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Arab Board Internal Medicine Part 1 study materials
Arab Board Internal Medicine Part 1 study resources

Arab Board Internal Medicine Part 1 practice questions

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Question 1Cardiology

A 58-year-old man has a blood pressure of 152/94 mmHg on two separate clinic visits, with no evidence of target-organ damage. According to standard classification, how should his hypertension be staged?

  1. Isolated systolic hypertension
  2. Stage 1 hypertension Correct answer.
  3. Normal blood pressure
  4. Stage 2 hypertension

Explanation

Stage 1 hypertension is defined as systolic 140-159 mmHg or diastolic 90-99 mmHg. A reading of 152/94 falls within this band without target-organ damage.

Question 2Cardiology

Which finding on the ECG is most characteristic of acute pericarditis?

  1. Sawtooth flutter waves at 300 per minute
  2. Widespread concave ST elevation with PR depression Correct answer.
  3. Deep Q waves in inferior leads
  4. ST elevation confined to leads V1-V3 with reciprocal depression

Explanation

Acute pericarditis classically produces diffuse concave-upward ST elevation across many leads together with PR-segment depression. The changes are not confined to a single coronary territory.

Question 3Cardiology

A patient with heart failure has an ejection fraction of 30 percent. Which medication has been shown to reduce mortality in this setting?

  1. Amlodipine
  2. Ranolazine
  3. Sacubitril-valsartan Correct answer.
  4. Ivabradine

Explanation

Sacubitril-valsartan is a guideline-directed therapy with proven mortality benefit in heart failure with reduced ejection fraction. It replaces an ACE inhibitor or ARB in eligible patients.

Question 4Cardiology

Which auscultatory finding is most typical of severe aortic stenosis?

  1. A fixed split second heart sound with a midsystolic murmur
  2. A pansystolic murmur radiating to the axilla
  3. A mid-diastolic rumble with an opening snap
  4. A soft second heart sound with a late-peaking systolic murmur Correct answer.

Explanation

Severe aortic stenosis produces a harsh crescendo-decrescendo murmur that peaks late in systole and is associated with a soft or absent aortic component of S2. These features reflect severe obstruction and delayed valve closure.

Question 5Cardiology

A 62-year-old woman has sudden-onset palpitations. The ECG shows a narrow-complex tachycardia at 180 beats per minute with no visible P waves. She is hemodynamically stable. What is the most appropriate initial management?

  1. Intravenous adenosine Correct answer.
  2. Intravenous amiodarone infusion
  3. Oral bisoprolol
  4. Immediate synchronized cardioversion

Explanation

A stable narrow-complex regular tachycardia without visible P waves is usually AV nodal reentrant tachycardia, and adenosine is the first-line acute therapy. It transiently blocks the AV node and terminates the reentry circuit.

Question 6Cardiology

Which finding best supports a diagnosis of infective endocarditis in a patient with a prosthetic valve?

  1. Elevated C-reactive protein alone
  2. Persistent bacteremia with a new paravalvular leak on echocardiography Correct answer.
  3. A single positive blood culture for coagulase-negative staphylococci
  4. A new systolic murmur with a normal echocardiogram

Explanation

Persistent bacteremia combined with a new paravalvular leak satisfies major Duke criteria for definite endocarditis. Both the microbiologic and imaging major criteria are met.

Question 7Cardiology

Which ECG change is the earliest electrocardiographic sign of acute transmural myocardial infarction?

  1. Pathologic Q waves
  2. Hyperacute T waves Correct answer.
  3. T-wave inversion
  4. ST-segment normalization

Explanation

Hyperacute, tall and broad T waves are the earliest ECG manifestation of acute transmural ischemia, appearing before ST elevation. Q waves and T-wave inversion occur later in the evolution of infarction.

Question 8Cardiology

A patient with acute decompensated heart failure is given intravenous furosemide. Which parameter best reflects an adequate diuretic response?

  1. Urine output and daily weight change Correct answer.
  2. Serum sodium concentration
  3. Heart rate variability
  4. Peak oxygen consumption

Explanation

Diuretic efficacy in acute decompensated heart failure is assessed by urine output and serial weight, which reflect net fluid removal. These measures guide titration of the diuretic dose.

Question 9Cardiology

Which mechanism best explains syncope in severe aortic stenosis during exertion?

  1. Sudden ventricular fibrillation from a long QT interval
  2. Orthostatic hypotension from volume depletion
  3. Failure of the cardiac output to rise because of a fixed outflow obstruction Correct answer.
  4. Excessive vagal tone causing reflex bradycardia

Explanation

A fixed stenotic valve prevents the stroke volume from increasing during exertion, so systemic pressure falls and cerebral perfusion drops. This produces exertional syncope.

Question 10Cardiology

Which lipid parameter is the primary target for statin therapy in secondary prevention of atherosclerotic cardiovascular disease?

  1. Triglycerides
  2. Lipoprotein(a)
  3. High-density lipoprotein cholesterol
  4. Low-density lipoprotein cholesterol Correct answer.

Explanation

Low-density lipoprotein cholesterol is the established primary target for lipid-lowering therapy in secondary prevention. Statin dosing is titrated to achieve defined LDL-C thresholds.

Question 11Cardiology

A 70-year-old man with atrial fibrillation has a CHA2DS2-VASc score of 3. What is the most appropriate antithrombotic strategy?

  1. Oral anticoagulation with a direct oral anticoagulant Correct answer.
  2. Dual antiplatelet therapy
  3. No antithrombotic therapy
  4. Aspirin monotherapy

Explanation

A CHA2DS2-VASc score of 2 or more in men warrants oral anticoagulation to prevent stroke. A direct oral anticoagulant is preferred over aspirin or dual antiplatelet therapy.

Question 12Cardiology

Which physical examination finding is most suggestive of cardiac tamponade?

  1. Bounding peripheral pulses with a wide pulse pressure
  2. Pulsus paradoxus with elevated jugular venous pressure Correct answer.
  3. A slow-rising carotid upstroke with a sustained apex beat
  4. A collapsing pulse with a low diastolic pressure

Explanation

Tamponade raises pericardial pressure, impairing diastolic filling and producing pulsus paradoxus together with elevated jugular venous pressure. These reflect the hemodynamic compromise of tamponade.

Question 13Cardiology

Which electrocardiographic criterion is used to diagnose left ventricular hypertrophy?

  1. Wells score
  2. Grace score
  3. Bazett formula
  4. Sokolow-Lyon voltage criteria Correct answer.

Explanation

The Sokolow-Lyon criteria use precordial voltage (S in V1 plus R in V5 or V6) to identify left ventricular hypertrophy. Voltage criteria are the standard ECG approach to this diagnosis.

Question 14Cardiology

Which feature distinguishes stable angina from unstable angina?

  1. Normal resting ECG between episodes
  2. Symptoms occurring at rest or with a changing crescendo pattern Correct answer.
  3. Pain provoked by heavy meals
  4. Reproducible chest pain on exertion relieved by rest

Explanation

Unstable angina is defined by ischemia occurring at rest, on minimal exertion, or with a worsening crescendo pattern. Stable angina is predictably provoked by exertion and relieved by rest.

Question 15Cardiology

A patient with a mechanical mitral valve requires long-term anticoagulation. Which agent is appropriate?

  1. Apixaban
  2. Warfarin with a target INR of 2.5 to 3.5 Correct answer.
  3. Rivaroxaban
  4. Dabigatran

Explanation

Mechanical mitral valves require warfarin with a target INR of 2.5 to 3.5 because direct oral anticoagulants are not approved for this indication. Warfarin remains the standard for mechanical valve thromboprophylaxis.

Question 16Cardiology

Which maneuver is used to differentiate a systolic murmur of hypertrophic cardiomyopathy from that of aortic stenosis?

  1. Rapid squatting
  2. Handgrip exercise
  3. Passive leg raise
  4. Valsalva maneuver Correct answer.

Explanation

The Valsalva maneuver decreases preload and increases the gradient in hypertrophic cardiomyopathy, so the murmur becomes louder. In aortic stenosis the murmur typically becomes softer.

Question 17Cardiology

Which finding on echocardiography indicates severe mitral stenosis?

  1. A mitral valve area of 2.5 square centimeters
  2. A normal valve leaflet appearance
  3. A mean gradient of 2 mmHg
  4. A mitral valve area of 1.0 square centimeter Correct answer.

Explanation

Severe mitral stenosis is defined by a valve area of 1.5 square centimeters or less. A valve area of 1.0 square centimeter therefore falls in the severe range.

Question 18Cardiology

Which drug is contraindicated in a patient with Wolff-Parkinson-White syndrome and pre-excited atrial fibrillation?

  1. Intravenous ibutilide
  2. Intravenous verapamil Correct answer.
  3. Direct current cardioversion
  4. Intravenous procainamide

Explanation

AV nodal blocking agents such as verapamil can accelerate conduction over the accessory pathway in pre-excited atrial fibrillation and precipitate ventricular fibrillation. Procainamide, ibutilide, or cardioversion are preferred.

Question 19Cardiology

Which condition is a recognized cause of a high-output state mimicking heart failure?

  1. Acute mitral regurgitation
  2. Severe anemia Correct answer.
  3. Constrictive pericarditis
  4. Cardiac tamponade

Explanation

Severe anemia lowers systemic vascular resistance and increases cardiac output, producing a high-output state with heart failure symptoms. Correcting the anemia reverses the syndrome.

Question 20Cardiology

Which risk factor most strongly predisposes to infective endocarditis in a patient with a native valve?

  1. Systemic hypertension
  2. Intravenous drug use Correct answer.
  3. Chronic obstructive pulmonary disease
  4. Type 2 diabetes mellitus

Explanation

Intravenous drug use introduces organisms directly into the bloodstream and commonly affects the tricuspid valve. It is a major risk factor for native valve endocarditis.

Question 21Cardiology

A patient with chronic stable heart failure has worsening dyspnea, a raised jugular venous pressure, and bilateral basal crackles. Which initial therapy is most appropriate?

  1. Oral potassium supplementation
  2. Beta-blocker dose increase
  3. Intravenous fluid bolus
  4. Intravenous loop diuretic Correct answer.

Explanation

Volume overload with elevated filling pressures and pulmonary congestion is treated with an intravenous loop diuretic. This relieves congestion and improves symptoms.

Question 22Cardiology

Which ECG feature is characteristic of Mobitz type I second-degree AV block?

  1. Constant PR interval with intermittent dropped beats
  2. Progressive PR interval prolongation before a dropped beat Correct answer.
  3. Complete dissociation of P waves and QRS complexes
  4. A shortened PR interval with a delta wave

Explanation

Mobitz type I (Wenckebach) shows progressive lengthening of the PR interval until a QRS complex is dropped. The block is usually at the AV node and is often benign.

Question 23Cardiology

Which finding is most consistent with constrictive pericarditis?

  1. A fixed split second heart sound
  2. Pericardial knock with prominent y descent on jugular venous pulse Correct answer.
  3. Pulsus paradoxus with absent y descent
  4. A systolic murmur radiating to the carotids

Explanation

Constrictive pericarditis causes rapid early diastolic filling that produces a pericardial knock and a prominent y descent on the jugular venous waveform. These reflect the rigid pericardial constraint.

Question 24Cardiology

A patient presents with tearing chest pain radiating to the back and a blood pressure difference of 25 mmHg between the arms. Which imaging test is the initial study of choice in a stable patient?

  1. Contrast-enhanced computed tomography angiography Correct answer.
  2. Exercise stress testing
  3. Transthoracic echocardiography
  4. Chest radiograph

Explanation

In a hemodynamically stable patient with suspected aortic dissection, contrast-enhanced CT angiography is the preferred initial imaging modality. It rapidly defines the extent and type of dissection.

Question 25Pulmonology

A 24-year-old man has sudden-onset pleuritic chest pain and breathlessness. He is tall and thin. Examination shows reduced breath sounds and hyper-resonance on the right, with tracheal deviation to the left. What is the most appropriate immediate management?

  1. Intravenous antibiotics and observation
  2. Urgent needle decompression followed by chest drain insertion Correct answer.
  3. High-flow oxygen and repeat chest radiograph in 6 hours
  4. Urgent CT pulmonary angiogram

Explanation

Tension pneumothorax is a clinical diagnosis; tracheal deviation away from the affected side with haemodynamic compromise mandates immediate decompression without waiting for imaging. Needle decompression is followed by a definitive intercostal drain.

Question 26Pulmonology

Which spirometric pattern is characteristic of idiopathic pulmonary fibrosis?

  1. Increased FEV1/FVC ratio with reduced total lung capacity Correct answer.
  2. Normal FEV1/FVC ratio with reduced transfer factor
  3. Increased FEV1/FVC ratio with increased total lung capacity
  4. Reduced FEV1/FVC ratio with increased residual volume

Explanation

Pulmonary fibrosis causes a restrictive defect, so total lung capacity falls while the FEV1/FVC ratio is preserved or raised because lung recoil increases. The transfer factor is also reduced.

Question 27Pulmonology

A 30-year-old woman has episodic wheeze, cough and chest tightness at night, with symptoms on three nights per week. Spirometry shows an FEV1 of 85% predicted with reversibility after salbutamol. What is the most appropriate initial maintenance therapy?

  1. Oral prednisolone for 2 weeks
  2. Long-acting beta-2 agonist alone
  3. Low-dose inhaled corticosteroid Correct answer.
  4. Short-acting beta-2 agonist as required only

Explanation

Asthma with symptoms on more than two days or nights per week requires regular controller therapy, and low-dose inhaled corticosteroid is the first-line preventer. A reliever alone is reserved for very infrequent symptoms.

Question 28Pulmonology

Which finding on arterial blood gas most strongly suggests chronic rather than acute respiratory acidosis in a patient with COPD?

  1. Low bicarbonate with low pH
  2. Raised PaCO2 with low pH
  3. Low PaO2 with normal PaCO2
  4. Raised bicarbonate with near-normal pH Correct answer.

Explanation

In chronic hypercapnia the kidneys retain bicarbonate, so pH is only mildly reduced or normal despite a raised PaCO2. This metabolic compensation distinguishes chronic from acute respiratory acidosis.

Question 29Pulmonology

A 58-year-old smoker has a 3 cm peripheral lung mass with no mediastinal lymphadenopathy and no distant metastases. What is the most appropriate next step in management?

  1. Concurrent chemoradiotherapy
  2. Surgical resection after staging assessment Correct answer.
  3. Palliative chemotherapy alone
  4. Targeted therapy without histological confirmation

Explanation

Early-stage non-small cell lung cancer confined to the lung without nodal or distant spread is potentially curable with surgery after full staging and fitness assessment. Histology and staging must be established first.

Question 30Pulmonology

Which organism is the most common cause of community-acquired pneumonia requiring hospital admission in adults?

  1. Mycoplasma pneumoniae
  2. Streptococcus pneumoniae Correct answer.
  3. Staphylococcus aureus
  4. Pseudomonas aeruginosa

Explanation

Streptococcus pneumoniae remains the leading cause of community-acquired pneumonia across all severities. Atypical organisms and Pseudomonas are less frequent and often associated with specific risk factors.

Question 31Pulmonology

A patient with a large pulmonary embolism becomes hypotensive with a systolic pressure of 75 mmHg and has a normal echocardiogram showing right ventricular dilatation. What is the most appropriate immediate treatment?

  1. Oral anticoagulation alone
  2. Systemic thrombolysis Correct answer.
  3. Inferior vena cava filter insertion
  4. Nebulised bronchodilators

Explanation

High-risk pulmonary embolism with haemodynamic instability and right ventricular strain is treated with systemic thrombolysis, followed by anticoagulation. Anticoagulation alone is insufficient in shock.

Question 32Pulmonology

Which feature on CT imaging is most characteristic of usual interstitial pneumonia in idiopathic pulmonary fibrosis?

  1. Unilateral pleural effusion with thickened pleura
  2. Central bronchiectasis with tree-in-bud opacities
  3. Peripheral basal honeycombing with traction bronchiectasis Correct answer.
  4. Upper-lobe predominant centrilobular nodules

Explanation

Usual interstitial pneumonia shows subpleural, basal-predominant reticulation, honeycombing and traction bronchiectasis. These features reflect progressive fibrosis and are central to the diagnosis.

Question 33Pulmonology

A young woman has recurrent episodes of angio-oedema, abdominal pain and urticaria with a low C4 level and a normal C1 inhibitor level. Which diagnosis is most likely?

  1. Hereditary angio-oedema type II
  2. Hereditary angio-oedema type I
  3. Acquired C1 inhibitor deficiency Correct answer.
  4. Angiotensin-converting enzyme inhibitor reaction

Explanation

Acquired C1 inhibitor deficiency produces angio-oedema with low C4 and low or normal C1 inhibitor, often in the context of a lymphoproliferative disorder. Hereditary forms show a family history and abnormal C1 inhibitor levels or function.

Question 34Pulmonology

Which of the following is the most important risk factor for the development of chronic obstructive pulmonary disease?

  1. Alpha-1 antitrypsin deficiency
  2. Recurrent childhood respiratory infection
  3. Cigarette smoking Correct answer.
  4. Occupational dust exposure

Explanation

Cigarette smoking is the single most important risk factor for COPD worldwide, accounting for the majority of cases. Other factors contribute but are less common causes.

Question 35Pulmonology

A 65-year-old man with COPD has a resting PaO2 of 50 mmHg and cor pulmonale. What is the most appropriate long-term management?

  1. Home nebulised salbutamol as sole therapy
  2. Oral corticosteroids indefinitely
  3. Prophylactic antibiotics continuously
  4. Long-term oxygen therapy for at least 15 hours daily Correct answer.

Explanation

Long-term oxygen therapy improves survival in chronic hypoxaemia with a PaO2 at or below 55 mmHg or with cor pulmonale. It should be used for at least 15 hours per day.

Question 36Pulmonology

A patient develops sudden pleuritic chest pain and hypoxaemia 5 days after major abdominal surgery. Which investigation is the most appropriate first-line test to diagnose pulmonary embolism when the patient is haemodynamically stable?

  1. CT pulmonary angiography Correct answer.
  2. Chest radiograph
  3. Ventilation-perfusion scan
  4. D-dimer assay

Explanation

CT pulmonary angiography is the first-line imaging test in stable patients with suspected pulmonary embolism and a high clinical probability. It directly visualises thrombus in the pulmonary arteries.

Question 37Pulmonology

Which of the following best describes the mechanism of action of omalizumab in severe allergic asthma?

  1. It causes broad immunosuppression of T lymphocytes
  2. It inhibits leukotriene receptor signalling
  3. It binds free IgE and prevents mast cell activation Correct answer.
  4. It blocks the interleukin-5 receptor on eosinophils

Explanation

Omalizumab is a monoclonal antibody that binds free IgE, preventing it from attaching to high-affinity receptors on mast cells and basophils. This reduces allergic mediator release and exacerbations.

Question 38Pulmonology

A patient with a large left-sided pleural effusion has a pleural fluid pH of 7.0 and glucose of 1.5 mmol/L. What is the most likely diagnosis?

  1. Empyema Correct answer.
  2. Chylothorax
  3. Pleural effusion due to hypothyroidism
  4. Transudate due to heart failure

Explanation

A low pleural fluid pH and low glucose suggest a complicated parapneumonic effusion or empyema, reflecting bacterial metabolism and pleural inflammation. These findings warrant drainage.

Question 39Pulmonology

Which of the following is a recognised cause of a transudative pleural effusion?

  1. Pulmonary tuberculosis
  2. Nephrotic syndrome Correct answer.
  3. Pulmonary infarction
  4. Rheumatoid arthritis

Explanation

Transudates arise from altered hydrostatic or oncotic pressures, as in nephrotic syndrome with hypoalbuminaemia. Exudates result from increased capillary permeability or impaired lymphatic drainage.

Question 40Pulmonology

A 70-year-old man with a 50 pack-year smoking history has hyponatraemia and a right hilar mass. Which paraneoplastic syndrome is most likely?

  1. Ectopic adrenocorticotrophic hormone secretion from adenocarcinoma
  2. Ectopic parathyroid hormone secretion from squamous cell carcinoma
  3. Ectopic calcitonin secretion from carcinoid tumour
  4. Ectopic antidiuretic hormone secretion from small cell carcinoma Correct answer.

Explanation

Small cell lung cancer commonly causes syndrome of inappropriate antidiuretic hormone, producing hyponatraemia with a central hilar mass. This is a classic paraneoplastic presentation.

Question 41Pulmonology

A patient with suspected obstructive sleep apnoea has an apnoea-hypopnoea index of 25 events per hour on polysomnography. What is the most appropriate first-line treatment?

  1. Nocturnal oxygen therapy alone
  2. Weight gain with sedative use
  3. Uvulopalatopharyngoplasty
  4. Continuous positive airway pressure therapy Correct answer.

Explanation

Moderate to severe obstructive sleep apnoea with an apnoea-hypopnoea index of 15 or more is treated first-line with continuous positive airway pressure. It reduces symptoms and cardiovascular risk.

Question 42Pulmonology

Which of the following is the most appropriate test to confirm a diagnosis of latent tuberculosis infection in an immunocompetent adult?

  1. Chest radiograph
  2. Sputum acid-fast bacilli smear
  3. Interferon-gamma release assay Correct answer.
  4. Tuberculin skin test with a 5 mm threshold

Explanation

Interferon-gamma release assays detect an immune response to Mycobacterium tuberculosis antigens and are preferred where available because they are unaffected by prior BCG vaccination. They indicate infection rather than active disease.

Question 43Gastroenterology and Hepatology

A 45-year-old man has recurrent epigastric pain relieved by meals and is found to have a duodenal ulcer. Which single factor is most strongly associated with duodenal ulcer disease?

  1. Helicobacter pylori infection Correct answer.
  2. Zollinger-Ellison syndrome
  3. Chronic NSAID use
  4. Crohn disease

Explanation

Helicobacter pylori is the dominant cause of duodenal ulcer disease worldwide, present in the great majority of cases. Eradication substantially reduces recurrence. NSAIDs are a more prominent cause of gastric ulcers, and the other entities are uncommon causes.

Question 44Gastroenterology and Hepatology

Which serological marker is the preferred initial screening test for coeliac disease in an adult who is still eating gluten?

  1. IgA tissue transglutaminase antibody Correct answer.
  2. Anti-double-stranded DNA antibody
  3. Anti-smooth muscle antibody
  4. Antimitochondrial antibody

Explanation

IgA tissue transglutaminase (with total IgA to exclude deficiency) is the recommended first-line serological test for coeliac disease while the patient remains on a gluten-containing diet. Small bowel biopsy confirms the diagnosis. The other antibodies relate to autoimmune liver and connective tissue disease.

Question 45Gastroenterology and Hepatology

A 60-year-old woman has a serum alkaline phosphatase twice the upper limit of normal with a normal bilirubin and only mildly raised ALT. Antimitochondrial antibody is positive. What is the most likely diagnosis?

  1. Acute viral hepatitis
  2. Primary sclerosing cholangitis
  3. Primary biliary cholangitis Correct answer.
  4. Gilbert syndrome

Explanation

A cholestatic pattern (disproportionately raised alkaline phosphatase) with positive antimitochondrial antibody in a middle-aged woman is characteristic of primary biliary cholangitis. Bilirubin is often normal early in the disease.

Question 46Gastroenterology and Hepatology

Which finding best distinguishes ascites due to portal hypertension from ascites due to peritoneal carcinomatosis?

  1. Ascitic fluid total protein
  2. Ascitic fluid glucose
  3. Serum ascites albumin gradient Correct answer.
  4. Ascitic fluid lactate dehydrogenase

Explanation

A serum ascites albumin gradient of 1.1 g/dL or more indicates portal hypertension with about 97% accuracy. Low gradient suggests an alternative cause such as malignancy or tuberculosis.

Question 47Gastroenterology and Hepatology

Which is the most common cause of acute pancreatitis in adults in most populations?

  1. Gallstones Correct answer.
  2. Hypercalcaemia
  3. Post-ERCP injury
  4. Hypertriglyceridaemia

Explanation

Gallstones and alcohol account for the majority of acute pancreatitis cases, with gallstones the leading cause overall. Metabolic and procedural causes are less frequent.

Question 48Gastroenterology and Hepatology

A patient presents with painless jaundice and a palpable gallbladder. Which diagnosis should be suspected?

  1. Chronic cholecystitis
  2. Acute cholecystitis
  3. Pancreatic head carcinoma Correct answer.
  4. Choledocholithiasis

Explanation

Painless progressive jaundice with a palpable, distended gallbladder (Courvoisier's law) suggests malignant obstruction, classically pancreatic head or distal bile duct carcinoma. Gallstone disease usually produces a fibrotic, non-distensible gallbladder.

Question 49Gastroenterology and Hepatology

A 32-year-old man has bloody diarrhoea and urgency. Colonoscopy shows continuous inflammation from the rectum. Which feature most favours ulcerative colitis over Crohn disease?

  1. Transmural inflammation
  2. Granulomas on biopsy
  3. Skip lesions
  4. Continuous mucosal disease starting in the rectum Correct answer.

Explanation

Ulcerative colitis characteristically involves the rectum and extends proximally in a continuous fashion, confined to the mucosa. Crohn disease is transmural with skip lesions and granulomas.

Question 50Gastroenterology and Hepatology

A 55-year-old man with cirrhosis presents with fever and abdominal pain. Diagnostic paracentesis shows 600 polymorphonuclear cells per microlitre. What is the most appropriate immediate management?

  1. Intravenous third-generation cephalosporin Correct answer.
  2. Therapeutic large-volume paracentesis
  3. Intravenous furosemide
  4. Oral lactulose

Explanation

A polymorphonuclear cell count of 250 per microlitre or more in ascitic fluid defines spontaneous bacterial peritonitis, which requires prompt intravenous antibiotics, typically a third-generation cephalosporin. Albumin is often added to reduce renal complications.