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ABPS GI Endoscopy study materials
ABPS GI Endoscopy study resources

ABPS GI Endoscopy practice questions

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Question 1Pre-procedural Assessment, Informed Consent, and Bowel Preparation

Which beverage is permitted on a clear-liquid diet before colonoscopy?

  1. Black coffee without milk Correct answer.
  2. Milk
  3. Creamy tomato soup
  4. Orange juice with pulp

Explanation

Clear liquids are those that can be seen through and leave little or no solid residue in the colon. Black coffee without milk or cream meets this definition. Milk, fruit pulp, and creamy soups contain fat, protein, or solid matter that can impair visualization.

Question 2Pre-procedural Assessment, Informed Consent, and Bowel Preparation

According to standard sedation fasting guidance, how long before endoscopy should a patient stop drinking clear liquids?

  1. 2 hours Correct answer.
  2. 8 hours
  3. 4 hours
  4. 6 hours

Explanation

Clear liquids empty rapidly from the stomach, so a 2-hour fast is sufficient to reduce aspiration risk while maintaining hydration. Longer fasting is required for solids, milk, and fatty liquids. Excessive clear-liquid fasting offers no additional safety benefit.

Question 3Pre-procedural Assessment, Informed Consent, and Bowel Preparation

For a morning colonoscopy, when should the second dose of a split-dose bowel preparation be completed?

  1. About 24 hours before the procedure
  2. Immediately before entering the procedure room
  3. About 4 to 6 hours before the procedure Correct answer.
  4. About 12 hours before the procedure

Explanation

The second dose is timed close to the procedure, generally 4 to 6 hours before, to clear residual stool while avoiding a long interval for secretions to reaccumulate. Completing it too early reduces cleansing effectiveness, and completing it too late risks sedation while the patient is still actively purging.

Question 4Pre-procedural Assessment, Informed Consent, and Bowel Preparation

Which medication is generally continued before an elective screening colonoscopy?

  1. Warfarin
  2. Apixaban
  3. Aspirin Correct answer.
  4. Clopidogrel

Explanation

Aspirin alone usually does not need to be stopped for diagnostic or low-risk endoscopic procedures, including most screening colonoscopies. Anticoagulants and P2Y12 inhibitors require individualized interruption based on bleeding and thrombotic risk.

Question 5Pre-procedural Assessment, Informed Consent, and Bowel Preparation

Which item is an essential element of informed consent for colonoscopy?

  1. The cost of the endoscope
  2. The endoscopist's malpractice coverage
  3. Discussion of reasonable alternative treatments Correct answer.
  4. The facility's scheduling policy

Explanation

Valid informed consent includes the nature of the procedure, its risks and benefits, and reasonable alternatives, including the option of no procedure. Logistics and billing information are not core consent elements.

Question 6Pre-procedural Assessment, Informed Consent, and Bowel Preparation

What should the stool look like when bowel preparation is adequate for colonoscopy?

  1. Mucus-streaked stool
  2. Clear or pale yellow liquid Correct answer.
  3. Formed brown stool
  4. Dark brown liquid

Explanation

Adequate cleansing produces clear or pale yellow effluent without solid residue. Brown liquid or formed stool indicates residual fecal material and predicts poor visualization.

Question 7Pre-procedural Assessment, Informed Consent, and Bowel Preparation

Which patient should avoid sodium phosphate bowel preparation?

  1. A 50-year-old with well-controlled hypertension
  2. A 35-year-old with no chronic illness
  3. A 62-year-old with stage 4 chronic kidney disease Correct answer.
  4. A 45-year-old with a history of hemorrhoids

Explanation

Sodium phosphate can cause acute phosphate nephropathy and electrolyte disturbances, so it is avoided in chronic kidney disease, heart failure, and volume depletion. PEG-based preparations are preferred for these patients.

Question 8Pre-procedural Assessment, Informed Consent, and Bowel Preparation

For an elective colonoscopy with planned polypectomy, clopidogrel is typically withheld for approximately how long before the procedure?

  1. 14 days
  2. 3 days
  3. 1 day
  4. 5 to 7 days Correct answer.

Explanation

Clopidogrel irreversibly inhibits platelet P2Y12 receptors, and stopping it 5 to 7 days beforehand allows adequate platelet function to return. The decision also depends on cardiovascular risk and should be coordinated with the prescribing clinician.

Question 9Pre-procedural Assessment, Informed Consent, and Bowel Preparation

Which condition is a contraindication to oral PEG-electrolyte bowel preparation?

  1. Prior uncomplicated colonoscopy
  2. Age over 70 years
  3. Suspected bowel obstruction Correct answer.
  4. Controlled type 2 diabetes

Explanation

Oral lavage is contraindicated when obstruction, perforation, or severe ileus is suspected because of the risk of aspiration, perforation, and electrolyte shifts. Diabetes and older age require monitoring but are not contraindications.

Question 10Pre-procedural Assessment, Informed Consent, and Bowel Preparation

The Mallampati classification is used during pre-procedural assessment to estimate which risk?

  1. Severity of bowel preparation
  2. Difficulty with airway management Correct answer.
  3. Risk of colonic perforation
  4. Risk of post-polypectomy bleeding

Explanation

Mallampati grading describes oropharyngeal visibility and predicts difficult mask ventilation or intubation, which is relevant when sedation is planned. It does not predict endoscopic, bleeding, or preparation outcomes.

Question 11Pre-procedural Assessment, Informed Consent, and Bowel Preparation

Who should sign the informed consent for an elective colonoscopy in a competent adult?

  1. The referring physician
  2. The patient's spouse
  3. The endoscopy nurse
  4. The patient Correct answer.

Explanation

A competent adult has the right to consent to or refuse treatment, and family members or staff cannot substitute for the patient's own decision. Surrogate consent applies only when the patient lacks decision-making capacity.

Question 12Pre-procedural Assessment, Informed Consent, and Bowel Preparation

What should the procedure note document about informed consent?

  1. Only the patient's signature
  2. Only the endoscopist's name
  3. The risks, benefits, alternatives, and patient questions discussed Correct answer.
  4. Only the procedure's billing code

Explanation

Documentation should reflect the substantive discussion, including risks, benefits, alternatives, and the patient's questions and agreement. A signature alone does not prove that a valid consent discussion occurred.

Question 13Pre-procedural Assessment, Informed Consent, and Bowel Preparation

What is the main advantage of split-dose bowel preparation over a single dose given the evening before colonoscopy?

  1. It requires a smaller total volume
  2. It eliminates the need for a clear-liquid diet
  3. It removes the need for sedation
  4. It improves cleansing, especially in the right colon Correct answer.

Explanation

Splitting the dose shortens the interval between the final laxative and the procedure, improving cleansing, particularly in the right colon, and is often better tolerated. It does not reduce the total volume or replace diet instructions.

Question 14Pre-procedural Assessment, Informed Consent, and Bowel Preparation

A patient with type 2 diabetes takes glipizide daily. What is the appropriate instruction for the day of a clear-liquid bowel preparation before afternoon colonoscopy?

  1. Hold the sulfonylurea and monitor glucose Correct answer.
  2. Take the usual glipizide dose
  3. Double the glipizide dose
  4. Stop all diabetes medications for one week

Explanation

Sulfonylureas can cause hypoglycemia when oral intake is reduced, so they are usually held on the preparation day with glucose monitoring. Insulin regimens also require adjustment and coordination with the prescribing clinician.

Question 15Pre-procedural Assessment, Informed Consent, and Bowel Preparation

A patient on warfarin for atrial fibrillation is scheduled for elective colonoscopy with polypectomy. What is the most appropriate pre-procedural step?

  1. Continue warfarin without checking the INR
  2. Administer vitamin K routinely before the procedure
  3. Stop warfarin only on the morning of the procedure
  4. Check the INR and coordinate interruption with the prescriber Correct answer.

Explanation

Warfarin interruption depends on the INR, procedure bleeding risk, and thrombotic risk, and the prescriber should be involved; bridging may be considered in selected high-risk patients. Routine vitamin K or same-day stopping is inappropriate.

Question 16Pre-procedural Assessment, Informed Consent, and Bowel Preparation

A patient who speaks limited English is scheduled for colonoscopy. How should informed consent be obtained?

  1. Proceed with signed consent in English only
  2. Use the patient's adult child as an interpreter
  3. Rely on gestures and written diagrams
  4. Use a qualified medical interpreter Correct answer.

Explanation

Consent must be understandable to the patient, and a qualified medical interpreter, in person or by phone or video, supports valid communication. Relying on family members or untrained staff can lead to inaccurate interpretation and invalid consent.

Question 17Pre-procedural Assessment, Informed Consent, and Bowel Preparation

A patient with a massive lower GI bleed is obtunded and requires urgent colonoscopy. No surrogate decision-maker is available. What is the best approach to consent?

  1. Obtain consent from the nearest available relative by phone
  2. Proceed under the emergency exception and document the rationale Correct answer.
  3. Wait indefinitely for a court-appointed guardian
  4. Perform the procedure without any documentation

Explanation

When immediate treatment is necessary to prevent serious harm and the patient cannot consent, the emergency exception permits treatment without formal consent. The clinician should document the emergency, the lack of a surrogate, and the treatment rationale.

Question 18Pre-procedural Assessment, Informed Consent, and Bowel Preparation

A patient has a poor bowel preparation with solid stool throughout the colon, and no high-risk lesion is seen on the limited examination. What is the most appropriate next step?

  1. Repeat the same preparation the next day
  2. Irrigate and complete the examination regardless of cleansing
  3. Reschedule with an intensified preparation Correct answer.
  4. Proceed with routine surveillance in 10 years

Explanation

Inadequate cleansing reduces adenoma detection and can miss clinically important lesions, so the examination should generally be repeated with a more intensive preparation, often split-dose PEG with adjuncts. The same preparation is likely to fail again, and surveillance intervals cannot be set reliably after an inadequate examination.

Question 19Pre-procedural Assessment, Informed Consent, and Bowel Preparation

A patient takes a weekly GLP-1 receptor agonist for diabetes and is scheduled for colonoscopy with sedation. What is the most appropriate pre-procedural consideration?

  1. Assess aspiration risk and consider holding the medication per current guidance Correct answer.
  2. Give additional sedation to overcome gastric retention
  3. No adjustment is needed because the medication is weekly
  4. Stop the medication permanently

Explanation

GLP-1 receptor agonists can delay gastric emptying and increase retained gastric contents, so aspiration risk should be assessed and holding the medication considered according to current guidance. The decision is evolving and should be individualized with the prescriber.

Question 20Pre-procedural Assessment, Informed Consent, and Bowel Preparation

For elective colonoscopy with high bleeding risk, apixaban is typically interrupted for at least how long in a patient with normal renal function?

  1. 36 hours
  2. 12 hours
  3. 48 hours Correct answer.
  4. 24 hours

Explanation

For high-bleeding-risk procedures, DOACs are usually stopped about 48 hours beforehand in patients with normal renal function; low-risk procedures may require shorter intervals. Renal function and procedure risk determine the exact timing.

Question 21Moderate Sedation and Patient Monitoring

Which statement best defines moderate sedation during GI endoscopy?

  1. Absence of any response to painful stimuli
  2. Requirement for jaw thrust to maintain airway
  3. Purposeful response to verbal command Correct answer.
  4. Complete alertness without sedative effect

Explanation

Moderate sedation is a drug-induced depression of consciousness in which patients respond purposefully to verbal commands, either alone or with light tactile stimulation. Airway patency and spontaneous ventilation are maintained, and cardiovascular function is usually stable. Loss of response to painful stimuli or need for airway support indicates deeper sedation.

Question 22Moderate Sedation and Patient Monitoring

Which ASA physical status class describes a patient with severe systemic disease that limits activity but is not incapacitating?

  1. ASA III Correct answer.
  2. ASA II
  3. ASA I
  4. ASA IV

Explanation

ASA III denotes severe systemic disease with definite functional limitation, such as poorly controlled diabetes or stable angina. ASA II is mild systemic disease without major functional limitation, and ASA IV is severe disease that is a constant threat to life.

Question 23Moderate Sedation and Patient Monitoring

Which medication is used to reverse the sedative effects of midazolam?

  1. Atropine
  2. Sugammadex
  3. Naloxone
  4. Flumazenil Correct answer.

Explanation

Flumazenil is a competitive benzodiazepine receptor antagonist that reverses benzodiazepines such as midazolam. Naloxone reverses opioids, atropine treats bradycardia, and sugammadex reverses aminosteroid neuromuscular blockers.

Question 24Moderate Sedation and Patient Monitoring

Which medication reverses opioid-induced respiratory depression during procedural sedation?

  1. Naloxone Correct answer.
  2. Glycopyrrolate
  3. Ketamine
  4. Flumazenil

Explanation

Naloxone is a competitive opioid receptor antagonist that rapidly reverses opioid-induced respiratory depression and sedation. It should be titrated to restore adequate ventilation while avoiding abrupt withdrawal and pain. Flumazenil reverses benzodiazepines, not opioids.

Question 25Moderate Sedation and Patient Monitoring

According to ASA fasting guidance, how long before procedural sedation should adults abstain from clear liquids?

  1. 6 hours
  2. 8 hours
  3. 2 hours Correct answer.
  4. 4 hours

Explanation

ASA guidance recommends a minimum 2-hour fast for clear liquids and 6 hours for light meals before procedural sedation in adults. Clear liquids include water, clear tea, and black coffee without pulp or milk. Longer fasting is not routinely required and may cause dehydration or hypoglycemia.

Question 26Moderate Sedation and Patient Monitoring

Which monitor most directly detects hypoventilation during moderate sedation?

  1. Capnography Correct answer.
  2. Pulse oximetry
  3. Noninvasive blood pressure
  4. Electrocardiography

Explanation

Capnography measures exhaled carbon dioxide and provides a breath-by-breath assessment of ventilation, allowing early detection of hypoventilation and apnea. Pulse oximetry reflects oxygenation and can remain normal despite significant hypoventilation, especially when supplemental oxygen is used. Blood pressure and ECG do not assess ventilation.

Question 27Moderate Sedation and Patient Monitoring

A patient receiving supplemental oxygen has an SpO2 of 99% but a respiratory rate of 6/min. Which statement best explains why pulse oximetry alone is insufficient monitoring?

  1. It is unaffected by changes in peripheral perfusion and temperature
  2. It can stay normal despite hypoventilation on oxygen Correct answer.
  3. It detects carbon dioxide retention early
  4. It directly measures alveolar ventilation

Explanation

Supplemental oxygen raises the alveolar oxygen partial pressure and can maintain hemoglobin saturation even when alveolar ventilation is markedly reduced. Pulse oximetry therefore may not fall until late in respiratory depression. Capnography or direct observation of ventilation is needed to detect hypoventilation early.

Question 28Moderate Sedation and Patient Monitoring

During sedation with supplemental oxygen, capnography shows a progressive rise in end-tidal CO2 and a respiratory rate of 5/min, while SpO2 remains 98%. What is the most appropriate interpretation?

  1. Hypoventilation masked by oxygen supplementation Correct answer.
  2. The capnography is artifactually elevated
  3. The patient has hyperventilation
  4. The patient is adequately ventilated because saturation is normal

Explanation

A rising end-tidal CO2 with a low respiratory rate indicates hypoventilation. Supplemental oxygen can keep SpO2 normal despite inadequate ventilation, so oximetry alone is misleading. The correct response is to stimulate the patient, support the airway, and reduce or reverse sedatives as needed.

Question 29Moderate Sedation and Patient Monitoring

Which vital sign should be recorded before sedation, at intervals during the procedure, and during recovery?

  1. Blood pressure Correct answer.
  2. Liver enzymes
  3. Platelet count
  4. Serum creatinine

Explanation

Blood pressure is a core vital sign monitored before, during, and after procedural sedation because sedatives and opioids can cause hypotension. Laboratory values such as creatinine, platelets, and liver enzymes are not continuous monitoring parameters. Heart rate, respiratory rate, and oxygen saturation are also monitored.

Question 30Moderate Sedation and Patient Monitoring

Which patient most warrants continuous electrocardiographic monitoring during moderate sedation for endoscopy?

  1. A 70-year-old with syncope and CAD Correct answer.
  2. A 30-year-old with no medical history
  3. A 45-year-old with well-controlled seasonal allergies and mild asthma
  4. A 25-year-old taking oral contraceptives

Explanation

Continuous ECG monitoring is particularly important in patients with known cardiovascular disease, arrhythmia, or syncope, because sedation and hypoxemia can precipitate arrhythmias. Healthy younger patients without cardiac risk factors generally require intermittent vital-sign monitoring rather than continuous ECG. The decision should follow institutional policy and patient risk.

Question 31Moderate Sedation and Patient Monitoring

Which statement about propofol for endoscopic sedation is correct?

  1. It can cause deep sedation with no reversal Correct answer.
  2. It has a specific reversal agent
  3. It is absolutely contraindicated in every patient with hypertension
  4. It rarely causes respiratory depression

Explanation

Propofol is a rapidly acting sedative-hypnotic that can easily produce deep sedation or general anesthesia, with respiratory depression and hypotension. No specific reversal agent exists, so airway support and cardiovascular support are the mainstays of management. It is not absolutely contraindicated in hypertension.

Question 32Moderate Sedation and Patient Monitoring

Which property is characteristic of ketamine sedation?

  1. No analgesic effect
  2. Reliable reversal with flumazenil
  3. Profound respiratory depression at sedative doses
  4. Preservation of airway reflexes and bronchodilation Correct answer.

Explanation

Ketamine is a dissociative anesthetic that provides analgesia and amnesia while generally preserving airway reflexes and respiratory drive. It also has bronchodilator effects, which can be useful in reactive airway disease. It may cause hypertension, tachycardia, and emergence reactions, and it is not reversed by flumazenil.

Question 33Moderate Sedation and Patient Monitoring

Which adverse effect is most characteristic of dexmedetomidine used for procedural sedation?

  1. Severe respiratory depression
  2. Renal tubular acidosis
  3. Profound amnesia
  4. Bradycardia and hypotension Correct answer.

Explanation

Dexmedetomidine is an alpha-2 agonist that provides sedation with relatively little respiratory depression, but it commonly causes bradycardia and hypotension. It does not reliably provide amnesia, so it is often combined with other agents. Renal tubular acidosis is unrelated.

Question 34Moderate Sedation and Patient Monitoring

An obese patient requires midazolam and fentanyl for endoscopy. Which dosing approach is safest?

  1. Give the full dose rapidly to shorten the procedure
  2. Titrate small doses to effect while monitoring ventilation Correct answer.
  3. Calculate all doses on total body weight without titration
  4. Use only the patient's age to determine the dose

Explanation

In obesity, sedative distribution and clearance are altered, and dosing on total body weight can cause oversedation. The safest approach is to start with lower doses and titrate carefully to clinical effect while monitoring ventilation and oxygenation. Rapid full dosing increases the risk of airway obstruction and respiratory depression.

Question 35Moderate Sedation and Patient Monitoring

Which finding is required before discharge after moderate sedation?

  1. The patient has received a routine antibiotic
  2. The patient's pain score is 10 out of 10
  3. The patient is still drowsy and cannot walk
  4. Alert, oriented, with stable vital signs Correct answer.

Explanation

Discharge criteria after moderate sedation typically require the patient to be alert and oriented, have stable vital signs, and be able to ambulate and drink fluids. A validated tool such as the Aldrete score may be used. Persistent drowsiness or uncontrolled pain and nausea preclude discharge.

Question 36Moderate Sedation and Patient Monitoring

Which instruction should be given to a patient after outpatient endoscopy with moderate sedation?

  1. No driving or machinery for 24 hours Correct answer.
  2. Drive home immediately if you feel fully alert
  3. Operate machinery after one hour
  4. Resume alcohol immediately

Explanation

Sedative effects can persist and impair reaction time even when the patient feels alert. Patients should avoid driving, operating machinery, and making important decisions for 24 hours after moderate sedation. They should arrange a responsible adult escort and avoid alcohol.

Question 37Moderate Sedation and Patient Monitoring

Why is the combination of a benzodiazepine and an opioid particularly risky during sedation?

  1. They prevent aspiration
  2. They have synergistic respiratory depressant effects Correct answer.
  3. They cancel each other's effects
  4. They cause hypertension in most patients

Explanation

Benzodiazepines and opioids both depress central respiratory drive, and their combined use produces greater respiratory depression than either alone. This synergy increases the risk of hypoventilation, apnea, and airway obstruction. Lower doses and careful titration are therefore required when they are used together.

Question 38Moderate Sedation and Patient Monitoring

An 82-year-old patient is scheduled for sedated endoscopy. Which adjustment is most appropriate?

  1. Reduce the initial sedative dose and titrate slowly Correct answer.
  2. Use higher initial doses because of increased tolerance
  3. Use only a fixed dose regardless of response
  4. Omit monitoring because age is not a risk factor

Explanation

Older adults have reduced clearance, increased sensitivity, and more comorbidities, so they require lower initial sedative doses and slower titration. Age is a risk factor for sedation-related hypotension, hypoxemia, and delirium. Monitoring should be at least as rigorous as in younger patients.

Question 39Moderate Sedation and Patient Monitoring

To reduce aspiration risk during sedated upper endoscopy, which position is preferred?

  1. Right lateral decubitus with the foot elevated
  2. Left lateral decubitus with the head elevated Correct answer.
  3. Prone with the head turned
  4. Supine with the head flat

Explanation

Left lateral decubitus positioning with the head elevated helps drain secretions and reduces the risk of aspiration during upper endoscopy. Supine positioning can promote pooling of oral secretions and regurgitation. Prone positioning is impractical and unsafe for sedated endoscopy.

Question 40Moderate Sedation and Patient Monitoring

Immediately before starting moderate sedation, which set of equipment is essential to have at the bedside?

  1. An ultrasound machine and a bronchoscope
  2. Suction, oxygen, bag-mask, defibrillator Correct answer.
  3. A mechanical ventilator and a chest tube insertion tray
  4. A syringe pump and a urinary catheter

Explanation

Before sedation begins, suction, supplemental oxygen, a bag-valve-mask, and a defibrillator must be immediately available for airway rescue and cardiovascular emergencies. Airway equipment and reversal agents should be checked routinely. Specialized devices such as a ventilator or chest tube tray are not required for routine moderate sedation.

Question 41Upper Gastrointestinal Endoscopy: Technique and Findings

Which patient position is standard for diagnostic upper gastrointestinal endoscopy?

  1. Right lateral decubitus
  2. Prone with head turned right
  3. Left lateral decubitus Correct answer.
  4. Supine with legs elevated

Explanation

The left lateral decubitus position allows oropharyngeal and gastric secretions to pool dependently and reduces aspiration risk. It also aligns the esophageal axis for easier passage of the endoscope.

Question 42Upper Gastrointestinal Endoscopy: Technique and Findings

An adult without delayed gastric emptying is scheduled for elective EGD. What is the minimum fasting interval for clear liquids?

  1. 2 hours Correct answer.
  2. 6 hours
  3. 30 minutes
  4. 8 hours

Explanation

Current sedation guidance recommends at least 2 hours of fasting after clear liquids before elective procedural sedation. Solids and non-clear liquids require longer fasting intervals.

Question 43Upper Gastrointestinal Endoscopy: Technique and Findings

At approximately what distance from the incisors is the upper esophageal sphincter encountered in an average adult?

  1. 10 cm
  2. 5 cm
  3. 25 cm
  4. 15 cm Correct answer.

Explanation

The upper esophageal sphincter lies roughly 15 cm from the incisors in an average adult. Recognizing this landmark helps avoid blind forceful passage.

Question 44Upper Gastrointestinal Endoscopy: Technique and Findings

The squamocolumnar junction, or Z-line, normally lies at which landmark?

  1. The aortic arch
  2. The upper esophageal sphincter
  3. The gastric cardia Correct answer.
  4. The proximal esophagus

Explanation

The Z-line marks the transition from squamous esophageal mucosa to columnar gastric mucosa at the gastroesophageal junction. It is normally located at or just above the gastric cardia.

Question 45Upper Gastrointestinal Endoscopy: Technique and Findings

Which monitoring modality is essential throughout sedated upper GI endoscopy?

  1. Intermittent blood glucose
  2. Continuous pulse oximetry Correct answer.
  3. Continuous capnography only
  4. Serial serum lactate

Explanation

Continuous pulse oximetry is a standard minimum monitor during procedural sedation and helps detect hypoxemia early. Capnography may be added but does not replace oximetry.

Question 46Upper Gastrointestinal Endoscopy: Technique and Findings

How should the endoscope pass the upper esophageal sphincter during insertion?

  1. Under direct vision as the patient swallows Correct answer.
  2. By rotating the scope 180 degrees
  3. With steady forward pressure until it gives way
  4. After inflating the esophagus with air

Explanation

The sphincter should be traversed under direct vision, often while the patient swallows, which relaxes the cricopharyngeus. Blind forceful pressure increases the risk of perforation, particularly in the hypopharynx.

Question 47Upper Gastrointestinal Endoscopy: Technique and Findings

How many biopsy specimens per level are recommended in the Seattle protocol for Barrett's esophagus?

  1. One
  2. Eight
  3. Four Correct answer.
  4. Two

Explanation

The Seattle protocol uses four-quadrant biopsies at intervals of 1 to 2 cm along the Barrett's segment. This systematic sampling improves detection of dysplasia compared with targeted biopsies alone.

Question 48Upper Gastrointestinal Endoscopy: Technique and Findings

A bleeding gastric ulcer contains a non-bleeding visible vessel. Which Forrest class is this?

  1. Forrest IIb
  2. Forrest Ib
  3. Forrest Ia
  4. Forrest IIa Correct answer.

Explanation

Forrest IIa denotes a non-bleeding visible vessel. Forrest Ia is spurting bleeding, Ib is oozing, and IIb is an adherent clot.

Question 49Upper Gastrointestinal Endoscopy: Technique and Findings

Reflux esophagitis with mucosal breaks involving at least 75% of the esophageal circumference is which Los Angeles grade?

  1. Grade D Correct answer.
  2. Grade B
  3. Grade A
  4. Grade C

Explanation

Los Angeles grade D is defined by mucosal breaks involving at least 75% of the circumference. Grade C involves more than 50% but less than 75%.

Question 50Upper Gastrointestinal Endoscopy: Technique and Findings

A patient taking a proton pump inhibitor for 2 weeks undergoes rapid urease testing. What is the main effect on the result?

  1. False-positive due to gastric metaplasia
  2. False-negative from suppressed bacterial load Correct answer.
  3. No effect because the test detects antibodies
  4. False-positive due to alkaline reflux

Explanation

Proton pump inhibitors suppress Helicobacter pylori and can reduce urease activity, producing a false-negative rapid urease test. Ideally the drug is withheld for about 2 weeks before testing when clinically feasible.