Medicine 3rd LE AY 2011-2012

Medicine II 3rd LE AY 2011-2012 1.

A patient came at the ER because of melena and hematochezia. Patient was noted to be diaphoretic and pale. Vital signs were as follows: BP: 80/60 HR: 120 RR:20 temp: afebrile. The patient must have lost at least how much of his blood volume? a. 10% b. 20% c. 30% d. 40%

2.

A 50-year old female came in because of melena. An endoscopy was done and was noted to have an ulcer crater with a visible vessel. What will be the treatment of choice for this patient? a. Injection sclerotherapy b. Injection sclerotherapy + hemoclip c. Injection sclerotherapy + APC d. Surgery

3.

A patient came in at the ER who presented with one episode of hematochezia. Upon consult, patient was noted to have a BP of 80/60 HR 110 RR 2. What will be you initial diagnostic of choice? a. Gastroscopy b. Enteroscopy c. RBC Tagging d. Colonoscopy

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Among these patients, who is most likely have continuous bleeding or would rebleed? a. A 40-year old female who presented with melena, with stable BP and history of vomiting b. A 40-year old with no known co-morbidities with adherent clot on endoscopy c. A 65-year old male with renal failure with clean based ulcer d. An 80-year old female with stage IV colon CA who presents with hematemesis A cirrhotic patient sought consult at the ER because of hematemesis. Endoscopy showed esophageal varices. What is the treatment of choice for this patient? a. Beta blocker b. Injection sclerotherapy c. Rubber band ligation d. Histoacryl glue injection A 70year old male was referred to you because of anemia with positive FOBT. You did an upper GI endoscopy and colonoscopy which were normal. What should be the next diagnostic step? a. Single or double balloon enteroscopy b. Capsule endoscopy c. Abdominal CT scan d. Mesenteric angiogram

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7.

A patient was admitted for persistent hematochezia. Gastroscopy and colonoscopy were normal. Which of the following would be the next most appropriate procedure? a. Capsule endoscopy b. CT scan of the whole abdomen c. Mesenteric angiogram d. Upper GI series with small bowel follow trough

8.

A 42 year old man consulted you for an episode of melena two days prior, after intake of NSAIDS for gout. Physical examination was normal. You performed a gastroscopy the next day and saw a 1 cm antral ulcer with a white-based crater. You should do a. Injection sclerotherapy b. Hemoclip application c. Argon plasma coagulation d. No endoscopic (therapeutic) intervention is necessary

9.

Which of the following diagnostic test is virtually diagnostic for acute viral hepatitis A a. Anti HAV-IgG b. Anti HAV-IgM c. Anti HAV-IgE d. NOTA

10. Which of the following diagnostic examination has the potential for treating certain biliary diseases such as obstructive jaundice secondary to a Choledocholithiasis a. Ultrasound of the liver b. CT scan c. ERCP d. MRCP 11. Which of the following test remains the gold standard in the evaluation of patients with chronic liver diseases and is more often useful in assessing the severity and stage of liver damage? a. Ultrasound of the liver b. CT scan c. ERCP d. MRCP 12. Which of the ff statement(s) about RUQ discomfort or pain is true? a. The pain arises from stretching or irritation of Glisson’s capsule, which surrounds the liver and is rich in nerve endings b. Recurrent RUQ pain is most typical of gallbladder disease c. The presence of a liver abscess may be a cause of RUQ abdominal pain d. AOTA 13. Which of the following signs of advanced liver disease is described as collateral veins seen radiating from the

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umbilicus and resulting from the recanulation of the umbilical vein? a. Grey-turner’s sign b. Cullen’s sign c. Caput medusa d. Hepatic fetor 14. Which of the following factors are part of the child-pugh classification of cirrhosis? a. Serum ALT, serum albumin, prothrombin time, ascites, hepatic encephalopathy b. Serum bilirubin, serum albumin, prothrombin time, ascites, hepatic encephalopathy c. Prothrombin time, serum GGTP, serum AST, serum bilirubin, serum albumin d. Serum ALT, serum AST, prothrombin time, ascites, hepatic encephalopathy 15. Which of the following diagnostic test pattern is commonly seen in wilson’s disease? a. Elevated iron saturation b. Elevated serum ferritin levels c. Decreased serum ceruloplasmin and increased urinary copper d. Positive finding on genetic testing for HFE gene mutations 16. A 32 year old previously asymptomatic callcenter agent was brought to the ER because of vomiting fresh blood amounting to about a cupful noted after a drinking spree. His companions narrated that the vomiting of fresh blood came after several episodes of vomiting previously ingested food and forceful retching. The most likely cause of his bleeding is: a. Rupture esophageal varix b. Alcohol induced gastritis c. Peptic ulcer disease d. Mallory Weiss tear 17. A 22 year old female dental intern consulted because of progressive dysphagia to both solids and liquids for about 6 months associated with regurgitation of bland food and nocturnal coughing. On CXR she was noted to have air fluid level at the midline. she most likely have: a. GERD b. DES c. Achalasia d. Esophageal wed 18. An 18 year old first year college student consulted because of odynophagia of 3 days duration. He noted the symptom to have started on the third day of his intake of doxycycline which was given by his urologist for his urethritis. The most likely cause of his odynophagia is: a. Candida esophagitis b. CMV esophagitis c. Pill-induced esophagitis d. Eosinophilic esophagitis

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19. A 58 year old construction worker with a strong history of smoking and alcohol intake was seen at the OPD because of progressive dysphagia to solid of 3 months duration associated with weight loss of about 5 kg. His PE was unremarkable except for signs of sudden weight loss. He most likely have: a. Laryngeal carcinoma extending to the esophagus b. Mediastinal mass c. Esophageal carcinoma d. Peptic stricture due to GERD 20. A 65 year old male previously diagnosed to have Peptic ulcer disease consulted because of repeated bouts of vomiting bland undigested food. On PER he was noted to have succession splash. What complication of PUD is he most likely suffering from? a. Hemorrhage b. Gastric outlet obstruction c. Perforation d. Malignant degeneration 21. A 25 year old female presents with a history of intermittent food impaction for which she has undergone 2 previous UGI endoscopy to treat the problem. The esophagus was noted to be normal on both examination. She has dysphagia for solids occasionally and no liquid dysphagia. You would: a. Request for UGI endoscopy with random biopsy b. Request for esophageal manometry c. Give empiric trial of PPI d. Give empiric trial of corticosteroid therapy 22. A 65 year old male came for consultation because of a 2 to 3 month history of dysphagia. He finds that solid foods seem to stick in the midneck area and that he has difficulty starting a swallow. He often coughs or chokes when he swallows and has difficulty because of liquids regurgitating into his nose. You would: a. Refer to ENT specialist for evaluation b. Refer to UGI endoscopy c. Refer for videofluoroscopy d. Refer for esophageal manometry 23. A 44 year old man comes to your office with symptoms of occasional heartburn for several years and intermittent abdominal pain. He uses magnesium hydroxide with simethicone approximately once a week with excellent relief of his heart burn symptoms. Due to his abdominal pain and heartburn, you perform an endoscopy. He is found to have Barrett’s esophagus by biopsy. What is the next step in management? a. Begin H2 receptor blockers b. Begin PPI c. Refer to surgeon for fundoplication d. Continue on demand treatment for heartburn

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24. A 26 year old man with a history of food impaction has had intermittent dysphagia for solids for 5 years. Barium swallow and esophageal manometry results are normal. Endoscopy reveals multiple rings throughout the length of the esophagus. Biopsy if the esophagus is likely to show which of the following conditions? a. Active esophagitis b. Columnar metaplasia c. Dense infiltrates of lymphocytes d. Eosinophilic infiltration 25. A 37 year old man with intermittent solid food dysphagia undergoes a barium swallow. The results show he has a ring like narrowing at the distal esophagus. The diameter of the ring is 12 mm. which of the following therapies is indicated at this time? a. Careful food preparation b. Endoscopy followed by bougie dilation c. Laser ablation d. PPI 26. A 25 year old Filipina with allergy to penicillin has been diagnosed to have H. pylori related duodenal bulb ulcer. What is the appropriate treatment regimen? a. PPI plus clarithromycin 500 mg and amoxicillin 1 g BID for 10 days b. PPI plus clarithromycin 500 mg and metronidazole BID c. PPI plus amoxicillin 1 g BID for 5 days the PPI plus levofloxacin 250mg BID for 5 days d. PPI plus clarithromycin 500 mg BID plus bismuth subsalicylate 525 mg 4 times a day 27. An 84 year old man with prosthetic cardia valve needs treatment for a painful joint. He is diagnosed with osteoarthritis. He is also on low dose aspiring and is receiving anticoagulation therapy with warfarin. The most correct advice for him is to a. Avoid NSAIDS b. Begin NSAIDs after stopping aspiring c. Start COX2 inhibitor d. Start COX2 inhibitor with a PPI 28. According to the american gastrointestinal association guidelines, which of the following patients should undergo prompt upper endoscopy? a. A 25 year old woman with a 1 week history of mid epigastric pains b. A 45 year old man reposting midepigastric pains responsive to two week history of PPI therapy c. A 70 year old man reposting a six week history of midepigastric pains associated with a 10 pound weight loss nausea and vomiting. d. A 60 year old asymptomatic woman with normal hemoglobin, heme positive stool and normal colonoscopic findings

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29. A 58 year old male underwent upper GI endoscopy for weight loss and dysphagia. Endoscopic evaluation showed a 2 cm circumferential ulcerated mass in the distal esophagus biopsies of which were consistent with adenocarcinoma. A CT scan of the whole abdomen revealed no evidence of metastatic disease. What staging modality should be used next? a. MRI of the chest b. PET c. Endoscopic US d. Laparoscopy 30. Peptic ulcer is a common complication of NSAID treatment. Which of the following statements regarding prophylactic therapy is correct? a. H2 receptor antagonist do not lower the risk b. Only high dose misoprostol provides effective prophylaxis c. H pylori infected patients should receive eradication therapy d. Ulcer bleeding can be prevented in high risk patients by omeprazole 31. Which of the following is the diagnostic criteria for IBS? a. Recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months b. Abnormal stool form c. Passage of mucus d. AOTA For questions 32-34, refer to the ff case: a 45 year old male patient presented at the clinic with recurrent abdominal pain associated with alternating constipation and diarrhea 32. The ff are alarm symptoms to look for except: a. Passage of mucus in the stools b. Bleeding per rectum c. Anemia d. AOTA 33. The patient mentioned above upon presentation at the clinic brought with him some initial lab tests done on him. Which of the ff confirms the diagnosis of IBS? a. Presence of parasites in the stools b. Anemia c. Leukocytosis d. NOTA 34. Referring to the above patient, patient claims that the reason he sought consultation aside from his symptoms was because his officemate was diagnosed with colon cancer. What is your next step in this patient? a. Refer for Upper GI endoscopy b. Refer for colonoscopy c. Treat with antispasmodics d. Assure the patient that his symptoms are not indicative of malignancy

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35. A 23 year old medical student presents at the ER because of recurrent abdominal pain and constipation of 3 months duration. The symptoms appeared just after the start of the current school year. The pain is localized in the lower abdominal area. What would be your next step? a. Look into the presence or absence of alarm symptoms b. Order for a double contrast barium enema c. Recommend a lactose free diet d. AOTA 36. A 27 year old female patient was diagnosed with IBS and prescribed anticholinergic for her abdominal pain. the ff are possible side effects that she may experience EXCEPT: a. Inzomi b. Blurred vision c. Dryness of mouth d. Urinary retention 37. In patients diagnosed with mild IBS, the approach to treatment includes the ff: a. Antidepressants b. Alosentron c. Patient education and reassurance d. AOTA 38. Which of the ff has the highest prevalence of IBD? a. Sephardic jews b. Ashkenazi jews c. Asians d. Hispanics For questions 39-41, refer to the ff case: a 45 year old male patient was being worked up for IBD. 39. Which of the ff is an expected radiographic finding in a patient with Crohn’s disease? a. Continuous involvement of the GI tract b. Stricture formation c. Loss of haustration of large intestines d. AOTA 40. Endoscopy was done on the above patient. which of the are typical endoscopic findings in patients with crohn’s disease? a. Rectal sparing b. Cobblestoning c. Fistula formation d. AOTA 41. Biopsy was done on the lesions found in the colon. Which of the ff Histopathologic findings are typical of crohn’s disease? a. Inflammation is limited to the submucosa b. Granuloma formation is observed

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c. d.

No intervening normal tissue between abnormal lesions AOTA

For questions 42-43, refer to the ff case: a 25 year old female accountant consulted at the clinic complaining of recurrent abdominal pain and on and off loose watery stools of 3 months duration. She has not observed blood in her stools though she notices mucus. She claims that her symptoms began shortly after she started on her new job. 42. Which of the ff does she most likely have? a. Ulcerative colitis b. Latose intolerance c. Irritable bowel syndrome d. AOTA 43. What would be your next step in managing this patient’s problem? a. Get a detailed dietary and medical history b. Treat immediately with anti diarrheals c. Refer for colonoscopy d. Prescribe amecides 44. Which of the ffhepatobiliary conditions will predispose a patient with IBD to cholangiocarcinoma? a. Pericholangitis b. Chronic active hepatitis c. Primary sclerosing cholangitis d. AOTA 45. A 30 year old female patient whom you have been managing for crohn’s disease asks you about the possible risks if and when she gets pregnant/ what would you counsel your patient? a. She cannot get pregnant as she is infertile b. There is no risk to pregnancy and childbirth in patients with crohn’s disease c. Women with IBD have greater complications in pregnancy compared to healthy controls d. Women with crohn’s disease have lesser complication sin pregnancy compare to women with ulcerative colitis For questions 46-52, refer to the ff case: a 45 year old salesman consulted you because of jaundice. No abdominal pain, fever noted. ultrasound showed a nodular and small liver. 46. Your impression is: a. Liver cirrhosis b. Biliary obstruction c. Liver abscess d. Fatty liver 47. A few months later, he develops melena and hematemesis. His abdomen is enlarged with shifting dullness. No abdominal pain/tenderness or fever was

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noted. vital signs were stable. You suspect UGIB secondary to esophageal varices. Initial management will be: a. Insert NGT to document bleeding b. TIPS c. Surgery d. Start octreotide or somatostatin 48. On upper GI endoscopy, esophageal varices were noted. the next procedure to be done would be to a. Give beta blockers b. TIPS c. Variceal ligation d. Surgery 49. As the medical resident in charge of the patient, you want to prevent possibility of problems associated with GI bleeding & ascites. You decide to start: a. Antibiotics b. Lactulose c. Low sodium diet d. Branched chain amino acids 50. Your patient was discharged with no more recurrence of GI bleeding. He was given furosemide, spironolactone and propanolol as home medications. you advise follow up after 2 weeks. On follow up, relatives told you of the changes in sensorium of the patient with no lateralizing signs. Your patient is experiencing: a. Cerebral infarction b. Cerebral hemorrhage c. Hepatic encephalopathy d. Septicemia 51. The most probable precipitation factor on why the above patient developed this problem is: a. Electrolyte abnormality b. Infection c. Recurrence of GI bleeding d. Hypertensive emergency 52. Treatment for the above patient will include: a. Discontinuing loop diuretics b. Giving antibiotics c. Control GI bleeding d. Anti-hypertensive medication For questions 53-56, refer to the ff case: a 40 year old overweight businessman consulted you because of ultrasound findings of hyperechoic liver. He is non-alcoholic and all blood tests are normal except for elevated fasting blood sugar. 53. Your impression on the patient is: a. Hepatitis b. NAFLD c. Normal liver d. Liver cyst

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54. As the medical clerk on duty, you would do the ff: a. Advise patient to undergo liver transplant b. Start anti-viral medications c. Advise patient to go on diet and weight loss program d. Start on insulin treatment for diabetes 55. A few years later, the patient consulted you because of elevated ALT’s, polyuria, polyphagia. FBS remains elevated. Ultrasound remains the same. Hepatitis profile is non-reactive for A, B, & C. impression at this time is: a. Hepatitis b. NASH c. Hepatocellular carcinoma d. Hepatic abscess 56. Treatment of the above patient may include: a. Anti-diabetic medications b. Surgery c. Percutaneous drain d. Observe For questions 57-59, refer to the ff case: a 53 y/o male, diagnosed with NASH for the past 10 years, was noted to be jaundiced with enlarging abdomen. Blood tests showed slightly elevated ALT, deranged prothrombin time, low albumin. PE showed (+) fluid wave. 57. Your impression is: a. Acute viral hepatitis b. Drug induced hepatitis c. Liver cirrhosis d. Ischemic hepatitis 58. On further history, a CT scan was used to diagnose his fatty liver. The following is the typical CT scan findings to a patient with fatty liver: a. Hypodense liver compared to spleen b. Hyperdense liver compared to spleen c. Same density as spleen and kidnyes d. Presence of mass lesion 59. A liver biopsy was done on a patient suspected of NASH. You would expect to see which of the ff findings which are the hallmarks for NASH: a. Steatosis b. Lobular inflammation c. Fibrosis d. Necrosis 60. A 35 year old male consulted you because of findings on ultrasound suggestive of fatty liver. Aside from NAFLD, the ff may present with the same ultrasound picture: a. Hemangiomas b. Alcoholic liver disease c. Lymphoma d. Hepatocellular carcinoma

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For questions 61-63, refer to the ff case” 37 year old female was rushed to the ER with complaints of severe epigastric pains radiating to the back which started a few hours prior to consult. The patient claimed to have had a drinking binge with her friends a few days prior to consult. On PE, patient was noted to be afebrile with stable VS. abdomen was soft with direct tenderness on the epigastric area. 61. Initial impression for the patient is: a. Acute cholangitis b. Acute pancreatitis c. Perforated PUD d. Acute mesenteric ischemia 62. If you are the medical resident on duty, what initial laboratory test would you request for this patient? a. Amylase/lipase b. Ultrasound of the abdomen c. Gastroscopy d. Plain abdominal xray 63. Management of the above patient would include: a. Starting IV antibiotics b. NGT insertion c. Placing the patient on NPO d. Start patient on PPI 64. A 54 y/o male was admitted to the ICU because of severe epigastric abdominal pain associated with tachycardia and hypotension. As the major intern in charge, your medical resident requested you to closely monitor the patient. on PE, you noted the presence of ecchymosis around the periumbilical area. This finding is known as: a. Cullen’s sign b. Grey turner’s sign c. Murphy’s sign d. Reynaud’s sign 65. A patient was admitted for acute pancreatitis for 1 week. 2 weeks after discharged, the patient was noted to have a 7 by 6 by 6 cm pseudocyst on ultrasound. Presently, the patient is asymptomatic with no subjective complaints. On PE findings, there is a palpable mass noted on the epigastric area. What will be the plan of action for this patient? a. Do percutaneous drainage of the pseudocyst b. Refer the patient to surgery c. Start the patient on antibiotic d. Clinical and radiographic follow up only 66. A 40 y/o female was brought to the ER because of severe epigastric pain of few hours duration. This was accompanied by nausea and vomiting. On past health history, patient claimed to have had previous hospital admissions because of recurrent acute pancreatitis. Patient does not smoke and does not drink alcohol. On PE, the patient was noted to have slight tenderness at

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the epigastric area and slight icterisia. Laboratory examinations showed slightly elevated liver enzymes, alkaline phosphatase, and serum bilirubins. The most likely etiology for the patient’s recurrent acute pancreatitis is: a. Alcohol b. Drug induced c. Gallstones d. Infection For questions 67-68, refer to the ff case: a 25 y/o male was rushed to the ER because of complaints of severe epigastric pain associated with vomiting. Patient was ill looking and initial vital signs at the ER showed BP of 80/60 mmHg; HR of 110 bpm; and an RR of 26/min. there was direct epigastric tenderness and abdominal guarding on palpation. Initial laboratories requested showed leukocytosis and elevated serum amylase and lipase more than 3x the upper limit of normal. 67. What is the most appropriate imaging modality to request to assess the severity of this patient’s condition? a. Plain abdominal xray b. Ultrasound of the abdomen c. CT scan d. MRI with MRCP 68. Differential diagnosis for this patient would include the ffEXCEPT: a. Acute severe pancreatitis b. Perforated peptic ulcer c. Acute intestinal obstruction d. Acute myocardial infarction 69. A 42 y/o bank executive consulted the clinic because of findings of gallstones on ultrasound; the largest of which measures about 0.8 cm. on history, the patient denies experiencing any recurrent form of abdominal pain or discomfort and according to him the ultrasound was done as part of his executive check up. physical findings for this patient was unremarkable and the rest of his laboratory examinations (blood chemistries) were within normal. What is the treatment plan for this patient? a. Start patient on medical dissolution therapy b. Start the patient on PPI c. Refer the patient to surgery for cholecystectomy d. Observe and monitor for occurrence of symptoms For question 70-72, refer to the ff case: a 38 year old, obese, female was brought in to the ER because of abdominal pain epigastric in location radiating tot eh RUQ, back and shoulder for more than 6 hours. Patient claims that she has had previous episodes of similar abdominal pain in the past, but the duration only lasted for at least an hour. On PE, patient is slightly icteric, febrile with inspiratory arrest on deep palpation at the RUQ area.

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70. What will be the primary impression for this patient? a. Peptic ulcer disease b. Cholecystolithiases/GB stones c. Acute cholecystitis d. Acute pancreatitis 71. If you were the medical resident attending to this patient, what is the initial imaging modality for this patient? a. Plain abdominal xray b. Ultrasound c. CT scan d. MRCP 72. What us the definitive treatment management for this patient? a. Observe the patient and monitor for recurrence of symptoms b. Start the patient on PPI c. Medical dissolution therapy d. Cholecystectomy with IOC 73. A 42 y/o female diagnosed to have cholecystolithiases consulted your clinic because she would like to find out if she can take ursodeoxychilic acid for her gallstones. She read on the internet that it is currently used in oral dissolution regimens. Which among the ff is a criterion for medical dissolution of GB stone? a. Pigment stones b. Radio-opaque stones on plain radiography c. Normal gallbladder/patent cystic duct d. Large stone 74. A 45 y/o patient underwent laparoscopic cholecystectomy for gallstones. Three weeks postcholecystectomy, patient went to the ER complaining of abdominal pain and tea colored urine. On PE, patient had stable vital signs and was noted to be jaundice. Initial laboratory examinations showed leukocytosis with elevated bilirubin and alkaline phosphatase. Ultrasound done showed dilated common bile duct. the next appropriate management for this patient would be: a. MRCP b. ERCP c. PTC with PTBD d. Surgical exploration 75. A 56 y/o male was rushed to the ER because of RUQ abdominal pain, jaundice and fever with altered mental status. According to the relatives, the patient was previously diagnosed with cholecystolithiases 2 years ago. On PE, patient was noted to be tachycardic and hypotensive. The constellation of the above symptoms is consistent with a. Charcot’s b. Corvousier’s c. Mirrizzi d. Reynaud’s/Reynold’s

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76. Which of the ff signs may be seen in patient with acute viral hepatitis? a. Contracted liver b. Splenomegaly c. Testicular atrophy d. Palmar erythema 77. Which of the ff abnormal laboratory results would indicate sever hepatic damage? a. ALT >2,000 IU/L b. Prothrombin time 3 seconds longer than control c. Alkaline phosphatase >7x upper level of normal d. Serum bilirubin >150 mmol/L 78. A patient with suspected acute viral hepatitis has the ff laboratory AST=1,200 IU/L, (+) HBsAg, (-) anti-HBc IgM, (+) anti-HAV IgM, (+) anti-HCV. What is your diagnosis? a. Acute hepatitis A, chronic hepatitis B and exposure to hepatitis C b. Acute hepatitis A, acute hepatitis B and exposure to hepatitis C c. Acute hepatitis A, acute hepatitis C and exposure to hepatitis B d. Acute hepatitis B, acute hepatitis C and exposure to hepatitis A 79. A patient with suspected acute viralhepatitis has the ff laboratory ALT=600 IU/L, (+) HBsAg, (-) anti-HBc IgM, (-) anti-HAV IgM, (+) anti-HCV. What is your diagnosis? a. Acute hepatitis B and exposure to hepatitis C b. Chronic hepatitis B and exposure to hepatitis C c. Acute hepatitis B and acute hepatitis C d. Chronic hepatitis B and acute hepatitis C 80. A patient who was previously diagnosed to have acute hepatitis B 8 weeks prior had the ff blood tests: (+) HBsAg, (+) anti-HBc IgM, (+) anto-HBe, and (-) anti-HBs. Which of the ff is correct regarding the patient’s prognosis? a. Patient will most likely become a chronic hepatitis B carrier b. Patient will most likely recover from the acute hepatitis B c. Patient has the potential to develop fulminant hepatitis B d. Patient is developing the low level carrier state 81. In a patient with presumed acute hepatitis B 4 months before and where the HBsAg and the anti-HBs are both negative, which of the ff serum markers would confirm the diagnosis? a. Anti-Hbe b. HBeAg c. Anti-HBc IgM d. HBV DNA

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82. An asymptomatic patient routinely tested revealed the ff test reults: (-) HBsAg, (+) anti-HBc total and (-) anti-HBs. The patient was given one shot of the hepatitis B vaccine which resulted in the appearance of anti-HBs after 1 month. Which of the ff is correct? a. Patient was a low-level carrier responsive to vaccination b. Patient had previous infection with recovery in the remote past c. The HBsAg was a false negative d. The anti-HBc total was false positive 83. A 30 y/o male patient known to be a carrier of hepatitis B virus for the past 2 years consulted you because of a persistently elevated AST of more than 60 IU/L for 6 months. Additional laboratory tests revealed (+) HBsAg, (-) HBeAg, (-) anti-HBe, HBV DNA =70,000 copies/mL.what is the most likely diagnosis? a. Hepatitis B with super-infection with hepatitis delta b. Hepatitis B with concomitant hepatitis C c. Pre-core mutant chronic active hepatitis B d. Escape mutant chronic active hepatitis B 84. Which of the ff laboratory tests is the most appropriate to use to confirm the hepatic source of an elevated serum AST? a. Serum alkaline phosphatase b. Serum ALT c. B1B2 d. Protime 85. Histochemical studies have localized the reproduction of which of the ff in the nucleus of the hepatocyte? a. HAV b. HBsAg c. HCV d. HDV 86. Which of the ff is true of babies born to hepatitis B carrier mothers who were presumably exposed to the virus during delivery? a. More likely to develop severe acute hepatitis in the neonatal period b. More likely to develop the carrier state because of immune tolerance c. More likely to develop reactivation hepatitis B in adolescence d. More likely to develop natural long-lasting immunity against the virus 87. In which of the following cases would the prolonged prothrombin time be corrected by the administration of parenteral vitamin K? a. Fulminant hepatitis A b. Fulminant hepatitis B c. Cholestatic hepatitis A d. Decompensated cirrhosis due to hepatitis B

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88. Which of the ff is true of a patient with a (+) HBsAg and (+) anti-HBs who is in the course of viral recovery? a. High HBsAg titer b. Anti-HBs is of a different sub-type than the HBsAg c. (+) anti-HBc IgM d. Decreasing anti-HBs titer when tested after 2 weeks 89. Disappearance of HBsAg and which of the ff should be documented before a diagnosis of hepatitis B virologic recovery can be made? a. Appearance of anti-Hbe b. Disappearance of anti-HBc IgM c. Appearance of anti-HBs d. Disappearance of HBeAg 90. In determining the etiology of acute viral hepatitis, which of the ff markers is basically useless and should not be tested? a. HBsAg b. Anti-HCV c. HBeAg d. Anti-HBcIgM 91. Which of the ff would present with “double bubble” sign on plain abdominal radiograph? a. Duodenal atresia b. Distal duodenal obstruction c. Annular pancreas d. AOTA 92. A 55 y/o male comes in complaining of intermittent vomiting and significant weight loss of 3 months duration. Upper gastrointestinal series reveals widening of the C-loop of the duodenum. What is your diagnosis? a. Pancreatic head neoplasm b. Cholangiocarcinoma c. TB of the GB d. Cholelithiasis 93. A 25 year old male presenting with abdominal pain and increasing abdominal girth. Upright plain abdominal radiograph shows free air in the left subdiaphragmatic area. What is your diagnosis? a. Small bowel obstruction b. Pneumoperitoneum c. Volvulus d. Gastric neoplasm 94. What is the most common cause of non-traumatic pneumoperitoneum? a. Perforated PUD b. Bowel obstruction c. Necrotizing enterocolitis d. Ruptured diverticulum

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95. What is/are the imaging modality/ies of choice for evaluating the esophagus a. Barium swallow b. Esophagogram c. Barium meal d. AOTA 96. Barium enema for evaluating intussusception can be a. Diagnostic b. Therapeutic c. Diagnostic and therapeutic d. NOTA 97. Which of the ff structures is not retroperitoneal in location? a. Pancreas b. 2nd portion of the duodenum c. 1st portion of the duodenum d. Ascending colon 98. The ff are advantages of MRCP over ERCP EXCEPT: a. Noninvasive b. Uses radiation c. Is less operator dependent d. Allows better visualization of ducts proximal to an obstruction 99. A 60 y/o female who complains 6 month history of crampy diarrhea of loss of appetite, change in bowel habits, melena and weight loss. On barium enema, study shows a mucosal irregularities and a constricting lesion with overhanging shoulders characteristic of an applecore lesion. This finding is suggestive of? a. Diverticulosis b. Amoebiasis c. Crohn’s colitis d. Colonic carcinoma 100. The modality of choice in evaluating the biliary tree a. Ultrasound b. CT scan c. Plain abdominal radiograph d. colonoscopy

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