Austin Block 6

1

Which of the following is not a characteristic feature of withdrawal (delerium tremens)?


  Onset within 24 hours of stopping drinking

  Tremor

  Visual hallucinations

  Seizures

  Excessive perspiration

2

Which of the following is the most sensitive indicator of intra vascular volume depletion following surgery?


  Resting tachycardia

  A cold sweaty periphery

  Pallor

  A low jugular venous pressure

  A postural blood pressure drop

3

A 78 year old woman with a past history of atrial fibrillation, ischaemic heart disease, cerebrovascular disease, peripheral vascular disease and peptic ulcer disease develops abdominal pain which gradually increases over 24 hours. On examination she looks unwell and has a temperature of 37.8°G. There is mild generalized abdominal tenderness. No bowel sounds are audible. Investigations reveal an elevated neutrophil count and a low bicarbonate. The most likely diagnosis is:


  perforated appendix

  pyloric stenosis

  perforated sigmoid carcinoma

  mesenteric infarction

  sigmoid volvulus

4

Which of the following is most consistent with a stone in the common bile duct?


  Colicky upper abdominal pain after eating

  Constant right upper quadrant pain and weight loss

  Constant dull right upper quadrant pain and an elevated ALT

  Colicky upper abdominal pain and vomiting

  Right upper quadrant pain, pale stools and dark urine

5

Pain referred to the back is a recognized feature of all the following abdominal conditions except:


  Carcinoma of the pancreas

  Chronic pancreatitis

  Small bowel obstruction

  Biliary tract disease

  Renal colic

6

A 45 year old female presents with colicky central abdominal pain followed by vomiting. She has a past history of hysterectomy. The plan X-ray shows dilated bowel loops with fluid levels. The most likely diagnosis is:


  Acute appendicitis

  Toris ion of an ovarian cyst

  Obstructed inguinal hernia

  Small bowel obstruction due to adhesions

  Crohn's disease

7

Which of the following is least likely in a patient with carcinoma of the caecum?


  Bleeding per rectum

  Small bowel obstruction

  Anaemia

  A mass in the right iliac fossa

  Weight loss, ascites and hepatomegaly

8

A 70 year old complains of intermittent gradually worsening dysphagia which began 3 years ago and was initially worse for liquids than solids. He has had some vomiting but no loss of weight. The most likely diagnosis is:


  Oesophageal stricture due to gastro-oesophageal reflux

  Carcinima of the oesophagus

  Multinodular gaiter with retrosternal extension

  Diffuse oesophageal spasm

  Achalasia

9

Which of the following is not a feature of the irritable bowel syndrome?


  Weight loss

  Diarrhoea

  Alternating constipation and diarrhoea

  Unsatisfied defaecation (tenesmus)

  Abdominal bloating

10

Which of the following is not a recognized complication of diverticular disease of the colon?


  large bowel obstruction

  rectal bleeding

  pnuematuria

  generalized peritonitis

  folate deficiency

11

Signs of chronic liver disease include all of the following except:


  testicular atrophy

  muscle wasting

  depigmentation of the skin

  gynaecomastia

  spider naevi

12

A 32 year old woman presents with intermittent loose bowel actions for six months associated with fever and episodes of colicky central abdominal pain. There is no blood in the stool. Physical examination reveals tenderness in the right iliac fossa and an anal fissure. What is the most likely diagnosis?


  ulcerative colitis

  irritable bowel syndrome

  carcinoma

  Crohn's disease

  mesenteric ischaemia

13

The commonest post-operative complication following haemorrhoidectomy is:


  primary haemorrhage

  secondary haemorrhage

  wound infection

  retention of urine

  pulmonary embolism

14

The most characteristic symptom of fissure in ano in a young adult is:


  mucous discharge

  pruritus ani

  bleeding

  faecal soiling

  pain

15

All of the following occur commonly in delirium tremens EXCEPT:


  Visual hallucinations

  Drowsiness

  Tremor

  Tachycardia

  Sweating

16

A jaundiced patient is noted to have an elevated plasma bilirubin but no bilirubin in the urine. Which of the following is likely to cause these findings:


  Alcoholic cirrhosis of the liver

  Drug induced haemolysis

  Gall stones in the biliary tree

  Infectious hepatitis

  Cholangiocarcinoma

17

Which of the following individuals carries the lowest risk of developing hepatitis B infection?


  A female with multiple sexual partners

  A scientist in a pathology laboratory

  A resident of a hostel for mentally retarded children

  An emigrant from Taiwan

  A sexually active homosexual male

18

Bleeding from haemorrhoids is best characterised by being:


  Bright in colour

  Mixed in with the motions

  Associated with pain during defaecation

  Associated with tenesmus

  Present only when straining at stool

19

Cholangitis has the following features EXCEPT:


  Jaundice

  Pain under right costal margin

  Shivers and shakes

  Ascites

  Intermittent fever

20

Femoral hernia:


  Causes bowel obstruction whenever it is strangulated

  Is the least dangerous variety of external hernia

  Lies medial to the pubic tubercle

  Usually lies below the inguinal ligament

  Transilluminates

21

A 70 year old man presents with bright rectal bleeding. On rectal examination you feel a hard mass within the lumen. The most likely diagnosis is:


  An internal pile

  A thrombosed pile

  A rectal carcinoma

  A rectal polyp

  A fistula-in-ano

22

Which of the following organs can never be palpated in a healthy person:


  Liver

  Kidney

  Pancreas

  Descending colon

  Caecum