2012 final Flashcards
A 25-year old patient underwent an ultrasound which showed an echogenic mass. Further studies on CT showed nodular enhancement with IV contrast and centripetal filling contrast in delayed scan. Diagnose.
Hepatic hemangioma
A 49-year old male presented with weight loss despite good appetite. He had loose voluminous stool. The fecal fat content was high. This is a radiograph from the patient: How would you manage this patient?
Pancreatic enzymes
A female known to have Sjogren syndrome will develop what?
MALToma
Biopsy of a salivary gland tumor showed cystic spaces lined by oncocytes embedded in lymphoid tissue. Diagnose.
Warthin’s tumor
Which parotid gland tumor is characterized by perineural invasion?
Adenoid cystic carcinoma
What is transmitted through the feco-oral route and causes jaundice?
Hepatitis A
What is best way to decrease the incidence of hepatitis A?
▪ Vaccination of all children above 1 year and improved sanitation
▪ Avoid contaminated food and water
▪ Vaccination of all children under 1 year
?
What is the effect of patients not being compliant to their treatment in a study?
▪ Bias to the treatment group
▪ Bias to the control group
▪ Decreased generalizability
▪ Decreased confounding effect
▪ Bias to the treatment group
Celiac disease is an abnormal immune reaction against which antigen?
▪ Gluten
▪ Vitamin B12
▪ Normal flora antigen
?
The vagus nerve passes through which opening?
Esophageal hiatus
What does intention to treat mean in a randomized controlled trial?
Maintain randomization at all costs
What is the parasympathetic innervation of the ascending colon?
Vagus nerve
. What gross appearance characterizes Crohn’s disease?
Cobblestoning
What abnormal immunological reaction occurs in celiac disease?
Immune system attacking bacterial flora
Which condition is related to the superior rectal vein?
Internal hemorrhoids
The drainage of the left kidney, adrenal gland, and gonad is affected by which structure?
Superior mesenteric artery
- Because it can compress the left renal vein
Which structure is related to the visceral surface of the left anatomical lobe of the liver?
▪ Stomach
▪ Kidney
▪ Duodenum
▪ Diaphragm
?
What is important for the function of the enterocytes?
Apical microvilli
A 55-year old female had normal bilirubin, ALT, and GGT but very high ALP. What is the source of this ALP?
▪ Bone
▪ Liver
▪ Erythrocytes
?
What constitutes the lining of a pancreatic pseudocyst?
Fibrin and granulation tissue
What is the first step in pancreatic enzyme activation?
Activation of trypsin by enterokinase
What describes the post-prandial effect?
Alkaline blood leaving the stomach after increased acid secretion
A lady visited the clinic for regular checkup. Her height was 162 cm and weight 95 kg. Her profile showed high ALT, AST, ALP, and globulins but normal GGT and CBC. What does she have?
Autoimmune chronic active hepatitis
. A 28-year old male presented with acid reflux and epigastric pain for 4 months. His symptoms are worsened after eating especially spicy foods. He has no weight loss, dysphagia, and no decrease in appetite. He’s physically active and takes no
medications. His physical examination was normal except for some epigastric
tenderness. What is the appropriate next step?
▪ Therapeutic trials of acid suppressive therapy
▪ Upper endoscopy
?
Where does retropulsion occur?
Stomach
Where does movement through controlled sharp angle and functional sphincter
occur?
Rectum
An alcoholic young male with a history of 15 Kg weight loss has a mild rise in ALP and GGT with positive glucose in urine. He also had a fatty liver and a dilated common bile duct. Diagnose.
▪ Chronic pancreatitis
▪ Choledolithiasis
?
A 56-year old diabetic man with a history of alcohol consumption presents with
diarrhea and weight loss. Endoscopy was performed and a biopsy taken to show normal enterocytes and villi. Diagnose.
Chronic pancreatitis
Which muscle assists the anal sphincter function by maintaining the anorectal angulation?
Puborectalis
What is palpated to locate McBurney’s point?
Anterior superior iliac spine
An alcoholic drinker with portal hypertension presented with hematemesis. Which of the following is the origin of his bleeding?
▪ Left gastric vein
▪ Short gastric vein
▪ Splenic vein
?
What is the cause of lobular and portal infiltration of lymphocytes and plasma cells responsive to immunosuppression?
Autoimmune hepatitis
What is inflammation of the anal sinus called?
Cryptitis
What describes the formation of slits in the anal mucosa?
Anal fissure
A manometer is inserted into a patient’s mouth passing through the pharynx, UES,
esophageal body, and LES. What are the pressure readings?
0→50→0→30
Which antioxidant is lipid soluble?
▪ Vitamin E ▪ Vitamin C ▪ Glutathione ▪ Glutathione peroxidase ▪ Superoxide dismutase ▪ Xanthine oxidase
?
Which antioxidant is water soluble?
▪ Vitamin E ▪ Vitamin C ▪ Glutathione ▪ Glutathione peroxidase ▪ Superoxide dismutase ▪ Xanthine oxidase
?
Which antioxidant is synthesized in the liver?
▪ Vitamin E ▪ Vitamin C ▪ Glutathione ▪ Glutathione peroxidase ▪ Superoxide dismutase ▪ Xanthine oxidase
?
What is an antioxidant for organic peroxides?
▪ Vitamin E ▪ Vitamin C ▪ Glutathione ▪ Glutathione peroxidase ▪ Superoxide dismutase ▪ Xanthine oxidase
?
What is the mechanism responsible for glucose transport across the apical
membrane of enterocytes in the bowel?
▪ Secondary active transport
▪ Primary active transport
?
Endoscopy in a 43-year old man showed white patches in mid-esophagus. A biopsy of this lesion would show?
▪ Candida esophagitis
▪ Squamous papilloma
▪ Adenocarcinoma
▪ Reflux esophagitis
?
A 54-year old man with long history of Barret’s esophagus presents with dysphagia to fluid and weight loss. Diagnose.
Adenocarcinoma
What do all the clinical manifestations of typhoid fever begin?
▪ After penetration of the ileal mucosa
▪ After penetration of the mesenteric lymph nodes
?
What keeps intragastric pressure constant during eating?
▪ Increased tension and radius in the stomach
▪ Increased radius with constant tension
?
Which muscles are attached to the pterygomandibular raphe?
▪ Buccinator and superior pharyngeal constrictor
▪ Superior and middle pharyngeal constrictors
▪ Middle and inferior pharyngeal constrictors
?
Which precursor in the serum distinguishes acute hepatitis from chronic hepatitis?
▪ Albumin
▪ Aminotransferase
▪ Bilirubin
▪ Alkaline phosphatase
?
A 4-month old boy presented with severe watery diarrhea. A biopsy was taken and
the enterocytes showed vacuolation?
▪ Abetalipoproteinemia
▪ Cystic fibrosis
▪ Viral gastroenteritis
?
What will be isolated from the stool of a lady who developed severe pseudomembranous colitis and a culture that grew anaerobic bacteria positive for toxin B?
▪ Clostridium difficile ▪ Salmonella typhi ▪ Staphylococcus aureus ▪ Vibrio parahemolyticus ▪ Campylobacter jejuni ▪ Shigella sonnei ▪ Bacillus cereus
?
A patient who consumed raw seafood presented with gastroenteritis. Stool culture with TCBS agar showed green colonies. What is the causative organism?
▪ Vibrio parahemolyticus
▪ Vibrio cholera
?
A patient traveled to Iraq and returned with profuse watery diarrhea. The sample grew yellow colonies on TCBS agar. What is the causative organism?
▪ Vibrio cholera
▪ Vibrio parahemolyticus
▪ Salmonella
▪ E. coli
?
What is stored in the gallbladder in a chronic carrier state?
▪ Salmonella typhi
▪ Salmonella enteritidis
?
Which drug is used to treat postoperative nausea and vomiting by inhibiting 5HT3
receptor?
Ondansetron
A 70-year old man presented to the clinic with upper abdominal pain, nausea, and
vomiting. He has a long history of type II diabetes and hypertension. In physical
examination, he is in severe pain.
Heart rate: 120 bpm
Blood pressure: 90/60
Temperature: 37 °C
Respiratory rate: 26
He also has mild abdominal tenderness, high AST, ALT, ALP, and amylase but normal bilirubin. What is the most important step in managing this patient?
▪ Intravenous fluids
▪ Administration of antibiotics
▪ Urgent endoscopic cholangiography
▪ Opioid analgesics to control the pain
- Acute pancreatitis is managed by intravenous fluids, whereas chronic pancreatitis is managed by enzyme supplementation and narcotics
?
A 56-year old male who is known to drink alcohol presented with diarrhea and
weight loss. What is the diagnosis?
▪ Acute pancreatitis
▪ Cystic fibrosis
▪ Viral gastroenteritis
?
A 54-year old female who had taken multiple antibiotic trials presents with dysuria. Nitrogen inhibition test was negative. What is the causative organism?
▪ Pseudomonas
▪ Klebsiella pneumonia
▪ E. coli
?
A couple developed severe vomiting after a few hours of eating Chinese food. What
is the causative organism?
▪ Bacillus cereus
▪ Klebsiella pneumonia
▪ E. coli
?
Metabolism of which component helps prevent acidosis in prolonged starvation?
▪ Unsaturated fatty acids ▪ Glycerol ▪ Glutamine ▪ Alanine ▪ Uric acid
?
What will not be affected if there is leakage into the lesser sac from the stomach?
▪ First part of duodenum
▪ Spleen
▪ Left adrenal gland
- The first part of the duodenum is intraperitoneal and it is superior to the other structures
?
What reactions is biotin responsible for?
▪ Carboxylation
▪ Oxidation
▪ Deamination
▪ Reduction
?
A 79-year old male presents with bilateral testicular masses. What will biopsy show?
▪ Lymphoma
▪ Seminoma
▪ Embryonal carcinoma
- Remember that seminoma although can rarely be bilateral, but it occurs in young adults (as the case of embryonal carcinoma).
?
An old anemic patient with a napkin-ring colorectal cancer has shown to have the
CpG island methylator phenotype and BRAF mutations. What is this type of tumor?
Serrated adenoma
A 60-year old male patient presented with hematuria and loin pain. He was found to be severely anemic. Colonoscopy showed an exophytic mass in his cecum. A biopsy showed adenocarcinoma with signet ring formation. The patient underwent colonoscopy 10 years ago to excise a serrated sessile adenoma. What is the mechanism of this somatic mutation?
▪ BRAF
▪ KRAS
▪ NRAS
▪ P53
?
