OS 214 Digestive Exam 2 Flashcards
Diarrhea 1) The most common intestinal maldigestion syndrome A. Pancreatic lipase deficiency B. Bacterial overgrowth C. Agammaglobulinemia D. Lactase deficiency
A
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
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
C
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
Answer: D – empiric treatment for infectious diarrhea which is most commonly caused by gram negative bacteria, especially S. typhi
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
C
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
C
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
C
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
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
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
D
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
B
12) Gastrointestinal pathogens causing acute inflammatory (invasion or cytotoxin) diarrhea A. Clostridium perfringens B. Clostridium difficile C. Vibrio cholera D. Bacillus cereus
B
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
B
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
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
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
Answer: A
Correct pairing: EIEC and dysentery, EHEC and hemolytic uremic syndrome, ETEC and traveler’s diarrhea
17) An inexpensive agent for the prophylaxis of traveller’s diarrhea A. Azithromycin B. Furazolidone C. Bismuth subsalicylate D. Ciprofloxacin
C
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
B
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
C
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
C
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
C
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
B
23) Abnormal value of which blood chemistry result indicates chronicity of a liver problem? A. Albumin B. Alkaline phosphatase C. ALT D. Bilirubin
A
24) PE finding suggestive of portal hypertension A. Ascites B. Jaundice C. Palmar erythema D. Spider angiomata
Answer: A (Other PE findings include hemorrhoids, caput medusa and other collaterals)
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) 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) 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) 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) The hallmark symptom of liver disease and perhaps the most reliable marker of severity A. Jaundice B. Anorexia C. Fatigue D. Pruritus
A
30) Best therapy for hepatorenal syndrome A. Albumin B. Octreotide C. Liver transplant D. Midodrine
C
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) 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) 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) 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) The following is/are signs of cirrhosis A. Palmar erythema B. Spider angioma C. Ascites D. AOTA
D
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) 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) 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) 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
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)
