2015 final Flashcards by Susan w

A 25-year-old patient underwent an Ultrasound which showed an echogenic mass. Further studies on CT should nodular enhancement with IV contrast and centripetal filling contrast in delayed scan. What is the diagnosis?

Hepatic hemangioma

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What is absent in the lamina propria of the colon?

A. lymphatics
B. Sinusoids
C. Lymphocytes
D. Collagen

A. lymphatics

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Where is the first place to see lymphatics of the liver?

periportal space of mall

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Left sided cecum and ascending colon, what is the cause?

A. Midgut loop clockwise rotation
B. Rotation up to 90 degrees
C. Rotation up to 180 degrees

C. Rotation up to 180 degrees

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At what level the inferior epigastric vessels penetrate the rectus abdominis muscle?

Arcuate line

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For truncal vagotomy, in order for the surgeon to save the other branches, where does the surgeon need to cut?

near the lesser curvature of the stomach distal to the esophagus

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After removal of parotid gland, patient presented with asymmetrical smile, which branch of facial nerve is most likely to be affected?

Marginal mandibular branch

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What increases the gastrointestinal transit time?

A. Haustrations
B. Segmentation
C. Propulsion
E. Reverse peristalsis

E. Reverse peristalsis

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A healthy person made a BaSO4 GI motility test and showed reverse peristalsis in one section, which part of the GI is this?

A. Colon
B. Ileum
C. Esophagus
E. Trachea

A. Colon

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What Is the first step of pancreatic enzyme activation?

A. Activation of trypsin by enterokinase
B. Activation of enterokinase by trypsin

A. Activation of trypsin by enterokinase

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Cytokines release in cancer or severe infection cause anorexia by which mechanism?

A. Directly inhibit AGRP in arcuate nucleus?
B. Activate CGRP releasing neurons

B. Activate CGRP releasing neurons

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Histopathology sample from a baby with failure to thrive showed normal duodenal sample but no plasma cells?

A. Giardiasis
B. TB
C. H. Pylori

A. Giardiasis

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Which of the following is responsible for immunogenic tissue damage in celiac disease?

A. pro-inflammatory cytokines
B. Cytotoxic T-cells
C. Immune complex formation
D. Antibodies against gluten

A. pro-inflammatory cytokines

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This cell transports the antigen from the lumen to the antigen presenting cell?

M-cell

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What is the bacterial causative agent of pseudomembranous colitis?

A. C.difficile
B. C.Perferinges
C. Shigella
D. ETEC

A. C.difficile

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Patient who acquired the disease 3 months ago: HBsAg: Positive
HBs Ab: Negative
IgM core: Positive
HBe Ag: positive

A. chronic active hepatitis B. Acute hepatitis

B. Acute hepatitis

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Which parotid gland tumor is characterized by perineural invasion?

Adenoid cystic carcinoma

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Pregnant women came with a vascular swelling in the gingiva that showed dilatation and proliferation of blood vessels?

A. Pyogenic granuloma
B. Aphthous ulcer
C. Herpes simplex

A. Pyogenic granuloma

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41-year-old woman just undergone right hemicolectomy for mucinous cecal adenocarcinoma after IDA. She had hysterectomy few years ago but otherwise healthy. Her mother died of uterine cancer at the age 51, and her aunt from mother side died of colon cancer at the age of 54. She has one child and 22-year-old son. She is concerned about herself and her 22-year-old son

A. Genetic testing for APC gene mutation
B. She has a defect in the genes coding for mismatch DNA repair proteins
C. Her son has to start colonoscopy at 40 years because he is at high risk of polyps and colon cancer
D. Her son is not risk because only women are affected

B. She has a defect in the genes coding for mismatch DNA repair proteins

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What makes Bilirubin water-soluble?

A. Oxidation to stercobilin
B. Oxidation to urobilin
C. Conversion to biliverdin
E. Glucuronidation

E. Glucuronidation

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A young female with weight loss despite having good appetite with foul smelling fatty stool. She had anemia with low hemoglobin, low folate, fat in stools and high anti- transglutaminase antibodies.
What is the appropriate management?

Gluten free diet

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Long scenario about acute pancreatitis, key thing is bleeding in flanks (gray turner sign)?

Acute pancreatitis

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What is found in Crohn’s?

A. Increased lipid oxidation
B. Decreased protein oxidation
C. Decreased resting metabolic rate
D. Increased thermogenesis

A. Increased lipid oxidation

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Young female presented with intraperitoneal hemorrhage, liver biopsy showed normal liver cells without bile ducts?

Liver cell adenoma

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Little boy with bone pain, brown urine, bilirubinemia, what makes you sure that it’s caused by hemolytic anemia? A. conjugated bilirubin > 5 total bilirubin B. Low haptoglobin C. High liver enzymes

B. Low haptoglobin

A manometer is inserted into a patient’s mouth passing through the pharynx, UES, esophageal body, and LES. What are the pressure readings?

0 → 50 → 0 → 30

60-year-old man with elevated liver enzymes, Diabetes mellitus, hypertension and atrial fibrillation, he is on metformin, metoprolol, atorvastatin, and warfarin, liver span is 16 cm, US shows fatty liver, what is the mechanism of liver damage? A. Increased glutathione B. inhibition of 3-hydroxy-3-methylglutryl by atorvastatin C. Toxic fatty acids D. decreased TG

B. inhibition of 3-hydroxy-3-methylglutryl by atorvastatin

A 28-year old male presented with acid reflux and epigastric pain for 4 months. His symptoms are worsened after eating especially spicy foods. He has no weight loss, dysphagia, and no decrease in appetite. He’s physically active and takes no medications, His physical examination was normal except for some epigastric tenderness. What is the appropriate next step? A. Therapeutic trials of acid suppressive therapy B. Upper endoscopy

A. Therapeutic trials of acid suppressive therapy

What is the rationale behind Quadruple therapy of peptic ulcer? A. Reduce the cost B. Decrease fatal adverse effects C. Decrease emergence of resistance species E. Decrease drug-drug interactions

C. Decrease emergence of resistance species

What is the process of transport of di and tri peptides along the enterocyte? A. primary active transport B. secondary active transport C. Tertiary active transport (co-transport with H+)

C. Tertiary active transport (co-transport with H+)

What happens with distension of the cecum? A. stimulation of peristalsis in ileum B. Closure of ileocecal valve

B. Closure of ileocecal valve

What is the gastrointestinal tumor that is positive for CD117 (C-Kit)?

GIST

Which of the following happens during the receptive relaxation of the LES? A. decreased VEF but decreased VIF B. Increase in VIF/VIP but no VEF

B. Increase in VIF/VIP but no VEF

Muscle that is supplied by recurrent laryngeal nerve?

Cricopharangeus

Glossopharyngeal nerve is superior to this structure?

Middle constrictor

What divides the peritoneal cavity into two compartments?

Transverse mesocolon

What is the Anatomical landmark that helps identify McBurney’s point?

ASIS

Is found at the level of L4?

iliac crest

thickenings? | Structural and functional unit of the colon because of its inner circular muscle

Haustrations

Dominant mixing motion in the colon?

Haustrations

What increases the transit time in the colon?

reverse peristalsis

What is actively removed from the gallbladder to concentrate its contents?

Glucose and galactose are coupled to what to be absorbed?

Parietal cells secrete H+ ions in exchange of what?

Tumor that is found at the middle 1/3 of the esophagus?

Squamous cell carcinoma (SCC)

Epithelium of lower esophagus replaced by columnar cells?

Barrett’s esophagus

Obliterated left umbilical vein?

Round ligament of the liver (It may not be the exact question but you have to know that round ligament is also known as ligamentum teres, and it’s a remnant of left umbilical vein).

Patient with facial angiofibroma, cortical tubers, renal angiomyolipoma, with a polyp that has dilatation, with mucus and neutrophils indicate what type of polyp would be found: ``` A. Sessile serrated polyp B. Hamartomatous C. Inflammatory D. Villous adenoma E. Tuberous adenoma ```

B. Hamartomatous | Description of tuberous sclerosis, colon cancer note by Dr. Issam week 8

Patient with malignancy in colon, thyroid cancer, and breast cancer, pancreatic cancer as well. indicate what type of polyp would be found: ``` A. Sessile serrated polyp B. Hamartomatous C. Inflammatory D. Villous adenoma E. Tuberous adenoma ```

B. Hamartomatous | this could either be peutz jeghers OR cowden so either type is associated with hamartomatous polyps

Red-velvety lesion in the mouth, with increased risk of Malignancy?

erythroplakia

Patient with vesicles on the mouth, showing intranuclear eosinophilic inclusions and multinucleated giant cells?

Herpes simplex

Man came with severe watery diarrhea due to consumption of shellfish ``` A. Campylobacter jujeni B. Vibrio parahemolyticus C. Clostridium difficile D. Staphylococcus aureus E. Salmonella typhi ```

B. Vibrio parahemolyticus

A man presented with bloody diarrhea and fever. Later he developed Gullian- barre syndrome ``` A. Campylobacter jujeni B. Vibrio parahemolyticus C. Clostridium difficile D. Staphylococcus aureus E. Salmonella typhi ```

A. Campylobacter jujeni

Resides in the gallbladder and causes the person to be a chronic carrier ``` A. Campylobacter jujeni B. Vibrio parahemolyticus C. Clostridium difficile D. Staphylococcus aureus E. Salmonella typhi ```

E. Salmonella typhi

What drug inhibits Cyp450 metabolism if administered with other drugs?

Cimetidine

Co-administration of this drug with cyclosporine will lead to a decrease in cyclosporine concentration?

Rifampicin

Bleeding from upper GI due to increase pressure in portocaval anastomosis?

Esophageal varices

``` A. ALP B. GGT C. AST E. AFP F. Ammonia ``` Which elevated analyte is considered diagnostic in the following case: 35-year-old women with biopsy confirming chronic liver disease and steatorrhea (stool fat more than 6g per day) malabsorption of fat soluble vitamins. She presented with tetany and bone pain.

A. ALP

``` A. ALP B. GGT C. AST E. AFP F. Ammonia ``` Which elevated analyte is considered diagnostic in the following cases: Patient with history of liver cirrhosis presented with decompensation and fetor hepaticus, as well as tremor and coma.

F. Ammonia

Patient with high ALP, severe pruritis, and Xanthelasma A. Primary biliary cirrhosis B. Primary sclerosing cholangitis D. NAFLD E. Drug induced hepatitis

A. Primary biliary cirrhosis

A child developed severe vomiting 3 hours after drinking milk. What could be the causative agent? A. S.aureus B. C.difficile C. C.botulinum D. Shigella

A. S.aureus