PATH 2023 Flashcards by Danea Saad

The following antibiotics can be used to treat pneumonia. List them in order of the most narrow spectrum (1) to the most broad spectrum (5)

Benzylpenicillin
Amoxicillin
Co-amoxiclav
Ceftriaxone
Piperacillin/Tazobactam

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An 18 year old university student presents with photophobia and a non-blanching rash. CSF analsis showed high protein, high WCC, high neutrophils (140, normal range <3), high protein. What is the most likely organism causing this?

Neisseria meningitidis
Strep pneumoniae
Haemophilus influenzae
Staphylococcus epidermidis
Mycobacterium Tuberculosis

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Rank the following conditions in order of neutrophil count highest to lowest:

Leucocyte adhesion deficiency
Acute pyelonephritis
Familial benign Neutropenia
Chronic idiopathic neutropenia
Kostmann’s syndrome

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Rank the following likely to cause allergy in children <5 years, most to least likely

Cow’s Milk
Peanut
Eggs
Fish
Rice

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Rank in order of highest number of reticulocytes to lowest number

Hereditary spherocytosis
Occult GI blood loss
ITP
Anaemia due to low dose oral myelosuppressive chemotherapy
Aplastic anaemia

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Thrombosis risk (lowest to highest, might have been highest to lowest)

Brisk 1 hour walk
75mg Aspirin
4 hour flight
COCP to someone heterozygous for Factor V Liden
Inherited antithrombin III deficiency

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72 yo Woman of Afro caribbean origin, on lots of different medications for high blood pressure, high cholesterol etc. Given her investigations (Na 145, K 3.0, normal functioning kidneys). Rank the diagnosis from highest to lowest (Repeat)
Conns
Essential hypertension
Cushings
Phaeochromocytoma
Addisons

Conns
Essential hypertension
Cushings
Phaeochromocytoma
Addisons

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Five patients (Patient A to E) each have a 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 to (5) highest pH. (repeat)

Patient E, has a cardiac arrest and has blood gases show low pO2 and high pCO2
Patient C, a 17 year old with type 1 diabetes who omits his insulin.
Patient A, a 59 year old with with very long standing COPD who has an acute exacerbation and is feeling breathless
Patient D, a 58 year old with very long standing COPD who Is currently quite well
Patient B, is having a panic attack, is hyperventilating and complains of tetany

ECADB

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Patient with anal carcinoma. Rank the following events from first (1) to last (5)

HPV infection
Anal intraepithelial neoplasia 3
Anal carcinoma in situ
Invasive anal carcinoma
Metastases

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Rank in order of occurrence (time wise I think):
Myocardial infarction
Mural thrombus
Myocardial aneurysm
Myocardial fibrosis
Cerebral embolism

Myocardial infarction
Mural thrombus
Myocardial aneurysm
Myocardial fibrosis
Cerebral embolism

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A 50s yo man returns from a long haul flight and suffers a DVT, no risk factors identified, how long should he have treatment for?

3 months

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Patient previously treated for breast cancer. Given a bunch of investigations, basically anaemic, tear drop poikilocytes, myelocytes and stuff, most likely haematological diagnosis?

Myelofibrosis

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Histology showed starry sky appearance. Most likely diagnosis?

Burkitts lymphoma

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Given a bunch of investigations, basically see Pelger Huet cells, diagnosis?

Myelodysplastic syndrome

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Abnormal bloods (DIC) + analysis showed t(15;17) translocation, PML-RARA fusion gene, diagnosis?

Acute promyelocytic leukaemia

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What infection is associated with P1104A variant of the TYK2?

Tuberculosis

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Man presents to GP for check up with high bilirubin, everything else normal, diagnosis?

Gilbert’s syndrome

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Man presents to GP for check up with high ALP, asymptomatic everything else normal, diagnosis?

Paget’s disease of the bone

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What enzyme is associated with Paget’s disease, osteoclasts resorption?

ALP

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What disease is associated with Kimmelsteil Wilson nodule?

Diabetic nephropathy

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What autoimmune condition is associated with a mutation on the “shared epiptope” on HLA-DR1 and HLA-DR4?

Rheumatoid arthritis

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Man with COPD, smoker, 40% JAK2 V167 mutation in cells. HCt 55%, Hb 190, diagnosis?

Polycythaemia vera

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What is the most common HLA association for a seronegative spondyloarthropathy?

HLA-B27

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Blood cultures reveal Candida spp (not albicans), what antifungal should be used?

Echinocandin e.g. anidulafungin

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A woman presents with a 4 month history of weight loss, hamoptysis and night sweats. CXR shows an upper lobe cavitation mass and there are hard palpable lymph nodes superclavicularly. What type of sideroom would you place her in.

Airbourne infection side room

What antibiotic should be used to treat mycoplasma pneumoniae in a 5 year old?

Clarithromycin

What antibiotic should be added to cover for Listeria in a 75 year old woman with meningitis already recieving ceftriaxone 2mg bd?

Amoxicillin

Child presents with chorioretinitis, cerebral calcifications. What is the most likely causative parasite in pregnancy to cause this?

Toxoplasma gondii

Other than adenocarcinoma, what is the most likely neoplasm caused by H.pylori?

MALT lymphoma

What virus causes progressive multifocal leukoencephalopathy in AIDS?

JC virus

What enzyme should be measured before administering azathioprine?

TPMT (thiopurine methyltransferase)

Patient has been admitted with severe influenza A pneumonia and is intubated in ITU. Given that she can’t have any oral medication, what is the most appropriate antiviral to start?

IV Peramivir

What antibody is associated with Grave’s disease?

anti-TSH receptor antibody

Patient presenting with progressive fatigue, difficulty chewing, ptosis. What antibody is associated with this pathology?

Anti-acetylcholine receptor antibody

Cystericosis is caused by taenia solium. How does a human contract cystericosis?

Taenia solium infected egg ingestion

Female patient presenting with low TSH, very high T4 - most likely diagnosis?

Graves disease

Patient with hypokalaemia. Predict the bicarb result? REPEAT 2022

Woman induced for labour. Presents with prolonged APTT, low fibrinogen. What is the likely obstetric event causing this presentation REPEAT

Placental abruption (causing DIC)

What can be done to prevent overwhelming bacterial sepsis in a sickle cell patient with Howell-jolly bodies on blood film. Name one of the two possible medical interventions.

Vaccination

What is the most common cause in the UK of granulomatous destruction of the bile ducts in the liver?

Primary biliary cholangitis

Prophylactic antibiotics often used once before surgery to improve outcomes. Usually one dose is administered. Give one of the two indications for further antibiotics during surgery

Major blood loss

What condition predisposes people to cholangiocarcinoma most in the UK?

Primary sclerosing cholangitis

Which form of inflammatory bowel disease is associated with transmural inflammation?

Crohn’s disease

A patient with T1DM has missed an insulin dose and now presents vomiting with Kussmaul respiration. What is the most likely PCO2 on their ABG? REPEAT

2kPA (LOW)

Given bloods that showed normal sodium, low potassium and something else. Guess the most likely bicarbonate to the nearest whole number (normal 22-30) REPEAT

HIGH e.g. 36

Patient with diarrhoea and iron deficiency anaemia is positive for IgA tissue transglutaminase, what is the most likely diagnosis?

Coeliac disease

Patient presenting with serum Na 130, all other electrolytes within range. Urinary Na 40, Urine Osmolality 680. What is the most likely diagnosis.

SIADH

Patient presenting with Na 130, Urinary Na 40, Urine Osmolality 680 (same bloods). How would you manage this patient?

Fluid restriction

Woman with low sodium high potassium high creatinine high urea low pH low CO2 low bicarb, presents passed out in ED. What is the diagnosis REPEAT

Addisons

Low sodium high potassium high creatinine high urea low pH low CO2 low bicarb ABG (same bloods as above) - which acid base disturbance REPEAT

Metabolic acidosis

Patient with myeloma, with high urea and creatinine - what is most likely cause of renal failure?

Light chain cast nephropathy

Patient presenting with monocular blindness with extremely high neutrophils (140s) , basophils - what is the diagnosis?

Chronic myeloid leukaemia

Most common renal cancer in adults?

Clear cell renal cell carcinoma

What condition occurs when endometrial glands grow outside of the uterus?

Endometriosis

A man presents with haemoptysis and nephritic syndrome. What antibody would confirm a diagnosis of goodpastures syndrome?

Anti-glomerular basement membrane

35 year old man presenting with shortness of breath, fever, pleuritic chest pain, low O2 sats (87%). 3 year old daughter recently had scarlet fever got amoxicillin for it. Already started on Amoxicillin in A&E. What antibiotic would add to that?

Clarithyromycin

A patient presents with breathlessness, bibasal lung craps, raised JVP and bilateral pitting oedema. He has a pastmedical history of treated refractory myeloma. On heart ausuclatation you hear a loud heart sound. Bloods show proBNP in 400s, electrolytes normal, urine 24h sodium 7g. Light chains and IgG levels were low (below reference range). What is the most likely diagnosis?

Amyloidosis restrictive heart failure

Most common primary CNS tumour in children?

pilocytic astrocytoma

Give an example of a live attenuated vaccine given in the UK

MMR

Young man going to Morocco to help some stray dogs. Has taken Hep B prophylaxis, tetanus. What other organism should they be vaccinated against?

Rabies

Diabetic patient recently started ACEi/ARB, now has high creatinine and urea. What is the underlying cause? (repeat)

Renal artery stenosis

How is LMWH monitored in a patient with renal failure?

anti-Xa assay

What is the histological hallmark of sarcoidosis?

Non-caseating granuloma

Child with anaemia, blood film shows spherocytes and DAT+(?) What is the cause?

Autoimmune haemolytic anaemia

What type of myocytes are responsible for transmitting signals from the atria via the septum to the ventricles?

Purkinje fibres

Woman with joint pain, rash.etc. Her blood tests show normal C3 and low C4, what is the cause?

Systemic lupus erythematosus

Which vaccine preventable infection causes coryzal symptoms, a grey coating on the back of the throat followed by swallowing/breathing problems? (REPEAT)

Diphtheria

Woman has had 2 children, her blood type is A-. Which naturally occurring IgM antibody would be present? (Repeat)

anti-B

Woman has low grade fever and sore mass in front of neck after an infection a couple of weeks ago??. TSH and T4 were low. What is the most likely diagnosis?

De Quervain’s thyroiditis

Man presents with fevers, swollen joints, and has a loss of function in the MEFV gene, diagnosis? (REPEAT)

Familial mediterranean fever

Something about person smear cells on blood film.

Chronic lymphocytic leukaemia

Neonate with jaundice. Mother is Rh -, baby is Rh +. What is the most likely diagnosis?

Haemolytic disease of the newborn

What organism causes D&V after eating reheated rice? Name genus and species.

Bacillus cereus

Neonate develops sepsis within first hours of life. Blood culture grow gram positive cocci in chains. Name the most likely causative organism.

Group B streptococcus

Which vaccine preventable disease presents initially with mild fever, swollen neck glands, anorexia, malaise and cough. After 2-3 days a membrane of dead cells forms in the throat, tonsils, larynx or nose which may narrow or occlude the airway leading to respiratory distress? (repeat)

Diphtheria

Which enzyme is most commonly deficient in congenital adrenal hyperplasia?

21 hydroxylase

1. Which exact strain of E.coli causes travelers diarrhoea? A. ETEC Toxigenic diarrhoea B. EIEC Invasive dysentery C. EHEC Haemorrhagic E. EPEC Infantile diarrhoea

ETEC Toxigenic diarrhoea

2. 2 year old child, aplastic anaemia with low reticulocyte count, sickle cell disease, diagnosis? a. Splenic sequestration b. Parvovirus B19 infection c. Sickle cell crisis

b. Parvovirus B19 infection

3. 2 year old with abdominal fullness, sickle cell disease, and generally unwell, high reticulocyte count - diagnosis? a. Splenic sequestration b. Parvovirus B19 c. Sickle cell crisis

Splenic sequestration

4. Male tested positive for COVID 3 days ago. Emergency intubation on AMU today. What retroviral should be used assuming no contraindications or allergies? a. Ribavirin b. Tenofivir c. Remdesivir d. Paxlovid e. Tocilizumab

Remdesivir

5. Most common cause for myocarditis? a. Virus b. Drugs c. Bacteria d. Fungi e. TB

Virus

6. When is mepolizumab (anti IL5) used? a. Eosinophilic asthma b. Rheumatoid arthritis c. Psoriasis

Eosinophilic asthma

7. What drug is used to treat CLL (name not used, drug class/MOAs were mentioned) a. Bruton’s kinase inhibitor b. ABL inhibitor

Bruton’s kinase inhibitor

8. Which virus causes hemorrhagic cystitis in immunocompromised host? a. CMV b. BK virus c. EBV d. HTLV1

BK virus

9. Man with diabetes has conjuncitivits and rhinitis with pus, what is the most likely causative organism? a. Crypococcus neoformas b. Candida (not albicans) c. Rhizopus

Rhizopus

10. Patient in hospital eight days after a dynamic hip screw develops pneumonia. What is the most likely causative organism? (Staph A and E.coli were not amongst the options) a. Strep. Pneumoniae, b. Haemiphilius influenzae c. Pseudomonas d. Legionella

Pseudomonas

11. Mode of inheritance for polycystic kidney disease presenting in adults? a. Autosomal dominant b. Autosomal recessive

Autosomal dominant

12. What causes low calcium in CKD? a. Increased tubular loss of Ca b. decreased a1hydroxylase c. Decreased PTH secretion

decreased a1hydroxylase

13. What does FAS mutation cause? (did not mention diseases for ALPS/APECED, more mechanism) a. Expansion of lymphocytes/ ALPS b. Chronic granulomatous disease c. Common variable immunodeficiency d. APECED

Expansion of lymphocytes/ ALPS

14. Anti-interferon antibody levels predict disease severity in which disease? a. TB b. COVID

COVID

15. What condition is associated with increased insulin insensitivity and hypoglycaemia? (repeat) a. Acromegaly b. ACTH deficiency c. Cushings d. Conn’s

ACTH deficiency

16. What is the most common cell type affected in primary immunodeficiency? a. B cell b. T cell c. Neutrophil d. Monocyte

a. B cell

17. What condition is IL-17 (secukinumab) used for? a. Plaque psoriasis b. Rheumatoid arthritis

Plaque psoriasis

18. Woman has confirmed falciparum malaria. Parasitaemia 4%. BP 86/57. What medication is indicated? a. IV artesunate b. Chloroquine/primaquine c. PO Atovaquone-proguanil with something else d. PO something else

IV artesunate

19. What infections other than HIV are routinely screened for in blood products? a. Malaria b. HTLV1 c. Rubella d. CMV

HTLV1

20. What cells mediate immunological memory? a. Neutrophils b. Macrophages c. Lymphocytes d. Eosinophils e. Dendritic cells

Lymphocytes

21. Child presenting with breathlessness, passing lots of dilute urine. Sodium is 147 (only thing given). What is the likely diagnosis? a. SIADH b. T2DM c. Cranial diabetes insipidus

Cranial diabetes insipidus

22. YOUNG PERSON presenting with neurological sx followed by cognitive impairment. What is the likely diagnosis? (repeat) a. Sporadic CJD b. Variant CJD c. Kuru d. Iatrogenic CJD e. Fatal familial insomnia

Variant CJD

23. What type of histological finding do you see in antibody-mediated graft rejection? a. Arterial inflammation and fibrosis b. Interstitial nephritis c. Tubulitis d. Glomerulopathy e. Renal thrombosis

Glomerulopathy

24. A 70 something year old with renal disease on dialysis develops a fever and cystitis. He had a catheter and is known to have vancomycin resistant enterococcus or something? What is the management (repeat) a. Meropenem b. Amoxicillin c. Linezolid d. Benzylpenicillin

Linezolid

25. Which immune condition is most likely to be treated with IV immunoglobulin? a. SLE b. Bruton’s XLA c. Chronic granulomatous disease d. Leukocyte adhesion deficiency

Bruton’s XLA

27. Patient with high calcium, back pain, very low kappa/lambda ratio, no serum protein. History of difficulty micturating. PTH was low, phosphate normal range. What is the likely diagnosis? a. Metastasis due to prostate cancer b. Myeloma c. Primary hyperparathyroidism d. Secondary hyperparathyoidism

Myeloma

28. IL-1 blockers used in a. TB b. COVID c. Other diseases

Other diseases (familial mediterranean fever, gout, adult onset stills disease)

29. IVDU presenting with new murmur, psoas abscess, fever etc. What is the most likely causative organism? a. Strep pyogenes b. Staph aureus c. Haemophilius

Staph aureus

31. Which infection will not cause harm to baby if mother is infected? a. Erythema infectiosum b. Hand foot and mouth disease c. Varicella Zoster virus d. Rubella e. HSV

Hand foot and mouth disease

32. Patient is on prednisolone and mycophenolate. Which vaccine should they not have? a. COVID b. Quadruple influenza c. Pneumococcal d. Zostavax e. Hep B

. Zostavax

What is the most likely finding in coeliac disease? a. Increased epithelial T lymphocytes b. Increased epithelial B lymphocytes c. Increased epithelial neutrophils d. Increased epithelial macrophages

Increased epithelial T lymphocytes

What is the most common receptor expression in breast cancer? a. Progesterone positive, estrogen positive, HER2 positive b. Progesterone negative estrogen negative,HER2 negative c. Progesterone positive, estrogen positive, HER2 negative

Progesterone positive, estrogen positive, HER2 negative

Which of the following would be most inkeeping with someone who has never been exposed to, but has been vaccinated against Hepatitis B? a. Surface antigen negative, surface antibody negative, core antibody negative b. Surface antigen negative, surface antibdy negative, core antibody positive c. Surface antigen negative, surface antibody positive, core antibody negative d. Surface antigen positive, surface antibody negative, core antibody negative e. Surface antigen positive, surface antibody negative, core antibody positive

Surface antigen negative, surface antibody positive, core antibody negative

Young woman returning from australia 8 weeks ago with non-healing ulcer that has been treated with 2 antibiotics already. Culture of lesion reveals positive acid-face bacilli and Zheel-Niehlson stain. What is the most likely causative organism? (list of atypical mycobaceria) a. Mycobacterium ulcerans b. Mycobacterium abscessus

Mycobacterium ulcerans

2cm pituitary mass. Prolactin level: 1400 (REPEAT). What’s the diagnosis? a. Non functional macro pituitary adenoma b. Prolactinoma

Non functional macro pituitary adenoma

Boy had pituitary mass removed. He felt a bit dizzy and serum sodium was 129. Observations and all other U&Es showed he was fit to be discharged. What’s the most important medication for him to be prescribed to take as outpatient a. Fludrocortisone b. Prednisolone c. Desmopressin (DDVAP) d. Growth hormone

Prednisolone

.Someone with dry eyes, dry mouth. Which antibody would be present? a. Anti-CCP b. Anti RO

Anti RO

Which drug do you give patients with pseudomonas infection? a. Ceftazidime b. Ceftriaxone c. Cefotaxime d. Cefalexin

Ceftazidime

What is the most common cause of adrenal insufficiency in the developed world? 1. TB 2. Autoimmune 3. Metastatic cancer 4. Pituitary

Autoimmune

Rituximab is a monoclonal antibody against CD20 used in the treatment of Rheumatoid Arthritis and others. What is the target cell? 1. T-lymphocytes 2. B-lymphocytes 3. Plasma cells

B-lymphocytes

. CAR-T cell against CD19 can be used in the treatment of what disease? (Repeat?) a. T-cell Lymphoma b. Another T-cell lymphoma c. AML d. Diffuse large B cell lymphoma

Diffuse large B cell lymphoma

What is the most likely thing seen with moderate alcohol consumption? (repeat) a. Normal GGT b. Low albumin c. High HDL d. Low triglycerides e. Almost normal AST

High HDL

Mom has ITP and gives birth to a healthy baby. What do you measure/ monitor in the baby once born? (repeat) a. One time cord FBC b. One time cord bilirubin (?) c. Five days FBC d. Five days bilirubin e. Perform DAT

One time cord FBC

What blister formig skin condition is characterised by suprabasal clefting of the epidermis? a. Bullous pemphigoid b. Pemphigus vulgaris

Pemphigus vulgaris

1. Hospital Autopsy. Coroner wants a spine specimen for teaching. What do you? (repeat) * Must ask family (next of kin) * Don’t need one as hospital and good for education (something like that) * Must have asked for consent previously from deceased

Must ask family (next of kin)

2. 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? (repeat) 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

3.Lady with learning disability doesn’t want flu vaccine. Then got the flu, then got staph aureus infection and died from cardioresp failure. What would the cause of death be? REPEAT a. 1a cardiorespiratory arrest, 1b pneumonia, 1c influenza b. 1a cardiorespiratory arrest, 1c c. 1a staph aureus infection, 1b influenza, 2 learning difficulty d. 1a staph aureus infection 1b influenza e. 1a staph aureus infection 1b influenza 1c learning difficulty

d. 1a staph aureus infection 1b influenza

Man has hep B and dies. Says the day before he doesn’t want his wife to know his diagnosis. Can you disclose the hep B to his wife? (repeat) a. Tell her to prevent medical harm to wife b. Tell her as he is dead and right to confidentiality ends with death c. Tell her as not saying is against the wife’s human rights d. Tell her because he is dead and it can’t hurt him

Tell her to prevent medical harm to wife

PATH 2023 Flashcards

(125 cards)