Bilateral ovarian metastases presenting as tumor masses are most characteristically associated with carcinoma of the:

Correct Answer: B

Rationale: The correct answer is B, stomach. Ovarian metastases from gastric carcinoma are commonly bilateral due to the close anatomical relationship between the stomach and ovaries. Stomach cancer frequently spreads to the ovaries through direct extension or lymphatic dissemination. In contrast, esophageal, small intestine, and appendix carcinomas less commonly metastasize to the ovaries, making choices A, C, and D less likely. Thus, the characteristic bilateral ovarian metastases are most commonly associated with carcinoma of the stomach.

Correct Answer: C

Rationale: The correct answer is C: Starch. Amylase is an enzyme that breaks down starch into maltose in the oral cavity. This process is the initial step in carbohydrate digestion. Proteins are primarily digested in the stomach by pepsin. Lipids are broken down by lipase in the small intestine. Amino acids are the end product of protein digestion, not the substrate for amylase. Therefore, the correct answer is C as amylase specifically targets starch for digestion.

Correct Answer: D

Rationale: Pepsin is the correct answer as it is the enzyme specifically produced by gastric chief cells in the stomach to break down proteins into peptides. It works optimally in the acidic environment of the stomach. Amylase (choice A) breaks down carbohydrates, protease (choice B) refers to a general term for enzymes that break down proteins, and lipase (choice C) breaks down fats, making them incorrect for this question.

Correct Answer: A

Rationale: The correct answer is A: mouth. Salivary amylase, an enzyme in saliva, initiates the breakdown of starch into maltose in the mouth. This process marks the beginning of chemical digestion of starch foods. In contrast, the stomach primarily digests proteins, the small intestine further breaks down carbohydrates, proteins, and fats, while the large intestine absorbs water and minerals. Therefore, options B, C, and D are incorrect as they do not represent the initial site of starch digestion.

Correct Answer: D

Rationale: The correct answer is D: Cobalamin (B ) supplements. Patients with Crohn's disease often have malabsorption issues leading to megaloblastic anemia due to vitamin B12 deficiency. Cobalamin supplements are essential for treating such anemia. Iron dextran infusions (A) and oral ferrous sulfate tablets (B) are used to treat iron deficiency anemia, not megaloblastic anemia. Routine blood transfusions (C) do not address the underlying cause of megaloblastic anemia in Crohn's disease.