Assessment Exam 4: GI

Question 1

Which layer of the GI tract is primarily responsible for secretion and absorption?
A) Serosa
B) Submucosa
C) Muscularis mucosae
D) Epithelium

Answer 1

Correct Answer: D) Epithelium
Rationale: The epithelium is the innermost layer of the mucosa, which is in direct contact with the contents of the GI tract. This positioning allows it to be actively involved in secretion and absorption processes.

Question 2

The serosa of the GI tract is analogous to which of the following structures in the heart?
A) Endocardium
B) Myocardium
C) Pericardium
D) Epicardium

Answer 2

Correct Answer: C) Pericardium
Rationale: The serosa is a smooth membrane that reduces friction between the GI tract and surrounding tissues, similar to how the pericardium encloses the heart and reduces friction between the heart and surrounding structures.

Question 3

What percentage of the total human body mass does the GI tract represent?
A) 2%
B) 5%
C) 10%
D) 12%

Answer 3

Correct Answer: B) 5%
Rationale: As stated on the slide, the GI tract constitutes approximately 5% of the total human body mass.

Question 4

Which of the following is not a main function of the GI tract as listed on the slide?
A) Immune response
B) Motility
C) Excretion
D) Circulation

Answer 4

Correct Answer: A) Immune response
Rationale: The main functions listed for the GI tract on the slide are motility, digestion, absorption, excretion, and circulation. The immune response is not mentioned, although the GI tract does play a significant role in immunity.

Question 5

The muscularis mucosae is found in which layer of the GI tract?
A) Mucosa
B) Submucosa
C) Muscularis externa
D) Serosa

Answer 5

Correct Answer: A) Mucosa
Rationale: The muscularis mucosae is a layer within the mucosa, the innermost layer of the GI tract wall.

Question 6

A drug that inhibits the contraction of the circular muscle layer would likely result in:
A) Increased intestinal motility
B) Decreased intestinal motility
C) No change in intestinal motility
D) Increased segmentation

Answer 6

Correct Answer: B) Decreased intestinal motility
Rationale: The circular muscle layer’s contraction decreases the diameter of the intestinal lumen and is essential for propelling contents along the GI tract. Inhibition of this contraction would lead to decreased motility.

Question 7

Which muscle layer’s activity would be most directly affected by a procedure that lengthens the intestine?
A) Longitudinal muscle layer
B) Circular muscle layer
C) Muscularis mucosae
D) Both A and B

Answer 7

Correct Answer: A) Longitudinal muscle layer
Rationale: The longitudinal muscle layer contracts to shorten the length of the intestinal segment. A procedure that lengthens the intestine would affect the tension and function of the longitudinal muscle layer.

Question 8

In conditions that cause paralysis of the gut, such as ileus, which two muscle layers’ functions are primarily affected?
A) Mucosal layers and circular muscle layer
B) Circular muscle layer and longitudinal muscle layer
C) Muscularis mucosae and submucosa
D) Submucosa and serosa

Answer 8

Correct Answer: B) Circular muscle layer and longitudinal muscle layer
Rationale: Ileus is a condition involving the paralysis of the muscular layers of the GI tract responsible for motility, namely the circular and longitudinal muscle layers.

Question 9

If a patient has a condition that specifically affects the ability of the intestinal tract to shorten, which of the following would be the primary muscle layer affected?
A) Circular muscle layer
B) Longitudinal muscle layer
C) Muscularis mucosae
D) Serosa

Answer 9

Correct Answer: B) Longitudinal muscle layer
Rationale: The longitudinal muscle layer is responsible for shortening the length of the intestinal segment, so a condition that affects this ability would primarily impact the longitudinal muscle layer.

Question 10

Which of the following is not a method used to perform a celiac plexus block?
A) Transcrural
B) Intraoperative
C) Endoscopic ultrasound-guided
D) Transdermal

Answer 10

Correct Answer: D) Transdermal
Rationale: The methods listed for performing a celiac plexus block include transcrural, intraoperative, peritoneal lavage and endoscopic ultrasound-guided techniques. Transdermal is not mentioned as a method for celiac plexus block.

Question 11

The inferior hypogastric plexus primarily innervates which sections of the GI tract?
A) Esophagus and stomach
B) Small intestine and proximal colon
C) Descending colon and distal GI tract
D) Liver and pancreas

Answer 11

Correct Answer: C) Descending colon and distal GI tract
Rationale: According to the slide, innervation of the descending colon and distal GI tract is provided by the inferior hypogastric plexus.

Question 12

A patient with pain originating from the pancreas may benefit from a block of which nerve plexus?
A) Superior mesenteric plexus
B) Celiac plexus
C) Auerbach’s plexus
D) Inferior hypogastric plexus

Answer 12

Correct Answer: B) Celiac plexus
Rationale: The celiac plexus provides innervation to the upper abdominal organs, including the pancreas, up to the proximal transverse colon. Therefore, a celiac plexus block could be beneficial for managing pancreatic pain.

Question 13

Which approach to celiac plexus block is typically performed during surgery?
A) Transcrural
B) Intraoperative
C) Endoscopic ultrasound-guided
D) Peritoneal lavage

Answer 13

Correct Answer: B) Intraoperative
Rationale: The intraoperative approach refers to interventions performed during surgery, including celiac plexus blocks.

Question 14

What is the primary reason for blocking the celiac plexus?
A) To enhance gastrointestinal motility
B) To treat chronic diarrhea
C) To manage upper abdominal pain
D) To manage lower abdominal pain

Answer 14

Correct Answer: C) To manage upper abdominal pain
Rationale: The celiac plexus block is primarily used to manage intractable pain in the upper abdomen that may be associated with conditions like pancreatic cancer or chronic pancreatitis.

Question 15

The primary role of the myenteric plexus is to:
A) Absorb nutrients
B) Secrete digestive enzymes
C) Regulate GI tract blood flow
D) Control GI tract motility

Answer 15

Correct Answer: D) Control GI tract motility
Rationale: The myenteric plexus lies between the smooth muscle layers of the GI tract and is primarily responsible for regulating gut motility.

Question 16

Which nervous system plexus is located in the submucosa of the GI tract?
A) Auerbach’s plexus
B) Meissner’s plexus
C) Myenteric plexus
D) Inferior hypogastric plexus

Answer 16

Correct Answer: B) Meissner’s plexus
Rationale: Meissner’s plexus, also known as the “submucosal plexus- what is on our slide”, is located in the submucosa of the GI tract and is responsible for transmitting information from the epithelium to the enteric and central nervous systems.

Question 17

The submucosal plexus primarily facilitates the communication between which two systems?
A) Muscularis and serosa
B) Epithelium and enteric nervous system
C) Enteric and somatic nervous system
D) Central and peripheral nervous systems

Answer 17

Correct Answer: B) Epithelium and enteric nervous system
Rationale: The submucosal plexus transmits sensory and motor information from the epithelium to the enteric nervous system, which is part of the autonomic nervous system.

Question 18

Dysfunction in which of the following plexuses would most likely result in impaired gut motility?
A) Myenteric plexus
B) Submucosal plexus
C) Inferior hypogastric plexus
D) Celiac plexus

Answer 18

Correct Answer: A) Myenteric plexus

Rationale: Auerbach’s plexus, also known as the myenteric plexus, directly regulates the smooth muscle activity and thus is critical for proper gut motility. Dysfunction here would impair peristalsis.

Question 19

If a patient has a condition that affects the communication between the GI epithelium and the central nervous system, which plexus might be involved?
A) Myenteric plexus
B) Submucosal plexus
C) Inferior hypogastric plexus
D) Superior hypogastric plexus

Answer 19

Correct Answer: B) Submucosal plexus
Rationale: The submucosal plexus is involved in the transmission of information from the GI epithelium to the central nervous system.

Question 20

The muscularis mucosae of the mucosa primarily facilitates the movement of which structures?
A) Villi
B) Glands in submucosa
C) Lymphatic tissue
D) Mesenteric arteries

Answer 20

Correct Answer: A) Villi
Rationale: The muscularis mucosae is a thin layer of smooth muscle that functions to move the villi, aiding in the processes of absorption and secretion within the gut.

Question 21

The lamina propria in the mucosa contains all of the following except:
A) Blood vessels
B) Nerve endings
C) muscle cells
D) Immune cells

Answer 21

Correct Answer: C) Muscle cells
Rationale: The lamina propria contains blood vessels, nerve endings, and immune cells. The muscularis mucosae is a separate layer of smooth muscle, not contained within the lamina propria.

Question 22

In the context of the GI tract, the epithelium is not responsible for:
A) Sensing GI contents
B) Secretion of enzymes
C) Absorption of nutrients
D) Absorbing waste

Answer 22

Correct Answer: D) Absorbing waste

Rationale: The epithelium of the GI tract is responsible for sensing contents, secreting enzymes, absorbing nutrients, and excreting waste. It is not involved in the synthesis of blood proteins, which generally occurs in the liver.

Question 23

A decrease in the function of which component of the mucosa would most likely result in impaired absorption of nutrients?
A) Smooth muscle of the muscularis mucosae
B) Lamina propria
C) Submucosal glands
D) Epithelium

Answer 23

Correct Answer: D) Epithelium
Rationale: The epithelium is the layer where most absorption of nutrients occurs. A decrease in its function would significantly affect the GI tract’s ability to absorb nutrients.

Question 24

Which part of the GI tract’s mucosa is most directly involved in the immune response to pathogens?
A) Muscularis mucosae
B) Lamina propria
C) Submucosa
D) Epithelium

Answer 24

Correct Answer: B) Lamina propria
Rationale: The lamina propria contains immune and inflammatory cells and is therefore integral to the immune response in the mucosa of the GI tract.

Question 25

Which of the following statements is true regarding the extrinsic nervous system’s influence on the GI tract?
A) The sympathetic division increases GI motility.
B) The parasympathetic division decreases GI motility.
C) The sympathetic division decreases GI motility.
D) Both the sympathetic and parasympathetic divisions are primarily inhibitory to GI motility.

Answer 25

Correct Answer: C) The sympathetic division decreases GI motility.
Rationale: The slide indicates that the extrinsic sympathetic nervous system (SNS) is primarily inhibitory and decreases GI motility, while the extrinsic parasympathetic nervous system (PNS) is primarily excitatory and activates GI motility.

Question 26

The enteric nervous system is responsible for:
A) Only GI motility
B) Only secretion within the GI tract
C) Only regulating GI blood flow
D) Controlling motility, secretion, and blood flow within the GI tract

Answer 26

Correct Answer: D) Controlling motility, secretion, and blood flow within the GI tract
Rationale: According to the slide, the enteric nervous system is an independent system that controls motility, secretion, and blood flow in the GI tract.

Question 27

Which nervous system component can function independently of the central nervous system to regulate the GI tract?
A) Extrinsic nervous system
B) Enteric nervous system
C) Sympathetic nervous system
D) Parasympathetic nervous system

Answer 27

Correct Answer: B) Enteric nervous system
Rationale: The enteric nervous system is described as an independent nervous system, indicating that it can function autonomously from the central nervous system to regulate the GI tract.

Question 28

A medication designed to enhance GI motility should ideally exert its effects on the:
A) Extrinsic sympathetic nervous system
B) Extrinsic parasympathetic nervous system
C) Enteric nervous system, independent of SNS and PNS influence
D) Central nervous system

Answer 28

Correct Answer: B) Extrinsic parasympathetic nervous system
Rationale: Since the extrinsic parasympathetic nervous system is primarily excitatory and activates GI motility, a medication designed to enhance GI motility should target this system.

Question 29

In a situation where the GI tract needs to conserve energy and resources during a fight-or-flight response, which part of the ANS is likely to be activated?
A) Extrinsic parasympathetic nervous system
B) Extrinsic sympathetic nervous system
C) Enteric nervous system
D) Central nervous system

Answer 29

Correct Answer: B) Extrinsic sympathetic nervous system
Rationale: During a fight-or-flight response, the sympathetic nervous system is activated, which would decrease GI motility to conserve energy and resources for the response.

Question 30

Interstitial cells of Cajal (ICC) in the myenteric plexus serve as:
A) The primary immune cells of the GI tract
B) GI pacemakers that generate rhythmic contractions
C) Main absorptive cells within the epithelium
D) Regulators of mucosal blood flow

Answer 30

Correct Answer: B) GI pacemakers that generate rhythmic contractions
Rationale: Interstitial cells of Cajal are described as GI pacemakers, which suggests their role in generating the slow waves of contraction that coordinate motility.

Question 31

The submucosal plexus does not control:
A) Motility
B) Absorption
C) Secretion
D) Mucosal blood flow

Answer 31

Correct Answer: A) Motility
Rationale: The myenteric plexus is specifically tasked with controlling motility, while the submucosal plexus controls absorption, secretion, and mucosal blood flow.

Question 32

Which of the following is a function of the myenteric plexus?
A) Nutrient absorption
B) Enzyme secretion
C) Motility regulation
D) Blood protein synthesis

Answer 32

Correct Answer: C) Motility regulation
Rationale: The slide indicates that the myenteric plexus controls motility, with the help of enteric neurons, interstitial cells of Cajal, and smooth muscle cells.

Question 33

A clinical intervention targeting the interstitial cells of Cajal (ICC) would most likely be aiming to modify:
A) The immune response in the GI tract
B) The rhythmic contractions of the GI smooth muscle
C) The secretion of digestive enzymes
D) The mucosal absorption of nutrients

Answer 33

Correct Answer: B) The rhythmic contractions of the GI smooth muscle
Rationale: Since ICC cells act as GI pacemakers, any intervention targeting them would be aiming to modify the rhythmic contractions of the GI smooth muscle.

Question 34

When considering treatments to affect GI motility and secretion, both the myenteric and submucosal plexuses:
A) Operate independently of the sympathetic and parasympathetic systems
B) Are influenced only by the parasympathetic system
C) Are influenced only by the sympathetic system
D) Respond to both sympathetic and parasympathetic stimulation

Answer 34

Correct Answer: D) Respond to both sympathetic and parasympathetic stimulation
Rationale: As the slide indicates, both the myenteric and submucosal plexuses respond to sympathetic and parasympathetic stimulation, which suggests that treatments affecting these systems would influence both plexuses.

Question 35

In the context of an upper gastrointestinal endoscopy, which of the following is an anesthesia challenge?
A) Requirement for a fully sterile field
B) Need for intraoperative radiography
C) Sharing airway with endoscopist
D) Need for deep muscle relaxation

Answer 35

Correct Answer: C) Sharing airway with endoscopist
Rationale: The slide lists sharing the airway with the endoscopist as an anesthesia challenge during an upper gastrointestinal endoscopy, as this can complicate airway management.

Question 36

A patient undergoing a colonoscopy may face specific anesthesia-related risks primarily due to:
A) Patient dehydration and NPO status
B) Use of contrast agents
C) The patient’s position during the procedure
D) Potential allergic reactions to anesthesia

Answer 36

Correct Answer: A) Patient dehydration and NPO status
Rationale: The slide indicates that patient dehydration due to bowel preparation and NPO (nil per os, nothing by mouth) status are anesthesia challenges in colonoscopy.

Question 37

Anesthesia for a colonoscopy is optional because:
A) The procedure is completely non-invasive
B) It is performed in the main OR where anesthesiologists are not available
C) The procedure can be done with minimal discomfort without anesthesia
D) Patient preference and procedural circumstances allow for flexibility

Answer 37

Correct Answer: D) Patient preference and procedural circumstances allow for flexibility
Rationale: The slide notes that both upper gastrointestinal endoscopies and colonoscopies may be done with or without anesthesia, implying that patient preference and the specifics of the procedure allow for the choice.

Question 38

Which of the following is a shared characteristic of both upper gastrointestinal endoscopies and colonoscopies in terms of anesthesia?
A) Always require general anesthesia
B) Can only be performed in the main OR
C) May be done with or without anesthesia
D) Always require the patient to be in the prone position

Answer 38

Correct Answer: C) May be done with or without anesthesia
Rationale: Both procedures are listed as possibly being done with or without anesthesia, indicating that anesthesia is not always a requirement and can be decided on a case-by-case basis.

Question 39

The management of which aspect is crucial for an anesthesiologist during an upper gastrointestinal endoscopy?
A) Maintaining the patient’s mobility
B) Ensuring the sterility of the endoscope
C) Coordinating with the endoscopist for airway management
D) Monitoring the patient’s bowel movements

Answer 39

Correct Answer: C) Coordinating with the endoscopist for airway management
Rationale: One of the anesthesia challenges during an upper gastrointestinal endoscopy is sharing the airway with the endoscopist, hence, coordination for airway management is crucial.

Question 39

High Resolution Manometry (HRM) is used to diagnose:
A) Inflammatory bowel disease
B) Gastroesophageal reflux disease
C) Esophageal motility disorders
D) Peptic ulcer disease

Answer 39

Correct Answer: C) Esophageal motility disorders
Rationale: HRM is a diagnostic procedure that measures pressures along the entire length of the esophagus and is generally used to diagnose motility disorders of the esophagus.

Question 39

A GI series with ingested barium is not used to assess:
A) The presence of a hiatal hernia
B) Swallowing function
C) Gastric acid secretion
D) GI tract transit

Answer 39

Correct Answer: C) Gastric acid secretion
Rationale: A GI series with ingested barium is a radiologic assessment of swallowing function and GI transit, not for measuring gastric acid secretion.

Question 40

In a gastric emptying study, the use of a radiotracer allows for the assessment of:
A) GI bleeding
B) The rate at which the stomach empties
C) The structural integrity of the stomach
D) The presence of Helicobacter pylori

Answer 40

Correct Answer: B) The rate at which the stomach empties
Rationale: A gastric emptying study involves a patient fasting and then consuming a meal with a radiotracer to assess the rate at which the stomach empties its contents.

Question 41

Which diagnostic procedure requires patient fasting prior to the test?
A) High Resolution Manometry
B) GI series with ingested barium
C) Gastric emptying study
D) Colonoscopy

Answer 41

Correct Answer: C) Gastric emptying study
Rationale: The gastric emptying study requires a patient to fast for at least 4 hours before consuming a meal with a radiotracer.

Question 42

The diagnostic purpose of a GI series with ingested barium includes all the following except:
A) Evaluating the mucosal lining of the GI tract
B) Assessing the mechanical function of swallowing
C) Measuring the pressure within the esophagus
D) Observing the transit of contents through the GI tract

Answer 42

Correct Answer: C) Measuring the pressure within the esophagus
Rationale: A GI series with ingested barium is used for radiologic assessment of swallowing function and GI transit, not for measuring esophageal pressure, which is the function of HRM.

Question 43

Small intestine manometry is performed to evaluate:
A) Structural abnormalities in the small intestine
B) Absorption efficiency of the small intestine
C) Contraction pressures and motility of the small intestine
D) Bacterial overgrowth in the small intestine

Answer 43

Correct Answer: C) Contraction pressures and motility of the small intestine
Rationale: Small intestine manometry uses a catheter to measure contraction pressures and motility, specifically during fasting, during a meal, and postprandial periods.

Question 44

When analyzing the results of a small intestine manometry, abnormal findings can suggest disorders that are:
A) Mechanical or structural
B) Myopathic or neuropathic
C) Oncologic or inflammatory
D) Infectious or pharmacologic

Answer 44

Correct Answer: B) Myopathic or neuropathic
Rationale: The slide mentions that abnormal results from a small intestine manometry are grouped into either myopathic (relating to muscle tissue) or neuropathic (relating to nerve tissue) causes.

Question 45

A lower GI series is distinctive from other GI diagnostic procedures because it:
A) Uses a catheter to measure pressure
B) Employs a barium enema visible on radiograph
C) Requires patient fasting and use of a radiotracer
D) Measures gastric emptying times

Answer 45

Correct Answer: B) Employs a barium enema visible on radiograph
Rationale: The lower GI series involves the administration of a barium enema, which outlines the intestines and is visible on a radiograph to detect anatomical abnormalities in the colon and rectum.

Question 46

Which diagnostic procedure is likely to provide information about the function of the GI tract during and after a meal?
A) Small intestine manometry
B) High Resolution Manometry
C) Lower GI series
D) Gastric emptying study

Answer 46

Correct Answer: A) Small intestine manometry
Rationale: Small intestine manometry evaluates contractions of the small intestine during three distinct periods, including during a meal and postprandially, providing insight into the GI function in these states.

Question 47

For which of the following conditions is a lower GI series most appropriate for diagnostic evaluation?
A) Esophageal dysphagia
B) Small bowel obstruction
C) Colon diverticula
D) Gastroesophageal reflux disease

Answer 47

Correct Answer: C) Colon diverticula
Rationale: A lower GI series is designed to visualize the colon and rectum, making it appropriate for detecting anatomical abnormalities such as diverticula in the colon.

Question 48

Which category of esophageal disease is characterized by a disruption in the normal pressure zones of the esophagus?
A) Anatomical
B) Mechanical
C) Neurologic
D) Hormonal

Answer 48

Correct Answer: A) Anatomical
Rationale: Anatomical causes of esophageal diseases, such as diverticula, hiatal hernia, and chronic acid reflux, can interrupt the normal pathway of food, altering the pressure zones within the esophagus.

Question 49

Achalasia, a condition where the lower esophageal sphincter fails to relax, is considered a:
A) Neurologic cause of esophageal disease
B) Mechanical cause of esophageal disease
C) Anatomical cause of esophageal disease
D) Hormonal cause of esophageal disease

Answer 49

Correct Answer: B) Mechanical cause of esophageal disease
Rationale: Achalasia is listed under mechanical causes of esophageal disease due to its association with the dysfunction of esophageal muscles and the lower esophageal sphincter (LES).

Question 50

A patient with esophageal abnormalities following a stroke may have which type of esophageal disease?
A) Anatomical
B) Mechanical
C) Neurologic
D) Infectious

Answer 50

Correct Answer: C) Neurologic
Rationale: Neurologic causes of esophageal diseases may result from neurologic disorders such as a stroke, vagotomy, or hormone deficiencies

Question 51

Esophageal spasm, a condition that causes painful contractions within the esophagus, falls into which category of esophageal disease?
A) Anatomical
B) Mechanical
C) Neurologic
D) Hormonal

Answer 51

Correct Answer: B) Mechanical
Rationale: Esophageal spasms are classified as a mechanical cause of esophageal disease because they involve abnormal contractions of the esophageal muscles.

Question 52

Hormone deficiencies are implicated in which type of esophageal disease according to the slide?
A) Anatomical
B) Mechanical
C) Neurologic
D) The slide does not specify hormone deficiencies as a cause

Answer 52

Correct Answer: C) Neurologic
Rationale: The slide mentions neurologic causes for esophageal diseases which may include hormone deficiencies, suggesting a relationship between hormonal balance and neurologic control of esophageal function.

Question 53

Dysphagia that occurs with both liquids and solids is indicative of:
A) Oropharyngeal dysphagia
B) Esophageal dysmotility
C) Mechanical esophageal dysphasia
D) Gastroesophageal reflux disease (GERD)

Answer 53

Correct Answer: B) Esophageal dysmotility
Rationale: The slide specifies that esophageal dysmotility involves symptoms (sx) occurring with both liquids and solids, suggesting a problem with the movement of the esophagus itself.

Question 54

Which of the following symptoms is not typically associated with Gastroesophageal reflux disease (GERD)?
A) Heartburn
B) Nausea
C) Difficulty swallowing with solid food only
D) Sensation of a lump in the throat

Answer 54

Correct Answer: C) Difficulty swallowing with solid food only
Rationale: Difficulty swallowing (dysphagia) with solid food only is associated with mechanical esophageal dysphasia, not GERD, which is characterized by heartburn, nausea, and a lump in the throat.

Question 55

Oropharyngeal dysphagia is commonly seen after:
A) Esophageal surgery
B) Head and neck surgeries
C) Abdominal surgeries
D) Lung surgeries

Answer 55

Correct Answer: B) Head and neck surgeries
Rationale: According to the slide, oropharyngeal dysphagia is common after head and neck surgeries, likely due to the proximity of surgical intervention to the structures involved in swallowing.

Question 56

Esophageal dysmotility and mechanical esophageal dysphasia are differentiated by their:
A) Associated symptoms of heartburn
B) Symptoms during liquid versus solid food intake
C) Time of symptom occurrence
D) Response to antacid medications

Answer 56

Correct Answer: B) Symptoms during liquid versus solid food intake
Rationale: Esophageal dysmotility is characterized by symptoms with both liquids and solids, whereas mechanical esophageal dysphasia presents symptoms only with solid food intake.

Question 57

The effortless return of gastric contents into the pharynx is a description of:
A) Achalasia
B) GERD
C) Esophageal diverticula
D) Esophageal spasm

Answer 57

Correct Answer: B) GERD
Rationale: GERD, or Gastroesophageal reflux disease, is described as the effortless return of gastric contents into the pharynx, along with associated symptoms like heartburn and nausea.

Question 58

Achalasia is theorized to be caused by:
A) Hyperactivity of the lower esophageal sphincter (LES)
B) Overproduction of inhibitory neurotransmitters in the LES
C) Loss of ganglionic cells in the esophageal myenteric plexus
D) Structural abnormalities in the esophageal lining

Answer 58

Correct Answer: C) Loss of ganglionic cells in the esophageal myenteric plexus
Rationale: Achalasia is theoretically caused by the loss of ganglionic cells of the esophageal myenteric plexus, leading to decreased inhibitory neurotransmission and inadequate LES tone.

Question 59

Which class of achalasia is characterized by esophageal spasms and is known to have the worst outcomes?
A) Type 1
B) Type 2
C) Type 3
D) Type 4

Answer 59

Correct Answer: C) Type 3
Rationale: Type 3 achalasia is described as having esophageal spasms with premature contractions and is associated with the worst outcomes among the classes listed.

Question 60

A patient with achalasia is at long-term increased risk for:
A) Esophageal cancer
B) Gastric ulcers
C) Duodenal ulcers
D) Pancreatitis

Answer 60

Correct Answer: A) Esophageal cancer
Rationale: The slide indicates that there is a long-term increased risk of esophageal cancer in patients diagnosed with achalasia.

Question 61

The diagnosis of achalasia is typically made with:
A) Barium swallow test
B) Upper GI series with barium
C) Esophageal manometry and/or esophagram
D) Gastric emptying study

Answer 61

Correct Answer: C) Esophageal manometry and/or esophagram
Rationale: Achalasia is diagnosed with esophageal manometry, which assesses esophageal motility, and/or an esophagram, an imaging test that evaluates the structure and function of the esophagus.

Question 62

Which class of achalasia responds best to treatment, particularly to myotomy?
A) Type 1
B) Type 2
C) Type 3
D) Type 4

Answer 62

Correct Answer: B) Type 2
Rationale: Type 2 achalasia, where the entire esophagus is pressurized, responds well to treatment, especially to myotomy, and is noted to have the best outcomes. i am assuming the treatment in the slide is the same.

Question 63

Which treatment is considered the most effective non-surgical therapy for achalasia?
A) Medications such as nitrates and CCBs
B) Endoscopic botox injections
C) Pneumatic dilation
D) Peri-oral endoscopic myotomy (POEM)

Answer 63

Correct Answer: C) Pneumatic dilation
Rationale: Pneumatic dilation is marked with an asterisk and noted as the most effective nonsurgical treatment for achalasia on the slide.

Question 63

What is the primary goal of achalasia treatments?
A) Curative
B) Palliative
C) Preventative
D) Diagnostic

Answer 63

Correct Answer: B) Palliative
Rationale: The slide states that all treatments for achalasia are palliative, meaning they aim to relieve symptoms rather than cure the disease.

Question 64

What is a significant complication associated with Peri-oral endoscopic myotomy (POEM)?
A) Esophageal perforation
B) Pneumothorax or pneumoperitoneum
C) Esophageal cancer
D) Achalasia recurrence

Answer 64

Correct Answer: B) Pneumothorax or pneumoperitoneum
Rationale: The slide mentions that 40% of patients who undergo POEM may develop pneumothorax or pneumoperitoneum, which are significant complications.

Question 65

What is the best surgical treatment for achalasia?
A) Pneumatic dilation
B) Laparoscopic Hellar Myotomy
C) Peri-oral endoscopic myotomy (POEM)
D) Esophagectomy

Answer 65

Correct Answer: B) Laparoscopic Hellar Myotomy
Rationale: The slide indicates that the best surgical treatment for achalasia is Laparoscopic Hellar Myotomy, as it is marked with an asterisk and identified as such.

Question 66

Patients with achalasia have an increased risk for:
A) Aspiration
B) Gastric ulcers
C) Barrett’s esophagus
D) Esophageal varices

Answer 66

Correct Answer: A) Aspiration
Rationale: The slide notes that patients with achalasia have an increased risk for aspiration, indicating that Rapid Sequence Induction (RSI) or awake intubation is indicated.

Question 67

Diffuse esophageal spasms are typically diagnosed using:
A) Barium swallow test
B) Endoscopy
C) Manometry
D) Echocardiogram

Answer 67

Correct Answer: C) Manometry
Rationale: Although not directly mentioned on the slide, manometry is the standard diagnostic tool for motility disorders such as diffuse esophageal spasms, which are characterized by spasms usually occurring in the distal esophagus.

Question 68

Which type of esophageal diverticulum is associated with bad breath due to food retention?
A) Pharyngoesophageal
B) Midesophageal
C) Epiphrenic
D) All of the above

Answer 68

Correct Answer: A) Pharyngoesophageal
Rationale: The slide specifically mentions that pharyngoesophageal diverticula (Zenker diverticulum) can cause bad breath due to food retention.

Question 69

atients with esophageal diverticula are at increased risk for:
A) Aspiration pneumonia
B) Acid reflux
C) Esophageal cancer
D) Peptic ulcer disease

Answer 69

Correct Answer: A) Aspiration pneumonia
Rationale: The slide notes that all types of esophageal diverticula pose an aspiration risk, indicating that patients are at increased risk for aspiration, which can lead to pneumonia.

Question 70

The pain from diffuse esophageal spasms can often be mistaken for:
A) Gastroenteritis
B) Irritable bowel syndrome
C) Angina
D) Appendicitis

Answer 70

Correct Answer: C) Angina
Rationale: According to the slide, the pain caused by diffuse esophageal spasms mimics angina, which is chest pain often associated with heart conditions.

Question 71

Treatment for diffuse esophageal spasms may include all the following except:
A) Nitroglycerin (NTG)
B) Proton pump inhibitors (PPIs)
C) Phosphodiesterase inhibitors (PD-Is)
D) Antidepressants

Answer 71

Correct Answer: B) Proton pump inhibitors (PPIs)
Rationale: The slide lists NTG, antidepressants, and PD-Is as treatments for diffuse esophageal spasms. PPIs are typically used for acid-related disorders and not listed as a treatment option for esophageal spasms.

Question 72

Hiatal hernias are characterized by:
A) Prolapse of the stomach into the thoracic cavity through the esophageal hiatus.
B) A muscular defect in the anterior abdominal wall.
C) The protrusion of the bowel into the groin.
D) The herniation of the esophagus into the stomach

Answer 72

Correct Answer: A) Prolapse of the stomach into the thoracic cavity through the esophageal hiatus.
Rationale: The slide defines a hiatal hernia as the herniation of the stomach into the thoracic cavity, occurring through the esophageal hiatus in the diaphragm.

Question 73

Which risk factor is NOT commonly associated with adenocarcinoma of the esophagus?
A) GERD
B) Barrett’s Esophagus
C) Obesity
D) Alcohol abuse

Answer 73

Correct Answer: D) Alcohol abuse

Rationale: According to the slide, common risk factors associated with esophageal adenocarcinomas include GERD, Barrett’s Esophagus, and obesity. While alcohol abuse is a risk factor for esophageal cancer, it is more commonly associated with squamous cell carcinoma of the esophagus.

Question 74

The majority of esophageal cancers in the United States are:
A) Squamous cell carcinomas
B) Adenocarcinomas
C) Sarcomas
D) Lymphomas

Answer 74

Correct Answer: B) Adenocarcinomas

Rationale: The slide states that most esophageal cancers are adenocarcinomas, which are typically found in the lower esophagus and related to GERD, Barrett’s esophagus, and obesity.

Question 75

The typical presentation of esophageal cancer includes:
A) Constipation and abdominal pain
B) Jaundice and clay-colored stools
C) Progressive dysphagia and weight loss
D) Vomiting blood and anemia

Answer 75

Correct Answer: C) Progressive dysphagia and weight loss
Rationale: Esophageal cancer commonly presents with progressive dysphagia and weight loss, as indicated on the slide.

Question 76

A hiatal hernia is often associated with which of the following conditions?
A) GERD
B) Achalasia
C) Gastric ulcers
D) Diverticulitis

Answer 76

Correct Answer: A) GERD
Rationale: The slide mentions that a hiatal hernia may be asymptomatic but is often associated with GERD (Gastroesophageal Reflux Disease).

Question 77

The weakening of the anchors at the gastroesophageal (GE) junction can lead to which of the following conditions?
A) Achalasia
B) Esophageal cancer
C) Hiatal hernia
D) Esophageal diverticulum

Answer 77

Correct Answer: C) Hiatal hernia
Rationale: The slide associates the weakening of the anchors at the GE (gastroesophageal junction) junction with the development of a hiatal hernia, where part of the stomach herniates into the thoracic cavity through the esophageal hiatus in the diaphragm

Question 78

What is a significant long-term complication for patients who have undergone an esophagectomy for esophageal cancer?
A) Chronic heartburn
B) Increased risk of developing Barrett’s esophagus
C) High lifelong risk of aspiration
D) Recurrence of esophageal cancer

Answer 78

Correct Answer: C) High lifelong risk of aspiration
Rationale: The slide mentions that patients post-esophagectomy have a very high aspiration risk for life, which is a significant concern that needs to be managed during the recovery and long-term care of these patients.

Question 79

Which approach to esophagectomy is not mentioned?
A) Transhiatal
B) Transthoracic
C) Transabdominal
D) Minimally invasive

Answer 79

Correct Answer: C) Transabdominal
Rationale: The slide lists transthoracic, transhiatal, and minimally invasive approaches to esophagectomy but does not mention the transabdominal approach.

Question 80

hat is the approximate rate of spontaneous resolution for recurrent laryngeal nerve injury after esophagectomy?
A) 20%
B) 40%
C) 60%
D) 80%

Answer 80

Correct Answer: B) 40%
Rationale: The slide states that there is a high risk of recurrent laryngeal nerve injury post-esophagectomy and that about 40% of these injuries resolve spontaneously.

Question 81

rior to undergoing an esophagectomy, patients often experience malnutrition due to:
A) Inability to swallow effectively
B) Metabolic demands of cancer
C) Side effects of chemotherapy
D) All of the above

Answer 81

Correct Answer: D) All of the above

Rationale: Although the slide does not detail the causes of malnutrition, it is common for esophageal cancer patients to experience malnutrition due to a combination of factors such as difficulty swallowing, the increased metabolic demands of cancer, and the side effects of chemotherapy or radiation treatments.

Question 82

Postoperative patients who have had chemotherapy or radiation for esophageal cancer are monitored for:
A) Hyperkalemia
B) Pancytopenia
C) Hypernatremia
D) Polycythemia

Answer 82

Correct Answer: B) Pancytopenia

Rationale: The slide indicates that patients with a history of chemotherapy or radiation may present with pancytopenia and dehydration, which would be of concern postoperatively

Question 83

An esophagectomy may be considered for esophageal cancer for what purpose?
A) Diagnostic examination of the esophagus
B) Palliative care to relieve symptoms
C) Only as a last resort in advanced disease
D) Curative intent or palliative relief

Answer 83

Correct Answer: D) Curative intent or palliative relief

Rationale: The slide specifies that esophagectomies may be performed with the intention to cure or for palliative care to alleviate symptoms associated with esophageal cancer.

Question 84

What is the normal pressure range of the lower esophageal sphincter (LES) that helps prevent GERD?
A) 10-15 mmHg
B) 20-25 mmHg
C) 29-34 mmHg
D) 35-40 mmHg

Answer 84

Correct Answer: C) 29-34 mmHg

Rationale: The slide mentions the normal LES pressure is 29 mmHg, and the average pressure in GERD is lower, at 13 mmHg. Therefore, the normal pressure range that helps to prevent GERD would be around or above 29 mmHg.

Question 85

Bile reflux in GERD is notably associated with the development of:
A) Peptic ulcer disease
B) Barrett metaplasia and adenocarcinoma
C) Squamous cell carcinoma
D) Esophageal varices

Answer 85

Correct Answer: B) Barrett metaplasia and adenocarcinoma

Rationale: The slide specifies that bile reflux is associated with Barrett metaplasia and adenocarcinoma, conditions related to the chronic injury of the esophageal lining.

Question 86

What percentage of adults are affected by GERD?
A) 5%
B) 10%
C) 15%
D) 20%

Answer 86

Correct Answer: C) 15%
Rationale: The slide states that GERD occurs in 15% of adults.

Question 87

Which is not listed as a mechanism of GE junction incompetence in GERD?
A) LES hypertension
B) Transient LES relaxation
C) LES hypotension
D) Autonomic dysfunction

Answer 87

Correct Answer: A) LES hypertension

Rationale: The slide lists transient LES relaxation, LES hypotension, and autonomic dysfunction as mechanisms of GE incompetence in GERD, not LES hypertension.

Question 88

Transient LES relaxation, a mechanism contributing to GERD, can be triggered by:
A) Esophageal spasms
B) Gastric distention
C) Consumption of alkaline substances
D) Supine body positioning

Answer 88

Correct Answer: B) Gastric distention

Rationale: The slide identifies transient LES relaxation as being elicited by gastric distention, which is a known factor contributing to the pathophysiology of GERD.

Question 89

Which medication is not typically used as a preoperative intervention for GERD?
A) Cimetidine
B) Ranitidine
C) Omeprazole
D) Acetaminophen

Answer 89

Correct Answer: D) Acetaminophen
Rationale: Acetaminophen is an analgesic and antipyretic and is not used for reducing acid secretion or increasing pH in the context of GERD.

Question 90

Surgical interventions for GERD include all of the following except:
A) Nissen Fundoplication
B) LINX device placement
C) Gastric bypass
D) Toupet Fundoplication

Answer 90

Correct Answer: C) Gastric bypass

Rationale: Gastric bypass is a weight-loss surgery and is not listed among the surgical treatments for GERD, which include Nissen Fundoplication, Toupet Fundoplication, and LINX device placement.

Question 91

Which procedure has become controversial regarding its efficacy in aspiration prevention during anesthesia induction for GERD patients?
A) Endotracheal intubation
B) Rapid Sequence Induction (RSI)
C) Administration of Sodium Citrate
D) Cricoid pressure

Answer 91

Correct Answer: D) Cricoid pressure

Rationale: The mention of controversy surrounding a procedure hints at cricoid pressure, which has been debated in recent times concerning its effectiveness in preventing aspiration during RSI.

Question 92

The class of drugs typically given the night before and the morning of surgery to reduce gastric acid volume and concentration includes:
A) Antibiotics
B) Beta-blockers
C) Proton pump inhibitors (PPIs)
D) Anticoagulants

Answer 92

Correct Answer: C) Proton pump inhibitors (PPIs)

Rationale: PPIs are commonly administered to decrease acid secretion, effectively reducing gastric acid volume and increasing pH preoperatively.

Question 93

Metoclopramide, a gastrokinetic agent, is often reserved for patients with GERD who are:
A) Diabetic
B) Obese
C) Pregnant
D) All of the above

Answer 93

Correct Answer: D) All of the above

Rationale: Metoclopramide is specifically noted as often being reserved for patients who are diabetic, obese, or pregnant due to its gastrokinetic properties.

Question 94

Which of these conditions does not directly increase the risk of intraoperative aspiration?
A) Hypothyroidism
B) Gastroparesis
C) Full Stomach
D) Morbid Obesity

Answer 94

Correct Answer: A) Hypothyroidism
Rationale: Among the options given, hypothyroidism is not listed as a direct risk factor for increased intraoperative aspiration risk. Gastroparesis, full stomach, and morbid obesity are mentioned as factors that elevate this risk.

Question 95

Which surgical position is associated with an increased risk of intraoperative aspiration?
A) Supine
B) Prone
C) Lithotomy
D) Lateral decubitus

Answer 95

Correct Answer: C) Lithotomy
Rationale: The lithotomy position is specified as a factor that can increase the risk of aspiration during surgery.

Question 96

Autonomic neuropathy may increase the risk of intraoperative aspiration due to:
A) Impaired cough reflex
B) Increased gastric emptying time
C) Decreased esophageal sphincter tone
D) All of the above

Answer 96

Correct Answer: D) All of the above

Rationale: Autonomic neuropathy can lead to multiple dysfunctions, including impaired cough reflex, delayed gastric emptying, and decreased esophageal sphincter tone, all of which can contribute to aspiration risk.

Question 97

A patient with diabetes mellitus (DM) undergoing surgery may have an increased aspiration risk due to:
A) Faster metabolism of anesthetic agents
B) Reduced insulin requirements perioperatively
C) Delayed gastric emptying
D) Increased risk of hypoglycemia

Answer 97

Correct Answer: C) Delayed gastric emptying
Rationale: DM can cause gastroparesis, which is delayed gastric emptying, a known risk factor for aspiration during surgery.

Question 98

Intraabdominal pressure is increased in all of the following conditions except:
A) Third-trimester pregnancy
B) Morbid obesity
C) Severe constipation
D) Emergent surgery

Answer 98

Correct Answer: D) Emergent surgery
Rationale: Increased intraabdominal pressure is a risk factor for aspiration and can occur in situations like pregnancy and morbid obesity. Emergent surgery is a separate risk factor for aspiration but is not associated with increased intraabdominal pressure itself.

Question 100

What is the primary role of the parasympathetic nervous system in stomach motility?
A) It decreases the number and force of contractions.
B) It increases the number and force of contractions.
C) It has no significant impact on stomach contractions.
D) It coordinates the contraction timing with the small intestine.

Answer 100

Correct Answer: B) It increases the number and force of contractions.

Question 101

Which of the following is not a neurohormone involved in gastric motility?
A) Gastrin
B) Motilin
C) Gastric inhibitory peptide
D) Insulin

Answer 101

Correct Answer: D) Insulin

Question 102

Sympathetic stimulation affects stomach motility by:
A) Increasing the frequency of contractions.
B) Decreasing the frequency of contractions.
C) Having no effect on the frequency of contractions.
D) Coordinating contractions with the duodenum.

Answer 102

Correct Answer: B) Decreasing the frequency of contractions.

Question 103

The breakdown of solids in the stomach into 1-2 mm particles is necessary for:
A) Effective mixing with chyme.
B) Facilitating the action of digestive enzymes.
C) Allowing the particles to enter the duodenum.
D) Both A and C.

Answer 103

Correct Answer: D) Both A and C.

Question 104

The intrinsic nervous system’s role in stomach motility is primarily to:
A) Provide sympathetic stimulation.
B) Coordinate the motility of the stomach.
C) Produce neurohormones like gastrin and motilin.
D) Inhibit the action of the vagus nerve.

Answer 104

correct Answer: B) Coordinate the motility of the stomach.

Question 105

What is the lifetime prevalence of peptic ulcer disease in men?
A) 5%
B) 10%
C) 12%
D) 15%

Answer 105

Correct Answer: C) 12%

women is 10%

Question 106

A patient with peptic ulcer disease may experience pain relief upon:
A) Initiating fasting.
B) Consuming a meal.
C) Engaging in vigorous exercise.
D) Taking NSAIDs.

Answer 106

Correct Answer: B) Consuming a meal.

Exacerbated w/ fasting

Question 107

: What percentage of patients with peptic ulcer disease risk perforation if left untreated?
A) 5%
B) 10%
C) 15%
D) 20%

Answer 107

Correct Answer: B) 10%

Question 108

The most common cause of non-variceal upper GI bleeding is:
A) Gastric cancer.
B) Peptic ulcer disease.
C) Esophageal varices.
D) Mallory-Weiss tear.

Answer 108

Correct Answer: B) Peptic ulcer disease.

Question 109

Which of the following best describes the risk of mortality associated with peptic ulcer disease?
A. It is predominantly due to malignancy in the ulcer.
B. Mortality is primarily due to shock or perforation after 48 hours.
C. It occurs immediately upon the onset of symptoms.
D. Mortality is most commonly due to Helicobacter pylori infection.

Answer 109

Correct Answer: B. Mortality is primarily due to shock or perforation after 48 hours.
Rationale: The slide indicates that mortality in peptic ulcer disease is predominantly due to shock or complications from perforation if not addressed within 48 hours. This implies the importance of prompt diagnosis and management of ulcer disease to prevent such complications. It does not indicate malignancy as a primary cause of death in peptic ulcer disease, nor does it suggest immediate mortality upon symptom onset.

Question 110

Which therapeutic intervention is most appropriate for acute gastric outlet obstruction as suggested ?
A. Long-term proton pump inhibitor therapy.
B. Nasogastric tube (NGT) and IV hydration.
C. Immediate surgical intervention.
D. Administration of oral bicarbonate solutions.

Answer 110

Correct Answer: B. Nasogastric tube (NGT) and IV hydration.

Rationale: The slide indicates that treatment (Tx) for pyloric obstruction includes NGT and IV hydration, and these interventions typically result in resolution within 72 hours. This acute management is essential to relieve symptoms, correct electrolyte imbalances, and stabilize the patient before any further interventions are considered.

Question 110

What is the association between Helicobacter pylori and peptic ulcer disease as indicated on the slide?
A. Helicobacter pylori infection is marginally associated with peptic ulcers.
B. Peptic ulcers may be associated with Helicobacter pylori infection.
C. Helicobacter pylori is a rare cause of peptic ulcers.
D. All peptic ulcers are caused by Helicobacter pylori.

Answer 110

Rationale: The slide mentions that peptic ulcers may be associated with Helicobacter pylori, which is an established causative factor in the development of most peptic ulcers. The wording “may be associated” suggests that while Helicobacter pylori is a common etiological agent, not all peptic ulcers are caused by it, acknowledging other causes like NSAID use.

Question 111

The typical biochemical disturbance associated with pyloric obstruction is:
A. Hypernatremic alkalosis.
B. Hypokalemic alkalosis.
C. Hyperchloremic acidosis.
D. Hyperchloremic alkalosis.

Answer 111

Correct Answer: D. Hyperchloremic alkalosis.

Rationale: The slide presents hyperchloremic alkalosis as a consequence of pyloric obstruction, a disturbance due to loss of gastric contents, which are rich in hydrogen ions, leading to a relative state of alkalosis with a compensatory increase in chloride.

Question 112

Chronic gastric outlet obstruction may develop as a result of which of the following?
A. Rapid resolution of edema in the pyloric channel.
B. Repetitive ulceration and scarring.
C. Intermittent pyloric spasms without underlying pathology.
D. Frequent use of antacid medications.

Answer 112

Correct Answer: B. Repetitive ulceration and scarring.
Rationale: The slide mentions that repetitive ulceration and subsequent scarring can lead to a fixed-stenosis, causing chronic obstruction. This suggests that ongoing injury and healing can result in anatomical changes that progressively narrow the pyloric channel, different from the transient nature of acute obstructions caused by edema and inflammation.

Question 113

Which classification of gastric ulcer is commonly associated with acid hypersecretion?
A. Type I
B. Type II
C. Type III
D. Type IV

Answer 113

Correct Answer: C. Type III

Rationale: Type III gastric ulcers are prepyloric with acid hypersecretion. Excessive acid secretion is a significant factor in the pathogenesis of these ulcers.

Question 114

The recommended treatment regimen for a Helicobacter pylori infection in gastric ulcers includes:
A. Dual therapy with a proton pump inhibitor and antibiotics for 7 days.
B. Triple therapy including two antibiotics and a proton pump inhibitor for 14 days.
C. Monotherapy with a proton pump inhibitor for 14 days.
D. Antacid monotherapy as needed.

Answer 114

Correct Answer: B. Triple therapy including two antibiotics and a proton pump inhibitor for 14 days.

Rationale: Helicobacter pylori infection in gastric ulcers is treated with a combination of two antibiotics to tackle the bacteria and a proton pump inhibitor to reduce gastric acid production, given for a period of 14 days to ensure eradication of the infection.

Question 115

A gastric ulcer that is not associated with acid hypersecretion and is found at the lesser curvature near the gastroesophageal junction is classified as:
A. Type I
B. Type II
C. Type III
D. Type IV

Answer 115

Correct Answer: D. Type IV

Rationale: Type IV gastric ulcers are located at the lesser curvature near the gastroesophageal junction and are not associated with acid hypersecretion. Understanding the location and pathophysiological characteristics of these ulcers is critical for appropriate treatment.

Question 116

Which type of gastric ulcer is typically associated with nonsteroidal anti-inflammatory drug (NSAID) use?
A. Type I
B. Type II
C. Type III
D. Type V

Answer 116

Correct Answer: D. Type V

Rationale: Type V gastric ulcers can occur anywhere in the stomach and are commonly associated with the use of NSAIDs. NSAIDs inhibit prostaglandin synthesis, which is protective to the gastric mucosa, thus increasing the risk for ulcer formation.

Question 117

What is the underlying pathology of Zollinger-Ellison Syndrome?
A. A non B cell islet tumor of the pancreas causing gastrin hyposecretion.
B. A B cell islet tumor of the pancreas leading to insulin overproduction.
C. A non B cell islet tumor of the pancreas causing gastrin hypersecretion.
D. Hyperplasia of gastric mucosa leading to increased gastric acid secretion.

Answer 117

Correct Answer: C. A non B cell islet tumor of the pancreas causing gastrin hypersecretion.

Rationale: Zollinger-Ellison Syndrome is characterized by gastrin-secreting tumors known as gastrinomas, typically found in the pancreas or duodenum, leading to excessive gastric acid secretion.

Question 118

Which feedback mechanism is dysfunctional in Zollinger-Ellison Syndrome?
A. Positive feedback on gastrin release by gastric acid.
B. Negative feedback of insulin on blood glucose levels.
C. Negative feedback inhibition of gastrin by gastric acid.
D. Positive feedback of gastric acid secretion by secretin.

Answer 118

Correct Answer: C. Negative feedback inhibition of gastrin by gastric acid.

Rationale: In normal physiology, gastric acid secretion is regulated by a negative feedback mechanism where the presence of acid in the stomach inhibits further gastrin release. This feedback loop is absent in Zollinger-Ellison Syndrome, leading to unregulated acid production.

Question 119

Preoperative management of a patient with Zollinger-Ellison Syndrome should include:
A. Reduction of gastric pH with antacids.
B. Correction of electrolyte imbalances and the use of medications to increase gastric pH.
C. Administration of medications to lower serum gastrin levels.
D. Immediate surgical resection of the gastrinoma without preoperative preparation.

Answer 119

Correct Answer: B. Correction of electrolyte imbalances and the use of medications to increase gastric pH.

Rationale: Patients with Zollinger-Ellison Syndrome often have increased gastric acid production leading to low gastric pH. Preoperative management focuses on correcting electrolyte imbalances that may result from severe acid secretion and using medications, such as proton pump inhibitors, to increase gastric pH and stabilize the patient before surgery.

RSI

Question 120

What is the primary function of segmentation in the small intestine?
A. To propel food particles rapidly through the digestive tract.
B. To mix the intestinal contents and expose them to digestive enzymes.
C. To allow for the elimination of undigested food substances.
D. To prevent backflow of intestinal contents into the stomach.

Answer 120

Correct Answer: B. To mix the intestinal contents and expose them to digestive enzymes.

Rationale: Segmentation’s rhythmic contractions help mix the intestinal contents with digestive enzymes, reducing particle size and increasing solubility, which aids in the digestion and absorption of nutrients.

Question 121

Which nervous system primarily controls the motility of the small intestine?
A. Somatic nervous system.
B. Sympathetic nervous system.
C. Enteric nervous system.
D. Central nervous system.

Answer 121

Correct Answer: C. Enteric nervous system.

Rationale: The enteric nervous system is responsible for regulating the functions of the gastrointestinal tract, including the motility of the small intestine, with modulation by the extrinsic nervous system.

Question 122

The process by which the small intestine circulates its contents to maximize absorption is known as:
A. Peristalsis.
B. Mastication.
C. Emulsification.
D. Segmentation.

Answer 122

Correct Answer: D. Segmentation.
Rationale: Segmentation in the small intestine is the major motility pattern that circulates the contents, exposing them to the mucosal wall to maximize absorption of nutrients, water, and vitamins.

Question 123

Which of the following conditions is considered a reversible cause of small bowel dysmotility?
A. Scleroderma.
B. Pseudo-obstruction.
C. Ileus.
D. Inflammatory bowel disease (IBD).

Answer 123

Correct Answer: C. Ileus.

Rationale: Ileus, which can result from electrolyte abnormalities or critical illness, is considered a reversible cause of small bowel dysmotility because its underlying causes can often be treated or resolve spontaneously.

Question 124

A patient with chronic intestinal pseudo-obstruction is likely to experience which symptoms?
A. Constipation and anemia.
B. Bloating, nausea, and abdominal pain.
C. Diarrhea and hyperactive bowel sounds.
D. Jaundice and hepatomegaly.

Answer 124

Correct Answer: B. Bloating, nausea, and abdominal pain.

Rationale: Pseudo-obstruction, characterized by uncoordinated intestinal contractions, typically presents with symptoms of bloating, nausea, vomiting, and abdominal pain due to the ineffective motility.

Question 125

What is a common factor in the nonreversible neuropathic causes of small bowel dysmotility?
A. Increased coordinated intestinal contractions.
B. The intrinsic and extrinsic nervous systems producing weak, uncoordinated contractions.
C. Acute inflammation of the bowel wall.
D. Complete cessation of bowel peristalsis.

Answer 125

Correct Answer: B. The intrinsic and extrinsic nervous systems producing weak, uncoordinated contractions.

Rationale: Neuropathic causes of small bowel dysmotility, such as pseudo-obstruction, involve alterations in the nervous system that lead to weak and uncoordinated intestinal contractions.

Question 126

Which of the following is classified as a structural nonreversible cause of small bowel dysmotility?
A. Electrolyte imbalances.
B. Connective tissue disorders.
C. Bacterial overgrowth.
D. Adhesions.

Answer 126

Correct Answer: B. Connective tissue disorders.

Rationale: Structural nonreversible causes include scleroderma and connective tissue disorders that physically affect the structure of the bowel wall, leading to dysmotility.

Question 127

The presence of a hernia as an etiology for small bowel dysmotility is categorized under which type of causes?
A. Reversible structural.
B. Reversible neuropathic.
C. Nonreversible structural.
D. Nonreversible neuropathic.

Answer 127

Correct Answer: A. Reversible structural.

Rationale: Hernias are mechanical obstructions and are classified under reversible structural causes of small bowel dysmotility since the obstruction can often be corrected surgically.

Question 128

What is the primary function of the large intestine in the digestive system?
A. Absorption of most nutrients from digested food.
B. Initial breakdown of carbohydrate-rich food.
C. Acting as a reservoir for waste and extracting water and electrolytes.
D. Production of digestive enzymes for food breakdown.

Answer 128

Correct Answer: C. Acting as a reservoir for waste and extracting water and electrolytes.

Rationale: The large intestine functions mainly to store waste and indigestible materials before elimination and to absorb the remaining water and electrolytes from the intestinal contents.

Question 129

The ileocecal valve’s relaxation and subsequent contraction is primarily triggered by:
A. The presence of nutrients in the ileum.
B. Distention of the ileum and subsequent cecal distention.
C. Hormonal signals from the pancreas.
D. Neural signals from the enteric nervous system.

Answer 129

Correct Answer: B. Distention of the ileum and subsequent cecal distention.

Rationale: The ileocecal valve relaxes in response to distention of the ileum, allowing contents to enter the colon, and contracts when the cecum becomes distended.

Question 130

Giant migrating complexes in the colon are responsible for:
A. Absorbing vitamins and minerals.
B. Producing digestive enzymes.
C. Producing mass movements across the large intestine.
D. Releasing hormones to regulate digestion.

Answer 130

Correct Answer: C. Producing mass movements across the large intestine.

Rationale: Giant migrating complexes facilitate mass movements, which are powerful contractions that occur a few times each day to move the contents of the large intestine toward the rectum.

Question 131

How frequently do giant migrating complexes typically occur in a healthy individual?
A. Once a day.
B. 2-3 times a day.
C. 6-10 times a day.
D. With each meal ingestion.

Answer 131

Correct Answer: C. 6-10 times a day.

Rationale: In the healthy state, giant migrating complexes occur approximately 6-10 times a day to ensure proper progression of intestinal contents through the colon.

Question 132

What effect does cecal distention have on the ileocecal valve?
A. It relaxes the valve to increase the flow from the ileum.
B. It contracts the valve to prevent backflow into the ileum.
C. It has no effect on the valve function.
D. It triggers enzymatic secretion in the ileum.

Answer 132

Correct Answer: B. It contracts the valve to prevent backflow into the ileum.

Rationale: The ileocecal valve contracts in response to cecal distention, which helps prevent the reflux of colonic contents back into the ileum.

Question 133

What are the two primary symptoms of colonic dysmotility?
A. Acid reflux and ulcers.
B. Altered bowel habits and intermittent cramping.
C. Blood in stool and weight loss.
D. Constipation and fecal incontinence.

Answer 133

Correct Answer: B. Altered bowel habits and intermittent cramping.

Rationale: Colonic dysmotility is characterized by changes in normal bowel habits, such as diarrhea or constipation, and may be accompanied by abdominal cramping.

Question 134

According to the Rome II criteria, which feature must be present for the diagnosis of IBS?
A. Abdominal discomfort relieved by defecation.
B. Pain exclusively post-prandial.
C. Constant pain without relation to bowel movements.
D. Pain relieved by antispasmodics only.

Answer 134

Correct Answer: A. Abdominal discomfort relieved by defecation.

Rationale: IBS, as per the Rome II criteria, is characterized by abdominal discomfort that is relieved by defecation, along with altered bowel habits and changes in stool form.

Question 135

In the context of IBD, how do giant migrating complexes affect the colonic wall?
A. They are reduced in frequency, lessening the wall compression.
B. They increase in frequency, causing potential compression of the inflamed mucosa.
C. Their frequency is unchanged, but the amplitude of contractions decreases.
D. They are completely absent due to inflammation.

Answer 135

Correct Answer: B. They increase in frequency, causing potential compression of the inflamed mucosa.

Rationale: In IBD, although the regular contractions may be suppressed, there is an increased frequency of giant migrating complexes that can further compress the already inflamed mucosa, potentially leading to complications like hemorrhage or erosion.

Question 136

Which diseases are most commonly associated with colonic dysmotility?
A. Gastroesophageal reflux disease (GERD) and peptic ulcers.
B. Crohn’s disease and ulcerative colitis.
C. Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD).
D. Celiac disease and lactose intolerance.

Answer 136

Correct Answer: C. Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD).

Rationale: IBS and IBD are the diseases most commonly associated with colonic dysmotility, which can manifest as altered bowel habits and cramping.

Question 137

The Rome II criteria for IBS includes which of the following features?
A. Pain associated with an abnormal frequency of defecation.
B. Defecation associated with a change in consistency of the stool.
C. Pain relieved by antacid medication.
D. Pain that is continuous and unchanging.

Answer 137

Correct Answer: A. Pain associated with an abnormal frequency of defecation.

Rationale: One of the features of IBS according to the Rome II criteria includes abdominal pain that is associated with an abnormal frequency of defecation, meaning more than three times per day or less than three times per week.

Question 138

Inflammatory Bowel Disease (IBD) is ranked as the second most common inflammatory disorder. What is the first?
A. Systemic Lupus Erythematosus (SLE).
B. Rheumatoid Arthritis (RA).
C. Psoriasis.
D. Ankylosing Spondylitis (AS).

Answer 138

Correct Answer: B. Rheumatoid Arthritis (RA).
Rationale: The slide specifies that IBD is the second most common inflammatory disorder after Rheumatoid Arthritis.

Question 139

Ulcerative Colitis (UC) is characterized by inflammation of:
A. Only the rectum.
B. The entire gastrointestinal tract.
C. The mucosa of the rectum and part or all of the colon.
D. The small intestine only.

Answer 139

Correct Answer: C. The mucosa of the rectum and part or all of the colon.

Rationale: UC is a type of IBD that specifically affects the mucosal layer of the rectum and can extend to part or all of the colon.

Question 140

A patient with Ulcerative Colitis may exhibit which laboratory abnormalities?
A. Decreased platelets, erythrocyte sedimentation rate, and albumin.
B. Increased erythrocyte sedimentation rate, platelets, and decreased hemoglobin and hematocrit.
C. Increased hemoglobin and hematocrit, decreased platelets.
D. Decreased erythrocyte sedimentation rate and increased albumin.

Answer 140

Correct Answer: B. Increased erythrocyte sedimentation rate, platelets, and decreased hemoglobin and hematocrit.

Rationale: The slide indicates that laboratory findings in UC may include an increased platelet count and erythrocyte sedimentation rate, which are markers of inflammation, as well as decreased hemoglobin and hematocrit (H&H) and albumin, which can indicate malnutrition or chronic disease.

Question 141

What is the mortality rate associated with colon perforation as a complication of IBD?
A. 5%
B. 10%
C. 15%
D. 20%

Answer 141

Correct Answer: C. 15%.

Rationale: The slide indicates that colon perforation is a dangerous complication of IBD with a mortality rate of 15%.

Question 142

The incidence of IBD is stated as 18 per 100,000 people.
A. The number of new cases diagnosed annually.
B. The total number of cases existing at a given time.
C. The number of cases resolved each year.
D. The mortality rate per year for IBD.

Answer 142

Correct Answer: A. The number of new cases diagnosed annually.

Rationale: Incidence typically refers to the number of new cases identified in a population over a specific period, suggesting the rate at which new individuals are diagnosed with IBD is 18 per 100,000 people annually.

Question 143

Crohn’s Disease is characterized by which types of inflammatory processes?
A. Only acute.
B. Only chronic.
C. Either acute or chronic.
D. Neither acute nor chronic.

Answer 143

Correct Answer: C. Either acute or chronic.

Rationale: Crohn’s Disease can present as an acute or chronic inflammatory process affecting any or all parts of the bowel.

Question 144

What is the most common presenting symptom of Crohn’s Disease involving the terminal ileum?
A. Constipation with left lower quadrant pain.
B. Diarrhea with right lower quadrant pain.
C. Vomiting with right upper quadrant pain.
D. Gastroesophageal reflux with central abdominal pain.

Answer 144

Correct Answer: B. Diarrhea with right lower quadrant pain.

Rationale: Crohn’s Disease often presents with ileocolitis, characterized by right lower quadrant pain and diarrhea, when the terminal ileum is involved.

Question 145

One-third of patients with Crohn’s Disease may have additional symptoms. Which of the following is NOT typically associated with it?
A. Arthritis.
B. Dermatitis.
C. Kidney stones.
D. Hypertension.

Answer 145

Correct Answer: D. Hypertension.

Rationale: While arthritis, dermatitis, and kidney stones are extraintestinal manifestations associated with Crohn’s Disease, hypertension is not commonly linked to it.

Question 146

In Crohn’s Disease, persistent inflammation may lead to what complication in the bowel?
A. Increased bowel elasticity.
B. Fibrous narrowing and stricture formation.
C. Enhanced absorptive function.
D. Increased bowel motility.

Answer 146

Correct Answer: B. Fibrous narrowing and stricture formation.

Rationale: Chronic inflammation in Crohn’s Disease can cause the bowel to become fibrotic, leading to narrowing and potential stricture formation.

Question 147

Colonic Crohn’s Disease can lead to which of the following complications?
A. Fistulization into the liver.
B. Development of peptic ulcers.
C. Fistulization into the stomach/duodenum.
D. Hyperactive bowel sounds.

Answer 147

Correct Answer: C. Fistulization into the stomach/duodenum.

Rationale: Crohn’s Disease affecting the colon can lead to fistulization, where abnormal connections form between the colon and adjacent organs like the stomach or duodenum, potentially resulting in fecal vomiting.

Question 148

What is the role of 5-Acetylsalicylic acid (5-ASA) in the management of Inflammatory Bowel Disease (IBD)?
A. To induce remission during acute flares.
B. As an adjunct for pain relief.
C. To manage bacterial infections.
D. As a mainstay treatment with antibacterial and anti-inflammatory properties.

Answer 148

Correct Answer: D. As a mainstay treatment with antibacterial and anti-inflammatory properties.

Question 149

Which class of medications is used during acute flares of IBD for their anti-inflammatory effects?
A. Antibiotics.
B. Glucocorticoids.
C. Purine analogues.
D. Anticholinergics.

Answer 149

Correct Answer: B. Glucocorticoids.

Question 150

When is surgical intervention considered in the treatment of IBD?
A. As a first-line treatment.
B. When maximum medical therapy fails to induce remission.
C. During the initial diagnosis.
D. Periodically as a preventive measure

Answer 150

Correct Answer: B. When maximum medical therapy fails to induce remission.

Question 151

esection of what proportion of the small intestine typically leads to “short bowel syndrome”?
A. Less than one-third.
B. More than one-half.
C. More than two-thirds.
D. Any resection of the small intestine.

Answer 151

Correct Answer: C. More than two-thirds.

Question 152

The use of antibiotics in IBD is indicated for what purpose?
A. To treat primary disease inflammation.
B. As a prophylactic measure in all patients with IBD.
C. To manage specific complications such as abscesses or fistulas.
D. To replace long-term immunosuppressive therapy.

Answer 152

Correct Answer: C. To manage specific complications such as abscesses or fistulas.

Question 153

Which substance is not typically secreted by carcinoid tumors?
A. Gastrin
B. Glucagon
C. Amylase
D. Serotonin

Answer 153

Correct Answer: C. Amylase

Rationale: Carcinoid tumors secrete various peptides and vasoactive substances like gastrin, insulin, somatostatin, motilin, neurotensin, tachykinins, glucagon, and serotonin, but not digestive enzymes such as amylase.

Question 154

Carcinoid syndrome may lead to a specific type of endocardial fibrosis. Which side of the heart is more commonly affected?
A. Left
B. Right
C. Both equally
D. Neither, the heart is typically unaffected

Answer 154

Correct Answer: B. Right

Rationale: Carcinoid syndrome can cause right heart endocardial fibrosis due to high levels of serotonin and other substances in the bloodstream, which do not get inactivated by the liver before reaching the right side of the heart.

Question 155

Why is the left heart usually not affected by the vasoactive substances in carcinoid syndrome?
A. The liver metabolizes these substances before they reach the left heart.
B. The right heart is more susceptible to these substances.
C. The lungs clear these substances before they reach the left heart.
D. These substances have a higher affinity for the right heart.

Answer 155

Correct Answer: C. The lungs clear these substances before they reach the left heart

Rationale: Vasoactive substances secreted by carcinoid tumors first pass through the right side of the heart; then, the lungs metabolize or inactivate many of these substances before they can affect the left heart.

Question 156

What is the role of Octreotide in the preoperative management of a patient with a carcinoid tumor?
A. To reduce insulin secretion
B. To decrease stomach acid production
C. To prevent hemodynamic instability
D. To enhance glucose metabolism

Answer 156

Correct Answer: C. To prevent hemodynamic instability

Rationale: Octreotide is used preoperatively in patients with carcinoid tumors to prevent hemodynamic instability by inhibiting the release of vasoactive substances that can cause severe fluctuations in blood pressure during tumor manipulation.

Question 157

Carcinoid syndrome occurs in a subset of patients with carcinoid tumors. What proportion of patients with carcinoid tumors typically develops carcinoid syndrome?
A. Less than 5%
B. About 10%
C. Approximately 25%
D. More than 50%

Answer 157

Correct Answer: B. About 10%

Rationale: Carcinoid syndrome, with symptoms like flushing, diarrhea, and bronchoconstriction, develops in approximately 10% of patients with carcinoid tumors when large amounts of vasoactive substances enter the systemic circulation, often when the tumors metastasize to the liver.

Question 158

Carcinoid tumors originating from the midgut typically present with which symptomatology?
A. High serotonin secretion and typical carcinoid syndrome.
B. Low serotonin secretion and atypical carcinoid syndrome.
C. Rare serotonin secretion and no carcinoid syndrome.
D. High ACTH secretion as the predominant feature.

Answer 158

Correct Answer: A. High serotonin secretion and typical carcinoid syndrome.

Question 159

Carcinoid tumors found in the small intestine most commonly present with:
A. Intestinal obstruction.
B. Abdominal pain.
C. Tumor.
D. Gastrointestinal bleeding.

Answer 159

Correct Answer: B. Abdominal pain.

Question 160

Which carcinoid tumor location is most likely to be discovered during physical examination or ultrasonography?
A. Small intestine.
B. Rectum.
C. Bronchus.
D. Ovary and testicle.

Answer 160

Correct Answer: D. Ovary and testicle.

Question 161

What percentage of patients with bronchial carcinoid tumors are asymptomatic?
A. 17%
B. 31%
C. 39%
D. 51%

Answer 161

Correct Answer: B. 31%.

Question 162

Carcinoid tumors are often found incidentally. Which condition is commonly being investigated when they are discovered?
A. Cholecystitis.
B. Appendicitis.
C. Peptic ulcer disease.
D. Inflammatory bowel disease.

Answer 162

Correct Answer: B. Appendicitis.

Question 163

What has likely contributed to the tenfold increase in the incidence of acute pancreatitis since the 1960s?
A. Improved diagnostic methods.
B. Increase in autoimmune diseases.
C. Decrease in alcohol consumption.
D. Genetic mutations.

Answer 163

Correct Answer: A. Improved diagnostic methods.

Question 164

Which mechanism is not a way that the pancreas normally prevents autodigestion?
A. Proteases activated within the pancreatic ducts.
B. Protease inhibitors.
C. Proteases packaged in precursor form.
D. Low intra-pancreatic calcium.

Answer 164

Correct Answer: A. Proteases activated within the pancreatic ducts.

Question 165

Gallstones contribute to acute pancreatitis by:
A. Directly damaging pancreatic tissue.
B. Obstructing the ampulla of Vater.
C. Causing systemic hypercalcemia.
D. Triggering autoimmune reactions.

Answer 165

Correct Answer: B. Obstructing the ampulla of Vater.

Question 166

In addition to gallstones and alcohol abuse, which other condition is a known risk factor for acute pancreatitis?
A. Immunodeficiency syndrome.
B. Hypothyroidism.
C. Hyperthyroidism.
D. Diabetes mellitus.

Answer 166

Correct Answer: A. Immunodeficiency syndrome.

and hyperparathyroidism/↑Ca²,
Trypsin is proteolytic enzyme triggered by calcium.. auto-digestion

Question 167

The presence of high intra-pancreatic calcium levels is associated with:
A. Increased protease activity.
B. Decreased trypsin activity.
C. Prevention of pancreatitis.
D. None of the above.

Answer 167

Correct Answer: A. increased protease activity

Trypsin is proteolytic enzyme triggered by calcium that can trigger auto-digestion if intra-pancreatic calcium is too high.

Question 168

What is the preferred method of nutritional support in the management of acute pancreatitis?
A. Total parenteral nutrition (TPN).
B. Aggressive intravenous fluids (IVF) only.
C. Nasogastric feeding.
D. Enteral feeding.

Answer 168

Correct Answer: D. Enteral feeding.

Rationale: Enteral feeding is preferred over TPN due to a lower risk of infectious complications and it promotes gut integrity.

Question 169

What is the role of Endoscopic Retrograde Cholangiopancreatography (ERCP) in acute pancreatitis?
A. It’s primarily used for diagnostic imaging.
B. It’s a therapeutic intervention to remove gallstones.
C. It is used to initiate antibiotic therapy.
D. It is the first-line treatment for all pancreatitis cases.

Answer 169

Correct Answer: B. It’s a therapeutic intervention to remove gallstones.

Rationale: ERCP is employed for therapeutic purposes, such as removing gallstones from the biliary or pancreatic ducts, placing stents, or performing sphincterotomy to relieve obstructions.

Question 170

Elevated serum amylase and lipase are hallmark lab findings in acute pancreatitis. What other symptom is typically associated with this condition?
A. Bradycardia.
B. Hypotension.
C. Jaundice.
D. Hypertension.

Answer 170

Correct Answer: B. Hypotension.

Rationale: Acute pancreatitis often presents with hypotension (HoTN) due to systemic inflammatory response and fluid sequestration.

Question 171

What percentage of acute pancreatitis patients experience serious complications such as shock or ARDS?
A. 10%
B. 25%
C. 50%
D. 75%

Answer 171

Correct Answer: B. 25%.

Rationale: Approximately 25% of patients with acute pancreatitis may suffer from severe complications, including shock, Acute Respiratory Distress Syndrome (ARDS), and renal failure.

Question 172

Which imaging modality is NOT typically used in the initial evaluation of acute pancreatitis?
A. Contrast-enhanced computed tomography (CT).
B. Magnetic resonance imaging (MRI).
C. Endoscopic ultrasound (EUS).
D. Plain abdominal radiography.

Answer 172

Correct Answer: D. Plain abdominal radiography.

Rationale: While contrast CT, MRI, and EUS are used in the assessment of pancreatitis, plain abdominal radiography is not typically used for initial evaluation as it is less sensitive and specific for this condition.

Question 173

Orthostatic hypotension in the context of GI bleeding typically indicates a hematocrit (HCT) level lower than what percentage?
A. 20%
B. 30%
C. 40%
D. 50%

Answer 173

Correct Answer: B. 30%.

Question 174

A BUN level greater than 40 mg/dL in a patient with GI bleeding suggests what about the source of the bleed?
A. The bleed is in the lower GI tract.
B. The bleed is below the cecum.
C. The bleed has been ongoing for less than 24 hours.
D. Absorption of nitrogen into the bloodstream from the upper GI tract.

Answer 174

Correct Answer: D. Absorption of nitrogen into the bloodstream from the upper GI tract.

this is due to absorbed Nitrogen

Question 175

What is the endoscopic procedure of choice for managing GI bleeding?
A. Mechanical balloon tamponade.
B. Surgical resection of the bleeding site.
C. Esophagogastroduodenoscopy (EGD).
D. Total colectomy.

Answer 175

Correct Answer: C. Esophagogastroduodenoscopy (EGD).

Question 176

Melena, a clinical finding in GI bleeding, indicates a bleed at which location?
A. Above the cecum.
B. Below the cecum.
C. At the rectum.
D. In the lower esophagus.

Answer 176

Correct Answer: A. Above the cecum.

Question 177

When is mechanical balloon tamponade used in the management of GI bleeding?
A. As a first-line treatment.
B. When endoscopic measures fail to control esophageal varices bleeding.
C. In all cases of upper GI bleeding.
D. In cases of duodenal ulcer perforation.

Answer 177

Correct Answer: B. When endoscopic measures fail to control esophageal varices bleeding.

Question 178

In which patient population is lower GI bleeding more commonly observed?
A. Newborns.
B. Adolescents.
C. Middle-aged adults.
D. Elderly.

Answer 178

Correct Answer: D. Elderly.

Question 179

What is the first-line diagnostic procedure for a hemodynamically stable patient suspected of lower GI bleeding?
A. Total colectomy.
B. Angiography.
C. Unprepped sigmoidoscopy.
D. Colonoscopy after full bowel prep.

Answer 179

Correct Answer: C. Unprepped sigmoidoscopy.

As soon as HD stable

Question 180

Colonoscopy in the context of lower GI bleeding is performed under which condition?
A. Immediately upon presentation to the emergency department.
B. After the patient is hemodynamically stable and can tolerate bowel preparation.
C. Only after angiography has been attempted.
D. As a last resort after other diagnostics have failed.

Answer 180

Correct Answer: B. After the patient is hemodynamically stable and can tolerate bowel preparation.

Question 181

Which intervention is considered when lower GI bleeding is persistent and not responsive to endoscopic treatment?
A. Prescriptive medication only.
B. Immediate surgical resection.
C. Therapeutic angiography and embolic therapy.
D. Watchful waiting with repeat labs.

Answer 181

Correct Answer: C. Therapeutic angiography and embolic therapy.

Question 182

What characterizes colonic ileus?
A. Mechanical blockage causing dilation.
B. Lack of peristalsis leading to dilation without mechanical obstruction.
C. Inflammation of the colon lining.
D. Infectious process within the colon.

Answer 182

Correct Answer: B. Lack of peristalsis leading to dilation without mechanical obstruction.

Rationale: Adynamic ileus involves massive dilation of the colon due to a loss of peristalsis, not caused by a physical obstruction but rather a functional impairment.

Question 183

What is a common treatment for adynamic ileus?
A. Surgical resection of the dilated segment.
B. Administration of broad-spectrum antibiotics.
C. Neostigmine 2-2.5mg over 5 minutes.
D. Immediate endoscopic evaluation.

Answer 183

Correct Answer: C. Neostigmine 2-2.5mg over 5 minutes.

Rationale: Neostigmine, an acetylcholinesterase inhibitor, is used to stimulate bowel motility in cases of adynamic ileus and can produce results in 80-90% of cases; cardiac monitoring is required due to the risk of bradycardia.

Question 184

Which condition, if left untreated, may complicate adynamic ileus?
A. Appendicitis.
B. Gastroenteritis.
C. Ischemia and perforation.
D. Ulcerative colitis.

Answer 184

Correct Answer: C. Ischemia and perforation.

Rationale: Untreated adynamic ileus can lead to complications such as ischemia due to prolonged distention and potential perforation of the colon.

other treatment
Tx: Restore e-lyte balance, hydrate, mobilize, NG suction, enemas

Question 185

What is the relationship between preoperative anxiety and GI activity?
A. Increased anxiety is associated with increased GI activity.
B. Anxiety has no effect on GI activity.
C. Increased anxiety is associated with decreased GI activity.
D. Only high levels of anxiety affect GI activity.

Answer 185

Correct Answer: C. Increased anxiety is associated with decreased GI activity.

Rationale: The inhibition of GI activity is directly proportional to the amount of norepinephrine released from sympathetic nervous system (SNS) stimulation; thus, higher anxiety, which can cause increased SNS activity, results in greater GI inhibition.

Question 186

Which part of the GI tract is the first to recover after anesthesia?
A. Stomach.
B. Colon.
C. Small intestine.
D. Esophagus.

Answer 186

Correct Answer: C. Small intestine.

Rationale: Postoperatively, the small intestine is the first to recover its function, usually within about 24 hours, followed by the stomach and then the colon within 30 to 40 hours.

Question 187

How do volatile anesthetics affect the GI system?
A. They stimulate peristalsis.
B. They have no impact on GI function.
C. They depress various functions including spontaneous and propulsive activity.
D. They increase the absorption of nutrients.

Answer 187

Correct Answer: C. They depress various functions including spontaneous and propulsive activity.

Rationale: Volatile anesthetics depress the spontaneous, electrical, contractile, and propulsive activity in the GI tract, affecting the stomach, small intestine, and colon.

Question 188

What effect does the combination of volatile agents and surgery have on GI function?
A. Promotes faster recovery of GI motility.
B. Does not affect GI function.
C. Can inhibit GI function and motility.
D. Enhances GI secretory functions.

Answer 188

Correct Answer: C. Can inhibit GI function and motility.

Rationale: The use of volatile anesthetic agents during surgery, along with the sympathetic nervous system hyperactivity often associated with surgery, can lead to an inhibition of GI function and motility.

Question 189

Nitrous oxide’s solubility in the blood impacts the gastrointestinal system by:
A. Decreasing bowel motility.
B. Having no significant effect on gas-containing cavities.
C. Causing shrinkage of gas-containing cavities.
D. Leading to distension of gas-containing cavities.

Answer 189

Correct Answer: D. Leading to distension of gas-containing cavities.

Rationale: Nitrous oxide is highly soluble in the blood, allowing it to rapidly diffuse into gas-containing cavities, which can lead to increased distension, especially in the presence of a gas-filled bowel.

Nitrous oxide is 30x more soluble than nitrogen in the blood

Question 190

In the context of anesthesia, which type of surgeries might warrant the avoidance of nitrous oxide?
A. Short, superficial procedures.
B. Lengthy abdominal surgeries.
C. Neurological procedures.
D. Cardiac surgeries.

Answer 190

Correct Answer: B. Lengthy abdominal surgeries.

Rationale: Nitrous oxide should be avoided in lengthy abdominal surgeries or when the bowel is already distended to prevent further increase in bowel size, which can complicate the surgical procedure and postoperative recovery.

Question 191

What is the impact of neuromuscular blockers (NMBs) on GI motility?
A. They increase GI motility.
B. They have no impact on GI motility.
C. They cause a decrease in GI motility.
D. They result in complete cessation of GI motility.

Answer 191

Correct Answer: B. They have no impact on GI motility.

Rationale: NMBs affect only skeletal muscle and do not influence the smooth muscle of the gastrointestinal tract, therefore GI motility remains intact.

Question 192

Neostigmine affects the GI system by:
A. Decreasing PNS activity and slowing peristalsis.
B. Increasing PNS activity and enhancing peristalsis.
C. Inhibiting PNS activity and causing constipation.
D. Increasing PNS activity and decreasing the intensity of contractions.

Answer 192

Correct Answer: B. Increasing PNS activity and enhancing peristalsis.

Rationale: Neostigmine, an acetylcholinesterase inhibitor (AChE-I), increases parasympathetic nervous system activity, which in turn increases the frequency and intensity of bowel peristalsis.

Question 193

The bradycardia associated with neostigmine can be counteracted by the administration of:
A. Cholinergic medications.
B. Calcium channel blockers.
C. Anticholinergic medications.
D. Epinephrine.

Answer 193

Correct Answer: C. Anticholinergic medications.

Rationale: The cholinergic activity induced by neostigmine can lead to bradycardia, which is often counteracted by the concurrent administration of anticholinergic medications like glycopyrrolate or atropine.

Question 194

What is the effect of Sugammadex on gastrointestinal motility?
A. It increases motility.
B. It decreases motility.
C. It has no effect on motility.
D. It causes unpredictable changes in motility.

Answer 194

Correct Answer: C. It has no effect on motility.

Rationale: Sugammadex, an alternate agent used for the reversal of neuromuscular blockade, does not impact the smooth muscle

Question 195

What common GI side effect is associated with opioid use?
A. Increased GI motility.
B. Reduced GI motility and constipation.
C. Improved digestion.
D. Decreased abdominal pain.

Answer 195

Correct Answer: B. Reduced GI motility and constipation.

Rationale: Opioids are known to reduce gastrointestinal motility, often leading to constipation due to their action on mu-opioid receptors in the GI tract.

Question 196

Opioids affect GI motility through their action on which types of receptors?
A. Mu, delta, and kappa receptors.
B. Alpha and beta receptors.
C. Histamine receptors.
D. Serotonin receptors.

Answer 196

Correct Answer: A. Mu, delta, and kappa receptors.

Rationale: Opioids exert their effects on GI motility by acting on central and peripheral mu, delta, and kappa opioid receptors, which are abundant in the GI tract.

Question 197

Where are mu-opioid receptors densely located in the GI system?
A. In the gastric lining.
B. In the myenteric and submucosal plexuses.
C. On the epithelial surface of the stomach.
D. Lamina Propria

Answer 197

Correct Answer: B. In the myenteric and submucosal plexuses.

Rationale: The GI tract has a high density of peripheral mu-opioid receptors particularly in the myenteric and submucosal plexuses, which modulate GI motility.

Question 198

Which additional adverse effects may opioids have on the GI system?
A. Increased appetite and weight gain.
B. Faster gastric emptying and increased bowel movement frequency.
C. Nausea, anorexia, delayed digestion, and abdominal pain.
D. Increased bile production and gallstone dissolution.

Answer 198

Correct Answer: C. Nausea, anorexia, delayed digestion, and abdominal pain.

Rationale: Besides reduced motility and constipation, opioids can cause other adverse GI events including nausea, anorexia, delayed digestion, abdominal pain, straining during bowel movements, and incomplete evacuation.

Question 199

The layers of the GI tract wall from outermost to innermost include all of the following except:
A. Mucosa.
B. Serosa.
C. Epithelium.
D. Circular muscle.

Answer 199

Correct Answer: C. Epithelium.

Rationale: The epithelium is a component of the mucosa layer and is not a separate layer of the GI tract wall.

The layers of the GI tract wall are (outermost to innermost): serosa, longitudinal muscle, circular muscle, submucosa, and mucosa

Question 200

The autonomic nervous system (ANS) division primarily responsible for excitatory effects on GI motility is the:
A. Sympathetic nervous system (SNS).
B. Parasympathetic nervous system (PNS).
C. Enteric nervous system (ENS).
D. Central nervous system (CNS).

Answer 200

Correct Answer: B. Parasympathetic nervous system (PNS).

Rationale: The PNS, an element of the autonomic nervous system, is primarily excitatory on GI tract motility, promoting movement and function.

Question 201

Which nervous system is specialized for controlling motility, secretion, and blood flow in the GI tract?
A. Sympathetic nervous system (SNS).
B. Central nervous system (CNS).
C. Enteric nervous system (ENS).
D. Somatic nervous system (SoNS).

Answer 201

Correct Answer: C. Enteric nervous system (ENS).

Rationale: The enteric nervous system, often referred to as the “brain of the gut,” autonomously regulates GI motility, secretion, and blood flow.

Question 202

What are the two primary types of movements within the GI tract?
A. Mixing and propulsive.
B. Oscillating and vibrating.
C. Centrifugal and centripetal.
D. Retrograde and anterograde.

Answer 202

Correct Answer: A. Mixing and propulsive.

Question 203

Which surgical factors can lead to ileus?
A. Hemodynamic stability and minimal bowel handling.
B. Hemodynamic changes, bowel manipulation, and open abdominal surgeries.
C. Laparoscopic surgeries and quick procedures.
D. Elective surgeries and local anesthesia.

Answer 203

Correct Answer: B. Hemodynamic changes, bowel manipulation, and open abdominal surgeries.

Question 204

What is a major reason for reducing the use of opioids in GI surgery?
A. To increase recovery time.
B. To decrease the risk of postoperative nausea.
C. To prevent an adverse effect on the bowel.
D. To reduce the cost of surgery.

Answer 204

Correct Answer: C. To prevent an adverse effect on the bowel.