OS 214 Digestive Exam 3 Flashcards
1
Q
1) The vomiting center is located in this area A. Basal ganglia B. Hypothalamus C. Medulla D. Cerebellum
A
C
2
Q
2) A 22 year old woman diagnosed with bulimia is observed by her boyfriend to be quietly chewing and swallowing several times in between mealtimes. What is this behavior called? A. Emesis B. Rumination C. Retching D. Gastroesophageal reflux
A
B
3
Q
3) A man is kicked in the testicles during a robbery attempt. He promptly vomits his lunch. What is the explanation for his reaction?
A. Testicles have afferent fibers traveling via the nucleus tractus solitarius to the emetic center
B. Testicular trauma activates the chemoreceptor trigger zone
C. Testicles have pathways in common with the vestibular system
D. Trauma to the testicles triggered syncope and resulting emesis
A
A
4
Q
4) A pregnant woman develops morning sickness at 8 weeks AoG. Which neurotransmitter receptor is primarily responsible for her misery? A. Cannabinoid CB-1 B. Neurokinin NK-1 C. GABA D. Histamine H2
A
D
5
Q
5) A 55 year old man received chemotherapy for colon cancer two days ago. Today he developed nausea and vomiting. Which receptor is responsible for his nausea and vomiting? A. Neurokinin NK-1 B. Histamine H2 C. Muscarinic M1 D. Histamine H1
A
A
6
Q
6) During vomiting, from which anatomic structure does forceful retrograde contraction originate? A. Lower esophageal sphincter B. Gastric cardia C. Duodenum D. Jejunum
A
D
7
Q
6) During vomiting, from which anatomic structure does forceful retrograde contraction originate? A. Lower esophageal sphincter B. Gastric cardia C. Duodenum D. Jejunum
A
Answer: D – The fact that her vomitus is undigested food gives you a clue to the origin of the problem. Undigested food corresponds to an esophageal problem, partially digested food corresponds to the stomach, and bilious vomiting indicates a postampullary problem. In this case, the problem is esophageal. Achalasia is a disorder where the esophagus lacks neural innervation, leading to a lack of peristalsis.
8
Q
8) Protective reflexes during vomiting does not include the following A. Glottis is closed B. Soft palate is raised C. Breathing is momentarily stopped D. Tongue retracts
A
D
9
Q
9) Surgery with highest risk for post operative nausea and vomiting A. Strabismus and middle ear surgery B. Oropharyngeal surgery C. Cardiac surgery D. Vascular surgery
A
Answer: A – Because the vestibular system is one source of signals causing nausea and vomiting, while being intimately related to the eyes and middle ear. Hence surgery involving these may affect the vestibular system and thus cause nausea and vomiting.
10
Q
10) Drug that can be used safely for nausea and vomiting in pregnancy A. Thalidomide B. Carbamazepine C. Ondansetron D. Phenytoin
A
Answer: C – The others are teratogenic
11
Q
11) Vomiting episodes which are stereotypical, with a predictable onset and duration separated by asymptomatic or almost asymptomatic intervals that range from 2 weeks to 6 months. A. Rumination syndrome B. Cyclical vomiting syndrome C. Bulimia nervosa D. Gastric outlet obstruction
A
B
12
Q
12) Initial best diagnostic test in the work-up of nausea and vomiting to rule out intestinal obstruction A. Endoscopy B. Plain abdominal x-rays C. Stool exams D. CT scan
A
B
13
Q
13) Best diagnostic test for gastric outlet obstruction A. Barium swallow xrays B. CT scan C. Manometry D. Colonoscopy
A
A
14
Q
14) In complete mechanical intestinal obstruction, the immediate cause of vomiting is
A. Marked intraluminal pressure build-up
B. Dilatation of proximal intestinal segment
C. Peritonitis from transmural extravasation of intestinal toxin
D. Intraluminal accumulation of succus entericus
A
A
15
Q
15) Vomiting can cause longitudinal mucosal and even transmural lacerations at the level of the gastroesophageal junction is called A. Boerrhave’s syndrome B. Mallory-Weiss tears C. Barrett’s esophagus D. Esophagitis
A
B
16
Q
Constipation 16) 26/M complains of passage of hard, lumpy stools more than 25% of the time, incomplete evacuation 50% of the time, and passes stools 2x/week. This patient has A. Constipation B. Outlet obstruction C. Colonic inertia D. Normal findings A
A
A
17
Q
17) 65/F complains of difficulty in passing bowel movement. Colonoscopy showed normal findings. Colonic transit study was done which showed passage of 80% of the markers by day 5. This is indicative of A. Constipation B. Outlet obstruction C. Colonic inertia D. Normal findings
A
D
18
Q
18) 48/M complains of decreased caliber of stools, hematochezia, no weight loss. Colonoscopy done showed a fungating mass occupying 50% of the circumference of the bowel wall at the sigmoid colon. This is most likely A. Intraluminal B. Extraluminal C. Mural D. Constipation
A
Answer: C
Intraluminal – parasites, hard stool, foreign body
Extraluminal – adhesions, endometriosis, gynecologic tumors
19
Q
19) 60/M complains of passage of stools 2x/week and passage of hard bulky stools. Digital rectal exam showed hard, stools in the rectal vault. Plain abdominal x-ray showed fecaloid material from the transverse colon to the sigmoid. Colonoscopy was normal. To normalize his bowel function, you would prescribe A. Enema and/or suppository B. Mineral oil C. Colonic irritants like senokot D. Bulk laxatives like metamucil
A
Answer: C – diagnosis is bowel impaction that reaches the transverse colon already
20
Q
20) The correct sequence of the defecatory process is A. 1, 3, 4, 5, 2 B. 1, 5, 4, 3, 2 C. 1, 3, 5, 4, 2 D. 1, 4, 3, 5, 2
1 – Distention of the rectum 2 – External anal sphincter relaxes and anal canal contents evacuated 3 – Internal anal sphincter relaxation 4 – Puborectalis muscle relaxatioin 5 – Valsalva maneuver
A
C
21
Q
21) The process of defecation is effected when the following takes place
A. The anorectal angle is around 95 degrees
B. The internal anal sphincter contracts and the external anal sphincter relaxes
C. The external sphincter and the puborectalis muscle relax
D. There is a mass movement of stools from the colon to the rectum
A
C
22
Q
21) The process of defecation is effected when the following takes place
A. The anorectal angle is around 95 degrees
B. The internal anal sphincter contracts and the external anal sphincter relaxes
C. The external sphincter and the puborectalis muscle relax
D. There is a mass movement of stools from the colon to the rectum
A
Answer: A – because meconium should be passed within 24 hours
23
Q
23) Basic in the management of constipation in children is A. Education and demystification B. Disimpaction C. Laxatives D. Pavlovian reflex
A
Answer: A – B is correct for acute cases, but for chronic cases A is better (according to the feedback haha)
24
Q
24) 6/F previously toilet-trained presents to the clinic for constipation. Her mother noted that the problem began when she started attending school. She takes in a fair amount of fluids but is not keen with eating vegetables. She has a piece of fruit for lunch and dinner. On PE, the abdomen was soft with palpable masses over the left lower quadrant and dry firm stools within the rectal vault. As the health personnel manning the clinic, your initial management for this child would consist of
A. Insert glycerin suppository
B. Start oral laxatives
C. Advise 7 portions of fruits and vegetables
D. Have the child sit in the toilet commode after each meal
A
Answer: A – to relieve the impacted feces
25
25) Which of the following patients is likely to be suffering from functional constipation
A. A 6 month old baby, mixed fed with breastmilk and milk formula with bowel movements occurring every other day associated with abdominal distention
B. A 3 year old boy with on and off history of blood-streaked stools associated with irregular bowel movements and straining on defection who recently had a strict caregiver
C. A 7 year old girl with cerebral palsy with passage of hard stools every other day, sometimes requiring manual extraction
D. A 9 year old stunted boy with mental age of 5 years who has a distended abdomen and palpable stools on LLQ
Answer: B (Because A, C, and D can have organic explanations)
26
```
26) A 3 year old boy is brought for outpatient consultation because the mother claims that the child has bowel movement every 3-4 days. She claims that the problem started when toilet training began 6 months ago. The patient would pass stool every 3-4 days associated with the child hiding behind the sofa while straining into his diaper. The stools are noted to be big and bulky and associated with some pain. There has been loss of appetite this week but no vomiting and no weight loss. Based on the history, the most likely diagnosis is
A. Functional constipation
B. Hirschsprung’s disease
C. Lymphoma
D. Colonic polyposis
```
A
27
```
27) A 12 year old boy is consulting for constipation associated with abdominal pain since three months ago. He claims that he is having on and off episodes of alternating constipation and diarrhea associated with anorexia and easy fatigability. His mother consulted several pediatricians where he was prescribed antibiotics for amebiasis and once underwent deworming. On PE, he was found to be slightly pale with BP 120/70 HR 106/min RR 24/min T 36.8 C. The abdomen was slightly distended with a palpable nontender mass at the left hemiabdomen. Rectal exam revealed an intraluminal mass at the tip of the examining finger. The most appropriate examination he needs is which of the following?
A. Plain abdominal xray
B. Barium enema
C. Proctosigmoidoscopy
D. CT scan
```
C
28
```
28) A 2 year old boy is brought to the outpatient clinic because of chronic constipation since he was born. The mother claims that the boy would only pass stools every 3-4 days only if she inserted a glycerine suppository per rectum. The boy was born at home as the 6th child and was noted by the mother that he only passed meconium on the 3rd day of life after rectal stimulation as suggested by the midwife the mother consulted. Since then, as the patient grew up, there were episodes of constipation associated with abdominal enlargement and occasional vomiting relieved by insertion of suppository per rectum. On PE, the boy had an enlarged abdomen with palpable distensible masses on the abdomen. Rectal exam resulted in a large gush of air and passage of voluminous loose stool and this decreased the boy’s abdominal girth. Based on history and PE, the most likely diagnosis is
A. Functional constipation
B. Abdominal lymphoma
C. Hirschsprung’s disease
D. Wilms’ tumor
```
C
29
29) The following minimizes constipation
A. Dietary intake of 20-30 grams non-starch polysaccharide
B. Intake of at least 8 glasses of fluids per day
C.Exercise
D. AOTA
D
30
```
30) To meet the Rome criteria for functional constipation, the patient must have fewer than 3 bowel movements per week, institute manual maneuvers to evacuate stool, straining, passage of lumpy/hard stools, incomplete evacuation, and have a sensation of anorectal obstruction/blockage more than _____% of the time
A. 25
B. 30
C. 35
D. 40
```
A
31
```
GI Malignancies
31) Nodular tumors arising at the bifurcation of the common bile duct
A. Charcot tumor
B. Klatskin tumor
C. Virchow tumor
D. Cuorvoisier tumor
```
B
32
```
32) Organisms associated with the development of cholangiocarcinoma
A. Opistorchis
B. Schistosomiasis
C. H. pylori
D. Ascaris
```
Answer: A (Opistorchis and Clonorchis are the parasites most closely associated with cholangiocarcinoma)
33
33) TRUE about colon cancer
A. Lesions in the ascending colon commonly present with constipation
B. Tumors arising from the descending colon would usually present with abdominal cramping and obstruction
C. Iron deficiency anemia in a menstruating healthy young woman warrants colonoscopy
D. Symptoms do not vary with the anatomic location of the tumor
A
B
34
```
34) Most common symptom of esophageal cancer
A. Weight loss
B. Hematemesis
C. Dysphagia
D. Odynophagia
```
Answer: C – in particular, progressive dysphagia is associated with esophageal cancer
35
```
35) Risk factors for gastric adenocarcinoma EXCEPT
A. Smoking
B. Nitrates
C. H. pylori infection
D. Blood type O
```
Answer: D – dapat blood type A (although smoking daw yung answer sa feedback)
36
```
36) The most frequent extranodal site of lymphoma
A. Duodenum
B. Lung
C. Stomach
D. Liver
```
C
37
```
37) Which form of gastric carcinoma has a poorer prognosis upon discovery?
A. Fungating type
B. Ulcerating type
C. Linitis plastica type
D. They all have similar prognosis
```
C
38
38) The more reliable criterion in determinin whether a gastric ulcer is malignant or not
A. Presence of tumor metastasis to adjacent lymph node
B. Biopsy of ulcer for histopathologic evaluation
C. Non-healing ulcer despite adequate treatment
D. Ulcer borders are markedly prominent
B
39
```
39) In the colon and rectum, an intramucosal carcinoma that shows no demonstrable vascular and lymphatic invasion, and whose morphology is not the poorly differentiated type will have
A. Zero metastatic potential
B. 25% metastatic potential
C. 50% metastatic potential
D. 75% metastatic potential
```
A
40
```
40) Type of gastric adenocarcinoma characterized by cohesive neoplastic cells that form glandlike tubular structures
A. Diffuse
B. Linitis plastica
C. Squamous
D. Intestinal
```
D
41
```
41) Organism associated with the development of gastric carcinoma
A. Schistosoma sp.
B. Clonorchis sinensis
C. Rotavirus
D. Helicobacter pylori
```
D
42
```
42) Which of the following is the most common tumor among infants and children?
A. Wilms’ tumor
B. Hepatoblastoma
C. Teratoma
D. Adenoma
```
A
43
```
43) The most feared complication of intestinal goblet cell metaplasia of the esophagus is
A. Peptic ulcer and perforation
B. Barrett’s esophagus
C. Adenocarcinoma
D. Reflux esophagitis
```
C
44
```
44) The most common malignant tumor of the stomach is
A. GIST
B. Lymphoma
C. Adenocarcinoma
D. Squamous cell carcinoma
```
C
45
```
45) You were called to assist an intern for a delivery at the OB Admitting Section. While doing newborn care, you noted an enlarged abdomen and a palpable left sided mass. In the newborn period, which organ/organ system would this mass likely originate from?
A. Gastrointestinal
B. Vascular-lymphatics
C. Endocrine
D. Genitourinary
```
D
46
```
46) The most common malignant tumor of the proximal 2/3 of the esophagus is
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Leiomyosarcoma
D. GIST
```
B
47
```
46) The most common malignant tumor of the proximal 2/3 of the esophagus is
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Leiomyosarcoma
D. GIST
```
D
48
```
48) Age at which screening colonoscopy may be advised for an asymptomatic without high-risk factors
A. 45
B. 50
C. 55
D. 60
```
B
49
```
49) Gastrointestinal polyposis syndrome with rare malignant potential to the GI tract
A. Lynch
B. FAP
C. Gardner’s / Gradner’s
D. Peutz-Jeghers
```
D
50
```
50) Most common physical sign in hepatocellular carcinoma
A. Ascites
B. Hepatomegaly
C. Jaundice
D. RUQ tenderness
```
C
51
```
50) Most common physical sign in hepatocellular carcinoma
A. Ascites
B. Hepatomegaly
C. Jaundice
D. RUQ tenderness
```
A
52
52) 25/M came in due to vomiting of fresh blood. He has had a drinking spree the night prior to admission. He had retching and vomiting of previously ingested food. This was followed by hematemesis. PE showed BP of 120/80 with PR of 120/min, pale palpebral conjunctivae, anicteric sclerae, rectal exam showed black stools. The rest of the PE was unremarkable. The most likely diagnosis in this case would be
A. UGIB secondary to bleeding peptic ulcer
B. UGIB secondary to bleeding esophageal varices
C. UGIB secondary to gastric CA
D. UGIB secondary to Mallory Weiss syndrome
D
53
53) Treatment of bleeding peptic ulcer would include
A. Proton pump inhibitor (PPI), injection hemostasis, hemoclipping
B. PPI, injection hemostasis, rubber band ligation
C. PPI, cyanoacrylate injection, rubber band ligation
D. PPI, endoloop ligation, hemoclipping
A
54
54) Upper GI bleeding may present as
A. Vomiting of fresh blood, hematochezia, hypotension, tachycardia
B. Vomiting of fresh blood, negative NGT aspirate, negative rectal exam
C. Absence of hematemesis, hematochezia, normal blood pressure, negative NGT aspirate
D. Absence of hematemesis, negative melena, negative NGT aspirate
A
55
55) Treatment of bleeding esophageal varices consists of
A. Insertion of Blakemore Sengstaken tube, cyanoacrylate injection, rubber band ligation
B. Insertion of Blakemore Sengstaken tube, rubber band ligation, somatostatin infusion
C. Cyanoacrylate injection, rubber band ligation, somatostating infusion
D. Cyanoacrylate injection, shunting procedure, somatostatin infusion
B
56
56) 45/M farmer from Leyte came in due to hematemesis. PE showed BP 80/50 PR 130/min, pale conjunctivae, globular tense abdomen with umbilical hernia. The most likely diagnosis would be
A. UGIB secondary to bleeding peptic ulcer
B. UGIB secondary to bleeding esophageal varices secondary to portal HPN secondary to schistosomiasis
C. UGIB secondary to bleeding esophageal varices secondary to portal HPN secondary to post hepatic cirrhosis
D. UGIB secondary to carcinomatosis secondary to gastric CA
B
57
57) 80/F with rheumatoid arthritis and hypertension came in at the ER due to melena. She had intake of naproxen for her joint pains. PE showed pallor with BP of 110/70 PR 125/min. There was tenderness over the epigastric area. Rectal exam showed black tarry stools. The most likely diagnosis in this case would be
A. UGIB secondary to bleeding peptic ulcer
B. UGIB secondary to bleeding esophageal varices
C. UGIB secondary to gastric CA
D. UGIB secondary to esophageal CA
A
58
58) The three most important things to do in cases of upper GI bleeding would be
A. Do a rectal exam, insert NGT, replace blood volume loss
B. Do a rectal exam, insert NGT, request for upper GI series
C. Do a rectal exam, insert NGT, refer to surgery
D. Insert NGT, refer to surgery, request for upper GI series
Answer: A – these are the first three things you must do when you encounter upper GI bleeding
59
59) A healthy 30 year old woman comes to your clinic complaining of painless, bright red rectal bleeding. Your anoscopy findings reveal a Grade II internal hemorrhoid on the right posterolateral area. Based on latest evidence, the following are the most ideal and acceptable forms of management for her lesion EXCEPT
A. Transanal hemorrhoidal dearterialization (THD)
B. Surgical hemorrhoidectomy
C. Rubber band ligation (RBL)
D. Injection sclerotherapy
B
60
60) A 70/M heavy smoker came in due to vomiting of previously ingested food followed by hematemesis. He was previously complaining of dysphagia to solids a few months prior to admission and lately dysphagia to liquids. He has lost 10 kg for the past month. PE is unremarkable save for slight pallor. The most likely diagnosis would be
A. UGIB secondary to bleeding peptic ulcer
B. UGIB secondary to bleeding esophageal varices
C. UGIB secondary to gastric CA
D. UGIB secondary to esophageal CA
D
61
61) A 36/M was referred by the orthopedic department due to melena. Patient had undergone open reduction for a femoral fracture. He was given analgesics post op. PE showed pale palpebral cojunctivae. BP of 100/60, PR 140/min. Slight epigastric tenderness. Tarry stools on rectal exam. NGT was inserted and was negative for blood. The most likely diagnosis in this case would be
A. UGIB secondary to bleeding gastric ulcer
B. UGIB secondary to bleeding duodenal ulcer
C. UGIB secondary to bleeding esophageal varices
D. UGIB secondary to Mallory Weiss syndrome
B
62
```
62) A 12 year old boy is brought to the ER because of blood in the stool. He was apparently well until yesterday when he noted that he had a streak of blood in his stool but he told no one about it. This morning, the patient passed bright red stool which frightened him, thus he told his stepmother and was brought to the ER. At the ER, he had 3 more episodes of copious bright red stools. On PE, he was found to be very pale with BP 90/50 HR 132/min RR 28/min T 36.2. The abdomen was full with no tenderness and no muscle guarding. Rectal exam revealed no tenderness and no mass, but there was bloody stool on the examining finger. What is the most appropriate diagnostic test that must be done for this patient?
A. Barium enema
B. Proctosigmoidoscopy
C. Meckel’s scan
D. CT scan
```
Answer: C - primary working impression here is lower GI bleeding, most commonly due to Meckel’s diverticulum
63
```
63) A 10 month old baby boy was brought in because of passage of bloody mucus per rectum. The patient was well until 6 days ago when he developed nasal catarrh and low grade fever. Yesterday, he was having bouts of abdominal pain later associated with vomiting of bilious material. There was gradual abdominal enlargement and on/off abdominal pain. This morning there was bloody mucus per rectum. Based on the history of the patient, the most likely diagnosis is
A. Midgut volvulus from malrotation
B. Intussusception
C. Septic ileus
D. Intestinal polyposis
```
B
64
```
63) A 10 month old baby boy was brought in because of passage of bloody mucus per rectum. The patient was well until 6 days ago when he developed nasal catarrh and low grade fever. Yesterday, he was having bouts of abdominal pain later associated with vomiting of bilious material. There was gradual abdominal enlargement and on/off abdominal pain. This morning there was bloody mucus per rectum. Based on the history of the patient, the most likely diagnosis is
A. Midgut volvulus from malrotation
B. Intussusception
C. Septic ileus
D. Intestinal polyposis
```
C
65
65) 25/M came in due to vomiting of fresh blood. He has had a drinking spree the night prior to admission. He had retching and vomiting of previously ingested food. This was followed by hematemesis. PE showed BP of 120/80 with PR of 120/min, pale palpebral conjunctivae, anicteric sclerae, rectal exam showed black stools. The rest of the PE was unremarkable. The most likely diagnosis in this case would be
A. UGIB secondary to bleeding peptic ulcer
B. UGIB secondary to bleeding esophageal varices
C. UGIB secondary to gastric CA
D. UGIB secondary to Mallory Weiss syndrome
D
66
```
66) A 46/M is admitted to the hospital for upper GI bleeding. He has a known history of peptic ulcer disease, for which he takes a proton pump inhibitor. His last admission for upper GI bleeding was 4 years ago. After fluid resuscitation, he is hemodynamically stable and his hematocrit has not changed in the past 8 hours. Upper endoscopy is performed. Which of the following findings at endoscopy is most reassuring that the patient will not have a significant rebleeding episode within the next 3 days?
A. Adherent clot on ulcer
B. Clean-based ulcer
C. Gastric ulcer with AV malformations
D. Visible bleeding vessel
```
B
67
```
67) True of gastric ulcer versus duodenal ulcer
A. Higher propensity for malignancy
B. H. pylori as cause
C. Responds well to PPI
D. AOTA
```
A
68
```
68) In the medical management of esophageal varices, the following are treatment targets
A. HR 55-60
B. BP 120/80
C. Hematocrit 0.40
D. NOTA
```
A
69
```
69) Most common foreign body ingested by children
A. Coins
B. Toy battery
C. Lego
D. Hair
```
A
70
70) The most important indication for an urgent endoscopy
A. Acute gastrointestinal obstruction
B. Acute biliary obstruction
C. Cancer diagnosis and staging
D. Severe acute gastrointestinal hemorrhage
D
71
```
Pharmacology
71) Hepatotoxic metabolite excessively formed from the metabolism of paracetamol in cases of drug overdose.
A. Glutathione
B. Anti-LKM2
C. NAPQI
D. CYP2E1
```
C
72
72) Which is TRUE of antacids
A. It has a delayed onset of action of about 2 hours
B. It has a long duration of action of about 12 hours
C. It should be given 1 and 3 hours after meals
D. It does not affect absorption of other medications
C
73
```
73) An enkephalinase inhibitor which does not alter motility or duration of intestinal transit while decreasing secretion of water and electrolytes
A. Attapulgite
B. Lubiprostone
C. Racecadotril
D. Zinc
```
C
74
```
74) Which of the following inhibits 90-98% of 24 hour acid secretion
A. Antacid
B. H1 antagonist
C. H2 antagonist
D. Proton pump inhibitor
```
D
75
```
75) Cimetidine was given to a 35 year old male for his gastritis. Adverse effects of this drug include
A. Increased libido
B. Gynecomastia
C. Priapism
D. Increased sperm count
```
B
76
```
76) An antimetabolite with immunosuppressive properties used for the induction and maintenance of remission of IBD
A. Natalizumab
B. Sulfasalazine
C. Prednisone
D. 6-mercaptopurine
```
D
77
```
77) The following is an opioid-derivative, anti-diarrheal drug that has selective action in the GIT, reduces frequency of passage of feces and duration of illness
A. Bismuth subsalicylate
B. Loperamide
C. Lactulose
D. Senna
```
B
78
```
78) A 42 year old call center agent with allergy to penicillins underwent endoscopy and tested positive for H. pylori infection. He was started on omeprazole and two antibiotics which may include the following
A. Moxifloxacin
B. Mefloquine
C. Minocycline
D. Metronidazole
```
Answer: D (Clarithromycin is probably the other one)
79
```
79) 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
80
```
80) A 5HT4 agonist used in female patients with irritable bowel syndrome
A. Domperidone
B. Dopamine
C. Erythromycin
D. Tegaserod
```
D
81
```
81) Lactulose, a non-absorbable disaccharide used for constipation, causes what type of diarrhea?
A. Secretory
B. Infectious
C. Inflammatory
D. Osmotic
```
Answer: D (The other type of diarrhea is dysmotile, besides those mentioned above)
82
```
82) Side effect of propranolol, a non-selective beta blocker used in the treatment of portal hypertension
A. Bronchoconstriction
B. Tachycardia
C. Increased libido
D. Weight loss
```
A
83
```
83) The mainstay of management in autoimmune hepatitis
A. PEG IFN
B. Prednisone
C. Entecavir
D. Azathioprine
```
B
84
```
84) The following are prokinetics EXCEPT
A. Domperidone
B. Metoclopramide
C. Loperamide
D. Erythromycin
```
C
85
```
85) Works in decreasing portal hypertension by decreasing splanchnic circulation
A. Epinephrine
B. Norepinephrine
C. Somatostatin
D. NOTA
```
C
86
```
Abdominal Pain
86) Patients afflicted with this type of pain lie still since any movement will aggravate the magnitude of pain
A. Visceral pain
B. Somatoparietal pain
C. Referred pain
D. AOTA
```
B
87
```
87) Patients move about in an attempt to relieve this type of pain
A. Visceral pain
B. Somatoparietal pain
C. Referred pain
D. AOTA
```
A
88
88) The visceral afferent fibers which convey pain impulses from the gastrointestinal tract are best described by which statement?
A. Composed mainly of A-delta fibers
B. Are poorly myelinated
C. Impulses that they transmit are felt as sharp and well-localized pain
D. They synapse with neurons which ascend along the ipsilateral dorsal columns
Answer: B – A, C, D all describe somatoparietal pain. Visceral pain is conveyed by smaller, poorly myelinated C fibers and is felt as dull poorly localized pain.
89
```
89) C fibers mediate the following types of pain EXCEPT
A. Distention
B. Spasms
C. Stretch
D. Inflammation
```
Answer: D – A to C are all causes or types of visceral pain, which is conveyed by C fibers.
90
90) An 8 year old girl was brought to the ER because of RLQ pain which started one day before admission. There was no fever but with one episode of non-bilious vomiting. The pain initially was bearable but as the hours progressed it became on and off with increasing severity. On PE the child was afebrile, not in acute distress, without pallor or jaundice, with a weight of 25 kg. There was essentially normal findings except for direct and rebound tenderness in the RLQ. Bowel sounds were normoactive. The resident on duty requested for a CBC which showed a WBC count of 21000/mm3. Urinalysis revealed pus cells of 20-25/hpf. The mother was anxious that something was terribly wrong with her child. What advice should be given?
A. The child will require surgery as evidence by the persistent pain, non-bilious vomiting, and leukocytosis.
B. Patient needs to be admitted. A trial of antibiotics can be given for 24 hours and if with positive improvement then medical management can be continued
C. Patient will need IV hydration at the ER, given one dose of IV antibiotic, then may be sent home to continue medications, and then followed up closely.
D. A presumptive diagnosis of UTI can be made and the patient can be sent home with oral antibiotics to be given for one week.
Answer: A – because this patient has acute appendicitis
91
91) Sam is a 6 week old baby boy who was brought to a pediatrician’s clinic because of incessant crying which started at 3 weeks of age. He was alright during the day but at around 6 pm he would usually cry incessantly for at least 3 hours, and was hard to console. The baby was first born, born full term with no complications, and never breastfed. Examination revealed normal findings. What options will be given to the mother?
A. The infant’s condition is self-limiting and the baby will outgrow the symptom
B. Mother can try alternative treatments such as massage
C. There is a need to change the milk
D. A trial of anticholinergic drug can be given
Answer: A – patient has infantile colic
92
Answer: A – patient has infantile colic
A
93
93) Abdominal pain in children as compared to adults
A. Easily elicited as children often verbalize their ailments to their caregivers
B. Radiologic and imaging studies not routinely ordered
C. A five year old complaining of on/off abdominal pain is considered to be malingering and there is no need for medical attention
D. Age-specific etiologies are usually observed, such as Hirschsprung’s disease being common in the adolescent age group
B
94
94) A child presenting with colicky abdominal pain more felt during evenings in the last two weeks was brought to the clinic for passage of worms per rectum. One of the things you will do is
A. Order for whole abdominal ultrasound
B. Prescribe an antihelminthic
C. Refer to surgery for possible biliary obstruction
D. Admit, give IV fluid while being given an antispasmodic to alleviate the pain
A (Para raw you can better visualize where the parasites are located and plan your treatment accordingly.)
95
Infant and Young Child Feeding
95) The following is true regarding Infant and Young Child Feeding Strategy
A. It is a global strategy aimed at alleviating poverty and addressing child development issues
B. It is a concerted effort to promote rational feeding practices that will impact on child survival
C. It is one of the more cost-effective strategies to reduce infant morbidity and mortality through breastfeeding and the rational use of breastmilk substitutes
D. It focuses on the infant less than 5 years of age since this is the vulnerable age where mortality due to improper feeding practices is highest and the impact is almost irreversible
B
96
96) A one month old baby girl was seen at a clinic for well baby check up. She was born full term with a birth weight of 3 kg to a primigravid. The baby is being exclusively breastfed since birth. Presently she weighs 3.2 kg. The mother admits that she is having difficulty with how the baby is being fed. She seems always hungry but only sucks for a few minutes. The mother developed sore and cracked nipples already in the process. You instructed the mother to continue breastfeeding and assured her that
A. The baby is gaining weight adequately
B. The success of breastfeeding is dependent on proper latching which should be observed in the clinic
C. Breastfeeding should not be painful and she has to wait for the milk to come out before starting breastfeeding
D. Frequent on demand feeding should be observed and that the baby should be fed every two to three hours, even awakening her from sleep if it is already time for feeding
B
97
97) Problems during lactation can arise and should be managed accordingly
A. Sore nipples is a consequence of poor latching on
B. Cracked nipples are managed by applying creams or ointments to lessen the pain and swelling
C. If one or both breasts become painful or inflamed, then mixed feeding with infant formula can be tried while the breasts are healing
D. Breastmilk jaundice is managed with the giving of medications that increase bile flow
A
98
98) A mother comes to you with a baby who is nearing six months of age. She is being full breastfed and mother wants to know how to feed other foods. The following will be one of the pieces of advice that you will give
A. Complementary feeding needs to be started when the baby is ready for it, even if the baby is more than 6 months of age
B. Start feeding when the baby is able to sit, starting with blenderized family foods
C. Give 2-3 tablespoons of rice porridge 3x a day, then gradually introduced mashed family foods
D. Give freshly squeezed fruit juice in between the feeds to meet the nutritional requirements for vitamin C
C
99
99) Feeding of infants is a two-way process and must involve the following
A. Feed the right amount and if he or she refuses then feeding should be forced, otherwise the baby cannot meet the nutritional requirements
B. Avoid distractions during feeding as these take away attention to eating
C. Limit feeding to one hour or until the food has been consumed
D. If the baby refuses the food offered, then do not persist since the baby will develop aversion to the particular food introduced
B
100
99) Feeding of infants is a two-way process and must involve the following
A. Feed the right amount and if he or she refuses then feeding should be forced, otherwise the baby cannot meet the nutritional requirements
B. Avoid distractions during feeding as these take away attention to eating
C. Limit feeding to one hour or until the food has been consumed
D. If the baby refuses the food offered, then do not persist since the baby will develop aversion to the particular food introduced
A
