Mount Kenya University · School of Medicine · Department of Internal Medicine
Paper details
- Paper: University examination 2019/2020, MBChB Level VI, unit code MBIM 6112, "Internal Medicine CAT 1", time 1 hour. The exact sitting date is not printed, so it is filed as undated.
- Questions: 30 multiple choice questions and 4 short answer questions.
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme. Student numbers, marks and pen notes on the scan were ignored and are not published.
- Topics tested: HIV and the gut, diarrhoea (infectious and non-infectious), alcoholic liver disease, hepatitis A, B and C, cirrhosis, liver tumours, cholera, shigella, gallstones and pancreatitis.
- Questions that need care: Q1, Q2, Q4, Q12, Q15 and Q27 are loosely worded. The explanation says which option is best and why.
Section A: Multiple choice questions
1. HIV enteropathy will involve all of the following EXCEPT:
- a) Cobalamin malabsorption
- b) Viral destruction
- c) Viral transmission
- d) Dysmaturation of intestinal epithelial cells
- e) None of the above
2. All the following are NOT associated with Th17 cells in HIV infection EXCEPT:
- a) No role in microbial translocation
- b) Th17 causes epithelial degeneration
- c) Impaired production of mucins
- d) Depressed production of claudins
- e) Recruitment of neutrophils and macrophages to infected enterocytes
3. Which statement least describes angular cheilitis?
- a) Association with erythema
- b) Can occur with or without erythematous candidiasis
- c) Fistula of the corner of the mouth
- d) Pseudomembranous candidiasis can be an association
- e) None of the above
4. The following may cause diarrhoea in HIV/AIDS:
- a) Blastocystis hominis
- b) Isospora belli
- c) Entamoeba histolytica
- d) Shigella
- e) All of the above
5. The following is useful in the diagnosis of cryptosporidiosis:
- a) DNA extraction from stool
- b) Acid-fast staining
- c) EIAs
- d) Direct fluorescent antibody
- e) All of the above
6. The following best explains the role of pentoxifylline in alcoholic liver disease:
- a) Increases blood viscosity
- b) No role in altering portal hypertension
- c) Associated with a significant decrease in the risk of developing hepatorenal syndrome
- d) Associated with angiogenesis
- e) Blocks oxygenation of pathogenic hepatocytes
7. Examination findings suggestive of chronic liver disease may include the following EXCEPT:
- a) Caput medusae
- b) Spider naevi
- c) Gynaecomastia
- d) Anorexia
- e) Pruritic skin lesions
8. Concerning alcohol metabolism, which statement is FALSE?
- a) Alcohol is well absorbed in the jejunum
- b) There is significant elimination in urine
- c) A small amount of alcohol is eliminated through sweating
- d) Cytochrome P450 metabolises alcohol in the liver
- e) Catalase is important in elimination
9. Concerning alcoholic hepatitis, which statement is FALSE?
- a) Bilirubin level is an independent prognostic marker
- b) Level of TGF is an independent prognostic marker
- c) Maddrey factor above 32 indicates steroid consideration
- d) ALT is usually below 400 IU/ml
- e) Kupffer cell activation is pathogenic
10. Alcoholic liver disease is associated with the following EXCEPT:
- a) Elevated carbohydrate-deficient transferrin
- b) Increased mean corpuscular volume
- c) Increased IgA to IgG ratio
- d) ALT to AST ratio of greater than 2
- e) None of the above
11. The following are important in Child-Turcotte-Pugh scoring EXCEPT:
- a) Encephalopathy
- b) Serum bilirubin
- c) Ascites
- d) Prothrombin time
- e) Urine albumin
12. The following are associated with inflammatory diarrhoea EXCEPT:
- a) Cytomegalovirus
- b) Salmonella
- c) Shigella
- d) Entamoeba histolytica
- e) Clostridium difficile
13. Concerning osmotic diarrhoea, which statement is NOT true?
- a) Fasting worsens the condition
- b) Lactose intolerance is the most common cause
- c) Osmotically active agents in the intestinal lumen prevent water absorption
- d) Antacids can be a cause
- e) Cholestyramine can be a cause
14. Which is FALSE concerning Escherichia coli O157:H7?
- a) Produces Shiga toxin
- b) Undercooked raw milk is a cause
- c) May lead to haemorrhagic diarrhoea
- d) Responds well to antibiotics if treated early
- e) May be associated with thrombocytopenia
15. Which microbe is well matched with its incubation period?
- a) Salmonella: 10 days
- b) Campylobacter: 1 to 3 hours
- c) Vibrio cholerae: up to 10 days
- d) Bacillus cereus: 12 to 72 hours
- e) Haemorrhagic E. coli: 5 to 7 days
16. Which is the odd one out?
- a) Campylobacter
- b) Entamoeba histolytica
- c) Shigella
- d) Enterotoxigenic E. coli
- e) Salmonella
17. The following endocrine conditions may cause non-infectious diarrhoea:
- a) Carcinoid
- b) Gastrinoma
- c) Addison's disease
- d) Hyperthyroidism
- e) All of the above
18. Which form of viral hepatitis can exist for years without symptoms?
- a) D
- b) B and C
- c) A
- d) E
- e) All of the above
19. In most patients, what are the symptoms of hepatitis C when first infected?
- a) Itching
- b) Jaundice
- c) Myalgia
- d) Nausea and vomiting
- e) Most patients do not experience symptoms
20. Which marker is the only one present after vaccination for hepatitis B?
- a) Anti-HBs
- b) Anti-HBc
- c) HBV DNA
- d) Anti-HBe
- e) None of the above
21. Which marker is best matched with its description?
- a) Anti-HBc IgG: a general marker of infection
- b) HBeAg: active replication of the virus
- c) HBsAg: past or chronic infection
- d) Anti-HBc IgM: active viral replication
- e) None of the above
22. Which statement is true of hepatitis C virus infection?
- a) Replicates exclusively in the cytoplasm
- b) Genotype 1 and 4 have a good response to interferon
- c) The morphological structure is well characterised
- d) All infected people present with jaundice
- e) In ascites, pegylated interferon is indicated
23. The risk of contracting cholera is increased in the following circumstances EXCEPT:
- a) Use of H2 receptor antagonists
- b) Use of protease inhibitors
- c) Gastrectomy
- d) Use of esomeprazole
- e) None of the above
24. Clinical findings in cholera with acidosis may include all of the following EXCEPT:
- a) Prerenal azotaemia
- b) Leukocytosis
- c) Raised packed cell volume
- d) Severe hypokalaemia
- e) Sodium retention
25. Concerning the cholera vaccine, which statement is true?
- a) Dukoral is not given with a buffer solution
- b) Euvichol requires a buffer for administration
- c) There must be a minimum of 7 days and no more than 6 weeks between doses
- d) Protection is lifelong
- e) None of the above
26. Which statement is FALSE concerning shigella?
- a) No natural food products harbour endogenous shigella species
- b) The infectious dose is quite low
- c) The incubation period is typically 2 to 4 days
- d) Shigella flexneri is associated with moderate infection
- e) Shigella invades mucosal cells beyond the lamina propria
27. Haemolytic uraemic syndrome is associated with all of the following EXCEPT:
- a) Coombs positive haemolytic anaemia
- b) Coombs negative haemolytic anaemia
- c) Plasma exchange
- d) Thrombocytopenia
- e) None of the above
28. Which is true of liver cirrhosis?
- a) There is peripheral arterial vasoconstriction
- b) SAAG is below 1.1 g/dL
- c) There is colloid shift to the spleen and bone marrow on imaging
- d) Anaerobes are the causative organisms in spontaneous bacterial peritonitis
- e) All of the above
29. Which is true of hepatocellular carcinoma?
- a) Aflatoxin B1 leads to p53 tumour suppressor gene mutation
- b) Incidence is higher with HBeAg-positive hepatitis
- c) On CT there is early enhancement in the venous phase
- d) Fine-needle biopsy is more useful than core-directed biopsy
- e) None of the above
30. Which statement is true regarding hepatic haemangiomas?
- a) The majority are greater than 5 cm
- b) Hormonal influence has a role
- c) If less than 10 cm there is no need to follow up
- d) It is the rarest of the liver tumours
- e) All of the above