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GASTROINTESTINAL BLOCK CASE 1 A 32-year-old woman presents to the clinic complaining of blood tinged diarrhoea.

She reports that she had 4 bowel movements of loose stool per day with intermittent rectal bleeding for the last 2 weeks. Further questioning reveals that she frequently sits on the toilet with the urge to daefecate, but does not have bowel movement. She was diagnosed to have ulcerative colitis 1. What is medical term for urge to daefecate without any bowel movement? (1 mark) 2. State the immunity of GI system briefly (4 marks) 3. Briefly described anatomy of large intestine (3 marks) 4. State 1 pharmacological treatment and 1 surgical treatment in this patient (2 marks) CASE 2 A 13 years old girl presents to A&E department with RLQ pain, nausea, vomiting. Just 12 hours earlier, she was experiencing vague, colicky periumbilical pain. On PE, you find that the patient has low grade fever and localized tenderness with guarding in the RLQ when palpated. Lab investigation reveals mild leukocytosis 1. State your diagnosis (1 mark) 2. List 3 materials that can cause disease you stated above (3 marks) 3. With the aid of diagram, described briefly the quadrants in the abdominal area. Give 2 organs located at each quadrant (4 marks) 4. Define and draw location of McBurneys point (2 marks) CASE 3 An 8 years old boy presents to the clinic because his parents have noticed strange, jerky movement and drastic change in his behaviour and personality. On PE, you see a brownish ring around the superior and inferior poles of cornea. He was diagnosed to have Wilsons disease 1. Described briefly the pathogenesis of Wilsons disease (4 marks) 2. What is the medical term of brownish ring around the superior and inferior poles of cornea (1 mark) 3. List 3 investigations and expected findings (3 marks) 4. State 1 treatment and state how it will help this patient (2 marks) CASE 4

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A 53 years old Chinese man with known alcoholic cirrhosis presents with increased abdominal girth and fever. Through PE and investigations, he was diagnosed to have hepatocellular carcinoma 1. Briefly described the portal circulation of liver (4 marks) 2. State 3 other risk factors for hepatocellular carcinoma (3 marks) 3. Explain 3 gross morphology that can be seen in this patients liver (3 marks)

CASE 5 You are asked to examine a newborn baby boy when his mother when his mother reports that he instantly regurgitated upon her first attempt to feed the baby. The mother reports that the baby started choking and coughing up breast milk. He was diagnosed to have tracheoesophageal fistula 1. With the aid of diagram, list 5 variant of tracheoesophageal fistula with the frequency of their appearance (8 marks) 2. What is the associated abnormalities with tracheoesophageal fistula, state 2 (2 marks) CASE 6 A 56-year old woman presents to the emergency department with history of vomiting blood. Further history reveals that she has also suffering from some epigastric pain. Past medical history is significant for long-standing rheumatoid arthritis. She was diagnosed to have chronic gastritis 1. State 6 risk factors of developing chronic gastritis (3 marks) 2. How do you classify chronic gastritis? Define and state 2 pathological findings in each type ( 6 marks) 3. How do you relate rheumatoid arthritis with chronic gastritis, explain (1 mark) CASE 7 A 54 years old Chinese man presents with gnawing epigastric pain. It was also associated with LOA and has been vomiting after meal. The pain however did not relieve by the used of over the counter antacids. He was diagnosed to have gastric carcinoma 1. State 3 cardinal risk factors in this patient (3 marks) 2. Explain briefly the metabolism of Polyaromatic Hydrocarbon (3 marks) 3. What do you mean by carcinogenesis, explain briefly explain the process of carcinogenesis (4 marks)

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CASE 8 A 2-year-old boy is examined with history of failed to pass meconium. PE reveals mthis child has abdominal distension consistent with an obstruction of bowel. He was diagnosed to have HIrschsprung disease 1. Explain the cause of HIrschsprung disease (2 marks) 2. State 1 genetic disease associated with HIrschsprung disease (1 mark) 3. Give 3 differential diagnosis of abdominal distension (3 marks) 4. You decided to have the patient to undergo surgery, explain how do you take the informed consent from his parents (4 marks)

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