GI

Question 1

most common salivary gland tumor

Answer 1

pleomorphic adenoma
epithelial and mesenchymal tissue
often affects the parotid gland as a painless mobile mass

Question 2

second most common benign salivary tumor

Answer 2

Warthin’s tumor

double layer of epithelial tissue around a benign germinal center (lymphoid like)

Question 3

most common malignant salivary tumor

Answer 3

mucoepidermoid carcinoma
mucinous and squamous components
painful mass that involves facial nerve commonly

Question 4

extruding viscera covered by sac and sometimes includes liver

Answer 4

omphalocele

Question 5

extruding viscera not covered by sac

Answer 5

gastroschisis

Question 6

esophageal diverticula and location

Answer 6

Zenker diverticulum: above UES
Traction: middle esophagus
Epiphrenic: above LES

Question 7

Plummer-Vinson syndrome

Answer 7

Dysphagia (esophageal webs), glossitis, and iron deficiency anemia

Question 8

hematemesis with retching

Answer 8

Mallory-Weiss syndrome

Question 9

specialized columnar epithelium on biopsy of esophagus

Answer 9

Barrett’s

Question 10

biopsy of a pt with esophagitis reveals large pink intranuclear inclusions and host cell chromatin that is pushed to the edge of the nucleus

Answer 10

HSV-1

Question 11

biopsy of pt with esophagitis reveals enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclear halo

Answer 11

CMV: cytomegalovirus

Question 12

esophageal biopsy reveals lack of ganglion cells between inner and outer muscular layers

Answer 12

Achalasia

Question 13

protrusion of the mucosa in the upper esophagus

Answer 13

esophageal web

associated with Plummer-Vinson

Question 14

outpouching of all layers of the esophagus found just above the LES

Answer 14

epiphrenic diverticulum

Question 15

goblet cells seen in the distal esophagus

Answer 15

Barrett’s

Question 16

a PAS stain on a biopsy obtained from pt with esophagitis reveals hyphate organisms

Answer 16

candida

Question 17

esophageal pouch found in the upper esophagus

Answer 17

Zenker diverticulum

Question 18

esophageal adenocarcinoma

Answer 18

progressive dysphagia and weight loss
Barrett’s, smoking, obesity and GERD predispose
most common in US

Question 19

esophageal squamous cell carcinoma

Answer 19

progressive dysphagia and weight loss
alcohol, diverticula, esophageal web, and hot liquids predispose
most common worldwide

Question 20

what receptors increase acid production

Answer 20

M3: ACh from vagus (atropine blocks)
H2: histamine from ECL cells stimulated by gastrin (H2 blockers)
CCKB: gastrin
prostaglandins and somatostatin inhibit

Question 21

stimulators of gastrin

Answer 21

phenylalanine, tryptophan, calcium

Question 22

stomach biopsy reveals neutrophils above the basement membrane, loss of surface epithelium, and fibrin-containing purulent exudate

Answer 22

acute gastritis

Question 23

stomach biopsy reveals lymphoid aggregates in the lamina propria, columnar absorptive cells, and atrophy of glandular structures

Answer 23

chronic gastritis

Question 24

diffuse thickening of gastric folds, elevated serum gastrin levels, biopsy reveals glandular hyperplasia without foveolar hyperplasia

Answer 24

Zollinger-ellison syndrome

Question 25

antacid causing diarrhea

Answer 25

magnesium hydroxide

Question 26

antacid causing constipation

Answer 26

aluminum hydroxide

Question 27

antacid causing hypercalcemia

Answer 27

calcium carbonate

Question 28

antacid causing hypokalemia

Answer 28

all 3 antacids

Question 29

Virchow's node

Answer 29

stomach cancer with mets to left supraclavicular node

Question 30

Krukenberg's tumor

Answer 30

bilateral mets to ovaries from stomach cancer | signet ring cells

Question 31

Sister Mary Joseph nodule

Answer 31

stomach cancer met to periumbilical nodes

Question 32

mucin-filled cell with a peripheral nucleus

Answer 32

signet ring cell (gastric and LCIS)

Question 33

most common type of stomach cancer

Answer 33

adenocarcinoma (US) | squamous cell worldwide

Question 34

ovarian metastasis from gastric cancer

Answer 34

Krukenberg tumor

Question 35

Gastric ulcerations and high gastrin levels

Answer 35

Zollinger-Ellison syndrome

Question 36

acute gastric ulcer associated with elevated ICP or head trauma

Answer 36

Cushing ulcer | brain injury causes increased vagal stimulation which increases ACh and acid

Question 37

acute gastric ulcer associated with severe burns

Answer 37

Curling ulcer | burns decreases plasma volume and cause sloughing of gastric mucosa

Question 38

retroperitoneal structures

Answer 38

A DUCK PEAR | adrenal glands, duodenum, ureters, colon, kidneys, pancreas, esophagus, aorta, rectum

Question 39

Prokinetic agents

Answer 39

cholinergic agonists (-chol) AChE inhibitors metocloproamide (5-HT4 agonist and D2 antagonist) macrolides (stimulate motilin receptors for MMC)

Question 40

antibodies associated with celiac sprue

Answer 40

anti-gliadin anti-transglutaminase anti-endomysial

Question 41

small intestinal muscosa laden with distended macrophages in the lamina propria (filled with PAS+ granules and rod-shaped bacilli seen on EM)

Answer 41

Whipple's disease | Tropheryma whipplei bacteria

Question 42

defect in chylomicron exportation

Answer 42

abetaliprproteinemia

Question 43

cramping associated with milk product

Answer 43

Lactase deficiency | disaccharidase def

Question 44

weight loss, diarrhea, arthritis, fever, adenopathy, and hyperpigmentation

Answer 44

Whipple disease

Question 45

common causes of small bowel obstruction

Answer 45

Adhesions Bulge/Hernia Cancer/Tumor (metastatic colorectal cancer)

Question 46

Classic symptoms of carcinoid syndrome

Answer 46

Bronchospasm Flushing Diarrhea Right sided heart murmur (valvular disease)

Question 47

which pathological lesions of the colon are precancerous

Answer 47

adenomatous polyps

Question 48

most common cancer of the appendix

Answer 48

carcinoid

Question 49

GI hamartomas, hyperpigmentation of the mouth and hands

Answer 49

Peutz-Jeghers syndrome

Question 50

multiple colon polyps, osteomas, soft tissue tumor

Answer 50

Gardner syndrome

Question 51

"apple core" lesion on barium enema

Answer 51

colon cancer

Question 52

treatment for diverticulitis

Answer 52

metronidazole and fluoroquinalone or TMP-SMX

Question 53

most common cause of acute RLQ pain

Answer 53

appendicitis

Question 54

most common cause of acute LLQ pain

Answer 54

diverticulitis

Question 55

most common cause of acute RUQ pain

Answer 55

cholecystitis

Question 56

colonoscopy reveals very friable mucosa extending from the rectum to the distal transverse colon

Answer 56

ulcerative colitis

Question 57

most common site of colonic diverticula

Answer 57

sigmoid

Question 58

"string sign" on contrast x-ray

Answer 58

Crohn's

Question 59

"lead pipe" appearance of colon on contrast x-ray

Answer 59

Ulcerative colitis

Question 60

what hormones stimulate pancreatic secretion

Answer 60

CCK and secretin

Question 61

rate-limiting step of carbohydrate digestion

Answer 61

oligosaccharide hydrolases

Question 62

causes of acute pancreatitis

Answer 62

``` BAD HITS biliary alcohol drugs (esp HIV protease inhibitors) Hypertriglyceridemia/hypercalcemia idiopathic trauma scorpion sting ```

Question 63

painless jaundice

Answer 63

pancreatic cancer

Question 64

most common cause of acute pancreatitis

Answer 64

gallstones and alcohol

Question 65

most common cause of chronic pancreatitis

Answer 65

alcohol

Question 66

enzyme responsible for conjugation of bilirubin

Answer 66

UDP glucuronyl transferase

Question 67

mildly decreased UDPGT

Answer 67

Gilbert syndrom

Question 68

completely absent UDPGT

Answer 68

Crigler-Najjar type I

Question 69

grossly black liver

Answer 69

dubin-johnson

Question 70

responds to phenobarbital

Answer 70

Crigler-Najjar type II

Question 71

treatment includes plasmapharesis and phototherapy

Answer 71

Crigler-Najjar type I

Question 72

asymptomatic unless under physical stress

Answer 72

Gilbert syndrome

Question 73

severe hyperbilirubinemia in a neonate

Answer 73

Crigle-Najjar type I

Question 74

mild, benign hyperbilirubinemia

Answer 74

Gilbert syndrome

Question 75

signs of portal HTN

Answer 75

caput medusae, esophageal varices, hematemesis and melena, hemorrhoids, splenomegaly, ascites

Question 76

drug cocktail for severe cirrhosis pt

Answer 76

diuretics, B-blocker, vit K, lactulose (for encephalopathy)

Question 77

triglyceride accumulation in hepatocytes

Answer 77

fatty liver disease

Question 78

eosinophilic inclusion in the cytoplasm of hepatocytes

Answer 78

Mallory bodies | seen in alcoholic hepatitis

Question 79

cancer closely linked to cirrhosis

Answer 79

hepatocellular carcinoma

Question 80

what is Budd-Chiari syndrome

Answer 80

occlusion of IVC or hepatic veins

Question 81

what is associated with Budd-Chiari syndrome

Answer 81

polycythemia vera, pregnancy, hepatocellular carcinoma

Question 82

mech of aspirin in Reye syndrome

Answer 82

aspirin inhibits mitochondrial enzymes which decreases B oxidation

Question 83

underlying problem in Wilson's disease

Answer 83

impaired copper excretion and accumulation in liver

Question 84

asterixis, basal ganglia degeneration, Parkinsonian, Kayser-Fleischer rings, decreased ceruloplasmin, cirrhosis

Answer 84

Wilson's disease

Question 85

treatment of Wilson's

Answer 85

penicillamine

Question 86

Diabetes, bronze skin, and cirrhosis

Answer 86

classic triad of hemochromatosis

Question 87

lab tests and treatment for hemochromatosis

Answer 87

increased ferritin, transferrin saturation, and serum iron, decreased TIBC TX: phlebotomy and deferoxamine

Question 88

risk factors for hepatocellular carcinoma

Answer 88

hep B and C, hemochromatosis, alpha 1 antitrypsin dis, hepatic adenoma, cirrhosis

Question 89

hepatomegaly, abdominal pain, ascites

Answer 89

Budd-Chiari syndrome

Question 90

green/yellow corneal deposits

Answer 90

Kayser-Fleischer rings (Wilson's disease)

Question 91

low serum ceuloplasmin

Answer 91

Wilson disease

Question 92

cirrhosis, diabetes, hyperpigmentation

Answer 92

hemochromatosis

Question 93

cholelithiasis

Answer 93

gallstones

Question 94

cholecystitis

Answer 94

inflammation/infection of gallbladder

Question 95

cholangitis

Answer 95

inflammation/infection of biliary tree

Question 96

choledocholithiasis

Answer 96

gallstones in biliary tree

Question 97

intrahepatic causes of biliary obstruction

Answer 97

primary biliary cirrhosis primary sclerosing cholangitis drugs

Question 98

extrahepatic causes of biliary obstruction

Answer 98

pancreatic neoplasms sclerosing cholangitis cholangiocarcinoma choledocholithiasis

Question 99

Primary biliary cirrhosis

Answer 99

autoimmune infection in middle aged females | anti-mitochondrial antibodies (AMA)

Question 100

primary sclerosing cholangitis

Answer 100

fibrosis of bile duct in men over 40 | positive pANCA and beads on a string sign

Question 101

50yo woman presents with pruritis without jaundice and lab reveals positive AMA

Answer 101

primary biliary cirrhosis

Question 102

patient with GI bleeding has buccal pigmentation

Answer 102

Peutz-Jeghers syndrome

Question 103

60yo woman with RA and no alcohol history presents with fatigue and right abdominal pain; lab studies reveal high levels of ANA and ASMA, elevated serum IgG, and no viral serologic markers

Answer 103

autoimmune hepatitis (classic)

Question 104

liver biopsy on a 23yo woman with elevated levels of LKM-1 antibodies, no alcohol history, and no viral serologic markers; shows infiltration of the portal and periportal area with lymphocytes

Answer 104

autoimmune hepatitis

Question 105

ERCP reveals alternating strictures and dilation

Answer 105

primary sclerosing cholangytis

Question 106

weight lifter undergoes emergency surgery for life threatening condition. examination of section of small bowel reveals focal hemorrhages. what is responsible

Answer 106

incarcerated inguinal hernia

Question 107

in addition to colon cancer, what is one of the most common causes of GI bleeding in the elderly

Answer 107

angiodysplasia