Test IV
Practice test
1. all of the following are digestive enzymes
secreted by the pancreas Except
a. lipase
b. amylase
c. proteases
d. ribonuclease
2. the main pancreatic duct is
a. duct of wirsung
b. duct of santori
c. ampulla of vater
d. none of the above
3. a condition typically presenting w/ upper
abdominal pain and increase in pancreatic enzyme levels (amylase, lipase) in
blood and urine that is secondary to pancreatic inflammation
a. acute pancreatitis
b. chronic pancreatitis
c. chronic relapsing pancreatitis
d. acute relapsing pancreatitis
4. the most common cause of acute pancreatitis
in the US is
a. gallstones
b. alcohol
c. drugs (eg. lasix, tetracyclines)
d. mumps
5. all of the
following can be seen in acute pancreatitis Except
a. abdominal pain radiating to the back
b. LUQ or epigastrium pain
c. nausea and vomiting
d. pain aggravated by sitting up and leaning
forward
e. pain lasting for hrs-days
6. all of the following are key signs in acute
pancreatitis Except
a. low grade fever
b. tachycardia
c. tachypnea
d. new onset diabetes mellitus
7. a bluish discoloration of the flanks
sometimes seen in acute pancreatitis is an
a. + Murphy's sign
b. trousseau's sign
c. grey turner's sign
d. collen's sign
8. all of the following are true statements
except
a. increase in serum amylase or lipase levels
do not correlate w/ severity of prognosis in pancreatitis
b. serum amylase levels may be normal in pts.
w/ alcoholic pancreatitis
c. serum amylase levels are usually elevated in
chronic pancreatitis
d. serum amylase levels elevated >4x normal
is an indication of acute pancreatitis
9. all of the following can be seen on labs for
acute pancreatitis except
a. increased serum glucose
b. increased WBCs
c. increased LFTs
d. increased serum Ca+
10. which of the following are key tests in
diagnosis of acute pancreatitis
a. CT scan
b. Ultrasound of abdomen
c. plain abdominal films
d. all of the above are key tests
11. treatment of acute pancreatitis includes all
of the following Except
a. NPO until pain subsides
b. parenteral analgesics w/ morphine
c. NG tube aspiration of stomach in all pts.
and those w/ mild pancreatitis
d. IV fluids to maintain fluid and electrolyte
balance
e. IV Ca+ if hypocalcemic
12. A 65 yo male pt presents to your office w/
signs and symptoms of acute pancreatitis. On labs you find his WBC to be
20,000, his blood glucose is 300, his calcium is 4mg/dl and his arterial Po2 is
40 mm/Hg. All other tests are
unremarkable. What is this pts.
mortality chances according to the Ranson Criteria.
a. <1%
b. <30%
c. <40%
d. »80%
e. 100%
13. all of the following are complications of
acute pancreatitis Except
a. pseudocyst
b. pancreatic abscess
c. hemorrhagic pancreatitis
d. adult respiratory distress syndrome
e. peptic ulcer dz.
14. what is the most common symptom in both
acute and chronic pancreatitis
a. abdominal pain
b. jaundice
c. abdominal distention
d. ascites
e. abdominal mass
15. what is the most common cause of chronic
pancreatitis in adults
a. alcoholism
b. cystic fibrosis
c. protein-calorie malnutrition
d. gallstones
e. abdominal trauma
16. what is the most common cause of acute
relapsing pancreatitis
a. alcoholism
b. cystic fibrosis
c. protein-calorie malnutrition\
d. gallstones
e. abdominal trauma
17. which of the following is pathognomonic
for chronic pancreatitis, however it is noted in only minority of the pts.
a. dilated main pancreatic duct w/ strictures
on ERCP
b. calcification seen on abdominal x-ray
c. pseudocyst seen on CT scan
d. constricted ducts seen on Ultrasound
18. Which of the following is not an adequate
symptomatic treatment for chronic pancreatitis
a. perform surgery when all other treatments
fail
b. treat steatorrhea w/ oral enzyme supplements
w/ meals
c. stop alcohol intake
d. calorie restriction for treatment of
diabetes
e. pain control w/ analgesics
19. all of the following are risk factors for
pancreatic cancer Except
a. alcoholism
b. cigarette smoking
c. diet high in fat and meats
d. diabetes mellitus
e. age >60yo
20. all of the following are true concerning
pancreatic carcinoma symptoms except
a. epigastric pain is the earliest symptom, it
may be vague, and may be worsened by eating or lying down
b. weight loss
and depression is a common symptom
c. jaundice and pruritus are often present
d. new onset of glucose intolerance may develop
e. pain is more severe than acute pancreatitis
21. concerning labs results for pancreatic
carcinoma, all of the following are true Except
a. glucose may be increased
b. CA 19-9 has a + predictive value of 92%
c. serum amylase and lipase are often elevated
d. liver enzymes (ALT/AST) are often elevated
e. alk phos is often elevated
22. regarding treatment of pancreatic cancer,
all of the following are true statements Except
a. staging of tumors requires a high resolution
CT scanner
b. whipple's procedure is often employed
c. Gemzar is FDA approved for treatment of
advanced pancreatic cancer
d. CT scan is not very accurate in predicting
unresectability
e. pain management is approved for palliative
therapy
A.
serum albumin
B. prothrombin time
C. Both
D. neither
23. reflect hepatic capacity for protein
synthesis
24. useful as a daily marker of hepatic function
25. all of the following are true concerning
screening tests for hepatobiliary dz. Except
a. serum bilirubin may take to normalize after
improvement in specific dz.
b. serum alk phos reflects activity of liver,
bone, intestine, placenta
c. serum alk phos may be decreased secondary to
puberty
d. GGT elevation is often d/t alcohol and drugs
e. cholestatic or biliary dz. is suggested by
increased bilirubin
A. AST
B. ALT
C. both
D. neither
26. found in hepatocytes, cardiac muscle, and
muscle cells
27. more specific for liver cell damage
28. all of the following are true concerning
jaundice Except
a. also known as icterus
b. it is often the 1st and sole manifestation
of liver dz.
c. it is clinically noted when serum bilirubin is
>2.5 mg/dl
d. it is best detected by the yellowing of the
skin
e. yellowing of the skin, sclerae, and mucous
membranes are produced by increased serum bilirubin secondary to
hyperbilirubinemia
29. all of the following are stages in the
normal metabolism of bilirubin Except
a. production
b. immobilization
c. uptake
d. conjugation
e. excretion
30. which of the following is the rate limiting
step in normal bilirubin metabolism
a. production
b. immobilization
c. uptake
d. conjugation
e. excretion
A. direct van der bergh reaction
B. indirect van der bergh reaction
C. both
D. neither
31. provides clinically useful info estimating
conjugated and unconjugated bilirubin
32. test shows colored reaction only w/ water
soluble (conjugated) bilirubin
A. Gilbert's syndrome
B. Crigler-Najjar syndrome (type I and II)
C. both
D. neither
33. decrease in conjugation
34. decrease in hepatic uptake
A. Crigler-Najjar syndrome type I
B. Crigler-Najjar syndrome type II
C. both
D. neither
35. congenital absolute deficiency of
UDP-glucoronyl transferase
36. photo therapy is the treatment of choice
A. Dubin-Johnson syndrome
B. Rotor syndrome
C. both
D. neither
37. is a familial disorder that causes impaired
hepatic excretion
38. liver biopsy is usually normal
A. hepatocellular dz
B. biliary obstruction
C. both
D. neither
39. transaminases are going to be increased
10-15x normal
40. transaminases are going to be increased
<5-10x normal
41. alk phos are going to be increased <2-3x
normal
42. alk phos are going to be increased >2-3x
normal
A. acute hepatitis
B. chronic hepatitis
C. both
D. neither
43. dz. lasts <6 months
44. piecemeal necrosis and bridging necrosis can
be seen on histological exams
45. all of the following are caused by an RNA
virus Except
a. hep A
b. hep B
c. hep C
d. hep D
e. hep G
A. Hep B
B. Hep C
C. both
D. neither
46. extra hepatic manifestation are usually not
present
47. IV drug use is the most common cause
48. vaccination is not contraindicated in
pregnancy
A. anti- HBc
B. anti- Hbs
C. both
D. neither
49. confers immunity
50. reliable marker of infection, past or
current
A. Hep C
B. Hep D
C. both
D. neither
51. recurrence after transplant is nearly 100%
52. massive hepatic necrosis can occur
53. A 50 yo male presents to your office w/
anorexia, nausea and vomiting, weight loss, and abdominal pain. On physical exam you note a fever,
hepatomegaly, and splenomegaly. By
taking good H&P you discover that he has been consuming 80gm of alcohol a
day for the last 25 years. You send off
for lab test and get results of mallory bodies seen near or around nuclei of
heptatocytes. His PMNs are infiltrating
the liver and he has spider fibrosis. You
suspect that the pt has. what diagnosis
a. alcoholic fatty liver
b. alcoholic hepatitis
c. cirrhosis
d. fulminant hepatic failure
e. a hangover
54. how would you treat the pt. in question #53
a. supportive therapy
b. treat his underlying alcoholism
c. high caloric diet w/ vitamin (thiamine, and
B vitamins) and folic acid supplementation
d. protein restriction if encephalopathy
develops
e. all of the above
55. which of the
following could be given to antidote acetaminophen overdose
a. isoniazid
b. tetracycline
c. 3rd generation cephalosporin
d. erythromycin
e. N-acetylcystine
56. all of the following could progress to
chronichepatitis Except
a. Hep A
b. Hep B
c. Hep C
d. Hep D
e. all of the
above
57. which of the following has the poorest
prognosis
a. chronic persistent hepatitis
b. chronic lobular hepatitis
c. chronic active hepatitis
d. all have poor prognosis
A. Hep B
B. Hec C
C. both
D. neither
58. 30-40% of pts develop cirrhosis
59. 30-40% of chronic hepatitis in the USA
A. Wilson's dz.
B. hemochromatosis
C. both
D. neither
60. presents in early life
61. will often have a family positive hx. of
liver dz.
62. On a histological exam of a pt. you see
fibrosis expansion of most portal areas w/ occasional portal-portal
bridging. What would you score this
fibrosis.
a. 1
b. 2
c. 3
d. 4
e. 5
63. all of the following are true concerning
primary biliary cirrhosis Except
a. affects middle age females
b. jaundice is often the initial symptom
c. some pts have bone pain, fractures, and
vertebral collapse d/t osteoporosis
d. + antimitochondrial antibody test is seen in
90-95% of pts
e. CREST syndrome is commonly associated w/
this dz.
64. all of the following are true concerning
hemochromatosis Except
a. males are affected more than females
b. it is a dz. of younger people (<15 yo)
c. its an autosomal recessive disorder
d. diagnosis is made definite by liver biopsy
e. weekly phlebotomies are an affective
treatment
A. Wilson's dz
B. Hemochromatosis
C. both
D. neither
65. defect on chromosome 6
66. defect on chromosome 13
67. kayser-fleischer rings are pathognomonic of
the dz.
68. the initial treatment for a pts w/ ascites
d/t portal HTN should be
a. salt restriction
b. bed rest
c. diuretics
d. water restriction
e. liver transplant
A. spontaneous bacterial peritonitis (SBP)
B. hepatorenal syndrome
C. both
D. neither
69. occurs in presence of ascites
70. Ecoli and Klebsiella are the most common
causes
71. A male pt. presents to the ER w/ disordered
consciousness and altered neuromuscular activity. You obtain his history from his wife who says he has drank 1/2 a
bottle of Windex (high in ammonia, and a known hepatotoxin). He has marked confusion, incoherent speech,
but is arousable. His EEG results are
abnormal and asterixis is present, along w/ clonus and brisk reflexes. What would you stage his hepatic
encephalopathy
a. stage 1
b. stage 2
c. stage 3
d. stage 4
e. stage 0
72. In pt. in question #71, what would be a good
treatment regimen to prevent ammonia diffusion from the bowel
a. give neomycin by retention enema
b. restrict protein intake to 20-40 gm/day
c. give norfloxin 400mg po QD
d. lactulose enema w/ pt lying in Trendelenburg
position
e. all of the above
73. encephalopathy occurring within 8 wks of
acute liver dz.
a. fulminant hepatic failure
b. late onset fulminant hepatic failure
c. cirrhosis
d. chronic persistent hepatitis
e. chronic active hepatitis
74. which of the following is the hallmark of
fulminant hepatic failure and marks its onset
a. cerebral edema
b. GI bleeding
c. hypoglycemia
d. hepatic encephalopathy
e. agitation
75. which of the following is the leading cause
of death in fulminant hepatic failure
a. cerebral edema
b. GI bleeding
c. hypoglycemia
d. hepatic encephalopathy
e. agitation
76. A pt presents to the ER w/ cerebral
edema. You note that the pt is agitated
and violent. Which of the following
would be a good therapy for this pt.
a. short acting banzodiazepines (eg. lorazepam)
b. haldol
c. morphine sulfate
d. pancuronium bromide
e. vitamin K
A. hemangiomas
B. hepatic adenomas
C. both
D. neither
77. women affected more than men
78. most common benign hepatic tumor
A. hepatoma
B. angiosarcoma
C. both
D. neither
79. men affected more than women
80. accounts for upto 50% of all cancers in
parts of Sub Sahara in Africa and Asia
81. thorotrast (a radiologic contrast used in
the past) is an associated risk factor
82. which of the following does metastatic liver
dz. most arise from
a. breast
b. colon
c. gallbladder
d. lung
e. stomach
83. A homosexual male that has just gotten
released from an African jail, presents to your office w/ RUQ pain, and
fever. You also find out that he has
pleuritic pain, chills, and night sweats.
His labs are as follows, WBC
30,000, alk phos is elevated, and his bilirubin is 10. Radionulcide liver scan shows decreased
filling time in his liver. You would
most likely suspect which of the following diagnosis
a. amebic liver abscess
b. pyogenic liver abscess
c. focal hepatic canididasis abscess
d. cirrhosis
e. hepatitis B
84. A proper treatment regimen for the pt. in
question #83 would be
a. amphotericin B
b. flagyl
c. chloroquinine
d. all of the above
e. only A and B
A. hepatic vein thrombosis
B. portal vein thrombosis
C. both
D. neither
85. diagnosis is established by inability to
catheterize hepatic veins w/ angiography
86. often manifests w/ portal HTN
87. also know as Budd Chiari syndrome
88. anticoagulants are no help
89. all of the following are definite
contraindication for hepatic transplantation Except
a. extra hepatic malignancies
b. systemic infections
c. cholangiocarcinoma
d. active alcohol or illicit drug use
e. severe renal dz. from causes other than
hepato renal syndrome
90. according to the CHILD-PUGH classification
what score would you give the following pt.
moderate ascites, bilirubin 2, albumin 2, PT 10 seconds.
a. 1A
b. 1B
c. 2A
d. 3B
e. 3C
A. 2a
B. 2b
C. both
D. neither
91. those who are very sick (eg. CHILD-PUGH
catagory 3)
92. very sick but not in the ICU
93. concerning complications from
immunosuppressive regimen, all of the following are true Except
a. many centers have begun using newer
immunosuppressive agents
b. most pts on these drugs loose 20-30% of
their renal function in the 1st year
c. neurologic symptoms (eg. HA, tremors,
musculoskeletal pain) are often seen
d. excessive hair growth and gingival
hyperplasia are complications of tacrolimus (FK 506)
e. hyperkalemia can often manifest
A. Ketoconazole
B. Phenytoin
C. both
D. neither
94. induces cytochrome P450 IIIA enzyme
95. increases the levels of immunosuppressive
drugs.
96. concerning gallstones, all of the following
are true except
a. cholesterol stones are more common than
pigment based stones
b. most stones are radiopaque
c. gallstones are the most common cause of
biliary tract dz. in the US
d. gallbladder is the key to gallstone
formation
e. radionuclide 99m HIDA scan is the most
accurate test for detecting gallstones
97. classic findings of biliary colic include
all of the following Except
a. epigastric tenderness
b. specific tenderness over the fundus of the
gallbladder
c. + Murphy's sign
d. progressive dz.
e. jaundice
98. complications of cholecystitis include all
of the following Except
a. empyema of gallbladder
b. gangrene
c. emphysematous cholecystitis
d. perforation
e. all of the above are complication of
cholecystitis
A. Acalculous cholecystitis
B. biliary dyskinesia
C. both
D. neither
99. signs and symptoms are similar to chronic
cholecystitis and biliary colic
100. fractional excretion HIDA scan is the test
of choice
A. adenocarcinoma of gallbladder
B. adenocarcinoma of bile duct
C. both
D. neither
101. not associated w/ gallstones
102. palpable,
enlarged, tender gallbladder
1.c
2.a
3.a
4.b
5.d
6.d
7.c
8.c
9.d
10.d
11.b
12.c
13.e
14.a
15.a
16.d
17.b
18.d
19.a
20.e
21.b
22.d
23.c
24.b
25.c
26.a
27.b
28.d
29.b
30.e
31.c
32.a
33.c
34.a
35.a
36.c
37.c
38.a
39.a
40.b
41.a
42.b
43.a
44.b
45.b
46.d
47.b
48.a
49.b
50.a
51.a
52.b
53.b
54.e
55.e
56.a
57.c
58.a
59.b
60.a
61.c
62.c
63.b
64.b
65.b
66.a
67.a
68.a
69.c
70.a
71.c
72.d
73.a
74.d
75.a
76.d
77.c
78.a
79.c
80.a
81.c
82.d
83.a
84.e
85.a
86.c
87.a
88.a
89.e
90.e
91.c
92.b
93.d
94.b
95.a
96.b
97.e
98.e
99.b
100.b
101.b
102.a