GIT & LIVER MODULE-II PAST PAPERS 3RD YEAR

ESOPHAGUS
 Barrett esophagus predisposes to what condition? Esophageal adenocarcinoma
 Pink columnar epithelium in lower esophagus? Barret esophagus
 Barrett’s esophagus? Columnar metaplastic
 Condition not predisposing to CA esophagus? Plummer Vinson syndrome, Zenker’s diverticulum,
Achalasia, Epidermolysis bullosa, Ectodermal dysplasia
 Regarding Achalasia? Decreased resting lower esophageal tone, Absence of myenteric plexus
 Achalasia triad? Inability of LES to relax + aperistalsis + ↑LES tone
 Management of Achalasia? Heller’s myotomy
 Hx of heart burn, endoscopy showed red esophageal mucosa near GE junction, dx? Barrett’s
esophagus
 Woman with severe retching & vomiting? Mallory Weiss
 Reflux esophagitis exacerbated by? Reflux of bile
 Morphology of GERD? Basal zone hyperplasia 20%
 Not a risk factor for GERD? Multiple small meals
 Esophagitis in immunocompromise? CMV
 A patient has anemia, dysphagia, atrophic glossitis. Diagnosis? Plummer Vinson syndrome
 60yr old man with progressive dysphagia has irresectable esophageal tumor. What Treatment will you
offer to relieve his dysphagia? Perform surgery, Band ligation, Endoscopy with metallic stent
placement
 Palliative care surgery? Esophageal stenting
 Surgical indication of esophageal varices? Cause other than cirrhosis or Child A
 Most common esophageal cause of hematemesis? Esophageal varices, Mallory Wiess tears
 A man of 55 yrs. age, vomited 2 cups of blood in his office. Has distended abdomen? Bleeding due
to esophageal varices.
 Varices can be detected by? Venogram
 Endoscopic banding? Management of varices to stop bleeding
 Initial management of hematemesis? Plasma expanders/ Terlipressin/ balloon ligation
 What do we do if sclerotherapy fails to stop variceal bleeding, once? And then it again bleeds after 12
hrs.? Do it again
 Histopathological form of squamous carcinoma of esophagus? Pedunculated, Exophytic, Flat,
 Most common site of squamous cell carcinoma of esophagus? Middle part of esophagus
 Except rare cases, carcinoma of esophagus: Epithelial, Connective tissue
STOMACH
 Burning in epigastrium not relieved by PPI? Test for H. pylori
 A male patient complains of abdominal fullness & bloating after having a meal since__. He also
reports to have lost 5 kg weight over a period of__. How will you further manage the patient?
Endoscopy, H.pylori test
 Female diagnosed as having H. pylori via blood test, in a health camp. She has no nausea, vomiting or
abdominal pain. What will u advise?
a. She may or may not have peptic ulcer
b. Start H. pylori treatment immediately
c. Wait for symptoms
d. She may have H pylori but not ulcer
 A person had symptoms related to chronic gastritis. Workup was performed and he was diagnosed
with H. pylori confirmed by endoscopy and biopsy. What further investigation is needed at this time?
U/S abdomen, CT abdomen, H Pylori Serology, Urea breath test
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 A case in which patient had gas under the diaphragm on x ray, leucopenia, fever. Dx? Typhoid ileal
perforation, PUD
 A case in which patient had gas under the right hemidiaphragm on x ray. Diagnosis? Peptic ulcer
 Most common cause of chronic Gastritis? H pylori, Autoimmunity, NSAID induced gastritis
 Most common factor causing gastric CA? H pylori, Lack of fruits and vegetables in diet,
Nitrosamines
 Most common site of peptic ulcer? Duodenum
 Regarding peptic ulcer disease: Cushing ulcers develop in raised intra cranial pressure.
 On and vomiting. pain after eating and before sleeping. Diagnosis? Acid peptic disease
 Characteristic of autoimmune gastritis: antibodies against IF
 Intestinal metaplasia risk ↑in? autoimmune gastritis
 Intr-epithelial neutrophils + plasma cells? H. pylori gastritis
 Best test for h pylori? Best is Culture
 Epigastric pain, spiral organism of microscope? H. pylori
 H. pylori most common site? Antrum
 A 60-year-old patient with dyspepsia took H.pylori eradication therapy but to no avail. What will be
further management? Endoscopy
 H. pylori confirmed by urea breath test, further investigation? Endoscopy with biopsy
 Man has duodenal perforation, management? Keep omental patch & suture the defect,
Gastrojejunostomy, Billroth I gastrectomy
 Wrong about gastric cell? Paneth, APUD, oxyntic ,parietal ,epithelial
 Board like rigidity? perforated duodenal ulcer
 Gastrinomas most commonly associated with: MEN 1
 Correct regarding gastric carcinoma? Diffuse type has good prognosis, Gastric carcinomas always
have bad prognosis, Gastric carcinomas are chemo sensitive
 Gastric carcinoma prognosis in USA? 5-year survival less than 30%
 Gastric carcinoma prognosis depends upon: invasion & metastasis to lymph nodes
 70 years old pt. with weight loss and endoscopy shows signet cells? Gastric adenocarcinoma
MALABSORPTION
 Whipple’s Disease? Defect in lymphatic transport
 Drug prescribed for 1 yr. in Whipple’s disease? Co-trimoxazole
 Management autoimmune enteropathy: gluten free diet, immunosuppression, steroids
 Total/subtotal villous atrophy: topical sprue
 Diff b/w topical sprue & celiac disease: villous bunting, crypt hyperplasia, distal bowel segment is
involved, intraepithelial lymphocytes
 Not seen in celiac disease? Intraepithelial CD8+T lymphocytes, infiltration of lymphocytes mast cells
plasma cells, crypt hyperplasia, villous atrophy, epithelial dysplasia
 Which of the following can precipitate a Celiac disease episode? Barley
 In celiac disease there is villous? Atrophy
 Celiac disease lymphocytes? T cells
 Another question for celiac disease morphology? Crypt hyperplasia intraepithelial lymphocytes
and villous atrophy
 True about celiac disease? Leads to lymphoma & adenocarcinoma
 Bloody diarrhea not seen in? Celiac disease
 Antibody in celiac? Anti-tissue transglutaminase (tTG) antibodies, endomysial antibodies (EMA)
 Wrong statement regarding Abetalipoproteinemia is: Autosomal dominant disease
 A patient not able to digest milk: disaccharidase deficiency

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 Characteristic morphologic feature seen in α-1 anti-trypsin deficiency? PAS positive & diastase
resistant granules
 Which is associated with malabsorption? Osteoporosis, jaundice, macrocytic hemolytic anemia,
hypothyroidism.
 A female patient with mid night pyrexia, weight loss n abdominal pain? Abdominal TB.
 Patient with abdominal pain n erythema nudism? IBD, Intestinal TB
 Which of these is not associated with an ulcer of intestinal TB? Intestinal perforation, Transversely
oriented ulcers, Intestinal malabsorption
 A person had history of fever, altered bowel habits, Diagnosis? Intestinal TB
COLON
 Patient has diarrhea, recurrent blood in stools, erythema nodosum: Inflammatory bowel disease
 A 25-yr. man has light abdominal pain which abates on defecation, have 2 to 3 diarrhea per day from
1 yr.? UC
 A lady with ulcerative colitis, no response to cyclosporine and steroids, Tx? infliximab
 A person, known case of ulcerative colitis for 13 years, came to the doctor. He has colitis in rectum
and right colon. Further management? Pan colectomy with ileostomy, Pan colectomy with ileoanal
pouch
 A 30 years old male presented with loose motion, abdominal cramps, joint pain & red eyes. Dx? IBD
 Not microscopically seen in ulcerative colitis? transmural inflammation, crypt abscesses
 Ulcerative colitis always involves: rectum
 Complication of ulcerative colitis: toxic megacolon
 Drug used in UC? Mesalamine
 A patient with left sided abdominal mass with UC? Megacolon
 UC, antibodies are? p-ANCA (75%)
 Many broad-based ulcers? UC
 Mucosal ulcers & pseudo polyps? UC
 Morphology ulcerative colitis? Diffuse inflammatory infiltrate of mucosa
 Morphology Crohn’s? non-caseating granuloma
 Not microscopically seen in Crohn’s Disease? Superficial Ulceration, Submucosal edema
 Most common sites involved in Crohn disease: terminal ileum, ileocecal valve, cecum
 4-fold increased risk of Crohn’s disease? NOD2
 Multiple perianal abscess? Crohn’s disease
 X-ray shoes many Aphthous ulcers? Crohn’s disease
 Common cause of morbidity after ulcer surgery? Dumping
 A question about Ischemic bowel disease? Transmural infarct by chronic -vascular obstruction, -
epithelial shedding
 Not found in IBS? Weight loss, Mucorrhoea, Bloating, Pain, diarrhea
 A 30 years old male came with loose motions, abdominal cramps, hematochezia, joint pain and red
eyes, proctoscopy was clear? Crohn’s Disease, Ulcerative colitis
 A patient has upper small bowel obstruction and develops abdominal pain, distention, vomiting. In
what order will the clinical features develop in this patient? Vomiting, dehydration, pain [PVD]
 20 years old male pt. presents with diarrhea, mucoid, pain relieves on defecation? IBS
 Cause of Ischemic bowel is?
 Patient has vomiting, abdominal distention, pain, constipation, temp 99, pulse 130/80, abdominal
examination shows previous scars of caesarian surgery. Likely cause: Adhesion, volvulus
 A case which describes signs and symptoms and x ray findings of a patient having intestinal
obstruction due to volvulus. The segment of large bowel undergoing volvulus is not mentioned.

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 Management? Untwisting of volvulus and fixation, Decompression of sigmoid, nasogastric tube and
rectal tube
 Common site for diverticulitis? Sigmoid
 Pseudo obstruction? Paralytic ileus
 What investigation to do to check the viability of bowel left in abdomen?
 2nd degree hemorrhoids on proctoscopy, next step of management? Sigmoidoscopy + band ligation,
Sigmoidoscopy, Band ligation
 Hallmark of acute appendicitis? Lymphoid Hyperplasia, Neutrophils in muscularis
 Woman with pain in right iliac fossa, diagnosed appendicitis. Surgeon opened abdomen & saw 500cc
frank/fresh blood. Diagnosis? Ruptured ectopic pregnancy, typhoid Ileal Perforation
 Man has 6-7 episodes of bleeding P/R bleed daily for 1 month. Next step that will diagnose? Rigid
Sigmoidoscopy, Colonoscopy, Barium Enema
 A person developed intestinal obstruction 2 years after appendix surgery? Adhesion
 Most common site of colorectal CA? Rectum
 Which of the following has the maximum capacity to convert in Colorectal carcinoma?
Adenomatous polyps
 Most common site where colonic cancer metastasizes: liver
 Pathology of colon cancers. What happens first. Something like this? Mutations of cancer
suppressor gene
 Malignant potential is highest in? Villous, Tubulovillous, Hemartamous
 Regarding metastasis of CRC? Lymph node invasion/ distant metastasis
 Cowden syndrome gene? PTEN
 CRC gene? APC
 Gardener syndrome associated tumor? Osteomas
 Serrated appearance of polyp? Hyperplastic
 Napkin ring on endoscopy of patient? CRC
 A patient developed left iliac mass? CRC
 Most common cause of adenoma? Alcohol
 Carcinoembryonic Antigen levels increased in? Metastatic colorectal CA
 Colonic carcinoma prognosis depends on? infiltration of bowel wall and lymph node metastases,
lymph node metastases and CEA levels
 Tumor of anal canal is associated with infection by? HPV
 a 70-year-old patient with Hx of constipation and pain for 3 days in left iliac fossa?
 polypoid bulge of mucosa of large bowel in ulcerative colitis is known as? pseudopolyps
 medically unexplained symptom best to handle by? Reassurance, evidence by negative reports,
somatization of unexplained symptoms.
 not a feature of right sided Ca colon? Obstruction, Iron def anemia, fatigue
LIVER
 What doesn’t include in Rosen criteria at the time of admission? AST, Bilirubin
 Most common symptom of obstructed jaundice
 Investigation for liver abscess? U/S
 Cherry red spot on macula and hepatosplenomegaly. what investigation will be done for final
diagnosis? BM biopsy (bcoz Neiman-Pick suspected)
 A pt. having GCS of 13/15, which improves & have bilirubin 17, what child's classification?
 Wrong about liver? Liver is endocrine gland
 True about liver anatomy? Structural & functional unit of liver is lobule
 Liver function is? Major metabolic
 Bile salts comes from? Cholic acid

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 Blood fluke? Schistosoma
 Larval stage is in? intermediate host
 Young female with pruritus, abdominal distension. ALP values were markedly raised compared to
ALT. Next best investigation? Anti-mitochondrial antibodies, Anti-nuclear antibodies.
 Girl had jaundice for 6 months or so, maybe had pruritis too, AST was around 1100 u/l, what do you
check next? PT, Serum albumin, AMA, ANA
 Best test for Wilsons? Liver Biopsy
 Sunflower cataract? Copper deposition
 Diagnostic feature of Wilson except resting tremor? Kayseri Fischer
 Female, right hypochondriac pain for 2 weeks, fever, jaundice, same episode 2 years back, transfused
fresh blood 3 years back due to obstetric complication. Diagnosis? Chronic viral hepatitis, AI
Hepatitis, Wilson disease
 Autoimmune hepatitis? Interface hepatitis with plasma cells
 Man had transfusion 8 years back has jaundice and something else too. What is the cause? Hep b,
Hep c, Autoimmune
 Histological feature of alcoholic hepatitis? Mallory bodies + hepatocyte swelling
 HO injured in needle prick while dealing HBV? Active with passive reaction
 Pregnant lady with abnormal liver tests? HepE, Hep a, Hep c
 Person transfused blood few years back develop abdominal distension. Which hepatitis? B
 Pregnant lady with jaundice for 15 days , infecting agent would be hep A virus or hep E virus
 Best test too diagnoses HCV? PCR + 3rd generation ELISA
 Chronic stage of HepB: anti-HepB, absent HBe, HBsAg, core mutant
 Fulminant hepatitis? Necrotizing
 incubation period of HAV? 30 days
 Risk factor for HCV? IV drug abuse
 How to check immunity for hep b? anti-HBs
 Hepatitis C can transform into hepatoma? Yes
 Morphology of hepatitis C? lymphoid aggregates with focal macrovascular steatosis
 what are Mallory bodies? eosinophil bodies with keratin and proteins(cytoplasm)
 Person suffering from encephalopathy and cirrhosis , what will you adjust in diet? Proteins
 In which condition protein less than1g/kg body weight is administered? Hep encephalopathy,
Cirrhosis and Encephalopathy,
 Grade 3 ascites treatment? Paracentesis
 Most common cause of death in ALD? Massive GI bleeding
 Ascites, pus in peritoneal cavity indicates? bacterial peritonitis, chemical, bleeding, billow
 worst prognosis of liver diseases is due to ↑ bilirubin or ↑pro-thrombin time corrected with vitamin k?
 Fulminant hepatic failure, poor prognosis: increased PT by Vit. K, decrease transaminase
 Alcohol liver disease, which inflammatory infiltrate: Neutrophils, eosinophils, macrophages
 Impaired hepatic blood flow to the liver, clinical manifestation:
a. Hepatomegaly
b. Splenomegaly
c. Intestinal congestion
d. Abdominal pain
 Portal hypertension can manifest by the obstruction at the level of? Intrahepatic
 Portal hypertension, which occurs? Splenomegaly, varices
 Which types of collagen are deposited in the space of Disse in cirrhosis? Type I and III
 Indication for liver transplantation in cirrhosis related ascites? Diuretic resistant ascites,
Hyponatremia, Post TIPSS encephalopathy

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 Prophylaxis for portal Hypertension? Propranolol, Spironolactone
 Treatment of encephalopathy? Lactulose, Neomycin, liver transplantation, Post TIPSS
encephalopathy
 95% of bile salts absorbed from? Small intestine, Lymphatics, Cistern chyle, Wirsung duct, pancreas
 patient with hx of weight loss, anorexia. worsening jaundice and pale skin? firm mass in RUQ.
 3 yrs. child fever, moderate hepatomegaly n jaundice, vomit?
 bronze pancreas is seen in? haemochromatosis
 not a complication of cirrhosis? Hypoestrogenimia
 synthetic ability of liver is assessed by? PT
 most common cause of liver transplantation in western is? A,C,B,D,E
 which infection would likely get after needle prick? B,C,D,H
 Vascular occlusion in liver causing portal hypertension at which level? Sinusoids
 Hepatic vein thrombus? Polyarteritis
 Pelosi’s hepatis is associated with? TB & anabolic steroids
 Pelosi’s hepatis? Blood filled cavities
 Rye syndrome is? Microvascular steatosis
 Patient has jaundice, weight loss, palpable abdominal mass in right upper quadrant:
Cholangiocarcinoma, hepatocellular carcinoma
 Malignant tumor after oral contraceptives? Angiosarcoma, Hepatoma, Adenoma
 Patient having umbilical hernia. Investigations revealed he also has CLD. Treatment/surgical
procedure? Conservative treatment, Liver Transplantation, Treat liver cirrhosis
 Tumor of 2 cm in liver. Treatment? Chemo, Radio, Transplant, Resection
 Most imp risk factor for hepatoma: Cirrhosis, alcohol, OCPs
 Alcoholic patient, risk of? Hepatoma
GALL BLADDER
 Fever, Rigors, Jaundice, RUQ pain. Diagnosis? Cholangitis
 Palpable mass in RUQ?
 Fever, Rigors, RUQ pain, tender gall bladder. Diagnosis? Acute cholecystitis
 Acute cholecystitis? Analgesics and antibiotics
 right hypochondrial pain, progressive jaundice? Cholangiocarcinoma
 acute cholecystitis with cholelithiasis? Surgery
 RUQ pain after major surgery? Acalculous cholecystitis
 Causes of acalculous cholecystitis? Hemolysis
 Fitter clinics? Reduce patient load in OPD
 Diagnostic test of acute cholecystitis: +ve Murphy’s sign, hyperesthesia around right shoulder
 How to diff between acute cholecystitis and biliary colic: Leukocytosis seen in acute cholecystitis.
 Male patient previously diagnosed as acute pancreatitis, now has gall stones & mild pancreatitis.
When to do cholecystectomy? wait for 6 weeks, 2 months after pancreatitis, in same hospital visit
 Diabetic woman having gall stone. Treatment? No treatment, Follow up, Control diabetes, Stone
dissolution, Elective cholecystectomy
 Pregnant woman having gall stone, test to confirm diagnosis? ERCP, CT, MRI, X-ray
 A lady has recurrent gallstones in CBD. No stones in gallbladder. Diagnosed as a case of primary
ductal calculi. Cause of stone formation? Foreign Bodies, Hyper saturated Cholesterol, Dec. bile
acids, Hemolysis
 Patient has fever, right hypochondriac pain. What would you ask in history to confirm diagnosis?
history of jaundice, history of rigors & chills, History of medications
 Investigation for gallstones? U/S
 Removal of CBD? ECRP

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 Choledocholithiasis... before stone removal what should be done? ERCP
 Palpable gall bladder associated with? Ca pancreatic head
 Palpable gallbladder, jaundice but no pain? Malignancy of GB
 Regarding gall bladder histology? mucosa is thrown into folds
 Solitary stone in GB in hemolytic patient? pigmented stones
 True about Gall stones? Pigment stones by infection and hemolysis, Cholesterol stones are
radiolucent, Pigment stones are radiopaque
 To prevent stone infection? Prophylaxis, education
 Cause of bile stones? Ascaris
 Risk factor for piment stones? Crohn’s Disease
PANCREAS
 Wrong about pancreas anatomy? Acini not found in head
 which doesn’t occur in acute pancreatitis? Hypoglycemia, hypocalcemia, hypoalbuminemia
 Characteristic feature of acute pancreatitis? Fat necrosis
 Pseudocyst pancreatic?
 Calcification on abdominal x-ray? Chronic pancreatitis
 A person who is known case of chronic pancreatitis is now seen to have dilated pancreatic duct,
stones in duct, multiple stricture formation. Management? Pancreatojejunostomy, Whipple’s
procedure, frays procedure, pancreatectomy
 A person has an irresectable pancreatic cancer. Which test is useful for staging the cancer? ERCP &
stenting, CT, MRI
 Acute pancreatitis is said to occur when inflammatory cells are in which layer?
 Gene in AP? SPINK1
 Hereditary pancreatitis mutation: p53, p63, PRSS1
DIARRHEA
 A patient presentation with bloody diarrhea. Which investigation not required to be performed?
upper GI endoscopy
 Most common cause of infectious diarrhea in pediatrics: Rotavirus
 Empirical treatment for diarrhea? Oral rehydration
 Drug used in acute diarrhea?
 18year drug abuser developed pro fused diarrhea, causative agent?
 Reiter syndrome associated with? Campylobacter
 common cause of diarrhea? Campylobacter (bloody in infants
 Non inflammatory diarrhea caused by? (vibrio, shigella, E. coli, E. histolytica)
 6-year-old child has diarrhea for more than 3 weeks & moderate dehydration. Classify child a/c to
IMNCI: chronic diarrhea, persistent diarrhea, severe persistent diarrhea
 Administer GIT fluid loss? Ringer lactate
 Signs of severe dehydration? Stage of severe dehydration
 Other most important exam in dehydration? Heart rate, tears
 Ringer lactate is administered in? 1, 2, 3 4, 6 hours
 IMNCI Rx of dysentery? 5 days
 Antibiotic associated colitis? C. difficile
 Prophylaxis for traveler’s diarrhea? Ampicillin/co-trimoxazole
 Food poisoning? Hydration with fruit juices
 Persistent diarrhea? 14 days
 A pt. with diarrhea relieves by taking RTI, explosive bloody diarrhea for 5 days?
Pseudomembranous colitis
 V. cholera causes diarrhea by? Increasing Cl secretion in gut
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 HERNIA
 Appearance of strangulated hernia pt.’s abdomen on x-ray? Multiple loops of distended
 Features of strangulated hernia? Incredibility, pain
 Treatment? Hospitalize, pass NG, pass IV, prepare for surgery
 Management plan for strangulated hernia? Emergency surgery
 Max age for surgical correction of hernia?
 Umbilical hernia, age of repair of child is?
 Hernia in a two-year-old child, which could be reduced manually and had a positive cough impulse.
Most likely diagnosis? Indirect inguinal hernia
SALIVARY GLANDS
 True about pleomorphic adenoma? Benign tumor of epithelial and myoepithelial cells
 Most common salivary gland malignant tumor? Mucoepidermoid CA, Adenoid cystic CA
 Salivary gland tumor exclusively in parotid: Warthin
 Atrophic glossitis caused by all except? Vit D3
 Pyogenic granuloma found on? Gingival mucosa
 Pyogenic granuloma? Capillary dilatation + inflammatory infiltrate
 Most common cause of salivary gland infection? Mumps
 Dry mouth found in? Sjogren syndrome
 Most common cancer of head n neck? Squamous
 Wrong about xerostomia? Anticholinergic are given in treatment
 Sialadenitis due to? inflammation by staph aureus, obstructing stone
 Risk factor for oral candidiasis? Diabetes, Aids, poor oral hygiene antibiotics
 A pt. having sublingual gland fluctuant swelling will mucin filled surrounded by granulomatous
tissue? Ranula, Mucocele
 wrong about pleomorphic adenoma? fast growing
PHARMACOLOGY
 Drug of choice for motion sickness? Scopolamine or H1 blockers
 Why octreotide is better than somatostatin? Prolong half-life, Less adverse effects
 Not the side effect of dopamine receptor antagonist?
 Pirenzepine is? Antimuscarinics
 Cyclizine is from which class? H1 anti-histamine
 Which is not 5 ASA? Octreotide
 Which of these is not a PPI? Entamizole (LIPPIN)
 Mesalamine is used in the treatment of? inflammatory bowel disease
 Which drug acts by inhibiting proton pump? Omeprazole
 30-year-old unmarried female has constipation? Give fiber, Avoid gluten
 Wrong statement regarding H2 receptor antagonists? Decrease acid secretion by inhibiting gastrin
action on parietal cells
 Wrong about H2 blockers? Famotidine is less potent than cimetidine
 Wrong statement regarding PPIs? Should be used with H2 receptor antagonists
 Gynecomastia &galactorrhea are side effects of: Cimetidine
 Zollinger Ellison: Omeprazole
 prokinetic agent use for post-partum lactation? Domperidone
 mechanism of 1st line treatment of peptic ulcer? Inhibit H+/k ATPase, healing by forming a layer,
eradication of H. pylori, blockage of receptor in secretion of HCL,
 Greatest acid suppression? Omeprazole
 PPI Causes which vitamin deficiency: B-12

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 Which drug causes irritation and increase motility? Phenolphthalein, Loperamide, MgSO4
 Regarding antacids? MgOH causes diarrhea , ulcers don’t heal
 For nocturnal GERD Tx is? PPI/cimetidine
 Drug for immediate relief of heartburn? PPI, antacid
 Centrally acting anti-emetic? Meclizine
 Diabetic patient pregnant, bloating, which prokinetic drug: metoclopramide
 Laxative: Senna
 Osmotic laxative? MgOH
 Which is not bulk laxative? Bisacodyl
 Alosetron? 5HT3 antagonist
 Drug for luminal amebiasis? D. furoate
 Wrong about antacids: NaHCO3 is not a systemic antacid
 Systemic antacid? NaHCO3
 Lamivudine: increase transaminase, Bone marrow suppression, mutation, decompensated cirrhosis
 Lamivudine can be given in? decompensated CLD
 Metoclopramide acts on? Dopamine receptors
 Prokinetic for diabetics? Metoclopramide
 Drug accumulate in canaliculi, H//K ATPase? Omeprazole
 Drug elevating liver enzymes? Cimetidine
 Drug for H. pylori? Clarithromycin
MISC.
 Hepatomegaly in all glycogen storages disorders except? McArdle
 the child was 2 years old, coarse facial features, developmentally slow, stiff joints, short stature,
corneal clouding. Diagnosis? Galactosemia
 Non milk extrinsic sugar (NMES) is present in: Fruits, Veg, milk, Honey
 Protein sparing diet? Carbohydrates
 High energy? Fats
 Partially hydrogenated Fatty acids, harmful for health: Trans fatty acid
 Bile salts are made by? Biliverdin, Bilirubin, Lecithin
 Lipids go bad. Rancidity
 Last region affected in starvation? Fat in gluteal region, Fat in mesentery, Fat in abdomen
 Brain during starvation uses? Ketone bodies
 Daily intake of nitrogen
 -ve N2 balance? Decreased uptake increased loss
 Protein content? Urinary
 Amount of N excreted in urine? 20-30g
 Nitrogen is transported from muscle to liver I form of? Alanine
 Nitrogen is mainly excreted in which form? Ammonia, Urea
 Old proteins replaced with new ones? Protein turn over
 Protein in normal adult's diet
 C-terminal amino acids broken down by: carboxy peptidase
 Medium glycemic index? 56-69
 Kg/m2 (kilograms per meter square) is the unit of: BMI
 Normal BMI? 18.5 to 24.9
 Energy expenditure calculator? Calorimeter
 Nutritional toxicology?
 Skin pinch gives? Overall nutritional status

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 A person had acidotic breath, was suffering from metabolic acidosis, : organic academia, tyrosinemia,
maple syrup urine disease,
 Basal metabolic rate of men: 1800, 1801, 1802, 1803, 1804
 Hookworm is transmitted as? Larva
 Calories and protein malnutrition? Marasmus, Kwashiorkor, Starvation
 Vit K in ? lettuce
 Bicarbonate is secreted from? Pancreas
 Enzyme required for digestion(most essential)? Pancreatic
 Pepsinogen is activated in? stomach by HCl
 Acid released by a hormone secretes from? Parietal cells
 Hormone extracted from islets causes gluconeogenesis and hyperglycemia? Glucagon
 Contraction of GIT is b/o uptake of ____ ion? Ca
 K+ secreted from: upper small bowel, middle small bowel, lower small bowel, colon e)stomach
 Imp in GIT: Motility, secretion, absorption, digestion, All
 Pacemaker cells of GI: Cajal cells
 Pancreatic juice pH is? 8
 Cause of death in acute starvation?
 About pancreatic anatomy marks the incorrect one? Lies in transpyloric plane, Head has acinar cells
 Regarding stomach. Had to mark the incorrect one
a. Lesser omentum attached to lesser curvature
b. Bed is formed by spleen pancreas and left kidney
c. Partially supplied by celiac trunk
 Bowel loops rotate 270 degree around an axis created by?
a. Superior mesenteric artery
b. Celiac axis
c. Umbilical artery
d. Umbilical vein
e. Inferior mesenteric artery
 Linea nigra? Pubis to umbilicus
 Crude death rate is not a good indicator
 For disease control, dietary factors are? mandatory
 A permanent stoma is made in: Abdominoperineal resection
 Salt n pepper appearance in which tumor?
 Insulinoma is aggravated by? Alcohol
 It is necessary to be aware of medical ethics because?
 Enzyme which removes nitrogen from amino acids in urea cycle? Glutamine synthase
 Females who worry too much about their health? Hypochondriac
 Most common site of carcinoid syndrome? Midgut, Hindgut, Foregut, Lungs
 A/C to WHO new classification which is not epithelial tumor: Adeno, squamous, carcinoid
 Sign of jejunal dilatation on radiograph? Coiled spring sign
 Which of the following is not used? Manometry
 Barium swallow for intestine? Barium sulphate contrast
 1st organelle affected from hypoxia? Mitochondria
 Sign of local peritonitis? Rebound tenderness on affected area
 Common of cause of pseudo obstruction? Surgery
 Metabolic disorder in gastric outlet obstruction? Hypochloremic hypokalemic metabolic acidosis
 Acquired diverticulosis, which layer is not present: lamina propria, muscularis, mucosa, serosa
 Early manifestation of SIDS? Drowsiness

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 Physiologic jaundice? Increased RBC and immature hepatocytes
 Physiological jaundice of the new born? 2-3 days after birth, Bilirubin level remains above 2 mg/dl
 Dehydration treatment: Plan B? fluid given 75ml/kg body weight
 Dehydration treatment: Plan C? ringer lactate/normal saline 100ml/kg
 Weight of child triples of birth weight at what age? 1 year
 All children with diarrhea should be given? oral rehydration therapy, exceptional antibiotic/IV
fluids
 Spleen/hepatomegaly, total bilirubin 18, direct 10 in a child with prolonged jaundice? Atresia
 Distribution of various age and sex groups in a population? Population pyramid
 Population growth has not stopped even after some balance? Population momentum, population
growth
 State of extreme emaciation is: Kwashiorkor, Marasmus, Malabsorption
 Characteristic feature of starvation in a dead body? Loss of subcutaneous fat, Tissue paper intestine,
Marked emaciation, Distended gallbladder
 Glycemic index: amount of glucose a diet can provide to blood

OSPEs
1. OSPE: Pg.770-771
 Diagnosis: Barrettes Esophagus
 Lesion: Metaplastic
 Cells: Goblet
 Affects which part of esophagus? Lower 1/3
 Prognosis in relation to cancer: Barrett's
esophagus is its strong association with
esophageal adenocarcinoma
2. OSPE: Pg.792 - Patient comes with pain, jejunectomy.
 Lesion: Ischemic injury
 Histology: atrophy & sloughing of epithelium
 Diagnostic or ____: Mucosa is hemorrhagic
 Trans mural ischemia/infarction: Arterial occlusion,
venous occlusion, vasculitis, dehydration
 Ischemia can cause: board like rigidity, severe pain
 Most common of ischemia? Intramural thrombus
3. OSPE(Fig.1)
 Diagnosis is? Cholesterolosis, Cholelithiasis, Fat necrosis, Fatty change, Stasis of bile
 This condition is most commonly associated with? Biliary atresia, Biliary cirrhosis,
Cholangiocarcinoma, Cholecystitis, Carcinoma of pancreas
 All of the following are complications of conditions except? Cystic duct obstruction, Empyema, Fat
necrosis, Ileus, Perforation
 A gallbladder showing extensive dystrophic calcification? Empyema of gallbladder, Mucocele of
gallbladder, Porcelain of gallbladder, Red currant gallbladder, Strawberry gallbladder
 Cholesterolosis of gallbladder is seen on microscope as? Cholesterol crystals, Cholesterol clefts,
Foamy macrophages, Epithelial cells, Giant cells
4. OSPE(Fig.2)
 Photograph A shows normal mucosa, in B lesion is identified as? Celiac disease
 It is associated with? Gluten
 microscopic features of condition is/are?
a. Thickening of mucosa and diffuse inflammatory infiltrates

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 b. Thickened mucosa with loss of villi
c. Diffuse enteritis
d. Diffuse enteritis with loss of villi
e. Normal thickness of mucosa with loss of villi
 Following statement is true about lesion: It is cell-mediated chronic inflammatory condition with
autoimmune component
 Lesion is highly associated with?
a. Large intestine adenocarcinoma
b. Hodgkin lymphoma
c. Squamous esophageal carcinoma
d. Hepatocellular carcinoma
e. Adenocarcinoma of stomach

Fig.1 Fig.2
5. OSPE
 Involved cells? Hepatocytes
 Most common organ involved? Liver
 Stain? Persian blue
 Caused by? Long term transfusions
 Element is? Iron
6. OSPE
 Diagnosis? Peptic ulcer
 Gastric cancer gene? Cag A
 Inflammation factor? IL-1, TNF
 Associated abnormality? Gastric cancer, obstruction, ulcer
 Triple therapy? Clarithromycin + PPI + Metronidazole
7. OSPE
 Which disease? Wilson
 Lesion in which another region? Cornea
 Best investigation? Liver copper content
 Special stain? Rhodamine
 Best treatment? Antidote administration
8. OSPE
 Which disease? Hepatitis C
 Morphology of Hep C? lymphoid follicles
 Which investigation is best to do? Viral markers
 Which other hepatitis is also transferred by IV? Hepatitis B
9. OSPE(Fig.3)
 Identify the above lesion?
a. Pleomorphic adenoma
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 b. Warthin tumor
c. Oncocytoma
d. Mucoepidermoid carcinoma
e. Adenoid cystic carcinoma
 Most common site of origin of this lesion?
a. Minor salivary glands
b. Sub-mandibular glands
c. Parotid glands
d. Sub-lingual glands
e. Lacrimal glands
 Above lesion is derived from? Myoepithelial or ductal reserve cells origin
10. OSPE(fig.4)
 What is the diagnosis of given picture?
a. Ulcers on intestine
b. Polyp on stomach
c. Inflammation of esophagus
d. Esophageal varices
e. Tuberculosis of intestine
 Cause of the disease is?
a. Cirrhosis of liver
b. Alcoholic hepatitis
c. Hepatic Schistosomiasis
d. Portal hypertension
e. Dilated and tortuous veins
 Complication of the disease is?
a. Chronic inflammation
b. Massive hemorrhage
c. Suffusion of wall with blood
d. Ulcer formation
e. Acute inflammation
 Primarily the disease appears as?
a. Tortuous vessels in esophagus
b. Tortuous vessels in submucosa of proximal and distal esophagus
c. Tortuous dilated veins lying in submucosa of distal esophagus and proximal stomach
d. Tortuous vessels around esophagus and stomach
e. Dilated sub-mucosal veins in the lower third of the esophagus

Fig.3 Fig.4
11. OSPE

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  Identify the lesion? Aphthous ulcers
 Most important cells in the above lesion? Mononuclear
infiltrate
 Fate of the above lesion? Spontaneously resolves
 Treatment of above lesion? Symptomatic
CASES:
12. Case: tobacco chewer, 48 years old.
 Diagnosis? Leukoplakia
 Leukoplakia is? Precancerous
 Leukoplakia characteristic? Verrucous
 Not found on? Lip
 Presents in age? 40+
13. Case; Banker, recurrent burning pain, aggravated with aspirin, loss of appetite, associated with food,
+ve urea breath test.
 Diagnosis: Acid peptic disease
 Treatment: PPIs + clarithromycin + amoxicillin or metronidazole
 Other test: histopathology of biopsy specimen
 If not treated: a)perforation b)gastric carcinoma
 Indication of surgery: a)perforation b)recurrent dyspepsia c)NSAIDs d)Nausea, Vomiting
14. Case;
 What disease? Celiac
 Important D/D? tropical sprue and celiac
 All can precipitate celiac except? Corn
 Most specific investigation? Biopsy
 Antibodies found? anti-tTG, anti-gliadin
 Treatment? Gluten free diet
 Which cells? CD4, CD8
15. Case; __ year old per rectal occult bleeding, father has same history & died of colorectal carcinoma.
 FAP Mutations: APC
 CRC Mutation: a)microsatellite instability pathway b)Increased RNA mismatch repair & increased
APC c)Increased COX-1
 Investigation: a)CT b)Colonoscopy* c)sigmoidoscopy d)barium enema
 CRC single drug: a)5-FU + folinic acid b)Methotrexate c)Azathioprine d)irinotecan
16. Case; Patient mucus discharge, fresh bleeding rectum, spastic pain.
 Diagnosis: Hemorrhoids
 Emergency hemorrhoidectomy indication: a)strangulation b)thrombosed c)fibrosed
 Stapled hemorrhoidectomy indications: a)fibrosed b)thrombosed c)prolapsed*
 Complication of hemorrhoidectomy not easy to treat: a)pain b)urinary retention c)anal stenosis
d)fecal incontinence
 Complication after sclerotherapy: a)proctitis b)vaginorectal fistula c)bleeding*
17. Case; A 40year old lady, BMI 38, severe pain in right upper abdomen, constant, not radiating, not
relieved by OTC drugs, patient has pale skin n sclera, Lab shows increased cholesterol, bilirubin in
urine but no urobilinogen, dark urine n stools, U/S shows thickened gall bladder wall n areas of
calcification.
 Investigations: a)LFTs, Amylase, CT b)CT, MRCP, ERCP c)CT, ERCP, AKR
 Diagnosis: a)Acute pancreatitis b)bile duct obstruction by stones c)Acute cholecystitis d)Carcinoma
of gall bladder
 Treatment: a)Cholecystectomy b)Pancreatojejunostomy

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 Patient at home: a)Lifestyle modification b)Decrease weight with statins c)Aspirin
 Complication: a)Gallstone ileus, empyema c)cholangitis d)chronic pancreatitis e)Pancreatic
carcinoma f)duodenal ulcer
18. Case; __ year old, pale skin, jaundice 3 days, drowsiness, GCS 12/15, slurred speech, 3 months dark
stools/melena.
 Cause of melena: Variceal hemorrhage
 Encephalopathy corrected, acute massive bleeding controlled by: a)Blackmore b)TIPPs
 Encephalopathy treatment: a)Neomycin b)lactulose
 Bilirubin 17mg/dl, Albumin 35, child’s classification: a)Child A b)B c)C d)All e)None
 Sclerosing therapy failed, next step: a)Reendow & banding b)Vasopressin c)TIPPs d)Surgery
19. Case; __ year medical student, withdrawing blood of encephalopathy patient, get prick, bleeding,
HBV.
 Which antibody to be given: a)IgA containing blood of anti HBs* b)HBsAg c)DNA
 If not infection: HsAg vaccine
 Infective/ replicative stage: a)HBcA &DNA
 Which family: hepadna
20. Case: Child with red currant jelly stool , no fever.
 Diagnosis? intussusception
 Investigation? X-ray, U/S, angiography, CT
 Non-ionizing radiation? MRI
 Following has therapeutic role also? Angiography, U/S, CT, X-ray
 Rx for the condition? Ba enema
21. Case; a lady presented with localized RUQ pain, BMI 38, stone on U/S
 Diagnosis? Acute cholecystitis
 Further investigation? CBC, LFT, amylase
 Rx? Surgery with urodeoxycholic acid
 For avoidance of recurrence? Lifestyle change, low fat diet
 Complications? Empyema, ileus, perforation, gallstones, fistula.
22. Case;
 Diagnosis? Varices
 Rx? Block new tube
 Investigation? Endoscopy
23. Newborn child, prolonged jaundice, hepatosplenomegaly, Tc99m scan shows no secretion of dye in
intestines.
 Diagnosis?
a. extrahepatic biliary atresia
b. alpha-1 anti-trypsin deficiency
c. idiopathic neonatal cholestasis
 What procedure should be done
a. Kasai procedure
b. liver transplant
 When to do surgery?
a. surgery as soon as possible
b. surgery after 8 weeks
c. surgery at 1 year of life with palliative measures
 Drug used to reduce pruritus?
a. Cholestyramine
b. UDCA
24. OSPE ON DIARRHEAL ORGANISM. A case of diarrhea was given
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 most common cause of gastroenteritis is ? h pylori, campylobacter, rotavirus
 most common cause of travelers’ diarrhea is ETEC
 solution give in severe dysentery? Ringer lactate, normal saline, dextrose
 treatment of acute diarrhea ? ciprofloxacin, azithromycin, clarithromycin
 region effected by shigella? distal colon, ileum n colon, colon n appendix
27. acute hepatitis OSPE
 indication of previous infection of HAV? Anti haV IgG
 marker of infectivity of organism? hbe ag.
 marker of chronic hep B? anti HB cag igG

GIT & LIVER II MODULE PAPER D22

1. A man at a BBQ party profuse vomiting, lower chest and upper abdominal pain, tenderness,
tachycardia, hypotension. Cause? Boerhaave syndrome
2. 1st line management of acute variceal bleeding? Terlipressin
3. Most common cause of esophageal varices bleeding? Cirrhosis
4. Cause of profuse, non-bilious vomiting after feeding in male baby? Pyloric stenosis
5. Histology showed spiral shaped organism in a pt. presented with epigastric pain? H. pylori
6. A female patient complains of abdominal pain for 7 months. She also reports to have lost 10 kg
weight. She is taking PPI. How will you further manage the patient? Endoscopy, Test for H. pylori,
Continue PPI
7. Parietal cell antibodies in? Chronic gastritis
8. Man has duodenal perforation, management? Keep omental patch & suture the defect
9. Endoscopy revealed ulcerated mass on antrum. Histopathology confirmed adenocarcinoma. Tumor
was confined to stomach, treatment? Total gastrectomy, Radical gastrectomy, Subtotal gastrectomy
10. A/C to WHO new classification which is not epithelial tumor: carcinoid
11. Subtotal villous atrophy? Celiac
12. Endoscopic biopsy of celiac? Villous atrophy
13. Which disease does not cause malabsorption? Diabetes
14. Recurrent aphthous ulcers of oral cavity associated with: IBD, Granulomatous disorder, celiac
disease
15. UC colitis under treatment developed moon facies & central obesity management? Proctocolectomy,
ileal resection, treat Cushing syndrome, continue steroid for remission
16. polypoid bulge of mucosa of large bowel in ulcerative colitis is known as? pseudopolyps
17. Most common site of colorectal CA? rectum
18. Screening for colorectal carcinoma? Colonoscopy
19. CEA levels are increased in? metastatic colorectal cancer
20. Adenocarcinoma linked to? Ulcerative colitis
21. Low fiber diet causes? Colon carcinoma
22. First hit in the pathogenesis of colorectal carcinoma? Pro oncogene mutation, Chromosomal
alteration, Methylation instability, Germline and somatic mutation of tumor suppressor genes
23. Pt tests revealed HBsAg -ve, Anti-HBs -ve, Anti HBe -ve, HBeAg -be, Anti HBc Ig M reactive.
Diagnosis? Acute hepatitis, Chronic with low virulence, Vaccination, Recovery from hepatitis
24. Mode of transmission of Hep E? feco-oral
25. Incubation period of HepA virus? 14 days, 21 days, 30 days, 8 days
26. Not a complication of acute liver failure? Infection
27. Ascites, encephalopathy due to? Portocaval anastomosis
28. Which disease does not cause neonatal cholestasis? Diabetes
29. How to diff between acute cholecystitis and biliary colic: WBC count.
30. History of weight loss, jaundice, pain & raised AFP? Hepatocellular carcinoma

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31. Regarding tumors of gall bladder: Infiltrative form is most common, Metastasize to spine, Are
squamous cell, 90% are diagnosed pre operatively
32. Most common symptom of tumor of head of pancreas? Epigastric discomfort, nausea & vomiting,
dark urine, obstructive jaundice
33. X-ray of intestinal obstruction? Step ladder fashion
34. Most common site of diverticulitis? Sigmoid
35. Weight loss, evening pyrexia night sweats? Intestinal tb
36. Most common site of intestinal TB? Terminal ileum
37. Appendix sign? Psoas sign
38. Palpation on LIF, pain on RIF? Rovsing Sign
39. Signs of localized peritonitis? Rebound tenderness on affected area, abdomen doesn’t with
respiration, irregular pulse, fever
40. Reiter syndrome? Campylobacter
41. Most common cause of infectious diarrhea in pediatrics: Rotavirus
42. Irritable child, skin pinch goes slowly back to normal, dry mucosal membrane. what should be the
treatment according to state of dehydration? Ringers plus metronidazole, ORS 300 mg/4hr, ORS 50-
60 mg/watery diarrhea, Normal saline,
43. A child skin pinch goes slowly back to normal, dry mucosal membrane. Classify dehydration? some
dehydration
44. Child with lethargy unconsciousness and acidotic breath. Which test? Blood sugar, CBC
45. Cherry red spots on macula, progressive loss of developmental milestones, mental retardation. Test to
be performed? LFTs, CBC, bone marrow biopsy, liver biopsy , Serum Ammonia
46. Child presented with abdominal distention, episodes of convulsions, hepatosplenomegaly,
hypoglycemia. diagnosis? Galactosemia, Niemann pick disease, Glycogen storage disease type 1
47. Mode of action of adefovir dipivoxil? DNA polymerase inhibitor
48. Drug given adjuvant to adefovir dipivoxil to prevent resistant? Ribavirin, lamivudine, Emtricitabine,
Afavirenz
49. Drug given adjuvant to adefovir dipivoxil to prevent resistant?
50. Metoclopramide and domperidone dopamine antagonists. What is not seen with domperidone ?
Tardive dyskinesia
51. Drug used for heart burn which lowers acid secretion by blocking a receptor? Cimetidine
52. A pt. taking cimetidine, he should be aware of? Gynecomastia
53. PPI use is associated with deficiency of which vitamin? Vit B12
54. Antibiotic for H. pylori? Clarithromycin
55. Methylxanthine MOA? Slows peristalsis
56. A woman physiologically capable of bearing and delivering children? Fertility, Total fertility,
Subfertility, Fecundity
57. Distribution of various age and sex groups in a population? Population pyramid
58. Population growth has not stopped even after some balance? Population momentum, population
growth
59. Chemical asphyxiant? CO, phosgene,
60. Antemortem sign of burns? Carboxyhemoglobin
61. Rule of nine for? Burns
62. Road rash is? Graze
63. Friction burn is type of? Abrasion
64. Pugilistic attitude is due to? Coagulation of muscle proteins
65. Convex shaped hemorrhage on imaging of brain? Subdural, Extra-Dural, Subarachnoid
66. Raindrops & hyper ketosis? Arsenic
67. Encephalopathy, Clenched hand? Mercury
68. State of extreme emaciation is: Kwashiorkor, Marasmus, Malabsorption

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69. Characteristic feature of starvation in a dead body? Loss of subcutaneous fat, Tissue paper intestine,
Marked emaciation, Distended gallbladder
70. Color of carboxyhemoglobin blood after adding 3% tannic acid? Cherry red, Pink, Purple, White
71. Glycemic index: amount of glucose a diet can provide to blood
72. Age of bruise? Greenish – 4th day
73. Nutritional assessment: to assess the ratio of malnourished peoples
74. Hypothyroid kid, to be treated with thyroxine:
75. 10 years kid with hyperglycemia 400mg/dl, convulsions, resp alkalosis, heavy breathing? Diabetic
ketoacidosis
76. A patient presented to ER in unconscious state having acidotic breath? Diabetic ketoacidosis
77. Intake of saturated fats is associated with? CVDs
78. True about pancreas: derived from foregut
79. Most important organ for digestive enzymes? Pancreas
80. Neurologic complication post-operative causes? Hyperkalemia, Metabolic acidosis, Uremia,
Hypokalemia, Hypernatremia

Case; a man presented with right hypochondriac pain.

81. 1st line investigation? LFTs, U/S
82. LFT shows increased ALP, U/S normal next investigation? ECRP
83. Management of stone in CBD? ERCP
84. Why is surgery of gall bladder done in asymptomatic Asian patients? Poor follow up, Good follow
up, Worsening of symptoms, Progression to gallbladder cancer

Case; a female patient presented with altered bowel habits, abdominal cramps.
85. Provisional diagnosis? IBS
86. Investigation? Colonoscopy, U/S abdomen, X-ray abdomen, Blood CP, thyroid profile
87. Diagnosis on the basis of? Rome’s criteria
88. Alarm symptom for further investigation? Bloody diarrhea & weight loss
89. Management? Reassurance & anti-spasmodic

Case; a male smoker with bilateral buccal mass.

90. Diagnosis? Warthin tumor
91. True about above condition? Second most common salivary gland tumor
92. Involves which gland? Parotid
93. Histology of above condition? Encapsulated

Case; A 60-year-old male presented with weakness, fatigue, pain in right iliac fossa & mass in RIF. On
dietary history he is taking red meat & carbohydrate.
94. Diagnosis? CRC
95. Associated with? Cowden syndrome, Diverticulitis
96. This condition most likely preceding from? UC
97. Protective effect for the symptoms of above condition? Chronic aspirin intake, Water intake, Juice
intake, Physical exercise
98. Further symptoms possible? Occult bleeding

GIT & LIVER-II ANNUAL PAPER D22

1. A man at a BBQ party profuse vomiting, lower chest and upper abdominal pain, tenderness,
tachycardia, hypotension. Cause? Boerhaave syndrome
2. Cause of profuse, non-bilious vomiting after feeding in male baby? Pyloric stenosis

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3. Antibiotic for H. pylori? Clarithromycin
4. Methylxanthine MOA? Slows peristalsis
5. A boy was playing baseball with his father when he ended up chasing after the ball and got hit by a
truck. He was brought to the emergency room with severe head injury, multiple broken ribs and
fractured tibia. Upon examination, blood and CSF were leaving his ears. Which part of the cranium
was fractured? Fracture of middle cranial fossa
6. This is due to the flanking and grazing by a bullet which produces a furrow in the outer table of the
skull. Name the fracture: gutter fracture
7. A person was hit from the side by a car while was crossing road. He fell on the ground and rolls over
for some distance. What type of injury does he have? Abrasion
8. Fracture in child abuse? Nabbing fracture
9. Penetrating injury from pointed weapon? Stab Wound
10. Injury on skull, exposure of bone without fracture: Shajjah-I-mudihah

Acute liver failure

11. Antibody found in acute hepatitis? Core IgM
12. Not seen in acute liver failure? Splenomegaly, cerebral edema
13. Lab not used in acute liver failure? X-ray, EEG
14. Which of the following is not seen in? hyperglycemia
15. Common cause of acute liver worldwide? Viral hepatitis

Case; A 60-year-old male presented with weakness, fatigue, pain in right iliac fossa & mass in RIF. On
dietary history he is taking red meat & carbohydrate.
16. Diagnosis? CRC
17. Associated with? Cowden syndrome, Diverticulitis
18. This condition most likely preceding from? UC
19. Protective effect for the symptoms of above condition? Chronic aspirin intake, Water intake, Juice
intake, Physical exercise
20. Further symptoms possible? Occult bleeding

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