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General Surgery > Esophagus and Stomach > Flashcards

Esophagus and Stomach Flashcards

1
Q

Thoracic esophagus starts __ from the incisors.

A

20 cm

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2
Q

The abdominal esophagus starts ___ from the incisors.

A

40 cm

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3
Q

The cricopharyngeal constrictor is:

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

A

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

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4
Q

The cervical esophagus is:

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

A

(1) courses to the left of the trachea.

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5
Q

The diaphragmatic esophageal hiatus arises from the:

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

A

(3) either.

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6
Q

Bronchoaortic constriction occurs at:

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

A

(2) the level of the fourth thoracic vertebrae.

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7
Q

The Meissner plexu is located in the

A

The Meissner plexus is located in the SUBMUCOSA.

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8
Q

The Auerbach plexus is located

A

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

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9
Q

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

A

True

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10
Q

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

(1) UES
(2) LES

A

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

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11
Q

Primary peristalsis is:

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

A

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

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12
Q

Secondary peristalsis is:

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

A

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

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13
Q

The esophageal resting pressure is

A

3 - 5 cm in length.

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14
Q

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

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

A

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

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15
Q

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

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

A

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

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16
Q

Esophageal dilation is treatment for:

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

A

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

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17
Q

Achalasia presents with a classic triad of symptoms:

A

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

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18
Q

Esophageal motility achalasia presents on imaging as:

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

A

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

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19
Q

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

A

(1) associated carcinoma or pseudo-achlasia

(2) distal esophageal stricture from reflux esophagitis.

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20
Q

Complications of achalasia:

(1) regurgitation
(2) no chance of aspiration

A

Complications of achalasia include (1) regurgitation.

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21
Q

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

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

A

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

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22
Q

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

A

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

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23
Q

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

A

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

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24
Q

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

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

A

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

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25
Q

Zenker’s diverticula occurs at the:

(1) At the junction of the pharynx and esophagus.
(2) near the tracheal bifurcation
(3) from the distal 10 cm of the esophagus.

A

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

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26
Q

The esophageal diverticula that arise from the distal 10 cm of the esophagus are:

(1) Zenkers
(2) para bronchial
(3) epiphrenic (supradiaphragmatic)

A

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

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27
Q

A true diverticulum:

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

A

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

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28
Q

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

A

True.

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29
Q

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

A

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

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30
Q

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

A

epiphrenic diverticulum

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31
Q

Caustic injury of the esophagus is diagnosed and treated via:

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

A

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

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32
Q

A patient presents with a caustic injury around 3 weeks ago. The patient complains of a tightness in the throat with dysphagia. Initial diagnosis includes:

(1) Dilatation of the esophagus.
(2) contrast studies at intervals of 3 weeks.

A

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

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33
Q

Esophageal surgery is indicated for:

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

A

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

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34
Q

A patient experienced a caustic injury to the esophagus approximately 4 days ago. A biopsy shows that there is tissue sloughing and granulation of the ulcer bed. The duration of the patient’s tissue injury is MOST likely:

(1) 1 - 4 days
(2) 3 - 12 days
(3) 1 - 6 months

A

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

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35
Q

Acute necrosis of the esophageal tissue begins at:

(1) 1 - 4 days
(2) 3 - 5 days
(3) 3 weeks

A

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

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36
Q

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

A

True.

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37
Q

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

A

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

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38
Q

A patient underwent an endoscopic procedure and the esophagus became perforated. You take a CXR of the patient. It is MOST likely to present with:

(1) Sharpness of the costophrenic angle.
(2) Dullness of the costophrenic angle

A

(2) Dullness of the costophrenic angle.

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39
Q

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

A

Esophagogram

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40
Q

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

A

True.

41
Q

Which of the following regarding benign esophageal tumors is TRUE?

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

A

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

42
Q

Which of the following regarding esophageal carcinoma is TRUE?

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

A

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

43
Q

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

A

Barrett’s metaplasia.

44
Q

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

A

esophagoscopy and biopsy.

45
Q

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

A

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

46
Q

You do a workup for a patient with GERD. You take a pH measurement. Before you do the pH measurement, you should take note that:

(1) Acid suppression ends immediately after PPI therapy has ended.
(2) Patient should be off PPI therapy for 1 week.

A

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

47
Q

Surgery is considered in GERD patients that

A

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

48
Q

Which of the following regarding Barrett’s esophagus is TRUE?

(1) It is not associated with prolonged GERD.
(2) Metaplastic columnar epithelium replaces the distal squamous mucosa.
(3) SCC is the most common type of esophageal carcinoma.

A

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

49
Q

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

A

True.

50
Q

Fundoplication is indicated for:

A

surgical treatment of GERD.

51
Q

Rugae of the stomach are present when the stomach is:

A

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

52
Q

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

A

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

53
Q

The mucosa of the stomach consists of:

(1) surface epithelium
(2) Lamina propria
(3) muscularis mucosae
(4) All of these

A

(4) All of these

54
Q

Receptive relaxation refers to:

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

A

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

55
Q

Gastrin release is inhibited by:

A

luminal acid.

56
Q

The cells that secrete BOTH gastric acid and intrinsic factor:

A

Parietal cells

57
Q

Somatostatin functions to

A

Inhibit gastrin release

58
Q

Somatostatin is inhibited by

A

Acetylcholine from vagal fibers.

59
Q

D cells produce:

(1) gastric acid
(2) bicarbonate
(3) somatostatin
(4) gastrin

A

(3) somatostatin

60
Q

T/F: Histamine inhibits acid secretion.

A

False.

61
Q

Chief cells are responsible for

A

Breaking down proteins (pepsinogen) and secreting gastric lipase.

62
Q

The cells that activate pepsin are:

(1) Chief cells
(2) G cells
(3) Parietal cells

A

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

63
Q

Which of the following is a local stimulus of gastric acid secretion?

(1) Acetylcholine
(2) Gastrin
(3) Histamine
(4) All of these

A

(4) All of these

64
Q

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

A

True.

65
Q

You start to salivate when smelling pizza. This phase of acid secretion is:

(1) cephalic phase
(2) gastric phase
(3) intestinal phase

A

(1) cephalic phase.

66
Q

The cephalic phase is stimulated by the:

A

Vagus nerve (acetylcholine and muscarinic receptors).

67
Q

NSAIDs inhibit

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

A

NSAIDs inhibit (3) prostaglandin production.

68
Q

Approximately 60% of ulcers are located at:

(1) Lesser curvature of the stomach.
(2) in the body of the stomach in combination with a duodenal ulcer.
(3) pre-pyloric area
(4) on the lesser curvature near the GE junction.

A

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

69
Q

The type of ulcers that can occur anywhere and are NSAID induced:

(1) Type 3
(2) Type 4
(3) Type 5

A

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

70
Q

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

A

True.

71
Q

Which of the following regarding stomach ulcers (caused by H. pylori) is TRUE?

(1) Very few ulcers are associated with H. pylori infection.
(2) In patients with H. pylori infection, basal and stimulated gastrin levels are increased.
(3) Once a person is infected, the organism dies out quickly.

A

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

72
Q

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

A

True.

73
Q

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

A

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

74
Q

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

A

duodenal perforation, bleeding, obstruction and metabolic alkalosis.

75
Q

A patient with duodenal ulcers may present with:

(1) hyperkalemic acidosis
(2) hyperchloremic acidosis
(3) hypochloremic, hypokalemic acidosis.

A

(3) hypocloremic, hypokalemic acidosis.

76
Q

The BEST treatment for duodenal ulcers is:

(1) PPIs
(2) H2 antagonsits

A

(1) PPIs.

77
Q

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

A

True.

78
Q

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

A

Peptic ulcer disease

79
Q

A patient presents with a bleeding peptic ulcer. This condition is:

(1) Approximately 80% of upper GI bleeds are not self-limited.
(2) Mortality increases with age
(3) Endoscopy does not show visible vessels or bleeding.

A

(2) Mortality increases with age.

80
Q

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

A

Higher mortality and high incidence of rebleeding.

81
Q

Late dumping occurs due to a

A

Rapid absorption of glucose.

82
Q

Afferent limb syndrome occurs when

A

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

83
Q

The most common metabolic defect appearing following gastrectomy is

A

Anemia (megaloblastic)

84
Q

Post vagotomy syndrome is characterized by:

(1) post-vagotomy diarrhea
(2) post-vagotomy gastric atony
(3) incomplete vagal transection.
(4) all of these

A

(4) All of these

85
Q

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

A

Deeper than other causes of gastric lesions.

86
Q

Which of the following regarding stress gastritis is TRUE?

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

A

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

87
Q

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

A

True.

88
Q

A patient with gastric neoplasia is MOST likely to present with:

(1) specific symptoms early in the course of disease.
(2) Early vague epigastric discomfort mistaken for gastritis.
(3) Occasional radiating pain relieved by foot ingestion.
(4) Clinically significant GI bleeding is common.

A

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

89
Q

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

A

Gastric neoplasia

90
Q

The diagnostic modality of choice for gastric neoplasia is:

A

Flexible upper endoscopy.

91
Q

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

A

98%.

92
Q

Which of the following regarding gastric neoplasia is TRUE?

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

A

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

93
Q

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

A

of 40 - 80% (high recurrence rates).

94
Q

The typical patient and presentation of gastric lymphoma:

A

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

95
Q

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

A

True

96
Q

The most common gastric lymphoma is:

A

diffuse large B-cell lymphoma.

97
Q

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

A

True.

98
Q

Radiation therapy for treatment of gastric lymphoma

A

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

General Surgery (12 decks)

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