Medicine- Gastroenterology Exam Prep MCQ Test

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Gastroenterology Quizzes & Trivia

Questions and Answers
  • 1. 

    A 41-year-old male with a history of chronic alcoholism has massive hematemesis following a bout of prolonged vomiting. This is most typical for:

    • A.

      Hiatal hernia

    • B.

      Mallory-Weiss tear

    • C.

        Esophageal variceal bleeding

    • D.

      Boerhaaeve’s syndrome

    Correct Answer
    B. Mallory-Weiss tear
    Explanation
    A Mallory-Weiss tear is the most likely cause of massive hematemesis in a 41-year-old male with a history of chronic alcoholism following prolonged vomiting. Mallory-Weiss tears occur due to a tear in the mucosal lining of the esophagus and stomach, usually caused by forceful or prolonged vomiting. This tear can result in significant bleeding, leading to the presentation of hematemesis. Hiatal hernia, esophageal variceal bleeding, and Boerhaave's syndrome are less likely causes in this scenario.

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  • 2. 

    True statements regarding diverticulosis include all of the following EXCEPT:

    • A.

      The diverticula are most common in the right colon

    • B.

      It occurs more in elderly and middle-aged persons

    • C.

       A high-fiber diet contributes to their formation

    • D.

      The diverticula may become inflamed and rupture.

    Correct Answer
    C.  A high-fiber diet contributes to their formation
    Explanation
    Diverticulosis is a condition where small pouches called diverticula form in the lining of the colon. True statements regarding diverticulosis include that it occurs more in elderly and middle-aged persons, the diverticula may become inflamed and rupture. However, the statement that a high-fiber diet contributes to their formation is incorrect. In fact, a high-fiber diet is often recommended to prevent diverticulosis. A low-fiber diet can lead to constipation and increased pressure in the colon, which can contribute to the formation of diverticula.

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  • 3. 

    True in suspected acute variceal bleeding except

    • A.

      Vigorous saline resuscitation should generally be avoided

    • B.

      If necessary, transfuse up to hemoglobin of 8g/dl only

    • C.

      Tracheal intubation prior to EGD should be considered

    • D.

      Prophylactic antibiotics should be given only in cirrhotic patients with ascites

    Correct Answer
    D. Prophylactic antibiotics should be given only in cirrhotic patients with ascites
    Explanation
    In suspected acute variceal bleeding, prophylactic antibiotics should be given to all patients, not just those with ascites. This is because acute variceal bleeding can lead to bacterial infection, and prophylactic antibiotics help prevent this complication. Therefore, the correct answer is that prophylactic antibiotics should be given to all patients with suspected acute variceal bleeding.

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  • 4. 

    The most frequent cause of lower GI bleeding is:

    • A.

      Colonic malignancy

    • B.

      Hemorrhoids

    • C.

      Colonic diverticulosis

    • D.

      Vascular ectasia

    Correct Answer
    B. Hemorrhoids
    Explanation
    Hemorrhoids are the most common cause of lower GI bleeding. Hemorrhoids are swollen blood vessels in the rectum or anus that can become irritated and bleed. They are often caused by straining during bowel movements, chronic constipation, or pregnancy. Colonic malignancy refers to cancer in the colon, which can also cause lower GI bleeding but is less common than hemorrhoids. Colonic diverticulosis is the presence of small pouches in the colon that can bleed if they become inflamed or infected. Vascular ectasia refers to dilated blood vessels in the colon that can cause bleeding, but it is not as common as hemorrhoids.

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  • 5. 

    Risk factors associated with diverticular bleeding except

    • A.

      Hypertension

    • B.

      Atherosclerosis

    • C.

      Frequent ingestion of nuts or seeds

    • D.

      Regular intake of NSAIDs

    Correct Answer
    C. Frequent ingestion of nuts or seeds
    Explanation
    Frequent ingestion of nuts or seeds is not a risk factor associated with diverticular bleeding. Diverticular bleeding is commonly caused by the rupture of blood vessels in the diverticula, which are small pouches that can form in the lining of the colon. Risk factors for diverticular bleeding include hypertension, atherosclerosis, and regular intake of NSAIDs. However, there is no evidence to suggest that frequent ingestion of nuts or seeds contributes to the development of diverticular bleeding.

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  • 6. 

    Institution of PPI therapy at presentation in all patients with UGIB

    • A.

      Downgrades high-risk ulcer characteristics

    • B.

      Decreases mortality

    • C.

      Decreases rebleeding

    • D.

      Increases survival

    • E.

      Option 5

    Correct Answer
    A. Downgrades high-risk ulcer characteristics
    Explanation
    The institution of PPI therapy at presentation in all patients with UGIB is the correct answer because it downgrades high-risk ulcer characteristics. This means that by starting PPI therapy early, the severity and risk associated with the ulcer are reduced. This can help prevent complications such as rebleeding and decrease mortality rates. Overall, starting PPI therapy at presentation is beneficial in managing UGIB cases.

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  • 7. 

    Endotracheal intubation for airway protection in the management of acute Upper GI bleeding should be considered:

    • A.

      In all cirrhotic patients 

    • B.

      In all patients with UGI bleeding 

    • C.

      In patients with altered mental status and ongoing hematemesis

    • D.

      In patients with stable COPD 

    Correct Answer
    C. In patients with altered mental status and ongoing hematemesis
    Explanation
    Endotracheal intubation for airway protection is necessary in patients with altered mental status and ongoing hematemesis. These patients may have compromised airways due to their altered mental status and the ongoing hematemesis increases the risk of aspiration. Intubation helps to secure the airway and prevent aspiration of blood into the lungs, which can lead to further complications. Therefore, in these specific patients, endotracheal intubation is crucial for their management.

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  • 8. 

    After initial stabilization and resuscitation of the patient, each of the following options should be considered in the management of UGI bleeding except:

    • A.

      Determine the source of bleeding 

    • B.

      Stop acute bleeding  

    • C.

      Prevent rebleeding

    • D.

      Emergency surgery

    Correct Answer
    D. Emergency surgery
    Explanation
    Emergency surgery should not be considered in the management of UGI bleeding after initial stabilization and resuscitation of the patient. The priority in managing UGI bleeding is to determine the source of bleeding, stop acute bleeding, and prevent rebleeding. Emergency surgery is usually reserved for cases where non-operative interventions have failed to control the bleeding or in cases of severe and life-threatening bleeding. However, it is not the first-line approach and should only be considered when other measures have been unsuccessful.

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  • 9. 

    The two most common causes of severe hematochezia requiring hospitalization are:

    • A.

      Vascular ectasia and internal hemorrhoids 

    • B.

      Diverticulosis and internal hemorrhoids

    • C.

      Colon cancer and colitis 

    • D.

      Vascular ectasia and diverticulosis 

    Correct Answer
    D. Vascular ectasia and diverticulosis 
    Explanation
    The correct answer is Vascular ectasia and diverticulosis. Severe hematochezia refers to the passage of fresh blood through the rectum, which can be a sign of serious underlying conditions. Vascular ectasia refers to the dilation of blood vessels in the gastrointestinal tract, which can lead to bleeding. Diverticulosis is the presence of small pouches in the colon that can become inflamed or infected, causing bleeding. These two conditions are commonly associated with severe hematochezia requiring hospitalization.

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  • 10. 

    A patient with an NSAID-related gastric ulcer complicated by UGI bleeding requires continued NSAID treatment. H. pylori test is positive. Which one of the following is the most effective approach once the index ulcer has healed?

    • A.

      Eradicate H. pylori, continue previous NSAID, maintenance PPI 

    • B.

      Eradicate H. pylori, shift to a  COX-2 selective NSAID

    • C.

      PPI maintenance therapy 

    • D.

      Eradicate H. pylori, shift to a COX-2 selective NSAID, maintenance PPI

    Correct Answer
    D. Eradicate H. pylori, shift to a COX-2 selective NSAID, maintenance PPI
    Explanation
    The most effective approach once the index ulcer has healed in a patient with an NSAID-related gastric ulcer complicated by UGI bleeding and a positive H. pylori test is to eradicate H. pylori, shift to a COX-2 selective NSAID, and continue maintenance PPI. This approach addresses both the underlying cause of the ulcer (H. pylori infection) and minimizes the risk of further gastric ulceration by switching to a COX-2 selective NSAID, which has a lower risk of gastrointestinal complications compared to non-selective NSAIDs. Maintenance PPI therapy is also important to further reduce the risk of recurrent ulcers.

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  • 11. 

    In a patient with severe hematochezia, hypotension, and anemia, both the upper gastroscopy and colonoscopy were not diagnostic. The patient continued to pass clots per rectum. Resuscitation has normalized her vital signs and maintained her Hct at 32%. What is the most effective management strategy?

    • A.

      Abdominal CT scan with contrast 

    • B.

      Magnetic resonance imaging 

    • C.

      Mesenteric angiography 

    • D.

      Emergency surgery

    Correct Answer
    C. Mesenteric angiography 
    Explanation
    Mesenteric angiography is the most effective management strategy in this case. Severe hematochezia, hypotension, and anemia suggest active bleeding in the gastrointestinal tract. Both upper gastroscopy and colonoscopy were not diagnostic, indicating that the source of bleeding is not visible through these procedures. The patient's stabilized vital signs and maintained hematocrit level suggest that resuscitation has been successful. Mesenteric angiography is a minimally invasive procedure that can accurately identify the source of bleeding and guide further intervention or embolization to stop the bleeding.

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  • 12. 

    Pharmacologic treatment for bleeding esophageal varices in a decompensated cirrhotic patient includes the following except:

    • A.

      Somatostatin infusion

    • B.

      PPI infusion

    • C.

      Antibiotics

    • D.

      Lactulose Enema

    Correct Answer
    B. PPI infusion
    Explanation
    Pharmacologic treatment for bleeding esophageal varices in a decompensated cirrhotic patient includes somatostatin infusion, antibiotics, and lactulose enema. Proton pump inhibitor (PPI) infusion is not recommended as a treatment for bleeding esophageal varices. PPIs are commonly used to reduce gastric acid production and treat conditions like acid reflux, but they do not directly address the bleeding and hemodynamic instability associated with esophageal varices. Therefore, PPI infusion is not included in the pharmacologic treatment options for this condition.

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  • 13. 

    A 54 year-old man with a history of "alcoholic liver disease" presents with frank hemetemesis, a blood pressure of 80/40, pulse rate of 110, and a respiratory rate of 26. After assessing and managing the airway, which of the following is most likely to provide definitive treatment?

    • A.

      Somatostatin infusion

    • B.

      PPI infusion

    • C.

      Emergent endoscopy with variceal ligation

    • D.

      Sengtaken-Blakemore tube insertion

    Correct Answer
    C. Emergent endoscopy with variceal ligation
    Explanation
    Emergent endoscopy with variceal ligation is the most likely to provide definitive treatment in this case. The patient's presentation of frank hematemesis and hemodynamic instability is consistent with bleeding from esophageal varices, which is a common complication of alcoholic liver disease. Variceal ligation is a procedure performed during endoscopy that can effectively stop bleeding from esophageal varices by placing rubber bands around the varices to constrict them. This procedure is considered the gold standard for the treatment of acute variceal bleeding and has been shown to improve outcomes and reduce mortality rates.

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  • 14. 

    Risk factors associated with poor outcome in acute upper gi bleeding except:

    • A.

      Increasing age

    • B.

      Comorbidities

    • C.

      Hematemesis

    • D.

      Outpatient bleeds

    Correct Answer
    D. Outpatient bleeds
    Explanation
    The correct answer is "Outpatient bleeds." Outpatient bleeds are not considered a risk factor associated with a poor outcome in acute upper GI bleeding. Increasing age, comorbidities, and hematemesis are all known risk factors that can contribute to a worse outcome in this condition. However, outpatient bleeds, which occur outside of a hospital or healthcare setting, are not typically associated with a higher risk of poor outcome.

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  • 15. 

    Which of the following findings at endoscopy is most reassuring that the patient will not have a significant rebleeding episode within the next 3 days?

    • A.

      Adherent clot on ulcer

    • B.

      Ulcer crater with a flat pigmented spot

    • C.

      Dieulafoy lesion

    • D.

      Esophageal varices with red color sign

    Correct Answer
    B. Ulcer crater with a flat pigmented spot
    Explanation
    An ulcer crater with a flat pigmented spot is the most reassuring finding that the patient will not have a significant rebleeding episode within the next 3 days. This is because a flat pigmented spot indicates that the ulcer has already undergone a healing process, suggesting that the bleeding has stopped and the risk of rebleeding is low. Adherent clot on ulcer, Dieulafoy lesion, and esophageal varices with red color sign are all findings that indicate a higher risk of rebleeding.

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  • 16. 

    The most common cause of clinically apparent chronic pancreatitis

    • A.

      Diabetes Mellitus

    • B.

      Gall stone Disease

    • C.

      Hypertriglyceridemia

    • D.

      Alcoholism

    Correct Answer
    D. Alcoholism
    Explanation
    Alcoholism is the most common cause of clinically apparent chronic pancreatitis. Excessive and chronic alcohol consumption can lead to inflammation and damage to the pancreas, resulting in the development of pancreatitis. Alcohol-induced pancreatitis is characterized by abdominal pain, digestive problems, and potentially severe complications. It is important to note that while alcoholism is the most common cause, other factors such as gallstone disease, hypertriglyceridemia, and diabetes mellitus can also contribute to the development of chronic pancreatitis.

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  • 17. 

    Diagnostic Test with the best sensitivity and specificity for chronic pancreatitis

    • A.

      MRCP

    • B.

      Endoscopic Ultrasound

    • C.

      Secretin Stimulation Test

    • D.

      Lipase

    Correct Answer
    C. Secretin Stimulation Test
    Explanation
    The Secretin Stimulation Test is the best diagnostic test for chronic pancreatitis because it has high sensitivity and specificity. This test involves injecting secretin, a hormone that stimulates the pancreas, and measuring the pancreatic secretions. In chronic pancreatitis, the pancreas does not respond properly to secretin, leading to abnormal secretions. This test can accurately diagnose chronic pancreatitis by detecting these abnormalities. MRCP and Endoscopic Ultrasound can also be used to visualize the pancreas, but they are not as specific for chronic pancreatitis. Lipase is an enzyme that can be elevated in pancreatitis, but it is not specific to chronic pancreatitis and can be elevated in other conditions as well.

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  • 18. 

    For Patients with Acute pancreatitis, it is a faint blue discoloration around the umbilicus which may occur as a sign of hemoperitoneum

    • A.

      Turner’s Sign

    • B.

      Cullen’s Sign

    • C.

      Boas’ Sign

    • D.

      Fox’s Sign

    Correct Answer
    B. Cullen’s Sign
    Explanation
    Cullen's sign refers to a faint blue discoloration around the umbilicus. It is a clinical finding that may be observed in patients with acute pancreatitis. This discoloration occurs due to the leakage of blood from the inflamed pancreas into the peritoneal cavity, resulting in hemoperitoneum. Therefore, Cullen's sign can be used as an indicator of internal bleeding in patients with acute pancreatitis.

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  • 19. 

    Indication for prophylactic cholecystectomy

    • A.

      Stone >1.5 CM

    • B.

      Diabetic Patient

    • C.

      Multiple stones

    • D.

      Congenitally anomalous GB

    Correct Answer
    D. Congenitally anomalous GB
    Explanation
    Congenitally anomalous GB refers to a gallbladder that has a structural abnormality present from birth. This can include variations in size, shape, or position of the gallbladder. Prophylactic cholecystectomy, or the removal of the gallbladder as a preventive measure, may be indicated in cases of congenitally anomalous GB to prevent potential complications such as gallstone formation, inflammation, or obstruction. The other indications listed, such as stone size, diabetes, and multiple stones, are not specifically related to congenital anomalies and do not provide a sufficient explanation for the correct answer.

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  • 20. 

    A 94 y/o diabetic, female suffering from congestive heart failure admitted in the CCU suddenly developed right upper quadrant pain and fever. UTZ showed dilated GB with multiple lithiases and pericholecystic fluid. What is the ideal management?

    • A.

      Laparoscopic cholecystectomy

    • B.

      ERCP

    • C.

      Open cholecystectomy

    • D.

      Cholecystostomy and tube drainage

    Correct Answer
    D. Cholecystostomy and tube drainage
    Explanation
    The ideal management for a 94-year-old diabetic female with congestive heart failure who suddenly developed right upper quadrant pain and fever, along with a dilated gallbladder with multiple stones and pericholecystic fluid, would be cholecystostomy and tube drainage. This is because the patient's age, comorbidities, and the presence of pericholecystic fluid indicate a high risk for complications with surgical interventions such as laparoscopic or open cholecystectomy. Cholecystostomy and tube drainage can provide temporary relief by draining the infected fluid and decompressing the gallbladder, allowing for stabilization of the patient's condition before considering further definitive management options.

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  • 21. 

    This occurs when the gallstone impacted in the cystic duct or neck of the gallbladder causing compression of the CBD

    • A.

      Bouveret Syndrome

    • B.

      Mirizzi’s Syndrome

    • C.

      Boerhaave Syndrome

    • D.

      Double Duct Syndrome

    Correct Answer
    B. Mirizzi’s Syndrome
    Explanation
    Mirizzi's syndrome is a condition where a gallstone becomes impacted in the cystic duct or neck of the gallbladder, leading to compression of the common bile duct (CBD). This compression can cause obstruction of the bile flow and result in symptoms such as jaundice, abdominal pain, and fever. It is important to differentiate Mirizzi's syndrome from other similar conditions like Bouveret syndrome, Boerhaave syndrome, and double duct syndrome, as the management and treatment approaches may differ.

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  • 22. 

    The treatment of choice for patients with uncomplicated acute cholecystitis

    • A.

      Antibiotic Therapy

    • B.

      Laparascopic Cholecystectomy within 72 hrs

    • C.

      Emergency Laporoscopic Cholecystectomy

    • D.

      Elective Laparoscopic cholecystectomy 1 week after discharge

    Correct Answer
    B. Laparascopic Cholecystectomy within 72 hrs
    Explanation
    The treatment of choice for patients with uncomplicated acute cholecystitis is laparoscopic cholecystectomy within 72 hours. This surgical procedure involves the removal of the gallbladder using minimally invasive techniques. It is preferred over antibiotic therapy alone because it provides definitive treatment by removing the source of infection and preventing future episodes of cholecystitis. Performing the surgery within 72 hours helps to minimize the risk of complications and improve outcomes for the patient.

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  • 23. 

    This type of chronic gastritis has predominantly antral involvement and correlated with H pylori Infection.

    • A.

      Type A

    • B.

      Type B

    • C.

      Type C

    • D.

      Type D

    Correct Answer
    B. Type B
    Explanation
    Type B chronic gastritis is characterized by predominantly antral involvement and is strongly correlated with H pylori infection. H pylori is a bacterium that infects the stomach lining and causes inflammation, leading to chronic gastritis. This type of gastritis typically affects the antrum, which is the lower part of the stomach. It is important to identify and treat H pylori infection in patients with type B chronic gastritis to alleviate symptoms and prevent complications such as peptic ulcers and gastric cancer.

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  • 24. 

    A 75 years old male came in due to severe abdominal pain accompanied by nausea and vomiting. History revealed that patient also had episodes of bloody stools. On PE Bp 100/60 HR 110 Bpm Irreglarly irregular. Abdomen was soft with slight tenderness on all quadrants. What would be the best imaging modality  for the patient

    • A.

      Scout film of the abdomen

    • B.

      Ultrasound of whole abdomen

    • C.

      MRI of the whole abdomen

    • D.

      Angiography

    Correct Answer
    D. Angiography
    Explanation
    Angiography would be the best imaging modality for this patient because the symptoms and history suggest a possible vascular issue. The patient's age, severe abdominal pain, and bloody stools may indicate a potential gastrointestinal bleed. Angiography can help identify the source of the bleeding by visualizing the blood vessels and detecting any abnormalities or areas of active bleeding. This imaging modality can provide valuable information for further diagnosis and treatment planning.

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  • 25. 

    Most common location of mesenteric ischemia

    • A.

      Ascending colon

    • B.

      Transverse Colon

    • C.

      Descending colon

    • D.

      Rectosigmoid Colon

    Correct Answer
    D. Rectosigmoid Colon
    Explanation
    Mesenteric ischemia refers to the restricted blood supply to the intestines, which can lead to tissue damage and potentially life-threatening complications. The rectosigmoid colon is the most common location for mesenteric ischemia because it is the area where the blood vessels supplying the colon are most prone to blockage or narrowing. This is due to the complex vascular anatomy and the presence of multiple branches in this region. When blood flow is compromised in the rectosigmoid colon, it can result in severe abdominal pain, bloody stools, and other symptoms associated with mesenteric ischemia.

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  • 26. 

    Which of these disorders have been shown to have a strong association with peptic ulcer disease?

    • A.

      Hyperparathyroidism

    • B.

      Coronary artery disease

    • C.

      Cirrhosis

    • D.

      Polycythemia vera

    Correct Answer
    C. Cirrhosis
    Explanation
    Cirrhosis has been shown to have a strong association with peptic ulcer disease. Cirrhosis is a condition in which the liver is damaged and scarred, leading to decreased liver function. This can result in increased production of stomach acid, which can contribute to the development of peptic ulcers. Additionally, cirrhosis can cause changes in the blood vessels of the stomach, making them more susceptible to damage and ulcer formation. Therefore, individuals with cirrhosis are at a higher risk of developing peptic ulcers.

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  • 27. 

    A 28-year-old female constantly complains of heartburn and regurgitation. A mechanism which contributes to her disorder: 

    • A.

      Persistent LES relaxation

    • B.

      Increased LES pressure

    • C.

      Anatomic distortion of the esophagogastric junction

    • D.

      None of the above

    Correct Answer
    C. Anatomic distortion of the esophagogastric junction
    Explanation
    The correct answer is "Anatomic distortion of the esophagogastric junction." This is because anatomic distortion of the esophagogastric junction can lead to a condition called hiatal hernia, which can cause symptoms such as heartburn and regurgitation. In this condition, the upper part of the stomach bulges through the diaphragm into the chest cavity, causing the lower esophageal sphincter (LES) to not function properly and allowing stomach acid to flow back into the esophagus. Persistent LES relaxation and increased LES pressure can also contribute to heartburn and regurgitation, but in this case, anatomic distortion is the most likely mechanism.

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  • 28. 

    The following is true of upper GI bleed (UGIB): 

    • A.

      Hyperactive bowel sounds and a decreased blood urea nitrogen are clues which point to UGIB

    • B.

      A nonbloody nasogastric aspirate may be seen in patients with UGIB

    • C.

      When melena is the presenting symptom of UGIB, it is associated with hemodynamic instability and dropping of hemoglobin

    • D.

      Melena indicates blood has been present in the GI tract for at least 24 h

    Correct Answer
    B. A nonbloody nasogastric aspirate may be seen in patients with UGIB
    Explanation
    A nonbloody nasogastric aspirate may be seen in patients with UGIB because the blood may have already clotted or the bleeding may be occurring in the lower gastrointestinal tract.

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  • 29. 

    A post-partum patient who underwent prolonged labor develops severe RUQ pain. She underwent cholecystectomy but no calculus was found in the biliary tree. What mechanism may be implicated in the pathogenesis of her condition?

    • A.

      Sphincter of Oddi dysfunction

    • B.

      High serum cholesterol

    • C.

      Bile sludge in the cystic duct

    • D.

      CBD lithiasis

    Correct Answer
    C. Bile sludge in the cystic duct
    Explanation
    Bile sludge in the cystic duct may be implicated in the pathogenesis of the patient's condition. Bile sludge is a mixture of cholesterol crystals, calcium bilirubinate, and mucin. It can form in the gallbladder due to stasis of bile, which can occur after prolonged labor. This sludge can then obstruct the cystic duct, leading to RUQ pain. The fact that no calculus was found in the biliary tree suggests that the obstruction is due to sludge rather than CBD lithiasis. Sphincter of Oddi dysfunction and high serum cholesterol are not directly related to the presence of sludge in the cystic duct.

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  • 30. 

    Upon diagnosis of cholelithiasis, you may recommend cholecystectomy to which of the following patients:

    • A.

      A young patient with silent stones

    • B.

      A patient with incidental finding of a single stone >15 mm

    • C.

      A history of a calcified or porcelain gallbladder

    • D.

      A patient who presented previously with 2 episodes of RUQ pain not interfering with activity, but has not recurred

    Correct Answer
    C. A history of a calcified or porcelain gallbladder
    Explanation
    A history of a calcified or porcelain gallbladder is a strong indication for cholecystectomy. A calcified or porcelain gallbladder is a rare condition in which the wall of the gallbladder becomes calcified, increasing the risk of gallbladder cancer. Therefore, it is recommended to remove the gallbladder in these cases to prevent any potential complications.

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  • 31. 

    The most discriminating symptom In duodenal ulcer:

    • A.

      Burning or gnawing epigastric discomfort

    • B.

      Pain that awakens the patient at night

    • C.

      Discomfort precipitated by food

    • D.

      Accompanied by nausea and vomiting

    Correct Answer
    B. Pain that awakens the patient at night
    Explanation
    The most discriminating symptom in duodenal ulcer is pain that awakens the patient at night. This symptom is characteristic of duodenal ulcers and is often described as a burning or gnawing sensation in the epigastric area. Discomfort precipitated by food is also a common symptom of duodenal ulcers, but it is not as specific as pain at night. Nausea and vomiting may occur in some cases, but they are not as common or specific to duodenal ulcers as nocturnal pain.

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  • 32. 

    You will recommend empiric therapy for acid peptic disorders in this case:

    • A.

      A 20 year old patient with persistent vomiting

    • B.

      A 35 year old with unexplained weight loss

    • C.

      A 35 year old patient who recurrent bloatedness who has tried alternative medicine techniques 

    • D.

      A 45 year old patient with uncontrolled Diabetes

    Correct Answer
    C. A 35 year old patient who recurrent bloatedness who has tried alternative medicine techniques 
    Explanation
    Empiric therapy is recommended for the 35-year-old patient with recurrent bloatedness who has tried alternative medicine techniques. This is because empiric therapy involves treating a condition based on the symptoms alone, without a confirmed diagnosis. In this case, the patient's recurrent bloatedness suggests an underlying acid peptic disorder, and since alternative medicine techniques have not been effective, empiric therapy can be used to provide relief from the symptoms. However, it is important to note that a proper diagnosis should be sought if the symptoms persist or worsen.

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  • 33. 

    What is the most important treatment intervention for acute pancreatitis? 

    • A.

      Administer safe, aggressive intravenous fluid resuscitation

    • B.

      Put the patient on NPO

    • C.

      Start IV antibiotics

    • D.

      Give adequate analgesia

    Correct Answer
    A. Administer safe, aggressive intravenous fluid resuscitation
    Explanation
    Administering safe, aggressive intravenous fluid resuscitation is the most important treatment intervention for acute pancreatitis because it helps to maintain adequate fluid balance and prevent complications such as hypovolemia and organ failure. Adequate fluid resuscitation also helps to reduce inflammation and support the healing process of the pancreas. NPO (nothing by mouth) is also important to rest the pancreas and reduce pancreatic stimulation, but fluid resuscitation takes priority in order to maintain hydration and prevent further complications. IV antibiotics may be used if there is evidence of infection, but they are not the most important intervention. Adequate analgesia is also important for pain control, but it is not the primary treatment intervention.

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  • 34. 

    What are the most important risk factors in the development of alcoholic liver disease

    • A.

      Quantity and gender

    • B.

      Duration and gender

    • C.

      Gender and Hepatitis C

    • D.

      Quantity and duration

    Correct Answer
    D. Quantity and duration
    Explanation
    The most important risk factors in the development of alcoholic liver disease are the quantity and duration of alcohol consumption. This means that the amount of alcohol consumed and the length of time it is consumed are key factors in determining the risk of developing this disease.

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  • 35. 

    True in the laboratory diagnosis of alcoholic fatty liver and alcoholic hepatitis

    • A.

      AST is increased two to sevenfold, >400 IU/L, greater than ALT

    • B.

      ALT is increased two – to sevenfold, >400 IU/L

    • C.

      AST / ALT is usually >1

    • D.

      Bilirubin is increased associated with marked elevation in alkaline phosphatase​​​​​​​

    Correct Answer
    C. AST / ALT is usually >1
    Explanation
    In the laboratory diagnosis of alcoholic fatty liver and alcoholic hepatitis, the AST (aspartate aminotransferase) to ALT (alanine aminotransferase) ratio is usually greater than 1. This means that the AST levels are higher than the ALT levels. This is a characteristic finding in these conditions and can help differentiate them from other liver diseases. The increased AST levels suggest liver damage, while the increased ALT levels indicate ongoing inflammation. Therefore, a higher AST/ALT ratio is indicative of alcoholic liver disease.

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  • 36. 

    Treatment for patients with severe alcoholic hepatitis, with a discriminant factor >32 or MELD > 20

    • A.

      Prednisone 40mg/day x 4 weeks then tapered

    • B.

      Pentoxyfylline 400 mg/tab TID x 4 weeks

    • C.

      Monoclonal antibodies that neutralize serum TNF-a

    • D.

      Immediate liver transplantation

    Correct Answer
    A. Prednisone 40mg/day x 4 weeks then tapered
    Explanation
    Patients with severe alcoholic hepatitis, with a discriminant factor >32 or MELD > 20, are at high risk of liver failure and death. The recommended treatment for these patients is prednisone 40mg/day for 4 weeks, followed by a tapering dose. Prednisone is a corticosteroid that helps reduce inflammation and suppress the immune response, which can be beneficial in treating alcoholic hepatitis. This treatment approach has been shown to improve survival and reduce the risk of liver failure in these patients. The other options, such as pentoxyfylline and monoclonal antibodies, may have some benefits but are not as effective as prednisone in this particular condition. Immediate liver transplantation is not the first-line treatment and is usually reserved for patients who do not respond to medical therapy or have advanced liver disease.

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  • 37. 

    52 y/o female consulted at your clinic, complaining of a 2-month history of vague abdominal pain, easy fatigability and chest heaviness. On PE: BP 100/60, HR 103, reg RR 22. She was pale, no NVE. Clear BS. DHS tachycardic, regular rhythm, no murmurs. Abdomen was soft, nontender nabs, no palpable mass. DRE: no mass/tenderness/blood PEF. CBC: hypochromic, microcytic anemia (hgb 88); 12-L ECG and 2D echo. FOBT negative.  You decided to do a colonoscopy, the most likely location of the lesion given her clinical presentation is at the: 

    • A.

      Ascending colon

    • B.

      Transverse colon

    • C.

      Descending colon

    • D.

      Rectosigmoid ​​​​​​​

    Correct Answer
    A. Ascending colon
    Explanation
    Based on the patient's symptoms of vague abdominal pain, easy fatigability, and chest heaviness, along with the physical examination findings of pale skin, tachycardia, and hypochromic, microcytic anemia, the most likely diagnosis is iron deficiency anemia. Iron deficiency anemia is commonly caused by chronic blood loss, which can occur from gastrointestinal bleeding. The location of the lesion causing the bleeding is most likely in the ascending colon, as this is the first part of the colon where blood enters after passing through the small intestine. A colonoscopy is necessary to confirm the diagnosis and locate the exact site of bleeding.

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  • 38. 

    A serum ascites-to-albumin gradient (SAAG) of > 1.1 g/dL indicates that the most likely cause of the ascites is:

    • A.

      Cirrhosis with portal hypertension

    • B.

      Infection such as TB peritonitis

    • C.

      Malignancy such as ovarian cancer

    • D.

      Renal failure

    Correct Answer
    A. Cirrhosis with portal hypertension
    Explanation
    A serum ascites-to-albumin gradient (SAAG) of > 1.1 g/dL indicates that the most likely cause of the ascites is cirrhosis with portal hypertension. This is because cirrhosis leads to increased pressure in the portal vein, causing fluid to accumulate in the abdomen. The SAAG value helps differentiate between causes of ascites, with a high SAAG indicating portal hypertension-related causes such as cirrhosis. Infection, malignancy, and renal failure are less likely to cause a high SAAG.

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  • 39. 

    Currently considered the most effective treatment regimen for acute hepatitis B:

    • A.

      Adefovir

    • B.

      Entecavir

    • C.

      Lamivudine

    • D.

      None of the above

    Correct Answer
    D. None of the above
    Explanation
    The question asks for the most effective treatment regimen for acute hepatitis B, and the correct answer is "None of the above." This means that neither Adefovir, Entecavir, nor Lamivudine is considered the most effective treatment for acute hepatitis B. The question does not provide any further information or options, so we cannot provide a more specific explanation.

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  • 40. 

    This condition resembling cholangitis results from progression of acute cholecystitis with persistent cystic duct obstruction to superinfection of the stagnant bile:

    • A.

      Empyema of the gallbladder

    • B.

      Emphysematous cholecystitis

    • C.

      Hydrops

    • D.

      Porcelain gallbladder

    Correct Answer
    A. Empyema of the gallbladder
    Explanation
    Empyema of the gallbladder is the correct answer because it is a condition that occurs when acute cholecystitis (inflammation of the gallbladder) progresses and leads to persistent obstruction of the cystic duct. This obstruction causes bile to become stagnant, which can then become superinfected. The term "empyema" refers to the presence of pus in a body cavity, in this case, the gallbladder. Therefore, empyema of the gallbladder accurately describes the condition resulting from the progression of acute cholecystitis with persistent cystic duct obstruction to superinfection of the stagnant bile.

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  • 41. 

    The usual clinical presentation of Crohn’s Disease:

    • A.

      Recurrent fever, abdominal pain and rectal bleeding

    • B.

      Recurrent abdominal cramping, constipation and abdominal distension

    • C.

      Recurrent right lower quadrant pain and diarrhea

    • D.

      Recurrent abdominal bloating, tenesmus and weight loss  

    Correct Answer
    C. Recurrent right lower quadrant pain and diarrhea
    Explanation
    The correct answer is recurrent right lower quadrant pain and diarrhea. Crohn's disease is a chronic inflammatory bowel disease that commonly affects the terminal ileum and the colon. The most common clinical presentation of Crohn's disease includes abdominal pain, typically in the right lower quadrant, and diarrhea. Other symptoms may include weight loss, fatigue, and occasionally rectal bleeding. However, the presence of recurrent right lower quadrant pain and diarrhea is the most characteristic and specific presentation of Crohn's disease.

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  • 42. 

    The most clinically benign form of Nonalcoholic Fatty Liver Disease (NAFLD), consisting of simple accumulation of triglycerides in hepatocytes:

    • A.

      Nonalcoholic steatohepatitis (NASH)

    • B.

      Hepatic steatosis

    • C.

      Nonalcoholic hepatitis

    • D.

      Benign hepatic chylomicronemia

    Correct Answer
    B. Hepatic steatosis
    Explanation
    Hepatic steatosis is the correct answer because it refers to the simple accumulation of triglycerides in hepatocytes, which is the most clinically benign form of Nonalcoholic Fatty Liver Disease (NAFLD). Nonalcoholic steatohepatitis (NASH) is a more severe form of NAFLD that involves inflammation and liver cell damage. Nonalcoholic hepatitis and benign hepatic chylomicronemia are not accurate terms for describing the simple accumulation of triglycerides in hepatocytes.

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  • 43. 

    Rovsing’s sign in acute appendicitis refers to:

    • A.

      Elicited abdomnal pain on internal rotation of the hip

    • B.

      Elicited pain on the RLQ on gentle palpation of the LLQ

    • C.

      Elicited pain in the right lower back on extending the right hip

    • D.

      Elicited pain on the RLQ on deep epigastric pressure

    Correct Answer
    B. Elicited pain on the RLQ on gentle palpation of the LLQ
  • 44. 

    X-ray images showing distention of fluid- and gas-filled bowel arranged in a “staircasing” pattern and an absence or paucity of colonic gas are pathognomonic for:

    • A.

      Mesenteric ischemia

    • B.

      Peritonitis

    • C.

                  Small intestinal obstruction

    • D.

      Diverticular perforation

    • E.

      Option 5

    Correct Answer
    C.             Small intestinal obstruction
    Explanation
    The X-ray images showing distention of fluid- and gas-filled bowel arranged in a "staircasing" pattern and an absence or paucity of colonic gas are characteristic findings of small intestinal obstruction. This pattern occurs because the small bowel becomes dilated proximal to the obstruction, causing a buildup of fluid and gas. The "staircasing" appearance is due to the fluid and gas filling the valvulae conniventes, which are the transverse folds in the small intestine. This finding is not specific to other conditions mentioned in the options.

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  • 45. 

    A patient with ulcerative colitis develops pustules on the feet, legs and chest that rapidly ulcerate and become violaceous. This extraintestinal complication is known as:

    • A.

      Dermatitis herpetiformis

    • B.

      Erythema nodosum

    • C.

      Sweet’s syndrome

    • D.

      Pyoderma gangrenosum

    Correct Answer
    D. Pyoderma gangrenosum
    Explanation
    Pyoderma gangrenosum is a rare skin condition characterized by the development of painful pustules that rapidly progress to ulcers and become violaceous in color. It is commonly associated with inflammatory bowel diseases such as ulcerative colitis. Dermatitis herpetiformis is a skin manifestation of celiac disease, while erythema nodosum is a skin condition associated with various underlying causes. Sweet's syndrome is a rare inflammatory condition characterized by fever, neutrophilic infiltrates in the skin, and various systemic symptoms.

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  • 46. 

    During the ”window period” or ”gap” when both HbsAg and anti-HBs are negative, this test may represent the only serologic evidence of recent or current HBV infection:

    • A.

      HBeAg

    • B.

      HbcAg

    • C.

      Anti-Hbe

    • D.

      Anti-HBc IgM

    Correct Answer
    D. Anti-HBc IgM
    Explanation
    During the "window period" or "gap" when both HbsAg and anti-HBs are negative, the presence of Anti-HBc IgM can be the only serologic evidence of recent or current HBV infection. This is because Anti-HBc IgM is an antibody that is produced early in the infection and is usually detectable before other antibodies like HbsAg and anti-HBs. Therefore, if both HbsAg and anti-HBs are negative, but Anti-HBc IgM is positive, it suggests that the person may have a recent or ongoing HBV infection.

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  • 47. 

    Regarding IBD and cancer, which of the following is NOT true?

    • A.

      Risk of cancer in UC increases with duration and extent of disease

    • B.

      Surveillance colonoscopy is recommended annually or biennially for patients with > 8 -10 yrs of pancolitis

    • C.

      Recommended approach to flat, low grade dysplasia is continued surveillance

    • D.

      IBD predisposes to other malignancies such as non-Hodgkin’s lymphoma, leukaemi

    Correct Answer
    C. Recommended approach to flat, low grade dysplasia is continued surveillance
    Explanation
    The recommended approach to flat, low grade dysplasia is not continued surveillance. Instead, it is recommended to undergo endoscopic resection or colectomy. Continued surveillance is usually recommended for patients with no dysplasia or with indeterminate dysplasia.

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  • 48. 

    Mucosa-associated lymphoid tissue (MALT), a well differentiated, superficial gastric lymphoma, is strongly associated with:

    • A.

      H. pylori infection

    • B.

      Chronic NSAID use

    • C.

      Cigarette smoking

    • D.

      Alcohol abuse

    Correct Answer
    A. H. pylori infection
    Explanation
    Mucosa-associated lymphoid tissue (MALT) is a type of lymphoma that is commonly found in the stomach. The given answer states that MALT is strongly associated with H. pylori infection. This is because H. pylori is a bacterium that can cause chronic inflammation in the stomach, leading to the development of MALT lymphoma. Studies have shown that the eradication of H. pylori can lead to the regression of MALT lymphoma in some cases. Therefore, the strong association between MALT lymphoma and H. pylori infection makes this answer the correct choice.

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  • 49. 

    Precore mutant Hepatitis B is characterized by the following, except:

    • A.

      Inability to secrete HBeAg

    • B.

      Lower incidence of hepatocellular carcinoma

    • C.

      Progresses more rapidly to cirrhosis

    • D.

      Lower levels of HBV DNA and variable aminotransferase activity

    Correct Answer
    B. Lower incidence of hepatocellular carcinoma
    Explanation
    Precore mutant Hepatitis B is a specific variant of the Hepatitis B virus that is characterized by the inability to secrete HBeAg, lower levels of HBV DNA, and variable aminotransferase activity. It is also known to progress more rapidly to cirrhosis. However, it is not associated with a lower incidence of hepatocellular carcinoma, which is a type of liver cancer commonly associated with chronic Hepatitis B infection.

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  • 50. 

    The recommended treatment for Acute Hepatitis C:

    • A.

      Lamivudine

    • B.

      Interferon α

    • C.

      Pegylated interferon plus ribavirin

    • D.

      None of the above

    Correct Answer
    C. Pegylated interferon plus ribavirin
    Explanation
    The recommended treatment for Acute Hepatitis C is pegylated interferon plus ribavirin. This combination therapy has been shown to be effective in treating acute hepatitis C by suppressing viral replication and improving liver function. Lamivudine is not recommended for the treatment of hepatitis C, and interferon α alone may not be as effective as the combination therapy. Therefore, the correct answer is pegylated interferon plus ribavirin.

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