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Path Mega Deck > Difficult Past Questions > Flashcards

Difficult Past Questions Flashcards

1
Q

How to monitor activity of SLE

A

C3 and C4 levels

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2
Q

Biologic in psoriasis

A

Ustekinemab (also anti-TNF if psoriatic arthritis)

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3
Q

DMARD for Wegener’s

A

Cyclophosphamide

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4
Q

Biologic for Chronic Granulomatous Disease

A

IFN-gamma

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5
Q

Non-neutralising antibodies formed against this HIV protein

A

p24

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6
Q

Deficiency in these complements increases encapsulated organisms

A

C5-9

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7
Q

Patient involved in trauma and transfused with O negative blood –> he lost consciousness a few minutes after the transfusion

A

Splenic Haemorrhage (NOT ABO as O-ve!!)

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8
Q

Antithrombin III deficiency

A

VTE runs in family

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9
Q

Normal Hb with positive sickle solubility test

A

Sickle trait

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10
Q

Diagnosis of C. diff

A

Toxin ELISA (not culture)

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11
Q

STI that can cross placenta in 3rd trimester

A

Syphillis

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12
Q

Bloody discharge from nipple –> mammogram does not show any lesions

A

Intraductal Papilloma

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13
Q

Thyroid cancer associated with Ret mutation

A

Medullary

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14
Q

Thyroid cancer associated with calcitonin staining

A

Medullary

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15
Q

Rate-limiting enzyme in haem synthesis

A

ALA synthase

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16
Q

Raised calcium and normal PTH

A

Primary hyperparathyroidism (inappropriately normal PTH!)

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17
Q

Definition of Impaired Glucose Tolerance

A

7.8 – 11.1mM

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18
Q

Stellate mass with fibrosis

A

Radial scar

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19
Q

Lump containing epithelium cells

A

Intraductal papilloma

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20
Q

Gene affected in FAP

A

APC gene

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21
Q

“Child presenting with a mass in abdomen”

A

Wilm’s Tumour

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22
Q

What are seen in Haversian lacunae?

A

Osteocytes

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23
Q

Smoker with raised parathyroid-related polypeptide

A

Squamous Cell

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24
Q

Investigation for hypotonia and hypoglycaemia in young child

A

Ketones

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25
Q

Oedema – pic shows red cell casts

A

Acute glomerulonephritis

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26
Q

Hypoglycaemia in neonates

A

<2.5

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27
Q

Hypothyroid –> confused/drowsy

A

Myxoedema coma (too hypothyroid)

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28
Q

Vitamin deficient in Beri Beri

A

B1

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29
Q

Immune cells which migrate to germinal centre

A

Dendritic Cells (APCs)

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30
Q

Biologic used in ankylosing spondylitis

A

Anti-TNF –> anti-IL-17

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31
Q

Cellular-mediated rejection vs GVHD

A 
Cell-mediated = T cells against donor
GVHD = T cells against host
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32
Q

Blood product to use if you want to avoid allergic reactions (e.g. donor allergic to proteins)

A

Washed RBCs = most of plasma, platelets and WBCs removed

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33
Q

Changes in pregnancy

A

Volume 50% increase
Red cell mass increases
Hb decreases (11 minimum)
WBC increases

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34
Q

Acute Promyelocytic Leukaemia key features (including translocation)

A

t(15;17)

Responds to all-trans retinoic acid

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35
Q

Gram positive showing increased resistance to vancomycin and teicoplanin

A

Enterococcus

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36
Q

Cervicitis and discharge

A

Chlamydia

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37
Q

Normal skin pathogen with low pathogenicity

A

Staph epidermis

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38
Q

Infection where baby only affected if mum infected <20 weeks (causes hydrops fetalis)

A

Parvovirus B19

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39
Q

Infection where baby can be asymptomatic initially, but then get problems

A

Beta herpesvirus (HHV6/7)
Also toxoplasmosis
Also HIV

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40
Q

Cause of aseptic meningitis

A

90% caused by enterovirus = Coxsackie Group B and Echovirus

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41
Q

Treatment of pseudomonas

A

Ceftazidime

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42
Q

Glycopeptide used to treat MRSA

A

Vancomycin

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43
Q

DNA synthesis inhibitor used to treat Pseudomonal infections but bad against anaerobes

A

Ciprofloxacin

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44
Q

Lady with discharge, no other symptoms, and causative infection found on wet slide microscopy

A

Bacterial Vaginosis (gardnerella vaginalis)

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45
Q

Positive urinary NAAT test

A

Chlamydia

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46
Q

Neonatal meningitis, Gram positive chains

A

Group B streptococcus

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47
Q

Organism targeted by vaccine: virus that resides in pharynx and GIT - 1:100 encephalitis, 1:1000 destruction of motor neurons

A

Poliovirus

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48
Q

Organism targeted by vaccine: maculopapular rash that starts on face –> can cause encephalitis and pneumonitis

A

Measles

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49
Q

Organism targeted by vaccine: lockjaw

A

Clostridium tetani

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50
Q

Mass after acute pancreatitis

A

Pancreatic pseudocyst

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51
Q

Pancreatic mass and hypoglycaemia

A

Insulinoma

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52
Q

Pancreatic cancer which metastasises to liver

A

Tumours in the tail and the body of the pancreas

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53
Q

What deposits in kidneys in Multiple Myeloma?

A

AL amyloid

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54
Q

Barrett’s changes

A

Stratified squamous to simple columnar

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55
Q

Radiosensitive testicular cancer in young man

A

Seminoma

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56
Q

Cancer associated with chronic schisto infection

A

SCC bladder cancer

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57
Q

Deaf and bowed legs

A

Paget’s

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58
Q

Post-MI: blood aspirated from pericardium

A

Cardiac tamponande

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59
Q

Treats lymphoma and rheumatoid

A

Anti-CD20 (rituximab)

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60
Q

Used to prevent transplant rejection, by blocking T cell proliferation and activation

A

Anti-CD25 (part of IL-2Rα) = basiliximab

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61
Q

Kill of cancerous cells and are inhibited by MHC-I

A

NK Cells

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62
Q

Mutation in FAS Pathway

A

ALPS = Autoimmune Lymphoproliferative Syndrome

-lymphocytes don’t apoptose –> HIGH lymphocytes

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63
Q

Philadelphia chromosome with 70% blasts

A

AML crisis

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64
Q

Tear drop poikilocytes and Jak2 mutation

A

Myelofibrosis

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65
Q

Pregnant with platelets 100 in 3rd trimester, no other problems

A

Gestational thrombocytopenia

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66
Q

INR target in AF

A

2.5

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67
Q

INR target for treatment of VTE

A

2.5

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68
Q

INR target in prosthetic heart valve

A

2.5

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69
Q

INR target in recurrent VTE/VTE whilst on anticoags

A

3.5

70
Q

Cause of Pellagra

A

B3 deficiency –> dementia, diarrhoea, dermatitis

71
Q

A man after a road traffic accident (Man vs Car) requires a 6 unit transfusion, and then becomes acutely breathless/SOB, with a fever and tachycardia

A

Transfusion related lung injury (TRALI)

72
Q

A man has had (a diagnosis of) beta thalassemia since 13 months of age. (?and receives regular transfusions?). He presents to an outpatient clinic with malaise and erectile dysfunction

A

Transfusion associated haemosiderosis

73
Q

Immunoglobulin raised in multiple myeloma

A

IgG paraprotein

74
Q

Patient with IgM paraprotein and visual disturbances

A

Lymphoplasmocytic lymphoma (a.k.a. Waldenstrom’s macroglobinaemia).

75
Q

An overweight individual with diabetes has longstanding bone/back pain. They are found to have paraprotein IgA ~8g/dl, and GFR 55mls/min/1.73m^2. FBC normal and albumin normal.

A

Monoclonal gammopathy of unknown significance

-as IgA < 30

76
Q

An elderly gentleman has really really elevated ALP on it’s own, and the other results are normal. He also reports a history of headaches.

A

Paget’s (headaches = frontal bossing)

77
Q

Used for mild CAP caused by HiB

A

Amoxicillin

78
Q

Treatment of listeria meningitis

A

Amoxicillin 21 days + gentamycin 7 days

79
Q

Which type of cancer develops in Barrett’s?oesophagus?

A

Adenocarcinoma

80
Q

What happens to the body of the stomach in a patient with pernicious anaemia?

A

Atrophy (atrophic gastritis)

81
Q

Most common type of malignancy in the breast

A

Invasive ductal carcinoma (75% breast cancer)

82
Q

Most common type of non-invasive breast cancer

A

DCIS

83
Q

Breast cancer with E-cadherins

A

Invasive ductal carcinoma

84
Q

Breast cancer without E-cadherins

A

Invasive lobular carcinoma

85
Q

Breast cancer which has a high, medium and low stage to it.

A

Ductal carcinoma in situ

86
Q

Enzyme raised in mumps

A

Amylase-S (S for salivary glands)

87
Q

Enzyme raised in pancreatitis

A

Amylase-P (P for pancreas)

88
Q

Defiency in this enzyme leads to high urate/Lesch-Nyhan

A

HGPRT

89
Q

Best antibody for Sjogren’s

A

Anti-La (La = “the” best)

90
Q

A man presents with the symptoms of a UTI and acute onset costovertebral pain. He is found to have pus cells and blood in his urine. What is the most likely cause?

A

Acute Pyelonephritis

91
Q

Most common cause of thrombocytopenia in pregnancy

A

Gestational thrombocytopenia (70% of thrombocytopenias in pregnancy)

92
Q

Normal change in pregnancy

A

Increased fibrinogen

93
Q

Man, ex-smoker, with history of hypertension and MI, has sudden chest pain which radiates to the neck

A

Descending internal carotid thrombus

94
Q

Gram positive rod causing meningitis in a 72 year old

A

Listeria monocytogenes

95
Q

What cancer can the Bruton tyrosine kinase inhibitor ibrutinib be used in?

A

Chronic lymphoblastic leukaemia (CLL)

-imatinib is used in CML!

96
Q

A Rhesus D negative woman is having a Haematopoietic stem cell transplant (HSCT) and is CMV IgG negative. What is the most important thing to ensure in the transplant?

A

CMV IgG negative

97
Q

HIV RNA forms HIV, via which error prone enzyme?

A

Reverse transcriptase

98
Q

Which of these vaccines must not be given to a pregnant woman:

a. MMR
b. Hep B
c. DTP

A

MMR (as contains live Rubella virus)

99
Q

Cancer cells express TdT

A

ALL (this trumps genetic tests i.e. t9;22 and TdT = ALL!)

100
Q

Which of these is a common finding in someone who has portal hypertension?

a. Splenomegaly
b. Hepatomegaly
c. Spider Naevi in distribution of Superior vena cava (SVC)
d. Hand flapping
e. Jaundice

A

Splenomegaly

101
Q

Itchiness of the skin is likely to be a feature of one of the following?

a. Hepatitis
b. intravascular haemolysis

A

Hepatitis

102
Q

The wall of vessels expresses anti-thrombotic factors why is this?

a. Because it secretes Tissue factor
b. Because it secrete Thrombomodulin
c. Because it secretes Von Willebrand factor

A

Thrombomodulin (cofactor in the thrombin-induced activation of protein C in the anticoagulant pathway)

103
Q

Which vector transmits Trypanosoma brucei rhodesiense?

A

Tsetse Fly

104
Q

Which vector transmits Leishmaniasis?

A

Sandfly

105
Q

What does the number of True positives divided by the total number who have the disease describe?

A

Sensitivity

106
Q

Which of these can cause peri/neonatal illness without causing damage to the foetus if the mother is infected antenatal?

a. Cytomegalovirus (CMV)
b. Herpes Simplex Virus (HSV)
c. Enterovirus
d. Varicella Zoster Virus (VZV)
e. Rubella

A

Enterovirus

107
Q

Most common cause of HAP

A

Pseudomonas

108
Q

Which feature is characteristic of acute lymphoblastic anaemia (ALL) –

a. anaemia and thrombocytopenia
b. neutropenia
c. macrocytosis
d. raised lymphocytes

A

Neutropenia (CLL = granulocytopenia)

109
Q

Name an infectious microorganism which is a common cause of meningitis in 3 months or older new-borns?

A

Neisseria (or strep)

110
Q

Hyperthyroid - good uptake vs poor uptake

A

Good uptake = Graves

Poor uptake = De Quervain’s

111
Q

An elderly man has a fall, and doesn’t become unconscious/lose consciousness, and presents two days later with a confusion, where is the likely site of bleeding?

A

Subdural (not extradural as should have loss of conscious –> lucid –> EXTRA loss of conscious)

112
Q

Person who had negative direct coombs test but who has anaemia and jaundice

A

Paroxysmal nocturnal hemoglobinuria, MAHA, drugs

113
Q

Which clotting factor falls most rapidly after administering warfarin?

A

Factor VII (shortest half-life, then Protein C)

114
Q

Biomarker in medullary thyroid cancer

A

Calcitonin

115
Q

A patient required an aortic valve replaced 3 months ago. They have now come back a few weeks later with jaundice, haemoglobinuria, and raised reticulocytes.

A

Mechanical Haemolytic Anaemia (non-immune)

116
Q

Which common condition can be treated with drugs that target with TNF, IL-17 and IL-12/23?

A

Psoriasis

117
Q

Which vasculitis cases a disease in which a branch of the external carotid is affected?

A

Giant Cell Arteritis (affects big vessels, like aorta)

118
Q

Type of amyloidosis in multiple myeloma

A

AL amyloidosis

119
Q

Name the main class of drug used to treat HIV

A

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

120
Q

What zoonotic disease does the Ixodes Tick cause?

A

Lyme disease

121
Q

Breast cancer also known as “no specific type”

A

Invasive ductal carcinoma

122
Q

Treatment of hyperviscosity in myeloma

A

Plasmapheresis

123
Q

Treatment of hypercalcaemia in myeloma

A

Bisphosphonates

124
Q

How to monitor unfractionated heparin

A

APTT

125
Q

How to monitor LMWH

A

None needed! (as reliable pharmacokinetics)

126
Q

Soldier returning from Afghanistan has a small ulcer on right ring finger that won’t heal and keeps getting bigger

A

Cutaneous Leishmaniasis

127
Q

“Snail-trail” oral ulcer

A

Treponema pallidum (syphilis)

128
Q

Infection with abdo pain and headache but specifically NO diarrhoea

A

Salmonella typhi

129
Q

Disease that requires rapid vaccination at birth/immunoglobulins if mother is highly infectious.

A

Hepatitis B

130
Q

• Disease that require C-section if mother has an outbreak at 34wks or later due to risk of transmission vaginally

A

Genital Herpes Simplex (greatest risk is within 6 weeks of delivery)

131
Q

Immunodeficiency with common gamma chain problem

A

X-linked SCID

132
Q

Traveller’s Diarrhoea (full name, not abbreviated)

A

Enterotoxigenic E. coli

133
Q

Enzyme responsible for gout

A

Xanthine Oxidase

134
Q

Most common virus causing aseptic meningitis?

A

Enterovirus

135
Q

15yo child with brain tumour extending outwards from cerebellum and invading subarachnoid space. Signs of ataxia.

A

Medulloblastoma

136
Q

Publican with diabetes, fatty stools, weight loss, ‘slate grey skin’ and joint pains.

A

Haemachromatosis

137
Q

What is the minimum amount of time to treat a VTE?

A

3 months

138
Q

Enzyme confirms heart failure

A

Brain Natriuretic Peptide

139
Q

Liver enzyme raised in MI

A

Aspartate aminotransferase

140
Q

Lady with Multiple myeloma and restrictive cardiomyopathy. What will you see on heart biopsy?

A

AL amyloid deposition

141
Q

Previous IVDU man is given Rituximab - CHOP treatment for Non-Hodgkin’s lymphoma. He later 8 months later develops fulminant liver failure and dies. Why?

A

Hep B reactivation from Rituximab +/- Hep D co-infection

142
Q

White things on the oesophagus seen in OGD of an alcoholic man with recurrent bleeding varices.

A

Candidiasis

143
Q

Lady who went to Mexico and ate unpasteurized dairy. 4 weeks later unwell. Which gram -ve rod caused this?

A

Brucella (long incubation period)

144
Q

IBD with aphtous ulcers

A

Crohn’s

145
Q

Non-Tuberculous mycobacterium on cut on hand in a man who cleaned a fish tank

A

Mycobacterium marinum

146
Q

Test to determine cause of haemolytic anaemia

A

Direct Antiglobulin Test

147
Q

Types of oesophageal cancer

A

Developed: adenocarcinoma
Developing: SCC

148
Q

Most common gastric cancer type

A

Adenocarcinoma (90%)

149
Q

Treatment for CLL with p53 mutation

A

Ibrutinib Bruton TKI

150
Q

MAHA - DAT +ve or -ve?

A

-ve

151
Q

Electrolyte raised in red cell lysis (Na, K, Ca, bicarb…)

A

Potassium

152
Q 
What is low during pregnancy?
•	Fibrinogen
•	Factor 7 (or 8?)
•	Protein S
•	Plasminogen activator inhibitor 1
•	Von willebrand’s factor
A

Protein S (anticoagulant)

153
Q 
How does a melanoma spread?
•	Lymphoid
•	Haematological
•	Perineural
•	Iatrogenic
•	Transcoelomic
A

Lymphoid first usually

154
Q

Man has just been started on allopurinol and now has ulcers of mucus membranes

A

Stevens-Johnsons Syndrome

155
Q

Enlarging fibroepithelial mass in woman >50, potentially aggressive, can arise with pre existing fibroadenoma
o ‘Proliferation of fibroepithelium and stromal tissue’

A

Phyllodes Tumour

156
Q

Bowel polyps not associated with increased cancer risk

A

Hamartomatous

157
Q

“Optic nerve tumour excised and now lump on hand”

A

Neurofibromatosis 1 (lump = neurofibroma)

158
Q

“Epileptic with patch on back and lumps in brain”

A

Tuberous Sclerosis

159
Q

“Mass under dura mater compressing frontal lobe”

A

Meningioma

160
Q

“Ship worker with pleural plaques”

A

Asbestosis

161
Q

Causes Meig’s syndrome

A

Ovarian Fibroma

162
Q

“Thalassaemia patient who looks tanned and has diabetes”

A

Transfusion haemosiderosis

163
Q

Rheumatoid arthritis patient with mycobacterial infections

A

TNF antagonists

164
Q

Marker of antibody mediated rejection

A

C4d

165
Q

AIRE mutation

A

APS1/APECED

166
Q

Hypersensitivity type in serum sickness

A

Type III

167
Q

Hypersensitivity type in atopic dermatitis

A

Type I

168
Q

Travel vaccine not given to someone with ank spond on anti-TNF

A

Yellow Fever

169
Q

Amantadine targets this

A

M2 channel

170
Q

What vaccine type is Hep B?

A

Conjugate

Path Mega Deck (24 decks)

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