3. Chapter 9: Small intestine...............................................................................................................................................75
A. Anatomy......................................................................................................................................................................75
B. Histology .....................................................................................................................................................................77
C: Physiology...................................................................................................................................................................80
D: Biochemistry...............................................................................................................................................................83
Chapter 10: Large intestine ............................................................................................................................................87
A. Physiology...................................................................................................................................................................87
B. Histology .....................................................................................................................................................................89
C: Pathology ....................................................................................................................................................................92
Chapter 11: Lower GIT Microbiology .................................................................................................................. 98
Chapter 12: Parasitology................................................................................................................................... 105
Chapter 13: Lower GIT Pharmacology............................................................................................................... 124
Chapter 14: Embryology................................................................................................................................... 128
4. Chapter 1: Introduction
1. ………….. is the transfer of the GIT contents
to the blood to be utilized by the body cells
a. Digestion
b. Absorption
c. Secretion
2. The saliva osmolality is less than 290 mOsm/L
a. True
b. False
3. All of the following is true concerning ENS:
a. Aurbach plexus is the motor one while
the Meissner is the sensory plexus
b. The neurons of sensory afferent nerves
pass through the submucosal plexus
c. The myenteric plexus mainly inhibitory
containing some excitatory neurons
d. The secretory functions mainly controlled
by the Meissner’s
4. Which of the following is true concerning the
extrinsic innervations of the GIT:
a. It’s modulated by ENS
b. The sympathetic is mainly excitatory to
GIT and the parasympathetic is the
inhibitory
c. Vagal innervations is excitatory to
sphincters
d. The sensory afferent fibers pass to the
prevertebral ganglia , spinal cord and
brain stem
5. All of the following is true concerning BER
except:
a. Initiated by interstitial cells of Cajal which
act as pacemakers
b. Rarely causing muscles contraction by
itself
c. Spike potential superimposing the most
depolarizing part of it to induce muscle
contraction while occurs during the
whole wave
d. Depolarization due to Ca++ influx while
repolarization due to K+ efflux
6. Sympathetic nervous system decreasing all of
the following except:
a. The no. of spikes & mucles tension
b. Motility & secretion
c. Tonicity of the sphincters
d. The activity of ENS
7. All of the following is true concerning
peristalsis except:
a. Local enteric reflex triggered by
distension of the gut
b. Mediated by Aurbach’s plexus
c. Contraction of the circular muscles &
relaxation of the longitudinal ones
inducing the receptive relaxation distal to
the food bolus
d. It proceeds analwards
Answers
1. b
2. a
3. c
4. d
5. c
6. c
7. c
5. Chapter 2: Mouth Cavity & Pharynx
A: Anatomy
1. All of the following is correct about the
temporal fossa EXCEPT:
a. It’s a space on the lateral side of the head
b. It lies above the zygomatic arch bounded
by bones and soft tissue
c. It communicates with the infratemporal
fossa through gap between the zygomatic
arch and the more lateral surface of the
skull
d. It’s filled by temporalis muscle
2. Temporalis muscle takes origin from :
a. Floor of temporal fossa
b. Deep surface of temporal fossa
c. Anterior border of the ramus of the
mandible
d. A & B
e. A & C
3. The nerve supplying temporalis muscle is:
a. Deep temporal nerve
b. Buccal nerve
c. Inferior alveolar nerve
d. None of the above
4. Masseter muscle is inserted in:
a. Lower border of zygomatic arch
b. Inner surface of zygomatic arch
c. Anterior border of the ramus of the
mandible
d. Lateral aspcet of the ramus of the
mandible
e. Coronoid process
5. The Action of the posterior fibers of
temporalis muscle is :
a. Elevation of the mandible
b. Retraction of the mandible
c. Protraction of the mandible
d. Side to side movements
6. Masseter muscle, lateral and medial pterygoid
muscles are supplied by the anterior division
of mandibular nerve:
a. True
b. False
7. The lower head of the later pterygoid muscle
takes origin from:
a. Infratemporal surface of the greater wing
of sphenoid bone
b. Floor of the temporal fossa and the deep
surface of temporal fascia
c. Lateral surface of the lateral pterygoid
plate
d. Maxillary tuberosity
8. All of the following are actions of the lateral
pterygoid muscle EXCEPT:
a. Pulling the head of mandible forward
during opening of the mouth
b. Protraction of the mandible
c. Side to side movments
d. Elevation of the mandible
6. 9. The superfacial head of medial pterygoid
muscle takes origin form:
a. Maxillary tuberosity
b. Coronoid process
c. Lateral surface of the lateral pterygoid
plate
d. Infratemporal surface of the greater wing
of sphenoid bone
10. Medial pterygoid muscle is inserted in:
a. Anterior border of the ramus of mandbile
b. Anterior aspect of the neck of mandible
c. Medial surface of the neck of mandible
d. Medial surface of the angle of mandible
11. All the branches of the posterior division of
mandibular nerve are sensory EXCEPT:
a. Inferior alveolar nerve
b. Lingual nerve
c. Mylohyoid nerve
d. Auricular nerve
e. B & C
12. Which of the following parts are supplied by
branches of the trunk of mandibular nerve:
a. Medial pterygoid muscle
b. Tensor tympani muscle
c. Tensor palate
d. Meninges of middle cranila fossa
e. All of the above
13. The buccal nerve is :
a. The only sensory branch arise from the
posterior division of mandibular nerve
b. It supplies the buccinator muscle
c. It supplies the mucous membrane of the
mouth in the inner surface of buccinator
muscle
d. All of the above
14. All of the following is correct about inferior
alveolar nerve EXCEPT:
a. It innervates the lower teeth
b. It enters the mandibular foramen on the
medial surface of the ramus of mandible
c. It gives motor nerve to mylohyoid muscle
and anterior belly of digastric
d. It divides into incisve and mental
branches adjacent to the incisor tooth
15. Lingual nerve originates in the floor of
temporal fossa:
a. True
b. False
16. Which of the following is not true about the
otic ganglion:
a. It’s a parasympathetic ganglion in the
infratemporal fossa
b. It has four roots; sensory, motor,
sypmathetic and parasympathetic roots
c. It lies below the foramen ovale lateral to
the main trunk of mandibular nerve
d. Gives parasympathetic postganglionic
branches to parotid gland
e. None of the above
17. The motor root of the otic ganglion comes
from:
a. Nerve to lateral pterygoid muscle
b. Trunk of mandibular nerve
c. Anterior division of mandibular nerve
d. None of the above
7. 18. Which of the following is incorrect about the
maxillary artery:
a. It’s the largest branch of the external
carotid artery
b. It’s the major source of blood supply for
nasal cavity, the lateral wall and roof of
the oral cavity, all teeth ,and the dura
mater in the cranial cavity
c. It has only three branches
d. All of the above
e. A & C
19. All of the following are branches of the
mandibular part of maxillary artery EXCEPT:
a. Deep auricular artery
b. Deep temporal artery
c. Inferior alveolar
d. Middle meningeal
e. Accessory meningeal
20. The 3rd
part of maxillary artery:
a. Ascends obliquely through infratemporal
fossa to enter the pterygopalatine fossa
b. Passes through pterygomaxillary fissure
c. Gives branches supplying nasal cavity,
roof of oral cavity, upper teeth, sinuses,
oropharynx and floor of the orbit
d. All of the above
21. What is related to parotid gland superiorly?
a. Ramus of the mandible
b. Angle of the mandible
c. Mandibular fossa
d. Sternomastoid muscle
22. Pterygoid process is extension of :
a. Superficial surface of parotid
b. Deep surface of parotid
c. Upper end
d. Lower end
23. Duct of parotid gland is lateral at first to
a. Buccinator muscle
b. Mandibular angle
c. Ramus of mandible
d. Messter muscle
24. Facial nerve enters Parotid gland in which
surface :
a. Posteromedial
b. Anteromedial
c. Superficial
d. None of the above
25. Retromandibular vein :
a. Formed by union of superficial
temporal vein and mandibular vein
b. Leaves parotid gland through
posteromedial surface
c. Branches to anterior and posterior
divisions
d. None of the above
26. Superficial temporal artery leaves parotid
gland at :
a. Upper end
b. Lower end
c. Superficial surface
d. Anteromedial
27. Which of the following is the main origin of
secremotor supply of Parotid gland :
a. Vagus nerve
b. Trigeminal nerve
c. Glossopharyngeal nerve
d. Facial nerve
8. 28. All are related to the posteromedial surface of
parotid gland except :
a. Posterior border of the
tempromandibular joint
b. Styloid process
c. Mastoid process
d. Internal jugular vein
29. Medial relation of sublingual gland is :
a. Submandibular fossa
b. Sublingual fossa
c. Maxilla
d. Lingual nerve
30. Blood supply of sublingual gland is :
a. Lingual artery and facial artery
b. Maxillary artery
c. ECA
d. CCA
31. Continuity between superficial & deep
surface of submandibular gland is in :
a. Posterior belly of digastric muscle
b. Anterior belly of digastric muscle
c. Posterior border of mylohyoid muscle
d. None of the above
32. All of the following is related to the medial
surface of superficial submandibular gland
except :
a. Mylohyoid muscles
b. Sublingual gland
c. Hyoglossas muscle
d. Medial Pterygoid muscle
33. One of the following is related to the
superficial surface of submandibular gland :
a. SM lymph nodes
b. Skin
c. Facial artery
d. Facial vein
34. The deep surface of the sub mandibular gland
extends in interval ,, what is the lateral side of
this interval :
a. Stylohyoid
b. Mylohyoid
c. Hyoglossus
d. Posterior belly of digastric
35. Secremotor branch of submandibular gland is
a. Lesser petrosal nerve
b. Chorda tympani of facial
c. Greater petrosal nerve
d. Lingual nerve
36. Pharyngobasilar fascia is :
a. Mucosal membrane of pharynx
b. Muscles of the pharynx
c. Outer fibrous coat
d. Inner fibrous coat
37. All of the following give origin to the superior
constrictor muscle except :
a. Lateral pterygoid plate
b. Medial pterygoid plate
c. Pterygoid hamulus
d. Mylohyoid line
38. All of the following give origin to the inferior
constrictor muscle except :
a. Lower part of stylohyoid ligament
b. Upper part of stylohyoid ligament
c. Greater horn of hyoid
d. Lesser horn of hyoid
39. Nerve supply of constrictor muscles is :
a. Pharyngeal plexus
b. Greater palatine nerve
c. Nerve to mylohyoid
d. Facial nerve
9. 40. The action of constrictor muscles is :
a. Close oropharyngeal isthmus
b. Widen nasopharyngeal isthmus
c. Pull the pharyngeal wall forwards
d. None of the above
41. All of the following elevates the pharynx
except :
a. Salpingopharyngeas
b. Stylopharyngeas
c. Platopharyngeas
d. Inferior constrictor muscle
42. Oropharynx starts at :
a. Superior border of the soft palate
b. Inferior border of the soft palate
c. Epiglottis
d. Base of the skull
43. Lateral boundary of the palatine tonsil is
a. Inferior constrictor muscle
b. Superior constrictor muscle
c. Middle constrictor muscle
d. Soft palate
44. The site of pyriform fossa related to the
aryegpiglottic fold :
a. Lateral
b. Medial
c. Behind
d. Anterior
45. Stylopharyngeas muscle is supplied by :
a. 10th
cranial nerve
b. 11th
cranial nerve
c. 9th
cranial nerve
d. 8th
cranial nerve
46. Lymphatic drainage of the pharynx is to
a. Deep cervical lymph nodes
b. Paratracheal lymph nodes
c. Retropharyngeal lymph nodes
d. All of the above
47. Capsule surrounds palatine tonsil :
a. Superiorly
b. Laterally
c. Medially
d. Inferiorly
Answers:
1. C
2. D
3. A
4. D
5. B
6. B
7. C
8. D
9. A
10. D
11. C
12. E
13. C
14. D
15. B
16. C
17. D
18. E
19. B
20. D
21. C
22. B
23. D
24. A
25. C
26. A
27. C
28. A
29. D
30. A
31. C
32. A
33. A
34. B
35. B
36. D
37. A
38. B
39. A
40. C
41. D
42. B
43. B
44. A
45. C
46. D
47. A
10. Essay
1. Enumerate the contents of infratemporal fossa
2. Give the relation of muscle of mastication to the infratemoral fossa
3. Give an account on all muscles of mastication concerning their: Origin- Insertion - Nerve supply &
Action
4. Give the course of mandibular nerve
5. List the branches of mandibular nerve : branches from trunk, anterior and posterior divisions
6. Compare between lateral and medial pterygoid muscle according to: origin, insertion, nerve supply
and action
7. Give an account on the otic ganglion and mention its site, roots & branches
8. Explain the course of maxillary artery and its origin
9. Ment Enumerate the boundaries of the two division of mouth cavity
10. Enumerate muscles of the floor of the mouth
11. Compare between geniohyoid and mylohyoid muscles
12. Discuss the origin, insertion, nerve supply and action of :
Digastric muscle
Stylohoid muscle
Mylohyoid muscle
Geniohyoid muscle
13. Compare between the two divisions of the palate
14. Enumerate the contents of the soft palate
15. Mention the boundaries of the hard and soft palate
16. Give an account on the Palatine aponeurosis
17. Compare between tensor and levator palati muscles: origin, insertion, NS & action
18. Discuss the origin, insertion, nerve supply and action of :
Levator palati
Tensor palati
Palatoglossus muscle
Palatopharyngeus muscle
Musculus uvulas
19. Give an account on three of muscles of the soft palate
20. Compare between palatoglossus and palatopharyngeus muscle
21. Discuss the nerve supply to the palate:
Sensory nerve supply
Motor sense supply
11. Palatine glands nerve supply
Taste sensation
22. Discuss the blood supply of the palate (venous and arterial) and its lymphatic drainage
23. Mention the nerve supply and lymph drainage of hard palate
24. Describe the mucous membrane of the dorsum of the tongue
25. Give an account on the 2 types of the tongue muscles
26. Enumerate the extrinsic muscles of the tongue
27. Compare between styloglossus and stylohyoid muscle
28. compare between geniohyoid and genioglossus muscle
29. give an account on hyoglossus muscle
30. Discuss the blood supply of the tongue (arterial and venous) and lymphatic drainage
31. Describe the nerve supply of the tongue (sensory and motor)
32. ion the branches of maxillary artery
33. Discuss the composition of the wall of the pharynx?
34. Compare between superior, middle and inferior constrictor muscle of the pharynx?
35. Compare between the stylopharyngeus and salpingopharyngeus muscle?
36. What are the relations of the palatine tonsils?
37. What are the blood supply and lymph drainage and nerve supply of palatine tonsils?
38. Discuss the pyriform fossa?
39. What is the nerve supply of the pharynx?
40. Discuss the blood supply of the pharynx and lymphatic drainage of the pharynx?
41. Discuss the surface anatomy of the parotid gland?
42. What are the structures within the parotid gland?
43. What are the relations of the parotid gland?
44. Compare between the relations of superficial part and the deep part of the sub mandibular gland?
45. What are the relations of the sublingual salivary gland?
46. Compare between the sublingual and submandibular gland in: (duct- blood supply- lymph drainage-
nerve supply)?
12. B: Physiology
1. All of the following is true concerning
salivary secretions except:
a. Serous type secreted mainly by the parotid
responsible for starch digestion while the
mucous secretion by submandibular &
sublingual for lubrication & the buffer
action
b. The pH varies from 6.9:7.1 which is
suitable for amylase enzyme
c. Hypotonic due to aldosterone action
d. Nervous control dominates hormonal one
2. All of the following is true concerning the
sympathetic innervations to the salivary
glands except:
a. The pregangilionic fibers arising from T1
& T2 spinal cord segments relaying in the
superior cervical ganglion
b. The postganglionic fibers pass with the
supplying arteries innervating the glands
c. Increasing the viscosity of the secretions
all of the salivary glands
d. VC & reduction of the blood flow
3. Which is true concerning the
parasympathetic supply to the parotid gland:
a. Increasing water & decreasing organic
content
b. Increasing O2 consumption 3 folds &
blood flow 10 times by VD
c. The pre-ganglionic fibers arising from
inferior salivary nucleus in the pons
passing through IX nerve to the otic
ganglion
d. The postganglionic fibers reaching the
gland through V n.
4. …………. Responsible of buffering action of
the salivary secretions :
a. Thiocyanates
b. CaHCO3
c. Lysozyme enzyme
d. NaHCO3
5. ……………. Responsible for the bactericidal
action of the saliva except:
a. Mucin
b. Lyzozyme
c. Thiocynates
d. Globulins
6. Excess alkali form tarter & calcium calculi
while excess acids dissolve teeth
a. True
b. False
7. All of the following are major salivary
functions except:
a. Articulation
b. Buffering oral secretions & cleaning
mouth cavity
c. Regulation of water intake & body
temperature in coordination with
hypothalamus
d. Excretion of urea & glucose under basal
conditions
8. All of the following true concerning
conditioned reflex except:
a. Stimulus is either mechanical as speech or
chemical as food
b. The receptors are taste, mechanical &
pharyngeal receptors
c. The afferent of taste sensation is VII , IX &
X nerves
13. d. The sympathetic center are the salivatory
centers
e. The efferent is ANS
9. Which is true concerning the acquired reflex:
a. The receptors are located in the buccal
cavity
b. Training dependant explained by Pavlov
experiment
c. The centers are the salivatory ones in the
cerebral cortex
d. Dependant on food presence in the mouth
10. All of the following are true concerning
mastication process except:
a. Voluntary & involuntary reflex
b. The stimulus is food & its center in the
pons
c. Begins with reflex contraction of the
muscles followed by reflex relaxation
d. The rate is 1 cycle/ min
11. All the following are reflexes that occur
during the 2nd phase except:
a. Reflex apnea.
b. Elevation of the larynx.
c. Adduction of the vocal cords.
d. Depression of the soft palate.
12. Which of the following is responsible for anti
reflux action:
a. Pharyngeal sphincter
b. Upper oesophageal sphincter
c. Cardiac sphincter
d. All the above.
13. which is true about oesophogeal sphincter:
a. Its tone is increased by gastrin.
b. Its tone decreased by VIP
c. Its rhythmic contraction.
d. All the above.
14. All the following are true about the peristaltic
contraction except:
a. The primary peristaltic contraction
depending mainly on the vagus nerve.
b. The primary peristaltic contraction starts
before reach the food to the oesophageus.
c. The myogenic stimuli stimulate the
secondary peristaltic contraction.
d. The two types of peristaltic ocuur at
separate times.
15. Which of the following phases is
voluntary:
a. Pharyngeal
b. Buccal.
c. Oesophageal.
d. All the above.
16. which of the following is true about the third
phase:
a. Its voluntary
b. It occur in the pharynx
c. Helped by mucin secretion
d. Afferent nerve is 11,12
17. The deglutation center present in the ?
a. Pons
b. Medulla
c. Cerebellum.
d. None of the above.
18. Which is true about the pharyngeal phase:
a. The afferent N are 5,9,10
b. Center is the pons.
c. Efferent N 5, 9, 10, and11 to the tongue.
14. Answers:
1. b
2. c
3. c
4. d
5. a
6. b
7. d
8. D
9. B
10. C
11. D
12. C
13. B
14. D
15. B
16. C
17. B
18. A
Essay
1. Mention the contents of temporal and infratemporal fossa
2. Define a)Temporal fossa b)Infratemporal fossa
3. enumerate the muscles of mastication
4. give an account on :
a) Temporalis muscle
b) Masseter muscle
c) Lateral pterygoid muscle
d) Medial pterygoid muscle
e) Mandibular nerve course
f) The trunk branches of mandibular n.
g) Mandibular n. Branches of anterior division
h) Mandibular n. Branches of posterior division
5. Mention the otic ganglion roots
6. Enumerate the otic ganglion branches
7. Define maxillary artery
8. Mention maxillary artery origin
9. Discuss course of maxillary artery
10. Give an account on maxillary artery branches
11. Give an accoiunt on salivary secretion
12. Discuss salivary secretion types
13. Explain how we can consider salivary secretion is an active process
14. Mention the effects of stimulation of parasympath. And sympathy. Innervations on salivary glands
functions
15. Give an account on saliva composition
16. Enumerate the functions of saliva
17. Explain the control of saliva secretion
18. Give a brief account on chewing
15. 19. Explain mastication importance
20. Define oesophagus
21. Give an account on oesophagus functions
22. Explain 1ry peristaltic contractions
23. Discuss 2ry peristaltic contractions
24. Give an account on deglutition phases
25. Mention the important protective reflexes
26. Explain the nervous pathways in deglutition
16. C: Histology
1. Which of the following in mouth cavity is/are
formed of keratinized stratified Squamous
epithelium?
a. Cheek
b. Gums
c. Skin surface
d. All of the above
2. Which of the following in mouth cavity are
thin layer
a. Cheek
b. Gums
c. Skin surface
d. Mucous membrane
3. Which gland is found in the cheek
a. Buccal gland
b. Labial gland
c. Lingual gland
d. None of the above
4. Which gland is found in the lips
a. Buccal
b. Labial
c. Lingual
d. None of the above
5. Which gland is found in the tongue
a. Buccal
b. Labial
c. Lingual
d. None of the above
6. Which gland are found in circumvalliate
papillae
a. Buccal
b. Labial
c. Lingual
d. None of the above
7. The covering of red margin of lips is
a. Thin keratinized str. Sq.
b. Thick keratinized str. Sq.
c. Thick non ker. Str. Sq.
d. Thin non ker. Str. Sq
8. Which layer of lips doesn't contain papillae
a. Skin surface
b. Red margin
c. Mucous surface
d. All of the above
9. The covering of the skin surface of lips is
a. Thin ker. str. sq.
b. Thin non ker. Str. Sq.
c. Thick ker. Str. Str. Sq.
d. Thick non ker. Str . sq,
10. The covering of mucous surface of lips is
a. Thin ker. Str. Sq.
b. Thin non ker. Str. Sq.
c. Thick ker. Str. Str. Sq.
d. Thick non ker. Str . Sq,
11. The labial glands found in …….. of lips
a. Skin layer
b. Red margin
c. Mucous
d. All of the above
12. The tongue is covered by all of the following
except
a. ker. Str. Sq.
b. Striated muscles
c. CT corium
d. None of the above
13. The mucosa of ventral surface of tongue
attach firmly
(A= true, B= False)
17. 14. Muscle layer of the tongue are embedded in
a. Adherent CT
b. Adipose tissue
c. Both a & b
d. None of the above
15. Lingual papillae are found in
a. Ant 2/3 of the ventral surface of the
tongue
b. Ant 2/3 of the dorsal surface of the tongue
c. Post1/3 of the ventral surface of the
tongue
d. Post 1/3 of the dorsal surface of the
tongue
16. Which type of lingual papillae are the largest
one
a. Filiform papillae
b. Fungiform papillae
c. Circumvillate papillae
d. Folliate papillae
17. Which type of lingual papillae are the longest
a. Filiform papillae
b. Fungiform papillae
c. Circumvillate papillae
d. Folliate papillae
18. Which type of lingual papillae are
keratinized
a. Filiform papillae
b. Fungiform papillae
c. Circumvillate papillae
d. Folliate papillae
19. Which type of lingual papillae contain van
ebner gland
a. Filiform papillae
b. Fungiform papillae
c. Circumvillate papillae
d. Folliate papillae
20. Which type of lingual papillae having long
secondry papillae
a. Filiform papillae
b. Fungiform papillae
c. Circumvillate papillae
d. Folliate papillae
21. Nasopharynx are lining by
a. Pseudostr. Ciliated
b. Non ker. Str. Sq.
c. Ker. Str. Sq.
d. None of the above
Answers
1. b
2. d
3. a
4. b
5. c
6. d
7. c
8. a
9. a
10. d
11. c
12. a
13. b
14. b
15. b
16. c
17. a
18. a
19. c
20. d
21. a
18. Essay:
1- Discuss the histological variations of the cheek from the mucous membrane of the oral cavity.
2- Compare between the parts of a lip
distinguished through sagittal section.
3- Compare between the lingual papillae (in the
human tongue).
4- Mention the site & function of the Von Ebner’s
glands.
5- Identify the organs & enumerate the labels.
6- Compare between the major & minor
salivary glands.
7- Compare between the different parts of the
duct system of the salivary glands.
8- Compare between mucous & serous acini.
9- Compare between parotid, submandibular &
sublingual salivary glands.
10- Identify this gland & mention the labels.
19. D: Microbiology
1. All are true about polio viruses except:
a. They belong to Rhinovirus genus.
b. They are small RNA viruses.
c. There are no permanent carriers of the
disease.
d. They can be recovered from throat swabs.
2. All of the following factors helped in
poliovirus eradication except:
a. It has a stable antigenic structure.
b. There are no permanent carriers of the
disease.
c. The virus can infect also infect animals.
d. None of the above.
3. The poliovirus can be recovered from:
a. A throat swab 4 weeks after onset of
disease.
b. A rectal swab 4 weeks after onset of
disease.
c. A CSF specimen.
d. All of the above.
4. All of the following are direct sequel of
poliovirus infection except:
a. Abortive poliomyelitis.
b. Aseptic meningitis.
c. Flaccid paralysis.
d. Progressive post-poliomyelitis muscle
dystrophy.
5. All are true about the Salk vaccine except:
a. It simulates natural infection and cause
long-lasting immunity.
b. It cause IgM and IgG titre rise.
c. It is given intravenously.
d. It is one of the killed viral vaccines.
6. The following infections can be caused by
coxsackie A,B viruses and echo viruses
except:
a. Skin eruptions and rash.
b. Aseptic meningitis.
c. Cold-like symptoms.
d. Viral myocarditis.
7. All are true about Mumps virus except:
a. It replicates in the gastrointestinal tract
especially Peyer’s patches of intestine.
b. It can affect ovaries and testis.
c. Immunity against it is permanent.
d. It can be prevented by trivalent MMR
vaccine.
8. Aseptic meningitis is characterized by:
a. Normal glucose CSF level.
b. High glucose CSF level.
c. Normal protein CSF level.
d. Few cellular debris in CSF.
Answers:
1. a
2. c
3. b
4. d
5. a
6. d
7. a
8. a
20. Essay:
1. Give a short account on pathogenesis of poliovirus.
2. Give 2 differences between the ‘’Salk’’ and the ‘’Sabin’’ vaccines.
3. What is meant by interference? Explain its effect in relation to polio vaccination.
4. Enumerate 4 diseases caused by Coxsackie A and B viruses.(4 examples each)
5. Give examples for organs affected with the Mumps virus.
6. Explain the lab diagnosis for a case of:
Epidemic parotitis.
Poliomyelitis.
21. E: Pathology of oral cavity
1. …… is a miscellaneous cause of oral lesions
a. Lichen planus
b. Behcet’s syndrome
c. Actinomycosis
d. ADIS
2. The commonest inflammatory injury of the
mouth is ……….
a. Traumatic stomatitis
b. Aphthous ulcers
c. Thrush stomatitis
d. Angular cheilitis
3. ………………. May cause viral encephalitis
in immunocompromised patient
a. Traumatic stomatitis
b. Aphthous ulcers
c. Herpetic stomatitis
d. Angular cheilitis
4. Vitamin B deficiency can cause ……………
a. Traumatic stomatitis
b. Aphthous ulcers
c. Thrush stomatitis
d. Angular cheilitis
5. Streptococcal infection is associated with
6. Treponema fusiformis can cause…………..
7. Antibiotics associated angina is …………
a. Vincent’s angina
b. Ludwing’s angina
c. Agranulocytic angina
8. Noma is associated with ………
9. Ranula caused by ………….
a. Vincent’s angina
b. Epulis
c. Retention cysts
d. Pyogenic granuloma
10. The most diagnostic feature of leukoplakia
a. Carcinoma in situ
b. Chronic inflammation
c. Hyperkeratosis
d. Can by scrapped off
11. …………. Is the most characteristic feature
of erythroplakia
a. Dysplasia & carcinoma in situ
b. Vascular dilatation
c. Subepithelial inflammatory reaction
d. Patches with sharply demarcated borders
12. All of the following are histologic patterns of
HNSCCs except:
a. Hyperplasia
b. Hyperkeratosis
c. Atypia
d. Metaplasia
e. Dysplasia
13. …………………. Has raised everted edges
14. ………………… with punched edges
15. ………………….. with undermined edges
a. Syphilitic ulcer of the tongue
b. Malignant ulcer
c. Tuberculous ulcers of the tongue
16. A precancerous lesion:
a. Acute glossitis
b. Chronic glossitis
c. Syphilitic glossitis
d. Tuberculous glossitis
17. Sjogren’s syndrome is associated with
a. Xerostomia
b. Miklulicz syndrome
c. Destruction of lacrimal glands
d. All of the above
22. 18. All of the following are complications of
sialolithiasis except:
a. Sialadenitis
b. Meals related swelling
c. Fibrosis & atrophy
d. Precancerous
19. All of the following are true concerning
pleomorphic adenoma except:
a. Encapsulated with tongue like protrusions
b. Composed of cystically dilated spaces
with abundant mucoid sroma
c. Transformed into malignant mixed tumor
of the parotid
d. Usually recurs
20. All of the following true concerning
adenolymphoma except:
a. Cystically dilated spaces
b. Surface palisading epithelial cells
c. Germinal centers
d. Recurs in 25% of the cases after removal
Answers:
1. b
2. b
3. c
4. d
5. b
6. a
7. c
8. a
9. c
10. c
11. a
12. d
13. b
14. a
15. c
16. b
17. d
18. d
19. b
20. d
Essay
1. List the causes of stomatitis
2. Differentiate the types of oral cavity
3. Mention three:
Oral lesions associated with certain diseases
Primary oral lesions
4. Discuss three stomatitis cases caused by infection
5. Give an account on:
Vincent’s angina
Ludwig’s angina
Aphtous ulcers
Moniliasis thrush stomatitis
23. 6. Talk about the three oral angina
7. Mention examples of reactive proliferation and soft tissue swellings in the oral cavity
8. Give an account on :
Ranula
Noma
9. Discuss two precancerous oral lesions
10. Compare between erythroplakia and leukoplakia grossly and microscopically
11. Classify tumors of the oral cavity
12. Mention the metastatic sites and the prognosis of the oral squamous cell carcinoma
13. List predisposing factors to oral squamous cell carcinoma
14. Discuss the morphology of oral squamous cell carcinoma
15. Define field cancerization
16. Define glossitis and enumerate its causes
17. Enumerate causes of precancerous lesion In the tongue
18. Enumerate congenital anomalies of the tongue
19. Classify ulcers of the tongue and differentiate between them
20. Define the sjogren syndrome and list the causes of xerostomia
21. Give an account on sialolithiasis and mention its effects
22. Discuss the etiology of sialadenitis
23. Compare between pleomorphic adenoma and adenolymphoma of salivary glands concerning :
Sites
Morphology
Prognosis
24. Chapter 3: Abdomen anatomy:
A: Ant. Abdominal wall
1. In physically fit people, the umbilicus lies at
the level of the intervertebral disc between
…….. vertebrae
a. L2 & L3
b. L3 & L4
c. L5 & S1
d. None of the above
2. ………. is a median fibrous white line or
band divides the anterior abdominal wall into
right and left halves
a. Umbilical cord
b. Linea alba
c. Linea semilunaris
d. Subcostal plane
3. All of the following are true about linea
semilunaris except
a. Curved line
b. Extend between 9th
costal cartilage &
pubic tubercle
c. indicates the lateral border of the
rectus abdominis muscle
d. convex medially
4. all of the following are true about subcostal
plane except
a. vertical plane
b. inferior to subcostal margins
c. passes through the body of L3
vertebra
d. all of the above are false
5. the fascia of anterior abdominal wall consists
of a superficial fascia and a deep fascia
a. true
b. false
6. ……….. is a Superficial fatty layer of
superficial fascia of anterior abdominal wall
a. Colle’s fascia
b. Fascia lata
c. Camper’s fascia
d. Scarpa’s fascia
7. All of the following are true about Scarpa’s
fascia except :
a. Deep membranous layer of superficial
fascia of anterior abdominal wall
b. Contain large amount of fat
c. Continuous with fascia lata
d. Continuous with colle’s fascia
8. All of the following are muscles of anterior
abdominal wall except
a. External abdominal oblique
b. Internal abdominal oblique
c. Psoas major
d. Rectus abdominis
9. All of the following are true about External
abdominal oblique muscle except
a. It’s origin from inner surface of lower
6 ribs
b. Supplied by 7- 11 intercostal nerves
c. Flexes and laterally bends the trunk
d. One of the anterior abdominal wall
muscles
25. 10. The External abdominal oblique , Internal
abdominal oblique and Transversus
abdominis have the same
a. Origin
b. Action
c. Nerve supply
d. Bothe b & c
11. All of the following are true about Internal
abdominal oblique muscle except
a. It’s origin from lateral 2/3 of the
inguinal ligament.
b. It’s fibers directed downward forward
and medially
c. Flexes and laterally bends the trunk
d. Supplied by 7- 11 intercostal nerves
12. Conjoint tendon is formed from the lowers
fibers of Internal abdominal oblique muscle
together with lower fibers of Transversus
abdominis muscle
a. True
b. False
13. All of the following give an origin to
Transversus abdominis muscle except
a. Inner surface of the lower 6 ribs
b. thoracolumbar fascia
c. anterior 2/3 of the inner lip of iliac
crest
d. Lateral 2/3 of inguinal ligament.
14. All of the following are true about rectus
abdominis except
a. It’s origin is lower fibers of internal
oblique muscle
b. Supplied by subcostal nerve
c. Flexes the trunk
d. Inserted in xiphoid process
15. ………. Draws the linea alba inferiorly
(stretch it )
a. External abdominal oblique
b. Internal abdominal oblique
c. Pyramidalis
d. Rectus abdominis
16. All of the following are true about
cremasteric muscle except :
a. Supplied by genital branch of
genitofemoral nerve
b. Elevates testis
c. Inserted in pubic tubercle
d. It’s origin is symphysis pubis
17. All of the following are blood supply of the
anterior abdominal wall except
a. internal thoracic artery
b. Inferior phrenic artery
c. Internal iliac artery
d. Lumbar arteries
18. N.S of anterior abdominal wall include
a. ventral rami of the inferior 6 thoracic
nerves
b. iliohypogastric nerve
c. ilioinguinal nerve
d. all of the above
19. The common blood supply of the skin &
muscles of anterolateral wall explain why
palpating abdomen with cold hands causes
the muscles of the abdominal wall to contract
a. True
b. False
20. the intercostal nerves run between the
external oblique and transversus abdominis
muscles
a. true
b. false
26. 21. lymphatics of anterior abdominal wall above
the umbilicus are drained into
a. axillary lymph nodes
b. superficial inguinal lymph nodes
c. deep inguinal lymph nodes
d. none of the above
22. superficial inguinal lymph nodes receive
lymph from
a. The lower abdominal wall
b. Buttocks
c. External genitalia
d. all of the above .
23. The anterior wall of upper part rectus sheath
is formed by:
a. 5,6,7 costal cartilage
b. aponeurosis of internal oblique
muscle
c. aponeurosis of external oblique
muscle
d. none of the above
24. Concerning the middle part rectus sheath,the
true statement is:
a. lies between the xiphoid process and
1st
line
b. its posterior wall is formed by
posterior wall of aponeurosis of
inrenal oblique+aponeurosis of
external oblique
c. its anterior wall is formed by
aponurosis of external
oblique+anterior layer of aponeurosis
of internal oblique
d. B & C
25. Lower arched boarder of fascia transversalis
at the posterior wall of lower part rectus
sheath:
a. inguinal ligament
b. deep inguinal ring
c. superficial inguinal ring
d. none of the above
26. Concerning the deep inguinal ring,the true
statement is :
a. Opening in external oblique
aponeurosis
b. Medial to inferior epigastric vessels
c. It is half an inch above the midpoint
of arcuate line
d. The inguinal canal begins at it
27. The anterior wall of the inguinal canal is
formed by :
a. Aponeurosis of external
oblique+fleshy fibers of internal
oblique
b. Inguinal+lacunar ligaments
c. Conjoint tendon +reflected ligament
d. None of the above
28. Inguinal canal floor:
a. Inguinal +reflected ligaments
b. Inguinal+lacunar ligaments
c. Arched fibers of internal oblique
d. None of the above
29. Concerning Hesselbachs triangle,the false
statement is:
a. Bounded laterally by lateral edge of
the rectus abdominus muscle
b. Its base is the inguinal ligament
c. Site of indirect inguinal hernia
d. A & C
27. 30. The remnant of the obliterated urachus:
a. medial umbilical ligament
b. lateral umbilical ligament
c. median umbilical ligament
d. none of the above
31. Lateral umbilical fold:
a. Covers inferior epigastric vessels
b. Extends from lateral side of deep
inguinal ring to arcuate line
c. A & B
d. None of the above
32. Sites of abdominal hernia include:
a. Inguinal
b. Epigastric
c. Femoral
d. All of the above
Answers
1. B
2. B
3. D
4. A
5. B
6. C
7. B
8. C
9. A
10. D
11. B
12. A
13. D
14. A
15. C
16. D
17. C
18. D
19. B
20. B
21. A
22. D
23. c
24. c
25. d
26. d
27. a
28. b
29. d
30. c
31. a
32. d
Essay:
1. Enumerate different layers forming the anterior abdominal wall.
2. Mention the action of:
- Rectus abdominus - External oblique muscle.
3. The lower free border of external oblique muscle is known as….
4. The part of anterior abdominal wall below the umbilicus is drained by …… LNs
5. Enumerate 3 different arteries that supply the anterior abdominal wall and mention the origin of
each.
6. Mention the nerves that supply anterior abdominal wall muscles.
7. Discuss the different parts of the rectus sheath and how they formed?
8. What is the content of the rectus sheath?
9. What is the relation and content of the inguinal canal?
10. Discuss the umbilical folds or ligaments in the inner surface of anterior abdominal wall?
11. What are the causes and most common sites of the hernia?
28. B: Posterior abdominal wall
1. Concerning psoas major muscle,the true
statement is:
a. The main lateral flexor of the trunk
b. Inserted in greater trochanter of the
femur
c. Supplied by femoral nerve
d. The genitofemoral nerve lies anterior
to it
2. Iliacus muscle is supplied by:
a. Femoral nerve
b. Obturator nerve
c. Anterior rami of l1-2-3
d. None of the above
3. Quadratus lumborum muscle originates
from:
a. Iliolumbar ,anterior sacroiliac
ligaments and internal lip of iliac crest
b. Iliolumbar,anterior sacroiliac
ligaments and outer lip of iliac crest
c. Transverse processes of t12-l5
d. None of the above
4. Concerning psoas minor muscle ,the false
statement is:
a. Inserted in lesser trochanter of femur
with iliacus
b. Supplied by anterior rami of l1
c. May be absent
d. Causes weak flexion of the trunk
5. Psoas major muscle is supplied by:
a. Femoral nerve
b. Obturator nerve
c. Anterior rami of L2-3-4
d. Anterior rami of L1-2-3
6. The following muscles take origin from
iliolumbar ligament, except:
a. Iliacus
b. Psoas major
c. Psoas minor
d. B & C
7. All the following nerves are lateral to psoas
major muscle, except:
a. Femoral
b. Lateral cutaneous nerve of the thigh
c. Lumbosacral trunk
d. Iliohypogastric
8. The genitofemoral nerve is formed from:
a. T12,L1
b. L1,2
c. L1,2,4
d. none of the above
9. The femoral nerve arises from:
a. anterior division of L2-3-4
b. posterior division of L1-2-3
c. anterior division of L1-2-3
d. posterior dvision of L2-3-4
10. Medial to psoas major muscle:
a. sympathetic trunk
b. obturator nerve
c. lumbosacral trunk
d. all of the above
11. Arises from posterior division of L2-3:
a. genitofemoral nerve
b. lateral cutaneous nerve of the thigh
c. femoral nerve
d. obturator nerve
29. 12. Concerning the sympathetic trunk ,the false
statement is:
a. has 4 ganglia in the abdomen
b. enters the abdomen deep to medial
arcuate ligament
c. lies along the anterior border of psoas
major
d. lies behind IVC and on the left side
13. Abdominal aorta enters the abdomen
opposite:
a. T10
b. T12
c. T8
d. none of the above
14. All of the following are on the right side of
abdominal aorta except:
a. azygous vein
b. inferior vena cava
c. thoracic duct
d. sympathetic trunk
15. All of the following are single branches of
abdominal aorta except:
a. median sacral artery
b. lumbar arteries
c. inferior mesenteric artery
d. coeliac trunk
16. All the following are anterior relations of
inferior vena cava except:
a. posterior surface of the liver
b. head of pancreas
c. coils of small intestine
d. anterior longitudinal ligament
17. The coeliac plexus receives its sympathetic
supply from:
a. greater,lesser splanchnic nerves
b. pelvic splanchnic nerve
c. L1-2 lumbar splanchnic nerves
d. none of the above
Answers
1. D
2. A
3. D
4. A
5. D
6. D
7. C
8. B
9. D
10. D
11. B
12. C
13. B
14. D
15. B
16. D
17. A
30. C: Anatomy of peritoneum
1. All of the following is true about the parietal
peritoneum EXCEPT:
a. It lines the walls of the abdominal cavity
b. It clothes the anterior and posterior
abdominal walls
c. It clothes the diaphragm and the pelvic
cavity
d. The peritoneal cavity lies between it and
the visceral peritoneum
e. None of the above
2. The visceral peritoneum :
a. Is a Continuation of the parietal
peritoneum
b. Leaves the posterior wall of the abdominal
cavity to invest certain viscera
c. Clothes the whole surface of all organs
the abdominal viscera
d. Forms the peritoneal cavity between it
and the abdominal viscera
e. A & B
3. Which of the following organs is partially
invaginated in the visceral peritoneum:
a. Stomach
b. Transverse colon
c. Small intestine
d. Kidney
e. Sigmoid colon
4. The upper layer of coronary ligament is
formed by :
a. The reflection of the peritoneum from the
posterior part of the inferior surface of
the liver to the front of the right kidney
and suprarenal gland
b. A continuation of the peritoneum on the
under surface of the diaphragm
c. The reflection of the peritoneum from the
under surface of diaphragm to the
superior surface of the liver
d. None of the above
5. The falciform ligament is a sickle shaped fold
of peritoneum connects the anterior
abdominal wall with the liver to the left of the
median plane.
a. True
b. False
6. Which of the following is correct about the
lower layer of coronary ligament:
a. It’s formed the reflection of the
peritoneum from the posterior part of the
inferior surface of the liver to the front of
the right kidney and suprarenal gland
b. It bounds with the upper layer the bare
area of the liver
c. It meets with the upper layer to form the
right triangular ligament at the apex of
the bare area of the liver
d. All of the above
31. 7. The lesser omentum :
a. A peritoneum fold connecting the liver
with the stomach
b. It’s Formed by a layer enclosing the
Stomach
c. It descends down and then recur up to be
attached to the anterior border of
pancreas
d. All of the above
8. The transverse mesocolon is a peritoneal fold
formed by the peritoneum of greater sac
passing down from the anterior border of the
pancreas:
a. True
b. False
9. Which of the following is not true about the
mesentry of small intestine:
a. It’s a reflection from the peritoneum
covering the posterior abdominal wall
b. It passes down to cover the posterior
surface of the pancreas
c. It passes along the course of superior
mesenteric artery
d. It encloses the free part of small intestine
10. which of the following is not true about the
lesser sac:
a. It’s a diverticulum from the greater sac
b. It extends down behind the stomach as far
as the transverse mesocolon
c. It’s bounded below the stomch by the
greater omentum
d. The epiploic foramen is its only opening
which lies behind the free edge of the
greater sac
e. None of the above
11. The inferior boundary of the epiploic
foramen is:
a. The inferior vena cava
b. The inferior surface of the liver
c. The first part of the duodenum
d. The portal vein of the liver
12. The posterior boundry of the epiploic
foramen is:
a. The inferior vena cava
b. The inferior surface of the liver
c. The first part of the duodenum
d. The common bile duct
13. Anterior wall of the lesser sac is formed by all
of the following EXCEPT:
a. The lesser omentum
b. Anterior two layers of the greater
omentum
c. Peritoneum covering the posterior surface
of the stomach
d. Peritoneum covering the first part of
duodenum
e. None of the above
14. The upper part of the lesser sac is related to
the peritoneum covering all of the following
organs EXCEPT:
a. Left crus of diaphragm
b. Left kidney
c. Upper surface of the pancreas
d. Left suprarenal gland
e. Upper part of abdominal aorta
32. 15. The upper border of the lesser sac is formed
by the reflection of peritoneum of the
posterior layer of lesser omentum on the
diaphragm:
a. True
b. False
16. The upper part of the left border of the lesser
sac is formed by
a. Gastrosplenic & lienorenal ligaments
b. left margin of the greater omentum
c. the epiploic foramen
d. None of the above
Answers
1. E
2. E
3. D
4. C
5. B
6. D
7. A
8. A
9. B
10. D
11. C
12. A
13. E
14. C
15. A
16. A
Essay
Anatomy of peritoneum
1- Classify the abdominal organs in relation to their peritoneal covering?
2- Compare between the greater and lesser sac?
3- What are the boundaries of the epiploic foramen?
4- What is the relation of the lesser sac of the peritoneum?
Anatomy of posterior abdominal wall, aorta and IVC
1- Compare between the different muscles of posterior abdominal wall?
2- What are the relations of the abdominal aorta?
3- Discuss the branches of the abdominal aorta?
4- What are the relations of IVC?
5- What are the tributaries of IVC?
6- What are the branches of the lumber plexus?
33. Chapter 5: Esophagus
A: Anatomy
1. Esophagus begins as a lower continuation of
the trachea and ends at the cardiac end of the
stomach
a. True
b. False
2. All of the following are true about the
cervical part of esophagus except
a. Begins opposite the lower border of
cricoid cartilage
b. At the level of 5th
cervical vertebra
c. Between the trachea anteriorly and
vertebral column posreriorly
d. Recurrent laryngeal nerve lies in the
groove between the trachea and
esophagus
3. …….. is the longest and the main part of the
esophagus .lies in the superior and posterior
mediastinum
a. Cervical
b. Thoracic
c. Abdominal
d. None of the above
4. In the posterior mediastinum , the esophagus
lies between the trachea anterior and the
vertebral column posterior
a. True
b. False
5. In the superior mediastinum, the …… is close
to the right side of the esophagus while ……..
is close to the left side
a. Azygos vien , thoracic duct
b. thoracic duct , Azygos vien
c. prevertebral muscle , trachea
d. trachea , prevertebral muscle
6. The esophagus enters the abdomen through
the opening In the right crus of the
diaphragm
a. True
b. False
7. The …… end of the esophagus is a asite of
portosystemic anastomosis so vulnerable to
esophageal varices in case of portal
hypertension
a. Upper
b. Cervical
c. Lower
d. All of the above
Answers
1. B
2. B
3. B
4. B
5. A
6. A
7. C
Essay
1- What are the parts of the esophagus?
2- What are the sites of esophageal constrictions?
3- What is the blood supply of the esophageal?
34. B: Histology
1. The surface epithelium of esophageal mucosa
is of the type:
a. Keratinized stratified squamous
b. Pseudostratified stratified ciliated
squamous
c. Non- keratinized stratified squamous
d. Simple columnar
2. The type of antigen presenting cells in
esophagus is
a. Macrophages
b. B-Cells
c. Dendritic cells
d. Langerhans cells
3. The oesophageal epithelium is non-
renewable
a. True
b. False
4. The oesophageal blood vessels, nerves and
lymphatics are found in the:
a. Lamina propria
b. Muscularis mucosa
c. Serosa
d. Adventitia
5. All of the following are true about the
mucosal esophageal glands EXCEPT:
a. Found at the uppermost part of the
esophagus and at the junction with
the stomach
b. They are compound tubule-alveolar
serous secreting type
c. Lined by columnar cells resembling
those of the cardiac glands of the
stomach
d. Falsely mistaken for erosion of
esophageal mucosa and are sites for
esophageal ulcers and cancer
6. All of the following are true about muscularis
mucosa of esophagus EXCEPT:
a. It’s mainly formed of smooth muscles
b. Less developed in the lower third
c. Absent in the upper third of
esophagus
d. At the level of the cricoid cartilage, it
is formed of a continuous layer of
longitudinal smooth muscle fibers
7. All are true about submucosal esophageal
glands EXCEPT:
a. Secrete acidic mucous
b. Its secretion is discrete for protection
of esophageal mucosa
c. They are compound tubule-alveolar
d. It’s found along the entire
oesophageal length
8. All are true about esophageal musculosa
EXCEPT:
a. Consists of an inner circular and outer
longitudinal layers
b. In the upper third of the esophagus, it
is formed of striated muscles
c. In the middle third consists of a
mixture of both striated and smooth
muscles
d. In the lower third it is made up of
voluntary muscle fibers only
Answers
1. C
2. D
3. B
4. A
5. B
6. B
7. B
8. D
35. Essay
1- Identify the layer and mention its function.
2- Give an account on the musculosa of the alimentary canal.
3- Compare between the upper, middle & lower thirds of the
oesophagus.
4- Discuss the histological structure of the oesophageal mucosa.
5- Compare between the mucosal & submucosal oesophageal
glands.
6- Identify the organ & mention the labels.
36. C: Pathology
1. Atresia of esophagus is characterized by all of
the following except
a. Associated congenital heart failure
b. Thick non canalized cord
c. Incompatible with life
d. None of the above
2. Plummer Vinson syd. consists of
a. Web of upper esophagus
b. Web of lower esophagus
c. Hiatal hernia
d. Diverticula
3. Loss of normal peristalsis of esophagus
associated with
a. Sliding hiatal hernia
b. Rolling hiatal hernia
c. Achalasia
d. Esophageal varicose
4. All of the following diseases of esophagus are
precancerous except
a. Sliding hiatal hernia
b. Achalasia
c. Diverticula
d. Plummer vinson syndrome
5. All of the following are complication of
sliding hiatal hernia except
a. Dysphagia
b. Peptic ulcer
c. Hepatic coma
d. None of the above
6. Rolling hiatal hernia is characterized by
a. Occurs in 90% of cases
b. Dissection of cardic portion of the heart
c. Traction on the stomach
d. All of the above
7. Traction diverticulum is characterized by
a. Occurs in lower & mid esophagus
b. Chronic fibrosing
c. Both A&B
d. None of the above
8. Barrett's esophagus is characterized by
a. Goblet cells above the level of GE junction
b. Patches of red velvety mucous
c. Intestinal metaplasia
d. All of the above
9. Carcinoma of esophagus occurs mainly in
a- Upper third
b- Middle third
c- Lower third
d- All of the above
10. Carcinoma of esophagus appears as
a. Fungating mass
b. Several patches
c. Intestinal metaplasia
d. None of the above
11. One of the following aren't a clinical feature
of carcinoma in esophagus
a. Dysphagia
b. Mediastinitis
c. Fistula
d. None of the above
37. 12. Causes of esophageal ulcer are
a. Trauma
b. Corrosive
c. Inflammation
d. All of the above
13. One of the following aren't site of dysphagia
a. Oral cavity
b. Pharynx
c. Esophagus
d. Stomach
14. Causes of esophageal dysphagia
a. Retro pharyngeal abscess
b. Plummer Vinson synd.
c. Achalasia
d. None of the above
Answers
1. B
2. A
3. C
4. C
5. C
6. D
7. C
8. D
9. B
10. A
11. D
12. D
13. D
14. A
Essay
1. Enumerate and describe the various congenital anomalies of the esophagus
2. Describe plummer Vinson syndrome
3. Define achalasia, explain its pathogenesis and complications
4. Compare between types of hiatal hernia as regard:
Pathogenesis
Morphology
Complication
5. Enumerate effects of axial hiatal hernia
6. Compare between the types of esophageal diverticulae as regard :
Sites
Pathogenesis
7. Discuss the esophageal varices as regard the mechanism of its formation and their complications
8. Mention causes of esophagitis
9. List three etiologic factors for esophagitis and give an account on its morphology
10. Discuss Barrett’s esophagus as regard (important)
Pathogenesis
Morphology
Complication
38. 11. Enumerate ulcers of esophagus
12. Define dysphagia and list its causes in: (important)
Oral cavity
Pharynx
Esophagus
13. Discuss the pathogenesis and the predisposing factors of the esophagus carcinoma (important)
14. Discuss the morphology of esophagus carcinoma (grossly and microscopically)
15. Give an account on the clinical features of carcinoma of the esophagus
39. Chapter 6: Stomach
A: Anatomy
1. The stomach is situated in ….. region/s
a. left hypochondriac
b. epigastric
c. umbilical
d. all of the above
2. ……….of the stomach Is dome shaped and
projects upward and to the left of the cardiac
orifice
a. Fundus
b. Body
c. Pyloric part
d. Lesser curvature
3. All of the following are true about lesser
curvature of the stomach except
a. Forms Right border of the stomach
b. Extend from cardiac orifice to the pylorus
c. Related to right and left gastroepipolic
vessels
d. Lesser omentum extends from it to the
liver
4. Greater curvature of the stomach gives
attachment to
a. Gastrophrenic
b. Gastrosplenic
c. Greater omentum
d. All of the above
5. Pyloric sphincter is a physiological sphincter
at the level of L1
a. True
b. False
6. All of the following are one of the relation of
anterior surface except
a. Left lope of the liver
b. Anterior abdominal wall
c. Spleen
d. Diaphragm
7. All of the following are considered as relation
of posterior surface of the stomach except
a. Lesser sac
b. Left suprarenal gland
c. Pancreas
d. Diaphragm
8. Left gastric artery is one of the blood supply
of the stomach which arise from
a. Hepatic artery
b. Splenic artery
c. Celiac artery
d. None of the above
9. ………… arises from the gastroduodenal
branch of the hepatic artery
a. Left gastroepipolic artery
b. Right gastroepipolic artery
c. Short gastric artery
d. Right gastric artery
10. As regard venous drainge of the stomach , the
left and right gastric veins drain directly into
a. Portal vein
b. Splenic vein
c. Superior mesenteric vein
d. All of the above
40. 11. As regard venous drainge of the stomach,
…… join the splenic vein
a. Short gastric vein
b. Left gastroepipolic vein
c. Right gastroepipolic vein
d. Both a & b
12. All the gastric lymph vessels drain ultimately
into the celiac lymph nodes
a. True
b. False
13. All of the following are true about the
sympathetic supply of the stomach except
a. From celiac plexus
b. Causes relaxation of the wall
c. Causes relaxation of the pyloric sphincter
d. Carries pain sensation
14. Parasympathetic supply arise from anterior
and posterior gastric nerves
a. True
b. False
15. An ulcer situated on the posterior wall of the
stomach may perforate into
a. Lesser sac
b. Greater sac
c. Pancreas
d. Both a & c
16. Malignant disease of the stomach may be
treated by partial gastrectomy
a. True
b. False
Answers
1. D
2. A
3. C
4. D
5. B
6. C
7. D
8. C
9. B
10. A
11. D
12. A
13. C
14. A
15. D
16. B
Essay
1- What are the relations of stomach?
2- What is the blood supply of the stomach?
3- What is the lymph drainage of the stomach?
41. B: Histology
1. The surface mucous cell of the fundus
characterized by all of the following except
a. Hold secreted mucus
b. Protect epitelium from autodigestion
c. Add an acidic fluid to the ingested food
d. Basal cytoplasm contain secretory
granules
2. All of the following are content of the lamina
propria of the fundus except
a. Loose CT
b. Oxyntic gland
c. Smooth muscle
d. Lymphocyte
3. Gastric gland characterized by all of the
following except
a. Simple branched tubular glands
b. Parallel to the stomach wall
c. Divide into 3 regions
d. Each 3-7 glands opens in the bottom of a
gastric pit
4. Oxynatic cell isn’t found in
a. Isthmus
b. Neck
c. Base
d. None of the above
5. Mucus secreted from mucus neck cell are
characterized by all of the following except
a. Thick
b. Insoluble
c. Slightly alkaline
d. Lubricate gastric content
6. All of the following are character of oxyntic
cells except
a. Present mainly in the lower half
b. Responsible for HCL secretion
c. Rounded cell
d. Vesicular nuclei
7. Doesn’t occur in activation of oxyntic cell:
a- Increase the number of microvilli
b- Increase tubulovesicular structure
c- Active ionic transport
d- Abundant scattered mitochondria
8. All of the following are character of the
peptic cells except
a. Present in the lower third of the gland
b. Contain protein secreting organelles
c. Pale basophilic cytoplasm
d. Filled with pepsinogen
9. Oxyntic cells doesn’t secrete:
a. HCL
b. Pepsin
c. Glycoprotein
d. Intrinsic factor
10. Peptic cells secrete all of the following except
a. Digestive enzymes
b. Glycoprotein
c. Pepsin
d. Gastric lipase
11. Enteroendocrine cells secrete all of the
following except
a. Serotonin
b. Histamine
c. Gastrin
d. Stomatrophin
42. Answers
1. D
2. C
3. B
4. A
5. B
6. A
7. B
8. C
9. B
10. B
11. C
Essay
1- Identify the cell 1 & 2, then identify the structure 3 &
mention its function.
2- Describe the LM & EM picture of the cell secreting pepsin &
gastric lipase.
3- Identify the level of this section in the stomach and
give reason for your answer.
4- Compare the mucosa in the different parts of the
stomach.
5- Compare between the cells of the fundic gland
regarding the site, structure & function.
43. C: Physiology
1. All the following are function of the vagus
except ……
a. Secretory
b. Motor to the muscle of the wall and
cardiac sphincter
c. Initiation of gastro colic reflex
d. Vasodilator effect
2. All of the following inhibit HCL secretion
except ……
a. Carbonic anhydrase inhibitor
b. Respiratory alkalosis
c. Vagus stimulation
d. Greater sphincter stimulus
3. All which is true about HCL Secretion except
……
a. It’s an active process
b. Combination of H+ and CL- occurs
extracellularly
c. The energy needed is derived from
glycolysis
d. Increase HCL secretion leads to
postprandial alkalinity
4. Function of HCL is …….
a. Needed for Ca ion transport
b. Activation of pepsinogen
c. Antibacterial action
d. All of the above
5. All of the following are true about Pepsinogen
except …..
a. It’s activated in highly acidic medium
b. It has antibacterial Property
c. It converts proteins to amino acids
d. It has proteolytic action
6. Which movement is responsible for removal
of residual food from the stomach
a. Migrating motor complex
b. Mixing movement
c. Grinding movement
d. All of the above
7. All of the following decrease gastric motility
except …..
a. CCK
b. Stress
c. Gastrin
d. GIP
8. The vomiting center is present in:
a. Pons.
b. Medulla oblongata.
c. Cerebral cortex.
d. None of the above.
9. All are true about the vomiting reflex except:
a. Laryngeal elevation and vocal cord
approximation occur.
b. It is caused by central or peripheral
stimuli.
c. The effectors include both plain and
striated muscles.
d. Intra-abdominal pressure is decreased.
10. Food reflux into the oesophagus is induced
by:
a. Relaxation of oesophegeal sphincter.
b. Contraction of pyloric sphincter.
c. Increased intra-abdominal pressure.
d. All of the above.
44. 11. Central causes leading to vomiting include all
of the following except:
a. Cerebral hemorrhage.
b. Stroke.
c. Brain edema.
d. Gastritis.
12. One of the endogenous chemicals stimulating
vomiting reflex is:
a. Urea.
b. Morphine.
c. Glucose.
d. Emetine.
13. When a large amount of fluid is lost from the
body due to excessive persistent vomiting, all
of the following will occur except:
a. Dehydration.
b. Metabolic acidosis.
c. Potassium depletion.
d. Metabolic alkalosis.
14. True or false:
- Kidney tumors may induce vomiting.
- When a person sees a nauseating sight,
vomiting reflex is stimulated through
afferents of the vagus nerve.
Answers
1. B
2. C
3. C
4. D
5. C
6. A
7. C
8. B
9. D
10. D
11. D
12. A
13. B
14. T/F
Essay
1. Mention stomach functions according to seceretory and motor
2. Give an account on stomach innervations as regarding parasympathetic and sympathetic
3. Discuss the gastric secretion composition
4. Discuss mechanisms by which hydrochloric acid act in the stomach
5. Enumerate the functions of HCl
6. Give an account on the enzymes of the gastric juice
7. Discuss gastric mucosal barrier against auto-digestion by gastric juice
8. Mention the nervous mechanism by which gastric secretion is regulated
9. Mention the hormonal mechanism by which gastric secretion is regulated
10. Give account on :
a. Tonic contractions
b. Hunger contractions
c. Receptive relaxation
d. Peristaltic movement
e. MMC
f. BER
g. Stomach emptying
45. D: Microbiology: Helicobacter Pylori
1. All are true about H.pylori except:
a. It is a gram negative helical non-motile
bacterium.
b. It gives positive catalase and oxidase test.
c. It doesn’t invade gastric mucosa.
d. One of the main causes of gastric ulcers.
2. H.Pylori is:
a. A bacterium that needs extra amount of
CO2 in growth medium.
b. A microaerophil that grows in low O2
concentration.
c. A main cause of enteric fever.
d. Urease negative.
3. All of the following are virulence factors of
H.pylori except:
a. Polar flagella that help bacterial motility.
b. Vacuolating cytotoxins.
c. Proteases.
d. Hemolysins.
4. For treatment of H.pylori, the following
combination is recommended:
a. Proton pump inhibitors with tetracycline.
b. Tetracyclin with metronidazole.
c. Systemic sulphonamides with
metronidazole.
d. Proton pump inhibitors with
clarithromycin and metronidazole.
5. One of the following is a selective medium
for growth of H.pylori:
a. Thayer-Martin medium.
b. Skirrow’s medium.
c. Chocolate agar.
d. McConkey’s agar.
Answers
1. A 2. B 3. D 4. D 5. B
Essay:
1. Explain the invasive procedures performed to diagnose H.pylori.
2. Mention 3 ways by which H.pylori can be transmitted.
3. H.pylori is a urease-producing bacterium. Mention the clinical use of such enzyme in diagnosis of
H.pylori infection.
46. E: Pathology
1. The disease occurring due to hypertrophy of
pyloric smooth muscle fibers :
a. Diaphragmatic hernias
b. Pyloric stenosis
c. Gastritis
d. Peptic ulcer
2. Acute respiratory embarrassment is present
in
a. Pyloric stenosis
b. Diaphragmatic hernia
c. Varices
d. Ulcer
3. Protection of gastric mucosa is enhanced by
all except :
a. Mucin
b. Bicarbonate
c. Apical epithelial cell transport system
d. Stability of epithelial cell and their long
age
4. Factors that impair the defense mechanisms
are all except :
a. H. Pylori infection
b. Abnormal motility
c. Aspirin
d. Shock
5. Enhancing aggressive damage forces occurs
by
a. Abnormal motility
b. Shock
c. Direct damage by alcohol
d. NSAID
6. All of the following are characters of the
acute gastritis except :
a. Ulceration
b. Red
c. Congested
d. Hypremia
e. Smooth surface
7. Chronic gastritis is characterized by all
except :
a. Precancerous
b. Mucosal atrophy
c. Caused by external factors only
d. Can be caused by infecting agent
8. Type B chronic gastritis is caused by :
a. Crohn's disease
b. Radiation
c. H. pylori
d. Autoimmune
9. Achlorohydria in chronic gastritis results
from :
a. Destruction of chief cells
b. Intrinsic factor absence
c. Loss of parietal cells
d. None of the above
10. All of the following is true about the
morphology of Type A chronic gastritis
except :
a. Lyphoplasmacystic infiltration around
parietal cells
b. Absence of rugal folds
c. H. pylori is found
d. Finally leads to simple gastric atrophy
47. 11. All of the following are complications of Type
A chronis gastritis except :
a. Multiple carcinoid tumours
b. Pernicious anemia
c. Gastric carcinoma
d. Aplastic anemia
12. All of the following is found in the type B
chronic gastritis except:
a. H pylori
b. Neutrophilic infiltration
c. In chronic atrophic gastritis with
intestinal metaplasia ,, H pylori can be
found
d. Lymphoid follicles can be found in deep
layers
13. Gastric lymphoma can be caused by :
a. Chronic type B gastritis
b. Chronic type A gastritis
c. Acute gastritis
d. Gastric ulceration
14. Which of the following is true about
ulceration and erosion :
a. Ulceration is more superficial
b. Erosion takes long time to heal
c. Erosion extends to submucosa
d. Ulceration is more severe than erosion
15. The most common site of peptic ulcer is :
a. Duodenum
b. Stomach
c. Lower esophagus
d. Illeum
16. Site of ulcer in stomach:
a. Lesser curvature
b. Greater curvature
c. Antrum
d. Cardiac sphincter
17. H. pylori is present more in which peptic
ulcer
a. Gastric
b. Duodenal
18. Which can't progress to peptic ulcer :
a. GERD
b. Chronic gastritis type B
c. Chronic gastritis type A
d. None of the above
19. The most superficial zone in ulcer is :
a. Fibrinoid necrotic debris
b. Fibrous scar
c. Inflamatory exudate
d. Granulation tissue
20. In case of malignant ulcer there is elevation
in edges :
a. True
b. False
21. Haematemisis may occur in acute gastritis :
a. True
b. False
22. All acute gastritis leads to sloughing of
mucosa
a. True
b. False
23. Bile reflux can cause both acute and chronic
gastritis :
a. True
b. False
48. Answers
1. B
2. B
3. D
4. A
5. C
6. E
7. C
8. D
9. C
10. C
11. D
12. C
13. A
14. D
15. A
16. A
17. B
18. C
19. A
20. B
21. A
22. B
23. A
Essay
1. Mention one cause of projectile vomiting in new born infants.
2. Mention 3 factors that could impair defense mechanisms of stomach against ulceration and gastritis.
3. Classify chronic gastritis and give short notes on the most common form.
4. Mention the main sites for peptic ulceration.
5. Describe the morphology of peptic ulcer grossly and microscopically
6. Enumerate the complications related to peptic ulcers.
49. F: Pharmacology
1. All of the following is true regarding
omeprazole except ……
a. It’s action last Up to 2 hours
b. It’s a proton pump inhibitor
c. It’s taken after the meal
d. It’s metabolized by Liver
2. Which of the following drugs taken at
bedtime …….
a. Omeprazole
b. NaHCO3
c. Nizatidine
d. Pirenzepine
3. Which is true about Cimetidine ……?
a. It’s mainly metabolized by liver
b. It inhibits Adenyl cyclase
c. It irreversibly blocks H2 Receptor
d. It’s the safest drug to be used in this group
4. The drug which has not antiandrogenic effect
……..
a. Omeprazole
b. Cimetidine
c. Nizatidine
d. None of the above
5. Proton pump inhibitor drug is ……
a. Pirenzepine
b. Sucralfate
c. Lanoprazole
d. All of the above
6. Which of the following drugs used before
anesthesia ……
a. Omeprazole
b. Nizatidine
c. Pirenzepine
d. Bismuth
7. All of the following drugs inhibit Cytochrome
P450 except ……
a. Omeprazole
b. Cimetidine
c. Nizatidine
d. Lanoprazole
8. The best drug used in cases of acute vomiting
attacks is …..
a. Ondansetron
b. Cyclizine
c. Aprepitant
d. Diazepam
9. Which of these drugs has a fewer side effects
on extrapyramidal system ….
a. Domperidon
b. Metoclopramide
c. Granisetron
d. Droperidol
10. Which of these drugs is used as a local drug
in treatment of motion sickness ……?
a. Cyclizine
b. Diphenhydramine
c. Scopolamine
d. Aprepitant
11. This of these combinations is used to reduce
extrapyramidal side effects of
metoclopramide, Metoclopramide with …….
a. Domperidon
b. Dexamesasone
c. Ondancetron
d. Cyclizine
50. 12. Which of these drugs is used in treatment of
anticipatory emesis ……?
a. Diphenhydramine
b. Diazepam
c. Metoclopramide
d. Granisetron
13. Which of these drugs is used as a prokinetic
…?
a. Metoclopramide
b. Aprepitant
c. Erythromycin
d. Both A and C
14. All of these drugs are used in treatment of
nausea due to chemotherapy except ……
a. Metoclopramide
b. Aprepitant
c. Methylprednisolone
d. Pirenzepine
15. The best combination used in prevention of
nausea and vomiting induced by
chemotherapy …..
a. Metoclopramide + Diphenhydramine +
Cyclizine
b. Dexamethasone + Diphenhydramine +
Aprepitant
c. Domperidon + Aprepitant + Cyclizine
d. None of the above
16. The first choice in treatment of vomiting of
pregnancy is ……
a. Pyridoxine B6
b. Metoclopramide
c. Cyclizine
d. Ondansetron
17. Which of these drugs can cause
Gynaecomastia as a side effect …..?
a. Metoclopramide
b. Cyclizine
c. Cimetidine
d. Both A and C
18. all of the following is true about antacids
except:
a. basic substances
b. neutralize gastric HCL
c. calcium ions are the most potent
d. sodium ions are the least potent
19. antacids are indicated in:
a. healing duodenal ulcer in small doses
b. treatment of GERD
c. acute gastritis
d. relief of occasional heart burn and
dyspepsia
20. The following mettalic ion causes rebound
acid secretion:
a. Ca
b. K
c. Mg
d. Al
21. The following are disadvantages of sodium
bicarbonate as antacid except:
a. Short duration of action
b. Laxative effect
c. Systemic alkalosis
d. Acid rebound
22. Mg tricilicate:
a. Has 2 mechanisms of action
b. Silicon dioxide acts as demulcent
c. Silicon dioxide absorb excess hcl
d. All of the above
51. 23. Disadvantages of aluminum hydroxide
include:
a. acid base balance disturbance
b. laxative effect
c. hypophosphatemia
d. hypermagnesenia
24. All of the following is true about misoprostol
except:
a. decreases mucosal blood flow
b. stimulates mucin secretion
c. decreases gastric acidity
d. stimulates intestinal motility
25. The following drugs is contraindicated in
pregnancy:
a. antacids
b. misoprostol
c. sucralfate
d. bismuth chelate
26. The following drugs used in peptic ulcer
except:
a. sucralfate
b. bismuth chelate
c. PPI
d. H2 blockers
27. the following drug has an antimicrobial
action:
a. PPI
b. H2 blockers
c. bismuth chelate
d. antacids
28. PPI based drug regimen:
a. 3 drugs
b. is the first kine regimn in h. pylori
eradication
c. gaiven twice daily
d. all of the above
True and false
29. Bismuth based 4 drug regimen is the second line regimen in H.pylori eradication.
30. Sucralfate canbe given with antacids.
Answers
1. C
2. C
3. B
4. C
5. C
6. B
7. C
8. C
9. A
10. C
11. D
12. B
13. D
14. D
15. B
16. A
17. D
18. c
19. d
20. a
21. b
22. d
23. c
24. a
25. b
26. b
27. c
28. d
29. T
30. F
Essay
1. Classify the main types of drugs used to treat peptic ulcer?
2. Compare between PPI and H2 antagonist in (pharmacokinetics – therapeutic uses – drug
interactions )
3. Compare between different types of antacids?
4. Mention the criteria of the ideal antacids?
5. Discuss the drug interactions of the antacids?
6. Mention the different drugs used as mucosal protective agents and show their mechanism of
actions?
52. 7. What are the regimens of eradications of H pylori? Ana mention its side effects?
8. What are the different drugs used in motion sickness and show there mechanism of action?
9. What are the adverse effects of primperan?
10. Mention the drugs used to prevent nausea and vomiting due to chemotherapy?
11. Discuss the combination regimens of antiemetic drugs?
12. How to control vomiting in pregnancy?
13. Discuss different types of drugs used as prokinetic drugs?
53. Chapter 7: Liver & Pancreas
A: Anatomy
1. Which of the following is not true about the
site of the liver:
a. It lies under the diaphragm
b. It lies in the right hypochondrium
c. It lies in the left hypochondrium
d. It lies in the epigastrium
e. None of the above
2. The liver is formed of four surfaces and five
lobes:
a. True
b. False
3. The right and left lobes of the liver are
formed by:
a. The attachment of falciform ligament on
the inferior and posterior surface
b. The attachment of falciform ligament on
the superior and anterior surface
c. Fissure for ligamentum venosum and
ligamentum teres on the posterior and
anterior surfaces
d. Fissure for ligamentum venosum and
ligamentum teres on the posterior and
visceral surfaces
e. A & C
f. B & C
4. The right surface of liver is related to :
a. 7th
to 11th
ribs
b. Diaphragm
c. Base of the right lung
d. Right pleura
e. All of the above
5. From left to right, the posterior surface of the
liver is formed of: Bare area of the liver,
groove for IVC, Caudate lobe, fissure for
ligamentum venosum and oesophageal notch
a. True
b. False
6. Which of the following is not ture about the
bare area of the liver:
a. It’s a triangular area related directly to
the diaphragm
b. Its base is formed by fossa for ligamentum
venosum
c. Its apex is formed by right triangular
ligament
d. Its sides are the two layers of coronary
ligaments
7. The Tuber omental is :
a. Elavated area in the left lobe
b. It lies in the visceral surface right to the
gastric impression
c. It overlies the greater omentum
d. A & B
e. A & C
8. All of the following are peritoneal
connections of the liver EXCEPT:
a. Upper layer of coronary ligament
b. Lower layer of coronary ligament
c. Falciform ligament
d. Left and right triangular ligament
e. Lesser omentum
f. None of the above
54. 9. Ligamentum venosum represents the
obliterated umblical vein in the embryo:
a. True
b. False
10. The ligamentum teres connects the umblicus
with the left branch of portal vein:
a. True
b. False
11. Which of the following areas of the liver is
not covered by peritoneum:
a. Bare areas of the liver
b. Groove for IVC
c. Fissure for ligamentum venosum and
ligamentum teres
d. Porta hepatis
e. All of the above
f. A & B
12. Hepatic segmentation according to vascular
distribution of the liver ( venus drainage of
the hepatic vein), the Caudate and Quadrate
lobes lie in the:
a. Medial part of the left lobe
b. Lateral part of the right lobe
c. Lateral part of the left lobe
d. Medial part of the medial lobe
13. Surface anatomy of the fundus of gall bladder
is:
a. Tip of the 7th
costal cartilage
b. Tip of the 8th
costal cartilage
c. Tip of the 9th
costal cartilage
d. Tip of the 10th
costal cartilage
14. Liver receives blood from:
a. Hepatic arteries
b. Portal vein
c. Hepatic veins
d. All of the above
e. A & B
15. The quadrate lobe is related (postero-
anteriorly) to:
a. Lesser omentum
b. Pyloris
c. 1st
part of duodenum
d. Transverse colon
e. All of the above
f. A & C
16. All of the following structures pass through
porta hepatis EXCEPT:
a. Hepatic duct
b. Hepatic artery
c. Portal vein
d. Hepatic veins
e. Lymphatics
17. The porta hepatis is bounded anteriorly by
Caudate lobe and posteriorly by Quadrate
lobe:
a. True
b. False
55. 18. All of the following are true about the
pancreas except
a. Extends from the concavity of the
duodenum on the right side to the spleen
on the left side
b. It’s head related posterior to transverse
colon
c. Uncinate process lies between abdominal
aorta and superior mesenteric vessels.
d. Supplied by pancreatic branches of spleen
19. All of the following are relations to head
of pancreas except
a. Transverse colon
b. IVC
c. Splenic artery
d. Main bile duct
20. The neck of pancreas is related to ……
anteriorly and ……. Posteriorly
a. Gastro- duodenal junction , portal vein
b. portal vein , Gastro- duodenal junction
c. transverse colon , IVC
d. IVC , transverse colon
21. Anterior surface of pancreas gives
attachment to greater omentum
a. True
b. False
22. ……….. of body of pancreas is related to
stomach and separated from it by lesser sac
a. Inferior surface
b. Anterior surface
c. Posterior surface
d. Inferior border
23. All of the following are relations of
inferior surface of body of pancreas except
a. duodeno-jejunal flexure
b. loops of ileum
c. transverse colon
d. aorta
24. Related to posterior surface of body of
pancreas
a. Aorta
b. Left psoas major
c. Left sympathetic chain
d. All of the following
25. ………. Border of pancreas gives
attachments to greater omentum and transverse
colon
a. Anterior
b. Superior
c. Inferior
d. None of the above
26. The head of pancreas reaches the hilum
of spleen via lieno-renal ligament
a. True
b. False
27. All of the following are true about main
pancreatic duct except
a. It drains the upper part of the head , all
the body and tail of pancreas
b. It runs from the tail to the head
c. It open in the 2nd
part of duodenum above
the ampulla of Vater
d. it unite with common bile duct
56. 28. Superior, inferior pancreatico-duodenal
arteries supply all of pancreas
a. True
b. False
29. Lower part of head of pancreas drains in
a. coeliac lymph nodes.
b. pancreatico-splenic lymph nodes.
c. superior mesenteric lymph
d. all of the above
30. Concerning 1st
part duodenum ,all true
except:
a. At the level of L2
b. Related anteriorly to quadrate lobe of the
liver
c. Related inferiorly to the head of pancreas
d. Is 2 inches
31. Anterior relation of the 1st
part
duodenum:
a. Epiploic foramen
b. Transverse colon
c. Neck of the gall bladder
d. A & C
32. All of the following are posterior relation
to 3rd
part duodenum except:
a. Right psoas major
b. Aorta
c. Right ureter
d. Left sympathetic trunk
33. All of the following are posterior relations
to 1st
part duodenum,except:
a. Portal vein
b. Bile duct
c. Hepatic artery
d. Gastroduodenal artery
34. Inferior mesenteric artery is a posterior
relation to:
a. 1st
+2nd
parts of duodenum
b. 3rd
+4th
parts of duodenum
c. 1st
+4th
parts of duodenum
d. None of the above
35. Concerning 3rd
part duodenum,the false
statement is:
a. Related anteriorly to root of
mesentry
b. Related posteriorly to left psoas
major
c. Related superiorly to head of
pancreas
d. Related inferiorly to loops of small
intestine
36. Right gastroepiploic artery is a branch of:
a. splenic artery
b. left gastric artery
c. hepatic artery
d. none of the above
37. All of the following are branches of the
hepatic artery ,except:
a. Right gastric
b. Left gastroepiploic
c. Gastroduodenal
d. B & C
57. Answers
1. E
2. B
3. F
4. E
5. B
6. B
7. D
8. F
9. B
10. A
11. E
12. A
13. C
14. E
15. E
16. D
17. B
18. b
19. c
20. a
21. b
22. b
23. d
24. d
25. a
26. b
27. c
28. b
29. c
30. a
31. c
32. d
33. c
34. b
35. b
36. c
37. b
Essay:
1. Enumerate surfaces and lobes of the liver
2. Describe the relations of the anterior, superior and right surfaces of the liver
3. Describe the triangular bare area of the liver
4. Describe the posterior and inferior surfaces of the liver
5. List the different fissures and impressions and their sites on the liver
6. Give an account on the lobe located on the visceral surface of the liver
7. Give an account on the porta hepatis
8. Name the arterial supply and venous drainage of the liver
9. Name the peritoneal connections and embryonic remnants of the liver and give their attachments
10. Name the bare areas of liver
11. Describe the surface anatomy of the liver
12. Give an account on the ampulla of vater:
Formation
Drainage
13. Give an account on the gall bladder and its arterial supply
14. Give the site and the parts of the pancreas
15. Mention the relations of the head of pancreas
16. Give the relations of the neck of pancreas and the uncinate process
17. List the relations of the anterior and inferior surface of the body of pancreas
18. Enumerate the relations of the posterior surface of the body of pancreas
19. Give an account on the pancreatic borders
20. Give an account on the tail of pancreas
21. Give an account on the ducts of pancreas
22. Describe the blood supply of pancreas
23. Give the lymphatic drainage of pancreas
58. B: Histology
1. The hepatic cords are separted from each
other by
a. Bile canaliculi
b. Blood sinusoids
c. Lymphocyte
d. Reticular fibers network
2. Hepatocytes are arranged in the form of
a. Anastomosing cell plates
b. Perpendicular to the surface
c. Parallel to the surface
d. None of the above
3. Cytoplasm of the hepatocyte are vaculoted
due to
a. Abundant mitochondria
b. Multiple golgicomlex
c. Abundant glycogen granules
d. All of the above
4. The function of the free ribosomes in the
hepatocyte are
a. Energy requirement
b. Synthesis of the plasma protein
c. Synthesis of intrinsic protein
d. Secretory activity formed by the cell
5. Which of the hepatocyte oragenlles are
responsible for detoxification of drugs
a. Mitochondria
b. Nucleus
c. Ribosomes
d. rER
6. The hepatic blood sinusoids are differ from
the typical in
a. Short diameter
b. Their linning cell
c. Abdundant content of the basal lamina
d. All of the above
7. Which of the following don't characterize
kupffer cells
a. Metabolized aged RBC's
b. Perforated by holes
c. Has an oval nuclei
d. None of the above
8. Space of disse have the following functions
except
a. Reticular fibers
b. Microvilli
c. Lipocyte
d. Endothelial cells
9. Space of disse have the following functions
except
a. Support the wall of sinusoids
b. Vit.A metabolism
c. Aged RBC's metabolism
d. In chronic inflammation they cause liver
fibrosis
10. Cells linning gering's canals have the
following functions except
a. replace damaged hepatocyte
b. differentiate to hepatic parenchyma
c. support the wall of parenchyma
d. transport bile pigment
59. 11. The hepatic stroma continuously form and
secrete bile that is poured into the bile
canaliculi
a. True
b. False
12. The bile canaliculi form a complex
anastomosing network of channels that are
confluent with larger bile ductules called
a. Portal canals
b. Common bile duct
c. Hering’s canal
d. Left hepatic duct
13. The cells lining ……. is said to be able to
differentiate and migrate to hepatic
parenchyma to replaced hepatocytes
a. Portal canals
b. Common bile duct
c. Hering’s canal
d. Left hepatic duct
14. The hepatic duct after receiving the cyctic
duct emerging from the gall bladder
continues as the
a. Portal canals
b. Common bile duct
c. Hering’s canal
d. Left hepatic duct
15. There are 3 conflicting classification in the
structural organization of the liver
a. True
b. False
16. All of the following are true about the
classical hepatic lobule except
a. A polygonal mass of liver cells
arranged radially around central vein
b. Blood and bile flow in opposite
directions
c. Each lobule drains its bile into the
centrally located bile duct
d. At the corners there are small
triangular area called portal tract
17. ……… is a triangular mass of liver cells from
three adjacent hepatic lobules
a. Liver acinus
b. classical heptic lobule
c. portal lobule
d. portal tract
18. As regard portal lobule of liver, it has at its
center ……. And at each of its angles …….
a. Portal tract , Central vein
b. Central vein , Portal tract
c. Central vein , hepatic artery
d. Central vein , bile duct
19. ……… is the functional unit of the liver , it is
a diamond shaped mass of the liver
a. Liver acinus
b. Classical heptic lobule
c. Portal lobule
d. Portal tract
20. All of the following are true about zone I in
hepatic acinus except
a. Closest to the blood vessels
b. Highly charged with metabolites
c. Excellent content of nutrients
d. Excellent content of oxygen
60. 21. As regard to liver , it receive only large amont
of well oxygenated blood from the general
circulation as its blood supply
a. True
b. False
22. As regard to liver, the portal vein system
begins with …… and ends in …..
a. Hepatic vein , IVC
b. Hepatic sinusoids , IVC
c. Portal vein , IVC
d. Central vein , hepatic vein
23. The liver is considered as exocrine and
endocrine gland
a. True
b. False
24. All of the following are functions of liver
except
a. Protein synthesis
b. Gluconeogenesis
c. Degradation of urea
d. Bile synthesis
25. All of the following are true about the gall
bladder except
a. Pear shaped hollow organ
b. Attached to lower surface of liver
c. Has a thick layer of regularly
arranged smooth muscle
d. Store and concentrate bile
Answers
1. b
2. a
3. c
4. c
5. d
6. b
7. b
8. d
9. c
10. c
11. b
12. c
13. c
14. b
15. b
16. c
17. c
18. a
19. a
20. b
21. b
22. c
23. a
24. c
25. c
Essay
Identify the organ, enumerate the labels (2) & (3) then discuss the cells
lining structure (1).
1- Identify the space of Disse & mention its contents.
2- Describe the hepatocyte as seen by LM & EM.
61. 3- Enumerate the pointed structures in the intercellular
side of the liver cells.
4- Label the following diagram then discuss a different
classification of liver lobulation.
5- Describe the histological features of the biliary tree.
6- Identify the organ, describe the histology of structure 1 then
label structure 2.
7- Describe the pancreatic duct system.
8- Identify the gland then compare it to another one of the
same type of acini.
9- Discuss the EM picture of the cells lining pancreatic acini.
10- Discuss el LM & EM of the hepatocyte. Correlate the
structure to the function.
11- Compare between the different surfaces of the
hepatocyte.
12- “The liver sinusoids differ from the typical ones”.
Discuss
13- Discuss the internal vasculature of the liver
14- Discuss the histology of the gall bladder
62. Chapter 8: Hepatobilary system
A: Anatomy
1. All of the following statements as
regards the gall bladder are true
except:
a. It’s fundus lies at the tip of the ninth
costal cartilage
b. It is supplied by the cystic artery
c. Its venous drainage passes to the cystic
vein that drains into left branch of portal
vein
d. Situated at the inferior surface of the liver
2. All of the following statements about
the biliary duct are correct except:
a. It descends in the free margin of lesser
omentum
b. It joins the pancreatic duct to form
ampulla of vatter
c. It is formed b the union of the cstic duct
and common hepatic duct
d. It descend behind the portal vein then
continues behind the duodenum( 1st part
)
3. Concerning the portal vein all of the
following are correct except:
a. It is formed by the union of superior
mesenteric and splenic veins infront of
the IVC
b. It passes in the free border of lesser
omentum as the most posterior structure
c. Inferior mesenteric and cystic veins are of
its tributatries
d. It is formed behind the neck of pancreas
4. All of the following are sites of
portosystemic anastomosis except:
a. Osophagus
b. Rectum
c. Around the umbilicus
d. At bare area of liver
5. The middle rectal artery originates
from:
a. Internal iliac artery
b. External iliac artery
c. Internal pudendal artery
d. Inferior mesenteric artery
e. Superior mesenteric artery
6. The inferior rectal artery originates
from:
a. Internal iliac artery
b. External iliac artery
c. Internal pudendal artery
d. Inferior mesenteric artery
e. Superior mesenteric artery
7. The following statements about the
upper part of the anal canal are correct
except:
a. It’s innervated by autonomic nerve fibers
b. It’s lymphatic drainage passes to the
superficial inguinal LN
c. It is endodermal in origion
d. It’s drained into the portal circulation
63. 8. As regards the ischiorectal fossa all are
correct except:
a. It is bounded superiorly by the linear
origion of levator ani muscles
b. The superior rectal artery is one of its
contents
c. The perineal branch of S4 is one of its
contents
d. It is filled with semiliquid pad of fat
9. All of the following are contents of the
ischiorectal fossa except:
a. Inferior rectal nerve
b. Scrotal nerve in males
c. Transverse perineal artery
d. Middle rectal vessels
10.Concerning the Rectum,All of the
following statements are true except:
a. It begins at the middle sacral piece and
terminates 1 inch below the tip of coccyx
b. It is completely covered with peritoneum
c. It contains valves
d. It is related posteriorly to superior rectal
artery and coccygeal nerves
11.All of the following are posterior
relations of the rectum except:
a. Piriformis muscle
b. Superior rectal artery
c. Lumbosacral trunk
d. Sacrum and coccyx
12.All of the following statements are true
except:
a. The superior rectal artery is the
continuation of inferior mesenteric
artery
b. The inferior rectal vein is one of the
tributaries of internal pudendal vein
c. The lumphatic drainage of the lower
half of rectum passes to the external
iliac LN
d. The anal canal is bounded posteriorly
by the anococcygeal raphe
Answers:
1. C
2. D
3. C
4. B
5. C
6. A
7. B
8. A
9. C
10. B
11. B
12. D
13. B
14. C
15. C
64. Essay:
1. Mention the surface anatomy of the fundus.
2. Discuss the different portions of the biliary system in breif.
3. Define portal circulation and give different examples of it found in our body.
4. State common bile duct relations
5. What are the different parts of GB
6. What's the composition of hepatic portal venous system
7. Mention the tributaries of the following
a. Splenic vein
b. Portal vein
c. Superior mesentric
d. Inferior mesentric
8. Mention the course of portal vein and its parts
9. Define portosystemic shunt (anastomosis) .. Mention it's different sites
10. Mention the effect of portal hypertension in sites containing portosystemic anastomosis
11. Mention the beginning, course and termination of Rectum
12. Explain the pattern of peritoneal covering of rectum
13. What are the different flexures of rectum?
14. Mention the rectum relations in male
15. What are the anterior and posterior relations of rectum in female?
16. Rectum derives its blood supply from many main vessels .. Mention its blood supply and origin of
each
17. Mention lymphatic drainage of rectum
18. Mention the beginning, course and termination of anal canal
19. What are the relations of anal canal?
20. Mention blood supply, lymph drainage and nerve supply of the anal canal
21. What's Hilton's line
22. What are the types of anal sphincters? Discuss
23. Anal triangle.. mention its boundaries and contents
24. What's ischiorectal fossa ?
25. What are the boundaries, contents of ischiorectal fossa?
26. Give a short account on pudendal canal
65. B: Pathology
1. The most common type of gall stones is:
a. Pure cholesterol.
b. Mixed cholesterol.
c. Pigment stones.
2. Cholelithiasis can lead to all of the following
except:
a. Empyema of gall bladder.
b. Mucocele.
c. Intestinal obstruction.
d. Cholesterolosis.
3. Hepatocellular jaundice may happen due to:
a. Impaired bilirubin uptake.
b. Impaired liver conjugation.
c. Impaired bilirubin secretion.
d. All of the above.
4. Liver flukes may lead to:
a. Hepatocellular jaundice.
b. Obstructive jaundice.
c. Hemolytic jaundice.
5. As regards Gall bladder stones ,all of the
following statements are correct except:
a. Pure cholesterol stone are usually
solitary while mixed ones are usually
multiple and faceted
b. Most of the cases are asymptomatic
c. More common among fatty fertile
females above 40
d. May be complicated with acute
pancreatitis if it occurs on the level of
cystic duct
6. Which of the following statements is true
about cholecystitis:
a. Gall stones predispose to cholecystitis
b. cholecystitis predispose to Gall stones
c. Chronic cholecystitis may be
associated with distended gall bladder
d. Chronic cholecystitis may be
associated with contracted gall
bladder
e. All of the above
7. Which of the following conditions isn’t a
complication of cystic duct obstruction:
a. Obstructive jaundice
b. Cholecystitis
c. Empyema of gallbladder
d. Mucocele of gallbladder
e. All of the above
8. All of the following statements about
carcinoma of gall bladder are incorrect
except
a. It may be in the form of malignant
ulcerative lesion
b. The most common microscopic type is
squamous cell carcinomait is the most
common cancer of the GIT
c. It has extremely poor diagnosis
66. 9. All are true about acute pancreatitis except:
a. Alcoholism is one of the main
predisposing factors.
b. Autodigestion plays a major role in its
pathogenesis.
c. Acute inflammation, fat necrosis with
remarkable hemorrhage are
characteristic.
d. It is asymptomatic and self-limited.
10. The following is common in both acute and
chronic pancreatitis:
a. Marked fibrosis.
b. Pancreatic enlargement.
c. Alcoholism.
d. Islets of langerhans injury.
11. The role of alcoholism in pancreatitis is
includes:
a. Acinar cell damage.
b. Precipitate for stone formation in
pancreatic ducts and aggravate
pancreatitis.
c. Abnormal protein secretion due to
free radical production.
d. All of the above.
12. Pancreatic carcinomas mostly arise in:
a. Head
b. Body
c. Tail
d. Diffuse
13. Obstructive jaundice may result due to all of
the following except:
a. Cancer head pancreas.
b. Biliary atresia.
c. Gall stones.
d. Cancer tail pancreas.
14. All of the following are causes of septic
peritonitis except:
a. Appendicitis.
b. Diverticulitis.
c. Bile.
d. Endometriosis
15. All of the following belongs to degeneration
changes in liver except :
a. Interface hepatitis
b. Steatosis
c. Hydropic changes
d. Fatty changes
16. The necrosis which is confined to a certain
area of lobule without spreading is :
a. Drop Out
b. Piece metal
c. Bridging
d. Interface
17. Submassive necrosis is a focal necrosis :
a. True
b. False
18. Liver is considered toti-potent organ
a. True
b. False
19. All of the following occurs in live injury
except :
a. Rise of ALT
b. Decrease of AST
c. Rise of bilirubin
d. Decrease of albumin
20. Yellow fever virus is a hepato-tropic virus :
a. True
b. False
67. 21. Hepatotropic virus is a cytotoxic virus :
a. True
b. False
22. % of chronic in HCV :
a. 50 %
b. 60 %
c. 70 %
d. 80 %
23. % of chronic in HAV :
a. Rare
b. 10 %
c. 30 %
d. 40 %
24. All of the following is present in acute
hepatitis except :
a. Bridging fibrosis
b. Ballooning
c. Apoptosis
d. Necrosis
25. Jaundice appears in which stage of acute
hepatitis :
a. Preicteric phase
b. Incubation period
c. Icteric phase
d. Convalescence
26. HAV can lead to carrier state :
a. True
b. False
27. HEV can lead to fuliminant in case of
pregnancy
a. True
b. False
28. HBV almost cause chronic hepatitis :
a. True
b. False
29. Concerning chronic viral hepatitis, all true
except:
a. About 80% of HDV coinfection leads
to it
b. Histologically, documented
inflammation without improvement
for more than 6 months
c. Prolongation of prothrombin time
d. Elevation of alkaline phosphatase
30. In chronic viral hepatitis we could see the
following morphological changes :
a. apoptosis
b. drop-out necrosis
c. fatty change
d. all of the above
31. The following biochemical changes could
occur in chronic viral hepatitis, except:
a. Hyperalbuminemia
b. Hypobilirubinemia
c. Prolongation of prothrombin time
d. A & B
32. Rapidly progressing hepatic insufficiency
with hepatic encephalopathy extends up to 3
months:
a. Fulminant hepatic failure
b. Acute hepatic failure
c. Subfulminant hepatic failure
d. None of the above
33. Carrier state:
a. Could occur with HBV,HCV and HEV
b. An individual cannot transmit the
virus during this period
c. An individual does not manifest
symptoms
d. A & C
