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The MCQ OF
Gastroenterology&liver
By
Prof.Rashed Hasan
1-Jaundice in Sickle Cell Anaemia can be classified under:
Congenital Hyperbilirubinaemia
Haemolytic
Hepatocellular
Obstru...
Answer: Obstructive
6-Immunological evidence of immunity to hepatitis B is the
presence of
A. hepatitis B core antibodies
...
10. A 40 year old man suddenly developed painless jaundice. He also
complains of abdominal pain with mucous diarrhea. The ...
C. coinfection of HBVand HDV
D. none of the above
Answer: Option A
15- Which of the following specimens contain/s hepatiti...
C. Polymerase chain reaction for detection of HEV RNA
D. ELISA test for IgG anti-HEV
Answer: Option C
19. Hepatocellular c...
D. All of these
Answer: Option D
23.The viruses, which is/are transmitted by parenteral and sexual routes is/are
A. Hepati...
27.A portal venous pressure of 30 mm. Hg (elevated)
and a hepatic venous wedge pressure of 5 mm. Hg
(normal) may be associ...
B. The enlarged liver presses on the diaphragm, which in turn
presses on the esophageal wall, causing collapse of blood
ve...
Answer: b
35 Treatment of Choice for gastric varices is
a) Sclerotherapy
b) Band Ligation
c) Transjugular Intrahepatic Por...
41-The most common cause of Ascites is:
a-myocardial infarction.
b-cerebral haemorrhage.
c-liver cirrhosis.
Answer:c
42-lo...
 a-True
 b-False .
The correct answer is a – true.
49- Asterixis is highly specific for the diagnosis of HE: 
 a-True
 b-F...
54- Which of the following is not an ultrasonic finding in acute
cholecystitis
a) Absence of gall stomes
b) Gall bladder w...
c- Sickle cell anemia
d- High protien diet
e- Rapid weight loss.
Answer. D.
60-The following are indications for cholecyst...
C. Mesenteric angiography is useful in the evaluation
of many patients with chronic pancreatitis.
D. Total pancreatectomy ...
66-In the performance of a pancreaticoduodenectomy
(Whipple procedure) .
a. The superior mesenteric vein is resected
b .Th...
69-The pathogenesis of cholesterol gallstones is :
a. Cholesterol deposition
b. Gallbladder stasis
c. Low bilirubin concen...
g. Cholinergic drugs
h. Caffeine
i. Nicotine
j. Gastric outlet obstruction
Answer:B
74-Babies and children do not develop ...
80- Factors associated with the development of complications of
gastroesophageal reflux disease include:
a. The presence o...
85-Effective ulcer treatment which works without any action on gastric acid secretion
is:
Lactulose
B. Aluminium hydroxide...
organism are associated with lower ulcer recurrence rates than those
in which the organism persists
d. The incidence of th...
92-. First-line therapy for routine peptic duodenal ulcer disease
includes:
A. Vagotomy and antrectomy.
B. Upper endoscopy...
. 97-Which of the following risk factors have been shown to increase
significantly the incidence of gastrointestinal bleed...
patients with active ulceration
Answer: b.
101-With regard to benign gastric ulceration, the most common
location of disea...
105- common manifestation of Crohn’s disease is perianal disease,
including anal fistulas , fissures, and perirectal absce...
108-. The following statement(s) is/are true concerning the surgical
management of Crohn’s disease.
a Not needed at all
b....
a. Transmural inflammation
b. Diffuse distribution
c. No granulomas
d. Associated with toxic megacolon.
Answer:A
112-Morph...
-ankylosing spondylitis
– aphthous (oral) ulcers
– iritis
- sclerosing cholangitis
– arthritis,
– All of the above.
Answer...
120-The following is NOT thought to be involved in the pathogenesis of IBD:
a. Genetics
b. Mucosal immune responses
c. Epi...
B-Patients with Crohn’s disease are more at risk of colorectal cancer
than UC patients.
C-Effectiveness of colonoscopic su...
Answer: D.
130-For the patient who is now stable after a severe UGI bleed associated
with NSAID ingestion, and who is foun...
B. hemodynamically stable, 3 cm ulcer with clean ulcer base
C. no comorbid illness, 1 cm clean ulcer base
D. melena with n...
138-Which is the most common cause of lower GI bleed under 50 years of
age?
p. Anal fissures
q. Benign polyps
r. Haemorrho...
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Mcq liver

  1. 1. The MCQ OF Gastroenterology&liver By Prof.Rashed Hasan
  2. 2. 1-Jaundice in Sickle Cell Anaemia can be classified under: Congenital Hyperbilirubinaemia Haemolytic Hepatocellular Obstructive Answer: Haemolytic 2-Jaundice in Viral Hepatitis can be classified under: • Congenital Hyperbilirubinaemia • Haemolytic • Hepatocellular • Obstructive Answer: Hepatocellular 3-Jaundice in Acute Cholecystitis can be classified under: • Congenital Hyperbilirubinaemia • Haemolytic • Hepatocellular • Obstructive Answer: Obstructive 4-Stercobilinogen is absent in the stools in the following type of jaundice: • Hemolytic • Hepatocellular • Obstructive Answer: Obstructive 5-Urobilinogen is absent in the urine in the following type of jaundice: • Hemolytic • Hepatocellular • Obstructive
  3. 3. Answer: Obstructive 6-Immunological evidence of immunity to hepatitis B is the presence of A. hepatitis B core antibodies B. hepatitis B core antigen C. hepatitis B surface antibodies D. hepatitis B surface antigen E. any of the above. ANSWER C 7-A 20 year old man presented with fever ,anorexia and upper abdominal pain followed by jaundice. On examination liver was palpable and tender. The most likely investigation is: a) Alfa feto protein b) CT abdomen c) HBsAg d) Alkaline phosphatase e) LFT Answer: b 8- A 45 years old man presented with jaundice and ascites. He gave history of jaundice for several episodes in last 5 years. The most likely investigation is not needed: a) Alfa feto protein b) CT abdomen c) HBsAg d) Alkaline phosphatase e) LFT Answer: d 9- A known case of cirrhosis suddenly developed severe jaundice and rapid deterioration of health. On examination liver was enlarged and tender. The most likely investigation is: a) Alfa feto protein b) CT abdomen c) HBsAg d) Alkaline phosphatase e) LFT Answer: b
  4. 4. 10. A 40 year old man suddenly developed painless jaundice. He also complains of abdominal pain with mucous diarrhea. The most likely investigation is: a) Alfa feto protein b) CT abdomen c) HBsAg d) Alkaline phosphatase e) LFT. Answer: b 11- A 55 year old women developed progressive jaundice with abdominal pain which radiates towards back and weight loss. The most likely investigation is: a) Alfa feto protein b) CT abdomen c) HBsAg d) Alkaline phosphatase e) LFT Answer: B . 12. Which of the following hepatitis viruses is not RNA virus? A. Hepatitis A virus B. Hepatitis B virus C. Hepatitis E virus D. Hepatitis G virus Answer: Option B 13-Which of the following nucleic acid is present in hepatitis B virus? A. dsDNA B. ssRNA C. ssDNA D. dsRNA Answer & Explanation Answer: Option A 14-The most serious infection is A. superinfection of an HBsAg carrier by HDV B. infection with HBV alone
  5. 5. C. coinfection of HBVand HDV D. none of the above Answer: Option A 15- Which of the following specimens contain/s hepatitis B virus in an infected person? A. Blood B. Semen C. Saliva D. All of these A Answer: Option D . 16-Vertical transmission may be seen in A. Hepatitis B virus B. Hepatitis C virus C. Hepatitis D virus D. All of these Answer: Option D . 17-Which of the following viral infections can result in chronic carrier state? A. HBV B. HCV C. HDV D. All of these Answer: Option D 18-Most reliable test for detection of hepatitis E infection is A. ELISA test for IgM anti-HEV B. Western blot assay for IgM anti-HEV
  6. 6. C. Polymerase chain reaction for detection of HEV RNA D. ELISA test for IgG anti-HEV Answer: Option C 19. Hepatocellular carcinoma (Hepatoma) may be caused by A. Hepatitis A virus B. Hepatitis C virus C. Both (a) and (b) D. None of these Answer: Option C 20. The diagnosis of hepatitis A virus infection is carried out from the method based on A. aminotransferase levels B. detection of faecal HAV by immunoelectron microscopy C. both (a) and (b) D. detection of IgM anti-HAV by ELISA Answer: Option D. . 21. --- Which of the following is not correct for hepatitis A virus? A. It can be grown in cell cultures of primate and human cells B. It is one of the most stable viruses infecting humans C. It may cause hepatocellular carcinoma D. None of the above Answer: Option C .22. Which of the following viruses can be transmitted by the parenteral route? A. HBV B. HCV C. HDV
  7. 7. D. All of these Answer: Option D 23.The viruses, which is/are transmitted by parenteral and sexual routes is/are A. Hepatitis B virus B. Hepatitis C virus C. Hepatitis G virus D. All of these Answer: Option D 24-Which of the following are true of hepatitis C infection ?: A Hepatitis C virus is a DNA virus B Infection is a risk factor for hepatocellular carcinoma C Infection is commoner in women D Commonly transmitted by sexual contact E Alpha-interferon is an effective treatment to cure the infection. Answer:B True . 25-Gallstones are proved to be associated With except: A Female sex B Pregnancy C Oral contraceptives D Ageing E Insulin therapy. Answer:E 26. In a patient with liver cirrhosis, the recommended diet is? A. Low protein B. High protein C. High fat D. Low fiber Answer B
  8. 8. 27.A portal venous pressure of 30 mm. Hg (elevated) and a hepatic venous wedge pressure of 5 mm. Hg (normal) may be associated with which of the following causes of portal hypertension? A. Portal vein thrombosis. B. Alcoholic cirrhosis. C. Schistosomiasis. D. Alcoholic hepatitis. Answer: AC 28-Which of the following complications of portal hypertension often require surgical intervention (for more than 25% of patients?( A. Hypersplenism. B. Variceal hemorrhage. C. Ascites. D. Encephalopathy. Answer: B. 29-A male client with a history of cirrhosis and alcoholism is admitted with severe dyspnea resulted to ascites. The nurse should be aware that the ascites is most likely the result of increased… A. Pressure in the portal vein B. Production of serum albumin C. Secretion of bile salts D. Interstitial osmotic pressure .Answer:A 30-The nurse is caring for a client with cirrhosis of the liver who has developed esophageal varices. The nurse understands that the best explanation for development of esophageal varices is which of the following? A. Chronic low serum protein levels result in inadequate tissue repair, allowing the esophageal wall to weaken.
  9. 9. B. The enlarged liver presses on the diaphragm, which in turn presses on the esophageal wall, causing collapse of blood vessels into the esophageal lumen. C. Increased portal pressure causes some of the blood that normally circulates through the liver to be shunted to the esophageal vessels, increasing their pressure and causing varicosities. D. The enlarged liver displaces the esophagus toward the left, tearing the muscle layer of the esophageal blood vessels, which allows small aneurysms to form along the lower esophageal vessels. Answer:c 31.In hepatitis C is false: a. cirrhosis develops in most untreated cases b. blood transfusion is the commonest mode of transmission in the UK. c. children born to hepatitis C infected mothers will not have the infection d. High serum alanine transaminase level indicate active liver disease Answer :C 32-Neuropsychiatric symptoms of hepatic insufficiency include: A) a reverse sleep pattern B) Argyll-Robertson pupils C) myelopathy with paraplegia D) diagnostic EEG abnormalities. Answer :A&D. 33- Which is not true regarding physiology of portal hypertension? a) Both the portal blood flow as well as portal resistance increases b) There is extensive hyperdynamic circulation c) Blood flow towards the portal vein increases because the systemic venous pressure increases. d) Splanchnic vasodilatation is caused by relaxation of splanchnic arterioles and splanchnic hyperemia. Answers.1. c 34.False about site of porto systemic collaterals in portal hypertension is a) Rectal Varices- Where Inferior mesenteric vein meets pudendal vein b) Retroperitoneal veins- Comunication between the iliac and renal veins c) Umbilicus- Obliterated umbilical vein and Left portal vein d) Varices in lower esophagus and stomach.
  10. 10. Answer: b 35 Treatment of Choice for gastric varices is a) Sclerotherapy b) Band Ligation c) Transjugular Intrahepatic Portosystemic Shunt d) Application of cyanoacrylate glue e) Shunt Surgery. Answer:. d 36. Measurement of Portal vein pressure can be done by all of these except a) Hepatic venous pressure gradient (HVPG) b) Direct measurement of portal pressure c) Splenic pulp pressure d) IVC pressur. Answer:. d 37 . False statement regarding endoscopic management of varices is: a) All patients with cirrhosis should undergo screening endoscopy. b) If no varices are found endocscopy should be done every 2-3 years c) Endoscopic management is useless. Answer:c 3 8-which is the most common cause of portal hypertension? a. Iatrogenic causes b. Trauma c. Chronic renal failure d. Liver cirrhosis e. Tumour. Answer:d .3 9- What are the tests that should be done on the ascitic fluid? a.wbcs. b.lymphocytes. c.total protein. d.culture. E.all of these. Answer:E 40-Ascites is fluid collection in the : a-pleura. b-pericardium. c-peritoneum, Answer:c
  11. 11. 41-The most common cause of Ascites is: a-myocardial infarction. b-cerebral haemorrhage. c-liver cirrhosis. Answer:c 42-low-salt diet anddiuretics in treatment of ascites has: a- very important role. b- Less important role. c- No role.   Answer:A 43-Standard treatment of spontaneous bacterial peritonitis (SBP) includes which of the following?  aAmpicillin and gentamicin.  bCeftriaxone 1 g intravenously daily for 5 days.  cCefotaxime 2 g intravenously every 8 hours for 5 days.  dCefotaxime and metronidazole. The correct answer is c  44-.In hepatic encephalopathyA significant proportion of portal vein ammonia is generated by intestinal ammonia.  a-True  b-False . : The correct answer is – true. 45-Hepatic encephalopathy (HE) primarily arises because of large portosystemic shunts.  a-True  b-False The correct answer is b – false. 46-Correction of precipitating factors for HE is effective therapy.  a-True  b-False The correct answer is a - true.. 47- Blood ammonia level are useful for the diagnosis of HE.   a-True  b-False : The correct answer is b – false. 48-Neomycin inhibits intestinal bacterial activity.
  12. 12.  a-True  b-False . The correct answer is a – true. 49- Asterixis is highly specific for the diagnosis of HE:   a-True  b-False : The correct answer is b – false. 50- The most common cause of death in the setting of acute liver failure is which of the  following?  a-Fungal infection.  b-Cerebral edema and brainstem herniation.  c-Electrolyte imbalance.  d-Renal failure. The correct answer is b. 51-The most common cause of ALF worldwide is which of the following?  a-Drug-induced liver injury  b-Viral hepatitis  c-Autoimmune hepatitis  d-Ischemic hepatitis . The correct answer is b.. 52- Which of the following statements describes functional renal failure in cirrhosis?   A-Renal failure where there is no structural damage in the kidneys.  b-Diagnosed when the serum creatinine is Les than 1 mg/dL.  c--The same as hepatorenal syndrome Answer.A&C 53-Which of the following statements applies in assessing a patient for a diagnosis of acute or type 1 hepatorenal syndrome?  a-One should always look for a precipitating event as hepatorenal syndrome never occurs spontaneously.  b-The patient usually has signs to suggest a hyperdynamic circulation.  c-The rise in serum creatinine occurs within 48 hours.  . Answer.A,b&C
  13. 13. 54- Which of the following is not an ultrasonic finding in acute cholecystitis a) Absence of gall stomes b) Gall bladder wall thickness more than 6 mm c) Pericholecystic fluid d) Murphy's sign Answer.d 55-- Signs and symptoms of acute cholecystitis usually include the following except: a- Jaundice b- RUQ pain c- Fever d- Elevated WBC count e- Nausea and vomiting. Answer A 56- In obstructive jaundice, LFTs usually shows a- Elevated indirect bilirubin and alkaline phosphatase b- Elevated indirect bilirubin and GGT c- Elevated direct bilirubin and alkaline phosphatase d- Elevated direct bilirubin and ALT e- Elevated direct bilirubin and AST. Answer. C 57- Prolonged PT (INR) in obstructive jaundice is due to decrease absorption of a- Vitamin A b- Vitamin D c- Vitamin E d- Vitamin K e- Calcium. Answer. D 58- In acute cholecystitis,the sonar shows a- Distended gallbladder b- Contracted gallbladder c- Non-filling of gallbladder d- Dilated common bile duct e- Bile leak.. Answer. C 59-Risk factors for gallstones include all the following except a- Obesity b- Contraceptive pills
  14. 14. c- Sickle cell anemia d- High protien diet e- Rapid weight loss. Answer. D. 60-The following are indications for cholecystectomy in asymptomatic gall bladder stone patients except a- Diabetes b- During surgery c- Stone 4 cm in size d- Ischemic heart diseas e- Hemolytic anemia. Answer. D. 61-The clinical picture of gallstone includes which of the following? A. Air in the biliary tree. B. Small bowel obstruction. C. A stone at the site of obstruction. D. Acholic stools. E. Associated bouts of cholangitis. Answer: C&E. 62-. Standard supportive measures for patients with acute pancreatitis include the following: A. Intravenous fluid and electrolyte therapy. B. analgesics as pethedin. C. Somatostatin therapy. D. Nasogastric decompression. E. Prophylactic antibiotics. Answer: A ,B&C. 63-. Which of the following statements about chronic pancreatitis is/are correct? A. Chronic pancreatitis is the inevitable result after repeated episodes of acute pancreatitis. B. Patients with chronic pancreatitis commonly present with jaundice, pruritus, and fever.
  15. 15. C. Mesenteric angiography is useful in the evaluation of many patients with chronic pancreatitis. D. Total pancreatectomy usually offers the best outcome in patients with chronic pancreatitis. E. Pancreatic enzymes replacement& symptomatic therapy are useful. Answer:A& E. 64-Which of the following statements about pancreatic ascites is/are correct? A. Patients typically present with painful ascites. B. The peritoneal fluid contains high concentrations of both amylase and protein. C. Pancreatic ascites can follow an episode of acute pancreatitis. D. Patients with pancreatic ascites may fail to improve with nonoperative therapy and require surgical procedures. At abdominal exploration an acceptable approach to the pancreatic duct disruption involves suture ligation with omental patching. Answer: B&C. 65-Which of the following statements about cancer of the pancreas is/are correct? A. It is the most common cause of cancer death in the U.S. B. Most cases occur in the body and tail of the pancreas C. prognosis appears to be independent of the presence of metastasis, margin status, or tumor diameter. D. The most accurate screening test involves surveillance of alfa fetoprotein Answer: A.
  16. 16. 66-In the performance of a pancreaticoduodenectomy (Whipple procedure) . a. The superior mesenteric vein is resected b .The head of pancrease &duodenum are resected c. performed in absence of tumour metastasis d. The superior mesenteric vein courses anterior to the neck of the pancreas Answer: b, c. 67-A 50-year-old man develops acute pancreatitis due to alcohol abuse, the patient is noted to have recurrent fever (38.5°C), progressive leukocytosis (18,500 WBC/mm3), and tachypnea. The most appropriate management includes: a. Laparotomy with pancreatic debridement b .Abdominal CT &serum lipase are useful. c. ERCP with sphincterotomy and placement of biliary stent d. Intravenous amphotericin B Answer: b. 68- Which of the following medical procedures has/have been associated with an increased risk of post-procedure acute pancreatitis? a. Uper endoscopy b. Endoscopic retrograde cholangiopancreatography c. paracentesis d. Colonoscopy Answer: b.
  17. 17. 69-The pathogenesis of cholesterol gallstones is : a. Cholesterol deposition b. Gallbladder stasis c. Low bilirubin concentration d. High bilirubin concentration Answer: a, b, c. 70- Risk factors associated with development of gallstones include: a. Increasing age b. Obesity c. Rapid weight loss d. Cirrhosis e. Diabetes mellitus Answer: a, b, c, d, e. 71- In which of the following clinical situations is pigment gallstones a more common problem? a. Amoebic abscess b. Morbid obesity c. Diabetes mellitus d. Haemoletic anemia e. Biliary tract stricture Answer: d, 72-:GERD is the back up of stomach acid into the esophagus. A.True. B.False. 73-Which is not a predisposing factor for GORD? f. High fatty food intake
  18. 18. g. Cholinergic drugs h. Caffeine i. Nicotine j. Gastric outlet obstruction Answer:B 74-Babies and children do not develop GERD. A.True. B.False. Answer:B 75-Reflux is an alternative term for AVomiting BAcid erosion CRegurgitation DSalivating.. Answer:CRegurgitation 76- GERD is diagnosed by blood tests. A.True. B.False. Answer:B 77-Barrett's esophagus is a potentially serious complication of GERD A.True. B.False. Answer:A. 78-Who is most likely to suffer from GERD? A-A pregnant woman BAn obese person CA cigarette/cigar smoker DAny of the above Answer: DAny of the above. 79-GERD is closely linked to which type of cancer? A.hepatoma. B.Cancer pancreas. c.oesophageal adenocarcinoma. Answer:C.
  19. 19. 80- Factors associated with the development of complications of gastroesophageal reflux disease include: a. The presence of a defective lower esophageal sphincter b. Inadequate esophageal clearance c. The presence of a hiatal hernia d. The presence of an alkaline component of the reflux material Answer: a, b, c, d. 81-Which is the most common cause of peptic ulcer disease of the following? A-Smoking B-NSAID’s C-Zollinger-Ellison syndrome D-Ethanol excess E-Family hx of PUD Answer:B. 82-Which is not correct regarding treatment of peptic ulcer disease/ A-Antacids are as effective as H2 antagonists in healing ulcers B-Proton pump inhibitors show more rapid healing and pain relief over 2-4 weeks compared to H2 antagonists. C-Colloidal bismuth subcitrate will suppress H.pylori and chelate with the base of the ulcer to aid healing. D-H.pylori eradication with omeprazole, Amoxil and metronidazole requires only one week of treatment. E-Misoprostal is indicated for prevention of NSAID induced ulcers, when treatment necessary with NSAID’s. Answer:D. 83-Which is the most common complication of Peptic ulcer disease? A-Perforation B-Gastric outlet obstruction C-Penetration D-Haemorrhage E-All are uncommon occurring in less than 5% of patients. Answer:D. 84-The best duration of treatment to ensure 90% duodenal ulcer healing with H2 receptor antagonist is: A. 1 week B. 2 weeks C. 4 weeks D. 8 weeks E. 1 year. Answer:D. 8 weeks.
  20. 20. 85-Effective ulcer treatment which works without any action on gastric acid secretion is: Lactulose B. Aluminium hydroxide C. Sucralfate D. Lactitol E. Magnesium trisilicate. Answer C. Sucralfate. 86-Antacid therapy relieves symptoms: A. Rapidly B. By complete neutralisation of gastric acid C. By eradicating Helicobacter pylori D. Indefinitely E. By protecting the mucosa from acid Answer A. Rapidly 87-Helicobacter pylori bacteria: A. Live in gastric acid B. Adhere to the gastric mucosa in an alkaline layer C. Are never seen in healthy people D. Can be simply identified in the endoscopy room by their urease activity E. Are associated with peptic ulcer relapse. Answer.B,D,E 88-Helicoabacter pylori has been investigated as a possible etiologic agent in duodenal ulceration. Which of the following statement(s) regarding H pylori infection in humans is/are correct? H pylori may be isolated from antral gastric mucosa in nearly 100% b. H pylori possess anticoagulant activity c. Therapeutic regimens for duodenal ulcer that eliminate the
  21. 21. organism are associated with lower ulcer recurrence rates than those in which the organism persists d. The incidence of the organism in the normal population increases with age e. Antral gastritis is associated with development of duodenal ulcer Answer: c, d, e. 89-Which is not true of H.pylori infection? A- patients with chronic infection will not develop ulcers B-the most common cause of peptic ulcer disease C-it is a risk factor for adenocarcinoma of the stomach D-IgG antibody test will remain positive for up to 2 years post eradication limiting its usefulness EThe CLO test is approx 90% sensitive and 100% specific for H.pylori. Answer: A 90-Which of the following statements about achalasia is/are correct? A. In most cases in the cause is a parasitic infestation . B. Chest pain and regurgitation are the usual symptoms. C. Distal-third esophageal adenocarcinomas is the main cause. D. Manometry demonstrates failure of LES relaxation on swallowing and absent or weak simultaneous contractions in the esophageal body after swallowing. E. PPI provide highly effective curative therapy for achalasia Answer:D 91-Which of the following statements about diffuse esophageal spasm is/are true? A. Chest pain due to esophageal spasm is readily differentiated from angina pectoris of cardiac origin. B. Bouts of esophageal obstruction and regurgitation of food are characteristic. C. Associated psychiatric disorders are common. D. During manometric assessment, unless the patient is having pain there may be no detectable multiphasic, high-amplitude, simultaneous esophageal contractions. E. The treatment of choice is surgery . Answer: CD .
  22. 22. 92-. First-line therapy for routine peptic duodenal ulcer disease includes: A. Vagotomy and antrectomy. B. Upper endoscopy and biopsy to rule out tumor. C. Evaluation for Helicobacter pylori. D. Serum gastrin determination. E. Cream or milk-based “Sippy” diet. Answer: C 93-Appropriate management of severe vomiting associated with gastric outlet obstruction from peptic ulcer disease includes all of the following except: A. Nasogastric suction. B. Intravenous hydration. C. Nutritional assessment; upper endoscopy to rule out malignancy. D. Intravenous H 2 antagonist. E. Oral antacid therapy. Answer: E 94- All of the following are complications of peptic ulcer surgery except: A. Post operative sepsis. B. Short stomach. C. Diarrhea. D. Delayed gastric emptying. E. Steatorrhea. Answer: E 95- In patients with bleeding duodenal ulcers, the endoscopic examination is essential: A.True. B.False. Answer:A. 96-All of the following contribute to peptic ulcer disease except: A. Cigarette smoking. B. Nonsteroidal anti-inflammatory drugs. C. Helicobacter pylori. D. Gastrinoma. E. Diet protein. Answer:E
  23. 23. . 97-Which of the following risk factors have been shown to increase significantly the incidence of gastrointestinal bleeding from gastritis: A. Glucocorticoid administration. B. Respiratory failure. C. Coagulopathy. D. Organ transplantation. E. Jaundice. Answer: AC 98-Which of the following measures are effective in preventing stress gastritis bleeding in critically ill patients? A. Improving systemic circulation by correcting any shocklike state resulting from blood loss or sepsis. B. Correcting systemic acid-base abnormality. C. Maintaining adequate nutrition. D. Reducing intragastric acidity by either antacid or H 2 antagonists. Answer: ABCD. 99-A 24-year-old woman develops epigastric pain and has a diagnosis of duodenal ulcer confirmed by esophagogastroduodenoscopy. The patient is in the third month of a pregnancy. The most appropriate treatment would be: a. Proximal gastric vagotomy b. Misoprostol 400 mg b.i.d. c. Sucralfate 1 gm q.i.d. d. Cimetidine 400 mg b.i.d. Answer: c. 100- Development of duodenal ulceration is dependent upon gastric acid secretion. Which of the following statements correctly characterizes acid secretion in duodenal ulcer patients? a. Groups of duodenal ulcer patients demonstrate decreased basal acid secretion b. High acid output c. Intake of alkali d. Somatostatin is ineffective in suppressing acid secretion in
  24. 24. patients with active ulceration Answer: b. 101-With regard to benign gastric ulceration, the most common location of disease is which of the following? a. Along the greater curvature b. Immediately distal to the esophagogastric junction along the lesser curvature c. In the area of the incisura angularis along the lesser curvature d. Within the gastric antrum Answer: c 102-Which of the following parasitic infestation can lead to malabsorption syndrome? A. Amoebiasis B. Ascariasis C. Hookworm infestation D. Giardiasis Correct answer : D. Giardiasis. 103-Simple screening tests for malabsorption include: A. Microscopic examination. B. D-xylose absorption. C. A 72-hour stool collection for fats. D. Small bowel x-ray series. Answer: ABD. 104- The enterohepatic circulation refers to the circular flow of bile through the small intestine and liver. Which of the following statement(s) concerning the absorption of bile salts is/are correct? a. The enterohepatic circulation is highly efficient with 80% to 90% of secreted bile salts reabsorbed and returned to the liver through the portal circulation b. The reabsorption of bile is not important c. The small amount of bile escaping in the colon is deconjugated by bacteria, promoting lipid solubility and passive colonic absorption Answer: a, c.
  25. 25. 105- common manifestation of Crohn’s disease is perianal disease, including anal fistulas , fissures, and perirectal abscesses. Which of the following statement(s) is/are true concerning perianal disease with Crohn’s disease? a. Perianal disease is the initial mode of presentation in the majority of patients b. The prevalence of perianal disease is increased in patients with either ileocolitis or isolated colonic involvement c. Metronidazole has been shown to be effective in the treatment of perianal disease secondary to Crohn’s d. An aggressive surgical approach is appropriate in most cases due to the frequent rapid progression of perianal disease Answer: b, c. 106-Nongastrointestinal complications of Crohn’s disease include: a. Renal calculi b. Cholelithiasis c. Arthritis d. Anemia Answer: a, b, c, d. 107-Which of the following points is/are true concerning the diagnosis of Crohn’s disease? a. CBC is specific for diagnosis b. In 10% of cases, Crohn’s disease cannot be distinguished from chronic ulcerative colitis based on clinical, radiologic, and pathologic criteria c. Although no specific laboratory tests exist for Crohn’s disease, the erythrocyte sedimentation rate has evolved as a useful measure of disease activity d. Specific endoscopic features encountered in Crohn’s disease which allow differentiation from ulcerative colitis include aphthous ulcers, cobblestoning, and skip areas Answer: b, c, d.
  26. 26. 108-. The following statement(s) is/are true concerning the surgical management of Crohn’s disease. a Not needed at all b. Essential to prevent recurrence of the disease c. Resecting only grossly involved segments of bowel d. Patients with Crohn’s disease confined to the colon may be treated with total proctocolectomy with construction of an ileal-anal pouch anastomosis Answer: c 109-The etiology of Crohn’s disease is unknown, although two major hypotheses have evolved: an infectious and an immunologic theory. The following statement(s) is/are true concerning the possible etiology of Crohn’s disease. a. The leading infectious agent thus far suggested is infection with a Mycobacterium species b. Strong evidence linking viral pathogens to Crohn’s disease has been developed c.No primary defect in the immune system has yet been identified d. Crohn’s disease is an autoimmune process Answer: a, .110- Crohn’s disease is an incurable disease, therefore recurrence after surgical resection is likely. Which of the following statement(s) regarding the recurrence of Crohn’s disease is/are accurate? a. Endoscopic evidence of recurrence is present in less than 50% of patients at five years b. Radiographic or endoscopic evidence of recurrence is frequently not accompanied by symptoms c. Clinical recurrence of Crohn’s disease is seen in 20% of patients at two years, and 40–50% at four years after surgery d. Reoperation for Crohn’s disease is necessary in the majority of patients by five years e. No solid evidence demonstrating prolongation of remission can be seen with corticosteroids, sulfasalazine, or antibiotics Answer: b, c, e. 111- Features of Crohn disease:
  27. 27. a. Transmural inflammation b. Diffuse distribution c. No granulomas d. Associated with toxic megacolon. Answer:A 112-Morphological features of Crohn disease include: a. Skip lesions b. Left-sided disease c. Broad-based ulcers d. Pseudopolyps. Answer:A 113-The two inflammtory bowel diseases are: a- Crohn’s disease and ulcerative colitis. b- Irritable bowel syndrome& ischemic colitis. c- Amoebic colitis &bilharzial colitis. ANSWER: Crohn’s disease and ulcerative colitis. 114- Inflammatory bowel disease: a. Is an acute autoimmune condition b. Includes ulcerative colitis and Crohn’s disease c. Is more common in men d. Frequently presents in the 5th decade. Answers :b 115-the cause of IBD is: A.No one knows, B- probably an autoimmune process C- environmental factors may contributing, D- All of the above. ANSWER:D. 116-Extraintestinal manifestations seen in both types of IBD are:
  28. 28. -ankylosing spondylitis – aphthous (oral) ulcers – iritis - sclerosing cholangitis – arthritis, – All of the above. Answer: All of the above, 117- In contrast to ulcerative colitis, Crohn’s disease of the colon which is false. a. Is not associated with increased risk of colon cancer b. Frequently presents as daily vomiting c. Is usually segmental rather than continuous d. Has a lower incidence of perianal fistulas e. Never develops toxic megacolon. Answer:a ,b&d. 118-Which is incorrect regarding management of Crohn’s Disease? A-Mesalamine (pentasa) has fewer side effects than sulphasalazine. B-Azathioprine has been used in severe cases. C-Metronidazole has a role in treatment . D-Corticosteroids hase no role in its treatment . E-Loperamide can be used to control diarrhoea. Answer:d 119-Features of ulcerative colitis: a. Transmural inflammation b. Skip lesions c. Marked pseudo polyps d. Mouth to anus distribution. Answer:C
  29. 29. 120-The following is NOT thought to be involved in the pathogenesis of IBD: a. Genetics b. Mucosal immune responses c. Epithelia defects d. Abnormal GI motility Answer:D 121-The extra-intestinal symptoms of both ulcerative colitis and Crohn’s disease may include all EXCEPT: a. Migratory polyarthritis b. Ankylosing spondylitis c. Uveitis d. Erythema multiforme Answer:D. 122-Morphological features of ulcerative colitis include: a. Skip lesions b. Cobblestone appearance of mucosa c. No granulomas d. Noncaseating granulomas Answer:C 123-. Complications of ulcerative colitis include all EXCEPT: a. Fistulae b. Neoplasia c. Primary sclerosing cholangitis d. Toxic megacolon. Answer:A.. 124-Which is INCORRECT regarding Ulcerative Colitis? a-Affects men more than woman b-Mild disease affects 60% of patients and consists of less than 4 bowel motions per day, with the disease limited to rectum in 80%. c-In severe disease there is usually hypoalbuminemia and mildly deranged LFT’s. d-Loperamide and other antidiarrhoeal agents should be avoided as they increase the risk of toxic megacolon. e-Toxic megacolon is not complication of the disease. Answer:E 125-Which is incorrect regarding inflammatory bowel disease? A-The risk of developing ulcerative colitis is higher in non-smokers than smokers.
  30. 30. B-Patients with Crohn’s disease are more at risk of colorectal cancer than UC patients. C-Effectiveness of colonoscopic surveillance in detecting colorectal cancer is controversial in IBD. D-Toxic megacolon occurs in Crohn’s and ulcerative colitis. E-Cobblestone appearance on bowel wall is more characteristic of Crohn disease. Answer:B.. 126-The most frequent cause of UGI(upper gastrointestinal bleeding) bleeding is: A. Esophageal varices B. Peptic ulcer disease C. Angiomata D. Mallory Weiss tear E. Gastritis Answer: B. 127-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. Treat the underlying abnormality D. Prevent rebleeding E. Emergency surgery. Answer: E. 128-Endotracheal intubation for airway protection in the management of UGI 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 E. unless it delays urgent endoscopy Answer C. 129-An important risk factor for peptic ulcer hemorrhage includes: A. Gastric acid hypersecretion B. Corticosteroid use C. Cigarette smoking D. Non-sterioidal anti-inflammatory drug use E. Ethanol consumption
  31. 31. Answer: D. 130-For the patient who is now stable after a severe UGI bleed associated with NSAID ingestion, and who is found to be H.pylori positive, what is the most effective management strategy? A. A.Stop NSAIDS, eradicate H.pylori, H2RA full dose or daily PPI maintenance therapy B. Stop NSAIDs, full dose H2RA or daily PPI maintenance therapy C. Stop NSAIDs D. Eradicate H.pylori, full dose H2RA or daily PPI maintenance therapy F. Full dose H2-receptor antagonist or daily PPI maintenance therapy Answer: A .131- For the patient with an UGI bleed and the endoscopic finding of a clean ulcer, the most appropriate management includes: A. Endoscopic hemostasis with multipolar or heater probe or injection treatment B. Endoscopic hemostasis with combination therapy C. Emergent surgery D. Medical therapy, early refeeding, same day discharge if stable(medically) and reliable E. Medical therapy alone in a monitored setting for three days Answer: D. 132-The two most common causes of severe hematochezia requiring hospitalization are: A. Small angioma and small internal hemorrhoids B. Diverticulitis and internal hemorrhoids C. Colon polyp and colitis D. Bilharzial and aembic colitis Answer is B. 133-A 65-year-old woman has a prior history of hospitalization for UGI bleeding from a duodenal ulcer. Which one of the following therapies is not useful for preventing recurrent ulcer hemorrhage? A. long-term maintenance therapy with full dose H2RA or daily PPI B. H. pylori eradication C. discontinuation of NSAID intake D. ulcer surgery E. bland diet Answer is E. NB: Dietary modifications have not been shown to decrease ulcer recurrence or hemorrhage. 134-Which one of the following patients should be considered for outpatient management of acute UGI bleed? A. young cirrhotic patient
  32. 32. B. hemodynamically stable, 3 cm ulcer with clean ulcer base C. no comorbid illness, 1 cm clean ulcer base D. melena with nonbleeding visible vessel and 0.5 cm ulcer E. coffee ground hematemesis with ulcer, with overlying active ulcer bleeding at endoscopy. Answer is C. 135-A 65-year-old presents with iron-deficiency anemia, refractory to iron treatment. No history of overt gastrointestinal bleeding, but fecal occult blood tests were positive on 4 of 5 occasions. A previous EGD showed a large hiatal hernia. Two colonoscopies and a small bowel radiographic series were unremarkable. . Which of the following is the most appropriate management of this condition? A. Endoscopic ligation B. Endoscopic sclerotherapy C. Laparoscopic Nissen fundoplication D. Distal esophagectomy E. Oral administration of a proton pump inhibitor twice daily and iron replacement therapy. Answer is E. 136-Regarding patients with upper GI bleeds which is incorrect? k. Use of NSAIDs doubles the risk for an upper GI bleed l. Urea will increase relative to creatinine in acute bleed m. Presence of fresh blood on aspiration of NG tube increases mortality as opposed to a clear aspirate. n. Active bleeding seen at endoscopy has a 100% risk of rebleeding after treatment. o. Most deaths occur from decompensation of other organ systems rather than exsanguination. Answer is .D 137- Which is not true of bleeding oesophageal varices? A-Mortality approaches 25-40% B-Use of octreotide IV is as effective as sclerotherapy controlling bleeding in 74-92% of cases. C-Sclerotherapy has a high rate of complications (40%) including perforation, aspiration, pyrexia, chest pain, ulcers and strictures. D-Endoscopic variceal ligation is as effective as sclerotherapy with fewer side effects. E-Use of the sengstaken-blackmore tube is effective in controlling severe bleeding, is easy to insert and has almost no complications. Answer is .E.
  33. 33. 138-Which is the most common cause of lower GI bleed under 50 years of age? p. Anal fissures q. Benign polyps r. Haemorrhoids s. Inflammatory bowel disease t. Diverticulosis. Answer is .C. ‫الطلب‬ ‫لبنائى‬ ‫بالتوفيق‬

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