5505 GI Mock Practical

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Question 1
A patient is having liver surgery done where the
Pringle maneuver will be performed. This
maneuver is done by compressing a ligament that
contains the proper hepatic artery. What is the
ligament that will be compressed?

A. Falciform ligament
B. Hepatoduodenal Ligament
C. Hepatogastric ligament
D. Gastrosplenic ligament

Answer 1
A patient is having liver surgery done where the
Pringle maneuver will be performed. This
maneuver is done by compressing a ligament that
contains the proper hepatic artery. What is the
ligament that will be compressed?
B the Hepatoduodenal ligament. This ligament
including the Hepatogastric ligament make up the
lesser omentum. The hepatoduodenal ligament
contains the bile duct, proper hepatic artery and the
hepatic portal vein. The ligament will connect the liver
to the duodenum.

A. Falciform ligament
B. Hepatoduodenal Ligament
C. Hepatogastric ligament
D. Gastrosplenic ligament
Question 2
You are examining a donor and
want to identify the muscles that
form the anterior abdominal wall.
Since you’re a smarty pants you
can identify this muscle by the
directions of their fibers alone.
What muscle is seen here?
Answer 2
You are examining a donor and
want to identify the muscles that
form the anterior abdominal wall.
Since you’re a smarty pants you
can identify this muscle by the
directions of their fibers alone.
What muscle is seen here?
This is the external oblique.
The direction of the fibers is the
EO are pointed downward and
medially (like putting your hands
in your pockets).
Question 3
70 year old female with heart failure
complains of difficulty swallowing.
Knowing the anatomy of the
esophagus and its interaction in the
mediastinum, what are the two
structures which may compress the
esophagus at the level of the
mediastinum?
Answer 3
70 year old female with heart failure
complains of difficulty swallowing.
Knowing the anatomy of the
esophagus and its interaction in the
mediastinum, what are the two
structures which may compress the
esophagus at the level of the
mediastinum?
The two mediastinal structures that may
constrict the esophagus are the left atrium
and the descending thoracic aorta. For
heart failure patients, increasing size of the left
atrium may compress both the esophagus and
recurrent laryngeal nerve. And in marfan or
tertiary syphilis patients, a thoracic aortic
aneurysm may compress the esophagus as
well.
Question 4
In an open abdominal exploration,
the surgeon suspects that a given
patient is suffering from a posterior
duodenal ulcer rupture. To reach
the posterior surface of the
duodenum without any further
dissection, what structure must the
surgeon pass their instruments
through?
Answer 4
In an open abdominal exploration, The foramen referred to here is the epiploic foramen.
the surgeon suspects that a given
patient is suffering from a posterior
duodenal ulcer rupture. To reach
the posterior surface of the
duodenum without any further
dissection, what structure must the
surgeon pass their instruments
through?
Question 5
44 year old female G3P3 BMI 40
presents complaining of right upper
quadrant pain, fever, and
nausea/vomiting. She is taken for
an emergent laparoscopic
cholecystectomy. Which artery
must be ligated in this patient’s
procedure?
Answer 5
44 year old female G3P3 BMI 40 This patient is more than likely going for a
presents complaining of right upper cholecystectomy. The artery that is most directly
quadrant pain, fever, and involved is the cystic artery.
nausea/vomiting. She is taken for
an emergent laparoscopic
cholecystectomy. Which artery
must be ligated in this patient’s
procedure?
Question 6
The pancreas contributes (typically)
two ducts to the second portion of
the duodenum. What are the proper
names for these ducts?
Answer 6
The pancreas contributes (typically)
two ducts to the second portion of
the duodenum. What are the proper
names for these ducts?
The two proper names for the ducts are the primary
duct of Wirsung and the secondary duct of
Santorini.
Question 7
To perform an appendectomy, you
must ligate the appendicular artery,
which is one of the branches of the
ileocolic artery. Which blood vessel
stemming from the anterior
abdominal aorta supplies this
region?
Answer 7 Superior mesenteric artery

The superior mesenteric artery supplies the GI tract

To perform an appendectomy, you from the duodenum to the distal transverse colon. As a
must ligate the appendicular artery, result, it covers the appendix in the ileocolic region.
which is one of the branches of the Knowing the regions of the three anterior branches of
ileocolic artery. Which blood vessel the aorta is super high yield and I have a simple
stemming from the anterior mnemonic to remember it. The small intestine can be
abdominal aorta supplies this divided into three sections: duodenum, jejunum, and
region? ileum. So can the colon: ascending, transverse,
descending (yes I know sigmoid and rectum exists too
Order of blood vessels
1. Celiac Trunk but we can ignore it for this okay).
2. SMA The first branch of the aorta, celiac trunk, goes up to
3. IMA
the first section of the small intestine. The second
Duodenum Jejunum Ileum branch of the aorta, the SMA, extends to the second
section of the large intestine. The third branch, IMA,
Ascending Transverse Descending takes care of the rest.
Question 8
A 60 year-old man is brought to the
emergency department shortly after he
began vomiting profuse amounts of
bright red blood. Blood pressure is 70/40
and pulse is 120. Despite appropriate
measures, he dies soon after admission.
Review of his most recent upper
endoscopy reveals the following image.
Which branch of the portal system is
responsible for this finding?
Answer 8 Left gastric vein
I like to think of the portal system as a Frankenstein creation from all three
branches of the arterial system. In this way, it also drains the whole GI tract from
A 60 year-old man is brought to the esophagus to rectum. They all keep the same name, which makes it easier to
emergency department shortly after he remember that the “left gastric” is both the artery & vein for the esophagus.
began vomiting profuse amounts of
bright red blood. Blood pressure is 70/40
and pulse is 120. Despite appropriate
measures, he dies soon after admission.
Review of his most recent upper
endoscopy reveals the following image.
Which branch of the portal system is
responsible for this finding?
Question 9
Identify the parietal cell.
 Answer: A

Answer 9 In an H&E stain, parietal cells will be the large, pink cells,
whereas chief cells will be the small, densely packed
Identify the parietal cell. purple cells. If you need a mnemonic just remember
“parietal = pink.”
Question 10 B

Which of the histology slides is

a slide of the duodenum?

D
C
Answer 10 B

Which of the histology slides is

a slide of the duodenum?

Answer: A
The arrows are pointing to Brunner
glands.These are going to be
predominantly in the duodenum. B. is A
going to be the ileum, and the
characterizing feature of this section D
are the Peyer’s patches. C. is the C
esophago-gastric junction, this area is
characterized by the epithelium
changing from stratified squamous to
simple columnar. D. is a histology
slide of the colon. This area is
characterized by a lack of villi, but it
will have the crypts of Lieberkuhn and
goblet cells.
Question 11
The ito cell depicted in the diagram is
responsible for storage of what substance?
Answer 11
Ito cells store vitamin A. They are also
The ito cell depicted in the diagram is
responsible for fibrous changes involved in
responsible for storage of what substance?
hepatosteatosis.
Question 12
Identify at least 1 hormone
produced by the cells included
in the structure imaged.
Answer 12
Identify at least 1 hormone Insulin, glucagon, or somatostatin.
produced by the cells included
in the structure imaged.
Question 13
You’re examining your patient’s mouth
and you notice this lesion. He’s a 70
year old man with a 30 year pack history
and drinks 6 beers a day. When you take
a biopsy of the lesion what do you
expect to see on histology? A B

C D
Answer 13
You’re examining your patient’s mouth
and you notice this lesion. He’s a 70
year old man with a 30 year pack history
and drinks 6 beers a day. When you take
a biopsy of the lesion what do you
expect to see on histology? A B

Answer: C

The patient has leukoplakia which is D

squamous dysplasia. On histology this will C
show pleomorphic cells with increased mitotic
figures with an intact basement
Question 14
You have a patient presenting with RUQ
colicky pain after eating. The patient
seems to be in an emergency situation
and you decide it’s in the best interest to
remove the gallbladder. When removed
you identify these masses in the lumen.
Of the following options which is the most
likely cause?

A. Increased peripheral aromatase

activity

B. Hereditary spherocytosis

C. Sickle cell anemia

D. Crigler Najar type 2

Answer 14
You have a patient presenting with RUQ Answer: A, Increased
colicky pain after eating. The patient peripheral aromatase activity
seems to be in an emergency situation
and you decide it’s in the best interest to Excess estrogen from
remove the gallbladder. When removed
you identify these masses in the lumen.
pregnancy, hormone
Of the following options which is the most replacement therapy, or birth
likely cause? control pills appears to increase
A. Increased peripheral aromatase cholesterol levels in bile and
activity decrease gallbladder movement,
B. Hereditary spherocytosis both of which can lead to
gallstones. All other answer
C. Sickle cell anemia
choices describe pigmented
D. Crigler Najar type 2 gallstones.
Question 15
A 39-year-old man presented to his
gastroenterologist with a one-day
history of cramping, lower
abdominal pain, bloating, and
bloody diarrhea. A partial colon
resection was performed with the
specimen seen in the photo below.
Which of the following best
characterizes this disease?

a. Continuous lesions
b. Pseudopolyps
c. Mucosal and submucosal
inflammation
d. Noncaseating granulomas
e. Rectum and colon
involvement
Answer 15
A 39-year-old man presented to his
gastroenterologist with a one-day
history of cramping, lower
abdominal pain, bloating, and
bloody diarrhea. A partial colon
resection was performed with the
specimen seen in the photo below.
Which of the following best
characterizes this disease?
a. Continuous lesions
b. Pseudopolyps
c. Mucosal and submucosal
inflammation
d. Noncaseating granulomas
e. Rectum and colon
involvement
D. Noncaseating granulomas.
This patient has Crohn’s disease
because of the cobblestone and skip
lesion appearance of the resected
colon. Some features of Crohn’s
disease include noncaseating
granulomas, skip lesions, spared
rectum, lesions extending from mouth to
anus, transmural inflammation, and
strictures. Continuous lesions,
pseudopolyps, mucosal and
submucosal inflammation, lack of
granulomas, and rectum and colon
involvement all describe Ulcerative
Colitis. Which can be seen in the photo
below
Question 16
A 60-year-old woman presents with an insidious
onset of weakness and fatigue. She has occasional
mild shortness of breath. Sometimes she feels a little
light-headed. She has indigestion and mild
heartburn. Physical exam reveals pale conjunctiva
and nail beds. After ordering a CBC and blood
smear, the results are shown in the image below.
The patient is subsequently diagnosed with
pernicious anemia due to a lack of intrinsic factor.
What cell normals secretes this protein?

A. Chief Cells
B. G Cells
C. D Cells
D. I Cells
E. K Cells
F. S Cells
G. ECL Cells
H. Parietal Cells
Answer 16
A 60-year-old woman presents with an insidious
H. Parietal Cells.
onset of weakness and fatigue. She has occasional
Parietal cells are found in the body
mild shortness of breath. Sometimes she feels a little
of the stomach and secrete HCl
light-headed. She has indigestion and mild
heartburn. Physical exam reveals pale conjunctiva and intrinsic factors. Chief cells are
and nail beds. After ordering a CBC and blood also found in the body of the
smear, the results are shown in the image below. stomach and secrete Pepsinogen.
The patient is subsequently diagnosed with
pernicious anemia due to a lack of intrinsic factor. D cells -> somatostatin
What cell normals secretes this protein? (somaDOstatin);
A. Chief Cells G cells -> gastrin;
B. G Cells
C. D Cells I cells -> CCK;
D. I Cells
E. K Cells S cells -> secretin;
F. S Cells
K cells -> GIP;
G. ECL Cells
H. Parietal Cells ECL cells -> histamine