Esophagus and Stomach

Question 1

Thoracic esophagus starts __ from the incisors.

Answer 1

20 cm

Question 2

The abdominal esophagus starts ___ from the incisors.

Answer 2

40 cm

Question 3

The cricopharyngeal constrictor is:

(1) consists of a circular ring of muscle.
(2) is a bow of muscle connecting the cricoid cartilage.
(3) courses to the left of the trachea.

Answer 3

(2) is a bow of muscle connecting the two lateral borders of the cricoid cartilage.

Question 4

The cervical esophagus is:

(1) courses to the left of the trachea.
(2) is most easily approached through a right-sided neck incision.
(3) A string of muscle fibers that arises from the right crux in 45% of patients.

Answer 4

(1) courses to the left of the trachea.

Question 5

The diaphragmatic esophageal hiatus arises from the:

(1) right crus
(2) left crus
(3) either

Answer 5

(3) either.

Question 6

Bronchoaortic constriction occurs at:

(1) cricopharyngeus sphincter.
(2) the level of the fourth thoracic vertebra.
(3) where the esophagus traverses the diaphragm.

Answer 6

(2) the level of the fourth thoracic vertebrae.

Question 7

The Meissner plexu is located in the

Answer 7

The Meissner plexus is located in the SUBMUCOSA.

Question 8

The Auerbach plexus is located

Answer 8

The Auerbach plexus is located between the circular and longitudinal layers.

Question 9

T/F: entry of air with each inspiration is prevented by the upper esophageal sphincter, which normally remains closed.

Answer 9

True

Question 10

The sphincter that prevents retrograde flow of gastric contents into the esophagus:

(1) UES
(2) LES

Answer 10

(2) The LES prevents retrograde flow of gastric contents into the esophagus.

Question 11

Primary peristalsis is:

(1) progressive and triggered by voluntary swallowing
(2) progressive by generated by distention or irritation.
(3) non-progressive contractions that may occur either after voluntary swallowing or between swallows.

Answer 11

Primary peristalsis is (1) progressive and triggered by voluntary swallowing.

Question 12

Secondary peristalsis is:

(1) progressive and triggered by voluntary swallowing.
(2) progressive but generated by distention or irritation, not by voluntary swallowing.
(3) non-progressive contractions that may occur after voluntary swallowing or spontaneously between swallows.

Answer 12

Tertiary contractions are (3) non-progressive (simultaneous) contractions that may occur either after swallowing or spontaneously between swallows.

Question 13

The esophageal resting pressure is

Answer 13

3 - 5 cm in length.

Question 14

Which of the following regarding Plummer-VInson syndrome is TRUE?

(1) It refers to the development of cervical dysphagia in patients with acute iron-deficiency anemia.
(2) It is usually a cervical esophageal web.
(3) Esophageal dilatation and correction of anemia are not recommended treatments.

Answer 14

Plummer-Vinson syndrome is usually (2) a cervical esophageal web.

Question 15

Schatzki’s ring is an esophageal web found at the:

1) cervical esophagus
(2) Lower esophagus (squamocolumnar epithelial junction

Answer 15

Schatzki’s ring is at the lower esophageal web at the (2) squamocolumnar epithelial junction.

Question 16

Esophageal dilation is treatment for:

(1) Plummer VInson syndrome
(2) Schatzkl’s ring
(3) All of these

Answer 16

Esophageal dilation is treatment for (3) both Plummer-Vinson syndrome and Schatzkl’s ring.

Question 17

Achalasia presents with a classic triad of symptoms:

Answer 17

Achalasia presents with the classic triad of dysphagia, regurgitation and weight loss.

Question 18

Esophageal motility achalasia presents on imaging as:

(1) CXR shows a single mediastinal stripe throughout the length of the chest and absence of retrocardiac air-fluid.
(2) Barium swallow s the distal bird-beak taper.
(3) The esophagus relaxes on manometry.

Answer 18

Achalasia presents with (2) barium swallow shows a distal bird-beak taper.

Question 19

Achalasia uses esophagoscopy to evlaute the severity or esophagitis or to rule out:

Answer 19

(1) associated carcinoma or pseudo-achlasia

(2) distal esophageal stricture from reflux esophagitis.

Question 20

Complications of achalasia:

(1) regurgitation
(2) no chance of aspiration

Answer 20

Complications of achalasia include (1) regurgitation.

Question 21

The treatment for achalasia that results in permanently opening the sphincter:

(1) pneumatic or hydrostatic forced dilatation of the esophagus.
(2) esophagomyotomy
(3) intrasphincteric botulinum toxin

Answer 21

The treatment for achalasia that results in permanent opening of the sphincter is (2) esophagomyotomy.

Question 22

A patient experiences chest pain and dysphagia. The patient is diagnosed with diffuse esophageal spasms after esophageal manometry. The criteria that led to this diagnosis are:

Answer 22

Simultaneous, multiphasic, repetitive high-amplitude contractions that occur AFTER a swallow and spontaneously in the smooth muscle portion.

Question 23

A patient with dermatomyositis, polymyositis, SLE and scleroderma are likely to present with nutcracker esophagus. This disorder is characterized by:

Answer 23

hypermotility disorder characterized by (1) extremely high amplitude (225 0 430 mm) progressive peristaltic contractions.

Question 24

The treatment for nutcracker esophagus that is more favorable and providers better results:

(1) esophageal dilatation with tapered dilators (50 - 60 French).
(2) long thoracic esophagomyotomy
(3) nitrates

Answer 24

(1) esophageal dilatation with tapered dilators (50 - 60 French).

Question 25

Zenker's diverticula occurs at the: (1) At the junction of the pharynx and esophagus. (2) near the tracheal bifurcation (3) from the distal 10 cm of the esophagus.

Answer 25

Zenker's diverticula occurs at the junction of the pharynx and esophagus.

Question 26

The esophageal diverticula that arise from the distal 10 cm of the esophagus are: (1) Zenkers (2) para bronchial (3) epiphrenic (supradiaphragmatic)

Answer 26

(3) epiphrenic (supradiaphragmatic) occur from the distal 10 cm of the esophagus.

Question 27

A true diverticulum: (1) contains all layers of the normal esophageal wall (mucosa, submucosa and muscle) (2) mucosa and submucosa only. (3) Pulsion diverticula is an example of true diverticula. (4) most of the diverticula are not of the pulsion variety.

Answer 27

A true diverticulum (1) contains all layers of the mucosa, submucosa and muscle.

Question 28

T/F: surgical therapy of a diverticulum MUST address the motor component of the disorder.

Answer 28

True.

Question 29

A patient presents with complaints of something being "stuck in the throat". They admit intermittent cough, increased salivation and difficulty swallowing at times. You diagnose the patient with Zenker's diverticulum of the upper esophagus. Treatment involves:

Answer 29

Cervical esophagomyotomy (7 - 10 cm) and resection of the diverticulum.

Question 30

The type of esophageal diverticulum that is BEST detected by barium esophagogram and motility studies:

Answer 30

epiphrenic diverticulum

Question 31

Caustic injury of the esophagus is diagnosed and treated via: (1) The verification of the etiologic agent is not urgent. (2) A patient may present with excessive salivation and inability to swallow or drink. (3) Esophagoscopy is not recommended. (4) the stomach doe snot have to be examined.

Answer 31

Caustic injury of the esophagus is diagnosed when (2) a patient presents with excessive salivation, inability to swallow or drink.

Question 32

A patient presents with a caustic injury around 3 weeks ago. The patient complains of a tightness in the throat with dysphagia. Initial diagnosis includes: (1) Dilatation of the esophagus. (2) contrast studies at intervals of 3 weeks.

Answer 32

Diagnosis of caustic esophageal injury includes contrast studies at intervals of 3 weeks.

Question 33

Esophageal surgery is indicated for: (1) Absence of a fistula between the esophagus and trachobronchial tree. (2) No iatrogenic perforation ofthe esophagus. (3) An ongoing requirement for dilatation of extensive or multiple strictures for more than 6 months. (4) Compliance with dilatations.

Answer 33

Esophageal surgery is indicated for (3) an ongoing requirement of dilatation of extensive or multiple fractures for more than 6 months.

Question 34

A patient experienced a caustic injury to the esophagus approximately 4 days ago. A biopsy shows that there is tissue sloughing and granulation of the ulcer bed. The duration of the patient's tissue injury is MOST likely: (1) 1 - 4 days (2) 3 - 12 days (3) 1 - 6 months

Answer 34

The duration of the patient's tissue injury is MOST likely 1 - 6 months.

Question 35

Acute necrosis of the esophageal tissue begins at: (1) 1 - 4 days (2) 3 - 5 days (3) 3 weeks

Answer 35

Acute necrosis of the esophageal tissue begins at (1) 1 - 4 days.

Question 36

T/F: Perforation of the esophagus is a medical emergency that is often due to endoscopic procedures.

Answer 36

True.

Question 37

Boerhaave's syndrome presents with (and is associated with)

Answer 37

Boerhaave's syndrome presents with esophageal rupture induced by straining. It is associated with chronic alcoholism.

Question 38

A patient underwent an endoscopic procedure and the esophagus became perforated. You take a CXR of the patient. It is MOST likely to present with: (1) Sharpness of the costophrenic angle. (2) Dullness of the costophrenic angle

Answer 38

(2) Dullness of the costophrenic angle.

Question 39

The procedure that will reveal the primary area of leakage in a patient with an esophageal perforation.

Answer 39

Esophagogram

Question 40

T/F: treatment of a perforated esophagus should include suture repair of the esophagus.

Answer 40

True.

Question 41

Which of the following regarding benign esophageal tumors is TRUE? (1) Approximately 60% are cysts. (2) barium swallow appearance is a mass with a smooth surface and distinct margins. (3) Endoscopy shows a broken mucosa and an endoscope cannot get past the tumor. (4) treatment should not involve excision of the tumor if it is > 5cm.

Answer 41

(2) Barium swallow appearance is a mass with a smooth surface and distinct margins.

Question 42

Which of the following regarding esophageal carcinoma is TRUE? (1) Heavy smoking and drinking do not contribute to its development. (2) In the USA, SCC is the most common histology; worldwide, adenocarcinoma is the most common. (3) The incidence of adenocarcinoma has decreased in Western countries over the last 20 years. (4) Prognosis for patients with invasive SCC is poor.

Answer 42

(4) Prognosis for patients with invasive SCC is poor.

Question 43

The incidence of esophageal adenocarcinoma has double over the last decade, which correlates with

Answer 43

Barrett's metaplasia.

Question 44

A patient presents with chest discomfort and indigestion, as well as dysphagia and weight loss. They complain of "foot getting stuck" at the location of the lesion. The tests that should be ordered to rule out esophageal carcinoma are:

Answer 44

esophagoscopy and biopsy.

Question 45

A patient presents with heartburn. You diagnose the patient with GERD. Medical treatment is:

Answer 45

PPI BID; the patient begins to see results after approximately 4 days of therapy.

Question 46

You do a workup for a patient with GERD. You take a pH measurement. Before you do the pH measurement, you should take note that: (1) Acid suppression ends immediately after PPI therapy has ended. (2) Patient should be off PPI therapy for 1 week.

Answer 46

(2) Patient should be off PPI therapy for one week.

Question 47

Surgery is considered in GERD patients that

Answer 47

Either have chronic GERD or for those in whom symptoms persist at a young age.

Question 48

Which of the following regarding Barrett's esophagus is TRUE? (1) It is not associated with prolonged GERD. (2) Metaplastic columnar epithelium replaces the distal squamous mucosa. (3) SCC is the most common type of esophageal carcinoma.

Answer 48

(2) Metastatic columnar epithelium replaces the distal squamous mucosa.

Question 49

T/F: Barrett's esophagus can be found in 10 - 15% of patients who have endoscopic examinations for symptoms of GERD.

Answer 49

True.

Question 50

Fundoplication is indicated for:

Answer 50

surgical treatment of GERD.

Question 51

Rugae of the stomach are present when the stomach is:

Answer 51

Rugae of the stomach are present when the stomach is EMPTY.

Question 52

The importance of the gastroduodenal artery (which comes from the hepatic artery) is:

Answer 52

A patient with duodenal ulcers can cause embolization of the gastroduodenal artery.

Question 53

The mucosa of the stomach consists of: (1) surface epithelium (2) Lamina propria (3) muscularis mucosae (4) All of these

Answer 53

(4) All of these

Question 54

Receptive relaxation refers to: (1) the process whereby the proximal portion of the stomach relaxes in anticipation of food intake. (2) It prevents liquids from passing from the stomach along the lesser curvature. (3) emptying of liquid fluid by the antrum.

Answer 54

Receptive relaxation refers to (1) the process whereby the proximal portion of the stomach relaxes in anticipation of food intake.

Question 55

Gastrin release is inhibited by:

Answer 55

luminal acid.

Question 56

The cells that secrete BOTH gastric acid and intrinsic factor:

Answer 56

Parietal cells

Question 57

Somatostatin functions to

Answer 57

Inhibit gastrin release

Question 58

Somatostatin is inhibited by

Answer 58

Acetylcholine from vagal fibers.

Question 59

D cells produce: (1) gastric acid (2) bicarbonate (3) somatostatin (4) gastrin

Answer 59

(3) somatostatin

Question 60

T/F: Histamine inhibits acid secretion.

Answer 60

False.

Question 61

Chief cells are responsible for

Answer 61

Breaking down proteins (pepsinogen) and secreting gastric lipase.

Question 62

The cells that activate pepsin are: (1) Chief cells (2) G cells (3) Parietal cells

Answer 62

The cells that activate pepsin are (3) parietal cells.

Question 63

Which of the following is a local stimulus of gastric acid secretion? (1) Acetylcholine (2) Gastrin (3) Histamine (4) All of these

Answer 63

(4) All of these

Question 64

T/F: histamine-2 receptor blockade diminishes the magnitude of acid secretion by 90%.

Answer 64

True.

Question 65

You start to salivate when smelling pizza. This phase of acid secretion is: (1) cephalic phase (2) gastric phase (3) intestinal phase

Answer 65

(1) cephalic phase.

Question 66

The cephalic phase is stimulated by the:

Answer 66

Vagus nerve (acetylcholine and muscarinic receptors).

Question 67

NSAIDs inhibit (1) Histamine production (2) Somatostatin production (3) Prostaglandin production

Answer 67

NSAIDs inhibit (3) prostaglandin production.

Question 68

Approximately 60% of ulcers are located at: (1) Lesser curvature of the stomach. (2) in the body of the stomach in combination with a duodenal ulcer. (3) pre-pyloric area (4) on the lesser curvature near the GE junction.

Answer 68

Approximately 60% of ulcers are located in the lesser curvature.

Question 69

The type of ulcers that can occur anywhere and are NSAID induced: (1) Type 3 (2) Type 4 (3) Type 5

Answer 69

(3) Type 5 ulcers that can occur anywhere and are NSAID induced.

Question 70

T/F: type 1 and type 4 gastric ulcers are not associated with excessive acid secretion.

Answer 70

True.

Question 71

Which of the following regarding stomach ulcers (caused by H. pylori) is TRUE? (1) Very few ulcers are associated with H. pylori infection. (2) In patients with H. pylori infection, basal and stimulated gastrin levels are increased. (3) Once a person is infected, the organism dies out quickly.

Answer 71

(2) In patients with H. pylori infection, basal and stimulated gastrin levels are increased.

Question 72

T/F: Duodenal ulcer is a disease of multiple etiologies.

Answer 72

True.

Question 73

Duodenal ulcer is a disease of multiple etiologies. The only relatively absolute requirements are:

Answer 73

acid and pepsin secretion in combination with either infection of H. pylori or ingestion of NSAIDs.

Question 74

A patient with duodenal ulcers is MOST likely to present with:

Answer 74

duodenal perforation, bleeding, obstruction and metabolic alkalosis.

Question 75

A patient with duodenal ulcers may present with: (1) hyperkalemic acidosis (2) hyperchloremic acidosis (3) hypochloremic, hypokalemic acidosis.

Answer 75

(3) hypocloremic, hypokalemic acidosis.

Question 76

The BEST treatment for duodenal ulcers is: (1) PPIs (2) H2 antagonsits

Answer 76

(1) PPIs.

Question 77

T/F: recurrence rates of h. pylori infection are high if the infection is not eradicated.

Answer 77

True.

Question 78

A truncal vagotomy and highly selective vagotomy (parietal cell vagotomy) are surgical treatments for

Answer 78

Peptic ulcer disease

Question 79

A patient presents with a bleeding peptic ulcer. This condition is: (1) Approximately 80% of upper GI bleeds are not self-limited. (2) Mortality increases with age (3) Endoscopy does not show visible vessels or bleeding.

Answer 79

(2) Mortality increases with age.

Question 80

A patient presents with a bleeding peptic ulcer. Endoscopy shows a visible vessel and oozing bright red blood. These findings are consistent with:

Answer 80

Higher mortality and high incidence of rebleeding.

Question 81

Late dumping occurs due to a

Answer 81

Rapid absorption of glucose.

Question 82

Afferent limb syndrome occurs when

Answer 82

There is partial or complete obstruction of the afferent limb of a gastric reconstruction.

Question 83

The most common metabolic defect appearing following gastrectomy is

Answer 83

Anemia (megaloblastic)

Question 84

Post vagotomy syndrome is characterized by: (1) post-vagotomy diarrhea (2) post-vagotomy gastric atony (3) incomplete vagal transection. (4) all of these

Answer 84

(4) All of these

Question 85

A patient presents with stress gastritis following intracranial trauma. Comparted to other causes, this gastric lesion will be:

Answer 85

Deeper than other causes of gastric lesions.

Question 86

Which of the following regarding stress gastritis is TRUE? (1) Patients at high risk for stress gastritis in the ICU setting are those with respiratory failure and underlying coagulopathy. (2) Antacids have a low efficacy in treatment. (3) H2 blockers have an advantage over antacids in treatment. (4) Sucralfate has not been used for prophylaxis.

Answer 86

(1) Patients at high risk for stress gastritis in the ICU setting are those with respiratory failure and underlying coagulopathy.

Question 87

T/F: a sessile polyp greater than 2 cm requires surgical removal..

Answer 87

True.

Question 88

A patient with gastric neoplasia is MOST likely to present with: (1) specific symptoms early in the course of disease. (2) Early vague epigastric discomfort mistaken for gastritis. (3) Occasional radiating pain relieved by foot ingestion. (4) Clinically significant GI bleeding is common.

Answer 88

A patient with gastric neoplasia is MOST likely to present with (1) specific symptoms early in the course of disease.

Question 89

Patients with a palpable abdominal, supraclavicular or periumbilical lymph nodes may have

Answer 89

Gastric neoplasia

Question 90

The diagnostic modality of choice for gastric neoplasia is:

Answer 90

Flexible upper endoscopy.

Question 91

A patient presents with a gastric neoplasia. You do an upper endoscopy and take 8 biopsies around the ulcer crater for histologic diagnosis. Taking more than 7 biopsies allows for a diagnostic accuracy of:

Answer 91

98%.

Question 92

Which of the following regarding gastric neoplasia is TRUE? (1) In the absenceof distant metastatic spread, aggressive surgical resection fo the gastric tumor is justified. (2) gastric tumors are characterized by slow intramural spread. (3) A luminal margin of 5 - 6 cm is not recommended with frozen section analysis.

Answer 92

(1) in the absence of distant metastatic spread, aggressive surgical resection of the gastric tumor is justified.

Question 93

The outcomes of gastric neoplasia are a high survival rate, with recurrence rates:

Answer 93

of 40 - 80% (high recurrence rates).

Question 94

The typical patient and presentation of gastric lymphoma:

Answer 94

60s - 70 year old males. Vague symptoms (epigastric pain, early satiety and fatigue).

Question 95

T/F: patients are considered to have gastric lymphoma if the stomach is the exclusive or predominant site of disease.

Answer 95

True

Question 96

The most common gastric lymphoma is:

Answer 96

diffuse large B-cell lymphoma.

Question 97

T/F: immunodeficiencies and H. pylori infection are risk factors for the development of primarily diffuse large B-cell lymphoma.

Answer 97

True.

Question 98

Radiation therapy for treatment of gastric lymphoma

Answer 98

Limited in usefulness for larger tumors and is not amenable to surgical cure in later stages.