Gastrointestinal pathology :)

Question 1 of 119

1

A middle-aged man with longstanding Barrett’s esophagus is referred for specialist review after he reports increasing dysphagia over the last 4 months. He has noted that it initially only affected solids but now struggles with liquids as well. What is the next most important investigation to aid diagnosis?

Select one of the following:

Blood investigation for tumour markers
Barium swallow
CT
PET
Endoscopy

Explanation

Question 2 of 119

1

What is the first line maintenance treatment for Ulcerative Collitis?

Select one of the following:

Mesalazine
Ciclosporin
Prednisolone
Infliximab
Azathioprine

Explanation

Question 3 of 119

1

What do parietal cells produce?

Select one of the following:

pepsinogen
somatostatin
gastrin and histamine
hydrochloric acid and intrinsic factor
histamine only

Explanation

Question 4 of 119

1

An elderly man with a history of alcohol abuse goes to ED with hematemesis for 1 day. He has no abdominal or chest pain. His eyes are reddened and he admits to drinking heavily the night before he vomited several times. What may be the reason for this?

Select one of the following:

Oesophageal varices
Lung Cancer
Achalasia
Perforated gastric ulcer
Mallory-Weiss tear

Explanation

Question 5 of 119

1

A 20-year-old man presents to the ED with fever and severe right lower quadrant (RLQ) pain for 1 day. Prior to this episode, he reports 2 months of crampy abdominal pain, generalized malaise, a 5kg weight loss, and occasional bloody diarrhoea. On physical exam, the patient appears uncomfortable and has a tender mass is in the RLQ. An abdominal CT scan demonstrates normal appendix and inflammation of the distal ileum and several areas of the colon without rectal involvement.Which of the following is the most likely diagnosis?

Select one of the following:

Crohn's Disease
Ulcerative Colitis
Appendicitis
Diverticulitis
Pseudomembranous colitis

Explanation

Question 6 of 119

1

An older woman arrives at ED complaining of abdominal pain. She states that the pain began as a vague aching but has migrated to the left side of her abdomen. She had a fever over the past 3 days and just not feeling like herself. She also complains of being more constipated than usual. Your abdominal exam reveals normal bowel sounds, mild distension, and tenderness over the left lower quadrant. What is most likely the reason for this

Select one of the following:

Colorectal cancer
Diverticulitis
Appendicitis
Crohn’s disease
Duodenal ulcer

Explanation

Question 7 of 119

1

What is the blood supply to the superior rectum?

Select one of the following:

celiac artery
superior mesenteric artery
inferior mesenteric artery
internal iliac artery
external iliac artery

Explanation

Question 8 of 119

1

A elderly man attends your clinic with a three-month history of weight loss ofapproximately 9 kg despite a normal appetite. A full blood count reveals that his hemoglobin is 9.0 g/dL (previous hemoglobin was 13.5 g/dL one year ago) and the MCV is 71 fL.

The abdominal examination is unremarkable and per rectum exam is unremarkable. The patient states that he has normal bowel habits and has been feeling quite tired lately. What is the most appropriate management?

Select one of the following:

Reassure and discharge
Prescribe iron tablet supplementation
have an abdominal ultrasound
have an abdominal x-ray
have an upper and lower GI endoscopy

Explanation

Question 9 of 119

1

A middle aged woman has a four-month history of diarrhoeaand bloating. Associated symptoms include lethargy and weight loss.

Full blood count reveals:
hemoglobin of 9.3 d/gL (13.8 to 17.2)
MCV 70 fL. (77-95)

What other investigation allow proper patient diagnosis?

Select one of the following:

Anti-mitochondrial antibodies
Anti-smooth muscle antibodies
Anti-nuclear antibodies
Anti-tissue transglutaminase antibodies
Anti-neutrophil cytoplasmic antibodies

Explanation

Question 10 of 119

1

You see an elderly man with an acute episode of hematemesis, who was admitted the night before and is awaiting an upper GI endoscopy. You are asked on the ward round about the common causes of upper GI bleeding. From the list below, which of the following is the most common cause of upper GI bleeding?

Select one of the following:

Mallory–Weiss tear
Peptic ulcers
Esophageal varices
Drug induced
Sporadic malignancy

Explanation

Question 11 of 119

1

You see a middle aged woman with Crohn’s disease. Due to a severe attack of Crohn’s which failed to respond to medical therapy, she had a small bowel resection. Your registrar tells you that she is at risk of developing vitamin B12 deficiency as a result of her surgery. Which part of the bowel is responsible for the absorption of vitamin B12?

Select one of the following:

Ascending colon
Terminal ileum
Duodenum
Jejunum
Proximal Ileum

Explanation

Question 12 of 119

1

You see a middle aged man who was admitted for an elective upper GI endoscopydue to longstanding GORD which has failed to improve on antacids and PPIs. Your registrar suspects that this patient may have Barrett’s oesophagus and asks you to define what this is:

Select one of the following:

Metaplasia of the squamous epithelium of the lower third of the esophagus to columnar epithelium
Metaplasia of the columnar epithelium of the upper third of the oesophagus to squamous epithelium
Metaplasia of the squamous epithelium of the middle third of the oesophagus to columnar epithelium
Metaplasia of the squamous epithelium of the upper third of the oesophagus to columnar epithelium
Metaplasia of the columnar epithelium of the lower third of the oesophagus to squamous epithelium

Explanation

Question 13 of 119

1

Which of the following is the most common cause of duodenal ulcers?

Select one of the following:

NSAIDs
Alcohol Abuse
Helicobacter pylori
Chronic corticosteroid therapy
Zollinger-Ellison syndrome

Explanation

Question 14 of 119

1

A middle-aged lorry driver presents to the GP with chest pain that usually occurs after having a meal. He has no major past medical history and he takes ibuprofen regularly. He is otherwise fit and healthy. What is the most important next step in management?

Select one of the following:

Urgent referral to endoscopy.
Routine referral to endoscopy.
Prescribe omeprazole, a PPI.
Perform a H. pylori urea test.
Perform a 12-lead ECG

Explanation

Question 15 of 119

1

You see a middle aged lorry driver, who presents to you with a three-month history of heartburn after meals which has not been settling with antacids and PPIs. You suspect that the patient has a hiatus hernia. The most appropriate investigation for diagnosing a hiatus hernia is:

Select one of the following:

CT scan
Chest x-ray
Barium meal
Ultrasound
Upper GI endoscopy

Explanation

Question 16 of 119

1

A middle-aged woman is referred for upper gastrointestinal (GI) endoscopy following a four-month history of epigastric pain despite treatment with antacids and proton pump inhibitors (PPIs). The results demonstrate a duodenal ulcer coupled with a positive campylobacter-like organism (CLO) test. The patient has no past medical history and has no known drug allergies. What is the most appropriate treatment?

Select one of the following:

Seven-day course of twice daily omeprazole 20 mg, 1 g amoxicillin and 500 mg clarithromycin
Seven-day course of twice daily omeprazole 20 mg
Seven-day course of twice daily omeprazole 20 mg and 1 g amoxicillin
Seven-day course of twice daily omeprazole 20 mg and 500 mg clarithromycin
Seven-day course of twice daily 1 g amoxicillin and 500 mg clarithromycin

Explanation

Question 17 of 119

1

You see a middle aged man with a three-month history of epigastric dullabdominal pain. The pain is worse in the mornings and is better after meals. There is no history of weight loss and the patient’s bowel habits are normal. His abdomen is soft and experiences moderate discomfort on palpation of the epigastric region. What is the most likely diagnosis?

Select one of the following:

Gastric ulcer
Gastro-oesophageal reflux disease (GORD)
Gastritis
Gastric carcinoma
Duodenal ulcer

Explanation

Question 18 of 119

1

You see an elderly man who comes to ED with epigastric pain. The pain started 3 days ago and today his stools color has changed to a ‘tarry-black’ color. Associated symptoms include nausea and lethargy.
The patient is alert and orientated with a pulse rate of 99 and blood pressure of 98/69, respiratory rateof 18, oxygen saturations of 98 per cent on room air and temperature of 37.2°C.
The abdomen is soft with marked tenderness in the epigastric region and bowel sounds are present. The rectum is empty, on PR examination, with some traces of melaena. The patient has been started on high flow oxygen and has been given some oral analgesia. The most appropriate next step in managing this patient is:

Select one of the following:

ECG
Intravenous omeprazole
Request an erect chest x-ray
Keep nil by mouth and arrange endoscopy
Intravenous cannulation and fluids

Explanation

Question 19 of 119

1

As you palpate the right upper quadrant (RUQ) of a middle aged woman’s abdomen, you notice that she stops her inspiration for a brief moment. The patient states that over the last 2 days she gets pain in her RUQ that radiates to her back shortly after eating.

Her vitals are temperature 38°C, heart rate (HR) 95, blood pressure (BP)130/75, respiratory rate (RR) 16. What is the initial diagnostic modality of choice for this disorder?

Select one of the following:

Plain film radiograph
CT scan
Ultrasound
MRI
ERCP

Explanation

Question 20 of 119

1

A middle-aged woman at ED complains of pain in her RUQ that is steady but gets worse with eating over the past 2 days. The pain also radiates to the right side of her mid-back. No vomiting. Her only medication is an oral contraceptive.
Her BP is 140/75 mm Hg, HRis 80 beats per minute, temperature is 37°C, and RR is 16 breaths perminute. Laboratory tests are within normal limits. What is the most likely diagnosis?

Select one of the following:

Cholangitis
Pancreatitis
Cholecystitis
Peptic ulcer disease
Biliary colic

Explanation

Question 21 of 119

1

A 50-year-old man presents to the ED complaining of abrupt onset of epigastric pain that radiates to his back. He describes the pain as constant and associated with nausea and vomiting. The pain improves mildly if he leans forward. He has a 20-pack-year smoking history and consumes a 6-pack of beer daily for more than 5 years. His BP is 150/80 mm Hg, HR is 98 beats per minute, temperature is 37.8°C, and his RR is 18 breaths perminute. He is tender to palpation in the epigastric area. His WBC count is normal and lipase 520 U/L (0-160 U/L). What is the most likely diagnosis?

Select one of the following:

Cholecystitis
Bowel perforation
Mesenteric ischemia
Abdominal aortic aneurysm
Pancreatitis

Explanation

Question 22 of 119

1

A 55-year-old man presents to the ED complaining of mild diffuse abdominal pain. The pain began upon waking up and is associated with some nausea. He denies fever, vomiting, diarrhoea, and rectal bleeding. His BP is 143/71 mm Hg, HR is 87 beats per minute, temperature is 36°C, and RR is 16 breaths per minute. His abdomen is tense but only mildly tender. You order baseline labs. His chest radiograph is seen below. Which of the following is the most likely diagnosis?

Select one of the following:

Ascending cholangitis
Acute pulmonary edema
Ruptured aneurysm
Pancreatitis
Perforation with pneumoperitoneum

Explanation

Question 23 of 119

1

A 33-year-old man presents to the ED complaining of lower abdominal pain. He states that last night he ate pizza with pepperoni for dinner, went to sleep, and awoke several hours later with a vague, periumbilical pain. The pain has been constant since its onset and has migrated to his lower abdomen more on the right than left. Since eating the pizza he has no appetite. He is nauseated and vomited twice in the ED. His BP is 125/70 mm Hg, HR is88 beats per minute, temperature is 38°C, and his RR is 16 breaths perminute. On exam, his RLQ is tender to palpation.What is the most likely diagnosis?

Select one of the following:

Cholangitis
Appendicitis
Diverticulitis
Pancreatitis
Acute cholecystitis

Explanation

Question 24 of 119

1

Patient presents with painless jaundice and palpable RUQ mass. Which of the following is the most likely diagnosis

Select one of the following:

Cholecystitis
Cholangitis
Abdominal aortic aneurysm
Crohn’s disease
Gall bladder carcinoma

Explanation

Question 25 of 119

1

A 71-year-old obese man is brought to the ED complaining of constant left middle quadrant abdominal pain with radiation into his back. His past medical history is significant for hypertension, peripheral vascular disease, and kidney stones. He smokes a pack of cigarettes daily. His BP is 145/80 mm Hg, HR is 90 beats per minute, temperature is 37.2°C, and RR is 16 breaths per minute. Abdominal exam shows a pulsatile abdominal mass. An abdominal radiograph reveals normal loops of bowel. Which of the following is the most likely diagnosis?

Select one of the following:

Biliary colic
Diverticulitis
Pancreatitis
Small bowel obstruction
Abdominal aortic aneurysm

Explanation

Question 26 of 119

1

A 78-year-old woman is brought to the ED by EMS complaining of vomiting and abdominal pain that began during the night. EMS reports that her BP is 90/50 mm Hg, HR is 110 beats per minute, temperature is 38°C, and RR is 18 breaths per minute. After giving her a 500 mL bolus of normal saline, her BP is 115/70 mm Hg. During the exam, you notice that her face and chest appear jaundiced. What is the most likely diagnosis?

Select one of the following:

Cholecystitis
Acute hepatitis
Cholangitis
Pancreatic cancer
Bowel obstruction

Explanation

Question 27 of 119

1

What is NOT true regarding GI anatomy?

Select one of the following:

The foregut is from the distal (abdominal) esophagus to hepatopancreatic ampulla of the duodenum (2nd part of the duodenum.)
The mesentery includes the liver, gallbladder, pancreas, and spleen
Midgut ends at 2/3rds along the transverse colon.
The Hindgut ends at the anus.

Explanation

Question 28 of 119

1

Fill the blank spaces to complete the text.

The GI wall, from the to the , has the same 4 layers (from outermost to innermost)

1.
2.
3.
4.

Explanation

Question 29 of 119

1

Fill the blank spaces to complete the text.

The foregut is supplied by the , which comes off the aorta at level .

The midgut is supplied by the artery, which comes off the aorta at level .

The hindgut is supplied by the artery, which comes off the aorta at level .

Explanation

Question 30 of 119

1

The GI tract lymphatics and vasculature is about the same.

Select one of the following:

True
False

Explanation

Question 31 of 119

1

Which is NOT a major lymph structures involved with abdominal drainage?

Select one of the following:

Celiac nodes
Superior Mesenteric Aortic/Caval nodes
Inferior Mesenteric Aortic/Caval nodes
Renal nodes

Explanation

Question 32 of 119

1

Click on each orange point and write the correct answer.

Label the parts.

Explanation

Question 33 of 119

1

Fill the blank spaces to complete the text.

Large Intestine Blood Supply:

rectal artery is a branch of the artery.

However, the rectal and rectal arterys are both branches of artery.

Explanation

Question 34 of 119

1

What is true regarding the esophagus' histology?

Select one or more of the following:

made of nonkeratinized squamous epithelium
upper skeletal sphincter
lower smooth sphincter
upper 1/3 skeletal muscle
middle 1/3 skeletal and smooth muscle
lower 1/3 smooth muscle
cyclic mucus secretions
upper 1/3rd squamous cells

Explanation

Question 35 of 119

1

Fill the blank spaces to complete the text.

Pharyngeal Pouch ( diverticulum) is an out-pouching (diverticulum) that develops from the wall of the just prior to the .

Explanation

Question 36 of 119

1

What is true regarding Zenker diverticulum?

Select one or more of the following:

management: surgery
investigation: barium swallow
management: corticosteroids
dysphagia
halitosis
stomach gurgling upon palpatation
constipation
diarrea

Explanation

Question 37 of 119

1

What is true regarding achalasia?

Select one or more of the following:

affects esophageal motility
lower esophageal sphincter unable to relax
gradual dysphagia to solids and liquids
weight loss
form of acid reflux--> damages esophageal cells
vomiting
prolonged dysphagia
drugs trtment: nitrates
drugs trtment: caclium channel blockers
investiagtion: manometry and endoscopy

Explanation

Question 38 of 119

1

Fill the blank spaces to complete the text.

(GERD/GORD) is a condition in which the stomach contents are regurgitated back the esophagus, usually because the sphincter is unable to fully close after swallowing.

Explanation

Question 39 of 119

1

What is true regarding GORD?

Select one or more of the following:

dyspepsia is main symptom
preferable investigation via endoscopy
manage via lifestyle changes
manage via proton pump inhibitors
manage via gastrin inhibitors
risk factors = smoking, alcohol, and obesity
risk factor = chocolate
risk factor= pregnancy
preferable investigation via blood tests
preferable investigation via sputum culture

Explanation

Question 40 of 119

1

Fill the blank spaces to complete the text.

A Mallory-Weiss Tear is when there is bleeding from a laceration in the at the junction of the and . This is usually caused by severe , such as from , bulimia, or food .

The signaling symptom is painful hematemesis. It is diagnosed by endoscopy.

Explanation

Question 41 of 119

1

Click on each orange point and write the correct answer.

Label the diagram showing the GI venous drainage. (the colors are just to differentiate between the various vessels)

Explanation

Question 42 of 119

1

Fill the blank spaces to complete the text.

The liver is supplied by the hepatic portal vein (which is made up of the vein and the vein) and the hepatic artery.

% of blood going to the liver is from the hepatic portal vein while % is from the hepatic artery.

However, blood is split ~50:50 between the portal vein and hepatic arteries.

Explanation

Question 43 of 119

1

Which of these does NOT directly come off of the celiac trunk?

Select one of the following:

splenic artery
common hepatic artery
left gastric artery
proper hepatic artery

Explanation

Question 44 of 119

1

The common hepatic artery becomes the proper hepatic artery after the gastroduodenal artery branch.

Select one of the following:

True
False

Explanation

Question 45 of 119

1

Click on each orange point and write the correct answer.

Label the parts of the GI arterial vasculature. (max amnt words for any answr is 3)

Explanation

Question 46 of 119

1

Which comes first in the development of a carcinoma?

Select one of the following:

metaplasia
dysplasia

Explanation

Question 47 of 119

1

Fill the blank spaces to complete the text.

is the reversible change of one cell type to another
is abnormal changes in the cell and disorganized
Carcinoma is the eventual transformation into malignant cells.

Explanation

Question 48 of 119

1

Fill the blank spaces to complete the text.

is a pre-malignant condition of the lower esophagus. This happens when the cells go through metaplasia and become cells. This change usually happens as defence against an environment, which may be due to conditions like . This condition puts the patient of increased risk of esophageal .

Explanation

Question 49 of 119

1

Fill the blank spaces to complete the text.

The management of Barret's Esophagus is to do a .

Premalignant changes are indicative of high-grade . The treatment for this in younger and more fit individuals is an . For others, it's .

If there are no premalignant channges, the patient will have regular , biopsy, and other anti-reflux measures, including long term (drugs).

Explanation

Question 50 of 119

1

What is true regarding esophageal carcinoma?

Select one or more of the following:

symptom: vomiting
symptom: weight loss
symptom: anorexia
presentation: progressive dysphagia
investigation: chest xray
investigation: urgent endoscopy + biopsy
investigation: CT or MRI chest and upper abdomen
symptom: hoarse voice
symptom: excessive acid reflux
investigation: neck ultrasound

Explanation

Question 51 of 119

1

The stomach has 2 muscle layers: inner oblique and outer longitudinal

Select one of the following:

True
False

Explanation

Question 52 of 119

1

The stomach is lined by simple squamous epithelial cells

Select one of the following:

True
False

Explanation

Question 53 of 119

1

What controls the secretion of gastric acid?

Select one or more of the following:

the parasympathetic nervous system
gastrin
histamine
PGE2
PGI2
pepsinogen concentration
gut bacteria

Explanation

Question 54 of 119

1

Prostaglandins increase acid secretion

Select one of the following:

True
False

Explanation

Question 55 of 119

1

A side effect of NSAIDs is peptic ulcers.

Select one of the following:

True
False

Explanation

Question 56 of 119

1

Which of these are considered GI drugs?

Select one or more of the following:

proton pump inhibitors
histamine receptors
synthetic prostaglandins
antacids
amoxicillin
metronidazole
clarithromycin
calcium channel blockers
beta blockers
pepto bismol

Explanation

Question 57 of 119

1

Click on each orange point and write the correct answer.

Fill in which drugs go into which parts of the cycle to help with acid control:

Explanation

Question 58 of 119

1

What is not a sign of dyspepsia?

Select one of the following:

epigastric pain
bloating
heartburn
burning sensation during defecation

Explanation

Question 59 of 119

1

Fill the blank spaces to complete the text.

Worrying symptoms of dyspepsia:
A
L loss of weight
A
R recent
M (tarry feces) and
S wallowing difficulty

Explanation

Question 60 of 119

1

What are ways to manage dyspepsia?

Select one or more of the following:

simple antacids for 4 weeks
test for H. Pylori and eliminate if possible
Proton pump inhibitors for 4 weeks
urgent endoscopy
biopsy
blood works

Explanation

Question 61 of 119

1

Click on each orange point and write the correct answer.

Label the different types of hiatus hernias

Explanation

Question 62 of 119

1

Barium swallow via fluoroscopy is how one is able to diagnose a hiatus hernia.

Select one of the following:

True
False

Explanation

Question 63 of 119

1

What is true regarding peptic ulcers?

Select one or more of the following:

include duodenal ulcers
include gastric ulcers
complication: hemorrhage
complication: ulcer perforation
complication: malignancy (tumor)
include jejunal ulcers
gastric ulcers > common than duodenal ulcers

Explanation

Question 64 of 119

1

What is true regarding duodenal ulcers?

Select one or more of the following:

epigastric tenderness
epigastric pain before meals
relief via milk
epigastric pain better at night
relief via lemon soda

Explanation

Question 65 of 119

1

Fill the blank spaces to complete the text.

Gastric ulcers:
- happens mainly in
- pain (dependent on and can be relieved by antacids)
- weight gain or loss

Explanation

Question 66 of 119

1

Click on each orange point and write the correct answer.

What is this sign and what is indicative of?

Explanation

Question 67 of 119

1

What is true regarding zollinger-ellison syndrome?

Select one or more of the following:

gastrinoma--> peptic ulcer
usually in duodenum
usually in pancreas
investigation: endoscopy
investigation: very high fasting and then serum gastrin level investigation
investigation: biopsy
management: surgery
management: proton pump inhibitors
management: antacids
usually in ileum

Explanation

Question 68 of 119

1

iron is absorbed in the jejunum.

Select one of the following:

True
False

Explanation

Question 69 of 119

1

Fill the blank spaces to complete the text.

is an inflammation of the proximal small intestine mucosa in response to dietary gluten.

It is Hypersensitivity . It is a disease of the small intestines in which causes villous atrophy and .

Explanation

Question 70 of 119

1

What are symptoms of Celiac's Disease?

Select one or more of the following:

diarrhea
malaise
abdominal discomfort
iron deficiency anemia
weight loss
steatorrhea
weariness
concentrated pain
bursts of energy

Explanation

Question 71 of 119

1

Celiac disease makes you at more risk of colon cancer and lymphoma.

Select one of the following:

True
False

Explanation

Question 72 of 119

1

Crohn's Disease treatment is a gluten free diet and necessary vitamin supplements.

Select one of the following:

True
False

Explanation

Question 73 of 119

1

Which of the following is not a way to diagnose Celiac's disease?

Select one of the following:

duodenal biopsy via endoscopy
blood test: abnormally high levels of IgA endomysial
blood test: if anti-tissue transglutaminase antibodies are found
abdominal x-ray

Explanation

Question 74 of 119

1

What is true regarding diverticulitis?

Select one or more of the following:

only in relation to the large intestine
inflammation of colon's diverticulae
more common in elderly patients
more common in those chronically constipated
more common in women
more common in those with acute constipation
commonly associated with anal fissures

Explanation

Question 75 of 119

1

Which are symptoms of diverticulitis?

Select one of the following:

lower left quadrant pain
lower left quadrant tenderness
fever
tenesmsus
diarrhea
constipation

Explanation

Question 76 of 119

1

How can you investigate for diverticulitis?

Select one of the following:

barium enema
colonoscopy
CT colonogram
rectal biopsy

Explanation

Question 77 of 119

1

Fill the blank spaces to complete the text.

Treatment of diverticulitis:

mild:
at home with , fluids, and .

severe or ill patients:
admission to hospital (cannot manage , problems with , )

Explanation

Question 78 of 119

1

Click on each orange point and write the correct answer.

What are these two colon related conditions?

Explanation

Question 79 of 119

1

Which conditions make up inflammatory bowel disease?

Select one or more of the following:

Crohn's disease
Celiac's disease
Ulcerative Colitis
Diverticulitis
Peptic Ulcers

Explanation

Question 80 of 119

1

Fill the blank spaces to complete the text.

is a chronic inflammatory bowel disease affecting all layers of the GI tract (). Its key characteristic is , and on a colonscopy there is a “ ." ANY part of the GI tract but most commonly the (can cause deficiency).

Explanation

Question 81 of 119

1

What are symptoms of Crohn's Disease?

Select one or more of the following:

diarrhea
abdominal pain
right lower quadrant mass
perianal disease
mouth ulcers
extra-intestinal manifestations
pale and bulky stools
right lower quadrant pain

Explanation

Question 82 of 119

1

What is not an investigation for Crohn's Disease?

Select one of the following:

stool sample
colonscopy and biopsy
endoscopy and biopsy
Blood: CRP/ESR
Blood: FBC
Blood: LFTs
Blood: B12
Blood: ferritin
Barium swallow

Explanation

Question 83 of 119

1

Fill the blank spaces to complete the text.

Management of Crohn Disease attacks:
Mild attacks:
Severe attacks: IV , nil by mouth, and IV .

Explanation

Question 84 of 119

1

Click on each orange point and write the correct answer.

Label the parts of the biliary tree?

Explanation

Question 85 of 119

1

Fill the blank spaces to complete the text.

Bile is produced by and is stored in the . Bile the fat and allows fat absorption in . An example of fat soluble vitamins:

Explanation

Question 86 of 119

1

Fill the blank spaces to complete the text.

An is any hormone secreted by the mucosa in response to dietary lipids that inhibits the caudal (or "forward, analward") motion of the contents of .

Explanation

Question 87 of 119

1

Fill the blank spaces to complete the text.

Relapsing inflammatory disorder of mucosa which usually begins in the and doesn’t spread past the valve is ulcerative colitis. This inflammation is not and is .

Explanation

Question 88 of 119

1

What is true regarding ulcerative colitis?

Select one or more of the following:

bloody diarrhea
abdominal pain
tenesmus
bathroom urgency
malaise
weight loss
extra-intestinal features
pale and bulky stool
dehydration

Explanation

Question 89 of 119

1

Which is not a way to investigate for ulcerative colitis?

Select one of the following:

FBC
liver function tests
urea and electrolytes profile
erythrocyte sedimentation rate
c reactive protein
ferritin
B12
folate
histamine

Explanation

Question 90 of 119

1

You can investigat for ulcerative colitis via sigmoidscopy or colonoscopy.

Select one of the following:

True
False

Explanation

Question 91 of 119

1

Fill the blank spaces to complete the text.

Management of Ulcerative Colitis:

(also known as 5-aminosalicylate) and steroids (such as ) to induce remission.

Surgery ( for those non-responsive to drugs)

Mesalazine to maintain remission.

Explanation

Question 92 of 119

1

Fill the blank spaces to complete the text.

Pancreatic secretions are controlled by the nervous system.

in response to H+ in the duodenum causes the pancreas to secrete .

In response to and in the duodenum, the pancreas releases CCK cholecystokinin (CCK). CCK also causes contractions.

These proteolytic enzymes are released inactively as to protect the pancreatic tissue from being destroyed.

Explanation

Question 93 of 119

1

Which of these are pancreatic enzymes?

Select one or more of the following:

trypsinogen
chymotripsinogen
procarboxypeptidase
pancreatic amylase
pancreatic lipase
gastrin
pepsinogen

Explanation

Question 94 of 119

1

Fill the blank spaces to complete the text.

pancreatic enzymes:

trypsin, chymotrypsin, carboxypeptidase: act on

pancreatic lipase acts on

pancreatic amylase acts on

ribonucleoase/deoyribonuclease acts on nucleic acids

Explanation

Question 95 of 119

1

What are examples of tumor markers?

Select one or more of the following:

CEA
alpha fetoprotein (aFP)
CA 1999
beta HCG
Ca 125
BRCA 2
Ca 187

Explanation

Question 96 of 119

1

Tumor suppressor genes cause tumors to actually progress.

Select one of the following:

True
False

Explanation

Question 97 of 119

1

p53 is a tumor suppressor gene that is important because it can trigger apoptosis.

Select one of the following:

True
False

Explanation

Question 98 of 119

1

What is the condition that describes a type of pain related to the gallbladder that occurs when a gallstone temporarily obstructs the cystic duct and the gallbladder contracts?

Select one of the following:

Biliary Colic
Cholangitis
Cholecystitis
Courvoisier's syndrome

Explanation

Question 99 of 119

1

What is true regarding biliary colic?

Select one or more of the following:

goldstone investigation: ultrasound of right upper quadrant
manage: analgesia
manage: rehydrate
medication given via orally
manage: elective cholecystectomy
nausea and vomiting
indigestion symptoms
pain after a fatty meal
right upper quadrant pain which radiates
acid reflux

Explanation

Question 100 of 119

1

Fill the blank spaces to complete the text.

cholecystitis:
Due to stone impaction in the gallbladder neck

Symptoms:
Continuous pain or pain which radiates to the right shoulder

fever

Investigation:

Treatment: Nil by mouth: analgesia; antibiotics; and

Explanation

Question 101 of 119

1

Fill the blank spaces to complete the text.

cholecystitis:
Stones cause chronic inflammation of gallbladder +/- inflammation

Symptoms:
Abdomen discomfort

nausea

fat intolerance

Investigation:
Treatment:

Explanation

Question 102 of 119

1

Fill the blank spaces to complete the text.

Courvoisier's law is that the possible malignancy of the /, such as swelling, is not probably due to .

Explanation

Question 103 of 119

1

What is not true regarding cholangitis?

Select one of the following:

inflammation of the common bile duct due to gall stones obstruction
investigation: ERCP
Charcot's triad
investigation: ultrasound

Explanation

Question 104 of 119

1

Fill the blank spaces to complete the text.

Pancreatitis is due to injuries that lead to autodigestion of the pancreas by its own .

pancreatitis is characterized by reversible pancreatic injury associated with inflammation. disease and alcoholism account for approximately 80% of cases of pancreatitis in Western countries.

pancreatitis is defined as prolonged inflammation of the pancreas associated with irreversible destruction of parenchyma, , and, in the late stages, the destruction of parenchyma. The most common cause of pancreatitis by far is long-term abuse

Explanation

Question 105 of 119

1

What is NOT true regarding pseudocyst?

Select one of the following:

most common complication of pancreatitis
is the accumulation n of fluid within and around the pancreatic tissue.
trtment: drainage of fluid into stomach's lumen
investigation: type II MRI

Explanation

Question 106 of 119

1

Which of these can cause chronic pancreatitis?

Select one or more of the following:

alcohol
cystic fibrosis
hemochromastosis
pancreatic duct obstruction
renal failure
liver disease
obesity

Explanation

Question 107 of 119

1

Ultrasound and CT to check for pancreatic calcifications is how to investigate for chronic pancreatitis.

Select one of the following:

True
False

Explanation

Question 108 of 119

1

What are symptoms of chronic pancreatitis?

Select one or more of the following:

epigastric pain radiating to the back
epigastric pain is less when sitting forward
epigastric pain is less with hot water bottles
bloating
weight loss
brittle diabetes
steatorrhea
manage: lipase and fat soluble vitamins
manage: low fat diet
manage: surgery

Explanation

Question 109 of 119

1

Fill the blank spaces to complete the text.

CAUSES for acute pancreatitis:

GET SMASHED:

(38%)
(35%)
(1.5%)

Scorpion venom
Hyperlipidaemia// hypercalcaemia
and emboli
Drugs.

Explanation

Question 110 of 119

1

What are the signs and symptoms of acute pancfdatitis?

Select one or more of the following:

tachycardia
fever
jaundice
Cullen's sign
Gray Turner's sign
gradual epigastric pain
severe epigastric man
vomiting
central abdominal pain which radiates to the back
investigation: dropped serum levels of amylase

Explanation

Question 111 of 119

1

Click on each orange point and write the correct answer.

Which sign is which?

Explanation

Question 112 of 119

1

Serum lipase is the most reliable investigating factor for pancreatitis.

Select one of the following:

True
False

Explanation

Question 113 of 119

1

Fill the blank spaces to complete the text.

Management of acute pancreatitis:
Nil by mouth:
+ may be needed if progressive jaundice.

Explanation

Question 114 of 119

1

Fill the blank spaces to complete the text.

Those at an increased risk of developing cancer often are born with one defective copy of a gene.

Explanation

Question 115 of 119

1

An oncogene is when a proto-oncogene becomes mutated.

Select one of the following:

True
False

Explanation

Question 116 of 119

1

Oncogenes cause uncontrolled tumor growth.

Select one of the following:

True
False

Explanation

Question 117 of 119

1

Fill the blank spaces to complete the text.

Appendicitis:

presentation:

RLQ pain or pain
nausea
vomiting

KEY: loss of appetite

investigation:

Explanation

Question 118 of 119

1

How does ischemic bowel NOT present?

Select one of the following:

severe abdominal pain
tachycardia + hypotension
raised leukocyte count
fever intervals

Explanation

Question 119 of 119

1

Murphy's sign is for acute cholecystitis.

Murphy's sign is that on palpation of the RUQ, patient stops inspiration for a moment.

Select one of the following:

True
False

	Created by Plymouth Med about 6 years ago

Content courtesy of Dayo's Mat 2 lecture. credits to him :)

Gastrointestinal pathology :)

Question 1 of 119

Select one of the following:

Explanation

Question 2 of 119

What is the first line maintenance treatment for Ulcerative Collitis?

Select one of the following:

Explanation

Question 3 of 119

What do parietal cells produce?

Select one of the following:

Explanation

Question 4 of 119

An elderly man with a history of alcohol abuse goes to ED with hematemesis for 1 day. He has no abdominal or chest pain. His eyes are reddened and he admits to drinking heavily the night before he vomited several times. What may be the reason for this?

Select one of the following:

Explanation

Question 5 of 119

Select one of the following:

Explanation

Question 6 of 119

Select one of the following:

Explanation

Question 7 of 119

What is the blood supply to the superior rectum?

Select one of the following:

Explanation

Question 8 of 119

Select one of the following:

Explanation

Question 9 of 119

A middle aged woman has a four-month history of diarrhoeaand bloating. Associated symptoms include lethargy and weight loss. Full blood count reveals: hemoglobin of 9.3 d/gL (13.8 to 17.2) MCV 70 fL. (77-95) What other investigation allow proper patient diagnosis?

Select one of the following:

Explanation

Question 10 of 119

Select one of the following:

Explanation

Question 11 of 119

Select one of the following:

Explanation

Question 12 of 119

You see a middle aged man who was admitted for an elective upper GI endoscopydue to longstanding GORD which has failed to improve on antacids and PPIs. Your registrar suspects that this patient may have Barrett’s oesophagus and asks you to define what this is:

Select one of the following:

Explanation

Question 13 of 119

Which of the following is the most common cause of duodenal ulcers?

Select one of the following:

Explanation

Question 14 of 119

A middle-aged lorry driver presents to the GP with chest pain that usually occurs after having a meal. He has no major past medical history and he takes ibuprofen regularly. He is otherwise fit and healthy. What is the most important next step in management?

Select one of the following:

Explanation

Question 15 of 119

You see a middle aged lorry driver, who presents to you with a three-month history of heartburn after meals which has not been settling with antacids and PPIs. You suspect that the patient has a hiatus hernia. The most appropriate investigation for diagnosing a hiatus hernia is:

Select one of the following:

Explanation

Question 16 of 119

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Explanation

Question 17 of 119

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Explanation

Question 18 of 119

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Explanation

Question 19 of 119

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Explanation

Question 20 of 119

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Explanation

Question 21 of 119

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Explanation

Question 22 of 119

Select one of the following:

Explanation

Question 23 of 119

Select one of the following:

Explanation

A middle aged woman has a four-month history of diarrhoeaand bloating. Associated symptoms include lethargy and weight loss.

Full blood count reveals:
hemoglobin of 9.3 d/gL (13.8 to 17.2)
MCV 70 fL. (77-95)

What other investigation allow proper patient diagnosis?

The GI wall, from the to the , has the same 4 layers (from outermost to innermost)

1.
2.
3.
4.

The foregut is supplied by the , which comes off the aorta at level .

The midgut is supplied by the artery, which comes off the aorta at level .

The hindgut is supplied by the artery, which comes off the aorta at level .

Large Intestine Blood Supply:

rectal artery is a branch of the artery.

However, the rectal and rectal arterys are both branches of artery.