1) Leukoplakia Refers To:: Description

Gastroenterology Qbank
Gastroenterology
Leukoplakia
1) Leukoplakia refers to:
A. A microscopic lesion
B. Atrophy
C. A cancer
D. A white patch
E. An ulcer
Answer: D* A white patch

Description:
As a result of chronic irritation, white patches in mouth and tongue may appear, they called
leukoplakia
Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan
2) All of the following can cause mouth ulceration, except:

A. Sarcoidosis
B. Herpes simplex type I
C. Syphilis
D. Crohn's disease
E. Behcet's disease
Answer: A* Sarcoidosis
Description:
Sarcoidosis is and inflammatory disease that cause non-caseating granuloma mostly in lung, it
is not known to cause mouth ulcer
Herpes simplex virus type 1 can cause mouth ulcer, while type 2 can cause genital ulcers
Syphilis, CD and Behcet's disease are all a known cause of mouth ulcers
3) All of the following can cause macroglossia, except:

A. Addison's disease
B. Hypothyroidism
C. Down's syndrome
D. Acromegaly
E. Amyloidosis
Answer: A* Addison's disease

Description:
Macroglossia is a term which means "large tongue"
Addison's disease is a disease of adrenal gland in which low levels of cortisone are the main
features which lead to hypotension, Hyperkalemia, hypoglycemia, hyponatremia, and skin
pigmentation; however it is not a cause of large tongue
Congenital hypothyroidism is known to cause short stature, mental retardation, large tongue
and umbilical hernia
In acromegaly: all human organs are enlarged due to excessive production of growth
hormone, and macroglossia is a features
Amyloidosis is a disease in which protein abnormally deposited in organs such as heart,
kidney, but in case it deposited in tongue; macroglossia will manifest
Dr Amjad Afeef – 0798843824 – Amman Jo

4) All of the following are features of herpetic stomatitis, except:

A. Vesicles and ulcers on the buccal mucosa as well as tongue and palate
B. Hepatosplenomegaly
C. Inflamed gums
D. Pain
E. Cervical lymph glands enlargement
Answer: B* Hepatosplenomegaly
Description:
Herpetic stomatitis is an inflammation and ulceration of mouth mucosa (including Gums,
palate and tongue) due to herpes simplex irus type 1
Painful vesicles appear and lymph node are enlarges in the cervical area
Hepatosplenomegaly is not a feature
Dysphagia
5) Dysphagia may occur in all of the following, except:
A. Carcinoma of esophagus
B. Systemic sclerosis
C. Achalasia
D. Candida esophagitis
E. Ulcerative colitis
Answer: E* Ulcerative colitis

Description:
Dysphagia is a difficulty of swallowing that can be caused by tumors, infection,
inflammation, ulceration, anatomical or motility abnormalities in the esophagus
Note that Ulcerative colitis (UC) is an inflammatory disease of GI tract that mainly affect
rectum and colon and never spread proximal to the cecum, UC never affect esophagus, so it
will never cause dysphagia
Other mentioned diseases are known to cause dysphagia
Esophageal Scleroderma
6) The manometric studies in scleroderma patient with esophageal involvement shows:
A. Absence peristalsis, decreased LES tone
B. Absence peristalsis, increased LES tone
C. Positive peristalsis, decreased LES tone
D. Positive peristalsis, increased LES tone
E. None of above
Answer: A* Absence peristalsis, decreased LES tone

Description:
Scleroderma is a generalized disorder of connective tissue that lead to fibrosis of skin, vessels
and viscera
It can affect the esophagus and cause dysmotility
Manometry is the best screening method to detect the esophageal involvement in scleroderma,
in which the motility will be absent and LES tone will be decreased
- Absent peristalsis with increased LES tone is diagnostic for achalasia
- Positive peristalsis with decreased LES tone present in GERD
- Positive peristalsis with increased LES tone present in esophageal spasms

Achalasia
7) Concerning achalasia of the esophagus all of the following are true, except:
A. It occurs more in women about forty years of age
B. There is progressive dysphagia but with periods of remissions and relapses
C. Regurgitation and aspiration pneumonia are common
D. Barium swallow shows dilatation of the esophagus above a smoothie narrowed lower end
E. Treatment of choice is by giving antispasmodics and antibiotics
Answer: E* Treatment of choice is by giving antispasmodics and antibiotics

Description:
Antispasmodics and antibiotics have no role in Achalasia
Achalasia usually present in middle age about 40 year old, female > male, due to failure of
nerve supply (vagus nerve) to LES and esophagus leading to absence of peristalsis in the body
of esophagus and increased LES tone
Longstanding, painless, slowly progressive Dysphagia (to liquid more than solid) with periods
of remission and relapse is the most common symptom
Night cough and pulmonary aspiration may occur due to regurgitation of esophageal content
to the pharynx
Barium swallow will show fluid level with distal tapering (Bird's beak sign)
Treatment:
- Endoscopic pneumatic dilatation of LES (safer than surgery)
- Botulinum toxin injection to LES
- Surgical myotomy (Heller Myotomy) (more effective than pneumatic dilatation)
Diffuse Esophageal Spasm

8) A lady presented with dysphagia to liquids and solids, also chest pain precipitated
by cold drinks and hot tea, by physician prescribes nitroglycerine which relieves
symptoms Most probably she has:
A. Pulmonary embolism
B. Esophageal stricture
C. Esophageal spasm
D. Esophageal compression
E. Ischemic heart disease
Answer: C* Esophageal spasm

Description:
Esophageal spasm is a cause of retrosternal chest pain that is related to hot or cold drinks and
can be relieved by nitroglycerine
To answer this kind of questions you should know that in differential diagnosis of chest pain:
- Cardiac chest pain due to IHD is the most important cause, it presents as typical chest
pain that relieved by nitroglycerine, but if not respond to nitroglycerin for more that
20 minutes you should suspect myocardial infarction, cardiac causes should be ruled
out firstly in any kind of chest pain
- GI causes for chest pain are common and usually related to food

o Of these causes esophageal spasm is related to hot or cold drinks and can be
relieved by nitroglycerine
o Fixed esophageal obstruction like strictures and compression can result in
chest pain and dysphagia but not relieved by nitroglycerine
- Pulmonary embolism cause a pleuritic chest pain not related to food and not
responsive to nitroglycerine
Vomiting
9) All of the following are causes of vomiting, except:
A. Raised intracranial pressure
B. Uncomplicated duodenal ulcer
C. Diabetic ketoacidosis
D. Hypercalcemia
E. Digitalis intoxication
Answer: B* Uncomplicated duodenal ulcer

Description:
Uncomplicated duodenal ulcer usually causes abdominal pain which is relieved by food but
doesn’t cause vomiting
Raised intracranial pressure usually cause pressure effect on the vomiting centre in the
medulla, and cause projectile vomiting not preceded by nausea
Hypercalcemia, digitalis and in case of DKA the H + ions from metabolic acidosis stimulate
the vomiting centre in medulla
Gastroesophageal Reflux Disease

10) All of the following are known complications of gastro-esophageal reflux, except:
A. Anemia
B. Aspiration
C. Barrett's esophagus
D. Motility disturbances
E. Gastric peptic ulcer
Answer: E* Gastric peptic ulcer

Description:
Gastric peptic ulcer is a discontinuation and ulceration of normal stomach mucosa, it is not
caused by GERD
GERD is a reflux of gastric content upward to esophagus, since the gastric content is highly
acidic, it may affect esophageal mucosa by ulceration and bleeding (esophagitis) of cause
dysplasia (Barrett's esophagus) , as well as by affecting motility of the esophagus
If the gastric content reflux to pharynx, it may enter the trachea and cause aspiration
Diarrhea
11) Diarrhea may occur with all of the following, except:
A. Crohn's disease
B. Diabetes mellitus
C. Sarcoidosis
D. Thyrotoxicosis

E. Lincomycin intake
Answer: C* Sarcoidosis
Description:
Diarrhea is an increased volume, frequency, of motions relatively to the usual pattern of the
individual
Sarcoidosis is an immune-mediated condition affecting multiple organs, especially the lungs,
lymph nodes, skin and eyes Gastrointestinal involvement is considered to be a rare
complication of sarcoidosis, occurring in <10% of the patients during the course of the
disease, in fact; sarcoidosis of the GI tract can cause diarrhea but that is very rare
Other mentioned causes are common to cause diarrhea
Crohn's disease is an inflammatory disease associated with bloody diarrhea
Diabetic diarrhea is a troublesome gastrointestinal complication of diabetes This condition
persists for several weeks to months, and it frequently accompanies fecal incontinence The
cause of diabetic diarrhea is not fully understood, but autonomic neuropathy is thought to be
an underlying mechanism
Thyrotoxicosis (hypersecretion of thyroid hormone) usually present with chronic diarrhea
Some antibiotics like lincomycin eradicate normal flora of intestine and cause a condition
called pseudomembranous colitis which present with diarrhea

A. Food poisoning
B. Viral gastroenteritis
C. Inflammatory bowel disease
D. Colonic neoplasia
E. Hypothyroidism
Answer: E* Hypothyroidism
Description:
Diarrhea is an increased volume, frequency, of motions relatively to the usual pattern of the
individual
Hyperthyroidism not hypothyroidism is a cause of diarrhea; note that hypothyroidism present
usually with constipation
Diarrhea may be caused by inflammatory processes in the GI tract like food poisoning,
gastroenteritis, IBD)
Feeding abnormalities (overfeeding, underfeeding or bad feeding) may be a cause
Drug induced diarrhea due to laxative use of antibiotics use
As well as secondary gastroenteritis due to tonsillitis, pneumonia, otitis media … etc

A. Diabetes mellitus
B. Hyperparathyroidism
C. Carcinoid syndrome
D. Zollinger-Ellison syndrome
E. Carcinoma of colon
Answer: B* Hyperparathyroidism
Description:
Hyperthyroidism not hyperparathyroidism is a cause of diarrhea

Diabetic diarrhea is a troublesome gastrointestinal complication of diabetes This condition

persists for several weeks to months, and it frequently accompanies fecal incontinence The
cause of diabetic diarrhea is not fully understood, but autonomic neuropathy is thought to be
an underlying mechanism
Carcinoid syndrome associated with flushing and diarrhea due to tumor secreting serotonin
Colonic neoplasia and colon cancer can be a cause of both constipation and diarrhea
14) Bloody diarrhea is caused by all the following, except:

A. Bacillary dysentery
B. Cholera
C. Colonic carcinoma
D. Ulcerative colitis
E. Schistosomiasis
Answer: B* Cholera
Description:
Cholera is a cause of watery diarrhea not bloody diarrhea The below table shows a differential
diagnosis between infectious watery versus bloody diarrhea
Bloody diarrhea causes Non-bloody diarrhea causes
- Salmonella - Shigella (diarrhea type)

- Shigella (dysentery type) - Entero pathogenic E coli
- Entero invasive E coli - Entero toxigenic E coli
- Entero hemorrhagic E coli - Vibrio cholera
( Shigella toxin
producing)
Carcinoma and ulcerations cause bleeding from mucosa and bloody diarrhea
15) All are causes of infectious diarrhea, except:

A. Giardia lamblia
B. Shigella sp
C. Salmonella sp
D. Yersinia enterocolitica
E. Helicobacter pylori
Answer: E* Helicobacter pylori

Description:
H pylori is a gram negative bacteria that cause ulceration and inflammation of he gastric or
duodenal mucosa,
It is not associated with diarrhea
Other mentioned causes are well known to cause diarrhea
16) A 25 years old man who just arrived from a trip overseas, complains of bloody
diarrhea for few days The least likely cause is:
A. Giardiasis
B. Shigella enteritis

C. Amoebic dysentery
D. Campylobacter infection
E. Ulcerative colitis
Answer: A* Giardiasis
Description:
In tricky questions you should be aware of the presence of distracters
A trip overseas is not an important point in this question
The most important is to differentiate bloody from watery diarrhea causes
The only cause of watery diarrhea is giardiasis
Other mentioned causes can be an etiology for bloody diarrhea
17) The most appropriate intervention to prevent dehydration in patients with watery
diarrhea is:
A. Limit oral intake
B. Intravenous saline
C. Oral rehydration salt (ORS) solution
D. Antimotility agents
E. Antibacterial agents
Answer: C* Oral rehydration salt (ORS) solution

Description:
ORS is the main intervention to prevent dehydration
Note that the question is about prevention before occurrence of dehydration, while treatment
of dehydration depends also on ORS but in severe cases IV fluid may be used
Limiting oral intake will worsen the condition as the patient is losing fluid and electrolytes by
diarrhea and should take adequate amount of them to prevent dehydration
Antimotility agents is not always indicated in diarrhea as diarrhea usually wash out the
infective pathogen outside the body, but Antimotility will delay this and may worsen the
condition
Antibiotics are rarely used in watery diarrhea as it mostly caused by viral infection and
antibiotics cant prevent dehydration
GI Bleeding
18) A 50 years old male presented with massive hematemesis and found to have
splenomegaly, clubbing and palmar erythema You must think of bleeding from:
A. Mallory-Weiss tear
B. Esophageal varices
C. Duodenal ulcer
D. Gastric ulcer
E. Erosive gastritis
Answer: B* Esophageal varices

Description:
Splenomegaly and clubbing raise the suspicion toward the diagnosis of liver cirrhosis,
The main complication of liver cirrhosis that leads to massive hematemesis is esophageal
varices
Other mentioned conditions may associate with hematemesis but not clubbing nor
splenomegaly

19) Which of the following is the commonest cause of acute upper gastrointestinal
bleeding?
A. Acute gastric ulcer
B. Gastric carcinoma
C. Varices (esophageal)
D. Duodenal ulcer
E. Mallory-Weiss syndrome
Answer: D* Duodenal ulcer

Description:
The mentioned choices are all known to cause upper GI bleeding, since peptic ulcer is the
most common cause and mainly duodenal ulcer is commoner than gastric ulcer it will be the
most common cause of UGIB
20) Hematemesis and melena may be caused by all of the following, except:
A. Gastric carcinoma
B. Gastric ulcer
C. Mallory-Weiss syndrome
D. Duodenal ulcer
E. Hypothyroidism
Answer: E* Hypothyroidism
Description:
Hematemesis is defined as vomiting of blood
Melena is the presence of blood of upper GI source in the stool; note that upper GI bleeding
lead to black stool due to digested blood while lower GI bleeds lead to bright red bleeding per
rectum
The mentioned choices are causes for upper GI bleeding except Hypothyroidism which is not
known to cause hematemesis and melena
Hypothyroidism can lead to GI symptoms like constipation
21) Causes of hematemesis include all of the following, except:

A. Peptic ulcer
B. Acute erosive gastritis
C. Gastric carcinoma
D. Pancreatic carcinoma
E. Mallory-Weiss syndrome
Answer: D* Pancreatic carcinoma

Description:
Hematemesis is defined as vomiting of blood, usually caused by upper GI bleeding
Pancreatic carcinoma is not a cause of upper GI bleeding
Peptic ulcer is bleeding from GI mucosa in lower esophagus, stomach or duodenum which
leads to hematemesis and melena
Gastritis and gastric carcinoma are also a cause of hematemesis and melena due to bleeding
from gastric mucosa
Malory-Weiss syndrome is a tear that occur in esophageal mucosa due to forceful vomiting
against closed epiglottis, which leads to bleeding in esophagus and hematemesis

A. Hematemesis and melena in a patient with liver cirrhosis is likely to be due to all of
the following, except:
A. Gastric ulcer
B. Hepatoma
C. Bleeding esophagus varices
D. Duodenal ulcer
E. Abnormal clotting mechanism
Answer: B* Hepatoma
Description:
Hepatoma is a benign tumor of liver which not cause cirrhosis and not known to cause melena
22) Which of the following is considered as a poor prognostic indicator in upper

gastrointestinal bleeding:
A. A presentation of melena rather than hematemesis
B. Young age
C. Chronic rather than acute ulcer
D. Duodenal rather than gastric ulcer
E. Female sex
Answer: D* Duodenal rather than gastric ulcer

Description:
- UGIB secondary to PUD, particularly duodenal ulcers, was associated with
significant morbidity and mortality Early readmissions increased over time
- Duodenal ulcers heal in 4 weeks and gastric ulcers in 8 weeks with PPI therapy
- After H pylori eradication, duodenal ulcer has less recurrence rate than gastric ulcer
- Other mentioned points in question are associated with better prognosis in PUD
bleeding
23) All of the following drugs may produce GI bleeding, except:

A. Salicylates
B. Mg trisilicate
C. Steroids
D. Anticoagulants
E. Phenothiazines
Answer: B* Mg trisilicate
Description:
Mg trisilicate are not known to cause GI bleeding
Drugs that are known to cause GI bleeding are:
- Anticoagulants (eg: warfarin, heparin)
- Antiplatelet (eg: aspirin, clopidogrel, dipyridamole, prasugrel, ticlopidine)
- NSAID's (especially non-selective COX 1 and 2 inhibitors)
- SSRI's (citalopram, escitalopram, fluoxetine, sertraline)
- Steroids (eg prednisolone)
- Antibiotics (eg; macrolides)
- Calcium channel blockers (eg: nifedipine, verapamil, diltiazem)
- Iron supplements
- Antipsychotics (eg: Phenothiazines)

24) All are causes of melena, except:

A. Esophageal varices
B. Bleeding duodenal ulcer
C. Aorto-duodenal fistula
D. Hematobilia
E. Hemorrhoids
Answer: E* Hemorrhoids
Description:
Melena is a black terry stool results from UGIB (digested blood)
Upper GI bleeding: is a bleeding proximal to the ligament of Treitz
Bright blood per rectum is not melena , Hemorrhoid is a cause of lower GI bleeding that is not
a cause of melena but bright red bleeding, Other mentioned causes are known to cause upper
GI bleeding and thus melena
- Esophageal varices: bleeding from esophagus due to variceal formation resulted from
portal HTN
- Bleeding duodenal ulcer: duodenal ulceration and upper GI bleeding
- Aorto-duodenal fistula: abnormal connection between aorta and duodenum  upper
GI bleeding
- Hematobilia: bleeding from biliary tree  upper GI bleeding
25) In acute bleeding from esophageal varices after resuscitation, the treatment of
choice is:
A. Intra-arterial vasopressin
B. Balloon tamponade
C. Endoscopic sclerotherapy
D. Portacaval shunt
E. Gastroesophageal devascularization
Answer: C* Endoscopic sclerotherapy

Description:
In any kind of bleeding the first step is to save your patient and control vital signs
(resuscitation), and stopping the site of bleeding,
Endoscopic band or sclerotherapy is the treatment of choice and can be diagnostic and
therapeutic
Balloon tamponade by Sengstaken-Blakemore tube can be inserted in case of severe bleeding
but it is not used in presence of endoscopy
Portacaval shunt used to prevent recurrence (TIPSS)
Gastroesophageal devascularization is used as last resort if all previous measures fail
Esophageal Webs and Rings

26) The following are recognized features of Plummer-Vinson syndrome, except:
A. Dysphagia
B. Post-cricoid web
C. Clubbing
D. Deficiency of iron
E. Glossitis
Answer: C* Clubbing
Description:

Plummer-Vinson syndrome composed of esophageal web that cause dysphagia and IDA,
glossitis may be present but clubbing is not a feature.
Barrett's Esophagus
27) With regard to Barrett's syndrome esophagus, all are true except:
A. Occurs when columnar metaplasia epithelium replaced the normal squamous epithelium
B. Associated with increased risk of developing esophageal SCC
C. Esophagectomy is warranted if high grade dysplasia is found
D. Operative therapy prevents further progression of the disease
E. It is found in around 10% of patients with long standing GERD
Answer: B* Associated with increased risk of developing esophageal SCC

Description:
In Barrett’s esophagus the Squamous lining of the lower esophagus is replaced by columnar
lining due to chronic exposure to acidity due to GERD.
It is a pre-malignant condition "0.5%/year risk of malignant transformation" can cause
adenocarcinoma of esophagus
Clinically asymptomatic and diagnosed by biopsy
Note that Barrett’s esophagus is associated with adenocarcinoma NOT squamous cell
carcinoma.
Gastritis
28) Acute erosive gastritis is best diagnosed by:
A. History
B. Gastric analysis
C. Endoscopy
D. Double-contrast upper GI
E. Capsule biopsy
Answer: C* Endoscopy
Description:
You can’t differentiate among gastritis, gastric ulcer and non-ulcer dyspepsia based on
clinical presentation only, the gold standard for diagnosis is by upper endoscopy.
29) Hypochlorhydria is caused by all of the following, except:

A. Carcinoma of stomach
B. Pregnancy
C. Pernicious anemia
D. Atrophic gastritis
E. Duodenal ulcer
Answer: E* Duodenal ulcer

Description:
Hypochlorhydria is a term that describe reduction in stomach acidity, doudenal ulcer will not
affect the acidity in stomach.
Parietal cells are responsible to release hydrochloric acid, and when they got dysfunction
hypochlorhydria develop.

Aging, stress, some medications, bacterial infections, and stomach surgeries are also known
causes of hypochlorhydria.
30) Gastrin is produced primarily in the:

A. Gastric fundus
B. Antrum
C. Pylorus
D. Liver
E. Pancreas
Answer: C* Pylorus
Description:
Gastrin is a peptide hormone that stimulates secretion of gastric acid (HCl) by the parietal
cells of the stomach and aids in gastric motility. It is released by G cells in the pylorus of the
stomach (primarily) as well as duodenum, and the pancreas.
Zollinger-Ellison Syndrome
31) The most common site of origin of the tumor associated with the Zollinger-Ellison
syndrome is:
A. Stomach
B. Duodenum
C. Lymph node
D. Spleen
E. Pancreas
Answer: E* Pancreas
Description:
Zollinger-Ellison syndrome is a non-β cell islet tumour of the pancreas (Gastrinoma), lead to
gastric acid hyper-secretion  result in severe ulceration.
90% is located in pancreatic head while the second most common site is proximal duodenum
Peptic Ulcer Disease PUD

32) Helicobacter pylori can lead to all the following except:
A. MALT lymphoma
B. Gastric ulcers
C. Duodenal ulcers
D. Gastric cancer
E. GERD
Answer: E* GERD
Description:
H. pylori is a gram negative bacteria that cause peptic ulcer disease (including gastric and
duodenum), gastric ulcer may become malignant and cause gastric cancer
MALT lymphoma is a known complication if H. pylori infection which is treated by H. pylori
eradication
GERD is not known to be caused by H. pylori.

33) All of the following about peptic ulcer diseases are true, except:
A. Helicobacter pylori is important factor
B. Duodenal ulcer may become malignant
C. Omeprazole is helpful in treatment
D. Zollinger-Ellison is a recognized cause
E. Relapse may occur
Answer: B* Duodenal ulcer may become malignant

Description:
Duodenal ulcer never be malignant and need no biopsy and no need to confirm resolution
with endoscopy after treatment
H. pylori is the most common cause of peptic ulcer disease in developing countries while
NSAID’s are the most common in USA.
Consider Zollinger-Ellison syndrome if ulcers are extensive, severe or at unusual sites like
jejunum, or associated with steatorrhea.
Relapse in peptic ulcer disease is common.
34) All of the following have been associated with chronic duodenal ulcer, except:
A. Hyperparathyroidism
B. Zollinger-Ellison syndrome
C. Chronic pulmonary insufficiency
D. Smoking
E. Pernicious anemia
Answer: E* Pernicious anemia

Description:
Pernicious anemia is associated with atrophic gastritis and malabsorption of B12 but not
known to cause ulcerations.
Hyperparathyroidism and peptic ulcer disease are shown to be in association, some studies
refer this to effect of hypercalcemia on mucus secretion in stomach and duodenum.
Some studies suggest that patients with smocking and COPD has increasing risk of peptic
ulcer disease
35) All of the following drugs are used in the treatment of duodenal ulcer, except:
A. Sucralfate
B. Calcium antagonists
C. Bismuth
D. Pirenzepine
E. H2-receptors antagonists
Answer: B* Calcium antagonists

Description:
Calcium channel blockers are used to treat motility disorders like esophageal spasms but not
ulcerations.
Duodenal ulcer treatment include:
H. pylori eradication (including Bismuth and other antibiotics)
Agents that reduce gastric acid secretions are used, PPI is the most effective, H2 blockers,
sucralfate is an antacid that reduce acidity of the stomach, and Muscarinic receptor
antagonists like Pirenzepine which is M1 antagonist that reduce acidity of the stomach

36) The following drugs are used in the management of peptic ulcer disease, except:
A. Famotidine
B. Sucralfate
C. Omeprazole
D. Anticholinergic drugs
E. Salazopyrin
Answer: E* Salazopyrin
Description:
Salazopyrin is an antiinflammatory agent that used to treat Inflammatory bowel disease, but
not peptic ulcer disease
Antacids, PPI, H2 blockers, and anticholinergics are known to reduce acidity of the stomach
and are used in treatment of peptic ulcer disease.
37) The following drugs are used in the management of peptic ulcer disease, except:
A. Ranitidine
B. Cimetidine
C. Famotidine
D. Omeprazole
E. Mebendazole
Answer: E* Mebendazole
Mebendazole is a medication used to treat a number of parasitic worm infestations, but not
used in peptic ulcer treatment.
Antacids, PPI, H2 blockers, and anticholinergics are known to reduce acidity of the stomach
and are used in treatment of peptic ulcer disease.
38) Cimetidine is:

A. A histamine analogue
B. A liberator of histamine from mast cells
C. An H1-receptor blocker
D. A selective Hl blocker with much less sedating properties
E. A selective H2 receptor blocker which inhibits gastric secretion
Answer: E* A selective H2 receptor blocker which inhibits gastric secretion

Description:
Cimetidine is an H2 blocker that used to reduce gastric acidity, now it become less used
because of its side effects and interactions.
39) All the following drugs are used for H pylori eradication, except:
A. Tetracycline
B. Metronidazole
C. Clarithromycin
D. Amoxicillin
E. Ciprofloxacin
Answer: E* Ciprofloxacin
Description:
Ciprofloxacin is not used in treatment of H pylori.

Triple therapy for H pylori include (amoxicillin, clarithromycin, and PPI)

Quadruple therapy include (metronidazole, tetracycline, Bismuth and PPI)
New Levofloxacin containing regimens now used and provide high success rate.
40) All the following are risk factors to develop gastric ulcer except:
A. Increased fiber in diet
B. NSAIDs
C. Stress
D. Smoking
E. Alcohol
Answer: A* Increased fiber in diet

Description:
Fiber diet has no risk on gastric ulcers.
H pylori infection, NSAID’s are the most common causes of PUD
Patient who has acute illness and stressful trauma should receive prophylaxis against stress
ulcer.
Note that smocking and alcohol are not a risk factors for peptic ulcer disease but they delay
healing of these ulcers
41) The best method to diagnose peptic ulcer disease is:

A. Barium meal
B. Upper gastro-intestinal endoscopy
C. Ultrasonography
D. Labeled RBCs
E. CT scanning of the upper abdomen
Answer: B* Upper gastro-intestinal endoscopy

Description:
Clinically, you cant differentiate between PUD, Gastritis and Non-ulcer dyspepsia.
Upper endoscopy with visualization of the ulcer is the most accurate test to confirm the
diagnosis.
42) Concerning chronic duodenal ulcer all are true, except:

A. It is more common in males than females
B. Pain usually occurs two hours after meals
C. Vomiting is rare unless stenosis has occurred
D. Increased high fasting gastric secretion is usual
E. Malignant change occurs in 5-10% of this ulcer
Answer: E* Malignant change occurs in 5-10% of this ulcer

Description:
Duodenal ulcer is never be malignant while gastric ulcer has 4% risk of malignancy
The other mentioned information about duodenal ulcer is true

43) The most common pathophysiologic mechanism of duodenal ulcer is primarily

related to:
A. Gastric acid hypersecretion
B. Hypergastrinemia
C. Deficient duodenal buffers
D. Rapid gastric emptying
E. Hyperpepsinogen secretion
Answer: A* Gastric acid hypersecretion

Description:
All the mentioned choices are predisposing to duodenal ulcers, but Gastric acid
hypersecretory states increase the risk for peptic ulcer disease (PUD), gastroesophageal reflux
disease (GERD) and gastrointestinal bleeding, and increase the morbidity and mortality
related to these conditions
Gastric acid hypersecretion is the most common pathophysiology in PUD.
Inflammatory Bowel Diseases IBD

44) All of the following about Crohn's disease are true, except:
A. May involve the esophagus
B. Is a transmural inflammation
C. Does not predispose to malignancy
D. Causes a characteristic cobble stones appearance of the mucosa
E. Perforation may occur
Answer: C* Does not predispose to malignancy

Description:
Even though the risk of malignancy is higher in ulcerative colitis, it still present in Crohn’s
disease
Crohn’s is a form of inflammatory bowel disease, may be seen anywhere from the mouth to
anus (including esophagus)
- Non-caseating granulomas are pathognomonic of CD, and not seen in UC
- Skip lesions may be present
- Inflammation in all layers from mucosa to serosa (full thickness)
- Increased goblet cells
- Deep ulcers, skip lesions - 'cobble-stone' appearance (Endoscopy)
- Perforation may occur in CD but not in UC
45) Concerning Crohn's disease, all the following are true, except:
A. It is a chronic transmural granulomatous inflammation
B. It involves the terminal ileum only
C. It commonly presents an abdominal mass, bloody diarrhea and anemia
D. Internal fistula is common
E. Commonly associated with perianal suppuration
Answer: B* It involves the terminal ileum only

Description:

Crohn’s is a form of inflammatory bowel disease, may be seen anywhere from the mouth to
anus (terminal ileum is the most common site)
46) In ulcerative colitis all of the following are true, except:

A. Arthritis may be present
B. Rectum is usually not involved
C. Steroids are used in the treatment
D. It is a pre-malignant condition
E. Toxic megacolon may occur
Answer: B* Rectum is usually not involved

Description:
In Ulcerative colitis, lesions started from rectum and extend proximally but never goes
beyond the ileocecal valve. So in all cases of UC the rectum should be affected.
Seronegative arthritis may occur as extraintestinal manifestations for ulcerative colitis
Malignancy is more common in UC than CD (despite risk is present in both of them)
Toxic megacolon occur in both UC and CD
And finally steroids used to induce remission in inflammatory bowel diseases.
47) Which of the following is true about ulcerative colitis:

A. D-penicillamine is an effective treatment
B. Rectum is involved in most cases
C. Fistula formation is a common problem
D. Skin lesion is characteristic
E. Inflammation involves all the layers of the colon even in early stages
Answer: B* Rectum is involved in most cases

Description:
In Ulcerative colitis, lesions started from rectum and extend proximally but never goes
beyond the ileocecal valve. So in all cases of UC the rectum should be affected.
D-penicillamine is a chelating agent used to treat Wilson’s disease
Fistula, skip lesions and full thickness involvement occur in CD but not UC
48) Systemic complications of ulcerative colitis include all of the following, except:
A. Ankylosing spondylitis
B. Sclerosing cholangitis
C. Keratoderma blennorrhagica
D. Episcleritis
E. Pericarditis
Answer: C* Keratoderma blennorrhagica

Description:
Keratoderma blennorrhagicum is commonly seen as an additional feature of reactive
arthritis in almost 15% of male patients, but not seen in ulcerative colitis.
Complications if UC include:
- Risk of colorectal cancer higher in UC than CD
- Toxic megacolon
- Cholangitis

- Pyoderma gangrenosum
- Ankylosing spondylitis
- Episcleritis
- Pericarditis
- Erythema nodosum
49) Recognized complications of ulcerative colitis include all of the following, except:
A. Cholangitis
B. Arthropathy
C. Toxic megacolon
D. Increased incidence of carcinoma of colon
E. Erythema marginatum
Answer: E* Erythema marginatum

Description:
Erythema nodosum not erythema marginatum is associated with Inflammatory bowel disease
- Toxic megacolon
- Cholangitis
- Episcleritis
- Pericarditis
- Erythema nodosum
50) Complications of ulcerative colitis include:

A. Increased incidence of carcinoma of colon
B. Pyoderma gangrenosum
C. Arthropathy
D. Cholangitis
E. All of the above
Answer: E* All of the above

Description:
- Toxic megacolon
- Cholangitis
- Episcleritis
- Pericarditis
- Erythema nodosum
51) Definite diagnosis of inflammatory bowel diseases by:

A. History
B. Clinical and rectal examination
C. Colonoscopic findings
D. Abdominal ultrasound
E. Histopathology
Answer: E* Histopathology
Description:
Biopsy of the lesion is the most accurate test to establish the diagnosis of either UC or CD
Other mentioned choices has wide differential diagnosis and not enough for confirming the
diagnosis.
52) All of the following symptoms are associated with ulcerative colitis, except:
A. Heartburn
B. Bloody diarrhea
C. Abdominal pain
D. Fatigue
E. Weight loss and anemia
Answer: A* Heartburn
Description:
Heart burn is upper GI symptom while Ulcerative colitis affect the rectum and never extend
proximal to the ileocecal valve, so heartburn is unlikely in UC
Other mentioned choices are known features
53) All of the following investigations are beneficial in the diagnosis of ulcerative colitis,
except:
A. Stool studies
B. Upper endoscopy
C. Colonoscopy
D. Abdominal X-Ray
E. Serologic studies (ANCA)
Answer: B* Upper endoscopy

Description:
There is no role for upper endoscopy in diagnosis of UC, due to the fact that UC affect rectum
and colon
Stool studies usually shows bloody stool, and a protein called calprotectin measured in stool
may predict relapse
Colonoscopy and biopsy is the best test for diagnosis
Abdominal X ray are a useful adjunct to imaging in cases of ulcerative colitis of acute onset.
In severe cases, the images may show colonic dilatation, suggesting toxic megacolon;
evidence of perforation; obstruction; or ileus.
Inflammatory bowel diseases are also associated with antibodies (pANCA and ASCA) that
may help to establish the diagnosis
54) All of the following complications are associated with ulcerative colitis, except:
A. Pyoderma gangrenosum
B. Uveitis

C. Primary sclerosing cholangitis

D. Vitamin B12 deficiency
E. Renal stones
Answer: D* B12 deficiency

Description:
Vitamin B12 is absorbed in the terminal ileum, and ulcerative colitis never extend beyond
ileocecal valve so the terminal ileum will never be affected and B12 absorption will never be
affected.
In Crohn’s disease; the terminal ileum may be affected but still studies shows that Only ileal
resections greater than 20 cm in Crohn's disease predispose to deficiency and warrant
treatment.
Other mentioned choices are known to occur as complications of UC.
55) Cigarette smoking is a risk factor for all of the following, except:
A. Emphysema
B. Peripheral vascular disease
C. Ischemic heart disease
D. Ulcerative colitis
E. Cancer of bladder
Answer: D* Ulcerative colitis

Description:
Despite the catastrophic effects of smoking on the human body, it still proved that smoking is
protective for some diseases like ulcerative colitis.
56) 70 years old male presented abdominal pain; on examination he has irregularly
irregular pulse and bloody diarrhea He gives history of CVA, peripheral vascular
disease and MI You must think of:
A. Ulcerative colitis
B. Pancreatitis
C. Inferior MI
D. Acute mesenteric ischemia
E. Diverticulitis
Answer: D* Acute mesenteric ischemia

Description:
Given the history of atherosclerosis and atrial fibrillation, acute mesenteric ischemia is more
likely since the source of embolus here is well known
Other mentioned choices are still in differential diagnosis but focus on the key point which
examiner gave you in the question.
Liver Diseases and Conditions
Hepatic Encephalopathy
57) Hepatic encephalopathy may be precipitated by all of the following, except:
A. Barbiturate
B. Morphine

C. High protein diet

D. Lactulose
E. Gastrointestinal hemorrhage
Answer: D* Lactulose
Description:
Nitrogenous substances produced by gut bacteria (Ammonia, or Gamma-aminobutyric
acid) usually metabolized by liver and not causing harm
If there is liver failure or the blood bypassing the liver  accumulates in brain  cause
decrease level of consciousness
Precipitating factors are
- Trauma
- Infection
- Heavy protein meal
- GI bleeding (same mechanism as heavy protein meal)
- Hepatotoxic drugs
- Constipation
Note that lactulose decrease the presence of material in GI tract and prevent formation of
Ammonia which will result to decrease risk of hepatic encephalopathy and is also used in
treatment.
58) The following can precipitate hepatic encephalopathy in a patient with liver
cirrhosis, except:
A. Infection
B. High carbohydrate diet
C. Gastrointestinal bleeding
D. Hypokalemia
E. Sedation
Answer: B* High carbohydrate diet

Description:
Hepatic encephalopathy result due to effect of ammonia on the brain
Note that ammonia is formed by protein and bacteria in the gut, so high protein diet not high
carbohydrate diet is responsible for hepatic encephalopathy.
Hypokalemia will result in constipation which predispose to hepatic encephalopathy.
59) Hepatic encephalopathy in a cirrhotic patient may be precipitated by all of the

following, except:
A. Use of diuretics
B. Constipation
C. Narcotics
D. Neomycin
E. Paracentesis
Answer: D* Neomycin
Description:
Neomycin is used in the treatment of hepatic encephalopathy as it kill the ammonia forming
bacteria in gut.
Diuretics may lead to potassium disturbance and results in constipation which predispose to
hepatic encephalopathy

Narcotics metabolism in liver makes additional load and more ammonia will get un-
metabolized by liver
Despite that diagnostic paracentesis is mandatory in all patients with ascites, is still has risk of
SBP, hepatorenal syndrome and hepatic encephalopathy.
60) All of the following are factors precipitating portosystemic encephalopathy, except:
A. Diarrhea
B. Infection
C. Diuretic therapy
D. Narcosis
E. Shunt operations
Answer: A* Diarrhea
Description:
Constipation not diarrhea is a risk factor, Shunt operations like TIPSS will increase risk of
encephalopathy because blood bypassing liver and ammonia easily reach brain
Hepatotoxic drugs are also known to increase the risk.
Cirrhosis
61) All of the following can cause liver cirrhosis, except:
A. Hemochromatosis
B. Hepatitis B, C
C. Budd-Chiari syndrome
D. Hepatitis A
E. Biliary cirrhosis
Answer: D* Hepatitis A
Description:
Liver cirrhosis is fibrosis and nodularity of the liver, it require chronic illness affecting the
liver
Hepatitis A is never be chronic, so it will not result in cirrhosis but can result in fulminant
hepatic failure.
The other mentioned choices are chronic processes and may result in cirrhosis
62) All of the following are signs of chronic liver disease, except:
A. Parotid gland enlargement
B. Increase of body hair
C. Spider Neiva
D. Gynecomastia
E. Palmar erythema
Answer: B* Increase of body hair

Description:
Body hair may be affected in chronic liver disease by changing from male to female type,
gynecomastia also may occur (feminization) because the fact that sex hormones are
metabolized in liver.
Other signs of CLD:
- Ascites

- Coagulopathy
- Asterixis and encephalopathy
- Hypoalbuminemia and edema
- Spider angioma
- Palmar erythema
- Portal HTN  varices
- Thrombocytopenia
- Hepatorenal syndrome
63) The Budd-Chiari syndrome is due to occlusion of the:

A. Hepatic veins
B. Portal veins
C. Mesenteric veins
D. Pancreatic veins
E. Splenic veins
Answer: A* Hepatic veins

Description:
Hepatic vein thrombosis is known as Budd-Chiari syndrome.
It is a very rare diseases that result in RUQ pain, jaundice, ascites, abdominal pain, and may
cause encephalopathy.
There are two forms of the disease which are the acute and the slower form.
64) All of the following can cause hemorrhagic ascites, except:

A. Malignancy
B. Liver cirrhosis
C. Ruptured ectopic pregnancy
D. Abdominal trauma
E. Acute pancreatitis
Answer: B* Liver cirrhosis

Description:
There will be no source of hemorrhage in case of liver cirrhosis, and the fluid will give
transudate picture and SAAG >1.1 and total ascitic protein < 25 g/l
Other mentioned choices may cause bloody or hemorrhagic ascites.
Hemochromatosis
65) A 35 years old male comes for evaluation of abdominal discomfort, tiredness and
arthralgia The examination reveals slate-grey skin pigmentation, hepatomegaly and
hypogonadism Random blood sugar is 250mg/dl The most likely diagnosis is:
A. Cirrhosis
B. Wilson disease
C. Hemochromatosis
D. SLE
E. Chronic pancreatitis

Answer: C* Hemochromatosis
Description:
Liver, skin, pancreas and other endocrine glands are affected by hemochromatosis.
So any patient with signs of liver cirrhosis, DM and skin pigmentation has hemochromatosis
until proven otherwise.
Autoimmune Hepatitis
66) 30 years old female (DM type 1) presented with jaundice, labs show increased in
ALT, AST, positive ANA, ASMA, negative antimitochondrial antibodies and normal
alkaline phosphatase The most likely diagnosis is:
A. Primary biliary cirrhosis
B. Primary sclerosing cholangitis
C. Viral hepatitis
D. Autoimmune hepatitis
E. Hepatocellular carcinoma
Answer: D* Autoimmune hepatitis

Description:
This is a classical picture of autoimmune hepatitis, a young female with signs of hepatitis and
associated other autoimmune disease (like T1DM)
Investigations here excluded obstructive liver diseases as the Alkaline phosphatase normal, so
choice B is excluded.
Antimitochondrial antibodies are present in Primary biliary cirrhosis which is negative here
Note that hepatocellular carcinoma is unlikely in 3 year old female in absence of chronic liver
diseases.
Wilson's disease
67) Wilson disease is a disorder of plasma protein of one of the following elements:
A. Iron
B. Cobalt
C. Zinc
D. Copper
E. Magnesium
Answer: D* Copper
Description:
Wilson’s disease is an autosomal recessive disorder of copper metabolism.
Copper normally absorbed at stomach and proximal small intestine  taken to the liver 
stored  incorporated into ceruloplasmin  secreted to blood
In Wilsons disease: no synthesis of ceruloplasmin  copper accumulation
Jaundice
68) Causes of conjugated hyperbilirubinemia include:
A. Crigler Najjar syndrome type 1
B. Gilbert's syndrome
C. Hemolysis
D. Dubin-Johnson syndrome

E. Carotenemia
Answer: D* Dubin-Johnson syndrome

Description:
Conjugated hyperbilirubinemia results from post hepatic cause,
Dubin johnson syndrome: it is an autosomal recessive disorder in which hepatocyte cant expel
conjugated bilirubin into biliary tree, resulting in retention of bilirubin to blood and jaundice.
Crigler Najjar and Gilbert syndromes are associated with defect in enzyme Glucuronyl
transferase which is responsible for conjugation so thy will result in unconjugated
hyperbilirubinemia.
Hemolysis is a prehepatic cause and results usually in unconjugated hyperbilirubinemia
Carotenemia: is a yellowish discoloration of skin due to prolonged excessive consumption of
carotene containing food like carrot and sweet potato, it is not hyperbilirubinemia at all.
69) Bilirubin in the plasma is tightly bound to which of the following:

A. Gamma globulin
B. Albumin
C. Haptoglobin
D. Ceruloplasmin
E. Fibrinogen
Answer: B* Albumin
Description:
Bilirubin is a part of Hemoglobin, and here is a quick points about its metabolism:
Bilirubin metabolism:
- RBC's destruction in reticuloendothelial system  Heme + Globin
- Globin  amino acids
- Heme biliverdin unconjugated (indirect) Bilirubin  conjugation in liver by
Glucuronyl transferase enzyme  conjugated (direct) bilirubin (water soluble)
secretion to the bile  excretion into intestine.
Bilirubin in intestine:
- Some are De-conjugated and reabsorbed
- Some changed to Urobilinogen  reabsorbed  excreted in urine
- Some changed to stercobilinogen  excreted with stool (main pigment in stool)
70) All of the following are etiologies of conjugated hyperbilirubinemia, except:

A. Dubin-Johnson syndrome
B. Methyltestosterone ingestion
C. Rotor's syndrome
D. Gilbert's syndrome
E. Carcinoma of the ampulla of Vater's nipple
Answer: D* Gilbert's syndrome

Description:
Gilbert syndrome is an autosomal dominant condition in which there is decreased amount of
UDP-glucuronyl transferase enzyme that is responsible for conjugation, resulting in
unconjugated hyperbilirubinemia.
The other mentioned choices are associated with conjugated hyperbilirubinemia.


GI and Nutritional Disorders
Nutritional Disorders
71) One of the following is not a feature of celiac disease:
A. Anemia
B. Weight loss
C. Fever
D. Diarrhea
E. Hypocalcemia
Answer: C* Fever
Description:
Celiac disease is an autoimmune disease, due to exposure to gliadin (gliadin is a product of
gluten breakdown).
This exposure can causes characteristic changes in the lining of the small intestine, resulting
in malabsorption (weight loss, anemia, hypocalcemia, vitamin deficiency
GI symptoms like bloating and diarrhea also present
Fever is not known to occur in celiac disease patient in absence of another causes.
72) The disease characterized by the three symptoms: diarrhea, dementia, and
dermatitis are caused by:
A. Ariboflavinosis
B. Beriberi
C. Scurvy
D. Pellagra
E. Kwashiorkor
Answer: D* Pellagra
Description:
Pellagra is a disease that caused by deficiency of Niacin (Vitamin B3), the main symptoms of
pellagra is dermatitis, dementia and diarrhea
Dermatitis related to pellagra usually causes a rash on the face, lips, feet, or hands. In some
people, dermatitis forms around the neck, a symptom known as Casual necklace.
GI Malabsorption
73) ***) One of the following is not dependent on bile salts for its absorption:
A. Vitamins A
B. Vitamin B
C. Vitamin K
D. Vitamin D
E. Vitamin E
Answer: B* Vitamin B
Description:
Vitamin B and C are a water soluble vitamins, while Vitamins A, D, E, and K are fat soluble.
Fat soluble vitamins dependent on their absorption on Bile salts.
Vitamin B and C don’t need bile salts to be absorbed.


74) Young female presented with leg pain, gum bleeding and Ecchymosis The most
appropriate vitamin deficiency is:
A. Vitamin A
B. Vitamin B12
C. Vitamin C
D. Vitamin D
E. Vitamin E
Answer: C* Vitamin C
Description:
In developed countries, vitamin C deficiency can occur as part of general undernutrition, but
severe deficiency (causing scurvy) is uncommon. Symptoms include fatigue, depression, and
connective tissue defects (eg, gingivitis, petechiae, rash, internal bleeding, impaired wound
healing). Since joints contain a lot of collagen-rich connective tissue, they can also be
affected by vitamin C deficiency and cause leg and joints pain and swelling. In infants and
children, bone growth may be impaired.
Diagnosis is usually clinical. Treatment consists of oral vitamin C.
75) Iron is absorbed at:

A. Stomach
B. Duodenum & Jejunum
C. Ileum
D. Colon
E. Descending colon
Answer: B* Duodenum & Jejunum

Description:
Since Iron need acidic environment for absorption, the best site for absorption is duodenum
To be absorbed it reduced from ferric (Fe+3) to ferrous form (Fe+2) by an enzyme called ferric
reductase enzyme (secreted by enterocyte of duodenum)
Tacking iron on empty stomach or with vitamin C increase acidic environment and enhance
iron absorption.
Factors that increase iron absorption:
- Increased acidity
- Alcohol
- Use of vitamin C supplement
- When iron is complemented with lactose
- Iron of animal source is more absorbable than plant source
Factors that decrease iron absorption:
- Tea drinking
- Use of PPI's or any acid suppressant
- Plant source iron
- Taking iron with food
76) Causes of malabsorption include all of the following, except:

A. Celiac disease
B. Pancreatic insufficiency
C. Intestinal lymphoma

D. Crohn's disease
E. Irritable bowel syndrome
Answer: E* Irritable bowel syndrome

Description:
IBS is functional disorder of large bowel that is not explained by investigations, it is a cause
of pain, diarrhea, constipation but never cause malabsorption.
The other mentioned choices are well known causes of malabsorption.
77) Causes of malabsorption include all of the following, except:

A. Gluten enteropathy
B. Systemic sclerosis
C. Bacterial overgrowth
D. Lymphoma
E. Cholecystitis
Answer: E* Cholecystitis
Description:
Cholecystitis is an inflammation of Gallbladder, presented with RUQ pain, tenderness, and
fever with positive Murphy’s sign.
The bile flow in this case is normal and will not result in malabsorption
The other mentioned choices are known to cause malabsorption.
78) Vitamin B12 is absorbed at:

A. Stomach
B. Jejunum
C. Ileum
D. Colon
E. Duodenum
Answer: C* Ileum
Description:
The main pathway for B12 absorption is the intrinsic factor terminal ileum pathway.
B12 ingested  binds to intrinsic factor at stomach  transferred to terminal ileum 
absorbed
 intrinsic factor secreted by parietal cells of the stomach
 if intrinsic factor is absent  no B12 absorption
 if terminal ileum resected or has bacterial overgrowth  no B12 absorption
79) Calcium, iron and folates are absorbed at:

A. Stomach
B. Upper small intestine
C. Ileum
D. Caecum
E. Descending colon
Answer: B* Upper small intestine

Description:

Here is the site for absorption for different nutrients:

- Stomach: Alcohol.
- Duodenum: Calcium, magnesium, iron, fat-soluble vitamins A and D, glucose.
- Jejunum: Fat, sucrose, lactose, fat-soluble vitamins A and D, water-soluble vitamins,
proteins and amino acids, glucose.
- Ileum: Proteins and amino acids, water-soluble vitamins, vitamin B 12.
- Colon: Water, potassium, sodium chloride, fatty acids from fiber digestion.
80) Primary site of folate absorption is:

A. Jejunum
B. Duodenum
C. Large bowel
D. Stomach
E. Esophagus
Answer: A* Jejunum
Description:
Folic acid is a water soluble vitamin that get absorbed in jejunum and ileum.
- Stomach: Alcohol.
- Ileum: Proteins and amino acids, water-soluble vitamins, vitamin B 12 and bile salts.
81) Regarding vitamins deficiency, one is not matching:

A. Vitamin D deficiency - Rickets
B. Vitamin A deficiency - Night blindness
C. Vitamin K deficiency - Hemorrhage disease of newborn
D. Vitamin B12 deficiency - Megaloblastic anemia
E. Biotin - Pellagra
Answer: E* Biotin – Pellagra

Description:
Niacin (Vitamin B3) deficiency results in disease called Pellagra
Pellagra is a disease that caused by deficiency of Niacin (Vitamin B3), the main symptoms of
pellagra is dermatitis, dementia and diarrhea
Biotin is vitamin B7 and its deficiency can result in anemia, rash, alopecia, dermatitis and
psychological manifestations.
82) Concerning hypovitaminosis all of the following statements are correct, except:
A. Vitamin A deficiency leads to xerophthalmia
B. Vitamin Bl (thiamine) deficiency leads to beriberi
C. Vitamin C deficiency leads to scurvy
D. Vitamin K deficiency leads to bleeding
E. Vitamin B12 deficiency leads to microcytic anemia

Answer: E* Vitamin B12 deficiency leads to microcytic anemia

Description:
Macrocytic anemia with megaloblasts is a result of vitamin B12 deficiency, while microcytic
anemia caused by iron deficiency, thalassemia, lead poisoning, Anemia of chronic disease and
sideroblastic anemia.
83) Which of the following mineral deficiencies is not matching:

A. Fluoride - Dental caries
B. Iodine - Congenital thyroid goiter
C. Potassium - Osteoporosis
D. Zink - Acrodermatitis enteropathica
E. Iron - Spoon nail
Answer: C* Potassium – Osteoporosis

Description:
Vitamin D if deficient or insufficient can lead to either Rickets in infants or osteoporosis in
adults, but hypokalemia manifest usually as arrhythmias constipation and muscle cramps.
84) All of the following statements concerning bile acid are true, except:
A. It is degradation product of old RBC
B. It is essential for digestion and absorption of fat and fat soluble-vitamins
C. It stimulates peristaltic movements
D. It has antiseptic action
E. It is absorbed mostly in the terminal ileum
Answer: D* It has antiseptic action

Description:
Bile acid formed in liver and stored in gallbladder, it is released into the first part of our small
intestine called the duodenum. This is where most of the digestion happens, then it reabsorbed
in the terminal ileum.
In addition to bile salts, bile contains cholesterol, water, bile acids and the pigment bilirubin
(which formed by destruction of old RBC’s). The role of bile (and bile salts) in the body is to:
- Aid digestion by breaking down fats
- Help absorb fat-soluble vitamins
- Eliminate waste products
- Stimulate peristaltic movement of the gut
There is no antiseptic effect of bile acid.
85) The terminal ileum is the absorptive site for which of the following:
A. Glucose
B. Folic acid
C. Bile salts
D. Xylose
E. Iron

Answer: C* Bile salts

Description:
- Stomach: Alcohol.
- Ileum: Proteins and amino acids, water-soluble vitamins, vitamin B 12 and bile salts.
86) Diseased or surgically resected terminal ileum will significantly reduce the
absorption of one of the following:
A. Iron
B. Bile salts
C. Folic acid
D. Vitamin
E. Calcium
Answer: B* Bile salts

Description:
B12 and Bile salts are exclusively absorbed in terminal ileum so they will be the most likely
to be affected
Vitamins other than B12 may be absorbed in duodenum or jejunum, so of the mentioned
choices bile salts will significantly reduced.
87) Which of the following has the greatest effect on enhancing calcium absorption from
the gastrointestinal tract:
A. 25-hydroxycholecalciferol
B. 24,25-dihydrocholecalciferol
C. 1,25-dihydrocholecalciferol
D. Parathyroid hormone
E. Calcitonin
Answer: C*1,25-dihydrocholecalciferol
Description:
To understand this point, you have to know the metabolism of vitamin D
There are 2 sources of Vitamin D:
- From Food: Two types of vitamin D in food:
o Vitamin D2 (plant origin)
o Vitamin D3 (animal origin)
- In Skin: Dehydrocholesterol à vitamin D3 (by UV light)
Then at liver it converted to 25 (OH) D3
In renal system 25 (OH) D3 converted to 24, 25 (OH) D3 (inactive form) or 1, 25 (OH) D3
(active form)
Function of 1, 25 (OH) D3:
- Calcium and phosphate deposition in Bones
- Increase renal reabsorption of calcium and phosphate
- Increase intestinal absorption of calcium and phosphate

So choice C (1,25 (HO)D3 is the active form of vitamin D that enhance absorption of calcium
from intestine.
88) All are fat-soluble vitamins, except:

A. Vitamins A
B. Vitamin B12
C. Vitamin K
D. Vitamin D
E. Vitamin E
Answer: B* Vitamin B12

Description:
A, D, E, K are the fat soluble vitamins while vitamin B and C are water soluble.
Fat soluble vitamins require bile salt and lipase to be absorbed, and their excess will
accumulate in the body and cause a disease.
But water soluble vitamins are excreted in urine (water) and usually not accumulate in excess
amount in the body.
89) Regarding Vitamin A, all the following are true, except:

A. Deficiency can cause keratinization of mucous membrane and skin
B. Overdose may cause pseudotumor cerebri
C. Craniotabes is characteristic in vitamin A deficiency
D. Bile is necessary for absorption
E. Xerophthalmia is a feature of vitamin A deficiency
Answer: C* Craniotabes is characteristic in vitamin A deficiency

Description:
Craniotabes defined as thinning and softening of the skull bones in infants or children
Vitamin D deficiency, marasmus, thalassemia is the main causes and it is not caused by
vitamin A deficiency.
A lake of vitamin A in the body leads to night blindness, xerophthalmia keratinization of
mucous membrane and skin, keratin “Bitot’s spot” or known as Imtiaz’s sign which is the
earliest sign of vitamin A deficiency.
As it is a fat soluble vitamin so bile acid is necessary for absorption.
Excess of vitamin A in the body will result in increased intracranial pressure called
pseudotumor cerebri.

1) Leukoplakia Refers To:: Description

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

1) Leukoplakia Refers To:: Description

Uploaded by

Copyright:

Available Formats

Gastroenterology Qbank

Answer: D* A white patch

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

2) All of the following can cause mouth ulceration, except:

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

3) All of the following can cause macroglossia, except:

Answer: A* Addison's disease

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Dr Amjad Afeef – 0798843824 – Amman Jo

4) All of the following are features of herpetic stomatitis, except:

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Answer: E* Ulcerative colitis

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Answer: A* Absence peristalsis, decreased LES tone

Dr Amjad Afeef – 0798843824 – Amman Jo

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Answer: E* Treatment of choice is by giving antispasmodics and antibiotics

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Diffuse Esophageal Spasm

Answer: C* Esophageal spasm

Dr Amjad Afeef – 0798843824 – Amman Jo

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Answer: B* Uncomplicated duodenal ulcer

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Gastroesophageal Reflux Disease

Answer: E* Gastric peptic ulcer

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Dr Amjad Afeef – 0798843824 – Amman Jo

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

12) Diarrhea may occur with all of the following, except:

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

13) Diarrhea may occur with all of the following, except:

Dr Amjad Afeef – 0798843824 – Amman Jo

Diabetic diarrhea is a troublesome gastrointestinal complication of diabetes This condition

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

14) Bloody diarrhea is caused by all the following, except:

Bloody diarrhea causes Non-bloody diarrhea causes

- Salmonella - Shigella (diarrhea type)

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

15) All are causes of infectious diarrhea, except:

Answer: E* Helicobacter pylori

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Dr Amjad Afeef – 0798843824 – Amman Jo

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Answer: C* Oral rehydration salt (ORS) solution

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Answer: B* Esophageal varices

Dr Amjad Afeef – 0798843824 – Amman Jo

Answer: D* Duodenal ulcer

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

21) Causes of hematemesis include all of the following, except:

Answer: D* Pancreatic carcinoma

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Dr Amjad Afeef – 0798843824 – Amman Jo

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

22) Which of the following is considered as a poor prognostic indicator in upper

Answer: D* Duodenal rather than gastric ulcer

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

23) All of the following drugs may produce GI bleeding, except:

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Dr Amjad Afeef – 0798843824 – Amman Jo

24) All are causes of melena, except: