Final Çıkmışları Flashcards
60 years old, male patient has a burning sensation in the epigastric region and pain
that wake up at night for the last 2 months. There are no other features in the history.
Which test should be preferred in this patient?
Colonoscopy
Enteroscopy
Colonoscopy
Upper GI Endoscopy
Wireless capsule endoscopy
Upper GI Endoscopy
Info: This case most likely is indicating duodenal ulcer. Therefore, upper GI endoscopy would be necessary to diagnose it.
A 30-year-old male patient, who had no known disease before, admitted to the
internal medicine clinic with the complaints of abdominal pain and diarrhea. In the
detailed anamnesis, it is learned that he defecates approximately 10 times a day
and he has seen red blood mixed with stool once. Colonoscopy revealed ulcers,
fragile mucosa and pseudopolyps in a continuous pattern from the rectum to the
splenic flexure. Which of the following microscopic findings would be expected to be seen in the biopsy sample taken from the ulcerated area of the colon?
An infiltrate consisting of tubular, anastomosing and branching
glands in a desmoplastic stroma
Mixed inflammatory infiltrate limited to mucosa and submucosa
and crypt abscesses
An ulcerated polyp with cystic spaces containing mucin and
inflammatory debris
Transmural mixed inflammatory infiltrate and granulomas
Villous processes lined by columnar epithelium with low-grade
dysplasia
Mixed inflammatory infiltrate limited to mucosa and submucosa
and crypt abscesses
Info1: The disease is UC
Info2: In a patient with bloody diarrhea with continuous involvement starting
from the rectum primarily suggests ulcerative colitis (UC). The major
histologic changes in ulcerative colitis (UC) are limited to the mucosa
and submucosa. There is no transmural inflammation. In the acute
stages, there is cryptitis with an increased number of inflammatory
cells within the epithelium as well as lamina propria, including
neutrophils, lymphocytes, plasma cells, histiocytes, eosinophils, and
mast cells. Granulomas with epithelioid histiocytes and multinucleated
giant cells are absent, unlike in Crohn disease. Neutrophils appear in
glandular lumen (crypt abscesses) and there is progressive
destruction of crypts.
An ulcerated polyp with cystic spaces containing mucin and
inflammatory debris is compatible with juvenile polyp.
Villous processes lined by columnar epithelium with low-grade
dysplasia is compatible with villous adenoma.
An infiltrate consisting of tubular, anastomosing and branching glands
in a desmoplastic stroma is compatible with adenocarcinoma
Transmural mixed inflammatory infiltrate and granulomas is
compatible with Crohn’s disease.
A 40-year-old woman presents to the hospital with fever, nausea, vomiting, severe colicky abdominal pain, and bloody diarrhea for one day. Her vital signs show a
heart rate of 110/min, blood pressure of 100/70 mmHg, and temperature of 38.3°C.
Clinical examination shows a distended abdomen with tenderness in the lower
abdomen. Stool analysis shows fecal leukocytes and red blood cells. Stool culture yields the growth of gram-negative, non-motile, facultatively anaerobic, and non- spore-forming bacilli, which produce toxins. Which of the following is the most likely diagnosis?
Shigellosis
Cholera
Giardiasis
Typhoid fever
Shigellosis
Info: Shigella is a gram-negative, non-motile, facultatively anaerobic,
and non-spore-forming bacillus that causes shigellosis.
According to the Forrest classification used in upper gastrointestinal bleeding; which
indicates a clean base ulcer?
Class IIa
Class Ia
Class Ib
Class IIa
Class III
Class III
In a 70-year-old male patient who presented with complaints of weakness,
abdominal pain and loss of appetite, iron deficiency anemia and fecal occult blood
test positivity in the stool are detected. On endoscopy; An ulcerative mass of 3 cm is
observed on the lesser curvature of the stomach at the localization of antrum and a
biopsy is taken. On the histopathological examination of the biopsy; a diffuse
infiltrate composed of signet ring cells invading through the entire wall of the
stomach is detected.
Which of the following is the most likely diagnosis of this patient?
MALToma
Intestinal metaplasia
Intestinal type adenocarcinoma
Gastrointestinal stromal tumor
Diffuse type adenocarcinoma
Diffuse type adenocarcinoma
Info1: Signet cell dendi mi akla bu gelecek.
Info2: Elderly male patient, the biopsy findings described are consistent with
diffuse type gastric adenocarcinoma.Diffuse type adenocarcinomas
are mostly composed of poorly differentiated / signet ring cells,
present as scattered individual cells or clusters. Neoplastic cells that
are isolated or arranged in small aggregates without well formed
glands.
Info3: Intestinal type gastric adenocarcinoma often forms a mass and
intestinal epithelial cells consisting of glands/glandular structures
(well-differentiated) are observed.
Gastrointestinal stromal tumor is a mesenchymal tumor of stomach
MALT lymphoma (MALToma) is a form of extranodal lymphoma
involving the mucosa-associated lymphoid tissue (MALT), frequently of the stomach. They are mostly extranodal Marginal B zone
Lymphomas. In the stomach, MALToma is induced, typically as a
result of chronic gastritis and H. pylori infection is the most common
cause. Mostly, H. pylori eradication results in durable remissions with
low rates of recurrence in most MALToma patients. The clinical
history and the microscopic features are regarding MALToma.
Which of the following change/dysfunction is the main mechanism of symptom
development in gastroesophageal reflux disease?
Weakening of the upper esophageal sphincter
Failure of the lower esophageal sphicter relaxation
Increased peristalsis of distal esophagus
Failure of the lower esophageal sphicter contraction
Atrophy of the lower esophageal sphincter
Failure of the lower esophageal sphicter contraction, only.
Other statements are of achalasia’s.
In GERD, hardening of upper esophageal sphincter is seen.
Which of the following diseases/disorders are among the manifestations of hepatic
failure (Choose as many as required)?
Cerebral edema
Acute kidney injury
Coagulopathy
Infectious diseases
Hypoglycemia
Hypoadrenalism
Jaundice
Low output cardiac failure
All except low output cardiac failure. ‘high’ output cardiac failure would be true.
Which of the following features regarding the subtypes of colonic polyps are
correct? (Choose as many as required)
The polyps associated with juvenile polyposis and Peutz-Jeghers syndrome are mostly inflammatory type polyps
The syndrome related juvenile polyps have increased risk of malignancy
Hyperplastic polyps are the most common types of colonic polyps
The polyps related to Gardner’s syndrome and Turcot’s syndrome are in the type of adenomatous polyps
All of the histologic subtypes of adenomatous polyps may have risk of malignancy
All except the first one are true.
Info: Hyperplastic polyps are the most common types of colonic polyps
The polyps associated with juvenile polyposis and Peutz-Jeghers
Syndrome are mostly hamartomatous type polyps
The syndrome related juvenile polyps have increased risk of
malignancy
All of the histologic subtypes of adenomatous polyps have risk of
malignancy (villous type polyps have greater risk)
The polyps related to Familial adenomatous polyposis, Gardner’s
syndrome and Turcot’s syndrome are in the type of adenomatous
polyps
Which of the following genes initiates the early polyp formation during the
development of colorectal cancer?
p53 (protein 53)
K- Ras
DCC (Deleted in Colon Cancer)
APC (Adenomatous Polyposis Coli)
APC (Adenomatous Polyposis Coli)
Info: APC (Adenomatous Polyposis Coli) gene mutation is almost
invariably found in all colorectal cancers and is assumed that its
mutation starts the early polup formation.
Which of the following is the drug used to differentiate between Crigler-Najjar type I
and II?
Phenobarbital
Doxazosin
Acetylsalicylic acid
Ibuprofen
Phenobarbital
Which of the following sentences are among the features of acute pancreatitis
(Choose as many as required)?
Acute necrotizing pancreatitis and hemorrhagic pancreatitis are the mild forms of the disease
Reversible pancreatic parenchymal injury associated with inflammation.
Associated with inappropriate release and activation of pancreatic enzymes
The major symptom is abdominal pain.
Cullen’s sign is a faint blue discoloration around the umbilicus which may occur as the result of hemoperitoneum in acute pancreatitis.
All except the first one are true.
Info: Acute pancreatitis is defined as reversible pancreatic parenchymal
injury associated with inflammation. It results from inappropriate
release and activation of pancreatic enzymes, which destroy
pancreatic tissue and lead to an acute inflammatory reaction. Acute
necrotizing pancreatitis and hemorrhagic pancreatitis are the severe
forms of the disease. The major symptom is abdominal pain and the
disease is among the reasons of acute abdomen. Cullen’s sign is a
faint blue discoloration around the umbilicus which may occur as the
result of hemoperitoneum in acute pancreatitis. Turner’s sign is a
blue-red-purple or green-brown discoloration of the flanks reflects
tissue catabolism of hemoglobin from severe necrotizing pancreatitis
with hemorrhage.
Which of the following should be applied for the treatment of duodenal ulcer?
Somatostatin
Endoscopic resection
Spiranolactone
Helicobacter pylori eradication
Somatostatin
Helicobacter pylori eradication
Which of the following symptoms can’t be associated with grade 2 hemorrhoids?
Perianal pain
Rectal bleeding
Perianal pain
Mucus discharge
Pruritus ani
Perianal pain
Grade 2 hemorrhoids are by definition located above the
dentate line and they do not cause pain.
Which of the following tumor is the most common primary malignant liver tumor?
Hepatoblastoma
Hepatocellular adenoma
Cavernous hemangioma
Hepatocellular carcinoma
Metastasis to liver
Hepatocellular carcinoma
The most common tumors of liver are metastasis tol iver. However,
the most common primary malignant liver tumor is hepatocellular
carcinoma, second common one is cholangiocarcinoma.
A biopsy of the duodenum taken by endoscopy from a 6-year-old boy with
malabsorption complaints reveals atrophy of the small intestine villi, hyperplasia of
the crypts, increased mitosis in the crypt epithelium, and diffuse enteritis.
Which of the following is the most likely diagnosis in this patient?
Abetalipoproteinemia
Whiplle’s disease
Celiac sprue
Disaccharidase deficiency
Lactose intolerance
Celiac sprue
