Question 1

A 41-year-old male with a history of chronic alcoholism has massive hematemesis following a bout of prolonged vomiting. This is most typical for:

A Hiatal hernia

B Esophageal laceration (Mallory-Weiss syndrome)

C Esophageal pulsion diverticulum

D Barrett's esophagus (metaplasia with gastric mucosa)

E Esophageal squamous cell carcinoma

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Question 2

Early gastric carcinoma (EGC) is best characterized by:

A Metastases only to regional lymph nodes

B A 5-year survival following resection of >90%

C A signet ring cell pattern by light microscopy

D The gross appearance of linitis plastica

E A high incidence of occurrence in the United States

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Question 3

All of the following are risk factors for squamous cell carcinoma of the esophagus EXCEPT:

A Zinc deficiency

B Food contaminated with Aspergillus

C Chronic alcoholism

D Diet rich in fruit

E Food containing nitrosamines

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Question 4

Which statement regarding small intestinal carcinoid tumors is INCORRECT:

A They may produce gastrin.

B The majority of them are histologically malignant.

C The carcinoid syndrome usually occurs with liver metastases.

D The neoplastic cells may contain neurosecretory granules.

E They are often multiple.

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Question 5

Which of the following statements regarding peptic ulcers is CORRECT:

A In the stomach, they are usually in the antrum.

B In the duodenum, they are usually periampullary.

C Gastric ulcers are associated with increased gastric acid production.

D Benign ulcers can be reliably distinguished by their smaller size.

E Duodenal ulcers are prone to malignant transformation.

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Question 6

A 15 year old male has acute onset of right upper quadrant abdominal pain. A laparoscopic cholecystectomy is performed. Opening the gallbladder reveals several 0.5 to 1 cm diameter dark, greenish black gallstones. These findings most strongly suggest:

A Sickle cell anemia

B Crohn's disease

C Hypercholesterolemia

D Hyperparathyroidism

E Primary biliary cirrhosis

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Question 7

A 34 year old female has the onset of severe abdominal pain. Physical examination reveals marked diffuse tenderness, and bowels sounds are absent. The serum amylase and lipase are markedly elevated. The LEAST likely etiology for these findings is:

A Hypertriglyceridemia

B Trauma

C Hypercalcemia

D Cystic fibrosis

E Viral infection

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Question 8

After an August camping trip in the Cascade mountains of Washington state, a 29-year-old male develops a mild watery diarrhea. The most probable cause is:

A Rotavirus

B Shigella flexneri

C Vibrio cholerae

D Giardia lamblia

E Entamoeba histolytica

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Question 9

A 45 year old male has had vague abdominal pain and nausea for several years unrelieved by antacid medications. Endoscopy reveals antral musocal erythema, but no ulcerations or masses. Microscopically there is a chronic non-specific gastritis. Which of the following findings is most likely to be present::

A Gastrinoma (Zollinger-Ellison syndrome)

B Pernicious anemia

C Helicobacter pylori

D Adenocarcinoma

E Crohn's disease

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Question 10

A 25-year-old male gives a history of recent cramping abdominal pain associated with fever, diarrhea, and right lower quadrant abdominal tenderness. A colonoscopy reveals mucosal edema and ulceration in the mid-transverse colon. The most characteristic microscopic finding would be:

A Crypt abscesses

B Entameba histolytica organisms

C Adenocarcinoma

D Band-like mucosal fibrosis

E Granulomas

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Question 11

A 72-year-old female has become increasingly jaundiced. Her total serum bilirubin is 10.2 mg/dl with direct bilirubin of 8.5 mg/dl. Her serum alkaline phosphatase is elevated to 224 IU/L. The AST and ALT are normal. These findings suggest that she has:

A Hemolysis

B Cirrhosis of the liver

C Extrahepatic biliary obstruction

D Gilbert's syndrome

E Biliary atresia

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Question 12

A 39-year-old male with a history of ulcerative colitis for the past 20 years is found to have a positive stool guaiac, and a mass lesion is palpable with digital rectal examination. This lesion is probably a( an):

A Lymphoma

B Malignant carcinoid

C Adenocarcinoma

D Kaposi's sarcoma

E Villous adenoma

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Question 13

If the antimitochondrial antibody (AMA) is negative, transaminases are not elevated, and cholangiography is unremarkable, the most likely etiology for jaundice in a 55-year-old female is:

A Carcinoma of the head of the pancreas

B Cystic fibrosis of the pancreas

C Chronic active hepatitis

D Primary biliary cirrhosis

E Chronic persistent hepatitis

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Question 14

A 45-year-old male is found at autopsy to have a 2500 gm liver (normal up to 1800 gm) that microscopically shows most hepatocytes to be filled with large lipid droplets. The probable etiology is:

A Alpha-1-antitrypsin deficiency

B Wilson's disease

C Acute hepatitis C

D Chronic alcoholism

E Biliary tract lithiasis

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Question 15

Which of the following conditions is the LEAST probable cause for weight loss from malabsorption:

A Lactase deficiency

B Crohn's disease

C Celiac disease

D Ileal adenocarcinoma

E Pancreatitis

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Question 16

A 27-year-old medical student has a needlestick injury performing phlebotomy. A year later transaminases are elevated and a liver biopsy shows collapse of liver lobules with piecemeal necrosis, bridging necrosis, and portal fibrosis. The best diagnosis is:

A Acute hepatitis B

B Chronic active hepatitis

C Primary biliary cirrhosis

D Reye's syndrome

E Acetaminophen overdose

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Question 17

A patient undergoes a colectomy, and over 200 adenomatous polyps are present on gross examination. He could have any of the following conditions EXCEPT:

A An autosomal dominant disorder

B Gardner's syndrome

C Peutz-Jehgers syndrome

D A high risk for colonic adenocarcinoma

E Onset of the disease in adolescence

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Question 18

A squamous cell carcinoma located in the mid-esophagus is most likely to have occurred in which of the following patients:

A A 50-year-old male smoker

B A 60-year-old female with pernicious anemia

C A 70-year-old male with Barrett's mucosa

D A 40-year-old female with hiatal hernia

E A 30-year-old male with acquired immunodeficiency syndrome

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Question 19

A solitary sharply demarcated 2-cm gastric antral ulcer in a 40-year-old male will be most commonly associated with which of the following:

A Gastric achlorhydria

B Crohn's disease

C Hematemesis

D Lymph node metastases

E Islet adenoma of pancreas

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Question 20

A long-term complication of micronodular cirrhosis of the liver, even if the patient stops drinking, is:

A Hepatocellular adenoma

B Focal nodular hyperplasia

C Cholelithiasis

D Angiosarcoma

E Hepatocellular carcinoma

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Question 21

A 22 year old female has liver failure with Wilson's disease. She may be expected to have each of the following findings EXCEPT:

A Increased serum ceruloplasmin

B Autosomal recessive pattern of inheritance

C Increased copper in liver biopsies

D Increased urinary copper

E Corneal Kayser-Fleischer rings

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Question 22

A 28-year-old female with recent onset of depression takes an entire bottle (100 capsules, 500 mg each) of a medication containing acetaminophen. In several days, the liver is most likely to show:

A Normal histology

B Extensive necrosis

C Bridging fibrosis

D Severe fatty change

E Portal chronic inflammation

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Question 23

A four week old male begins to exhibit forceful vomiting after each meal. The child had been fine previously. Which of the following conditions is the probable cause:

A Congenital duodenal atresia

B Necrotizing enterocolitis

C Mallory-Weiss syndrome

D Hirschsprung's disease

E Pyloric stenosis

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Question 24

Esophageal dysmotility in a 45-year-old female whose lower esophagus on biopsy shows atrophy along with fibrosis of smooth muscle most strongly suggests:

A Mallory-Weiss syndrome

B Scleroderma

C Iron deficiency

D Portal hypertension

E Barrett's esophagus

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Question 25

At the time of biopsy, chronic atrophic gastritis of autoimmune etiology (type A) can be associated with each of the following findings EXCEPT:

A Helicobacter infection

B Achlorhydria

C High serum gastrin levels

D Risk for adenocarcinoma

E Pernicious anemia

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Question 26

A 35-year-old male has malabsorption. A jejunal biopsy shows flattening of villi with chronic inflammation. The best treatment for his condition is:

A Antibiotic therapy

B Gluten-free diet

C Partial small bowel resection

D Corticosteroid therapy

E A vegetarian diet

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Question 27

A surgical pathologist receives an appendix with the history "acute appendicitis". On microscopic examination, all the inflammation is limited to the serosa. What should he suspect:

A Mild early acute appendicitis

B Chronic appendicitis

C Polyarteritis nodosa

D Peritonitis from disease in another organ

E The patient has no disease process

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Question 28

Seen by colonoscopy in a 41 year old male is a 1cm polyp on a narrow stalk that is located in the descending colon. Microscopically, there are crowded, tubular, atypical colonic-type glands in this polyp. The best diagnosis is:

A Adenomatous polyp

B Inflammatory fibroid polyp

C Peutz-Jehgers polyp

D Ulcerative colitis

E Hyperplastic polyp

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Question 29

True statements regarding diverticulosis include all of the following EXCEPT:

A The diverticula are most common in the descending colon.

B It occurs more in elderly and middle-aged persons.

C A high-fiber diet contributes to their formation.

D The diverticula may become inflamed and rupture.

E There is no increased risk for development of adenocarcinoma.

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Question 30

A 39 year old female with a long history of substernal burning pain following meals has upper endoscopy performed, and biopsies are taken of the lower esophagus which show islands of intestinal type mucosa. These findings most strongly suggest that this condition:

A Is a congenital anomaly

B Increases the risk for squamous cell carcinoma

C Is acquired with chronic gastroesophageal reflux

D May lead to formation of a diverticulum

E Is associated with iron deficiency anemia

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Question 31

Gastric biopsies from a 54 year old male reveal the presence of Helicobacter pylori organisms which are most likely to be:

A Invasive with an associated septicemia

B Associated with chronic gastritis

C An infection antecedent to pernicious anemia

D Seen mostly in association with hypochlorhydria

E Present with decreasing frequency with age

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Question 32

Whipple's disease:

A Responds to a gluten-free diet

B Causes malabsorption by overgrowth of infectious organisms

C Demonstrates PAS-positive macrophages histologically

D Is limited to the duodenum

E Does not respond to antibiotic therapy

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Question 33

Pre-neoplastic conditions of the gastrointestinal tract include all of the following EXCEPT:

A Barrett's esophagus

B Ulcerative colitis

C Crohn's disease

D Chronic atrophic gastritis

E Diverticulitis

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Question 34

A 54 year old Asian male who is hepatitis B surface antigen positive has a firm, nodular liver. All of the following findings can occur as complications of this condition EXCEPT:

A Hepatocellular carcinoma

B Coagulopathy

C Ascites

D Splenomegaly

E Hepatic infarction

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Question 35

Neoplasms of the islets of Langerhans:

A Are the most common cause of carcinoid syndrome

B May produce insulin, glucagon, or gastrin

C Usually function and are associated with hyperglycemia

D Grow rapidly and have a poor overall prognosis

E Are seen more frequently in association with diabetes mellitus

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Question 36

Gallstones can be implicated in the appearance of all of the following conditions EXCEPT:

A Primary sclerosing cholangitis

B Acute pancreatitis

C Hyperbilirubinemia

D Adenocarcinoma of gallbladder

E Chronic cholecystitis

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Question 37

Sharply circumscribed ulcers are seen on endoscopy in the lower esophagus of a 35-year-old patient with AIDS who has pain on swallowing. These ulcers are probably due to:

A Helicobacter pylori

B Candida albicans

C Herpes simplex

D Mycobacterium avium-intracellulare

E Cytomegalovirus

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Question 38

Active ulcerative colitis (UC):

A Shows a proximal pattern of colonic involvement

B Usually has transmural inflammation

C Has no familial predisposition

D Shows crypt abscesses histologically

E Is not associated with sclerosing cholangitis

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Question 39

A 56-year-old male with a 28 year history of chronic alcoholism is most likely to develop which of the following problems:

A Colonic angiodysplasia

B Crohn's disease

C Ileal submucosal telangiectasia

D Adenocarcinoma of the colon

E Esophageal varices

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Question 40

A first year medical student fails to use proper disinfection techniques with his microbiology experiment. Two weeks later, he has spiking fevers, cramping abdominal pain with diarrhea, a palpable spleen and leukopenia. What organism was he using in his experiment:

A Salmonella typhi

B Entameba histolytica

C Shigella flexneri

D Clostridium difficile

E Yersinia enterocolitica

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Question 41

The liver biopsy from a 41-year-old male with elevated transaminases demonstrates abundant Mallory's hyaline, neutrophils, necrosis of hepatocytes, and fatty change. The probable etiology for these findings is:

A Acute hepatitis A infection

B Sclerosing cholangitis

C Alcoholic hepatitis

D Chronic hepatitis B infection

E Acetaminophen toxicity

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Question 42

The condition intermediate between the presence of a sliding hiatal hernia and later development of an adenocarcinoma of the lower esophagus will probably be:

A Varices

B Mallory-Weiss syndrome

C Barrett's esophagus

D Crohn's disease

E Achalasia

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Question 43

A 6 month old male infant has marked abdominal distention along with infrequent bowel movements. A radiograph reveals marked colonic dilation. What pathologic finding would be most likely found in this setting:

A An aganglionic segment of colon

B Congenital malrotation

C Volvulus

D Intussusception

E Meconium ileus

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Question 44

Of the following, the most common cause for ischemic bowel disease is:

A Adenocarcinoma

B Venous thrombosis

C Volvulus

D Incarcerated hernia

E Hypotension

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Question 45

A long-term complication of chronic constipation with heroin use is:

A Hemorrhoids

B Megacolon

C Angiodysplasia

D Perirectal fistulae

E Adenocarcinoma

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