GASTROINTESTINAL SYSTEM
DISORDERS Practice Exam #6 -
QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
2023/2024
GRADED A+ NEW
1. Question
Which of the following conditions can cause a hiatal hernia?
A. Increased intrathoracic pressure.
B. Weakness of the esophageal muscle.
C. Increased esophageal muscle pressure.
D. Weakness of the diaphragmatic muscle.
Correct Answer: D. Weakness of the diaphragmatic muscle.
A hiatal hernia is caused by weakness of the diaphragmatic muscle and increased
intra-abdominal—not intrathoracic—pressure. This weakness allows the stomach to
slide into the esophagus. The esophageal supports weaken, but esophageal muscle
weakness or increased esophageal muscle pressure isn’t a factor in hiatal hernia. A
hiatal hernia is a medical condition in which the upper part of the stomach or other
internal organ bulges through an opening in the diaphragm.
Option A: The diaphragm is a muscular structure that assists in respiration and has a
small opening, a hiatus, through which the esophagus passes prior to connecting to the
stomach. This is called the gastroesophageal junction (GEJ). In a hiatal hernia, the
stomach pushes through that opening and into the chest and compromises the lower
esophageal sphincter (LES).
,Option B: Hiatal hernias may be congenital or acquired. There is an increased
prevalence in older people. It is believed that muscle weakness with loss of flexibility
and elasticity with age predisposes to the development of a hiatal hernia. This may
cause the upper part of the stomach to not return to its natural position below the
diaphragm during swallowing.
Option C: Other predisposing factors have been identified, such as elevated intra
abdominal pressure. This typically is a result of obesity, pregnancy, chronic constipation,
and chronic obstructive pulmonary disease (COPD). Trauma, age, previous surgeries,
and genetics can also play a role in the development of a hiatal hernia.
2. Question
Risk factors for the development of Hiatal hernias are those that lead to increased
abdominal pressure. Which of the following complications can cause increased
abdominal pressure?
A. Obesity
B. Volvulus
C. Constipation
D. Intestinal obstruction
Correct Answer: A. Obesity
Obesity may cause increased abdominal pressure that pushes the lower portion of the
stomach into the thorax. In a hiatal hernia, the stomach pushes through that opening
and into the chest and compromises the lower esophageal sphincter (LES). This laxity
of the LES can allow gastric content and acid to back up into the esophagus and is the
leading cause of gastroesophageal reflux disease (GERD).
Option B: Volvulus occurs when a loop of intestine twists around itself and the
mesentery that supports it, causing bowel obstruction. Symptoms include abdominal
distension, pain, vomiting, constipation, and bloody stools. The onset of symptoms may
be insidious or sudden. The mesentery becomes so tightly twisted that blood supply
becomes cut off, resulting in an ischemic bowel.
Option C: The cause of constipation is multifactorial. The problem may arise in the colon
or rectum or it may be due to an external cause. In most people, slow colonic motility
that occurs after years of laxative abuse is the problem. In a few patients, the cause
may be related to an outlet obstruction like rectal prolapse or a rectocele.
Option D: A bowel obstruction can either be a mechanical or functional obstruction of
the small or large intestines. The obstruction occurs when the lumen of the bowel
becomes either partially or completely blocked. Obstruction frequently causes
, abdominal pain, nausea, vomiting, constipation-to-obstipation, and distention. This, in
turn, prevents the normal movement of digested products.
3. Question
Which of the following symptoms is common with a hiatal hernia?
A. Left arm pain
B. Lower back pain
C. Esophageal reflux
D. Abdominal cramping
Correct Answer: C. Esophageal reflux
Esophageal reflux is a common symptom of a hiatal hernia. This seems to be
associated with chronic exposure of the lower esophageal sphincter to the lower
pressure of the thorax, making it less effective. In a hiatal hernia, the stomach pushes
through that opening and into the chest and compromises the lower esophageal
sphincter (LES). This laxity of the LES can allow gastric content and acid to back up into
the esophagus and is the leading cause of gastroesophageal reflux disease (GERD).
Option A: There is no left arm pain in hiatal hernia. The typical presentation leading to
an evaluation for a hiatal hernia is gastroesophageal reflux disease (GERD). Patients
typically complain of heartburn and sometimes regurgitation. While heartburn is the
most common complaint, some patients will present with extra-esophageal symptoms
such as a chronic cough or asthma.
Option B: Lower back pain is not associated with hiatal hernia. The presentation of
regurgitation or extra-esophageal symptoms typically is a sign of disease progression.
However, not all patients with regurgitation have GERD, and it is important to note if the
regurgitated food is digested or undigested.
Option D: Abdominal cramping is not a symptom of hiatal hernia. Physical examination
in patients with a hiatal hernia and GERD rarely helps confirm the diagnosis. The
presence of abnormal supraclavicular lymph nodes in patients with heartburn and
dysphasia may suggest esophageal or gastric cancer and is an important part of the
evaluation.
4. Question
Which of the following tests can be performed to diagnose a hiatal hernia?
A. Colonoscopy
B. Lower GI series
DISORDERS Practice Exam #6 -
QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
2023/2024
GRADED A+ NEW
1. Question
Which of the following conditions can cause a hiatal hernia?
A. Increased intrathoracic pressure.
B. Weakness of the esophageal muscle.
C. Increased esophageal muscle pressure.
D. Weakness of the diaphragmatic muscle.
Correct Answer: D. Weakness of the diaphragmatic muscle.
A hiatal hernia is caused by weakness of the diaphragmatic muscle and increased
intra-abdominal—not intrathoracic—pressure. This weakness allows the stomach to
slide into the esophagus. The esophageal supports weaken, but esophageal muscle
weakness or increased esophageal muscle pressure isn’t a factor in hiatal hernia. A
hiatal hernia is a medical condition in which the upper part of the stomach or other
internal organ bulges through an opening in the diaphragm.
Option A: The diaphragm is a muscular structure that assists in respiration and has a
small opening, a hiatus, through which the esophagus passes prior to connecting to the
stomach. This is called the gastroesophageal junction (GEJ). In a hiatal hernia, the
stomach pushes through that opening and into the chest and compromises the lower
esophageal sphincter (LES).
,Option B: Hiatal hernias may be congenital or acquired. There is an increased
prevalence in older people. It is believed that muscle weakness with loss of flexibility
and elasticity with age predisposes to the development of a hiatal hernia. This may
cause the upper part of the stomach to not return to its natural position below the
diaphragm during swallowing.
Option C: Other predisposing factors have been identified, such as elevated intra
abdominal pressure. This typically is a result of obesity, pregnancy, chronic constipation,
and chronic obstructive pulmonary disease (COPD). Trauma, age, previous surgeries,
and genetics can also play a role in the development of a hiatal hernia.
2. Question
Risk factors for the development of Hiatal hernias are those that lead to increased
abdominal pressure. Which of the following complications can cause increased
abdominal pressure?
A. Obesity
B. Volvulus
C. Constipation
D. Intestinal obstruction
Correct Answer: A. Obesity
Obesity may cause increased abdominal pressure that pushes the lower portion of the
stomach into the thorax. In a hiatal hernia, the stomach pushes through that opening
and into the chest and compromises the lower esophageal sphincter (LES). This laxity
of the LES can allow gastric content and acid to back up into the esophagus and is the
leading cause of gastroesophageal reflux disease (GERD).
Option B: Volvulus occurs when a loop of intestine twists around itself and the
mesentery that supports it, causing bowel obstruction. Symptoms include abdominal
distension, pain, vomiting, constipation, and bloody stools. The onset of symptoms may
be insidious or sudden. The mesentery becomes so tightly twisted that blood supply
becomes cut off, resulting in an ischemic bowel.
Option C: The cause of constipation is multifactorial. The problem may arise in the colon
or rectum or it may be due to an external cause. In most people, slow colonic motility
that occurs after years of laxative abuse is the problem. In a few patients, the cause
may be related to an outlet obstruction like rectal prolapse or a rectocele.
Option D: A bowel obstruction can either be a mechanical or functional obstruction of
the small or large intestines. The obstruction occurs when the lumen of the bowel
becomes either partially or completely blocked. Obstruction frequently causes
, abdominal pain, nausea, vomiting, constipation-to-obstipation, and distention. This, in
turn, prevents the normal movement of digested products.
3. Question
Which of the following symptoms is common with a hiatal hernia?
A. Left arm pain
B. Lower back pain
C. Esophageal reflux
D. Abdominal cramping
Correct Answer: C. Esophageal reflux
Esophageal reflux is a common symptom of a hiatal hernia. This seems to be
associated with chronic exposure of the lower esophageal sphincter to the lower
pressure of the thorax, making it less effective. In a hiatal hernia, the stomach pushes
through that opening and into the chest and compromises the lower esophageal
sphincter (LES). This laxity of the LES can allow gastric content and acid to back up into
the esophagus and is the leading cause of gastroesophageal reflux disease (GERD).
Option A: There is no left arm pain in hiatal hernia. The typical presentation leading to
an evaluation for a hiatal hernia is gastroesophageal reflux disease (GERD). Patients
typically complain of heartburn and sometimes regurgitation. While heartburn is the
most common complaint, some patients will present with extra-esophageal symptoms
such as a chronic cough or asthma.
Option B: Lower back pain is not associated with hiatal hernia. The presentation of
regurgitation or extra-esophageal symptoms typically is a sign of disease progression.
However, not all patients with regurgitation have GERD, and it is important to note if the
regurgitated food is digested or undigested.
Option D: Abdominal cramping is not a symptom of hiatal hernia. Physical examination
in patients with a hiatal hernia and GERD rarely helps confirm the diagnosis. The
presence of abnormal supraclavicular lymph nodes in patients with heartburn and
dysphasia may suggest esophageal or gastric cancer and is an important part of the
evaluation.
4. Question
Which of the following tests can be performed to diagnose a hiatal hernia?
A. Colonoscopy
B. Lower GI series
