Internal Flashcards
May decrease oesophageal sphincter tone, except: A) atropine B) domperidone C) glucagon D) cholecystokinin E) nifedipine
B) domperidone
EXPLANATION
Lower oesophageal sphincter tone is decreased by the other substances listed, with the exception of domperidone.
When are the most of gastric fluids produced from the daily 1,5 L? A) between meals B) in the cephalic phase C) in the gastric phase D) in the intestinal phase
C) in the gastric phase
EXPLANATION
More than half of the daily amount of gastric fluids are produced after a meal, the so-called gastric phase. The cephalic phase of gastric secretion is triggered by stimulation of the taste receptors in the mouth. The cephalic phase-secreted fluids were named by Pavlov as “appetite fluids.” During the intestinal phase and between meals, the amount of secreted gastric fluids are negligible compared to the gastric and cephalic phases.
A 53-year-old man was hospitalized with the following symptoms: epigastric pain, lower extremity oedema, diarrhea. Laboratory findings confirmed iron deficiency anaemia. The gastroscopy shows giant folds in the stomach. The trial breakfast shows reduced acid secretion. Biopsy taken from the deeper layer of the mucosa also shows no malignancy. Which disease is it? A) Ménétrier disease B) Stomach lymphoma C) Zollinger-Ellison syndrome D) Scleroderma
A) Ménétrier disease
EXPLANATION
Ménétrier disease or exsudative gastropathy is a rare disease of unknown origin, characterized by diffuse thickening of the gastric wall caused by excessive proliferation of the mucous membrane. In the stomach the macroscopic view of the stomach shows a huge, soft, swollen, curving mucous membrane that resembles the cerebral cortex. Microscopic features are elongated, convoluted glandular enlargement, cystic dilation, in which parietal cells are often replaced by cells resembling mucus or intestinal metaplastic cells. One of the most important clinical features is the loss of proteins through gastric lesions. This leads to oedema formation. In addition, patients often complain of epigastric pain and diarrhea. Unlike the Zollinger-Ellison syndrome, there are no multiple ulcers in the stomach. Diagnosis of gastric lymphoma can be confirmed histologically. In scleroderma, lesions develop in the gastrointestinal tract, primarily in the oesophagus and in the distal duodenum and proximal jejunum. It is not characterized by the image of these giant folds in the stomach.
All but one of the factors listed increases pepsinogen secretion: A) somatostatin B) gastrin C) histamine D) vagal stimulation
A) somatostatin
EXPLANATION
The most potent stimulus for pepsinogen release is vagal stimulation. Histamine primarily stimulates hydrochloric acid secretion but also significantly enhances pepsinogen secretion. Gastrin also enhances the secretion of pepsinogen. Somatostatin inhibits gastrin release and does not increase pepsinogen release.
The most common type of polyp in the stomach: A) hyperplasiogen B) adenomatosus C) juvenile D) carcinoid
A) hyperplasiogen
EXPLANATION
Polyps occurring in the stomach can be classified into epithelial and non-epithelial origin. Of the epithelial origin, hyperplasic polyps are the most common, and usually develop in the antrum. During their growth, they might rarely show adenomatous transformation.
Typical site for Helicobacter pylori colonization: A) antrum B) antrum-corpus border C) fundus D) duodenum
A) antrum
EXPLANATION
A typical site for Helicobacter pylori colonisation is the antrum. Among the pathogenetic factors indispensable for colonisation, the pathogen’s urease activity, appropriate motility and adhesion can be highlighted. The enzyme urease plays a central role in protecting the bacterium from hydrochloric acid and creating the alkaline microenvironment for colonization.
The most common localization of gastrinoma is: A) pancreas B) duodenum C) jejunum D) appendix
A) pancreas
EXPLANATION
Of the neuroendocrine tumors of the gastrointestinal tract, gastrinomas are most frequently (30-60%) located in the pancreas.
Methods used nowadays to treat Zollinger-Ellison ulcer, except: A) total gastrectomy B) H2 receptor blocking agents C) proton pump inhibitors (PPIs) D) removal of the gastrinoma
A) total gastrectomy
EXPLANATION
Methods used to treat ulcer in Zollinger-Ellison syndrome: administration of proton pump inhibitors and H2 receptor blockers, according to the severity of the condition. Due to the efficacy of these drugs, we do not perform total gastrectomy today. In the case of known tumor localization, the causal treatment is removal of the gastrinoma.
In gastroesophageal reflux disease, the endoscopic view of the esophagus may be: 1) diffuse mucosal hyperaemia 2) mucosal ulcers in the lower third of the esophagus 3) isolated linear erosion over cardia 4) intact esophageal epithelium A) only answers 1, 2 and 3 are correct B) only answers 1 and 3 are correct C) only answers 2 and 4 are correct D) only answer 4 is correct E) all of the answers are correct
E) all of the answers are correct
EXPLANATION
In GORB, the endoscopically visible (macroscopic) image of the oesophagus may show intact epithelium (non-erosive reflux disease), oesophagitis of various stages (erosive reflux disease), or gastric mucosa (cardiac metaplasia). Erosive reflux disease can be classified into different stages. The stage classification currently used worldwide is based on the Los Angeles classification.
Used for the diagnosis of gastroesophageal reflux disease: 1) proton pump inhibitor test 2) esophageal impedance test 3) 24-hour oesophageal pH monitoring 4) pentagastric test A) only answers 1, 2 and 3 are correct B) only answers 1 and 3 are correct C) only answers 2 and 4 are correct D) only answer 4 is correct E) all of the answers are correct
A) only answers 1, 2 and 3 are correct
EXPLANATION
In addition to the proton pump inhibitor test, which is a basic method in GORB diagnostics, and the 24-hour intra-oesophageal pH monitoring, the oesophageal function test, which has high specificity, although not yet routine, can be used to confirm both weak acidic and non-acidic reflux. for separating liquid and gas reflux. The pentagastric test, which reveals the acidity of the stomach, is not suitable for the diagnosis of GORB.
It may favorably affect the symptoms of diffuse oesophageal spasm, except: 1) diltiazem 2) glyceryl trinitrate 3) nifedipine 4) ranitidine A) only answers 1, 2 and 3 are correct B) only answers 1 and 3 are correct C) only answers 2 and 4 are correct D) only answer 4 is correct E) all of the answers are correct
D) only answer 4 is correct
EXPLANATION
Symptoms of diffuse esophageal spasm may be favorably affected by the listed Ca-channel blocking agents (diltiazem, nifedipine) and NO donor (glyceryl trinitrate). The H2 receptor antagonist ranitidine, which inhibits gastric acid secretion, has no effect on symptoms.
Increases the incidence of oesophageal epithelial cell carcinomas: 1) Barrett's metaplasia 2) achalasia cardiae 3) nutcracker esophagus 4) smoking A) only answers 1, 2 and 3 are correct B) only answers 1 and 3 are correct C) only answers 2 and 4 are correct D) only answer 4 is correct E) all of the answers are correct
C) only answers 2 and 4 are correct
EXPLANATION
Among the listed answers, achalasia and smoking are factors that increase the incidence of oesophageal epithelial cell carcinomas. Barrett’s metaplasia (intestinal type), on the other hand, is precancerous to adenocarcinoma. Walnut-esophagus is a primary motility disorder of the oesophagus and does not present an increased risk of malignant neoplasm of the oesophagus.
The effects of proton pump inhibitors are true:
1) Proton pump inhibitors act on the H + / K + -ATPase pump.
2) PPIs significantly increase serum gastrin levels.
3) They are among the basic drugs for Helicobacter pylori eradication schemes.
4) It should not be administered with NSAIDs due to drug interactions.
A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct
A) only answers 1, 2 and 3 are correct
EXPLANATION
Proton pump inhibitors act by inhibiting the enzyme H + / K + -ATPase. Because they inhibit the activity of the H + / K + -ATPase enzyme, thus causing the inhibition of hydrochloric acid secretion, which leads to an increase in serum gastrin levels through a feedback mechanism. Proton pump inhibitors are one of the basic drugs for Helicobacter pylori eradication schemes. There is no drug interaction when combining proton pump inhibitors with NSAIDs, and in fact, the most effective treatment for treating NSAID-induced ulcers is the use of proton pump inhibitors. The first 3 answers are correct.
In the treatment of peptic ulcer disease:
1) All H2 blocker is effective in treating peptic ulcer.
2) H2 blockers are usually given 3 times a day before main meals.
3) PPIs reduce ulcer pain faster than H2 blockers.
4) PPIs and H2 blockers are usually cured within 2-4 weeks.
A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct
B) only answers 1 and 3 are correct
EXPLANATION
The use of H2 blockers and proton pump inhibitors is both accepted in the treatment of peptic ulcer disease. H2 blockers are usually given twice daily, and in many cases a single evening administration is sufficient. Proton pump inhibitors reduce ulcer pain more rapidly than H2 blockers through a more potent antacid effect and generally heal ulcers faster than H2 blockers. Answers 1 and 3 are correct.
Most important things to do in case of upper gastrointestinal bleeding:
1) stabilizing the circulation with fluid and, if necessary, blood supplementation
2) gastric tube insertion, gastric lavage
3) gastroscopy to localize the source of bleeding, if possible
4) immediate administration of PPI or H2 blocker orally to reduce acid secretion
A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct
A) only answers 1, 2 and 3 are correct
EXPLANATION
In the case of upper gastrointestinal bleeding, the most important thing is to compensate for the volume loss caused by the bleeding and to stabilize the circulation with fluid and, if necessary, blood supplementation. In addition, it is important to insert the gastric tube to clean the stomach and drain stagnant blood. Subsequently, after proper preparation, gastroscopy can be performed to localize the source of the bleeding and for possible endoscopic intervention. In the case of gastric bleeding, oral antacid therapy is ineffective and unnecessary. If a secretory inhibitor treatment is to be used, it should be administered parenterally. The first 3 answers are correct.
The following substances enhance gastric secretion: 1) gastrin 2) caffeine 3) histamine 4) somatostatin A) only answers 1, 2 and 3 are correct B) only answers 1 and 3 are correct C) only answers 2 and 4 are correct D) only answer 4 is correct E) all of the answers are correct
A) only answers 1, 2 and 3 are correct
EXPLANATION
Gastric acid secretion is enhanced by gastrin, histamine and caffeine. In clinical practice, pentagastrin is used nowadays to quantitatively determine gastric acidity conditions, which has replaced the trial of histamine or caffeine. Somatostatin inhibits gastric acid secretion and the release of several gastrointestinal hormones, including gastrin.
It is true that:
1) CEA and AFP play a prominent role in the early diagnosis of gastric cancer.
2) Ectopic gastric mucosa can occur in almost any area of the gastrointestinal tract without clinical significance.
3) Gastric cancer has characteristic early symptoms.
4) Gastric cancer may be classified into two main groups according to its histological division: intestinal and diffuse gastric cancer.
A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct
D) only answer 4 is correct
EXPLANATION
Gastric cancer is a malignant disease that develops without characteristic early symptoms. Tumor markers (CEA, AFP) have no role in early diagnosis. Gastric cancers fall into two main histopathological groups: intestinal and diffuse gastric cancers.
What did your barium swallow test result show based on the above diagnosis?A 48-year-old non-smoking, abstinent woman turns to you for having increased swallowing difficulties for half a year, weight loss, unpleasant mouth odor and frequent regurgitation of undigested food. 1) dilated esophagus 2) spastic esophageal contractions 3) cardia for drinking cold, cold water 4) uneven constriction over cardia A) only answers 1, 2 and 3 are correct B) only answers 1 and 3 are correct C) only answers 2 and 4 are correct D) only answer 4 is correct E) all of the answers are correct
B) only answers 1 and 3 are correct
EXPLANATION
Diagnosis of Achalasia cardiae is confirmed when a barium swallow test confirms dilated, aperistaltic esophageal body and narrow, upon cold water drinking opening cardia. The uneven narrowing of the cardia in itself but in combination with vigorous (spastic) progressive contractions, further raises the possibility of a malignant process. Intermittent, non-progressive, spastic contractions with preserved cardiac function may indicate other primary esophageal motility disorders (diffuse esophageal spasm, nutcracker esophagus).
In which section of the small intestine is iron mostly absorbed?
A) proximal small intestine
B) the central section of the small intestines
C) distal small intestine
D) the entire small intestines
A) proximal small intestine
Causes of diarrhea, except: A) taking laxatives B) taking dopamine antagonist drugs C) malabsorption D) indigestion E) taking dopamine agonist
E) taking dopamine agonist
EXPLANATION
Diarrhea occurs for numerous reasons, including laxatives, dopamine antagonist medication, absorption and indigestion. Dopamine agonists cause constipation.
Causes of constipation, except: A) tricyclic antidepressants B) SSRI type antidepressants C) diabetes mellitus D) persistent hypokalaemia
B) SSRI type antidepressants
EXPLANATION
Constipation may be caused by the use of tricyclic antidepressants due to an increase in sympathetic tone, a partial manifestation of autonomic neuropathy in diabetes mellitus, and a reduction in the intensity of smooth muscle contractions in persistent hypokalaemia. Antidepressants acting on the serotonin system also increase serotonin levels in the gastrointestinal tract, which, as a transmitter, results in increased contractility.
Causes of tetany in patients with steatorrhea, except:
A) decreased calcium absorption
B) the amount of calcium excreted in the faeces increases
C) reduced vitamin D absorption
D) decreased potassium absorption
E) the amount of ionized calcium in the body is reduced
D) decreased potassium absorption
Patients suffering from digestive disorders who have steatorrhea also have a deficiency in the absorption of calcium, vitamin D, other fat soluble vitamins (A, E, K), in the case of malabsorption, the absorption of other nutrients, vitamins and minerals is impaired. According to clinical practice, total serum calcium is low in severe digestive and absorption disorders. Total calcium level is protein-bound and non-protein-bound, so-called ionized calcium together. Therefore, in severe maldigestion and malabsorption disorders, total calcium levels are reduced. If the serum protein is low due to other disorders, serum calcium may also be low because calcium cannot bind sufficiently to the protein. Hypocalcaemic tetany is caused by a decrease of ionized calcium.
Malabsorption of carbohydrates is characterized by:
1) low sugar tolerance curve
2) diarrhea occurs during lactose tolerance test
3) flat starch tolerance curve
4) during lactulose tolerance test, the amount of hydrogen in the exhaled air increases
A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct
E) all of the answers are correct
EXPLANATION
Carbohydrate absorption disorders (at different levels) are characterized by all the options listed in the question.
The following laboratory tests can confirm malabsorption syndrome: 1) flat sugar tolerance curve 2) flat iron load curve 3) schilling test value less than 10% 4) increased orocoecal transit time A) only answers 1, 2 and 3 are correct B) only answers 1 and 3 are correct C) only answers 2 and 4 are correct D) only answer 4 is correct E) all of the answers are correct
A) only answers 1, 2 and 3 are correct
EXPLANATION
Patients with malabsorption syndrome have a flat sugar tolarence and iron load curve and impaired B12 absorption. The orocoecal transit time does not increase.
In conditions with diarrhea, gallstone formation occurs due to:
1) a higher amount of bile is excreted in the faeces
2) endogenous cholesterol production increase
3) loss of bile acid via stool
4) the lithogenicity of the bladder increase
A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct
E) all of the answers are correct
EXPLANATION
In conditions with diarrhea all of the above are involved in contribution of gallstone formation; particularly important is the loss of bile acid, which contributes to the lithogenicity of the bladder.
In acute pancreatitis, serum calcium levels drop abruptly for the following reasons:
1) the patient receives only an isotonic infusion of NaCl2
2) pancreatic tissue is disolves
3) acute pancreatitis is accompanied by low serum calcium levels
4) due to fat necrosis, calcium stearates are formed
A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all of the answers are correct
C) only answers 2 and 4 are correct
EXPLANATION
A sudden decrease in serum calcium in severe acute pancreatitis means that a significant amount of pancreatic tissue has fallen apart. Because pancreatic tissue is high in fat, endogenous soap (calcium stearate) is formed with calcium. This results in a rapid decrease in calcium levels (characteristic of haemorrhagic and necrotizing pancreatitis).
The following medications are used successfully in the treatment of giardiasis: 1) antispasmodics 2) tetracyclin derivatives 3) analgesics 4) tinidazole derivatives A) only answers 1, 2 and 3 are correct B) only answers 1 and 3 are correct C) only answers 2 and 4 are correct D) only answer 4 is correct E) all of the answers are correct
D) only answer 4 is correct
Tinidazole - similar to metronidazole.
The correct indications for jejunal (enteral) nutrition are as follows: 1) oesophagus stenosis due to tumor 2) acute pancreatitis 3) stomach outwards stenosis 4) the patient is unable to eat orally for less than 6 weeks A) only answers 1, 2 and 3 are correct B) only answers 1 and 3 are correct C) only answers 2 and 4 are correct D) only answer 4 is correct E) all of the answers are correct
C) only answers 2 and 4 are correct
EXPLANATION
The most common indications for jejunal feeding tube in addition to severe, acute pancreatitis are the difficulty or impossibility of oral nutrition. In the latter case, the situation needs to be considered and resolved as soon as possible. If oral feeding was not restored, PEG insertion is well-founded. In the case of oesophagus stenosis due to tumor the implantation of an expandable metal stent, which is endoscopically placed, restores or significantly improves oral feeding.
Characteristics of primary biliary cholangitis (PBC), except:
A) antimitochondrial antibody (AMA) is present
B) serum-IgM is frequently elevated
C) female dominance
D) corticosteroid is indicated for treatment
E) it might be associated with sclerodermae
D) corticosteroid is indicated for treatment
EXPLANATIONPrimary biliary cholangitis (PBC) is an idiopathic cholestatic liver disease, presumably autoimmune in nature. It is predominant in women, and may be associated with scleroderma, the antimitochondrial antibody (AMA), is a typical serological marker of the disease, and may result in elevated levels of serum-IgM. Its treatment is not completely developed, and corticosteroid is not indicated. In its early phase, ursodeoxycholic acid is the most useful medication.
It can trigger hepatic encephalopathy in severe liver cirrhosis, except: A) gastrointestinal bleeding B) metabolic acidosis C) aggressive diuretic therapy D) enteral infection E) high amount of oral protein intake
B) metabolic acidosis
EXPLANATIONIn severe liver cirrhosis patients, hepatic encephalopathy may be caused by gastrointestinal bleeding, aggressive diuretic therapy, enteral infection, or a large amount of per os protein intake, but not by metabolic acidosis.
True for the ascites in liver cirrhosis without further cirrhotic complications:
A) it is bloody
B) protein content is always above 30 g/l
C) malignant cells are found in the sediment
D) serum albumin - ascites albumin gradient >11 g/l
E) neutrophil granulocyte count is above 1000/mm3
D) serum albumin - ascites albumin gradient >11 g/l
EXPLANATION
In cirrhosis, in which there are no additional complications, ascites develops as the consequence of portal hypertension, and, in such cases, it is typically characteristic of serum albumin - ascites albumin gradient is more than 11 g/l.
The earliest sign of primary biliary cholangitis (PBC) can be: A) spider nevi B) dilated abdominal wall veins C) skin hematomas D) jaundice E) pruritus
E) pruritus
EXPLANATION
Itchiness may be the primary, early symptom in primary biliary cirrhosis.
45-year-old alcoholic male patient is admitted to the hospital with ascites, restlessness, bizarre behavior. In his sudden deterioration provoking factors might be, except:
A) asymptomatic duodenal bleeding
B) aggressive diuretic therapy
C) he discontinued lactulose, consumed large amount of protein
D) his protein intake was insufficient
E) spontaneous bacterial peritonitis developed
D) his protein intake was insufficient
EXPLANATION
Except in the event of low or diminished protein intake! This does not cause hepatic encephalopathy!
Cause of fatty liver can be, except: A) metabolic syndrome B) coeliac disease C) Wilson’s disease D) autoimmune liver disease E) drugs
D) autoimmune liver disease
EXPLANATION
Fatty liver may be caused by metabolic syndrome, coeliac disease, Wilson’s disease and drug-induced liver injury. Autoimmune liver diseases are not associated with the development of fatty liver.null
Characteristics of hepatitis B virus infection, except:
A) it is prevented by vaccination
B) chronic hepatitis develops mostly when newborns are infected
C) HBV incorporates into the host’s genome
D) it increases the risk of HCC
E) diagnosis is based on detection of HBV RNA
E) diagnosis is based on detection of HBV RNA
EXPLANATION
Hepatitis B virus infection is typically preventable in the event of vaccination. Chronic hepatitis develops mostly if and when newborns are infected. HBV incorporates into the host’s genome, therefore it increases the risk of HCC. The diagnostic of chronic HBV infection is based on the detection of HBV DNA, instead of a.
Characteristics of primary biliary cholangitis, except:
A) it remains asymptomatic for a long time
B) pruritus might be the first symptom
C) antimitochondrial antibody (AMA) is often positive
D) circulating immuncomplexes, increased IgM level
E) usually younger females are affected
E) usually younger females are affected
EXPLANATION
The primary biliary cholangitis is typically asymptomatic for a lengthy period of time, therefore, it is usually diagnosed in middle-aged women and not seen in younger women. Itchiness may arise as a primary symptom. The antimitochondrial antibody (AMA) is often positive and circulating immune complexes, and an increased IgM level may also be observed.null
Protein electrophoresis shows increased polyclonal gammopathy in primary biliary cholangitis, which is mostly: A) IgA B) IgM C) IgG D) IgD E) IgE
B) IgM
EXPLANATION
Primary biliary cirrhosis (PBC) is characteristic for the increased serum IgM immunoglobulins.
It can cause chronic hepatitis in immunocompromised patients:
1) hepatitis B-virus
2) hepatitis E-virus
3) hepatitis C-virus
4) hepatitis A-virus
A) 1., 2. and 3. answers are correct B) 1. and 3. answers are correct C) 2. and 4. answers are correct D) only 4. answer is correct E) all of the answers are correct
A) 1., 2. and 3. answers are correct
EXPLANATION
In immunocompromised patients, chronic hepatitis may be caused by hepatitis B-, C-and E- virus, as well. Hepatitis A-virus does not lead to chronic hepatitis.null
It can be used for the treatment of chronic hepatitis B: 1) interferon 2) entecavir 3) tenofovir 4) azathioprin A) 1., 2. and 3. answers are correct B) 1. and 3. answers are correct C) 2. and 4. answers are correct D) only 4. answer is correct E) all of the answers are correct
A) 1., 2. and 3. answers are correct
EXPLANATION
Among the listed statements, the treatment of chronic hepatitis B involves interferon, entecavir and tenofovir.
It can be administered to prevent rebleeding of esophageal varicosity: 1) endoscopic variceal sclerotherapy or ligation 2) portocaval shunt insertion 3) propranolol 4) carvediol A) 1., 2. and 3. answers are correct B) 1. and 3. answers are correct C) 2. and 4. answers are correct D) only 4. answer is correct E) all 4 answers are correct
E) all 4 answers are correct
EXPLANATION
The most commonly applied therapies in the prevention of the rebleeding of esophageal varices include variceal sclerotherapy or ligation, TIPS implantation, and propranolol and carvediol treatment.
True for hepatitis C virus infection:
1) it can lead to cirrhosis for decades
2) acute hepatitis is usually asymptomatic
3) it increases the risk of HCC
4) liver transplantation is never recommended
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct
A) 1., 2. and 3. answers are correct
EXPLANATION
It is true in the case of hepatitis C virus infection, in which it often leads to cirrhosis, over a period of decades, and therefore, increases the risk of HCC. Acute hepatitis is usually symptom-free. If liver cirrhosis is induced by decompensated HCV, the expected survival is shorter than 1-2 years. In the event there is no surgical contraindication, liver transplantation in patients is recommended.null
Chronic hepatitis C can be cured with new direct antiviral therapies in approximately 90% of the cases, because these medications can be given to patients with cirrhosis.
A) both parts are correct, causative relation exists
B) both parts are correct, causative relation does not exist
C) first part is correct, the second is incorrect
D) first part is incorrect, second part is correct
E) both parts are incorrect
B) both parts are correct, causative relation does not exist
EXPLANATION
In approximately 90% of the cases, chronic hepatitis C can be cured with the new direct-acting antiviral therapies inhibiting the replication of the virus. Furthermore, these new medications can be administered to cirrhotic patients who formerly could not benefit from IFN therapy. However, there is no cause-effect relation between the two statements.
What is the diagnosis? 50-year-old alcoholic male patient visits his physician with following symptoms: fatigue for months, abdominal girth is increased, distended, swelling of the legs, jaundice appeared, lost some weight. He became febrile few days ago and felt abdominal pain. Physical examination reveals jaundice, ascites, enlarged liver with finely irregular surface, mild diffuse abdominal tenderness. Laboratory parameters: serum bilirubin 65 μmol/l, AST 60 E, GGT 560 E, albumin 26 g/l, INR: 1.7, leucocyte count 12 000 G/l, platelet count: 75 000 G/l. A) alcoholic hepatitis B) hepatocellular carcinoma C) liver cirrhosis D) right-sided cardiac failure
C) liver cirrhosis
EXPLANATION
The case indicates liver cirrhosis.
What would be the recommended drug therapy for this complication?
50-year-old alcoholic male patient visits his physician with following symptoms: fatigue for months, abdominal girth is increased, distended, swelling of the legs, jaundice appeared, lost some weight. He became febrile few days ago and felt abdominal pain. Physical examination reveals jaundice, ascites, enlarged liver with finely irregular surface, mild diffuse abdominal tenderness. Laboratory parameters: serum bilirubin 65 μmol/l, AST 60 E, GGT 560 E, albumin 26 g/l, INR: 1.7, leucocyte count 12 000 G/l, platelet count: 75 000 G/l.
A) penicillin
B) rifaximin
C) lactulose
D) norfloxacin or ceftriaxon
E) all of the above
D) norfloxacin or ceftriaxon
EXPLANATION
Among the listed medications, norfloxacin or ceftriaxone, are the most recommended treatments for spontaneous bacterial peritonitis.
Which symptom is not characteristic to disorders of biliary excretion? A) abdominal distension B) ”fullness” feeling C) severe steatorrhoea D) abdominal discomfort E) pain under the right ribs
C) severe steatorrhoea
EXPLANATION
Abdominal distension and discomfort, ”fullness” feeling and pain under the right ribs are all characteristic to disorders of biliary excretion. However, severe steatorrhoea is characteristic to malabsorption and pancreatic insufficiency. In physiological cases, with a daily 75 g fat intake the daily excreted faeces consists no more than 7 g of fat. However, in cases of malabsorption 20-40% and in cases of pancreatic insufficiences 60% of the daily fat intake can be excreted with the faeces resulting in severe steatorrhoea.
How often is the outlet of the ductus choledochus and the ductus pancreaticus joint (Ampulla of Vater)? A) 10% B) 30% C) 50% D) 70% E) 90%
E) 90%
EXPLANATION
In 90% of the cases there is a joint duct and outlet of the ductus pancreaticus and the ductus choledochus resulting in the so-called Ampulla of Vater. Frequently, and accessorial pancreatic duct also exists (duct of Santorini) ending in the ductus pancreaticus in the majority of the cases, however sometimes an independent outlet may also be present. In 5-10% of the cases, when pancreas divisum exists ductus pancreaticus does not communicate with the ductus choledochus (see also BGY-8.27.
Which of the following does decrease the spasm of the Oddi sphincter? 1) nitrates 2) chocolate 3) cholecystokinin 4) morphine A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
EXPLANATION
Nitrates, chocolate and cholecystokinin decreases, while morphin increases the spasm of the Oddi sphincter. Cholecystokinin has a pivotal role in the postprandial relaxation of the Oddi sphincter. Chocolate also decreases the spasm of the Oddi sphincter. Additionally, nitrates may be therapeutically applied in cases of biliary colic. Contrary, giving major analgeticum (morphin) in cases of biliary colic is not recommended, because it may result in sphincter spasm enhancing the pain, and it may also mask the clinical manifestation of an acute abdominal catastrophe (perforation of the gallbladder).
What are the indications of endoscopic sphincterotomy?
1) choledocholithiasis
2) Oddi-sphincter-dyskinesis
3) acute recidive gallbladder attack resulting in acute pancreatitis
4) carcinoma of the pancreatic head
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
EXPLANATION
Indications for endoscopic sphincterotomy during ERCP include choledocholithiasis, Oddi-sphincter-dyskinesis and acute recidive gallbladder attack resulting in acute pancreatitis. Main aim of the intervention is to assure optimal bile excretion and flow and prevent the emergence of a secondary inflammation. Sphincterotomy is indispensable for the proper removal of a stone, however in cases of carcinoma of the pancreatic head only an operation can be curable. In palliative cases sphincterotomy is also inssufficient, since implantation of a stent is also needed.
Which of the following procedures are useful for functional examination of the gallbladder?
1) liver scintigraphy
2) MRCP (magnetic resonance cholangiopancreatography)
3) intravenous urography
4) cholescintigraphy
A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct
C) 2nd and 4th answers are correct
EXPLANATION
Functional examination of the gallbladder and the bile ducts can be carried out using cholescintigraphy, cholangio-CT and cholangio-MR. During cholescintigraphy, isotope-labeled agents which are metabolised by the hepatocytes and secreted into the bile are administered and detected using gamma camera. In the case of obstruction of the bile ducts when ultrasound examination cannot detect the cause of the obstruction or when ERCP is not recommended, cholangio-CT and cholangio-MR might help the diagnosis. Nowadays classical oral or intravenous cholangiocholecystography is only rarely performed. Intravenous urography is a false answer.
What is the most important differentiating laboratory parameter in cases of obstructive jaundice? 1) elevated direct bilirubin 2) elevated total bilirubin 3) elevated urinary UBG 4) no UBG in the urine A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct
D) only 4th answer is correct
EXPLANATION
In cases of obstructive jaundice, urinary UBG levels decrease in accordance with the extent of the obstruction an after total obstruction, urinary UBG is no longer detectable. The colour of the faeces is becoming lighter as well resulting in acholic faeces. In cases of prehepatic or hepatic jaundice, urinary UBG levels are elevated. In obstructive jaundice, total bilirubin and direct bilirubin levels are elevated, jaundice occurs in cases of partial obstruction as well.
Which of the following may be the complication of gallstones? 1) obstructive jaundice 2) acute pancreatitis 3) cholecystitis 4) chronic pancreatitis A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct
E) all of the answers are correct
EXPLANATIONThe most common complication of gallstones is obstructive jaundice, acute panreatitis and cholecystitis. In 15-20% of gallbladder stone cases, choledocholithiasis is present as well, which is the main cause of the obstructive jaundice. Gallstones jammed into the major duodenal papilla causes acute biliary pancreatitis. In some cases, the resence of gallstone or sludge is not present during the diagnosis, because it has already passed over the major duoenal papilla. In 90% of the acute cholecystitis cases, gallstone jammed into the ductus cysticus is the cause. Local irritation and refractory acute inflammations may cause chronic cholecystitis as well. In 4% of the chronic pancreatitis cases gallstones are the main cause of the disease (see also. BGY-8.17.).
Klatskin tumour can be easily removed surgically, because the tumour is located in the porta hepatis.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
D) the statement is false, but the explanation itself is true
EXPLANATION
Klatskin tumor, located in the porta hepatis, is usually unresectable at the time of the diagnosis. In case of resectable tumor the local resection has to be combined with liver resection, therefore is considered a hardly feasible operation. As palliative therapy the preparation of biliodigestive anastomosis, surgical or endoscopic stent implantation, chemoembolization, or irradiation come into question. Thus the statement is incorrect, the explanation itself is correct.
Ultrasound scan detects bile duct stones with great certainty, because ultrasound is absolute reliable in the detection of gallbladder stones as well.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
D) the statement is false, but the explanation itself is true
EXPLANATION
Although abdominal ultrasound is very efficient in detecting gallbladder stones, in the diagnosis of bile duct stones, despite of good specificity (80 percent) the sensitivity is low (60 percent), therefore ultrasound is unreliable in detecting bile duct stones. In case of suspicion of bile duct stones, exact diagnosis can be expected from invasive methods (ERCP, rarely percutaneous transhepatic cholangiography, PTC). Modern imaging methods (CT, CT-cholangiography, MR) have differential diagnostic role. Therefore the statement is incorrect, the explanation itself is correct.
In case of gallstones the first choice of treatment is always medical stone dissolution, because it is cheap and only 10% of gallstones recur within two years.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
E) both the statement and the explanation are false
EXPLANATIONBile acid treatment dissolves or reduces gallstones in 1-3 years in 50-60 percent of patients. Great disadvantage of stone solution is its expense, and that after the cessation of treatment the stones recur shortly in 30-50 percent of cases. The definitive treatment of cholelithiasis is cholecystectomy. Thus both the statement and the explanation are incorrect (see also BGY-8.20.).
What lab test helps setting the correct diagnosis?
A 45-year-old woman with known bile stones complains of a cramping, severe abdominal pain under the right ribs irradiating in the scapulae, beginning about 30 minutes after eating and associated by nausea. During physical examination she indicates a strong pain on pressure under the right ribs, and fluctuating resistance can be felt here.
1) white blood cell count
2) serum-amylase
3) total urine
4) direct bilirubin
A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct
E) all of the answers are correct
EXPLANATION
All four examinations may help setting the diagnosis. Increased white blood cell count may refer to cholecystitis; elevated serum-amylase may confirm biliary pancreatitis; complete urinalysis, through the changes of bilirubinuria and urobilinogenuria may help differentiate between hepatocellular and mechanical icterus; direct bilirubin level my refer to the severity of jaundice and the extent of mechanical obstruction.
What is the most probable diagnosis? A 45-year-old woman with known bile stones complains of a cramping, severe abdominal pain under the right ribs irradiating in the scapulae, beginning about 30 minutes after eating and associated by nausea. During physical examination she indicates a strong pain on pressure under the right ribs, and fluctuating resistance can be felt here. A) acute pancreatitis B) gallstone ileus C) gastric perforation D) hydrops vesicae felleae E) choledocholithiasis
D) hydrops vesicae felleae
EXPLANATION
‘The symptoms are typical for biliary colic. The painful, fluctuating resistance palpated during physical examination after the colic is gallbladder hydrops, that develops as a consequence of a gallstone stuck in the cystic duct. In old patients the hydrops has to be differentiated from the nontender gallbladder accompanied with escalating jaundice without colic (Courvoisier’s sign), which is typical for carcinoma of the ampulla of Vater and head of pancreas (see also BGY-8.13.).
What therapuetic interventions are considered?
A 45-year-old woman with known bile stones complains of a cramping, severe abdominal pain under the right ribs irradiating in the scapulae, beginning about 30 minutes after eating and associated by nausea. During physical examination she indicates a strong pain on pressure under the right ribs, and fluctuating resistance can be felt here.
1) inserting a central venous catheter and administering nitrates
2) laparoscopic cholecystectomy
3) endoscopic sphincterotomy and stone extraction
4) complete fasting, conservative medical treatment
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
C) 2nd and 4th answers are correct
EXPLANATION
Medical treatment consists of complete fasting, fluid and electrolyte replacement, symptomatic treatment (parenteral analgesics and spasmolytics), and in case of inflammatory signs, also parenteral antibiotics. The definitive solution is cholecystectomy. According to the modern surgical approach, the preferred method is the so called early laparoscopic cholecystectomy, i.e. the operation has to be carried out within 24-72 hours after the presentation of symptoms. With early cholecystectomy severe, often life threatening complications (acute cholecystitis, gallbladder perforation, cholangitis, acute pancreatitis) can be prevented, hospitalization is shorter, treatment is less expensive.
What is the next examination of choice? A 78-year-old man is admitted to the hospital because of significant weight loss and jaundice. Abdominal US confirms a gallbladder without stone and dilated intrahepatic bile ducts, the extrahepatic bile ducts are not wider. A) iv. cholescintigraphy B) abdominal CT C) ERCP D) percutaneous transhepatic drainage
C) ERCP
EXPLANATION
Certain diagnosis is provided by ERCP, that accurately localizes the bile duct obstruction and gives information about the degree of obstruction. If ERCP cannot be carried out due to technical reasons or the general state of the patient, a non-invasive MR-cholangiography may help in the diagnosis. If endoscopy is insolvable (e.g. after Billroth’s II resection of the stomach, significant duodenum stenosis etc.), percutaneous transhepatic drainage may lead to diagnosis and serve as palliative treatment
Which laboratory results help in setting the diagnosis?
A 78-year-old man is admitted to the hospital because of significant weight loss and jaundice. Abdominal US confirms a gallbladder without stone and dilated intrahepatic bile ducts, the extrahepatic bile ducts are not wider.
1) normal CRP level
2) elevated erythrocyte sedimentation rate
3) high LDH level
4) elevated CEA level
A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct
C) 2nd and 4th answers are correct
EXPLANATION
Elevated erythrocyte sedimentation rate (ESR) and elevated CEA level may help setting the diagnosis. However, it has to be emphasized, that normal ESR does not exclude the possibility of malignancy; the sensitivity and specificity of CEA in bile duct (Klatskin) tumour is low (high level is found in only 20 percent of cases). CRP and LDH are less helpful in the diagnosis because of low specificity and sensitivity.
What is the most probable diagnosis? A 78-year-old man is admitted to the hospital because of significant weight loss and jaundice. Abdominal US confirms a gallbladder without stone and dilated intrahepatic bile ducts, the extrahepatic bile ducts are not wider. A) acute cholecystitis B) acute hepatitis C) primary biliary cirrhosis D) bile duct tumour (Klatskin) E) pancreas head carcinoma
D) bile duct tumour (Klatskin)
EXPLANATION
Besides the anamnesis (old patient, weight loss, jaundice) the dilated intrahepatic bile ducts without extrahepatic dilation refer to proximal hilar bile duct (Klatskin) tumour. Weight loss and the lack of gallstones are against cholecystitis; elderly age, weight loss, dilated intrahepatic bile ducts are against acute hepatitis and primary biliary cirrhosis. In pancreas head carcinoma primarily the extrahepatic bile ducts are dilated.
What is the treatment of choice? A 78-year-old man is admitted to the hospital because of significant weight loss and jaundice. Abdominal US confirms a gallbladder without stone and dilated intrahepatic bile ducts, the extrahepatic bile ducts are not wider. A) bypass surgery B) ERCP, stent implantation C) duodenal tube D) treatment with ursodeoxycholic acid E) bedrest, supportive treatment
B) ERCP, stent implantation
EXPLANATION
In case of resectable tumour the treatment of choice is naturally surgical resection. Klatskin tumour located in the hepatic hilum is often unresectable at the time of diagnosis. Therefore the solution of jaundice and possible palliative treatment may be stent implantation during ERCP. The resectability of the tumour is determined during surgical exploration after the cessation of jaundice.
Typical symptoms of Caroli syndrome: 1) recurring cholangitis 2) haematuria 3) shaking chills, fever 4) peptic duodenal ulcer A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct
B) 1st and 3rd answers are correct
EXPLANATION
Recurring cholangitis may appear in Caroli syndrome, with symptoms like shaking chills and fever and the development of septic state. Recurring cholangitis is caused by stasis and bacterial infection in the dilated bile ducts.
Caroli syndrome = cystic dilation of intrahepatic bile ducts. Autosomal recessive.
Morphological characteristics of Caroli syndrome:
1) fusiform dilation of intrahepatic bile ducts
2) crooked cystic duct
3) bile duct stenosis
4) shortened common bile duct
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
B) 1st and 3rd answers are correct
EXPLANATION
In Caroli syndrome both the dilation of intrahepatic bile ducts and bile duct stenosis may be present, thus B is the correct answer.
Characteristics of Mirizzi’s syndrome: 1) obstructive icterus 2) normal bilirubin level 3) dilated hepatic duct 4) diarrhoea A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct
B) 1st and 3rd answers are correct
EXPLANATION
Mirizzi’s syndrome is characterized by obstructive icterus and dilated hepatic duct, because the stone in the gallbladder fundus presses the common bile duct, with the mentioned symptoms as consequences.
Mirrizi syndrome= stone in cystic duct that compresses the hepatic bile duct.
Possible symptom of postcholecystectomy syndrome: 1) constipation 2) weight loss 3) nausea 4) diarrhoea A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct
D) only 4th answer is correct
EXPLANATION
After cholecystectomy, diarrhoea may develop due to the constant bile flow.
Characteristics of juxtapapillary diverticulum:
1) can be cause of chronic liver disease
2) endoscopic papillotomy is contraindicated
3) is often associated with bile duct malformations
4) raises the risk of bile duct stones
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
D) only 4th answer is correct
EXPLANATION
D is the correct answer, because juxtapapillary diverticulum raises the risk of bile duct stone by a supposed bile flow obstruction. It does not cause chronic liver disease, endoscopic papillotomy is not contraindicated anymore, and it is not often associated with bile duct malformations.
Juxtapapillary diverticulum=outpouching of duodenal wall??
Predisposing factors of acute acalculous cholecystitis, except:
1) prolonged starvation
2) immobility
3) hemodynamic instability associated with severe abdominal diseases
4) nonalcoholic steatohepatitis
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
D) only 4th answer is correct
EXPLANATION
D is the correct answer, because nonalcoholic steatohepatitis does not cause acalculous cholecystitis. The conditions listed as 1., 2., 3. cause gallbladder dysfunction, and therefore may lead to cholecystitis.
Which enzyme gene mutation causes hereditary pancreatitis? A) carbonic anhydrase B) cationic trypsin C) phospholipase D) kallikrein E) hexokinase
B) cationic trypsin
EXPLANATION
Cationic trypsin mutations are responsible for two-thirds of hereditary pancreatitis, mutations in other enzymes do not cause pancreatitis. Bile flow is blocked by the obstructed and compressed choledochus by a pancreas head cancer. The cholecyst is intact, stretching, but it cannot compensate to the obstructive icterus. In the other diseases the cholecyst does not expand, because it is inflamed and ill, or there is no distal choledochus obstruction.
It is characteristic for the SPINK1 gene:
A) It is located on chromosome 8.
B) It encodes a protein called pancreatic secretory trypsin inhibitor.
C) The production of the protein that it encodes is essential for the activation of trypsin.
D) Its mutation leads in all ceases to pancreatits.
E) It often occur in pancreatitis with hereditary or familial accumulation.
B) It encodes a protein called pancreatic secretory trypsin inhibitor.
EXPLANATION
The human SPINK1 gene is located on chromosome 5, it is 7.1 kilobases long, it contains 4 exons and it encodes a protein of 6.3 kilodaltons, a physiological inhibitor of trypsin named pancreatic secretory trypsin inhibitor. This genetic alteration is present in 16% of the idiopathic patients, but it rarely occurre in cases with hereditary or family accumulation. Unlike PRSS1 gene mutations, that can not be found in healthy people.
The most sensitive and specific imaging method is for the diagnosis of chronic pancreatitis: A) transabdominal ultrasound B) abdominal CT C) endoscopic ultrasound D) ERCP E) native abdominal X-ray F) irrigoscopy
D) ERCP
EXPLANATION
Endoscopic retrograd cholangiopancreatography is still the most sensitive and most specific of the listed imaging techniques in chronic pancreatitis, but it can be soon replaced by dynamic MRCP in this diagnostic function.
In the case of chronic pseudocysts, primarily selectable procedures are, excluded:
A) percutaneous drainage
B) endoscopic cystogastrostomy or cystoduodenostomy
C) transpapillar drainage of the pseudocyst
D) surgical cystogastrostomy posterior or cystoduodenostomy
E) surgical cystowirsungogastrostomy or cystowirsungo-jejunostomy
A) percutaneous drainage
EXPLANATION
Percutaneous drainage should not be selected for chronic pseudocysts, because the cyst comes back, since the cavity is usually connected with the pancreatic duct.
Mutations in the CFTR molecule in the pancreas can cause the following diseases or increase their risks, except: A) cystic fibrosis B) chronic pancreatitis C) acute pancreatitis D) pancreatic carcinoma E) pancreatic division
E) pancreatic division
EXPLANATION
Mutations in the CFTR molecule can cause or increase the risk of pancreatitis or cystic fibrosis. The pancreatic division is an anatomical disorder, that is not related to the mutation of the CFTR gene.
It is characteristic of pancreatic tumors:
1) the five-year survival rate is below 5%
2) it usually begins with jaundice and severe spastic abdominal pain
3) it mainly origins from acinic cells
4) it never causes pancreatitis
5) it responds well to cytostatics
A) the 1., 2. and 3. answers are correct
B) the 1., 2. and 4. answers are correct
C) the 1., 2. and 5. answers are correct
D) only the 1. answer is correct
E) the 3. and 4. answers are correct
D) only the 1. answer is correct
EXPLANATION
Pancreatic tumors mainly origin from the ductal cells, their prognosis is not good at all. The five-year survival rate is below 5%. They usually develop silently and asymptomatic. The first symptom is often the jaundice of the patient. Cytostatic therapy can lengthen the survival time only minimal. In case of severe stricture of the pancreatic duct pancreatitis may be induced.
Tactile, dilated, tight, painless gall bladder (Courvoisier-symptom) and icterus are characteristic of pancreatic tail tumors, because the tumors near the ducus choledochus are able to slowly compress the duct, blocking hereby the flow of the bile.
A) both are correct, there is a causal relationship between them
B) both are correct, but there is no causal relationship between them
C) the first is correct in itself, but the second is wrong
D) the first is wrong, the second is correct in itself
E) both are wrong
D) the first is wrong, the second is correct in itself
EXPLANATIONThe bile flow is blocked by the choledochus obstructed and compressed by a pancreas head cancer. The cholecyst is intact, stretching, but it cannot compensate to the obstructive icterus. Cholecyst does not expand in case of pancreatic tail tumors, and there is no distal choledochus obstruction.
In case of chronic pancreatitis with pain, a pancreatic preparation with high lipase activity should be given, to put pancreas rest through the pancreatoduodenal feedback system, and to reduce secretion pressure.
A) both are correct, there is a causal relationship between them
B) both are correct, but there is no causal relationship between them
C) the first is correct in itself, but the second is wrong
D) the first is wrong, the second is correct in itself
E) both are wrong
D) the first is wrong, the second is correct in itself
EXPLANATION
Pancreatic calmness and reduction of secretion can be achieved with high-protease pancreatin by inhibiting duodenal CCK release. The lipase has no effect on feedback, and on pancreatogenic pain.
Which laboratory tests will provide a valuable help in evaluation of the prognosis of this case at the 48. hour of the observation?
A 35-year-old man complains of increased epigastric pain radiating under the left rib and to the back from early morning hours, after abundant food and alcohol consumption last night. He feels nausea, had vomited several times, but there is no relief. Blood pressure is 105/70 Hgmm, pulse is 120/min and easy to suppress. The abdomen of the patient is meteoristic, difficult to touch, but there is no pronounced defense, and in the epigastrium, undetermined resistance can be detected.
1) white blood cell count
2) hematocrit
3) LDH
4) urea nitrogen
5) blood sugar
6) calcium
7) SGOT
8) arterial pO2
9) bicarbonate
10) albumin
11) C-reactive protein
12) serum amylase,-lipase
A) 2., 4., 6., 8. and 9. answers are correct
B) 1., 3., 5. and 7. answers are correct
C) 2., 4., 6., 8., 9., 10. and 11. answers are correct
D) 1., 3., 5., 7. and 12. answers are correct
C) 2., 4., 6., 8., 9., 10. and 11. answers are correct
EXPLANATION
It does not means a good prognosis at the 48. hour of the observation, if hematocrit, urea nitrogen, calcium, arterial pO2, bicarbonate, albumin and C-reactive protein are significantly impaired.
The prevalence of diabetic nephropathy in Type 1 diabetes mellitus: A) below 5% B) 20–30% C) 80–90% D) it develops in all patients
B) 20–30%
EXPLANATIONBased on data in the literature, 20-30% of patients with Type 1 diabetes, and 40% of patients with Type 2 diabetes are found to develop diabetic nephropathy.
Prevalence of DM1 in gen pop: 0.2%
