PATH 2021 Flashcards by Danea Saad

In a range of scenarios and medical conditions, the platelet count may be abnormal.
Rank these conditions on the likely platelet count. Rank in the order; (1) highest platelet count to (5) lowest platelet count.

Essential thrombocythaemia
Rheumatoid arthritis
B Thalassaemia trait
Normal pregnancy
Auto-immune thrombocytopenic purpura

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● Five patients (Patient A to E) each have a blood gas sample sent to the laboratory. The clinical details of the cases are detailed below. Rank these cases on the expected pH from (1) lowest pH (acidosis) to (5) highest pH (alkalosis)

Patient C, a 17 year old with type 1 diabetes who omits his insulin.
Patient D, a 58 year old with very long standing COPD who is currently quite well
Patient A, a 59 year old with with very long standing COPD who has an acute exacerbation and is feeling breathless.
Patient E, has a cardiac arrest and has blood gases show a low p02 and a high pC02
Patient B, is having a panic attack, is hyperventilating and complains of tetany

ECADB

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Cancers of the lymphatic system have highly variable natural histories. In the absence of treatment which may alter the cinical course, rank the following lymphoid cancers by their median survival. Rank in the order (1) shortest survival to (5) longest survival.

Gene mutated Burkitt Lymphoma (BL)
Diffuse Large B Cell Lymphoma (DLBCL)
Mantle Cell Lymphoma (MCL)
Chronic Lymphocytic Leukaemia (CLL) IgH variable gene unmutated
Chronic Lymphocytic Leukaemia (CLL) IgH variable

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Healing of an acute myocardial infarction follows an ordered sequence of events. Rank the following events in chronological order starting from earliest (1) to latest (5)

Flocculent densities form within mitochondria
Neutrophils begin to arrive at the area of coagulative necrosis
Macrophages begin to arrive at the area of coagulative necrosis
Granulation tissue begins to form
Collagen is deposited, forming a fibrous scar

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● Rank the following diagnoses in order of expected measured serum potassium, with (1) being the highest potassium and (5) being the lowest.

Addison’s disease
Pneumonia
Phaeochromocytoma
Cushing’s disease
Conn’s syndrome

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A 69-year-old man presents with a red, hot swollen knee. He has type 2 diabetes mellitus and osteoarthritis, but it is a native joint. In this case of septic arthritis, rank the causative organisms below in order of likelihood, with (1) being the most likely and (5) being the least likely.

Staphylococcus aureus
Streptococcus pyogenes
Escherichia coli
Staphylococcus epidermidis
Brucella melitensis

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● A 56 year old female presents with dryness of her eyes, confirmed with ocular staining, and intermittent swelling of her submandibular glands. Rank the following investigations in order of specificity for confirmation of her diagnosis, with (1) having the highest specificity and (5) the lowest.

Positive anti-Ro antibody
Positive anti-nuclear antibody raised
Immunoglobulin G raised
Neutrophil count raised
C-reactive protein

Positive anti-Ro antibody
Positive anti-nuclear antibody raised
Immunoglobulin G raised
Neutrophil count raised
C-reactive protein
Neutrophil count raised

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Regarding the uterine cervix, the process of transformation from normal tissue to a malignant tumour passes through several histologically recognisable stages. Rank the following stages in chronological order starting from earliest (1) to latest (5).

Squamous metaplasia
Mild dysplasia
Moderate dysplasia
Carcinoma in situ
Invasive carcinoma

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Platlets 162 x 109/L (150-400)
CRP 34 mg/L (<5)
ESR 86 mm/hr (<20)
Complement C3 0.84 g/L (0.70-1.70)
Complement C4 0.50 g/L (0.16 0.54) Anti-nuclear antibody: negative
Anti-nuclear cytoplasmic antibody: weak (1+) c-ANCA +ve
His renal, liver and bone profiles are normal. He has been investigated for possible infection and all results are negative, including blood film for malaria and elispot for Mycobacterium tuberculosis. Results for the anti-myeloperoxidase (MPO) and anti-proteinase 3 (PR3) antibodies are pending. Rank the following in order of likelihood of diagnosis, with (1) being the most likely and (5) being the least.

Granulomatosis with polyangiitis (GPA)
Microscopic polyangiitis (MPA)
Chronic granulomatous disease
Systemic lupus erythematosus
Lymphoma

Granulomatosis with polyangiitis (GPA)

Microscopic polyangiitis (MPA)

Lymphoma

Systemic lupus erythematosus (SLE)

Chronic granulomatous disease (CGD)

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● A 23 year old man presents with cellulitis having cut himself while skateboarding. A wound swab has grown Streptococcus pyogenes (Group A Streptococcus). List the following antimicrobials which can be used for treatment in order of spectrum of activity with being the narrowest spectrum and 5 being the broadest spectrum agent.

Benzylpenicillin
Amoxicillin
Ceftriaxone
Piperacillin/tazobactam
Meropenem

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● A 32 year old woman who is 32 weeks pregnant has an FBC performed, the results are reported below. What is the most likely diagnosis?

Hb 115 g/L (115-165)
MCV 84 fL (80-96)
WBC 5.6 x 109/L (3.0-10.0)
Neutrophils 3.1 x 10°/L (2.0-7.5) Lymphocyte
2.1 x 109/L (1.5-4.0)
Platelets 123 X 10°/ (150-400)

Gestational thrombocytopaenia

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● A 23 year old woman attends her GP because of weight loss and feeling non specificaly unwell. On examination she has bilateral cervical lymphadenopathy. On direct questioning, she has experienced night sweats for four months and when drinking alcohol she has experienced pain in her neck. What is the most likely diagnosis?

Hodgkin’s lymphoma

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● An asymptomatic 58 year old man undergoes a routine insurance medical. The FBC results are reported below. The blood film comment notes the presence of myelocytes. What is most likely diagnosis
Hb 175 g/L (130-175)
WBC 35 x 10°/L (3.0-10.0)
Neutrophils 30 x 10°/L (2.0-7.5) Basophils 1.1x 10°/L (0-0.1) Lymphocytes 3.4 x 10°/ L (1.5-4.0)
Platelets 430 × 10°/L (150-400)

Chronic Myeloid Leukaemia

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A patient is admitted to the ED after severe trauma and blood loss. Without time for blood ABO grouping, he required emergency resus wth RBC and FFP. What blood group should be used?

O negative

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Asymptomatic 58 yo man undergoes routine medical. FBC results below. Blood film comments notes no immature cells seen, smear cells present. What is the most likely diagnosis?

Chronic lymphocytic leukaemia

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An elderly man presents with fatigue and recurrent chest infections, The FBC results are reported below, The blood film shows hypogranular hypolobulated neutrophils. What is the most likely cause?

myelodysplastic syndrome

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A 25 year old Greek woman who is 12 weeks pregnant attends a routine antenatal appointment, the following blood test results are obtained. Based on these results, tp determine if the future health of this fetus may be at risk, what is the first action/investigation required ?

screen father

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A 21 year old Syrian woman who has recently moved to the UK from a refugee camp attends a haematology clinic. She has Beta Thalassaemia major and for the last six years has received regular blood transfusions as treatment for anaemia. On examination she has signs of congestive cardiac failure and gonadal failure. What is the most likely explanation for these clinical findings ?

iron overload

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In a patient with Hodgkin Lymphoma, the Ann Arbor stage of disease is determined by the extent of spread, with stage 1 disease involving only one group of nodes, and stage IV disease involving extra nodal spread. What would stage 3 Hodgkin Lymphoma suggest?

disease in lymph nodes above and below diaphragm

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A five year old boy is reported to be non specifically unwell, for twomonths and has complained of hip pain and is now walking with a limp. On examination he has a petechial rash involving the lower limbs. The FBC result is presented below. Microscopy of peripheral blood notes the presence of blast calls. By immunophenotype the blasts are: TdT (Terminal deoxynucelotidyl transferase) and CD10 positive. What is the likely diagnosis?

Acute lymphoblastic leukaemia

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A 66 year old man with prostate cancer is experiencing fatigue and frank haematuria. The FBC result is presented below. The blood film report notes the presence of, myelocytes, tear drop poikilocytes and nucleated red blood cells. What is the most likely explanation for the anaemia

secondary myelofibrosis

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55yo man attends GP complaining of backache and feeling tired all the time. Blood results below. What is the diagnosis?

multiple myeloma

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What is the effect of male sex on the risk of venous thrombosis recurrence?

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doubles

Folic acid supplementation taken periconceptually and in early pregnancy is important to prevent what condition?

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neural tube defects

A 52 year old woman who is a vegan, is taking carbimazole therapy as treatment for hyperthyroidism, She develops fatigue and easy bruising. The FBC results are reported below. What is the most likely diagnosis?

drug induced aplastic anaemia

Which leucocyte actively participates in an acute inflammatory reaction, contains myeloperoxidase within its primary granules and alkaline phosphatase in it secondary granules?

neutrophil

A 71 year old mate has a slowly growing, ulcerated lesion on the pinna of his right ear. The lesion is surgically excised, and histologic sections reveal infiltrating groups of cells in the dermis. These cells have eosinophilic cytoplasm, intercellular bridges, and intracellular keratin formation. What is the correct histopathotogical diagnosis of this lesion?

squamous cell carcinoma

A plain chest X-ray of a 47 year old male reveals a 2.5 cm “coin lesion” in the upper lobe of his left lung. The lesion is removed. The report describes a clear cell carcinoma. What is the most likely primary site of origin for this carcinoma.

renal cell carcinoma

A 70 year old male with a history of alcoholism and chronic liver disease presents with weight loss and ascites. A CT scan of the abdomen events a sanity mass in the left lobe of the liver, No other lesions are seen. Peripheral blood a-fetoprotein levels are e raised. What is the likely diagnosis of the liver mass?

hepatocellular carcinoma

What is the most common histologic type of carcinoma involving the oral cavity?

squamous

A patient with Sjogren's syndrome has a salivary gland biopsy. What cells are the most common infiltrating cell type likely to be seen?

t or b lymphocyte

A 42 year old male presents in renal failure, His kidneys are grossly enlarged by multiple large, thin-walled cysts. Some of the cysts contain blood clots. What is the likely diagnosis?

ADPKD

A 5 year old has abdominal pain and a palpable abdominal mass. CT scan. shows the mass to be arising from the left kidney. What is the most likely diagnosis?

wilm's tumor

A 42 year old male has fever, night sweats and haemoptysis. A transbronchial lung biopsy shows granulomas with necrosis. What is the most likely cause?

A 27 year old male with weight loss and diarrhoea is found to be anaemic. His duodenal biopsy is reported to show villous atrophy with a raised intra-- epithelial lymphocyte count (>60/100 enterocytes), What is the most likely diagnosis?

COELIAC

von hippel lindau

A 72 year old male develops worsening heart failure. Investigations show decreased left ventricular filling due to decreased compliance of the left ventricle. Two months later he dies. Post-mortem microscopic examination of the heart muscle reveals deposits of eosinophilic Congo red-positive material in the interstitium of his heart. This material shows apple-green birefringence under polarised light. What is the diagnosis?

amyloidosis constrictive heart failure

A 39 year old male farmer from Southern Africa has been exposed to mouldy grain during his working life. He has worsening abdominal pain and jaundice. There is a large mass in the right lobe of his liver. Biopsy of the mass reveals hepatocellular carcinoma, What extrinsic agent is likely to have played a role in the development of this tumour?

aflatoxin from aspergillus

A 31 year old female has a right ovarian mass removed. Bisection of the mass shows hair and sebaceous material. What diagnosis?

teratoma

A patient with multiple endocrine neoplasia type 2 has had a thyroidectomy for medullary thyroid carcinoma but now presents with hypertension and. palpitations. What is the likely diagnosis?

phaeo

A18 year old student collapses and dies whilst playing football. A post-mortem finds asymmetric hypertrophy of the interventricular septum, Microscopic examination shows thickened and disorganized muscle fibres with hyperchromatic nuclei. Dx?

HOCM

A 50 year old man is brought to the Emergency Department unconscious, an urgent ECG is performed {ECG 2.) He had been seen in the Emergency Department one week previously and was well on discharge. An ECG was taken at the time of discharge (ECG 1.) What urgent treatment does he now require?

Cant get pic of ECGs but answer was cardiac resynchronisation therapy)

A 21 year old patient with type 1 diabetes collapses. His cap blood glucose is 0.77mM and a repeat confirms this. He is unrousable with a GCS of 3. He has no visible veins. What is the best emergency treatment for hypoglycaemia in an unconscious patient with no intravenous access?

IM glucagon

A 24 year old patient with known type 1 diabetes presents having missed her insulin, and is now vomiting with Kussmaul’s respiration. Predict the likely bicarbonate concentration in this patient. (bicarbonate reference range 22-29 mmol/L)

A 32 year old female physiotherapist is overweight with excess facial hair and also experiences recurrent acne. Over the past nine months her periods have been infrequent. Testosterone 3.7 nmol/L (0.22.9), What is the likely diagnosis?

pcos

A 45 year old man joins a new GP surgery, He is asymptomatic and has the following blood test results, What is the most likely diagnosis?

pagets

Which liver enzyme can be measured in the blood and is found to be raised in Paget's disease, osteomalacia and rickets and is a marker of osteoblastic activity?

alp

A neonate presents with a salt losing crisis, and is thought to have congenital adrenal hyperplasia. What is the commonest enzyme deficiency that causes this? Name the enzyme

21 hydroxylase

50 year old has tetany. Ix below. Dx?

secondary hyperpth

Which liver enzyme can be measured in the blood and specifically suggests obstructive jaundice if levels are found to be raised?

alp

A patient complains of a painful knee, and has it aspirated. Microscopy of the fluid reveals positively birefringent crystals. What is the likely diagnosis?

pseudogout

The biochemistry laboratory reports the following set of results on a patient. Based on the findings, what is the likely bicarbonate concentration in this patient? {Estimate to the nearest whole number in mmol/L. Reference range 22- 29 mmol/L)

30yo man comes to ED having taken a drug overdose. ABG below. What drug is he likely to have taken?

salycilate

A 35 year old man with no complaints has the following blood test results when he joins a new GP surgery. What is the most likely diagnosis?

gilberts

24F presents with weight loss and palpitations. Bilateral exophthalmos seen. Results of TFTs below TSH 0.1 (0.3-4.2) Free T4 32 (9-25) She has developed auto antibodies to which surface protein?

anti-tsh receptor

A monoclonal antibody specific for receptor activator nuclear factor kappa-b ligand (RANK ligand) is effective in management of which condition?

osteoporosis

PATH 2021 Flashcards

(57 cards)