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UKMPPD (UKNPDPD) study materials
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UKMPPD (UKNPDPD) practice questions

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Question 1Kardiovaskular

A 58-year-old man with no prior cardiac history presents with sudden-onset central chest pain that radiates to the left arm, accompanied by diaphoresis and nausea. Which single finding on a 12-lead ECG most strongly supports an acute ST-elevation myocardial infarction?

  1. First-degree atrioventricular block
  2. Sinus tachycardia at 110 beats per minute
  3. Premature ventricular complexes in a bigeminal pattern
  4. ST-segment elevation of 1 mm or more in two contiguous leads Correct answer.

Explanation

Acute STEMI is defined by new ST-segment elevation meeting threshold criteria in anatomically contiguous leads, reflecting transmural myocardial injury. Tachycardia, AV block, and ventricular ectopy are non-specific findings that can accompany many conditions and do not localize acute injury.

Question 2Kardiovaskular

A 45-year-old woman has a resting blood pressure repeatedly around 150/95 mmHg on three visits. She is asymptomatic, has no target-organ damage, and has no diabetes or kidney disease. According to standard hypertension staging, how is her blood pressure best classified?

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

Explanation

Grade 1 hypertension corresponds to a systolic pressure of 140-159 mmHg or a diastolic pressure of 90-99 mmHg. Her values fall within this range without evidence of higher-grade elevation.

Question 3Kardiovaskular

A patient with chronic heart failure has reduced ejection fraction and persistent volume overload despite optimal diuretic therapy. Which medication class has been shown to reduce mortality in this setting by antagonizing the mineralocorticoid receptor?

  1. Nitrates
  2. Loop diuretics
  3. Thiazide diuretics
  4. Mineralocorticoid receptor antagonists Correct answer.

Explanation

Mineralocorticoid receptor antagonists such as spironolactone and eplerenone reduce mortality in heart failure with reduced ejection fraction. Loop and thiazide diuretics relieve congestion but do not confer the same mortality benefit, and nitrates are used mainly for symptom control.

Question 4Kardiovaskular

A 24-year-old man is found to have a blood pressure of 170/110 mmHg with a resting heart rate of 105 beats per minute, tremor, weight loss, and heat intolerance. Which underlying cause should be considered first?

  1. Hyperthyroidism Correct answer.
  2. Primary hyperaldosteronism
  3. Renal artery stenosis
  4. Pheochromocytoma

Explanation

The combination of hypertension, tachycardia, tremor, weight loss, and heat intolerance points to a hyperadrenergic state from thyrotoxicosis. Hyperthyroidism commonly produces systolic hypertension with a wide pulse pressure and resting tachycardia.

Question 5Kardiovaskular

Which auscultatory finding is most characteristic of mitral stenosis?

  1. An early diastolic decrescendo murmur at the left sternal border
  2. A pansystolic murmur at the apex radiating to the axilla
  3. An opening snap followed by a mid-diastolic rumble at the apex Correct answer.
  4. A crescendo-decrescendo systolic murmur at the right upper sternal border

Explanation

Mitral stenosis produces an opening snap and a low-pitched mid-diastolic rumbling murmur at the apex. The other described murmurs correspond to mitral regurgitation, aortic regurgitation, and aortic stenosis, respectively.

Question 6Kardiovaskular

A 62-year-old man with atrial fibrillation has a CHA2DS2-VASc score of 3. He has no contraindications to anticoagulation. Which management is most appropriate for stroke prevention?

  1. Observation without antithrombotic therapy
  2. Oral anticoagulation Correct answer.
  3. Aspirin alone
  4. Clopidogrel monotherapy

Explanation

A CHA2DS2-VASc score of 2 or higher in men warrants oral anticoagulation for stroke prevention in non-valvular atrial fibrillation. Aspirin and antiplatelet monotherapy are inferior to anticoagulation for this indication.

Question 7Kardiovaskular

A 70-year-old woman presents with syncope and is found to have a third-degree (complete) atrioventricular block with a wide-complex escape rhythm at 35 beats per minute. Which intervention is definitive?

  1. Oral beta-blocker therapy
  2. Intravenous atropine
  3. Temporary transcutaneous pacing followed by permanent pacemaker insertion Correct answer.
  4. Carotid sinus massage

Explanation

Complete AV block with a slow escape rhythm is an indication for pacing; temporary pacing stabilizes the patient until a permanent pacemaker is implanted. Atropine has limited effect on infranodal block, and beta-blockers or carotid massage would worsen the situation.

Question 8Kardiovaskular

A 34-year-old woman has palpitations and a regular narrow-complex tachycardia at 180 beats per minute. She is hemodynamically stable. Vagal maneuvers fail. Which is the most appropriate next step?

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

Explanation

For a stable regular narrow-complex supraventricular tachycardia, adenosine is the first-line pharmacologic therapy after failed vagal maneuvers because of its rapid onset and short half-life. Synchronized cardioversion is reserved for unstable patients.

Question 9Kardiovaskular

A 55-year-old man with an anterior STEMI undergoes primary percutaneous coronary intervention. Which medication should be given along with aspirin as part of dual antiplatelet therapy?

  1. Warfarin
  2. Unfractionated heparin alone
  3. A direct oral anticoagulant
  4. A P2Y12 inhibitor such as clopidogrel or ticagrelor Correct answer.

Explanation

Dual antiplatelet therapy after PCI combines aspirin with a P2Y12 receptor inhibitor to prevent stent thrombosis and recurrent ischemic events. Anticoagulants serve a different role and are not part of routine dual antiplatelet therapy.

Question 10Kardiovaskular

A 68-year-old man with heart failure and reduced ejection fraction has persistent dyspnea and bilateral crackles. His blood pressure is 88/60 mmHg. Which medication is most likely to worsen his hypotension and should be used cautiously or withheld?

  1. Furosemide
  2. Sacubitril-valsartan Correct answer.
  3. Spironolactone
  4. Ivabradine

Explanation

Sacubitril-valsartan combines a neprilysin inhibitor with an angiotensin receptor blocker and can cause significant hypotension, particularly in patients with low baseline blood pressure. Diuretics, mineralocorticoid antagonists, and ivabradine do not typically cause marked hypotension.

Question 11Kardiovaskular

A 40-year-old woman has a systolic murmur at the upper sternal border that increases with Valsalva maneuver and decreases with squatting. Which diagnosis is most likely?

  1. Mitral regurgitation
  2. Hypertrophic cardiomyopathy Correct answer.
  3. Aortic stenosis
  4. Ventricular septal defect

Explanation

Dynamic murmurs from hypertrophic cardiomyopathy increase with maneuvers that reduce preload, such as Valsalva, and decrease with maneuvers that increase preload, such as squatting. Aortic stenosis, mitral regurgitation, and VSD murmurs behave differently with these maneuvers.

Question 12Kardiovaskular

A 60-year-old man has a history of myocardial infarction and now has an ejection fraction of 30% with a QRS duration of 150 ms and left bundle branch block. He remains symptomatic despite optimal medical therapy. Which therapy is most likely to improve his symptoms and survival?

  1. Long-term oral amiodarone
  2. Radiofrequency ablation of the AV node
  3. Cardiac resynchronization therapy Correct answer.
  4. Implantable cardioverter-defibrillator alone

Explanation

Cardiac resynchronization therapy improves symptoms and survival in patients with reduced ejection fraction, prolonged QRS, and left bundle branch block who remain symptomatic on medical therapy. An ICD alone prevents sudden death but does not resynchronize ventricular contraction.

Question 13Kardiovaskular

A 72-year-old woman with a mechanical mitral valve requires long-term anticoagulation. Which agent is appropriate?

  1. Rivaroxaban
  2. Dabigatran
  3. Apixaban
  4. Warfarin Correct answer.

Explanation

Warfarin remains the anticoagulant of choice for patients with mechanical heart valves; direct oral anticoagulants are contraindicated because of inadequate and unreliable protection against valve thrombosis.

Question 14Kardiovaskular

A 65-year-old man presents with tearing chest pain radiating to the back, and imaging shows a Stanford type B aortic dissection. He is hemodynamically stable without complications. Which is the preferred initial management?

  1. Emergency open surgical repair
  2. Observation without medications
  3. Aggressive blood pressure and heart rate control Correct answer.
  4. Immediate thrombolysis

Explanation

Uncomplicated type B aortic dissection is managed medically with aggressive blood pressure and heart rate control to reduce aortic wall stress. Surgery is reserved for complicated type B or type A dissections.

Question 15Kardiovaskular

A 30-year-old man has recurrent episodes of palpitations with a heart rate of 200 beats per minute, a regular rhythm, and a delta wave on baseline ECG. Which mechanism explains his tachycardia?

  1. Atrioventricular nodal block
  2. Reentry through an accessory pathway Correct answer.
  3. Enhanced automaticity of the sinus node
  4. Increased vagal tone

Explanation

Wolff-Parkinson-White syndrome involves an accessory pathway that permits reentrant tachyarrhythmias, producing a delta wave on baseline ECG. The tachycardia results from reentry, not from sinus automaticity or increased vagal tone.

Question 16Kardiovaskular

A 58-year-old woman with long-standing hypertension has exertional dyspnea, an S4 gallop, and echocardiography showing concentric left ventricular hypertrophy with a preserved ejection fraction. Which diagnosis best fits?

  1. Acute myocarditis
  2. Constrictive pericarditis
  3. Dilated cardiomyopathy
  4. Heart failure with preserved ejection fraction Correct answer.

Explanation

Heart failure with preserved ejection fraction commonly results from chronic hypertension causing concentric hypertrophy and diastolic dysfunction, with an S4 on examination. Dilated cardiomyopathy, constrictive pericarditis, and myocarditis have different structural and clinical features.

Question 17Kardiovaskular

A 50-year-old man with a history of alcohol use presents with palpitations, and ECG shows an irregularly irregular rhythm with no discernible P waves. His ventricular rate is 140 beats per minute and he is hemodynamically stable. Which management best addresses his symptoms and stroke risk?

  1. Immediate synchronized cardioversion
  2. Rate control and assessment for anticoagulation Correct answer.
  3. Observation without treatment
  4. Digoxin loading for acute conversion

Explanation

For stable atrial fibrillation, rate control relieves symptoms, and stroke risk assessment with CHA2DS2-VASc determines the need for anticoagulation. Immediate cardioversion is reserved for unstable patients or after appropriate anticoagulation planning.

Question 18Kardiovaskular

A 66-year-old man has severe aortic stenosis. He develops exertional syncope. Which mechanism best explains syncope in this condition?

  1. Increased left ventricular compliance
  2. Fixed cardiac output with inability to increase flow during exertion Correct answer.
  3. Loss of atrial kick during sleep
  4. Excessive vagal bradycardia at rest

Explanation

In severe aortic stenosis, the fixed obstruction limits the ability to augment cardiac output during exertion, causing cerebral hypoperfusion and syncope. This is a classic symptom indicating severe disease and a poor prognosis.

Question 19Kardiovaskular

A 45-year-old woman has a blood pressure of 160/100 mmHg and hypokalemia. Her aldosterone is elevated with suppressed renin. Which diagnosis is most likely?

  1. Renovascular hypertension
  2. Primary hyperaldosteronism Correct answer.
  3. Cushing syndrome
  4. Pheochromocytoma

Explanation

Primary hyperaldosteronism produces hypertension with hypokalemia, elevated aldosterone, and suppressed renin due to autonomous aldosterone secretion. Renovascular hypertension typically raises renin, and the other causes have different hormonal profiles.

Question 20Kardiovaskular

A 28-year-old man has a loud, harsh systolic murmur at the left lower sternal border with a thrill, and echocardiography shows a ventricular septal defect. Which finding best indicates a large left-to-right shunt?

  1. A normal ECG with no chamber enlargement
  2. A loud murmur with cardiomegaly and pulmonary congestion Correct answer.
  3. A soft murmur with a normal chest radiograph
  4. A diastolic murmur at the apex

Explanation

A large left-to-right shunt causes volume overload of the pulmonary circulation and left heart, leading to cardiomegaly and pulmonary congestion. Small defects typically produce louder murmurs but little hemodynamic consequence.

Question 21Pernapasan

A 24-year-old man has sudden-onset right-sided pleuritic chest pain and breathlessness while at rest. He is tall and thin. On examination, he is tachycardic with reduced breath sounds and hyperresonance over the right hemithorax. Which is the most likely diagnosis?

  1. Primary spontaneous pneumothorax Correct answer.
  2. Acute exacerbation of asthma
  3. Pulmonary embolism
  4. Lobar pneumonia

Explanation

Sudden pleuritic pain with ipsilateral reduced breath sounds and hyperresonance in a tall thin young man is the classic picture of primary spontaneous pneumothorax, caused by rupture of a subpleural bleb. Hyperresonance and reduced breath sounds reflect air in the pleural space rather than consolidation or bronchospasm.

Question 22Pernapasan

Which spirometric pattern is characteristic of chronic obstructive pulmonary disease?

  1. Reduced FEV1/FVC ratio with reduced FEV1 Correct answer.
  2. Increased FEV1/FVC ratio with reduced total lung capacity
  3. Normal FEV1/FVC ratio with reduced diffusion capacity alone
  4. Normal FEV1/FVC ratio with reduced FVC

Explanation

COPD causes airflow obstruction, defined by a post-bronchodilator FEV1/FVC ratio below 0.70, with a reduced FEV1 proportional to disease severity. The obstruction is not fully reversible, distinguishing it from asthma.

Question 23Pernapasan

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

  1. Mycoplasma pneumoniae
  2. Streptococcus pneumoniae Correct answer.
  3. Haemophilus influenzae
  4. Legionella pneumophila

Explanation

Streptococcus pneumoniae remains the most frequently identified pathogen in community-acquired pneumonia across all severity levels. Atypical organisms and Haemophilus influenzae are less common overall and often associated with specific risk factors.

Question 24Pernapasan

A patient with an acute asthma attack has a silent chest on auscultation and is becoming drowsy. What does this finding indicate?

  1. Life-threatening asthma requiring immediate escalation Correct answer.
  2. Mild asthma suitable for outpatient management
  3. Vocal cord dysfunction
  4. Resolution of bronchospasm

Explanation

A silent chest reflects such severe airflow limitation that air movement is insufficient to generate wheeze, and drowsiness indicates impending respiratory failure. Both are features of life-threatening asthma requiring urgent critical care.

Question 25Pernapasan

Which finding on arterial blood gas most directly indicates that a patient with an exacerbation of COPD has type II respiratory failure?

  1. Reduced arterial partial pressure of oxygen alone
  2. Raised bicarbonate
  3. Raised arterial partial pressure of carbon dioxide Correct answer.
  4. Reduced pH alone

Explanation

Type II respiratory failure is defined by hypercapnia, that is a raised arterial partial pressure of carbon dioxide, usually accompanying hypoxaemia. Hypoxaemia alone defines type I failure, and bicarbonate rise is a compensatory response rather than the defining feature.

Question 26Pernapasan

A 30-year-old woman has episodic wheeze, cough and breathlessness at night that improve with a short-acting beta-2 agonist. Spirometry shows an FEV1/FVC ratio of 0.68 with a 15% improvement after bronchodilator. Which is the most appropriate initial maintenance therapy?

  1. Long-acting beta-2 agonist alone
  2. Inhaled corticosteroid Correct answer.
  3. Oral theophylline
  4. Long-term oral corticosteroid

Explanation

The history and reversible obstruction support asthma, for which an inhaled corticosteroid is the cornerstone of controller therapy because it treats airway inflammation. Long-acting beta-2 agonists are added only in combination with a corticosteroid when control is inadequate.

Question 27Pernapasan

A 68-year-old smoker with a 40 pack-year history has chronic productive cough and progressive breathlessness. Spirometry shows FEV1/FVC of 0.55 with no significant bronchodilator reversibility. Which intervention most improves long-term survival?

  1. Pulmonary rehabilitation alone
  2. Smoking cessation Correct answer.
  3. Regular short-acting bronchodilators
  4. Annual influenza vaccination

Explanation

Smoking cessation is the only intervention shown to slow the accelerated decline in lung function and improve survival in COPD. Bronchodilators, vaccination and rehabilitation improve symptoms and reduce exacerbations but do not modify the underlying disease course.

Question 28Pernapasan

A 55-year-old man presents with fever, productive cough and right-sided pleuritic pain. Chest examination shows dullness to percussion and bronchial breath sounds at the right base. Which is the most likely diagnosis?

  1. Pulmonary fibrosis
  2. Lobar pneumonia Correct answer.
  3. Pneumothorax
  4. Pleural effusion without infection

Explanation

Fever, purulent sputum and focal dullness with bronchial breath sounds indicate consolidation of the underlying lung, typical of lobar pneumonia. Bronchial breath sounds occur because the consolidated lung transmits sound more effectively.

Question 29Pernapasan

A patient is diagnosed with a large primary spontaneous pneumothorax and is breathless. Which is the most appropriate immediate management?

  1. High-flow oxygen alone without drainage
  2. Observation with repeat chest radiograph in 24 hours
  3. Immediate surgical pleurodesis
  4. Needle or chest drain decompression of the pleural space Correct answer.

Explanation

A large or symptomatic pneumothorax requires active removal of pleural air, typically by aspiration or chest drain insertion, to allow lung re-expansion and relieve breathlessness. Observation is reserved for small, asymptomatic cases.

Question 30Pernapasan

A patient with a suspected tension pneumothorax is hypotensive, tachycardic and has distended neck veins with tracheal deviation away from the affected side. What is the most appropriate immediate action?

  1. Intravenous fluids as the sole initial treatment
  2. Emergency needle decompression without waiting for imaging Correct answer.
  3. Immediate bronchoscopy
  4. Urgent portable chest radiograph before any intervention

Explanation

Tension pneumothorax is a clinical diagnosis with haemodynamic compromise, and treatment must not be delayed for imaging because the raised intrathoracic pressure impairs venous return and can cause cardiac arrest. Needle decompression is followed by a chest drain.

Question 31Pernapasan

A 35-year-old woman has recurrent episodes of breathlessness with inspiratory stridor, often triggered by stress, and normal spirometry between attacks. Which diagnosis should be considered?

  1. Inducible laryngeal obstruction Correct answer.
  2. Bronchial asthma
  3. Pulmonary embolism
  4. Chronic obstructive pulmonary disease

Explanation

Inspiratory stridor with normal interval spirometry suggests upper airway narrowing, such as inducible laryngeal obstruction, which often mimics asthma but lacks the expiratory wheeze and reversibility of asthma. Direct laryngoscopy during an episode can confirm the diagnosis.

Question 32Pernapasan

A 22-year-old man has sudden breathlessness and chest pain. He is tall and thin, and chest radiograph shows a pneumothorax with no mediastinal shift. Which underlying lung disease is most strongly associated with this presentation?

  1. Bronchogenic carcinoma
  2. Advanced pulmonary fibrosis
  3. None; this is a primary spontaneous pneumothorax Correct answer.
  4. Active pulmonary tuberculosis

Explanation

Primary spontaneous pneumothorax occurs without clinically apparent underlying lung disease, typically in tall thin young men due to rupture of apical subpleural blebs. Secondary pneumothorax is the term used when an underlying lung disease is present.

Question 33Pernapasan

A 70-year-old man with COPD presents with increased breathlessness, increased sputum purulence and increased sputum volume. He is alert with a respiratory rate of 22 and oxygen saturation of 90% on air. Which is the most appropriate initial management?

  1. High-flow oxygen to achieve saturation of 100%
  2. Immediate non-invasive ventilation before any medical therapy
  3. Intravenous diuretics
  4. Controlled oxygen therapy, inhaled bronchodilators and oral corticosteroids with antibiotics Correct answer.

Explanation

This is an infective exacerbation of COPD, managed with titrated oxygen to a target saturation range of 88-92%, bronchodilators, a short course of oral corticosteroids and antibiotics when sputum is purulent. Non-invasive ventilation is reserved for persistent hypercapnic acidaemia despite optimal medical therapy.

Question 34Pernapasan

Which statement best describes the physiological basis of a reduced transfer factor for carbon monoxide in emphysema?

  1. Loss of alveolar surface area reduces gas diffusion across the membrane Correct answer.
  2. Airway inflammation increases the diffusion pathway
  3. Air trapping increases the diffusing capacity
  4. Increased haemoglobin binds carbon monoxide more avidly

Explanation

Emphysema destroys alveolar walls, reducing the surface area available for gas exchange and thus lowering the transfer factor. This contrasts with asthma, where the transfer factor is typically normal.

Question 35Pernapasan

A 60-year-old woman with a 6-month history of progressive breathlessness has bilateral basal fine crackles and finger clubbing. Spirometry shows a reduced FVC with a normal or increased FEV1/FVC ratio. Which pattern does this represent?

  1. Obstructive ventilatory defect
  2. Normal spirometry
  3. Restrictive ventilatory defect Correct answer.
  4. Mixed obstructive and restrictive defect

Explanation

A reduced FVC with a preserved or raised FEV1/FVC ratio indicates a restrictive pattern, in which lung volumes are reduced but airflow is not obstructed. Clubbing with basal crackles suggests interstitial lung disease as the cause.

Question 36Pernapasan

A 45-year-old man has haemoptysis, weight loss and a cavitating upper lobe lesion on chest radiograph. He has a history of homelessness and alcohol misuse. Which is the most likely diagnosis?

  1. Primary spontaneous pneumothorax
  2. Pulmonary embolism
  3. Pulmonary tuberculosis Correct answer.
  4. Acute bronchitis

Explanation

Haemoptysis, weight loss and upper lobe cavitation in a patient with social risk factors strongly suggest pulmonary tuberculosis. Sputum examination for acid-fast bacilli and culture are required to confirm the diagnosis.

Question 37Gastrointestinal, Hepatobilier, dan Pankreas

A 45-year-old man has burning retrosternal pain and regurgitation that worsen after meals and when lying down. He has no dysphagia or weight loss. Which single investigation is most appropriate to confirm the diagnosis?

  1. Barium swallow
  2. 24-hour ambulatory oesophageal pH monitoring Correct answer.
  3. Upper gastrointestinal endoscopy
  4. Oesophageal manometry

Explanation

Typical reflux symptoms without alarm features can be diagnosed clinically, but objective confirmation of pathological acid exposure is obtained with ambulatory pH monitoring, ideally after endoscopy has excluded mucosal disease. Endoscopy is used first when alarm features or complications are suspected.

Question 38Gastrointestinal, Hepatobilier, dan Pankreas

A 58-year-old man with long-standing gastro-oesophageal reflux disease develops progressive dysphagia and unintentional weight loss. Which diagnosis must be excluded first?

  1. Achalasia
  2. Eosinophilic oesophagitis
  3. Diffuse oesophageal spasm
  4. Oesophageal adenocarcinoma Correct answer.

Explanation

New progressive dysphagia with weight loss in a patient with chronic reflux is a red flag for oesophageal malignancy, and Barrett's oesophagus is the main predisposing lesion. Urgent endoscopy with biopsy is required.

Question 39Gastrointestinal, Hepatobilier, dan Pankreas

A 32-year-old woman has intermittent dysphagia to both solids and liquids, and a barium swallow shows a smooth tapering 'bird-beak' narrowing at the lower oesophagus. Which finding on manometry is expected?

  1. Absent peristalsis with failure of lower oesophageal sphincter relaxation Correct answer.
  2. Hypertensive peristaltic contractions with normal sphincter relaxation
  3. Premature contractions in the proximal oesophagus only
  4. Normal peristalsis with a hypotensive lower oesophageal sphincter

Explanation

Achalasia is characterised by loss of oesophageal body peristalsis and failure of the lower oesophageal sphincter to relax, reflecting loss of inhibitory ganglion cells. The bird-beak appearance on barium reflects the non-relaxing sphincter.

Question 40Gastrointestinal, Hepatobilier, dan Pankreas

A 28-year-old man presents with sudden severe epigastric pain radiating to the back, and serum lipase is more than three times the upper limit of normal. What is the most common cause of this condition in the UK?

  1. Hypertriglyceridaemia
  2. Alcohol excess
  3. Gallstones Correct answer.
  4. Endoscopic retrograde cholangiopancreatography

Explanation

Acute pancreatitis is diagnosed by two of three criteria: characteristic pain, enzyme elevation above three times normal, and imaging. Gallstones and alcohol are the two leading causes, and gallstones are the most common overall.

Question 41Gastrointestinal, Hepatobilier, dan Pankreas

A 60-year-old man with acute gallstone pancreatitis has a serum calcium of 1.85 mmol/L and a PaO2 of 7.8 kPa on day two of admission. Which scoring system uses these parameters to predict severity?

  1. Rockall score
  2. MELD score
  3. Child-Pugh score
  4. Ranson criteria Correct answer.

Explanation

The Ranson criteria and the modified Glasgow (Imrie) score use early physiological and biochemical derangements, including hypocalcaemia and hypoxaemia, to stratify severity of acute pancreatitis. Persistent organ failure beyond 48 hours defines severe disease under the revised Atlanta classification.

Question 42Gastrointestinal, Hepatobilier, dan Pankreas

A 52-year-old woman with recurrent biliary colic undergoes cholecystectomy. A stone is found impacted in the gallbladder neck, compressing the common hepatic duct and causing jaundice. What is the name of this syndrome?

  1. Courvoisier law
  2. Mirizzi syndrome Correct answer.
  3. Bouveret syndrome
  4. Charcot triad

Explanation

Mirizzi syndrome occurs when a stone impacted in the cystic duct or gallbladder neck compresses the adjacent common hepatic duct, producing obstructive jaundice. It is important to identify before surgery because of the risk of bile duct injury.

Question 43Gastrointestinal, Hepatobilier, dan Pankreas

A 70-year-old woman has fever, jaundice and right upper quadrant pain, with a heart rate of 110/min and blood pressure of 90/60 mmHg. What is the most appropriate immediate management alongside resuscitation and antibiotics?

  1. Oral ursodeoxycholic acid
  2. Urgent biliary drainage by ERCP Correct answer.
  3. Elective laparoscopic cholecystectomy in six weeks
  4. Percutaneous cholecystostomy

Explanation

This is acute cholangitis with sepsis (Reynolds pentad), which requires resuscitation, broad-spectrum antibiotics and urgent decompression of the infected biliary tree. Endoscopic biliary drainage by ERCP is the first-line drainage method.

Question 44Gastrointestinal, Hepatobilier, dan Pankreas

A 55-year-old woman has right upper quadrant pain after fatty meals and an ultrasound shows multiple gallstones with a normal common bile duct. She has no fever or jaundice. What is the best definitive treatment?

  1. Extracorporeal shockwave lithotripsy
  2. Long-term low-fat diet alone
  3. ERCP with sphincterotomy
  4. Laparoscopic cholecystectomy Correct answer.

Explanation

Symptomatic gallstones are best treated definitively by laparoscopic cholecystectomy, which removes the stone-forming organ and prevents recurrence and complications. ERCP is reserved for ductal stones or obstruction.

Question 45Gastrointestinal, Hepatobilier, dan Pankreas

A 68-year-old man has painless progressive jaundice, a palpable non-tender gallbladder and weight loss. Which investigation is most likely to identify a pancreatic head tumour?

  1. Serum amylase
  2. Plain abdominal radiograph
  3. Contrast-enhanced computed tomography of the pancreas Correct answer.
  4. Abdominal ultrasound of the gallbladder only

Explanation

A painless palpable gallbladder with jaundice (Courvoisier law) suggests malignant biliary obstruction, usually a pancreatic head or periampullary tumour. Contrast-enhanced CT with a pancreatic protocol is the standard for detection, staging and assessment of vascular involvement.

Question 46Gastrointestinal, Hepatobilier, dan Pankreas

A 40-year-old man has recurrent epigastric pain, steatorrhoea and new-onset diabetes. Imaging shows calcification within the pancreatic gland. What is the most likely diagnosis?

  1. Acute pancreatitis
  2. Pancreatic adenocarcinoma
  3. Autoimmune pancreatitis
  4. Chronic pancreatitis Correct answer.

Explanation

Chronic pancreatitis causes irreversible inflammation and fibrosis, producing chronic pain, exocrine insufficiency with steatorrhoea, endocrine failure with diabetes and pancreatic calcification. Alcohol is the commonest cause.

Question 47Gastrointestinal, Hepatobilier, dan Pankreas

A 50-year-old man with alcohol-related chronic pancreatitis has steatorrhoea and weight loss despite adequate diet. Which treatment is most appropriate?

  1. Pancreatic enzyme replacement with meals Correct answer.
  2. Cholestyramine
  3. High-dose proton pump inhibitor alone
  4. Oral iron supplementation

Explanation

Exocrine pancreatic insufficiency causes fat malabsorption and steatorrhoea, treated with pancreatic enzyme replacement taken with meals. Dose is titrated to symptom control and fat absorption.

Question 48Gastrointestinal, Hepatobilier, dan Pankreas

A 30-year-old woman has a 20 mm gallstone visible on ultrasound and a normal common bile duct. She remains asymptomatic. What is the most appropriate management?

  1. ERCP
  2. Laparoscopic cholecystectomy
  3. Conservative management with advice to seek help if symptoms develop Correct answer.
  4. Ursodeoxycholic acid

Explanation

Asymptomatic gallstones generally do not require intervention because the risk of complications is low and does not outweigh surgical risk. Patients are advised to report symptoms such as biliary colic or jaundice.

Question 49Gastrointestinal, Hepatobilier, dan Pankreas

A 62-year-old man has a 3 cm hepatic mass on ultrasound and a raised alpha-fetoprotein. He has a history of hepatitis B cirrhosis. What is the most likely diagnosis?

  1. Pyogenic liver abscess
  2. Hepatocellular carcinoma Correct answer.
  3. Focal nodular hyperplasia
  4. Hepatic haemangioma

Explanation

A new liver mass in a cirrhotic liver with a markedly raised alpha-fetoprotein strongly suggests hepatocellular carcinoma, and surveillance is recommended in at-risk patients. Diagnosis is often made on characteristic multiphasic imaging without biopsy.

Question 50Gastrointestinal, Hepatobilier, dan Pankreas

A 48-year-old man with chronic hepatitis C and cirrhosis has ascites. Which regimen is recommended for initial ascites control?

  1. Intravenous albumin alone
  2. Spironolactone with furosemide Correct answer.
  3. Furosemide alone
  4. Spironolactone alone

Explanation

Ascites in cirrhosis is managed with dietary sodium restriction and a combination of an aldosterone antagonist with a loop diuretic, titrated to weight loss and renal function. Combined therapy is more effective than either agent alone.