MEDI2011 Formative Assessment Week 15 2013

1. A woman brings her three year old son to the paediatrician because she has noticed
a bulge in his belly. Examination reveals a hernia in the inguinal region. During
surgery it is noted that this hernia is lateral to the inferior epigastric vessels. Which of
the following applies best to this hernia.
a) It passes through Hesselbachs triangle.
b) The hernia sac does not pass through the deep inguinal ring.
c) The hernia sac represents the remains of the processus vaginalis.
d) It frequently results from weakening of the conjoint tendon.
2. In a 25 year old woman with gluten-sensitive enteropathy, which one of the
following statements is correct?
a) The anaemia is most likely due to Vitamin B12 deficiency.
b) Corn contains gluten and should be excluded from the diet.
c) When placed on a strict gluten-free diet, the small bowel histology will improve
markedly within two weeks.
d) There is an association with the development of lymphoma.
3. A 46 year old woman presents to her GP because of voluminous, malodorous, bulky
stools. The diarrhoea usually abates on fasting. Faeces analysis shows an increased
stool osmolality and fat content. Serum electrolytes show Na 149 (135-147mmol/L)
K 3.5(3.5-5.0mmol/L), Cl 110 (95-105mmol/L) & HCO3 18 (22-28mmol/L). Which
of the following pathological mechanisms is the most likely responsible for the
patients presentation?
a) Exudative diarrhoea
b) Malabsorption
c) Motility derangement
d) Osmotic diarrhoea
4. An 8 year old boy presents to the emergency department with a two hour history of
vomiting after eating dinner at a seafood buffet. Arterial blood gas analysis reveals a
pH of 7.5, a bicarbonate level of 34 (22-28mmol/L) and partial carbon dioxide
pressure of 40mmHg(33-44mmHg). Which of the following best describes the acidbase disturbance occurring in this patient?
a) Metabolic acidosis
b) Metabolic acidosis/respiratory alkalosis
c) Metabolic alkalosis
d) Metabolic alkalosis/ respiratory compensation

5. A 19 year old man presents to the emergency department with a new onset of right
lower quadrant abdominal pain. On physical examination, the patient has a
temperature of 38.5?C and a WBC count of 13x109/L (4.5-11.0x109/L). Flexion at
his hip elicits pain. Release of manual pressure on the abdomen causes more pain
than deep palpation. Which of the following is also most likely present in this
patient?
a) Abdominal distension
b) Dyspnoea
c) Nausea and vomiting
d) Profuse watery diarrhoea
6. A 27 year old man goes to the doctor for an annual physical examination. On rectal
examination, masses are palpated. The patient is referred for a colonoscopy, which
reveals adenomatous polyps located diffusely throughout the colon. When asked
about his family history, the patient states that his father passed away from colon
cancer. A diagnosis of familial adenomatous polyposis is suspected, and the patient
asks how he got this. Which of the following is the inheritance pattern of this
condition?
a) Autosomal dominant
b) Autosomal recessive
c) Autosomal trisomy
d) X-linked recessive
7. A 45 year old woman presents with steatorrhoea, abdominal discomfort, bloating
and weight loss. On examination she has mouth ulcers and angular stomatitis. Her
symptoms improve with the removal of wheat, rye and barley from the diet. Which
one of the following complications is most likely to occur, even with a long-term
gluten-free diet.
a) Infertility
b) Polyneuropathy
c) Depression
d) Osteoporosis
8. Following the ingestion of a meal the nutrients are absorbed. Which one of the
following statements about absorption are correct?
a) Glucose is absorbed by simple diffusion
b) Bile salts are absorbed in the jejunum
c) Emulsification of fat predominantly occurs in the small intestine
d) Vitamin B12 is absorbed in the proximal ileum
9. Which ONE of the following statements about colonic polyps is TRUE?
a) 75% of polyps occur in the right hemicolon
b) The typical histology is that of tubular adenoma
c) Polyps <2cm in diameter are usually malignant
d) Presentation with colonic bleeding is typical

10. Of the 1500ml of material entering the large intestine on a daily basis,
approximately how much is reabsorbed ?
a)
b)
c)
d)

500ml
750ml
1000ml
1200ml

11. What percentage of body weight in men is water?

a) 15%
b) 30%
c) 60%
d) 90%
12. If one litre of solute free water is lost from the body, what volume of that fluid is
lost from the intracellular fluid compartment?
a) 333 ml
b) 667 ml
c) 1000ml
d) None
13. Extracellular osmolality in a healthy adult is
a) More than intracellular osmolality
b) Less than intracellular osmolality
c) The same as intracellular osmolality
d) Varies depending on fluid intake
14. A patient has quickly lost one litre of whole blood following an accident. What
clinical features can you expect in this patient?
a) Tachycardia
b) Postural hypotension
c) Peripheral vasoconstriction with cool extremities
d) Oliguria
e) All of above
15. The most prevalent electrolyte in the extracellular fluid is
a) Potassium
b) Sodium
c) Chloride
d) Calcium
e) Phosphate