1- A 24 year old woman had ulcerative colitis for seven years and was prescribed mesalazine 1.5 g per day. She smoked 20 cigarettes per day and was 10 weeks pregnant. She complained of worsening symptoms with six bloody stools per day. Which one of the following statements is correct?
1) Azathioprine is contraindicated.
2) Initiation of an elemental diet risks fetal malnutrition.
3) Oral corticosteroids are contraindicated.
4) Oral mesalazine therapy should be withdrawn.
5) Termination of the pregnancy is advisable.
Answers-2
2-Which of the following features would be expected on lipid analysis in a 57 year old female with two year history of primary biliary cirrhosis?
1) A lipaemic appearance of the serum would be expected.
2) is treated with clofibrate therapy
3) is characteristically associated with tendon xanthomas
4) is characteristically associated with palmar xanthomas
5) No evidence of a dyslipidaemia would be expected with this short a duration of disease
Answers-4
3- A 55 year-old man on no current treatment for his quiescent ulcerative colitis is found to have a raised ESR.
Investigations show:
Haemoglobin 13.2g/L
WCC 4.5
PLT 160
Corrected Calcium 2.58
IgG 25 (6-13)
IgA 1.8 (0.9-3)
IgM 1.6 (0.4-2.2).
What is the most appropriate next investigation?
1) Bone marrow trephine and aspiration.
2) Isotope bone scan.
3) Plasma immunoelectrophoresis.
4) Rectal biopsy.
5) X-Ray Skeletal survey.
Answers-3
4- Which ONE of the following statements regarding colon cancer is correct:
1) In non-familial cases, gene mutations in the cancer cells are unusual
2) In familial cases the inheritance pattern is typically autosomal recessive
3) It occurs most commonly in the ascending colon
4) It is a characteristic feature of the Peutz-Jegher syndrome
5) In familial polyposis coli the increased cancer risk is due to inheritance of a mutated suppressor gene
Answers-5
5- A 40-year-old man has a history of left-sided Crohn's colitis. Though, previously treated with steroids and mesalazine, he has had several relapses in the past year. The last relapse, treated with high doses of steroids, was complicated by gastric bleeding.
Investigations show:
Haemoglobin 10.8 g/L (13.0-18.0)
MCV 76 fL (80-96)
MCH 24 pg (28-32)
White cell count 10 x 109/L (4-11)
Platelets 400 x 109/L (150-400)
Serum total protein 70 g/L (61-76)
Serum albumin 30 g/L (37-49)
Serum CRP 30 mg/L(<10)
Abdo X-ray normal
Which of the following is the most appropriate management?
1) A trial of oral metronidazole for three months.
2) Total colectomy with ileostomy construction.
3) Total colectomy with pouch construction.
4) Treatment with azathioprine.
5) Treatment with oral budesonide.
Answers-4
6- A 45 year old man was receiving phenytoin for long-standing epilepsy. He admitted to heavy alcohol consumption. Examination revealed no focal or neurological signs, 3cm hepatomegaly but no splenomegaly. Investigations showed: Haemoglobin 10.0 g/dL (13-18), MCV 122 fL (80-96), White cell count 2.2 x 109/L (4-11), Platelet count 90 x 109/L (150-400). What is the most likely planation for these results?
1) Alcoholic liver disease.
2) Aplastic anaemia.
3) Folate deficiency.
4) Hypothyroidism.
5) Scurvy.
Answers-1
7- A 60-year-old woman with known alcoholic liver cirrhosis presents with vague abdominal pains, malaise and nausea. She has been abstinent since she was diagnosed eight months ago. On examination she had moderate ascites and mild, generalised abdominal tenderness.
Investigations: Haemoglobin 11.2 g/dL (11.5 - 16.5) WCC 15 x 10 9/L (4 - 11) prothrombin time 21 s (<15s) serum albumin 28 g/L (37 - 49) serum total bilirubin 56 micromol/L (1 - 22) ascitic fluid protein 26 g/L ascitic fluid amylase normal ascitic fluid white cell count 500 x 109/L What is the most likely reason for her current problem?
1) hepatic vein thrombosis
2) pancreatic pseudocyst rupture
3) portal vein thrombosis
4) primary liver cancer
5) spontaneous bacterial peritonitis
Answers-5
8- A 32-year-old man develops profuse diarrhoea with mucus and blood. Biopsies from the flexible sigmiodoscopy shows evidence of ulcerative colitis. Which of the following is true of the condition?
1) mesalazine therapy is associated with infertility in males
2) pseudopolyps on sigmoidoscopic examination have premalignant potential
3) topical 5-aminosalicylic acid are less effective than topical steroids in proctitis
4) colectomy may produce regression of gall bladder disease
5) goblet cells are unaffected in the mucosa
Answers-4
9- Which ONE of the following statements is true of autoimmune hepatitis:
1) It usually presents as an acute hepatitis
2) It rarely presents before 20 years of age
3) It may be associated with keratoconjunctivitis sicca
4) It is associated with hypogammaglobulinaemia
5) It rarely interferes with menstruation except in later stages
Answers-3
10- Compared with bottle feeding, breast feeding is relatively protective against which of the following?
1) Late haemorrhagic disease of the newborn
2) Maternal breast cancer
3) Late onset diabetes
4) Prolonged jaundice
5) Under-feeding
Answers-2
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1) Azathioprine is contraindicated.
2) Initiation of an elemental diet risks fetal malnutrition.
3) Oral corticosteroids are contraindicated.
4) Oral mesalazine therapy should be withdrawn.
5) Termination of the pregnancy is advisable.
Answers-2
2-Which of the following features would be expected on lipid analysis in a 57 year old female with two year history of primary biliary cirrhosis?
1) A lipaemic appearance of the serum would be expected.
2) is treated with clofibrate therapy
3) is characteristically associated with tendon xanthomas
4) is characteristically associated with palmar xanthomas
5) No evidence of a dyslipidaemia would be expected with this short a duration of disease
Answers-4
3- A 55 year-old man on no current treatment for his quiescent ulcerative colitis is found to have a raised ESR.
Investigations show:
Haemoglobin 13.2g/L
WCC 4.5
PLT 160
Corrected Calcium 2.58
IgG 25 (6-13)
IgA 1.8 (0.9-3)
IgM 1.6 (0.4-2.2).
What is the most appropriate next investigation?
1) Bone marrow trephine and aspiration.
2) Isotope bone scan.
3) Plasma immunoelectrophoresis.
4) Rectal biopsy.
5) X-Ray Skeletal survey.
Answers-3
4- Which ONE of the following statements regarding colon cancer is correct:
1) In non-familial cases, gene mutations in the cancer cells are unusual
2) In familial cases the inheritance pattern is typically autosomal recessive
3) It occurs most commonly in the ascending colon
4) It is a characteristic feature of the Peutz-Jegher syndrome
5) In familial polyposis coli the increased cancer risk is due to inheritance of a mutated suppressor gene
Answers-5
5- A 40-year-old man has a history of left-sided Crohn's colitis. Though, previously treated with steroids and mesalazine, he has had several relapses in the past year. The last relapse, treated with high doses of steroids, was complicated by gastric bleeding.
Investigations show:
Haemoglobin 10.8 g/L (13.0-18.0)
MCV 76 fL (80-96)
MCH 24 pg (28-32)
White cell count 10 x 109/L (4-11)
Platelets 400 x 109/L (150-400)
Serum total protein 70 g/L (61-76)
Serum albumin 30 g/L (37-49)
Serum CRP 30 mg/L(<10)
Abdo X-ray normal
Which of the following is the most appropriate management?
1) A trial of oral metronidazole for three months.
2) Total colectomy with ileostomy construction.
3) Total colectomy with pouch construction.
4) Treatment with azathioprine.
5) Treatment with oral budesonide.
Answers-4
6- A 45 year old man was receiving phenytoin for long-standing epilepsy. He admitted to heavy alcohol consumption. Examination revealed no focal or neurological signs, 3cm hepatomegaly but no splenomegaly. Investigations showed: Haemoglobin 10.0 g/dL (13-18), MCV 122 fL (80-96), White cell count 2.2 x 109/L (4-11), Platelet count 90 x 109/L (150-400). What is the most likely planation for these results?
1) Alcoholic liver disease.
2) Aplastic anaemia.
3) Folate deficiency.
4) Hypothyroidism.
5) Scurvy.
Answers-1
7- A 60-year-old woman with known alcoholic liver cirrhosis presents with vague abdominal pains, malaise and nausea. She has been abstinent since she was diagnosed eight months ago. On examination she had moderate ascites and mild, generalised abdominal tenderness.
Investigations: Haemoglobin 11.2 g/dL (11.5 - 16.5) WCC 15 x 10 9/L (4 - 11) prothrombin time 21 s (<15s) serum albumin 28 g/L (37 - 49) serum total bilirubin 56 micromol/L (1 - 22) ascitic fluid protein 26 g/L ascitic fluid amylase normal ascitic fluid white cell count 500 x 109/L What is the most likely reason for her current problem?
1) hepatic vein thrombosis
2) pancreatic pseudocyst rupture
3) portal vein thrombosis
4) primary liver cancer
5) spontaneous bacterial peritonitis
Answers-5
8- A 32-year-old man develops profuse diarrhoea with mucus and blood. Biopsies from the flexible sigmiodoscopy shows evidence of ulcerative colitis. Which of the following is true of the condition?
1) mesalazine therapy is associated with infertility in males
2) pseudopolyps on sigmoidoscopic examination have premalignant potential
3) topical 5-aminosalicylic acid are less effective than topical steroids in proctitis
4) colectomy may produce regression of gall bladder disease
5) goblet cells are unaffected in the mucosa
Answers-4
9- Which ONE of the following statements is true of autoimmune hepatitis:
1) It usually presents as an acute hepatitis
2) It rarely presents before 20 years of age
3) It may be associated with keratoconjunctivitis sicca
4) It is associated with hypogammaglobulinaemia
5) It rarely interferes with menstruation except in later stages
Answers-3
10- Compared with bottle feeding, breast feeding is relatively protective against which of the following?
1) Late haemorrhagic disease of the newborn
2) Maternal breast cancer
3) Late onset diabetes
4) Prolonged jaundice
5) Under-feeding
Answers-2
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