UERM GIT Diseases and Nutrition

Question 1

Which division of the embryonic GIT give rise to the following structures?

1. appendix
2. esophagus
3. jejunum
4. common bile insertion
5. descending colon
6. distal colon
7. pancreas
8. salivary glands

Answer 1

Question 2

midgut protrusion out of abdominal cavity, returns, and rotates - this process is usually complete by ____ of gestation

Answer 2

8 weeks

Question 3

the midgut returns to the abdminal cavity and rotates in [clockwise/counterclockwise] fashion until the cecum lies in the [right/left] [upper/lower] quadrant of the abdomen

Answer 3

counterclockwise, right, lower

Question 4

connects the umbilical vesicle with the intestinal tube

Answer 4

omphalomesenteric duct

Question 5

what protrudes from the abdominal cavity at the 10th week of gestation

Answer 5

distal duodenum up to the mid-transverse colon

Question 6

at the 10th week of gestation, the structures that protruded out make how many degrees of rotation?

Answer 6

The
distal duodenum up to mid-transverse colon elongates &
goes into the umbilical cord until it is outside the abdominal
cavity. Outside the cavity, there will be 360° rotation of the
intestinal loop

Question 7

axis of rotation of the at the 10th week of gestation

Answer 7

By 10th week, they protrude from the abdominal cavity. The
distal duodenum up to mid-transverse colon elongates &
goes into the umbilical cord until it is outside the abdominal
cavity. Outside the cavity, there will be 360° rotation of the
intestinal loop with the mesenteric artery serving as the axis

Question 8

1. In deglutition, oropharyngeal dysphagia occurs when the
   passage of food bolus from the mouth to esophagus is
   impaired due to:
   a. closure of glottis
   b. neuromuscular disorder
   c. tight GE sphincter
   d. lack of ganglion cells

Answer 8

b. neuromuscular disorder

Question 9

2. A 4 hour old patient became cyanotic and tachypneic with
   presence of intercostal and subcostal retractions after the first
   feed. Upon PE, patient was noted to have scaphoid abdomen and
   hypoactive bowel sounds. No cardiac murmurs noted. What’s the
   diagnosis?
   a. Hirschsprung’s disease
   b. Diaphragmatic hernia
   c. Tracheoesophageal fistula/ Tracheoesophageal atresia
   d. Duodenal atresia

Answer 9

b. Diaphragmatic hernia

Question 10

3. 3mo old diagnosed with chalasia, you assure the mother that
   for this condition:
   a. surgery is treatment of choice
   b. milk may be taken
   c. condition resolves spontaneously
   d. b&c

Answer 10

d. b&c

Question 11

Adynamic ileus in cases of dehydration

a. hypoK
b. hyperK
c. hyperNa
d. hypoNa

Answer 11

a. hypoK

Question 12

5. The empiric anti-reflux therapy includes ameliorating acidity of gastric
   contents by
   a. Calcium Channel Blockers
   b. Anti H. pylori Antibiotics
   c. Proton Pump Inhibitors

Answer 12

c. Proton Pump Inhibitors

Question 13

6. In the chronology of symptoms of acute appendicitis, the
   classic type is characterized by:
   a. Vomiting is followed by periumbilical pain and watery
   diarrhea
   b. RLQ pain follows periumbilical pain

c. Periumbilical pain follows fever and RLQ
d. RLQ pain is followed by fever and vomiting

Answer 13

c. Periumbilical pain follows fever and RLQ

Question 14

This is a manifestation of peritonitis:

a. Kernig’s sign
b. Positive skin tests
c. Rovsing’s sign
d. Leg raise test

Answer 14

c. Rovsing’s sign

Question 15

Differentiate

Megarectum versus Megacolon (i n hirschprung’s)

Answer 15

Upon DRE of megarectum, impacted fecal bolus is felt,
while in megacolon of Hirschsprung’s disease, an empty
rectal vault is felt.

Question 16

A 5 mo old baby presented with constipation, failure to thrive, poor weight gain and with associated enterocolitis. Upon rectal exam, there is empty rectal vault. barium enema was done and found to have delayed evacuation of barium. What would be the primary working diagnosis?

Answer 16

hirschprung’s disease

Question 17

Upon re-entry, the duodenum moves to the region of the ________________

Answer 17

Ligamentum of Treitz

Question 18

________________ are fibrous stalks of peritoneal tissue that attach the cecum to the abdominal wall

Answer 18

Ladd’s bands

Question 19

Type of rotational defect usually associated with heterotaxy syndrome

Answer 19

Mal-rotation

Question 20

congenital anomaly wherein the abdominal wall failed to fuse

Answer 20

Gastrochisis

Question 21

Congenital anomaly wherein the intestine or other abdominal organs stick out of the belly button

Answer 21

Omphalocele

Question 22

presence of IgA, mucosal antibodies

a. 8 weeks
b. 9 weeks
c. 10 weeks
d. 11 weeks

Answer 22

d. 11 weeks

Question 23

(T/F) lactase activity reach maximal levels at 36th week

Answer 23

T

Question 24

topmost enzyme of mucosal surface

Answer 24

lactase

Question 25

1st line of GIT defense

Answer 25

secretory IgA

Question 26

2nd line of defense

Answer 26

IgG activation --\> cytokine release and immuomodulation

Question 27

lining where unwanted atigen or foreign body adheres to

Answer 27

Mucus

Question 28

dominant microbiota in the human stomach

Answer 28

helicobacter pylori

Question 29

dominant microbiota in the small intestines

Answer 29

lactobacilli

Question 30

What do you call this event/phenomenon? under certain conditions, microbes can break the intestinal barrier → activation of proinflammatory response → onset of allergic reactions & autoimmune diseases

Answer 30

dysbiosis

Question 31

protuberant abdomen is normal up to ___ years old

Answer 31

2

Question 32

physiologic jaundice normal within

Answer 32

first 3 days of life

Question 33

what sign? bluish discoloration seen around the umbilicus indicating severe acute pancreatitis

Answer 33

Cullen’s sign

Question 34

Swallowin is controlled by the medullary center of the brainstem via what pathways?

Answer 34

3 Pathways: o Glossopharyngeal Nerve o Vagus Nerve: along the esophageal musculature o Intrinsic nerves in the esophageal smooth muscles

Question 35

what phase of deglutition does glottis closure occur?

Answer 35

Question 36

painful swallowing,

Answer 36

odynophagia.

Question 37

In a patient with a esophageal atresia, MATERNAL HYDRAMNIOS may be present. Maternal hydramnios is defined as increase in amniotic fluid with an amniotic fluid index of \_\_\_

Answer 37

more than 20

Question 38

MC type of TEA and TEF

Answer 38

Type A - Atresia with distal fistula

Question 39

Also called H- type

Answer 39

Tracheoesophageal Fistula:

Question 40

which TEA/TEF type will have a lot of abdominal distention

Answer 40

Type C

Question 41

TEA/TEF type which may present as an airless, scaphoid abdomen.

Answer 41

type B

Question 42

Type of diaphragmatic hernia: They occur posteriorly and are due to a defect in the posterior attachment of the diaphragm when there is a failure of pleuroperitoneal membrane closure in utero

Answer 42

Bochdalek

Question 43

Retrosternal diaphragmatic hernia is characterized by herniation through what structure

Answer 43

the foramen of Morgagni

Question 44

vomiting center

Answer 44

medulla

Question 45

In a nonbilious type of vomitus, where is the likely location of the GI problem

Answer 45

above the ampulla of vater