krok 2 (Gasteroenterology) with explanation part 1

Correct answer for all Question is A
1). The 28 y.o. woman applied to doctor because of limited loss of the hair. In the anamnesis -
she had frequent headache indisposition, arthromyalgia, fever, irregular casual sexual life, drug
user. RW is negative. What examination must be done first?
A. Examination for HIV
B. Examination for neuropathology
C. Examination for gonorrhea
D. Examination for fungi
E. Examination for trichomoniasis

Explanation: Because of history of  causal sex , drug user are major risk factor for HIV transmission associated  to this given patient. 

2). 33 y.o. woman works as the secretary. Her diet contains 150 g of protein (including 100 g of animal protein), 200 g of fat, 600 g of carbohydrates. What pathologycan develop from this
diet?
A. Obesity
B. Schizophrenia
C. Paradontosis
D. Common cold
E. Uterine fibromyoma
Explanation: She is secretary meaning her work doesn’t need much energy so diet containing that amount of fat and carbohydrate will lead to build up of calories.At least 130 grams of carbohydrate is required daily , protein 100 grams enough for single day.

3). A 33 y.o. male patient was admitted to a hospital. A patient is pale, at an attempt to stand
up he complains of strong dizziness. There was vomiting like coffee-grounds approximately
hour ago. BP- 90/60 mm Hg., pulse- 120 b/min. In anamnesis, a patient has suffered from ulcer
of the stomach, painless form during 4 years. An ulcer was exposed at gastrofibroscopy. Your
diagnosis:
A. Ulcer of stomach, complicated with bleeding
B. Ulcer of duodenum, complicated with bleeding
C. Erosive gastritis
D. Acute pleurisy
E. Acute myocardial infarction, abdominal
Explanation : History of stomach ulcer and signs of bleeding ( vomiting like coffee ground because of gastric acid react with hemoglobin and pale, dizziness, hypotension indicate bleeding)

4). A 27 y.o. man complains of pain in epigastrium which is relieved by food intake. EGDFS
shows antral erosive gastritis, biopsy of antral mucous presents Hеlicobacter Pylori. What can
be diagnosed in this case?
A. Gastritis of type B
B. Gastritis of A type
C. Reflux - gastritis
D. Menetrier’s disease
E. Rigid antral gastritis
Explanation : EGDFS shows erosive gastritis. H. pyloric causes the type B Gastritis and mostly affected antrum.  Gastritis A type is autoimmune gastritis.
Mnemonic:
Autoimmune gastritis type A = Autoimmune (Atrophy)
Autoimmune gastritis type B = Bacteria (H. pylori)
Autoimmune gastritis type C = Chemical (Bile)

5). A 38 y.o. woman was hospitalized to the surgical unit with vomiting and acute abdominal
pain irradiating to the spine. On laparocentesis hemmorhagic fluid is obtained. What disease
should be suspected?
A. Acute pancreatitis
B. Renal colic
C. Acute enterocolitis
D. Perforated gastric ulcer
E. Acute appendicitis
Explanation :  Acute abdominal pain irradiating to the spine is hallmark for pancreatitis. pancreas location retroperitoneal.

6). 47 y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is
hyperpigmentated. There is multiple xanthelasma palpebrae. The liver is +6 cm enlarged, hard
with acute edge. The blood analysis revealed total bilirubin 160 mkmol/L, direct – 110 mkmol/L,
AST (asparate aminotransferase)- 2,1 mmol/L per hour, ALT– 1,8 mmol/L, alkaline phosphotase-
4,6 mmol/L per hour, cholesterol– 9,2 mmol/L, antimitochondrial antibodies M2 in a high titer.
What is the probable diagnosis?
A. Primary biliary liver cirrhosis
B. Primary liver cancer
C. Chronic viral hepatitis B
D. Acute viral hepatitis B
E. Alcoholic liver cirrhosis
Explanation: High titer for antimitochondrail antibody M2 is specific for primary bilary cirrhosis. It is an autoimmune condition.

7). The complications of acute cholecystitis which require surgical intervention are as follows
EXCEPT:
A. Jaundice
B. Empyema of the gall-bladder
C. Emphysematous gall-bladder
D. Gall-bladder perforation
E. Cholangitis conditioned by the presence of stones in the bile tract
Explanation : Jaundice is a symptom of a disease rather than a disease itself ,  the rest are medically emergency situation so must treated surgically.


8). A 40 y.o. patient was admitted to the gasteroenterology with skin itching, jaundice,
discomfort in the right subcostal area, generalized weakness. On examination: skin is jaundice,
traces of scratches, liver is +5 cm, splin is 6x8 cm. In blood: alkaline phosphatase - 2,0
mmol/(hour*L), general bilirubin - 60 mkmol/L, cholesterol - 8,0 mmol/L. What is the leading
syndrome in the patient?
A. Сholestatic
B. Сytolytic
C. Mesenchymal inflammatory
D. Asthenic
E. Liver-cells insufficiency
Explanation : Presence of  Sign and symptoms of liver. Skin itching and traces of scratches indicate bile obstruction ( cholestasis) .

9). A 51 y.o. woman complains of dull pain in the right subcostal area and epigastric area,
nausea, appetite decline during 6 months. There is a history of gastric peptic ulcer. On
examination: weight loss, pulse is 70 bpm, AP is 120/70 mm Hg. Diffuse tenderness and
resistance of muscles on palpation.There is a hard lymphatic node 1x1cm in size over the left
clavicle. What method of investigation will be the most useful?
A. Esophagogastroduodenoscopy with biopsy
B. Ultrasound examination of abdomen
C. pH-metry
D. Ureatic test
E. Stomach X-ray
Explanation :- Above mentioned is elderly patient and have the history of gastric peptic ulcer and there is loss of weight, appetite loss and lymph node  involvement and thus patient is suspected to have cancer and the best method of investigation in this case is Esophagogastroduodenoscopy with biopsy.

10). A 36 y.o. patient was admitted to the hospital with sharp pain in substernal area following
occasional swallowing of a fish bone. On esophagoscopy the foreign body wasn’t revealed. The
pain increased and localized between scapulas. In a day temperature elevated, condition
became worse, dysphagia intensified. What complication has developed?
A. Perforation of esophagus with mediastinitis
B. Esophageal hemorrhage
C. Obstruction of esophagus
D. Pulmonary atelectasis
E. Aspirative pneumonia
Explanation : Fish bone pierced through the esophagus to the posterior structures which led to the inflammation of the mediastinum.

To be continued.. part 2