krok 2 (Gasteroenterology) with explanation part 10

91).  A  64-year-old  patient  has  been  referred  to  planned  hospitalization  for  general  weakness,  poor appetite,  progressive  jaundice  which  appeared  over  3  weeks  ago  and  wasn’t  accompanied  by  pain syndrome.  Objectively:  body  temperature  is  at  the  rate  of  36,8oC,Ps-78/min,  abdomen  is  soft  and painless,  the  symptoms  of  peritoneal  irritation  are  present,  palpation  reveals  a  dramatically  enlarged, 

tense gallbladder. What disease are these symptoms typical for?
A.Cancer of the pancreatic head

B.Duodenal ulcer
C.Acute cholecystitis
D.Chronic cholecystitis
E.Lamblia-induced cholecystitis
Explanation:   Elderly is risk factor. weight is alarm sign for cancer.  enlarged, tense gallbladder due to bile outflow obstruction by pancreatic head cancer.

92).A patient is 31 years old. Double-contrast barium swallow revealed a filling defect on the posterior wall in the middle segment of  esophagus. The defect looked like  a well-defined oval 1,8x1,3 cm  large. Mucosal  folds  adjacent  to   the  defect   were  intact,  peristalsis  and   elasticity  of   the  walls  remained unchanged. Digestive tract problems were absent. What is the provisional diagnosis?
A.Esophageal tumour
B.Achalasia cardia
C.Esophageal burn
D.Diverticulum
E.Barrett’s esophagus
Explanation :-  Double-contrast barium swallow revealed a filling defect on the posterior wall in the middle segment of  esophagus and well defined oval mass indicate esophageal tumor.

93). A  28-year-oldmale  patient  complains  of regurgitation,  cough  and  heartburn  that  occurs  every  day after  a  meal,  when  bending  forward  or  lying  down.  These  problems  have  been  observed  for  4  years. Objective status and laboratory values are normal. FEGDS revealed endoesophagitis. What is leading
factor in the development of this disease?
A.Failure of the inferior esophageal sphincter
B.Hypersecretion of hydrochloric acid
C.Duodeno-gastric reflux
D.Hypergastrinemia
E.Helicobacter pylori infection
Explanation: patient had specific character of GERD(Gastroesophageal reflux disease (GERD) is a chronic digestive disease. GERD occurs when stomach acid or, occasionally, stomach content, flows back into food pipe (esophagus) and reflux irritates the lining of esophagus and causes GERD)

94).A 33-year-old female complains of escalating spastic pain in the abdomen after the psycho-emotional stress.  The  patient  has  intermittent bowel  movements,  that is  2-3  bowel  movements  after  waking  up alternate   with   constipation   lasting   for   1-2   days.   Objectively:   body   weight   is   unchanged,   there   is moderate   pain   on   palpation   of   the   sigmoid   colon.   Hb-   130   g/l,   WBC-5,2·   109/l,   ESR-   9mm/h. Proctosigmoidoscopy  causes pain  due  to spastic  bowel  condition, intestinal  mucosa  is not changed.  In the lumen there is a lot of mucus. What is the most likely diagnosis?
A.Irritable bowel syndrome
B.Crohn’s disease
C.Non-specific ulcerative colitis
D.Acute bowel ischemia
E.Malabsorption syndrome
Explanation : Diagnostic Criteria for Irritable Bowel Syndrome (IBS) :
1) Recurrent abdominal pain or discomfort at least 3 days/month in the last 3 months 
Plus two or more of the following
2) Improvement with defecation
3) change in frequency of stool
4) change in stool form(appearance)

Note: There is no pathological changes in bowel.

95.A  44-year-old  male  patient  complains  of  severe  non-localized  abdominal  pain,  pain  in  the  right shoulder  girdle,  repeated  vomiting,  red  urine.  The  onset  of  the  disease  is  associated  with  alcohol consumption. The face is hyperemic. AP- 70/40 mm Hg. Abdominal radiography reveals no pathological shadows. Hemodiastase is 54 mg/h/l. Prothrombin is 46%. What is the provisional diagnosis?
A.Acute pancreatitis
B.Acute myocardial infarction
C.Perforated gastric ulcer
D.Thrombosis of mesenteric vessels
E.Aneurysm of the abdominal aorta
Explanation: Acute pancreatitis is associated with alcohol consumption.

96).A 40-year-old male patient has had heaviness in the epigastric region for the last 6  months. He has not  undergone  any  examinations.  The  night  before,  he  abused  vodka.  In   the  morning  there  was vomiting,   and   30   minutes   after   physical   activity   the   patient   experienced   dizziness   and   profuse hematemesis. What pathology should be suspected in the first place?
A.Mallory-Weis’s syndrome
B.Menetrier’s disease
C.Gastric ulcer
D.Perforated ulcer
E.Zollinger-Ellison syndrome
Explanation: Mallory-Weiss syndrome (MWS) is a condition marked by a tear in the mucous membrane, or inner lining, where the esophagus meets the stomach. It is mainly caused by severe repeated vomiting and alcoholism.

97).A  46-year-old  male  patient  complains  of  periodic  epigastric  pain  that occurs  at  night.  Objectively: HR- 70/min, AP- 125/75 mm Hg, tenderness in the epigastric region is present. EGD confirms duodenal ulcer of 0,6 cm in diameter. Test for H. Pylori is positive. Which of the given antisecretory drugs will be a compulsory element of the treatment regimen?
A.Omeprazole
B.Famotidine
C.Pirenzepine
D.Atropine
E.Maalox
Explanation: Triple therapy = PPI(omeprazole), Amoxycillin, clarithromysin. 
Quadraple therapy: Bismuth(De-nol), ppI, metronidazole, tetracycline.


98).A  49-year-old  male  patient  complains  of  retrosternal  pain,  heartburn,  weight loss  of 8kg  over  the last year, constipation, weakness. The patient has been a smoker for 20 years, and has a 10-year history of Gastroesophageal  reflux disease. The patient is asthenic, has dry  skin. EGD  revealed an ulcer in the lower third of the esophagus and esophageal stricture accompanied by edema, hyperemia and multiple erosions of the mucosa. What study is required for more accurate diagnosis?
A.Biopsy of the esophageal mucosa
B.X-ray examination of the esophagus
C.Respiratory test for Helicobacter pylori
D.pH-metry of the esophagus and the stomach
E.Fecal occult blood test
Explanation :- Above mentioned is elderly, smoker patient and have the history of GERD and there is loss of weight which is alarm sign for cancer. thus patient is suspected to have esophageal cancer because of esophageal erosion, stricture, edema. The best method of investigation in this case is Biopsy of the esophageal mucosa.