PATH 2020 Flashcards
(153 cards)
1
Q
- An old lady has fatigue. She is pale with slight tachycardia. Hb is low, WBC is low, platelets are low, MCV is high. LAMI. No polychromasia present. Rank the following in order of likelihood, with (1) being the most likely and (5) being the least likely
- Aplastic anaemia
- Vitamin B12 deficiency
- ITP
- CLL
- Myelodysplastic syndrome
A
MDS
Aplastic anaemia
B12 deficiency
CLL
ITP
2
Q
- Rank the following in order of reticulocyte count, with (1) being the highest and (5) being the lowest
a. Occult GI blood loss
b. ITP
c. Anaemia due to low dose oral myelosuppressive chemotherapy
d. Severe aplastic anaemia
e. Hereditary spherocytosis
A
Hereditary spherocytosis
Occult GI blood loss
ITP
Anaemia due to low dose oral myelosuppressive chemotherapy
Severe aplastic anaemia
2
Q
- Rank cancers as cause of death in UK men according to frequency with
(1) being the most common
a. Lung
b. Colon
c. Head and Neck
d. Breast
e. Prostate
A
Lung
Prostate
Colon
Head and Neck
Breast
3
Q
- Rank the following stages of oesophageal adenocarcinoma progression in chronological order
a. Reactive
b. Metaplasia
c. Low grade dysplasia
d. High grade dysplasia
e. Adenocarcinoma
A
Reactive
Metaplasia
Low grade dysplasia
High grade dysplasia
Adenocarcinoma
4
Q
- Woman has acute SOB. PMHx includes hypertension and T2D. Her medication is metformin, atorvastatin, amlodipine. Blood pressure was high. She had a third heart sound, no murmurs, and bibasal crackles. Blood tests - sodium was normal, potassium was 3.5, urea was high, creatinine was high. Rank diagnosis with (1) being most likely.
a. Cushing’s syndrome
b. Phaeochromocytoma
c. Conn’s syndrome
d. Addison’s disease
e. Essential hypertension
A
essential hypertension
conns
cushings
phaechromocytoma
addisons disease
5
Q
Rank in order of potency at reducing LDL with (1) being the most potent
a. Evolocumab
b. Simvastatin
c. Atorvastatin
d. Bezafibrate
e. Prednisolone
A
evolocumab
atorvastatin
simvastatin
bezafibrate
prednisolone
6
Q
Woman has dry mouth, severe dryness that affects her eyes. Also fatigue and arthralgia of hand.
Blood test - normal urate, high ESR, high IgG, high rheumatoid factor, normal anti-CCP antibody, ANA is high and has a speckled pattern. Rank with (1) being most likely
a. Rheumatoid arthritis
b. Osteoarthritis and keratoconjunctivitis sicca
c. Gout
d. Primary sjogren’s syndrome
e. Osteogenesis imperfecta
A
d) Primary sjogren’s syndrome
Rheumatoid arthritis
b) Osteoarthritis and keratoconjunctivitis sicca
c) Gout
e) Osteogenesis imperfecta
7
Q
- A young female presents with mild SLE. Rank the results of investigations in order of likelihood in this patient, with (1) being most likely
a. Positive anti-dsDNA
b. Positive ANA
c. Low C3
d. Absent IgG
e. Positive C3 nephritic factor
A
b) Positive ANA
a) Positive anti-dsDNA
c) Low C3
e) Positive C3 nephritic factor
d) Absent IgG
8
Q
- Young woman with dysuria, urinary frequency and suprapubic pain. Rank organisms with (1) being most likely
a. Escherichia coli
b. Staph saprophyticus
c. Proteus mirabilis
d. Candida albicans
e. Acinetobacter baumanii
A
a. Escherichia coli
b. Staph saprophyticus
c. Proteus mirabilis
d. Candida albicans
e. Acinetobacter baumanii
9
Q
- A neonate presents at 36 hours of life with meningitis signs. Rank the organisms with (1) being most likely
a. GBS
b. E. coli
c. Listeria
d. Pseudomonas
e. Cryptococcus
A
Gbs
E coli
Listeria
Pseudomonas
cryptococcus
10
Q
- Middle aged man has pruritus, and has an emergency thrombotic cerebrovascular accident. He has a high Hb, and JAK2 V617F mutation. What is the likely diagnosis?
A
Polycythaemia Rubra Vera
11
Q
- Fatigue and mild jaundice, has spherocytes on blood film. Coombs test positive. Likely diagnosis?
A
Autoimmune Haemolytic Anaemia
12
Q
- Which coagulation factor falls most rapidly after starting warfarin?
A
VII
13
Q
- Young woman requires therapeutic anticoagulation during the 1st trimester of pregnancy. Which anticoagulant should be given?
A
LMWH
14
Q
- Imatinib is used for what leukaemia?
A
CML
15
Q
- Man has fatigue and back pain. Blood results show - high creatinine, low IgG, low IgM, no paraprotein detected (via electrophoresis), low serum kappa light chains, high lamda light chains, low kappa/lamda ratio. What is the likely diagnosis?
A
Multiple Myeloma
16
Q
- Woman has chest pain, SOB, persistent swelling in neck. Large mass in supraclavicular fossa is biopsied - malignant cells with reactive fibrosis and high eosinophils [exact pictures below were included in question]. What is the likely diagnosis?
A
Hodgkins
17
Q
- Pregnant women given misoprostol to induce labour. She suddenly has severe shivers, clammy skin, vomiting. Observations - high HR, low BP. Blood results - INR of 1.9, high APTT, , high D-dimers. What is the most likely obstetric event?
A
amniotic fluid embolism
18
Q
- At what temperature can platelet transfusions be stored?
A
22 degrees
19
Q
- Pregnant women has amniocentesis, she is group O-ve. What therapeutic intervention is required?
A
Anti-D prophylaxis
20
Q
- Woman is group A-ve. She has had two previous pregnancies. What naturally occurring antibody will be present in her blood?
A
Anti-B
21
Q
Infants with sickle cell disease (HbSS) may have splenic sequestration Why malignant cells with reactive fibrosis and high eosinophils does this not occur before 3 months of age?
A
HbF present
22
Q
- Venetoclax is a BCL2 inhibitor used in CLL. What cellular process does it affect?
A
Apoptosis
23
Q
- Old woman with painless lymphadenopathy. Blood results - normal Hb, normal neutrophils, normal platelets, high lymphocytes. Smear cells present. Lymphocytes are CD5+ve and CD19+ve.
A
CLL
24
25. Man has returned from India. Whilst abroad, he has malaise and jaundice which self-resolved. He now has fatigue and easy bruising. Blood results - low Hb, normal MCV, low reticulocytes, low WCC, low neutrophils, normal lymphocytes, low platelets. What is the likely diagnosis?
dengue
aplastic anaemia secondary to hepatitis
25
26. Commonest primary tumour of the heart?
Myxoma
26
28. Commonest histological type of primary malignant breast cancer?
Invasive Ductal Carcinoma
27
31. What is the commonest cause of constrictive pericarditis in the developing world?
tb
28
32. What is the most common cause of nephrotic syndrome in adults that is a glomerular pathology?
membranous nephropathy
29
33. What is the commonest cause of portal vein thrombosis?
Liver cirrhosis
30
34. Which organism that causes pneumonia and bloody sputum that is associated with alcoholics and diabetics?
Klebsiella Pneumoniae
31
35. A dysgerminoma is a type of tumour that affects the ovary. What is the equivalent tumour type in the testes?
Seminoma
32
36. What is the most common histological type of oesophageal cancer in the UK?
Oesophageal Adenocarcinoma
33
37. Intestinal metaplasia in Barrett’s (columnar-lined) oesophagus is most commonly due to the presence of which cell?
Goblet Cells
34
38. Which vascular tumour is associated with infection by HHV8 ?
Kaposi Sarcoma
35
39. What is the commonest cause of myocarditis?
viral infection
36
40. Raised AMA antibodies are characteristic of which liver disease?
Primary Biliary Cirrhosis
37
41. Which virus characteristically causes encephalitis involving the temporal lobes?
Herpes Simplex Virus 1
38
42. What is the most common cause of hypocalcaemia in the community?
Vitamin D deficiency
39
43. Which liver enzyme can be measured in the blood and specifically suggests obstructive jaundice if levels are raised?
ALP
40
44. Addison’s patient is admitted in adrenal crisis. Her BP is low. What fluid should be given?
0.9% Sodium Chloride
41
45. Which adrenal zone produces cortisol?
Zona Fasciculata
42
46. Woman has neck pain, which radiates to the upper neck and jaw. Pain is worse on swallowing. She has PMHx of URTI two weeks ago. Investigations - high T4, high T3, low TSH. Technetium scanning of thyroid shows low uptake. What is the likely cause of hyperthyroidism?
De Quervain’s thyroiditis
43
47. What condition occurs in both MEN1 and MEN2a?
primary hyperPTH
44
48. What enzyme does allopurinol inhibit?
45
49. What vitamin deficiency causes pellagra?
B3
46
50. Which hormone increases urinary phosphate excretion?
PTH
47
51. Alcoholic has severe abdominal pain, rigid abdomen - he has acute pancreatitis. What blood test will confirm the diagnosis?
Lipase
48
52. What active enzyme in sarcoidosis patients causes hypercalcaemia
1 alpha hydroxylase
49
53. What is the commonest cause of hypercalcaemia in the community?
Primary Hyperparathyroidism
50
54. What hormone is produced by fat cells, and has receptors in the hypothalamus?
Leptin
51
55. Deficiency of which plasma protein occurs in patients with liver disease and a movement disorder?
Caeruloplasmin
52
56. Patient has hypertension. Blood results - normal sodium, low potassium, normal urea, normal creatinine, raised aldosterone, renin suppressed. What is the diagnosis?
Conns
53
57. What is the name for a fully differentiated B-cell that produces antibody?
Plasma cell
54
58. What condition involves the upper and lower airways and kidneys, and is ANCA positive with cytoplasmic staining and is specific for proteinase 3?
Wegener’s granulomatosis
55
59. Which condition is caused by reactivation of human polyoma virus 2 (John Cunningham (JC) virus) in immunosuppressed people?
Progressive multifocal leukoencephalopathy
56
60. Which drug should be given as an immediate IM injection to an individual presenting with acute anaphylaxis?
IM adrenaline 1:1000
56
61. Patient has periodic fevers and is found to have a mutation in MEFV. What is the condition?
Familial Mediterranean fever
57
62. A woman has Graves’ disease. What antibody should be tested?
Anti TSH receptor antibody
58
63. Doctors should measure the level/activity of which enzyme before prescribing azathioprine?
TPMT: thiopurine methyltransferase
59
64. Child with recurrent bacterial and fungal infections. A dihydrorhodamine test shows that neutrophils fail to oxidise dihydrorhodamine. What is the likely diagnosis?
Chronic Granulomatous disease
60
65. Which isotype of antibody is involved in allergies to food and insect venom?
IgE
61
a. 5 month baby has failure to thrive and recurrent infections. Investigations - mutation affecting IL2RG gene, which encdoes IL2 common gamma chain. What is the diagnosis?
X-linked SCID
62
a. CAR T-cells are engineered to bind to CD19. They have immunoglobulin variable fragments to CD19 linked to cytoplasmic T-cell activation domains.
They are effective in treating haem malignancies of which cell type?
B cell
63
67. In bare lymphocyte syndrome which affects the HLA class II transactivator, which type of immune cell will be deficient?
CD4
64
68. Mutation of CD40 ligand is associated with which form of primary immunodeficiency?
Hyper IgM
65
69. Denosumab is a monoclonal antibody specific for RANKL. What condition is it used to treat?
osteoporosis
66
70. Woman with iron deficiency anaemia is found to have IgA antibodies specific for tissue transglutaminase. What is the underlying condition?
Coeliac disease
67
71. Which class of antibiotics has concentration dependent killing (i.e. the goal of therapy is to maximise peak > MIC)
aminoglycosides
68
72. Man has recently returned from trip to India, has high fever and abdominal pain but no diarrhoea. His blood cultures - gram-ve bacilli. Malaria rapid diagnostic test is -ve. What is the most appropriate antibiotic therapy?
ceftriaxone
69
73. What feature of the MMR vaccine makes it contra-indicated in pregnancy?
Live attenuated vaccine
70
74. Elderly woman has 24 hour history of headache, confusion, photophobia, fever. Gram stain of CSF shows gram+ve rods. What is the causative organism?
Listeria Monocytogenes
71
75. Which human herpes virus is associated with post transplant lymphoproliferative disorder
Epstein-Barr Virus
72
76. This vaccine preventable disease causes headache, fever, parotid swelling (unilateral or bilateral). Complications include epididymo-orchitis in postpubertal males and more rarely meningitis. What is the causative organism?
mumps
73
Woman has hot, swollen and painful left knee. Gram stain of joint aspirate - gram +ve cocci in clusters. Patient has no drug allergies and MRSA screen is -ve. What narrow spectrum antibiotic is indicated?
flucloxacillin
74
78. Elderly woman has type 6 stool which is green and mucoid. She is on the 6th day of IV ceftriaxone. What is the likely causative organism?
clostridium difficile
75
Patient receiving chemotherapy for leukaemia. She has prolonged neutropenia and ongoing fever, raised inflammatory markers despite broad antibacterial therapy with meropenem and amikacin. CT scan shows multiple nodules with surrounding hypo-attenuation (halo sign). What is the most likely organism?
Aspergillus fumigatus
76
80. Young woman has severe headache, neck stiffness, fever. She is HIV+ve but is poorly compliant with medication, does not attend her appointments. She has yeasts in her CSF. What is the causative organism?
cryptococcus neoformans
77
81. Aid worker returns from camp in Yemen. He has profuse watery diarrhoea, which looks like water rice has been cooked in. He is very dehydrated. What is the likely cause of his diarrhoea?
vibrio cholera
78
82. Infection with which virus in the first 20 weeks of pregnancy causes hydrops fetalis?
parvovirus b19
79
83. Poorly controlled person with T2DM has headache, sinus pain, periorbital oedema and orbital cellulitis. His symptoms have progressed rapidly. He has purulent discharge from his nose. ENT surgeons bring him to theatre as an emergency. What antifungal therapy should be started ASAP?
amphotericin B
80
84. 4 year old goes on school trip to petting farm, later has bloody diarrhoea and HUS. What is the causative organism?
E.coli 0157
81
85. Young man has headache, neck stiffness and photophobia. He was not confused, did not have features of encephalitis. HSV1 was detected on PCR of CSF obtained from LP. What antiviral should be given?
Aciclovir
82
87. What is the cause of beta-thalassaemia major?
a. Decreased production of alpha-globin chains
b. Decreased production of beta-globin chains
c. Decreased production of gamma-globin chains
d. Increased production of alpha-globin chains
e. Increased production of beta-globin chains
Decreased production of beta-globin chains
83
88. Elderly woman has fever and productive cough in GP. She has pleural rub. Spleen is not palpable, no lymphadenopathy. Her WBC is 15x10^9 with neutrophilia. The Hb concentration is slightly low and platelet count is normal. Blood film - toxic granulation, left shift. CRP is high. What is the diagnosis?
a. AML
b. Aplastic anaemia
c. CML
d. Infectious mononucleosis
e. Reactive neutrophilia
Reactive neutrophilia
84
89. Bleeding patient has prolonged APTT and PT, but normal platelet count and normal fibrinogen. What is the most suitable blood component for treatment?
a. Albumin
b. Anti-D
c. Cryoprecipitate
d. Fresh frozen plasma
e. Platelets
FFP
85
90. Young girl has pains in her legs, and miserable for past few weeks. She is pale, has several bruises and generalised lymphadenopathy with nodes up to 2cm diameter. Investigations - low Hb, normal MCV, high WCC, low platelets. Blood film shows 80% blast cells. What is the diagnosis?
a. ALL
b. AML
c. CLL
d. CML
e. Infectious mononucleosis
ALL
86
91. 55 year old male smoker, on long term frusemide. Investigations - high Hb, high Hct, normal red cell mass. Plasma volume is low. What is the most likely diagnosis?
a. Polycythaemia vera
b. Primary polycythaemia
c. Secondary polycythaemia
d. Relative polycythaemia
e. High affinity haemoglobinopathy
Relative polycythaemia
87
92. 75 year old woman has neutropenic sepsis secondary to myelodysplasia. Her blood count is lower than it was 6 weeks ago, with marked
panyctopaenia. Blood film shows numerous large cells of primitive appearance. What is the likely explanation?
a. Development of iron deficiency
b. Development of aplastic anaemia
c. Progression to AML
d. Progression to CML
e. Progression to myelofibrosis
Progression to AML
88
93. 55 year old man started on therapy with DOAC rivaroxaban. What advice would you give regarding monitoring whilst on treatment?
a. Platelet count
b. No monitoring required
c. INR
d. APTT
e. Anti-Xa assay
No monitoring required
89
94. Acute GvHD post-allogenic haematopoietic stem cell transplant is mediated by which cell type?
a. Donor T-cells
b. Donor B-cells
c. Recipient B-cells
d. Recipient NK cells
e. Recipient T-cells
donor T cells
90
95. Which of the following is NOT normally associated with a diagnosis of multiple myeloma?
a. Anaemia
b. Humoral immune dysfunction
c. Osteolytic bone lesions
d. Renal impairment
e. Splenomegaly
Splenomegaly
91
96. In obstetric practice, the maximum risk of fatal maternal thrombo- embolism occurs at which stage of pregnancy?
a. 1st trimester
b. 2nd trimester
c. 3rd trimester
d. Post partum
e. Post amniocentesis
Post partum
92
97. What is the most appropriate 1st line therapy for CML with acquired Philadelphia translocation, in chronic phase?
a. Ibrutinib, a Brutyrosine kinase inhibitor
b. Rituximab, an anti-CD20 monoclonal antibody
c. Thalidomide, an anti-angiogenic agent
d. on tyrosine kinase inhibitor
e. Imatinib, an ABL1 tTocilizumab, an anti-IL6R monoclonal antibody
Imatinib,
93
98. Which of the following decreases during pregnancy?
a. Von Willebrand factor
b. Protein S
c. Plasminogen activator inhibitor 1
d. Fibrinogen
e. Factor VIII
Protein S
94
99. 25 year old with acute leukaemia requires an allogeneic haematopoietic stem cell transplant. She is mixed Afro-Carribean and European heritage, and has one sibling. What is the chance of the sibling being HLA identical?
a. 1:100
b. 1:4
c. 1:2
d. 1:11000
e. 1:1
I in 4
95
100. In Hodgkin lymphoma, PET CT scan at diagnosis demonstrates disease involving the following sites only: supraclavicular fossa, mediastinum, inguinal nodes and spleen. What anatomical stage is this?
a. Stage 0
b. Stage 1
c. Stage 2
d. Stage 3
e. Stage 4
stage 3
96
101. Which type of necrosis is associated with a MI?
a. Liquefactive necrosis
b. Fat necrosis
c. Coagulative necrosis
d. Caseous necrosis
e. Abscess formation
Coagulative necrosis
97
102. Palpable lymph node in the left supraclavicular fossa in a gastric cancer patient is referred to as?
a. Virchow node
b. Sister Mary Joseph node
c. Krukenberg tumour
d. Cushing’s node
e. Blumer shelf
Virchow node
98
103. What is the most common ovarian tumour?
a. Serous mucinous cystadenocarcinoma
b. Serous cystadenoma
c. Mucinous cystadenoma
d. Mucinous cystadenocarcinoma
e. Brenner tumour
Serous cystadenoma
99
104. An extradural (epidural) haemorrhage is due to damage to which blood vessel/vascular lesion?
a. Middle meningeal artery
b. Middle cerebral artery
c. Internal carotid
d. Bridging veins
e. Berry aneurysm
Middle meningeal artery
100
105. Which virus is associated with the development of nasopharyngeal carcinoma?
a. EBV
b. HBV
c. HHV-8
d. HPV-16
e. HCV
EBV
101
106. Pulmonary oedema due to liver disease is an example of which type of cause of pulmonary oedema?
a. Lymphatic obstruction
b. Indirect injury to alveolar wall
c. Increased hydrostatic pressure
d. Direct injury to alveolar wall
e. Decreased osmotic pressure
Decreased osmotic pressure
102
107. What is the commonest cause of adult ARDS?
a. Sepsis
b. Trauma
c. Pancreatitis
d. Drug reaction
e. Aspiration
SEPSIS
103
109. What is the most common cause of mitral valve stenosis?
a. Systemic lupus
b. Rheumatic heart disease
c. Pulmonary hypertension
d. Infective endocarditis
e. Congenital
Rheumatic heart disease
104
108. Which is the commonest glial cell in the CNS?
a. Oligodendrocytes
b. Microglia
c. Ependymal cells
d. Endothelial cells
e. Astrocytes
Astrocytes
105
110. Which of the following is the inheritance of genetic haemochromatosis?
a. X-linked recessive
b. X-linked dominant
c. Polygenic
d. Autosomal recessive
e. Autosomal dominant
Autosomal recessive
106
111. Which is the commonest cause of pancreatitis in adults? [Q did not specify acute or chronic]
a. Alcohol
b. Autoimmune disease
c. Cystic fibrosis
d. Drugs
e. Gallstones
Acute - gallstones
Chronic - alcohol
107
112. Brain tumour which most commonly occurs near the surface of the brain and is frequently asymptomatic is most likely to be?
a. GBM
b. Haemangioma
c. Meningioma
d. Schwannoma
e. Oligodendroglioma
Meningioma
108
113. In IVDU, which valve is characteristically associated with infectious endocarditis?
a. Aortic valve
b. Prosthetic valve
c. Pulmonary valve
d. Mitral valve
e. Tricuspid valve
Tricuspid
109
114. Which is the most common skin cancer?
a. Keratoacanthoma
b. Melanoma
c. Metastatic cancer
d. Squamous cell carcinoma
e. Basal cell
Basal cell
110
115. 25 year man is in A&E with abdominal pain and having collapsed, he had a low blood pressure and was in shock. Blood results - low sodium, high potassium, low HCO3-, slightly high urea, high creatinine, slightly low glucose [blood gases were also listed but can’t remember them]. What is the likely diagnosis?
a. Addison’s disease
b. Conn’s syndrome
c. Diabetic ketoacidosis
d. Acute abdomen
e. Cushing’s syndrome
Addison’s disease
111
116. 25 year man is in A&E with abdo pain and having collapsed, he had a low blood pressure and was in shock. Blood results - low sodium, high potassium, low HCO3-, slightly high urea, high creatinine, slightly low glucose [blood gases were also listed but can’t remember them]. What is the cause of his electrolyte abnormalities?
a. Renal loss of sodium
b. Vomiting
c. Renal failure
d. Perforated appendix
e. Dehydration
Renal loss of sodium
112
117. 60 year old man with BMI of 28 has abdo pain. His LFTs - high total BR, high ALP, high ALT, high AST, high GGT, high creatine kinase. What is the most likely diagnosis?
. Acute pancreatitis
a. Viral hepatitis
b. Alcoholic cirrhosis
c. Haemolytic jaundice
d. Obstructive jaundice due to gallstones
Obstructive jaundice due to gallstones
113
118. Which of the following can cause hypoglycaemia?
a. Atorvastatin
b. Bendrofluazide
c. Glucagon
d. Prednisolone
e. Quinine
Quinine
114
119. Increased insulin sensitivity results in low plasma glucose and occurs in which of the following?
a. PCOS
b. Phaeochromocytoma
c. Cushing’s disease
d. ACTH deficiency
e. Acromegaly
ACTH deficiency
115
120. Which one of the following is correct in a patient with moderate alcohol intake?
a. Elevated HDL
b. AST is nearly normal
c. Normal GGT
d. Normal triglycerides
e. Reduced albumin
Elevated HDL
116
121. Clinical features of hypercalcaemia include which one of the following?
a. Polyuria and polydipsia
b. Tetany
c. Hypotension
d. Diarrhoea
e. Easy bruising
Polyuria and polydipsia
117
122. 40 year old woman has a headache, normal visual fields. MRI shows 4mm pituitary adenoma. Investigations - normal cortisol [upper boundary of normal], normal ACTH, high prolactin of 1400, normal TSH, normal T4. What is the likely diagnosis?
a. Acromegaly
b. Non-functioning pituitary macroadenoma
c. Prolactinoma
d. TSHoma
e. Hypopituitarism
c. Prolactinoma
118
123. 40 year old woman has post-partum haemorrhage, unable to breastfeed. Investigations - low cortisol, low ACTH, low prolactin, normal TSH, normal T4. What is the likely diagnosis?
a. Acromegaly
b. Non-functioning pituitary macroadenoma
c. Prolactinoma
d. TSHoma
e. Hypopituitarism
Hypopituitarism
119
124. 25 year man is in A&E with abdo pain and having collapsed, he had a low blood pressure and was in shock. Blood results - low sodium, high potassium, low HCO3-, slightly high urea, high creatinine, slightly low glucose [blood gases were also listed but can’t remember them]. What is the likely diagnosis?
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis
e. Compensated respiratory acidosis
METABOLIC ACIDOSIS
120
125. Which of the following is found in obstructive jaundice
a. There is increased bilirubin in urine
b. The stools are dark
c. GGT is usually normal
d. AST is usually normal
e. ALP is usually normal
AST is usually normal
121
126. Which of the following is found in haemolytic jaundice
a. Bilirubin is normal
b. AST is raised
c. CK is raised
d. The stools are pale
e. There is increased urobilinogen in urine
e. There is increased urobilinogen in urine
122
127. Which of the following binds to receptors in the adrenal and stimulates aldosterone release?
a. Angiotensin 2
b. ACTH
c. Renin
d. Sodium
e. Calcium
Angiotensin 2
123
40 year old woman has a headache and bitemporal hemianopia. MRI shows 2cm pituitary macroadenoma. Investigations - normal cortisol, normal ACTH, high prolactin of 1400, normal TSH, normal T4. What is the likely diagnosis?
a. Acromegaly
b. Non-functioning pituitary macroadenoma
c. Prolactinoma
d. TSHoma
e. Hypopituitarism
Non-functioning pituitary macroadenoma
124
129. Which type of vaccine should not given to immunosuppressed individuals
a. Vaccine containing lipid adjuvant
b. Toxoid
c. Subunit
d. Live attenuated
e. Conjugate
D
125
130. In a histology slide showing antibody mediated rejection of a renal allograft, where is the inflammatory infiltrate seen?
a. Capillaries
b. Capsule
c. Interstitium
d. Tubules
e. Adipose tissue
Capillaries
126
131. Which of the following is a mixed pattern auto-inflammatory auto-immune disease characterised by sacroiliac joint inflammation
a. Ankylosing spondylitis
b. Osteitis condensans illi
c. Osteoarthritis
d. Rheumatoid arthritis
e. Gout
ank spond
127
132. Routine of a HIV patient should include testing for which leukocyte subset?
a. CD8 T-cells
b. CD4 T-cells
c. B-cells
d. Monocytes
e. NK cells
CD4 T-cells
128
133. Conjugate vaccine of polysaccharide and protein carrier may be used to enhance B-cell immunity to which of the following?
a. HIV
b. TB
c. Rabies
d. Streptococcus pneumoniae
e. Vibrio cholerae
Streptococcus pneumoniae
129
134. 21 year old woman has joint pain, rashes, fevers, pleuritic chest pain. Blood tests - high ESR, low CRP, high ANA titre, positive dsDNA antibody, low C3 level, low C4 level. What is the likely diagnosis?
a. SLE
b. Systemic sclerosis
c. Lyme arthritis
d. Granulomatosis with polyangiitis
e. Dermatomyositis
SLE
130
135. Development of auto-antibodies specific for gastric parietal cells is associated with which disease?
a. T1D
b. Rheumatoid arthritis
c. Multiple sclerosis
d. Graves’ disease
e. Pernicious anaemia
pernicious anaemia
131
136. Gel and Coombs type III hypersensitivity is mediated by which of the following mechanisms?
a. Activation of complement by antibody binding to cellular antigen
b. Cytotoxic T-cell mediated cell destruction
c. Activation of pre-existing IgE bound to antigen
d. Deposition of antibody-antigen complexes in blood vessel walls
e. Modulation of cell function by antibody binding to cell surface receptor
Deposition of antibody-antigen complexes in blood vessel walls
132
137. Failure to regulate cryopyrin driven activation of neutrophils is characteristic of which of the following diseases?
a. Auto-immune lymphoproliferative syndrome (ALPS)
b. Behcet’s disease
c. Familial Mediterranean fever
d. Microscopic polyangiitis
e. Ulcerative colitis
Familial Mediterranean fever
133
138. Which of the following monoclonal antibody therapies enhances T-cell immunity and is used in management of some malignancies?
a. Infliximab (anti-TNFalpha)
b. Pembrolizumab (anti-PD1)
c. Rituximab (anti-CD20)
d. Tocilizumab (anti-IL6R)
e. Ustekinumab (anti-IL12/23)
Pembrolizumab (anti-PD1)
134
139. Which one of the following agents is effective as a biological disease modifying anti-rheumatic drug (b-DMARD) as part of rheumatoid arthritis management?A
a. Adalimumab (anti-TNFalpha)
b. Basiliximab (anti-CD25)
c. Denosumab (anti-RANKL)
d. Pembrolizumab (anti-PD1)
e. Secukinumab (anti-IL17A)
Adalimumab (anti-TNFalpha)
135
140. Which one of the following is a standard immunosuppressive regimen for patients who received an allograft?
a. Azathioprine, mycophenolate mofetil, prednisolone
b. Cyclophosphamide, methotrexate, rituximab
c. Cyclosporine, rapamycin, tacrolimus
d. Mycophenolate mofetil, prednisolone, tacrolimus
Mycophenolate mofetil, prednisolone, tacrolimus
136
141. Which of the following exists in an immature form in the periphery where they recognise pathogens, and then mature and become adapted for presenting antigen to T-cells in lymph nodes
a. B-cells
b. Dendritic cells
c. Eosinophils
d. Erythrocytes
e. Plasma cells
dendritic
137
142. Which of the following immune-mediated diseases may respond to treatment with plasmapheresis?
a. Ankylosing spondylitis
b. Goodpasture syndrome
c. IgA vasculitis
d. Sjogren’s syndrome
e. Takayasu’s arteritis
Goodpasture syndrome
138
143. 72 year old man is a close household contact of someone recently diagnosed with smear positive pulmonary TB. What is his lifetime risk of developing TB?
a. 0.1%
b. 1%
c. 10%
d. 50%
e. 90%
10
139
144. 72 year old man has returned from a 7 day holiday in Italy. He has signs of pneumonia and Legionella urinary antigen is positive. Which of the following antibacterials is the most appropriate initial therapy?
a. Azithromycin
b. Amoxicillin
c. Ceftriaxone
d. Co-trimoxazole
e. Meropenem
Azithromycin
140
145. Which hepatitis virus is associated with more severe disease if acquired in pregnancy potentially leading to fulminant hepatic failure and death?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
e. Hepatitis E
Hepatitis E
141
146. Which of the following serological tests is useful in the diagnosis of invasive Candida albicans infections?
a. Beta-D-Glucan
b. Galactomannan
c. RFR
d. TPPA
e. Widal test
Beta-D-Glucan
142
147. Infants under 12 months should not be fed honey due to an increased risk of food poisoning caused which of the following organisms?
a. Campylobacter jejuni
b. Clostridium botulinum
c. Escherichia coli 0157
d. Salmonella typhi
e. Vibrio cholerae
Clostridium botulinum
143
148. 45 year old woman has 2-day history of fever and headache. She returned 5 days ago from a 2 week visit to Ghana. She initially thought she had a cold but her partner brought her in as she is now drowsy and confused. GCS is 11, temperature is 39.1 degrees, HR is 108 bpm, BP is 90/60. Malaria rapid diagnostic test is positive and parasitemia is 10%. Which of the following is the most appropriate initial antimalarial therapy?
a. IV artesunate
b. IV quinine
c. Oral artemether and lumefantrine
d. Oral atovaquone and proguanil
e. Oral mefloquine
IV artesunate
144
149. Which of the following antivirals is used for chronic hepatitis B treatment?
a. Aciclovir
b. Oseltamivir
c. Tenofovir
d. Zanamivir
e. Ribavirin
Tenofovir
145
150. Streptobacillus moniliformis is the causative organism of which of the following infections?
a. Bacillary angiomatosis
b. Lyme disease
c. Q fever
d. Rat bite fever
e. Syphilis
rat bite
146
151. What is the commonest form of prion disease?
a. Fatal familial insomnia
b. Iatrogenic Creutzfeldt-Jakob disease
c. Kuru
d. Sporadic Creutzfeldt-Jakob disease
e. Variant Creutzfeldt-Jakob disease
Sporadic Creutzfeldt-Jakob disease
147
152. 31 year old man is found unconscious in his flat surrounded by empty whisky bottles and recreational drugs. Shortly after arriving in the emergency department, he has a cardiac arrest and dies. His brother, his next of kin, arrives at the hospital a few hours later. He explains that his brother has alcohol related seizures but had not seen his doctor for several years. Which advice should be given to the Emergency department team regarding a post-mortem?
a. If the police suspect that the man’s death is a crime, then the team should refer to the coroner for a coroner’s post-mortem
b. In this situation, the case should be referred to the Coroner for a Coroner’s post-mortem
c. The cause of death is most likely to be related to recreational drugs and alcohol so a post-mortem is not needed
d. The cause of death is uncertain so it would be preferable to perform a post-mortem
e. The cause of death is uncertain so it would be preferable to perform a post-mortem but it can only be performed with the brother’s consent
In this situation, the case should be referred to the Coroner for a Coroner’s post-mortem
148
153. 56 year old man admitted with a reduced conscious level, fever and seizures. His brain MRI shows gross hydrocephalus and lesions suspicious of neurocysticercosis, a parasitic disease usually contracted from eating infected pork. A shunt is inserted to relieve the hydrocephalus but he develops shunt sepsis and dies 1 week post-surgery. The patient’s wife says that they are orthodox Jews and do not want the case discussed with the coroner. She is anxious that the coroner will request a post-mortem that could confirm neurocysticercosis. Which advice should be given regarding disclosure to the coroner?
a. Explain to the wife that the right of confidentiality does not extend after death
b. In this situation, disclosure to the coroner would be a breach of the wife’s article 8 right to a private life under the Human Rights Act 1998
c. The wife has an absolute right to confidentiality so her request must be respected
d. There is a legal duty to disclose relevant medical information to the coroner in this situation irrespective of consent
e. Where non-disclosure is requested on religious grounds and the diagnosis has been confirmed, it is not necessary to discuss the case with the coroner
There is a legal duty to disclose relevant medical information to the coroner in this situation irrespective of consent
149
154. 56 year old single man with known cystic fibrosis and severe learning disability (mental age of 4 years) is admitted to hospital with a severe pneumonia. He dies 5 days later. His mother died over 10 years previously. His stepfather, who has been his main carer since the mother died, has requested a post-mortem. However, his sister is deeply opposed to this. The coroner has advised that a coroner’s post-mortem is not required. How should you advise his medical team regarding the post mortem?
a. A post mortem cannot be performed if the coroner has not requested one
b. Provided one family member gives consent, the post mortem can be performed in this situation
c. Provided the stepfather was the next of kin, then the post mortem can be performed
d. The post mortem cannot be performed in the face of the sister’s refusal
e. Where there is family disagreement the post-mortem should be referred to the Court of Protection
The post mortem cannot be performed in the face of the sister’s refusal
150
155. 17 year old boy, with no known health problems dies suddenly while playing football. Hypertrophic cardiomyopathy is diagnosed as the cause of death at the coroner’s post-mortem. The pathologist wishes to retain the heart for teaching purposes. The mother agrees but his 26 year old brother is completely opposed to this. What is the legal position regarding organ retention in this situation?
a. Following a coroner’s post-mortem, organ or tissue retention is required as evidence for the cause of death
b. Organ or tissue retention can lawfully process with the mother’s consent
c. Organ or tissue retention cannot lawfully proceed where there is family disagreement
d. Organ or tissue retention following a coroner’s autopsy does not require consent
e. Organ or tissue retention for the purpose of medical education does not required the family’s consent
Organ or tissue retention can lawfully process with the mother’s consent
151
155) 63 year old man admitted with decompensated liver failure, hepatic encephalopathy and GCS of 7. He is found to have previously diagnosed hepatitis C. His wife asks for more information. Her husband is now alert but still acutely confused. His consultant thinks it is likely that his encephalopathy will resolve in the next few days. Which advice should be given in terms of disclosure of this man’s hepatitis C status to the wife?
a) Disclosure should wait until the man has regained mental capacity to consent to disclosure
b) Disclosure should wait until the mode of transmission of hepatitis C has been confirmed
c) Failure to disclose the diagnosis of hepatitis to the wife at the earliest opportunity would be a breach of her article 2 right to life under the Human Rights Act 1998
d) The man lacks mental capacity. Therefore, provided the wife is the next of kin, she should be informed of the diagnosis
e) The wife may have contracted hepatitis C from her husband and there she should be informed of the diagnosis
Disclosure should wait until the man has regained mental capacity to consent to disclosure
