31- In the diarrhoea associated with cholera toxin, there is activation of which of the following enzyme systems?
1) Adenylate cyclase.
2) ATP.
3) Guanylate cyclase.
4) Na-glucose co-transporter.
5) Na+/K+ ATPase pump.
Answers-1
32- A 36-year-old man presented with a three day history of bloody diarrhoea. He was apyrexial and mildly icteric.
Investigations revealed:
Haemoglobin 10.5 g/dL (13.0-18.0)
White cell count 19 x 109/L (4-11)
Platelets 70 x 109/L (150-400)
Serum urea 12.5 mmol/L (2.5-7.5)
Serum aspartate aminotransferase 90 IU/L (1-31)
Prothrombin time 12s (11.5-15.5)
Blood film fragmented red cells
What is the most likely cause of his illness?
1) Escherichia coli 0157 colitis
2) Ischaemic colitis
3) Leptospirosis
4) Salmonella enterocolitis
5) Ulcerative colitis
Answers-1
33- A 52 year old woman presented with history of worsening dysphagia over many years. Recently there had been episodes of ill-defined central chest discomfort and nocturnal cough.
What is the most likely diagnosis?
1) achalasia
2) Barrett's oesophagus
3) motor neurone disease
4) oesophageal carcinoma
5) pharyngeal pouch
Answers-1
34- Which of the following is true of Gilbert's syndrome?
1) inheritance is autosomal recessive
2) serum conjugated bilirubin levels are elevated
3) serum bilirubin levels are decreased by fasting
4) serum bilirubin levels are decreased by liver enzyme inducers
5) there is bilirubinuria
Answers-4
35- A 26 year old presents in the first trimester of her first pregnancy (six weeks gestation) for an ante-natal check, she feels well. Blood tests show a Bilirubin of 40 µmol/l the other LFT's are completely normal. The most likely diagnosis is:
1) Gilbert's syndrome
2) Primary biliary cirrhosis
3) Primary sclerosing cholangitis
4) Dubin-Johnson syndrome
5) Cholestasis of pregnancy
Answers-1
36- Which of the following conditions may give a false/positive sweat test?
1) Congenital adrenal hyperplasia
2) Hyperthyroidism
3) Hyperparathyroidism
4) Obesity
5) Glucose-6-phosphatase deficiency
Answers-5
37- Which of the following statements regarding jejunal biopsy is correct?
1) Electron microscopy is necessary to confirm the presence of villous atrophy
2) Sub-total villous atrophy is diagnostic of gluten-sensitive enteropathy and is not found in other conditions
3) It is contra-indicated over the age of 70 years
4) In tropical countries apparently healthy people have a mucosal structure which would be regarded as abnormal in Europe
5) It can be used to diagnose Whipple’s disease
Answers-5
38- A 54-year-old woman presented with an eighteen month history of chest pain and dysphagia for both solids and liquids. She smokes 20 cigarettes per day and drinks 16 units of alcohol per week. Clinical examination was normal. What is the most likely diagnosis?
1) Achalasia.
2) Bronchial neoplasm.
3) Oesophageal neoplasm.
4) Oesophageal web.
5) Pharyngeal pouch.
Answers-1
39- A 46 year old man with a family history of haemochromatosis presented to outpatients for advice.
Investigations revealed.
serum ferritin 453ug/L (15 – 300)
serum iron 29 umol/L (12 – 30)
serum iron binding capacity 46 umol/L (45 – 75)
iron saturation 63 per cent (20 – 50)
What is the most appropriate next step in management?
1) arrange for DNA analysis
2) begin a venesection programme
3) monitor his serum ferritin regularly
4) take no action unless the iron saturation exceeds 90 per cent
5) undertake a liver biopsy
Answers-1
40- A 45 year old woman is diagnosed with a duodenal ulcer. Which one of the following is the most sensitive test for detecting current infection with Helicobacter pylori?
1) A gastric fundal biopsy.
2) Culture of a gastric biopsy.
3) The (13C) urea breath test.
4) The presence of Helicobacter pylori serum antibodies.
5) The urease test on gastric biopsy.
Answers-2
1) Adenylate cyclase.
2) ATP.
3) Guanylate cyclase.
4) Na-glucose co-transporter.
5) Na+/K+ ATPase pump.
Answers-1
32- A 36-year-old man presented with a three day history of bloody diarrhoea. He was apyrexial and mildly icteric.
Investigations revealed:
Haemoglobin 10.5 g/dL (13.0-18.0)
White cell count 19 x 109/L (4-11)
Platelets 70 x 109/L (150-400)
Serum urea 12.5 mmol/L (2.5-7.5)
Serum aspartate aminotransferase 90 IU/L (1-31)
Prothrombin time 12s (11.5-15.5)
Blood film fragmented red cells
What is the most likely cause of his illness?
1) Escherichia coli 0157 colitis
2) Ischaemic colitis
3) Leptospirosis
4) Salmonella enterocolitis
5) Ulcerative colitis
Answers-1
33- A 52 year old woman presented with history of worsening dysphagia over many years. Recently there had been episodes of ill-defined central chest discomfort and nocturnal cough.
What is the most likely diagnosis?
1) achalasia
2) Barrett's oesophagus
3) motor neurone disease
4) oesophageal carcinoma
5) pharyngeal pouch
Answers-1
34- Which of the following is true of Gilbert's syndrome?
1) inheritance is autosomal recessive
2) serum conjugated bilirubin levels are elevated
3) serum bilirubin levels are decreased by fasting
4) serum bilirubin levels are decreased by liver enzyme inducers
5) there is bilirubinuria
Answers-4
35- A 26 year old presents in the first trimester of her first pregnancy (six weeks gestation) for an ante-natal check, she feels well. Blood tests show a Bilirubin of 40 µmol/l the other LFT's are completely normal. The most likely diagnosis is:
1) Gilbert's syndrome
2) Primary biliary cirrhosis
3) Primary sclerosing cholangitis
4) Dubin-Johnson syndrome
5) Cholestasis of pregnancy
Answers-1
36- Which of the following conditions may give a false/positive sweat test?
1) Congenital adrenal hyperplasia
2) Hyperthyroidism
3) Hyperparathyroidism
4) Obesity
5) Glucose-6-phosphatase deficiency
Answers-5
37- Which of the following statements regarding jejunal biopsy is correct?
1) Electron microscopy is necessary to confirm the presence of villous atrophy
2) Sub-total villous atrophy is diagnostic of gluten-sensitive enteropathy and is not found in other conditions
3) It is contra-indicated over the age of 70 years
4) In tropical countries apparently healthy people have a mucosal structure which would be regarded as abnormal in Europe
5) It can be used to diagnose Whipple’s disease
Answers-5
38- A 54-year-old woman presented with an eighteen month history of chest pain and dysphagia for both solids and liquids. She smokes 20 cigarettes per day and drinks 16 units of alcohol per week. Clinical examination was normal. What is the most likely diagnosis?
1) Achalasia.
2) Bronchial neoplasm.
3) Oesophageal neoplasm.
4) Oesophageal web.
5) Pharyngeal pouch.
Answers-1
39- A 46 year old man with a family history of haemochromatosis presented to outpatients for advice.
Investigations revealed.
serum ferritin 453ug/L (15 – 300)
serum iron 29 umol/L (12 – 30)
serum iron binding capacity 46 umol/L (45 – 75)
iron saturation 63 per cent (20 – 50)
What is the most appropriate next step in management?
1) arrange for DNA analysis
2) begin a venesection programme
3) monitor his serum ferritin regularly
4) take no action unless the iron saturation exceeds 90 per cent
5) undertake a liver biopsy
Answers-1
40- A 45 year old woman is diagnosed with a duodenal ulcer. Which one of the following is the most sensitive test for detecting current infection with Helicobacter pylori?
1) A gastric fundal biopsy.
2) Culture of a gastric biopsy.
3) The (13C) urea breath test.
4) The presence of Helicobacter pylori serum antibodies.
5) The urease test on gastric biopsy.
Answers-2
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