521. Oesophageal varices
A. occur in one third of all cirrhotic patients.
B. account for more than 50% of episodes of haem ate me sis.
C. are most often associated with hepatitis C cirrhosis.
D. have a 40% mortality during the first episode of rupture.
E. lie primarily in the middle portion of the oesophagus.

522. In cirrhosis
A. fibrosis is confined to delicate bands around central veins.
B. nodularity is uncommon.
C. vascular architecture is preserved.
D. the Ito cell is a major source of excess collagen.
E. the left lobe of the liver is the most affected.

523. In hepatitis B
A. acute infection causes sub-clinical disease in 65% of cases.
B. the majority of cases of persistent infection result in cirrhosis.
C. surface antigen (HBsAg) appears soon after overt disease.
D. infection does not play a role in development of hepatocellular carcinoma.
E. Anti HBs appears soon after HbsAg.

524. Hepatitis C
A. is acquired by faecal – oral transmission.
B. has it’s highest seroprevalence in haemodialysis patients.
C. transmission by sexual contact is at a high rate.
D. causes chronic hepatitis at a higher rate than does hepatitis B.
E. exposure confers effective immunity to subsequent infection.

525. Regarding pancreatitis
A. the second most common cause is infectious agents.
B. trypsin is implicated as an activator of the kinin system.
C. elastase is the only pancreatic enzyme that acts to limit pancreatitis.
D. the chronic form is usually due to gallstones.
E. duct obstruction is not the mechanism of injury in alcoholic pancreatitis.

526. In acute pancreatitis
A. fat necrosis occurs in other intra-abdominal fatty depots.
B. trauma is the precipitating cause in 30% of cases.
C. erythromycin has been implicated in severe cases.
D. kallikrein converts trypsin to activate the complement system.
E. alcohol is directly toxic to the Islets of Langerhans.

527. Type II diabetes is characterised by
A. onset in early adulthood.
B. 50% concordance in twins.
C. severe beta-cell depletion.
D. Islet cell antibodies.
E. normal or increased blood insulin.

528. In Type I diabetes
A. associated organ-specific auto-immune disorders are common.
B. a genetic susceptibility is not supported by evidence.
C. Finnish children have a 60-70 fold increased risk compared with Korean children.
D. Influenza and varicella viruses are suspected as initiators of the disease.
E. children who ingest cows’ milk early in life have a lower incidence.

529. Concerning acute tubular necrosis
A. ischaemic tubular necrosis is uncommon after haemorrhagic shock.
B. rhabdomolysis is not a cause.
C. casts are found in the loop of Henle.
D. nephrotoxic causes are associated with a poor prognosis.
E. cephalosporins are not a causative agent.

530. In pyelonephritis
A. ureteral obstruction makes haematogenous infection less likely.
B. ureteral obstruction allows bacteria to ascend the ureter into the pelvis.
C. 85% of infections are caused by G-ve faecal flora.
D. infection is less likely during pregnancy.
E. papillary necrosis and perinephric abscess are common sequelae.

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