Gastroenterology.

1. A 22-year-old male presents to the emergency department with abdominal pain, anorexia,
nausea, and low-grade fever. Pain started in the mid-abdominal region 6 hours ago and is
now in the right lower quadrant of the abdomen. The pain was steady in nature and
aggravated by coughing. Physical examination reveals a low-grade fever (38°C tenderness
on palpation at right lower quadrant (McBurney's sign), and leukocytosis (12 x 10%L/ or
12,000/microlitre) with 85% neutrophils.
1. Acute appendicitis.
2. Irritable Bowel Syndrome.
3. Ulcerative colitis.
4. Haemorrhoids.

2. A 40-year-old housewife complains of recurrent constipation. She has had problems since
her 20s, but they are worse now. The constipation is accompanied by abdominal bloating
and abdominal pain, and the discomfort is only better when she has a bowel movement. On
her gynaecologist's advice, she has tried more fibre in her diet, including fresh fruits and
leafy vegetables, but that has only made the bloating worse. Her past history includes a
cholecystectomy and a hysterectomy. Physical examination is entirely normal. Rectal
examination reveals normal consistency stool. Stool samples test negative
for occult blood.
1. Ulcerative colitis.
2. irritable bowel syndrome.
3. Crohn's disease.
4. Tropical sprue.

3. A 42-year-old man presents to his primary care physician complaining of a 3-month

history of lower intestinal bleeding. He describes the bleeding as painless, bright blood
appearing on the tissue following a bowel movement. He has had 2 episodes recently where
blood was visible in the toilet bowl following defecation. He denies any abdominal pain and
any family history of gastrointestinal malignancy. Physical examination reveals a healthy
man with the only finding being bright blood on the examining finger following a digital rectal
examination.
1. Hemorrhoids.
2. Anorectal abscess.
3. Irritable bowel syndrome (IBS).
4. Celiac disease.

4. A. 32-year-old man presents to the emergency department complaining of perirectal pain

and swelling. The symptoms began 24 hours earlier and have become progressively worse.
The patient denies any rectal bleeding and describes the pain as very severe and localized
to the area of the swelling. He relates a subjective history of fever but denies any change in
bowel habits. He also denies any history of recent or chronic medical problems.
1. Acute appendicitis.
2. Irritable bowel syndrome.
3. Hemorrhoids.
4. Anorectal abscess.
5. A28-year-old woman presents with a history of severe pain on defecation for the last 3
months. She has noticed a small amount of blood on the stool. The pain is severe and
she is worried about the pain she will experience with the next bowel action. Pain after
defecation typically lasts for up to an hour, but may be of longer duration and sometimes
lasts for many hours.
1. Anal fissure.
2. Irritable bowel syndrome.
3. Haemorrhoids.
4. Anorectal abscess.

6. A 54 year old man presents with two days of forcing generalized abdominal pain. he is
nauseated and the pain is worse after eating. He was hospitalized last month with acute
pancreatitis and was found to have a splenic vein thrombus during the admission.
1. Peptic ulcer.
2. Achalasia.
3. Ischaemic bowel disease.
4. Acute appendicitis.

7. An 18-year-old girl presents with sudden-onset severe generalized abdominal pain

associated with nausea, vomiting, and diarrhea. On examination she appears unwell and
has a temperature of 40°C Her abdomen is tense with generalized tenderness and guarding.
No bowel sounds are present. The patient's pain intensifies during coughing
1. Acute appendicitis.
2. Ischaemic bowel disease.
3. Irritable bowel syndrome.
4. Celiac disease.

8. A75-year-old man with type 2 diabetes mellitus presents to the accident and emergency
department (A&E) with a 5-day history of abdominal pain that started in the left lower
quadrant and was associated with obstipation, nausea and vomiting, and weakness. He has
no prior history of abdominal disease or abdominal surgery. The patient is febrile (39.0°C),
tachycardic (heart rate 110 bpm), and hypotensive (systolic blood pressure 80 mmHg). He
says he has generalized abdominal pain that is more localized to the left lower quadrant. He
has not had any food in the last 24 hours.
1. Tropical sprue.
2. Intra-abdominal abscess.
3. Irritable bowel syndrome.
4. Ischaemic bowel disease.

9. A 32-year-old woman who is at 30 weeks' gestation comes to the office because she has
had pain on defecation during the past week. She says she also has had pain when
attempting to cleanse the anal region as well as pain when sitting. Based on these findings,
which of the following types of hemorrhoid is most likely to be noted on further evaluation of
this patient?
1. External.
2. Internal.
3. Strangulated.
4.Thrombosed.

10. Which of the following differentiates Crohn disease from ulcerative colitis?
1. In Crohn disease, inflammation is confined to mucosa and submucosa except in severe
cases.
2. In Crohn disease, the bowel wall is affected symmetrically and uninterruptedly from the
rectum proximally.
3. In Crohn disease, endoscopic appearance is patchy, with sections of
normal-appearing mucosa.
4. In Crohn disease, inflammation is uniform and diffuse.

11. Abdominal pain is a frequent gastrointestinal (GI) complaint, and determining the location
of the pain can help determine the diagnosis. When a patient has pain in the left upper
quadrant of the abdomen, which of the following is a possible diagnosis?
1. Appendicitis.
2. Inflammatory bowel disease.
3. Perforated duodenal ulcer.
4. Splenic rupture.

12. Which of the following conditions usually is asymptomatic?

1. Diverticulitis.
2. Crohn's disease.
3. Inflammatory bowel disease.
4. Diverticulosi.

13. Which of the following tests are preferred for initial diagnosis of H. pylori infection?
1. Endoscopy to obtain mucosal biopsy samples.
2. Serologic antibody assays.
3. Urea breath testing.
4. Stool antibody assays.

14. When associated with nausea and vomiting, which of the following raises suspicion of a
more serious etiology of chronic constipation?
1. Occasional bouts of diarrhea.
2. Change in color of stool.
3. Distended, tympanitic abdomen.
4. Abdominal pain.

15. Abdominal pain associated with appendicitis is generally described as:

1. Near the diaphragm.
2. Relieved by eating.
3. Near or around the umbilicus and in the right lower quadrant of the abdomen.
4. Worse in the morning.
16. Acommon colon disorder characterized by constipation, does not cause permanent
damage to the colon is:
1. Irritable bowel syndrome.
2. Crohn disease.
3. Ulcerative colitis.
4. Inflammatory bowel disease.
_________________________________________________________________________

Endocrinology

1. What is the most common cause for the overproduction of growth hormone in
acromegaly?
A. Pituitary lesion.
B. Hypothalamic lesions.
C. Pituitary adenoma.
D. Hyperplasia of the pituitary stalk.

2. All of the following are causes of Addison's disease, except:

A. Pyelonephritis.
B. Autoimmune destruction of the adrenal cortex.
C. Tuberculosis.
D. Adrenoleukodystrophy.

3. Which of the following is not a cause of nephrogenic diabetes insipidus?

A. Post obstructive uropathy.
B. Amyloidosis.
C. Mutations in vasopressin genes.
D. Mutations in the vasopressin (ADH) receptor gene.

4. Which of the following is correct regarding the effects of increased levels of growth
hormone in acromegaly?
A. Increased levels of growth hormone stimulate increased production of vasopressin from
the adrenal glands.
B. Increased levels of growth hormone stimulate increased production of insulin like growth
factor one (IGF1) from the adrenal glands.
C. Increased levels of growth hormone stimulate increased production of insulin like
growth factor one (IGF1) from the liver.
D. Increased levels of growth hormone stimulate increased production of vasopressin from
the liver.

5. Which one of the following statements best describes an Addisonian crisis?

A. Severe adrenal insufficiency resulting in dangerously low serum cortisol levels.
B. Dangerously high levels of testosterone.
C. Dangerously high serum cortisol levels.
D. Severe adrenal insufficiency resulting in dangerously low serum testosterone levels.
6. Which of the following does the adrenal cortex produce?
A. Cortisol.
B. Adrenaline.
C. Aldosterone.
D. Noradrenaline.

7. Which of the following is not a cause of neurogenic diabetes insipidus?

A. Polycystic kidney disease.
B. Trauma.
C. Sheehan's syndrome.
D. Pituitary adenoma.

8. What of the following statements best describes a toxic thyroid adenoma?

A. An autoimmune disease directed against thyroid stimulating hormone (TSH) receptors.
The autoantibodies stimulate the TSH receptors causing increased T3 and T4 production.
B. Inflammation of the thyroid gland due to lymphocytic infiltration causing stored thyroid
hormones to be released into the circulation leading to hyperthyroidism.
C. A benign tumor of the thyroid gland which produces excessive amounts of thyroid
hormones. These arise from the follicular cells of the thyroid.
D. A malignant tumor of the thyroid gland which produces excessive amounts of thyroid
hormones. These arise from the follicular cells of the thyroid gland.

9. What is the most common cause of hyperthyroidism?

A. Thyroiditis.
B. Toxic multinodular goiter.
C. Grave's disease.
D. Toxic thyroid adenoma.

10. In males which hormone stimulates Sertoli cells to produce androgen binding globulin
(ABG)?
A. Oxytocin.
B. Luteinizing hormone (LH).
C. Gonadotropin releasing hormone (GnRH).
D. Follicle stimulating hormone (FSH).

11. Which one of the following is acromegaly caused by?

A. Overproduction of growth hormone (GH).
B. Overproduction of adrenocorticotropic hormone (ACTH).
C. Overproduction of vasopressin (antidiuretic hormone).
D. Overproduction of gonadotropin releasing hormone (GnRH).

12. Which of the following statements best describes Cushing's syndrome?

A. Cushing’s syndrome refers to a disease process caused by abnormally low levels of
aldosterone.
B. Cushing’s syndrome refers to a disease process caused by abnormally high levels
of cortisol.
C. Cushing’s syndrome refers to a disease process caused by abnormally low levels of
cortisol.
D. Cushing’s syndrome refers to a disease process caused by abnormally high levels of
aldosterone.

13. What is the most common cause of Cushing's syndrome?

A. Ectopic ACTH production.
B. Glucocorticoid treatment (iatrogenic).
C. Pituitary adenoma.
D. Adrenal adenoma.

14. Which of the following is not a symptom of Addison's disease?

A. Hyperpigmentation.
B. Moon face.
C. Weight loss.
D. Postural hypotension.

15. Which of the following is not a common symptom of hyperthyroidism?

A. Urinary frequency.
B. Tremor.
C. Heat intolerance.
D. Diarrhea.

16. Which of the following statements best describes Hashimoto's thyroiditis?

A. Iodine deficiency.
B. Inflammation of the thyroid gland as the result of a virus. The disease is often preceded
by an upper respiratory tract infection.
C. A destructive autoimmune disease caused by auto-reactive antibodies against
thyroglobulin.
D. Excess iodine.

17. Which of the following is a common symptom of hypothyroidism?

A. Oily skin.
B. Weight loss.
C. Weight gain.
D. Excessive hair growth.

18. Which of the following hormones is not produced by the adrenal cortex?
A. Cortisol.
B. 5-DHEA.
C. Epinephrine (adrenaline).
D. Aldosterone.

19. Which age group does acromegaly most commonly affect?

A. 10-25 yrs.
B. 30-50 yrs.
C. 25-40 yrs.
D. 55-70 yrs.
20. Which is a more sensitive measure of thyroid function?
A. Thyroid stimulating hormone (TSH).
B. Free T4.
C. Free T3.
D. Thyroglobulin.

Diabetes Mellitus

1. The risk factors for type 1 diabetes include all of the following, except:
A. Diet.
B. Genetic.
C. Autoimmune.
D. Environmental.

2. Type 2 diabetes is characterized by:

A. Insulin resistance.
B. Insulin is lacking.
C. Beta cell destruction.
D. None of the above.

3. Type 2 diabetes accounts for approximately what percentage of all cases of diabetes in
adults?
A. 55%-60%.
B. 35%-40%.
C. 90-95%.
D. 25-30%.

4. A 35 year old patient comes to the clinic with a newly diagnosed DM. Lab tests reveal no
C-peptide in her blood. She has lost a lot of weight recently, despite the fact that she has
been eating a lot. This patient has:
A. Adult-onset diabetes.
B. GDM.
C. Type 2 diabetes.
D. Type 1 diabetes.

5. Risk factors for type 2 diabetes include all of the following, except:
A. Advanced age.
B. Obesity.
C. Eating fiber rich food.
D. Physical inactivity.

6. The hormone that is secreted by the alpha cells of the pancreas that raises blood glucose
when levels are low is:
A. Glucagon.
B. Epinephrine.
C. Insulin.
D. Cortisol.
7. What percentage of women with gestational diabetes are diagnosed with type 2 diabetes
following pregnancy?
A. 25%-30%.
B. 5%-10%.
C. <5%.
D. 20%-25%.

8. Which of the following is a long-term/chronic complication of diabetes:

A. End stage renal failure.
B. Acute renal failure.
C. Nephrotic syndrome.
D. Primary renal disease.

9. Untreated diabetes may result in all of the following, except:

A. Blindness.
B. Cardiovascular disease.
C. Kidney disease.
D. Tinnitus.

10. Which of the following tissues requires insulin for glucose entry into cells:
A. Muscle.
B. Liver.
C. Kidney tissue.
D. Nervous tissue.

11. Prediabetes is associated with all of the following, except:

A. Increased risk of developing type 2 diabetes.
B. Impaired glucose tolerance.
C. Increased risk of heart disease and stroke.
D. Increased risk of developing type 1 diabetes.

12. The period of a temporary remission of type 1 diabetes that occurs shortly after
diagnosis is called:
A. Dawn period.
B. Somogyi period.
C. Refractory period.
D. Honeymoon period.

13. Diabetic patients are at increased risk of heart disease if they also:
A. Smoke.
B. Have high HDL cholesterol levels.
C. Take aspirin.
D. Consume a high-fiber diet.

14. The renal threshold for glucose is:

A. 180 mg/dl.
B. 120 mg/dl.
C. 200 mg/dl.
D. 140 mg/dl.

15. Blood sugar is well controlled when Hemoglobin A1C is:

A. Below 7%.
B. Between 12%-15%.
C. Less than 180 mg/dL.
D. Between 90 and 130 mg/dL.

16. All of the following prevent or slow the progression of in the diabetic patient, except:
A. Controlling blood glucose.
B. Controlling ABP.
C. Controlling blood lipids.
D. Normal thyroid function.

17. Excessive thirst and volume of very dilute urine may be symptoms of:
A. Urinary tract infection.
B. Diabetes insipidus.
C. Viral gastroenteritis.
D. Hypoglycemia.

18. A 19-year old boy with diabetes had exercised earlier in the day and hadn't eaten since.
He most likely may develop a:
A. Hyperglycemic episode.
B. Hypoglycemic episode.
C. Ketotic episode.
D. None of the above.

19. Among female children and adolescents, the first sign of type 1 diabetes may be:
A. Rapid weight gain.
B. Constipation.
C. Genital candidiasis.
D. Insomnia.

20. Untreated hyperglycemia may lead to all of the following complications, except:
A. Hyperglycemic nonketotic hyperosmolar syndrome (HHS).
B. Vitiligo.
C. Diabetic ketoacidosis (DKA).
D. Coma.

1. Thyroid gland produces the following hormones?

multiple answers
a. T3.
b. T4.
c. FT4.
d. TSH.

2. The main functions of thyroid hormones are all except? multiple choice:
a. mental development.
b. physical development and maturation.
c. body metabolic rate.
d. sensitivity to adrenergic system.
e. answer on glucose load.

3. Thyroid hormone synthesis sequence:

1. Take the raw material.
2. Release of Tg into the lumen, organification, coupling.
3. Tg Synthesis.
4. Tg uptake.
5. Storage of Tg.
6. proteolysis.
7. Come T3, T4 into the circulation.

4. NIS is the Sodium/Iodide Symporter, that does everything, except one:

Multiple choice
1. mediate iodide uptake.
2. is expressed at the basolateral membrane of thyroid follicular cells.
3. is expressed at the apical membrane of thyroid follicular cells.
4. low levels are present in the salivary glands, lactating breast, and placenta.

5. The following conditions have a negative influence on Iodide transport:

True/false
1. Inactivating mutations in the symporter gene.
2. Autoantibodies to the symporter protein.

6. Each Thyroglobulin (Tg) molecule forms approximately:

Multiple choice
1. 10 thyroid hormone molecules.
2. 40 thyroid hormone molecules.
3. 100 thyroid hormone molecules.

7. TPO has the following functions, except:

Multiple choice
1. oxidization iodide into iodine I2.
2. organification of iodine to tyrosine residue.
3. activation of proteolysis process.
4. fuse with each other MIT and DIT or DIT and DIT.
8. How many percent of total intake iodine is consumed by the thyroid gland?
Multiple choice
1. 80%.
2. 20%.
3. 40 %.

9. TSH is composed by the 2 subunits - α and β. Which one is common to the other
glycoprotein hormones (luteinizing hormone, follicle- stimulating hormone, human chorionic
gonadotropin [hCG])?
Multiple choice
1. TSH α subunit.
2. TSH β subunit.

10. Dominant gain- of-function mutations of TSH R cause all the below mentioned, except
one:
Multiple choice
1. sporadic familial hyperthyroidism.
2. familial hyperthyroidism.
3. Goiter.
4. congenital hypothyroidism.
5. thyroid cell hyperplasia.
6. autonomous functioning.

11. The following hormones suppress TSH, except one:

Multiple choice
1. Dopamine.
2. glucocorticoids.
3. ADH.
4. somatostatin.

12. Is single measurement of TSH adequate for assessing its circulating level, or not?
Yes/not

13. what are characterized features for Wolff-Chaikoff effect?

Multiple answer
1. Iodide excess, that transiently inhibits thyroid iodide organification.
 2. Due to this phenomenon thyroid hormone production is switched off.
3. Iodine deficiency increases thyroid blood flow and upregulates the NIS, stimulating more
efficient iodine uptake.
4. Due to this phenomenon thyroid hormone production is switched on.

14. what is the T4/T3 ratio, secreted from the thyroid gland into the blood?
Multiple choice
1. 10/1.
2. 20/1.
3. 8/1.

15. The unbound hormone FT4, FT3:

Multiple answers
1. Are biologically available to tissues.
2. Are biologically unavailable to tissue.
3. The homeostatic mechanisms that regulate the thyroid axis are directed toward
maintenance of normal concentrations of unbound hormones.
4. The homeostatic mechanisms that regulate the thyroid axis are not directed toward
maintenance of normal concentrations of unbound hormones.

16. Measurement of unbound T3 level is necessary to confirm thyrotoxicosis:

Multiple choice
1. In patients with a suppressed TSH and elevated T4 levels.
2. In patients with a suppressed TSH but normal unbound T4 levels.

17. Tg measurement is important in following conditions:

Multiple answers
1. In the follow-up of thyroid cancer patients.
2. After total thyroidectomy.
3. After the hemithyroidectomy.
4. After radioablation.

18. Thyroid scintigraphy:

Multiple choice
1. is used in the routine evaluation of patients with thyroid nodules.
2. should be performed if the serum TSH level is subnormal.

1. Infection/inflammation/ hormone resistance may be a reason of endocrine gland

hyperfunction as well as hypofunction:
false/true

2. What are the general areas of physiological functions of hormones?

true/false
1.​growth and differentiation.
2.​maintenance of homeostasis.
3.​reproduction.

3. The most reliable testing method of hormone measurement is:

multiple choice
1. Immunoassays: immunochemiluminescent ICMA or immunoradiometric IRMA .
2. Mass spectroscopy (measure specific hormone).
3. Chromatography.
4. Enzymatic methods.
5. Bioassays.

4. 24-hour urine test is most frequently used for the measurement of the all of them except one:
multiple choice
1. norepinephrine.
2. epinephrine.
3. insulin.
4. dopamine.
5. cortisol.

5. Positive stimulation tests indicate that:

multiple choice
1. problem lies w/hypothalamus or in pituitary.
2. the problem lies outside hypothalamus/pituitary.

6. Suppression tests-they are the tests which reflect negative feedback systems that control
secretion of hormones from the hypothalamus:
True/false

7. Which from the following are recommended as the screening tests for T2 Diabetes?
multiple choice
1. FPG, HbA1c.
2. HbA1c.
3. FPG.
4. Lipid Profile.
5. microalbumin.

8. Which from the following are recommended as the screening tests for
hyperparathyroidism?
multiple choice
1. Calcium level, PTH.
2. Calcium and phosphorus levels.
3. Lipid Profile.
4. Microalbumin.
5. PTH.
6. Phosphorus level.

9. Which from the following are recommended as the screening test for menopause?
multiple choice
1. LH.
2. FSH.
3. Prolactin.
4. TSH.

10. Which from the following are recommended as the screening tests for hypogonadism?
multiple choice
1. FSH.
2. Testosterone.
3. Free testosterone, LH.
4. LH, Testosterone.

11. Multiple Endocrine Neoplasia MEN1 is characterized primarily by the triad of:
multiple choice
1. parathyroid, pancreatic islet, and pituitary tumors.
2. thyroid, pancreatic islet and adrenal tumors.
3. parathyroid, pancreatic islet and adrenal tumors.

12. What is the effect of elevated level of hCG (Human Chorionic Gonadotropin) during
pregnancy?
multiple choice​
1. stimulation of TSH receptor, increase in T4, decrease in TSH.
2. only increase in thyroid hormone levels.
3. decrease in TSH, stimulation of anti-TSH receptor.
4. increase in TSH, increase in FT4​.

13. lipid soluble hormones are all the hormones listed below except:
multiple choice
1. steroids.
2. thyroid hormones.
3. vit D.
4. Insulin.
14. High concentrations of insulin bind to the IGF-I receptor, perhaps accounting for some of
the clinical manifestations seen in conditions with chronic hyperinsulinemia.
True/false

15. Each of the major hypothalamic-pituitary- hormone axes are governed by:
multiple choice
1. negative feedback.
2. positive feedback.

16. These are hormones produced by anterior pituitary, except one​:

multiple choice
1. Prolactin.
2. growth hormone.
3. adrenocorticotropic hormone​.
4. follicle-stimulating hormone.
5. thyroid-stimulating hormone.
6. antidiuretic hormone.

17. Increase GH in children result in:

multiple choice
1. increased linear growth​.
2. increase risk of cancer and colorectal polyps​.
3. increased linear growth with abnormally large feet and hands.
4. frontal bossing.

18. SIADH characterized by :

​multiple choice
1. ADH deficiency.
2. ectopic ADH production.
3. serum osmolality more than urine osmolality.
4. hypernatremia.

19. More than 50% increase in urine osmolality after ADH analog administration indicate:
​multiple choice
1. central diabetes insipidus.
2. nephrogenic diabetes insipidus.
3. both​.
4. none of the above.
​
20. Which effect has dopamine on pituitary:
​multiple choice​
1. activate anterior pituitary.
2. activate posterior pituitary.
3. inhibit anterior pituitary.
4. inhibit posterior pituitary and anterior pituitary.

21. Dopamine antagonist:

multiple choice
1. stimulate prolactin secretion.
2. inhibit prolactin secretion.
3. has no effect on prolactin.
4. may stimulate or inhibit prolactin secretion depending on the dose.

22. Which of the following is the most common presentation of anterior pituitary
hyposecretion in a 26-year-old woman? ​
multiple choice
1. occurrence of myxedema.
2. decreased melanin pigmentation.
3. emaciation and cachexia.
4. loss of axillary and pubic hairs.
5. Amenorrhea​​.
____________________________________________________________________________

Hepatology

1. Which of the following is indicative of acute HBV infection?

A. Negative HBsAg, negative AntiHBcIgM, positive AntiBs.
B. Negative HBsAg, negative AntiHBelgM, negative AntiHBs.
C. Positive HBsAg, positive AntiHBcIgM, negative AntiHiBs.
D. Positive HBsAg, negative AntiHBs, positive AntiHBcIgG.
E. Negative HBsAg, Positive AntiHBcIgG, positive AntiHBs.

2. What is the treatment of acute hepatitis A infection?

A. Supportive.
B. Ribavirin.
C. Corticosteroids.
D. Pegylated interferon.
E. Interferon alfa plus Lamivudine combination therapy.
3. A patient underwent a serology testing panel for hepatitis B virus. The results were
positive for AntiHBlgG and AntiHBs only, and the rest of the parameters had negative
results. How can these results be interpreted?
A. The patient is a chronic hepatitis B virus carrier.
B. The patient has acute hepatitis B infection.
C. The patient had a prior vaccination for hepatitis B.
D. The patient had a prior infection of hepatitis B.
E. The patient has chronic active hepatitis B.

4. A 55 year old man is diagnosed with liver cirrhosis secondary to hepatitis C. Which
complication should this patient be screened for every six months?
A. Focal nodular hyperplasia.
B. Primary sclerosing cholangitis.
C. Hepatic adenoma.
D. Hepatocellular carcinoma.
E. Hemangioma.

5. Which of the following tumor markers is characteristically increased in hepatocellular

carcinoma?
A. Ca 19-9.
B. HCG.
C. CEA.
D. AFP.
E. Inhibin.

6. A 38 year old man who works as a reporter for a travel magazine comes to his physician
because of the acute onset of jaundice, malaise, and temperature to 38C. He had returned
from Burna 2 weeks ago, where he spent 4 weeks. He says that abstains from alcohol
beverages and does not take any medications. Laboratory studies show elevated serum
aminotransferases, high bilirubin (both total and direct), and negative serology for hepatitis A
virus (HAV) and C virus (HCV) infection. He was vaccinated for hepatitis B virus (HBV) 3
years ago and is now positive for AntiHBs. Which of the following markers should be tested
as the most appropriate next step in diagnosis?
A. AntiHCV IgG antibodies by RIBA.
B. Anti HDV IgG antibodies.
C. Anti HEV IgM antibodies.
D. Anti HGV IgG antibodies.
E. HbsAg.

7. 6 years old boy refers to the hospital with fever, malaise, vomiting, abdominal discomfort.
Examination show mild right abdominal tenderness, hepatomegaly, mild jaundice. General
blood analyses show no significant changes. Biochemistry panel shows: elevated total
bilirubin, ALT - 1200 U/L, AST - 840 U/L. Urine is dark. The patient attends kindergarten.
Which of the following is the more likely reason for this condition?
A. Hepatitis A virus.
B. Hepatitis B virus - acute HBV infection.
C. Hepatitis B virus - chronic HBV infection.
D. Chronic hepatitis C.
8. A 23 year old nurse obtains a needlestick injury while drawing blood from a patient with
acute hepatitis B. She received a hepatitis B vaccination series 5 years ago. Upon starting
her most recent nursing job last month, she was found to be AntiBs positive. What is the
most appropriate next step in the management of the nurse?
A. Administration of hepatitis B immunoglobulin (HBIG).
B. Vaccination against HBV.
C. Give both HBIG and HBV vaccines.
D. Test for HBsAg.
E. Reassurance.

9. Which of the following conditions should be included in the differential diagnosis of

patients with hepatosplenomegaly, abnormal liver function tests and bridging liver fibrosis?
A. Alcoholic liver disease.
B. Nonalcoholic fatty liver disease.
C. Chronic hepatitis B and C.
D. Autoimmune hepatitis.
E. Wilson disease.
F. All of them.

10. Which patient population is not at increased risk of nonalcoholic fatty liver disease?
A. Patients with lipid abnormalities.
B. Patients with diabetes mellitus type2.
C. Patients with hyperthyroidism.
D. Patients with obesity.

11. A 42 year old man comes to the office after attempting to donate blood when he was
found to have abnormal viral serologic results for hepatitis. The patient drinks one or two
beers on weekdays and five or six on the weekend. He used injection drugs for several
years in his 20s but not recently, the patient does not use tobacco. He has had several
sexual partners over his lifetime but currently is in a monogamous relationship temperature
is 36.7C, blood pressure is 136/85 mmhg and Pulse is 84/min, BMI is 34.2kg/m2. A smooth
non-tender liver Edge is palpable 3 cm below the right costal margin otherwise the physical
examination is unremarkable. laboratory results are as follows: ASL 156U/Ll ALT 214U/L,
HBsAG is negative, Anti-HBs positive antiHCV is positive. Which of the following is the most
appropriate next step in management of this patient?
A. Abdominal CT scan.
B. Hepatitis B vaccination.
C. Hepatitis C virus RNA PCR testing.
D. Ledipasvir/Sofosbuvir therapy.
E. Liver biopsy.

12. A previously unvaccinated health care worker incurs a needle stick from a patient with
known active hepatitis B infection. What is the appropriate management for the health care
worker?
A. Hepatitis B immunoglobulin.
B. Hepatitis B vaccine plus hepatitis B immunoglobulin.
C. Hepatitis B vaccine.
D. Hepatitis B vaccine plus Lamivudine.
E. Lamivudine plus Tenofovir.

13. A 29-year-old woman at 25 weeks gestation comes to the clinic for routine prenatal care.
She has a history of chronic hepatitis C infection acquired approximately 10 years ago. Her
pregnancy has been otherwise uncomplicated to date. Her past medical history is significant
only for an appendectomy at age 12. She has not been immunized against hepatitis A and
B. She takes no medications, aside from a daily prenatal multivitamin. Which of the following
recommendations should be given to this patient?
A. Avoid breastfeeding the baby.
B. Start antiviral therapy.
C. Schedule an elective cesarean delivery.
D. Obtain hepatitis A and B vaccinations.
E. Use barrier protection for all sexual intercourse.

14. What is infection rate of infants who are born to hepatitis B surface antigen positive
mothers and who do not receive hepatitis B immunoglobulin and hepatitis B
vaccination at birth?
A. Up to 90%.
B. Up to 50%.
C. Up to 65%.
D. Up to 20%.
E. Up to 5%.

15. How often should screening ultrasonography be done in patients with chronic liver
disease and liver cirrhosis?
A. Every 6 months.
B. Every 12 months.
C. Every 3 months.
D. Every 2 months.
E. Every 2 years.

16. A middle-aged man complained of acute onset of fever, nausea, and pain in the right
upper abdominal quadrant. There was jaundice, and dark urine had been observed several
days earlier. A laboratory test was positive for HAV IgM antibody. The physician can tell the
patient that:
A. He probably acquired the infection from a recent blood transfusion.
B. He will probably develop chronic hepatitis.
C. He will be at high risk of developing hepatocellular carcinoma.
D. He will be resistant to infection with hepatitis E virus.
E. He may transmit the infection to family members by person-to-person spread for up to 2
weeks.
_________________________________________________________________________

1-What is the primary cause of liver cirrhosis in most cases?

a) Alcohol abuse.
b) Hepatitis A.
c) Type 2 diabetes.
d) Genetic factors.

2-Which of the following conditions is characterized by an accumulation of bilirubin in the

blood and tissues?
a) Liver cirrhosis.
b) Alcoholic fatty liver disease.
c) Hyperbilirubinemia.
d) Non-alcoholic fatty liver disease.

3-Excessive alcohol consumption can lead to which of the following liver conditions?
a) Hyperthyroidism.
b) Hepatitis C.
c) Alcoholic hepatitis.
d) Lung cancer.

4-Which type of fatty liver disease is often associated with obesity, insulin resistance, and
metabolic syndrome?
a) Alcoholic fatty liver disease..
b) Non-alcoholic fatty liver disease (NAFLD).
c) Cirrhotic fatty liver disease.
d) Viral fatty liver disease.

5-What is the main function of bilirubin in the body?

a) Transport of oxygen in the blood.
b) Breakdown of carbohydrates.
c) Removal of waste products from the body.
d) Digestion of fats.

6-The presence of jaundice, a yellowing of the skin and eyes, is a common symptom of:
a) Hyperthyroidism.
b) Hyperbilirubinemia.
c) Hypoglycemia.
d) Osteoporosis.

7-In the context of liver cirrhosis, what does the term "ascites" refer to?
a) Scarring of the liver.
b) Abdominal fluid buildup.
c) Yellowing of the skin.
d) Enlargement of the spleen.

8-Which of the following is NOT a potential complication of liver cirrhosis?

a) Liver cancer.
b) Hepatitis A.
c) Portal hypertension.
d) Kidney dysfunction.
9-Non-alcoholic fatty liver disease (NAFLD) is most commonly associated with which dietary
factor?
a) High sugar intake.
b) Low fiber intake.
c) Excessive protein consumption.
d) High salt intake.

10-The condition known as hemolysis can contribute to the development of:

a) Hyperthyroidism.
b) Liver cirrhosis.
c) Hyperbilirubinemia.
d) Type 1 diabetes.
_________________________________________________________________________

1. Which type of hepatitis is primarily transmitted through contaminated food or water?

a) Hepatitis A.
b) Hepatitis B.
c) Hepatitis C.
d) None of the above.

2. Which hepatitis virus can lead to a chronic infection?

a) Hepatitis A.
b) Hepatitis B.
c) Hepatitis C.
d) Hepatitis D.

3. What is the most common mode of transmission for Hepatitis B?

a) Sexual contact.
b) Sharing needles.
c) Contaminated food.
d) Casual contact.

4. Which type of hepatitis can be prevented with a vaccine?

a) Hepatitis A.
b) Hepatitis B.
c) Hepatitis C.
d) Both A and B.

5. Chronic infection with Hepatitis C can lead to:

a) Liver cirrhosis.
b) Heart disease.
c) Lung cancer.
d) Diabetes.

6. Which hepatitis virus is also known as the "silent epidemic"?

a) Hepatitis A.
b) Hepatitis B.
c) Hepatitis C.
 d) Hepatitis D.

7. Which type of hepatitis is known as "serum hepatitis"?

a) Hepatitis A
b) Hepatitis B
c) Hepatitis C
d) Hepatitis D

8. What is the primary source of infection for Hepatitis D?

a) Contaminated food.
b) Sharing needles.
c) Sexual contact.
d) Blood-to-blood contact.

9. Which hepatitis virus can cause liver cancer?

a) Hepatitis A.
b) Hepatitis B.
c) Hepatitis C.
d) Hepatitis E.

10. Which hepatitis virus has a vaccine available for both children and adults?
a) Hepatitis A.
b) Hepatitis B.
c) Hepatitis C.
d) Hepatitis D.

11. Hyperbilirubinemia is a condition characterized by an excess of what pigment in the

blood?
a) Hemoglobin.
b) Bilirubin.
c) Albumin.
d) Glucose.

12. Jaundice is a common symptom of hyperbilirubinemia. What causes the yellowing of the
skin and eyes in jaundice?
a) High cholesterol levels.
b) Elevated bilirubin levels.
c) Excessive sugar intake.
d) Low blood pressure.

13. What organ is primarily responsible for processing bilirubin in the body?
a) Lungs.
b) Kidneys.
c) Liver.
d) Stomach.

14. Neonatal jaundice, common in newborns, is a form of hyperbilirubinemia caused by:

 a) Maternal smoking.
b) Premature birth.
c) High caffeine intake.
d) Low iron levels.

15. Which of the following conditions can lead to increased bilirubin production and result in
hyperbilirubinemia?
a) Anemia.
b) Hypertension.
c) Asthma.
d) Osteoporosis.

16. Which laboratory test is commonly used to diagnose hyperbilirubinemia?

a) Blood glucose test.
b) Complete blood count (CBC).
c) Bilirubin test.
d) Urinalysis.

17. In Gilbert's syndrome, a mild and common form of hyperbilirubinemia, bilirubin levels are
typically elevated due to:
a) Impaired liver function.
b) Reduced bilirubin production.
c) Inherited genetic factors.
d) High alcohol consumption.

18. What is the recommended treatment for severe hyperbilirubinemia in infants?

a) Antibiotics.
b) Phototherapy.
c) Physical therapy.
d) Surgery.

19. What is the name of the condition in which bilirubin builds up in the brain and causes
neurological problems?
a) Kernicterus.
b) Jaundice.
c) Anemia.
d) Cirrhosis.

20. What dietary changes can help manage hyperbilirubinemia?

a) Low-fat diet.
b) High-sugar diet.
c) Low-carb diet.
d) High-fiber diet.