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Free STEP3 Exam Braindumps (page: 74)

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PDF with 804 Questions

You perform an upper endoscopy on a patient and find changes suggestive of Barrett's esophagus. How do you explain this to the patient and his family?

  1. Is a condition where the normal esophageal lining is replaced by columnar epithelium.
  2. Is a condition where the normal esophageal lining is replaced by dysplastic squamous cells.
  3. Two biopsies with histologic changes are needed to confirm the diagnosis.
  4. The main risk associated with Barrett's esophagus is bleeding.
  5. It is related to peptic ulcer disease.

Answer(s): A

Explanation:

Barrett's esophagus is related to GERD. It is found proximal to the LES and is thought to be a result of constant acidic exposure. It is a condition where the normal esophageal squamous cell epithelium is replaced by columnar epithelium, similar to intestinal metaplasia. A single biopsy is all that is needed to confirm the diagnosis. In fact, many biopsies should be taken during endoscopy if the diagnosis is suspected in an effort to find dypslasia. The risk of malignant degeneration is the most important risk associated with Barrett's esophagus.



On your surgery rotation you are assisting in a gastric surgical procedure. The attending surgeon asks you to describe the vascular supply to the stomach. You reply with which of the following?

  1. The right gastric artery arises from the celiac axis.
  2. The left gastric artery arises from the common hepatic artery.
  3. The right gastroepiploic arises from the right hepatic artery.
  4. The short gastric arteries arise from the splenic artery.
  5. The left gastroepiploic arises from the left gastric artery.

Answer(s): D

Explanation:

The main blood supply to the stomach comes from the right gastric artery (from the hepatic artery), the left gastric artery (from the celiac axis), the right gastroepiploic artery (from the gastroduodenal artery), the left gastroepiploic (from the splenic artery), and the short gastric arteries from the splenic artery.



A patient with dyspepsia has a positive serologic test for Helicobacter pylori and is concerned that he could have an ulcer. Which of the following statements about H. pylori and ulcer disease would be most accurate?

  1. Gastric ulcers are usually caused by hypersecretion of acid, not bacteria.
  2. A positive IgG serology confirms an active infection with H. pylori.
  3. H. pylori is associated with both gastric and duodenal ulcers.
  4. Most patients with H. pylori have ulcers.
  5. The use of antibiotics alone is successful in eradicating H. pylori.

Answer(s): C

Explanation:

Duodenal ulcers are usually associated with hypersecretion of acid, whereas gastric ulcers may be related to breakdown of the mucosal protective mechanisms or to malignancy. Type I gastric ulcers are the most common. They are usually associated with altered mucosal defense and not hypersecretion of acid. Type II gastric ulcers are caused by a duodenal ulcer and the resulting pyloric obstruction. Type III gastric ulcers are found proximal to the pylorus and are associated with hypersecretion and duodenal ulcers. H. pylori is found in 95% of duodenal and 80% of gastric ulcer patients. However, only 10% of people who carry the bacteria actually manifest ulcer disease. Serologic testing does not determine the presence of an active infection. Active infections can be determined by endoscopic biopsy sampling or the use of urease breath testing. All currently recommended regimens to eradicate H. pylori utilize both antibiotics and acid suppression.



Which of the following patients is most likely to have symptoms of the carcinoid syndrome?

  1. patient with carcinoid tumor localized to the appendix
  2. patient with carcinoid tumor of the small intestine and a 3-cm nodule in the liver seen on CT scan
  3. patient with an apple core lesion seen on barium enema
  4. patient with adrenal mass and elevated levels of urinary vanillylmandelic acid(VMA)
  5. patient with a retroperitoneal carcinoid tumor

Answer(s): E

Explanation:

Carcinoid syndrome is seen in less than 10% of patients with metastatic carcinoid disease. It is seen in patients with elevated serotonin levels, which is metabolized by the liver. Thus, only patients with massive hepatic metastasis or with tumors that bypass the hepatic filter--such as a retroperitoneal tumor--show symptoms. 5-Hydroxyindoleacetic acid (5-HIAA) levels can be tested in the urine to give the diagnosis (urinary vanillylmandelic acid [VMA] is indicative of a pheochromocytoma). An apple core lesion on the colon is most likely to be a large adenocarcinoma, which would not be associated with carcinoid symptoms. Common symptoms of carcinoid syndrome include flushing, diarrhea, right heart failure, and asthma.
Weight loss and liver failure are uncommon symptoms.






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