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case 3 Flashcards

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1
Q

These are referred to as the major cells of the liver

a. Kupffer cells
b. Stellate cells
c. Hepatocytes
d. Ito cells

A

C

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2
Q

It prevents bilirubin from going back to the blood circulation.

a. Glutathione-S-transferase
b. Heme oxygenase
c. Biliverdin reductase
d. Uridine diphosphate-glucuronosyl transferase

A

A

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3
Q

A group of colorless tetrapyrroles

a. Biliverdin
b. Urobilinogens
c. Urubilins
d. Stercobilin

A

B

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4
Q

Common in patients with chronic hemolytic states

a. Pigment stones
b. Cholesterol stones
c. Black stones
d. Brown stones

A

C

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5
Q

It is the type of bilirubin which appears in the urine

a. unconjugated
b. conjugated
c. delta
d. unbound

A

b

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6
Q

It is responsible for kernicterus

a. unconjugated
b. conjugated
c. delta
d. unbound

A

D

Bilirubin in the circulation or unconjugated bilirubin not yet conjugated with glucuronic acid

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7
Q

Which of the following is not a finding during physical exam of a px with obstructive jaundice?

a. palpable gallbladder
b. mass in the abdomen
c. positive Courvoisier’s Sign/Law
d. weight loss

A

D

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8
Q

Impaired bilirubin conjugation caused by defect
in first exon A1

a. Crigler-Najjar syndrome type 1A
b. Crigler-Najjar syndrome type 1B
c. Crigler-Najjar syndrome type 2
d. Gilbert’s syndrome

A

B

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9
Q

It is characterized by the presence of coarsely granular pigment in the lysosomes of centrilobular hepatocytes called “black liver”

a. Benign recurrent intrahepatic cholestasis
b. Rotor syndrome
c. Dubin-johnson syndrome
d. Wilsom disease

A

C

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10
Q

RUQ pain described as doubling over with cramping colicky pain is an indication of which of the following?

a. GERD
b. renal stone
c. pancreatitis
d. cholecystitis

A

B

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11
Q

It is the estimation of the point course of the natural history of the disease

a. diagnosis
b. grading
c. staging

A

C

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12
Q

It is the most common and most characteristic symptom of liver disease

a. fatigue
b. RUQ pain
c. jaundice
d. nausea

A

A

jaundice - hallmark symptom

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13
Q

Procedure of choice for biliary tree visualization

a. US
b. CT
c. MRI
d. ERCP

A

D

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14
Q

Found in the liver, cardiac muscle, skeletal muscle, kidneys, brain, pancreas, lungs, leukocytes, and erythrocytes

a. AST
b. ALT
c. ALP
d. GGT

A

A

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15
Q

Single best enzyme to measure for the dx of acute pancreatitis

a. serum amylase
b. serum lipase
c. AST
d. ALT

A

B

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16
Q

Which of the following is a physical exam finding in cholecystitis?

a. RUQ tenderness
b. palpable gallbladder
c. fever
d. Courvoisier sign

A

A

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17
Q

It is the presence of stones within the common bile duct

a. Cholelithiasis
b. Choledocholithiasis
c. Cholangitis
d. Cholecystitis

A

B

18
Q

In the Modified Kramer’s Scale for neonatal jaundice, dermal zone 4 refers to which of the following?

a. chest, upper abdomen
b. lower abdomen, thighs
c. arms, lower legs
d. palms, soles

A

C

19
Q

Hepatocellular pattern exhibits which of the following?

a. ALP > ALT/AST
b. ALT/AST > ALP
c. AST > ALT/ALP
d. ALT > ALP/AST

A

B

20
Q

It is the current mainstay of surgical treatment for periampullary cancers

a. pylorus-sparing duodenectomy
b. pancreaticojejunostomy
c. pancreaticoduodenectomy
d. cholecystojejunostomy

A

C

21
Q

Which of these biochemical parameters is/are elevated in obstructive jaundice of the liver?

a. ALT
b. AST
c. ALP
d. Any of the options

A

tayo maganswer haha

22
Q

Which of these parasitic infestations predispose to brown gallstone formation in rural areas?

a. Opisthorchis sinensis
b. Entamoeba histolytica
c. Giardia lamblia
d. Toxocara canil

A

A daw

23
Q

Which of the following stones is most likely seen in adults with cholelithiasis?

a. Brown pigment stone
b. Cholesterol stone
c. Black pigment stone
d. Any of the options

A

B TALAGA

24
Q

Which is the diagnostic limitation of ultrasonography for evaluation of the gallbladder diseases?

a. Pregnancy
b. Serum bilirubin 200 umol/L
c. Ascites
d. Thin patients

A 
C. ASCITES
Limitation of Gallbladder ultrasonography includes:
- Bowel gas
- Massive obesity
- Ascites
25
Q

Which of the following statements about biliary sludge is/are correct?

a. It is made up of lecithin-cholesterol liquid crystals and mucin gels.
b. It may disappear without surgical intervention.
c. Any of the options.
d. None of the options.

A

C

26
Q

Which of the following is/are independent predictors of a bad prognosis of primary sclerosing cholangitis?

a. Advanced age
b. Elevated liver function test
c. Diabetes mellitus
d. Any of the options

A

A. Advanced age
Independent predictors of a bad prognosis in PSC were advanced age, serum bilirubin concentrations, and liver histologic changes

27
Q

JK, 60, M, consulted because of chronic diarrhea described as foul smelling and oily. He notes that the bowel movements occur after heavy meals. This is accompanied by intermittent epigastric pain and significant weight loss. He is a heavy smoker, and heavy alcoholic beverage drinker. Abdominal xray showed calcifications on the epigastric part. Amylase 40 IU/L, lipase 30 IU/L. what is your most likely diagnosis?

A. Acute pancreatitis
B. Chronic pancreatitis
C. Pancreatic CA
D. Pancreatic TB

A

B

Patients with chronic pancreatitis seek medical attention predominantly because of two symptoms: abdominal pain or maldigestion and weight loss. Pain may be constant or intermittent.

Maldigestion is manifested as chronic diarrhea, steatorrhea, weight loss, and fatigue.

CT may show calcifications, dilated ducts, or atrophic pancreas. Diffuse calcifications are pathognomonic for chronic pancreatitis.

28
Q

Which of the following is most likely to occur with pre-existing systemic illness in children?

A. Calculous cholecystitis
B. Acalculous cholecystitis
C. Cholestasis
D. Cholelithiasis

A

B. acalculous cholecystitis
Acute acalculous cholecystitis is uncommon in children and is usually caused by infection.

Acalculous cholecystitis may also be seen with a variety of other systemic disease processes (e.g., sarcoidosis, cardiovascular disease, tuberculosis, syphilis, actinomycosis)

29
Q

Which of the following is most likely specific symptom of gallstone disease

A. Abdominal pain
B. Anorexia
C. Biliary colic
D. Diarrhea

A

C. Biliary Colic

The most specific and characteristic symptom of gallstone disease is biliary colic that is a constant and often long-lasting pain

30
Q

Increased peristaltic waves appreciated during inspection of the abdomen in which of the following GIT pathology.

a. Ascites
b. Hernia
c. Renal artery stenosis
d. Intestinal obstruction

A

A. Ascites

A positive fluid wave, shifting dullness, and peripheral edema makes the presence of ascites to three to six times more likely

31
Q

The enzyme measurement of choice for the diagnosis of acute pancreatitis is.

a. Ascitic fluid enzyme
b. Serum amylase
c. Serum lipase
d. Serum elastase

A

C. Serum lipase

Lipase is the single best enzyme to measure for the diagnosis of acute pancreatitis.

32
Q

A 20 year old male, presented with elevated serum bilirubin with jaundice, severe RUQ pain and chills. What is your most likely diagnosis

a. Ascending cholangitis
b. Hepatic congestion
c. Abdominal malignancy
d. Pancreatic cancer

A

A. Ascending cholangitis

Charcot’s triad of jaundice, abdominal pain, and fever is present in ~70% of patients with ascending cholangitis and biliary sepsis.

33
Q

In adults and children, which is the most common cause of acute or chronic cholecystitis?

a. Cholelithiasis
b. Choledocholilithiasis
c. Calculous cholecystitis
d. Acalculous cholecystitis

A

C. Calculous cholecystitis

Acute inflammation of the gallbladder wall usually follows obstruction of the cystic duct by a stone
(Calculous) Ultrasound will demonstrate calculi in 90–95% of cases

34
Q

DR 30 year old male, consulted because of “yellow eyes”, fever, and body weakness for one week. He also claimed to have loose stools the past 2 days. He loves to eat street foods. On PE: he has tattoos on both upper extremities. Laboratory results: AST 450; ALT: 600; Anti Hbs Reactive. What is your most likely diagnosis?

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

A

B. Hepatitis B
Anti Hbs Reactive
Variability exists in the time of appearance of anti-HBs after HBV infection, occasionally a gap of several weeks or longer may separate the disappearance of HBsAg and the appearance of anti-HBs. During this “gap” or “window” period, anti-HBc may represent the only serologic evidence of current or recent HBV infection

35
Q

RT, 42 year old female, known diabetic, consulted because of epigastric pain. Patient claimed to have drunk 2 bottles of beer before the pain occurred. Ultrasound showed a thickened gallbladder wall with posterior acoustic shadowing. What is your most likely diagnosis?

a. Peptic ulcer disease
b. Acute pancreatitis
c. Cholelithiasis
d. Choledocholithiasis

A

C. Cholelithiasis
Ultrasonography of the gallbladder is very accurate in the identification of cholelithiasis and has replaced oral cholecystography (OCG).Stones as small as 1.5 mm in diameter may be confidently identified provided that firm criteria are used (e.g., acoustic “shadowing” of opacities that are within the gallbladder lumen and that change with the patient’s position [by gravity])

36
Q

All the following are risk factors for cholelithiasis in adolescents. Which one is the EXCEPTION?

a. Abdominal surgery
b. Artificial heart valves
c. Hemolytic disease
d. Hepatobiliary disease

A

b

37
Q

Which of the following is LEAST associated with increased risk for cholelithiasis?

a. Chronic hemolytic anemia
b. Obesity
c. High protein diet
d. Pregnancy

A

C

38
Q

A 50-year-old, female, chronic RUQ pain, easy fatigability, anorexia, and hematemesis. Which of the following clinical presentations is a sign of portal hypertension?

a. Chronic RUQ pain
b. Hematemesis
c. Anorexia
d. Easy fatigability

A

b?

39
Q

Which of the following is a predisposing factor for pigment stone formation?

a. Pregnancy
b. Alcoholic liver cirrhosis
c. Estrogens
d. Obesity

A

b

40
Q

Which of the following permits direct bilirubin to persist in circulation and delays resolution of jaundice?

a. Unconjugated bilirubin
b. Unbound bilirubin
c. Conjugated bilirubin
d. Delta bilirubin

A

d

41
Q

The composition of primary bile include the following:

a. Deoxycholic acid
b. Lithocholic acid
c. Chenodeoxycholic acid
d. Ursodeoxycholic acid

A

C

GIT (4 decks)

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