Gastroenterology

Question 1

Motility disorders of the esophagus include:
A. Mallory Weiss syndrome
B. nutcracker esophagus
C. squamous cell carcinoma of the esophagus
D. reflux esophagitis
E. hiatus hernia

Answer 1

B. nutcracker esophagus

Question 2

Choose the correct answer that belongs to the set of characteristics of achalasia:
A. propulsive esophageal peristalsis is normal
B. the cause may be the collapse of inhibitory neurons in the wall of the esophagus
C. chest pain is a rare symptom
D. calcium channel antagonists are a successful and permanent drug
E. patients are well fed

Answer 2

B. the cause may be the collapse of inhibitory neurons in the wall of the esophagus

Question 3

Which of the following applies to physiological gastroesophageal reflux:
A. occurs before eating food
B. occurs between meals
C. appears after a meal (appears after a meal and between meals during periods of
spontaneous sphincter relaxation. Is this the most correct answer?)
D. formation is linked to the act of swallowing
E. is present in 90% of people

Answer 3

C. appears after a meal (appears after a meal and between meals during periods of
spontaneous sphincter relaxation. Is this the most correct answer?)

Question 4

The following does NOT apply to pathological gastroesophageal reflux:
A. it is caused by inappropriate relaxation of the lower esophageal sphincter
B. the cleaning action of the esophagus is weakened
C. a hiatus hernia may be present
D. all patients with pathological gastroesophageal reflux have reflux
esophagitis
E. it is more common in obese people

Answer 4

D. all patients with pathological gastroesophageal reflux have reflux
esophagitis

Question 5

Everyday reflux problems are listed by:
a) 40% of people
b) 10% of people
c) 5% of people
d) 100% of people
e) 95% of people

Answer 5

c) 5% of people

Question 6

As a rule, what does NOT belong to the symptoms of esophageal disease?
a) chest pain
b) pain under the rib cage
c) dysphagia
d) odynophagia
e) pyrosis

Answer 6

b) pain under the rib cage

Question 7

Choose the combination of correct statements regarding reflux esophagitis:
A. Reflux esophagitis occurs in 50% of patients with reflux
B. reflux esophagitis causes reflux of stomach acid
C. reflux esophagitis causes reflux of duodenal contents
D.reflux esophagitis is caused by an infection withHelicobacter pylori
E. reflux esophagitis causes hypergastrinemia
a) statements A, B, E are correct
b) statements B, C, D are correct
c) statements B, Č, E are correct
d) statements A, B, C are correct
e) all statements are correct

Answer 7

d) statements A, B, C are correct

Question 8

Which of the following is true of reflux esophagitis:
a) the diagnosis is established by endoscopy
b) the diagnosis is established by X-ray examination of the esophagus
c) the diagnosis is made with laboratory tests
d) we always make the diagnosis based on the anamnesis
e) the diagnosis is established by clinical examination

Answer 8

a) the diagnosis is established by endoscopy

Question 9

How do we identify motility disorders of the esophagus?
a. with chest CT
b. with contrast X-ray examination of the esophagus
c. with esophagoscopy
d. with esophageal pH-metry
e. with capsule endoscopy

Answer 9

b. with contrast X-ray examination of the esophagus

Question 10

A symptom or disease that is not related to GERD is:
a) asthma
b) chronic cough
c) diarrhea
d) tooth enamel erosion
e) chronic laryngitis

Answer 10

c) diarrhea

Question 11

For the treatment of esophageal reflux disease, a personal physician may prescribe the following to the patient
for two weeks as a therapeutic test:
a) H2 receptor antagonist 800 mg/day
b) proton pump inhibitor in a therapeutic dose twice a day
c) paracetamol 500 mg daily
d) acetylsalicylic acid 100 mg
e) Hygienic - dietary regime in GERD

Answer 11

b) proton pump inhibitor in a therapeutic dose twice a day

Question 12

Choose the correct doses of drugs for the treatment of esophageal reflux disease:
a) lansoprazole 120mg/day
b) pantoprazole 2x40mg/day for 14 days
c) omeprazole 30 mg/day
d) omeprazole 2x60 mg/day
e) pantoprazole 80 mg/day for 14 days

Answer 12

b) pantoprazole 2x40mg/day for 14 days

Question 13

What is NOT considered an alarm sign in gastroesophageal reflux disease?
a) dysphagia
b) odynophagia
c) positive stool hematest
d) persistent vomiting
e)night cough

Answer 13

e)night cough

Question 14

Dysphagia occurs when eating dry food in a patient with gastroesophageal reflux disease. What
would be the most appropriate action?
a) The patient is prescribed a prokinetic drug and ordered to undergo a follow-up
outpatient examination
b) We prescribe a proton pump blocker to the patient and tell him to come
back in 2 weeks if the problem persists
c) The patient is immediately referred for gastroscopy
d) The patient is admitted to the hospital and a chest CT is performed immediately
e) We advise the patient to avoid dry food

Answer 14

c) The patient is immediately referred for gastroscopy

Question 15

The question is really about H2 receptor blockers, which
they are only effective for a short time due to tachyphylaxis (receptors get used to them after a few days)
a. due to a carcinogenic effect (no research has confirmed this)
b. because they cause steatorrhea
c. because with permanent treatment, they only have a temporary effect, which is not reversible even if
we increase the dose
d. because they are too expensive for chronic treatment
e. because they are very effective and can mask the alarm signs

Answer 15

a. due to a carcinogenic effect (no research has confirmed this)

Question 16

A characteristic complication of long-term reflux esophagitis is:
a) esophageal atresia
b) esophageal achalasia
c) squamous esophageal cancer
d) adenocarcinoma of the esophagus
e) lymphoma of the esophagus

Answer 16

d) adenocarcinoma of the esophagus

Question 17

. Choose the correct statement for Barrett’s esophagus :
A. is associated with the formation of squamous esophageal cancer
B. is associated with chronic laryngitis
C. is associated with the formation of adenocarcinoma
D. it is associated with chronic infectionwith Helicobacter pylori
E. it is hyperplasia of the squamous epithelium in the distal esophagus

Answer 17

C. is associated with the formation of adenocarcinoma

Question 18

Choose the correct statements for Barrett’s esophagus :
a) occurs in patients with duodenoesophageal reflux
b) histologically, it is a metaplasia of the glandular epithelium of the gastric mucosa v
esophagus
c) occurs in the first year of severe reflux disease
d) occurs in smokers
e) Barrett’s esophagus is treated exclusively with drugs

Answer 18

b) histologically, it is a metaplasia of the glandular epithelium of the gastric mucosa v
esophagus

Question 19

Which of the following is true of non-reflux esophagitis?
A. it is caused by anaerobic bacteria
B. it is caused by viruses of the human herpes virus group
C. it is caused by dermatophytes
D. it is caused by the rota virus
E. it is caused by actinomycetes

Answer 19

B. it is caused by viruses of the human herpes virus group

Question 20

Reflux esophagitis is associated with:
A. axial hiatus hernia
B. paraesophageal hernia
C. esophageal atresia
D. agenesis of the esophagus
E. esophageal diverticula

Answer 20

A. axial hiatus hernia

Question 21

What is characteristic of achalasia?
a) absence of esophageal peristalsis
b) esophageal stricture
c) esophageal diverticulum, which obstructs peristalsis
d) spasm of the lower esophageal sphincter
e) ulcer on the lower esophageal sphincter

Answer 21

d) spasm of the lower esophageal sphincter

Question 22

Which of the following is a typical etiological factor for non-reflux esophagitis?
a) AIDS
b) immunosuppressive treatment
c) Herpes simplex virus
d) eating hot food
e) sicca syndrome, e.g. in the context of Sjogren’s syndrome

Answer 22

a) AIDS
b) immunosuppressive treatment
c) Herpes simplex virus

Question 23

Zencker’s diverticulum is indicated by all the listed symptoms except:
A. pressure on the neck
B. bad breath
C. regurgitation of several days old food
D. hemohesia
E. dysphagia

Answer 23

D. hemohesia

Question 24

Which of the following is NOT true of esophageal cancer :
A. the most common form in Caucasians is adenocarcinoma
B. is associated with smoking and alcohol
C. can cause hoarseness
D. radical surgical treatment is possible in 70% of patients
E. progressive dysphagia may be present

Answer 24

D. radical surgical treatment is possible in 70% of patients

Question 25

To estimate the prevalence of esophageal cancer, we use:
A. endoscopy (endoscopic US and CT are complementary)
B. ultrasound examination of the abdomen
C. clinical examination
D. computed tomography - CT
E. x-ray examination of the esophagus with contrast

Answer 25

D. computed tomography - CT

Question 26

A 19-year-old young man, who has been completely healthy so far and has no vices, accompanied by friends, comes
to the emergency clinic because of chest pain and shortness of breath. The pain is burning, localized behind the
sternum, spreading from the spoon upwards in the chest, intensity 5/10, constant, it appeared half an hour before
arriving at the emergency room - after he had drunk 2 dcl of red wine at his friends’ house. The pain is worse if he bends
over. Since the onset of the pain, he has not taken any medicine or drunk anything.
On arrival, he is unharmed, oriented, agitated, and does not appear to be drunk. Palpation of the epigastrium is somewhat
painful, otherwise the results of the physical examination are within normal limits.
Based on the anamnesis, taking into account all the listed risk factors, the most likely working
diagnosis is:
A. acute myocardial infarction
B. alcoholic hepatitis
C. achalasia
D. esophageal reflux disease
E. pulmonary embolism

Answer 26

D. esophageal reflux disease

Question 27

A 19-year-old young man, who has been completely healthy up to now and has no vices, accompanied by friends,
comes to the emergency clinic because of burning pain in the chest and shortness of breath. The pain is burning,
localized behind the sternum, spreading from the spoon upwards in the chest, intensity 5/10, constant, it appeared half
an hour before arriving at the emergency room - after he had drunk 2 dcl of red wine at his friends’ house. The pain is
worse if he bends down. Since the onset of the pain, he has not taken any medicine or drunk anything.
On arrival, he is unharmed, oriented, agitated, and does not appear to be drunk. Palpation of the epigastrium is somewhat
painful, otherwise the results of the physical examination are within normal limits.
The emergency team recorded an EKG, took blood for basic tests, because the young man still
complains of chest pain, the doctor on duty decides to treat him immediately.
According to the working diagnosis, he will decide to:
A. heparin 5,000 units iv.
B. calcium antagonist, e.g. verapamil 40mg po.
C. Nitroglycerin under the tongue, Aspirin direct, oxygen and morphine as an analgesic
D. a proton pump inhibitor in a therapeutic dose iv. or after
E. iv infusion of 0.9% NaCl solution with the addition of 100 mg Thiamine

Answer 27

D. a proton pump inhibitor in a therapeutic dose iv. or after

Question 28

A 19-year-old young man, who has been completely healthy so far and has no vices, accompanied by friends,
comes to the emergency clinic because of chest pain and shortness of breath. The pain is burning, localized behind the
sternum, spreads from the spoon upwards into the chest, has a strength of 5/10, is constant, appeared half
7
hours before arriving at the emergency room - after he drank 2 dcl of red wine at his friends’ house. The pain is worse
if he bends over. Since the onset of the pain, he has not taken any medicine or drunk anything.
On arrival, he is unharmed, oriented, agitated, and does not appear to be drunk. Palpation of the epigastrium is somewhat
painful, otherwise the results of the physical examination are within normal limits.
Twenty minutes after the iv injection of the proton pump inhibitor, he dies. EKG and laboratory tests
are normal. The doctor reassures the young man and explains to him why the pain occurred and how
the treatment will proceed in the future. What is the next appropriate procedure in such a patient?
A. proton pump inhibitor in a therapeutic dose for 14 days
B. initiation of treatment with vitamin K antagonists
C. Aspirin 100 mg for life
D. gastroscopy
E. initiation of calcium antagonist therapy

Answer 28

A. proton pump inhibitor in a therapeutic dose for 14 days

Question 29

The characteristics of the parietal cells of the stomach are all of the above except:
a) they secrete gastric acid and intrinsic factor
b) secrete pepsinogen
c) are predominantly in the fundus and body of the stomach
d) they are stimulated by gastrin
e) they are stimulated by histamine

Answer 29

b) secrete pepsinogen

Question 30

Mucous cells of the stomach secrete:
a) mucus and pepsinogen
b) mucus
c) pepsinogen
d) mucus and HCl
e) mucus and bicarbonate

Answer 30

e) mucus and bicarbonate

Question 31

Acute gastritis can be thought of with the following symptoms:
A. Vomiting
B. pain in the spoon
C. bleeding
D. all three of the above
E. with none of the above

Answer 31

D. all three of the above

Question 32

In which condition would you expect gastric hypersecretion?
a. atrophic gastritis
b. after vagotomy
c. in chronic renal failure
d. in Zollinger-Ellison syndrome
e. treatment with esomeprazole

Answer 32

d. in Zollinger-Ellison syndrome

Question 33

How does severe gastric hypersecretion affect digestion? Choose the WRONG answer.
a. causes malabsorption
b. causes
c. causes diarrhea
d. causes duodenal and jejunum ulcers
e. causes incomplete protein digestion

Answer 33

e. causes incomplete protein digestion

Question 34

Which statement refers to infection withH. pyloriit isINCORRECT? :
A. leads to the formation of gastric ulcer
B. infection is associated with the appearance of MALT lymphoma
C. we prove it with the Schiller test
D. the infection can be asymptomatic throughout life
E. can lead to duodenal ulcers

Answer 34

C. we prove it with the Schiller test

Question 35

Choose the correct combination that contains all the correct statements about autoimmune
gastritis:
a.causes megaloblastic anemia
b. antimitochondrial antibodies are characteristic
c.causes atrophy of the corpus mucosa
d. we treat it with vitamin B-12

Answer 35

a.causes megaloblastic anemia
c.causes atrophy of the corpus mucosa

Question 36

The most common causes of peptic ulcer of the stomach and duodenum are:
a) Treatment with nonsteroidal antirheumatic drugs
b) Zollinger-Ellison syndrome
c) Crohn’s disease
d) Treatment with calcium channel blockers
e) Treatment with vitamin K antagonists

Answer 36

a) Treatment with nonsteroidal antirheumatic drugs

Question 37

Choose the correct statement regarding peptic ulcer:
A. the pain is characteristically colicky
B. Bleeding is common (1 out of 10 duodenal ulcers bleeds)
C.often progresses to adenocarcinoma
D. the pain often radiates to the right iliac area, so it can be replaced
for acute appendicitis
E. pain is always present

Answer 37

B. Bleeding is common (1 out of 10 duodenal ulcers bleeds)

Question 38

Medicines of choice for the treatment of peptic ulcer in case of infection withH. pyloriare:
A. antibiotics
B. proton pump inhibitors
C. both (antibiotics and proton pump inhibitors)
D. H receptor blockers2
E.antacids

Answer 38

C. both (antibiotics and proton pump inhibitors)

Question 39

Treatment of duodenal ulcer disease in case of infection withH. pyloriconsists of:
A. one-week antibiotic treatment
B. two-week antibiotic treatment
C. three-week treatment with proton pump inhibitors
D. one week of antibiotics and proton pump inhibitors (from the book: recommended
eradication treatment lasts one week in Europe, and in the USA 2)
E. antibiotics for one week and proton pump inhibitors for three weeks

Answer 39

E. antibiotics for one week and proton pump inhibitors for three weeks

Question 40

The drug of choice for the treatment of peptic ulcer is/are:
A. bismuth subsalicylate
B.proton pump inhibitors(right)
C. H2 receptor blockers
D. antacids
E. mesalazine

Answer 40

B.proton pump inhibitors(right)

Question 41

Choose the right combination! Success of eradication treatmentHelicobacter pylori
controlled by:
a. mucosal biopsy
b. serological tests (basically it is with urea breath test and fecal test, nowhere
it doesn’t say that a 1x biopsy is done, WHO WOULD KNOW)
c. urea breath test
d. polymerase chain reaction – it will always be wrong in this context!!!

Answer 41

a. mucosal biopsy
c. urea breath test

Question 42

Common complications of ulcer disease include all except:
A. pyloric stenosis
B. bleeding
C. perforations
D. ileus
E.penetrations

Answer 42

D. ileus

Question 43

Symptoms of pyloric stenosis are all of the above except:
A. pain after feeding
B. vomiting food
C. vomiting of hematinized contents
D.vomiting of bile (100% because bile is secreted in the duodenum,
this one stays in the stomach)
E. poor appetite

Answer 43

D.vomiting of bile (100% because bile is secreted in the duodenum,
this one stays in the stomach)

Question 44

Zollinger-Ellison syndrome causes excessive secretion of :
A. gastrin
B. somatostatin
C.VIP’s
D. Glucagon
E. cholecystokinin

Answer 44

A. gastrin

Question 45

In the case of a patient suspected of having a perforation of a hollow abdominal organ
due to free air under the diaphragm, further treatment requires:
A. perform an emergency endoscopy of the upper gastrointestinal tract
B. do an abdominal ultrasound
C. make a computed tomography of the abdomen
D. refer the patient to a surgeon as an emergency
E. perform magnetic resonance angiography of the abdomen

Answer 45

D. refer the patient to a surgeon as an emergency

Question 46

How is gastroparesis defined?
a.Symptomatic disturbance in gastric emptying, which is not the result of a mechanical obstruction
b. Any symptomatic disturbance in gastric emptying
c. Symptomatic or asymptomatic gastric emptying disorder resulting from achlorhydria
d. Symptomatic or asymptomatic gastric emptying disorder secondary to stroke
e. Symptomatic or asymptomatic gastric emptying disorder resulting from vagotomy

Answer 46

a.Symptomatic disturbance in gastric emptying, which is not the result of a mechanical obstruction

Question 47

Blind gyrus syndrome indicates:
A. malabsorption of di- and polysaccharides
B. malabsorption of fats and iron
C. malabsorption of saccharides and iron
D. malabsorption of fat and vitamin B-12
E. malabsorption of thiamine

Answer 47

D. malabsorption of fat and vitamin B-12

Question 48

Gastric bradygastria is:
a. reduced frequency of the formation of peristaltic waves in the stomach
b. slow pulse in stomach ulcer
c. shortened stomach after partial resection
d. formation of shorter peristaltic waves in the stomach
e. nothing, it’s a joke

Answer 48

a. reduced frequency of the formation of peristaltic waves in the stomach

Question 49

Choose a combination of correct answers! A peptic ulcer on the jejunum can be caused by:
a. Zollinger-Ellison syndrome
b. glucagonoma
c. after gastric resection according to Billroth II
d. after choledochojejunoanastomosis

Answer 49

a. Zollinger-Ellison syndrome
c. after gastric resection according to Billroth II

Question 50

Which of the following is NOT true of gastric disease resulting from NSAIDs?
a. the disease is characterized primarily by stomach ulcers
b. it is caused by aspirin and other nonsteroidal anti-inflammatory drugs that inhibit
cyclooxygenase
c. COX-2 selective cyclooxygenase inhibitors cannot cause gastric ulcers
d. treatment includes discontinuation of the causative drug and treatment with a proton
pump inhibitor
e. patients who are at high risk of gastric ulcer when taking NSAIDs should be protected
while taking these drugs with a proton pump inhibitor

Answer 50

c. COX-2 selective cyclooxygenase inhibitors cannot cause gastric ulcers

Question 51

What is NOT true of stress gastric disease?
a. caused by hypoperfusion of the stomach in critically ill patients
b.arises due to increased secretion of HCl in the stomach
c. manifested by bleeding from the stomach
d. it is mostly gastric erosions, ulcers are less common
e. bleeding from erosions is stopped endoscopically

Answer 51

b.arises due to increased secretion of HCl in the stomach

Question 52

The most common polyps in the stomach are histologically:
A. adenomas (non-invasive intraepithelial neoplasia)
B. hyperplastic polyps
C. adenocarcinomas
D. squamous cell carcinomas
E. fundic gland polyps

Answer 52

E. fundic gland polyps

Question 53

The most reasonable examination for polyps in the stomach is:
A. X-ray examination of the stomach and polypectomy
B. gastroscopy and polypectomy
C. X-ray examination of the stomach only
D. determination of the level of oncofetal antigens in the serum
E. computed tomography of the abdomen

Answer 53

B. gastroscopy and polypectomy

Question 54

Gastric carcinoma does NOT occur often in the following circumstances: :
A. in pernicious anemia
B. in atrophy of the gastric mucosa
C. in intestinal metaplasia
D. after Helicobacter pylori infection
E. with regular consumption of strongly spiced food

Answer 54

E. with regular consumption of strongly spiced food

Question 55

The following applies to early gastric carcinoma:
A. endoscopy is the investigation of choice
B. endoscopic biopsy is 100% reliable
C. often arises from a stomach ulcer
D. never radiates to the lymph nodes
E. staging with additional tests upon discovery is not necessary

Answer 55

A. endoscopy is the investigation of choice

Question 56

Radiation to the lymph nodes can be present in:
a. early stomach cancer
b. adenoma
c.scirrhous gastric cancer(non-ulcerating gastric cancer, same as adenocarcinoma,
EUZ for diagnostics)
d. advanced stomach cancer

Answer 56

a. early stomach cancer
c.scirrhous gastric cancer(non-ulcerating gastric cancer, same as adenocarcinoma,
EUZ for diagnostics)
d. advanced stomach cancer

Question 57

The preoperative treatment of a patient with stomach cancer includes everything except:
A. upper gastrointestinal endoscopy
B. histological examination of the tissue sample
C. serology atHelicobacter pylori
D. ultrasound examination of the abdomen
E. endoscopic ultrasound of the stomach

Answer 57

C. serology atHelicobacter pylori

Question 58

Which of the following is the most reliable sign that a gastric ulcer is benign? :
A. When the gastric ulcer heals
B. If the gastric mucosa and lymph nodes near the stomach during endoscopic ultrasound
they show no signs of malignant infiltration
C. If bleeding from the ulcer does not recur within 14 days
D. If the lymph nodes near the stomach and the celiac trunk do not show according to the CT criteria
signs of malignant infiltration
E. Pathohistology of ulcer causes is negative for malignancy

Answer 58

E. Pathohistology of ulcer causes is negative for malignancy

Question 59

Choose the combination of correct statements! Precancerous changes of the gastric mucosa
include:
a. atrophic gastritis
b. endocrine cell hyperplasia
c. intestinal metaplasia
d. adenoma polyp

Answer 59

a. atrophic gastritis
c. intestinal metaplasia
d. adenoma polyp

Question 60

Everything applies to a stress ulcer, except:
A. it is caused by neurosurgical interventions
B. leading symptom is bleeding
C. patients have characteristic pain (they do not, the ulcer does not have characteristic pain,
often these are also unconscious patients)
D. bleeding is stopped endoscopically
E. we prevent it with proton pump inhibitors

Answer 60

C. patients have characteristic pain (they do not, the ulcer does not have characteristic pain,
often these are also unconscious patients)

Question 61

Early stomach cancer indicates:
A. grows limited to the mucosa and submucosa, with lesions in regional areas
with or without lymph nodes
B. grows limited to the mucosa
C. absence of lymph node metastases
D. histologically exclusively intestinal type according to Lauren
E. histologically exclusively mixed cell type according to Lauren

Answer 61

A. grows limited to the mucosa and submucosa, with lesions in regional areas
with or without lymph nodes

Question 62

The most common localization of cancer on the stomach is: at least not in this form
A.the lower third of the stomach(antrum, moving up today)
B. fundus of the stomach
C. pyloric duct
D. lesser curvature of the stomach (from surgery: most often it is limited to the lesser curvature
middle third of the stomach)
E. body of the stomach

Answer 62

A.the lower third of the stomach(antrum, moving up today)

Question 63

Choose the combination of correct statements! The following symptoms are characteristic of developed gastric carcinoma:
a.anemia
b. vomiting
c. weight loss
d. dysphagia
e. constipation

Answer 63

a.anemia
c. weight loss
d. dysphagia

Question 64

Low-grade non-Hodgkin’s MALT lymphoma is:
A. in 90% associated with infection withHelicobacter pylori
B. 50% associated with EBV infection
C. we treat it with surgery
D. we treat it with diet
E. treatment is started with chemotherapy

Answer 64

A. in 90% associated with infection withHelicobacter pylori

Question 65

Which of the following is NOT true of melena? :
A. melena is most often a sign of bleeding from the upper gastrointestinal tract
B. melena is the result of digestion of blood in the lumen of the gastrointestinal tract
C. may occur simultaneously with hematemesis
D. is more common than hematemesis
E. occurs even with insignificant bleeding in the gastrointestinal tract

Answer 65

E. occurs even with insignificant bleeding in the gastrointestinal tract

Question 66

Hematemesis is:
A. vomiting of fresh, coagulated or old black blood
B. Vomiting of yellow fluid
C. a sure sign of gastric carcinoma
D. rare in esophageal bleeding
E. common in bleeding from the jejunum

Answer 66

A. vomiting of fresh, coagulated or old black blood

Question 67

Hematochezia occurs in all conditions except:
A. hemorrhoids
B. intestinal tumors
C. Crohn’s disease
D. duodenal peptic ulcers
E. pseudomembranous colitis

Answer 67

D. duodenal peptic ulcers

Question 68

The most common source of bleeding from the lower gastrointestinal tract is
A. hemorrhoids and intestinal tumors
B. colonic polyps and hemorrhoids
C. diverticula
D. angiodysplasia of the colon
E. chronic inflammatory bowel disease

Answer 68

C. diverticula

Question 69

The initial method of choice for localization of bleeding in the gastrointestinal tract is:
A. angiography
B. endoscopy
C. computed tomography
D. scintigraphy with labeled erythrocytes
E. endoscopic ultrasound

Answer 69

B. endoscopy

Question 70

Choose the correct answers related to the treatment of gastrointestinal bleeding:
a. most often it is stopped endoscopically
b. we use photocoagulation to stop the bleeding
c. fibrin glue is used to stop the bleeding
d. in most cases, bleeding from the upper gastrointestinal tract can only be stopped by surgery
intervention, surgery

Answer 70

a. most often it is stopped endoscopically
b. we use photocoagulation to stop the bleeding
c. fibrin glue is used to stop the bleeding

Question 71

Contraindications for emergency endoscopy in case of bleeding from the upper gastrointestinal tract are:
A. poor general condition of the patient
B. acute myocardial infarction
C. injury by ingestion of lye or acid more than 12 hours ago
D. acute alcohol intoxication
E. severe bleeding

Answer 71

E. severe bleeding

Question 72

Typical signs of shock due to severe bleeding are all except:
A. pallor
B. bradycardia
C. low blood pressure
D. disturbance of consciousness
E. dizziness

Answer 72

B. bradycardia

Question 73

In which of the described patients would you NOT decide to transfuse concentrated
erythrocytes? :
a. previously healthy patient, bleeding has stopped, hemoglobin value 90
g/l
b. previously healthy patient, still bleeding heavily, hemoglobin value 90 g/l
c. severe cardiac patient, bleeding stopped, hemoglobin value 100 g/l
d. severe cardiac patient, bleeding not stopped, hemoglobin value 100 g/l
e. shocked patient, still bleeding, previously healthy, hemoglobin value 120 g/l

Answer 73

a. previously healthy patient, bleeding has stopped, hemoglobin value 90
g/l

Question 74

The family doctor is called to the clinic in the morning by the relatives of a gentleman with known liver
cirrhosis. He was recently hospitalized in the gastroenterology department due to worsening of the disease with
ascites and swelling of the legs, at which time the degree of liver function impairment was assessed as Child
Pugh class C. He drank yesterday, he felt bad in the morning. He vomited fresh blood twice in the morning, and
shortly afterwards his relatives found him lying on the toilet floor. They noticed completely black, smelly, liquid
feces in the toilet bowl. He soon regained consciousness, but he is still “bad” during the phone call.
Which working diagnosis is most likely?
A. Bleeding from a duodenal ulcer
B. Bleeding from Mallory Weiss poke
C. Bleeding from esophageal varices
D. Bleeding from the papilla of Vateri
E. Bleeding from angiodysplasias of the small intestine

Answer 74

C. Bleeding from esophageal varices

Question 75

The family doctor is called to the clinic in the morning by the relatives of a gentleman with a known liver problem
cirrhosis. Due to aggravation of the disease with ascites and swelling of the legs, he was recently
hospitalized in the gastroenterology department, at that time the degree of liver function impairment
rated Child Pugh class C. Yesterday he drank, this morning he felt bad. In the morning e
twice vomited fresh blood, shortly afterwards his relatives found him lying on the toilet floor. V
completely black, smelly, liquid faeces were observed in the toilet bowl. He soon regained consciousness, however
is still “bad” during a phone call.
The family doctor informed the emergency team about the patient’s condition and the most likely diagnosis.
Upon their arrival, the patient was pale, cold, blood pressure was 80/50 mmHg, saturation was measured
on the finger 88%, signs of recent gastrointestinal bleeding were present. He’s an emergency doctor
prescribed infusions of colloidal solution, oxygen by mask with 60% of oxygen in inhaled air
and transferred him to internal medicine first aid.
Which examination is necessary for the patient in such a case?
A. urgent CT angiography
B. emergency rectoscopy
C. emergency endoscopic ultrasound
D. emergency angiography with superselective embolization of the bleeding vessel
E. emergency esophagogastroduodenoscopy

Answer 75

E. emergency esophagogastroduodenoscopy

Question 76

The family doctor is called to the clinic in the morning by the relatives of a gentleman with a known liver disease
cirrhosis. Due to aggravation of the disease with ascites and swelling of the legs, he was recently
hospitalized in the gastroenterology department, at that time the degree of liver function impairment
rated Child Pugh class C. Yesterday he drank, this morning he felt bad. In the morning e
twice vomited fresh blood, shortly afterwards his relatives found him lying on the toilet floor. V
completely black, smelly, liquid faeces were observed in the toilet bowl. He soon regained consciousness, however
is still “bad” during a phone call.
The doctor at the internal medicine first aid found anemia with a hemoglobin of 67g/L, and ordered blood
for transfusion and referred the patient to the appropriate emergency examination, where they diagnosed and treated
gastrointestinal bleeding.
What can you do in a patient with profuse gastrointestinal bleeding and known cirrhosis of the liver Child Pugh C
expected in the next few hours?
A. Development or worsening of hepatic encephalopathy(due to protein digestion
rich own blood, which appeared in the gastrointestinal tract due to bleeding - high N content)
B. Development of ileus
C. Perforation of the hollow digestive organ
D. Development of iatrogenic pancreatitis
E. Sepsis (not far from the truth, but all patients in such cases get AB
protection (amoxicillin, so sepsis is unlikely)

Answer 76

A. Development or worsening of hepatic encephalopathy(due to protein digestion
rich own blood, which appeared in the gastrointestinal tract due to bleeding - high N content)

Question 77

The efficiency of sodium absorption in the small intestine is:
A. 30%
B. 60%
C. 90%
D. 99%
E. 10%

Answer 77

D. 99%

Question 78

Nutrients pass through the small intestine by the following mechanisms
a. by simple diffusion
b. endocytosis
c. apoptosis
d. active transport

Answer 78

a. by simple diffusion
b. endocytosis
d. active transport

Question 79

Iron is resorbed in :
A. proximal jejunum
B. distal jejunum
C. to the ileum
D. colon
E. stomach

Answer 79

A. proximal jejunum

Question 80

Choose a combination of correct answers! Maldigestion is caused by:
a. chronic pancreatitis
b. cystic fibrosis
c. lactase deficiency
d. cholecystectomy

Answer 80

a. chronic pancreatitis
b. cystic fibrosis
c. lactase deficiency

Question 81

The oral iron absorption test is used in diagnostics:
A. malabsorption
B. hemochromatosis
C. steatorrhea
D. sideroblastic anemia
E. chronic pancreatitis

Answer 81

A. malabsorption

Question 82

Choose the correct statements regarding prothrombin time:
a. a prolonged prothrombin time may be a sign of liver disease
b. prolonged prothrombin time is common in steatorrhea
c. a prolonged prothrombin time indicates a dietary vitamin B-12 deficiency
d. the length of the prothrombin time is part of the classification of liver cirrhosis according to Child -
to Pough

Answer 82

a. a prolonged prothrombin time may be a sign of liver disease
b. prolonged prothrombin time is common in steatorrhea
d. the length of the prothrombin time is part of the classification of liver cirrhosis according to Child -
to Pough

Question 83

In what proportion of people older than 50 can we expect lactase deficiency:
A. 5% of the population
B. 25% of the population
C. 50% of the population
D. 75% of the population (the book says 40-100% hahaha)
E. 100% of the population

Answer 83

D. 75% of the population (the book says 40-100% hahaha)

Question 84

The most common cause of malabsorptive syndrome is:
A. Whipple’s disease
B. celiac disease
C. scleroderma
D. intestinal lymphoma
E. colorectal carcinoma

Answer 84

B. celiac disease

Question 85

Bacterial colonization of the small intestine prevents:
a. normal peristalsis
b. bactericidal action of gastric juice
c.the presence of an ileocecal valve(this valve allows the passage of bacteria only
down but not up)
d. stasis of intestinal contents

Answer 85

a. normal peristalsis
b. bactericidal action of gastric juice
c.the presence of an ileocecal valve(this valve allows the passage of bacteria only
down but not up)

Question 86

Fully expressed short bowel syndrome is the result of all of the above EXCEPT :
A. loss of absorptive surface
B. loss of microvilli in the small intestine
C. rapid passages of food
D. bacterial colonization of the small intestine
E. malabsorption of nutrients and fluid from the chyme

Answer 86

B. loss of microvilli in the small intestine

Question 87

Short bowel syndrome develops when the length of the small intestine is:
A. shorter than 500 cm
B. shorter than 300 cm
C. shorter than 100 cm
D. shorter than 200 cm
E. longer than 400 cm

Answer 87

C. shorter than 100 cm

Question 88

Choose the combination of correct statements! Which of the following is true of celiac disease?
a. is gluten intolerance
b. it occurs in genetically susceptible people
c. shows a characteristically altered colonic mucosa
d. it always begins in childhood
e. it always gets confused with lymphoma

Answer 88

a. is gluten intolerance
b. it occurs in genetically susceptible people

Question 89

How does atypical celiac disease differ from typical? :
A. after an extraordinary disability
B. after an asymptomatic course
C. after the absence of antibody against tissue transglutaminase 2
D. after the colon is affected
E. after normal intestinal histology

Answer 89

A. after an extraordinary disability

Question 90

Celiac disease is characterized by:
A. obesity
B. eating disorders
C. poor nutrition and weight loss
D. body mass index above 30 kg/m2
E. erythrocytosis

Answer 90

C. poor nutrition and weight loss

Question 91

Choose the correct statements regarding celiac disease:
a. often presents with sideropenic anemia due to gastrointestinal bleeding (no,
due to malabsorption of Fe and B12)
b. recurrent aphthous stomatitis is characteristic
c.a shuffling gait is a sign of myopathy
d. hyposplenism is common

Answer 91

b. recurrent aphthous stomatitis is characteristic
c.a shuffling gait is a sign of myopathy
d. hyposplenism is common

Question 92

. Which of the listed clinical pictures does NOT belong to the different forms of celiac disease?
A. typical symptomatic celiac disease
B. atypical celiac disease with non-threatening symptoms
C. tropical sprue
D.refractory sprue
E.ulcerative jejunoileitis (belongs to ulcers of the small intestine and is clinically
similar to celiac disease

Answer 92

C. tropical sprue

Question 93

A gluten-free diet is the first therapy of choice for patients with:
A. typical symptomatic celiac disease
B. Whipple’s disease
C. tropical sprue
D. refractory sprue
E. Crohn’s disease

Answer 93

A. typical symptomatic celiac disease

Question 94

Celiac disease is ruled out by:
A. Absence of diarrhea
B. Absence of anemia
C. Obesity
D. Absence of information about celiac disease in the family
E. None of the above

Answer 94

E. None of the above

Question 95

Whipple’s disease - all apply EXCEPT :
A. multiorgan involvement is characteristic
B. it is caused by actinomycetes
C. the diagnosis is confirmed histologically
D. a 14-day treatment is required
E. if the patient is not treated, the disease is fatal

Answer 95

D. a 14-day treatment is required

Question 96

In eosinophilic gastroenteritis, there is always:
A. peripheral eosinophilia
B. peripheral leukocytosis
C. increased presence of eosinophils in the mucosa of the gastrointestinal tract
D. increased CRP value
E. fever

Answer 96

C. increased presence of eosinophils in the mucosa of the gastrointestinal tract

Question 97

The drug of choice for eosinophilic gastroenteritis is:
A. Loperamide
B. antibiotic
C.corticosteroid
D. antihistamine
E. aminosalicylic acid

Answer 97

C.corticosteroid

Question 98

The following applies to tumors of the small intestine:
A. they are most often localized in Meckel’s diverticulum
B. the most common are liposarcomas
C. are much rarer than colon tumors
D. are common in young people
E. patients with carcinoid have defects of the mitral and aortic valves

Answer 98

C. are much rarer than colon tumors

Question 99

In the diagnosis of tumors of the small intestine, we use all of the above except:
A. contrast enteroclysis
B. colonoscopy with ileoscopy
C. angiography
D. scintigraphy with marked leukocytes
E. enteroscopy

Answer 99

D. scintigraphy with marked leukocytes

Question 100

Acute mesenteric ischemia - which of the following is true? Choose the most appropriate
combination of answers:
a. it is most often the result of embolism or thrombosis of the upper mesenteric
arteries
b. formation is associated with arrhythmias
c. it is characterized by massive bleeding in the gastrointestinal tract
d. the diagnostic method is a native x-ray of the abdomen
e. characterized by severe abdominal pain

Answer 100

a. it is most often the result of embolism or thrombosis of the upper mesenteric
arteries
b. formation is associated with arrhythmias
e. characterized by severe abdominal pain

Question 101

Crohn’s disease always affects:
A. rectum
B. terminal ileum
C. stomach
D. duodenum
E. None of the above

Answer 101

E. None of the above

Question 102

An inflammatory reaction that spreads to all layers of the GIT wall is characteristic of:
a) ulcerative colitis
b) Crohn’s disease
c) celiac disease
d) superficial colitis
e)gastritis associated with infection withH. pylori

Answer 102

b) Crohn’s disease

Question 103

All apply to Crohn’s disease EXCEPT:
A. can involve the entire gastrointestinal tract
B. inflammation extends to the submucosa
C. segments of the healthy and affected digestive tract typically alternate
D. in the late phase has a characteristic pseudopolyposis appearance
E. fistulas develop in about a third of patients

Answer 103

B. inflammation extends to the submucosa

Question 104

Deep fissures and fistulas are characteristic of:
a) ulcerative colitis
b) Crohn’s disease
c) Lymphoma of the ileum
d) tuberculous enteritis

Answer 104

b) Crohn’s disease
d) tuberculous enteritis

Question 105

Choose the combination of correct statements! The clinical characteristics of ulcerative colitis are:
a) bloody mucous stool
b) constipation
c) false calls to the mud
d) abdominal pain

Answer 105

a) bloody mucous stool
c) false calls to the mud
d) abdominal pain

Question 106

Extraintestinal symptoms of Crohn’s disease do NOT include:
A. arthritis
B. ankylosing spondylitis
C. iritis
D. dermatitis herpetiformis
E. erythema nodosum

Answer 106

D. dermatitis herpetiformis

Question 107

Characteristic blood count in Crohn’s disease does NOT include:
A. leukopenia
B. thrombocytosis
C. elevated C-reactive protein
D. increased sedimentation of erythrocytes
E. anemia

Answer 107

A. leukopenia

Question 108

Choose the combination of correct statements! Anemia in Crohn’s disease can be caused by:
a) bleeding
b) malabsorption of B-12 and folates
c) iron malabsorption
d) hemolysis

Answer 108

a) bleeding
b) malabsorption of B-12 and folates
c) iron malabsorption

Question 109

The prevalence and localization of Crohn’s disease is assessed by:
A. radioisotope examination with marked erythrocytes
B. radioisotope examination with labeled leukocytes
C. only by gastroscopy
D. only with colonoscopy
E. only by rectoscopy

Answer 109

B. radioisotope examination with labeled leukocytes

Question 110

Choose all the correct statements regarding Crohn’s disease:
a) mostly affects young people
b) using a radioisotope examination with marked leukocytes, we visualize the bleeding site
c) terminal ileum and colon are most often affected
d) often occurs in certain families

Answer 110

a) mostly affects young people
c) terminal ileum and colon are most often affected
d) often occurs in certain families

Question 111

Pseudomembranous colitis is associated with the causative factor:
a) taking antibiotics
b) consumption of diuretics
c) taking beta receptor blockers
d) consumption of laxatives
e) intravenous injection of drugs

Answer 111

a) taking antibiotics

Question 112

The following applies to pseudomembranous colitis:
A. it is an infection with a histolytic amoeba
B. we prove it by determining Clostridium difficile toxin A
C. it is a fungal infection
D. it is a viral infection of the colon
E. is a type of ulcerative colitis

Answer 112

B. we prove it by determining Clostridium difficile toxin A

Question 113

Choose the correct statements regarding toxic megacolon:
a) is a complication of ulcerative colitis
b) is a complication of Crohn’s disease
c) patients are highly febrile
d) colectomy is often required for resolution
e) it can be recognized on a transparent X-ray image of the abdomen

Answer 113

a) is a complication of ulcerative colitis
c) patients are highly febrile
d) colectomy is often required for resolution
e) it can be recognized on a transparent X-ray image of the abdomen

Question 114

To treat chronic inflammatory bowel disease, we use all EXCEPT:
A. sulfasalazine
B.trimethoprim - sulfamethoxazole
C. 5-aminosalicylic acid
D. corticosteroid
E. infliximab

Answer 114

B.trimethoprim - sulfamethoxazole

Question 115

With treatment, we achieve successful remission in chronic inflammatory bowel disease in:
A. 30% of cases
B. 10% of cases
C. 50% of cases
D. 55% of cases
E. 90% of cases

Answer 115

E. 90% of cases

Question 116

Signs of diverticulitis are all EXCEPT:
a) abdominal pain
b) leukocytosis
c) painful resistance in the left atrial quadrant of the abdomen
d) hematochezia
e) elevated indicators of inflammation

Answer 116

d) hematochezia

Question 117

In case of acute suspicion of acute diverticulitis, the first examination to be carried out is:
1. flexible sigmoidoscopy
2. irrigography
3. full colonoscopy
4. ultrasound of the abdomen with examination of the intestines
5. stool examination for parasites

Answer 117

4. ultrasound of the abdomen with examination of the intestines

Question 118

The most common colon polyps are:
A. inflammatory polyps
B. adenomas
C. hamartomas
D. dysplastic polyps
E. malignant

Answer 118

B. adenomas

Question 119

The following applies to adenomas of the colon:
a. they can arise as part of familial adenomatous polyps
b. we treat them with endoscopic removal
c. most colorectal cancers originate from adenomas
d. patients require surgery

Answer 119

a. they can arise as part of familial adenomatous polyps
b. we treat them with endoscopic removal
c. most colorectal cancers originate from adenomas

Question 120

Characteristics of familial adenomatous polyposis are:
a. autosomal dominant inheritance
b. is a precancer with 100% mortality from colorectal carcinoma
c. requires screening of relatives
d. has low penetrance
e. pedunculated polyps are common

Answer 120

a. autosomal dominant inheritance
b. is a precancer with 100% mortality from colorectal carcinoma
c. requires screening of relatives

Question 121

Which of the following is NOT true of familial adenomatous polyposis - FAP :
A. APC gene mutation
B. DCC gene mutation
C. carriers of the gene are detected by a blood test
D. is treated with preventive colectomy
E. Intestinal cancer develops early in carriers of the gene

Answer 121

B. DCC gene mutation

Question 122

Constipation is the result of a disorder:
a. disturbances in the motility of the colon
b. disturbed rectal emptying
c. consumption of laxatives
d. improper diet
e. consumption of prokinetics

Answer 122

a. disturbances in the motility of the colon
b. disturbed rectal emptying

Question 123

All of the above applies to dyspepsia, except:
A. it is often a functional disorder
B. we must pay attention to the so-called warning signs
C. most patients are infected withHelicobacter pylori
D. is a disorder of gastric emptying
E. pain in the upper half of the abdomen is often present

Answer 123

C. most patients are infected withHelicobacter pylori

Question 124

The Rome criteria (Roma III) for the diagnosis of irritable bowel syndrome include all EXCEPT:
A. persistent or recurring abdominal pain or discomfort for at least 3 months in the
past 6 months
B. relief after passing stool
C. altered frequency of bowel movements
D. discharge of mucus mixed with blood
E. altered hardness of the stool

Answer 124

D. discharge of mucus mixed with blood

Question 125

Irritable colon syndrome applies to:
a. that it is the most common functional disease of the gastrointestinal tract
b. the pathophysiological mechanism of the disease is known
c. mostly men are affected
d. the symptoms improve in most cases already with dietary measures (we advise against coffee, alcohol, etc.)
e. it is often accompanied by symptoms and signs of an inflammatory process
A. a, d
B. d, e
C. a, c
D. a, b
E. b, c

Answer 125

A. a, d

Question 126

In case of suspicion of an acute surgical abdomen, the following investigations are reasonable
a. determination of the number of leukocytes in the peripheral blood
b. native x-ray of the abdomen
c. endoscopic ultrasound of the upper gastrointestinal tract
d. ultrasound examination of the abdomen

Answer 126

a. determination of the number of leukocytes in the peripheral blood
b. native x-ray of the abdomen
d. ultrasound examination of the abdomen

Question 127

For neuroendocrine tumors of the gastrointestinal tract, all EXCEPT:
A. Diarrhea is often present
B. patients always lose weight(insulinoma can be treated + keyword is always - because
neuroendocrine tumors progress slowly, there are often no symptoms for a long time)
C. octreoscen is positive in 80-90% of cases
D. can be benign or malignant
E. may be asymptomatic or cause symptoms due to hormone secretion

Answer 127

B. patients always lose weight(insulinoma can be treated + keyword is always - because
neuroendocrine tumors progress slowly, there are often no symptoms for a long time)

Question 128

The following applies to carcinoid syndrome:
a. it is the result of the action of serotonin, histamine, kallikrein and other substances
b. symptoms usually appear before the tumor spreads to the liver
c. it is most often manifested by flushes of redness in the face and upper body
d. it is proven by determining catecholamines in urine
e. in carcinoid syndrome, we expect a solitary tumor without seeds
f. the prognosis is good

Answer 128

a. it is the result of the action of serotonin, histamine, kallikrein and other substances
c. it is most often manifested by flushes of redness in the face and upper body

Question 129

Choose the correct statements regarding acute pancreatitis:
a. it is most often the result of pancreatic division
b. drugs are never the cause of its formation
c. the disease takes place in 80% of cases in a severe form
d. accompanied by abdominal pain
e. it is proven by an increase in pancreatic enzymes in the blood

Answer 129

d. accompanied by abdominal pain
e. it is proven by an increase in pancreatic enzymes in the blood

Question 130

The most important initial event of acute pancreatitis is the activation of:
a) lipases
b) amylase
c) transcription factors
d) trypsinogen
e) chymotrypsin

Answer 130

d) trypsinogen

Question 131

Free fluid in the abdomen can be a complication:
A. acute cholecystitis
B. acute pancreatitis
C. acute appendicitis
D. peritonitis
E. all of the above

Answer 131

E. all of the above

Question 132

The following applies to the clinical picture of acute pancreatitis:
a. often occurs after drinking alcohol
b. elevated temperature speaks against pancreatitis
c. may occur simultaneously with jaundice
d. the severe form occurs with complex complications or multiple organ failure
e. most patients have known hypertriglyceridemia
f. vomiting is not a common sign, after vomiting the pain subsides for patients

Answer 132

a. often occurs after drinking alcohol
c. may occur simultaneously with jaundice
d. the severe form occurs with complex complications or multiple organ failure

Question 133

Acute pancreatic pseudocyst is:
a. salivary fluid surrounded by epithelium
b. develops more often in biliary than in alcoholic pancreatitis
c. occurs four or more weeks after the onset of illness
d. all patients have symptoms at the expense of predocyst
e. the pseudocyst is usually sterile

Answer 133

c. occurs four or more weeks after the onset of illness
e. the pseudocyst is usually sterile

Question 134

Circle the correct answers that apply to acute pancreatitis :
a. it is confirmed by finding an increase in amylase and lipase in the blood
b. an increase in lipase in the urine is characteristic
c. the level of amylase normalizes in 2-3 days, and the level of lipase after 1 week
d. amylase and lipase activity in the serum is a measure of the intensity of inflammation
e. An isolated increase in amylase always means pancreatitis

Answer 134

a. it is confirmed by finding an increase in amylase and lipase in the blood
c. the level of amylase normalizes in 2-3 days, and the level of lipase after 1 week

Question 135

Acute pancreatitis can be accompanied by metabolic changes:
a. hyperglycemia
b. hypoglycemia
c. hyperammonemia
d. hypertriglyceridemia
e. hypocalcemia

Answer 135

a. hyperglycemia
d. hypertriglyceridemia
e. hypocalcemia

Question 136

X-ray findings of the sentinel gyrus are:
1. often a sign of acute pancreatitis
2. indicates localized ileus of the jejunum
3. accompanied by acute appendicitis
4. is a sign of perforation
5. always associated with vomiting

Answer 136

1. often a sign of acute pancreatitis
2. indicates localized ileus of the jejunum

Question 137

Acute biliary pancreatitis indicates:
a. increased indirect bilirubin
b. increased alkaline phosphatase
c. gallstones visible on ultrasound
d. AST is more than twice as elevated as ALT
e. endoscopic papillotomy is required

Answer 137

b. increased alkaline phosphatase
c. gallstones visible on ultrasound
e. endoscopic papillotomy is required

Question 138

Ranson’s indicators are used to classify the level/intensity:
A. sepsis
B. acute pancreatitis
C. diabetic ketoacidosis
D. hypovolemic shock
E. multiorgan failure

Answer 138

B. acute pancreatitis

Question 139

Ranson’s indicators include:
a. age
b. hematocrit value
c. number of leukocytes
d. amylase value
e. CK value

Answer 139

a. age
b. hematocrit value
c. number of leukocytes

Question 140

In acute pancreatitis, the use of all the listed analgesics is allowed, except:
A. paracetamol
B. tramadol
C. morphine
D. pentazotocin
E. piritramide

Answer 140

C. morphine

Question 141

We do not prescribe opiates when obstruction of the common bile duct is suspected:
A. because they cause a disturbance of consciousness
B. because they can lead to respiratory arrest
C. because they increase the tone of the sphincter of Oddi
D. because they increase the tone of the pylorus
E. because they can induce vomiting

Answer 141

C. because they increase the tone of the sphincter of Oddi

Question 142

The most common cause of chronic pancreatitis is .
1. hereditary pancreatitis
2. idiopathic pancreatitis
3. alcoholic – toxic pancreatitis
4. autoimmune pancreatitis
5. Pancreatitis due to pancreatic division

Answer 142

3. alcoholic – toxic pancreatitis

Question 143

In severe pancreatitis with retroperitoneal necrosis, a sign may be present
A. Murphy’s sign
B. Blumberg’s sign
C. Cullen’s sign
D. Castello’s sign
E. Traube’s sign

Answer 143

C. Cullen’s sign

Question 144

Acute pancreatitis was diagnosed in a 45-year-old previously healthy patient at the internist’s first
aid, which, according to his story, developed after a dietary violation. In the laboratory results, ALT is
elevated five times, AST twice, gamma-glutamyl transferase and alkaline phosphatase are elevated, direct
hyperbilirubinemia is present. The patient denies excessive consumption of alcoholic beverages.
What is the most likely etiology of pancreatitis?
A. iatrogenic pancreatitis
B. idiopathic pancreatitis
C. alcoholic pancreatitis
D. Pancreatitis due to steroids
E. biliary pancreatitis

Answer 144

E. biliary pancreatitis

Question 145

Acute pancreatitis was diagnosed in a 45-year-old previously healthy patient at the internist’s first
aid, which, according to his story, developed after a dietary violation. In the laboratory results, ALT is
elevated five times, AST twice, gamma-glutamyl transferase and alkaline phosphatase are elevated, direct
hyperbilirubinemia is present. The patient denies excessive consumption of alcoholic beverages.
Which examination will be used to confirm the etiology of pancreatitis in the described patient?
A. gastroscopy
B. blood ethanol
C. pancreatic biopsy
D. abdominal ultrasound
E. X-ray of the abdomen “on empty”

Answer 145

D. abdominal ultrasound

Question 146

The clinical picture of chronic pancreatitis includes:
a. overweight
b. chronic or recurring abdominal pain
c. steatorrhea
d. Diabetes
e. it is more common in women

Answer 146

b. chronic or recurring abdominal pain
c. steatorrhea
d. Diabetes
e. it is more common in women

Question 147

In the treatment of chronic pancreatitis, we use all EXCEPT:
A. abstinence from alcohol
B. oral vitamin replacement
C. endoscopic removal of stones from the pancreatic duct
D. H2 receptor antagonists
E. enzyme preparations containing amylase

Answer 147

B. oral vitamin replacement

Question 148

All of the above apply to pancreatic cancer EXCEPT :
A. is more common in men than in women
B. one-year survival is 20%
C. the most common type is acinar cell carcinoma
D. smoking is a risk factor
E. if it arises in the head of the pancreas, it usually causes obstructive jaundice

Answer 148

C. the most common type is acinar cell carcinoma

Question 149

What is the first ultrasound (imaging?) diagnostic imaging examination when a pancreatic
tumor is suspected? :
A. ultrasound examination of the abdomen
B. computed tomography
C. endoultrasound
D. x-ray examination of the abdomen natively
E. endoscopic retrograde cholangiopancreatography (ERCP)

Answer 149

A. ultrasound examination of the abdomen

Question 150

Which tumor marker is suitable for the diagnosis of pancreatic tumor v
early stages of the disease? :
a) alpha-fetoprotein
b) About 19-9
c) CEA
d) ANCA
e) There is no suitable tumor marker for the diagnosis of the early stage of the disease

Answer 150

e) There is no suitable tumor marker for the diagnosis of the early stage of the disease

Question 151

Which of the tumor markers would you choose to confirm advanced pancreatic
carcinoma (Interna 4, 630):
A. About 19-9
B. About 15-3
C. Alpha-fetoprotein
D. PSA
E. TPA

Answer 151

A. About 19-9

Question 152

In acute pancreatitis (AP), the following applies:
A. Hyperamylasemia is pathognomonic
B. Both enzymes - amylase and lipase - are always equally elevated
C. The most common cause is autoimmune
D. Most often, the cause of AP remains unexplained - idiopathic pancreatitis
E. The most common causes of acute pancreatitis are gallstones and alcohol

Answer 152

E. The most common causes of acute pancreatitis are gallstones and alcohol

Question 153

Increased urobilinogenuria is a sign (Interna 4, 635):
A. hemolytic jaundice
B. intrahepatic cholestasis
C. extrahepatic cholestasis
D. steatorrhea
E. chronic pancreatitis

Answer 153

A. hemolytic jaundice

Question 154

Prolonged prothrombin time is corrected after intravenous vitamin K supplementation in:
A. hemolytic jaundice
B. prison jaundice
C. parenchymal jaundice
D. acute liver failure
E. liver cirrhosis

Answer 154

B. prison jaundice

Question 155

Indirect hyperbilirubinemia is:
a. may be a congenital metabolic disorder
b. indicates hemolysis
c. it is dangerous in adulthood
d. cause of bilirubinuria
e. histological examination of the liver shows hepatitis

Answer 155

a. may be a congenital metabolic disorder
b. indicates hemolysis
e. histological examination of the liver shows hepatitis

Question 156

. The following applies to alkaline phosphatase in the blood:
a. it is formed exclusively in the liver
b. it is formed in the bones, intestines and liver
c. it is excreted mainly through the kidneys
d. it is excreted with bile
e. an elevated value is an indicator of impaired bilirubin conjugation
f. an elevated value is an indicator of biliary obstruction

Answer 156

b. it is formed in the bones, intestines and liver
d. it is excreted with bile
f. an elevated value is an indicator of biliary obstruction

Question 157

The following applies to AST and ALT aminotransferases:
a. ALT is a more specific indicator of liver damage than AST
b. ALT and AST are equally specific indicators of liver damage
c. ALT is elevated only in hepatitis
d. the magnitude of the increase in AST and ALT is not proportional to the severity of the liver lesion
e. in circulatory shock, aminotransferase values are reduced

Answer 157

a. ALT is a more specific indicator of liver damage than AST

Question 158

Choose the correct answers related to hepatitis A:
a. is transmitted via the fecal-oral route
b. it is confirmed by evidence of HAV antigen in the serum
c. often becomes chronic with chronic carriers
d. we use active immunization to prevent infection
e. AST is more elevated than ALT

Answer 158

a. is transmitted via the fecal-oral route
d. we use active immunization to prevent infection

Question 159

. Choose the correct answers regarding hepatitis B
a. often has a fulminant course
b. 90% progress to cirrhosis
c. usually transmitted intrauterinely
d. it may be accompanied by polyarteritis nodosa
e. the first sign of infection is the presence of HBs antigen

Answer 159

d. it may be accompanied by polyarteritis nodosa
e. the first sign of infection is the presence of HBs antigen

Question 160

HBc antigen in hepatitis B is demonstrated:
1. in the blood
2. in serum
3. in plasma
4. in hepatocytes
5. in leukocytes

Answer 160

4. in hepatocytes

Question 161

When in contact with a patient with HBV infection, protection with immunoglobulins is required for:
A. needle stick / mucosal contact in unvaccinated adults
B. sexual contact with a chronic carrier of HBV, unvaccinated
C. family members of a chronic HBV carrier
D. sexual contact with a chronic carrier of HBV, vaccinated
E. in adults with a high titer of anti-HBs antibodies

Answer 161

A. needle stick / mucosal contact in unvaccinated adults
B. sexual contact with a chronic carrier of HBV, unvaccinated
C. family members of a chronic HBV carrier

Question 162

Choose the correct answers regarding acute hepatitis C:
A. Hepatitis C infection often takes the form of acute icteric hepatitis
B. the fulminant course is in 20%
C. is often (in 70-80% of cases) asymptomatic
D. passes into a chronic form in 70-80%
E. is a common cause of HCC

Answer 162

C. is often (in 70-80% of cases) asymptomatic
D. passes into a chronic form in 70-80%
E. is a common cause of HCC

Question 163

Choose the correct answers related to autoimmune hepatitis:
a. is a disease of young women
b. it is often accompanied by arthralgias
c. splenomegaly is never present
d. it is successfully treated with Interferon

Answer 163

a. is a disease of young women
b. it is often accompanied by arthralgias

Question 164

Which disease is characterized by AMA antibodies
A. autoimmune hepatitis
B. primary biliary cirrhosis
C. primary sclerosing cholangitis
D. alcoholic hepatitis
E. chronic C hepatitis

Answer 164

B. primary biliary cirrhosis

Question 165

What is true about chronic hepatitis B?:
a. develops in 80% of those infected with the hepatitis B virus
b. patients have characteristic clinical symptoms
c. it is proven by determining anti-HBs antibodies in the serum
d. the presence of HBs antigen in the serum indicates infectivity
e. a late complication may be hepatocellular carcinoma

Answer 165

d. the presence of HBs antigen in the serum indicates infectivity
e. a late complication may be hepatocellular carcinoma

Question 166

The second (immunoreactive) phase of chronic hepatitis B is manifested by: :
a. characteristic symptoms
b. permanent increase of ALT and AST
c. positive HBsAg
d. low concentration of HBV DNA in the blood
e. negative HBsAg

Answer 166

c. positive HBsAg
d. low concentration of HBV DNA in the blood

Question 167

Choose which of the following characterizes healthy HBs antigen carriers:
A. presence of anti-HBs
B. presence of HBe antigen
C. low or undetectable HBV DNA
D. elevated aminotransferases
E. absence of HBs-Ag in the blood

Answer 167

C. low or undetectable HBV DNA

Question 168

Chronic hepatitis B is treated with:
a. interferon alfa-2
b. interferon beta
c. with lamivudine
d. with adefovir
e. with cyclosporine

Answer 168

a. interferon alfa-2
c. with lamivudine
d. with adefovir

Question 169

Choose the correct answers that refer to the successful treatment of chronic hepatitis
B:
a. it is characterized by the disappearance of HBsAg
b. characterized by a decrease in HBV DNA
c. is successful in 60% of patients
d. normalization of elevated ALT

Answer 169

a. it is characterized by the disappearance of HBsAg
b. characterized by a decrease in HBV DNA
d. normalization of elevated ALT

Question 170

Choose the correct statement related to hepatitis C:
A. 70% of patients are acutely icteric
B. often progresses to cirrhosis
C. needs the presence of HBs antigen
D. we confirm it by determining HCV DNA
E. active prophylaxis with vaccination is possible

Answer 170

B. often progresses to cirrhosis

Question 171

Chronic hepatitis C is treated with:
a. corticosteroids
b. interferon alfa-2
c. ribavirin
d. lamivudine
e. the best response is in patients with genotype 1 B

Answer 171

b. interferon alfa-2
c. ribavirin

Question 172

Alcoholic liver cirrhosis develops ( 659):
a. in 10% of alcoholics
b. the type of alcoholic beverage is important
c. occasional abstinence worsens liver disease
d. in men, the activity of ADH in the gastric mucosa is lower than in women
e. the cause lies in genetic factors

Answer 172

a. in 10% of alcoholics
e. the cause lies in genetic factors

Question 173

Alcoholic liver disease is characterized by:
a. spider nevi
b. enlarged liver
c. AST : ALT ratio: < 2
d. hypertriglyceridemia
e. increase in uric acid

Answer 173

a. spider nevi
b. enlarged liver
d. hypertriglyceridemia
e. increase in uric acid

Question 174

The characteristics of hyperkinetic circulation in liver cirrhosis are:
a. decreased peripheral resistance
b. arterial hypertension
c. increased cardiac output
d. decreased central blood volume

Answer 174

a. decreased peripheral resistance
c. increased cardiac output

Question 175

An increase in IgM is characteristic of :
A. alcoholic liver cirrhosis
B. primary biliary liver cirrhosis
C. bile duct atresia
D. alcoholic hepatitis
E. worsening of liver cirrhosis of any etiology

Answer 175

B. primary biliary liver cirrhosis

Question 176

The Child-Turcott-Pugh classification for assessing the degree of liver disease includes:
a. assessment of encephalopathy
b. bilirubin level
c. assessment of ascites
d. gamma globulin concentration
e. prothrombin time

Answer 176

a. assessment of encephalopathy
b. bilirubin level
c. assessment of ascites
e. prothrombin time

Question 177

Signs of portal hypertension are ( 667):
a. prolonged prothrombin time
b. enlarged spleen
c. hemorrhoids
d. jaundice
e. ascites

Answer 177

b. enlarged spleen
c. hemorrhoids
e. ascites

Question 178

Which pressure difference between the portal vein and the inferior vena cava is
considered preclinical portal hypertension? :
A. 2-5 mm Hg
B. 5-9 mm Hg
C. 10-12 mm Hg
D. 15-20 mm Hg
E. 20-25 mm Hg

Answer 178

B. 5-9 mm Hg

Question 179

The pressure difference between the portal vein and the inferior vein that causes the clinical picture of portal
hypertension is:
A. above >7 mm Hg
B. above >10 mm Hg
C. above >12 mm Hg
D. above >20 mm Hg
E. above >30mmHg

Answer 179

B. above >10 mm Hg

Question 180

Which of the listed drugs are used for the preventive treatment of portal
hypertension? :
a. propranolol
b. nifedipine
c. atenolol
d. Nadolol
e. sotalol

Answer 180

a. propranolol
d. Nadolol

Question 181

Bleeding in portal hypertension is treated:
a. with dobutamine
b. with octapressin
c. with vasopressin
d. endoscopically
e. with dopamine

Answer 181

b. with octapressin
c. with vasopressin
d. endoscopically

Question 182

A functioning TIPS (transjugular portosystemic shunt) can worsen:
1. hepatic encephalopathy
2. ascites
3. hypotension
4. state of nutrition
5. survival of patients with liver cirrhosis

Answer 182

1. hepatic encephalopathy

Question 183

Hepatic encephalopathy in liver cirrhosis is:
a. the result of a decrease in the function of liver parenchymal liver cells
b. portal hypertension
c. anemia
d. hyperuricemia

Answer 183

a. the result of a decrease in the function of liver parenchymal liver cells
b. portal hypertension

Question 184

Hepatic encephalopathy is triggered by:
a. gastrointestinal bleeding
b. dehydration
c. benzodiazepines, narcotics, alcohol
d. paracentesis of a very large volume of ascites
e. excessive dietary protein intake

Answer 184

All

Question 185

The characteristics of ascites in cirrhosis are:
a. specific gravity is lower than 1016
b. protein concentration is lower than 25 g/L
c. the number of leukocytes is higher than 250 cm3
d. a difference in the concentration of albumin in serum and albumin in ascites that is higher
than 11 g/L is characteristic of ascites in portal hypertension

Answer 185

a. specific gravity is lower than 1016
b. protein concentration is lower than 25 g/L
d. a difference in the concentration of albumin in serum and albumin in ascites that is higher
than 11 g/L is characteristic of ascites in portal hypertension

Question 186

Choose the correct measures related to the treatment of ascites in liver cirrhosis:
a. limit salt to 1-2 g/day
b. spironolactone
c. furosemide
d. body weight is reduced by 3 kg/day
e. paracentesis without albumin replacement

Answer 186

a. limit salt to 1-2 g/day
b. spironolactone
c. furosemide

Question 187

Which of the following is true of hepatorenal syndrome?
a. it is progressive oliguric renal failure due to altered systemic hemodynamics in
severe liver damage
b. occurs only in acute severe liver failure
c. properly treated has an excellent prognosis
d. the most common cause is treatment with non-steroidal anti-inflammatory drugs
e. it is treated with a kidney transplant

Answer 187

a. it is progressive oliguric renal failure due to altered systemic hemodynamics in
severe liver damage

Question 188

Spontaneous bacterial peritonitis
a. is a common complication of cirrhosis
b. the number of leukocytes in ascites is lower than 250 mm3
c. most leukocytes in ascites are lymphocytes
d. he is treated with cefotaxime 2 g every 8-12 hours iv.

Answer 188

a. is a common complication of cirrhosis
d. he is treated with cefotaxime 2 g every 8-12 hours iv.

Question 189

Which of the following is not a cause of hemochromatosis?
A. genetic factors
B. transfusions
C. iron therapy
D. sickle cell anemia
E. alcohol consumption

Answer 189

D. sickle cell anemia

Question 190

Among the listed diseases, circle those that are characteristic of hemochromatosis.
a. cirrhosis
b. diabetes
c. myocardiopathy
d. renal failure

Answer 190

a. cirrhosis
b. diabetes
c. myocardiopathy

Question 191

Genetic (primary) hemochromatosis can be distinguished from secondary hemochromatosis by:
A. presence of iron in hepatocytes
B. the presence of iron in the spleen
C. the presence of iron in the bone marrow
D. the presence of iron in Kupfer cells
E. the presence of iron in the basal ganglia

Answer 191

A. presence of iron in hepatocytes

Question 192

Hemochromatosis appears more often in men:
a. over 45 years old
b. over the age of 55
c. over 65 years old.
d. We treat it with venipunctures
e. Elevated iron and decreased ceruloplasmin are characteristic in the serum

Answer 192

b. over the age of 55
d. We treat it with venipunctures

Question 193

The most common cause of death in untreated hemochromatosis is:
A. sepsis
B. left-sided heart failure
C. uncontrolled diabetes
D. hepatocellular carcinoma
E. hypothyroidism

Answer 193

D. hepatocellular carcinoma

Question 194

Patients with genetic hemochromatosis have accumulated in their body
A. 3 to 5 g of iron
B. 10 to 15 g of iron
C. 20 to 30 g of iron
D. 25 to 50 g of iron
E. More than 100g of iron

Answer 194

C. 20 to 30 g of iron

Question 195

Secondary hemochromatosis is prevented by:
a) deferoxamine is added during transfusions
b) to perform venipunctures
c) to treat with deferoxamine tablets
d) to give patients high doses of vitamin C
e) with oral iron

Answer 195

a) deferoxamine is added during transfusions

Question 196

Choose the correct statements related to Wilson’s disease:
a. it often presents first with neurological symptoms
b. serum ceruloplasmin is decreased
c. serum ferritin is elevated
d. the disease is curable in its early stages with lifelong treatment
e. a Keyser Fleischer ring is present

Answer 196

a. it often presents first with neurological symptoms
b. serum ceruloplasmin is decreased
d. the disease is curable in its early stages with lifelong treatment
e. a Keyser Fleischer ring is present

Question 197

CREST syndrome is typically associated with:
1. primary biliary cirrhosis
2. autoimmune hepatitis
3. celiac disease
4. Crohn’s disease
5. MALT lymphoma

Answer 197

1. primary biliary cirrhosis

Question 198

The first signs of primary biliary cirrhosis are:
a. jaundice
b. itchy skin
c. increased alkaline phostatase
d. increased IgM
e. lowered cholesterol

Answer 198

b. itchy skin
c. increased alkaline phostatase
d. increased IgM

Question 199

Primary biliary cirrhosis is confirmed in the laboratory by:
a. by evidence of anti-MPO antibodies
b. by evidence of Scl antibodies
c.by evidence of antibodies against pyruvate dehydrogenase of mitochondria
d. by evidence of anti-centromere antibodies
e. no lab test can help us, a liver biopsy is needed

Answer 199

c.by evidence of antibodies against pyruvate dehydrogenase of mitochondria

Question 200

Hepatic steatosis is associated with all EXCEPT:
A. accumulation of triglycerides in hepatocytes
B. obesity
C. alcohol consumption
D. herpes virus infection
E. increased mobilization of fatty acids from adipose tissue

Answer 200

D. herpes virus infection

Question 201

Clinical features of steatosis are
a. enlarged liver
b. enlarged liver and spleen
c. spider nevi
d. elevated ALT
e. diabetes

Answer 201

a. enlarged liver
d. elevated ALT
e. diabetes

Question 202

Non-alcoholic steatohepatitis is:
A. alcoholic steatohepatitis in a patient who does not admit to alcohol consumption
B. accumulation of fat in liver cells in people who consume < 30g of alcohol per
week
C. steatosis of the liver in a patient receiving an excessive daily amount of glucose in
parenteral nutrition
D. steatohepatitis resulting from congenital hyperlipidemia
E. steatohepatitis resulting from insulin therapy

Answer 202

B. accumulation of fat in liver cells in people who consume < 30g of alcohol per
week

Question 203

Choose the correct combination of answers. Pregnancy-specific liver disease is all
EXCEPT:
a. acute steatosis
b. HELLP syndrome
c. intrahepatic cholestasis
d. primary biliary cirrhosis
e. autoimmune hepatitis

Answer 203

d. primary biliary cirrhosis
e. autoimmune hepatitis

Question 204

The most common benign liver tumors in adults are among the following:
A. lipomas
B. hemangiomas
C. focal nodular hyperplasia
D. hemangioendotheliomas
E. germinomas

Answer 204

B. hemangiomas

Question 205

Choose the correct answer regarding hepatic hemangiomas:
A. is a common tumor of the liver
B. causes symptoms in most people
C. accompanied by elevated alpha-fetoprotein
D. diagnosis is made by liver biopsy
E. we treat it with surgery

Answer 205

A. is a common tumor of the liver

Question 206

Choose a combination of correct answers. Which of the following liver tumors are associated with the
use of oral contraceptives:
a. adenoma
b. focal nodular hyperplasia
c. hemangioma
d. hepatocellular carcinoma
e. hemangioendothelioma

Answer 206

a. adenoma
b. focal nodular hyperplasia

Question 207

Choose the correct answers that apply to hepatocellular carcinoma:
a. occurs in cirrhosis
b. is often associated with HBV and HCV infection
c. is associated with exposure to vinyl chloride
d. has characteristic symptoms
e. cytostatic treatment is successful

Answer 207

a. occurs in cirrhosis
b. is often associated with HBV and HCV infection

Question 208

Liver metastases are characterized by:
a. liver enlargement
b. elevation of aminotransferases
c. elevation of alkaline phosphatase and LDH
d. most are detected by ultrasound
e. the diagnosis is established by biopsy

Answer 208

a. liver enlargement
c. elevation of alkaline phosphatase and LDH
d. most are detected by ultrasound
e. the diagnosis is established by biopsy

Question 209

Budd-Chiari syndrome applies to:
a. it is caused by hepatic vein disease
b. patients have ascites
c. the liver is painful
d. treatment with anticoagulant therapy is effective

Answer 209

All of them

Question 210

Choose the statements that apply to gallstones:
a. 10 to 20% of the population have them
b. they are common after the age of 60
c. the most common are pigment stones
d. the cause is increased secretion of cholesterol from hepatocytes
e. formation of boils aspirin

Answer 210

a. 10 to 20% of the population have them
b. they are common after the age of 60
d. the cause is increased secretion of cholesterol from hepatocytes
e. formation of boils aspirin

Question 211

Choose the correct statements that apply to cholecystolithiasis
a. it is usually asymptomatic and is discovered by chance
b. may cause colic with obstructive jaundice
c. we find it out with an ultrasound
d. asymptomatic cholecystolithiasis is treated with surgery
e. characteristic is the Courvoiser sign

Answer 211

a. it is usually asymptomatic and is discovered by chance
b. may cause colic with obstructive jaundice
c. we find it out with an ultrasound

Question 212

Choose the correct statements related to choledocholithiasis
a. may be a primary disease of the bile ducts
b. it is always accompanied by characteristic symptoms
c. it is always accompanied by an increase in amylase and lipase
d. we treat it with endoscopic papillotomy

Answer 212

a. may be a primary disease of the bile ducts
d. we treat it with endoscopic papillotomy

Question 213

The most common form of cholecystitis is:
1. Acute acalculous cholecystitis
2.Acute calculous cholecystitis
3. Chronic acalculous cholecystitis
4. Viral cholecystitis
5. Gangrenous cholecystitis

Answer 213

2.Acute calculous cholecystitis

Question 214

What applies to acute cholangitis
a. Charcot’s triad is typical
b. sepsis originating from the bile duct
c. the most common source of infection is portal blood
d. endoscopic papillotomy is indicated
e. common causative agents of cytomegalovirus infection

Answer 214

a. Charcot’s triad is typical
b. sepsis originating from the bile duct
d. endoscopic papillotomy is indicated

Question 215

Primary sclerosing cholangitis is:
a. purulent inflammation of the bile ducts
b. 70% associated with ulcerative colitis
c. it is labeled by anti-mitochondrial antibodies
d. elevated alkaline phosphatase is characteristic
e. cholangiocarcinoma is a complication in 10-15% of patients

Answer 215

b. 70% associated with ulcerative colitis
d. elevated alkaline phosphatase is characteristic
e. cholangiocarcinoma is a complication in 10-15% of patients

Question 216

Dyspepsia means:
a. upper abdominal pain
b. “heartburn”
c. a common term for discomfort in the upper abdomen
d. regurgitation of stomach contents into the esophagus
e. a general term for all symptoms resulting from inadequate secretion of pepsin

Answer 216

c. a common term for discomfort in the upper abdomen

Question 217

to a 60-year-old patient , who comes to the doctor because of dyspepsia
a. we have to do a gastroscopy
b. first an antacid or H2 receptor blocker is prescribed for 14 days
c. eradication treatment for H. pylori is prescribed first
d. a gastroscopy is performed in case of anemia
e. first, we prescribe an ulcer diet for 14 days

Answer 217

a. we have to do a gastroscopy

Question 218

The smell of feces in vomited mass indicates:
a. ileus
b. organophosphate poisoning
c. gastrointestinal bleeding
d. disease of the biliary system
e. flatulence

Answer 218

a. ileus

Question 219

Which is usually the first examination when a perforation of the alimentary canal is suspected:
a. ultrasound
b. plain radiograph of the abdomen
c. CT
d. lab. blood tests
e. rectal examination

Answer 219

b. plain radiograph of the abdomen

Question 220

How much is a typical example:
a. visceral pain
b. parietal pain
c. transmitted pain
d. phantom pains
e. none of the above

Answer 220

a. visceral pain

Question 221

Jaundice becomes visible with a concentration of bilirubin that:
a. exceeds the upper limit of normal
b. exceeds the upper limit of normal by 50%
c. exceeds the upper limit of normal by 100%
d. exceeds the upper limit of normal by 300%
e. it may also be in the normal range

Answer 221

d. exceeds the upper limit of normal by 300%

Question 222

Bilirubin in urine is a sign of:
a. direct hyperbilirubinemia
b. indirect hyperbilirubinemia
c. prehepatic jaundice
d. kidney disease
e. Gilbert’s disease

Answer 222

a. direct hyperbilirubinemia

Question 223

Direct hyperbilirubinemia and an increase in alkaline phosphatase and gGT raise the suspicion of:
a. obstruction of the bile ducts by gallstones
b. hemolytic anemia
c. Gilbert syndrome
d. resorption of blood from a large hematoma
e. none of the above

Answer 223

a. obstruction of the bile ducts by gallstones

Question 224

Indirect hyperbilirubinemia is found in:
a. Gilbert’s syndrome
b. alcoholic liver disease
c. gallstones
d. primary biliary cirrhosis
e. bleeding in the gastrointestinal tract

Answer 224

a. Gilbert’s syndrome

Question 225

An enlarged and palpably painful liver is amonglistedcauses most likely sign:
a. carcinoma
b. acute cholecystitis
c. alcoholic liver cirrhosis
d. of acute left-sided heart failure
e. viral hepatitis

Answer 225

e. viral hepatitis

Question 226

A strongly increased concentration of alkaline phosphatase is most indicative of:
a. acute hepatitis
b. obstruction of the bile duct
c. alcoholic liver cirrhosis
d. carbon monoxide poisoning
e. extravascular hemolysis

Answer 226

b. obstruction of the bile duct

Question 227

When direct bilirubin increases, the first thing to do is:
a. Ultrasound of the liver and bile ducts
b. Abdominal CT
c. gastroscopy (and, if necessary, endoscopic ultrasound)
d. bone marrow puncture
e. lumbar puncture

Answer 227

a. Ultrasound of the liver and bile ducts

Question 228

The normalization of the prolonged prothrombin time in a patient with hyperbilirubinemia after three
days of vitamin K administration speaks most in favor of the following of the listed diagnoses:
a. Gilbert syndrome
b. alcoholic hepatitis
c. viral hepatitis
d. carcinoma of the bile ducts
e. paracetamol poisoning

Answer 228

d. carcinoma of the bile ducts

Question 229

Diarrhea in ulcerative colitis is
a. osmotic
b. secretarial
c. exudative
d. motility
e. none of the above

Answer 229

c. exudative

Question 230

Osmotic diarrhea can be distinguished from secretory diarrhea with the help of:
a. starvation test
b. haematesta stool
c. rectal examination
d. gastroscopy
e. autopsies

Answer 230

a. starvation test

Question 231

A 60-year-old chronic alcoholic comes to the doctor because of a 14-day swelling of the left
lower extremity distal to the knee. Among the listed causes, the most likely is:
a. heart failure (alcoholic cardiomyopathy)
b. hypoproteinemia due to inadequate nutrition
c. nephrotic syndrome
d. local inflammation
e. liver cirrhosis

Answer 231

d. local inflammation

Question 232

What is not a symptom of GERD
a) regurgitation
b) heartburn
c) constipation
d) weakness
e) epigastric pain

Answer 232

c) constipation

Question 233

H. Pylori
a) duodenal cancer
b) eradication does not cure GERD
c) evidence by the Rutgers NE test
d)mimics duodenal ulcer

Answer 233

b) eradication does not cure GERD
d)mimics duodenal ulcer

Question 234

Ulcerative colitis:
a) terminal ileum and large intestine
b) small intestine
c) fistulas
d) general involvement of the gastrointestinal tract
e) inflammation limited to the mucosa

Answer 234

d) general involvement of the gastrointestinal tract
e) inflammation limited to the mucosa

Question 235

For adematous polyps of the colon, the following applies:
a) the basic treatment is surgical
b) cause of inflammation, pain, bleeding
c) most cancers arise from them
d) treatment is endoscopic
e) they can occur in the family

Answer 235

c) most cancers arise from them
d) treatment is endoscopic
e) they can occur in the family

Question 236

Choose the correct statements for Barrett’s esophagus:
a) occurs in patients with duodenoesophageal reflux
b) histologically, it is a metaplasia of the glandular epithelium of the gastric mucosa in the esophagus
c) occurs in the first year of severe reflux disease
d) occurs in smokers
e) Barrett’s esophagus is treated exclusively with drugs

Answer 236

b) histologically, it is a metaplasia of the glandular epithelium of the gastric mucosa in the esophagus

Question 237

Which examination is used to determine motility disorders of the esophagus?
a) X-ray
b) MR
c) pH-metry
d) manometry
e) Ultrasound

Answer 237

d) manometry

Question 238

The most common pattern for peptic ulcer formation is:
a)NSAIDs
b) stress
c) Zollinger-Ellison syndrome
d) Crohn’s disease

Answer 238

a)NSAIDs

Question 239

Acute pancreatitis is treated:
a. fluids are replaced
b. he must not eat fatty food for three days
c. analgesic
d. an antibiotic
e. fasting for a couple of days

Answer 239

a. fluids are replaced
c. analgesic
e. fasting for a couple of days

Question 240

How do you treat infected necrotizing pancreatitis?
a. liquids
b. analgesics
c. antibiotics
d. you remove the stone if it is biliary pancreatitis
e. surgically

Answer 240

e. surgically

Question 241

76-year-old, healthy, 3 hours on
the abdomen, which quickly escalated
to bloody stool, the tachycardia is
becoming more painful, the abdominal
papal X-ray does not show perforation.
a) CT
b) MR
c) CT angiography
d) Ultrasound

Answer 241

c) CT angiography

Question 242

How do we treat bleeding from a duodenal ulcer? Circle the wrong answer:
a) methylprednisolone
b) surgical
c) endoscopically

Answer 242

a) methylprednisolone

Question 243

Risk factors for colorectal cancer are:
a. frequent occurrence in the family
b. chronic inflammatory bowel diseases
c. constipation

Answer 243

a. frequent occurrence in the family
b. chronic inflammatory bowel diseases

Question 244

Focal nodular hyperplasia (circle the wrong one)
a) most often in women between the ages of 20 and 50
b) lesion with central necrosis spreading in a stellate manner
c)not related to taking oral contraceptives
d) treated surgically with liver resection

Answer 244

c)not related to taking oral contraceptives

Question 245

Treatment of necrotizing pancreatitis
a) broad-spectrum antibiotics
b)fluid replacement
c)analgesics
d) calcium channel inhibitors

Answer 245

b)fluid replacement
c)analgesics

Question 246

What is not a warning sign?
a) weight loss
b)regurgitation
c) dysphagia
d) bleeding from the gastrointestinal tract

Answer 246

b)regurgitation

Question 247

What about H. Pylori
a) GERD can be cured by eradication
b)causes stomach cancer
c) causes duodenal carcinoma

Answer 247

b)causes stomach cancer

Question 248

Which of the following is not true of melena?
a) It can occur simultaneously with hematochezia
b)we prove it with hematest
c) can occur due to bleeding into the small intestine
d) indicates bleeding from the upper gastrointestinal tract

Answer 248

b)we prove it with hematest

Question 249

Hematemesis is:
a) vomiting yellow liquid
b)common with bleeding from esophageal varices
c) rare in bleeding from the esophagus
d) vomiting of brown stomach contents

Answer 249

b)common with bleeding from esophageal varices

Question 250

Hematochezia occurs in all conditions except:
a) hemorrhoids
b) intestinal tumors
c) Crohn’s disease
d)duodenal peptic ulcers
e) pseudomembranous colitis
f) celiac disease

Answer 250

d)duodenal peptic ulcers

Question 251

Risk factors for the development of colon cancer (circle the correct one, several
correct ones):
a)that someone in the family has had colorectal cancer
b)severe IBD for several years
c)survived colorectal cancer
d)adenomas
e) prolonged constipation

Answer 251

a)that someone in the family has had colorectal cancer
b)severe IBD for several years
c)survived colorectal cancer
d)adenomas

Question 252

Acute Pancreatitis Condition Definition Scale (circle the correct one, multiple correct ones):
a)Ranson’s indicators
b)Glasgow Scale
c)APACHE II
d)Child-Turcott-Pugh classification

Answer 252

a)Ranson’s indicators
b)Glasgow Scale
c)APACHE II

Question 253

The clinical picture of chronic pancreatitis includes:
a)overweight
b)chronic or recurring abdominal pain
c)steatorrhea
d)Diabetes
e)it is more common in women

Answer 253

b)chronic or recurring abdominal pain
c)steatorrhea
d)Diabetes

Question 254

Incarcerated hernia:
a)it is not returnable
b)the stalk is inflamed
c)is reposable

Answer 254

a)it is not returnable

Question 255

An elderly man (63 years old), tachycardic, hypertensive, severe sudden
abdominal pain, once passed slimy bloody thin stools. X-ray shows no
perforation. What do we do after that?
a) emergency gastroscopy
b) hemodynamic stabilization
c) CT angiography

Answer 255

c) CT angiography

Question 256

Case report for acute biliary pancreatitis. Which diagnostic and therapeutic
method will you use?
a) angiography
b) ct
c) endoscopic ultrasound
d) transcutaneous ultrasound
e) X-ray

Answer 256

d) transcutaneous ultrasound

Question 257

Damage to the mucous membrane of the
esophagus is caused by:
● aspirin
● NSAIDs
● folic Acid
● antacids

Answer 257

● aspirin
● NSAIDs

Question 258

Esophageal perforation can manifest as:
● you may have subcutaneous emphysema of the neck
● may be a complication of gastroscopy
● may be a complication of Boerhaave syndrome
● it is common in summer due to cold drinks

Answer 258

● you may have subcutaneous emphysema of the neck
● may be a complication of gastroscopy
● may be a complication of Boerhaave syndrome

Question 259

Risk factors for upper gastrointestinal bleeding after taking NSAIDs
● Advanced age(>65 years old)
● Proton pump inhibitors
● Previous ulcer

Answer 259

● Advanced age(>65 years old)
● Previous ulcer