medgems Flashcards
(196 cards)
1
Q
CT Head non contrast reveals hyperdense enhancement adjacent to the circle of willis
A
subarachnoid haemorrhage
2
Q
What scoring system is used to grade prostate tumours?
A
Gleason score
3
Q
Which valve is predominantely affected in acute rheumatic fever?
A
mitral
4
Q
Epigastric pain that worsens after food is a classical history of what form of peptic ulcer disease?
A
gastric ulcer
5
Q
Which lobe of the brain does HSV encephalitis classically affect?
A
temporal
6
Q
What intracerebral tumour is Multiple Endocrine Neoplasia Type 1 associated with?
A
pituitary adenoma
7
Q
A 40 year old man has routine bloods done for yearly statin monitoring at his GP. His monitoring blood tests last year were normal
One week prior he broke his ankle falling off his bike.
Blood tests show a normal ALT, raised ALP, normal AST, normal bilirubin.
What is the likely explanation for his deranged liver function?
A
fracture
8
Q
What cancer is associated with the presence of “oat shaped cells” on biopsy?
A
small cell lung cancer
9
Q
Give an example of a blood test that may be used to monitor hepatic synthetic function
A
prothrombin time or albumin
10
Q
Barrett’s oesophagus is a premalignant change associated with what histological malignancy of the oesophagus?
A
adenocarcinoma
11
Q
Which type of cell forms foam cells in the formation of atheromatous plaques?
A
macrophage
12
Q
man with positive pregnancy test (high HCG)
A
testicular cancer
13
Q
What is the name given to the criteria used for diagnosis of infective endocarditis?
A
Dukes criteria
14
Q
imaging for pancreatic cancer
A
CT abdomen
15
Q
A 64 year old gentleman with hypertension and Type 2 Diabetes Mellitus presents to the emergency department with sudden onset weakness in his right arm.
Neurological examination in the emergency department is normal.
What is the most likely diagnosis?
A
TIA
16
Q
How many major stages, classified by glomerular filtration rate, of chronic kidney disease are there?
A
5
17
Q
What is the main hormone produced by delta cells in the pancreas?
A
somatostatin
18
Q
A 30 year old woman has experienced a week of progressive retro ocular pain with a loss of visual acuity in the right eye. She does not wear glasses. There is a family history of Type 1 Diabetes.
On examination, there is a right relative afferent pupillary defect with reduced visual acuity. Fundoscopy and intraocular pressure is normal.
What investigation would be diagnostic?
A
MRI Brain and Optic Nerve
optic neuritis secondary to MS
19
Q
What histochemical stain would reveal the presence of iron in a liver biopsy with a patient with haemachromatosis?
A
prussian blue
20
Q
What is the inheritance pattern of alport’s syndrome?
A
X-linked recessive
21
Q
What is the inheritance pattern of Wilson’s disease?
A
autosomal recessive
22
Q
What histochemical stain would reveal the presence of copper in a liver biopsy with a patient with Wilson’s disease?
A
rhodanine
23
Q
Chest X ray reveals irregular pleural thickening and a peripheral homogenous opacity in the left lower lung field.
A
mesothelioma
24
Q
A 80 year old man is undergoing elective bilateral knee arthroplasty. He has hypertension but no other past medical history. He is under general anaesthetic.
During the operation, he develops 4mm convex ST elevation in leads II and III. The cardiac monitor immediately alarms and alerts the anaesthetist.
A blood test for high sensitivity Troponin is taken and the anaesthetist informs the surgeon.
30 minutes later, the troponin is reported by the lab as normal.
What is the diagnosis?
A
MI
takes 4hrs for trop to rise
25
5 day old baby with suspected sepsis. gram negative rod - organism?
Eschericia coli
26
breast
-microcalification on mammography
-biopsy: non invasive group of dysplastic cells which has not penetrated the basement membrane
ductal carcinoma in situ
27
A 83 year old man is started on bicalutamide for treatment of his metastatic prostate cancer.
What is the method of action of bicalutamide?
androgen antagonist
28
Head trauma causing loss of consciousness followed by a lucid interval before the patient deteriorates is a classical history of what cerebral pathology?
extadural haematoma
29
A 18 year old man presenting with nephritic syndrome, cataracts and sensorineural deafness suggests what underyling diagnosis?
alports syndrome
30
A biopsy, taken at autopsy, reads: "There is pathological intimal thickening of the right renal artery with significant occlusion of the luminal space. Immunohistochemical staining reveals the presence of macrophages"
What pathology does the report describe?
atherosclerosis
31
A biopsy sample from a patient with suspected renal cancer is reported as follows:
"There are neoplastic cells with transparent cytoplasm. Cells are arranged in nests with intervening blood vessels"
What is the specific histological type of cancer?
clear cell carcinoma
32
Which renal syndrome is characterised by proteinuria, oliguria and haematuria?
nephritic syndrome
33
Clinical Assessment and Imaging are two parts of the "Triple Assessment" for suspected breast malignancy.
What is the final component of Triple Assessment?
Histology
34
Give an example of a misfolded protein implicated in the pathogenesis of alzheimer's disease
Tau
35
What is the main hormone produced by of alpha cells in the pancreas?
glucagon
36
What is the first line chemotherapy drug for treating prostate cancer in the UK?
Docetaxel
37
Damage to which artery is commonly associated with an extradural haemorrhage?
middle meningeal artery
38
A fasting blood glucose value above what value (in mmol/L) on two consecutive occasions in an asymptomatic individual confirms a diagnosis of diabetes?
7
39
soft, systolic murmurs heard best at the left lower sternal edge - found in hyperdynamic circulation (pregnancy, anaemia, severe blood loss)
flow murmur
40
Which form of inflammatory bowel disease may, on biopsy, show evidence of transmural inflammation?
crohns
41
What is the inheritance pattern of adult polycystic kidney disease?
AD
42
paraneoplastic cushings - cancer type
small cell lung cancer
43
waxy casts in urine
CKD
44
A 42 year old woman with Type 1 Diabetes Mellitus is investigated for fatigue and pruritus.
She has an elevated serum ALP and an elevated anti mitochondrial antibody titre.
An ultrasound of the biliary tree shows no gross dilatation.
What is the likely diagnosis?
primary billiary cirrhosis
45
A 75 year old man has a resting tremor in his right hand. On examination there is cogwheel rigidity of the right arm only. The tremor is made worse on distraction.
In addition, he walks with small steps and "shuffles" his feet across the floor. He reports loss of his sense of smell.
What is the diagnosis?
idiopathic parkinsons disease
46
What respiratory condition is characterised by airspace enlargement and alveolar wall destruction?
emphysema
47
Which organism is classically associated with haemolytic uraemic syndrome?
E.coli
48
What is the preferred surgical option for treating prostate cancer?
radical prostatectomy
49
Schistosomiasis infection predisposes to what urological malignancy?
bladder - squamous cell carcinoma
50
What structures, present in the large bowel, represent weak points in the bowel wall and allow for the formation of diverticula?
taenia coli
51
What is the typical inheritance pattern of Hereditary non-polyposis colorectal cancer/Lynch Syndrome?
AD
52
Kimmelstiel Wilson nodules found in a renal biopsy are associated with what underlying disease?
diabetes / diabetic nephropathy
53
A biopsy viewed under light microscopy shows thickening of the glomerular basement membrane.
Immunofluorescence shows the presence of antibody complexes and complement deposits. There are visible areas of scarring of the glomerular basement membrane, however, some areas appear spared.
What subtype of nephrotic syndrome does this histological pattern and history suggest?
focal segmental glomerulosclerosis
54
What is the first line treatment for severe haemachromatosis?
therapeutic phlebotomy
55
A renal biopsy is performed on a 34 year old man with significant proteinuria. He is known to have Chronic Hepatitis B.
The biopsy reads: "Thickened basement membrane with spike and dome appearance due to electron dense deposits in the subepithelial layer"
What is the likely diagnosis?
membranous glomerulonephritis
56
What is the name given to dilated veins, commonly found in the oesophagus and are often associated with portal hypertension?
They are a common cause of sudden, life threatening, haematemesis in alcoholics.
varices
57
What is the commonest cause of oesophagitis in UK adults over 50?
GORD
58
Other than zinc, what is the first line pharmacological treatment for Wilson's disease?
penicillamine
59
What is the commonest type of dementia in over 60 year olds?
alzheimers
60
Which adrenal tumour is most commonly associated with Multiple Endocrine Neoplasia?
phaeochromocytoma
61
What is the name given to areas of regenerating mucosa which project into the lumen of the bowel, which may be visualised during a colonoscopy of a patient with ulcerative colitis?
pseudopolyp
62
A 55 year old gentleman with newly diagnosed bipolar disorder is seen by a psychiatrist. An ECG is performed as part of the workup for starting lithium, a mood stabiliser.
His past medical history includes an anterior STEMI 4 months ago.
The ECG shows ST elevation in leads V2, V3, V4 and V5. He denies chest pain, breathlessness or any other symptoms.
What is the diagnosis?
Ventricular aneurysm
63
Expression of what receptor may confer a good prognosis in invasive breast carcinoma?
ER (estrogen receptor)
64
Expression of what receptor may confer a bad prognosis in invasive breast carcinoma?
HER2
65
A 68-year-old woman presents to her GP with a non-tender, hard lump with irregular borders in her left breast. She denies any nipple discharge, weight loss or malaise.
She was in a car accident 6 months ago and sustained significant bruising to the chest wall.
She undergoes triple assessment. Ultrasound shows a solid mass with indistinct margins.
The biopsy report is lost however the system recorded that the specimen was benign.
What condition may explain the lump?
fat necrosis
66
What is the most common type of lung cancer in the UK?
adenocarcinoma
67
A 58-year-old woman presents to her GP with a painful lump in her left breast.
There is palpable axillary lymphadenopathy and she reports recent significant weight loss and malaise.
She is assessed for breast cancer.
What histological subtype of breast cancer will this patient most likely have?
invasive ductal carcinoma
68
A patient undergoing investigation for lung cancer has a bronchoscopy.
He has a 40 pack year history of smoking and is has recently been given a diagnosis of myasthenia gravis.
A tumour is visualised by the bronchoscope in the left main bronchus. A biopsy is taken.
What histological type of lung cancer is this likely to be?
small cell
69
A liver biopsy from a patient with chronic hepatitis B shows areas of fibrosis and hepatocyte necrosis. There are visible nodules of regenerating hepatocytes.
An upper GI endoscopy reveals the presence of large, dilated veins in the oesophagus.
What diagnosis is likely responsible for the increase in portal venous pressure?
cirrhosis
70
What is the inheritance pattern of benign familial haematuria?
benign familial haematuria
71
A 83 year old woman was admitted to hospital for a severe chest infection. At the time of admission, her CURB-65 was 4. Her blood pressure was 80/40
She was diagnosed as having an acute kidney injury.
What is the likely cause of the AKI?
hypovolaemia --> ATN
72
In which gross anatomical section of the pancreas does pancreatic cancer typically occur?
head
73
What is the most common cancer in the UK?
breast
74
Which tumour marker is used in the diagnosis of hepatocellular carcinoma?
AFP (alpha-fetoprotein)
75
75
Infection by what organism classically precipitates acute rheumatic fever
strep pyogenes
76
A 32 year old man presents to the emergency department with cola coloured urine.
He denies pain or fever. He has had a sore throat for the past five days. He has no other medical history of note and this has not happened before.
He also has a non-blanching rash over his legs.
What is the likely cause of the nephritic syndrome?
IgA nephropathy
77
Which hepatobilary pathology is classically associated with an elevated p-ANCA?
primary sclerosing cholangitis
78
The ECG leads V1 and V2 represent which specific region of the heart?
anteroseptal
79
A 45 year old man presents to their GP with a chronic cough and mild breathlessness on exertion. He has a 60 pack year history of smoking. Spirometry reveals an obstructive picture with FEV1 75% of predicted. There is no association with time of day or seasonality.
What is the most likely diagnosis?
COPD
80
An autopsy of an 18 year old boy in Africa reveals the following histopathological findings
"Deforming fibrosis of the mitral, and to a lesser extent aortic valves are seen. The valvular leaflets are thickened and have retracted, suggesting stenosis"
What is the likely causative organism?
strep pyogenes
81
A 40 year old man is referred to cardiology clinic due to reduced exercise tolerance. He is found to have mitral stenosis.
He previously reported episodes of spontaneous, rapid, jerking movements that he could not control during a period of illness when he was a teenager. His sister had similar symptoms at that time.
What illness may he have had in his youth which has precipitated his heart murmur today?
rheumatic fever
82
What is the most common histological type of prostate cancer?
adeocarcinoma
83
Which neuroendocrine tumour is associated with Zollinger-Ellison syndrome?
gastrinoma
84
A 3 year old girl has progressive abdominal distension.
On examination there is a firm, smooth, non tender mass in the upper left quadrant of the abdomen.
A urine dip shows microscopic haematuria.
What is the likely diagnosis?
nephroblastoma
85
What liver enzyme may be measured in the blood and, if raised, is suggestive of biliary obstruction?
alkaline phosphatase (ALP)
86
Which common medication are hepatic adenomas associated with?
COCP
87
A histopathologist looks at a piece of excised lung tumour under a microscope.
She notes the presence of mucin and glandular differentiation.
Which histological subtype of lung cancer is associated with mucin production?
adenocarcinoma
88
Kayser Fleischer rings represent the deposition of what substance in the cornea?
copper
89
A 64-year-old man is brought to the accident and emergency due to a collapse while shopping.
On examination an ejection systolic murmur is heard in the aortic region and there is radiation of the murmur to the carotids.
What is the most likely diagnosis?
aortic stenosis
90
What is the most common chemical composition of renal stones?
calcium oxalate
91
What type of fluid motion promotes development of atherosclerotic disease in blood vessels?
turbulent flow
92
What is the commonest cause of chronic renal failure in the UK?
diabetes
93
What condition is characterised by microangiopathic haemolytic anaemia, thrombocytopenia and stroke-like symptoms in an adult?
Thrombotic Thrombocytopenic Purpura (TTP)
94
What is the term used to describe small, tube shaped microscopic particles found in urine?
urinary casts
95
How much glucose is given, in grams, for an oral glucose tolerance test for the diagnosis of diabetes?
75g
96
A CT-KUB from a patient with renal colic reveals the presence of a radiopaque, laminated density which conforms to the shape of the renal pelvis.
There is evidence of dilation of the renal calyces.
What is the typical chemical composition of this density?
Magnesium Ammonium Phosphate (struvite)
97
What histological type of bladder cancer is most common?
Transitional Cell Carcinoma
98
A 72-year-old woman presents to her GP.
She has become progressively confused over the past 2 years. She reports she has trouble shopping and paying with coins. She is becoming progressively more forgetful.
At night, she sees children playing in her house and has called the police on several occasions despite her husband trying to calm her down.
For the last few months she has had difficulty getting out of chairs and began walking with a shuffling gait.
What is the likely diagnosis?
lewy body dementia
99
In which form of inflammatory bowel disease may non-caseating granulomas be seen on biopsy?
crohns
100
A 70 year old man presents to his GP reporting dysuria and increased urinary frequency.
He is given 7 days of oral nitrofurantoin by his GP. He denies any weight loss, loss of appetite or other symptoms.
At the same appointment, he has his annual routine yearly bloods taken.
His Prostate Specific Antigen (PSA) is raised at 3x the upper limit of normal.
The GP performs a DRE which is normal.
What is the most appropriate action regarding his elevated PSA?
repeat in 2 wks
101
What syndrome is characterised by the quartet of hypoalbuminemia, oedema, hyperlipidaemia and proteinuria?
nephrotic
102
What condition is the presence of fatty casts in urine associated with?
nephrotic
103
n the emergency department what imaging is required in the initial workup of a suspected stroke?
CT head non contrast
104
What is the most common histopathological subtype of pancreatic cancer?
adenocarcinoma
105
What histopathological description is given to cells that have lost their intercellular connections between neighbouring cells?
An example could be the loss of desmosomal connections in pemphigus vulgaris.
acantholysis
106
What type of kidney stone are patients on chemotherapy for chronic lymphocytic lymphoma at increased risk of?
uric acid
107
What monoclonal antibody therapy targets human epidermal growth factor receptor 2 and is used in the treatment of breast cancer?
Trastuzumab
108
What protein is defective in adult polycystic kidney disease?
polycystin 1
109
What kind of cancer is associated with the histological finding of keratin pearls?
squamous cell carcinoma
110
What is the most common histological type of renal malignancy?
renal cell carcinoma
111
In which form of inflammatory bowel disease does smoking classically worsen symptoms?
crohns
112
113
A 5 year old boy is generally oedematous in his arms, face, legs, abdomen and feet. It started with facial swelling two days ago. His parents noted that he has particularly frothy urine.
He had a cold 5 days ago but is otherwise well with no medical history.
On examination there is generalised pitting oedema.
What is the most likely diagnosis?
minimal change disease
114
What is the most common cause of a pulmonary embolus?
DVT
115
Classically the triad of bronchoconstriction, flushing and diarrhoea is described as what paraneoplastic syndrome?
carcinoid syndrome
116
A 14 year old boy undergoes a renal biopsy due to proteinuria.
Two weeks ago he developed symptoms of a sore throat and an upper respiratory tract infection.
Renal biopsy showed endothelial proliferation and on electron microscopy showed evidence of immune complex deposits below the epithelium.
What is the likely diagnosis?
post-streptococcal glomerulonephritis
117
What surgical procedure may be used to treat pancreatic cancer affecting the head, neck and body of the pancreas?
whipple's procedure
118
What sign describes painless jaundice in the presence of a palpable gallbladder?
courvoisier's sign
119
Which strain of Escheriscia coli is classically associated with haemolytic uraemic syndrome in children who have spent time around farmyard animals?
0157:H7
120
A fasting blood glucose value above what value (in mmol/L) will confirm a diagnosis of diabetes in an individual with polyuria and polydipsia?
7
121
What tumour marker is most commonly used in the diagnosis of colorectal cancer?
CEA (carcinoembryonic antigen)
122
What condition is characterised by microangiopathic haemolytic anaemia, thrombocytopenia and renal failure in children?
HUS
123
What is the most common histochemical stain used to visualise cells for light microscopy, such as that used for diagnosis of cancers?
Haematoxylin and eosin stain
124
What is the most common histopathological type of colorectal cancer?
adenocarcinoma
125
A 80 year old presents to the emergency department with severe shortness of breath. She is visibly breathless at rest with a respiratory rate of 25 and oxygen saturations of 89%. Her JVP is elevated and she has pitting oedema to the level of the knee.
She reports she has been coughing up pink, frothy sputum for the last 3 days.
What is the most likely reason for her shortness of breath?
pulmonary oedema
126
A 18 year old woman collapses after running a half marathon. She is noted to be drowsy and acting like she is drunk.
Her BMI is 28kg/m2 and she ate a sufficient breakfast prior to starting the run. She is normally fit and well.
There is a family history of Multiple Endocrine Neoplasia Type 1.
Paramedics record her blood sugar as 2.4mmol/L. They administer dextrose and she becomes more alert.
What is the probable cause of her hypogylcaemic episode?
insulinoma
127
Give an example of a biomarker that suggests the presence of hepatic ischaemia
ALT (Alanine Aminotransferase)
128
Expression of what cell surface receptor may confer a bad prognosis in invasive breast carcinoma?
HER2
129
What is the typical inheritance pattern of Maturity Onset Diabetes of the Young (MODY)?
AD
130
A 62-year-old man presents with a 3 months of right-sided flank discomfort.
He reports 5 days of gross haematuria with some clot formation.
On examination, his blood pressure is 157/95 mmHg. There is a palpable right sided mass in the lower abdomen.
What is the likely underlying diagnosis?
renal cell cancer
131
Damage to what muscle within the heart may result in mitral regurgitation?
papillary
132
Which hepatobiliary condition may be described as: fibrosis of bile ducts throughout the biliary tree with associated stricture formation?
PSC
133
134
The ECG leads II, III and aVF represent which region of the heart?
inferior
135
A GFR of less than what value is considered reflecting End Stage Renal Failure in chronic kidney disesease?
15
136
A 55-year-old man presents to his GP with a chronic productive cough of 6 months duration. He has had mild weight loss. He has had two hospitalisations for pneumonia in the last two years.
Spirometry in the practice was normal. Chest x ray was normal.
High resolution CT scan reveals bronchial wall thickening with a positive signet ring sign.
What is the diagnosis?
bronchiectasis
137
What is the typical inheritance pattern of hypertrophic obstructive cardiomyopathy (HOCM)?
AD
138
What is the cancer with the highest mortality in the UK?
lung
139
An elderly woman who lives alone is brought into hospital after being found lying on the ground at home by her daughter this morning. She says she collapsed the previous evening and was unable to reach the phone. You suspect she has a fractured hip. Her bloods show a raised potassium and very high levels of serum creatine kinase. She is found to have very dark urine. What protein is responsible for the dark urine?
myoglobin
140
Which hepatobillary condition may be described as a slow, insidious process of autoimmune destruction of intrahepatic bile ducts, associated with cholestasis?
PBC
141
A 54 year old gentleman with type 2 diabetes mellitus presents to his GP. He reports seeing blood in his urine. In addition, he has felt feverish and tired for a few weeks. He has no night sweats or weight loss and there is no family history of any medical problems.
Physical examination revealed a quiet diastolic murmur and a palpable mass in the left upper quadrant of the abdomen.
Blood tests showed an elevated CRP with a normal haemoglobin.
Results of the urine dip are below:
Blood ++
Proteinuria ++
What is the cause of this constellation of symptoms?
infective endocarditis
142
A histopathologist looks under the microscope at a granuloma.
What cell type will she be looking at?
macropage
143
Which form of inflammatory bowel disease is associated with Primary Sclerosing Cholangitis?
UC
144
An immune response directed against myelin basic protein and proteo-lipoprotein results in what autoimmune condition?
MS
145
A histopathologist looks at a piece of excised lung tumour under a microscope.
There is no evidence of glandular or squamous differentiation. The cells are poorly differentiated with large nuclei.
Which histological subtype of lung cancer has these features?
large cell carcinoma
146
Which hepatobiliary pathology is associated with the finding of "beading" of bile ducts during an endoscopic retrograde cholangiopancreatogram (ERCP)?
PSC
147
Which hepatobiliary pathology, associated with a positive antimitochondrial antibody, may show the presence of granulomas on biopsy?
PBC
148
What sign, which may be visible around the nails, is seen in Graves' disease and is due to periosteal bone growth in the nail bed?
thyroid acropachy
149
Which enzyme, released by neutrophils, does the compound alpha-1 antitrypsin inhibit to prevent the development of emphysema in the lungs?
neutrophil elastase
150
151
What tumour marker is associated with prostate cancer?
prostate specific antigen (PSA)
152
A 75 year old woman notices an itchy, maculopapular area of erythema around her right nipple.
What condition is associated with this clinical sign?
breast cancer
153
An 84 year old Asian woman presented to the ED with chest pain of 10 hours duration, which began while watching television. The pain was 9/10 and did not radiate. She reported being under extreme stress since the death of her 50 year old son a week ago.
An ECG revealed ST elevation in V2 and V3. Chest X ray was normal. Troponin and electrolytes were normal. Percutaneous Coronary Intervention was unremarkable with no occlusions and no evidence of atherosclerotic disease.
An echocardiogram showed apical akinesis with an ejection fraction of 36%. There was hypertrophy of the interventricular septum.
What is the diagnosis?
Takotsubo's Cardiomyopathy
154
A nephrologist is investigating a 40 year old man with nephrotic syndrome.
A biopsy viewed under light microscopy shows thickening of the glomerular basement membrane.
Immunofluorescence shows the presence of antibody complexes and complement deposits throughout the glomerular basement membrane.
The patient's renal function has continued to decline despite high dose pulsed IV methylprednisolone.
What is the likely primary cause of the nephrotic syndrome?
membranous glomerulonephritis
155
A positive Courvoisier's sign - painless jaundice in the presence of a palpable gallbladder - is most commonly caused by of what diagnosis?
pancreatic cancer
156
What condition is the presence of granular ("muddy brown") casts seen in the urine associated with?
ATN
157
What is the other condition that, together with emphysema, makes up COPD?
chronic bronchitis
158
159
What spirometry pattern is characterised by a reduced FEV1, reduced FVC and a normal FEV1/FVC ratio?
restrictive
160
What type of bladder cancer is associated with chronic cystitis?
squamous
161
A 45 year old diabetic man is investigated for heart failure.
A panel of blood tests shows an elevated serum ferritin in the absence of a fever, with a low total iron binding capacity and elevated transferrin saturation. He recalls that his brother has something wrong with iron in his body.
What is the diagnosis?
haemochromatosis
162
A 60 year old with longstanding alcoholism, weight loss and epigastric pain undergoes a pancreatic biopsy.
The biopsy shows evidence of destruction of exocrine tissue, associated with fibrosis and calcification. Duct dilatation is noted.
There is no elevation in CA-19-9.
What is the likely diagnosis?
chronic pancreatitis
163
164
A 20-year-old man with cystic fibrosis presents to his GP with a chronic productive cough, that has been getting worse over the last two years. He is known to be colonised with pseudomonas aeruginosa.
His BMI is 18.5. Temperature in the surgery was 36.8c.
Examination revealed coarse crackles at the bases which shifted upon coughing.
Chest x ray was reported as showing tram-track opacities.
What is the diagnosis?
bronchiectasis
165
A 20 year old man with liver failure and parkinsonism is a classical history of what condition?
wilsons
166
What is the most common pattern of disease progression in Multiple Sclerosis?
relapsing remitting
167
A 24 year old woman presents to their GP with progressive shortness of breath on exertion associated with wheezing. She also has a productive cough, present most days.
Spirometry shows an obstructive picture with FEV1 47% of predicted.
A chest X ray shows evidence of hyperinflation.
What genetic condition should she be investigated for?
Alpha 1 Antitrypsin deficiency
168
Degeneration of neurons in the substantia nigra is implicated in the pathogenesis of what synucleinopathy?
PD
169
Aschoff bodies found in the heart of a patient who has died of acute heart failure suggests what causative diagnosis?
rheumatic fever
170
What condition is the presence of epithelial casts in urine associated with?
ATN
171
172
Which protein, detected in the stool of patients with inflammatory bowel disease, reflects the presence of intraluminal neutrophils and hence the presence of intestinal inflammation?
calprotectin
173
In which liver condition will cytoplasmic Mallory Denk Bodies most commonly be found on biopsy?
alcoholic hepatitis
174
A biopsy specimen from the gastric antrum of a patient is reported as showing evidence of acute gastritis.
What cell of the immune system is found disproportionately in biopsies of acute gastritis?
neutrophil
175
176
Severe epigastric pain associated with an elevated serum lipase is highly suggestive of what diagnosis?
pancreatitis
177
A 84 year old man with atrial fibrillation presents to the emergency department with increasing disorientation and headache. He has been having frequent falls at home over the last few months.
CT head reveals a unilateral, hypodense, crescent shaped mass underlying the left parietal bone.
What is the likely diagnosis?
subdural haematoma
178
A 64 year old lady with osteoarthritis of the hip presents to her GP reporting fevers and bilateral joint pain. She suffers from heart failure and gout. She thinks her symptoms started after a recent course of amoxicillin for a chest infection. Her usual medications are furosemide, naproxen, omeprazole and allopurinol.
Blood tests show a Stage 1 AKI and mild eosinophilia. Her blood pressure is 142/90 and her urine dip shows leucocytes +1.
Urine microscopy shows the presence of white cell casts.
What is the likely underlying diagnosis?
acute intersistial nephritis
179
A 73 year old man presents to his GP with progressive exertional dyspnoea and a dry cough.
On examination there is bilateral digital clubbing and fine end inspiratory crackles on auscultation of the chest.
Chest X ray is normal and spirometry reveals a decreased FEV1, decreased FVC and increased FEV1/FVC ratio.
What specific further investigation would be diagnostic?
high resolution lung CT
180
180
Staghorn calculi are typically formed when there is the presence of certain pathogenic bacteria.
Which enzyme, produced by these bacteria, is responsible for the formation of staghorn calculi?
urease
181
What is the second most common type of non small cell lung cancer in the UK?
squamous
182
A histopathologist reviews a microscopy slide taken from a prostate biopsy. She reports the cell populations as follows:
Grade 1: 25% of cells in sample
Grade 2: 30% of cells in sample
Grade 3: 11% of cells in sample
Grade 4: 33% of cells in sample
Grade 5: 1% of cells in sample
What is the overall Gleason Grade for this tumour?
4+2 = 6
| add 2 most common ones
183
What is the most common paraneoplastic syndrome associated with Small Cell Lung Cancer?
SIADH
184
What type of fluid motion causes high wall sheer stress on vascular endothelia and hence is protective against atherosclerosis?
laminar flow
185
A histopathologist reviews a microscopy slide taken from a prostate biopsy. She reports the cell populations as follows:
Grade 1: 100% of cells in sample
Grade 2: 0% of cells in sample
Grade 3: 0% of cells in sample
Grade 4: 0% of cells in sample
Grade 5: 0% of cells in sample
What is the overall Gleason Grade for this tumour?
1+1 = 2
186
What is the most appropriate treatment for non-small cell lung cancer that is present in both lungs?
palliative care
187
Where in blood vessels is turbulent blood flow most likely to occur?
Vessel bifurcations
188
What is the strongest risk factor for developing small cell lung cancer?
smoking
189
A 22 year old man with a past medical history of ADHD describes a 3 day history of fever and productive cough of green sputum.
He feels generally unwell.
Clinical examination reveals coarse crepitations with bronchial breathing in the left mid zone.
A chest x ray reveals the presence of consolidation in the left mid zone.
What is the diagnosis?
pneumonia
190
the higher the gleason score?
the worse the prognosis.
8= high grade
191
What hormone is produced by small cell lung cancer and is responsible for paraneoplastic Cushing's Syndrome?
ACTH
192
What malignancy is Lambert Eaton Myasthenic Syndrome associated with?
small cell lung cancer
193
What is the first line treatment for non small cell lung cancer?
surgery
194
A 74 year old gentleman is found to have persistent ST elevation following a STEMI 2 weeks prior. He has no ongoing chest pain and his primary disease was stented.
What is the most appropriate investigation to identify the cause of the persistent ST elevation?
ECHO
