GIT 1

Question 1

Pancreatic secretions

Answer 1

Isotonic fluid; low flow → high Cl−, high flow → high HCO3−.

Question 2

Pancreatic proteases

Answer 2

trypsin, chymotrypsin, elastase, carboxypeptidases

Question 3

Trypsinogen Converted to active enzyme by

deficiency:

Answer 3

enterokinase/ enteropeptidase,

both fat and protein malabsorption

Question 4

Peyer patches location

Answer 4

Unencapsulated lymphoid tissue, found in lamina propria and submucosa of ileum

Question 5

_______ catalyzes rate-limiting step of bile acid synthesis.

Answer 5

Cholesterol 7α-hydroxylase

Question 6

Best initial test for cholestasis is

Answer 6

USG

Question 7

Conjugated bilirubin undergoes 2 reactions in gut carried out by bacteria:

Answer 7

1. Conjugated → Unconjugated by beta-glucuronidase

2. Unconjugated → Urobilinogen

Question 8

Bile duct obstruction: Urine findings

Answer 8

Bilirubin in urine (dark urine)

Absent urobilinogen → Absent urobilin

Question 9

Breast milk jaundice causes _____ hyperbilirubinemia that peaks at age of _____

Answer 9

indirect, 2 weeks

Question 10

Breast milk jaundice mechanism:

Answer 10

Beta-glucuronidase in breast milk decojugates bilirubin → ↑absorption → ↑enterohepatic circulation of bilirubin

Urine and stool appearance unchanged

Question 11

Dubin johnson syndrome: defect in _______

Why NO PRURITIS?

Answer 11

Multidrug resistance proteins

pruritis is caused by BILE SALTS. in obstructed diseases bile salt is not excreted and accumulates in skin causing PRURITIS

Question 12

Biliary atresia: Fibro-obliterative destruction of _________

presentation:

Answer 12

extrahepatic bile ducts

newborn with persistent jaundice after 2 weeks of life, darkening urine, acholic stools, hepatomegaly.

Question 13

Physiologic neonatal jaundice

Answer 13

At birth, immature UDP-glucuronosyltransferase , short HL of RBCs, ↑enterohepatic circulation of bilirubin (due to low bacteria in GIT) ► unconjugated hyperbilirubinemia

Question 14

Physiologic neonatal jaundice Occurs ____ first 24 hours of life and usually resolves without treatment in ____

Answer 14

after

1–2 weeks

Question 15

Crigler Najjar syndrome Type II is less severe and responds to ____ which _____

Answer 15

phenobarbital,

↑ liver enzyme synthesis.

Question 16

Effect of cirrhosis on heart:

Answer 16

high output heart failure due to chronic splanchnic vasodilation and development of shunts

Question 17

Sinusoidal HTN:

Answer 17

loss of protein rich fluid in space of Disse → ↑formation of hepatic lymph → Ascites

Question 18

Parthenogenesis of autoimmune hepatitis

Answer 18

molecular mimicry

Question 19

AST > ALT in nonalcoholic liver disease suggests _____

Answer 19

progression to advanced fibrosis or cirrhosis

Question 20

Fulminant hepatitis:

Answer 20

Hepatic encapth within 6 weeks of hepatiic insult

Question 21

Underlying mechanism of fulminant hepatitis is ___

Answer 21

hypersensitivity reaction to drug → immune mediated attack against hepatocytes.

Question 22

Autopsy findings of fulminant hepatitis:

Answer 22

atrophy and shrunken

Question 23

Alcoholic hepatitis histology

Answer 23

Swollen and necrotic hepatocytes with neutrophilic infiltration. 
Mallory bodies  (intracytoplasmic eosinophilic inclusions of damaged keratin filaments).

Question 24

Fibrous tissue (thickened collagenous bands) is stained with

Answer 24

stained blue with Masson trichrome stain

Question 25

Hepatic encephalopathy → ↓NH3 removal causes

Answer 25

(due to renal failure, diuretics, bypassed hepatic blood flow post-TIPS).

Question 26

the liver is the site of production of all major coagulation factors, except _______

Answer 26

factor VIII.

Question 27

symptoms of volvulus:

Answer 27

bilious vomiting, abdominal distention, and bloody stools.

Question 28

In children, volvulus almost always occurs in the _____

Answer 28

small intestine

Question 29

in liver Acetaminophen is known to cause _____

Answer 29

centrilobular necrosis

Question 30

drugs associated with granuloma formation include _____

Answer 30

SHAQ | sulfonamides, hydralazine, allopurinol, quinidine,, and methyldopa

Question 31

______ can chelate and ↓effectiveness of other drugs (eg, tetracycline)

Answer 31

Calcium carbonate (antacid)

Question 32

Hypolglycemia in hepatocellular carcinoma due to:

Answer 32

1. ↑ metabolic rate of tumor | 2. produces insulin like growth factor-II

Question 33

Most common benign liver tumor_____

Answer 33

cavernous hemangioma