SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
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 are the treatment options for uclerative colitis
ALT>AST
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Gastric glands
Upregulated intracellular signal transduction
2. What are additional risk factors for CRC
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Dec PGE2 leading to dec gastric mucosa protection
Phenobarbital - inc liver enzyme synthesis
3. In PUD - with gastric ulcers - does pain inc or dec with meals?
Early childhood - neuro sx and malabsorption
Inc - weight loss
Lamina propria
Striated
4. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Serous on the sides parotids - mucinous in the middle sublingual
Short gastrics - left greater and lesser
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
5. What kind of digestion is bile needed for
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
So hypertrophied they look like brain gyri
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
6. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Cystic dilation of the viteline duct
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Primary sclerosing cholangitis
Necrotizing enterocolitis
7. likely infectious form of malabsorption - responds to antibiotics
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
Alcoholic cirrhosis
Tropical sprue
Inc smooth muscle relaxation - including lower esophageal sphincter
8. What commonly leads to appendicity in kids vs adults
Inguninal ligament - sartorius muscle - adductor longus
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Gut bacteria
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
9. At what spinal level does the celiac trunk exit
Brunners
T12
Cholesterol - 10-20% opaque due to calcifications
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
10. why infxn is implicated in duodenal PUD
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
H pylori (almost 100%)
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
11. signet ring cells - acanthosis nigracans - dz - character/association - spread
L2
External spermatic fascia only
Cystic dilation of the viteline duct
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
12. People of what decent are associated with celiac sprue and what findings/antibodies are present
Epithelium
The gastroduodenal
Muscularis mucosae
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
13. What parts of the small bowel can tropical sprue effect
Increase tumorigenesis
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Lack or have an attenuated muscularis externa - often in the sigmoid colon
The entire
14. What does loss of p53 cause
Alcoholic cirrhosis
Increase tumorigenesis
Unconjugated - water insoluble
90%
15. What is the other name for GIP (gastric inhibitory peptide)
Glucose dependent insulinotropic peptide
VZV and influenza B treated with salicylates
Meconium ileus
Internal thoracic to superior epigastric to inferior epigastric
16. Achalasia increases the risk For what complication
Duodenum - 2nd - 3rd and 4th parts
Esophageal carcinoma
Juvenille polyps - no risk if single
Cholesterol - 10-20% opaque due to calcifications
17. How many layers of spermatic fascia are covers an indirect inguinal hernia
Dilated esophagus with an area of distal stenosis - birds beak
Juvenile polyposis syndrome - inc risk of adenocarcinoma
All 3
Peutz jeghers
18. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Ceruplasmin
CCK8 receptor - Gq inc IP3/Ca
Acute pancreatitis
Can lead to hematemesis - found in EtOHics and bulimics
19. Acute gastritis is caused By what process
Erosive - disruption of mucosal barrier leading to inflammation
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Primarly through ECL leading to histamine release
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
20. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Esophageal cancer
Dubin johnson
Crohns = noncaseating granulomas - UC = crypt abscesses
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
21. At what level do the testicular/ovarian arteries exit the aorta
Cystic dilation of the viteline duct
Ceruplasmin
Volvulus
L2
22. How are all 3 monosaccharides transported to the blood
Fasting and stress
AST >ALT - ration is usually 1.5
GLUT 2
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
23. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Left gastric vein and esophogeal vein - esophagus
Downs
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
24. How do villi appear in disaccharidease def
Normal
H2 receptor - inc cAMP
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
25. multiple juvenil polyps in GI tract - risk
PAS- positive globules in liver -
Juvenile polyposis syndrome - inc risk of adenocarcinoma
AST
Zollinger ellison - brunners glands
26. Achalasia can be secondary to what infectious disease common in South America
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
In the mucus that covers the gastric epithelium
Chagas disease
27. What is the action of NO as a GI hormone
Inc smooth muscle relaxation - including lower esophageal sphincter
Liver metabolizes 5HT
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
90%
28. Through which aspect of the inguinal canal does a direct inguinal go
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Epigastric abdominal pain radiating to back - anorexia - nausea
External (superficial) ring only
29. With caput medusaw - between what vessels is the anastomoses and Where is it
Paraumbilical and superficial and inferior epigastric - umbilicus
Volvulus
Unconj - absent (acholuria) - inc
Spleen to posterior abdominal wall - splenic artery and vein
30. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Via the superior pancreaticduodenal
Normal
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
L1
31. With internal hemorrhoids Where is the anastomoses and Where is it
Superior rectal and middle and inferior rectal - rectum
Backup of blood into the liver - RHF - budd chiari
Striated
Crohns = maybe - UC= always
32. Where does an indirect inguinal hernia enter the deep inguinal ring
Lateral to the inferior epigastric artery
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Chronic gastritis and pernicious anemia
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
33. What makes a true diverticula
All 3 gut layers outpouch as in Meckels
Stercobilin
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
34. Where is folate absorbed
The jejunum
Stimulate intestinal persistalsis
Low pressure proximal to LES
Alk pho
35. What does K- ras mutation cause
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Carcinoid syndrome
Upregulated intracellular signal transduction
Meconium ileus
36. trypsinogen is converted to trypsin via what enzyme
T12
Female - fat - fertile - forty
Enterokinase/enteropeptidase from the duodenal mucosa
Sister mary joseph nodule
37. What kind of muscle is in the lower 1/3 of the esophagus
Smooth
Via the superior pancreaticduodenal
Mallory bodies
Striated
38. Why does indirect inguinal hernia happen in infacnts
Failure of the processus vagainlis to close
Adhesion
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Unconj - absent (acholuria) - inc
39. What are the foregut structures and what supplies their blood and PANS innvervation
Reye's syndrome
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Heme metabolism
Complications of UC
40. Where is the pectinate line
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
With albumin
Where hindgut meets ectoderm
Dilated esophagus with an area of distal stenosis - birds beak
41. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Cholesterol
Low pressure proximal to LES
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
No - chronic - can present with diarrhea or constipation or alternation - treat sx
42. What serum markers increase in cholecystitis with bile duct involvement
GERD - may also present with nocturnal cough and dyspnea
Glucouronate - water soluble (direct)
HPNCC
Alk phos
43. What are the four Fs of gallstones
Inguninal ligament - sartorius muscle - adductor longus
Female - fat - fertile - forty
Crohns = maybe - UC= always
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
44. What is Trousseau's sign
Obstruction of the common bile duct
Ampulla of vater
Redness and tenderness on palpation of extremities
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
45. What structures feed into the common bile duct
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Angiodysplasia
Erosive - disruption of mucosal barrier leading to inflammation
Cystic duct and common hepatic duct
46. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
CEA - CA-19-9
Older patients
Krukenbergs tumor
Left gastric vein and esophogeal vein - esophagus
47. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Causes of gall stones
FAP
Complications of UC
48. What layer of fascia covers a direct inguinal hernia
External spermatic fascia only
Centrilobular leading to congestive liver disease
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Causes of gall stones
49. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
50. How does hirschsprung present and appear on imaging
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
In the mucus that covers the gastric epithelium
Unconjugated - water insoluble
Femoral hernia