OS 214 Digestive Exam 3 Flashcards
1) The vomiting center is located in this area A. Basal ganglia B. Hypothalamus C. Medulla D. Cerebellum
C
2) A 22 year old woman diagnosed with bulimia is observed by her boyfriend to be quietly chewing and swallowing several times in between mealtimes. What is this behavior called? A. Emesis B. Rumination C. Retching D. Gastroesophageal reflux
B
3) A man is kicked in the testicles during a robbery attempt. He promptly vomits his lunch. What is the explanation for his reaction?
A. Testicles have afferent fibers traveling via the nucleus tractus solitarius to the emetic center
B. Testicular trauma activates the chemoreceptor trigger zone
C. Testicles have pathways in common with the vestibular system
D. Trauma to the testicles triggered syncope and resulting emesis
A
4) A pregnant woman develops morning sickness at 8 weeks AoG. Which neurotransmitter receptor is primarily responsible for her misery? A. Cannabinoid CB-1 B. Neurokinin NK-1 C. GABA D. Histamine H2
D
5) A 55 year old man received chemotherapy for colon cancer two days ago. Today he developed nausea and vomiting. Which receptor is responsible for his nausea and vomiting? A. Neurokinin NK-1 B. Histamine H2 C. Muscarinic M1 D. Histamine H1
A
6) During vomiting, from which anatomic structure does forceful retrograde contraction originate? A. Lower esophageal sphincter B. Gastric cardia C. Duodenum D. Jejunum
D
6) During vomiting, from which anatomic structure does forceful retrograde contraction originate? A. Lower esophageal sphincter B. Gastric cardia C. Duodenum D. Jejunum
Answer: D – The fact that her vomitus is undigested food gives you a clue to the origin of the problem. Undigested food corresponds to an esophageal problem, partially digested food corresponds to the stomach, and bilious vomiting indicates a postampullary problem. In this case, the problem is esophageal. Achalasia is a disorder where the esophagus lacks neural innervation, leading to a lack of peristalsis.
8) Protective reflexes during vomiting does not include the following A. Glottis is closed B. Soft palate is raised C. Breathing is momentarily stopped D. Tongue retracts
D
9) Surgery with highest risk for post operative nausea and vomiting A. Strabismus and middle ear surgery B. Oropharyngeal surgery C. Cardiac surgery D. Vascular surgery
Answer: A – Because the vestibular system is one source of signals causing nausea and vomiting, while being intimately related to the eyes and middle ear. Hence surgery involving these may affect the vestibular system and thus cause nausea and vomiting.
10) Drug that can be used safely for nausea and vomiting in pregnancy A. Thalidomide B. Carbamazepine C. Ondansetron D. Phenytoin
Answer: C – The others are teratogenic
11) Vomiting episodes which are stereotypical, with a predictable onset and duration separated by asymptomatic or almost asymptomatic intervals that range from 2 weeks to 6 months. A. Rumination syndrome B. Cyclical vomiting syndrome C. Bulimia nervosa D. Gastric outlet obstruction
B
12) Initial best diagnostic test in the work-up of nausea and vomiting to rule out intestinal obstruction A. Endoscopy B. Plain abdominal x-rays C. Stool exams D. CT scan
B
13) Best diagnostic test for gastric outlet obstruction A. Barium swallow xrays B. CT scan C. Manometry D. Colonoscopy
A
14) In complete mechanical intestinal obstruction, the immediate cause of vomiting is
A. Marked intraluminal pressure build-up
B. Dilatation of proximal intestinal segment
C. Peritonitis from transmural extravasation of intestinal toxin
D. Intraluminal accumulation of succus entericus
A
15) Vomiting can cause longitudinal mucosal and even transmural lacerations at the level of the gastroesophageal junction is called A. Boerrhave’s syndrome B. Mallory-Weiss tears C. Barrett’s esophagus D. Esophagitis
B
Constipation 16) 26/M complains of passage of hard, lumpy stools more than 25% of the time, incomplete evacuation 50% of the time, and passes stools 2x/week. This patient has A. Constipation B. Outlet obstruction C. Colonic inertia D. Normal findings A
A
17) 65/F complains of difficulty in passing bowel movement. Colonoscopy showed normal findings. Colonic transit study was done which showed passage of 80% of the markers by day 5. This is indicative of A. Constipation B. Outlet obstruction C. Colonic inertia D. Normal findings
D
18) 48/M complains of decreased caliber of stools, hematochezia, no weight loss. Colonoscopy done showed a fungating mass occupying 50% of the circumference of the bowel wall at the sigmoid colon. This is most likely A. Intraluminal B. Extraluminal C. Mural D. Constipation
Answer: C
Intraluminal – parasites, hard stool, foreign body
Extraluminal – adhesions, endometriosis, gynecologic tumors
19) 60/M complains of passage of stools 2x/week and passage of hard bulky stools. Digital rectal exam showed hard, stools in the rectal vault. Plain abdominal x-ray showed fecaloid material from the transverse colon to the sigmoid. Colonoscopy was normal. To normalize his bowel function, you would prescribe A. Enema and/or suppository B. Mineral oil C. Colonic irritants like senokot D. Bulk laxatives like metamucil
Answer: C – diagnosis is bowel impaction that reaches the transverse colon already
20) The correct sequence of the defecatory process is A. 1, 3, 4, 5, 2 B. 1, 5, 4, 3, 2 C. 1, 3, 5, 4, 2 D. 1, 4, 3, 5, 2
1 – Distention of the rectum 2 – External anal sphincter relaxes and anal canal contents evacuated 3 – Internal anal sphincter relaxation 4 – Puborectalis muscle relaxatioin 5 – Valsalva maneuver
C
21) The process of defecation is effected when the following takes place
A. The anorectal angle is around 95 degrees
B. The internal anal sphincter contracts and the external anal sphincter relaxes
C. The external sphincter and the puborectalis muscle relax
D. There is a mass movement of stools from the colon to the rectum
C
21) The process of defecation is effected when the following takes place
A. The anorectal angle is around 95 degrees
B. The internal anal sphincter contracts and the external anal sphincter relaxes
C. The external sphincter and the puborectalis muscle relax
D. There is a mass movement of stools from the colon to the rectum
Answer: A – because meconium should be passed within 24 hours
23) Basic in the management of constipation in children is A. Education and demystification B. Disimpaction C. Laxatives D. Pavlovian reflex
Answer: A – B is correct for acute cases, but for chronic cases A is better (according to the feedback haha)
24) 6/F previously toilet-trained presents to the clinic for constipation. Her mother noted that the problem began when she started attending school. She takes in a fair amount of fluids but is not keen with eating vegetables. She has a piece of fruit for lunch and dinner. On PE, the abdomen was soft with palpable masses over the left lower quadrant and dry firm stools within the rectal vault. As the health personnel manning the clinic, your initial management for this child would consist of
A. Insert glycerin suppository
B. Start oral laxatives
C. Advise 7 portions of fruits and vegetables
D. Have the child sit in the toilet commode after each meal
Answer: A – to relieve the impacted feces
25) Which of the following patients is likely to be suffering from functional constipation
A. A 6 month old baby, mixed fed with breastmilk and milk formula with bowel movements occurring every other day associated with abdominal distention
B. A 3 year old boy with on and off history of blood-streaked stools associated with irregular bowel movements and straining on defection who recently had a strict caregiver
C. A 7 year old girl with cerebral palsy with passage of hard stools every other day, sometimes requiring manual extraction
D. A 9 year old stunted boy with mental age of 5 years who has a distended abdomen and palpable stools on LLQ
Answer: B (Because A, C, and D can have organic explanations)
26) A 3 year old boy is brought for outpatient consultation because the mother claims that the child has bowel movement every 3-4 days. She claims that the problem started when toilet training began 6 months ago. The patient would pass stool every 3-4 days associated with the child hiding behind the sofa while straining into his diaper. The stools are noted to be big and bulky and associated with some pain. There has been loss of appetite this week but no vomiting and no weight loss. Based on the history, the most likely diagnosis is A. Functional constipation B. Hirschsprung’s disease C. Lymphoma D. Colonic polyposis
A
27) A 12 year old boy is consulting for constipation associated with abdominal pain since three months ago. He claims that he is having on and off episodes of alternating constipation and diarrhea associated with anorexia and easy fatigability. His mother consulted several pediatricians where he was prescribed antibiotics for amebiasis and once underwent deworming. On PE, he was found to be slightly pale with BP 120/70 HR 106/min RR 24/min T 36.8 C. The abdomen was slightly distended with a palpable nontender mass at the left hemiabdomen. Rectal exam revealed an intraluminal mass at the tip of the examining finger. The most appropriate examination he needs is which of the following? A. Plain abdominal xray B. Barium enema C. Proctosigmoidoscopy D. CT scan
C
28) A 2 year old boy is brought to the outpatient clinic because of chronic constipation since he was born. The mother claims that the boy would only pass stools every 3-4 days only if she inserted a glycerine suppository per rectum. The boy was born at home as the 6th child and was noted by the mother that he only passed meconium on the 3rd day of life after rectal stimulation as suggested by the midwife the mother consulted. Since then, as the patient grew up, there were episodes of constipation associated with abdominal enlargement and occasional vomiting relieved by insertion of suppository per rectum. On PE, the boy had an enlarged abdomen with palpable distensible masses on the abdomen. Rectal exam resulted in a large gush of air and passage of voluminous loose stool and this decreased the boy’s abdominal girth. Based on history and PE, the most likely diagnosis is A. Functional constipation B. Abdominal lymphoma C. Hirschsprung’s disease D. Wilms’ tumor
C
29) The following minimizes constipation
A. Dietary intake of 20-30 grams non-starch polysaccharide
B. Intake of at least 8 glasses of fluids per day
C.Exercise
D. AOTA
D
30) To meet the Rome criteria for functional constipation, the patient must have fewer than 3 bowel movements per week, institute manual maneuvers to evacuate stool, straining, passage of lumpy/hard stools, incomplete evacuation, and have a sensation of anorectal obstruction/blockage more than \_\_\_\_\_% of the time A. 25 B. 30 C. 35 D. 40
A
GI Malignancies 31) Nodular tumors arising at the bifurcation of the common bile duct A. Charcot tumor B. Klatskin tumor C. Virchow tumor D. Cuorvoisier tumor
B
32) Organisms associated with the development of cholangiocarcinoma A. Opistorchis B. Schistosomiasis C. H. pylori D. Ascaris
Answer: A (Opistorchis and Clonorchis are the parasites most closely associated with cholangiocarcinoma)
33) TRUE about colon cancer
A. Lesions in the ascending colon commonly present with constipation
B. Tumors arising from the descending colon would usually present with abdominal cramping and obstruction
C. Iron deficiency anemia in a menstruating healthy young woman warrants colonoscopy
D. Symptoms do not vary with the anatomic location of the tumor
A
B
34) Most common symptom of esophageal cancer A. Weight loss B. Hematemesis C. Dysphagia D. Odynophagia
Answer: C – in particular, progressive dysphagia is associated with esophageal cancer
35) Risk factors for gastric adenocarcinoma EXCEPT A. Smoking B. Nitrates C. H. pylori infection D. Blood type O
Answer: D – dapat blood type A (although smoking daw yung answer sa feedback)
36) The most frequent extranodal site of lymphoma A. Duodenum B. Lung C. Stomach D. Liver
C
37) Which form of gastric carcinoma has a poorer prognosis upon discovery? A. Fungating type B. Ulcerating type C. Linitis plastica type D. They all have similar prognosis
C
38) The more reliable criterion in determinin whether a gastric ulcer is malignant or not
A. Presence of tumor metastasis to adjacent lymph node
B. Biopsy of ulcer for histopathologic evaluation
C. Non-healing ulcer despite adequate treatment
D. Ulcer borders are markedly prominent
B
39) In the colon and rectum, an intramucosal carcinoma that shows no demonstrable vascular and lymphatic invasion, and whose morphology is not the poorly differentiated type will have A. Zero metastatic potential B. 25% metastatic potential C. 50% metastatic potential D. 75% metastatic potential
A
40) Type of gastric adenocarcinoma characterized by cohesive neoplastic cells that form glandlike tubular structures A. Diffuse B. Linitis plastica C. Squamous D. Intestinal
D
