Infernal Diagnosis – Test II study guide

1. WOF should be true regarding hx of pt presenting w/ a fluid wave on an abdominal exam? (MA)
a. Hx-alcoholism (M/C cause of fluid wave is ascites  portal HTN)
b. Hx-smoking
c. Yellow skin
d. Easy bruising

2. Visible abdominal peristalsis is associated w/ adynamic ileus & early bowel obstruction.
a. False

3. You suspect from hx that your pt might have an infectious esophagitits. WOF might you also suspect to
find (MA)
a. Substernal chest pain
b. Immunocompromise
c. CMV infection
d. Fluid wave on abdominal exam

4. Your 16 yr old female pt that you have been tx for 3 months for IBD complains of an enlarging painful
mass in the LLQ of abdomen. She started noticing it month ago but was afraid to tell u. she has low-
grade fever. WOF concerns you?
a. Crohn’s disease or abscess formation
b. Colon cancer
c. Appendicitis w/ abscess formation
d. Diverticulitis w/ abscess formation

5. Pt complains of abdominal bloating, diarrhea, IBD. Plain lumbar film x-ray demonstrates loss of bone
density WOF is most consistent w/ these?
a. Peritonitis
b. Gluten intolerance (vit D malabsorption)
c. Diverticulitis w/ perforation
d. UC

6. WOF involves the use of a manometer

a. Barium swallow w/ small bowel follow thru
b. EGD
c. Retrograde pyelogram
d. Esophagram (barium swallow)

7. WOF most typically cause radiating pain into right shoulder region?
a. Gallbladder disease
b. Prostatitis (hope not.)
c. Appendicitis
d. Crohn's

8. Pt has 3 small scars on the mid abdomen in RUQ on abdominal exam. WOF would be on top of your list
for reason of these scars? (MA)
a. cholecystectomy (Classic) – 1 scope, 1 light, 1 insuflation
b. laparoscopy
c. laparotomy
d. manometry (EGD)
9. WOF is the M/C type of abdominal hernia?
a. Inguinal (M/C by far)
b. Umbilical
c. Femoral
d. Dystrophic cranial rectal inversion

10. 26 yr old female present w/ bright red blood per rectum 3x/wk. WOF could cause this indication?
a. Hemorrhoids -yes
b. Diverticulitis - no
c. Esophageal CA - no
d. UC – yes
e. A & B

11. WOF is associated w/ rectal pain & itching

a. Fistula or fissure
b. Colon CA
c. Diverticulosis
d. Cholelithiasis ("Gallstones")

12. WOF are untrue regarding normal esophageal Peristalsis?

a. UT = waves from swallowing are called secondary peristalsis
b. UT = curling is a normal finding (not uncommon, but not normal)
c. Primary peristalsis is initiated by swallowing
d. UT = peristalsis is slightly quicker in elderly

13. DES (diffuse esophageal spasm) is pero(?) relaxation to lower esophageal sphincter w/ dysphagia
(difficulty swallowing) and odynophagia (painful swallowing) typically in younger pts.
a. False

14. Achalasia effects the esophagus by causing relaxation which leads to dilation typically in pts w/ DSS
a. False (dilation is d/t obstruction stricture)

15. 58 yr old male colorectal Ca. pt reports an enlarging mass in his L groin over last few months. WOF is
most likely to associated w/:
a. Stage 1
b. Stage 2
c. Stage 3 (regional lymphadenopathy) – Correct Answer per DW!
d. Stage 4

16. 65 yr old female pt has acute IBD that is unchanged by changing her body position. She feels very tired
and wants to sleep. WOF is most primary concern?
a. Post lat disc protrusion
b. AAA
c. Colorectal carcinoma
d. Malingering

17. Testing confirms your pt has fecal occult blood where could the blood be coming from? (MA)
a. Sigmoid colon (can come from anywhere from sigmoid and up)
b. Esophagus
c. Mouth
d. Stomach
18. Regarding PUD: (MA)
a. Multiple ulcers are seen with Zollinger Ellison syndrome.
b. It is unnecessary to biopsy ulcers when performing EGD
c. Eating may relieve pain or aggravate pain depending upon location
d. Manipulation may be a beneficial part of treatment

19. You suspect your pt has a hiatus hernia. WOF would NOT be commonly found w/ this condition?
a. GERD
b. Remission & exacerbation of symptoms
c. Younger pt
d. Gurgling feeling in chest

20. Dyspepsia that begins 30-60 min after eating is M/C associated w/ WOF? (MA)
a. Esophageal achalasia – (No! Stricture prevents anything from going back up)
b. GERD
c. Esophageal Chalasia
d. PUD –(No! Dyspepsia means "burning in chest")

21. Itching is associated w/ WOF condition:

a. Jaundice
b. EtOH cirrhosis – No!
c. Splenomegaly
d. Ascites

22. WOF is M/C location for stomach CA

a. Pylorus
b. Fundus
c. Lesser curvature
d. Greater curvature

23. WOF are risk factors for gastric CA? (MA)

a. Hepatitis A
b. Eating lots smoked foods
c. Over 40 yr old
d. Cigarette smoking

24. Presence of multiple peptic ulcers should be an indication to consider WOF?

a. Duodenal malignancy
b. Zollinger Ellison syndrome - Yes
c. Incredible poor diet
d. Gastronoma - Yes
e. Both B & D

25. Most esophageal masses are benign where as most stomach masses are malign
a. False – it's backwards

26. Presence of supraclavicular lymphdenopathy in a 68 yr old male typically indicates WOF?

a. Cirrhosis
b. Portal HTN
c. GI malignancy w/ mets
d. Achalasia
27. The M/C clinical presentation for Stage 1 cancer in abdominal organs in the normal physical exam
a. True

28. Any male over 40 yrs old that has anemia has WOF until proven otherwise:
b. GI cancer

29. Gastric CA can be associated w/ WOF? (MA)

a. Early satiety
b. Melena
c. Hematomesis
d. LUQ abdominal pain

30. Poststenotic dilation w/ odynanophagia is commonly associated w/ achalasia?

a. False – it's prestenotic dilation

31. Reflex esophagitis is GERD that results in permanent damage to the lower esophagus, trachea (no),
vocal cords (no)
a. False

32. M/C location for esophageal CA’s

a. Supragliotic region
b. Upper ½ of esophagus
c. Lower ½ of esophagus
d. Esophageal sphincter

33. Regarding lactose intolerance?

a. Only milk products are implicated
b. Disease is secondary to lactase deficiency
c. Bloating is common symptom
d. Only involves terminal ileum
e. Both B &C

34. Most GI malignancy’s have a very favorable b/c they are identified early in the course of the dz
a. False

35. Regarding tumors of the colon…(MA)

a. Polyps are relatively common
b. Most occur in proximal colon - False
c. Malign is 3x more common in women
d. Polyps can become adenocarcinomas

36. The major symptoms of esophageal carcinoma are weight loss and progressive dysphagia for solid
foods.
a. True

37. Regarding traction esophageal diverticulum: (MA)

a. Traction esophageal diverticulum results from lesion outside esophagus
b. Occurs ___ vasorectum
c. Occurs in middle pt esophagus
d. Much more common than pulsion diverticulum
38. 5 yr survival rate for colon CA is only 10%
a. False

39. A colon diverticulum is a pusion type diverticulum and m/c occurs in the L colon
a. True

40. Trying to get chiropractors to agree…

a. TRUE!!!