Mount Kenya University · School of Medicine · Internal Medicine
Paper details
- Paper: "4th year 1st semester CAT", time 2 hours. The scan has no printed date or unit code, so it is filed as undated.
- Questions: 30 multiple choice questions (most are "which one is NOT") and 2 short answer questions.
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme. The student's pen marks on the scan were ignored.
- Topics tested: HIV-related mouth, oesophageal and bowel disease, hepatitis B and C, non-alcoholic fatty liver disease, portal hypertension and varices, liver function tests, acute pancreatitis, cholera, peptic ulcer disease, and causes of rectal bleeding.
- Questions that need care: Q1, Q5, Q10, Q13 and Q21 are loosely worded. The explanation says which option is best and why.
Section A: Multiple choice questions
1. The following are typical ulcerative HIV-associated lesions. Which one is NOT?
- A. Pseudomembranous candidiasis
- B. Herpes simplex viral infection
- C. Oral hairy leukoplakia
- D. Kaposi's sarcoma
- E. None of the above
2. All the following are associated with HIV-related oesophageal candidiasis. Which one is NOT?
- A. Echinocandins
- B. Mostly associated with solitary lesions
- C. Voriconazole
- D. No role for topical agents
- E. All of the above
3. Cryptosporidiosis is associated with all of the following EXCEPT one:
- A. Acalculous cholecystitis
- B. Incubation period of 10 days
- C. Nitazoxanide
- D. Modified Ziehl-Neelsen stain
- E. Treatment with fumagillin
4. The following statements are true of Isospora belli. Which one is NOT?
- A. Multicellular
- B. Protozoan
- C. Associated with eosinophilia
- D. Transmission is faeco-oral
- E. None of the above
5. Which one of the following statements is true of HIV-hepatitis B co-infection?
- A. TDF monotherapy can be used if there is liver decompensation
- B. There is no role for adefovir
- C. Entecavir is the first-line treatment
- D. Entecavir induces M164V mutation
- E. None of the above
6. The following statements are associated with non-alcoholic steatohepatitis. Which one is NOT?
- A. Pre-diabetes
- B. Inflammation
- C. Ballooning
- D. Occurs in men who drink more than 30 g of ethanol
- E. Occurs in women who drink less than 20 g of alcohol
7. Which one of the following conditions may NOT be a typical association with NASH?
- A. Heredity
- B. Polycystic ovarian syndrome
- C. Sleep apnoea
- D. Commoner in the black race
- E. None of the above
8. All the following mechanisms may be associated with NASH. Which one is NOT?
- A. Mitochondrial dysfunction
- B. Insulin hypersensitivity
- C. Cirrhosis
- D. Fat droplets in the cytoskeleton
- E. Inflammation
9. The following statements are true of portal hypertension. Which one is NOT?
- A. Portal hypertension is defined as HVPG greater than 5 mmHg
- B. Portal hypertension
- C. Portal vein thrombosis is a post-hepatic cause of portal hypertension
- D. Budd-Chiari syndrome is associated with post-hepatic portal hypertension
- E. Banti's syndrome is associated with pre-hepatic portal hypertension
10. The following conditions fall under sinusoidal causes of portal hypertension. Which one is NOT?
- A. Primary biliary cirrhosis
- B. NASH
- C. Amyloidosis
- D. Alcoholic hepatitis
- E. Secondary syphilis
11. The following statements on varices caused by portal hypertension are true. Which one is NOT?
- A. Sengstaken-Blakemore tube may be used
- B. HVPG of 5 mmHg is typically associated with variceal rupture
- C. 30% of patients with varices will bleed
- D. About 10% of cirrhotics develop varices every year
- E. Tense ascites may predict bleeding
12. Which of the following is true of treatment of oesophageal varices?
- A. Initial 50 µg IV bolus of octreotide
- B. Initial 500 µg IV bolus of octreotide
- C. 500 µg IV/hour infusion for 1 week
- D. Vasopressin 20 to 40 units in normal saline every 2 hours until bleeding stops
- E. None of the above
13. The following statements are true of liver function tests. Which one is NOT?
- A. GGT is sensitive but non-specific
- B. 30% of the population has abnormal liver function tests
- C. AST may be altered in brain pathology
- D. Isolated increase in GGT does not require further evaluation
- E. GGT is necessary to evaluate the source of GGT
14. Which of the following statements is FALSE concerning primary sclerosing cholangitis?
- A. Can be cured on proper medical therapy
- B. Liver transplantation is the only effective therapy
- C. May recur after liver transplantation
- D. Is associated with autoimmune conditions
- E. Associated with non-suppurative inflammation
15. One of the following statements is true of liver disease:
- A. Haemolytic jaundice is not associated with urobilinogen in urine
- B. Trace bilirubin is usually found in urine
- C. In obstructive jaundice no urobilinogen is found in urine
- D. Van den Bergh reaction is indirect positive in obstructive jaundice
- E. None of the above
16. The following statements are true of liver disease except one:
- A. In hepatocellular disease the faeces pigment is light brown
- B. Dubin-Johnson syndrome is associated with decreased urobilinogen in urine
- C. Gilbert's syndrome is associated with normal conjugated bilirubin
- D. Post-hepatic obstructive jaundice is associated with increased urine urobilinogen
- E. None of the above
17. A 30-year-old pregnant woman is HBsAg positive. Which factor is MOST useful in determining the risk of transmission to her baby?
- A. Hepatitis B e antigen (HBeAg) status
- B. Hepatitis B core IgG status
- C. ALT of 23 IU/L
- D. Her alcohol history
- E. AST/ALT ratio over 2
18. A 20-year-old man has 3 months of bloody mucoid diarrhoea. Colonoscopy shows diffuse erythema and ulcerations in the entire colon and patchy ulceration in the terminal ileum. The MOST likely diagnosis is:
- A. Ulcerative colitis
- B. Crohn's disease
- C. Amoebic colitis
- D. Shigellosis
- E. Tuberculous enteritis
19. A 25-year-old man with chronic hepatitis B has HBV DNA of 100 million IU/mL. All of the following would be required before initiating treatment EXCEPT:
- A. Liver function tests
- B. Hepatitis B e antigen test
- C. Hepatitis B core antigen test
- D. Hepatitis C virus screen
- E. Thyroid function tests
20. A 70-year-old man has generalised pruritus and weight loss, green jaundice and a palpable, non-tender gall bladder. The MOST likely diagnosis is:
- A. Acute cholelithiasis
- B. Acute cholecystitis
- C. Hepatocellular carcinoma
- D. Pancreatic malignancy
21. Which of the following seromarkers is correctly matched with its role?
- A. HBsAg: immunity to hepatitis B infection
- B. HBsAb: immunity to hepatitis B infection
- C. HBeAg: active replication of virus
- D. HBcIgM: chronic infection
- E. None of the above
22. Eligibility for treatment of hepatitis may require all of the following except one:
- A. ALT
- B. Biopsy
- C. HBeAg
- D. AST
- E. HBsAg
23. The following statements are true of acute pancreatitis EXCEPT one:
- A. It is generally self-limiting
- B. A minority of cases have systemic complications
- C. Viral hepatitis is not a possible cause
- D. Alpha-1 antitrypsin deficiency is a possible susceptibility factor
- E. None of the above
24. Which of the following statements is NOT true concerning acute pancreatitis?
- A. Pain worsens by lying flat
- B. Pulmonary decompensation may arise
- C. Absolute lipase level correlates with severity
- D. Serial measurements of lipase during treatment are not of much value
- E. Raised carboxypeptidase levels may indicate pancreatitis
25. The statements below are true of acute pancreatitis. Which one is NOT?
- A. Haematocrit above 48% at 48 hours after admission predicts necrosis
- B. Obesity is always linked to mortality
- C. Base deficit is assessed as part of Ranson's criteria
- D. Pethidine is a first-line narcotic in treatment
- E. Early enteral feeding is encouraged
26. Which of the following statements concerning cholera is FALSE?
- A. Patients with blood group AB are less likely to be affected
- B. El Tor is involved in mild disease
- C. Is Gram negative
- D. Colonises the small intestine
- E. Is always aerobic
27. Which of the following is the most common cause of duodenal ulcers?
- A. NSAIDs
- B. Helicobacter pylori
- C. Alcohol abuse
- D. Chronic corticosteroid therapy
- E. Zollinger-Ellison syndrome
28. Which organism is NOT responsible for causing blood-stained diarrhoea?
- A. Campylobacter spp.
- B. Salmonella spp.
- C. Escherichia coli
- D. Shigella spp.
- E. Staphylococcus spp.
29. A 50-year-old woman has a week of jaundice and right upper quadrant pain, with dark urine and pale stools, no weight loss and no alcohol. Bilirubin 40 µmol/L, ALT 40, AST 50, ALP 350 IU/L. The most likely diagnosis is:
- A. Gallstones
- B. Viral hepatitis
- C. Alcoholic hepatitis
- D. Carcinoma of the head of the pancreas
- E. Autoimmune hepatitis
30. The following are roles of TH17 in HIV enteropathy. Which one is NOT?
- A. Intestinal homeostasis
- B. Cessation of mucin production
- C. Epithelial regeneration
- D. Induces claudins expression
- E. None of the above