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Test your basic knowledge |
USMLE GI
Start Test
Study First
Subjects
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health-sciences
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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 of fascia covers a direct inguinal hernia
External spermatic fascia only
Esophageal varices
Femoral hernia
Via the superior pancreaticduodenal
2. Where does copper accumulate in Wilsons and What are ABCD
AR
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Barrett's esophagus
Necrotizing enterocolitis
3. If the hemochromatosis is primary - What is the pattern of inheritance
AR
Smooth
Failure of the processus vagainlis to close
Duodenum - 2nd - 3rd and 4th parts
4. What is the omphalomesenteric cyst
Cystic dilation of the viteline duct
Mucosa - submucosa - muscularis externa - serosa/adventitia
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
5. How does brain injury lead to acute gastritis and What is it called
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
GERD - may also present with nocturnal cough and dyspnea
Femoral hernia
6. occlusion of IVC or hepatic veins
Short gastrics - left greater and lesser
Budd chiari syndrome
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
7. rare - often fatal childhood hepatoencephalopathy
8. What is the lumen of the pancreatic duct
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Penicillinamine - AR inheritance
Celiac sprue
Ampulla of vater
9. What does a gastrinoma cause
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
ALT>AST
Enterokinase/enteropeptidase from the duodenal mucosa
Reye's syndrome
10. why infxn is implicated in duodenal PUD
The submucosal nerve plexus - meissner's
Positive urease test
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
H pylori (almost 100%)
11. trypsinogen is converted to trypsin via what enzyme
Causes of gall stones
Osmotic
Enterokinase/enteropeptidase from the duodenal mucosa
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
12. What does loss of APC cause
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Lamina propria
Decreased intercellular adhesion and increased proliferation
13. most common malignant salivary gland tumor
Obstruction of the common bile duct
Ischemic colitis
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Mucoepidermoid carcinoma
14. If the abdominal aorta is blocked - How does blood get to the left colic artery
Stimulate intestinal persistalsis
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Gastrohepatic ligament
Via the middle colic
15. most common non - neoplastic polyp in colon
Hirschsprungs
Hyperplastic
Female - fat - fertile - forty
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
16. Cholecytsokinin - source - action - regulation
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Punched out - clean margins - carcinoma =raised irregular margins
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
Stimulate the H/K ATPase
17. What can hemochromatosis be secondary to...
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Alpha1 antitrypsin def - codominant trait
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
18. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Pleuroperitoneal
Zollinger Ellison - phenylalanine and tryptophan
Adhesion
19. What skin condition is associated with celiac sprue
Colovesical leading to pneumaturia
Crohns = noncaseating granulomas - UC = crypt abscesses
Dermatitis herpetiformis
Closer to isotonic because of less time to reabsorb NaCl
20. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Hydrocele
Amylase
Diverticulum
21. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
IgA secreting plasma cells - ultimately reside in the lamina proporia
2ndary biliary cirrhosis
The proximal small bowel
Upregulated intracellular signal transduction
22. What is the path of an indirect inguinal hernia
Via the superior pancreaticduodenal
Stimulate intestinal persistalsis
Below
Goes through deep inguinal ring - external inguinal ring and into the scrotum
23. In viral hepatitis - which liver enzyme is higher
Terminal ileum and colon
ALT>AST
Diarrhea - steatorrhea - weight loss - weakness
Hydrocele
24. What drug blocks the H2R
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Cimetidine
Repeated phlebotomy - deferoxamine - HLA- A3
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. Where is the pectinate line
Where hindgut meets ectoderm
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Esophageal cancer
Stimulate the H/K ATPase
26. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Mucoepidermoid carcinoma
Ischemic colitis
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
27. What artery passes around the duodenum
Striated
Hemosiderosis - hemochromatosis
AST
The gastroduodenal
28. What receptor does histamine bind on the parietal cell and What does it activate
L4
H2 receptor - inc cAMP
Muscularis mucosae
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
29. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Zollinger Ellison - phenylalanine and tryptophan
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
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
30. What structure is Not contained in the femoral sheath
Bleeding - intussusception - volvulus - obstruction near terminal ileum
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Stimulate intestinal persistalsis
31. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Meckels
Low pressure proximal to LES
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Mucosa - submucosa - muscularis externa - serosa/adventitia
32. What do you use to diagnose meckels
Dermatitis herpetiformis
Cholesterol - 10-20% opaque due to calcifications
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Pertechnetate - study for uptake
33. What are the structures of the femoral triangle and how are they organized
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
NAV = nerve artery vein - venous near the penis (NAVEL)
Mitochondrial abnl - fatty liver - hypoglycemia - coma
34. Where does type B chronic gastritis occur and What causes it
Around the central vein (zone III)
CHF and inc risk of HCC
Antrum - H.pylori - inc risk of MALT lymphoma
Erosive - disruption of mucosal barrier leading to inflammation
35. What is the ddx associated with appendicitis
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
H2 receptor - inc cAMP
Diverticulitis in elderly - ectopic pregs use hCG to rule out
HPNCC
36. What is pancreatic adenocarcinoma associated with
Cigarettes and chronic pancreatitis - not EtOH
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Inc - weight loss
Corticosteroids - infliximab
37. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Pyoderma gangrenosum - primary sclerosing cholangitis
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
IBS at least 2 with recurrent abdominal pain
GERD - may also present with nocturnal cough and dyspnea
38. What are the treatment options for uclerative colitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
With albumin
12 waves/min
39. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Striated
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Pleomorphic adenoma
40. What are the branches of the celiac trunk and What do they supply
Mucosa - submucosa - muscularis externa - serosa/adventitia
Turcot
Menetriers disease
Common hepatic - splenic - left gastric - main blood supply for stomach
41. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
IgA secreting plasma cells - ultimately reside in the lamina proporia
GLUT 2
FAP
When diffusely infiltrative - thickened rigid appearance like a leather bottle
42. What complication can arise from indirect inguinal hernias
Hydrocele
FAP
Phenobarbital - inc liver enzyme synthesis
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
43. What serum markers increase in cholecystitis with bile duct involvement
Warthins' tumor
Alk phos
Volvulus
3 waves/min
44. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
GERD - may also present with nocturnal cough and dyspnea
Peyers patches
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Colovesical leading to pneumaturia
45. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
IgA secreting plasma cells - ultimately reside in the lamina proporia
Nonkeritinized stratified sqamous epithelium
...
Duodenum - 2nd - 3rd and 4th parts
46. What cells make pepsin - What does it do - and what regulates it
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
AST>ALT
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
47. What serum enzyme is decreased in wilsons disease
Ceruplasmin
Dense core bodies
Inc conj bilirubin - inc cholesterol - inc alk phos
Dermatitis herpetiformis
48. FAP + malignant CNS tumor
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Turcot
49. What do the rugae of stomach look like in menetriers disease
Peutz jeghers
Left gastric vein and esophogeal vein - esophagus
So hypertrophied they look like brain gyri
Gut bacteria
50. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Duodenal atresia - Downs
Repeated phlebotomy - deferoxamine - HLA- A3
2ndary biliary cirrhosis
Falciform - ligamentum teres - fetal umbilical vein