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PP Flashcards

1
Q

Dysphagia is typically present in

Achalasia

Gastric ulcer

Acute pancreatitis

All of the above

A

Dysphagia is typically present in

Achalasia

Gastric ulcer

Acute pancreatitis

All of the above

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2
Q

“Alarm signs” necessitating endoscopy in all patients presenting with symptoms of GERD include

Loss of weight

Intensive salivation (water brash)

Persistentcough

Heartburn

A

“Alarm signs” necessitating endoscopy in all patients presenting with symptoms of GERD include

Loss of weight

Intensive salivation (water brash)

Persistentcough

Heartburn

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3
Q

Typical signs of gastroesophageal reflux disease (GERD) include

Heartburn

Regurgitation

Erucation (belching)

All of the above

A

Typical signs of gastroesophageal reflux disease (GERD) include

Heartburn

Regurgitation

Erucation (belching)

All of the above

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4
Q

“Alarm signs” necessitating endoscopy in all patients presenting with the symptoms of gastroesophageal reflux disease (GERD)

Epigastrial pain

Erucation (belching)

GIbleeding

Heartburn

A

“Alarm signs” necessitating endoscopy in all patients presenting with the symptoms of gastroesophageal reflux disease (GERD)

Epigastrial pain

Erucation (belching)

GI bleeding

Heartburn

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5
Q

A 60-year-old man presenting with typical signs and symptoms of GERD requires

Esophageal pH recording without endoscopy and treatment with proton pump inhibitors

Endoscopic evaluation and treatment with proton pump inhibitors

Empiric treatment with proton pump inhibitors, re-evaluation of symptoms after 4 weeks

and endoscopy if symptoms persist

Endoscopic evaluation, esophageal pH recording and treatment with proton pump

inhibitors.

A

A 60-year-old man presenting with typical signs and symptoms of GERD requires

Esophageal pH recording without endoscopy and treatment with proton pump inhibitors

Endoscopic evaluation and treatment with proton pump inhibitors

Empiric treatment with proton pump inhibitors, re-evaluation of symptoms after 4 weeks and endoscopy if symptoms persist

Endoscopic evaluation, esophageal pH recording and treatment with proton pump

inhibitors.

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6
Q

A 25-year-old man presenting with typical signs and symptoms of GERD requires

Endoscopic evaluation and treatment with proton pump inhibitors

Esophageal pH recording without endoscopy and treatment with proton pump inhibitors

Empiric treatment with proton pump inhibitors, without endoscopy, and later re-

evaluation of symptoms

Endoscopic evaluation, esophageal pH recording and treatment with proton pump

inhibitors.

A

A 25-year-old man presenting with typical signs and symptoms of GERD requires

Endoscopic evaluation and treatment with proton pump inhibitors

Esophageal pH recording without endoscopy and treatment with proton pump inhibitors

Empiric treatment with proton pump inhibitors, without endoscopy, and later re-evaluation of symptoms

Endoscopic evaluation, esophageal pH recording and treatment with proton pump

inhibitors.

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7
Q

Diagnosis of gastroesophageal reflux disease may include

Endoscopy

Esophageal pH recording

Esophageal manometry

All of the above

A

Diagnosis of gastroesophageal reflux disease may include

Endoscopy

Esophageal pH recording

Esophageal manometry

All of the above

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8
Q

Extraesophageal symptoms of gastroesophageal reflux disease (GERD) include the following, EXCEPT

Asthma bronchiale

Dental caries

Pernicious anemia

Laryngitis

A

Extraesophageal symptoms of gastroesophageal reflux disease (GERD) include the following, EXCEPT

Asthma bronchiale

Dental caries

Pernicious anemia

Laryngitis

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9
Q

In a patient presenting with typical signs of gastroesophageal reflux disease (GERD) endoscopy reveals no signs of esophagitis. To confirm reflux disease, the next diagnostic step would be…

Esophageal manometry

Esophageal pH recording

Contrast radiography

Endoscopic ultrasound

A

In a patient presenting with typical signs of gastroesophageal reflux disease (GERD) endoscopy reveals no signs of esophagitis. To confirm reflux disease, the next diagnostic step would be…

Esophageal manometry

Esophageal pH recording

Contrast radiography

Endoscopic ultrasound

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10
Q

To confirm reflux disease, the following diagnostic steps can be taken, except:

Esophageal manometry

Esophageal pH recording

Endoscopicultrasound

Multichannel intraluminal impedance

A

To confirm reflux disease, the following diagnostic steps can be taken, except:

Esophageal manometry

Esophageal pH recording

Endoscopic ultrasound

Multichannel intraluminal impedance

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11
Q

Esophageal manometry allows…

Visualization of the mucous membrane of the esophagus

Recording pH of the esophagus

Measurement of pressure in the esophagus and of the LES (lower esophageal sphincter)

All of the above

A

Esophageal manometry allows…

Visualization of the mucous membrane of the esophagus

Recording pH of the esophagus

Measurement of pressure in the esophagus and of the LES (lower esophageal sphincter)

All of the above

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12
Q

Predisposing factors to gastroesophageal reflux disease (GERD) include the following, EXCEPT…

Increased pressure of lower esophageal sphincter (LES)

Impaired clearance of esophagus

Hiatus hernia

Decreased gastric motility

A

Predisposing factors to gastroesophageal reflux disease (GERD) include the following, EXCEPT…

Increased pressure of lower esophageal sphincter (LES)

Impaired clearance of esophagus

Hiatus hernia

Decreased gastric motility

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13
Q

Treatment of gastroesophageal reflux disease (GERD) may include…

Prokinetics

Proton pump inhibitors

Lifestyle changes, such as avoiding alcohol, mint and chocolate

Any of the above

A

Treatment of gastroesophageal reflux disease (GERD) may include…

Prokinetics

Proton pump inhibitors

Lifestyle changes, such as avoiding alcohol, mint and chocolate

Any of the above

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14
Q

Barrett esophagus refers to …

typically intestinal metaplasia in the esophagus

impaired relaxation of the lower esophageal sphincter

diffuse spasm of the esophagus

ulceration of the esophagus

A

Barrett esophagus refers to …

typically intestinal metaplasia in the esophagus

impaired relaxation of the lower esophageal sphincter

diffuse spasm of the esophagus

ulceration of the esophagus

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15
Q

Barrett esophagus can be diagnosed with…

Esophageal pH monitoring

Endoscopy and biopsy

Esophageal manomentry

Any of the above

A

Barrett esophagus can be diagnosed with…

Esophageal pH monitoring

Endoscopy and biopsy

Esophageal manomentry

Any of the above

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16
Q

Barrett esophagus always requires…

Immediate operation

Regular endoscopic screening

Regular contrast radiography

All of the above

A

Barrett esophagus always requires…

Immediate operation

Regular endoscopic screening

Regular contrast radiography

All of the above

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17
Q

Barrett’s metaplasia increases the risk of…

Esophageal adenocarcinoma

Pepticulcer

Pernicious anemia

Achalasia

A

Barrett’s metaplasia increases the risk of…

Esophageal adenocarcinoma

Pepticulcer

Pernicious anemia

Achalasia

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18
Q

During the diagnostic evaluation of achalasia ……… should be carried out.

Endoscopic ultrasound

Esophageal manometry

pH monitoring of the esophagus

All of the above

A

During the diagnostic evaluation of achalasia ……… should be carried out.

Endoscopic ultrasound

Esophageal manometry

pH monitoring of the esophagus

All of the above

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19
Q

“Classic” achalasia refers to…

Increased tone of the lower esophageal sphincter

Increased peristalsis of the distal esophagus

Increased tone of the upper esophageal sphincter

All of the above

A

“Classic” achalasia refers to…

Increased tone of the lower esophageal sphincter

Increased peristalsis of the distal esophagus

Increased tone of the upper esophageal sphincter

All of the above

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20
Q

Typical signs and symptoms of achalasia, EXCEPT…

Chest pain

Weight loss

Regurgitation

GIbleeding

A

Typical signs and symptoms of achalasia, EXCEPT…

Chest pain

Weight loss

Regurgitation

GIbleeding

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21
Q

A 40-year-old man presents with the symptoms of burning epigastrial pain that appears usually at night, aggravated by alcohol or coffee and relieved by eating. His appetite is maintained, belching and bloating are absent. This clinical presentation is highly suspicious to…

A. Duodenal ulcer
B. Gastric tumor
C. Gastric ulcer
D. Functional dyspepsia

A

A 40-year-old man presents with the symptoms of burning epigastrial pain that appears usually at night, aggravated by alcohol or coffee and relieved by eating. His appetite is maintained, belching and bloating are absent. This clinical presentation is highly suspicious to…

A. Duodenal ulcer
B. Gastric tumor
C. Gastric ulcer
D. Functional dyspepsia

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22
Q

Achalasia is typically caused by…

the loss of neurons in the myenteric plexus

intestinal metaplasia of the esophagus

infectious esophagitis

hiatus hernia

A

Achalasia is typically caused by…

the loss of neurons in the myenteric plexus

intestinal metaplasia of the esophagus

infectious esophagitis

hiatus hernia

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23
Q

Barium X-ray showing dilated esophagus with a beak-like narrowing of the lower esophageal sphincter is typical in

Barrett’s metaplasia

Achalasia

Diffuse esophageal spasm

A

Barium X-ray showing dilated esophagus with a beak-like narrowing of the lower esophageal sphincter is typical in

Barrett’s metaplasia

Achalasia

Diffuse esophageal spasm

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24
Q

The diagnosis of diffuse esophageal spasm requires

Manometry

pH recording of the esophagus

Endoscopy

Any of the above

A

The diagnosis of diffuse esophageal spasm requires

Manometry

pH recording of the esophagus

Endoscopy

Any of the above

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25
Q

Signs of Candida esophagitis can include…

Odynophagia

Dysphagia

Substernal pain

Any of the above

A

Signs of Candida esophagitis can include…

Odynophagia

Dysphagia

Substernal pain

Any of the above

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26
Q

Mallory-Weiss syndrome refers to

Hemorrhages from lacerations of the cardiac orifice of the stomach due to vomiting

Rupture of the esophagus due to excessive vomiting

Bleeding due to corrosive injury of the esophagus

Variceal bleeding of the esophagus

A

Mallory-Weiss syndrome refers to

Hemorrhages from lacerations of the cardiac orifice of the stomach due to vomiting

Rupture of the esophagus due to excessive vomiting

Bleeding due to corrosive injury of the esophagus

Variceal bleeding of the esophagus

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27
Q

Typical symptoms of pill esophagitis includeA. Waterbrash (excessive salivation)
B. Odynophagia
C. Vomiting

D. GIbleeding

A

Typical symptoms of pill esophagitis include

A. Waterbrash (excessive salivation)
B. Odynophagia
C. Vomiting

D. GIbleeding

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28
Q

Boerhaave syndrome refers to

Hemorrhages from lacerations of the cardiac orifice of the stomach due to vomiting

Rupture of the esophagus due to excessive vomiting

Intestinal metaplasia of the esophagus

Variceal bleeding of the esophagus

A

Boerhaave syndrome refers to

Hemorrhages from lacerations of the cardiac orifice of the stomach due to vomiting

Rupture of the esophagus due to excessive vomiting

Intestinal metaplasia of the esophagus

Variceal bleeding of the esophagus

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29
Q

Odynophagia refers to

pain either caused by or exacerbated by swallowing

the perception of a lump or fullness in the throat that is felt irrespective of swallowing

a feeling of food “sticking” or even lodging in the chest

a behavior in which recently swallowed food is regurgitated and then re-swallowed

repetitively

A

Odynophagia refers to

pain either caused by or exacerbated by swallowing

the perception of a lump or fullness in the throat that is felt irrespective of swallowing

a feeling of food “sticking” or even lodging in the chest

a behavior in which recently swallowed food is regurgitated and then re-swallowed

repetitively

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30
Q

Globus sensation refers to

pain either caused by or exacerbated by swallowing

the perception of a lump or fullness in the throat that is felt irrespective of swallowing

a feeling of food “sticking” or even lodging in the chest

a behavior in which recently swallowed food is regurgitated and then re-swallowed

repetitively

A

Globus sensation refers to

pain either caused by or exacerbated by swallowing

the perception of a lump or fullness in the throat that is felt irrespective of swallowing

a feeling of food “sticking” or even lodging in the chest

a behavior in which recently swallowed food is regurgitated and then re-swallowed

repetitively

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31
Q

Rumination refers to…

pain either caused by or exacerbated by swallowing

the perception of a lump or fullness in the throat that is felt irrespective of swallowing

a feeling of food “sticking” or even lodging in the chest

D. a behavior in which recently swallowed food is regurgitated and then re-swallowed repetitively

A

Rumination refers to…

pain either caused by or exacerbated by swallowing

the perception of a lump or fullness in the throat that is felt irrespective of swallowing

a feeling of food “sticking” or even lodging in the chest

D. a behavior in which recently swallowed food is regurgitated and then re-swallowed repetitively

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32
Q

Acute gastritis is often caused by…A. Excessive alcohol consumption B. NSAID abuse
C. Infections

D. Any of the above

A

Acute gastritis is often caused by…
A. Excessive alcohol consumption
B. NSAID abuse
C. Infections

D. Any of the above

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33
Q

Autoantibodies typically found in autoimmune gastritis

ANCA

Anti ds-DNA

Autoantibodies against the intrinsic factor

All of the above

A

Autoantibodies typically found in autoimmune gastritis

ANCA

Anti ds-DNA

Autoantibodies against the intrinsic factor

All of the above

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34
Q

Biopsy is always required in…

Gastric ulcers

Duodenal ulcers

Both conditions

Neither condition

A

Biopsy is always required in…

Gastric ulcers

Duodenal ulcers

Both conditions

Neither condition

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35
Q

Pain associated with gastric ulcer typically appears…

At night

Rapidly after eating

Aftervomiting

All of the above

A

Pain associated with gastric ulcer typically appears…

At night

Rapidly after eating

Aftervomiting

All of the above

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36
Q

Typical signs of gastric ulcer

Epigastric pain

Nausea

Loss of weight

All of the above

A

Typical signs of gastric ulcer

Epigastric pain

Nausea

Loss of weight

All of the above

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37
Q

Pain associated with duodenal ulcer typically appears…

rapidly after eating

at night

in a constant manner

any of the above

A

Pain associated with duodenal ulcer typically appears…

rapidly after eating

at night

in a constant manner

any of the above

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38
Q

Frequent finding during physical examination in patients with peptic ulcer…

Epigastric tenderness

Jaundice

Muscular defense

Absent liver dullness

A

Frequent finding during physical examination in patients with peptic ulcer…

Epigastric tenderness

Jaundice

Muscular defense

Absent liver dullness

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39
Q

Complications of peptic ulcers include…

Acute pancreatitis

Gastric outlet obstruction

Pernicious anemia

Any of the above

A

Complications of peptic ulcers include…

Acute pancreatitis

Gastric outlet obstruction

Pernicious anemia

Any of the above

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40
Q

Absent liver dullness in a person with peptic ulcer indicates

Gastric outlet obstruction

Gastrointestinal bleeding

Perforation

Concomitant hepatitis

A

Absent liver dullness in a person with peptic ulcer indicates

Gastric outlet obstruction

Gastrointestinal bleeding

Perforation

Concomitant hepatitis

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41
Q

Transmission of Helicobacter pylori includes…

Animal-to-human transmission (zoonosis)

Human-to-human fecal-oral transmission

Human-to-human airborne transmission

Any of the above

A

Transmission of Helicobacter pylori includes…

Animal-to-human transmission (zoonosis)

Human-to-human fecal-oral transmission

Human-to-human airborne transmission

Any of the above

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42
Q

Helicobacter pylori prevalence is…

higher in the young than in older individuals

higher in developing countries than in industrialized countries

higher in men than in women

all the above are true

A

Helicobacter pylori prevalence is…

higher in the young than in older individuals

higher in developing countries than in industrialized countries

higher in men than in women

all the above are true

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43
Q

Screening for H. pylori …

is suggested in the general population

may be performed with urea breath test

both statements are true

neither statement is true

A

Screening for H. pylori …

is suggested in the general population

may be performed with urea breath test

both statements are true

neither statement is true

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44
Q

Urea breath test is used to screen for…

H. pylori infection

Lactose intolerance

Perniciousanemia

Celiac disease

A

Urea breath test is used to screen for…

H. pylori infection

Lactose intolerance

Perniciousanemia

Celiac disease

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45
Q

Schilling’s test is used to screen for…

H. pylori infection

Lactose intolerance

Pernicious anemia

Chronic pancreatitis

A

Schilling’s test is used to screen for…

H. pylori infection

Lactose intolerance

Pernicious anemia

Chronic pancreatitis

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46
Q

Non-invasive screening for H. pylori infection may be performed using…

Rapid urease test

Urea breath test

Biopsystaining

Any of the above

A

Non-invasive screening for H. pylori infection may be performed using…

Rapid urease test

Urea breath test

Biopsystaining

Any of the above

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47
Q

Potential treatment regimen of H. pylori infection
A. Proton pump inhibitor + ranitidin bismuth citrate
B. Amoxicillin + clarithromycin + metronidazole
C. Proton pump inhibitor + clarithromycin + metronidazoleD. Proton pump inhibitor + metronidazole

A

Potential treatment regimen of H. pylori infection
A. Proton pump inhibitor + ranitidin bismuth citrate
B. Amoxicillin + clarithromycin + metronidazole
C. Proton pump inhibitor + clarithromycin + metronidazole

D. Proton pump inhibitor + metronidazole

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48
Q

Treatment duration of the antibiotic treatment for H. pylori eradication

3-5 days

7-14 days

1-2 months

lifelong

A

Treatment duration of the antibiotic treatment for H. pylori eradication

3-5 days

7-14 days

1-2 months

lifelong

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49
Q

Potential treatment regimen of H. pylori eradication

Proton pump inhibitor + amoxicillin + clarithromycin

Ranitidin-bismuth citrate + metronidazole

Proton pump inhibitor + bismuth subsalicilate + tetracyclin

Proton pump inhibitor + amoxicillin + clindamycin

A

Potential treatment regimen of H. pylori eradication

Proton pump inhibitor + amoxicillin + clarithromycin

Ranitidin-bismuth citrate + metronidazole

Proton pump inhibitor + bismuth subsalicilate + tetracyclin

Proton pump inhibitor + amoxicillin + clindamycin

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50
Q

Successful eradication of H. pylori can be proved using urea breath test…

immediately after eradication treatment

one month after eradication treatment and stopping PPI treatment

one month after eradication treatment while the person is still on PPI treatment

eradication can be proved only with repeated endoscopy and rapid urease test

A

Successful eradication of H. pylori can be proved using urea breath test…

immediately after eradication treatment

one month after eradication treatment and stopping PPI treatment

one month after eradication treatment while the person is still on PPI treatment

eradication can be proved only with repeated endoscopy and rapid urease test

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51
Q

Endoscopy reveals gastric ulcer in a person with potential H. pylori infection. The easiest and most rapid way to diagnose H. pylori infection in this case is…
A. Biopsy rapid urease test
B. Serology

C. Culture
D. Urea breath test

A

Endoscopy reveals gastric ulcer in a person with potential H. pylori infection. The easiest and most rapid way to diagnose H. pylori infection in this case is…
A. Biopsy rapid urease test
B. Serology

C. Culture
D. Urea breath test

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52
Q

Treatment of peptic ulcer may include the following, EXCEPT…

NSAIDS to relieve pain

Sucralfat

H2 receptor antagonists

Proton pump inhibitors

A

Treatment of peptic ulcer may include the following, EXCEPT…

NSAIDS to relieve pain

Sucralfat

H2 receptor antagonists

Proton pump inhibitors

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53
Q

The gold standard method of diagnosing peptic ulcer

Endoscopy

Double-contrast barium study

Abdominal CT

Abdominal ultrasound

A

The gold standard method of diagnosing peptic ulcer

Endoscopy

Double-contrast barium study

Abdominal CT

Abdominal ultrasound

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54
Q

Select the FALSE statement about afferent loop syndrome

It may develop in patients undergone partial gastric resection with Billroth II anastomosis

It may be due to bacterial overgrowth in the afferent loop

It may be due to incomplete drainage of bile and pancreatic secretions from the afferent

loop that is partially obstructed

It is explained by rapid emptying of hyperosmolar gastric contents into the small

intestine.

A

Select the FALSE statement about afferent loop syndrome

It may develop in patients undergone partial gastric resection with Billroth II anastomosis

It may be due to bacterial overgrowth in the afferent loop

It may be due to incomplete drainage of bile and pancreatic secretions from the afferent

loop that is partially obstructed

It is explained by rapid emptying of hyperosmolar gastric contents into the small intestine.

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55
Q

Early dumping syndrome is due to…

bacterial overgrowth in the afferent loop

incomplete drainage of bile and pancreatic secretions from the afferent loop that is

partially obstructed

rapid emptying of hyperosmolar gastric contents into the small intestine

D. hypoglycemia from excessive insulin release

A

Early dumping syndrome is due to…

bacterial overgrowth in the afferent loop

incomplete drainage of bile and pancreatic secretions from the afferent loop that is

partially obstructed

rapid emptying of hyperosmolar gastric contents into the small intestine

D. hypoglycemia from excessive insulin release

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56
Q

Late dumping syndrome is due to…

bacterial overgrowth in the afferent loop

incomplete drainage of bile and pancreatic secretions from the afferent loop that is

partially obstructed

rapid emptying of hyperosmolar gastric contents into the small intestine

hypoglycemia from excessive insulin release

A

Late dumping syndrome is due to…

bacterial overgrowth in the afferent loop

incomplete drainage of bile and pancreatic secretions from the afferent loop that is

partially obstructed

rapid emptying of hyperosmolar gastric contents into the small intestine

hypoglycemia from excessive insulin release

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57
Q

Zollinger-Ellison syndrome refers to severe peptic ulcer formation due to…

H. pylori infection

Autoimmune origin

NSAID abuse

gastrinoma

A

Zollinger-Ellison syndrome refers to severe peptic ulcer formation due to…

H. pylori infection

Autoimmune origin

NSAID abuse

gastrinoma

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58
Q

Diagnostic procedure of Zollinger-Ellison syndrome includes the following, EXCEPT…

Measurement of fasting serum gastrin levels

Urea breath test

OctreoScan

Assessment of acid secretion

A

Diagnostic procedure of Zollinger-Ellison syndrome includes the following, EXCEPT…

Measurement of fasting serum gastrin levels

Urea breath test

OctreoScan

Assessment of acid secretion

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59
Q

The most common cause of chronic gastroparesis

H. pylori infection

Diabetes mellitus

Hypothyroidism

Scleroderma

A

The most common cause of chronic gastroparesis

H. pylori infection

Diabetes mellitus

Hypothyroidism

Scleroderma

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60
Q

Typical signs and symptoms of gastroparesis, EXCEPTA. GIbleeding
B. Vomiting
C. Earlysatiety

D. Loss of weight

A

Typical signs and symptoms of gastroparesis, EXCEPTA.

GIbleeding
B. Vomiting
C. Earlysatiety

D. Loss of weight

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61
Q

Treatment of gastroparesis includes the following

Prokinetic agents

Antiemetics

Gastric pacemaker

Any of the above

A

Treatment of gastroparesis includes the following

Prokinetic agents

Antiemetics

Gastric pacemaker

Any of the above

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62
Q

Pernicious anemia…

necessitates endoscopic evaluation of the stomach

is associated with increased risk of gastric cancer

may be diagnosed using the Schilling’s test

All statements are true.

A

Pernicious anemia…

necessitates endoscopic evaluation of the stomach

is associated with increased risk of gastric cancer

may be diagnosed using the Schilling’s test

All statements are true.

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63
Q

A 35-year-old female presents with the longstanding and unchanged symptoms of abdominal discomfort, early satiety, nausea, belching and bloating. Her weight is constant. This clinical presentation is highly suspicious to…
A. Gastric ulcer

B. Gastric tumor

C. Crohn’s diseaes
D. Functional dyspepsia

A

A 35-year-old female presents with the longstanding and unchanged symptoms of abdominal discomfort, early satiety, nausea, belching and bloating. Her weight is constant. This clinical presentation is highly suspicious to…
A. Gastric ulcer

B. Gastric tumor

C. Crohn’s diseaes
D. Functional dyspepsia

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64
Q

Hypertensive gastropathy is a common consequence of…A. Cirrhosis
B. Systemic hypertension
C. H. pylori infection

D. GERD

A

Hypertensive gastropathy is a common consequence of…

A. Cirrhosis
B. Systemic hypertension
C. H. pylori infection

D. GERD

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65
Q

H2 breath test is used to screen for…A. Lactose intolerance
B. H.pyloriinfection
C. Chronicpancreatitis

D. Pernicious anemia

A

H2 breath test is used to screen for…

A. Lactose intolerance

B. H.pyloriinfection
C. Chronicpancreatitis

D. Pernicious anemia

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66
Q

Lactose intolerance…
A. Is often congenital
B. Isequivalenttomilkallergy
C. IstypicallyassociatedwithsteatorrheaD. None of the above

A

Lactose intolerance…
A. Is often congenital
B. Isequivalenttomilkallergy
C. Istypicallyassociatedwithsteatorrhea

D. None of the above

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67
Q

Treatment of lactose intolerance includes the dietary elimination of…A. milk
B. fructose
C. gluten

D. all the above

A

Treatment of lactose intolerance includes the dietary elimination of…

A. milk
B. fructose
C. gluten

D. all the above

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68
Q

Signs and symptoms of lactose intolerance include the following, EXCEPT…A. Flatulence
B. Abdominal distension and bloating
C. Bloody diarrhea

D. Cramping abdominal pain

A

Signs and symptoms of lactose intolerance include the following, EXCEPT…

A. Flatulence
B. Abdominal distension and bloating
C. Bloody diarrhea

D. Cramping abdominal pain

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69
Q

Select the FALSE statement about celiac disease!
A. Signs and symptoms include steatorrhea and weight lossB. Signsandsymptomsalwaysmanifestinchildhood
C. Manypatientsareasymptomatic.
D. It may cause iron or folate deficiency

A

Select the FALSE statement about celiac disease!
A. Signs and symptoms include steatorrhea and weight loss
B. Signs and symptoms always manifest in childhood
C. Manypatientsareasymptomatic.
D. It may cause iron or folate deficiency

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70
Q

Autoantibodies typically found in celiac diseaseA. ANCA
B. Anti-tissuetransglutaminase(tTG)
C. Autoantibodiesagainstintrinsicfactor

D. All of the above

A

Autoantibodies typically found in celiac diseaseA. ANCA
B. Anti-tissuetransglutaminase(tTG)
C. Autoantibodiesagainstintrinsicfactor

D. All of the above

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71
Q

Diet of a person diagnosed with celiac diseaseA. Wheat
B. Barley
C. Maize

D.Rye

A

Diet of a person diagnosed with celiac disease

A. Wheat
B. Barley
C. Maize

D.Rye

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72
Q

Celiac disease may be associated withA. alopecia areata
B. Dermatitis herpetiformis
C. type 1 diabetes mellitus

D. any of the above

A

Celiac disease may be associated with

A. alopecia areata
B. Dermatitis herpetiformis
C. type 1 diabetes mellitus

D. any of the above

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73
Q

The gold standard diagnostic procedure in celiac diseaseA. Demonstration of ANCA
B. Duodenal endoscopy and biopsy
C. Schilling’s test

D. H2 breath test

A

The gold standard diagnostic procedure in celiac disease

A. Demonstration of ANCA
B. Duodenal endoscopy and biopsy
C. Schilling’s test

D. H2 breath test

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74
Q

Treatment of celiac disease includes…
A. Decreased intake of gluten-containing foodB. Temporary gluten-free diet
C. Permanent gluten-free diet
D. Surgical removal of the duodenum

A

Treatment of celiac disease includes…
A. Decreased intake of gluten-containing foodB. Temporary gluten-free diet
C. Permanent gluten-free diet
D. Surgical removal of the duodenum

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75
Q

An abnormal D-xylose test in a person with steatorrhea suggests…A. Exocrine pancreatic insufficiency
B. Smallbowelmucosaldisease
C. Bothconditions

D. Neither condition

A

An abnormal D-xylose test in a person with steatorrhea suggests…

A. Exocrine pancreatic insufficiency
B. Small bowel mucosal disease
C. Bothconditions

D. Neither condition

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76
Q

Savary-Miller and Los Angeles staging refers to stages of…A. Acute pancreatitis
B. Gastroesophageal reflux disease (GERD)
C. Pepticulcer

D. Colon cancer

A

Savary-Miller and Los Angeles staging refers to stages of…A. Acute pancreatitis
B. Gastroesophageal reflux disease (GERD)
C. Pepticulcer

D. Colon cancer

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77
Q

Signs of small-bowel bacterial overgrowth include…A. Bloating
B. Steatorrhea
C. Flatulence

D. Any of the above

A

Signs of small-bowel bacterial overgrowth include…A. Bloating
B. Steatorrhea
C. Flatulence

D. Any of the above

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78
Q

Risk factors for small bowel bacterial overgrowth include…

anatomic alterations of the stomach / small intestine

Intestinal motility disorders

achlorhydria

all of the abov

A

Risk factors for small bowel bacterial overgrowth include…

anatomic alterations of the stomach / small intestine

Intestinal motility disorders

achlorhydria

all of the above

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79
Q

The Rome criteria are used to diagnose…A. Inflammatory bowel disease
B. Irritable bowel syndrome
C. Gastroesophageal reflux disease (GERD)D. Malabsorption syndrome

A

The Rome criteria are used to diagnose..

.A. Inflammatory bowel disease
B. Irritable bowel syndrome
C. Gastroesophageal reflux disease (GERD)D. Malabsorption syndrome

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80
Q

Select the true statement about Whipple disease!

It is a common condition, affecting 2-5% of the population in developing countries.

It is caused by parasitic infection of the GI tract.

It usually presents with diarrhea, arthralgia and weight loss.

Untreated cases have good prognosis.

A

Select the true statement about Whipple disease!

It is a common condition, affecting 2-5% of the population in developing countries.

It is caused by parasitic infection of the GI tract.

It usually presents with diarrhea, arthralgia and weight loss.

Untreated cases have good prognosis.

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81
Q

Clinical manifestation of ulcerative colitis typically includes…

Small bowel involvement

Gross rectal bleeding

Significant perianal lesions

Epitheloid granulomas

A

Clinical manifestation of ulcerative colitis typically includes…

Small bowel involvement

Gross rectal bleeding

Significant perianal lesions

Epitheloid granulomas

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82
Q

In Crohn’s disease…

Endoscopic appearance is patchy, with discrete ulcerations separated by segments of normal-appearing mucosa.

Inflammationisconfinedtomucosaexceptinseverecases.

Significant perianal lesions never occur.

All statements are true.

A

In Crohn’s disease…

Endoscopic appearance is patchy, with discrete ulcerations separated by segments of normal-appearing mucosa.

Inflammationisconfinedtomucosaexceptinseverecases.

Significant perianal lesions never occur.

All statements are true.

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83
Q

Cigarette smoking decreases the risk of…

Crohn’s disease

Ulcerative colitis

Both disorders

Neither disorder

A

Cigarette smoking decreases the risk of…

Crohn’s disease

Ulcerative colitis

Both disorders

Neither disorder

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84
Q

Extraintestinal disorders that usually parallel (i.e., wax and wane) with IBD flare-ups,

EXCEPT

erythema nodosum

peripheral arthropathy (type I)

erythema multiforme

aphtous stomatiti

A

Extraintestinal disorders that usually parallel (i.e., wax and wane) with IBD flare-ups,

EXCEPT

erythema nodosum

peripheral arthropathy (type I)

erythema multiforme

aphtous stomatiti

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85
Q

A 80-year-old man presenting with painless rectal bleeding (hematochezia) is highly

suggestive to…

diverticulosis

acute appendicitis

ulcerative colitis

duodenal ulceration

A

A 80-year-old man presenting with painless rectal bleeding (hematochezia) is highly

suggestive to…

diverticulosis

acute appendicitis

ulcerative colitis

duodenal ulceration

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86
Q

Extraintestinal disorders that are clearly associated with IBD but appear independently of IBD

activity include

ankylosing spondilitis

rheumatoid arthritis

Reiter’s syndrome

D. All of the above

A

Extraintestinal disorders that are clearly associated with IBD but appear independently of IBD

activity include

ankylosing spondilitis

rheumatoid arthritis

Reiter’s syndrome

D. All of the above

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87
Q

In Crohn’s disease…

Colonic involvement is usually left-sided

Gross rectal bleeding is always present

Inflammation is uniform and difuse

Microscopic inflammation and fissuring extend transmurally.

A

In Crohn’s disease…

Colonic involvement is usually left-sided

Gross rectal bleeding is always present

Inflammation is uniform and difuse

Microscopic inflammation and fissuring extend transmurally.

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88
Q

Typical initial symptoms of Crohn’s disease include the following…

abdominal pain

anorexia

fever

any of the above

A

Typical initial symptoms of Crohn’s disease include the following…

abdominal pain

anorexia

fever

any of the above

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89
Q

The most common autoantibodies in Crohn’s disease

Anti–Saccharomyces cerevisiae antibodies

ANCA

Anti-tissue transglutaminase(anti-tTG)

All of the above

A

The most common autoantibodies in Crohn’s disease

Anti–Saccharomyces cerevisiae antibodies

ANCA

Anti-tissue transglutaminase(anti-tTG)

All of the above

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90
Q

First-line treatment in mild Crohn’s disease localized to the ileum includes…

azathioprine

budesonide

iv. corticosteroids

anti-TNF alfa agents

A

First-line treatment in mild Crohn’s disease localized to the ileum includes…

azathioprine

budesonide

iv. corticosteroids

anti-TNF alfa agents

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91
Q

First-line treatment in moderate-to-severe Crohn’s disease includes…

5-ASA (mesalamin)

anti-CD20 agents

cyclophosphamide and iv. corticosteroids

oral corticosteroids

A

First-line treatment in moderate-to-severe Crohn’s disease includes…

5-ASA (mesalamin)

anti-CD20 agents

cyclophosphamide and iv. corticosteroids

oral corticosteroids

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92
Q

Maintenance therapy in Crohn’s disease typically includes the following agents, EXCEPT

Systemic corticosteroids

Azathioprine

Infliximab

Adalimuma

A

Maintenance therapy in Crohn’s disease typically includes the following agents, EXCEPT

Systemic corticosteroids

Azathioprine

Infliximab

Adalimuma

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93
Q

Signs of toxic or fulminant colitis typically include…A) Constipation
B) High fever
C) Jaundice

D) All of the above

A

Signs of toxic or fulminant colitis typically include…A) Constipation
B) High fever
C) Jaundice

D) All of the above

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94
Q

Signs of toxic or fulminant colitis typically include…A) Rebound tenderness
B) Sudden violent diarrhea
C) Abdominal pain

D) All of the above

A

Signs of toxic or fulminant colitis typically include…A) Rebound tenderness
B) Sudden violent diarrhea
C) Abdominal pain

D) All of the above

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95
Q

The most common autoantibodies in ulcerative colitis

Anti–Saccharomyces cerevisiae (ASCA) antibodies

ANCA

Anti-tissue transglutaminase(anti-tTG)

Antinuclear antibodies

A

The most common autoantibodies in ulcerative colitis

Anti–Saccharomyces cerevisiae (ASCA) antibodies

ANCA

Anti-tissue transglutaminase(anti-tTG)

Antinuclear antibodies

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96
Q

In fulminant ulcerative colitis the following diagnostic approach is suggested

Abdominal X-ray or abdominal CT

Colonoscopy

Barium enema

All of the above

A

In fulminant ulcerative colitis the following diagnostic approach is suggested

Abdominal X-ray or abdominal CT

Colonoscopy

Barium enema

All of the above

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97
Q

Treatment of patients with mild, left-sided ulcerative colitis typically includes…

Mesalamin (5-ASA) enemas

Systemic corticosteroids

Azathioprine

Anti-TNF drug

A

Treatment of patients with mild, left-sided ulcerative colitis typically includes…

Mesalamin (5-ASA) enemas

Systemic corticosteroids

Azathioprine

Anti-TNF drug

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98
Q

Biologic therapy in inflammatory bowel diseases includes…

Anti-CD20 monoclonal antibodies

mTOR-inhibitors

anti-TNF alfa drugs

IL-1-receptor antagonists

A

Biologic therapy in inflammatory bowel diseases includes…

Anti-CD20 monoclonal antibodies

mTOR-inhibitors

anti-TNF alfa drugs

IL-1-receptor antagonists

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99
Q

Treatment of patients with extensive ulcerative colitis typically includes…

oral5-ASA formulations

oral corticosteroids

azathioprine

any of the above

A

Treatment of patients with extensive ulcerative colitis typically includes…

oral5-ASA formulations

oral corticosteroids

azathioprine

any of the above

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100
Q

Patients with fulminant ulcerative colitis should receive…

Antibiotics

Antidiarrheal drugs

Azathioprine

All of the above

A

Patients with fulminant ulcerative colitis should receive…

Antibiotics

Antidiarrheal drugs

Azathioprine

All of the above

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101
Q

A 40-year-old man returning from a half-year- long Southeast Asian trip develops megaloblastic anemia and symptoms of malabsorption. This condition is highly suggestive of…

Chronic pancreatitis

Tropical sprue

Atrophic gastritis

Celiac disease

A

A 40-year-old man returning from a half-year- long Southeast Asian trip develops megaloblastic anemia and symptoms of malabsorption. This condition is highly suggestive of…

Chronic pancreatitis

Tropical sprue

Atrophic gastritis

Celiac disease

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102
Q

Surgical intervention in ulcerative colitis…

most commonly includes restorative proctocolectomy with ileal pouch-anal anastomosis

(IPAA)

Is indicated in case of massive hemorrhage or toxic megacolon.

Both statements are true.

A

Surgical intervention in ulcerative colitis…

most commonly includes restorative proctocolectomy with ileal pouch-anal anastomosis

(IPAA)

Is indicated in case of massive hemorrhage or toxic megacolon.

Both statements are true.

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103
Q

Surgical intervention in Crohn’s disease…

may be curative in case of total colectomy

is best reserved for intestinal obstruction due to long segment fibrotic stenosis or fistulas or

abscesses

is necessary only in < 1% of all patients

all statements are true

A

Surgical intervention in Crohn’s disease…

may be curative in case of total colectomy

is best reserved for intestinal obstruction due to long segment fibrotic stenosis or fistulas or abscesses

is necessary only in < 1% of all patients

all statements are true

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104
Q

Colonic diverticula

are true diverticula

are more common in people on high-fiber diet

most of them are symptomatic

become more common with aging

A

Colonic diverticula

are true diverticula

are more common in people on high-fiber diet

most of them are symptomatic

become more common with aging

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105
Q

Management of diverticulosis typically includes…

high-fiber diet

antidiarrheal drugs

antibiotics

all of the above

A

Management of diverticulosis typically includes…

high-fiber diet

antidiarrheal drugs

antibiotics

all of the above

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106
Q

Diagnosis of diverticulosis requires…

Abdominal X-ray

Angiography

Colonoscopy

None of the above

A

Diagnosis of diverticulosis requires…

Abdominal X-ray

Angiography

Colonoscopy

None of the above

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107
Q

Common findings in diverticulitis include…

rebound tenderness

nausea

fever

all of the above

A

Common findings in diverticulitis include…

rebound tenderness

nausea

fever

all of the above

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108
Q

Common findings in diverticulitis include…

abdominal pain / tenderness

melena

jaundice

all of the above

A

Common findings in diverticulitis include…

abdominal pain / tenderness

melena

jaundice

all of the above

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109
Q

The preferred method of diagnosing diverticulitis

abdominal CT

colonoscopy

barium enema

angiography

A

The preferred method of diagnosing diverticulitis

abdominal CT

colonoscopy

barium enema

angiography

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110
Q

In the majority of cases, serious diverticulitis affects the…

ascending colon

transverse colon

rectum

sigmoid colon

A

In the majority of cases, serious diverticulitis affects the…

ascending colon

transverse colon

rectum

sigmoid colon

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111
Q

Complications of diverticulitis include…

abscess formation

fistulas

free intraperitoneal perforation

all of the above

A

Complications of diverticulitis include…

abscess formation

fistulas

free intraperitoneal perforation

all of the above

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112
Q

A patient with diverticulitis develops pneumaturia. This symptom indicates…

bowel obstruction

perirectal abscess

fistula development involving the bladder

septicem

A

A patient with diverticulitis develops pneumaturia. This symptom indicates…

bowel obstruction

perirectal abscess

fistula development involving the bladder

septicem

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113
Q

In most cases, treatment of diverticulitis includes…

antibiotics

steroids

surgical intervention

all of the abov

A

In most cases, treatment of diverticulitis includes…

antibiotics

steroids

surgical intervention

all of the abov

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114
Q

Etiology of irritable bowel syndrome may include the following factors, EXCEPT.

..A. psychologic distress
B. visceral hyperalgesia
C. inflammatory bowel disease

D. exaggerated gastro-colonic reflex

A

Etiology of irritable bowel syndrome may include the following factors, EXCEPT…

A. psychologic distress
B. visceral hyperalgesia
C. inflammatory bowel disease

D. exaggerated gastro-colonic reflex

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115
Q

Typical findings in irritable bowel syndrome, EXCEPT…

A. Signs and symptoms usually begin in teens and 20s.

B. Symptoms often rouse the sleeping patients.
C. Symptoms are often triggered by food.

D. Symptoms may recur at irregular periods.

A

Typical findings in irritable bowel syndrome, EXCEPT…

A. Signs and symptoms usually begin in teens and 20s.

B. Symptoms often rouse the sleeping patients.
C. Symptoms are often triggered by food.

D. Symptoms may recur at irregular periods.

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116
Q

Signs and symptoms of irritable bowel syndrome may include…

A. Alternation of diarrhea and constipation
B. Cramping abdominal discomfort
C. Abdominal pain relieved by defecation

D. Any of the above

A

Signs and symptoms of irritable bowel syndrome may include…

A. Alternation of diarrhea and constipation
B. Cramping abdominal discomfort
C. Abdominal pain relieved by defecation

D. Any of the above

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117
Q

Signs and symptoms of irritable bowel syndrome often include…
A. steatorrhea
B. fever
C. extraintestinal symptoms (fatigue, fibromyalgia, chronic headache)

D. weight loss

A

Signs and symptoms of irritable bowel syndrome often include…
A. steatorrhea
B. fever
C. extraintestinal symptoms (fatigue, fibromyalgia, chronic headache)

D. weight loss

118
Q

Alarm signs indicating organic disease rather than irritable bowel syndrome include…A. loss of weight
B. vomiting
C. rectal bleeding

D. all of the above

A

Alarm signs indicating organic disease rather than irritable bowel syndrome include..

.A. loss of weight
B. vomiting
C. rectal bleeding

D. all of the above

119
Q

Irritable bowel syndrome…
A. is often caused by lactose intolerance
B. may result in malabsorption

​C. both statements are true
D. neither statement is true

A

Irritable bowel syndrome…
A. is often caused by lactose intolerance
B. may result in malabsorption

C. both statements are true
D. neither statement is true

120
Q

Treatment of diarrhea-predominant irritable bowel syndrome may include…A. Tricyclic antidepressants
B. Serotonine receptor modulation by 5HT4-agonists
C. Metoclopramide

D. Domperidone

A

Treatment of diarrhea-predominant irritable bowel syndrome may include…

A. Tricyclic antidepressants
B. Serotonine receptor modulation by 5HT4-agonists
C. Metoclopramide

D. Domperidone

121
Q

In irritable bowel syndrome…
A. drug therapy is directed toward the dominant symptomsB. cognitive-behavioral therapy may help some patients
C. both statements are true
D. neither statement is true

A

In irritable bowel syndrome…
A. drug therapy is directed toward the dominant symptomsB. cognitive-behavioral therapy may help some patients
C. both statements are true
D. neither statement is true

122
Q

Common nonspecific symptoms of liver disease include the following, EXCEPT

A. fatigue
B. anorexia
C. nausea

D. fever

A

Common nonspecific symptoms of liver disease include the following, EXCEPT

A. fatigue
B. anorexia
C. nausea

D. fever

123
Q

Risk factor(s) of liver disorders include

A. Alcohol
B. Transfusion
C. Drugs

D. Any of the above

A

Risk factor(s) of liver disorders include

A. Alcohol
B. Transfusion
C. Drugs

D. Any of the above

124
Q

Fever associated with liver disease isa typical feature in

A. hemochromatosis
B. acute alcoholic hepatitis
C. hepatic vein obstruction

D. none of the above

A

Fever associated with liver disease isa typical feature in

A. hemochromatosis
B. acute alcoholic hepatitis
C. hepatic vein obstruction

D. none of the above

125
Q

In a person with liver disease, the term asterixis refers to

Bilateral, asynchronous flapping of dorsiflexed hands with the arms outstretched

Sweet, pungent smell associated with end-stage liver disease

Muddy skin pigmentation and excoriations caused by constant pruritus

Visibly dilated abdominal veins

A

In a person with liver disease, the term asterixis refers to

Bilateral, asynchronous flapping of dorsiflexed hands with the arms outstretched

Sweet, pungent smell associated with end-stage liver disease

Muddy skin pigmentation and excoriations caused by constant pruritus

Visibly dilated abdominal veins

126
Q

Acute liver failure may be the consequence of

Amanita phalloides mushroom poisoning

Hepatitis B infection

Wilson’s disease

Any of the above

A

Acute liver failure may be the consequence of

Amanita phalloides mushroom poisoning

Hepatitis B infection

Wilson’s disease

Any of the above

127
Q

Acute liver failure often develops due to

Gilbert’s disease

Acetaminophen overdose

Acute pancreatitis

Any of the above

A

Acute liver failure often develops due to

Gilbert’s disease

Acetaminophen overdose

Acute pancreatitis

Any of the above

128
Q

Acute liver failure is characterized by

A. Jaundice
B. Coagulopathy
C. Encephalopathy

D. All of the above

A

Acute liver failure is characterized by

A. Jaundice
B. Coagulopathy
C. Encephalopathy

D. All of the above

129
Q

Budd-Chiari syndrome is the consequence of

hepatic vein thrombosis

portal vein thrombosis

hepaticarterythrombosis

any of the above

A

Budd-Chiari syndrome is the consequence of

hepatic vein thrombosis

portal vein thrombosis

hepaticarterythrombosis

any of the above

130
Q

Hepatic encephalopathy is typically associated with elevated level of

ammonia

urea

both of them

neither of them

A

Hepatic encephalopathy is typically associated with elevated level of

ammonia

urea

both of them

neither of them

131
Q

Treatment of acute liver failure may include the following modalities, EXCEPT

Fresh frozen plasma

Hemodialysis

Infusion of arginine hydrochloride and glutamic acid (Glutarsin)

Liver transplantation

A

Treatment of acute liver failure may include the following modalities, EXCEPT

Fresh frozen plasma

Hemodialysis

Infusion of arginine hydrochloride and glutamic acid (Glutarsin) NOT SURE

Liver transplantation

132
Q

Treatment of severe coagulopathy in acute liver failure

Fresh frozen plasma

N-acetylcystein

Infusion of arginine hydrochloride and glutamic acid (Glutarsin)

All of the above

A

Treatment of severe coagulopathy in acute liver failure

Fresh frozen plasma

N-acetylcystein

Infusion of arginine hydrochloride and glutamic acid (Glutarsin)

All of the above

133
Q

The most common cause of ascites

Budd-Chiari syndrome

Portal hypertension due to cirrhosis

Severe alcoholic hepatitis without cirrhosis

Portal vein thrombosis

A

The most common cause of ascites

Budd-Chiari syndrome

Portal hypertension due to cirrhosis

Severe alcoholic hepatitis without cirrhosis

Portal vein thrombosis

134
Q

Pathomechanism of ascites formation includes

Higher plasma oncotic pressure

decreased hepatic lymph formation

increased renal Na retention

all of the above

A

Pathomechanism of ascites formation includes

Higher plasma oncotic pressure

decreased hepatic lymph formation

increased renal Na retention

all of the above

135
Q

Pathomechanism of ascites formation includes

Increased portal venous hydrostatic pressure

Decreased renal Na retention

Increased plasma oncotic pressure

All of the above

A

Pathomechanism of ascites formation includes

Increased portal venous hydrostatic pressure

Decreased renal Na retention

Increased plasma oncotic pressure

All of the above

136
Q

A clear, straw-colored ascites with low protein concentration, low WBC count and high serum-to ascites albumin concentration gradient is a typical finding in

Spontaneous bacterial peritonitis

Portal hypertension

Lymphatic duct occlusion

Peritoneal carcinosis

A

A clear, straw-colored ascites with low protein concentration, low WBC count and high serum-to ascites albumin concentration gradient is a typical finding in

Spontaneous bacterial peritonitis

Portal hypertension

Lymphatic duct occlusion

Peritoneal carcinosis

137
Q

If the following disorder is suspected, diagnostic paracentesis should always be performed …

Acute alcoholic hepatitis

Spontaneous bacterial peritonitis

Alcoholiccirrhosis

Paracentesis should always be done if ascites is present

A

If the following disorder is suspected, diagnostic paracentesis should always be performed …

Acute alcoholic hepatitis

Spontaneous bacterial peritonitis

Alcoholiccirrhosis

Paracentesis should always be done if ascites is present

138
Q

The sound during percussion in case of ascites is …

tympanic

resonant

dull

none of the above

A

The sound during percussion in case of ascites is …

tympanic

resonant

dull

none of the above

139
Q

Treatment of ascites includes…

Dietary Na restriction

Diuretics (furosemide, spironolactone)

Both interventions

Neither intervention

A

Treatment of ascites includes…

Dietary Na restriction

Diuretics (furosemide, spironolactone)

Both interventions

Neither intervention

140
Q

Transjugular intrahepatic portosystemic shunt (TIPS) creates a connection between…A. Hepatic artery and jugular vein

Portal vein and hepatic vein

Hepatic artery and portal vein

D. Peritoneal cavity and superior vena cava

A

Transjugular intrahepatic portosystemic shunt (TIPS) creates a connection between…

A. Hepatic artery and jugular vein

Portal vein and hepatic vein

Hepatic artery and portal vein

D. Peritoneal cavity and superior vena cava

141
Q

Spontaneous bacterial peritonitis is a common consequence of…

alcoholic cirrhosis

acute appendicitis

diverticulitis

all of the above

A

Spontaneous bacterial peritonitis is a common consequence of…

alcoholic cirrhosis

acute appendicitis

diverticulitis

all of the above

142
Q

Spontaneous bacterial peritonitis is often caused by…

E.coli

S. aureus

C. difficile

Any of the above

A

Spontaneous bacterial peritonitis is often caused by…

E.coli

S. aureus

C. difficile

Any of the above

143
Q

Signs of spontaneous bacterial peritonitis include…

absent liver dullness

diffuse abdominal discomfort

diarrhea

all of the above

A

Signs of spontaneous bacterial peritonitis include…

absent liver dullness

diffuse abdominal discomfort

diarrhea

all of the above

144
Q

Diagnosis of spontaneous bacterial peritonitis is based on…

abdominal ultrasound

diagnostic paracentesis

abdominalX-ray

all of the above

A

Diagnosis of spontaneous bacterial peritonitis is based on…

abdominal ultrasound

diagnostic paracentesis

abdominalX-ray

all of the above

145
Q

Polymorphonuclear leukocyte (PMN) count in ascites indicating spontaneous bacterial peritonitis is…

A. >250/􏰞L
B. >1000/􏰞L
C. >3000/􏰞L
D. > 10 000/􏰞L

A

Polymorphonuclear leukocyte (PMN) count in ascites indicating spontaneous bacterial peritonitis is…

A. >250/􏰞L
B. >1000/􏰞L
C. >3000/􏰞L
D. > 10 000/􏰞L

146
Q

Select the true statement(s) about spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis develops if abdominal wall becomes discontinuous.

Signs of spontaneous bacterial peritonitis include worsening of hepatic failure and unexplained clinical deterioration.

All cirrhotic patients require antibiotic prophylaxis to prevent spontaneous bacterial

peritonitis.

All statements are true.

A

Select the true statement(s) about spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis develops if abdominal wall becomes discontinuous.

Signs of spontaneous bacterial peritonitis include worsening of hepatic failure and

unexplained clinical deterioration.

All cirrhotic patients require antibiotic prophylaxis to prevent spontaneous bacterial

peritonitis.

All statements are true.

147
Q

Treatment of spontaneous bacterial peritonitis includes…

A. explorative laparotomy
B. antibiotics
C. regulartherapeuticparacentesis

D. all of the above

A

Treatment of spontaneous bacterial peritonitis includes..

.A. explorative laparotomy
B. antibiotics
C. regulartherapeuticparacentesis

D. all of the above

148
Q

Non-alcoholic steatohepatitis (NASH) typically includes…

A. fat accumulation
B. inflammation
C. fibrosis

D. all of the above

A

Non-alcoholic steatohepatitis (NASH) typically includes…

A. fat accumulation
B. inflammation
C. fibrosis

D. all of the above

149
Q

Non-alcoholic steatohepatitis is often associated with

A. acetaminophen overdose
B. metabolic syndrome
C. hemochromatosis

D. hepatitisAinfection

A

Non-alcoholic steatohepatitis is often associated with

A. acetaminophen overdose
B. metabolic syndrome
C. hemochromatosis

D. hepatitisAinfection

150
Q

Complications of non-alcoholic steatohepatitis include

Cirrhosis

Wilson’s disease

Budd-Chiari syndrome

Chronic viral hepatitis

A

Complications of non-alcoholic steatohepatitis include

Cirrhosis

Wilson’s disease

Budd-Chiari syndrome

Chronic viral hepatitis

151
Q

The most common laboratory abnormalities in non-alcoholic steatohepatitis

A. Elevated transaminase levels
B. Hypalbuminemia
C. ElevatedAFPlevel

D. Decreased cholinesterase level

A

The most common laboratory abnormalities in non-alcoholic steatohepatitis

A. Elevated transaminase levels
B. Hypalbuminemia
C. ElevatedAFPlevel

D. Decreased cholinesterase level

152
Q

AST/ALT (GOT/GPT) ratio in non-alcoholic steatohepatitis is typically

A. <1
B. 1
C. >1

D. cannot be predicted

A

AST/ALT (GOT/GPT) ratio in non-alcoholic steatohepatitis is typically

A. <1
B. 1
C. >1

D. cannot be predicted

153
Q

To establish the diagnosis of non-alcoholic steatohepatitis, the following conditions should be ruled out

Alcoholism

Chronic hepatitis B infection

Chronic hepatitis C infection

All of the above

A

To establish the diagnosis of non-alcoholic steatohepatitis, the following conditions should be ruled out

Alcoholism

Chronic hepatitis B infection

Chronic hepatitis C infection

All of the above

154
Q

Common cause of unconjugated hyperbilirubinemia

Hemolysis

Viral hepatitis

Extrahepaticcholestasis

All of the above

A

Common cause of unconjugated hyperbilirubinemia

Hemolysis

Viral hepatitis

Extrahepaticcholestasis

All of the above

155
Q

Common cause of conjugated hyperbilirubinemia

Ineffective erythropoiesis

Gilbert syndrome

Alcoholic liver disease

All of the above

A

Common cause of conjugated hyperbilirubinemia

Ineffective erythropoiesis

Gilbert syndrome

Alcoholic liver disease

All of the above

156
Q

Jaundice due to hemolysis is often associated with..

.A. Acholic (clay-colored) stool
B. Conjugatedhyperbilirubinemia
C. Bilirubinuria

D. None of the above

A

Jaundice due to hemolysis is often associated with…

A. Acholic (clay-colored) stool
B. Conjugatedhyperbilirubinemia
C. Bilirubinuria

D. None of the above

157
Q

Jaundice due to Gilbert disease is often associated with…

A. Bilirubinuria
B. Acholic (clay-colored) stool

C. Unconjugated hyperbilirubinemia
D. All of the above

A

Jaundice due to Gilbert disease is often associated with…

A. Bilirubinuria
B. Acholic (clay-colored) stool

C. Unconjugated hyperbilirubinemia
D. All of the above

158
Q

Jaundice due to viral hepatitis is often associated with…

Bilirubinuria

Unconjugated hyperbilirubinemia

Acholic (clay-colored) stool

All of the above

A

Jaundice due to viral hepatitis is often associated with…

Bilirubinuria

Unconjugated hyperbilirubinemia

Acholic (clay-colored) stool

All of the above

159
Q

Jaundice associated with the absence of urobilinogen from urine suggests…

A. Hemolysis
B. Hepatocellulardysfunction
C. Biliaryobstruction

D. None of the above

A

Jaundice associated with the absence of urobilinogen from urine suggests…

A. Hemolysis
B. Hepatocellulardysfunction
C. Biliaryobstruction

D. None of the above

160
Q

Jaundice associated with the absence of bilirubin from urine suggests…

A. Hemolysis
B. Hepatocellulardysfunction
C. Biliaryobstruction

D. None of the above

A

Jaundice associated with the absence of bilirubin from urine suggests…

A. Hemolysis
B. Hepatocellulardysfunction
C. Biliaryobstruction

D. None of the above

161
Q

Jaundice associated with acholic (clay-colored) stool suggests…

A. Hemolysis
B. Hepatocellulardysfunction
C. Biliaryobstruction

D. Any of the above

A

Jaundice associated with acholic (clay-colored) stool suggests…

A. Hemolysis
B. Hepatocellular dysfunction
C. Biliary obstruction

D. Any of the above

162
Q

Jaundice associated with highly elevated aminotransferase levels suggests..

.A. Hemolysis
B. Hepatocellulardysfunction
C. Extrahepaticcholestasis

D. All of the above

A

Jaundice associated with highly elevated aminotransferase levels suggests..

.A. Hemolysis
B. Hepatocellulardysfunction
C. Extrahepaticcholestasis

D. All of the above

163
Q

Jaundice associated with highly elevated alkaline phosphatase and GGT and moderately elevated aminotransferases suggests…

A. Hemolysis
B. Hepatocellulardysfunction

C. Cholestasis
D. All of the above

A

Jaundice associated with highly elevated alkaline phosphatase and GGT and moderately elevated aminotransferases suggests…

A. Hemolysis
B. Hepatocellulardysfunction

C. Cholestasis
D. All of the above

164
Q

Gilbert syndrome is typically associated with elevated level of…

Bilirubin

Aminotransferases (AST, ALT)

Alkaline phosphatase and GGT

All of the above

A

Gilbert syndrome is typically associated with elevated level of…

Bilirubin

Aminotransferases (AST, ALT)

Alkaline phosphatase and GGT

All of the above

165
Q

Gilbert syndrome…

A. is a common condition that may affect as many as 5% of people

is most often detected in young adults by finding an elevated bilirubin level that

tends to increase with fasting and other stresses

requires no treatment

all statements are true

A

Gilbert syndrome…

A. is a common condition that may affect as many as 5% of people

is most often detected in young adults by finding an elevated bilirubin level that

tends to increase with fasting and other stresses

requires no treatment

all statements are true

166
Q

Portal hypertension may be caused by…

cirrhosis

schistosomiasis

hepatic vein thrombosis

any of the above

A

Portal hypertension may be caused by…

cirrhosis

schistosomiasis

hepatic vein thrombosis

any of the above

167
Q

Consequences of portal hypertension include…

hypertensive gastropathy

visible abdominal wall collaterals

rectal varices

all of the above

A

Consequences of portal hypertension include…

hypertensive gastropathy

visible abdominal wall collaterals

rectal varices

all of the above

168
Q

The level of portal venous pressure gradient at which the risk of variceal bleeding increases…

significantly

4 mmHg

12 mmHg

20 mmHg

30 mmHg

A

The level of portal venous pressure gradient at which the risk of variceal bleeding increases…

significantly

4 mmHg

12 mmHg

20 mmHg

30 mmHg

169
Q

Complications of portal hypertension include…

A. Sudden painless upper GI bleeding
B. Portosystemicencephalopathy
C. Hypersplenism

D. All of the above

A

Complications of portal hypertension include…

A. Sudden painless upper GI bleeding
B. Portosystemicencephalopathy
C. Hypersplenism

D. All of the above

170
Q

Portal hypertensive gastropathy is best diagnosed by …

Upper endoscopy

Abdominal ultrasound

Double-contrast barium study

ERCP

A

Portal hypertensive gastropathy is best diagnosed by …

Upper endoscopy

Abdominal ultrasound

Double-contrast barium study

ERCP

171
Q

Long-term drug therapy for varices that have bled involves…

diuretics

nonselective beta blockers

ACE inhibitors

all of the above

A

Long-term drug therapy for varices that have bled involves…

diuretics

nonselective beta blockers

ACE inhibitors

all of the above

172
Q

Signs of portosystemic encephalopathy include

Impaired concentration

Poor handwriting

Somnolence

Any of the above

A

Signs of portosystemic encephalopathy include

Impaired concentration

Poor handwriting

Somnolence

Any of the above

173
Q

Routine diagnosis of portosystemic encephalopathy includes…

serum ammonia levels

cerebrospinal fluid examination

diagnostic paracentesis

all of the above

A

Routine diagnosis of portosystemic encephalopathy includes…

serum ammonia levels

cerebrospinal fluid examination

diagnostic paracentesis

all of the above

174
Q

Treatment of portosystemic encephalopathy includes…

Diuretics

Oral nonabsorbable antibiotics

Non-selective beta blockers

Anti-diarrheal drugs

A

Treatment of portosystemic encephalopathy includes…

Diuretics

Oral nonabsorbable antibiotics

Non-selective beta blockers

Anti-diarrheal drugs

175
Q

Hepatorenal syndrome…

refers to the structural damage of the kidneys in advanced liver disease

usually necessitates hemodialysis

often has rapid progression and fatal outcome

all statements are true

A

Hepatorenal syndrome…

refers to the structural damage of the kidneys in advanced liver disease

usually necessitates hemodialysis

often has rapid progression and fatal outcome

all statements are true

176
Q

In males, alcoholic cirrhosis is often associated with…

gynecomastia

erectile dysfunction

decreases spermatogenesis

all of the above

A

In males, alcoholic cirrhosis is often associated with…

gynecomastia

erectile dysfunction

decreases spermatogenesis

all of the above

177
Q

Treatment of acetaminophen-related liver injury should include…A. Nonselective beta blockers
B. Diuretics
C. N-acetylcystein

D. Deferoxamin

A

Treatment of acetaminophen-related liver injury should include…

A. Nonselective beta blockers
B. Diuretics
C. N-acetylcystein

D. Deferoxamin

178
Q

Disproportionally elevated aminotransferase levels with an AST to ALT (GOT to GPT) ratio being > 2 is characteristic of…

alcoholic liver injury

non-alcoholic steatohepatitis

viral hepatitis

all forms of hepatitis

A

Disproportionally elevated aminotransferase levels with an AST to ALT (GOT to GPT) ratio being > 2 is characteristic of…

alcoholic liver injury

non-alcoholic steatohepatitis

viral hepatitis

all forms of hepatitis

179
Q

The main risk factors in alcoholic liver disease involve…

Quantity and duration of alcohol use

Gender

Nutritional status

All of the above

A

The main risk factors in alcoholic liver disease involve…

Quantity and duration of alcohol use

Gender

Nutritional status

All of the above

180
Q

Pathophysiology of alcoholic liver disease includes…

hepatic fat accumulation

increased absorption of endotoxins from the gut

oxidative damage

all of the above

A

Pathophysiology of alcoholic liver disease includes…

hepatic fat accumulation

increased absorption of endotoxins from the gut

oxidative damage

all of the above

181
Q

Laboratory alterations in alcoholic cirrhosis often include…

microcytic anemia

elevated GGT

decreasedaminotransferases

all of the above

A

Laboratory alterations in alcoholic cirrhosis often include…

microcytic anemia

elevated GGT

decreasedaminotransferases

all of the above

182
Q

Child-Pugh scoring system is used to assess the severity of…

cirrhosis

GERD

colon cancer

acute pancreatitis

A

Child-Pugh scoring system is used to assess the severity of…

cirrhosis

GERD

colon cancer

acute pancreatitis

183
Q

Transmission is primarily fecal-oral for…

hepatitisAvirus

hepatitis B virus

hepatitis C virus

hepatitis D virus

A

Transmission is primarily fecal-oral for…

hepatitisAvirus

hepatitis B virus

hepatitis C virus

hepatitis D virus

184
Q

Hepatitis C virus is most commonly transmitted through…

sexual intercourse

blood

insect bite

fecal-oral route

A

Hepatitis C virus is most commonly transmitted through…

sexual intercourse

blood

insect bite

fecal-oral route

185
Q

Chronic infection typically occurs in case of…

hepatitisAinfection

hepatitis B infection

hepatitis E infection

all of the above

A

Chronic infection typically occurs in case of…

hepatitisAinfection

hepatitis B infection

hepatitis E infection

all of the above

186
Q

Hepatitis D can replicate…

alone

only in the presence of hepatitis B

only in the presence of hepatitis C

in the presence of either hepatitis B or C

A

Hepatitis D can replicate…

alone

only in the presence of hepatitis B

only in the presence of hepatitis C

in the presence of either hepatitis B or C

187
Q

Hepatitis E infection often causes fulminant hepatitis in…

pregnant women

youngchildren

the elderly

the general population

A

Hepatitis E infection often causes fulminant hepatitis in…

pregnant women

youngchildren

the elderly

the general population

188
Q

Prodromal symptoms of viral hepatitis infection include…

profound anorexia

right upper quadrant abdominal pain

nausea and vomiting

all of the above

A

Prodromal symptoms of viral hepatitis infection include…

profound anorexia

right upper quadrant abdominal pain

nausea and vomiting

all of the above

189
Q

Jaundice in viral hepatitis…

is usually the first sign of the disease

is often associated with the regression of prodromal symptoms

typically lasts 1-2 days

all statements are true

A

Jaundice in viral hepatitis…

is usually the first sign of the disease

is often associated with the regression of prodromal symptoms

typically lasts 1-2 days

all statements are true

190
Q

The highest rate of chronicity is associated with…

hepatitisAinfection

hepatitis B infection

hepatitis C infection

hepatitis E infection

A

The highest rate of chronicity is associated with…

hepatitisAinfection

hepatitis B infection

hepatitis C infection

hepatitis E infection

191
Q

Diagnosis of acute hepatitis A infection involves the detection of…

Hepatitis A virus surface antigen (HAsAg)

anti-HAVIgM

anti-HAVIgG

any of the above

A

Diagnosis of acute hepatitis A infection involves the detection of…

Hepatitis A virus surface antigen (HAsAg)

anti-HAVIgM

anti-HAVIgG

any of the above

192
Q

IgG anti-HAV suggests…

acute hepatitis A infection

previous exposure to hepatitis A

chronichepatitisAinfection

none of the above

A

IgG anti-HAV suggests…

acute hepatitis A infection

previous exposure to hepatitis A

chronichepatitisAinfection

none of the above

193
Q

Routine diagnosis of acute hepatitis B infection involves the detection of…A. Hepatitis B surface antigen (HBsAg)
B. anti-HBs
C. HBcAg

D. any of the above

A

Routine diagnosis of acute hepatitis B infection involves the detection of..

.A. Hepatitis B surface antigen (HBsAg)
B. anti-HBs
C. HBcAg

D. any of the above

194
Q

The presence of HBsAg and the absence of anti-HBs…

always suggests acute infection

always suggests chronic infection

may be associated with either acute or chronic infection

indicates proper immunization

A

The presence of HBsAg and the absence of anti-HBs…

always suggests acute infection

always suggests chronic infection

may be associated with either acute or chronic infection

indicates proper immunization

195
Q

Routine diagnosis of hepatitis C infection involves…

Hepatitis C surface antigen (HCsAg)

Anti-HCV

HCVDNA

Any of the above

A

Routine diagnosis of hepatitis C infection involves…

Hepatitis C surface antigen (HCsAg)

Anti-HCV

HCVDNA

Any of the above

196
Q

The presence of anti-HCV suggests…

always acute, never chronic hepatitis C infection

always chronic, never acute hepatitis C infection

proper immunization and protection against HCV infection

acute or chronic hepatitis C infection

A

The presence of anti-HCV suggests…

always acute, never chronic hepatitis C infection

always chronic, never acute hepatitis C infection

proper immunization and protection against HCV infection

acute or chronic hepatitis C infection

197
Q

Preexposure prophylaxis is NOT available for…

hepatitisAinfection

hepatitis B infection

hepatitis C infection

hepatitis E infection

A

Preexposure prophylaxis is NOT available for…

hepatitisAinfection

hepatitis B infection

hepatitis C infection

hepatitis E infection

198
Q

Infants born to HBsAg-positive mothers should receive…

only hepatitis B immune globulin (HBIG)

only hepatitis B vaccination

both of the above

neither of the above, since these infants have no risk of infection

A

Infants born to HBsAg-positive mothers should receive…

only hepatitis B immune globulin (HBIG)

only hepatitis B vaccination

both of the above

neither of the above, since these infants have no risk of infection

199
Q

Treatment of chronic hepatitis B virus infection involves…

corticosteroids

pegylated interferon alpha

ribavirin

hepatitis B immune globulin (HBIG

A

Treatment of chronic hepatitis B virus infection involves…

corticosteroids

pegylated interferon alpha

ribavirin

hepatitis B immune globulin (HBIG

200
Q

Treatment of chronic hepatitis C virus infection may involve…

corticosteroids

anti-TNF alpha drugs

ribavirin

all of the abov

A

Treatment of chronic hepatitis C virus infection may involve…

corticosteroids

anti-TNF alpha drugs

ribavirin

all of the abov

201
Q

Autoimmune hepatitis is usually associated with elevated levels of…

anti-mitochondrial antibody

anti smooth muscle antibody

ANCA

tissue transglutaminase antibody

A

Autoimmune hepatitis is usually associated with elevated levels of…

anti-mitochondrial antibody

anti smooth muscle antibody

ANCA

tissue transglutaminase antibody

202
Q

Treatment of autoimmune hepatitis involves…

A. corticosteroids
B. pegylated interferon alpha

C. ribavirin
D. anti TNF alpha drugs

A

Treatment of autoimmune hepatitis involves…

A. corticosteroids
B. pegylated interferon alpha

C. ribavirin
D. anti TNF alpha drugs

203
Q

Signs of acute hepatic venous outflow obstruction typically include…

tender hepatomegaly

ascites

nausea and vomiting

all of the abov

A

Signs of acute hepatic venous outflow obstruction typically include…

tender hepatomegaly

ascites

nausea and vomiting

all of the abov

204
Q

Diagnosis of hepatic venous outflow obstruction is based on…

Abdominal Doppler ultrasonography

ERCP

Upper endoscopy

Liver biopsy

A

Diagnosis of hepatic venous outflow obstruction is based on…

Abdominal Doppler ultrasonography

ERCP

Upper endoscopy

Liver biopsy

205
Q

Treatment of hepatic venous outflow obstruction includes…

anticoagulation

inhibition of thrombocyte aggregation

corticosteroids

all of the above

A

Treatment of hepatic venous outflow obstruction includes…

anticoagulation

inhibition of thrombocyte aggregation

corticosteroids

all of the above

206
Q

The “5F rule – female, fair, fat, forty, fecund” summarizes risk factors of

acute pancreatitis

pepticulcer

cholelithiasis

diverticulosis

A

The “5F rule – female, fair, fat, forty, fecund” summarizes risk factors of

acute pancreatitis

pepticulcer

cholelithiasis

diverticulosis

207
Q

The most common form of gallstones in the Western world is

cholesterol stones

black pigment stones

brown pigment stones

all stones are equally common

A

The most common form of gallstones in the Western world is

cholesterol stones

black pigment stones

brown pigment stones

all stones are equally common

208
Q

In the biliary tract, infection, inflammation or parasitic infestation favor the formation of

cholesterol stones

black pigment stones

brown pigment stones

none of the stones

A

In the biliary tract, infection, inflammation or parasitic infestation favor the formation of

cholesterol stones

black pigment stones

brown pigment stones

none of the stones

209
Q

True statements about symptoms and signs of gallstones

Most individuals (~80%) are asymptomatic

The most common symptom is biliary colic

Complications include cholecystitis

All of the above are true

A

True statements about symptoms and signs of gallstones

Most individuals (~80%) are asymptomatic

The most common symptom is biliary colic

Complications include cholecystitis

All of the above are true

210
Q

Pain associated with biliary colic

characteristically begins in the right upper quadrant

typically remains at steady intensity for >24 h

is always associated with fever and chills

all of the above

A

Pain associated with biliary colic

characteristically begins in the right upper quadrant

typically remains at steady intensity for >24 h

is always associated with fever and chills

all of the above

211
Q

Signs and symptoms of biliary colic typically include

enlarged, palpable, painless gallbladder

signs of peritoneal irritation

nausea and vomiting

absent liver dullness

A

Signs and symptoms of biliary colic typically include

enlarged, palpable, painless gallbladder

signs of peritoneal irritation

nausea and vomiting

absent liver dullness

212
Q

Gas, bloating and nausea…

occur only in cholecystitis, not in cholelithiasis.

are specific signs of gallbladder disease

are common nonspecific signs, having about equal prevalence in cholelithiasis, peptic ulcer disease, and functional GI disorders

only rarely occur in gallbladder disease

A

Gas, bloating and nausea…

occur only in cholecystitis, not in cholelithiasis.

are specific signs of gallbladder disease

are common nonspecific signs, having about equal prevalence in cholelithiasis, peptic ulcer disease, and functional GI disorders

only rarely occur in gallbladder disease

213
Q

Diagnosis of gallstones is based on

ERCP

ultrasonography

elevated alkaline phosphatase levels

cholescintigraphy

A

Diagnosis of gallstones is based on

ERCP

ultrasonography

elevated alkaline phosphatase levels

cholescintigraphy

214
Q

Complications of gallstones include

cholangitis

pancreatitis

choledocholithiasis

all of the above

A

Complications of gallstones include

cholangitis

pancreatitis

choledocholithiasis

all of the above

215
Q

Substance used for gallstone dissolution

A. ursodeoxycholic acid
B. 5-aminosalicylate
C. azathioprine
D. cholestyramine

A

Substance used for gallstone dissolution

A. ursodeoxycholic acid
B. 5-aminosalicylate
C. azathioprine
D. cholestyramine

216
Q

Acute cholecystitis develops…

in ~95% in the presence of gallstones, and in ~5% without stones

in ~50% in the presence of gallstones, and in ~50% without stones

in ~5% in the presence of gallstones, and in ~95% without stones

only in the presence of gallstones

A

Acute cholecystitis develops…

in ~95% in the presence of gallstones, and in ~5% without stones

in ~50% in the presence of gallstones, and in ~50% without stones

in ~5% in the presence of gallstones, and in ~95% without stones

only in the presence of gallstones

217
Q

Typical signs and symptoms of cholecystitis include

A. severe and steady pain lasting > 6h
B. vomiting
C. low-gradefever

D. all of the above

A

Typical signs and symptoms of cholecystitis include

A. severe and steady pain lasting > 6h
B. vomiting
C. low-gradefever

D. all of the above

218
Q

Acute acalculous cholecystitis…

is typically associated with critical illness (e.g., major surgery, burns, sepsis, or trauma)

has high mortality

both statements are true

neither statement is true

A

Acute acalculous cholecystitis…

is typically associated with critical illness (e.g., major surgery, burns, sepsis, or trauma)

has high mortality

both statements are true

neither statement is true

219
Q

The term cholecystectomy à froid refers to…

early cholecystectomy done during the first 24 to 48 h of acute cholecystitis

deferred

cholecystectomy done after the resolution of cholecystitis (≥ 6 wk later)

cholecystectomy performed after the dissolution of gallstones

laparoscopic cholecystectomy

A

The term cholecystectomy à froid refers to…

early cholecystectomy done during the first 24 to 48 h of acute cholecystitis

deferred cholecystectomy done after the resolution of cholecystitis (≥ 6 wk later)

cholecystectomy performed after the dissolution of gallstones

laparoscopic cholecystectomy

220
Q

In case of acute cholecystitis, cholecystectomy…

is best done between 3 to7 days after the onset of the disease be done

should always

during the first 24 to 48 hrs

should always be deferred until cholecystitis resolves (

none of the statements is true

A

In case of acute cholecystitis, cholecystectomy…

is best done between 3 to7 days after the onset of the disease be done

should always

during the first 24 to 48 hrs

should always be deferred until cholecystitis resolves (

none of the statements is true

221
Q

Ultrasonographic finding of gallstones in slightly thick-walled, shrunken gallbladder suggests

acute cholecystitis

chronic cholecystitis

cholangitis

cholangiocarcinoma

A

Ultrasonographic finding of gallstones in slightly thick-walled, shrunken gallbladder suggests

acute cholecystitis

chronic cholecystitis

cholangitis

cholangiocarcinoma

222
Q

Choledocholithiasis may be the consequence of

Stone formation in the bile duct

Migration of stones formed inthe gallbladder into the bile duct

Residual stones, which are missed at the time of cholecystectomy

All of the mechanisms above

A

Choledocholithiasis may be the consequence of

Stone formation in the bile duct

Migration of stones formed inthe gallbladder into the bile duct

Residual stones, which are missed at the time of cholecystectomy

All of the mechanisms above

223
Q

Charcot’s triad includes…

abdominal pain, jaundice, and fever

jaundice, melena and loss of weight

abdominal pain, bloating and nausea

diarrhea, fever and anorexia

A

Charcot’s triad includes…

abdominal pain, jaundice, and fever

jaundice, melena and loss of weight

abdominal pain, bloating and nausea

diarrhea, fever and anorexia

224
Q

Charcot’s triad is characteristic of…A. acute pancreatitis
B. cholangitis
C. diverticulitis

D. all of the above

A

Charcot’s triad is characteristic of..

.A. acute pancreatitis
B. cholangitis
C. diverticulitis

D. all of the above

225
Q

Laboratory findings in acute cholangitis typically include elevated levels of

WBC

conjugated bilirubin

alkaline phosphatase

all of the above

A

Laboratory findings in acute cholangitis typically include elevated levels of

WBC

conjugated bilirubin

alkaline phosphatase

all of the above

226
Q

Retained stones in the common bile duct can be effectively visualized by

abdominal ultrasound

magnetic resonance cholangiopancreatography (MRCP) or ERCP

all of the methods

none of the methods

A

Retained stones in the common bile duct can be effectively visualized by

abdominal ultrasound

magnetic resonance cholangiopancreatography (MRCP) or ERCP

all of the methods

none of the methods

227
Q

Ultrasonography in acute cholangitis typically and accurately displays

dilated extrahepatic bile ducts

gallstones in the extrahepatic bile ducts

shrunken, fibrotic gallbladder

all of the above

A

Ultrasonography in acute cholangitis typically and accurately displays

dilated extrahepatic bile ducts

gallstones in the extrahepatic bile ducts

shrunken, fibrotic gallbladder

all of the above

228
Q

Treatment of acute cholangitis includes

ERCP and sphincterotomy

broad-spectrum antibiotics

both interventions

neither intervention

A

Treatment of acute cholangitis includes

ERCP and sphincterotomy

broad-spectrum antibiotics

both interventions

neither intervention

229
Q

Primary sclerosing cholangitis is often associated with

A. ulcerative colitis
B. primarybiliarycirrhosis
C. diverticulosis

D. chronic pancreatitis

A

Primary sclerosing cholangitis is often associated with

A. ulcerative colitis
B. primarybiliarycirrhosis
C. diverticulosis

D. chronic pancreatitis

230
Q

Signs and symptoms of primary sclerosing cholangitis typically include

A. progressive fatigue
B. jaundice
C. pruritus

D. all of the above

A

Signs and symptoms of primary sclerosing cholangitis typically include

A. progressive fatigue
B. jaundice
C. pruritus

D. all of the above

231
Q

Primary sclerosing cholangitis….

is a benign disease without progression

is best treated with corticosteroids

can be cured by total colectomy, if associated with ulcerative colitis

increases the risk of cholangiocarcinoma

A

Primary sclerosing cholangitis….

is a benign disease without progression

is best treated with corticosteroids

can be cured by total colectomy, if associated with ulcerative colitis

increases the risk of cholangiocarcinoma

232
Q

Laboratory findings in primary sclerosing cholangitis typically include elevated levels of the following substances, EXCEPT

alkaline phosphatase

pANCA

antimitochondrial antibodies

IgM

A

Laboratory findings in primary sclerosing cholangitis typically include elevated levels of the following substances, EXCEPT

alkaline phosphatase

pANCA

antimitochondrial antibodies

IgM

233
Q

ERCP displaying multiple strictures and dilations in the intrahepatic and extrahepatic bile

ducts is characteristic of…

primary sclerosing cholangitis

autoimmune pancreatitis

liver cirrhosis

acute cholecystitis

A

ERCP displaying multiple strictures and dilations in the intrahepatic and extrahepatic bile

ducts is characteristic of…

primary sclerosing cholangitis

autoimmune pancreatitis

liver cirrhosis

acute cholecystitis

234
Q

Treatment modalities applied in primary sclerosing cholangitis include

liver transplantation

ursodeoxycholicacid

ERCP dilation and stenting of a dominant stricture

all of the above

A

Treatment modalities applied in primary sclerosing cholangitis include

liver transplantation

ursodeoxycholicacid

ERCP dilation and stenting of a dominant stricture

all of the above

235
Q

Acute pancreatitis may be triggered by…

heavy alcohol intake

hypertrigliceridemia

certain viral infections

any of the above

A

Acute pancreatitis may be triggered by…

heavy alcohol intake

hypertrigliceridemia

certain viral infections

any of the above

236
Q

Select the FALSE statement about pain in acute pancreatitis

It is typically a steady, boring upper abdominal pain

It is often severe enough to require large doses of parenteral opioids

It usually persists for less than 24 hrs

Sitting up and leaning forward may reduce pain

A

Select the FALSE statement about pain in acute pancreatitis

It is typically a steady, boring upper abdominal pain

It is often severe enough to require large doses of parenteral opioids

It usually persists for less than 24 hrs

Sitting up and leaning forward may reduce pain

237
Q

Common finding in acute pancreatitis, EXCEPT

Muscular defense

Nausea and vomiting

Hypoactive bowel sounds

Upper abdominal distension

A

Common finding in acute pancreatitis, EXCEPT

Muscular defense

Nausea and vomiting

Hypoactive bowel sounds

Upper abdominal distension

238
Q

A positive Cullen sign is characteristic of…

hemorrhagic pancreatitis

acute cholangitis

acute cholecystitis

pancreatic cancer

A

A positive Cullen sign is characteristic of…

hemorrhagic pancreatitis

acute cholangitis

acute cholecystitis

pancreatic cancer

239
Q

Laboratory findings in acute pancreatitis may include elevated levels of

lipase

WBC

triglycerides

any of the above

A

Laboratory findings in acute pancreatitis may include elevated levels of

lipase

WBC

triglycerides

any of the above

240
Q

The most sensitive imaging technique for the visualization of necrosis, fluid collections and

pseudocysts associated with acute pancreatitis are…

abdominal ultrasound

abdominal X-ray

abdominal CT scan

ERCP

A

The most sensitive imaging technique for the visualization of necrosis, fluid collections and

pseudocysts associated with acute pancreatitis are…

abdominal ultrasound

abdominal X-ray

abdominal CT scan

ERCP

241
Q

Treatment of acute pancreatitis always includes the following, EXCEPT

iv. fluid resuscitation

parenteral analgesics

antibiotics

fasting

A

Treatment of acute pancreatitis always includes the following, EXCEPT

iv. fluid resuscitation

parenteral analgesics

antibiotics

fasting

242
Q

ERCP in acute pancreatitis…

is always contraindicated

should be performed in patients with gallstone pancreatitis, who do not improve after 24h

of treatment

should be performed in patients with alcoholic pancreatitis, who do not improve after 24h

of treatment

D. should be performed in all cases

A

ERCP in acute pancreatitis…

is always contraindicated

should be performed in patients with gallstone pancreatitis, who do not improve after 24h of treatment

should be performed in patients with alcoholic pancreatitis, who do not improve after 24h

of treatment

D. should be performed in all cases

243
Q

Signs and symptoms of chronic pancreatitis include

decreased glucose tolerance

steatorrhea

episodic abdominal pain

all of the above

A

Signs and symptoms of chronic pancreatitis include

decreased glucose tolerance

steatorrhea

episodic abdominal pain

all of the above

244
Q

In everyday clinical practice, the diagnosis of chronic pancreatitis is typically based on…

various exocrine tests (Lundh tests, pancreolauryl test etc…)

elevated levels of amylase and lipase

detection of pancreatic calcification or ductal dilations and strictures

quantification of lipids in the stool

A

In everyday clinical practice, the diagnosis of chronic pancreatitis is typically based on…

various exocrine tests (Lundh tests, pancreolauryl test etc…)

elevated levels of amylase and lipase

detection of pancreatic calcification or ductal dilations and strictures

quantification of lipids in the stool

245
Q

Treatment of chronic pancreatitis may include

pancreatic enzyme supplementation

alcohol abstinence

pancreas resection

all of the above

A

Treatment of chronic pancreatitis may include

pancreatic enzyme supplementation

alcohol abstinence

pancreas resection

all of the above

246
Q

Select the FALSE statement about pain relief in chronic pancreatitis

It may be best achieved by NSAIDs

It may require increased amounts of opioids, with the threat of addiction

It may include denervation of the celiac plexus

It may be achieved by pseudocyst decompression surgery

A

Select the FALSE statement about pain relief in chronic pancreatitis

It may be best achieved by NSAIDs

It may require increased amounts of opioids, with the threat of addiction

It may include denervation of the celiac plexus

It may be achieved by pseudocyst decompression surgery

247
Q

The site of upper gastrointestinal bleeding is located above the…

pyloric ring

ligament of Treitz

ileocecal valve

hepatic flexure

A

The site of upper gastrointestinal bleeding is located above the…

pyloric ring

ligament of Treitz

ileocecal valve

hepatic flexure

248
Q

Upper GI bleeding > 200 ml always results in

hematemesis

melena

both hematemesis and melena

hematochezia

A

Upper GI bleeding > 200 ml always results in

hematemesis

melena

both hematemesis and melena

hematochezia

249
Q

Common cause of lower GI bleeding in the elderly patient

angiodysplasia

inflammatory bowel disease

irritable bowel syndrome

any of the above

A

Common cause of lower GI bleeding in the elderly patient

angiodysplasia

inflammatory bowel disease

irritable bowel syndrome

any of the above

250
Q

If colonoscopy cannot visualize the source and ongoing lower GI bleeding is sufficiently rapid

0.5 to 1 mL/min), the optimal next diagnostic step is…

angiography

enteroscopy

capsule endoscopy

explorative laparotomy

A

If colonoscopy cannot visualize the source and ongoing lower GI bleeding is sufficiently rapid

0.5 to 1 mL/min), the optimal next diagnostic step is…

angiography

enteroscopy

capsule endoscopy
​
explorative laparotomy

251
Q

Classic symptoms of acute appendicitis include

periumbilical pain that shifts to the right lower quadrant

nausea

anorexia

all of the above

A

Classic symptoms of acute appendicitis include

periumbilical pain that shifts to the right lower quadrant

nausea

anorexia

all of the above

252
Q

Pain felt in the right lower quadrant with palpation of the left lower quadrant (Rovsing sign) suggests…

acute appendicitis

acute pancreatitis

cholelithiasis

irritable bowel syndrome

A

Pain felt in the right lower quadrant with palpation of the left lower quadrant (Rovsing sign) suggests…

acute appendicitis

acute pancreatitis

cholelithiasis

irritable bowel syndrome

253
Q

Select the true statement about acute appendicitis

Abdominal ultrasound never visualizes the inflamed appendix.

Appendicitis remains primarily a clinical diagnosis.

The suspicion of acute appendicitis always necessitates abdominal CT scan.

Clinical diagnosis must be confirmed with colonoscopy

A

Select the true statement about acute appendicitis

Abdominal ultrasound never visualizes the inflamed appendix.

Appendicitis remains primarily a clinical diagnosis.

The suspicion of acute appendicitis always necessitates abdominal CT scan.

Clinical diagnosis must be confirmed with colonoscopy

254
Q

Acute appendicitis…

does not necessitate the administration of antibiotics

requires surgical intervention only in case of perforation

both statements are true

neither statement is true

A

Acute appendicitis…

does not necessitate the administration of antibiotics

requires surgical intervention only in case of perforation

both statements are true

neither statement is true

255
Q

Hyperactive, high-pitched bowel sounds are characteristic of …

intestinal obstruction

acute appendicitis

acute intestinal perforation

all of the above

A

Hyperactive, high-pitched bowel sounds are characteristic of …

intestinal obstruction

acute appendicitis

acute intestinal perforation

all of the above

256
Q

On plain X-ray, ladderlike series of distended small-bowel loops and fluid levels in the bowel suggest…

intestinal obstruction

intestinal bleeding

intestinalperforation

none of the above

A

On plain X-ray, ladderlike series of distended small-bowel loops and fluid levels in the bowel suggest…

intestinal obstruction

intestinal bleeding

intestinalperforation

none of the above

257
Q

The term miserere refers to…

coffee-ground vomiting due to exposure of blood to gastric juice

vomiting of small bowel content due to intestinal obstruction

absent bowel sounds due to paralytic ileus

abdominal muscle guarding due to peritonitis

A

The term miserere refers to…

coffee-ground vomiting due to exposure of blood to gastric juice

vomiting of small bowel content due to intestinal obstruction

absent bowel sounds due to paralytic ileus

abdominal muscle guarding due to peritonitis

258
Q

The diagnostic procedure of choice in acute mesenteric ischemia is…

CT angiography

abdominal ultrasound

colonoscopy

double-contrast barium enema

A

The diagnostic procedure of choice in acute mesenteric ischemia is…

CT angiography

abdominal ultrasound

colonoscopy

double-contrast barium enema

259
Q

The first sign of acute mesenteric ischemia is…

severe abdominal pain

abdominal muscle guarding

absent bowel sounds

fever

A

The first sign of acute mesenteric ischemia is…

severe abdominal pain

abdominal muscle guarding

absent bowel sounds

fever

260
Q

Treatment of acute abdominal perforation

Necessitates immediate surgical intervention

antibiotics and deferred surgical intervention performed after the resolution of peritonitis

( > 6 wks)

both options are feasible

neither option is suggested

A

Treatment of acute abdominal perforation

Necessitates immediate surgical intervention

antibiotics and deferred surgical intervention performed after the resolution of peritonitis

( > 6 wks)

both options are feasible

neither option is suggested

261
Q

Non-surgical causes of acute abdomen include

lead poisoning

acute porphyria

sickle cell crisis

all of the above

A

Non-surgical causes of acute abdomen include

lead poisoning

acute porphyria

sickle cell crisis

all of the above

262
Q

Typical histologic alteration(s) in celiac disease

A. ​Lack or shortening of villi (villous atrophy)

B. Crypt inflammation and abscesses​ (crypt ​hyperplasia ​occurs)

C. Hyperplastic inflammatory mucosa(pseudopolyps)

D. Any of the above

A

Typical histologic alteration(s) in celiac disease

A. ​Lack or shortening of villi (villous atrophy)
​
B. Crypt inflammation and abscesses​ (crypt ​hyperplasia ​occurs)

C. Hyperplastic inflammatory mucosa(pseudopolyps)

D. Any of the above

263
Q

75) Long-term complication of untreated celiac disease includes…

A. Diabetes mellitus
B. ​T-cell lymphoma
C. Duodenal fistules

D. Duodenal stenosis

A

75) Long-term complication of untreated celiac disease includes…

A. Diabetes mellitus
B. ​T-cell lymphoma
C. Duodenal fistules

D. Duodenal stenosis

264
Q

Diagnosis of small bowel bacterial overgrowth may be based on…???

A. lactulose H2 breath test
B. ​14​C-xylose breath test
C. Both methods

D. Neither method

A

Diagnosis of small bowel bacterial overgrowth may be based on…???

A. lactulose H2 breath test
B. ​14​C-xylose breath test
C. Both methods

D. Neither method

265
Q

83) Select the ​FALSE​ statement about short bowel syndrome!

A.​ It results from an extensive resection of the large bowel
B. Diarrhea and nutritional deficiencies are common
C. Patients often require total parenteral nutrition

D. Necessitates intensive monitoring of electrolytes

A

83) Select the ​FALSE​ statement about short bowel syndrome!

A. It results from an extensive resection of the large bowel
B. Diarrhea and nutritional deficiencies are common
C. Patients often require total parenteral nutrition

D. Necessitates intensive monitoring of electrolytes

266
Q

86) In ulcerative colitis…
A. Microscopic inflammation and fissuring extend transmurally
B. Endoscopic appearance is patchy, with discrete ulcerations separated by segments of normal-appearing mucosa.
C. ​Fistulas do not occur.
D. Abdominal mass and abscess development is common.

A

86) In ulcerative colitis…
A. Microscopic inflammation and fissuring extend transmurally
B. Endoscopic appearance is patchy, with discrete ulcerations separated by segments of normal-appearing mucosa.
C. ​Fistulas do not occur.
D. Abdominal mass and abscess development is common.

267
Q

87) Select the FALSE statement about ulcerative colitis!
A. ​Colonic involvement is usually right-sided.​ ​(FALSE, typically left side)
B. Primary disease activity is confined to the colon . (TRUE)
C. Initial disease invariably involves the rectum (n.b. patient is treated with suppositories). (T)
D. The colonic wall is affected uninterruptedly from rectum extending proximally. (T, continuous lesion

A

87) Select the FALSE statement about ulcerative colitis!
A. ​Colonic involvement is usually right-sided
B. Primary disease activity is confined to the colon
C. Initial disease invariably involves the rectum patient
D. The colonic wall is affected uninterruptedly from rectum extending proximally.

268
Q

88) In Crohn’s disease…
A. Gross rectal bleeding is rare, except in Crohn colitis. ​
B. Small bowel is involved in at least 60% of cases.
C. Fistula, mass, and abscess development is common.
D. ​All statements are true.

A

88) In Crohn’s disease…

A. Gross rectal bleeding is rare, except in Crohn colitis. ​
B. Small bowel is involved in at least 60% of cases.
C. Fistula, mass, and abscess development is common.
D. ​All statements are true.

269
Q

90) Select the FALSE statement about Crohn’s disease

A. ​Rectosigmoid is invariably involved​
B. Fistula, mass, and abscess development is common.
C. Perianal lesions are significant in 25‒35% of cases. ​
D. Epitheloid (sarcoid-like) granulomas are detected in bowel wall or lymph nodes in 25‒50% of cases.

A

90) Select the FALSE statement about Crohn’s disease​

A. ​Rectosigmoid is invariably involved
B. Fistula, mass, and abscess development is common.
C. Perianal lesions are significant in 25‒35% of cases. ​
D. Epitheloid (sarcoid-like) granulomas are detected in bowel wall or lymph nodes in 25‒50% of cases. ​

270
Q

93) Extraintestinal disorder that is clearly associated with IBD but appears independently of IBD activity

A. primary biliary cirrhosis
B. primary sclerosing cholangitis

C. type 1 diabetes mellitus

D. autoimmune pancreatitis

A

93) Extraintestinal disorder that is clearly associated with IBD but appears independently of IBD activity

A. primary biliary cirrhosis

B. primary sclerosing cholangitis

C. type 1 diabetes mellitus

D. autoimmune pancreatitis

271
Q

150) Treatment of refractory ascites may include…
A. autologous infusion of ascitic fluid (peritoneovenous shunt)

B. transjugular intrahepatic portosystemic shunting (TIPS)

C. regular therapeutic paracentesis
D. any of the above

A

150) Treatment of refractory ascites may include…

A. autologous infusion of ascitic fluid (peritoneovenous shunt)

B. transjugular intrahepatic portosystemic shunting (TIPS)
C. regular therapeutic paracentesis
D. any of the above

272
Q

164) Select the true statement(s) about non-alcoholic steatohepatitis

A. Liver biopsy clearly distinguishes alcoholic and non-alcoholic steatohepatitis.

B. managment includes discontinuation of drugs or toxins, weight loss, and treatment for dyslipidemia or hyperglycemia.​

C. Prognosis is poor: most patients develop cirrhosis or liver tumor.

D. All statements are true.

A

164) Select the true statement(s) about non-alcoholic steatohepatitis
​
A. Liver biopsy clearly distinguishes alcoholic and non-alcoholic steatohepatitis.

B. managment includes discontinuation of drugs or toxins, weight loss, and treatment for dyslipidemia or hyperglycemia.​

C. Prognosis is poor: most patients develop cirrhosis or liver tumor.

D. All statements are true.

273
Q

188) A young woman taking ciprofloxacin to cure her pyelonephritis develops malaise and right upper quadrant abdominal pain, associated with marked elevation in aminotransferase levels. This is a typical presentation of…
A. hepatorenal syndrome

B. drug-induced liver injury (DILI)

C. non-alcoholic steatohepatitis

D. any of the above

A

188) A young woman taking ciprofloxacin to cure her pyelonephritis develops malaise and right upper quadrant abdominal pain, associated with marked elevation in aminotransferase levels. This is a typical presentation of…
A. hepatorenal syndrome

B. drug-induced liver injury (DILI)

C. non-alcoholic steatohepatitis

D. any of the above

274
Q

192) Symptoms of alcoholic fatty liver typically include…

A.​ enlarged and smooth nontender liver ​
B. fatigue, fever, jaundice, right upper quadrant pain and tender hepatomegaly
C. small liver with signs of portal hypertension
D. any of the above

A

192) Symptoms of alcoholic fatty liver typically include…

​ A.​ enlarged and smooth nontender liver ​
B. fatigue, fever, jaundice, right upper quadrant pain and tender hepatomegaly
C. small liver with signs of portal hypertension
D. any of the above

275
Q

193) Symptoms of acute alcoholic hepatitis typically include…

A. enlarged and smooth nontender liver
B. ​fatigue, fever, jaundice, right upper quadrant pain and tender hepatomegaly​ ​correct
C. small liver with signs of portal hypertension
D. any of the above

A

193) Symptoms of acute alcoholic hepatitis typically include…

A. enlarged and smooth nontender liver
B. ​fatigue, fever, jaundice, right upper quadrant pain and tender hepatomegaly​
C. small liver with signs of portal hypertension
D. any of the above

276
Q

194) Symptoms of alcoholic cirrhosis typically include…
A. enlarged and smooth nontender liver

B. fatigue, fever, jaundice, right upper quadrant pain and tender hepatomegaly

C. ​small liver with signs of portal hypertension​ i double thiss

D. any of the above

A

194) Symptoms of alcoholic cirrhosis typically include…
A. enlarged and smooth nontender liver

B. fatigue, fever, jaundice, right upper quadrant pain and tender hepatomegaly

C. ​small liver with signs of portal hypertension​ i double thiss

D. any of the above

277
Q

230) Cholecystectomy …

A. ​effectively prevents future biliary colic

B. is warranted in all patients with gallstones, regardless of symptoms.​

C. requires strict dietary limitations ​Wrong, normal diet is ok.

D. all statements are true

A

230) Cholecystectomy …
​
A. ​effectively prevents future biliary colic

B. is warranted in all patients with gallstones, regardless of symptoms.​

C. requires strict dietary limitations ​Wrong, normal diet is ok.

D. all statements are true

278
Q

233) Murphy’s sign refers to…
A. palpable, painless, distended gallbladder

B.​ deep inspiration exacerbates the pain during palpation of the right upper quadrant andhalts inspiration

C. livid discoloration of skin around the umbilicus

D. the combination of jaundice, fever and right upper quadrant pain

A

233) Murphy’s sign refers to…

A. palpable, painless, distended gallbladder

B.​ deep inspiration exacerbates the pain during palpation of the right upper quadrant andhalts inspiration

C. livid discoloration of skin around the umbilicus

D. the combination of jaundice, fever and right upper quadrant pain

279
Q

234) Gallstone ileus develops if…
A. gallstones pass from the gallbladder into the biliary tract and block the pancreatic duct

B. gallstone becomes impacted in the cystic duct and compresses and obstructs the common bile duct

C.a large stone erodes the gallbladder wall, creating a fistula into the small bowel and

D. free perforation and peritonitis occurs

A

234) Gallstone ileus develops if…
A. gallstones pass from the gallbladder into the biliary tract and block the pancreatic duct

B. gallstone becomes impacted in the cystic duct and compresses and obstructs the common bile duct

C. a large stone erodes the gallbladder wall, creating a fistula into the small bowel and

D. free perforation and peritonitis occurs

280
Q

251) Pathophysiology of acute pancreatitis may include

A. Pancreatic ductal obstruction by protein plugs

B. Activation of pancreatic enzymes within the gland itself

C. Activation of the complement system and the inflammatory cascade, producing cytokines

D.​ ​All of the above

A

251) Pathophysiology of acute pancreatitis may include
​
A. Pancreatic ductal obstruction by protein plugs

B. Activation of pancreatic enzymes within the gland itself

C. Activation of the complement system and the inflammatory cascade, producing cytokines

D.​ ​All of the above

281
Q

252) Acute pancreatitis is always associated with…

A. Necrosis and hemorrhage of the gland

B. ​Inflammation and edema formation

C. Infection of necrotic pancreatic tissue by enteric bacteria

D. All of the above

A

252) Acute pancreatitis is always associated with…

A. Necrosis and hemorrhage of the gland
​
B. ​Inflammation and edema formation

C. Infection of necrotic pancreatic tissue by enteric bacteria

D. All of the above

282
Q

255) Cullen sign refers to…

A. a palpable, painless, distended gallbladder

B. deep inspiration exacerbates the pain during palpation of the right upper quadrant and halts inspiration

C. ​a livid discoloration of skin around the umbilicus

D. the combination of jaundice, fever and right upper quadrant pain

A

255) Cullen sign refers to…

A. a palpable, painless, distended gallbladder

B. deep inspiration exacerbates the pain during palpation of the right upper quadrant and halts inspiration

C. ​a livid discoloration of skin around the umbilicus

D. the combination of jaundice, fever and right upper quadrant pain

283
Q

259) In acute pancreatitis imaging may reveal…

A. localized ileus in the left upper quadrant on abdominal X-ray

B. left-sided atelectasis or a pleural effusion on chest X-ray

C. overlying gas obscuring the b on abdominal ultrasound

D. ​any of the above

A

259) In acute pancreatitis imaging may reveal…
​
A. localized ileus in the left upper quadrant on abdominal X-ray

B. left-sided atelectasis or a pleural effusion on chest X-ray

C. overlying gas obscuring the b on abdominal ultrasound

D. ​any of the above

284
Q

261) Fluid resuscitation in acute pancreatitis…
A. is not necessary

B. should not exceed 1 to 2 L/day

C.​ is essential, up to 6 to 8 L/day of fluid may be required

D. is preferably done orally

A

261) Fluid resuscitation in acute pancreatitis…
A. is not necessary

B. should not exceed 1 to 2 L/day

C.​ is essential, up to 6 to 8 L/day of fluid may be required

D. is preferably done orally

285
Q

263) The most common cause of chronic pancreatitis in the Western world is…

A. primary sclerosing cholangitis
B. ​alcoholism
C. autoimmune pancreatitis

D. cholelithiasis

A

263) The most common cause of chronic pancreatitis in the Western world is…

A. primary sclerosing cholangitis
B. ​alcoholism
C. autoimmune pancreatitis

D. cholelithiasis

286
Q

265) The term steatorrhea refers to …

A. passing undigested muscle fibers in the feces
B. ​passing large-volume, greasy, foul-smelling stool

C. passing digested blood in the stool
D. passing undigested blood in the stool

A

265) The term steatorrhea refers to …

A. passing undigested muscle fibers in the feces
B. ​passing large-volume, greasy, foul-smelling stool

C. passing digested blood in the stool
D. passing undigested blood in the stool

287
Q

269) The term melena refers to…
A. passing undigested muscle fibers in the feces

B. passing large-volume, greasy, foul-smelling stool

C. ​passing digested blood in the stool

D. passing undigested blood in the stool

A

269) The term melena refers to…
A. passing undigested muscle fibers in the feces

B. passing large-volume, greasy, foul-smelling stool

C. ​passing digested blood in the stool

D. passing undigested blood in the stool

288
Q

270) The term hematochezia refers to…

A. passing undigested muscle fibers in the feces
B. passing large-volume, greasy, foul-smelling stool

C. passing digested blood in the stool
D. ​passing undigested blood in the stool

A

270) The term hematochezia refers to…

A. passing undigested muscle fibers in the feces
B. passing large-volume, greasy, foul-smelling stool

C. passing digested blood in the stool
D. ​passing undigested blood in the stool

289
Q

273) Treatment of variceal bleeding may include
A. Iv. octreotid injection

B. Endoscopic banding of varices

C. Mechanical compression of bleeding varices with a Sengstaken-Blakemore tube

D.​ Any of the above

A

273) Treatment of variceal bleeding may include
A. Iv. octreotid injection
​
B. Endoscopic banding of varices

C. Mechanical compression of bleeding varices with a Sengstaken-Blakemore tube

D.​ Any of the above

290
Q

275) The risk of variceal rupture is increased if …

A. portal/systemic pressure gradient is >12 mm Hg
B. varices exhibit red color sign (“cherry red spots”)

C. ​in both conditions
D. in neither condition

A

275) The risk of variceal rupture is increased if …
​
A. portal/systemic pressure gradient is >12 mm Hg
B. varices exhibit red color sign (“cherry red spots”)

C. ​in both conditions
D. in neither condition

291
Q

276) Small bowel GI bleeding distal to the proximal jejunum may be visualized by

A. Upper endoscopy

B. Colonoscopy​ ​can only go from rectum up until the distal ileum

C.​ Enteroscopy/Capsule endoscopy​ ​this is correct!

D. Any of the above

A

276) Small bowel GI bleeding distal to the proximal jejunum may be visualized by

A. Upper endoscopy

B. Colonoscopy​ ​can only go from rectum up until the distal ileum

C.​ Enteroscopy/Capsule endoscopy​ ​

D. Any of the above

internal med pp (1 decks)

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