krok 2 (Gasteroenterology) with explanation part 5

41). A 48 year old man complains of fatique and shortness of breath. His Ht is 32%, and Hb - 103
g/l. Peripheral blood smear reveals macrocytosis. Serum vitamin B12 level is 90 pg/ml (normal
is 170 to 940); serum folate level is 6 ng/ml (normal is 2 to 14). Possible causes to consider
include all of the following EXCEPT:
A. Colonic diverticulitis
B. Vegetarianism
C. Regional enteritis
D. Pancreatitis
E. Fish tapeworm infection
Explanation: Cause of vitamin B12 deficiency include: Vegetarianism (low dietary content), Regional enteritis ( B12 readily absorbed in the last part of the small intestine i.e ileum) Pancreatitis (Vitamin B12 bind two carrier proteins haptocorrin [R binder] and intrinsic factor, but only its binding to intrinsic factor allows its absorption and R binder is removed by pancreatic enzyme which is defficient in pancreatitis), Fish tapeworm infection (parasite absorbing 80% or more of the host's B12 intake)

42). A 41 year old patient was admitted to the intensive care unit with haemorrhagic shock due
to gastric bleeding. He has a history of hepatitis B during the last 5 years. The source of
bleeding are esophageal veins. What is the most effective method for control of the bleeding?
A. Introduction of obturator nasogastric tube
B. Intravenous administration of pituitrin
C. Hemostatic therapy
D. Operation
E. Administration of plasma
Explanation: Esophageal Veins begin to dilate and swell as a result of increased blow flow. Cirrhosis is the most common cause of portal hypertension which lead to esophageal  bleeding The goal of treatment is to stop acute bleeding as soon as possible by blakemore obturator tube.

43). A 75 year old man who has been suffering from diabetes for the last six months was found
to be jaundiced. He was asymptomatic except for weight loss at the rate of 10 pounds in 6
months. Physical examination revealed a hard, globular, right upper quadrant mass that moves
during respiration. A CT scan shows enlargement of the head of the pancreas, with no filling
defects in the liver. The most likely diagnosis is:
A. Carcinoma of the head of the pancreas
B. Infectious hepatitis
C. Haemolytic jaundice
D. Malignant biliary stricture
E. Metastatic disease of liver
Explanation:   Elderly is risk factor. weight is alarm sign for cancer. On examination, hard, globular mass which move during respiration . CT scan shows enlargement of the head of the pancreas that indicate cancer.

44). A 50 year old woman complained of attacks of right subcostal pain after fatty meal she has
been suffering from for a year. Last week the attacks repeated every day and became 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
Explanation: patient suspected to have cholecystitis so gold standard is USG of gallbladder .

45). During an operation for presumed appendicitis the appendix was found to be normal;
however, the terminal ileum is evidently thickened and feels rubbery, its serosa is covered with
grayish-white exudate, and several loops of apparently normal small intestine are adherent to
it. The most likely diagnosis is:
A. Crohn’s disease of the terminal ileum
B. Perforated Meckel’s diverticulum
C. Ulcerative colitis
D. Ileocecal tuberculosis
E. Acute ileitis
Explanation:Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any part of the gastrointestinal tract from mouth to anus.Mostly affected in crohn's disease is terminal ileum. Skip lesion, transmural involvement are main characteristic of this disease.

46). A 68 year old patient has been suffering from chronic pancreatitis for 35 years. During the
last 5 years he has been observing abatement of pain syndrome, abdominal swelling, frequent
defecations up to 3-4 times a day (feces are greyish, glossy, with admixtures of undigested
food), progressing weight loss. Change of symptom set is caused by joining of:
A. Exocrine pancreatic insufficiency
B. Endocrine pancreatic insufficiency
C. Syndrome of lactase deficiency
D. Irritable bowels syndrome
E. Chronic enterocolitis

Explanation: Main function of exocrine part of pancreas is production of enzyme i.e pancreatic amylase, lipase, proteases.  Chronic pancreatitis lead to these enzyme deficiency resulting in undigestion(undigested food in stool). 


47). A 32 year old patient complains about heartburn and dull pain in the epigastrium that
appear 2-3 hours after meal. Exacerbations happen in spring and in autumn. The patient has
food intolerance of eggs and fish. Objectively: stomach palpation reveals painfulness in the
gastroduodenal area. Electrophasoduodenoscopy revealed a 5 mm ulcer on the anterior wall of
duodenum. Urease test is positive. What is the most probable leading mechanism of disease
development?
A. Helicobacterial infection
B. Dietary allergy
C. Autoantibody production
D. Reduced prostaglandin synthesis
E. Disorder of gastric motor activity
Explanation:- Urease test positive reaveles Helicobacterial infection.

48). A 10 year old girl complains about abdominal pain that is arising and getting worse after
eating rough or spicy food. She complains also about sour eructation, heartburn, frequent
constipations, headache, irritability. She has been suffering from this for 12 months.
Objectively: the girl’s diet is adequate. Tongue is moist with white deposit at the root.
Abdomen is soft, painful in its epigastric part. What study method will help to make a
diagnosis?
A. Esophagogastroduodenoscopy
B. Intragastral pH-metry
C. Fractional examination of gastric juice
D. Contrast roentgenoscopy
E. Biochemical blood analysis
Explanation: Esophagogastroduodenoscopy is gold standard for GERD.

49). A patient complains about pyrosis and permanent pain behind his breastbone. When he
bends forward after eating there appears regurgitation. Roentgenological examination revealed
extrasaccular cardiofunctional hernia of esophageal opening of diaphragm. Esophagoscopy
revealed signs of reflux-esophagitis. What is the necessary tretment tactics?
A. Operation in a surgical department
B. Conservative treatment in an outpatients’ clinic
C. Conservative treatment in the therapeutic hospital
D. Conservative treatment in a surgical department
E. Treatment at a health resort
Explanation:-hernia of esophageal opening of diaphragm is emergency case so patient should be operated as soon as possible.

50). A 12 year old child has the ulcer disease of stomach. What is the etiology of this disease?
A. Intestinal bacillus
B. Helicobacter pylory
C. Salmonella
D. Lambliosis
E. Influenza
Explanation:ulcer disease is mainly caused by H. pylory but in krok base answer given Intestinal bacillus.
part 6