Esophagus and gastric diseases

Question 1

The “Alarm” signs of gastroesophageal reflux disease, except:
A) dysphagia
B) nausea
C) weight loss
D) anemia

Answer 1

B) nausea

Question 2

Oesophageal motility disorder in gastroesophageal reflux disease may be characterized as, except:
A) decreased basal tone of the lower oesophageal sphincter
B) transient relaxation of the lower oesophageal sphincter
C) increased clearance of the oesophagus
D) damage to the primary peristalsis function of the oesophagus
E) regular upper oesophageal sphincter relaxation

Answer 2

C) increased clearance of the oesophagus

Question 3

May decrease oesophageal sphincter tone, except:
A) atropine
B) domperidone
C) glucagon
D) cholecystokinin
E) nifedipine

Answer 3

B) domperidone

Question 4

There is no correlation between gastritis Helicobacter pylori gastritis and:
A) adenocarcinoma of the stomach
B) elevated gastrin levels
C) neutrophilic infiltration
D) perniciosis of anemia

Answer 4

D) perniciosis of anemia

Question 5

The main proteolytic enzyme from gastric enzymes is:
A) gastric lipase
B) motilin
C) secretin
D) pepsin

Answer 5

D) pepsin

Question 6

When are the most of gastric fluids produced from the daily 1,5 L?
A) between meals
B) in the cephalic phase
C) in the gastric phase
D) in the intestinal phase

Answer 6

C) in the gastric phase

Question 7

They increase the risk of developing gastric cancer, except:
A) anemia perniciosa
B) adenomatous polyp in the stomach
C) previous gastric surgery for ulcer
D) blood type B

Answer 7

D) blood type B

Question 8

Determines the prognosis of gastric cancer, except:
A) stage of tumor growth
B) localization of the tumor
C) presence of stromafibrosis in the tumor tissue
D) degree of tumor differentiation

Answer 8

C) presence of stromafibrosis in the tumor tissue

Question 9

True for gastric lymphoma, except:
A) most of them are diffuse histiocytic lymphoma
B) lymphoma in the stomach is less frequent than in the colon
C) stage is the most important prognostic factor
D) may be associated with chronic gastritis, intestinal metaplasia

Answer 9

B) lymphoma in the stomach is less frequent than in the colon

Question 10

The following statements are true for gastric carcinoid tumors, except:
A) The stomach is the most common site for carcinoid tumors.
B) Carcinoid tumors of the stomach are randomly detected.
C) Gastric carcinoid tumors produce 5HT (serotonin).
D) Carcinoid tumor develops more frequent in the stomach in case of atrophic gastritis or in association with pernicious anemia.

Answer 10

A) The stomach is the most common site for carcinoid tumors.

Question 11

Which condition is not typical for the clinical appearance of Zollinger-Ellison syndrome?
A) Over 60% of patients experience heartburn.
B) Diarrhoea does not occur in the syndrome.
C) Hyperparathyroidism and hypercalcaemia may be associated with increased acid secretion in multiple endocrine neoplasia.
D) Ulcers appear at unusual location in the syndrome.

Answer 11

B) Diarrhoea does not occur in the syndrome.

Question 12

Medications for gastroesophageal reflux disease, except:
A) proton pump inhibitors
B) prokinetic agents in monotherapy
C) proton pump inhibitors in combination with prokinetic agents
D) H2 receptor antagonists

Answer 12

B) prokinetic agents in monotherapy

Question 13

A 53-year-old man was hospitalized with the following symptoms: epigastric pain, lower extremity oedema, diarrhea. Laboratory findings confirmed iron deficiency anaemia. The gastroscopy shows giant folds in the stomach. The trial breakfast shows reduced acid secretion. Biopsy taken from the deeper layer of the mucosa also shows no malignancy. Which disease is it?
A) Ménétrier disease
B) Stomach lymphoma
C) Zollinger-Ellison syndrome
D) Scleroderma

Answer 13

A) Ménétrier disease

Question 14

Which is the most common anemia after total gastrectomy?
A) iron deficiency
B) vitamin B12 deficiency
C) folate deficiency
D) hemolytic

Answer 14

B) vitamin B12 deficiency

Question 15

All but one of the factors listed increase pepsinogen secretion:
A) somatostatin
B) gastrin
C) histamine
D) vagal stimulation

Answer 15

A) somatostatin

Question 16

The key enzyme of hydrochloric acid secretion in the apical part of the capillary cells:
A) Na + -K + -ATPase
B) H + -K + -ATPase
C) tyrosine kinase
D) carbonic anhydrase

Answer 16

B) H + -K + -ATPase

Question 17

The most common type of polyp in the stomach:
A) hyperplasiogen
B) adenomatosus
C) juvenile
D) carcinoid

Answer 17

A) hyperplasiogen

Question 18

Peptic ulcer diseases, except:
A) NSAID ulcer
B) KCI ulcer
C) Helicobacter-positive ulcer
D) Zollinger-Ellison syndrome

Answer 18

B) KCI ulcer

Question 19

Factors that are known to play a role in the pathogenesis of classical peptic ulcer disease, except:
A) stress
B) smoking
C) Helicobacter pylori
D) viral infection

Answer 19

D) viral infection

Question 20

Typical site for Helicobacter pylori colonization:
A) antrum
B) antrum-corpus border
C) fundus
D) duodenum

Answer 20

A) antrum

Question 21

Characteristics of NSAID ulcers, except:
A) mild dyspepsic complaints
B) relatively poor symptoms
C) typical hunger pain
D) tendency to bleed, perforate

Answer 21

C) typical hunger pain

Question 22

The most common localization of NSAID ulcers is:
A) esophagus
B) stomach
C) duodenum
D) jejunum

Answer 22

B) stomach

Question 23

Mechanisms involved in the formation of NSAID ulcers, except:
A) inhibition of the synthesis of protective prostaglandins
B) an increase in the blood supply to the gastric mucosa
C) activation of the lipoxygenase pathway
D) an increase in hydrochloric acid secretion

Answer 23

B) an increase in the blood supply to the gastric mucosa

Question 24

The most common localization of gastrinoma is:
A) pancreas
B) duodenum
C) jejunum
D) appendix

Answer 24

A) pancreas

Question 25

The most specific diagnostics in Zollinger-Ellison syndrome is:
A) determination of hydrochloric acid secretion
B) X-ray of the stomach
C) secretin-provocation test with serum-gastrin assay
D) endoscopy

Answer 25

C) secretin-provocation test with serum-gastrin assay

Question 26

Methods used nowadays to treat Zollinger-Ellison ulcer, except:
A) total gastrectomy
B) H2 receptor blocking agents
C) proton pump inhibitors (PPIs)
D) removal of the gastrinoma

Answer 26

A) total gastrectomy

Question 27

In gastroesophageal reflux disease, the endoscopic view of the esophagus may be:
1) diffuse mucosal hyperaemia
2) mucosal ulcers in the lower third of the esophagus
3) isolated linear erosion over cardia
4) intact esophageal epithelium

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 27

E) all of the answers are correct

Question 28

Used for the diagnosis of gastroesophageal reflux disease:
1) proton pump inhibitor test
2) esophageal impedance test
3) 24-hour oesophageal pH monitoring
4) pentagastric test

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 28

A) only answers 1, 2 and 3 are correct

Question 29

It may not favorably affect the symptoms of diffuse oesophageal spasm:
1) diltiazem
2) glyceryl trinitrate
3) nifedipine
4) ranitidine

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 29

D) only answer 4 is correct

Question 30

Increases the incidence of oesophageal epithelial cell carcinomas:
1) Barrett’s metaplasia
2) achalasia cardiae
3) nutcracker esophagus
4) smoking

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 30

C) only answers 2 and 4 are correct

Question 31

Important in staging esophageal carcinomas:
1) chest CT scan
2) oesophageal endosonography
3) endoscopy by histological examination
4) barium swallow test

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 31

A) only answers 1, 2 and 3 are correct

Question 32

Gastrointestinal side effects of NSAIDs include:
1) Non-steroidal anti-inflammatory drugs (NSAIDs) cause gastric mucosal damage by inhibition of protective prostaglandins.
2) Mortality due to gastrointestinal complications is 3-4 times higher in chronic NSAID users.
3) NSAIDs can cause erosions and ulcers.
4) NSAID ulcers always cause intense pain.

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 32

A) only answers 1, 2 and 3 are correct

Question 33

Characteristics of the duodenal ulcer:
1) hunger pain
2) is more common than gastric ulcer with NSAIDs treatment
3) can cause pylorusstenosis
4) never penetrates the surrounding organs

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 33

B) only answers 1 and 3 are correct

Question 34

The effects of proton pump inhibitors are true:
1) Proton pump inhibitors act on the H + / K + -ATPase pump.
2) PPIs significantly increase serum gastrin levels.
3) They are among the basic drugs for Helicobacter pylori eradication schemes.
4) It should not be administered with NSAIDs due to drug interactions.

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 34

A) only answers 1, 2 and 3 are correct

Question 35

In the treatment of peptic ulcer disease:
1) All H2 blocker is effective in treating peptic ulcer.
2) H2 blockers are usually given 3 times a day before main meals.
3) PPIs reduce ulcer pain faster than H2 blockers.
4) PPIs and H2 blockers are usually cured within 2-4 weeks.

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 35

B) only answers 1 and 3 are correct

Question 36

Think of malignant stomach cancer:
1) if patient has a history of epigastric pain and significant weight loss.
2) if the patient has meat aversion.
3) if epigastric resistance is palpable.
4) if the patient is anacid and the Virchow gland is palpable.

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 36

E) all of the answers are correct

Question 37

In case of suspected recurrent gastric ulcer:
1) it is sufficient to perform an x-ray of the stomach.
2) gastroscopic examination is preformed to confirm Helicobacter pylori infection.
3) anti-ulcer therapy can be started without examination.
4) because of the tendency of ventricular ulcer to malignancy, gastroscopic examination should be performed for histological sampling.

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 37

C) only answers 2 and 4 are correct

Question 38

The following diseases and conditions may be associated with gastroparesis:
1) multiple sclerosis
2) diabetes mellitus
3) hypokalaemia
4) Parkinson’s disease

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 38

E) all of the answers are correct

Question 39

Most important things to do in case of upper gastrointestinal bleeding:
1) stabilizing the circulation with fluid and, if necessary, blood supplementation
2) gastric tube insertion, gastric lavage
3) gastroscopy to localize the source of bleeding, if possible
4) immediate administration of PPI or H2 blocker orally to reduce acid secretion

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 39

A) only answers 1, 2 and 3 are correct

Question 40

If gastric ulcer perforation is suspected:
1) gastroscopic examination should be performed immediately
2) physical examination shows the absence of liver dullness
3) barium gastric x-ray should be performed immediately
4) native abdominal imaging should be performed immediately

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 40

C) only answers 2 and 4 are correct

Question 41

In case of haematemesis oesophageal varices should be considered in the following diseases:
1) cirrhosis hepatis
2) v. portae thrombosis
3) an advanced stage of Budd-Chiari syndrome
4) oesophageal cancer

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 41

A) only answers 1, 2 and 3 are correct

Question 42

The disturbance of gastric emptying may be caused by:
1) pylorusstenosis caused by duodenal ulcer
2) antrumtumor spreading to pylorus
3) large pancreaspseudocyst
4) liver cirrhosis

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 42

A) only answers 1, 2 and 3 are correct

Question 43

The following substances enhance gastric secretion:
1) gastrin
2) caffeine
3) histamine
4) somatostatin

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 43

A) only answers 1, 2 and 3 are correct

Question 44

It is true that:
1) CEA and AFP play a prominent role in the early diagnosis of gastric cancer.
2) Ectopic gastric mucosa can occur in almost any area of the gastrointestinal tract without clinical significance.
3) Gastric cancer has characteristic early symptoms.
4) Gastric cancer may be classified into two main groups according to its histological division: intestinal and diffuse gastric cancer.

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 44

D) only answer 4 is correct

Question 45

Which of the following is the most likely diagnosis?
A 48-year-old non-smoking, abstinent woman turns to you for having increased swallowing difficulties for half a year, weight loss, unpleasant mouth odor and frequent regurgitation of undigested food.
A) corrosive stricture
B) bulbar palsy
C) gastroesophageal reflux disease
D) achalasia cardiae
E) nutcracker esophagus

Answer 45

D) achalasia cardiae

Question 46

What did your barium swallow test result show based on the above diagnosis?
A 48-year-old non-smoking, abstinent woman turns to you for having increased swallowing difficulties for half a year, weight loss, unpleasant mouth odor and frequent regurgitation of undigested food.
1) dilated esophagus
2) spastic esophageal contractions
3) cardia for drinking cold, cold water
4) uneven constriction over cardia

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 46

B) only answers 1 and 3 are correct

Question 47

What further examinations may confirm the above diagnosis?
A 48-year-old non-smoking, abstinent woman turns to you for having increased swallowing difficulties for half a year, weight loss, unpleasant mouth odor and frequent regurgitation of undigested food.
1) endoscopy
2) standard acid reflux test
3) esophageal manometry
4) 24-hour oesophageal pH monitoring

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 47

B) only answers 1 and 3 are correct

Question 48

Possible means of treatment, except:
A 48-year-old non-smoking, abstinent woman turns to you for having increased swallowing difficulties for half a year, weight loss, unpleasant mouth odor and frequent regurgitation of undigested food.
A) diltiazem
B) pneumatic dilatation
C) metoprolol
D) nitroglycerin
E) cardiomyotomy

Answer 48

C) metoprolol