MCQ Gastrointestinal 2010

1. A 52-year-old man with peptic ulcer disease has been on drug therapy for 3 months.
While on this regimen, he noticed changes in his bowel habits, increasing headaches,
dizziness, skin rashes, loss of libido, and gynecomastia.
Which drug is the most likely responsible for these effects?
A. cimetidine
B. famotidine
C. misoprostol
D. omeprazole
E. ranitidine

2. A 50-year-old businessman came into emergency department after vomiting blood. He

also has history of black stool for 2 weeks. He also admit that he regularly take aspirin if
he has a headache after long and stressful hours of work. On the endoscopic procedure
the doctor found an ulcer on lesser curvature near the pylorus part of the stomach. Which
of the following vessel was most likely to be ruptured on this case?
a. Right gastroepiploic artery
b. Left gastroepiploic artery
c. Right gastric artery
d. Left gastric artery
e. Gastroduodenal artery

3. A 32-year-old man was stabbed on the back; he was brought to a small hospital with a
surgery facility. On the examination his hemodynamic status was stable but he feels
intense pain in the abdomen which radiates to the back. The plain abdominal photos
reveal a free-air under the diaphragm, but the diagnostic peritoneal lavage shows no
bleeding or feces in the peritoneum. Which of the following structure was most likely to
be perforated?
a. Transverse colon
b. Ileum
c. Jejunum
d. Duodenum
e. Stomach

4. A 73-year-old man came to the hospital because of progressive pain on the right upper
quadrant since 1 month ago. He also has history of bleeding stool and constipation since
6 months ago and doesn’t seek a medical help for his condition. On the radiographic
examination you found multiple radio opaque lesions in the liver, dilated large bowel and
a mass-like lesion on the distal colon. Which of the following vessel was the most likely
route of hematogenic spread of the disease?
a. Splenic vein
b. Superior mesenteric vein
c. Inferior rectal vein
d. Hepatic vein
e. Inferior mesenteric vein

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5. A 30-year-old woman suffers a gastric pain and burning sensation all the time and
relieved by food and antacids. Family doctor asks her to get endoscopic examination and
found ulcer in the surface of gastric mucosa. Which organism was most likely to cause
the disease above is
a. Enteroaggregative E. Coli
b. Campylobacter jejuni
c. Yersinia enterolitica
d. Helicobacter pylori
e. Vibrio parahaemolyticus

6. Which swallowing reflex was most likely to be altered on the disease above?
a. Glottic closure
b. Inhibition of respiration
c. Peristaltic ring contraction of esophageal muscles
d. Relaxation of lower esophageal sphincter
e. Contraction of pharyngeal muscles that pushes bolus into the esophagus

7. A 20-year-old student, had difficulty to concentrate while attending class because of

abdominal pain. The pain was very strong and continuous though not in a regular way.
She stays in a rented room and takes her meal when it is convenient to go out. After
visiting the student health center she found out that the pain were caused by
a. Irregular menstrual cycle
b. Spasms of the gastrointestinal tract
c. Decreased motility of the gastrointestinal tract
d. Excessive fluid secretion into gastric lumen
e. Deficiency of pancreatic enzyme

8. Fearing of overweight, a 28-year-old woman has for some time taken an inhibitor of α-
amylase obtained from red kidney beans. She was losing weight because of maldigestion.
Effect of red kidney beans extraction product on digestion mechanism was insufficiency
to carry out
a. Secretion of gastric juice
b. Secretion of pancreatic juice
c. Digestion of oligosaccharides
d. Digestion of glycogen
e. Hydrolysis of maltose

9. A patient presents in the general medicine clinic is treated with a number of prescription
drugs, one of which is misoprostol. Which of the following is the most likely purpose for
which this drug is being administered?
a. routine management of gastroesophageal reflux disease (GERD)
b. prophylaxis for ulcers during long-term therapy with some NSAIDs
c. eradicating H.pylori in patients with acute and recurrent gastric ulcers
d. prevention of acute stress ulcers
e. managing ulcers that tend to develop during pregancy

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10. A 24 year old woman comes to your private practice because of experiencing heartburn
after meals, especially when reclining on her sectional at home. Her symptoms are
typically relieved by antacids. In addition to an H2 blockers or PPI drugs, what additional
agent could help treat her esophagitis by coating necrotic tissue with a protective barrier,
and thereby promote healing of the ulcer?
a. Attapulgite
b. Calcium carbonate
c. Loperamide
d. Mg-Al hydroxide
e. Sucralfate

11. A patient came to your clinic with severe abdominal pain and a ‘burning’ sensation in the
upper abdomen. Endoscopy reveals several benign ulcers in the anthral mucosa of the
stomach. Which of the following drugs is most likely to provide the fastest relief of the
discomfort with just a single dose?
a. Antacid
b. Belladonna alkaloids
c. Omeprazole
d. Misoprostol
e. Propantheline

12. A 21 years old woman, a college student, presents with complaint of abdominal
discomfort in the upper abdomen since 2 weeks ago, everyday but it’s not all day long. It
feels like her stomach bloated. Unpleasant abdominal fullness after a normal size meal.
The pain centered especially at epigastric region, without any radiation. The pain is not
associated with change of position, or rest. Sometimes the meal could relieve the
abdominal discomfort. She said she never experience heartburn, nausea, or vomits. She
denies any dysphagia, odynophagia, fever, or cough. She has no problem with urination
and defecation. She had a regular period; the last period was 3 weeks ago. Endoscopy
reveals no abnormalities. What is the most likely diagnosis?
a. Ulcer like dyspepsia
b. Reflux like dyspepsia
c. Dismotility like dyspepsia
d. Unspecific dyspepsia
e. Organic ulcer dyspepsia

13. A 51-year-old woman presents with abdominal pain, weight loss, early satiety, and night
sweats. On physical exam she appears cachectic, multiple enlarged lymph nodes are
present in her neck (supraclavicular area), and a mass is palpated in the epigastrium.
Laboratory data reveal hemoglobin of 8 g/dL and a normal WBC count.
Which of the following is the gold-standard examination for establishing the diagnosis?
a. Upper GI x-ray
b. Peripheral blood smear

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 c. CT of the abdomen
d. Upper endoscopy with biopsy
e. Exploratory laparotomy

14. A 60 years old man, came to hospital unconscious. From his relatives, we knew that he
rarely feels epigastric pain, nausea and heartburn. Antacid had been taken but there was
no improvement. He has taken aspirin for his heart disease since 5 years ago. There was
no hematemesis and no abnormality on the physical findings. Endoscopic results showed
some erosions and bleeding particularly in the anthrum. What is the most recommended
treatment to prevent this disease?
a. Mucoprotector
b. H-2 receptor blocker
c. COX-2 specific inhibitors
d. Proton Pump Inhibitor
e. Prostaglandin analogue

15. A 34-year-old patient with dyspepsia and epigastric pain, was admitted to the polyclinic.
The lab test result was Hb 12 mg/dl (13-16), WBC 15.000/ul (5000 -10.000), Platelet
300.000 (150.000 - 500.000). The doctor suspected that the patient is suffering from
acute gastritis. What further investigation will help the doctor to confirm his definitive
diagnosis?
a. Plain abdominal photo
b. Endoscopy
c. Culture of Biopsy tissue
d. Culture of Gastric fluid
e. Blood culture

16. A 42-year old male has a 6 months history of epigastric pain and is constant in nature
especially after meals. His passed tarry stool (black stool) over the previous 2 months.
Laboratory of stool’s test showed occult blood. What organ is the most likely to be
affected?
a. Jejunum
b. Gaster
c. Ileum
d. Appendix
e. Gallbladder

17. An 18-year-old man comes to the clinic with fever since 7 days ago. He also complains
constipation, nausea, and vomiting. He brings laboratory test which shown that he got
positive result for Widal test. On the basis of your histologic knowledge which part of the
GI tract was the primary location of infection of the disease?
a. Duodenum
b. Jejunum
c. Ileum
d. Colon
e. Appendix

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A 41-year-old man from overseas come to developing country was admitted to the hospital with
abdominal pain, fever, and diarrhea. He was eating some local food yesterday. There was blood
and mucus on his stool.
18. Which of the following pathogens would most likely be the cause of her illness?
a. Vibrio cholera
b. Shigella dysentriae
c. Salmonella typhi
d. Campylobacter jejuni
e. Giardia lamblia

A 35-year-old woman recently traveled to Aceh one week pasca tsunami. She developed diarrhea
causing hypovolemic shock and metabolic ascidosis. Her symptoms started abruptly, with watery
diarrhea followed by vomiting. She had no fever and denies abdominal pain.
19. What is the most likely organism responsible for her disease?
a. Salmonella typhi
b. Shigella dysentriae
c. Vibrio cholerae
d. Staphylococcus aureus
e. Escherichia coli

20. Which of the following bacterial structure is strongly associated with the disease above?
a. H antigen
b. K antigen
c. Lipopolysaccharide
d. R antigen
e. IgA protease

A female tourist developed gastroenteritis while visiting small town in Indonesia and tried some
Indonesian traditional food. The onset of the disease is abrupt with abdominal cramps and watery
diarrhea. She had no fever or nausea or vomiting. The symptoms have resolved within 24 hour
and no subsequent recurrences. They report the disease to district public health office. The
investigation found that one of the food products eaten by this tourist was contaminated by
suspected pathogens.

21. What is the suspected pathogen may cause the disease above?
a. Salmonella typhi
b. Shigella dysenteriae
c. Enterohemorragic E. coli
d. Staphylococcus aureus
e. Enterotoxigenic E.coli

22. Several children are hospitalized with bloody diarrhea and severe hematologic
abnormalities. A 4 year old girl dies of kidney failure shortly after admittance. An
epidemiological investigation establishes that all of the patients developed symptoms
following consumption of hamburgers from the same fast-food restaurant. Which of the
following organism is most likely to be responsible for the outbreak?

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 a. Camphylobacter jujeni
b. Vibrio cholera
c. Escherichia coli
d. Shigella dysentriae
e. Salmonella typimurium

A 20-month-old boy presents with a diarrhea since 3 days before admission. He is having watery
diarrhea for 3-5 times per day with blood and mucous; not malodorous, and is not bulky or oily.
Physical examination: irritable and lethargic. BP 88/50 Pulse 110, RR 32, temp 38,6 OC. He has
sunken eyes and fontanel; decreased tears; dry mucous membranes; mild delay in elasticity (skin
turgor); and delayed capillary refill. His urine output is less than usual. He is no apparent
distress. His breath sounds are equal and clear. His abdomen is nondistended with positive bowel
sounds. There are no masses and no hepatosplenomegaly. There are no perianal lesions.
23. What is your initial management for this patient?
a. Oral rehydration solution 100-200mL every episode of diarrhea
b. Isotonic IV solution 30 ml/kg/0,5 hours, then 70 ml/kg/2,5 hours
c. Isotonic IV solution 100 ml/kg/3 hours
d. Oral rehydration solution 75 ml/kg/3hrs
e. Oral Rehydration ad libitum (as much as patient desired )

24. A 1-month-old baby presents with a diarrhea since 2 days before admission. He is having
watery diarrhea for 4-6 times per day with no blood no mucous; acid smell, and are not
bulky or oily. Her mother complained that her baby has rash around his buttock. What
substance that is not properly absorbed in the case above?
a. Fats
b. Proteins
c. Carbohydrate
d. Vitamins
e. Minerals

25. A 38-year-old businessman goes to see his doctor with complaints of watery, foul-
smelling diarrhea and flatulence for the past 3 weeks. He reports feeling fatigued since
his return from Kalimantan 2 months previously, and has suffered abdominal cramping
and intermittent loose, nonbloody stools since then. Microscopic examination in stool
specimen shows pear-shaped flagellated trophozoites. Which one of the following
organisms is the MOST likely cause?
a. Fascilolopsis buski
b. Entamoeba histolytica
c. Balantidium coli
d. Giardia lamblia
e. Cryptosporidium parvum

26. A 30- year-old man works on pig farm. He presents with complaints of bloody and
mucoid diarrhea of more than 2 months duration. Laboratory examination of the stools

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 shows 60-70 micron cystic parasites with macronulei. Which of the following is the most
likely diagnosis?
a. Isospora belli
b. Entamoeba histolytica
c. Balantidium coli
d. Giardia lamblia
e. Cryptosporidium parvum

27. A 24-year-old man has been able to eat well for 2 weeks because of vomiting, abdominal
pain, and 3 months watery diarrhea, no blood or mucous. His laboratory results show:
HIV (+), and CD4 is 100/ul. Microscopic stool examination with modified acid-fast
(Kiyoun) stain shows 4 µm oocysts. Which of the following is the most likely diagnosis?
a. Blastocystis hominis
b. Entamoeba histolytica
c. Balantidium coli
d. Giardia lamblia
e. Cryptosporidium parvum

28. A 42 year old, came to emergency department with a mild fever, followed by malaise,
fatigue, nausea and vomiting for 5 days. Acholic stool and darkening urine are also
appeared. Sclera and the skin looked yellow. The liver is palpable 2 cm below the costal
margin, tender and the spleen is enlarged. The patient was unconscious. No prior history
of the disease.
What is the mechanism of the darkening urine through the above case?
a. The unconjugated bilirubin filtered by the glomerulus
b. The red blood cells filtered by the glomerulus and appears in the urine
c. It is appears due to inflammation reaction in the renal
d. The unconjugated bilirubin is water soluble so it can appears in the urine
e. The conjugated bilirubin increase in plasma and filtered by glomerulus

29. A 48-year-old man presents with a complaint of chronic no bloody diarrhea and right
lower quadrant pain with a palpable mass and tenderness. He states that this "flare-up" is
one of the worst he has ever experienced. Radiographic exam reveals evidence of
ulceration, stricturing, and fistula development of the colon and small bowel.
Which of the following drugs would be the most appropriate for treating this patient?
a. Diphenoxylate
b. Loperamide
c. Hyoscyamine
d. Mesalamine
e. Prednisone

30. A 18-year-old HIV-infected patient presented to his primary-care doctor complaining of

chronic, severe, profuse, nonbloody, watery diarrhea. He had nausea and a poor appetite,

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 and had experienced a 10-kg weight loss over the past several months.The patient showed
signs of dehydration on examination. The doctor ordered stool specimens for culture for
enteric pathogens and for routine examination for ova and parasites. The routine culture
was negative for enteric pathogens. Microscopic examinationof the wet preparation from
concentrated sediments of the stool was showed ellipsoid oocyst (25-30 µm). The oocyst
contains two sporoblasts, each of which contains four cigar-shaped sporozoites. Which of
the following is the most likely diagnosis?
a. Blastocystis hominis
b. Cyclospora cayetanensis
c. Cryptosporidium parvum
d. Isospora belli
e. Giardia lamblia

31. A 10-year-old child came with the complants of diarrhea, occasionally with blood and
mucus. Two days ago, the patient complained about the swelling in the anus. On physical
examination was found prolapse of the rectum. On stool examination was found parasite
eggs. The most likely cause is the parasite of spesies :
a. Entamoeba histolytica
b. Balantidium coli
c. Trichuris trichiura
d. Fascilopsis buski
e. Blastocystis hominis

32. A 78-year-old man with chief complain nausea,vomiting, and epigastric pain. He was
given stomach medication, three hour later, he had dyskinesia and rigidity. (extra-
pyramidal sign). Which of the following is the most appropriate drug can cause this?
a. domperidone
b. metoclopramide
c. ondansetron
d. omeprazole
e. sucralfate

33. A 43-year-old woman came to the emergency room with colicky abdominal pain on the
right upper quadrant of the abdomen. On the sonography examination the doctor found a
stone in the duct which drains directly to gallbladder.
Which of the following structure was seen on the examination?
a. Santorin’s duct
b. Wirsung’s duct
c. Common bile duct
d. Cystic duct
e. Hepatic duct

34. A 2-day-old infant was treated in NICU after complicated birth. Suddenly the baby’s
condition worsens and according to the pediatrician needs a central line, so the doctor

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 inserts an intravenous catheter on the baby’s umbilical cord.
Which of the following was the remnant of the structure manipulated by the doctor?
a. Gastrohepatic ligament
b. Anterior coronary ligament
c. Posterior coronary ligament
d. Round ligament
e. Falciform ligament

35. A 45-year-old woman complained to her physician with discomfort and abdominal pain
localized to the right upper quadrant. An abdominal USG showed a multiple diffuse
nodules in liver. Biopsy showed tumor cells that have more prominent nucleoli, coarser
chromatin and Mallory’s hyaline. This finding is typical for:
a. Hepatocellular adenoma
b. Hepatocellular carcinoma
c. Cavernous Hemangioma
d. Cholangio sarcoma
e. Hamartoma

36. A 17-year-old girl intravenous drug user with history of nausea, vomiting and passage of
dark urine was brought into ER with high fever by her mother. Physical examination
revealed icteric sclera, mild jaundice, enlargement liver and several fresh-healed track
marks on her arms. A liver biopsy showed hydrophic degeneration of hepatocytes. Which
of the following liver diseases is most likely to present?
a. Liver cirrhosis
b. Acute hepatitis A infection
c. Acute hepatitis B infection
d. Choleducholithiasis
e. Fatty steatosis

37. A 30-year-old female had epigastric pain and dyspepsia for 3 months. She went to her
internist and a biopsy by endoscopy at distal esophagus was performed. Microscopic
showed the stratum basal of squamous epithelial at distal esophagus thicker than normal,
papillae sub-epithelial also higher than normal and increasing lymphocytes between intra
epithelial. From the microscopic appearance, this finding is typical for:
a. Barrets esophagus
b. Varices esophagus
c. Ulcer esophagus
d. Reflux esophagus
e. Scleroderma

38. A 55-year-old woman whom you examine for the first time feels well. You do a complete
physical examination, which is normal except for a few very small palpable and
moveable, non-tender nodes in both cervical chains. However, her laboratory studies
show the following hepatitis B virus profile: HBsAg (-), anti-HBs (+), low levels of IgG
anti-HBc, HBeAg (-), and anti-HBe (+). What is the most likely diagnosis in this patient?
b. Acute HBV infection, high infectivity

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 c.Late-acute HBV, low infectivity
d. Recovered from HBV infection
e.Chronic HBV infection, high infectivity
f. Immunization with HBsAg vaccine

39. A 51-year-old man comes to your private practice with a history of mid epigastric upper
abdominal pain that diminished by eating or taking antacid tablets. He drinks 2-3 glasses
of beer every night, also taking 2-3 tablets of aspirin frequently for his stress related
headache. PE reveals no evidence for blood in the stool. You advised him to replace the
aspirin with acetaminophen and stop his drinking of beer; you give him a prescription of
famotidine 20 mg bid.
Which of the following is the mechanism of action of famotidine?
a.Eradication of H.pylori
b. Increase of motility
c.Inhibit acid secretion
d. Neutralized gastric acid
e.Protect gastric mucous

40. A 40-years-old woman comes to the Emergency Department with upper abdominal pain
that lasts for several hours. The pain gradually increases in severity, and localizes to the
epigastrium and right hypochondrium, with radiation to the shoulder area. She also
experiences nausea, vomiting, anorexia, and low grade fever. The findings on physical
examination are mild icteric sclerae, epigastric and hypochondrium tenderness,
inspiratory arrest on palpation of the right upper quadrant. What structure is the most
involved from this patient?
a. Liver
b. Pancreas
c. Duodenum
d. Gall bladder
e. Gaster

41. A 45-years-old woman presents with colic abdominal pain suddenly and persist with
severe intensity for 3 hours. She feels steady ache and fullness in the epigastrium and
right upper quadrant with radiation to the right scapula. Colic is precipitated by eating a
fatty meal.
What is the most appropriate laboratory examination?
a. Alkaline Phosphatase
b. SGOT and SGPT
c. Bilirubin
d. Amilase
e. Ca 19-9

42. A 34-year-old woman has the sudden onset of severe abdominal pain. On physical

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 examination she is afebrile. The pain is centered in the mid-epigastric region, though
there is marked diffuse tenderness in all quadrants. Laboratory studies show her serum
amylase is 410 U/L and lipase is 610 U/L. Which of the following laboratory test findings
is most likely to be present in this woman?
a. Hypoproteinemia
b. Positive urea breath test
c. Hyperglycemia
d. Elevated sweat chloride
e. Positive serology for HBsAg

A 43-year-old woman came to a clinic with complains of yellowish color on her eyes and skin.
Five days ago she suffered right upper abdominal colicky pain for several days especially after
eating fatty food. Now the colic is gone for two days.

43. Which substance that most likely to be increase in the serum?

a. Unconjugated bilirubin
b. Albumin
c. Globulin
d. Cholecystokinin
e. Conjugated bilirubin

44. A 60-year-old male, come to the Siloam Hospital with a chief complain of bloody
vomiting. The blood was red and fresh. The patient also tells that his stool was dark. At
physical examination, there are palmar eritema, spider naevi, and ascites at the abdomen.
The USG show a nodul on the right lobule of the hepar. Which of the following test that
can help you diagnose?
a. CA 19-9
b. -feto protein
c. PSA
d. CA-153
e. CEA

45. A 17-year-old male presented jaundice and dark yellow urine. He also complained of
nausea, low-grade fever, loss of appetite, and right hypochondrial pain. Of relevance in
his history was the fact that he had recently eaten raw oysters and return from summer
camps. His physician sent a blood sample for analysis.
46.
Which of the following serological profile was most likely to be detected?
a. Anti-HAV IgM
b. Anti-HBV IgM
c. Anti-HCV IgM
d. Anti-HDV IgM
e. Anti-HEV IgM

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 46. Mr. Satria 59-year-old, came to a clinic with complains of abdominal discomfort since 2
months ago. The physical examination reveals a distended abdomen, ascites (+), liver not
palpable. Laboratory result: Total protein: 4,8 g/dL (N : 5,5 – 8 ), Albumin 2,0 g/dL (N :
3,5 – 5,5), Globulin 2,8 g/dL (N : 2 – 3,5), AST 40 mg/dL (N < 35 mg/dL), ALT 59
mg/dL (N < 40 mg/dL) Alkaline phosphatase: 28 U/L (N :30 – 120), Hb 10,5 gr/dL (N:
13 – 16), Leukocyte 8700 /mm³ (N : 5000- 10800), Platelets 120.000/mm³ (N : 150.000
– 400.000). What is the most possible diagnosis for this patient?
a. Acute hepatitis
b. Dengue Hemorrhagic fever
c. Typhoid fever
d. Cirrhosis hepatis
e. Hepatitis Fulminant

47. A 53-year-old male with history constipation and weight loss has a positive stool occult
blood on a routine rectal examination. A colonoscopy reveals a mass 6 cm in diameter.
Colectomy was carried out. Gross appearance showed a cauliflower-annular encircling
mass in upper portion of descending colon and several lymphnodes of mesocolon around
this mass.
The condition that most likely to present is,
a. Hodgkin lymphoma
b. Squamous Cell Carcinoma
c. Adenocarcinoma
d. Non Hodgkin lymphoma
e. Leiomyosarcoma

A 60-year-old woman came to emergency room because of cramping abdominal pain, vomiting,
distended abdomen, and lack of defecation or flatus for the last 2 days. Abdominal examination
elicited abdominal distention and hyperactive of bowel sound.
48. What is the most likely diagnosis for this case?
a. Pancreatic tumor
b. Gastric carcinoma
c. Perforated appendicitis
d. Colorectal tumor
e. Rectal polyp

49. A 48-year-old woman recently diagnosed with an adenocarcinoma. The oncologist

schedules her for radiation and chemotherapy. Because nausea and vomiting are common
complications, you recommend antiemetic premedication with dexamethasone.
Which of the following drugs would be the most appropriate for this condition?
a.Chlorpromazine
b. Dimenhydrinate
c.Ondansetron

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 d. Prometazine
e.Scopolamine

50. An 8-year-old girl presents in the emergency department with a 24-hour history of
increasingly severe right lower quadrant abdominal pain. The pain began in the
periumbilical region, which was associated with nausea and vomiting. On physical
examination, she has tenderness in the right lower quadrant with rebound, and there is no
mass. On rectal examination also reveals right-sided tenderness. Low grade fever and
mild leukocytosis are present. After surgical management, what is the most likely
pathology?
a. Perforation
b. Acute inflammation
c. Urolithiasis
d. Cystitis
e. Intussusceptions

51. A patient in your office tells you that he had an episode of vomiting bright red blood
twice in a day about 1 week ago, followed the next day by three or four episodes of
vomiting material that looked like coffee grounds. He could not afford to seek medical
help then. The past 3 days he noticed black ‘sticky’ stools and he finally came to see you.
What is your first concern
a. Bleeding colon cancer.
b. Bleeding from lung cancer
c. Crohn’s disease
d. Cirrhosis
e. Bleeding peptic ulcer

52. A 10-year-old boy was too hungry to chew his rice properly before swallowing. His
grandmother warned him, he was not going to get any energy from his food. While his
mother did not agree with his eating style, she also has opinion that he would still have
benefit from his hastily swallowed food. What’s the reason behind her opinion?
a. Rice is a good source of fiber
b. Amylase in rice is easily digested
c. Saliva swallowed with rice contains amylase activity
d. Pancreas excretes amylase and other digestive enzymes
e. Intestinal glands excrete amylase more active than salivary enzyme

53. Reni, a third year university student, wished to cut breakfast time by only taking one fried
egg and a glass of milk in the morning. She never drinks milk since primary school.
However, as soon as the first class started she was feeling cramps in her abdomen and
later on she had diarrhea. Which of these conditions was most likely to cause Reni’s
problem?
a. Gastric protease deficiency
b. Pancreatic amylase deficiency
c. Lingual lipase deficiency
d. Intestinal sucrose deficiency
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 e. Intestinal lactase deficiency

54. At a ladies lunch gathering, Mrs. Rina told her audience not to consider cholesterol as
absolutely harmful to the body and to be drastically avoided. She was actually referring
to one of the benefits of cholesterol which is a precursor for the synthesis of
a.Bile acid
b. Bile pigments
c.Cholecystokinin
d. Cholestyramine
e.Chylomicrons

55. Meri, a 3-year-old girl, came to the Puskesmas with ulcer on her left leg. Through the
history taking it was revealed that Meri had not been well fed in this past year since her
father lost his job. From her physical examination it was found that her BMI (body mass
index) was below -2 SD (standard deviation) for girls of her age. She was fully alert but
looked pale with a face appearance like a thin old person. Her ribs were very prominent
but her both legs were oedema. Based on this information, Meri was likely to be
classified in which condition below?
a. marasmus
b. kwashiorkor
c. marasmic-kwashiorkor
d. energy malnutrition
e. protein malnutrition

56. A 16-year-old woman, brought to a clinic with complains of fearing of being overweight.
She hasn’t got period for more than 3 months. Her weight is dropped from 52 kg to 38
kg, and had difficulties to concentrate, memory problem and also bad smell mouth odor.
She often had headache and faints easily. She also felt anxious and had sleep problem.
What underlying metabolic problem has occurred?
a. The energy source come mostly from carbohydrate
b. The energy source come mostly from protein
c. The energy source come mostly from fat
d. The energy source come mostly from water
e. The energy source come mostly from vitamin

A 42-year-old alcoholic man came into your clinic with severe epigastric pain. The pain comes
abruptly 30 minutes after meal, he also vomit 2 times on that period. On physical examination
you’ve got blood pressure 80/60 mmHg, heart rate 132 x/min, respiratory rate 28 x/min,
temperature 37,4 OC, tenderness and guarding on left upper quadrant, and diminished bowel
sound. Lab result returns with serum amylase 1000 (53-153) and serum lipase 4500 (10-150).
RBS 250 mg/dL (<200 mg/dL)
57. What is the basic pathologic mechanism of the condition above?
a. Infection
b. Malignancy
c. Autodigestion
d. Obstruction
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 e. Perforation

58. What is the basic mechanism that can cause shock in this patient?
a. Fluid loss due to vomiting
b. Fluid loss due to diarrhea
c. Blood loss to the intestinal lumen
d. Blood loss into peritoneal cavity
e. Sequestration of fluid into third space

59. Which of the following drugs is most appropriate to relieve the pain in this patient?
a. Morphine
b. Codeine
c. Pethidine
d. Mefenamic acid
e. Ibuprofen

A 10-month-old boy brought to the emergency department by his mother with abdominal pain
and vomiting in the recent 2 hour. The boy was brought to a pediatrician yesterday because of
diarrhea; the last stool was like red-currant-jelly and has stopped since the boy suffers the pain.
On the examination there is distended and tender abdomen, a palpable mass with sausage-like-
appearance on right side of abdomen, and increased bowel sound.
60. Which of the following findings may be seen on the plain abdominal photos?
a. Air distribution in the sigmoid colon
b. Free-air under the diaphragm
c. Enlargement of the liver
d. Dilated small bowel with air-fluid level
e. Thickening of the wall of appendix

61. Where is the most possible anatomical location of this pathologic condition?
a. Transverse colon
b. Duodenum
c. Liver
d. Ileocecal junction
e. Appendix

62. A 17-year-old male presents to the emergency department with 2 days diarrhea. There is
neither abdominal pain nor blood in the stool. On examination he is dehydrated and
recognized to have infectious diarrhea due to Vibrio cholerae. What is the
pathophysiology of his diarrhea?
a. The toxin migrates through the wall to paralyze the muscular layer
b. The toxin activates intracell enzyme and secretes chloride ions
c. The toxin causes necrosis of the secretory glands of the colon
d. The toxin causes necrosis and slough of the intestinal mucosa
e. The toxin causes irritable bowel syndrome

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63. A 31-year-old man has continuous symptoms of dyspepsia. He takes large amounts of
antacids during and following his meals. Despite this he develops an ulcer. The most
likely cause for this in increased secretion of which hormone?
a. Gastrin
b. Secretin
c. CCK
d. Somatostatin
e. Pancreatic bicarbonate

64. A 46-year-old alcoholic male develops chronic pancreatitis where 95% of pancreas is
destroyed. He continues to lose weight due to problems with digestion of food products.
Which of the following is likely to occur?
a. Steatorrhoea
b. Bloody diarrhea
c. Tarry black stool
d. Mucous diarrhea
e. Watery diarrhea

65. A 24-year-old man is discovered to have colon cancer. It is known that at least 2 family
members developed colon cancer at relatively young ages. What is the most likely
causative mechanism for his cancer?
a. Poor diet
b. Hereditary nonpolyposis colon cancer gene
c. Autosomal tumor suppressor gene (FAP)
d. Obesity
e. P53 gene

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