Past Paper Questions Flashcards
1
Q
Conn’s like picture ( low k, high na), but with markedly raised renin?
A
Renal Artery Stenosis
2
Q
A patient presents with both low urine and serum sodium?
A
Psychogenic Polydipsia
3
Q
Which enzyme would be raised in a patient who has been taking cocaine?
A
AST
4
Q
List three indications for dialysis.
A
Refractory Hyperkalaemia
Metabolic Acidosis
Uraemic Encepalopathy
5
Q
Low calcium, high PTH
A
Osteomalacia (Vitamin D deficiency)
6
Q
High Calcium, Low PTH
A
Bone metastases
7
Q
High Calcium, High PTH
A
Hyperparathyroidism
8
Q
Low Calcium, Low PTH
A
Hypoparathyroidism
9
Q
Normal calcium, normal pth
A
Osteoporosis
10
Q
Which enzyme is the rate limiting step in the haem biosynthesis pathway?
A
ALA synthase
11
Q
How do you calculate anion gap?
A
Na + K - Cl - Bicarb
12
Q
How do you calculate plasma osmolality?
A
2(Na+K) + urea + glucose
13
Q
Vitamin deficiency defined by dermatitis, diarrhoea and mental disturbance
A
Pellagra (B3, Niacin)
14
Q
Isolated rise in unconjugated bilirubin with all other parameters normal
A
Gilbert’s
15
Q
Which enzyme works to 30% capacity in Gilbert’s?
A
UDP glucorynyl transferase
16
Q
Raised ALT, ALP, GGT in a young patient with a short history of coryzal symptoms and jaundice
A
Viral Hepatitis
17
Q
High ALT, GGT, low Albumin, signs of chronic liver disease including haematemesis, spider naevi, dupuytren’s contracture and gynaecomastia
A
Cirrhosis
18
Q
Which enzyme is raised in Mumps?
A
Amylase - S
19
Q
Which enzyme is raised in Vitamin D deficiency?
A
ALP
20
Q
Which enzyme is raised in rhabdomyolysis?
A
Creatine Kinase
21
Q
What may be deficient in a child with frontal bossing, bowed legs, cupping of metaphysis and widened epiphyses on x ray?
A
Vitamin D
22
Q
Which enzyme manufactures monosodium urate, the substance implicated in gout?
A
Xanthine Oxidase
23
Q
Which drugs may be used in an acute attack of gout?
A
Cochicine
NSAIDs
Steroids
24
Q
Patient presents with diabetes, steatorrhoea, weight loss, slate grey skin and joint pains. What is causing this?
A
Haemochromatosis
25
Which enzyme would you use to confirm cardiac failure?
Brain Natriuretic Peptide
26
Which liver enzyme may be raised in acute Myocardial infarction?
Aspartate aminotransferase
27
Which substance may cause dark urine in a patient suffering from rhabdomyolysis?
Myoglobin
28
What does the drug Denosumab target?
RANK Ligand
29
Which drug may be used to treat osteoporosis, bone metastases or Giant cell tumours of the bone?
Denosumab, a RANK Ligand targeting monoclonal antibody
30
Pt presents with hyperthyroidism, but a technetium scan shows low to no uptake. What is the likely diagnosis?
De Quervain's Thyroiditis
31
What would you test if a patient was found to have a Low K, but High Na, and why?
Renin, as high renin may indicate renal artery stenosis, whilst low renin may indicate Conn's Syndrome
32
Which substance does Evolucumab, a PCSK9 inhibitor halve?
LDL
33
Which molecule binds cholesterol for transport to the liver/other steroidogenesis organs?
HDL
34
Which hormone stimulates prolactin release?
TRH
35
Which ion abnormality may be attributed to erythrocyte haemolysis?
Potassium
36
What must be tested for if factitious hypoglycaemia is suspected, but C-peptide levels are normal?
Sulfonylureas
37
Describe the metabolic disturbance that may be seen in a neonate with congenital adrenal hyperplasia
Hyponatraemia
Hyperkalaemia
Hypovolaemia
38
Which medication would have to be stopped if a patient is prescribed allopurinol?
Azathioprine
39
Which sign is commonly seen on examination of a patient with portal hypertension?
Splenomegaly
40
Which test would be used to confirm a diagnosis of Cushing's Syndrome?
High Dose Dexamethasone Suppression test
41
What does the number of true positives divided by the total of cases represent?
Sensitivity
42
Which ion is likely to be deranged in an alkalotic patient?
Potassium
43
How is response to therapy monitored in Polycythaemia?
Haematocrit
44
Which test is used to detect Beta Thalassaemia?
High performance liquid chromatography
45
A patient feels itchy after a transfusion. This calms down after taking an anti-histamine. What is the most likely diagnosis?
Allergic Reaction
46
A man requires a tranfusion after a traffic collision, and 2 hours later becomes breathless, feverish and tachycardic. What is the most likely diagnosis?
Transfusion-associated lung injury
47
A patient with thalassaemia presents with malaise and erectile dysfunction. What is the most likely diagnosis?
Transfusion-related haemosiderosis
48
A lady who undergoes regular transfusions for myelodysplastic syndrome becomes tachycardic, has site pain and is hypotensive 10 minutes after her latest transfusion. What is the most likely diagnosis?
ABO incompatability
49
An alcoholic undergoes a transfusion during surgery for repair of an Aortic Aneurysm. 2 Days later he develops a fever, becomes anaemic and jaundiced. What is the likely diagnosis?
Delayed haemolytic transfusion reaction
50
A women undergoes surgery after a placental abruption, and is found to have low fibrinogen and prolonged APTT and PT. What is the most likely cause?
Disseminated Intravascular Coagulation
51
A woman presents in the first trimester with significant thrombocytopaenia. What is the most likely cause?
ITP
52
A woman presents in the third trimester with a slightly reduced platelet count. What is the most likely cause?
Gestational Thrombocytopaenia
53
How would you manage renal failure in a patient with Myeloma?
Haemodialysis
54
How would you manage spinal cord compression in a patient with myeloma?
Radiotherapy
55
How would you prevent pathological bone fractures in a patient with myeloma?
Bisphosphonates
56
How would you manage hyperviscosity in a patient with myeloma?
Plasmapheresis
57
How would you manage hypercalcaemia in a patient with myeloma?
Bisphosphonates
58
What would you monitor in a patient on long-term unfractionated heparin?
aPTT
59
A man has spherocytes, polychromasia and reticulocytosis on blood film, what is the most likely diagnosis?
Hereditary Spherocytosis
60
A patient experiences a haemolytic anaemia after undergoing antimalarial treatment. What is the most likely diagnosis?
G6PD Deficiency
61
A patient presents with high IgG paraprotein, back pain and loss of sensation down her legs. What is the most likely diagnosis?
Multiple Myeloma
62
A patient presents with high IgM paraprotein and visual disturbances. What is the most likely diagnosis?
Lymphoplasmacytic Lymphoma (Waldenstrom's Macroglobulinaemia)
63
An asymptomatic patient presents with low neutrophils, but normal blood film. What is the most likely diagnosis?
Chronic idiopathic neutropenia
64
A man is found to have pancytopenia and immature myeloid cells on blood film. What is the most likely diagnosis?
Acute Myeloid Leukaemia
65
A patient presents with longstanding bone and back pain. He has a high paraprotein IgA and a low GFR. FBC and albumin are both normal. What is the most likely diagnosis?
Multiple Myeloma
66
Which haematological complication may occur as a result of amniotic fluid embolism?
Disseminated Intravascular Coagulation
67
How should you manage a patient who becomes pregnant whilst on life-long DOAC treatment?
Switch to LMWH
68
What may cause neonatal thrombocytopaenia?
Maternal idiopathic thrombocytopaenia purpura
69
What would be the most likely diagnosis if you saw Smear Cells on a blood film?
CLL
70
How much more likely are males to experience a recurrence of a VTE?
3x
71
What type of hypersensitivity reaction is Myasthenia Gravis?
Type II
72
When would you test for direct antiglobulins as opposed to osmotic fragility in a patient with a haemolytic anaemia?
When there are indications to suggest it may be autoimmune, such as pre-existing diagnoses (SLE etc.)
73
Which viruses are screened for in platelet donations intended for pregnant women?
HIV
HBV
Cytomegalovirus
74
What does Chimeric receptor T-Cell Therapy against CD19 target?
B Cell Lymphoma/Leukaemia
75
A patient presents with low WCC, thrombocytopaenia and tear drop poikilocytes on blood film. What is the most likely diagnosis?
Myelofibrosis
76
Which cancer is HTLV1 virus associated with?
Adult T Cell Lymphoma
77
Which test would be used to diagnose hereditary spherocytosis after seeing spherocytes on blood film?
Eosin-5'-maleimide dye test
78
Which investigation would be important to carry out in an elderly patient with an iron deficiency anaemia?
OGD
79
What is the minimum length of time needed for treatment of a VTE?
3 Months
80
Which cell type does Rituximab target?
B Cells
81
Which coagulation factor decreases first upon administration of warfarin?
Factor VII
82
How does Myeloma cause cardiomyopathy?
Amyloid deposition
83
Which mutation is commonly implicated in Polycythaemia and myelodysplastic diseases?
JAK2 V617F
84
What may cause a non-autoimmune haemolytic anaemia?
MAHA
Valve-associated haemolysis
Sickle Cell Anaemia
85
How do proteasome inhibitors, such as Bortezomib, work?
Inhibited protein degradation leads to amino acid build up, shortage and cell death
86
Which agent is the first line treatment for CML?
Imatinib
87
Describe the mechanism of action of Imatinib.
BCR-ABL Tyrosine Kinase Inhibitor
88
What is the most likely diagnosis in a man found to have a high haematocrit on a background of chronic heart disease? He is negative for JAK2 mutations.
Secondary Polycythaemia
89
What is the first line treatment for a patient with CLL and a confirmed p53 mutation?
Ibrutininb, a Bruton Tyrosine Kinase inhibitor
90
What is the mechanism behind hyperacute allograft rejection?
Pre-formed antibodies attack the graft
91
Which coagulation factor is most commonly low in pregnancy?
Protein S
92
What is the likely diagnosis and trigger in a sickle cell patient presenting with low reticulocytes, a severe anaemia and no splenomegaly?
Aplastic crisis triggered by Parvovirus B19
93
What is targeted in graft vs host disease?
HLA
94
Which cells does Pembrolizumab target?
T Cells, targets antiPD-1
95
Which molecule is expressed by vessel walls in their resting state, and has anti-thrombotic activity?
Thrombomodulin
96
Which antibody may be positive in a patient with Autoimmune hypothyroidism?
Anti-Thyroglobulin
97
Which antibody may be positive in a patient with Sjogren's Syndrome?
Anti-Ro Anti-La
98
Which antibody may be positive in a patient with Myasthenia Gravis?
Anti-Acetylcholine Receptor
99
Which antibody may be positive in a patient presenting with Calcinosis, Raynaud's, Esophageal Dysmotility, Sclerodactyly and telangiectasia?
Anti-Centromere
100
What is the first line biological treatment for Ankylosing Spondylitis?
Anti-TNF Alpha
| Etanercept, Adalimumab, Infliximab
101
What is the treatment for resistant psoriasis?
Anti-TNF alpha
| Etanercept, Adalimumab, Infliximab
102
What is the treatment for chronic granulomatous disease?
IFN-Gamma
103
Which cells are FOXP3 +ve and mature in the Thymus?
T regulatory Cells
| CD4+ve
104
Which immune cell detects antigens peripherally, and moves to the lymph nodes for presentation?
Dendritic Cells
105
Which immune cell detects inactivated MHC1 and kills virus infected cells and cancer cells?
Natural Killer Cells
106
Which immune cells are targeted by HIV?
Memory CD4+
107
Which antibodies might be positive in a patient with polymyositis, presenting with aches and joint stiffness all over?
Anti-Jo1
108
What would be the most likely diagnosis in a teenage girl who develops an erythematous rash after running in winter?
Cold urticaria
109
What would be the likely diagnosis in a man who gets swollen lips when eating fresh apples, but is able to eat apple pie with no problem?
Oral food allergy
110
A patient presents with recurrent infections. They are found to have reduced total serum protein, and an autoimmune thrombocytopaenia. What is the most likely diagnosis?
Common variable immunodeficiency
111
A child presents with recurrent chest infections and has an ongoing ear infection. He is found to have no mature B cells. What is the most likely diagnosis?
Bruton's Agammaglobulinaemia
112
A patient presents with recurrent infections. Both a DHR and Nitrazolium Blue test return negative results. What is the most likely diagnosis?
Chronic Granulomatous Disease
113
A child is found to have no CD4 cells, but CD8 cells and B cells are present. What is the most likely diagnosis?
Bare Lymphocyte Syndrome 2
114
A boy's father has TB. The same boy develops a mycobacterial infection after receiving his BCG vaccine. What is the most likely diagnosis?
IFN-Gamma deficiency.
115
A young boy presents with recurrent infections, and is found to have normal B cells but a complete absence of CD4+ and CD8+ cells. What is the most likely diagnosis?
X-Linked Severe Combined Immunodeficiency.
116
A patient presents with recurrent pneumococcal infections and meningitis. What is the most likely underlying diagnosis?
Complement Deficiency.
117
Name two drugs which may be used in malignant melanoma that target T-Cell Checkpoints.
Ipilimumab
| Nivolumab
118
Name an immune therapy which may be used to treat Lymphoma or Rheumatoid Arthritis.
Rituximab
119
List 2 drugs which may be used to prevent transplant rejection by blocking T cell activation.
Tacrolimus
| Cyclosporin
120
List 2 drugs which may be used to treat NSAID-resistant Ankylosing Spondylitis.
Etanercept
| Infliximab
121
A patient is found to have high lymphocyte numbers with a large spleen and lymph nodes. They also have auto-immune cytopenias, and were treated for a lymphoma in the past. They were found to have a mutation within the FAS pathway of lymphocyte apoptosis. What is the most likely diagnosis?
Auto-Immune lymphoproliferative syndrome (ALPS)
122
A patient presents with periodic fevers, abdominal pain and chest pain. They were found to have a mutation in the MEFV gene. What is the most likely diagnosis?
Familial Mediterranean Fever
123
A patient was found to have mutations in their NOD2 and CARD15 genes. Which condition are they most likely to suffer from?
Crohn's Disease
124
Which HLA is Ankylosing Spondylitis associated with?
HLA-B27
125
A child presents with an IgE-mediated rash on their extensor surfaces. What is the most likely diagnosis?
Atopic Dermatitis/Eczema
126
A patient is found to be positive for anti-endomysial antibodies. Which condition are they most likely to suffer from?
Coeliac Disease
127
Which virus may lead to the development of post transplantation lymphoproliferative disease?
Ebstein-Barr Virus
128
Which virus may cause progressive multifocal leukoencepalopathy?
John Cunningham Virus
129
What is the mechanism behind graft vs host disease?
Donor white blood cells attack host tissues.
130
Which cell type mediates antibody-mediated rejection?
B Cells
131
Which cell type mediates cellular graft rejection?
T Cells
132
Which receptor mutation may be protective in HIV?
CCR5
133
Which cell type is affected by Immune Dysregulation, Polyendocrinopathy, Enteropathy (IPEX)?
Regulatory T Cells
134
A patient presents with pleuritic chest pain and joint pain and is found to have a raised ESR and positive Anti nuclear, anti smooth-muscle and anti double stranded dna antibodies. What is the most likely diagnosis?
Systemic Lupus Erythematosus
135
What type of malignancy does Chimeric antigen receptor T-Cell therapy against CD19 target?
Acute Lymphoblastic Leukaemia
136
A child presents with hypocalcaemia, cleft palate, low-set ears and a low T-Cell count. What is the most likely diagnosis?
DiGeorge Syndrome
137
Which molecule may be targeted in a patient with Ankylosing Spondylitis who didn't respond to NSAIDs or Anti-TNF alpha agents?
IL-17
138
A woman with a normal FBC and a history of autoimmune disease is found to have low IgM, IgA and IgE levels. What is the most likely diagnosis?
Common variable immunodeficiency
139
A deficiency in which molecule may lead to malabsorption of B12?
Intrinsic factor
140
A patient presents with a microcytic anaemia. Distal Duodenal Biopsy shows crypt hyperplasia and non-caseating granulomas. What is the most likely diagnosis?
Crohn's Disease
141
A patient has a duodenal biopsy, which shows villous atrophy and crypt hyperplasia. What is the most likely diagnosis?
Coeliac Disease
142
Which immunodeficiency is characterised by an issue with common gamma chains?
X-Linked SCID
143
What is the maximum number of HLA mismatches possible?
6
144
A man presents with glomerulonephritis and lung changes. he is found to be c-ANCA positive. What is the most likely diagnosis?
Granulomatosis with Polyangiitis
145
A woman presents with a purple, periorbital rash (heliotrope rash), and a rash on her knees. What is the most likely diagnosis, and which enzyme is likely to be elevated?
Dermatomyositis
| Creatine Kinase
146
What does Nivolumab target?
PD1 on T Cells
147
What type of hypersensitivity causes serum sickness?
Type III
148
What is the effect of the MEFV gene mutation in Familial Mediterranean Fever?
Increased IL-1 production
149
What is the mechanism behind hyperacute allograft rejection?
Preformed antibodies against HLA/ABO
150
List 3 drugs which may be used for prophylaxis against allograft rejection?
Mycophenolate Motefil
Predinsolone
Tacromilus
151
Which natural antibody may confer protective immunity against HIV?
gp120
152
In which disease might you see intraepithelial lymphocytes on biopsy?
Coeliac
153
Which genetic mutation is characteristic for DiGeorge Syndrome?
22q11.2 deletion
154
Describe the pathophysiology of hereditary angioedema.
Acquired C1-inhibitor deficiency
155
Which antiviral agent can be used to treat Cytolomegalovirus retinitis?
Ganciclovir
156
Which antiviral agent may be used to treat Herpes-Simplex Meningitis?
Aciclovir
157
Which antiviral agent may be used to treat Varicella-Zoster infection in an adult?
Aciclovir
158
An asthmatic presents with severe flu. Which antiviral may be useful in their treatment?
Oseltamivir
159
A child with multiple co-morbidities presents with RSV infection. Which antiviral agent may be used?
Ribavarin
160
An HIV patient presents with pneumonia. When walking around the ward, they rapidly desaturate. What is the most likely causative organism?
Pneumocystis jirovecii
161
A girl receiving chemotherapy for leukaemia develops pneumonia. A 'halo sign' is seen on chest x ray. What is the most likely causative organism?
Aspergillus fumigatus
162
A patient presents with a lower lobe pneumonia and is coughing up rusty coloured sputum, what is the most likely causative organism?
Streptococcus pneumoniae
163
An alcoholic presents with pneumonia. On cxr, upper lobe cavitation is seen. What is the most likely causative organism?
Klebsiella Pneumoniae
164
A smoker returns from a trip abroad. He presents with pneumonia, and is also hyponatraemic and confused. What is the most likely causative organism?
Legionella pneumophilia
165
An HIV patient with a low CD4+ count presents with meningitis. What is the most likely causative organism?
Cryptococcus neoformans
166
A water polo player presents with an itchy scaly rash on lateral toe which then moved along the lateral side of their foot. What is the most likely causative organism?
Trichophytum rubrum
167
A lady returns from a holiday in America, where she stayed in Arizona. She presents with systemic symptoms, including a fever. What is the most likely diagnosis and causative organism?
Valley fever
| Coccidioides
168
A man in his 60s with poorly controlled diabetes presents with rapidly progressing periorbital swelling, sinus pain and confusion. Black discharge can be seen in his nasal cavity. What is the likely diagnosis, and causative organism?
Mucormycosis, caused by Rhizopus spp.
169
A man returning from travelling in the middle east presents with a small ulcer on his finger that won't heal and is growing in size. What is the likely diagnosis?
Leishmaniasis
170
A homosexual man presents with a painless oral 'snail trail' ulcer. What is the most likely diagnosis and causative organism?
Primary Syphylis
| Treponema Pallidum
171
A man from Peru presents with fever and bloody diarrhoea. A cyst in the right lobe of his liver is detected on USS. What is the most likely diagnosis?
Entamoeba Histolytica
172
A woman who has just returned from travelling in Asia presents with abdominal pain, headache and constipation. A gram negative rod is later cultured from her blood. What is the most likely diagnosis?
Salmonella typhi
173
Which virus may cause Hydrops Fetalis if caught in the first trimester?
Parvovirus
174
Which virus, if active at >34wks gestation, causes a c-section to be indicated?
HSV
175
Which virus can cause babies to have cataracts, sensironeural deafness, hepatomgely and thrombocytopaenia?
Rubella
176
Which virus, if transmitted antenatally, may be symptomless at first, but may later present with jaundice, rash, hearing loss, development delay and microcephaly?
Cytomegalovirus
177
What is the most common cause of traveller's diarrhoea?
Entero-toxigenic Escherichia Coli
178
A man presents with cramping pain and foul-smelling diarrhoea. He attended a barbeque 5 days prior. What is the likely causative organism?
Campylobacter jejuni
179
A woman develops vomiting a few hours after eating lots of rice. What is the likely diagnosis?
Bacillus cereus
180
A woman has developed watery diarrhoea after recently finishing a course of antibiotics. What is the likely causative organism?
Clostridium difficile
181
Multiple patients on the same ward get diarrhoea. What is the likely causative organism?
Norovirus
182
Which antibiotic may be added to meningitis treatment to cover for Listeria monocytogenes?
Amoxicillin
183
Which antibiotic is first line for Group A Strep pharyngitis?
Benzylpenicilin
184
Which antibiotic is indicated to treat cystitis in a young woman. The causative organism is fully sensitive E coli
Trimethoprim
185
Which antibiotic is used to treat MRSA?
Vancomycin
186
Which antibiotic is used to treat methicillin-sensitive Staphylococcus aureus
Flucloxacilin
187
A student presents with meningitis. The causative organism is found to be a gram negative diplococcus, what is it most likely to be?
Neisseria meningitides
188
A man is found to have meningitis caused by a gram positive diplococcus. What is it most likely to be?
Streptococcus pneumoniae
189
Which organism is a gram negative rod, and may cause sepsis in a neonate?
Escherichia Coli
190
Which organism is a gram negative rod which may cause meningitis in immunocompromised patients?
Listeria monocytogenes
191
Name a beta-lactam antibiotic that may be used for Pseudomonas spp.
Ceftazidime
192
Name a broad spectrum beta-lactam with no pseudomonal activity. it is typically given with a beta lactamase inhibitor
Amoxicillin
193
Name a glycopeptide antibiotic which may be used to treat MRSA.
Vancomycin
194
Name an antibiotic which is a DNA synthesis inhibitor which may be used to treat Pseudomonal infections. It is, however, poor against anaerobes.
Ciprofloxacin
195
Name a macrolide which may be used to treat some atypical pneumonias.
Clarithromycin
196
A woman presents with a UTI. Culture grows gram positive cocci in clusters. What is the most likely causative organism?
Staphylococcus saprophyticus
197
A middle aged man with no medical problems develops septic arthritis. What is the most likely causative organism?
Staphylococcus aureus
198
A teenage rugby player presents with boils. Members of his team, and his family, all have similar boils. What is the most likely causative organism?
Staphylococcus aureus
199
A neonate presents with meningitis. Culture grows a Gram Positive organism in chains. What is the most likely causative organism?
Group B Streptococcus
200
Which virus resides in the pharynx and gastrointestinal tract, causes encephalitis in 1/100, and destruction of motor neurones in 1/1000?
Poliovirus
201
A patient presents with coryzal symptoms and a grey film on the back of his throat. What is the most likely causative organism?
Diptheria
202
Which organism causes lockjaw?
Tetanus
203
Which organism causes cat scratch disease?
Bartonella henselae
204
Which stain is used to confirm infection with acid-fast bacili?
Ziehl-Neelsen
205
What are the 3 characteristics of influenza A that could cause a pandemic?
Novel Antigenicity
Efficient replication in human airways
Efficient Transmission between humans
206
What is the lifetime risk of an immunocompetent person developing active TB after contact with someone with TB?
10%
207
What does it mean if urine MC&S has epithelial cells and mixed bacterial growth?
The sample has not been properly taken.
208
Which antibiotic is used for Salmonella typhi?
Ceftriaxone
209
Which organism causes scarlet fever?
Streptococcus pyogenes
210
What is the most common cause of viral meningitis?
Non polioviruses
| Echo/Coxsackie Viruses
211
Which virus causes Kaposi Sarcoma?
HHV8
212
How does Hepatitis A spread?
Faeco-orally
213
What is the treatment for Pseudomembranous Colitis
Metronidazole
| Vancomycin
214
Which drug is used to treat severe falciparum malaria?
IV Artesunate
215
Name the main class of drugs used to treat HIV
Nucleoside reverse transcriptase inhibitors
216
Which disease is carried by the Ixodes tick?
Borrelia burgdorferi
| Lyme Disease
217
Which test would be most useful in confirming EBV infection in an immunocompetent individual 2 weeks after exposure?
IgM
218
Name a polysaccharide and conjugate vaccine.
Pneumococcal vaccine (Prenevar)
219
What is, overall, the most common cause of cellulitis?
Streptococcus pyogenes
220
Name a vaccine-preventable organism which causes cough, lymph node enlargement and may occlude the airway.
Corynebacterium diptheriae
| Haemophilus influenzae?
221
Which vector transmits Trypanasoma brucei rhodesiense?
Tsetse Fly
222
Which strain of Hepatitis does not lead to chronic infection?
Hepatitis A
223
What is the most common cause of Fever in a returning traveller?
Malaria
224
A man presents with abdominal pain radiating to the back. He then collapses and dies. What is the most likely diagnosis?
Acute Aortic Aneurysm
225
A 60 year old lady with a background of stepwise memory loss and hypertension is hospitalised. What is the most likely cause of her memory decline?
Multiple Cerebral Infarcts (Vascular Dementia)
226
An elderly man with atrial fibrillation presents with new onset right flank pain. What is the most likely diagnosis?
Renal Thrombus
227
What histological finding would be seen in the kidneys in a case of post-streptococcal glomerulonephritis?
Immune Complex Deposition
228
What is the classic renal finding on histology of a patient with Malignant Hypertension?
Fibrinoid Necrosis
229
What would be seen on histology of a patient with pyelonephritis?
Leukocyte casts
230
What finding may be seen on kidney histology of a man with Multiple Myeloma?
Amyloid Deposition
231
A man is found to have a tumour in the head of his pancreas that has invaded into his portal vein. There is a palpable mass in the liver. What is the likely diagnosis?
Adenocarcinoma
232
A man with known H.Pylori infection has a stomach biopsy. An abnormal area is seen in the antrum, with mitotic figures and cells with a raised nuclear to cytoplasmic ratio. The mass is not invading the basement membrane. What is the most likely diagnosis?
B Cell Lymphoma
233
A woman presents with appendicitis. A 5mm tumour is found during removal. What is the most likely histological subtype?
Neuroendocrine Tumour
234
Which cancer develops in Barrett's Oesophagus?
Adenocarcinoma
235
Which process takes place in response to exposure to stomach acid?
Metaplasia
236
What happens to the body of the stomach in a patient with pernicious anaemia?
Chronic Gastritis
| Atrophy
237
Which cancer is associated with H Pylori Infection?
Gastric MALT Lymphoma
238
Which cancer is associated with poorly controlled coeliac disease?
Enteropathy-associated T-cell Lymphoma
239
What is the most common type of malignancy in the breast?
Invasive Ductal Carcinoma
240
Which breast malignancy is also known as 'non-specific type'?
Invasive Ductal Carcinoma
241
Which breast malignancy may be described as a 'Fibro-epithelial Tumour with abundant stromal elements'?
Phyllode's Tumour
242
A man presents with UTI symptoms and costovertebral pain. He has pus cells and blood in his urine. What is the most likely diagnosis?
Acute Pyelonephritis
243
A woman presents with loin-to-groin pain, haematuria and pain at the end of micturition. What is the most likely diagnosis?
Calculi
244
A man presents with painless haematuria and a mass palpable on one side. What is the most likely diagnosis?
Renal Cell Carcinoma
245
An infant has a palpable unilateral abdominal mass when his mother picks him up. What is the most likely diagnosis?
Wilm's Tumour/Nephroblastoma
246
A man presents with a pancreatic mass following an episode of acute pancreatitis. What is the most likely diagnosis?
Pancreatic Pseudocyst
247
A patient presents with severe abdominal pain, and undergoes a cholecystectomy. During the procedure, the surgeons notice grey specks around the pancreas. What is the most likely diagnosis?
Ductal Adenocarcinoma
248
Which pancreatic tumour most classically metastasises to the liver?
Ductal Adenocarcinoma
249
A patient presents with a pancreatic mass and hypoglycaemia. What is the most likely diagnosis?
Insulinoma
250
On histology of a kidney mass, it is noted that it extends into the renal vessels and into the perinephric fat. What is the most likely diagnosis?
Angiomyolipoma
251
A patient presents with a craggy, enlarged, uneven prostate. What is the most likely diagnosis?
Adenocarcinoma
252
Which testicular cancer is radiosensitive, and typically has a white/smooth appearance?
Seminoma
253
Which cancer is associated with schistosomiasis?
Squamous Cell Carcinoma of the bladder
254
A young man presents with a lytic lesion in the diaphysis of his leg. Night pains are relieved by aspirin. What is the most likely diagnosis?
Osteoid Osteoma
255
A man goes deaf, and on examination is noted to have bowed legs. What is the most likely diagnosis?
Paget's Disease
256
A patient presents with a sudden onset severe headache, and shows signs of meningism. What is the most likely diagnosis?
Subarachnoid Haemorrhage
257
A patient with HIV presents with signs of raised ICP and new onset epilepsy. What is the most likely diagnosis?
Primary CNS Lymphoma
258
A woman presents with an eczematous nipple rash caused by 'individual malignant cells' What is the most likely diagnosis?
Paget's Disease of the Breast
259
How many cusps does the pulmonary valve typically have?
3
260
What is the most common cause of Acute Pancreatitis?
Gallstones
261
Which cancer typically causes an increase in Calcitonin?
Medullary Thyroid Carcinoma
262
Which thyroid cancer most commonly metastasises to the lymph nodes?
Papillary
263
How do you distinguish between PBC and PSC?
```
PBC = Intrahepatic only, F>M, Anti-mitcohondrial
PSC = Extra/Intrahepatic, M>F, p-ANCA
```
264
A young man falls and hits his head. 2 days later he loses consciousness. What is the most likely diagnosis?
Subdural Haemorrhage
265
An ovarian mass is found in a Japanese woman. Histology shows signet ring cells. What is the most likely diagnosis?
Krukenberg Tumour
266
Which liver change characteristically occurs in diabetic patients?
Non-alcoholic fatty liver disease
267
A teenage boy presents with ataxia. Imaging shows a brain tumour extending outwards from the cerebellum and invading the subarachnoid space. What is the most likely type?
Medulloblastoma
268
What is the most common type of oesophageal cancer in the UK?
Adenocarcinoma
269
What is the most common type of oesophageal cancer worldwide?
Squamous Cell Carcinoma
270
What is the most common type of gastric cancer?
Adenocarcinoma
271
A biopsy of a cancerous lesion shows large amounts of keratin and intercellular bridges, what type of cancer is this?
Squamous Cell Carcinoma
272
Which disease is seen in MEN 1 and 2a?
Parathyroid Hyperplasia
273
What would happen to free fatty acid levels in a patient with an Insulinoma?
Low
274
What procedure is performed for urgent diagnosis of a specimen during sugery?
Intra-operative Frozen Section
275
A man with a history of Polycystic Kidney Disease has a cerebral haemorrhage. Which type is it most likely to be?
Subarachnoid Haemorrhage
276
A non-smoker presents with a peripheral lung tumour. What is it most likely to be?
Adenocarcinoma
277
Which condition causes hypertension limited to the upper half of the body?
Coarctation of the aorta
278
A man presents with a midshaft femur fracture without a serious history of trauma. What may have caused this?
Chondrosarcoma
279
A middle aged lady has a liver biopsy. It shows loss of bile ducts and the presence of granulomas. What is the most likely diagnosis?
Primary Biliary Cholangitis
280
Which electrolyte abnormality might be seen in a patient with pseudomembranous colitis?
Hypovolaemic Hyponatraemia
281
A man with a recent history of head trauma presents with raised sodium, raised plasma osmolality and low urine osmolality. What is the likely diagnosis?
Cranial Diabetes Insipidus
282
Which test, when raised, may be useful in diagnosis of Giant Cell Arteritis?
ESR
283
How are ACTH levels measured?
Inferior Petrosal Sinus Sampling
284
A patient presents with hyperuricaemia. Name one enzyme which they may be deficient in.
HGPRT
285
List two signs which may be seen on x-ray of a patient with Rickets.
Widened Epiphyses
| Metaphysis Cupping
286
What is the most common cause of congenital adrenal hyperplasia?
21-Hydroxylase Deficiency
287
Which hormones would be high in 21-Hydroxylase Deficiency?
Sex Steroid Hormones
| ACTH
288
What would you prescribe a patient post-removal of a pituitary adenoma?
Desmopressin (DDAVP)
289
How are relations ranked with regards to giving consent for autopsy according to the Human Tissue Act?
```
Spouse
Parent/Child
Sibling
Grand-relation
Niece/Nephew
Stepparent
Half-Sibling
Friend
```
