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Flashcards in 2018 module exam Deck (77)
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1
Q

Which nerve is injured in appendectomy leading to numbness in groin area?

a) Genitofemoral
b) Iliohypogastric
c) Femoral

A

b) Iliohypogastric

2
Q

Which anatomical landmark do surgeons use to locate the appendix?

a) iliocecal junction
b) confluence of taenia coli

A

b) confluence of taenia coli

3
Q

which nerve carries preganglionic parasympathetic fibers to the hindgut?

A- pelvic splanchnic nerve
B- greater splanchnic nerve
C- lesser splanchnic nerve
D- illiohypogastric

A

A- pelvic splanchnic nerve

4
Q

Neonate with feeding intolerance and gastric distension following breastfeeding. Investigations show narrowing of the 2nd part of the duodenum with subsequent dilation of
the first part of the duodenum. What is this congenital anomaly?

a) Omphalocele
b) vitiline fistula
c) tracheoesophageal fistula
d) annular pancreas

A

d) annular pancreas

5
Q

Which peritoneal reflection connects the stomach with the transverse colon?

a) lesser ommentum
b) greater ommentum
c) Gastrophrenic ligament

A

b) greater ommentum

6
Q

Which two structures lie in the the imaginary plane that divides the functional right and
left lobes of the liver?
A. Fossa of gall bladder & round ligament of liver
B. Falciform ligament & ligamentum venosum
C. Fossa of gall bladder & IVC
D. Falciform ligament and right hepatic vein

A

C. Fossa of gall bladder & IVC

7
Q

What is the weakest part of the pharynx?

A. Sinus of morgagni
B. Killian’s dihiscence
C. Pyriformis fossa
D. Pharyngeal recess

A

B. Killian’s dihiscence

8
Q

Portal HTN in a patient with alcoholic cirrhosis, the doctors plan to do a bypass between
the portal and caval system. Which is the best bypass plan?
a) Inferior mesenteric vein & splenic vein
b) splenic vein & left renal vein
c) superior rectal and middle rectal vein

A

b) splenic vein & left renal vein

9
Q

-What is the location of a direct hernia?

a) Deep inguinal ring
b) Medial inguinal fossa
c) Lateral inguinal fossa
d) Superficial inguinal ring

A

b) Medial inguinal fossa

10
Q

35 Years old patient with right 2nd right molar mandible pain due to dental caries.
What nerve is responsible for this central pain ?
a) Bucal
b) Inferior alveolar
c) maxillary
d) lingual

A

b) Inferior alveolar

11
Q

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

A

c) Superficial temporal

12
Q
what marks the junction in the anal canal between the mucosa of the GIT and external
keratinized squamous epithelium?
a) transitional zone
b) White line
c) Pectineate line
A

b) White line
“The anocutaneous line/white line represents the transition point from non-keratinized
stratified squamous epithelium of the anal canal to keratinized stratified squamous
epithelium of the anus and perianal skin.”

13
Q

What is the function of M cells?

a) transport antigens
b) act as antigen presenting cells

A

M cells?

a) transport antigens

14
Q

Which rotavirus group is the predominant worldwide?

a) Rotavirus A
b) Rotavirus B
c) Rotavirus C
d) Rotavirus D

A

a) Rotavirus A

15
Q

An immune compromised person presents with diarrhea after eating raw eggs

A

salmonella

16
Q
A female with a history of renal transplant 3 months ago, went to France 3 weeks ago
and ate raw delicacies.
a) HEV
b) HBV
c) HCV
d) HDV
A

a) HEV

17
Q

What is the most appropriate treatment for a patient with HDV superinfection who is
also a HBV carrier and an IV drug abuser?
a) protease inhibitors
b) limevurdin
c) tenoforin
d) interferon

A

d) interferon

18
Q

67 years old male developed nausea, vomiting and abdominal cramps 6 hrs after eating a
sandwich with sliced meat. what’s the most likely causative agent ?
A) staphylococcus aureus
B) salmonella typhi
C) listeria monocytogenes
D) entamoeba histolytica

A

A) staphylococcus aureus

19
Q
3 year old developed hemolytic uremic syndrome after eating undercooked hamburger.
What is the most likely causative agent?
a) listeria monocytogenes
b) salmonella typhimurium
c) E. Coli O157:H7
d) entamoeba histolytica
A

c) E. Coli O157:H7

20
Q
A 24 year old man came for HCV and HBV screening. HCV-RNA: -, HCV Ab: -, HbsAg: +,
HBeAg: -, HBeAb: +, HBcAb: +
a) Passive immunization of HBV
b) Recovery
c) Chronic HBV with low infectivity
d) Acute HBV infection
A

c) Chronic HBV with low infectivity

21
Q

What antibiotic treats c difficile infection.

a) vancomycin
b) Streptomycin
c) clarithromycin
d) amoxicillin

A

a) vancomycin

22
Q

Which adenovirus serotypes are responsible for Gastroenteritis?

a. serotypes 50 and 51
b. serotypes 20 and 21
c. serotypes 17 and 18
d. serotypes 40 and 41

A

d. serotypes 40 and 41

23
Q
What is the toxin critical for the pathogenesis of Clostridioides difficile-associated
diarrhea?
A) Toxin A (TcdA)
B) Binary toxin (Cdt A)
C) Toxin B (TcdB)
D) Binary toxin (CdtB)
A

C) Toxin B (TcdB)

24
Q

Which laboratory test is used to confirm the identification of salmonella typhi?

a. O and H antigen
b. F antigen
c. Urease test
d. H2S production

A

a. O and H antigen

25
Q
Which of the following drugs can treat acid reflux and may cause galactorrhea and
gynecomastia?
a. Dicyclomine
b. Misoprostol
c. Cimetidine
d. Omeprazole
A

c. Cimetidine

26
Q

What is the mechanism of metoclopramide?

  • block u opioid receptors
  • Block D2 receptors in CTZ
  • block 5HT3 receptors in vomiting center
A
  • Block D2 receptors in CTZ
27
Q

What is a characteristic of drug induced intrinsic hepatotoxicity?

A. Not predictable
B. Dose dependent
C. Appears in only a few individuals
D. Triggered by subtherapeutic doses of a drug

A

B. Dose dependent

28
Q

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
c) stimulates secretions in the GIT

A

b) Retains fluid in the bowel lumen by osmosis

29
Q

A 35-year-old woman presented with a recurring blister in the oral cavity. Tissue section shows Multinucleated giant cells with ground glass appearance and molding. What is the most likely causative organism?

A) B hemolytic streptococci
B) candida spp.
C) HSV
D) EBV

A

C) HSV

30
Q

A patient had net-like lesions in buccal mucosa?

a) pemphigus vulgaris
b) lichen planus
c) steven johnson syndrome
d) HSV

A

b) lichen planus

31
Q

a 55 y/o man presented with asymptomatic enlarging mass in the buccal mucosa,
histology shows malignant cells with perineural invasion. In which of the following conditions is this finding common?

a) Adenoid cystic carcinoma
b) mucoepidermoid carcinoma

A

a) Adenoid cystic carcinoma

32
Q
patient with retrosternal pain and a mass in the lower esophageal lumen, most common
cancer?
a) adenocarcinoma
b) squamous cell carcinoma
c) leiomyosarcoma
A

a) adenocarcinoma

33
Q

What is the most common complication of peptic ulcer disease?

A. Perforation
B. Bleeding
C. Stricture
D. Malignant transformation

A

B. Bleeding

34
Q

what has the most important association with duodenal ulcer disease?

A) intestinal dysplasia of the esophagus epithelium
B) metaplasia - dysplasia- carcinoma sequence
C) H.pylori infection
D) pernicious anemia and achlorhydria

A

C) H.pylori infection

35
Q

A 65 year old woman presented with severe nausea, vomiting, early satiety and 10 kg
weight loss. Upper gastrointestinal radiographs showed that the stomach is small and shrunken. A gastric biopsy was taken. What do you expect the biopsy to show?

A) Early gastric carcinoma
B) Intestinal adenocarcinoma
C) Signet ring cell adenocarcinoma
D) Chronic atrophic gastritis

A

C) Signet ring cell adenocarcinoma

36
Q

What is the most common site for carcinoma in the stomach?

a) fundus
b) Body
c) Antrum
d) Pylorus
e) Greater curvature

A

d) Pylorus

37
Q

What is the most common location for GIST tumor?

a) Esophagus
b) Stomach
c) Duodenum
d) Jeujenum

A

b) Stomach

38
Q

A 55-year old male came to the clinic for a routine check-up. Fecal occult blood test was positive. CBC and other blood tests were normal. Which next investigation is the most cost-effective?

a) Colonoscopy
b) Flexible sigmoidoscopy
c) Double contrast barium enema
d) CT of the abdomen

A

a) Colonoscopy

39
Q

A 53yr man with history of abdominal distention, and found to have: ballooning
degeneration, mallory hyaline bodies with neutrophils
What could be the reason behind that?

a) ethanol
b) Liver cirrhosis
c) Acetaminophen

A

a) ethanol

the idea is that mallory hyaline bodies are pathognomonic for alcoholic liver disease

40
Q

A 60 year old with a 30 year history of alcohol abuse presented with bilateral swelling in
the legs, abdominal distention, splenomegaly, spider angiomata, and testicular atrophy.
Which of the following is the cause to his presentation?

A. Liver cirrhosis
B. Cholangitis
C. Cholcystitis

A

A. Liver cirrhosis

41
Q

A 30 year old male with Iron deficiency anemia, his fecal occult blood test was positive.
A biopsy shows undifferentaited cells+mucinous.
What is the molecular cause?

A

-Defective dna mismatch
(Presence of fecal occult blood indicates presence of colorectal cancer. The patient is young
which points to a hereditary CRC, and a colonic tumor that is mucinous is characteristic of
HNPCC/Lynch → mutation in mismatch repair system. I think the question also mentioned
genetic anticipation, which is another characteristic of lynch)

42
Q

A 56 y/o male patient had resection of a rectal mass. The tumor was found to arise from
muscularis propria layer, and microscopic examination showed intersecting fascicles of plump spindle cells with eosinophilic cytoplasm with hyalinized stroma. Tumor cells are positive for CD117 and CD34, but negative for desmin and keratin stains.
What’s the likely cell of origin in such tumor?

(a) Surface enterocytes
(b) Neuroendocrine
(c) Autoimmune
(d) Intestinal Cells of Cajal

A

(d) Intestinal Cells of Cajal

43
Q

young male patient admitted with abdominal pain, fever, watery diarrhea and was
operated on. what finding is suggestive of Crohn’s disease?
a) entero-enteric fistula
b) circumferential mucoasal ulcerations
c) mucosal thinning and sloughing
d) thinning and distention of colon

A

a) entero-enteric fistula

44
Q
A patient was suspected to have sporadic CRC, he was tested positive for p53, in which
stage is his tumor?
a) metastatic carcinoma
b) early adenoma
c) carcinoma
d) late adenoma
A

c) carcinoma

45
Q

Assessment of hepatic fibrosis is done by using which marker?

a) Glucagon
b) Biliruben
c) AAT
d) Hylorunic acid

A

d) Hylorunic acid

answer is from pharma LT

46
Q
Part of the thoracic esophagus was removed, during the procedure an associated nerve
was affected. What the effect?
a) Relaxation of pylorus
b) Decrease gastric motility
c) Increased gastric motility
A

b) Decrease gastric motility

47
Q

Which type of cells are responsible for fibrosis in the liver?

A

ito cells

48
Q

Which cell takes up old erythrocytes and free heme for re-use?

a) ito cells
b) Hepatocytes
c) kupffer cells
d) holangiocytes

A

c) kupffer cells

49
Q

A 47 y/o woman is admitted to the hospital with jaundice and epigastric pain that
migrates to the patient’s right side and posteriorly toward the scapula. Radiographic examination reveals cholecystitis with a large stone. Which of the following is the most likely
site for a gallstone to lodge?

A- common bile duct
B- Hepatopancreatic ampulla
C-Right hepatic duct
D-Left hepatic duct

A

A- common bile duct
B- Hepatopancreatic ampulla
We’re not sure :(

50
Q

64 yo woman diagnosed with carcinoma in distal GIT. Inguinal, sacral, and internal iliac
lymph nodes were taken to pathology lab. Only the ingiunal lymph nodes have cancerous cells . Where is the site of the tumor?

A. Distal rectum
B. Proximal rectum
C. Mucosal layer of anal canal
D. Pectinate line of anal canal
E. Cutaneous layer of anal canal
A

E. Cutaneous layer of anal canal

51
Q

what drives the transport of conjugated bilirubin into the bile canaliculi?

a. ATP hydrolysis
b. Na symport
c. binding to ligandins
d. organic anion antiport

A

a. ATP hydrolysis

52
Q

How does blue light help in treating jaundice?

A- breaking Glucuronidated bonds
B-breaking hydrogen bonds

A

B-breaking hydrogen bonds

53
Q

what is the metabolic effect of increased short chain fatty acids?

A- decreased thermogenesis in brown adipose tissue
B- increased lipolysis in white
C- increased fatty acids oxidation from hepatocytes
D- decreased fatty acids oxidation from skeletal muscles

A

C- increased fatty acids oxidation from hepatocytes

54
Q

Which of the following demonstrated the role of gut microbiota in the development in
Kwashiorkor?

A

a- The use of RUTF and antibiotics improved the outcomes for kwashiorkor patients
compared to RUTF alone

55
Q

Which drug can cause malnutrition in IBD?

A. Sulfasalazine reduced absorption of iron
B. Antibiotic reduced absorption of protein
C. corticosteroids reduced absorption of calcium

A

C. corticosteroids reduced absorption of calcium

56
Q

What is the consequence of a high protein diet on the gut microbiome?

a) increase in bile tolerant species
b) increase in butyrate-producing species
c) increase in fermenting species

A

b) increase in butyrate-producing species

57
Q

A 52 year old male with long history of heart burn presents with 3-month history of
progressive difficulty of swallowing of solids but not liquids, what is the most likely diagnosis?

A. Achalasia
B. Esophageal ring
C. Diffuse esophageal spasm
D. Peptic stricture

A

D. Peptic stricture

58
Q

which signaling pathway is associated with FAP?

A

wnt pathway

59
Q

A 22-year old female complains of frequent soft stool with blood and mucus, no abdominal pain, and no weight loss What is likely to be seen in colonoscopy?

a) deep serpengious ulcer in terninal ileum
b) inflammed and ulcerated rectal mucosa
c) multiple diverticula along the colon
d) multiple polyps throughout the colon

A

b) inflammed and ulcerated rectal mucosa

60
Q

55yr male, smoker, alcoholic presented w / epigastric pain and foul-smelling diarrhea
What is the abnormal finding that will be present?

A

-chronic pancreatitis

61
Q
23 years old male presented with generalized pruritis and dark urine for 2 months. He
has a history of ulcerative colitis.
AST 25
ALT 20
ALP 290 (High)
Bilirubin 35 (High)
What condition does he have ?

A- Non-alcoholic fatty liver disease
B- Primary sclerosing cholangitis
C- Chronic HBV
D- Autoimmune hepatitis

A

B- Primary sclerosing cholangitis

62
Q

A 40-year-old female presented with mild right upper quadrant pain and yellow
discoloration of the sclera. her symptoms were progressively getting worse over the past 2 weeks. she has past a medical history of hypothyroidism. laboratory test showed: high ALT, high AST, normal alkaline phosphatase, high total
bilirubin. (the exact values were given along with the normal range)
what is the most likely diagnosis?

a. PBC
b. PSC
c. pancreatic cancer
d. autoimmune hepatitis

A

d. autoimmune hepatitis

63
Q

Question about manometry reading of achalasia (diagram was provided)

A

High LES pressure with low pressure in the esophagus

64
Q

patient with nausea but no vomiting, no weight loss, no abdominal pain, and a duodenal
ulcer was found. What’s the best test?
a) Urease Breath Test
b) Hydrogen breathe test

A

a) Urease Breath Test

65
Q

A 60 year old patient came with symptoms of dypepsia and has H. pylori infection. What
cancer is he at most risk for?

A. Small bowel adenocarcinoma
B. Gastric adenocarcinoma
C. Pancreatic adenocarcinoma

A

B. Gastric adenocarcinoma

66
Q

A 50 yr old man presented to the hospital with severe epigastric pain radiating to the
back. He was also presenting with nausea and vomiting. He felt this pain after a binges of alcohol. Which diagnostic test helps in diagnosing the patient’s pain?

A) Serum calcium
B) Serum trypsin
C) Serum protease
D) Serum amylase

A

D) Serum amylase

67
Q

Question about manometry reading, symptoms & diagram were provided: Patient presented with retrosternal chest pain and dysphagia of both solid and liquid.
Barium swallow x-ray showed:
Choose the appropriate esophageal manometry:

A

Manometry reading of

diffuse esophageal spasm: high pressure waves in esophagus at the same time

68
Q

Which of the following chronic liver diseases is associated with the
highest risk of hepatocellular carcinoma?
A. Autoimmune hepatitis
B. Primary sclerosing cholangitis
C. Alcoholic liver disease
D. HBV

A

D. HBV

69
Q

A 27yr female pregnant in 3rd trimester complaining of epigastric pain & vomiting. Dark
urine & yellow discoloration of sclera are noted. Elevated hepatic enzymes consistent w/ acute hepatitis.
Which viral hepatitis is associated w/ highest mortality in this patient?

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

A

D. HEV

70
Q

a 61 year old male was in a cerebrovascular accident resulting in difficulty in swallowing
and speech. Which of the following is the best diagnostic test?

a. 24 hour esophageal pH
b. modified barium swallow test
c. esophageal motility
d. upper GI endoscopy

A

b. modified barium swallow test

71
Q
63 year old Patient came with 1 week history of jaundice, gallbladder is palpable but not
tender.
-gallstones
-pancreatic adenocarcinoma
-hepatitis
A

-pancreatic adenocarcinoma
(the most important concept here is PAINLESS jaundice in an old person = biliary
obstruction caused by a pancreatic adenocarcinoma, the cancer compressed the CBD. A
similar question came, the patient was in his 70s and had jaundice but no abdominal pain.
His LFTs showed increased bilirubin and ALP. His serum amylase was normal. Normal serum
amylase/lipase does NOT exclude pancreatic cancer! So again painless jaundice = pancreatic
cancer)

72
Q

what is a characteristic of the saliva?

A) increase rate with vagotomy
B) hypotonic relative to plasma
C) contain protease
D) have less HCO3 than plasma

A

B) hypotonic relative to plasma

73
Q

What is secreted by smooth muscle cells to relax GIT?

  • secretin
  • VIP
  • CIK
A
  • VIP
74
Q

Gallbladder concentrates bile by actively removing which substance?

A. Ca
B. K
C. Na
D. HCO3-

A

C. Na

75
Q
Which of the following signaling molecule is released in response to low ph in
duodenum?
-CCK
-gastrin
-secretin
-somatostatin
A

-secretin

76
Q

which will occur in defecation?

A- relaxation of the rectum
B- contraction of the internal anal sphincter
C- relaxation of the external anal sphincter

A

C- relaxation of the external anal sphincter

77
Q

A 60-year-old man died after acute attack of severe abdominal pain,fever, guarding,
and shock. An autopsy performed showed abdominal cavity filled with blood and abdominal viscera were autolyzed with omental fat necrosis, what is most likely the cause?

A-Ruptured aortic aneurysm
B-Perforated peptic ulcer
C-Acute hemorrhagic pancreatitis
D-Perforated colonic carcinoma

A

C-Acute hemorrhagic pancreatitis