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Gastrointestinal pathology :)

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Content courtesy of Dayo's Mat 2 lecture. credits to him :)
Plymouth Med
Quiz by Plymouth Med, updated more than 1 year ago
Plymouth Med
Created by Plymouth Med about 6 years ago
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Resource summary

Question 1

Question
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?
Answer
  • Blood investigation for tumour markers
  • Barium swallow
  • CT
  • PET
  • Endoscopy

Question 2

Question
What is the first line maintenance treatment for Ulcerative Collitis?
Answer
  • Mesalazine
  • Ciclosporin
  • Prednisolone
  • Infliximab
  • Azathioprine

Question 3

Question
What do parietal cells produce?
Answer
  • pepsinogen
  • somatostatin
  • gastrin and histamine
  • hydrochloric acid and intrinsic factor
  • histamine only

Question 4

Question
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?
Answer
  • Oesophageal varices
  • Lung Cancer
  • Achalasia
  • Perforated gastric ulcer
  • Mallory-Weiss tear

Question 5

Question
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?
Answer
  • Crohn's Disease
  • Ulcerative Colitis
  • Appendicitis
  • Diverticulitis
  • Pseudomembranous colitis

Question 6

Question
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
Answer
  • Colorectal cancer
  • Diverticulitis
  • Appendicitis
  • Crohn’s disease
  • Duodenal ulcer

Question 7

Question
What is the blood supply to the superior rectum?
Answer
  • celiac artery
  • superior mesenteric artery
  • inferior mesenteric artery
  • internal iliac artery
  • external iliac artery

Question 8

Question
A elderly man attends your clinic with a three-month history of weight loss of approximately 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?
Answer
  • Reassure and discharge
  • Prescribe iron tablet supplementation
  • have an abdominal ultrasound
  • have an abdominal x-ray
  • have an upper and lower GI endoscopy

Question 9

Question
A middle aged woman has a four-month history of diarrhoea and 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?
Answer
  • Anti-mitochondrial antibodies
  • Anti-smooth muscle antibodies
  • Anti-nuclear antibodies
  • Anti-tissue transglutaminase antibodies
  • Anti-neutrophil cytoplasmic antibodies

Question 10

Question
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?
Answer
  • Mallory–Weiss tear
  • Peptic ulcers
  • Esophageal varices
  • Drug induced
  • Sporadic malignancy

Question 11

Question
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?
Answer
  • Ascending colon
  • Terminal ileum
  • Duodenum
  • Jejunum
  • Proximal Ileum

Question 12

Question
You see a middle aged man who was admitted for an elective upper GI endoscopy due 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:
Answer
  • 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

Question 13

Question
Which of the following is the most common cause of duodenal ulcers?
Answer
  • NSAIDs
  • Alcohol Abuse
  • Helicobacter pylori
  • Chronic corticosteroid therapy
  • Zollinger-Ellison syndrome

Question 14

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

Question 15

Question
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:
Answer
  • CT scan
  • Chest x-ray
  • Barium meal
  • Ultrasound
  • Upper GI endoscopy

Question 16

Question
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?
Answer
  • 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

Question 17

Question
You see a middle aged man with a three-month history of epigastric dull abdominal 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?
Answer
  • Gastric ulcer
  • Gastro-oesophageal reflux disease (GORD)
  • Gastritis
  • Gastric carcinoma
  • Duodenal ulcer

Question 18

Question
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 rate of 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:
Answer
  • ECG
  • Intravenous omeprazole
  • Request an erect chest x-ray
  • Keep nil by mouth and arrange endoscopy
  • Intravenous cannulation and fluids

Question 19

Question
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?
Answer
  • Plain film radiograph
  • CT scan
  • Ultrasound
  • MRI
  • ERCP

Question 20

Question
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, HR is 80 beats per minute, temperature is 37°C, and RR is 16 breaths per minute. Laboratory tests are within normal limits. What is the most likely diagnosis?
Answer
  • Cholangitis
  • Pancreatitis
  • Cholecystitis
  • Peptic ulcer disease
  • Biliary colic

Question 21

Question
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 per minute. 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?
Answer
  • Cholecystitis
  • Bowel perforation
  • Mesenteric ischemia
  • Abdominal aortic aneurysm
  • Pancreatitis

Question 22

Question
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?
Answer

Question 23

Question
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 is 88 beats per minute, temperature is 38°C, and his RR is 16 breaths per minute. On exam, his RLQ is tender to palpation. What is the most likely diagnosis?
Answer
  • Cholangitis
  • Appendicitis
  • Diverticulitis
  • Pancreatitis
  • Acute cholecystitis

Question 24

Question
Patient presents with painless jaundice and palpable RUQ mass. Which of the following is the most likely diagnosis
Answer
  • Cholecystitis
  • Cholangitis
  • Abdominal aortic aneurysm
  • Crohn’s disease
  • Gall bladder carcinoma

Question 25

Question
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?
Answer
  • Biliary colic
  • Diverticulitis
  • Pancreatitis
  • Small bowel obstruction
  • Abdominal aortic aneurysm

Question 26

Question
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?
Answer
  • Cholecystitis
  • Acute hepatitis
  • Cholangitis
  • Pancreatic cancer
  • Bowel obstruction

Question 27

Question
What is NOT true regarding GI anatomy?
Answer
  • 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.

Question 28

Question
The GI wall, from the [blank_start]lower[blank_end] [blank_start]espohagus[blank_end] to the [blank_start]anus[blank_end], has the same 4 layers (from outermost to innermost) 1. [blank_start]Serosa[blank_end] 2. [blank_start]Muscularis[blank_end] 3. [blank_start]Submucosa[blank_end] 4. [blank_start]Mucosa[blank_end]
Answer
  • lower
  • espohagus
  • anus
  • Serosa
  • Muscularis
  • Submucosa
  • Mucosa

Question 29

Question
The foregut is supplied by the [blank_start]celiac[blank_end] [blank_start]trunk[blank_end], which comes off the aorta at level [blank_start]T12[blank_end]. The midgut is supplied by the [blank_start]superior[blank_end] [blank_start]mesenteric[blank_end] artery, which comes off the aorta at level [blank_start]L1[blank_end]. The hindgut is supplied by the [blank_start]inferior[blank_end] [blank_start]mesenteric[blank_end] artery, which comes off the aorta at level [blank_start]L3[blank_end].
Answer
  • celiac
  • trunk
  • T12
  • superior
  • mesenteric
  • L1
  • inferior
  • mesenteric
  • L3

Question 30

Question
The GI tract lymphatics and vasculature is about the same.
Answer
  • True
  • False

Question 31

Question
Which is NOT a major lymph structures involved with abdominal drainage?
Answer
  • Celiac nodes
  • Superior Mesenteric Aortic/Caval nodes
  • Inferior Mesenteric Aortic/Caval nodes
  • Renal nodes

Question 32

Question
Label the parts.
Image:
Screen Shot 2018 03 09 At 12.54.44 Am (binary/octet-stream)
Answer
  • right
  • left
  • hastura
  • tenie coli
  • sigmoid
  • omental appendices

Question 33

Question
Large Intestine Blood Supply: [blank_start]Superior[blank_end] rectal artery is a branch of the [blank_start]inferior[blank_end] [blank_start]mesenteric[blank_end] artery. However, the [blank_start]middle[blank_end] rectal and [blank_start]inferior[blank_end] rectal arterys are both branches of [blank_start]internal[blank_end] [blank_start]iliac[blank_end] artery.
Answer
  • inferior
  • mesenteric
  • internal
  • iliac
  • Superior
  • middle
  • inferior

Question 34

Question
What is true regarding the esophagus' histology?
Answer
  • 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

Question 35

Question
Pharyngeal Pouch ([blank_start]Zenker[blank_end] diverticulum) is an out-pouching (diverticulum) that develops from the [blank_start]posterior[blank_end] wall of the [blank_start]pharynx[blank_end] just prior to the [blank_start]esophagus[blank_end].
Answer
  • posterior
  • pharynx
  • esophagus
  • Zenker

Question 36

Question
What is true regarding Zenker diverticulum?
Answer
  • management: surgery
  • investigation: barium swallow
  • management: corticosteroids
  • dysphagia
  • halitosis
  • stomach gurgling upon palpatation
  • constipation
  • diarrea

Question 37

Question
What is true regarding achalasia?
Answer
  • 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

Question 38

Question
[blank_start]Gastroesophageal[blank_end] [blank_start]Reflux[blank_end] [blank_start]Disease[blank_end] (GERD/GORD) is a condition in which the stomach contents are regurgitated back the esophagus, usually because the [blank_start]lower[blank_end] [blank_start]esophageal[blank_end] sphincter is unable to fully close after swallowing.
Answer
  • Gastroesophageal
  • Reflux
  • Disease
  • esophageal
  • lower

Question 39

Question
What is true regarding GORD?
Answer
  • 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

Question 40

Question
A Mallory-Weiss Tear is when there is bleeding from a laceration in the [blank_start]mucosa[blank_end] at the junction of the [blank_start]stomach[blank_end] and [blank_start]esophagus[blank_end]. This is usually caused by severe [blank_start]vomiting[blank_end], such as from [blank_start]alcoholism[blank_end], bulimia, or food [blank_start]poisoning[blank_end]. The signaling symptom is painful hematemesis. It is diagnosed by endoscopy.
Answer
  • mucosa
  • stomach
  • esophagus
  • vomiting
  • alcoholism
  • poisoning

Question 41

Question
Label the diagram showing the GI venous drainage. (the colors are just to differentiate between the various vessels)
Image:
Screen Shot 2018 03 09 At 6.35.04 Pm (binary/octet-stream)
Answer
  • inferior mesenteric vein
  • superior mesenteric vein
  • hepatic portal vein
  • splenic vein
  • splenic vein

Question 42

Question
The liver is supplied by the hepatic portal vein (which is made up of the [blank_start]splenic[blank_end] vein and the [blank_start]superior[blank_end] [blank_start]mesenteric[blank_end] vein) and the hepatic artery. [blank_start]75[blank_end]% of blood going to the liver is from the hepatic portal vein while [blank_start]25[blank_end]% is from the hepatic artery. However, [blank_start]oxygenated[blank_end] blood is split ~50:50 between the portal vein and hepatic arteries.
Answer
  • splenic
  • mesenteric
  • superior
  • 75
  • 25
  • oxygenated

Question 43

Question
Which of these does NOT directly come off of the celiac trunk?
Answer
  • splenic artery
  • common hepatic artery
  • left gastric artery
  • proper hepatic artery

Question 44

Question
The common hepatic artery becomes the proper hepatic artery after the gastroduodenal artery branch.
Answer
  • True
  • False

Question 45

Question
Label the parts of the GI arterial vasculature. (max amnt words for any answr is 3)
Image:
Screen Shot 2018 03 09 At 6.43.08 Pm (binary/octet-stream)
Answer
  • abdominal aorta
  • celiac artery
  • splenic artery
  • left gastric artery
  • Superior Posterior Pancreatoduodenal
  • Superior Anterior Pancreatoduodenal
  • Superior pancreatoduodenal artery
  • Right gastroepiploic artery
  • common hepatic artery
  • Hepatic artery proper
  • Right gastric artery
  • Gastroduodenal artery

Question 46

Question
Which comes first in the development of a carcinoma?
Answer
  • metaplasia
  • dysplasia

Question 47

Question
[blank_start]Metaplasia[blank_end] is the reversible change of one cell type to another [blank_start]Dysplasia[blank_end] is abnormal changes in the cell and disorganized [blank_start]growth[blank_end] Carcinoma is the eventual transformation into malignant [blank_start]neoplastic[blank_end] cells.
Answer
  • Metaplasia
  • growth
  • Dysplasia
  • neoplastic

Question 48

Question
[blank_start]Barrett’s[blank_end] [blank_start]Esophagus[blank_end] is a pre-malignant condition of the lower esophagus. This happens when the [blank_start]squamous[blank_end] cells go through metaplasia and become [blank_start]columnar[blank_end] cells. This change usually happens as defence against an [blank_start]acidic[blank_end] environment, which may be due to conditions like [blank_start]GERD[blank_end]. This condition puts the patient of increased risk of esophageal [blank_start]adenocarcinoma[blank_end].
Answer
  • Barrett’s
  • Esophagus
  • squamous
  • columnar
  • acidic
  • GERD, GORD
  • adenocarcinoma

Question 49

Question
The management of Barret's Esophagus is to do a [blank_start]biopsy[blank_end]. Premalignant changes are indicative of high-grade [blank_start]dysplasia[blank_end]. The treatment for this in younger and more fit individuals is an [blank_start]esophageal[blank_end] [blank_start]resection[blank_end]. For others, it's [blank_start]mucosal[blank_end] [blank_start]ablation[blank_end]. If there are no premalignant channges, the patient will have regular [blank_start]endoscopy[blank_end], biopsy, and other anti-reflux measures, including long term [blank_start]proton[blank_end] [blank_start]pump[blank_end] [blank_start]inhibitors[blank_end] (drugs).
Answer
  • endoscopy
  • proton
  • pump
  • inhibitors
  • dysplasia
  • esophageal
  • resection
  • ablation
  • mucosal
  • biopsy

Question 50

Question
What is true regarding esophageal carcinoma?
Answer
  • 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

Question 51

Question
The stomach has 2 muscle layers: inner oblique and outer longitudinal
Answer
  • True
  • False

Question 52

Question
The stomach is lined by simple squamous epithelial cells
Answer
  • True
  • False

Question 53

Question
What controls the secretion of gastric acid?
Answer
  • the parasympathetic nervous system
  • gastrin
  • histamine
  • PGE2
  • PGI2
  • pepsinogen concentration
  • gut bacteria

Question 54

Question
Prostaglandins increase acid secretion
Answer
  • True
  • False

Question 55

Question
A side effect of NSAIDs is peptic ulcers.
Answer
  • True
  • False

Question 56

Question
Which of these are considered GI drugs?
Answer
  • proton pump inhibitors
  • histamine receptors
  • synthetic prostaglandins
  • antacids
  • amoxicillin
  • metronidazole
  • clarithromycin
  • calcium channel blockers
  • beta blockers
  • pepto bismol

Question 57

Question
Fill in which drugs go into which parts of the cycle to help with acid control:
Image:
Screen Shot 2018 03 09 At 10.19.19 Pm (binary/octet-stream)
Answer
  • histamine
  • prostaglandin analogues
  • muscarinic acetylcholine
  • proton pump inhibitors
  • gastrin receptor

Question 58

Question
What is not a sign of dyspepsia?
Answer
  • epigastric pain
  • bloating
  • heartburn
  • burning sensation during defecation

Question 59

Question
Worrying symptoms of dyspepsia: A [blank_start]anemia[blank_end] L loss of weight A [blank_start]anorexia[blank_end] R recent [blank_start]progressive[blank_end] [blank_start]symptoms[blank_end] M [blank_start]melena[blank_end] (tarry feces) and [blank_start]hematemesis[blank_end] S wallowing difficulty
Answer
  • anemia
  • anorexia
  • progressive
  • symptoms
  • melena
  • hematemesis

Question 60

Question
What are ways to manage dyspepsia?
Answer
  • simple antacids for 4 weeks
  • test for H. Pylori and eliminate if possible
  • Proton pump inhibitors for 4 weeks
  • urgent endoscopy
  • biopsy
  • blood works

Question 61

Question
Label the different types of hiatus hernias
Image:
Screen Shot 2018 03 09 At 10.42.01 Pm (binary/octet-stream)
Answer
  • sliding
  • rolling

Question 62

Question
Barium swallow via fluoroscopy is how one is able to diagnose a hiatus hernia.
Answer
  • True
  • False

Question 63

Question
What is true regarding peptic ulcers?
Answer
  • include duodenal ulcers
  • include gastric ulcers
  • complication: hemorrhage
  • complication: ulcer perforation
  • complication: malignancy (tumor)
  • include jejunal ulcers
  • gastric ulcers > common than duodenal ulcers

Question 64

Question
What is true regarding duodenal ulcers?
Answer
  • epigastric tenderness
  • epigastric pain before meals
  • relief via milk
  • epigastric pain better at night
  • relief via lemon soda

Question 65

Question
Gastric ulcers: - happens mainly in [blank_start]elderly[blank_end] - [blank_start]epigastric[blank_end] pain (dependent on [blank_start]meals[blank_end] and can be relieved by antacids) - weight gain or loss
Answer
  • elderly
  • epigastric
  • meals

Question 66

Question
What is this sign and what is indicative of?
Image:
Screen Shot 2018 03 09 At 10.55.20 Pm (binary/octet-stream)
Answer
  • Virchow's node
  • gastric cancer

Question 67

Question
What is true regarding zollinger-ellison syndrome?
Answer
  • 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

Question 68

Question
iron is absorbed in the jejunum.
Answer
  • True
  • False

Question 69

Question
[blank_start]Celiac[blank_end] [blank_start]disease[blank_end] is an inflammation of the proximal small intestine mucosa in response to dietary gluten. It is Hypersensitivity [blank_start]IV[blank_end]. It is a disease of the small intestines in which [blank_start]prolamin[blank_end] [blank_start]intolerance[blank_end] causes villous atrophy and [blank_start]malabsorption[blank_end].
Answer
  • Celiac
  • disease
  • IV
  • prolamin
  • intolerance
  • malabsorption

Question 70

Question
What are symptoms of Celiac's Disease?
Answer
  • diarrhea
  • malaise
  • abdominal discomfort
  • iron deficiency anemia
  • weight loss
  • steatorrhea
  • weariness
  • concentrated pain
  • bursts of energy

Question 71

Question
Celiac disease makes you at more risk of colon cancer and lymphoma.
Answer
  • True
  • False

Question 72

Question
Crohn's Disease treatment is a gluten free diet and necessary vitamin supplements.
Answer
  • True
  • False

Question 73

Question
Which of the following is not a way to diagnose Celiac's disease?
Answer
  • duodenal biopsy via endoscopy
  • blood test: abnormally high levels of IgA endomysial
  • blood test: if anti-tissue transglutaminase antibodies are found
  • abdominal x-ray

Question 74

Question
What is true regarding diverticulitis?
Answer
  • 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

Question 75

Question
Which are symptoms of diverticulitis?
Answer
  • lower left quadrant pain
  • lower left quadrant tenderness
  • fever
  • tenesmsus
  • diarrhea
  • constipation

Question 76

Question
How can you investigate for diverticulitis?
Answer
  • barium enema
  • colonoscopy
  • CT colonogram
  • rectal biopsy

Question 77

Question
Treatment of diverticulitis: mild: at home with [blank_start]paracetamol[blank_end], fluids, and [blank_start]oral[blank_end] [blank_start]antibiotics[blank_end]. severe or ill patients: admission to hospital (cannot manage [blank_start]pain[blank_end], problems with [blank_start]dehydration[blank_end], [blank_start]frail[blank_end])
Answer
  • paracetamol
  • antibiotics
  • oral
  • pain
  • dehydration
  • frail

Question 78

Question
What are these two colon related conditions?
Image:
Screen Shot 2018 03 09 At 11.39.18 Pm (binary/octet-stream)
Answer
  • diverticulitis
  • diverticulosis

Question 79

Question
Which conditions make up inflammatory bowel disease?
Answer
  • Crohn's disease
  • Celiac's disease
  • Ulcerative Colitis
  • Diverticulitis
  • Peptic Ulcers

Question 80

Question
[blank_start]Crohn’s[blank_end] is a chronic inflammatory bowel disease affecting all layers of the GI tract ([blank_start]transmural[blank_end]). Its key characteristic is [blank_start]skip[blank_end] [blank_start]lesions[blank_end], and on a colonscopy there is a “[blank_start]cobblestone[blank_end] [blank_start]appearance[blank_end]." ANY part of the GI tract but most commonly the [blank_start]terminal[blank_end] [blank_start]ileum[blank_end] (can cause [blank_start]vitamin[blank_end] [blank_start]B12[blank_end] deficiency).
Answer
  • Crohn’s, Crohn's Disease
  • transmural
  • skip
  • lesions
  • cobblestone
  • appearance
  • terminal
  • ileum
  • B12
  • vitamin

Question 81

Question
What are symptoms of Crohn's Disease?
Answer
  • diarrhea
  • abdominal pain
  • right lower quadrant mass
  • perianal disease
  • mouth ulcers
  • extra-intestinal manifestations
  • pale and bulky stools
  • right lower quadrant pain

Question 82

Question
What is not an investigation for Crohn's Disease?
Answer
  • stool sample
  • colonscopy and biopsy
  • endoscopy and biopsy
  • Blood: CRP/ESR
  • Blood: FBC
  • Blood: LFTs
  • Blood: B12
  • Blood: ferritin
  • Barium swallow

Question 83

Question
Management of Crohn Disease attacks: Mild attacks: [blank_start]Prednisolone[blank_end] Severe attacks: IV [blank_start]steroids[blank_end], nil by mouth, and IV [blank_start]hydration[blank_end].
Answer
  • Prednisolone
  • steroids
  • hydration

Question 84

Question
Label the parts of the biliary tree?
Image:
Screen Shot 2018 03 10 At 12.02.22 Am (binary/octet-stream)
Answer
  • liver
  • right hepatic tree
  • left hepatic duct
  • common hepatic duct
  • common bile duct
  • pancreatic
  • pancreatic duct
  • duodenum
  • sphincter of Oddi
  • cystic duct
  • gallbladder

Question 85

Question
Bile is produced by [blank_start]hepatocytes[blank_end] and is stored in the [blank_start]gallbladder[blank_end]. Bile [blank_start]emulsifies[blank_end] the fat and allows fat absorption in [blank_start]enterocytes[blank_end]. An example of fat soluble vitamins: [blank_start]ADEK[blank_end]
Answer
  • hepatocytes
  • gallbladder
  • emulsifies
  • enterocytes
  • ADEK

Question 86

Question
An [blank_start]enterogastrone[blank_end] is any hormone secreted by the [blank_start]duodenum[blank_end] mucosa in response to dietary lipids that inhibits the caudal (or "forward, analward") motion of the contents of [blank_start]chyme[blank_end].
Answer
  • enterogastrone
  • duodenum
  • chyme

Question 87

Question
Relapsing inflammatory disorder of [blank_start]colonic[blank_end] mucosa which usually begins in the [blank_start]rectum[blank_end] and doesn’t spread past the [blank_start]ileocaecal[blank_end] valve is ulcerative colitis. This inflammation is not [blank_start]transmural[blank_end] and is [blank_start]continous[blank_end].
Answer
  • colonic
  • rectum
  • ileocaecal
  • transmural
  • continous

Question 88

Question
What is true regarding ulcerative colitis?
Answer
  • bloody diarrhea
  • abdominal pain
  • tenesmus
  • bathroom urgency
  • malaise
  • weight loss
  • extra-intestinal features
  • pale and bulky stool
  • dehydration

Question 89

Question
Which is not a way to investigate for ulcerative colitis?
Answer
  • FBC
  • liver function tests
  • urea and electrolytes profile
  • erythrocyte sedimentation rate
  • c reactive protein
  • ferritin
  • B12
  • folate
  • histamine

Question 90

Question
You can investigat for ulcerative colitis via sigmoidscopy or colonoscopy.
Answer
  • True
  • False

Question 91

Question
Management of Ulcerative Colitis: [blank_start]Mesalazine[blank_end] (also known as 5-aminosalicylate) and steroids (such as [blank_start]prednisolone[blank_end]) to induce remission. Surgery ([blank_start]colectomy[blank_end] for those non-responsive to drugs) Mesalazine to maintain remission.
Answer
  • Mesalazine
  • colectomy
  • prednisolone

Question 92

Question
Pancreatic secretions are controlled by the [blank_start]parasympathetic[blank_end] nervous system. [blank_start]Secretin[blank_end] in response to H+ in the duodenum causes the pancreas to secrete [blank_start]bicarbonate[blank_end]. In response to [blank_start]fats[blank_end] and [blank_start]amino[blank_end] [blank_start]acids[blank_end] in the duodenum, the pancreas releases CCK cholecystokinin (CCK). CCK also causes [blank_start]gallbladder[blank_end] contractions. These proteolytic enzymes are released inactively as [blank_start]zymogens[blank_end] to protect the pancreatic tissue from being destroyed.
Answer
  • parasympathetic
  • Secretin
  • bicarbonate
  • gallbladder
  • fats
  • amino
  • acids
  • zymogens

Question 93

Question
Which of these are pancreatic enzymes?
Answer
  • trypsinogen
  • chymotripsinogen
  • procarboxypeptidase
  • pancreatic amylase
  • pancreatic lipase
  • gastrin
  • pepsinogen

Question 94

Question
pancreatic enzymes: trypsin, chymotrypsin, carboxypeptidase: act on [blank_start]proteins[blank_end] pancreatic lipase acts on [blank_start]fat[blank_end] pancreatic amylase acts on [blank_start]carbohydrates[blank_end] ribonucleoase/deoyribonuclease acts on nucleic acids
Answer
  • proteins
  • fat
  • carbohydrates

Question 95

Question
What are examples of tumor markers?
Answer
  • CEA
  • alpha fetoprotein (aFP)
  • CA 1999
  • beta HCG
  • Ca 125
  • BRCA 2
  • Ca 187

Question 96

Question
Tumor suppressor genes cause tumors to actually progress.
Answer
  • True
  • False

Question 97

Question
p53 is a tumor suppressor gene that is important because it can trigger apoptosis.
Answer
  • True
  • False

Question 98

Question
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?
Answer
  • Biliary Colic
  • Cholangitis
  • Cholecystitis
  • Courvoisier's syndrome

Question 99

Question
What is true regarding biliary colic?
Answer
  • 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

Question 100

Question
[blank_start]Acute[blank_end] cholecystitis: Due to stone impaction in the gallbladder neck Symptoms: Continuous [blank_start]RUQ[blank_end] pain or [blank_start]Epigastric[blank_end] pain which radiates to the right shoulder [blank_start]vomiting[blank_end] fever Investigation: [blank_start]Ultrasound[blank_end] Treatment: Nil by mouth: analgesia; antibiotics; and [blank_start]cholecystectomy[blank_end]
Answer
  • Acute
  • RUQ
  • Epigastric
  • vomiting
  • Ultrasound
  • cholecystectomy

Question 101

Question
[blank_start]Chronic[blank_end] cholecystitis: Stones cause chronic inflammation of gallbladder +/- [blank_start]colic[blank_end] inflammation Symptoms: Abdomen discomfort [blank_start]distension[blank_end] nausea [blank_start]flatulence[blank_end] fat intolerance Investigation: [blank_start]Ultrasound[blank_end] Treatment: [blank_start]cholecystectomy[blank_end]
Answer
  • Chronic
  • colic
  • distension
  • Ultrasound
  • cholecystectomy
  • flatulence

Question 102

Question
Courvoisier's law is that the possible malignancy of the [blank_start]gallbladder[blank_end]/[blank_start]pancreas[blank_end], such as swelling, is not probably due to [blank_start]gallstones[blank_end].
Answer
  • gallbladder
  • pancreas
  • gallstones

Question 103

Question
What is not true regarding cholangitis?
Answer
  • inflammation of the common bile duct due to gall stones obstruction
  • investigation: ERCP
  • Charcot's triad
  • investigation: ultrasound

Question 104

Question
Pancreatitis is due to injuries that lead to autodigestion of the pancreas by its own [blank_start]enzymes[blank_end]. [blank_start]Acute[blank_end] pancreatitis is characterized by reversible pancreatic [blank_start]parenchymal[blank_end] injury associated with inflammation. [blank_start]Biliary[blank_end] [blank_start]tract[blank_end] disease and alcoholism account for approximately 80% of cases of [blank_start]acute[blank_end] pancreatitis in Western countries. [blank_start]Chronic[blank_end] pancreatitis is defined as prolonged inflammation of the pancreas associated with irreversible destruction of [blank_start]exocrine[blank_end] parenchyma, [blank_start]fibrosis[blank_end], and, in the late stages, the destruction of [blank_start]endocrine[blank_end] parenchyma. The most common cause of [blank_start]chronic[blank_end] pancreatitis by far is long-term [blank_start]alcohol[blank_end] abuse
Answer
  • enzymes
  • Acute
  • Chronic
  • parenchymal
  • tract
  • Biliary
  • acute
  • chronic
  • alcohol
  • exocrine
  • endocrine
  • fibrosis

Question 105

Question
What is NOT true regarding pseudocyst?
Answer
  • 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

Question 106

Question
Which of these can cause chronic pancreatitis?
Answer
  • alcohol
  • cystic fibrosis
  • hemochromastosis
  • pancreatic duct obstruction
  • renal failure
  • liver disease
  • obesity

Question 107

Question
Ultrasound and CT to check for pancreatic calcifications is how to investigate for chronic pancreatitis.
Answer
  • True
  • False

Question 108

Question
What are symptoms of chronic pancreatitis?
Answer
  • 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

Question 109

Question
CAUSES for acute pancreatitis: GET SMASHED: [blank_start]Gallstones[blank_end] (38%) [blank_start]Ethanol[blank_end] (35%) [blank_start]Trauma[blank_end] (1.5%) [blank_start]Steroids[blank_end] [blank_start]Mumps[blank_end] [blank_start]Autoimmune[blank_end] Scorpion venom Hyperlipidaemia/[blank_start]hypothermia[blank_end]/ hypercalcaemia [blank_start]ERCP[blank_end] and emboli Drugs.
Answer
  • Gallstones
  • Ethanol
  • Trauma
  • Steroids
  • Autoimmune
  • Mumps
  • hypothermia
  • ERCP

Question 110

Question
What are the signs and symptoms of acute pancfdatitis?
Answer
  • 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

Question 111

Question
Which sign is which?
Image:
Screen Shot 2018 03 10 At 2.07.46 Am (binary/octet-stream)
Answer
  • cullen's sign
  • turner's sign

Question 112

Question
Serum lipase is the most reliable investigating factor for pancreatitis.
Answer
  • True
  • False

Question 113

Question
Management of acute pancreatitis: Nil by mouth: [blank_start]analgesia[blank_end] [blank_start]ERCP[blank_end] + [blank_start]gallstone[blank_end] [blank_start]removal[blank_end] may be needed if progressive jaundice.
Answer
  • analgesia
  • ERCP
  • gallstone
  • removal

Question 114

Question
Those at an increased risk of developing cancer often are born with one defective copy of a [blank_start]tumor[blank_end] [blank_start]suppressor[blank_end] gene.
Answer
  • tumor
  • suppressor

Question 115

Question
An oncogene is when a proto-oncogene becomes mutated.
Answer
  • True
  • False

Question 116

Question
Oncogenes cause uncontrolled tumor growth.
Answer
  • True
  • False

Question 117

Question
Appendicitis: presentation: [blank_start]Fever[blank_end] RLQ pain or [blank_start]umbulical[blank_end] pain nausea vomiting KEY: loss of appetite investigation: [blank_start]Xray[blank_end]
Answer
  • Xray, x-ray
  • umbulical
  • Fever

Question 118

Question
How does ischemic bowel NOT present?
Answer
  • severe abdominal pain
  • tachycardia + hypotension
  • raised leukocyte count
  • fever intervals

Question 119

Question
Murphy's sign is for acute cholecystitis. Murphy's sign is that on palpation of the RUQ, patient stops inspiration for a moment.
Answer
  • True
  • False
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