You are caring for a 45-year-old male with a 10 year history of gastroesophageal reflux disease (GERD). He underwent endoscopy and was found to have Barrett's Esophagus. You counsel him that he is at risk for development of Esophageal Adenocarcinoma and that another risk factor that he may want to consider stopping or changing is:
use of antacids
Which of the following prevents the pancreas from digesting itself?
Digestive enzymes secreted in their active form
Enterokinase is separated from the pancreas.
High concentrations of Calcium in pancreatic secretion.
Trypsin activator is secreted from the acinar cells.
You are seeing a 53yoF with end-stage renal disease (ESRD) on dialysis. She has not been able to keep up with her nutritional needs on diet alone and you are talking about starting a supplemental formula. What is the best choice of formula for this patient?
Formula low in potassium and protein
Formula high in sodium and potassium
Formula with high amounts of medium chain triglycerides
Formula low in fat and carbohydrates
A 45-year-old man is brought to the emergency department with a shallow knife wound to the abdomen. The knife entered the
anterior abdominal wall at the midline, just inferior to the xiphoid process of the sternum. Which of the following structures is
located most superficially in this area, and is most likely to have been lacerated by the knife?
You have a 52 yo M patient with acute onset epigastric abdominal pain, nausea, vomiting, and tachycardia. You suspect he has acute alcohol-related pancreatitis. He is admitted to the hospital, kept from eating (NPO) for 24-hours and his pain seems well controlled. He does not have any desire to resume eating. Which of the following treatment options would you consider for this patient?
You are eating a fatty meal consisting of a double bacon cheeseburger and large fries. After your stomach starts to release the
chyme into the duodenum, which cell type is stimulated by the fatty content of the meal?
What is the main viral target site for Rotavirus, Astrovirus, Calicivirus, and Adenovirus?
differentiated epithelial cells
intraintestinal blood capillaries
immature epithelial cells
Which area of the GI tract accounts for the most absorption of nutrients?
You are caring for a 29yo M who was stabbed in the right lower quadrant (RLQ) four years ago and lost a significant portion of his
right colon and terminal ileum. He has been eating all foods including green leafy veggies again and despite his 4-6 loose stools a
day has been generally well. Over the last 2-months, he has had increasing fatigue. He has a macrocytic anemia. Which lab test is best to order next to confirm the suspected vitamin deficiency?
Iron/Total Iron Binding Capacity
Folic acid level
25-OH vitamin D level
Secondarily retroperitoneal organs were initially intraperitoneal. Which of the following structures is secondarily retroperitoneal and fused with the posterior abdominal wall?
Which of the following is a defining characteristic of the liver?
The flow of blood within a liver lobule is directed from the central vein toward the area of the portal triad
Blood from both the hepatic artery and the hepatic portal vein enter the central vein of a liver lobule.
The flow of bile within a hepatic lobule is in the same direction as the flow of blood.
The three principle conduits that define the portal triad are components of the circulatory system.
Use the image attached to answer the following question. This image of swelling on the left supraclavicular space is most
consistent with which of the following diagnosis?
You are taking care of a patient who has severe gastroparesis. You have been trying to feed into the stomach for the last 6-weeks with continued problems of vomiting due to slow gastric motility. You are talking with your patient about a SHORT TERM trial of a feeding tube for enteral feeds. What is the best feeding tube option for this patient?
Gastrostomy tube (G-tube)
Central line (CVL)
A 28-year-old woman who is 8-months pregnant goes to the outpatient clinic for her prenatal checkup. An ultrasound examination
of the fetus reveals Gastroschisis, with herniation of the small bowel into the amniotic cavity. Which of the following embryonic
structures failed to form normally, resulting in this condition?
The lateral folds (incorporating the midgut).
The head fold (incorporating the foregut).
The tail fold (incorporating the hindgut).
The neural folds (closure of the rostral and caudal neuropores).
Use the image attached to answer the following question. A 65-year-old man presented to your office with epigastric pain. His past
medical history is notable for chronic pancreatitis related to alcohol ingestion. He is a 2 PPD smoker. Physical examination
disclosed epigastric tenderness with a palpable gallbladder. CT scan disclosed a mass in the head of the pancreas. He eventually
underwent a Whipple procedure, and final pathology is consistent with adenocarcinoma. A representative H&E image of his
malignancy is shown. If molecular testing were pursued, which is the most likely earliest precursor gene mutation in the evolution
from IPMN to adenocarcinoma?
What is the best initial screening test for celiac disease?
Serum tissue transglutaminase (tTG)
Blood HLA-DQ genotyping
You are caring for a patient with pancreatic insufficiency and you're having a hard time finding the right dose of pancreatic
replacement enzyme (PERT) so he is still having copious amounts of steatorrhea (fat excretion in the stool). You want to improve his weight gain by adding fat into the diet. Which type of fat can you add that is most likely to be absorbed?
long chain fatty acids
di and tri peptides
medium chain fatty acids
You are caring for a 45yoM recovering alcoholic, who has been alcohol free for the last 5-months. He states ³I never want to drink again´and has been taking vitamins that were recommended to him. On further discussion you figure out he has been taking 4-times the recommended daily dose of niacin. What are the side effects he has been exhibiting?
nausea, vomiting, diarrhea and fatigue
central nervous system excitation
The synthesis and secretion of bile is a primary function of which of the following?
the gall bladder mucosa
the epithelium lining the bile ducts
If you are performing a total gastrectomy (i.e., resection of the entire stomach) on a patient, which artery would you be very careful
NOT to ligate (i.e., "tie off"
hepatic artery proper
left gastroepiploic artery
right gastric artery
short gastric arteries
When gastrin is released from G-cells of the stomach, it has a paracrine reaction to the enterchromaffin cells to release which
Which of the following ligamentous structures (i.e. mesenteries) is attached to the liver?
The defining role of pancreatic islets is which of the following?
Store and secrete digestive enzymes
Alveolar secretory units that drain into intercalated ducts
Secrete hormones such as glucagon and insulin into the blood
Secrete a bicarbonate rich fluid that neutralizes acidic chime within the duodenum
You are reviewing the biopsy slides of a 45yoF with intermittent abdominal pain and diarrhea. On the slides you note villus blunting and an increase in intraepithelial lymphocytes. What is this patient's diagnosis?
H. pylori infection
A 33 yo woman presents with worsening chronic epigastric abdominal pain and loose stools. CT imaging of her abdomen demonstrates atrophy of the pancreas with pancreatic calcifications and pseudocysts, consistent with chronic pancreatitis. The most likely etiology of her chronic pancreatitis is which of the following?
You are caring for a 13-month-old female who presents with a 3-day history of watery non-bloody diarrhea that is occurring 8-10 times a day. Yesterday she had a fever to 38.9C. She has also vomited 3-4 times a day during the last 2 days, but has not vomited today. She last urinated 6 hours ago. Which therapy option is the best to offer at this time?
Oral rehydration therapy
Acid suppression (omeprazole)
Which types of proteins can be absorbed by the enterocyte?
di and tripeptides
A 22-year old female is presenting with chronic constipation and recurrent bacterial vaginitis. On exam you note that she has poor rectal tone and there seems to be feculent material in her vaginal discharge. What is the most likely congenital defect that would cause these symptoms?
Of the 9 liters of water that the GI system sees every day how much is absorbed by the small intestine?
You are rotating through a family medicine clinic when you see a 57yoF who has generally been healthy and now presents with redness and tenderness of her legs. The redness has been moving to different parts of her legs, but mostly on the posterior aspect of the lower leg. It is tender to palpation and you feel some superficial cords that are mobile under your fingers. Which GI cancer is
this associated with?