Formative Assessments 1 Flashcards
(130 cards)
1
Q
What is the name of the main effector cell in acute inflammation?
A
Neutrophil Polymorph
2
Q
What is the name of cells that produce collagen in fibrous scarring?
A
Fibroblasts
3
Q
Which of the following is an example of acute inflammation? A. Glandular fever B. Leprosy C. Appendicitis D. Tuberculosis
A
A. Glandular fever B. Leprosy = chronic inflammation *C. Appendicitis = correct * D. Tuberculosis = chronic inflammation
4
Q
What crystals are deposited in joints in gout?
A
Uric Acid crystals
5
Q
In which of the following does granulomatous inflammation occur?
A
*A. Crohn’s disease = correct * B. Acute appendicitis = acute inflammation C. Infectious mononucleoisis = chronic inflammation D. Lobar pneumonia = acute inflamm
6
Q
Which of the following is a chronic inflammatory process from its start?
A
A. Appendicitis B. Cholecystitis C. Infectious mononucleosis = correct D. Lobar pneumonia
7
Q
What is the name of the cells that produce antibodies
A
Plasma cells
8
Q
Name a tumour that never metastasises?
A
Basal cell carcinoma of the skin
9
Q
What is the name of a malignant tumour of striated muscle?
A
Rhabdomyosarcoma Rhabdo = striated Myo = muscle Sarcoma = malignant neoplasm of soft tissue
10
Q
Which of the following tumours does not commonly metastasise to bone? A. Breast B. Lung C. Prostate D. Liposarcoma
A
*D. Liposarcoma = correct *
11
Q
What term describes a cancer that has not invades through the basement membrane?
A
Carcinoma in situ (non invasive)
12
Q
Which of the following is not a known carcinogen in humans? A. Hep C B. Ionising radiation C. Aromatic amines D. Aspergillus niger
A
*D. Aspergillus niger = correct*
13
Q
What is the name of a benign tumour of fat cells?
A
Lipoma
14
Q
What is the name of a malignant tumour of glandular epithelium?
A
Adenocarcinoma Adeno = glandular
15
Q
True or false: A transitional cell carcinoma of the bladder is malignant?
A
True
16
Q
True or false: A leiomyoma is a benign tumour of smooth muscle?
A
True
17
Q
Is radon gas a cause of lung cancer?
A
yes
18
Q
Which lifestyle factor is most likely to cause cancer? A. Drinking half a bottle of wine a day B. Being obese C. Running for 20 minutes twice a week D. Smoking 20 a day
A
*D. Smoking 20 a day = 26x risk *
19
Q
Activation of naive T cells is best achieved by which antigen presenting cells? a) Neutrophils b) Mast cells c) Macrophages d) Dendritic cells
A
(d) dendritic cells Activation of naive T cells is best achieved by dendritic cells
20
Q
What cell type is described below: Located exclusively in tissues, has an important role in both the innate and adaptive immune system, are antigen presenting cells and have phagocytic properties a) Macrophage b) Neutrophil c) Eosinophil d) Mast cell e) Fibroblast
A
(a) Macrophage Macrophages are located exclusively in tissues and they have an important role in both innate and adaptive immunity, are antigen presenting cells and have phagocytic properties
21
Q
Which of the following is not involved in innate immunity? a) Anatomic barriers b) Phagocytic c) Inflammatory mechanisms d) Antibody production e) Skin
A
(d) Antibody production
22
Q
T cells recognise antigens… a) In solution in plasma b) When presented on red blood cells c) Following presentation on antigen presenting cells d) In a 3-dimensional form e) Following presentation on pattern recognition receptors
A
(c) Following presentation on antigen presenting cells T cells recognise antigens following presentation on antigen presenting cells
23
Q
Influenza vaccine is targeted towards ‘at risk’ groups in the UK. Which of the following are classified as ‘at risk’? a) Over 65 years b) 16 years old c) The obese of any age d) Teenagers e) Under 2 years old
A
(a and e) Over 65 and Under 2
24
Q
Which of the following is administered as a live attenuated vaccine in the UK? a) Hepatitis A b) Measles, Mumps, Rubella c) Tetanus d) Flu e) Polio
A
b) Measles, Mumps, Rubella
25
Complements are the proteins that are involved in the clearance of antigen/bacteria. Which of the following is NOT part of the Elimination phase of complement activation? a) Opsonisation b) Target cell lysis c) Chemoattraction of leukocytes d) Production of interferons e) Phagocytosis
d) Production of interferons
26
Which of the following is a polysaccharide vaccine? a) anthrax vaccine b) Hib vaccine (Haemophilus influenza type c) rabies vaccine d) hepatitis A
(b) Hib vaccine
27
Which if the following are features of the adaptive immune response? a) Does not require prior contact with the pathogen b) It works with B and T lymphocytes c) Lacks specificity d) Distinguishes "self" from "non-self" e) Enhanced by complement
b) It works with B and T lymphocytes
28
What are the two types of immune response in humans? Immunological tolerance b) Immune surveillance c) Innate and acquired d) Intrinsic and extrinisic e) Overt and covert
(c) innate and acquired
29
Which of the following is not an organ-specific auto immune disease? a) Ulcerative colitis b) Type 1 diabetes mellitus c) Graves disease d) Hashimoto’s thyroiditis e) Sjogren's syndrome
(a) ulcerative colitis
30
Which of the following is not a classical PAMP? a) peptidoglycan, found in bacterial cell walls; b) flagellin, a protein found in bacterial flagella; c) lipopolysaccharide (LPS) from the outer membrane of gram-negative bacteria; d) Interleukin 12 e) nucleic acids such as viral DNA or RNA.
(d) interleukin 12
31
Which of these is a gram negative bacillus that ferments lactose? A.Shigella sonnei B.Listeria monocytogenes C. Neisseria meningitidis D. Eschericia coli E. Streptococcus pyogenes
D. Eschericia coli
32
Which is incorrect? Haemophilus influenzae is an important cause of a). meningitis in pre-school children b). Otitis media c). Pharyngitis d). Gastroenteritis e). Exacerbations of Chronic Obstructive Pulmonary Disease (COPD)
d). Gastroenteritis
33
Which of the following is normally a sterile site? a). The pharynx b). The urethra c). Cerebrospinal fluid d). The lung e). Skin
c). Cerebrospinal fluid
34
Which of these is NOT a means by which viruses can cause disease? a).direct destruction of host cells b). cell proliferation and cell immortalisation c). inducing immune system mediated damage d). Endotoxin production e). modification of host cell structure or function
d). Endotoxin production
35
When diagnosing viral infections, which of the following is NOT true? a). The sample must come from a sterile site b). Electron microscopy is rarely used c). Use a green swab not a black swab d). PCR results take 1-2 days e). A detectable IgM in serum may be diagnostic
a). the sample must come from a sterile site
36
Which is the most accurate: the HIV virus envelope contains? a). RNA + capsid + DNA polymerase b). DNA + capsid + Reverse transcriptase c). DNA + p24 + protease d). RNA + capsid + reverse transcriptase
d). RNA + capsid + reverse transcriptase
37
Which pair is correct? a). Pityriasis versicolor = bacterium b). Ringworm = helminth c). Aspergillus fumigatus = mycobacterium d). Falciparum malariae = fungal e). Giardia lamblia = protozoal
e). Giardia lamblia = protozoal
38
Myocbacteria, which is not a feature? a). Resistance to destaining by acid and alcohol b). Cell wall contains lipoarabinomannan c). They only divide every 20 hours d). They cannot withstand phagolysosomal killing e). May cause meningitis
d). They cannot withstand phagolysosomal killing
39
Regarding antimicrobial resistance, which is true? a). it is spread by plasmid mediate gene transfer b). spontaneous gene mutations do not occur c). MRSA refers to vancomycin resistant S. aureus d). Only Mereopenem is effective against all gram negative bacteria
c). MRSA refers to vancomycin resistant S. aureus
40
Antimicrobials. Which pairing is incorrect? a). S. pyogenes : can use penicillin b). Meropenem : a carbapenem c). Glycopeptides : use for MRSA d). Co-amoxiclav : contains a Beta-lactamase inhibitor e). Cefuroxime : a macrolide
e). Cefuroxime : a macrolide
41
A 34 year old gay man who has had prolonged diarrhoea now presents short of breath with a dry cough and hypoxia. Which is most accurate? a). This is bacterial pneumonia caused by pneumocysitis jirovecii. b). It is too early for a 4th generation HIV test to be positive c). The CD4 T cell count will be between 500 and 750 d). Even if the HIV test is negative this man has AIDS e). With appropriate therapy he has a good prognosis
e). With appropriate therapy he has a good prognosis
42
Which of these does NOT feature in the definition of Sepsis? a). Temperature \>38.3oC or \<36oC b). Heart rate \>90 c). Systolic blood pressure \>130 d). White Cell count \>12 e). Hypoxia
c). Systolic blood pressure \>130
43
What is the role of the catalase test? A: identifies staph aureus B: identifies staph from non-staph C: identifies mycobacterium D: identifies fungi
B: identifies staph from non-staph
44
What is the role of coagulase test? A: identifies staph aureus B: identifies staph from non-staph C: identifies mycobacterium D: identifies fungi
A: identifies staph aureus
45
For which group of bacteria should you do an optochin test? A: alpha-haemolytic staph B: alpha-haemolytic strep C: beta-haemolytic strep D: enterococcus
B: alpha-haemolytic strep
46
Optochin +ve test: what is the bug? A: strep pneumoniae B: strep viridians C: strep pyogenes D: strep agalactiae
A: strep pneumoniae
47
Example of group A strep? A: strep pneumoniae B: strep viridians C: strep pyogenes D: strep agalactiae
C: strep pyogenes
48
Example of group B strep? A: strep pneumoniae B: strep viridians C: strep pyogenes D: strep agalactiae
D: strep agalactiae
49
Which of the following describes C. difficile? A: gram –ve bacilli B: gram –ve cocci C: gram +ve cocci D: gram +ve bacilli
D: gram +ve bacilli
50
Antibiotic for C. difficile A: amoxicillin B: cefotaxime C: carbapenem D: metronidazole
D: metronidazole
51
Which of the following is gram +ve diplococci on microscopy A: Neisseria gonorrhoea B: strep pneumoniae C: Moraxella catarrhalis D: mycobacterium tb
B: strep pneumoniae
52
Which of the following is gram -ve diplococci on microscopy A: Neisseria gonorrhoea B: strep pneumoniae C: Moraxella catarrhalis D: mycobacterium tb
A: Neisseria gonorrhoea
53
When is chocolate agar important? To culture: A: mycobacterium tb B: haemophilus influenza C: Treponema pallidum D: Not important, blood agar can be substituted
B: haemophilus influenza
54
MacConkey test – shows yellow, what possible bug? A: pseudomonas aeruginosa B: e.coli C: klebsiella pneumoniae
A: pseudomonas aeruginosa
55
MacConkey test – shows pink, what bug? A: pseudomonas aeruginosa B: staph aureus C: strep pneumoniae D: e.coli
D: e.coli
56
Which stain is needed for mycobacteria? A: Lowenstein-Jensen stain B: Methylene blue C: Oxidase purple D: Ziehl-Neelsen stain
D: Ziehl-Neelsen stain
57
Which of the following is not under the control of the pituitary gland? A. Thyroid B. Adrenal cortex C. Adrenal medulla D. Testis E. Ovary
C. Adrenal Medulla
58
Which of the following statements is false? A. The pituitary gland lies in the sella turcica B. The weight of the pituitary gland is around 0.5g C. ACTH is secreted from the pituitary during stress D. The pituitary regulates calcium metabolism E. The anterior and posterior pituitary are distinct on an MRI scan
D. The pituitary regulates calcium metabolism
59
|n men, all the following are mainly produced in the adrenal cortex except? A. DHEAS B. Testosterone C. Aldosterone D. 17-OH progesterone E. Androstenedione
B. Testosterone
60
Where is growth hormone's main site of action to stimulate IGF1 release? A. Bone B. Liver C. Adrenal cortex D. Muscle E. Pancreas
B. Liver
61
The following are typical features of excess growth hormone secretion except? A. Polyuria B. Joint pains C. Sweating D. Hypotension E. Headaches
D. Hypotension
62
The following hormones all have a circadian rhythm except? A. Cortisol B. Testosterone C. DHEA D. 17OH progesterone E. Thyroxine (T4)
E. Thyroxine (T4)
63
Typical features of cortisol deficiency include the following features except? A. Hypotension B. Muscle aches C. Weight loss D. Hyperglycaemia E. Lethargy
D. Hyperglycaemia
64
A 30 year old lady presented with weight gain, menorrhagia and constipation. She is most likely to be suffering from? A. Cushing’s syndrome B. Addison’s disease C. Primary hypothyroidism D. Graves disease E. Acromegaly
C. Primary hypothyroidism
65
Which test would you want to perform in a patient with proximal muscle weakness, purple striae and thin skin? A. Synacthen test B. Overnight dexamethasone suppression test C. Insulin tolerance test D. Glucagon test E. Skin allergy tests
B. Overnight dexamethasone suppression test
66
A 24 year old girl presents with hirsutism, oligimenorrohoea and acne, what test would you likely carry out from below? A. Ultra sound adrenals B. Ultra sound ovaries C. MRI ovaries D. CT scan adrenals E. Prolactin
B. Ultrasound ovaries
67
A 54 year old gentleman presented with hyponatraemia. All the following conditions need excluding before confirming SIADH except? A. Hypothyroidism B. Hypervolaemia C. Euvolaemia D. Adrenal insufficiency E. Diuretic use
C. Euvolaemia
68
A 66 year old gentleman had a serum sodium of 124 mmol/l and a urine sodium of 52 mmol/l. What would you like to perform first? A. Chest X-ray B. CT brain C. Skin turgor and jugular venous pressure test D. Thyroid function tests E. Synacthen test
C. Skin turgor and jugular venous pressure test
69
All of the following are most likely causes of SIADH except? A. Multiple sclerosis B. Lung abscess C. Subdural haemorrhage D. Lymphoma E. Cerebrovascular accident
A. Multiple sclerosis
70
A 28 year old presented with a microprolactinoma. what is the most unlikely symptom? A. Galactorrhoea B. Oligomenorrhoea C. Decreased sexual appetite D. Headaches E. Visual field defects
E. Visual field defects
71
The following suppress appetite except: A. Peptide YY B. Ghrelin C. CCK D. GLP1 E. Glucose
B. Ghrelin
72
The main adipose signal to the brain is? A. CCK B. Neuropeptide y C. Leptin D. Agouti-related peptide E. Adiponectin
C. Leptin
73
A 65 year old lady is diagnosed with SIADH, her sodium is 123mmol/l. What is your first line of management? A. If she is symptomatic I will treat with fluid restriction B. If she is asymptomatic I will treat with hypertonic saline C. If she is asymptomatic I will treat with fluid restriction D. If she is asymptomatic I will repeat the sodium level the next day E. If she is asymptomatic I will give normal saline
C. If she is asymptomatic i will treat with fluid restriction
74
A patient with Addisons disease presents with a chest infection, what do you do? A. Omit his steroids to avoid immunosuppression B. Stop his steroids as they have precipitated a chest infection C. Double his steroid dose whilst unwell D. Keep him on his usual steroid dose E. Not of the above
C. Double is steroid dose whilst unwell
75
The following tests are typical of secondary hypogonadism: A. Low LH; High testosterone B. Low LH; Low testosterone C. High prolactin; high testosterone D. Low FSH; Low prolactin E. None of the above
B. Low LH, low testosterone
76
A patient has a noon testosteronal level below the normal range, what will you do? A. Treat with testosterone gel B. Repeat the test at 0900h and check for symptoms C. Repeat the test at noon to keep things equal D. Refer to endocrinology E. Ignore it
B. Repeat test a 0900h and check for symptoms
77
The first line of treatment for a patient with symptomatic prolactinoma is usually: A. Radiotherapy B. Transphenoidal surgery C. Dopamine agonists D. Transfrontal surgery E. Somatostatin analogues
C. Dopamine agonists
78
Typical visual field defect of a patient with a large pituitary mass is: A. Unilateral quadrantanopia B. Bitemporal hemianopia C. Complete unilateral visual field loss D. Complete bilateral visual field loss E. None of the above
B. Bitemporal hemianopia
79
Satiety is: A. The physiological feeling of no hunger B. Inhibited by activation of POMC neurons C. The physiological feeling of hunger D. Induced by ghrelin release E. Enhanced by Agoutirelated peptide
A. The physiological feeling of no hunger
80
The centres of appetite regulation in the brain are mainly found in the: A. Pituitary B. Cerebellum C. Hypothalamus D. Basal ganglia E. Brain cortex
C. Hypothalamus
81
Lidocaine is effective in the treatment of ventricular tachycardias because it.... A. slows conduction in healthy heart tissue B. opens sodium channels C. blocks sodium channels at rest D. blocks the activation gate of the sodium channel E. blocks the inactivation gate of the sodium channel
E. blocks the inactivation gate of the sodium channel
82
Digoxin can be a useful drug in the treatment of supra ventricular tachycardias because... A. stimulates the release of acetylcholine from sympathetic nerves B. is inotropic C. makes the membrane potential more positive releasing acetylcholine from parasympathetic nerves D inhibits calcium channels E. stimulates sodium/calcium exchange
C. makes the membrane potential more positive releasing acetylcholine from parasympathetic nerves
83
Amlodipine and verapamil are both calcium channel blockers, what property makes verapamil the more effective anti-arrhythmic agent? A. Additional sodium channel blockade B. Once daily treatment C. Lack of effect on the calcium channel at rest D. Blockade of all calcium channel types (L,N & T) E. Additional potassium channel blockade
C. Lack of effect on the calcium channel at rest
84
Which additional property makes propranolol the most useful beta blocker to help control the arrhythmias which occur immediately following a heart attack? A. Calcium channel block B. Potassium channel block C. Heart block D. Sodium channel block E. Parasympathetic activation
D. Sodium channel blocker
85
In the treatment of heart failure, which transport protein or ion channel is inhibited by the loop diuretic, furosemide? A. Na/K ATP-ase B. Epithelial Na channel C. K channel D. Na/K/2Cl transporter E. Na/Cl transporter
D. Na/K/2Cl transporter
86
ACE inhibitors reduce the circulating levels of which adrenal hormone? A. Aldosterone B. Adrenaline C. Cortisone D. Angiotensin II E. Atrial Natriuretic Peptide
A. Aldosterone
87
Which drug exerts a direct inotropic effect on the heart muscle? A. Ramipril B. Losartan C. Digoxin D. Spironolactone E. Glyceryl Trinitrate
C. Digoxin
88
In chronic heart failure beta blockers are...? A. Contra-indicated B. Beneficial by slowing the heart rate C. Beneficial by depressing the myocardium D. Beneficial by increasing oxygen demand E. Effective by blocking reflex sympathetic responses which stress the failing heart
E. Effects by blocking reflex sympathetic responses which stress the failing heart
89
For which CVS drug is bronchospasm a potential side effect? A. Morphine B. Beta blocker C. Aspirin D. Nitrate E. ACE inhibitor
B. Beta blocker .
90
For which CVS drug is cough a potential side effect? A. Morphine B. Beta blocker C. Aspirin D. Nitrate E. ACE inhibitor
E. ACEi
91
For which CVS drug is tolerance a potential side effect? A. Calcium antagonist B. Beta blocker C. Aspirin D. Nitrate E. ACE inhibitor
D. Nitrate
92
Which CVS drug is most likely to induce postural hypotension as a potential side effect? A. Calcium antagonist B. Beta blocker C. Aspirin D. Nitrate E. ACE inhibitor
A. Calcium antagonist
93
Doxazosin is an antagonist at which peripheral receptor? A. Alpha-1 adrenoceptor B. Purine receptor C. Angiotensin II receptor D. Vasopressin receptor E. Beta-1 adrenoceptor F. Dopamine receptor
A. Alpha-1 adrenoreceptor
94
Atenolol is an antagonist at which type of peripheral receptor? A. Alpha-1 adrenoceptor B. Purine receptor C. Angiotensin II receptor D. Vasopressin receptor E. Beta-1 adrenoceptor F. Dopamine receptor
E. Beta-1 adrenoreceptor
95
What enzyme does linsopril inhibit? A. Kininase II B. Renin C. Na/K ATP-ase D. Angiotensin Converting Enzyme (ACE) E. DOPA decarboxylase
D. Angiotensin Converting Enzyme
96
Which of the following drug side effects is less likely to be seen when treating hypertension with an angiotensin receptor blocker (ARB) rather than ACEi? A. Hyperkalaemia B. Cough C. Angioedema D. Renal failure in the presence bilateral renal E. stenosis
B. Cough
97
How to beta blockers work to relieve the pain from angina pectoris? A. Reduce O2 demand by slowing the heart rate B. Reduce O2 demand by reducing myocardial contractility C. Improve O2 distribution by slowing the heart rate D. Increase the O2 supply by dilating the coronary arteries E. Increase O2 supply by stimulating respiration
A. Reduce O2 demand by slowing the heart rate B. Reduce O2 demand by reducing myocardial contractility C. Improve O2 distribution by slowing the heart rate
98
What is the major mechanism by which glyceryl trintrate can relieve the pain of angina pectoris? A. Dilatation of veins to reduce the preload on the heart B. Dilatation of arterioles to reduce the after load on the heart C. Dilatation of coronary arteries to increase cardiac perfusion D. Opening of collateral blood vessels to improve cardiac perfusion E. A positive inotropic effect
A. Dilation of the veins to reduce preload on the heart
99
Which of the following drugs is likely to be more situable for the treatment of variant angina due to coronary artery vasospasm? A. Bumetanide B. Losartan C. Isosorbide D. Amlodipine E. Glyceryl trintrate
D. Amlodipine (CCB)
100
Which of the following drugs might be used to reduce atheromatous disease, the underlying cause of angina pectoris? A. Atenolol B. Amlodipine C. Simvastatin D. Glyceryl trinitrate E. Enalapril
C. Simvastatin
101
What is the characteristic genetic abnormality in Chronic Myeloid Leukemia? A. ATRA gene B. Philadelphia chromosome C. AML/ETO gene D. cMYC oncogene
B. Philidelphia chromosome First example of an isolated genetic abnormality that consistently causes cancer
102
What class of drug best describes Rituximab? A. Cytotoxic chemotherapy B. Disease modifying therpy C. Monoclonal antibody D. Antibiotic
C. Monoclonal antibody
103
Which age group is characteristically affected by Hodgkin lymphoma? A. Children B. Teens and young adults C. Middle age D. Older aged
B and D
104
What is the correct mechanism of action fot the anti emetic drug Ondansetron? A. Peripheral D2 antagonist B. Central D2 antagonist C. Anti-cholinergic D. 5HT3 antagonist
D. 5HT3
105
In sickle cell anaemia, what would you expect the reticulocyte count to be? A. Absent B. Low C. Normal D. Raised
D. Raised
106
Bacterial infection usually causes? A. Low lymphocytes B. Low neutrophils C. High lymphocytes D. High neutrophils
D. High neutrophils
107
Which best outlines the approach to the management of a patient with suspected febrile neutropaenia? A. Encourage fluids and paracetamol B. Perform cultures and wait for results before starting antibiotics C. Perform cultures and start oral antibiotics D. Perform cultures and start broad spectrum antibiotics
D. Perform cultures and start broad spectrum antibiotics E.G TAZOSIN
108
How does Aspirin exert its effect? A. ADP receptor antagonist B. Inhibition of cyclooxygenase enzyme C. Inhibition of glycoprotein IIb-IIIa D. Inhibition of PAR4 receptor
B. Inhibition of cyclooxygenase enzyme
109
What is the commonest cause of microcytic anaemia? A. Thalassemia B. Hepatitis A C. Sickle cell D. Iron deficiency
D. Iron deficiency
110
How is myeloma bone disease usually assessed? A. DEXA bone scan B. CT bone scan C. Plain X ray
C. Plain X ray
111
A 74 year old man presents with a change in bowel habit and anaemia. Colonoscopy and subsequent CT shown below, what is the Duke stage of his cancer?
A.Dukes A
B.Dukes B
C.Dukes C
D.Dukes D
D. Dukes D
112
Which one of the folowing is false regarding colorectal cancer?
A. Bowel cancer screening is offered to people aged 55 or over
B. The majority of cancers occur in the proximal colon
C. FAP and HNPCC are two inherited causes of colon cancer
D. Proximal cancers usually have a worse prognosis
E. Patients with PSC and UC have increased risk of developing colon cancer
B. The majority of cancers occur in the proximal colon FALSE because the majority of colorectal cancers occur in the DISTAL colon
113
A 50 year old man presents with dysphagia. Which one of the following suggests a benign nature of his disease?
A. Weight loss
B. Dysphagia to solids initally then to liquids
C. Dysphagia to solids and liquids from the start
D. Anaemia
E. Recent onset of the symptom
C. Dysphagia to solids and liquids from the start
114
A 32 year old lady complains of a 6 month history of bloating an diarrhoea. What is the most likely diagnosis based on the small bowel hisology?
A. Crohns
B. Ulcerative colitis
C. Micrscopic colitis
D. Coeliac disease
E. Irritable bowel sydrome
D. Coeliac disease
Hypertrophic villi with no crypts
115
A 32 year old lady complains of a 6 month history of bloating an diarrhoea. What is the most likely diagnosis based on the small bowel hisology?
A. Crohns
B. Ulcerative colitis
C. Micrscopic colitis
D. Coeliac disease
E. Irritable bowel sydrome
A. Crohns
Arrow is pointing at granuloma
116
A 32 year old lady complains of a 6 month history of bloating an diarrhoea. What is the most likely diagnosis based on the small bowel hisology?
A. Crohns
B. Ulcerative colitis
C. Micrscopic colitis
D. Coeliac disease
E. Irritable bowel sydrome
B. Ulcerative colitis
Arrow is pointing at crypt abcess
117
A 19 year old girl presents with abdominal pain and loose stool, which of the features suggest that she has irritable bowel sydrome?
A.Anaemia
B.Nocturnal diarrhoea
C.Weight loss
D.Blood in stool
E.Abdominal pain relieved by defaecation
E. Abdominal pain relieved by defaecation
118
Which statement about Helicobacter pylori is true?
A.It is a gram positive bacteria
B.HP prevalence is similar in developing and developed countries
C.15% of patients with a duodenal ulcer are infected with H. Pylori
D.PPIs should be stopped 1 week before a H. Pylori stool antigen test – false 2 weeks
E.It is associated with an increased risk of gastric cancer
E. It is associated with an increased risk of gastric cancer
- it is gram negative
- greater presence in developing countreis
- majority of patients with duodenal ulcers have h pylori
- PPis should be stopped 2 weeks before h pylori stool antigen test
119
A 56 year old man presents with abdominal distension and shortness of breath. Examination revealed fever of 38C a tense distended abdomen with shifting dullness. He also has dullness to percussion in the right lung base. Several spider naevi are sneed on his chest. What is the most important management in this patient and what is the most likely diagnosis?
A.CXR
B.Ultrasound abdomen
C.Echocardiogram
D.Ascitic tap
D. Ascitic tap
Liver cirrhosis
120
Which of the following features best distinguishes ulceratiive colitis from crohns?
A.Ileal involvement
B.Continuous colonic involvement on endoscopy
C.Non-caseating granuloma
D.Transmural inflammation
E.Perianal disease
B. Continous colonic involvement on endoscopy - no skip lesions
Also no granulomas, fistulas or peri-anal disease however rectal involvement is common
121
122
10. A 68 year old lady presents with abdominal pain and distention. She last opened her bowels 5 days ago. She has a poor appetite and has lost some weight recently. Her PMH includes an abdominal hysterectomy and diverticulosis. She drinks 20 units of alcohol a week and smokes 5 a day. Examination reveals a distended abdomen with tympanic percussion throughout. There is a small left groin lump with a cough impulse. Which one of the following is NOT likely to be the cause of her abdominal pain and distention?
A.Colon cancer
B.Adhesions
C.Ascites
D.Diverticulitis
E.Strangulated hernia
C.Ascites = you would be able to see this
123
11. A patient drinks 4 pints (568ml=1 pint) of beer (4%) a day, and 2 standard (175ml) glasses of red wine (13%) on Saturday and Sunday additionally. How many units of alcohol is he drinking per week? (round up to nearest whole number)
A.73 units
B.62 units
C.94 units
D.57 units
E.49 units
A. 73
(ABV x ml) / 1000 = units!
124
12. A 71 year old man was admitted to hospital with pneumonia after he returned from a cruise holiday in the Mediterranean Sea. He was treated with a week of augmentin (co-amoxiclav) for his pneumonia. On day 7 of his admission, he started having diarrhoea 10 times a day without any blood. He feels unwell and dehydrated. He had a flexible sigmoidoscopy which showed this. What is the likely organism responsible for his diarrhoea?
A.Norovirus
B.Escherichia coli
C.Giardia lamblia
D.Clostridium difficile
E.Salmonella enteritidis
D. Clostridium difficile
125
A 52 year old lady presents with fatigue and itching. She noticed pale stool and dark urine naevi, and hepatomegaly. Her bloods showed Bili 150, ALP 988, ALT 80, positive AMA and a raised IgM. What is the most likely diagnosis? (and why), also what is this patient at increased risk of?
A.Simvastatin induced liver injury
B.Primary biliary cirrhosis
C.Gall stones
D.Autoimmune hepatitis
E.Primary sclerosing cholangitis
B.Primary biliary cirrhosis
positive AMA and raised IgM = blood markers
image shows = xathelasma
associated with RA and sjogrens
INCREASED RISK OF HEPATOCELLULAR CARCINOMA
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A 16 year old girl is admitted with vomiting and abdominal pain. She reports taking 20 paracetamol tablets after her boyfriend split up with her. Which one of the following test results would you NOT expect to see?
A.Metabolic acidosis
B.A prolonged prothrombin time
C.A raised creatinine
D.Hyperglycaemia
E.ALT 1000
D Hyperglycaemia - you would expect HYPOGLYCAEMIA
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A 68 year old unkempt and malnourished homeless man was brought to the hospital with haematemesis. Endoscopy found bleeding varices. Subsequent USS showed a coarse shrunken liver. On day 2 admission he was found to be ataxic, confused with nystagmus. What is the most likely cause of his neurological presentation?
A.Alcohol toxicity
B.Alcohol withdrawal
C.Delirium tremens
D.Wernicke’s encephalopathy
E.Korsakoff syndrome
D.Wernicke’s encephalopathy
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16. A 23 year old man was brought in at 2am with RIF pain and was diagnosed with acute appendicitis. He was stable and was scheduled for appendicectomy in the morning. During the ward round, he acutely deteriorated. He was immediately brought to theatre for a perforated appendix. What clinical signs would you NOT expect to see? (and what is the likley diagnosis)
A.Fever
B.Bowel sounds
C.Tachycardia
D.Rebound tenderness
E.Guarding
B.Bowel sounds
Peritonitis
