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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 congenital birth defect is associated with Hirschsprung
Crohns = noncaseating granulomas - UC = crypt abscesses
Alk pho
Myenteric nerve plexus - aurbach
Downs
2. At what level of the spine does the IM exit the aorta
Black - rotors syndrome
L3
Paraumbilical and superficial and inferior epigastric - umbilicus
Dubin johnson
3. What is the most common esophageal cancer worldwide and in the US
Nonkeritinized stratified sqamous epithelium
Worldwide - SC - US - adeno
L4
When diffusely infiltrative - thickened rigid appearance like a leather bottle
4. What is contained in the gastrosplenic and What areas does it separate
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
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
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
5. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Left gastric vein and esophogeal vein - esophagus
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
6. What is the lumen of the pancreatic duct
Decreased intercellular adhesion and increased proliferation
Ampulla of vater
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Lateral to the inferior epigastric artery
7. What reaction does salivary amylase catalyze
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Positive urease test
Inc lower esphogeal tone leading to achalasia
8. How are all 3 monosaccharides transported to the blood
GLUT 2
Esophageal cancer
Crigler - najjar type 1
Lamina propria
9. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Brunners
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Mallory bodies
Complications of crohns
10. What serum enzyme is elevated in acute pancreatitis and mumps
Amylase
Colonic polyps
H pylori (almost 100%)
Alpha1 antitrypsin def - codominant trait
11. What do tumors that arise in the head of the pancreas cause
Epithelium
Antrum - H.pylori - inc risk of MALT lymphoma
Obstruction of the common bile duct
Short gastrics - left greater and lesser
12. what percentage of colonic polyps are non - neoplastic
90%
Esophageal carcinoma
2ndary biliary cirrhosis
Alcoholic cirrhosis
13. Where is folate absorbed
The jejunum
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Lubricate food (glycoprotiens)
With albumin
14. What is the cause of Barrett's and the assocaited complications
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Complications of UC
Neural muscarinic pathways
Stercobilin
15. What does K- ras mutation cause
Upregulated intracellular signal transduction
Carcinoid syndrome
Sister mary joseph nodule
Neutralizes gastric acid allowing pancreatic enzymes to fxn
16. What layer in the mucosa is responsible for absorption
H+
Virchow's node
Epithelium
Krukenbergs tumor
17. What is one potential precipitating factor for intussusception
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
Closer to isotonic because of less time to reabsorb NaCl
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
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
18. What structure is Not contained in the femoral sheath
Celiac sprue
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
19. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Alk pho
20. Where are carcinoid tumors most commonly malignant
Crypts but not villi
Small intestine
Striated
IgA secreting plasma cells - ultimately reside in the lamina proporia
21. Where is bicarb trapped
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Juvenille polyps - no risk if single
Striated and smooth
In the mucus that covers the gastric epithelium
22. What histological findings are present in the stomach
Gastric glands
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
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
23. What percentage of gall stones are cholesterol stones and What are the associations
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Falciform - ligamentum teres - fetal umbilical vein
Alk pho
Esophageal varices
24. What are the complications of Meckels
Repeated phlebotomy - deferoxamine - HLA- A3
Serous on the sides parotids - mucinous in the middle sublingual
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Redundant mesentary
25. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
Skip lesions =crohns - colon = UC
Jaundice - fever - RUQ
In the mucus that covers the gastric epithelium
Inc conj bilirubin - inc cholesterol - inc alk phos
26. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Gallbladder
Krukenbergs tumor
Cholesterol - 10-20% opaque due to calcifications
Hemosiderosis - hemochromatosis
27. At what spinal level does the is the bifurcation of aorta
Lipase - phospholipase A - colipase
L4
Conj/unconj - inc - nl to dec
Left gastric vein and esophogeal vein - esophagus
28. When and why is stomach cancer termed linitis plastica
Inspiratory arrest on deep palpation due to pain
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Celiac sprue
When diffusely infiltrative - thickened rigid appearance like a leather bottle
29. 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
Liver metabolizes 5HT
Jaundice - fever - RUQ
Inspiratory arrest on deep palpation due to pain
30. What is the risk with peutz jehgers
Lateral
Below
Alfatoxin in peanuts
Inc risk of CRC and other visceral malignancies
31. What does a low flow rate mean for saliva
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Decreased intercellular adhesion and increased proliferation
Crohns = noncaseating granulomas - UC = crypt abscesses
Hypotonic because of more time to reabsorb NaCl
32. Autodigestion of pancreas by pancreatic enzymes
Acute pancreatitis
Terminal ileum and colon
Necrotizing enterocolitis
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
33. What kind of muscle is in the middle 1/3 of esophagus
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Striated and smooth
Below
Penicillinamine - AR inheritance
34. What are the complications of acute pancreatitis
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
CEA - CA-19-9
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Centrilobular congestion and necrosis - cardiac cirrhosis
35. Which IBD is autoimmune and which may be a disordered response to bacteria
GLUT 2
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
36. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery
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37. What artery passes around the duodenum
The gastroduodenal
Brunners
EtOH
Elevated amylase - and lipase
38. In viral hepatitis - which liver enzyme is higher
Alcoholic cirrhosis
Pertechnetate - study for uptake
Sphincter of oddi
ALT>AST
39. What does loss of p53 cause
Gilbert's
Increase tumorigenesis
Amylase
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
40. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Zollinger ellison - brunners glands
External spermatic fascia only
External (superficial) ring only
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
41. What is a positive murphy's sign
Dense core bodies
Ceruplasmin
Oligosaccharide digestion
Inspiratory arrest on deep palpation due to pain
42. Where does copper accumulate in Wilsons and What are ABCD
Inguninal ligament - sartorius muscle - adductor longus
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Angiodysplasia
43. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Crohns = maybe - UC= always
EtOH
Alpha amylase
Boerhaave's Syndrome - Been heaving syndrome
44. Where does crohns usually affect the GI tract
Terminal ileum and colon
Inc - weight loss
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Esophageal cancer
45. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
HPNCC
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Dermatitis herpetiformis
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
46. concentric onion skin bile duct fibrosis
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
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
Primary sclerosing cholangitis
47. What are the complications of chronic pancreatitis
Esophageal carcinoma
Primary sclerosing cholangitis
Causes of gall stones
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
48. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Volvulus
All 3
Jewish and African American men
Meconium ileus
49. What is biliary colic
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Dermatitis herpetiformis
Poor anastamoses
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
50. conjugated hyperbilirubinemia due to defective liver excretion
IgA secreting plasma cells - ultimately reside in the lamina proporia
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
NAV = nerve artery vein - venous near the penis (NAVEL)
Dubin johnson