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Gastroenterology Flashcards

1
Q

A 73 year old male, with a known history if ischemic heart disease and maintained in aspirin. He accidentally sustained a fractured arm due to fall and this caused him severe pain. How would you best manage the pain of the patient?
A. Give non-selective NSAID plus a proton pump inhibitor
B. Give selective COX2 inhibitor alone
C. Give non-selectivee NSAID alone
D. Give a selective COX2 inhibitor plus a proton pump inhibitor

A

A. Give non-selective NSAID plus a proton pump inhibitor

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2
Q

True about alcoholic liver disease EXCEPT
A. Men exhibit increased susceptibility alcoholic liver disease at amounts >20 g/d; two drinks per day is probably safe
B. In men, 40-80 g/d of ethanol produces
fatty liver; 160 g/d for 10-20 years causes hepatitis or cirrhosis
C. Alcohol injury does not require
malnutrition, but obesity and fatty liver
from the effect of carbohydrate on the
transcriptional control of lipid synthesis
and transport may be factors
D. HCV infection concurrent with alcoholic liver disease is associated with younger age for severity, more advanced histology, decreased survival

A

A. Men exhibit increased susceptibility alcoholic liver disease at amounts >20 g/d; two drinks per day is probably safe

women

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3
Q

True regarding diverticula of the colon
A. Bleeding from a diverticula results from infection
B. Most commonly seen among females of the reproductive age
C. Absence in the rectum is due to the triple age layer of muscles in that area
D. Most commonly seen at the left colon

A

D. Most commonly seen at the left colon

C. 2 layers - ICOL

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4
Q

True about HDV infection involve, EXCEPT
A. Requires helper function of HBV
B. Defective DNA virus
C. Diagnosis for HBV/HDV superinfection - IgG anti HBc and anti-HDV
D. Diagnosis for HBVHDV coinfection – IgM anti-HBc and anti-HDV

A

B. Defective DNA virus

RNA

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5
Q

A 32 y/o male, deep sea diver experienced sever abdominal pain few hours after coming from a diving activity, ascending from the dive at an unusually rapid pace. There were no other known illnesses. What intestinal ischemic syndrome must he be suffering from?
A. Acute mesenteric arterial thrombosis
B. Chronic mesenteric arterial insufficiency
C. Acute mesenteric arterial embolism
D. Mesenteric venous thrombosis

A

D. Mesenteric venous thrombosis

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6
Q

Disease that endoscopically features a Varioliform gastritis

A. Menetrier’s disease
B. Lymphocytic gastritis
C. Granulomatous gastritis
D. Eosinophilic gastritis

A

B. Lymphocytic gastritis

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7
Q

A feature exclusively seen in Crohn’s disease

A. Recurrence after surgery is common
B. Fever
C. Caseating granuloma
D. Steroids may be a treatment

A

A. Recurrence after surgery is common

c. non-caseating granuloma

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8
Q

True about cirrhosis EXCEPT

A. Development of fibrosis to the point that there is architectural distortion
B. Decreased amounts of collagen and other
components of the extracellular matrix
C. Activation of the hepatic stellate cells
D. The formation of regenerative nodules

A

B. Decreased amounts of collagen and other
components of the extracellular matrix

increased

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9
Q

This acute cholecystitis followed by ischemia or gangrene of the gallbladder wall and infection by gas-producing organisms, such as C. welchii or C. perfrigens, and aerobes, such as E. coli:ystuiti
A. Emphysematous Cholecystitis
B. Chronic Cholecystitis
C. Acalculous Cholecystopathy
D. Hydrops of the Gallbladder

A

A. Emphysematous Cholecystitis

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10
Q

A patient with a history of intestinal surgery was noted to have iron deficiency anemia. If the anemia was related to the surgery, it may be because of
a. Resection of the duodenum
b. Resection of the jejunum
c. Resection of the rectum
d. Creation of a bilio-enteric bypass

A

a. Resection of the duodenum

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11
Q

The small intestines have the ability to absorb nutrients efficiently because

a. The villi of the intestines increase the surface area for absorption
b. The diameter of the intestines may increase to accommodate more food
c. The length of the colon greatly helps in the absorption of nutrients
d. The small intestines have slower motility than the colon thereby allowing the nutrients more time to be absorbed in the former

A

a. The villi of the intestines increase the surface area for absorption

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12
Q

A 48 year old female who was diagnosed with duodenal ulcer. Apparently, she was positive for H. pylori infection. What is the best treatment option for the patient?

a. Omeprazole 20mg BID + Amoxicillin 500mg 2 caps BID + Clarithromycin 500mg 1 tab BID for 2 weeks. Total duration of Omeprazole is 4 weeks
b. Omeprazole 20mg 1 cap OD + Amoxicillin 500mg 1 cap BID + Clarithromycin 500mg 1 tab BID for 2 weeks. Total duration of Omeprazole is 8 weeks
c. Omeprazole 20mg 1 cap BID for 6-8 weeks
d. Omeprazole 20mg 1 cap BID + Metronidazole 500mg 1 tab TID + Clarithromycin 1 tab 500mg BID for 2 weeks. Total duration of Omeprazole is 4 weeks

A

d. Omeprazole 20mg 1 cap BID + Metronidazole 500mg 1 tab TID + Clarithromycin 1 tab 500mg BID for 2 weeks. Total duration of Omeprazole is 4 weeks

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13
Q

Definitive diagnosis of colon cancer is possible with this procedure

a. Capsule endoscopy
b. Fecal immunochemical testing
c. CT colonography
d. Colonoscopy

A

d. Colonoscopy

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14
Q

Disease associated with Plummer Vinson Syndrome
a. Esophageal ring
b. Squamous Cell Carcinoma
c. Schatzki Ring
d. Vitamin A deficiency

A

b. Squamous Cell Carcinoma

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15
Q

True regarding the etiology of Pseudomembranous enterocolitis

a. It is an invasive organism
b. Clostridium perfingens
c. Shigella flexneri is the etiologic agent
d. It is an anaerobe

A

d. It is an anaerobe

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16
Q

A rare disease that is characterized by enlarged gastric folds due to overexpression of growth factors

a. Dieulafroy disease
b. Granulomatous gastritis
c. Menetrier’s disease
d. Lymphocytic gastritis

A

c. Menetrier’s disease

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17
Q

This is NOT compatible with the diagnosis of irritable Bowel Syndrome

a. Age of onset of symptoms is during young adulthood
b. GI bleeding, overt and occult must be absent
c. Signs of thyroid dysfunction is ruled out
d. Weight loss which may indicate severity of
the disease

A

d. Weight loss which may indicate severity of the disease

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18
Q

A 56 year old male, underwent surgery for an obstructing colonic mass which proved to be colon cancer. Among the date needed to asses possible recurrence after surgery are the following EXCEPT

a. Number of lymph nodes positive for tumor cells
b. Size of the primary lesion
c. Presence of Poorly differentiated histology
d. Tumor adherence to adjacent organs

A

b. Size of the primary lesion

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19
Q

A patient with cirrhosis whom we assess to have an altered synthetic and preserved function is as follows EXCEPT

a. AST/ALT ratio less than 1
b. High bilirubin (> 1.5mg/dL)
c. Low albumin (< 3.8 g/dL)
d. Prolonged prothrombin time (INR >1.3)

A

a. AST/ALT ratio less than 1

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20
Q

True about HAV Except
a. Previous infection: IgG anti-HAV
b. May develop reinfection if exposed to virus again
c. Diagnosis: IgM anti-HAV
d. May develop Early fecal shedding

A

b. May develop reinfection if exposed to virus again

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21
Q

Most objective definition of Diarrhea

a. Stool weight more than 200 grams in a day
b. Increase in stool frequency
c. Increase in stool fluidity

A

a. Stool weight more than 200 grams in a day

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22
Q

True about bile acids EXCEPT

a. Bile acids are detergent-like molecules that in aqueous solutions

b. The primary bile acids, cholic acid and chenodeoxycholic acid (CDCA), are synthesized from cholesterol in the liver, conjugated with glycine or taurine and secreted into the bile

c. Bile salt recirculation, the active transport mechanism for conjugated bile acids in the transverse colon

d. Secondary bile acids, including deoxycholate and lithocholate, are formed in the colon as bacterial metabolites of the primary bile acids

A

c. Bile salt recirculation, the active transport mechanism for conjugated bile acids in the transverse colon

“recirculation”

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23
Q

Zenker’s diverticulosis
a. Arises at the mid esophagus
b. True diverticula
c. May be caused by traction from adjacent pulmonary tuberculosis
d. Results from increased intraluminal pressure associated with distal obstruction

A

d. Results from increased intraluminal pressure associated with distal obstruction

A,B,C = Midesophageal diverticulum

It is understood that a Zenker diverticulum involves impaired cricopharyngeal compliance, usually due to fibrotic changes, what causes increased intrabolus pressure with swallowing

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24
Q

Regarding FODMAPS in the management of Irritable Bowel Syndrome

a. High FODMAP diet is recommended for IBS Diarrhea
b. FODMAPS are fermentable food substances
c. High FODMAPS in the diet results to constipation
d. High FODMAPS in the diet reduces abdominal bloatedness

A

b. FODMAPS are fermentable food substances

A. Low FODMAP
C. fiber intake instead of FODMAP
D. increases bloatedness

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25
Q

These diseases share the same mechanism of chronic diarrhea, EXCEPT

a. Lactase deficiency
b. Chronic pancreatitis
c. Whipple’s disease
d. Ulcerative colitis

A

b. Chronic pancreatitis

Alterations in fluid and electrolyte movement associated with diarrhea are increased luminal osmolality, decreased fluid absorption, increased intestinal secretion, and altered intestinal motility.

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26
Q

Most common congenital malformation:
a. isolated fistula
b. isolated atresia
c. proximal TEF with atresia
d. distal TEF with atresia

A

d. distal TEF with atresia

a. isolated fistula 8 %
b. isolated atresia 4% -complicated of life
c. proximal TEF with atresia 1% distal
d. distal TEF with atresia 81%

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27
Q

Most common esophageal symptom:
a. Dysphagia
b. Odynophagia
c. Pyrosis
d. Chest pain

A

c. Pyrosis

a. dysphagia -sensation of sticking
b. odynophagia- painful swallowing
c. pyrosis Heart burn (TRANS-Chismis)
d. chest pain -most common cause of GERD

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28
Q

Disease with double contrast feline esophagitis
a. eosinophilic esophagitis
b. CMV esophagitis
c. Achalasia

A

a. Eosinophilic esophagitis

CMV = volcano like vesicles

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29
Q

Test to diagnose Barrett’s esophagitis
a. CT Scan
b. endoscopy with ultrasound
c. Upper GI endoscopy

A

Upper GI endoscopy

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30
Q

Which time has the lowest pH in stomach at circadian rhythm?
a. 5am – 11am
b. 11am – 2pm
c. 2pm – 11pm
d. 11pm – 5am

A

a. 5am – 11am

2PM-11PM – highest

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31
Q

possible sign of malignancy:
a. gastric ulcer
b. duodenal ulcer
c. both

A

a. Gastric ulcer

duodenal ulcer - extremely rare

32
Q

Sequelae of H. pylori induced antral predominant gastritis
a. Gastric ulcer
b. Duodenal ulcer
c. MALT lymphoma
d. Adenocarcinoma

A

d. Adenocarcinoma

33
Q

Most common penetration of duodenal ulcer
a. Left hepatic lobe
b. Pancreas
c. Spleen
d. Colon

A

b. Pancreas

DU : posteriorly into pancreas
GU: left hepatic lobe

34
Q

Patient diagnosed with squamous cell carcinoma of the esophagus
a. Tumor location lower third
b. Hypercalcemia
c. CT better than UTZ
d. Symptomatic in early stage

A

b. Hypercalcemia

35
Q

Etiologic agent for esophageal adenocarcinoma
a. H. pylori infection
b. Diet Nitrate
c. Plummer
d. Chronic Reflux

A

d. Chronic reflux - GERD

36
Q

56 y/o male diagnosed with SCCA
a. ocation of tumor in lower third of esophagus
b. hypercalcemia due to presence of parathyroid hormone
c. CT is better than EUS in assessing depth of tumor
d. associated with Barrett’s esophagus

A

b. hypercalcemia due to presence of parathyroid hormone

37
Q

most common type of gastric ca
a. Hodgkin’s, B cell
b. Non-Hodgkin’s, B cell
c. Hodgkin’s, T cell
d. Non-Hodgkin’s, T cell

A

Non-Hodgkin’s, B cell

38
Q

esophageal disease that needs…
a. Barret’s
b. achalasia
c. nutcracker
d. scleroderma

A

b. Achalasia

a. Barret’s – dx: endoscopy and biopsy
b. achalasia – barium enema: bird’s beak
c. nutcracker – esophageal manometry
d. scleroderma – associated with CREST

39
Q

NSAID with worst GI effect:
a. diclofenac
b. ketoprofen
c. piroxicam
d. mefenamic acid

A

b. ketoprofen

most harmful

40
Q

Type II Gastritis
a. related to H. Pylori
b. Associated to Pernicious Anemia
c. Body and Fundus
d. Gastrin secretion due to achalasia

A

a. related to H. Pylori
type I autoimmune
type iii reactive gastritis

type A (I) = Auto-immune =Antral sparring

41
Q

detect mediastinal air in booerhaave syndrome
a. Endoscopy
b. CT scan
c. barium swallow
d. ultrasonography

A

b. CT scan – most reliable tool

42
Q

patient was diagnosed with obstructive esophageal adenocarcinoma stage 4. What is the best management for the patient?
a. placement of STEM B
b. radiotherapy + surgery
c. radical resection of the distal esophagus
and upper stomach
d. radiotherapy + surgery + chemotherapy

A

a. placement of STEM B - Palliative (stage 4)

43
Q

type II gastric ulcer
a. body – low gastric acid production
b. antrum – low to normal gastric acid
production
c. within 3 cm of the pylorus and accompanied by duodenal ulcers – normal to high gastric acid production
d. cardia – low gastric acid production

A

b. antrum – low to normal gastric acid production

1-B
2-A
3-P
4-C

Type I – body (low gastric acid production)
Type II – antrum (low to normal gastric acid production)
Type III – within 3 cm of the pylorus and accompanied by duodenal ulcers (normal or high gastric acid production)
Type IV – cardia (low gastric acid production)

44
Q

characteristic of H. pylori associated with higher risk of premalignant lesion, gastric cancer and pud:
a. lipopolysaccharide
b. urease
c. flagella
d. cag – PAI

A

d. cag – PAI

H. pylori strains that are cag-PAI positive are associated with a higher risk of peptic ulcer disease, premalignant gastric lesions and gastric cancer than are strains that lack the cag-PAI

45
Q

Non-epithelial tumors that arise from gastrointestinal pacemaker cell.
a. Gastric leiomyosarcoma
b. GIST
c. MALT lymphoma
d. Adenocarcinoma

A

b. GIST

Gastrointestinal Stromal Tumor (GIST) – Non-epithelial (mesenchymal) tumors that arise from the gastrointestinal pacemaker cells (Intestinal cells of Cajal)

46
Q

Lymphocytic gastritis
a. Also called varioliform gastritis
b. Primarily in the body of the stomach
c. Presence of lymphocytes
d. Have thickened folds

A

d. Have thickened folds

Endoscopic appearance of the mucosa is varied and unreliable as it can appear as nodules, erosions, enlarged and prominent rugae, or normal

47
Q

Eosinophilic gastritis
a. Primarily in the antrum
b. Edematous folds
c. Presence of eosinophils
d. Can lead to outlet obstruction

A

c. Presence of eosinophils

At present, eosinophilic esophagitis (EoE) is diagnosed only by the presence of eosinophilic infiltration (EI) in the esophagus, while eosinophilic gastroenteritis (EGE) is diagnosed only by the presence of EI in the gastrointestinal tract

48
Q

Anemia, palpitation and weakness are signs and symptoms of colorectal cancer found in
a. Cecum
b. Transverse colon
c. Descending colon
d. Rectum

A

a. Cecum

obstruction of a tumor at the right side (cecum) manifests as bleeding causing anemia

49
Q

Least common cause of mechanical SI obstruction
a. Neoplastic
b. Adhesions
c. Hernia
d. Volvulus

A

a. Neoplastic - common for large intestine 9-10%

50
Q

Which is purely diagnostic alone
a. Colonoscopy
b. Barium enema
c. CT cholangiography
d. Enteroclysis

A

c. CT cholangiography

51
Q

Sign of ruptured appendicitis except
a. Mass
b. Abdominal rigidity
c. Absent bowel sound
d. (+) Rovsing’s sign

A

c. Absent bowel sound - can lead to peritonitis

52
Q

True regarding C. difficile infection
a. Community acquired than hospital
b. An invasive organism
c. Secrete toxin leading to Pseudomembranous Enterocolitis
d. An anaerobic organism

A

c. Secrete toxin leading to Pseudomembranous Enterocolitis - cytotoxic assay gold standard
d. An aerobic organism sa ibang samplex

53
Q

Best acceptable risk factor for irritable bowel syndrome
a. Psychosis
b. Genetic predisposition
c. Old age
d. Previous campylobacter infection

A

d. Previous campylobacter infection

54
Q

Mesentericangiography(notsureoftheexact question)
a. Superior mesenteric artery
b. Non occlusive mesenteric ischemia
c. Superior mesenteric artery embolus
d. Mesenteric venous thrombosis

A

b. Non occlusive mesenteric ischemia

55
Q

Treatment for IBS-D
a. Lactulose
b. SSRI
c. Desipranozasine
d. Bisacodyl

A

c. Desipranozasine

Desipramine, initiated at 50 mg at bedtime and titrated up by 50 mg weekly to a maintenance dose of 150 mg at bedtime, was found to be efficacious for IBS

56
Q

Hepatototxic
a. Prescription drugs
b. Environmental toxin
c. Metabolites of CYP450
d. Metabolites of glucuronidation

A

d. Metabolites of glucuronidation - facilitates elimination of potentially harmful substances reducing toxicity

57
Q

True of viral hepatitis
a. Hepa A is dsDNA
b. Hepa B is ssDNA
c. Hepa D is dsDNA
d. Hepa C is ssRNA

A

b. Hepa B is ssDNA

hep B – dsDNA; The rest are ssRNA

58
Q

Parameters in differentiating jaundice from hyperbilirubinemia of other cause except
a. Greenish discoloration of the skin
b. Nasolabial fold involvement
c. Sparing of the sclera
d. Predominant involvement of palms and
forehead
e. Sparing of the non exposed skin to sun

A

e. Sparing of the non exposed skin to sun

59
Q

Bilirubin metabolic process that most likely causing bilirubinuria
a. Conjugation of bilirubin to glucocoronic acid
b. Conversion of biliverdin to bilirubin
c. Transfer og unconjugated bilirubin
d. Transfer of conjugated bilirubin

A

a. Conjugation of bilirubin to glucocoronic acid

Any bilirubin found in urine is conjugated

60
Q

Complication of Hepatitis C except
a. Cryoglobinemia dermatitis
b. Lymph sialadenitis
c. B cell lymphoma
d. T cell lymphoma

A

d. T cell lymphoma

61
Q

Low risk immunocompromised booster after primary given
a. Every year
b. Every 5-7 years
c. Every 10-15 years
d. Not needed

A

d. Not needed

62
Q

Superior vena cava obstruction
a. Bulging flanks
b. Collateral venous
c. Pulsatile liver
d. Venous hum

A

b. Collateral venous

As the flow of blood within the SVC becomes obstructed, venous collaterals form alternative pathways for the return of venous blood to the right atrium

63
Q

(+) HbsAg, no need for therapy
a. 35, female, ALT 150, HbeAg (+), HBV DNA (+)
b. 35, female, alt 150, HBV DNA (+), HbeAg (-)
c. 35,female, ALT 150, HBV DNA (-), HbeAg (-)
d. 35,female, anti-HbsAg (+), with liver cirrhosis

A

c. 35,female, ALT 150, HBV DNA (-), HbeAg (-)

64
Q

Basolateral iron transport
a. Ferroportin
b. Transferring
c. Ferritin
d. DMTI

A

a. Ferroportin

65
Q

Viral hepatitis which causes a risk fatality among the pregnant
a. Hepa B
b. Hepa C
c. Hepa A
d. Hepa E

A

d. Hepa E

66
Q

Which of the following conditions does hepatic venous pressure do not correlate with actual portal pressure?
a. Budd chiari
b. Alcohol induced cirrhosis (?)
c. Venoocclusive disease
d. Portal vein thrombosis

A

d. Portal vein thrombosis

67
Q

True of alcoholic liver injury
a. Increases peripheral transport of fatty
acids
b. Convert NAD to NAPH
c. Bridging fibrosis
d. Microvesicular injury

A

c. Bridging fibrosis

68
Q

Best marker for liver injury
a. Serum albumin
b. Bilirubin
c. Factors II,VII,IX,X
d. EPO

A

a. Serum albumin

69
Q

OCP hepatotoxic effects
a. Macrovesicular steatosis
b. Hepatic vein thrombosis
c. Hepatic adenomas
d. Intrahepatic cholestasis

A

a. Macrovesicular steatosis

70
Q

True about alcoholic liver disease except
a. PPAR can induce FPA and transport genes
b. PPAR can induce synthesizing FPA
c. Downregulation of PPAR
d. Downregulation of SREB

A

d. Downregulation of SREB

71
Q

Causes of liver cirrhosis except
a. Wilson’s disease
b. Glycogen storage disease
c. TB
d. Schistosomiasis

A

c. TB - long term exposure to environmental toxins and severe reactions to prescription drugs

72
Q

Fibrolamellar HCC
a. Children, adult and elderly
b. Common in OCP users
c. frequent in males
d. Worse prognosis than other HCC

A

d. Worse prognosis than other HCC

73
Q

For patient with HBsAg who does not need treatment
a. ALT 150, HBeAg +/ HBV DNA +
b. ALT 250, HBeAg -/ HBV DNA +
c. ALT 20 HBeAg -/ HBV DNA -
d. Anti HBsAg

A

c. ALT 20 HBeAg -/ HBV DNA -

74
Q

Fulminant hepatitis includes all of the following except
a. Collapsed reticulin network
b. Hepatic failure in 6 months
c. Presence of massive necrosis with only
portal tract visible
d. Maybe due to reactivation of chronic or acute hepatitis

A

d. Maybe due to reactivation of chronic or acute hepatitis

75
Q

73 y/o male underwent surgery due to intestinal ischemia and gangrene, later on develop malabsorption. Why?
a. Bacterial overgrowth
b. Short bowel syndrome
c. Destruction of intestinal mucosal function and structure
d. Instestinal obstruction

A

b. Short bowel syndrome

Short bowel syndrome (SBS) in adults is defined as less than 180 to 200 centimeters of remaining small bowel (normal length 275 to 850 cm) leading to the need for nutritional and fluid supplements
SBS can result from extensive surgical resection or congenital intestinal diseases. The most common pathologies that lead to SBS in adults are Crohn disease, mesenteric ischemia, radiation enteritis, post-surgical adhesions, and post-operative complications

76
Q

Bird beak appearance on esophagogram
a. Scleroderma
b. Esophageal ring
c. Achalasia
d. Hypertensive motor disorder

A

c. Achalasia

77
Q

Pathophysiology of liver cirrhosis except
a. Irreversible chronic injury of hepatic parenchyma
b. Extensive fibrosis
c. Regenerating nodule
d. Histopathological diagnosis

A

a. Irreversible chronic injury of hepatic parenchyma

IM (11 decks)

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