In esophageal atresia, the obstructed segment is replaced by a:
A. Thin non-canalized cord
B. Hypertrophied muscle ring
C. Necrotic fibrous band
D. Dilated mucosal pouch

A. Thin non-canalized cord

The main consequence of esophageal atresia is:
A. Functional obstruction
B. Mechanical obstruction
C. Vascular compression
D. Neuromuscular dysphagia

B. Mechanical obstruction

Esophageal atresia most commonly occurs near the:
A. Gastroesophageal junction
B. Cricopharyngeus muscle
C. Tracheal bifurcation
D. Distal stomach

C. Tracheal bifurcation

Esophageal atresia is usually associated with a fistula to the:
A. Bronchus or trachea
B. Pleural cavity only
C. Pharyngeal pouch only
D. Aortic arch

A. Bronchus or trachea

The most common form of congenital intestinal atresia is:
A. Jejunal atresia
B. Duodenal atresia
C. Ileal atresia
D. Imperforate anus

D. Imperforate anus

Imperforate anus results from failure of the:
A. Vitelline duct to regress
B. Cloacal diaphragm to involute
C. Tracheoesophageal septum to form
D. Urorectal septum to descend

B. Cloacal diaphragm to involute

Diaphragmatic hernia results when incomplete formation of the diaphragm allows:
A. Air into the mediastinum
B. Pleura into the abdomen
C. Abdominal viscera into thorax
D. Esophagus into the neck

C. Abdominal viscera into thorax

Omphalocele is best described as:
A. Failure of gut rotation
B. Ventral sac herniation
C. Diaphragmatic rupture
D. Acquired fascial defect

B. Ventral sac herniation

Omphalocele occurs because closure of the abdominal musculature is:
A. Delayed only
B. Excessive
C. Incomplete
D. Inflamed

C. Incomplete

Omphalocele is commonly associated with:
A. Other birth defects
B. Hirschsprung disease only
C. pyloric atresia only
D. Isolated reflux only

A. Other birth defects

The most frequent site of ectopic gastric mucosa is the:
A. Distal ileum
B. Upper third esophagus
C. Sigmoid colon
D. Gastric antrum

B. Upper third esophagus

Ectopic gastric mucosa in the upper esophagus is called:
A. Zenker patch
B. A ring
C. Inlet patch
D. B ring

C. Inlet patch

Gastric heterotopia refers to ectopic gastric mucosa in the:
A. Small bowel or colon
B. Distal esophagus only
C. Oral cavity only
D. Appendix only

A. Small bowel or colon

Gastric heterotopia may present with blood loss from:
A. Variceal rupture
B. Angiodysplasia
C. Hemorrhoids
D. Peptic ulcerations

D. Peptic ulcerations

A true diverticulum is a blind outpouching that:
A. Lacks luminal communication
B. Contains all three layers
C. Contains mucosa only
D. Always becomes inflamed

B. Contains all three layers

The most common true diverticulum is:
A. Zenker diverticulum
B. Sigmoid diverticulum
C. Meckel diverticulum
D. Traction diverticulum

C. Meckel diverticulum

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

D. Ileum

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

D. Sigmoid colon

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

A. Males

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

B. Turner syndrome

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

C. Trisomy 18

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

B. Azithromycin

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

A. Erythromycin

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

C. Congenital aganglionic megacolon

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

B. Neural crest-derived ganglion cells

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

C. Ganglion cells

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

B. Acetylcholinesterase

Functional obstruction of the esophagus results from disruption of:
A. Coordinated peristalsis
B. LES blood flow
C. Mucosal regeneration
D. Gastric acid secretion

A. Coordinated peristalsis

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

C. High-amplitude distal contractions

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

B. Circular and longitudinal muscle

Zenker diverticulum results from impaired relaxation and spasm of the:
A. Lower esophageal sphincter
B. Pyloric sphincter
C. Cricopharyngeus muscle
D. Ileocecal valve

C. Cricopharyngeus muscle

Zenker diverticulum usually develops after age:
A. 20
B. 35
C. 40
D. 50

D. 50

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

A. Regurgitation and halitosis

Esophageal stenosis is commonly caused by chronic GERD, irradiation, or:
A. Malrotation
B. Caustic injury
C. Vagotomy
D. Diverticulosis

B. Caustic injury

Patients with benign esophageal strictures generally maintain:
A. Appetite and weight
B. Hearing and vision
C. Posture and tone
D. Temperature and pulse

A. Appetite and weight

Malignant esophageal strictures are more often associated with:
A. Hyperphagia
B. Polyuria
C. Weight loss
D. Hematuria

C. Weight loss

Distal esophageal rings above the GE junction are called:
A. B rings
B. C rings
C. A rings
D. D rings

C. A rings

A rings are covered by:
A. Gastric cardia-type mucosa
B. Squamous mucosa
C. Intestinal metaplasia
D. Respiratory epithelium

B. Squamous mucosa

Rings at the squamocolumnar junction of the lower esophagus are:
A. A rings
B. Web rings
C. Traction rings
D. B rings

D. B rings

The undersurface of a B ring contains:
A. Colonic-type mucosa
B. Squamous mucosa only
C. Gastric cardia-type mucosa
D. Pancreatic acini

C. Gastric cardia-type mucosa

Achalasia is characterized by incomplete relaxation of the:
A. Upper esophageal sphincter
B. Lower esophageal sphincter
C. Pyloric sphincter
D. Ileocecal sphincter

B. Lower esophageal sphincter

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

C. Increased

A classic motility feature of achalasia is:
A. Hyperperistalsis
B. Aperistalsis
C. Reverse peristalsis only
D. Pylorospasm

B. Aperistalsis

Which symptom pattern best fits achalasia?
A. Dysphagia solids only
B. Dysphagia liquids only
C. Dysphagia to solids and liquids
D. Odynophagia with diarrhea

C. Dysphagia to solids and liquids

Another common achalasia symptom is:
A. Easy belching
B. Difficult belching
C. Hematochezia
D. Chronic cough only

B. Difficult belching

Primary achalasia results from degeneration of distal esophageal:
A. Inhibitory neurons
B. Skeletal myocytes
C. Epithelial stem cells
D. Goblet cells

A. Inhibitory neurons

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

C. Ganglion cell degeneration

Secondary achalasia may occur in:
A. Crohn disease
B. Chagas disease
C. Celiac disease
D. Ulcerative colitis

B. Chagas disease

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

C. Myenteric plexus

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

A. Esophageal dilatation

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

A. Allgrove syndrome

Triple A syndrome is inherited in an:
A. Autosomal dominant pattern
B. Autosomal recessive pattern
C. X-linked recessive pattern
D. Mitochondrial pattern

B. Autosomal recessive pattern

Longitudinal mucosal tears near the gastroesophageal junction are called:
A. Boerhaave ruptures
B. Zenker diverticula
C. Mallory-Weiss tears
D. Schatzki rings

C. Mallory-Weiss tears

After forceful vomiting, a patient develops transmural rupture of the distal esophagus. This is:
A. Achalasia
B. Mallory-Weiss syndrome
C. Eosinophilic esophagitis
D. Boerhaave syndrome

D. Boerhaave syndrome

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

B. Severe mediastinitis

In otherwise healthy individuals, infectious esophagitis is usually caused by:
A. Herpes simplex virus
B. Candida albicans
C. Cytomegalovirus
D. Adenovirus

A. Herpes simplex virus

Endoscopic “punched-out” esophageal ulcers most strongly suggest:
A. CMV infection
B. Reflux esophagitis
C. Eosinophilic esophagitis
D. Herpes simplex virus

D. Herpes simplex virus

The glands most prominent in the proximal and distal esophagus are the:
A. Mucosal glands only
B. Brunner glands
C. Submucosal glands
D. Oxyntic glands

C. Submucosal glands

Esophageal submucosal glands protect mucosa by secreting:
A. Mucin and bicarbonate
B. Pepsin and acid
C. Bile and phospholipids
D. Histamine and gastrin

A. Mucin and bicarbonate

LES relaxation contributing to GERD can be mediated by:
A. Sympathetic pathways
B. Vagal pathways
C. Phrenic pathways
D. Somatic reflex arcs

B. Vagal pathways

Which can trigger reflux-related LES relaxation?
A. Hypercalcemia
B. Hypothyroidism
C. Gastric distention
D. Hypovolemia

C. Gastric distention

Hiatal hernia is defined by:
A. Distal esophageal ganglion loss
B. Gastric volvulus only
C. Diaphragmatic eventration
D. Stomach protrusion into thorax

D. Stomach protrusion into thorax

Symptoms of hiatal hernia most commonly resemble:
A. Achalasia
B. GERD
C. Boerhaave syndrome
D. Diffuse spasm

B. GERD

Most patients with eosinophilic esophagitis are:
A. Atopic
B. Heavy alcohol users
C. Chronically uremic
D. Immunocompromised

A. Atopic

The cardinal histologic feature of eosinophilic esophagitis is:
A. Basal ganglion loss
B. Villous blunting
C. Transmural neutrophils
D. Superficial intraepithelial eosinophils

D. Superficial intraepithelial eosinophils

Failure to improve with high-dose PPI favors:
A. GERD
B. Viral esophagitis
C. Eosinophilic esophagitis
D. Hiatal hernia

C. Eosinophilic esophagitis

Barrett esophagus is a complication of chronic GERD marked by:
A. Intestinal metaplasia
B. Smooth muscle hypertrophy
C. Squamous dysplasia only
D. Transmural ulceration

A. Intestinal metaplasia

The major concern in Barrett esophagus is increased risk of:
A. Squamous carcinoma
B. Adenocarcinoma
C. Leiomyosarcoma
D. Small cell carcinoma

B. Adenocarcinoma

Diagnosis of Barrett esophagus requires:
A. Positive fecal occult blood
B. Weight loss and dysphagia
C. Columnar mucosa above GEJ
D. Loss of ganglion cells

C. Columnar mucosa above GEJ

The most common benign esophageal tumor is:
A. Papilloma
B. Lipoma
C. Fibroma
D. Leiomyoma

D. Leiomyoma

Esophageal leiomyomas usually arise within the:
A. Esophageal wall
B. Mucosal surface
C. Lymphatic channels
D. Subserosal fat

A. Esophageal wall

Rising rates of esophageal adenocarcinoma are most linked to:
A. CMV esophagitis/Barrett
B. Obesity-related GERD/Barrett
C. Alcohol-related retching/Barrett
D. Congenital rings/Barrett

B. Obesity-related GERD/Barrett

Additional risk factors for esophageal adenocarcinoma include:
A. Asthma and eczema
B. Burns and trauma
C. Achalasia and alacrima
D. Tobacco and radiation

D. Tobacco and radiation

Esophageal adenocarcinoma most often arises in the:
A. Upper third
B. Middle third
C. Distal third
D. Cervical esophagus

C. Distal third

Esophageal adenocarcinoma often invades the adjacent:
A. Duodenal bulb
B. Gastric cardia
C. Tracheal bifurcation
D. Pancreatic head

B. Gastric cardia

Most esophageal squamous cell carcinomas are associated with:
A. Tobacco and alcohol
B. Obesity and GERD
C. Barrett metaplasia
D. Eosinophilic inflammation

A. Tobacco and alcohol

About half of esophageal squamous cell carcinomas occur in the:
A. Distal esophagus only
B. Upper third
C. GE junction
D. Middle third

C. GE junction

Squamous cancers in the upper third most often spread to:
A. Cervical lymph nodes
B. Celiac lymph nodes
C. Axillary lymph nodes
D. Inguinal lymph nodes

A. Cervical lymph nodes

Middle-third esophageal tumors most often spread to:
A. Gastric/paratracheal/tracheobronchial nodes nodes
B. Mediastinal/paratracheal/tracheobronchial nodes
C. Cervical nodes/paratracheal/tracheobronchial nodes
D. Mesenteric/paratracheal/tracheobronchial nodes

B. Mediastinal/paratracheal/tracheobronchial nodes

Lower-third esophageal tumors most often spread to:
A. Cervical and celiac nodes
B. Axillary and celiac nodes
C. Gastric and celiac nodes
D. Inguinal and celiac nodes

C. Gastric and celiac nodes

NSAIDs injure gastric mucosa by inhibiting COX-dependent synthesis of:
A. Gastrin and secretin
B. Leukotrienes C4 and D4
C. Nitric oxide and endothelin
D. Prostaglandins E2 and I2

D. Prostaglandins E2 and I2

Gastric prostaglandins E2 and I2 normally:
A. Increase acid secretion
B. Reduce mucosal blood flow
C. Support mucosal defense
D. Inhibit epithelial restitution

C. Support mucosal defense

Ammonium ions in uremia or H. pylori may cause injury by inhibiting gastric:
A. Chloride channels
B. Potassium pumps
C. Sodium channels
D. Bicarbonate transporters

D. Bicarbonate transporters

Proximal duodenal ulcers associated with severe burns or trauma are:
A. Cushing ulcers
B. Curling ulcers
C. Stress erosions
D. Aftoid ulcers

B. Curling ulcers

Which esophageal tear typically requires surgical intervention?
A. Boerhaave syndrome
B. Mallory-Weiss tear
C. Eosinophilic esophagitis
D. Hiatal hernia

A. Boerhaave syndrome

Gastric, duodenal, and esophageal ulcers occurring with intracranial disease are called:
A. Cushing ulcers
B. Curling ulcers
C. Stress erosions
D. Peptic ulcers

A. Cushing ulcers

Cushing ulcers are notable for a high incidence of:
A. Obstruction
B. Hematochezia
C. Perforation
D. Intussusception

C. Perforation

Stress-related gastric mucosal injury most often results from local:
A. Autoimmunity
B. Ischemia
C. Hyperplasia
D. Metaplasia

B. Ischemia

A contributor to stress-related gastric injury is:
A. Increased bicarbonate secretion
B. Reduced endothelin release
C. Increased mucosal perfusion
D. Splanchnic vasoconstriction

D. Splanchnic vasoconstriction

A Dieulafoy lesion is caused by a:
A. Mucosal venous malformation
B. Large unbranched submucosal artery
C. Distal esophageal tear
D. Hypertrophied muscularis mucosa

B. Large unbranched submucosal artery

The most common site of a Dieulafoy lesion is the:
A. Lesser curvature near GEJ
B. Gastric fundus
C. Distal duodenum
D. Mid-esophagus

A. Lesser curvature near GEJ

Bleeding from a Dieulafoy lesion is often:
A. Malignant
B. Painlessly obstructive
C. Due to varices
D. Self-limited

D. Self-limited

H. pylori organisms are best described as:
A. Gram-positive cocci
B. Branching filamentous rods
C. Spiral or curved bacilli
D. Encapsulated diplococci

C. Spiral or curved bacilli

H. pylori is present in almost all patients with:
A. Duodenal ulcers
B. Crohn gastritis
C. Autoimmune gastritis
D. Mallory-Weiss tears

A. Duodenal ulcers

Acute H. pylori infection usually:
A. Causes severe epigastric pain
B. Produces no notable symptoms
C. Causes major GI bleeding
D. Leads to immediate cancer

B. Produces no notable symptoms

Compared with acute infection, chronic H. pylori infection more often:
A. Remains entirely silent
B. Produces only perforation
C. Causes adrenal insufficiency
D. Comes to medical attention

D. Comes to medical attention

H. pylori most often presents as:
A. Body-predominant gastritis
B. Pangastritis with achlorhydria
C. Antral-predominant gastritis
D. Fundic granulomatous gastritis

C. Antral-predominant gastritis

In typical H. pylori antral gastritis, acid production is:
A. Always absent
B. Normal or increased
C. Severely decreased
D. Irrelevant diagnostically

B. Normal or increased

In H. pylori gastritis, local gastrin may rise, but _____ is uncommon.
A. Hypergastrinemia
B. Dysphagia
C. Achalasia
D. Pernicious anemia

A. Hypergastrinemia

Which H. pylori gene is linked to higher gastric cancer risk?
A. APC
B. RET
C. CagA
D. KRAS

C. CagA

CagA-expressing strains can colonize the gastric body and cause:
A. Distal esophageal webs
B. Acute appendicitis
C. Autoimmune thyroiditis
D. Multifocal atrophic gastritis

D. Multifocal atrophic gastritis

Which cytokine pattern is linked to pangastritis and gastric cancer?
A. ↑TNF/IL-1β, ↓IL-10
B. ↓TNF/IL-1β, ↑IL-10
C. ↑IL-10, ↓gastrin
D. ↑IFN-γ, ↓acid only

A. ↑TNF/IL-1β, ↓IL-10

Intraepithelial neutrophils and subepithelial plasma cells suggest:
A. Autoimmune gastritis
B. H. pylori gastritis
C. Viral esophagitis
D. Lymphocytic colitis

B. H. pylori gastritis

Lymphoid aggregates with germinal centers in H. pylori gastritis represent induced:
A. Peyer patches
B. Lamina propria fibrosis
C. Paneth cell metaplasia
D. MALT

D. MALT

H. pylori-associated MALT may transform into:
A. Adenocarcinoma
B. Leiomyoma
C. Lymphoma
D. Carcinoid tumor

C. Lymphoma

Autoimmune gastritis typically spares the:
A. Fundus
B. Antrum
C. Body
D. Oxyntic mucosa

B. Antrum

Autoimmune gastritis is commonly associated with:
A. Hypergastrinemia
B. Hyperchlorhydria
C. Hypopepsinuria
D. Hypoglycemia

A. Hypergastrinemia

Autoimmune gastritis often features antibodies to parietal cells and:
A. Pepsin
B. Gastrin
C. Intrinsic factor
D. Mucin

C. Intrinsic factor

Loss of parietal cells causes impaired secretion of:
A. Bile and pepsin
B. Gastrin and mucus
C. Pepsinogen and bile
D. Acid and intrinsic factor

D. Acid and intrinsic factor

Reduced serum pepsinogen I in autoimmune gastritis reflects loss of:
A. Chief cells
B. G cells
C. Goblet cells
D. Paneth cells

A. Chief cells

The principal agents of injury in autoimmune gastritis are:
A. Neutrophils
B. CD4+ T cells
C. Eosinophils
D. Plasma cells

B. CD4+ T cells

Autoimmune gastritis mainly damages the oxyntic mucosa of the:
A. Antrum and pylorus
B. Cardia and antrum
C. GE junction only
D. Body and fundus

D. Body and fundus

Vitamin B12 deficiency from autoimmune gastritis can cause:
A. Nephrolithiasis
B. Pancreatitis
C. Peripheral neuropathy
D. Hemarthrosis

C. Peripheral neuropathy

Lymphocytic gastritis preferentially affects:
A. Women
B. Men
C. Neonates
D. Elderly smokers

A. Women

Lymphocytic gastritis is strongly associated with:
A. Chagas disease
B. Alcohol use
C. H. pylori only
D. Celiac disease

D. Celiac disease

Histologically, lymphocytic gastritis shows increased:
A. Plasma cells
B. Intraepithelial T lymphocytes
C. Eosinophils
D. Neutrophilic abscesses

B. Intraepithelial T lymphocytes

Lymphocytic gastritis often involves the:
A. Antrum only
B. Fundus only
C. Entire stomach
D. Distal duodenum only

C. Entire stomach

Another name for lymphocytic gastritis is:
A. Giant hypertrophic gastritis
B. Reactive gastropathy
C. Atrophic pangastritis
D. Varioliform gastritis

D. Varioliform gastritis

The most common specific cause of granulomatous gastritis is:
A. Crohn disease
B. Sarcoidosis
C. Tuberculosis
D. Ulcerative colitis

A. Crohn disease

After Crohn disease, granulomatous gastritis is next associated with:
A. GERD and Barrett
B. Hyperthyroidism and celiac
C. Sarcoidosis and infections
D. NSAIDs and smoking

C. Sarcoidosis and infections

Peptic ulcer disease refers to chronic mucosal ulceration of the:
A. Esophagus or duodenum
B. Stomach or duodenum
C. Jejunum or duodenum
D. Colon or rectum

B. Stomach or duodenum

Nearly all peptic ulcers are associated with H. pylori, NSAIDs, or:
A. Cigarette smoking
B. Lactose intolerance
C. Achalasia
D. Gallstones

A. Cigarette smoking

H. pylori is present in about what fraction of chronic gastritis cases?
A. 25%
B. 50%
C. 75%
D. 90%

D. 90%

Autoimmune gastritis may also show:
A. Villous atrophy
B. Endocrine cell hyperplasia
C. Mural thrombosis
D. Transmural fissures

B. Endocrine cell hyperplasia

The most common form of peptic ulcer disease occurs in the:
A. Gastric antrum or duodenum
B. Fundus or cardia
C. Jejunum or ileum
D. Esophagus or colon

A. Gastric antrum or duodenum

The most common peptic ulcers are most strongly linked to chronic:
A. Autoimmune gastritis
B. H. pylori gastritis
C. Viral gastritis
D. Granulomatous gastritis

B. H. pylori gastritis

H. pylori-related peptic ulcer disease is associated with:
A. Decreased acid, increased bicarbonate
B. Increased acid, increased bicarbonate
C. Increased acid, decreased duodenal bicarbonate
D. Decreased acid, decreased bicarbonate

C. Increased acid, decreased duodenal bicarbonate

In patients older than 60, increased duodenal peptic ulcer disease is especially associated with:
A. Corticosteroid use
B. NSAID use
C. Celiac disease
D. Crohn disease

B. NSAID use

Duodenal peptic ulcer risk is particularly increased when low-dose aspirin is combined with:
A. Antibiotics
B. PPIs
C. Other NSAIDs
D. Anticoagulants only

C. Other NSAIDs

Peptic ulcer disease is also associated with cigarette use and cardiovascular disease because they decrease:
A. Mucosal blood flow and healing
B. Gastrin and acid secretion
C. Duodenal motility and appetite
D. Intrinsic factor and pepsin

A. Mucosal blood flow and healing

Most duodenal peptic ulcers occur:
A. In the distal duodenum
B. Near the ligament of Treitz
C. In the proximal duodenum
D. In the jejunum

C. In the proximal duodenum

Duodenal peptic ulcers are usually located within a few centimeters of the:
A. GE junction
B. Pyloric valve
C. Ampulla of Vater
D. Ileocecal valve

B. Pyloric valve

The duodenal wall most commonly involved by peptic ulcer is the:
A. Posterior wall
B. Lateral wall
C. Inferior wall
D. Anterior wall

D. Anterior wall

Gastric peptic ulcers are most commonly found along the:
A. Greater curvature
B. Cardia
C. Lesser curvature
D. Fundus

C. Lesser curvature

Gastric peptic ulcers are typically located near the interface of the:
A. Body and antrum
B. Cardia and fundus
C. Fundus and body
D. Pylorus and duodenum

A. Body and antrum

Pain from peptic ulcer disease is typically:
A. Better 1–3 hours after meals
B. Worse 1–3 hours after meals
C. Unchanged by meals
D. Only present with fasting

B. Worse 1–3 hours after meals

Peptic ulcer pain is classically:
A. Better at night
B. Worse at night
C. Only morning-predominant
D. Absent during sleep

B. Worse at night

Nighttime peptic ulcer pain is often relieved by:
A. Exercise only
B. Alkali or food
C. Vomiting only
D. Water restriction

B. Alkali or food

The type of gastritis with the greatest risk of gastric adenocarcinoma is:
A. H. pylori gastritis
B. Lymphocytic gastritis
C. Reactive gastropathy
D. Autoimmune gastritis

D. Autoimmune gastritis

In autoimmune gastritis, increased cancer risk may relate to:
A. Hyperchlorhydria
B. Rapid gastric emptying
C. Achlorhydria with bacterial overgrowth
D. Excess pepsin secretion

C. Achlorhydria with bacterial overgrowth

Bacterial overgrowth in autoimmune gastritis may increase formation of carcinogenic:
A. Ketone bodies
B. Nitrosamines
C. Bile salts
D. Leukotrienes

B. Nitrosamines

Hypertrophic gastropathies are characterized by giant cerebriform enlargement of rugal folds due to:
A. Inflammation and ulceration
B. Smooth muscle hypertrophy
C. Epithelial hyperplasia without inflammation
D. Fibrosis and calcification

C. Epithelial hyperplasia without inflammation

Hypertrophic gastropathies are linked to excessive release of:
A. Histamine
B. Growth factors
C. Pepsin
D. Somatostatin

B. Growth factors

Menetrier disease is associated with excessive secretion of:
A. TGF-α
B. TNF-α
C. EGF receptor blockade
D. IL-10

A. TGF-α

Menetrier disease is characterized by diffuse hyperplasia of the:
A. Chief cells
B. Parietal cells
C. Foveolar epithelium
D. Enterochromaffin cells

C. Foveolar epithelium

Menetrier disease most prominently affects the:
A. Antrum and fundus
B. Body and fundus
C. Pylorus and fundus
D. GE junction only

B. Body and fundus

A major clinical consequence of Menetrier disease is:
A. Protein-losing enteropathy
B. Massive GI perforation
C. Esophageal varices
D. Pancreatic insufficiency

A. Protein-losing enteropathy

Fundic gland polyps occur sporadically and in patients with:
A. Lynch syndrome
B. MEN1
C. Familial Adenomatous Polyposis
D. Peutz-Jeghers syndrome

C. Familial Adenomatous Polyposis

The rising prevalence of fundic gland polyps is linked to increased use of:
A. H2 blockers
B. PPIs
C. NSAIDs
D. Bile acid binders

B. PPIs

PPIs increase fundic gland polyps in part by causing increased:
A. Secretin secretion
B. Motilin release
C. Gastrin secretion
D. Somatostatin tone

C. Gastrin secretion

Increased gastrin promotes growth of:
A. Oxyntic glands
B. Paneth cells
C. Goblet cells
D. Brunner glands

A. Oxyntic glands

Dysplasia and carcinoma may occur in:
A. Sporadic fundic gland polyps only
B. FAP-associated fundic gland polyps
C. All hyperplastic polyps equally
D. Menetrier disease only

B. FAP-associated fundic gland polyps

Sporadic fundic gland polyps carry:
A. High cancer risk
B. Moderate lymphoma risk
C. No cancer risk
D. Only sarcoma risk

C. No cancer risk

In gastric adenomas, adenocarcinoma risk is most related to:
A. Patient age alone
B. Lesion size
C. Presence of H. pylori only
D. Degree of acid secretion

B. Lesion size

Gastric adenomas are usually:
A. Multiple and fundic
B. Solitary and under 2 cm
C. Diffuse and infiltrative
D. Pedunculated and duodenal

B. Solitary and under 2 cm

Gastric adenomas are most commonly located in the:
A. Fundus
B. Body
C. Cardia
D. Antrum

D. Antrum

Gastric adenomas are best classified as:
A. Hamartomatous lesions
B. Reactive lesions
C. Premalignant neoplastic lesions
D. Purely inflammatory lesions

C. Premalignant neoplastic lesions

Compared with intestinal adenomas, gastric adenomas have a:
A. Lower invasive cancer risk
B. Similar invasive cancer risk
C. Much higher invasive cancer risk
D. Negligible malignant potential

C. Much higher invasive cancer risk

The most common malignancy of the stomach is:
A. Lymphoma
B. GIST
C. Neuroendocrine tumor
D. Adenocarcinoma

D. Adenocarcinoma

Gastric adenocarcinoma accounts for more than:
A. 50% of gastric cancers
B. 70% of gastric cancers
C. 90% of gastric cancers
D. 99% of gastric cancers

C. 90% of gastric cancers

The intestinal type of gastric adenocarcinoma typically forms:
A. Diffuse infiltrative thickening
B. Bulky masses
C. Pure ulcers only
D. Signet-ring sheets only

B. Bulky masses

The diffuse type of gastric adenocarcinoma characteristically:
A. Forms exophytic polyps
B. Produces only mucosal plaques
C. Infiltrates and thickens the wall
D. Spares the muscularis

C. Infiltrates and thickens the wall

The diffuse type of gastric adenocarcinoma is composed of:
A. Reed-Sternberg cells
B. Signet ring cells
C. Plasma cells
D. Squamous pearls

B. Signet ring cells

Spread of gastric adenocarcinoma to the pouch of Douglas is called:
A. Krukenberg tumor
B. Blumer shelf
C. Irish node
D. Virchow node

B. Blumer shelf

Blumer shelf may be detected on:
A. Thyroid exam
B. Pelvic ultrasound only
C. Rectal exam
D. Chest percussion

C. Rectal exam

The overall reduction in gastric cancer is most closely related to decreased prevalence of:
A. Crohn disease
B. NSAID use
C. H. pylori
D. Barrett esophagus

C. H. pylori

Another contributor to declining gastric cancer rates may be reduced intake of dietary:
A. Oxalates
B. N-nitroso compounds
C. Gluten peptides
D. Short-chain fatty acids

B. N-nitroso compounds

Familial gastric cancer is strongly associated with germline loss-of-function mutation in:
A. APC
B. KRAS
C. CDH1
D. TP53

C. CDH1

CDH1 encodes:
A. β-catenin
B. E-cadherin
C. N-cadherin
D. p16

B. E-cadherin

Loss of function of E-cadherin is a key step in development of:
A. Intestinal gastric cancer
B. Diffuse gastric cancer
C. MALT lymphoma
D. Duodenal adenoma

B. Diffuse gastric cancer

Sporadic intestinal-type gastric cancers are strongly associated with increased signaling through the:
A. Notch pathway
B. Hedgehog pathway
C. MAPK pathway
D. Wnt pathway

D. Wnt pathway

Increased Wnt signaling in sporadic intestinal-type gastric cancer can result from gain-of-function mutation in:
A. β-catenin
B. E-cadherin
C. SMAD4
D. PTEN

A. β-catenin

Increased Wnt signaling can also result from loss-of-function mutation in:
A. RET
B. APC
C. KIT
D. RB1

B. APC

Patients with FAP who carry germline mutations in which gene have increased risk of intestinal-type gastric cancer?
A. APC
B. KRAS
C. TP53
D. CDH1

A. APC

Most gastric adenocarcinomas involve the gastric:
A. Fundus
B. Cardia
C. Antrum
D. pylorus

C. Antrum

Compared with the greater curvature, gastric adenocarcinoma more often involves the:
A. lesser curvature
B. greater curvature
C. posterior wall
D. fundic dome

A. lesser curvature

Diffuse gastric cancer is composed of discohesive signet ring cells because of loss of:
A. APC
B. E-cadherin
C. KIT
D. chromogranin A

B. E-cadherin

Intestinal-type gastric cancer typically develops from precursor lesions such as:
A. adenomas and flat dysplasia
B. chronic ulcers and flat dysplasia
C. fundic polyps and flat dysplasia
D. carcinoid nodules and flat dysplasia

A. adenomas and flat dysplasia

Because most gastric cancers are discovered late, the overall 5-year survival is:
A. excellent
B. moderate
C. variable
D. low, under 30%

D. low, under 30%

Extranodal lymphomas most commonly arise in the GI tract, especially the:
A. jejunum
B. stomach
C. esophagus
D. colon

B. stomach

The most common primary gastric lymphoma is:
A. diffuse large B-cell
B. mantle cell lymphoma
C. marginal zone B-cell
D. Burkitt lymphoma

C. marginal zone B-cell

In the stomach, MALT is most often induced by:
A. chronic gastritis
B. autoimmune hepatitis
C. portal hypertension
D. acute pancreatitis

A. chronic gastritis

The most common inducer of gastric MALT is:
A. EBV
B. NSAID use
C. CMV
D. H. pylori

D. H. pylori

Gastric MALTomas can transform into tumors identical to:
A. Hodgkin lymphoma
B. diffuse large B-cell lymphoma
C. follicular lymphoma
D. plasmacytoma

B. diffuse large B-cell lymphoma

If NF-kB is constitutively active due to MALToma translocations, H. pylori treatment:
A. is curative
B. is partly effective
C. is not effective
D. is first-line anyway

C. is not effective

Gastric MALTomas typically express CD19 and:
A. CD20
B. CD3
C. CD5
D. CD10

A. CD20

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

B. Zollinger-Ellison syndrome

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

a. rarely

b. often

a. rarely

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

a. jejunum, ileum

b. stomach, ileum

c. duodenum, ileum

a. jejunum, ileum

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

C. polypeptide hormones

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

A. abdominal pain and weight loss

The most common mesenchymal tumor in the abdomen is:
A. leiomyoma
B. liposarcoma
C. schwannoma
D. GI stromal tumor

D. GI stromal tumor

GISTs arise from the:
A. enteric ganglion cells
B. smooth muscle cells
C. interstitial cells of Cajal
D. submucosal fibroblasts

C. interstitial cells of Cajal

The cell of origin for GIST is found in the GI:
A. mucosa
B. muscularis propria
C. serosa
D. lamina propria

B. muscularis propria

Gastric GIST, paraganglioma, and pulmonary chondroma:
A. Johnson Triad
B. Carney Triad
C. Zollinger-Ellison Triad

B. Carney Triad

Carney triad is seen most often in:
A. elderly men
B. adolescent boys
C. middle-aged women
D. young women

D. young women

Most GISTs are due to gain-of-function mutations in:
A. APC or RB
B. KIT or PDGFRA
C. KRAS or NRAS
D. RET or ALK

B. KIT or PDGFRA

The most useful diagnostic marker for GIST is:
A. desmin
B. S100
C. KIT
D. CD20

C. KIT

Acquired pyloric stenosis in adults most often results from:
A. antral gastritis or nearby ulcers
B. congenital muscle hypertrophy
C. aganglionosis
D. volvulus formation

A. antral gastritis or nearby ulcers

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

D. rectum

The main symptom of esophageal mucosal webs is:
A. progressive odynophagia
B. non-progressive dysphagia
C. hematemesis
D. chest pain only

B. non-progressive dysphagia

Which feature best distinguishes diffuse gastric cancer from intestinal type?
A. precursor adenomas
B. bulky gland-forming masses
C. discohesive signet ring cells
D. high-risk geography

C. discohesive signet ring cells

Which statement is correct regarding gastric malignancy?
A. most are found early
B. stomach is uncommon for extranodal lymphoma
C. MALT is congenital in stomach
D. gastric adenocarcinoma often presents advanced

D. gastric adenocarcinoma often presents advanced