Path 17 Flashcards

Gastric ulcers present with pain that is _____ by meals (eating stimulates _____ secretion in the stomach).

Duodenal ulcers characteristically present with pain that _____ with meals (eating stimulates _____ secretion in the duodenum).

What hereditary disease is characterized by an inherited mutation in one copy of the APC gene?

_____ _____ _____ - inherited APC mutation (chromosome _____)

Familial Adenomatous Polyposis:

Thousands of _____ develop in _____ - high risk for _____ transformation

What is the most common cause of Vitamin B12 deficiency?

_____ _____ gastritis

Chronic autoimmune gastritis leads to destruction of parietal cells which secrete _____ _____ (_____ anemia)

Achalasia represents damage to the _____ cells of the _____ plexus.

Which type of hypersensitivity is responsible for chronic autoimmune gastritis?
A. Type I (IgE-mediated)
B. Type II (antibody-mediated)
C. Type III (immune complex-mediated)
D. Type IV (T-cell mediated)

Intrinsic factor deficiency in chronic autoimmune gastritis is best explained by:
A. Direct antibody-mediated destruction of intrinsic factor
B. Loss of parietal cells due to T-cell–mediated damage
C. Increased degradation of intrinsic factor in the intestine
D. Decreased secretion from chief cells

Why are anti-intrinsic factor antibodies detected in chronic autoimmune gastritis?
A. They initiate the disease process
B. They are produced secondary to parietal cell destruction
C. They directly activate T cells
D. They prevent vitamin B12 absorption by binding ileal receptors

In chronic autoimmune gastritis, what is the role of anti-parietal cell antibodies?
A. Directly destroy parietal cells
B. Activate complement to lyse gastric mucosa
C. Are a consequence of parietal cell damage
D. Prevent T-cell activation

inner layers of the tract protrude through the muscular layer, meckel or zenker?

A 70-year-old man presents with dysphagia, regurgitation of undigested food, and chronic cough. Imaging reveals a posterior pharyngeal outpouching. Which muscle is primarily responsible for forming a sphincter and contributing to the pathophysiology?
A. Thyropharyngeus
B. Stylopharyngeus
C. Cricopharyngeus
D. Palatopharyngeus

In achalasia, LES tone is typically:
A. Decreased
B. Normal
C. Increased
D. Absent

A patient with Zenker diverticulum undergoes surgical treatment. Which of the following interventions directly addresses the underlying cause of this condition?
A. Esophageal dilation of the lower esophageal sphincter
B. Resection of the diverticulum alone
C. Cricopharyngeal myotomy
D. Fundoplication

Zenker: Herniation of ____ through a muscular defect due to increased ____ pressure

An elderly patient presents with dysphagia, regurgitation of undigested food, halitosis, and recurrent aspiration pneumonia. What is the most appropriate diagnostic test to confirm this condition?
A. Barium contrast esophagogram
B. CT scan of the neck
C. Upper endoscopy (EGD)
D. Esophageal manometry

Primary achalasia causes inability to relax the LES because of:
A. Muscular rupture
B. Inflammatory fibrosis only
C. Ganglion cell degeneration
D. Vagal hyperstimulation

In Chagas disease, secondary achalasia is caused by destruction of the:
A. Submucosal plexus only
B. Serosal mesothelium
C. Myenteric plexus
D. Muscularis mucosae

What demographic is most commonly affected by Zenker diverticulum?

_____ _____

Between Mallory-Weiss syndrome and esophageal varices, which presents with painful hematemesis and which presents with painless hematemesis?

Secondary achalasia in Chagas disease leads to failure of peristalsis and:
A. Esophageal dilatation
B. Gastric volvulus
C. Pyloric closure
D. Colonic ischemia

what is this?

A patient has achalasia, alacrima, and ACTH-resistant adrenal insufficiency. This syndrome is:
A. Allgrove syndrome
B. MEN 2A
C. Cowden syndrome
D. Peutz-Jeghers syndrome

The most feared complication of Boerhaave syndrome is:
A. Barrett metaplasia
B. Severe mediastinitis
C. Tracheoesophageal fistula
D. Portal hypertension

What type hernias are found in about half of patients with Mallory-Weiss syndrome and are considered a strong predisposing factor?

What test/imaging study is used to diagnose a Mallory-Weiss tear? _____

Proximal esophageal atresia with the distal esophagus arising from the trachea.

What is the likely diagnosis in a patient with alcohol use disorder who presents with epigastric pain and hematemesis following multiple episodes of vomiting (normal X-ray)?

What are dilated submucosal veins in the lower 1/3rd of the esophagus

esophageal varices rise secondary to _____ hypertension

_____ is characterized by disordered esophageal motility due to inability to relax the _____ esophageal sphincter

Dysphagia for both solids and liquids

Putrid breath

High LES pressure on esophageal manometry

Bird-beak sign on barium swallow study

A 45-year-old man presents after repeated episodes of forceful vomiting with hematemesis. He is hemodynamically stable, and the bleeding stops spontaneously. Which of the following best describes the underlying lesion?
A. Transmural rupture of the distal esophagus
B. Linear mucosal tear at the gastroesophageal junction
C. Variceal rupture due to portal hypertension
D. Full-thickness gastric perforation

A patient presents with chest pain and subcutaneous emphysema after severe vomiting. Imaging reveals pneumomediastinum. Which of the following best describes the underlying lesion?
A. Transmural rupture of the distal esophagus
B. Linear mucosal tear at the gastroesophageal junction
C. Variceal rupture due to portal hypertension
D. Full-thickness gastric perforation

A patient presents with hematemesis following excessive alcohol intake and vomiting. The bleeding is bright red and resolves without intervention. Which diagnosis is most likely?
A. Boerhaave syndrome
B. Esophageal varices
C. Mallory-Weiss tear
D. Peptic ulcer disease

delete

What is management of tracheoesophageal fistula?

Baby is born with respiratory distress and excess drooling

_____ _____

GERD: Reflux of acid from the stomach due to ____ ____ in the ____ esophageal sphincter

A newborn presents with excessive drooling, choking during feeds, and inability to pass a nasogastric tube into the stomach. Imaging reveals air in the stomach and intestines. Which of the following is the most likely anatomical abnormality?
A. Isolated esophageal atresia without fistula
B. H-type tracheoesophageal fistula without atresia
C. Proximal esophageal atresia with distal tracheoesophageal fistula
D. Distal esophageal atresia with proximal tracheoesophageal fistula

A 58-year-old man with a long history of GERD presents with worsening reflux symptoms and intermittent dysphagia. A hiatal hernia is suspected. What is the most appropriate initial diagnostic test?
A. Esophageal manometry
B. Upper endoscopy (EGD)
C. Barium swallow study
D. CT scan of the chest

A patient with chronic GERD is found to have a hiatal hernia on imaging. After initial evaluation, which test is most appropriate to assess for complications such as Barrett esophagus?
A. Esophageal manometry
B. Barium swallow
C. Upper endoscopy (EGD)
D. Abdominal ultrasound

Gastroesophageal reflux disease (GERD) may damage the ____ of teeth

Gastroesophageal reflux disease (GERD) may present with chronic cough and adult-onset _____

Gastroesophageal reflux disease (GERD) often presents with _____, which can mimic cardiac chest pain

what is this?

A huge risk factor for esophageal adenocarcinoma involves ____ ____

_____ of the esophagus is a malignant proliferation of glands

acidic damage to stomach mucosa: ____ gastristis

Dysphagia, Iron Deficiency Anemia, and Esophageal webs are the triad characteristic of which syndrome?

Neonate with extra-abdominal intestines; to the right of the umbilicus and not contained in a membrane?
A. Omphalocele
B. Gastroschisis
C. Umbilical hernia
D. Diaphragmatic hernia

A newborn has a midline defect with organs in a sac. What embryologic failure occurred?
A. Failure of lateral fold fusion
B. Failure of intestinal return to cavity
C. Failure of mesoderm differentiation
D. Failure of cloacal partitioning

often presents with a palpable olive -like mass in the epigastric region of the abdomen

is a congenital hypertrophy of the pyloric smooth muscle

Which antibiotic used in infants is associated with hypertrophic pyloric stenosis?

A 3-week-old infant presents with progressive, forceful vomiting after feeds. The vomitus is nonbilious, and the parents report increased hunger after episodes. On exam, visible peristaltic waves are noted across the abdomen. Which of the following additional findings is most likely on physical examination?
A. Diffuse abdominal tenderness with guarding
B. Palpable olive-like mass in epigastrium
C. Absent bowel sounds in all quadrants
D. Hepatosplenomegaly with abdominal distension

A patient is diagnosed with gastric cancer characterized by diffuse infiltration of the stomach wall and desmoplastic reaction causing linitis plastica. Which of the following risk factor profiles is most consistent with this condition?
A. Chronic Helicobacter pylori infection with intestinal metaplasia
B. High intake of nitrosamines from smoked foods
C. Blood type A with chronic atrophic gastritis
D. No association with Helicobacter pylori infection

acidic damage to stomach mucosa

chronic inflammation of stomach mucosa that leads to intestinal metaplasia

chronic or acute gastritis etiologies?

A 58-year-old woman has fatigue and glossitis. Labs show macrocytic anemia and elevated gastrin. Endoscopy shows fundic mucosal atrophy. Which mechanism best explains her condition?
A. T-cell destruction of parietal cells
B. Urease-mediated injury of antrum
C. NSAID-induced prostaglandin depletion
D. Zollinger-Ellison acid hypersecretion

A 49-year-old man has chronic epigastric pain. Gastric biopsy shows intestinal metaplasia in the antrum. Urea breath test is positive. What cancer risk is most increased?
A. Diffuse-type gastric adenocarcinoma
B. Intestinal-type gastric adenocarcinoma
C. Esophageal squamous cell carcinoma
D. Gastrointestinal stromal tumor

A patient with chronic gastritis is found to have achlorhydria, high gastrin, and anti–intrinsic factor antibodies. Which additional finding is most likely?
A. Antral-predominant active inflammation
B. Megaloblastic anemia from B12 deficiency
C. Positive stool antigen only
D. Duodenal ulcer from excess acid

A 45-year-old man has recurrent dyspepsia and a positive stool antigen test. Gastric biopsy shows chronic inflammation involving the antrum. Which treatment is most appropriate?
A. Vitamin B12 and iron
B. High-dose steroids and biopsy
C. PPI plus clarithromycin and amoxicillin
D. H2 blocker monotherapy alone

A patient has chronic gastritis with biopsy showing intestinal metaplasia. Which additional finding would most strongly favor autoimmune gastritis over chronic H pylori gastritis?
A. Positive urea breath test
B. Antral-predominant mucosal inflammation
C. Epigastric pain with ulceration
D. Anti-parietal cell antibodies

MALT lymphoma risk, what type of gastritis?

A 32-year-old man has recurrent epigastric pain that improves shortly after meals. Endoscopy shows an ulcer in the proximal duodenum. Which cause is most likely?
A. Helicobacter pylori infection
B. Chronic NSAID-associated injury
C. Gastric reflux into esophagus
D. Left gastric artery ischemia

A 61-year-old woman has epigastric pain that becomes worse with meals. Endoscopy shows an ulcer along the lesser curvature of the stomach. Which factor most likely caused this ulcer?
A. Hypertrophy of Brunner glands
B. Excess bicarbonate production
C. Long-term NSAID use
D. Elevated gastrin only

What ulcer? diagnostic endoscopic biopsy shows ulcer with hypertrophy of Brunner glands!

A patient with a posterior duodenal ulcer suddenly develops hematemesis and signs of shock. Which structure was most likely eroded?
A. Splenic artery posteriorly
B. Left gastric artery
C. Gastroduodenal artery
D. Inferior pancreaticoduodenal vein

A patient is diagnosed with a gastric ulcer. Which feature most strongly distinguishes it from a typical duodenal ulcer?
A. Usually improves after meals
B. Never requires biopsy
C. Higher malignant potential
D. Commonly caused by Zollinger-Ellison

duodenal ulcer is more present in anterior or posterior?

which ulcer is more likely to cause pancreatitis?

A 64-year-old man presents with weight loss and early satiety. Endoscopy reveals a large, irregular gastric ulcer with heaped-up margins along the lesser curvature of the antrum. Which type of gastric carcinoma is most likely?
A. Diffuse-type carcinoma with signet ring cells
B. Intestinal-type carcinoma forming glandular structures
C. Gastrointestinal stromal tumor with spindle cells
D. Primary gastric lymphoma from B cells

A patient is diagnosed with gastric adenocarcinoma located along the lesser curvature of the antrum. Which of the following risk factors is most strongly associated with this subtype?
A. Chronic autoimmune gastritis with achlorhydria
B. Intestinal metaplasia and nitrosamine exposure
C. CDH1 mutation causing E-cadherin loss
D. Epstein-Barr virus gastric infection

A 55-year-old patient presents with early satiety and weight loss. Endoscopy shows a diffusely thickened, rigid stomach wall without a discrete mass. Biopsy reveals malignant cells with mucin pushing the nucleus to the periphery. What is the most likely diagnosis?
A. Intestinal-type gastric adenocarcinoma forming glands
B. Diffuse-type gastric carcinoma with signet ring cells
C. Gastrointestinal stromal tumor with spindle cells
D. Primary gastric lymphoma from mucosal lymphoid tissue

what is this?

A patient is diagnosed with gastric cancer characterized by diffuse infiltration of the stomach wall and desmoplastic reaction causing linitis plastica. Which of the following risk factor profiles is most consistent with this condition?
A. Chronic Helicobacter pylori infection with intestinal metaplasia
B. High intake of nitrosamines from smoked foods
C. Blood type A with chronic atrophic gastritis
D. No association with Helicobacter pylori infection

_____ carcinoma presents late with weight loss, abdominal pain, anemia, _____ satiety

gastric carcinoma can spread to lymph nodes, such as the _____ supraclavicular node (_____ node)

Which type of gastric carcinoma is associated with a Sister Mary Joseph nodule? Kruckenburg?

Intestinal or Diffuse

Meckel diverticulum most commonly occurs in the:
A. Duodenum
B. Jejunum
C. Sigmoid colon
D. Ileum

The most common site of acquired diverticula (Pseudodiverticula) is the:
A. Transverse colon
B. Cecum
C. Ileum
D. Sigmoid colon

Congenital hypertrophic pyloric stenosis is more common in:
A. Males
B. Females
C. Turner patients only
D. Premature infants only

Which syndrome increases risk of hypertrophic pyloric stenosis?
A. Marfan syndrome
B. Turner syndrome
C. Down syndrome
D. Noonan syndrome

Which trisomy is linked to hypertrophic pyloric stenosis?
A. Trisomy 13
B. Trisomy 21
C. Trisomy 18
D. Trisomy 16

Which antibiotic exposure in the first 2 weeks increases pyloric stenosis risk?
A. Gentamicin
B. Azithromycin
C. Amoxicillin
D. Metronidazole

Another antibiotic linked to pyloric stenosis risk is:
A. Erythromycin
B. Vancomycin
C. Ceftriaxone
D. Doxycycline

intussusception: _____ of the bowel

A 2-year-old child develops episodic abdominal pain and vomiting. Imaging suggests that one bowel segment has invaginated into the immediately distal segment after a wave of peristalsis. Which diagnosis is most likely?

A. Volvulus
B. Intussusception
C. Adhesion
D. Incarcerated hernia

A 70-year-old patient presents with acute abdominal distention, obstipation, severe pain, and signs of bowel ischemia. Imaging suggests twisting of bowel around its mesenteric attachment. Which diagnosis is most likely?

A. Intussusception
B. Volvulus
C. Adhesion
D. Hernia

The pathophysiology of volvulus most directly causes:

A. Secretory and osmotic loss
B. Mucosal and lymphatic failure
C. Luminal and vascular compromise
D. Serosal and neural inflammation

Once the bowel segment becomes trapped in intussusception, ongoing peristalsis typically causes it to:

A. Retract spontaneously
B. Pull mesentery along
C. Perforate immediately
D. Untwist at the base

A pathology specimen shows necrosis limited to the mucosa and not extending beyond the muscularis mucosae. This is best classified as:

A. Mural infarction
B. Transmural infarction
C. Mucosal infarction
D. Serosal infarction

Infarction involving the mucosa and submucosa is best termed:

A. Mural infarction
B. Mucosal infarction
C. Transmural infarction
D. Mesenteric strangulation

Necrosis involving all layers of the intestinal wall, from the mucosa to the serosa.

A. Mucosal infarction
B. Mural infarction
C. Transmural infarction
D. Focal serosal necrosis

If untreated, intussusception may progress to:

A. Fistula and pseudomembranes
B. Dysentery, malabsorption, infarction
C. Obstruction, vessel compression, infarction
D. Ascites, jaundice, varices

Lactose intolerance is caused by decreased function of the _____ enzyme found in brush border enterocytes

A 28-year-old man presents with chronic diarrhea, weight loss, and fatigue. He also reports an intensely pruritic, blistering rash on his elbows and knees. Skin biopsy shows granular IgA deposition at the tips of dermal papillae. Which of the following is the most likely associated condition?
A. Psoriasis with autoimmune keratinocyte proliferation
B. Dermatitis herpetiformis associated with celiac disease
C. Pemphigus vulgaris with anti-desmoglein antibodies
D. Bullous pemphigoid with subepidermal blistering

A 24-year-old woman develops chronic diarrhea, bloating, and weight loss after eating wheat-containing foods. Small-bowel biopsy suggests immune-mediated enteropathy. Which diagnosis is most likely?

A. Environmental enteropathy
B. Celiac disease
C. Autoimmune enteropathy
D. Crohn disease

In celiac disease, gliadin peptides presented by HLA-DQ2/DQ8 primarily activate which immune cell?

A. CD8+ T cells
B. Plasma cells
C. CD4+ T cells
D. Neutrophils

Celiac disease most commonly involves which regions of the GI tract?

A. Duodenum and jejunum
B. Ileum and cecum
C. Stomach and duodenum
D. Colon and rectum

The malabsorption in celiac disease is most directly caused by:

A. Pancreatic enzyme deficiency
B. Ileal bile salt loss
C. Lymphatic obstruction
D. Loss of brush border

The most sensitive serologic test for celiac disease is measurement of IgA antibodies against:

A. Endomysium
B. Tissue transglutaminase
C. Gliadin peptidase
D. Deamidated gluten

The most common malignancy associated with celiac disease is:

A. Colonic adenocarcinoma
B. Gastric lymphoma
C. Enteropathy-associated T-cell lymphoma
D. Pancreatic adenocarcinoma

A 35-year-old man returns from the Caribbean with chronic diarrhea, weight loss, and fatigue following an episode of infectious gastroenteritis. Biopsy shows mucosal damage predominantly in the jejunum and ileum. Which of the following is the most likely diagnosis?
A. Celiac disease with villous atrophy
B. Tropical sprue responding to antibiotics
C. Crohn disease with transmural inflammation
D. Lactose intolerance with enzyme deficiency

A 52-year-old man presents with chronic diarrhea, weight loss, and bulky, foul-smelling stools. He also reports migratory joint pain. Small-bowel biopsy shows foamy macrophages in the lamina propria that stain positive with periodic acid–Schiff. Which of the following best explains his steatorrhea?
A. Macrophages compress lacteals and impair chylomicron transport
B. Autoimmune villous injury reduces brush-border enzyme activity
C. Pancreatic enzyme deficiency prevents intraluminal fat digestion
D. Terminal ileal inflammation blocks bile acid reabsorption

A patient with chronic malabsorption is found to have PAS-positive foamy macrophages in the lamina propria of the small intestine. Which infectious organism is most likely responsible for this finding?
A. Tropheryma whipplei within macrophage lysosomes
B. Giardia lamblia attached to duodenal mucosa
C. Mycobacterium avium in intestinal macrophages
D. Entamoeba histolytica invading the colonic wall

A 6-month-old infant presents with failure to thrive, chronic diarrhea, and steatorrhea. Laboratory studies show extremely low levels of LDL and VLDL. Which of the following is the most likely underlying defect?
A. Impaired synthesis of apolipoprotein B-48 and B-100
B. Defective pancreatic enzyme secretion into duodenum
C. Inability to reabsorb bile acids in terminal ileum
D. Autoimmune destruction of small intestinal villi

A child is diagnosed with a genetic disorder causing fat malabsorption due to defective chylomicron formation. Which of the following mechanisms best explains this finding?
A. Lack of apolipoprotein B prevents chylomicron assembly
B. Decreased bile salt synthesis impairs fat emulsification
C. Increased intestinal motility reduces fat absorption time
D. Brush border enzyme deficiency limits lipid digestion

A patient with abetalipoproteinemia is found to have absent circulating LDL and VLDL particles. Which of the following best explains this laboratory finding?
A. Failure of apolipoprotein B-100 production in liver
B. Increased clearance of lipoproteins by macrophages
C. Reduced dietary fat intake causing low lipid levels
D. Impaired conversion of HDL to LDL in circulation

A peripheral smear in a patient with abetalipoproteinemia would most likely show:

A. Schistocytes
B. Acanthocytes
C. Spherocytes
D. Target cells

Abetalipoproteinemia is best described as an inherited inability to:

A. Absorb gluten peptides
B. Hydrolyze brush-border sugars
C. Produce pancreatic lipase
D. Secrete triglyceride-rich lipoproteins

A 56-year-old patient is found to have a submucosal, polyp-like lesion in the small intestine during evaluation for vague abdominal discomfort. Biopsy reveals a low-grade malignant tumor composed of neuroendocrine cells. Which of the following is the most likely diagnosis?
A. Gastrointestinal stromal tumor from interstitial cells
B. Carcinoid tumor from neuroendocrine cell proliferation
C. Adenocarcinoma forming irregular glandular structures
D. Primary intestinal lymphoma from B lymphocytes

A patient with a small bowel tumor develops flushing, diarrhea, and wheezing. Laboratory testing shows elevated urinary 5-HIAA levels. Why are these symptoms typically absent in early disease?
A. Serotonin is degraded by hepatic monoamine oxidase
B. Tumor does not produce vasoactive substances initially
C. Kidneys rapidly excrete serotonin before circulation
D. Intestinal enzymes inactivate serotonin before absorption

A patient with a neuroendocrine tumor of the gut is asymptomatic until liver metastases develop. Which of the following best explains the onset of carcinoid syndrome at that stage?
A. Increased tumor size leads to intestinal obstruction
B. Metastases bypass hepatic metabolism of serotonin
C. Liver failure increases production of serotonin
D. Immune response triggers systemic cytokine release

A 60-year-old patient with a known small bowel neuroendocrine tumor develops flushing, diarrhea, and wheezing. Imaging reveals liver metastases. What is the most likely explanation for the onset of these symptoms?
A. Increased local tumor growth causing bowel obstruction
B. Serotonin release bypasses hepatic metabolism via metastases
C. Decreased monoamine oxidase activity in intestinal mucosa
D. Enhanced renal reabsorption of serotonin metabolites

Gastric carcinoid tumors may be associated with autoimmune chronic:
A. superficial gastritis
B. erosive gastritis
C. atrophic gastritis
D. viral gastritis

A syndrome associated with gastric neuroendocrine tumors is:
A. Peutz-Jeghers syndrome
B. Zollinger-Ellison syndrome
C. Carney triad
D. Cowden syndrome

Neuroendocrine tumors within the stomach and duodenum ______ metastasize and are generally cured by resection.

Neuroendocrine tumors that arise in the ____ and ____ are often multiple and tend to be aggressive.

Rectal neuroendocrine tumors tend to produce:
A. catecholamines
B. bile salts
C. polypeptide hormones
D. mucin only

Symptomatic rectal neuroendocrine tumors may present with:
A. abdominal pain and weight loss
B. jaundice and ascites
C. dysphagia and regurgitation
D. hemoptysis and cough

In Hirschsprung disease, which segment is always involved?
A. cecum
B. sigmoid colon
C. ileum
D. rectum

Hirschsprung disease is also called:
A. Congenital pyloric stenosis
B. Functional ileus syndrome
C. Congenital aganglionic megacolon
D. Distal colonic atresia

Hirschsprung disease results from abnormal migration or loss of:
A. Smooth muscle cells
B. Neural crest-derived ganglion cells
C. Enterochromaffin cells
D. Mesothelial cells

Definitive diagnosis of Hirschsprung disease requires absence of:
A. Goblet cells
B. Paneth cells
C. Ganglion cells
D. Chief cells

Ganglion cells in Hirschsprung evaluation may be identified using stains for:
A. Creatine kinase
B. Acetylcholinesterase
C. Myeloperoxidase
D. Acid phosphatase

A large Zenker diverticulum commonly causes:
A. Regurgitation and halitosis
B. Hematemesis and melena
C. Jaundice and pruritus
D. Tenesmus and fever

Nutcracker esophagus reflects loss of coordination between the:
A. Mucosa and serosa
B. Circular and longitudinal muscle
C. Vagus and phrenic nerves
D. Upper and lower sphincters

Nutcracker esophagus is characterized by:
A. Absent lower sphincter tone
B. Distal perforation
C. High-amplitude distal contractions
D. Proximal web formation

A newborn fails to pass meconium within the first 48 hours and develops abdominal distension. Rectal biopsy shows absence of ganglion cells in the distal colon. Which of the following is the most appropriate definitive treatment?
A. Resection of aganglionic bowel segment
B. High-fiber diet with stool softeners
C. Long-term laxative therapy for motility
D. Endoscopic dilation of narrowed segment

outpounchings of mucosa and submucosa through muscularis propria: ______ diverticula

A 68-year-old man with chronic constipation presents with left lower quadrant pain and fever. CT scan shows inflamed outpouchings in the sigmoid colon. What is the underlying structural abnormality?
A. Herniation of mucosa through muscularis propria
B. Full-thickness outpouching involving all bowel layers
C. Transmural inflammation with granuloma formation
D. Hypertrophy of circular muscle without herniation

An elderly patient presents with painless hematochezia. Colonoscopy reveals multiple diverticula in the sigmoid colon. Which anatomic feature explains where these lesions most commonly form?
A. Areas of maximal peristaltic contraction
B. Sites where vasa recta penetrate bowel wall
C. Regions of highest lymphoid tissue density
D. Junction between small and large intestine

A patient develops a fistula connecting the colon to the bladder. What is the most likely preceding condition?
A. Chronic low-fiber diet without inflammation
B. Acute appendicitis in right lower quadrant
C. Diverticulitis with localized inflammation
D. Ischemic colitis with mucosal necrosis

Which of the following best distinguishes colonic diverticulosis from a true diverticulum such as Meckel diverticulum?
A. Location in distal small intestine
B. Presence of ectopic gastric mucosa
C. Involvement of all bowel wall layers
D. Only mucosa and submucosa herniate

A 72-year-old patient has long-standing constipation and is diagnosed with colonic diverticulosis. Which factor most contributed to the development of this condition?
A. High-fiber diet increasing stool bulk
B. Increased intraluminal pressure from straining
C. Rapid intestinal transit time
D. Decreased colonic segmentation activity

An older adult presents with intermittent lower GI bleeding. Colonoscopy shows malformed mucosal and submucosal vessels in the cecum. Which diagnosis best fits?

A. Volvulus
B. Angiodysplasia
C. Dysentery
D. Intussusception

A 34-year-old woman presents with recurrent nosebleeds and episodes of gastrointestinal bleeding. Physical exam reveals multiple small red lesions on the lips and oral mucosa. Which of the following is the most likely underlying condition?
A. Autosomal dominant disorder causing fragile blood vessels
B. Autoimmune vasculitis with immune complex deposition
C. Platelet dysfunction due to von Willebrand deficiency
D. Vitamin C deficiency impairing collagen synthesis

A patient with hereditary hemorrhagic telangiectasia develops chronic iron deficiency anemia. Which of the following best explains the source of bleeding?
A. Ulceration from gastric acid hypersecretion
B. Rupture of thin-walled mucosal blood vessels
C. Immune-mediated destruction of vascular endothelium
D. Thrombocytopenia causing impaired clot formation

A 40-year-old man has a history of recurrent epistaxis and visible telangiectasias on his tongue. Which inheritance pattern is most consistent with this condition?
A. Autosomal recessive with enzyme deficiency
B. X-linked recessive affecting clotting factors
C. Autosomal dominant with vascular malformations
D. Mitochondrial inheritance affecting energy metabolism

A 72-year-old man with a history of atherosclerosis presents with sudden left lower quadrant abdominal pain followed by bloody diarrhea. Which area of the colon is most likely affected?
A. Cecum supplied by ileocolic artery
B. Transverse colon near hepatic flexure
C. Splenic flexure watershed region
D. Rectum supplied by inferior rectal artery

A patient with severe atherosclerosis develops postprandial abdominal pain and weight loss. Which mechanism best explains progression to ischemic colitis?
A. Reduced blood flow through superior mesenteric artery
B. Autoimmune inflammation of colonic mucosa
C. Increased intraluminal pressure from constipation
D. Venous thrombosis of inferior mesenteric vein

A hospitalized patient develops acute abdominal pain and later passes bloody stools. Imaging suggests colonic ischemia. Which sequence best explains this presentation?
A. Chronic inflammation leads to mucosal ulceration
B. Ischemia progresses to infarction causing bleeding
C. Infection causes toxin-mediated epithelial damage
D. Obstruction leads to proximal bowel dilation

A 35-year-old woman presents with recurrent abdominal pain, bloating, and alternating diarrhea and constipation. She notes that her pain improves after bowel movements. Which of the following is the most likely diagnosis?
A. Irritable bowel syndrome with functional bowel disorder
B. Crohn disease with transmural inflammation
C. Ulcerative colitis with continuous mucosal ulceration
D. Celiac disease with gluten-induced villous atrophy

A patient reports chronic abdominal discomfort associated with changes in bowel habits. Extensive workup including colonoscopy is normal. Which feature most strongly supports irritable bowel syndrome?
A. Pain improves after defecation
B. Presence of bloody diarrhea
C. Unintentional weight loss
D. Nocturnal awakening with symptoms

A 60-year-old patient undergoes routine colonoscopy, which reveals multiple small polyps in the rectosigmoid colon. Biopsy shows serrated architecture with hyperplasia of glands but no dysplasia. What is the most likely diagnosis?
A. Hyperplastic polyp
B. Adenomatous polyp
C. Hamartomatous polyp
D. Inflammatory polyp

A patient is found to have a colonic polyp with serrated histologic appearance and polyclonal glandular hyperplasia. Which of the following best describes its malignant potential?
A. High risk of progression to adenocarcinoma
B. Moderate risk depending on size
C. No risk of malignant transformation
D. Risk only if associated with inflammation

Which of the following features most strongly supports a diagnosis of hyperplastic polyp rather than an adenomatous polyp?
A. Presence of dysplastic epithelial cells
B. Serrated glands without cytologic atypia
C. Villous architecture with high mitotic activity
D. Large size with irregular borders

A 58-year-old patient undergoes colonoscopy and is found to have a polyp. Biopsy reveals monoclonal proliferation of dysplastic glandular epithelium. Which of the following is the most likely diagnosis?
A. Hyperplastic polyp with polyclonal gland growth
B. Adenomatous polyp with neoplastic gland proliferation
C. Hamartomatous polyp with disorganized tissue elements
D. Inflammatory polyp with regenerative mucosal changes

A patient is diagnosed with a colonic polyp that is benign but has potential to progress to malignancy. Which pathway best describes this progression?
A. Chronic inflammation to dysplasia sequence
B. Adenoma to carcinoma sequence
C. Metaplasia to hyperplasia sequence
D. Hamartoma to sarcoma sequence

Which dietary pattern most promotes progression of diverticular disease?

A. High-protein diet
B. High-fat diet
C. Lactose-free diet
D. Low-fiber diet

Which statement about diverticular disease is most accurate?

A. Usually presents with obstruction
B. Most patients are asymptomatic
C. Has high malignant potential
D. Usually involves true diverticula

The pathogenesis of diverticular disease is most closely related to:

A. Elevated intraluminal pressure
B. Transmural granulomatous inflammation
C. Mucosal ischemic necrosis
D. Defective enteric innervation

Colorectal adenocarcinoma develops in ____% of untreated FAP patients

Which finding is required for diagnosis of classic familial adenomatous polyposis?

A. At least 10 polyps
B. Rectal cancer before age 30
C. Biallelic APC mutation only
D. At least 100 polyps

Familial adenomatous polyposis is best described as which syndrome?

A. APC-associated adenomatous polyposis
B. Mismatch repair deficiency syndrome
C. Hamartomatous polyposis syndrome
D. Biallelic MYH serrated syndrome

The standard preventive treatment for classic familial adenomatous polyposis is:

A. Annual polypectomy
B. Endoscopic ablation
C. Prophylactic colectomy
D. Small-bowel resection

After colectomy for FAP, which medication class can reduce polyps in the residual rectum?

A. NSAIDs
B. Antimetabolites
C. Corticosteroids
D. Bile acid binders

A 3-year-old child presents with painless rectal bleeding. Parents report a small mass that occasionally protrudes from the rectum during defecation. Which of the following is the most likely diagnosis?
A. Juvenile polyp with benign hamartomatous growth
B. Juvenile polyp with dysplastic epithelial cells
C. Hyperplastic polyp with serrated glandular pattern
D. Hyperplastic polyp due to chronic colitis

A 16-year-old girl presents with multiple dark pigmented spots on her lips and oral mucosa. She has a history of recurrent abdominal pain, and imaging reveals multiple polyps throughout the gastrointestinal tract. Which of the following is the most likely diagnosis?
A. Peutz-Jeghers syndrome
B. Familial adenomatous polyposis
C. Lynch syndrome
D. Juvenile polyposis

A 4-year-old child presents with intermittent painless rectal bleeding. Colonoscopy reveals a solitary rectal polyp composed of disorganized but mature tissue elements. Which diagnosis is most likely?

A. Hyperplastic polyp
B. Tubular adenoma
C. Juvenile polyp
D. Inflammatory pseudopolyp

Juvenile polyps are best classified as:

A. Hamartomatous polyps
B. Neoplastic adenomas
C. Inflammatory lesions
D. Vascular malformations

Which presentation is most typical of a juvenile polyp?

A. Watery secretory diarrhea
B. Small bowel obstruction
C. Mucocutaneous pigmentation
D. Rectal bleeding

A child has multiple hamartomatous colorectal polyps and a family history of similar lesions. Which syndrome should raise concern for future colonic adenocarcinoma?

A. Lynch syndrome
B. FAP
C. Juvenile polyposis syndrome
D. Cowden syndrome

Juvenile polyposis syndrome is often associated with mutation in:

A. SMAD4
B. APC
C. KRAS
D. MLH1

The major long-term malignancy risk in juvenile polyposis syndrome is:

A. Gastric lymphoma
B. Pancreatic carcinoma
C. Small bowel carcinoid
D. Colonic adenocarcinoma

In Peutz-Jeghers syndrome, hamartomatous polyps most often involve the:

A. Small intestine
B. Rectum
C. Esophagus
D. Appendix

Which gene is characteristically mutated in Peutz-Jeghers syndrome?

A. SMAD4
B. TP53
C. STK11
D. BRAF

A 10-year-old boy presents with acute abdominal pain that began periumbilically and migrated to the right lower quadrant. Imaging confirms appendicitis. Which of the following is the most likely underlying cause in this patient?
A. Lymphoid hyperplasia causing luminal obstruction
B. Fecalith obstruction of appendiceal lumen
C. Autoimmune inflammation of intestinal mucosa
D. Ischemic injury from vascular insufficiency

A 35-year-old man presents with right lower quadrant abdominal pain, fever, and leukocytosis. Which of the following mechanisms most likely initiated this condition?
A. Obstruction by fecalith leading to bacterial overgrowth
B. Viral infection causing diffuse mucosal inflammation
C. Decreased blood flow causing ischemic necrosis
D. Autoimmune destruction of appendiceal tissue

A 29-year-old patient has chronic abdominal pain and diarrhea. Endoscopy shows inflamed bowel separated by normal intervening mucosa. Which diagnosis is most likely?

A. Ulcerative colitis
B. Ischemic colitis
C. Crohn disease
D. Microscopic colitis

Which feature best distinguishes Crohn disease from ulcerative colitis?

A. Transmural inflammation
B. Rectal involvement
C. Toxic megacolon risk
D. Mucosal ulceration only

A patient with inflammatory bowel disease develops enteroenteric fistulas and bowel wall fibrosis. Which diagnosis best fits?

A. Ulcerative colitis
B. Infectious colitis
C. Pseudomembranous colitis
D. Crohn disease

Which distribution is most typical of ulcerative colitis?

A. Any GI segment
B. Colon and rectum
C. Small bowel only
D. Stomach and duodenum

Histology from an inflamed bowel segment shows noncaseating granulomas and transmural inflammation. Which disorder is most likely?

A. Crohn disease
B. Ulcerative colitis
C. Ischemic colitis
D. Diverticulitis

A patient with longstanding inflammatory bowel disease develops severe colonic dilation and systemic toxicity. Which disease is classically associated with this complication?

A. Crohn disease
B. Celiac disease
C. Angiodysplasia
D. Ulcerative colitis

Which gross feature is classically associated with Crohn disease?

A. Continuous rectosigmoid disease
B. Diffuse pseudopolyposis
C. Creeping fat
D. Superficial mucosal erosion

Ulcerative colitis is typically confined to which bowel layers?

A. Muscularis and serosa
B. Mucosa and superficial submucosa
C. Full bowel wall thickness
D. Subserosa and mesentery

A patient with Crohn disease develops recurrent obstructive symptoms from fibrosing bowel narrowing. Which treatment is often required?

A. Surgical resection
B. Total colectomy
C. Air enema reduction
D. Anticoagulation

A patient with severe ulcerative colitis undergoes total colectomy. What is the expected effect on the intestinal disease?

A. Disease shifts to ileum
B. Fistulas continue
C. Skip lesions persist
D. Intestinal disease is cured

A 29-year-old man with chronic inflammatory bowel disease presents with fatigue and pruritus. Laboratory testing reveals a cholestatic pattern, and imaging shows multifocal stricturing of the bile ducts. Which of the following associated conditions is most likely present?
A. Primary sclerosing cholangitis with p-ANCA positivity
B. Autoimmune hepatitis with anti-smooth muscle antibodies
C. Primary biliary cholangitis with antimitochondrial antibodies
D. Alcoholic liver disease with AST greater than ALT

what is this associated with?

UC or Crohns?

UC or Crohns?

what is happening here?

UC or Crohns?

UC or Crohns?

A neonate with polyhydramnios has excessive salivation, choking with feeds, and failure to pass an NG tube. Esophageal atresia most commonly occurs near which anatomic level?

A. Upper esophageal sphincter
B. Tracheal bifurcation
C. Diaphragmatic hiatus
D. Gastroesophageal junction

Prenatal imaging shows abdominal viscera in the thorax. After delivery, the infant develops severe respiratory distress. Which paired finding is most characteristic of congenital diaphragmatic hernia?

A. Right-sided defect; pulmonary hypoplasia
B. Left-sided defect; renal agenesis
C. Right-sided defect; bowel atresia
D. Left-sided defect; pulmonary hypoplasia

A newborn has a midline abdominal wall defect covered by a membranous sac. Which genetic association is classically linked to this lesion?

A. Down syndrome
B. Turner syndrome
C. Marfan syndrome
D. Noonan syndrome

Endoscopy identifies an “inlet patch” of ectopic gastric mucosa in the esophagus. Where is this finding most commonly located?

A. Distal third
B. Gastric cardia
C. Upper third
D. Terminal ileum

A child presents with painless lower GI bleeding from a congenital true diverticulum containing ectopic tissue. This lesion most commonly arises in the:

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

Meckel diverticulum results from failure of involution of a structure that normally connects the:

A. Foregut to allantois
B. Hindgut to cloaca
C. Developing gut to yolk sac
D. Stomach to liver bud

A neonate with abdominal distention and empty rectum is suspected of having Hirschsprung disease. Which gene is most classically implicated by loss-of-function mutation?

A. APC
B. CFTR
C. FBN1
D. RET

What is the earliest classic postnatal clue to Hirschsprung disease?

A. Bilious emesis
B. Failure to pass meconium
C. Projectile vomiting
D. Hematochezia

A patient with intermittent chest pain and dysphagia has a barium swallow showing a corkscrew esophagus. Which manometric feature best fits this disorder?

A. Normal amplitude contractions
B. Increased LES relaxation
C. Absent peristaltic activity
D. Gray-white pseudomembranes

A patient has recurrent chest pain with hypertensive but coordinated peristaltic waves on manometry. Which description would argue against nutcracker esophagus?

A. Low-amplitude coordinated waves
B. High-amplitude coordinated waves
C. High-amplitude uncoordinated waves
D. Absent LES relaxation

In Plummer-Vinson syndrome, esophageal webs classically occur with glossitis, cheilosis, and:

A. Hemolytic anemia
B. Iron deficiency anemia
C. Pernicious anemia
D. Aplastic anemia

A patient with dysphagia to solids and liquids has incomplete lower esophageal sphincter relaxation. Which additional pair completes the classic achalasia triad?

A. Increased tone with aperistalsis
B. Low tone with spasm
C. Normal tone with eosinophilia
D. Weak tone with webs

After repeated retching, a patient develops hematemesis. Endoscopy shows longitudinal mucosal lacerations near the gastroesophageal junction. These lesions are called:

A. Boerhaave rupture
B. Mallory-Weiss tears
C. Barrett metaplasia
D. Plummer-Vinson webs

Which precipitating event most classically causes Mallory-Weiss tears?

A. Portal venous congestion
B. Atopic mucosal inflammation
C. Chronic caustic ingestion
D. Repetitive forceful vomiting

Candidiasis of the esophagus is characterized by:

A. Linear mucosal furrows
B. Salmon-colored mucosa
C. Gray-white pseudomembranes
D. Circumferential ulcers

Which mechanism is a major driver of GERD pathogenesis?

A. Transient LES relaxation
B. Esophageal muscular hypertrophy
C. Congenital distal web
D. Chronic fungal colonization

Biopsy of distal esophageal mucosa in chronic reflux disease most classically shows:

A. Goblet cell metaplasia
B. Basal zone hyperplasia
C. Full-thickness dysplasia
D. Granulomatous inflammation

A patient with chronic heartburn and acid regurgitation has uncomplicated GERD. Which drug class is standard therapy?

A. Sucralfate
B. Budesonide
C. Octreotide
D. Proton pump inhibitors

A young adult with asthma and multiple food allergies has recurrent solid-food dysphagia. Which underlying process best fits eosinophilic esophagitis?

A. Atopic disease
B. Alcohol misuse
C. Chagas disease
D. Portal hypertension

A cirrhotic patient presents with massive hematemesis from dilated submucosal veins in the distal esophagus. The most likely underlying cause is:

A. Diffuse esophageal spasm
B. Incomplete LES relaxation
C. Portal hypertension
D. Iron deficiency anemia

Barrett esophagus represents which metaplastic transition?

A. Columnar to squamous
B. Squamous to cuboidal
C. Glandular to squamous
D. Squamous to columnar

Which cell type is required for the diagnosis of Barrett esophagus?

A. Paneth cells
B. Goblet cells
C. Chief cells
D. Parietal cells

Which epidemiologic pattern for esophageal cancer is correct?

A. West squamous, world adenocarcinoma
B. West adenocarcinoma, world adenocarcinoma
C. West adenocarcinoma, world squamous
D. West squamous, world squamous

Which condition is a major risk factor for esophageal adenocarcinoma?

A. Barrett esophagus
B. Alcohol dependence
C. Nutcracker esophagus
D. Candida esophagitis

Esophageal adenocarcinoma most often arises in which location?

A. Proximal third
B. Distal third
C. Midesophagus
D. Upper esophageal sphincter

Which exposure pattern is most strongly associated with esophageal squamous cell carcinoma?

A. Chronic iron deficiency
B. Childhood atopy
C. Barrett metaplasia
D. Alcohol and tobacco

Which esophageal malignancy is more likely to spread to lymph nodes and carry a poorer prognosis?

A. Esophageal squamous carcinoma
B. Distal Barrett adenocarcinoma
C. Mallory-Weiss syndrome
D. Candidal esophagitis

Acute gastritis is defined histologically by the presence of:

A. Neutrophils
B. Eosinophils
C. Plasma cells
D. Fibroblasts

chronic use of what can cause gastritis by inhibiting production of vasodilation products?

A critically ill patient with extensive full-thickness burns develops hematemesis several days after admission. Which ulcer type is most classically associated with this setting?

A. Cushing ulcer
B. Stress-free ulcer
C. Curling ulcer
D. Marginal ulcer

Ulcers occurring in the context of intracranial disease is termed:

A. Curling ulcer
B. Cushing ulcer
C. Meckel ulcer
D. Dieulafoy ulcer

Chronic gastritis worldwide is most commonly caused by:

A. Autoimmune injury
B. Crohn disease
C. NSAID exposure
D. Helicobacter pylori

H. pylori occurs mostly in which part of the stomach?

A. Body
B. Fundus
C. Incisura
D. Antrum

A urease breath test is positive in a patient with dyspepsia. H. pylori uses urease primarily to generate which compound that promotes survival?

A. Nitric oxide
B. Hydrogen peroxide
C. Ammonia
D. Sulfur dioxide

Expression of CagA by H. pylori has what effect on gastric cancer risk?

A. Eliminates malignant potential
B. Decreases dysplasia risk
C. Has no prognostic role
D. Increases cancer risk

A patient with chronic H. pylori gastritis develops dense lymphoid aggregates in the stomach. This infection is a risk factor for formation of:

A. GIST
B. Carcinoid tumor
C. MALT lymphoma
D. Leiomyoma

Which feature best distinguishes autoimmune gastritis from H. pylori gastritis?

A. Antral predominance
B. Hypergastrinemia with antral sparing
C. Urease-mediated ammonia production
D. Curling ulcers after burns

Autoimmune gastritis is primarily associated with immune-mediated loss of which gastric cell type?

A. Mucous neck cells
B. Chief cells
C. G cells
D. Parietal cells

A patient with autoimmune atrophic gastritis develops fatigue, glossitis, and macrocytosis. Which associated manifestation is most expected?

A. Iron deficiency anemia
B. Hemolytic anemia
C. Megaloblastic anemia
D. Microcytic anemia

Histology from autoimmune atrophic gastritis most characteristically shows injury involving which anatomic regions?

A. Cardia and pylorus
B. Body and fundus
C. Antrum and cardia
D. Pylorus and duodenum

A patient with peripheral eosinophilia and recurrent gastric symptoms has biopsy-proven eosinophilic gastritis. Which mechanism is most likely responsible?

A. Allergic reaction
B. Portal hypertension
C. H. pylori colonization
D. Intracranial hypertension

In Western populations, the most common cause of granulomatous gastritis is:

A. Sarcoidosis
B. Tuberculosis
C. Crohn disease
D. Whipple disease

Which trio most completely accounts for the great majority of peptic ulcers involving the stomach or duodenum?

A. Alcohol, steroids, CMV
B. H. pylori, NSAIDs, smoking
C. Autoimmunity, Crohn, stress
D. Zollinger-Ellison, burns, trauma

Peptic ulcer disease most commonly affects which gastric location?

A. Greater curvature body
B. Cardia near GE junction
C. Fundus along posterior wall
D. Antrum lesser curvature

H. pylori infection that predominantly involves the fundus and body is most associated with which physiologic pattern?

A. Increased acid without atrophy
B. Decreased acid with atrophy
C. Normal acid with ulcers
D. Increased gastrin without injury

Which condition carries the greater association with gastric adenocarcinoma?

A. Autoimmune atrophic gastritis
B. H. pylori antral gastritis
C. Eosinophilic gastritis
D. Granulomatous Crohn gastritis

A patient with giant rugal folds, edema, and protein-losing gastropathy is found to have overexpression of which cytokine?

A. Transforming growth factor beta
B. Tumor necrosis factor alpha
C. Transforming growth factor alpha
D. Epidermal growth factor

Menetrier disease is most classically characterized by which pair of findings?

A. Parietal hyperplasia and hypercalcemia
B. Goblet metaplasia and dysphagia
C. Chief cell loss and ulceration
D. Foveolar hyperplasia and hypoproteinemia

A patient has severe recurrent peptic ulcers and markedly increased gastrin levels from a pancreatic neuroendocrine tumor. Which gastric cell type is expected to be especially enlarged?

A. Parietal cells
B. Chief cells
C. Mucous neck cells
D. Enterochromaffin cells

Zollinger-Ellison gastrinomas are classically associated with which inherited syndrome?

A. MEN2A
B. MEN2B
C. MEN1
D. VHL syndrome

Fundic gland polyps and intestinal-type gastric adenocarcinoma are both associated with mutations in which gene?

A. RB1
B. APC
C. KRAS
D. SMAD4

Which set best lists classic metastatic sites of gastric adenocarcinoma?

A. Cervical spine, liver, spleen, lung
B. Brain, pancreas, kidney, femur
C. Virchow, umbilical, ovaries, axilla
D. Adrenal, pleura, jejunum, bladder

A family with hereditary diffuse gastric cancer is found to carry a germline mutation in which gene?

A. MLH1
B. STK11
C. KIT
D. CDH1

Which viral infection is implicated in lymphoproliferation and GI lymphoma formation?

A. Epstein-Barr virus
B. Cytomegalovirus
C. Human papillomavirus
D. Hepatitis B virus

A patient with episodic flushing develops wheezing, secretory diarrhea, and tricuspid dysfunction. Which syndrome best fits this presentation?

A. VIPoma syndrome
B. Zollinger-Ellison syndrome
C. Carcinoid syndrome
D. Menetrier disease

Neuroendocrine tumors from which embryologic region tend to be the most aggressive?

A. Foregut
B. Midgut
C. Hindgut
D. Cloacal remnant

A submucosal GI spindle-cell tumor is found to arise from the gut’s pacemaker cells. What is its cell of origin?

A. Smooth muscle cells
B. Enteric ganglion cells
C. Schwann cells
D. Interstitial cells of Cajal

About 75% of gastrointestinal stromal tumors harbor gain-of-function mutations in which gene?

A. KIT
B. RET
C. APC
D. CDH1

Worldwide, the most frequent cause of intestinal obstruction is:

A. Hernias
B. Volvulus
C. Intussusception
D. Adhesions

An elderly patient develops sudden abdominal pain, distention, and bowel ischemia after a segment of colon twists around its mesenteric attachment. This process is termed:

A. Intussusception
B. Volvulus
C. Ileus
D. Stricture

A 14-month-old child develops intermittent colicky pain, vomiting, and drawing up of the legs. Which is the most common cause of intestinal obstruction in children younger than 2 years?

A. Hirschsprung disease
B. Inguinal hernia
C. Intussusception
D. Midgut volvulus

A patient with profound hypotension develops ischemic colitis at a bowel region supplied by the terminal branches of both the SMA and IMA. Which site is this severe watershed zone?

A. Cecum
B. Splenic flexure
C. Rectosigmoid junction
D. Terminal ileum

A premature, low-birth-weight neonate develops abdominal distention, bloody stools, and pneumatosis intestinalis. Which GI emergency best fits?

A. Meconium ileus
B. Jejunal atresia
C. Hirschsprung enterocolitis
D. Necrotizing enterocolitis

Which HLA profile is most strongly associated with celiac disease?

A. HLA-B27 and DR4
B. HLA-DQ2 and DQ8
C. HLA-A3 and B8
D. HLA-DR3 and DR5

Autoimmune enteropathy is classically associated with mutations in which gene?

A. APC
B. FOXP3
C. RET
D. MYO5B

An infant with intractable secretory diarrhea is diagnosed with microvillus inclusion disease. Which gene is most likely mutated?

A. MTP
B. CFTR
C. MYO5B
D. FOXP3

Abetalipoproteinemia is caused by mutation in which protein?

A. MTP
B. ApoA-I
C. NPC1L1
D. LDL receptor

A patient with profuse “rice-water” diarrhea is infected by a comma-shaped gram-negative organism. Which pathogen best fits?

A. Shigella dysenteriae
B. Salmonella typhi
C. Campylobacter jejuni
D. Vibrio cholerae

Which cholera toxin component is responsible for the downstream activation leading to CFTR-mediated ion and water efflux?

A. B subunit
B. M protein
C. A subunit
D. S1 nuclease

Based on the material provided, the most common bacterial cause of traveler’s diarrhea and food poisoning is:

A. Salmonella enteritidis
B. Campylobacter jejuni
C. Vibrio cholerae
D. Shigella sonnei

A patient develops inflammatory diarrhea after undercooked poultry and later presents with asymmetric arthritis. Which HLA type is associated with this postinfectious complication?

A. HLA-B27
B. HLA-DQ2
C. HLA-DR4
D. HLA-DQ8

A patient develops ascending weakness several weeks after diarrheal illness due to Campylobacter jejuni. Which neurologic complication is classically associated?

A. Multiple sclerosis
B. Myasthenia gravis
C. Guillain-Barré syndrome
D. Subacute combined degeneration

Campylobacter jejuni is best described as which of the following?

A. Bacillus, gram-positive
B. Comma-shaped, gram-negative
C. Cocci, gram-negative
D. Spiral, acid-fast

Which statement about Shigella is correct?

A. Gram-positive coccus
B. Acid-fast bacillus
C. Gram-negative organism
D. Encapsulated diplococcus

Shigella organisms are classically taken up by which intestinal cells?

A. Goblet cells
B. M cells
C. Paneth cells
D. Enteroendocrine cells

A foodborne diarrheal illness is caused by a gram-negative bacillus. Which organism best matches this morphology and classification?

A. Vibrio cholerae
B. Campylobacter jejuni
C. Shigella flexneri
C. Salmonella enteritidis

Nontyphoidal salmonellosis is most classically caused by:

A. Salmonella typhi
B. Campylobacter jejuni
C. Salmonella enteritidis
D. Shigella sonnei

Which organism is the classic cause of typhoid fever?

A. Salmonella typhi
B. Salmonella enteritidis
C. Vibrio cholerae
D. Shigella dysenteriae

Typhoid fever disseminates primarily through:

A. Bile and pancreatic ducts
B. Blood and lymphatics
C. Portal venous shunts
D. Intestinal crypt abscesses

A patient with typhoid fever develops abdominal distention and GI bleeding from inflamed lymphoid tissue in the ileum. Which structure is classically enlarged?

A. Brunner glands
B. Crypts of Lieberkühn
C. Peyer patches
D. Paneth cells

Which statement about typhoid fever is most accurate?

A. It remains confined to colon
B. It causes only watery diarrhea
C. It resolves without complications
D. It can cause extraintestinal disease

A child with iron overload develops enterocolitis from a pathogen that invades M cells and is enhanced by iron availability. Which organism best fits?

A. Yersinia enterocolitica
B. Vibrio cholerae
C. Campylobacter jejuni
D. Enterotoxigenic E. coli

Which extraintestinal manifestation is classically associated with Yersinia infection?

A. Hemolytic anemia
B. Erythema nodosum
C. Right-sided valvulopathy
D. Migratory thrombophlebitis

A patient with Yersinia enterocolitica develops symptoms outside the intestine. Which additional finding is characteristic?

A. Hemoptysis
B. Uveitis
C. Glossitis
D. Pharyngitis

Another patient with Yersinia infection presents with joint pain several days after enterocolitis. Which extraintestinal manifestation best fits?

A. Raynaud phenomenon
B. Facial nerve palsy
C. Arthralgia
D. Polycythemia

Which morphology best describes Escherichia coli?

A. Gram-negative bacillus
B. Gram-positive coccus
C. Acid-fast bacillus
D. Encapsulated diplococcus

A child develops hemorrhagic colitis after eating undercooked beef. Antibiotics are avoided because toxin release may precipitate which complication?

A. Reactive arthritis
B. Toxic megacolon
C. Hemolytic-uremic syndrome
D. Guillain-Barré syndrome

A hospitalized patient develops fever, abdominal cramping, and pseudomembranes after broad-spectrum antibiotic use. Which pathogen is most likely responsible?

A. Clostridium difficile
B. Salmonella typhi
C. Norovirus
D. Giardia lamblia

Which treatment pair is listed as effective first-line therapy for C. difficile infection?

A. Ciprofloxacin and rifaximin
B. Metronidazole and vancomycin
C. Ceftriaxone and azithromycin
D. Trimethoprim and sulfamethoxazole

In Whipple disease, malabsorptive diarrhea most directly reflects:

A. Crypt cell apoptosis
B. Villous autoantibodies
C. Paneth cell destruction
D. Impaired lymph drainage

Which triad is classic for Whipple disease?

A. Diarrhea, weight loss, arthralgia
B. Fever, rash, renal failure
C. Dysphagia, anemia, glossitis
D. Cough, hematuria, edema

About half of viral gastroenteritis cases are attributed to:

A. Rotavirus
B. Adenovirus
C. Norovirus
D. Astrovirus

Which statement about rotavirus is correct?

A. It is double-stranded RNA
B. It is nonenveloped DNA
C. It lacks a capsid
D. It is acid-fast

Which IBD subtype affects both the ileum and colon?

Which IBD subtype presents with a diffuse and continuous distribution?

Which IBD subtype presents with difficulties absorbing fats and vitamins?

Which IBS subtype predominates in the colon only?

Which IBD subtype is described as transmural?

Which IBD subtype is limited to only the mucosa and submucosa?

Which IBD subtype is characterized by skip lesions?

Which IBD disorder is limited to the colon and rectum?

Which IBD subtype leads to an increased risk of toxic megacolon, increasing risk of perforation?

Which type of polyp is most often regarded as genetically determined?

A. Adenomatous
B. Hyperplastic
C. Inflammatory
D. Hamartomatous

In older adults, decreased epithelial shedding can produce mucosal elevations in the gut known as:

A. Fissures
B. Ulcers
C. Polyps
D. Fistulas

A patient develops colitis after surgical diversion performed during treatment of Hirschsprung disease. Which diagnosis best fits?

A. Diversion colitis
B. Crohn disease
C. Ulcerative colitis
D. IBS

Which gene is implicated in increased risk of Crohn disease, despite accounting for less than half of total disease risk?

A. APC
B. STK11
C. RET
D. NOD2

A patient with early-onset right-sided colon cancer has few polyps but a strong family history of similar malignancies. Which syndrome best fits?

A. Gardner syndrome
B. Lynch syndrome
C. Peutz-Jeghers syndrome
D. Juvenile polyposis

Lynch syndrome most classically involves mutations in which gene pair?

A. APC and KRAS
B. KIT and RET
C. STK11 and SMAD4
D. MSH2 and MLH1

The defective pathway in Lynch syndrome normally mediates:

A. Base excision repair
B. Homologous recombination
C. Mismatch repair
D. Nucleotide excision repair

Most colorectal adenocarcinomas involve mutation of which gene?

A. APC
B. FOXP3
C. CDH1
D. MYO5B

A colorectal carcinoma arises in the setting of DNA mismatch repair deficiency. Which molecular phenomenon is most characteristic?

A. Chromothripsis
B. Microsatellite instability
C. Trinucleotide expansion
D. Loss of imprinting

Which two features are most important for prognosis in colorectal cancer?

A. Tumor grade and mucin
B. KRAS status and age
C. Size and ulceration
D. Depth and nodal spread

A patient with anal canal cancer is found to have a viral-associated squamous cell carcinoma. Which pathogen is most strongly linked?

A. EBV
B. CMV
C. HPV
D. HBV

Which statement about the appendix is correct?

A. It is a true diverticulum
B. It is a false diverticulum
C. It lacks muscularis propria
D. It lacks serosal covering

The most common appendiceal tumor is:

A. Mucinous adenocarcinoma
B. GIST
C. Lymphoma
D. Neuroendocrine tumor

Tumors arising from the peritoneal lining are called:

A. Adenomas
B. Leiomyomas
C. Mesotheliomas
D. Hamartomas

Which pair correctly describes Shigella?

A. Encapsulated and motile
B. Encapsulated and nonmotile
C. Unencapsulated and nonmotile
D. Unencapsulated and motile