Medicine II 3rd LE AY 2011-2012 7. A patient was admitted for persistent hematochezia.

Gastroscopy and colonoscopy were normal. Which of the

1. A patient came at the ER because of melena and following would be the next most appropriate
hematochezia. Patient was noted to be diaphoretic and procedure?
pale. Vital signs were as follows: BP: 80/60 HR: 120 RR:20 a. Capsule endoscopy
temp: afebrile. The patient must have lost at least how b. CT scan of the whole abdomen
much of his blood volume? c. Mesenteric angiogram
a. 10% d. Upper GI series with small bowel follow trough
b. 20%
c. 30% 8. A 42 year old man consulted you for an episode of
d. 40% melena two days prior, after intake of NSAIDS for gout.
Physical examination was normal. You performed a
2. A 50-year old female came in because of melena. An gastroscopy the next day and saw a 1 cm antral ulcer
endoscopy was done and was noted to have an ulcer with a white-based crater. You should do
crater with a visible vessel. What will be the treatment of a. Injection sclerotherapy
choice for this patient? b. Hemoclip application
a. Injection sclerotherapy c. Argon plasma coagulation
b. Injection sclerotherapy + hemoclip d. No endoscopic (therapeutic) intervention is
c. Injection sclerotherapy + APC necessary
d. Surgery
9. Which of the following diagnostic test is virtually
3. A patient came in at the ER who presented with one diagnostic for acute viral hepatitis A
episode of hematochezia. Upon consult, patient was a. Anti HAV-IgG
noted to have a BP of 80/60 HR 110 RR 2. What will be b. Anti HAV-IgM
you initial diagnostic of choice? c. Anti HAV-IgE
a. Gastroscopy d. NOTA
b. Enteroscopy
c. RBC Tagging 10. Which of the following diagnostic examination has the
d. Colonoscopy potential for treating certain biliary diseases such as
obstructive jaundice secondary to a Choledocholithiasis
4. Among these patients, who is most likely have a. Ultrasound of the liver
continuous bleeding or would rebleed? b. CT scan
a. A 40-year old female who presented with c. ERCP
melena, with stable BP and history of vomiting d. MRCP
b. A 40-year old with no known co-morbidities
with adherent clot on endoscopy 11. Which of the following test remains the gold standard in
c. A 65-year old male with renal failure with clean the evaluation of patients with chronic liver diseases and
based ulcer is more often useful in assessing the severity and stage of
d. An 80-year old female with stage IV colon CA liver damage?
who presents with hematemesis a. Ultrasound of the liver
b. CT scan
5. A cirrhotic patient sought consult at the ER because of c. ERCP
hematemesis. Endoscopy showed esophageal varices. d. MRCP
What is the treatment of choice for this patient?
a. Beta blocker 12. Which of the ff statement(s) about RUQ discomfort or
b. Injection sclerotherapy pain is true?
c. Rubber band ligation a. The pain arises from stretching or irritation of
d. Histoacryl glue injection Glissons capsule, which surrounds the liver and
is rich in nerve endings
6. A 70year old male was referred to you because of b. Recurrent RUQ pain is most typical of
anemia with positive FOBT. You did an upper GI gallbladder disease
endoscopy and colonoscopy which were normal. What c. The presence of a liver abscess may be a cause
should be the next diagnostic step? of RUQ abdominal pain
a. Single or double balloon enteroscopy d. AOTA
b. Capsule endoscopy
c. Abdominal CT scan 13. Which of the following signs of advanced liver disease is
d. Mesenteric angiogram described as collateral veins seen radiating from the

Team D5 KVO Page 1 of 9

 umbilicus and resulting from the recanulation of the
umbilical vein?
a. Grey-turners sign
b. Cullens sign
c. Caput medusa
d. Hepatic fetor
14. Which of the following factors are part of the child-pugh
classification of cirrhosis?
a. Serum ALT, serum albumin, prothrombin time,
ascites, hepatic encephalopathy
b. Serum bilirubin, serum albumin, prothrombin
time, ascites, hepatic encephalopathy
c. Prothrombin time, serum GGTP, serum AST,
serum bilirubin, serum albumin
d. Serum ALT, serum AST, prothrombin time,
ascites, hepatic encephalopathy
15. Which of the following diagnostic test pattern is
commonly seen in wilsons disease?
a. Elevated iron saturation
b. Elevated serum ferritin levels
c. Decreased serum ceruloplasmin and increased
urinary copper
d. Positive finding on genetic testing for HFE gene
mutations
16. A 32 year old previously asymptomatic callcenter agent
was brought to the ER because of vomiting fresh blood
amounting to about a cupful noted after a drinking spree.
His companions narrated that the vomiting of fresh blood
came after several episodes of vomiting previously
ingested food and forceful retching. The most likely
cause of his bleeding is:
a. Rupture esophageal varix
b. Alcohol induced gastritis
c. Peptic ulcer disease
d. Mallory Weiss tear
17. A 22 year old female dental intern consulted because of
progressive dysphagia to both solids and liquids for about
6 months associated with regurgitation of bland food and
nocturnal coughing. On CXR she was noted to have air
fluid level at the midline. she most likely have:
a. GERD
b. DES
c. Achalasia
d. Esophageal wed
18. An 18 year old first year college student consulted
because of odynophagia of 3 days duration. He noted the
symptom to have started on the third day of his intake of
doxycycline which was given by his urologist for his
urethritis. The most likely cause of his odynophagia is:
a. Candida esophagitis
b. CMV esophagitis
c. Pill-induced esophagitis
d. Eosinophilic esophagitis
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19. A 58 year old construction worker with a strong history
of smoking and alcohol intake was seen at the OPD
because of progressive dysphagia to solid of 3 months
duration associated with weight loss of about 5 kg. His PE
was unremarkable except for signs of sudden weight loss.
He most likely have:
a. Laryngeal carcinoma extending to the
esophagus
b. Mediastinal mass
c. Esophageal carcinoma
d. Peptic stricture due to GERD
20. A 65 year old male previously diagnosed to have Peptic
ulcer disease consulted because of repeated bouts of
vomiting bland undigested food. On PER he was noted to
have succession splash. What complication of PUD is he
most likely suffering from?
a. Hemorrhage
b. Gastric outlet obstruction
c. Perforation
d. Malignant degeneration
21. A 25 year old female presents with a history of
intermittent food impaction for which she has undergone
2 previous UGI endoscopy to treat the problem. The
esophagus was noted to be normal on both examination.
She has dysphagia for solids occasionally and no liquid
dysphagia. You would:
a. Request for UGI endoscopy with random biopsy
b. Request for esophageal manometry
c. Give empiric trial of PPI
d. Give empiric trial of corticosteroid therapy
22. A 65 year old male came for consultation because of a 2
to 3 month history of dysphagia. He finds that solid foods
seem to stick in the midneck area and that he has
difficulty starting a swallow. He often coughs or chokes
when he swallows and has difficulty because of liquids
regurgitating into his nose. You would:
a. Refer to ENT specialist for evaluation
b. Refer to UGI endoscopy
c. Refer for videofluoroscopy
d. Refer for esophageal manometry
23. A 44 year old man comes to your office with symptoms
of occasional heartburn for several years and
intermittent abdominal pain. He uses magnesium
hydroxide with simethicone approximately once a week
with excellent relief of his heart burn symptoms. Due to
his abdominal pain and heartburn, you perform an
endoscopy. He is found to have Barretts esophagus by
biopsy. What is the next step in management?
a. Begin H2 receptor blockers
b. Begin PPI
c. Refer to surgeon for fundoplication
d. Continue on demand treatment for heartburn
Page 2 of 9
24. A 26 year old man with a history of food impaction has
had intermittent dysphagia for solids for 5 years. Barium
swallow and esophageal manometry results are normal.
Endoscopy reveals multiple rings throughout the length
of the esophagus. Biopsy if the esophagus is likely to
show which of the following conditions?
a. Active esophagitis
b. Columnar metaplasia
c. Dense infiltrates of lymphocytes
d. Eosinophilic infiltration
25. A 37 year old man with intermittent solid food dysphagia
undergoes a barium swallow. The results show he has a
ring like narrowing at the distal esophagus. The diameter
of the ring is 12 mm. which of the following therapies is
indicated at this time?
a. Careful food preparation
b. Endoscopy followed by bougie dilation
c. Laser ablation
d. PPI
26. A 25 year old Filipina with allergy to penicillin has been
diagnosed to have H. pylori related duodenal bulb ulcer.
What is the appropriate treatment regimen?
a. PPI plus clarithromycin 500 mg and amoxicillin 1
g BID for 10 days
b. PPI plus clarithromycin 500 mg and
metronidazole BID
c. PPI plus amoxicillin 1 g BID for 5 days the PPI
plus levofloxacin 250mg BID for 5 days
d. PPI plus clarithromycin 500 mg BID plus bismuth
subsalicylate 525 mg 4 times a day
27. An 84 year old man with prosthetic cardia valve needs
treatment for a painful joint. He is diagnosed with
osteoarthritis. He is also on low dose aspiring and is
receiving anticoagulation therapy with warfarin. The
most correct advice for him is to
a. Avoid NSAIDS
b. Begin NSAIDs after stopping aspiring
c. Start COX2 inhibitor
d. Start COX2 inhibitor with a PPI
28. According to the american gastrointestinal association
guidelines, which of the following patients should
undergo prompt upper endoscopy?
a. A 25 year old woman with a 1 week history of
mid epigastric pains
b. A 45 year old man reposting midepigastric pains
responsive to two week history of PPI therapy
c. A 70 year old man reposting a six week history
of midepigastric pains associated with a 10
pound weight loss nausea and vomiting.
d. A 60 year old asymptomatic woman with normal
hemoglobin, heme positive stool and normal
colonoscopic findings
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29. A 58 year old male underwent upper GI endoscopy for
weight loss and dysphagia. Endoscopic evaluation
showed a 2 cm circumferential ulcerated mass in the
distal esophagus biopsies of which were consistent with
adenocarcinoma. A CT scan of the whole abdomen
revealed no evidence of metastatic disease. What staging
modality should be used next?
a. MRI of the chest
b. PET
c. Endoscopic US
d. Laparoscopy
30. Peptic ulcer is a common complication of NSAID
treatment. Which of the following statements regarding
prophylactic therapy is correct?
a. H2 receptor antagonist do not lower the risk
b. Only high dose misoprostol provides effective
prophylaxis
c. H pylori infected patients should receive
eradication therapy
d. Ulcer bleeding can be prevented in high risk
patients by omeprazole
31. Which of the following is the diagnostic criteria for IBS?
a. Recurrent abdominal pain or discomfort at least
3 days per month in the last 3 months
b. Abnormal stool form
c. Passage of mucus
d. AOTA
For questions 32-34, refer to the ff case: a 45 year old male
patient presented at the clinic with recurrent abdominal pain
associated with alternating constipation and diarrhea
32. The ff are alarm symptoms to look for except:
a. Passage of mucus in the stools
b. Bleeding per rectum
c. Anemia
d. AOTA
33. The patient mentioned above upon presentation at the
clinic brought with him some initial lab tests done on
him. Which of the ff confirms the diagnosis of IBS?
a. Presence of parasites in the stools
b. Anemia
c. Leukocytosis
d. NOTA
34. Referring to the above patient, patient claims that the
reason he sought consultation aside from his symptoms
was because his officemate was diagnosed with colon
cancer. What is your next step in this patient?
a. Refer for Upper GI endoscopy
b. Refer for colonoscopy
c. Treat with antispasmodics
d. Assure the patient that his symptoms are not
indicative of malignancy
Page 3 of 9
35. A 23 year old medical student presents at the ER because
of recurrent abdominal pain and constipation of 3
months duration. The symptoms appeared just after the
start of the current school year. The pain is localized in
the lower abdominal area. What would be your next
step?
a. Look into the presence or absence of alarm
symptoms
b. Order for a double contrast barium enema
c. Recommend a lactose free diet
d. AOTA
36. A 27 year old female patient was diagnosed with IBS and
prescribed anticholinergic for her abdominal pain. the ff
are possible side effects that she may experience
EXCEPT:
a. Inzomi
b. Blurred vision
c. Dryness of mouth
d. Urinary retention
37. In patients diagnosed with mild IBS, the approach to
treatment includes the ff:
a. Antidepressants
b. Alosentron
c. Patient education and reassurance
d. AOTA
38. Which of the ff has the highest prevalence of IBD?
a. Sephardic jews
b. Ashkenazi jews
c. Asians
d. Hispanics
For questions 39-41, refer to the ff case: a 45 year old male
patient was being worked up for IBD.
39. Which of the ff is an expected radiographic finding in a
patient with Crohns disease?
a. Continuous involvement of the GI tract
b. Stricture formation
c. Loss of haustration of large intestines
d. AOTA
c. No intervening normal tissue between abnormal
lesions
d. AOTA
For questions 42-43, refer to the ff case: a 25 year old female
accountant consulted at the clinic complaining of recurrent
abdominal pain and on and off loose watery stools of 3
months duration. She has not observed blood in her stools
though she notices mucus. She claims that her symptoms
began shortly after she started on her new job.
42. Which of the ff does she most likely have?
a. Ulcerative colitis
b. Latose intolerance
c. Irritable bowel syndrome
d. AOTA
43. What would be your next step in managing this patients
problem?
a. Get a detailed dietary and medical history
b. Treat immediately with anti diarrheals
c. Refer for colonoscopy
d. Prescribe amecides
44. Which of the ffhepatobiliary conditions will predispose a
patient with IBD to cholangiocarcinoma?
a. Pericholangitis
b. Chronic active hepatitis
c. Primary sclerosing cholangitis
d. AOTA
45. A 30 year old female patient whom you have been
managing for crohns disease asks you about the possible
risks if and when she gets pregnant/ what would you
counsel your patient?
a. She cannot get pregnant as she is infertile
b. There is no risk to pregnancy and childbirth in
patients with crohns disease
c. Women with IBD have greater complications in
pregnancy compared to healthy controls
d. Women with crohns disease have lesser
complication sin pregnancy compare to women
with ulcerative colitis

40. Endoscopy was done on the above patient. which of the For questions 46-52, refer to the ff case: a 45 year old
are typical endoscopic findings in patients with crohns salesman consulted you because of jaundice. No abdominal
disease? pain, fever noted. ultrasound showed a nodular and small
a. Rectal sparing liver.
b. Cobblestoning
c. Fistula formation 46. Your impression is:
d. AOTA a. Liver cirrhosis
b. Biliary obstruction
41. Biopsy was done on the lesions found in the colon. Which c. Liver abscess
of the ff Histopathologic findings are typical of crohns d. Fatty liver
disease?
a. Inflammation is limited to the submucosa 47. A few months later, he develops melena and
b. Granuloma formation is observed hematemesis. His abdomen is enlarged with shifting
dullness. No abdominal pain/tenderness or fever was

Team D5 KVO Page 4 of 9

 noted. vital signs were stable. You suspect UGIB
secondary to esophageal varices. Initial management will
be:
a. Insert NGT to document bleeding
b. TIPS
c. Surgery
d. Start octreotide or somatostatin
48. On upper GI endoscopy, esophageal varices were noted.
the next procedure to be done would be to
a. Give beta blockers
b. TIPS
c. Variceal ligation
d. Surgery
49. As the medical resident in charge of the patient, you
want to prevent possibility of problems associated with
GI bleeding & ascites. You decide to start:
a. Antibiotics
b. Lactulose
c. Low sodium diet
d. Branched chain amino acids
50. Your patient was discharged with no more recurrence of
GI bleeding. He was given furosemide, spironolactone
and propanolol as home medications. you advise follow
up after 2 weeks. On follow up, relatives told you of the
changes in sensorium of the patient with no lateralizing
signs. Your patient is experiencing:
a. Cerebral infarction
b. Cerebral hemorrhage
c. Hepatic encephalopathy
d. Septicemia
51. The most probable precipitation factor on why the above
patient developed this problem is:
a. Electrolyte abnormality
b. Infection
c. Recurrence of GI bleeding
d. Hypertensive emergency
52. Treatment for the above patient will include:
a. Discontinuing loop diuretics
b. Giving antibiotics
c. Control GI bleeding
d. Anti-hypertensive medication
For questions 53-56, refer to the ff case: a 40 year old
overweight businessman consulted you because of
ultrasound findings of hyperechoic liver. He is non-alcoholic
and all blood tests are normal except for elevated fasting
blood sugar.
53. Your impression on the patient is:
a. Hepatitis
b. NAFLD
c. Normal liver
d. Liver cyst
Team D5 KVO
54. As the medical clerk on duty, you would do the ff:
a. Advise patient to undergo liver transplant
b. Start anti-viral medications
c. Advise patient to go on diet and weight loss
program
d. Start on insulin treatment for diabetes
55. A few years later, the patient consulted you because of
elevated ALTs, polyuria, polyphagia. FBS remains
elevated. Ultrasound remains the same. Hepatitis profile
is non-reactive for A, B, & C. impression at this time is:
a. Hepatitis
b. NASH
c. Hepatocellular carcinoma
d. Hepatic abscess
56. Treatment of the above patient may include:
a. Anti-diabetic medications
b. Surgery
c. Percutaneous drain
d. Observe
For questions 57-59, refer to the ff case: a 53 y/o male,
diagnosed with NASH for the past 10 years, was noted to be
jaundiced with enlarging abdomen. Blood tests showed
slightly elevated ALT, deranged prothrombin time, low
albumin. PE showed (+) fluid wave.
57. Your impression is:
a. Acute viral hepatitis
b. Drug induced hepatitis
c. Liver cirrhosis
d. Ischemic hepatitis
58. On further history, a CT scan was used to diagnose his
fatty liver. The following is the typical CT scan findings to
a patient with fatty liver:
a. Hypodense liver compared to spleen
b. Hyperdense liver compared to spleen
c. Same density as spleen and kidnyes
d. Presence of mass lesion
59. A liver biopsy was done on a patient suspected of NASH.
You would expect to see which of the ff findings which
are the hallmarks for NASH:
a. Steatosis
b. Lobular inflammation
c. Fibrosis
d. Necrosis
60. A 35 year old male consulted you because of findings on
ultrasound suggestive of fatty liver. Aside from NAFLD,
the ff may present with the same ultrasound picture:
a. Hemangiomas
b. Alcoholic liver disease
c. Lymphoma
d. Hepatocellular carcinoma
Page 5 of 9

For questions 61-63, refer to the ff case 37 year old female
was rushed to the ER with complaints of severe epigastric
pains radiating to the back which started a few hours prior to
consult. The patient claimed to have had a drinking binge
with her friends a few days prior to consult. On PE, patient
was noted to be afebrile with stable VS. abdomen was soft
with direct tenderness on the epigastric area.
61. Initial impression for the patient is:
a. Acute cholangitis
b. Acute pancreatitis
c. Perforated PUD
d. Acute mesenteric ischemia
62. If you are the medical resident on duty, what initial
laboratory test would you request for this patient?
a. Amylase/lipase
b. Ultrasound of the abdomen
c. Gastroscopy
d. Plain abdominal xray
63. Management of the above patient would include:
a. Starting IV antibiotics
b. NGT insertion
c. Placing the patient on NPO
d. Start patient on PPI
64. A 54 y/o male was admitted to the ICU because of severe
epigastric abdominal pain associated with tachycardia
and hypotension. As the major intern in charge, your
medical resident requested you to closely monitor the
patient. on PE, you noted the presence of ecchymosis
around the periumbilical area. This finding is known as:
a. Cullens sign
b. Grey turners sign
c. Murphys sign
d. Reynauds sign
65. A patient was admitted for acute pancreatitis for 1 week.
2 weeks after discharged, the patient was noted to have
a 7 by 6 by 6 cm pseudocyst on ultrasound. Presently, the
patient is asymptomatic with no subjective complaints.
On PE findings, there is a palpable mass noted on the
epigastric area. What will be the plan of action for this
patient?
a. Do percutaneous drainage of the pseudocyst
b. Refer the patient to surgery
c. Start the patient on antibiotic
d. Clinical and radiographic follow up only
66. A 40 y/o female was brought to the ER because of severe
epigastric pain of few hours duration. This was
accompanied by nausea and vomiting. On past health
history, patient claimed to have had previous hospital
admissions because of recurrent acute pancreatitis.
Patient does not smoke and does not drink alcohol. On
PE, the patient was noted to have slight tenderness at
Team D5 KVO
the epigastric area and slight icterisia. Laboratory
examinations showed slightly elevated liver enzymes,
alkaline phosphatase, and serum bilirubins. The most
likely etiology for the patients recurrent acute
pancreatitis is:
a. Alcohol
b. Drug induced
c. Gallstones
d. Infection
For questions 67-68, refer to the ff case: a 25 y/o male was
rushed to the ER because of complaints of severe epigastric
pain associated with vomiting. Patient was ill looking and
initial vital signs at the ER showed BP of 80/60 mmHg; HR of
110 bpm; and an RR of 26/min. there was direct epigastric
tenderness and abdominal guarding on palpation. Initial
laboratories requested showed leukocytosis and elevated
serum amylase and lipase more than 3x the upper limit of
normal.
67. What is the most appropriate imaging modality to
request to assess the severity of this patients condition?
a. Plain abdominal xray
b. Ultrasound of the abdomen
c. CT scan
d. MRI with MRCP
68. Differential diagnosis for this patient would include the
ffEXCEPT:
a. Acute severe pancreatitis
b. Perforated peptic ulcer
c. Acute intestinal obstruction
d. Acute myocardial infarction
69. A 42 y/o bank executive consulted the clinic because of
findings of gallstones on ultrasound; the largest of which
measures about 0.8 cm. on history, the patient denies
experiencing any recurrent form of abdominal pain or
discomfort and according to him the ultrasound was
done as part of his executive check up. physical findings
for this patient was unremarkable and the rest of his
laboratory examinations (blood chemistries) were within
normal. What is the treatment plan for this patient?
a. Start patient on medical dissolution therapy
b. Start the patient on PPI
c. Refer the patient to surgery for cholecystectomy
d. Observe and monitor for occurrence of
symptoms
For question 70-72, refer to the ff case: a 38 year old, obese,
female was brought in to the ER because of abdominal pain
epigastric in location radiating tot eh RUQ, back and shoulder
for more than 6 hours. Patient claims that she has had
previous episodes of similar abdominal pain in the past, but
the duration only lasted for at least an hour. On PE, patient is
slightly icteric, febrile with inspiratory arrest on deep
palpation at the RUQ area.
Page 6 of 9
70. What will be the primary impression for this patient?
a. Peptic ulcer disease 76. Which of the ff signs may be seen in patient with acute
b. Cholecystolithiases/GB stones viral hepatitis?
c. Acute cholecystitis a. Contracted liver
d. Acute pancreatitis b. Splenomegaly
c. Testicular atrophy
71. If you were the medical resident attending to this d. Palmar erythema
patient, what is the initial imaging modality for this
patient? 77. Which of the ff abnormal laboratory results would
a. Plain abdominal xray indicate sever hepatic damage?
b. Ultrasound a. ALT >2,000 IU/L
c. CT scan b. Prothrombin time 3 seconds longer than control
d. MRCP c. Alkaline phosphatase >7x upper level of normal
d. Serum bilirubin >150 mmol/L
72. What us the definitive treatment management for this
patient? 78. A patient with suspected acute viral hepatitis has the ff
a. Observe the patient and monitor for recurrence laboratory AST=1,200 IU/L, (+) HBsAg, (-) anti-HBc IgM,
of symptoms (+) anti-HAV IgM, (+) anti-HCV. What is your diagnosis?
b. Start the patient on PPI a. Acute hepatitis A, chronic hepatitis B and
c. Medical dissolution therapy exposure to hepatitis C
d. Cholecystectomy with IOC b. Acute hepatitis A, acute hepatitis B and
exposure to hepatitis C
73. A 42 y/o female diagnosed to have cholecystolithiases c. Acute hepatitis A, acute hepatitis C and
consulted your clinic because she would like to find out if exposure to hepatitis B
she can take ursodeoxychilic acid for her gallstones. She d. Acute hepatitis B, acute hepatitis C and
read on the internet that it is currently used in oral exposure to hepatitis A
dissolution regimens. Which among the ff is a criterion
for medical dissolution of GB stone? 79. A patient with suspected acute viralhepatitis has the ff
a. Pigment stones laboratory ALT=600 IU/L, (+) HBsAg, (-) anti-HBc IgM, (-)
b. Radio-opaque stones on plain radiography anti-HAV IgM, (+) anti-HCV. What is your diagnosis?
c. Normal gallbladder/patent cystic duct a. Acute hepatitis B and exposure to hepatitis C
d. Large stone b. Chronic hepatitis B and exposure to hepatitis C
c. Acute hepatitis B and acute hepatitis C
74. A 45 y/o patient underwent laparoscopic d. Chronic hepatitis B and acute hepatitis C
cholecystectomy for gallstones. Three weeks post-
cholecystectomy, patient went to the ER complaining of 80. A patient who was previously diagnosed to have acute
abdominal pain and tea colored urine. On PE, patient had hepatitis B 8 weeks prior had the ff blood tests: (+)
stable vital signs and was noted to be jaundice. Initial HBsAg, (+) anti-HBc IgM, (+) anto-HBe, and (-) anti-HBs.
laboratory examinations showed leukocytosis with Which of the ff is correct regarding the patients
elevated bilirubin and alkaline phosphatase. Ultrasound prognosis?
done showed dilated common bile duct. the next a. Patient will most likely become a chronic
appropriate management for this patient would be: hepatitis B carrier
a. MRCP b. Patient will most likely recover from the acute
b. ERCP hepatitis B
c. PTC with PTBD c. Patient has the potential to develop fulminant
d. Surgical exploration hepatitis B
d. Patient is developing the low level carrier state
75. A 56 y/o male was rushed to the ER because of RUQ
abdominal pain, jaundice and fever with altered mental 81. In a patient with presumed acute hepatitis B 4 months
status. According to the relatives, the patient was before and where the HBsAg and the anti-HBs are both
previously diagnosed with cholecystolithiases 2 years negative, which of the ff serum markers would confirm
ago. On PE, patient was noted to be tachycardic and the diagnosis?
hypotensive. The constellation of the above symptoms is a. Anti-Hbe
consistent with b. HBeAg
a. Charcots c. Anti-HBc IgM
b. Corvousiers d. HBV DNA
c. Mirrizzi
d. Reynauds/Reynolds

Team D5 KVO Page 7 of 9

82. An asymptomatic patient routinely tested revealed the ff
test reults: (-) HBsAg, (+) anti-HBc total and (-) anti-HBs. 88. Which of the ff is true of a patient with a (+) HBsAg and
The patient was given one shot of the hepatitis B vaccine (+) anti-HBs who is in the course of viral recovery?
which resulted in the appearance of anti-HBs after 1 a. High HBsAg titer
month. Which of the ff is correct? b. Anti-HBs is of a different sub-type than the
a. Patient was a low-level carrier responsive to HBsAg
vaccination c. (+) anti-HBc IgM
b. Patient had previous infection with recovery in d. Decreasing anti-HBs titer when tested after 2
the remote past weeks
c. The HBsAg was a false negative
d. The anti-HBc total was false positive 89. Disappearance of HBsAg and which of the ff should be
documented before a diagnosis of hepatitis B virologic
83. A 30 y/o male patient known to be a carrier of hepatitis B recovery can be made?
virus for the past 2 years consulted you because of a a. Appearance of anti-Hbe
persistently elevated AST of more than 60 IU/L for 6 b. Disappearance of anti-HBc IgM
months. Additional laboratory tests revealed (+) HBsAg, c. Appearance of anti-HBs
(-) HBeAg, (-) anti-HBe, HBV DNA =70,000 d. Disappearance of HBeAg
copies/mL.what is the most likely diagnosis?
a. Hepatitis B with super-infection with hepatitis 90. In determining the etiology of acute viral hepatitis, which
delta of the ff markers is basically useless and should not be
b. Hepatitis B with concomitant hepatitis C tested?
c. Pre-core mutant chronic active hepatitis B a. HBsAg
d. Escape mutant chronic active hepatitis B b. Anti-HCV
c. HBeAg
84. Which of the ff laboratory tests is the most appropriate d. Anti-HBcIgM
to use to confirm the hepatic source of an elevated
serum AST? 91. Which of the ff would present with double bubble sign
a. Serum alkaline phosphatase on plain abdominal radiograph?
b. Serum ALT a. Duodenal atresia
c. B1B2 b. Distal duodenal obstruction
d. Protime c. Annular pancreas
d. AOTA
85. Histochemical studies have localized the reproduction of
which of the ff in the nucleus of the hepatocyte? 92. A 55 y/o male comes in complaining of intermittent
a. HAV vomiting and significant weight loss of 3 months
b. HBsAg duration. Upper gastrointestinal series reveals widening
c. HCV of the C-loop of the duodenum. What is your diagnosis?
d. HDV a. Pancreatic head neoplasm
b. Cholangiocarcinoma
86. Which of the ff is true of babies born to hepatitis B c. TB of the GB
carrier mothers who were presumably exposed to the d. Cholelithiasis
virus during delivery?
a. More likely to develop severe acute hepatitis in 93. A 25 year old male presenting with abdominal pain and
the neonatal period increasing abdominal girth. Upright plain abdominal
b. More likely to develop the carrier state radiograph shows free air in the left subdiaphragmatic
because of immune tolerance area. What is your diagnosis?
c. More likely to develop reactivation hepatitis B in a. Small bowel obstruction
adolescence b. Pneumoperitoneum
d. More likely to develop natural long-lasting c. Volvulus
immunity against the virus d. Gastric neoplasm

87. In which of the following cases would the prolonged 94. What is the most common cause of non-traumatic
prothrombin time be corrected by the administration of pneumoperitoneum?
parenteral vitamin K? a. Perforated PUD
a. Fulminant hepatitis A b. Bowel obstruction
b. Fulminant hepatitis B c. Necrotizing enterocolitis
c. Cholestatic hepatitis A d. Ruptured diverticulum
d. Decompensated cirrhosis due to hepatitis B

Team D5 KVO Page 8 of 9

95. What is/are the imaging modality/ies of choice for
evaluating the esophagus
a. Barium swallow
b. Esophagogram
c. Barium meal
d. AOTA

96. Barium enema for evaluating intussusception can be

a. Diagnostic
b. Therapeutic
c. Diagnostic and therapeutic
d. NOTA

97. Which of the ff structures is not retroperitoneal in

location?
a. Pancreas
b. 2nd portion of the duodenum
c. 1st portion of the duodenum
d. Ascending colon

98. The ff are advantages of MRCP over ERCP EXCEPT:

a. Noninvasive
b. Uses radiation
c. Is less operator dependent
d. Allows better visualization of ducts proximal to
an obstruction

99. A 60 y/o female who complains 6 month history of

crampy diarrhea of loss of appetite, change in bowel
habits, melena and weight loss. On barium enema, study
shows a mucosal irregularities and a constricting lesion
with overhanging shoulders characteristic of an apple-
core lesion. This finding is suggestive of?
a. Diverticulosis
b. Amoebiasis
c. Crohns colitis
d. Colonic carcinoma

100. The modality of choice in evaluating the biliary tree

a. Ultrasound
b. CT scan
c. Plain abdominal radiograph
d. colonoscopy

Team D5 KVO Page 9 of 9