Medicosmos Surgery MCQ stomach and oesophagus MCQ
Stomach and Esophagus MCQ
1. Which of the following statements about the anatomic course of the esophagus is
correct?
A. The cervical esophagus passes behind and to the right of the trachea.
B. The thoracic esophagus enters the posterior mediastinum anterior to the aortic
arch.
C. The thoracic esophagus passes behind the right mainstem bronchus and the
pericardium.
D. The esophagus enters the diaphragmatic hiatus at the level of T8.
E. The esophagus deviates anteriorly and to the left as it enters the abdomen.
Answer: E
2. Which of the following statements about esophageal anatomy is correct?
A. The esophagus has a poor blood supply, which is segmental in distribution and
accounts for the high incidence of anastomotic leakage.
B. The esophageal serosa consists of a thin layer of fibroareolar tissue.
C. The esophagus has two distinct muscle layers, an outer, longitudinal one and an
inner, circular one, which are striated in the upper third and smooth in the distal two
thirds.
D. Injury to the recurrent laryngeal nerve results in vocal cord dysfunction but does
not affect swallowing.
E. The lymphatic drainage of the esophagus is relatively sparse, localized primarily to
adjacent paraesophageal lymph nodes.
Answer: C
3. Which of the following statements about the lower esophageal sphincter (LES)
mechanism, or high-pressure zone (HPZ), is true?
A. The LES is a circular smooth muscle ring that is 3 to 5 cm. long.
B. In assessing esophageal manometric data, mean HPZ pressure less than 6 mm. Hg
or overall length less than 2 cm. is more likely to be associated with incompetence of
the LES and gastroesophageal reflux.
C. Esophageal manometry and the acid perfusion (Bernstein) test reliably identify the
patient with an incompetent LES mechanism.
D. Distal HPZ relaxation occurs within 5 to 8 seconds of initiating a swallow.
E. Twenty-four–hour distal esophageal pH monitoring is achieved with an
intraesophageal pH electrode positioned at the esophagogastric junction. Answer: B
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4. Which of the following statements about esophageal motility is/are true?
A. The act of swallowing initiates UES relaxation, which persists until the bolus of
food passes the LES.
B. The primary peristaltic wave normally propels the swallowed bolus through the
esophagus in 4 to 8 seconds.
C. Normally, a progressive peristaltic contraction (primary wave) follows 50% of all
swallows, the remainder being secondary or tertiary contractions.
D. Secondary peristalsis is initiated when the entire swallowed bolus of food fails to
empty from the esophagus into the stomach.
E. Tertiary esophageal contractions are high-amplitude progressive peristaltic
contractions that produce the “corkscrew” appearance of esophageal spasm on
barium esophagography.
Answer: BD
5. Which of the following statements about UES dysfunction are correct?
A. This condition is diagnosed by the characteristic manometric findings of UES spasm.
B. Typical symptoms include cervical dysphagia, expectoration of saliva, and
hoarseness.
C. The classic finding on barium esophagogram is a posterior cricopharyngeal bar.
D. Medical or surgical therapy of gastroesophageal reflux may be curative.
E. A cervical esophagomyotomy for UES dysfunction should be limited to 2 to 3 cm. in
length so that normal muscle is not damaged.
Answer: BCD
6. Which of the following statements about achalasia is/are correct?
A. In most cases in North America the cause is a parasitic infestation by Trypanosoma
cruzi.
B. Chest pain and regurgitation are the usual symptoms.
C. Distal-third esophageal adenocarcinomas may occur in as many as 20% of patients
within 10 years of diagnosis.
D. Manometry demonstrates failure of LES relaxation on swallowing and absent or
weak simultaneous contractions in the esophageal body after swallowing.
E. Endoscopic botulinum toxin injection of the LES, pneumatic dilatation, and
esophagomyotomy provide highly effective curative therapy for achalasia.
Answer: D
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7. Which of the following statements about diffuse esophageal spasm is/are true?
A. Chest pain due to esophageal spasm is readily differentiated from angina pectoris
of cardiac origin.
B. Bouts of esophageal obstruction and regurgitation of food are characteristic.
C. Associated psychiatric disorders are common.
D. During manometric assessment, unless the patient is having pain there may be no
detectable multiphasic, high-amplitude, simultaneous esophageal contractions.
E. The treatment of choice is a long esophagomyotomy from the aortic arch to the
esophagogastric junction.
Answer: CD
8. Which of the following statements about epiphrenic diverticula of the esophagus
is/are correct?
A. They are traction diverticula that arise close to the tracheobronchial tree.
B. They characteristically arise proximal to an esophageal reflux stricture.
C. The degree of dysphagia correlates with the size of the pouch.
D. They are best approached surgically through a right thoracotomy.
E. The operation of choice is a stapled diverticulectomy, long esophagomyotomy, and
partial fundoplication.
Answer: E
9. Which of the following statements about Schatzki's ring is correct?
A. The ring represents a panmural fibrotic stricture resulting from gastroesophageal
reflux.
B. Dysphagia occurs when the ring diameter is 13 mm. or less.
C. The ring occurs within 1 to 2 cm. of the squamocolumnar epithelial junction.
D. Schatzki's ring indicates reflux esophagitis.
E. Schatzki's ring signifies the need for an antireflux operation.
Answer: B
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10. Choose the distance in centimeters from the upper incisor teeth at which the
following radiographically identified esophageal lesions would be encountered
endoscopically:
A. 10 cm. 1. Zenker's diverticulum
B. 15 cm. 2. Traction diverticulum
C. 25 cm. 3. Tumor 10 cm. proximal to the esophagogastric junction
D. 30 cm.
E. 40 cm.
Answer: 1-B, 2-C, 3-D
11. Which of the following statements about pathology encountered at esophagoscopy
is/are correct?
A. Reflux esophagitis should be graded as mild, moderate, or severe, to promote
consistency among different observers.
B. An esophageal reflux stricture with a 2-mm. lumen is not dilatable and is best
treated with resection.
C. A newly diagnosed radiographic distal esophageal stricture warrants dilation and
antireflux medical therapy.
D. In patients with Barrett's mucosa, the squamocolumnar epithelial junction occurs 3
cm. or more proximal to the anatomic esophagogastric junction.
E. After fasting at least 12 hours, a patient with megaesophagus of achalasia can
safely undergo flexible fiberoptic esophagoscopy.
Answer: D
12. Which of the following statements about the diagnosis and treatment of
esophageal leiomyomas is/are correct?
A. The majority are diagnosed after they cause dysphagia and chest pain.
B. Biopsy is indicated at the time of esophagoscopy, to rule out carcinoma.
C. Full-thickness elliptical excision of the esophageal wall is the preferred surgical
approach.
D. Endoscopic ultrasonography is a reliable means of following leiomyomas
conservatively.
E. Recurrence of resected leiomyomas is minimized by wide local excision.
Answer: D
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Stomach and Esophagus MCQ
1. Which of the following statements about the anatomic course of the esophagus is
correct?
A. The cervical esophagus passes behind and to the right of the trachea.
B. The thoracic esophagus enters the posterior mediastinum anterior to the aortic
arch.
C. The thoracic esophagus passes behind the right mainstem bronchus and the
pericardium.
D. The esophagus enters the diaphragmatic hiatus at the level of T8.
E. The esophagus deviates anteriorly and to the left as it enters the abdomen.
Answer: E
2. Which of the following statements about esophageal anatomy is correct?
A. The esophagus has a poor blood supply, which is segmental in distribution and
accounts for the high incidence of anastomotic leakage.
B. The esophageal serosa consists of a thin layer of fibroareolar tissue.
C. The esophagus has two distinct muscle layers, an outer, longitudinal one and an
inner, circular one, which are striated in the upper third and smooth in the distal two
thirds.
D. Injury to the recurrent laryngeal nerve results in vocal cord dysfunction but does
not affect swallowing.
E. The lymphatic drainage of the esophagus is relatively sparse, localized primarily to
adjacent paraesophageal lymph nodes.
Answer: C
3. Which of the following statements about the lower esophageal sphincter (LES)
mechanism, or high-pressure zone (HPZ), is true?
A. The LES is a circular smooth muscle ring that is 3 to 5 cm. long.
B. In assessing esophageal manometric data, mean HPZ pressure less than 6 mm. Hg
or overall length less than 2 cm. is more likely to be associated with incompetence of
the LES and gastroesophageal reflux.
C. Esophageal manometry and the acid perfusion (Bernstein) test reliably identify the
patient with an incompetent LES mechanism.
D. Distal HPZ relaxation occurs within 5 to 8 seconds of initiating a swallow.
E. Twenty-four–hour distal esophageal pH monitoring is achieved with an
intraesophageal pH electrode positioned at the esophagogastric junction. Answer: B
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,Medicosmos Surgery MCQ stomach and oesophagus MCQ
4. Which of the following statements about esophageal motility is/are true?
A. The act of swallowing initiates UES relaxation, which persists until the bolus of
food passes the LES.
B. The primary peristaltic wave normally propels the swallowed bolus through the
esophagus in 4 to 8 seconds.
C. Normally, a progressive peristaltic contraction (primary wave) follows 50% of all
swallows, the remainder being secondary or tertiary contractions.
D. Secondary peristalsis is initiated when the entire swallowed bolus of food fails to
empty from the esophagus into the stomach.
E. Tertiary esophageal contractions are high-amplitude progressive peristaltic
contractions that produce the “corkscrew” appearance of esophageal spasm on
barium esophagography.
Answer: BD
5. Which of the following statements about UES dysfunction are correct?
A. This condition is diagnosed by the characteristic manometric findings of UES spasm.
B. Typical symptoms include cervical dysphagia, expectoration of saliva, and
hoarseness.
C. The classic finding on barium esophagogram is a posterior cricopharyngeal bar.
D. Medical or surgical therapy of gastroesophageal reflux may be curative.
E. A cervical esophagomyotomy for UES dysfunction should be limited to 2 to 3 cm. in
length so that normal muscle is not damaged.
Answer: BCD
6. Which of the following statements about achalasia is/are correct?
A. In most cases in North America the cause is a parasitic infestation by Trypanosoma
cruzi.
B. Chest pain and regurgitation are the usual symptoms.
C. Distal-third esophageal adenocarcinomas may occur in as many as 20% of patients
within 10 years of diagnosis.
D. Manometry demonstrates failure of LES relaxation on swallowing and absent or
weak simultaneous contractions in the esophageal body after swallowing.
E. Endoscopic botulinum toxin injection of the LES, pneumatic dilatation, and
esophagomyotomy provide highly effective curative therapy for achalasia.
Answer: D
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,Medicosmos Surgery MCQ stomach and oesophagus MCQ
7. Which of the following statements about diffuse esophageal spasm is/are true?
A. Chest pain due to esophageal spasm is readily differentiated from angina pectoris
of cardiac origin.
B. Bouts of esophageal obstruction and regurgitation of food are characteristic.
C. Associated psychiatric disorders are common.
D. During manometric assessment, unless the patient is having pain there may be no
detectable multiphasic, high-amplitude, simultaneous esophageal contractions.
E. The treatment of choice is a long esophagomyotomy from the aortic arch to the
esophagogastric junction.
Answer: CD
8. Which of the following statements about epiphrenic diverticula of the esophagus
is/are correct?
A. They are traction diverticula that arise close to the tracheobronchial tree.
B. They characteristically arise proximal to an esophageal reflux stricture.
C. The degree of dysphagia correlates with the size of the pouch.
D. They are best approached surgically through a right thoracotomy.
E. The operation of choice is a stapled diverticulectomy, long esophagomyotomy, and
partial fundoplication.
Answer: E
9. Which of the following statements about Schatzki's ring is correct?
A. The ring represents a panmural fibrotic stricture resulting from gastroesophageal
reflux.
B. Dysphagia occurs when the ring diameter is 13 mm. or less.
C. The ring occurs within 1 to 2 cm. of the squamocolumnar epithelial junction.
D. Schatzki's ring indicates reflux esophagitis.
E. Schatzki's ring signifies the need for an antireflux operation.
Answer: B
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, Medicosmos Surgery MCQ stomach and oesophagus MCQ
10. Choose the distance in centimeters from the upper incisor teeth at which the
following radiographically identified esophageal lesions would be encountered
endoscopically:
A. 10 cm. 1. Zenker's diverticulum
B. 15 cm. 2. Traction diverticulum
C. 25 cm. 3. Tumor 10 cm. proximal to the esophagogastric junction
D. 30 cm.
E. 40 cm.
Answer: 1-B, 2-C, 3-D
11. Which of the following statements about pathology encountered at esophagoscopy
is/are correct?
A. Reflux esophagitis should be graded as mild, moderate, or severe, to promote
consistency among different observers.
B. An esophageal reflux stricture with a 2-mm. lumen is not dilatable and is best
treated with resection.
C. A newly diagnosed radiographic distal esophageal stricture warrants dilation and
antireflux medical therapy.
D. In patients with Barrett's mucosa, the squamocolumnar epithelial junction occurs 3
cm. or more proximal to the anatomic esophagogastric junction.
E. After fasting at least 12 hours, a patient with megaesophagus of achalasia can
safely undergo flexible fiberoptic esophagoscopy.
Answer: D
12. Which of the following statements about the diagnosis and treatment of
esophageal leiomyomas is/are correct?
A. The majority are diagnosed after they cause dysphagia and chest pain.
B. Biopsy is indicated at the time of esophagoscopy, to rule out carcinoma.
C. Full-thickness elliptical excision of the esophageal wall is the preferred surgical
approach.
D. Endoscopic ultrasonography is a reliable means of following leiomyomas
conservatively.
E. Recurrence of resected leiomyomas is minimized by wide local excision.
Answer: D
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