单选题 62- year- old woman is sent to the Gastroenterology Clinic for review. Her medical history of note includes ulcerative colitis and prolonged use of oral ketoconazole for recurrent nail- bed infections. On examination in the clinic she is jaundiced and has two- finger- breadth hepatomegaly. Biochemistry results show: bilirubin 260 μmol/l (normal range 1-22 μmol/l), alanine aminotransferase (ALT) of 410 U/l (5-35 U/l) and a non- specific increase in globulin levels. You note that her LFTs were normal 1 year earlier. Autoantibody screen reveals anti- LKM2 antibodies. What diagnosis fits best with this clinical picture?

单选题 19- year- old patient comes to the gastroenterology clinic complaining of bloating, weight loss and diarrhoea. She has no other significant medical history. Her symptoms are partially eased when she goes on a gluten- free diet. Her coeliac screen was borderline. She is very reluctant to consume gluten for the purposes of a gastroscopy and duodenal biopsy, because she is worried about coping with her symptoms during work. Which of the following tests can exclude coeliac disease and thus avoid the need for an unnecessary gastroscopy?

单选题 Which of the following is the most likely diagnosis?

单选题 Which of these findings is most indicative of an upper GI bleed?

单选题 66- year- old woman with a history of chronic liver disease, secondary to autoimmune hepatitis, presents with abdominal pain and confusion. She denies any vomiting or diarrhoea. On examination, her temperature is 38.0°C, BP is 110/60 mmHg and pulse is 94/min and regular. Her abdomen is distended, with evidence of shifting dullness. It is soft, with generalised tenderness. A PR reveals an empty rectum. She scores 7/10 on the abbreviated mental test. Investigations reveal: Haemoglobin 10.1 g/dl (11.5-15.5), WCC 12.3 × 10^9/l (4-11), Platelets 198 × 10^9/l (150-400), Sodium 137 mmol/l (135-145), Potassium 4.9 mmol/l (3.5-5.0), Creatinine 540 μmol/l (50-120), Bilirubin 45 μmol/l (2-17), CRP 189 mg/l (0-10). Which is the next best step in management?

单选题 34 - year - old man with a history of ulcerative colitis attends the Emergency Department. He was started on high - dose oral corticosteroids in the gastroenterology clinic 3 days earlier because he was opening his bowels 6 - 10 times per day with bloody diarrhoea. His symptoms have not improved; if anything his abdomen is more distended and there has been no difference in his bowel frequency. Examination reveals a BP of 105/70 mmHg, his pulse is 95/min and regular, and temperature is elevated at 38.2°C. His abdomen is distended and diffusely tender, and he has active bowel sounds. Investigations show: Haemoglobin 10.9 g/dl (13.5 - 17.5), WCC 13.2 × 10^9/l (4 - 11), Platelets 550 × 10^9/l (150 - 400), Sodium 137 mmol/l (135 - 145), Potassium 3.3 mmol/l (3.5 - 5.0), Creatinine 132 μmol/l (50 - 120), Urea 10.2 mmol/l (2.5 - 6.5), ESR 85 mm/1st hour (0 - 10). Which of the following is the most important next investigation?

单选题 22 - year - old patient presents to the Emergency Department with fatigue and jaundice. She has suffered from increasing nausea and flu - like symptoms over the past few days, with darkening of her urine, and now feels unable to eat. She has recently travelled to Mexico and admits to previous use of IV heroin. She is a non - smoker. Her only medication of note is the combined oral contraceptive pill. On examination she is icteric, temperature is 37.5°C, BP is 105/70 mmHg and pulse is 75/min and regular. Her abdomen is soft, although she is tender in the right upper quadrant. Investigations show: Haemoglobin 13.1 g/dl (11.5 - 15.5), WCC 11.9 × 10^9/l (4 - 11), Platelets 199 × 10^9/l (150 - 400), Sodium 137 mmol/l (135 - 145), Potassium 4.9 mmol/l (3.5 - 5.0), Creatinine 110 μmol/l (50 - 120), ALT 1210 IU/l (5 - 30), Bilirubin 85 μmol/l (2 - 17), Alkaline Phosphatase 295 IU/l (30 - 130), Anti HBs IgG Positive, Anti HBc IgG Positive, HB - e antigen Negative, Anti - Hep A IgM Positive, Anti - HCV IgG HCV RNA Positive: O viral copies/ml. Which of the following is the most likely diagnosis?

单选题 12- year- old girl is admitted to the Emergency Department complaining of lethargy, headaches, bloody diarrhoea and, most recently, easy bruising over the past few days. She is usually completely well and the only history of note is that she visited a petting farm with her younger sister a few days earlier. She takes no regular medication. Her temperature is 38.2°C, BP is 142/82 mmHg, and pulse is 95/min and regular. She has bruising over her arms and legs and small petechial haemorrhages. Her abdomen is soft, although is generally tender. Investigations show: Haemoglobin 9.8 g/dl (11.5-15.5), WCC 13.2 × 10^9/l (4-11), Platelets 67 × 10^9/l (150-400), Sodium 138 mmol/l (135-145), Potassium 5.3 mmol/l (3.5-5.0), Creatinine 213 μmol/l (50-120), CRP 230 mg/l (0-10). What would you expect to see on the blood film?

单选题 Which of the following is the correct next investigation?