Chemical Pathology Flashcards
(223 cards)
1
Q
A 65-year-old chronic alcoholic presents to the A&E Department with a minor head injury. On examination he is found to be pale. Blood tests show a high MCV. What is the likeliest result of MCV (fl) in a normal person? A. 130 B. 30 C. 15 D. 4 E. 290 F. 90 G. 2.2
A
F. 90
2
Q
A 40-year-old woman presents with a two month history of tiredness, intermittent pyrexia and abdominal pain. On examination she has an enlarged palpable spleen. Blood tests show anaemia with a raised white cell count. What is the likeliest result of a white cell count (x 109 per l) in a normal person? A. 130 B. 30 C. 15 D. 4 E. 290 F. 90 G. 2.2
A
D. 4
3
Q
A 5-year-old boy presents with a purpuric rash and petechiae following a recent viral infection. Blood tests showed thrombocytopenia. What is the likeliest result of a platelet count (x109/l) in a normal adult? A. 130 B. 30 C. 15 D. 4 E. 290 F. 90 G. 2.2
A
E. 290
4
Q
A 35-year-old man presents with hypertension. Blood tests show normal sodium, urea and glucose and a raised potassium. What is the likeliest result of potassium (mmol/l) in a normal person? A. 130 B. 30 C. 15 D. 4 E. 290 F. 90 G. 2.2
A
D. 4
5
Q
A 70-year-old woman presents in a coma with a long history of polyuria and polydipsia. Investigations show that her plasma osmolarity is raised. What is the likeliest result of plasma osmolarity (mmol/l) in a normal person? A. 130 B. 30 C. 15 D. 4 E. 290 F. 90 G. 2.2
A
E. 290
6
Q
A 14-year-old boy presents with symptoms of chronic liver failure. LFTs display abnormally high levels of transaminases with normal alk phos & bilirubin levels. There’s marked accumulation of copper-associated protein in hepatocytes obtained from a biopsy. His serum copper levels and caeruloplasmin are abnormally low. A. Primary hepatocellular carcinoma B. Chronic hepatitis B C. Wilson's disease D. Crigler Najjar syndrome E. Chronic hepatitis C F. Budd-Chiari syndrome G. Primary biliary cirrhosis H. Hepatitis A
A
C. Wilson’s disease
7
Q
A 30-year-old Thai male presents to a day surgery unit for a cholecystectomy. His LFTs reveal very elevated transaminases with normal bilirubin & alk phos levels. Microscopy of a liver biopsy identifies antigens from a dsDNA virus in the cytosol of hepatocytes. A. Primary hepatocellular carcinoma B. Chronic hepatitis B C. Wilson's disease D. Crigler Najjar syndrome E. Chronic hepatitis C F. Budd-Chiari syndrome G. Primary biliary cirrhosis H. Hepatitis A
A
B. Chronic hepatitis B
8
Q
A 58-year-old woman presents with recent onset of Jaundice. LFTs reveal increased bilirubin & markedly elevated alk phos & normal transaminases. Further investigations uncovered raised IgM and serum cholesterol. Anti mitochondrial antibodies are also detected. A liver biopsy shows enlargement of the portal tracts by white blood cells and granulomas. Bile ducts are also less than normal. A. Primary hepatocellular carcinoma B. Chronic hepatitis B C. Wilson's disease D. Crigler Najjar syndrome E. Chronic hepatitis C F. Budd-Chiari syndrome G. Primary biliary cirrhosis H. Hepatitis A
A
G. Primary biliary cirrhosis
9
Q
A 48-year-old male returning from a 6mths round the world trip presents with a recent Hx of nausea, anorexia & distaste for cigarettes. He developed jaundice; his urine became dark and his stools pale. His spleen was palpable. Investigations showed bilirubinuria, increased urinary urobilinogen & a raised serum AST & ALT. Within 4 weeks his symptoms had completely subsided. A. Primary hepatocellular carcinoma B. Chronic hepatitis B C. Wilson's disease D. Crigler Najjar syndrome E. Chronic hepatitis C F. Budd-Chiari syndrome G. Primary biliary cirrhosis H. Hepatitis A
A
H. Hepatitis A
10
Q
A 55-year-old woman presents with a short Hx of nausea and abdominal pain; tender hepatomegaly and ascities. LFTs show mildly raised transaminases, bilirubin and normal alk phos. The woman also had polycythaemia rubra vera. Liver biopsy suggests venous outflow obstruction. A. Primary hepatocellular carcinoma B. Chronic hepatitis B C. Wilson's disease D. Crigler Najjar syndrome E. Chronic hepatitis C F. Budd-Chiari syndrome G. Primary biliary cirrhosis H. Hepatitis A
A
F. Budd-Chiari syndrome
11
Q
A liver enzyme raised after a myocardial infarction A. Gamma glutamyl transpeptidase B. Aspartate transaminase C. Alkaline phosphatase D. Albumin E. Total bilirubin F. Direct bilirubin G. Alanine transaminase H. Activated partial thromboplastin time I. Gamma globulin J. Prothrombin time
A
B. Aspartate transaminase
12
Q
A test of the integrity of the extrinsic pathway A. Gamma glutamyl transpeptidase B. Aspartate transaminase C. Alkaline phosphatase D. Albumin E. Total bilirubin F. Direct bilirubin G. Alanine transaminase H. Activated partial thromboplastin time I. Gamma globulin J. Prothrombin time
A
J. Prothrombin time
13
Q
An enzyme markedly raised in obstructive jaundice along with direct bilirubin A. Gamma glutamyl transpeptidase B. Aspartate transaminase C. Alkaline phosphatase D. Albumin E. Total bilirubin F. Direct bilirubin G. Alanine transaminase H. Activated partial thromboplastin time I. Gamma globulin J. Prothrombin time
A
C. Alkaline phosphatase
14
Q
Raised in alcohol abuse A. Gamma glutamyl transpeptidase B. Aspartate transaminase C. Alkaline phosphatase D. Albumin E. Total bilirubin F. Direct bilirubin G. Alanine transaminase H. Activated partial thromboplastin time I. Gamma globulin J. Prothrombin time
A
A. Gamma glutamyl transpeptidase
15
Q
Levels can be affected by diet
A
D. Albumin
16
Q
A 26-year-old receptionist presents to her GP with a history steatorrhoea, abdominal pain and weight loss, as well as feeling tired all the time. Initial blood tests reveal a microcytic anaemia.
A
J. Anti-endomysial antibodies (Coeliac disease)
17
Q
A 60-year-old woman with hypothyroidism presents with progressive dyspnoea and tiredness. FBC reveals macrocytic anaemia. A. Anti-GAD B. c-ANCA C. Anti-smooth muscle antibody D. ANA E. Ham's test F. Osmotic fragility test G. p-ANCA H. Anti-mitochondrial antibody I. Anti-DsDNA J. Anti-endomysial antibodies K. Anti-acetylcholine receptor antibody L. Anti-scl70 M. Anti-gastric parietal cell antibodies
A
M. Anti-gastric parietal cell antibodies (Pernicious anaemia)
18
Q
A 40-year-old plumber presents to his GP with a history of wheezing and lethargy, along with recurrent nose bleeds. On examination he has crackles in his upper left lung field. Urine dipstick is positive for blood and protein. A. Anti-GAD B. c-ANCA C. Anti-smooth muscle antibody D. ANA E. Ham's test F. Osmotic fragility test G. p-ANCA H. Anti-mitochondrial antibody I. Anti-DsDNA J. Anti-endomysial antibodies K. Anti-acetylcholine receptor antibody L. Anti-scl70 M. Anti-gastric parietal cell antibodies
A
B. c-ANCA (Wegener’s)
19
Q
A 30-year-old market trader presents with tiredness and jaundice, and further history reveals he suffered from a chest infection one week previously. On examination mild splenomegaly is noted, and blood tests show reticulocytosis, hyperbilirubinaemia, and spherocytosis. A. Anti-GAD B. c-ANCA C. Anti-smooth muscle antibody D. ANA E. Ham's test F. Osmotic fragility test G. p-ANCA H. Anti-mitochondrial antibody I. Anti-DsDNA J. Anti-endomysial antibodies K. Anti-acetylcholine receptor antibody L. Anti-scl70 M. Anti-gastric parietal cell antibodies
A
F. Osmotic fragility test (Spherocytosis)
20
Q
An 80-year-old retired clerk presents with a 2-month history of skin itching and lethargy. Examination is normal. LFTs are: bilirubin 6umol/l (reference range 0-17umol/l); ALT 24U/l (reference range 0-31U/l); Alk Phos 500U/l (reference range 30-130U/l). A. Anti-GAD B. c-ANCA C. Anti-smooth muscle antibody D. ANA E. Ham's test F. Osmotic fragility test G. p-ANCA H. Anti-mitochondrial antibody I. Anti-DsDNA J. Anti-endomysial antibodies K. Anti-acetylcholine receptor antibody L. Anti-scl70 M. Anti-gastric parietal cell antibodies
A
H. Anti-mitochondrial antibody (Primary biliary cirrhosis)
21
Q
A 10-year-old girl presents with weight loss, polyuria, tachypnoea, vomiting. Looks very dehydrated. Beta hydroxybutyrate is raised in the blood. A. Anti-GAD B. c-ANCA C. Anti-smooth muscle antibody D. ANA E. Ham's test F. Osmotic fragility test G. p-ANCA H. Anti-mitochondrial antibody I. Anti-DsDNA J. Anti-endomysial antibodies K. Anti-acetylcholine receptor antibody L. Anti-scl70 M. Anti-gastric parietal cell antibodies
A
A. Anti-GAD (Type 1 diabetes)
22
Q
A 55-year-old woman is warned of future risk of AML given her recent diagnosis of PNH following a spontaneous cerebral venous sinus thrombosis. A. Anti-GAD B. c-ANCA C. Anti-smooth muscle antibody D. ANA E. Ham's test F. Osmotic fragility test G. p-ANCA H. Anti-mitochondrial antibody I. Anti-DsDNA J. Anti-endomysial antibodies K. Anti-acetylcholine receptor antibody L. Anti-scl70 M. Anti-gastric parietal cell antibodies
A
E. Ham’s test (Paroxysmal nocturnal haemoglobinuria)
23
Q
A 40-year-old woman presents with polyuria and polydipsia. She has a fasting glucose 5.1mmol/L and an oral glucose tolerance test value of 5.0mmol/L. She has a corrected calcium of 2.80mmol/L and a PTH of 7.2pmol/L. A. Malignancy B. Lung cancer C. Impaired fasting glucose D. Hypocalcaemia E. Secondary hyperthyroidism F. Diabetes mellitus type 2 G. Impaired glucose tolerance H. Diabetes mellitus type 1 I. Crohn’s disease J. Primary hyperparathyroidism K. Psychogenic polydipsia L. Gestational diabetes M. Tuberculosis N. Sarcoidosis O. Vitamin D deficiency
A
J. Primary hyperparathyroidism
24
Q
A 35-year-old Afro-Caribbean woman presents with polyuria and polydipsia. She also complains of a dry cough. She has a fasting glucose of 5.8mmol/L and an oral glucose tolerance test value of 6.5mmol/L. She has a corrected calcium of 2.7mmol/L and a PTH of <0.1pmol/L. A. Malignancy B. Lung cancer C. Impaired fasting glucose D. Hypocalcaemia E. Secondary hyperthyroidism F. Diabetes mellitus type 2 G. Impaired glucose tolerance H. Diabetes mellitus type 1 I. Crohn’s disease J. Primary hyperparathyroidism K. Psychogenic polydipsia L. Gestational diabetes M. Tuberculosis N. Sarcoidosis O. Vitamin D deficiency
A
N. Sarcoidosis
25
```
A 15-year-old girl presents with weight loss, polyuria and polydipsia. Over the last few months she reports feeling increasingly tired and complains of perianal itching. On examination you notice a small perianal abscess. Her fasting glucose is 22.3mmol/L. His corrected calcium is 2.5mmol/L and his PTH is 7.0pmol/L.
A. Malignancy
B. Lung cancer
C. Impaired fasting glucose
D. Hypocalcaemia
E. Secondary hyperthyroidism
F. Diabetes mellitus type 2
G. Impaired glucose tolerance
H. Diabetes mellitus type 1
I. Crohn’s disease
J. Primary hyperparathyroidism
K. Psychogenic polydipsia
L. Gestational diabetes
M. Tuberculosis
N. Sarcoidosis
O. Vitamin D deficiency
```
H. Diabetes mellitus type 1
26
```
A 56-year-old obese woman presents with polyuria and polydipsia. She complains of tiredness and depression. Her fasting glucose is 4.9mmol/L and her OGTT is 4.5mmol/L. She has a corrected calcium of 2.4mmol/L and a PTH of 7.1mmol/L.
A. Malignancy
B. Lung cancer
C. Impaired fasting glucose
D. Hypocalcaemia
E. Secondary hyperthyroidism
F. Diabetes mellitus type 2
G. Impaired glucose tolerance
H. Diabetes mellitus type 1
I. Crohn’s disease
J. Primary hyperparathyroidism
K. Psychogenic polydipsia
L. Gestational diabetes
M. Tuberculosis
N. Sarcoidosis
O. Vitamin D deficiency
```
K. Psychogenic polydipsia
27
```
A 58-year-old Afro-Caribbean gentleman presents with polyuria, polydipsia and weight loss. He has an oral glucose tolerance test of 10.1mmol/L. His corrected calcium is 2.5mmol/L and his PTH is 7.0pmol/L.
A. Malignancy
B. Lung cancer
C. Impaired fasting glucose
D. Hypocalcaemia
E. Secondary hyperthyroidism
F. Diabetes mellitus type 2
G. Impaired glucose tolerance
H. Diabetes mellitus type 1
I. Crohn’s disease
J. Primary hyperparathyroidism
K. Psychogenic polydipsia
L. Gestational diabetes
M. Tuberculosis
N. Sarcoidosis
O. Vitamin D deficiency
```
G. Impaired glucose tolerance
28
```
Varies with posture when sample is taken.
A. Glucose
B. ALP
C. Cortisol
D. ALT
E. Albumin
F. Potassium
G. Urea
H. Triglycerides
I. Creatinine Kinase
```
E. Albumin
29
```
Varies with exercise
A. Glucose
B. ALP
C. Cortisol
D. ALT
E. Albumin
F. Potassium
G. Urea
H. Triglycerides
I. Creatinine Kinase
```
I. Creatinine Kinase
30
```
Increases during pregnancy
A. Glucose
B. ALP
C. Cortisol
D. ALT
E. Albumin
F. Potassium
G. Urea
H. Triglycerides
I. Creatinine Kinase
```
B. ALP
31
```
Varies with race
A. Glucose
B. ALP
C. Cortisol
D. ALT
E. Albumin
F. Potassium
G. Urea
H. Triglycerides
I. Creatinine Kinase
```
I. Creatinine Kinase
32
```
Most likely to vary with time of sampling
A. Glucose
B. ALP
C. Cortisol
D. ALT
E. Albumin
F. Potassium
G. Urea
H. Triglycerides
I. Creatinine Kinase
```
C. Cortisol
33
```
A 19-year-old woman admitted to hospital with acute asthma suffered a cardiac arrest after treatment. She was already taking several medications for her respiratory condition. What drug excess is likely to have caused this problem?
A. GI system
B. High therapeutic index
C. Warfarin
D. Rosiglitazone
E. Low therapeutic index
F. Conjugation by sulphate/gluconaride
G. Poor compliance
H. Lungs
I. Theophylline
J. Oxidation by cytochrome P450
K. Gentamicin
L. Digoxin
M. Kidneys
N. Liver
```
I. Theophylline
34
```
Failure to respond to drug therapy is commonly caused by what?
A. GI system
B. High therapeutic index
C. Warfarin
D. Rosiglitazone
E. Low therapeutic index
F. Conjugation by sulphate/gluconaride
G. Poor compliance
H. Lungs
I. Theophylline
J. Oxidation by cytochrome P450
K. Gentamicin
L. Digoxin
M. Kidneys
N. Liver
```
G. Poor compliance
35
```
Lipid soluble drugs require metabolism by the liver in two phases. What is Phase I?
A. GI system
B. High therapeutic index
C. Warfarin
D. Rosiglitazone
E. Low therapeutic index
F. Conjugation by sulphate/gluconaride
G. Poor compliance
H. Lungs
I. Theophylline
J. Oxidation by cytochrome P450
K. Gentamicin
L. Digoxin
M. Kidneys
N. Liver
```
J. Oxidation by cytochrome P450
36
```
Drugs are mainly excreted by which organ?
A. GI system
B. High therapeutic index
C. Warfarin
D. Rosiglitazone
E. Low therapeutic index
F. Conjugation by sulphate/gluconaride
G. Poor compliance
H. Lungs
I. Theophylline
J. Oxidation by cytochrome P450
K. Gentamicin
L. Digoxin
M. Kidneys
N. Liver
```
M. Kidneys
37
```
The effect of which drug can be measured by the surrogate marker HbA1C
A. GI system
B. High therapeutic index
C. Warfarin
D. Rosiglitazone
E. Low therapeutic index
F. Conjugation by sulphate/gluconaride
G. Poor compliance
H. Lungs
I. Theophylline
J. Oxidation by cytochrome P450
K. Gentamicin
L. Digoxin
M. Kidneys
N. Liver
```
D. Rosiglitazone
38
```
A 58-year-old man presents to your A&E complaining of chest pain and palpitations. He says he takes several drugs for his 'heart problems' and admits to being diabetic. What drug could be causing his problems?
A. GI system
B. High therapeutic index
C. Warfarin
D. Rosiglitazone
E. Low therapeutic index
F. Conjugation by sulphate/gluconaride
G. Poor compliance
H. Lungs
I. Theophylline
J. Oxidation by cytochrome P450
K. Gentamicin
L. Digoxin
M. Kidneys
N. Liver
```
L. Digoxin
39
```
Peak and trough levels of this drug should be taken
A. Carbamazepine
B. Clonazepam
C. Aspirin
D. Phenobarbitone
E. Warfarin
F. Theophylline
G. Gentamicin
H. Heparin - Low molecular weight
I. Ethosuximide
J. Heparin - unfractionated
K. Lithium
L. Phenytoin
M. Digoxin
N. Ciclosporin
```
G. Gentamicin
40
```
Symptoms of under-treatment and toxicity may be similar
A. Carbamazepine
B. Clonazepam
C. Aspirin
D. Phenobarbitone
E. Warfarin
F. Theophylline
G. Gentamicin
H. Heparin - Low molecular weight
I. Ethosuximide
J. Heparin - unfractionated
K. Lithium
L. Phenytoin
M. Digoxin
N. Ciclosporin
```
M. Digoxin
41
```
Decreased excretion, increased plasma concentration and increased risk of toxicity may occur when this taken in conjunction with thiazide diuretics
A. Carbamazepine
B. Clonazepam
C. Aspirin
D. Phenobarbitone
E. Warfarin
F. Theophylline
G. Gentamicin
H. Heparin - Low molecular weight
I. Ethosuximide
J. Heparin - unfractionated
K. Lithium
L. Phenytoin
M. Digoxin
N. Ciclosporin
```
K. Lithium
42
```
Is ototoxic and nephrotoxic
A. Carbamazepine
B. Clonazepam
C. Aspirin
D. Phenobarbitone
E. Warfarin
F. Theophylline
G. Gentamicin
H. Heparin - Low molecular weight
I. Ethosuximide
J. Heparin - unfractionated
K. Lithium
L. Phenytoin
M. Digoxin
N. Ciclosporin
```
G. Gentamicin
43
```
Requires regular monitoring of APTT
A. Carbamazepine
B. Clonazepam
C. Aspirin
D. Phenobarbitone
E. Warfarin
F. Theophylline
G. Gentamicin
H. Heparin - Low molecular weight
I. Ethosuximide
J. Heparin - unfractionated
K. Lithium
L. Phenytoin
M. Digoxin
N. Ciclosporin
```
J. Heparin - unfractionated
44
```
A man was put into custody after driving under the influence of drugs. On arrest he was reported as acting extremely aggressive and paranoid. He also claimed his heart was racing. One hour later he was found dead. There was suspicion of police brutality.
A. Ethanol
B. Amphetamines
C. Cannabis
D. Cocaine
E. Benzodiazepines
F. Ecstasy
G. Methadone
H. Paracetamol
I. Organophosphate
J. Cyanide
K. Carbon monoxide
L. Heroin
M. Police brutality
N. Aspirin
O. Methanol
P. Strychnine
```
D. Cocaine
45
```
A 24-year-old woman goes to a party where she has some pills. She subsequently becomes feverish and confused. She was found to be hyperthermic and blood results showed a raised urea and creatinine, her myoglobin was also found to be high.
A. Ethanol
B. Amphetamines
C. Cannabis
D. Cocaine
E. Benzodiazepines
F. Ecstasy
G. Methadone
H. Paracetamol
I. Organophosphate
J. Cyanide
K. Carbon monoxide
L. Heroin
M. Police brutality
N. Aspirin
O. Methanol
P. Strychnine
```
F. Ecstasy
46
```
James Pond comes to A&E claiming he’s been poisoned. Minutes later he dies. His skin was brick red and there was a faint odour of almonds.
A. Ethanol
B. Amphetamines
C. Cannabis
D. Cocaine
E. Benzodiazepines
F. Ecstasy
G. Methadone
H. Paracetamol
I. Organophosphate
J. Cyanide
K. Carbon monoxide
L. Heroin
M. Police brutality
N. Aspirin
O. Methanol
P. Strychnine
```
J. Cyanide
47
```
Following a death in the family, a young woman is brought into the hospital with confusion. On inspection she appears jaundiced. Her friend reports that she had been vomiting earlier and that she had found an empty medicine bottle in her room.
A. Ethanol
B. Amphetamines
C. Cannabis
D. Cocaine
E. Benzodiazepines
F. Ecstasy
G. Methadone
H. Paracetamol
I. Organophosphate
J. Cyanide
K. Carbon monoxide
L. Heroin
M. Police brutality
N. Aspirin
O. Methanol
P. Strychnine
```
H. Paracetamol
48
```
A man was found collapsed on the floor of his room and his breathing was found to be severely depressed. A urine test was found to be positive for 6-MAM.
A. Ethanol
B. Amphetamines
C. Cannabis
D. Cocaine
E. Benzodiazepines
F. Ecstasy
G. Methadone
H. Paracetamol
I. Organophosphate
J. Cyanide
K. Carbon monoxide
L. Heroin
M. Police brutality
N. Aspirin
O. Methanol
P. Strychnine
```
L. Heroin
49
```
A 30-year-old farmer presents to casualty complaining of diarrhoea and painful mouth ulcers. On questioning he admitted accidentally ingesting liquid paraquat
A. Atropine
B. Desferrioxamine
C. Gastric lavage
D. Naloxone
E. Hyperbaric oxygen
F. Dicobalt edentate
G. Activated charcoal
H. Glucagon
I. N-acetylcysteine
J. Symptomatic and Supportive treatment
K. Haemodialysis
```
G. Activated charcoal
50
```
A 15-year-old girl presents with sweats and hyperventilation indicative of a severe metabolic acidosis; after taking a large number of salicylate tablets
A. Atropine
B. Desferrioxamine
C. Gastric lavage
D. Naloxone
E. Hyperbaric oxygen
F. Dicobalt edentate
G. Activated charcoal
H. Glucagon
I. N-acetylcysteine
J. Symptomatic and Supportive treatment
K. Haemodialysis
```
K. Haemodialysis
51
```
A 26-year-old woman collapses after a massive overdose of atenolol. She remains in cardogenic shock despite initial treatment with IV atropine
A. Atropine
B. Desferrioxamine
C. Gastric lavage
D. Naloxone
E. Hyperbaric oxygen
F. Dicobalt edentate
G. Activated charcoal
H. Glucagon
I. N-acetylcysteine
J. Symptomatic and Supportive treatment
K. Haemodialysis
```
H. Glucagon
52
```
A pregnant 30-year-old woman is found drowsy in her rented flat. She complains of severe nausea for the last 3 hours. Her carboxyhaemoglobin level is 41%.
A. Atropine
B. Desferrioxamine
C. Gastric lavage
D. Naloxone
E. Hyperbaric oxygen
F. Dicobalt edentate
G. Activated charcoal
H. Glucagon
I. N-acetylcysteine
J. Symptomatic and Supportive treatment
K. Haemodialysis
```
E. Hyperbaric oxygen
53
```
A 25-year-old man is delirious and hyperpyrexial after taking a pill in a club. He is hyperreflexic and is hyponatraemic
A. Atropine
B. Desferrioxamine
C. Gastric lavage
D. Naloxone
E. Hyperbaric oxygen
F. Dicobalt edentate
G. Activated charcoal
H. Glucagon
I. N-acetylcysteine
J. Symptomatic and Supportive treatment
K. Haemodialysis
```
J. Symptomatic and supportive treatment
54
```
An 18 year old female is brought in to A&E from a rave in the early hours of the morning. On initial examination she is agitated with a heart rate of 120 bpm. She is very sweaty and has wide dilated pupils
A. Desferrioxamine
B. Naloxone
C. Carbon Monoxide
D. Methanol
E. Salicylates
F. Lithium
G. Tricyclic antidepressants
H. Ecstasy
I. Paracetamol
J. Organophosphates
K. Acetylcysteine
```
H. Ecstasy
55
```
A 25 year old male is admitted with hyperventilation. He is sweating and appears nauseous. He says that he has ringing in his ears. Blood gases show that he has mixed acid-base disturbance
A. Desferrioxamine
B. Naloxone
C. Carbon Monoxide
D. Methanol
E. Salicylates
F. Lithium
G. Tricyclic antidepressants
H. Ecstasy
I. Paracetamol
J. Organophosphates
K. Acetylcysteine
```
E. Salicylates
56
```
An 80 year old man and his 79 year old wife were brought in after a neighbour found them collapsed in their home. On questioning the neighbour it was found that the couple had not been feeling well for a few weeks and had been complaining of nausea, headaches and dizziness
A. Desferrioxamine
B. Naloxone
C. Carbon Monoxide
D. Methanol
E. Salicylates
F. Lithium
G. Tricyclic antidepressants
H. Ecstasy
I. Paracetamol
J. Organophosphates
K. Acetylcysteine
```
C. Carbon Monoxide
57
```
A depressed 30 year old woman was brought into A&E after being found by a friend. On examination she appears very drowsy with sinus tachycardia and wide dilated pupils. She has marked reflexes and extensor plantar responses. ECG shows a wide QRS interval
A. Desferrioxamine
B. Naloxone
C. Carbon Monoxide
D. Methanol
E. Salicylates
F. Lithium
G. Tricyclic antidepressants
H. Ecstasy
I. Paracetamol
J. Organophosphates
K. Acetylcysteine
```
G. Tricyclic antidepressants
58
```
A 45 year old farm worker is admitted complaining primarily of nausea and vomiting. On further questioning it is revealed that he also has a headache, hypersalivation and he is finding it hard to breathe. On examination the patient appears sweaty and has flaccid paresis of his limb muscles
A. Desferrioxamine
B. Naloxone
C. Carbon Monoxide
D. Methanol
E. Salicylates
F. Lithium
G. Tricyclic antidepressants
H. Ecstasy
I. Paracetamol
J. Organophosphates
K. Acetylcysteine
```
J. Organophosphates
59
```
Which of the above techniques can be used to test for all classes of drugs of abuse (DOA)?
A. Paracetamol
B. Liver sample
C. Immunoassay
D. Benzodiazepines
E. Urine sample
F. Drugs of abuse (DOA)
G. Liquid chromotography
H. Barbituates
I. Stool sample
J. Blood sample
K. Thin layer chromotography
```
C. Immunoassay
60
```
What sample is required for use with gas chromatography mass spectroscopy?
A. Paracetamol
B. Liver sample
C. Immunoassay
D. Benzodiazepines
E. Urine sample
F. Drugs of abuse (DOA)
G. Liquid chromotography
H. Barbituates
I. Stool sample
J. Blood sample
K. Thin layer chromotography
```
J. Blood sample
61
```
Colorimetric can be used to test for which drug commonly taken in overdose?
A. Paracetamol
B. Liver sample
C. Immunoassay
D. Benzodiazepines
E. Urine sample
F. Drugs of abuse (DOA)
G. Liquid chromotography
H. Barbituates
I. Stool sample
J. Blood sample
K. Thin layer chromotography
```
A. Paracetamol
62
```
Which of the above techniques can be used to test for benzodiazepines and various antipsychotic drugs?
A. Paracetamol
B. Liver sample
C. Immunoassay
D. Benzodiazepines
E. Urine sample
F. Drugs of abuse (DOA)
G. Liquid chromotography
H. Barbituates
I. Stool sample
J. Blood sample
K. Thin layer chromotography
```
G. Liquid chromatography
63
```
Which of the above techniques can be used to analyse samples of stool, liver and also urine?
A. Paracetamol
B. Liver sample
C. Immunoassay
D. Benzodiazepines
E. Urine sample
F. Drugs of abuse (DOA)
G. Liquid chromotography
H. Barbituates
I. Stool sample
J. Blood sample
K. Thin layer chromotography
```
K. Thin layer chromatography
64
```
Which option is the best specimen for assessing long-term drug use?
A. THC
B. Hair
C. Cocaine
D. Toxicology
E. Forensics
F. MDMA
G. Urine
H. Blood
I. Saliva
J. Paracetamol
K. Morphine
```
B. Hair
65
```
Which drug is found in the most addict related deaths?
A. THC
B. Hair
C. Cocaine
D. Toxicology
E. Forensics
F. MDMA
G. Urine
H. Blood
I. Saliva
J. Paracetamol
K. Morphine
```
K. Morphine
66
```
Which option is responsible for the analysis of samples for drugs and poisons?
A. THC
B. Hair
C. Cocaine
D. Toxicology
E. Forensics
F. MDMA
G. Urine
H. Blood
I. Saliva
J. Paracetamol
K. Morphine
```
D. Toxicology
67
```
Which option is the best example of a quick, cheap, easy and non-invasive specimen which is likely to be adulterated for forensic drug analysis? Disadvantages include a small window of detection.
A. THC
B. Hair
C. Cocaine
D. Toxicology
E. Forensics
F. MDMA
G. Urine
H. Blood
I. Saliva
J. Paracetamol
K. Morphine
```
I. Saliva
68
```
Which drug is not excreted into saliva?
A. THC
B. Hair
C. Cocaine
D. Toxicology
E. Forensics
F. MDMA
G. Urine
H. Blood
I. Saliva
J. Paracetamol
K. Morphine
```
A. THC
69
```
A 25 year old male with a history of tuberculosis presenting with a plasma osmolality of 205mmol/l, potassium of 6.3mmol/l and sodium of 115mmol/l.
A. Addison's disease
B. Cushing’s syndrome
C. SIADH
D. Diuretic use
E. Diabetic ketoacidosis
F. Vomiting
G. Haemorrhage
H. Artifactual
I. Acute Renal Failure
J. Alcohol abuse
K. Renal tubular acidosis
L. Rhabdomyolysis
M. Diarrhoea
```
A. Addison's disease
70
```
A 76 year woman with known congestive cardiac failure presenting with digoxin toxicity
A. Addison's disease
B. Cushing’s syndrome
C. SIADH
D. Diuretic use
E. Diabetic ketoacidosis
F. Vomiting
G. Haemorrhage
H. Artifactual
I. Acute Renal Failure
J. Alcohol abuse
K. Renal tubular acidosis
L. Rhabdomyolysis
M. Diarrhoea
```
D. Diuretic use
71
```
Following a severe car crash, a patient’s ECG shows a broad QRS complex with peaked T waves.
A. Addison's disease
B. Cushing’s syndrome
C. SIADH
D. Diuretic use
E. Diabetic ketoacidosis
F. Vomiting
G. Haemorrhage
H. Artifactual
I. Acute Renal Failure
J. Alcohol abuse
K. Renal tubular acidosis
L. Rhabdomyolysis
M. Diarrhoea
```
L. Rhabdomyolysis
72
```
A 53 year old man in hospital following a minor operation was observed to have a potassium of 7.0mmol/l on a routine blood test but clinically well. A repeat test 4 hours later was 4.0mmol/l.
A. Addison's disease
B. Cushing’s syndrome
C. SIADH
D. Diuretic use
E. Diabetic ketoacidosis
F. Vomiting
G. Haemorrhage
H. Artifactual
I. Acute Renal Failure
J. Alcohol abuse
K. Renal tubular acidosis
L. Rhabdomyolysis
M. Diarrhoea
```
H. Artifactual
73
```
An 18 year old woman presents comatose, with a urinary pH of 3.5 and plasma potassium of 6.5mmol/l. 6 hours after treatment potassium drops to 3.1mmol/l.
A. Addison's disease
B. Cushing’s syndrome
C. SIADH
D. Diuretic use
E. Diabetic ketoacidosis
F. Vomiting
G. Haemorrhage
H. Artifactual
I. Acute Renal Failure
J. Alcohol abuse
K. Renal tubular acidosis
L. Rhabdomyolysis
M. Diarrhoea
```
E. Diabetic ketoacidosis
74
```
A 68 year old woman, K+ = 3.0 mmol/L with a history of congestive cardiac failure complains of general discomfort.
A. Insulin administration
B. Hypokalaemia
C. Laxative abuse
D. Cushing's disease
E. Rhabdomyalysis
F. Addison's disease
G. Diuretic use
H. Artefactual
I. Hyperkalaemia
J. Burns
K. Renal tubular disease
```
G. Diuretic use
75
```
An ECG of a 27 year old man in casualty shows peaked T waves in leads V2 and V3.
A. Insulin administration
B. Hypokalaemia
C. Laxative abuse
D. Cushing's disease
E. Rhabdomyalysis
F. Addison's disease
G. Diuretic use
H. Artefactual
I. Hyperkalaemia
J. Burns
K. Renal tubular disease
```
I. Hyperkalaemia
76
```
A 2 month old infant vomits profusely, pH = 7.57, H+= 26 nmol/L, HCO3= 50 mmol/L
A. Insulin administration
B. Hypokalaemia
C. Laxative abuse
D. Cushing's disease
E. Rhabdomyalysis
F. Addison's disease
G. Diuretic use
H. Artefactual
I. Hyperkalaemia
J. Burns
K. Renal tubular disease
```
B. Hypokalaemia
77
```
A 47 year old woman complains of tiredness, muscle weakness, mood swings and loss of appetite over several months. K+= 5.9 mmol/L
A. Insulin administration
B. Hypokalaemia
C. Laxative abuse
D. Cushing's disease
E. Rhabdomyalysis
F. Addison's disease
G. Diuretic use
H. Artefactual
I. Hyperkalaemia
J. Burns
K. Renal tubular disease
```
F. Addison's disease
78
```
A 15 year old girl with K+ = 3.2 mmol/L admits to taking Bisacodyl over several months to lose weight.
A. Insulin administration
B. Hypokalaemia
C. Laxative abuse
D. Cushing's disease
E. Rhabdomyalysis
F. Addison's disease
G. Diuretic use
H. Artefactual
I. Hyperkalaemia
J. Burns
K. Renal tubular disease
```
C. Laxative abuse
79
```
A 47 year old female presents to her GP with severe loin pain. On further questioning the patient complains of a 6 month history of recurrent fevers and vomiting with more recent generalised weakness and pain in some of her joints. A subsequent blood test shows hypokalaemia.
A. Corticosteroid use
B. Vomiting
C. Addison's disease
D. Diarrhoea
E. Diuretics
F. Fistula
G. Haemolysis
H. Renal failure
I. Delayed separation
J. Drip arm sample
K. Renal tubular acidosis
```
K. Renal tubular acidosis
80
```
A 20 year old medical student presents to his GP with bowel disturbances. He recently returned from holiday in Thailand. Blood tests reveal that he is hypokalaemic.
A. Corticosteroid use
B. Vomiting
C. Addison's disease
D. Diarrhoea
E. Diuretics
F. Fistula
G. Haemolysis
H. Renal failure
I. Delayed separation
J. Drip arm sample
K. Renal tubular acidosis
```
D. Diarrhoea
81
```
A junior doctor received a blood report from the pathology lab for a 50 year old male who was recovering from an inguinal hernia repair. The report described the patient as being hyperkalaemic. Most of the porters at the hospital were on strike at the time.
A. Corticosteroid use
B. Vomiting
C. Addison's disease
D. Diarrhoea
E. Diuretics
F. Fistula
G. Haemolysis
H. Renal failure
I. Delayed separation
J. Drip arm sample
K. Renal tubular acidosis
```
I. Delayed separation
82
```
An 82 year old female caught a bad cold on a flight to Heathrow for a holiday from India, where she has lived all her life. Six days later she comes into A+E weak, confused with abdominal pain. Blood tests show a potassium of 6.2mmol/L.
A. Corticosteroid use
B. Vomiting
C. Addison's disease
D. Diarrhoea
E. Diuretics
F. Fistula
G. Haemolysis
H. Renal failure
I. Delayed separation
J. Drip arm sample
K. Renal tubular acidosis
```
C. Addison's disease
83
```
A 72 year old male is referred to cardiothoracic surgery outpatients following an episode of unconsciousness. The patient had an aortic valve replacement operation 5 years ago. Following investigation the valve is found to have malfunctioned. A blood test shows that the patient is hyperkalaemic.
A. Corticosteroid use
B. Vomiting
C. Addison's disease
D. Diarrhoea
E. Diuretics
F. Fistula
G. Haemolysis
H. Renal failure
I. Delayed separation
J. Drip arm sample
K. Renal tubular acidosis
```
G. Haemolysis
84
```
A 65 year old lady presents to A & E with her son who describes decreasing mental function over the last week or so. On questioning you discover that she is a smoker with a 40 pack year history and that she has had a chronic, productive cough for several weeks. Bloods include Na=120, K=4.5, Cl=85, HC03=22, serum osmolality=260
A. Dehydration
B. Psychogenic polydipsia
C. Normal
D. SIADH
E. Nephrogenic diabetes insipidus
F. Illicit drug abuse
G. Iatrogenic
H. Diuretic excess
I. Alcohol abuse
J. Cranial Diabetes insipidus
```
D. SIADH
85
```
A 75 year old lady is recovering from a hip replacement after fracturing her neck of femur. The post-operative period has been uneventful but today you, the F1, notice that her blood results are slightly abnormal: Na=126, K=3.2, serum osmolality=262. You consult your registrar, who tells you not to worry and advises ‘watchful waiting’.
A. Dehydration
B. Psychogenic polydipsia
C. Normal
D. SIADH
E. Nephrogenic diabetes insipidus
F. Illicit drug abuse
G. Iatrogenic
H. Diuretic excess
I. Alcohol abuse
J. Cranial Diabetes insipidus
```
G. Iatrogenic
86
```
A young drama student attends clinic complaining of polyuria and sleep disturbance. Her past medical history includes an appendicectomy, a skull fracture, and hayfever. Her biochemistry reveals Na=148, K=3.6. She denies excessive fluid intake.
A. Dehydration
B. Psychogenic polydipsia
C. Normal
D. SIADH
E. Nephrogenic diabetes insipidus
F. Illicit drug abuse
G. Iatrogenic
H. Diuretic excess
I. Alcohol abuse
J. Cranial Diabetes insipidus
```
J. Cranial Diabetes insipidus
87
```
A male medical student consults you after a lecture on disorders of acid-base balance and ion handling. He is concerned that his high fluid intake (2-3litres/day) may be causing a ‘dilutional hyponatraemia’ as he finds it hard to concentrate in lectures. Initial investigations include biochemistry: Na=126, K=3.8, pH=7.39
A. Dehydration
B. Psychogenic polydipsia
C. Normal
D. SIADH
E. Nephrogenic diabetes insipidus
F. Illicit drug abuse
G. Iatrogenic
H. Diuretic excess
I. Alcohol abuse
J. Cranial Diabetes insipidus
```
B. Psychogenic polydipsia
88
```
A 37 year old banker presents to A & E complaining of nausea and dizziness. He describes treating his hangover this morning with a ‘good run’ and tells you that he had a coffee to ‘steady himself’ before coming in. On examination you note a mild tachycardia and cannot confidently assess his JVP. Routine bloods reveal Na=152, K=4.1, urea=25, creatinine=190.
A. Dehydration
B. Psychogenic polydipsia
C. Normal
D. SIADH
E. Nephrogenic diabetes insipidus
F. Illicit drug abuse
G. Iatrogenic
H. Diuretic excess
I. Alcohol abuse
J. Cranial Diabetes insipidus
```
A. Dehydration
89
```
Normovolaemic and hyponatraemic
A. Achalasia
B. Diuretic excess
C. Cardiac failure
D. Pernicious anaemia
E. Vomiting
F. Acromegaly
G. COPD
H. Osteomalacia
I. Chronic renal failure
J. Guillain-Barre syndrome
K. SIADH
```
K. SIADH
90
```
Hypovolaemic with urinary Na+ <10 mmol/L
A. Achalasia
B. Diuretic excess
C. Cardiac failure
D. Pernicious anaemia
E. Vomiting
F. Acromegaly
G. COPD
H. Osteomalacia
I. Chronic renal failure
J. Guillain-Barre syndrome
K. SIADH
```
E. Vomiting
91
```
Raised JVP, peripheral oedema and urinary Na+ <10 mmol/L
A. Achalasia
B. Diuretic excess
C. Cardiac failure
D. Pernicious anaemia
E. Vomiting
F. Acromegaly
G. COPD
H. Osteomalacia
I. Chronic renal failure
J. Guillain-Barre syndrome
K. SIADH
```
C. Cardiac failure
92
```
Hypotension with urinary Na+ >20 mmol/L
A. Achalasia
B. Diuretic excess
C. Cardiac failure
D. Pernicious anaemia
E. Vomiting
F. Acromegaly
G. COPD
H. Osteomalacia
I. Chronic renal failure
J. Guillain-Barre syndrome
K. SIADH
```
B. Diuretic excess
93
```
Hypervolaemic with urinary Na+ >20 mmol/L
A. Achalasia
B. Diuretic excess
C. Cardiac failure
D. Pernicious anaemia
E. Vomiting
F. Acromegaly
G. COPD
H. Osteomalacia
I. Chronic renal failure
J. Guillain-Barre syndrome
K. SIADH
```
I. Chronic renal failure
94
```
A 23 year old male patient presents to GI outpatients clinic following disturbances since his return from a one month trip to India. Routine bloods reveal that he is mildly hypokalaemic. Results of rigid sigmoidoscopy were normal
A. Use of corticosteroids
B. Drip arm sample
C. Severe tissue damage
D. Vomiting
E. Fistula
F. Renal Failure
G. Haemolysis
H. Use of diuretics
I. Diarrhoea
J. Renal tubular acidosis
K. Addisonian crisis
```
I. Diarrhoea
95
```
A 46 year old female presents with confusion and complains of hallucinations. On further questioning she reveals that she has been feeling generally tired and weak for the last 8 weeks. During this period she has lost 8 kg in weight. Her past history revealed an episode of TB 22 years ago. Her electrolyte results revealed Sodium 105 mmol/l; potassium 5.5 mmol/l and osmolality 220 mmol/l.
A. Use of corticosteroids
B. Drip arm sample
C. Severe tissue damage
D. Vomiting
E. Fistula
F. Renal Failure
G. Haemolysis
H. Use of diuretics
I. Diarrhoea
J. Renal tubular acidosis
K. Addisonian crisis
```
K. Addisonian crisis
96
```
A 78 year old male presents with hypokalaemia. He has previously been diagnosed with congestive heart failure, which has been controlled with medication. Serum sodium was 126 mmol/l and bicarbonate was raised.
A. Use of corticosteroids
B. Drip arm sample
C. Severe tissue damage
D. Vomiting
E. Fistula
F. Renal Failure
G. Haemolysis
H. Use of diuretics
I. Diarrhoea
J. Renal tubular acidosis
K. Addisonian crisis
```
H. Use of diuretics
97
```
A 35 year old male body builder presents to his GP surgery with genital atrophy. Routine blood tests reveal that the patient is hypokalamic.
A. Use of corticosteroids
B. Drip arm sample
C. Severe tissue damage
D. Vomiting
E. Fistula
F. Renal Failure
G. Haemolysis
H. Use of diuretics
I. Diarrhoea
J. Renal tubular acidosis
K. Addisonian crisis
```
A. Use of corticosteroids
98
```
A 19 year old female patient presents to A&E with severe dehydration, and is rapidly infused. Blood samples obtained by a trainee nurse reveals gross hyponatraemia. Glucose levels was also raised markedly.
A. Use of corticosteroids
B. Drip arm sample
C. Severe tissue damage
D. Vomiting
E. Fistula
F. Renal Failure
G. Haemolysis
H. Use of diuretics
I. Diarrhoea
J. Renal tubular acidosis
K. Addisonian crisis
```
B. Drip arm sample
99
```
A 45 year old female with long-term poorly controlled asthma presents to her GP complaining of weight gain and excessive sweating. A recent routine abdominal CT scan revealed atrophy of the adrenal glands.
A. Iatrogenic Cushing’s Syndrome
B. Nelson’s Syndrome
C. Addison’s Disease
D. Congenital Adrenal Hyperplasia
E. Cushing’s Syndrome
F. Adrenal Carcinoma
G. Multiple Endocrine Neoplasia Syndrome
H. Aldosterone Secreting Adrenal Adenoma
I. Phaeochromocytoma
J. Ectopic ACTH Secretion
K. Cushing’s Disease
L. Schmidt’s Syndrome
M. Addisonian Crisis
N. Pseudo-Cushing’s Syndrome
```
A. Iatrogenic Cushing's Syndrome
100
```
The next patient on the endocrine ward round has just received the results of a high dose dexamethasone suppression test. The consultant informs you that the cortisol levels have been suppressed and asks you the most likely cause of this patient’s cushingoid symptoms
A. Iatrogenic Cushing’s Syndrome
B. Nelson’s Syndrome
C. Addison’s Disease
D. Congenital Adrenal Hyperplasia
E. Cushing’s Syndrome
F. Adrenal Carcinoma
G. Multiple Endocrine Neoplasia Syndrome
H. Aldosterone Secreting Adrenal Adenoma
I. Phaeochromocytoma
J. Ectopic ACTH Secretion
K. Cushing’s Disease
L. Schmidt’s Syndrome
M. Addisonian Crisis
N. Pseudo-Cushing’s Syndrome
```
K. Cushing's disease
101
```
A 35 year old female arrives in A&E at 16:30 in a very distressed state. Examination reveals tachycardia and postural hypotension. She complains of ongoing weakness and confusion following a recent operation on her knee. Blood tests reveal hyperkalaemia, hyponatraemia. Further tests measure cortisol levels at 50 nmol/L.
A. Iatrogenic Cushing’s Syndrome
B. Nelson’s Syndrome
C. Addison’s Disease
D. Congenital Adrenal Hyperplasia
E. Cushing’s Syndrome
F. Adrenal Carcinoma
G. Multiple Endocrine Neoplasia Syndrome
H. Aldosterone Secreting Adrenal Adenoma
I. Phaeochromocytoma
J. Ectopic ACTH Secretion
K. Cushing’s Disease
L. Schmidt’s Syndrome
M. Addisonian Crisis
N. Pseudo-Cushing’s Syndrome
```
M. Addisonian Crisis
102
```
A 52 year old male complains of muscle cramps and headaches. Examination reveals hypertension. Blood tests are ordered and reveal a marked hypokalaemia. The renin-aldosterone ratio is noted at 0.02 and the House Officer orders an abdominal CT scan.
A. Iatrogenic Cushing’s Syndrome
B. Nelson’s Syndrome
C. Addison’s Disease
D. Congenital Adrenal Hyperplasia
E. Cushing’s Syndrome
F. Adrenal Carcinoma
G. Multiple Endocrine Neoplasia Syndrome
H. Aldosterone Secreting Adrenal Adenoma
I. Phaeochromocytoma
J. Ectopic ACTH Secretion
K. Cushing’s Disease
L. Schmidt’s Syndrome
M. Addisonian Crisis
N. Pseudo-Cushing’s Syndrome
```
H. Aldosterone Secreting Adrenal Adenoma
103
```
A 65 year old female presents to her new GP 5 years after an operation on her abdomen. She cannot remember the details of the operation but does remember that she was suffering from severe Cushing’s Disease at the time. She now notes a progressive “tanning” of the skin
A. Iatrogenic Cushing’s Syndrome
B. Nelson’s Syndrome
C. Addison’s Disease
D. Congenital Adrenal Hyperplasia
E. Cushing’s Syndrome
F. Adrenal Carcinoma
G. Multiple Endocrine Neoplasia Syndrome
H. Aldosterone Secreting Adrenal Adenoma
I. Phaeochromocytoma
J. Ectopic ACTH Secretion
K. Cushing’s Disease
L. Schmidt’s Syndrome
M. Addisonian Crisis
N. Pseudo-Cushing’s Syndrome
```
B. Nelson's Syndrome
104
```
A 57 year old Type 1 diabetic woman presents with weight loss, weakness and depression. Examination reveals postural hypotension, hyperpigmentation in the palmar creases and widespread patchy vitiligo. Full blood count is unremarkable but U&Es reveal Na+ 130 mmol/l, K+ 6.0 mmol/l, Urea 7.4 mmol/l and Ca 2+ 2.70 mmol/l.
A. Phaeochromocytoma
B. Congenital adrenal hyperplasia
C. Iatrogenic Cushing's syndrome
D. Adrenal carcinoma
E. Iatrogenic Addison's disease
F. Pseudo-Cushing's syndrome
G. Cushing's disease
H. Addison's disease
I. Adrenal adenoma
J. Conn's syndrome
K. Ectopic ACTH secretion
L. Carney's syndrome
```
H. Addison's disease
105
```
A 32 year old woman presents with a one year history of weight loss, fatigue and hirsutism. Examination reveals thin skin, easy bruising, purple abdominal striae and a supraclavicular fat pad. Plasma cortisol and ACTH levels are both raised but suppress after high dose dexamethasone suppression test.
A. Phaeochromocytoma
B. Congenital adrenal hyperplasia
C. Iatrogenic Cushing's syndrome
D. Adrenal carcinoma
E. Iatrogenic Addison's disease
F. Pseudo-Cushing's syndrome
G. Cushing's disease
H. Addison's disease
I. Adrenal adenoma
J. Conn's syndrome
K. Ectopic ACTH secretion
L. Carney's syndrome
```
G. Cushing's disease
106
```
A 64 year old man, who is known to suffer from ulcerative colitis, presents with a long history of weight gain, fatigue and depression. Examination reveals a moon-shaped face, centripetal obesity, thin skin and easy bruising. Serum cortisol levels are elevated and fail to suppress after low dose dexamethasone suppression test.
A. Phaeochromocytoma
B. Congenital adrenal hyperplasia
C. Iatrogenic Cushing's syndrome
D. Adrenal carcinoma
E. Iatrogenic Addison's disease
F. Pseudo-Cushing's syndrome
G. Cushing's disease
H. Addison's disease
I. Adrenal adenoma
J. Conn's syndrome
K. Ectopic ACTH secretion
L. Carney's syndrome
```
C. Iatrogenic Cushing's syndrome
107
```
A 21 year old man presents with rapid palpitations associated with chest tightness, severe headache, tremor and sweating. History reveals that the man had just consumed a large amount of alcohol.
A. Phaeochromocytoma
B. Congenital adrenal hyperplasia
C. Iatrogenic Cushing's syndrome
D. Adrenal carcinoma
E. Iatrogenic Addison's disease
F. Pseudo-Cushing's syndrome
G. Cushing's disease
H. Addison's disease
I. Adrenal adenoma
J. Conn's syndrome
K. Ectopic ACTH secretion
L. Carney's syndrome
```
A. Phaeochromocytoma
108
```
A 27 year old woman presents with a three month history of weight gain, deepening voice and secondary amenorrhoea. Examination reveals clitoromegaly, acne, greasy skin and hirsutism. Serum cortisol is grossly elevated and ACTH levels are undetectable.
A. Phaeochromocytoma
B. Congenital adrenal hyperplasia
C. Iatrogenic Cushing's syndrome
D. Adrenal carcinoma
E. Iatrogenic Addison's disease
F. Pseudo-Cushing's syndrome
G. Cushing's disease
H. Addison's disease
I. Adrenal adenoma
J. Conn's syndrome
K. Ectopic ACTH secretion
L. Carney's syndrome
```
D. Adrenal Carcinoma
109
```
The commonest enzyme deficiency seen in CAH
A. Hyponatreamia with Hypokalaemia
B. Hyponatreamia with Hyperkalaemia
C. 21-Hydroxylase Deficiency
D. Raised ACTH
E. Reduced Cortisol
F. 17α-Hydroxylase deficiency
G. Aldosterone
H. Deoxycortisol
I. Normal ACTH levels
J. 17-Hydroxyprogesterone
K. Hypernatreamia with Hypokalaemia
L. Pregnanetriol
M. Chromosome 6
N. Hypernatreamia with Hyperkalaemia
O. 11β-Hydroxylase deficiency
```
C. 21-Hydroxylase Deficiency
110
```
Levels of this steroid are raised in the serum of CAH patients
A. Hyponatreamia with Hypokalaemia
B. Hyponatreamia with Hyperkalaemia
C. 21-Hydroxylase Deficiency
D. Raised ACTH
E. Reduced Cortisol
F. 17α-Hydroxylase deficiency
G. Aldosterone
H. Deoxycortisol
I. Normal ACTH levels
J. 17-Hydroxyprogesterone
K. Hypernatreamia with Hypokalaemia
L. Pregnanetriol
M. Chromosome 6
N. Hypernatreamia with Hyperkalaemia
O. 11β-Hydroxylase deficiency
```
J. 17-Hydroxyprogesterone
111
```
Increased levels are seen in the urine of CAH patients
A. Hyponatreamia with Hypokalaemia
B. Hyponatreamia with Hyperkalaemia
C. 21-Hydroxylase Deficiency
D. Raised ACTH
E. Reduced Cortisol
F. 17α-Hydroxylase deficiency
G. Aldosterone
H. Deoxycortisol
I. Normal ACTH levels
J. 17-Hydroxyprogesterone
K. Hypernatreamia with Hypokalaemia
L. Pregnanetriol
M. Chromosome 6
N. Hypernatreamia with Hyperkalaemia
O. 11β-Hydroxylase deficiency
```
L. Pregnanetriol
112
```
The sodium and potassium pattern seen in CYP21 deficiency.
A. Hyponatreamia with Hypokalaemia
B. Hyponatreamia with Hyperkalaemia
C. 21-Hydroxylase Deficiency
D. Raised ACTH
E. Reduced Cortisol
F. 17α-Hydroxylase deficiency
G. Aldosterone
H. Deoxycortisol
I. Normal ACTH levels
J. 17-Hydroxyprogesterone
K. Hypernatreamia with Hypokalaemia
L. Pregnanetriol
M. Chromosome 6
N. Hypernatreamia with Hyperkalaemia
O. 11β-Hydroxylase deficiency
```
B. Hyponatreamia with Hyperkalaemia
113
```
A doctor suspecting his patient is suffering from CAH has just received some results that proves otherwise
A. Hyponatreamia with Hypokalaemia
B. Hyponatreamia with Hyperkalaemia
C. 21-Hydroxylase Deficiency
D. Raised ACTH
E. Reduced Cortisol
F. 17α-Hydroxylase deficiency
G. Aldosterone
H. Deoxycortisol
I. Normal ACTH levels
J. 17-Hydroxyprogesterone
K. Hypernatreamia with Hypokalaemia
L. Pregnanetriol
M. Chromosome 6
N. Hypernatreamia with Hyperkalaemia
O. 11β-Hydroxylase deficiency
```
I. Normal ACTH levels
114
```
An overweight 35-year old shop-assistant visits her GP complaining of debilitating tiredness. Her periods have also become infrequent in this time. Despite it being a warm day, she wears a coat and jumper inside. On examination, she has a symmetrical painless lump on her neck. The patient has a history of well-controlled SLE.
A. Prader-Willi Syndrome
B. De Quervain’s thyroiditis
C. Cushing’s syndrome
D. Cushing’s disease
E. Pregnancy
F. Type I diabetes
G. Type II diabetes
H. Long-term insulin use
I. PCOS
J. Alcohol excess
K. Hashimoto’s thyroiditis
L. Simple Obesity
M. Menopause
N. Steroid abuse
```
K. Hashimoto's thyroiditis
115
```
A 14-year old boy visits his GP with his mother, having been recommended to by the school nurse, following an inability to attend PE lessons, due to his weight. Both seem generally unconcerned, with his mother stating that she never makes him do exercise at home anyway. The boy describes McDonalds and Playstation as his favourite hobbies. As a precaution, the GP performs a blood sample, which showed no endocrine abnormalities, but a raised cholesterol.
A. Prader-Willi Syndrome
B. De Quervain’s thyroiditis
C. Cushing’s syndrome
D. Cushing’s disease
E. Pregnancy
F. Type I diabetes
G. Type II diabetes
H. Long-term insulin use
I. PCOS
J. Alcohol excess
K. Hashimoto’s thyroiditis
L. Simple Obesity
M. Menopause
N. Steroid abuse
```
L. Simple obesity
116
```
A 29-year old, clinically obese accountant presents with a relapsing of her acne, which had disappeared in her teens. On further questioning, she admits to infrequent periods over the last year, and a greater than normal growth of hair on her face. Blood tests show an elevated serum testosterone.
A. Prader-Willi Syndrome
B. De Quervain’s thyroiditis
C. Cushing’s syndrome
D. Cushing’s disease
E. Pregnancy
F. Type I diabetes
G. Type II diabetes
H. Long-term insulin use
I. PCOS
J. Alcohol excess
K. Hashimoto’s thyroiditis
L. Simple Obesity
M. Menopause
N. Steroid abuse
```
I. PCOS
117
```
A 33-year old overweight man complains of headaches and visual disturbances which he blames for two car accidents he has been involved in the last month. He has a ruddy appearance, and the GP notes that his weight is mainly concentrated in a ‘pot belly’. The man’s blood pressure is 150/100, and following a 48hr low –dose dexamethasone test, the patient has a cortisol of 500nm/L, and after a 48hr high-dose dexamethasone test, the cortisol was 250nmol/L
A. Prader-Willi Syndrome
B. De Quervain’s thyroiditis
C. Cushing’s syndrome
D. Cushing’s disease
E. Pregnancy
F. Type I diabetes
G. Type II diabetes
H. Long-term insulin use
I. PCOS
J. Alcohol excess
K. Hashimoto’s thyroiditis
L. Simple Obesity
M. Menopause
N. Steroid abuse
```
D. Cushing's disease
118
```
A 65-year old overweight Indian gentleman presents to his GP, complaining of problems with his eyesight, which has become blurred recently, despite 20/20 vision for the rest of his life. On further questioning, he admits to increased urinary frequency, which he put down to his age, though recalls that he has been drinking more recently. On dip-sticking the urine, glucose was +++, and following a blood test, the blood sugar was 18mmol/L
A. Prader-Willi Syndrome
B. De Quervain’s thyroiditis
C. Cushing’s syndrome
D. Cushing’s disease
E. Pregnancy
F. Type I diabetes
G. Type II diabetes
H. Long-term insulin use
I. PCOS
J. Alcohol excess
K. Hashimoto’s thyroiditis
L. Simple Obesity
M. Menopause
N. Steroid abuse
```
G. Type II diabetes
119
```
A 15 year old overweight schoolgirl presents to her GP complaining of oligomenorrhoea. She is very self conscious and concerned about acne and excessive facial hair. Tests reveal raised serum LH and androgen concentrations.
A. Urine dipstick
B. Genetic testing
C. Chest X-ray
D. Lipid profile
E. Exercise tolerance test
F. BMI quantification
G. Thyroid autoantibodies
H. Ovarian ultrasound
I. Cortisol measurement
```
H. Ovarian ultrasound
120
```
A 54 year old businessman comes to you with a wound in his foot that has failed to heal over a few weeks. You notice various other minor lesions on both feet and he tells you that he has recently ‘lost feeling’ in his legs. His BMI is 31 and his blood pressure is 145/95.
A. Urine dipstick
B. Genetic testing
C. Chest X-ray
D. Lipid profile
E. Exercise tolerance test
F. BMI quantification
G. Thyroid autoantibodies
H. Ovarian ultrasound
I. Cortisol measurement
```
A. Urine dipstick
121
```
A 38 year old secretary presents with a 3 month history of increasing fatigue and lethargy. She says that her muscles ‘don’t seem to work any more’ and you note slow relaxing reflexes on neurological examination. She complains of weight gain and seems very depressed.
A. Urine dipstick
B. Genetic testing
C. Chest X-ray
D. Lipid profile
E. Exercise tolerance test
F. BMI quantification
G. Thyroid autoantibodies
H. Ovarian ultrasound
I. Cortisol measurement
```
G. Thyroid autoantibodies
122
```
A 3 year old child is brought in by his parents who are concerned about his development, both physically and behaviourally. Her mother complains that he is continually eating, despite some feeding difficulties present in early infancy. On examination, you note some mild mental retardation, distinctive facial features and hypogonadism.
A. Urine dipstick
B. Genetic testing
C. Chest X-ray
D. Lipid profile
E. Exercise tolerance test
F. BMI quantification
G. Thyroid autoantibodies
H. Ovarian ultrasound
I. Cortisol measurement
```
B. Genetic testing
123
```
A 60 year old ex-RAF pilot presents with breathlessness on exercise. Questioning reveals that he has difficulty sleeping and requires 3/4 pillows. He is wheezy but puts that down to a lifetime of smoking (40 pack years). Further examination reveals ankle oedema, crepitations and a displaced apex beat.
A. Urine dipstick
B. Genetic testing
C. Chest X-ray
D. Lipid profile
E. Exercise tolerance test
F. BMI quantification
G. Thyroid autoantibodies
H. Ovarian ultrasound
I. Cortisol measurement
```
C. Chest X-ray
124
```
A 62 year old Indian gentleman visits his GP, complaining of pins and needles in his feet, which is worse at night. He also mentions that he has been passing urine more often than he used to, and puts this down to the fact that he has been drinking more. Blood tests reveal a fasting plasma glucose of 11.4 mmol/l.
A. PCOS
B. Cushing's disease
C. Menopause
D. Alcohol excess
E. Graves' disease
F. Type 2 diabetes
G. Cushing's syndrome
H. Familial hypercholesterolaemia
I. Type 1 diabetes
J. Hashimoto's thyroiditis
```
F. Type 2 diabetes
125
```
A 21 year old obese student visits her GP, feeling very depressed about her hair loss, which has got progressively worse since the age of 16. She is also worried about the irregularity of her periods, which has been going on for about a year and a half. Serum testosterone is raised.
A. PCOS
B. Cushing's disease
C. Menopause
D. Alcohol excess
E. Graves' disease
F. Type 2 diabetes
G. Cushing's syndrome
H. Familial hypercholesterolaemia
I. Type 1 diabetes
J. Hashimoto's thyroiditis
```
A. PCOS
126
```
A 31 year old research assistant presents to her GP complaining of weight gain. On questioning, she thinks that most of this weight has been put on around her middle, and her face looks much rounder. The patient has a history of ulcerative colitis that is well controlled by medication.
A. PCOS
B. Cushing's disease
C. Menopause
D. Alcohol excess
E. Graves' disease
F. Type 2 diabetes
G. Cushing's syndrome
H. Familial hypercholesterolaemia
I. Type 1 diabetes
J. Hashimoto's thyroiditis
```
G. Cushing's syndrome
127
```
A 45 year old sales assistant presents with extreme tiredness. On examination, the GP notes a painless lump on the front of her neck that moves up with swallowing, and that her hands are cold and dry. The patient has a history of pernicious anaemia.
A. PCOS
B. Cushing's disease
C. Menopause
D. Alcohol excess
E. Graves' disease
F. Type 2 diabetes
G. Cushing's syndrome
H. Familial hypercholesterolaemia
I. Type 1 diabetes
J. Hashimoto's thyroiditis
```
J. Hashimoto's thyroiditis
128
```
A 36 year old woman visits her GP, worried about the chest pain brought on by her daily run in the park. On examination, the GP notes dark patches on the backs of her hands. She mentions that her younger sister has the same dark patches. Serum cholesterol is 9.4 mmol/l.
A. PCOS
B. Cushing's disease
C. Menopause
D. Alcohol excess
E. Graves' disease
F. Type 2 diabetes
G. Cushing's syndrome
H. Familial hypercholesterolaemia
I. Type 1 diabetes
J. Hashimoto's thyroiditis
```
H. Familial hypercholesterolaemia
129
```
An 11 year old boy is taken to the GP by his parents after complaining that “his wee-wee is a funny colour”. The parents reveal that their son hasn’t been too well lately, “He’s been very tired, feeling sick and has had temperature the last few days. We thought he’s just picked up a virus because he had a sore throat about 10days ago, but now that his urine has gone this smoky colour and his eyes are puffy, we thought we’d bring him in…”
A. Clear cell renal carcinoma
B. Acute diffuse proliferative glomerulonephritis
C. Polycystic kidney disease
D. Wilms tumour
E. Bacterial endocarditis
F. Alport's disease
G. Goodpasture's
H. Hypertensive renal damage
I. Henoch-Schonlein purpura
J. Cannonball metastases
K. SLE
L. Diabetic nephropathy
M. Wegener's granulomatosis
```
B. Acute diffuse proliferative glomerulonephritis
130
```
A gentleman who presented with haemoptysis and haematuria. Histology shows the accumulation of macrophages in Bowmans capsule. Immunology reveals the patient is HLA-DR2, and possesses Anti-glomerualr basement membrane antibody.
A. Clear cell renal carcinoma
B. Acute diffuse proliferative glomerulonephritis
C. Polycystic kidney disease
D. Wilms tumour
E. Bacterial endocarditis
F. Alport's disease
G. Goodpasture's
H. Hypertensive renal damage
I. Henoch-Schonlein purpura
J. Cannonball metastases
K. SLE
L. Diabetic nephropathy
M. Wegener's granulomatosis
```
G. Goodpasture's
131
```
A 50 year old male with a persistant runny nose and sinusitis that is worsening. Immunology reveals circulating auto-antibodies against neutrophil cytoplasmic antigents (C-ANCA). Histology also shows the accumulation of macrophages in Bowmans capsule.
A. Clear cell renal carcinoma
B. Acute diffuse proliferative glomerulonephritis
C. Polycystic kidney disease
D. Wilms tumour
E. Bacterial endocarditis
F. Alport's disease
G. Goodpasture's
H. Hypertensive renal damage
I. Henoch-Schonlein purpura
J. Cannonball metastases
K. SLE
L. Diabetic nephropathy
M. Wegener's granulomatosis
```
M. Wegener's granulomatosis
132
```
A 63 year old Scandanavian male presents with painless haematuria, fatigue, weight loss and fever. On examination a mass is found unilaterally in the loin. Family History reveals his father had Von Hippel-Lindau disease.
A. Clear cell renal carcinoma
B. Acute diffuse proliferative glomerulonephritis
C. Polycystic kidney disease
D. Wilms tumour
E. Bacterial endocarditis
F. Alport's disease
G. Goodpasture's
H. Hypertensive renal damage
I. Henoch-Schonlein purpura
J. Cannonball metastases
K. SLE
L. Diabetic nephropathy
M. Wegener's granulomatosis
```
A. Clear cell renal carcinoma
133
```
A 70year old man being investigated for haematuria and loin discomfort develops dyspnoea.
A. Clear cell renal carcinoma
B. Acute diffuse proliferative glomerulonephritis
C. Polycystic kidney disease
D. Wilms tumour
E. Bacterial endocarditis
F. Alport's disease
G. Goodpasture's
H. Hypertensive renal damage
I. Henoch-Schonlein purpura
J. Cannonball metastases
K. SLE
L. Diabetic nephropathy
M. Wegener's granulomatosis
```
J. Cannonball metastases
134
```
A 35-year-old alcoholic presents to A&E with confusion and maleana. On examination, he has signs of chronic liver disease and is pale and clammy. BP is 90/50mmHg and he has a weak thready pulse of 130bpm. Investigations reveal FBC: Hb 6.3g/dl, MCV 108fl, WCC 3.8 x 109/l, Plt 23 x 109/l; U&Es: Na+ 123mmol/l, K+ 4.4mmol/l, urea 27mmol/l, Cr 123umol/l.
A. Diclofenac
B. Carcinoma of the prostate
C. Renal artery stenosis
D. Diabetes mellitus
E. Benign prostatic hypertrophy
F. Multiple myeloma
G. Haemorrhage
H. Henoch-Schonlein purpura
I. Rhabdomyolysis
J. IgA nephropathy
```
G. Haemorrhoage
135
```
A 74-year-old man presents to his GP with increasing malaise and back pain associated with hesitancy and poor urinary stream. Subsequent investigations reveal U&Es: Na+ 134mmol/l, K+ 6.4mmol/l, urea 31.2mmol/l, Cr 1023umol/l; PSA 123nmol/l; bilateral hydronephrotic kidneys on USS.
A. Diclofenac
B. Carcinoma of the prostate
C. Renal artery stenosis
D. Diabetes mellitus
E. Benign prostatic hypertrophy
F. Multiple myeloma
G. Haemorrhage
H. Henoch-Schonlein purpura
I. Rhabdomyolysis
J. IgA nephropathy
```
B. Carcinoma of the prostate
136
```
A 61-year-old woman with kown peripheral vascular and ischaemic heart disease is started on an ACEi by her GP. 3 weeks later she is admitted to hospital with increasing confusion and pruritis. Investigations reveal FBC: Hb 12.3g/dl, MCV 85.2fl, WCC 6.8 x 109/l, Plt 403 x 109/l; U&Es: Na+ 130mmol/l, K+ 7.4 mmol/l, urea 37mmol/l, Cr 841umol/l; urinalysis – protein ++, ketones +, blood nil.
A. Diclofenac
B. Carcinoma of the prostate
C. Renal artery stenosis
D. Diabetes mellitus
E. Benign prostatic hypertrophy
F. Multiple myeloma
G. Haemorrhage
H. Henoch-Schonlein purpura
I. Rhabdomyolysis
J. IgA nephropathy
```
C. Renal artery stenosis
137
```
An 84-year-old woman is found collapsed in her flat by a neighbour. She had a fall 3 days prior to her rescue and had been unable to get up or raise the alarm. On admission to hospital investigations reveal FBC: Hb 15.3g/dl, MCV 91.2fl, WCC 23.1 x 09/l, Plt 403 x 109/l; U&Es: Na+ 145mmol/l, K+ 7.1mmol/l, urea 32.9mmol/l, Cr 649umol/l; CK 23,089iu/l.
A. Diclofenac
B. Carcinoma of the prostate
C. Renal artery stenosis
D. Diabetes mellitus
E. Benign prostatic hypertrophy
F. Multiple myeloma
G. Haemorrhage
H. Henoch-Schonlein purpura
I. Rhabdomyolysis
J. IgA nephropathy
```
I. Rhabdomyolysis
138
```
A 24-year-old man presents to his GP with an increasing rash over his lower limbs and buttocks associated with arthralgia and haematuria. He is admitted to the local hospital where investigations reveal deranged renal function and a raised serum IgA.
A. Diclofenac
B. Carcinoma of the prostate
C. Renal artery stenosis
D. Diabetes mellitus
E. Benign prostatic hypertrophy
F. Multiple myeloma
G. Haemorrhage
H. Henoch-Schonlein purpura
I. Rhabdomyolysis
J. IgA nephropathy
```
H. Henoch-Schonlein purpura
139
```
A 65 yr old lady with ischaemic heart disease and peripheral vascular disease presents at a&e with increasing confusion, hiccups and pruritus. She was started on ACE inhibitors a week ago.
A. Wegner’s granulomatous
B. Acute tubular necrosis
C. Renal obstruction
D. Acute glomerulonephritis
E. Myeloma associated ARF
F. Renal artery stenosis
G. Acute interstitial nephritis
```
F. Renal artery stenosis
140
```
A 21 yr old man is admitted to hospital with multiple fractures after his motorcycle collided into a lorry on the motorway. There is myoglobin in his urine
A. Wegner’s granulomatous
B. Acute tubular necrosis
C. Renal obstruction
D. Acute glomerulonephritis
E. Myeloma associated ARF
F. Renal artery stenosis
G. Acute interstitial nephritis
```
B. Acute tubular necrosis
141
```
A 50 yr old lady with A BMI of 24 who had intermittent pain in the loin, with nausea and vomiting now has a low urine output and urinalysis shows microscopic haematuria.
A. Wegner’s granulomatous
B. Acute tubular necrosis
C. Renal obstruction
D. Acute glomerulonephritis
E. Myeloma associated ARF
F. Renal artery stenosis
G. Acute interstitial nephritis
```
C. Renal obstruction
142
```
A 45 yr old man with known renal problems has bilateral leg oedema. There is blood in his urine, and urine stix testing also confirms the presence of protein. Microscopy also reveals red cell casts.
A. Wegner’s granulomatous
B. Acute tubular necrosis
C. Renal obstruction
D. Acute glomerulonephritis
E. Myeloma associated ARF
F. Renal artery stenosis
G. Acute interstitial nephritis
```
D. Acute glomerulonephritis
143
```
A 25 yr old man presents to his GP with a cough, nasal discharge and swollen legs. He is extremely dehydrated and is taken to hospital.He has a high cANCA titre
A. Wegner’s granulomatous
B. Acute tubular necrosis
C. Renal obstruction
D. Acute glomerulonephritis
E. Myeloma associated ARF
F. Renal artery stenosis
G. Acute interstitial nephritis
```
A. Wegener's granulomatous
144
```
A 62-year old man presents with lethargy and tiredness. He tells you that he is ‘on painkillers for back pain after a fall at work 6 weeks ago’. On examination he is pale. Blood tests reveal urea 39.2 mmol/L (normal 1.7-8.3) and creatinine 1158 μmol/L (normal 62-106). His records show that he had a creatinine of 90 μmol/L 3 months ago.
A. Renal acidosis
B. Thin membrane nephropathy
C. Nephrotic syndrome
D. Acute interstitial nephritis
E. Ureteric stones
F. Urethral stones
G. Chronic kidney disease
H. Hypokalemia
I. IgA nephropathy
J. Hyperkalemia
```
D. Acute interstitial nephritis
145
```
A 40-year old man presents acutely unwell with back pain that radiates to his groin, and nausea and vomiting. He tells you he has seen blood in his urine. On examination he is febrile.
A. Renal acidosis
B. Thin membrane nephropathy
C. Nephrotic syndrome
D. Acute interstitial nephritis
E. Ureteric stones
F. Urethral stones
G. Chronic kidney disease
H. Hypokalemia
I. IgA nephropathy
J. Hyperkalemia
```
E. Ureteric stones
146
```
A poorly controlled 48-year old diabetic lady presents with a swollen face and ankles. Blood tests show albumin <30g/L (normal 40g/L), ↑ cholesterol and normal creatinine. 24 hour urine collection reveals protein >3g.
A. Renal acidosis
B. Thin membrane nephropathy
C. Nephrotic syndrome
D. Acute interstitial nephritis
E. Ureteric stones
F. Urethral stones
G. Chronic kidney disease
H. Hypokalemia
I. IgA nephropathy
J. Hyperkalemia
```
C. Nephrotic syndrome
147
```
A 25 year old man tells you he had dark brown urine after a sore throat and has since had microscopic haematuria. Renal biopsy reveals proliferation of the mesangium.
A. Renal acidosis
B. Thin membrane nephropathy
C. Nephrotic syndrome
D. Acute interstitial nephritis
E. Ureteric stones
F. Urethral stones
G. Chronic kidney disease
H. Hypokalemia
I. IgA nephropathy
J. Hyperkalemia
```
I. IgA nephropathy
148
```
One of the complications of chronic kidney disease which has ECG features of peaked T waves, loss of the P wave and broad QRS complex
A. Renal acidosis
B. Thin membrane nephropathy
C. Nephrotic syndrome
D. Acute interstitial nephritis
E. Ureteric stones
F. Urethral stones
G. Chronic kidney disease
H. Hypokalemia
I. IgA nephropathy
J. Hyperkalemia
```
J. Hyperkalaemia
149
```
The gold standard for measuring glomerular filtration rate (GFR)
A. 40 mls/min
B. Cystatin C
C. 30 mls/min
D. 20 mls/24 hrs
E. Potassium exccretion
F. 35 mls/min
G. Injected radio-isotopes
H. Bowman's capsule
I. Inulin
J. Serum urea
K. Iohexol
L. Serial creatinine readings
M. Serum creatinine
N. 20 mls/min
O. Glucose
P. Phosphate excretion
```
I. Inulin
150
```
Calculate the creatinine clearance for the following renal patient, following a 24 hour urine collection: urine volume 2litres; urine creatinine concentration 3mmol/l and plasma creatinine concentration 208 micro mol/l.
A. 40 mls/min
B. Cystatin C
C. 30 mls/min
D. 20 mls/24 hrs
E. Potassium exccretion
F. 35 mls/min
G. Injected radio-isotopes
H. Bowman's capsule
I. Inulin
J. Serum urea
K. Iohexol
L. Serial creatinine readings
M. Serum creatinine
N. 20 mls/min
O. Glucose
P. Phosphate excretion
```
N. 20 mls/min
151
```
Calculate the GFR for the following renal patient, following a 24 hour urine collection: urine volume 2.7litres; urine creatinine concentration 2mmol/l and plasma creatinine concentration 107 micro mol/l.
A. 40 mls/min
B. Cystatin C
C. 30 mls/min
D. 20 mls/24 hrs
E. Potassium exccretion
F. 35 mls/min
G. Injected radio-isotopes
H. Bowman's capsule
I. Inulin
J. Serum urea
K. Iohexol
L. Serial creatinine readings
M. Serum creatinine
N. 20 mls/min
O. Glucose
P. Phosphate excretion
```
F. 35 mls/min
152
```
A good indicator of renal function
A. 40 mls/min
B. Cystatin C
C. 30 mls/min
D. 20 mls/24 hrs
E. Potassium exccretion
F. 35 mls/min
G. Injected radio-isotopes
H. Bowman's capsule
I. Inulin
J. Serum urea
K. Iohexol
L. Serial creatinine readings
M. Serum creatinine
N. 20 mls/min
O. Glucose
P. Phosphate excretion
```
L. Serial creatinine readings
153
```
Reflects the muscle mass of a person
A. 40 mls/min
B. Cystatin C
C. 30 mls/min
D. 20 mls/24 hrs
E. Potassium exccretion
F. 35 mls/min
G. Injected radio-isotopes
H. Bowman's capsule
I. Inulin
J. Serum urea
K. Iohexol
L. Serial creatinine readings
M. Serum creatinine
N. 20 mls/min
O. Glucose
P. Phosphate excretion
```
M. Serum creatinine
154
```
Useful in staging and monitoring treatment of extracapsular spread of prostatic carcinoma
A. Renin
B. Lactate dehydrogenase
C. Alanine aminotransferase
D. Triglyceride
E. Acid phosphatase
F. Creatine kinase
G. Alkaline phosphatase
H. Acetylcholinesaterase
I. Porphobilinogen deaminase
J. Angiotensin converting enzyme (ACE)
```
E. Acid phosphatase
155
```
Reflects increased osteoblastic activity and may be raised in osteomalacia and rickets
A. Renin
B. Lactate dehydrogenase
C. Alanine aminotransferase
D. Triglyceride
E. Acid phosphatase
F. Creatine kinase
G. Alkaline phosphatase
H. Acetylcholinesaterase
I. Porphobilinogen deaminase
J. Angiotensin converting enzyme (ACE)
```
G. Alkaline phosphatase
156
```
Indicates a feature of biliary outflow obstruction rather than hepatocellular damage
A. Renin
B. Lactate dehydrogenase
C. Alanine aminotransferase
D. Triglyceride
E. Acid phosphatase
F. Creatine kinase
G. Alkaline phosphatase
H. Acetylcholinesaterase
I. Porphobilinogen deaminase
J. Angiotensin converting enzyme (ACE)
```
G. Alkaline phosphatase
157
```
This enzyme is more liver-specific although its changes are parallel to that of aspartate aminotransferase
A. Renin
B. Lactate dehydrogenase
C. Alanine aminotransferase
D. Triglyceride
E. Acid phosphatase
F. Creatine kinase
G. Alkaline phosphatase
H. Acetylcholinesaterase
I. Porphobilinogen deaminase
J. Angiotensin converting enzyme (ACE)
```
C. Alanine aminotransferase
158
```
Raised in active sarcoidosis
A. Renin
B. Lactate dehydrogenase
C. Alanine aminotransferase
D. Triglyceride
E. Acid phosphatase
F. Creatine kinase
G. Alkaline phosphatase
H. Acetylcholinesaterase
I. Porphobilinogen deaminase
J. Angiotensin converting enzyme (ACE)
```
J. Angiotensin converting enzyme (ACE)
159
```
71 year old man has a 3 month history of severe back pain. On further questioning he has also experienced urinary frequency, dysuria, nocturia and has lost 6kg in the past 7 months. What enzyme would you expect to find elevated in this patient?
A. AST
B. Amylase
C. Creatine Kinase (MB)
D. Insulin
E. Alkaline Phosphatase
F. GGT
G. Creatine Kinase (MM)
H. Glucagon
I. LDH
J. Troponin
K. Creatine Kinase (BB)
```
E. Alkaline phosphatase
160
```
Which enzyme rapidly rises post myocardial infarction but then rapidly declines and is a useful marker of reinfarction?
A. AST
B. Amylase
C. Creatine Kinase (MB)
D. Insulin
E. Alkaline Phosphatase
F. GGT
G. Creatine Kinase (MM)
H. Glucagon
I. LDH
J. Troponin
K. Creatine Kinase (BB)
```
C. Creatine Kinase (MB)
161
```
A 3 year old unimmunised boy presents with Mumps. Which enzyme is likely to be raised?
A. AST
B. Amylase
C. Creatine Kinase (MB)
D. Insulin
E. Alkaline Phosphatase
F. GGT
G. Creatine Kinase (MM)
H. Glucagon
I. LDH
J. Troponin
K. Creatine Kinase (BB)
```
B. Amylase
162
```
A 19 year old African boy presented with cervical lymph nodes, 3 month history of night sweats and a 3kg weight loss. Lymph node biopsy showed the presence of Reed-Sternberg cells loss. Following chemotherapy which enzyme would you expect to be elevated?
A. AST
B. Amylase
C. Creatine Kinase (MB)
D. Insulin
E. Alkaline Phosphatase
F. GGT
G. Creatine Kinase (MM)
H. Glucagon
I. LDH
J. Troponin
K. Creatine Kinase (BB)
```
I. LDH
163
```
Which enzyme would you expect to see decline late in chronic pancreatitis?
A. AST
B. Amylase
C. Creatine Kinase (MB)
D. Insulin
E. Alkaline Phosphatase
F. GGT
G. Creatine Kinase (MM)
H. Glucagon
I. LDH
J. Troponin
K. Creatine Kinase (BB)
```
B. Amylase
164
```
A 66-year-old man presents to his GP complaining of back and hip pain. His sister also wanted him to mention that his neighbours have complained that his radio has become increasingly loud in the last few weeks. Due to his brother presenting with tibial bowing and similar bone pain 2 years previously the GP sends him for radiological investigation. Osteolytic changes are noted and further bone scans reveal osteoporosis circumscripta in the Skull. Prostate examination and PSA testing are unremarkable. Which of the above would be most raised?
A. Glucose
B. CKMB
C. Lactate Dehydrogenase
D. Creatanine
E. CKBB
F. Cardiac Troponin
G. Alpha-amylase
H. Plasma Cholinesterase
I. Alkaline Phosphatase
J. Gamma Glutamyl Transpeptidase
K. Prostate Specific Antigen
L. Placental Dehydrogenase
M. Calcium
```
I. Alkaline phosphatase
165
```
A 71-year-old man presents to his GP with increasing tiredness and back pain. He also describes increasing urinary frequency, a feeling of incomplete voiding and perineal pain. On examination investigation reveals a tender lower thoracic spine and a palpable bladder. Prostatic biopsy histology reveals a Gleason score of 9. Which of the above would you also expect to be raised?
A. Glucose
B. CKMB
C. Lactate Dehydrogenase
D. Creatanine
E. CKBB
F. Cardiac Troponin
G. Alpha-amylase
H. Plasma Cholinesterase
I. Alkaline Phosphatase
J. Gamma Glutamyl Transpeptidase
K. Prostate Specific Antigen
L. Placental Dehydrogenase
M. Calcium
```
K. Prostate specific antigen
166
```
A 67-year-old man, BMI 27, presents to A+E having collapsed with chest pain and nausea at his local social club dinner. Past medical history revealed he had been suffering from increasing breathlessness over the last month when walking to the post office to collect his weekly pension. Upon further questioning he admitted to the use of his wife’s ‘chest pain relief spray’ twice in the last week. Having argued with his wife before presenting to A+E and it is now 12 hours since the onset of the chest pain therefore, which of the above would aid you most in determining whether he had suffered an acute myocardial infarction?
A. Glucose
B. CKMB
C. Lactate Dehydrogenase
D. Creatanine
E. CKBB
F. Cardiac Troponin
G. Alpha-amylase
H. Plasma Cholinesterase
I. Alkaline Phosphatase
J. Gamma Glutamyl Transpeptidase
K. Prostate Specific Antigen
L. Placental Dehydrogenase
M. Calcium
```
F. Cardiac troponin
167
```
A semi-conscious 6-year-old-boy presents to A+E with his father, a farmer who suspects he has accidentally drunk something from one of the barns in which he was playing. Prior to his collapse the boy had been found vomiting in the yard in the time period before presentation at A+E he had become increasingly restless, irritable, nauseous, had suffered extreme diarrhoea and seemed to be dribbling saliva uncontrollably. On examination the boy was found to have bradycardia, hypotension, reduced muscle tone, constricted pupils and a decreasing respiratory rate. Which of the above is most likely to be decreased?
A. Glucose
B. CKMB
C. Lactate Dehydrogenase
D. Creatanine
E. CKBB
F. Cardiac Troponin
G. Alpha-amylase
H. Plasma Cholinesterase
I. Alkaline Phosphatase
J. Gamma Glutamyl Transpeptidase
K. Prostate Specific Antigen
L. Placental Dehydrogenase
M. Calcium
```
H. Plasma cholinesterase
| organophosphate poisoning. SLUDGE mnemonic: salivation, lacrimation, urination, defecation, GI upset, emesis
168
```
A 44-year-old woman known to have multi-focal ER and PR negative breast cancer that is inoperable is admitted with sudden onset of nausea, vomiting, polyuria and delirium. She also has reduced muscle strength and her husband describes her marked personality change and increased thirst over the previous few days as well as increasing back and hip pain not well relieved with her oral morphine preparation. Pelvic radiology reveals Osteolytic lesions. Which of the above do you think would be raised given her presenting symptoms?
A. Glucose
B. CKMB
C. Lactate Dehydrogenase
D. Creatanine
E. CKBB
F. Cardiac Troponin
G. Alpha-amylase
H. Plasma Cholinesterase
I. Alkaline Phosphatase
J. Gamma Glutamyl Transpeptidase
K. Prostate Specific Antigen
L. Placental Dehydrogenase
M. Calcium
```
M. Calcium
169
```
A 55 year old man presents to A & E with a crushing central chest pain which radiates down his left arm. 3 hours later his blood tests show a large increase in a cardiac enzyme. This increase is still present when he is discharged 3 days later. Which enzyme is most likely to be raised?
A. Bone Alkaline Phosphatase
B. Creatine Kinase
C. Lactase Dehydrogenase
D. Acid Phosphatase
E. Amylase
F. Alpha-1 Antitryspin
G. Liver Alkaline Phosphatase
H. AST
I. Cardiac Troponin
J. Uroporphyrinogen decarboxylase
K. Gamma Glutanyl Transferase
```
I. Cardiac troponin
170
```
A 53 year old woman presents to her GP because she has become increasingly tired recently. She also complains of itching which keeps her awake at night. On examination both scratch marks and signs of jaundice are found. Abnormalities in her blood tests include anti-mitochondrial antibodies. Which enzyme is most likely to be raised?
A. Bone Alkaline Phosphatase
B. Creatine Kinase
C. Lactase Dehydrogenase
D. Acid Phosphatase
E. Amylase
F. Alpha-1 Antitryspin
G. Liver Alkaline Phosphatase
H. AST
I. Cardiac Troponin
J. Uroporphyrinogen decarboxylase
K. Gamma Glutanyl Transferase
```
G. Liver alkaline phosphatase
171
```
A 45 year old woman with known gallstones presents to A & E with abdominal pain which radiates to her back. The pain is relieved by sitting forward. The pain has been constant for several hours and she has also vomited twice. Which enzyme is most likely to be raised?
A. Bone Alkaline Phosphatase
B. Creatine Kinase
C. Lactase Dehydrogenase
D. Acid Phosphatase
E. Amylase
F. Alpha-1 Antitryspin
G. Liver Alkaline Phosphatase
H. AST
I. Cardiac Troponin
J. Uroporphyrinogen decarboxylase
K. Gamma Glutanyl Transferase
```
E. Amylase
172
```
A 34 year old woman previously diagnosed with Hashimoto’s thyroiditis presents to her GP complaining of anorexia, amenorrhea and increasing fatigue. On examination she is found to have palmar erythema. Her blood tests show anti-smooth muscle and anti-nuclear antibodies. Which enzyme is most likely to be raised?
A. Bone Alkaline Phosphatase
B. Creatine Kinase
C. Lactase Dehydrogenase
D. Acid Phosphatase
E. Amylase
F. Alpha-1 Antitryspin
G. Liver Alkaline Phosphatase
H. AST
I. Cardiac Troponin
J. Uroporphyrinogen decarboxylase
K. Gamma Glutanyl Transferase
```
H. AST
173
```
A 60 year old presents to his GP because of the onset of deafness in his right ear. He also mentions suffering from recurrent back pain. The gentleman has a bowed tibia.
A. Bone Alkaline Phosphatase
B. Creatine Kinase
C. Lactase Dehydrogenase
D. Acid Phosphatase
E. Amylase
F. Alpha-1 Antitryspin
G. Liver Alkaline Phosphatase
H. AST
I. Cardiac Troponin
J. Uroporphyrinogen decarboxylase
K. Gamma Glutanyl Transferase
```
A. Bone alkaline phosphatase
174
```
An elderly man turns up at his GP complaining of tiredness and a troublesome back pain. His wife interrupts to say that he keeps getting up during the night to go to the toilet. On further questioning concerning his waterworks, he admits to some difficulty in passing urine and a feeling of incomplete voiding. You order some blood tests. Which enzyme is most likely to be raised?
A. Alkaline phosphotase
B. Prostate specific antigen
C. Galctosidase A
D. Alanine aminotransferase
E. Glucose-6-phosphate
F. Porphobilinogen deaminase
G. Mycophosphorylase
H. Glucagon
I. Adenosine deaminase
J. Lactate dehydrogenase
```
B. Prostate specific antigen
175
```
A 3-month-old boy was admitted to hospital with failure to thrive, and a persistent cough. On examination his height and weight were below the third centile. Subsequent immunological investigations have shown marked T- and B-cell lymphopaenia and hypogammaglobulinaemia, suggestive of severe combined immunodeficiency (SCID). This disorder is frequently caused by a deficiency in which enzyme?
A. Alkaline phosphotase
B. Prostate specific antigen
C. Galctosidase A
D. Alanine aminotransferase
E. Glucose-6-phosphate
F. Porphobilinogen deaminase
G. Mycophosphorylase
H. Glucagon
I. Adenosine deaminase
J. Lactate dehydrogenase
```
I. Adenosine deaminase
176
```
A worried mother brings her obese 12 year old son to the GP, saying that he avoids exercise and has been recently found to be skipping his PE lessons. When confronted about this, the boy claimed that ‘it hurts when he exercises’. The skeptical GP was about to say ‘no pain, no gain’, when he remembered a lecture in medical school about McArdle’s glycogen storage disease (type V), which causes stiffness following exercise. He referred the boy for a muscle biopsy, which confirmed a deficiency in an enzyme involved in glycogen metabolism. Name this enzyme.
A. Alkaline phosphotase
B. Prostate specific antigen
C. Galctosidase A
D. Alanine aminotransferase
E. Glucose-6-phosphate
F. Porphobilinogen deaminase
G. Mycophosphorylase
H. Glucagon
I. Adenosine deaminase
J. Lactate dehydrogenase
```
G. Mycophosphorylase
177
```
A 36 year old pregnant woman presents with abdominal pain in the right upper quadrant. Blood tests reveal elevation of liver enzymes, in a pattern which suggests biliary outflow obstruction. Which enzyme is likely to be the most elevated?
A. Alkaline phosphotase
B. Prostate specific antigen
C. Galctosidase A
D. Alanine aminotransferase
E. Glucose-6-phosphate
F. Porphobilinogen deaminase
G. Mycophosphorylase
H. Glucagon
I. Adenosine deaminase
J. Lactate dehydrogenase
```
A. Alkaline phosphatase
178
```
A young man presents with a history of recurrent febrile illness associated with painful parasthesiae in his hands and feet. On examination, you notice small red papules clustered in his pelvic and thigh region. Urine dipstick shows protein +++. The patient complains that no doctor has been able to find out what is wrong with him. However, having recently passed your path exam, you suspect he might have Fabry’s disease, an X-linked disorder of glycolipid metabolism due to deficiency of which of the above?
A. Alkaline phosphotase
B. Prostate specific antigen
C. Galctosidase A
D. Alanine aminotransferase
E. Glucose-6-phosphate
F. Porphobilinogen deaminase
G. Mycophosphorylase
H. Glucagon
I. Adenosine deaminase
J. Lactate dehydrogenase
```
C. Galactosidase A
179
```
A 10 year old boy is brought by his mother to your clinic. He is very thin, but has a distended abdomen. What is it that his diet does not contain to cause this?
A. Iron
B. Folate
C. Niacin
D. Fluoride
E. Protein
F. Caeruloplasmin
G. Riboflavin
H. Carbohydrate
I. Vitamin D
J. Iodine
K. Viatamin K
L. Lipid
M. Thiamine
```
E. Protein
180
```
A 50 year old homeless man walks into A and E. He is very thin, smells of alcohol and is vomiting. On neurological examination, you note he has nystagmus and walks with a broad based gait. You give him advice on how to stop drinking, what else would you give?
A. Iron
B. Folate
C. Niacin
D. Fluoride
E. Protein
F. Caeruloplasmin
G. Riboflavin
H. Carbohydrate
I. Vitamin D
J. Iodine
K. Viatamin K
L. Lipid
M. Thiamine
```
M. Thiamine
181
```
You see a young boy in your clinic. He complains of bone pain and he says he has felt unwell for a few weeks. On examination he is knock-kneed and walks with a waddling gait. What would you be most likely to treat him with?
A. Iron
B. Folate
C. Niacin
D. Fluoride
E. Protein
F. Caeruloplasmin
G. Riboflavin
H. Carbohydrate
I. Vitamin D
J. Iodine
K. Viatamin K
L. Lipid
M. Thiamine
```
I. Vitamin D
182
```
A 16 year old girls presents with pain in her joints and her Mother says that she has become increasingly forgetful over recent times. Last week she put a pan of water on the stove and forgot about it until it boiled dry and melted the pan. On examination you notice Kayser-Fleischer rings in the eyes. What is this girl most likely to be deficient in?
A. Iron
B. Folate
C. Niacin
D. Fluoride
E. Protein
F. Caeruloplasmin
G. Riboflavin
H. Carbohydrate
I. Vitamin D
J. Iodine
K. Viatamin K
L. Lipid
M. Thiamine
```
F. Caeruloplasmin
183
```
A 40 year old woman is brought in by her husband. He explains that she has started getting up during the night and going for walks and then forgetting her way home. She says she has terrible diarrhoea day and night and she wakes to go to the toilet. On examination she has a tremor and you see red scaly patches on her skin. Which vitamin is she most likely to be deficient in?
A. Iron
B. Folate
C. Niacin
D. Fluoride
E. Protein
F. Caeruloplasmin
G. Riboflavin
H. Carbohydrate
I. Vitamin D
J. Iodine
K. Viatamin K
L. Lipid
M. Thiamine
```
C. Niacin
184
```
An 85 year old smoker lady is brought to the GP by concerned relatives. She lives alone and has become increasingly withdrawn. On close questioning it appears that over the past few months she has been smoking more heavily and surviving on little more than tea and toast.
A. Copper deficiency
B. Vitamin C excess
C. Folic Acid deficiency
D. Vitamin B12 deficiency
E. Magnesium deficiency
F. Iron deficiency
G. Vitamin B1 deficiency
H. Vitamin K deficiency
I. Vitamin A deficiency
J. Vitamin D deficiency
K. Vitamin E deficiency
L. Vitamin B6 deficiency
M. Sodium deficiency
N. Vitamin C deficiency
```
N. Vitamin C deficiency
185
```
A 39 year old house wife is referred to clinic with a 6 month history of fatigue and depression, as well as "burning feet". She also gives a one month history of tingling in her fingers and toes at night
A. Copper deficiency
B. Vitamin C excess
C. Folic Acid deficiency
D. Vitamin B12 deficiency
E. Magnesium deficiency
F. Iron deficiency
G. Vitamin B1 deficiency
H. Vitamin K deficiency
I. Vitamin A deficiency
J. Vitamin D deficiency
K. Vitamin E deficiency
L. Vitamin B6 deficiency
M. Sodium deficiency
N. Vitamin C deficiency
```
D. Vitamin B12 deficiency
186
```
An 18 year old cystic fibrosis sufferer presents to A&E, with a long history of severe steatorrhoea. Recently he has started to bruise easily and experience severe protracted nose bleeds. The patient is now distraught after the onset both melena and haematuria today.
A. Copper deficiency
B. Vitamin C excess
C. Folic Acid deficiency
D. Vitamin B12 deficiency
E. Magnesium deficiency
F. Iron deficiency
G. Vitamin B1 deficiency
H. Vitamin K deficiency
I. Vitamin A deficiency
J. Vitamin D deficiency
K. Vitamin E deficiency
L. Vitamin B6 deficiency
M. Sodium deficiency
N. Vitamin C deficiency
```
H. Vitamin K deficiency
187
```
A young Muslim woman presents to her GP complaining of generalised pain in her muscles which “hurts her down to her bones” and tiredness as even getting up from a chair is difficult.
A. Copper deficiency
B. Vitamin C excess
C. Folic Acid deficiency
D. Vitamin B12 deficiency
E. Magnesium deficiency
F. Iron deficiency
G. Vitamin B1 deficiency
H. Vitamin K deficiency
I. Vitamin A deficiency
J. Vitamin D deficiency
K. Vitamin E deficiency
L. Vitamin B6 deficiency
M. Sodium deficiency
N. Vitamin C deficiency
```
J. Vitamin D deficiency
188
```
A 56 year old is man found unconscious on the street and is admitted to A&E. On regaining consciousness he is found to be long standing alcoholic.
A. Copper deficiency
B. Vitamin C excess
C. Folic Acid deficiency
D. Vitamin B12 deficiency
E. Magnesium deficiency
F. Iron deficiency
G. Vitamin B1 deficiency
H. Vitamin K deficiency
I. Vitamin A deficiency
J. Vitamin D deficiency
K. Vitamin E deficiency
L. Vitamin B6 deficiency
M. Sodium deficiency
N. Vitamin C deficiency
```
G. Vitamin B1 deficiency
189
```
A woman planning to get pregnant with a history of previous pregnancies complicated by spina bifida comes to see you
A. Vitamin D
B. Vitamin E
C. Reduce protein
D. Vitamin C
E. Increase protein
F. Reduce unsaturated fats
G. Folic acid
H. Copper
I. Iron
J. Vitamin A
K. Increase complex carbohydrates
L. Reduce saturated fats
```
G. Folic acid
190
```
An elderly lady from a residential home presents with widespread bone pain and a history of fractures.
A. Vitamin D
B. Vitamin E
C. Reduce protein
D. Vitamin C
E. Increase protein
F. Reduce unsaturated fats
G. Folic acid
H. Copper
I. Iron
J. Vitamin A
K. Increase complex carbohydrates
L. Reduce saturated fats
```
A. Vitamin D
191
```
A 45 year lorry driver with a BMI of 35 comes to see you complaining of chest pains when he exerts himself.
A. Vitamin D
B. Vitamin E
C. Reduce protein
D. Vitamin C
E. Increase protein
F. Reduce unsaturated fats
G. Folic acid
H. Copper
I. Iron
J. Vitamin A
K. Increase complex carbohydrates
L. Reduce saturated fats
```
L. Reduce saturated fats
192
```
A 30 year old woman presents with heavy periods, you notice on examination she has brittle hair and her nails are spoon shaped
A. Vitamin D
B. Vitamin E
C. Reduce protein
D. Vitamin C
E. Increase protein
F. Reduce unsaturated fats
G. Folic acid
H. Copper
I. Iron
J. Vitamin A
K. Increase complex carbohydrates
L. Reduce saturated fats
```
I. Iron
193
```
A routine exam of an overweight 50 year old Asian lady reveals a plasma glucose level of 12mmol/l.
A. Vitamin D
B. Vitamin E
C. Reduce protein
D. Vitamin C
E. Increase protein
F. Reduce unsaturated fats
G. Folic acid
H. Copper
I. Iron
J. Vitamin A
K. Increase complex carbohydrates
L. Reduce saturated fats
```
K. Increase complex carbohydrates
194
```
A 50-year-old unemployed actor who is an alcoholic, presents to hospital with peripheral neuropathy and worsening loss of memory. On examination, he also has ataxia, nystagmus and mild pedal oedema. He is admitted for investigation where the nurses notice he is confabulating.
A. Vitamin B1 (thiamin)
B. Nicotinic Acid (niacin)
C. Vitamin D
D. Vitamin K
E. Folate
F. Vitamin C
G. Vitamin B12 (cobalamin)
H. Vitamin A
I. Vitamin E
J. Vitamin B6 (pyridoxine)
```
A. Vitamin B1 (thiamin)
195
```
A 38-year-old women presents with dyspepsia and shortness of breath on exercise. Blood tests show a severe anaemia, which on investigation is found to be megaloblastic. Gastric biopsies taken at endoscopy show severe atrophic gastritis, predominantly in the corpus. Anti-parietal cell antibodies are detected in the serum
A. Vitamin B1 (thiamin)
B. Nicotinic Acid (niacin)
C. Vitamin D
D. Vitamin K
E. Folate
F. Vitamin C
G. Vitamin B12 (cobalamin)
H. Vitamin A
I. Vitamin E
J. Vitamin B6 (pyridoxine)
```
G. Vitamin B12 (cobalamin)
196
```
A 52-year-old man suffers from longstanding chronic pancreatitis. This has lead to steatorrhoea. He presents with recurrent epistaxis, malaena and haematuria. On examination he also has numerous bruises on his arms and shins.
A. Vitamin B1 (thiamin)
B. Nicotinic Acid (niacin)
C. Vitamin D
D. Vitamin K
E. Folate
F. Vitamin C
G. Vitamin B12 (cobalamin)
H. Vitamin A
I. Vitamin E
J. Vitamin B6 (pyridoxine)
```
D. Vitamin K
197
```
An eighty-year-old woman who lives alone is visited by social services after a worried neighbour says she has not seen her for a few months. On questioning she admits that she has hardly left her flat for four months as she has become increasingly agoraphobic. She has been surviving on tinned soup and crackers. Her GP finds she has swollen, bleeding gums, and bruises over her shins. Her skin shows a hyperkeratotic popular rash and petechial haemorrhages.
A. Vitamin B1 (thiamin)
B. Nicotinic Acid (niacin)
C. Vitamin D
D. Vitamin K
E. Folate
F. Vitamin C
G. Vitamin B12 (cobalamin)
H. Vitamin A
I. Vitamin E
J. Vitamin B6 (pyridoxine)
```
F. Vitamin C
198
```
A 3-year-old Indian boy whose parents are strict vegans is taken to his GP with a cough. On examination of his chest, he is found to have anterior protusion of the sternum. The GP also notices that he has lumbar lordosis and bowing of the legs.
A. Vitamin B1 (thiamin)
B. Nicotinic Acid (niacin)
C. Vitamin D
D. Vitamin K
E. Folate
F. Vitamin C
G. Vitamin B12 (cobalamin)
H. Vitamin A
I. Vitamin E
J. Vitamin B6 (pyridoxine)
```
C. Vitamin D
199
A 35yr old female vegan presents to her GP with a history of tiredness and fatigue. On investigation her blood test shows an MCV of 125fl and a Hb of 9.4 g/dL.Serum folate is normal. When looking under the microscope abnormally large reticulocytes (megaloblasts) were noted.
A. Sideroblastic anaemia
B. Chronic renal failure
C. Vitamin B12 deficiency due to lack of dietary intake
D. Vitamin A deficiency
E. Ulcerative colitis
F. Iron deficiency anaemia
G. Liver disease
H. Vitamin B12 deficiency due to malabsorption because of surgical removal of the ileum
I. Thalassaemia
J. Vitamin B12 deficiency due to lack of intrinsic factor because of pernicious anaemia
K. Folate deficiency due to lack of dietary intake
L. Anaemia of chronic disease
M. Vitamin B12 deficiency due to lack of intrinsic factor post-gastrectomy
C. Vitamin B12 deficiency due to lack of dietary intake
200
A 65yr old female with blonde hair and blue eyes with a long history of rheumatoid arthritis and Hashimoto’s thyroiditis presents to her GP with tiredness and fatigue. On investigation her blood test shows an MCV of 125fl and a Hb of 9.4 g/dL. When looking under the microscope abnormally large reticulocytes (megaloblasts) were noted.
A. Sideroblastic anaemia
B. Chronic renal failure
C. Vitamin B12 deficiency due to lack of dietary intake
D. Vitamin A deficiency
E. Ulcerative colitis
F. Iron deficiency anaemia
G. Liver disease
H. Vitamin B12 deficiency due to malabsorption because of surgical removal of the ileum
I. Thalassaemia
J. Vitamin B12 deficiency due to lack of intrinsic factor because of pernicious anaemia
K. Folate deficiency due to lack of dietary intake
L. Anaemia of chronic disease
M. Vitamin B12 deficiency due to lack of intrinsic factor post-gastrectomy
J. Vitamin B12 deficiency due to lack of intrinsic factor because of pernicious anaemia
201
A 55yr old female with a history of small bowel resection due to chronic inflammatory bowel disease presents to her GP with tiredness and fatigue. On investigation her blood test shows an MCV of 125fl and a Hb of 9.4 g/dL. When looking under the microscope abnormally large reticulocytes (megaloblasts) were noted.
A. Sideroblastic anaemia
B. Chronic renal failure
C. Vitamin B12 deficiency due to lack of dietary intake
D. Vitamin A deficiency
E. Ulcerative colitis
F. Iron deficiency anaemia
G. Liver disease
H. Vitamin B12 deficiency due to malabsorption because of surgical removal of the ileum
I. Thalassaemia
J. Vitamin B12 deficiency due to lack of intrinsic factor because of pernicious anaemia
K. Folate deficiency due to lack of dietary intake
L. Anaemia of chronic disease
M. Vitamin B12 deficiency due to lack of intrinsic factor post-gastrectomy
H. Vitamin B12 deficiency due to malabsorption because of surgical removal of the ileum
202
A 25yr old Asian female who is a vegetarian presents to her GP with tiredness and fatigue. On questioning her periods were noted to be particularly heavy. On investigation her blood test shows an MCV of 80fl, Hb 9.4 g/dL and MCH 22pg.
A. Sideroblastic anaemia
B. Chronic renal failure
C. Vitamin B12 deficiency due to lack of dietary intake
D. Vitamin A deficiency
E. Ulcerative colitis
F. Iron deficiency anaemia
G. Liver disease
H. Vitamin B12 deficiency due to malabsorption because of surgical removal of the ileum
I. Thalassaemia
J. Vitamin B12 deficiency due to lack of intrinsic factor because of pernicious anaemia
K. Folate deficiency due to lack of dietary intake
L. Anaemia of chronic disease
M. Vitamin B12 deficiency due to lack of intrinsic factor post-gastrectomy
F. Iron deficiency anaemia
203
A 10yr old female who recently emigrated from south East Asia presents to A&E with kidney stones. While talking to the parents it is noted that she has particular problems seeing in dim light.
A. Sideroblastic anaemia
B. Chronic renal failure
C. Vitamin B12 deficiency due to lack of dietary intake
D. Vitamin A deficiency
E. Ulcerative colitis
F. Iron deficiency anaemia
G. Liver disease
H. Vitamin B12 deficiency due to malabsorption because of surgical removal of the ileum
I. Thalassaemia
J. Vitamin B12 deficiency due to lack of intrinsic factor because of pernicious anaemia
K. Folate deficiency due to lack of dietary intake
L. Anaemia of chronic disease
M. Vitamin B12 deficiency due to lack of intrinsic factor post-gastrectomy
D. Vitamin A deficiency
204
```
A 65 yr old woman presents with a four week Hx of weight gain, tiredness, constipation and a puffy face. On Ix she is found to have a TSH level of 20mU/l and a free T4 level of 7pmol/l
A. Toxic multinodular goitre
B. Follicular thyroid cancer
C. Papillary thyroid cancer
D. Primary hypothyroidism
E. Post partum thyroiditis
F. Sick euthyroid
G. Single toxic adenoma
H. Medullary thyroid cancer
I. Subacute granulomatous thryroiditis
J. Post Grave’s disease
K. Grave’s Disease
```
D. Primary hypothyroidism
205
```
A 35 yr old woman presents with pain in her neck which radiates to her upper neck, jaw and throat. The pain is worse on swallowing. She has a Hx of an upper respiratory tract infection two weeks ago. On Ix she has a free T4 of 30pmol/l, free T3 of 11pmol/l and a TSH level of 0.1mU/l. On technetium scanning of the thyroid there is low iodine uptake.
A. Toxic multinodular goitre
B. Follicular thyroid cancer
C. Papillary thyroid cancer
D. Primary hypothyroidism
E. Post partum thyroiditis
F. Sick euthyroid
G. Single toxic adenoma
H. Medullary thyroid cancer
I. Subacute granulomatous thryroiditis
J. Post Grave’s disease
K. Grave’s Disease
```
I. Subacute granulomatous thyroiditis
206
```
A 30 yr old woman presents with a Hx of weight loss, diarrhoea, tremor and a marked swelling at the front of her neck. On Ix she is found to have a TSH level of 0.05mU/l a free T4 level of 30pmol/l and a free T3 of 12pmol/l. On technetium scanning the thyroid shows increased iodine uptake.
A. Toxic multinodular goitre
B. Follicular thyroid cancer
C. Papillary thyroid cancer
D. Primary hypothyroidism
E. Post partum thyroiditis
F. Sick euthyroid
G. Single toxic adenoma
H. Medullary thyroid cancer
I. Subacute granulomatous thryroiditis
J. Post Grave’s disease
K. Grave’s Disease
```
K. Grave's disease
207
```
A 25 year old male patient, in hospital with viral meningitis is found to have a slightly raised TSH and slightly low free T4.
A. Toxic multinodular goitre
B. Follicular thyroid cancer
C. Papillary thyroid cancer
D. Primary hypothyroidism
E. Post partum thyroiditis
F. Sick euthyroid
G. Single toxic adenoma
H. Medullary thyroid cancer
I. Subacute granulomatous thryroiditis
J. Post Grave’s disease
K. Grave’s Disease
```
F. Sick euthyroid
208
```
A 70 yr old lady is found to have a tumour of the thyroid gland. She is also found to have high levels of circulating calcitonin
A. Toxic multinodular goitre
B. Follicular thyroid cancer
C. Papillary thyroid cancer
D. Primary hypothyroidism
E. Post partum thyroiditis
F. Sick euthyroid
G. Single toxic adenoma
H. Medullary thyroid cancer
I. Subacute granulomatous thryroiditis
J. Post Grave’s disease
K. Grave’s Disease
```
H. Medullary thyroid cancer
209
```
25 Year old female presents with recent weight loss despite increased appetite and irritability. On examination, she was noted to have a tremor, exophthalmos and was tachycardic, a pretibial myxoedema and a beefy red tongue were noted. A firm, moderately enlarged goitre was palpated. Histologically, the gland showed hyperplasia of the acinar epithelium and infiltrated lymphocytes.
A. Follicular adenoma
B. Iatrogenic hypothyroidism
C. Riedel's thyroiditis
D. Simple colloid goitre
E. Graves' disease
F. Hashimoto's thyroiditis
G. Simple parenchymal goitre
H. Functioning adenoma
I. Toxic nodular goitre
J. Giant cell thyroiditis
```
E. Grave's disease
210
```
32 year old female presented with weight loss and anxiety. The thyroid gland was enlarged, firm, fleshy and pale, infiltrated by lymphocytes. Askanazy cells were noted.
A. Follicular adenoma
B. Iatrogenic hypothyroidism
C. Riedel's thyroiditis
D. Simple colloid goitre
E. Graves' disease
F. Hashimoto's thyroiditis
G. Simple parenchymal goitre
H. Functioning adenoma
I. Toxic nodular goitre
J. Giant cell thyroiditis
```
F. Hashimoto's thyroiditis
211
```
48 year old diabetic female on metformin (sulphonylurea) presented with increased weight gain and dry skin
A. Follicular adenoma
B. Iatrogenic hypothyroidism
C. Riedel's thyroiditis
D. Simple colloid goitre
E. Graves' disease
F. Hashimoto's thyroiditis
G. Simple parenchymal goitre
H. Functioning adenoma
I. Toxic nodular goitre
J. Giant cell thyroiditis
```
B. Iatrogenic hypothyroidism
212
```
22 yr old male presents with stridor. On examination, a multi-nodular thyroid is noted.
A. Follicular adenoma
B. Iatrogenic hypothyroidism
C. Riedel's thyroiditis
D. Simple colloid goitre
E. Graves' disease
F. Hashimoto's thyroiditis
G. Simple parenchymal goitre
H. Functioning adenoma
I. Toxic nodular goitre
J. Giant cell thyroiditis
```
D. Simple colloid goitre
213
```
A 12 yr old male presents with 1/7 of fever. Thyroid swelling and tenderness on palpation was noted. Histologically, the gland was infiltrated by neutrophils and lymphocytes. This child had not been vaccinated against the MMR.
A. Follicular adenoma
B. Iatrogenic hypothyroidism
C. Riedel's thyroiditis
D. Simple colloid goitre
E. Graves' disease
F. Hashimoto's thyroiditis
G. Simple parenchymal goitre
H. Functioning adenoma
I. Toxic nodular goitre
J. Giant cell thyroiditis
```
J. Giant cell thyroiditis
214
```
Recommended therapy used in an attack of acute intermittent porphyria,
A. Diclofenac
B. Co-trimoxazole
C. Diazepam
D. Alcohol
E. Haem arginate
F. Nystatin
G. Propanolol
H. Chlorpromazine
```
E. Haem arginate
215
```
Anti-inflammatory drug that is contraindicated in patients with porphyria
A. Diclofenac
B. Co-trimoxazole
C. Diazepam
D. Alcohol
E. Haem arginate
F. Nystatin
G. Propanolol
H. Chlorpromazine
```
A. Diclofenac
216
```
Drug that can result in chronic porphyria
A. Diclofenac
B. Co-trimoxazole
C. Diazepam
D. Alcohol
E. Haem arginate
F. Nystatin
G. Propanolol
H. Chlorpromazine
```
D. Alcohol
217
```
Drug recommended for management in acute attacks of anxiety.
A. Diclofenac
B. Co-trimoxazole
C. Diazepam
D. Alcohol
E. Haem arginate
F. Nystatin
G. Propanolol
H. Chlorpromazine
```
C. Diazepam
218
```
A second drug that is contraindicated in patients with porphyria that is not an NSAID
A. Diclofenac
B. Co-trimoxazole
C. Diazepam
D. Alcohol
E. Haem arginate
F. Nystatin
G. Propanolol
H. Chlorpromazine
```
B. Co-trimoxazole
219
```
Autosomal dominantly inherited porphyria with neurovisceral manifestations only, resulting from porphobilinogen deaminase deficiency.
A. Uroporphyrinogen III
B. 5-aminolevulinic acid
C. Porphyria cutanea tarda
D. Acute intermittent porphyria
E. Toxic porphyria
F. ALA dehydratase deficiency
G. ALA synthase
H. Activated porphyrins and oxygen free radicals
```
D. Acute intermittent porphyria
220
```
Neurotoxic product(s) of heme breakdown producing neurovisceral damage in certain porphyrias
A. Uroporphyrinogen III
B. 5-aminolevulinic acid
C. Porphyria cutanea tarda
D. Acute intermittent porphyria
E. Toxic porphyria
F. ALA dehydratase deficiency
G. ALA synthase
H. Activated porphyrins and oxygen free radicals
```
B. 5-aminolevulinic acid
221
```
Autosomal dominantly inherited (or spontaneous mutation) porphyria with cutaneous manifestations only, resulting from uroporphyrinogen decarboxylase deficiency
A. Uroporphyrinogen III
B. 5-aminolevulinic acid
C. Porphyria cutanea tarda
D. Acute intermittent porphyria
E. Toxic porphyria
F. ALA dehydratase deficiency
G. ALA synthase
H. Activated porphyrins and oxygen free radicals
```
C. Porphyria cutanea tarda
222
```
Enzyme that catalyses the rate-limiting step of heme breakdown
A. Uroporphyrinogen III
B. 5-aminolevulinic acid
C. Porphyria cutanea tarda
D. Acute intermittent porphyria
E. Toxic porphyria
F. ALA dehydratase deficiency
G. ALA synthase
H. Activated porphyrins and oxygen free radicals
```
G. ALA synthase
223
```
Product(s) of heme breakdown resulting in photosensitivity (i.e. cutaneous) damage in certain porphyrias
A. Uroporphyrinogen III
B. 5-aminolevulinic acid
C. Porphyria cutanea tarda
D. Acute intermittent porphyria
E. Toxic porphyria
F. ALA dehydratase deficiency
G. ALA synthase
H. Activated porphyrins and oxygen free radicals
```
H. Activated porphyrins and oxygen free radicals
