front 1 In esophageal atresia, the obstructed segment is replaced by
a: | back 1 A. Thin non-canalized cord |
front 2 The main consequence of esophageal atresia is: | back 2 B. Mechanical obstruction |
front 3 Esophageal atresia most commonly occurs near the: | back 3 C. Tracheal bifurcation |
front 4 Esophageal atresia is usually associated with a fistula to
the: | back 4 A. Bronchus or trachea |
front 5 The most common form of congenital intestinal atresia is: | back 5 D. Imperforate anus |
front 6 Imperforate anus results from failure of the: | back 6 B. Cloacal diaphragm to involute |
front 7 Diaphragmatic hernia results when incomplete formation of the
diaphragm allows: | back 7 C. Abdominal viscera into thorax |
front 8 Omphalocele is best described as: | back 8 B. Ventral sac herniation |
front 9 Omphalocele occurs because closure of the abdominal musculature
is: | back 9 C. Incomplete |
front 10 Omphalocele is commonly associated with: | back 10 A. Other birth defects |
front 11 The most frequent site of ectopic gastric mucosa is the: | back 11 B. Upper third esophagus |
front 12 Ectopic gastric mucosa in the upper esophagus is called: | back 12 C. Inlet patch |
front 13 Gastric heterotopia refers to ectopic gastric mucosa in the: | back 13 A. Small bowel or colon |
front 14 Gastric heterotopia may present with blood loss from: | back 14 D. Peptic ulcerations |
front 15 A true diverticulum is a blind outpouching that: | back 15 B. Contains all three layers |
front 16 The most common true diverticulum is: | back 16 C. Meckel diverticulum |
front 17 Meckel diverticulum most commonly occurs in the: | back 17 D. Ileum |
front 18 The most common site of acquired diverticula is the: | back 18 D. Sigmoid colon |
front 19 Congenital hypertrophic pyloric stenosis is more common in: | back 19 A. Males |
front 20 Which syndrome increases risk of hypertrophic pyloric
stenosis? | back 20 B. Turner syndrome |
front 21 Which trisomy is linked to hypertrophic pyloric stenosis? | back 21 C. Trisomy 18 |
front 22 Which antibiotic exposure in the first 2 weeks increases pyloric
stenosis risk? | back 22 B. Azithromycin |
front 23 Another antibiotic linked to pyloric stenosis risk is: | back 23 A. Erythromycin |
front 24 Hirschsprung disease is also called: | back 24 C. Congenital aganglionic megacolon |
front 25 Hirschsprung disease results from abnormal migration or loss
of: | back 25 B. Neural crest-derived ganglion cells |
front 26 Definitive diagnosis of Hirschsprung disease requires absence
of: | back 26 C. Ganglion cells |
front 27 Ganglion cells in Hirschsprung evaluation may be identified using
stains for: | back 27 B. Acetylcholinesterase |
front 28 Functional obstruction of the esophagus results from disruption
of: | back 28 A. Coordinated peristalsis |
front 29 Nutcracker esophagus is characterized by: | back 29 C. High-amplitude distal contractions |
front 30 Nutcracker esophagus reflects loss of coordination between
the: | back 30 B. Circular and longitudinal muscle |
front 31 Zenker diverticulum results from impaired relaxation and spasm of
the: | back 31 C. Cricopharyngeus muscle |
front 32 Zenker diverticulum usually develops after age: | back 32 D. 50 |
front 33 A large Zenker diverticulum commonly causes: | back 33 A. Regurgitation and halitosis |
front 34 Esophageal stenosis is commonly caused by chronic GERD, irradiation,
or: | back 34 B. Caustic injury |
front 35 Patients with benign esophageal strictures generally
maintain: | back 35 A. Appetite and weight |
front 36 Malignant esophageal strictures are more often associated
with: | back 36 C. Weight loss |
front 37 Distal esophageal rings above the GE junction are called: | back 37 C. A rings |
front 38 A rings are covered by: | back 38 B. Squamous mucosa |
front 39 Rings at the squamocolumnar junction of the lower esophagus
are: | back 39 D. B rings |
front 40 The undersurface of a B ring contains: | back 40 C. Gastric cardia-type mucosa |
front 41 Achalasia is characterized by incomplete relaxation of the: | back 41 B. Lower esophageal sphincter |
front 42 In achalasia, LES tone is typically: | back 42 C. Increased |
front 43 A classic motility feature of achalasia is: | back 43 B. Aperistalsis |
front 44 Which symptom pattern best fits achalasia? | back 44 C. Dysphagia to solids and liquids |
front 45 Another common achalasia symptom is: | back 45 B. Difficult belching |
front 46 Primary achalasia results from degeneration of distal
esophageal: | back 46 A. Inhibitory neurons |
front 47 Primary achalasia causes inability to relax the LES because
of: | back 47 C. Ganglion cell degeneration |
front 48 Secondary achalasia may occur in: | back 48 B. Chagas disease |
front 49 In Chagas disease, secondary achalasia is caused by destruction of
the: | back 49 C. Myenteric plexus |
front 50 Secondary achalasia in Chagas disease leads to failure of peristalsis
and: | back 50 A. Esophageal dilatation |
front 51 A patient has achalasia, alacrima, and ACTH-resistant adrenal
insufficiency. This syndrome is: | back 51 A. Allgrove syndrome |
front 52 Triple A syndrome is inherited in an: | back 52 B. Autosomal recessive pattern |
front 53 Longitudinal mucosal tears near the gastroesophageal junction are
called: | back 53 C. Mallory-Weiss tears |
front 54 After forceful vomiting, a patient develops transmural rupture of the
distal esophagus. This is: | back 54 D. Boerhaave syndrome |
front 55 The most feared complication of Boerhaave syndrome is: | back 55 B. Severe mediastinitis |
front 56 In otherwise healthy individuals, infectious esophagitis is usually
caused by: | back 56 A. Herpes simplex virus |
front 57 Endoscopic “punched-out” esophageal ulcers most strongly
suggest: | back 57 D. Herpes simplex virus |
front 58 The glands most prominent in the proximal and distal esophagus are
the: | back 58 C. Submucosal glands |
front 59 Esophageal submucosal glands protect mucosa by secreting: | back 59 A. Mucin and bicarbonate |
front 60 LES relaxation contributing to GERD can be mediated by: | back 60 B. Vagal pathways |
front 61 Which can trigger reflux-related LES relaxation? | back 61 C. Gastric distention |
front 62 Hiatal hernia is defined by: | back 62 D. Stomach protrusion into thorax |
front 63 Symptoms of hiatal hernia most commonly resemble: | back 63 B. GERD |
front 64 Most patients with eosinophilic esophagitis are: | back 64 A. Atopic |
front 65 The cardinal histologic feature of eosinophilic esophagitis
is: | back 65 D. Superficial intraepithelial eosinophils |
front 66 Failure to improve with high-dose PPI favors: | back 66 C. Eosinophilic esophagitis |
front 67 Barrett esophagus is a complication of chronic GERD marked
by: | back 67 A. Intestinal metaplasia |
front 68 The major concern in Barrett esophagus is increased risk of: | back 68 B. Adenocarcinoma |
front 69 Diagnosis of Barrett esophagus requires: | back 69 C. Columnar mucosa above GEJ |
front 70 The most common benign esophageal tumor is: | back 70 D. Leiomyoma |
front 71 Esophageal leiomyomas usually arise within the: | back 71 A. Esophageal wall |
front 72 Rising rates of esophageal adenocarcinoma are most linked to: | back 72 B. Obesity-related GERD/Barrett |
front 73 Additional risk factors for esophageal adenocarcinoma
include: | back 73 D. Tobacco and radiation |
front 74 Esophageal adenocarcinoma most often arises in the: | back 74 C. Distal third |
front 75 Esophageal adenocarcinoma often invades the adjacent: | back 75 B. Gastric cardia |
front 76 Most esophageal squamous cell carcinomas are associated with: | back 76 A. Tobacco and alcohol |
front 77 About half of esophageal squamous cell carcinomas occur in
the: | back 77 C. GE junction |
front 78 Squamous cancers in the upper third most often spread to: | back 78 A. Cervical lymph nodes |
front 79 Middle-third esophageal tumors most often spread to: | back 79 B. Mediastinal/paratracheal/tracheobronchial nodes |
front 80 Lower-third esophageal tumors most often spread to: | back 80 C. Gastric and celiac nodes |
front 81 NSAIDs injure gastric mucosa by inhibiting COX-dependent synthesis
of: | back 81 D. Prostaglandins E2 and I2 |
front 82 Gastric prostaglandins E2 and I2 normally: | back 82 C. Support mucosal defense |
front 83 Ammonium ions in uremia or H. pylori may cause injury by inhibiting
gastric: | back 83 D. Bicarbonate transporters |
front 84 Proximal duodenal ulcers associated with severe burns or trauma
are: | back 84 B. Curling ulcers |
front 85 Which esophageal tear typically requires surgical
intervention? | back 85 A. Boerhaave syndrome |
front 86 Gastric, duodenal, and esophageal ulcers occurring with intracranial
disease are called: | back 86 A. Cushing ulcers |
front 87 Cushing ulcers are notable for a high incidence of: | back 87 C. Perforation |
front 88 Stress-related gastric mucosal injury most often results from
local: | back 88 B. Ischemia |
front 89 A contributor to stress-related gastric injury is: | back 89 D. Splanchnic vasoconstriction |
front 90 A Dieulafoy lesion is caused by a: | back 90 B. Large unbranched submucosal artery |
front 91 The most common site of a Dieulafoy lesion is the: | back 91 A. Lesser curvature near GEJ |
front 92 Bleeding from a Dieulafoy lesion is often: | back 92 D. Self-limited |
front 93 H. pylori organisms are best described as: | back 93 C. Spiral or curved bacilli |
front 94 H. pylori is present in almost all patients with: | back 94 A. Duodenal ulcers |
front 95 Acute H. pylori infection usually: | back 95 B. Produces no notable symptoms |
front 96 Compared with acute infection, chronic H. pylori infection more
often: | back 96 D. Comes to medical attention |
front 97 H. pylori most often presents as: | back 97 C. Antral-predominant gastritis |
front 98 In typical H. pylori antral gastritis, acid production is: | back 98 B. Normal or increased |
front 99 In H. pylori gastritis, local gastrin may rise, but _____ is
uncommon. | back 99 A. Hypergastrinemia |
front 100 Which H. pylori gene is linked to higher gastric cancer risk? | back 100 C. CagA |
front 101 CagA-expressing strains can colonize the gastric body and
cause: | back 101 D. Multifocal atrophic gastritis |
front 102 Which cytokine pattern is linked to pangastritis and gastric
cancer? | back 102 A. ↑TNF/IL-1β, ↓IL-10 |
front 103 Intraepithelial neutrophils and subepithelial plasma cells
suggest: | back 103 B. H. pylori gastritis |
front 104 Lymphoid aggregates with germinal centers in H. pylori gastritis
represent induced: | back 104 D. MALT |
front 105 H. pylori-associated MALT may transform into: | back 105 C. Lymphoma |
front 106 Autoimmune gastritis typically spares the: | back 106 B. Antrum |
front 107 Autoimmune gastritis is commonly associated with: | back 107 A. Hypergastrinemia |
front 108 Autoimmune gastritis often features antibodies to parietal cells
and: | back 108 C. Intrinsic factor |
front 109 Loss of parietal cells causes impaired secretion of: | back 109 D. Acid and intrinsic factor |
front 110 Reduced serum pepsinogen I in autoimmune gastritis reflects loss
of: | back 110 A. Chief cells |
front 111 The principal agents of injury in autoimmune gastritis are: | back 111 B. CD4+ T cells |
front 112 Autoimmune gastritis mainly damages the oxyntic mucosa of
the: | back 112 D. Body and fundus |
front 113 Vitamin B12 deficiency from autoimmune gastritis can cause: | back 113 C. Peripheral neuropathy |
front 114 Lymphocytic gastritis preferentially affects: | back 114 A. Women |
front 115 Lymphocytic gastritis is strongly associated with: | back 115 D. Celiac disease |
front 116 Histologically, lymphocytic gastritis shows increased: | back 116 B. Intraepithelial T lymphocytes |
front 117 Lymphocytic gastritis often involves the: | back 117 C. Entire stomach |
front 118 Another name for lymphocytic gastritis is: | back 118 D. Varioliform gastritis |
front 119 The most common specific cause of granulomatous gastritis is: | back 119 A. Crohn disease |
front 120 After Crohn disease, granulomatous gastritis is next associated
with: | back 120 C. Sarcoidosis and infections |
front 121 Peptic ulcer disease refers to chronic mucosal ulceration of
the: | back 121 B. Stomach or duodenum |
front 122 Nearly all peptic ulcers are associated with H. pylori, NSAIDs,
or: | back 122 A. Cigarette smoking |
front 123 H. pylori is present in about what fraction of chronic gastritis
cases? | back 123 D. 90% |
front 124 Autoimmune gastritis may also show: | back 124 B. Endocrine cell hyperplasia |
front 125 The most common form of peptic ulcer disease occurs in the: | back 125 A. Gastric antrum or duodenum |
front 126 The most common peptic ulcers are most strongly linked to
chronic: | back 126 B. H. pylori gastritis |
front 127 H. pylori-related peptic ulcer disease is associated with: | back 127 C. Increased acid, decreased duodenal bicarbonate |
front 128 In patients older than 60, increased duodenal peptic ulcer disease is
especially associated with: | back 128 B. NSAID use |
front 129 Duodenal peptic ulcer risk is particularly increased when low-dose
aspirin is combined with: | back 129 C. Other NSAIDs |
front 130 Peptic ulcer disease is also associated with cigarette use and
cardiovascular disease because they decrease: | back 130 A. Mucosal blood flow and healing |
front 131 Most duodenal peptic ulcers occur: | back 131 C. In the proximal duodenum |
front 132 Duodenal peptic ulcers are usually located within a few centimeters
of the: | back 132 B. Pyloric valve |
front 133 The duodenal wall most commonly involved by peptic ulcer is
the: | back 133 D. Anterior wall |
front 134 Gastric peptic ulcers are most commonly found along the: | back 134 C. Lesser curvature |
front 135 Gastric peptic ulcers are typically located near the interface of
the: | back 135 A. Body and antrum |
front 136 Pain from peptic ulcer disease is typically: | back 136 B. Worse 1–3 hours after meals |
front 137 Peptic ulcer pain is classically: | back 137 B. Worse at night |
front 138 Nighttime peptic ulcer pain is often relieved by: | back 138 B. Alkali or food |
front 139 The type of gastritis with the greatest risk of gastric
adenocarcinoma is: | back 139 D. Autoimmune gastritis |
front 140 In autoimmune gastritis, increased cancer risk may relate to: | back 140 C. Achlorhydria with bacterial overgrowth |
front 141 Bacterial overgrowth in autoimmune gastritis may increase formation
of carcinogenic: | back 141 B. Nitrosamines |
front 142 Hypertrophic gastropathies are characterized by giant cerebriform
enlargement of rugal folds due to: | back 142 C. Epithelial hyperplasia without inflammation |
front 143 Hypertrophic gastropathies are linked to excessive release
of: | back 143 B. Growth factors |
front 144 Menetrier disease is associated with excessive secretion of: | back 144 A. TGF-α |
front 145 Menetrier disease is characterized by diffuse hyperplasia of
the: | back 145 C. Foveolar epithelium |
front 146 Menetrier disease most prominently affects the: | back 146 B. Body and fundus |
front 147 A major clinical consequence of Menetrier disease is: | back 147 A. Protein-losing enteropathy |
front 148 Fundic gland polyps occur sporadically and in patients with: | back 148 C. Familial Adenomatous Polyposis |
front 149 The rising prevalence of fundic gland polyps is linked to increased
use of: | back 149 B. PPIs |
front 150 PPIs increase fundic gland polyps in part by causing
increased: | back 150 C. Gastrin secretion |
front 151 Increased gastrin promotes growth of: | back 151 A. Oxyntic glands |
front 152 Dysplasia and carcinoma may occur in: | back 152 B. FAP-associated fundic gland polyps |
front 153 Sporadic fundic gland polyps carry: | back 153 C. No cancer risk |
front 154 In gastric adenomas, adenocarcinoma risk is most related to: | back 154 B. Lesion size |
front 155 Gastric adenomas are usually: | back 155 B. Solitary and under 2 cm |
front 156 Gastric adenomas are most commonly located in the: | back 156 D. Antrum |
front 157 Gastric adenomas are best classified as: | back 157 C. Premalignant neoplastic lesions |
front 158 Compared with intestinal adenomas, gastric adenomas have a: | back 158 C. Much higher invasive cancer risk |
front 159 The most common malignancy of the stomach is: | back 159 D. Adenocarcinoma |
front 160 Gastric adenocarcinoma accounts for more than: | back 160 C. 90% of gastric cancers |
front 161 The intestinal type of gastric adenocarcinoma typically
forms: | back 161 B. Bulky masses |
front 162 The diffuse type of gastric adenocarcinoma
characteristically: | back 162 C. Infiltrates and thickens the wall |
front 163 The diffuse type of gastric adenocarcinoma is composed of: | back 163 B. Signet ring cells |
front 164 Spread of gastric adenocarcinoma to the pouch of Douglas is
called: | back 164 B. Blumer shelf |
front 165 Blumer shelf may be detected on: | back 165 C. Rectal exam |
front 166 The overall reduction in gastric cancer is most closely related to
decreased prevalence of: | back 166 C. H. pylori |
front 167 Another contributor to declining gastric cancer rates may be reduced
intake of dietary: | back 167 B. N-nitroso compounds |
front 168 Familial gastric cancer is strongly associated with germline
loss-of-function mutation in: | back 168 C. CDH1 |
front 169 CDH1 encodes: | back 169 B. E-cadherin |
front 170 Loss of function of E-cadherin is a key step in development
of: | back 170 B. Diffuse gastric cancer |
front 171 Sporadic intestinal-type gastric cancers are strongly associated with
increased signaling through the: | back 171 D. Wnt pathway |
front 172 Increased Wnt signaling in sporadic intestinal-type gastric cancer
can result from gain-of-function mutation in: | back 172 A. β-catenin |
front 173 Increased Wnt signaling can also result from loss-of-function
mutation in: | back 173 B. APC |
front 174 Patients with FAP who carry germline mutations in which gene have
increased risk of intestinal-type gastric cancer? | back 174 A. APC |
front 175 Most gastric adenocarcinomas involve the gastric: | back 175 C. Antrum |
front 176 Compared with the greater curvature, gastric adenocarcinoma more
often involves the: | back 176 A. lesser curvature |
front 177 Diffuse gastric cancer is composed of discohesive signet ring cells
because of loss of: | back 177 B. E-cadherin |
front 178 Intestinal-type gastric cancer typically develops from precursor
lesions such as: | back 178 A. adenomas and flat dysplasia |
front 179 Because most gastric cancers are discovered late, the overall 5-year
survival is: | back 179 D. low, under 30% |
front 180 Extranodal lymphomas most commonly arise in the GI tract, especially
the: | back 180 B. stomach |
front 181 The most common primary gastric lymphoma is: | back 181 C. marginal zone B-cell |
front 182 In the stomach, MALT is most often induced by: | back 182 A. chronic gastritis |
front 183 The most common inducer of gastric MALT is: | back 183 D. H. pylori |
front 184 Gastric MALTomas can transform into tumors identical to: | back 184 B. diffuse large B-cell lymphoma |
front 185 If NF-kB is constitutively active due to MALToma translocations, H.
pylori treatment: | back 185 C. is not effective |
front 186 Gastric MALTomas typically express CD19 and: | back 186 A. CD20 |
front 187 Gastric carcinoid tumors may be associated with autoimmune
chronic: | back 187 D. viral gastritis |
front 188 A syndrome associated with gastric neuroendocrine tumors is: | back 188 B. Zollinger-Ellison syndrome |
front 189 Neuroendocrine tumors within the stomach and duodenum ______ metastasize and are generally cured by resection. a. rarely b. often | back 189 a. rarely |
front 190 Neuroendocrine tumors that arise in the ____ and ____ are often multiple and tend to be aggressive. a. jejunum, ileum b. stomach, ileum c. duodenum, ileum | back 190 a. jejunum, ileum |
front 191 Rectal neuroendocrine tumors tend to produce: | back 191 C. polypeptide hormones |
front 192 Symptomatic rectal neuroendocrine tumors may present with: | back 192 A. abdominal pain and weight loss |
front 193 The most common mesenchymal tumor in the abdomen is: | back 193 D. GI stromal tumor |
front 194 GISTs arise from the: | back 194 C. interstitial cells of Cajal |
front 195 The cell of origin for GIST is found in the GI: | back 195 B. muscularis propria |
front 196 Gastric GIST, paraganglioma, and pulmonary chondroma: | back 196 B. Carney Triad |
front 197 Carney triad is seen most often in: | back 197 D. young women |
front 198 Most GISTs are due to gain-of-function mutations in: | back 198 B. KIT or PDGFRA |
front 199 The most useful diagnostic marker for GIST is: | back 199 C. KIT |
front 200 Acquired pyloric stenosis in adults most often results from: | back 200 A. antral gastritis or nearby ulcers |
front 201 In Hirschsprung disease, which segment is always involved? | back 201 D. rectum |
front 202 The main symptom of esophageal mucosal webs is: | back 202 B. non-progressive dysphagia |
front 203 Which feature best distinguishes diffuse gastric cancer from
intestinal type? | back 203 C. discohesive signet ring cells |
front 204 Which statement is correct regarding gastric malignancy? | back 204 D. gastric adenocarcinoma often presents advanced |