154 all gastro QCM

For patients with diagnosis as dyspepsia, they may have many symptoms. Which of the following symptoms is the most likely encountered?

. For the patient you consult for dyspepsia, you have to do anamnesis and clinical examination to find the causes. Which of the following etiology that is the most likely play a role?

. Some drugs can cause dyspepsia. So during your anamnesis for patient with dyspepsia, you have to think of some drug name. What medication is the most likely responsible?

Rome III diagnostic criteria are used to diagnose functional dyspepsia. Which one of the following propositions is based for Rome criteria?

In case of dyspepsia, we have to find some alarm features (“Red flags"), which is suggestive of gastric malignancy. Which one among the following propositions is the most appropriate?

A patient of 55 years old comes to see you for symptoms of dyspepsia. Anamnesis and clinical examination revealed that he lost 5 kg for the past 2 months and his father died of gastric cancer so you have to diagnose whether the patient was infected by H. Pylori. Which of the following tests would you think is the most appropriate?

The co-factors of irritable bowel syndrome can be related to many factors. Which one of the following factor is the most likely play a role?

In patients with irritable bowel syndrome, symptom for which we have to look for in the alarm features were below. Which of the following propositions is the most likely?

In people who meet the IBS diagnostic criteria, the following investigations are recommended. Which of the following para-clinic exams is the most likely requested as minima?

. A patient of 45 years old comes to see you for symptom of irritable bowel syndrome about 2 months. He has rectal bleeding one to two times weekly. Which investigation is the most likely diagnostic?

Monsieur X., âgé de 58 ans, est hospitalisé au service urgence pour une hématémèse. A l’examen clinique: la tension artérielle est de 100/60mmHg avec la fréquence cardiaque à 110/min, les téguments et muqueuses sont pâles. Il présente un ictère, des angiomes stellaires sur le tronc et des circulations veineuses collatérales. L’abdomen est distendu avec la matité déclive avec splénomégalie. TR : méléna. Quel diagnostic étiologique le plus probable évoquez-vous?

Un patient âgé de 66 ans est hospitalisé pour une hématémèse. A l'interrogatoire, vous notez qu'il a de l'hématémèse 3fois. Comme l'antécédent: l'infarctus du myocarde il y a 3mois. A l'examen clinique: TA: 98/72mmHg, FC: 100/mn, absence de marbrure. Quel critère de gravité de ce patient que vous inquiétez le plus?

Mme Y. âgée de 40ans est hospitalisée pour une hémorragie digestive haute. Elle a la notion de la prise de l'ANIS depuis 5jours. Elle a bénéficié d'une endoscopie haute qui a montré un ulcère gastrique Forrest IIb. Quelle hormone de la défense de muqueuse gastrique qui est perturbé lors de l'utilisation de l'AINS?

Un homme de 60 ans ayant antécédent familial de cancer colorectal, est admis au service urgence porte pour une rectorragies massives. A l'examen clinique: TA: 90/60mHg, FC: 120/mn, le tégument et muqueuse sont pâle et le reste de l'examen est normal. Quel est le premier examen paraclinique à visée diagnostique et thérapeutique à faire?

Une femme de 40 ans est admise dans le servie de l’hépato-gastroentérologie pour une hématémèse. Elle a bénéficié d'une endoscopie oeso-gastroduodénale qui a montré un grand ulcère gastrique Forrest Ib. L'hémostase endoscopique a été réalisée. Quel est le traitement médical le plus approprie proposez-vous?

Le 16/11/2014, 20h40, Vous êtes interne au service urgence porte d’un hôpital à Phnom Penh. Monsieur C.V, âgé de 53 ans amené par son fils pour une émission de selle noirâtre une fois à 17 heures. Question 16 (QRU) 20h42, vous avez un doute sur ce méléna à l’interrogatoire. Quel est le geste le plus approprie que vous devez faire pour le confirmer ?

Le 16/11/2014, 20h40, Vous êtes interne au service urgence porte d’un hôpital à Phnom Penh. Monsieur C.V, âgé de 53 ans amené par son fils pour une émission de selle noirâtre une fois à 17 heures. Question 17 (QRU) 20h45, l'hémorragie digestive est confirmée après votre examen. La tension artérielle est à 80/40mmHg, FC 110/mn, FR 22/mn, SpO2 96% en air ambiant, la température à 370C, Glasgow 15. Vous reprenez votre interrogatoire minutieux, vous avez noté que c’est le premier épisode de méléna. Il n’en a pas de l’antécédent médical, chirurgical ou familial connu. Il n'a jamais pris de médicament. Il n’a pas d’allergie connue. Il fume 1 paquet par jour et il boit du vin du riz 1 litre par jour depuis l’âge de 30 ans. A l'examen clinique, vous avez trouvé des angiomes stellaires, circulation veineuse collatérale avec ictère conjonctival. Quel type de médicament le plus utile prescrivez-vous pour ce patient?

Le 16/11/2014, 20h40, Vous êtes interne au service urgence porte d’un hôpital à Phnom Penh. Monsieur C.V, âgé de 53 ans amené par son fils pour une émission de selle noirâtre une fois à 17 heures. Question 18 (QRU) 21h00. Après votre prise en charge immédiate l'état hémodynamique du patient est stable. Le patient a bénéficié d'une endoscopie en urgence qui montre de trois cordons variqueuse oesophagienne de stade III avec des signes rouge. La ligature élastique a été réalisée. Votre sénior vous a demandé, pourquoi existe-il des varice oesophagiennes pour ce patient?

Le 16/11/2014, 20h40, Vous êtes interne au service urgence porte d’un hôpital à Phnom Penh. Monsieur C.V, âgé de 53 ans amené par son fils pour une émission de selle noirâtre une fois à 17 heures. Question 19 (QRU) 21h30. La ligature des varices oesophagiennes a été réalisée avec succès. Quels types de traitement prescrivez-vous pour la prévention de l'encéphalopathie chez ce patient?

Le 16/11/2014, 20h40, Vous êtes interne au service urgence porte d’un hôpital à Phnom Penh. Monsieur C.V, âgé de 53 ans amené par son fils pour une émission de selle noirâtre une fois à 17 heures. Question 20 (QRU) Le lendemain, le patient allait mieux. Il n'existe pas de désorientation temporo-spatiale. A l'examen clinique vous trouvez de l'ictère, des angiomes stellaires, d'ascite de moyenne abondance avec des circulations veineuses collatérales. Le bilan biologique: Hb: 80g/L, VGM : 84,7 fl, GB : 8,39giga/l, Plaquettes : 85 giga/l. Transaminase: ASAT: 3 fois à la normal et ALAT: 2 fois à la normal. Urée et créatinine sanguine sont normales. L'échographie a confirmé la cirrhose du foie chez ce patient. Votre sénior vous demande de faire le bilan biologique pour calculer le score de Child-Pugh. Quel est la proposition la plus appropriée pour calculer ce score?

Monsieur CX âgé de 30ans se présent au Service des urgences porte pour douleurs épigastriques intense transfixant intermittente calmée par la position antéflexion avec vomissements et l’ arrêt des matières. Dans son antécédent: plusieurs épisodes de ce type de douleur mais régressée spontanément. Une ASP a montré de quelques calcifications à la région épigastrique sans image hydro-aérique ni croissance gazeux. Quel est le diagnostic le plus probable de ce patient?

Madame XG âgé de 44 ans divorcé 10ans, elle boit beaucoup de la bière depuis la séparation avec son marie. Le diagnostic de la pancréatite chronique est porté il y a 6mois. Récemment, elle a des vomissements post prandiaux avec sensation d’un gène épigastrique. L'échographie ne montre pas des anomalies particulières sous réserve de gaz abondance. Mais vous avez encore le doute sur le pseudo-kyste du pancréas. Vous êtres a l’hôpital Calmette, quel examen para-clinique le plus adapte demandez-vous dans ce cas?

Vous faite la visite matinale avec votre senior, vous s'occuper d'une dame de 54ans ayant la pancréatite chronique. La patiente a des vomissements répètes, Ceux-ci sont dues aux complications de la pancréatite chronique. Quelle complication la plus probable est responsable de vomissements répétés chez cette patiente?

Lors d'un bilan scannographique du Monsieur TG âgé de 39ans pour l'ictère, on a découvert fortuitement d'un pseudo-kyste du pancréas de taille 30x40mm. Quelle est la cause possible de cet ictère?

Monsieur XK âgé de 56ans ayant la pancréatite chronique. Il a la douleur quant il mange n'import quoi. Il vient vous voir pour le régime. Quelle est la meilleure recommandation pour lui?

Vous avez vu en consultation Mme TX âgée de 56ans ayant un adénocarcinome du pancréas avec métastase hépatique. L'état général est bon sans syndrome de cholestase biologique. Quel traitement le plus approprie faite-vous pour cette dame?

Monsieur JF âgé de 61ans ayant une altération de l'état général. Le bilan complet a montré une tumeur de tête du pancréas (30mm) de type adénocarcinome sans envahissement locorégional ni métastase à distance. Quel est le taux de survie à 5ans pour ce patient s'il est d'accord pour l'opération?

Monsieur CR âgé de 45ans est admis au service de Médicine A4 de l'hôpital Calmette pour un doute d'une tumeur du pancréas. Votre confrère vous a contacté et vous a posé la question: quel examen complémentaire le plus performance dans le carde de diagnostic d'un adénocarcinome du pancréas ?

Madame TS âgée de 54ans avec notion familial de cancer du pancréas. Elle vous demande quels sont les symptômes faisant évoquer une tumeur du pancréas?

Un patient âgé de 60ans ayant un adénocarcinome de la tête du pancréas est hospitalisé au service d'urgent pour l'état fébrile. Quelle est la cause qu'on doit rechercher en premier intention ?

The most frequent cause of UGI bleeding is:

. After initial stabilization and resuscitation of the patient, each of the following options should be considered in the management of UGI bleeding except:

. Endotracheal intubation for airway protection in the management of UGI bleeding should be considered:

A 73 year old man presents with several episodes of hematemesis. Examination shows signs of orthostatic hypotension and melena. What is the first priority in caring for this patient?

An important risk factor for peptic ulcer hemorrhage includes:

For the patient who is now stable after a severe UGI bleed associated with NSAID ingestion, and who is found to be H.pylori positive, what is the most effective management strategy?

. For the patient with an UGI bleed and the endoscopic finding of a clean ulcer, the most appropriate management includes:

A sixty-six-year old man presents to the emergency department with a history of one episode of melena. Past history includes coronary artery disease, hypertension . He is on one baby aspirin daily. An urgent upper endoscopy is negative. What is the most appropriate next step?

A fifty-eight year old female patient presents to the emergency department with a 24-hour history of several hematemesis. She is found to be hypotensive and anemic. Resuscitative measures are instituted. What is the most appropriate next step?

A fifty-eight year old female patient presents to the emergency department in Calmette hospital with a 24-hour history of several hematochesia. Physical examination show: hypotension, and anemia. Both the upper endoscopy and colonoscopy are not diagnostic. The patient continues to pass clots per rectum. Resuscitation has normalized her vital signs and maintained her Hct at 32%. What is the most effective management strategy?

A 65-year-old woman has a prior history of hospitalization for UGI bleeding from a duodenal ulcer. Which one of the following therapies is not useful for preventing recurrent ulcer hemorrhage?

A 68-year-old healthy woman with a history of duodenal ulcer is placed on low-dose aspirin for coronary prophylaxis. Two weeks later she presents to the emergency room in Calmette hospital with one episode of melena . Physical examination showed : blood pressure and resting heart rate of 90 beats per minute without orthostatic changes. Melena is confirmed on rectal examination. Her admission hematocrit is 36%. She is placed on high dose proton pump inhibitor therapy (omeprazole 40 mg b.i.d.). Due to other complications, endoscopy is not performed until the tenth hospital day, and it shows a small (5 mm) duodenal ulcer with a clean base. Biopsy for CLO test is negative. Which one of the following should be performed now?

A 32-year-old female presents with her third episode of symptomatic peptic ulcer. She has previously undergone multiple upper endoscopies, which have shown a non healing-benign-appearing antral ulcer. Multiple biopsies have always been negative for malignancy and gastritis. H. Pylori testing with both CLO tests and stool antigen are negative. Serum gastrin is normal. Which one of the following should be considered now?

An 82-year-old debilitated woman with coronary artery disease and breast cancer presents with hematochezia requiring 4 units of blood. Following colonic preparation, colonoscopy demonstrates fresh blood in the left colon with marked diverticulosis. The right colon is normal and bilious material is seen in the cecal pole. Upon withdrawal of the colonoscope, there was active oozing of blood from the neck of a diverticulum in the distal sigmoid colon. The most appropriate management now is

A 65-year-old presents with iron-deficiency anemia, refractory to iron treatment. No history of overt gastrointestinal bleeding, but fecal occult blood tests were positive on 4 of 5 occasions. A previous EGD showed a large hiatal hernia. Two colonoscopies and a small bowel radiographic series were unremarkable. An endoscopic finding of a repeat EGD is shown ulcerative esophagitis. Which of the following is the most appropriate management of this condition?

A 72-year-old woman with cryptogenic cirrhosis has developed progressive dyspnea for the past 3 months. Her laboratory investigations show hemoglobin of 8.4 g/dL with mean corpuscular volume of 62 μm3 and serum ferritin level of 10 ng/mL. Stool specimens are brown but positive for occult blood. Colonoscopy is normal. An endoscopic view of the gastric antrum is shown Angiodysplasia. Which of the following is the most appropriate next step in management of this condition?

A 62-year-old woman with a past medical history of chronic renal insufficiency presents with iron-deficiency anemia and intermittent melena for 2 months requiring multiple blood transfusions. She underwent multiple endoscopic investigations, including EGD, colonoscopy, CT scan of the abdomen and pelvis, and upper gastrointestinal series. No bleeding source was identified. Wireless capsule endoscopy shows multiple vascular abnormalities in the jejunum . Which of the following is the most like diagnosis?

. A 68-year-old man presents with intermittent episodes of hematochezia for several months. His stools are normal, but he passes blood clots a few times per week. His past medical history is significant for prostate cancer, for which he received radiation therapy 4 years ago. He denied any weight loss or diarrhea. Physical examination is unremarkable. An endoscopic view of the rectum showed: rectum appears with friability and telangiectasia pale. These findings are limited to the distal rectum. Which of the following is the most likely diagnosis?

A 28-year-old woman with a history of an appendectomy presents with a non-tender palpable mass in the right lower quadrant abdominal incision. The following statement(s) is/are true concerning the diagnosis and management of this patient.

The following statement about peritonitis are all true except:

Acute appendicitis is most commonly associated with which of the following signs?

Which of the following most often initiates the development of acute appendicitis?

The best type of x-ray to locate free abdominal air is:

The most helpful diagnostic radiographic procedure in small bowel obstruction is:

The most commonly used imaging method for diagnosis of acute cholecystitis is

Meckel's diverticulitis most often occurs in the:

Of adult patients presenting to the emergency room for evaluation of acute abdominal pain, which one of the following answers includes the most common diagnoses?

Visceral pain is typically:

A 26-year old woman in her first trimester of pregnancy presents with a 2-day history of right lower quadrant pain and fever. Physical examination reveals a tender, palpable, right lower quadrant mass. There is no evidence of peritonitis or systemic sepsis. Laboratory evaluation is remarkable for mild leukocytosis, and abdominal ultrasound demonstrates an inflammatory mass but no evidence of abscess. As the surgeon on call, your recommendation would be:

True statements regarding appendiceal neoplasms include which of the following?

Gastro-oesophageal reflux can reliably be diagnosed by

Which of the following statements about the anatomic course of the esophagus is correct?

Which of the following statements about esophageal anatomy is correct?

Which of the following statements about the lower esophageal sphincter (LES) mechanism, or high-pressure zone (HPZ), is true?

Which of the following statements about achalasia is/are correct?

Which of the following statements about epiphrenic diverticula of the esophagus is/are correct?

Which of the following statements about Schatzki's ring is correct?

Which of the following statements about pathology encountered at esophagoscopy is/are correct?

Which of the following statements about the diagnosis and treatment of esophageal leiomyomas is/are correct?

Which of the following statements regarding the pathology of esophageal carcinoma is/are correct?

Which of the following statements about the surgical treatment of esophageal carcinoma is/are correct?

The best management for a 48-hour-old distal esophageal perforation is:

A 50-year-old patient develops sudden left lower chest pain and epigastric pain after vomiting. The patient shows diaphoresis, breath sounds are decreased on the left, and there is abdominal guarding. The most appropriate diagnostic test is:

The following statements about the influence of diet and lifestyle on lower esophageal sphincter (LES) function are true except one. Identify the incorrect statement.

When a stricture is present in association with gastroesophageal reflux, each of the following is an acceptable repair for reflux control except one. Identify the poorest repair.

When assessing gastroesophageal reflux disease by manometry each of the following statements is correct except one. Identify the incorrect one

The presence of a nonmalignant mid- or upper esophageal stricture always indicates the presence of:

Which of the following is most reliable for confirming the occurrence of a significant esophageal caustic injury?

First-line therapy for routine peptic duodenal ulcer disease includes:

Appropriate management of severe vomiting associated with gastric outlet obstruction from peptic ulcer disease includes all of the following except:

Secretion of gastric juice is stimulated by

Bile acts as activator of which enzyme

HCI of the gastric juice

Activatea gastrin

Brunner’s glands are present in

Crypts of Lieberkuhn are present in

Oxyntic cells secrete

The hepatic cells which act as phagocytes are

Which answers are true? In contrast to ulcerative colitis, Crohn's disease of the colon:

Crohn's disease:

Recurrence after operation for Crohn's disease:

Which statements about anorectal Crohn's disease are true?

The most common indication for operation in Crohn's disease of the colon is:

Patient case: you have a friend who is going to China for 7 months. She leaves in 2 weeks. She has never received either hepatitis A or B vaccines. Which is the best choice today for her immunoprophylaxis of hepatitis A

What are the most important patient education informations to give your friend about avoiding hepatitis A exposure or infection?

An indicator of good response to peg-interferon and Ribavirin for a patient with chronic hepatitis C infection is :

In Cambodia, the hepatitis B vaccine series should be administered to all

Patient case: ST, a 35-year-old man, was diagnosed with chronic hepatitis B infection 5 years ago. His primary risk factor is intravenous drug use. His liver disease is progressing, as measured by persistently elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. ST had a liver biopsy 6 months ago that showed chronic active hepatitis. He has never been treated for his chronic hepatitis. Which of the following are important goal of treating chronic viral hepatitis B infection?

Patient case: ST, a 35-year-old man, was diagnosed with chronic hepatitis B infection 5 years ago. His primary risk factor is intravenous drug use. His liver disease is progressing, as measured by persistently elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. ST had a liver biopsy 6 months ago that showed chronic active hepatitis. He has never been treated for his chronic hepatitis. Which of the following are important goal of treating chronic viral hepatitis B infection?

Patient case: TS, a 45-year-old man, Cambodian was diagnosed with chronic hepatitis B infection 5 years ago. His primary risk factor is intravenous drug use. His liver disease is progressing, as measured by persistently elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. ST had a liver biopsy 6 months ago that showed chronic active hepatitis. His serological profile : HBe Ag +, Ac HBe-, PCR-VHB = 190,000,000IU/ml. He has never been treated for his chronic hepatitis. Of the following, which is the possible treatment do you recommend for chronic hepatitis B for TS ?

Patient case: SP, a 40-year-old man, was diagnosed with chronic hepatitis B infection 2 years ago, his mother was known as chronic hepatits B patient and died last month of Hepato Cellular Carcinoma (HCC) . His liver disease is not progressing, as measured by persistently non elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, His Fibroscan 3 days ago showed elasticity of 14 KPa. He has never been treated for his chronic hepatitis. 99)Which of the following criteria should you based on for commencing the treatment of his hepatitis B ?

Questions 7 and 8 refer to the following case: TAS, a 40-year-old man, was diagnosed with chronic hepatitis C infection 5 years ago (viral genotype 2). His primary risk factor is intravenous drug use. He has been diagnosed with chronic active hepatitis. 100) Which of the following is the most important goal of treating chronic viral hepatitis C infection

What specific treatment do you recommend for chronic hepatitis C infection for TAS

Which of the following viral causes of hepatitis is the most common cause of chronic hepatitis in Cambodia ?

) A nurse sustains a needle stick from a patient who is known to be HBsAg-positive. She has been vaccinated previously with hepatitis B vaccine and is a known nonresponder. What post-exposure prophylaxis should the nurse receive?

Which of the following viral causes of hepatitis is transmitted by contaminated food or water

Which of the following causes of viral hepatitis are common in Asia

When a patient is HBsAg-negative, and anti-HBs-positive, what is the status of his or her hepatitis B infection ?

When a patient is HBsAg-negative, and anti-HBs-positive, what is the status of his or her hepatitis B infection ?

Which of these things can cause hepatitis?

The disease exists in short-term (acute) and long-term (chronic) forms. How long does acute hepatitis last?

What are the symptoms of hepatitis?

Which form of hepatitis can be passed on through contaminated food or water?

Which form can exist for years without symptoms?

Vaccines have been developed to protect against which hepatitis viruses?

A 28-year-old woman with a history of an appendectomy presents with a non-tender palpable mass in the right lower quadrant abdominal incision. The following statement(s) is/are true concerning the diagnosis and management of this patient.

The following statement(s) is/are true concerning umbilical hernias in adults.

The following statement(s) is/are true concerning the anterior abdominal wall musculature.

Which of the following statements concerning intraperitoneAccumulation of lymph within the peritoneal cavity usually results from trauma as tumor involving the intra-abdominal lymphatic structures. @al fluid collections are correct?

The following statement about peritonitis are all true except:

Which of the following most often initiates the development of acute appendicitis?

The diagnosis of acute appendicitis is most difficult to establish in:

Once a diagnosis of acute appendicitis has been made and appendectomy decided upon, which of the following is/are true?

The best type of x-ray to locate free abdominal air is

A. Symptoms@ B. Biopsy histology of the gastro-oesophageal junction C. Manometry D. 24 hour pH monitoring E. Bernstein test Answer : A 61)Which of the following statements about the anatomic course of the esophagus is correct? A. The cervical esophagus passes behind and to the right of the trachea. B. The thoracic esophagus enters the posterior mediastinum anterior to the aortic arch. C. The thoracic esophagus passes behind the right mainstem bronchus and the pericardium. D. The esophagus enters the diaphragmatic hiatus at the level of T8. E. The esophagus deviates anteriorly and to the left as it enters the abdomen. @ Answer: E 62). Which of the following statements about esophageal anatomy is correct? A. The esophagus has a poor blood supply, which is segmental in distribution and accounts for the high incidence of anastomotic leakage. B. The esophageal serosa consists of a thin layer of fibroareolar tissue. C. The esophagus has two distinct muscle layers, an outer, longitudinal one and an inner, circular one, which are striated in the upper third and smooth in the distal two thirds.@ D. Injury to the recurrent laryngeal nerve results in vocal cord dysfunction but does not affect swallowing. E. The lymphatic drainage of the esophagus is relatively sparse, localized primarily to adjacent paraesophageal lymph nodes. Answer: C 63). Which of the following statements about the lower esophageal sphincter (LES) mechanism, or high-pressure zone (HPZ), is true? A. The LES is a circular smooth muscle ring that is 3 to 5 cm. long. B. In assessing esophageal manometric data, mean HPZ pressure less than 6 mm. Hg or overall length less than 2 cm. Is more likely to be associated with incompetence of the LES and gastroesophageal reflux.@ C. Esophageal manometry and the acid perfusion (Bernstein) test reliably identify the patient with an incompetent LES mechanism. D. Distal HPZ relaxation occurs within 5 to 8 seconds of initiating a swallow. E. Twenty-four–hour distal esophageal pH monitoring is achieved with an intraesophageal pH electrode positioned at the esophagogastric junction. Answer: B 64. Which of the following statements about achalasia is/are correct? A. In most cases in North America the cause is a parasitic infestation by Trypanosoma cruzi. B. Chest pain and regurgitation are the usual symptoms. C. Distal-third esophageal adenocarcinomas may occur in as many as 20% of patients within 10 years of diagnosis. D. Manometry demonstrates failure of LES relaxation on swallowing and absent or weak simultaneous contractions in the esophageal body after swallowing.@ E. Endoscopic botulinum toxin injection of the LES, pneumatic dilatation, and esophagomyotomy provide highly effective curative therapy for achalasia. Answer: D 65. Which of the following statements about epiphrenic diverticula of the esophagus is/are correct? A. They are traction diverticula that arise close to the tracheobronchial tree. B. They characteristically arise proximal to an esophageal reflux stricture. C. The degree of dysphagia correlates with the size of the pouch. D. They are best approached surgically through a right thoracotomy. E. The operation of choice is a stapled diverticulectomy, long esophagomyotomy, and partial fundoplication.@ Answer: E 66. Which of the following statements about Schatzki's ring is correct? A. The ring represents a panmural fibrotic stricture resulting from gastroesophageal reflux. B. Dysphagia occurs when the ring diameter is 13 mm. Or less. @ C. The ring occurs within 1 to 2 cm. Of the squamocolumnar epithelial junction. D. Schatzki's ring indicates reflux esophagitis. E. Schatzki's ring signifies the need for an antireflux operation. Answer: B 67. Which of the following statements about pathology encountered at esophagoscopy is/are correct? A. Reflux esophagitis should be graded as mild, moderate, or severe, to promote consistency among different observers. B. An esophageal reflux stricture with a 2-mm. Lumen is not dilatable and is best treated with resection. C. A newly diagnosed radiographic distal esophageal stricture warrants dilation and antireflux medical therapy. D. In patients with Barrett's mucosa, the squamocolumnar epithelial junction occurs 3 cm. Or more proximal to the anatomic esophagogastric junction.@ E. After fasting at least 12 hours, a patient with megaesophagus of achalasia can safely undergo flexible fiberoptic esophagoscopy. Answer: D 68. Which of the following statements about the diagnosis and treatment of esophageal leiomyomas is/are correct? A. The majority are diagnosed after they cause dysphagia and chest pain. B. Biopsy is indicated at the time of esophagoscopy, to rule out carcinoma. C. Full-thickness elliptical excision of the esophageal wall is the preferred surgical approach. D. Endoscopic ultrasonography is a reliable means of following leiomyomas conservatively.@ E. Recurrence of resected leiomyomas is minimized by wide local excision. Answer: D 69. Which of the following statements regarding the pathology of esophageal carcinoma is/are correct? A. Worldwide, adenocarcinoma is the most common esophageal malignancy. B. Squamous cell carcinoma is most common in the distal esophagus, whereas adenocarcinoma predominates in the middle third. C. Patients with Barrett's metaplasia are 40 times more likely than the general population to develop adenocarcinoma. @ D. Metastases from esophageal carcinoma are characteristically localized to regional mediastinal lymph nodes adjacent to the tumor. E. Achalasia, radiation esophagitis, caustic esophageal stricture, Barrett's mucosa, and Plummer-Vinson syndrome are all premalignant esophageal lesions that predispose to the development of squamous cell carcinoma. Answer: C 70. Which of the following statements about the surgical treatment of esophageal carcinoma is/are correct? A. The finding of severe dysphagia in association with Barrett's mucosa is an indication for an antireflux operation to prevent subsequent development of carcinoma. B. Long-term survival is improved by radical en bloc resection of the esophagus with its contained tumor, adjacent mediastinal tissues, and regional lymph nodes. C. The morbidity and mortality rates for cervical esophagogastric anastomotic leak are substantially less than those associated with intrathoracic esophagogastric anastomotic leak@. D. The leading complications of transthoracic esophagectomy and intrathoracic esophagogastric anastomosis are bleeding and wound infection. E. Transhiatal esophagectomy without thoracotomy achieves better long-term survival than transthoracic esophagectomy. Answer: C 71. The best management for a 48-hour-old distal esophageal perforation is: A. Antibiotics and drainage. B. Division of the esophagus and exclusion of the perforation. C. Primary repair with buttressing.@ D. Resection with cervical esophagostomy, gastrostomy, and jejunostomy. E. T-tube fistula and drainage. Answer: C 72. A 50-year-old patient develops sudden left lower chest pain and epigastric pain after vomiting. The patient shows diaphoresis, breath sounds are decreased on the left, and there is abdominal guarding. The most appropriate diagnostic test is: A. Aortography. B. Esophagoscopy. C. Electrocardiogram. D. Film of the chest. @ E. White blood count. Answer: D 73.The following statements about the influence of diet and lifestyle on lower esophageal sphincter (LES) function are true except one. Identify the incorrect statement. A. A high-protein diet increases LES pressure. B. A fat meal results in sustained decrease in LES pressure. C. Chocolate ingestion causes a decrease in LES pressure. D. Peppermint produces a transient decrease in LES values. E. Cigarette smoking produces no significant changes in LES pressures. @ Answer: E 74. When a stricture is present in association with gastroesophageal reflux, each of the following is an acceptable repair for reflux control except one. Identify the poorest repair. A. Intrathoracic total fundoplication. B. Lengthening gastroplasty with total fundoplication. C. Total fundoplication. D. Lengthening gastroplasty with partial fundoplication. E. Partial fundoplication.@ Answer: E 75. When assessing gastroesophageal reflux disease by manometry each of the following statements is correct except one. Identify the incorrect one. A. Absent or extremely low LES pressures have predictive value in identifying more severe reflux. B. Peristaltic dysfunction increases with increasing severity of esophagitis. C. With established reflux disease the UES is hypertensive. @ D. Esophageal functional changes are worst in patients with a circumferential columnar-lined esophagus. E. Absence of peristalsis may be associated with more severe forms of reflux disease. Answer: C 76. The presence of a nonmalignant mid- or upper esophageal stricture always indicates the presence of: A. Alkaline reflux esophagitis. B. Barrett's esophagus.@ C. Idiopathic reflux disease. D. Mediastinal fibrosis. E. Scleroderma. Answer: B 77. Which of the following is most reliable for confirming the occurrence of a significant esophageal caustic injury? A. History of the event. B. Physical examination of the patient. C. Barium esophagraphy. D. Endoscopy.@ E. Manometry Answer: D 78. First-line therapy for routine peptic duodenal ulcer disease includes: A. Vagotomy and antrectomy. B. Upper endoscopy and biopsy to rule out tumor. C. Evaluation for Helicobacter pylori.@ D. Serum gastrin determination. E. Cream or milk-based “Sippy” diet. Answer: C 79. Appropriate management of severe vomiting associated with gastric outlet obstruction from peptic ulcer disease includes all of the following except: A. Nasogastric suction. B. Intravenous hydration. C. Nutritional assessment; upper endoscopy to rule out malignancy. D. Intravenous H 2 antagonist. E. Oral antacid therapy. @ Answer: E 80. Secretion of gastric juice is stimulated by a) enterogastrin b) gastrin@ c) cholecystokini d) non of enterogastrin, gastrin, cholecystokine e) prostaglandin 81. Bile acts as activator of which enzyme a) lipase@ b) pepsinogen c) pancreatic amylase d) trypsinogen e). Glucagon 82. HCI of the gastric juice a) activates both pepsin and ptyalin b) inactivates both pepsin and ptyalin c) activates pepsin and inactivates ptyalin@ d) activates ptyalin and inactivates pepsin e) activatea gastrin 83. Cholecystokinin stimulates a) pancreas b) gall bladder @ c) gastric gland d) none of pancreas, gall bladder, gastric gland e) Brunner’ s gland 84. Brunner’s glands are present in a)stomach b) ileum c) duodenum@ d) oesophagus e) colon 85. Crypts of Lieberkuhn are present in a)intestine@ b) stomach c) oesophagus d) intestine, stomach, oesophagus e) colon 86. Oxyntic cells secrete a) trypsin b) HCI@ c)NaoH d)pepsin e) Mucous 87. The hepatic cells which act as phagocytes are a)kuffer cells@ b)acinar cells c)Hansen’s cells d)Ito cell e) Fibroblaste 88. Which answers are true? In contrast to ulcerative colitis, Crohn's disease of the colon: A. Is not associated with increased risk of colon cancer. B. Seldom presents with daily hematochezia@ C. Is usually segmental rather than continuous@ D. Has a lower incidence of perianal fistulas. E. Never develops toxic megacolon. 89. Crohn's disease: A. Is caused by Mycobacterium paratuberculosis. B. Is more common in Jews than in Asians@ C. Tends to occur in families@ D. Is less frequent in temperate climates than in tropical ones. E. Is improved by smoking. 90. Recurrence after operation for Crohn's disease: A. Occurs after operations for ileal Crohn's but not colonic Crohn's. B. Is usually found just proximal to an enteric anastomosis. C. Frequently requires reoperation, that why surgery is reserved for the last option. D. Occurs in 1% of patients at risk per year during the first 10 years after the operation. E. Is prevented by maintenance therapy with corticosteroids. 91. Which statements about anorectal Crohn's disease are true? A. It may be the only overt manifestation of Crohn's disease@ B. It accompanies large intestine Crohn's more often than small intestine Crohn's@ C. It subsides when associated small intestinal Crohn's is excised. D. It should not be treated operatively. E. It may subside in response to metronidazole, 250 mg. q.i.d@ 92. The most common indication for operation in Crohn's disease of the colon is: A. Obstruction@ B. Chronic debility. C. Bleeding. D. Perforation @ E. Carcinoma@ Patient case: you have a friend who is going to China for 7 months. She leaves in 2 weeks. She has never received either hepatitis A or B vaccines. 93. Which is the best choice today for her immunoprophylaxis of hepatitis A A) A dose of hepatitis A vaccine B) A dose of IM immunoglobulin and a dose of hepatitis A vaccine@ C) A dose of IM immunoglobulin anti-HBV D) First dose of hepatitis A vaccine today and a booster dose the day before she leaves E) A dose of immunoglobulin polyvalence.@ Patient case: you have a friend who is going to China for 7 months. 94)What are the most important patient education informations to give your friend about avoiding hepatitis A exposure or infection? A) Tell her to avoid sharing needles or using nonsterile needles. B) Remind her about using insect repellant and mosquito netting at night. C) Encourage her to take safe sex precautions. D) Explain good hand washing and food and water precautions.@ E) Advise her to be vaccinated against hepatitis A 6 months before departure@ 95) An indicator of good response to peg-interferon and Ribavirin for a patient with chronic hepatitis C infection is : A) low pretreatment HCV RNA. @ B) genotype 1 C) high pretreatment aminotransferases. D) hepatic fibrosis. @ E) genotype 2.@ 96) In Cambodia, the hepatitis B vaccine series should be administered to all A) international travelers .@ B) pregnant women. C) healthy infants. @ D) patients with acute hepatitis B infection. E) New born baby to chronic hepatitis B carrier mother@ Patient case: ST, a 35-year-old man, was diagnosed with chronic hepatitis B infection 5 years ago. His primary risk factor is intravenous drug use. His liver disease is progressing, as measured by persistently elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. ST had a liver biopsy 6 months ago that showed chronic active hepatitis. He has never been treated for his chronic hepatitis. 97). Which of the following are important goal of treating chronic viral hepatitis B infection? A) Normalie ALT and AST. B) Improve symptoms. C) Lose HBsAg from serum. @ D) Decrease symptoms. E) Viral suppression.@ Patient case: TS, a 45-year-old man, Cambodian was diagnosed with chronic hepatitis B infection 5 years ago. His primary risk factor is intravenous drug use. His liver disease is progressing, as measured by persistently elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. ST had a liver biopsy 6 months ago that showed chronic active hepatitis. His serological profile : HBe Ag +, Ac HBe-, PCR-VHB = 190,000,000IU/ml. He has never been treated for his chronic hepatitis. 98). Of the following, which is the possible treatment do you recommend for chronic hepatitis B for TS ? A) Interferon-a + lamivudine B) Entecavir @ C) No drug treatment, he is unlikely to respond to drug therapy. D) No drug treatment the risks of adverse effects from the available treatments are too great in TS. E) Tenofovir@ Patient case: SP, a 40-year-old man, was diagnosed with chronic hepatitis B infection 2 years ago, his mother was known as chronic hepatits B patient and died last month of Hepato Cellular Carcinoma (HCC) . His liver disease is not progressing, as measured by persistently non elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, His Fibroscan 3 days ago showed elasticity of 14 KPa. He has never been treated for his chronic hepatitis. 99)Which of the following criteria should you based on for commencing the treatment of his hepatitis B ? A) Age 40@ B) Family history of HCC@ C) Degree of fibrosis D) Pre-C mutant E) Normal transaminases Questions 7 and 8 refer to the following case: TAS, a 40-year-old man, was diagnosed with chronic hepatitis C infection 5 years ago (viral genotype 2). His primary risk factor is intravenous drug use. He has been diagnosed with chronic active hepatitis. 100) Which of the following is the most important goal of treating chronic viral hepatitis C infection A) Normalie ALT and AST. B) Improve symptoms. C) Reverse cirrhosis. D) Eliminate the HCV RNA from serum.@ E) Seroconversion Ac HCV Answer D 101) What specific treatment do you recommend for chronic hepatitis C infection for TAS A) Interferon- ribavirin B) Lamivudine C) Sofosbuvir and Ribavirin. @ D) Sofosbuvir and Ledispavir. E) Peg-interferon and Ribavirin Answer : C 102) Which of the following viral causes of hepatitis is the most common cause of chronic hepatitis in Cambodia ? A) Hepatitis D B) Hepatitis C @ C) Hepatitis B D) Hepatitis A E) Hepatitis E Answer : B,C 103) A nurse sustains a needle stick from a patient who is known to be HBsAg-positive. She has been vaccinated previously with hepatitis B vaccine and is a known nonresponder. What post-exposure prophylaxis should the nurse receive? A) One dose of HBIG and one dose of hepatitis B vaccine @ B) Give the nurse Tenofovir for 30 days C) One dose of hepatitis B vaccine D) Test the nurse for anti-HBs level and treat accordingly E) Give the nurse double dose of vaccine Answer :A 104) Which of the following viral causes of hepatitis is transmitted by contaminated food or water A) Hepatitis D B) Hepatitis E @ C) Hepatitis C D) Hepatitis B E) Hepatits A@ Answer : B, E 105) Hepatitis D is commonly associated with what other type of viral hepatitis A) Hepatitis E B) Hepatitis C C) Hepatitis B @ D) Hepatitis G E) Hepatitis B and C Answer : C 106) Which of the following causes of viral hepatitis are common in Asia A) Hepatitis A @ B) Hepatitis B @ C) Hepatitis C @ D) Hepatitis E E) Hepatitis D Answer : A,B,C 107) When a patient is HBsAg-negative, and anti-HBs-positive, what is the status of his or her hepatitis B infection ? A) Resolved @ B) Chronic carrier C) Early acute D) Chronic hepatitis E) Vaccinated@ Answer : A, E 108). Which of these things can cause hepatitis? A. Viruses @ B. Medicines and alcohol @ C. Immune system that's not working as it should @ D. Fatty Liver@ E. Iron overload@ Answer : A,B,C,D,E 109) The disease exists in short-term (acute) and long-term (chronic) forms. How long does acute hepatitis last? A. Less than 6 months @ B. Less than 3 months C. About 6 weeks D. 1 month E. 1 year Answer : A 110). What are the symptoms of hepatitis? A. Tiredness (fatigue)@ B. Low fever @ C. Nausea @ D. Muscle pain@ E. Icterus@ Answer : A,B,C,D,E 111). Which form of hepatitis can be passed on through contaminated food or water? A. B B. C C. A and E @ D. B and C E. D Answer: C 112). Which form can exist for years without symptoms? A. D @ B. B and C C. A D. E E. B an D@ Answer : A,E 113). Vaccines have been developed to protect against which hepatitis viruses? A. Hepatitis A virus B. hepatitis B virus C. Hepatitis D virus D. Hepatitis A and hepatitis B virus @ E. Hepatitis C virus Answer: D 114. A 28-year-old woman with a history of an appendectomy presents with a non-tender palpable mass in the right lower quadrant abdominal incision. The following statement(s) is/are true concerning the diagnosis and management of this patient. a. The best diagnostic test involves imaging of the abdominal wall by either CT or MRI@ b. Resection of the mass with a 2 cm margin is usually adequate c. Low dose radiation is a suitable alternative to surgery for primary treatment d. Re-resection for recurrence will likely have a higher rate of recurrence than for primary resection e. Therapeutic endoscopic should be an option for the treatment of the mass. 115. The following statement(s) is/are true concerning umbilical hernias in adults. a. Most umbilical hernias in adults are the result of a congenital defect carried into adulthood b. A paraumbilical hernia typically occurs in multiparous females @ c. The presence of ascites is a contraindication to elective umbilical hernia repair. d. Incarceration is uncommon with umbilical hernias e. Umbilical hernia can see in decompensated cirrhosis@ 116. The following statement(s) is/are true concerning the anterior abdominal wall musculature. a. The lateral musculature of the abdominal wall consists of three muscle layers. These are, from external to internal, the external oblique, the transversus abdominis, and the internal oblique muscles b. The transversalis fascia lies on the deep side of the transversus muscle and extends to form an essentially complete fascial envelope of the abdominal cavity@ c. Above the semicircular line, the internal oblique aponeurosis splits into posterior and anterior laminae @ d. The rectus abdominis muscles originate on the ribs superiorly and on the pubis inferiorly and are clearly distinct throughout their entire length e. Peritoneum is part of the anterior abdominal wall musculature 117. Which of the following statements concerning intraperitoneal fluid collections are correct? A. Ascites occurs when either the peritoneal fluid secretion rate increases or the absorption rate decreases. @ B. Accumulation of lymph within the peritoneal cavity usually results from trauma as tumor involving the intra-abdominal lymphatic structures. @ C. Choleperitoneum (intraperitoneal bile) generally occurs following biliary surgery, but spontaneous perforation of the bile duct has been reported. @ D. The most common cause of hemoperitoneum is trauma to the liver or spleen.@ E. Hepatocellular carcinoma can cause hemoperitoneum@ 118. The following statement about peritonitis are all true except: A. Peritonitis is defined as inflammation of the peritoneum. B. Most surgical peritonitis is secondary to bacterial contamination. C. Primary peritonitis has no documented source of contamination and is more common in adults than in children and in men than in women.@ D. Tuberculous peritonitis can present with or without ascites. E. Cirrhotic ascites can complicate to peritonitis Answer: C 119. Acute appendicitis is most commonly associated with which of the following signs? A. Temperature above 104؛ F. B. Frequent loose stools. C. Anorexia, abdominal pain, and right lower quadrant tenderness.@ D. White blood cell count greater than 20,000 per cu. mm. E. Anuria, hypothermy, constipation 120. Which of the following most often initiates the development of acute appendicitis? A. A viral infection. B. Acute gastroenteritis. C. Obstruction of the appendiceal lumen. @ D. A primary clostridial infection. E. Therapeutic colonoscopy Answer: C 121. The diagnosis of acute appendicitis is most difficult to establish in: A. Persons aged 60 and older.@ B. Women aged 18 to 35. C. Infants younger than 1 year.@ D. Pregnant women. E. Situs inversus patient@ 122. Once a diagnosis of acute appendicitis has been made and appendectomy decided upon, which of the following is/are true? A. Prophylactic antibiotics should be administered. @ B. Prophylactic antibiotics are not necessary unless there is evidence of perforation. C. If the appendix is not ruptured and not gangrenous, antibiotics may be discontinued after 24 hours. @ D. Multiple antibiotics are in all cases preferable to a single agent. E. Large bowel cleaning is necessary prior to surgery 123. The best type of x-ray to locate free abdominal air is: A. A posteroanterior view of the chest. B. A flat and upright view of the abdomen. C. Computed tomograph (CT) of the abdomen. D. A lateral decubitus x-r E. plain X-Ray on the bed of the patient 124. The most helpful diagnostic radiographic procedure in small bowel obstruction is: A. CT of the abdomen. B. Contrast study of the intestine. C. Supine and erect x-rays of the abdomen. @ D. Ultrasonography of the abdomen. E. MRI of abdomen. 125. The most commonly used imaging method for diagnosis of acute cholecystitis is: A. CT of the abdomen. B. Ultrasonography of the gallbladder. @ C. Oral cholecystogram. D. Radionuclide (HIDA) scan of the gallbladder. E. Endoscopic ultrasound 126. Meckel's diverticulitis most often occurs in the: A. Proximal jejunum. B. Distal jejunum. C. Proximal ileum. D. Distal ileum.@ E. Proximal colon 127. Of adult patients presenting to the emergency room for evaluation of acute abdominal pain, which one of the following answers includes the most common diagnoses? a. Urologic problems, cholelithiasis, pelvic inflammatory disease b. Mittelschmerz, appendicitis, ureterolithiasis c. Nonspecific abdominal pain, appendicitis, intestinal obstruction@ d. Appendicitis, pelvic inflammatory disease, perforated ulcer E. Ectopic pregnancy complication 128. Nonsurgical causes of acute abdominal pain may include which of the following? a. Hyperthyrodism b. Adrenal insufficiency@ c. Pneumonia @ d. Diabetic ketoacidosis @ E. Acute pancreatitis@ 129. Which of the following cause visceral pain from the abdominal organs? a. Stretching and contraction b. Traction, compression, torsion c. Cutting d. Certain chemicals e. Distension@ 130. Factors which may influence the clinical presentation of intraabdominal pathology include which of the following? a. Pregnancy @ b. Oral anticoagulants@ c. Age @ d. HIV infection @ e.Obesity 131. Visceral pain is typically: a. Well localized b. Sharp c. Mediated via spinal nerves d. Perceived to be in the midline @ e. Burning 132. True statements regarding the pathophysiology of acute appendicitis include which of the following: a. Fecaliths are responsible for the disease process in approximately 30% of adult patients @ b. Lymphoid hyperplasia is a frequent cause of appendicitis in young patients @ c. Clostridium difficile is implicated as a pathogenic organism d. Carcinoid tumors account for approximately 5% of all cases of acute appendicitis e. Colonoscopy can sometimes cause acute appendicitis. 133. A 26-year old woman in her first trimester of pregnancy presents with a 2-day history of right lower quadrant pain and fever. Physical examination reveals a tender, palpable, right lower quadrant mass. There is no evidence of peritonitis or systemic sepsis. Laboratory evaluation is remarkable for mild leukocytosis, and abdominal ultrasound demonstrates an inflammatory mass but no evidence of abscess. As the surgeon on call, your recommendation would be: a. . Intravenous hydration, antibiotic prophylasis, and urgent appendectomy @ b. Intravenous hydration, antibiotics, bowel rest, and interval appendectomy in 4 to 6 weeks c. Intravenous hydration, antibiotics, and appendectomy if no improvement in 12 to 24 hours d. Intravenous hydration, antibiotics, and interval appendectomy when fever has subsided, leukocyte count has returned to normal, and the patient is pain free e. Emergent obstetrical consultation for evaluation and treatment of possible ectopic pregnancy 134. True statements regarding appendiceal neoplasms include which of the following? a. Carcinoid tumors of the appendix less than 1.5 cm are adequately treated by simple appendectomy@ b. Appendiceal carcinoma is associated with secondary tumors of the GI tract in up to 60% of patients c. Survival following right colectomy for a Dukes’ stage C appendiceal carcinoma is markedly better than that for a similarly staged colon cancer at 5 years d. Mucinous cystadenocarcinoma of the appendix is adequately treated by simple appendectomy, even in patients with rupture and mucinous ascites e. Up to 50% of patients with appendiceal carcinoma have metastatic disease, with the liver as the most common site of spread 135. Un homme de 62 ans vous voyez en consultation pour une trouble du transite récente. Il se plaint d’avoir une constipation depuis environs 2 mois. Le symptôme s’est aggravé depuis environs 2 semaines. A l’interrogatoire vous notez des épisodes de rectorrhagie minime depuis environs 2 mois et une notion de perte de poids de 5 kg en 2 mois. Cliniquement, le ventre est souple, pas de masse palpable. Quel est le diagnostic le plus probable? A. Constipation chronique B. Trouble fonctionnelle intestinale C. Cancer colorectal D. Hémorroïde E. Hypothyroïdie 136. Un homme de 67 ans vous voyez en consultation pour une rectorrhagie. Il se plaint d’avoir des épisodes de rectorrhagie depuis environs 6 mois. Il n’y pas de douleur ou de trouble du transit. A l’interrogatoire vous notez des épisodes de rectorrhagie minime parfois émission de caillots de sang par l’anus. Cliniquement, le ventre est souple, pas de masse palpable. Les conjonctives sont pâles. Le pouls est de 96/mn. Quel l’examen demandez vous pour confirmer le diagnostique? A. Examen proctologique B. Recto-sigmoïdoscopie C. Echographie abdominale D. Scanner abdomino-pelvienne E. Coloscopie totale 137. Une coloscopie chez un patient de 55 ans retrouve une tumeur moyenne rectum biopsiée, l’anatomo-pathologie retrouve un adénocarcinome lieberkühnien. Quel est votre bilan d’extension ? A. TDM thoraco-abdomino-pelvienne B. PET TDM C. Radiographie pulmonaire D. IRM abdomino-pelvienne E. Echographie abdominale 138. Une femme de 58 ans admise au service d’hépatogastroentérologie pour suspicion cancer du colon. Elle se plaint d’avoir une constipation depuis environ 1 mois et le symptôme semble aggraver depuis environs 2 semaines. Elle a l’ATCD de lithiase de la vésicule biliaire et alcoolisme chronique. Après avoir bu 2 litres de Fortran pour la préparation colique, elle se plaint de douleur abdominale assez importante avec le ventre très ballonné. Quel diagnostic évoquez-vous ? A. Occlusion du intestinale B. Perforation colique C. Ischémie mésentérique D. Pancréatite aiguë E. Cholécystite aiguë 139. Au cours d'une occlusion par cancer sténosant du sigmoïde : A. Les vomissements sont précoces B. L’ 'arrêt des matières et des gaz est tardif C. L'angle colique gauche est distendu D. Le toucher rectal fait le diagnostic E. L’abdomen est mat �  la percussion 140. Parmi les données de l'examen histopathologique d'une pièce opératoire de cancer du colon ou du rectum qui ont une influence sur le pronostic, on peut citer : A. Le caractère circonférentiel de la lésion B. Le niveau d'invasion selon Astler et Coller C. Le caractère infiltrant de la lésion D. Le cancer développé sur polype E. L'atteinte ganglionnaire 141. Quelle est l'attitude thérapeutique �  proposer chez un homme de 50 ans, en bon état général chez lequel le bilan d'extension d'un cancer du rectum �  4 cm de la marge anale découvre une métastase hépatique unique superficielle du segment VI de 2 cm de diamètre ? A. Dérivation colique et chimiothérapie B. Irradiation pelvienne et chimiothérapie C. Radiothérapie de contact et chimiothérapie D. Amputation abdomino-périnéale et métastasectomie E. Amputation abdomino-périnéale et chimiothérapie intra-hépatique 142. Un cancer du rectum T3 N1 M0 en bilan pré-opératoire nécessite un traitement adjuvant par une seule méthode avant l'intervention. Laquelle? A. Curiethérapie B. Radiothérapie et chimiothérapie intensive C. Radiothérapie avec 5 FU potentialisant l'effet de la radiothérapie D. Chimiothérapie associant 5 FU, Cisplatyl, acide folinique E. Aucune de ces propositions n'est exacte 143. La surveillance du cancer du côlon après résection chirurgicale �  visée curative comporte pendant les 3 premières années : (quelle est la proposition exacte?) A. Un dosage du CA 19-9 tous les 3 mois B. Une tomodensitométrie abdomino-pelvienne tous les 3 �  6 mois C. Une immuno-scintigraphie par anticorps monoclonaux pour repérage de l'ACE tumoral D. Une coloscopie tous les 3 �  6 mois E. Une échographie tous les 3 �  6 mois 144. Un homme de 45 ans vient de subir une résection antérieure pour un adénocarcinome du rectum situé �  8 cm de la marge anale. L'examen anatomo-pathologique conclut �  un stade pT1 pNO MO (envahissement de la sous-muqueuse). Quelle attitude complémentaire faut-il programmer? A. Association chimiothérapie-radiothérapie B. Immunothérapie active non spécifique C. Irradiation pelvienne D. Surveillance clinique et endoscopique E. Aucune de ces attitudes 145. Vous voyez en consultation une femme de 60 ans une douleur HCD minime intermittente depuis environs 6 mois. La tempţérature est de 38oC mais il n’y a pas d’ictère. L’examen physique montre une douleur HCD minime �  la palpation. Elle n’a pas ATCD particulier. Echographie abdominal est demandée et montre une épaississement et irrégularité de la paroi vésiculaire. Quel est le diagnostic le plus probable ? A. Cholécystite aiguë lithiasique B. Cholécystite aiguë alithiasique C. Cholécystite chronique C. Cancer de la vésicule biliaire D. Abcès de la vésicule biliaire 146. Une femme de 45 ans consulte pour un ictère fébrile. La Température est �  39oC. La TA est �  100/60 mmHg, le pouls est �  110/mm. L’examen biologique montre : GB 20 Giga/L, CRP 200 mg/l, ASAT 60 UI/L, ALAT 120 UI/L, PAL 300 UI/L, GGT 122 UI/L, Bili T 100mg/L, Bili D 45mg/L. Quel examen de première intension demandez-vous pour confirmer le diagnostic ? A. ASP B. Échographie abdominale C. Scanner abdominal D. IRM E. CPRE 147. Une femme de 38 ans, obèse, admise au Urgence pour une douleur HCD, fièvre et ictère. Ses symptômes commencent depuis environs 3 jours. À l’interrogatoire, elle vous révèle que la douleur survienne brutalement et s’aggrave �  l’inspiration profonde. L’examen physique montre un signe de Murphy positive. Quel est le diagnostic le plus probable ? A. Cholécystite aiguë lithiasique B. Angiocholite lithiasique C. Pancréatite aiguë D. Abcès du foie E. Colique hépatique 148. Une femme de 45 ans sans antécédent particulier vient vous voir pour le bilan de santé. L’échographie abdominale montre un calcul de 10 mm dans la vésicule biliaire. Elle n’a ni fièvre ni douleur. L’examen physique est complètement normal. Quel traitement proposez-vous ? A. Cholecystectomie B. CPRE avec sphincterotomie C. Abstention thérapeutique D. Antibiothérapie E. Traitement médical 149. Une femme de 45 ans sans antécédent particulier vient vous voir pour le bilan de santé. Elle est complètement asymptomatique. L’examen physique est complètement normal. L’échographie abdominale montre une vésicule biliaire scléro-atrophique. Quel traitement proposez-vous ? A. Cholecystectomie B. Surveillance échographique C. Abstention thérapeutique D. Antibiothérapy E. CPRE avec sphincterotomie 150. Un home de 50 ans, obèse, vient vous voir en consultation spécialisé pour une vésicule de porcelaine ayant découverte fortuitement sur un bilan de santé. Il est complètement asymptomatique. Son médecin lui demande d’opérer, mais il a peur de l’opération. Il veut savoir votre avis. Quel est le risque s’il n’opère pas ? A. Cholécystite aiguë lithiasique B. Angiocholite lithiasique C. Pancréatite aiguë D. Abcès du foie E. Cancer de la vésicule biliaire 151. Un homme de 45 ans, se présence aux urgences pour douleurs abdominales survenues brutalement il y a quelques heures. Il s’agit de douleurs épigastriques intenses (EVA �  8) avec irradiation postérieure associées �  2 épisodes de vomissements alimentaire. Le diagnostique de pancréatite aiguë est confirmé. Le scanner de 48 heures est réalisé. Quelle est la proposition juste ? A. A = Foie, B = Pancréas, C = Intestin grêle B. A = Foie, B = vésicule biliaire, C = Pancréas C. A = Foie, B = Intestin grêle, C = Pancréas D. A = Rate, B = Intestin grêle, C = Pancréas E. A = Rate, B = Pancréas, C = Intestin grêle 152. Un homme de 40 ans, se présence aux urgences pour douleurs abdominales survenues brutalement il y a quelques heures. Il s’agit de douleurs épigastriques intenses (EVA �  7) avec irradiation postérieure associées �  2 épisodes de vomissements alimentaires. Elles sont soulagées par la position en chien de fusil. Il est alcoolisme chronique. Pas d’autres antécédents notables. Quel est le bilan biologique le plus approprié pour confirmer le diagnostique de pancréatite aiguë ? A. Lipasémie > 3N B. Amylasémie > 3N C. Lipasémie > 2N D. Amylasémie > 2N E. Triglycéridémie > 15g/dl 153. Une femme de 40 ans, obèse, se plaint de douleurs sus ombilicale �  prédominant HCD survenue brutalement depuis environs 4 heures. La douleur est intense (EVA �  8) avec irradiation postérieure. Dans ses ATCD on note : HAT (-), daibète (-), Alcool (-), Tabac (-), cholécystectomie pour une cholécystite aiguë il y a 2 mois. ECG réalisé en urgence est normale. Quel est le diagnostique le plus probable ? A. Infarctus du myocarde B. Angiocholite lithiasique C. Ulcère gastrique D. Pancréatite aiguë lithiasique E. Infarctus mésentérique 154. Un homme de 38 ans, alcoolisme chronique active, se présence aux urgences pour douleurs abdominales survenues brutalement il y a quelques heures. Il s’agit de douleurs épigastriques intenses (EVA �  8) avec irradiation postérieure associées �  2 épisodes de vomissements alimentaires. Elles sont soulagées par la position en chien de fusil. Il est alcoolisme chronique. Pas d’autres antécédents notables. Le diagnostique de pancréatite aiguë est confirmé. Quel est le bilan biologique le plus simple pour évaluer la gravité de ce patient ? A. CRP > 150 B. CRP > 50 C. Lipasémie > 7 N D. Lipasémie > 10 N E. Hématocrite < 40 % A. Symptoms@ B. Biopsy histology of the gastro-oesophageal junction C. Manometry D. 24 hour pH monitoring E. Bernstein test Answer : A 61)Which of the following statements about the anatomic course of the esophagus is correct? A. The cervical esophagus passes behind and to the right of the trachea. B. The thoracic esophagus enters the posterior mediastinum anterior to the aortic arch. C. The thoracic esophagus passes behind the right mainstem bronchus and the pericardium. D. The esophagus enters the diaphragmatic hiatus at the level of T8. E. The esophagus deviates anteriorly and to the left as it enters the abdomen. @ Answer: E 62). Which of the following statements about esophageal anatomy is correct? A. The esophagus has a poor blood supply, which is segmental in distribution and accounts for the high incidence of anastomotic leakage. B. The esophageal serosa consists of a thin layer of fibroareolar tissue. C. The esophagus has two distinct muscle layers, an outer, longitudinal one and an inner, circular one, which are striated in the upper third and smooth in the distal two thirds.@ D. Injury to the recurrent laryngeal nerve results in vocal cord dysfunction but does not affect swallowing. E. The lymphatic drainage of the esophagus is relatively sparse, localized primarily to adjacent paraesophageal lymph nodes. Answer: C 63). Which of the following statements about the lower esophageal sphincter (LES) mechanism, or high-pressure zone (HPZ), is true? A. The LES is a circular smooth muscle ring that is 3 to 5 cm. long. B. In assessing esophageal manometric data, mean HPZ pressure less than 6 mm. Hg or overall length less than 2 cm. Is more likely to be associated with incompetence of the LES and gastroesophageal reflux.@ C. Esophageal manometry and the acid perfusion (Bernstein) test reliably identify the patient with an incompetent LES mechanism. D. Distal HPZ relaxation occurs within 5 to 8 seconds of initiating a swallow. E. Twenty-four–hour distal esophageal pH monitoring is achieved with an intraesophageal pH electrode positioned at the esophagogastric junction. Answer: B 64. Which of the following statements about achalasia is/are correct? A. In most cases in North America the cause is a parasitic infestation by Trypanosoma cruzi. B. Chest pain and regurgitation are the usual symptoms. C. Distal-third esophageal adenocarcinomas may occur in as many as 20% of patients within 10 years of diagnosis. D. Manometry demonstrates failure of LES relaxation on swallowing and absent or weak simultaneous contractions in the esophageal body after swallowing.@ E. Endoscopic botulinum toxin injection of the LES, pneumatic dilatation, and esophagomyotomy provide highly effective curative therapy for achalasia. Answer: D 65. Which of the following statements about epiphrenic diverticula of the esophagus is/are correct? A. They are traction diverticula that arise close to the tracheobronchial tree. B. They characteristically arise proximal to an esophageal reflux stricture. C. The degree of dysphagia correlates with the size of the pouch. D. They are best approached surgically through a right thoracotomy. E. The operation of choice is a stapled diverticulectomy, long esophagomyotomy, and partial fundoplication.@ Answer: E 66. Which of the following statements about Schatzki's ring is correct? A. The ring represents a panmural fibrotic stricture resulting from gastroesophageal reflux. B. Dysphagia occurs when the ring diameter is 13 mm. Or less. @ C. The ring occurs within 1 to 2 cm. Of the squamocolumnar epithelial junction. D. Schatzki's ring indicates reflux esophagitis. E. Schatzki's ring signifies the need for an antireflux operation. Answer: B 67. Which of the following statements about pathology encountered at esophagoscopy is/are correct? A. Reflux esophagitis should be graded as mild, moderate, or severe, to promote consistency among different observers. B. An esophageal reflux stricture with a 2-mm. Lumen is not dilatable and is best treated with resection. C. A newly diagnosed radiographic distal esophageal stricture warrants dilation and antireflux medical therapy. D. In patients with Barrett's mucosa, the squamocolumnar epithelial junction occurs 3 cm. Or more proximal to the anatomic esophagogastric junction.@ E. After fasting at least 12 hours, a patient with megaesophagus of achalasia can safely undergo flexible fiberoptic esophagoscopy. Answer: D 68. Which of the following statements about the diagnosis and treatment of esophageal leiomyomas is/are correct? A. The majority are diagnosed after they cause dysphagia and chest pain. B. Biopsy is indicated at the time of esophagoscopy, to rule out carcinoma. C. Full-thickness elliptical excision of the esophageal wall is the preferred surgical approach. D. Endoscopic ultrasonography is a reliable means of following leiomyomas conservatively.@ E. Recurrence of resected leiomyomas is minimized by wide local excision. Answer: D 69. Which of the following statements regarding the pathology of esophageal carcinoma is/are correct? A. Worldwide, adenocarcinoma is the most common esophageal malignancy. B. Squamous cell carcinoma is most common in the distal esophagus, whereas adenocarcinoma predominates in the middle third. C. Patients with Barrett's metaplasia are 40 times more likely than the general population to develop adenocarcinoma. @ D. Metastases from esophageal carcinoma are characteristically localized to regional mediastinal lymph nodes adjacent to the tumor. E. Achalasia, radiation esophagitis, caustic esophageal stricture, Barrett's mucosa, and Plummer-Vinson syndrome are all premalignant esophageal lesions that predispose to the development of squamous cell carcinoma. Answer: C 70. Which of the following statements about the surgical treatment of esophageal carcinoma is/are correct? A. The finding of severe dysphagia in association with Barrett's mucosa is an indication for an antireflux operation to prevent subsequent development of carcinoma. B. Long-term survival is improved by radical en bloc resection of the esophagus with its contained tumor, adjacent mediastinal tissues, and regional lymph nodes. C. The morbidity and mortality rates for cervical esophagogastric anastomotic leak are substantially less than those associated with intrathoracic esophagogastric anastomotic leak@. D. The leading complications of transthoracic esophagectomy and intrathoracic esophagogastric anastomosis are bleeding and wound infection. E. Transhiatal esophagectomy without thoracotomy achieves better long-term survival than transthoracic esophagectomy. Answer: C 71. The best management for a 48-hour-old distal esophageal perforation is: A. Antibiotics and drainage. B. Division of the esophagus and exclusion of the perforation. C. Primary repair with buttressing.@ D. Resection with cervical esophagostomy, gastrostomy, and jejunostomy. E. T-tube fistula and drainage. Answer: C 72. A 50-year-old patient develops sudden left lower chest pain and epigastric pain after vomiting. The patient shows diaphoresis, breath sounds are decreased on the left, and there is abdominal guarding. The most appropriate diagnostic test is: A. Aortography. B. Esophagoscopy. C. Electrocardiogram. D. Film of the chest. @ E. White blood count. Answer: D 73.The following statements about the influence of diet and lifestyle on lower esophageal sphincter (LES) function are true except one. Identify the incorrect statement. A. A high-protein diet increases LES pressure. B. A fat meal results in sustained decrease in LES pressure. C. Chocolate ingestion causes a decrease in LES pressure. D. Peppermint produces a transient decrease in LES values. E. Cigarette smoking produces no significant changes in LES pressures. @ Answer: E 74. When a stricture is present in association with gastroesophageal reflux, each of the following is an acceptable repair for reflux control except one. Identify the poorest repair. A. Intrathoracic total fundoplication. B. Lengthening gastroplasty with total fundoplication. C. Total fundoplication. D. Lengthening gastroplasty with partial fundoplication. E. Partial fundoplication.@ Answer: E 75. When assessing gastroesophageal reflux disease by manometry each of the following statements is correct except one. Identify the incorrect one. A. Absent or extremely low LES pressures have predictive value in identifying more severe reflux. B. Peristaltic dysfunction increases with increasing severity of esophagitis. C. With established reflux disease the UES is hypertensive. @ D. Esophageal functional changes are worst in patients with a circumferential columnar-lined esophagus. E. Absence of peristalsis may be associated with more severe forms of reflux disease. Answer: C 76. The presence of a nonmalignant mid- or upper esophageal stricture always indicates the presence of: A. Alkaline reflux esophagitis. B. Barrett's esophagus.@ C. Idiopathic reflux disease. D. Mediastinal fibrosis. E. Scleroderma. Answer: B 77. Which of the following is most reliable for confirming the occurrence of a significant esophageal caustic injury? A. History of the event. B. Physical examination of the patient. C. Barium esophagraphy. D. Endoscopy.@ E. Manometry Answer: D 78. First-line therapy for routine peptic duodenal ulcer disease includes: A. Vagotomy and antrectomy. B. Upper endoscopy and biopsy to rule out tumor. C. Evaluation for Helicobacter pylori.@ D. Serum gastrin determination. E. Cream or milk-based “Sippy” diet. Answer: C 79. Appropriate management of severe vomiting associated with gastric outlet obstruction from peptic ulcer disease includes all of the following except: A. Nasogastric suction. B. Intravenous hydration. C. Nutritional assessment; upper endoscopy to rule out malignancy. D. Intravenous H 2 antagonist. E. Oral antacid therapy. @ Answer: E 80. Secretion of gastric juice is stimulated by a) enterogastrin b) gastrin@ c) cholecystokini d) non of enterogastrin, gastrin, cholecystokine e) prostaglandin 81. Bile acts as activator of which enzyme a) lipase@ b) pepsinogen c) pancreatic amylase d) trypsinogen e). Glucagon 82. HCI of the gastric juice a) activates both pepsin and ptyalin b) inactivates both pepsin and ptyalin c) activates pepsin and inactivates ptyalin@ d) activates ptyalin and inactivates pepsin e) activatea gastrin 83. Cholecystokinin stimulates a) pancreas b) gall bladder @ c) gastric gland d) none of pancreas, gall bladder, gastric gland e) Brunner’ s gland 84. Brunner’s glands are present in a)stomach b) ileum c) duodenum@ d) oesophagus e) colon 85. Crypts of Lieberkuhn are present in a)intestine@ b) stomach c) oesophagus d) intestine, stomach, oesophagus e) colon 86. Oxyntic cells secrete a) trypsin b) HCI@ c)NaoH d)pepsin e) Mucous 87. The hepatic cells which act as phagocytes are a)kuffer cells@ b)acinar cells c)Hansen’s cells d)Ito cell e) Fibroblaste 88. Which answers are true? In contrast to ulcerative colitis, Crohn's disease of the colon: A. Is not associated with increased risk of colon cancer. B. Seldom presents with daily hematochezia@ C. Is usually segmental rather than continuous@ D. Has a lower incidence of perianal fistulas. E. Never develops toxic megacolon. 89. Crohn's disease: A. Is caused by Mycobacterium paratuberculosis. B. Is more common in Jews than in Asians@ C. Tends to occur in families@ D. Is less frequent in temperate climates than in tropical ones. E. Is improved by smoking. 90. Recurrence after operation for Crohn's disease: A. Occurs after operations for ileal Crohn's but not colonic Crohn's. B. Is usually found just proximal to an enteric anastomosis. C. Frequently requires reoperation, that why surgery is reserved for the last option. D. Occurs in 1% of patients at risk per year during the first 10 years after the operation. E. Is prevented by maintenance therapy with corticosteroids. 91. Which statements about anorectal Crohn's disease are true? A. It may be the only overt manifestation of Crohn's disease@ B. It accompanies large intestine Crohn's more often than small intestine Crohn's@ C. It subsides when associated small intestinal Crohn's is excised. D. It should not be treated operatively. E. It may subside in response to metronidazole, 250 mg. q.i.d@ 92. The most common indication for operation in Crohn's disease of the colon is: A. Obstruction@ B. Chronic debility. C. Bleeding. D. Perforation @ E. Carcinoma@ Patient case: you have a friend who is going to China for 7 months. She leaves in 2 weeks. She has never received either hepatitis A or B vaccines. 93. Which is the best choice today for her immunoprophylaxis of hepatitis A A) A dose of hepatitis A vaccine B) A dose of IM immunoglobulin and a dose of hepatitis A vaccine@ C) A dose of IM immunoglobulin anti-HBV D) First dose of hepatitis A vaccine today and a booster dose the day before she leaves E) A dose of immunoglobulin polyvalence.@ Patient case: you have a friend who is going to China for 7 months. 94)What are the most important patient education informations to give your friend about avoiding hepatitis A exposure or infection? A) Tell her to avoid sharing needles or using nonsterile needles. B) Remind her about using insect repellant and mosquito netting at night. C) Encourage her to take safe sex precautions. D) Explain good hand washing and food and water precautions.@ E) Advise her to be vaccinated against hepatitis A 6 months before departure@ 95) An indicator of good response to peg-interferon and Ribavirin for a patient with chronic hepatitis C infection is : A) low pretreatment HCV RNA. @ B) genotype 1 C) high pretreatment aminotransferases. D) hepatic fibrosis. @ E) genotype 2.@ 96) In Cambodia, the hepatitis B vaccine series should be administered to all A) international travelers .@ B) pregnant women. C) healthy infants. @ D) patients with acute hepatitis B infection. E) New born baby to chronic hepatitis B carrier mother@ Patient case: ST, a 35-year-old man, was diagnosed with chronic hepatitis B infection 5 years ago. His primary risk factor is intravenous drug use. His liver disease is progressing, as measured by persistently elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. ST had a liver biopsy 6 months ago that showed chronic active hepatitis. He has never been treated for his chronic hepatitis. 97). Which of the following are important goal of treating chronic viral hepatitis B infection? A) Normalie ALT and AST. B) Improve symptoms. C) Lose HBsAg from serum. @ D) Decrease symptoms. E) Viral suppression.@ Patient case: TS, a 45-year-old man, Cambodian was diagnosed with chronic hepatitis B infection 5 years ago. His primary risk factor is intravenous drug use. His liver disease is progressing, as measured by persistently elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. ST had a liver biopsy 6 months ago that showed chronic active hepatitis. His serological profile : HBe Ag +, Ac HBe-, PCR-VHB = 190,000,000IU/ml. He has never been treated for his chronic hepatitis. 98). Of the following, which is the possible treatment do you recommend for chronic hepatitis B for TS ? A) Interferon-a + lamivudine B) Entecavir @ C) No drug treatment, he is unlikely to respond to drug therapy. D) No drug treatment the risks of adverse effects from the available treatments are too great in TS. E) Tenofovir@ Patient case: SP, a 40-year-old man, was diagnosed with chronic hepatitis B infection 2 years ago, his mother was known as chronic hepatits B patient and died last month of Hepato Cellular Carcinoma (HCC) . His liver disease is not progressing, as measured by persistently non elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, His Fibroscan 3 days ago showed elasticity of 14 KPa. He has never been treated for his chronic hepatitis. 99)Which of the following criteria should you based on for commencing the treatment of his hepatitis B ? A) Age 40@ B) Family history of HCC@ C) Degree of fibrosis D) Pre-C mutant E) Normal transaminases Questions 7 and 8 refer to the following case: TAS, a 40-year-old man, was diagnosed with chronic hepatitis C infection 5 years ago (viral genotype 2). His primary risk factor is intravenous drug use. He has been diagnosed with chronic active hepatitis. 100) Which of the following is the most important goal of treating chronic viral hepatitis C infection A) Normalie ALT and AST. B) Improve symptoms. C) Reverse cirrhosis. D) Eliminate the HCV RNA from serum.@ E) Seroconversion Ac HCV Answer D 101) What specific treatment do you recommend for chronic hepatitis C infection for TAS A) Interferon- ribavirin B) Lamivudine C) Sofosbuvir and Ribavirin. @ D) Sofosbuvir and Ledispavir. E) Peg-interferon and Ribavirin Answer : C 102) Which of the following viral causes of hepatitis is the most common cause of chronic hepatitis in Cambodia ? A) Hepatitis D B) Hepatitis C @ C) Hepatitis B D) Hepatitis A E) Hepatitis E Answer : B,C 103) A nurse sustains a needle stick from a patient who is known to be HBsAg-positive. She has been vaccinated previously with hepatitis B vaccine and is a known nonresponder. What post-exposure prophylaxis should the nurse receive? A) One dose of HBIG and one dose of hepatitis B vaccine @ B) Give the nurse Tenofovir for 30 days C) One dose of hepatitis B vaccine D) Test the nurse for anti-HBs level and treat accordingly E) Give the nurse double dose of vaccine Answer :A 104) Which of the following viral causes of hepatitis is transmitted by contaminated food or water A) Hepatitis D B) Hepatitis E @ C) Hepatitis C D) Hepatitis B E) Hepatits A@ Answer : B, E 105) Hepatitis D is commonly associated with what other type of viral hepatitis A) Hepatitis E B) Hepatitis C C) Hepatitis B @ D) Hepatitis G E) Hepatitis B and C Answer : C 106) Which of the following causes of viral hepatitis are common in Asia A) Hepatitis A @ B) Hepatitis B @ C) Hepatitis C @ D) Hepatitis E E) Hepatitis D Answer : A,B,C 107) When a patient is HBsAg-negative, and anti-HBs-positive, what is the status of his or her hepatitis B infection ? A) Resolved @ B) Chronic carrier C) Early acute D) Chronic hepatitis E) Vaccinated@ Answer : A, E 108). Which of these things can cause hepatitis? A. Viruses @ B. Medicines and alcohol @ C. Immune system that's not working as it should @ D. Fatty Liver@ E. Iron overload@ Answer : A,B,C,D,E 109) The disease exists in short-term (acute) and long-term (chronic) forms. How long does acute hepatitis last? A. Less than 6 months @ B. Less than 3 months C. About 6 weeks D. 1 month E. 1 year Answer : A 110). What are the symptoms of hepatitis? A. Tiredness (fatigue)@ B. Low fever @ C. Nausea @ D. Muscle pain@ E. Icterus@ Answer : A,B,C,D,E 111). Which form of hepatitis can be passed on through contaminated food or water? A. B B. C C. A and E @ D. B and C E. D Answer: C 112). Which form can exist for years without symptoms? A. D @ B. B and C C. A D. E E. B an D@ Answer : A,E 113). Vaccines have been developed to protect against which hepatitis viruses? A. Hepatitis A virus B. hepatitis B virus C. Hepatitis D virus D. Hepatitis A and hepatitis B virus @ E. Hepatitis C virus Answer: D 114. A 28-year-old woman with a history of an appendectomy presents with a non-tender palpable mass in the right lower quadrant abdominal incision. The following statement(s) is/are true concerning the diagnosis and management of this patient. a. The best diagnostic test involves imaging of the abdominal wall by either CT or MRI@ b. Resection of the mass with a 2 cm margin is usually adequate c. Low dose radiation is a suitable alternative to surgery for primary treatment d. Re-resection for recurrence will likely have a higher rate of recurrence than for primary resection e. Therapeutic endoscopic should be an option for the treatment of the mass. 115. The following statement(s) is/are true concerning umbilical hernias in adults. a. Most umbilical hernias in adults are the result of a congenital defect carried into adulthood b. A paraumbilical hernia typically occurs in multiparous females @ c. The presence of ascites is a contraindication to elective umbilical hernia repair. d. Incarceration is uncommon with umbilical hernias e. Umbilical hernia can see in decompensated cirrhosis@ 116. The following statement(s) is/are true concerning the anterior abdominal wall musculature. a. The lateral musculature of the abdominal wall consists of three muscle layers. These are, from external to internal, the external oblique, the transversus abdominis, and the internal oblique muscles b. The transversalis fascia lies on the deep side of the transversus muscle and extends to form an essentially complete fascial envelope of the abdominal cavity@ c. Above the semicircular line, the internal oblique aponeurosis splits into posterior and anterior laminae @ d. The rectus abdominis muscles originate on the ribs superiorly and on the pubis inferiorly and are clearly distinct throughout their entire length e. Peritoneum is part of the anterior abdominal wall musculature 117. Which of the following statements concerning intraperitoneal fluid collections are correct? A. Ascites occurs when either the peritoneal fluid secretion rate increases or the absorption rate decreases. @ B. Accumulation of lymph within the peritoneal cavity usually results from trauma as tumor involving the intra-abdominal lymphatic structures. @ C. Choleperitoneum (intraperitoneal bile) generally occurs following biliary surgery, but spontaneous perforation of the bile duct has been reported. @ D. The most common cause of hemoperitoneum is trauma to the liver or spleen.@ E. Hepatocellular carcinoma can cause hemoperitoneum@ 118. The following statement about peritonitis are all true except: A. Peritonitis is defined as inflammation of the peritoneum. B. Most surgical peritonitis is secondary to bacterial contamination. C. Primary peritonitis has no documented source of contamination and is more common in adults than in children and in men than in women.@ D. Tuberculous peritonitis can present with or without ascites. E. Cirrhotic ascites can complicate to peritonitis Answer: C 119. Acute appendicitis is most commonly associated with which of the following signs? A. Temperature above 104؛ F. B. Frequent loose stools. C. Anorexia, abdominal pain, and right lower quadrant tenderness.@ D. White blood cell count greater than 20,000 per cu. mm. E. Anuria, hypothermy, constipation 120. Which of the following most often initiates the development of acute appendicitis? A. A viral infection. B. Acute gastroenteritis. C. Obstruction of the appendiceal lumen. @ D. A primary clostridial infection. E. Therapeutic colonoscopy Answer: C 121. The diagnosis of acute appendicitis is most difficult to establish in: A. Persons aged 60 and older.@ B. Women aged 18 to 35. C. Infants younger than 1 year.@ D. Pregnant women. E. Situs inversus patient@ 122. Once a diagnosis of acute appendicitis has been made and appendectomy decided upon, which of the following is/are true? A. Prophylactic antibiotics should be administered. @ B. Prophylactic antibiotics are not necessary unless there is evidence of perforation. C. If the appendix is not ruptured and not gangrenous, antibiotics may be discontinued after 24 hours. @ D. Multiple antibiotics are in all cases preferable to a single agent. E. Large bowel cleaning is necessary prior to surgery 123. The best type of x-ray to locate free abdominal air is: A. A posteroanterior view of the chest. B. A flat and upright view of the abdomen. C. Computed tomograph (CT) of the abdomen. D. A lateral decubitus x-r E. plain X-Ray on the bed of the patient 124. The most helpful diagnostic radiographic procedure in small bowel obstruction is: A. CT of the abdomen. B. Contrast study of the intestine. C. Supine and erect x-rays of the abdomen. @ D. Ultrasonography of the abdomen. E. MRI of abdomen. 125. The most commonly used imaging method for diagnosis of acute cholecystitis is: A. CT of the abdomen. B. Ultrasonography of the gallbladder. @ C. Oral cholecystogram. D. Radionuclide (HIDA) scan of the gallbladder. E. Endoscopic ultrasound 126. Meckel's diverticulitis most often occurs in the: A. Proximal jejunum. B. Distal jejunum. C. Proximal ileum. D. Distal ileum.@ E. Proximal colon 127. Of adult patients presenting to the emergency room for evaluation of acute abdominal pain, which one of the following answers includes the most common diagnoses? a. Urologic problems, cholelithiasis, pelvic inflammatory disease b. Mittelschmerz, appendicitis, ureterolithiasis c. Nonspecific abdominal pain, appendicitis, intestinal obstruction@ d. Appendicitis, pelvic inflammatory disease, perforated ulcer E. Ectopic pregnancy complication 128. Nonsurgical causes of acute abdominal pain may include which of the following? a. Hyperthyrodism b. Adrenal insufficiency@ c. Pneumonia @ d. Diabetic ketoacidosis @ E. Acute pancreatitis@ 129. Which of the following cause visceral pain from the abdominal organs? a. Stretching and contraction b. Traction, compression, torsion c. Cutting d. Certain chemicals e. Distension@ 130. Factors which may influence the clinical presentation of intraabdominal pathology include which of the following? a. Pregnancy @ b. Oral anticoagulants@ c. Age @ d. HIV infection @ e.Obesity 131. Visceral pain is typically: a. Well localized b. Sharp c. Mediated via spinal nerves d. Perceived to be in the midline @ e. Burning 132. True statements regarding the pathophysiology of acute appendicitis include which of the following: a. Fecaliths are responsible for the disease process in approximately 30% of adult patients @ b. Lymphoid hyperplasia is a frequent cause of appendicitis in young patients @ c. Clostridium difficile is implicated as a pathogenic organism d. Carcinoid tumors account for approximately 5% of all cases of acute appendicitis e. Colonoscopy can sometimes cause acute appendicitis. 133. A 26-year old woman in her first trimester of pregnancy presents with a 2-day history of right lower quadrant pain and fever. Physical examination reveals a tender, palpable, right lower quadrant mass. There is no evidence of peritonitis or systemic sepsis. Laboratory evaluation is remarkable for mild leukocytosis, and abdominal ultrasound demonstrates an inflammatory mass but no evidence of abscess. As the surgeon on call, your recommendation would be: a. . Intravenous hydration, antibiotic prophylasis, and urgent appendectomy @ b. Intravenous hydration, antibiotics, bowel rest, and interval appendectomy in 4 to 6 weeks c. Intravenous hydration, antibiotics, and appendectomy if no improvement in 12 to 24 hours d. Intravenous hydration, antibiotics, and interval appendectomy when fever has subsided, leukocyte count has returned to normal, and the patient is pain free e. Emergent obstetrical consultation for evaluation and treatment of possible ectopic pregnancy 134. True statements regarding appendiceal neoplasms include which of the following? a. Carcinoid tumors of the appendix less than 1.5 cm are adequately treated by simple appendectomy@ b. Appendiceal carcinoma is associated with secondary tumors of the GI tract in up to 60% of patients c. Survival following right colectomy for a Dukes’ stage C appendiceal carcinoma is markedly better than that for a similarly staged colon cancer at 5 years d. Mucinous cystadenocarcinoma of the appendix is adequately treated by simple appendectomy, even in patients with rupture and mucinous ascites e. Up to 50% of patients with appendiceal carcinoma have metastatic disease, with the liver as the most common site of spread 135. Un homme de 62 ans vous voyez en consultation pour une trouble du transite récente. Il se plaint d’avoir une constipation depuis environs 2 mois. Le symptôme s’est aggravé depuis environs 2 semaines. A l’interrogatoire vous notez des épisodes de rectorrhagie minime depuis environs 2 mois et une notion de perte de poids de 5 kg en 2 mois. Cliniquement, le ventre est souple, pas de masse palpable. Quel est le diagnostic le plus probable? A. Constipation chronique B. Trouble fonctionnelle intestinale C. Cancer colorectal D. Hémorroïde E. Hypothyroïdie 136. Un homme de 67 ans vous voyez en consultation pour une rectorrhagie. Il se plaint d’avoir des épisodes de rectorrhagie depuis environs 6 mois. Il n’y pas de douleur ou de trouble du transit. A l’interrogatoire vous notez des épisodes de rectorrhagie minime parfois émission de caillots de sang par l’anus. Cliniquement, le ventre est souple, pas de masse palpable. Les conjonctives sont pâles. Le pouls est de 96/mn. Quel l’examen demandez vous pour confirmer le diagnostique? A. Examen proctologique B. Recto-sigmoïdoscopie C. Echographie abdominale D. Scanner abdomino-pelvienne E. Coloscopie totale 137. Une coloscopie chez un patient de 55 ans retrouve une tumeur moyenne rectum biopsiée, l’anatomo-pathologie retrouve un adénocarcinome lieberkühnien. Quel est votre bilan d’extension ? A. TDM thoraco-abdomino-pelvienne B. PET TDM C. Radiographie pulmonaire D. IRM abdomino-pelvienne E. Echographie abdominale 138. Une femme de 58 ans admise au service d’hépatogastroentérologie pour suspicion cancer du colon. Elle se plaint d’avoir une constipation depuis environ 1 mois et le symptôme semble aggraver depuis environs 2 semaines. Elle a l’ATCD de lithiase de la vésicule biliaire et alcoolisme chronique. Après avoir bu 2 litres de Fortran pour la préparation colique, elle se plaint de douleur abdominale assez importante avec le ventre très ballonné. Quel diagnostic évoquez-vous ? A. Occlusion du intestinale B. Perforation colique C. Ischémie mésentérique D. Pancréatite aiguë E. Cholécystite aiguë 139. Au cours d'une occlusion par cancer sténosant du sigmoïde : A. Les vomissements sont précoces B. L’ 'arrêt des matières et des gaz est tardif C. L'angle colique gauche est distendu D. Le toucher rectal fait le diagnostic E. L’abdomen est mat �  la percussion 140. Parmi les données de l'examen histopathologique d'une pièce opératoire de cancer du colon ou du rectum qui ont une influence sur le pronostic, on peut citer : A. Le caractère circonférentiel de la lésion B. Le niveau d'invasion selon Astler et Coller C. Le caractère infiltrant de la lésion D. Le cancer développé sur polype E. L'atteinte ganglionnaire 141. Quelle est l'attitude thérapeutique �  proposer chez un homme de 50 ans, en bon état général chez lequel le bilan d'extension d'un cancer du rectum �  4 cm de la marge anale découvre une métastase hépatique unique superficielle du segment VI de 2 cm de diamètre ? A. Dérivation colique et chimiothérapie B. Irradiation pelvienne et chimiothérapie C. Radiothérapie de contact et chimiothérapie D. Amputation abdomino-périnéale et métastasectomie E. Amputation abdomino-périnéale et chimiothérapie intra-hépatique 142. Un cancer du rectum T3 N1 M0 en bilan pré-opératoire nécessite un traitement adjuvant par une seule méthode avant l'intervention. Laquelle? A. Curiethérapie B. Radiothérapie et chimiothérapie intensive C. Radiothérapie avec 5 FU potentialisant l'effet de la radiothérapie D. Chimiothérapie associant 5 FU, Cisplatyl, acide folinique E. Aucune de ces propositions n'est exacte 143. La surveillance du cancer du côlon après résection chirurgicale �  visée curative comporte pendant les 3 premières années : (quelle est la proposition exacte?) A. Un dosage du CA 19-9 tous les 3 mois B. Une tomodensitométrie abdomino-pelvienne tous les 3 �  6 mois C. Une immuno-scintigraphie par anticorps monoclonaux pour repérage de l'ACE tumoral D. Une coloscopie tous les 3 �  6 mois E. Une échographie tous les 3 �  6 mois 144. Un homme de 45 ans vient de subir une résection antérieure pour un adénocarcinome du rectum situé �  8 cm de la marge anale. L'examen anatomo-pathologique conclut �  un stade pT1 pNO MO (envahissement de la sous-muqueuse). Quelle attitude complémentaire faut-il programmer? A. Association chimiothérapie-radiothérapie B. Immunothérapie active non spécifique C. Irradiation pelvienne D. Surveillance clinique et endoscopique E. Aucune de ces attitudes 145. Vous voyez en consultation une femme de 60 ans une douleur HCD minime intermittente depuis environs 6 mois. La tempţérature est de 38oC mais il n’y a pas d’ictère. L’examen physique montre une douleur HCD minime �  la palpation. Elle n’a pas ATCD particulier. Echographie abdominal est demandée et montre une épaississement et irrégularité de la paroi vésiculaire. Quel est le diagnostic le plus probable ? A. Cholécystite aiguë lithiasique B. Cholécystite aiguë alithiasique C. Cholécystite chronique C. Cancer de la vésicule biliaire D. Abcès de la vésicule biliaire 146. Une femme de 45 ans consulte pour un ictère fébrile. La Température est �  39oC. La TA est �  100/60 mmHg, le pouls est �  110/mm. L’examen biologique montre : GB 20 Giga/L, CRP 200 mg/l, ASAT 60 UI/L, ALAT 120 UI/L, PAL 300 UI/L, GGT 122 UI/L, Bili T 100mg/L, Bili D 45mg/L. Quel examen de première intension demandez-vous pour confirmer le diagnostic ? A. ASP B. Échographie abdominale C. Scanner abdominal D. IRM E. CPRE 147. Une femme de 38 ans, obèse, admise au Urgence pour une douleur HCD, fièvre et ictère. Ses symptômes commencent depuis environs 3 jours. À l’interrogatoire, elle vous révèle que la douleur survienne brutalement et s’aggrave �  l’inspiration profonde. L’examen physique montre un signe de Murphy positive. Quel est le diagnostic le plus probable ? A. Cholécystite aiguë lithiasique B. Angiocholite lithiasique C. Pancréatite aiguë D. Abcès du foie E. Colique hépatique 148. Une femme de 45 ans sans antécédent particulier vient vous voir pour le bilan de santé. L’échographie abdominale montre un calcul de 10 mm dans la vésicule biliaire. Elle n’a ni fièvre ni douleur. L’examen physique est complètement normal. Quel traitement proposez-vous ? A. Cholecystectomie B. CPRE avec sphincterotomie C. Abstention thérapeutique D. Antibiothérapie E. Traitement médical 149. Une femme de 45 ans sans antécédent particulier vient vous voir pour le bilan de santé. Elle est complètement asymptomatique. L’examen physique est complètement normal. L’échographie abdominale montre une vésicule biliaire scléro-atrophique. Quel traitement proposez-vous ? A. Cholecystectomie B. Surveillance échographique C. Abstention thérapeutique D. Antibiothérapy E. CPRE avec sphincterotomie 150. Un home de 50 ans, obèse, vient vous voir en consultation spécialisé pour une vésicule de porcelaine ayant découverte fortuitement sur un bilan de santé. Il est complètement asymptomatique. Son médecin lui demande d’opérer, mais il a peur de l’opération. Il veut savoir votre avis. Quel est le risque s’il n’opère pas ? A. Cholécystite aiguë lithiasique B. Angiocholite lithiasique C. Pancréatite aiguë D. Abcès du foie E. Cancer de la vésicule biliaire 151. Un homme de 45 ans, se présence aux urgences pour douleurs abdominales survenues brutalement il y a quelques heures. Il s’agit de douleurs épigastriques intenses (EVA �  8) avec irradiation postérieure associées �  2 épisodes de vomissements alimentaire. Le diagnostique de pancréatite aiguë est confirmé. Le scanner de 48 heures est réalisé. Quelle est la proposition juste ? A. A = Foie, B = Pancréas, C = Intestin grêle B. A = Foie, B = vésicule biliaire, C = Pancréas C. A = Foie, B = Intestin grêle, C = Pancréas D. A = Rate, B = Intestin grêle, C = Pancréas E. A = Rate, B = Pancréas, C = Intestin grêle 152. Un homme de 40 ans, se présence aux urgences pour douleurs abdominales survenues brutalement il y a quelques heures. Il s’agit de douleurs épigastriques intenses (EVA �  7) avec irradiation postérieure associées �  2 épisodes de vomissements alimentaires. Elles sont soulagées par la position en chien de fusil. Il est alcoolisme chronique. Pas d’autres antécédents notables. Quel est le bilan biologique le plus approprié pour confirmer le diagnostique de pancréatite aiguë ? A. Lipasémie > 3N B. Amylasémie > 3N C. Lipasémie > 2N D. Amylasémie > 2N E. Triglycéridémie > 15g/dl 153. Une femme de 40 ans, obèse, se plaint de douleurs sus ombilicale �  prédominant HCD survenue brutalement depuis environs 4 heures. La douleur est intense (EVA �  8) avec irradiation postérieure. Dans ses ATCD on note : HAT (-), daibète (-), Alcool (-), Tabac (-), cholécystectomie pour une cholécystite aiguë il y a 2 mois. ECG réalisé en urgence est normale. Quel est le diagnostique le plus probable ? A. Infarctus du myocarde B. Angiocholite lithiasique C. Ulcère gastrique D. Pancréatite aiguë lithiasique E. Infarctus mésentérique 154. Un homme de 38 ans, alcoolisme chronique active, se présence aux urgences pour douleurs abdominales survenues brutalement il y a quelques heures. Il s’agit de douleurs épigastriques intenses (EVA �  8) avec irradiation postérieure associées �  2 épisodes de vomissements alimentaires. Elles sont soulagées par la position en chien de fusil. Il est alcoolisme chronique. Pas d’autres antécédents notables. Le diagnostique de pancréatite aiguë est confirmé. Quel est le bilan biologique le plus simple pour évaluer la gravité de ce patient ? A. CRP > 150 B. CRP > 50 C. Lipasémie > 7 N D. Lipasémie > 10 N E. Hématocrite < 40 % The most helpful diagnostic radiographic procedure in small bowel obstruction is:

The most commonly used imaging method for diagnosis of acute cholecystitis is

Meckel's diverticulitis most often occurs in the:

Of adult patients presenting to the emergency room for evaluation of acute abdominal pain, which one of the following answers includes the most common diagnoses?

Nonsurgical causes of acute abdominal pain may include which of the following?

Which of the following cause visceral pain from the abdominal organs?

Factors which may influence the clinical presentation of intraabdominal pathology include which of the following?

Visceral pain is typically:

True statements regarding the pathophysiology of acute appendicitis include which of the following

A 26-year old woman in her first trimester of pregnancy presents with a 2-day history of right lower quadrant pain and fever. Physical examination reveals a tender, palpable, right lower quadrant mass. There is no evidence of peritonitis or systemic sepsis. Laboratory evaluation is remarkable for mild leukocytosis, and abdominal ultrasound demonstrates an inflammatory mass but no evidence of abscess. As the surgeon on call, your recommendation would be:

True statements regarding appendiceal neoplasms include which of the following?

Un homme de 62 ans vous voyez en consultation pour une trouble du transite récente. Il se plaint d’avoir une constipation depuis environs 2 mois. Le symptôme s’est aggravé depuis environs 2 semaines. A l’interrogatoire vous notez des épisodes de rectorrhagie minime depuis environs 2 mois et une notion de perte de poids de 5 kg en 2 mois. Cliniquement, le ventre est souple, pas de masse palpable. Quel est le diagnostic le plus probable?

Un homme de 67 ans vous voyez en consultation pour une rectorrhagie. Il se plaint d’avoir des épisodes de rectorrhagie depuis environs 6 mois. Il n’y pas de douleur ou de trouble du transit. A l’interrogatoire vous notez des épisodes de rectorrhagie minime parfois émission de caillots de sang par l’anus. Cliniquement, le ventre est souple, pas de masse palpable. Les conjonctives sont pâles. Le pouls est de 96/mn. Quel l’examen demandez vous pour confirmer le diagnostique?

Une coloscopie chez un patient de 55 ans retrouve une tumeur moyenne rectum biopsiée, l’anatomo-pathologie retrouve un adénocarcinome lieberkühnien. Quel est votre bilan d’extension ?

Une femme de 58 ans admise au service d’hépatogastroentérologie pour suspicion cancer du colon. Elle se plaint d’avoir une constipation depuis environ 1 mois et le symptôme semble aggraver depuis environs 2 semaines. Elle a l’ATCD de lithiase de la vésicule biliaire et alcoolisme chronique. Après avoir bu 2 litres de Fortran pour la préparation colique, elle se plaint de douleur abdominale assez importante avec le ventre très ballonné. Quel diagnostic évoquez-vous ?

Au cours d'une occlusion par cancer sténosant du sigmoïde

Parmi les données de l'examen histopathologique d'une pièce opératoire de cancer du colon ou du rectum qui ont une influence sur le pronostic, on peut citer :

Quelle est l'attitude thérapeutique à proposer chez un homme de 50 ans, en bon état général chez lequel le bilan d'extension d'un cancer du rectum à 4 cm de la marge anale découvre une métastase hépatique unique superficielle du segment VI de 2 cm de diamètre ?

Un cancer du rectum T3 N1 M0 en bilan pré-opératoire nécessite un traitement adjuvant par une seule méthode avant l'intervention. Laquelle?

La surveillance du cancer du côlon après résection chirurgicale à visée curative comporte pendant les 3 premières années : (quelle est la proposition exacte?)

Un homme de 45 ans vient de subir une résection antérieure pour un adénocarcinome du rectum situé à 8 cm de la marge anale. L'examen anatomo-pathologique conclut à un stade pT1 pNO MO (envahissement de la sous-muqueuse). Quelle attitude complémentaire faut-il programmer?

Vous voyez en consultation une femme de 60 ans une douleur HCD minime intermittente depuis environs 6 mois. La tempţérature est de 38oC mais il n’y a pas d’ictère. L’examen physique montre une douleur HCD minime à la palpation. Elle n’a pas ATCD particulier. Echographie abdominal est demandée et montre une épaississement et irrégularité de la paroi vésiculaire. Quel est le diagnostic le plus probable ?

Une femme de 45 ans consulte pour un ictère fébrile. La Température est à 39oC. La TA est à 100/60 mmHg, le pouls est à 110/mm. L’examen biologique montre : GB 20 Giga/L, CRP 200 mg/l, ASAT 60 UI/L, ALAT 120 UI/L, PAL 300 UI/L, GGT 122 UI/L, Bili T 100mg/L, Bili D 45mg/L. Quel examen de première intension demandez-vous pour confirmer le diagnostic ?

Une femme de 38 ans, obèse, admise au Urgence pour une douleur HCD, fièvre et ictère. Ses symptômes commencent depuis environs 3 jours. À l’interrogatoire, elle vous révèle que la douleur survienne brutalement et s’aggrave à l’inspiration profonde. L’examen physique montre un signe de Murphy positive. Quel est le diagnostic le plus probable ?

Une femme de 45 ans sans antécédent particulier vient vous voir pour le bilan de santé. L’échographie abdominale montre un calcul de 10 mm dans la vésicule biliaire. Elle n’a ni fièvre ni douleur. L’examen physique est complètement normal. Quel traitement proposez-vous ?

Une femme de 45 ans sans antécédent particulier vient vous voir pour le bilan de santé. Elle est complètement asymptomatique. L’examen physique est complètement normal. L’échographie abdominale montre une vésicule biliaire scléro-atrophique. Quel traitement proposez-vous ?

Un home de 50 ans, obèse, vient vous voir en consultation spécialisé pour une vésicule de porcelaine ayant découverte fortuitement sur un bilan de santé. Il est complètement asymptomatique. Son médecin lui demande d’opérer, mais il a peur de l’opération. Il veut savoir votre avis. Quel est le risque s’il n’opère pas ?

Un homme de 45 ans, se présence aux urgences pour douleurs abdominales survenues brutalement il y a quelques heures. Il s’agit de douleurs épigastriques intenses (EVA à 8) avec irradiation postérieure associées à 2 épisodes de vomissements alimentaire. Le diagnostique de pancréatite aiguë est confirmé. Le scanner de 48 heures est réalisé. Quelle est la proposition juste ?

Un homme de 40 ans, se présence aux urgences pour douleurs abdominales survenues brutalement il y a quelques heures. Il s’agit de douleurs épigastriques intenses (EVA à 7) avec irradiation postérieure associées à 2 épisodes de vomissements alimentaires. Elles sont soulagées par la position en chien de fusil. Il est alcoolisme chronique. Pas d’autres antécédents notables. Quel est le bilan biologique le plus approprié pour confirmer le diagnostique de pancréatite aiguë ?

Une femme de 40 ans, obèse, se plaint de douleurs sus ombilicale à prédominant HCD survenue brutalement depuis environs 4 heures. La douleur est intense (EVA à 8) avec irradiation postérieure. Dans ses ATCD on note : HAT (-), daibète (-), Alcool (-), Tabac (-), cholécystectomie pour une cholécystite aiguë il y a 2 mois. ECG réalisé en urgence est normale. Quel est le diagnostique le plus probable ?

. Un homme de 38 ans, alcoolisme chronique active, se présence aux urgences pour douleurs abdominales survenues brutalement il y a quelques heures. Il s’agit de douleurs épigastriques intenses (EVA à 8) avec irradiation postérieure associées à 2 épisodes de vomissements alimentaires. Elles sont soulagées par la position en chien de fusil. Il est alcoolisme chronique. Pas d’autres antécédents notables. Le diagnostique de pancréatite aiguë est confirmé. Quel est le bilan biologique le plus simple pour évaluer la gravité de ce patient ?