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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. How do burns cause acute gastritis and What is it called
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2. To what substance is bilirubin conjugated and why
Glucouronate - water soluble (direct)
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Fe2+ in the duod
L3
3. Which kind of hemorrhoids are painful and why
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Alcoholic hepatitis
4. What are the barium swallow findings of achalasia
Celiac sprue
Repeated phlebotomy - deferoxamine - HLA- A3
Serous on the sides parotids - mucinous in the middle sublingual
Dilated esophagus with an area of distal stenosis - birds beak
5. Who gets gastric ulcers
Older patients
Oligosaccharide digestion
Left gastric vein and esophogeal vein - esophagus
Dilated esophagus with an area of distal stenosis - birds beak
6. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Osmotic
Crohns = maybe - UC= always
HPNCC
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
7. What causes carcinoid syndrome amd What are the symptoms
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Falciform - ligamentum teres - fetal umbilical vein
Can lead to hematemesis - found in EtOHics and bulimics
8. What does alpha amylase do and what inactivates it
Reye's syndrome
Lamina propria
Hemosiderosis - hemochromatosis
Begins starch digestion - inactivated by low pH upon reaching the stomach
9. What is the prognosis of adenocarcinoma
Averages 6 months - very aggressive - usually already metastasized at presentation
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Reye's syndrome
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
10. Malabsorption syndromes have what common clinical presentation
Diarrhea - steatorrhea - weight loss - weakness
Celiac sprue
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Jaundice - fever - RUQ
11. What structures feed into the common hepatic duct
Right and left hepatic duct
Myenteric nerve plexus - aurbach
Unconjugated - water insoluble
Inferior rectal nerve
12. What are the common causes of gastric ulcers - What causes gastric ulcer
The jejunum
Stimulate the H/K ATPase
Inspiratory arrest on deep palpation due to pain
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
13. What kind of muscle is in the middle 1/3 of esophagus
Inspiratory arrest on deep palpation due to pain
Brush border of intestine - produce monosaccharides from oligo and di
Striated and smooth
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
14. B cells stimuated in the germinal centers of peyers patches differentiate into what?
T cell lymphoma
In the ileum with bile acids - requires IF
IgA secreting plasma cells - ultimately reside in the lamina proporia
The entire
15. How are all 3 monosaccharides transported to the blood
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Dubin johnson
Boerhaave's Syndrome - Been heaving syndrome
GLUT 2
16. rare - often fatal childhood hepatoencephalopathy
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17. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
HSV-1 - CMV - Candida
Warthins' tumor
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Alpha amylase
18. What artery passes around the duodenum
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
The gastroduodenal
Jewish and African American men
Dense core bodies
19. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Gallbladder
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Barrett's esophagus
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
20. Where is there sclerosis in alcoholic cirrohosis
Crypts but not villi
Esophageal carcinoma
Diverticulum
Around the central vein (zone III)
21. In alchoholic hepatitis which liver enzyme is higher
Peyers patches
AST>ALT
M3 - Gq - inc IP3/Ca
L2
22. At what spinal level does the SMA exit
Crohns = maybe - UC= always
Muscularis mucosae
L1
Phototherapy
23. What are the borders of Hesselbach's triangle
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Antrum - H.pylori - inc risk of MALT lymphoma
Low pressure proximal to LES
Diverticulitis in elderly - ectopic pregs use hCG to rule out
24. What are the extraintestinal manifestations of ulcerative colitis
Gallbladder
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Pyoderma gangrenosum - primary sclerosing cholangitis
Urobilin
25. HCC is associated with what other conditions
Colovesical leading to pneumaturia
Alcoholic cirrhosis
Duodenum - 2nd - 3rd and 4th parts
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
26. What does loss of APC cause
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Sphincter of oddi
Decreased intercellular adhesion and increased proliferation
Hyperplastic
27. What does extrahepatic biliary obstruction cause
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
AST>ALT
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
28. involvement of left supraclavicular node by mets from stomach
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29. Where does an indirect inguinal hernia enter the deep inguinal ring
Portal HTN
Superior rectal
Lateral to the inferior epigastric artery
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
30. What is contained within the muscularis externa
Hyperpigmented mouth - lips - hands - genitalia
Myenteric nerve plexus - aurbach
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Hemosiderosis - hemochromatosis
31. What is the lumen of the pancreatic duct
Pleuroperitoneal
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Femoral hernia
Ampulla of vater
32. conjugated hyperbilirubinemia due to defective liver excretion
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Positive urease test
Dubin johnson
33. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Ampulla of vater
Zollinger Ellison - phenylalanine and tryptophan
Alk pho
34. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Gut bacteria
Left gastric vein and esophogeal vein - esophagus
CHF and inc risk of HCC
Adhesion
35. Where is folate absorbed
The jejunum
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
8-9 waves/min
Trypsin - chymotrypsin - elastase - carboxypeptidases
36. What cells make pepsin - What does it do - and what regulates it
Epithelium
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
VZV and influenza B treated with salicylates
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
37. Where are carcinoid tumors most commonly malignant
Lactase is located at the tips of intestinal villi
CCK8 receptor - Gq inc IP3/Ca
The proximal small bowel
Small intestine
38. How does gastrin increase acid secretion?
All 3 gut layers outpouch as in Meckels
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
CCK8 receptor - Gq inc IP3/Ca
Primarly through ECL leading to histamine release
39. 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
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
The entire
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
40. What test and result confirms H pylori infxn
H+
Positive urease test
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Lamina propora and submucosa
41. What is the leading cause of bowel incarceration
Closer to isotonic because of less time to reabsorb NaCl
Older patients
Femoral hernia
Pancreatic and bile
42. What cells secrete bicarb - What does it do - and what regulates it
Uremia
Colonic polyps
Common hepatic - splenic - left gastric - main blood supply for 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
43. What makes a true diverticula
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
All 3 gut layers outpouch as in Meckels
Below
Gastrohepatic ligament
44. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Can lead to hematemesis - found in EtOHics and bulimics
Failure of the processus vagainlis to close
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
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
45. What layer of fascia covers a direct inguinal hernia
External spermatic fascia only
Achalasia due to loss of myenteric plexus (auberach)
Ischemic colitis
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
46. What kind of muscle is in the lower 1/3 of the esophagus
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Smooth
GERD - may also present with nocturnal cough and dyspnea
Duodenum - 2nd - 3rd and 4th parts
47. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Glucouronate - water soluble (direct)
Brunners
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Colonic polyps
48. trypsinogen is converted to trypsin via what enzyme
Enterokinase/enteropeptidase from the duodenal mucosa
Lipase - phospholipase A - colipase
Above
Peyers patches
49. Where is bicarb trapped
Lactase is located at the tips of intestinal villi
Gamma glutamyl transferase GGT
In the mucus that covers the gastric epithelium
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
50. What portion of the bowel does sprue effect
The proximal small bowel
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Ischemic colitis
Dilated esophagus with an area of distal stenosis - birds beak