NMS Q&A Family Medicine

chap ter 15Surgical Issues of theGastrointestinal TractExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 A 25-year-old man enters the office with pain in theabdomen with the onset 36 hours ago and increasinglyworse since then. Initial examination of thechest is negative and the abdomen, while in tender todeep palpation in the lower midline, manifests neitherrebound tenderness nor positive Rovsig sign.However, when the doctor lays the patient on the leftside and directs the patient to extend his right hipwhile the doctor resists the effort, the patient complainsof severe pain deep in the right lumbar area.This finding may indicate each of the following diagnosesexcept for which one?(A) Positive in retrocaecal appendicitis(B) Positive in Crohn disease(C) Positive in perinephric abscess(D) Positive in pelvic appendicitis(E) May be positive, if pain is elicited by a digitalrectal examination, palpating posteriorly.2 Which of the following may exhibit purpuric discolorationin any or all of the following areas: periumbilical(Cullen sign), inguinal region (Fox sign),and the flanks (Grey sign):(A) Acute cholecystitis(B) Irritable bowel syndrome(C) Hemorrhagic pancreatitis(D) Peptic ulcer(E) Superior mesenteric artery insufficiency3 A 65-year-old man, previously healthy, has noteddysphagia with both liquids and solids for about2 months. It occurs in paroxysms that last for up to20 to 30 minutes. The frequency of the attacks has beenincreasing recently. Without further history, which ofthe following is the most likely cause of the symptom?(A) Esophageal diverticulum(B) Adenocarcinoma of the esophagus(C) Stricture from peptic esophagitis(D) Functional motility disorder(E) Postradiation therapy4 Which of the following is true about carcinomas ofthe upper gastrointestinal (GI) tract?(A) Incidence of carcinoma of the stomach isincreasing in the United States.(B) Incidence of carcinoma of esophagus andproximal stomach is increasing.(C) Carcinoma of the stomach is a disease for whichroutine screening is appropriate.(D) Vitamin C intake is a risk factor for carcinomaof the stomach.(E) Excess intake of fruits and vegetables is a riskfactor for carcinoma of the stomach.5 A 56-year-old man is concerned about stomach cancerbecause of the death of a co-worker from that disease.Each of the following is a risk factor for stomachcancer except which one?(A) Familial adenomatous polyposis(B) History of a gastric ulcer that revealedhigh-grade dysplasia(C) Atrophic gastritis(D) Helicobacter pylori infection(E) Hyperplastic polyps6 Which of the following is the most important, productive,and practical reason to offer or refer forupper endoscopy in any patient over 45 years withpersistent dyspepsia?(A) To diagnose gastric peptic ulcer(B) To diagnose gastroesophageal reflux(C) To diagnose early stomach cancer(D) To diagnose peptic duodenal ulcer disease(E) To diagnose atrophic gastritis7 You suspect atypical presentation of appendicitis in a26-year-old woman who has had abdominal pain for2 days: There is no rebound tenderness, questionableobturator and psoas signs, and a higher white bloodcell (WBC) count than is usually encountered in95