Ngenge exam is very very near. Let’s have some fun with these GIT questions:
55 year old man presents with increased skin pigmentation, steatorrhea and diabetis mellitus. The mechanism most likely responsible for this constellation findings is:
- alcoholic cirrhosis
- a defect in iron metabolism
- alpha1-antitrypsin deficiency
- a defect in copper metabolism
Answer: Hemochromatosis – metabolic liver disease in which the defect is in iron metabolism.
60 year old woman has conjugated bilirubin 57% of the total bilirubin. What is the most likely diagnosis?
Answer: cholestasis @ post-hepatic obstruction
And a bit about biochemistry:
A 35 years old Malaysian woman has a long history of explosive diarrhea and abdominal distension after eating dairy products. What is the pathogenesis of her diarrhea?
- antigliadin antibodies
- cAMP activation
- mucosal invasion
- intraluminal osmotically active solutes
Answer: This one is quite a killer question, no one got this right. Choice (1) is the pathogenesis of celiac disease, not the diarrhea. The next 3 choices below explain the pathogenesis of diarrhea.
- Secretory diarrhea – by vibrio cholera and enterotoxigenic E. Coli (ETEC) @ traveler’s diarrhea. Pathogenesis includes increasing in cAMP thus increasing secretion. This is choice no. 2.
- Invasive diarrhea – by Shigellosis and enteroinvasive E. Coli (EIEC). On fecal smear can see bloody diarrhea and pus. This is choice no.3.
- Osmotic diarrhea – due to lactase deficiency. The person is intolerant to lactose (dairy products). The blunting of villi in this person’s intestinal mucosa leads to malabsorption of dairy products -> intraluminal hyperosmosis. The correct answer is choice no. 4.
Congratulations for trying to answer! The winner is – the boss! Ngenge…