I I

'1/2/1
'. I
I

:1
"

I'

SINGLE MULTIPLE CHOICE QUESTIONS

I., 'The lUJar' ·n11H: ·dJurJaul diMa- ta Ichild.~ hood In developedcouatrte. :t.: (RTP (J.BOO4J1)
.. In.

·.'.01Ile

C., sar'"-'.',',:•... ~"-... mone ..

~ •. ", ,"1,. ': .. .', ,j J' ,

UR4f-U~

i"'!!.... , ....... :;,.

1." "

-a
_!

..

,~-~,

I::'Ii

wi'" :-,".<,",;.:,

'D" S·'··' "','. ...... '..• ""'.hige·'·"!a:']~'

" . _'_. I ._"'" "~I"~

-B' _

___:__,!I!]

,_':

C-R"o' .....

,j.,,,,, ..
~"',",''-"'~,

ri·,... ii a
·r ' .

,!!'I;. '._

..... _ liMa

.... af': .'~¥"'~_'!iiI.,.'1IoV '. Jl 0..~~. n' Sale ,Ai+. ..-' 8. 5... 0% 1 e, ID 5-20,% D~ 20.a0% .. More than 30%
iiII'fttI~~,':.~'!

·p'-iI'IIo!BlI'lIIIOrp. 11:1__ ,
-

"':1-, ~.

.• 'U:w_

·.:11,_.'.,.,..'.1...I:"'i!!.: ....

(n TP--t" p'~.'J i,~ ,.,n7~1 ~.,' ( -~~

I

'i.'' .

3:

ci

IIlIi~!liII·_·-~I.- r- {_J_'U\HI!Ma _ 00-',_:· ., • ..il_-e'· :_,:~,

A. Sarco£dLosia

6''''

1:_

,-t ._. ._.-..1- .. -.' __- 'w"": __ -i .. 'i..,. -.~. _~.

,-,_. .'i ~~_, '.'.,'aA-- .._-.-.

.. IlIa-a'I'."-'
..
r ..
_!~_' ,... '~_

:B~ :Maligmmit lymphoma. C:.MacroglobWin,emia ,D. Neurobtastoma :B. .Leukemla .

,n..

,iIiUi!!!'"

:_'li..___,. .........

(RTP p~,,2,25)

l'UUu:,iluS

A._"',Il,."":"';

Copy rig hted m ateri al

,,)IDA: ..

IMU.~'

Ji.l~O'"

Ifl" ., vu ... ~~.,

in Qn~~I:I'

,II·. The mmmoaeat

_\til! __ ' __ '_' .. . ,._,,_'._

_.

..

.B. :Rellnxoesophagitis

Alec"boB..
S,pices

101 _p-'.'iliillliifh4., II· "_'I~''''''''''' ,_"

,_ .. '.,

(RTP' p.71O,'

.e.

:D~ Sm~l:

~Tea.

'6,. Com ...... .,..,.,. Is:: A. Lip B. .BuocaJ.

bltnoral

"10'

:UI..a"'ou cell cucd~

tOW pl.,10S)'

D1i ~-O'~BUe B. PbMyIm 7:~ '8IrIp ..... 01

e.

Ji100r of mouth

mucosa.

".,..,t m,

.lDtutIae

:. tile

,A. Cbttmicw~

oo6till

_lID (RTP I'1,.9'1to ,applied S)

I

& Crobn~ disease

c.
_

D., TYPhoid ulcer

~ ~ul~;

Tu'.berculosb,

j" .................... ....... 1=...:1..., ,.,.;, ,1

'W&1U!D
~I ....

•-

111'-',11. '.-: --.• u

-:.toq , ... . 'fIIIiiIIIIIi: __ '-#""" _,,.... ~

v _'

~ ...

-AI .. .._, with.. .. ~

I_, ..

A. C:hronie:ulcerative:

It MUltiple :poiyposis

ooUtia,

(RTP 1'".,8'1',. ,82"~'

Ie.

,Jiu:venle polyps D..All of the: ,abow: :a, None ,of the above

gl~ ~'II .ID.kre.:

A." ·S,tomach

lof IUtroiatatlaal.

·tact, '~' (OiTP' p" 1.2'11"'1.2'1.2)

:B~ Dleo-caecaa. 'region,

C. ,Colon D· li,.ll!;sop~ .••~ '1i"''''--'~ha!Q'ill-"""D-8
B. :None of the a1xwe 1 Peptla: ·'lll.ceadol :aot ••.
I .~~

OGClB'

.t::

,L '~as,u:a-e~phageal junctiOn B.Up·-iW"i" end. of oeIT~la~.I··1i;-S, ~Duoo.,ennm D'. .Meckel's, ,ll'B¥erticmum B. Pylorus.
Ur~~W

Copy rig hted m ateri al

:ll..~
Jl ....

ted. 'with:

cptoICI_ IDtelti.a'll. the . .~

m:'I'I't ~ ....

:0-',~,I-w.cu. . ft;llj_,"II~..Ii ~~"'"in"," ?IiiF._::.1...,..LD.

tORP ,P,.3(9) tAP' ".,,"155)

:111, _ .... DOt,

'

-II, I'->ji

&~QysMis,~ C,., Duodenal ulcer D.. ~litis B. Asthma ,..... _ """"moa" ,_" ... .liu.
"¥¥MZ ~!I!;

af- P'!!I'~'~ 'ulcer 'I&: ........,.. ~ ,'A.r. 'Greater eursamre (RTP'p." 19~)
--,-'-: '_'_'~

B. 'Lesser c:tH'YD.t1i.1n:
...... UQgUlU"liiii' .' _"!IIIin'n..I"·h····,l!li;--.· . -.-.".n.a'o .............. ,~, r ,-' .... _

D'. Duodenum

_6: -:111 J".'I' I~'\o;W·· 00·· .. ,', .' _,)'t'!II,., ..... _144'
-

B.McCkel·s, divm1icu1Dm
1,3.. PlDDUD~VbI.aoa.

:.,Ddmmedou :1IOt .ow': ,LMaie pre;po.nderance . (RTP' p.758J, 778) B. :1ron',..deficien,'Y anaemia, C. Webs in upper oe8D,P~S D'. Atrophic gastritis IL Female prepondennce

14.. Branaw ....... ,

~ Stomach.

PIOH:at la, tJte=

B~ ,Duod'mum

(~'TP'p,'J303) (O'J7iJ' P'" 1'1'1'1)

o, :Ileum

D'" JejlUfJum B. 0''-'0'9 l5,., ptIoric , ...... .

.II a.
n-L_i!.'·

etapl .....

,e.

B..BnttIDlc: :r~r
B~, Ade~l\, "_u ..', -.=_,: _

""-4U1UI8

. ...1: .. ' - - -

UlSCaSC,nlJu'

(A"I"V ~p ',' "'~B'!'~ ~ P',,-'~--v,i Q~,p.~;u., "O"TP' 1'24'1:,1 ~'<l,

1IlQ" '.....

, :Iu:

:D,ji 'U,icerati.ve: cou'tis

Ueocaecat tuberculosis
e;tomftcb
111. '1lIMfd
I"
',;11 •.

16.. The: celli m,nt .t.u:adaat III, the! ....

'RTP

wtpta
,..".~

nll80311 ,'I
.• - •• '

Copy rig hted m ateri al

',f,lI!IIe _'IDU

'M"C:Q"'s-"I"iI, ~~~U' ,.' ,.,_.,_:_ _ . ,UJ,~ r[Itf~,I~., _

17. 'OMIua'. dtH_ :favolvea'dun:

4, :M'UC08Il only
,B~, Submucosa [cml;y ,e. :M:uacularla prop,ria :&,
j

(RTP,p.,816-'1rJ

:D., :M:uoosa and submucosa, oo,tb

18. :Paaetll '••

:MUC08a ,SUbmllOOla and. :musculmis, 'p~pria

'lDetaplBla ..,.

& [Collagenous [colitis

be Hea ID;
(OW' 1J,,1'23,,)

"~...:I[ D·' . .'.. . lU'CID.ON,

:B., [Cbronic ulcerative ODlitis ,e. Cm[hn,~8disease

:B.

.Amoebic ooUtis,
,_AI_-..-:I........ 'eD~,UHIi

..• MIi,-1'9,' _••••

.....-1I1l~.

A.. Hiematmw'1n and. eosin, 'B, [ron-'hematolWin

'OJ. ,PA·S, :D., :Ya.. 8on's,F:'oD,tana s

m ,.........-t·· an -~ 'IiMOP_o - --~~

.a..-b' ....I1 11- ... . . '~~_':_.u, -'-I'l'~

(CARLcr;ONS

p,'.308-30,9)[

,A. 'ifYII'I,;iIl;p ,'r'",Ji"n.g

''D
..1.1 •.•

""0·' '. --',-1_","'. AI' ...10.,.:~ ....... illl' •• aUlab.tI:ae 1Jl0i ,_ -,IiI,I;i: : W .. ,_Ul.', : .(OTP p'.,1175:) r(RTP fl., 802; & ·5-6 feet. :& 12:..:210 feet 'e" 20'-:25 reet :D., 2'·5~35feet :B,'~ :More thanS5 .feet 2:::Il~he: .. oat fbIad pat 01 'tile ... ,'lllate.tIne III: T .... _.uvue __ RTP_ ,.",.02,'.'; n.. 8 :/ ~ :D- Ai; -_n:'UID., ..
'V::~ ~ILM
I~~_',~ __ , -'~ :~_: :_. _:~

v.~
c ....
C ~

(..'

,B~. J'ejUDlilm

·C~ :Duodenrum. ,and jejunum both ·D.. :ProxiJnal ileilllm B.. :Di3ta,~.:ileum :22. 'Tunt •. co:U &aI: ReD, Ia tU=: A. Stomach.~, 'Duoden.um c.. :Eleum ,Di Caecum,

(,OW 1'.1178)

~ ·Colo,n

as..

"'a.... ·be ca_d '" 'whleh '0.1 'the fOIIowl•• aatfblou.? (RTP p.809~1,(~) .&AmpicUUn B~ Chloramphenicol c.,
Clmdamycin. B. C·~oaoillin,

PR"•••

coB., .. "

DJ. N[to:rD;Ycin.

Copy rig hted m aterl al

88,~ 1'IImur' [twDcnIn IHatlDllli? ~ Oeso,phqtta ~ Small bowel,

uel'Ue~ID

wbich of"the 1OIJow,IDI

:B~,:Stomach
_. '.-_ .......... va

.(R'TPp[.826)

D~ Large. bowel
~

~~""""!"--_. :,"",1/6;-. L Stomach Cl. IIeo~eeaJ], 'region B. Descending colon [40[1' ......... ,colli II, du A. .An:rug~sic8.
i=-'tI

a~ ,

IL Mwtb
,ftIIL_ .......
~ ..

:a-r-""i'__~".·, __

~~...._'II'-~, .-a.~1I&II.aI&

g-" , _.•
1

a, JejWlum :D[I' ,Appendix B., Cathartics

(R,iTPp\<8~OljJ of: tAP' ,p,.fOSS,

to[ :loD,l: term,lapltlOa

B. Steroids "4'\1'· a,- -:-llg.·' bovlDan ~e

, '.tI,

c,.

Lin,COmycinD[1

Oes,tropns
,.- . ····a

L Cholem

-'1, ~'~~i..a""11 ... ~.iw.u_,

-1........ -:,'-:,'"'1_"'"

,~,...,~-... , ,_~"',

".L___

Ia=

,~., ..... L'UU ,-11:·1 .... unI.!;,I;,'_Il:~ II... .D' ,~~.:

(RTPp',B(YI<J8)

Dill Typhoid, S. Crohn~ disease 4-2.. IImU_ple: polWpa lD 'the oo1as, are: DOt Rea :1m L FamUiaJ polyposis (R'TPp,,82[~ 83[1) B. G,ardner~s syndro,m,e C., Retimltis ,piglll,en:t-Ol8! D. 1\m)ot~~8 syndrome: ,D'I! clliOiitl~e~ yn :r- n..,I ·",",-~-I'I!~IIIi:Ii!I':"'S, :s-:---,:;-drome _
C

c.

Tu'beroulosi.8

41. [Crc,bn:J., dl .....

4..

'.'

:8" Caseating grarllwomas, [e. :Skip l[esio-Ds D., Transmural infla'iD:mation B Pu'1 -:[--~- &"aD_ ___. __ ' laMa,", ,j',Jlonc .~.. ;-d. m,~tap-.·,· '.
-11;.

:f'uttare.~ A.. H'ose-p,ipe eelen

, not .baw one 'Df'the fo:lcl.hll

fRTP p,8'16:, 8'17)

'1.11 c

~.

AlA . [C~:'L~-:O'~- ,~"",,_~"I'_~ .... _1i;ll".i.- ....---,II~' 1. -:11:-- __ .... D&Ii ......."ViII,.W,y!lljill 'UVU..... "
1 ~,
I ....

.... n....-alJiili[idII' ~~~

r,. :~~~ •.•. .,._..~. "t. __

."

_"''ft' ~ tRTP'c'C]
¥'~
~!_

..
,~,~.~

nrc
_'

,_,_J:.

A. :Pseudopolyps[ B~ Clyp,t ,abscess, C;. Transm'ILUaJ. :inflam mation,

8'18-~~~ ~v...1
_'-_"

¥. _ '

__ ."

D.. Toxic megacolon

III! MucodJepletiol'll

Copy rig hted m ateri al

'45~,Th. comma... t, If_u. :Ia:

"'1

of

,aD

,~ A;ppendix
.<

""pIo ... en.He: [/Rr-P p~.789~

~l f [.
~i

y. [eckell~~DAl:lijj~l uJCUilUID ,:,yi~c,-'c D. '.'. 0 UJ,Y'!CJi

C., Oe.sophagUB

p[", Stomach

II. Periam,pUl[aryrqion

46~,Thel'OUDwIq: .tatemeau

pdc m'IlO"'~:
A.
O00Ul'8

aN'

crue' ,of' cogp:ldt.I,

,(RTP ,.789)[

in Wants

B. Vomiting: e., ,As'sociatfit, vritil, ,Ii ,ps:trlc: ulcer D,t Hypertroplgr of' pylorus, a M'Qre: common, in males 47~Cut...... ' aIaen , .. . oompRcatm:D.

L AJ.cohol
B4 Steroids,

of:

fR[TP' p. 798~

e~ SalicyIa'lte:s

B. ,All 0'£ the above ,48.,ZolUapl'--BIlIIoa :QDlckoIDJI: dee. llCI,t lad ... 'wblch of 'the :fol1Dwlnlfl {R ff'p,,79[7) & Gu:trlc acid h~Hcretion Di ,Pepti,euleeradon
l

D~ None of the above

C.Beta~el!1, tumour' of' :pane.reS!S D. Non beta-cetl 'msu:n.u Qf pan,creELS,

B\!Diarrhoe8.,

[49~Veme,' 1I0000D ."lIaome ,don Dot i!aelwle': A Pr-ofu1iC: ,gi8ll'noea (PPSP ,p'.,1'374) (GOP ,p.4i1)

,~ypokalemja, D. Achlorhydria B'i AU 'ot the above 10[", 'Th,e: com.,oa.'lt orp:n1un ,uu,l .. melelltenc:
0101, III
~'I .·B.·.·,..

B~ Gu,trie: acid bypersecretion

c.

..

'''I:'.[''i1i---~~~

ueereie

(OTP J:t 1,21'3)

1o.-'""1'iI'I::,'

ioe-

~,wIU.8

'!lA""I"i .... ';--P.··, _iii:II' ~..:i_,"m j5 1~r;yI.u.i&;I,;I,.~ It.'H, '-4i;11'

c .• YersmulJ ,e,nte,rocolitioo ,
Dii Ascaris

,lumbriOOUi'es'

,B. GiCu'd1a Ultnbl'ia

Copy rig hted m ateri al

[5,1. The

[COIImIDDUt ...

of ,patrie

CUlCI'[

iI:
(RTP pl.,BOOj'

A., pYlorus and. antrum B. Ca:rdia C~ Body

D~ Q,utroesophqeal Junctlon B. Equail, distribution

_!!!'II[, U,••
I

'~,.au;:

:A.''''~~'":'''-, [_"11., Ii_, 6,"',_, ._ ~ ~ au,

t,pa['

!I.aI,IIiI. 'mrAM.~·

.• tI~: "-.,e!.' ,"'L~,.. ·lIIr ,.. ",~, ,6f.:· ... ~ UU

,A. ,5[

mUll"

e,

B. 15

B~ " D'~ 12

13" T,lIe COm-aa.lt [01111' 1 'tranlmanl iDfa.rotloD of' 0 the: : ... all boweIlti: . (Rrp 1".8[20, A. Mesenteric vem" tl'trombosis

C~ lIJ'ilssectmg aot1;ilc; ane1!..UJ'sm '-D"',~~\ ... 'V-in. ~1f:oi""'c-~,bc_Q sis I ,_:,," ICVI,!I.itU_ e U!,I,lIQIQ. _ :B,Po1ycytbem'ia ,14. Tbe :mortallt:v .te 01 bowel InfarcUoIl .'E A ''''''S''S than__. '1 'OiBl; B~ - '__o.;"~ 1: V ,~, '5~Q.t~ ,(:EJTP,--=-, ,,. ~_ .'_. ',_.._ .. ~"" "70 _.~ .. _,In; '_'.
,l'Q.

SUperior mesen't-eric ,atteryt.hrombosi$

" C.. ~~l5 , ..SS%,

& ,St)-75%
""'!iO"'[..i"'[5[~il_
I~"~ _.-.·~I._

D" 35-,SO[%

"'~I~'~'1
n[_,a?~il " If: 1:, A"I

,155~ fte
1'","-'

&. Less them. 10%

'II
_

klcld.aee,of n.t1du Ia 'CIOhn'. cUaeue: g;

B. 10~1.51%
lUT-a

~ rt

ir fJ'.I;.J~i

"'~

}"lg1

D'. 25~30%
W~

''!!!,

_: ,r" . '. 'btwe- .'_'.: -:- i ,,-:~-.'.' "_' :~ '~:. ". .-,~ , '. _ -~ ',,'., .

A-

'3'00/Q- "'-', '

,~.:.,- ~,ii;lU~ ;I;.D,1!I!i 1""Ii:L-i~~-'~"'~~.,ojo ~...,_.~~.,· ...

&'IIi .' ,1IIUi'!lliiii

'''',a',t'! -

-:ijjti.'~

,oI!i:f. -, ""~~ • __ "J:"J~ ~ ;t.iilii'''''--... u

:I""~ .. ~

A. :Flat mucow :11. ,Nio::nnal. v:ilUi

:suriace'
",_R,! _.... ~ __

(RTP iJ'.[S'1[3)

C., Inereased plasma, 'cdls in lamina pr-opria., D"._, L-~-[:[:,--,b~-~ iith,~Ii",,1 l~:-~o":: n _ ~;ymp__ ~,p B~ Fattyva£uolation of e:nt-e~s
-=['7 .,' !Ii' U-:'. " -:.'.'

AIU----a, ·t-.......
I.• 'Al"

~.,

'~J:_ jI'IIi'

AJ--'iIIH..... ~~V:

,-II.-.II.1:_p--o- ~~, ---u.IIIi.,""

.
l,.'~" ..

''''-I~
il!oU",J

.L ActetlOC&lcin,om;a, B. T-cell lymrpboma C~Al(pha'"chain disease D,. Crohn.~B disease :B.. Argentafl'''Inoma. ,

(R[TP {J.B'13'

Copy rig hted m ateri al

[.1Va :ta Gib.• ractedHlel [01: ,(RTP ·p'.,8fJ9~10)[ ,~ Ulcerative colitis B. CQlapIlQUS, coUIl.s c,. Pseud_omeDl 'b - -- .raDOUS conus... _JI:';'; D[~ Q,angrene B. Crolm.~. disease 61~, Tho bleIUace of oucIDoma, ,DCCUJ'dq III, • wD1DM :1Ii: (RTP p~"B,2')' A. :Lees 'than,S% B. 6...1.0% : C. 11-,25% D. 26",40% 'B., :More 't:IlaJn ,400ib 166.. ft. ,:bacld.aee '., CU"Cbtama :m aU oola. pol, .. 18: .L, O~ % 1 B~ 0",6%, (R'TP p.829,

14~ A, '._ ......

m••

pedJ .....

le'•wiD

ulcera ,ID tile

".aoma,
1

C__>iQ.1illIc. _ B~, 10r%

-D
~..

O'~~U

~11l1t

67'.. Patleata 'IIIas, 8j:GIND.'., .,.ckome have: • hl,per

bachIeace [oft A. Papil:Wy caretnoma thyroid

B. Pleomorphic

(R;rpp,.2[28)

D[. None of' the abave B. Allo.f'i!he above

C. M'siignant lymphoma

adenoma

117==.·--· '..• __ 61'"

~_ -1m A.E c:_rp itheBal~IUl"" - i_~.',,1 ; i I_V& vwem, 1:10 -'.

"'

I[d·,·;, .... _.-',- '--'.' t..1iiUDUMK'.

do'

.....

!IIi_ '11·.··...... , ~,--_'.,, I

1 ..........

u.

'_. '_0-,1-',' -;~_..: ..

,

;',-,~ " -1' '(R'fP p., 7'10-7')'

_v_~

B~ Stromal p1roliftr,ation
Cl.Ca:rtilege

D';;Pseudomucin, :B.~,Hke s1irUCitu.f;es

H[..... otic: •• Iuoe.~ . '~' of I"' •.,. De01ID In whiCh lite" ,(AP p',1()f9~ .L :Spme B~ ~ 'C~,J,aw D~ Lung "Skin 'M. The ,oaDUllGaMt llo._paIe qat 11::: o ,A, CalcifYing' ,odQ:n1to~nic qst tAP p,.1(23) C., G:ingivaJ. c,st D~ Periapical qat It, ferido,ntal ,cyst
B. Dentigerou's, cyst

Copy rig hted m aterl al

'.,.9,a ; ,',_ CJlI

,~!KJ"'. '-.'.0;11 Ufo

...... Q. "D' Ii!""'

'.n

q,.,.(ji"II9I'~;1i,ii r'G!Il",'~"'-!'!'~,1'

It:1 IS Paneth, eel[ metap.lasia ]j.Boften co:as,'picu()US :in, the 'queiSI'"

cent phase of ulce:ra'lti~e coUtis.,' During this p'base:,

.... ~t·', ~".J'IJ,r'.·,

I""n'~tbllWJI. li.:II~~' n·· but 4.1..,. 'e'","';" U.D'i!" Ul.~ '-, .. ~:.rl~ . tichit~tu['al darnageremams mUQc:terlsed by ,tr:ypt artro,pihy",'01t.1i1,er':r_~ :incbld!eWJ.'.i~ed, num'ben: of &.r:IJfOphiil oells and, :promitl'u'!f!I,t lym,pbmd, follicles 'm.
,,,",,D···o..,,g,;;;;ae-'sg.."_.~IIw!W'Ii.::ng,_,!, _:

'''''1-' -, a.JJ,1JI;i1

>:"'0,1:1,..",1

'U\I;"

'O,Ri ....

,I,

.I'IIWI.,.,

memuQOM,t ren,etppear,aJ)ce tennedfoltieular

'lID .~ ~:~ ,~

p:roctitis"

' . c ,-,-.,~,"'C s 'Il"''l'!liotanOi ,IM.'i'asso:n 1-, 1)',""", '... _~,

C!~I~'"r" Jia ~!Ii.QlU_~, ,Ii,!;;!

"1Io"",A~
!o'I!<!~,

+;... IiU

;Citwn ~ ... _~'

~llo,~ y~,

.,..~~'C :::n~CI"": ~"'IiUocnne

c:eUs in, the gut., This Swr.UitD,e argentaffw, ,granules, Qr:an.ge red and, the Duclei!. blue. ,!!"IO·' ,..".' me F'·' "rri , O'Cme -.,.;I'lllt Bm~ m.'c$~Jle '. ' J8 ap,~a'I~...y .·t, 1' , . _H]'te . ti " .. " ." il!"L Bth· .:en:-6,I~~, +1:... ~.c.I.J 1.2 to, 20 Ftet, (5, :m~b'e8:~,

:a I, A

'The d.uOOeDl.!lmis th,e: ftrst r-~ ~rtiQn

.'1 -.

of' 'the: 'sma:!inte8r-

tinei, it is 'the: 'widest ,and: most. flix.ed, part ,of' the small, mt~9ti.ne, It :~s shaped, Uke:tbe letter All parts ,of the colon exce,pttn,e tectum haW! three, longitudinal strips of muscle: flbenia ad'Q running thew

c..

wbole lenglil,between :23 C Pseudamembsaneue

ba:u:stra.tian,s, 'Dr sacc:u]ations.

which the '~l.pouc'he3mro

i:9,

e:nteroco,lUis

an ,occasional

com,:p,]j),ca:tion of at :m~jo:rsmgiea1 procedure usualily on the illte~,tinaJI, trs;ct, 'It has a bigh mo,rtaJj.ty.I't, invaria,blly occurs i~p(?ttients 'Who have: 'had ,anti'biotiic. the.rapy~. eispecJ;aUyit has been re~aited to Cllildrunycm therapy,. 1 ~it·,retn.L S f:'.': .-. u~~'.LI.L esults ~rom .o4j,- ,C'F~"""'I:';:·::'Clf (L the~'n'l)tf iD~a,(Ui~:! .~. '""I lb.' ;1;t~-?,,:,1 L y,ru~!Ce ~ __ flii.lr,El and infectiQn by C'tolStncli'u:m rJJfflci~'e w'hlcn e:tahorates a 'Patent en,terotoxi:!l,. il"i4 1I"iI W M !;.u tn, 'Fml., ·I·d··· " ·t ceus areseen mme . 1 . ,·b"d·· ......... I, L..'I\;e~.Y' .' .... " ... 1i. ..ynl,p~.~Ol!' tli-j .,'.' :gla:n: . u ,'tissue of. the a:p,pe:ndix:and in other ;sites of lym.p:boid 'us8uemU1e 'pnxJ:romal stage of measles. ' 15 CThelam.iIna p'f1{Jpria the :smd iintesUn,e: c;::cm.tains:many o:f' :p'Ja.sma ,ocIlla. in addUiQ:u to :lymphQoytes and macro,puage 9" :,1.., C,~":-,
~,~: I

,ue p~I;-,·-;,-,;o;, o"i;o!iI;'U'j:oj, .\iIIssmg, ........

_Q

seerete
_"'

... _""

:Unm"\'I~,""~.···1·1 g:, !~bu1in~I.' '-'Y.l!i"'~""-,

pa:rticu.'~ady[gA" 'These'se~:

,M,

:imlportant

g"

£unction aplin.,t bac;lle:ria1Jmvasinn (muooaai[ bn:m:unill;y)., B The goblet ,ooKs,are' paQked 'with, .Dl"UCig~ panule.~", Thel,e create large a,p~:eal'Va.cu:Qle:8 that gi,vocea;n. ,a:ppearan.oe re,semibling a goblet, Thes.e eells aretbe ',", f.,1... ,,...,111 .,. .'." source 0,f 'm',llcOrlUt secreuo:n o~ "Q~eamau ,rnte'9:~.n~"
·D·.·· .C,c .. '\.I!'UI ....... !\.iI.· IIiIII. J U\IIil.ll 'Ci~'[l"liIU'!'m'~"""''JI''iII~'cI·
g,&

:protec1ive:

JIl"Ii,~

oil'

.B'[I"IiH~!iO'\IIII '~a,B1i'1I! IW.II: .. ~~ .... 1IIi!ll1 ~~1Ii1

,n.TilI V-l"'-' LoW· C'IIII~IIIIinI;5'~.~11 l"~j. ....llftni't~,~ W .. :I,

'~~ .... IUila...

t,'

is :raiseam, the serum in l.ower gasi:ro:in'testinal cancer

Copy rig hted m ateri al

G8,sJ'01tJ[~~dn8r T' t- ;ifon", t~ ," ,,,",,....4<'" ,I' ~'reo_.'i,~,.,l

[~speQiaiDy [ool!lrecuo

cancer.

Raised

'been, :f'ound,in, eaneers o:fthe breas[t and lUnS~ Its jmporlmlc~ in co]arectal cancer is ,after 8\.U':ieIY when :it disappears :from, the serum completely., Ibl :reappea',-

level.1 bavc:.[aIso

ranee "in the: serum, indlica,tes

noo<pla.8m,.

..

recurrence: of tb.e prim 8!_rJ

l

:18.[ l~w.oJd tu.m,OUf' d; 'themo8t oommo.I)Jtumour of 'the appendix., ortis l.tl\(1!lW.Uy ~,ptoiDRtiC ondfound a8 an inc.ideIl:t,a.JJrU1d~gin appendecmmy specimens removed tof' [El.CU:: appen~_cl [,--So ", 'te ' , "~',~'~di'ti ' ,29 DAeute:
litis

,wi;th, 'or without ,P!Cnbmtion e:.,g.,appendilcitil~di~erticur

peptic ulcer and :ru:pUlted [ectopj,c PRgnan,~.Th,e common. 'Qlpm~ms ,are Esch.erichitJ;, ,~ fm't:eU9[ 8lnd
entel'lOOocci..,
l,

ba;c:t~e:riaJ perUQni.til;l 1:6 U7H')i$t ,ff'eiq'ueu'tb" mOOUltltemdj, 'wl'llibtf1ltunma,tj,Oi], efthe alXiominal organ,s;,
cho:lecy:s,titisJ, infarwOll, of in'il.estine.tpenora.teCl

30:0

Primmy' tumeuss of the peri.tone~l!lm, re rare, the a

cammo-n,est.
'tUim,our

Is A m'eso[th,eUo,ma.

:r-t

similar to lung :me,sothelj,oma., 81 B U:m& [~ ween'}[ parallelw the bowel lengith ,are seen classieally in elltedc:feverMdYersutia [entel'flCOitis.

~~"'iHj"';':"i.:;,','L..i~-'~ t...... 'C i5,~""-.~""'o ~V:iii"IO':;,'ji~ ...~Wlu,!oH'Ii!il!IUP [I."'" a~ueB~!il!i_",iI:""'!i:I! ' !..'U'~

:''ifl' ,a[O:1. 1i'\Ii!ijO ",~, 0 1:""",11,

cent
_11:11,.

l'bOWfj a
"-;Oli,i5'AIC'I

_!i:I!

These uWe.rs,
-.;;; ...~_ .: -.:_~

QiCcur due: to ,swe~g of'the hyer's ,patches with. shedding: [or{ the: overlying mucosa. Theuleers 'slow)y
"_ - --_'-. I,

beal,without :scarnng though they' canped;O,taR' during the acute, stage" L" ,_r-. .. I':. • .~... 12: D Meebl:~[ di~cul11ml :is,a diverti.culum,en tile; an~g, .. mesenteric ,as.p~t, [of thetermmm Ueump:roxim.alto[ ·the :ij)~caecail valve and posaeesee ,all th[e layeni, o~ the:
:. "

mfl~t.edc
SD}alIl

8lQaU mtesttne. It is a remnant of the om:pbaJ,o-

aa

b1.J,t1'n 50 percent ofcaBeS~p:EJ,tric ~~C<lSQ is present" 1'0 these: eases :it :roanMests as peptic ulc~r.ation MJil,. hem[()rrrlmge:" CThe ,oommonestbenign, tumeur er th,e: "mall, mtestine j,9 leiomyoma •.being; next in frequency 00 tbe:8tomaob" [t ~P~:J ',gre'wl' :m,to the gut lumen. (b,nmngthe bead. ,of an :in,tussuBCe:pUon. A. small leiomyoma Qr the mtes~ •.mfltybe: the :~: ,0:1 ~ssive~ .bem~hage.

,m,res:"«ne

duct.. Its mucosa is usua]ly 'that of 'the

Copy rig hIed m ateri al

;II""
'!lAIIii

I,,.,,.,ii""'ii. mL..r~'.,-"

In'

,~'.iIo~.' ,rcrln..H~i '

I
[L:,

• .._ 'B'. [......:LII.IICII ". -, , _:nll ,.,~---~-,-.-., GI"'!I' au.

_' ., ,..

.. '

,;jo'Lu.d=
..,._..,

-.- ....-,.,--': ...., C8:I"Cl:DO:uaB

.... '.' . I ,. ,are, 'yeI-'"<lIW"-~' ... c.' ._. - -. ~~J'

__ I ,

. ... on ._.__

[o"!!'II'''I .... ~Wi

,t

II,

[e

aection, bu,t, tilmcolour ,ldmetimes may not be diltino .. 'tive :from, ,other neop1uma.

PamiUaI, 'nndtiple palypoe'18

Idi8etlige"

.~. d~op ~ the, second, tD third decad,e:of Jjfe~ A member of the :ramil,' who[ :hEUI not devdo,ped polypi
'by' 40 ,yean of lap; :i.8 not, Ubily' 'to develop 'them later.

'1ihe poIyp8, ,h~do:mrt

m an

autosomal

diomlnant dlevelop :m, ChDdImod~

36 B Many' patholQgleulbelieve that diet p'lays, a ~igni600nt :rOle; in [tauBing eolorec,ta]J, [cancer'. The :factum imp6ca'ted ,are: (~U The l~l ordi~ ,animaii _t, ,and protem (~) 'I1le ibre cootent of 'the diet. A diet :richmmeat with tts a,ciColm.pa,nyinJJ; f.'t,c,a.1ll;8e:8, fonnation of
t::I! . !I,:,U
r

[w, [I-l~"";""~d·lA, d,11w.rw ~ ~1...,., """~,,,,,mry:' ":.' _.·r-!li:. ,.... . I,UIin e [...1iJ~'I'I"""'6. -, ...~ IU.ue:;tu;;J. iI;,.oI!ii .: ,ilK"', ':R~; UJ.~II,; UU'eCi 1:.iL1.!W Uie.. :not ,caU8e stasis and hmeethe: ca:rcli'w,geRs do not. get adequate 'time: for ac:;{!lon. 17 D The, :Bru.nnerl. glands, are, distinctive' of 'the duoden:um, Th,,,, .ar.re l~la:bol',a'lteb'branehed, andpen.etrate the
'High- ' :., .' :
. .

[c:a.roinogml WIn neuUtlil sterols or &om incretlMd level)s

'M,l!l8Cularis mucosae
[GD

·C·-, Ho; ....... _·.~ .v 1-"~Ii;:.;y&C.ui'J t'~~i~ ,"".-,IPi[-,-.'id·,·· m··[I.....,~~at1i.·,- -[lit·:: 'A,',t'I m.iI&
I • _ ~~ ......... ,..

~_'Oio_

in;IW' the submucosa..

;8mOJA

_F W ,oi<lil~
~ ~ ..

.+1... ...... Uile ..,....~. a.i,!lJliii.

"'.1'1

+4:_ ............. +.,1. :WU,~iWI,I;:i: !IAIU!

,1;.............

~I_,
~Ii,

A]···I!If(l,.;,oi"d'llYlf'io .. JUlrUU.!SI"

.2~1a: UI,l!l;ii

6DiiQ]] ~ .... ro.....,~ ...,..,WICI,

":-:_-=_.

of the ,entire :~, of the gastromte8t:imd,b:'s:ct~ the neoplasm heIle' acc:ount, fbI" ooly [3 to 6 per ,ceo,t ,of all pBtroin:tes:tin.ai tum.()-tttS~ 89 C Tbe Meckel~8[ (UvlerUculum :il ,B"persistence: 0'£' 'the: ~tuents7S
:pei" [cent

,omphalomesenteric duct:
'111t!: ~,~.
Iol_·.. " WilD

'.''t'!IM

Up~

[2'...... ;;;J ,l~ ~ &....- ..t. 1-__""' .... 11 .: W ~. L..-t' U,UUlI, wre . .~¥'_w:,.__
I

~y

U.luaiy

within 12

ill. oocurs

proximaD.Y
......

:mcnes
:~

of

8OmCi~

40 B :MehlnOfJis collis,

the, OOl!'l!cUtic.t1in which the, m:uOOWi!, membrane of the oolon and append1ix :may acquire: a brown oolotli':' due: to the: accumlJdu,tion of a.,btuwn~

FanUlu'
prop~
babiilll!al

pii.gm'le:n.t in. the: phB:gocytee, of the:1a:milna The condi1!:iWn :is Rlalted to colon ,st_ls and th,e:
use

or .anthraoo,ne

~~I.

[41, :B, Enwo~

labile. ktxinsJ, the :.rmr bas a ;si!mUar action ki ,cbolw toxin. This ,group :is lone: of th,e: oomntD'lle8t ca'lllls.e: of

E. COR produce beat-s,table: and heat-

tmvelilen diarrhoea No sman bowel. clw'J.ees have been

J

de.~1;-.-..II ~.,&~

'"''''''t,'....... .. ,1LitU,-

til'~n-I+~no~1,..~I~;c-: D". 1~,-Ur--RUJJ'!Ii'!'~7W·.J,I,l.··,

19n' -.,_ ... 4L. ....,...~t-·J·;e;' . \,""'~:' jL.ICI,'~~ICI,ICJ,IL.~.' u~

Copy rig hted m ateri al

of' ,cJianjboea in infant&, These adbe:l"c, to the cn'tcro,cytc:p l,lllm,a DI'!!l:m br,a;nC8. :Membran.elo[ the: en.teroin.vaeiye grou:p resemble SNipIa 8:pecie8, and are colonic: pathopn6~ 4a C ~,tmiti8 p~gmJentosa,is inherited, 8.9, ,an, ,au., somal, :recesmve characterised by retinal depneration l~gtb nightbllmCln9m,. :It i. :nDt aesociat.cd -tb
l

con are: a 'common cause

U8U8iD,.

,eo1onie polyps.

43, B :Nion!~tdng gran:u1omuwith, ot' without :giant eels are ~ in the inte8tb\c!:; as we1l os theregionallym:pll :nodea in, about 501..70 per ,cent cases' of Cmbn''a di8ease~
:However caeation is not a fea:ture" These gnmuJ)omas are ,a valUable feabrre of C:robn,~ disease.,

44 C TraDam'l!lI'fJi[

:inDammation, :is, cbaract-eriatic ,of ,Cmh!n'. disease., 'Th,e, :a,ubmucQISS" is :frc: que n,U_y' widened. by
oedema. andftbrosi8.Fooal
I~~

... '......

iB ... ti:II~L!~.~,'~

.,.,~...,..d.l, fhrou......:'I"""UI I ......... •It· LUi .. _. _ .

~.I>v. __ ',.

a~eptes
..~., ~.IUIiiJIW, L~~~ LA.ilWCI,

of lymphocytes,
C-""_~~. W',iI:ILU,.,

'I TjI....__,.II+;..' ....., Url'-'-~\,I;Ig}U""1Ii:ji1

lcoUtiei.sa chronic

mfllntJ.'maWI)"

disease' of the, bowel

which is, :prim.arl1--Y mueoaal d~8ei1se:,i,the ~tlon, ,a 1De:btg confmed to 'tnt!: mucosa, aD Panererd;h:::tiesuem, the: form of dDcretenodwes of acinar and ductal tiasue ,andoeca:&ionally' isleta oif' Lang:erban/s are COTn'monlJ!"aeen, in, 'the atomach., The: Q!th'e-r61:tes, e;rethe d.uod,en:um j~jQll,um:~:Metlk'ei;e
jI

[di~1m1

and appendix.

46

[e Consemta]

withgas:triic ulcer, 47 D Curling$! ulcers are acute wcers [of the' :~tQmadl IQr dl!.1Od,e.num U8OC.iaitOO. mth UU11Sive: burns. 48 C ZOl!l:inpr:.;SUilOn ~drome [orgMtrinoma. :is the: name
QSi~ted

o.i thepylornIs. It is not

h,_ypert:ropbic pYlorie s:teno6i.s, is, a familial malt\mc,tion Icharacterised by h;ypertrophyand h~ .. :plaaia, of' the cin1:War muele of' the m~s ,propria

usually ,of' the: paru:teas, bilt sumtutDomB ,ariae in 'the d.uodenum,. 49 8 V!ernet-,M'otJ'h~n ~drome: or 'V1Po:ma,~B an islet oeU

,~ri""', lLU lb"1. a.'~IIQU,_,· " ~Nd'l __ ,',~ j'i;'iilrti~,d;...;,co·····n· [_,r' ~:U.L~ WJ and :pe,ptic uloeratmnwlltn, a gastrin-~g
~J''''''''.&
[~a~#i
1a&ir.L_·J

iI.,~"~'.i"i.+'Ii' u,.trv..~!\iIiI~wv"lJ,

t;:wnour IDa,J also,

'tum.OUJ' 'tba.t indluccs

'watery diarrhoea. :~blemia and, acbllor:hydrla. ltfs due tn release [Oof v:eJKl~iIivc' 'mtestma], peptide from, the tum,our. GeMme .ttcld hyper''"

Copy rig hIed m ateri al

,. ,~tiiQn, ·,

IS not :~elll

'"

m hi "b r_ w.~.~.c;,', ,~.QWevc{'a, leatiur-e :~$

U,ii:

-t'

SO

,e

zllllmg:er-E1liBOfi syndrome. Yemini£1, lenm,rocOlitiOa :11 an, ,(Jrganiam 'whilc:b causes ,enrer(,eolitia, 'cbaraeterlsedbymi~bsce8Ies rim_mea ~. mononuclear' "bei.~-es, .. I't is a commencause 0:, ,r· ""'6""' ....J""' i CSiuae er
'U~ ,_.~. " . . ..
1 ,. . .. , .. ' ",

tho ne

m 'illill!l,~"t'\IIII:riic,: ~-!Q"lii ••IUI,~.'IIIlI,._.

I

'-'~~Ili'til" i;iItI,'1:lI,II3I,1,1I"";n",,, I:ILU:~_.. !iii! ~~

,a'¥~'L.'ul.->i:1, .,,,,,,,4!i1..e LU.~,LI, IIJIWU L!U U.I

~_.,__, 1I~'!w.-~"''''''-

tieing 8!lld, suppuratiVe leOm8, of' the ,gut. 1,1, A The oom'mon.est: site,'oC :m,YOlvemen.t. o,fps.mc cancer ,is the: ant.ruJ:n on Oil'"' :near tile pealer' 'cunrat'U!l'e. Uloera-, In '",'

. 'UIv,t cancers, in ':pariiCula:rnave ,ap,redileation :fQr looa .. , tiQn i!nproximity to the: ~ter ~ture: orthe "lQ__ru~.
~,t..lo!!! WI", ,...., .....

,I:. ,!!'II.

v..

"

IC' ..·

chromaffin p:Dsi:Uve. 'The endeerlne ,oen8 aeerete

hQnnon~2J 'Uhe ~dn~
:K'a,I'HkI eln,-like, ,~es"
1

leeUs have been dle8c:f..ibed,~y ultra.structural and :imm,1llnohis.toebem.fca], :feat:urns. All con,tam, WJe'1l-d,efmed secre:tJory' gramales, V'D,e sUlb:9i!tt is ugentailln and
oboleCY,fj,'ItI)Mnm'ji

'~ill+ ~.,.;'Il~~"",,+ .... ~'"'l'~, a ~!o.U''', ~~ ,!YI,~""~~~,~

n.i!n,o ~ __ -,1l;;io

f;;i~iIIi'....~ '!"l7,iIc'

~ Il;I,I

,::::,nJd•I~~.:;.,Mi.I<.... . t'!:l,& .. _,

:serotonin and

53 B fia!nsmrur,-aJj, ilD:fareuon,
I

Oftlhel :intes'une, is an 'Uflcomm,o:n bu:t grave di90.rder a!ssodated wiiltha, high mortalty. It ',.. IP_ ~~~ml_:_,::S'Ji8 ... boll: +..... oeeurs d1'U.e: '~ +i..._ ·bo·' ..Of' 'enll.:....:._.,_'sm, "f '0,,.tne supenor
...'1'

' ....~.~""'"",I.'l m,;i!i,OA- .. ·'ii'!io •.:.'\i!II,..,Ji

"

i!:Ii.·It"f\:· .iI!1:"'IlJ' a.. .....L,; 1 : ".'. .......... ,.1

,.. ,m A~i"'l.• ,: ·a ... .. .... ... ,:I-i : ~JI"-,,,,iU!;l~ ..

I

'0'.

~,liV.'..· '•.' .,',!i'U--;J '!..II

'L.I,e.· 'i:I\!!,!;:!,t:U..!!, 'IUUW~i!. ~ ....:-. ,'_·..'I'nll i'"....._'.'.",- ......:c._.·' "'

\a\~~it "I

~',i"iI ,u,i!;,

~,.. ~a-tre' -:.Ii,~, b:;" ~.~Q'- vaneed .,i ',' at.her 0- '''''·c'l''''''''o· ...,~.."" ·m.8!D8',n·t'8I,ri ... ~_~',iI\II:I!~i" red : 'U' ' ' , .a..:I,..... _~-, '!\.'!.,'. venQUS "thrombosis accounts for :25, percent of the cases and pru1ial n~g (,I( 'the iU1'e-riesor 'Yem9,~ the
~i,' -rg; ",
1 "-~!\r.,

about naIf' the cases ,ArteriaJltbt,am,ootdi9, are :most ,often

_~\ ,,a'\oiI!

remain,au

of the Casel"

54,.

l3:owe1l infuction hft.1 a :mortallity o:f' 50 'to 7S%" ,Promp,t diagnosis Md, immediate:: surger;y offer the a,nly' bO'pe of
to bl.... la-'88fi.d: ~y :9,1"1]"",.",1,,,, ove~ 'fi'A ~~tL __ ::'1'"" _~ _~~ -~-~J wh.elmiing infectiio;n, or periomuo-n of' the 'in,t;estine"i
"-", ~, ::.:. [):::: -~:~,:: -"-',:~,~,C.~ ~ .eaIYJ!.occurs uUe
,c.,

,SIB

,of Crohn.~s disease, 'Th~' :m~Y' 'be: internal',!, 'involVing: other Q~6
:Pistula.s, cQm,p~i,cat:elonl"'stan-ding, eases
l

of' otller'SGgtne:nt8 of '1he intestine or 'eDetneJJ opening mto the :s'1dn Qr the abduttJ"en ,after swgicm procedures", 51 A '1bia, disease: 18 Msokno-Wll as, ~Illllten~s:ensi!tiw e:nte:ro~ :patl1y~asit f'Wlow,!j, :oomebnp:~ment following rem,O\I"ru of the wheat protem, :fto:mthedi!et.1~be prlmru:y' :m,UcosaJ ~eMoo takes the fonn, ·of s.uibtotm villous atropby of crypt bypetp'lastic type giving the ap~ce uf afla!t

Copy rig hted m ateri al