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Topic 21. Pathophysiology of digestive system

Дата конвертації25.01.2021
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Topic 21. Pathophysiology of digestive system.
1. After taking a fatty food a patient feels nausea, flaccidity, later the sign of steatorrhea has appeared, cholesterol in the blood 9,2ml/c. The cause of this state is the deficiency of:

  1. Chylomicrons.

  2. Triglycerides. C. Bile acids.*

  1. Fatty acids.

  2. Phospholipids.

2. A patient aged 45 had the diagnosis ulcer of the stomach. On examination of secretory function of the stomach it was determined that the amount of basal secretion was 100mole/hr, acidity of basal secretion -60mml/hr. What factors action contributes to the hypersecretion in the stomach?

  1. Gastrin.*

  2. Pancreatic polypeptide.

  3. Somatostatin.

  4. Glucagon.

  5. Beta-endorphin.

3. On laboratory examination increased amount of diastase in the urine and also a large amount of undigested fat in stool were revealed in a patient female with complain of circular character pain in epigastric area. What form of gastrointestinal tract pathology are described signs typical for?

  1. Inflammation of large intestine.

  2. Acute appendicitis.

  3. Infectious gastritis.

  4. Ulcerous disease of the stomach.

  5. Acute pancreatitis.*

4. A part of patient pancreas was resected. What kinds of product must be limited in his diet?

  1. Sour milk product

  2. Fruits.

  3. Not fatty boiled meat.

  4. Fatty and fried meal.*

  5. Vegetables.

5. What enzyme deficiency is the cause of maldigestion of fats in the gastrointestinal tract and increase of neutral fats in the stool?

A. Gastric lipase B. Intestinal lipase. C. Hepatic lipase,

  1. Enterokinase.

  2. Pancreatic juice.*

6. Decrease of synthesis and secretion of trypsin is observed in chronic pancreatitis. The splitting of what substances is broken?

  1. Proteins.*

  2. Nucleic acids C. Polysaccharides.

  1. Lipids.

  2. Liposoluble vitamins.

7. In coprologic investigation it is determined that stool is discolored, there are drops of neutral fat in it. The most possible cause of this is the impairment of? A. Secretion of intestinal juice.

B. Process of absorption in the intestine. C. Entering of bile into the intestine.*

  1. Acidity of gastric juice.

  2. Secretion of pancreatic juice.

8. A patient had been taking antibiotics of a wide spectrum of action for a long period of time that caused decrease of appetite, nausea, and diarrhea with saprogenic smell.

What is the side effect of treatment? A. Hepatotoxic action.

  1. Allergic reaction.

  2. Dysbacteriosis.* D. Nephrotoxic action.

E. Direct irritative action
9. On examination of a patient suffering from acute pancreatitis increased amount of chylomicrons was determined in the blood. What enzyme activity is sharply decreased in this pathology?

  1. Lipoprotein lipase.*

  2. Pancreatic lipase.

  3. Pancreatic phospholipase.

  4. Tissue triglyceride lipase.

  5. Tissue diglyceride lipase.

10. The analysis of gastric juice of an elderly man who complained of unmotivated weakness, sickness, absence of appetite showed achylia, achlorhydria, and presence of lactic acids and coagulated blood, decreased of pepsin secretion. What disease causes such clinical-laboratory symptoms? A. Cancer of the stomach.*

  1. Chronic gastritis.

  2. Chronic pancreatitis.

  3. Cavitary Maldigestion.

  4. Acute gastritis.

11. A man with chronic hepatitis has dyspeptic disorders: decrease of appetite, nausea, unstable stool, and steatorrhea. What is the mechanism of dyspeptic disorders in hepatic pathology? A. Intoxication

  1. Hypoglycemia

  2. Cholemia

  3. Hypocholia*

  4. Hyperbilirubinemia

12. Spasmodic pains in the abdomen and repeated diarrhea with mucus appeared in a healthy person 3-5 hours later after taking meals. This was preceded by nausea and vomiting, general weakness, loss of appetite. What is the most possible cause of the desired symptoms?

  1. Chronic pancreatitis

  2. Food intoxication*

  3. Enterocolitis

  4. Hyperacid state of the stomach

  5. Chronic gastritis

13. A man who works at a storage battery plants complains of constant feeling of weight and periodical spasmodic pains in the abdomen, constant retention of stool (not more often than one time per three day). This is accompanied by frequent headaches, flaccidity, absence of appetite, and bad taste in the mouth. What are the causes of these disorders?

  1. Hyperacid state of the stomach

  2. Hypoacid state of the stomach

  3. Spastic lead colic with constipation*

  4. Chronic pancreatitis

  5. Parietal maldigestion

14. Due to chronic gastritis a man has the impaired structure of the mucous membrane, decreased indices of acid formation function of the stomach. The most essential negative result of this will be the impairment of:

  1. Excretion of secretum

  2. Pancreatic juice secretion

  3. Secretory function of small intestine

  4. Evacuation of chyme into duodenum

  5. Protein digestion*

15. On laboratory examination increased amount of diastase in the urine and also a large amount of undigested fat in stool were revealed in a patient with complains of circular character pains in epigastric area. What form of gastrointestinal tract pathology are the described signs typical for? A. Inflammation of the large intestine

  1. Acute appendicitis

  2. Infectious hepatitis

  3. Ulcerous disease of the stomach

  4. Acute pancreatitis*

16. A patient aged 35 with ulcerous disease had a rejection of antral portion of the stomach. What gastrointestinal hormone secretion will be impaired due to operation? A. Gastrin*

  1. Secretin

  2. Neurotensin

  3. Histamine

  4. Cholecystokinin

17. A patient aged 57 was admitted to a gastrointestinal department with suspicious on Zollinger-Ellison syndrome, which was proved by sharp increase of gastrin level in the blood serum. What impairment of secretory gastric function is the most possible?

  1. Hyperacid hyposecretion

  2. Hyperacid hypersecretion*

  3. Hypoacid hypersecretion

  4. Achylia

  5. Hypoacid hyposecretion

18. A patient with signs of encephalopathy was hospitalized in neurological in- patients department and co relation between increase of encephalopathy and substances passing from intestine into systemic blood circulation was determined. What compounds formed in the intestine may cause endotoxemia?

  1. Acetoacetate

  2. Biotin

  3. Indole *

  4. Ornithine

  5. Butyrate

19. 150 ml of meat broth were introduced into the stomach cavity of experimental dog to a probe the content of what substance will increase quickly in the animal’s blood?

  1. Insulin

  2. Vasoactive intestinal peptide

  3. Neurotensin

  4. Somatostatin

  5. Gastrin*

20. A patient age 37 was admitted into a surgical department with the signs of acute pancreatitis; vomiting, diarrhea, bradycardia, hypotension, fatigue, dehydration of the organism. What preparation must be used first of all?

  1. Ephedrine

  2. No-spa

  3. Perphenazine

  4. Contrical*

  5. Platyphyllin

21. A patient has a stone in the common bile duct, which has stopped passing bile into the intestines. The impairment of what digestive process is observed in this case?

  1. Digestion of carbohydrates

  2. Absorption of carbohydrates

  3. Digestion of fats*

  4. Absorption of proteins

  5. Digestion of proteins

22. On fiberscopy of the stomach ulcer was revealed in antrum portion, which was associated with dissemination of mucosa by Helicobacter pylori. The role of this agent in the formation of ulcer results in: A. Damage of mucous barrier*

  1. Inhibition of mucosa regeneration

  2. Impairment of microcirculation in mucous

  3. Stimulation of HCL secretion

  4. Stimulation of pepsin secretion

23. A patient with ulcer of stomach has impairment of equilibrium between the factors of aggression and defense. What factor contributes to the development of gastric ulcer?

  1. Mucin

  2. Helicobacter pylori*

  3. Bicarbonate

  4. Prostaglandin E2

  5. Prostacyclin

24. After resection of duodenum a patient has developed a syndrome of duodenal in sufficiency due to the impairment of its endocrine function with signs of cell insufficiency of APUD system. What hormone is produced by A-cells of this portion of intestine? A. Histamine

  1. Insulin

  2. Serotonin

  3. Secretin

  4. Glucagon*

25. A patient complains of nausea, which often ends with vomiting. These dyspeptic phenomena become more laborious with time. What stomach function is infringed in this patient? A. Evacuation*

  1. Motility

  2. Reservoir

  3. Incretory

  4. Secretory

26 A patient aged 42 was admitted to the hospital with gastric hemorrhage (ulcerous disease was excluded by a patient). Ulcer and hyperplasia of gastric mucosa were revealed. What investigation is it necessary to carry out to confirm the diagnosis of Zollinger-Ellison syndrome in this patient?

  1. Definition of gastrin level in the blood.*

  2. Tomography of pancreas

  3. Definition of secretin level in the blood

  4. Definition of activity level of pancreatic enzymes

  5. Investigation of activity level of pancreatic secretion

27 The amount of protein in the blood was examined in a patient after resection of sizable part of small intestine. What change of protein amount may be expected in this patient?

  1. Hyperproteinemia

  2. Hypoproteinemia*

  3. Paraproteinemia

  4. Hypergammaglobulinemia

  5. Dysproteinemia

28 Ulcerous disease of the stomach is revealed in a woman aged 52, who has been ill with contact dermatitis. On examination it is determined that the patient had been taking corticosteroid preparations for a long period of time, but acidity of gastric juice was increased. What mechanism caused the increase of gastric secretion?

  1. Decrease of prostaglandin content*

  2. Increase of secretin secretion

  3. Gastrin hyposecretion

  4. Increase of histamine content

  5. Increase of gastrin excretion

29 A patient complains of vomiting, eructation, pain in epigastric area, constipation, and emaciation. On examination a basal secretion of HCL is 6mml/gr; maximal one is 60mml/gr. What state has acid-forming function of this patient?

  1. Hypoacid

  2. Anacid

  3. Hyperacid*

  4. Hypersecretory

  5. Normacid

30 A patient aged 42 complains of pains in epigastric area, vomiting; vomitory masses have color of “coffee grounds”, melena. In anamnesis there is ulcerous disease of the stomach. On examination: skin is pale, heart rate-110 beats per minute; BP90/50mm.hg. Blood analyses: erythrocytes-2.8 x 1012/l; leucocytes-8x109/l; hemoglobin-90gr/l. What is the possible complication that developed in the patient? A. Penetration

  1. Perforation

  2. Hemorrhage*

  3. Cancerous degeneration

  4. Pylorostenosis

31 The investigation of pancreatic function was carried out in experimental animal by radioisotopic method. The percentage of excreted with stool 1131- albumin is 53%. This is the evidence of:

  1. Increase of exocrine function

  2. Increase of incretory function

  3. Inhibition of incretory function

  4. Inhibition of exocrine function*

  5. Normal function

32 Malabsorption syndrome is:

  1. Syndrome of membranous maldigestion

  2. Syndrome of gastric malabsorption

  3. Syndrome of malabsorption in small intestine

  4. Syndrome of intestinal malabsorption*

  5. Malabsorption of proteins

33. A patient complains of dyspeptic disorders, melena, hemorrhoidal bleedings. While examination of the patient enlargement of veins at the anterior surface of abdomen and increased abdomen dimensions were revealed. What pathology of GIT may manifest by such symptoms?

  1. Colitis

  2. Portal hypertension*

  3. Intestinal autointoxication

  4. Peptic ulcer

  5. Enteritis

34. A 67-year-old woman, who has cholecystitis for a long time, suddenly developed sharp pain in the upper part of abdomen, nausea, and vomiting after food intake. Acute pancreatitis was diagnosed in this patient. What is the main link in pathogenesis of this disease?

  1. Preliminary activation of pancreatic enzymes*

  2. Decrease in enzyme levels in pancreatic juice

  3. Intensification of enzyme activation in duodenum

  4. Reduction of pancreatic polypeptide secretion

  5. Increased level of cholecystokinin

35. A patient has increased gastric secretion in response to both mechanical and chemical stimuli. He has high acidity of gastric juice with pH equals 2.0 on an empty stomach. After the breakfast pH restores to normal in 12 minutes and is continuously dropping during following 2 hours. What type of stomach secretion is being observed in this patient? A. Excitable*

  1. Inhibited

  2. Inert

  3. Asthenic

  4. Normal

36. Frequent liquid stool, signs of intoxication, and dehydration developed in a newborn at 5-6 day. After this newborn was fed by acid-milk mixtures indicated symptoms disappeared. The conclusion of innate lactose deficiency was made. What process was broken in this newborn?

  1. Membrane digestion*

  2. Cavital digestion

  3. Excretory function of intestine

  4. Secretory function of pancreas

  5. Secretion of gastric juice

37. Ulcers of stomach were found out in a patient, who was treated with glucocorticoids for a long time. What is the main mechanism of ulcer development in this case?

  1. Increase in secretion and acidity of gastric juice*

  2. Decrease in histamine concentration in stomach wall

  3. Increased tonus of sympathetic nervous system

  4. Increased production of prostaglandins E

  5. Decreased tonus of parasympathetic nervous system

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