2013 module exam Flashcards by Susan w

A patient took Panadol (Acetaminophen) for his toothache. Which hepatocytes will initially be affected in the liver?

A. Perilobular hepatocytes
B. Perisinusoidal hepatocytes
C. Pericentral hepatocytes

A. Perilobular hepatocytes

Note: Anatomically, any toxin (e.g. acetaminophen) affects initially hepatocytes in zone 1, which are perilobular. However, these hepatocytes are able to regenerate rapidly due to the rich blood and oxygen supply, and that’s why acetaminophen toxicity is generally described as “centrilobular necrosis” referring to zone 3 hepatocytes (i.e. pericentral hepatocytes) that have poor blood supply and hence do not regenerate as efficiently. All hepatocytes are perisinusoidal so it can’t be the answer. The answer has been confirmed by Dr. Narayana. Choice “B” was also counted correct after arguing.

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What type of bilirubin is shown in this figure and what is its water solubility?

A. Unconjugated, insoluble in water
B. Conjugated, soluble in water

A. Unconjugated, insoluble in water

Note: Internal hydrogen bonds (dashed blue lines) characterize indirect bilirubin.

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Thissignallingcascade is initiated by a product of hememetabolism. What is the product and what is the enzyme?

A. Biliverdin and biliverdin reductase
B. Bilirubin and glucuronic-s-transferase
C. CO and Heme oxygenase

C. CO and Heme oxygenase

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What is the origin of the greater splanchnic nerves?

A. T5-T9
B. T10-T11
C. T12
D. L1-L2

A. T5-T9

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Which nerve will most likely be injured during tonsillectomy?

A. Hypoglossal nerve
B. Glossopharyngeal nerve
C. Mandibularnerve
D. Lacrimal nerve

B. Glossopharyngeal nerve

Note: Glossopharyngeal nerve is present in the tonsillar bed below the palatine tonsil.

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A patient complains of numbness in the groin region after undergoing appendectomy. Which nerve was most likely injured?

A. Femoral
B. Genitofemoral
C. Ilioinguinal
D. Obturator

C. Ilioinguinal

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What is the sensory innervation of the anterior 2/3 of the tongue?

A. Lingual nerve
B. Chordae tympani
C. Facial nerve
D. Glossopharyngeal

A. Lingual nerve

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What is the embryological origin of the muscles of the small intestine?

A. Splanchnic mesoderm
B. Somatic mesoderm
C. Intermediate mesoderm
D. Paraxial mesoderm

A. Splanchnic mesoderm

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What is the remnant of the left umbilical vein?

A. Ligamentum teres
B. Falciform ligament
C. Ligamentum venosum

A. Ligamentum teres

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What is the medial boundary of the subinguinal space?

A. Reflected inguinal ligament B. Iliopubic tract
C. Lacunar ligament
D. Coopers ligament

C. Lacunar ligament

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What is the site of convergence of tenia coli?

A. Cecum
B. Appendix
C. Rectum
D. Sigmoid colon

B. Appendix

*The answer has been confirmed by Dr. Rao

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At which point do the inferior epigastric vessels enter the rectus sheath?

A. Arcuate line
B. Third tendinous intersection of rectus abdominis muscle
C. Second tendinous intersection of rectus abdominis muscle
D. First tendinous intersection of rectus abdominis muscle

A. Arcuate line

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What stimulates gastric acid secretion?

A. Submucosal plexus
B. Vagal trunk

B. Vagal trunk

Note: The answer has been confirmed by Dr. Khalid Khan. Some students argued that we took
in physiology that the parasympathetic effect (vagus) is indirect, and thus they chose
“submucosal plexus”. However, Dr.Khan refused to count it correct because “stimulation” is different from “regulation”.

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Which nerves give preganglionic sympathetic fibers to the stomach?

A. Greater splanchnic nerves
B. Pelvic splanchic nerves
C. Sacral plexus
D. Celiac ganglion

A. Greater splanchnic nerves

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Which cell is characterized by an intracellular canalicular system?

A. Enteroendocrine cell
B. Mucus neck cells
C. Parietal cells
D. Chief cells

C. Parietal cells

Note: Explanation of the functional importance of the canalicular system for anyone who is interested: This system acts as a reservoir of the plasma membrane (PM) containing active proton pumps. In the resting cell, tubulovesicular structures are present in the apical region just below the PM. In the active (stimulated) cell, these vesicles fuse with the PM to form canaliculi and microvilli increasing the surface area for ion pumps.

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Which embryological abnormality is associated with persistent cloacal membrane?

A. Imperforate anus
B. Vesicorectal fistula
C. Rectocutaneus fistula

A. Imperforate anus

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What embryological abnormality is associated with excessive growth of tissue around the duodenum?

A. Annular pancreas
B. Pancreatic divisim
C. Duodenal atresia

A. Annular pancreas

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What is formed by the fusion of the lower fibers of internal oblique and transversus abdominis muscles?

A. Conjoined tendon
B. Iliopubic tract
C. Lacunar ligament
D. Superficial inguinal ring

A. Conjoined tendon

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Which structure crosses linea alba and blends into the contralateral external oblique aponeurosis?

A. Reflected inguinal ligament
B. Pectineal ligament
C. Lacunar ligament
D. Poupart’s ligament

A. Reflected inguinal ligament

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Which structure is supplied by both superior mesenteric and inferior mesenteric arteries?

A. Rectum
B. Segmoid
C. Transverse colon
D. Ascendingcolon

C. Transverse colon

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Which artery supplies the cecum?

A. Ileocolic artery
B. Middle colic artery
C. Left colic artery

A. Ileocolic artery

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Which structure is least likely to be affected after inferior mesenteric artery ligation?

A. Cecum
B. Transverse colon 
C. Descending colon 
D. Sigmoid colon
E. Rectum

A. Cecum

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Which of the following structures is used as a surgical guide to resect a mass in segment III of the liver?

A. Left hepatic vein
B. Intermediate hepatic vein
C. Right hepatic vein

A. Left hepatic vein

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An injury to the posterior aspect of the epiploic foramen causes bleeding from which of the following structures?

A. Inferior vena cava
B. Portalvein
C. Gastroduodenal artery
D. Aorta

A. Inferior vena cava

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Which structure is located at the level of L4 vertebra? A. Iliac crest B. Iliactubercle C. Subcostal margin D. Transpyloric plane

A. Iliac crest

Which structure is used to locate McBurney's point? A. ASIS B. PSIS C. AIIS D. PIIS

A. ASIS

A patient can’t close his eyes tightly after surgical removal of the parotid gland due to weakness in orbicularis oculi muscle. Which nerve is injured in this case? A. Facial nerve B. Trigeminal nerve C. Glossopharyngeal nerve

A. Facial nerve

Which nerve carries the postganglionic parasympathetic fibers to the sublingual and submandibular glands? A. Lingual nerve B. Glossopharyngeal nerve

A. Lingual nerve

Which muscle is supplied by the mandibular nerve? A. Tensor veli palatini B. Stylopharygeus C. Levator veli palatini D. Palatoglossus

A. Tensor veli palatini

Which of the following is a slit-like lesion in the anal mucosa? A. Anal Fissure B. Cryptitis C. Anal abscess

A. Anal Fissure

What is an infection of the anal sinus called? A. Cryptitis B. Anal fissure C. Anal fistula

A. Cryptitis

Which nerves result in localized liver pain in a patient with hepatomegaly? A. Lower thoracic spinal nerves B. Upper thoracic spinal nerves C. Right and left phrenic nerves

A. Lower thoracic spinal nerves Note: Hepatomegaly results in distension of Glisson’s capsule, which is innervated by the lower thoracic spinal nerves (somatic innervation -> localized pain).

Which artery passes through the transverse mesocolon? A. Middle colic B. Left colic C. Right colic D. Sigmoid colic

A. Middle colic

Which artery will be ruptured due to perforation of a duodenal peptic ulcer? A. Gastroduodenal artery B. Right gastric artery C. Leftgastricartery D. Esophageal artery

A. Gastroduodenal artery Note: Posterior perforation of the duodenum results in rupture of the gastro-duodenal artery while posterior perforation of the stomach results in rupture of the splenic artery, which is present in the stomach bed (lesser sac).

Through which peritoneal formation do the lymphatics of the liver communicate with the lymphatics of the anterior abdominal wall? A. Falciform ligament B. Ligamentum teres C. Greater omentum D. Lesser omentum

A. Falciform ligament

Which feature reflects the absorptive function of the enterocytes? A. Microvilli B. Basal mitochondria

A. Microvilli

What keeps unconjugated bilirubin soluble in the plasma? A. Albumin B. Heme oxygenase C. Biliverdin reductase

A. Albumin

Which of the following is generated from bile salts by the action of microbes in the GIT? A. Secondary bile acids B. Primary bile acids

A. Secondary bile acids

Which component is abundant in gallstones? A. Cholesterol B. Calcium C. Carbonate

A. Cholesterol

# Choose the most appropriate energy source in the following situations: Which of the following is first utilized in response to an increase in glucagon? ``` A. Liver glycogen B. Muscle protein C. Blood amino acids D. Muscle glycogen E. Adipose triglycerides F. Liver glycogen ```

A. Liver glycogen

# Choose the most appropriate energy source in the following situations: What is the main source of energy supply during early starvation? ``` A. Liver glycogen B. Muscle protein C. Blood amino acids D. Muscle glycogen E. Adipose triglycerides F. Liver glycogen ```

B. Muscle protein Note: Muscle protein and not blood amino acids. Muscle protein would be broken down and delivered to the liver via the blood to undergo gluconeogenesis. Muscle protein is more accurate. If this option wasn’t there blood amino acids would be the answer.

Which protein is required to transport conjugated bilirubin out of the liver?

MRP2 transporter

Which precaution should be considered when treating severe malnutrition?

Limiting initial protein intake

What facilitates the uptake of bilirubin by the liver?

Ligandin

Which of the following is associated with eating raw meat? A. Vitamin B12 deficiency B. Niacindeficiency C. Biotindeficiency D. Thiamine deficiency

A. Vitamin B12 deficiency

Which of the following is an H1-receptor antagonist that is used for motion sickness?

Cyclizine

Which of the following is a 5-HT3-receptor antagonist?

Ondansetron

Which of the following drugs stimulates peristalsis?

Senna

What is the mechanism of action of Omeprazole?

Irreversible Inhibition of K+-H+ ATPase

Which cytoprotective agent is used in the combination therapy for the treatment of H-pylori? A. Bismuth subsalicylate B. Sucralfate

Bismuth subsalicylate

Which drug produces black tongue and stool as a side effect?

Bismuth subsalicylate Note: Questions 50 & 51 were in the same EMQ with the same answer “Bismuth subsalicylate”

Why it is not advised to drink grapefruit juice with cyclosporine in a patient who has undergone renal transplantation? A. Because a higher dose of cyclosporine will be needed to achieve the therapeutic concentration B. Because it inhibits cyclosporine metabolism by CYP450 enzymes C. Because there is a risk of transplant rejection

B. Because it inhibits cyclosporine metabolism by CYP450 enzymes

Which of the following is an example of phase II reactions?

Conjugation

What is the most likely cause of acetaminophen hepatotoxicity?

Accumulation of electrophilic metabolites

A 43-year-old Egyptian patient presented with a high-grade fever, splenomegaly, hepatomegaly, rose spots, and bradycardia. What is the most likely causative organism? A. Salmonella typhi B. C.difficile

A. Salmonella typhi

Which cell transports antigens from the intestinal lumen across its cell membrane? A. M cells B. B cells C. T cells

A. M cells

What is the pathogenesis of C. difficle-associated diarrhoea? A. Spore formation B. Production of toxin B C. Invading the mucosal surface of the intestine

B. Production of toxin B

. A patient presented with symptoms of gastroenteritis after consuming shell fish. Stool culture on TCBS agar showed green colonies. What is the causative organism? A. Vibrio parahemolyticus B. Vibrio cholera

A. Vibrio parahemolyticus

A patient has travelled to Iraq and returned with profuse watery diarrhoea. Stool sample grew yellow colonies on TCBS agar. What is the causative organism? A. Vibrio cholera B. Vibrio parahemolyticus C. Salmonella D. E. coli

A. Vibrio cholera

An elderly has undergone colonic surgery, and then he developed diarrhoea after taking broad spectrum antibiotics. What is the most likely causative organism? A. C. difficle B. Pseudomonas

A. C. difficle

Which of the following is the best method to eradicate Salmonella Typhi? A. Educate people B. Improve sewage disposal C. Clear the environment D. Vaccine

B. Improve sewage disposal

What protects IgA against enzymatic degradation?

Secretory component

# Choose the most appropriate cell type that is responsible for the following: Tissue damage in Crohn's disease. A. Th2 B. Th1 C. Intraepithelial CD8+ lymphocytes D. M cells

B. Th1

# Choose the most appropriate cell type that is responsible for the following: Activates B cell to produce IgA. A. Th2 B. Th1 C. Intraepithelial CD8+ lymphocytes D. M cells

A. Th2

``` A 31-year-old man was found to have elevated liver enzymes (ALT 1200) during his regular check- up for liver enzymes. He had a history of unprotected sexual intercourse 6 months ago. He was screened for HBV and HCV. HCV-Ab: - HBsAg: + HBeAg: + HB anti-core Antibodies: + HBeAb: - HBsAb: - What is the diagnosis? ``` A. Chronic HBV with high infectivity B. Chronic HBV with low infectivity C. Acute Hepatitis D. Recovery stage

A. Chronic HBV with high infectivity

Antibody against which antigen has a diagnostic relevance in Primary Biliary Cirrhosis?

Mitochondrial antigen

# Choose the causative agent for the following conditions: Keratinizing squamous cell carcinoma in the oral cavity. ``` A. HPV B. HIV C. EBV D. CMV E. HSV-1 F. HSV-2 ```

A. HPV

Choose the causative agent for the following conditions: An oral blister showed histologically multinucleated giant cells with nuclear eosinophilic inclusions and Cowdry bodies. ``` A. HPV B. HIV C. EBV D. CMV E. HSV-1 F. HSV-2 ```

E. HSV-1

A 43-year-old man presented with epigastric pain and vomiting. Urease test was positive. What would gastric biopsy show? A. Hypertrophic hypersecretory gastropathy B. Active chronic H. pylori gastritis C. Reactive inflammatory gastropathy D. Pedunculated gastric adenoma

B. Active chronic H. pylori gastritis

``` A 40-year-old female presented with jaundice and enlarged spleen. Her liver function test results showed the following: AST 200 ALT 150 GGT 646 ALP 246 INR 2.3 (prolonged) Haemoglobin 93 (low) Albumin is normal. What is the cause of her jaundice? ``` A. Hereditary spherocytosis B. Chronic alcoholic liver disease C. Stone in the cystic duct D. Acute hepatitis A

B. Chronic alcoholic liver disease Note: Reversal of ALT/AST ratio (AST>ALT) and elevation of GGT support this diagnosis. This lady has cirrhosis complicated by portal hypertension, which leads to splenomegaly so haemoglobin is low because of hypersplenism.

. What is the most important risk factor for gallbladder carcinoma? ``` A. Alcohol B. Obesity C. Female sex D. Age above 40 E. Cholelithiasis ```

E. Cholelithiasis

A patient with family history of colon cancer in each generation in his family requested genetic testing. Which of the following gene is prioritized for gene testing? A. MLH1 B. MSH2 C. APC D. PMS

C. APC

A 29-year old female presented with brown oral pigmentation and hamartomatous colonic polyps. What is the diagnosis?

Peutz-Jegher syndrome

Which of the following TNM scores carries the best 5-year survival rate (or the best prognosis)?

T1 N0 M0

A Chinese man with a history of hepatitis C infection presented with a 10-cm abdominal mass. What is the most likely diagnosis?

Hepatocellular carcinoma

A 47-year-old obese diabetic male has elevated liver enzymes. His liver biopsy showed fatty liver with inflammation and hepatocellular damage. What’s the most likely diagnosis?

Non-alcoholic steatohepatitis

What is interface hepatitis?

Inflammation and necrosis of hepatocytes at the limiting plate

# Choose the most appropriate diagnosis in the following scenarios: A young female was found to have breast cancer, soft tissue sarcoma, endocrine tumors, and melanomas. Genetic testing revealed a mutation in p53 gene. ``` A. GIST B. Li Fraumani syndrome C. Cowden syndrome D. FAP E. Familial pancreatic cancer ```

B. Li Fraumani syndrome

# Choose the most appropriate diagnosis in the following scenarios: A woman had stomach and pancreatic cancers. Genetic testing showed mutation in PDGFRA. ``` A. GIST B. Li Fraumani syndrome C. Cowden syndrome D. FAP E. Familial pancreatic cancer ```

A. GIST

What is the mechanism of acute necrotizing pancreatitis?

Proteolytic destruction of the pancreatic parenchyma

A patient presented with migratory erythema, diabetes, and anaemia. What is the diagnosis?

Glucagonoma

What is the diagnosis in the following cases: Family members were identified to have NOD2 (nucleotide binding domain 2) susceptibility genes.

Crohn’s disease

What is the diagnosis in the following cases: A 30-year-old woman was found to have creeping fat over the serosal surface of the terminal ileum with thickening of the wall.

Crohn’s disease

An appendicial mass showed histologically sheets of monotonous cells with salt and pepper chromatin and inconspicuous nucleolus. Electron microscopy showed membrane-bound neurosecretory granules. What is the diagnosis?

Carcinoid tumour

Rupture of which of the following tumors in the appendix will cause pseudmyxoma peritoneii?

Mucinous cystadenocarcinoma

A flat mass in the colon showed serrated architecture and dysplastic cells. What is the diagnosis?

Sessile serrated Adenoma

A female patient had a gastric tumour that stained positive for CD117 on IHC. She had a family history of a similar condition. What’s the most likely diagnosis?

GIST

Which of the following is an indication of liver decompensation in a patient with ascites?

Prolonged prothrombin time Note: Indications of liver decompensation: increased bilirubin (jaundice), prolonged INR, hepatic encephalopathy, low albumin (edema), ascites, and variceal bleed.

Ulcerative colitis and infestation of liver flukes are considered risk factors to which of the following conditions? A. Extra-hepatic bile duct carcinoma (cholangiocarcinoma) B. Gallbladder carcinoma

A. Extra-hepatic bile duct carcinoma (cholangiocarcinoma)

An old lady presented with a painful tumour in the parotid gland that showed perineural invasion. What is the diagnosis?

Adenoidcystic carcinoma

Backflow of blood into which vein causes esophageal varices? A. Left gastric vein B. Esophagealvein C. Short gastric vein

A. Left gastric vein

An obese diabetic male presented with symptoms of liver disease. What is the Diagnosis?

NAFLD

What causes achalasia?

Degeneration of neurons in the Myenteric (Auerbach) plexus

A patient took acetaminophen 6 hours ago. Which of the following changes in the liver are associated with acetaminophen toxicity? A. Hepatocellular damage and necrosis of zone 1 B. Hepatocellular damage and necrosis of zone 3

B. Hepatocellular damage and necrosis of zone 3 Note: Both answers were counted correct in the exam but “B” is the best answer. It was clearly stated in the PBL case summary that acetaminophen toxicity is associated with centrilobular (zone 3) necrosis. Compare this question to question number 32. If the question is about the first zone that is affected (anatomy), think of zone 1. However, if the question is about acetaminophen toxicity in general (pharmacology/clinical medicine), think of zone 3.

Which of the following is a marker for hepatocellular carcinoma?

Alfa-fetoprotein

A male patient who is a known case of celiac disease was on a gluten-free diet but he wasn’t compliant to the management. He developed a mass in the duodenum and jejunum. What is the diagnosis?

Enteropathy-associated T-cell lymphoma

A 50-year-old male presented with a non-scrapable white lesion on the tongue. Microscopy showed mitosis and pleomorphism but no invasion. What is the diagnosis? A. Squamous cell carcinoma B. Squamous cell dysplasia C. Squamouscellmetaplasia D. Squamous cell hyperplasia

B. Squamous cell dysplasia Note: Leukoplakia is a white plaque that cannot be scraped off. It is considered a precursor lesion for squamous cell carcinoma of the oral cavity and hence shows dysplasia.

A 23-year-old patient has sickle cell anemia. Which of the following is expected to be high in his blood?

Unconjugated bilirubin

A child presented with fever and bilateral parotid swelling. Laboratory results showed high amylase. Microscopy showed diffuse interstitial edema, necrosis, and an inflammatory infiltrate composed of lymphocytes and plasma cells. What is the most likely diagnosis?

Mumps infection

A heavy alcohol drinker presented with vomiting blood (hematemesis). What is the diagnosis? A. Mallory-Weiss tear B. Esophageal varices

A. Mallory-Weiss tear *The answer has been confirmed.

A patient presented with epigastric pain. Histology of the esophagus showed basal cell hyperplasia, elongated papillae, and scattered eosinophils in the epithelium. What does this indicate?

Reflux esophagitis

A woman presented to the emergency room with melena. Choose the most appropriate diagnosis in the following scenario: 102. She reported a 20-year history of chronic hepatitis B infection for which she didn't take regular treatment. ``` A. Peptic ulcer B. Esophageal varices C. Crohn’s disease D. Gastric erosions E. Swallowed blood ```

B. Esophageal varices Note: Melena (i.e. black tarry stools) indicates bleeding in the upper GIT because this blood will be disintegrated by the time it reaches the lower GIT and passes with the stools. The first scenario implies that she has developed cirrhosis complicated by portal hypertension. In the second scenario, the presentation and the positive family history for the same chronic condition supports the diagnosis of Crohn’s disease.

A woman presented to the emergency room with melena. Choose the most appropriate diagnosis in the following scenario: She reported a history of chronic diarrhoea and abdominal pain for more than one year. Her sister had the same problem for which she is on regular treatment. ``` A. Peptic ulcer B. Esophageal varices C. Crohn’s disease D. Gastric erosions E. Swallowed blood ```

C. Crohn’s disease Note: Melena (i.e. black tarry stools) indicates bleeding in the upper GIT because this blood will be disintegrated by the time it reaches the lower GIT and passes with the stools. The first scenario implies that she has developed cirrhosis complicated by portal hypertension. In the second scenario, the presentation and the positive family history for the same chronic condition supports the diagnosis of Crohn’s disease.

A heavy smoker male developed cancer in the middle of his esophagus. What is the most likely histological type of this cancer?

Squamous cell carcinoma Note: Smoking -> risk factor for squamous cell carcinoma mostly in the middle of the esophagus. GERD -> risk factor for esophageal adenocarcinoma in the lower third of the esophagus.

Which of the following cells is responsible for the hepatic damage in autoimmune hepatitis?

Cytotoxic T-cells

An 18-year-old girl presented with anorexia, nausea, and jaundice. There is no history of drug use. She has recently come back from a one-month trip to Syria. Lab results showed the following: ALT: very high; AST: very high; ALP: high; PT: normal; Bilirubin: high. Which serologic marker is consistent with the patient’s presentation? A. Anti-HAV IgG: positive B. Anti-HAV IgM: positive C. HBsAg: Negative D. Anti-CMV IgG: positive

B. Anti-HAV IgM: positive

An immunocompromised patient presented with dysphagia. Endoscopy showed ulcers in the lower esophagus. Histopathological examination showed eosinophilic intra-nuclear inclusions and ground glass nuclei. What is the diagnosis? A. Herpetic esophagitis B. Candida esophagitis

A. Herpetic esophagitis

A 55-year-old male came to the clinic for a routine check-up. Fecal occult blood test was positive. CBC and other tests were normal. Which investigation is the most cost-effective and initial diagnostic test? ``` A. Colonoscopy B. Gastroscopy C. Flexible sigmoidoscopy D. Double-contrast barium enema E. CT of the abdomen. ```

A. Colonoscopy Note: The answer has been confirmed by Dr. Waleed. Some students were tricked by the word “cost-effective” and thus they chose “C”. Although colonoscopy is more expensive than flexible sigmoidoscopy (FS), it is still considered cost-effective because it is the gold standard test and doesn’t need further confirmation. On the other hand, a positive result on FS still needs confirmation by colonoscopy so the patient would have to pay for 2 tests.

A 38-year-old male presented with jaundice of 2-day duration. Choose the most appropriate cause of his jaundice in the following scenarios: He presented with dark urine, hypotension, and pallor. On physical examination, capillary refilling time was 5 seconds and the spleen was found to be 2 cm above the costal margin (splenomegaly) but there is no hepatomegaly. Prothrombin time was normal. Soon after, he became normal. ``` A. Chronic liver decompensation B. Acute liver decompensation C. Autoimmune disease D. Pancreatic mass E. Haemolytic anemia F. Hepatoblastoma ```

E. Haemolytic anemia

A 38-year-old male presented with jaundice of 2-day duration. Choose the most appropriate cause of his jaundice in the following scenarios: He presented with dark urine and lethargy but his blood pressure was normal and there is no pallor. Capillary refilling time was 2 seconds. He also had hepatomegaly associated with right-sided tenderness. His prothrombin time was prolonged. ``` A. Chronic liver decompensation B. Acute liver decompensation C. Autoimmune disease D. Pancreatic mass E. Haemolytic anemia F. Hepatoblastoma ```

B. Acute liver decompensation

A patient presented with an oral aphthous ulcer, diarrhoea, right iliac fossa pain and perianal discharge. Examination revealed a mass in the right iliac fossa. Which investigation would you do to diagnose this patient? A. Colonoscopy B. Small bowel enteroscopy C. Upper endoscopy D. Capsule endoscopy

A. Colonoscopy Note: The answer has been confirmed by Dr. Iqbal Siddique. Some students were tricked by the presentation which may indicate the involvement of the terminal ileum/proximal large intestine so they chose “B”. Actually, 60% of Crohn’s cases can be diagnosed by colonoscopy (ileal/ileocolonic/colitis). Also, colonoscopy can reach up to the terminal ileum that’s why it is also called “ileocolonoscopy”.

A young patient presented with salivary gland tumour that showed uniform cells with central nuclei and abundant basophilic or clear cytoplasm. What is the diagnosis?

Acinic cell carcinoma

A salivary gland tumour is composed histologically of epithelial elements arranged in ducts and mucomyxoid stroma (mesenchymal element). What is the diagnosis?

Pleomorphic adenoma

Upper GI endoscopy in a patient revealed a gastric polyp that showed dysplasia on HPE. What is the diagnosis? A. Adenomatous polyp B. Fundic gland polyp C. Hyperplasticpolyp

A. Adenomatous polyp

Which of the following indicates bad prognosis in a patient with acute pancreatitis? A. Low arterial pO2 B. Absent bowel sounds C. Pancreatic edema D. Very high pancreatic amylase (1300)

A. Low arterial pO2

An immunocompromised patient presented with symptoms of esophagitis. Histology showed large cells with intra-nuclear and intra-cytoplasmic inclusions. What is the causative agent?

CMV

What is the imaging protocol for staging gastrointestinal tumors?

CT scan of the lung and liver

Which imaging modality is used to readily diagnose acute cholecystitis? A. CT B. Ultrasound C. MRI D. X-ray

B. Ultrasound

Which mechanism is used to transport bile acids from hepatocytes into bile canaliculi?

Primary active transport

Which of the following is a characteristic feature of smooth muscles in the gastrointestinal tract? A. Depolarize by stretch B. HyperpolarizebyAch C. Depolarize by norepinephrine

A. Depolarize by stretch

Choose the correct combination of ions with the digestion products that are co-transported with them in the intestine.

Na+ with glucose; H+ with peptides

What is true about secondary peristalsis?

Starts at the site where food is stuck in the esophagus after a wave of primary peristalsis

What is secreted from pancreatic duct cells? A. Cl and K B. HCO3-andCl-

B. HCO3-andCl-

As fecal material is being emptied into the rectum, passive pressure of the rectum will increase up to a threshold then the recto-rectal reflex will start. What will happen next? A. Contraction of rectum B. Relaxation of rectum C. Contraction of internal anal sphincter D. Relaxation of external anal sphincter

A. Contraction of rectum

What is the correct sequence of activation of pancreatic enzymes?

Trypsinogen→ trypsin → activate the inactive enzymes

What is the correct sequence of contraction of smooth muscles?

Ca-Calmodulin → MLCK → myosin-p → cross-bridges

What causes movement of water in the salivary glands? A. Active transport of Na and isotonic fluid secretion B. Paracellular Na transport and isotonic fluid secretion

B. Paracellular Na transport and isotonic fluid secretion Note: The answer has been confirmed by Dr. Hameed. In contrast to movement of water in the pancreas and gallbladder which follows active transport of Na.

What activates gastric secretions?

Stomach distention

What stimulates secretion of secretin?

Low duodenal pH

Which hormone stimulates the hunger canter?

Ghrelin

Which hormone stimulates appetite?

Ghrelin

What causes vasodilation to increase the secretion of the salivary glands? A. VIP and Bradykinin B. NE and Bradykinin

A. VIP and Bradykinin

What induces the mixed micelle to release its contents at the absorbing epithelium?

High H+ concentration near the mucosa

What controls bile acid synthesis and secretion?

The concentration of bile acids in the portal vein

After glucose administration to a patient, his serum glucose level has increased but when he was given lactose, glucose serum levels didn't increase. Which abnormality underlies these findings?

Deficiency of brush border lactase enzyme

The pancreatic fluid is released into the small intestine during which phase of digestion? A. Basal B. Intestinal C. Gastric D. Cephalic

B. Intestinal

Which of the following is a characteristic feature of smooth muscles in the gastrointestinal tract?

Changing membrane potential

Which hormone causes contraction of the gallbladder?

CCK

Amylase is inactive at pH 4; however, most of starch digestion by salivary amylase takes place in the stomach. What is the explanation for that?

pH in the core of the food is suitable for digestion by salivary amylase

EBM: An RCT was conducted to evaluate the effect of a drug on decreasing the levels of triglycerides in the blood in patients at risk of stroke (cerebrovascular accidents). Study results showed that this drug decreased the level of triglycerides by 0.03 mg. The confidence interval was (0.01-0.05). This decline in the level of triglycerides didn’t decrease the incidence of stroke. Which of the following statements is true? A. We cannot tell whether the results are statistically significant because the p value is not provided B. The results of the study are statistically insignificant C. The results of the study are not clinically significant

C. The results of the study are not clinically significant Note: Choice “A” is wrong because we can tell that the results are statistically significant because the confidence interval does not contain the null value which is zero (we don’t need the p value).