Start Assessment: Gastrointestinal Pathophysiology MCQ Assessment

Question: A 45 year-old man comes to the emergency room after passing tarry black stool for 3 days. He has had intermittent epigastric pain with nausea but no vomiting. An upper endoscopy is performed and a large ulcer in the duodenal bulb is seen. Which of the following would you most likely find in this patient’s stomach?

Choices:

Basal acid production twice below normal

High acid production in response to a meal

Negative rapid urease test for h.pylori

Reduced sensitivity of parietal cells to gastrin

Very high serum gastrin levels

Question: A 54 year-old man complains of frequent heartburn. He reports a burning sensation in his chest within an hour of eating a large meal. He notes a similar sensation when he is in a supine position, particularly at bedtime. He denies any dysphagia or odynophagia. Which of the following is the most likely mechanism resulting in the patient’s symptoms?

Choices:

Absent peristalsis in the esophageal body

Transient relaxations of the LES (lower esophageal sphincter) without peristalsis

Multiple, simultaneous peristaltic contractions

High amplitude peristaltic contractions in the esophageal body

High LES pressure with failure of the LES to relax with swallowing

Question: An 85 year-old woman is taking aspirin after recently suffering a myocardial infarction. She is admitted to the hospital from the nursing home with coffee ground emesis and several days of black stool. She is found to be hypotensive in the emergency room and severely anemic. She receives intravenous fluid, packed red blood cell transfusions, and pantoprazole intravenously. Once she is stabilized, an upper endoscopy is performed. Multiple small gastric ulcers are seen in the gastric antrum. They are all superficial and not actively bleeding. Which of the following is the most likely cause for this patient’s ulcers?

Choices:

h.pylori infection

Lack of gastric mucus

Exuberant blood supply to stomach

Inhibition of cyclooxygenase

Very high gastric acid production

Question: A 45 year-old man comes to the emergency room after passing tarry black stool for 3 days. He has had intermittent epigastric pain with nausea but no vomiting. An upper endoscopy is performed and a large ulcer in the duodenal bulb is seen. Which of the following would you most likely find in this patient’s stomach?

Choices:

Basal acid production twice below normal

High acid production in response to a meal

Negative rapid urease test for h.pylori

Reduced sensitivity of parietal cells to gastrin

Very high serum gastrin levels

Question: An 85 year-old woman is taking aspirin after recently suffering a myocardial infarction. She is admitted to the hospital from the nursing home with coffee ground emesis and several days of black stool. She is found to be hypotensive in the emergency room and severely anemic. She receives intravenous fluid, packed red blood cell transfusions, and pantoprazole intravenously. Once she is stabilized, an upper endoscopy is performed. Multiple small gastric ulcers are seen in the gastric antrum. They are all superficial and not actively bleeding. Which of the following is the most likely cause for this patient’s ulcers?

Choices:

h.pylori infection

Lack of gastric mucus

Exuberant blood supply to stomach

Inhibition of cyclooxygenase

Very high gastric acid production

Question: A 62 year-old woman complains of progressive dysphagia to both solids and liquids. She has intermittent symptoms of heartburn. Her physical exam is remarkable for very taut skin on the face as well as sclerodactly. An upper endoscopy is unrevealing. An esophageal motility study is performed. Which of the following manometric findings is most likely in this patient?

Choices:

High LES pressure; Low or absent peristaltic activity in the esophageal body; Normal LES relaxation with swallowing

High LES pressure; Normal peristaltic activity in the esophageal body; Abnormal LES relaxation with swallowing

Low LES pressure; Low or absent peristaltic activity in the esophageal body with swallowing; Abnormal LES relaxation with swallowing

Low LES pressure; Normal peristaltic activity in the esophageal body; Normal LES relaxation with swallowing

Low LES pressure; Normal peristaltic activity in the esophageal body; Abnormal LES relaxation with swallowing

Question: For questions #2 and #3, match the most likely cause of diarrhea from the list below.

Choices:

Laxative abuse

Chronic pancreatitis

Crohn’s disease

Bile acid malabsorption

Celiac sprue

Ischemic colitis

Carcinoid syndrome

Zollinger-Ellison syndrome

Hyperthyroidism

Irritable bowel syndrome

Ulcerative colitis

Amebiasis

Question: A 75 year-old woman complains of severe chest pain. A cardiac evaluation is unrevealing. An upper endoscopy shows erythema and linear ulcerations in the distal esophagus. Her only medication is synthroid (thyroid hormone replacement). Which of the following is the most likely explanation for these endoscopic findings?

Choices:

Caustic injury

Cytomegalovirus infection

Mucosal injury from bile

Mucosal injury from acid

Mucosal injury from a foreign body

Question: A 48 year-old man is seen by his primary care physician for evaluation of epigastric abdominal pain and nausea of 3 months duration. There has been no vomiting, hematemesis, or melena (gastrointestinal bleeding). He does not use aspirin or other non-steroidal anti-inflammatory medications. His primary care doctor recommends beginning over the counter prilosec, one tablet in the morning, and she checks H.pylori serology which returns positive. Which of the following would you most likely expect to see in this patient?

Choices:

Positive urea breath test

Type A gastritis

Gastrin level greater than 1000

Pernicious anemia

Numerous ulcers in the 3rd and 4th portion of the duodenum

Question: A 25 year-old man comes to your office complaining of frequent bloating, gas, and diarrhea. His diarrhea is non-bloody and he has no associated fevers nor has he lost weight. Stool specimens checked for various infectious organisms all return negative. He notes that his symptoms typically occur shortly after eating ice cream or cheese pizza. You check stool sodium and potassium concentration and calculate the fecal osmotic gap. Which of the following results for the fecal osmotic gap would you most likely find in this patient?

Choices:

75 mosm/kg H20

25 mosm/kg H20

140 mosm/kg H20

55 mosm/kg H20

100 mosm/kg H20

Question: A 48 year-old man is seen by his primary care physician for evaluation of epigastric abdominal pain and nausea of 3 months duration. There has been no vomiting, hematemesis, or melena (gastrointestinal bleeding). He does not use aspirin or other non-steroidal anti-inflammatory medications. His primary care doctor recommends beginning over the counter prilosec, one tablet in the morning, and she checks H.pylori serology which returns positive. Which of the following would you most likely expect to see in this patient?

Choices:

Positive urea breath test

Type A gastritis

Gastrin level greater than 1000

Pernicious anemia

Numerous ulcers in the 3rd and 4th portion of the duodenum