Gastroenterology 2023
Anki:
https://docs.google.com/document/d/e/2PACX-1vTLD1ngXwmIhscq86Dn1O
Fd7_-IGxHFOxV1gcfLzvd4Vz2P5RN4dndJwJXcxQxwdNntk9Q9BIO1-aCV/pu
b
● This is an endoscopic image of:
● a) Gastric ulcer
● b) Gastric varices
● c) Foreign body
● d) Gastric cancer
● e) Gastric bezoar
○ d) Gastric cancer
● A 60-year-old man hospitalized for advanced cirrhosis complicated by ascites and
encephalopathy is evaluated for massive hematemesis and hypotension. The
patient's medications are spironolactone, furosemide, and lactulose. On physical
examination ,the temperature is 35.6°C (96°F), the blood pressure is 80/50 mm Hg,
the pulse rate is 146/min, and the respiration rate is 20/min. The patient has just
vomited red blood and has large-volume ascites; the stool is brown and positive
for occult blood. Laboratory studies show hemoglobin of 9 g/dL (90 g/L), platelet
count of 60,000/μL (60 × 109 /L), and INR of 3. In addition to rapid volume
resuscitation, which of the following is the most appropriate management of this
patient? #1
● A. Abdominal CT with contrast
● B. Esophagogastroscopy
● C. Intravenous omeprazole
● D. Mesocaval shunt
● E. Transjugular intrahepatic portosystemic shunt
● The most common cause of chronic viral hepatitis in Bulgaria is:#19
● A. HCV
● B. HAV
,● C. HBV
● D. HEV
● E. EBV
○ C. HBV
● The most common cause of chronic viral hepatitis in Europe is:#19
● A. HCV
● B. HAV
● C. HBV
● D. HEV
● E. EBV
○ A. HCV
● In patients with acute viral hepatitis, the jaundice precedes or combines with the
following symptoms and syndromes associated with acute infection with HAV,
HBV or HCV#19
● A. Fever
● B. Diarrhea
● C. Loss of appetite, nausea
● D. Haematuria
● E. А) and B) and C)
○ E. А) and B) and C)
● Extrahepatic manifestations of chronic C hepatitis are:#19
● A. Arthralgia or arthritis
● B. Fever and peripheral lymphadenopathy
● C. Skin manifestations of cryoglobulinemia
● D. Glomerulonephritis
● E. А), C) and D)
○ E. А), C) and D)
● The most common genotype of HCV in Europe is:#19
● A. HCV 1a
● B. HCV 1b
● C. HCV 2
● D. HCV 3a
● E. HCV 4
○ B. HCV 1b
,● In most cases, acute HCV infection occurs asymptomatically (in 90%) and only
about 10% of patients develop flu-like symptoms, jaundice, and elevations of
transaminases. This statement is:#19
● A. Absolutely true
● B. False
● C. t Not complete
● D. Inaccurately
● E. There is no such statement
○ A. Absolutely true
● What are the common features of Crohn's disease and ulcerative colitis #19
● A. autoimmune pathogenesis;
● B. corticosteroids and 5-aminosalicylicilates are administered for induction of remission
● C. the colonoscopy (ileo-colonoscopy) is a main diagnostic method
● D. The treatment of severe forms includes drugs directed against TNF-alpha
● E. All of the above are true
○ E. All of the above are true
● What proportion of patients with chronic hepatitis C develop liver cirrhosis? #19
● A. Less than 5%
● B. 5-10%
● C. 20-30%
● D. 50-60%
● E. All patients with chronic HCV infection
○ C. 20-30%
● What proportion of patients with liver HCV cirrhosis develop hepatocellular cancer
within 1 year? #19
● A. a Less than 0.5%
● B. 1 to 5%
● C. 10 to 20%
● D. 30to40%
● E. More than 50%
○ B. 1 to 5%
● Factors for progression of fibrosis stage in chronic C hepatitis are:#19
● A. Genetic factors
● B. Immuneresponse
● C. Viral load (HCV RNA level)
, ● D. Obesity and diabetes mellitus
● E. А), B) and D)
○ E. А), B) and D)
● Laboratory constellation in hepatocellular injury with the cause of chronic C-viral
hepatitis includes#19
● A. Four-digit values of transaminase activity
● B. Increase in transaminases, predominantly ALT, usually up to 5, maximum up to 10x
upper limit of normal without hyperbilirubinaemia
● C. Increase in transaminases, hypoalbuminemia, hyperbilirubinaemia
● D. Increase in GGT and ALP and normal transaminases
● E. Increase in transaminases predominantly in AST, increase in LDH and bilirubin
○ B. Increase in transaminases, predominantly ALT, usually up to 5, maximum up
to 10x upper limit of normal without hyperbilirubinaemia
● Detection of HCV by screening serology (EIA) is based on the detection of: #19
● A. HCV antigens, in particular viral envelope proteins
● B. HCV antigens, components of the viral nucleocapsid
● C. Antibodies against viral antigens from non-structural proteins, specifically the NS3,
NS4, NS5 regions
● D. HCV RNA
● E. HCV DNA
○ C. Antibodies against viral antigens from non-structural proteins, specifically the
NS3, NS4, NS5 regions
● Continue the statement: "The immune enzyme method (EIA 3rd Generation)
method for detecting circulating antibodies against HCV may show a false
negative result after infection with HCV ..." #19
● A. In the first 6-8 weeks - the so-called window period from HCV infection to
seroconversion
● B. In the first 12-16 weeks of HCV infection n
● C. Throughout the whole period of acute to chronic C hepatitis
● D. Because of the immunosuppressive status of the HCV infected patient
● E. The correct answers are А) and D)
○ E. The correct answers are А) and D)
Anki:
https://docs.google.com/document/d/e/2PACX-1vTLD1ngXwmIhscq86Dn1O
Fd7_-IGxHFOxV1gcfLzvd4Vz2P5RN4dndJwJXcxQxwdNntk9Q9BIO1-aCV/pu
b
● This is an endoscopic image of:
● a) Gastric ulcer
● b) Gastric varices
● c) Foreign body
● d) Gastric cancer
● e) Gastric bezoar
○ d) Gastric cancer
● A 60-year-old man hospitalized for advanced cirrhosis complicated by ascites and
encephalopathy is evaluated for massive hematemesis and hypotension. The
patient's medications are spironolactone, furosemide, and lactulose. On physical
examination ,the temperature is 35.6°C (96°F), the blood pressure is 80/50 mm Hg,
the pulse rate is 146/min, and the respiration rate is 20/min. The patient has just
vomited red blood and has large-volume ascites; the stool is brown and positive
for occult blood. Laboratory studies show hemoglobin of 9 g/dL (90 g/L), platelet
count of 60,000/μL (60 × 109 /L), and INR of 3. In addition to rapid volume
resuscitation, which of the following is the most appropriate management of this
patient? #1
● A. Abdominal CT with contrast
● B. Esophagogastroscopy
● C. Intravenous omeprazole
● D. Mesocaval shunt
● E. Transjugular intrahepatic portosystemic shunt
● The most common cause of chronic viral hepatitis in Bulgaria is:#19
● A. HCV
● B. HAV
,● C. HBV
● D. HEV
● E. EBV
○ C. HBV
● The most common cause of chronic viral hepatitis in Europe is:#19
● A. HCV
● B. HAV
● C. HBV
● D. HEV
● E. EBV
○ A. HCV
● In patients with acute viral hepatitis, the jaundice precedes or combines with the
following symptoms and syndromes associated with acute infection with HAV,
HBV or HCV#19
● A. Fever
● B. Diarrhea
● C. Loss of appetite, nausea
● D. Haematuria
● E. А) and B) and C)
○ E. А) and B) and C)
● Extrahepatic manifestations of chronic C hepatitis are:#19
● A. Arthralgia or arthritis
● B. Fever and peripheral lymphadenopathy
● C. Skin manifestations of cryoglobulinemia
● D. Glomerulonephritis
● E. А), C) and D)
○ E. А), C) and D)
● The most common genotype of HCV in Europe is:#19
● A. HCV 1a
● B. HCV 1b
● C. HCV 2
● D. HCV 3a
● E. HCV 4
○ B. HCV 1b
,● In most cases, acute HCV infection occurs asymptomatically (in 90%) and only
about 10% of patients develop flu-like symptoms, jaundice, and elevations of
transaminases. This statement is:#19
● A. Absolutely true
● B. False
● C. t Not complete
● D. Inaccurately
● E. There is no such statement
○ A. Absolutely true
● What are the common features of Crohn's disease and ulcerative colitis #19
● A. autoimmune pathogenesis;
● B. corticosteroids and 5-aminosalicylicilates are administered for induction of remission
● C. the colonoscopy (ileo-colonoscopy) is a main diagnostic method
● D. The treatment of severe forms includes drugs directed against TNF-alpha
● E. All of the above are true
○ E. All of the above are true
● What proportion of patients with chronic hepatitis C develop liver cirrhosis? #19
● A. Less than 5%
● B. 5-10%
● C. 20-30%
● D. 50-60%
● E. All patients with chronic HCV infection
○ C. 20-30%
● What proportion of patients with liver HCV cirrhosis develop hepatocellular cancer
within 1 year? #19
● A. a Less than 0.5%
● B. 1 to 5%
● C. 10 to 20%
● D. 30to40%
● E. More than 50%
○ B. 1 to 5%
● Factors for progression of fibrosis stage in chronic C hepatitis are:#19
● A. Genetic factors
● B. Immuneresponse
● C. Viral load (HCV RNA level)
, ● D. Obesity and diabetes mellitus
● E. А), B) and D)
○ E. А), B) and D)
● Laboratory constellation in hepatocellular injury with the cause of chronic C-viral
hepatitis includes#19
● A. Four-digit values of transaminase activity
● B. Increase in transaminases, predominantly ALT, usually up to 5, maximum up to 10x
upper limit of normal without hyperbilirubinaemia
● C. Increase in transaminases, hypoalbuminemia, hyperbilirubinaemia
● D. Increase in GGT and ALP and normal transaminases
● E. Increase in transaminases predominantly in AST, increase in LDH and bilirubin
○ B. Increase in transaminases, predominantly ALT, usually up to 5, maximum up
to 10x upper limit of normal without hyperbilirubinaemia
● Detection of HCV by screening serology (EIA) is based on the detection of: #19
● A. HCV antigens, in particular viral envelope proteins
● B. HCV antigens, components of the viral nucleocapsid
● C. Antibodies against viral antigens from non-structural proteins, specifically the NS3,
NS4, NS5 regions
● D. HCV RNA
● E. HCV DNA
○ C. Antibodies against viral antigens from non-structural proteins, specifically the
NS3, NS4, NS5 regions
● Continue the statement: "The immune enzyme method (EIA 3rd Generation)
method for detecting circulating antibodies against HCV may show a false
negative result after infection with HCV ..." #19
● A. In the first 6-8 weeks - the so-called window period from HCV infection to
seroconversion
● B. In the first 12-16 weeks of HCV infection n
● C. Throughout the whole period of acute to chronic C hepatitis
● D. Because of the immunosuppressive status of the HCV infected patient
● E. The correct answers are А) and D)
○ E. The correct answers are А) and D)
