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Flashcards in 2014 final Deck (67)
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1
Q

an 18-year-old boy who went to a doctor asking for weight controlling pills claiming that he is overweight. His weight on the age weight graph was as shown (was underweight). What does this patient have? a. Anorexia nervosa b. Bulimia nervosa c. LH damage

A

a. Anorexia nervosa

2
Q

A 51-year-old man complains of passing foul-smelling fatty stools. He noticed recent loss of weight as well; an abdominal x-ray was performed, and findings can be observed as below. How would u manage this patient?

A

By supplementing him with pancreatic enzymes

3
Q

A 47-year-old woman complaining of abdominal pain was found to have jaundice on examination. An ERCP was done and showed a dilated bile duct that is completely blocked by stones. What values do you expect on further investigation?

  1. increased bilirubin, decreased urobilinogen, decreased stercobilinogen
  2. increased bilirubin, increased urobilinogen, increased stercobilinogen
A
  1. increased bilirubin, decreased urobilinogen, decreased stercobilinogen
4
Q

This is a graph of ion concentrations in pancreatic secretion at different rates of secretion. Which of the following is correct?

A

High HCO3- concentration secreted by Cl-HCO3 exchanger at higher rates of secretion

5
Q

What biochemical reaction requires vitB12 as a cofactor?

a. Amination
b. Dehydrogenation
c. Hydroxylation
d. Methylation

A

d. Methylation

6
Q

Following appendectomy, the patient complained of numbness in the groin area. Which nerve is likely to be injured?

a. Genitofemoral
b. Femoral
c. Ilioinguinal
d. Obturator
e. Femoral

A

c. Ilioinguinal

7
Q

A 50-year-old female with keratoconjunctivitis sicca and xerostomia due to lymphocytic destruction of exocrine glands. What is the diagnosis?

a. Sialadenitis
b. Sialithiasis
c. Sialadenosis
d. Sjogren syndrome

A

d. Sjogren syndrome

8
Q

What precipitates gout?

a. Purine anabolism
b. Purine catabolism
c. Pyrimidine anabolism
d. Pyrimidine catabolism

A

b. Purine catabolism

9
Q

What is the process of transport of di and tri peptidases along the enterocyte?

a. Primary active transport
b. Cotransport with Na+
c. Cotransport with H+

A

c. Cotransport with H+

10
Q

A 9-year-old boy presented with purpuric rash, oliguria, general weakness and bloody diarrhea for 1 week. What is the most likely organism?

a. E. coli O157:H7
b. Shigella flexneri
c. Salmonella typhimurium
d. Campylobacter jejun

A

a. E. coli O157:H7

11
Q

What happens during hepatic blood flow regulation in hepatic arterial buffer response HABR, when portal blood flow increases?

a. Hepatic blood flow remains constant
b. Buffers vasoconstrict to reduce blood flow
c. Hepatic arterial blood flow increase
d. Autoregulation reduces portal blood flow

A

b. Buffers vasoconstrict to reduce blood flow

12
Q

Which structure can be damaged if the hepatoduodenal ligament is injured?

a. Pancreatic duct
b. Bile duct
c. Hepatic vein
d. Splenic vein

A

b. Bile duct

13
Q

The secretory functions of the submandibular salivary gland may be impaired due to injury of which nerve?

a. Chorda tympani
b. Auriculotemporal
c. Hypoglossal
d. Glossopharyngeal
e. Inferior alveolar

A

a. Chorda tympani

14
Q

Which of the following is a product formed by intestinal microflora?

A

Secondary bile acids

15
Q

Which of the following will be affected the least in case of inferior mesenteric artery blockage?

a. Cecum
b. Sigmoid colon
c. Descending colon
d. Ileum

A

a. Cecum
d. Ileum

 (in our module exam we had the same question but without ileum in the choices so we went with
 the same answer cecum)
16
Q

What is the rationale behind quadruple therapy of peptic ulcer disease?

a. Decrease fatal adverse side effects
b. Decrease drug interactions
c. Decrease resistance of emerging species

A

c. Decrease resistance of emerging species

17
Q

A female patient presents with a lesion in her oral cavity. On examination, the lesion was shown to be white reticulated or netlike; what is the likely diagnosis?

a. Lichen planus
b. Crohn’s
c. Pemphigus vulgaris

A

a. Lichen planus

18
Q

A 60-year-old male with an inguinal mass and difficulty urinating. This mass does not extend to the scrotum and is relieved by rest. What is the diagnosis?

a. Direct inguinal hernia
b. Indirect inguinal hernia

A

a. Direct inguinal hernia

19
Q

In Vogelstein model a mutation in which of the following genes is involved in the progression of late adenoma to colorectal carcinoma?

a) P53 gene
b) K-ras gene
c) APC gene

A

a) P53 gene

20
Q

A nurse was working in the ward when she accidently pricked her finger with a used needle. What is the maximum number of days for postexposure prophylaxis for Hep B?

a. 2
b. 7
c. 14

A

b. 7

21
Q

What happens if there’s a distention of the cecum?

a. Stimulation of peristalsis in ileum
b. Closure of ileocecal valve
c. Reverse peristalsis in colon

A

b. Closure of ileocecal valve

22
Q

What is the mechanism of action of scopolamine?

A

Antagonism of muscarinic receptors

23
Q

A 10-year-old Kuwaiti boy presented to the emergency room with pain in his hands. On examination, he had marked jaundice, pallor and splenomegaly. What will increase suspension of hemolytic anemia?

a. Elevated aminotransferase
b. Elevated plasma haptoglobin
c. Elevated urine urobilinogen

A

c. Elevated urine urobilinogen

24
Q

What is the basis of tissue damage in Crohn’s disease?

a. Hypersensitivity towards gluten
b. Cell mediated immune reaction against bacterial flora

A

b. Cell mediated immune reaction against bacterial flora

25
Q

An endoscopy of the esophagus found red cherry spots near its distal end. What is the anatomical basis of this finding?

a. Abrasion of the esophageal mucosa at the Z line
b. Dilated submucosal veins
c. Dilated submucosal arteries d. Dilated lymphatics

A

a. Abrasion of the esophageal mucosa at the Z line

26
Q

Which organ does Salmonella Typhi invade to reach the small intestine?

a. Liver
b. Kidney
c. Gallbladder
d. Spleen

A

c. Gallbladder

27
Q

What is required to diagnose an adenoma on histology?

A

Presence of dysplasia

28
Q

A woman complains of jaundice and fever after consuming oysters in a seafood restaurant. What is the most likely cause?

a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
e. Hepatitis E

A

a. Hepatitis A

29
Q

A child had fever with flu-like symptoms. A week later he presented with jaundice and enlarged liver. A liver biopsy showed microvascular steatosis. What is the pathogenesis behind his condition?

a. Defective beta oxidization due to damaged mitochondria
b. Alpha antitrypsin deficiency

A

a. Defective beta oxidization due to damaged mitochondria

30
Q

What endogenous liver tumor resembles a metastatic adenocarcinoma in biopsy microscopically?

a. Hepatic adenocarcinoma
b. Bile duct adenoma
c. Cholangiocarcinoma

A

c. Cholangiocarcinoma

31
Q

Investigations of a patient applying for a job showed the following: Hypertension, high glucose level, high cholesterol. Patient’s liver function test: High ALT and AST (ALT was higher than AST), ALP is normal. Liver span was 15 cm. He denied drinking alcohol. What is the diagnosis?

a. Nonalcoholic fatty liver disease
b. Drinks alcohol secretly

A

a. Nonalcoholic fatty liver disease

32
Q

A patient recently returned from a vacation in Mexico. He developed severe diarrhea, abdominal pain and fever. What is the most likely causative organism?

A

ETEC

33
Q

Why are infants/children not prone to develop C. Difficile associated diarrhea?

a. Enterocytes have no receptors for C. Difficile toxin
b. No toxin production
c. C. Difficile doesn’t colonize the intestine of infants/children

A

a. Enterocytes have no receptors for C. Difficile toxin

34
Q

A 72-year-old man was found to have a mass in the middle 3rd of the esophagus. What is the
most likely diagnosis?

a. Squamous cell carcinoma
b. Adenocarcinoma

A

a. Squamous cell carcinoma

35
Q

What is the main plexus for coordinated contraction of the gastrointestinal smooth muscle?

a. Submucous
b. Myenteric
c. Celiac

A

b. Myenteric

36
Q

What is the treatment for chronic hepatitis C patient? (EMQ)

a. Interferon
b. Ribavirin
c. Protease inhibitors
d. Tenofovir
e. Lamivudine
f. Adefovir

A

a. Interferon
b. Ribavirin

We are not sure of the answer.

37
Q

What forms the medial boundary of the subinguinal space?

A

Lacunar ligament

38
Q

Crosses to the external oblique aponeurosis on the opposite side and blends with it?

A

Crossed inguinal ligament

39
Q

A 29-year-old man from Bihar, India recently visited Kuwait presented with fever, weight loss and anemia. On examination, he had hepatosplenomegaly. What is the diagnosis? (EMQ)

A

Typhoid fever

40
Q

Congenital defect where the liver is mainly on the left side? (EMQ)

A

Situs inversus

41
Q

Congenital defect where there’s failure of the anal/ pectineal membrane to rupture. (EMQ)

A

Imperforate anus

42
Q

A drug that is considered cytoprotective for the gastric mucosa and is part of the treatment of H. Pylori. (EMQ)

a. Misoprostol
b. Bismuth subsalicylate
c. Dicyclomine
d. Sucralfate
e. Omeprazole

A

b. Bismuth subsalicylate

43
Q

Which of the following drugs is contraindicated in pregnancy?

A

Misoprostol

44
Q

Which of the following veins is involved in the pathogenesis of esophageal varices?

A

Left gastric vein

45
Q

What happens to the intestinal motility when autonomic innervation is cut?

A

Motility not affected because ENS is dependent

46
Q

A child with pouch distension on the anterior abdominal wall that is connected to the umbilicus. The pouch is translucent and umbilical vessels can be seen through it. What is the condition? (EMQ)

a. Omphalocele
b. Vitelline cyst
c. Meckel’s diverticulum

A

a. Omphalocele

check, not sure

47
Q

Perforation of a peptic ulcer in the duodenum causes the rupture of which artery?

A

Gastroduodenal artery

48
Q

A 15-year-old boy with colonic polyposis and desmoid cyst in the abdominal wall. What is the diagnosis?

a. Gardner syndrome
b. Turcot syndrome
c. FAP

A

a. Gardner syndrome

(FYI Gardner syndrome (AD) is a variant of FAP associated with osseous and soft tissue tumor and
hypertrophy of RPE, whereas Turcot syndrome (AR- the only exception) is a variant of FAP and is
associated with CNS tumors (e.g. medulloblastoma and glioma)

49
Q

A patient with hyperpigmentation in the skin and oral mucosa. Multiple polyps were found in the colon. What is the diagnosis?

A

Peutz-Jegher syndrome

50
Q

A disease that is common in the Caucasian populations and characterized by NOD 2 susceptibility mutation. (EMQ)

a. Crohn’s disease
b. Ulcerative colitis

A

a. Crohn’s disease

51
Q

Colonoscopy showed erythematous and hemorrhagic mucosa. Microscopic examination showed inflammation in the rectum and sigmoid colon with thin mucosa and mucosal inflammation, and multiple crypt abscesses.

A

Ulcerative colitis

52
Q

What is the dominant mixing movement in colon?

a. Haustrations
b. Segmentations

A

a. Haustrations

53
Q

A movement that occurs in both esophagus and stomach during swallowing?

a. Peristalsis
b. Receptive relaxation

A

b. Receptive relaxation

54
Q

Mixing chyme in the stomach against a closed pyloric sphincter?

A

Retropulsion

55
Q

What causes rectovesical fistula?

A

Incomplete septation of cloaca

56
Q

This component is the substrate for 7-alpha hydroxylase:

a. glucuronic acid
b. bile salts
c. secondary bile acids
d. cholesterol

A

d. cholesterol

57
Q

This component has an amphipathic detergent action:

a. glucuronic acid
b. bile salts
c. secondary bile acids
d. cholesterol

A

b. bile salts

58
Q

A gastrointestinal tumor that is positive for CD117 (C-KIT)?

A

GIST

59
Q

How is bilirubin uptake into hepatocytes enhanced?

A

Binding to ligandin

60
Q

How do IgA antibodies defend the body against invading organisms?

A

Prevents adherence to mucosa

61
Q

Eating palatable food makes you want to eat more, what is the mechanism behind that? (Check answer)

a. Dopamine released from VTA to NAcc causing disinhibition of LH
b. Opioid peptide-related inhibition of POMC neurons in arcuate nucleus.

A

a. Dopamine released from VTA to NAcc causing disinhibition of LH (m7sen)
b. Opioid peptide-related inhibition of POMC neurons in arcuate nucleus. (3krma)

62
Q

Linear ulcers and perforation of terminal ileum (was a scenario but we forgot it)

A

Typhoid fever

63
Q

What is the mechanism of hepatocytes destruction in autoimmune hepatitis?

a. Autoantibodies
b. Cytokines production from cytotoxic cells

A

b. Cytokines production from cytotoxic cells

64
Q

A tumor excised from the parotid gland showed cystic spaces that are lined with eosinophilic columnar cells and dense lymphatic tissue. What is the diagnosis?

A

Warthin’s tumor

65
Q

Results from failure of return of physiological hernia/ results from failure of intestinal loop to return following physiological hernia?

A

Omphalocele

66
Q

A 7-year-old Indian child presented to the medical clinical with fever, anemia, and hepatosplenomegaly. The doctor decided to take a bone marrow biopsy. What is the most likely diagnosis?

A

leishmania donovani

67
Q

a 35-year-old man traveled to India, there he developed bloody diarrhea associated with pain and discomfort in RUQ for 10 days. Also it was noted that he had fever, jaundice, and weight loss. Ultrasound revealed hepatic abscess. What is the causative organism?

A

Entamoeba histolytica