Block 6 - Stomach, Small Intestines, Colon, Rectum, and Anus

Question 1

The most accurate evaluation procedure in the study of colon and rectum.

Answer 1

A. Endoscopy

Question 2

Characterized by polyps carpeting the entire colon

Answer 2

A. Juvenile polyposis coli

Question 3

Elderly and malnourished patients are susceptible to this condition

Answer 3

Pseudomembranous colitis

Question 4

This condition commonly occurs in elderly individuals

Answer 4

A. Ischemic colitis

Question 5

Characterized by bright red, painless rectal bleeding

Answer 5

A. Internal hemorrhoids

Question 6

Located above the dentate line

Answer 6

A. Internal hemorrhoids

Question 7

The rule which guides the location of the internal sphincter in Fistula-in-ano is

Answer 7

A. Goodsall’s rule

Question 8

The most common location of colorectal cancer is

Answer 8

A. Recto-sigmoid

Question 9

Which of the ff. is characterized by an outpouching of the entire wall of the colonic wall?

Answer 9

A. True diverticulum

Question 10

The ff. is/are cause of lower GI bleeding

Answer 10

A. Diverticulosis

Question 11

Which of the ff. is a precancerous lesion?

Answer 11

A. Adenomatous polyp

Question 12

Inverted U or bent inner tube sign on abdominal X-ray of a patient with abdominal pain and distension is a characteristic of

Answer 12

A. Volvulus

Question 13

The findings of plaques on proctoscopy in a patient with watery diarrhea is a characteristic of

Answer 13

A. Pseudomembranous colitis

Question 14

Characterized by remission and exacerbation of symptoms

Answer 14

A. Ulcerative colitis

Question 15

Which portion of the rectum drains into the portal system?

Answer 15

A. Superior rectum

Question 16

Surgery may be indicated in the ff.

Answer 16

A. Complicated diverticulitis
B. Recurrent attacks of diverticulitis

Question 17

Massive lower GI bleed is commonly caused by the ff. except

Answer 17

A. Angiodysplasia
B. Diverticular disease
C. Colon cancer
D. None of the above- answer

Question 18

A 60 year old male was diagnosed A 60 year old male was diagnosed to have fungating middle 3rd rectal lesion. Biopsy showed poorly differentiated adenocarcinoma. Which subsequent procedure is/are options?

Answer 18

A. Do cancer staging

Question 19

The most accurate diagnostic procedure for the diagnosis of colorectal diseases is

Answer 19

A. Endoscopy

Question 20

The etiologic agent of Pseudomembranous colitis is

Answer 20

A. Clostridium difficile

Question 21

Follows after exposure of 5000 rads or more

Answer 21

A. Radiation enterocolitis

Question 22

True regarding rectal cancer except:

Answer 22

A. Transverse colon is the most commonly affected

Question 23

The ff. is/are true regarding Amebic colitis:

Answer 23

A. Can complicate into hepatic abscess
B. Treated with Metronidazole

Question 24

Occurs below the dentate line

Answer 24

A. External hemorrhoids

Question 25

Presents with pain in the anal area:

Answer 25

A. External hemorrhoids C. Perianal abscess

Question 26

Has external and internal opening

Answer 26

A. Fistula-in-ano

Question 27

The prolapsing mucosa is concentric

Answer 27

A. Rectal prolapse

Question 28

Often times diagnosed as acute appendicitis

Answer 28

A. Meckel’s diverticulitis

Question 29

“Collar bone ulcers”

Answer 29

A. Ulcerative colitis

Question 30

Most common caustic agent ingested

Answer 30

A. Alkali

Question 31

Cause/s of GERD

Answer 31

A. Incompetent esophageal sphincter

Question 32

Best diagnostic tool in esophageal diseases

Answer 32

A. Endoscopy

Question 33

Best initial approach to manage swallowing of caustic substance

Answer 33

A. Neutralize the acid or alkali

Question 34

Transformation of epithelial lining in the lower esophagus

Answer 34

A. Barrett's esophagus

Question 35

Risks factors for esophageal cancer:

Answer 35

A. Alcohol B. Smoking C. Papilloma virus

Question 36

Substernal pain and crepitus in the neck area after upper GI endoscopy suggests

Answer 36

A. Esophageal perforation

Question 37

Full thickness caustic injury to the gastroesophageal wall follows

Answer 37

A. Alkali ingestion

Question 38

Characterized by external and internal opening

Answer 38

A. Fistula-in-ano

Question 39

Timing of endoscopy after caustic ingestion is

Answer 39

A. 12-48 hours

Question 40

Smell of food stimulates gastric acid production by secreting

Answer 40

A. Acetylcholine

Question 41

The gastro-esophageal junction is supplied by what artery?

Answer 41

A. Left gastric

Question 42

The Criminal Nerve of Grassi is a branch of

Answer 42

A. Posterior vagus

Question 43

Helicobacter pylori contributes to the development of peptic ulcers by inhibiting?

Answer 43

A. D cells

Question 44

76 year old/M, slightly pale, complained of epigastric pain, your primary clinical impression is?

Answer 44

A. Peptic ulcer disease

Question 45

Patient admitted because of diffuse board like abdomen, to help confirm impression you request?

Answer 45

Chest Xray upright

Question 46

Which part of ulcer surgery will address gastrin stimulus?

Answer 46

A. Antrectomy

Question 47

Patient is diagnosed to have gastric carcinoma with an intraoperative findings of a 3 cm mass at the antrum, no lymph nodes noted, surgical procedure should be?

Answer 47

A. Radical subtotal gastrectomy

Question 48

Which bleeding artery of the stomach would require surgery once seen by endoscopy?

Answer 48

A. Mucosal artery

Question 49

Patient is diagnosed to have Patient is diagnosed to have massive upper GI bleed, endoscopy showed a bleeding mucosal vessel at the proximal body, your diagnosis is?

Answer 49

A. Dieulafoy’s lesion

Question 50

Which ulcer surgery will preserve the GI function?

Answer 50

Proximal gastric vagotomy

Question 51

Patient was diagnosed to have gastric adenocarcinoma, with a 5 cm epigastric mass, and left supraclavicular lymph node. No other signs of organ metastasis. Stage is?

Answer 51

A. III

Question 52

Patient presented with gastric outlet obstruction, with a resectable gastric adenocarcinoma with liver metastasis, you recommend?

Answer 52

A. Gastric bypass

Question 53

10 years after Billroth II surgery for PUD, patient had melena and weight loss, your diagnosis is?

Answer 53

A. Recurrent peptic ulcer disease

Question 54

The longest portion of the duodenum is?

Answer 54

A. Descending

Question 55

H. pylori infection increases acid secretion in the stomach through the?

Answer 55

A. Inhibitory effect on antral D cells

Question 56

The largest part of the stomach is the?

Answer 56

A. Body

Question 57

Highly selective vagotomy means cutting the?

Answer 57

Anterior vagus nerve

Question 58

Which epithelial cell at the mucosal crypts is responsible for the secretion of growth factors?

Answer 58

A. Paneth cells

Question 59

A 30 year old male who had a history of ruptured appendicitis 10 years ago was admitted because of vomiting and absence of bowel movement for three days. PE: tachycardic, distended abdomen with slight tenderness at the epigastric area. What diagnostic procedure will help you in your diagnosis?

Answer 59

Scout film of the abdomen

Question 60

How would you manage the above mentioned case?

Answer 60

Start total parenteral nutrition

Question 61

A 28 year old female complaining of recurrent abdominal pain and diarrhea. Upper GI endoscopy revealed a superficial ulcer with surrounding erythema at the antrum. You recommend?

Answer 61

A. H. pylori regimen

Question 62

After exploratory laparotomy for a trauma, a greenish, foul-smelling discharge amounting to 300 ml per day and a CT scan finding of complex mass at the right lower quadrant. The recommended management would be?

Answer 62

A. Surgical exploration

Question 63

70 year old female was admitted because of a 15 day history of moderate to high grade fever and sudden severe abdominal pain. Your primary clinical impression is?

Answer 63

A. Perforated typhoid ileitis

Question 64

A 65 year old male uncontrolled diabetic was admitted because of a right lower quadrant mass, he had a previous history of an epigastric pain radiating to the right lower quadrant. On physical examination, he was febrile with episodes of hypotension and direct and rebound tenderness on the right lower quadrant. Your recommendation would be?

Answer 64

A. Surgical drainage

Question 65

A 25 year old male undergoing exploratory laparotomy for trauma had an incidental finding of a non-obstructing 4x4 mass at the jejunum, you will?

Answer 65

A. Leave the mass and do close monitoring and follow up

Question 66

The most common benign symptomatic tumor of the small intestine is?

Answer 66

A. Leiomyoma

Question 67

A 26 year old G1P1 on her first trimester of pregnancy was admitted because of a right lower quadrant pain. PE showed vital signs stable, low grade fever, and direct tenderness at the right lower quadrant. You recommend?

Answer 67

A. Appendectomy (Laparoscopic)

Question 68

A 35 year old male was scheduled for emergency exploratory laparotomy for massive lower GI bleeding. Intraoperatively an diverticulum was noted 2 feet proximal to the ileocecal valve, you proceed with?

Answer 68

A. Segmental ileal resection

Question 69

Meissner’s plexus is located in the

Answer 69

A. Submucosa

Question 70

30 year old male with history of surgical exploration presented with abdominal distention, vomiting, and absence of flatus for three days. On PE, he is afebrile, tachycardic, and normotensive. Abdominal exam revealed distended abdomen and a bulging mass at the previous incision site. You recommend?

Answer 70

Conservative treatment

Question 71

On the seventh post-operative day, a clear yellow non-foul smelling discharge was noted on the incision site. Your initial impression is?

Answer 71

A. Seroma

Question 72

Patients diagnosed with enterocutaneous fistula should undergo nutritional support by giving

Answer 72

A. High protein oral supplements B. High caloric milk formulas by NGT C. Elemental diet D. Total parenteral nutrition

Question 73

Patient is diagnosed to have post-operative adhesions and was treated conservatively upon admission. On the second hospital day, NGT drainage was 1.5 L greenish, non-tender abdomen with no passage of flatus. Repeat abdominal film showed no air-fluid levels, thickened inter-serosal folds, and string of pearl gas pattern. Your management is?

Answer 73

A. Start oral liquids

Question 74

During surgery, you noted an 8 cm submucosal mass at the ileum. You proceed with?

Answer 74

A. Frozen section biopsy