Gastrointestinal Hardest Practice Exam! Trivia Quiz

Which of the following is correct regarding the contents of the layers of the alimentary canal?

• The mucosal layer contains all of the smooth muscle

• Meissner's plexus is located in the muscularis externa

• Retroperitoneal organs are defined as having serosa

• Auerbach's plexus is located in the muscularis externa

• Auerbach's plexus is located in the mucosa

A 4 month old infant present with bilious vomiting and abdominal distention.  X-ray shows What is the mechanism behind this patient's disease?

• Exposure to teratogens results in the loss of contractile ability of the smooth muscle cells

• Gestational diabetes leads to a neuropathy causing the inability to relax the smooth muscle segement

• The absence of intramural ganglion cells causes uncoordinated movement of the bowel segment, leading to obstruction

• Release of excess neurotransmitters results in the dyskinetic movement of the bowel segment

Which of these is not part of the functional lower esophageal sphincter?

• Smooth muscle

• Skeletal muscle

• Diapraghm

• Costal cartilage

• None (all of the above are part of the LES)

Which of these statements is/are true regarding the enzyme lactase?

• It is found in the brush border

• Deficiency is common in the elderly (defined as older than the dean of your medical school)

• Many experts don't consider lactase deficiency to be a disease because it is so common in otherwise healthy adults

• All of the above

• None of the above

Which phase is the least common cause of dysphagia in the elderly?

• Preparatory

• Oral

• Pharyngeal

• Esophageal

A 20-year-old man presents with 1 episode of hematochezia. He is concerned because his mother died of colorectal cancer at 50 years of age. He has no further information about his family history. He undergoes colonoscopy and is found to have 20 adenomas ranging in size from 4 to 15 mm.  On further exam and testing, he is found to have with supernumerary teeth, osteomas, epidermoid cysts and lipomas.What is the most likely diagnosis?

• Turcot syndrome

• FAP

• HNPCC

• Gardner's syndrome

• Juvenile polyposis

Which of the following statements is true regarding the genetics of colon cancer?

• P53 inactivation is a critical early step in the APC pathway of colon cancer

• Mismatch repair genes play a key role in the APC pathway

• SMAD2 and SMAD4 loss on 18q21 is a late factor in the APC pathway

• The first hit in the HNPCC pathway consists of change in function of E-cadherin or B-catenin

• The HNPCC pathway is the most common pathway of colon cancer development

(MULTIPLE ANSWER QUESTION)In this adenocarcinoma biopsy, which of the following are seen?

• Hyperchromatism of nuclei

• Normal goblet cells

• Pleomorphism of nuclei

• Neoplastic glands

Which of the following are symptoms of diverticulitis?

• Nausea

• Diarrhea

• Pneumaturia

• Leukocytosis

• All of the above

A 55 year old man with a history of atrial fibrillation presents to your office 2 months post myocardial infarction.  He has had sudden-onset, diffuse abdominal pain that began 18 hours ago. He has not been vomiting, but he has had several episodes of diarrhea, the last of which was bloody. What is the most likely mechanism behind his current symptoms?

• Arterial embolism

• Venous thrombosis

• Arterial thrombosis

• Nonocclusive ischemia

• All of the above

A 40-year-old housewife complains of recurrent constipation. She has had problems since her 20s, but they are worse now. The constipation is accompanied by abdominal bloating and abdominal pain, and the discomfort is only better when she has a bowel movement. On her gynecologist's advice, she has tried more fiber in her diet, including fresh fruits and leafy vegetables, but that has only made the bloating worse. Her past history includes a cholecystectomy and a hysterectomy. Physical examination is entirely normal. Rectal examination reveals normal consistency stool. Stool samples test negative for occult blood.  She denies anorexia, malnutrition, weight loss, or waking up at night in pain.What is the most likely diagnosis?

• Ulcerative colitis

• Crohn's disease

• Celiac disease

• Irritable bowel syndrome

• Staph aureus infection

What is true about the mechanism of action of the IBS medications Alosetron and Tegaserod?

• Alosetron and Tegaserod are both 5HT agonists

• Alosetron and Tegaserod are both 5HT antagonists

• Alosetron is a 5HT3 agonist and Tegaserod is a 5HT4 antagonist

• Alosetron is a 5HT3 antagonist and Tegaserod is a 5HT4 agonist

Which of the following metal ions has primarily a structural (as opposed to catalytic) role within the body?

• Fe2+

• Co2+

• Mg2+

• Mn2+

• Ca2+

What is the role of Folic acid (B9) in amino acid metabolism and nucleotide synthesis?

• Coenzyme for redox reactions

• Catalyze aldehyde transfer rxns

• Source of 1-Carbon fragments

• Maintains activity of Fe2+-dependent hydroxylases

A 55-year-old male smoker is admitted with pneumonia. He lives alone and has been unemployed for several years, since being kicked out of medical school.  He is receiving unemployment benefit but no additional social support. He is unkempt and thin, with a BMI of 19 kg/m^2.  He shows signs of irritability, fatigue, headaches, and peripheral edema.  The following day it is noted that the man is increasingly confused and requiring full nursing support as he is too unsteady to stand unaided. The ward doctor notes that he has nystagmus. High alcohol intake is queried, but no independent social history is available. The patient gradually improves but has continuing problems with his memory and appears to invent events to compensate for this. He remains unsteady on his feet and is found to have poor sensation in his lower limbs. The patient is judged no longer able to care for himself, and is admitted to a nursing home for long-term care.What vitamin deficiency is most likely here?

• B1

• B3

• B6

• B12

• C

A medical student preparing to pull an all-nighter to prepare for the upcoming GI test decides to make the ultimate energy drink.  He takes a 6 pack of 5 hour energy drinks (each containing 40 mg of B6), combines them in a beer stein, and adds 4 ground-up 100 mg B6 supplements to the mixture, then drinks it all in one sitting.  Which of the following symptoms is he most likely to have as a result of his concoction?

• Photosensitivity

• Loss of position and vibratory sense (motor strength intact)

• Loss of vibratory but not position sense

• All of the above

• A and B only

Which of these laxatives is hyperosmolar laxative?

• Methylcellulose

• Polycarbophil

• Lactulose

• Psyllium hydrophilic mucilloid

What is the most common process that leads to anorectal suppuration?

• Carcinoma

• Trauma

• Radiation

• Surgery

• Cryptoglandular

Hematemesis is usually caused by a bleeding site that is proximal to which structure?

A 48-year-old man presents to the ER after several episodes of vomiting blood after periods of forceful retching and vomiting. He has been binge drinking alcohol over the preceding 2 days.  Endoscopic view is seen here:What is the diagnosis?

• Mallory-Weiss tear

• Neoplasm

• Acute esophagitis

• Cameron lesion

• Gastric varices

A 78 year old man presents to his PCP with a recent history of painless bloody stools of the past 2 days.  He has no hemorrhoids or other obvious source of bleeding.  A representative colonoscopic view is shown. What is true about the pathogenesis of this condition?

• Exact mechanism is clearly known

• Unrelated to age, because aging is not a disease!

• Dilitation and tortuosity of veins leads to small AV communication

• Usually occurs because of trauma

• This is a rare cause of lower GI bleeds

The above image is most representative of which polyposis?

• Juvenile polyposis

• Peutz-Jegher

• Adenomatous polyposis coli

• HNPCC

A 46-year-old woman presents with fatigue and is found to have iron deficiency with anemia. She has experienced intermittent episodes of mild diarrhea for many years, previously diagnosed as irritable bowel syndrome and lactose intolerance. She has no current significant gastrointestinal symptoms. Examination reveals 2 oral aphthous ulcers and pallor. Abdominal examination is normal and results of fecal testing for occult blood are negative.  Biopsy is shown above.  What is the diagnosis?

• Crohn's

• Ulcerative colitis

• Celiac sprue

• HNPCC

• Chronic gastritis

Which of the following is true about the condition depicted here?

• Caused by trauma

• Most common in elderly adults

• Most common site is the ileo-cecal valve

• Common in the colon

• Underlying cause is clearly understood

A 6-month-old boy presents with a history of low-grade fever of 100°F (37.7°C) and nonbilious vomiting (6 episodes per day) for 2 days. This is followed by diarrhea (15 stools per day) 24 hours later. Stools are watery and do not contain blood or mucus. His mother is unsure of the urine output but the infant has lost 1.5 lb of weight in the past few days. His mother also reports that the infant is more irritable and has decreased activity level since the onset of the illness. The infant has never been breastfed and has not had rotavirus vaccination. He attends a day-care center. His 2-year-old brother who attends the same day-care center has just got over a bout of "stomach flu."What is the most likely diagnosis?

• Norovirus

• Rotavirus

• H. influenza

• Measles

• Influenza A

A 42-year-old man presents with a 48-hour history of bloody diarrhea. He has been opening his bowel 6 to 8 times per day and has associated nausea, lethargy, and generalized abdominal discomfort. There is no recent travel history. He lives with his wife and 2 children, who are all well. They had a meal in a restaurant 5 days ago, when he ate a beef burger and French fries. A friend who was with them ate the same meal and has developed similar symptoms. Exam shows a low-grade pyrexia (99.5°F (37.5°C)) but is otherwise unremarkable. CBC reveals a raised white cell count (15,000/mm^3). Further testing will probably reveal the presence of which bacteria?

• Bacillus cereus

• Staph aureus

• C. dificile

• E. Coli O157:H7

• Salmonella

HLA DQ2 and HLA DQ 4 are associated with Celiac sprue.

• True

• False

Which of the following are true about IgA EMA and tTG testing for celiac disease?

• May be falsely negative in immunodeficient patients

• Both tests have >90% sensitivity and specificity

• All of the above

• None of the above

Which of the following are true about the hormonal control of calcium absorption?

• 1,25-DHC is formed in the liver under the control of PTH

• 1, 25 DHC binds to the vitamin D receptor

• When too much Ca2+ is absorbed, more PTH is released to slow down absorption

• Calcium can only enter the villous cell through active transport

Glucose and galactose enter the enterocyte via which receptor?They exit via which receptor?

• GLUT2; SGLT1

• GLUT5; SGLT1

• SGLT1; GLUT5

• SGLT1; GLUT2

• GLUT5; GLUT2

MULTIPLE ANSWER QUESTIONWhich enzyme precursors are activated by Trypsin?

• Pepsinogen

• Prolipase

• Proelastase

• Proamylase

• Procarboxypeptidase

MULTIPLE ANSWER QUESTIONWhich of the following hydrolyze dietary lipids?

• Lingual lipase

• Pancreatic amylase

• Pancreatic cholesterol ester hydrolase

• Pancreatic phospholipase A2

• Pepsin

Which of the following is true about saliva stimulation?

• Parasympathetic stimulation produces a profuse watery salivary secretion

• Sympathetic stimulation produces low mucus content

• Sympathetic stimulation produces low amylase content

• Cranial nerves VI and VII stimulate saliva production

These cells are found in the fundal gland area of the stomach

• G cells

• D cells

• Chief cells

• Stratified squamous epithelial cells

• All of the above

A 67 year old man with a 30 year history of GERD presents with a progressive dysphagia that affects solid foods more than liquid.  He denies weight loss.  Endoscopic image seen here is indicative of his disease.  What condition does he have?

• Zenker's diverticulum

• Schatzki's ring

• Peptic stricture

• A type lower esophageal ring

• Epiphrenic diverticulum

A 42 year old politician who recently completed a course of doxycycline due to an anthrax attack at his office presents with odynophagia.  Which image below represents what you would expect his esophagus to look like?A: B: C: D:

• A

• B

• C

• D

What is the most common site of peptic ulcers?

• Stomach

• Duodenum

• Ascending colon

• Jejunum

• Ileum

A 45-year-old male presents with abdominal pain, diarrhea and heartburn. Physical exam is unremarkable. On endoscopy he is found to have multiple gastric and duodenal ulcers. The patient is prescribed proton-pump inhibitors and treated for Helicobacter pylori, which relieves his symptoms temporarily. However, he has multiple recurrences of symptoms and ulcers.What is true about his condition?

• Easily refractive to proper treatment

• Ulcers are only found in the duodenum and stomach

• Can be caused by G cell tumors

• Associated with decreased acid in the gut

• All of the above

Which of the following are true about the condition depicted here?

• Most cases occur in females

• Infants present with non-bilious vomiting

• There is atrophy of the muscularis propria of the pylorus

• It typically presents at age 3-6 months

• Usually associated with other congenital anomalies

What is the diagnosis depicted in this image?(Hint:  There is lobular disarray with focal hepatocyte necrosis, along with giant cell  transformation, lymphocytic infiltration, Kupffer cell hyperplasia, and cholestasis.)

Which of these are risk factors for this condition?

• Smoking

• Alcohol

• Diet

• Barrett's esophagus

• A, B, and C

An otherwise healthy 45-year-old male executive complains of heartburn. He has tried over-the-counter medications with no relief. He was tried on a course of proton pump inhibitors for 6 weeks, but still has heartburn. He has no weight loss or dysphagia.30 years later, after never receiving any more treatment for his heartburn, the above biopsy is obtained from his esophagus.  What is the diagnosis?

• Adenocarcinoma

• Barrett's esophagus

• Squamous cell carcinoma

• A and B

• All of the above

MULTIPLE ANSWER QUESTION!!What are the findings in this image?

• Gastric adenocarcinoma (diffuse type)

• Gastric adenocarcinoma (intestinal type)

• Clear vacuoles of mucin

• Plentiful glandular tissue

• Lymphocytic infiltrate