Internal medicine - Esophagus and gastric diseases Flashcards
INT - 5.1
The “Alarm” signs of gastroesophageal reflux disease, except:
A) dysphagia
B) nausea
C) weight loss
D) anemia
ANSWER
B) nausea
EXPLANATION
In case of “Alarm” signs, the possibility of an oesophagus-narrowing malignancy should always be considered. These include dysphagia, weight loss and anemia. The exception is nausea.
INT - 5.2
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
C) increased clearance of the oesophagus
EXPLANATION
In gastroesophageal reflux disease (GORB) is characterized by oesophageal motility disorders: decreased basal tone of the lower oesophageal sphincter, prolonged relaxation, increased incidence of transient (without swallowing occuring) relaxation, and damage to the primary peristalsis of the esophagus. Taken considered all characteristics above they result in a worsening (decrease) in esophageal clearance. The upper oesophageal sphincter and pharynx region are not affected by the motility disorder.
INT - 5.3
May decrease oesophageal sphincter tone, except:
A) atropine
B) domperidone
C) glucagon
D) cholecystokinin
E) nifedipine
ANSWER
B) domperidone
EXPLANATION
Lower oesophageal sphincter tone is decreased by the other substances listed, with the exception of domperidone.
INT - 5.4
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
D) perniciosis of anemia
EXPLANATION
Helicobacter pylori infection leads to chronic gastritis with neutrophilic granulocyte infiltration in the mucosa upon histological examination predominantly lymphocytic and plasma cell infiltration. Helicobacter-induced chronic gastritis may be associated with atrophy and intestinal metaplasia during progression. Atrophy in chronic gastritis can lead to adenocarcinoma through the following chain of events: atrophy → intestinal metaplasia → dysplasia. Helicobacter pylori infection may be confirmed in more than 50% of gastric adenocarcinomas. Atrophic gastritis in pernicious anemia is also a precancerous condition but the mechanism of its development is not related to Helicobacter pylori infection. Serum gastrin level is elevated in chronic gastritis caused by Helicobacter.
INT - 5.5
The main proteolytic enzyme from gastric enzymes is:
A) gastric lipase
B) motilin
C) secretin
D) pepsin
ANSWER
D) pepsin
EXPLANATION
The main protein-degrading enzyme from gastric enzymes is pepsin. Pepsinogen secreted by the chief cells of the gastric mucosa is the inactive precursor of pepsin, which is converted into active pepsin in an acidic medium. The optimum pepsin effect is between pH 1.5 and 2.0, and primarily cleaves peptide bonds whose amino group is derived from phenylalanine or tyrosine. Gastric lipase, like pancreatic lipase, is a fat-breaking enzyme. Secretin is a hormone in the duodenum that stimulates pancreatic fluid volume and bicarbonate secretion and bile secretion. Motilin is also a gastrointestinal hormone isolated from the small intestinal mucosa. The main physiological effect of the hormone is considered to be the regulation of interdigestive intestinal motility.
INT - 5.6
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
C) in the gastric phase
EXPLANATION
More than half of the daily amount of gastric fluids are produced after a meal, the so-called gastric phase. The cephalic phase of gastric secretion is triggered by stimulation of the taste receptors in the mouth. The cephalic phase-secreted fluids were named by Pavlov as “appetite fluids.” During the intestinal phase and between meals, the amount of secreted gastric fluids are negligible compared to the gastric and cephalic phases.
INT - 5.7
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
D) blood type B
EXPLANATION
The risk of developing gastric cancer is increased by adenomatous polypus in the stomach, atrophic gastritis in pernicious anemia. In cases of gastric resection due to an ulcer 15 to 20 years earlier may lead to so-called gastric stump carcinomas.
INT - 5.8
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
C) presence of stromafibrosis in the tumor tissue
EXPLANATION
The prognosis of gastric cancer is determined by the stage of tumor growth (TNM), tumor localization and histological type, including degree of differentiation
INT - 5.9
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
B) lymphoma in the stomach is less frequent than in the colon
EXPLANATION
The most common site of appearance of primary extranodal lymphomas is the gastrointestinal tract. In the stomach, lymphoma may be the primary manifestation, but it may be the result of infiltration from another area (approximately 30-50% in total). Low-grade malignancy, so-called MALT lymphomas are associated with chronic gastritis, intestinal metaplasia due to Helicobacter pylori. The regression observed after eradication of Helicobacter pylori emphasizes the pathogenetic role of the pathogen in the etiology of low-grade malignant MALT lymphomas. The most common histological type of gastric lymphoma is the diffuse histiocytic form. The best prognostic factor for the course of the disease is the Ann-Arbor staging established at detection.
INT - 5.10
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
A) The stomach is the most common site for carcinoid tumors.
EXPLANATION
The detection of gastric carcinoid tumors is random. The incidence of carcinoid in the stomach is rare (2-3% of gastrointestinal carcinoid cases). Carcinoid tumor often develops from atrophic gastritis and may be associated with pernicious anemia. Carcinoid tumors produce 5HT (serotonin).
INT - 5.11
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
B) Diarrhoea does not occur in the syndrome.
EXPLANATION
The clinical syndrome caused by gastrin overproduction is called Zollinger-Ellison syndrome, characterized by the clinical triad of severe peptic ulcerations, extreme hyperacidity, and non-β-cell tumor of the pancreas. Gastrinoma grows approx. 50% in the endocrine islet cells of the pancreas, ca. 40% in the wall of the duodenum. The disease can occur at any age, ulcers are multiplex, have atypical localization (deep duodenum, jejunum), may recur after surgical resection, patient may complain about diarrhea or severe heartburn. The Zollinger-Ellison syndrome is part of approx. 20% of patients with multiplex endocrine adenomatosis type 1 (MEN-1). Neoplasm of the parathyroid gland is almost 100% prevalent in MEN-1 syndrome.
INT - 5.12
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
B) prokinetic agents in monotherapy
EXPLANATION
The most cost-effective treatment for gastroesophageal reflux disease (GORB) is the use of proton pump inhibitors (PPIs). Prokinetic agents are nowadays not used at all in monotherapy. Their combination with PPI in the treatment of certain extraoesophageal manifestations of GORB may be considered. Currently, H2 receptor antagonists are used primarily in the maintenance of mild forms of GORB in the context of a step-down treatment strategy.
INT - 5.13
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
A) Ménétrier disease
EXPLANATION
Ménétrier disease or exsudative gastropathy is a rare disease of unknown origin, characterized by diffuse thickening of the gastric wall caused by excessive proliferation of the mucous membrane. In the stomach the macroscopic view of the stomach shows a huge, soft, swollen, curving mucous membrane that resembles the cerebral cortex. Microscopic features are elongated, convoluted glandular enlargement, cystic dilation, in which parietal cells are often replaced by cells resembling mucus or intestinal metaplastic cells. One of the most important clinical features is the loss of proteins through gastric lesions. This leads to oedema formation. In addition, patients often complain of epigastric pain and diarrhea. Unlike the Zollinger-Ellison syndrome, there are no multiple ulcers in the stomach. Diagnosis of gastric lymphoma can be confirmed histologically. In scleroderma, lesions develop in the gastrointestinal tract, primarily in the oesophagus and in the distal duodenum and proximal jejunum. It is not characterized by the image of these giant folds in the stomach.
INT - 5.14
Which is the most common anemia after total gastrectomy?
A) iron deficiency
B) vitamin B12 deficiency
C) folate deficiency
D) hemolytic
ANSWER
B) vitamin B12 deficiency
EXPLANATION
The gastric mucosa produces the “intrinsic factor” essential for the absorption of vitamin B12, which is required for the production of red blood cells. Thus, after total gastrectomy, the most common anemia is vitamin B12 deficient anemia. Since iron is absorbed to a lesser extent in the stomach and to a greater extent in the duodenum and upper jejunum, gastrectomy alone does not lead to iron deficient anemia. Iron deficiency can have many causes; most commonly seen after blood loss or in chronic inflammatory or tumorous disease. Less commonly, iron deficiency may develop in intestinal absorption disorders. Folic acid deficiency and hemolytic anemia are also unrelated to total gastrectomy.
INT - 5.15
All but one of the factors listed increase pepsinogen secretion:
A) somatostatin
B) gastrin
C) histamine
D) vagal stimulation
ANSWER
A) somatostatin
EXPLANATION
The most potent stimulus for pepsinogen release is vagal stimulation. Histamine primarily stimulates hydrochloric acid secretion but also significantly enhances pepsinogen secretion. Gastrin also enhances the secretion of pepsinogen. Somatostatin inhibits gastrin release and does not increase pepsinogen release.
INT - 5.16
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
B) H + -K + -ATPase
EXPLANATION
The microscopic morphology of parietal cells is characterized by high levels of mitochondria and high levels of energy storage compounds (ATP) in the cells. These cellular components provide the hydrogen ions with about one million fold concentration in the opposite direction to the electron gradient. The proton pump (H + / K + -ATPase) is the enzyme that allows the H + and Cl - ions to be released from the cytosol. The energy required for hydrogen ion secretion is obtained from cells by hydrolysis of ATP. K + and bicarbonate motions also occur in synchronization with the hydrogen ion.
INT - 5.17
The most common type of polyp in the stomach:
A) hyperplasiogen
B) adenomatosus
C) juvenile
D) carcinoid
ANSWER
A) hyperplasiogen
EXPLANATION
Polyps occurring in the stomach can be classified into epithelial and non-epithelial origin. Of the epithelial origin, hyperplasic polyps are the most common, and usually develop in the antrum. During their growth, they might rarely show adenomatous transformation.
INT - 5.18
Peptic ulcer diseases, except:
A) NSAID ulcer
B) KCI ulcer
C) Helicobacter-positive ulcer
D) Zollinger-Ellison syndrome
ANSWER
B) KCI ulcer
EXPLANATION
Peptic ulcers include ulcers due to Helicobacter pylori infection, Zollinger-Ellison syndrome, and adverse reactions to non-steroidal anti-inflammatory therapy. In these types of ulcers, despite the various pathogenetic factors, anatomical lesion is due to the digestive action of hydrochloric acid pepsin, and these ulcers are called peptic ulcers. The mechanism of KCl ulcer is different.
INT - 5.19
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
D) viral infection
EXPLANATION
Classical peptic ulcer disease is a multifactorial disease, Helicobacter pylori infection is considered one of the most important pathogenetic factors today. In addition, stress, hyperacidity, smoking, etc. play an important role in the development of ulcer disease.
