Gastrointestinal Hardest Practice Exam! Trivia Quiz

The correct answer is Mallory-Weiss tear. Mallory-Weiss tear is a condition characterized by a tear in the mucous membrane of the lower part of the esophagus or upper part of the stomach. It is commonly caused by forceful retching and vomiting, which can occur in individuals who have been binge drinking alcohol. The endoscopic view provided in the question may show evidence of this tear, such as linear mucosal lacerations. Neoplasm, acute esophagitis, Cameron lesion, and gastric varices are not consistent with the given clinical presentation and endoscopic findings.

Smoking, alcohol consumption, and diet are all risk factors for the given condition. Smoking is known to increase the risk of various health problems, including this condition. Alcohol consumption can also contribute to the development of this condition. Additionally, an unhealthy diet, especially one that is high in fatty and processed foods, can increase the risk of developing this condition. Therefore, options A, B, and C are all correct as they include smoking, alcohol, and diet as risk factors for the condition.

This is most likely to be IBS at this point because of the long history of abdominal pain that gets better with BMs and normal exam results, along with the pertinent negative of weight loss.

All are correct
Leukocytosis is part of the 'triad' along with LLQ pain, and fever.
Diarrhea is a common presenting symptom, as is nausea.
Pneumaturia can result from a colovesical fistula from diverticulitis.

The most likely diagnosis in this case is rotavirus infection. The patient's symptoms of low-grade fever, vomiting, diarrhea, weight loss, irritability, and decreased activity level are consistent with rotavirus gastroenteritis. The fact that the patient attends a day-care center and his brother recently had a similar illness further supports this diagnosis. Rotavirus is a common cause of gastroenteritis in young children, especially those who have not been vaccinated against it. Norovirus, H. influenza, measles, and influenza A are less likely diagnoses based on the clinical presentation.

Parasympathetic stimulation is responsible for producing a profuse watery salivary secretion. This means that when the parasympathetic nervous system is activated, it triggers the release of a large amount of saliva that is thin and watery in consistency. This response is important for lubricating the mouth and facilitating the initial stages of digestion.

Peptic ulcers are most often found in duodenum (4x as often as stomach, which is next)

This is Hirschsprung disease, this congenital condition almost always presents in infants as an obstruction. It is caused by a lack of ganglionic cells in a bowel segment. This causes that area to be tonically closed, leading to obstruction.

Lactulose is a hyperosmolar laxative because it works by drawing water into the colon, which increases the water content of the stool and stimulates bowel movements. This helps to soften the stool and relieve constipation. Methylcellulose, polycarbophil, and psyllium hydrophilic mucilloid are all bulk-forming laxatives, which work by adding bulk to the stool and promoting regular bowel movements. Therefore, lactulose is the correct answer as it belongs to the hyperosmolar laxative category.

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The patient's symptoms of bloody diarrhea, nausea, lethargy, and abdominal discomfort, along with the raised white cell count, are suggestive of an infectious bacterial cause. E. Coli O157:H7 is a strain of E. Coli that produces a toxin causing bloody diarrhea and is commonly associated with foodborne illness. The fact that the patient and his friend both developed similar symptoms after eating the same meal suggests that the bacteria may have been present in the beef burger or French fries they consumed. Therefore, further testing will likely reveal the presence of E. Coli O157:H7.

Lactase is an enzyme crucial for the digestion of lactose, a sugar found in dairy products. It is primarily located in the brush border of the small intestine, where it facilitates the breakdown of lactose into absorbable sugars. Contrary to the notion that lactase deficiency is associated with age, it is not strictly defined by age criteria. While a decrease in lactase activity can occur with age, lactase deficiency can affect individuals at any age. As for the claim that many experts do not consider lactase deficiency a disease due to its prevalence in healthy adults, it's important to note that lactase deficiency can lead to lactose intolerance, causing digestive discomfort in those affected. Therefore, recognizing lactase deficiency as a condition is essential for understanding and managing its impact on individuals' ability to digest lactose-containing foods.

Both IgA EMA and tTG testing for celiac disease may be falsely negative in immunodeficient patients. Additionally, both tests have a sensitivity and specificity of over 90%. Therefore, all of the statements provided are true.

The given answer states that the most common site for the condition depicted here is the ileo-cecal valve. This means that out of all the potential locations where this condition can occur, the ileo-cecal valve is the most frequently affected. This information suggests that the condition has a higher likelihood of occurring in this specific area compared to other parts of the body.

The given endoscopic image and the patient's symptoms of progressive dysphagia affecting solid foods more than liquid, along with a history of GERD, are indicative of a peptic stricture. Peptic strictures are caused by chronic acid reflux, which leads to the formation of scar tissue in the esophagus, narrowing its lumen and causing difficulty in swallowing. This condition does not typically cause weight loss, which is consistent with the patient's denial of weight loss. Zenker's diverticulum, Schatzki's ring, and lower esophageal ring are different conditions that do not match the patient's presentation. Epiphrenic diverticulum is also unrelated to the symptoms described.

Auerbach's plexus is located between the inner and outer layers of SM in the muscularis externa.

Hematemesis, which is the vomiting of blood, is typically caused by bleeding that occurs in the upper gastrointestinal tract. The Ligament of Treitz is a structure located in the upper part of the small intestine, specifically where the duodenum transitions into the jejunum. Since hematemesis is caused by bleeding that is proximal, or closer, to the Ligament of Treitz, it is a likely site for the bleeding to originate from. Therefore, the correct answer is the Ligament of Treitz.

Barrett's esophagus describes a change in the squamous epithelium of the esophagus to intestinal-type epithelium with metaplasia on biopsy.

This is Gardner's syndrome, which is a familial polyposis that presents with extra-intestinal manifestations including extra-intestinal manifestations including epidermal inclusion cysts, osteomas, desmoid tumors, and dental abnormalities.

Turcot syndrome is associated with CNS tumors.
FAP is the broader term that this falls under, but because of the smaller number of polyps ( Juvenile polyposis usually presents with bleeding and iron deficiency anemia.
HNPCC would not explain anything else besides the polyps, so it is not the right answer here.

The diagnosis depicted in the image is neonatal hepatitis, specifically neonatal giant cell hepatitis. This is supported by the presence of lobular disarray, focal hepatocyte necrosis, giant cell transformation, lymphocytic infiltration, Kupffer cell hyperplasia, and cholestasis. These findings are characteristic of neonatal hepatitis, a condition that causes inflammation and damage to the liver in newborns. Neonatal giant cell hepatitis refers specifically to the presence of giant cells, which are large multinucleated cells that can be seen in the liver tissue.

A and B are typical for B6 toxicity
C is more typical of B12 deficiency
I would also expect him to have some nausea, too.

Chief cells are found in the fundal gland area of the stomach. These cells are responsible for producing pepsinogen, an inactive enzyme that is later converted into the active enzyme pepsin. Pepsin plays a crucial role in the digestion of proteins in the stomach. Therefore, chief cells are an important component of the stomach's digestive function.

This is a medication induced stricture caused by the doxycycline.

The correct answer is A and B because the patient's symptoms of chronic heartburn, lack of relief from medication, and the biopsy findings from the esophagus indicate the presence of both adenocarcinoma and Barrett's esophagus. Adenocarcinoma is a type of cancer that can develop in the esophagus due to chronic acid reflux, while Barrett's esophagus is a condition characterized by the replacement of normal esophageal cells with cells resembling those of the intestines, often caused by long-term acid reflux. The combination of these findings suggests a diagnosis of both adenocarcinoma and Barrett's esophagus.

HLA DQ-2 and HLA DQ-8 are the two associated with Celiac

The correct diagnosis in this case is celiac sprue. This is supported by the patient's iron deficiency anemia, intermittent episodes of mild diarrhea, previous diagnosis of irritable bowel syndrome and lactose intolerance, oral aphthous ulcers, and negative fecal testing for occult blood. The biopsy shown above would likely reveal characteristic histological findings such as villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis, which are consistent with celiac sprue.

This is Zollinger-Ellison syndrome, which is characterized by excess gastrin and acid, sometimes due to G cell secreting tumors.

A: kidney, not liver
B: correct
C: PTH is released when too little Ca2+ is being absorbed, and it causes increased absorption
D: Enters through facilitated diffusion

A: males>females
B: correct
C: hypertrophy
D: 3-4 weeks
E: Usually not associated, but can be seen in Turner's, Tri 18, and esophageal atresia

Calcium (Ca2+) primarily has a structural role within the body. It is an essential mineral that is mainly found in bones and teeth, providing strength and rigidity to support the body. Calcium also plays a crucial role in muscle contraction, nerve function, and blood clotting. While other metal ions listed may have some structural roles or catalytic functions, calcium's primary function is structural.

The 'intrinsic' part of the sphincter includes the SMC's, while the 'external'includes the skeletal muscle and crural part of the diaphragm.

A is the best answer because it is the most common cause of acute mesenteric ischemia, and the patient has two risk factors for it: his recent MI and his atrial fibrillation
B is more common in hypercoagulable states or heart failure.
C is possible, but statistically less likely, and there is no proof in the vignette that he has PVD.
D is not likely because he is not in a low flow state

Juvenile polyposis. A, Juvenile polyp. Note the surface erosion and cystically dilated crypts. B, Inspissated mucous, neutrophils, and inflammatory debris can accumulate within dilated crypts. 

Glucose and galactose enter the enterocyte through the SGLT1 receptor. This receptor is responsible for actively transporting these sugars from the intestinal lumen into the enterocyte against their concentration gradient. Once inside the enterocyte, glucose and galactose exit through the GLUT2 receptor. GLUT2 is a facilitative transporter that allows the passive diffusion of glucose and galactose from the enterocyte into the bloodstream.

Keys here are the Wernicke-Korsakoff syndrome and the wasting, headaches, irritability, peripheral edema and peripheral nerve damage suggest dry beriberi.

Alosetron is classified as a 5HT3 antagonist, which means it blocks the action of serotonin at the 5HT3 receptors. Tegaserod, on the other hand, is a 5HT4 agonist, which means it activates the 5HT4 receptors. This difference in mechanism of action suggests that Alosetron and Tegaserod have opposite effects on serotonin signaling in the body. Alosetron reduces the activity of serotonin, while Tegaserod enhances it.

Mentioned in the Geriatric GI lecture that A, B, and C are the most common.

See the Colorectal cancer lecture if you don't recognize this image.

A is what riboflavin does
B is what thiamine does
C is correct
D is what ascorbate does

Lingual lipase, pancreatic cholesterol ester hydrolase, and pancreatic phospholipase A2 are all enzymes that are involved in the hydrolysis of dietary lipids. Lingual lipase is secreted by the salivary glands and begins the digestion of lipids in the mouth. Pancreatic cholesterol ester hydrolase is produced by the pancreas and helps in the breakdown of cholesterol esters. Pancreatic phospholipase A2 is also produced by the pancreas and aids in the digestion of phospholipids. Therefore, all three of these enzymes play a role in the hydrolysis of dietary lipids.

This infectious process develops most commonly secondary to an infection in the anal gland, but multiple other causes should be considered.

-C is correct
-A is incorrect because P53 inactivation is a late step in FAP
-B is incorrect because that refers to the HNPCC pathway
-D is incorrect because that is the second hit in the FAP pathway
-E is incorrect because APC is the most common pathway

Trypsin is an enzyme that is responsible for the activation of various other enzymes in the digestive system. Prolipase, proelastase, and procarboxypeptidase are all enzyme precursors that require activation by trypsin in order to become functional enzymes. Therefore, these are the correct answers as they are the enzyme precursors that are activated by trypsin.

This gastric adenocarcinoma is so poorly differentiated that glands are not visible. Instead, rows of infiltrating neoplastic cells with marked pleomorphism are seen. Many of the neoplastic cells have clear vacuoles of mucin.