Histology of Oral Cavity

1. What consists of epithelium and the underlying loose connective tissue and may contain a third, thin smooth muscular layer muscularis mucosae?

2. The tunica mucosa covers the cavities connected where?3. What is a lymphatic aggregation in the mucous membrane?4. What consists of mesothelium and underlying loose connective tissue and

covers closed body cavities and external surface of most of the GI tract?5. Haematoxylin is a ____, basic dye? Stains what kind of stuctures?6. Eosin is a ___, acidic dye? Stains what kind of structures?7. General wall structure of GI tract involves ___epithelium and ___ that

consists of loose connective tissue?8. Next is a thin structure called ___ that consists of inner circular and outer

longitudinal smooth muscle?9. Then is the ___ consisting of dense irregular connective tissue containing

glands, vessels, nerve plexuses?10.Then is the ___ containing thick inner circular, outer longitudinal smooth

muscle?11.Then is the ___ containing loose connective tissue and simple squamous

___?12.The ___ epithelium is the surface across which most substances enter the

body?13.Four functions of the alimentary mucosa?14.What type of mucosa in the oral cavity connected to underlying bone?15.What type of mucosa in oral cavity connected to underlying striated

muscle?16.Specialized mucosa on dorsum of tongue contains ___?17.What type of epithelium does masticatory mucosa have?18.What is interesting about the lamina propria of masticatory mucosa?19.Where is masticatory mucosa located?20.What is secreted at the gingiva that is a basal lamina like material that

adheres to the tooth?21.What lines lips, cheeks, floor of mouth, bottom of tongue and soft palate?22.What type of epithelium does lining mucosa have? What type at rubor

labii? 23.Lining mucosa has a ___ except at inferior surface of tongue?

Occasionally has sebaceous glands without hair follicles at angle of mouth called ___ spots?

24.___ papillae are the largest, mark border between back of tongue and dorsum of tongue?

25.___ papillae are normally on side of tongue?26.What papillae are found everywhere?27.Filiform papillae have __ epithelium, ___ taste buds and function ___?28.Foliate papillae have ___ epithelium, ___ opening into clefts and ___ in

the side?

29.Circumvallate papilla have __ epithelium and ___ on the side? Where are they located and how many?

30.Fungiform have a slightly ___ epithelium31.3 cell types in taste buds?32.Striations between enamel rods that show evidence of growth?33.___ is composed of 70% hydroxyapatite and collagen fibers? Inner

surface is covered by columnar cells and ____?34.The odontoblasts have processes that run in ____ and reach the opposite

surface? 35.What is the thin layer that covers the root of the tooth? Similar to bone

tissue, but ___?36.___ fibers are collagen fibers projecting from cementum and attached to

alveolar bone that form the bulk of the periodontal ligament? 37.___ form enamel, ___ form dentin towards each other and these two

layers are separated by what?38.Epithelium of the oral cavity protrudes into the underlying mesenchyme

making the dental bud in what stage?39.Deep surface of the dental bud is invaginated by the dental papilla is what

stage?40.What is the only serous major salivary gland? Which is mostly serous?

What is mostly mucous?41.What part of salivon has serous, mucous or mixed acini cuboidal cells?42.What part has low cuboidal cells, secrete bicarb, absorb chlorine, long in

serous glands short in mucous glands?43.What part has simple cuboidal becoming columnar, striations of plasma

membrane that enclose mitochondria to power reabsorption of sodium, secretion of potassium and bicarb?

44.What part has pseudostratified columnar and stratified cuboidal and columnar?

45.A ___ acinus has a small acinus and lumen, spheroid central nucleus and basophilic cytoplasm full of protein and rough ER?

46.A __ acinus has a large acinus and lumen, flattened basal nucleus and empty cytoplasm in H and E stain?

47.The nasopharynx has ___ respiratory epithelium with ___ cells?48.The oropharynx and laryngopharynx have ____ epithelium?

Histology of Stomach/Esophagus1. Mucous membrane consist of ___ epithelium, ____ that is loose

connective tissue and ___ that is a thin muscular layer?2. ___ consists of dense irregular connective containing glands, vessels,

nerve plexuses?3. ___ consists of thick layer of muscle?4. ___ consists of tunica adventitia or tunica serosa?5. All esophageal glands are what type and located in what layer?6. Located at the __ part of esophagus, at esophageal___ junction and

frequently at ___ of esophagus? What is the point of these glands?

7. What type of glands are scattered along entire length of esophagus, are in submucosa and produce slightly acidic mucus?

8. The muscularis externa of esophagus differ from that found in rest of GI tract how?

9. Upper third of esophagus has what type of muscle? Middle third? Lower third?

10.The gastric mucosa surface epithelium is a simple __ epithelium that produces what?

11.___ glands are simple, branched and tubular?12.___ glands are coiled, branched and tubular?13.___ are similar to another one but shorter, coiled, branched and tubular?14. In the fundic glands, what type of cells are similar to surface of mucous

cells but provide soluble mucus?15.What type of cells are basophilic protein secreting cells, mainly on base of

glands? What do they secrete? 16.What type are largely eosinophillic cells, secreting HCl located in middle

third of the glands?17.What type are small cells resting on basal lamina and produce GI

hormones?18.Pyloric glands have a wide ___ and where do the glands enter? Cell

types are mostly ___ with a few __ and no ___ or ___ cells?19.Cardiac glands have what type of cells? 20.Fundic glands have what type of cells?

GI PHYS 11. The first neural network of the GI system is at the border of __ and ___

called what? 2. The second neural network of the GI system is located where? 3. Contraction of circular muscle reduces ___ but lengthens____?4. Why is the circular muscle unique? 5. The longitudinal muscle increases ___ but reduces?6. Unitary smooth muscle has spontaneous ___, is activated by ___ and

located in what two locations?7. Multi-unit smooth muscles requires direct ___, lacks ___ contraction and

is located in what two locations?8. In the stomach, slow waves cause what but in other locations it does

what? 9. What is the order of increasing contractions: stomach,colon,small

intestine?10.What cells regulate slow wave activity? They have ___ directly onto

smooth muscle?11.Stretch,acetylcholine and parasympathetics are ___ factors?12.Sympathetics and norepi are ___ factors?13.Parasympathetics have long or short pre-ganglionics? Where do they

synapse?

14.The enteric reflex has receptors where? Sends afferents to ____, very local reflex contained within gut wall?

15.Pre-vertebral reflexes are ___ -mediated inhibitory reflexes?16.When food hits duodendum, the sympathetic ___-____ reflex send

inhibitory signals to the stomach?17.The brainstem/spinal cord GI reflex is ___ mediated through vagus nerve?18.Hormones can regulate motility by an increase in intracellular calcium

leading to increased ___?19.Gastrin does what to gastric motility?20.CCK does what to gastric motility and emptying, what to intestinal motility,

and ___ of gallbladder?21.Secretin does what to gastric and intestinal motility?22.GIP and GI1P does what to gastric motility?23.Motilin does what and when?24. Inhibitory neurons in the GI are doing what?25.When you have ___ you lose inhibitory neurons, tube is then in a ___

state causing cramping? 26.Vasoactive Intestinal Peptide and Nitric Oxide are ___ neurotransmitters?

What does VIP do to gastric secretions?27.Substance P and acetylcholine are ___ neurotransmitter?28. If we want things to move through the tube, we need what to happen so

things can flow?29.Peristaltic movement is a ___ movement, are always a contractile ring

followed by downstream ___?30.Peristalsis is programmed by ___ plexus firing?31.Mixing involves ___ contractions and involves segmentations and ___ in

large intestine?32.Rhythmical contractions of intestinal smooth muscle during fasting state

known as? Happen every ___ minutes?33. Is signaled from ___ or ___ and goes entire length of intestine? What

inhibits the MMC? 34.The function of MMC is to clear intestines of __ material, bacteria and

wash ___ through? What two things regulate MMC?35.Parasympathetic regulation of circulation involves ___ increasing blood

flow?36.Sympathetic regulation of circulation involves ___ decreasing blood flow?

What is avoided by auto flow regulation?37.4 hormonal vasodilators? What about kinins? 38.Decreased O2 levels leads to increased __ concentrations which is a

vasodilator?39. In the villus circulation, countercurrent flow means oxygen exchange occur

before reaching the ____? But during digestion, ___ of the tips causes increased flow of O2?

40.Vasoconstriction of villus arterioles can cause what? Why are crypts less sensitive to O2 debt?

Embryology of GI1. Gastrulation event occurs at day ___? Two-layered, flat embryo to a

trilaminar embryo with what 3 layers?2. What two things remain outside the embryo after folding?3. Middle of GI tract remains in contact with yolk sac through what duct?

Allantois forms what? 4. What forms the smooth muscle of GI tract?5. What congenital anomaly is associated with vitelline duct? State rule of

2s, including 2 types of ectopic tissue? 6. Endoderm forms what from pharynx to upper 2/3s of anal canal?7. Also the epithelium of all organs that form as evaginations from gut tube

which are? 5 of them 8. Ectoderm contributes to ___ at ends of tube and ___ contributes to the

ganglia?9. The foregut is supplied mainly by which artery? 10.Midgut supplied by what artery? Hindgut by which artery?11.The vagal trunks were initially right and left, but respectively become

what?12.As a resulting of the stretching of the dorsal mesentery, what sac is

formed?13.Most of the substance of the pancreas is derived from the ___bud? Most

of the main pancreatic duct is derived from the ___ bud?14.The ventral bud also forms the inferior part of the ___ and the ___

process?15.During week ___, due to development of other structures, the abdominal

cavity is reduced and as a result the midgut rotates 90 degrees and herniates out the umbilical ring?

16.When does the midgut return back in? How many degrees rotation total?17.Results of rotation are twisting of ___ and placement of __ within

abdominal cavity?18.The hindgut terminates in the ___, an endoderm lined cavity that is in

cavity with surface ectoderm forming a membrane?19.Urorectal septum from which two folds? 20.Esophageal achalasia is a loss of ganglion cells leading to a ___

esophagus?21.What is associated with projectile vomiting? 22.What usually results in bile containing vomit?23.What is associated with double bubble sign? 24. If jaundice occurs shortly after birth and stool is clay-colored and urine is

dark?25.Annular pancreas involve the ___ pancreatic bud encircling and contricting

the duodenum, what sex more affected?26. If the midgut fails to return to the abdominal cavity and is covered by

amnion it is what?27. If a protruding mass through the umbilicus is covered by subcutaneous

tissue and skin it is what?

28. If intestines rupture into umbilical cord after returning to abdominal cavity and involves rupture of the amnion this is what?

29.Name the vomit type with esophageal atresia, gastric atresia and duodenal atresia?

30.Most common location of intestinal duplication?

Anatomy Review1. Parotid is suppled by ___ artery, drained by __ vein, supplied by ___

lymph nodes which go where? Autonomics via CN ___ to otic and sensation via what?

2. Submandibular/Sublingual by what arteries and veins? What nodes? What CN for autonomic and sensation?

3. What are the retroperitoneal organs? 4. What is gas introduced into peritoneal cavity for laproscopic procedures? 5. Can also arise pathologically from what? 6. What innervates esophagus? 7. 3 big branches of celiac artery? 8. What artery supplies the ascending colon? 9. Where the middle colic artery anastomoses with the left colic artery is

called what?10.Blood supply above pectinate line? Vein called ___ drains to where?

What nerves, what nodes?11.Below pectinate line which arteries? Which veins draining where? Which

nerves? Which nodes?12.What tethers the splenic flexure of the colon to the body wall?13.Peritonitis is painful when it involves what?

GI Phys 21. Three phases of swallowing?2. The point of chewing is to increase ___ for enzymes and get food where?3. Non-voluntary phase involves covering of the ___ and this is a ___

movement?4. Also the __ approximate and the ___ covers the trachea?5. When food is higher up in esophagus, __ relaxation occurs at the point of

transition from skeletal to smooth muscle?6. What nerve is needed for relaxation of lower esophageal sphincter? What

two neurotransmitters are used? 7. ___ in esophagus leads to secondary peristalsis that keeps occurring until

food is cleared? Mediators of this?8. ___ from vagus acts as an excitatory NT and will tighten lower esophageal

sphincter? What two act as relaxers of LES?9. In Chaga’s disease what is destroyed and what happens?10.Receptive relaxation of stomach is triggered by what?11.Adaptive relaxation of stomach is triggered by what? 12.Feedback relaxation is triggered by what?13.What two things are released by duodenum to help relax stomach?

14.What is constantly happening in stomach when there is a decrease in volume?

15.Vagotomy is loss of ___ relaxation? Loss of ___ signals lead to more tonic contractions?

16.What initiates contraction with the antral pump in the stomach?17.Why does the pylorus contract during the antral pump?18.What is the point of retropulsion during the gastric pump?19.Enterogastric reflexes seek to do what to gastric emptying? 20.What tonicity in the duodenum triggers release of hormones to decrease

gastric emptying? 21.Fats trigger chemoreceptors that release what two things to decrease

gastric emptying? 22.Acid triggers what to release that decreases gastric emptying? 23. Is a fatter meal going to empty slower or faster due to more CCK? 24.Vagal neuropathy or diabetic neuropathy to vagus will caused decreased

or increased emptying? 25.Belching/vomiting associated with which? Cramping,diarrhea with which?26.The peristaltic reflex happens when local ___ causes wave to begin

proximal and ___ happens distally? 27. If there is irritation, excessive distension or extrinsic/intrinsic neural control

what can happen in intestines?28.When we stretch stomach, what happens in colon and what is this called?29.Pressure in ileum does what to ileocecal valve? Pressure in ascending

colon does what? 30.What does the large intestine have that are large regions of contractions?31.Ascending colon dwell time is more or less than the time in transverse

colon?32.Where is the site of water and electrolyte removal?33.Mass movements trigger feces where? Triggers what reflex?34.When feces moves into the anal canal, what happens to internal anal

sphincter?35.Contraction of ___ and ___ muscle maintains continence?

Gi Phys 31. Mucins in the saliva lubricate and ___ and creates a food bolus?2. The extracellular fluid in the saliva lubricates, washes away ___ and

buffers ___?3. What salivary proteins bind Vitamin B12 in the stomach?4. What salivary gland is stimulated during a meal?5. The excretion coming out of the acinus is similar to what in composition?6. What happens to the excretion at the intercalated duct? 7. In the end, the excretion is isotonic, hypertonic or hypotonic?8. With parasympathetic control of salivary glands, what does acetylcholine

do? What does VIP do?9. With sympathetic control of salivary glands, what does norepi do to

enzymatic output and water output?

10.Parasympathetic regulation of blood flow works through what enzyme to produce what mediator to increase blood supply?

11.A 50% decrease in saliva production is known as what? 12.With lack of saliva you see oral hygiene issues like ___ due to lack of

defense proteins, changes in mouth ___ and tooth decay?13.What muscarinic agonist can be used for Xerostomia?14.What secretions lubricate the esophagus? 15.Compound mucous glands are nearer to the ___ and produce what two

things?16.Within the gastric pits there are pyloric glands that contain __ cells that

secrete what?17.The other type of glands within gastric pits that account for 80% are what

and contain what two cell types?18.Two secretions by parietal cells?19.Draw the production of HCl by parietal cells?20.Histamine,Gastrin and acetylcholine due what to the hydrogen/potassium

pump?21.What two things decrease insertion of the pump? 22.3 methods of decreasing hydrochloric acid production?23.At low flow rates, what is the composition of the gastric secretion? 24.How does the composition change at high flow rates? 25.2 neural and 4 hormonal activators of chief cell pepsinogen secretion?26.When the vagus nerve stimulates the submucosal plexus what two

neurotransmitters are released?27.Ach will then act on the ___ cell to produce what that then acts on the

parietal cell to produce more hcl? 28.Ach can also act where to directly produce more Hcl? 29.GRP can act on the ___ cell to produce ___ that acts on the parietal cell? 30.Gastrin can also act on the ECL to produce what? 31.When food moves into the ___, 4 hormones (secretin,glucagon, GIP,VIP)

will act on ____ which produces somatostatin? 32.Somatostatin will act on what two cells to reduce hydrochloric acid?33.Which prostaglandin acts on ECL, G, and parietal cells to reduce acid

secretion?34.Two methods of regulation of GRP and ach? 35.What stimuli can cause a enterogastric reflex leading to sympathetic

stimulation decreasing gastric acid?36.Secretin, CCK, GIP,VIP and Peptide VYY are intestinal hormones that do

what to acid? 37.ACH and PGE2 can stimulate ___ from neck cells?

Phys 41. Zymogens of the pancreas sit and wait in the __ until secreted?2. What prevents self digestion? 3. What is the main stimulator of pancreas acinar cells? Causes an increase

of __ leading to fusion of vesicles?

4. Ach can also act on acinus through __ receptor to increase calcium?5. VIP and Secretin act through what in pancreatic acinus? 6. CCK is primarily regulated from __ cells in duodenum and what

potentiates it? 7. The ductal cells secrete __ to neutralize stomach acid, is a ___ regulated

response?8. Chloride is actively moved out by the ___ so that it can be exchanged for

what? 9. Main activator of CFTR? 10.Ductal secretion are primarily regulated by what? What potentiates it? 11.Pancreas is turned on ahead of digestion due to cephalic phase through

__ nerve?12.This turns on acinar cells slightly and potentiates ___ cells? 13.What is structurally similar to CCK that will stimulate CCK receptors in

pancreas?14.Main stimulator of pancreas is during the __ phase, I-cell is going to

secrete ___ which goes to acinar cells and causes release of what? 15.Hydrogen stimulates the __ cells, releasing __ which acts on what? 16.A bulimic will have lower levels of __ due to acid being lost? This will in

turn not act on __ to produce as much bicarb?17.Liver __ synthesize bile, secreted into canaliculi then into ___? Stored in

GB when what is closed? 18.Bile __ dependent flow is key with the liver, mediated by uptake of bile

back into __? This is a secondary active transporter with ___, then a facilitated transporter into bile ducts?

19.Bile-indepdent flow is for __ release to add to ducts? Depends on what hormone?

20. What stimulates liver ductal secretions? 21.CCK via bloodstream causes ___ contraction and relaxation of what? 22.Four ways to recapture bile include ___, a very small amount. 90% is ___

transport? In the colon and terminal ileum moving in to cecum you can __ the bile acids so they can be passively diffused?

23.What is a precipitation of cholesterol in gb? 24.What are specifically located between pyloric sphincter and sphincter of

oddi that produces bicarb? 25.Tips of villi are involved in what? Crypts involved in what? 26.Small intestinal crypts secrete what? Large intestinal crypts?27.What accounts for HCO3 secretion from crypt cells? 28. In the intestine we actively get rid of __ which is the __ channel that works

through cAMP activated by toxins, __ and ___?29. In __ diarrhea there is excess water and electrolyte secretion? What type

of hormonal tumors?30.What type of diarrhea from lactose, fructose, pancreatic insuffiency, bile,

sprue?31.

Esophageal Disorders

1. From the mouth to the stomach is about how many cm?2. Three indentations on the esophagus? 3. Unlike the remainder of the GI tract, the esophagus has no what? (4. The esophagus begins where the inferior pharyngeal ___ merges with the

___?5. Pseudo-dysphagia can be caused by what? (6. What is an aberrant right subclavian artery coming off the left aortic arch

going around the esophagus posteriorly producing dysphagia called?7. At the level of ___ , the esophageal body leaves the thorax through a

hiatus located within the ___ ___ of the diaphragm? 8. What ligament contributes to fixation of the LES within the diaphragmatic

hiatus? 9. What is an outpouching of pharyngeal mucosa through a weakness

between the inferior pharyngeal constrictor and cricopharyngeus muscle (location known as Killian’s triangle)?

10.Who will it most likely present in? What will they complain of? 11.What type of diverticulum could be present if you push NG tube in and

don’t hear gurgling?12.What is a rare condition that show flask-shaped outpouchings within the

esophageal wall due to dilation of excretory ducts of submucosal glands? 13.What is the broad symmetric band of hypertrophic muscle that contristcs

the tubular esophageal lumen at its junction with the vestibule? 14.What is always associated with a hiatal hernia and is recognized as a thin

membrane that constricts the esophageal lumen at the junction of vestibule with the gastric cardia?

15.What is the B ring composed of? 16.When should surgical intervention be consider for a Schatzki’s ring? 17.What can be found in females who are iron-deficient anemia, who present

with dysphagia and proximal esophageal webs? 18.Pain with swallowing is known as what? 19. If a patient with diabetes or on immunosuppresants presents with plaques

in their esophagus that bleed when pulled away it may be what? 20.What presents with “volcano” lesion, burning when swallow and are

usually immunocompromised? 21.What other virus can create a solitary, open ulcer in the esophagus?22.What can cause pain with swallowing along with transient fever, chills,

malaise and rash and later as giant, deep ulcers extending up to several centimeters

23.What type of tumor is submucosal, most of the time distal, and is very smooth looking and shouldn’t be biopsied?

24.What are benign tumors that are histologically composed of finger-like projections of lamina propria covered by hyperplastic squamous epithelium?

25.What can happen to people at water fountains taking pills that complain of dysphagia and odynophagia? First pill to do it?

26. If a child comes in with lots of oral local pain and drooling after caustic ingestion is this a good sign or bad sign?

27. If a patient presents with no oral problems after caustic ingestion what does this mean?

28.Compare strong acids versus strong alkalis in terms of damage to stomach versus esophagus?

29.What is an acquired anomaly in which esophagogastric junction and stomach project above the diaphragm and into the thorax?

30.These types of hernias seem to be common in patients with ___ esophagitis?

31.What is it called when fundus sneak up and compromises the opening of the esophagus?

32.Patient may present with ___ pain and projectile ___? 33.What is a congenital anomaly of ectopic gastric mucosa located by the

LES? 34. What is it called when there is forceful vomiting causing an esophageal

perforation? 35.What do we do in an esophageal perforation? 36.What are lacerations in the region of the gastro-esophageal junction that

present with vomiting, retching, or couching preceding hematemesis in an alcoholic patient?

37.How are they usually resolved? 38.Any battery or any magnet that is swallowed, what has to happen? 39.What is the rule of 7s for dealing with swallowed objects?40.

GERD:Fierro1. 44% of adults have ___ at least once monthly? 7% of adults have ___

GERD symptoms?2. One or more mucosal breaks no longer than 5 mm, none of which extends

between the tops of two mucosal folds is what grade?3. What makes a grade D?4. GERD results from exposure of the esophageal mucosa to refluxed ___

contents?5. In patients where exposure is within normal limit, GERD may be due to

decreased ___ resistance?6. GERD caused by increased exposure can be due to ___ dysfunction, a __

hernia, defective esophageal ___, delayed __ emptying or increased ___ pressure?

7. Defective esophageal clearance is due to ineffective ___, reduced ___ secretion or reduced secretion from ___ submucosal glands?

8. Two autoimmune diseases that can do this?9. Reflux-related symptoms occur primarily after ___? 10.Unusually ___ meals can do it? Bending, stooping or ___ can do it?

11.Atypical symptoms of GERD include ___ pain, sore ___, __itis, ___ and cough?

12.What two things can complicate the disease? What two red flags? Or failure of ___ therapy?

13.What type of treatment shows relief of heartburn in 50% of patients and indicated for healing of erosive esophagitis?

14.What two side effects of PPIs are most concerning?15.What is the mainstay of therapy for GERD?16.What provides most rapid and symptomatic relief and heal esophagus in

highest percentage?17. If someone failed a course of H2 blocker, failed an attempted step down,

have high grade esophagitis, peptic strictures what should they not do?18.The ___ has no intrinsic defense or clearance mechanisms for gastric acid

exposure? 19.Classic findings of laryngoesophageal reflux involve ___ changes,

granuloma, ___ appearance?20.Clinical symptoms involve ___ drip, laryngeal irritation, __ clearing,

chronic___ and ___ changes?

Fierro 3: Esophageal Disorders1. 4 phases of swallowing include ___, sealing the ___, ___ coming up and

moving trachea out of the way and __ flapping over?2. Obstructing lesions of oropharynx include __ in cervical region, and ___?3. What is a loss of ganglion cells in wall of esophagus? Loss of ___ cells in

esophageal sphincter?4. Major criteria for achalasia is no ___ and incomplete ___ relaxation?5. Drugs for achalasia? Surgery?6. Scleroderma can cause __ obliteration and fibrosis in ___ leading to weak

LES, poor esophageal contractility and delayed gastric emptying?7. Scleroderma presents with CREST which is what? 8. On barium study what does it look like? 9. How do adults present with eosinophillic esophagitis? How do we confirm

endoscopically? 10.Need ___ biopsies from 2 separate areas?11.EoE is usually seen in __ or child with food impaction, will be hyper___

and spitting up?12.Trial of ___ should be done before EoE diagnosis?13.What will EoE look like on endoscopy?14.What two swallowed steroids can work well?15. If no response to steroids what do we do?16.How else can we treat EoE during diagnostic evaluation

Esophageal Path1. Esophageal abnormalities are associated with congential ___ defects, ___

malformations and ___ disease?

2. In esophageal ___, develop is incomplete and there is a thin, noncanalized cord? Where is most common location? Usually associated with what?

3. Intestinal atresia usually involves the what?4. What is the most common form of congenital intestinal atresia? Failure of

the __ diaphragm to involute?5. What can happen if there is incomplete formation of the diaphragm? The

___ viscera can herniate into the thoracic cavity to cause ___ hypoplasia?6. What is it called when the abdominal viscera herniate into a ventral

membranous sac?7. What is similar but involves all of the layers of the abdominal wall?8. What is the most common site of ectopia in the esophagus?9. The esophagus/stomach can also have ectopic ___ tissue? 10.The small bowel/colon can have patches of ___ that may present with

blood loss due to peptic ulceration?11.What is a blind outpouching of the alimentary tract that has

communication with the lumen and includes all three layers of the bowel wall?

12.What is the most common type and where is it located?13.Congenital hypertrophic ___ stenosis is 3-5 times more common in

males? Related to ___ syndrome and trisomy ___? What antibiotic orally or via mother’s milk in first 2 weeks of life?

14.How do pyloric stenosis patients present? (symptoms, age?)15.How do we cure pyloric stenosis?16.What is congenital aganglionic megacolon also called? Seen in what

syndrome? 17.Hirschsprung shows absent what ganglions?18.Also shows absent coordinated ___, a functional ___ and dilation ___ to

the segment?19.Hirschsprung shows heterozygous loss-of-function mutations in the

receptor tyrosine kinase ___?20.What is ALWAYS affected in Hirschsprung?21.Clinical featurs of Hirsch will show failure to pass ___, obstruction or ___,

___ distension and __ vomitting?22.Compared to Hirschsprung disease, what is a way to get acquired

megacolon?23.What are idiopathic ledge-like semi-circumferential protrusions of mucosa

that consist of fibrovascular connective tissue with overlying epithelium?24.Who are these seen in? Associated with __, chronic ___ disease or

blistering skin disease?25.Main symptoms of webs?26.Webs accompanied by iron-deficiency anemia, glossitis and cheilosis is

what?27.Esophageal rings are circumferential, thicker and include what three

things?28.A rings are located where? Covered by __ mucosa?

29.B rings are at the __ junction of lower esophagus and have what type of mucosa on their undersurface?

30.Achalasia is characterized by the triad: incomplete LES ___, increased LES ___ and __ of the esophagus?

31.Symptoms of achalasia shows dysphagia for both ___ and __, difficulty in ___ and pain where?

32.What are longitudinal mucosal tears at GE junction/proximal gastric mucosa due to severe retching or vomiting?

33.What is a transmural tearing through esophagus and rupture that is a catastrophic event leading to severe mediastinitis and surgical intervention?

34.With a lye or bleach in esophagus, will you see neutrophils?35.Chemical and infectious esophagitis show dense infiltrates of ___? 36.Pill-induced esophagitis shows __, superficial ___ with __ tissue and

fibrosis?37.What if the esophagus shows ulcers, and adherent, white-gray

pseudomembranes?38.What if you see punched-out ulcers on endoscopy and nuclear viral

inclusions at margin of ulcer?39.What if you see shallower ulcerations on endoscopy and on biopsy you

see nuclear and cytoplasmic inclusions within capillary endothelium and stromal cells?

40.3 Ms of herpes? 41.What shows heartburn, dysphagia and regurgitation of sour-tasting gastric

contents with severe chest pain?42.Biggest complication to worry about in reflux esophagitis?43.What will show similar symptoms but is the protrusion of stomach into

thorax through a gap?44.Most common cause of GERD? Mediated by __ pathways, triggered by

__ distension, mild __ stimulation that doesn’t trigger swallowing, stress, __ and ___ use, obesity, CNS depressants, and pregnancy?

45.Reflux esophagitis shows simple ___ on endoscopy? In mild Gerd what does the biopsy look like?

46. In significant GERD, what are in the mucosa? What is hyperplastic? What is elongated?

47.Cardinal histologic finding in eosinophillic esophagitis? What is not prominent clinically?

48.An EE patient will be __ with dermatitis, rhinitis, asthma and peripheral eosinophilla? Treatment for EE?

49.What layer are varices mostly seen in? OF the distal ___ and proximal___?

50.What is a complication of chronic GERD? Involves ___ metaplasia within the esophageal ___ mucosa?

51.Most common in white __ between __ and __ years of age? Increased risk of what type of cancer?

52.Endoscopic findings in Barret’s?

53.The metaplasia of Barret show distinct ___ vacuoles stained pale blue in the shape of a ___ goblet?

54.Low grade dysplasia in Barret’s will show atypical ___, nuclear hyper___, and abnormal gland architecture including ___, irregular __ and cellular ___?

55.How does high grade differ? 56.Most esophageal adenocarcinoma arise from what? Additional risk factor

include __ use and exposure to ___?57. Is 7x more common in ___ and __ people?58.EA shows pain or difficulty with __, progressive __ loss, vomiting __, chest

pain? By the time they have symptoms this means it has already spread where?

59.Where is it found in the esophagus? Shows ___ or raised patches, with diffuse infiltration and __ with deep invasion?

60.Less common patterns of EA involve diffuse infiltration of ___ cells?61.Esophageal squamous cell carcinoma is in adults older than ___, males

__ more frequent and ___x more common in African Americans?62.ESCC shows ___, ___, altering diet from solid to liquid due to ___?63.First symptoms of ESCC? Metastasizes to the ___ which produces a poor

prognosis?64.Where does ESCC occur in esophagus? Shows a lack of maturation of

__ cells with __-like thickenings? 65.ESCC in the upper third will go to __ lymph nodes, middle third will go to

___,paratracheal and tracheobronchial nodes?66.ESCC in lower third will go to __ and __ nodes?67.What does ESCC look like on endoscopy?

Stomach Pathology1. What is a mucosal inflammatory process of the stomach? If there are

neutrophils it is what?2. What shows absent/rare inflammatory cells in the stomach? What can

cause it?3. Gastropathy also shows acute mucosal erosion or hemorrhage known as

___ ulcers?4. Menetrier and ZE syndrome are examples of ___ gastropathy?5. Gastropathy shows moderate edema where with slight vascular

congestion? Also shows ___ cell hyperplasia with corkscrew glands and epithelial proliferation?

6. Gastritis by definition is ___ above the basement membrane in direct contact with epithelial cells?

7. Gastritis shows loss of the ___ with a superficial mucosal defect? A fibrin-containing purulent exudate is in the ___ and there may be hemorrhage?

8. Acute erosive hemorrhagic gastritis shows concurrent ___ and hemorrhage?

9. Severe trauma, extensive burns, intracranial disease and major surgery can cause what type of mucosal disease?

10.A __ ulcer is due to shock, sepsis or severe trauma?11.A ___ ulcer is in the proximal duodenum due to severe burns or trauma?12.A ___ ulcer is gastric, duodenal or esophageal due to intracranial

disease?13.These mucosal insults are due to local ___, systemic hypotension,

reduced blood flow?14. Intracranial injury lesions are due to direct simulation of __ nuclei leading

to hypersecretion of gastric acid and systemic acidosis?15.Stress-related ulcers are rounded and less than __? What color is the

ulcer base?16.What is a submucosal artery that does not branch properly within wall of

stomach, most commonly found along lesser curvature near GEJ? 17.Erosion of the overlying epithelium of this can lead to gastric bleeding is

associated with what?18.What is referred to as watermelon stomach and are created by ectatic

mucosal vessels?19.Histologically, the antrum shows reactive __ With dilated capillaries

containing __ thrombi?20.What is GAVE associated with?21.Most common cause of chronic gastritis? Most common cause without

infection?22.H. pylori is associated with __, household crowding, limited education and

what ethnicity? Route of infection?23.Where is h. Pylori concentrated? What biopsy is preferred?24.Where are the neutrophils with h.pylori gastritis? 25. In the superficial lamina propria there are large numbers of ___ cells,

increases numbers of lymphocytes and macrophage?26.With HPG there is a chance of MALT turning in to what?27.With long-standing H.pylori gastritis, there is involvement of __ and ___

and mucosa can atrophy with loss of what two cell type?28.Development of the atrophy is associated with ___ metaplasia and

increased risk of gastric ___?29.Autoimmune gastritis spares the ___, and is associated with hyper____?30.Characterized by antibodies to ___ and ___? Shows reduced serum ___,

___ cell hyperplasia, ___ deficiency and defective ___ secretion?31.The absence of acid production stimulates __ release leading to

hyperplasia of antral ___ cells?32.What are the principal agents of injury in autoimmune gastritis?33. In autoimmune gastritis there are what three inflammatory infiltrates?

Extensive loss of what two cell types?34.Median age at diagnosis of autoimmune gastritis? What sex more

affected? Associated with other __ disease?35.Complication of chronic gastritis is ___ disease leading to chronic mucosal

ulceration in what two locations?

36.Nearly all peptic ulcers are associated with __ infections, NSAIDs or what?

37.Peptic ulcers show ___ burning or aching pain? Also ___ anemia, hemorrhage or perforation?

38.Peptic ulcers are worse __ hours after meals during the day, worse at ___, relieved by alkali or ___ and show nausea, vomiting, and bloating, belching and significant _?

39.Peptic ulcer disease most common where? Involve the ___ wall? The classic peptic ulcer is ___ to oval sharply punched out defect with ___ and ___ deposition?

40.Active ulcers are lined by what? Have what type of infiltrate with ___ tissue and a fibrous or collagenous scar at the ulcer __?

41.Hypertrophic gastropathies show giant cerebriform enlargement of what? Due to __ hyperplasia without inflammation and linked to excessive ____ release?

42. In Menetrier disease there is excessive secretion of what? The hyperplasia of the foveolar epithelium is where?

43.Shows ___ due to being a protein-losing enteropathy and an increased risk of gastric ___?

44.What are most common in individuals between 50 and 60 and are associated with chronic gastritis? What shape with a smooth surface?

45.Microscopic findings of inflammatory and hyperplastic polyps involve irregular, cystically dilated and elongated ___ glands? Also edema and acute/chronic inflammation of ___?

46.What type of polyps are sporadic and seen in familial adenomatous polyposis? Why are they associated with PPI therapy?

47.What type of cancer between 50 and 60, 3x more common in males and increased in individuals with FAP?

48.Gastric adenomas are solitary lesions less than ___ in diameter, located in the __ of the stomach and show intestinal-type __ epithelium?

49. If the lesion is larger than 2 cm and most common malignancy of stomach?

50.Early symptoms of gastric adenocarcinoma? DDN51.Advanced stage symptoms?52.Gastric adenocarcinoma metastases to supraclavicular sentinel lymph

node is known as ___ node? Periumbilical lymph nodes known as ___ nodule?

53.Left axillary lymph node known as ___ node? Ovary known as ___? Pouch of douglas known as ___?

54.For gastric AC what curvature usually affected? 55. Intestinal morphology type gastric AC are __ tumors with glandular

structures, and show apical ___ vacuoles and abudance of mucin in the __?

56.Diffuse infiltrative growth pattern tumors show __ cells that are large mucin vacuoles that expand the cytoplasm? Permeate the mucosa and stomach wall individually or in ___?

57.GAC shows __ reaction that stiffens the wall due to the body trying to wall it off? Also shows a rigid, thickened wall called linitis plastic that is a ___ appearance?

58.Lymphomas are seen in stem cell and organ transplant recipients as ___ virus-positive B cell proliferations?

59.A Gastric MALToma is a dense lymphocytic infiltration where? Shows reactive-appearing ___ follicles?

60.What are intramural or submucosal masses with intact or ulcerated overlying mucosa, yellow or tan and very firm?

61.Show what endocrine granule markers? 62.Seen in what decade of life? Ileal tumors produce a carcinoid syndrome

of cutaneous ___, sweating, abdominal pain, and right-sided cardiac valvular ___?

63.Foregut carcinoid tumors at stomach, duodendum proximal to ligament of Treitz and esophagus rarely __ and are cured how?

64.Which has a worse outcome that are multiple, and aggressive?65.Hindgut carcinoids are located where? Almost always what?66.Most common mesenchymal tumor of abdomen? Arises from what type of

cells? Mean age?67.GISTS in childrens show a Carney Triad of young __, gastric, para____,

and pulmonary ___?68.Approximately 75-80% of all GISTS are oncogenic, gain of function

mutations in what kinase? 69.Primary gastric GISTs are ___cm in diameter, cut surface shows whorled

appearance full of __ cells and ___ cells?

Oral Microbiology1. Which strep presents as an oral pathogen? 2. What spirochete presents as an oral pathogen?3. What is a well organized multispecies biofilm attach to the tooth surface?4. What is a plaque called above gingival margin? What about below

gingival margin?5. Caries are formed when bacteria produced ____ which causes a ___

drop?6. What is the predominant dental caries-causing organism? 7. What does S mutans synthesize that promotes aggregation of bacteria?8. Protection for the mouth involves saliva that contain ____ and ___? 9. What do the tongue and buccal membranes do for protection? 10.Dental caries can complicate and cause infection of ___ chamber and can

on to become necrotic?11.The caries infection can become intra___, retro___ or ___pulmonary?12.Where do dental caries disseminate through blood?

13.What is an acute and chronic inflammation of the gingiva? Involves a __ plaque present with a tendency for ___ to blood?

14.What type of pain with peridontitis? What eventually happens to the teeth?

15.Odontogenic infections are associated with ___ and subacute bacterial ___, low ___ ___ babies?

16.Dental infections are also associated with increased risk of what two things?

17.What is chronically inflamed and a major cause of adult tooth loss?18.What is a common cause of juvenile periodontitis? Is a gram ___, what

morphology? Is a member of HACEK group that causes what?19.What is characterized by soft tissue necrosis, rapid periodontal destruction

and interproximal bone loss? 20. Is NUP painful? 21.What predisposes to NPD? 22.Signs of NPD involve rapid onset of pain in ___, necrosis in interdental

___, a characteristic ___ with altered taste sensation, also show fever, malaise and regional ___?

23.Bacteria associated with NPD are what?24.Bacteroides fragilis has a ___ capsule that inhibits ___ and promotes ___

formation? Resistant to what antibiotic?25.How do we treat an anaerobic oral infection, what mouthwash, what

antibiotic?26.How about for Bacteroides fragilis? 27.Actionmyces spp., is a natural flora where?28. Is an ____, gram ___ with or without spores? Are __, branching and

produce ___ granules that are yellow or orange in color?29.Most common cause of actinomycoses, 60% of cases are what, affects

what sex more? Is an ___ infection?30.Actinomycosis is referred to as what? Produces a draining ___ and can

spread to contiguous ___, bone, lymph nodes?31.What is an oxidase positive, gram negative rod that is a natural flora of

oropharynx? 32.What does Eikenella corrodens smell like, what does it look like on agar?33. Is see in human ___ or ___ infections/procedures?34.What causes oral thrush? Shows white ___ on buccal mucosa, palate,

tongue and oropharynx? What happens if you wipe it off?35.Shows angular cheilitis which is what? If it is seen in adults what should

you consider?36.How do we diagnose Candidiasis? 37.How do we treated Candidiasis? 38.Herpes simplex has what type of DNA, and is it enveloped or

nonenveloped?39.HSV-1 stays latent in what ganglia?40.What can trigger HSV recurrence? 41.Herpetic whitlow most likely candidate and in whom?

42.HSV is diagnosed with a ___ smear to look for ___ bodies?43.Causative agent of hand, foot and mouth disease? Is a what type of

genetic material, what type of envelope? 44.Usually in children under ___ years old in what season?45.Transmission is through __ and ___ secretions, blister fluid and ___?46.Symptoms are a mild ___, malaise, sore throat and lesions where?47.How do we treat hand, mouth and foot disease?

Stomach and Peptic Ulcer Disease: Bradley1. Submucosa provides the supporting ___ tissue that separates the mucosa

from underlying muscularis propria?2. Surface mucous cells line the mucosal ___ and gastric __?3. Parietal (oxynitic) cells are concentrated in the mid and upper portions of

the glands of ___-type mucosa?4. What are located in the mid portions of the glands of the antrum and in the

crypts of the duodenum that secrete gastrin?5. Pepsinogen secretion is closely related to acid secretion and is increased

by ___, histamine and ___ stimulation?6. Is gastric proteolysis essential for protein degradation? 7. Which gastrin constitutes about 2/3 of gastrin in fasting subjects and half

life of 30 minutes? Which increases during prandial period and is majority released from gastric antrum with a half life of 7 mins?

8. Basal gastric acid secretion takes place in __ state and shows high rates in __ and low rates in __? Mainly dependent on what?

9. Prandial secretion is mediated by the __ phase, the __ phase and the __ phase?

10.What neurochemical mechanism turn off acid secretion? 11.30-50% of chronic __ patients have increased acid-pepsin secretion?12.What is an ilset cell tumor in pancreas that increases gastrin concentration

thereby increasing basal acid output?13.Potassium chloride, iron and hepatic arterial chemotherapy are rare

causes of what? 14.Type A gastritis is ___, in the fundus and body, progressive mucosal

damage, onset at __ age, and associated with gastric ___ and cancer?15.Type B gastritis is associated with ___, is in the antrum, damage may ___,

onset at what age and associated disease states?16.What characteristically involves gastric fundus and body and shows

progressive histologic damage? Final clinic expression is ___?17.How do we give B12? 18.Lifetime prevalence for developing PUD in first-degree patients is about

___ times greater?19.The inheritance of what blood group is associated with DU incidence?

What HLA subtypes?20.What two major risk factors for PUD?

21.Only association between ethanol intake and ulcer diseases exists in patients with what?

22.What sex predominates in prevalence of DU? 23.What ethnicity? 24.Ulcer risk of NSAIDs is said to be what? 25.PUD presents with pain where? 20% of patients have __ at some point?

And symptoms of delayed gastric emptying due to obstruction in areas of __ due to scar tissue?

26.Gold standard for diagnosis PUD?27.Occurrence of DU along with GU does what to likelihood of malignancy?28.Antacids with __ produce diarrhea? Aluminum and calcium produce

what? 29.Why are prostaglandins contraindicated in pregnancy? 30.How many weeks for PPi therapy for DU? Endoscopy?31.For gastric ulcers how many weeks? Endoscopy? 32.Patients with DU who remain symptomatic after standard treatment should

be switched to what medication and questioned about what?33.Surgical intervention for perforated ulceration? If this can’t be done what

do we do?34.H.pylori can survive in the stomach because of its associated __ enzyme

which hydrolyzes urea to ammonium and bicarbonate? 35.Prevalence of H. pylori is higher in ___ countries and in __ age groups?36.Virtually all H.pylori-positive patients demonstrate ___ gastritis? 37.Nearly all __ patients have HPG?38. If the patient is under 55 with HPG what do we do? If over 55 what do we

do?39.One way to diagnose at bedside is __ __ testing? What can mess it up?40.What is the key regiment for HP and how many days? 41.H.pylori infection is associated with what two types of cancers?42.ZE consists of __ hypersecretion, severe ___ disease and a tumor of the

__?43.Tumors are localized usually to ___, duodenal wall or regional lymph

nodes?44.About one-fourth of ZE have ____ which consists of tumors of parathyroid,

pituitary and pancreatic islets?45.ZE is a gastrinoma consisting of a __ state leading to gastric acid

secretion leading to PUD, diarrhea or GERD? How high are gastrin levels?

46. If no evidence of tumor in ZE, what do we do? 47.Menetrier’s disease is most frequent in men over the age of ___? Shows

hypertrophic ___ located in fundus and body of stomach? 48.Symptoms of Menetriers is vague __ discomfort, diarrhea, weakness,

anemia, weight loss, and edema secondary to what? Treatment?49.What are persistent concretions of foreign matter found in the stomach? 50.Anything that does what can predispose to bezoar? Most common drugs

to do it?

51.What is an abnormal degree of rotation of one part of the stomach around another?

52.A ___ volvulus is a rotation around a line joining the pylorus to the GE junction?

53.A __ volvulus is a rotation around a horizontal line that runs from center of greater curvature to porta hepatis?

54.Triad of symptoms of volvulus involves unproductive __, acute localized __ distention and inability to pass a __? Treatment?

55.Best study to determine gastroparesis?

Malabsorption1. __ is defective mucosal absorption of nutrients? __ is impaired nutritional

hydrolysis? 2. What is absorbed in terminal ileum?3. Chronic pancreatitis, cystic fibrosis and carcinoma of the pancreas can

show an intraluminal defect of what? 4. Severe liver disease, interruption of enterohepatic circulation, and

bacterial overgrowth can lead to what? 5. Hypo or achlorhydria or small intestine stagnation can lead to what? 6. Celiac sprue is defined as malabsorption of nutrients by that portion of the

__ that is damage, a characteristic lesion of the small intestinal __, and prompt clinical improvement following withdrawal of what?

7. Celiac sprue shows atrophy of what? Affects how many, what sex? 8. Most common symptom of celiac sprue? Other symptoms include a skin

disorder called ___, anemia, tetany, osteomalacia and malnutrition? 9. How is diagnosis made? What serum antibody is present in some

patients? Two most common HLA types? 10.What is the first thing you check for if a patient relapses despite strict

gluten-free diet?11.What is a chronic disorder acquired in endemic tropical areas

characterized by abnormalities of small intestinal structure and function that become progressively more severe?

12.How do we treat? 13.Tropical sprue shows acute episode of watery, non-bloody __ leading to

development of chronic ___? And then development of what? 14.What is an uncommon systemic disease that may affect virtually any

organ system in the body but mostly affects small intestine? 15.Who is it seen in? 16.Clinical triad of Whipple’s? How do you make diagnosis? 17.Treatment for Whipple’s? 18.What is characterized by dilatation of intestinal lacteals that may lead to

steatorrhea? 19.A quantitative fecal fat test requires a collection of stool over ___ hours

consuming a diet of ___ gms a fat a day? If the amount of fat in the stool is less than __/24hrs and the weight of the stool is <__/24 hr the patient probably doesn’t have a malabsorption?

20.Best non-invasive method to indicate malabsorption? 21.How does the Schilling test work? 22.When lactose is not digested, it creates an osmotic __ by its large

molecular size and fermentation by ___ creates considerable gas formation?

23.Anytime someone is on colchicine you have to give what?

Anti-Ulcer Drugs1. Parietal cells are stimulated by what three things? 2. What is the MAJOR neural stimulatory of parietal cells? 3. What is the MAJOR endocrine regulated? Triggered by a meal of __ and

gastric ___? Increases release of what? 4. What is a potent inhibitor of acid secretion that inhibits gastrin and

histamine release? From wht cells? Released when __ and __ is present?

5. PPI work by blocking ACTIVE ___ pumps in parietal cells? 6. They are best taken when due to amount of ATPase being greatest after

prolonged fast? 7. What seems to be the longest acting PPI? 8. How are the PPIs metabolized? How are they excreted? 9. When someone is put on a PPI, why may they get diarrhea? 10.Two major side effects of long time use of PPIs?11.Which PPI seems to be best for avoiding interactions? Which to avoid in

pregnancy? 12.H2RA work by __ competing with histamine for binding to __ receptors? 13.The most prominent effects of H2RAs are on secretion when? 14. Is metabolized where? Excreted where? 15.Really bad side effect of cimetidine? 16.What type of drug is Misoprostol? Stimulates secretion of __ and __?

Most frequent side effect? 17.What is a octasulfate of sucrose complexed with aluminum hydroxide

which in acidic environments produces a viscous gel?18.When should it be taken? Indications? 19.Most common side effects? 20.Antacids can cause ___ which involve n/v, hypocalcemia, arrhythmias and

diarrhea?21.What is a syndrome of hypercalcemia, alkalosis and renal impairment? 22.What is used to treat diarrhea, heartburn and upset stomach? Can also

be used in combo with PPIs to treat what?23.Can do what to stools?24.For someone with sporadic uncomplicated heartburn, in the setting of

known precipitating factor, with 2-3 episodes per week what is the treatment?

25.For greater than 2-3 episodes per week? 26.For someone who has chronic, unrelenting symptoms and EGD shows

barret’s, strictures or ulcers how do we treat?

27.For PUD, we use PPIs BID for ___ days, and ___ for 7-14 days and ___ for 7-14 days?

28. If allergic to penicillin? 29.Mainstay of treatment for acute GI bleeds secondary to PUD? 30.Definite risk factors for the development of stress ulcers include ___ for

more than 48 hours and coagulopathy? 31.How do we treat ZE?

Diarrhea: Bradley1. Daily stool output is less than __gm or mL per day? Normal frequency is

what? 2. Normal function of the colon is reabsorption of ___ and secretion of __?3. Osmotic gap of feces equation? 4. Effect of fasting on osmotic diarrhea? Fecal volume? Osmotic gap? 5. Effect of fasting on secretory diarrhea? Fecal volume? Osmotic gap? 6. Exogenous agents causing osmotic diarrhea? Unabsorbed nutrients? 7. Chewing gum has ___ that can cause osmotic diarrhea? Also ___

deficiencies? 8. Exogenous causes of secretory diarrhea? Endogenous agents? 9. Acute secretory diarrhea caused by what two bacteria? 10.Chronic secretory diarrhea seen in whom? 11.Cholera and ETEC primarily affect ____ secretion? See __ diarrhea with

___ and rare fecal __?12.Shigella, salmonella, campylobacter will show what about the diarrhea? 13.Frequent, small volume diarrhea with tenesmus and urgency and blood

and mucus is usually what side? 14.Large volume, less frequent diarrhea with uncommon blood and no

tenesmus or urgency is what side? 15. If fecal leukocytes are seen what bacteria? If absent probably what? 16. If they have had antibiotic (wide spectrum) think what bacteria? If they

have ate seafood? 17.ETEC, Norwalk, rotavirus and giardia produce what type of diarrhea? 18.Yersinia can mimic what? 19.Most common cause of infectious bloody diarrhea in US? If rectal

involvement think what? 20.How do we treat ETEC? 21.When do we avoid pepto-bismo? 22.Which E.coli will produce bloody diarrhea and renal failure? 23.Which E.coli will produce fever and bloody diarrhea? 24.With EHEC you see colitis on barium study which looks like what? 25.Shigella is transmitted how? Symptoms? Rare complications? 26.Antibiotics for shigella? 27.What should we check for in sickle-cell or IBD, with someone exposed to

turtles,salamanders, amphicians? 28.Symptoms? Treatment?

29. If campylobacter infection is bad enough what antibiotic? 30.Yersinia comes from what? Primarily infects where? 31.What comes from mayo, meats or dairy and shows intractable vomiting,

pain and severe cramps?32.What comes from rice? 33.Which comes from pork or meat pie and patients can get really sick and

go into shock? 34.Biggest vector for giardia? Also in AIDs/___ contact, daycares and

patients with ___ deficiency? 35.Treatment for adults and children with giardia? What about pregnant

patients? 36.What can be seen in immunocompromised that can go on to debilitating

infection? 37.What if you see yellow-white plaques on lining of colon? 38.Most common cause of C. diff? 39.Main drug for C. diff and back up plan? 40.Decreased motility with small bowel bacterial overgrowth seen in what

disease?41. Increased motility with delayed contact time?

IBS1. IBS or ___ is attributed to the __ and associated with symptoms of ___,

bloatedness and __?2. Criteria for IBS include continuous or recurrent symptoms of __ pain

relieved with defection AND/OR disturbed ___, passage of ___ with bloating or feeling of distension?

3. What sex is affected more? What age group? 4. Abnormal ___ perception is key to IBS, also ___ distress? 5. Key history of IBS is pain eased after ___, mucus and incomplete __?6. Red flags for IBS are __ loss, onset in ___ patients, __ awakening and

family history of cancer or IBD?7. Rifaximin can be used for what type of IBS? Alosetron for what type?

Linaclotide for what type? 8. If the main symptoms are bloating/gas give them __ right way? 9. In pediatrics patients what is predominantly used?

Inflammatory Bowel Disease1. There is a slight __ predominance in UC? Slight female in ___?2. Males are more frequently diagnosed than females in __ and __ decades

of life?3. Which one seems to be a lot higher in identical twins? 4. Disease of what type of countries? 5. In people with IBD, they can’t do what? 6. Environmental stress for IBD involves __ use, stress, diet and ___? 7. IBD have a loss of tolerance for normal GI ___, and have altered

composition?

8. Cigarette smoking is a MAJOR risk factor for which one, but negative for the other?

9. Appendectomy is a major for which one, negative for which one?10. Increased sugar intake related to which one? 11.Extensive ___ and higher age at diagnosis increase the risk of fatal

outcome in __?12.Ulcerative Colitis is a mucosal ulceration limited to the ___? Extensive is

considered anything that extends beyond what? 13.CD is considered a ___ inflammation and can be seen from mouth to

anus, but most common areas? 14. If you see patchy colitis in intestine, unable to stop smoking, and there are

granulomas it is what? 15.UC has __ inflammation, starts in __ with no skip lesions? What are very

rare? 16. If you see growth failure in children look for what? UC can develop __

leading to perforations? 17.Major fistula seen in CD? 18. In severe UC you can see a much thickened __ due to inflammation?19.Major complication of UC? 20.What type of arthritis in CD? What type in UC?21.Why osteoporosis chance greater in CD? 22.Bamboo spine is independent of ___ state and associated with what

haplotype? Other type of arthritis that is common in UC? 23.The peripheral arthritis seen in CD is what? 24.Patients with UC what type of kidney stones? With CD> 25.Why obstructive hydronephritis with CD? 26. If you see erythema nodosum over the shin it is non-specific for __ and

directly related to what? 27. If you see an ulcerative lesion over the shin, what is it? 28.Can also see painful, injected eye called __ that is independent of disease

state? 29.4-6% of patients with UC can have __ which is what? What is a

complication that Walter Payton died of ?30.What may happen in CD patients with terminal ileal involvement? 31.UC will have diarrhea typically with what? Will also show __ for bowel

movement? 32.Always have to rule out what when making UC diagnosis? 33.Why is colonoscopy contraindicated in acute UC? 34.The antibody pANCA is useful for what? The antibody ASCA for what? 35.A colon that has had repeated inflammatory changes and is very scarred

down is known as __ in UC?36.For mild UC we use what to induce remission? Maintenance dose,

breakthrough flare? 37. In UC, a hemorrhage, perforation, cancer or unresponsive acute disease

what is indicated? 38.Most common surgery for UC? Have to watch for what?

39.Problem with surgery for UC? 40.Crohn’s disease will show distorted ___ on histology and 50% will show

what? 41.Gold standard for CD? 42.For CD, aminosalicylates are only useful when CD is confined to where?

Mainstay to induce remission? Immunomodulators? 43.What two antibiotics used in CD are similar to steroids? 44.What do corticosteroids not do? 45.For azathioprine or 6-MCP we want to measure __ enzyme levels to make

sure they don’t get toxic levels and get neutropenia or hepatotoxicity? 46.Common side effects with these? 47.What is used in peds CD? Side effects? 48.What cytokine does infliximab work on? 49.What do we have to screen for before starting immunomodulators? 50.Natalizumab works on what? 51.Longer patients have UC the higher the risk of what? 52.What will happen to IBD during pregnancy?

Biochem Digestion1. Amylopectin is a polymer of ___ made up of __ linkages and __ linkages

every 20-30 units?2. Amylose is a polymer of glucose with a majority of what linkages?3. What is it about cellulose we can’t digest? 4. Sucrose is what 2? Lactose? Maltose? 5. Major components of enzyme in mouths? No major digestion of what?6. In the stomach how do we digest lipids? Proteins? Carbs? 7. Pancreas produces what to activate protein digestion enzymes? 8. ___ causes contraction of smooth muscle of gall bladder and secretion of

pancreatic enzymes? 9. __ stimulates HCl, pepsinogen and intrinsic factor as well as pepsinogen

and histamine? 10.Salivary alpha-amylase is an ___glucosidase acting on what bonds? 11.Glucoamylase is an __glucosidase acting on what bonds?12.Sucrase-isomaltase is bodies ability to deal with what? 13.Carbs are absorbed where? 14.What GLUT transports fructose? Which one is insulin sensitive? Which

for pancreatic beta cells? 15.__ cleavage activates all of the other pancreatic peptideases? 16.Some small __ can be secondary actively transported with hydrogen from

the gut? Some proteins can be __?17.Pancreatic lipase breaks TAGs into what? __ binds to fat and lipase

activating pancreatic lipase? 18.Then __ removes fatty acids from phospholipids and __ removes fatty acid

from cholesterol esters? 19.Lipids are absorbed as __ and what diffuses into enterocyte only to be

reconstituted at TAGs?

20.Free FAs to 2-MAGs requires 2 __ molecules one __?21.Since TAGs are not water soluble, __ are dietary that help us transporter

and __ are our own? 22.Protein part of lipoproteins called __ and consists of __ in chylomicrons

and __ in VLDL? 23.FAs and 2-MAGs enter cells and are re-esterified to TAGs in ___, the

major apoprotein for chylomicrons are made where? Nasecent chylomicrons secreted into blood after how long?

24.How do chylomcrons mature in blood? 25.Fat soluble vitamins and their disorders? 26.Location of iron absorption? What can interfere with absorption? 27.Over 50% of sodium absorbed where? Potassium absorbed where?

Calcium absorbed where? 28.___ can cause a blocked pancreatic duct resulting in decreased secretion

of digestive enzymes into the intestinal lumen? 29.Microsomal triglyceride transfer protein is required to assemble what? 30.What is caused by lack of this activity? What symptoms? 31.What shows an absence of neutral amino acid transport, with high levels

of tryptophan in urine? 32. In celiac disease, gluten destroys ___? Shows ___, malabsorption of fats

and fat soluble vitamins, weight loss and lethargy?

Oral Health1. Antbiotic prophylaxis should be done in patients with ___ cardiac valve,

previous __, or a congenital heart disease? 2. What antibiotics can be used? 3. Actinomyces mainly causes what type of caries? Is __ and acid producer

that is filamentous? 4. Which strep is an acid producer and anaerobic, also produces glucans but

less than mutans? 5. What bacteria plays more a role in later stage caries? 6. What helps teeth remineralize? 7. Best process for fluoride is to be incorporated into matrix of ___ tooth?

Can give it in the form of what? 8. What gum helps reduce strep mutans? What rinse? 9. A parent putting a child to sleep with bottle in mouth has a tendency to

cause what? 10.Healthy gums do not __, are coral __ or ___, are firmly attached to bone

and appear __ like an orange peel? 11.What is an infection of tissue supporting teeth?12.__ is milder and reversible only infecting gingiva?13.__ is more severe infection of gingiva and alveolar bone? 14.Warning signs include easily __ gums, __ gums, persistent bad __, and

permanent teeth are loose? 15.Gum disease is caused by poor oral __ and failure to remove __ and food

material from teeth and gumlines?

16.Prevention of gum disease involves __ and __, pits and fissure __, and routine ___?

17.A dental pulp infection is an __ infection, and show swelling, pain without __ pain due to hot __?

18.What three 3 things can do it? 19.Endodontic treatment involves removal of __ and replacement with what? 20.Swelling of an abscess usually indicates a __ pulp with spread into soft

tissue? 21. In an acute odonotogenic infection usually present as a __,upset child,

with raised temp and red,swollen face?22. In chronic odontogenic a __ may be present that is usually labial or

buccal, a __ tooth, halitosis and discolored teeth? 23.We treat by removing the cause, local __ and debridement, extraction of

__ teeth or ___ for permanent teeth, oral __ if systemic? 24.___ presents with pain in or around ear, tenderness of jaw, clicking and

popping noises, chronic headaches, chronic neck aches? 25.Treatments include ___ like a bite guard, heat and ice therapy, anti-

inflammatory, muscle __ like valium? 26.With an avulsed tooth you can do what two things? 27.Treatment for cracked tooth? 28.Recent tooth injury is what color? An older injury is what color?

Radiology1. Explain the 3,6,9 rule?2. Main risk of barium sulfate? 3. What should we use if perforation is present? Major risk? 4. The __ is arbitrarily defined as the proximal 2/5 of the small bowel and the

ileum is the distal ___?5. The jejunum has a more __ pattern and more prominent __? Ileum is __

with less ___?6. ___ films are obtained for evaluation of air-fluid levels within bowel and to

rule out perforation? 7. ___ studies are method of choice in the esophagus, stomach and large

bowel?8. Main advantage of CT enterography? 9. Normal appendix diameter? 10.Normal wall of GB is not greater than ___ and diameter is < __? Minimum

of __ hours of fasting to distend GB?11.Flow within the portal vein can be described as ___ which is normal and

directed toward the liver? Or __ which is abnormal and directed way from liver?

12.__ is presently the imaging choice for evaluation of pyloric stenosis?13.The overall typical echogenicity pattern of organs of the abdomen is

__>liver>___?14.HIDA or hepatobiliary scan is considered normal if the gallbladder is

visualized within ___?

15.The hallmark of acute cholecystitis is non-visualization of the gallbladder on the __ and __ hour image?

16.Study of choice of Meckel’s in pediatrics?