Portal Hypertension Quiz

GI End of Block Mock - RareaWare

• This is a mock exam for a GI (Gastrointestinal) systems module.

Question 1

• A 53-year-old male presented with dysphagia, regurgitation, and retrosternal pain.
• High-resolution manometry was performed.
• The HRM trace showed a characteristic pattern suggestive of achalasia.

Question 1 Answer

• The correct answer is achalasia.

Question 1 Explanation

• Achalasia: Characterized by hypertonic lower esophageal sphincter (LES) which doesn't relax properly during swallowing causing food to be trapped. This leads to an abnormal trace in HRM.
• Hiatus hernia: A structural issue where part of the stomach herniates into the chest. The HRM trace would show different characteristics to achalasia.
• Scleroderma: A connective tissue disease that causes hardening and tightening of the skin and internal organs. HRM trace would show different characteristics to achalasia.
• Jackhammer esophagus: A condition of repetitive, high-pressure peristaltic waves. HRM trace would show different characteristics to achalasia.
• Diffuse esophageal spasm: A condition characterized by non-propulsive contractions in the esophagus. HRM trace would show different characteristics to achalasia

Question 2

• Which drug decreases colonic motility?
• The answer is Loperamide.

Question 2 Explanation

• Loperamide is a gut selective opiate mu receptor agonist. It decreases myenteric plexus tone and activity leading to slower colonic transit.
• Stimulant laxatives increase gut motility by acting on the intestinal wall.
• Prucalopride is a selective 5HT4 receptor agonist and promotes ACh release, stimulating motility.
• Linaclotide increases intestinal fluid volume, speeding colonic transit.
• Cholinergics enhance colonic motor activity. Anti-cholinergics are used to reduce motility.

Question 3

• Which of the following stimulates gastric acid secretion?
• The answer is Histamine.

Question 3 Explanation

• Histamine is produced from ECL cells and acts on H2 receptors in parietal cells to stimulate acid secretion.
• Cholecystokinin, gastric inhibitory peptide, and secretin inhibit gastrin release and acid secretion.
• Somatostatin inhibits gastric acid secretion and stimulates bile and pancreatic juice production.

Question 4

• A 45-year-old female with H. pylori infection and penicillin allergy. What is the most appropriate first-line treatment?
• Answer: Omeprazole, metronidazole, and clarithromycin.

Question 4 Explanation

• First-line treatment for H. pylori infection is omeprazole, metronidazole, and amoxicillin.
• If there is a penicillin allergy, metronidazole is substituted with clarithromycin.

Question 5

• Which phase of the metastatic cascade is shown in the image?
• The answer is intravasation.

Question 5 Explanation

• Intravasation is the entry of tumor cells into the circulatory system.
• Extravasation is the exit of the cancer cells from the circulatory system.
• Metastatic colonization is the formation of secondary tumors at a distant site.
• Local invasion and neovascularization is the stage prior to intravasation.
• Arrest at a distant organ site is the final stage in the metastatic process.

Question 6

• Which of the following is not a sign of upper gastrointestinal bleeding?
• The answer is overt faecal bleeding.

Question 6 Explanation

• Overt faecal bleeding is a sign of lower GI bleeding.
• Hematemesis, coffee ground vomiting, and melaena are all signs of upper GI bleeding.
• Iron deficiency anemia can be a consequence of bleeding.

Question 7

• Which of the following is not a common cause of acute pancreatitis?
• Answer: Hypocalcemia.

Question 7 Explanation

• The causes listed which include gallstones, alcohol, scorpion stings, endoscopic retrograde cholangiopancreatography (ERCP) are all related to acute pancreatitis.
• Hypocalcemia is a possible consequence of pancreatitis, not a cause.

Question 8

• A 24-year-old female with abdominal pain presented with these pancreatic function test results. What's the most likely diagnosis?
• Answer: Acute pancreatitis.

Question 8 Explanation

• The patient's results showed elevated serum amylase, urine amylase, and serum lipase levels above the normal range. These are key indicators of acute pancreatitis. Faecal elastase levels were within the normal range.

Question 9

• A 15-year-old boy with suspected appendicitis is admitted. Where is McBurney's point located?
• Answer: One-third of the distance from the umbilicus to the right anterior superior iliac spine (ASIS).

Question 10

• What is the correct definition of cirrhosis?
• Answer: Diffuse process with fibrosis and nodular formation.

Question 11

• A 73-year-old male with portal hypertension due to liver failure. Which sign is unlikely to be a result of this?
• Answer: Palmar erythema.

Question 11 Explanation

• Portal hypertension is a consequence of impaired blood flow through the liver.

Question 12

• Where is Murphy's point located?
• Answer: Between the lateral border of the rectus abdominus muscle and the costal margin—at the 9th costal cartilage on the right side.

Question 13

• Which of the following is not a known risk factor for gallstones?
• Answer: >50 years of age.

Question 14

• Which of the following is a cause of extrinsic biliary compression?
• Answer: Mirizzi syndrome.

Question 15

• Which of the following is the correct description of the fissure for ligamentum teres?
• Answer: Lies between the quadrate lobe and the left liver lobe; remnant of the umbilical vein.

Question 16

• A 34-year-old male presents with jaundice. What is the most likely diagnosis given these liver function test results?
• Answer: Gilbert's disease.

Question 17

• A 50-year-old female with liver concerns presents with abnormal LFTs. What's the most likely diagnosis from the results?
• Answer: Alcoholic liver disease.

Question 18

• A 42-year-old male with uncontrolled haemochromatosis, diabetes, and cardiomyopathy. This is related to which gene mutation?
• Answer: HFE gene.

Question 19

• A 23-year-old female with diarrhoea, vomiting, and dermatitis herpetiformis has a biopsy. What is the most likely diagnosis?
• Answer: Celiac disease.

Question 20

• Which of the following is not required for a diagnosis of coeliac disease?
• Answer: Positive faecal calprotectin.

Question 21

• What is an action of beta cells of the pancreas?
• Answer: Lowers blood glucose levels.

Question 22

• Which artery supplies the head of the pancreas?
• Answer: Superior pancreaticoduodenal artery.

Question 23

• Which of the following drugs is not licensed for use in active immunotherapy for bowel cancer?
• Answer: Rituximab.

Question 24

• A 74-year-old man is undergoing an angiogram for a GI bleed. The coeliac axis arises from the aorta at which spinal level?
• Answer: T12.

Question 25

• A 48-year-old male with recurrent gastro-oesophageal reflux, after endoscopy showing Barrett's oesophagus, what type of metaplasia has occurred?
• Answer: Stratified squamous to simple columnar.

Question 26

• A 22-year-old female with crampy abdominal pains, fever, and bloody diarrhoea. Which pathogen is most likely?
• Answer: Campylobacter.

Question 27

• A 75-year-old male with stage 3 bowel cancer undergoing left hemicolectomy. Which artery supplies the affected colon?
• Answer: Inferior mesenteric artery.

Question 28

• A 78-year-old female with colon cancer, stage T3N2M1. What does T3 stand for?
• Answer: Local invasion into muscularis propria.

Question 29

• Which of the following is a benefit of colonoscopy?
• Answer: Allows for interventional options.

Question 30

• Which of the following is not a cause of secretory diarrhoea?
• Answer: Crohn's disease.

Test your knowledge on portal hypertension and its complications. This quiz covers various aspects of the condition, including causes, consequences, and visible signs. Perfect for students and professionals in the medical field!