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MCQ's on Gastroenterology Quiz for Staff Nurse and Medical Exams [Objective]

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...

Gastroenterology quiz mcq

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4) Oral mesalazine therapy should be withdrawn.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.


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


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.


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


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.


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.


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 ascetic fluid amylase normal ascetic 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


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


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


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


11- A 28 year old male presents with a four day history of profuse bloody diarrhoea after returning from a holiday in the Far East. Which of the following regarding his illness is true?
1) a negative amoebic fluorescent antibody test excludes a diagnosis of acute amoebic dysentry
2) Cysts to E. histolytica in the stools confirms a diagnosis of acute amoebic dysentry
3) cholera is a likely diagnosis
4) Giardiasis is a likely diagnosis
5) shigellosis is a likely diagnosis


12- A 63 year old patient with known alcohol related cirrhosis presented with ascites, abdominal tenderness and peripheral oedema. A diagnostic tap revealed a neutrophil count of 400/mm3 (normal <250mm3). Which of the following would be of most immediate benefit?
1) fluid restriction and a no added salt diet
2) intravenous antibiotics
3) oral spironolactone
4) therapeutic paracentesis
5) trans-jugular intrahepatic porto-systemic shunt


13- A 29-year-old man presents with anaemia, bleeding tendency, diarrhoea and abdominal pain. Examination reveals a palpable mass in the right lower quadrant and anal skin tags. What is the most likely underlying condition?
1) chronic pancreatitis
2) coeliac disease
3) crohn's disease
4) intestinal lymphoma
5) ulcerative colitis


14- Ten individuals are admitted to casualty with profuse vomiting after attending a retirement dinner in a chinese restaurant. They all ate at roughly 7 pm and became ill at roughly midnight. Nine ate a mixture of dishes except one female who ate vegetarian dishes with her rice. What is the most likely infective organism?
1) Salmonella enteriditis
2) Staphylococcus aureus
3) E. Coli
4) Clostridium perfringens
5) Bacillus cereus


15- Which of the following is activated by Cholera toxin?
1) Adenylate cyclase
2) Guanlyate cyclase
3) Peroxisome proliferator receptor (PPAR) gamma
4) Sodium/potassium ATPase
5) The glucose-sodium transporter


16- Which of the following is NOT true of a patient with ascites due to liver cirhosis:
1) Spontaneous bacterial peritonitis is a recognised feature
2) The usual source of the ascitic fluid is mainly from the exudation from the surface of the liver
3) Hepatic intrasinusoidal pressure is elevated
4) Urinary sodium concentration is usually less than 10 mmol/l
5) Cardiac output is often elevated


17- A 35-year-old woman with a history of recurrent anaemia was noted to have target cells and Howell-Jolly bodies on a blood film examination. Investigations revealed:

  • Haemoglobin 7.0 g/dL (11.3-16.5)
  • MCV 77 fl (80-96)
  • MCH 26.2 pg (28-32)
  • Serum B12 140 ug/L (160-760)
  • Red cell folate 95 ug/L (160-640)
  • Serum ferritin 10 ug/L (15-300)

What disease specific antibody is most likely to be present?
1) Anti-endomysial
2) Anti-gastric parietal cell
3) Anti-glutamic acid decarboxylase
4) Anti-intrinsic factor
5) Antimitochondrial


18- Which one of the following is a feature of the VIPoma syndrome?
1) Alkalosis
2) Hypoglycaemia
3) Hypokalaemia
4) Increased gastric acid seceretion
5) Provocation of VIP release by somatostatin


19- A 40 year old single man returned from holiday in Europe with mild bloody diarrhoea which had lasted for two weeks. He had lost 2.5 kg in weight, had occasional lower abdominal cramping discomfort and a painful swelling of his left knee. What is the most likely diagnosis?
1) amoebiasis
2) campylobacter infection
3) Crohn's disease
4) gonococcal septicaemia
5) ulcerative colitis


20- A 43 year old male presents with weight loss and watery diarrhoea. Investigations reveal hypokalaemia with a pancreatic mass. Which of the following would support the diagnosis of a VIPoma?
1) Achlorhydria
2) Hypoglycaemia
3) Increased Pancreatic polypeptide
4) Migratory erythema
5) Pellagra


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


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


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


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


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


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


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


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.


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.


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


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.


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


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


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


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


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


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


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.


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


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.


41- A 32 year-old woman with Crohn's Disease has a history of a right hemicolectomy for ileo-colonic disease. Since the operation she has had frequent diarrhoea but no blood in the stools.
Investigations show:
ESR 10
PLT 240
serum CRP 7 (<10)
Which is the best treatment?
1) Cholestyramine
2) Mesalazine
3) Metronidazole
4) Omeprazole
5) Prednisolone


42- A 24 year old woman was referred with tiredness and intermittent bloody diarrhoea and a past history of cerebral venous thrombosis. On examination, the sclera of the right eye was inflamed, and multiple mouth ulcers were noted. At the colonoscopy, which confirmed colitis, two large vulval ulcers were noted. Which is the most likely diagnosis?
1) Behcet's disease.
2) Crohn's disease.
3) HIV infection
4) Syphilis
5) Ulcerative colitis.


43- Which of the following is the commonest cause of traveller's diarrhoea?
1) E. Coli
2) Entamoeba Histolytica
3) Giardia Lamblia
4) Shigella Flexneri
5) Yersinia enterocolitica


44- A 59 year old woman has had insulin dependent diabetes mellitus for over two decades. The degree of control of her disease is characterized by the laboratory finding of a HbA1c of 10.1%. She complains of repeated episodes of abdominal pain following meals. These episodes have become more frequent and last for longer periods over the last couple of months. On physical examination, there are no abdominal masses or organomegaly and no tenderness to palpation. Which of the following findings is most likely to be present?
1) Acute pancreatitis
2) Chronic renal failure
3) Hepatic infarction
4) Mesenteric artery occlusion
5) Ruptured aortic aneurysm


45- Which of the following is true of Spontaneous bacterial peritonitis?
1) A survival rate of over 50% is expected at one year
2) Gentamicin is the treatment of choice
3) is characteristically caused by aerobic bacteria.
4) is diagnosed by culture of ascitic fluid.
5) is due to intestinal perforation


46- A 30 year old caucasian male presents with a six month history of weight loss, abdominal pain, and diarrhoea. On examination you note finger clubbing. Which of the following diagnoses is least likely.
1) Crohn's disease
2) Ulcerative colitis
3) Coeliac disease
4) Whipple's disease
5) Ileo-caecal TB


47- Reflux oesophagitis of gastric contents
1) is a cause of asthma
2) can be improved by Helicobacter pylori eradication
3) Occurs during transient relaxation of the lower oesophageal sphincter
4) Is neutralised by bicarbonate secreted by the oesophageal mucosa
5) Can be excluded by a normal appearance at endoscopy


48- Which statement is true concerning iron?
1) Iron absorption is mainly in the distal jejunum.
2) Parenteral iron is indicated if the haemoglobin level is not raised within 3 days by oral iron.
3) Sustained release preparations are useful if larger doses are required.
4) 200mg iron sulphate has more elemental iron than an equal dose of iron gluconate.
5) Absorption is prevented by ascorbic acid.


49- Following factors decrease large intestinal motility:
1) Parasympathetic activity
2) Anticholinergic agents
3) Gastric Distension
4) CCK-PZ
5) Laxatives.


50- Which of the following statements is correct of hepatitis C virus infection?
1) Cell cultures of virus are routinely used to assess response to drug therapy
2) High antibody titres are an indication for therapy
3) Less than 5% of cases lead to chronic infection
4) More likely to be transmitted by the sexual route than hepatitis B virus
5) Treatment with ribavirin and interferon alpha is more effective than interferon alpha alone


51- Which ONE statement is true regarding the treatment of iron deficiency anaemia:
1) iron is absorbed in the distal jejunum
2) absorption of iron is increased by ascorbic acid
3) sustained release iron is a useful way of giving larger doses
4) ferrous sulphate 200mg has less elemental iron than the same dose of ferrous gluconate
5) parenteral iron is indicated when the anaemia responds slowly to oral iron


52- A 35 year old woman with alcoholic cirrhosis is admitted with deteriorating encephalopathy and abdominal discomfort. An ascitic tap revealed a polymorphonuclear cell count of 350 cells per mm3. Which of the following is the most appropriate therapy?
1) Intravenous amoxicillin
2) Intravenous cefotaxime
3) Intravenous metronidazole
4) Oral neomycin
5) Oral norfloxacin


53- A 56-year-old man from Thailand presented with abdominal pain and a mass in the right upper quadrant. He reported that he had been diagnosed with viral hepatitis several years previously.
Investigations showed:
Serum alpha-fetoprotein 13,500 IU/L (< 10)
What is the most likely underlying viral infection?
1) Hepatitis A virus
2) Hepatitis B virus
3) Hepatitis C virus
4) Hepatitis D virus
5) Hepatitis E virus


54- A 58-year-old man has had an enlarging abdomen for several months. He has experienced no abdominal or chest pain. On physical examination he has a non-tender abdomen with no masses palpable, but there is a fluid thrill. An abdominal Ultrasound Scan shows a large abdominal fluid collection with a small cirrhotic liver. A chest X-ray shows a globally enlarged heart. Which of the following conditions is most likely to be present?
1) Dilated cardiomyopathy
2) Lymphocytic myocarditis
3) Myocardial amyloid deposition
4) Nonbacterial thrombotic endocarditis
5) Severe occlusive coronary atherosclerosis


55- Which of the following is true of Spontaneous bacterial peritonitis?
1) A survival rate of over 50% is expected at one year
2) Gentamicin is the treatment of choice
3) is characteristically caused by aerobic bacteria.
4) is diagnosed by culture of ascitic fluid.
5) is due to intestinal perforation


56- 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


57- 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


58- 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 explanation for these results?
1) Alcoholic liver disease.
2) Aplastic anaemia.
3) Folate deficiency.
4) Hypothyroidism.
5) Scurvy.


59- Which of the following is true concerning a hepatitis E infection?
1) It can be transmitted with hepatitis B.
2) It is a recognised cause of chronic liver disease.
3) CT scan of the liver with contrast shows diagnostic appearances.
4) The incidence of chronic liver disease is reduced by administration of alpha interferon.
5) It does not result in a carrier state.


60- Which of the following statements is correct of hepatitis C virus infection?
1) Cell cultures of virus are routinely used to assess response to drug therapy
2) High antibody titres are an indication for therapy
3) Less than 5% of cases lead to chronic infection
4) More likely to be transmitted by the sexual route than hepatitis B virus
5) Treatment with ribavirin and interferon alpha is more effective than interferon alpha alone


61- 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


62- A 68-year-old man has been very ill for months following the onset of chronic liver disease with hepatitis C infection. He experiences a sudden loss of consciousness and then exhibits paraplegia on the right. A cerebral angiogram reveals lack of perfusion in the left middle cerebral artery distribution. The most likely cardiac lesion to be associated with this finding is?
1) Acute rheumatic fever
2) Left atrial myxoma
3) Libman-Sacks endocarditis
4) Non-bacterial thrombotic endocarditis
5) Paradoxical thromboembolus


63- 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


64-A 42-year-old female with Ulcerative Colitis is found to have anti219 smooth muscle antibodies. Which is the next most appropriate test for this patient?
1) Abdominal Ultrasound
2) Colonoscopy
3) Full blood count
4) Liver biopsy
5) Liver function tests


65-Twenty one people are on a Nile boat cruise and present one week into their cruise with diarrhoea. What is the most likely causative organism?
1) Campylobacter
2) Cryptosporidium parvum
3) Entamoeba histolytica
4) Giardia lamblia
5) Shigella species

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