Esophageal and Gastric Disorders Practice Questions

25 multiple-choice questions on Esophageal and gastric disorders for paramedic and EMT students, from Chapter 21 (Abdominal and Gastrointestinal Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. After taking a doxycycline capsule with a sip of water at bedtime, a patient has severe pain with swallowing. The most likely cause is:

   1. A. Gastric outlet obstruction
   2. B. Esophageal varices
   3. C. Acute appendicitis
   4. D. Pill esophagitis
   Show answer

   Answer: D. Pill esophagitis

   Pills such as doxycycline, NSAIDs, potassium, and bisphosphonates can lodge in the esophagus, especially when taken with little water before lying down, and cause a painful chemical ulcer. Prevention is a full glass of water and staying upright.

2. A 58-year-old with known GERD has burning chest pain, diaphoresis, and nausea. Your best next step is:

   1. A. Give an antacid and reassess later
   2. B. Advise him to sit up and eat less
   3. C. Treat as possible ACS, 12-lead ECG
   4. D. Release him to see his own doctor
   Show answer

   Answer: C. Treat as possible ACS, 12-lead ECG

   Cardiac ischemia can feel exactly like heartburn, especially with diabetes or in women. A history of GERD never rules out ACS.

3. Chronic GERD can change the lining of the lower esophagus, raising cancer risk. This is called:

   1. A. Barrett esophagus
   2. B. Boerhaave syndrome
   3. C. Achalasia
   4. D. Mallory-Weiss syndrome
   Show answer

   Answer: A. Barrett esophagus

   In Barrett esophagus, acid exposure causes the normal lining to change into intestinal-type cells, which can progress to adenocarcinoma.

4. Painful swallowing is called:

   1. A. Dysphagia
   2. B. Odynophagia
   3. C. Dysphasia
   4. D. Dyspepsia
   Show answer

   Answer: B. Odynophagia

   Odynophagia means pain with swallowing; dysphagia means difficulty swallowing. Dysphasia is a speech problem, and dyspepsia is indigestion.

5. A patient who feels food stuck in the lower chest and cannot swallow saliva most likely has:

   1. A. Gastroesophageal reflux
   2. B. Acute gastritis
   3. C. Food impaction
   4. D. Biliary colic
   Show answer

   Answer: C. Food impaction

   Inability to handle secretions means complete obstruction. Position upright, suction as needed, and transport for endoscopy.

6. A patient choked on steak 30 minutes ago. He is speaking, breathing normally, but drooling and spitting. You should:

   1. A. Keep him upright, suction, transport
   2. B. Perform abdominal thrusts right away
   3. C. Give water to wash the food down
   4. D. Have him lie flat to relax the throat
   Show answer

   Answer: A. Keep him upright, suction, transport

   He is moving air, so abdominal thrusts are not indicated. This is an esophageal impaction; protect the airway and transport for removal.

7. A hiatal hernia occurs when:

   1. A. Bowel pushes through the groin canal
   2. B. The umbilicus protrudes outward
   3. C. The esophagus tears from vomiting
   4. D. Part of the stomach enters the chest
   Show answer

   Answer: D. Part of the stomach enters the chest

   Part of the stomach passes up through the diaphragm's esophageal opening. It is associated with reflux and can occasionally twist or strangulate.

8. Which factors most worsen GERD symptoms?

   1. A. Obesity, smoking, alcohol, large meals
   2. B. High-fiber diet and walking
   3. C. Small meals spaced evenly through the day
   4. D. Sleeping with the head raised
   Show answer

   Answer: A. Obesity, smoking, alcohol, large meals

   These factors increase abdominal pressure or relax the LES. Raising the head of the bed reduces nighttime reflux.

9. Severe chest pain after forceful vomiting, with crackling under the skin of the neck, suggests:

   1. A. Mallory-Weiss tear
   2. B. Acute gastritis
   3. C. Hiatal hernia
   4. D. Boerhaave syndrome
   Show answer

   Answer: D. Boerhaave syndrome

   Esophageal rupture lets air and contents escape into the mediastinum, causing subcutaneous emphysema. It has high mortality and needs emergency surgery.

10. Projectile, non-bilious vomiting after every feed in a 4-week-old suggests:

    1. A. Intussusception
    2. B. Pyloric stenosis
    3. C. Acute appendicitis
    4. D. Gastroenteritis
    Show answer

    Answer: B. Pyloric stenosis

    Thickened pyloric muscle blocks stomach outflow in infants aged 2 to 8 weeks. The infant is hungry after vomiting and can become dehydrated quickly.

11. Green (bilious) vomiting in a newborn is concerning because it suggests:

    1. A. Simple overfeeding by parents
    2. B. Pyloric muscle thickening
    3. C. Blockage below the bile duct
    4. D. Mild physiologic reflux
    Show answer

    Answer: C. Blockage below the bile duct

    Bile enters the bowel in the duodenum, so bilious vomiting means the block is distal to that point. Malrotation with volvulus is a surgical emergency.

12. Gastroparesis, common in long-standing diabetes, is:

    1. A. Rupture of the stomach wall
    2. B. Excess production of acid
    3. C. Infection of the stomach lining
    4. D. Delayed emptying of the stomach
    Show answer

    Answer: D. Delayed emptying of the stomach

    Diabetic nerve damage slows stomach emptying, causing nausea, bloating, and vomiting of food eaten hours earlier. It also affects blood glucose control.

13. Achalasia is:

    1. A. A tear in the esophagus
    2. B. An infection of the stomach
    3. C. Failure of the LES to relax
    4. D. A twist in the small bowel
    Show answer

    Answer: C. Failure of the LES to relax

    The LES stays tight and the esophagus loses peristalsis, so food backs up. It causes progressive dysphagia to both solids and liquids.

14. Esophageal cancer usually presents with:

    1. A. Worsening dysphagia, weight loss
    2. B. Sudden chest pain after retching
    3. C. Heartburn that eases with antacids
    4. D. Painful swallowing after a pill
    Show answer

    Answer: A. Worsening dysphagia, weight loss

    Difficulty swallowing first solids, then liquids, along with weight loss, is the classic picture. These red-flag symptoms need evaluation. Sudden pain after retching suggests a tear, painful swallowing after a pill suggests pill esophagitis, and heartburn relieved by antacids fits reflux.

15. Acute gastritis is most commonly caused by:

    1. A. Gallstones blocking the duct
    2. B. Alcohol, NSAIDs, infection
    3. C. Appendix obstruction
    4. D. Portal hypertension alone
    Show answer

    Answer: B. Alcohol, NSAIDs, infection

    These irritate the stomach lining and cause epigastric pain, nausea, and sometimes coffee-ground emesis.

16. An older patient with dysphagia after a stroke is at high risk of:

    1. A. Esophageal varices
    2. B. Barrett esophagus
    3. C. Gastric outlet obstruction
    4. D. Aspiration pneumonia
    Show answer

    Answer: D. Aspiration pneumonia

    Impaired swallowing lets food and fluid enter the airway. Positioning upright and reporting the dysphagia to receiving staff help prevent aspiration. Varices come from portal hypertension, Barrett esophagus from long-term reflux, and gastric outlet obstruction from ulcer scarring or tumors; a stroke causes none of these.

17. Drain cleaner ingestion is especially dangerous to the esophagus because alkalis:

    1. A. Are neutralized quickly by stomach acid
    2. B. Burn only the outer skin
    3. C. Cause deep liquefaction necrosis
    4. D. Always cause early vomiting
    Show answer

    Answer: C. Cause deep liquefaction necrosis

    Alkalis penetrate deeply and can perforate the esophagus. Do not induce vomiting; protect the airway, which may swell.

18. After a caustic ingestion, the patient develops hoarseness and stridor. This indicates:

    1. A. Mild throat irritation from the fumes
    2. B. Airway swelling needing urgent control
    3. C. Expected nausea before vomiting
    4. D. The burn is limited to the mouth
    Show answer

    Answer: B. Airway swelling needing urgent control

    Stridor and voice change signal upper airway edema that can quickly progress to obstruction. Prepare for difficult airway management.

19. Antacids relieve heartburn by:

    1. A. Neutralizing stomach acid
    2. B. Blocking acid made by parietal cells
    3. C. Killing H. pylori bacteria
    4. D. Speeding gastric emptying
    Show answer

    Answer: A. Neutralizing stomach acid

    Antacids chemically neutralize existing acid. H2 blockers and proton pump inhibitors reduce acid production.

20. A 24-year-old with asthma and food allergies has had several episodes of food sticking, and now a piece of chicken is lodged. A likely underlying cause is:

    1. A. Esophageal varices
    2. B. Achalasia from aging
    3. C. Eosinophilic esophagitis
    4. D. Hiatal hernia strangulation
    Show answer

    Answer: C. Eosinophilic esophagitis

    Eosinophilic esophagitis is an allergic inflammation of the esophagus that is common in young men with atopy and is a leading cause of food impaction. Achalasia is uncommon in this age group, and varices do not cause food sticking.

21. Which symptom with dyspepsia is a red flag needing evaluation?

    1. A. Occasional burping
    2. B. Unintended weight loss
    3. C. Mild bloating after meals
    4. D. Heartburn after spicy food
    Show answer

    Answer: B. Unintended weight loss

    Weight loss, dysphagia, vomiting blood, or anemia suggest ulcer, cancer, or other serious disease.

22. An older patient with trouble swallowing regurgitates undigested food eaten days ago and has very bad breath. This suggests:

    1. A. A Zenker diverticulum
    2. B. A peptic ulcer
    3. C. Gastritis from NSAIDs
    4. D. Acute cholecystitis
    Show answer

    Answer: A. A Zenker diverticulum

    A Zenker diverticulum is a pouch in the upper esophagus that traps food, causing dysphagia, regurgitation of old food, bad breath, and aspiration risk. Ulcers and gastritis cause pain and bleeding, not retained food.

23. Which description best fits pain from esophageal spasm?

    1. A. Burning after meals
    2. B. Sharp pain worse on deep breaths
    3. C. Tearing pain into the back
    4. D. Angina-like squeezing pain
    Show answer

    Answer: D. Angina-like squeezing pain

    Esophageal spasm can mimic cardiac pain and may even respond to nitroglycerin. Rule out ACS first. Burning after meals suggests reflux, sharp pain on breathing suggests a pleural or pericardial cause, and tearing pain into the back suggests aortic dissection.

24. A patient with a large hiatal hernia has sudden severe chest pain and retches but cannot bring anything up. You should suspect:

    1. A. Simple heartburn
    2. B. Biliary colic
    3. C. Peptic ulcer pain
    4. D. Gastric volvulus
    Show answer

    Answer: D. Gastric volvulus

    A large hiatal hernia can twist (gastric volvulus), causing severe pain, unproductive retching, and inability to pass a tube (the Borchardt triad). It can strangulate the stomach and is a surgical emergency, unlike heartburn or uncomplicated ulcer pain.

25. Shortly after a sugary meal, a patient who had gastric bypass surgery develops sweating, palpitations, cramps, and diarrhea. This is most likely:

    1. A. An allergic reaction
    2. B. A leaking ulcer
    3. C. Dumping syndrome
    4. D. Acute cholecystitis
    Show answer

    Answer: C. Dumping syndrome

    After bypass, food enters the small bowel rapidly, drawing fluid into the gut and causing cramps, diarrhea, sweating, and tachycardia within about 30 minutes (early dumping); late dumping causes hypoglycemia hours later. Check a glucose and treat as needed.