Krok 2 Medicine (Gasteroenterology) with Explanation ||
A 1). The 28 y.o. woman applied to doctor because of limited loss of the hair. In the anamnesis -
she had frequent headache indisposition, arthromyalgia, fever, irregular casual sexual life, drug
user. RW is negative. What examination must be done first?
A. Examination for HIV
B. Examination for neuropathology
C. Examination for gonorrhea
D. Examination for fungi
E. Examination for trichomoniasis
Explanation: Because of history of causal sex , drug user are major risk factor for HIV transmission associated to this given patient.
2). 33 y.o. woman works as the secretary. Her diet contains 150 g of protein (including 100 g of animal protein), 200 g of fat, 600 g of carbohydrates. What pathologycan develop from this
diet?
A. Obesity
B. Schizophrenia
C. Paradontosis
D. Common cold
E. Uterine fibromyoma
Explanation: She is secretary meaning her work doesn’t need much energy so diet containing that amount of fat and carbohydrate will lead to build up of calories.At least 130 grams of carbohydrate is required daily , protein 100 grams enough for single day.
3). A 33 y.o. male patient was admitted to a hospital. A patient is pale, at an attempt to stand
up he complains of strong dizziness. There was vomiting like coffee-grounds approximately
hour ago. BP- 90/60 mm Hg., pulse- 120 b/min. In anamnesis, a patient has suffered from ulcer
of the stomach, painless form during 4 years. An ulcer was exposed at gastrofibroscopy. Your
diagnosis:
A. Ulcer of stomach, complicated with bleeding
B. Ulcer of duodenum, complicated with bleeding
C. Erosive gastritis
D. Acute pleurisy
E. Acute myocardial infarction, abdominal
Explanation : History of stomach ulcer and signs of bleeding ( vomiting like coffee ground because of gastric acid react with hemoglobin and pale, dizziness, hypotension indicate bleeding)
4). A 27 y.o. man complains of pain in epigastrium which is relieved by food intake. EGDFS
shows antral erosive gastritis, biopsy of antral mucous presents Hеlicobacter Pylori. What can
be diagnosed in this case?
A. Gastritis of type B
B. Gastritis of A type
C. Reflux - gastritis
D. Menetrier’s disease
E. Rigid antral gastritis
Explanation : EGDFS shows erosive gastritis. H. pyloric causes the type B Gastritis and mostly affected antrum. Gastritis A type is autoimmune gastritis.
Mnemonic:
Autoimmune gastritis type A = Autoimmune (Atrophy)
Autoimmune gastritis type B = Bacteria (H. pylori)
Autoimmune gastritis type C = Chemical (Bile)
5). A 38 y.o. woman was hospitalized to the surgical unit with vomiting and acute abdominal
pain irradiating to the spine. On laparocentesis hemmorhagic fluid is obtained. What disease
should be suspected?
A. Acute pancreatitis
B. Renal colic
C. Acute enterocolitis
D. Perforated gastric ulcer
E. Acute appendicitis
Explanation : Acute abdominal pain irradiating to the spine is hallmark for pancreatitis. pancreas location retroperitoneal.
6). 47 y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is
hyperpigmentated. There is multiple xanthelasma palpebrae. The liver is +6 cm enlarged, hard
with acute edge. The blood analysis revealed total bilirubin 160 mkmol/L, direct – 110 mkmol/L,
AST (asparate aminotransferase)- 2,1 mmol/L per hour, ALT– 1,8 mmol/L, alkaline phosphotase-
4,6 mmol/L per hour, cholesterol– 9,2 mmol/L, antimitochondrial antibodies M2 in a high titer.
What is the probable diagnosis?
A. Primary biliary liver cirrhosis
B. Primary liver cancer
C. Chronic viral hepatitis B
D. Acute viral hepatitis B
E. Alcoholic liver cirrhosis
Explanation: High titer for antimitochondrail antibody M2 is specific for primary bilary cirrhosis. It is an autoimmune condition.
7). The complications of acute cholecystitis which require surgical intervention are as follows
EXCEPT:
A. Jaundice
B. Empyema of the gall-bladder
C. Emphysematous gall-bladder
D. Gall-bladder perforation
E. Cholangitis conditioned by the presence of stones in the bile tract
Explanation : Jaundice is a symptom of a disease rather than a disease itself , the rest are medically emergency situation so must treated surgically.
8). A 40 y.o. patient was admitted to the gasteroenterology with skin itching, jaundice,
discomfort in the right subcostal area, generalized weakness. On examination: skin is jaundice,
traces of scratches, liver is +5 cm, splin is 6x8 cm. In blood: alkaline phosphatase - 2,0
mmol/(hour*L), general bilirubin - 60 mkmol/L, cholesterol - 8,0 mmol/L. What is the leading
syndrome in the patient?
A. Сholestatic
B. Сytolytic
C. Mesenchymal inflammatory
D. Asthenic
E. Liver-cells insufficiency
Explanation : Presence of Sign and symptoms of liver. Skin itching and traces of scratches indicate bile obstruction ( cholestasis) .
9). A 51 y.o. woman complains of dull pain in the right subcostal area and epigastric area,
nausea, appetite decline during 6 months. There is a history of gastric peptic ulcer. On
examination: weight loss, pulse is 70 bpm, AP is 120/70 mm Hg. Diffuse tenderness and
resistance of muscles on palpation.There is a hard lymphatic node 1x1cm in size over the left
clavicle. What method of investigation will be the most useful?
A. Esophagogastroduodenoscopy with biopsy
B. Ultrasound examination of abdomen
C. pH-metry
D. Ureatic test
E. Stomach X-ray
Explanation :- Above mentioned is elderly patient and have the history of gastric peptic ulcer and there is loss of weight, appetite loss and lymph node involvement and thus patient is suspected to have cancer and the best method of investigation in this case is Esophagogastroduodenoscopy with biopsy.
10). A 36 y.o. patient was admitted to the hospital with sharp pain in substernal area following
occasional swallowing of a fish bone. On esophagoscopy the foreign body wasn’t revealed. The
pain increased and localized between scapulas. In a day temperature elevated, condition
became worse, dysphagia intensified. What complication has developed?
A. Perforation of esophagus with mediastinitis
B. Esophageal hemorrhage
C. Obstruction of esophagus
D. Pulmonary atelectasis
E. Aspirative pneumonia
Explanation : Fish bone pierced through the esophagus to the posterior structures which led to the inflammation of the mediastinum.
11). A 43 y.o. woman complains of severe pain in the right abdominal side irradiating in the right supraclavicular area, fever, dryness and bitterness in the mouth. There were multiple
vomitings without relief. Patient relates the onset of pain to the taking of fat and fried food. Physical examination: the patient lies on the right side, pale, dry tongue, tachycardia. Right side
of abdomen is painful during palpation and somewhat tense in right hypochondrium. What is
the most likely diagnosis?
A. Perforative ulcer
B. Acute cholecystitis
C. Acute bowel obstruction
D. Acute appendicitis
E. Right-sided renal colic
Explanation: Correct answer is Acute cholecystitis but in krok base gives perforative ulcer.
12). A 74 y.o. female patient complains of pain, distended abdomen, nausea. She suffers from
heart ichemia, postinfarction and diffusive cardiosclerosis. On examination: grave condition,
distended abdomen, abdominal wall fails to take active part in breathing. On laparoscopy:
some cloudy effusion, one of the bowel loops is dark-blue. What is the most probable
diagnosis?
A. Mesenterial vessels thrombosis
B. Volvulus
C. Acute intestinal obstruction
D. Ichemic abdominal syndrome
E. Erysipelas
Explanation: Bowel loop dark blue due to ischemia which is caused by thrombosis because she had history of heart ischemia and diffuse cardiosclerosis.
13). A 56 y.o. man, who has taken alcoholic drinks regularly for 20 years, complains of intensive
girdle pain in the abdomen. Profuse nonformed stool 2- 3- times a day has appeared for the last
2 years, loss of weight for 8 kg for 2 years. On examination: abdomen is soft, painless. Blood
amylase - 12g/L. Feces examination-neutral fat 15 g per day, starch grains. What is the most
reasonable treatment at this stage?
A. Pancreatine
B. Contrykal
C. Aminocapron acid
D. Levomicytine
E. Imodium
Explanation: Patient had history of alcoholism for 20 years. alcoholism is major cause of pancreatitis. since 20 year alcoholism history patient develop chronic pancreatitis so there is defficiency of pancreatitic enzyme (lipase) which is essential for conversion of triglyceride to monoglycerides and free fatty acids which is absorbed. Due to lipase deficiency cause natural fat in stool. Thus, chronic pancreatitis is treated by pancreatic enzyme replacement (pancreatine).
14). A 41 y.o. woman has suffered from nonspecific ulcerative colitis during 5 years. On
rectoromanoscopy: marked inflammatory process of lower intestinal parts, pseudopolyposive
changes of mucous. In blood: WBC- 9, 8 ∗ 109/L, RBC- 3, 0 ∗ 1012/L, sedimentation rate- 52
mm/hour. What medication provides pathogenetic treatment of this patient?
A. Sulfasalasine
B. Motilium
C. Vikasolum
D. Linex
E. Kreon
Explanation: Drug of choice for Ulcerative colitis is sulfasalizine.
15). A 2 y.o. boy was admitted to the hospital with weight loss, unstable discharges, anorexia,
following the semolina’s introduction (since 5 months). The child is adymanic, flabby, pale dry
skin, subcutaneous layer is emaciated. Distended and tensed abdomen, tympanitis on
percussion of the upper part of the abdomen, splashing sounds, feces are foamy, of light color,
foul. On coprocytogram: a lot of neutral fat. What is the cause of the disease?
A. Celiakia (celiac disease)
B. Mucoviscidosis (cystic fibrosis)
C. Intestinal dysbacteriosis
D. Chronic enteritis
E. Disaccharidase insufficiency
Explanation: Semolina’s is purified wheat. In this case patient develop celiac disease which is an autoimmune disease caused by intolerance to gluten (protein found in wheat). which act as antigen and forms an immune complex in intestinal mucosa. Thus, cause malabsorption syndrome (loss of villi and proliferation of crypt cells). Coprocytogram show a lot of natural fat main feature of malabsorption.
16). A patient, aged 25, suffering from stomach ulcer. Had a course of treatment in the
gastroenterological unit. 2 weeks later developed constant pain, increasing and resistant to
medication. The abdomen is painful in epigastric area, moderate defence in pyloroduodenal
area. Which complication development aggravated the patient’s state?
A. Malignisation
B. Penetration
C. Perforation
D. Haemorrhage
E. Stenosis
Explanation: Constant pain due to the stomach ulcer , increasing and resistant to medication is feature of penetration but in krok base Malignisation is correct answer. Malignisation is less common develop in younger age(25 year).
17). A male patient complains of heartburn which gest stronger while bending the body,
substernal pain during swallowing. There is a hiatus hernia on X-ray. What disoeder should be
expected at gastroscopy?
A. Gastroesophageal reflux
B. Chronic gastritis
C. Gastric peptic ulcer
D. Acute erosive gastritis
E. Duodenal peptic ulcer
Explanation: Main feature of Gastroesophageal reflux is substernal pain during swallowing which is aggravated during bending forward. Heartburn due to acid reflux.
18). A 43 y.o. male complains of stomach pain, which relieves with defecation, and is
accompanied by abdominal winds, rumbling, the feeling of incomplete evacuation or urgent
need for bowel movement, constipation or diarrhea in alternation. These symptoms have
lasted for over 3 months. No changes in laboratory tests. What is the most likely diagnosis?
A. Irritable bowel syndrome
B. Spastic colitis
C. Colitis with hypertonic type dyskinesia
D. Chronic enterocolitis, exacerbation phase
E. Atonic colitis
Explanation : Diagnostic Criteria for Irritable Bowel Syndrome (IBS) :
1) Recurrent abdominal pain or discomfort at least 3 days/month in the last 3 months
Plus two or more of the following
2) Improvement with defecation
3) change in frequency of stool
4) change in stool form(appearance)
Note: There is no pathological changes in bowel.
19). A 76 y.o. woman complains of progressing swallowing disorder, mostly she has had problems
with solid food for the last 6 weeks. Sometimes she has regurgitation of solid masses.
Swallowing is not painful. She lost 6 kg. 10 years ago she had myocardiac infarction, she takes
constantly aspirine and prolonged nitrates. She consumes alcochol in moderate proportions,
smokes. Objectively: icteric skin, neck has no pecularities, lymph nodes are not enlarged.
Thorax has no changes, cardiovascular system has no evident changes. Liver is +3 cm. What is
the preliminary diagnosis?
A. Cancer of esophagus
B. Diaphragmatic hernia
C. Diffuse constriction of esophagus
D. Myasthenia
E. Esophageal achalasia
Explanation : Elderly, Alcoholism, smokes is associated with esophageal squamous cell carcinoma . In esophageal carcinoma, there is progressive dysphasia i.e initially solid food later liquid also. Weight loss is one of the alarm sign of cancer.
20). A 38 y.o. man complains of having occasional problems with swallowing of both hard and
fluid food for many months. Sometimes he feels intense pain behind his breast bone, epecially
after hot drinks. There are asphyxia onsets at night. He has not put off weight. Objectively: his
general condition is satisfactory, skin is of usual colour. Examination revealed no changes of
gastrointestinal tract. X-ray picture of thorax organs presents esophagus dilatation with level of
fluid in it. What is the preliminary diagnosis?
A. Esophagus achalasia
B. Myastenia
C. Cancer of esophagus
D. Esophagus candidosis
E. Gastroesophageal reflux
Explanation: Achalasia is a condition in which the muscles of the lower part of the oesophagus fail to relax, preventing solid and liquid food from passing into the stomach. Bird beak or rat tail (esophageal dilatation with level of fluid ) radiological sign is specific for achalasia.
21). A 35 y.o. woman consulted a doctor about occasional pains in paraumbilical and iliac region
that reduce after defecation or passage of gases. Defecation takes place up to 6 times a day,
stool is not solid, with some mucus in it. Appetite is normal, she has not put off weight. First
such symptoms appeared 1,5 year ago, but colonoscopy data reveals no organic changes.
Objectively: abdomen is soft, a little bit painful in the left iliac region. Blood and urine are
normal. What is the preliminary diagnosis?
A. Irritable bowels syndrome
B. Celiac disease
C. Crohn’s disease
D. Pseudomembranous colitis
E. Dispancreatism
Explanation : Diagnostic Criteria for Irritable Bowel Syndrome (IBS) :
1) Recurrent abdominal pain or discomfort at least 3 days/month in the last 3 months
Plus two or more of the following
2) Improvement with defecation
3) change in frequency of stool
4) change in stool form(appearance)
Note: There is no pathological changes in bowel.
22). The family doctor examined a patient and diagnosed an acute bleeding of an intestine.
What is professional tactics of the doctor in this situation?
A. The urgent hospitalization in surgical department
B. To inject intravenously the aminocapronic acid
C. The urgent hospitalization in therapeutic department
D. Treatment at a day time hospital
E. Treatment at home
Explanation : Acute bleeding of an intestine is medical emergency.
23). A 27 y.o. man complained of aching epigastric pain right after meal, heartburn and nausea.
Stomach endoscopy revealed a large amount of mucus, hyperemia and edema of mucous
membrane in gastric fundus with areas of atrophy. Make a diagnosis.
A. Chronic gastritis of type A
B. Chronic gastritis of type B
C. Peptic ulcer of stomach
D. Chronic gastritis of type C
E. Menetrier’s disease
Explanation: Gastritis A type is autoimmune gastritis which cause atrophy of gastric mucosa.
Mnemonic:
Autoimmune gastritis type A = Autoimmune (Atrophy)
Autoimmune gastritis type B = Bacteria (H. pylori)
Autoimmune gastritis type C = Chemical (Bile)
24). 47 y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is
hyperpigmentated. There are multiple xanthelasma palpebrae. The liver is +6 cm enlarged, solid
with acute edge. The blood analysis revealed total bilirubin - 160 mkmol/L, direct - 110
mkmol/L, AST- 2,1 mmol/L, ALT- 1,8 mmol/L, alkaline phosphotase - 4,6 mmol/L, cholesterol-
9,2 mmol/L, antimitochondrial antibodies M2 in a high titer. What is the probable diagnosis?
A. Primary biliary liver cirrhosis
B. Primary liver cancer
C. Chronic viral hepatitis B
D. Acute viral hepatitis B
E. Alcoholic liver cirrhosis
Explanation: High titer for antimitochondrail antibody M2 is specific for primary bilary cirrhosis. It is an autoimmune condition.
25). A 60 y.o. woman complains of unbearable pains in the right hypochondrium. In the
medical hystory: acute pancreatitis. Body temperature is 38, 20. Objectively: sclera
icteritiousness. No symptoms of peritonium irritation arepresent. There are positive Ortner’s
and Hubergrits-Skulski’s symptoms. Urine diastase is 320 g/h. What diagnosis is the most
probable?
A. Chronic pancreatitis
B. Acute cholangitis
C. Chronic cholecystitis
D. Acute cholecystitis
E. Cancer of pancreas
Explanation: Ortner’s and Hubergrits-Skulski’s sign posative sign for pancreatitis in this case patient had history of acute pancreatitis thus, history of acute pancreatitis leads to chronic pancreatitis.
To be continued.. Krok 2 Medicine (Gasteroenterology) with Explanation ||
part 2
user. RW is negative. What examination must be done first?
A. Examination for HIV
B. Examination for neuropathology
C. Examination for gonorrhea
D. Examination for fungi
E. Examination for trichomoniasis
Explanation: Because of history of causal sex , drug user are major risk factor for HIV transmission associated to this given patient.
2). 33 y.o. woman works as the secretary. Her diet contains 150 g of protein (including 100 g of animal protein), 200 g of fat, 600 g of carbohydrates. What pathologycan develop from this
diet?
A. Obesity
B. Schizophrenia
C. Paradontosis
D. Common cold
E. Uterine fibromyoma
Explanation: She is secretary meaning her work doesn’t need much energy so diet containing that amount of fat and carbohydrate will lead to build up of calories.At least 130 grams of carbohydrate is required daily , protein 100 grams enough for single day.
3). A 33 y.o. male patient was admitted to a hospital. A patient is pale, at an attempt to stand
up he complains of strong dizziness. There was vomiting like coffee-grounds approximately
hour ago. BP- 90/60 mm Hg., pulse- 120 b/min. In anamnesis, a patient has suffered from ulcer
of the stomach, painless form during 4 years. An ulcer was exposed at gastrofibroscopy. Your
diagnosis:
A. Ulcer of stomach, complicated with bleeding
B. Ulcer of duodenum, complicated with bleeding
C. Erosive gastritis
D. Acute pleurisy
E. Acute myocardial infarction, abdominal
Explanation : History of stomach ulcer and signs of bleeding ( vomiting like coffee ground because of gastric acid react with hemoglobin and pale, dizziness, hypotension indicate bleeding)
4). A 27 y.o. man complains of pain in epigastrium which is relieved by food intake. EGDFS
shows antral erosive gastritis, biopsy of antral mucous presents Hеlicobacter Pylori. What can
be diagnosed in this case?
A. Gastritis of type B
B. Gastritis of A type
C. Reflux - gastritis
D. Menetrier’s disease
E. Rigid antral gastritis
Explanation : EGDFS shows erosive gastritis. H. pyloric causes the type B Gastritis and mostly affected antrum. Gastritis A type is autoimmune gastritis.
Mnemonic:
Autoimmune gastritis type A = Autoimmune (Atrophy)
Autoimmune gastritis type B = Bacteria (H. pylori)
Autoimmune gastritis type C = Chemical (Bile)
5). A 38 y.o. woman was hospitalized to the surgical unit with vomiting and acute abdominal
pain irradiating to the spine. On laparocentesis hemmorhagic fluid is obtained. What disease
should be suspected?
A. Acute pancreatitis
B. Renal colic
C. Acute enterocolitis
D. Perforated gastric ulcer
E. Acute appendicitis
Explanation : Acute abdominal pain irradiating to the spine is hallmark for pancreatitis. pancreas location retroperitoneal.
6). 47 y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is
hyperpigmentated. There is multiple xanthelasma palpebrae. The liver is +6 cm enlarged, hard
with acute edge. The blood analysis revealed total bilirubin 160 mkmol/L, direct – 110 mkmol/L,
AST (asparate aminotransferase)- 2,1 mmol/L per hour, ALT– 1,8 mmol/L, alkaline phosphotase-
4,6 mmol/L per hour, cholesterol– 9,2 mmol/L, antimitochondrial antibodies M2 in a high titer.
What is the probable diagnosis?
A. Primary biliary liver cirrhosis
B. Primary liver cancer
C. Chronic viral hepatitis B
D. Acute viral hepatitis B
E. Alcoholic liver cirrhosis
Explanation: High titer for antimitochondrail antibody M2 is specific for primary bilary cirrhosis. It is an autoimmune condition.
7). The complications of acute cholecystitis which require surgical intervention are as follows
EXCEPT:
A. Jaundice
B. Empyema of the gall-bladder
C. Emphysematous gall-bladder
D. Gall-bladder perforation
E. Cholangitis conditioned by the presence of stones in the bile tract
Explanation : Jaundice is a symptom of a disease rather than a disease itself , the rest are medically emergency situation so must treated surgically.
8). A 40 y.o. patient was admitted to the gasteroenterology with skin itching, jaundice,
discomfort in the right subcostal area, generalized weakness. On examination: skin is jaundice,
traces of scratches, liver is +5 cm, splin is 6x8 cm. In blood: alkaline phosphatase - 2,0
mmol/(hour*L), general bilirubin - 60 mkmol/L, cholesterol - 8,0 mmol/L. What is the leading
syndrome in the patient?
A. Сholestatic
B. Сytolytic
C. Mesenchymal inflammatory
D. Asthenic
E. Liver-cells insufficiency
Explanation : Presence of Sign and symptoms of liver. Skin itching and traces of scratches indicate bile obstruction ( cholestasis) .
9). A 51 y.o. woman complains of dull pain in the right subcostal area and epigastric area,
nausea, appetite decline during 6 months. There is a history of gastric peptic ulcer. On
examination: weight loss, pulse is 70 bpm, AP is 120/70 mm Hg. Diffuse tenderness and
resistance of muscles on palpation.There is a hard lymphatic node 1x1cm in size over the left
clavicle. What method of investigation will be the most useful?
A. Esophagogastroduodenoscopy with biopsy
B. Ultrasound examination of abdomen
C. pH-metry
D. Ureatic test
E. Stomach X-ray
Explanation :- Above mentioned is elderly patient and have the history of gastric peptic ulcer and there is loss of weight, appetite loss and lymph node involvement and thus patient is suspected to have cancer and the best method of investigation in this case is Esophagogastroduodenoscopy with biopsy.
10). A 36 y.o. patient was admitted to the hospital with sharp pain in substernal area following
occasional swallowing of a fish bone. On esophagoscopy the foreign body wasn’t revealed. The
pain increased and localized between scapulas. In a day temperature elevated, condition
became worse, dysphagia intensified. What complication has developed?
A. Perforation of esophagus with mediastinitis
B. Esophageal hemorrhage
C. Obstruction of esophagus
D. Pulmonary atelectasis
E. Aspirative pneumonia
Explanation : Fish bone pierced through the esophagus to the posterior structures which led to the inflammation of the mediastinum.
11). A 43 y.o. woman complains of severe pain in the right abdominal side irradiating in the right supraclavicular area, fever, dryness and bitterness in the mouth. There were multiple
vomitings without relief. Patient relates the onset of pain to the taking of fat and fried food. Physical examination: the patient lies on the right side, pale, dry tongue, tachycardia. Right side
of abdomen is painful during palpation and somewhat tense in right hypochondrium. What is
the most likely diagnosis?
A. Perforative ulcer
B. Acute cholecystitis
C. Acute bowel obstruction
D. Acute appendicitis
E. Right-sided renal colic
Explanation: Correct answer is Acute cholecystitis but in krok base gives perforative ulcer.
12). A 74 y.o. female patient complains of pain, distended abdomen, nausea. She suffers from
heart ichemia, postinfarction and diffusive cardiosclerosis. On examination: grave condition,
distended abdomen, abdominal wall fails to take active part in breathing. On laparoscopy:
some cloudy effusion, one of the bowel loops is dark-blue. What is the most probable
diagnosis?
A. Mesenterial vessels thrombosis
B. Volvulus
C. Acute intestinal obstruction
D. Ichemic abdominal syndrome
E. Erysipelas
Explanation: Bowel loop dark blue due to ischemia which is caused by thrombosis because she had history of heart ischemia and diffuse cardiosclerosis.
13). A 56 y.o. man, who has taken alcoholic drinks regularly for 20 years, complains of intensive
girdle pain in the abdomen. Profuse nonformed stool 2- 3- times a day has appeared for the last
2 years, loss of weight for 8 kg for 2 years. On examination: abdomen is soft, painless. Blood
amylase - 12g/L. Feces examination-neutral fat 15 g per day, starch grains. What is the most
reasonable treatment at this stage?
A. Pancreatine
B. Contrykal
C. Aminocapron acid
D. Levomicytine
E. Imodium
Explanation: Patient had history of alcoholism for 20 years. alcoholism is major cause of pancreatitis. since 20 year alcoholism history patient develop chronic pancreatitis so there is defficiency of pancreatitic enzyme (lipase) which is essential for conversion of triglyceride to monoglycerides and free fatty acids which is absorbed. Due to lipase deficiency cause natural fat in stool. Thus, chronic pancreatitis is treated by pancreatic enzyme replacement (pancreatine).
14). A 41 y.o. woman has suffered from nonspecific ulcerative colitis during 5 years. On
rectoromanoscopy: marked inflammatory process of lower intestinal parts, pseudopolyposive
changes of mucous. In blood: WBC- 9, 8 ∗ 109/L, RBC- 3, 0 ∗ 1012/L, sedimentation rate- 52
mm/hour. What medication provides pathogenetic treatment of this patient?
A. Sulfasalasine
B. Motilium
C. Vikasolum
D. Linex
E. Kreon
Explanation: Drug of choice for Ulcerative colitis is sulfasalizine.
15). A 2 y.o. boy was admitted to the hospital with weight loss, unstable discharges, anorexia,
following the semolina’s introduction (since 5 months). The child is adymanic, flabby, pale dry
skin, subcutaneous layer is emaciated. Distended and tensed abdomen, tympanitis on
percussion of the upper part of the abdomen, splashing sounds, feces are foamy, of light color,
foul. On coprocytogram: a lot of neutral fat. What is the cause of the disease?
A. Celiakia (celiac disease)
B. Mucoviscidosis (cystic fibrosis)
C. Intestinal dysbacteriosis
D. Chronic enteritis
E. Disaccharidase insufficiency
Explanation: Semolina’s is purified wheat. In this case patient develop celiac disease which is an autoimmune disease caused by intolerance to gluten (protein found in wheat). which act as antigen and forms an immune complex in intestinal mucosa. Thus, cause malabsorption syndrome (loss of villi and proliferation of crypt cells). Coprocytogram show a lot of natural fat main feature of malabsorption.
16). A patient, aged 25, suffering from stomach ulcer. Had a course of treatment in the
gastroenterological unit. 2 weeks later developed constant pain, increasing and resistant to
medication. The abdomen is painful in epigastric area, moderate defence in pyloroduodenal
area. Which complication development aggravated the patient’s state?
A. Malignisation
B. Penetration
C. Perforation
D. Haemorrhage
E. Stenosis
Explanation: Constant pain due to the stomach ulcer , increasing and resistant to medication is feature of penetration but in krok base Malignisation is correct answer. Malignisation is less common develop in younger age(25 year).
17). A male patient complains of heartburn which gest stronger while bending the body,
substernal pain during swallowing. There is a hiatus hernia on X-ray. What disoeder should be
expected at gastroscopy?
A. Gastroesophageal reflux
B. Chronic gastritis
C. Gastric peptic ulcer
D. Acute erosive gastritis
E. Duodenal peptic ulcer
Explanation: Main feature of Gastroesophageal reflux is substernal pain during swallowing which is aggravated during bending forward. Heartburn due to acid reflux.
18). A 43 y.o. male complains of stomach pain, which relieves with defecation, and is
accompanied by abdominal winds, rumbling, the feeling of incomplete evacuation or urgent
need for bowel movement, constipation or diarrhea in alternation. These symptoms have
lasted for over 3 months. No changes in laboratory tests. What is the most likely diagnosis?
A. Irritable bowel syndrome
B. Spastic colitis
C. Colitis with hypertonic type dyskinesia
D. Chronic enterocolitis, exacerbation phase
E. Atonic colitis
Explanation : Diagnostic Criteria for Irritable Bowel Syndrome (IBS) :
1) Recurrent abdominal pain or discomfort at least 3 days/month in the last 3 months
Plus two or more of the following
2) Improvement with defecation
3) change in frequency of stool
4) change in stool form(appearance)
Note: There is no pathological changes in bowel.
19). A 76 y.o. woman complains of progressing swallowing disorder, mostly she has had problems
with solid food for the last 6 weeks. Sometimes she has regurgitation of solid masses.
Swallowing is not painful. She lost 6 kg. 10 years ago she had myocardiac infarction, she takes
constantly aspirine and prolonged nitrates. She consumes alcochol in moderate proportions,
smokes. Objectively: icteric skin, neck has no pecularities, lymph nodes are not enlarged.
Thorax has no changes, cardiovascular system has no evident changes. Liver is +3 cm. What is
the preliminary diagnosis?
A. Cancer of esophagus
B. Diaphragmatic hernia
C. Diffuse constriction of esophagus
D. Myasthenia
E. Esophageal achalasia
Explanation : Elderly, Alcoholism, smokes is associated with esophageal squamous cell carcinoma . In esophageal carcinoma, there is progressive dysphasia i.e initially solid food later liquid also. Weight loss is one of the alarm sign of cancer.
20). A 38 y.o. man complains of having occasional problems with swallowing of both hard and
fluid food for many months. Sometimes he feels intense pain behind his breast bone, epecially
after hot drinks. There are asphyxia onsets at night. He has not put off weight. Objectively: his
general condition is satisfactory, skin is of usual colour. Examination revealed no changes of
gastrointestinal tract. X-ray picture of thorax organs presents esophagus dilatation with level of
fluid in it. What is the preliminary diagnosis?
A. Esophagus achalasia
B. Myastenia
C. Cancer of esophagus
D. Esophagus candidosis
E. Gastroesophageal reflux
Explanation: Achalasia is a condition in which the muscles of the lower part of the oesophagus fail to relax, preventing solid and liquid food from passing into the stomach. Bird beak or rat tail (esophageal dilatation with level of fluid ) radiological sign is specific for achalasia.
21). A 35 y.o. woman consulted a doctor about occasional pains in paraumbilical and iliac region
that reduce after defecation or passage of gases. Defecation takes place up to 6 times a day,
stool is not solid, with some mucus in it. Appetite is normal, she has not put off weight. First
such symptoms appeared 1,5 year ago, but colonoscopy data reveals no organic changes.
Objectively: abdomen is soft, a little bit painful in the left iliac region. Blood and urine are
normal. What is the preliminary diagnosis?
A. Irritable bowels syndrome
B. Celiac disease
C. Crohn’s disease
D. Pseudomembranous colitis
E. Dispancreatism
Explanation : Diagnostic Criteria for Irritable Bowel Syndrome (IBS) :
1) Recurrent abdominal pain or discomfort at least 3 days/month in the last 3 months
Plus two or more of the following
2) Improvement with defecation
3) change in frequency of stool
4) change in stool form(appearance)
Note: There is no pathological changes in bowel.
22). The family doctor examined a patient and diagnosed an acute bleeding of an intestine.
What is professional tactics of the doctor in this situation?
A. The urgent hospitalization in surgical department
B. To inject intravenously the aminocapronic acid
C. The urgent hospitalization in therapeutic department
D. Treatment at a day time hospital
E. Treatment at home
Explanation : Acute bleeding of an intestine is medical emergency.
23). A 27 y.o. man complained of aching epigastric pain right after meal, heartburn and nausea.
Stomach endoscopy revealed a large amount of mucus, hyperemia and edema of mucous
membrane in gastric fundus with areas of atrophy. Make a diagnosis.
A. Chronic gastritis of type A
B. Chronic gastritis of type B
C. Peptic ulcer of stomach
D. Chronic gastritis of type C
E. Menetrier’s disease
Explanation: Gastritis A type is autoimmune gastritis which cause atrophy of gastric mucosa.
Mnemonic:
Autoimmune gastritis type A = Autoimmune (Atrophy)
Autoimmune gastritis type B = Bacteria (H. pylori)
Autoimmune gastritis type C = Chemical (Bile)
24). 47 y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is
hyperpigmentated. There are multiple xanthelasma palpebrae. The liver is +6 cm enlarged, solid
with acute edge. The blood analysis revealed total bilirubin - 160 mkmol/L, direct - 110
mkmol/L, AST- 2,1 mmol/L, ALT- 1,8 mmol/L, alkaline phosphotase - 4,6 mmol/L, cholesterol-
9,2 mmol/L, antimitochondrial antibodies M2 in a high titer. What is the probable diagnosis?
A. Primary biliary liver cirrhosis
B. Primary liver cancer
C. Chronic viral hepatitis B
D. Acute viral hepatitis B
E. Alcoholic liver cirrhosis
Explanation: High titer for antimitochondrail antibody M2 is specific for primary bilary cirrhosis. It is an autoimmune condition.
25). A 60 y.o. woman complains of unbearable pains in the right hypochondrium. In the
medical hystory: acute pancreatitis. Body temperature is 38, 20. Objectively: sclera
icteritiousness. No symptoms of peritonium irritation arepresent. There are positive Ortner’s
and Hubergrits-Skulski’s symptoms. Urine diastase is 320 g/h. What diagnosis is the most
probable?
A. Chronic pancreatitis
B. Acute cholangitis
C. Chronic cholecystitis
D. Acute cholecystitis
E. Cancer of pancreas
Explanation: Ortner’s and Hubergrits-Skulski’s sign posative sign for pancreatitis in this case patient had history of acute pancreatitis thus, history of acute pancreatitis leads to chronic pancreatitis.
To be continued.. Krok 2 Medicine (Gasteroenterology) with Explanation ||
part 2