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WorksheetsGEM Module 5 Mock
Total questions: 100
Worksheet time: 2hrs 40mins
Name
Class
Date
1.
A 45-year-old woman presents with acute, severe right upper quadrant pain that radiates to her right scapula. An ultrasound confirms the presence of gallstones. Which anatomical structure is most likely obstructed by a gallstone to cause this classic pain pattern?
a)
Cystic duct
b)
Common hepatic duct
c)
Accessory pancreatic duct
d)
Hepatopancreatic ampulla (of Vater)
e)
Left hepatic duct
2.
A 60-year-old man with a history of alcohol misuse is admitted with haematemesis. Endoscopy reveals bleeding oesophageal varices. These varices are a consequence of portosystemic anastomoses. Which venous connection is responsible for this specific complication?
a)
Superior rectal vein with middle/inferior rectal veins
b)
Para-umbilical veins with superficial epigastric veins
c)
Esophageal veins with the azygos vein
d)
Left gastric vein with the inferior vena cava
e)
Veins of Retzius with the systemic circulation
3.
A medical student is revising the histology of the small intestine. Which structural feature is primarily responsible for the massive surface area increase that facilitates efficient nutrient absorption?
a)
Plicae circulares
b)
Brunner's glands
c)
Crypts of Lieberkühn
d)
Goblet cells
e)
Muscularis mucosae
4.
A 28-year-old woman is diagnosed with pernicious anaemia. What is the fundamental pathophysiological defect in this condition?
a)
Dietary deficiency of vitamin B12
b)
Autoimmune destruction of pancreatic beta cells
c)
Impaired absorption of vitamin B12 in the terminal ileum
d)
Autoimmune destruction of gastric parietal cells
e)
Genetic defect in the intrinsic factor molecule
5.
A clinical trial reports a new drug for heart failure with a Relative Risk (RR) of 0.75 for all-cause mortality compared to placebo. How should this RR be interpreted?
a)
The drug increases the risk of death by 25%.
b)
The drug has no effect on mortality.
c)
The drug reduces the risk of death by 25%.
d)
75% of patients in the treatment group died.
e)
The Number Needed to Treat (NNT) is 4.
6.
During a laparoscopic cholecystectomy, the surgeon must carefully identify and ligate the cystic artery to avoid haemorrhage. This artery is most commonly a branch of which vessel?
a)
Common hepatic artery
b)
Left hepatic artery
c)
Right hepatic artery
d)
Coeliac trunk
e)
Gastroduodenal artery
7.
A patient with Crohn's disease undergoes a resection of the terminal ileum. Which substance's absorption is most likely to be impaired as a long-term consequence?
a)
Iron
b)
Folate
c)
Vitamin B12
d)
Vitamin D
e)
Calcium
8.
A 55-year-old man with cirrhosis is started on propranolol for primary prophylaxis of oesophageal variceal bleeding. Why might the bioavailability of oral propranolol be significantly increased in this patient?
a)
Increased first-pass metabolism
b)
Reduced plasma protein binding
c)
Portosystemic shunting
d)
Enhanced hepatocyte uptake
e)
Induction of cytochrome P450 enzymes
9.
A 70-year-old man presents with painless jaundice, weight loss, and a palpable gallbladder (Courvoisier's law). Which pathology is the most likely cause?
a)
Choledocholithiasis (gallstones in the common bile duct)
b)
Alcoholic hepatitis
c)
Carcinoma of the head of the pancreas
d)
Chronic viral hepatitis
e)
Sclerosing cholangitis
10.
A 40-year-old woman with a history of recurrent urinary tract infections is prescribed trimethoprim. She develops a macrocytic anaemia. What is the most likely mechanism?
a)
Inhibition of DNA synthesis
b)
Iron chelation
c)
Haemolysis
d)
Bone marrow suppression
e)
Vitamin B12 malabsorption
11.
During a trauma laparotomy, a surgeon notices a retroperitoneal haematoma near the duodenojejunal flexure. Injury to which artery should be suspected?
a)
Superior Mesenteric Artery (SMA)
b)
Inferior Mesenteric Artery (IMA)
c)
Coeliac Trunk
d)
Middle Colic Artery
e)
Splenic Artery
12.
A patient with coeliac disease has persistent diarrhoea and steatorrhoea. Which type of nutrient malabsorption is directly responsible for the steatorrhoea?
a)
Carbohydrate
b)
Protein
c)
Fat
d)
Vitamin B12
e)
Iron
13.
A 25-year-old man is brought to A&E with severe abdominal pain, confusion, and dark red urine following a weekend of fasting and alcohol consumption. Which investigation is most likely to confirm the suspected diagnosis?
a)
Serum amylase
b)
Urinary porphobilinogen
c)
Serum lead level
d)
Anti-transglutaminase antibodies
e)
Abdominal CT scan
14.
A patient with metastatic colorectal cancer is noted to have a palpable, hard nodule in the left supraclavicular fossa. This node is eponymously known as:
a)
Virchow's node
b)
Sister Mary Joseph node
c)
Troisier's sign
d)
Sentinel node
e)
Osler's node
15.
A 19-year-old student presents with right lower quadrant pain, nausea, and low-grade fever. Examination reveals tenderness at a point one-third of the way along a line from the right anterior superior iliac spine (ASIS) to the umbilicus. This is known as:
a)
Rovsing's sign
b)
McBurney's point
c)
Murphy's sign
d)
Psoas sign
e)
Obturator sign
16.
The hepatorenal syndrome is a functional renal failure that complicates advanced liver disease. What is the primary underlying haemodynamic abnormality?
a)
Renal artery vasoconstriction
b)
Systemic hypertension
c)
Splanchnic vasoconstriction
d)
Increased renal blood flow
e)
Cardiac failure
17.
A patient with irritable bowel syndrome (IBS) is referred for cognitive behavioural therapy (CBT). This approach is most aligned with which model of health and disease?
a)
Biomedical Model
b)
Biopsychosocial Model
c)
Pathological Model
d)
Statistical Model
e)
Psychodynamic Model
18.
A 60-year-old man is diagnosed with a direct inguinal hernia. This hernia protrudes through which anatomical area?
a)
Deep inguinal ring
b)
Superficial inguinal ring
c)
Femoral canal
d)
Hesselbach's triangle
e)
Inguinal ligament
19.
The defaecation reflex involves coordinated relaxation of the internal and external anal sphincters. The internal anal sphincter is composed of what type of muscle and is under what type of control?
a)
Skeletal muscle; voluntary control
b)
Skeletal muscle; involuntary control
c)
Smooth muscle; voluntary control
d)
Smooth muscle; involuntary control
e)
Mixed muscle; autonomic control
20.
A patient with a history of peptic ulcer disease presents with melaena. Endoscopy reveals a bleeding ulcer in the duodenum. Which artery is the most likely source of significant haemorrhage?
a)
Left Gastric Artery
b)
Short Gastric Arteries
c)
Gastroduodenal Artery
d)
Right Gastro-omental Artery
e)
Splenic Artery
21.
Which of the following best describes the mechanism of action of ondansetron, a first-line antiemetic for chemotherapy-induced nausea and vomiting?
a)
Dopamine (D2) receptor antagonist
b)
Muscarinic receptor antagonist
c)
Histamine (H1) receptor antagonist
d)
Serotonin (5-HT3) receptor antagonist
e)
Neurokinin-1 (NK1) receptor antagonist
22.
A 50-year-old woman undergoes a total thyroidectomy. Post-operatively, she develops tingling in her fingers and perioral area. Which electrolyte abnormality is most likely responsible?
a)
Hyponatraemia
b)
Hyperkalaemia
c)
Hypocalcaemia
d)
Hypomagnesaemia
e)
Hypercalcaemia
23.
The liver acinus model divides the functional unit into zones 1, 2, and 3. Which zone is most susceptible to damage from ischaemia?
a)
Zone 1 (Periportal)
b)
Zone 2
c)
Zone 3 (Pericentral)
d)
All zones are equally susceptible
e)
Zone 4
24.
A 30-year-old man with cystic fibrosis is diagnosed with pancreatic insufficiency. Which of the following findings would you most expect to see?
a)
Microcytic, hypochromic anaemia
b)
Elevated serum folate
c)
Steatorrhoea and weight loss
d)
Hypoglycaemia
e)
Elevated serum vitamin A
25.
In the UK Bowel Cancer Screening Programme, what is the next step for an asymptomatic 60-year-old with a Faecal Immunochemical Test (FIT) result of 15 μg Hb/g?
a)
Repeat FIT in 3 months
b)
Urgent referral for colonoscopy
c)
CT colonography
d)
Reassurance and repeat screening in 2 years
e)
Test for CEA tumour marker
26.
A patient with chronic kidney disease and iron deficiency anaemia is intolerant of oral iron. Which of the following is an advantage of intravenous iron over oral iron in this patient?
a)
It raises haemoglobin more rapidly.
b)
It has a lower risk of anaphylaxis.
c)
It is more effective at replenishing total body iron stores.
d)
It does not cause gastrointestinal side effects.
e)
It can be administered without monitoring.
27.
The phrenico-oesophageal ligament plays a role in anchoring the gastro-oesophageal junction. It is a derivative of which embryological structure?
a)
Dorsal Mesentery
b)
Ventral Mesentery
c)
Primitive Foregut
d)
Septum Transversum
e)
Pleuroperitoneal Membrane
28.
A patient presents with jaundice, dark urine, and pale stools. Blood tests show a predominantly conjugated hyperbilirubinaemia and a markedly elevated Alkaline Phosphatase (ALP). What is the most likely type of jaundice?
a)
Pre-hepatic
b)
Hepatic
c)
Post-hepatic
d)
Gilbert's syndrome
e)
Crigler-Najjar syndrome
29.
A 45-year-old man with a history of alcohol misuse is found to have an AST:ALT ratio of 3:1. This pattern is most suggestive of:
a)
Viral hepatitis
b)
Non-alcoholic fatty liver disease (NAFLD)
c)
Alcoholic liver disease
d)
Autoimmune hepatitis
e)
Drug-induced liver injury
30.
Which of the following is a key function of short-chain fatty acids (SCFAs) like butyrate produced by the gut microbiome?
a)
Emulsification of dietary fats
b)
Primary energy source for colonocytes
c)
Activation of pancreatic zymogens
d)
Inhibition of gastric acid secretion
e)
Binding to intrinsic factor
31.
A surgeon is about to make a Gridiron (McBurney's) incision for an appendicectomy. Which abdominal muscle layers will be encountered and split in the direction of their fibres?
a)
Rectus abdominis
b)
External oblique, internal oblique, transversus abdominis
c)
Transversus abdominis and rectus abdominis
d)
External oblique and transversus abdominis
e)
Internal oblique and rectus abdominis
32.
The sensation of taste from the anterior two-thirds of the tongue is carried by which cranial nerve?
a)
Trigeminal (V3)
b)
Facial (VII)
c)
Glossopharyngeal (IX)
d)
Vagus (X)
e)
Hypoglossal (XII)
33.
A patient with coeliac disease is at risk of developing multiple nutritional deficiencies. Which of the following anaemias is most commonly associated with this condition?
a)
Macrocytic anaemia due to B12 deficiency
b)
Macrocytic anaemia due to folate deficiency
c)
Microcytic anaemia due to iron deficiency
d)
Normocytic anaemia of chronic disease
e)
Haemolytic anaemia
34.
A 65-year-old man presents with difficulty swallowing, initially to solids and now to liquids. He has a long history of heartburn. The most likely pathological diagnosis in the oesophagus is:
a)
Squamous cell carcinoma
b)
Adenocarcinoma
c)
Achalasia
d)
Oesophageal web
e)
Pharyngeal pouch
35.
A clinical trial for a new statin reports a 95% confidence interval for the Absolute Risk Reduction (ARR) of heart attack as 1.5% to 3.5%. What is the correct interpretation of this result?
a)
There is a 95% probability the true ARR is 2.5%.
b)
The result is not statistically significant.
c)
We are 95% confident the true ARR lies between 1.5% and 3.5%.
d)
The p-value is greater than 0.05.
e)
The Number Needed to Treat (NNT) is between 29 and 67.
36.
A patient with a history of rheumatic fever is due to have a tooth extraction. Which of the following is the most appropriate antibiotic prophylaxis to prevent infective endocarditis, according to current UK (NICE) guidelines?
a)
Prophylaxis is not routinely recommended.
b)
Amoxicillin 3g orally one hour pre-procedure
c)
Clindamycin 600mg orally one hour pre-procedure
d)
Gentamicin IV at induction
e)
Vancomycin IV at induction
37.
During development, the pancreas arises from which two embryological buds?
a)
Hepatic and cystic buds
b)
Dorsal and ventral buds
c)
Cranial and caudal buds
d)
Foregut and hindgut buds
e)
Mesenteric and omental buds
38.
A patient with Crohn's disease is found to have a vitamin B12 deficiency. Which part of the gastrointestinal tract is most likely affected?
a)
Duodenum
b)
Jejunum
c)
Ileum
d)
Ascending colon
e)
Descending colon
39.
Loperamide is a commonly used antimotility agent for diarrhoea. What is its primary mechanism of action?
a)
Alpha-2 adrenergic receptor agonist
b)
Mu-opioid receptor agonist
c)
Somatostatin analogue
d)
5-HT3 receptor antagonist
e)
Chloride channel activator
40.
A 50-year-old woman with a body mass index (BMI) of 35 kg/m² is found to have non-alcoholic fatty liver disease (NAFLD). Which of the following is the most appropriate first-line management?
a)
Ursodeoxycholic acid
b)
Vitamin E supplementation
c)
Lifelong metformin therapy
d)
Lifestyle modification (diet and exercise)
e)
Referral for bariatric surgery
41.
The pectinate line in the anal canal is an important landmark. Which of the following is true for structures located ABOVE this line?
a)
They are innervated by somatic nerves.
b)
They drain to superficial inguinal nodes.
c)
They are sensitive to pain.
d)
They are lined by stratified squamous epithelium.
e)
They are supplied by the superior rectal artery.
42.
A patient presents with recurrent episodes of severe, colicky abdominal pain. A CT scan reveals a calcified stone in the pelviureteric junction. Which of the following is the most likely underlying cause?
a)
Hypercalciuria
b)
Hyperuricaemia
c)
Struvite stones
d)
Cystinuria
e)
Renal tubular acidosis
43.
In the context of haem synthesis, which enzyme is inhibited by lead, contributing to the anaemia seen in lead poisoning?
a)
ALA synthase
b)
ALA dehydratase and Ferrochelatase
c)
Uroporphyrinogen decarboxylase
d)
PBG deaminase
e)
Heme oxygenase
44.
A 75-year-old man is admitted with a fractured neck of femur. He is started on enoxaparin for thromboprophylaxis. On day 3, his platelet count drops to 50 x 10⁹/L. What is the most likely diagnosis?
a)
Immune Thrombocytopenic Purpura (ITP)
b)
Haemolytic Uraemic Syndrome (HUS)
c)
Heparin-Induced Thrombocytopenia (HIT)
d)
Disseminated Intravascular Coagulation (DIC)
e)
Vitamin K deficiency
45.
Which of the following hormones is responsible for stimulating the release of bicarbonate-rich fluid from the pancreas in response to acidic chyme entering the duodenum?
a)
Gastrin
b)
Cholecystokinin (CCK)
c)
Secretin
d)
Gastric Inhibitory Peptide (GIP)
e)
Motilin
46.
A 28-year-old woman presents with chronic watery diarrhoea and is found to have a VIPoma. Which of the following is the classic triad of symptoms associated with this tumour?
a)
Verner-Morrison syndrome
b)
Zollinger-Ellison syndrome
c)
Carcinoid syndrome
d)
Somatostatinoma syndrome
e)
Glucagonoma syndrome
47.
A patient with chronic liver disease develops fetor hepaticus. What is the cause of this distinctive breath odour?
a)
Elevated blood ethanol
b)
Ketone production
c)
Exhalation of mercaptans
d)
Poor oral hygiene
e)
Pulmonary infection
48.
According to the General Adaptation Syndrome described by Hans Selye, what is the final stage of the stress response?
a)
Alarm
b)
Resistance
c)
Exhaustion
d)
Allostasis
e)
Resilience
49.
A 22-year-old man is diagnosed with appendicitis. Pain from the appendix is initially referred to which abdominal region?
a)
Right Iliac Fossa
b)
Epigastrium
c)
Left Iliac Fossa
d)
Suprapubic region
e)
Right Hypochondrium
50.
A patient with a bleeding duodenal ulcer is found to be Helicobacter pylori positive. What is the most appropriate eradication therapy?
a)
Amoxicillin + Clarithromycin
b)
PPI + Amoxicillin + Clarithromycin
c)
PPI + Metronidazole + Clarithromycin
d)
PPI + Amoxicillin + Metronidazole
e)
Bismuth + Tetracycline + Metronidazole
51.
The portal triad at the hilum of the liver contains which three structures?
a)
Hepatic artery, portal vein, common bile duct
b)
Hepatic artery, hepatic vein, cystic duct
c)
Portal vein, common hepatic duct, hepatic vein
d)
Hepatic artery, portal vein, common hepatic duct
e)
Hepatic artery, portal vein, hepatic vein
52.
A patient with a history of partial gastrectomy develops symptoms of dizziness, sweating, and palpitations 30 minutes after a meal. What is the most likely diagnosis?
a)
Zollinger-Ellison syndrome
b)
Gastroparesis
c)
Dumping syndrome
d)
Carcinoid syndrome
e)
Reactive hypoglycaemia
53.
A 60-year-old man with atrial fibrillation presents with sudden onset of severe abdominal pain and bloody diarrhoea. On examination, he has abdominal tenderness but no signs of peritonism. What is the most likely diagnosis?
a)
Diverticulitis
b)
Ischaemic colitis
c)
Inflammatory Bowel Disease flare
d)
Infectious colitis
e)
Colorectal cancer
54.
A patient with chronic pancreatitis develops diabetes mellitus. What is the most likely mechanism?
a)
Autoimmune destruction of beta cells
b)
Insulin resistance
c)
Amylin deposition
d)
Destruction of islets of Langerhans
e)
Glucagon excess
55.
A 70-year-old man is found to have a positive faecal occult blood test. He is scheduled for a colonoscopy. He has a history of a metallic aortic valve replacement. What is the most appropriate management regarding his anticoagulation?
a)
Continue warfarin as normal.
b)
Stop warfarin 5 days before the procedure.
c)
Stop warfarin and start a heparin bridge.
d)
Reduce the warfarin dose by 50%.
e)
Check INR on the day of the procedure.
56.
The ligament of Treitz is an important anatomical landmark. What does it suspend?
a)
The ileocaecal junction
b)
The hepatic flexure of the colon
c)
The duodenojejunal flexure
d)
The spleen
e)
The tail of the pancreas
57.
Which of the following is the primary site for the absorption of dietary folate?
a)
Stomach
b)
Duodenum and Jejunum
c)
Ileum
d)
Colon
e)
Throughout the small intestine
58.
A patient with a suspected small bowel obstruction has a "stepladder" appearance of air-fluid levels on an erect abdominal X-ray. This is most characteristic of which type of obstruction?
a)
Gastric outlet obstruction
b)
Large bowel obstruction
c)
Paralytic ileus
d)
Mechanical small bowel obstruction
e)
Volvulus
59.
A patient with ulcerative colitis is started on mesalazine. What is the primary mechanism of action of this drug?
a)
Immunosuppression via calcineurin inhibition
b)
Inhibition of tumour necrosis factor-alpha (TNF-α)
c)
Topical anti-inflammatory action on the colonic mucosa
d)
Antibiotic action against gut flora
e)
Systemic corticosteroid effect
60.
A 45-year-old woman presents with pruritus and jaundice. Blood tests show an elevated Alkaline Phosphatase and positive Anti-Mitochondrial Antibodies (AMA). What is the most likely diagnosis?
a)
Autoimmune Hepatitis
b)
Primary Sclerosing Cholangitis (PSC)
c)
Primary Biliary Cholangitis (PBC)
d)
Drug-induced liver injury
e)
Hepatitis A
61.
A patient is diagnosed with a strangulated femoral hernia. Which structure forms the medial border of the femoral canal?
a)
Inguinal ligament
b)
Femoral vein
c)
Lacunar ligament
d)
Pectineal ligament
e)
Sartorius muscle
62.
Which phase of gastric acid secretion is triggered by the sight, smell, and taste of food and is mediated by the vagus nerve?
a)
Cephalic phase
b)
Gastric phase
c)
Intestinal phase
d)
Basal phase
e)
Digestive phase
63.
A 55-year-old man with a history of alcohol misuse presents with confusion, ataxia, and ophthalmoplegia. Which of the following is the most appropriate immediate treatment?
a)
Oral Thiamine
b)
Intravenous Thiamine
c)
Intravenous Glucose
d)
Oral Vitamin B12
e)
Intravenous Naloxone
64.
A 30-year-old woman with a family history of colon cancer is found to have hundreds of adenomatous polyps throughout her colon on colonoscopy. What is the most likely genetic defect?
a)
BRCA1 mutation
b)
APC gene mutation
c)
Mismatch repair gene mutation
d)
KRAS mutation
e)
TP53 mutation
65.
A patient with acute pancreatitis has a Ranson's score of 5 on admission. What does this indicate?
a)
Mild disease, likely uneventful recovery
b)
Severe disease, with a high predicted mortality
c)
The need for immediate ERCP
d)
A diagnosis of autoimmune pancreatitis
e)
A gallstone aetiology
66.
A patient with chronic liver disease develops asterixis. What is the underlying pathophysiology of this sign?
a)
Peripheral neuropathy
b)
Cerebellar dysfunction
c)
Metabolic encephalopathy
d)
Uraemia
e)
Vitamin B12 deficiency
67.
A 25-year-old medical student volunteers for a research study. After giving informed consent, he is told the study involves a painful stimulus. He is free to withdraw at any time without giving a reason. This principle is known as:
a)
Beneficence
b)
Non-maleficence
c)
Justice
d)
Autonomy
e)
Veracity
68.
The blood supply to the majority of the stomach is derived from which major arterial trunk?
a)
Superior Mesenteric Artery
b)
Inferior Mesenteric Artery
c)
Coeliac Trunk
d)
Abdominal Aorta
e)
Renal Artery
69.
Which of the following is a characteristic feature of coeliac disease on duodenal biopsy?
a)
Crypt abscesses
b)
Intraepithelial lymphocytosis and villous atrophy
c)
Non-caseating granulomas
d)
Goblet cell depletion
e)
Collagenous colitis
70.
A patient with a history of peptic ulcer disease presents with profuse vomiting of undigested food eaten many hours earlier. There is a succussion splash on physical examination. What is the most likely diagnosis?
a)
Pyloric stenosis
b)
Gastric outlet obstruction
c)
Achalasia
d)
Small bowel obstruction
e)
Gastroparesis
71.
Ursodeoxycholic acid is used in the treatment of primary biliary cholangitis. What is its primary mechanism of action?
a)
Immunosuppression
b)
Dissolution of cholesterol gallstones
c)
Hepatoprotection and displacement of toxic bile acids
d)
Stimulation of bile flow (choleresis)
e)
Inhibition of bile acid synthesis
72.
A 60-year-old man with a history of diverticular disease presents with left lower quadrant pain, fever, and a palpable mass. A CT scan confirms diverticulitis with a contained perforation. What is the most appropriate initial management?
a)
Urgent surgical resection
b)
Percutaneous drainage
c)
Bowel rest and intravenous antibiotics
d)
Colonoscopy
e)
High-fibre diet
73.
A patient with chronic kidney disease stage 4 is scheduled for a colonoscopy. Which bowel preparation agent is contraindicated in this patient?
a)
Polyethylene glycol (PEG)
b)
Sodium picosulfate
c)
Oral Sodium Phosphate (OSP)
d)
Bisacodyl
e)
Senna
74.
The myenteric (Auerbach's) plexus is located between which two layers of the gut wall?
a)
Mucosa and Submucosa
b)
Submucosa and Circular Muscle
c)
Circular Muscle and Longitudinal Muscle
d)
Longitudinal Muscle and Serosa
e)
Serosa and Mesentery
75.
A 50-year-old woman presents with episodic flushing, diarrhoea, and wheezing. Echocardiography reveals tricuspid regurgitation. What is the most likely diagnosis?
a)
VIPoma
b)
Carcinoid syndrome
c)
Systemic mastocytosis
d)
Phaeochromocytoma
e)
Medullary thyroid carcinoma
76.
A patient with acute liver failure develops a prolonged prothrombin time (INR >1.5). What is the most appropriate immediate treatment to correct this coagulopathy prior to a planned liver biopsy?
a)
Oral Vitamin K
b)
Intravenous Vitamin K
c)
Fresh Frozen Plasma (FFP)
d)
Platelets
e)
Prothrombin Complex Concentrate (PCC)
77.
A 70-year-old man is admitted with a large upper GI bleed. He is a Jehovah's Witness and has an advance directive refusing blood products. He is now unconscious and his haemoglobin is 5 g/dL. According to UK law and GMC guidance, what is the most appropriate course of action?
a)
Transfuse him as it is a life-threatening emergency.
b)
Respect his advance directive and do not transfuse.
c)
Ask his family for consent to transfuse.
d)
Seek a court order to permit transfusion.
e)
Give intravenous iron and erythropoietin.
78.
Which of the following is the most common location for a Meckel's diverticulum?
a)
Terminal ileum, within 60 cm of the ileocaecal valve
b)
Jejunum, 100 cm from the duodenojejunal flexure
c)
Antimesenteric border of the ileum, 2 feet from the ileocaecal valve
d)
Antimesenteric border of the ileum, 2 feet from the ileocaecal valve
e)
Antimesenteric border of the ileum, 2 feet from the ileocaecal valve
79.
Which hormone is primarily responsible for stimulating the contraction of the gallbladder?
a)
Gastrin
b)
Secretin
c)
Cholecystokinin (CCK)
d)
Gastric Inhibitory Peptide (GIP)
e)
Motilin
80.
A 40-year-old man presents with recurrent episodes of severe epigastric pain radiating to the back, associated with high serum triglycerides. What is the most likely underlying cause of his pancreatitis?
a)
Alcohol
b)
Gallstones
c)
Hypercalcaemia
d)
Hypertriglyceridaemia
e)
ERCP
81.
A patient with inflammatory bowel disease is started on azathioprine. What is the most important baseline monitoring test prior to initiating this therapy?
a)
Serum Amylase
b)
Thiopurine methyltransferase (TPMT) activity
c)
HLA-B*5701 genotype
d)
Urea and Electrolytes
e)
Chest X-ray
82.
A 55-year-old man with a history of alcohol misuse presents with massive ascites. Which of the following is the most appropriate first-line diuretic regimen?
a)
Furosemide 40mg daily
b)
Spironolactone 100mg daily
c)
Hydrochlorothiazide 25mg daily
d)
Furosemide 40mg and Spironolactone 100mg daily
e)
Metolazone 5mg daily
83.
A 30-year-old woman presents with chronic constipation and is found to have a dilated rectum full of faeces on digital rectal examination. Which of the following is the most likely diagnosis?
a)
Hirschsprung's disease
b)
Slow-transit constipation
c)
Rectocele
d)
Descending Perineum Syndrome
e)
Obstructed Defaecation Syndrome
84.
Which of the following is the most common benign liver tumour?
a)
Hepatic adenoma
b)
Focal nodular hyperplasia
c)
Haemangioma
d)
Hepatocellular carcinoma
e)
Biliary cystadenoma
85.
A patient with coeliac disease is advised to follow a strict gluten-free diet. This is an example of what level of disease prevention?
a)
Primordial
b)
Primary
c)
Secondary
d)
Tertiary
e)
Quaternary
86.
The spleen is developmentally derived from which embryological structure?
a)
Foregut
b)
Midgut
c)
Hindgut
d)
Dorsal Mesentery
e)
Ventral Mesentery
87.
A patient with short bowel syndrome following massive small bowel resection is at risk of developing D-lactic acidosis. What is the cause of this?
a)
Overgrowth of Lactobacillus species
b)
Deficiency of pancreatic lipase
c)
Impaired hepatic gluconeogenesis
d)
Uraemia
e)
Accumulation of ketoacids
88.
A 65-year-old man presents with weight loss and jaundice. An abdominal CT shows a "double duct sign". Which pathology is most likely?
a)
Choledocholithiasis
b)
Chronic pancreatitis
c)
Carcinoma of the head of the pancreas
d)
Cholangiocarcinoma
e)
Ampullary carcinoma
89.
A patient with a suspected small bowel carcinoid tumour undergoes an imaging study with a radiolabelled somatostatin analogue. What is the basis for this test?
a)
The tumour has a high metabolic rate.
b)
The tumour expresses somatostatin receptors.
c)
The tumour secretes somatostatin.
d)
The tumour has increased glucose uptake.
e)
The tumour causes angiogenesis.
90.
A 20-year-old woman presents with a 2-day history of severe right iliac fossa pain and vomiting. She is apyrexial. Urine hCG is negative. What is the most appropriate initial investigation?
a)
Urinalysis
b)
Abdominal X-ray
c)
Transvaginal Ultrasound
d)
Diagnostic Laparoscopy
e)
CT Abdomen and Pelvis
91.
Which nerve provides the primary motor innervation to the diaphragm?
a)
Vagus nerve (CN X)
b)
Intercostal nerves (T1-T11)
c)
Phrenic nerve (C3, C4, C5)
d)
Long thoracic nerve (C5, C6, C7)
e)
Spinal accessory nerve (CN XI)
92.
A patient with Zollinger-Ellison syndrome has recurrent peptic ulcers. What is the underlying mechanism?
a)
Hypergastrinaemia
b)
Hypochlorhydria
c)
H. pylori infection
d)
NSAID use
e)
Impaired mucosal defence
93.
A 50-year-old woman with rheumatoid arthritis on long-term NSAIDs presents with dyspepsia. Which of the following is the most appropriate prophylactic agent to protect her gastric mucosa?
a)
Omeprazole
b)
Ranitidine
c)
Sucralfate
d)
Misoprostol
e)
Antacids
94.
A patient with decompensated cirrhosis develops spontaneous bacterial peritonitis (SBP). Which of the following organisms is most commonly responsible?
a)
Escherichia coli
b)
Bacteroides fragilis
c)
Streptococcus pneumoniae
d)
Enterococcus faecalis
e)
Clostridium difficile
95.
A 35-year-old man is admitted with acute severe ulcerative colitis. He is started on intravenous hydrocortisone. After 72 hours, he has not improved and has >8 bloody stools per day. What is the most appropriate next step in management?
a)
Continue IV steroids for another 48 hours.
b)
Add in an oral 5-ASA agent.
c)
Start intravenous ciclosporin or infliximab.
d)
Schedule a total colectomy.
e)
Switch to oral prednisolone.
96.
The appendix is typically located in which abdominal quadrant?
a)
Right Upper Quadrant
b)
Left Upper Quadrant
c)
Right Lower Quadrant
d)
Left Lower Quadrant
e)
Periumbilical
97.
Which of the following is a characteristic feature of Hirschsprung's disease?
a)
Dilated segment of colon proximal to the aganglionic segment
b)
Presence of ganglion cells in the submucosal plexus
c)
Onset of symptoms in adolescence
d)
Association with Down's syndrome is rare
e)
It always affects the entire colon
98.
A patient with chronic pancreatitis has persistent steatorrhoea. What is the minimum daily dose of pancreatic enzyme supplementation required to control symptoms?
a)
10,000 units of lipase with meals
b)
25,000 units of lipase with meals
c)
50,000 units of lipase with meals
d)
75,000 units of lipase with meals
e)
100,000 units of lipase with meals
99.
A 60-year-old man is diagnosed with oesophageal cancer. Which of the following is the strongest risk factor for the squamous cell carcinoma subtype?
a)
Gastro-oesophageal reflux disease (GORD)
b)
Smoking and alcohol consumption
c)
Obesity
d)
Barrett's oesophagus
e)
Achalasia
100.
A 45-year-old woman is referred to the breast clinic with a palpable lump. A core biopsy is reported as B5 (malignant). What is the next step?
a)
Repeat the core biopsy.
b)
Perform a fine needle aspiration (FNA).
c)
Arrange a mammogram.
d)
Discuss definitive surgical options (e.g., wide local excision or mastectomy).
e)
Commence neoadjuvant chemotherapy.
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