2016 module exam

Question 1

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

Answer 1

An exchanger transporter

Question 2

A lady had an accident and got her left mandible fractured and the left hypoglossal nerve injured. What will be the effect?

a. Deviation of the tongue to the left upon protrusion
b. Loss of sensation in the anterior 2/3rds of the tongue
c. Deviation of the uvula to the left

Answer 2

a. Deviation of the tongue to the left upon protrusion

Question 3

A slow growing tumor deep in the parotid gland has compressed structures within the gland. Pulse in which artery will be decreased?

a. Facial artery
b. Lingual artery
c. Superficial temporal
d. Superior thyroid

Answer 3

c. Superficial temporal

Question 4

A patient undergone removal of glandular tissue, problem with removing his tongue, which gland was removed?

a. Sublingual gland
b. Parotid gland
c. Buccal glands
d. Submandibular gland

Answer 4

d. Submandibular gland

Question 5

You examined a pancreatic and a parotid gland under the microscope, what will differentiate between the two?

a. Centroacinar cells in pancreas and striated ducts in parotid
b. Striated ducts in the pancreas while centroacinar cells are seen in the parotid

Answer 5

a. Centroacinar cells in pancreas and striated ducts in parotid

Question 6

A patient feels pain in the lower right second molar tooth, which nerve is responsible for the pain
sensation?

a. Maxillary nerve
b. Lingual nerve
c. Inferior alveolar

Answer 6

c. Inferior alveolar

Question 7

Upon tonsillectomy, the patient developed dysphagia and swallowing difficulty. Which nerve was affected?

a. Glossopharyngeal nerve
b. V agus nerve
c. Hypoglossal nerve

Answer 7

a. Glossopharyngeal nerve

Question 8

A surgeon wants to remove lymph nodes located in the retropharangyeal space because of cacer metastasis. He started from the lumen, What is the outermost layer he must incise before reaching the lymph nodes?

a. mucosa
b. submucosa
c. pharyngobasilar
d. buccopharyngeal

Answer 8

d. buccopharyngeal

Question 9

a surgeon removed a part of the thoracic esophagus and damaged a nerve. What will happen as a result?

a. Increased gastric motility
b. Decreased gastric motility
c. Decreased peristalsis of sigmoid colon
d. Increased peristalsis of sigmoid colon
e. Closure/contraction of pyloric sphincter

Answer 9

b. Decreased gastric motility

Question 10

Hernia covered with the covering of the spermatic cord

. Femoral hernia

b. Direct inguinal hernia
c. Indirect inguinal hernia

Answer 10

c. Indirect inguinal hernia

Question 11

What is the efferent nerve fiber for the cremasteric reflex?

a. Iliohypogastric nerve
b. Genitofemoral nerve
c. Lateral cutaneous nerve of the thigh
d. Subcostal nerve

Answer 11

b. Genitofemoral nerve

Question 12

Infection from appendicitis reached the subphrenic recess. How?

Answer 12

Paracolic gutter

Question 13

Patient suffers from epigastric pain and left shoulder pain. He suffers from gastritis and gastric ulcer with posterior perforation. What is responsible for the pain in the left shoulder?

a. Occlusion of artery in the lesser curvature of the stomach
b. Injury to posterior gastric nerve
c. Involvement of the thoracic splanchnic nerves
d. Peritonitis
e. Splenic enlargement that is compressing the stomach

Answer 13

d. Peritonitis

Question 14

A middle-aged man with PUD in the first part of the duodenum, presented with peritoneal
bleeding in the abdominal cavity. What artery is affected?

a. Splenic artery
b. Anterior superior pancreatiduodenal artery
c. Gastroduodenal artery
d. Left gastric artery

Answer 14

c. Gastroduodenal artery

Question 15

What is secreted by the parietal cells?

Answer 15

HCl and intrinsic factor

Question 16

Which congenital abnormality is associated with excessive growth around the 2nd part of the
duodenum?/ narrowing of the second part of the duodenum and dilation of the first part?

Answer 16

Annular pancreas

Question 17

A student was looking at a hepatocyte under an electronic microscope she identified an organelle with circular profile, membrane-bounded tubules. which organelle was that?

a. lysosome
b. peroxisome
c. rough endoplasmic reticulum
d. smooth endoplasmic reticulum

Answer 17

d. smooth endoplasmic reticulum (the answer is confirmed by medical education
department)

Question 18

A student was looking at a hepatocyte under an electronic microscope she identified a cell with a
fat droplet in the perisinusoidal space

a. Kupffer cells
b. Stellate cells

Answer 18

b. Stellate cells

Question 19

Peritoneal impression in the visceral surface of the liver segments V-Vlll (causing a prominent line) just lateral to the gallbladder. Relation to which organ?

a. Right kidney
b. Right colic flexure
c. Right suprarenal gland
d. Descending part of the duodenum

Answer 19

a. Right kidney (the answer is confirmed by medical education department)

Question 20

Solutes in ileum are actively transported from lumen to lamina propria, which structural feature necessities the phenomenon?

a. Impermeable tight junction
b. presence of Microvilli
c. presence of numerous goblet cell
d. presence of intracellular space

Answer 20

a. Impermeable tight junction

Question 21

How do surgeons locate the appendix?

Answer 21

Confluence of tenia coli

Question 22

Woman presented with rectal incontinence after giving birth. Contrast radiograph shows reduced angulation between rectum and anal canal. Which muscle is mostly affected?

a. Iliococcygeus
b. Puborectalis
c. Ischiococcygeal
d. Internal anal sphincter

Answer 22

b. Puborectalis

Question 23

What oral tumor is the end result of notch1 p53 p63?
a. Oral squamous cell carcinoma

b. Salivary gland adenocarcinoma

Answer 23

b. Salivary gland

Question 24

Which of the following is known as pregnancy tumor?

Answer 24

Pyogenic granuloma

Question 25

A histology of a salivary gland showed cystic glandular spaces embedded in dense lymphoid tissue (know that they also have oncocytes)

Answer 25

Warniths tumor

Question 26

Endoscopy in a 43-yo man showed white patches in mid-esophagus. A biopsy of this lesion would show? a. Candida esophagitis b. Squamous papilloma c. Adenocarcinoma d. Reflux esophagitis

Answer 26

a. Candida esophagitis (the answer is confirmed by medical education department)

Question 27

Severe coughing spells interfering with breathing after eating observed in a neonate. Further, the baby had frequent pulmonary infections and bouts of abdominal bloating. Which of the following may be the cause of the above symptoms? a. Annular pancreas b. Tracheoesophageal fistula c. Inversion of pancreatic duct d. Malrotation of the gut

Answer 27

b. Tracheoesophageal fistula

Question 28

What is the mechanism of diet-induced carcinogenesis? a. Inhibition of h. Pylori b. Production of nitrosamines c. Inhibition of IGF1

Answer 28

b. Production of nitrosamines

Question 29

A 54 y/o man with epigastric pain that improves with eating. Endoscopy shows duodenal ulcer and antral gastritis. Biopsy of the antrum shows lymphocytic tissue with gram negative rods. a. Duodenal carcinoma b. Peptic ulcer c. Chronic atrophic gastritis d. MALT lymphoma

Answer 29

b. Peptic ulcer

Question 30

A 30 y/o male presented with heartburn that occurs after eating large meals. Endoscopy of the esophagus showed tongue-like projections in the lower 1/3rd of the esophagus. Biopsy showed columnar metaplasia. What is the diagnosis?

Answer 30

GERD (it can also be barret esophagus but it wasn’t among the choices)

Question 31

What is the cause of malnutrition in inflammatory bowel diseases? a. Anorexia due to inflammatory cytokines b. Diet restrictions due to steroid intake c. Maldigestion due to TNF and IL-6 d. Malabsorption due to alteration of intestinal flora

Answer 31

a. Anorexia due to inflammatory cytokines (the answer is confirmed by medical education department)

Question 32

Which immune factor is found around the bile ducts in primary biliary cirrhosis? a. Mast cells b. T helper cells c. Natural killer cells d. B cells

Answer 32

b. T helper cells

Question 33

A 62-year-old woman with stomach tumor size 6x6x7cm with histological spindle shape cells and positive for CD117. What is it?

Answer 33

GIST

Question 34

A 40 y/o woman with epigastric pain for 3 months, GI endoscopy of the anterior wall showed ulcer in the first part of the duodenum what is the most likely pathogen? a. H pylori b. Acanthus c. Herpes simplex

Answer 34

a. H pylori

Question 35

Which of the following is the oncogene most commonly mutated in sporadic colorectal carcinoma? a. P53 b. K-ras c. C-kit d. C-myc

Answer 35

b. K-ras

Question 36

Which mutations of tumor suppressor genes are found in both sporadic and familial CRC? a. APC and P53 b. K-RAS and SMAD4

Answer 36

a. APC and P53

Question 37

Loss of rugae, thick stomach wall, and signet cells?

Answer 37

Poorly differentiated diffuse gastric carcinoma

Question 38

A polyp was found on colonoscopy. On histology, it was star shaped with no dysplasia. What is it? a. Inflammatory polyp b. Hyperplastic polyp c. Sessile adenoma d. Tubular adenoma

Answer 38

b. Hyperplastic polyp

Question 39

A patient with past history of ulcerative colitis presents with ..... on radiological examination, the colon is enlarged so colectomy was carried out. A biopsy is taken and seen under the microscope. What is the greatest evidence that this is ulcerative colitis? a. Perforation b. Inflammation limited to mucosa and submucosa c. Non caseating granulomas

Answer 39

b. Inflammation limited to mucosa and submucosa

Question 40

Female with a mass, Positive for CD20 and on histology shows lymphocytes a. Follicular gastritis b. Gastric carcinoid c. MALT lymphoma

Answer 40

c. MALT lymphoma

Question 41

Female taking NSAIDS for her osteoarthritis. Biopsy of stomach will show:

Answer 41

reactive gastritis with minimal inflammation

Question 42

When do all of the clinical manifestations in typhoid fever begin? a. After penetration of the mesenteric lymph nodes b. After penetration of the ileal mucosa

Answer 42

b. After penetration of the ileal mucosa

Question 43

What is the gene that is usually mutated in HNPCC? a. MSH1 b. APC c. MLH1 d. SMAD4

Answer 43

c. MLH1

Question 44

What is a consequence of reduced intake of dietary essential amino acids? a. Increase excretion of protein in form of urea b. Decrease excretion of protein in form of ammonia c. Compensatory reduction in protein degradation d. Decreased protein synthesis

Answer 44

d. Decreased protein synthesis

Question 45

Bands of fibrous tissue and nodularity in the liver with absence of central vein?

Answer 45

cirrhosis

Question 46

What vitamin deficiency is associated with kwashiorkor? a. Vitamin A b. Vitamin B12 c. Vitamin C d. Vitamin B1

Answer 46

a. Vitamin A

Question 47

What form of vitamin B12 is used to fortify/supplement food? a. Folic acid b. Cyanocobalamin c. Methylcobalamin d. Transcobalamin 1

Answer 47

b. Cyanocobalamin

Question 48

Which of the following may cause pernicious anemia? a. A higher intake of cyanocobalamin b. A deficiency in immunoglobulin A c. Immunity against intrinsic factor d. Mutation in transcobalamin ll gene

Answer 48

c. Immunity against intrinsic factor

Question 49

Which step of metabolism is defected that causes dark liver (Dubin Johnson Syndrome)? a. Conjugation b. Hepatocyte uptake c. Ligand binding d. Secretion in bile canaliculi

Answer 49

d. Secretion in bile canaliculi

Question 50

This signaling cascade is initiated by a product of heme metabolism. What is the enzyme and what is the product? a. Biliverdin reductase; carbon monoxide b. Heme oxygenase; carbon monoxide

Answer 50

b. Heme oxygenase; carbon monoxide

Question 51

A patient who suffered a cerebrovascular attack now presented with chocking, food regurgitation into the nose. What is the appropriate method of diagnosis? a. GI endoscopy b. Modified barium swallow c. Esophageal motility

Answer 51

b. Modified barium swallow

Question 52

A physician is a non-responder to the HBV vaccine had a needle stick injury when dealing with an HBV positive patient. What will be the post-exposure prophylaxis? a. Adenofovir b. HBIG c. HB vaccine

Answer 52

b. HBIG

Question 53

A lady visited the clinic for regular checkup. Her height was 162cm and weight 95 kg. Her profile showed (we had a table with the results and the normal ranges) : high ALT (72), AST(75), ALP, and globulins. Normal GGT and CBC. Blood glucose high (9.5). What does she have? a. Autoimmune chronic active hepatitis b. Non-alcoholic steatohepatitis

Answer 53

b. Non-alcoholic steatohepatitis

Question 54

A 21-year-old female presented with steatorrhea, anemia, and weight loss. Rash of extensor of her forearm and elevated tTG. What is your next step to diagnose the patient? a. D-xylose test b. Endoscopy with biopsy c. Gluten-free diet d. Antibody tests

Answer 54

b. Endoscopy with biopsy

Question 55

A 52 y/o woman known case of gallstones admitted due to sudden upper abdominal pain with jaundice and low-grade fever. Then she went on circulatory shock and found an ecchymosis on the flank. What is the diagnosis? a. Recurrent biliary colic b. Acute pancreatitis c. Intestinal hemorrhage

Answer 55

b. Acute pancreatitis

Question 56

Responsible for the immunological response in celiac disease? a. Th1 reactivity to gluten b. Cytotoxic T cell reaction to gluten c. Immune complex mediated d. Antibodies against intrinsic factor

Answer 56

a. Th1 reactivity to gluten

Question 57

Normal level of total bilirubin is commonly found in: a. Acute hepatitis b. Hemochromatosis c. Hepatic tumors d. Gilbert syndrome

Answer 57

c. Hepatic tumors (the answer is confirmed by medical education department)

Question 58

A long history of a woman tested positive for anti-ANA, anti-SMA, as well as anti-mitochondrial antibodies. She responded well to corticosteroids. What is the diagnosis? a. Primary biliary cirrhosis b. Autoimmune hepatitis

Answer 58

b. Autoimmune hepatitis

Question 59

A 21-year-old woman complains of fever, malaise, abdominal pain for 1 week duration. She returned from India 3 weeks ago. She has slightly elevated AST and ALT. Which will be found on testing? a. IgM HAV b. IgM HCV c. IgG hepatic biliary sclerosis

Answer 59

a. IgM HAV

Question 60

A patient presented with RUQ pain, jaundice, dark urine, and clay colored stool. What is the cause of the pale stool? a. Absence of urobilinogen in intestines b. Increased direct bilirubin in plasma

Answer 60

a. Absence of urobilinogen in intestines

Question 61

A 52-year-old female has undergone colonoscopy. A 2.5cm flat polyp was found and removed. When should the next surveillance colonoscopy happen? a. 2-6 months b. 1 year c. 3 years d. 5 years e. 3 months

Answer 61

c. 3 years

Question 62

What reflects the function of liver anion transport? a. Albumin b. Bilirubin c. Haptoglobin d. Transferrin

Answer 62

b. Bilirubin

Question 63

A 40-year-old patient presented with a history of gallstones, presented with epigastric pain, examination revealed no bowel sounds and guarding. We were given a table with all vital signs being normal except for mild tachycardia. Amylase>5000 and pO2 is low. What is the diagnosis? a. Cholecystitis b. Pancreatitis c. Pneumonitis d. Hepatitis

Answer 63

b. Pancreatitis

Question 64

A 27-year-old male had liver transplantation 4 months ago complaining of (vomiting, nausea, fever, jaundice....) he recently traveled to France and ate raw delicacies. What is the most likely diagnosis? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis D e. Hepatitis E

Answer 64

e. Hepatitis E

Question 65

A 30-year-old woman with abdominal pain, jaundice, fever for one week. She had cosmetic surgey 3 weeks before, in Thailand. She was tested for HBV and the results showed: HBsAg+, HBeAg+, HBc IgM+, total HBcAB-, HBsAb-, what does she have? a. Chronic hepatitis with high infectivity b. Acute hepatitis B c. Recovered from previous infection d. V accinated

Answer 65

b. Acute hepatitis B

Question 66

What is the treatment of choice for enteric fever? a. Ciprofloxacin b. Cephalosporins c. Clindamycin d. Cefotaxime

Answer 66

a. Ciprofloxacin

Question 67

What is the etiological agent of enteric fever? a. Salmonella typhi b. Campylobacter jejuni c. Salmonella enteritidis d. Entamoeba histolytica

Answer 67

a. Salmonella typhi

Question 68

Which of the following organisms causes Hemolytic Uremic Syndrome?

Answer 68

Verotoxygenic E. Coli

Question 69

``` A 31-year-old man was found to have elevated liver enzyme (ALT 1200) during his regular checkup for liver enzymes. He had history of unprotected sexual intercourse 6 months ago. He was screened for HBV and HCV. HCVab -ve HBsAg +ve HBeAg +ve HB anti-core abs +ve HBeAb -ve HBsAb -ve ``` a. Chronic HBV with high infectivity b. Acute hepatitis c. Chronic HBV with low infectivity d. Recovery

Answer 69

a. Chronic HBV with high infectivity

Question 70

Treatment of C.difficile? a. Clindamycin b. Cephalosporin c. Metronidazole

Answer 70

c. Metronidazole

Question 71

What is the function of M cells in intestinal epithelial layer?

Answer 71

Ingests antigens and transports them from surface to wall

Question 72

What is the most common source of Shigella? a. Undercooked chicken b. Fried rice c. Humans d. Shellfish

Answer 72

c. Humans

Question 73

A 3-year-old presented with pyrexia of unknown origin a. Salmonella typhi b. Shigella Sonei

Answer 73

a. Salmonella typhi

Question 74

A man came with severe watery diarrhea due to consumption of shellfish. What is the causative organism?

Answer 74

Vibrio parahemolyticus

Question 75

What is the type of bacteria in stomach? a. Acid-tolerant lactobacilli b. Bacterioides c. Coliforms

Answer 75

Acid-tolerant lactobacilli

Question 76

Improvement in the sanitation chain will help reduce which viral disease? a. Hepatitis A b. Hepatitis B c. Hepatitis C

Answer 76

a. Hepatitis A

Question 77

Which of the following is contraindicated in pregnancy? a. Promethazine b. Misoprostol

Answer 77

b. Misoprostol

Question 78

What drug is used to treat acetaminophen hepatotoxicity? a. Halothane b. N-acetylcystein c. Isoniazid d. Rifampicin

Answer 78

b. N-acetylcystein

Question 79

Which drug can result in hepatotoxicity in both fast and slow acetylators? a. Acetaminophen b. Isoniazid

Answer 79

b. Isoniazid

Question 80

Which of the following drugs can cause galactorrhea and gynecomastia? a. Dicyclominine b. Misoprostol c. Cimetidine d. Omeprazole

Answer 80

c. Cimetidine

Question 81

What is the mechanism of action of lactulose? a. Forms a bulky hydrated mass in the gut b. Retains fluid in the bowel lumen by osmosis

Answer 81

b. Retains fluid in the bowel lumen by osmosis

Question 82

Which of the following is a H/k ATPase blocker?

Answer 82

Omeprazole

Question 83

A patient with duodenal ulcer presented with hematemisis, electrocautry was done to treat the ulcer. What will you administer at this stage? a. Omeprazole b. Ranitidine c. Somatostatin d. Sucralfate

Answer 83

a. Omeprazole (the answer is confirmed by medical education department)

Question 84

Which drug can cause hepatotoxicity due to immunological reaction? a. Acetaminophen b. Halothane

Answer 84

b. Halothane

Question 85

Which drug is used for gastric damage caused by NSAIDs? a. Misoprostol b. Bismuth subsalicylate

Answer 85

a. Misoprostol

Question 86

Which of the following factors is responsible for the copious secretions of the salivary gland? A. Ach and VIP by parasympathetic B. Ach and NE by sympathetic C. NE and NO by sympathetic D. NE and Ach by ANS

Answer 86

A. Ach and VIP by parasympathetic

Question 87

A patient with liver disease develops peripheral edema. What is the underlying mechanism? a. Decreased plasma colloid osmotic pressure b. Increased plasma colloid osmotic pressure c. Decreased tissue colloid osmotic pressure d. Increased tissue colloid osmotic pressure

Answer 87

a. Decreased plasma colloid osmotic pressure

Question 88

High activity of fibers that secrete VIP on LES smooth muscle but vagal cholinergic fibers show no action potential. What does it indicate? 1. LES maintaining resting tone 2. Over tightening of LES 3. LES relaxation 4. Absence of ANS control (*not sure*)

Answer 88

3. LES relaxation

Question 89

Main function of bile acids a. Emulsify fat b. Hydrolyze fa

Answer 89

a. Emulsify fat

Question 90

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+)

Answer 90

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

Question 91

A manometer is inserted into the patient’s mouth passing through the pharynx, UES, esophageal body, and LES. What are the pressure readings? a. 0 --> 50 --> 0 --> 30 b. 50-->30-->0-->0 c. 0-->30-->0-->50

Answer 91

a. 0 --> 50 --> 0 --> 30

Question 92

Distension of the rectum by the fecal matter induces contraction of the rectum. This is followed by relaxation of the internal anal sphincter. If defecation is desired, the rectum will relax. What reflex is responsible for that? a. Clonorectal b. Anorectal c. Rectorectal d. Rectosphinctric

Answer 92

b. Anorectal

Question 93

What increases blood flow in the hepatic artery? a. Low CO2 in portal vein b. Low O2 in portal vein c. High pH in portal vein d. Increased blood flow of portal vein

Answer 93

b. Low O2 in portal vein

Question 94

What increases the amplitude and duration of slow waves in the stomach? a. Ach b. NE c. Secretin

Answer 94

a. Ach

Question 95

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

Answer 95

a. H+ ions

Question 96

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? 1. the liver doesn’t utilize lactose 2. lactose does not change the serum glucose level 3. lack of the enzyme lactase in the enterocyte brush border

Answer 96

3. lack of the enzyme lactase in the enterocyte brush border Note: in our exam galactose was instead of lactose. I think it was a mistake, the doctor said he will check the question!

Question 97

What happens if there is distention of the cecum? a. Stimulation of peristalsis in the ileum b. Closure of the ileocecal valve c. Reverse peristalsis in the colon

Answer 97

b. Closure of the ileocecal valve

Question 98

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 d. Trachea

Answer 98

a. Colon

Question 99

Pancreatic enzymes are first secreted as pro-enzymes to prevent destruction of the pancreatic tissue; they then get activated in the small intestine. What is the initiating event leading to the activation of these enzymes? 1. Activation of trypsinogen by brush border enterokinase 2. Activation of enterokinase by trypsin

Answer 99

1. Activation of trypsinogen by brush border enterokinase

Question 100

The pancreatic fluid is released into the small intestine during which phase of digestion? 1. Basal 2. Intestinal 3. Gastric 4. Cephalic

Answer 100

2. Intestinal

Question 101

What is a characteristic of peristalsis in the small intestine? 1. it involves the contraction of the inner circular layer and relaxation of outer longitudinal layer in front of the food bolus 2. it involves the contraction of the inner circular layer and relaxation of outer longitudinal layer behind the food bolus 3. mixes the food bolus 4. it is innervated by the central nervous system (CNS)

Answer 101

2. it involves the contraction of the inner circular layer and relaxation of outer longitudinal layer behind the food bolus

Question 102

The lowest intensity of segmental contractions in normal colonic and rectal motility? 1. Transverse colon 2. Descending colon 3. Upper rectum 4. Lower rectum

Answer 102

4. Lower rectum

Question 103

An instrument was inserted into the intestine of a dog to measure the electrical activity of the GI tract. Intense bursts of electrical activity were recorded, which took place every 90 minutes while fasting. What do these waves represent?

Answer 103

Migrating myoelectric complex

Question 104

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

Answer 104

Primary active transport

Question 105

What needs further processing before being absorbed by the intestinal epithelium? 1. Sucrose 2. Glucose 3. Galactose 4. Tri and di peptides

Answer 105

1. Sucrose