1. Stomach/Small Intestine

2. Kaposi’s sarcoma Kaposi’s sarcoma

3. Splenic artery Splenic artery

4. Pepsinogen Pepsinogen

5. Motilin agonist Motilin agonist

6. Type III Type III Etiology? Etiology? Acid Acid

7. Roscoe-Graham patch Roscoe-Graham patch

8. Duodenum Duodenum

9. Hypokalemic hypochloremic metabolic alkalosis Hypokalemic hypochloremic metabolic alkalosis

10. A

11. Submucosa Submucosa

12. Glutamine Glutamine

13. Appendix Appendix

14. IVC IVC

15. FRIENDS FRIENDS Foreign body Foreign body Radiation Radiation IBD, infection IBD, infection Epithelialization Epithelialization Neoplasia Neoplasia Distal obstruction Distal obstruction Short tract Short tract

16. Adenoma Adenoma

17. Adenocarcinoma Adenocarcinoma

18. Cajal Cajal

19. Imatinib (Gleevec) Imatinib (Gleevec) MOA? MOA? Tyrosine kinase inhibitor

20. C-kit C-kit

21. Eradication of H. Pylori Eradication of H. Pylori

22. Adhesions Adhesions Hernia Hernia Mass (neoplasm) Mass (neoplasm)

23. Take appendix unless base (cecum) involved Take appendix unless base (cecum) involved

24. Wedge resection with clear margins

25. Lesser curve: L gastric (celiac) Lesser curve: L gastric (celiac) Greater curve: L gastroepiploic, short gastrics (splenic), R gastroepiploic (GDA) Greater curve: L gastroepiploic, short gastrics (splenic), R gastroepiploic (GDA) Pyloroduodenal area: R gastric (common hepatic) Pyloroduodenal area: R gastric (common hepatic)

26. Serum gastrin level is elevated Serum gastrin level is elevated Gastric acid output is elevated Gastric acid output is elevated Secretin stimulation markedly increases gastrin level Secretin stimulation markedly increases gastrin level Protein meal markedly increases gastrin levels Protein meal markedly increases gastrin levels Bombesin stimulation markedly increases gastrin level Bombesin stimulation markedly increases gastrin level ZE syndrome ZE syndrome Antral G-cell hyperplasia Antral G-cell hyperplasia Both Both Neither Neither

27. Which of the following best describes the effects that parietal cell vagotomy would cause in a previously normal stomach (no other procedure is performed in addition to the vagotomy)? (A) Both liquids and solids would empty significantly faster. (B) Both liquids and solids would empty significantly slower. (C) Liquids would empty significantly faster, whereas the emptying rate of solids would not change significantly. (D) Solids would empty significantly faster, whereas the emptying rate of liquids would not change significantly.

28. (A) H. pylori organisms bind only to gastric-type epithelium (B) The majority of persons living in developed countries harbor H. pylori in their stomachs (C) H.pylori organisms directly stimulate G cells to secrete gastrin, thereby increasing acid secretion. (D) Despite cure of H. pylori infection in patients with healed duodenal ulcer disease, over 25% will have a recurrence of ulcer disease.

29. (A) Gastrin in high levels has been shown to cause gastric mucosal hypertrophy. (B) Glucose in a meal is one of the most potent stimulators of gastrin release. (C) Gastrin-secreting cells (G cells) are found only in the gastric antrum and pylorus. (D) Regular administration of antacids will suppress gastrin release as long as pH is kept consistently above 5.0. (E) Omeprazole, a proton pump inhibitor, can completely suppress gastrin secretion if taken regularly.

30. (A) Parasympathetic innervation of the liver is through the left vagus nerve. (B) Sensation of gastric pain occurs through both vagus nerves, right and left. (C) Only approximately 10% of the vagal trunk fibers are motor or secretory efferents, leaving the remaining 90% vagal fibers as afferent back to the central nervous system. (D) The left vagal trunk winds around the esophagus and rests close to the anterior surface of the esophagus after exiting the esophageal hiatus.

31. (A) Parietal cell vagotomy has the lowest ulcer recurrence rate among the three. (B) Truncal vagotomy and antrectomy is technically the least demanding and is the quickest to perform in an emergency situation. (C) Parietal cell vagotomy is associated with the lowest occurrence of postoperative dumping syndrome. (D) All three procedures involve severing the celiac and hepatic divisions of the vagus nerves.

32. (A) two-week regimen of clarithromycin and amoxicillin, followed by repeat endoscopic evaluation with deep antral biopsies 1 month after completion (B) combined chemotherapy and radiation therapy (C) generous antrectomy with frozen section evaluation of surgical margins (D) parietal cell vagotomy, followed by repeat endoscopic evaluation with deep antral biopsies 1 month later

33. (A) Right gastroepiploic (B) Left gastroepiploic (C) Right gastric (D) Left gastric

34. (A) 10% (B) 25% (C) 50% (D) 75%

35. (A) Serologic test (B) Urea breath test (C) Histology (D) Rapid urease test

36. (A) Expectant management (B) Oral glucose for symptoms (C) Octreotide (D) Surgical conversion to a Roux- en-Y drainage

37. (A) Subtotal gastrectomy (B) Radiotherapy (C) Chemotherapy (D) Wide local excision

38. (A) Beginning bismuth, tetracycline, and metronidazole (B) Beginning omeprazole (C) Endoscopy and coagulation of the bleeding vessel (D) Pyloroduodenotomy and oversewing of the bleeding vessel

39. (A) Bicarbonate (B) Intrinsic factor (C) Lipase (D) Pepsinogen (E) Glucagon

40. (A) Severe periumbilical pain (B) Elevation of creatine phosphokinase levels (C) Hyperkalemia (D) Metabolic acidosis

41. (A) pancreaticoduodenectomy (B) sphincterotomy and stent placement (C) choledochoduodenostomy (D) extensive Kocher maneuver with duodenectomy

42. (A) H2 blockade followed by diverticulectomy (B) Diverticulectomy alone (C) Diverticulectomy and oversewing of the bleeding point (D) Segmental small bowel resection to include the Meckel's diverticulum

43. (A) Segmental resection only (B) Adjuvant chemotherapy followed by segmental resection (C) Segmental resection followed by chemotherapy (D) Resection, chemotherapy, and X- ray therapy

44. (A) Observation (B) Endoscopic resection (C) Surgical resection (D) Surgical bypass

45. (A) Pyoderma gangrenosum (B) Erythema nodosum (C) Ankylosing spondylitis (D) Nodular arthritis

46. (A) The duodenum (B) The jejunum (C) The proximal ileum (D) The terminal ileum

47. (A) Hemangiopericytoma (B) Leiomyoma (C) Lipoma (D) Metastatic carcinoma

48. (A) Octreotide is an analog of native somatostatin with a longer elimination half-life. (B) Pharmacologic effects of octreotide include reduction of GI, biliary, and pancreatic secretions as well as decreased intestinal motility. (C) Clinical studies suggest that octreotide significantly decreases fistula output in patients with persistent ECFs. (D) Clinical studies suggest that octreotide significantly increases the rate of spontaneous closure of ECFs. (E) Possible side effects of octreotide administration include mild hyperglycemia and pain at the site of injection.

49. (A) Most are biochemically atypical tumors lacking the enzyme dopa decarboxylase. (B) They are the most common GI carcinoid tumors. (C) Regional lymph node involvement is common in tumors less than 1 cm in size. (D) Diagnosis is frequently made in patients prior to surgery. (E) Among carcinoid tumors, they are associated with the lowest rate of second primary malignancies.

50. (A) Its release stimulates pancreatic acinar cell secretion, pancreatic growth, and insulin release. (B) It is released by the small bowel in response to contact with carbohydrates. (C) Its release stimulates gallbladder contraction and sphincter of Oddi relaxation. (D) It is released by the small bowel in response to contact with tryptophan and phenylalanine.

51. (A) postoperative enterocutaneous fistulas (ECFs) (B) duodenal obstruction (C) small bowel obstruction that has not improved with conservative management (D) child with secondary growth retardation related to CD (E) all of the above

52. (A) high output fistula (B) radiation enteritis (C) active IBD of fistulized segment (D) fistula tract <2.5 cm in length (E) all of these prevent fistula closure

53. (A) a 3 cm pedunculated adenoma in the second segment of the duodenum (B) a 3 cm Brunner's gland adenoma in the second segment of the duodenum (C) a 3 cm villous adenoma in the second segment of the duodenum (D) all of the above can be managed endoscopically