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WorksheetsResident Quiz
Total questions: 40
Worksheet time: 1hrs 20mins
Name
Class
Date
1.
An asymptomatic 78-year-old man underwent esophagogastroduodenoscopy that revealed a 4-cm segment of Barrett esophagus at 36–40 cm from the incisors. The abnormal segment is circumferential but has no ulcerations or nodularity. Biopsies from all 4 quadrants revealed high-grade dysplasia but no invasive cancer. Which of the following is the best treatment option?
a)
Photodynamic therapy
b)
Radiofrequency ablation
c)
Repeat endoscopy in 3 months
d)
Esophagectomy
2.
Which of the following statements is true regarding the pathophysiology of peptic ulcer disease?
a)
Type II peptic ulcers are unlikely to be associated with Helicobacter pylori
b)
High acid secretion is associated with type IV gastric ulcers
c)
Nonsteroidal anti-inflammatory drugs increase acid secretion
d)
Gastrin hypersecretion leads to increased parietal cell production of acid
3.
Proximal esophageal squamous cell carcinoma with clinical complete response after chemoradiotherapy
a)
Resection
b)
Observation
c)
Both
d)
Neither
4.
Distal esophageal adenocarcinoma with clinical complete response after chemoradiotherapy
a)
Resection
b)
Observation
c)
Both
d)
Neither
5.
A 48-year-old woman who is morbidly obese is referred to your office with an incidental CT finding of an aberrant right subclavian artery running in a retroesophageal path. What is the management strategy of choice?
a)
Observation
b)
Reimplantation or bypass of subclavian artery
c)
EGD
d)
UGI study
6.
A 65-year-old male presents with prolonged vomiting. He undergoes an EGD and is diagnosed with a gastric outlet obstruction. Which of the following would correspond with the metabolic abnormality seen with this type of patients?
a)
Hypochloremic, hypokalemic metabolic alkalosis
b)
Hyperchloremic, hyperkalemic metabolic acidosis
c)
Hyponatremic, hypochloremic metabolic acidosis
d)
Hypernatremic, hypochloremic metabolic alkalosis
7.
What is the histologic subtype of Barrett tissue?
a)
Junctional epithelium
b)
Specialized columnar epithelium
c)
Gastric fundus epithelium
d)
Specialized squamous epithelium
8.
A 35-year-old woman has underwent an EGD, which shows a prepyloric ulcer. What type of ulcer is this?
a)
Type I
b)
Type II
c)
Type III
d)
Type IV
9.
What is the treatment for an early-stage gastric MALT lymphoma?
a)
Gastrectomy
b)
Radiation treatment
c)
Chemotherapy
d)
H pylori eradication followed by regular EGD follow-up
10.
The most common cause of chylothorax is:
a)
Trauma to the spine and chest wall
b)
Lymphatic obstruction from mediastinal lymphoma
c)
Lymphatic leakage after mediastinal lymph node dissection
d)
Thoracic duct injury during esophagectomy
11.
A 34-year-old male patient has been experiencing gastric reflux symptoms and recently underwent a workup, which included a upper endoscopy. The upper endoscopy revealed Barrett esophagus. The most appropriate therapy for this patient is:
a)
Esophagectomy
b)
Repeat endoscopy in 3 months
c)
Repeat endoscopy in 6 months
d)
Medical therapy with acid suppression and referral for fundoplication
12.
Which of these patients has an indication for stress gastritis prophylaxis?
a)
Intubated patient (>48 hrs) with an INR of 3
b)
Stable trauma patient with an isolated pelvic fracture
c)
Long-term ICU patient tolerating tube feeds at goal for 2 weeks
d)
NPO patient with a postoperative ileus following elective colon resection
13.
Boerhave esophageal rupture normally occurs at:
a)
Cervical esophagus
b)
Proximal thoracic esophagus
c)
Middle thoracic esophagus
d)
Distal thoracic esophagus
14.
An elderly man was experiencing progressive dysphagia with regurgitation of undigested food. A thorough workup revealed he had a cervical Zenker diverticulum. What is the treatment of choice for this condition?
a)
Observation
b)
Diverticulectomy
c)
Diverticulectomy with cricopharyngeal myotomy
d)
Esophagectomy
15.
An aberrant left hepatic artery originates from:
a)
Right gastric artery
b)
Left gastric artery
c)
Left gastroepiploic artery
d)
SMA
16.
After a 3 incision esophagectomy with a cervical anastomosis, the patient begins to develop leukocytosis, fever, and erythema of the wound. A barium swallow is performed and there is an anastomotic leak noted. What is the most appropriate management of this patient?
a)
Open the wound and redo the anastomosis
b)
Open the wound and widely drain the anastomosis
c)
Endoluminal stent
d)
IV antibiotics and NPO
17.
A 50-year-old man comes in complaining of progressive dysphagia. CT scan shows no evidence of tumor. An upper GI study shows no tumor or functional obstruction. An EGD is performed and a small tear is iatrogenically created with the EGD scope. The patient has some mild chest pain and is started on antibiotics. A stat CT scan shows a small, contained perforation just above the GE junction. What is the treatment of choice?
a)
NPO, antibiotics and observation
b)
Thoracotomy, primary repair and muscle patch
c)
Esophageal stenting
d)
Endoluminal repair with clips
18.
Where are the chief cells found in the stomach?
a)
Fundus
b)
Body
c)
Antrum
d)
Pylorus
19.
A patient recently underwent an Ivor-lewis esophagectomy for cancer. The initial operation was straight-forward and the operation took 4 hours. On postoperative day 7, the patient began to develop fevers, tachycardia, and shortness of breath. He developed hypotension and was refractory to IV fluid boluses and is now on vasopressors to maintain an adequate perfusion pressure. A CT demonstrated a large right-sided pleural effusion and extravasation of the oral contrast material. The patient was brought back for re-exploration and the anastomosis was disrupted. In addition, the gastric conduit was dusky and there was concern about its viability. What is the best treatment option at this point?
a)
Staple off the necrotic stomach; perform a diverting esophagostomy
b)
Resect the necrotic stomach and redo the anastomosis
c)
Resect the gastric conduit and perform colonic interposition
d)
Wide drainage with chest tubes and long-term antibiotics with TPN
20.
The most common form of esophageal cancer diagnosed in the US is
a)
Adenocarcinoma
b)
Squamous cell carcinoma
c)
Anaplastic carcinoma
d)
Leiomyosarcoma
21.
Physiologic reflux happens most commonly when a person is
a)
Awake and supine
b)
Awake and upright
c)
Asleep and supine
d)
Asleep and semi-erect
22.
Which blood group is associated with an increased risk of gastric cancer
a)
A
b)
B
c)
AB
d)
O
23.
Which of the following is secreted by gastric parietal cells?
a)
Pepsinogen
b)
Intrinsic factor
c)
Gastrin-releasing peptide
d)
Histamine
24.
Which of the following esophageal layers contains Meissner's plexus
a)
Mucosa
b)
Submucosa
c)
Muscularis mucosea
d)
Muscularis propria
25.
Which of the following esophageal layers contains Auerbach's plexus
a)
Mucosa
b)
Submucosa
c)
Muscularis mucosea
d)
Muscularis propria
26.
Which test most accurately assess the T stage of esophageal cancer?
a)
MRI
b)
CT scan
c)
Endoscopic ultrasonography
d)
Esophagogastroduodenoscopy
27.
The most common cause of a deficient LES is
a)
inadequate overall length
b)
mean resting pressure >6 mm Hg
c)
inadequate intra-abdominal length
d)
failure of receptive relaxation
28.
An upward dislocation of both the cardia and gastric fundus is which type of hiatal hernia
a)
I
b)
II
c)
III
d)
IV
29.
Which of the following options is the least preferable reconstruction for patients undergoing antrectomy for PUD?
a)
Billroth I
b)
Billroth II
c)
Roux-en-Y gastrojejunostomy
d)
All are equally preferable
30.
How long after completion of neoadjuvant chemoradiation should esophagectomy be performed?
a)
4-6 weeks
b)
6-8 weeks
c)
8-10 weeks
d)
>10 weeks
31.
All of the following hormones decrease LES tone EXCEPT
a)
Gastrin
b)
Estrogen
c)
Somatostatin
d)
CCK
32.
The incidence of metaplastic Barret esophagus progressing to adenocarcinoma is
a)
0.2 to 0.5% per year
b)
1 to 3% per year
c)
3 to 5% per year
d)
>5% per year
33.
The histologic hallmark of BE is
a)
Columnar epithelium
b)
Goblet cells
c)
Parietal cells
d)
Cuboidal epithelium
34.
The preoperative test most heavily correlated with the ability to tolerate an esophagectomy is
a)
DLCO
b)
FEV1
c)
Ability to climb a flight of stairs
d)
FVC
35.
The treatment of choice for an isolated 3 cm GIST in the body of the stomach is
a)
Imatinib
b)
Endoscopic ablation
c)
Wedge resection
d)
Subtotal gastrectomy
36.
H pylori infection primarily mediates duodenal ulcer pathogenesis via
a)
Antral alkalinization leading to inhibition of somatostatin release
b)
Direct stimulation of gastrin release
c)
Local inflammation with autoimmune response
d)
Upregulation of parietal cell acid production
37.
Which of the following inhibits gastrin secretion
a)
Histamine
b)
Acetylcholine
c)
Amino acids
d)
Acid
38.
Which of the following disorders involves simultaneous nonperistaltic contractions of the esophagus
a)
Achalasia
b)
Diffuse esophageal spasm
c)
Hypertensive lower esophageal sphincter
d)
Nutcracker esophagus
39.
The effect of erythromycin on gastric emptying is through its function as a
a)
Dopamine antagonist
b)
Cholinergic agonist
c)
Motilin agonist
d)
Cholinergin antagonist
40.
Which of the following is the most painful motility disorder
a)
Achalasia
b)
Diffuse esophageal spasm
c)
Hypertensive esophageal sphincter
d)
Nutcracker esophagus
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