Minimum Questions of Gastroenterology

Minimum questions of Gastroenterology

1. Characteristic for achalasia, except one A. female predominance B. onset in young age C. accompanied by frequent diarrhoea X D. accompanied by frequent vomitus

2. Which two of the following classifications is used for reflux oesophagitis? A. Vienna classification B. Los Angeles classification X C. Savary-Miller classification X D. Ann-Arbor classification

3. Characteristic for reflux oesophagitis, except one A. heartburn A. weight loss X B. acid regurgitation C. more frequent in obese patients

4. What does the „Mallory-Weiss” syndrome mean? A. bleeding oesophageal varicosity B. praepyloric bleeding ulcer C. liver failure in chronic alkoholic patient D. fissure of the cardiac region with bleeding X

5. The followings are signs of portal hypertensio, except one A. erythema nodosum X B. ascites C. portal gastropathy D. spider naevi

6. In case of reflux oesophagitis, which of the following managements can be suggested? A. elevation of the body weight B. increase of physical activity C. elevation of the leg end of the bed D. elevation of the head end of the bed X

7. Which of the following drugs can worsen the function of the LES? A. Nitrates X B. H2 receptor antagonists C. Prokinetics D. Erythromycin

8. Extraoesophageal manifestations of reflux oesophagitis, except one A. chronic bronchitis B. dental erosiones C. Mallory-Weiss syndrome X D. Chronic laryngitis 9. Which of the following drugs are the most effective in the treatment of symptoms of reflux disease? A. H2 receptor angatonists B. ACE receptor antagonists C. Prokinetics D. Proton pump inhibitors X

10. What does the expression: „odynophagia” mean? A. pain during chewing B. dyscomfort following swallowing C. pain following swallowing X D. heartburn

11. Important tasks in case of acute corrosive damage of the oesophagus, except one: A. analgesia B. balloon dilatation X C. antibiotics D. steroid

12. When is endoscopy indicated in case of acut corrosive damage of the oesophagus? A. within the first 6-8 hours X B. after one day C. after 3 days D. not indicated

13. Which of the following sings mean: major risk for variceal bleeding? A. insufficient closure of the cardia B. Shatzki-ring C. Dilation of gastric varices D. Cherry red spot X

14. Which of the following can be cause of iron deficiency anemia in elderly? A. hiatal herniation X B. mycosis of the oesophagus C. atrophic gastritis D. achalasia

15. Where is iron absorbed from the gastrointestinal tract? A. stomach B. distal ileum C. proximal jejunum X D. distal jejunum

16. What is absorbed of the following substances in the terminal part of ileum? A. Iron and calcium B. Bile acids and vitamin B12 X C. Glucose and unsaturated fatty acids D. Iron and vitamin B12 17. Which of the following antibodies are charateristic in coeliac disease? A. Anti-endomysium ab B. Anti gliadin ab C. Anti transglutraminase ab D. All of the above X

18. Which type of antibodies are of clinical significance in coeliac disease? A. IgM type antibodies B. IgG type antibodies C. IgA type antibodies X D. All of the above

19. What kind of morphological alterations are characteristic in coeliac disease? A. villous atrophy of the intestine X B. Crypt abscessus of the intestine C. Bacterial deposits in the basal membrane of the intestine D. All of the above

20. What are the two most important clinical signs in coeliac disease? B. macrocytic anemia A. diarrhoea X C. hypercalcaemia D. malnutrition X

21. Helicobacter pylori infection is accepted to play role in the following diseases A. duodenal ulcer, ulcerative colitis, gastric cancer B. Duodenal ulcer, MALT lymphoma, gastric cancer X C. Ventricular ulcer, Crohn’s disease, MALT lymphoma D. Gastric cancer, Reflux oesophagitis, duodenal ulcer

22. Which of the following is the most widely used diagnostic test of Helicobacter pylori infection? A. urea breath test X B. H2 exhalation test C. Microbiologic cultivation D. Serologic test

23. Which two of the following combinations is most often used for H. pylori eradication? A. 2x PPI + 2x1000 mg Amoxicillin + 2x500 mg Clarythromycin X B. 2x H2 receptor antagonist + 2x1000 mg Clarythromycin + 2x500 mg Amoxicillin C. 2x PPI + 2x1000 mg Clarythromycin + 2x1000 mg Metronidazol D. 2xPPI + 2x500 mg Clarythromycin + 2x500 mg Metronidazol X

24. Which of the following pathologic alterations is of special interest in the development of gastric cancer? A. chronic gastritis B. chronic atrophic gastritis X C. eosinophilic gastritis D. erosiv gastritis 25. Which pathologic finding should be considered as premalignant in the stomach? A. hyperplastic polypus B. intestinal metaplasia C. portal gastropathy D. atrophic gastritis with dysplasia X

26. What are the types of gastric cancer according to Lauren classification? A. intestinal type and diffuse type X B. anaplastic type and diffuse type C. polypoid type and intestinal type D. polypoid type and diffuse type

27. What of the following signs may suggest gastric cancer? A. male sex, age under 40, iron deficiency anaemia, chronic diarrhoea B. female sex, age above 40, weight loss, right upper quadrant abdominal pain C. male sex, age above 40, weight loss, iron deficiency anaemia, X D. female sex, age under 40, iron deficiency anaemia, right upper quadrant abdominal pain

28. Which is the most frequent place of gastric cancer? A. cardiac region B. back wall of the stomach C. front wall of the stomach D. antrum of the stomach X

29. What does Barrett metaplasia mean? A. intestinal metaplasia in the distal segment of the oesophagus X B. gastric metaplasia in the distal segment of the oesophagus C. chronic inflammation in the distal part of the oesophagus D. eosinophil infiltration in the distal part of the oesophagus

30. Which of the following clinical signs would suggest gastric perforation? A. sudden unset of epigastric pain, vomitus, fever, cough B. left upper quadrant pain, diarrhoea, fever, cough C. sudden unset of epigastric pain, disappearing of liver dullnes, nausea X D. right lower abdominal pain, subileus, fever, vomitus

31. Which of the following drugs is known to cause acute pancreatitis? A. Digoxin B. Methotrexat C. Penicillin D. Azathioprin X

32. What are the Ransone and the Appache II score used for? A. to describe the severity and prognosis of septic shock B. to describe the severity and prognosis of liver failure C. to describe the severity and prognosis of acute pancreatitis X D. to describe the severity and prognosis of acute cholangitis 33. What diagnosis would you suggest in case of the following complains: fever, right upper quadrant pain, vomitus, jaundice? A. acute pancreatitis B. acute cholangitis with stone X C. acut appendicitis D. liver abscess

34. What of the following symptoms is most characteristic for acute pancreatitis ? A. deep pain in the umbilical region, subileus, vomitus, hypocalcaemia X B. intensive epigastric pain, diarrhoea, fever, hypoglycaemia C. intensive right upper quadrant pain, vomitus, fever, diarrhoea D. intensive left lower abdominal pain, subileus, hypercalcaemia, blood in urine

35. Which of the following lists of managements is the most relevant in severe acute pancreatitis? A, Antibiotics, volume replacement, lipid-free diet, laxativum B. Volumen replacement, „zero diet”, NSAID painkiller, antibiotics C. Volume replacement, antibiotics, nasojejunal feeding, PPI, X D. Antibiotics, nasojejunal feeding, loperamid, PPI

36. Which viral infection has the most pronounced tendency for chronicity? A. Hepatitis A virus B. Hepatitis delta virus C. Hepatitis B virus D. Hepatitis C virus X

37. What of the following clinical data are characteristic in obstructive jaundice? A. Elevated GGT, elevated alkaline phosphatase, elevated conjugated bilirubin level X B. Elevated GGT, elevated alkaline phophatase, elevated unconjugated bilirubin level C. Elevated GGT, elevated, AST(GOT), elevated LDH levels D. Elevated AST(GOT), elevated ALT(GPT), elevated conjugated bilirubin level

38. What of the following data would suggest alkoholic liver disease? A. macrocytic anaemia, elevated ALT (GPT) level, elevated unconjugated bilirubin level B. Microcytic anaemia, elevated GGT, elevated CDT (carbohydrate depleted transferrin), , elevated iron level C. Macrocytic anaemia, elevated GGT, elevated CDT (carbohydrate depleted transferrin), lover folic acid level X D. Microcytic anaemia, elevated AST (GOT), elevated CDT (carbohydrate depleted transferrin), elevated unconjugated bilirubin level

39. What laboratory parameter can be of help in the diagnosis of portal encephalopathy? A. plasma ammonia level X B. plasma bilirubin level C. plasma glucose level D. plasma LDH level 40. What is „ligation” used for? A. treatment of duodenal ulcer bleeding B. treatment of oesophageal variceal bleeding X C. treatment of portal gastropathy D. treatment of gastric polyps

41. Which two of the following drugs are accepted for usage for the reduction of portal hypertension during variceal bleeding? A. Terlipressin X B. Vasopressin C. Noradrenalin D. Octreotid X

42. What can be used for the long lasting drug treatment of portal hypertension? A. Ca channel blockers and nitrates B. Ca channel blockers and prokinetics C. Beta receptor blockers and nitrates X D. Beta receptor blockers and prokinetics

43. What can be used for the treatment of oesophageal variceal bleeding, except one A. sclerotherapy B. LMWH X C. Histoacrilate D. Sengstaken-tube

44. What of the following laboratory parameters can be used for the evaluation of liver capabilities, except one A. APTT B. Albumine level C. Cholinesterase level D. Blood urea nitrogen level X

45. What of the following parameters predispose to gallstones, except one A. obesity B. male sex X C. female sex D. age above 50 years

46. What has to be replaced on the long run, following gastric resection? A. Vitamin B12 X B. Vitamin D C. Vitamin E D. Iron

47. Which of the following drugs may cause gastro-duodenal ulceration, except one A. NSAIDs B. Aspirin C. Steroids D. Beta blockers X 48. What is the most frequent cause of liver abscess formation? A. cytomegalovirus infection B. amoebiasis X C. salmonellosis D. ornithosis

49. Which of the following infections has an oral route? A. Hepatitis C B. Hepatitis B C. Hepatitis E X D. Cytomegalovirus

50. Which organ is the most frequently involved in metastasis formation among gastrointestinal tumours? A. Lung B. Suprarenal glands C. Spleen D. Liver X

51. Where does the endosonography play the most important role? A. in staging of pancreas neoplasm B. in staging of gastric cancer C. in staging of oesophageal tumours X D. in staging of colon tumours

52. Which of the following gastrointestinal tumours has the worse prognosis? A. gallbladder cancer X B. gastric cancer C. colon cancer D. rectal cancer

53. What is the most widely used chemotherapeutic agent in gastrointestinal tumours? A. methotrexat B. adriamycin C. 5-fluoro-uracyl X D. cisplatin

54. What would be the possible diagnosis if resistance in the right lower abdominal region is palpated, diarrhoea is present, mild signs of malnutrition can be observed and a fistula in the perirectal region is found?: A. ulcerativ colitis B. neoplasm in the coecum C. Whipple disease D. Crohn’s disease X 55. What is of help in the differentiation from clinical point of view, between Morbus Crohn and ulcerative colitis?

A. depth of mucosal lesion and segmental appearance X B. depth of mucosal lesion and extracolonic manifestations C. colonic involvement and extracolonic manifestations D. laboratory parameters and colonic involvement

56. Which of the following disorders can more frequently accompany IBD? A. dermatitis herpetiformis Duhring B. primary biliary cirrhosis C. Barrett oesophagus D. Primary sclerotizing cholangitis X

57. Portal hypertension with ascites is caused by the following disorders, except one A. Budd-Chiari syndrome B. Dubin-Johnson syndrome X C. Vena portae thrombosis D. Congestiv right heart failure

58. What is characteristic of the Zollinger-Ellison syndroma, except one A. elevated gastrin level B. multiple gastro-duodenal ulcers C. constipation X D. BAO/MAO is above 60%

59. What is the most frequent benign colonic disorder in the elderly people? A. ulcerativ colitis B. diverticulosis X C. haemorrhoidal nodes D. familiar polyposis

60. What is the newest, biologic treatment option in Crohn’s disease with fistulas? A. Infliximab X B. Salazopyrin C. Budesonid D. Azathioprin

61. Which of the following hystologic findings should be considered as premalignant? A. villous adenomatosus polyp X B. tubular adenomatosus polyp C. hamartoma D. hyperplastic polyp

62. What is characteristic of Gilbert’s disease? A. mild elevation of conjugated bilirubin, especially following physical activity B. mild elevation of unconjugated bilirubin, especially following physical activity (X) C. mild elevation of blood uric acid, especially following physical activity D. mild elevation of lactate dehydrogenase levels following physical activity 63. What are the main tasks of endoscopy, except one A. pH measurement X B. hystologic specimen taking C. removal of polyps D. diagnostic overview of the mucosal surface

64. What is the rectal digital examination used for, except one A. to discover ampullary tumours B. to check hemorrhoid nodules C. to discover diverticulosis X D. to check hypertrophy of the prostate

65. What are the most frequent benign causes of hematochesia, except one A. haemorrhoids B. benign hyperplastic polyps X C. ulcerative procto-colitis D. diverticulosis

66. What is the stimulant, used for BAO/MAO investigation? A. histamin B. caffein C. pentagastrin X D. atropin

67. All of the following drugs can deteriorate portal encephalopathy, except one A. lactulose X B. diazepam C. furosemid D. barbiturate

68. What are the most frequently discovered gastrointestinal tumours in Europe? A. 1. Colorectal tumours, 2. Gastric tumours, 3. Pancreatic cancer X B. 1. Gastric tumours, 2. Gall bladder tumours, 3. Colorectal tumours C. 1. Pancreatic cancer, 2. Colorectal cancer, 3. Gastric cancer D. 1. Colorectal cancer, 2. Gastric cancer, 3. Metastatic liver tumours

69. What is the most favourable choice in the treatment of acute pancreatic pseudocyst, larger than 6 cm? A. nasojejunal feeding up to 6 weeks X B. transduodenal or transgastric endoscopic drainage C. surgical drainage, i.e. marsupialization D. zero diet for 2 weeks and antibiotics

70. What are the most frequent indications of ERCP, except one A. mechanic obstruction of the biliary tract B. common bile duct stone C. gall stones X D. suspected tumours of the papilla Vateri 71. What is the recently developed alternative investigation to diagnostic ERCP? A. EUS B. MRCP X C. HIDA D. PTD

72. If ileus is suspected, which of the following examinations is the most relevant? A. abdominal ultrasound B. native abdominal X-ray X C. enema D. barium passage investigation

73. Elevated gamma glutamyl transpeptidase level is associated to the following causes, except one A. recent use of penicillin X B. chronic alkoholism C. resent use of anti-epileptic drugs D. primary biliary cirrhosis

74. Which is the predominant localisation for gastrointestinal lymphomas? A. appendix B. stomach X C. ileum D. colon

75. Which two of the following statements are true for carcinoembryonal antigen (CEA)? E. reduction of CEA level following operative treatment is a good prognostic sign X A. normal serum CEA level is exclusive for gastrointestinal malignancy B. serum CEA level is exclusively elevated in colorectal cancer C. re-elevation of CEA after operative treatment is suggestive of disease progression X

76. Which of the following tumour markers is the most specific for gastric cancer? A. CA 125 B. CA 72-4 X C. CEA D. AFP

77. Which of the following statement is correct for diverticulosis? A. The development of diverticulosis may progress with the congestion of fibers B. Diverticulosis is predominantly seen in the right colon and the coecum C. Diverticulosis is rare among people above 60 years D. Diverticulitis is generally consequence of covered perforation of diverticula X 78. H2 exhalation test can be used for the investigation of the following problems, except one A. Helicobacter pylori infection X B. Oro-coecal transit time C. Dysbacteriosis D. Lactase deficiency

79. Above which pressure gradient in the porto-systemic circulation does the risk of variceal bleeding significantly increase? A. 2 Hgmm B. 20 Hgmm C. 12 Hgmm X D. 30 Hgmm

80. Elevated alkaline phosphatase and elevated gamma glutamin transpeptidase levels are characteristic in the following disorders, except one A. jaundice of mechanic origin B. hepatitis A virus infection X C. primary biliary cirrhosis D. primary sclerotizing cholangitis

81. The following alterations are characteristic for both ulcerativ colitis and Crohn’s disease, except one A. mucosal ulceration B. perianal fistulas X C. pseudopolyp formation D. diarrhoea

82. Which two of the following symptoms are characteristic in Wilson’s disease? A. Kayser-Fleischer ring X B. Low plasma levels of coeruloplasmin X C. Hyperuricaemia D. Hypocalcaemia

83. What is the Forrest classification used for? A. description of polyp size B. description of reflux oesophagitis C. description of grade of varicosity D. description of peptic ulcer bleeding X

84. What are the main indications for TIPS implantation? A. Recurrent variceal bleeding, therapy refraktory ascites X B. Recurrent variceal bleeding, progredient portal encephalopathy C. Therapy refraktory ascites, haemorrhoidals D. Therapy refraktory ascites, progredient portal encephalopathy

85. The following list contains possible complications of duodenal ulcer, except one A. penetration B. carcinoma X C. bleeding D. pylorus stenosis

86. What is the surgical management of gastro-oesohageal reflux? A. Heller myotomy B. Billroth I. resection C. Dixon resection D. Nissen fundoplication X

87. All of the following clinical conditions can later lead to malignancy, except one A. proctocolectomy X B. gastric resection C. chronic reflux oesophagitis D. ulcerativ colitis

88. What is the correct treatment of maldigestion in chronic pancreatitis? A. sufficient enzyme supplementation X B. diet, rich in lipids C. frequent, large volume meals D. sufficient vitamine supplementation

89. The following complications can be associated with coeliac disease, except one A. intestinal lymphoma B. gout X C. steatorrhoea D. diarrhoea

90. What is true of the following statements in hereditaer non-polypotic colon cancer? A. it is more frequent in the right colon, it may develop under the age of 40 years X B. it is more frequent in the left colon, it generally developes above the age of 60 years C. it is more frequent in the left colon, it developes under the age of 40 years D. it is more frequent in the right colon, it developes generally above the age of 60 years

91. What is true of the following statements, regarding adenomatous colon polyps, except one A. they are mainly located in the left colon B. their size is in correlation with malignant transformation C. all of them are bleeding X D. villous types have higher risk to progrediate into cancer than tubular types

92. Which of the following sequences can be accepted according to present knowledge? A. chronic atrophic gastritis, dysplasia, intestinal metaplasia, cancer B. intestinal metaplasia, chronic atrophic gastritis, dysplasia, cancer C. intestinal metaplasia, dysplasia, chronic atrophic gastritis, cancer D. chronic atrophic gastritis, intestinal metaplasia, dysplasia, cancer X

93. What does it mean: ulcer, Forrest II.A? A. ulcer with spurting arterial bleeding B. ulcer with firmly attached clot C. ulcer with oozing bleeding D. ulcer with visible vessel stump X

94. What is the main risk of Barrett metaplasia in the oesophagus? A. development of lymphoma B. development of adenocarcinoma X C. development of squamous cell carcinoma D. development of epithelial cell carcinoma

95. Which of the following clinical conditions has an increased risk for the development of hepatocellular carcinoma, except one A. Chronic B virus infection B. Haemochromatosis C. -1 antitrypsin deficiency D. non-alkoholic steatohepatitis X

96. What of the following clinical conditions is accompanied with the highest mortality? A. acute mesenterial ischaemia X B. acut appendicitis C. acute peritonitis D. acute biliary osbtruction

97. What is the probable rate of Helicobacter pylori positivity in gastric peptic ulcer in Europe? A. 20-30 % B. 50-70% X C. 90-95% D. 5-10%

98. What is the probable diagnosis of a young female, with recurrent episodes of fever, diarrhoea, accompanied with mucous stool, sometimes also bloody stools? A. irritable bowel syndrome B. non-tropical sprue C. lactase deficiency D. ulcerativ colitis X

99. What is the most relevant treatment for chronic hepatitis C virus infection? A. pegylated interferon + ribavirin X B. pegylated interferon + lamivudine C. ribavirin + lamivudine D. ribavirin + alfa interferon

100. What kind of antibiotics may be used in the treatment of Crohn’s disease A. Azithromycin, metronidazol B. Metronidazol, ciprofloxacin X C. Ciprofloxacin, doxycyclin D. Doxycyclin, metronidazol