MEDICINE: PRACTICE 11

                         SINGLE BEST OPTION SERIES
         INSTRUCTION: SELECT THE SINGLE BEST OPTION

1.        The following are usual about the pains from pyogenic liver abscess except?
   a.       The pain is always in the right hypochondrium
   b.      The pain may be pleuritic in nature
   c.       The pain may radiate to the right shoulder
   d.      Tenderness is elicited by gentle percussion over the organ
   e.      Abdominal pain is the commonest symptom of this abscess
   2.       Which of the following is incorrect about pyogenic liver abscess?
   
   
   a. Hepatomegaly is found in more than 50% of patients
   b.       Multiple organisms are present in it in about one-third of patients
   c.      Blood cultures are positive for the causative organism in greater than 50% of patients
   d.      Liver imaging shows about 90% or more of symptomatic abscess
   e. none of the above
   3.       The most common cause of death in pyogenic liver  abscess is:
   a.       Old age of patients
   b.      Multiple abscesses
   c.       Failure to make the diagnosis
   d.      Immunocompromise
   e.      Chronic persistent abscess
   4.       The most common cause of pyogenic liver abscess is:
   a.       Ascending infection due to biliary obstruction or contiguous spread from empyema of the gallbladder
   b.      Trauma
   c.       Mesenteric infection
   d.      Infection of liver tumour or cyst
   e.      None of the above
   5.       Which of the following is incorrect about pyogenic liver abscess?
   a.       There is need to exclude colorectal carcinoma if gut-derived organisms are involved.
   b.      Needle aspiration under ultrasound guidance confirms the diagnosis
   c.       Jaundice is usually mild but may be severe when large abscesses cause biliary obstruction
   d.      There is reduced mortality when there are multiple abscesses
   e.      Multiple abscesses are usually due to infection secondary to biliary obstruction
   6.       The most common organisms implicated in liver abscess include the following except:
   a.      E. coli
   b.      Streptococcus milleri
   c.       Bacteriodes
   d.      All of the above
   e.      None of the above
   7.       Which of the following is incorrect about the management options for pyogenic liver abscess?
   a.       Empirical treatment involve combination of ampicillin, gentamicin and metronidazole
   b.      Surgical drainage for chronic persist abscess
   c.       Associated biliary obstruction and cholangitis require biliary drainage
   d.       Aspiration or catheter drainage under ultrasound guidance is encouraged for large abscess and when the patient is not responding to antibiotics
   e.      Short duration of antibiotics is usually encouraged when the abscess is drained.
   8.       Risk factors for pyogenic liver abscess does not include:
   a.       Old age
   b.      Immunocompromise
   c.       Empyema of the gall bladder
   d.      Necrotic colorectal cancer
   e.      None of the above
   9.       Which of the following is usually inconsistent with a diagnosis of pyogenic liver abscess?
   a.       Raised right hemi-diaphragm on chest X-ray
   b.      Effusion at the base of the right lung and lung collapse
   c.       Normal serum albumin
   d.      Leucocytosis
   e.      Elevated plasma alkaline phosphatise
   10.   Which of the following is incorrect about type 1 diabetes mellitus?
   a.       There is selective beta cell destruction and severe or absolute insulin deficiency
   b.      More than 50% of patients have a positive family history
   c.       Most patients are younger than 30 years of age at the time of diagnosis
   d.      The incidence is in people from Northern Europe and from Sardinia
   e.      The cause may either be immune or idiopathic
   
   
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