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12

Gastroenterology (Current practice in internal medicine)

:

tests

:

1.

An elderly housewife was operated on for gallstones and at operation a gangrenous gallbladder was removed. A couple of days later she complained of nausea and feeling unwell. Operative sepsis is suspected. Choose the single most likely management

A. *

Combination antibiotics

B.

Furosemide

C.

Aspirin

D.

Radiotherapy

E.

Anxiolytics

2.

A 60-yr-old warehouse man has been acutely breathless for the past week. He is a smoker and he has had a chronic productive cough for 15 yr. Underlying lung malignancy is suspected. Choose the single most likely management

A.

Combination antibiotics

B.

Furosemide

C.

Aspirin

D. *

Antiemetics

E.

Anxiolytics

3.

A 62-yr-old lifelong smoker has a dry cough, weight loss and haemoptysis. CXR and CT show right middle lobe collapse. He is sent to chest clinic for investigation. Lung cancer is suspected. Choose the single most likely investigation

A.

Mantoux test

B.

ECHO

C. *

Fibreoptic bronchoscopy

D.

Sputum culture

E.

Arterial blood gases

4.

A 54-yr-old farmer with intermittent dry cough fever and dyspnoea progressive weight loss and fine crepitations on auscultation. Extrinsic allergic alveolitis (Farmers lung) is suspected. Choose the single most likely investigation

A.

Mantoux test

B. *

Serum precipitins and high resolution CT

C.

Fibreoptic bronchoscopy

D.

Sputum culture

E.

Arterial blood gases

5.

Choose the single most characteristic lung function test picture for exacerbation of asthma.

A. *

FEV1/FVC-58%, 25% to bronchodilators, normal transfer factor

B.

FEV1/FVC ratio90%, TLC reduced by 30%

C.

Normal PFTs

D.

FEV1/FVC-89%

E.

FEV1/FVC62%, no bronchodilators, gas trapping, and reduced transfer factor

6.

Choose the single most characteristic lung function test picture for emphysema.

A.


B.


C.

Normal PFTs

D.

FEV1/FVC-89%

E. *


7.

Choose the single most characteristic lung function test picture for pneumonectomy.

A. *

Spirometry, lung volumes and incorrected transfer factor predicted.

B.


C.

Normal PFTs

D.


E.


8.

Choose the single most characteristic lung function test picture for neuromuscular disease.

A. *

FEV1/FVC85%. Globally lung vols. Reduced expiratory mouth pressures

B.


C.

Normal PFTs

D.


E.


9.

Choose the single most characteristic lung function test picture for interstitial lung disease.

A.


B. *


C.

Normal PFTs

D.

FEV1/FVC-89%

E.


10.

Contraindication for glucocorticosteroid therapy of bronchial asthma is:

A. *

Bleeding from gastric ulcer

B.

Chronic persistant hepatitis

C.

Exacerbation of respiratory-heart failure

D.

Emphysema of lungs

E.

Respiratory failure

11.

Sharko-Leiden crystals are seen in:

A. *

Bronchial asthma

B.

Bronchiectasis

C.

Chronic bronchitis

D.

Wegners granulomatosis

E.

All of the above

12.

Curschmann's spirals in sputum are seen in:

A. *

Bronchial asthma

B.

Bronchiectasis

C.

Chronic bronchitis

D.

Wegners granulomatosis

E.

All of the above

13.

Curshmann's spirals in sputum is seen in:

A. *

Asthma

B.

Tuberculosis

C.

Bronchitis

D.

Bronchiectasis

E.

Pneumonia

14.

Decreased maximum mid-expiratory flow rate indicates obstruction in:

A. *

Small airways

B.

Trachea

C.

Large airways

D.

Trachea & bronchi both

E.

Nothing of the above

15.

Drug of choice in asthma with heart disease is

A. *

Ipratropium

B.

Rimiterol

C.

Terbutaline

D.

Cromolyn sodium

E.

All of the above

16.

Exercise induced asthma is not precipitated by :

A. *

Swimming in hot water

B.

High altitude climb and exercises

C.

Cycling in cold weather

D.

Swimming in cold water

E.

All of the above

17.

FEV1/FVC is reduced in case of:

A. *

Asthma

B.

Pleural effusion

C.

Lung fibrosis

D.

All of the above

E.

Nothing of the above

18.

Pancreatic calcification may be seen in the following cases except:

A. *

primary diabetes mellitus

B.

severe protein-calorie malnutrition

C.

hereditary pancreatitis,

D.

posttraumatic pancreatitis,

E.

hyperparathyroidism

19.

What is the only major technique that provides a direct view of the pancreatic duct?

A. *

Endoscopic retrograde cholangiopancreatography

B.

Sonography,

C.

CT,

D.

Plain radiography

E.

Laparoscopy.

20.

Ultrasonography can provide important information in patients with all of the following except:

A. *

perforated duodenal ulcer

B.

acute pancreatitis,

C.

chronic pancreatitis,

D.

pancreatic calcification,

E.

pseudocyst.

21.

In acute pancreatitis, the pancreas:

A. *

is characteristically enlarged

B.

has scattered calcification

C.

has ductal decompression

D.

is replaced

E.

no changes

22.

Most lesions of pancreas on CT are characterized by all of the following except:

A. *

the presence of ductal decompression

B.

enlargement of the pancreatic outline,

C.

distortion of the pancreatic contoura

D.

a fluid filling that has a different attenuation coefficient than normal pancreas

E.

none of above

23.

The differential diagnosis of chronic pancreatitis should include all of the following disorders except:

A. *

paroxysmal atrium fibrillatium

B.

perforated peptic ulcer;

C.

acute cholecystitis and biliary colic;

D.

acute intestinal obstruction;

E.

mesenteric vascular occlusion

24.

The differential diagnosis of chronic pancreatitis includes:

A. *

All of above

B.

myocardial infarction;

C.

dissecting aortic aneurysm;

D.

pneumonia;

E.

peptic ulcer.

25.

The secretin-cholecystokinin test is useful in the evaluation of patients with suspected chronic pancreatitis. Which statement regarding this test is correct?

A. *

Secretion of pancreatic enzymes may be measured.

B.

Those with chronic pancreatitis usually have a high bicarbonate output after stimulation.

C.

In patients with early chronic pancreatitis, enzyme output is relatively more deranged than failure to achieve an adequate bicarbonate concentration.

D.

Endocrine hormone output after stimulation is an end-point of the test.

E.

The test can distinguish between chronic pancreatitis and pancreatic carcinoma.

26.

Which is the common cause of chronic pancreatitis?

A. *

Alcohol

B.

Autoimmune diseases

C.

Gall stones

D.

None of above

E.

Tumour of stomach

27.

According to ERCP, what are found to have associations with chronic pancreatitis?

A. *

Biliary obstruction and Pancreatic duct abnormalities

B.

Pancreatic duct abnormalities

C.

Biliary obstruction

D.

None of above

E.

Tumour of pancreas

28.

It is supposed that gall stones can result in chronic pancreatitis because they may induce:

A. *

Inflammation and stenosis or obstruction of ampulla of Vater

B.

Fever

C.

Abdominal pain

D.

None of above

E.

Peptic ulcer

29.

What patients with gall stones tend to induce pancreatitis?

A. *

Those patients who have common pancreaticobiliary channels in the ampullary of Vater

B.

Those patients who do not have common pancreaticobiliary channels

C.

Anyone who has gall stones

D.

None of above

E.

All of above

30.

Which of the following is not true regarding blood supply of pancreas?

A. *

Postero superior pancreaticoduodenal artery is a branch of Superior mesenteric artery.

B.

Body and tail of pancreas is supplied by Splenic artery

C.

It receives blood supply from coeliac trunk and superior mesenteric artery.

D.

All major pancreatic arteries lie posterior to pancreatic ducts.

E.

None of above

31.

Most Common Cause of death in early acute Pancreatitis is

A. *

Respiratory Failure

B.

Cardiac failure

C.

Renal Failure

D.

Uncontrolled Coagulopathy

E.

None of above

32.

All of the following have been used in management of Acute Pancreatitis except

A. *

Interleukin-10

B.

Quamatel

C.

Somatostatin

D.

Peritoneal dialysis

E.

None of above

33.

Which of the following is not true for ectopic pancreas

A. *

Islet tissue is present in all the organs where ectopic pancreas is present.

B.

Ectopic pancreas appears as a submucosal irregular nodule in the wall

C.

stomach and duodenum are the most common site

D.

Ulceration, bleeding and obstruction are the most common symptoms

E.

None of above

34.

Which feature of pancreatic pseudocyst on CT suggests secondary infection?

A. *

Gas formation in the cyst.

B.

Calcification of the cyst wall.

C.

Heterogeneous attenuation of cyst contents.

D.

Enhancement of the cyst wall after IV contrast injection.

E.

Extrapancreatic extension.

35.

Which imaging technique or procedure is most specific for differentiating a mucinous cystic tumor from a microcystic adenoma?

A. *

Percutaneous cyst aspiration.

B.

Endoscopic retrograde cholangiopancreatography (ERCP).

C.

MR cholangiopancreatography.

D.

CT.

E.

Endoscopic sonography.

36.

Which organ also functions as an endocrine gland

A. *

Pancreas

B.

Gall bladder

C.

Liver

D.

Spleen

E.

Duodenum

37.

Which organ releases digestive substances but does not produce them

A. *

Gall bladder

B.

Pancreas

C.

Liver

D.

Spleen

E.

Duodenum

38.

Which organ functions in detoxification of the blood

A. *

Liver

B.

Gall bladder

C.

Pancreas

D.

Spleen

E.

Duodenum

39.

Which organ releases the digestive hormone secretin

A. *

Duodenum

B.

Gall bladder

C.

Liver

D.

Spleen

E.

Pancreas

40.

Which organ releases a buffer that neutralizes acid from the stomach

A. *

Pancreas

B.

Gall bladder

C.

Liver

D.

Spleen

E.

Duodenum

41.

Which organ produces bile salts

A. *

Liver

B.

Gall bladder

C.

Pancreas

D.

Spleen

E.

Duodenum

42.

Markers of Cytolitic syndromein liver cirrhosis

A. *

ÂST, ÂLT, ^GGT, ^Bilirubin

B.

^Bilirubin, Âlkaline phosphatase, ^GGT, ^cholesterol

C.

vAlbumine, vprothrombin, vcholesterol, vfibrinogen

D.

ÊSR, ^?-globulins, ^timol test ^Le, ^C-react. protein

E.

None of above

43.

Markers of Cholestatic syndrome in liver cirrhosis

A. *


B.


C.


D.


E.

None of above

44.

Markers of Liver cellular insufficiency syndrome in liver cirrhosis

A. *


B.


C.


D.


E.

None of above

45.

Markers of Mesenchyme-inflammatory syndrome in liver cirrhosis

A. *


B.


C.

Bilirubin, Âlkaline phosphatase, ^GGT, ^cholesterol

D.


E.

None of above

46.

Markers of Hypersplenism syndrome in liver cirrhosis

A. *

anemia, thrombocytopenia, leukocytopenia

B.


C.


D.


E.

None of above

47.

Markers of Cholestatic syndrome in hepatitis

A. *

All of above

B.

^cholesterol

C.

^Bilirubin

D.

Âlkaline phosphatase

E.

^GGT

48.

Marker of Cholestatic syndrome in hepatitis

A. *


B.

All of above

C.

vfibrinogen

D.

ÂST

E.

ALT

49.

Markers of Cholestatic syndrome in hepatitis are all except

A. *

ALT

B.

^cholesterol

C.

^Bilirubin

D.


E.

^GGT

50.

Markers of Liver cellular insufficiency syndromein hepatitis

A. *

All of above

B.

vAlbumine

C.

vcholesterol

D.

vprothrombin

E.

vfibrinogen

51.

Marker of Liver cellular insufficiency syndromein hepatitis

A. *

vAlbumine

B.

ÂLT

C.

^GGT

D.

^Bilirubin

E.

ÂST

52.

Markers of Liver cellular insufficiency syndromein hepatitis are all except

A. *

ÂLT

B.

vAlbumine

C.

vcholesterol

D.

vprothrombin

E.

vfibrinogen

53.

Markers of Hypersplenism syndromein liver cirrhosis

A. *

All of above

B.

anemia

C.

thrombocytopenia

D.

leukocytopenia

E.

None of above

54.

Markers of Hypersplenism syndromein liver cirrhosis

A. *


B.

ÂLT

C.

^GGT

D.

^Bilirubin

E.

ÂST

55.

HEMOCHROMATOSIS is characterized by:

A. *

Characterized by excessive deposition of iron in liver

B.

Characterized by excessive deposition of copper in liver

C.

results in cirrhosis and emphysema

D.

None of above

E.

All of above

56.

WILSON DISEASE is characterized by:

A. *


B.


C.


D.

None of above

E.

All of above

57.

What is true about ?1-ANTITRYPSIN DEFICIENCY:

A. *


B.


C.


D.

None of above

E.

All of above

58.

Pathologic Mallory stain findings characterizes

A. *

Alcoholic hepatitis

B.

Autoimmune Hepatitis

C.

Cryptogenic Hepatitis

D.

Chronic Viral Hepatitis B

E.

Chronic Viral Hepatitis C

59.

Chronic hepatitis is generally defined as disease that has lasted for:

A. *

6 months or longer

B.

1 months

C.

2 months

D.

2,5 months

E.

3 months

60.

What is true about Autoimmune Hepatitis

A. *

All of above

B.

It is four times more common in women than in men

C.

There is a rise in IgG, a positive anti-smooth-muscle antibody present in 60%.

D.

Antinuclear antibody and liver-kidney microsomal antibody (LKM-1) may be present.

E.

Response rate to corticosteroids therapy is 70-90%.

61.

Autoimmune Hepatitis is characterized by

A. *

There is a rise in IgG, a positive anti-smooth-muscle antibody present in 60%

B.

It is most aggressive when it presents in the firsr and second decades

C.

All of above

D.

It is more common in men than in women

E.

None of above

62.

What is not true about Autoimmune Hepatitis

A. *


B.

It can be associated with other autoimmune diseases

C.


D.


E.


63.

DRUG-INDUCED CHRONIC HEPATITIS may be caused by

A. *

All of above

B.

Paracetamol

C.

Isoniazid

D.

Oestrogens

E.

Antibiotics

64.

What is true about CRYPTOGENIC HEPATITIS

A. *

Unknown cause

B.


C.


D.


E.


65.

Chronic hepatitis is characterized by next clinical syndromes

A. *

All of above

B.

Cholestatic

C.

Hepatomegaly

D.

Dispeptic

E.

None of above

66.

Chronic hepatitis is not characterized by next clinical syndrome

A. *

Portal hypertension

B.

Cholestatic

C.

Hepatomegaly

D.

Dispeptic

E.

Pain

67.

Liver cirrhosis is characterized by next clinical syndromes

A. *

All of above

B.

Cholestatic

C.

Hepatomegaly

D.

Dispeptic

E.

Miocardial infarction

68.

What is true regarding congenital hypertrophic pyloric stenosis :

A. *

Hypochloremic alkalosis

B.

More common in girls

C.

Hellers myotomy is the procedure of choice.

D.

Most often manifests at birth

E.

None of above

69.

A child presents with massive hemetemesis and systemic hypotension. He has no fever or other significant history. Examination reveal massive splenomegaly but no hepatomegaly. Likely diagnosis is

A. *

Non-cirrhotic portal fibrosis

B.

Bleeding duodenal ulcer

C.

Oesophageal varices

D.

Hepatocellular carcinoma

E.

None of the above

70.

A 19 year old male has presented with repeated episodes of hematemesis. There is no history of jaundice or liver decompensation. On examination the significant findings include splenomegaly (8 cms below costal margin), and presence of esophageal varices. There is no ascites or peptic ulceration. The liver function tests are normal. The most likely diagnosis is-

A. *

Non cirotic portal fibrosis

B.

Extahepatic portal venous obstruction

C.

Cirrhosis

D.

Hepatic venous outflow tract obstruction

E.

None of the above

71.

Ingestion of arsenic causes

A. *

Non cirrhotic portal fibrosis

B.

Hepatic adenoma

C.

Hepatic carcinoma

D.

Hepatic cirrhosis

E.

None of the above

72.

Commonest cause of Budd Chiary syndrome is:

A. *

Paroxysmal nocturnal hemoglobinuria

B.


C.

Right ventricular failure

D.

Renal cell carcinoma

E.

None of above

73.

Hepatic-encephalopathy may be precipitated by all of the following except:

A. *

Hyperkalemia

B.

Barbiturates

C.

Anemia

D.

Hypothyroidism

E.

Hypokalemia

74.

In a case of hypertrophic pyloric stenosis, the metabolic disturbance is

A. *

Metabolic alkalosis with paradoxical aciduria

B.

Metabolic acidosis

C.

Respiratory alkalosis

D.

Metabolic alkalosis with alkaline urine

E.

None of above

75.

Skip granulomatous lesions are seen in

A. *

Crohn's disease

B.

Ulcerative colitis

C.

Whipple's disease

D.

Reiter's disease

E.

None of above

76.


A. *


B.

Hepatic adenoma

C.

Hepatic carcinoma

D.

Hepatic cirrhosis

E.

None of the above

77.


A. *

Hyperkalemia

B.

Barbiturates

C.

Anemia

D.

Hypothyroidism

E.

Hypokalemia

78.

In patients with acute liver failure, the best prognostic indicator is:

A. *

Factor V estimation

B.

Serum alpha feto protein

C.

Serum bilirubin

D.

Serum albumin

E.

None of above

79.

Which of the following statements is true regarding a-fetoprotein :

A. *

High levels are seen in hepatic carcinoma

B.

Pre-operative high level indicates worse prognosis

C.

High level are seen in stomach carcinoma

D.

Levels may be increased in hepatitis

E.

None of above

80.

Gall bladder stone formation in influenced by all except:

A. *

Leucocytosis

B.

Hyperalimentation

C.

Primary biliary cirrhosis

D.

Clofibrate therapy

E.

None of above

81.

Peptic ulcer should be differentiated with

A.

Cholecystitis

B.

Gastritis

C.

Myocardial infarction

D.

Pancreatitis

E. *

All of above

82.

Which is not a paraneoplastic syndrome for Hepatocellular Carcinoma

A. *

Hyperglycemia

B.

Hypoglycemia

C.

Erythrocytosis

D.

Hypercalcemia

E.

None of above

83.

Which of the following structures do not form the external part of anal canal mechanism?

A. *

Internal Sphincter

B.

Levator Ani

C.

Pubo rectalis

D.

External Sphincter

E.

None of above

84.

Most common site for cholangiocarcinoma is

A. *

Hepatic duct bifurcation

B.

Intrahepatic

C.

Lower End of CBD (Common Bile Duct)

D.

Lower 1/3rd of CBD (Common Bile Duct)

E.

None of above

85.

Which of the following is not a congenital abnormality associated with Juvenile polyps

A. *

Macrocephaly

B.

Meckel's diverticulum

C.

Malrotation

D.

Mesenteric lymphangioma

E.

None of above

86.

A 47-yr-old agricultural worker complains of a chronic cough, purulent sputum and abdominal distention. He has just arrived in England from Spain where he was picking grapes. Choose the single most likely diagnosis from the list of options above.

A. *

Tuberculosis

B.

Cirrhosis

C.

Malabsorption

D.

Pancreatitis

E.

Peptic ulcer

87.

A 32-year-old mn has bloody diarrhea of 1 days duration associated with abdominal pain, fever, and small, frequent stools. He was previously well.Which of the following pathogens is most likely causing this patients acute illness?

A. *

Campylobacter jejuni

B.

Cryptosporidium

C.

Giardia lambli

88.

Which of the following statements regarding eosinophilic enteritis is correct?

A. *

It may be difficult to distinguish from regional enteritis.

B.

It affects only the small intestine.

C.

The majority of patients have a history of food allergies or asthma.

D.

Treatment with glucocorticoids is not indicated.

89.

There are following diagnostic tests for chronic hepatitis B except:

A. *

HDV RNA

B.

IgG anti-HBc

C.

HBeAg

D.

HBV DNA

E.

HBsAg

90.

There are following diagnostic tests for chronic cryptogenic hepatitis except:

A. *

all negative

B.

HBsAg

C.

IgG anti-HBc,

D.

HBeAg

E.

all positive,

91.

For Primary biliary cirrhosis select the circulating antibodies with which it is most closely associated:

A. *

antibodies to mitochondria

B.

antibodies to native DNA;

C.

antibodies to smooth muscle cells;

D.

antibodies to acetylcholine receptors;

E.

antibodies to parietal cells.

92.

Liver involvement in systemic diseases is the following except:

A. *

Ischemic hepatitis

B.

Sarcoidosis

C.

Amyloidosis

D.

Celiac disease

E.

Tuberculosis

93.

The stage of chronic hepatitis is based on the all of following except:

A. *

no fibrosis

B.

mild fibrosis

C.

necrosis.

D.

moderate fibrosis

E.

severe fibrosis, including bridging fibrosis,

94.

Morphologic characteristics of chronic active hepatitis mainly include all of the following except:

A. *

severe fibrosis, including bridging fibrosis.

B.

a dense mononuclear infiltrate of the portal tracts,;

C.

destruction of the hepatocytes at the periphery of the lobule,;

D.

connective tissue septa surrounding portal tracts and extending from the portal zones into the lobule,isolating parenchymal cells into clusters and enveloping bile ducts;

E.

evidence of hepatocellular regeneration"rosette" formation, thickened liver cell plates, and regenerative "pseudolobules";

95.

Causes of Cirrhosis and/or Chronic Liver Disease are all of the following except:

A. *

Herpes virus.

B.

Brucellosis,

C.

Capillariasis,

D.

Toxoplasmosis,

E.

Viral hepatitis C,

96.

Hemochromatosis is associated with all of the following clinical manifestations EXCEPT:

A. *

gout

B.

cirrhosis

C.

diabetes mellitus

D.

gonadotropin deficiency

E.

cardiomyopathy

97.


A. *

antibodies to mitochondria;

B.


C.


D.


E.


98.

There are all of the following causes of noncirrhotic hepatic fibrosis except:

A. *

All of them.

B.

Intrahepatic phlebosclerosis and fibrosis;

C.

Portal and splenic vein sclerosis;

D.

Portal and splenic vein thrombosis;

E.

Schistosomiasis;

99.

A typical battery of blood tests used for initial assessment of liver disease includes measuring all of the following except:

A. *

urea

B.

levels of serum alanine and aspartate aminotransferases

C.

alkaline phosphatase

D.

direct and total serum bilirubin

E.

albumin.

100.

In which of the following causes of fatty liver is microvesicular fat seen in biopsy specimens of liver?

A. *

Acute fatty liver of pregnancy

B.

None of above

C.

Total parenteral nutrition

D.

Prolonged intravenous hyperalimentation

E.

Carbon tetrachloride poisoning

101.

Chronic active hepatitis is most reliably distinguished from chronic persistent atitis by the presence of:

A. *

characteristic liver histology

B.

hepatitis B surface antigen in the serum

C.

antibody to hepatitis B core antigen in the serum

D.

a significant titer of anti-smooth-muscle antibody

E.

extrahepatic manifestations

102.

Which one of the following statements about hepatitis B e antigen (HBeAg) is LEAST accurate?

A. *

The absence of HBeAg in the serum rules out chronic infection caused by the hepatitis B virus.

B.

The presence of HBeAg in the serum is correlated with infectiousness.

C.

HBeAg can be detected transiently in the sera of patients ill with acute hepatitis B infection.

D.

HBeAg is immunologically distinct from HBsAg but is genetically related to HBcAg.

E.

The disappearance of HBeAg from the serum may be a harbinger of resolution of acute hepatitis B infection.

103.

Which of the following statements regarding delta hepatitis virus (HDV) is correct?

A. *

HDV can infect only persons infected with hepatitis B virus (HBV).

B.

HDV is a defective DNA virus.

C.

The HDV genome is partially homologous with HBV DNA.

D.

HDV infection has been found only in limited areas of the world.

E.

Simultaneous infection with HDV and HBV results in an increased risk of the development of chronic hepatitis.

104.

A 56-year-old man presents with fatigue and teacolored urine. Physical examination reveals icteric sclerae but is otherwise unremarkable. Which of the following conditions is LEAST likely to account for these findings?

A. *

Autoimmune hemolytic anemia

B.

Gallbladder cancer

C.


D.

Pancreatic cancer

E.

Viral hepatitis

105.

Which of the following cell types is most directly responsible for the excess deposition of collagen in the liver typically seen in alcoholic cirrhosis?

A. *

Stellate cell

B.

Hepatocyte

C.

Kupffer cell

D.

Cannilicular cell

E.

None of above

106.

Which of the following conditions are known to predispose to the formation of cholesterol gallstones?

A. *

Surgical resection of the ileum

B.

Hypercholesterolemia

C.

Autoimmune hemolytic anemia

D.

Sickle cell anemia

E.

None of above

107.

The Marseiles-Rome classification of 1988 includes all of the following except:

A. *

Chronic autoimmune pancreatitis

B.

Chronic calcifying pancreatitis

C.

Chronic obstructive pancreatitis

D.

Chronic inflammatory pancreatitis

E.

None of above

108.

Which of the following could falsely depress the serum amylase level in a patient suspected of having acute pancreatitis?

A. *

Hypertriglyceridemia

B.

Hypercholesterolemia

C.

Hypocalcemia

D.

Associated pleural effusion

E.

None of above

109.

A 61-yr-old man presents with a 2-yr history of pain in the right upper quadrant exacerbated by eating rich foods. Choose the single most likely investigation from the list of options above.

A. *

Upper GI endoscopy

B.

Oesophageal manometry

C.

Motility studies

D.

Mesenteric angiography

E.

Barium enema

110.

A 49-year-old white man is evaluated because of a 2-month history of dysphagia for solid foods and a 7-kg (15-Ib) weight loss. He has had heartburn for many years that is relieved by antacids. Which of the following should be done next?

A. *

Upper endoscopy

B.

Esophageal manometry

C.

Ambulatory 24-hour esophageal pH monitoring

D.

Abdominal USG

E.

Upright Chest X-ray

111.

A 24-yr-old female presents with fever and right upper quadrant pain. On examination she has adnexal tenderness and purulent cervical discharge. Choose the single most likely investigation from the list of options below.

A. *

Endocervical smear and culture

B.

Barium enema

C.

Abdominal X-ray

D.

Upright Chest X-ray

E.

Abdominal USG

112.

A 41-yr-old man says he cannot finish his stool and that what he does pass is streaked with blood. He says he has always been regular. He wants to know if a laxative will help. Choose the single most likely diagnosis

A. *

Adhesions

B.

Food poisoning

C.

Rectal carcinoma

D.

Irritable bowel syndrome

E.

None of above

113.

A healthy young woman presents with ulcer near her anus. It is painless, macular and hard. Choose the single most likely diagnosis from the list of options above.

A. *

Syphilis

B.

Ulcerative colitis

C.

Crohn's disease

D.

Anaemia

E.

Haemorrhoids

114.

A 21-yr-old woman with a history of grumbling appendix presents with persisting diarrhoea. On physical examination you find the liver to be slightly enlarged. She also complains of flushing and difficulty in breathing. Choose the single most likely diagnosis from the list of options above.

A. *

Carcinoid syndrome

B.

Pancreatic adenoma

C.

Peptic ulcer

D.

Bowel cancer

E.

Crohn's disease

115.

A 45-yr-old woman has melanotic skin pigmentation, pruritus, hepatospleno-megaly and dark urine. She develops jaundice 5 yrs after onset. Choose the single most likely diagnosis from the list of options above.

A. *


B.

Leptospirosis

C.

Haemolytic anaemia

D.

Gallstones

E.

Hepatitis B associated with primary hepatocellular carcinoma

116.

A 60-yr-old man presents with jaundice, hepatomegaly, nocturnal abdominal pain radiating through to the back and weight loss. Choose the single most likely diagnosis from the list of options above.

A. *

Pancreatic carcinoma

B.

Leptospirosis

C.

Haemolytic anaemia

D.

Gallstones

E.


117.

A 45-yr-old man develops deep jaundice, abdominal pain, hypoglycaemia, fever. Liver biopsy shows Mallory's hyaline and collagen deposition. Choose the single most likely diagnosis from the list of options above.

A. *

Alcoholic hepatitis

B.

Leptospirosis

C.


D.

Gallstones

E.


118.

A 39 -year-old woman for 1 year complained of attacks of right subcostal pain after fatty meal. Last week the attacks have repeated every day and become more painful. What diagnostic study would you recommend?

A. *

Ultrasound examination of the gallbladder

B.

Blood cell count

C.

Ultrasound study of the pancreas

D.

X-ray examination of the gastrointestinal tract

E.

Liver function tests

119.

A 49-year-old white man is evaluated because of a 2-month history of dysphagia for solid foods and a 7-kg (15-Ib) weight loss. He has had heartburn for many years that is relieved by antacids. Which of the following should be done next?

A. *

Upper endoscopy

B.

Esophageal manometry

C.

Ambulatory 24-hour esophageal pH monitoring

D.

Barium swallow

E.

USD

120.

A 50 -year-old woman for 1 year complained of attacks of right subcostal pain after fatty meal. Last week the attacks have repeated every day and become more painful. What diagnostic study would you recommend?

A. *


B.


C.


D.


E.

Blood cell count

121.

A 39-year-old man with chronic alcoholism is admitted to the hospital with acute pancreatitis. On the third hospital day sudden, complete blindness develops in the left eye. The most likely explanation is

A. *

Purtschers retinopathy

B.

transient ischemic attack (transient monocular blindness)

C.

occlusion of the retinal vein

D.

acute glaucoma

E.

None of above

122.

A 39-year-old man with chronic alcoholism is admitted to the hospital with acute pancreatitis. On the third hospital day sudden, complete blindness develops in the left eye. The most likely explanation is

A. *

Purtschers retinopathy

B.

transient ischemic attack (transient monocular blindness)

C.

occlusion of the retinal vein

D.

acute glaucoma

E.

None of above

123.

A 51-year-old woman with long-standing reflux esophagitis has developed improvement in his heartburn. However, he also complains of progressive dysphagia after swallowing both liquids and solids, a chest x-ray shows absence of the gastric air bubble and an air-fluid level in the mediastinum. An infusion of cholecystokinin during esophageal manometry would show

A. *

increase in lower esophageal sphincter pressure

B.

no change in lower esophageal sphincter pressure

C.

fall in lower esophageal sphincter pressure

D.

rise in upper esophageal sphincter pressure

E.

fall in upper esophageal sphincter pressure

124.


A. *

all negative

B.

HBsAg,

C.

IgG anti-HBc,

D.

HBeAg

E.

all of them,

125.


A. *

antibodies to mitochondria

B.


C.


D.


E.


126.

40-year-old woman for 1 year complained of attacks of right subcostal pain after fatty meal. Last week the attacks have repeated every day and become more painful. What diagnostic study would you recommend?

A. *


B.

Blood cell count

C.


D.


E.


127.

Causes chronic hepatitis are all of the following except:

A. *

Budd-Chiari syndrome

B.

viral hepatitis A

C.

viral hepatitis B

D.

viral hepatitis C

E.

cryptogenic hepatitis

128.

Liver involvement in systemic diseases is the following except:

A. *

Ischemic hepatitis

B.

Sarcoidosis

C.

Amyloidosis

D.

Celiac disease

E.

Tuberculosis

129.


A. *

HDV RNA

B.

HBsAg,

C.

IgG anti-HBc,

D.

HBeAg,

E.

HBV DNA

130.


A. *

all negative

B.

HBsAg,

C.

IgG anti-HBc,

D.

HBeAg

E.

anti-HBc,

131.

All of the following statements concerning transmission of viral hepatitis are true EXCEPT

A. *

Hepatitis A causes chronic infection

B.

children are at considerably less risk for hepatitis B infection than spouses of an infected individual

C.

in developing countries, vertical transmission (mother to child) is the major route of transmission vertical transmission results most often from transplacental infection

D.

in developing countries, vertical transmission (mother to child) is the major route of transmission vertical transmission results most often from transplacental infection

E.

Maternal-infant transmission occurs with both hepatitis B

132.


A. *

gout

B.

cirrhosis

C.

diabetes mellitus

D.


E.

cardiomyopathy

133.

Typical physical findings in liver disease are all of the following except:

A. *

heart failure

B.

palmar erythema,

C.

excoriations

D.

ascites

E.

edema

134.

A child presents with massive hemetemesis and systemic hypotension. He has no fever or other significant history. Examination reveals massive splenomegaly but no hepatomegaly. Likely diagnosis is

A. *

Non-cirrhotic portal fibrosis

B.

Bleeding duodenal ulcer

C.

Oesophageal varices

D.


E.

No one mentioned

135.

A nursing student has just completed her hepatitis B vaccine series. On reviewing her laboratory studies (assuming she has no prior exposure to hepatitis B), you expect

A.

Positive test for hepatitis B surface antigen

B. *

Antibody against hepatitis B surface antigen (anti-HBS) alone

C.

Antibody against hepatitis core antigen (anti-HBC)

D.

Antibody against both surface and core antigen

E.

Antibody against hepatitis E antigen

136.


A. *

urea

B.


C.


D.


E.

albumin.

137.


A. *

urea

B.

Aminotransferases

C.


D.


E.

albumin.

138.


A. *

urea

B.

Aminotransferases

C.

Gamma-glutamyl transferase

D.


E.

Prothrombin time.

139.


A. *

urea

B.

Aminotransferases

C.


D.


E.

Serum sodium.

140.


A. *

urea

B.

Aminotransferases

C.


D.


E.

Coagulation test.

141.


A. *

urea

B.

Aminotransferases

C.


D.

General blood analysis

E.

Coagulation test.

142.


A. *

urea

B.

Aminotransferases

C.


D.


E.

Coagulation test.

143.

A typical battery of blood tests used for initial assessment of liver cirrhosis includes measuring all of the following except:

A. *

urea

B.

Aminotransferases

C.


D.


E.

albumin.

144.


A. *

urea

B.

Aminotransferases

C.


D.


E.

albumin.

145.


A. *

urea

B.

Aminotransferases

C.


D.


E.

Prothrombin time.

146.


A. *

urea

B.

Aminotransferases

C.


D.


E.

Serum sodium.

147.


A. *

urea

B.

Aminotransferases

C.


D.


E.

Coagulation test.

148.


A. *

urea

B.

Aminotransferases

C.


D.


E.

Coagulation test.

149.


A. *

urea

B.

Aminotransferases

C.


D.


E.

Coagulation test.

150.


A. *

urea

B.

Aminotransferases

C.


D.

autoantibodies

E.

Coagulation test.

151.


A. *

urea

B.

Aminotransferases

C.


D.

autoantibodies

E.

Ferritin and transferrin saturation.

152.


A. *

urea

B.

Aminotransferases

C.


D.

autoantibodies

E.

copper and ceruloplasmin.

153.


A. *

urea

B.

Aminotransferases

C.


D.

autoantibodies

E.

Immunoglobulin levels.

154.


A. *

urea

B.

Aminotransferases

C.


D.

autoantibodies

E.

Cholesterol and glucose.

155.


A. *

urea

B.

Aminotransferases

C.


D.

autoantibodies

E.

Alpha 1-antitrypsin.

156.


A. *

urea

B.


C.


D.


E.

albumin.

157.

As a consequence of severe liver damage, hepatic amino acid handling is deranged. In this situation, plasma levels of which of the following are likely to be lower than normal?

A. *

Urea

B.

Ammonia (NH ) 3

C.

Ammonium (NH ) _

D.

Alanine

E.

Glycine

158.

Autoimmune Hepatitis is characterized by

A. *

There is a rise in IgG, a positive anti-smooth-muscle antibody present in 60%

B.

It is most aggressive when it presents in the firsr and second decades

C.

All mentioned

D.


E.

No one mentioned

159.


A. *

Viral hepatitis A.

B.

Autoimmune,

C.

Viral hepatitis C,

D.

Viral Hepatitis B

E.

Viral Hepatitis B with hepatitis D

160.


A. *

Viral hepatitis E.

B.

Autoimmune,

C.

Viral hepatitis C,

D.

Viral Hepatitis B

E.

Viral Hepatitis B with hepatitis D

161.

Causes of Cirrhosis and/or Chronic Liver Disease are all of the following except

A. *

Herpes virus

B.

Brucellosis,

C.

Capillariasis,

D.

Toxoplasmosis,

E.

Viral hepatitis C,

162.

Causes of Liver Cirrhosis are all of the following except:

A. *

Viral hepatitis A.

B.

Autoimmune,

C.

Viral hepatitis C,

D.

Viral Hepatitis B

E.

Alcoholic liver disease

163.


A. *

Viral hepatitis A.

B.

Autoimmune,

C.

Viral hepatitis C,

D.

Non-alcoholic steatohepatitis

E.


164.


A. *

Viral hepatitis A.

B.

Primary biliary cirrhosis,

C.

Viral hepatitis C,

D.


E.


165.


A. *

Viral hepatitis A.

B.

Primary biliary cirrhosis,

C.

Viral hepatitis C,

D.


E.

Primary sclerosing cholangitis

166.


A. *

Viral hepatitis A.

B.

Hereditary hemochromatosis,

C.

Viral hepatitis C,

D.


E.


167.


A. *

Viral hepatitis A.

B.


C.

Wilson's disease,

D.


E.


168.


A. *

Viral hepatitis A.

B.


C.

Wilson's disease,

D.

Alpha 1-antitrypsin deficiency

E.


169.


A. *

Viral hepatitis A.

B.


C.

Cardiac cirrhosis,

D.


E.


170.


A. *

Viral hepatitis A.

B.

Hepatotoxic drugs or toxins,

C.

Cardiac cirrhosis,

D.


E.


171.

Chronic active hepatitis is most reliably distinguished from chronic persistent hepatitis by the presence of

A. *


B.


C.


D.


E.


172.

Chronic active hepatitis is most reliably distinguished from chronic persistent hepatitis by the presence of

A. *


B.


C.


D.


E.


173.

Chronic hepatitis is characterized by following clinical syndromes

A. *

All mentioned

B.

Cholestatic

C.

Hepatomegaly

D.

Dyspeptic

E.

No one mentioned

174.

Chronic hepatitis is generally defined as disease that has lasted for:

A. *

6 months or longer

B.

1 months

C.

2 months

D.

2,5 months

E.

3 months

175.

Chronic hepatitis is not characterized by following clinical syndrome

A. *

Portal hypertension

B.

Cholestatic

C.

Hepatomegaly

D.

Dyspeptic

E.

Hypochondriac pain

176.

Complications of liver cirrhosis are all of the following except

A. *

Hyperuricemia

B.

Bruising and bleeding

C.

Jaundice due to decreased processing of bilirubin

D.

Itching (pruritus)

E.

Hepatic encephalopathy

177.


A. *

Hyperuricemia

B.


C.


D.

Itching (pruritus)

E.

Sensitivity to medication

178.


A. *

Hyperuricemia

B.


C.


D.

Itching (pruritus)

E.


179.


A. *

Hyperuricemia

B.


C.


D.

Itching (pruritus)

E.

Esophageal varices

180.


A. *

Hyperuricemia

B.


C.


D.

Itching (pruritus)

E.

Portal hypertension

181.


A. *

Hyperuricemia

B.


C.


D.

Itching (pruritus)

E.

Ascites

182.


A. *

Hyperuricemia

B.


C.


D.

leading to infection

E.

Ascites

183.

DRUG-INDUCED CHRONIC HEPATITIS is not be caused by

A. *

silymarin

B.

Paracetamol

C.

Isoniazid

D.

Oestrogens

E.

Antibiotics

184.


A. *

antibodies to mitochondria;

B.

anantibodies to Phospholipid;

C.


D.


E.


185.

Gall bladder stone formation in caused by all except:

A. *

Leucocytosis

B.

Hyperalimentation

C.


D.

Clofibrate therapy

E.

None of mentioned

186.


A. *

gout

B.

liver cirrhosis

C.

diabetes mellitus

D.


E.

cardiomyopathy

187.

Hemochromatosis is characterized by:

A. *


B.


C.

Results in cirrhosis and emphysema

D.

No one mentioned

E.

All mentioned

188.

Hepatic-encephalopathy may be aggravated by all of the following except:

A. *

Hyperkalemia

B.

Barbiturates

C.

Alkalosis

D.

Hypothyroidism

E.

Hyponatraemia

189.


A. *

Hyperkalemia

B.

Renal failure

C.

Alkalosis

D.

Hypoxia

E.

Dehydration

190.


A. *

Hyperkalemia

B.

Renal failure

C.

Alkalosis

D.

Constipation

E.

Dehydration

191.


A.

Hypokalemia

B. *

Ascites

C.

Alkalosis

D.

Alcohol intoxication

E.

Dehydration

192.


A. *

Hyperkalemia

B.

Barbiturates

C.

Anemia

D.

Hypothyroidism

E.

Hyponatraemia

193.

In patients with acute liver failure, the best prognostic indicator is:

A. *

Factor V estimation

B.

Serum alpha feto protein

C.

Serum bilirubin

D.

Serum albumin

E.

Level of GGT

194.

In which of the following causes of fatty liver is microvesicular fat seen in biopsy specimens of liver?

A. *

Acute fatty liver of pregnancy

B.

Jejunoileal bypass for morbid obesity

C.

Total parenteral nutrition

D.

Prolonged intravenous hyperalimentation

E.

Carbon tetrachloride poisoning

195.


A. *


B.

Hepatic adenoma

C.

Hepatic carcinoma

D.

Hepatic cirrhosis

E.

No one mentioned

196.

Liver cirrhosis is characterized by following clinical syndromes

A. *

All mentioned

B.

Cholestatic

C.

Hepatomegaly

D.

Dyspeptic

E.

Hemorrhagic syndrome

197.

Many patients have Budd-Chiari syndrome as a complication of:

A. *

Paroxysmal nocturnal hemoglobinuria

B.


C.


D.


E.

Pneumonia

198.

Marker of Cholestatic syndrome in hepatitis is

A. *

Alkaline phosphatase

B.

All of above

C.

vfibrinogen

D.

ÂST

E.

ÂLT

199.

Marker of Cytolitic syndrome in hepatitis is

A. *

ÂLT

B.

All of mentioned

C.


D.

^cholesterol

E.

vfibrinogen

200.

Marker of Liver cellular insufficiency syndrome in hepatitis is

A. *

vAlbumine

B.

ÂLT

C.

^GGT

D.

^Bilirubin

E.

ÂST

201.

Markers of Hypersplenism syndrome in liver cirrhosis are all of the following except

A. *

leukocytosis, ÊSR

B.

thrombocytopenia

C.

anemia+ thrombocytopenia

D.

anemia+ thrombocytopenia +leukocytopenia

E.

anemia+ ÊSR

202.

Markers of Hypersplenism syndrome in liver cirrhosis are

A. *


B.


C.


D.


E.

No one mentioned

203.


A. *

All mentioned

B.

anemia

C.

thrombocytopenia

D.

leukocytopenia

E.

No one mentioned

204.


A. *


B.

ÂLT, ^GGT

C.

^GGT, ^Bilirubin

D.

^Bilirubin, ÂLT, ^GGT

E.

ÂST, ÂLT, ^GGT

205.

Markers of Mesenchyme-inflammatory syndrome in liver cirrhosis are

A. *

ÊSR,

B.

G-globulins, ^timol test ^Le, ^C-react. protein

C.


D.


E.


F.

No one mentioned

206.

Morphologic characteristics of chronic active hepatitis mainly include all of the following except:

A. *

severe fibrosis, including bridging fibrosis

B.

a dense mononuclear infiltrate of the portal tracts;

C.

destruction of the hepatocytes at the periphery of the lobule;

D.

connective tissue septa surrounding portal tracts and extending from the portal zones into the lobule,isolating parenchymal cells into clusters and enveloping bile ducts;

E.

evidence of hepatocellular regeneration"rosette" formation, thickened liver cell plates, and regenerative "pseudolobules";

207.

Pathologic Mallory stain findings characterizes

A. *

Alcoholic hepatitis

B.

Autoimmune Hepatitis

C.

Cryptogenic Hepatitis

D.

Chronic Viral Hepatitis B

E.

Chronic Viral Hepatitis C

208.

Peptic ulcer should be differentiated with

A. *

All mentioned

B.

Cholecystitis

C.

Gastritis

D.

Miocardial infarction

E.

Pancreatitis

209.

Pruritus, elevation of alkaline phosphatase and positive antimitochondrial antibody test are characteristic signs of

A. *


B.

Sclerosing cholangitis

C.

Anaerobic liver abscess

D.

Hepatoma

E.

Hepatitis C

210.

Risk factor of Budd-Chiari syndrome is:

A. *

Hormonal contraception

B.


C.


D.


E.

Pneumonia

211.

Signs of liver cirrhosis are all of the following except

A. *

Erythema nodosum

B.

Spider angiomata

C.

Palmar erythema

D.

Nail changes

E.

Hypertrophic osteoarthropathy

212.

The stage of chronic hepatitis is based on the all of following except:

A. *

no fibrosis,

B.

mild fibrosis,

C.

necrosis

D.

moderate fibrosis,

E.

severe fibrosis, including bridging fibrosis,

213.

There are all of the following causes of noncirrhotic hepatic fibrosis except:

A. *

All of them

B.


C.


D.


E.

Schistosomiasis;

214.

There are cholestatic diseases all of the following except:

A. *

gall stone,

B.

malignant obstruction

C.

primary biliary cirrhosis,

D.

drug-induced liver diseases,

E.

passive congestion

215.


A. *

HDV RNA

B.

IgG anti-HBc,

C.

HBeAg,

D.

HBV DNA

E.

HBsAg,

216.

Typical physical findings in liver disease are all of the following except:

A. *

hypertension

B.

icterus,

C.

hepatomegaly,

D.

hepatic tenderness,

E.

splenomegaly

217.

What is not true about Autoimmune Hepatitis

A. *


B.

It can be associated with other autoimmune diseases

C.


D.


E.


218.

What is not true about CRYPTOGENIC HEPATITIS

A. *

All mentioned

B.


C.


D.


E.


219.

What is true about L1-ANTITRYPSIN DEFICIENCY:

A. *

It results in cirrhosis and emphysema

B.


C.


D.

No one mentioned

E.

All mentioned

220.

Which answer below represents an osmotic laxative?

A. *

Lactulose.

B.

Psyllium.

C.

Magnesium citrate.

D.

Castor oil.

E.

Lubiprostrone.

221.

Which is not a paraneoplastic syndrome for Hepatocellular Carcinoma

A. *

Hyperglycemia

B.

Hypoglycemia

C.

Erythrocytosis

D.

Hypercalcemia

E.

None of mentioned

222.

Which of the following is an important physiologic function of bile acids?

A. *

Facilitating absorption of dietary fats

B.

Conjugation with toxic substances, thus allowing

C.

Allowing the excretion of hemoglobin breakdown

D.

Aiding the absorption of vitamin B12

E.

Maintaining appropriate intestinal pH

223.

Which of the following statements is true regarding alpha-fetoprotein- L3?

A. *

High levels are seen in hepatic carcinoma

B.

Pre-operative high level indicates worse prognosis

C.

High level are seen in stomach carcinoma

D.

Levels may be increased in hepatitis

E.

No one mentioned

224.

Which of the following statements regarding cryptogenic hepatitis is true?

A. *

No specific test,

B.

HBsAg

C.

IgG anti-HBc,

D.

HBeAg

E.

anti-HBs,

225.

Which of the following statements regarding delta hepatitis virus (HDV) is correct?

A. *

HDV can infect only persons infected with hepatitis

B.

HDV is a defective DNA virus.

C.

The HDV genome is partially homologous with

D.

HDV infection has been found only in limited areas

E.

Simultaneous infection with HDV and HBV results

226.

Which of the following statements regarding liver cirrhosis isnt true?

A. *

caused by viral hepatitis A

B.

is generally irreversible condition

C.

treatment focuses on preventing progression and complications

D.

caused by alcoholism

E.

caused by hepatitis B and C

227.

Which of the following statements regarding liver cirrhosis isnt true?

A. *

caused by viral hepatitis A

B.

is generally irreversible condition

C.

treatment focuses on preventing progression and complications

D.

caused by fatty liver disease

E.

ascites is the most common complication

228.

Which of the following statements regarding primary biliary cirrhosis (PBC) is correct?

A. *

Rheumatoid arthritis, CREST syndrome, and scleroderma

B.

A positive anti-pus antibody test is present in more

C.

Glucocorticoid treatment is helpful.

D.

The majority of these patients are men.

E.

Administration of D-penicillamine appears to be an

229.

Which of the following statements regarding the prophylaxis of viral hepatitis is true?

A. *

HBIg and hepatitis B vaccine can be effectivelyadministered simultaneously.

B.

Although immune globulin (Ig) is effective in preventingclinically apparent type A hepatitis, not allIg preparations have adequate anti-HAV titers tobe protective.

C.

If given soon enough after exposure to hepatitis B,hepatitis immune globulin (HBIg) is effective inpreventing infection.

D.

Hepatitis B vaccine is ineffective in preventingdelta hepatitis infection in persons who are notHBsAg carriers.

E.

Ig prophylaxis after needle-stick, sexual, or perinatalexposure to hepatitis C is effective in preventinginfection

230.

Which one of the following is the cause of Non Cirrhotic portal fibrosis?

A. *

All of mentioned.

B.


C.


D.


E.

Schistosomiasis;

231.

Which one of the following statements about hepatitis B e antigen (HBeAg) is LEAST accurate?

A. *

The absence of HBeAg in the serum rules out chronic infection caused by the hepatitis B virus.

B.

The presence of HBeAg in the serum is correlated with infectiousness.

C.

HBeAg can be detected transiently in the sera of patients ill with acute hepatitis B infection.

D.

HBeAg is immunologically distinct from HBsAg but is genetically related to HBcAg.

E.

The disappearance of HBeAg from the serum may be a harbinger of resolution of acute hepatitis B infection.

232.

Wilsons disease is characterized by:

A. *


B.


C.


D.

No one mentioned

E.

All mentioned

233.

All of the following statements stand true for telengiectasia of colon except:

A.

May be seen in person with systemic scleroderma

B.

May be seen in person more than 60 years of age

C.

Common site is caecum

D.

May be seen in person less than 40 years of age

E. *

50% involve rectum

234.

As more severe Crohn's disease develops, aphthous ulcers dont become

A. *

"collar-button" ulcers

B.

enlarged

C.

deeper

D.

occasionally connected to one another

E.

forming linear ulcers

235.

Best test for Small intestine malabsorption of carbohydrates is :

A.

Shilling test

B.

Lund meal test

C.

Follacin test

D.

None of above

E. *

D-Xylose test

236.

Colonoscopy shows segmental areas of inflammation. SBFT shows nodular thickening of the terminal ileum. What is the most likely diagnosis?

A.

Ulcerative colitis

B. *

Crohns disease

C.

Ischemic colitis

D.

Diverticulitis

E.

Amebic colitis

237.

Complications of Crohns disease include all of the following except

A. *

strictures occurring in the rectum

B.

intestinal obstruction

C.

massive hemorrhage

D.

malabsorption

E.

severe perianal disease

238.

Complications of Crohns disease include all of the following except

A. *


B.

fistula formation

C.

free perforation

D.

generalized peritonitis

E.

intraabdominal abscess

239.

Complications of ulcerative colitis include

A. *


B.

intestinal obstruction

C.

toxic megacolon

D.

generalized peritonitis

E.

intraabdominal abscess

240.

Crohns disease affects the lips:

A. *

Rarely

B.

Sometimes

C.

Frequently

D.

Never

E.

Invariably

241.

Crohns disease is a disease that usually involves

A.

the rectum

B.

the mouth

C.

the anus

D.

small bowel disease alone

E. *

the terminal ileum

242.

CT findings in Crohns disease include all of the following except

A. *

absence of small bowel thickening

B.

mural thickening >2 cm

C.

homogeneous wall density

D.

mural thickening of small bowe

E.

adenopathy

243.

CT findings in ulcerative colitis include

A. *

absence of small bowel thickening

B.

mural thickening >2 cm

C.

homogeneous wall density

D.

mural thickening of small bowe

E.

mesenteric fat stranding

244.

Deep ulcerations in ulcerative colitis can appear as

A. *

"collar-button" ulcers

B.

enlarged

C.

deeper

D.

occasionally connected to one another

E.

forming linear ulcers

245.

Hyperpigmentation, hepatomegaly, polyarthritis, hyperglycemia are the signs of

A.

Insulin-dependent diabetes mellitus

B.

Pancreatic carcinoma

C.

Addisons disease

D. *

Hemochromatosis

E.

Chronic Hepatitis C

246.

In more advanced Crohn's disease all of the following may be detected except

A.

Strictures

B.

Fistulas

C.

inflammatory masses

D.

abscesses

E. *

Signet ring cells on gastric biopsy

247.

Intestinal hypomotility is seen in all the following except:

A.

Parkinsonism

B.

Amyloidosis

C.

Diabetes

D.

Scleroderma

E. *

All of mentioned

248.

Macrophages containing large quantities of undigested and partial digested bacteria in intestine are seen in

A.

Amyloidosis

B.

Immunoapproliferative small instetinal disease

C.

Vibro cholerae infection

D.

Crohns disease

E. *

Whipple's disease

249.

Mechanical obstruction of the colon is most commonly caused by

A.

adhesions

B. *

carcinoma

C.

volvulus

D.

hernia

E.

sigmoid diverticulitis

250.

Metabolic changes associated with excessive vomitting includes the following:

A.

Metabolic acidosis

B.

Hyperchloremia

C.

Decreases bicarbonates

D.

Hypercalciemia

E. *

Hypokalemia

251.

Most common Central nervous system manifestation of Whipple's disease is:

A.

Seizure

B.

Supranuclear ophthalmoplegia

C.

Cerebellar ataxia

D.

Coma

E. *

Dementia

252.

Patient presents with diarrhea, weight loss, and RLQ pain, a tender mass is noted in the RLQ on exam; the stool is guaiac-positive. What is the most likely diagnosis?

A.

Ulcerative colitis

B. *

Crohns disease

C.

Ischemic colitis

D.

Diverticulitis

E.

Amebic colitis

253.

Pseudopolyps are features of

A.

Crohn's disease

B.

Celiac sprue

C.

Whipple's disease

D.

Reiter's disease

E. *

Ulcerative colitis

254.

Sigmoidoscopy shows inflamed, friable mucosa from rectum to midsigmoid. What is the most likely diagnosis?

A. *

Ulcerative colitis

B.

Crohns disease

C.

Ischemic colitis

D.

Diverticulitis

E.

Amebic colitis

255.

Skip granulomatous lesions are seen in

A.

Whipple's disease

B.

Ulcerative colitis

C.

Reiter's disease

D.

Coeliac disease

E. *

Crohn's disease

256.

Skip granulomatous lesions of bowel are seen in

A. *

Crohn's disease

B.

Ulcerative colitis

C.

Whipple's disease

D.

Reiter's disease

E.

Irritable bowel disease

257.

Skip granulomatous lesions of bowel are seen in

A. *

Crohn's disease

B.

Celiac disease

C.

Whipple's disease

D.

Reiter's disease

E.

Irritable bowel disease

258.

Subacute ischemic colitis can best be described by which of the following statements?

A. *

Cobblestoning is noted on contrast studies.

B.

Patients present with an acute abdomen.

C.

Involvement of the rectum is common.

D.

Symptoms and signs of nonocclusive ischemic colitis rarely resolve.

E.

Angiography is the definitive diagnostic procedure.

259.

The disease of gastrointestinal tract when aphthoid ulcerations are seen in ileal is

A. *

Crohn's disease

B.

Ulcerative colitis

C.

Whipple's disease

D.

Reiter's disease

E.

Celiac sprue

260.

The earliest macroscopic findings of colonic Crohn's disease are

A. *

aphthous ulcers.

B.

Strictures

C.

Fistulas

D.

inflammatory masses

E.

abscesses

261.

The early roentgenographic findings in the small bowel include thickened folds are typical in

A.

Gastro-oesophageal reflux disease

B. *

Crohn's disease

C.

Ulcerative colitis

D.


E.

Celiac sprue

F.


G.

Crohn's disease

H.

Ulcerative colitis

I.


J.

Celiac sprue

262.

The endoscopic changes - aphthoid ulcerations are typical for

A.


B. *

Crohn's disease

C.

Ulcerative colitis

D.


E.

Celiac sprue

263.

The histological features of coeliac disease include all of the following, except:

A.

Crypt hyperplasia

B.

Lymphocyte infiltration of crypts

C.

Increase in inflammatory cells in lamina propyria

D.

Blunting of villi

E. *

Increase in thickness of the mucosa

264.

The most likely histological abnormality associated with celiac sprue (gluten-sensitive enteropathy) is

A.

Signet ring cells on gastric biopsy

B.

Mucosal inflammation and crypt abscesses on sigmoidoscopy

C. *

Villous atrophy and increased lymphocytes in the lamina propria on small bowel biopsy

D.

Small, curved gram-negative bacteria in areas of intestinal metaplasia on gastric biopsy

E.

Edema and basal hyperplasia

265.

The roentgenographic changes - "string sign" are typical in

A.


B. *

Crohn's disease

C.

Ulcerative colitis

D.


E.

Celiac sprue

266.

Toxic megacolon is most commonly associated with

A.

Reiter's disease

B.

Crohn's disease

C.

Whipple's disease

D.

Coeliac disease

E. *

Ulcerative colitis

267.

Ulcerative colitis is a mucosal disease that usually involves

A. *

the rectum

B.

the mouth

C.

the anus

D.

small bowel disease alone

E.

the terminal ileum

268.

Ulcerative colitis:

A.

is more common in smokers than in non-smokers

B.

is treated first-line with infliximab

C.

commonly involves the jejunum

D.

is associated in most patients with psoriasis

E. *

is associated with HLA B27

269.

What extrabowel sing of ulcerative colitis may be in patient if insidious onset of progressive fatigue, pruritus, and jaundice have developed?

A.

Bile duct tumor

B.

Choledocholithiasis

C.

Congenital polycystic liver

D.


E. *


270.

What imaging modality is most appropriate for patient with diverticulitis?

A.

Ultrasound of the abdomen.

B. *

CT scan with and without contras

C.

Colonoscopy.

D.

Barium enema.

E.

Plain upright abdominal x-ray.

271.

What is drug of choice for mild activity of ulcerative colitis:

A.

Vitamin B

B.

Prednisolone

C.

Mercaptopurine

D.

Misoprostol

E. *

5-amino salicylic acid

272.

What is the most likely diagnosis in 72-year-old male with of severe abdominal pain after eating? His past medical history is positive for peripheral vascular disease and hypertension.

A.

Small bowel obstruction.

B.

Diverticulitis.

C. *

Mesenteric ischemia.

D.

Viral gastroenteritis.

E.

Ulcerative colitis.

273.

What is the next step in management of patient with peritonitis after obtaining a sample of the peritoneal fluid and send it for culture and analysis?

A.

Obtain CT scan of the abdomen.

B.

Perform a complete therapeutic pericentesis.

C.

Start IV dexamethasone.

D. *

Start empiric antibiotics.

E.

Barium radiology

274.

What street drug has the side effect of constipation, which may border on obstipation in severe cases?

A. *

Methamphetamines.

B.

Heroin.

C.

Smokable cocaine (Crack).

D.

Phencylidine.

E.

Inhalents.

275.

Which ANSWER below represents an osmotic laxative?

A.

Euphyllin.

B.

Magnesium sulfat.

C.

Castor oil.

D.

Lubiprostrone.

E. *

Lactulose.

276.

Which modality below comprises an acceptable colon cancer screening strategy for average-risk patients?

A.

Fecal occult blood testing (FOBT) on three consecutive stools semi-annually.

B.

FOBT on at least five stools over 2 years.

C.

Single-contrast barium enema every 5 years.

D. *

Double-contrast barium enema every 5 years.

E.

Flexible sigmoidoscopy every 7 years.

277.

Which of the following conditions does not cause secretory diarrhea?

A.

Medullary carcinoma of the thyroid

B.

Resection of the distal ileum

C.

Zollinger-Ellison syndrome

D. *

Somatostatinoma

E.

Carcinoid tumor

278.

Which of the following represents an incorrect mechanism of action for the laxative noted?

A.

Psyllium increases stool bulk.

B.

Docusate salts lower the surface tension of stool.

C. *

Sorbitol stimulates colonic motor activity.

D.

Cisapride enhances intestinal transit.

E.

Castor oil stimulates intestinal secretion.

279.

Which of the following statements describing Meckels diverticulum is correct?

A. *

It is the most common congenital anomaly of the digestive tract

B.

Mechanical obstruction resulting from stricture may occur

C.

In young adults inflammatory complications may produce a clinical syndrome indistinguishable from gastroenteritis.

D.

It is usually present in the jejunum.

E.

Barium studies are valuable in the diagnosis of diverticula associated with gastrointestinal bleeding.

280.

Which of the following statements regarding eosinophilic enteritis is correct?

A. *

It may be difficult to distinguish from regional enteritis.

B.

It affects only the small intestine.

C.

The majority of patients have a history of food allergies or asthma.

D.

Treatment with glucocorticoids is not indicated.

E.

Peripheral blood eosinophilia is rare.

281.

Which of the following structures does not form the external part of anal canal mechanism?

A. *

Internal Sphincter

B.

Levator Ani

C.

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