Essay questions: Q1. Write in short about the necessary steps in management of a patient admitted to hospital with clinical diagnosis of Crimean – Congo haemorrhage fever(CCHF). Q2: Comment briefly on clinical features, laboratory diagnosis and treatment of a patient with Ancylostomiasis. Q3: Write briefly on clinical features and possible complications of Schistosoma Haematobium. Q4: Name a single helminthic cause for each of the following clinical conditions and then mention the method(s) of transmission, and drug of choice for each : A. Iron deficiency anemia and epigastric upset. B. Haematuria. C. Intestinal obstruction. E. Intense pruritis ani. G. Epileptic fits. Single choice questions: Second term The drug of choice that can be used for the treatment of all 3 types of human schistosomiasis is: A. Praziquantil. B. Albendazole. C. Mebenmdazole. D. Metrifonate. E. Oxamniquine. Respiratory symptoms could be a feature during some stages of all of the following worms, except: A. Ascaris lumbricoids. B. Anychlostom duodenali. C. Schistosoma haematobium. D. Schistosoma mansoni. E. Taenia Saginata. Eosinophila is an expected feature of all of the following helminthic diseases, except: A. Katayama fever. B. Loefflers syndrome. C. Anyclostomiasis. D. Enteribiasis vermicularis. E. T. Saginata. All the following about Crimean-Congo haemorrhagic fever are true, except: A. Transmitted through tick bite. B. Incubation period is > 2 weeks. C. Mortality is high. D. Gastrointestinal features are common. E. Permanent immunity is a role after recovery. Features of Katayama fever include all the following, except: A. Fever with abdominal pain. B. C. D. E. Hepatomegaly. Portal hypertension. Subside of features with 2 weeks. Usually rare with S. haematobium. All the following are features of chronic S. mansoni infestation, except: A. Terminal hematuria. B. Bloody diarrhea.. C. Portal hypertension. D. Hepatomegaly. E. Hematemesis. Single choice questions: All the following drugs are useful for treatment of chloroquine and fansidar (sulfadoxine + pyrimethamine) resistant falciparum malaria, except: A. Quinine. B. Mefloquine. C. Doxycycline. D. Co-artemether (CoArtem). E. Primaquine. The unlikely cause of unintentional significant weight loss due to endocrinal disorders is: A. Hypothyroidism. B. Phaeochromocytoma. C. Diabetes mellitus. D. Diabetes inspidus. E. Addison's disease. Which of the following conditions is most likely cause of oropharyngeal dysphagia? A. Oesophgeal polyp. B. Carcinoma of oesophagus. C. Gastroesophageal reflux disease(GERD). D. Achalasia. E. Bulbar palsy. The least likely feature of dyspepsia is: A. Abdominal fullness. B. Lower abdominal pain. C. Acidity. D. Early satiety. E. Nausea. The most likely cause of dyspepsia is: A. Duodenal ulcer. B. Gastric ulcer. C. Functional. D. Hepatobiliary and pancreatic diseases. E. Gastric lymphoma. The least likely cause of dyspepsia is: A. Gastric cancer. B. Acute gastritis. C. Duodenal ulcer. D. Gastric ulcer. E. Hepatobiliary and pancreatic diseases. All the following are bad prognostic factors in upper GIT bleeding, except: A. B. C. D. E. A young age group. Endoscopic finding of non-bleeding visible vessel. Association with co-morbidities. Re-bleeding. Presentation with shock. The least likely cause of severe, acute lower GIT bleeding is: A. B. C. D. E. Bowel ischaemia. Diverticular disease of large bowel. Meckel’s diverticulum. Angiodysplasia. Haemorrhoids The following are features of small bowel diarrhea, except: A. B. C. D. E. Large volume stool. Central abdominal pain. Tenesmus. Absence of blood in stool. Abdominal distension. 1. In the absence of physiological and intentional causes; the minimal amount of weight loss that may signify an organic disease is: A. 3 kg in 6 months. B. 10 kg in 6 months. C. 5 kg in 6 months. D. 20% of body weight loss in 6 months. E. 5 kg in 3 months. Training questions All the following are features of Crohn’s disease, except: A. B. C. D. E. ASCA positive is more common than pANCA positive serology. Crypt abscess. Enterovesicular fistulas. Rectal sparing. Association with primary sclerosing cholangitis. The best investigatory method for detection of Crohn's fistula is: A. B. C. D. E. Endoscopy. CT scan. MRI. Barium study. Capsule endoscopy. 2. Which of the following large intestine site of involvement makes Crohn’s disease diagnosis is unlikely? A. Caecum. B. Rectum. C. Sigmoid colon. D. Transverse colon. E. Hepatic flexure of the colon. All the following about toxic megacolon are true, except: A. B. C. D. E. Complicates both ulcerative colitis and Crohn’s colitis. Colonoscopy is not advised. Plain abdominal X-ray may be diagnostic. Most commonly occur after several attacks of colitis. May lead to circulatory failure. All the following are recognized extra-intestinal complications of inflammatory bowel disease, except: A. B. C. D. E. Primary biliary cirrhosis. Cholangiocarcinoma. Gallstones. Sacroilitis. Thromboembolic disease. Q1: Comment on hospital - management of a 40-year-old patient with severe, fulminant ulcerative colitis. Q2: Mention at least 5 features (clinical, colonoscopical and histological) that differentiate Crohn’s disease(CD) from ulcerative colitis(UC). The following are unfavourable features of acute pancreatitis, except: A. B. C. D. E. Very high s. amylase level early in disease. WBC count > 15 000/ml Mild pleural effusion. Calcium level < 2mmol/l. Age above 65 years. The most common cause of acute pancreatitis among the following is: A. B. C. D. E. Post – ERCP procedure. Gall stones. Idiopathic. Drug induced. Viral infection. Q2: Comment on complications of acute pancreatitis. The most frequent cause of acute ischaemia of small bowel is: A. B. C. D. E. Embolism to superior mesenteric artery from e. g. heart. Vasculitis. Thrombosis of underlying atherosclerotic vessels. Hypotension following extensive myocardial infarction. Sudden blood loss. Q3: Comment briefly on diagnosis of irritable bowel syndrome (IBS). The least likely feature of irritable bowel syndrome is: A. B. C. D. E. Weight loss. Recurrent lower abdominal pain. Excessive mucus passage with stool. Stool frequency of > 3 times/day or < 3 times/week. Association with frequency of urination. All the following medications are approved for treatment of irritable bowel syndrome with diarrhea and abdominal pain, except: A. B. C. D. E. Loperamide. Clidinium bromide. Amitriptyline. Lubiprostone Alosetron. Single choice questions: Select the most appropriate answer: All the following conditions are recognized associations with Coeliac disease, except: A. Type 2 diabetes mellitus. B. Dermatitis Herpetiform. C. Down syndrome. D. Thyroid diseases. E. Lymphocytic and Collagenous Colitis. The aggressive forces against gastric mucosa include all the following, except: A. Pepsins secretion. B. Bile acid. C. Ischaemia. D. Smoking. E. Prostaglandins. All the following are true about H. pylori infection, except: A. Megaloplastic anaemia is an association due to intrinsic factor deficiency. B. D cells that produce somatostatin decrease. C. Intestinal metaplasia of gastric mucosa is recognized feature. D. MALToma is a rare complication. E. Antibiotic therapy is not indicated in asymptomatic infections. The following are possible causes of chronic diarrhea due to malabsorption syndrome, except: A. Giardiasis. B. Chronic pancreatitis. C. Gluten induced enteropathy. D. Amoebiasis. E. Prolonged obstructive jaundice. The best practical and more convenient test for diagnosis of H. pylori infection is: A. Serum antibody detection. B. Urea breathe test. C. Stool antigen detection. D. Biopsy and special staining for H. pylori. E. Biopsy and urease test. Essay questions: Q1: Mention the significance of the following serological tests that are linked to HB virus infection. a. Positive anti-HBc (IgM) but negative HBsAg. b. Positive both HBsAg and anti-HBc (IgG). c. Highly positive HBe Ag. d. High titers of anti-HBsAg. Q2: Comment briefly on the following statements in association with chronic hepatitis and liver cirrhosis: a. Features in history, clinical examination and investigations that accuse Alcohol as possible cause of cirrhosis. b. possible complications (enumerate only). c. If a chronic hepatitis C virus infection is the cause; name 3 specific drugs used for its treatment. Q3: Comment on following features that are linked to liver cirrhosis: A. Liver size. B. Spider angiomata. C. Endocrine changes. D. Features attributed to portal hypertension. Q4: Comment on tests that determine the severity of liver disease. Q5: Mention: A. Complications of acute viral hepatitis. B. Causes of liver cirrhosis. Single choice questions: Select the most appropriate answer: 3. Which of the following causes of acute liver diseases is most likely to evolve into chronic liver disease in the future? A. Acute paracetamol poisoning. B. Hepatitis A viral infection. C. Hepatitis E and B viral infection. D. Non-alcoholic fatty liver disease (NAFLD). E. Infectious mononucleosis hepatitis. Which of the following vitamins is stored in small amounts in liver and disappeared rapidly if dietary intake is insufficient? A. B. C. D. E. Vitamin A. Vitamin K. Vitamin B12. Vitamin D. Vitamin A and D. Which one of the following liver diseases is likely to be associated with macrocytosis: A. B. C. D. E. Alcoholic liver disease. Chronic hepatitis C infection. Wilson disease. Primary biliary cirrhosis. Hepatocellular carcinoma(HCC). Which of the following auto-antibodies is most likely associated with primary biliary cirrhosis: A. B. C. D. E. Anti-smooth muscle antibodies. anti-LKM (liver-kidney microsomal) antibodies. Antinuclear antibodies. Anti-mitochondrial antibodies. Anti-thyroid antibodies. All the following are adverse prognostic factors in patient with liver disease, except: A. B. C. D. E. Serum bilirubin: 100µmol/l. Serum sodium: 120 mmol/l. Serum ALT: 700 IU/l. Serum albumin concentration: 28 gm/l. Serum creatinine: 1.5 mg/dl. Single choice questions first term: The most frequent anatomical site for gastric adenocarcinoma is: A. Antrum. B. Body toward lessor curvature. C. Body toward greeter curvature. D. Fundus. E. Cardia. The unlikely cause of acute gastritis among the following conditions is: A. Bile reflux. B. Aspirin. C. Ibuprofen. D. Viral infection. E. Autoimmune disorders. Which of the following diets is likely to link with gastric carcinoma? A. Diet rich in fresh vegetable. B. Diet rich in vitamin C. C. Vitamin A containing diet. D. High fruit containing diet. E. Salted, smoked diet. All of the following are well recognized risk factors for gastric adenocarcinoma, except: A. Dietary factors. B. Smoking and alcohol consumption. C. Familial adenomatous polyposis. D. History of previous gastric surgery. E. Presence of specific gene mutation. Autoimmune chronic gastritis is associated with all the following, except: A. Macrocytic anaemia. B. Hypothyroidism. C. Primarily involving the antrum. D. Predispose to gastric adenocarcinoma. E. Presence of specific serum antibodies against parietal cells. Capsule endoscopy is of particular valve in detection: A. Proximal colonic lesions. B. Distal ileal lesions. C. Crohn's complications. D. Meckel's diverticulum. E. Obscure major gastrointestinal bleeding. Q1: Enumerate the factors that are promoting antimicrobial resistance. Give examples of antibiotic therapy that help in reducing the emergence of resistance. Q2: Comment on problems with antibiotic therapy in elderly. MCQS: All the following drugs can be prescribed safely during pregnancy, except: A. Cephalosporins. B. Clarithromycin. C. Clindamycin. D. Erythromycin. E. Levofloxacine. All the following about vancomycin are true, except: A. Oral form is effective against C. difficle infections. B. Effective against Methicillin resistant staphylococci auras (MRSA). C. Can cause nephrotoxicity especially if given with metronidazole. D. May cause hypersensitivity reactions. E. Thrombophlebitis is a recognized complication of parenteral therapy. All the following are true regarding imipenem, except: A. It is effective against gram positive and negative bacteria. B. It is related to carbapenems. C. Best single choice for nosocomial infection. D. It is the treatment of choice for gonococcal infection. E. It is given only by parenteral route. Which of the following quinolones is more effective against pseudomonas in patients with cystic fibrosis infections: A. Ofloxacine. B. Ciprofloxacine. C. Norfloxacine. D. Levofloxacine. E. Moxifloxacine. Problem solving questions: Q1: A 45-year-old man who has drunk heavily for more than 5 years is admitted to hospital for intensive medical care. The patient had been suffered from fever, upper abdominal discomfort, nausea, vomiting and darkening of his urine for a week. His condition markedly deteriorated and he became drowsy just few hours before admission. Clinical examination revealed yellowish sclera with tender hepatomegaly. A provisional diagnosis of acute hepatitis was given for his condition. A. What is the most likely cause of his deterioration? Mention some other features (signs and symptoms) of this complication. B. If the provisional diagnosis is correct, mention at least 3 causes that may be responsible for this illness. C. What are laboratory tests that establish alcohol misuse is the sole cause for his current illness? D. If the answer C is positive and the patient is recovered completely from his illness; what is the best advice one can offer to him in order to avoid future liver problems? E. Mention 3 groups of liver problems that are linked with alcohol consumption. Q2: For the following 3 scenarios; give the most appropriate clinical diagnosis, comment on at least two important specific investigations and outline the treatment for each. A. An 18-year-old lady who described her stools as bulky, offensive and greasy. She had history of recurrent herpitiform skin rash on extensor surfaces of the body. On examination she looked chronically ill and pale. Her abdomen was distended but shifting dullness was negative. B. A 45-year-old man with prolonged history of alcoholism who had suffered from recurrent, severe upper abdominal pain in addition. His stools were containing undigested food particle of previous meals. C. A 20-year-old male patient who had been suffered from recurrent bloody diarrhea and attacks of severe abdominal pain concentrated mainly near right iliac fossa. Perirectal examination revealed the presence of two skin tags and a perianal fistula. Q3: A nurse came for investigation because her colleagues noted a yellowish discoloration of her sclera a day before. Her past history revealed that she had been exposed to needle stick injury following a blood sample taking from a patient with Hepatitis B before two months. Her blood tests showed a total bilirubin 80 µmol/l, ALT 300 U/l and AST 170 U/l. a. What other investigations are necessary for this patient? Comment on results. b. How can you manage the patient at this stage? c. If abnormal liver function tests are persist beyond 6 months, how can the management differ at this stage? d. What are the future possible complications if her condition is not settle? Q4: A young male farmer was admitted to the intensive care unit in a state of coma. The condition began several hours after exposure to a kind of insecticidal spray in his farm. The wife declared that her husband returned home earlier and felt tired and nauseating. He also developed repeated vomiting, abdominal pain, and diarrhea with some chest tightness. a. What is the most likely chemical substance that was responsible for his condition? b. What physical signs do you look for to confirm the diagnosis? c. How could you save this patient? Q5: An eighteen year old male patient with acute leukaemia, presented with fever, malaise and dizziness few days after receiving a course of combined cytotoxic therapy. On examination: The patient appeared very ill with cold hands, oral temperature 38.5 Cº, pulse 110/min and weak, and BP 80/50mm Hg. The collected urine volume was not more than 250 cc/24 hours despite IV fluid therapy. a. What is the most likely diagnosis of the current condition? b. Mention the possible predisposing factor(s) for such a condition in this patient. c. What subsequent additional complications might occur with this condition? d. Comment on three important investigations that are most useful in this condition. e. Outline the subsequent treatment of the patient at this stage. Single choice questions: Which of the following therapeutic options takes the first priority in management of a patient with severe diarrhea? a) Giving a fluid challenge as soon as you assess the patient. +++ b) Immediate antibiotic therapy. c) Antispasmodics to relieve abdominal discomfort. d) Agents to suppress diarrhea. e) Sending a sample of stool for examination.