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 is biliary colic
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Zollinger Ellison - phenylalanine and tryptophan
Diverticulum
Crohns = maybe - UC= always


2. What are the structures of the femoral triangle and how are they organized
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Failure of neural crest migration
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
NAV = nerve artery vein - venous near the penis (NAVEL)


3. What are the complications of duodenal PUD
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Intussusception
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Bleeding - penetration into pancreas - perforation - obstruction


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

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5. What gives urine its characteristic color
Liver metabolizes 5HT
Urobilin
Gardner's syndrome
Hirschsprungs


6. What are the results of hemochromatosis
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
M3 - Gq - inc IP3/Ca
90%
CHF and inc risk of HCC


7. rare - often fatal childhood hepatoencephalopathy

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8. Dysphagia in achalasia results from
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Sphincter of oddi
Femoral hernia
Failure of neural crest migration


9. What pancreatic proteases are secreted as zymogens
Short gastrics - left greater and lesser
Dermatitis herpetiformis
Trypsin - chymotrypsin - elastase - carboxypeptidases
Decrease - weight gain


10. What are the two molecular pathways that lead to CRC
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Sphincter of oddi
MSI (15%) and APC/beta catenin chromosomal instability (85%)
T cell lymphoma


11. Which patients have pigment stones
All 3
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Poor anastamoses
Superior rectal and middle and inferior rectal - rectum


12. Which kind of hemorrhoids are painful and why
Celiac sprue
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Myenteric nerve plexus - aurbach
The submucosal nerve plexus - meissner's


13. What is the most common indication of emergent abdominal surgery in children
T cell lymphoma
Appendicitis
External spermatic fascia only
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria


14. What layer in the mucosa is responsible for support
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Lamina propria
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Hydrocele


15. involvement of left supraclavicular node by mets from stomach

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16. What is Trousseau's sign
Redness and tenderness on palpation of extremities
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Cystic duct and common hepatic duct
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD


17. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Alcoholic hepatitis
Fe2+ in the duod
Celiac sprue


18. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
12 waves/min
Juvenille polyps - no risk if single
AST >ALT - ration is usually 1.5


19. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
PAS- positive globules in liver -
H2 receptor - inc cAMP
Ischemic colitis
Achalasia due to loss of myenteric plexus (auberach)


20. What does extrahepatic biliary obstruction cause
Lateral to the inferior epigastric artery
Failure of the processus vagainlis to close
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Inc risk of CRC and other visceral malignancies


21. What are the complications of acute pancreatitis
T12
Failure of neural crest migration
External spermatic fascia only
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure


22. What is the epi for CRC
Budd chiari syndrome
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Dense core bodies
Centrilobular congestion and necrosis - cardiac cirrhosis


23. What are additional risk factors for CRC
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Jewish and African American men
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx


24. What is the lumen of the pancreatic duct
Cystic dilation of the viteline duct
Dec PGE2 leading to dec gastric mucosa protection
Alpha1 antitrypsin def - codominant trait
Ampulla of vater


25. Bilirubin is the product of what?
Older patients
External spermatic fascia only
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Heme metabolism


26. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Alpha1 antitrypsin def - codominant trait
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Zenkers - halitosis - dysphagia and obstruction


27. What is the frequency of basal electric rhythm of the stomach
Alcoholic hepatitis
3 waves/min
Alfatoxin in peanuts
Obstruction of the common bile duct


28. What do the rugae of stomach look like in menetriers disease
In the mucus that covers the gastric epithelium
So hypertrophied they look like brain gyri
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Stimulate intestinal persistalsis


29. Gallstones that reach the common channel at ampulla can block which two ducts
Increase tumorigenesis
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Pancreatic and bile
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum


30. Acute gastritis is caused By what process
True and most common congenital anomoly of GI tract
Myenteric nerve plexus - aurbach
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Erosive - disruption of mucosal barrier leading to inflammation


31. What are the hindgut structures and what supplies their blood and PANS innvervation
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
L/R renal artery around L1
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD


32. What does loss of APC cause
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Decreased intercellular adhesion and increased proliferation
Positive
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder


33. What is the TX of physiologic neonatal jaundice
Acute pancreatitis
Phototherapy
Alcoholic hepatitis
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose


34. What layer in the mucosa is repsonsible for motility
Positive
Muscularis mucosae
GERD - may also present with nocturnal cough and dyspnea
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith


35. When and How does Abetalipoproteinemia present
AR
Older patients
AST>ALT
Early childhood - neuro sx and malabsorption


36. What are the histological findings in the ileum

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37. Transmural esophageal rupture due to violent retching

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38. What does GET SMASHED stand for in acute pancreatitis
Hepatic steatosis
H pylori (almost 100%)
Neutralizes oral bacertial acids and maintains dental health
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)


39. At what level of the spine does the IM exit the aorta
Epithelium
Stimulate intestinal persistalsis
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
L3


40. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Oral glucose
Inferior rectal nerve
Squamous - upper 1/3 - adeno - lower 1/3
Dubin johnson


41. What test and result confirms H pylori infxn
Positive urease test
Heme metabolism
True and most common congenital anomoly of GI tract
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn


42. Where and How is iron absorbed
Right and left hepatic duct
Fe2+ in the duod
Zollinger ellison - brunners glands
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial


43. What are motilin receptor agonists used for clinically
Fasting and stress
AST>ALT
Left gastric vein and esophogeal vein - esophagus
Stimulate intestinal persistalsis


44. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Meckels
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
L1
Serous on the sides parotids - mucinous in the middle sublingual


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

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46. What is the rate limiting step of carbohydrate digestion
Positive urease test
Oligosaccharide digestion
H+
The jejunum


47. Failure of relaxation of lower esophageal sphincter - Name and etiology
GERD - may also present with nocturnal cough and dyspnea
Achalasia due to loss of myenteric plexus (auberach)
Hypotonic because of more time to reabsorb NaCl
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN


48. Where are carcinoid tumors most commonly malignant
Penicillinamine - AR inheritance
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Small intestine
8-9 waves/min


49. List the clinical findings of HCC
L3
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Stimulate intestinal persistalsis
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia


50. What receptors does ACH bind on the parietal cells and What does it activate
M3 - Gq - inc IP3/Ca
Hypercoaguability - polycythemia vera - pregnancy - HCC
Where hindgut meets ectoderm
ALT>AST