WorksheetsCh 9 Practice Questions
Total questions: 10
Worksheet time: 5mins
A 62-year-old man with a history of GERD presents with progressive dysphagia to solids and liquids, weight loss, and retrosternal discomfort. Endoscopy reveals a strictured distal esophagus with adjacent salmon-colored mucosa. Biopsy shows intestinal metaplasia with low-grade dysplasia. Which sequence best explains his current findings?
Chronic inflammation → squamous hyperplasia → carcinoma in situ
LES spasm → food stasis → mucosal ulceration
Chronic acid reflux → columnar metaplasia → dysplasia → fibrotic stricture formation
Achalasia → proximal dilation → squamous atrophy
A 53-year-old woman presents with jaundice, pruritus, and pale stools. Labs: elevated ALP, GGT, conjugated bilirubin. Ultrasound shows a dilated common bile duct with a stone near the ampulla of Vater. Which downstream consequence is most likely if the obstruction persists?
Non-alcoholic fatty liver disease
Hemolytic anemia
Steatorrhea from lack of bile salts in the intestine
Hypergastrinemia from loss of somatostatin
A 61-year-old man with alcoholic cirrhosis presents with confusion, asterixis, and fetor hepaticus. Labs: elevated ammonia, INR 2.0. Which physiologic change most directly explains his mental status change?
Cerebral vasospasm from toxin exposure
Astrocyte swelling from ammonia-induced glutamine accumulation
Dopamine depletion in basal ganglia
Cortisol excess from adrenal hyperactivity
A 29-year-old woman with a history of Crohn’s disease develops macrocytic anemia and peripheral neuropathy. Which segment of her GI tract is most likely involved in this complication?
Jejunum
Duodenum
Terminal ileum
Ascending colon
A 44-year-old man presents with acute epigastric pain radiating to the back, hypotension, and mottled skin after a binge-drinking episode. Labs: markedly elevated amylase/lipase. Which additional finding would most strongly indicate a transition to severe necrotizing pancreatitis?
Hypocalcemia from albumin loss
Hypocalcemia from saponification of peripancreatic fat
Hyperkalemia from tissue breakdown
Hypernatremia from dehydration
A 38-year-old man develops severe abdominal distension, rebound tenderness, and hypotension two days after colectomy. Paracentesis of ascitic fluid shows elevated neutrophils. Which sequence of events best explains his presentation?
Venous thrombosis → bowel infarction → peritonitis
Bowel perforation → bacterial contamination of peritoneal cavity → inflammatory exudate formation
Portal hypertension → transudative ascites → spontaneous bacterial peritonitis
Hypoperfusion → ileus → sterile peritoneal irritation
A 70-year-old man with long-standing ulcerative colitis undergoes surveillance colonoscopy. Multiple pseudopolyps are seen, and biopsies from flat mucosa show high-grade dysplasia. Which mechanism most likely accounts for his increased cancer risk?
Germline APC mutation
Chronic inflammatory oxidative stress causing DNA damage and dysplasia
KRAS mutation from dietary carcinogens
Loss of mismatch repair gene function
A 49-year-old man presents with profuse watery diarrhea, flushing, and right-sided heart murmurs. Labs: elevated urinary 5-HIAA. Which GI tumor is most likely causing his presentation?
Gastrinoma
Insulinoma
Metastatic carcinoid tumor of the ileum
VIPoma
A 35-year-old woman develops acute LLQ pain, fever, and leukocytosis. CT shows sigmoid diverticulitis with localized perforation. Which vascular factor predisposes the sigmoid colon to diverticular formation?
Absence of collateral arterial supply
Increased lymphatic vessel density in mucosa
Weak points where vasa recta penetrate the circular muscle layer
Venous congestion from pelvic varices
A 59-year-old man with pancreatic head adenocarcinoma develops progressive cachexia. Which factor primarily mediates this wasting despite adequate caloric intake?
Increased leptin secretion from adipose tissue
Tumor-induced release of TNF-α and other cytokines increasing basal metabolic rate and muscle breakdown
Impaired pancreatic enzyme secretion causing nutrient malabsorption
Insulin resistance from glucagon overproduction
