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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.
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
7.
Choose the single most characteristic lung function test picture for pneumonectomy.
A. *
Spirometry, lung volumes and incorrected transfer factor predicted.
B.
FEV1/FVC ratio90%, TLC reduced by 30%
C.
Normal PFTs
D.
FEV1/FVC-58%, 25% to bronchodilators, normal transfer factor
E.
FEV1/FVC62%, no bronchodilators, gas trapping, and reduced transfer factor
8.
Choose the single most characteristic lung function test picture for neuromuscular disease.
A. *
FEV1/FVC85%. Globally lung vols. Reduced expiratory mouth pressures
B.
FEV1/FVC ratio90%, TLC reduced by 30%
C.
Normal PFTs
D.
FEV1/FVC-58%, 25% to bronchodilators, normal transfer factor
E.
FEV1/FVC62%, no bronchodilators, gas trapping, and reduced transfer factor
9.
Choose the single most characteristic lung function test picture for interstitial lung disease.
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
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. *
^AST, ^ALT, ^GGT, ^Bilirubin
B.
^Bilirubin, ^Alkaline phosphatase, ^GGT, ^cholesterol
C.
vAlbumine, vprothrombin, vcholesterol, vfibrinogen
D.
^ESR, ^?-globulins, ^timol test ^Le, ^C-react. protein
E.
None of above
43.
Markers of Cholestatic syndrome in liver cirrhosis
A. *
^Bilirubin, ^Alkaline phosphatase, ^GGT, ^cholesterol
B.
^AST, ^ALT, ^GGT, ^Bilirubin
C.
vAlbumine, vprothrombin, vcholesterol, vfibrinogen
D.
^ESR, ^?-globulins, ^timol test ^Le, ^C-react. protein
E.
None of above
44.
Markers of Liver cellular insufficiency syndrome in liver cirrhosis
A. *
vAlbumine, vprothrombin, vcholesterol, vfibrinogen
B.
^AST, ^ALT, ^GGT, ^Bilirubin
C.
^Bilirubin, ^Alkaline phosphatase, ^GGT, ^cholesterol
D.
^ESR, ^?-globulins, ^timol test ^Le, ^C-react. protein
E.
None of above
45.
Markers of Mesenchyme-inflammatory syndrome in liver cirrhosis
A. *
^ESR, ^?-globulins, ^timol test ^Le, ^C-react. protein
B.
^AST, ^ALT, ^GGT, ^Bilirubin
C.
Bilirubin, ^Alkaline phosphatase, ^GGT, ^cholesterol
D.
vAlbumine, vprothrombin, vcholesterol, vfibrinogen
E.
None of above
46.
Markers of Hypersplenism syndrome in liver cirrhosis
A. *
anemia, thrombocytopenia, leukocytopenia
B.
^AST, ^ALT, ^GGT, ^Bilirubin
C.
^Bilirubin, ^Alkaline phosphatase, ^GGT, ^cholesterol
D.
vAlbumine, vprothrombin, vcholesterol, vfibrinogen
E.
None of above
47.
Markers of Cholestatic syndrome in hepatitis
A. *
All of above
B.
^cholesterol
C.
^Bilirubin
D.
^Alkaline phosphatase
E.
^GGT
48.
Marker of Cholestatic syndrome in hepatitis
A. *
^Alkaline phosphatase
B.
All of above
C.
vfibrinogen
D.
^AST
E.
ALT
49.
Markers of Cholestatic syndrome in hepatitis are all except
A. *
ALT
B.
^cholesterol
C.
^Bilirubin
D.
^Alkaline phosphatase
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.
^ALT
C.
^GGT
D.
^Bilirubin
E.
^AST
52.
Markers of Liver cellular insufficiency syndromein hepatitis are all except
A. *
^ALT
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. *
anemia, thrombocytopenia, leukocytopenia
B.
^ALT
C.
^GGT
D.
^Bilirubin
E.
^AST
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. *
Characterized by excessive deposition of copper in liver
B.
Characterized by excessive deposition of iron in liver
C.
results in cirrhosis and emphysema
D.
None of above
E.
All of above
57.
What is true about ?1-ANTITRYPSIN DEFICIENCY:
A. *
results in cirrhosis and emphysema
B.
Characterized by excessive deposition of iron in liver
C.
Characterized by excessive deposition of copper in liver
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. *
It is more common in men than in women
B.
It can be associated with other autoimmune diseases
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%.
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.
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%.
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.
Hepatocellular carcinoma
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.
Ingestion of arsenic causes
A. *
Non cirrhotic portal fibrosis
B.
Hepatic adenoma
C.
Hepatic carcinoma
D.
Hepatic cirrhosis
E.
None of the above
77.
Hepatic-encephalopathy may be precipitated by all of the following except:
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.
For Primary biliary cirrhosis select the circulating antibodies with which it is most closely associated:
A. *
antibodies to mitochondria;
B.
antibodies to acetylcholine receptors;
C.
antibodies to native DNA;
D.
antibodies to smooth muscle cells;
E.
antibodies to parietal cells.
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.
Primary biliary cirrhosis
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. *
Primary biliary cirrhosis
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.
Hepatitis B associated with primary hepatocellular carcinoma
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.
Primary biliary cirrhosis
D.
Gallstones
E.
Hepatitis B associated with primary hepatocellular carcinoma
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. *
Ultrasound examination of the gallbladder
B.
Liver function tests
C.
X-ray examination of the gastrointestinal tract
D.
Ultrasound study of the pancreas
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.
There are following diagnostic tests for chronic cryptogenic hepatitis except:
A. *
all negative
B.
HBsAg,
C.
IgG anti-HBc,
D.
HBeAg
E.
all of them,
125.
For Primary biliary cirrhosis select the circulating antibodies with which it is most closely associated:
A. *
antibodies to mitochondria
B.
antibodies to acetylcholine receptors;
C.
antibodies to native DNA;
D.
antibodies to smooth muscle cells;
E.
antibodies to parietal cells.
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. *
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
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.
There are following diagnostic tests for chronic hepatitis B except:
A. *
HDV RNA
B.
HBsAg,
C.
IgG anti-HBc,
D.
HBeAg,
E.
HBV DNA
130.
There are following diagnostic tests for chronic cryptogenic hepatitis except:
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.
Hemochromatosis is associated with all of the following clinical manifestations EXCEPT:
A. *
gout
B.
cirrhosis
C.
diabetes mellitus
D.
gonadotropin deficiency
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.
Hepatocellular carcinoma
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 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.
137.
A typical battery of blood tests used for initial assessment of liver disease includes measuring all of the following except:
A. *
urea
B.
Aminotransferases
C.
alkaline phosphatase
D.
direct and total serum bilirubin
E.
albumin.
138.
A typical battery of blood tests used for initial assessment of liver disease includes measuring all of the following except:
A. *
urea
B.
Aminotransferases
C.
Gamma-glutamyl transferase
D.
direct and total serum bilirubin
E.
Prothrombin time.
139.
A typical battery of blood tests used for initial assessment of liver disease includes measuring all of the following except:
A. *
urea
B.
Aminotransferases
C.
Gamma-glutamyl transferase
D.
direct and total serum bilirubin
E.
Serum sodium.
140.
A typical battery of blood tests used for initial assessment of liver disease includes measuring all of the following except:
A. *
urea
B.
Aminotransferases
C.
Gamma-glutamyl transferase
D.
direct and total serum bilirubin
E.
Coagulation test.
141.
A typical battery of blood tests used for initial assessment of liver disease includes measuring all of the following except:
A. *
urea
B.
Aminotransferases
C.
Gamma-glutamyl transferase
D.
General blood analysis
E.
Coagulation test.
142.
A typical battery of blood tests used for initial assessment of liver disease includes measuring all of the following except:
A. *
urea
B.
Aminotransferases
C.
Gamma-glutamyl transferase
D.
General blood analysis
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.
alkaline phosphatase
D.
direct and total serum bilirubin
E.
albumin.
144.
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.
Gamma-glutamyl transferase
D.
direct and total serum bilirubin
E.
albumin.
145.
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.
Gamma-glutamyl transferase
D.
direct and total serum bilirubin
E.
Prothrombin time.
146.
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.
Gamma-glutamyl transferase
D.
direct and total serum bilirubin
E.
Serum sodium.
147.
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.
Gamma-glutamyl transferase
D.
direct and total serum bilirubin
E.
Coagulation test.
148.
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.
Gamma-glutamyl transferase
D.
General blood analysis
E.
Coagulation test.
149.
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.
Gamma-glutamyl transferase
D.
General blood analysis
E.
Coagulation test.
150.
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.
Gamma-glutamyl transferase
D.
autoantibodies
E.
Coagulation test.
151.
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.
Gamma-glutamyl transferase
D.
autoantibodies
E.
Ferritin and transferrin saturation.
152.
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.
Gamma-glutamyl transferase
D.
autoantibodies
E.
copper and ceruloplasmin.
153.
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.
Gamma-glutamyl transferase
D.
autoantibodies
E.
Immunoglobulin levels.
154.
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.
Gamma-glutamyl transferase
D.
autoantibodies
E.
Cholesterol and glucose.
155.
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.
Gamma-glutamyl transferase
D.
autoantibodies
E.
Alpha 1-antitrypsin.
156.
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.
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.
It is more common in men than in women
E.
No one mentioned
159.
Causes of Cirrhosis and/or Chronic Liver Disease are all of the following except:
A. *
Viral hepatitis A.
B.
Autoimmune,
C.
Viral hepatitis C,
D.
Viral Hepatitis B
E.
Viral Hepatitis B with hepatitis D
160.
Causes of Cirrhosis and/or Chronic Liver Disease are all of the following except:
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.
Causes of Liver Cirrhosis are all of the following except:
A. *
Viral hepatitis A.
B.
Autoimmune,
C.
Viral hepatitis C,
D.
Non-alcoholic steatohepatitis
E.
Alcoholic liver disease
164.
Causes of Liver Cirrhosis are all of the following except:
A. *
Viral hepatitis A.
B.
Primary biliary cirrhosis,
C.
Viral hepatitis C,
D.
Non-alcoholic steatohepatitis
E.
Alcoholic liver disease
165.
Causes of Liver Cirrhosis are all of the following except:
A. *
Viral hepatitis A.
B.
Primary biliary cirrhosis,
C.
Viral hepatitis C,
D.
Non-alcoholic steatohepatitis
E.
Primary sclerosing cholangitis
166.
Causes of Liver Cirrhosis are all of the following except:
A. *
Viral hepatitis A.
B.
Hereditary hemochromatosis,
C.
Viral hepatitis C,
D.
Non-alcoholic steatohepatitis
E.
Primary sclerosing cholangitis
167.
Causes of Liver Cirrhosis are all of the following except:
A. *
Viral hepatitis A.
B.
Hereditary hemochromatosis,
C.
Wilson's disease,
D.
Non-alcoholic steatohepatitis
E.
Primary sclerosing cholangitis
168.
Causes of Liver Cirrhosis are all of the following except:
A. *
Viral hepatitis A.
B.
Hereditary hemochromatosis,
C.
Wilson's disease,
D.
Alpha 1-antitrypsin deficiency
E.
Primary sclerosing cholangitis
169.
Causes of Liver Cirrhosis are all of the following except:
A. *
Viral hepatitis A.
B.
Hereditary hemochromatosis,
C.
Cardiac cirrhosis,
D.
Alpha 1-antitrypsin deficiency
E.
Primary sclerosing cholangitis
170.
Causes of Liver Cirrhosis are all of the following except:
A. *
Viral hepatitis A.
B.
Hepatotoxic drugs or toxins,
C.
Cardiac cirrhosis,
D.
Alpha 1-antitrypsin deficiency
E.
Primary sclerosing cholangitis
171.
Chronic active hepatitis is most reliably distinguished from chronic persistent hepatitis 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
172.
Chronic active hepatitis is most reliably distinguished from chronic persistent hepatitis by the presence of
A. *
characteristic liver histology
B.
extrahepatic manifestations
C.
hepatitis B surface antigen in the serum
D.
antibody to hepatitis B core antigen in the serum
E.
a significant titer of anti-smooth-muscle antibody
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.
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.
Sensitivity to medication
178.
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.
Hepatocellular carcinoma
179.
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.
Esophageal varices
180.
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.
Portal hypertension
181.
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.
Ascites
182.
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.
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.
For Primary biliary cirrhosis select the circulating antibodies with which it is most closely associated:
A. *
antibodies to mitochondria;
B.
anantibodies to Phospholipid;
C.
antibodies to native DNA;
D.
antibodies to smooth muscle cells;
E.
antibodies to parietal cells.
185.
Gall bladder stone formation in caused by all except:
A. *
Leucocytosis
B.
Hyperalimentation
C.
Primary biliary cirrhosis
D.
Clofibrate therapy
E.
None of mentioned
186.
Hemochromatosis is associated with all of the following clinical manifestations EXCEPT:
A. *
gout
B.
liver cirrhosis
C.
diabetes mellitus
D.
gonadotropin deficiency
E.
cardiomyopathy
187.
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.
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.
Hepatic-encephalopathy may be aggravated by all of the following except:
A. *
Hyperkalemia
B.
Renal failure
C.
Alkalosis
D.
Hypoxia
E.
Dehydration
190.
Hepatic-encephalopathy may be aggravated by all of the following except:
A. *
Hyperkalemia
B.
Renal failure
C.
Alkalosis
D.
Constipation
E.
Dehydration
191.
Hepatic-encephalopathy may be aggravated by all of the following except:
A.
Hypokalemia
B. *
Ascites
C.
Alkalosis
D.
Alcohol intoxication
E.
Dehydration
192.
Hepatic-encephalopathy may be precipitated by all of the following except:
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.
Ingestion of arsenic causes
A. *
Non cirrhotic portal fibrosis
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.
Hepatocellular carcinoma
C.
Right ventricular failure
D.
Renal cell carcinoma
E.
Pneumonia
198.
Marker of Cholestatic syndrome in hepatitis is
A. *
Alkaline phosphatase
B.
All of above
C.
vfibrinogen
D.
^AST
E.
^ALT
199.
Marker of Cytolitic syndrome in hepatitis is
A. *
^ALT
B.
All of mentioned
C.
^Alkaline phosphatase
D.
^cholesterol
E.
vfibrinogen
200.
Marker of Liver cellular insufficiency syndrome in hepatitis is
A. *
vAlbumine
B.
^ALT
C.
^GGT
D.
^Bilirubin
E.
^AST
201.
Markers of Hypersplenism syndrome in liver cirrhosis are all of the following except
A. *
leukocytosis, ^ESR
B.
thrombocytopenia
C.
anemia+ thrombocytopenia
D.
anemia+ thrombocytopenia +leukocytopenia
E.
anemia+ ^ESR
202.
Markers of Hypersplenism syndrome in liver cirrhosis are
A. *
anemia, thrombocytopenia, leukocytopenia
B.
^AST, ^ALT, ^GGT, ^Bilirubin
C.
^Bilirubin, ^Alkaline phosphatase, ^GGT, ^cholesterol
D.
vAlbumine, vprothrombin, vcholesterol, vfibrinogen
E.
No one mentioned
203.
Markers of Hypersplenism syndrome in liver cirrhosis
A. *
All mentioned
B.
anemia
C.
thrombocytopenia
D.
leukocytopenia
E.
No one mentioned
204.
Markers of Hypersplenism syndrome in liver cirrhosis
A. *
anemia, thrombocytopenia, leukocytopenia
B.
^ALT, ^GGT
C.
^GGT, ^Bilirubin
D.
^Bilirubin, ^ALT, ^GGT
E.
^AST, ^ALT, ^GGT
205.
Markers of Mesenchyme-inflammatory syndrome in liver cirrhosis are
A. *
^ESR,
B.
G-globulins, ^timol test ^Le, ^C-react. protein
C.
^AST, ^ALT, ^GGT, ^Bilirubin
D.
^Bilirubin, ^Alkaline phosphatase, ^GGT, ^cholesterol
E.
vAlbumine, vprothrombin, vcholesterol, vfibrinogen
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. *
Primary biliary cirrhosis
B.
Sclerosing cholangitis
C.
Anaerobic liver abscess
D.
Hepatoma
E.
Hepatitis C
210.
Risk factor of Budd-Chiari syndrome is:
A. *
Hormonal contraception
B.
Hepatocellular carcinoma
C.
Right ventricular failure
D.
Renal cell carcinoma
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.
Intrahepatic phlebosclerosis and fibrosis;
C.
Portal and splenic vein sclerosis;
D.
Portal and splenic vein thrombosis;
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.
There are following diagnostic tests for chronic hepatitis B except:
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. *
It is more common in men than in women
B.
It can be associated with other autoimmune diseases
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%.
218.
What is not true about CRYPTOGENIC HEPATITIS
A. *
All mentioned
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%.
219.
What is true about L1-ANTITRYPSIN DEFICIENCY:
A. *
It results in cirrhosis and emphysema
B.
Characterized by excessive deposition of iron in liver
C.
Characterized by excessive deposition of copper in liver
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.
Intrahepatic phlebosclerosis and fibrosis;
C.
Portal and splenic vein sclerosis;
D.
Portal and splenic vein thrombosis;
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. *
Characterized by excessive deposition of copper in liver
B.
Characterized by excessive deposition of iron in liver
C.
results in cirrhosis and emphysema
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. *
strictures occurring in the rectum
B.
fistula formation
C.
free perforation
D.
generalized peritonitis
E.
intraabdominal abscess
239.
Complications of ulcerative colitis include
A. *
strictures occurring in the rectum
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.
Irritable bowel syndrome
E.
Celiac sprue
F.
Gastro-oesophageal reflux disease
G.
Crohn's disease
H.
Ulcerative colitis
I.
Irritable bowel syndrome
J.
Celiac sprue
262.
The endoscopic changes - aphthoid ulcerations are typical for
A.
Gastro-oesophageal reflux disease
B. *
Crohn's disease
C.
Ulcerative colitis
D.
Irritable bowel syndrome
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.
Gastro-oesophageal reflux disease
B. *
Crohn's disease
C.
Ulcerative colitis
D.
Irritable bowel syndrome
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.
Primary biliary cirrhosis
E. *
Primary sclerosing cholangitis
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.