2021/2019 Path Exam PPQs Flashcards
(190 cards)
1
Q
ToF - what type of shunt?
A
Right to left shunt
2
Q
What type of section is done for urgent diagnosis during surgery?
A
Frozen section
3
Q
Which of the following vaccine is a polysaccharide and conjugate vaccine?
A
Strep pneumo
4
Q
What is one of the complications of Parvovirus B19?
A
Hydrops fetalis
5
Q
What is the first-line treatment for CML?
A
Imatinib
6
Q
Antibody for Graves
A
- stimulatory anti-TSH receptor Ab
7
Q
PCSK9 inhibitor - evolucumab, what does it halve?
A
LDL levels
8
Q
EBV serology 2 weeks post infection
A
EBV IgM
9
Q
Which disease do you see in both MEN1 and MEN2a?
A
Primary hyperparathyroidism
10
Q
How do you initially treat Malaria falciparum; 38.9 fever, hypotension, 4% parasitaemia?
A
IV artesunate
11
Q
Insulinoma. What would you find?
A
Low FFAs
12
Q
Woman, non-smoker, peripheral lung tumour, which type is it most likely to be?
A
Adenocarcinoma
13
Q
Woman with periorbital purple rash and rash on legs (dermatomyositis?), which enzyme is elevated?
A
CK
14
Q
Vitamin deficiency that causes megaloblastic anaemia & NTD?
A
Folate
15
Q
- What Type Hypersensitivity causes serum sickness?
A
Type 3
16
Q
High PTH and low Ca, what can this be?
A
Osteomalacia
17
Q
- Young gentleman brought to A&E by friends due to confusion. CSF is clear, raised lymphocytes, high protein, normal glucose. Causative organism?
A
HSV
18
Q
- Low sodium (124) and specific gravity of 1.000 cause?
A
psychogenic polydipsia
19
Q
- Neonate (2 day old) has meningitis and blood cultures isolate gram negative rods, what is the organism?
A
E.coli
20
Q
- Gram +ve cocci UTI in a woman?
A
Staphylococcus sacrophyticus
21
Q
- What would be high in most common cause of Congenital Adrenal Hyperplasia
A
ACTH
22
Q
What vaccine preventable organism causes cough, lymph node enlargement and has a potential to occlude the airway?
A
Corynebacterium diphtheriae
23
Q
- Which hormone leads to release of prolactin?
A
TRH
24
Q
Transfusion level for platelets after trauma?
A
<100
25
What is the effect of the gene mutation in familial mediterranean fever
Increased IL-1 production
26
Man with cyanotic heart disease has a haematocrit of 54% (high) and is found to be negative for JAK2 mutation. What does he have?
Secondary polycythaemia
27
Man with history of PKD has a cerebral bleed - what type?
Subarachnoid
28
What cell type is raised in the blood in schistosomiasis?
Eosinophils
29
Boy visits grandparents in Wiltshire, comes back with 5 days of diarrhoea, no vomiting, and unexplained bruises all over body
E.coli - 0157: H7
30
Mechanism of hyperacute allograft rejection
Pre-formed antibodies??
Sensitisation
31
What is common feature between MEN1 and MEN2a?
Parathyroid hyperplasia
32
Receptor mutation that could be protective in HIV?
CCR5.
33
Which is a naturally occurring cytokine that is able to inhibit HIV fusion to CD4+ T-lymphocytes?
MIP-1a?
34
2) What is done to blood donations to reduce GvHD?
Irradiation (leucodepletion)
35
3) Eczematous nipple rash caused by individual ‘malignant cells’?
Paget's disease of the breast
36
4) Cat scratch disease full name (genus and species) of bacteria:
Bartonella Henslae
37
5) What is the stain for TB:
Ziehl Nielson
38
6) Picture of pulmonary valve whats wrong with it (looked kinda like this viewed from the side- closest google could find soz)
Bicuspid (should be tricuspid)
39
7) Coeliac disease cancer?
Enteropathy associated T cell lymphoma (EATL)
40
8) VTE recurrence risk how does being male affect it?
3x increase
41
9) Smear cells, what is diagnosis?
CLL
42
10) What type of hypersensitivity (Gel and Coombs classification) is myasthenia gravis and what cell?
Type 2.
43
11) Woman on a DOAC. Advice in pregnancy. Lady with life long DOAC, has never had problems, when becomes pregnant what should you do?
Change to LMWH
44
12) Most common cause of acute pancreatitis?
Gallstones
45
13) Increased calcitonin. Type of cancer?
Medullary thyroid carcinoma
46
MEN2 medullary thyroid adenoma. What hormone would you measure?
Calcitonin
47
15) IPEX affects what type of immune cell?
T reg cell
48
16) CAH which enzyme deficiency is most common?
21-alpha hydroxylase
49
17) 2 questions with low TSH, raised T3/4 following a viral infection
Viral thyroiditis
50
Most common type of primary thyroid cancer to metastasise to lymph node?
Papillary
51
24) Lady with SLE, has spherocytes, low Hb, raised bilirubin how do you test for diagnosis?
DAT test
52
25) What is the definition of herd immunity threshold
1- (1/R0)
53
26) Name 1 of the 3 characteristics of Influenza A that could cause a pandemic?
Novel antigenicity, efficient replication in human airway, efficiency viral transmission between people
54
27) Patient is on low molecular weight heparin, what do you measure to monitor this?
Anti-Xa assay
55
28) 16 year old girl has pleuritic chest pain, joint pain, positive ANA and Anti-Sm, no liver enzyme derangement, raised ESR?
SLE
56
29) Alcoholic man is on ceftriaxone for meningitis, what organism is he at risk of which this does not cover for?
Listeria Monocytogenes
57
31) What virus increases risk of nasopharyngeal cancer?
EBV
58
32) What additional virus apart from HIV and HBV are screened for in platelet donations to pregnant women?
CMV
59
What is associated with UC?
PSC
60
34) Chimeric antigen receptor T-cell therapy against CD19: what type of haematological malignancy does it target?
B cell
61
35) Kid has low calcium, cleft palate, low T cells?
Di George syndrome
62
36) Has contact with someone with TB, what is the risk of getting active TB?
10%?
63
37) Ankylosing spondylitis - they’ve tried NSAID and TNF inhibitor?, what else can you target?
IL-17
64
38) Diffuse continuous inflammation rectal to caecal, with no granulomas
UC
65
39) 45yo woman with autoimmune diseases, low IgM, IgA and IgE; full blood count is normal?
Common variable immunodeficiency
66
41) Which enzyme is raised in Paget’s, Osteomalacia etc. and is caused by osteoblast activation?
Alkaline phosphatase
67
Patient wit GI conditions, lack of which substance leads to B12 being malabsorbed?
Intrinsic factor
68
43) T1DM with hypoglycaemia, What is the management option if no IV access?
IM glucagon
69
What blood group plasma should be used in an emergency?
AB +ve
70
The combination of hemangioblastomas in the cerebellum and retina, multiple and
bilateral renal cell carcinomas, and cysts of the pancreas and kidneys iS characteristic of
what neurocutaneous syndrome ?
Von Hippel Lindau Syndrome
71
A patient with Sjögren's syndrome has a salivary gland biopsy. What cells are the most
common infiltrating cell type likely to be seen?
Lymphocytes
72
Important histological stain
haematoxylin-eosin (H&E) staining
73
A 21 year old patient with type 1 diabetes collapses. His capillary blood glucose is
0.7mM and a repeat confirms this. He is unrousable with a GCS of 3. He has no visible
veins. What is the best emergency reatment for hypoglycaemia in an unconscious
patient with no intravenous access?
IM glucagon
74
A 35 year old man with no complaints has the following blood test results when he joins
a new GP surgery. What is the most likely diagnosis? 35 Bilirubin (<17) ALP 70 IU/L (25-
115) ALT 24 IU/L (10-50) AST 17 IU/L (10-40) GGT 30 IU/L (9-40)
Gilbert's
75
Which liver enzyme can be measured in the blood and is found to be raised in Paget's
disease, osteomalacia and rickets and is a marker of osteoblast activity?
ALP
76
A 42 year old male presents in renal failure. His kidneys are grossly enlarged by multiple
large, thin-walled cysts. Some of the cysts contain blood clot. What is the likely
diagnosis?
PKD
77
A 31 year old female has a right ovarian mass removed. Bisection of the mass shows hair
and sebaceous material. What is the diagnosis?
Mature teratoma
78
A patient complains of a painful knee, and has it aspirated. Microscopy of the fluid
reveals positively birefringent crystals. What is the likely diagnosis?
Pseudogout
79
An 18 year old student collapses and dies whilst playing football. A postmortem finds
asymmetric hypertrophy of the interventricular septum. Microscopic examination shows
thickened and disorganized muscle fibres with hyperchromatic nuclei. What is the most
likely diagnosis?
HOCM
80
Which leucocyte actively participates in an acute inflammatory reaction, contains
myeloperoxidase within its primary granules and alkaline phosphatase in its secondary
granules?
Neutrophils
81
Which liver enzyme can be measured in the blood and specifically suggests obstructive
jaundice if levels are found to be raised?
ALP
82
A 42 year old male has fever, night sweats and haemoptysis. A transbronchial lung
biopsy shows granulomas with necrosis. What is the most likely cause?
Tuberculosis
83
A plain chest X-ray of a 47 year old male reveals a 2.5 cm "coin lesion" in the upper lobe
of his left lung. The lesion is removed. The pathology report describes a clear cell
carcinoma. What is the most likely primary site of origin for this carcinoma?
Kidney
84
A 72 year old male develops worsening heart failure. Investigations show decreased left
ventricular filling due to decreased compliance of the left ventricle. Two months later he
dies. Post-mortem microscopic examination of the heart muscle reveals deposits of
eosinophilic, Congo red-positive material in the interstitium of his heart. This material
shows apple-green birefringence under polarised light. What is the diagnosis?
Amyloidosis
85
An asymptomatic 58 year old man undergoes a routine insurance medical. The FBC
results are reported below. The blood film comment notes, no immature cells seen,
smear cells present. What is the most likely diagnosis ?
CLL
86
A 5 year old has a abdominal pain and a palpable abdominal mass. CT scan shows the
mass to be arising from the left kidney. What is the most likely diagnosis?
Wilm's tumour
87
An 21 year old Syrian woman who has recently moved to the UK from a refugee camp,
attends a haematology clinic. She has Beta Thalassaemia major and for the last six years
has received regular blood transfusions as treatment for anemia. On examination she
has signs of congestive cardiac failure and gonadal failure. What is the most likely
explanation for these clinical findings ?
Iron overload
88
What is the effect of male sex on the risk of venous thrombosis recurrence?
HIGHER 3X
89
A 39 year old male farmer from Southern Africa has been exposed to mouldy grain
during his working life. He has worsening abdominal pain and jaundice. There is a large
mass in the right lobe of his liver. Biopsy of the mass reveals hepatocellular carcinoma.
What extrinsic agent is likely to have played a role in the development of this tumour?
Aflotoxin
90
A 45 year old man joins a new GP surgery. He is asymptomatic and has the following
blood test results. What is the most likely diagnosis? Bilirubin 12 umol/L (<17) ALT 25
IU/L (10-50) AST 19 IU/L (10-40) GGT 38 IU/L (9-40) Alkaline Phosphatase 500 IU/L (25-
115)
Paget's
91
In a patient with Hodgkin Lymphoma, the Ann Arbor stage of disease is determined by the extent of spread, with stage 1 disease involving only one group of nodes, and stage IV disease involving extra nodal spread. What would stage III Hodgkin Lymphoma suggest?
Lymph nodes affected above and below the diaphragm
92
Folic acid supplementation taken periconceptually and in early pregnancy is important to prevent what condition ?
Neural tube defects
93
An elderly man presents with fatigue and recurrent chest infections. The FBC results are reported below. The blood film shows hypogranular hypolobated neutrophils. What is the most likely cause?
Kostmann syndrome
94
A 25 year old Greek woman who is 12 weeks pregnant attends a routine antenatal appointment, the following blood test results are obtained. Based on these results, to determine if the future health of this fetus may be at risk, what is the first action/investigation required ? Hb 114 g/L (115-165) MCV 70 fL (80-96) Hb A2 concentration 5.2% (2.0-3.5) Ferritin 13ug/L (12-200) Serum transferrin 2.4u/L (1.7-3.4)
HbA2 of partner
95
A 66 year old man with prostate cancer is experiencing fatigue and frank haematuria. The FBC result is presented below. The blood film report notes the presence of, myelocytes, tear drop poikilocytes and nucleated red blood cells. What is the most likely explanation for the anaemia? Hb 91 g/L (130-175) MCV 92 fL (80-96) WBC 3.4 x 10°/L (3.0-10.0) Neutrophils 0.8 x 10°/L (2.0-7.5) Lymphocytes 2.8 x 10°/L (1.5-4.0) Platelets 95 × 109/L (150-400)
Myelofibrosis
96
A 47 year old male with a history of alcoholism and chronic liver disease presents with weight loss and ascites. A CT scan of the abdomen reveals a solitary mass in the left lobe of the liver. No other lesions are seen. Peripheral blood a-fetoprotein levels are raised. What is the likely diagnosis of the liver mass?
Hepatocellular carcinoma
97
A 71 year a old male has a slowly growing, ulcerated lesion on the pinna of his right ear. The lesion is surgically excised, and histologic sections reveal infiltrating groups of cells in the dermis. These cells have eosinophilic cytoplasm, intercellular bridges, and intracellular keratin formation. What is the correct histopathological diagnosis of this lesion?
SCC
98
A patient is admitted to The Emergency Department after severe trauma and blood loss.
Without time for blood ABO grouping, he required emergency resuscitation with red cells and fresh frozen plasma. What blood group plasma should be used?
AB +ve
99
A 27 year old male with weight loss and diarrhoea is found to be anaemic. His duodenal biopsy is reported to show villous atrophy with a raised intra-epithelial lymphocyte count (>60/100 enterocytes). What is the most likely diagnosis?
Coeliac disease
100
What is the most common histologic type of carcinoma involving the oral cavity?
Adenocarcinoma
101
A 32 year old, female physiotherapist has overweight with excess facial hair she also exeriences recurrent acne. Over the past nine months her menstrual periods have been infrequent. Testosterone 3.7 nmol/L (0.2-2.9). What is the likely diagnosis?
PCOS
102
A 30 year old man comes to the Emergency Department having take a drug overdose. His arterial blood gases are shown below. What drug is he likely to have taken? pH 7.4 (7.35-7.45 pcO2 1.8 kPa (4.6-6.4) pO2 15 kPa (11-15)
Aspirin
103
A 24 year old patient with known type 1 diabetes presents having missed her insulin, and is now vomiting with Kussmaul respiration. Predict the likely bicarbonate concentration in this patient. (bicarbonate reference range 22-29 mmol/L)
14
104
A 50 year old man has tetany. Investigations: Calcium 1.95 mmol/L (2.2-2.6) Phosphate 0.7 mmol/L (0.8-1.5) PTH 27.2 pmol/L (1.6-8.5) Creatinine 90 mol/L (60-120) What is the likely diagnosis?
Secondary hyperparathyroidism
105
A patient with multiple endocrine neoplasia type 2 has had a thyroidectomy for medullary thyroid carcinoma but now presents with hypertension and palpitations. What is the likely diagnosis?
Phaeochromocytoma
106
A monoclonal antibody specific for receptor activator nuclear factor kappa-b ligand (RANK ligand) is effective in management of which condition?
Osteoporosis
107
A young child presents with recurrent infections and hepatosplenomegaly. In a dihydrorhodamine (DHR) assay the neutrophils remain negative for HR fluorescence after activation. What is the likely diagnosis?
Chronic granulomatous disease
108
A neonate presents with a salt losing crisis, and is thought to have congenital adrenal hyperplasia. What is the commonest enzyme deficiency that causes this? Name the enzyme.
21 alpha hydroxylase
109
A young man presents with episodes of fever, pleurisy and peritonitis. Investigations confirm a mutation a of the MEFV gene encoding pyrin. Which drug inhibiting neutrophil function is regarded as the agent of choice for prophylaxis against acute febrile illness and prevention of amyloidosis?
Colchicine
110
A 24 year old female presents with weight loss, heat intolerance and palpitations. She has bilateral exopthalmus. Results of thyroid function tests are shown below. TSH 0.1
mU/L (0.3-4.2) Free T4 32 pmol/L (9-25) She has developed auto-antibodies specific for which surface protein?
Anti-TSH receptor
111
A 23 year old female presents with a facial rash, arthralgias, mouth ulcers, hair fall and pleuritic chest pain. What is the most likely diagnosis?
SLE
112
What is the maximum number of HLA class I mismatches that may occur if a parent acts as a kidney donor for a child?
3
113
A 7 month old male child presents with pneumococcal pneumonia. He has a history of cellulitis and recurrent otitis media. A full blood count showed neutrophilia. Flow cytometry confirmed presence of CD19+ B cells and CD3+ T cells, including both CD8+ and CD4+ T cells. Serum immunoglobulin levels are shown below. IgA <0.1 g/L (0-0.83) IgG 0.02 g/L (2.3-14.0) IgM 1.84 g/L (0-1.45) Mutation of which gene is most likely to explain the presentation?
CD40
Hyper IgM syndrome
114
A 38 year old male develops fluctuating muscle weakness and ptosis. His symptoms improve following an injection of tensilon. Which autoantibody plays a role in the pathogenesis of this condition?
Anti-acetylcholine receptor
115
A 6 month old baby has presented with recurrent infections and is being investigated for immunodeficiency. Analysis of lymphocyte subsets shows presence of B cells and CD8+ T cells but very low numbers of CD4+ T cells. Analysis of immunoglobulin subsets shows presence of IgM but low levels of IgG. Which is the most likely diagnosis?
Bare lymphocyte II syndrome
116
A 25 year old man has a 10 year history of low back pain and stiffness, with symptoms being worse at night and in the early mornings. An MRI scan has shown bone marrow oedema at the sacroiliac joints. Blood tests confirm an acute phase response with C- reactive protein 18 mg/L (<5). He has shown a partial response to non-steroidal anti- inflammatory drugs. Which cytokine could be targeted to improve disease control?
IL-17/TNF-alpha??? (describing ankylosing spondylitis)
117
A 49 year old male presents with haemoptysis and acute renal failure. Investigations confirm pulmonary hemorrhage and glomerulonephritis. The renal biopsy is sent for immunofluoresence and this shows a linear deposition of antibody along the glomerular basement membrane. The effector mechanism for immunopathology in this condition is typical of which type of Gel and Coombs hypersensitivity reaction?
Type II hypersensitivity reaction
118
Antibodies bind to which cell type during the effector phase of antibody mediated rejection of solid organ allografts?
Graft endothelium
119
A baby is born with tetralogy of Fallot and is also noted to have features of hypoparathyroidism including low serum calcium. He develops recurrent infections after 3 months of age, including with viruses and bacteria. Which immune cell type is deficient?
T cells (diGeorge syndrome)
120
Serology for what polysaccharide is used for the diagnosis of invasive Aspergillus infection?
Aspergillus galactomannan (GM)
121
A 26 year old woman presents with fever, headache and confusion. She has an HIV infection and has refused to take antiretroviral therapy for the past four years. What rapid test should you ask the microbiology laboratory to perform on her serum sample to confirm the likely diagnosis?
Cryptococcal antigen test
122
Urinary antigen tests are useful in the diagnosis of community acquired pneumonia. State one organism that the commonly available tests can detect?
Legionella pneumonia
123
Which cytokine is key in promoting the development and terminal differentiation of eosinophils
IL-5
124
A 35 year old person who injects drugs (PWID) is admitted with fever, shortness of breath and haemoptysis. Her chest x-ray has been reported as showing multiple pulmonary infiltrates compatible with pulmonary emboli. Which ONE microbiology investigation should you send before commencing empiric antibiotics?
Blood culture
125
A 72 year old woman is refered from the Emergency Department with signs and symptoms consistent with meningitis. She is known to have hypertension and type 2 diabetes mellitus. She is not confused and has no features suggestive of encephalitis. A lumbar puncture has been performed and she has been commenced her on ceftriaxone 2g i.v. twice daily. There are no known drug allergies. Given this clinical picture what one antimicrobial should be be given in addition?
Amoxicillin
126
A 2-day-old neonate develops meningitis. The microbiology laboratory telephone to report that a Gram stain of her CSF shows Gram-negative bacilli. What is the most likely causative organism?
E.coli
127
What species of Coagulase Negative Staphylococcus is a common cause of lower urinary tract infection in young women?
Staphylococcus sacrophyticus
128
What double stranded DNA virus is associated with nephritis in renal transplant recipients immunosuppresive therapy?
BK virus - BK haemorrhagic cystitis
129
Which vaccine preventable disease presents initially with mild fever, swollen neck glands, anorexia, malaise and cough. After 2-3 days a membrane of dead cells forms in the throat, tonsils, larynx or nose which may narrow or occlude the airway leading to respiratory distress?
Diptheria
130
A 32 year old man presents with fever, abdominal pain and constipation. He has recently returned from Pakistan. He undertook no vaccinations prior to travel. Blood cultures taken on admission have grown non-lactose fermenting Gram negative bacilli in both bottles. What is the most likely causative organism?
Salmonella typhi
131
Which helminth is capable of autoinfection in humans via the following life cycle? Infective filariform larvae penetrate intact skin and migrate to the small intestine where they become adults. Eggs hatch into rhabditifom larvae which mature into filariform larvae which can autoinfect via perianal skin.
Schisctomiasis
132
Exposure of the foetus to which vaccine-preventable infection during the first trimester of pregnancy is associated with a high probability of developing a syndrome characterised by the presence at birth of sensorineural deafness, eye abnormalities ( including cataract, microphthalmia and retinopathy), and congenital heart disease (including patent ductus arteriosus)?
Rubella
133
A 32 year old woman has been diagnosed with a superficial infection of a caesarean section wound. The preliminary report from a wound swab states Staphylococcus aureus isolated with susceptibilities to follow. The pre-operative MRSA screen was negative and there are no known drug allergies. She is breast feeding her new daughter. What narrow spectrum antimicrobial would you prescribe to treat his infection?
Flucloxacillin
134
A 67-year-old woman presents with a chronic cough, haemoptysis and fevers particularly at night. She states she has lost 10 kg of weight over the past 3 months and her chest X-ray shows left upper zone shadowing. Her son reports she has a history of excess alcohol consumption. What is the most likely causative organism?
Mycobacterium tuberculosis
135
What Hepatitis virus typically causes a brief, self-limiting infection but is associated with more severe disease and mortality in pregnant women and can cause chronic infection in immunocomromised patients?
Hepatitis E
136
What happens to the platelet count in RA?
Increases due to inflammation
137
What are nucleated red blood cells?
Reticulocytes
138
A 66 year old man with prostate cancer is experiencing fatigue and frank haematuria. The FBC result is presented below. The blood film report notes the presence of, myelocytes, tear drop poikilocytes and nucleated red blood cells. What is the most likely explanation for the anaemia? Hb 91 g/L (130-175) MCV 92 fL (80-96) WBC 3.4 x 10°/L (3.0-10.0) Neutrophils 0.8 x 10°/L (2.0-7.5) Lymphocytes 2.8 x 10°/L (1.5-4.0) Platelets 95 × 109/L (150-400)
Leucoerythroblastic anaemia
139
The combination of hemangioblastomas in the cerebellum and retina, multiple and bilateral renal cell carcinomas, and cysts of the pancreas and kidneys iS characteristic of what neurocutaneous syndrome?
Von-Hippel Lindau syndrome
140
A 24 year old woman with known type 1 diabetes accidentaly missed an insulin dose. She presents with vomiting and Kussmaul respiration. Predict in kPa the likely pCO2 reading that you will find on the Arterial Blood Gas sample. pCO2 normal range (4.6-6.4 kPa)
Low - around 3
141
A 42 year old male presents in renal failure. His kidneys are grossly enlarged by multiple large, thin-walled cysts. Some of the cysts contain blood clot. What is the likely diagnosis?
Polycystic kidney disease
142
A 24 year old patient with known type 1 diabetes presents having missed her insulin, and is now vomiting with Kussmaul respiration. Predict the likely bicarbonate concentration in this patient. (bicarbonate reference range 22-29 mmol/L)
Something low like 15
143
A 23 year old man presents with cellulitis having cut himself while skateboarding. A wound swab has grown Streptococcus pyogenes (Group A Streptococcus). List the following antimicrobials which can be used for treatment in order of spectrum of activity with being the narrowest spectrum and 5 being the broadest spectrum agent.
Benzylpenicillin
Ceftriaxone
Amoxicillin
Piperacillin/tazobactam
Meropenem
Benpen 2
Cef 1
Amox 4
Pip/Taz 5
Mero 3
144
A 56 year old female presents with dryness of her eyes, confirmed with ocular staining, and intermittent swelling of her submandibular glands. Rank the following investigations in order of specificity for confirmation of her diagnosis, with (1) having the highest specificity and (5) the lowest.
Positive anti-Ro antibody
Positive anti-nuclear antibody
Raised immunoglobulin G
Raised neutrophil count
Raised C-reactive protein
Positive anti-Ro - 1
Positive ANA - 2
Raised IgG - 2
Raised neutrophil count - 4
Raised CRP - 5
(Sjorgen's syndrome)
145
A 69 year old man presents with a red, hot swollen knee. He has type 2 diabetes mellitus and osteoarthritis but it is a native joint. In this case of septic arthritis, rank the causative organisms below in order of likelihood, with (1) being the most likely and (5) being the least likely.
Staphylococcus aureus
Streptococcus pyogenes
Escherichia coli
Staphylococcus epidermidis Brucella melitensis
Staph Aureus - 1
Strep Pyogenes - 4
E.Coli - 2
Staph Epidermidis - 3
Brucella Melitensis - 5
146
Rank the following diagnoses in order of expected measured serum potassium, with (1) being the highest potassium and (5) being the lowest.
Addison's disease
Pneumonia
Cushing's disease
Phaeochromocytoma
Conn's syndrome
Addison's
Pneumonia
Cushing's
Phaeo
Conn's
147
Healing of an acute myocardial infarction follows an ordered sequence of events. Rank the following events in chronological order starting from earliest (1) to latest (5) .
Neutrophils begin to arrive at the area of coagulative necrosis
Macrophages begin to arrive at the area of coagulative necrosis
Granulation tissue begins to form
Flocculent densities form within mitochondria
Collagen is deposited, forming a fibrous scar
Neutrophils begin to arrive at the area of coagulative necrosis Macrophages begin to arrive at the area of coagulative necrosis Granulation tissue begins to form
Flocculent densities form within mitochondria
Collagen is deposited, forming a fibrous scar
148
Cancers of the lymphatic system have highly variable natural histories. In the absence of treatment which may alter the cinical course, rank the following lymphoid cancers by their median survival. Rank in the order (1) shortest survival to (5) longest survival.
Mantle Cell Lymphoma (MCL)
Diffuse Large B Cell Lymphoma (DLBCL)
Chronic Lymphocytic Leukaemia (CLL) IgH variable gene unmutated Chronic Lymphocytic Leukaemia (CLL) IgH variable gene mutated Burkitt Lymphoma (BL)
Mantle Cell Lymphoma - 4
DLBL - 5
CLL IGH WT - 3
CLL IGH - 2
BL - 1
149
- Droopy eyelid which is fatiguable - antibody present?
Anti-acetylcholine receptor antibody
150
Treatment for child with RSV
Ribavarin
151
CMV retinitis treatment?
Gancyclovir
152
Man with cough, SoB and wt loss. Hyponatraemia, low serum osmolality, urine Na and osmo were inappropriately normal
SIADH
153
Elderly woman with C. diff and profuse diarrhoea
Hypovolaemia
154
- Man who has been in a car accident, raised sodium and plasma osmolality, low urine osmolality - diagnosis?
Cranial diabetes insipidus
155
- Hyperaldosterone picture with raised Na, low K, HTN but raised renin?
Renal artery stenosis
156
What enzyme is raised in Pagets?
Alkaline phosphatase
157
- What would be raised in obstructive jaundice due to gallstones?
Alkaline phosphatase
158
- What would be raised in obstructive jaundice due to pancreatic adenocarcinoma?
Alkaline phosphatase
159
- Temporal arteritis test which will help with diagnosis? -
ESR
160
Indication for dialysis?
Hyperkalaemia
161
- What is a sign that your patient has been taking cocaine?
Dilated pupils
162
Multiple myeloma - what would you see in kidneys?
Amyloid deposition (AL)
163
Woman comes in with bitemporal hemianopia, 2cm mass, and a raised prolactin 1400?
Non-functioning pituitary macroadenoma
163
Woman comes in with bitemporal hemianopia, 2cm mass, and a raised prolactin 1400?
Non-functioning pituitary macroadenoma
164
Woman comes in with bitemporal hemianopia, 2cm mass, and a raised prolactin 1400?
Non-functioning pituitary macroadenoma
165
Pneumonia in HIV patient?
PCP pneumocystis jirovecii
166
Pneumonia in Girl receiving chemotherapy for leukaemia ‘Halo’ sign on CXR?
Aspergillosis
167
3) Lower lobe pneumonia in a 22 year old, Gram-positive diplococci?
Streptococcus pneumoniae
168
4) Upper lobe cavitation + alcoholic
Klebsiella pneumophilia
169
5) Smoker back from holiday in Spain, also hyponatraemic and confused
Legionella
170
- Water polo player with itchy scaly rash on lateral toe then moved along lateral side of foot?
Trichophytum rubrum
171
Pityriasis versicolor
Malassezia furfur
172
- Lady came back from visiting her sister in Arizona with systemic sx - fever etc?
Coccidioides
173
- Man in his 60s with poorly controlled diabetes pr\esents with rapidly progressing periorbital swelling, sinus pain, confusion and sinusitis?
apparently Rhizopus spp. causing mucormycosis
174
Treatment for Ankylosing spondylitis
Etanercept
175
Treatment for Resistant Psoriasis?
Etanercept
176
Chronic granulomatous disease treatment
Interferon gamma
177
Treatment for Osteoporosis?
Denosumab
178
- Hyper IgM syndrome treatment?
Human Ig
179
Tumour in head of pancreas, invading into portal vein, mass in liver - what is it?
Adenocarcinoma
180
- Tumour in oesophagus with keratin and intercellular bridges
Squamous cell carcinoma
181
- What immune cell resides in bone marrow until migrates to site of injury. Oxidative and non-oxidative killing. Dies once job’s done?
Neutrophils
182
- Something Foxp3+ cells, I think it also said they mature in the thymus
T regulatory cells
183
- What immune cells detects antigen in the periphery and moves to lymph nodes?
Dendritic cells
184
- What immune cell detects MHC1 and kills virus infected/cancer cells. Is inhibited by MHC 1?
Natural killer cells
185
- What immune cells is targeted by HIV?
CD4 cells
186
What would you measure to check for beta thalassaemia?
HbA2
187
- How to monitor therapy in someone with polycythaemia vera?
Haematocrit and haemaglobin
188
- Test for autoimmune haemolytic anaemia
Direct antiglobulin test
189
Definitive test for hereditary spherocytosis?
Eosin 5-malemide test
