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GI module - 4th year > 2016 module exam > Flashcards

2016 module exam Flashcards

1
Q

What is the mechanism by which the ions above are regulated in pancreatic secretions?

A

An exchanger transporter

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2
Q

A lady had an accident and got her left mandible fractured and the left hypoglossal nerve injured. What will be the effect?

a. Deviation of the tongue to the left upon protrusion
b. Loss of sensation in the anterior 2/3rds of the tongue
c. Deviation of the uvula to the left

A

a. Deviation of the tongue to the left upon protrusion

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3
Q

A slow growing tumor deep in the parotid gland has compressed structures within the gland. Pulse in which artery will be decreased?

a. Facial artery
b. Lingual artery
c. Superficial temporal
d. Superior thyroid

A

c. Superficial temporal

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4
Q

A patient undergone removal of glandular tissue, problem with removing his tongue, which gland was removed?

a. Sublingual gland
b. Parotid gland
c. Buccal glands
d. Submandibular gland

A

d. Submandibular gland

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5
Q

You examined a pancreatic and a parotid gland under the microscope, what will differentiate between the two?

a. Centroacinar cells in pancreas and striated ducts in parotid
b. Striated ducts in the pancreas while centroacinar cells are seen in the parotid

A

a. Centroacinar cells in pancreas and striated ducts in parotid

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6
Q

A patient feels pain in the lower right second molar tooth, which nerve is responsible for the pain
sensation?

a. Maxillary nerve
b. Lingual nerve
c. Inferior alveolar

A

c. Inferior alveolar

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7
Q

Upon tonsillectomy, the patient developed dysphagia and swallowing difficulty. Which nerve was affected?

a. Glossopharyngeal nerve
b. V agus nerve
c. Hypoglossal nerve

A

a. Glossopharyngeal nerve

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8
Q

A surgeon wants to remove lymph nodes located in the retropharangyeal space because of cacer metastasis. He started from the lumen, What is the outermost layer he must incise before reaching the lymph nodes?

a. mucosa
b. submucosa
c. pharyngobasilar
d. buccopharyngeal

A

d. buccopharyngeal

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9
Q

a surgeon removed a part of the thoracic esophagus and damaged a nerve. What will happen as a result?

a. Increased gastric motility
b. Decreased gastric motility
c. Decreased peristalsis of sigmoid colon
d. Increased peristalsis of sigmoid colon
e. Closure/contraction of pyloric sphincter

A

b. Decreased gastric motility

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10
Q

Hernia covered with the covering of the spermatic cord

. Femoral hernia

b. Direct inguinal hernia
c. Indirect inguinal hernia

A

c. Indirect inguinal hernia

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11
Q

What is the efferent nerve fiber for the cremasteric reflex?

a. Iliohypogastric nerve
b. Genitofemoral nerve
c. Lateral cutaneous nerve of the thigh
d. Subcostal nerve

A

b. Genitofemoral nerve

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12
Q

Infection from appendicitis reached the subphrenic recess. How?

A

Paracolic gutter

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13
Q

Patient suffers from epigastric pain and left shoulder pain. He suffers from gastritis and gastric ulcer with posterior perforation. What is responsible for the pain in the left shoulder?

a. Occlusion of artery in the lesser curvature of the stomach
b. Injury to posterior gastric nerve
c. Involvement of the thoracic splanchnic nerves
d. Peritonitis
e. Splenic enlargement that is compressing the stomach

A

d. Peritonitis

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14
Q

A middle-aged man with PUD in the first part of the duodenum, presented with peritoneal
bleeding in the abdominal cavity. What artery is affected?

a. Splenic artery
b. Anterior superior pancreatiduodenal artery
c. Gastroduodenal artery
d. Left gastric artery

A

c. Gastroduodenal artery

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15
Q

What is secreted by the parietal cells?

A

HCl and intrinsic factor

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16
Q

Which congenital abnormality is associated with excessive growth around the 2nd part of the
duodenum?/ narrowing of the second part of the duodenum and dilation of the first part?

A

Annular pancreas

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17
Q

A student was looking at a hepatocyte under an electronic microscope she identified an organelle with circular profile, membrane-bounded tubules. which organelle was that?

a. lysosome
b. peroxisome
c. rough endoplasmic reticulum
d. smooth endoplasmic reticulum

A

d. smooth endoplasmic reticulum (the answer is confirmed by medical education
department)

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18
Q

A student was looking at a hepatocyte under an electronic microscope she identified a cell with a
fat droplet in the perisinusoidal space

a. Kupffer cells
b. Stellate cells

A

b. Stellate cells

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19
Q

Peritoneal impression in the visceral surface of the liver segments V-Vlll (causing a prominent line) just lateral to the gallbladder. Relation to which organ?

a. Right kidney
b. Right colic flexure
c. Right suprarenal gland
d. Descending part of the duodenum

A

a. Right kidney (the answer is confirmed by medical education department)

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20
Q

Solutes in ileum are actively transported from lumen to lamina propria, which structural feature necessities the phenomenon?

a. Impermeable tight junction
b. presence of Microvilli
c. presence of numerous goblet cell
d. presence of intracellular space

A

a. Impermeable tight junction

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21
Q

How do surgeons locate the appendix?

A

Confluence of tenia coli

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22
Q

Woman presented with rectal incontinence after giving birth. Contrast radiograph shows reduced angulation between rectum and anal canal. Which muscle is mostly affected?

a. Iliococcygeus
b. Puborectalis
c. Ischiococcygeal
d. Internal anal sphincter

A

b. Puborectalis

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23
Q

What oral tumor is the end result of notch1 p53 p63?
a. Oral squamous cell carcinoma

b. Salivary gland adenocarcinoma

A

b. Salivary gland

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24
Q

Which of the following is known as pregnancy tumor?

A

Pyogenic granuloma

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25
Q

A histology of a salivary gland showed cystic glandular spaces embedded in dense lymphoid tissue (know that they also have oncocytes)

A

Warniths tumor

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26
Q

Endoscopy in a 43-yo man showed white patches in mid-esophagus. A biopsy of this lesion
would show?

a. Candida esophagitis
b. Squamous papilloma
c. Adenocarcinoma
d. Reflux esophagitis

A

a. Candida esophagitis (the answer is confirmed by medical education department)

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27
Q

Severe coughing spells interfering with breathing after eating observed in a neonate. Further, the baby had frequent pulmonary infections and bouts of abdominal bloating. Which of the following may be the cause of the above symptoms?

a. Annular pancreas
b. Tracheoesophageal fistula
c. Inversion of pancreatic duct
d. Malrotation of the gut

A

b. Tracheoesophageal fistula

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28
Q

What is the mechanism of diet-induced carcinogenesis?

a. Inhibition of h. Pylori
b. Production of nitrosamines
c. Inhibition of IGF1

A

b. Production of nitrosamines

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29
Q

A 54 y/o man with epigastric pain that improves with eating. Endoscopy shows duodenal ulcer
and antral gastritis. Biopsy of the antrum shows lymphocytic tissue with gram negative rods.

a. Duodenal carcinoma
b. Peptic ulcer
c. Chronic atrophic gastritis
d. MALT lymphoma

A

b. Peptic ulcer

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30
Q

A 30 y/o male presented with heartburn that occurs after eating large meals. Endoscopy of the
esophagus showed tongue-like projections in the lower 1/3rd of the esophagus. Biopsy showed columnar metaplasia. What is the diagnosis?

A

GERD (it can also be barret esophagus but it wasn’t among the choices)

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31
Q

What is the cause of malnutrition in inflammatory bowel diseases?

a. Anorexia due to inflammatory cytokines
b. Diet restrictions due to steroid intake
c. Maldigestion due to TNF and IL-6
d. Malabsorption due to alteration of intestinal flora

A

a. Anorexia due to inflammatory cytokines (the answer is confirmed by medical education department)

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32
Q

Which immune factor is found around the bile ducts in primary biliary cirrhosis?

a. Mast cells
b. T helper cells
c. Natural killer cells
d. B cells

A

b. T helper cells

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33
Q

A 62-year-old woman with stomach tumor size 6x6x7cm with histological spindle shape cells and positive for CD117. What is it?

A

GIST

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34
Q

A 40 y/o woman with epigastric pain for 3 months, GI endoscopy of the anterior wall showed
ulcer in the first part of the duodenum what is the most likely pathogen?

a. H pylori
b. Acanthus
c. Herpes simplex

A

a. H pylori

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35
Q

Which of the following is the oncogene most commonly mutated in sporadic colorectal
carcinoma?

a. P53
b. K-ras
c. C-kit
d. C-myc

A

b. K-ras

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36
Q

Which mutations of tumor suppressor genes are found in both sporadic and familial CRC?

a. APC and P53
b. K-RAS and SMAD4

A

a. APC and P53

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37
Q

Loss of rugae, thick stomach wall, and signet cells?

A

Poorly differentiated diffuse gastric carcinoma

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38
Q

A polyp was found on colonoscopy. On histology, it was star shaped with no dysplasia. What is
it?

a. Inflammatory polyp
b. Hyperplastic polyp
c. Sessile adenoma
d. Tubular adenoma

A

b. Hyperplastic polyp

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39
Q

A patient with past history of ulcerative colitis presents with ….. on radiological examination, the colon is enlarged so colectomy was carried out. A biopsy is taken and seen under the microscope. What is the greatest evidence that this is ulcerative colitis?

a. Perforation
b. Inflammation limited to mucosa and submucosa
c. Non caseating granulomas

A

b. Inflammation limited to mucosa and submucosa

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40
Q

Female with a mass, Positive for CD20 and on histology shows lymphocytes

a. Follicular gastritis
b. Gastric carcinoid
c. MALT lymphoma

A

c. MALT lymphoma

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41
Q

Female taking NSAIDS for her osteoarthritis. Biopsy of stomach will show:

A

reactive gastritis with minimal inflammation

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42
Q

When do all of the clinical manifestations in typhoid fever begin?

a. After penetration of the mesenteric lymph nodes
b. After penetration of the ileal mucosa

A

b. After penetration of the ileal mucosa

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43
Q

What is the gene that is usually mutated in HNPCC?

a. MSH1
b. APC
c. MLH1
d. SMAD4

A

c. MLH1

44
Q

What is a consequence of reduced intake of dietary essential amino acids?

a. Increase excretion of protein in form of urea
b. Decrease excretion of protein in form of ammonia
c. Compensatory reduction in protein degradation
d. Decreased protein synthesis

A

d. Decreased protein synthesis

45
Q

Bands of fibrous tissue and nodularity in the liver with absence of central vein?

A

cirrhosis

46
Q

What vitamin deficiency is associated with kwashiorkor?

a. Vitamin A
b. Vitamin B12
c. Vitamin C
d. Vitamin B1

A

a. Vitamin A

47
Q

What form of vitamin B12 is used to fortify/supplement food?

a. Folic acid
b. Cyanocobalamin
c. Methylcobalamin
d. Transcobalamin 1

A

b. Cyanocobalamin

48
Q

Which of the following may cause pernicious anemia?

a. A higher intake of cyanocobalamin
b. A deficiency in immunoglobulin A
c. Immunity against intrinsic factor
d. Mutation in transcobalamin ll gene

A

c. Immunity against intrinsic factor

49
Q

Which step of metabolism is defected that causes dark liver (Dubin Johnson Syndrome)?

a. Conjugation
b. Hepatocyte uptake
c. Ligand binding
d. Secretion in bile canaliculi

A

d. Secretion in bile canaliculi

50
Q

This signaling cascade is initiated by a product of heme metabolism. What is the enzyme and what is the product?

a. Biliverdin reductase; carbon monoxide
b. Heme oxygenase; carbon monoxide

A

b. Heme oxygenase; carbon monoxide

51
Q

A patient who suffered a cerebrovascular attack now presented with chocking, food regurgitation
into the nose. What is the appropriate method of diagnosis?

a. GI endoscopy
b. Modified barium swallow
c. Esophageal motility

A

b. Modified barium swallow

52
Q

A physician is a non-responder to the HBV vaccine had a needle stick injury when dealing with an HBV positive patient. What will be the post-exposure prophylaxis?

a. Adenofovir
b. HBIG
c. HB vaccine

A

b. HBIG

53
Q

A lady visited the clinic for regular checkup. Her height was 162cm and weight 95 kg. Her profile showed (we had a table with the results and the normal ranges) : high ALT (72), AST(75), ALP, and globulins. Normal GGT and CBC. Blood glucose high (9.5). What does she have?

a. Autoimmune chronic active hepatitis
b. Non-alcoholic steatohepatitis

A

b. Non-alcoholic steatohepatitis

54
Q

A 21-year-old female presented with steatorrhea, anemia, and weight loss. Rash of extensor of
her forearm and elevated tTG. What is your next step to diagnose the patient?

a. D-xylose test
b. Endoscopy with biopsy
c. Gluten-free diet
d. Antibody tests

A

b. Endoscopy with biopsy

55
Q

A 52 y/o woman known case of gallstones admitted due to sudden upper abdominal pain with
jaundice and low-grade fever. Then she went on circulatory shock and found an ecchymosis on the flank. What is the diagnosis?

a. Recurrent biliary colic
b. Acute pancreatitis
c. Intestinal hemorrhage

A

b. Acute pancreatitis

56
Q

Responsible for the immunological response in celiac disease?

a. Th1 reactivity to gluten
b. Cytotoxic T cell reaction to gluten
c. Immune complex mediated
d. Antibodies against intrinsic factor

A

a. Th1 reactivity to gluten

57
Q

Normal level of total bilirubin is commonly found in: a. Acute hepatitis

b. Hemochromatosis
c. Hepatic tumors
d. Gilbert syndrome

A

c. Hepatic tumors (the answer is confirmed by medical education department)

58
Q

A long history of a woman tested positive for anti-ANA, anti-SMA, as well as anti-mitochondrial antibodies. She responded well to corticosteroids. What is the diagnosis?

a. Primary biliary cirrhosis
b. Autoimmune hepatitis

A

b. Autoimmune hepatitis

59
Q

A 21-year-old woman complains of fever, malaise, abdominal pain for 1 week duration. She
returned from India 3 weeks ago. She has slightly elevated AST and ALT. Which will be found on testing?

a. IgM HAV
b. IgM HCV
c. IgG hepatic biliary sclerosis

A

a. IgM HAV

60
Q

A patient presented with RUQ pain, jaundice, dark urine, and clay colored stool. What is the cause of the pale stool?

a. Absence of urobilinogen in intestines
b. Increased direct bilirubin in plasma

A

a. Absence of urobilinogen in intestines

61
Q

A 52-year-old female has undergone colonoscopy. A 2.5cm flat polyp was found and removed.
When should the next surveillance colonoscopy happen?

a. 2-6 months
b. 1 year
c. 3 years
d. 5 years
e. 3 months

A

c. 3 years

62
Q

What reflects the function of liver anion transport?

a. Albumin
b. Bilirubin
c. Haptoglobin
d. Transferrin

A

b. Bilirubin

63
Q

A 40-year-old patient presented with a history of gallstones, presented with epigastric pain, examination revealed no bowel sounds and guarding. We were given a table with all vital signs being normal except for mild tachycardia. Amylase>5000 and pO2 is low. What is the diagnosis?

a. Cholecystitis
b. Pancreatitis
c. Pneumonitis
d. Hepatitis

A

b. Pancreatitis

64
Q

A 27-year-old male had liver transplantation 4 months ago complaining of (vomiting, nausea, fever, jaundice….) he recently traveled to France and ate raw delicacies. What is the most likely diagnosis?

a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
e. Hepatitis E

A

e. Hepatitis E

65
Q

A 30-year-old woman with abdominal pain, jaundice, fever for one week. She had cosmetic surgey 3 weeks before, in Thailand. She was tested for HBV and the results showed: HBsAg+, HBeAg+, HBc IgM+, total HBcAB-, HBsAb-, what does she have?

a. Chronic hepatitis with high infectivity
b. Acute hepatitis B
c. Recovered from previous infection
d. V accinated

A

b. Acute hepatitis B

66
Q

What is the treatment of choice for enteric fever?

a. Ciprofloxacin
b. Cephalosporins
c. Clindamycin
d. Cefotaxime

A

a. Ciprofloxacin

67
Q

What is the etiological agent of enteric fever?

a. Salmonella typhi
b. Campylobacter jejuni
c. Salmonella enteritidis
d. Entamoeba histolytica

A

a. Salmonella typhi

68
Q

Which of the following organisms causes Hemolytic Uremic Syndrome?

A

Verotoxygenic E. Coli

69
Q 
A 31-year-old man was found to have elevated liver enzyme (ALT 1200) during his regular checkup for liver enzymes. He had history of unprotected sexual intercourse 6 months ago. He was screened for HBV and HCV.
HCVab -ve
HBsAg +ve
HBeAg +ve
HB anti-core abs +ve 
HBeAb -ve
HBsAb -ve

a. Chronic HBV with high infectivity
b. Acute hepatitis
c. Chronic HBV with low infectivity
d. Recovery

A

a. Chronic HBV with high infectivity

70
Q

Treatment of C.difficile?

a. Clindamycin
b. Cephalosporin
c. Metronidazole

A

c. Metronidazole

71
Q

What is the function of M cells in intestinal epithelial layer?

A

Ingests antigens and transports them from surface to wall

72
Q

What is the most common source of Shigella?

a. Undercooked chicken
b. Fried rice
c. Humans
d. Shellfish

A

c. Humans

73
Q

A 3-year-old presented with pyrexia of unknown origin

a. Salmonella typhi
b. Shigella Sonei

A

a. Salmonella typhi

74
Q

A man came with severe watery diarrhea due to consumption of shellfish. What is the causative
organism?

A

Vibrio parahemolyticus

75
Q

What is the type of bacteria in stomach?

a. Acid-tolerant lactobacilli
b. Bacterioides
c. Coliforms

A

Acid-tolerant lactobacilli

76
Q

Improvement in the sanitation chain will help reduce which viral disease?

a. Hepatitis A
b. Hepatitis B
c. Hepatitis C

A

a. Hepatitis A

77
Q

Which of the following is contraindicated in pregnancy?

a. Promethazine
b. Misoprostol

A

b. Misoprostol

78
Q

What drug is used to treat acetaminophen hepatotoxicity?

a. Halothane
b. N-acetylcystein
c. Isoniazid
d. Rifampicin

A

b. N-acetylcystein

79
Q

Which drug can result in hepatotoxicity in both fast and slow acetylators?

a. Acetaminophen
b. Isoniazid

A

b. Isoniazid

80
Q

Which of the following drugs can cause galactorrhea and gynecomastia?

a. Dicyclominine
b. Misoprostol
c. Cimetidine
d. Omeprazole

A

c. Cimetidine

81
Q

What is the mechanism of action of lactulose?

a. Forms a bulky hydrated mass in the gut
b. Retains fluid in the bowel lumen by osmosis

A

b. Retains fluid in the bowel lumen by osmosis

82
Q

Which of the following is a H/k ATPase blocker?

A

Omeprazole

83
Q

A patient with duodenal ulcer presented with hematemisis, electrocautry was done to treat the ulcer. What will you administer at this stage?

a. Omeprazole
b. Ranitidine
c. Somatostatin
d. Sucralfate

A

a. Omeprazole (the answer is confirmed by medical education department)

84
Q

Which drug can cause hepatotoxicity due to immunological reaction?

a. Acetaminophen
b. Halothane

A

b. Halothane

85
Q

Which drug is used for gastric damage caused by NSAIDs?

a. Misoprostol
b. Bismuth subsalicylate

A

a. Misoprostol

86
Q

Which of the following factors is responsible for the copious secretions of the salivary gland?

A. Ach and VIP by parasympathetic
B. Ach and NE by sympathetic
C. NE and NO by sympathetic
D. NE and Ach by ANS

A

A. Ach and VIP by parasympathetic

87
Q

A patient with liver disease develops peripheral edema. What is the underlying mechanism?

a. Decreased plasma colloid osmotic pressure
b. Increased plasma colloid osmotic pressure
c. Decreased tissue colloid osmotic pressure
d. Increased tissue colloid osmotic pressure

A

a. Decreased plasma colloid osmotic pressure

88
Q

High activity of fibers that secrete VIP on LES smooth muscle but vagal cholinergic fibers show no action potential. What does it indicate?

  1. LES maintaining resting tone
  2. Over tightening of LES
  3. LES relaxation
  4. Absence of ANS control (not sure)
A
  1. LES relaxation
89
Q

Main function of bile acids

a. Emulsify fat
b. Hydrolyze fa

A

a. Emulsify fat

90
Q

What is the process of transport of di and tri peptides along the enterocyte?

a. primary active transport.
b. secondary active transport
c. Tertiary active transport (co-transport with H+)

A

c. Tertiary active transport (co-transport with H+)

91
Q

A manometer is inserted into the patient’s mouth passing through the pharynx, UES, esophageal body, and LES. What are the pressure readings?

a. 0 –> 50 –> 0 –> 30
b. 50–>30–>0–>0
c. 0–>30–>0–>50

A

a. 0 –> 50 –> 0 –> 30

92
Q

Distension of the rectum by the fecal matter induces contraction of the rectum. This is followed by relaxation of the internal anal sphincter. If defecation is desired, the rectum will relax. What reflex is responsible for that?

a. Clonorectal
b. Anorectal
c. Rectorectal
d. Rectosphinctric

A

b. Anorectal

93
Q

What increases blood flow in the hepatic artery?

a. Low CO2 in portal vein
b. Low O2 in portal vein
c. High pH in portal vein
d. Increased blood flow of portal vein

A

b. Low O2 in portal vein

94
Q

What increases the amplitude and duration of slow waves in the stomach?

a. Ach
b. NE
c. Secretin

A

a. Ach

95
Q

An increase in the level of which solute at the microenvironment of enterocyte surface causes
micelles to release digested fat products?

a. H+ ions
b. K+ ions
c. Cl- ions

A

a. H+ ions

96
Q

When a patient was administered 100g of oral glucose, his blood glucose went up by 20%.
However, when he was orally administered 200g of lactose, his blood glucose did not change. What does that suggest?

  1. the liver doesn’t utilize lactose
  2. lactose does not change the serum glucose level
  3. lack of the enzyme lactase in the enterocyte brush border
A
  1. lack of the enzyme lactase in the enterocyte brush border

Note: in our exam galactose was instead of lactose. I think it was a mistake, the doctor said he will check the question!

97
Q

What happens if there is distention of the cecum?

a. Stimulation of peristalsis in the ileum
b. Closure of the ileocecal valve
c. Reverse peristalsis in the colon

A

b. Closure of the ileocecal valve

98
Q

A healthy person made a BaSO4 GI motility test and showed reverse peristalsis in one section, which part of the GI is this?

a. Colon
b. Ileum
c. Esophagus
d. Trachea

A

a. Colon

99
Q

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?

  1. Activation of trypsinogen by brush border enterokinase
  2. Activation of enterokinase by trypsin
A
  1. Activation of trypsinogen by brush border enterokinase
100
Q

The pancreatic fluid is released into the small intestine during which phase of digestion?

  1. Basal
  2. Intestinal
  3. Gastric
  4. Cephalic
A
  1. Intestinal
101
Q

What is a characteristic of peristalsis in the small intestine?

  1. it involves the contraction of the inner circular layer and relaxation of outer longitudinal layer in front of the food bolus
  2. it involves the contraction of the inner circular layer and relaxation of outer longitudinal layer behind the food bolus
  3. mixes the food bolus
  4. it is innervated by the central nervous system (CNS)
A
  1. it involves the contraction of the inner circular layer and relaxation of outer longitudinal layer behind the food bolus
102
Q

The lowest intensity of segmental contractions in normal colonic and rectal motility?

  1. Transverse colon
  2. Descending colon
  3. Upper rectum
  4. Lower rectum
A
  1. Lower rectum
103
Q

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?

A

Migrating myoelectric complex

104
Q

What is the mechanism by which bile acid is secreted into the bile canaliculi?

A

Primary active transport

105
Q

What needs further processing before being absorbed by the intestinal epithelium?

  1. Sucrose
  2. Glucose
  3. Galactose
  4. Tri and di peptides
A
  1. Sucrose

GI module - 4th year (17 decks)

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