OS 214 Digestive Exam 2 Flashcards
1
Q
Diarrhea 1) The most common intestinal maldigestion syndrome A. Pancreatic lipase deficiency B. Bacterial overgrowth C. Agammaglobulinemia D. Lactase deficiency
A
A
2
Q
2) Which of the following is true?
A. Ulcerative colitis is a mucosal disease that usually involves the rectum and extends to involve all or part of the colon
B. The earliest lesions are aphthoid ulcerations and focal crypt abscesses
C. Presence of non-caseating granuloma
D. Presents as segmental colitis
A
A
3
Q
3) A 20 year old engineering student had 8 episodes of voluminous rice-watery diarrhea for the past 2 hours and with decreasing urine output. Which of the following will be the most important aspect of the management?
A. Tetracycline 500 mg QID for 2 days
B. Loperamide TID to decrease stool output
C. Fluid and electrolyte correction
D. Ask the patient to fast from food and drinks to decrease fluid load to GI tract
A
C
4
Q
4) Which of the following is an appropriate empiric treatment for a previously healthy adult patient with fever and diarrhea that has not resolved in 3 days? A. Fluids B. Macrolide C. Loperamide D. Quinolone
A
Answer: D – empiric treatment for infectious diarrhea which is most commonly caused by gram negative bacteria, especially S. typhi
5
Q
5) 45 year old woman drinks milk twice daily to prevent osteoporosis. She consults you with complaints of crampy abdominal pain and passage of soft stools every time especially after drinking her second glass of milk. She is otherwise asymptomatic and PE is normal. What is the appropriate management for her?
A. Have a stool culture done to rule out bacterial infection
B. Refer patient for colonoscopy to rule out malignancy or inflammatory bowel disease
C. Advise patient to avoid dairy products and eat other calcium-rich foods
D. Treat with quinolone for two weeks and see the response
A
C
6
Q
6) Ingestion of milk gives you abdominal bloating, excessive flatus, and diarrhea. What is the cause of your diarrhea according to predominant pathologic mechanism? A. Inflammatory B. Dysmotility C. Osmotic D. Secretory
A
C
7
Q
7) Shaina is 9 months old and weighs 7 kg. Her mother brought her to you because of diarrhea for 1 week. The mother tells you that Shaina is too tired to drink from a cup. You found her abnormally sleep, has sunken eyes, and skin pinch goes back very slowly. What is the assessment and classification of Shaina’s dehydration? A. Moderate dehydration B. Some dehydration C. Severe dehydration D. Septic shock
A
C
8
Q
8) What is the preferred solution for IV therapy in severe dehydration? A. Ringer’s lactate B. Darrow’s solution C. Half normal saline in 5% dextrose D. Plain dextrose
A
A
9
Q
9) A potent laxative which increases peristalsis but can cause dependence and colonic atony and dilatation when used chronically A. Bisacodyl B. Lactulose C. Magnesium sulfate D. Methylcellulose
A
A
10
Q
10) Presence of WBC and blood in stools are seen in enteric infections with inflammatory response. Which of the following manifests with dysenteric symptoms? A. EPEC B. ETEC C. Rotavirus D. Shigella flexneri
A
D
11
Q
11) Norovirus is the common cause of viral gastroenteritis encountered in adulthood. Which of the following is CORRECT?
A. Lifetime immunity can be achieved with the different genotypes
B. It leads to malabsorption of carbohydrates and fats
C. Oral vaccines, monovalent and pentavalent are available
D. High infectious dose is needed to develop disease
A
B
12
Q
12) Gastrointestinal pathogens causing acute inflammatory (invasion or cytotoxin) diarrhea A. Clostridium perfringens B. Clostridium difficile C. Vibrio cholera D. Bacillus cereus
A
B
13
Q
13) WHO Oral Rehydration Solution A. Sodium chloride 3.5 g B. Potassium chloride 1.5 g C. Sodium bicarbonate 2.5 g D. Glucose 20 g
A
B
14
Q
14) True about diagnostic testing for amebiasis
A. The presence of amebic trophozites containing RBCs in a diarrheal stool is highly suggestive of E histolytica
B. Amebiasis will never present months or years after travel to or residence in an endemic area
C. PCR assay for DNA in stool samples is the standard diagnostic approach in most hospitals worldwide
D. Microscopy is the most sensitive and specific method for identifying histolytica infection
A
A
15
Q
15) Correct management of cases of cholera
A. Treatment first and foremost requires fluid resuscitation
B. Administration of plain water may take the place of ORS
C. Potassium intake should be discouraged
D. Among commercial IV fluids, normal saline is the best choice
A
A
16
Q
16) Correctly paired E coli pathotype with its clinical syndrome
A. EHEC (enterohemorrhagic) hemorrhagic colitis
B. EPEC (enteropathogenic): dysentery
C. EAEC (enteroadherent): hemolytic uremic syndrome
D. EIEC (enteroinvasive): traveler’s diarrhea
A
Answer: A
Correct pairing: EIEC and dysentery, EHEC and hemolytic uremic syndrome, ETEC and traveler’s diarrhea
17
Q
17) An inexpensive agent for the prophylaxis of traveller’s diarrhea A. Azithromycin B. Furazolidone C. Bismuth subsalicylate D. Ciprofloxacin
A
C
18
Q
18) Miss Estolas wondered why despite her appetite she seemed to be wasting away (she’s not panicking?!). She has been having vague abdominal pain and watery diarrhea for a month now, despite treatment with ciprofloxacin. She consults you regarding this, wondering if it has anything to do with her love for raw fish. Upon doing a battery of tests, you note an albumin level of 12 (normal 40). Fecalysis showed peanut-shaped eggs, clinching the diagnosis of A. Trichinella B. Capillariasis C. Enterobiasis D. Ascariasis
A
B
19
Q
19) Which of the following causes opportunistic infection and life threatening diarrhea among HIV/AIDS patients? A. Entamoeba histolytica B. Giardia intestinalis C. Cryptosporidium parvum D. Blastocystic hominis
A
C
20
Q
20) 45 year old woman drinks milk twice daily to prevent osteoporosis. She consults you with complaints of crampy abdominal pain and passage of soft stools every time especially after drinking her second glass of milk. She is otherwise asymptomatic and PE is normal. What is the appropriate management for her?
A. Have a stool culture done to rule out bacterial infection
B. Refer patient for colonoscopy to rule out malignancy or inflammatory bowel disease
C. Advise patient to avoid dairy products and eat other calcium-rich foods
D. Treat with quinolone for two weeks and see the response
A
C
21
Q
Cirrhosis and Liver Failure
21) TRUE regarding cirrhosis
A. Once cirrhosis sets in, fibrosis is never reversible
B. PE findings in cirrhotic patients reveal the etiology in most cases
C. Cases of treated hepatitis C and hemochromatosis are examples of etiologies of cirrhosis that may show reversibility of fibrosis
D. Complications of cirrhosis are unique for each etiology
A
C
22
Q
22) Portal hypertension is defined as elevation of hepatic venous gradient of at least A. 2 mmHg B. 5 mmHg C. 7 mmHg D. 10 mmHg
A
B
23
Q
23) Abnormal value of which blood chemistry result indicates chronicity of a liver problem? A. Albumin B. Alkaline phosphatase C. ALT D. Bilirubin
A
A
24
Q
24) PE finding suggestive of portal hypertension A. Ascites B. Jaundice C. Palmar erythema D. Spider angiomata
A
Answer: A (Other PE findings include hemorrhoids, caput medusa and other collaterals)
25
```
25) The most common cause of ascites worldwide
A. Abdominal malignancy
B. Peritoneal tuberculosis
C. Portal hypertension from cirrhosis
D. Right-sided heart failure
```
C
26
```
26) 50/M chronic alcoholic was brought to the ER for disorientation. He complained of fever and watery diarrhea four days prior to admission. He had not been eating meals or drinking water or any fluids since the day before admission. Relatives have noted that he was progressively becoming irritable and occasionally disoriented when spoken to. On PE, he was drowsy, with intermittent disorientation to place and time but could recognize his family. He was icteric, febrile, had spider angiomata and slightly globular abdomen. He had (+++) reflexes and asterixis. In what stage of hepatic encephalopathy is he?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
```
Answer: B (Because asterixis is a volitional test, therefore it can only be performed on an awake, cooperative patient. Thus when stage III and IV are reached, the patient’s sensorium has deteriorated to the point that asterixis can no longer be
27
```
27) An 11 month old female with a diagnosis of chronic liver disease secondary to (something) was brough to the ER for abdominal distension. On PE, she was a generally comfortable infant with generalized jaundice, an enlarged nodular liver, and presence of fluid wave and shifting dullness. Which of the following IS NOT a cause of ascites in this patient?
A. Increase in the RAAS
B. Sodium retention
C. Splanchnic arteriolar vasodilation
D. Decreased prothrombin time
```
D
28
```
28) Factors used to calculate the Child-Pugh score, a reasonably reliable predictor of survival in many liver diseases, and predicts the likelihood of major complications of cirrhosis
A. Partial thromboplastine time
B. Serum creatinine
C. Serum ALT
D. Prothrombin time
```
Answer: D (APABE – ascites, prothrombin time, albumin, bilirubin, encephalopathy)
29
```
29) The hallmark symptom of liver disease and perhaps the most reliable marker of severity
A. Jaundice
B. Anorexia
C. Fatigue
D. Pruritus
```
A
30
```
30) Best therapy for hepatorenal syndrome
A. Albumin
B. Octreotide
C. Liver transplant
D. Midodrine
```
C
31
31) AM, a 64/M who has been diagnosed with CLD secondary to ALD develops mental status changes. His family mentioned that they found him always sleepy and on consult at the ER, was difficult to rouse. On PE, you note that the patient opens his eyes to name calling, was not oriented to time place and person, had confusion, and could not follow commands. Vital signs were: BP 90/60 HR 85 RR 24 T 37.9 There was note of musty breath, distended abdomen with caput medusa and (+) bipedal edema. Appropriate management would be as follows EXCEPT
A. Do peritoneal tap to r/o spontaneous bacterial peritonitis
B. Look for evidence of GI bleeding
C. Protein restriction
D. Lactulose to promote 2-3 soft stools/day
C
32
```
32) The following may present as high serum ascites albumin gradient EXCEPT
A. Cirrhosis
B. Alcoholic hepatitis
C. Massive liver metastasis
D. Nephrotic syndrome
```
Answer: D – High SAAG (>1.1 mg/dL) corresponds to portal hypertension, pointing to liver disorders that involve portal hypertension. These include cirrhosis, alcoholic hepatits, massive liver metastasis
33
```
33) Postsinusoidal cause of portal hypertension
A. Schistosomiasis
B. Budd-Chiari Syndrome
C. Portal vein thrombosis
D. Splenic vein thrombosis
```
Answer: B (Pre-sinusoidal causes of portal hypertension are portal vein thrombosis and schistosomiasis, sinusoidal – cirrhosis, everything else is post-sinusoidal)
34
```
34) 50/M chronic alcoholic was brought to the ER for disorientation. He complained of fever and watery diarrhea four days prior to admission. He had not been eating meals or drinking water or any fluids since the day before admission. Relatives have noted that he was progressively becoming irritable and occasionally disoriented when spoken to. On PE, he was drowsy, with intermittent disorientation to place and time but could recognize his family. He was icteric, febrile, had spider angiomata and slightly globular abdomen. He had (+++) reflexes and asterixis. In what stage of hepatic encephalopathy is he?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
```
B
35
```
35) The following is/are signs of cirrhosis
A. Palmar erythema
B. Spider angioma
C. Ascites
D. AOTA
```
D
36
```
Jaundice
36) Which of the following is an inherited cause of isolated indirect hyperbilirubinemia?
A. Criggler-Najjar syndrome
B. Dubin-Johnson syndrome
C. Paroxysmal nocturnal hemoglobinuria
D. Rotor syndrome
```
Answer: A (All the others are causes of direct hyperbilirubinemia)
37
37) Laboratory finding which points to alcoholic hepatitis more than other causes of jaundice from hepatocellular injury
A. AST:ALT ratio of >2
B. Transaminases >25 times the upper limit of normal
C. Prothrombin time prolongation that is at least 2x the control
D. Serum albumin of
A
38
```
38) A 3 year old boy presents with a history of vague abdominal pain later associated with deepening jaundice. PE revealed that he had a RUQ mass. Which of the following is a likely diagnosis?
A. Pancreatic head mass
B. Choledochal cyst
C. Choledocholithiasis
D. Metastatic liver tumor
```
B
39
39) Neonatal cholestatic jaundice is characterized by
A. Retention of unconjugated bilirubin
B. Conjugated bilirubin 90% of total bilirubin
D. Conjugated bilirubin >20% of total bilirubin
D
40
39) Neonatal cholestatic jaundice is characterized by
A. Retention of unconjugated bilirubin
B. Conjugated bilirubin 90% of total bilirubin
D. Conjugated bilirubin >20% of total bilirubin
Answer: D (A is a metabolic cause, B is hematologic, C is infectious)
41
```
41) Type of choledochal cyst where there is dilatation of the intraduodenal portion of the common bile duct
A. I
B. II
C. III
D. IV
```
C.
Type 1 = solitary fusiform dilatation extrahepatic, type 2 = supraduodenal dilatation extrahepatic, type 3 = intraduodenal diverticulum choledochocoele, type 4a = fusiform and intrahepatic cysts, type 4b = multiple extrahepatic, type 5 = multiple intrahepatic (also known as Caroli’s disease)
42
```
42) Which of the following conditions can cause pathologic jaundice in newborns
A. Neonatal infection
B. Breastmilk intake
C. G6PD deficiency
D. AOTA
```
Answer: D (Take note that breast milk jaundice, while not an absolute contraindication to breast feeding compared to galactosemia, it is still a cause of pathologic jaundice in newborns due to decreased conjugation of bilirubin in the liver.)
43
43) The best diagnostic modality to differentiate intrahepatic from extrahepatic disorder in a jaundiced neonate is
A. Ultrasound of the hepatobiliary tract
B. DISIDA scan
C. Percutaneous liver biopsy
D. Endoscopic retrograde cholangiopancreatography
Answer: C (though B yung sagot ng lecturer, apparently)
| Although A is the usual modality used, the gold standard for assessing pediatric jaundice is always a liver biopsy.
44
```
44) A 2 month old was brought to the ER for jaundice, acholic stool, and dark colored urine. Pertinent in the PE was a palpable abdominal mass. Immediately you make a request for
A. CT scan of the abdomen
B. CBC
C. Alpha-fetoprotein
D. UTZ of the hepatobiliary tract
```
D
45
45) 48/F sought consult due to icterus which started 2 weeks prior. She had passage of tea-colored urine and pruritus. She claims to have episodes of post-prandial abdominal pain which spontaneously resolves after several minutes. She denies having intake of any medications/alcohol. PE revealed scleral icterus, flabby abdomen, normal sized liver and spleen, no spider angiomata/palmar erythema, no abdominal tenderness. BP 110/70 HR 70 RR 16 Temp 37C Height 158 cm Weight 65 kg. 3 days prior she had some lab exams done which showed the following findings:
Unremarkable CBC
AST 90 IU/L (N 6-40 IU/L) ALT 75 IU/L (N 6-40 IU/L) Alkaline phosphatase 690 (N 30-120 IU/L) Total bilirubin 3.8 mg/dl (0.1-1.0 mg/dL) Direct bilirubin 2.9 mg/dL (0.1-0.4 mg/dL) Indirect bilirubin 0.9 mg/dl
What is the next step in the management of this case?
A. Request for viral serologies
B. Endoscopic retrograde pancreatography (ERCP)
C. Hepatobiliary tree UTZ
D. Liver biopsy
C
46
46) In a patient with cholestatic pattern of liver test, the initial examination involves
A. Fractionate bilirubin
B. CT/BRCP
C. Review of drugs
D. Checking for anti-mitochondrial antibody
C
47
```
47) A nontender, palpable mass at the RUQ of the abdomen in a patient with obstructive jaundice secondary to a periampullary malignancy is termed what?
A. Gallbladder hydrops
B. Gallbladder empyema
C. Courvoisier’s gallbladder
D. Murphy’s sign
```
C
48
48) Which of the following is an invasive way to image the bile ducts in a patient with jaundice?
A. Ultrasound of the liver and bile ducts
B. Endoscopic retrograde cholangiopancreatography
C. CT scan of the abdomen
D. Magnetic resonance cholangiopancreatography
B
49
```
49) Most common cause of extrahepatic cholestasis
A. Cholangiocarcinoma
B. Choledocholithiasis
C. Pancreatic malignancy
D. Primary sclerosing cholangitis
```
B
50
50) A 51/F came to the ER due to fever (39.3 C) and chills that started 2 hours ago. She has a 10 month history of intermittent epigastric and right upper quadrant pain relieved by NSAIDS taken as needed. 1 week ago she developed jaundice with associated tea-colored urine and pruritus. Right upper quadrant and epigastric tenderness was elicited on PE. The most likely diagnosis is?
A. Fulminant viral hepatitis infection
B. Sepsis secondary to bowel perforation
C. Cholangitis secondary to choledocholithiasis
D. Obstructive jaundice secondary to periampullary malignancy
Answer: C – the triad of jaundice, abdominal pain, and fever
51
```
51) What disease may present as both cholestatic or parenchymal type of jaundice?
A. Viral hepatitis
B. Primary biliary cirrhosis
C. Wilson’s disease
D. Pancreatic head adenocarcinoma
```
A
52
52) A 60/F was clinically diagnosed with a pancreatic head tumor. What is the best test to confirm this diagnosis among the choices listed below?
A. Hepatobiliary-pancreatic ultrasound
B. Endoscopic retrograde cholangiopancreatography (ERCP)
C. Upper abdominal CT scan
D. Percutaneous transhepatic cholangiography (PTC)
C
53
53) Cholestatic type of jaundice may be differentiated from parenchymal type of jaundice by?
A. AST/ALT elevation
B. Elevated indirect bilirubin
C. Presence of dilated ducts on ultrasound
D. Increased ceruloplasmin levels
C
54
54) Drug-induced liver toxicity causes primarily?
A. Parenchymal pattern of jaundice
B. Parenchymal pattern of jaundice and intrahepatic cholestasis
C. Intrahepatic and extrahepatic cholestasis
D. Parenchymal pattern of jaundice and extrahepatic cholestasis
B
55
```
55) Predisposing factors for cholesterol stone formation
A. Weight loss
B. Chronic hemolysis
C. Hemolytic anemia
D. Young age
```
Answer: A
Sudden weight loss can be a predisposing factor for CHOLESTEROL stone formation. Chronic hemolysis and hemolytic anemia are usually for pigment stones. Young people won’t usually have cholesterol stones
56
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Radiology
56) Mucosal irregularities in the colon with occasional loss of haustral markings is seen in
A. Collitis
B. Polyposis
C. Diverticulosis
D. Malignant tumor
```
A
57
57) A calcified gallstone is seen in HBT/GB ultrasound as
A. Hypoechoic structure in the gallbladder without posterior sonic shadowing
B. Hyperechoic structure in the gallbladder with posterior sonic shadowing
C. Hypoechoic structure in the gallbladder with posterior sonic shadowing
D. Hyperechoic structure in the gallbladder without posterior sonic shadowing
B
58
```
58) The following are EMERGENCIES where abdomen x-rays are very useful EXCEPT
A. Volvulus
B. Intussucception
C. Intestinal parasitism
D. Mechanical small bowel obstruction
```
C
59
```
59) Meckel’s diverticulum is seen in the
A. Duodenum
B. Esophagus
C. Distal ileum
D. Jejunum
```
C
60
60) The following are radiographic findings of pneumoperitoneum EXCEPT
A. Pneumatosis intestinalis
B. Rigler’s sign
C. Air between the diaphragm and the liver
D. Falciform ligament sign
A
61
```
61) Zenker’s Diverticulum is seen in
A. The posterior wall of the proximal esophagus
B. Medial wall of the distal esophagus
C. Proximal duodenum
D. Distal duodenum
```
A
62
62) In Hirschsprung’s disease, the pathologic portion of the rectum as seen on barium enema is the
A. Dilated portion of the rectum
B. Constricted portion of the rectum
C. Portion of the rectum with mucosal out-pouchings
D. Portion of the rectum with filling defects
B
63
```
63) Feathery appearance on contrast imaging is seen in the
A. Stomach
B. Duodenum
C. Jejunum
D. Ileus
```
C
64
```
64) The imaging of choice for cholecystolithiasis is
A. Plain abdomen x-ray
B. HBT/GB ultrasound
C. MRI
D. CT scan
```
B
65
```
65) Smooth filling defects appearing as round black shadows on barium enema is seen in
A. Malignant colonic ulcers
B. Benign polyps of the colon
C. Ulcers in colonic mucosa
D. Ischemia of the colonic wall
```
B
66
```
66) Rat tail appearance in the ileocecal area seen on barium enema is indicative of
A. SI polyposis
B. Ileocecal Koch’s infection
C. Gardners disease
D. Diverticulosis
```
B
67
67) The following are pathognomonic radiologic findings of colonic obstruction in plain abdomen xrays
A. Dilated air-filled bowel loop segments
B. Multiple air-fluid levels at different levels in the lateral decubitus or upright view
C. Pneumointestinalis
D. Centrally-located bowel loops
Answer: B – Both SBO and LBOs have dilated air-filled bowel loop segments. C is the presence of air-filled cysts in the bowel wall, suggestive of necrotizing enterocolitis. D pertains to SBO.
68
```
68) Widening of the C-loop of the duodenum on UGIS is seen in patients with
A. Duodenal ulcer
B. Duodenal diverticulum
C. Pancreatic mass
D. Liver mass
```
C
69
```
69) The following are radiographic findings of early Crohn’s disease EXCEPT
A. Thickened folds
B. Ulcerations
C. String sign
D. Submucosal edema
```
Answer: B – these are late manifestations of Crohn’s
70
```
70) Which of the following imaging techniques is most useful in diagnosing Crohn’s disease?
A. Barium swallow
B. Gastric series of UGIS
C. Small intestine series
D. Barium enema
```
C
71
71) Which of the following is not a radiographic finding of small bowel gas?
A. Centrally located
B. Diameter not more than 2”
C. Valvulae extends across the lumen
D. Walls of the bowel exhibit linear streaks of lucencies
Answer: D (by elimination, check page 4, left column of radio trans)
72
```
72) The following are causes of mechanical obstruction EXCEPT
A. Adhesions
B. Intussuception
C. Hernia
D. NOTA
```
Answer: D (all can cause mechanical obstruction)
73
```
73) An ulcer niche found within the lumen of the stomach on UGIS is seen in
A. Peptic ulcer
B. Malignant gastric ulcer
C. Gastric lymphoma
D. Gastritis
```
B
74
```
74) Which of the following is the best imaging modality used in monitoring the response of a rectal cancer patient to his/her treatment?
A. Pelvic CT scan
B. Pelvic MRI
C. Barium enema
D. PET-CT scan
```
D
75
```
75) Smooth filling defects appearing as round black shadows on barium enema is seen in
A. Malignant colonic ulcers
B. Benign polyps of the colon
C. Ulcers in the colonic mucosa
D. Ischemia of the colonic wall
```
B
76
```
Abdominal Enlargement
76) Which of the following factors is suspected to cause arteriolar vasodilation initiating ascites formation?
A. Aldosterone
B. Acetylcholine
C. Nitric oxide
D. Renin
```
C
77
```
77) A 66/M complained of abdominal enlargement secondary to ascites. Ascitic fluid analysis showed neutrophil count of 1050/mm3 and multiple isolates of both gram positive and gram negative organism. The appropriate treatment for this patient is:
A. Third generation cephalosporin alone
B. Exploratory laparotomy
C. Large volume paracentesis (LVP)
D. LVP with albumin infusion
```
B
78
78) A 43/M OFW with 20 year history of chronic hepatitis B infection complained of sudden abdominal enlargement, fever, and abdominal pain. Which of the following conditions should be considered in this cirrhotic patient?
A. Spontaneous bacterial peritonitis (SBP) and acute pancreatitis
B. Acute pancreatitis and biliary leak
C. Biliary leak and superimposed malignancy (hepatocellular carcinoma/HCC)
D. Superimposed malignancy (HCC) and SBP
D
79
79) A 54 year old alcoholic male with recent onset of grade 1 ascites will require
A. Spironolactone and furosemide
B. Dietary salt restriction to 2 g/day
C. Therapeutic paracentesis
D. Hospitalization with complete bed rest
B
80
```
80) A 56/F with ascites underwent paracentesis with the following findings: total protein 5.4 g/dl, albumin 1.4 g/dl, serum albumin requested was 3.2 g/dL. Which of the following conditions is consistent with these findings?
A. Pancreatitis
B. Biliary leak
C. Tuberculous peritonitis
D. Congestive heart failure
```
D
81
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81) 35/M with abdominal enlargement underwent x-ray of the abdomen which showed dilated small intestines and large intestines. He had hypoactive bowel sounds. The most likely cause of his distention is
A. Abdominal obstruction
B. Pancreatitis
C. Ileus
D. Portal hypertension
```
C
82
had a history of cervical carcinoma 5 years ago. If she has malignant ascites which of the following treatments will be LEAST helpful?
A. Sodium restriction and diuretics
B. Diuretics and large volume paracentesis (LVP)
C. LVP and transcutaneous drainage catheter placement
D. Transcutaneous drainage catheter placement and sodium restriction
Answer: A
A
83
83) Refractory ascites can be defined as persistent ascites despite
A. LVP and maximal diuretic use
B. Maximal diuretic use and sodium restriction
C. Sodium restriction and water restriction
D. Water restriction and LVP
B
84
```
84) 30/F who underwent explore-lap for pelvic abscess 3 months ago came back at the hospital because of generalized abdominal enlargement. PE revealed an abdomen with hyperactive bowel sounds, hypertympanic with no direct and rebound tenderness. Rectal examination revealed empty rectal vault. The most likely clinical impression is
A. Ileus
B. Partial intestinal obstruction
C. Complete intestinal obstruction
D. Strangulated intestinal obstruction
```
C
85
85) 30/F with persistent vomiting consulted because of progressive painless abdominal enlargement and full rectal vault. This finding will expectedly be seen in this case
A. Segmental intestinal dilation by plain radiography
B. Hypoactive bowel sounds
C. Temperature >39C
D. Severe abdominal tenderness
Answer: B – patient has ileus
86
86) In strangulated intestinal obstruction, the immediate cause of localized abdominal tenderness is
A. Marked intraluminal pressure build-up
B. Diltation of proximal intestinal segment
C. Transmural extravasation of intestinal toxin into the peritoneal cavity
D. Intraluminal accumulation of succus entericus
C
87
```
87) Conservative management for 48-72 hours in an adult patient with intestinal obstruction secondary to postoperative adhesion consists of
A. Nothing per orem
B. Nasogastric tube decompression
C. Correction of fluid and electrolytes
D. AOTA
```
D
88
88) Indication for laparotomy in a patient with intestinal obstruction due to postoperative adhesion
A. Failure of conservative management
B. Clinical evidence of complete obstruction
C. Clinical evidence of strangulated obstruction
D. AOTA
D
89
89) 38/M who underwent explore lap for ruptured appendicitis 2 weeks ago came back at the hospital because of generalized abdominal enlargement. PE revealed an abdomen with hyperactive bowel sounds, hypertympanitic with mild to absent tenderness at the mid-abdomen. The most likely reason for these physical findings will be
A. Retroperitoneal abscess formation
B. Intraperitoneal abscess formation of transudative fluid
C. Multiple solid organ enlargement
D. Proximal intraluminal fluid accumulation due to distal obstruction
Answer: D – patient has intestinal obstruction secondary to post-operative adhesions
90
```
90) Component/s of conservative management in an adult patient with intestinal obstruction secondary to postoperative adhesion consists of
A. Clear liquid diet
B. Nasogastric tube decompression
C. Deprivation of fluid and electrolytes
D. AOTA
```
B
91
```
90) Component/s of conservative management in an adult patient with intestinal obstruction secondary to postoperative adhesion consists of
A. Clear liquid diet
B. Nasogastric tube decompression
C. Deprivation of fluid and electrolytes
D. AOTA
```
Answer: A – because TB ascites is a low SAAG condition, with lymphocytic predominance
92
```
92) Angela consulted you because of abdominal distention. Your PE was negative for shifting dullness. However, subsequent ultrasound showed ascites. This can be explained because ascites to be detected by PE must be at least (in ml or cc):
A. 500
B. 800
C. 1500
D. 1800
```
C
93
```
93) Component/s of conservative management in an adult patient with intestinal obstruction secondary to postoperative adhesion consists of
A. Clear liquid diet
B. Nasogastric tube decompression
C. Deprivation of fluid and electrolytes
D. AOTA
```
B
94
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94) The recommended surgical procedure for complete intestinal obstruction due to adhesion in the presence of a viable bowel with no perforation is
A. Resection and anastomosis
B. Adhesiolysis
C. Proximal ileostomy
D. Bypass procedure
```
B
95
```
95) Which of the following DOES NOT account for the majority (60%) of abdominal masses in children?
A. Enlarged liver
B. Enlarged spleen
C. Enlarged kidneys
D. Teratoma
```
Answer: D – Majority of masses in children are organomegaly. Alin ang hindi organ? D! haha
96
96) The following is more likely to require diagnostic investigation
A. 4 year old boy, thriving well, with a 3 month history of difficult passage of stools following episodes of passage of blood-streaked stools
B. 3 year old girl with weight-for-height z-score of zero with straining on defecation after his previous nanny was replaced by a new one
C. 2 month old baby breastfed boy with abdominal distention, vomiting, and irregular passage of stools
D. 1 month old breastfed baby girl with bowel movements every 7 days
C
97
```
97) The most common etiology of mechanical small bowel obstruction in a 20 year old male with no previous laparotomy is
A. Intussusception
B. Groin hernia
C. Volvulus
D. Peritoneal adhesion
```
Answer: B – otherwise, the most common cause of mechanical SBO in adults is post-op adhesions
98
```
98) The recommended surgical procedure for strangulated small intestinal obstruction due to postoperative adhesion with resulting non-viable segment of small bowel will be
A. Resection and anastomosis
B. Adhesiolysis
C. Proximal ileostomy
D. Bypass procedure
```
A
99
99) Which one is not a clinical feature of a functional intestinal obstruction?
A. Segmental dilation by plain radiography
B. Hypoactive bowel sounds
C. Generalized abdominal enlargement
D. Moderate to severe abdominal tenderness
Answer: A – because if it’s ileus, the dilation is generalized
100
```
100) Which one is considered to be a cardinal symptom of intestinal obstruction?
A. Colicky abdominal pain
B. Diarrhea
C. Generalized abdominal enlargement
D. Fever
```
A
