21- A 68 year old male presents with alcoholic cirrhosis complicated by mild ascites. Which of the following features is likely in this patient?
1) Increased serum sodium
2) Increased vascular resistance
3) Reduced urinary potassium excretion
4) Reduced renin concentrations
5) Reduced urinary sodium excretion
Answers-5
22- A 58-year-old man complains of tiredness, fever, weight loss, arthralgia and diarrhoea. Jejunal biopsy reveals flattened mucosa containing periodic acid-Schiff (PAS) positive macrophages. What is the most likely diagnosis?
1) coeliac's disease
2) tuberculosis
3) tropical sprue
4) parasitic infection
5) whipple's disease
Answers-5
23- A 48-year-old woman complains of pruritis, steatorrhoea and bruising. On examination, she is jaundiced, pigmented with spider naevi and hepatosplenomegaly. What is the most likely underlying diagnosis?
1) autoimmune hepatitis
2) primary biliary cirrhosis
3) alcoholic liver disease
4) alpha-1 antitrypsin deficiency
5) Wilson's disease
Answers-2
24- Which of the following concerning the conjugation of bilirubin is correct?
1) is catalysed by a glucuronyl transferase
2) occurs in the Kupfer cells of the liver
3) is increased by valproate
4) is inhibited by rifampicin
5) is impaired in Dubin-Johnson syndrome
Answers-1
25- A 70 year old man was admitted with pallor, light-headedness and loss of energy. On the day prior to admission he had reported loose dark stools. Examination revealed a pulse of 90 per minute and a blood pressure of 110/70 mmHg.
Investigations revealed:
Haemoglobin 7.2 g/dL (14-18)
MCV 72 fL. (78-96)
White cell count 11.3 x 109/L (4-11)
Platelet count 480 x 109/L (150-400)
What is the most appropriate next step in his management?
1) Barium meal
2) Blood transfusion
3) Endoscopy
4) Parenteral iron infusion
5) Proton pump inhibitor therapy
Answers-2
26- Which of the following is correct regarding infection with Salmonella typhi
1) children are particularly likely to become carriers
2) most carriers are female
3) faecal culture is almost always positive during the first week of illness
4) relapse does not occur if antibiotics are taken for 2 weeks
5) vaccinated individuals who develop the disease will have a mild illness
Answers-2
27- A 28-year-old lady develops abdominal pain, jaundice and ascites worsening over a week. She drinks ten units of alcohol each week and takes the oral contraceptive pill. Which of the following findings would make a diagnosis of hepatic vein thrombosis (Budd-Chiari syndrome) MOST likely?
1) alanine aminotransferase of 345 U/L (5 - 35)
2) acute liver failure
3) ankle oedema
4) ascites fluid protein of 38 g/L
5) tender enlarged liver
Answers-5
28- A 52 year old man with a diagnosis as a child of coeliac disease had been asymptomatic despite poor dietary compliance. He presents with a one month history of intermittent, colicky, central abdominal pain and 3 kilogram weight loss and positive faecal occult bloods. What is the most appropriate investigation?
1) Anti-endomysial antibody.
2) Colonoscopy.
3) CT scan of abdomen.
4) Distal duodenal biopsy.
5) Small bowel enema.
Answers-2
29- A 44 year old male with Child's grade C cirrhosis presented with haematemesis. Which one of the following drugs, administered intravenously, would be the most appropriate, immediate, treatment?
1) Isosorbide dinitrate.
2) Omeprazole.
3) Propranolol
4) Somatostatin
5) Tranexamic acid.
Answers-4
30- A 24-year-old man with chronic diarrhoea and malabsorption is suspected of having coeliac disease. A jejunal biopsy is taken. Which of the following findings would be expected in coeliac disease?
1) Shows leaf-shaped villi
2) Shows flattening of the crypts
3) Appearances may resemble severe tropical sprue
4) Shows fissures penetrating into the submucosa
5) Characteristically shows epithelial cells distended with fat globules
Answers-3
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1) Increased serum sodium
2) Increased vascular resistance
3) Reduced urinary potassium excretion
4) Reduced renin concentrations
5) Reduced urinary sodium excretion
Answers-5
22- A 58-year-old man complains of tiredness, fever, weight loss, arthralgia and diarrhoea. Jejunal biopsy reveals flattened mucosa containing periodic acid-Schiff (PAS) positive macrophages. What is the most likely diagnosis?
1) coeliac's disease
2) tuberculosis
3) tropical sprue
4) parasitic infection
5) whipple's disease
Answers-5
23- A 48-year-old woman complains of pruritis, steatorrhoea and bruising. On examination, she is jaundiced, pigmented with spider naevi and hepatosplenomegaly. What is the most likely underlying diagnosis?
1) autoimmune hepatitis
2) primary biliary cirrhosis
3) alcoholic liver disease
4) alpha-1 antitrypsin deficiency
5) Wilson's disease
Answers-2
24- Which of the following concerning the conjugation of bilirubin is correct?
1) is catalysed by a glucuronyl transferase
2) occurs in the Kupfer cells of the liver
3) is increased by valproate
4) is inhibited by rifampicin
5) is impaired in Dubin-Johnson syndrome
Answers-1
25- A 70 year old man was admitted with pallor, light-headedness and loss of energy. On the day prior to admission he had reported loose dark stools. Examination revealed a pulse of 90 per minute and a blood pressure of 110/70 mmHg.
Investigations revealed:
Haemoglobin 7.2 g/dL (14-18)
MCV 72 fL. (78-96)
White cell count 11.3 x 109/L (4-11)
Platelet count 480 x 109/L (150-400)
What is the most appropriate next step in his management?
1) Barium meal
2) Blood transfusion
3) Endoscopy
4) Parenteral iron infusion
5) Proton pump inhibitor therapy
Answers-2
26- Which of the following is correct regarding infection with Salmonella typhi
1) children are particularly likely to become carriers
2) most carriers are female
3) faecal culture is almost always positive during the first week of illness
4) relapse does not occur if antibiotics are taken for 2 weeks
5) vaccinated individuals who develop the disease will have a mild illness
Answers-2
27- A 28-year-old lady develops abdominal pain, jaundice and ascites worsening over a week. She drinks ten units of alcohol each week and takes the oral contraceptive pill. Which of the following findings would make a diagnosis of hepatic vein thrombosis (Budd-Chiari syndrome) MOST likely?
1) alanine aminotransferase of 345 U/L (5 - 35)
2) acute liver failure
3) ankle oedema
4) ascites fluid protein of 38 g/L
5) tender enlarged liver
Answers-5
28- A 52 year old man with a diagnosis as a child of coeliac disease had been asymptomatic despite poor dietary compliance. He presents with a one month history of intermittent, colicky, central abdominal pain and 3 kilogram weight loss and positive faecal occult bloods. What is the most appropriate investigation?
1) Anti-endomysial antibody.
2) Colonoscopy.
3) CT scan of abdomen.
4) Distal duodenal biopsy.
5) Small bowel enema.
Answers-2
29- A 44 year old male with Child's grade C cirrhosis presented with haematemesis. Which one of the following drugs, administered intravenously, would be the most appropriate, immediate, treatment?
1) Isosorbide dinitrate.
2) Omeprazole.
3) Propranolol
4) Somatostatin
5) Tranexamic acid.
Answers-4
30- A 24-year-old man with chronic diarrhoea and malabsorption is suspected of having coeliac disease. A jejunal biopsy is taken. Which of the following findings would be expected in coeliac disease?
1) Shows leaf-shaped villi
2) Shows flattening of the crypts
3) Appearances may resemble severe tropical sprue
4) Shows fissures penetrating into the submucosa
5) Characteristically shows epithelial cells distended with fat globules
Answers-3
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