SBAs Flashcards
A man breaks his leg and it is plastered for 6 weeks. When the plaster is removed, the leg is much thinner than the other leg. What has happened? a) Atrophy b) Hyperplasia c) Hypertrophy d) Metaplasia D) Dysplasia
A
Acute inflammation actively involves A) Constriction of arterioles B) Capillary endothelial cell enlargement C) Influx of macrophages D) Influx of mast cells E) Influx of neutrophils
A
Most common type of cell present in appendicitis? A. Neutrophils B. Basophils C. Eosinophils D. Macrophages E. Lymphocytes
A
Which 2 cell types are involved in the response to acute inflammation?
a) Neutrophils and basophils
b) Eosinophils and basophils
c) Neutrophils and monocytes
d) Neutrophils and lymphocytes
e) Lymphocytes and monocytes
C
Which of these is NOT an outcome of acute inflammation?
a) Pus formation
b) Destruction
c) Organisation
d) Resolution
e) Progression to chronic inflammation
B
Hypertrophy is best described as:
a) Increased size of organ/tissue due to increased number of cells
b) Increased size of organ/tissue due to decreased number of cells
c) Increased cell growth and decreased differentiation
d) Increased size of organ/tissue due to increased size of cells
e) Replacement of one differentiated tissue by another
D
In which pathological process would you expect:
- Organelles to be damaged
- Cell lysis
- Inflammation
- Altered chromatin
a) Metaplasia
b) Apoptosis
c) Dysplasia
d) Hypertrophy
e) Necrosis
E
What is a malignant neoplasm of smooth muscle called?
a) Adenocarcinoma
b) Leiomyoma
c) Rhabdomyoma
d) Leiomyosarcoma
e) Adenoma
D
What is a malignant neoplasm of glandular origin called?
a) Adenocarcinoma
b) Leiomyoma
c) Rhabdomyoma
d) Leiomyosarcoma
e) Adenoma
A
You suspect a patient has Sarcoidosis, which blood marker do you investigate? A) D-Dimer B) Phosphate C) Serum ACE D) FBC E) c-ANCA
C
What is the name of a benign neoplasm of secretory epithelium? A) Myeloma B) Adenoma C) Leioma D) Adenocarcinoma E) Sarcoma
B
What is the name of a malignant neoplasm of connective tissue? A) Myeloma B) Adenoma C) Leioma D) Adenocarcinoma E) Sarcoma
E
Which of the following does not typically spread to bone? A) Breast B) Lung C) Thyroid D) Adrenal E) Prostate
D
Which of the following is NOT a stage of metastasis? A) Intravasion B) Adherance to endothelium C) Evasion of host defence D) Angiogenesis E) Invasion of host cells
E
What best describes extravasation A) Erosion of tissue boundaries by enzymes B) Colonisation of a new site C) Development of its own blood supply D) Gaining access to metastatic routes E) Excretion of enzymes
B
Which of the following is not typically a drug target A) Ducts B) Receptors C) Enzymes D) Transporters E) Ion channels
A
Which of the following is true A) Agonists show affinity only B) Antagonists show affinity and efficacy C) Agonists show efficacy only D) Agonists show affinity and efficacy E) Antagonists show efficacy only
D
Which condition is a contraindication of beta-blockers? A) Kidney failure B) Asthma C) Liver cirrhosis D) Headaches E) Hypertension
B
In a typical 70Kg man, which of the following is correct for the amount of water in his extracellular compartment? A) 28L B) 11L C) 14L D) 3L E) 42L
C
Which of the following is not a stage of pharmacokinetics? A) Ingestion B) Absorption C) Distribution D) Metabolism E) Excretion
A
What are foam cells? A) Endothelial cells B) Macrophages that have taken up LDLs C) Neutrophils that have accumulated lipid D) Macrophages that have taken up HDLs E) Smooth muscle cells
B
Which of the following does NOT trigger apoptosis in a cell A) Bcl-2 B) Bax C) Fas ligands D) Caspases E) p53
A
Which of the following is not a type of necrosis? A) Coagulative necrosis B) Liquefactive necrosis C) Gangrene D) Caseous necrosis E) Epithelious necrosis
E
Which of the following is linked to Burkitt's lymphoma? A) Smoking B) EBV C) HPV D) UV radiation E) Aflatoxins
B
Which of the following is linked to hepatocellular carcinoma? A) Smoking B) EBV C) HPV D) UV radiation E) Aflatoxins
E
Which of the following is a characteristic of malignant tumours? A) Does not invade the basement membrane B) Exophytic C) Low mitotic activity D) Necrosis and ulceration common E) Circumscribed
D
What is used for cervical cancer staging? A) The FIGO system B) The Enneking system C) Duke's classification D) Ann Arbor Staging E) Binet System
A
What is used for leukaemia staging? A) The FIGO system B) The Enneking system C) Duke's classification D) Ann Arbor Staging E) Binet System
E
Which of the following would indicate breast cancer? A) High PSA B) High calcitonin C) CA 15.3 D) CA 19.9 E) Alpha-Fetoprotein
C
Which of the following would indicate germ cell tumours? A) High PSA B) High calcitonin C) beta-hCG D) CA 19.9 E) Alpha-Fetoprotein
C
Which of the following does not have a screening programme? A) Breast cancer B) Cervical cancer C) Bowel cancer D) Prostate cancer E) Abdominal aortic aneurysm
D
Which tumour has the shortest median survival
a. Basal cell carcinoma of the skin
b. Malignant melanoma of the skin
c. Breast cancer
d. Anaplastic carcinoma of the thyroid
D
Which one of the following is not a feature of malignant tumours?
a. Vascular invasion
b. Metastasis
c. Increased cell division
d. Growth related to overall body growth
D
Which of the following is not known to be a carcinogen in humans?
a. Hepatitis C virus
b. Ionising radiation
c. Aromatic amines
d. Aspergillus niger fungus
D
Which of the following tumours never metastasises?
a. Malignant melanoma
b. Small cell carcinoma of the lung
c. Basal carcinoma of the skin
d. Breast cancer
C
Which of the following is length-bias?
A) Volunteers for screening are more at risk of good-prognosis tumours
B) Diagnosis of lesions that, although histologically malignant, are clinically relatively harmless
C) Preferential detection of slow growing tumours with intrinsically better prognosis
D) Earlier detection does not affect the inevitable fatal outcome, but prolongs the apparent survival time
C
Where in the mitochondria is the site of glycolysis? A) Cytosol B) Matrix C) Cristae D) Inner membrane E) Outer membrane
A
What is the function of the perioxisomes?
A) Synthesis and processing of proteins
B) Synthesis of lipids
C) Structural support
D) Contains acid hydrolases for digestion and recycling
E) Fatty acid and ethanol oxidation
E
What is paracrine communication?
A) Chemical released form cell into ECF and acts upon itself
B) Local cellular communication; travels short distances. Travels in the ECF
C) Secretion into blood not via a duct. Long distance communication
D) The whole cell is lost with the secretion
E) No part of the cell is lost with the secretion
B
What is autocrine communication?
A) Chemical released form cell into ECF and acts upon itself
B) Local cellular communication; travels short distances. Travels in the ECF
C) Secretion into blood not via a duct. Long distance communication
D) The whole cell is lost with the secretion
E) No part of the cell is lost with the secretion
A
Which of the following can cause hyponatraemia? A) Renal failure B) mineralocorticoid excess C) Diabetes insipidus D) Excess IV fluid E) ACE inhibitors
D
Which of the following can cause hyperkalaemia? A) Renal failure B) mineralocorticoid excess C) Diabetes insipidus D) Excess IV fluid E) Hypomagnesemia
A
What is a consequence of Hypercalcaemia? A) Metastatic calcification B) Tetany C) Risk of MI D) Weakness E) Cardiac dysrhythmia
A
What is a consequence of hypokalaemia? A) Metastatic calcification B) Tetany C) Risk of MI D) Metastases E) Cardiac dysrhythmia
E
What does Glucose+Fructose form? A) Lactose B) Maltose C) Galactose D) Glycogen E) Sucrose
E
Which of the following is NOT true?
A) Topoisomerase relieves the supercoils, unwinding the double helix
B) Single strand binding protein keeps the two DNA strands held together during synthesis- preventing annealing
C) DNA polymerase reads 3’ to 5’, and prints 5’ to 3’
D) A primer is a short stand of DNA that acts as a starting point for DNA synthesis
E) DNA helicase breaks hydrogen bonds between the two strands, exposing nucleotides
B
In which phase of mitosis does crossing over occur? A) Prophase B) Prometaphase C) Metaphase D) Anaphase E) Telophase
A
Which of the following would decrease BMR? A) High BMI B) Hyperthyroidism C) Pregnancy D) Higher age E) Infection
D
What is NOT true about the RAAS?
A) Angiotensin 1 is converted to Angiotensin 2.
B) Renin is secreted by the kidney.
C) Aldosterone causes the kidney to reabsorb NaCl.
D) Angiotensinogen is secreted by the liver.
E) Angiotensin Convulsing Enzyme is secreted by the kidney.
E
What is the energy value of lipids? A) 4kcal/g B) 7kcal/g C) 9kcal/g D) 7mmHg E) 9mmHg
C
Which of the following is true regarding ketogenesis/ ketone bodies?
A) Ketones are strong alkalis.
B) Ketones are weak acids.
C) Increased ketone bodies can lead to diabetic ketoacidosis.
D) NADH is an example of a ketone.
E) Increased ketone bodies enhance oxygen binding to haemoglobin.
C
Which of the following is not a typical antigen presenting cell? A) T cells B) Macrophages C) Dendritic cells D) B cells
A
What cell type is measured in HIV monitoring? A) CD4+ B) CD8 C) TREG cells D) CD17 E) B cells
A
Which of the following is not a polymorphonuclear leukocyte? A) Neutrophil B) Macrophage C) Basophil D) Eosinophil
B
Which of the following is not a stage of phagocytosis? A) Binding of insult B) Engulfment C) Phagosome formation D) Presentation of MHC I E) Secretion of waste products
D
Which of the following is not a component of innate immune system
a) Skin
b) Antimicrobial peptides
c) Antibodies
d) Mucosa
C
Antigen presenting cells process and present antigens for recognition by
A) Neutrophils
B) Red blood cells
C )Eosinophils
D) T cells
D
Which of the following are features of the adaptive immune response
A) Does not require prior contact with the pathogen
B) It works with B and T lymphocytes
C) Lacks specificity
D) Distinguishes “self” from “non-self”
E) Enhanced by complement
D
Which of the following is not part of the Elimination phase of complement activation? A) Opsonisation B) Production of interferons C) Target cell lysis D) Chemoattraction of leukocytes E) Phagocytosis
B
Influenza vaccine is targeted towards 'at risk' groups in the UK. Which of the following aren't classified as 'at risk'? A) Asthmatics B) Diabetics C) The obese of any age D) 6 months of age
D
Which of the following is not a classical PAMPs?
A) Flagellin, a protein found in bacterial flagella
B) Lipopolysaccharide (LPS) from the outer membrane of gram-negative bacteria
C) Peptidoglycan, found in bacterial cell walls
D) Lipoarabinomannan of mycobacteria
E) Interleukin 12
E
Which of the following is not a component of the innate immune system? A) Complement system B) Toll-like receptors C) Macrophages D) T helper cells E) C-reactive protein
D
Which of the following is a type 3 hypersensitivity reaction- A) Tuberculosis B) Goodpasture’s Disease C) Systemic Lupus Erythematosus D) Contact Dermatitis E) Anaphylaxis
C
Which of the following antibodies is implicated in asthma? A) IgG B) IgA C) IgM D) IgE E) IgD
D
Which of the following antibodies is implicated in the secondary response to infection? A) IgG B) IgA C) IgM D) IgE E) IgD
A
Which type of cytokine causes B cells to produce IgE? A) IL-1 B) IL-3 C) IL-4 D) IL-5 E) IL-13
C
What type of T cell plays an important role in type 1 hypersensitivity reactions? A) Th-1 B) Th-2 C) Th-17 D) TC E) Treg
B
The immune system is made up of both innate and adaptive aspects and involves a variety of cells. Which is the most abundant white blood cell in humans? A) Basophils B) CRP C) Neutrophils D) Mast Cells E) Lymphocytes
C
A mother brings her 3-year-old child to the GP saying he has a fever and is generally unwell. The GP suspects the they have a viral infections such as respiratory syncytial virus. What cell would you expect to be raised in this patient? A) Mast Cell B) Microglia C) Neutrophils D) Macrophages E) Lymphocytes
E
A 34-year-old male comes into the GP complaining of haemoptysis. He notes that he wakes up at night due to waking up in a pool of sweat and mentions he recently returned from a holiday in Pakistan. The GP suspects tuberculosis. Which of the following cytokines is primarily responsible for activating macrophages? A) IL-2 B) IL-4 C) TNFα D) IL-1β E) IFN-γ
E
A 5-year-old girl is brought to the GP after repeated episodes of allergic rhinitis and eczema. Which cytokine is involved in atopy and, amongst other things, causes class switching of immunoglobulins to IgE? A) IL-4 B) IL-17 C) IL-5 D) IL-1β E) IFN-γ
A
A 35-year-old woman presents to her GP complaining of unintentional weight loss, palpitations, and oligomenorrhoea. She is subsequently diagnosed with Graves disease by a specialist. Given their involvement in autoimmunity, where does T cell maturation occur? A) Spleen B) Bone Marrow C) Bursa of Fabricius D) Thymus E) Liver
D
It’s your first day on placement and you take a history from an elderly gentleman who is currently running a high-grade fever. You later find out he is currently suffering from a Pseudomonas aeruginosa infection. Which pattern recognition receptor is most likely to detect this infection? A) TLR2 B) TLR6 C) TLR4 D) NOD-2 E) RIG1
C
It’s your second day on placement and you take a history from an elderly gentleman who is currently running a high-grade fever. You later find out he is currently suffering from a Streptococcus pneumoniae infection. Which pattern recognition receptor is most likely to detect this infection? A) TLR2 B) TLR6 C) TLR4 D) NOD-2 E) RIG1
A
An intravenous drug user presents to A&E complaining of fever, a hot painful red lump, and general malaise. The F1 who clerked them suspects an MRSA infection. Which white blood cell is most likely to be raised in this patient? A) Neutrophil B) Mast Cell C) Basophil D) Lymphocyte E) Dendritic cell
A
An infant presents to hospital with a fever, shortness of breath and a cough producing yellow sputum. She has had many previous admissions due to similar infections and has been diagnosed with a deficiency in mannose binding lectin (MBL). Which substance is failing to trigger a complement cascade reaction in this patient? A) IgE B) IgM C) C3 Convertase D) Pathogen surface carbohydrates. E) Membrane attack complex
D
A 13-year-old boy has been brought to the GP by his dad after having a sore throat and a cough for the last week. After an examination, the GP concludes that he likely has a viral infection that will resolve without other treatment. Which immune cells are responsible for directly combating this type of infection through apoptosis? A) Basophils B) Plasma Cells C) T helper cells D) Neutrophils E) Cytotoxic T-cells
E
A 10-year-old boy presents with an itchy rash on his elbows. The rash is red and there are excoriation marks. He has a past history of hay fever and has generally dry skin. The GP diagnoses him with eczema and he is prescribed hydrocortisone. Which antibody is responsible for mediating type 1 hypersensitivity? A) IgG B) IgA C) IgM D) IgE E) IgD
D
A mother is concerned about infection of her newborn child. She asks her GP about best to protect their child from infections. Which is the most abundant antibody in colostrum? A) IgG B) IgA C) IgM D) IgE E) IgD
B
A 38-year-old male attends the human immunodeficiency virus (HIV) clinic for routine blood tests for monitoring of his condition. The number of which of the following cells is used to measure the progression of disease in HIV positive patients? A) Neutrophils B) B Cells C) NK cells D) CD4 T cells E) CD8 T cells
D
A 34-year-old man is referred to the gastroenterologist due to persistent epigastric pain and nausea. He returned travelling from south-east Asia ten weeks ago. Blood tests reveal iron deficiency anaemia, and faecal microscopy reveals the presence of hookworm eggs. Which immune cell is responsible for the defense against helminths? A) Basophils B) Eosinophils C) Neutrophils D) Macrophages E) Dendritic Cells
B
A 14-year-old boy complains of a 3-day history of fatigue, aches and pains, and fever. Upon examination his temperature is 38ºC and his tonsils are inflamed. He is suspected to have a bacterial infection which will be fought by his adaptive immune system. Which of the following cell-surface proteins are found on cytotoxic T-cells? A) CD4 B) CRP C) MHC I D) CD 8 E) MHC II
D
A 65-year-old man is admitted to hospital following a fall. He subsequently developed hospital-acquired pneumonia. Given the most likely causative microorganism, which molecule is responsible for presenting its antigenic material to immune cells? A) CD4 B) MHC III C) MHC I D) TCR E) MHC II
E
A father brings their 6-year-old boy to the GP complaining of an incredibly lengthy chest infection and recurrent gastritis. He is referred to an immunologist. His bloods extremely low levels of IgA and IgG. He is diagnosed with common variable immunodeficiency (CVID). Which adaptive cell type is essential in aiding class switching of B cells? A) Natural Killer T cells. B) Th17 cells C) Th2 cells D) Th1 cells E) Dendritic Cells
D
A 24-year-old lady collapses after being stung by a wasp. You run to her aid and find marked facial oedema and a loud wheeze. You suspect anaphylaxis. Which type of immunoglobulin (Ig) is associated with this kind of reaction? A) IgG B) IgA C) IgM D_ IgE E) IgD
D
Which of the following develops from a common lymphoid progenitor? A) Natural killer cell B) Erythrocyte C) Thrombocyte D) Eosinophil E) Mast cell
A
Which of the following is a primary lymphoid organ? A) Lymph nodes B) Bone marrow C) Spleen D) Transient germinal centres
B
Which of the following is not a function of the spleen?
A) Mechanical filtration of RBC
B) Active immune response
C) Production of RBCs up to 5 months gestation
D) Aids in the production of thrombocytes
e) Storage of RBCs, lymphocytes and other elements
D
Which of the following is a characteristic of innate immunity? A) Highly specific B) Fast (hours to days) C) Highly regulated D) Has amplification E) Lasts a long time
B
What is the name of an inactivated X chromosome in women? A) Heinz body B) Bite cell C) Barr Body D) Popcorn Cells E) Fragment cells
C
What is the main source of histamine? A) Mast cells B) Basophils C) Eosinophils D) B cells E) Neutrophils
A
Which of the following cells do not present MHC-I? A) Neutrophils B) Antigen presenting cells C) Erythrocytes D) Thrombocytes E) Macrophages
C
Which of the following does not typically present MHC-II? A) T cells B) Macrophages C) Dendritic cells D) B cells
A
Which of the following is not required for a T cell response to occur? A) Binding of primary receptors B) Binding of co-stimulatory molecules C) A robust release of cytokines D) Multiple APC binding
D
What cell type is antagonistic to Treg cells? A) Th17 B) Th1 C) Th2 D) Cd4+ E) Th20
A
What region of an antibody binds to epitopes of an antigen? A) Fab Region B) Fc Region C) Light chain D) Constant region E) Hinge region
A
Which type of antibody is most abundant in the blood? A) IgA B) IgM C) IgG D) IgE E) IgD
C
Which type of antibody is bound to mast cells and basophils by the Fc-epsilon-receptor? A) IgA B) IgM C) IgG D) IgE E) IgD
D
Which type of antibody is the least abundant in the blood? A) IgA B) IgM C) IgG D) IgE E) IgD
D
What promotes IgA class switching? A) IL-5 B) IL-4 C) IL-10 D) IL-12 E) TNF-alpha
A
What promotes IgE class switching? A) IL-5 B) IL-4 C) IL-10 D) IL-12 E) TNF-alpha
B
Which type of hypersensitivity is Th1 mediated? A) 1 B) 2 C) 3 D) 4
D
What is the first line treatment for anaphylaxis? A) Adrenaline B) Clorphenamine C) Hydrocortisone D) Prednisolone E) Beta-blocker
A
Which of the following is true of passive immunity? A) Produced by the host immune system B) Durable effective protection C) Immunological memory D) Boosted effect on subsequent dose E) No negative phase
E
Which of the following cytokines is anti-inflammatory? A) IL-1 B) IL-2 C) IL-4 D) IL-12 E) TNF-Alpha
C
Which of the following cytokines is produced by Th1 cells? A) IL-1 B) Interferon-gamma C) IL-4 D) IL-10 E) TNF-alpha
B
Which of the following cytokines is not involved in inducing fever? A) IL-1 B) IL-6 C) IL-10 D) TNF-alpha
C
Which cell surface marker is associated with activated B cells? A) CD4 B) CD25 C) CD20 D) CD14 E) CD56
C
Which of the following is not used as part of the gram staining process? A) Crystal violet B) Iron sulphide C) Iodine D) Alcohol E) Safranin
B
A man presents with diarrhoea. You take a stool sample for culture. The bacteria grown appears pink on gram staining and is a rod. It goes pink on MacConkey Agar. What is it likely to be? A) E. Coli B) Salmonella C) Shigella D) Vibro. Cholerae E) H. Pylori
A
A man presents with diarrhoea. You take a stool sample for culture. The bacteria grown appears pink on gram staining and is a rod. It is negative on the oxidase test. What is it likely to be? A) E. Coli B) Salmonella C) C. Jejuni D) Vibro Cholerae E) H. Pylori
B
A woman presents with a skin infection. You take a skin swab, and the bacteria grown is a class A beta haemolytic bacteria. What is it likely to be? A) Staph. Aureus B) Strep Pyogenes C) Strep Agalactiae D) Staph Epidermis E) Strep oralis
B
A woman presents with a throat infection. You take a swab, and the bacteria grown is a class A beta haemolytic bacteria. What is it likely to be? A) Staph. Aureus B) Strep Pyogenes C) Strep Agalactiae D) Staph Epidermis E) Strep oralis
B
A woman presents with a chest infection. A blood culture is taken, and the bacteria grown appears as a purple cocci on gram staining. It is grown on a CBA plate and appears dark green. It is optochin sensitive. What is it likely to be? A) Staph. Aureus B) Strep Pyogenes C) Strep Pneumoniae D) Staph Epidermis E) Strep oralis
C
A woman presents with a severe chest infection. A blood culture is taken, and the bacteria grown appears red on ziehl-Neelson stain. What is it likely to be? A) Staph. Aureus B) Strep Pyogenes C) Strep Pneumoniae D) Mycobacterium Tuberculosis E) Strep oralis
D
A woman presents with a skin infection. You take a swab, and the bacteria appears as a coagulase positive cocci that sits in clusters. What is it likely to be? A) Staph. Aureus B) Strep Pyogenes C) Strep Pneumoniae D) Staph. Epidermis E) Strep oralis
A
A woman presents with a skin infection. You take a swab, and the bacteria appears as a coagulase positive cocci that sits in clusters. How would you treat her? A) Oral Flucloxacillin B) Oral Benzylpenicillin C) Oral Amoxicillin D) Trimethoprim E) Oral cephalosporins
A
A woman presents with a skin infection. You take a swab, and the bacteria appears as a coagulase positive cocci that sits in clusters. On sensitivity testing, it appears to be methicillin resistant. How would you treat her? A) Oral Flucloxacillin B) Oral Vancomycin C) Oral Amoxicillin D) Trimethoprim E) Oral cephalosporins
B
A man presents with diarrhoea. You take a stool sample for culture. The bacteria grown appears pink on gram staining and is a rod. It goes pink on MacConkey Agar. How would you treat him? A) Oral flucloxacillin B) Oral Vancomycin C) Trimethoprim D) Oral Co-amoxiclav E) Oral Metronidazole
D
A woman presents with thin grey vaginal discharge and a burning pain. You think the bacteria must be Gardnerella vaginalis. How would you treat her? A) Oral flucloxacillin B) Oral Vancomycin C) Trimethoprim D) Oral Co-amoxiclav E) Oral Metronidazole
E
You see a man on the ward who has been diagnosed with peritonitis. On gram staining, his bacteria was found to be a gram negative anaerobic bacilli. What would you treat him with? A) Oral flucloxacillin B) Oral Vancomycin C) Trimethoprim D) Oral Co-amoxiclav E) Oral Metronidazole
E
You see a man on the ward who has been diagnosed with peritonitis. You are unable to culture, so what would you treat him with? A) 6 weeks IV Flucloxacillin B) Benzylpenicillin and clindamycin C) Oral Metronidazole D) Oral Co-amoxiclav E) IV Cefuroxime and metronidazole
E
Which of the following types of antibiotics, does not work by inhibiting cell wall synthesis? A) Glycopeptides B) Penicillins C) Macrolides D) Cephalosporins E) Carbapenems
C
A patient comes in presenting with minor hospital acquired pneumonia, thought to be due to E. Coli. His PMX includes recurrent chest infections, and a hypersensitivity reaction to amoxicillin. He is a smoker. What would you prescribe? A) Clarithromycin B) Co-Amoxiclav C) Gentamicin D) Flucloxacillin E) Benzylpenicillin
A
Which of the following antibiotics does not work by inhibiting protein synthesis? A) Erythromycin B) Doxycycline C) Gentamicin D) Flucloxacillin E) Chloramphenicol
D
Which of the following antibiotics does not work by inhibiting nucleic acid synthesis? A) Trimethoprim B) Doxycycline C) Rifampicin D) Metronidazole E) Ciprofloxacin
B
Which of these tests differentiates the types of streptococci? A) Haemolysis B) Catalase C) Coagulase D) Oxidase
A
Which of the following describes shigella?
A) Gram positive bacilli, non-lactose fermenting
B) Gram negative bacilli, lactose fermenting
C) Gram negative cocci, positive oxidase test
D) Non-lactose fermenting, negative oxidase test
D
Which of these is the most appropriate way of detecting viruses? A) Light microscopy B) Culturing C) PCR D) API strip
C
Chains of purple cocci are seen on a gram film. They don't grow near the optochin disc These are probably.. A) Streptococcus pneumoniae B) Staphylococcus epidermidis C) Viridans Streptococci D) S. pyogenes E) Neisseria meningitidis
A
A pink colony is picked off a MacConkey plate and is found to contain pink staining bacilli with Gram's staining. Which organism is most likely? A) Shigella sonnei B) Listeria monocytogenes C) Neisseria meningitidis D) Eschericia coli E) Streptococcus pyogenes
D
Which of the following is Haemophilus influenzae NOT an important cause of? A) meningitis in pre-school children B) Otitis media C) Pharyngitis D) Gastroenteritis E) Exacerbations of COPD
D
Which of these is NOT a means by which viruses cause disease?
A) direct destruction of host cells
B) cell proliferation and cell immortalisation
C) inducing immune system mediated damage
D) Endotoxin production
E) modification of host cell structure or function
D
The HIV envelope contains
A) RNA + capsid + DNA polymerase
B) DNA + capsid + RNA reverse transcriptase
C) DNA + p24 + RNA polymerase
D) RNA + capsid + RNA reverse transcriptase
E) RNA + gp120 + RNA polymerase
D
What is the definition of potency?
A) How well the ligand activates the receptor
B) Binding affinity of the drug for the receptor
C) Fraction of the drug that reaches systemic circulation unaltered
D) Binds to a receptor and activates it
E) Binds to a receptor and blocks its activation
B
What is the definition of efficacy?
A) How well the ligand activates the receptor
B) Binding affinity of the drug for the receptor
C) Fraction of the drug that reaches systemic circulation unaltered
D) Binds to a receptor and activates it
E) Binds to a receptor and blocks its activation
A
A patient presents with suspected paracetamol over dose. Which of the following would you not expect to find? A) Metabolic acidosis B) Hypoglycaemia C) Raised PTT D) Raised creatinine E) Decreased ALT
E
Which of the following is not an action of alpha-1 adrenoceptor activation?
A) Vasoconstriction
B) Increased closure of internal sphincter of bladder
C) Mydriasis
D) Increased peripheral resistance
E) Tachycardia
E
Which of the following is not an action of beta-2 adrenoceptor activation? A) Vasodilation B) Bronchodilation C) Increased glucagon release D) Relaxed uterine smooth muscle E) Increased release of renin
E
Which of the following is a beta-2 agonist? A) Tamsulosin B) Adrenaline C) LABA D) Cocaine E) Dopamine
C
Which of the following is an alpha-1 antagonist? A) Tamsulosin B) Adrenaline C) LABA D) Cocaine E) Dopamine
A
Which of the following is a COX-2 selective NSAID? A) Celecoxib B) Diclofenac C) Ibuprofen D) Naproxen E) Aspirin
A
A patient presents with hypertension and oedema caused by ischaemic heart disease. What would you prescribe? A) Ramipril B) Furosemide C) Candesartan D) Propranolol E) Atenolol
B
A drug given through IV route is assumed to have a bioavailability of.. A) 50% B) 75% C) 100% D) 10%
C
Which of the following processes do beta lactam antibiotics intefere with... A) Bacterial protein synthesis B) Bacterial cell wall synthesis C) Bacterial nucleic acid synthesis D) Viral protein synthesis
B
Which of the following is an irreversible enzyme inhibitor... A) Enalapril B) Aspirin C) Ibuprofen D) Salbutamol
B
Acromegaly is the overproduction of which pituitary hormone? A) Prolactin B) Growth hormone releasing hormone C) Growth hormone D) LH E) ACTH
C
Which of the following is not a cause of primary adrenal insufficiency? A) Addison's disease B) Steroids C) Surgical removal D) TB E) ACTH resistance
B
What cells produce catecholamines? A) Chromaffin cells B) C cells C) P cells D) Follicular cells E) Parafollicular cells
A
A 48-year-old man has a 4-month history of increasing fatigue and anorexia. He has lost 5.5 kg and noticed increased skin pigmentation. He has been otherwise healthy. His mother has Hashimoto’s thyroiditis and one of his sisters has type 1 diabetes. His blood pressure is 110/85 mmHg (supine) and 92/60 mmHg (sitting). His face shows signs of wasting and his skin has diffuse hyperpigmentation, which is more pronounced in the oral mucosa, palmar creases, and knuckles
What condition does this man likely have?
A) Conn’s syndrome
B) Type 1 diabetes
C) Addison’s disease
D) Cushings syndrome
E) Hypothyroidism
C
A 12-year-old girl is brought to the emergency department by her parents due to 12 hours of rapidly worsening nausea, vomiting, abdominal pain, and lethargy. Over the last week she has felt excessively thirsty and has been urinating a lot. Physical examination reveals a lean, dehydrated girl with deep rapid respirations, tachycardia, and no response to verbal commands.
What is the most likely condition she is suffering from?
A) Hyperosmolar-hyperglycaemic state
B) Diabetic Ketoacidosis
C) Adrenal crisis
D) Anaphylactic shock
E) Hypoglycaemia
B
A 34-year-old woman presents with complaints of weight gain and irregular menses for the last several years. She has gained 20 kg over the past 3 years and feels that most of the weight gain is in her abdomen and face. She notes bruising without significant trauma, difficulty rising from a chair, and proximal muscle wasting. She was diagnosed with type 2 diabetes and hypertension 1 year ago.
What is the most likely condition she is suffering from?
A) Addison’s disease
B) Cushing syndrome
C) Pheochromocytoma
D) Polycystic Ovary Syndrome
B
A 30-year-old female presented to you last week in an ill-fitting T-shirt and shorts, looking wide-eyed and fidgety. She said she is always hungry. What is her most likely diagnosis? A: Generalised Anxiety Disorder B: Pituitary tumour C: Hyperthyroidism D: Carcinoid Syndrome E: Hypothyroidism
C
Which of these is NOT a symptom of hypercalcaemia? A: Fractures B: Long QT C: Constipation D: Kidney stones E: Depression
B
A 45-year-old man presents to you complaining of joint pain and struggling to see out the corner of his eyes. He also says he is frequently urinating, even at night. What is the first line investigation for his possible disease? A: HBA1C B: Growth hormone levels C: CT head D: ILGF-1 Levels
B
A 28-year-old woman presents with frequent headaches and a white discharge from her nipple. Upon further questioning she hasn't had her period for 5 months. Her urine is negative for hCG. What is her most likely diagnosis? A: Pregnancy B: Malnutrition C: Prolactinoma D: Breast infection
C
What is the TFT profile of hypothyroidism caused by apoplexy (bleed in the pituitary)? A: high TSH, low T3/4 B: low TSH, high T3/4 C: Low TSH, Low T3/4 D: High TSH, high T3/4
A
What test can differentiate between Nephrogenic and neurogenic DI? A: Fluid restriction test B: glucose tolerance test C: ADH suppression test D: U and Es
C
A 66-year-old man with lung cancer has been rushed to hospital. He is unresponsive, with his wife saying he was confused and weak before having a seizure. She says that he hadn’t been to the toilet for some time. His U and Es showed low sodium and normal potassium. CT showed dilated ventricles and no lesions. What is his most likely possible diagnosis? A: Brain tumour B: SIADH C: hypothyroidism D: Addison’s disease
B
A 89-year-old person comes in with convulsions, a long QT and Paraesthesia. What else would you expect from this hypocalcaemic individual? A: Euphoria B: Tetany C: Renal stones D: Wt. gain
B
A 55-year-old woman comes in, saying she is feeling a bit down and cold all the time, which she puts down to losing the warmth of joy in her heart. She says the extra weight she has put on in recent months has not insulated her. She is struggling to pass stools. She has a history of Atopy and type 1 diabetes. Which is a likely diagnosis? A: depression B: hypothyroidism C: hypercalcaemia D: Addison’s disease
B
Which of the following antibodies is not typically present in type 1 diabetes? A) Anti-GAD B) Pancreatic islet autoantibodies C) Islet antigen-2 antibodies D) Anti-TPO
D
A 26 year old woman presents with suspected hypothyroidism. She has recently found out that she is pregnant. Which of the following is not a possible complication that could arise due to her hypothyroidism? A) Low birth weight B) Neonatal goitre C) Post-partum haemorrhage D) Eclampsia
D
Which of the following medications could be given to lower cortisol? A) Ketoconazole B) Carbimazole C) Levothyroxine D) Metformin E) Demeclocycline
A
Which of the following medications could be given to lower ADH? A) Ketoconazole B) Carbimazole C) Levothyroxine D) Metformin E) Demeclocycline
E
Which of the following is not a feature of diabetic ketoacidosis? A) Kaussmaul breathing B) Polyuria C) Dehydration D) Hypertension E) Tachycardia
D
A 16 year old patient presents with a failure to start puberty. You perform some blood tests, and she shows a decreased GnRH. What condition does she have? A) Kallmann's syndrome B) Carcinoid syndrome C) PCOS D) Endometriosis E) Klinefelter's syndrome
A
What hormone is secreted in carcinoid tumours? A) Aldosterone B) Serotonin C) Cortisol D) Thyroxine E) Prolactin
B
Which of the following does not cause diabetes? A) Acromegaly B) Cushing's C) Pheochromocytoma D) Glucocorticoid use E) SIADH
E
Which of the following substances increases appetite? A) PPY B) Lectin C) CCK D) GLP-1 E) Ghrelin
E
A patient presents with a fracture. He also reports having small testes and has a notably short stature. On examination, he has some breast growth, and on questioning, he reveals he has quite a low sex drive, and him and his partner have being trying to get pregnant for a few years without success. What test would you order?
A) Pituitary function tests
B) A blood test for the presence of an extra X chromosome
C) Pituitary MRI scan
D) Serum prolactin
E) Serum PSA
b
A patient is 180 cm and weighs 70kg. What is their BMI category? A) Underweight B) Normal weight C) Overweight D) Obese E) Morbidly obese
B
A patient is 186 cm and weighs 92kg. What is their BMI category? A) Underweight B) Normal weight C) Overweight D) Obese E) Morbidly obese
C
Which of the following is not typically a place that pituitary tumour metastasise to? A) Prostate B) Breast C) Lung D) Stomach E) Kidney
A
Which of the following antibodies is not typically raised in Graves' disease? A) TSHR-ab B) TPO antibodies C) Thyroglobulin antibodies D) Anti-GAD
D
Which of the following is not under control of the pituitary? A) Thyroid B) Adrenal cortex C) Adrenal medulla D) Testis E) Ovary
C
Which of the following statements is false?
A) The pituitary gland lies in the sella turcica
B) The weight of the pituitary gland is around 0.5g
C) ACTH is secreted from the pituitary during stress
D) The pituitary regulates calcium metabolism
E) The anterior and posterior pituitary are distinct on an MRI scan
D
In men all the following are mainly produced in the adrenal cortex except? A. DHEAS B. Testosterone C. Aldosterone D. 17-OH progesterone E. Androstenedione
B
Which of the following regarding AVP is false?
A. AVP levels have a linear relationship with serum osmolality
B. It is produced in the pituitary gland
C. It stimulates reabsorption of water in the collecting duct of the nephron
D. In hypotension baroreceptors predominantly activate ADH production and secretion
E. Further AVP production is no longer effective once urine osmolality has reached a plateau
B
Where is growth hormone’s main site of action to stimulate IGF1 release? A. Bone B. Liver C. Adrenal cortex D. Muscle E. Pancreas
B
The following are typical features of excess growth hormone secretion except? A. Polyuria B. Joint pains C. Sweating D. Hypotension E. Headaches
D
The following hormones all have a circadian rhythm except? A. Cortisol B. Testosterone C. DHEA D. 17OH progesterone E. Thyroxine (T4)
E
Typical features of cortisol deficiency include the following except? A. Hypotension B. Muscle aches C. Weight loss D. Hyperglycaemia E. Lethargy
D
A 38 year old lady presented with weight gain, menorrhagia and constipation. She is most likely to be suffering from? A. Cushing’s syndrome B. Addison’s disease C. Primary hypothyroidism D. Graves disease E. Acromegaly
C
Which test would you likely want to perform in a patient with proximal muscle weakness, purple striae and thin skin?
A. Synacthen test
B. Overnight dexamethasone suppression test
C. Insulin tolerance test
D. Glucagon test
E. Skin allergy tests
B
A 24 year old girl presented with hirsutism, oligomenorrhoea and acne. What test would you likely carry out from the ones below? A. Ultra sound adrenals B. Ultra sound ovaries C. MRI ovaries D. CT scan adrenals E. Prolactin
B
A 54 year old gentleman presented with hyponatraemia. All the following conditions need excluding before confirming SIADH except? A. Hypothyroidism B. Hypervolaemia C. Euvolaemia D. Adrenal insufficiency E. Diuretic use
C
A 66 year old gentleman had a serum sodium of 124 mmol/l, serum osmolality 265 mmol/l and a urine sodium of 52 mmol/l. What would you like to perform first?
A. Chest X-ray
B. CT brain
C. Skin turgor and jugular venous pressure test
D. Thyroid function tests
E. Synacthen test
C
The following are most likely causes of SIADH except? A. Multiple sclerosis B. Lung abscess C. Subdural haemorrhage D. Lymphoma E. Cerebrovascular accident
A
A 28 year old presented with a microprolactinoma. What is the most unlikely symptom? A. Galactorrhoea B. Oligomenorrhoea C. Decreased sexual appetite D. Headaches E. Visual field defects
E
The main adipose signal to the brain is A. CCK B. Neuropeptide y C. Leptin D. Agouti-related peptide E. Adiponectin
C
A 65 year old lady is diagnosed with SIADH. Her sodium is 123mmol/l. What is your first line of management?
A. If she is symptomatic I will treat with fluid restriction
B. If she is asymptomatic I will treat with hypertonic saline
C. If she is asymptomatic I will treat with fluid restriction
D. If she is asymptomatic I will repeat the sodium level the next day
E. If she is asymptomatic I will give normal saline
C
A patient with Addison’s disease presents with a chest infection. What do you do?
A. Omit his steroids to avoid immunosuppression
B. Stop his steroids as they have precipitated a chest infection
C. Double his steroid dose whilst unwell
D. Keep him on his usual steroid dose
E. Not of the above
C
The following tests are typical of secondary hypogonadism A. Low LH; High testosterone B. Low LH; Low testosterone C. High prolactin; high testosterone D. Low FSH; Low prolactin E. None of the above
B
Typical features of hypogonadism in a male include the following except: A. Decreased sweating B. Joint and muscular aches C. Decreased sexual appetite D. Decreased hair growth E. Asymptomatic
A
A patient has a noon testosterone level below the normal range. What will you do?
A. Treat with testosterone gel
B. Repeat the test at 0900h and check for symptoms
C. Repeat the test at noon to keep things equal
D. Refer to endocrinology
E. Ignore it
B
The first line treatment for a patient with a symptomatic prolactinoma is usually: A. Radiotherapy B. Transphenoidal surgery C. Dopamine agonists D. Transfrontal surgery E. Somatostatin analogues
C
Typical visual field defect of a patient with a large pituitary mass is A. Unilateral quadrantanopia B. Bitemporal hemianopia C. Complete unilateral visual field loss D. Complete bilateral visual field loss E. None of the above
B
Satiety is
A. The physiological feeling of no hunger
B. Inhibited by activation of POMC neurons
C. The physiological feeling of hunger
D. Induced by ghrelin release
E. Enhanced by Agoutirelated peptide
A
The centres of appetite regulation in the brain are mainly found in the: A. Pituitary B. Cerebellum C. Hypothalamus D. Basal ganglia E. Brain cortex
C
What type of enzyme converts T4 to T3 peripherally A) Deiodinases B) Triiodinases C) TPO D) Iodine Dehydrogenase
A
Which one of these would most likely be found in graves disease A) TSH high, T3 and T4 low B) TSH high, T3 and T4 high C) TSH low, T3 and T4 high D) TSH low, T3 and T4 low E) TSH, T3 and T4 normal
C
Which one of these is not a symptom of hyperthyroidism A) Diarrhoea B) Weight loss C) Palpitations D) Cold intolerance E) Irritability
D
Which condition is characterised by a diffusely reduced uptake on a radioiodine scan of the thyroid A) Grave's B) Toxic adenoma C) De Quervain's thyroiditis D) Iodine deficiency
C
A patient presents with feeling very down. He thinks that this low mood could be related to the changes he has noticed to his body, including weight gain around his tummy, acne, and dark purple stretch marks. What investigation would you order?
A) Overnight dexamotheasone suppression test
B) Plasma aldosterone: renin ratio
C) HbA1c
D) Plasma GH levels
E) Thyroid function testing
A
You are looking through a patients results that have just been sent to you. They show that the patient had an overnight dexomethasone suppression test, and had no suppression. What medication would you prescribe? A) Ketoconazole B) Spironlactone C) Demeclocycline D) Lanreotide E) Metformin
A
A 30 year old man presents with hypertension. He had been started on an ACE-Inhibitor a few weeks ago but his blood pressure has not improved, and he has noticed some weakness and cramps. What is a likely diagnosis? A) Atherosclerosis B) Cushing's syndrome C) Conn's syndrome D) Phaeochromocytoma
C
A 30 year old man presents with hypertension. He had been started on an ACE-Inhibitor a few weeks ago but his blood pressure has not improved, and he has noticed some weakness and cramps. What investigations would you order?
A) Plasma aldosterone:Renin ratio and serum K+
B) Serum Na+ and urine Na+
C) Overnight dexamethasone suppression test
D) Thyroid function testing
E) CT angiogram
A
An alcoholic man has recently started a detox regime. However, he has noticed a significant loss of appetite, weakness, confusion, and aching pains. He attends the GP practice after he had a fit in his home. You order some tests, and everything is normal except for a low sodium. How would you treat? A) Laproscopic adrenalectomy B) Radioactive iodine C) Loop diuretic D) Immediate ABC E) Restrict fluids and demeclocycline
E
A 56-year-old man presents with a headache, decreased libido, excessive sweating and snoring. On examination, he has macroglossia and slight visual disturbances. What investigation would you order?
A) Plasma aldosterone:Renin ratio and serum K+
B) Serum Na+ and urine Na+
C) Overnight dexamethasone suppression test
D) Thyroid function testing
E) Glucose tolerance testing
E
Which of the following is not a typical complication of diabetes? A) Staph skin infections B) Retinopathy C) Erectile dysfunction D) Addison's disease E) Candida infection
D
A man presents to A&E with decreased consciousness, and severe dehydration. He has hyperglycaemia and glycosuria on dipstick. He has a past medical history of T2DM, and angina. How would you treat?
A) Low flow insulin and heparin
B) Oral sugar and long acting starch
C) Watch and wait
D) IV hydrocortisone and replace steroids
E) Oral carbimazole and oral propanolol
A
Which of the following does not cause hypoglycaemia? A) Pituitary insufficiency B) Liver failure C) Addison's disease D) Hyperthyroidism E) Exogenous drugs
D
A woman presents with low mood and a new tanned pigmentation of the skin. She also has amenorrhoea and constipation. What test would you order?
A) Plasma aldosterone:Renin ratio and serum K+
B) Short ACTH stimulation test
C) Overnight dexamethasone suppression test
D) Thyroid function testing
E) Glucose tolerance testing
B
Which of the following is the most common cause of Addison's disease worldwide? A) Autoimmune adrenalitis B) TB C) Adrenal metastases D) Long term steroid use E) Opportunistic infections
B
A patient presents with lid lag, palmar erythema, diarrhoea and heat intolerance. What would you give first for rapid control of symptoms? A) Propanolol B) Carbimazole C) Propylthiouracil D) Radioactive iodine E) Potassium iodide
A
You are looking through a patients results that have just been sent to you. It shows raised TSH receptor stimulating antibodies. What do you diagnose? A) Carcinoid Syndrome B) Grave's disease C) Hashimoto's thyroiditis D) Toxic multinodular goire E) de Quervain's thyroiditis
B
You are looking through a patients results that have just been sent to you. Their ECG shows tall tented T waves, small P waves and a wide QRS. What do they have? A) Hyperkalaemia B) Hypernatraemia C) Hypercalcaemia D) Hypokalaemia E) Hypocalcaemia
A
Which of the following does not cause hypokalaemia? A) Thiazide diuretics B) Increased aldosterone C) AKI D) Diarrhoea E) Salbutamol
C
You are looking through a patients results that have just been sent to you. They have a low PTH, with normal skeletal appearance. What do they have? A) Hypoparathyrodism B) Pseudohypoparathyrodisim C) Pseudopseudohypoparathyroidism D) Pituitary tumour E) None of the above
A
What is the most common cause of hypocalcaemia? A) Vitamin D deficiency B) diGeorge syndrome C) Bisphosphonates D) CKD E) Calcitonin
D
A patient is being prescribed oral desmopressin. What condition do they likely have? A) Nephrogenic diabetes insipidus B) SIADH C) Cranial diabetes insipidus D) Diabetes mellitus type 1 E) Diabetes mellitus type 2
C
What is the most common type of thyroid carcinoma? A) Papillary B) Follicular C) Anaplastic D) Lymphoma E) Medullary cell
A
A 58 year old man has been admitted to the general medical ward with abdominal pain and fluctuating consciousness. On examination he has shifting dullness and yellowing of sclera. A social history has been taken and he has been started on a reducing regime of diazepam. Blood tests have been undertaken, which show: Hb 92 g/l (normal 135-180), MCV 130fl (80-102fl), platelet count 145 (140-450). What is the most likely cause for this patient’s anemia?
A) Autoimmune pernicious anaemia
B) Malabsorption causing folate deficiency
C) Iron deficiency anaemia
D) Anaemia of chronic disease
E) Chronic excess alcohol
E
A 4 year old boy came to clinic to have bloods taken for a check-up following a recent stay in hospital with a chest infection. However, following venipuncture, his mother has noticed that he bled for quite some time. On examination you also notice multiple petechiae on his legs, without any history of significant trauma. Mum remembers that her brother had the same problem when he was young. Blood tests show PT 12 seconds (normal 11-14), APTT 55 seconds (normal 29-39) & fibrinogen 2.2g/l (normal 1.9-4.3). Von Willebrand factor is normal. Factor VIII assay is reduced, whilst factor IX is normal. What is the most likely cause of the above presentation? A) Non Accidental Injury B) Ehlers-Danlos syndrome C) Von Willebrand Disease D)Hemophilia A E) Hemophilia B
D
A 68 year old man has presented with progressive shortness of breath, fatigue and worsening pain in his left leg and back. He has lost 2 stone of weight in the past year. On his last appointment it was noted that his renal function was deranged. Routine bloods show Hb 104g/l (normal 135-180), MCV 93fl (normal 80-102fl), WCC 2.8 (normal 3.4-11.0). Which of the following investigations would be most useful initially in finding the source of his symptoms?
A) Abdominal ultrasound
B) Lumbar spine X ray
C) Blood film
D) Urine electrophoresis (Bence Jones protein)
E) DEXA Scan
D
A 7 year old girl has presented with petechiae on her knees and shins as well as frequent nosebleeds. She had a viral infection 2 weeks ago from which she apparently recovered. She appears clinically well in herself, with no temperature. She has no joint pain. PT, APTT, vW factor, factor VIII and factor IX are all normal. Her platelets are 100 (140-450). What is the most likely cause of these findings? A) Meningococcal septicaemia B) Henoch-Schonlein purpura C) Idiopathic thrombocytopenic purpura D) Von Willebrand’s disease E) Non-accidental injury
C
A 19-year-old female presents to the GP with a one-week history of fever, numbness, and difficulty speaking. She has never experienced anything like this before, and takes no medication. On examination, splenomegaly is noted as well as several purpura on her extremities. Bloods reveals normocytic anemia, decreased platelets, and elevated creatinine. What is the most likely diagnosis?
A) Disseminated intravascular coagulation
B) Drug-induced thrombocytopenia
C) Haemolytic uraemic syndrome
D) Immune thrombocytopenic purpura
E) Thrombotic thrombocytopenia purpura
E
A four-year-old boy presents to the GP surgery with his mother. He has been feeling unwell for the past 3 weeks, with fevers, headaches and tiredness. His mother is concerned that he has been getting worse over time instead of better. He looks very pale and has many bruises and petechiae on his arms and legs, which have appeared spontaneously over the past week. Abdominal examination reveals an enlarged liver and spleen. An urgent full blood count shows: haemoglobin 68g/L (normal 120-180), platelets 25 (normal 150-450), white cell count 83 (normal 3.4-11.0). What is the most likely diagnosis in this child? A) Acute lymphoblastic leukaemia B) Aplastic anaemia C) Epstein-Barr virus D) Idiopathic thrombocytopenic purpura E) Lymphoma
A
A 6-month-old baby boy born to Pakistani parents presents with failure to thrive. He is found to have pallor and hepatosplenomegaly. His FBC shows Hb 78 g/l (99–141), MCV 65 fl (71–84) and MCH 18 pg (24–34). His blood film shows hypochromia, microcytosis and some nucleated red blood cells. Serum ferritin is 25 μg/l (14–200). What is the most likely diagnosis A) β thalassaemia B) Congenital dyserythropoietic anaemia C) Congenital sideroblastic anaemia D) Iron deficiency anaemia E) Lymphoma
A
A 63-year-old man with rheumatoid arthritis has come in complaining about tiredness and fatigue. His blood tests show an Hb of 98 g/l (low) and an MCV of 78 fl ( 80-100). His serum iron and TIBC are low and his serum ferritin is 115 μg/l (15–200). The most likely diagnosis is: A) Iron deficiency Anemia B) Acquired sideroblastic anemia C) Anemia of chronic disease D) Aplastic Anemia E) β thalassemia trait
C
A 59-year-old woman presents with fatigue. Her FBC shows WBC 4.8 × 109 /l(normal), Hb 93 g/l (low), MCV 115 fl(80-100). Her blood film shows macrocytes and hypersegmented neutrophils. She has a past history of Hashimoto thyroiditis. What is the most appropriate test to confirm the diagnosis you suspect?
A) Beta cell antibodies
B) Intrinsic factor antibodies and Parietal cell antibodies
C) Adrenal antibodies
D) Plasma homocysteine
E) Serum iron levels
B
A 1-year-old boy presents with sudden-onset fever and vomiting. Findings include irritability, tachycardia, pallor, cold extremities, diffuse skin rash with abdominal petechiae, signs of meningeal irritation and is hypotensive. He is bleeding from the IV sites. Blood tests show leukocytosis, markedly decreased platelet count, increased prothrombin time (PT) and partial thromboplastin time (APTT), decreased fibrinogen, elevated fibrin degradation products, elevated urea, and metabolic acidosis. What is the most likely diagnosis?
A) Hemolytic Uremic Syndrome
B) Thrombotic Thrombocytopenic Purpura
C) Disseminated Intravascular Coagulation
D) ITP
E) Von Willebrand Disease
C
A 20-year-old female student is referred by her GP to your specialist clinic because she has felt unwell for the past two weeks. She has had a sore throat and felt very fatigued. On examination she seems pale, her throat is inflamed, and she has swollen cervical lymph nodes. You examine her abdomen and find a palpable spleen just below the left costal margin. Her blood tests show low hemoglobin, elevated LDH and bilirubin and a positive Direct Coombs Test for complement on the surface of cells. What is the most likely diagnosis
A) Autoimmune Hemolytic Anemia
B) Hemolytic uremic syndrome
C) Disseminated intravascular coagulation
D) Malaria
E) Paroxysmal nocturnal hemoglobinuria
A
A 16-year-old boy presents to his GP complaining of nosebleeds and bleeding after brushing his teeth. He is unsure of how long this has been occurring but decided to seek advice after having to continually excuse himself from lessons. On examination you notice he has some skin bruises. A blood test shows a prolonged bleeding time and activated partial thromboplastin time (APTT), while platelet count and prothrombin times are all normal. The most likely diagnosis is:
A) Von Willebrand disease
B) Liver disease
C) Disseminated intravascular coagulation
D) Congenital afibrinogenaemia
E) Glanzmann’s thrombasthenia
A
A 33-year-old man travels to South Africa to take part in a safari. On arriving, the patient takes his antimalarial tablets. A few days into his course he becomes ill complaining of shortness of breath, pallor and bloody urine. Blood tests reveal anemia and reduced hematocrit, while a blood smear shows the presence of Heinz bodies. The most likely diagnosis is:
A) Hereditary elliptocytosis
B) Glucose-6-phosphate dehydrogenase deficiency
C) Hereditary spherocytosis
D) Autoimmune hemolytic anemia
E) Microangiopathic hemolytic anemia
B
A 65-year-old man presents to you reporting he has become increasingly worried about his lack of energy in the last 2 weeks. He mentions he has been increasingly tired, sleeping for long periods and has suffered from fevers unresponsive to paracetamol. He became increasingly worried when he noticed bleeding originating from his gums. A blood film shows rod like inclusion bodies in granular blast cells. The most likely diagnosis is:
A) Acute lymphoblastic leukemia
B) DiGeorge syndrome
C) Disseminated intravascular coagulation
D) Acute myeloid leukemia
E) Afibrinogenemia
D
A 47-year-old woman presents complaining of dark stools and painful fingers on both hands. She appears plethoric and complains of severe itching, often when she takes a hot shower. A large liver and spleen is palpable. You measure red cell mass which is raised but EPO levels were decreased. Which of the following is likely to be the diagnosis? A) Anemia of chronic disease B) AML C) Polycythemia Rubra Vera D) ALL E) Pyruvate-Kinase deficiency
C
A 55 year old man presents with fatigue. He has had several episodes of haematemesis in the past 48 hours. He has a history of alcoholic cirrhosis and is being treated for ascites and encephalopathy. OE he has a HR of 85bpm and BP 84/62. What is the most likely cause of his fatigue? A) Excess alcohol intake B) Azathioprine use C) Acute blood loss D) Lead poisoning E) Haemolysis
C
A 45 year old woman presents with symptoms of fatigue, depression and weight gain. OE she has a heart rate of 58bpm, dry skin and bilateral eyelid oedema. FBC reveals a macrocytic anemia. What is the likely cause of the anemia? A) Iron deficiency B) B12 deficiency C) Alcohol D) Hypothyroidism E) Lead poisoning
D
A 62 year old male presents to his GP for his annual review. He denies any weight loss, fevers or fatigue. Bloods are taken and show an elevated WBC, predominantly lymphocytes. On blood smear, ruptured white blood cells are seen. What is the most likely diagnosis? A) CLL B) AML C) Hodgkin’s lymphoma D) ALL E) Myeloma
A
Which of the following drugs works by inhibiting CD20? A) Doxorubicin B) Bleomycin C) Vincristine D) Rituximab E) Cyclophosphamide
D
"An accumulation of mature B cells that have escaped apoptosis and undergone cell cycle arrest" A) CLL B) CML C) ALL D) AML
A
"Blood count would show low/normal Hb, very high WCC with high lymphocytes, smudge cells in vitro" A) CLL B) CML C) ALL D) AML
A
"Uncontrolled clonal proliferation of myeloid cells due to Philladelphia chromosome" A) CLL B) CML C) ALL D) AML
B
"Blood count would show low Hb, very high WCC with high neutrophils, basophils and eosinophils." A) CLL B) CML C) ALL D) AML
B
"Treated using Imatinib (a tyrosine kinase inhibitor) or stem cell transplant" A) CLL B) CML C) ALL D) AML
B
"A cancer of childhood" A) CLL B) CML C) ALL D) AML
C
"Malignancy of immature lymphoid cells= Usually B cell precursors if in children" A) CLL B) CML C) ALL D) AML
C
"Neoplastic proliferation of blast cells derived from marrow myeloid" A) CLL B) CML C) ALL D) AML
D
A 39 year old man presents with a three month history of lethargy, fatigue and night sweats. On examination you note enlarged, painless cervical lymph nodes and splenomegaly. Blood tests show Hb 103 g/l (normal 135-180g/l), WCC 12.0 (normal 3.4-11), ESR 70 (<12). Histologically multinucleated giant cells (Reed-Sternberg cells) are noted. What is the most likely cause of this patient’s symptoms? A) Burkitt’s Lymphoma B) Hodgkin’s Lymphoma C) Chronic Myeloid Leukemia D) Non-Hodgkin’s Lymphoma E) Tuberculosis
B
A 58 year old man has been admitted to the general medical ward with abdominal pain and fluctuating consciousness. On examination he has shifting dullness and yellowing of sclera. A social history has been taken and he has been started on a reducing regime of diazepam. Blood tests have been undertaken, which show: Hb 92 g/l (normal 135-180), MCV 130fl (80-102fl), platelet count 145 (140-450). What is the most likely cause for this patient’s anemia?
A) Autoimmune pernicious anaemia
B) Malabsorption causing folate deficiency
C) Iron deficiency anaemia
D) Anaemia of chronic disease
E) Chronic excess alcohol
E
Which of the following blood types is the most common A) A+ B) B+ C) AB+ D) O+ E) None of the above
D
Angular stomatitis, lemon-yellow skin, ataxia and delusions are hallmarks of which type of anaemia? A) Pernicious anaemia B) Iron deficiency anaemia C) Anaemia of chronic disease D) Blood loss anaemia E) Sickle cell anaemia
A
You are a junior doctor on your haematology rotation. You have just seen a 50 year old woman who presented with anaemia, gum hypertrophy and bone pain. You do a full blood count which shows thrombocytopaenia and neutropoenia. A bone marrow biopsy shows Auer rods. What would you treat this woman for? A) ALL B) AML C) CLL D) CML E) None of the above
B
You are an F2 on a tropic medicine rotation. You are seeing a patient who has recently been on holiday to Asia and is now complaining of nausea, loss of appetite, abdominal pain and some weight loss. Her symptoms started 6 weeks after returning to the UK. You perform some tests and diagnose tapeworm.
Which of the following would you expect to see?
A) Neutrophilia
B) Neutropenia
C) Eosinophilia
D) Lymphocytosis
E) Lymphocytopenia
C
You are looking through a patients results that have just been sent to you. They show microcytic red blood cells, a low serum iron, and high transferrin receptors. What do you diagnose?
A) Autoimmune pernicious anaemia
B) Malabsorption causing folate deficiency
C) Iron deficiency anaemia
D) Anaemia of chronic disease
E) Chronic excess alcohol
C
A 24 year old woman presents with brittle hair and nails, headaches, and ulceration at the courner of the mouth. What is it most likely to be?
A) Autoimmune pernicious anaemia
B) Malabsorption causing folate deficiency
C) Iron deficiency anaemia
D) Anaemia of chronic disease
E) Chronic excess alcohol
C
Which of the following is not a cause of normocytic anaemia A) Acute blood loss B) Anaemia of chronic disease C) Pregnancy D) Liver failure E) Hypothyroidism
D
What is the most common cause of anaemia world wide?
A) Autoimmune pernicious anaemia
B) Malabsorption causing folate deficiency
C) Iron deficiency anaemia
D) Anaemia of chronic disease
E) Chronic excess alcohol
C
A patient presents with anaemia. They have yellowing of the skin, and have a past medical history of Addison's disease. How would you treat? A) Ferrous sulphate B) Erythropoietin C) IM Hydroxocobalamin D) IV iron E) Oral B12
C
A 64 year old man presents with a pain in his leg. It is swollen, red and there are enlarged veins. He has recently travelled back from USA. What would be your first line investigation? A) Plasma D dimer B) X Ray C) Aspiration D) Blood culture E) FBC
A
A 64 year old man presents with a pain in his leg. It is swollen, red and there are enlarged veins. He has recently travelled back from USA. How would you treat? A) Oral Imatinib B) Allopurinol C) Prednisolone D) Bed rest E) Enoxaparin and warfarin
E
A patient presents with painless 'rubbery' cervical lymphadenopathy, but no other symptoms. On CT, they appear to have tumour spread to multiple lymph nodes; the axillary lymph nodes, the cervical lymph nodes and the inguinal lymph nodes. What Ann Harbor stage are they at? A) IA B) IB C) IIA D) IIIA E) IIIB
D
A patient presents with painless 'rubbery' cervical lymphadenopathy, but no other symptoms. On CT, they appear to have tumour spread to multiple lymph nodes; the axillary lymph nodes, the cervical lymph nodes and the inguinal lymph nodes. What chemotherapy regime would you use? A) ABVD B) RCHOP C) VAD D) ECF E) CMV
A
A 72 year old patient presents with hypercalcaemia, thirst, fatigue and back pain. What tests would you order?
A) CT of chest
B) Bone marrow aspirate
C) Serum and urine electrophoresis for bence jones protein and B-12 microglobulin
D) Genetic screen for JAK2 mutation
E) Coagulation screen
C
A 72 year old patient presents with hypercalcaemia, thirst, fatigue and back pain. What chemotherapy regime would you use? A) ABVD B) RCHOP C) VAD D) ECF E) CMV
C
Which type of immunoglobulin is most commonly used in myeloma? A) IgA B) IgG C) IgM D) IgD E) IgE
B
A patient is positive for JAK2 mutation. What condition is this associated with? A) Multiple Myeloma B) Burkitt's lymphoma C) Thalassemia D) Polycythaemia vera E) G6PD Deficiency
D
A 68 year old patient presents with headaches and tiredness. On questioning, she also reveals that she often gets burning sensations in her fingers, and feels very itchy after having a hot bath. When you examine her, she has hepatosplenomegaly and hypertension. How would you treat? A) Radioactive phosphorus B) Venesection C) Warfarin D) Stem cell transplant E) Fresh frozen plasma
B
What would spherocytes and a negative direct Coombs' test be indicative of? A) Drugs e.g. NSAIDs B) Autoimmune haemolytic anaemia C) Hereditary spherocytosis D) Thrombotic thrombyctopenia E) DIC
C
What is haemolytic anaemia associated with? A) Bite cells B) Blister cells C) Heinz Bodies D) Popcorn cells E) Fragmented red blood cells
E
A patient presents with a rash and fever. They appear confused. On blood tests, they show fragmented red blood cells, and a raised lactate dehydrogenase. What is it likely to be? A) ITP B) TTP C) SLE D) DIC E) Thalassemia
B
How would you treat thrombotic thrombocytopenic purpura?
A) Plasma exchange
B) Splenectomy
C) IV immunoglobulins
D) Folic acid and BMT if severe
E) Replace platelets, plasma and fibrinogen
A
How would you treat immune thrombocytopenic purpura?
A) Plasma exchange
B) Corticosteroids
C) Chemotherapy
D) Folic acid and BMT if severe
E) Replace platelets, plasma and fibrinogen
B
A patient presents with fatigue and headaches. She also reports pain in the hands and feet, and this appears worse on cold days. How would you treat her?
A) Plasma exchange
B) Corticosteroids
C) Chemotherapy
D) Folic acid and BMT if severe
E) Replace platelets, plasma and fibrinogen
D
A woman has just had an emergency C section. Afterwards, the midwife notices that she seems pale, confused and is bleeding from her IV sites and nose. What is it likely to be? A) ITP B) TTP C) SLE D) DIC E) Thalassemia
D
How would you treat warfarin overdose? A) Protamine sulfate B) Phytomenadione C) N-acetylcysteine D) Activated charcoal E) Fomepizole
B
John, a 56 year-old male, is recovering chemotherapy treatment for his Acute Myeloid Leukaemia. You perform a blood test which reveals hyperkalaemia, hyperuricemia, hyperphosphatemia, hypocalcaemia. What condition has john developed? A) Anaemia of chronic disease B) Mucositis C) Hand-foot syndrome D) Tumour lysis syndrome E) Multiple myeloma
D
Which of the following is not a common side effect of ferrous sulphate? A) Nausea B) Black stools C) GI Upset D) Abdominal discomfort E) Headaches
E
Camilla is a 25 year old lady who has just returned home from visiting Ghana. She presents with very generic flu-like symptoms (fever, headache, cough) and is concerned that something is wrong. Whilst taking her history, you learn that she suffered from many mosquito bites during her trip.
What investigation would you organise to confirm your diagnosis?
A) FBC
B) Thick and thin blood smears
C) Coagulation factors
D) X Ray
E) BLood culture
B
You are an F1 who sees a 5 year-old patient. His mother tells you that he has recently had a lot of nosebleeds and feels tired all the time. What is it likely to be? A) ITP B) TTP C) SLE D) DIC E) Thalassemia
A
Which of the following is not typically present on pulmonary embolism X ray? A) Westermark sign B) Palla's sign C) Kernig's sign D) Hampton's hump E) Melting sign
C
A patient with recently diagnosed heart failure comes to your GP practice for a check-up and medication review. He tells you that he has felt a little weaker and more tired than usual recently. His current medications include: Furosemide, Ramipril, Bisoprolol
His blood results show: Sodium: 142 (135-145) Potassium: 2.4 (3.5-5.5)
Which of the following drugs is the most likely cause of the electrolyte abnormality?
a) Furosemide
b) Ramipril
c) Bisoprolol
d) None of the above
A
A patient with recently diagnosed heart failure comes to your GP practice for a check-up and medication review. He tells you that he has felt a little weaker and more tired than usual recently. His current medications include: Furosemide, Ramipril, Bisoprolol
His blood results show: Sodium: 142 (135-145) Potassium: 2.4 (3.5-5.5)
Which of the following diuretics is most appropriate?
A) Furosemide
B) Bendroflumethiazide
C) Spirolactone
D) Verapamil
c
A patient presents to A and E following an episode where they lost consciousness. They were alone so are unsure how long they were out for. On questioning, you find out that the episode was preceded by palpitations, dizziness and shortness of breath, and that they have a family history of ‘heartbeat problems’.
You perform an ECG, which shows a sawtooth pattern.
What is the most likely diagnosis?
A) Atrial fibrillation
B) Atrial flutter
C) Mobitz II heart block
D) Tachycardia
B
You are a junior doctor and see a 26 year old woman who came to A&E complaining of chest pain. She has a past medical history of type 1 diabetes, and has a family history of rheumatoid arthritis. You decide to perform an ECG, and whilst you’re placing the leads you notice a widespread rash on the patient’s cheeks, neck and chest, which she says gets worse after she’s been in the sun.
The ECG shows widespread saddle-shaped ST elevation.
What is the likely cause of her chest pain?
A) STEMI
B) Infective Endocarditis
C) Prinzmetal Angina
D) Pericarditis
D
You are a junior doctor and see a 26 year old woman who came to A&E complaining of chest pain. She has a past medical history of type 1 diabetes, and has a family history of rheumatoid arthritis. You decide to perform an ECG, and whilst you’re placing the leads you notice a widespread rash on the patient’s cheeks, neck and chest, which she says gets worse after she’s been in the sun.
The ECG shows widespread saddle-shaped ST elevation.
What is the most likely underlying cause?
A) Type 1 Diabetes Mellitus
B) Rheumatoid arthritis
C) Systemic Lupus Erythematosus
D) Mycobacterium Tuberculosis
C
22 year old presents to the GP saying sometimes he experiences ‘his heart racing’ and he gets really dizzy. He sometimes gets chest pain during these episodes. His dad and grandad both died in their twenties/thirties, but he doesn’t remember what from, and he is scared that he has the same condition.
Which of the following differential diagnoses is the most common cause of sudden cardiac death in young people?
A) Restrictive cardiomyopathy
B) Dilated cardiomyopathy
C) Hypertrophic cardiomyopathy
D) Pericarditis
C
You are the on-call doctor for the cardiology ward, and the dental hospital sends you an urgent referral for a patient who they are treating for gum disease, who has signs of sepsis. The patient is a known intravenous drug user.
What diagnosis springs to mind without even seeing the patient?
A) Pericarditis
B) Infective endocarditis
C) NSTEMI
D) Rheumatic fever
B
You are the on-call doctor for the cardiology ward, and the dental hospital sends you an urgent referral for a patient who they are treating for gum disease, who has signs of sepsis. The patient is a known intravenous drug user.
Which of the following signs would help towards your diagnosis
A) Splinter haemorrhages
B) Roth spots
C) Neither
D) Both
D
You take blood cultures for a patient with infective endocarditis, which show MRSA growth. What antibiotics do you use? A) Rifampicin B) Vancomycin + Rifampicin C) Erythromycin + Vancomycin E) Amoxicillin
B
Mrs S is a 56-year-old woman who comes to GP complaining of increased fatigue and palpitations. On examination, you hear a pansystolic murmur at the apex that radiates into the axilla. Which pathology causes this murmur? A) Mitral stenosis B) Aortic stenosis C) Mitral regurgitation D) Aortic regurgitation
C
Mrs S is a 56-year-old woman who comes to GP complaining of increased fatigue and palpitations. On examination, you hear a pansystolic murmur at the apex that radiates into the axilla. When you ask about previous episodes of palpitations, Mrs S tells you that when she was around 12 and still lived in India, she did experience palpitations, fever and a rash on her torso which she thinks happened around 3 weeks after she had a sore throat.
What was the likely cause of her childhood illness?
A) Infective endocarditis
B) Rheumatic fever
C) Scarlet fever
D) Hypertension
B
Which of the following is a Lancefield Group A, Beta-Haemolytic streptococcus. A) Streptococcus pyogenes. B) Streptococcus pneumoniae C) Streptococcus bovis D) Streptococcus aureus
A
What is the Wells score used for? A) Assessment of risk for DVT or PE B) Risk of developing cardiovascular disease in the next 10 years C) Risk of stroke after TIA D) Risk of mortality in ICU E) Severity of pneumonia
A
What is the QRISK score used for? A) Assessment of risk for DVT or PE B) Risk of developing cardiovascular disease in the next 10 years C) Risk of stroke after TIA D) Risk of mortality in ICU E) Severity of pneumonia
B
What is the ABCD2 score used for? A) Assessment of risk for DVT or PE B) Risk of developing cardiovascular disease in the next 10 years C) Risk of stroke after TIA D) Risk of mortality in ICU E) Severity of pneumonia
C
What is the apache score used for? A) Assessment of risk for DVT or PE B) Risk of developing cardiovascular disease in the next 10 years C) Risk of stroke after TIA D) Risk of mortality in ICU E) Severity of pneumonia
D
What is the CURB65 score used for? A) Assessment of risk for DVT or PE B) Risk of developing cardiovascular disease in the next 10 years C) Risk of stroke after TIA D) Risk of mortality in ICU E) Severity of pneumonia
E
Which of the following is not a true stage of the fontaine classification? A) Asymptomatic B) Intermittent claudication C) Rest pain D) Oxygen debt E) Necrosis
D
What would be the first-line treatment for a 49-year-old Caribbean male with a BP of 148/96? A) Ramipril B) Amlidopine C) Candesartan D) Hydrochlorothiazide E) Furosemide
B
What would be the first-line treatment for a 46-year-old white male with a BP of 148/96? A) Ramipril B) Amlidopine C) Candesartan D) Hydrochlorothiazide E) Furosemide
A
What would be the first-line treatment for a 46-year-old white male with a BP of 148/96. He has severe asthma. A) Ramipril B) Amlidopine C) Candesartan D) Hydrochlorothiazide E) Furosemide
C
Which of the following arteries does not typically get atherosclerosis? A) Ascending aorta B) Cerebral C) Common iliac D) Coronary E) Carotid
A
A 69-year-old man presents to you with shortness of breath, tiredness and swelling in his ankles. Which of the following blood test abnormalities would you expect to see? A) Low haemoglobin and reticulocytes B) Bence jones protein band C) Increased BNP D) Raised plasma D dimer E) CRP and ESR raised
C
What is the commonest cause of heart failure? A) Ischaemic heart disease B) Cardiomyopathy C) Valvular heart disease D) Hypertension E) Cor pulmonale
A
What is the most common congenital heart defect? A) Tetralogy of Fallot B) Ventricular septal defect C) Patent ductus arteriosus D) Atrial septal defect E) None of the above
B
Which of the following is not one of the components of tetralogy of fallot?
A) A large, maligned ventricular septal defect
B) An overriding aorta
C) RV outflow obstruction
D) Stenosis of aortic valves
E) RV hypertrophy
D
A 3 day old baby is brought into A&E as baby's mother is concerned that baby's tummy has a blue tinge. She also appears distressed and doesn't want to eat. You order an X ray, and it shows a boot shaped heart. What is it likely to be? A) Tetralogy of Fallot B) Ventricular septal defect C) Patent ductus arteriosus D) Atrial septal defect E) None of the above
A
A patient presents with a tight pain in the chest that radiates to the jaw. This pain lasted around 15 minutes, and when the patient sat back down the pain dissipated. However when walking into the GP surgery today, the pain returned. What investigation would you order? A) CXR B) Echocardiogram C) FBC and BNP D) CT coronary angiography E) Abdominal MRI
D
A 65 year old man has just had his abdominal aortic aneurysm screen, and the ultrasound doctor noted an aneurysm that is roughly 5cm diameter. How would you treat? A) Endovascular stent B) Urgent antihypertensives C) Watch and wait D) GTN Spray E) Coronary revascularisation
C
How are abdominal aortic aneurysms screened for? A) Ultrasound B) MRI C) CT D) Abdominal X ray E) Echocardiogram
A
A 58 year old man presents with a sudden onset of severe central chest pain. He appears shocked and after some initial tests, you note that alongside the main problem, he has AKI and hypertension. His ECG all appears normal. What investigation would you order? A) Echocardiogram B) CT chest and abdomen C) Abdominal ultrasound D) CT coronary angiography E) ECG
B
A 58 year old man presents with a sudden onset of severe central chest pain. He appears shocked and after some initial tests, you note that alongside the main problem, he has AKI and hypertension. His ECG all appears normal. What is it likely to be? A) Aortic aneurysm B) Aortic dissection C) Angina D) Acute pericarditis E) Infective endocarditis
B
Which of the following is not part of the steps of immediate management of ACS? A) Morphine/ other analgesic B) Statins C) Nitrate D) Aspirin 300mg stat E) Clopidogrel
B
A patient presents with central chest pain that radiates. Their ECG shows ST elevation. What would your treatment of choice be? A) Fondaparinux B) Clopidogrel C) PCI D) Nitrate E) None of the above
C
A patient presents with central chest pain that radiates. Their ECG shows ST depression but normal troponins. What is it likely to be? A) STEMI B) NSTEMI C) Unstable angina D) Stable angina E) Aortic dissection
C
Which of the following is not typically given for ACS prevention? A) ACE-I B) Clopidogrel C) Atorvastatin D) Aspirin E) Nitrate
E
Which of the following is not a common complication of ACS? A) Sudden death B) Rupture of myocardium C) Oedema D) Increased risk of aortic dissection E) Arrhythmias
D
A 67 year old man presents with chest pains and palpitations. You perform an ECG and it shows an irregular and rapid QRS complex with absent P waves. What is it likely to be? A) Atrial flutter B) Atrial fibrillation C) Ventricular tachycardia D) Long QT E) Sinus Tachycardia
B
Which of the following is most likely to be seen in atrial flutter?
A) Irregular and rapid QRS complex with absent P waves
B) Regular sawtooth-like F waves
C) Rapid ventricular rhythm
D) Prolonged QT interval
E) Saddle shaped ST elevation
B
Which of the following is most likely to be seen in atrial fibrillation?
A) Irregular and rapid QRS complex with absent P waves
B) Regular sawtooth-like F waves
C) Rapid ventricular rhythm
D) Prolonged QT interval
E) Saddle shaped ST elevation
A
Which of the following is most likely to be seen in acute pericarditis ?
A) Irregular and rapid QRS complex with absent P waves
B) Regular sawtooth-like F waves
C) Rapid ventricular rhythm
D) Prolonged QT interval
E) Saddle shaped ST elevation
E
A patient presents with regular sawtooth like flutter waves on ECG. How would you treat?
A) Electrical cardioversion with enoxaparin beforehand
B) Calcium channel blocker
C) IV Isoprenaline
D) Carotid massage
E) IV antibiotics
A
A patient presents with absent femoral pulses and cold white legs. They report that during exercise they pain in the leg. He smokes and has a PMH of hypertension and type 2 diabetes. How would you diagnose? A) ECG and Echo B) Echocardiogram C) Ankle-brachial pressure index and USS D) CXR E) CT coronary angiography
C
Which of the following is not a symptom of acute lower limb ischaemia? A) Pallor B) Perishing cold C) Pulselessness D) Paraplegia E) Pins and needles
D
What is the commonest cause of infective endocarditis? A) P. Aeruginosa B) Staph Aureus C) Strep Viridans D) Enterovirus E) Autoimmune
B
What is the commonest cause of pericarditis? A) P. Aeruginosa B) Staph Aureus C) Strep Viridans D) Enterovirus E) Autoimmune
D
A 27 year old man reports to A&E with a severe fever, headache, confusion and chest pains. You perform a transoesophageal echo and notice an embolism at the pulmonary valves. What is the most likely cause of his infective endocarditis? A) IV drug use B) Dental surgery/ treatment C) Skin infection D) Cardiac surgery E) Bicuspid valves
A
A 27 year old man reports to A&E with a severe fever, headache, confusion and chest pains. You perform a transoesophageal echo and notice an embolism at the pulmonary valves. You perform some tests and notice that it is a coagulase positive, gram positive cocci. How would you treat? A) IV benzylpenicillin B) IV amoxicillin C) IV Cefuroxime and metronidazole D) Erythromycin + Vancomycin E) IV vancomycin and Rifampicin
E
A 27 year old man reports to A&E with a severe fever, headache, confusion and chest pains. You perform a transoesophageal echo and notice an embolism at the pulmonary valves. Which of the following is not a likely sign? A) Splinter haemorrhages on nail beds B) Osler nodes C) Janeway lesions D) Kerley B lines E) Roth spots
D
A woman presents with a severe chest pain that is worse when she breathes in, and feels better when she leans forwards. She also has a fever and is breathless. She has a PMH of Sjorgrens syndrome. How would you diagnose? A) ECG B) Transoesophageal Echocardiogram C) Ankle-brachial pressure index and USS D) Blood culture E) CT coronary angiography
A
A woman presents with a severe chest pain that is worse when she breathes in, and feels better when she leans forwards. She also has a fever and is breathless. She has a PMH of Sjorgrens syndrome. How would you treat? A) IV benzylpenicillin B) Aspirin C) IV Cefuroxime and metronidazole D) Colchicine for 3 weeks E) IV vancomycin and Rifampicin
D
How do you diagnose bundle branch block? A) ECG B) Transoesophageal Echocardiogram C) Ankle-brachial pressure index and USS D) Blood culture E) CT coronary angiography
A
What is anaphylactic shock a type of? A) Hypovolaemic shock B) Cardiogenic shock C) Distributive shock D) Anaemic shock E) Cytotoxic shock
C
How can you quickly check for shock? A) ECG B) Transoesophageal Echocardiogram C) Ankle-brachial pressure index and USS D) Capillary refill time E) CT coronary angiography
D
Wat is the most common cause of cardiac death in young people?
A) Arrhythmogenic right ventricular cardiomyopathy
B) Restrictive cardiomyopathy
C) Dilated cardiomyopathy
D) Hypertrophic cardiomyopathy
E) None of the above
D
Which of the following would be the ECG finding of Wolff-Parkinson-White syndrome?
A) Irregular and rapid QRS complex with absent P waves
B) Regular sawtooth-like F waves
C) Wide QRS complex that begins with a slurred Delta wave
D) Prolonged QT interval
E) Saddle shaped ST elevation
C
A patient presents with breathlessness, chest pain and oedema of the ankles. On examination, the apex beat is displaced inferiorly and laterally, and you can hear systolic ejection murmer. She has a Corrigan's pulse. What is it likely to be? A) Aortic regurgitation B) Aortic stenosis C) Mitral regurgitation D) Mitral stenosis E) None of the above
A
A patient presents with breathlessness and angina. On examination, you can hear an systolic ejection murmer that has crescendo-descendo character. What is it likely to be? A) Aortic regurgitation B) Aortic stenosis C) Mitral regurgitation D) Mitral stenosis E) None of the above
B
Which of the following does not typically cause aortic stenosis? A) Calcium build up B) Congenital BAV C) Rheumatic heart disease D) Anaemia E) Past radiotherapy
D
Which valve defect is the most common? A) Aortic regurgitation B) Aortic stenosis C) Mitral regurgitation D) Mitral stenosis E) None of the above
B
A patient presents with malar flush and atrial fibrilation. On examination, she has a mid-diastolic, low pitched rumbling murmer. What is it most likely to be? A) Aortic regurgitation B) Aortic stenosis C) Mitral regurgitation D) Mitral stenosis E) None of the above
D
A patient presents for a regular check up, but on examination you notice she has a pan systolic, high pitched whistling murmur. She has a PMH of Marfans syndrome. What is it most likely to be? A) Aortic regurgitation B) Aortic stenosis C) Mitral regurgitation D) Mitral stenosis E) None of the above
C
What medication would you prescribe for a patient with heart failure A) Statins B) Digoxin C) Calcium channel blocker D) Enoxaparin E) Warfarin
B
Which of the following is false regarding colorectal cancer..
A) Bowel cancer screening is offered to people aged 60+
B) The majority of cancers occur in the proximal colon
C) FAP and HNPCC are two inherited causes of colon cancer
D) Proximal cancers usually have a worse prognosis
E) Patients with PSC and UC have an increased risk of developing colon cancer
B
A 50 year old man presents with dysphagia. Which one of the following suggests a benign nature of the disease
A) Weight loss
B) Dysphagia to solids initially then both solids and liquids
C) Dysphagia to solids and liquids from the start
D) Anaemia
E) Recent onset of symptoms
C
A 19 year old girl presents with abdominal pain and loose stool. Which of the following would suggest IBS A) Anaemia B) Nocturnal diarrhoea C) Weight loss D) Blood in stool E) Abdominal pain related to daefacation
E
Which statement is true regarding H pyolri
A) It is a gram positive bacteria
B) HP prevalence is similar in developing and developed countries
C) 15% of patients with duodenal ulcer are infected with H pylori
D) PPIs should be stopped a week before a H pylori stool antigen test
E) It is associated with an increased risk of gastric cancer
E
Which of the following features best distinguishes ulcerative colitis from Crohn’s disease
A) Ileal involvement
B) Continuous colonic involvement on endoscopy
C) Non caseating granuloma
D) Transmural inflammation
E) Perianal disease
B
A 68 year old lady presents with abdominal pain and distention. She last opened her bowel 5 days ago. She has a poor appetite and has lost weight recently. She drinks and smokes regularly. She previously had abdominal hysterectomy and diverticulosis. On examination there is tympanic percussion throughout. There is a small left groin lump with a cough impulse. Which of the following is not the likely cause A) Colon cancer B) Adhesions C) Ascites D) Diverticulitis E) Strangulated hernia
C
A 16 year old girl is admitted with vomitting and abdominal pain. She reports taking 20 paracetamol tablets after her boyfriend split up with her. Which one of the following would you not expect to see A) Metabolic acidosis B) Prolonged prothrombin time C) A raised creatinine D) Hyperglycaemia E) ALT 1000
D
Which of the following has continuous lesions... A) IBS B) UC C) Crohn's D) Coeliac's
B
Which of the following can be managed with TCAs... A) IBS B) UC C) Crohn's D) Coeliac's
A
Which of the following has transmural lesions... A) IBS B) UC C) Crohn's D) Coeliac's
C
Which of the following has no nocturnal diarrhoea... A) IBS B) UC C) Crohn's D) Coeliac's
A
Which of the following shows villous Atrophy... A) IBS B) UC C) Crohn's D) Coeliac's
D
Which of the following is more likely to have mucoid Diarrhoea... A) IBS B) UC C) Crohn's D) Coeliac's
B
Which of the following has dermatitis herpetiformis... A) IBS B) UC C) Crohn's D) Coeliac's
D
Which of the following is a pANCA positive IBD... A) IBS B) UC C) Crohn's D) Coeliac's
B
Which of the following has smoking as a protective factor... A) IBS B) UC C) Crohn's D) Coeliac's
B
Which of the following is tTG and EMA positive... A) IBS B) UC C) Crohn's D) Coeliac's
D
Which of the following has 3 distinct subtypes... A) IBS B) UC C) Crohn's D) Coeliac's
A
Which of the following would use methotrexate to maintain remission... A) IBS B) UC C) Crohn's D) Coeliac's
C
A 13 year old child presents in a&e with severe pain and vomitting. The pain has migrated over the last few hours around their umbillicus to a sharp pain in her RLQ. She has guarding and tenderness in this area. Which of the following is the least common cause of acute appendicitis A) Trauma B) Metastases C) Worms D) Bezoars E) Lymphoid hyperplasia
B
Which of the following is the most common cause of diarrhoea in adults... A) Norovirus B) C. Jejuni C) Rotavirus D) E. Coli E) Salmonella
A
What is the first line test for coeliac disease A) FBC B) HLA DQ2 genotyping C) Serology D) Duodenal Biopsy E) Colonoscopy
C
Glenis is a 78 year old lady with a 3 hour history of severe and worsening abdominal pain. On examination, she is very uncomfortable but there are few findings. She has a PMH of HTN and AF. What is the most likely diagnosis? A) Pancreatitis B) Gastroenteritis C) Peritonitis D) Volvulus E) Mesenteric Ischaemia
E
Where does diverticular disease normally occur? A) Ascending colon B) Transverse colon C) Rectum D) Sigmoid colon E) Descending colon
D
What is used for colon cancer staging? A) The FIGO system B) The Enneking system C) Duke's classification D) Ann Arbor Staging E) Binet System
C
Which types of hepatitis are foecal-oral spread? A) A only B) B, C, D C) A and E D) E only E) B only
C
A patient had a chest infection and was prescribed ciprofloxacin. However, after afew days she developed severe diarrhoea. What should the antibiotic be changed to? A) Oral Clindamycin B) Oral Vancomycin C) Trimethoprim D) Oral Co-amoxiclav E) Oral Metronidazole
E
Simon, a 57-year-old banker, comes in to the surgery complaining of pain immediately below the ribs. After a taking a history, he tells you the pain is typically worse at night and when he’s hungry but has found that a glass of milk seems to help. He had a MI 3 years ago and takes aspirin daily. What is this history suggestive of? A) Diverticulitis B) Appendicitis C) Duodenal ulcer D) Peritonitis E) Gastritis
C
A doctor is performing an abdominal examination of a patient with suspected bowel obstruction.
When they percuss an area of the bowel they hear tympanic sounds. What does this indicate is the contents of the bowel in this area?
A) Stool
B) Liquid
C) Air/Gas
D) None of the above
C
Patients with Crohn’s disease are often put on long term steroids. Which of the following is not a common side effect? A) Weight gain B) Hypotension C) Osteoporosis D) Hyperglycaemia E) Oedema
B
Which of the following is not a part of reynold's pentad? A) RUQ pain B) Hypertension C) Jaundice D) Fever E) Tachycardia
B
Which of the following is not correct? A) G cells= Gastric acid B) Parietal cells= Intrinsic factor C) Chief cells= Pepsinogen D) D cells= Somatostatin E) Enterochromaffin-like cells= Histamine
A
A 74 year old man presents with a change in bowel habit and anaemia. On colonoscopy it is seen that he has a large tumour in his large bowel which travels into the lumen, and on CT he has metastases in the liver. What Duke's stage is his cancer? A) Dukes A B) Dukes B1 C) Dukes B2 D) Dukes C1 E) Dukes D
E
A 74 year old man presents with a change in bowel habit and anaemia. On colonoscopy it is seen that he has a tumour that invades the wall but doesn't appear to go through the wall. On CT he has no metastases. What Duke's stage is his cancer? A) Dukes A B) Dukes B1 C) Dukes B2 D) Dukes C1 E) Dukes D
A
What is used for coeliac's disease villous atrophy staging? A) The FIGO system B) The Enneking system C) Duke's classification D) Marsh Stages E) Binet System
D
What is the midgut supplied by? A) Coeliac trunk B) Greater splanchnic C) Superior mesenteric D) Inferior mesenteric E) Least splanchnic
C
Which of the following is not crossed in the transpyloric plane of Addison? A) Gallbladder B) Calots triangle C) Pancreas D) Duodenal-jejunal flexure E) Kidneys
B
Which of the following is not a fat soluble vitamin? A) A B) B C) D D) E E) K
B
Which of the following is associated with coeliac's disease A) HLA DQ2 B) HLA B27 C) NOD2 D) HLA DR3 E) None of the above
A
A patient presents with a sudden onset of left sided abdominal pain, and has been passing bright red bloody stools. She appears pale and confused, and she has a rapid and weak pulse. What is it most likely to be? A) Acute appendicitis B) Mesenteric ischaemia C) Colonic polyps D) Obstruction E) Cholangitis
B
A patient presents with a sudden onset of left sided abdominal pain, and has been passing bright red bloody stools. She appears pale and confused, and she has a rapid and weak pulse. Why would you not do a colonoscopy and biopsy immediately? A) Perforation risk B) Risk of strictures C) Risk of abscess formation D) Risk of septic peritonitis E) Risk of gangrene
B
A patient presents with umbilical pain that migrates to the right side after afew hours. She is vomitting and on examination, her abdomen is tender. How would you diagnose? A) Ultrasound scan B) Barium swallow C) Colonoscopy with biopsy D) CT abdomen E) X ray abdomen
D
A patient presents with umbilical pain that migrates to the right side after afew hours. She is vomitting and on examination, her abdomen is tender. You schedule her for surgery, but in the meantime, what antibiotic would you prescribe? A) 6 weeks IV Flucloxacillin B) Benzylpenicillin and clindamycin C) Oral Metronidazole D) Oral Co-amoxiclav E) IV Cefuroxime and metronidazole
E
What is the most common cause of acute appendicitis? A) Malignancy B) Faecolith C) Lymphoid hyperplasia D) Filarial worms E) Foreign object
B
A 42 year old man presents to the GP with a pain in his chest. He has also noticed reoccuring hiccups, and bloating. Which of the following does not typically trigger his condition? A) Being overweight B) Pregnancy C) Smoking D) Aspirin E) Anxiety and stress
E
Which of the following is a proton pump inhibitor that would be given for GORD? A) Omeprazole B) Ranitidine C) Ramipril D) Lansoprazole E) Simvastatin
A
A 45 year old man presents to the GP with recurrent burning epigastric pain. It is worse in the evenings, and he has noticed that it seems worse when he is hungry. What would be your first line investigation? A) Gastroscopy B) Stool antigen testing C) Gastric histology D) Biopsy urease test E) CT abdomen
B
A 45 year old man presents to the GP with recurrent burning epigastric pain. It is worse in the evenings, and he has noticed that it seems worse when he is hungry. You perform a stool antigen test and it shows positive for H pylori. What would be an appropriate treatment regime?
A) Omeprazole, Metronidazole, Amoxicillin
B) Ranitidine, Clarithromycin, Amoxicillin
C) Omeprazole, Lansoprazole, Metronidazole
D) Clarithromycin, metronidazole, amoxicillin
E) Metronidazole, Ranitidine, Lansoprazole
A
A 33 year old woman presents to her GP with abdominal pain and bloating. On questioning, she also reports that she is frequently getting diarrhoea, and her period seems more painful than it did prior. This has been happening for 7 months. How would you treat her diarrhoea? A) Mavicol B) Lactulose C) Tricyclic antidepressant D) Antispasmodics E) Loperamide
E
A 61 year old patient presents to A&E with an acute, severe abdominal pain. She has no other symptoms. How would you diagnose? A) Gastroscopy B) Stool antigen testing C) Colonoscopy with biopsy D) Barium swallow E) CT angiography
E
A 61 year old patient presents to A&E with an acute, severe abdominal pain. She has no other symptoms. What would you suspect? A) Pancreatitis B) Gastroenteritis C) Peritonitis D) Volvulus E) Mesenteric Ischaemia
E
A patient presents with weight loss and vomitting. On a blood test he has anaemia, and you request a gastroscopy and biopsy. The results show a gastric adenoma at the pylorus. What chemotherapy regime would you use? A) ABVD B) RCHOP C) VAD D) ECF E) CMV
D
A 78 year old man presents with bloody stool, night sweats and weight loss. You perform a few tests, and find he also has anaemia. What test should you order? A) X ray B) Colonoscopy and biopsy C) CT abdomen D) Stool antigen test E) Barium swallow
B
Which of the following is not a cardinal sign of obstruction? A) Vomitting B) Abdominal distension C) Colicky abdominal pain D) Absolute constipation E) Pallor
E
A patient presents with constant abdominal pain and distension. After afew hours he develops vomitting. He reports he hasn't opened his bowels in several days. What is the most likely cause of his condition? A) Colon Malignancy B) Volvus C) Adhesions D) Hernia E) Crohn's disease
A
A patient presents with colicky abdominal pain that develops into a constant pain. He is vomitting, and on examination he has increased bowel sounds. He reports he hasn't opened his bowels in several days. What is the most likely cause of his condition? A) Colon Malignancy B) Volvus C) Adhesions D) Hernia E) Crohn's disease
C
A patient presents with constant abdominal pain and distension. After afew hours he develops vomitting. He reports he hasn’t opened his bowels in several days. What would be your first line investigation?
A) CT
B) X Ray
C) MRI
D) Immediate treatment without investigation
E) Colonoscopy
B
A patient presents with constant abdominal pain and distension. After afew hours he develops vomitting. He reports he hasn’t opened his bowels in several days. What would be your gold standard investigation?
A) CT
B) X Ray
C) MRI
D) Immediate treatment without investigation
E) Colonoscopy
A
A patient presents with constant abdominal pain and distension. After afew hours he develops vomitting. He reports he hasn't opened his bowels in several days. What would be your gold standard treatment? A) "Drip and suck" technique B) Antispasmodics for the pain C) IV metronidazole D) Appendicectomy E) Supportive treatment
A
Which of the following does not cause malabsorption? A) Pancreatitis B) Anorexia nervosa C) Coeliac disease D) Giardia lamblia E) Disaccharidase deficiency
B
A patient presents with bloody diarrhoea and abdominal pain. She also has mouth ulcers and says she feels "tired all the time". On bloods she is faecal calprotectin positive, and pANCA negative. What would be the gold standard investigation? A) Abdominal X ray B) Abdominal CT C) Barium swallow D) Serology E) Colonoscopy with biopsy
E
You are reviewing a patients results that have been sent to you. It shows anaemia, raised ESR and CRP, abnormal liver biochemistry, faecal calprotectin positive, and pANCA negative. What is it most likely to be? A) Ulcerative colitis B) Crohn's disease C) Coeliac's disease D) IBS E) Peritonitis
B
You are reviewing a patients results that have been sent to you. It shows anaemia, raised ESR and CRP, abnormal liver biochemistry, faecal calprotectin positive, and pANCA positive. What is it most likely to be? A) Ulcerative colitis B) Crohn's disease C) Coeliac's disease D) IBS E) Peritonitis
A
A patient presents with bloody diarrhoea and abdominal pain. She also has mouth ulcers and says she feels "tired all the time". On bloods she is faecal calprotectin positive, and pANCA negative. What would you prescribe to induce remission? A) 5-Aminosalicylic acid B) Azathioprine C) Cefuroxime D) Lidnocaine E) Prednisolone
E
A patient presents with bloody diarrhoea and abdominal pain. She also has mouth ulcers and says she feels "tired all the time". On bloods she is faecal calprotectin positive, and pANCA negative. What would you prescribe to maintain remission? A) 5-Aminosalicylic acid B) Azathioprine C) Cefuroxime D) Lidnocaine E) Prednisolone
B
You are reviewing a patient's results that have just been sent to you. It reports a CT showing cobblestone bowel in the descending colon and terminal ilium. What is it most likely to be? A) Ulcerative colitis B) Crohn's disease C) Coeliac's disease D) IBS E) Peritonitis
B
A patient presents with bloody diarrhoea and abdominal pain. She also has mouth ulcers and says she feels "tired all the time". On bloods she is faecal calprotectin positive, and pANCA positive. What would be the gold standard investigation? A) Abdominal X ray B) Abdominal CT C) Barium swallow D) Serology E) Colonoscopy with biopsy
E
A patient presents with bloody diarrhoea and abdominal pain. She also has mouth ulcers and says she feels "tired all the time". On bloods she is faecal calprotectin positive, and pANCA positive. What would you prescribe? A) 5-Aminosalicylic acid B) Azathioprine C) Cefuroxime D) Lidnocaine E) Prednisolone
A
You are reviewing a patient's results that have just been sent to you. It reports a CT showing reddened and inflamed colon, extending from the rectum for about 5 inches. What is it most likely to be? A) Ulcerative colitis B) Crohn's disease C) Coeliac's disease D) IBS E) Peritonitis
A
You are reviewing a patient's results that have just been sent to you. It reports a CT showing villous atrophy and crypt hyperplasia. What is it most likely to be? A) Ulcerative colitis B) Crohn's disease C) Coeliac's disease D) IBS E) Peritonitis
C
A patient presents with diarrhoea and vomitting that has been happening on and off for the past 4 months. This has started waking her up in the night which has caused her to be increasingly worried. She has a PMH of hypothyroidism. What would be your first line investigation? A) Serology B) Distal duodenal biopsy C) FBC D) Erect CXR E) CT abdomen
A
A patient presents with diarrhoea and vomitting that has been happening on and off for the past 4 months. This has started waking her up in the night which has caused her to be increasingly worried. She has a PMH of hypothyroidism. What would be your gold standard investigation? A) Serology B) Distal duodenal biopsy C) FBC D) Erect CXR E) CT abdomen
B
A 46 year old man presents with abdominal pain. He reports that it only seems to improve when he lies down and puts his hands on his tummy. You perform some blood tests, and it shows a raised WCC and CRP. How would you treat? A) 6 weeks IV Flucloxacillin B) Benzylpenicillin and clindamycin C) Oral Metronidazole D) Oral Co-amoxiclav E) IV Cefuroxime and metronidazole
E
A 46 year old man presents with abdominal pain. He reports that it only seems to improve when he lies down and puts his hands on his tummy. You perform some blood tests, and it shows a raised WCC and CRP. You insert an ascitic tap, and it shows the growth of a gram negative bacilli that is a lactose fermenter. What is it most likely to be? A) E. Coli B) Salmonella C) Shigella D) Vibro. Cholerae E) H. Pylori
E
A 24 year old man presents to A&E with haematemesis. He appears confused, and his blood alcohol levels are relatively high. What is it most likely to be? A) Variceal bleeding B) Mallory-Weiss Tear C) Peptic ulcer D) Oesophageal tumour E) Mesenteric ischaemia
B
A 67 year old man presents with fever and constipation. On examination, he has tachycardia, and has tenderness and guarding on the left side of the abdomen. You perform some blood tests, and it shows a raised WCC, and CRP. How would you treat? A) 6 weeks IV Flucloxacillin B) Benzylpenicillin and clindamycin C) Oral Metronidazole D) Oral Co-amoxiclav E) IV Cefuroxime and metronidazole
E
A patient presents with a bulging lump at the top of the thigh. It is not painful and it does press back down. It points towards the groin. What is it most likely to be? A) Direct inguinal hernia B) Indirect inguinal hernia C) Femoral hernia D) Incisional hernia E) Hiatus hernia
B
A patient presents with a bulging lump in the stomach. It is not painful and it does press back down. She had an appendicectomy 3 months ago. What is it most likely to be? A) Direct inguinal hernia B) Indirect inguinal hernia C) Femoral hernia D) Incisional hernia E) Hiatus hernia
D
A patient presents with a distended abdomen and pain. You examine and can show shifting dullness. How would you diagnose? A) Aspiration of ascitic tap B) Stool antigen testing C) Colonoscopy with biopsy D) Barium swallow E) CT angiography
A
Which of the following is not a component of bile? A) CCK B) Bilirubin C) Cholesterol D) Bicarbonate E) Lecithin
A
Which of the following liver diseases affects the pancreas and heart? A) Haemochromatosis B) Hep B C) Alpha-1-antitrypsin D) Wilson’s disease
A
What is the characteristic FBC finding in alcoholic liver disease A) High platelets B) Macrocytic anaemia C) Microcytic anaemia D) Low WCC
B
How to monitor for HCC in patients with cirrhosis A) LFTs B) FBC C) MRI liver D) AFP + USS
D
Which of the following has a complication of cholangiocarcinoma A) Autoimmune hepatitis B) Hep B C) PSC D) PBC
C
Which of the following clotting factors is not produced by the liver? A) 2 B) 5 C) 7 D) 9 E) 10
B
What is the maximum recommended weekly alcohol intake? A) 10 Units B) 12 Units C) 14 Units D) 16 Units E) 18 Unites
C
How is hepatic encephalopathy treated? A) Mavicol B) Lactulose C) Tricyclic antidepressant D) Antispasmodics E) Loperamide
B
An Egyptian business man presents to clinic on routine screen. He feels well and has not left the UK for the last 5 years. His partner has recently tested positive for acute hepatits B, but he has no jaundice and feels well. On ultrasound, he has a bright echogenic liver texture but with no focal abnormalitiy. What is it likely to be? A) Hepatitis A B) Acute Hepatitis B C) Chronic Hepatitis B D) Acute Hepatitis D E) Chronic Hepatitis E
C
A 21 year old women travelled to Malaysia and was well throughout the holiday. She was unwell for 3 weeks on return with headache, lethargy, aches, poor apetite and fevers. This was self limitting, but she then noticed yellowing of the skin. What is it likely to be? A) Hepatitis A B) Acute Hepatitis B C) Chronic Hepatitis B D) Acute Hepatitis D E) Chronic Hepatitis E
A
A 46 year old woman presents with lethargy, poor appetite, yellow skin and dark orange urine. On examination she has tender hepatomegaly and mild pitting oedema. She has not left the UK in over a year, and has a Egyptian new partner recently. What is it likely to be? A) Hepatitis A B) Acute Hepatitis B C) Chronic Hepatitis B D) Acute Hepatitis D E) Chronic Hepatitis E
b
A 27-year-old man presents underweight with tender liver. He is not jaundiced, but reports that he has used IV heroine and crack cocaine frequently. On ultrasound, he has a cirrhotic liver. What is it likely to be? A) Hepatitis A B) Acute Hepatitis B C) Chronic Hepatitis B D) Acute Hepatitis D E) Chronic Hepatitis c
E
How would you treat a patient with Wernicke-Korsakoff encephalopathy? A) Mavicol B) Lactulose C) IV Thiamine D) Fomepizole E) Loperamide
C
A patient presents with history of drinking with dark sticky faeces and blood in her vomit. Which drug would you use to treat her? A) Spironolactone B) Ciprofloxacin C) Propranolol D) Amlodipine E) None of the above
C
Which type of hepatitis is acute only? A) Hepatitis A B) Hepatitis A and E C) Hepatitis B D) Hepatitis B, C and D E) Hepatitis E
A
What condition would a patient with Charcot's triad likely have? A) Pancreatitis B) Cholangitis C) Appendicitis D) Peritonitis E) Gallstones
B
What is the most common cause of portal hypertension worldwide? A) Portal vein thrombosis B) Cirrhosis C) Schistosomiasis D) Right heart failure E) Sarcoidosis
C
What is the most common cause of portal hypertension in the UK? A) Portal vein thrombosis B) Cirrhosis C) Schistosomiasis D) Right heart failure E) Sarcoidosis
B
A patient presents with fatigue and joint pain. Afew months later, he presents with bronze skin pigmentation, hepatomegaly and diabetes mellitus. What is it likely to be? A) Hepatocellular carcinoma B) Addison's disease C) Gross iron overload D) Alcoholic liver disease E) Portal hypertension
C
A patient presents with fatigue and joint pain. He returns afew months later with a slate-gray skin pigmentation and arrhythmia. What would be a first line investigation? A) Serum iron and ferritin B) MRI C) Liver biopsy D) Transabdominal ultrasound E) Abdominal CT
A
A patient presents with fatigue and joint pain. He returns afew months later with a slate-gray skin pigmentation and arrhythmia. How would you treat? A) Surgery B) Lifelong venesection C) Iron supplementation D) Liver transplant E) Avoid food high in copper
B
What is the most common place for pancreatic adenocarcinoma to occur? A) Pancreatic head B) Pancreatic tail C) Pancreatic body D) Uncinate process E) Pancreatic neck
A
What would be raised in hepatocellular carcinoma? A) Alpha fetoprotein B) Beta-hCG C) PSA D) CA15.3 E) CEA
A
What would be raised in breast cancer? A) Alpha fetoprotein B) Beta-hCG C) PSA D) CA15.3 E) CEA
D
What would be raised in colon cancer? A) Alpha fetoprotein B) Beta-hCG C) PSA D) CA15.3 E) CEA
E
What would be raised in testicular carcinoma? A) SCC Antigen B) Beta-hCG C) PSA D) CA15.3 E) CEA
B
A patient presents with a sudden onset severe abdominal pain that is increasing. It radiates over the right shoulder. The pain began at around 9pm and lasted until 4am. All lab tests appear normal. What would be your first line investigation? A) MRC B) Genetic testing C) Biopsy D) Enhance CT E) Ultrasound scan
E
A patient presents with a sudden onset severe RUQ pain that is increasing. It radiates over the right shoulder. Blood tests show a raised WCC, Increased CRP, Increased serum bilirubin and increased alk phos. What is it likely to be? A) Biliary Colic B) Cholecystitis C) Pancreatic adenocarcinoma D) Hepatocellular carcinoma E) Wilson's disease
B
A patient presents with a sudden onset severe RUQ pain that is increasing. It radiates over the right shoulder. Blood tests show a raised WCC, Increased CRP, Increased serum bilirubin and increased alk phos. What would be your first line investigations? A) MRC B) Genetic testing C) Biopsy D) Enhance CT E) Ultrasound scan
E
A patient presents with a green-brown pigment around the eye, and hepatitis. What element do they likely have too much of? A) Copper B) Iron C) Phosphorus D) Sodium E) Calcium
A
A patient presents with a green-brown pigment around the eye, and hepatitis. How would you treat? A) Thiamine B) Fomepizole C) Penicillamine D) Lactulose e) Ferrous sulphate
C
Which of the following is not a cause of pancreatitis? A) Alcohol B) Gallstones C) ERCP D) Iron overload E) Steroids
D
A patient presents with severe epigastric pain that radiates to the back. She appears severely dehydrated and has hypotension with tachycardia. Her temperature is raised, and she has left flank bruising. What is it likely to be? A) Ascending cholangitis B) Obstruction C) Acute pancreatitis D) Acute appendicitis E) Mesenteric ischaemia
C
A patient presents with severe epigastric pain that radiates to the back. She appears severely dehydrated and has hypotension with tachycardia. Her temperature is raised, and she has left flank bruising. Which lab test would you expect to see? A) Raised WCC B) Raised serum amylase C) Raised ESR D) Viral markers E) Alpha-fetoprotein
B
A 48 year old man presents with haematemesis and abdominal pain. He has a PMH of cirrhosis and is taking diazepam and ramipril. What is it likely to be? A) Variceal bleeding B) Mallory-Weiss Tear C) Peptic ulcer D) Oesophageal tumour E) Mesenteric ischaemia
A
A 48 year old man presents with haematemesis and abdominal pain. He has a PMH of cirrhosis and is taking diazepam and ramipril. What would be the first line investigation? A) Ultrasound scan B) Barium swallow C) Endoscopy D) CT abdomen E) X ray abdomen
C
What blood test result would show heavy drinking? A) Raised alk phos B) Increased MCV C) Decreased MCV D) Leucocytosis E) Elevated serum bilirubin
B
How do you treat delerium tremens? A) Thiamine B) Fomepizole C) Penicillamine D) Lactulose E) Diazepam
E
A patient presents with liver failure. Which of the following would you not expect to find? A) Low ammonia B) Hyperglycaemia C) Raised PTT D) Raised creatinine E) Decreased ALT
A
A patient presents with finger clubbing, palmar erythema, spider naevi and xanthelasma. On examination, you find ascites and a low albumin. What would be the gold standard diagnosis? A) Serum iron and ferritin B) MRI C) Liver biopsy D) Transabdominal ultrasound E) Abdominal CT
C
Which of the following is not included in the child-pugh classification for cirrhosis? A) Long prothrombin time B) Serum albumin C) Total serum bilirubin D) Hepatomegaly E) Acites
D
What is used to inhibit osteoclasts from bone resorption? A) RANK B) RANKL C) OPG D) GLUT-2 E) Calcitonin
C
What is used to inhibit osteoclasts from bone resorption? A) RANK B) RANKL C) OPG D) GLUT-2 E) Calcitonin
C
What is a disease in which there is excessive and unorganised deposition and resorption of the bone? A) Osteoporosis b) Osteomalacia C) Osteopenia D) Osteogenesis imperfecta E) Paget’s disease
E
