Midterm 1 Çıkmışları

Question 1

Which statement is not correct for toddler diarrhea?

A) Fat intake of less than 3 g/kg/d may contribute to toddler’s diarrhea

B) Patients with toddler’s diarrhea often have loose stools with undigested food particles

C) Toddler diarrhea is a well-known cause of failure to thrive

D) Excessive free fluid and carbohydrate intake can cause toddler’s diarrhea

Answer 1

c is incorrect.

Question 2

Which of the following drugs would be appropriate to eliminate toxic enteric products in a 50 y.o. cirrhotic man who was recently diagnosed of portal-systemic encephalopathy?

He was admitted to the hospital because of drowsiness and disorientation in time and place.

Sucralfate

Lactulose

Omeprazole

Aprepitant

Ranitidine

Loperamide

Answer 2

Lactulose

Info: Eliminating toxic enteric products (mainly fecal ammonia) is a therapeutic goal in portal-systemic encephalopathy. Patients with severe liver disease have an impaired capacity to detoxify ammonia coming from the colon, where it is produced by bacterial metabolism of fecal urea. Ammonia is an important cause of brain toxicity. Lactulose, also known as 1,4 beta galactoside-fructose, is a non-absorbable synthetic disaccharide made up of galactose and fructose, in high doses, can lower colonic pH, which results in “trapping” of the ammonia by its conversion to polar ammonium ion, which is poorly absorbed.

Question 3

What is the life-threatening complication of upper gastrointestinal tract endoscopy?

Itching

Aspiration pneumonia

Pain

Insomnia

Bleeding

Answer 3

Aspiration pneumonia

Question 4

Which of the following is not among the characteristics of visceral pain?

A- It can be replicated by physical examination

B- It is often poorly localized

C- It is carried by unmyelinated C fibers

D- It is often felt on the midline

Answer 4

A- It can be replicated by physical examination

Info: Unlike parietal pain which is usually caused by direct irritation, visceral pain is mainly caused by distention of the viscerum. Lack of direct irritation makes it hard, if not impossible to replicate by physical examination.

Question 5

Which of the following is the best liver function test?

Alkaline phosphatase

AST/ALT

Bilirubin

Insulin

INR (International Normalized Ratio)

Answer 5

INR (International Normalized Ratio)

Info: Of the above, only the INR is a true liver function test as it examines the capacity of the liver to synthesize clotting factors. AST and ALT are enzymes that are elevated in hepatocellular injury. Alkaline phosphatase is an enzyme that is elevated in cholestatic injury. Bilirubin is a pigment secreted by the liver that is elevated with liver dysfunction but can also be elevated with bile obstruction (even though liver function is normal).

Question 6

A partial gastrectomy has been performed for a patient with an antral tumor, who is known to be a carrier of H.pylori and a history of adenomatous polyp. The histopathologic examination result of the specimen is compatible with early gastric adenocarcinoma.
Which of the following histopathologic results can be defined as “early gastric cancer” for this patient? (Choose as many as required)

1) Mucosa is involved by the tumor, there is no lymph node metastasis

2) Mucosa is involved by the tumor, there are multiple lymph node metastasis

3) Muscularis propria is involved by tumor and, there are multiple lymph node metastasis

4) Muscularis propria is involved by tumor and, there is no lymph node metastases

5) Mucosa and submucosa is involved by the tumor, there are multiple lymph node metastasis

6) Mucosa and submucosa is involved by the tumor, there is only one lymph node metastasis

7) Muscularis propria is involved by tumor and, there is only one lymph node metastasis

8) Mucosa is involved by the tumor, there is only one lymph node metastasis

Answer 6

1, 2, 5, 6, 8 are correct. Others are incorrect. These are written below:

Correct
Mucosa is involved by the tumor, there is no lymph node metastasis

Correct
Mucosa is involved by the tumor, there are multiple lymph node metastasis

X
Muscularis propria is involved by tumor and, there are multiple lymph node metastasis

X
Muscularis propria is involved by tumor and, there is no lymph node metastases

Correct
Mucosa and submucosa is involved by the tumor, there are multiple lymph node metastasis

Correct
Mucosa and submucosa is involved by the tumor, there is only one lymph node metastasis

X
Muscularis propria is involved by tumor and, there is only one lymph node metastasis

Correct
Mucosa is involved by the tumor, there is only one lymph node metastasis

The definitions of early gastric cancer are:

1. The carcinoma that is limited to mucosa and/or submucosa (lymph nodes may or may not be involved)
2. Invasive gastric cancer that invades no more deeply than the submucosa, irrespective of lymph node metastasis

If the tumor invades beyond submucosa it cannot be defined as early gastric carcinoma anymore.

Question 7

Which statement is not correct about magnetic resonance cholangiopancreatography (MRCP)?

Clearly shows, gall bladder, intra and extrahepatic bile ducts and biliary duct stones on the same slice

Images may be acquired in multiple planes (axial, sagittal, coronal or oblique)

Ability to image without the use of ionizing x-rays

Requires contrast media

Can detect intra and extraductal pathologies

Answer 7

‘Requires contrast media’ statement is incorrect.

Info: MRCP does not require any contrast medium, because slow-flowing in the bile duct acts like a contrast medium.

Question 8

Which of the colorectal cancer screening methods is the most appropriate for a 45 years old average risk person?

gFOBT (guaiac based Fecal Occult Blood Test)

FIT (Fecal Immunochemical Test)

Colonoscopy

Sigmoidoscopy

Answer 8

FIT (Fecal Immunochemical Test)

Info: Considering an average risk person at 45 non-invasive tests should first be considered. Among the given non invasive tests, FIT has the highest sensitivity.

Question 9

Which of the following is the International Hepatitis B vaccination Schedule for adults?

At 0, 1, 2 and 12 months

At 0, 1, 2 and 6 months

At 0, 3 and 6 months

At 0, 3 and 12 months

At 0, 1 and 6 months

Answer 9

At 0, 1 and 6 months

Question 10

Which of the following features is correct for Irritabl bowel syndrome?

Always resolves with a gluten free diet

May be associated with constipation

Is primarily a psychological problem

Is a contra-indication to colonoscopy

Answer 10

May be associated with constipation

Symptoms of Irritable bowel syndrome includes diarrhea, constipation or both

Question 11

Which of the following sentences about vomiting center is not correct?

he vomiting center is connected to the respiratory and salivation centers

The vomiting center is located in the dorsal part of the medulla oblongata

Mechanical stimulation of the vomiting center causes vomiting

Electrical stimulation of the vomiting center causes vomiting

The vomiting center is located in the corpus pallidum and is closely related to the chemoreceptor trigger zone (CTZ)

Answer 11

‘The vomiting center is located in the corpus pallidum and is closely related to the chemoreceptor trigger zone (CTZ)’ statement is incorrect.

Info: The vomiting center is not located in the corpus pallidum and is not closely related to the CTZ. The vomiting center is located in the lateral reticular formation of the medulla oblongata.

Question 12

Which of the following is the cause of prehepatic jaundice?

Common bile duct stones

Autoimmune hepatitis

Non-alcoholic fatty liver disease

Pancreatic head cancer

Hemolysis

Answer 12

Hemolysis

Only hemolysis causes prehepatic jaundice

Question 13

Motility pattern of esophagus showing reduced amplitude of contractions in lower esophagus, simultaneous in onset with hypertensive lower esophageal sphincter nonrelaxing on swallowing is suggestive of which of the following disorder?

Achalasia

Gastroesophageal reflux

Scleroderma

Diffuse esophageal spasm

Answer 13

Achalasia

Info: Achalasia is characterized by impaired esophageal peristalsis and lack of lower esophageal sphincter relaxation during swallowing.

Question 14

Which of the following characteristics is not among the properties of parietal pain?

It is well localized

It can cause autonomic responses

It is carried by myelinated c fibers

It is usually induced by direct irritation

Answer 14

‘It can cause autonomic responses’ is not a correct statement

Info: Unlike visceral pain which is carried by central nervous system, parietal pain is carried by peripheral nervous system and does not cause accompanying autonomic responses.

Question 15

Which of the anatomical landmark delineate the presence of nociceptors?

Dentate line

Houston valves

Hilton line

Morgagni crypts

Answer 15

Dentate line

Info: The anal canal and distal rectum converges at the dentate line above which there are no nociceptors.

Question 16

Which of the following features regarding fundic gland polyps of stomach are correct? (Choose as many as required)

1) They are mostly asymptomatic rather than symptomatic

2) Familial fundic gland polyps have no risk of malignancy

3) They can be single or multiple

4) They have an association with a long-term use of proton pump inhibitors

5) Histopathological examination reveals hyperplastic foveolar epithelium, thick walled blood vessels and lamina propria with mixed inflammatory infiltrate

Answer 16

1, 3, 4 are correct.

Info: They are mostly asymptomatic. (like all gastric polyps)

They have an association with a long-term use of proton pump inhibitors.

Familial fundic gland polyps have risk of malignancy.

They can be single or multiple.

The histopathological examination given is related to hyperplastic polyp of stomach

Question 17

A 32-year-old woman presents to the gastroenterology clinic with a history of recurrent episodes of bloody diarrhea and abdominal pain for the past 6 months. She reports having urgency and tenesmus. She also describes crampy abdominal pain, particularly during bowel movements. On physical examination, she appears pale and fatigued. Vital signs are within normal limits. Abdominal examination reveals diffuse tenderness on deep palpation, predominantly in the left lower quadrant. Colonoscopic biopsy reveals diffuse mucosal and submucosal inflammation with loss of vascular pattern, predominantly involving the rectosigmoid colon. Biopsies show crypt distortion, crypt abscesses, and infiltration by inflammatory cells.

According to the given information above, which of the following is the most likely diagnosis of this patient?

Ischemic colitis

Ulcerative colitis

Crohn’s disease

Infectious colitis

Diverticulitis

Answer 17

Ulcerative colitis

Info: The clinical manifestations, endoscopic biopsy results and histopathological features (especially the mucosal and submucosal inflammation) are related to ulcerative colitis.

Question 18

A 50-year-old male presents to the emergency department with severe abdominal pain radiating to his back, nausea, and vomiting. He admits to a history of heavy alcohol consumption. On examination, he appears acutely unwell and is tender to palpation in the epigastric region. Laboratory tests reveal elevated serum amylase and lipase levels. An abdominal CT scan demonstrates inflammation and edema of the pancreas. Which of the following pathophysiological mechanisms is most likely contributing to the development of pancreatitis in this patient?

Excessive alcohol consumption leading to pancreatic fibrosis

Ischemic injury to the pancreas due to hypoperfusion

Autoimmune destruction of pancreatic tissue

Obstruction of the pancreatic duct by gallstones

Activation of pancreatic enzymes within the pancreas

Answer 18

Activation of pancreatic enzymes within the pancreas

Info: Activation of pancreatic enzymes within the pancreas: Pancreatitis often involves the inappropriate activation of pancreatic enzymes within the pancreas, leading to autodigestion of pancreatic tissue. Normally, pancreatic enzymes are synthesized and stored in an inactive form (zymogens) within pancreatic acinar cells. When pancreatitis occurs, these enzymes can become activated prematurely, leading to inflammation and tissue damage. Alcohol consumption is one of the common causes of pancreatitis, as it can lead to ductal hypertension and premature activation of pancreatic enzymes.
Obstruction of the pancreatic duct by gallstones: While gallstone pancreatitis is a common cause of acute pancreatitis, particularly in patients with a history of heavy alcohol consumption, this choice does not directly explain the pathophysiological mechanism underlying pancreatitis. Gallstones can obstruct the pancreatic duct, leading to reflux of bile and activation of pancreatic enzymes, which contributes to pancreatitis. However, the primary mechanism in gallstone pancreatitis is not the obstruction itself but rather the subsequent activation of pancreatic enzymes and inflammation.
Autoimmune destruction of pancreatic tissue: Autoimmune pancreatitis is a rare form of chronic pancreatitis characterized by autoimmune-mediated inflammation and fibrosis of the pancreas. However, in this case, the patient’s history of heavy alcohol consumption suggests that alcoholic pancreatitis is the more likely cause, rather than autoimmune destruction of pancreatic tissue.
Ischemic injury to the pancreas due to hypoperfusion: Ischemic pancreatitis can occur in the setting of severe hypoperfusion or shock, leading to inadequate blood flow to the pancreas and subsequent tissue necrosis. However, this mechanism is less common than other causes of pancreatitis, such as alcohol consumption or gallstone obstruction. In this case, the patient’s history of heavy alcohol consumption suggests that alcoholic pancreatitis is the more likely cause of pancreatitis rather than ischemic injury.
Excessive alcohol consumption leading to pancreatic fibrosis: Chronic alcohol consumption is a well-established risk factor for the development of chronic pancreatitis, which can eventually lead to pancreatic fibrosis. However, in this case, the patient’s presentation is more consistent with acute pancreatitis, which is typically triggered by acute inflammation and autodigestion of pancreatic tissue rather than chronic fibrosis.

Question 19

Which of the following histopathologic findings are characteristic of Celiac disease? (Choose as many as required)

Intestinal metaplasia

Villous atrophy

Transmural inflammation

Increased goblet cell density

Crypt hyperplasia

Villous hyperplasia

Intraepithelial lymphocytosis

Answer 19

Intestinal metaplasia

Correct
Villous atrophy

Transmural inflammation

Increased goblet cell density

Correct
Crypt hyperplasia

Villous hyperplasia

Correct
Intraepithelial lymphocytosis

Info: Key features of Celiac disease are villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis.

According to these histopathological findings the disease will be classified with Marsh classification

Question 20

53 year-old man has weight loss, chronic diarrhea, and steatorrhea. He undergoes diagnostic investigations including small bowel biopsises. The biopsy report reveals normal small bowel mucosa.

Which of the following is the most likely diagnosis?

Post gastrectomy steatorrhea

Nontropical sprue

Whipple’s disease

Tropical sprue

Abetalipoproteinemia

Answer 20

Post gastrectomy steatorrhea

Info: In postgastrectomy steatorrhea, the small intestine mucosa is normal, The others have impaired mucosal absorption, small bowell mucosa is not normal.

Question 21

Which of the following features regarding colon adenocarcinomas are correct when divided as right-sided or left-sided colon carcinomas? (Choose as many as required)

1) Right sided colon carcinomas have tendency to cause melena, when compared to left sided ones.

2) Right sided colon carcinomas have tendency of being constrictive when compared to left sided ones.

3) Right sided colon carcinomas have tendency to cause fatigue and weakness due to iron deficiency anemia when compared to left sided ones.

4) Right sided colon carcinomas have tendency to cause gross bleeding when compared to left sided ones.

5) Right sided colon carcinomas have tendency to cause tenesmus when compared to left sided ones.

6) Right sided colon carcinomas have tendency to cause obstruction when compared to left sided ones.

Answer 21

1,3 is correct

Info: Right-Sided Colon Carcinoma:

*Polypoid, exophytic masses
*Fatigue and weakness due to iron deficiency anemia
*Melena /guaiac positive stool (FOBT)
*Rarely cause obstruction
Left-Sided Colon Carcinoma:

*Annular (circular) lesions /constricting lesions
*Napkin-ring (Apple-core) appearance
Luminal narrowing (obstruction)
Changes in bowel habit
Cramping and left lower quadrant discomfort
*Gross bleeding

Question 22

Which of the following brain regions represent a site of the antiemetic action of ondansetron administered for prophylaxis to a 60 y.o.-man during his cancer chemotherapy protocol?

Nucleus accumbens

Putamen

Locus ceruleus

Medial forebrain bundle

Nucleus tractus solitarius

Answer 22

Nucleus tractus solitarius

Info: Serotonergic receptor antagonists (setrones) are currently considered as first-line agents for prevention of chemotherapy-induced nausea and vomiting (CINV). Ondansetron and congeners block 5-HT3 serotonin receptors located in the nucleus tractus solitarius (NTS), chemoreceptor trigger zone (CTZ), and visceral afferent nerves. In this way, it is thought that they can prevent both peripheral and central stimulation of the vomiting center.

Question 23

Which of the following is not correct regarding the gallstone disease?

Most frequent type of stones are cholesterol stones

Surgery is often unnecessary in asypmtomatic individuals

Gallbladder polyps always precedes the formation of gallstones

Main diagnostic tool is ultrasound imaging

Answer 23

Gallbladder polyps always precedes the formation of gallstones

Question 24

Which of the following is not a sign of liver cirrhosis?

Palmar erythema

Spider angioma

Left supraclavicular lymphadenopathy

Ascites

Lack of body hair

Answer 24

Left supraclavicular lymphadenopathy
IS NOT a sign of liver cirrhosis

Question 25

Which of the following enzymes is thought to start the enzymatic chain reaction in acute pancreatitis?

Amylase

Trypsinogen

Lipase

Elastase

Answer 25

Trypsinogen

Info: A small amount of trypsinogen is spontaneously activated in the pancreas at any given time which is counter balanced with certain mechanisms. Tripsin being a celaving enzyme for proenzymes, is thought to be the starting enzyme in acute pancreatitis.

Question 26

Which of the microorganism below causes an inflammatory diarrhea with a very low infectious dose (like 100-200 bacteria) characterized with ulcerations in the colon and in which the transmission route is described as 4F (fly, finger, food, feces)?

Enteroinvasive Escherichia coli

Salmonella enteritidis

Campylobacter jejuni

Vibrio cholerae

Shigella flexneri

Answer 26

Shigella flexneri

Info:

Shigella flexneri: Transmission is described as 4F- fly, finger, food, feces Shigella has a low ID , as 100- 200 bacteria. It multiplies in the small intestine and passes to the colon where the bacteria adheres to epithelium, causes penetration, invasion, proliferation, inflammation, epithelial cell death, ulceration and also causes disorder in fluid absorption in the colon with its shiga toxin. Stoll will consist blood, mucus and pus.

Campylobacter jejuni, Salmonella enteritidis, enteroinvasive Escherichia coli and Vibrio cholerae are other agents causing gastroenteritis and enerocolitis whic do not have all the characteristics of the microorganism described above.

Question 27

Which of the following conditions doesn’t require further investigation in a term newborn?

Jaundice that peaks (12 mg/dl) and resolves within the first week of life

Direct hyperbilirubinemia

Bilirubin level rises >5 mg/dl/day

Jaundice persisting beyond 2 weeks of life

Presence of jaundice within the first 24 hours of life

Answer 27

Jaundice that peaks (12 mg/dl) and resolves within the first week of life

Info: Pathological jaundice is characterized by the presence of jaundice within the first 24 hours of life, a bilirubin level that rises by >5 mg/dL per day or >0.2 mg/dL per hour, jaundice persisting beyond 2 weeks of life, and direct hyperbilirubinemia. These conditions necessitate further assessment. Jaundice that peaks and resolves within the first week of life is typical for physiologic jaundice.

Question 28

Which procedure is appropriate for a patient who has a positive fecal occult blood test and does not have anemia?

Colonoscopy

Rectal smear

Ultrasonography

Abdominal computed tomography

Rectoscopy

Answer 28

Colonoscopy

Question 29

Inflammatory bowel disease includes both Crohn’s disease and ulcerative colitis. Inflamatuary bowel disease is a relapsing and remitting condition characterized by chronic inflammation at various sites in the gastrointestinal tract resulting in diarrhea and abdominal pain.

Which of the following is indicative of Crohn’s disease but not Ulcerative colitis?

Rectum is often spared

Inflammation is uniform and diffuse

Gross rectal bleeding is always present

Inflammation is confined to mucosa except in severe cases

Answer 29

Rectum is often spared

In Crohn’s disease, the rectum is often spared, while in ulcerative colitis the rectum is involved

Question 30

In Crohn’s disease, the rectum is often spared, while in ulcerative colitis the rectum is involved

It keeps stomach contents from traveling back into the esophagus

It produces a protective coating against stomach acid

It is located at the bottom of the esophagus

It opens to allow food the pass from the esophagus to the stomach

Answer 30

It produces a protective coating against stomach acid

Info: Lower esophageal sphincter does not produce secretion

Question 31

A 45-year-old man presents to his primary care physician with complaints of frequent heartburn and regurgitation of sour-tasting fluid, especially after large meals or when lying down at night. He reports experiencing these symptoms for the past several months, which have significantly impacted his quality of life. He is overweight, has a history of smoking, and consumes alcohol regularly. Upon further questioning, he also mentions occasional difficulty swallowing solid foods.

When you think about the most probable diagnosis of this patient, which of the following findings would be consistent with the diagnosis?

Histopathological examination showing squamous cell carcinoma of the esophagus

Radiographic evidence of a sliding hiatal hernia

Presence of hyperplastic polyp on endoscopic biopsy

Elevated levels of serum gastrin

Family history of esophageal cancer

Answer 31

Radiographic evidence of a sliding hiatal hernia

Info: Gastroesophageal reflux disease (GERD) is characterized by the retrograde flow of gastric contents into the esophagus due to a weakened lower esophageal sphincter (LES) or increased intra-abdominal pressure. Clinical manifestations often include heartburn, regurgitation, and difficulty swallowing (dysphagia). Risk factors for GERD include obesity, smoking, alcohol consumption, and hiatal hernia. A sliding hiatal hernia is a common anatomical abnormality associated with GERD, where a portion of the stomach protrudes through the esophageal hiatus of the diaphragm into the thoracic cavity. Radiographic studies, such as barium swallow or upper gastrointestinal series, may reveal the presence of a sliding hiatal hernia, supporting the diagnosis of GERD. Other diagnostic modalities for GERD include endoscopy with biopsy to evaluate for complications such as Barrett’s esophagus or esophageal adenocarcinoma, but these findings are not specific for GERD itself.

Question 32

A 5-year-old previously healthy boy is rushed to the emergency room for sudden-onset vomiting and lethargy. He was born at full-term without complications and had been meeting all milestones. Two weeks ago, he had headaches, myalgias, and fevers and tested positive for influenza A virus. At that time, his parents tried multiple anti-pyretic medications, including ibuprofen, acetaminophen, and aspirin. On physical exam, he is dehydrated and has hepatomegaly. Labs show increased liver enzymes and ammonia. A head computed tomography (CT) shows diffuse cerebral edema. He is admitted to the intensive care unit (ICU) and started on steroids.

According to this medical history which of the following histopathological change is expected to be seen if a liver biopsy was taken?

Microvesicular fatty change

Bridging necrosis

Portal-central fibrosis

Granulomas surrounding bile ducts

Interphase hepatitis

Answer 32

Microvesicular fatty change

INFO: The patients has Reye’s Syndrome triggered with aspirin. The disease is rare but potentially fatal. In pathogenesis mitochondrial dysfunction of liver causes microvesicular fatty change. Granulomas surrounding bile ducts can be seen in primary biliary cirrhosis, interphase hepatitis, bridging necrosis and portal-central fibrosis are among the features of HBV related hepatitis.

Question 33

Colorectal cancer is among the best understood solid tumor in terms of genetics. Several tumor suppressor genes and oncogenes play a significant role in its development. Which of the following is not a tumor suppressor gene that is affected in the pathogenesis of colorectal cancer?

DCC

APC

RAS

TP53

Answer 33

RAS

Info: RAS is an oncogene that plays role in multiple types of cancer. KRAS variant is the most frequently mutated in human colorectal cancers. Moreover; RAS mutations are found in up to 50% of sporadic colorectal cancers and 50% of colonic adenomas larger than 1 cm.

Question 34

Which prototype enterotoxin below has a protein composed of a monomer A that has the enzymatic activity and pentomer B that binds the holotoxin to the enterocyte surface receptor causing diarrhea?

Bacillus cereus toxin

Vibrio cholerae toxin

Shiga toxin

Enterotoxigenic E. coli toxin

Clostridium difficile toxin

Answer 34

Vibrio cholerae toxin

Info: Vibrio cholerae toxin: is a prototype enterotoxin -cholera toxinthat has a heterodimeric protein composed of 1 A and 5 B (pentamer) subunits A : enzymatic activity of the toxin B : binds holotoxin to the enterocyte surface receptor, the ganglioside GM1 A - catalyzes the adenosine diphosphate (ADP) ribosylation of a guanosine triphosphate–binding protein and causes persistent activation of adenylate cyclase that results with an increase of cyclic AMP in the intestinal cell

Shiga toxin,Clostridium difficile toxin, Bacillus cereus toxin and Enterotoxigenic E. coli toxin have all different type of structures then the structure described in the question

Question 35

A 60-year-old man presents to the gastroenterology clinic with a chief complaint of progressive dysphagia and unintended weight loss over the past six months. He reports experiencing dysphagia of solid foods, especially for bread, which often feel stuck in his chest. He also complains of frequent heartburn and occasional episodes of regurgitation. He has history of tobacco smoking for over 40 years and moderate alcohol consumption. There are no significant findings on physical examination other than paleness. Esophagogastroduodenoscopy reveals an ulcerated mass lesion with irregular borders in the mid-esophagus. Microscopic examination of the biopsies taken from that ulcerated area reveal nests and sheets of atypical squamous cells infiltrating the submucosa.
Based on the clinical presentation, radiological findings, and histopathological results, what is the most likely diagnosis for this patient?

Adenocarcinoma of the esophagus

Squamous cell carcinoma of the esophagus

Gastroesophageal reflux disease

Barrett’s esophagus

Achalasia

Answer 35

Squamous cell carcinoma of the esophagus

Info: Summary of the clues for the diagnosis of esophageal squamous cell carcinoma based on the question:

Clinical Manifestations:

Progressive dysphagia (difficulty swallowing) with solid foods.
Unintended weight loss.
History of tobacco smoking and moderate alcohol consumption.

Endoscopic Biopsy Results:

Esophagogastroduodenoscopy (EGD) reveals an ulcerated, friable mass lesion with irregular borders in the mid-esophagus. Histopathological examination of biopsy specimens shows nests and sheets of atypical squamous cells infiltrating the submucosa, with cellular pleomorphism, increased mitotic activity, and keratin pearl formation, consistent with squamous cell carcinoma.

Question 36

Which one is the most common type of rejection which occurs most often within the first 3-6 months following the transplantation, mainly driven by T cells and responds well to increased level of immunosuppression?

Hyperacute rejection

Acute rejection

All of them

Chronic rejection

Answer 36

Acute rejection

Info: Acute rejection, the most common type of rejection, usually occurs within a few days or weeks posttransplant, mainly driven by T cells and responds well to increased levels of immunosuppression

Question 37

A 32 years old male has HBeAg-positive, very high HBV DNA (usually >7 log11 IU/mL) and HBsAg levels (>3 log11 IU/mL), and persistently normal ALT. What phase of chronic HBV infection is the patient in?

Resolved phase

Immune active phase

Inactive carrier phase

Immune tolerant phase

HBeAg negative immune active phase

Answer 37

Immune tolerant phase

Question 38

According to Türkiye’s national colorectal cancer screening program, at what age does cancer screening begin?

30

40

50

60

70

Answer 38

50

Question 39

Which of the following is not a complication of peptic ulcer disease?

Obstruction

Perforation

Bleeding

Penetration

Diverticulitis

Answer 39

Diverticulitis

Question 40

Which of the following statements regarding Barrett’s esophagus are correct? (Choose as many as required)

It is characterized by squamous metaplasia with goblet cells

It is an irreversible process

For the diagnosis of Barrett esophagus, it is enough to see the “salmon colored mucosa” via endoscopic examination

It increases the risk of adenocarcinoma of the esophagus

Acid suppression over a long-term period is recommended

Answer 40

Only the last 2 options are correct.

Info: Barrett esophagus is a complication of chronic GERD that is characterized by intestinal metaplasia with goblet cells. Barrett esophagus is a precursor lesion to cancer and increases the risk of esoph­ageal adenocarcinoma. Barrett’s esophagus can only be identified through endoscopic biopsy. Endoscopic examination is not enough. Acid suppression over a long-term period is recommended. It can be a reversible process because we know that reversibility is one of the common features of adaptation types and also metaplasia is a type of adaptation

Question 41

Which of the following clinical features are correct for abdominal pain in children and adolescents? (Choose as many as required)

Irritable Bowel Syndrome is a subset of functional abdominal pain, with stool pattern fluctuating between diarrhea and constipation. Symptoms are linked to gut motility and there is relief of pain with defecation

In functional abdominal pain syndrome, pain is often associated with a tendency toward anxiety and perfectionism. Diagnostic criteria for this syndrome is symptom based, not physical exam or laboratory based

The most common extra-abdominal causes for acute abdominal pain in children and adolescents include pneumonia and pharyngitis

Children and adolescents having inflammatory bowel disease always present with the classic symptoms of weight loss, abdominal pain, and bloody diarrhea

Answer 41

1 2 and 3 are correct.

Response Feedback:
Children and adolescents having inflammatory bowel disease can present with the classic symptoms of weight loss, abdominal pain, and bloody diarrhea, but many present with non-classic symptoms of isolated poor growth, anemia, or other extraintestinal manifestations.

Question 42

An immunocompetent patient presented to the polyclinic with a complaint of a dark coloured urine and light-colored stools. Physical evaluation showed yellow skin and scleras, accompanied with hepatomegaly with tenderness. Aspartate aminotransferase, alanine aminotransferase, direct and indirect bilirubin levels were highly and alkaline phosphatase levels were mildy elevated. Serology results were as following: HAV IgG positive, HAV IgM negative, HBsAg positive, Anti-HBs negative, HBcIgM negative, HBc IgG positive, HBV DNA positive, HCV IgG negative, HCV RNA negative, HDV IgG positive, HEV IgG negative.

What is the etiologic agent for this acute infection?

Hepatitis A B C D E

Answer 42

Hepatitis D virus

Info: Patient has an acute hepatitis. It is not HAV acute infection because HAV IgG is positive but HAV IgM is negative. It is not HBV acute infection because HBsAg is positive , HBc IgG is positive, Anti – HBs is negative, HBV DNA is positive but HBcIgM is negative. It is not an acute HCV hepatitis because HCV IgG and HCV RNA is negative. It is not an acute HEV infection because HEV IgG is negative.

Question 43

Which statement is correct regarding inherited disorders of bilirubin metabolism?

Crigler-Najjar syndrome is caused by a mutation affecting the bilirubin transport protein

Dubin-Johnson syndrome is characterized by a deficiency in the enzyme UDP-glucuronosyltransferase

Dubin-Johnson syndrome is characterized by impaired conjugation of bilirubin

Gilbert syndrome results from a defect in the hepatocyte canalicular membrane

Rotor syndrome is characterized by elevated levels of direct bilirubin in the blood

Answer 43

Rotor syndrome is characterized by elevated levels of direct bilirubin in the blood

Info: Crigler-Najjar and Gilbert syndromes are caused by a deficiency in the enzyme UDP-glucuronosyl transferase. Dubin Johnson ve Rotor syndromes are carecterized by impaired extrusion of bilirubin and direct hyperbilirubinemia.

Question 44

An interesting case of 25 year old woman who had inflamatory diarrhea after her cat had a diarrhea in the house whom she had a close contact was evaluated for the etiologic agent. The bacterial culture of the stool was only possible under microaerophilic conditions, at 42°C with a pH of 5.3. Colonies revealed spiral shaped Gram negative bacteria.

What is the most probable agent causing gastroenteritis in this young woman?

Shigella flexneri

Vibrio cholerae

Campylobacter jejuni

Enteroinvasive Escherichia coli

Salmonella enteritidis

Answer 44

Campylobacter jejuni

Info: Campylobacter are mainly spiralshaped (“S”-shaped, curved) Gram negative and microaerophilic ( 3-5% O2 , 5-10% CO2 )bacteria. Their 0ptimum temperature for growth is 32-45°C and the minimum is pH : 5.3. C. jejuni causes enteric infections. C jejuni can cause diarrhea in pets.

Shigella flexneri, Salmonella enteritidis and enteroinvasive Escherichia coli are Gram negative bacilli. Vibrio cholerae does not need the conditions described in the question for bacterial culture.

Question 45

Which of the following statements regarding inflammatory bowel disease are correct? (Choose as many as required)

1 Crohn’s disease has a higher risk of cancer compared with Ulcerative colitis.

2 Skip lesions are the features of Crohn’s disease.

3 Granuloma formation is a common finding that is both seen Crohn’s disease and Ulcerative colitis.

4 Terminal ileum is the mostly affected region in Crohn’s disease.

5 Backwash ileitis is a term used in relation to Crohn’s disease.

Answer 45

2 and 4 are correct.

Terminal ileum is the most affected region in Crohn’s disease.

Crohn’s disease involves more layers (transmural inflammation) of the intestine than ulcerative colitis (mucosa/ mucosa and submucosa) does.

Ulcerative colitis has a higher risk of cancer compared with Crohn’s disease.

Rectal bleeding is more common in Ulcerative colitis compared with Crohn’s disease

Backwash ileitis is a term used in relation to ulcerative colitis

Granuloma formation is a only seen in Crohn’s disease

Skip lesions are the features of Crohn’s disease

Question 46

Which is not one of the changes that occur during reductive adaptation?

Reducing physical activity and growth

Increasing inflammatory and immune responses

Reducing basal metabolism

Mobilizing of fat stores

Answer 46

Increasing inflammatory and immune responses

Question 47

What is the most probable bacterial etiologic agent when a person has nausea, vomiting, diarrhea after two hours having eaten food like ham, poultry, potato/egg salad, mayonnaise, cream pastries or puddings?

Bacillus cereus

Enterotoxigenic Escherichia coli

Campylobacter jejuni

Staphylococcus aureus

Shigella flexneri

Answer 47

S aureus

Info: Bacillus cereus and Staphylococcus aureus causes nausea, vomiting, diarrhea in a short time after food consumption (30 minutes- 8 hours). S.aureus intoxications appear after consumption of food like ham, poultry, potato/egg salad, mayonnaise, cream pastries, puddings etc.

Question 48

A 65-year-old female with a history of chronic hepatitis C presents to the clinic with complaints of increasing abdominal distention and lower extremity edema over the past few weeks. She reports fatigue and difficulty breathing when lying flat. On examination, she has prominent ascites, bilateral lower extremity edema, and spider angiomas on her chest. Laboratory tests reveal hypoalbuminemia, elevated serum bilirubin, and prolonged prothrombin time. An echocardiogram shows normal cardiac function.

Which of the following pathophysiological mechanisms is most likely contributing to the development of complications in this patient?

Portal hypertension leading to ascites and peripheral edema

Hyperdynamic circulation leading to hepatic encephalopathy

Hepatorenal syndrome due to renal vasoconstriction

Reduced synthesis of clotting factors resulting in coagulopathy

Impaired bilirubin metabolism causing jaundice and pruritus

Answer 48

Portal hypertension leading to ascites and peripheral edema

Portal hypertension leading to ascites and peripheral edema: Portal hypertension, a common complication of hepatic failure, results from increased resistance to blood flow within the liver. This leads to the development of collateral vessels and increased hydrostatic pressure in the portal venous system. Ascites and peripheral edema occur as a result of fluid leakage into the peritoneal cavity and interstitial tissues due to increased portal pressure.
Impaired bilirubin metabolism causing jaundice and pruritus: Impaired bilirubin metabolism is indeed a common manifestation of hepatic failure, leading to jaundice. However, pruritus is more commonly associated with cholestasis, which can occur in hepatic failure but is not directly related to impaired bilirubin metabolism.
Reduced synthesis of clotting factors resulting in coagulopathy: This is a common complication of hepatic failure due to decreased synthesis of clotting factors by the liver. The liver is responsible for synthesizing factors involved in the coagulation cascade, and when its function is impaired, it can lead to coagulopathy, as evidenced by the prolonged prothrombin time in the patient. However, this does not directly explain the development of ascites and peripheral edema.
Hyperdynamic circulation leading to hepatic encephalopathy: Hepatic encephalopathy is indeed a complication of hepatic failure, but it is primarily attributed to the accumulation of neurotoxins such as ammonia in the bloodstream due to impaired liver function. Hyperdynamic circulation, characterized by increased cardiac output and systemic vasodilation, is associated with advanced liver disease but is not the primary cause of hepatic encephalopathy.
Hepatorenal syndrome due to renal vasoconstriction: Hepatorenal syndrome is a severe complication of advanced liver disease characterized by renal vasoconstriction and renal failure. While it can occur in patients with hepatic failure, it typically presents with progressive renal impairment and oliguria rather than ascites and peripheral edema as seen in this patient.

Question 49

Which of the following statements about exocrine pancreatic insufficiency (EPI) is accurate?

Exocrine pancreatitis rarely occurs in patients with acute pancreatitis

Extrapancreatic conditions have not been shown to lead to exocrine pancreatic insufficiency

Exocrine pancreatic insufficiency is a frequent late-stage manifestation of chronic pancreatitis

Fat digestion is not discernibly diminished until lipase output decreases to less than 5% of the normal level

Answer 49

The statement ‘Exocrine pancreatic insufficiency is a frequent late-stage manifestation of chronic pancreatitis’ is accurate.

Exocrine pancreatic insufficiency is a frequent late-stage manifestation of chronic pancreatitis

Additional info: Exocrine pancreatic insufficiency is most commonly associated with diseases of the exocrine pancreas and is a frequent late-stage manifestation of chronic pancreatitis. The exocrine pancreas retains a large reserve capacity for enzyme secretion; as such, fat digestion is not clearly impaired until lipase output decreases to less than 10% of the normal level.

A recent literature review found a high prevalence (62%) of exocrine pancreatic insufficiency among patients during first admission for acute pancreatitis. At follow-up, which was at least 1 month following discharge, the pooled prevalence of exocrine pancreatic insufficiency was 35%. An increased prevalence was also found among patients with severe acute pancreatitis versus those with mild acute pancreatitis.

Certain extra pancreatic conditions may lead to exocrine pancreatic insufficiency. These include celiac disease, Crohn disease, autoimmune pancreatitis, Zollinger-Ellison syndrome, and gastrointestinal and pancreatic surgical procedures.

Question 50

What type of diarrhea occurs in lactose intolerance?

Inflammatory

Motility related diarrhea

Osmotic

Secretory

Answer 50

Osmotic

Question 51

When associated with nausea and vomiting, which of the following raises suspicion of a more serious etiology of chronic constipation?

Change in color of stool

Distended, tympanitic abdomen

Abdominal pain

Occasional bouts of diarrhea

Answer 51

Distended, tympanitic abdomen

Info: Distended, tymapanitic abdomen along with nausea and vomiting, suggest mechanical obstruction. Others may indicate less serious disorders

Question 52

Which of the following agents could be suggested for somebody who is planning to take a trip to a region whose previous visitors have suffered from diarrhea possibly due to contaminated water supply?

Loperamid

Bismuth subsalicylate

Linoclotide

Alosetron

Answer 52

Bismuth subsalicylate

Info: Adsorbents like bismuth subsalicylate are routinely recommended during travel to areas known for their endemic contaminated water sources or inadequate food washing procedures. The adsorbent taken prophylactically (2 tablets four times a day) lines the intestine to impair microbial transmission and may complex with the organisms, facilitating their removal in the feces.

Question 53

How many of the conditions in the list should be considered as alarm symptoms in a patient with dyspepsia?

• New onset at age >55 years
• Unexplained weight loss >10%
• Progressive dysphagia
• Gastrointestinal bleeding
• Iron deficiency anemia

1 2 3 4 or 5?

Answer 53

5

Question 54

Which of the following therapeutic regimens would be appropriate to prevent stress-related mucosal bleeding in 75 y.o. woman who complained of epigastric pain the day after a surgical operation to remove a polyp in her colon?

Note: She was transferred to the intensive care unit because of septic shock.

Misoprostol by nasogastric tube

Metoclopramide by intravenous (IV) infusion

Sucralfate by nasogastric tube

Ondansetron by IV infusion

Bismuth salicylate by nasogastric tube

Famotidine by IV infusion

Answer 54

Famotidine by IV infusion

Info: Acute stress-related mucosal bleeding is a type of erosive gastritis that occurs in critically ill patients with severe psychological stress (surgery, trauma, sepsis, etc.). The patient was in septic shock, and her abdominal pain suggested that stress-related mucosal bleeding was impending. Therefore, she needed aggressive prophylactic treatment. H2 antagonists are the most widely used drugs for prevention of stress ulcer. They must be given intravenously, and infusion is more effective than a single bolus in maintaining the gastric pH above 4. Although proton pump inhibitors (not listed) would appear to be the preferred option because of their greater ability to inhibit gastric acid secretion, there is very little evidence to confirm the clinical superiority to H2 antagonists for stress ulcer prevention.

Metoclopramide and Ondansetron have no antiulcer properties.
Other antiulcer drugs listed are much less effective than H2 antagonists and are not suited for emergency treatment.

Question 55

A 55-year-old female presents to the clinic with complaints of right upper quadrant abdominal pain, nausea, and vomiting for the past two days. She describes the pain as sharp and colicky, radiating to her back. She reports a history of occasional heartburn and fatty food intolerance. On examination, she has tenderness in the right upper quadrant with a positive Murphy’s sign. Laboratory tests show elevated liver enzymes, serum bilirubin, and alkaline phosphatase levels. An ultrasound reveals multiple gallstones in the gallbladder with evidence of mild biliary dilation.

Which of the following pathophysiological mechanisms is most likely contributing to the development of cholestasis in this patient?

Decreased bile secretion by hepatocytes secondary to liver cirrhosis

Impaired bile salt synthesis due to hepatocyte dysfunction

Mechanical obstruction of the common bile duct by gallstones

Autoimmune destruction of bile ducts leading to biliary obstruction

Excessive bile salt reabsorption in the ileum due to ileal disease

Answer 55

Mechanical obstruction of the common bile duct by gallstones

Info: Mechanical obstruction of the common bile duct by gallstones: Cholelithiasis, or the presence of gallstones in the gallbladder or bile ducts, can lead to mechanical obstruction of the common bile duct. When gallstones obstruct the flow of bile, it can result in cholestasis, which is the impairment or cessation of bile flow. This obstruction can lead to elevated levels of liver enzymes, bilirubin, and alkaline phosphatase, as seen in this patient.

Impaired bile salt synthesis due to hepatocyte dysfunction: While hepatocyte dysfunction can lead to various liver disorders, impaired bile salt synthesis is not a typical mechanism of cholestasis related to cholelithiasis. Cholestasis in this context is primarily due to mechanical obstruction by gallstones rather than impaired bile salt synthesis.
Decreased bile secretion by hepatocytes secondary to liver cirrhosis: Liver cirrhosis can lead to impaired bile secretion due to the distortion of liver architecture and hepatocyte dysfunction. However, in this case, the patient’s history and presentation are suggestive of cholestasis related to cholelithiasis rather than liver cirrhosis as the primary cause of bile flow obstruction.
Autoimmune destruction of bile ducts leading to biliary obstruction: Autoimmune destruction of bile ducts can occur in conditions such as primary biliary cholangitis (PBC) or autoimmune cholangitis. However, this is not typically associated with cholelithiasis-related cholestasis, which is primarily due to mechanical obstruction by gallstones rather than autoimmune-mediated bile duct injury.
Excessive bile salt reabsorption in the ileum due to ileal disease: Excessive bile salt reabsorption in the ileum can occur in conditions such as ileal resection or diseases affecting ileal function, leading to bile salt wasting and subsequent cholestasis. However, this mechanism is not directly related to cholelithiasis and is less likely to be the cause of cholestasis in this patient with gallstones obstructing the common bile duct.

Question 56

Canan 27 year-old female admitted gastroenterology outpatient clinic for heartburn, bloating, uncomfortable feeling in her stomach, gastroenterologisit’s evaluation and gastroscopy did not described any problem and referred to psychiatry.

Psychiatric evaluation: She had sleep problems, feeling tired and less interested in her weekend activities, can not concantrate at work, problems with her partner. She thinks these problems are related to her gastrointestinal problems.

Find the best choice for Canan

Psychoeducation for stress related problems

Cognitive Behavioral Therapy planning

Antidepressant prescription

Cooperation with gastroenterologist for planning co-treatment

Answer 56

Cooperation with gastroenterologist for planning co-treatment

Info: Cooperation of 2 disciplines and planning co-treatment will be best, other choice could be all of the above.(true)

GI symptom treatment is also important with psychiatric treatment (saves patient from the feeling of abondonment by GI doc, (true not enough)

Psychoeducation with GI treatment helps the patient for stress related problems (True not enough)

Our patient has depression symptomatology, antidepressant prescription will help (true not enough)

Cognitive Behavioral Therapy could be included in the plan if the patient agrees (true not enough)

Question 56

A 32-year-old woman presents to the clinic with complaints of persistent jaw pain and the recent discovery of multiple masses in her abdomen. She reports experiencing discomfort while chewing and occasional difficulty opening her mouth fully. Additionally, she has noticed several painless, firm masses in her abdomen over the past few months. She denies any recent weight loss, changes in bowel habits, or blood in stools. On physical examination she appears well-nourished and in no acute distress. Examination of the oral cavity reveals multiple osteomas along the mandible, causing asymmetry and restricted jaw movement. Abdominal examination reveals palpable masses in the right lower quadrant. In addition, numerous colonic polyps are noted, particularly in the colon. Biopsy results of colonic polyps reveal numerous adenomatous polyps with varying degrees of dysplasia.

According to your most likely diagnosis, which of the following findings are also expected to be seen?

Pemphigus vulgaris

Dermatitis herpetiformis

Glioblastoma

Medulloblastoma

Epidermal inclusion cyst

Answer 56

Epidermal inclusion cyst

Info: The clinical manifestations, examination results and histopathological results characteristic of Gardner’s syndrome.

Gardner syndrome is a form of polyposis characterized by the presence of multiple polyps in the colon. The polyps are adenomatous type polyps. The extracolonic tumors may include osteomas of the skull like in this case, thyroid cancer and also epidermoid cysts.

Dermatitis herpetiformis is the skin rash that can be seen in Celiac patients.

Question 56

Which statement is incorrect about ultrasonographic examination?

Quick and cheap, portabl

Does not contain radiation

Easiest way to diagnose of hepatobiliary system pathologies

Should be the first diagnostic method in the diagnosis of gall bladder and basic liver pathologies

Requires intravenous contrast media

Answer 56

‘Requires intravenous contrast media’ statement is incorrect

Info: Ultrasound does not require any contrast media or other drugs.

Question 57

Which of the following statements are correct for Rotavirus gastroenteritis? (Choose as many as required)

1 Dehydration is common in younger children and it is a common cause of morbidity and mortality in infants

2 Rotavirus is highly contagious by fecal-oral transmission.

3 The peak incidence, of rotavirus infection is between 12 to 24 months

4 Rotavirus is the most common cause of sporadic, severe, dehydrating diarrhea in young children

5 Primary Rotavirus infection may cause moderate to severe disease in infancy but less severe later in lif

Answer 57

1 2 4 and 5 are correct.

Info: The peak incidence, of rotavirus infection is between 3 to 15 months

Question 58

A 40-year-old male presents to the emergency department with complaints of nausea, vomiting, and right upper quadrant abdominal pain for the past two days. He reports taking over-the-counter pain medications for a recent headache. On examination, he appears jaundiced, and his liver is tender to palpation. Laboratory tests reveal elevated liver enzymes and serum bilirubin levels. He denies a history of alcohol abuse or pre-existing liver disease.

Which of the following pathophysiological mechanisms is most likely contributing to the development of hepatotoxicity in this patient?

Direct hepatocyte damage due to drug metabolism

Impaired bile secretion leading to bile stasis and toxicity

Hepatic artery thrombosis causing ischemic liver injury

Autoimmune destruction of hepatocytes mediated by autoantibodies

Induction of liver fibrosis by toxic metabolites

Answer 58

Direct hepatocyte damage due to drug metabolism

Info: Direct hepatocyte damage due to drug metabolism: Hepatotoxicity refers to liver damage caused by exposure to drugs, chemicals, or toxins. Many medications undergo hepatic metabolism, where they may be converted into reactive metabolites that can directly damage hepatocytes. Acetaminophen (paracetamol) is a well-known example of a drug that can cause hepatotoxicity through the formation of toxic metabolites, particularly when taken in overdose. In this case, the patient’s history of taking over-the-counter pain medications suggests that drug-induced hepatotoxicity is the likely mechanism of liver injury.
Induction of liver fibrosis by toxic metabolites: While some hepatotoxic substances may lead to liver fibrosis over time, this is typically a consequence of chronic liver injury rather than the primary mechanism of hepatotoxicity. The development of liver fibrosis involves complex processes such as inflammation, fibrogenesis, and tissue remodeling, which occur gradually over an extended period rather than acutely as seen in hepatotoxicity.
Impaired bile secretion leading to bile stasis and toxicity: Impaired bile secretion and bile stasis can lead to cholestasis, a condition characterized by the accumulation of bile within the liver. Cholestasis can cause liver injury, but it is not the primary mechanism of hepatotoxicity. In this case, the patient’s presentation is more consistent with direct hepatocyte damage due to drug metabolism rather than cholestatic liver injury.
Autoimmune destruction of hepatocytes mediated by autoantibodies: Autoimmune liver diseases such as autoimmune hepatitis can indeed cause liver damage through the autoimmune destruction of hepatocytes mediated by autoantibodies. However, in this case, there is no indication of pre-existing liver disease or autoimmune etiology. The patient’s presentation is more suggestive of acute liver injury secondary to drug exposure.
Hepatic artery thrombosis causing ischemic liver injury: Hepatic artery thrombosis can lead to ischemic liver injury, but it is not a common cause of hepatotoxicity. Hepatotoxicity typically involves direct damage to hepatocytes rather than ischemic injury due to vascular compromise. In this case, the patient’s history of taking over-the-counter pain medications suggests drug-induced hepatotoxicity as the primary mechanism of liver injury.

Question 59

One of your patients has a history of melena. Which of the following is most likely the cause?

Damage to the colon

A bacterial infection

An ulcer in the stomach causing bleeding

A viral infection

Answer 59

An ulcer in the stomach causing bleeding

Info: Melena is a sign of stomach bleeding

Question 60

Which of the following statements regarding inflammatory bowel disease are
correct? (Choose as many as required)

1 Backwash ileitis is a term used in relation to ulcerative colitis.

2 Crohn’s disease involves more layers of the intestine than ulcerative colitis does.

3 Terminal ileum is the mostly affected region in ulcerative colitis.

4 Rectal bleeding is more common in Crohn’s disease compared with ulcerative colitis.

5 Crohn’s disease has a higher risk of cancer compared with Ulcerative colitis.

Answer 60

1 and 2 are correct. Others are incorrect.

Info: Terminal ileum is the most affected region in Crohn’s disease.
Crohn’s disease involves more layers (transmural inflammation) of
the intestine than ulcerative colitis (mucosa/ mucosa and
submucosa) does.
Ulcerative colitis has a higher risk of cancer compared with
Crohn’s disease.
Rectal bleeding is more common in Ulcerative colitis compared
with Crohn’s disease
Backwash ileitis is a term used in relation to ulcerative colitis

Question 61

Which of the following is not a laboratory test used for the assessment of the
function of “exocrine pancreas”?

Faecal fat
Serum amylase
Serum lipase
Serum insulin
Faecal elastase

Answer 61

Serum insulin