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Gastrointestinal #1 – Histology
1) Which of the following is considered an exocrine function of the liver?
a) Thyroxine conversion
b) Vitamin D conversion
c) Bile production
d) Growth hormone releasing factor (GHRH) conversion
e) Insulin and glucagon
2) 75% of the liver’s blood supply comes from the hepatic portal vein, a component of
the portal triad (with hepatic artery and bile duct). Connecting which of the following
veins would act as a portocaval shunt for a patient with portal hypertension?
a) Esophageal vein and superficial/inferior epigastric veins
b) Left gastric vein and paraumbilical vein
c) Middle rectal vein and inferior rectal vein
d) Superior rectal vein and superior mesenteric vein
e) Left renal vein and splenic vein
3.1) What structural organization of the liver emphasizes the exocrine functions of the
liver, mainly bile secretion?
a) Classic lobule model
b) Portal lobule module
c) Liver acinus model
d) None of the above
3.2) Which zone in the liver acinus model represents the area that is the first to show
ischemic necrosis, the first to show fat accumulation, and the last to respond to toxic
substances and bile stasis? (i.e. bile flows opposite of blood flow)
a) Zone 1
b) Zone 2
c) Zone 3
d) Zones 1 and 3
e) None of the above
4) Hepatic sinusoids contain specialized cells that function in the final breakdown of red
blood cells and are become very useful after a splenectomy. What are these cells called?
a) Howell-Jolly bodies
b) Goblet cells
c) Chief cells
d) Kupffer cells
e) Crypt cells
5) The space of Disse lies between the basal surfaces of hepatocytes and the basal
surfaces of endothelial cells that line the sinusoids. It contains blood-forming cells, which
are usually only found in the liver but may present elsewhere in chronic anemia, and
hepatic stellate cells (Ito cells). What is the role of these cells in physiologic conditions?
a) Vitamin A storage
b) Vitamin D storage
c) Vitamin D conversion
d) Vitamin K storage
e) Iron storage
6) What process occurs in hepatic stellate cells in pathologic conditions?
Gastrointestinal #2 – Microbiology
1.1) A patient presents with flu-like symptoms and jaundice after eating green onions at a
Mexican restaurant. FDA investigation finds the onions were grown using human
manure. Which of the following is most likely?
a) Hepatitis A virus (HAV)
b) Hepatitis B virus (HBV)
c) Hepatitis C virus (HCV)
d) Hepatitis D virus (HDV)
e) Hepatitis E virus (HEV)
1.2) The hepatitis B vaccine can prevent which of the following?
a) Hepatitis B only
b) Hepatitis A & B
c) Hepatitis C & B
d) Hepatitis D & B
e) Hepatitis A, B, C, & D
2) Which of the following describes HAV (icosahedral)?
a) Positive sense, single stranded RNA (ssRNA), non-enveloped (naked)
d) Naked DNA
10) A Dane particle comprises the virion (in larger spherical form) of which of the
following?
a) Hepatitis A virus (HAV)
b) Hepatitis B virus (HBV)
c) Hepatitis C virus (HCV)
d) Hepatitis D virus (HDV)
e) Hepatitis E virus (HEV)
11) Which of the following would be used to determine if HBV is actively replicating?
a) HBcAb (core antibody)
b) HBsAg (surface antigen)
c) HBsAb (surface antibody)
d) HBeAg (“e” antigen)
e) HBeAb (“e” antibody)
12) Which HBsAg glycoprotein is the major component, self-associating into spherical
particles and releasing from cells?
a) L
b) M
c) S
13) Which of the following is true of the HBV replication cycle?
a) Makes RNA in the nucleus then uses cell machinery to make DNA
b) Makes RNA in the nucleus then uses reverse transcriptase to make DNA
c) Replicates in Kupffer cells and is excreted in feces via bile
d) Makes DNA in the nucleus then uses cell machinery to make RNA
e) Makes DNA in the nucleus then uses polymerase to make RNA
14) Which of the following is true of cell mediated immunity in HBV?
a) Causes clinical symptoms
b) Resolves the infection
c) Is ineffective in resolving infection
d) A & B
e) A & C
15) HBV is seen in high rates in Italy, Greece, Africa, and Southeast Asia. What is the
most common method of transmission, especially in the United States?
a) Droplet
b) Blood borne
c) Fecal-oral
d) Direct contact
e) Biological vector
16) What is the number one vaccine (HBV) preventable cancer in the United States?
a) Squamous cell carcinoma
b) Mesothelioma
c) Colorectal cancer
d) Gastric adenocarcinoma
e) Primary hepatocellular carcinoma
17) In a HBV infection, the antigen and antibody can clump to form an immune complex,
which is associated with clinical symptoms. These symptoms include rash, myalgias, and
arthritis. What type of hypersensitivity reaction is this?
a) Type I
b) Type II
c) Type III
d) Type IV
18) Which of the following surface antigen and antibody combinations would signify that
a patient is currently infected with the HBV virus?
a) HBsAg positive, HBsAb positive
b) HBsAg positive, HBsAb negative
c) HBsAg negative, HBsAb positive
d) HBsAg negative, HBsAb negative
19) Which of the following surface antigen and antibody combinations would signify that
a patient has resolved an acute HBV infection?
a) HBsAg positive, HBsAb positive
b) HBsAg positive, HBsAb negative
c) HBsAg negative, HBsAb positive
d) HBsAg negative, HBsAb negative
Match the HBV serologic panel with the case scenario:
HBcAb HBsAg HBsAb HBeAg HBeAb
20.1) + - - - - a) Acute Infected
20.2) + + - + - b) Acute Resolved
20.3) - - + - - c) Window Period
20.4) + + - - + d) Chronic Active
20.5) - + - - - e) Chronic Passive
20.6) + - + - - f) Vaccinated
21) What is the best method of HBV prevention, which is heavily used in the United
States?
a) Screening blood products
b) Safe sexual practices
c) Clean IV needles
d) Health worker safety
e) Vaccination
22) The HBV vaccine is given in a series of three (1 and 6 months after first vaccination).
What type of vaccine is available in the United States for HBV?
a) Live
b) Killed
c) Subunit
d) Toxoid
23) Which of the following describes HCV?
a) Positive sense, single stranded RNA (ssRNA), non-enveloped (naked)
b) Negative sense, single stranded RNA (ssRNA), non-enveloped (naked)
c) Positive sense, single stranded RNA (ssRNA), enveloped
d) Negative sense, single stranded RNA (ssRNA), enveloped
e) Double stranded RNA (dsRNA), non-enveloped
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13) Which of the following is primarily used for chemotherapy-induced nausea and
vomiting, with the beneficial effect of increasing appetite, but may cause euphoria,
sedation, dry mouth, and conjunctival injection?
a) Meclizine (Antivert)
b) Scopolamine (generic patch)
c) Prochlorperazine (Compazine)
d) Dimenhydrinate (Dramamine)
e) Diphenhydramine (Benadryl)
f) Dronabinol (Marinol)
Gastrointestinal #6 – Pathology
1) A teenager presents with abdominal pain that began in the periumbilical region then
localized to the right lower quadrant. The patient has nausea, mild fever, and says he has
vomited. Labs show leukocytosis. Rovsing, Psoas, and Obturator signs are positive.
Which of the following is most likely?
a) Early acute appendicitis
b) Acute suppurative appendicitis
c) Acute gangrenous appendicitis
d) Suppurative peritonitis
e) Bacteremia
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f) Alagille syndrome
18) Inflammation from biliary obstruction initiates periportal fibrosis, which eventually
leads to hepatic scarring and nodule formation, generating biliary cirrhosis. Histology is
characterized by coarse fibrous septae that subdivide the liver in a jigsaw-like pattern.
What is the most common cause of obstruction in adults, leading to this problem?
a) Biliary atresia
b) Cystic fibrosis
c) Choledochal cysts
d) Insufficient intrahepatic bile duct syndrome
e) Extrahepatic cholelithiasis
19) A middle-aged woman presents with insidious onset of pruritis and fatigue. Blood
tests show increased serum alkaline phosphatase and cholesterol. Circulating anti-
mitochondrial antibodies are presents. Liver biopsy shows destruction of intrahepatic bile
ducts. Which of the following is most likely?
a) Primary biliary cirrhosis
b) Secondary biliary cirrhosis
c) Primary sclerosing cholangitis
d) Budd-Chiari syndrome
e) Peliosis hepatic
20) A middle-aged man presents with fatigue and pruritis. Blood tests show elevated
serum alkaline phosphatase. No auto-antibodies are seen. Barium radiograph of the
intrahepatic and extrahepatic biliary tree show a beading pattern with irregular strictures
and dilations. Biopsy shows concentric periductal fibrosis. Which of the following is
most likely?
a) Primary biliary cirrhosis
b) Secondary biliary cirrhosis
c) Primary sclerosing cholangitis
d) Budd-Chiari syndrome
e) Peliosis hepatic
21) Which of the following is true of heart failures and the liver?
a) Right-sided and left-sided failure cause passive congestion
b) Right-sided and left-sided failure cause centrilobular necrosis
c) Right-sided failures causes passive congestion and left-sided failure causes
centrilobular necrosis
d) Right-sided failures causes centrilobular necrosis and left-sided failure causes
passive congestion
22) A female athlete is found to have sinusoidal dilation of the liver. She is currently
taking danazol for endometriosis, oral contraceptives, and admits to using anabolic
steroids. Which of the following is most likely?
a) Fatty liver of pregnancy
b) Veno-occlusive disease of the liver
c) Primary sclerosing cholangitis
d) Budd-Chiari syndrome
e) Peliosis hepatic
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23) A patient with polycythemia vera presents with hepatomegaly and ascities. Testing
finds obstruction of three major hepatic veins. Immediate surgery is scheduled for a
portocaval shunt. What was the diagnosis?
a) Primary biliary cirrhosis
b) Veno-occlusive disease of the liver
c) Primary sclerosing cholangitis
d) Budd-Chiari syndrome
e) Peliosis hepatic
24) A Jamaican man presents with tender hepatomegaly, ascities, weight gain, and
jaundice. History reveals a recent allogeneic marrow transplant. The clinician opts not to
do a liver biopsy due to risk, but feels she would have found obliteration of hepatic vein
radicles and hemosiderin-laden macrophages. Which of the following is most likely?
a) Primary biliary cirrhosis
b) Veno-occlusive disease of the liver
c) Primary sclerosing cholangitis
d) Budd-Chiari syndrome
e) Peliosis hepatic
25) Which of the following signs signifies that a pregnant patient has moved from pre-
eclampsia to eclampsia?
a) Peripheral edema
b) Hyperreflexia
c) Coagulation abnormalities
d) Proteinuria
e) Maternal hypertension
26) A mother in her third trimester presents with signs of hepatic failure. Biopsy shows
microvesicular steatosis with Sudan stain (acute fatty liver). What is the primary
treatment for this patient?
a) Penicillamine and transfusion
b) Liver transplant and prednisone
c) Reduction of fat in the diet
d) Supportive
e) Termination of the pregnancy
27.1) Which of the following conditions affecting the liver after a bone marrow (or liver)
transplant is due to a direct attack of donor lymphocytes on epithelial cells of the liver,
resulting in necrosis of hepatocytes and inflammation of the parenchyma and portal tracts
without bile duct destruction?
a) Oxygen free radical damage and drug toxicity
b) Acute graft-versus-host disease
c) Chronic graft-versus-host disease
d) Acute cellular rejection
e) Chronic cellular rejection
27.2) Which of the following conditions affecting the liver after a bone marrow (or liver)
transplant is defined by severe obliterative arteritis resulting in ischemic changes?
a) Oxygen free radical damage and drug toxicity
b) Acute graft-versus-host disease
c) Chronic graft-versus-host disease
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39) Which of the following congenital anomalies of the pancreas has the highest
incidence and is caused by failure of the fetal duct of the dorsal and ventral pancreatic
primordial to fuse, predisposing the patient to chronic pancreatitis?
a) Agenesis
b) Pancreas divisum
c) Annular pancreas
d) Ectopic pancreas
40) Acute pancreatitis is mainly caused by biliary tract disease and alcoholism in the
Western world. What is the cardinal feature of acute pancreatitis?
a) Nausea
b) Vomiting
c) Diarrhea
d) Abdominal pain
e) Jaundice
41) A middle-aged man presents with repeated bouts of acute interstitial pancreatitis and
steatorrhea. The clinician does not do a biopsy, but feels he would find protein plugs and
parenchymal fibrosis. As this is a chronic condition, the clinician warns the patient of the
risk of developing pancreatic cancer. What is the most likely cause of this patient’s
condition?
a) Coxsackie virus
b) HBV + HDV
c) HCV
d) Alcohol use
e) High fat diet
42.1) Which of the following always arises in women and presents as painless, slow-
growing masses in the body or tail of the pancreas?
a) Serous cystadenoma
b) Mucinous cystic neoplasm
c) Intraductal papillary mucinous neoplasm (IPMN)
d) Solid-pseudopapillary tumor
e) Ductal adenocarcinoma
42.2) Which of the following produces cysts containing mucin, is more common in men,
and affects the head of the pancreas?
a) Serous cystadenoma
b) Mucinous cystic neoplasm
c) Intraductal papillary mucinous neoplasm (IPMN)
d) Solid-pseudopapillary tumor
e) Ductal adenocarcinoma
42.3) A patient presents with abdominal pain and migratory thrombophlebitis (Trousseau
sign). Testing shows a cancer affecting the head of the pancreas that has created a
desmoplastic reaction. The clinician speculates that the cells would show dramatic
telomere shortening. The patient is schedules for surgery as this type of cancer has a very
high mortality rate. What is the diagnosis?
a) Serous cystadenoma
b) Mucinous cystic neoplasm
c) Intraductal papillary mucinous neoplasm (IPMN)
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d) Solid-pseudopapillary tumor
e) Ductal adenocarcinoma
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b) IgM anti-HBc
c) IgG anti-HBc
d) HBeAg
e) Anti-HBe
4) A patient presents with fever, arthritis, urticaria (hives), and angioedema. Polyarteritis
nodosa (PAN) is diagnosed. What hepatitis infection is associated with this?
a) Hepatitis A virus (HAV)
b) Hepatitis B virus (HBV)
c) Hepatitis C virus (HCV)
d) Hepatitis D virus (HDV)
e) Hepatitis E virus (HEV)
5) Inability to clear a HBV infection is most common in what population?
a) Elderly
b) Adults
c) Healthy teens
d) Healthy children
e) Neonates
6) Patients with active chronic HBV are at higher risk for cirrhosis, liver failure, and:
a) Squamous cell carcinoma
b) Serous cystadenoma
c) Ductal adenocarcinoma
d) Gastric adenocarcinoma
e) Hepatocellular carcinoma
7) HBV patients who are at high risk for developing cancer should have their alpha-
fetoprotein levels tested bi-annually as well as undergo:
a) Biopsy
b) Radiography
c) Ultrasonography
d) SPECT scanning
e) Cholangiography
8) Which HBV patients are candidates for interferon alpha therapy?
a) Non-replicating (passive) infection
b) Low levels of aminotransferases
c) Abnormal AST levels
d) Abnormal ALT levels
e) Abnormal alkaline phosphatase
9) Hepatitis D virus (HDV) mainly affects IV drug users and requires what concomitant
infection?
a) Hepatitis A virus (HAV)
b) Hepatitis B virus (HBV)
c) Hepatitis C virus (HCV)
d) Hepatitis E virus (HEV)
e) No other infection is required
10) What is the major risk factor for hepatitis C?
a) Health care contact
b) Poor hygiene
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c) Blood transfusion
d) Sexual contact
e) IV drug use
11) Which of the following is NOT recommended for follow-up after a needlestick
exposure to hepatitis C?
a) Baseline testing for HCV
b) Baseline testing of ALT
c) Prophylactic immune globulin therapy
d) Another follow-up at 4-6 months
12) Which of the following is most likely to become chronic?
a) Hepatitis A virus (HAV)
b) Hepatitis B virus (HBV)
c) Hepatitis C virus (HCV)
d) Hepatitis D virus (HDV)
e) Hepatitis E virus (HEV)
13) What does the presence of anti-HCV mean?
a) Patient was immunized
b) Patient is currently infected
c) Patient cleared a previous infection
d) A & C
e) B & C
14) What lab presentation is likely in a patient who is currently infected with HCV?
a) Presence of anti-HCV and an abnormal ALT level
b) Presence of anti-HCV and an abnormal AST level
c) Presence of anti-HBc an abnormal ALT level
d) Presence of anti-HBc an abnormal AST level
15) What is the initial test that is performed for anti-HCV determination?
a) HCV RIBA test
b) ELISA/EIA
c) Aspartate aminotransferase (AST)
d) Alkaline phosphatase (ALP)
e) Alanine aminotransferase (ALT)
16) What is the test used to confirm chronic hepatitis C?
a) HCV RIBA test
b) ELISA/EIA
c) Aspartate aminotransferase (AST)
d) Alkaline phosphatase (ALP)
e) Alanine aminotransferase (ALT)
17) Chronic hepatitis usually presents with mild to moderate increase in ALT levels and:
a) Asymptomatic, fatigue, right upper quadrant pain
b) Malaise, anorexia, jaundice, abdominal pain
c) Ascities, caput medusea, confusion
d) Weight loss, night sweats, fever, nausea
e) Bouts of extreme right upper quadrant pain
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18) Approximately 1-4% of patients with chronic hepatitis C develop hepatoma each
year. Approximately what percent develop end stage renal cirrhosis after 20-25 years of
infection?
a) 2%
b) 5%
c) 7%
d) 12%
e) 25%
19) Treatment of chronic HCV infection is aimed at:
a) Curing the disease
b) Preventing future complications
c) Alleviating right upper quadrant pain
d) Preventing disease spread
e) There are no treatment options
20) Which of the following is seen in the Far East, Africa, and Central America and poses
a high risk for fulminant hepatitis in pregnant patients?
a) Hepatitis A virus (HAV)
b) Hepatitis B virus (HBV)
c) Hepatitis C virus (HCV)
d) Hepatitis D virus (HDV)
e) Hepatitis E virus (HEV)
21) A 14-year-old girl presents with rapid onset of jaundice and a firm hepatomegaly.
Testing shows thyroiditis, positive ANA, anti-dsDNA, smooth muscle antibody (SMA),
and ANCA. Which of the following is most likely?
a) Alcoholic liver disease
b) Hepatitis C virus
c) Autoimmune chronic hepatitis
d) Fatty liver of pregnancy
e) Nonalcoholic fatty liver disease (NAFLD)
22) Treatment of the above 14-year-old patient is aimed at decreasing serum levels of
aminotransferases below five times normal. Which of the following is used to accomplish
this goal?
a) Ribavirin
b) Interferon alpha
c) Interferon beta
d) Vaccination
e) Prednisone
23) A middle-aged man presents icteric and critically ill. He complains of weight loss,
anorexia, nausea, vomiting, and abdominal pain. Exam reveals hepatomegaly, ascities,
and fever. Liver biopsy shows fatty change with degeneration and necrosis with the
presence of Mallory bodies. Labs show leukocytosis and increased AST that is less than
400U/L. The AST/ALT ratio is greater than 2. Which of the following is most likely?
a) Alcoholic liver disease
b) Hepatitis C virus
c) Autoimmune chronic hepatitis
d) Fatty liver of pregnancy
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b) Hemachromatosis
c) HCV
d) HBV
e) HAV
2) What is the most common cause of hepatoma in the United States?
a) Alpha-1 antitrypsin deficiency
b) Alcoholic liver disease
c) HCV
d) Autoimmune hepatitis
e) Hemochromatosis
3) Which of the following findings in a cirrhotic patient is diagnostic for hepatoma?
a) Very high alkaline phosphatase
b) Bloody ascities
c) Alpha-fetoprotein > 400
d) RUQ bruit and tender hepatomegaly
e) Increased hematocrit levels and hypercalcemia
4) What is the treatment of choice for patients with hepatoma?
a) Penicillamine
b) Prednisone
c) Interferon alpha
d) Lactulose
e) Liver transplant
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d) 2L diuresis
e) Salt and water restriction
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James Lamberg
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AnswerKey 17) C GI #5
GI #1 18) B 1) C
1) C 19) C
2) E 20.1) C GI #6
3.1) B 20.2) D 1) B
3.2) C 20.3) F 2) E
4) D 20.4) E 3) B
5) A 20.5) A 4) C
6) A 20.6) B 5) D
7.1) B 21) E 6) B
7.2) D 22) C 7) A
7.3) C 23) C 8) B
7.4) A 24) D 9) D
7.5) A 25) E 10) C
8.1) B 26) B 11.1) A
8.2) C 27) C 11.2) E
9) C 28) D 11.3) D
10) D 29) E 12) C
11) A 30) B 13) A
12.1) D 31) B 14) B
12.2) C 32) D 15) D
12.3) B 33) C 16) C
12.4) E 34) C 17) D
12.5) A 35) C 18) E
13) C 19) A
14.1) D GI #3 20) C
14.2) C 1.1) E 21) C
1.2) A 22) E
GI #2 2) C 23) D
1.1) A 3) A 24) B
1.2) D 4) B 25) B
2) A 5) C 26) E
3) B 6) D 27.1) B
4) C 7) A 27.2) E
5) E 8) D 28.1) C
6) C 9) A 28.2) D
7) C 10) B 29) E
8) B 11) D 30) D
9) B 12) B 31) E
10) B 13) F 32) D
11) D 33) A
12) C GI #4 34) E
13) B 1) C 35) D
14) D 2) B 36) B
15) B 37) C
16) E 38) E
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39) B 13) E 4) A
40) D 14) A 5) C
41) D 15) B
42.1) B 16) A GI #18
42.2) C 17) A 1) E
42.3) E 18) E
19) B GI #19
GI #7 20) E 1) D
1) A 21) C 2) B
2) E 22) E
3) A 23) A GI #20
4) C 24) E 1) C
5) C 25) E 2) C
6) B
GI #12 GI #21
GI #8 1) A 1) A
1) C 2) C 2) D
2) D 3) B
3) E GI #13 4) E
4) C 1) B 5) C
5) A 2) C 6) B
6) B 3) E
7) A 4) D GI #22
8) D 5) B 1) D
6) D 2) D
GI #9 7) D 3) A
1) A 4) C
GI #14 5) B
GI #10 1) E 6) B
1) D 7) C
2) D GI #15
3) C 1) E
2) B
GI #11 3) C
1) B 4) E
2) A
3) B GI #16
4) B 1.1) B
5) E 1.2) A
6) E 1.3) D
7) C 2) E
8) D
9) B GI #17
10) E 1) D
11) C 2) A
12) C 3) B
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