Intestines and Appendix

Question 1

The portion of the small intestine that absorbs amino acids, disaccharides, iron and electrolytes:

(1) duodenum
(2) jejunum
(3) ileum

Answer 1

The (1) duodenum is the portion of the small intestine that absorbs amino acids, disaccharides, iron and electolyes.

Question 2

The portion of the small intestine that absorbs fatty acids, minerals, folate and vitamins A, D, E and K

(1) duodenum
(2) jejunum
(3) ileum

Answer 2

The (2) jejunum is the portion of the small intestine that absorbs fatty acids, minerals, folate and vitamins A, D, E and K.

Question 3

The portion of the small intestine that absorbs vitamin B12, intrinsic factor and bile acids:

(1) duodenum
(2) jejunum
(3) ileum

Answer 3

The (3) ileum is the portion of the small intestine that absorbs vitamin B12, intrinsic factor and bile acids.

Question 4

The blood supply to the duodenum is the:

(1) superior mesenteric artery
(2) inferior mesenteric artery
(3) inferior vena cava

Answer 4

(1) superior mesenteric artery and the superior mesenteric vein.

Question 5

T/F: the jejenum has fewer vascular arcades compared to the rectum.

Answer 5

True.

Question 6

The enzymes responsible for the final digestion of starch molecules are concentrated in the:

Answer 6

brush border of the luminal surface.

Question 7

T/F: glucose and galactose are absorbed by active transport and fructose is absorbed through facilitated diffusion.

Answer 7

True.

Question 8

In the small intestine, proteins come in contact with proteases. These proteases are from:

Answer 8

the pancreas.

Question 9

Dietary fat and unconjugated bile acids are absorbed in the:

(1) duodenum
(2) jejunum
(3) ileum

Answer 9

Dietary fat and unconjugated bile acids are absorbed in the (2) jejunum.

Question 10

T/F: medium chain fatty acids require chylomicrons for absorption.

Answer 10

True.

Question 11

Which of the following is digested or absorbed by the small intestine?

(1) sodium and chloride
(2) calcium
(3) iron
(4) fat and water soluble vitamins
(5) all of these

Answer 11

(5) All of these

Question 12

CCK is responsible for

Answer 12

stimulating pancreatic enzyme secretion, bicarbonate secretion and gallbladder contraction.

Question 13

Somatostatin is responsible for

Answer 13

inhibiting motility and gastrin release.

Question 14

PIP is a neuropeptide that is responsible for

Answer 14

pancreatic and intestinal secretion.

Question 15

Peyer’s patches, lamina propria lymphoid cells and intra-epithelial lymphocytes in the small intestine are used for

Answer 15

immune function

Question 16

One of the major protective immune mechanisms for the intestinal tract is the synthesis and secretion of

Answer 16

IgA

Question 17

The MOST common cause of small bowel obstruction is:

(1) adhesions and extraluminal etiologies.
(2) processes intrinsic to the bowel wall (e.g., primary tumors).
(3) intraluminal obturator obstruction (gallstones, enteroliths, foreign bodies etc).

Answer 17

The MOST common cause of small bowel obstruction is (1) adhesions and extraluminal etiologies.

Question 18

In small bowel obstruction, intestinal fatigue and bowel dilation occur during:

Answer 18

Late stage

Question 19

A patient with bowel obstruction is MOST likely to present with:

(1) fever
(2) polyuria
(3) hypotension and shock

Answer 19

(3) hypotension and shock

Question 20

T/F: a small bowel obstruction does not result in increased venous return, elevaiton of the diaphragm or compromised ventilation.

Answer 20

False.

Question 21

A patient presents with abdominal pain and nausea. The patient appears sweaty and dehydrated and has a low blood pressure. The patient is diagnosed with small bowel obstruction. The patient is also likely to present with:

(1) no bacterial translocation.
(2) compression of venous return

Answer 21

(2) compression of venous return.

Question 22

Small bowel obstruction has cardinal symptoms of

(1) hypertension
(2) diarrhea
(3) colicky abdominal pain and constipation.

Answer 22

(3) colicky pain and constipation.

Question 23

You auscultate the bowel of a patient with small bowel disease. There are hyperactive bowel sounds with audible rushes associated with peristalsis (borborgymi) the stage of small bowel obstruction is MOST likely:

Answer 23

late stage small bowel obstruction.

Question 24

Palpation of an abdomen with small bowel obstruction will MOST likely reveal:

Answer 24

MILD abdominal tenderness with or without a palpable mass.

Question 25

A patient with small bowel obstruction will MOST likely reveal on palpation of the abdomen: (1) mild abdominal tenderness (2) incarcerated hernia (3) localized tenderness, rebound and guarding. (4) intraluminal masses/stool for occult blood.

Answer 25

(1) mild abdominal tenderness with or without a palpable mass.

Question 26

"stack of coins sign", small bowel air entrapment and pligate circularis are examples of CXR findings consistent with

Answer 26

small bowel obstruction

Question 27

Which of the following regarding small bowel obstruction is TRUE? (1) most patients have strangulating obstructions (2) SImple bowel obstruction involve mechanical blockage of the flow of luminal conents with compromise to the itnestinal wall. (3) Strangulating involves a closed loop and intestinal infarction.

Answer 27

(3) strangulating involves a closed loop and intestinal infarction.

Question 28

T/F: bowel ischemia and strangulation cannot be reliably diagnosed PRE-OP in all cases by any known clinical parameter or combination of parameters.

Answer 28

True.

Question 29

Treatment for small bowel obstruction includes Ringer's lactate. This:

Answer 29

an isotonic saline solution.

Question 30

Which of the following is treatment for small bowel obstruction? (1) Isotonic saline (2) Nasogastric tube decompression (3) operative intervention if there is a complete bowel obstruction. (4) all of these.

Answer 30

(4) all of these.

Question 31

The imaging modality for acute post-operative small bowel obstruction

Answer 31

CT scans

Question 32

T/F: both partial reobstruction and complete re-obstruction require another surgical correction.

Answer 32

False.

Question 33

Ileal obstruction is defined as: (1) complete absence of passage of luminal contents with a mechanical obstruction. (2) Reuslts from drug-induced etiologies only. (3) Treatment is surgery and hsould not involve nasogastric decompression.

Answer 33

Ileal obstruction is the (1) complete absence of passage of luminal contents with a mechanical obstruction.

Question 34

Ileal small bowel obstruction can be caused by: (1) post laparotomy (2) metabolic and electrolyte derangements. (3) drugs (4) intra-abdominal infections. (5) All of these

Answer 34

(5) All of these.

Question 35

A patient presents with colicky abdominal pain and increased bowel sounds. Labs show small bowel dilation and no dilation in the large bowel. You treat with NG tube suction, IV fluids and surgical exploration. The patient MOST likely has:

Answer 35

small bowel obstruction.

Question 36

A patient presents with abdominal pain and minimal abdominal sounds. The patient had recent surgery and presents with hypokalemia. Lab/simaging show small bowel dilation and large bowel dilation. You treat the underlying cuase. The patient MOST likely has:

Answer 36

Paralytic ileus

Question 37

Which of the following regarding small intestine neoplasms is TRUE? (1) carcinoid is the most common type. (2) Most patients are under 60 years old (3) females have a higher incidence than males.

Answer 37

(1) Carcinoid is the most common type of small intestine neoplasms.

Question 38

T/F: the GI tract is the most common site for carcinoid tumors.

Answer 38

True.

Question 39

In the small intestine, carcinoids almost always occurs within the last 2 feet of the: (1) duodenum (2) jejunum (3) ileum

Answer 39

(3) ileum

Question 40

Carcinoid tumors arise from:

Answer 40

enterochromaffin cells found in the crypts of LIeberkuhn.

Question 41

The type of carcinoid tumor that presents the HIGHEST levels of serotonin and substance P: (1) foregut (2) midgut (3) hindgut

Answer 41

(2) Midgut

Question 42

Which of the following regarding small intestine neuroendocrine tumors is TRUE? (1) 70 - 80% of carcinoids are symptomatic and are found before operation. (2) More than 90% of carcinoids are found in the appendix, ileum and rectum. (3) Synchronous adenocarcinoma is seen in with all carcinoid tumors.

Answer 42

(2) More than 90% of carcinoids are found in the appendix, ileum and rectum.

Question 43

A patient presents with a small bowel tumor. The patient presents with cutaneous flushing, diarrhea, hepatomegaly and cardiac lesions. You note that the patient is also at risk of malabsorption and pellagra. The type of carcinoid tumor the patient MOST likely has is:

Answer 43

malignant carcinoid syndrome.

Question 44

Carcinoid syndrome presents with: (1) Cutaneous flushes with no cyanosis. (2) constipation (3) hepatomegaly, and retroperitoneal and pelvic fibrosis.

Answer 44

(3) hepatomegaly and retroperitoneal and pelvic fibrosis.

Question 45

A patient with small intestine neuroendocrine tumors may be diagnosed via: (1) serotonin (HIAA) (2) Chromogranin A (CgA) (3) all of these

Answer 45

(3) All of these

Question 46

T/F: Neuroendocrine tumors of the small intestine can be diagnosed via HIAA. This test is highly specific, but not very sensitive.

Answer 46

True.

Question 47

A patient presents with small intestine neuroendocrine tumors. For primary tumors < 1 cm in diameter without evidence of regional lymph node metastasis:

Answer 47

A segmental intestinal resection is adequate.

Question 48

A patient presents with small intestine neuroendocrine tumors > 1 cm in diameter. Treatment should involve:

Answer 48

wide excision of the bowel and mesentery.

Question 49

Anesthesia should be avoided in treatment of small intestine neuroendocrine tumors because:

Answer 49

It may precipitate a carcinoid crisis characterized by hypotension, bronchospasm, flushing and tachycardia; predisposing to arrhythmias.

Question 50

A patient has small intesine neuroendocrine tumors. You the put the patient under anesthesia and they start to exhibit a carcinoid crisis. Treatment of this condition is

Answer 50

IV octreotide.

Question 51

T/F: Cytotoxic chemotherapy is the gold standard of treatment for metastatic small intestine neuroendocrine tumros.

Answer 51

False.

Question 52

Which of the following regarding diverticular disease is TRUE? (1) A true diverticulum consists of the submucosa and mucosa protruding through a defect in the muscle coat and are acquired defects. (2) Duodenal diverticula are the most common acquired diverticula of the small bowel. (3) Meckel's diverticulum is a rare congenital diverticulum of the small bowel.

Answer 52

(2) Duodenal diverticula are the most common acquired diverticula of the small bowel.

Question 53

Small bowel ulcerations may be due to: (1) Chron's disease, typhoid fever, TB, lymphoma. (2) KCL tablets, corticosteroids or NSAIDs. (3) All of these

Answer 53

(3) All of these.

Question 54

An enterocutaneous fistula is usually the result of:

Answer 54

surgical misadventure.

Question 55

T/F: The more proximal the enterocutaneous fistula, the more serious the problem with greater fluid and electrolyte loss.

Answer 55

True.

Question 56

A patient presents with dehydration and depletion of fluids and electrolytes. There is necrosis of the skin around the duodenal area. In order to rule out an enterocutaneous fistula, imaging should involve:

Answer 56

CT scan with contrast (inject contrast dye through the fistula tract).

Question 57

A patient with an enterocutaneous fistula presents with output of 750 ml/24 hours. There is 75% circumference disruption of the intestinal continuity. The fistula tract is 2.0 cm. According to these findings the fistula is:

Answer 57

Unlikely to close.

Question 58

Which of the following symptoms is NOT associated with enterocutaneous fistula? (1) Foreign body in tract (2) radiation enteritis (3) Drained abscess with no infection. (4) Epithelialization of the fistual tract (5) Neoplasm (cancer) (6) Distal obstruction

Answer 58

(3) drained abscess with no infection.

Question 59

Successful management of enterocutaneous fistulas involves:

Answer 59

Managemnent of damage, sepsis and prevention of fluid/electrolyte depletion, protection of skin, provision of adequate nutrition.

Question 60

Surgical management of an enterocutaneous fistula should be considered:

Answer 60

After conservative therapy for 4 - 6 weeks has not improved symptoms.

Question 61

A patient presents with diarrhea and steatorrhea. The patient has noticed weight loss and abdominal pain. Labs shows bacterial overgrowth in the bowel secondary to stenosis. You diagnose the patient with blind loop syndrome. Conservative treatment is:

Answer 61

vitamin B therapy.

Question 62

A patient with blind loop syndrome is scheduled for surgical correction of the deformity. This is indicated in patients who:

Answer 62

Require multiple rounds of antibiotics.

Question 63

A patient is MOST likely to experience symptoms (diarrhea, abdominal pain and malabsorption) from radiation enteritis if the radiation exposure:

Answer 63

exceeds 5000 cGy.

Question 64

Damage to the small submucosal blood vessels is seen in radiation enteritis when:

Answer 64

Late and severe stages of radiation enteritis.

Question 65

Which of the following regarding short bowel syndrome is TRUE? (1) It results from a total small bowel length that is adequate to support nutrition. (2) Most cases occur from massive intestinal resection. (3) In neonates, it is not associated with necrotizing enterocolitis. (4) All patients are permanently dependent on TPN. (5) Distal bowel resection is tolerated much better than proximal resection.

Answer 65

(2) Most cases occur from massive intestinal resection.

Question 66

The clinical hallmarks of short bowel syndrome include:

Answer 66

diarrhea, fluid and electrolyte disturbances, as well as malnutrition.

Question 67

Early phase treatment of short bowel syndrome involves:

Answer 67

control of diarrhea, replacement of fluid and electrolytes and the prompt institution of TPN.

Question 68

T/F: bacteriology peritoneal cultures will be positive in more than 85% of patients with gangrenous or perforated appendicitis.

Answer 68

True.

Question 69

The diagnosis of appendicitis is primarily based on: (1) clinical history and physical findings. (2) labs and imaging (3) surgical exploration.

Answer 69

(1) Clinical history and physical findings.

Question 70

Imaging is used for diagnosis of appendicitis in:

Answer 70

Children and pregnant women.

Question 71

T/F: A completely normal leukocyte count and differential is uncommon in patients with appendicitis.

Answer 71

True.

Question 72

Before surgery, appendicitis treatment should involve:

Answer 72

fluid resuscitation.

Question 73

A patient who is indicated for urgent appendectomy has:

Answer 73

acute, non-perforated appendicitis.

Question 74

Antibiotics used for appendicitis should contain coverage of:

Answer 74

enteric anaerobic and gram negative bacteria.

Question 75

A patient has appendicitis. Imaging shows that there is fecal impaction (fecalith). Treatment should involve:

Answer 75

appendectomy.

Question 76

A patient presents with a perforated appendicitis with peritonitis. Prior to performing an appendectomy, you should take note to:

Answer 76

adequately resuscitate the patient and provide broad-spectrum antibiotics (negative aerobes and anaerobes).

Question 77

The preferred approach to the management of appediceal mass (abscess is)

Answer 77

Percutaneous drainage (use US or CT to guide this) as well as IV antibiotics directed against aerobic gram negative and anaerobic organisms.

Question 78

A pregnant patient presents with appendicitis. Treatment should invovle:

Answer 78

early surgical intervention in all trimesters.

Question 79

A patient with Chron's disease presents with appendicitis. Treatment should involve:

Answer 79

appendectomy.

Question 80

Appendix carcinoid tumors are derived from

Answer 80

midgut argentaffin cells of neural crest origin.

Question 81

T/F: Carcinoids are the most common appendiceal neoplasms.

Answer 81

True.

Question 82

A patient presents with a 2.5 cm appendiceal carcinoid tumor. The treatment of this should involve:

Answer 82

Simple appendectomy; however note that the lesion size has a higher incidence of distant metastases adn a right hemicolectomy may be necessary.

Question 83

The blood supply of the colon is the:

Answer 83

superior mesenteric artery and inferior mesenteric artery.

Question 84

The anastomosis or linking of arcades between the superior and inferior mesenteric vessels of the colon is known as the:

Answer 84

Arc of Riolan

Question 85

T/F: between 1000 and 1500 ml of fluid is poured into the cecum by the daily ileal effluent, making it the most efficient site of absorption in the GI tract per surface area.

Answer 85

True.

Question 86

The colonic mucosa absorbs

Answer 86

Bile acids and water

Question 87

The gastrocolic reflex refers to:

Answer 87

the effects of a meal on colonic motility; they can be prasympathetic and sympathetic.

Question 88

The Auerbach's plexus is a set of nerves in the colon located in the:

Answer 88

Muscularis propria

Question 89

The main source of energy for intestinal flora are:

Answer 89

cmoplex carbohydrates (dietary fiber)

Question 90

The main organism in the colon is:

Answer 90

bacteroides

Question 91

Which of the following regarding diverticular disease is TRUE? (1) It is prevalent in countries with Low intake of dietary fiber. (2) It results when there is too much "bulk" in the colon, causing herniations of the mucosa. (3) True and false diverticula are the same things. (4) Younger people are more likely to have diverticula than older people.

Answer 91

(1) It is prevalent in countries with a low intake of dietary fiber.

Question 92

The MOST common site for diverticulum formation in the colon is:

Answer 92

sigmoid colon.

Question 93

Which of the following regarding diverticular disease is TRUE? (1) they do not coexist with other colonic pathologies. (2) THey are most common in the right side of the colon. (3) They occur frequently in the rectum. (4) complications are inflammation, bleeding and perforation/fistulization of the bladder.

Answer 93

(4) Complications are inflammation, bleeding and perforation/fistualization of the bladder.

Question 94

Indications for surgical correction of diverticular disease are:

Answer 94

peritonitis, closed loop obstruction, multiple episodes of uncomplicated acute diverticulitis, presence of colonic fistual.

Question 95

The first line treatment for acute diverticular disease is:

Answer 95

IV antibiotic therapy

Question 96

Cecal volvulus presents with:

Answer 96

bird's beak image representing the point of torsion.

Question 97

The MOST common type of colonic volvulus is:

Answer 97

Sigmoid volvulus (> 90%).

Question 98

Megacolon, concomitant laxative abuse, Ogilvie's syndrome and Chaga's disease are all associated with:

Answer 98

Sigmoid volvulus.

Question 99

T/F: surgical resection of a sigmoid volvulus is only indicated for emergency cases.

Answer 99

False.

Question 100

T/F: operation for cecal volvulus is urgent.

Answer 100

True.

Question 101

Which of the following regarding colon cancer is TRUE? (1) It is the leading cause of cancer deaths in the USA for both men and women. (2) Genetics is the most common etiology. (3) Majority are adenocarcinoma/sporadic.

Answer 101

(3) The majority of colon cancers are adenocarcinoma/sporadic.

Question 102

A patient presents with colorectal cancer. The development of the condition is a process that takes:

Answer 102

10 - 15 years and evolves from initiation through well-defined phases of progression.

Question 103

The earliest expression of neoplastic change in colorectal cancer is

Answer 103

aberrant crypt foci.

Question 104

A patient presents with colorectal polyps on a recent colonoscopy. The polyps should be:

Answer 104

completely excised or undergo biopsy to assess the malignant potential.

Question 105

Adenomatous polyps can be tubular, villous or tubulovillous. The type of polyp that contain malignant potential:

Answer 105

all adenomatous polyps contain malignant potential.

Question 106

The extent of colon resection in colorectal cancer is determined by:

Answer 106

location of the tumor, blood supply and draining lymphatic vessels; as well as the presence or absence of direct extension into adjacent organs.

Question 107

When treating colorectal cancer, radiation therapy:

Answer 107

is helpful but makes urgery more challenging.