GI - 2006
1. What is correct regarding the nutritional state screening tool, the Subjective
Global Assessment?
a. The goal is to define exactly the nutritional state of the patient in order
to establish a treatment plan
b. It is a screening tool aimed to generating statistical reports about all the
hospitalized patients
c. In order to estimate a patient with this tool, anamnesis, physical
examination and laboratory results are required
d. This tool enables classifying patients into high risk patients following
their nutritional state, patients in probable risk following their health
state, and patients in normal state
e. It is a mere theoretical tool, as long time is needed for the actual
screening
2. Out of all the patients hospitalized in internal medicine wards, how many are
undernourished (approximately)?
a. 5%
b. 10%
c. 20-30%
d. 40-50%
e. above 80%
3. A 55-yo man attends his general physician with the complaints of diarrhea 8
times, without blood, with abdominal pain and fever up to 38oC from the night.
Upon examination he is in good general condition, no distress, BP 120/80, pulse
80, the abdomen is soft, slightly tender, no signs of peritoneal irritation. Which
of the following conditions is meaningful for starting antibiotic treatment?
a. The abdominal pain is severe and colicky
b. The patient's condition deteriorates, his BP falls and fever increases up
to 39oC
c. Fecal culture grows invasive e.coli (EIEC)
d. The patient's son suffers from similar symptoms
e. The patient has been successfully treated by antibiotics in the past and
he demands the same treatment again
4. A 85-yo man is hospitalized following abundant diarrhea, sometimes bloody,
with deterioration in his general condition. Upon history - a week ago he's been
treated by amoxicillin-clavulonate (augmentin) due to pneumonia. At
examination the patient seem obtunded, diarrhea in large amount, abdomen soft
and tender. Blood test shows leukocytosis of 30,000, low potassium levels (due
to diarrhea), metabolic alkalosis (as part of dehydration process). Fecal sample
for culture and parasites - negative. Feces for clostridium dificile toxin positive. You give the patient fluid infusion and start a specific treatment in
parallel. What is the specific treatment and why?
a. The patient presents a picture of sepsis, thus there is place for wide
range antibiotic treatment
b. The patient has developed a complication following the previous
antibiotic treatment, thus the appropriate treatment now would be
surgical
c. The above tests allow diagnosis of clostridium infection, thus the
treatment would be metronidazol (flagyl)
d. The tests above lack sufficient information, thus colonoscopy is
required before decision of a treatment can be made
e. The tests suggest a clostridium dificile infection, but at the age of 85
this finding can be meaningless, so further investigation is required
5. Which of the following imaging studies is not appropriate for the diagnosis?
-1-
a.
b.
c.
d.
e.
Small intestine obstruction - plain abdominal film
Acute cholecystitis - US upper abdomen
Acute diverticulitis - abdominal CT
Perforated duodenal ulcer - US upper abdomen
Acute appendicitis - abdominal CT
6. From the following findings - what is most appropriate to the diagnosis?
a. Murphy's sign - biliary colic
b. Psoas sign - acute diverticulitis
c. Cullen's sign - acute pancreatitis
d. Rovsing's sign - perforated duodenal ulcer
e. Atrial fibrillation - mesenteric ischemia
7. Which of the following statements is correct regarding diverticulosis?
a. The most common complication is bleeding
b. The age of the patient does not affect the treatment decision in the case
of diverticulitis
c. In part of the patients an abdominal mass can be palpated
d. Diverticulitis can not be diagnosed by abdominal US
e. It is rare that bleeding from diverticuli would be a massive bleeding
8. Addition to survival by adjuvant treatment of stage 3 colon cancer, following
surgical treatment, is:
a. 50%
b. 12%
c. 2%
d. Depends on the differentiation state of the tumor
9. A 5-yo child suffers from iron deficiency anemia. Serological tests show high
level of TTG antibodies. Small intestine biopsy shows flattening of the mucosa.
What is correct?
a. The child suffers from latent celiac
b. The child should begin gluten-free nutrition
c. The dietary recommendations should be postponed until IgA levels are
determined
d. There is no connection between celiac and iron deficiency anemia
10. What is correct regarding inflammatory bowel diseases?
a. Crohn's disease (CD) and ulcerative colitis (UC) are more common in
Jews from the Sephardic origin
b. CD usually begins at the rectum and progresses continually
c. In UC there is no development of large intestinal strictures
d. The extra-intestinal manifestations are similar between the two diseases
e. Toxic mega colon is an uncommon complication of both diseases
11. A 25-yo man suffers for the last month from bloody mucusy diarrhea up to 5
times a day. No fever and no weight loss. There is abdominal pain while
defecating. Sigmoidoscopy shows a continuous disease from the anus up for 50
cm. The most effective treatment is:
a. Rafassal (5-ASA) rectal suppository 1 gram a day for 2 months
b. Rafassal enema 1 gr/d in the evening before sleep for 2 months
c. Rafassal tabs 3 gr/d for an extended period
d. Combination of rafassal PO 3 gr/d for extended period along with
rafassal enemas for 2 months
e. Combination of rafassal PO 3 gr/d for extended period along with
rafassal rectal suppositories for 2 months
12. An infection with helicobacter pylori (HP) will cause during the years:
a. Chronic gastritis in 50% of patients
-2-
b. Duodenal ulcer in 50% of patients
c. Chronic gastritis in most patients and duodenal ulcer in up to 15% of
patients
d. Chronic gastritis in most patients and duodenal ulcer in up to 50% of
patients
e. There is no relation between peptic ulcer and HP infection
13. What is correct regarding peptic ulcer?
a. The incidence of peptic ulcer is higher in patients using NSAIDs,
patients with cirrhosis, IBS and asthma
b. The incidence of peptic ulcer is higher in patients using NSAIDs,
patients with cirrhosis, COPD and chronic renal failure
c. The clinical manifestation is similar in patients with peptic ulcer due to
NSAIDs treatment and those with ulcer due to HP infection
d. Most of the patients with peptic ulcer complain of right upper
abdominal pain that increases with food ingestion and is accompanied
by heartburn and nausea
14. Complications of reflux include all of the following, except:
a. Teeth erosions
b. Chronic cough
c. Recurrent pneumonia
d. Coarseness
e. Gastritis
15. A 65-yo patient presents with difficulty swallowing both solids and liquids for
the last 6 months, along with 6 kg weight loss. The first testing for investigation
of those complaints is:
a. Esophageal manometry
b. EGD (esophago-gastro-duodenal) radiology
c. Gastroscopy
d. pH-metry
e. Impedance testing
16. Which of the following is not characteristic of reflux esophagitis?
a. Basal zone hyperplasia
b. Epithelial atrophy
c. Elongation of lamina propria papillae
d. Intraepithelial neutrophils
e. Intraepithelial eosinophils
17. Which of the following findings is diagnostic of Barrett's esophagus?
a. Intraepithelial eosinophils
b. Gastric type epithelium
c. Intestinal metaplasia
d. Low grade dysplasia
e. Granulomas
18. A biopsy of the lower esophagus with Barrett's esophagus shows glands with
marked atypical changes that invade the sub-mucosa. What is the most
important diagnosis that can be concluded from this picture?
a. Low grade dysplasia
b. High grade dysplasia
c. Invasive adenocarcinoma
d. Intestinal metaplasia
e. Reflux esophagitis
19. The most common complication of duodenal peptic ulcer is:
a. Malignant transformation
b. Perforation
-3-
c. Bleeding
d. Peritonitis
e. Obstruction
20. Which of the following diseases is characterized by presence of large groups of
histiocytes in the intestinal mucosa?
a. Ulcerative colitis
b. Pseudomembranous colitis
c. Amebic colitis
d. Celiac disease
e. Whipple disease
21. Which of the following is characteristic of the disease presented at slide
number 5 (squamous cell carcinoma of esophagus)?
a. Composed of poorly differentiated glands
b. Originates from Barrett's esophagus
c. Develops following esophageal varices
d. In most cases the symptoms appear late in the course of the disease
e. In most cases does not send metastases to lymph nodes and distant
organs
22. All of the following are correct regarding gastric carcinoma, except:
a. The incidence of the tumor is different in different parts of the world
b. The prognosis is related to the stage of the disease
c. The diffuse type shows glandular structures in various sizes and shapes
d. The incidence is higher in patients who have undergone partial
gastrectomy in the past
e. The intestinal type appears on the background of chronic gastritis with
intestinal metaplasia
23. A 22-yo man, who suffers from malabsorption, is brought to a surgery
following obstruction in the ileo-cecal area. The most probable diagnosis is:
a. Crohn's disease
b. Ulcerative colitis
c. Adenocarcinoma of colon
d. Pseudomembranous colitis
e. Peptic ulcer disease
24. The disease presented at slide number 6 (ulcerative colitis) is characterized by:
a. There are granulomas as part of the inflammatory process
b. The rectum is always involved in the disease
c. Crypt abscesses are diagnostic of the disease
d. Signet ring cells are present
e. There is intestinal metaplasia
25. All of the following are correct regarding Crohn's disease, except:
a. There are skip lesions
b. Lymphatic collections are characteristic finding of the disease
c. There are granulomas as part of the inflammatory process
d. The ulcers are superficial, no deeper than the sub-mucosa
e. There is a high incidence of peri-anal lesions
-4-
26. The risk of small bowel lymphoma is increased in:
a. Whipple disease
b. Crohn's disease
c. Celiac disease
d. Ulcerative colitis
e. Giardiasis
27. The following macroscopic findings are characteristic of Crohn's disease,
except:
a. Cloudy and granular serosa
b. Thickened wall
c. Fat surrounding the whole perimeter of the diseased bowel
d. Aphtous ulcer
e. Flask-shaped ulcer
28. What is the name of a non-neoplastic polyp that is composed of coiled glands
with goblet cells and absorptive cells?
a. Hyperplastic polyp
29. Slide number 4 - what is the diagnosis?
a. Juvenile polyp
Possible answers:
1. d
2. d (question was cancelled)
3. b
4. c
5. d
6. c
7. c
8. a
9. b
10. e
11. d
12. c
13. b
14. e
15. c
16. b
17. c
18. c
19. c
20. e
21. d
22. c
23. a
24. b
25. d
26. c
27. e
28. a
29. a
-5-