Block 6 GI Histo Univ Of VirGInia W Expl Prt 1
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From U of Virg med school
- 1.The fluorescent nucleotide analog bromodeoxyuridine (BrdU) has been used widely to label cells engaged in DNA synthesis and thereby identify regions in tissues where cell proliferation is occurring. If you apply BrdU labeling to the gastrointestinal tract and sample tissues at increasing times for examination by fluorescence microscopy, which one of the following outcomes might you expect to observe?
- A.
No labeling in the esophageal mucosal epithelium because it doesn’t undergo turnover
- B.
Labeling of chief cells at the base of gastric glands in the stomach but not labeling of surface mucous cells
- C.
Labeling in the mucosal glands (crypts of Lieberkuhn) of the jejunum at earlier times and labeling of cells on villi only at later times
- D.
Labeling in Peyer’s patches but not in the mucosal epithelium of the ileum
- E.
Labeling only on villi in the colon
- 2.
- A.
Squamous metaplasia
- B.
Esophageal varices
- C.
Malt lymphoma
- D.
Dysplasia
- E.
Hiatal hernia
- 3.A three week old male presents to your clinic with projectile vomiting and weight loss. Following surgery, the baby makes a complete recovery. A family history reveals that the baby’s maternal uncle also had a pyloric stenosis. No other cases in the family were noted. What is the most likely mode of inheritance in this family?
- A.
Autosomal dominant
- B.
Autosomal recessive
- C.
X-linked recessive
- D.
Multifactorial
- 4.
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All of the following are true of the cells marked by the arrows EXCEPT:- A.
They can be found in the esophagus, stomach, small intestine, and large intestine.
- B.
They facilitate the peristalsis of the gut
- C.
They are derived from the stem cells that are located in crypts of Lieberkuhn
- D.
They are very active in protein synthesis
- E.
They are absent in the distal colon in Hirschsprung’s disease
- 5.A 48 year old female presents to your office with 9 days of bloody diarrhea. Her symptoms started with diarrhea nausea vomiting and fever to 38.7 C. She has no history of inflammatory bowel disease. One of her coworkers also developed nausea and diarrhea around the same time her symptoms began. You send stool cultures which come back positive for salmonella. If you were to take biopsies of the colonic mucosa, you are most likely to see an increase in which of the following cells:
- A.
T-lymphocytes
- B.
Dendritic cells
- C.
Macrophages
- D.
Neutrophils
- E.
Plasma cells
- 6.
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- A.
Nitroglycerin
- B.
Calcium channel blocker
- C.
Surgical myotomy of the lower esophageal sphincter
- D.
Botulinum toxin injection into the upper esophageal sphincter
- E.
A and B
- 7.A 68 year-old man is evaluated for chronic epigastric discomfort, heartburn, and diarrhea of 4 years' duration. His weight has been stable during this time period. The patient has no significant medical history and takes no medications. On physical examination, there is mild epigastric tenderness but no rebound or guarding. Rectal examination reveals brown stool that is hemoccult positive. Laboratory studies reveal a hemoglobin of 12.4 g/dL with a mean corpuscular volume of 73. Test for serum Helicobacter pylori antibody is negative. EGD shows prominent gastric folds, mild linear erosions, and multiple ulcers in the first and second portions of the duodenum. Which of the following is the most appropriate next step in the evaluation of this patient?
- A.
CT scan of the abdomen and pelvis
- B.
Abdominal ultrasound
- C.
Measurement of serum gastrin
- D.
Flexible sigmoidoscopy
- 8.A 24 year old nurse presents with 8 weeks of progressive bloody diarrhea. Stool studies are negative for enteric pathogens. She undergoes colonoscopy, which shows active inflammation throughout the colon. Biopsies were obtained. In biopsy specimens from the colon, the most important finding that distinguishes Crohn’s disease from ulcerative colitis is:
- A.
Crypt abcesses
- B.
Lymphoid aggregates
- C.
Eosinophils
- D.
Granulomas
- E.
Ulceration
- 9.The mucosal immune system is present in six or more human organs but faces huge challenges in carrying out its functions. These include:
- A.
Denying entry of micro-organisms to the body, despite an abundance of intra-luminal bacteria and viruses nearby
- B.
Distinguishing harmless from pathological micro-organisms, in order to make an immune response only when appropriate
- C.
Protecting a vast surface area, estimated to be the size of two tennis courts in the gut alone
- D.
All of the above
- 10.Misoprostil is contraindicated in:
- A.
GERD
- B.
Duodenal ulcers
- C.
Diabetics
- D.
Heroin addicts
- E.
Reproductive women
- 11.During surgery, you must excise the anterior rectus sheath between the xiphoid process and the umbilicus. In this region, the sheath is derived from the aponeurosis of the
- A.
External abdominal oblique only
- B.
Internal abdominal oblique only
- C.
External and internal abdominal oblique
- D.
Internal oblique and tranversus abdominis
- E.
Transversus abdominis only
- 12.A 55-year-old man is admitted to the hospital with severe abdominal pain. Gastroscopy and CT scan examinations revealed a perforating ulcer in the posterior wall of the stomach. Where would peritonitis most likely develop initially?
- A.
Hepatorenal recess
- B.
Omental bursa (lesser sac)
- C.
Right subphrenic space
- D.
Left infracolic gutter
- 13.A hard mass (a fecolith) in the ostium of a 27-year-old patient's appendix had led to a local infection (appendicitis). The initial pain from the infection was dull and difficult to localize, but the patient placed his hand in the periumbilical area to indicate the general area of discomfort. The region of the umbilicus receives its sensory supply from with of the following spinal nerves?
- A.
T7
- B.
T8
- C.
T10
- D.
T12
- E.
L1
- 14.
- A.
Of all GI disorders GERD has the most economic impact
- B.
Elderly patients tend to have more serious manifestations of GERD
- C.
Esophageal adenocarcinoma can be associated with GERD
- D.
President Clinton's hoarseness was likely due to GERD
- E.
All of the above
- 15.
- A.
Start the patient on a strict diet eliminating all dairy and beef
- B.
Screen stool for ova and parasites, obtain a total IgE level, refer to an Allergist and consider further etiologies contributing to the peripheral eosinophilia and esophagitis
- C.
Consider referral to a Pediatric Allergist for evaluation for possible environmental and food exposures that may be contributing to EoE
- D.
Start the patient on 2mg/kg/day of methylprednisolone x 2 months with slow taper
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