Questions Over GI PASS623
Which of the following clinical findings would be seen in a patient with food poisoning caused by Staphylococcus aureus? A. Ingestion of mayonnaise-based salads 48 hours earlier B. Bloody diarrhea with mucus for one week C. Abdominal cramps and vomiting for 48 hours D. High fever for 1 week
(c) C. Abdominal cramps, nausea, vomiting, and watery diarrhea typically last 1-2 days with staphylococcal foodpoisoning.
Which of the following subtypes of viral hepatitis requires the presence of the hepatitis B virus for replication? A. hepatitis A B. hepatitis C C. hepatitis D D. hepatitis E
(c) C. In the United States, hepatitis D is most commonly seen in persons exposed frequently to blood or blood products, such as drug addicts. It requires the presence of hepatitis B virus for its replication and expression.
Which of the following typical findings would be revealed during a sigmoidoscopy on a patient with Crohn's disease of the intestine? A. Rectal pseudopolyps B. Diffuse ulceration and bleeding C. Sheets of WBCs with inflamed mucosa D. Intermittent longitudinal mucosal ulcers and fissures
(c) D. Ulcerations tend to be linear with transverse fissures in Crohn's disease. These skip lesions are common with Crohn's disease Everything else sounds like Ulcerative colitis
A 48 year-old male presents with complaints of heartburn that occurs approximately 45 minutes after eating about three times a week that is relieved by antacids. He claims to have followed advice about elevating the head of the bed, avoiding spicy foods, and losing weight, but continues to have heartburn. Which of the following is the most appropriate next step? A. Ranitidine (Zantac) B. Sucralfate (Carafate) C. Metoclopramide (Reglan) D. Misoprostol (Cytotec)
*(c) A. Ranitidine, an H2 receptor blocker, is indicated for the treatment of mild, intermittent symptoms of gastroesophageal reflux disease.* (u) B. Sucralfate is used in the treatment of duodenal ulcers. (u) C. Metoclopramide is indicated for the treatment of gastroparesis as a first-line agent and as a second-line agent in the treatment of refractory gastroesophageal reflux. (u) D. Misoprostol is indicated for the prevention of NSAID-induced gastritis.
Which are approriate Tx for GERD? H3 blocker avoid EtOH and fatty foods elevate feet at bedtime stop smoking lie down after meals for 30 min
*H3 blocker* *avoid EtOH and fatty foods* elevate feet at bedtime *stop smoking* lie down after meals for 30 min
Which of the following are true statements regarding salivary glands? Saliva tests are accurate since saliva is a filtrate of blood Saliva tests are not affected by oral artifacts Mumps is caused by a virus and can be vaccinated against Atropine reduces salivary secretions Saliva has more acid than plasma
*Saliva tests are accurate since saliva is a filtrate of blood* Saliva tests are not affected by oral artifacts *Mumps is caused by a virus and can be vaccinated against* *Atropine reduces salivary secretions* Saliva has more acid than plasma
Below is a list of events that occur during the act of vomiting. 1 the LES and UES are open 2 forced inspiration against a closed glottis 3 reverse peristalsis from the mid small intestine 4 the LES is open and the UES is closed 5 relaxation of the pyloric sphincter 6 forceful contractions of the stomach Indicate the correct sequence of events involved in the act of vomiting
3 reverse peristalsis from the mid small intestine 5 relaxation of the pyloric sphincter 2 forced inspiration against a closed glottis 6 forceful contractions of the stomach 4 the LES is open and the UES is closed 1 the LES and UES are open
A 35-year old woman presents with a 1-year history of episodic diarrhea and blood in her stool. She reports loose stools with an increasing amount of blood and abdominal cramping. The patient has been eating at home and has no history of recent traveling to developing countries. She says she has bowel movements several times a day and about three times per nigh. Endoscopic examination and biopsy reveals the diagnosis of ulcerative colitis. Which of the following mechanisms of diarrhea would most likely be present in this patient? A. Exudative Diarrhea B. Osmotic Diarrhea C. Rapid Transit Diarrhea D. Secretory Diarrhea E. Traveler's Diarrhea
A. Exudative Diarrhea
The two main patterns of liver injury are? A. Hepatocellular and Cholestatic B. Cholestatic and Obstructive C. Necrotic and Hepatocellular D. Neoplastic and Cholestatic
A. Hepatocellular and Cholestatic
Which of the following pathophysiological processes is believed to initiate acute appendicitis? A. Obstruction B. Perforation C. Hemorrhage D. Vascular compromise
A. Obstruction of the appendiceal lumen by lymphoid hyperplasia, a fecalith or foreign body initiates most cases of appendicitis.
Gallstones usually result in biliary symptoms by causing inflammation or obstruction following migration into the common bile duct or A. cystic duct. B. pancreatic duct. C. duodenal ampulla. D. common hepatic duct.
A. Obstruction of the cystic duct by gallstones causes the typical symptom of biliary colic. Once obstructed the gallbladder distends and becomes edematous and inflamed. Gallstones can also migrate into the common bile duct through the cystic duct leading to a condition known as choledocholithiasis.
A 70-year-old woman presents with abdominal pain. The pain is located in the epigastric region and radiates through to the back. She also notes nausea, vomiting, and fever. The family states that the patient has a history of alcoholism. On physical examination, tenderness is noted in the epigastric region. Laboratory testing reveals an elevated lipase and normal liver function tests. Which of the following is the most likely diagnosis? © Kaplan A. Pancreatitis B. Endometriosis C. Acute cholecystitis D. Peptic ulcer disease E. Mesenteric ischemia
A. Pancreatitis
A 3 year-old presents with a 24-hour history of diarrhea. The patient is afebrile and the stool is noted to be loose and watery. No blood is noted in the stool. Fecal WBC is negative. Which of the following is the most likely diagnosis? A. viral gastroenteritis B. toxic megacolon C. ulcerative colitis D. intussusception Explanations
A. Patients with viral gastroenteritis are afebrile and noted to have loose, watery, non-bloody diarrhea. Fecal WBC is negative.
A 40 year-old female complains of acute right upper quadrant pain radiating to the back and low grade fever. Laboratory evaluation indicates the presence of urinary bilirubin and an elevation of serum alkaline phosphatase. Which of the following is the most likely diagnosis? A. cholecystitis B. viral hepatitis C. Gilbert's syndrome D. Dubin-Johnson syndrome
A. The presence of urinary bilirubin indicating conjugated hyperbilirubinemia coupled with the elevation of serum alkaline phosphatase suggests biliary obstruction that may lead to cholecystitis.
Ulcerative colitis usually presents with which of the following? A. bloody diarrhea B. toxic megacolon C. fever and left quadrant pain D. alternating constipation and diarrhea
A. Ulcerative colitis typically presents with episodic bloody diarrhea, lower abdominal cramps, and urgency to defecate.
Patients with congenital absence of one of the luminal GI enterocyte amino acid carriers do not become deficient in that specific amino acid. This fact is most likely due to the which of the following: A. they can still absorb di- and tri-peptides that contain the amino acid B. Each single aminoacid can still easily diffuse into the iintestinal cell C. Each single amino acid can use an unspecific carrier when necessary D. All amino acids can be synthesized when necessary E. Most diets have proteins and amino acids in excess
A. they can still absorb di- and tri-peptides that contain the amino acid
Choose the correct salivary condition with its name. A non painful inflammation of the salivary duct = Sialolithiasis An autoimmune disease causing dry mouth = Sjögren's syndrome A stone in the salivary duct = Sialadenitis Cancer of the salivary gland = Sialadenosis
An autoimmune disease causing dry mouth = Sjögren's syndrome
Another name for the myenteric plexus is the ________________ Submucosal Plexus Serosal Plexus Auerbach's Plexus Celiac Plexus
Auerbach's Plexus
A 30-year old man presents with a 2 week history of nausea, vomiting, fatigue. on PE; patient is afebrile, scleras are icteric, enlarged liver. Lab results: AST 854 ALT 1054 ALP 143 Total bili 5 mg.dL What is the most likely diagnosis? A. Acute Cholangitis B. Acute Viral Hepatitis C. Primary Biliary Cirrhosis D. Choledocholithiasis
B. Acute Viral Hepatitis
Which of the following can be a very serious consequence of using antidiarrheals in a patient with inflammatory bowel disease? A. Lymphoma B. Toxic megacolon C. Bone marrow suppression D. Delayed serum sickness-like reaction
B. Antidiarrheals may cause the development of toxic megacolon when used by patients with active severe inflammatory bowel disease.
The following statements are all true, except: A. The liver is the largest solid organ in the body B. Blood supply to the liver is only through the hepatic artery C. Portal tracts in the liver are composed by a hepatic arteriole, a portal venule and a bile ductule D. Blood leaves the liver through the hepatic veins
B. Blood supply to the liver is only through the hepatic artery The liver, the largest organ in the body, has a dual blood supply: hepatic artery and portal vein. In the normal liver 75% of the blood supply to the liver comes from the portal vein. The portal triad is composed by a branch of the hepatic artery, a branch of the portal vein and a branch of the bile duct. Blood from the portal triads travels through hepatic sinusoids, reaching the central hepatic venule and leaving the liver through hepatic veins.
What is the pathologic mechanism of Hirschsprung's disease? A. Pyloric circular muscle hypertrophy causing gastric outlet obstruction B. Absence of ganglion cells in the mucosal and muscular layers of the colon C. A defect in the diaphragm leading to protrusion of the abdominal viscera into the thoracic cavity D. Absence of relaxation of the lower esophageal sphincter and lack of peristalsis in the esophageal body
B. Hirschsprung's disease results from an absence of ganglion cells in the mucosal and muscular layers of the colon.
Which of the following is an antidiarrheal agent whose mechanism of action decreases GI motility? A. Bismuth Subsalicylate (Pepto Bismol) B. Loperamide (Imodium) C. Aluminum Hydroxide D. Kaolin Pectin E. Erythromycin
B. Loperamide (Imodium)
A patient presents complaining of vague anal discomfort. On examination, the patient is noted to have a few small external hemorrhoids and edema in the anal region. Which of the following is the most appropriate intervention? A. proctoscopy followed by a hemorrhoidectomy B. increased dietary fiber and sitz baths C. hemorrhoidal banding D. inject a sclerosing agent
B. Most hemorrhoids respond well to conservative treatment such as fiber and sitz baths.
A patient presents with a long history of dyspepsia refractory to maximum appropriate therapy. A recent upper GI series revealed *multiple gastric and duodenal ulcerations with prominent mucosal folds*. What diagnostic study would be confirmatory of this patient's suspected diagnosis? A. EGD with duodenal biopsy B. Serum gastrin level C. Helicobacter pylori serology D. Abdominal CT scan
B. Serum gastrin levels can be elevated for many reasons; however significant elevations in a fasting state as well as with the secretin stimulation test are confirmatory for Zollinger-Ellison syndrome which is highly suspect in this case.
The initial manifestation of acute pancreatitis is often A. generalized pruritus. B. epigastric pain. C. epigastric mass. D. anorexia.
B. The typical findings in acute pancreatitis include nausea, vomiting, and abdominal pain. Epigastric pain, generally abrupt in onset, is steady and severe.
23 year-old female presents with a 24-hour history of watery diarrhea, nausea and vomiting after returning from a cruise. On exam, the vitals reveal HR 120, BP 90/60, and RR 20. The abdomen is soft and non-tender, with hyperactive bowel sounds. Which of the following is the most appropriate management at this time? A. loperamide (Imodium) B. IV hydration C. bismuth sulfate (Pepto bismol) D. ciprofloxacin (Cipro)
B. This is most likely a self-limiting viral gastroenteritis and is treated with hydration and supportive care
A 30-year-old man presents with bloody diarrhea, fecal urgency, anemia, and a low serum albumin. Physical examination is unremarkable. Colon biopsy reveals inflammation of the mucosa and submucosa. Which of the following is the most likely diagnosis? © Kaplan A. Crohn's disease B. Ulcerative colitis C. Acute diverticulosis D. Wiskott-Aldrich syndrome E. Adenocarcinoma of the colon
B. Ulcerative colitis
Which of the following is a known risk factor for the development of adenocarcinoma of the esophagus? Chronic ingestion of green tea Diet high in salt Aspirin intake Radon Exposure Barrett's esophagus
Barrett's esophagus - GERD
Where would you expect to find unconjugated bilirubin normally? blood biliary system small intestine kidneys both answers 1 and 4
Blood
What is the most likely diarrhea pathogen for Improper Home Canning?
C Perfringens
What is the most likely diarrhea pathogen for Post Antibiotic Tx?
C diff
What is the most common type of motility associated with the descending colon? A haustrations B antipropulsive movements C mass movement D perisatalsis E segmentation
C mass movement
A 30-y/o woman presents with a three-day history of diarrhea. She denies any blood, mucus, nigh awakening diarrhea. On PE; the patient is afebrile. The abdominal exam is unremarkable. Which of the following should be the initial approach? A. Metronidazole (flagyl) B. Flexible Sigmoidoscopy C. Fluids and Antidiarrheal Medications D. Stool Culture and Ova Parasite test E. Stool for C diff toxins A and B
C. Fluids and Antidiarrheal Medications
Which of the following can lead to the development of prehepatic jaundice? A. Viral Hepatitis B. Cholelithiasis C. Sickle Cell Anemia D. Pancreatic Cancer E. Acetaminophen
C. Sickle Cell Anemia
A 25 year-old man presents with odynophagia and dysphagia. On endoscopic examination, small, white, patches with surrounding erythema are noted. Silver stain is positive for hyphae. The best treatment option for this patient is A. acyclovir (Zovirax). B. omeprazole (Prilosec). C. fluconazole (Diflucan). D. penicillin G.
C. The patient has Candida esophagitis and the treatment of choice is fluconazole.
Which of the Following Agents is Produced in the Duodenum & Stimulates the Pancreas in a True Hormonal Fashion to Produce an Enzyme-Rich Secretion? CCK GIP Gastrin Secretin VIP
CCK
*Which of the following drugs is an antacid? (Know the uses of all the drugs listed.)* Calcium carbonate (TUMS) Omeprazole (Prilosec) Cimetidine (Tagamet) Metoclopramide (Reglan)
Calcium carbonate (TUMS)
You have sat down to a scrumptious meal consisting of a spinach salad, a juicy piece of very lean filet mignion (16 oz.), a baked potato with generous gobs of butter and sour cream, and a fine glass of a robust wine. Which of the following represents the BEST order in which the above items are sequentially emptied from the stomach? A fillet mignion, potato, wine, butter B wine, filet mignion, potato, butter C potato, filet mignion, butter, wine D wine, potato, filet mignion, butter E potato, wine, butter, filet mignion
D wine, potato, filet mignion, butter
Which of the following should be recommended to the 50-year-old patient in whom a polyp is found on routine sigmoidoscopy? © Kaplan A. Colonoscopy B. Barium enema C. Annual fecal occult blood testing D. Repeat sigmoidoscopy in two years E. No additional evaluation is needed at this time
D. Repeat sigmoidoscopy in two years
Which of the following is used to screen for malabsorption disorders of the intestines? A. serum gastrin level B. urea breath test C. fecal eosinophils D. stool fecal fat
D. Stool fecal fat is the gold standard test for the evaluation of patients with malabsorption of the intestine.
A 32 year-old presents with a 3-day history of diarrhea. The patient denies blood, mucus, or night awakening with diarrhea. He recently returned from a business trip to Canada. On physical examination, the patient is afebrile and vital signs reveal BP 115/80, pulse is 76, and respirations are 14. The abdominal examination reveals hyperactive bowel sounds, but is otherwise unremarkable. Which of the following is the most appropriate initial intervention? A. Stool for culture, ova, and parasites B. Proctosigmoidoscopy C. Metronidazole (Flagyl) D. Supportive treatment
D. Symptomatic treatment, including dietary management and over-the-counter antidiarrheals, is indicated for afebrile patients with watery diarrhea of less than 5 days duration.
A 45 year-old male presents with abdominal pain and one episode of mild hematemesis, which happened days ago. On physical examination, vital signs are stable and he is in no acute distress. Hemoglobin and hematocrit are unremarkable; endoscopy reveals non-bleeding small superficial ulceration of the duodenal bulb. Rapid urease test is positive. Which of the following is the most appropriate treatment at this time? A. Schedule for a selective vagotomy and antrectomy B. Start an antacid along with omeprazole (Prilosec) C. Schedule elective ulcer excision and start sucralfate (Carafate) D. Start omeprazole (Prilosec) and antibiotic therapy against H. pylori
D. Treatment goals of H. pylori associated ulcers include eradicating the infection with appropriate antibiotics as well as use of a proton pump inhibitor, such as omeprazole, to promote ulcer healing.
40 year old presents with nocturnal, burning epigastric pain. The pain typically occurs 2-3 hours after his last meal and has awakened him from sleep in the early morning. Relief is obtained by eating a small snack or an antacid. He denies weight loss, nausea, vomiting, or hematemesis. On examination mild epigastric tenderness is noted. Which of the following is the most likely diagnosis? Kaplan Answer Esophageal reflux disease Duodenal ulcer Gastric cancer Esophagitis Achalasia
Duodenal ulcer
A patient, three days post appendectomy, presents with mild diffuse abdominal pain, nausea, and vomiting. On physical examination, bowel sounds are diminished, general abdominal distension is noted, and there is mild tenderness to palpation. Abdominal x-rays reveal distended gas-filled loops of small and large bowel. No sign of mechanical obstruction on abdominal CT scan. Which of the following is the most appropriate management for this patient? A. Barium enema with decompression B. Exploratory laparoscopy C. Lubiprostone (Amitiza) D. Glycerin suppositories E. Restrict oral intake
E. Restrict oral intake
What is the most likely diarrhea pathogen for Traveler's diarrhea?
Ecoli
Acute cholecystitis is a common cause of acute cholestasis: True False
False Acute cholecystitis is not associated with cholestasis unless there is external compression of the common bile duct from an inflamed gallbladder or compression of the common hepatic duct from a stone impacted in the cystic duct (Mirizzi syndrome) which occurs in less than 2% of the cases.
What is a true fact about gastric inhibitory peptide (GIP)? GIP release is stimulated by acidification of the duodenum GIP enhances insulin secretion and is stimulated by glucose in the duodenum GIP has structural similarities w/ CCK and hence bines to CCK receptors GIP causes G cells to produce gastrin GIP causes the pyloric sphinctor to open
GIP enhances *insulin secretion* and is stimulated by glucose in the duodenum
What is the most likely diarrhea pathogen for Stream Water Contamination?
Giardia
Which statement is incorrect? Most to all Asian Americans are lactose intolerant. Lactode is found in milk. There is an autoimmune component to IBD IBS shows changes in the bowel tissue on biopsy while IBD does not.
IBS shows changes in the bowel tissue on biopsy while IBD does not.
The best liver function test is: AST/ALT Alkaline phosphatase Bilirubin INR
INR Of the above, only the INR is a true liver function test as it examines the capacity of the liver to synthesize clotting factors. AST and ALT are enzymes that are elevated in hepatocellular injury. Alkaline phosphatase is an enzyme that is elevated in cholestatic injury. Bilirubin is a pigment secreted by the liver that is elevated with liver dysfunction but can also be elevated with bile obstruction (even though liver function is normal).
Excessive absorption of which substance is responsible for hemochromatosis? magnesium iron copper calcium
Iron
A Pt vomits forcefully several times previously and then vomits fresh looking red blood. According to the lecture the most likely diagnosis is? stomach cancer MS Mallory Weiss ALS Wittenberg's
Mallory Weiss
A a 52-year old women with recent breast cancer diagnosis reports GI distress following chemotherapy tx targeting fast-replicating cells. Which GI layer is most likely effected by the treatment? Circular Muscle Longitudinal Muscle Mucosal Epithelium Submucosal Plexus Serosa
Mucosal Epithelium
Which of the following diseases are not involved in lipid absorption? Abetalipoprotenemia small intestinal disease Na+ SGLT I transport deficiency hepatic disease
Na+ SGLT I transport deficiency - glucose uptake of the intestine and kidney
Which of the following substances must be further digested before it can be absorbed through the apical plasma membrane of enterocytes? Dipeptides Phenylalanine Tripeptides None of these All of these
None of these
What is the most likely diarrhea pathogen for Day Care Virus?
Norovirus/Rotavirus
Which of the following medications works by competitively inhibiting the binding of histabine to H2 receptors on gastric parietal cells, reducing gastric acid secretion? Metoclopramide Omeprazole Misoprostol Ranitidine Sucrasulfate
Ranitidine
How does the autonomic nervous system affect salivary secretory rate? Salivary secretory rate is increased at the same rate in response to both parasympathetic and sympathetic stimulation. Salivary secretory rate is decreased in response to parasympathetic and sympathetic stimulation. Salivary secretory rate is increased in response to parasympathetic stimulation and decreased to a minimal level in response to sympathetic stimulation. Salivary secretory rate is decreased in response to parasympathetic stimulation and increased in response to sympathetic stimulation.
Salivary secretory rate is increased at the same rate in response to both parasympathetic and sympathetic stimulation.
What is the most likely diarrhea pathogen for Poultry?
Salmonella
Adenocarcinoma of the colon most commonly presents in which section of the colon? Cecum Sigmoid Ascending Transverse Descending
Sigmoid
Which of the following stimuli induces the release of gastrin? Inhibits gastric acidity (low pH) Secretin Small peptides, rich in arginine, trytophane, and phenylalanine Somatostatin
Small peptides, rich in arginine, trytophane, and phenylalanine
A 40 year old male complaining of abdominal pain. The upper GI series revealed the presence of a gastric ulcer. Gastrin levels are 74 pg/ml (normal range is 50 to 150 pg/ml). Hydrochloric acid levels are 2mmoles/hr (normal range is 1 to 5 mmoles/hr). Blood analysis reveals elevated levels of macrophages and other immunocytes. From the given information, this individual is most likely suffering from ___________ which is best treated with__________. Superficial Gastritis - antibiotics Crohns's Disease - somatostatin Celiac Disease - opiates Deep gastric H. Pylori infection - NSAIDS
Superficial Gastritis - antibiotics
T/F: AST and ALT elevations are indicative of hepatocellular injury.
True The hallmark of hepatocellular injury is elevation of aminotransferases (AST and ALT). These enzymes get liberated with hepatocyte necrosis.
A 51-year-old smoker presents with gastric pain that is well localized and non-radiating. Pain has been getting gradually worse over the past several months and is relieved somewhat by eating. Patient denies any weight loss. Which of the following is the next step in the evaluation of this patient? ©Kaplan Barium swallow Upper endoscopy Serum gastrin level Stool H. pylori antigen test
Upper endoscopy
What is the most likely diarrhea pathogen for Shellfish?
Vibrio cholerae
The following statements are all true, except: a. Hepatic stellate cells produce bile b. Bile formed in the liver is transported to the gut c. Bile helps digest fat d. Cholesterol forms a part of bile
a. Hepatic stellate cells produce bile Hepatocytes produce and secrete bile components into the bile canaliculus, a channel formed by grooves on the plasma membrane of two opposing hepatocytes. Bile subsequently drains into the intrahepatic and extrahepatic biliary system and reaches the gut where it facilitates fat digestion. Bile is a mixed micellar solution of bile salts, phospholipids, and cholesterol as well as bilirubin and other solutes. Hepatic stellate cells, when activated by injury produce fibrous tissue.
The two main patterns of liver injury are: Hepatocellular and cholestatic Cholestatic and obstructive Necrotic and hepatocellular Neoplastic and cholestatic
a. Hepatocellular and cholestatic The two main patterns of liver injury are hepatocellular (main injury as the hepatocyte level) and cholestatic (main injury at any level of the biliary excretory system). Liver cell necrosis will lead to a hepatocellular injury pattern. Obstruction or damage to the bile ducts and infiltrative disease will lead to cholestasis.
Standard workup for acute hepatitis includes all of the following, except: Liver biopsy Antinuclear antibodies IgM-anti-HAV HBsAg
a. Liver biopsy A liver biopsy is almost never useful in acute hepatocellular injury as it will only show hepatocyte necrosis, which will not be specific for the cause of injury and does not have prognostic value. The most common causes of acute hepatitis are viral and therefore hepatitis A and hepatitis B should be excluded with the determination of IgM-anti-HAV (for hepatitis A) and HBsAg and IgM-anti-HBc (for hepatitis B). Since autoimmune hepatitis can present as acute hepatitis and antinuclear antibodies are considered standard in the workup of acute hepatitis.
Bilirubin can be elevated in both cholestatic and hepatocellular processes: a. True b. False
a. True Bilirubin is excreted in bile and it therefore can be elevated when there is cholestasis (i.e. when bile is "static" or not moving). Bilirubin can also be a marker of liver dysfunction, when the bilirubin excretory ability of the hepatocytes becomes altered.
AST and ALT are the best markers of the *severity* of acute hepatitis True False
b. False Although elevated AST and ALT elevations are the hallmark of acute hepatitis, the severity of the disease depends on preservation (or not) of liver synthetic function. Hepatitis is severe if and when there is evidence of liver dysfunction, specifically prolonged prothrombin time/INR or development of encephalopathy.
All of the following are causes of chronic hepatocellular injury, except: a. Viral hepatitis b. Autoimmune hepatitis c. Ischemic hepatitis d. Nitrofurantoin
c. Ischemic hepatitis Ischemic hepatitis is an acute injury that results from a sudden loss of blood flow to the liver and occurs with worsening heart failure, arrhythmia, hypotension or shock. Viral hepatitis B and C can lead to chronic hepatitis. Autoimmune hepatitis is a disorder in which the immune system attacks hepatocytes chronically and nitrofurantoin-induced liver injury can lead to an identical clinical presentation.
The initial test in a patient with cholestasis should be: a. Antimitochondrial antibodies b. HBsAg c. Liver ultrasound d. Iron tests
c. Liver ultrasound Ultrasonography is currently the first imaging option in the workup of a patient with cholestasis. If biliary dilatation is present, cholestasis is 'extrahepatic'. If biliary dilatation is not present, cholestasis is 'intrahepatic'. Although in a patient with clinical characteristics suggestive of PBC (middle-aged woman, associated thyroid disease), AMA is the initial test, an ultrasound should always be performed to rule out extrahepatic obstruction. Hepatitis B is very rarely the cause of cholestasis. Hemochromatosis does not lead to cholestasis.
*What type of cell releases somatostatin?* a cells b cells c hepatocytes d cells
d cells
In a patient with chronic liver disease, all of the following suggest the presence of chronic liver insufficiency, except: Low albumin Prolonged prothrombin time Elevated bilirubin Elevated aminotransferases
d. Elevated aminotransferases Aminotransferases are indicative of hepatocyte necrosis but are not indicators of liver synthetic function. Albumin, prothrombin time and bilirubin are real liver function tests and will be altered with liver insufficiency. While INR is the best indicator of acute liver failure, albumin is the best indicator of chronic liver failure.
A 45 year old woman presents with dysphagia (difficulty in swallowing) for solid foods and liquids. A barium swallow reveals dilation of the proximal esophagus, and a beak-like tapering of the distal esophagus. You correctly diagnosis achalasia and fully expect to see all of the following characteristics EXCEPT: increased tone in the lower esophageal sphincter (LES) absence of a coordinated peristaltic effort down the esophagus nonfunctional or absence of the esophageal intramural plexuses (i.e. ENS) decreased amounts of skeletal muscle along the upper third of esophagus simultaneous low pressure increases along the entire length of the esophagus during swallowing
decreased amounts of skeletal muscle along the upper third of esophagus
Which motility pattern/gastric function is distorted in diabetes mellitus? the ability to store chyme the ability to regulate gastric emptying gastric emptying due to neuropathy inability to mix gastric contents
gastric emptying due to neuropathy
Which is not a small intestine motility pattern? enterogastric jejunalilieal ilieocecal gastroilieal gastrocecal
jejunalilieal
Which is the incorrect statement? somatostatin is produced by D cells gastrin is produced by G cells secretin enhances H+ reabsorption CCK is part of the gastrin family of digestive hormones
secretin enhances H+ reabsorption Nope - together with CCK and ACH, secretin stimulates HCO3 secretion, acts through cAMP
The binding of cholera toxin irreversibly activates adenylate cyclase in the plasma membranes of crypt cells of the small intestine. This is most likely to cause: gallstones jaundice secretory diarrhea osmotic diuresis
secretory diarrhea
Which drug type is least damaging to the GI tract? non selective NSAIDS selective COX-1 inhibitors selective COX-2 inhibitors acetyl salicylic acid
selective COX-2 inhibitors
Which disease primary affects the internal anal sphincter? Alzheimers multiple schlerosis ulcerative colitits hi volume secretory diarrhea young normal children
ulcerative colitits
