GI Pathology

Question 1

Which of the following decreases lower esophageal sphincter tone? 
A. Metoclopramide
B. Neostigmine
C. Dopamine
D. Succinylcholine
E. Ranitidine

Answer 1

C. Dopamine

Question 2

Which of the following do you NOT expect to see in patients with GERD?
A. Chest pain (heartburn)
B. Recurrent lower respiratory infections
C. Pulmonary fibrosis
D. Lower esophageal sphincter tone greater than 30mmHg

Answer 2

D. lower esophageal sphincter tone greater than 30 mmHg

Question 3

Your patient is on warfarin for chronic atrial fibrillation. Which of the following medication(s) do you need to be cautious with? (Select 2)
A. Cimetidine
B. Famotidine
C. Ranitidine	
D. Nizatidine

Answer 3

A. Cimetidine

C. Ranitidine

Question 4

Which of the following statements are accurate about Helicobacter pylori infection? (Select 2)
A. Decreases in gastric acid secretion in the early stage of the infection
B. Affects the function of Chief cells
C. Increases bicarbonate production from the duodenum
D. Affects the function of Gastric cells

Answer 4

A. Decreases in gastric acid secretion in the early stage of the infection
D. Affects the function of Gastric cells

Question 5

Which statement is accurate about reasons for a patient with Barrett’s esophagus to undergo upper GI endoscopy regularly for screening?
A. Barrett’s esophagus increases risks for gastric polyps
B. Barrett’s esophagus causes weakness in the posterior hypopharyngeal wall
C. Barrett’s esophagus causes no symptoms
D. Barrett’s esophagus is linked to adenocarcinomas

Answer 5

D. Barrett’s esophagus is linked to adenocarcinomas

Question 6

Which statement(s) is true about a patient undergoing esophagectomy for esophageal cancer? (Select all that apply)
A. Patients are at risk for postoperative airway obstruction due to recurrent laryngeal nerve palsy
B. Postoperative acute lung injury occurs seldom, yet it is associated with a high mortality
C. Patients are at high risk for aspiration pneumonitis during the immediate postoperative period
D. Patients are at risk for a leak from the surgical incision postoperatively
E. Lumber epidural should be considered for postoperative pain management

Answer 6

D. Patients are at risk for a leak from the surgical incision postoperatively

Question 7

Which statement accurately describes Zenker’s diverticulum?
A. Occurs in midesophageal area
B. Associated with halitosis
C. Sellick maneuver is a part of the standard of care for these patients
D. A nasogastric tube should be placed preoperatively in order to reduce the risk for aspiration during induction
E. Corkscrew esophagus in esophagram is known as a hallmark of this pathology

Answer 7

B. Associated with halitosis

Question 8

Which statement accurately describes dysphagia?
A. Difficulty with swallowing of liquids often accompanies a structural issue
B. Dysphagia secondary to Schatzki’s ring is indicative of adenocarcinoma
C. Diagnosis of dysphagia secondary to Achalasia can be made by esophagram
D. Trazodone is often a treatment of choice for dysphagia secondary to eosinophilic esophagitis

Answer 8

C. Diagnosis of dysphagia secondary to Achalasia can be made by esophagram

Question 9

Milk-alkali syndrome is associated with
A. Antibiotic treatment for Helicobacter pylori infection
B. A diet modification called FODMAP for irritable bowel syndrome
C. Chronic use of Tums for acid reflux
D. Lactose intolerance

Answer 9

C. Chronic use of Tums for acid reflux

Question 10

Which following statement(s) describes accurately about peptic ulcer disease? (Select 2)
A. Perforation may occur 1 in 100 cases when patients do not receive proper treatment
B. Most common cause of nonvariceal upper GI bleeding
C. Patients with PUD induced pyloric obstruction should receive sodium bicarbonate preoperatively
D. Misoprostol, one of the pharmacological treatment options for PUD, is contraindicated during pregnancy

Answer 10

B. Most common cause of nonvariceal upper GI bleeding

D. Misoprostol, one of the pharmacological treatment options for PUD, is contraindicated during pregnancy

Question 11

In some cases of PUD, vagotomy (surgical resection of vagal nerve) is required. Which of the following statements is accurate about vagotomy? (Select 3)
A. A truncal vagotomy is performed frequently to treat severe case of PUD
B. Selective proximal vagotomy is performed to denervate only the areas in which the parietal cells are located.
C. Truncal vagotomy is performed in combination with pyloroplasty.
D. Selective gastric vagotomy preserves innervation to the pylorus, liver, biliary duct, intestines, and celiac plexus

Answer 11

B. Selective proximal vagotomy is performed to denervate only the areas in which the parietal cells are located.
C. Truncal vagotomy is performed in combination with pyloroplasty.
D. Selective gastric vagotomy preserves innervation to the pylorus, liver, biliary duct, intestines, and celiac plexus

Question 12

Which of the following statement(s) describes Zollinger-Ellison syndrome (ZES) accurately? (Select 3)
A. The clinical presentation of ZES includes abdominal pain, increased gastric acid secretion, peptic ulcers, erosive esophagitis, diarrhea, and gastroesophageal reflux.
B. ZES should be suspected in patients with multiple or refractory peptic ulcers, ulcers distal to the duodenum, enlarged gastric folds, multiple endocrine neoplasm (MEN) Type 1, or diarrhea responsive to proton pump inhibitors.
C. ZES is caused by secretion of gastrin from gastrinomas in the stomach and liver.
D. Early and late dumping usually occur 10-30 mins and 1-3 hours respectively, following the meal.

Answer 12

A. The clinical presentation of ZES includes abdominal pain, increased gastric acid secretion, peptic ulcers, erosive esophagitis, diarrhea, and gastroesophageal reflux.
B. ZES should be suspected in patients with multiple or refractory peptic ulcers, ulcers distal to the duodenum, enlarged gastric folds, multiple endocrine neoplasm (MEN) Type 1, or diarrhea responsive to proton pump inhibitors.
D. Early and late dumping usually occur 10-30 mins and 1-3 hours respectively, following the meal.

Question 13

Which of the following statement(s) accurately describes dumping syndrome? (Select 2)
A. It is caused by rapid emptying of hyperosmolar chyme into the small intestine
B. Early dumping is due to release of excessive insulin release.
C. Late dumping is due to the effects of vasoactive GI hormones.
D. Early and late dumping usually occurs 10-30 mins and 1-3 hours respectively, following the meal.

Answer 13

A. It is caused by rapid emptying of hyperosmolar chyme into the small intestine
D. Early and late dumping usually occurs 10-30 mins and 1-3 hours respectively, following the meal.

Question 14

Crohn’s disease is an inflammatory bowel disease that affects \_\_\_\_\_\_\_\_\_\_\_.
    A. mucosa
    B. Circular muscle
    C. Longitudinal muscle
    D. All of the above

Answer 14

D. All of the above

Question 15

Which of the following statement is true about Crohn’s disease? (Select 3)
A. There are penetrating-fistulous pattern and obstructing pattern
B. The terminal ileum is the most common site of the inflammation.
C. Clinical presentations sometimes mimic acute appendicitis
D. Tenesmus is one of the hallmark symptoms of Crohn’s disease.

Answer 15

A. There are penetrating-fistulous pattern and obstructing pattern
B. The terminal ileum is the most common site of the inflammation.
C. Clinical presentations sometimes mimic acute appendicitis

Question 16

Which of the following is NOT true about ulcerative colitis (UC)?
A. Some patients with UC also manifest arthritis, uveitis, or kidney stones.
B. It affects the mucosal layers.
C. Colonoscopy should be avoided in hospitalized patients with severe UC.
D. In severe cases, patients may develop toxic megacolon.

Answer 16

A. Some patients with UC also manifest arthritis, uveitis, or kidney stones.

Question 17

Which of the following medications should be avoided in patients with carcinoid tumor?
A. Desflurane
B. Fentanyl
C. Succinylcholine
D. Propofol

Answer 17

C. Succinylcholine

Question 18

Which of the following statement(s) is true when caring for a patient undergoing carcinoid tumor resection? (Select 3)
A. Need invasive hemodynamic monitoring intraoperatively.
B. Avoid serotonin antagonist
C. Prepare to admit a patient to an ICU for postoperative monitoring.
D. Consider administrating octreotide preoperatively and prior to manipulation of the tumor.

Answer 18

A. Need invasive hemodynamic monitoring intraoperatively.
C. Prepare to admit a patient to an ICU for postoperative monitoring.
D. Consider administrating octreotide preoperatively and prior to manipulation of the tumor.

Question 19

Which of the following statement(s) is accurate about GI bleed? (Select 2)
A. Bleeding from the descending colon represents 80% of all GI bleed.
B. Melena indicates the source of bleed is above the cecum.
C. A transjugular intrahepatic portosystemic shunt (TIPS) may be performed for nonvariceal bleeding.
D. Sigmoidoscopy should be performed as soon as possible to rule out anorectal lesions.

Answer 19

B. Melena indicates the source of bleed is above the cecum.

D. Sigmoidoscopy should be performed as soon as possible to rule out anorectal lesions.

Question 20

Which of the following statement(s) is accurate about adynamic ileus? (Select all that apply)
A. Absence of a mechanical obstruction
B. Absence of effective peristalsis
C. The cecal diameter greater than 12 cm suggests a high risk for perforation
D. Suggests impaired sympathetic input

Answer 20

A. Absence of a mechanical obstruction
B. Absence of effective peristalsis
C. The cecal diameter greater than 12 cm suggests a high risk for perforation