Mount Kenya University · School of Medicine · Internal Medicine
Paper details
- Paper: "CAT 1 MBChB 4 2022", time 1 hour. The month and day are not printed.
- What this page has: MCQs 1 to 12 only. Question 13 (acute pancreatitis case) is cut off after its first lines, and the pages with questions 14 to 16 and the rest of the paper are not in the scanned file.
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme. The student's name, registration number, marks and pen marks on the scan were left out.
- Topics tested: jaundice and liver tests, alcoholic liver disease, hepatitis B, Child-Pugh score, GI bleeding, digestion and pancreatitis.
- Questions that need care: Q1, Q7 and Q11 are loosely worded. The explanation says which option is best and why.
Multiple choice questions
1. An alcoholic man has pale stools, dark urine, right upper quadrant pain, AST 2000, ALP 100, bilirubin 50, vomiting and diarrhoea. The most likely diagnosis is:
- A. Drug-induced hepatitis
- B. Viral hepatitis
- C. Obstructive jaundice
- D. Chronic active hepatitis
- E. Alcoholic cirrhosis
2. A known alcoholic with anorexia and nausea has become jaundiced, with dark urine and pale faeces and discomfort in the right hypochondrium. AST is 2000 IU/L, ALP 100 IU/L and bilirubin 75 µmol/L. The best treatment would be:
- A. Withdrawal of alcohol
- B. Expectant management
- C. Operation to remove obstruction (gallstones, tumour)
- D. Urgent liver biopsy
- E. Endoscopy
3. Jaundice without bilirubin in the urine is seen in:
- A. Carcinomatosis
- B. Acquired haemolytic anaemia
- C. Obstruction of the common bile duct
- D. Infective hepatitis
- E. Chlorpromazine hepatitis
4. Hepatocellular damage is indicated by raised:
- A. AST
- B. Alkaline phosphatase
- C. Alanine transaminase
- D. A and C
- E. CK
5. The double-stranded hepatitis B virus can survive outside the body for:
- A. Less than 4 hours
- B. Six to twelve hours
- C. One to two days
- D. Two to seven days
- E. More than seven days
6. Immunological evidence of immunity to hepatitis B is the presence of:
- A. Hepatitis B core antibodies
- B. Hepatitis B core antigen
- C. Hepatitis B surface antibodies
- D. Hepatitis B surface antigen
- E. Any of the above
7. The most correct statement regarding the Child-Pugh score for liver disease is that:
- A. A high-risk score is not possible with normal aminotransferase levels
- B. A high-risk score is possible without encephalopathy
- C. A prothrombin time greater than 10 seconds above normal confers extra points to the raw score
- D. It has not been validated for non-shunt and non-transplant laparotomies
- E. It was originally developed for patients undergoing hepatic transplantation
8. A patient with a third episode of gastrointestinal haemorrhage from an unknown site should first be offered:
- A. Early endoscopy
- B. Barium radiology
- C. Laparotomy
- D. Intravenous acid-suppressing therapy
- E. A Sengstaken tube
9. Fat digestion is facilitated by:
- A. Bile juice
- B. Pancreatic juice
- C. Gastric juice
- D. None of these
10. Pancreatic juice contains:
- A. Trypsin, lipase and maltase
- B. Pepsin, trypsin and maltase
- C. Trypsin, chymotrypsin, amylase and lipase
- D. Trypsin, pepsin and amylase
11. A gasless abdomen on X-ray is a sign of:
- A. Ulcerative colitis
- B. Acute pancreatitis
- C. Intussusception
- D. Necrotising enterocolitis
12. The most diagnostic investigation for acute pancreatitis is:
- A. Serum LDH
- B. Serum amylase
- C. Serum lipase
- D. Serum P-isoamylase