2011 module exam Flashcards
Ahmed is an 18 year old boy who went to a doctor asking for weight- controlling pills claiming that he is overweight. His weight on the age- weight graph was as shown. What does Ahmed have?
Anorexia nervosa
a 19 year old boy presents with finger clubbing, weight loss, watery diarrhea and a mass in the right iliac fossa. A barium enema of the gastrointestinal tract was performed, and findings were as below. What is the likely diagnosis?
Crohn’s disease
Note: the presence of strictures is noted in the barium enema, a characteristic of Crohn’s (string sign)
A 51 year old man complains of passing foul-smelling fatty stools. He noticed recent loss of weight as well; an abdominal x-ray was performed and findings can be observed as below. How would u manage this patient?
By supplementing him with pancreatic enzymes
Note: pancreatic calcifications are noted in the x-ray and are indicative of chronic pancreatitis
A 61 year old man complains of weight loss and is deeply jaundiced. He was found to have high liver enzymes and high GGT and ALP. An ERCP was performed which showed dilated bile duct without presence of stones. What is the likely diagnosis?
Pancreatic adenocarcinoma
Which structure does the internal oblique muscle participate in the formation of?
- Conjoint tendon
- Inguinal ligament
- Conjoint tendon
Note: the conjoint tendon is formed by the aponeuroses of internal oblique and transversus abdominus muscles
Which anatomical landmark is found at the level of L4 vertebra?
Iliac crest
Which of the following truly describes the submandibular gland?
- It is innervated by the facial nerve
- It is predominantly serous
- It is innervated by the facial nerve
- It is predominantly serous
Note: both statements are correct and both were among the choices; the question has been taken care of
Which blood vessel traverses the hepatoduodenal ligament?
The portal vein
Which nerve can be injured by an object in the piriform fossa?
Internal laryngeal nerve
In which layer of the esophagus are the glands found?
Submucosa
Which of the following is present in the muscularis externa?
Auerbach plexus
. Which of the following receives fibers from the greater splanchnic nerves?
Celiac ganglion
Which nerve carries parasympathetic fibers to the foregut?
The vagus
What is the main secretion of the glands in the body of the stomach?
- Intrinsic factor
- Pepsin
- Mucus
- Gastrin
- Intrinsic factor
Note: this is a trick question; the glands in the body produce pepsinogen not pepsin so intrinsic factor would be the correct answer
Which vein is used as a landmark for surgeons?
Prepyloric vein
What is the embryological origin of the muscles of the intestinal wall?
Splanchnic mesoderm
Which embryological abnormality can result in the entry of amniotic fluid into the lungs?
Tracheoesophageal fistula
Which embryological abnormality is associated with excessive growth of tissue around the duodenum?
Annular pancreas
Which embryological abnormality is the result of a persistent cloacal membrane?
Imperforate anus
Which structure forms the boundaries of the bare area of the liver?
The coronary ligament
What is the remnant of the left umbilical vein?
The round ligament
A surgeon wants to resect a 2 cm tumor in the hepatic segment III. Which vein is used to guide the surgeon in the resection?
Left hepatic vein
How the function of Ito cells changes when exposed to prolonged toxic states?
It starts collagen synthesis
Which variation in the cystic duct can result in damage to the common hepatic duct during surgery?
Adherence of the cystic duct to the common hepatic duct via fibrous tissue
.Which feature reflects the absorptive function of the enterocytes?
- Microvilli
- Basal mitochondria
- Microvilli
Which cells of the small intestine produce lysozymes?
Paneth cells
Which cells of the small intestine produce cholecystokinin?
Enteroendocrine cells
Which cells act as antigen presenting cell?
Microfold cells
Which anatomical landmark surgeons use to locate the appendix?
- Tenia coli
- Ileocecal junction
- Tenia coli
Note: the three bundles of tenia coli merge altogether at the base of the appendix creating a landmark used to locate the base
Which of the following regions exhibits maximum tenderness in appendicitis?
McBurney’s point
Which anatomical landmark is palpated to locate McBurney’s point?
Anterior superior iliac spine
Note: Mcburney’s point is located two third the way from the umbilicus toward the anterior superior iliac spine, at a plane called the spinoumbilical plane
In case of atherosclerosis of the inferior mesenteric artery blocking the blood flow, which two arteries will provide collateral blood to the region supplied by the inferior mesenteric artery?
Middle and left colic arteries
Note: due to the presence of anastomoses between branches of the superior and inferior mesenteric arteries, blood would flow in the middle colic artery, a branch of the superior mesenteric, toward the left colic artery, a branch of the inferior mesenteric supplying the area of that artery
Which muscle maintains anal continence?
Puborectalis
What is a slit like lesion of the anal mucosa called?
Anal fissure
What is inflammation of the anal sinus called?
Cryptitis
Which of the following conditions involves the superior rectal veins?
Internal hemorrhoids
A manometer was inserted into a patient’s mouth passing through the pharynx, upper esophageal sphincter, body of the esophagus, and lower esophageal sphincter. What are the pressure readings measured by the manometer in that sequence?
0 -> 50 -> 0 -> 30
Which of the following mediates receptive relaxation of the
stomach?
Vasoactive intestinal peptide
Which process takes place in both the esophagus and the stomach after swallowing?
Receptive relaxation
Which of the following happens during receptive relaxation of the lower esophageal sphincter?
Increase in action potentials of vagal inhibitory fibers and absence of action potentials of vagal excitatory fibers
The stomach efficiently mixes food by contracting the antrum against a closed pyloric sphincter. What is this process called?
Retropulsion
After a meal, the active acid secretion by the parietal cells in the stomach results in changing the composition of blood leaving the stomach. What does that blood contain?
High levels of bicarbonate
A patient with liver disease develops peripheral edema. What is the underlying mechanism?
Reduced plasma colloid osmotic pressure
By which mechanism are bile acids excreted into bile canaliculi?
Primary active transport
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?
Activation of trypsinogen by brush border enterokinase in the small insestine
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?
Migrating myoelectric complex
How are tri- and dipeptides absorbed in the small intestine?
By tertiary active transport
Absorption of glucose and amino acids are dependent on the gradient of which ion?
Sodium
What induces the fat micelle to release its contents at the absorbing epithelium?
High hydrogen concentration
What are the mixing movements in the colon called?
Haustrations
On barium sulfate swallow of the GI tract, some peristaltic movements were noticed in a reverse direction. Which part of the GI tract manifests that type of movements?
Colon
The peristaltic movements of the descending colon are stronger than those taking place in the ascending colon. What is the reason behind that?
To increase the transit time of the colon
Which of the following is true regarding the effect of parasympathetic fibers on blood vessels of the salivary glands?
VIP and bradykinin are vasodilators
A32 year old female patient was found to have a red velvety lesion in the oral mucosa. What is this lesion likely to be?
Erythroplakia
A female patient presents with a lesion in her oral cavity. On examination, the lesion was shown to be white reticulated or net- like; what is the likely diagnosis?
Lichen planus
A woman cannot cry in sad occasion and has a dry mouth. What is expected to be seen on histology of the salivary glands?
Lymphocytic infiltration with germinal centers
Which tumor of the salivary gland has morphology characterized by neoplastic epithelial cells and myxoid stroma?
Pleomorphic adenoma
Histology of a salivary gland showed cystic glandular spaces embedded in dense lymphoid tissue. What is the likely tumor?
Warthin’s tumor
A 53 year old male presents with a mass in his face which was found to be in the salivary gland. On cytology, there were small cells around magenta colored hyaline globules. What is the likely pathology?
Adenoidcystic carcinoma
A 27 year old male presents with dysphagia and food regurgitation. He was found to have a narrowed lower esophageal sphincter as well as a decreased number of ganglion cells in the esophagus. What is the likely cause?
Chagas disease
A man who binges on alcohol suffered from severe vomiting the next morning with hematemesis. The esophagus was found to be perforated; what is the likely diagnosis?
Boerhaave syndrome
A 53 year old male was found to have hyperkeratotic lesions on his palms and feet. Which condition is he at risk of developing?
Squamous cells carcinoma of the esophagus
Which of the following gastric conditions has a predilection to develop at mucosal junctions?
Peptic ulcer disease
A 50 year old male presents with epigastric discomfort, weight loss and edema. A gastric biopsy showed cerebriform morphology of the rugae; what is the likely diagnosis?
Menetrier disease
A gastric biopsy of elevated mucosal polyps showed dilated cystic glands in the fundus. What is the pathology likely to be associated with?
Use of proton pump inhibitors
A woman had a tumor in her stomach removed 30 years ago; it was thought to be benign, but she presented with a mass in her liver that has the same histological appearance of the previous tumor. What is the likely pathology?
Gastrointestinal stromal tumor
Which of the following is true regarding gastrointestinal stromal tumor?
- Responds well to treatment with imatinib
- Responds well to treatment with trastuzumab
- Responds well to treatment with imatinib
Note: imatinib is used to treat cancers expressing c-kit receptors while trastuzumab is used to treat those expressing her-2
Which of the following conditions is associated with liver steatosis without inflammation or fibrosis?
Methotrexate hepatotoxicity
A liver biopsy showed fat deposition, inflammation and Mallory hyaline bodies in a patient with high liver enzymes. What is the likely pathology?
Alcoholic steatohepatitis
A 44 year old female presents with jaundice and mild abdominal pain; liver biopsy showed an autoimmune damage to the bile ducts associated with high levels of GGT and immunoglobulins. What is the likely diagnosis?
Primary biliary cirrhosis
A pregnant woman was found to have liver pathology associated with microvesicualr fat deposition. What is the underlying mechanism?
Abnormal mitochondrial beta fatty acid oxidation
Which analyte will be elevated in a patient who developed flapping tremors, fetor hepaticus, and went into a coma?
Ammonia
Which analyte will be elevated a patient who presents with jaundice, weight loss and a craggy liver?
Alpha fetoprotein
Note: this clinical scenario describes hepatocellular carcinoma
A male patient presents with abdominal pain that radiates to the back and jaundice; he was found to have pancreatitis. What can the cause be?
- Gallstones
- Drugs
- Gallstones
A 27 year old female presents with weight loss associated with diarrhea. Laboratory tests showed that she is anemic as well. A small bowel biopsy was taken and revealed villous atrophy of the mucosa. Which of the following describe the likely pathogenesis?
Destruction of intestinal villi by cytotoxic cells
A 17 year old male suffers from oral ulcers, bloody diarrhea and abdominal cramps that are relieved by defecation. Endoscopy showed inflammation of the bowe, and a biopsy was taken; on histology, there were inflammatory cells and non-caseating granulomas. What is the likely diagnosis?
- Crohn’s disease
- Ulcerative colitis
- Crohn’s disease
On a colonic endoscopy, a male patient was found to have a sessile mass that was resected. On histology, the polyp showed dysplasia; what is the likely pathology?
Villous adenoma
Which of the following TNM scores confers the best prognosis of colon cancer?
T1N0M0
A patient presents with fever and abdominal pain. His ileum was found to have longitudinally oriented ulcers over hyperplastic Peyer patches. What is the likely diagnosis?
Typhoid fever
What is the mechanism of action of omeprazole?
Irreversible inhibition of the H/K ATPase
What is the goal of triple therapy in treating peptic ulcer disease?
To eliminate or reduce the occurrence of drug resistance
Which drug increases the synthesis of CYTP450 enzymes?
Rifampicin
Which drug inhibits the metabolism of other drug?
Cimetidine
Which drug interacts with cyclosporine and inhibits its metabolism resulting in organ rejection?
Rifampicin
How does senna exert its laxative effects?
Stimulates the colonic activity and increases peristalsis
Which drug can result in hepatotoxicity in both fast and slow acetylators?
Isoniazide
Which drug causes centrolobular pattern of necrosis in the liver?
Acetaminophen
Which drug is associated with hepatocanalicular type of injury in the liver?
Chlorpromazine
Which of the following is removed from bile slats by the action of microbial flora in the small intestine?
Taurine
Which of the following is produced by modification of bile salts by the intestinal flora?
Secondary bile acids
Which of the following molecules acts as a substrate for 7 alpha- hydroxylase?
Cholesterol
Which of the following causes contraction of the smooth muscles of the gallbladder resulting in the release of bile?
Cholecystokinin
Which of the following pairs is correctly matched?
CO – anti-inflammatory
What binds to bilirubin and prevents its deposition in the brain?
Albumin
The level of which of the following increases in the absence of glucoronyltransferase?
Unconjugated bilirubin
A patient was found to have vitamin B12 deficiency; however, he had normal VitB12 intake and normal levels of intrinsic factor. What could be the cause of VitB12 malabsorption?
Defect in the Vitamin B12 receptor
Mutation in which of the following genes is involved in the progression of late adenoma to colorectal carcinoma?
P53 gene
What is the most important risk factor for developing colorectal cancer at an early age (less than 40 years)?
Family history
What is the function of MSH2 protein?
They are involved in DNA mismatch repair
How does superoxide dismutase act as an antioxidant?
- By suppression of iron-sulfur center destruction
- By suppression of hydrogen peroxide
- By suppression of iron-sulfur center destruction
A pregnant woman had travelled to Bangladesh. When she came 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
Which of the following indicates an active and infective HBV case?
HBeAg
A patient was found to have an HBV infection for more than six months, but the infection was of a low grade. What does the patient suffer from?
Chronic persistent hepatitis
What is a characteristic of HBV infection?
It can be prevented by a serum-derived vaccine
Which hepatitis virus has been associated with zoonotic spread?
Hepatitis E virus
A man has travelled to Egypt recently; when he came back, he developed jaundice and fever and a diagnosis of hepatitis was established. What is the causative agent?
Hepatitis A virus
A male patient has travelled to Bangladesh few months back. He now presents with fever, jaundice, and dark urine and is diagnosed with amoebic abscess. Which test is used to confirm the diagnosis?
Serology for anti-amoeba antibodies
When do all the clinical manifestations of typhoid fever begin?
- After penetration of the ileal mucosa
- After penetration of the mesenteric lymph nodes
- After penetration of the ileal mucosa
A Kuwaiti student who was studying in India has recently developed fever, abdominal pain and rose spot rash; which drug can be used to treat him?
- Cefuroxime
- Ciprofloxacin
- Cefuroxime
Note: patients who come from India and presenting with enteric fever shouldn’t be treated with ciprofloxacin; third generation cephalosporins are used instead
How does Bacteroides fragilis escape immune surveillance in human body?
By constantly changing its capsular polysaccharides
A patient underwent an abdominal surgery after which some bacteria moved out of the gastrointestinal tract and disseminated in throughout his body where he developed sepsis. What is this process called?
Bacterial translocation
What toxin does clostridium difficile produce that is crucial for developing diarrhea and colitis?
- Toxin B
- Toxin A
- Binary toxin
- Toxin B
What is the gold standard test for diagnosing clostridium difficile associated diarrhea?
Toxin detection in stool and its neutralization by antibodies
An elderly patient underwent a colorectal surgery after which he developed severe watery diarrhea. What could be the causative agent?
Clostridium difficile
Note: old age and undergoing an abdominal surgery are two of the risk factors for developing clostridium difficile-associated diarrhea
A man has travelled recently to Bangladesh. After returning back to Kuwait, he developed profuse watery diarrhea, and the culture yielded sucrose-fermenting organism. What is the causative agent?
Vibrio cholerae
What could cause watery diarrhea in a two year old child?
Enteropathogenic E. coli
What could cause watery diarrhea in a patient who has just come back from Africa?
Enterotoxinogenic E. coli
What mediates tissue damage in inflammatory bowel disease?
Inflammatory cytokines
.What activates B cells to produce IgA antibodies in the gastrointestinal tract?
Th2 cells
A 35 year old man presents with a bulging mass in the inguinal region. On physical examination, the mass was found to have extended into the scrotum, and the doctor was able to push it back into the abdominal cavity. What is this patient likely to have?
- Indirect inguinal hernia
- Direct inguinal hernia
- Indirect inguinal hernia
A female patient presents with a 10 year history of dysphagia for both solids and liquids; she stated that she was regurgitating food that she ate two days back. A manometry was performed; which of the following manometries represents her condition?
Choose manometry consistent with achalasia
Which of the following is a complication of cirrhosis?
Ascites
Which of the following is due to the hemodynamic effects of liver disease?
- Caput medusae
- Gynecomastia
- Testicular atrophy
- Spider angiomata
- Palmar erythema
- Caput medusae
Note: the other choices are due to the hormonal (estrogen) effects
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 his 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 in which the head can cause narrowing of the distal portion of the CBD (the intrapancreatic segment)
.A 52 year old male who denies drinking alcohol presented with an enlarged liver and is deeply jaundiced. He is diabetic and has a high BMI. Investigational studies revealed high ALT, AST, and ALP. What is the likely diagnosis?
Non-alcoholic fatty liver disease
A woman who is normally healthy has a height of 164 and weighs 92 kg. She was found to have high blood sugar, high ALT, AST, ALP, and globulins. What could be the likely cause?
Non-alcoholic steatohepatitis
A young man who is applying for a job underwent some investigational tests which revealed moderately elevated liver enzymes. What could he have?
Chronic viral hepatitis
Which of the following reflects the observations seen in a patient presenting with bile duct obstruction?
High urine bilirubin and absent urine and fecal urobilinogen
A patient presents with right upper quadrant pain and is deeply jaundiced. He is passing dark urine and pale stools. What causes the pale color of stools?
Low fecal urobilinogen
A 65 year old man presents with deep jaundice that was not associated with pain and weight loss; he noticed he was passing pale stools. Which of the following enzyme and bilirubin profiles would be observed?
Moderately increased AST and ALT, increased bilirubin, and markedly increased ALP
A 31 year old woman complains of fever, vomiting, and abdominal tenderness. She has a recent travel history to south East Asia. Which of the following enzyme and bilirubin profiles would be observed?
Markedly increased ALT and AST, increased bilirubin, and moderately increased ALP and GGT
A 45 year old woman presents with a one week history of right upper quadrant pain, jaundice and fever with rigors. On physical examination of the abdomen, there was slight tenderness. She was tachycardic as well. What is the most likely diagnosis?
Gallstones
A 43 year old woman presents to the emergency room with severe abdominal pain that radiates to the back with nausea and vomiting. Her blood pressure was 90/50, and she was tachycardic and pale. What would be the first step in managing this patient?
- Administration of IV fluids
- Abdominal CT
- Cholecystectomy
- Administration of IV fluids
Note: IV hydration and NPO is the mainstay of management of acute pancreatitis
A 31 year old woman passes pale voluminous stools. On physical examination, she was found to have pruritic rash on the extensor surface of her forearms. What would be the next appropriate step in diagnosing this patient?
- Small bowel biopsy
- D-xylose test
Small bowel biopsy
Note: the combination of steatorrhea and pruritic rash (dermatitis herpitiformis) leads us to suspect celiac disease
A 35 year old woman passes pale voluminous stools. On physical examination, she was found to have pruritic rash on the extensor surface of her forearms. Investigational tests revealed high levels of anti-transglutaminase and anti-endomysial antibodies. How would this patient be managed?
By following a gluten-free diet for life
Which gene is involved in the initiation mutation according to the model of colorectal cancer?
APC gene
Which hormone is involved in the regulation of body weight by regulating food intake and suppressing appetite?
Leptin
If the parents of a child are both obese, what is the probability this child will develop obesity eventually?
70%
Note: if neither parent is obese, the probability is 10%; if one parent is, the probability is 40%, and if both are, the probability is 70%
A man has recently had a trauma to his head after which he could not stop eating. Which part of the brain is likely to be injured?
Ventromedial hypothalamus
EBM: A randomized controlled trial was conducted where one group was given vitamin B12 and the other was given placebo. The study was conducted to evaluate the effects of vitamin B12 in decreasing the mortality associated with cardiovascular disease. The cumulative incidence of death in the treatment group is 3% and in the control group is 2.4%.What would be the number needed to treat?
150-170
EBM: A study was conducted to evaluate the effect of a drug on decreasing the levels of triglycerides in blood. The drug was shown to decrease triglycerides by 0.03 which was statistically significant. However, this decrease didn’t decrease the incidence of stroke. Which of the following statement is true?
The results of the study are not clinically significant and don’t have a major role to play in the medical practice
