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Surgery > Small Intestine > Flashcards

Small Intestine Flashcards

1
Q

Duodenum arises from

A

Junction of foregut and midgut

Jejunum and ileum - midgut

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2
Q

Duodenal glands that produce an alkaline secretion to protect against acidic gastric chyme.

A

Brunner’s

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3
Q

The strongest layer of the SI.

A

submucosa

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4
Q

Antibiotic that enhances GI motility by functioning as an agonist at the motilin receptor.

A

Erythromycin

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5
Q

Most common surgical disorder of the SI in which obstruction is accompanied by ↑ secretion and ↓ absorption.

A

Small-Bowel Obstruction

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6
Q

Calcium is primarily absorbed in the

A. Stomach
B. Duodenum
C. Jejunum
D. Ileum

A

B. Duodenum

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7
Q

Which of the following distinguishes jejunum from ileum?

A. Less prominent plica circularis
B. Smaller diameter
C. Thinner wall
D. Longer vasa recta

A

D

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8
Q

There are four cell types which originate in the crypts of the small bowel mucosa. Which one of these cell types completes differentiation in the crypt instead of during migration to the villus?

A. Enterocyte
B. Goblet cell
C. Enteroendocrine cell
D. Paneth cell

A

D

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9
Q

The first hormone discovered in the human body was

A. Insulin
B. Secretin
C. Vasoactive intestinal peptide
D. Somatostatin

A

B

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10
Q

Somatostatin causes

A. Stimulation of intestinal secretion
B. Stimulation of intestinal motility
C. Inhibition of splanchnic perfusion
D. Stimulation of intestinal mucosal growth

A

C

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11
Q

The total volume of fluid secreted daily by the salivary glands, stomach, liver, and pancreas in a normal adult is approximately

A. 2 liters
B. 4 liters
C. 6 liters
D. 8 liters

A

C

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12
Q

Mutation in the NOD2 gene is associated with an increased risk of

A. Crohn’s disease
B. Cholera
C. Adenocarcinoma of the small bowel
D. Pseudo-obstruction

A

A. Crohn’s disease

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13
Q

Which of the following statements about gut-associated lymphoid tissue (GALT) is NOT true?

A. GALT contains approximately 20% of the body’s immune cells
B. Peyer’s patches are part of the GALT and function as an inductive site (to process foreign antigens)
C. IgA is produced by plasma cells in the lamina propria of the small bowel
D. IgA dimmers bound to secretory components are resistant to degradation in the lumen of the gut by proteolytic enzymes

A

A

70%

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14
Q

The digestion of proteins in healthy individuals is initiated by

A. Pepsin
B. Trypsin
C. Chymotrypsin
D. Carboxypeptidase

A

A

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15
Q

Which of the following is the origin of the epithelium of the small bowel?

A. Ectoderm
B. Mesoderm
C. Endoderm
D. Neural crest

A

C

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16
Q

Which of the following decreases absorption of intraluminal water in the small bowel?

A. Dopamine
B. Somatostatin
C. Glucosteroids
D. Vasopressin

A

D

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17
Q

What is the approximate clinical recurrence rate (return of symptoms) 5 years after surgery for Crohn’s disease?

A. 10%
B. 35%
C. 60%
D. 95%

A

C

18
Q

Which of the following is NOT a known cause of chronic intestinal pseudo-obstruction?

A. Scleroderma
B. Parkinson’s disease
C. Hyperthyroidism
D. Familial visceral myopathy (type I)

A

C

19
Q

Which of the following is the most common indication for surgery in a patient with Crohn’s disease?

A. Intestinal obstruction
B. Intestinal perforation
C. Gastrointestinal hemorrhage
D. Growth retardation

A

A

20
Q

The most common location for a primary adenocarcinoma of the small bowel is

A. Duodenum
B. Jejunum
C. Ileum
D. None of the above—the distribution is roughly equal

A

A

Carcinoid - ileum

21
Q

Following a gastric bypass, which form of calcium should be used as a supplement?

A. Calcium carbonate
B. Calcium chloride
C. Calcium gluconate
D. Calcium citrate

A

D

22
Q

The most common cause of acute mesenteric ischemia is

A. Arterial embolus
B. Arterial thrombosis
C. Vasospasm (nonocclusive mesenteric ischemia)
D. Venous thrombosis

A

A

All are causes
Embolic source: heart

23
Q

Which of the following factors is associated with poor spontaneous enterocutaneous fistulae closure rate?

A. Radiation
B. Albumin level >4
C. Long (>2 cm) fistula tract
D. Anscence of epithelialization in fistula tract

A

A

malnutrition, sepsis, inflammatory bowel disease, cancer, radiation, obstruction of the intestine distal to the origin of the fistula, foreign bodies, high output, short fistulous tract (2 cm), and epithelialization of the fistula tract

24
Q

Which of the following has been shown to be effective in reducing the duration of postoperative ileus?

A. NG suction
B. Aggressive fluid administration
C. Early enteral feeding
D. Rectal suppository

A

C

NSAID

25
Q

Which of the following is a recognized risk factor for Crohn’s disease?

A. Male gender
B. Having been breastfed as an infant
C. Low socioeconomic status
D. Smoking

A

D

26
Q

A patient with an asymptomatic 4-cm duodenal diverticulum should be treated with

A. Observation alone
B. Endoscopic ablation of the diverticular mucosa
C. Diverticulectomy
D. Segmental duodenectomy

A

A

27
Q

Which of the following findings is virtually pathognomic for Crohn’s disease?

A. Terminal ileal inflammation
B. Thickened ileal wall
C. Fat wrapping
D. Ulceration in the ileal mucosa

A

C

28
Q

Which of the following is the LAST to recover from postoperative ileus?

A. Stomach
B. Small bowel
C. Colon
D. None of the above—the recovery is simultaneous

A

C

SI > Stomach > LI

29
Q

Which of the following is NOT a known cause of ileus?

A. Pneumonia
B. Hypomagnesemia
C. Myocardial infarction
D. Hyperkalemia

A

D

30
Q

A high output enterocutaneous fistula is defined as draining more than

A. 100 mL/day
B. 500 mL/day
C. 1000 mL/day
D. 2000 mL/day

A

B

Enterocutaneous fistulas that drain less than 200 mL of fluid per day are known as low-output fistulas, whereas those that drain more than 500 mL of fluid per day are known as high-output fistulas

31
Q

The most common complication seen in adults with a Meckel’s diverticulum is

A. Obstruction
B. Meckel’s diverticulitis
C. Perforation
D. Bleeding

A

A

32
Q

Which of the following is NOT an extraintestinal manifestation of Crohn’s disease?

A. Pyoderma gangrenosum
B. Erythema nodosum
C. Alopecia
D. Arthritis

A

C

33
Q

Stricturoplasty is contraindicated in a patient with Crohn’s disease who, at the time of surgery, is found to have

A. Multiple areas of stenosis
B. Stricture(s) >12 cm in length
C. A fistula at the level of the stricture
D. A stricture proximal to severe ileocecal disease

A

C

34
Q

Which of the following is NOT associated with successful weaning of TPN in patients with shortbowel syndrome?

A. Length of small bowel >200 cm
B. Presence of ileocecal valve
C. Presence of colon
D. Age >30 years

A

D

Pediatric patients adapt better than adult patients.

35
Q

Which of the following agents has been shown to improve closure of enterocutaneous fistulae in Crohn’s disease?

A. Metotrexate
B. 5-ASA
C. Infliximab
D. Corticosteroids

A

C

Anti TNF

36
Q

Which of the following is a branch of the inferior mesenteric artery?

A. Middle colic artery
B. Ileocolic artery
C. Sigmoidal arteries
D. Right colic artery

A

C

37
Q

Bacteria make up what percentage of the dry weight of feces?

A. 10%
B. 30%
C. 50%
D. 70%

A

B

38
Q

Which of the following is associated with colorectal carcinoma?

A. Activation of the K-ras gene
B. Activation of APC
C. Activation of DCC (deleted in colorectal carcinoma)
D. Activation of p53

A

A

Should be inactivation of the tumor suppressor genes

39
Q

Deletion in the tumor suppressor phosphatase and tensin homolog (PTEN) is associated with all ofthe following EXCEPT

A. Familial adenomatous polyposis
B. Peutz-Jeghers syndrome
C. Juvenile polyposis
D. Cowden syndrome

A

A

40
Q

The origin of the middle rectal artery is the

A. Inferior mesenteric artery
B. Iliac artery
C. Internal pudendal artery
D. Inferior epigastric artery

A

B

Surgery (10 decks)

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