krok 2 (Gasteroenterology) with explanation part 7

61). A 60-year-old woman, mother of 6 children, developed a sudden onset of upper abdominal
pain radiating to the back, accompanied by nausea, vomiting, fever and chills. Subsequently,
she noticed yellow discoloration of her sclera and skin. On physical examination the patient was
found to be febrile with temp. of 38, 9oC, along with right upper quadrant tenderness. The
most likely diagnosis is:
A. Choledocholithiasis
B. Benign biliary stricture
C. Malignant biliary stricture
D. Carcinoma of the head of the pancreas
E. Choledochal cyst
Explanation: 
5F are to risk factors for the development of cholelithiasis in an event of upper abdominal pain:
Fair: more prevalent in Caucasian population(fair)
Fat: BMI >30
Female gender
Fertile: one or more children
Forty: age ≥40

62). In which of the following disorders does the pathophysiology of portal hypertension involve
presinusoidal intrahepatic obstruction?
A. Congenital hepatic fibrosis
B. Alcoholic cirrhosis
C. Hemochromatosis
D. Budd-Chiari syndrome
E. Cavernomatous transformation of the portal vein

63). A 50-year-old man comes to the emergency room with a history of vomiting of 3 days’
duration. His past history examination reveals that for about 20 years he has been suffering
from epigasric pain lasting for 2 to 3 weeks, during early spring and autumn. He remembers
getting relief from pain by taking milk and antacids. Physical examination showed a fullness in
the epigastric area with visible peristalsis, absence of tenderness, and normal active bowel
sounds. The most likely diagnosis is:
A. Gastric outlet obstruction
B. Small bowel obstruction
C. Volvulus of the colon
D. Incarcerated umbilical hernia
E. Cholecystitis
Explanation: Obstruction of gastric out cause fullness in epigastric region with visible peristalsis. Obstruction is one of the complication of duodenal ulcer (environmental risk factor spring and autumn).

64). A 24-year-old law student is brought to the emergency room complaining of severe
abdominal pain of 6-8 hours duration. He had been to a party the night before. The pain is in
the epigastrium radiating to the back and is accompanied by nausea. The patient had vomited
twice prior to coming to the emergency room. Clinical examination revealed that the young
man was anxious, with acute condition, with a regular pulse rate of 100/min, blood pressure of
100/68 mm Hg, and body temperature of 38, 1oC. The most likely diagnosis is:
A. Acute pancreatitis
B. Acute cholecystitis
C. Acute appendicitis
D. Acute diverticulitis
E. Mesenteric adenitis
Explanation :  Acute abdominal pain irradiating to the spine is hallmark for pancreatitis. pancreas location retroperitoneal. Acute pancreatitis is associated with alcoholism.

65). A 45-year-old woman, mother of four children, comes to the emergency room complaining
of a sudden onset of the epigastric and right upper quadrant pain, radiating to the back,
accompanied by vomiting. On examination, tenderness is elicited in the right upper quadrant,
bowel sounds are decreased, and laboratory data shows leukocytosis, normal serum levels of
amylase, lipase, and bilirubin. The most likely diagnosis is:
A. Acute cholecystitis
B. Perforated peptic ulcer disease
C. Myocardial infarction
D. Sigmoid diverticulitis
E. Acute pancreatitis

66). A female patient has been suffering from pain in the right subcostal area, bitter taste in the
mouth, periodical bile vomiting for a month. The patient put off 12 kg. Body temperature in the
evening is 37, 6oC. Sonography revealed that bile bladder was 5,5х2,7 cm large, its wall - 0,4
cm, choledochus - 0,8 cm in diameter. Anterior liver segment contains a roundish hypoechoic
formation up to 5 cm in diameter and another two up to 1,5 cm each, walls of these formations
are up to 0,3 cm thick. What is the most likely diagnosis?
A. Alveolar echinococcus of liver
B. Liver cancer
C. Liver abscess
D. Cystous liver cancer
E. Paravesical liver abscesses
Explanation: Echinococcosis, also called hydatid disease, It is a parasitic disease of tapeworms of the Echinococcus type. The two main types of the disease are alveolar echinococcosisand  cystic echinococcosis . USG show multiple  hypo-echoic cyst like formation.

67). In autumn a 25-year-old patient developed stomach ache that arose 1,5-2 hours after
having meals and at night. He complains about pyrosis and constipation. The pain is getting
worse after consuming spicy, salty and sour food, it can be relieved by means of soda and hot-
water bag. The patient has been suffering from this disease for a year. Objectively: furred moist
tongue. Abdomen palpation reveals epigastrial pain on the right, resistance of abdominal
muscles in the same region. What is the most likely diagnosis?
A. Duodenal ulcer
B. Chronic cholecystitis
C. Diaphragmatic hernia
D. Stomach ulcer
E. Chronic pancreatitis
Explanation: Duodenal ulcer is associated stomach pain that arose  1.5-2.5 hours after having meal and get relief by meal. Spring and autumn are environmental risk factor for duodenal ulcer.

68). A 50-year-old patient complains about having pain attacks in the right subcostal area for
about a year. He pain arises mainly after taking fattening food. Over the last week the attacks
occurred daily and became more painful. On the 3rd day of hospitalization the patient
presented with icteritiousness of skin and scleras, light-colored feces and dark urine. In blood:
neutrophilic leukocytosis - 13, 1 · 109/l, ESR - 28 mm/h. What is the most likely diagnosis?
A. Chronic calculous cholecystitis
B. Chronic recurrent pancreatitis
C. Fatty degeneration of liver
D. Chronic cholangitis, exacerbation stage
E. Hypertensive dyskinesia of gallbladder

69). A patient suffering from gastroesophageal reflux has taken from time to time a certain
drug that "reduces acidity"over 5 years. This drug was recommended by a pharmaceutist. The
following side effects are observed: osteoporosis, muscle asthenia, indisposition. What drug
has such following effects?
A. Aluminium-bearing antacid
B. Inhibitor of proton pump
C. H2-blocker
D. Metoclopramide
E. Gastrozepin
Explanation: Antacid used to treat GERD. which neutralize gastric acid. osteoporosis, muscle asthenia, indisposition are side effect of Aluminium-bearing antacid.

70). In autumn a 25-year-old patient developed stomach ache arising 1,5-2 hours after having
meals and at night. He complains of pyrosis and constipation. The pain is getting worse after
consuming spicy, salty and sour food, it can be relieved by means of soda and hot-water bag.
The patient has been suffering from this disease for a year. Objectively: furred moist tongue.
Abdomen palpation reveals epigastrial pain on the right, resistance of abdominal muscles in the
same region. What is the most likely diagnosis? 
A. Duodenal ulcer
B. Chronic cholecystitis
C. Diaphragmatic hernia
D. Stomach ulcer
E. Chronic pancreatitis
Explanation: Duodenal ulcer is associated stomach pain that arose  1.5-2.5 hours after having meal and get relief by meal. Spring and autumn are environmental risk factor for duodenal ulcer.
part 8