SMALL INTESTINE Multiple Choice Questions and Answers pdf :-
1. The most common site of adenocarcinoma of the small intestine is the:
2. The most common benign tumor of the small intestine is:
3. Vigorous bleeding from a small bowel lesion is most likely caused by:
B. Arteriovenous malformation.
4. The lamina propria between the intestinal epithelium and the muscularis mucosae contains:
A. Blood and lymph vessels.
B. Undifferentiated epithelial cells.
C. Nerve fibers.
D. Enterochromaffin cells.
F. Connective tissue.
5. The intestinal epithelial cells, 22 to 26 mm. tall, exhibit a striated luminal border (brush border). The brush border microvilli:
A. Produce the brush border appearance.
B. Contain amylase.
C. Contain dissacharidases.
D. Increase absorptive area.
E. Play an important role in digestion.
F. Contain trypsinogen.
6. Which of the following statements about carbohydrate digestion are true?
A. Amylopectin has 1-4 straight chains and 1-6 side chains.
B. Amylase has 1-4 straight chains and 1-6 side chains.
C. Amylase breaks 1-4 glucose linkages.
D. Amylase breaks 1-6 side chains.
E. An adult may ingest about 350 gm. of carbohydrate daily.
F. Dietary starch contains two glucose polymers, amylopectin and amylase.
7. Which of these statements about the digestion of fat are true?
A. Micellar solution provides an optimal environment for the action of pancreatic lipase.
B. Decreasing the pH below 5.5 increases the effectiveness of pancreatic lipase in hydrolyzing fat.
C. Co-lipase blocks triglyceride hydrolysis.
D. Lipase catalyzes the hydrolysis of dietary triglyceride into 2-monoglyceride and fatty acids.
E. Fatty acids and 2-monoglyceride are held in micellar solutions.
F. Fatty acid and 2-monoglyceride enter the intestinal cell by active transport.
8. Complete mechanical small bowel obstruction can cause dehydration by:
A. Interfering with oral intake of water.
B. Inducing vomiting.
C. Decreasing intestinal absorption of water.
D. Causing secretion of water into the intestinal lumen.
E. Causing edema of the intestinal wall.
9. History and physical examination permit the diagnosis of intestinal obstruction in most cases. Which of the following are important for the clinical diagnosis of small bowel obstruction?
A. Crampy abdominal pain.
D. Abdominal distention.
E. Leukocyte count above 12,000.
F. Abdominal tenderness.
10. Patients with established, complete, simple, distal small bowel obstruction usually have the following findings on plain and upright abdominal radiographs:
A. Distended small bowel identifiable by the valvulae conniventes.
B. Multiple air-fluid levels.
C. Modest amount of gas in the pelvis.
D. Peripheral, rather than central, distribution of gas.
E. Prominent haustral markings.
F. Free air.
11. All of the following statements about the embryology of Meckel’s diverticulum are true except:
A. Meckel’s diverticulum usually arises from the ileum within 90 cm. of the ileocecal valve.
B. Meckel’s diverticulum results from the failure of the vitelline duct to obliterate.
C. The incidence of Meckel’s diverticulum in the general population is 5%.
D. Meckel’s diverticulum is a true diverticulum possessing all layers of the intestinal wall.
E. Gastric mucosa is the most common ectopic tissue found within a Meckel’s diverticulum.
12. Meckel’s diverticulum most commonly presents as:
A. Gastrointestinal bleeding.
D. Intermittent abdominal pain.
13. Which of the following statements about the surgical treatment of carcinoid tumors are true?
A. Carcinoid tumors should be treated by resection, regardless of the presence of metastases.
B. Appendiceal tumors larger than 1.5 cm. should be treated by ileocolectomy.
C. Local excision with margins is adequate for a rectal carcinoid of any size.
D. Carcinoid tumors are associated with a large percentage of other synchronous or metachronous neoplasms.
14. Which of the following statements about carcinoid syndrome are true?
A. Carcinoid syndrome occurs only when hepatic metastases are present.
B. Serotonin is thought to be responsible for the diarrhea, cardiac lesions, and flushing in patients with carcinoid syndrome.
C. Foregut carcinoid tumors cause atypical carcinoid syndrome; hindgut tumors are rarely, if ever, associated with the syndrome.
D. The long-acting somatostatin analog provides the best symptomatic treatment for carcinoid syndrome.
15. Simple screening tests for malabsorption include:
A. Microscopic examination.
B. D-xylose absorption.
C. A 72-hour stool collection for fats.
D. Small bowel x-ray series.
16. Extensive resection of the small bowel, leaving only 2 or 3 feet beyond the ligament of Treitz anastomosed to the transverse colon, can lead to the following metabolic complications:
A. Gastric hyperacidity and hypersecretion.
C. Hypermetabolic response.
D. Fat-soluble vitamin deficiency.
17. Which of the following physical factors of irradiation is/are related to the potential for radiation injury?
A. The dimension of the radiation portals.
B. The number of portals.
C. The number of fractions.
D. The total amount of irradiation.
E. All of the above.
18. For which of the following consequences of radiation injury of the intestine is urgent laparotomy required?
A. Small bowel obstruction.
B. Colonic perforation.
C. Rectovaginal fistula.
D. Malabsorption and diarrhea.
E. Rectal stenosis.
19. In addition to its absorptive and digestive roles, the small bowel also plays a significant role in the body’s immune system. Gut-associated lymphoid tissue (GALT) represents a major division of the immune system. Which of the following statement(s) is/are true concerning the immunologic functions of the small intestine?
a. The B lymphocytes of the small intestine do not produce immunoglobulin A (IgA)
b. Peyer’s patches, an example of an aggregated cellular portion of the gut-associated lymphoid system tissue, are large collections of lymphoid follicles found on the antimesenteric border of the ileum
c. The major immunoglobulin of the intestinal immune system is IgM
d. IgA produced by the intestinal immune system produces the classic Fc-mediated inflammatory reactions to antigen stimulus
20. During the fasting state, a well-defined pattern of small bowel electrical activity occurs which is known as the interdigestive myoelectric complex or the migrating motor complex (MMC). Which of the following statement(s) is/are true concerning the MMC?
a. This complex consists of a cyclic pattern of spike bursts and muscular contractions that migrate from the duodenum to the terminal ileum and can be divided into four phases
b. The major activity during the MMC occurs during phase I
c. In humans the MMC usually lasts less than one hour
d. Blood levels of the GI peptide, motilin, correlate closely with MMC activity and exogenous motilin can induce the MMC front
Answer: a, d
21. Which of the following statement(s) is/are true concerning the anatomy of the small intestine?
a. The second (descending), third (transverse) and fourth (ascending) portions of the duodenum lie in the retroperitoneum and are mobilized for surgical procedures via the Kocher maneuver
b. The identification of the superior mesenteric vein and artery can be facilitated by an extensive Kocher maneuver mobilizing the transverse portion of the duodenum and exposing the vessels as they course over the duodenum and under the neck of the pancreas
c. In only the minority of patients can the accessory pancreatic duct (the duct of Santorini) be seen on endoscopic exam entering the duodenum
d. The ileum is the widest portion of the small intestine, with the diameter of the small bowel progressively increasing as the ileocecal valve is approached
Answer: a, b
22. Historically, the small intestine was presumed to have only digestive and absorptive function. However, in the last decade the small intestine has become recognized as the body’s largest endocrine organ, producing a number of hormones, neurotransmitters, and paracrine substances. Which of the following statement(s) is/are true concerning small bowel hormones?
a. Cholecystokinin (CCK) is produced from cells in the mucosa of the duodenum and jejunum and is released in response to luminal fats and proteins
b. Secretin is released in response to rising intraduodenal pH, resulting in inhibition of pancreatic secretion
c. Motilin is a 22-amino acid peptide released during the fasting state with increased levels corresponding with the onset of the migrating motor complex (MMC)
d. Neurotensin is produced primarily in the duodenal mucosa and its release is stimulated primarily by carbohydrates and proteins
Answer: a, c
23. The enterohepatic circulation refers to the circular flow of bile through the small intestine and liver. Which of the following statement(s) concerning the absorption of bile salts is/are correct?
a. The enterohepatic circulation is highly efficient with 80% to 90% of secreted bile salts reabsorbed and returned to the liver through the portal circulation
b. The reabsorption of bile is entirely an active process
c. The small amount of bile escaping in the colon is deconjugated by bacteria, promoting lipid solubility and passive colonic absorption
d. Ileal resection results in presenting high concentrations of bile salts to the colon which promotes diarrhea by bacterial overgrowth
Answer: a, c
24. The most obvious function of the GI tract is digestion and absorption of food for continued growth and survival of the organism. Which of the following statement(s) is/are true concerning small bowel absorption?
a. The jejunum is the site of maximum absorption for most ingested materials with almost all jejunal absorption performed via active transfer mechanisms
b. Eighty percent of water presented to the gastrointestinal system is reabsorbed by the small bowel
c. The absorption of carbohydrates requires digestion of large starch molecules by salivary and pancreatic amylase, therefore presenting smaller oligosaccharides to the brush border of the jejunum to complete the digestion and absorptive process
d. Dietary fiber represents poorly digestible carbohydrates which can absorb organic materials such as bile salts and lipids
Answer: b, c, d
25. Which of the following statement(s) is/are true concerning the pathophysiology of small bowel obstruction?
a. Most of gas seen on plane abdominal radiographs is produced by gas forming microorganisms
b. Elevation of luminal pressure contributes to fluid accumulation in the small bowel in closed loop but not open loop small bowel obstructions
c. Intestinal blood flow initially increases to the bowel wall in early bowel obstruction
d. In the face of obstruction, myoelectrical activity of the bowel is consistently increased
Answer: b, c
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26. A 45-year-old man with a history of previous right hemicolectomy for colon cancer presents with colicky abdominal pain which has become constant over the last few hours. He has marked abdominal distension and has had only minimal vomiting of a feculent material. His abdomen is diffusely tender. Abdominal x-ray shows multiple air fluid levels with dilatation of some loops to greater than 3 cm in diameter. The most likely diagnosis is:
a. Proximal small bowel obstruction
b. Distal small bowel obstruction
c. Acute appendicitis
d. Closed-loop small bowel obstruction
27. In the patient described above, the following statement(s) is/are true concerning the possible etiology of bowel obstruction.
a. Simple obstruction secondary to an adhesion is most likely to resolve nonoperatively
b. It is most likely that the patient’s obstruction is secondary to recurrent malignancy
c. A history of colon cancer makes carcinomatosis the most likely diagnosis
d. Lower abdominal procedures are more likely to result in obstructive adhesions than are upper abdominal procedures
Answer: a, d
28. Which of the following statement(s) is/are true concerning laboratory tests which might be obtained in the patient discussed above?
a. The presence of a white blood cell count > 15,000 would be highly suggestive of a closed-loop obstruction
b. Metabolic acidosis mandates emergency exploration
c. An elevation of BUN would suggest underlying renal dysfunction
d. There is no rapidly available test to distinguish tissue necrosis from simple bowel obstruction
29. The patient discussed above was admitted to the hospital and after 24 hours remained distended with no evidence of resolution. Which of the following radiographic studies would be considered appropriate at this time?
a. Contrast enema
b. Enteroclysis study with dilute barium
c. CT scan with dilute barium oral contrast
d. None of the above
Answer: a, b, c, d
30. A 75-year-old woman is hospitalized after a fall in which she has experienced a hip fracture. Several days after her surgical procedure, progressive painless abdominal distension is noted. Which of the following statement(s) is/are true concerning her diagnosis and management?
a. Colon distension with a cecal diameter in excess of 12 cm should indicate the need for urgent operation
b. Endoscopic decompression may be attempted but seldom is successful
c. After successful colonoscopic decompression, recurrence is unlikely
d. A rectal tube as the primary treatment is generally not successful
31. Which of the following statement(s) is/are true concerning the etiology of intestinal obstruction?
a. In the United States, peritoneal adhesions account for over half of the cases of small bowel obstruction
b. A leading cause of bowel obstruction is early postoperative adhesions
c. Bowel obstruction cannot occur with a Richter’s hernia
d. Ninety percent of adult cases of intussusception are associated with a pathologic process, most commonly a tumor
Answer: a, d
32. Which of the following statement(s) is/are true concerning postoperative ileus?
a. The use of intravenous patient-controlled analgesia has no effect on return of small bowel motor activity
b. The presence of peritonitis at the time of the original operation delays the return of normal bowel function
c. The routine use of metoclopramide will hasten the return of small intestinal motor activity
d. Contrast radiographic studies have no role in distinguishing early postoperative bowel obstruction from normal ileus
33. The initial management of this patient should consist of:
a. Fluid resuscitation with D5 half normal saline with 40 mEq of potassium chloride/liter
b. Placement of an indwelling urinary catheter
c. Nasogastric decompression with a nasogastric tube
d. Immediate surgery
e. The patient should be begun on broad spectrum antibiotics at the time of admission
Answer: b, c
34. An 82-year-old female nursing home resident is admitted with massive abdominal distension and constant abdominal pain with diffuse tenderness. Abdominal x-ray shows a massively distended loop of colon with a characteristic “bent inner tube” appearance. The management of this patient should include:
a. Urgent laparotomy because of the massive colon distension
b. An attempt at endoscopic decompression with a flexible sigmoidoscope
c. Elective laparotomy and sigmoid resection should follow if endoscopic decompression is successful
d. If at urgent laparotomy resected bowel is present, colon resection with primary anastomosis is in order
Answer: b, c
35. A common manifestation of Crohn’s disease is perianal disease, including anal fistulas with extension to adjacent organs and soft tissue regions, fissures, and perirectal abscesses. Which of the following statement(s) is/are true concerning perianal disease with Crohn’s disease?
a. Perianal disease is the initial mode of presentation in the majority of patients
b. The prevalence of perianal disease is increased in patients with either ileocolitis or isolated colonic involvement
c. Metronidazole has been shown to be effective in the treatment of perianal disease secondary to Crohn’s
d. An aggressive surgical approach is appropriate in most cases due to the frequent rapid progression of perianal disease
Answer: b, c
36. Nongastrointestinal complications of Crohn’s disease include:
a. Renal calculi
Answer: a, b, c, d
37. Which of the following points is/are true concerning the diagnosis of Crohn’s disease?
a. Recurrent disease on contrast radiographs frequently lags behind the development of clinical signs and symptoms
b. In 10% of cases, Crohn’s disease cannot be distinguished from chronic ulcerative colitis based on clinical, radiologic, and pathologic criteria
c. Although no specific laboratory tests exist for Crohn’s disease, the erythrocyte sedimentation rate has evolved as a useful measure of disease activity
d. Specific endoscopic features encountered in Crohn’s disease which allow differentiation from ulcerative colitis include aphthous ulcers, cobblestoning, and skip areas
Answer: b, c, d
38. The following statement(s) is/are true concerning the surgical management of Crohn’s disease.
a. Strictureplasty, although offering short-term benefits, is associated with a higher rate of recurrence when compared to resection
b. Frozen section examination of the margin of resection is essential to prevent both recurrent disease and early anastomotic complications
c. Conservative margins of resection are appropriate, resecting only grossly involved segments of bowel
d. Patients with Crohn’s disease confined to the colon may be treated with total proctocolectomy with construction of an ileal-anal pouch anastomosis
39. The etiology of Crohn’s disease is unknown, although two major hypotheses have evolved: an infectious and an immunologic theory. The following statement(s) is/are true concerning the possible etiology of Crohn’s disease.
a. The leading infectious agent thus far suggested is infection with a Mycobacterium species
b. Strong evidence linking viral pathogens to Crohn’s disease has been developed
c. Although many alterations in cellular and immune functions in patients with Crohn’s disease have been observed, no primary defect in the immune system has yet been identified
d. The identification of antibodies to enterocytes provides strong support for the theory that Crohn’s disease is an autoimmune process
Answer: a, c
40. Crohn’s disease is an incurable disease, therefore recurrence after surgical resection is likely. Which of the following statement(s) regarding the recurrence of Crohn’s disease is/are accurate?
a. Endoscopic evidence of recurrence is present in less than 50% of patients at five years
b. Radiographic or endoscopic evidence of recurrence is frequently not accompanied by symptoms
c. Clinical recurrence of Crohn’s disease is seen in 20% of patients at two years, and 40–50% at four years after surgery
d. Reoperation for Crohn’s disease is necessary in the majority of patients by five years
e. No solid evidence demonstrating prolongation of remission can be seen with corticosteroids, sulfasalazine, or antibiotics
Answer: b, c, e
41. Which of the following statement(s) is/are true concerning drug therapy for Crohn’s disease?
a. Corticosteroids have been demonstrated to effectively treat acute exacerbations and to prolong remission in patients with Crohn’s disease
b. Sulfasalazine is indicated primarily for the treatment of patients with acute exacerbations of Crohn’s disease involving the small bowel
c. Azathioprine, an immunosuppressant, has been shown to be effective in maintaining remission of Crohn’s disease
d. Low dose cyclosporine has significant therapeutic benefit for patients with both low and high disease activity
42. Which of the following are predominant histologic features of Crohn’s disease?
a. The presence of granulomas involving the bowel wall and mesenteric lymph nodes
b. Transmural inflammation
c. Fissures and ulceration extending into the muscularis propria
d. Chronic fibrotic changes
Answer: a, b, c, d
43. The following statement(s) is/are true concerning the epidemiology of Crohn’s disease.
a. Crohn’s disease has an age distribution with peaks between the ages of 15 and 30 years and 65 and 75 years
b. There is a definite female predilection for Crohn’s disease
c. The disease is equally prevalent in industrialized versus underdeveloped countries
d. First and second generation relatives with Crohn’s disease have an increased prevalence when compared to the general population
44. The management of adenocarcinoma of the small intestine depends primarily on tumor location. Which of the following statements concerning surgical management are true?
a. Radical pancreaticoduodenectomy (Whipple resection) is necessary for resection of most duodenal adenocarcinomas
b. Adenocarcinomas of the jejunum or ileum are managed by limited segmental resection including resection of the mesentery down to the first vascular arcade
c. Distal ileal carcinomas are best managed by right hemi-colectomy to include lymph node chains along the ileo-cecal blood supply
d. Small invasive adenocarcinomas of the ampulla and peri-ampullary duodenum can frequently be managed by local excision
Answer: a, c
45. The management of carcinoid tumors must be individualized based on the findings at surgery. Which of the following is/are components of optimal care?
a. Limited segmental resection without lymphadenectomy
b. Careful exploration of the remaining small bowel and colon
c. Non-anatomic resection of small multiple liver metastases
d. Postoperative adjuvant chemotherapy for all carcinoid tumors regardless of size or level of invasion
Answer: b, c
46. An increased evidence of adenocarcinoma of the small intestine has been established with which of the following conditions?
a. Peutz-Jegher Syndrome
b. Crohn’s disease
c. Simple tubular adenomas of the small intestine
d. Colon carcinoma
47. A 60-year-old male presents with nonspecific symptoms of fatigue, malaise, weight loss and abdominal pain. Barium small bowel series shows a limited segment of small intestine with thickened mucosal folds and partial obstruction. CT scan confirms small intestinal wall thickening and suggests the presence of bulky mesenteric lymph nodes. Which of the following is/are components of optimal care?
a. Attempts at percutaneous biopsy of the mesenteric mass
b. Surgical exploration with aggressive resection of the localized disease including wide, en bloc lymphadenectomy
c. Liver biopsy and sampling of periaortic and mesenteric lymph nodes outside the field of resection
Answer: b, c
48. Malignant neoplasms of the small bowel tend to have a characteristic anatomic distribution. Which of the following statements are true?
a. Adenocarcinomas of the small intestine show a distinct polarity with decreasing frequency from duodenum to ileum
b. Adenocarcinoma of the small intestine associated with Crohn’s disease occurs primarily in the ileum
c. Lymphomas of the small intestine arise primarily in the jejunum
d. The vast majority of carcinoid tumors of the small intestine occur in the ileum
Answer: a, b, d
49. Small intestinal carcinoids may present in a multitude of fashions. Which of the following may be seen as a presentation of carcinoid tumors of the small intestine?
a. Intestinal obstruction
b. Gastrointestinal bleeding
c. Small intestinal infarction
Answer: a, b, d
50. With regard to benign neoplasms of the small intestine, which of the following are true statements?
a. Many are asymptomatic and only found as incidental findings
b. Leiomyomas are the most common symptomatic benign neoplasm and may present with gastrointestinal bleeding
c. Villous adenomas carry a distinct malignant potential and occur most commonly in the periampullary duodenum
d. Peutz-Jegher Syndrome is associated with multiple adenomatous polyps throughout the small intestine
Answer: a, b, c
51. Primary gastrointestinal lymphomas involving the small bowel are uncommon accounting for less than 5% of all lymphomas. Conditions associated with small intestinal lymphomas include which of the following?
a. Acquired immune deficiency syndrome (AIDS)
b. Celiac disease
c. Crohn’s disease
d. Rheumatoid arthritis
Answer: a, b, c, d