View Answer

A

13. A 75-year-old male patient presents to the emergency room 2 hours after developing severe chest pain with repeated episodes of vomiting. He is tachycardic and febrile. A chest radiograph demonstrates a left pleural effusion. Emergent barium swallow reveals extravasation of contrast into the left chest. Proper definitive treatment of this patient would include which of the following?

A Observation

B Emergent surgical intervention

C Placement of left chest tube

D Intravenous antibiotics and admission to the hospital

E Upper endoscopy

View Answer

B

Questions 14–15

A 65-year-old patient has been treated with pharmacologic therapy for an antral gastric ulcer for 12 weeks. A repeat upper gastrointestinal series shows approximately 50% shrinkage of the ulcer.

14. What further management should the patient undergo at this time?

A Continued pharmacologic therapy with a repeat upper gastrointestinal series in 8–12 weeks

B A change in pharmacologic therapy with a repeat upper gastrointestinal series in 12 weeks

C An upper endoscopy with multiple biopsies

D Total gastrectomy

E Surgery with limited excision of the ulcer

View Answer

C

After further diagnostic work-up, the patient is found to have a gastric adenocarcinoma. Metastatic work-up is negative.

15. Therapy with curative intent would involve which of the following?

A Radiation therapy followed by chemotherapy alone

B Distal gastrectomy followed by adjuvant chemoradiotherapy

C Total gastrectomy

D Total gastrectomy and splenectomy

E Local excision of the ulcer with clear margins followed by radiotherapy

View Answer

B

16. Which of the following statements is true about the performance of a parietal cell vagotomy?

A It divides the vagus nerve at the gastroesophageal junction.

B It maintains innervation of the pylorus so that a drainage procedure is not required.

C The recurrence rate is less than 5%.

D It cannot be performed laparoscopically.

E It is contraindicated for bleeding or perforated ulcers.

View Answer

B

17. What innerves the stomach resulting in parietal cell secretion and gastrin release?

A Phrenic nerve

B Vagus nerve

C Greater splanchnic nerves

D Celiac ganglion

E T4 root

View Answer

B

18. Which of the following is true regarding intestinal absorption of nutrients?

A Bile or bile salts are essential for absorption of vitamin B₁₂.

B An iron-deficient individual can absorb up to 80% of dietary iron.

C Parathormone increases the intestinal absorption of dietary calcium.

D Intestinal epithelial cells resynthesize triglycerides before their release into the portal circulation.

E Triglycerides are absorbed intact in a bile salt micelle-dependent process.

View Answer

C

Questions 19–20

A previously healthy 43-year-old man presents with a 6-month history of nonbloody diarrhea, fever, and 10-pound weight loss and now develops urosepsis. On evaluation, an enterovesical fistula (from the ileum to the bladder) is found. At laparotomy, findings include inflammation and “fat wrapping” of three separate segments of ileum. Each segment is approximately 20 cm in length and is separated by less than 20-cm segments of normal-appearing bowel (skip areas). The distal-most of the three segments is more severely inflamed than the others and involves the terminal ileum all the way to the cecum. This segment of ileum is densely adherent to the right superior aspect of the bladder.

19. Which of the following is true?

A All of the abnormal-appearing bowel should be resected.

B This patient has complications of Meckel's diverticulitis.

C All of the bladder wall involved in the inflammatory process must be removed.

D Extensive resection can reduce the potential for a recurrence to less than 10%.

E Closure of the fistula and resection of the involved bowel are preferred.