Instructions:

• Answer 50 questions in 15 minutes.
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• 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
Osmotic
Downs
Begins starch digestion - inactivated by low pH upon reaching the stomach
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin


2. What are the histological findings of the colon
Inspiratory arrest on deep palpation due to pain
Crypts but not villi
Lamina propora and submucosa
Ischemic colitis


3. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue

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4. subQ peribumbilical metastasis
Inguninal ligament - sartorius muscle - adductor longus
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
Sister mary joseph nodule
GERD - may also present with nocturnal cough and dyspnea


5. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Via the superior pancreaticduodenal
Left gastric vein and esophogeal vein - esophagus
Esophageal cancer
Low pressure proximal to LES


6. rare - often fatal childhood hepatoencephalopathy

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7. What separates the right greater and lesser sacs
Gastrohepatic ligament
Mallory bodies
Brush border of intestine - produce monosaccharides from oligo and di
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)


8. inflammatino of gallbadder
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Right and left hepatic duct
True and most common congenital anomoly of GI tract
Alcoholic cirrhosis


9. What layer in the mucosa is responsible for absorption
Phenobarbital - inc liver enzyme synthesis
Repeated phlebotomy - deferoxamine - HLA- A3
Epithelium
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS


10. likely infectious form of malabsorption - responds to antibiotics
Complications of UC
Tropical sprue
Neutralizes oral bacertial acids and maintains dental health
Hyperpigmented mouth - lips - hands - genitalia


11. How does CRC present in the distal and proximal colon
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Hepatic steatosis
The gastroduodenal
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin


12. Gastrin - source - action - regulation
Mucoepidermoid carcinoma
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
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith


13. What are the hindgut structures and what supplies their blood and PANS innvervation
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
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Ischemic colitis
Reye's syndrome


14. What kind of pancreatitis is associated with EtOH and smoking
All 3 gut layers outpouch as in Meckels
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Decrease - weight gain
Cystic dilation of the viteline duct


15. At what spinal level does the celiac trunk exit
Inc lower esphogeal tone leading to achalasia
Epithelium
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
T12


16. What carcinogens are associated with HCC
Alfatoxin in peanuts
Hernia
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Above


17. Which is used more quickly - an oral glucose load - or that by IV
Alcoholic hepatitis
Unconjugated - water insoluble
Oral glucose
External spermatic fascia only


18. What transforms conjugated bilirubin to urobilinogen
H+
Gut bacteria
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
Mallory bodies


19. What is the most important mechanism in gastric acid secretion
Upregulated intracellular signal transduction
Diverticulum
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers


20. What is the classic triad of hemochromatosis

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21. What is diverticulosis
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
8-9 waves/min


22. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery

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23. How does brain injury lead to acute gastritis and What is it called
Crohns = maybe - UC= always
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
NAV = nerve artery vein - venous near the penis (NAVEL)
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion


24. FAP + osseous and soft tissue tumors - retinal hyperplasia

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25. What drug inhibits the H/K ATPase
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Necrotizing enterocolitis
Omeprazole
Smooth


26. What pancreatic enzymes are responsible for fat digestion
Lipase - phospholipase A - colipase
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Pancreatic and bile
High LES opening pressure and uncoordinated peristalsis - both solids and liquids


27. what percentage of colonic polyps are non - neoplastic
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Cimetidine
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
90%


28. Why does volvulus occur more at cecum and sigmoid colon
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
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
The jejunum
Redundant mesentary


29. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
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
Hypercoaguability - polycythemia vera - pregnancy - HCC
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Alpha1 antitrypsin def - codominant trait


30. What are the histological findings in the jejunum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
MSI (15%) and APC/beta catenin chromosomal instability (85%)
PAS- positive globules in liver -
Cigarettes and chronic pancreatitis - not EtOH


31. At what level of the spine does the IM exit the aorta
L3
Repeated phlebotomy - deferoxamine - HLA- A3
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
US and cholecystectomy


32. What is the path of an indirect inguinal hernia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
T12
Paraumbilical and superficial and inferior epigastric - umbilicus


33. What arteries exit just below the SMA
L/R renal artery around L1
Increase tumorigenesis
Upregulated intracellular signal transduction
NAV = nerve artery vein - venous near the penis (NAVEL)


34. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Carcinoid syndrome
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
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Crohns = noncaseating granulomas - UC = crypt abscesses


35. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus

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36. What are the midgut structures and what supplies their blood and PANS innervation
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
AST>ALT
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Female - fat - fertile - forty


37. What are the complications of Meckels
Left and right gastroepiploics - left and right gastrics
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Cirrhosis
Alpha1 antitrypsin def - codominant trait


38. Where does type A chronic gastritis occur and What causes it
Mucosa - submucosa - muscularis externa - serosa/adventitia
Gastrohepatic ligament
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial


39. What kind of anemia is in Wilsons
Increase tumorigenesis
Trypsin - chymotrypsin - elastase - carboxypeptidases
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Hemolytic anemia


40. Where is the pectinate line
Hirschsprungs
Reye's syndrome
L2
Where hindgut meets ectoderm


41. What kind of insults results in macronodular cirrhosis
Corticosteroids - infliximab
Colovesical leading to pneumaturia
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Tropical sprue


42. What does GET SMASHED stand for in acute pancreatitis
Lateral to the inferior epigastric artery
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)


43. What is a positive murphy's sign
Lactase is located at the tips of intestinal villi
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Inspiratory arrest on deep palpation due to pain
Superior rectal


44. What do tumors that arise in the head of the pancreas cause
H pylori (almost 100%)
Celiac sprue
Obstruction of the common bile duct
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion


45. What are the treatmet options for crohns
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
L/R renal artery around L1
Left and right gastroepiploics - left and right gastrics
Corticosteroids - infliximab


46. What does extrahepatic biliary obstruction cause
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
L4
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)


47. What serum enzyme is decreased in wilsons disease
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
So hypertrophied they look like brain gyri
Ceruplasmin


48. Which patients have pigment stones
CHF and inc risk of HCC
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
2ndary biliary cirrhosis
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial


49. What are the complications of duodenal PUD
Bleeding - penetration into pancreas - perforation - obstruction
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Conj/unconj - inc - nl to dec


50. Bile is critical for exrection of what substance
L3
Superior rectal
Cholesterol
External spermatic fascia only