Question 1
Question
Decreasing in frequency as you go from proximal to distal in the bowel, which of the following types of contractions in the gut allows for mixing and improved digestion and absorption?
Answer
-
peristalsis
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migrating motor complex
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gastric mixing
-
segmentation
Question 2
Question
Please use the attached image to answer the following: A 14-year-old boy is being evaluated for celiac disease. You order a series
of laboratory tests and schedule the patient for upper endoscopy. H&E sections of the biopsy are shown in the image. Although
the pathologic findings are not specific, which two features are seen that are compatible with a diagnosis of celiac disease?
Answer
-
Intestinal metaplasia and increased intraepithelial eosinophils.
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Lamina propria chronic inflammation and villous blunting.
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Neutrophilic inflammation and villous blunting.
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Increased intraepithelial lymphocytes and villous blunting.
Question 3
Question
Metastasis from the root of the tongue would most likely spread to which lymph nodes?
Answer
-
Deep cervical lymph nodes
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submandibular lymph nodes
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submental lymph nodes
-
superficial cervical lymph nodes
Question 4
Question
While working at an overseas clinic, you meet a 13-year-old patient with a hairline gap extending from his left nostril through his upper lip and jaw. Which of the following failures best describes the cause of this gap?
Answer
-
Failure of the maxillary prominence to fuse with medial nasal pits
-
Failure of the two medial nasal prominences to fuse correctly, preventing formation of midline structures in the upper lip (including the philtrum)
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Failure of the maxillary prominence to fuse with the intermaxillary segment (formed by the medial nasal prominences)
-
Failure of the pharyngeal pouches to descend correctly
Question 5
Question
You are seeing a teenage boy back in clinic after confirming the diagnosis of eosinophilic esophagitis (EoE) via biopsy 2 weeks ago. He had been on omeprazole for 8 weeks prior to the endoscopy and still had significant disease at the time of the endoscopy. He and his mother are here to discuss next treatment options. Which of the following is the next appropriate treatment option for
EoE?
Question 6
Question
Which of the following is associated with peptic ulcer disease, and can be a complication of H. pylori infection?
Answer
-
esophageal dysmotility
-
pancreatitis
-
MALT lymphoma
-
cirrhosis
Question 7
Question
Of all the ways to test for H. pylori, which is the only test that does not offer information about a current active infection?
Question 8
Question
Which of the following compounds act as an inhibitor of acid secretion?
Answer
-
gastrin
-
histamine
-
acetycholine
-
somatostatin
Question 9
Question
When discussing the phases of digestion with a classmate, you describe the following: receptive relaxation, peristalsis &
retropulsion, and increase gastrin & pepsinogen levels. Which phase of digestion are you referring to?
Answer
-
cephalic phase
-
gastric phase
-
intestinal phase
-
colonic phase
Question 10
Question
You are rotating at an internal medicine clinic and seeing a 42yoM who is having significant heartburn. You talk with your supervising attending about acid suppression choices. You bring up H2 blockers and, in turn, your attending asks you which of the
following is a side effect associated with Cimetidine?
Answer
-
gynecomastia
-
alopecia
-
QT prolongation
-
darkening of the tongue
Question 11
Question
You are caring for a 28yoF who is getting ready to go on a cruise. She is quite concerned about having nausea on this trip because she has a history of motion sickness. You decide to prescribe a scopolamine patch to be used on this trip. What is the mechanism of action?
Question 12
Question
Which of the following is a defining characteristic of salivary gland striated ducts?
Answer
-
They are lined with a stratified columnar or stratified squamous epithelium.
-
High density of mitochondria within basal in-foldings of the cell membrane.
-
They are always extralobular and surrounded by a thick layer of connective tissue, just proximal to where the ducts open into the oral cavity.
-
Their principal function is to secrete hydrogen ions into the lumen, acidifying the saliva.
Question 13
Question
Which of the following characteristics of H. pylori allows for production of ammonia to provide a neutral microenvironment?
Answer
-
urease
-
CagA
-
VacA
-
Adhesins
Question 14
Question
Which of the following structural specializations is a defining feature of the lip¶s intra-oral surface?
Answer
-
Hair follicles
-
keratinized stratified squamous epithelium
-
minor salivary glands beneath the epithelium
-
simple columnar epithelium
Question 15
Question
Please use the attached image to answer the following: Identify the region of the GI tract in the attached image.
Answer
-
Ileum-colon
-
esophagus-stomach
-
pylorus-duodenum
-
duodenum-ileum
Question 16
Question
You are caring for a 67-year-old man who was in a bar fight 2 weeks ago and had severe blunt trauma to his left face affecting his facial nerve. At this time, he cannot smile or control the lower part of his left face. He is drooling on the left. You want to evaluate
his chewing and swallowing ability, and expect to find the following problem:
Question 17
Question
A parietal cell utilizes which of the following cellular mechanisms to secrete HCl from its apical surface?
Question 18
Question
You are rotating at an internal medicine clinic and seeing a 42yoM who is having significant heartburn. You explain medication choices to him and describe a medication that irreversibly inhibits the hydrogen potassium ATPase. Which medication are you
describing?
Answer
-
Ranitidine
-
Metoclopramide
-
Omeprazole
-
Sucralfate
Question 19
Question
Which of the following is a defining feature of the esophagus?
Answer
-
mucosal or submucosal glands
-
a lumen lined with simple columnar epithelium
-
a muscularis externa that varies from skeletal muscle to smooth muscle depending on region
-
a muscularis muscose i.e. smooth muscle layer separating the lamina propria and submucosa
Question 20
Question
You are seeing a 2 week old infant for a well child check while on your pediatrics rotation. During your interview with Mom she
mentions that the baby seems to have difficulty latching to breastfeed and ³just can¶t seem to create any suction´You and your
attending examine the child and note that they have ankyloglosia. Remembering your embryology lecture, you recall that this is a
result of which of the following?
Answer
-
epiglottis elongation from branchial arch mesenchyme
-
lingual frenulum length from branchial arch mesenchyme
-
mandibular prominence malformation
-
pharyngeal pouch 2 dissociation
Question 21
Question
You are reviewing a swallow study done by your local radiologist on a patient that has complaints of feeling like food gets stuck in
his esophagus when eating solids and occasionally with liquids. The swallow study reports a dilated esophagus with bird beak
appearance. What is the most likely diagnosis you are to encounter when you perform an esophageal manometry study?
Answer
-
Zenker's diverticulum
-
Achalasia
-
Eosinophilic esophagitis
-
diffuse esophageal spasm
Question 22
Question
The housekeeper of the intestine is the Migrating Motor Complex. In between meals, this large sweep of material from the gastric
antrum through the ileocecal valve (ICV) occurs with which frequency?
Answer
-
Every 50-60 min
-
Every 60-80 min
-
Every 90-120 min
-
Every 150-200 min
Question 23
Question
Which medication stimulates mucus and bicarbonate secretion and works to enhance mucosal blood flow as a protoglandin E
(PGE) analogue?
Answer
-
Colloidal bismuth
-
Lansoprazole
-
Famotidine
-
Misoprostol
Question 24
Question
A 5-year-old boy presents to your ENT clinic with an opening in the upper part of his neck that has had intermittent mucoid
discharge. The opening of the tract moves with swallowing and protrusion of the tongue. No dysphagia, halitosis (bad breath) or
respiratory distress. The pinhole opening is at the midline below the hyoid bone. No erythema or edema. You inject 1% methylene
blue into the cannulated opening and that results in leakage of the dye through the internal opening in the region of the foramen
caecum. Neck ultrasound reveals a normal thyroid gland without masses. What is the most likely initial diagnosis?
Answer
-
Thyroid gland tumor
-
Thyroglossal fistula
-
Branchial cyst
-
Branchial sinus
Question 25
Question
Which of the following muscles is the most powerful depressor of the mandible?
Answer
-
digastric
-
masseter
-
Medial pterygoid
-
Temporalis