Esophageal Diseases

Question 1

Which of the following is the most common esophageal symptom?

A. Pyrosis
B. Regurgitation
C. Chest pain
D. Dysphagia

Answer 1

A. Pyrosis

Question 2

Which of the following disorders presents dysphagia for both liquids and solid food?

A. Achalasia
B. Diffuse Esophageal Spasm
C. GERD
D. Gastritis

Answer 2

A. Achalasia

Question 3

This refers to the perception of a lump or fullness in the throat that is felt irrespective of swallowing.

A. Globus esophagus
B. Globus tonsilitis
C. Globus pharyngeus
D. Globus pallidus

Answer 3

C. Globus pharyngeus

Question 4

This is the most useful test for evaluation of the proximal gastrointestinal tract.

A. EGD
B. Ultrasound
C. Manometry
D. Radiography

Answer 4

A. EGD

Question 5

This is the most sensitive procedure for diagnosing achalasia.

A. Endoscopy
B. Ultrasound
C. Manometry
D. Radiography

Answer 5

C. Manometry

Question 6

The ultimate cause of achalasia is an autoimmune process attributable to a latent infection with which of the following?

A. HSV-1
B. HSV-2
C. HTLV-1
D. HTLV-2

Answer 6

A. HSV-1

Question 7

Corkscrew or rosary bead esophagus is a characteristic of which of the following conditions?

A. Achalasia
B. Diffuse Esophageal Spasm
C. GERD
D. Chronic gastritis

Answer 7

B. Diffuse Esophageal Spasm

Question 8

Beak-like appearance of the LES is a characteristic of which of the following conditions?

A. Achalasia
B. Zollinger-Ellison syndrome
C. GERD
D. Infectious esophagitis

Answer 8

A. Achalasia

Question 9

Spasm mostly occurs in which part of the esophagus?

A. Proximal
B. Medial
C. Distal
D. Any of the options

Answer 9

C. Distal

Question 10

All of the following contribute to the development of GERD EXCEPT

A. Transient LES relaxation
B. LES hypotension
C. Anatomic distortion of the esophagogastric junction
D. None of the options

Answer 10

D. None of the options

Question 11

All of the following are risk factors that exacerbate reflux EXCEPT:

A. Abdominal obesity
B. Pregnancy
C. Gastric hyposecretory states
D. Gluttony

Answer 11

C. Gastric hyposecretory states

Question 12

Which of the following is the endoscopic hallmark of GERD?

A. Erosive esophagitis
B. Eosinophilic esophagitis
C. Candida esophagitis
D. Herpetic esophagitis

Answer 12

A. Erosive esophagitis

Question 13

Which of the following is the most severe histologic consequence of GERD?

A. Esophageal dysplasia
B. Barrett’s metaplasia
C. Colorectal carcinoma
D. Esophageal adenocarcinoma

Answer 13

B. Barrett’s metaplasia

Question 14

Which of the following is the mostly recommended for GERD patients?

A. Avoidance of refluxogenic foods
B. Avoidance of acidic foods
C. Elevate head of the bed
D. Weight reduction

Answer 14

D. Weight reduction

Question 15

Nicola, a 21-year old physician was visited by one of her patients with a complaint of heartburn and regurgitation. Upon diagnosing, she found out that her patient has GERD. Which of the following medications should she recommend?

A. Combination of aluminum hydroxide and magnesium hydroxide
B. Cimetidine
C. Omeprazole
D. Colloidal bismuth subcitrate

Answer 15

C. Omeprazole

Question 16

Another patient walks in to Nicola’s clinic. This time, the patient experiences pain and dyspepsia accompanied with fever. You suspected a possible infection. Which of the following microorganisms would you consider as an etiologic agent?

A. Clostridium difficile
B. Helicobacter pylori
C. Escherichia coli
D. Pseudomonas aeruginosa

Answer 16

B. Helicobacter pylori

Question 17

With Nicola’s accurate suspicion, which of the following should she give as part of the patient’s medication?

A. PPI + Clarithromycin + Amoxicillin
B. PPI + Levofloxacin + Amoxicillin
C. PPI + H2 blocker
D. PPI only

Answer 17

A. PPI + Clarithromycin + Amoxicillin

Question 18

Upon giving the right prescription, Nicola explained the possible complication of the drug given. Which of the following is the most feared complication of amoxicillin?

A. Pseudomembranous candidiasis
B. Pseudomembranous colitis
C. Pseudomembranous esophagitis
D. Clostridium difficile infection

Answer 18

B. Pseudomembranous colitis

Question 19

For NSAID-related injury, which of the following would you recommend is the patient has an active ulcer but the use of NSAID has been already discontinued?

A. PPI
B. Selective COX-2 inhibitor
C. H2 blocker
D. Bed rest

Answer 19

A. PPI

Question 20

Which of the following conditions present with white plaques with friability and given with fluconazole as medication?

A. Candida esophagitis
B. Herpetic esophagitis
C. Cytomegalovirus esophagitis
D. All of the options

Answer 20

A. Candida esophagitis

Question 21

This is most common in patients with organ transplants. Lesions of this condition appear as serpiginous ulcers.

A. Candida esophagitis
B. Herpetic esophagitis
C. Cytomegalovirus esophagitis
D. Esophageal perforation

Answer 21

C. Cytomegalovirus esophagitis

Question 22

This is a nontransmural tear at the GE junction caused by vomiting, retching, or vigorous coughing.

A. Esophageal perforation
B. Mallory-Weiss tear
C. Corrosive Esophagitis
D. Food impaction

Answer 22

B. Mallory-Weiss tear

Question 23

This is a spontaneous rupture at the GE junction caused by forceful vomiting or retching.

A. Esophageal perforation
B. Radiation esophagitis
C. Corrosive esophagitis
D. Erosive esophagitis

Answer 23

A. Esophageal perforation

Question 24

Which of the following conditions present infiltration and destruction of muscularis propria with collagen deposition and fibrosis?

A. Eosinophilic esophagitis
B. Infectious esophagitis
C. GERD
D. Scleroderma

Answer 24

D. Scleroderma

Question 25

All of the following can be seen in the right upper quadrant EXCEPT: A. Gallbladder B. Duodenum C. Spleen D. Pylorus of the stomach

Answer 25

C. Spleen

Question 26

All of the following can present epigastric pain EXCEPT A. Esophageal reflux B. Esophageal spasm C. Peptic ulcer D. Gallbladder disease

Answer 26

B. Esophageal spasm

Question 27

All of the following are not palpable EXCEPT A. Stomach B. Liver C. Spleen D. Pancreas

Answer 27

D. Pancreas

Question 28

Dome of diaphragm lies at _____ A. 4th ICS B. 5th ICS C. 6th ICS D. 7th ICS

Answer 28

B. 5th ICS

Question 29

You have a patient that complains about chest pain. This pain is considered what type of abdominal pain? A. Visceral pain B. Parietal pain C. Referred pain D. Extraabdominal pain

Answer 29

C. Referred pain Visceral = hollow abdominal organs are distended or stretched Parietal = inflammation of parietal peritoneum (steady, aching pain, more severe Referred = felt in more distant sites

Question 30

Which of the following drugs is mostly associated with tardive dyskinesia? A. Sucralfate B. Metoclopramide C. Pantoprazole D. Domperidone

Answer 30

B. Metoclopramide

Question 31

Which of the following is the first line of mucosal defense system? A. Mucus-bicarbonate-phospholipid layer B. Surface epithelial cells C. Subepithelial cells D. Any of the options

Answer 31

A. Mucus-bicarbonate-phospholipid layer

Question 32

A 25-year-old man is severely injured in a motor vehicle collision. After 6 weeks of total parenteral nutrition (intravenous feeding), the stomach and small intestines have atrophied substantially. A lack of which of the following gastrointestinal hormones is most likely to account for the atrophy in this man? ``` A) Cholecystokinin B) Gastrin C) Glucose-dependent insulinotropic peptide D) Motilin E) Secretin ```

Answer 32

B) Gastrin is secreted mainly by the G-cells of the antrum of the stomach. The primary actions of gastrin are (1) stimulation of gastric acid secretion and (2) stimulation of mucosal growth throughout the gastrointestinal tract.

Question 33

A 43-year-old woman eats a meal consisting of 70% carbohydrate, 20% protein, and 10% fat. Six hours after consuming the meal, intense peristaltic contractions travel from the stomach to the colon over a period of about 90 minutes. Which of the following hormones is most likely to mediate the intense peristaltic contractions in this woman? ``` A) Cholecystokinin B) Gastrin C) Glucose-dependent insulinotropic peptide D) Motilin E) Secretin ```

Answer 33

D) Motilin is secreted by the duodenum and jejunum during fasting, and the only known function of this hormone is to increase gastrointestinal motility. Motilin is released cyclically and stimulates waves of gastrointestinal motility called interdigestive myoelectric complexes (or migrating motility complexes) that move through the stomach and small intestine every 90 minutes in a person who has fasted.

Question 34

Dietary fat can cause the release of all gastrointestinal hormones EXCEPT one. Which one is the EXCEPTION? ``` A) Cholecystokinin B) Gastrin C) Glucose-dependent insulinotropic peptide D) Motilin E) Secretin ```

Answer 34

B) Gastrin is secreted in response to vagal stimulation as well as stimuli associated with ingestion of a meal, such as distention of the stomach and the breakdown products of proteins. However, fat does not cause the release of gastrin as it does with other gastrointestinal hormones.

Question 35

Biopsies are taken from the antral and duodenal mucosa of a 48-year- old woman. Which of the following hormones can be found in tissue homogenates from both locations? ``` A) Secretin B) Gastrin C) Cholecystokinin (CCK) D) Motilin E) Glucose-dependent insulinotropic peptide (GIP) ```

Answer 35

B) Gastrin is the only gastrointestinal hormone listed that is produced and stored in the antrum of the stomach. All five gastrointestinal hormones are produced and stored in the duodenum and jejunum.

Question 36

Oral administration of a histamine H2 receptor antagonist is most likely to cause which of the following changes in the ability of gastrin, acetylcholine, and histamine to stimulate gastric acid secretion? A) Gastrin increased; acetylcholine increased; histamine increased B) Gastrin decreased; acetylcholine decreased; histamine decreased C) Gastrin no change; acetylcholine decreased; histamine no change D) Gastrin increased; acetylcholine decreased; histamine decreased E) Gastrin decreased; acetylcholine no change; histamine decreased

Answer 36

B) The three secretagogues for gastric acid secretion are gastrin, histamine, and acetylcholine. These secretagogues have a synergistic or multiplicative action on acid secretion, which means that blocking the action of one secretagogue will cause the other secretagogues to be less effective. Hence, blocking the actions of histamine with an H2 antagonist causes gastrin and acetylcholine to be less effective in stimulating acid secretion.

Question 37

A 34-year-old physician visits a gastroenterologist because of nausea, abdominal pain, and diarrhea. The physician was exposed to raw sewage and polluted water on a recent mission trip to an underprivileged area. The gastroenterologist administers a proton pump inhibitor and tetracycline. All the symptoms go away in 2 weeks. Which of the following best describes the condition for which the physician was treated? ``` A) Excessive alcohol consumption B) Ulcerative colitis C) Psychogenic diarrhea D) Posttraumatic stress syndrome E) Helicobacter pylori infection ```

Answer 37

E) Helicobacter pylori is endemic in many underprivileged areas of the world. At least 75% of persons with peptic ulcers have been found to have chronic infection of the terminal portions of the gastric mucosa and initial portions of the duodenal mucosa, most often caused by the bacterium H. pylori. Once this infection begins, it can last a lifetime unless it is eradicated by antibacterial therapy.

Question 38

A 10-year-old boy consumes a cheeseburger, fries, and a chocolate shake. The meal stimulates the release of several gastrointestinal hormones. The presence of fat, carbohydrate, or protein in the duodenum stimulates the release of which hormone from the duodenal mucosa? ``` A) Cholecystokinin (CCK) B) Glucose-dependent insulinotropic peptide (GIP) C) Gastrin D) Motilin E) Secretin ```

Answer 38

B) GIP is the only gastrointestinal hormone released by all three major foodstuffs (fats, proteins, and carbohydrates). The presence of fat and protein in the small intestine stimulates the release of CCK, but carbohydrates do not stimulate its release.

Question 39

The proenzyme pepsinogen is secreted mainly from which of the following structures? A) Acinar cells of the pancreas B) Ductal cells of the pancreas C) Epithelial cells of the duodenum D) Gastric glands of the stomach

Answer 39

29. D) Pepsinogen is the precursor of the enzyme pepsin. Pepsinogen is secreted from the peptic or chief cells of the gastric gland (also called the oxyntic gland).

Question 40

Which hormone is released by the presence of fat and protein in the small intestine and has a major effect in decreasing gastric emptying? ``` A) Cholecystokinin B) Glucose-dependent insulinotropic peptide C) Gastrin D) Motilin E) Secretin ```

Answer 40

Cholecystokinin (CCK) is the only gastrointestinal hormone that inhibits gastric emptying under physiological conditions.