16 Odt

MANAGEMENT OF PATIENTS WITH PORTAL HYPERTENSION
1. A 71-year-old man presents with fevers, chills, weight loss, and malaise. His examination demonstrates splinter
hemorrhages in his nail beds and conjunctival petechiae. A lll/VI HSM is heard at the cardiac apex. Echocardiography
demonstrates a vegetation on his mitral valve and moderate MR. Blood cultures are obtained and grow Streptococcus
bovis. He is placed on appropriate antibiotics and remains hemodynamically stable. Further evaluation at this stage
should include:
a) Thoracic CT scan
b) Colonoscopy
c) Cardiac catheterization
d)СТ scan of the head
2. A 40-year-old white female complains on pruritus. She has an elevated alkaline phosphatase and positive
antimitochondrial antibody test. What is the most prabable disease does this woman has?
a) Sclerosing cholangitis.
b)Hepatitis C.
c)Hepatoma.
d)Primary biliary cirrhosis
3. A 41-year-old morbidly obese female came to the emergency department with colicky abdominal pain in her right
upper part of abdomen. She says that recently pain became more severe than it has been. Also pain often occurs after
meals for the last 4 months. Her previous medical history is positive for diabetes mellitus type 2, hypertension,
hyperlipidemia and smoking. On physical examination her temperature is 38.1°C and her scleras are mildly icteric.
What imaging modality may be limited in this patient?
a) Ultrasonography
b)CT scan.
c)MRCP
d)Esophogastroduodenoscopy (EGD)
4. A 45-year-old female with long-standing alcohol abuse complains on abdominal swelling which has been
progressive for last several months. On physical examination there are spider angiomas and palmar erythema.
Abdominal collateral vessels are seen around the umbilicus. A paracentesis is performed. The serum albumin is
decreased and ascitic fluid albumin is 1.4 g/dL. The most probable diagnosis is:
a) Ascitis
b) Tuberculous peritonitis
c)Portal hypertension.
d) Pancreatitis.
5.A 47-year-old agricultural worker complains on a chronic cough, purulent sputum and abdominal distention. He has
just arrived in England from Spain where he was picking up grapes. Choose the most probable diagnosis from the list
of options.
a) Pancreatitis.
b)Malabsorption.
c)Peptic ulcer.
d)Tuberculosis
6. A 60-year-old man who is alcoholic is admitted to the emergency department with hematemesis. His pulse is
110/min, blood pressure is 100/60 mm Hg and respiration rate is 19/min. He has multiple spider angiomata on his
back and chest with bilateral gynecomastia. Abdominal examination revealed hepatosplenomegaly. Also his abdomen
is distended and tympanic on percussion, a fluid level is easily detectable. His testicles are small and a rectal
examination produces guaiac-negative stool. His hematocritis is 23%. After placement of a nasogastric tube 400 mL
of bright red blood has been evacuated. After initial fluid resuscitation, what is the following, most appropriate
investigation?
a)Esophagogastroscopy.
b)Exploratory celiotomy.
c)Investigestion with barium.
d) Selective angiography
7.A 70-year-old male is presented with a complaint on fatigue. There is no history of alcohol abuse or liver disease.
This patient does not take medication. Scleral are not noticed to be icterus on physical examination. There is no
evidence of chronic liver disease on physical examinatio and the liver and spleen are nonpalpable. The patient is
noticed to have a normocytic, normochromic anemia. The first step of such patient’s investigation is:
a)Esophagogastroduodenoscopy.
b)CT scan of the abdomen.
c) Abdominal ultrasound
d)Liver function tests, including direct and indirect bilirubin and urine bilirubin
8. A 75 y.o. man has acute pain in the paraumbilical region accompanied by vomiting and feeling of abdominal
swelling in approximately 30 minutes after meals. He lost 10 kg during the last months because he doesn't eat in order
to avoid pain. Abdomen examination reveals no changes in the periods between pain attacks. Above the right femoral
artery a murmur can be auscultated, peripheral pulsation in the lower extrimities is weak. X-ray examination of
stomach and colonoscopy reealed no changes. What is the leading factor of this pathogenesis?
a) Neoplastic process
b)Psychogenic changes
c)Inflammation
d)Ischemia
9. Medical examination of a man revealed "geographic tongue". This microsymptom is the evidence of the following
vitamin deficiency:
a) Vitamin C
b) Vitamin PP
c) Vitamins of B group
d)Vitamin D
10. A 45 y.o. man complains of having intensive pain in the epigastric region 1,5-2 hours later after food intake. He
has been suffering from ulcer for 11 years. Objectively: t0- 36,50С, RR- 16/min, Ps- 70 bpm, AP- 120/80 mm Hg. On
palpation: local painfulness in the right epigastric region. What parameters of intragastric Ph-meter in the region of
stomach body are the most typical for this patient's disease?
a) рН = 4,0-5,0
b)рН = 3,0-4,0
c) рН = 5,0-6,0
d)рН = 1,0-2,0

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MANAGEMENT OF PATIENTS WITH PORTAL HYPERTENSION

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