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Example Questions
Example Question #1 : Gastrointestinal Conditions
Which of the following is described as a malformation resulting in narrowing or absence of a portion of the intestine?
Hirschsprung's disease
Intestinal atresia
Malrotation
Volvulus
Intestinal atresia
Intestinal atresia is a malformation resulting in narrowing or absence of a portion of the intestine. Duodenal atresia is the most common type, followed by ileal atresia. Hirschsprung's disease is an issue of innervation in the large intestine that can result in narrowing due to contraction, but there is no structural malformation in the bowel itself. Malrotation and volvulus are often seen together when a part of the intestine does not anchor or turn correctly during formation (malrotation) and then becomes twisted around itself (volvulus), resulting in constriction and loss of function.
Example Question #1 : Gastrointestinal Conditions
What is the triad of symptoms often seen with intussusception?
Bloody vomit, black stool, and low back pain
"Coffee-ground" emesis, bloating, and diarrhea
Constipation, projectile vomiting, jaundice
Colicky abdominal pain, bilious vomit, and red "currant jelly" stool
Colicky abdominal pain, bilious vomit, and red "currant jelly" stool
Intussusception occurs when part of the intestine folds into another section of intestine, much like a telescope. This results in sharp, crampy, or colicky abdominal pain, vomit of bile, and bloody red "currant jelly" stool. Black stool and "coffee ground" emesis are both symptoms of upper gastrointestinal bleeding (stomach, generally), while projectile vomiting may be associated with pyloric stenosis.
Example Question #1 : Identifying Gastrointestinal Conditions
What is the most common location for diverticulitis?
Transverse colon
Sigmoid colon
Ascending colon
Splenic flexure
Sigmoid colon
The most common location for diverticulitis is the sigmoid colon. This area generally has increased pressure as compared to the rest of the large intestine and is especially vulnerable to weakness in the muscle layers of the colon wall.
Example Question #4 : Gastrointestinal Conditions
What part of the bowel is most often affected by Crohn's disease?
The sigmoid colon
The terminal ileum
The ascending colon
The rectum
The terminal ileum
While Crohn's disease can affect any part of the alimentary canal, the small intestine, particularly the terminal ileum, is the most common site of serosal inflammation.
Example Question #1 : Gastrointestinal Conditions
What is the characteristic mucosal alteration seen in ulcerative colitis?
Skip lesions
Crypt abscess
Thickened mucosa
Granulomas
Crypt abscess
The characteristic histological alteration seen in ulcerative colitis is the crypt abscess, in which inflammation causes loss of goblet cells due to neutrophilic exudate in glandular lumens. Granulomas, thickened mucosa, and skip lesions are all seen in Crohn's disease.
Example Question #1 : Identifying Gastrointestinal Conditions
Frequent projectile, non-bilious vomiting starting 2-3 weeks after birth is indicative of what condition?
Diverticulitis
Infant gastroesophageal reflux disease (GERD)
Congenital hypertrophic pyloric stenosis
Intussusception
Congenital hypertrophic pyloric stenosis
In congenital hypertrophic pyloric stenosis, the smooth muscle of the pylorus becomes thickened, decreasing the lumen size of the pylorus. This prevents food from passing out of the stomach and into the small intestine, resulting in vomiting which is often projectile and tends to be non-bilious. Intussusception may show vomiting, but the more obvious sign is bloody "currant jelly" stools. Infant gastroesophageal reflux disease (GERD) may result in frequent spitting up, but projectile vomiting is rare. Diverticulitis is generally a condition of the elderly and tends to present as abdominal pain with alterations in bowel function and mild fever.
Example Question #1 : Gastrointestinal Conditions
What co-moridity is generally seen with esophageal varices?
Hiatal hernia
Cirrhosis
Achalasia
Gastroesophageal reflux disease (GERD)
Cirrhosis
Esophageal varices are most commonly seen in patients with cirrhosis due to portal hypertension. Gastroesophageal reflux disease (GERD) is associated with esophagitis and occasionally with metaplastic changes. Neither hiatal hernia nor achalasia are associated with esophageal varices.
Example Question #1161 : Nclex
What sign might indicate Hirshsprung's disease in a newborn?
Vomiting within 48 hours of delivery
Failure to pass meconium within 48 hours of delivery
Unrelenting crying
Bloody stool 3-5 days after birth
Failure to pass meconium within 48 hours of delivery
While an infant with Hirshsprung's disease may have vomiting and bloody stool, the most common sign is failure to pass meconium within 48 hours of delivery. Hirschsprung's disease, which is an absence of innervation to the large intestine, which results in narrowing and constriction of one part of the bowel and dilation of the preceding segment, can be diagnosed by biopsy of the distally narrowed segment of the bowel.
Example Question #1 : Gastrointestinal Conditions
What tissue of the gastrointestinal tract is affected in Celiac disease?
Small intestine, causing villous atrophy
Large intestine, causing ulceration
Rectum, causing fistulation
Stomach, causing gastritis
Small intestine, causing villous atrophy
While individuals with Celiac disease can certainly have gastritis, fistulas, and ulceration due to inflammation, the primary effect of Celiac disease is villous atrophy in the small intestine. Villi become blunted, leading to loss of ability to absorb nutrients, including minerals and fat-soluble vitamins.
Example Question #1 : Identifying Gastrointestinal Conditions
Which of the following refers to bleeding from partial-thickness tears in the mucosa at the junction of the stomach and esophagus?
Boerhaave's syndrome
Barrett's esophagus
Mallory–Weiss syndrome
Esophagitis
Mallory–Weiss syndrome
Mallory–Weiss syndrome refers to bleeding from partial-thickness tears in the mucosa at the junction of the stomach and esophagus, often from trauma such as violent retching or coughing. This is compared to Boerhaave's syndrome, which is a full-thickness tear of the esophageal wall. Esophagitis is most commonly caused by gastroesophageal reflux disease (GERD) and does not present with bleeding. Barrett's esophagus refers to a type of metaplasia in the lower esophagus which is thought to be caused by chronic GERD.
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