2013 final Flashcards
A 38-year-old male presented with a 6-month history of heartburn and epigastric pain aggravated especially after eating spicy food and on lying down. He doesn’t have dysphagia, odynophagia, or weight loss. Barium swallow X-ray was performed. Which of the following is the next step in his management?
A. Upper GI endoscopy
B. Therapeutic trials of acid suppression
B. Therapeutic trials of acid suppression
A 60-year-old patient presented with changes in bowel movements and bleeding per rectum. Barium enema showed apple core appearance of the colon. What is the diagnosis?
A. Colon cancer
B. Ulcerativecolitis
C. Toxic mega colon
A. Colon cancer
Choose the group of lymph nodes responsible for the lymphatic drainage of the following parts of the tongue:
Apex of the tongue.
A. Submental lymph nodes B. Submandibular lymph nodes C. Inferior deep cervical lymph nodes D. Superior deep cervical lymph nodes E. Superficial cervical lymph nodes F. Retropharyngeal lymph nodes
A. Submental lymph nodes
Choose the group of lymph nodes responsible for the lymphatic drainage of the following parts of the tongue:
Lateral 2/3 of the tongue.
A. Submental lymph nodes B. Submandibular lymph nodes C. Inferior deep cervical lymph nodes D. Superior deep cervical lymph nodes E. Superficial cervical lymph nodes F. Retropharyngeal lymph nodes
B. Submandibular lymph nodes
Choose the most appropriate structure:
A structure supplied by both right and left branches of the portal vein.
A. Right portal lobe B. Right anatomical lobe C. Left portal lobe D. Left anatomical lobe E. Quadrate lobe F. Caudate lobe G. Porta hepatis
F. Caudate lobe
Choose the most appropriate structure:
The gallbladder is located on the right side of this structure.
A. Right portal lobe B. Right anatomical lobe C. Left portal lobe D. Left anatomical lobe E. Quadrate lobe F. Caudate lobe G. Porta hepatis
E. Quadrate lobe
Which of the following nerves carries taste sensation from the anterior 2/3 of the tongue?
Chorda tympani
Which of the following nerves carries preganglionic parasympathetic fibers to the submandibular gland?
Chorda tympani
What can be the source of bleeding from the anterior wall of the epiploic foramen during reduction of herniation of the intestinal loops through epipolic foramen into the lesser sac?
A. Inferior vena cava
B. Portal vein
B. Portal vein
Through which peritoneal recess would an abscess from burst appendix reach the subphrenic space?
Paracolic gutter
In which peritoneal recess would peritoneal fluid accumulate in a female in supine position?
Hepatorenal pouch
Note: In erect position, the most dependent part of the peritoneal cavity in females is Douglas pouch (recto-uterine pouch)
Which of the following is responsible for the parasympathetic innervation of the hindgut?
Pelvic splanchnic nerves
Which of the following differentiates the pancreas from the parotid gland histologically?
Centroacinar cells are found in the pancreas but there is no striated ducts
Which point confers the first and maximal resistance during insertion of a nasogastric tube?
Pharyngoesophageal junction
Which of the following structures is traversed by the transpyloric plane?
Duodojejunal junction
Which of the following is the characteristic feature of the ileum?
Peyer’s patches
Which of the following structures is present in the vestibule of the oral cavity?
A. Submandibular duct
B. Sublingual duct
C. Parotid duct
D. Lingual tonsils
C. Parotid duct
Backflow of blood through which veins is responsible for caput medusa in chronic liver disease?
A. Paraumbilical veins
B. Short gastric veins
C. Left gastric vein
A. Paraumbilical veins
Which of the following muscles plays the most important role in maintaining anal continence?
A. Internal anal sphincter
B. Puborectalis
B. Puborectalis
Which of the following is true about RAS in the gallbladder?
Their presence is abnormal and indicates an increased risk of gallstones & cholecystitis
Which of the following is true about Sjögren syndrome?
Infiltration by lymphoplasmacytic cells
Which analyte is responsible for fetor hepaticus and hepatic encephalopathy in chronic liver disease?
Ammonia
choose the most appropriate causative agent of the following histopathological findings:
Spindle cells surrounded by slit-like vascular spaces and hyaline globules.
A. EBV B. HIV C. HHV-8 D. HPV E. HSV-1 F. HSV-2
C. HHV-8
Note: The question describes “Kaposi Sarcoma”. It is seen in patients with HIV because they are prone to infections but the “causative agent” is HHV-8
choose the most appropriate causative agent of the following histopathological findings:
An immunocompromised patient presented with a white patch on his tongue with hairy
projections that showed balloon cells histologically.
A. EBV B. HIV C. HHV-8 D. HPV E. HSV-1 F. HSV-2
A. EBV
Note: The question describes hairy leukoplakia, which is seen in HIV patients; however, the causative agent is EBV not HIV.
A well-defined solid tumor in the liver histologically showed uniform-looking hepatocytes and no bile ducts. What is the diagnosis?
Hepatic adenoma
What characterizes liver cirrhosis histologically?
Bridging fibrosis and regenerating hepatocyte nodules
An oral blistering lesion histologically showed splitting of the epidermis caused by anti- Desmoglin 3 antibodies. What is the diagnosis?
Pemphigus vulgaris
A 30-year-old male presented with heartburn that occurs after eating large meals. Endoscopy of the esophagus showed tongue-like projections in the lower third. Biopsy showed columnar metaplasia. What is the diagnosis?
Gastro-esophageal reflux disease
Note: “Barrett’s esophagus” was not among the choices.
A 9-year-old girl presented with diarrhea and weight loss. Histopathological examination of the duodenum showed atrophic villi and intraepithelial lymphocytes that stained positive for CD13+ on immunohistochemistry. HLA analysis was performed and the results confirmed the diagnosis. What is the diagnosis?
A. Celiac disease
B. Tropical sprue
C. Whipple’s disease
A. Celiac disease
Which of the following is a cause of esophagitis?
Uremia
Which of the following genes is mutated in most Gastro-Intestinal Stromal Tumors (GIST)?
C-KIT
Choose the most appropriate diagnosis in the following scenarios:
A female presented to the gastroenterologist with irritation in bowel movements. She requested
screening for colorectal cancer. Gene analysis showed mutations in APC, K-RAS, and SMAD4.
A. Familial adenomatous polyposis B. Sporadic colorectal cancer C. Peutz-Jegher syndrome D. Li Fraumani syndrome E. Lynch syndrome
B. Sporadic colorectal cancer
Choose the most appropriate diagnosis in the following scenarios:
Genetic screening in a female with family history of CRC and endometrial cancer showed mutations in MSH2 and PMS2.
A. Familial adenomatous polyposis B. Sporadic colorectal cancer C. Peutz-Jegher syndrome D. Li Fraumani syndrome E. Lynch syndrome
E. Lynch syndrome
Choose the culprit of the following pathogenic events in celiac disease:
Production of anti-tissue transglutaminase, anti-deamidated gliadin, and anti-endomysial
antibodies.
A. IL-15
B. CD4+ T cells
C. Blymphocytes
D. CD8+ T cells
C. Blymphocytes
Choose the culprit of the following pathogenic events in celiac disease:
Damage to mucosal enterocytes.
A. IL-15
B. CD4+ T cells
C. Blymphocytes
D. CD8+ T cells
D. CD8+ T cells
Which of the following histopathological features characterizes chronic pancreatitis?
A. Diffuse fibrosis and acinar atrophy
B. Diffuse destruction of islets of Langerhans
C. Fat necrosis
D. Hemorrhagic necrosis
A. Diffuse fibrosis and acinar atrophy
Which of the following pathological changes in the liver is associated with acetaminophen overdose?
Panlobular and panacinar necrosis
A 22-year-old female presented to the gastroenterologist with painless jaundice and flu-like symptoms. Her laboratory test results are provided.
LFTs: Total bilirubin: High; Direct bilirubin: Normal; Liver enzymes: Normal
Urine analysis showed yellow urine with urine specific gravity of 1030, negative RBCs and urobilinogen, and trace amounts of sugar.
She later became asymptomatic as the flu resolved. What is the diagnosis?
Gilberts syndrome
Which of the following is removed from bile salts during the deconjugation reaction by intestinal microflora?
Glycine
A young man had to undergo some investigational tests before his employment. The results were normal except for moderately elevated liver enzymes (AST & ALT). What is the diagnosis?
Chronic viral hepatitis
Choose the most appropriate diagnosis in the following scenarios:
Upon routine check-up, a previously healthy male was found to have elevated ALT but normal AST & GGT.
A. Acute cholecystitis B. Acute liver disease C. Chronic liver disease D. Alcoholic liver disease E. Liver cirrhosis F. Choledocholithiasis G. Pancreatic cancer
C. Chronic liver disease
Choose the most appropriate diagnosis in the following scenarios:
A 78-year-old male presented with a 1-week history of jaundice without abdominal pain. His lab results showed the following:
Total bilirubin: 250 (High)
Unconjugated bilirubin: Normal
ALP: 650 (Markedly elevated) ALT: 95 (Mildly elevated) AST: 87 (Mildly elevated) Amylase: Normal
Lipase: Normal
US showed dilated intrahepatic bile ducts and distended gallbladder but there were no gallstones.
A. Acute cholecystitis B. Acute liver disease C. Chronic liver disease D. Alcoholic liver disease E. Liver cirrhosis F. Choledocholithiasis G. Pancreatic cancer
G. Pancreatic cancer
Note: the fact that pancreatic enzymes are normal doesn’t rule out pancreatic cancer. Actually, serum amylase and/or lipase levels are elevated in less than 50% of patients with pancreatic cancer. Furthermore, a non-tender palpable (distended) gallbladder in a patient with PAINLESS jaundice is not caused by gallstones. This is called “Courvoisier’s sign”. The cause of such presentation is obstruction of the common bile duct typically due to a mass in the head of the pancreas.
A 40-year-old woman presented with biliary colic and jaundice. ERCP showed gallstones obstructing the bile duct. Which set of laboratory data would be found in such patient?
Increased urine bilirubin – decreased urine urobilinogen – decreased fecal stercobilin
A 38-year-old female presented with jaundice and enlarged spleen. Her liver function test results showed the following: AST 200 ALT 150 GGT 646 ALP 246 INR 2.3 (prolonged) Hemoglobin 93 (low) Albumin is normal. What is the cause of her jaundice?
A. Hereditaryspherocytosis
B. Chronic alcoholic liver disease
C. Stone in the cystic duct
D. Acute viral hepatitis A
B. Chronic alcoholic liver disease
An intravenous drug user who is already infected with HBV presented with symptoms of acute hepatitis (jaundice, enlarged tender liver, and elevated liver enzymes). Screening tests for HDV were positive. Which of the following agents is the best to be used in the treatment?
A. Protease inhibitor
B. Interferon
C. Lamivudine
D. Tenofovir
B. Interferon
What mediates the mucosal damage and villous atrophy in celiac disease?
Inflammatory cytokines
What is the role of IgA antibody in mucosal immunity in the GIT?
A. Activates NK cells
B. Prevents bacterial adhesion to the epithelium
C. Cytotoxicity
B. Prevents bacterial adhesion to the epithelium
Which of the following is the most appropriate method to diagnose C. difficle-associated diarrhea?
A. Colonoscopy
B. Imaging of the small intestine
C. Detection of toxin B in stool
D. Detection of the antigen in urine
C. Detection of toxin B in stool
What mediates hepatic damage in autoimmune hepatitis?
A. Cytokines
B. Macrophages
C. Antibody-dependent cell-mediated cytotoxicity
A. Cytokines
Choose the most appropriate drug:
Treatment of C. difficile-associated diarrhea.
A. Vancomycin
B. Clindamycin
C. Clarithromycin
A. Vancomycin
Choose the most appropriate drug:
The cause of C. difficile-associated diarrhea.
A. Vancomycin
B. Clindamycin
C. Clarithromycin
B. Clindamycin
Choose the most appropriate causative agent in the following scenarios:
A 40-year-old male has recently travelled to Egypt. Two days later he developed profuse watery diarrhea.
A. Salmonella typhi B. Vibrio parahemolyticus C. ETEC D. VTEC E. Campylobacter jejuni
C. ETEC
Choose the most appropriate causative agent in the following scenarios:
A 65-year-old male presented with severe bloody diarrhea, which deteriorated rapidly. Two days later he died from hemolytic uremic syndrome (HUS).
A. Salmonella typhi B. Vibrio parahemolyticus C. ETEC D. VTEC E. Campylobacter jejuni
D. VTEC
Choose the drug that is responsible for the following hepatotoxic effects:
Toxic doses of this drug cause centrilobular pattern of necrosis in the liver.
A. Valporic acid B. Tetracycline C. Acetaminophen D. Methotrexate E. Chlorpromazine F. Amiodarone
C. Acetaminophen
Choose the drug that is responsible for the following hepatotoxic effects:
Pruritus and jaundice are common features of the cholestatic effect of this drug
(hepatocanalicular injury).
A. Valporic acid B. Tetracycline C. Acetaminophen D. Methotrexate E. Chlorpromazine F. Amiodarone
E. Chlorpromazine
What is the treatment of choice (or antidote) for acetaminophen toxicity?
N-acetylcystiene
. Which of the following happens during the receptive relaxation of the LES?
A. Increase in VIP and decrease in Ach
B. Increase in VIP and decrease in NE
A. Increase in VIP and decrease in Ach
What is the difference between the primary salivary secretion and oral saliva?
The primary secretion contains more K+
What is migrating myoelectric complex (MMC)?
Bursts of intense electrical contractions
Distension of the rectum by the fecal matter induces contraction of the rectum. This is followed by relaxation of the internal anal sphincter and contraction of the external anal sphincter. Which of the following happens next to maintain continence?
A. Contraction of the rectum
B. Relaxation of the rectum (Anorectal reflex)
B. Relaxation of the rectum (Anorectal reflex)
A patient with chronic liver disease developed peripheral edema. Which starling capillary pressure is the cause of this manifestation?
A. Decrease in plasma colloid oncotic pressure
B. Decrease in tissue colloid oncotic pressure
A. Decrease in plasma colloid oncotic pressure
Choose the enzyme that fits the following features:
Enzyme needs emulsification to optimize its function.
A. Trypsin
B. Chymase
C. Pepsin
D. Pancreatic lipase
D. Pancreatic lipase
Choose the enzyme that fits the following features:
An enzyme that is degraded in the alkaline medium.
A. Trypsin
B. Chymase
C. Pepsin
D. Pancreatic lipase
C. Pepsin
What happens to intestinal motility if autonomic innervation of the gut is cut?
A. Reverse peristalsis
B. Motilitystops
C. Motility is unaffected
D. Relaxation of all smooth muscles
C. Motility is unaffected
. What is the imaging modality of choice to stage gastrointestinal tumors?
A. CT of chest and abdomen
B. MRI of chest and abdomen
C. X-ray of chest & abdomen
A. CT of chest and abdomen
EBM: The strongest feature that increases the validity of an RCT and makes treatment arms equal on all factors except for the treatment.
A. No drop-outs B. Blinding C. Intention to treat D. Stratification E. Randomization
E. Randomization
EBM: This feature prevents systemic error (bias) in outcome assessment in an RCT.
A. No drop-outs B. Blinding C. Intention to treat D. Stratification E. Randomization
B. Blinding
EBM: A screening test for iron deficiency anemia has a pretest probability pf 90%. What is the effect of decreasing pretest probability from 90% to 10%?
A. Sensitivity: Increase Specificity: Decrease PPV: Decrease NPV: Increase
B. Sensitivity: Decrease Specificity: Increase PPV: Increase NPV: Decrease
C. Sensitivity: Same Specificity: Same PPV: Decrease NPV: Increase
D. Sensitivity: Same Specificity: Same PPV: Increase NPV: Decrease
C. Sensitivity: Same Specificity: Same PPV: Decrease NPV: Increase
EBM: An RCT usually has a description of the baseline characteristics (age, sex, race … etc.) based on the treatment status (treatment group and placebo group). What is the main purpose of providing this table?
A. To show that confounding effect was minimized
B. To show that random error was controlled
C. To show the efficacy of the treatment
D. To show the statistical difference in different groups
A. To show that confounding effect was minimized
