PP Flashcards

Question

Signs of Candida esophagitis can include... Odynophagia Dysphagia Substernal pain Any of the above

Answer 1

Signs of Candida esophagitis can include... Odynophagia Dysphagia Substernal pain **Any of the above**

Answer 2

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

Answer 3

Typical symptoms of pill esophagitis include A. Waterbrash (excessive salivation) **B. Odynophagia** C. Vomiting D. GIbleeding

Answer 4

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

Answer 5

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

Answer 6

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

Answer 7

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**

Answer 8

Acute gastritis is often caused by... A. Excessive alcohol consumption B. NSAID abuse C. Infections ## Footnote **D. Any of the above**

Answer 9

Autoantibodies typically found in autoimmune gastritis ANCA Anti ds-DNA **Autoantibodies against the intrinsic factor** All of the above

Answer 10

Biopsy is always required in... **Gastric ulcers** Duodenal ulcers Both conditions Neither condition

Answer 11

Pain associated with gastric ulcer typically appears... At night **Rapidly after eating** Aftervomiting All of the above

Answer 12

Typical signs of gastric ulcer Epigastric pain Nausea Loss of weight **All of the above**

Answer 13

Pain associated with duodenal ulcer typically appears... rapidly after eating **at night** in a constant manner any of the above

Answer 14

Frequent finding during physical examination in patients with peptic ulcer... **Epigastric tenderness** Jaundice Muscular defense Absent liver dullness

Answer 15

Complications of peptic ulcers include... Acute pancreatitis Gastric outlet obstruction Pernicious anemia **Any of the above**

Answer 16

Absent liver dullness in a person with peptic ulcer indicates Gastric outlet obstruction Gastrointestinal bleeding **Perforation** Concomitant hepatitis

Answer 17

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

Answer 18

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**

Answer 19

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

Answer 20

Urea breath test is used to screen for... **H. pylori infection** Lactose intolerance Perniciousanemia Celiac disease

Answer 21

Schilling’s test is used to screen for... H. pylori infection Lactose intolerance **Pernicious anemia** Chronic pancreatitis

Answer 22

Non-invasive screening for H. pylori infection may be performed using... Rapid urease test **Urea breath test** Biopsystaining Any of the above

Answer 23

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

Answer 24

Treatment duration of the antibiotic treatment for H. pylori eradication 3-5 days **7-14 days** 1-2 months lifelong

Answer 25

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

Answer 26

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

Answer 27

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

Answer 28

Treatment of peptic ulcer may include the following, EXCEPT... **NSAIDS to relieve pain** Sucralfat H2 receptor antagonists Proton pump inhibitors

Answer 29

The gold standard method of diagnosing peptic ulcer **Endoscopy** Double-contrast barium study Abdominal CT Abdominal ultrasound

Answer 30

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.**

Answer 31

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

Answer 32

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**

Answer 33

Zollinger-Ellison syndrome refers to severe peptic ulcer formation due to... H. pylori infection Autoimmune origin NSAID abuse **gastrinoma**

Answer 34

Diagnostic procedure of Zollinger-Ellison syndrome includes the following, EXCEPT... Measurement of fasting serum gastrin levels **Urea breath test** OctreoScan Assessment of acid secretion

Answer 35

The most common cause of chronic gastroparesis H. pylori infection **Diabetes mellitus** Hypothyroidism Scleroderma

Answer 36

Typical signs and symptoms of gastroparesis, EXCEPTA. **GIbleeding** B. Vomiting C. Earlysatiety D. Loss of weight

Answer 37

Treatment of gastroparesis includes the following Prokinetic agents Antiemetics Gastric pacemaker **Any of the above**

Answer 38

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.**

Answer 39

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**

Answer 40

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

Answer 41

H2 breath test is used to screen for... **A. Lactose intolerance** B. H.pyloriinfection C. Chronicpancreatitis D. Pernicious anemia

Answer 42

Lactose intolerance... A. Is often congenital B. Isequivalenttomilkallergy C. Istypicallyassociatedwithsteatorrhea **D. None of the above**

Answer 43

Treatment of lactose intolerance includes the dietary elimination of... **A. milk** B. fructose C. gluten D. all the above

Answer 44

Signs and symptoms of lactose intolerance include the following, EXCEPT... A. Flatulence B. Abdominal distension and bloating **C. Bloody diarrhea** D. Cramping abdominal pain

Answer 45

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

Answer 46

Autoantibodies typically found in celiac diseaseA. ANCA **B. Anti-tissuetransglutaminase(tTG)** C. Autoantibodiesagainstintrinsicfactor D. All of the above

Answer 47

Diet of a person diagnosed with celiac disease A. Wheat B. Barley **C. Maize** D.Rye

Answer 48

Celiac disease may be associated with A. alopecia areata B. Dermatitis herpetiformis C. type 1 diabetes mellitus ## Footnote **D. any of the above**

Answer 49

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

Answer 50

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

Answer 51

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

Answer 52

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

Answer 53

Signs of small-bowel bacterial overgrowth include...A. Bloating B. Steatorrhea C. Flatulence ## Footnote **D. Any of the above**

Answer 54

Risk factors for small bowel bacterial overgrowth include... anatomic alterations of the stomach / small intestine Intestinal motility disorders achlorhydria **all of the above**

Answer 55

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

Answer 56

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.

Answer 57

Clinical manifestation of ulcerative colitis typically includes... Small bowel involvement **Gross rectal bleeding** Significant perianal lesions Epitheloid granulomas

Answer 58

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.

Answer 59

Cigarette smoking decreases the risk of... Crohn’s disease **Ulcerative colitis** Both disorders Neither disorder

Answer 60

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

Answer 61

A 80-year-old man presenting with painless rectal bleeding (hematochezia) is highly suggestive to... **diverticulosis** acute appendicitis ulcerative colitis duodenal ulceration

Answer 62

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

Answer 63

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.**

Answer 64

Typical initial symptoms of Crohn’s disease include the following... abdominal pain anorexia fever **any of the above**

Answer 65

The most common autoantibodies in Crohn’s disease **Anti–Saccharomyces cerevisiae antibodies** ANCA Anti-tissue transglutaminase(anti-tTG) All of the above

Answer 66

First-line treatment in mild Crohn’s disease localized to the ileum includes... azathioprine **budesonide** iv. corticosteroids anti-TNF alfa agents

Answer 67

First-line treatment in moderate-to-severe Crohn’s disease includes... 5-ASA (mesalamin) anti-CD20 agents cyclophosphamide and iv. corticosteroids **oral corticosteroids**

Answer 68

Maintenance therapy in Crohn’s disease typically includes the following agents, EXCEPT **Systemic corticosteroids** Azathioprine Infliximab Adalimuma

Answer 69

Signs of toxic or fulminant colitis typically include...A) Constipation **B) High fever** C) Jaundice D) All of the above

Answer 70

Signs of toxic or fulminant colitis typically include...A) Rebound tenderness B) Sudden violent diarrhea C) Abdominal pain ## Footnote **D) All of the above**

Answer 71

The most common autoantibodies in ulcerative colitis Anti–Saccharomyces cerevisiae (ASCA) antibodies **ANCA** Anti-tissue transglutaminase(anti-tTG) Antinuclear antibodies

Answer 72

In fulminant ulcerative colitis the following diagnostic approach is suggested **Abdominal X-ray or abdominal CT** Colonoscopy Barium enema All of the above

Answer 73

Treatment of patients with mild, left-sided ulcerative colitis typically includes... **Mesalamin (5-ASA) enemas** Systemic corticosteroids Azathioprine Anti-TNF drug

Answer 74

Biologic therapy in inflammatory bowel diseases includes... Anti-CD20 monoclonal antibodies mTOR-inhibitors **anti-TNF alfa drugs** IL-1-receptor antagonists

Answer 75

Treatment of patients with extensive ulcerative colitis typically includes... oral5-ASA formulations oral corticosteroids azathioprine **any of the above**

Answer 76

Patients with fulminant ulcerative colitis should receive... **Antibiotics** Antidiarrheal drugs Azathioprine All of the above

Answer 77

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

Answer 78

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.**

Answer 79

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

Answer 80

Colonic diverticula are true diverticula are more common in people on high-fiber diet most of them are symptomatic **become more common with aging**

Answer 81

Management of diverticulosis typically includes... **high-fiber diet** antidiarrheal drugs antibiotics all of the above

Answer 82

Diagnosis of diverticulosis requires... Abdominal X-ray Angiography **Colonoscopy** None of the above

Answer 83

Common findings in diverticulitis include... rebound tenderness nausea fever **all of the above**

Answer 84

Common findings in diverticulitis include... **abdominal pain / tenderness** melena jaundice all of the above

Answer 85

The preferred method of diagnosing diverticulitis **abdominal CT** colonoscopy barium enema angiography

Answer 86

In the majority of cases, serious diverticulitis affects the... ascending colon transverse colon rectum **sigmoid colon**

Answer 87

Complications of diverticulitis include... abscess formation fistulas free intraperitoneal perforation **all of the above**

Answer 88

A patient with diverticulitis develops pneumaturia. This symptom indicates... bowel obstruction perirectal abscess **fistula development involving the bladder** septicem

Answer 89

In most cases, treatment of diverticulitis includes... **antibiotics** steroids surgical intervention all of the abov

Answer 90

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

Answer 91

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.

Answer 92

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 ## Footnote **D. Any of the above**

Answer 93

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

Answer 94

Alarm signs indicating organic disease rather than irritable bowel syndrome include.. .A. loss of weight B. vomiting C. rectal bleeding ## Footnote **D. all of the above**

Answer 95

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**

Answer 96

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

Answer 97

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

Answer 98

Common nonspecific symptoms of liver disease include the following, EXCEPT A. fatigue B. anorexia C. nausea ## Footnote **D. fever**

Answer 99

Risk factor(s) of liver disorders include A. Alcohol B. Transfusion C. Drugs ## Footnote **D. Any of the above**

Answer 100

Fever associated with liver disease isa typical feature in A. hemochromatosis **B. acute alcoholic hepatitis** C. hepatic vein obstruction D. none of the above

Answer 101

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

Answer 102

Acute liver failure may be the consequence of Amanita phalloides mushroom poisoning Hepatitis B infection Wilson’s disease **Any of the above**

Answer 103

Acute liver failure often develops due to Gilbert’s disease **Acetaminophen overdose** Acute pancreatitis Any of the above

Answer 104

Acute liver failure is characterized by A. Jaundice B. Coagulopathy C. Encephalopathy ## Footnote **D. All of the above**

Answer 105

Budd-Chiari syndrome is the consequence of **hepatic vein thrombosis** portal vein thrombosis hepaticarterythrombosis any of the above

Answer 106

Hepatic encephalopathy is typically associated with elevated level of **ammonia** urea both of them neither of them

Answer 107

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

Answer 108

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

Answer 109

The most common cause of ascites Budd-Chiari syndrome **Portal hypertension due to cirrhosis** Severe alcoholic hepatitis without cirrhosis Portal vein thrombosis

Answer 110

Pathomechanism of ascites formation includes Higher plasma oncotic pressure decreased hepatic lymph formation **increased renal Na retention** all of the above

Answer 111

Pathomechanism of ascites formation includes **Increased portal venous hydrostatic pressure** Decreased renal Na retention Increased plasma oncotic pressure All of the above

Answer 112

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

Answer 113

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

Answer 114

The sound during percussion in case of ascites is ... tympanic resonant **dull** none of the above

Answer 115

Treatment of ascites includes... Dietary Na restriction Diuretics (furosemide, spironolactone) **Both interventions** Neither intervention

Answer 116

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

Answer 117

Spontaneous bacterial peritonitis is a common consequence of... **alcoholic cirrhosis** acute appendicitis diverticulitis all of the above

Answer 118

Spontaneous bacterial peritonitis is often caused by... **E.coli** S. aureus C. difficile Any of the above

Answer 119

Signs of spontaneous bacterial peritonitis include... absent liver dullness **diffuse abdominal discomfort** diarrhea all of the above

Answer 120

Diagnosis of spontaneous bacterial peritonitis is based on... abdominal ultrasound **diagnostic paracentesis** abdominalX-ray all of the above

Answer 121

Polymorphonuclear leukocyte (PMN) count in ascites indicating spontaneous bacterial peritonitis is... **A. \>250/􏰞L** B. \>1000/􏰞L C. \>3000/􏰞L D. \> 10 000/􏰞L

Answer 122

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.

Answer 123

Treatment of spontaneous bacterial peritonitis includes.. .A. explorative laparotomy **B. antibiotics** C. regulartherapeuticparacentesis D. all of the above

Answer 124

Non-alcoholic steatohepatitis (NASH) typically includes... A. fat accumulation B. inflammation C. fibrosis ## Footnote **D. all of the above**

Answer 125

Non-alcoholic steatohepatitis is often associated with A. acetaminophen overdose **B. metabolic syndrome** C. hemochromatosis D. hepatitisAinfection

Answer 126

Complications of non-alcoholic steatohepatitis include **Cirrhosis** Wilson’s disease Budd-Chiari syndrome Chronic viral hepatitis

Answer 127

The most common laboratory abnormalities in non-alcoholic steatohepatitis **A. Elevated transaminase levels** B. Hypalbuminemia C. ElevatedAFPlevel D. Decreased cholinesterase level

Answer 128

AST/ALT (GOT/GPT) ratio in non-alcoholic steatohepatitis is typically **A. \<1** B. 1 C. \>1 D. cannot be predicted

Answer 129

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**

Answer 130

Common cause of unconjugated hyperbilirubinemia **Hemolysis** Viral hepatitis Extrahepaticcholestasis All of the above

Answer 131

Common cause of conjugated hyperbilirubinemia Ineffective erythropoiesis Gilbert syndrome **Alcoholic liver disease** All of the above

Answer 132

Jaundice due to hemolysis is often associated with... A. Acholic (clay-colored) stool B. Conjugatedhyperbilirubinemia C. Bilirubinuria ## Footnote **D. None of the above**

Answer 133

Jaundice due to Gilbert disease is often associated with... A. Bilirubinuria B. Acholic (clay-colored) stool **C. Unconjugated hyperbilirubinemia** D. All of the above

Answer 134

Jaundice due to viral hepatitis is often associated with... **Bilirubinuria** Unconjugated hyperbilirubinemia Acholic (clay-colored) stool All of the above

Answer 135

Jaundice associated with the absence of urobilinogen from urine suggests... A. Hemolysis B. Hepatocellulardysfunction **C. Biliaryobstruction** D. None of the above

Answer 136

Jaundice associated with the absence of bilirubin from urine suggests... **A. Hemolysis** B. Hepatocellulardysfunction C. Biliaryobstruction D. None of the above

Answer 137

Jaundice associated with acholic (clay-colored) stool suggests... A. Hemolysis B. Hepatocellular dysfunction **C. Biliary obstruction** D. Any of the above

Answer 138

Jaundice associated with highly elevated aminotransferase levels suggests.. .A. Hemolysis **B. Hepatocellulardysfunction** C. Extrahepaticcholestasis D. All of the above

Answer 139

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

Answer 140

Gilbert syndrome is typically associated with elevated level of... **Bilirubin** Aminotransferases (AST, ALT) Alkaline phosphatase and GGT All of the above

Answer 141

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**

Answer 142

Portal hypertension may be caused by... cirrhosis schistosomiasis hepatic vein thrombosis **any of the above**

Answer 143

Consequences of portal hypertension include... hypertensive gastropathy visible abdominal wall collaterals rectal varices **all of the above**

Answer 144

The level of portal venous pressure gradient at which the risk of variceal bleeding increases... significantly 4 mmHg **12 mmHg** 20 mmHg 30 mmHg

Answer 145

Complications of portal hypertension include... A. Sudden painless upper GI bleeding B. Portosystemicencephalopathy C. Hypersplenism ## Footnote **D. All of the above**

Answer 146

Portal hypertensive gastropathy is best diagnosed by ... **Upper endoscopy** Abdominal ultrasound Double-contrast barium study ERCP

Answer 147

Long-term drug therapy for varices that have bled involves... diuretics **nonselective beta blockers** ACE inhibitors all of the above

Answer 148

Signs of portosystemic encephalopathy include Impaired concentration Poor handwriting Somnolence **Any of the above**

Answer 149

Routine diagnosis of portosystemic encephalopathy includes... **serum ammonia levels** cerebrospinal fluid examination diagnostic paracentesis all of the above

Answer 150

Treatment of portosystemic encephalopathy includes... Diuretics **Oral nonabsorbable antibiotics** Non-selective beta blockers Anti-diarrheal drugs

Answer 151

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

Answer 152

In males, alcoholic cirrhosis is often associated with... gynecomastia erectile dysfunction decreases spermatogenesis **all of the above**

Answer 153

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

Answer 154

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

Answer 155

The main risk factors in alcoholic liver disease involve... Quantity and duration of alcohol use Gender Nutritional status **All of the above**

Answer 156

Pathophysiology of alcoholic liver disease includes... hepatic fat accumulation increased absorption of endotoxins from the gut oxidative damage **all of the above**

Answer 157

Laboratory alterations in alcoholic cirrhosis often include... microcytic anemia **elevated GGT** decreasedaminotransferases all of the above

Answer 158

Child-Pugh scoring system is used to assess the severity of... **cirrhosis** GERD colon cancer acute pancreatitis

Answer 159

Transmission is primarily fecal-oral for... **hepatitisAvirus** hepatitis B virus hepatitis C virus hepatitis D virus

Answer 160

Hepatitis C virus is most commonly transmitted through... sexual intercourse **blood** insect bite fecal-oral route

Answer 161

Chronic infection typically occurs in case of... hepatitisAinfection **hepatitis B infection** hepatitis E infection all of the above

Answer 162

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

Answer 163

Hepatitis E infection often causes fulminant hepatitis in... **pregnant women** youngchildren the elderly the general population

Answer 164

Prodromal symptoms of viral hepatitis infection include... profound anorexia right upper quadrant abdominal pain nausea and vomiting **all of the above**

Answer 165

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

Answer 166

The highest rate of chronicity is associated with... hepatitisAinfection hepatitis B infection **hepatitis C infection** hepatitis E infection

Answer 167

Diagnosis of acute hepatitis A infection involves the detection of... Hepatitis A virus surface antigen (HAsAg) a**nti-HAVIgM** anti-HAVIgG any of the above

Answer 168

IgG anti-HAV suggests... acute hepatitis A infection **previous exposure to hepatitis A** chronichepatitisAinfection none of the above

Answer 169

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

Answer 170

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

Answer 171

Routine diagnosis of hepatitis C infection involves... Hepatitis C surface antigen (HCsAg) **Anti-HCV** HCVDNA Any of the above

Answer 172

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**

Answer 173

Preexposure prophylaxis is NOT available for... hepatitisAinfection hepatitis B infection **hepatitis C infection** hepatitis E infection

Answer 174

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

Answer 175

Treatment of chronic hepatitis B virus infection involves... corticosteroids **pegylated interferon alpha** ribavirin hepatitis B immune globulin (HBIG

Answer 176

Treatment of chronic hepatitis C virus infection may involve... corticosteroids anti-TNF alpha drugs **ribavirin** all of the abov

Answer 177

Autoimmune hepatitis is usually associated with elevated levels of... **anti-mitochondrial antibody** anti smooth muscle antibody ANCA tissue transglutaminase antibody

Answer 178

Treatment of autoimmune hepatitis involves... **A. corticosteroids** B. pegylated interferon alpha C. ribavirin D. anti TNF alpha drugs

Answer 179

Signs of acute hepatic venous outflow obstruction typically include... tender hepatomegaly **ascites** nausea and vomiting all of the abov

Answer 180

Diagnosis of hepatic venous outflow obstruction is based on... **Abdominal Doppler ultrasonography** ERCP Upper endoscopy Liver biopsy

Answer 181

Treatment of hepatic venous outflow obstruction includes... **anticoagulation** inhibition of thrombocyte aggregation corticosteroids all of the above

Answer 182

The “5F rule – female, fair, fat, forty, fecund” summarizes risk factors of acute pancreatitis pepticulcer **cholelithiasis** diverticulosis

Answer 183

The most common form of gallstones in the Western world is **cholesterol stones** black pigment stones brown pigment stones all stones are equally common

Answer 184

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

Answer 185

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**

Answer 186

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

Answer 187

Signs and symptoms of biliary colic typically include enlarged, palpable, painless gallbladder signs of peritoneal irritation **nausea and vomiting** absent liver dullness

Answer 188

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

Answer 189

Diagnosis of gallstones is based on ERCP **ultrasonography** elevated alkaline phosphatase levels cholescintigraphy

Answer 190

Complications of gallstones include cholangitis pancreatitis choledocholithiasis **all of the above**

Answer 191

Substance used for gallstone dissolution **A. ursodeoxycholic acid** B. 5-aminosalicylate C. azathioprine D. cholestyramine

Answer 192

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

Answer 193

Typical signs and symptoms of cholecystitis include A. severe and steady pain lasting \> 6h B. vomiting C. low-gradefever ## Footnote **D. all of the above**

Answer 194

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

Answer 195

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

Answer 196

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**

Answer 197

Ultrasonographic finding of gallstones in slightly thick-walled, shrunken gallbladder suggests acute cholecystitis **chronic cholecystitis** cholangitis cholangiocarcinoma

Answer 198

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**

Answer 199

Charcot's triad includes... **abdominal pain, jaundice, and fever** jaundice, melena and loss of weight abdominal pain, bloating and nausea diarrhea, fever and anorexia

Answer 200

Charcot’s triad is characteristic of.. .A. acute pancreatitis **B. cholangitis** C. diverticulitis D. all of the above

Answer 201

Laboratory findings in acute cholangitis typically include elevated levels of WBC conjugated bilirubin alkaline phosphatase **all of the above**

Answer 202

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

Answer 203

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

Answer 204

Treatment of acute cholangitis includes ERCP and sphincterotomy broad-spectrum antibiotics **both interventions** neither intervention

Answer 205

Primary sclerosing cholangitis is often associated with **A. ulcerative colitis** B. primarybiliarycirrhosis C. diverticulosis D. chronic pancreatitis

Answer 206

Signs and symptoms of primary sclerosing cholangitis typically include A. progressive fatigue B. jaundice C. pruritus ## Footnote **D. all of the above**

Answer 207

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**

Answer 208

Laboratory findings in primary sclerosing cholangitis typically include elevated levels of the following substances, EXCEPT alkaline phosphatase pANCA **antimitochondrial antibodies** IgM

Answer 209

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

Answer 210

Treatment modalities applied in primary sclerosing cholangitis include liver transplantation ursodeoxycholicacid ERCP dilation and stenting of a dominant stricture **all of the above**

Answer 211

Acute pancreatitis may be triggered by... heavy alcohol intake hypertrigliceridemia certain viral infections **any of the above**

Answer 212

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

Answer 213

Common finding in acute pancreatitis, EXCEPT **Muscular defense** Nausea and vomiting Hypoactive bowel sounds Upper abdominal distension

Answer 214

A positive Cullen sign is characteristic of... **hemorrhagic pancreatitis** acute cholangitis acute cholecystitis pancreatic cancer

Answer 215

Laboratory findings in acute pancreatitis may include elevated levels of lipase WBC triglycerides **any of the above**

Answer 216

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

Answer 217

Treatment of acute pancreatitis always includes the following, EXCEPT iv. fluid resuscitation parenteral analgesics **antibiotics** fasting

Answer 218

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

Answer 219

Signs and symptoms of chronic pancreatitis include decreased glucose tolerance steatorrhea episodic abdominal pain **all of the above**

Answer 220

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

Answer 221

Treatment of chronic pancreatitis may include pancreatic enzyme supplementation alcohol abstinence pancreas resection **all of the above**

Answer 222

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

Answer 223

The site of upper gastrointestinal bleeding is located above the... pyloric ring **ligament of Treitz** ileocecal valve hepatic flexure

Answer 224

Upper GI bleeding \> 200 ml always results in hematemesis **melena** both hematemesis and melena hematochezia

Answer 225

Common cause of lower GI bleeding in the elderly patient **angiodysplasia** inflammatory bowel disease irritable bowel syndrome any of the above

Answer 226

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

Answer 227

Classic symptoms of acute appendicitis include periumbilical pain that shifts to the right lower quadrant nausea anorexia **all of the above**

Answer 228

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

Answer 229

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

Answer 230

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**

Answer 231

Hyperactive, high-pitched bowel sounds are characteristic of ... **intestinal obstruction** acute appendicitis acute intestinal perforation all of the above

Answer 232

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

Answer 233

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

Answer 234

The diagnostic procedure of choice in acute mesenteric ischemia is... **CT angiography** abdominal ultrasound colonoscopy double-contrast barium enema

Answer 235

The first sign of acute mesenteric ischemia is... **severe abdominal pain** abdominal muscle guarding absent bowel sounds fever

Answer 236

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

Answer 237

Non-surgical causes of acute abdomen include lead poisoning acute porphyria sickle cell crisis **all of the above**

Answer 238

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

Answer 239

75) Long-term complication of untreated celiac disease includes... A. Diabetes mellitus **B. T-cell lymphoma** C. Duodenal fistules D. Duodenal stenosis

Answer 240

Diagnosis of small bowel bacterial overgrowth may be based on...??? A. lactulose H2 breath test B. 14C-xylose breath test **C. Both methods** D. Neither method

Answer 241

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

Answer 242

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.

Answer 243

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.

Answer 244

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.**

Answer 245

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.

Answer 246

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

Answer 247

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**

Answer 248

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.

Answer 249

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

Answer 250

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

Answer 251

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

Answer 252

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

Answer 253

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

Answer 254

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

Answer 255

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

Answer 256

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**

Answer 257

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

Answer 258

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

Answer 259

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**

Answer 260

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

Answer 261

263) The most common cause of chronic pancreatitis in the Western world is... A. primary sclerosing cholangitis **B. alcoholism** C. autoimmune pancreatitis D. cholelithiasis

Answer 262

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

Answer 263

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

Answer 264

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**

Answer 265

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**

Answer 266

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

Answer 267

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