2020 Paper Path Flashcards by Verity Loake

Which type of necrosis is associated with a MI?

c) Coagulative necrosis

How well did you know this?

Not at all

Perfectly

25 year old with acute leukaemia requires an allogeneic haematopoietic stem cell transplant. She is mixed Afro-Carribean and European heritage, and has one sibling. What is the chance of the sibling being HLA identical?

1:4

How well did you know this?

Not at all

Perfectly

Which of the following decreases during pregnancy?
a) Von Willebrand factor
b) Protein S
c) Plasminogen activator inhibitor 1
d) Fibrinogen
e) Factor VIII

Protein S

How well did you know this?

Not at all

Perfectly

In obstetric practice, the maximum risk of fatal maternal thrombo-embolism occurs at which stage of pregnancy?

Post partum

How well did you know this?

Not at all

Perfectly

93) Acute GvHD post-allogenic haematopoietic stem cell transplant is mediated by which cell type?

Donor T cells

How well did you know this?

Not at all

Perfectly

55 year old man started on therapy with DOAC rivaroxaban. What advice would you give regarding monitoring whilst on treatment?

No monitoring required

How well did you know this?

Not at all

Perfectly

75 year old woman has neutropenic sepsis secondary to myelodysplasia. Her blood count is lower than it was 6 weeks ago, with marked panyctopaenia. Blood film shows numerous large cells of primitive appearance. What is the likely explanation?

Progression to AML

How well did you know this?

Not at all

Perfectly

55 year old male smoker, on long term frusemide. Investigations - high Hb, high Hct, normal red cell mass. Plasma volume is low. What is the most likely diagnosis?

Reactive polycythaemia (pseudo polycythaemia)

How well did you know this?

Not at all

Perfectly

Bleeding patient has prolonged APTT and PT, but normal platelet count and normal fibrinogen. What is the most suitable blood component for treatment?
a) Albumin
b) Anti-D
c) Cryoprecipitate
d) Fresh frozen plasma
e) Platelets

Fresh frozen plasma

How well did you know this?

Not at all

Perfectly

Elderly woman has fever and productive cough in GP. She has pleural rub. Spleen is not palpable, no lymphadenopathy. Her WBC is 15x10^9 with neutrophilia. The Hb concentration is slightly low and platelet count is normal. Blood film - toxic granulation, left shift. CRP is high. What is the diagnosis?
a) AML
b) Aplastic anaemia
c) CML
d) Infectious mononucleosis
e) Reactive neutrophilia

Reactive neutrophilia

How well did you know this?

Not at all

Perfectly

Describe imatinib

An ABL1 tyrosine kinase inhibitor

How well did you know this?

Not at all

Perfectly

101) Palpable lymph node in the left supraclavicular fossa in a gastric cancer patient is referred to as?

Virchow node

How well did you know this?

Not at all

Perfectly

102) What is the most common ovarian tumour?
a) Serous mucinous cystadenocarcinoma
b) Serous cystadenoma
c) Mucinous cystadenoma
d) Mucinous cystadenocarcinoma
e) Brenner tumour

Serous cystadenoma

How well did you know this?

Not at all

Perfectly

103) An extradural (epidural) haemorrhage is due to damage to which blood vessel/vascular lesion?
a) Middle meningeal artery
b) Middle cerebral artery
c) Internal carotid
d) Bridging veins
e) Berry aneurysm

Middle meningeal artery

How well did you know this?

Not at all

Perfectly

104) Which virus is associated with the development of nasopharyngeal carcinoma?
a) EBV
b) HBV
c) HHV-8
d) HPV-16
e) HCV

EBV

How well did you know this?

Not at all

Perfectly

105) Pulmonary oedema due to liver disease is an example of which type of cause of pulmonary oedema?
a) Lymphatic obstruction
b) Indirect injury to alveolar wall
c) Increased hydrostatic pressure
d) Direct injury to alveolar wall
e) Decreased osmotic pressure

Increased hydrostatic pressure

How well did you know this?

Not at all

Perfectly

106) What is the commonest cause of adult ARDS?
a) Sepsis
b) Trauma
c) Pancreatitis
d) Drug reaction
e) Aspiration

Sepsis

How well did you know this?

Not at all

Perfectly

107) Which is the commonest glial cell in the CNS?
a) Oligodendrocytes
b) Microglia
c) Ependymal cells
d) Endothelial cells
e) Astrocytes

Astrocytes

How well did you know this?

Not at all

Perfectly

108) What is the most common cause of mitral valve stenosis?
a) Systemic lupus
b) Rheumatic heart disease
c) Pulmonary hypertension
d) Infective endocarditis
e) Congenital

Rheumatic heart disease

How well did you know this?

Not at all

Perfectly

What is the inheritance of genetic haemochromatosis?

Autosomal recessive

How well did you know this?

Not at all

Perfectly

110) Which is the commonest cause of pancreatitis in adults? [Q did not specify acute or chronic]

Gallstones

How well did you know this?

Not at all

Perfectly

111) Brain tumour which most commonly occurs near the surface of the brain and is frequently asymptomatic is most likely to be?

Meningioma

How well did you know this?

Not at all

Perfectly

112) In IVDU, which valve is characteristically associated with infectious endocarditis?
a) Aortic valve
b) Prosthetic valve
c) Pulmonary valve
d) Mitral valve
e) Tricuspid valve

Tricuspid valve

How well did you know this?

Not at all

Perfectly

113) Which is the most common skin cancer?
a) Keratoacanthoma
b) Melanoma
c) Metastatic cancer
d) Squamous cell carcinoma
e) Basal cell carcinoma

Basal cell carcinoma

How well did you know this?

Not at all

Perfectly

Which of the following is NOT normally associated with a diagnosis of multiple myeloma? a) Anaemia b) Humoral immune dysfunction c) Osteolytic bone lesions d) Renal impairment e) Splenomegaly

Splenomegaly

114) 25 year man is in A&E with abdominal pain and having collapsed, he had a low blood pressure and was in shock. Blood results - low sodium, high potassium, low HCO3-, slightly high urea, high creatinine, slightly low glucose [blood gases were also listed but can’t remember them]. What is the likely diagnosis? a) Addison’s disease b) Conn’s syndrome c) Diabetic ketoacidosis d) Acute abdomen e) Cushing’s syndrome

Addison's disease

115) 25 year man is in A&E with abdo pain and having collapsed, he had a low blood pressure and was in shock. Blood results - low sodium, high potassium, low HCO3-, slightly high urea, high creatinine, slightly low glucose [blood gases were also listed but can’t remember them]. What is the cause of his electrolyte abnormalities? a) Renal loss of sodium b) Vomiting c) Renal failure d) Perforated appendix e) Dehydration

Renal loss of sodium

116) 60 year old man with BMI of 28 has abdo pain. His LFTs - high total BR, high ALP, high ALT, high AST, high GGT, high creatine kinase. What is the most likely diagnosis? a) Acute pancreatitis b) Viral hepatitis c) Alcoholic cirrhosis d) Haemolytic jaundice e) Obstructive jaundice due to gallstones

Obstructive jaundice due to gallstones

117) Which of the following can cause hypoglycaemia? a) Atorvastatin b) Bendrofluazide c) Glucagon d) Prednisolone e) Quinine

Quinine

ncreased insulin sensitivity results in low plasma glucose and occurs in which of the following? a) PCOS b) Phaeochromocytoma c) Cushing’s disease d) ACTH deficiency e) Acromegaly

ACTH deficiency

119) Which one of the following is correct in a patient with moderate alcohol intake? a) Elevated HDL b) AST is nearly normal c) Normal GGT d) Normal triglycerides e) Reduced albumin

Elevated HDL

Clinical features of hypercalcaemia include which one of the following? a) Polyuria and polydipsia b) Tetany c) Hypotension d) Diarrhoea e) Easy bruising

Polydipsia and polyuria

122) 40 year old woman has post-partum haemorrhage, unable to breastfeed. Investigations - low cortisol, low ACTH, low prolactin, normal TSH, normal T4. What is the likely diagnosis? a) Acromegaly b) Non-functioning pituitary macroadenoma c) Prolactinoma d) TSHoma e) Hypopituitarism

Hypopituitarism

123) 25 year man is in A&E with abdo pain and having collapsed, he had a low blood pressure and was in shock. Blood results - low sodium, high potassium, low HCO3-, slightly high urea, high creatinine, slightly low glucose [blood gases were also listed but can’t remember them]. What is the likely diagnosis? a) Metabolic acidosis b) Metabolic alkalosis c) Respiratory acidosis d) Respiratory alkalosis e) Compensated respiratory acidosis

Metabolic acidosis

Potassium level in metabolic alkalosis

Low

Which of the following is found in obstructive jaundice a) There is increased bilirubin in urine b) The stools are dark c) GGT is usually normal d) AST is usually normal e) ALP is usually normal

There is increased billirubin in the urine

125) Which of the following is found in haemolytic jaundice a) Bilirubin is normal b) AST is raised c) CK is raised d) The stools are pale e) There is increased urobilinogen in urine

Increased urobilinogen in urine

126) Which of the following binds to receptors in the adrenal and stimulates aldosterone release? a) Angiotensin 2 b) ACTH c) Renin d) Sodium e) Calcium

Angiotensin 2

127) 40 year old woman has a headache and bitemporal hemianopia. MRI shows 2cm pituitary macroadenoma. Investigations - normal cortisol, normal ACTH, high prolactin of 1400, normal TSH, normal T4. What is the likely diagnosis? a) Acromegaly b) Non-functioning pituitary macroadenoma c) Prolactinoma d) TSHoma e) Hypopituitarism

Non-functioning pituitary macroadenoma

128) Which type of vaccine should not given to immunosuppressed individuals a) Vaccine containing lipid adjuvant b) Toxoid c) Subunit d) Live attenuated e) Conjugate

Live attenuated

129) In a histology slide showing antibody mediated rejection of a renal allograft, where is the inflammatory infiltrate seen? a) Capillaries b) Capsule c) Interstitium d) Tubules e) Adipose tissue

Interstitium

130) Which of the following is a mixed pattern auto-inflammatory auto-immune disease characterised by sacroiliac joint inflammation a) Ankylosing spondylitis b) Osteitis condensans illi c) Osteoarthritis d) Rheumatoid arthritis e) Gout

Ankylosing spondylitis

131) Routine of a HIV patient should include testing for which leukocyte subset? a) CD8 T-cells b) CD4 T-cells c) B-cells d) Monocytes9 e) NK cells

CD4 T cells

132) Conjugate vaccine of polysaccharide and protein carrier may be used to enhance B-cell immunity to which of the following? a) HIV b) TB c) Rabies d) Streptococcus pneumoniae e) Vibrio cholerae

Streptococcus pneumoniae

133) 21-year-old woman has joint pain, rashes, fevers, pleuritic chest pain. Blood tests - high ESR, low CRP, high ANA titre, positive dsDNA antibody, low C3 level, low C4 level. What is the likely diagnosis? a) SLE b) Systemic sclerosis c) Lyme arthritis d) Granulomatosis with polyangiitis e) Dermatomyositis

SLE

Development of auto-antibodies specific for gastric parietal cells is associated with which disease? a) T1D b) Rheumatoid arthritis c) Multiple sclerosis d) Graves’ disease e) Pernicious anaemia

Pernicious anaemia

135) Gel and Coombs type III hypersensitivity is mediated by which of the following mechanisms? a) Activation of complement by antibody binding to cellular antigen b) Cytotoxic T-cell mediated cell destruction c) Activation of pre-existing IgE bound to antigen d) Deposition of antibody-antigen complexes in blood vessel walls e) Modulation of cell function by antibody binding to cell surface receptor

Deposition of antibody-antigen complexes in blood vessel walls

ailure to regulate cryopyrin driven activation of neutrophils is characteristic of which of the following diseases? a) Auto-immune lymphoproliferative syndrome (ALPS) b) Behcet’s disease c) Familial Mediterranean fever d) Microscopic polyangiitis e) Ulcerative colitis

Familial Mediterranean fever Treat with colchicine

Which of the following monoclonal antibody therapies enhances T-cell immunity and is used in management of some malignancies? a) Infliximab (anti-TNFalpha) b) Pembrolizumab (anti-PD1) c) Rituximab (anti-CD20) d) Tocilizumab (anti-IL6R) e) Ustekinumab (anti-IL12/23)

Pembrolizumab (anti-PD1)

138) Which one of the following agents is effective as a biological disease modifying anti-rheumatic drug (b-DMARD) as part of rheumatoid arthritis management? a) Adalimumab (anti-TNFalpha) b) Basiliximab (anti-CD25) c) Denosumab (anti-RANKL) d) Pembrolizumab (anti-PD1) e) Secukinumab (anti-IL17A)

Adalimumab

139) Which one of the following is a standard immunosuppressive regimen for patients who received an allograft? a) Azathioprine, mycophenolate mofetil, prednisolone b) Cyclophosphamide, methotrexate, rituximab c) Cyclosporine, rapamycin, tacrolimus d) Mycophenolate mofetil, prednisolone, tacrolimus

Mycophenolate mofetil, prednisolone, tacrolimus

140) Which of the following exists in an immature form in the periphery where they recognise pathogens, and then mature and become adapted for presenting antigen to T-cells in lymph nodes a) B-cells b) Dendritic cells c) Eosinophils d) Erythrocytes e) Plasma cells

Dendritic cells CCR7 is an important cytokine in trafficking DCs

141) Which of the following immune-mediated diseases may respond to treatment with plasmapheresis? a) Ankylosing spondylitis b) Goodpasture syndrome c) IgA vasculitis d) Sjogren’s syndrome e) Takayasu’s arteritis

Goodpasture syndrome

142) 72-year-old man is a close household contact of someone recently diagnosed with smear positive pulmonary TB. What is his lifetime risk of developing TB? a) 0.1% b) 1% c) 10% d) 50% e) 90%

10%

143) 72 year old man has returned from a 7 day holiday in Italy. He has signs of pneumonia and Legionella urinary antigen is positive. Which of the following antibacterials is the most appropriate initial therapy? a) Azithromycin b) Amoxicillin c) Ceftriaxone d) Co-trimoxazole e) Meropenem

Azithromycin

What type of pneumonia can be picked up by urinary antigen testing?

Legionella

144) Which hepatitis virus is associated with more severe disease if acquired in pregnancy potentially leading to fulminant hepatic failure and death? a) Hepatitis A b) Hepatitis B c) Hepatitis C d) Hepatitis D e) Hepatitis E

Hepatitis E

145) Which of the following serological tests is useful in the diagnosis of invasive Candida albicans infections? a) Beta-D-Glucan b) Galactomannan c) RFR d) TPPA e) Widal test

Galactomannan

146) Infants under 12 months should not be fed honey due to an increased risk of food poisoning caused which of the following organisms? a) Campylobacter jejuni b) Clostridium botulinum c) Escherichia coli 0157 d) Salmonella typhi e) Vibrio cholerae

Clostridium botulinum

147) 45 year old woman has 2-day history of fever and headache. She returned 5 days ago from a 2 week visit to Ghana. She initially thought she had a cold but her partner brought her in as she is now drowsy and confused. GCS is 11, temperature is 39.1 degrees, HR is 108 bpm, BP is 90/60. Malaria rapid diagnostic test is positive and parasitemia is 10%. Which of the following is the most appropriate initial antimalarial therapy? a) IV artesunate b) IV quinine c) Oral artemether and lumefantrine d) Oral atovaquone and proguanil e) Oral mefloquine

IV artesunate

148) Which of the following antivirals is used for chronic hepatitis B treatment? a) Aciclovir b) Oseltamivir c) Tenofovir d) Zanamivir e) Ribavirin

Tenofovir

149) Streptobacillus moniliformis is the causative organism of which of the following infections? a) Bacillary angiomatosis b) Lyme disease c) Q fever d) Rat bite fever e) Syphilis

Rat bite fever

150) What is the commonest form of prion disease? a) Fatal familial insomnia b) Iatrogenic Creutzfeldt-Jakob disease c) Kuru d) Sporadic Creutzfeldt-Jakob disease e) Variant Creutzfeldt-Jakob disease

Sporadic Creutzfeld-Jakob disease

Middle aged man has pruritus, and has an emergency thrombotic cerebrovascular accident. He has a high Hb, and JAK2 V617F mutation. What is the likely diagnosis?

Polycythaemia vera

Fatigue and mild jaundice, has spherocytes on blood film. Coombs test positive. Likely diagnosis?

Autoimmune haemolytic anaemia

Which coagulation factor falls most rapidly after starting warfarin?

What factors does warfarin inhibit?

2,7,9,10

Young woman requires therapeutic anticoagulation during the 1st trimester of pregnancy. Which anticoagulant should be given?

Low molecular weight heparin

Imatinib is used for what leukaemia?

Chronic myeloid leukaemia

Man has fatigue and back pain. Blood results show - high creatinine, low IgG, low IgM, no paraprotein detected (via electrophoresis), low serum kappa light chains, high lamda light chains, low kappa/lamda ratio. What is the likely diagnosis?

Amyloidosis

Woman has chest pain, SOB, persistent swelling in neck. Large mass in supraclavicular fossa is biopsied - malignant cells with reactive fibrosis and high eosinophils [exact pictures below were included in question]. What is the likely diagnosis?

Hodgkin lymphoma (look for reed sternberg cells, which have more than one nucleus)

Pregnant women given misoprostol to induce labour. She suddenly has severe shivers, clammy skin, vomiting. Observations - high HR, low BP. Blood results - INR of 1.9, high APTT, low fibrinogen, high D-dimers. What is the most likely obstetric event?

DIC

At what temperature can platelet transfusions be stored?

Room temperature - most likely to have microbes in

Pregnant women has amniocentesis, she is group O-ve. What therapeutic intervention is required?

Anti-D

Woman is group A-ve. She has had two previous pregnancies. What naturally occurring antibody will be present in her blood?

Anti-B

Infants with sickle cell disease (HbSS) may have splenic sequestration. Why does this not occur before 3 months of age?

Newborns have high levels of protective fetal hemoglobin

Venetoclax is a BCL2 inhibitor used in CLL. What cellular process does it affect?

Inhibits anti apoptotic proteins

Old woman with painless lymphadenopathy. Blood results - normal Hb, normal neutrophils, normal platelets, high lymphocytes. Smear cells present. Lymphocytes are CD5+ve and CD19+ve.

CLL

Man has returned from India. Whilst abroad, he has malaise and jaundice which self-resolved. He now has fatigue and easy bruising. Blood results - low Hb, normal MCV, low reticulocytes, low WCC, low neutrophils, normal lymphocytes, low platelets. What is the likely diagnosis?

Aplastic anaemia due to malarial infection

Commonest primary tumour of the heart?

Atrial myxoma

Most likely cause of mobile mass in young woman’s breast?

Fibroadenoma

Commonest histological type of primary malignant breast cancer?

Invasive ductal carcinoma

What type of emphysema is associated with smoking

Centriacinar emphysema

What is the commonest cause of constrictive pericarditis in the developing world?

What is the most common cause of nephrotic syndrome in adults that is a glomerular pathology

Focal segmental glomerular sclerosis

What is the commonest cause of portal vein thrombosis?

Cirrhosis

Which organism that causes pneumonia and bloody sputum that is associated with alcoholics and diabetics?

Klebsiella pneumoniae

A dysgerminoma is a type of tumour that affects the ovary. What is the equivalent tumour type in the testes?

Seminoma

What is the most common histological type of oesophageal cancer in the UK?

Adenocarcioma. Rest of world = SCC

Intestinal metaplasia in Barrett’s (columnar-lined) oesophagus is most commonly due to the presence of which cell?

Goblet cells

Which vascular tumour is associated with infection by HHV8

Kaposi sarcoma

What is the commonest cause of myocarditis?

Viruses eg. influenza

Raised AMA antibodies are characteristic of which liver disease?

Primary biliary cirrhosis

What condition are anti-smooth muscle antibodies associated with?

autoimmune hepatitis

Which virus characteristically causes encephalitis involving the temporal lobes?

Herpes simplex virus 1 (HSV 1)

What is the most common cause of hypocalcaemia in the community?

Hypoalbuminaemia

Which liver enzyme can be measured in the blood and specifically suggests obstructive jaundice if levels are raised?

Alkaline phosphatase

Addison’s patient is admitted in adrenal crisis. Her BP is low. What fluid should be given?

IV 0.9% saline

Which adrenal zone produces cortisol?

Fasciculata

Which adrenal zone produces aldosterone?

Glomerulosa

Which adrenal zone produces androgens?

Reticularis

What does the adrenal medulla produce?

Catecholamines - adrenaline and noradrenaline

Woman has neck pain, which radiates to the upper neck and jaw. Pain is worse on swallowing. She has PMHx of URTI two weeks ago. Investigations - high T4, high T3, low TSH. Technetium scanning of thyroid shows low uptake. What is the likely cause of hyperthyroidism?

De Quervain's/viral thyroiditis

What condition occurs in both MEN1 and MEN2a?

Parathyroid adenoma/hyperplasia

What enzyme does allopurinol inhibit?

Xanthine oxidase

What vitamin deficiency causes pellagra?

Vitamin B3 (nicacin) Dementia, dermatitis, Beads around the neck

Which hormone increases urinary phosphate excretion?

Parathyroid hormone

Alcoholic has severe abdominal pain, rigid abdomen - he has acute pancreatitis. What blood test will confirm the diagnosis?

Amylase

What active enzyme in sarcoidosis patients causes hypercalcaemia?

1-alpha hydroxylase

What is the commonest cause of hypercalcaemia in the community?

Parathyroid adenoma

What hormone is produced by fat cells, and has receptors in the hypothalamus?

Leptin

Deficiency of which plasma protein occurs in patients with liver disease and a movement disorder?

Caeruloplasmin

Patient has hypertension. Blood results - normal sodium, low potassium, normal urea, normal creatinine, raised aldosterone, renin suppressed. What is the diagnosis?

Conn's

Patient has hypertension. Blood results - normal sodium, low potassium, normal urea, normal creatinine, raised aldosterone, renin high. What is the diagnosis?

Renal artery stenosis

Chronic infection in CF?

Chronic infection with Burkholderia cepacia is an important CF-specific contraindication to lung transplantation

What is the name for a fully differentiated B-cell that produces antibody?

Plasma cell

What condition involves the upper and lower airways and kidneys, and is ANCA positive with cytoplasmic staining and is specific for proteinase 3?

Wegener's glomerulonephritis/ Granulomatosis with Polyangiitis

Which condition is caused by reactivation of human polyoma virus 2 (John Cunningham (JC) virus) in immunosuppressed people?

Progressive multifocal leukcoencephalopathy

Which drug should be given as an immediate IM injection to an individual presenting with acute anaphylaxis?

Adrenaline

Patient has periodic fevers and is found to have a mutation in MEFV. What is the condition?

Familial mediterranean fever

A woman has Graves’ disease. What antibody should be tested?

Anti-TSH receptor antibodies

Doctors should measure the level/activity of which enzyme before prescribing azathioprine?

Thiopurine methyltransferase (TPMT)

Child with recurrent bacterial and fungal infections. A dihydrorhodamine test shows that neutrophils fail to oxidise dihydrorhodamine. What is the likely diagnosis?

Chronic granulomatous disease

64) Which isotype of antibody is involved in allergies to food and insect venom?

IgE

5 month baby has failure to thrive and recurrent infections. Investigations - mutation affecting IL2RG gene, which encdoes IL2 common gamma chain. What is the diagnosis?

SCID

CAR T-cells are engineered to bind to CD19. They have immunoglobulin variable fragments to CD19 linked to cytoplasmic T-cell activation domains. They are effective in treating haem malignancies of which cell type?

B cell leukaemias

In bare lymphocyte syndrome which affects the HLA class II transactivator, which type of immune cell will be deficient?

CD4 T cells

68) Mutation of CD40 ligand is associated with which form of primary immunodeficiency?

Hyper IgM syndrome

Denosumab is a monoclonal antibody specific for RANKL. What condition is it used to treat?

Osteoporosis

Woman with iron deficiency anaemia is found to have IgA antibodies specific for tissue transglutaminase. What is the underlying condition?

Coeliac disease

Which class of antibiotics has concentration dependent killing (i.e. the goal of therapy is to maximise peak > MIC)

Aminoglycosides

Man has recently returned from trip to India, has high fever and abdominal pain but no diarrhoea. His blood cultures - gram-ve bacilli. Malaria rapid diagnostic test is -ve. What is the most appropriate antibiotic therapy?

IV ceftriaxone then PO azithromycin (assuming its typhoid)

What feature of the MMR vaccine makes it contra-indicated in pregnancy?

Live atenuated

Elderly woman has 24 hour history of headache, confusion, photophobia, fever. Gram stain of CSF shows gram+ve rods. What is the causative organism?

Listeria monocytogenes

75) Which human herpes virus is associated with post transplant lymphoproliferative disorder?

Epstein Barr Virus

This vaccine preventable disease causes headache, fever, parotid swelling (unilateral or bilateral). Complications include epididymo-orchitis in postpubertal males and more rarely meningitis. What is the causative organism?

Mumps virus

Woman has hot, swollen and painful left knee. Gram stain of joint aspirate - gram +ve cocci in clusters. Patient has no drug allergies and MRSA screen is -ve. What narrow spectrum antibiotic is indicated?

Flucloxacillin

Elderly woman has type 6 stool which is green and mucoid. She is on the 6th day of IV ceftriaxone. What is the likely causative organism?

Clostridium difficile

Patient receiving chemotherapy for leukaemia. She has prolonged neutropenia and ongoing fever, raised inflammatory markers despite broad antibacterial therapy with meropenem and amikacin. CT scan shows multiple nodules with surrounding hypo-attenuation (halo sign). What is the most likely organism?

Aspergillus fumigatus

Halo sign on CT?

Aspergillus fumigatus

Young woman has severe headache, neck stiffness, fever. She is HIV+ve but is poorly compliant with medication, does not attend her appointments. She has yeasts in her CSF. What is the causative organism?

Cryptococcus neoformans

Aid worker returns from camp in Yemen. He has profuse watery diarrhoea, which looks like water rice has been cooked in. He is very dehydrated. What is the likely cause of his diarrhoea?

Vibrio cholerae

Infection with which virus in the first 20 weeks of pregnancy causes hydrops fetalis?

Parvovirus B19

Poorly controlled person with T2DM has headache, sinus pain, periorbital oedema and orbital cellulitis. His symptoms have progressed rapidly. He has purulent discharge from his nose. ENT surgeons bring him to theatre as an emergency. What antifungal therapy should be started ASAP?

Amphotericin B

4 year old goes on school trip to petting farm, later has bloody diarrhoea and HUS. What is the causative organism?

E-coli 0157:H7

Young man has headache, neck stiffness and photophobia. He was not confused, did not have features of encephalitis. HSV1 was detected on PCR of CSF obtained from LP. What antiviral should be given?

Aciclovir

3) Rank cancers as cause of death in UK men according to frequency with (1) being the most common a) Lung b) Colon c) Head and Neck d) Breast e) Prostate

Lung (1) Prostate (2) Colon(3) Head and Neck(4) Breast (5)

Describe the blood results in myelofibrosis

Normally anaemia. High WBC and platelets at time of presentation. Leucoerythroblastic blood film (tear drop cells).

In severe bleeding, maintain the platelet count above what?

Above 50 x 109/l.

In patients with multiple trauma, traumatic brain injury or spontaneous intracerebral haemorrhage maintain the platelet count above what level?

Above 100 x 109/l (2C)

In patients with bleeding that is not considered severe or life-threatening, consider platelet transfusion if the platelet count is below what level?

Below 30 x 109/l (2C)

Which joints are spared in RA?

RA spares the distal interpharangeal joints (DIPs) and the spine with the exception of the cervical spine

What is Onycholysis?

When your nail separates from its nail bed. Seen in psoriasis.

What bleeds in a subdural haematoma?

Bridging veins

Treatment for Wilson's disease?

Penicillamine