Digestive Disorders Practice Questions

1. Persons with celiac disease cannot tolerate:
  1. Gluten
  2. Lactose
  3. Peanuts
  4. Eggs
2. GERD is a risk factor for the development of:
  1. Celiac disease
  2. Biliary Atresia
  3. Barrett’s Esophagus
  4. Inguinal Hernia
3. Risk factors for hepatitis A include all of the following except:
  1. Men who have sex with men
  2. Illegal drug users
  3. Overweight 
  4. Persons who visit developing countries
4. Interferon is prescribed for the treatment of:
  1. Hepatitis A
  2. Chronic Hepatitis B
  3. GERD
  4. Diverticulitis
5. Persons of Jewish heritage are disproportionately affected by:
  1. Barrett’s Esophagus
  2. Diverticulosis
  3. Appendicitis
  4. Crohn’s disease
6. Which of the following conditions usually is asymptomatic?
  1. Diverticulitis
  2. Crohn’s disease
  3. Inflammatory bowel disease
  4. Diverticulosis
7. Bowel diversion surgery may be indicated for all of the following conditions except:
  1. Gastroparesis
  2. Cancer
  3. Inflammatory bowel disease
  4. Bowel obstruction
8. The most frequent cause of abdominal adhesions is:
  1. Abdominal surgery
  2. Gastroenteritis
  3. Hepatitis A
  4. Hepatitis B
9. The most frequent cause of emergency abdominal surgery is:
  1. Inflammatory bowel disease
  2. Appendicitis
  3. Viral gastroenteritis
  4. Barrett’s Esophagus
10. Abdominal pain associated with appendicitis is generally described as:
  1. Near the diaphragm
  2. Relieved by eating
  3. Near or around the umbilicus and in the right lower quadrant of the abdomen
  4. Worse in the morning
11. Physical examination of a patient with acute appendicitis may reveal all of the following except:
  1. Guarding
  2. Rectal bleeding
  3. Rebound tenderness
  4. Rovsing’s sign
12. Symptoms of ulcerative colitis may include abdominal pain, rectal bleeding, diarrhea, and all of the following except:
  1. Anemia
  2. Weight loss
  3. Joint pain
  4. Bradycardia
13. Peptic ulcers may be caused by all of the following except:
  1. Emotional stress and eating spicy foods 
  2. Bacterial infection with Helicobacter pylori
  3. Long-term use of nonsteroidal anti-inflammatory agents (NSAIDS)
  4. Malignant tumors in the stomach or pancreas
14. All of the following are symptoms of peptic ulcer except:
  1. Pain is relieved by eating
  2. Pain is unrelenting and quickly worsens
  3. Pain is relieved by antacids
  4. Pain occurs at night when the stomach is empty
15. Which of the following symptoms is not associated with dyspepsia?
  1. Feeling overly full after a normal meal
  2. Mild to severe epigastric pain
  3. Black tarry stools
  4. Epigastric burning sensations
16. In the United States the most common causes of hepatitis C are:
  1. Wilson disease, cystic fibrosis, and glycogen storage diseases
  2. Alpha-1 antitrypsin deficiency and hemochromatosis
  3. Chronic hepatitis B and D
  4. Excessive alcohol consumption, hepatitis C, and obesity
17. Food borne illness associated with eating raw and undercooked eggs is generally attributable to:
  1. Campylobacter jejuni
  2. L. monocytogenes
  3. Salmonella enteriditis
  4. C. botulinum
18. About 80% of gallstones are composed of:
  1. Calcium
  2. Bile
  3. Bilirubin
  4. Hardened cholesterol
19. Persons at risk for gallstones include all of the following except:
  1. Adults age 60 and older
  2. Pregnant women or women using hormone replacement therapy or oral contraceptives
  3. Native Americans and Mexican Americans
  4. People with rheumatoid or osteoarthritis
20. Disorders that increase risk for chronic pancreatitis include all of the following except:
  1. Cystic fibrosis
  2. Hypercalcemia
  3. Excessive alcohol consumption
  4. Hyperthyroidism


Answers and Explanations

1. A

Celiac disease is a T cell-mediated autoimmune, inflammatory condition of the small intestine, prompted by the consumption of gluten (contained in foods such as wheat, rye, and barley) in genetically susceptible individuals. Between one and two percent of the U.S. population is believed to suffer from celiac disease.

2. C

Gastroesophageal reflux disease (GERD) is persistent acid reflux and is a risk factor for the development of Barrett’s Esophagus, the condition in which the lining of the esophagus is replaced by mucosal tissue like that which lines the intestines. A small percentage of persons with Barrett’s Esophagus develop a form of esophageal cancer.

3. C

Hepatitis A is viral infection that is preventable. The hepatitis A vaccine consists of two injections administered 6 months to one year apart. Hepatitis A is commonly spread by contact with an infected person’s stool.

4. B

Chronic hepatitis B is treated with interferon and peginterferon as well as with orally administered agents, including lamivudine, telbivudine, adefovir and entecavir. When chronic hepatitis B results in liver failure, liver transplantation may be indicated.

5. D

Crohn’s disease is an inflammatory bowel disease that frequently presents in young adults ages 20 to 30. Symptoms include pain in the lower right quadrant of the abdomen, diarrhea, weight loss, arthritis, and rectal bleeding. Complications include intestinal blockage, nutritional deficiencies, skin problems, gallstones, and kidney stones.

6. D

The presence of diverticula (pouches in the intestines) is common with advancing age; nearly half of persons age 60 and older have diverticulosis, which is generally asymptomatic. In contrast, persons with diverticulitis experience abdominal pain and other symptoms such as cramping fever and chills.

7. A

Bowel diversion surgeries such as colostomy, ileostomy and ileoanal reservoir surgery remove damaged or diseased portions of the intestines. Gastroparesis, or delayed gastric emptying, may be treated with diet, drugs including metoclopramide, erythromycin, domperidone, parenteral nutrition, or gastric electrical stimulation.

8. A

Abdominal surgery, especially bowel and gynecological procedures are the most frequent cause of abdominal adhesions. Abdominal adhesions may cause intestinal obstruction and female infertility.

9. B

Appendicitis, an acute infection and inflammation of the appendix, results in more emergency abdominal surgeries than any other condition. Medical history and physical examination are often sufficient to establish the diagnosis, however laboratory tests and imaging studies may be performed if the patient presents with atypical symptoms.

10. C

In addition to worsening right abdominal pain the symptoms of appendicitis may include nausea and vomiting, constipation or diarrhea, low-grade fever, and abdominal swelling. 11. B: Guarding, rebound tenderness, and Rovsing’s tenderness (pain in the lower right quadrant of the abdomen when the examiner presses and releases pressure on the left side) are indicative of appendicitis as are psoas sign (flexing the psoas produces pain) and obturator sign (flexing the obturator produces abdominal pain).

12. D

Ulcerative colitis symptoms are often chronic and intermittent. They may be mild or severe and also include fatigue, anorexia, malnutrition, skin lesions, and impaired growth in children. The goal of treatment for ulcerative colitis is to reduce symptoms and achieve a remission. The drugs used to induce remission include aminosalicylates, corticosteroids, and immunomodulators.

13. A

H. pylori is responsible for most peptic ulcers. The bacteria weaken the mucosal lining of the stomach, rendering it acid permeable. The combination of the bacteria and acid erode the lining and produce the ulcer. Although stress and a diet of spicy food do not cause peptic ulcers, both may exacerbate symptoms.

14. B

Peptic ulcer pain is described as dull and gnawing and is often intermittent – arising and subsiding over the course of several days. It generally occurs within a couple of hours of eating and may be accompanied by bloating, nausea, and vomiting.

15. C

Mild dyspepsia, or indigestion, may be treated by diet (several small, low-fat meals rather than three large meals, eliminating alcohol, coffee and carbonated beverages from the diet, stopping smoking, and eliminating use of drugs that are known to irritate the gastric mucosa such as aspirin and anti-inflammatory agents) and managing stress. Nonprescription antacids, H2 receptor antagonists, proton pump inhibitors, and prokinetics also may relieve symptoms.

16. D

All of the conditions listed above may cause cirrhosis, the condition in which healthy liver is replaced by scar tissue. Cirrhosis is the 12th leading cause of death and many people have more than one causal factor. Rising rates of obesity have resulted in increasing number of cases of nonalcoholic fatty liver disease, which causes cirrhosis.

17. C

Food borne illnesses that result from consuming raw and undercooked meat and poultry are generally attributable to Campylobacter jejuni, E. coli O157:H7, L. monocytogenes, and Salmonella. Food borne illnesses that result from consuming raw foods and unpasteurized milk and dairy products are generally attributable to L. monocytogenes, Salmonella, Shigella, Staphylococcus aureus, and C. jejuni. Improperly canned goods and smoked or salted fish may harbor C. botulinum.

18. D

An estimated 10% of the population has gallstones but most people are asymptomatic and as such, require no treatment. In instances where gallstones injure or lodge in bile ducts or impede the flow of bile or digestive enzymes, oral dissolution therapy, contact dissolution therapy or surgery – laparoscopic cholecystectomy or in about 5% of cases open procedures – may be indicated.

19. D

Populations at risk for gallstones include the above-mentioned groups as well as persons who are overweight or obese, persons who experience rapid weight loss such as bariatric surgery patients, diabetics, persons with a family history of gallstones, and persons who take statin drugs.

20. D

Chronic pancreatitis is often presents in adults ages 30 to 40 and in addition to chronic, excessive alcohol use, cystic fibrosis, and hypercalcemia may be caused or precipitated by hyperlipidemia, hypertriglyceridemia, or autoimmune disorders. Untreated, chronic pancreatitis results in calcification, which is permanent damage, and may require surgical excision.