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Flashcards in 2015 module exam Deck (109)
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1
Q

What is the mechanism by which the ions above are regulated in pancreatic secretions?

A

An exchanger transporter

2
Q

RCT for pprevention of colorectal cancer in patients with lynch syndrome reported 5 years CI of 4.2% in aspirin group and 6.9% in placebo group.

What measure is calculated as the inverse of the difference between the two incidence estimates?

A. NNT
B. CI
C. relative hazard
D. OR
E. Kaplan meir curve
A

A. NNT

3
Q

RCT for pprevention of colorectal cancer in patients with lynch syndrome reported 5 years CI of 4.2% in aspirin group and 6.9% in placebo group.

What can be used in a cox regression model to figure out confounding?

A. NNT
B. CI
C. relative hazard
D. OR
E. Kaplan meir curve
A

C. relative hazard

4
Q

It is used in treatment of acid reflux and may cause gynecomastia and galactorrhea?

A

Cimetidine

5
Q

A 9-year-old boy with a rectal polyp that is bleeding. After excision of the polyp, the biopsy showed dilated glands filled with mucin and inflammatory debris. What is the diagnosis?

A. Inflammatory polyp
B. Hyperplastic polyp
C. Sessile serrated adenoma
D. Hamartomatous polyp

A

D. Hamartomatous polyp

6
Q

A patient with Clostridium difficile infection is treated successfully with?

A. Clindamycin
B. Cephalosporin
C. Metronidazole

A

C. Metronidazole

7
Q

A 49-year-old woman, known case of rheumatoid arthritis on NSAIDs therapy, presents with recent weight gain. Upon examination there was massive ascites, and lower limb edema. Liver was palpable 3cm below costal margin. BP and vital signs were normal. She has Hypoalbuminemia and proteinuria (5gm/24 hrs). She had recently (few weeks before) traveled to South East Asia. What is the most likely of hepatomegaly?

A. Fatty liver disease
B. Acute hepatitis
C. Hepatic amyloidosis 
D. Autoimmune hepatitis 
E. NSAIDs induced
A

C. Hepatic amyloidosis

8
Q

Which nerve carry the efferent for the cremasteic reflex?

A. Subcostal n.
B. Lateral cutaneous n.
C. Genetofemoral n.
D. Ilioinguinal n.

A

C. Genetofemoral n.

9
Q

A biopsy of a polyp in a 49-year-old woman showed glands with finger like projection and dysplastic

A. Villous adenoma
B. Tubular adenoma
C. Invasive adenocarcinoma D. Hamartomatous polyp

A

A. Villous adenoma

10
Q

Which colonic polyp has the highest chance of malignant transformation on follow up?

A. Tubular polyp
B. Villous polyp
C. Inflamatory polyp 
D. Hypertrophic polyp 
E. Traditional serrated
A

B. Villous polyp

11
Q

Which of the following is used to confirm the diagnosis of colonic adenomas arising from colonic mucin polyp?

A. Positivefamilyhistory
B. Evidence of epithelial dysplasia on microscopy
C. Recurrence of polyp after polypectomy
D. Evidence of genetic mutations

A

B. Evidence of epithelial dysplasia on microscopy

12
Q

The bile duct is posterior to which part of the duodenum?

A. First part
B. Second part
C. Third part
D. 4th part

A

A. First part

13
Q

A tumor is compressing the structures that traverse jugular foramen. Decreased secretions of which gland may be observed in the patient?

A. lacrimal gland
B. submandibular gland
C. mucus glands innasopharynx
D. parotid gland

A

D. parotid gland

14
Q

A 15 years old case presented with elevated unconjugated bilirubin but no serious health problems

A

Gilbert’s syndrome

15
Q

A 32 years old women presents with stomach cancer and mucocutaneous pigmentation. Her family history is positive for breast and uterine cancer and STK11 mutation was found upon genetic testing. What is the diagnosis?

A. Peutz jeghers syndrome
B. Juvenile polyposis
C. HNPCC

A

A. Peutz jeghers syndrome

16
Q

A 42-year-old African American teacher presented with fresh blood in his stool. He mentioned that he has been diagnosed with hemorrhoids from sport staining. Everything else is normal. What would you suggest

A. occult blood
B. colonoscopy
C. Digital rectal exam
D. Flexible sigmoidoscopy

A

?

17
Q

Motor Incoordination of pharyngeal innervation causes swallowing difficulties in a middle aged women. Which muscles is the basis of this finding?

A. Cricopharyngues
B. Middleconstricter 
C. Thyropharyngues 
D. Palatopharyngues 
E. Stylopharyngeues
A

A. Cricopharyngues

18
Q

During a surgery for bowel perforation repair, ulcerated swollen peyer’s patches is seen in the terminal ileum of the patient. Which could be the cause?

A. salmonella typhi
B. Tb of th terminal ileum
C. Chron’s Disease

A

A. salmonella typhi

19
Q

what is the most common cause of pernicious anemia?

A. autommunity against intrinsic factor
B. irresponsible medication use

A

A. autommunity against intrinsic factor

20
Q

What forms superficial inguinal ring.

A. transversalis aponeurosis
B. external oblique aponeurosis 
C. internal oblique aponeurosis 
D. median umbilical ligament
E. medial umbilical ligament
A

B. external oblique aponeurosis

21
Q

Why famotidine reduces the effect of sucralfate?

A. Inhibition of protonpump
B. Inhibition of prostaglandin
C. Induces CYP450
D. Reduces the acidity of stomach

A

D. Reduces the acidity of stomach

22
Q

Receives the preganglionic sympathetic fibers from greater splanchnic nerve?

A. celiac ganglion
B. supperior mesentric ganglion 
C. inferior hypogastric plexus
D. aurebach’s plexus
E. missenier’s plexus
A

A. celiac ganglion

23
Q

After truncal vagotomy, how does the stomach continue to secrete gastrin?

A

Distention of the stomach activates the enteric nervous system

24
Q

A 63-year-old man with known chronic alcoholic liver disease, developed sudden ascites. On investigation, he had a 7 cm mass in the right lobe of his liver. What is going on?

A

Hepatocellular carcinoma

25
Q

Upon looking at a liver resection biopsy under the microscope, what makes you think of liver cell carcinoma?

A. irregular tumor border 
B. sizeofmore7cm
C. central scarring
D. Central necrosis
E. Surrounding cirrhotic tissue
A

E. Surrounding cirrhotic tissue

26
Q

What does the bile duct traverse through?

A. Hepatoduodenal ligament
B. Hepatogastric ligament

A

A. Hepatoduodenal ligament

27
Q

The internal oblique abdominal muscle contributes to the formation of which structure?

A. Deep inguinal ring
B. Inguinal ligament
C. Reflected inguinal ligament 
D. Conjoint tendon
E. Internal spermatic fascia
A

D. Conjoint tendon

28
Q

A cholecystectomy specimen showed multiple black stones. What is the possible history behind that?

A. advance age
B. Oralcontraceptives
C. insulin resistance
D. hereditary spherocytosis
E. Hormone replacement therapy
A

D. hereditary spherocytosis

29
Q

The low pH of the stomach antrum causes the release of which of the following?

A. Secretin
B. Somatostatin

A

B. Somatostatin

30
Q

Which of the following results in significant decrease of albumin?

A. Liver cirrhosis
B. HAV infection
C. NAFLD

A

A. Liver cirrhosis

31
Q

what divides the subphrenic space?

A. Coronary ligament
B. Falciform ligament

A

B. Falciform ligament

32
Q

A 9-month-old girl presents with 2 day history of fever, nausea, vomiting, and watery diarrhea. Stool sample showed rotavirus. Which of the following is the most appropriate management?

A. rotateq
B. Oral rehydration therapy
C. Isolation

A

B. Oral rehydration therapy

33
Q

A 54 year old man with long-standing sclerosing cholangitis developed a liver neoplasm that found by CT. A biopsy showed glandular epithelial malignant cell. What is the diagnosis?

A

Cholangiocarcinoma

34
Q

How will a surgeon know the part he is holding is the jejunum not theileum?

A. Long vasa recta
B. Many arcades
C. Fat pockets
D. Right iliac fossa

A

A. Long vasa recta

35
Q

What is the mechanism of action of Omepzarole?

A

Inhibiting H+/K+ ATPase on apical surface of parietal cells

36
Q

A 52-year-old male comes to routine physical examination. He feels well, has no significant medical history, no medication taken, no family history for colorectal cancer, with normal physical and complete blood count. However, he was positive for fecal occult blood test. What should be done next?

A. Colonoscopy
B. flexible sigmoidoscopy
C. repeat fecal occult test
D. digital rectal examination

A

A. Colonoscopy

37
Q

Tumor cells of parotid gland biopsy were laden with mitochondria. What is he diagnosis?

A. Oncocytoma
B. Adenoid cystic carcinoma
C. Warthin’s tumor
D. Pleomorphic adenoma

A

A. Oncocytoma

38
Q

What can be diagnosed without a liver biopsy?

A. Primary sclerosing cholangitis
B. Autoimmune hepatitis
C. NAFLD
D. Primary billiary cholangitis 
E. Drug induced hepatitis
A

?

39
Q

A patient experienced diarrhea after a long antibiotic course treatment? Which of the following could be the one?

A. Chloramphenicol
B. Metronidazole
C. clindamycin

A

C. clindamycin

40
Q

A surgeon dissected the mucosa and submucosa of the oropharyngeal lumen in a procedure to remove a retropharyngeal tumor. Which layer will he incise next?

A. Buccopharyngeal fascia 
B. Circularmusclelayer
C. Longitudinal muscle layer
D. pharyngobasilar fascia
E. Prevertebral fascia
A

D. pharyngobasilar fascia

41
Q

A 24 year old man developed diarrhea, abdominal cramps, nausea, and vomiting 4 hrs. after eating fried rice. What could be the possible causative agent?

A. B. cereus
B. S. aureus
C. C. Jejunei

A

A. B. cereus

42
Q

What is the most common source of vibrio parahemolyticus?

A

Seafood (shellfish)

43
Q

The postganglionic parasympathetic for the sublingual salivary gland pass through which nerve?

A

Lingual nerve

44
Q

What is released in response to low pH in duodenum?

A. Secretin
B. CCK

A

A. Secretin

45
Q

What is the most common cause of pernicious anemia?

A. autoimmunity against intrinsic factor
B. genetic mutation in transcobalamlin II

A

A. autoimmunity against intrinsic factor

46
Q

A squamous cell carcinoma of the esophagus was resected from a patient. The tumor has reached the muscularis propria and extended to lymph nodes with no metastasis. What is the TNM staging?

A. T1 N1 M1 
B. T2 N1 M0 
C. T3 N1 M1 
D. T4 N1 M0 
E. Tis N1 M0
A

B. T2 N1 M0

47
Q

Gastric antrum showed inflammation and intestinal metaplasia. What could be the cause?

A. H.Pyloriinfection
B. Autoimmune gastritis

A

A. H.Pyloriinfection

48
Q

What increases the amplitude and duration of slow waves in the stomach?

A. Ach
B. NE
C. Secretin

A

A. Ach

49
Q

An increase in the level of which solute at the microenvironment of enterocyte surface causes micelles to release digested fat products?

A. H+ ions
B. K+ ions
C. Cl- ions

A

A. H+ ions

50
Q

A 56-year-old female has undergone colonoscopy. A 2.5 flat polyp was found and taken out. When should the next surveillance colonoscopy happen?

A. 2-6moths
B. 1 year
C. 3 years
D. 5 years

A

C. 3 years

51
Q

What increases blood flow in the hepatic artery?

A. Low co2
B. Increased o2
C. increased post parandial Hyperosmolarity

A

C. increased post parandial Hyperosmolarity

52
Q

A young pathologist conducted a study on all past gallbladder primary malignant tumors of Kuwaiti subject. What tumor do you think the study will show most commonly?

A. liposarcoma
B. leimyoscarcoma
C. Malignant GIST
D. adenocarcinoma
E. non hodgkins lymphoma
A

D. adenocarcinoma

53
Q

Which group of lymph nodes ultimately collects lymph from the hepatobiliary system?

A. Celiac
B. Supperior mesenteric
C. Cystic
D. hepatic

A

A. Celiac

54
Q

A 22-year-old man developed diarrhea and abdominal pain 48 hours after eating undercooked barbecued chicken. What is the possible causative agent?
A. campylobacter jejuni
B. E. coli

A

A. campylobacter jejuni

55
Q

A 60-year-old man presented with loss of weight and craggy mass in the RUQ of abdomen with raised serum alpha fetoprotein. What is the possible diagnosis?

A. hepatic fibrosis
B. hepatic hyperbillirubenemia
C. post hepatic hyperbillirubenemia 
D. gilbert’s disease
E. hepatocellular carcinoma
A

E. hepatocellular carcinoma

56
Q

Retropulsion and grinding is the main movement of which organ?

A. espohagus
B. stomach
C. small intestines 
D. cecum
E. ascending colon
A

B. stomach

57
Q

What structure passes close to the submandibular duct?

A. Hypoglossal nerve
B. Lingual artery
C. Lingual nerve
D. Glossopharyngeal nerve 
E. Chorda tympani
A

C. Lingual nerve

58
Q

Which type of lingual papilla will show no taste buds under microscopy?

A. filiform
B. circumvillette
C. foliate
D. fungiform

A

A. filiform

59
Q

Which of the following factors is responsible for the copious secretions of the salivary gland?

A. Ach and VIP byparasympathetic
B. Ach and NE by sympathetic
C. NE and NO bysympathetic
D. NE and Ach by ANS

A

A. Ach and VIP byparasympathetic

60
Q

Which of the following nerves carry the efferent fiber for the gag reflex?

A. Internal laryngeal
B. Recurrent laryngeal
C. Hypoglossal
D. Vagus

A

D. Vagus

61
Q

A young man came for routine checkup. His serology showed: positive HbsAb but negative HCV Ab, HbsAg, HbeAg, and HbcAb. What is the diagnosis?

A

vaccinated

62
Q

A drug that relieves peptic ulcer disease caused by NSAIDS?

A

Misoprostil

63
Q

What lies in the submucosal layer of the intestines wall?

A

Meissner’s plexus

64
Q

A 55-year-old patient with a history of hepatitis had a mass of 4 cm in segment I of liver on CT. Which structure would help the surgeon to navigate the mass?

A. caudate lobe veins
B. middle hepatic vein
C. left hepatic vein
D. right hepatic vein
E. right portal vein
A

A. caudate lobe veins
B. middle hepatic vein

(A was the best answer; but B was also counted correctly by Dr. Narayana)

65
Q

what is the mechanism of action of metoclopramide as an antiemetic?

A. D2 receptor antagonist
B. 5-HT receptor antagonist

A

A. D2 receptor antagonist

66
Q

Which of the following is part of the innate immunity in the intestinal gut?

A. cytotoxic t cells
B. proteolytic enzymes
C. IgA

A

B. proteolytic enzymes

67
Q

What binds to 5-HT3 receptor?

A

ondansetron

68
Q

Which of the following absorbs the highest amount of water in the GI tract?

A. small intestine
B. esophagus
C. colon
D. D stomach

A

A. small intestine

69
Q

A 4-month-old boy presented with sudden onset of low-grade fever, vomiting, watery diarrhea, severe dehydration. A stool sample was examined under electron microscope and showed wheel like virus. What is the most likely cause?

A. astrovirus
B. rotavirus
C. enteric adenovirus
D. norovirus

A

B. rotavirus

70
Q

A gastric tumor showed spindle cells in histology. What is the possible diagnosis?

A

GIST

71
Q

Which congenital abnormality is associated with excessive growth of tissue around the second part of the duodenum?

A

Annular Pancreas

72
Q

After eating, the stomach PH increases even though acid secretion increases. What is the reason behind this?

A

the buffering effect of food

73
Q

Women presented rectal incontinence after giving birth. Constrast radiograph showed reduced angulation between rectum and anal canal. Which muscle is most likely affected?

A. Puborectalis
B. Iliococcygeus
C. Ischiococcygeus
D. Internal anal sphincter

A

A. Puborectalis

74
Q

Distension of the rectum by the fecal matter induces contraction of the rectum. This is followed by relaxation of the internal anal sphincter and contraction of the external anal sphincter. Which of the following happens next to maintain continence?

A. Contraction of the rectum
B. Relaxation of the rectum (Anorectal reflex)

A

B. Relaxation of the rectum (Anorectal reflex)

75
Q

Which of the following happens in the anal sinus?

A. cryptitis
B. anal fistula
C. anal fissure

A

A. cryptitis

76
Q

Which of the following is a H/K ATPaseblocker?

A

Omeprazole

77
Q

When a patient was administered 100g of oral glucose, his blood glucose went up by 20%. However, when he was orally administered 200g of lactose, his blood glucose did not change. What does that suggest?

A. the liver doesn’t utilize lactose
B. lactose do not change the serum glucose level
C. lack of the enzyme lactase in the enterocyte brush border

A

C. lack of the enzyme lactase in the enterocyte brush border

78
Q

what is the function of the collagen table in the large intestine?

A. Controls of amount of lymphoid tissue
B. Provides rigidity for the lamina propria
C. Supports the lymphatic tissue
D. Supports the basal lamina
E. Absorbs water into the venules
A

E. Absorbs water into the venules

79
Q

A randomized control trial to assess the effect of aggressive vs usual BP control therapy showed the following results:
1- year CI of stroke:
- Aggressive therapy = 0.065
- Usual therapy = 0.116

In what range is the Number needed to treat (NNT) for one year to prevent one stroke?

A. 0-5
B. 10-20
C. 40 – 60
D. 60 100
E. NNT cannot be calculated
A

B. 10-20

80
Q

What arises from an imbalance between the gastric mucosal defenses and acid secretion?

A

Peptic ulcer

81
Q

A patient presented with multiple pustules on his oral mucosa. What could be the diagnosis?

A. Erythema Multiforme
B. Chron’s disease
C. Lichen planus

A

B. Chron’s disease

82
Q

Which tumor is responsive to a kinase inhibitor?

A. Esophageal adenocarcinoma
B. Linitis plastica
C. GIST

A

C. GIST

83
Q

What is the mechanism by which bile acid is secreted into the bile canaliculi?

A

Primary active transport

84
Q

What is a slit like lesion of the anal mucosal canal?

A. Anal fissure
B. Anal hemorrhoids

A

A. Anal fissure

85
Q

Which of thefollowing is a pancreatic tumor that common in women and resection usually is curative even if there were evidence of dysplasia?

A

Solid pseudopapillary neoplasm

86
Q

The mesentery of this organ is related to the common iliac artery?

A. Sigmoid colon
B. Transverse colon
C. Ascending colon
D. Descending colon

A

A. Sigmoid colon

87
Q

The mesentery of this organ is related to the anterio-inferior surface of the pancreas?

A. Sigmoid colon
B. Transverse colon
C. Ascending colon
D. Descending colon

A

B. Transverse colon

88
Q

Which of the following deficiencies causes macrocytic anemia?

A. Vit B12
B. Iron
C. Vit E

A

A. Vit B12

89
Q

Which mutation is responsible for the late transformation of adenoma to carcinoma?

A. P53
B. APC
C. MHL

A

A. P53

90
Q

Which of the following the mode of transmission for shigella?

A. Infected people
B. Unsanitary water

A

A. Infected people

91
Q

What is used to confirm an ameobic infection in serology?

A. Antibodies
B. Anitgens

A

A. Antibodies

92
Q

What is the mutation in in HNPCC?

A

MLH1

memorize the whole genes properly because they were quite tricky XD

93
Q

An immunocompromised person consumed a raw liver delicacy. Subsequently, he developed viral hepatitis. What is the probable virus?

A. HAV 
B. HBV 
C. HCV 
D. HDV 
E. HEV
A

E. HEV

94
Q

What is the mechanism by which each compound affects the feeding behavior?
Ghrelin:

A. Decrease food intake by stimulating POMC neurons in arcuate nucleus
B. Stimulate food intake by inhibiting oxytocinogenic neurons in PVN
C. Stimulates food intake by stimulating lateral hypothalamus (LH)

A

B. Stimulate food intake by inhibiting oxytocinogenic neurons in PVN

95
Q

What is the mechanism by which each compound affects the feeding behavior?
Serotonin:

A. Decrease food intake by stimulating POMC neurons in arcuate nucleus
B. Stimulate food intake by inhibiting oxytocinogenic neurons in PVN
C. Stimulates food intake by stimulating lateral hypothalamus (LH)

A

A. Decrease food intake by stimulating POMC neurons in arcuate nucleus

96
Q

What is the mechanism by which each compound affects the feeding behavior?
AGRP:

A. Decrease food intake by stimulating POMC neurons in arcuate nucleus
B. Stimulate food intake by inhibiting oxytocinogenic neurons in PVN
C. Stimulates food intake by stimulating lateral hypothalamus (LH)

A

C. Stimulates food intake by stimulating lateral hypothalamus (LH)

97
Q

Which of the following is true about chronic pancreatitis? (query)

A. Alcoholism, but not smoking, is a risk factor
B. Development of jaundice indicates a malignant transformation
C. One third of the patient complains of steatorrhea with no abdominalpain
D. 4-5% of the patients develop pancreatic cancer
E. steatorrhea benefits more from pain medication than enzyme replacement

A

?

98
Q

A 67-year-old patient presented with complaints of fatigue, pallor, and iron deficiency anemia. During physical examination, a 7 cm mass was found in his liver. What is the next step of management?

A. Check seruma-fetoprotein
B. Perform a Colonoscopy

A

B. Perform a Colonoscopy

99
Q

An infant presented with a mass in the middle of his spermatic cord. The diagnosis was based on the idea that his processus vaginalis did not close properly. Which of the following is the diagnosis?
A. Hydrocele of the testes
B. Hydrocele of the spermatic cord
C. Indirect hernia

A

B. Hydrocele of the spermatic cord

100
Q

After eating a rich meal, what inhibits further eating desire?

A. Stimulation of Nucleus tractus solitarius (NTS) by Vagus
B. Insulin stimulation of POMC

A

A. Stimulation of Nucleus tractus solitarius (NTS) by Vagus

101
Q

Which of the following organization is based on the exocrine functions of the liver?

A. Classic lobule
B. Portal lobule
C. Liver acinus

A

B. Portal lobule

102
Q

Where is the suspensory muscle of the duodenum attached?

A. 1st part of the duodenum
B. 2nd part of the duodenum
C. 4th part of the duodenum
D. Duodenojeujenal flexure

A

D. Duodenojeujenal flexure

103
Q

Which of the following tumors shows perineural invasion?

A

Adenoid cystic carcinoma of the salivary glands

104
Q

Which clotting factor is not synthesized in the hepatocytes?

A. Factor VIII
B. Factor VII
C. Factor X

A

A. Factor VIII

105
Q

Which of the following is the treatment for chronic HCV infection?

A

Protease inhibitors

106
Q

Which species predominates in the distal colon?

A

Anaerobes

107
Q

What is the most important and effective way to control enteric fever?

A. Provide clean water
B. Vaccinate the infection

A

A. Provide clean water

108
Q

Which of the following is the causative agent of traveler’s diarrhea?

A. ETEC
B. EPEC
C. EIEC
D. EHEC

A

A. ETEC

109
Q

Which of the following is a side effect of IBD management?

A

Osteoporosis secondary to corticosteroids