2012 module exam Flashcards
What is lateral to the femoral ring?
§ Femoral vein § Femoral artery § Femoral nerve § Medial side of the rectus abdominis § Inguinal ligament
§ Femoral vein
*The answer to this question is found in the e-loops
A 20-year old medical student with occasional heartburn will show which of the following readings on a manometer?
A
A woman presented with dysphagia for both solids and liquids with progressive food regurgitation. Which manometry reading is associated with her condition?
B
A 48-year old female with pain in her joints, localized thickness, and tightness in fingers and toes. Which manometry reading is appropriate for his condition?
C
A patient presented with retrosternal chest pain and dysphagia of both solid andliquid. Barium swallow x-ray showed,Choose the appropriate esophageal manometry
D
What supplies the hepatic flexure?
§ Right colic artery
§ Middle colic artery
§ Right colic artery
- Dr. Naryana: “Hepatic flexure is supplied by the right colic artery”. Hepatic flexure is part of the ascending colon and is supplied predominantly by the right colic artery, hence the other name of the flexure is “right colic” flexure
Which of the following is true regarding the surface anatomy of the abdominal wall?
The transpyloric plane traverses the duodenojejunal junction
Which nerve will be damaged during appendectomy?
§ Ilioinguinal nerve
§ Femoral nerve
§ Obturator nerve
§ Ilioinguinal nerve
A salivary gland biopsy showed myxoid stroma and epithelia. Diagnose.
Pleomorphic adenoma
A 62-year old smoker, presented with unilateral painless neck swelling of 3 months’ duration, associated with an ulcer in the undersurface of the tongue. What would a biopsy show?
§ Islets of malignant squamous cells
§ Clusters of malignant glands
§ Enlarged plasmoblasts
§ Reed-Sternberg cells
§ Islets of malignant squamous cells
Parotidectomy to a patient resulted in weakness of orbicularis oris muscle. Which nerve was damaged?
§ Facial nerve
§ Hypoglossal nerve
§ Auriculotemporal nerve
§ Facial nerve
A male suffered from road rage and was lying supine with hemaperitoneal fluid. In which space the fluid will be found?
§ Hepatorenal recess
§ Pouch of Douglas
§ Subphrenic recess
§ Hepatorenal recess
What is responsible for taste sensation in the anterior 2/3 of the tongue?
§ Chorda tympani
§ Glossopharyngeal nerve
§ Chorda tympani
Secretions of the submandibular salivary gland are affected by injury to which nerve?
§ Chorda tympani
§ Glossopharyngeal nerve
§ Chorda tympani
Nerves innervating the striated muscles of the pharynx are located in which nucleus?
§ Nucleus ambiguus
§ Dorsal vagal nucleus
§ Nucleus tractus solitarii
§ Nucleus ambiguus
- The nucleus ambiguus controls the motor innervation of ipsilateral muscles of the soft palate, pharynx, larynx and upper esophagus
Resting pressures in the pharynx, upper esophageal sphincters, body of the esophagus, and lower esophageal sphincter were measured. Which of the following best estimate these pressures respectively?
0 → 50 → 0 → 30
A patient who underwent vagotomy goes out with his friends to eat in a restaurant. In which phase will gastrin secretion be inhibited?
§ When he thinks about the food
§ When the bolus of food reaches his stomach
§ When he thinks about the food
What is the embryonic origin of the inner lining of small intestines?
§ Endoderm
§ Ectoderm
§ Splanchnic mesoderm
§ Somatic mesoderm
§ Endoderm
Which nerve has fibers in the tonsillar bed?
§ Glossopharyngeal nerve
§ Lingual nerve
§ Glossopharyngeal nerve
What is a characteristic feature of the esophagus?
Nonkeratinized stratified squamous epithelium
Which nerve supplies the muscles attached to the pterygomandibular raphe?
§ Facial and vagus
§ Mandibular and vagus
§ Maxillary and mandibular
§ Facial and vagus
- “The superior pharyngeal constrictor muscle is innervated by the pharyngeal branch of the vagus nerve via the pharyngeal plexus. Motor innervation of the buccinator is from the buccal branch of the facial nerve (cranial nerve VII). Sensory innervation is supplied by the buccal branch (one of the muscular branches) of the mandibular part of the trigeminal (cranial nerve V).”
Which recording of vagal inhibitory fibers (VIF) and vagal excitatory fibers (VEF) will be seen with receptive opening of the lower esophageal sphincter?
§ Increased firing of VIF and absent firing of VEF
§ Both VIF and VEF action potentials are increased
§ Both VIF and VEF action potentials are decreased
§ Increased firing of VIF and absent firing of VEF
Where is the synapse between the pre and postganglionic sympathetic fibers to the stomach?
§ Celiac ganglion
§ Sympathetic ganglion
§ Submucosal ganglion
§ Myenteric plexus
§ Celiac ganglion
Which lymph nodes are the last to receive stomach lymphatics before reaching cisterna chyli?
Celiac lymph nodes
An RCT was done to assess the reduction of stroke in high risk individuals of clopidogrel/aspirin compared to aspirin only. Both drugs combined resulted in 2.4% improvement and aspirin only resulted in 1.9% improvement. Calculate NNT
200
- NNT= 1/ARR and since ARR= 0.024 – 0.019= 0.005 then NNT= 1/0.005=200
What is the mechanism of action of dicyclomine?
Muscarinic antagonist
What has maximum activity at pH 3?
Pepsin
What activates all pancreatic enzymes?
Trypsin
What causes decreased secretion from gastric glands?
Acidic pH in the antrum
What is the site of sensory neurons to the stomach?
§ Dorsal root ganglion
§ Greater splanchnic nerve
§ Myenteric plexus
§ Submucosal plexus
§ Dorsal root ganglion
A 57-year old lady complained of epigastric pain when eating for the past year. Endoscopy showed erythematous plaques in the lower esophageal mucosa. Biopsy showed basal squamous epithelia, taller papillae, and intraepithelial neutrophils with few eosinophils. Diagnose.
§ Reflux esophagitis
§ Adenocarcinoma
§ Barrett’s esophagus
§ Reflux esophagitis
A 54-year old woman presented with a gastric polyp that showed tubular morphology and low grade dysplasia. Diagnose.
§ Adenoma
§ Adenocarcinoma
§ Adenoma
Which of the following is a paracrine hormone released from enterochromaffin cells?
Histamine
Which of the following may be increased in gastritis?
§ Plasma cells
§ Undifferentiated cells
§ Submucosal plexus
§ Neck mucous cells
§ Plasma cells
Which of the following is related to vitamin B12 deficiency?
Parietal cells
What increases if parietal cells are hyperactive?
§ Intrinsic factor
§ Gastrin
§ Intrinsic factor
Which of the following is found in the isthmus of the gastric gland?
§ Undifferentiated cells
§ Mucus neck cells
§ Undifferentiated cells
A 67-year old female presented with 9 Kg weight loss, fatigue, and nausea. Biopsy showed erosion and signet cells. Diagnose.
§ Diffuse carcinoma
§ GIST
§ Adenoma
§ Diffuse carcinoma
Which tumor will stain positive for C-Kit (CD117)?
GIST
During surgery, the posterior boundary of the omental foramen was damaged and there was profuse bleeding. What is the source?
§ Inferior vena cava
§ Portal vein
§ Gastroduodenal artery
§ Inferior vena cava
Endoscopy in a 54-year old woman showed pyloric stenosis. Biopsy showed necrosis, inflammation, and granulation tissue with H. pylori. What is the most likely diagnosis?
Peptic ulcer
What is a prominent feature of the empty stomach?
Gastric rugae
Which substance has receptors on oxyntic cells and inhibits their activity?
Somatostatin
What is responsible for receptive relaxation of both lower esophageal sphincter and stomach?
VIP
Which drug prevents gastric damage caused by NSAIDs?
Misoprostol
What inhibits H+/K+ ATPase pump?
Omeprazole
A patient with epilepsy using phenytoin and he had peptic ulcer. Which drug should be avoided?
§ Omeprazole
§ Famotidine
§ Magnesium
§ Misoprostol
§ Omeprazole
Hepatocytes around this vessel tend to be affected first due to low oxygen in the blood. What describes this vessel?
§ Central vein § Hepatic artery § Hepatic vein § Portal vein § Sublobular vein
§ Central vein
What are the only hepatitis viruses that have immunoprophylaxis?
§ HAV and HBV § HAV only § HBV only § HCV only § HBV and HCV
§ HAV and HBV
What mediates damage in autoimmune hepatitis?
§ Cytotoxic T cells
§ Antibody-mediated cellular toxicity
§ Cytotoxic T cells
Which of the following describes the discontinuous endothelium facilitating nutrient absorption to hepatocytes?
Sinusoids
How would fluid in the liver region reach the lower part of the greater sac?
Paracolic gutter
Primary biliary cirrhosis is characterized by immunological destruction of bile ducts. What immune effectors are usually found around bile ducts?
§ Helper T cells
§ Natural killer cells
§ Neutrophils
§ Helper T cells
Which vessel is used to follow segment VII of the liver?
Right hepatic vein