbadder
Trypsin - chymotrypsin - elastase - carboxypeptidases
Spleen to posterior abdominal wall - splenic artery and vein
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Inc lower esphogeal tone leading to achalasia
31. What serum enzyme is elevated in acute pancreatitis and mumps
Turcot
Amylase
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Tropical sprue
32. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Epithelium
Complications of crohns
Above
Uridine glucuronyl transferase
33. What pancreatic enzymes are responsible for fat digestion
Alk pho
3 waves/min
Lipase - phospholipase A - colipase
Dermatitis herpetiformis
34. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Decreased intercellular adhesion and increased proliferation
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
35. What layer in the mucosa is responsible for absorption
Muscularis mucosae
Chronic gastritis and pernicious anemia
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Epithelium
36. What are the extraintestinal manifestations of ulcerative colitis
Pyoderma gangrenosum - primary sclerosing cholangitis
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Hemolytic anemia
Can lead to hematemesis - found in EtOHics and bulimics
37. How does abetalipoproteinemia lead to malabsorption
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Paraumbilical and superficial and inferior epigastric - umbilicus
2ndary biliary cirrhosis
Internal thoracic to superior epigastric to inferior epigastric
38. What are the extraintestinal manifestations of crohns
Primary sclerosing cholangitis
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Amylase
39. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Hypotonic because of more time to reabsorb NaCl
Diverticulum
Brush border of intestine - produce monosaccharides from oligo and di
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
40. Which patients have pigment stones
Fe2+ in the duod
Meconium ileus
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
HPNCC
41. How many layers of spermatic fascia are covers an indirect inguinal hernia
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
Inspiratory arrest on deep palpation due to pain
Black - rotors syndrome
All 3
42. What is biliary colic
AST>ALT
Sphincter of oddi
In the mucus that covers the gastric epithelium
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
43. What is the most important mechanism in gastric acid secretion
Hydrocele
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
Closer to isotonic because of less time to reabsorb NaCl
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
44. What findings are associated with reyes
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Sister mary joseph nodule
Repeated phlebotomy - deferoxamine - HLA- A3
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
45. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Hernia
Unconj - absent (acholuria) - inc
Short gastrics - left greater and lesser
Striated
46. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Alpha1 antitrypsin def - codominant trait
Portal HTN
47. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Pancreatic and bile
Hyperplastic
Mucoepidermoid carcinoma
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
48. What cells secrete bicarb - What does it do - and what regulates it
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Elevated amylase - and lipase
Begins starch digestion - inactivated by low pH upon reaching the stomach
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
49. Who gets Whipple disease and How do they present
Old men - arthralgias - cardiac and neuro sx
Alcoholic hepatitis
Inc risk of CRC and other visceral malignancies
Antrum - H.pylori - inc risk of MALT lymphoma
50. why infxn is implicated in duodenal PUD
In the mucus that covers the gastric epithelium
Failure of neural crest migration
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
H pylori (almost 100%)