2011 final Flashcards
During the insertion of a nasogastric tube in the esophagus, what point would confer the highest resistance to the insertion?
The junction of the pharynx with the esophagus
A patient who has portal hypertension vomited fresh blood. Which vein has most likely ruptured?
Left gastric vein
Note: left gastric vein participates in one of the portal-caval anastomoses so in portal hypertension, branches of this vein are liable to dilation producing varices and can eventually rupture
Which of the following structures is located in the submucosal layer?
Meissners plexus
Which of the following structures receives fibers from the greater splanchnic nerves?
Celiac ganglion
Why is liver acinus considered the metabolic and pathological unit of the liver?
Because blood flows in a direction from the portal area to the central vein in the acinus
What is the main feature of enterocytes and is important for its function?
Microvilli
Which part of the gastrointestinal tract has numerous glandular invaginations but no villi?
Colon
Which part of the gastrointestinal tract has its outer layer of muscularis developed into longitudinal bands?
Colon
Which structure divides the greater sac into supra- and infracolic compartments?
Transverse mesocolon
In which structure is the inferior recess of the lesser sac located?
Greater omentum
Which muscles maintains fecal continence?
Puborectalis
Where does fluid drain into if a person is lying in a supine position?
Hepatorenal recess
Where does retropulsion take place?
Stomach
If primary peristalsis fails to clear the bolus, a wave of secondary peristalsis is initiated at the site of the bolus. Where does that take place?
Esophagus
Which of the following factor promote gastric emptying?
Gastric distension
What determines the rate of synthesis and excretion of bile salts into bile?
Concentration of bile salts in the portal vein blood
What happens to the motility of the gastrointestinal tract after being denervated from the autonomic nervous system?
The motility doesn’t change because of the presence of the enteric nervous system
Amylase is inactive at a very low pH; however, most of the starch digestion by amylase takes place in the stomach. What would provide a proper explanation for that?
The pH at the core of food is being lowered slowly
After glucose administration, the amount of hydrogen present in the patient’s breath is insignificant. However, after giving him lactose, the hydrogen level in his breath dramatically increased. Which abnormality would underlie this change?
Lactase enzyme deficiency in the intestinal mucosal lining
Which part of the gastrointestinal tract is characterized by the presence of a weak functional sphincter and sharp angulation?
Rectum
A 22 year old woman developed annular narrowing of her esophagus along with dysphagia and hypochromic microcytic anemia. What would her esophagus show?
Esophageal web
Which best describes the abnormality in the esophagus of an asthmatic child with dysphagia?
Trachea-like esophagus
A 59 year old heavy smoker obese male presented with dysphagia. An endoscope-guided biopsy of the esophagus was taken and showed malignant cells around irregular glands. What is the most important risk factor for developing this condition?
- Barrett esophagus
- smoking
• Barrett esophagus
A 52 year old woman with a history of rheumatoid arthritis took an aspirin pill. Right after, she developed epigastric pain and passed dark stools. What would the pathology in her stomach show?
- Erosive gastritis
- Chronic active gastritis
• Erosive gastritis
A doctor received the gastric biopsy results of his patient. The results confirmed the presence of a tumor in the stomach. However, instead of referring his patients to an oncologist, the doctor prescribed amoxicillin, metronidazole, and clarithromycin. What could the tumor be?
MALT lymphoma
Note: antibiotic therapy is the first line treatment for MALT lymphoma since it is associated with H. pylori infection
A salivary gland tumor being malignant is inversely proportional to the size of the gland. Which of the following glands has most share of malignant tumors?
- Sublingual gland
- Minor salivary glands of the soft palate
- Minor salivary gland of the hard palate
• Sublingual gland
An 8 year old boy acquired an infection with a high fever that reached 40 degrees. After few days, he developed herpes labialis on his lower lip. What would the cells in the blisters show?
Intranuclear inclusions
A 45 year male suffered a severe abdominal pain radiating to the back. When the doctors operated on him, the found extensive necrosis of the tissues in the abdomen along with the greater omentum. What is the most likely cause of his condition?
Acute hemorrhagic pancreatitis
Which analyte will be elevated in a patient who developed flapping tremors, fetor hepaticus, and went into a coma?
Ammonia
Which analyte would be elevated in a 40 year old male with psychosis who was found to be a silent alcohol drinker?
gamma glutamyl transferase
A 4 cm liver mass was found in a female patient. A partial lobectomy was performed. The mass was solid, uniform in color, had a well-defined border. The surgeon comforted the patient and told her that no further therapy is required. What could the mass be?
- hepatic adenoma
- bile duct hamartoma
• hepatic adenoma
Which of the following pathological features is used to differentiate between chrons disease and ulcerative colitis?
Chrons disease has non-caseating granulomas, nut ulcerative colitis does not
Which of the following is a severe complication of a long-standing ulcerative colitis?
Toxic megacolon
What could be the cause in a young female patient that presents with chronic watery diarrhea and normal endoscopy?
Microscopic colitis
What would the stomach show in the case of helicobacter pylori infection?
Lymphoid follicles and plasma cells in the lamina propria
A 6 year old child presents with chronic fatty diarrhea and failure to thrive. The organism showed on duodenal biopsy; what could it be?
Giardia lamblia
How does ranitidine reduces the efficacy of sucralfate?
It reduces the acidity of the stomach
Which anti-emetic drug acts by blocking 5-HT3 receptors?
Ondansetron
What is the mechanism of action of lactulose?
It traps fluid in the bowel lumen by osmosis
Which drug can cause hepatotoxicity in children less than 3 years old?
Valproic acid
Hepatoxicity to which drug can be treated with N-acetylcysteine?
Acetaminophen
What is the risk factor for acquiring clostridium difficile infection?
- Old age
- Immune deficiency
• Old age
A patient is undergoing chemotherapy for acute myeloid leukemia. He developed severe diarrhea. Cysts were identified which were acid fast positive. What is the causative agent?
Cryptosporidium parvum
A pregnant woman had travelled to Bangladesh. When shecame back she developed fever, jaundice, and fulminant hepatic failure after which she died. What could be the causative agent?
Hepatitis E virus
A patient developed a severe hepatitis B infection but later he was found to have a co-infection with another RNA virus. Which virus could that be?
Hepatitis D virus
Which virus has caused large outbreaks in India, Mexico, and North Africa where the source of infection is fecal contamination of water supplies?
Hepatitis E virus
What is the cause of vitamin B12 deficiency in pernicious anemia?
Antibodies against intrinsic factor
Which of the following drug nutrient interactions occur in patients with inflammatory bowel disease?
- Corticosteroids reduce absorption of calcium
- Sulfasalazine reduces absorption of iron
• Corticosteroids reduce absorption of calcium
What is true regarding hereditary non polyposis colon cancer?
There is a defect in the mismatch DNA repair mechanism
A 56 year old female developed colon cancer. She has a history of endometrial cancer for which she had undergone a hysterectomy. Her aunt developed colon cancer as well. She has a 22 year old son. She came to you asking for the risk that her son might develop colon cancer. What should you tell her?
- You have a defect in the genes coding for mismatch DNA repair proteins
- Your son should be going for endoscopy at age of 40
- You should do DNA sequencing for germline APC mutation
• You have a defect in the genes coding for mismatch DNA repair proteins
A 60 year old diabetic obese man takes metformin and other drugs for his diabetes. His liver function tests revealed high ALT and AST. He is an alcohol drinker too. What could be the cause of elevated liver enzymes?
Toxic fatty acids
A 55 year old male with a long history of excessive alcohol intake presents with a three month history of bloating and voluminous loose motion. He lost 15 kg in the past 6 months. Physical examination was normal. ALP was high, GGT was high, salivary amylase was normal. Ultrasound showed fatty liver and dilated common bile duct. What could be the cause of the dilated bile duct?
- Chronic pancreatitis
- Choledocolithiasis
• Chronic pancreatitis
Note: the common bile duct passes through the head of the pancreas to reach the ampulla of vater. In chronic pancreatitis, there is inflammation and fibrosis of the pancreas which in the head can cause narrowing of the distal portion of the CBD (the intrapancreatic segment)
A 32 year old male present with a 5 month history of heartburn especially after eating fatty food and on lying down. There was no associated dysphagia or odynophagia. A barium swallow for his esophagus was done. What is the most appropriate step to take next?
Therapeutic trials of acid suppressive therapy
Note: if the patient is young as in this case with a history of heartburn less than 5 years, then you head to PPI trials; however, if he is older or with a long history of GERD, then you head to endoscopy to rule out Barrett esophagus and subsequent carcinoma
A female patient presents with intermittent dysphagia for solids and liquids, food regurgitation. What would the esophageal manometry show?
Manometry consistent with achalasia
What would the manometry show in a woman with tightening of the skin of her face, around her fingers and toes?
Manometry consistent with systemic sclerosis
A 22 year old medical student with occasional heartburn. What would the manometry show?
Normal manometry
EBM: In a randomized control trial, 200 patients were given a drug and another 200 were not. After completing the trial, the participants were asked if they improved or not. Which of the following would worry you the most about the results?
Measurements were not taken to make sure there is no unbiased outcome ascertainment
EBM: What is the most important aspect for the validity of a randomized control trial?
Randomization
EBM: Which of the following is most specific?
Metformin and insulin and diabetes
EBM: A study was done and a hazard ratio of impaired physical activity was compared to unimpaired physical activity and was 0.55 [0.46-0.65]. What would be the best comment regarding effect size and sample size?
Effect size is large and sample size is sufficient
Note: effect size means magnitude of association and to assess it, you look at the hazard ratio value; for the sample size, you check the confidence interval which when wide, it implies a small sample size and when narrow, a large sample size
EBM: Which of the following is important in order to have a high positive predictive value and rule in a disease?
High specificity and high pre-test probability
