‘SMALL INTESTINE / APPENDIX LONG EXAMA.¥ 2018-2019 1.) A 38 year old female came in because of epigastric pain, ‘vague in character, 7/10 inthe pain scale,non-radiatingand associated with nausea, no vomiting and no fever. Which ofthe fis the least likely diagnosis a. Acute appendicitis, . Acute cholecystitis >. Acid peptic disease Mesenteric adenitis 2.) A gross specimen was sent to the laboratory after an explore lap resection-anastomosis. The specimen has 2 rosettes and 1 lunette, long vasa recti. The specimen is most likelyto be the a. Duodenum . jejunum 4. Sigmoid 3) A6 ylo patientcame in because of abdominal colicky pain, 1 day PTC had bouts of loose bowel movement on physical exam, and abdomenis globular. The right lower quadrant is empty ‘witha palpable mass atthe right upper quadrant. “The most likely diagnosis is 2. Acute appendicitis b.Intussweption c. Meckel’s diverticulum 4. Volvulus 4.) The more common cause of intestinal obstruction is a. Incarcerated hernia «Tumor b. Adhesions 4 Bezoar 5) Most common site of GIST inthe small intetineis in the a. Duodenum >. Jejunum e.lleum No difference in incidence 6.) The stem cells are usually found in the a. Vill Submucosa Crypts 4. Lamina propria 7) What is the average life span ofthe intestinal stemeell? as days 15 days: b. 10 days 4.21 days 8.) Which of the ff stem cells is responsible forintestinal absorption? a. Enterocytes Paneth cells Goblet cells 4 Enteroendocrine cells 9.) Which of the fTcells secrete growth factors and. anti-microbial peptides? a. Enterocytes Goblet cells Paneth cells 4 Enteroendocrine cells 10.) Upright film ofthe abdomen showed markedly dilated bowels with no visible pelvic gas. The most probable diagnosis a. Mesenteric ischemia ¢ Intestinal obstruction >. Functional lleus NOTA 11.) Which of the fis the most important eriteria in determining the viability of the small intestine a. Peristalsis ». Pulsation Warm to touch .Color 12.) A 33 year patient s/p explore lap came in because of an enterocutaneous fistula which usually drains about 1500 ce of| succus entericus. The best mode of treatment is? a. Hyperalimentation . Antibiotics . Observation 4. Surgery 13,) The main pathology of GIST is the a. loss of heterozygosity ¢ Transduction of KIT ’b. Mismatch repair 4. RAS antigen expression 14,) Carcinoids arise from a. Kultchitsky cells >. Argentaffin cells ¢ Enlerochromaffin cells < AOTA NOTA 15) A patient was diagnosed to have an acute superior mesenteric artery thrombosis. What structures would be involved? 2. Duodenum, Jejunumandlleum only > Jejunum and leum only « Jejunum, eum and Ascending Colon 4. Jejunum only 16.) Most aggressive ofthe adenomas a. Villous ¢ Tubulovillous . Tuberous 4d. Hamartoma 17.) Most common cause of acute appendicitis in children is a Fecalith Ascariasis ’. Lymphoid hyperplasia 4. Carcinoids 18.) Most common cause ofacute appendicitis inadultsis| a Fecalith Ascariasis ’. Lymphoid hyperplasia 4. Carcinoids 19.) Microscopically the hallmark of acute appendicitis is a. wall edema >. lymphocytic infiltration of the muscularis mucosa c-neutrophilicinfiltration of the muscularis mucosa . teal obstruction presents with vomiting early in its course «. Proximal jejunal obstruction may present with vomiting with ‘minimal abdominal distention d. NOTA. 23.) Membrane that attachescecum to posterolateral wall a. Lane’s membrane «Jackson's membrane . McBurney’s point 4. Lade’s band 24.) Which of the ff statements isfare true of Meckel’s diverticulum a. composed of intestinal and gastric mucosa >. the most common complication in adult is obstruction «. due to failure of rotation ofthe intestine @AOTA NOTA 25.) True statements about Crohn’s disease a. 4x higher incidence among Ashkenazi Jewish descent ». inflammation is intramural skip lesionsis prominent @AOTA NOTA 26.) Which ofthe ffstatementsis not trueabout Crohn’s disease a. fistulaformationis common >. presents with cobblestone appearance on xray «surgery is reserved or complications NOTA 27.) The most common benign tumor of the small intestine is, a.GIST Adenoma . Rbroma . Leiomyoma 28,) True statement about GIST except 2. the most common mesenchymal tumor of the small intestine >. defining feature is the gain of function mutation ofthe protooncogene kit «usualy arises from the interstitial cell ofCajal NOTA 29, Hevated s-hydroxyindole acetic acid is sen in Gist «Lymphoma 'b, Metastatic Colon Ca 4. Carcinoid 30.) Acute mesenteric ischemia can be caused by the ff except a. Embolism Vasospasm >. Venous Thrombosis NOTA ©. AOTA 31.) Minimum length of small bowel to prevent short bowel syndrome a.200 em b.300em «400m <4. 500.cm 32.) Thesubstance absorbed in the distal ileum is/are 2. intrinsic factor bealcium Giron d. AOTA 33.) patient came in with draining fistula 6 months after explore lap resection with anastomosis ofthe small intestine. The daily output ‘of the fistula is about 100 ce, The best treatment is a explore lap closure of the fistula antibiotic tx Db hyperalimentation _ d. plug the opening of the fistula 34) The most common location ofthe appendix isin the a.antececal —b.retrocecal¢. promontoric_d. midinguinal 35.) A patient had an Alvarado score of 3. The next step will be a. Immediate appendectomy ’. diagnostic laparoscopy CT scan NOTA 36.) Mostcommon complication of Meckel’s diverticulum onadults a perforation b. bleeding c.obstruction —d. intussuception 37.) The stem cell that do not mature as it reaches the tip ofthe villi a enterocyte goblet cell b.enteroendocrinecells 4 paneth cells 38.) Meckel’s diverticulum arises from a.Omphalomesenteric duct ¢. Urachus ». Vitelline duct NOTA 39.) Hematologic conditions seen after an ileal resection? a. Aplasticanemia__b, Idiopathic Thrombocytopenic Purpura Megaloblastic anemia 4. Hypochromic anemia 40.) Patient underwent ileal resection with ileocolic anastomosis. Which of the freonditionsmaybe seen a. Hypochromic anemia . Aplasticanemia b. Megaloblastic anemia LAOTA 41.) Mucosa of small intestine is made up of the except a. lamina propria Deepithelium « muscularis propria 4d. muscularis mucoseeMATCHING TYPE ahigh grade fever, toxic patient, severe pain >. right lower quadrant pain epigastric pain 4. treacherous clam of duropois €- leukocytosis 42.) Congestive Appendicitis 43.) Suppurative Appendicitis 44.) Gangrenous Appendicitis __45,) Perforative Appendicitis a. esophageal varices bleeding ’. provocative test for insulin €. provocative test for gastrinoma gallbladder contraction «maximal gastric acid secretion 46.) Gastrin 47) Cholecystokinin 8) Secretin 49.) Glucagon 50.) Somatostatin