Path - Mock VSAs and SBAs Flashcards Preview

Fess' Flashcards: 5th Year > Path - Mock VSAs and SBAs > Flashcards

Flashcards in Path - Mock VSAs and SBAs Deck (71)
Loading flashcards...
1

A 25-year-old woman complains of right iliac fossa pain, diarrhoea and weight loss worsening over several weeks. Laparotomy reveals an oedematous, reddened terminal ileum and a biopsy uncovers transmural inflammation with the presence of granulomas.

What is the most likely diagnosis?

Crohn's disease

2

A 35-year-old woman presents with diarrhoea and lower abdominal pain. Examination of her stools reveals blood and mucus. A biopsy reveals a continuous superficial ulceration of the colon.

What is the most likely diagnosis?

Ulcerative colitis

3

A 60-year-old patient presents with chronic left-sided abdominal discomfort and the passage of fresh blood from the rectum. He denies weight loss and on examination has no palpable masses. However a colonoscopy reveals pouches of mucosa extruding through the muscle layer.

What is the most likely diagnosis?

Diverticular disease

Accept:
DIverticulitis

4

A 70-year-old man who has been receiving broad-spectrum antibiotic treatment develops profuse diarrhoea and frequent episodes of incontinence. A biopsy of the colon reveals a membrane like material covering the surface composed of mucin, fibrin, polymorphs and what seems to be debris of leukocytes and mucosal epithelial cells.

What is the most likely diagnosis?

Pseudomembranous colitis

Accept:
Clostridium difficile infection

5

A 68-year-old man presents with rectal bleeding and new onset constipation. Some years ago, he was diagnosed with polyps in his colon and recently has lost a lot of weight. An abdominal examination reveals a mass in the right lumbar region which is non-tender.

What is the most likely diagnosis?

Colonic carcinoma

6

6. A 28 year-old junior doctor comes in feeling ‘pretty lousy and aching all over’. She is wearing dark glasses and complains of a stiff neck. CSF examination reveals a normal CSF/blood glucose ratio and slightly raised protein of 0.7 g/L with a lymphocyte count of 150 and no neutrophils. There were no red cells in the CSF which proved that the lumbar puncture was well carried out, and that the SHO undertaking it had not punctured any veins.

What is the most likely diagnosis?

Viral meningitis

Accept:
Aseptic meningitis

7

7. A 56 year-old male presents with fever, vomiting and seizures. Examination reveals a well- established ear infection and there is a ‘ring-enhancing’ lesion on the MRI of his brain.

What is the most likely diagnosis?

Cerebral abscess

Accept:
Tuberculoma

8

A 40 year-old man complains of a stiff neck. He is the member of a cheese club and enjoys unpasteurised cheese. He has a high neutrophil count in the CSF, and gram staining reveals gram positive rods.

What is the most likely causative organism?

Listeria monocytogenes

9

Gram staining of a blood culture reveals Gram positive diplococci.

What is the likely organism?

Streptococcus pneumoniae

10

A 27 year old patient has a knee effusion drained. The gram stain reveals Gram negative intracellular diplococci.

What is the likely organism?

Neisseria gonorrhoea

11

A 28 year old woman presents with malaise, weight loss, an erythematous rash on the face and joint pains. Both antinuclear antibodies (ANA) and double-stranded DNA (dsDNA) antibodies were found in the serum.

What is the most likely diagnosis?

Systemic Lupus Erythematosus

12

A 40 year old man presents with weight loss, muscle aches and abdominal pain. On examination he has high BP and urine dipstick reveals blood + and protein +. The patient is thought to have a vasculitis and is p-ANCA positive.

What is the most likely diagnosis?

Microscopic polyangitis

Accept:
Primary sclerosing cholangitis
Eosinophilic Granulomatosis with Polyangiitis
Ulcerative Colitis
Glomerulonephritis

13

A patient is found to have a very high titre of anti-mitochondrial antibody.

What is the likely diagnosis?

Primary biliary cirrhosis/ primary biliary cholangitis (same thing)

14

A patient presents with haemoptysis and haematuria. She is thought to have Goodpasture's syndrome.

What antibody should you look for?

Anti-glomerular basement membrane

15

A 32yr old woman complains of fatiguability in many muscles and double vision. She is thought to be at risk of other autoimmune diseases as she has a family history of various autoimmune diseases and herself has autoimmune hypothyroidism. Her thyroid function is normal because she is well replaced with thyroxine.

What might be causing her muscle weakness?

Myasthenia gravis

16

A four-year-old boy presents with a purpuric rash across the legs and buttocks. Two weeks previously you had seen the child about a chest infection. Further examination reveals abdominal pain and haematuria. Serum IgA levels are raised.

What is the likely diagnosis?

Henoch-Schonlein purpura

17

A patient is found to have a positive Coombes (anti-globulin) test.

What is the likely diagnosis?

Autoimmune haemolytic anaemia

18

A child is found to be anaemic, and molecular studies show a defect in the spectrin molecule.

What is the diagnosis?

Hereditary spherocytosis

Hereditary elliptocytosis is also acceptable

19

A 70 year old lady presents with pallor and has the following results:

Hb 90 (NR 120-150) g/dl
MCV 125 fl (NR 76-96)

The film shows hyper-segmented neutrophils. The patient also has type 1 diabetes and hypothyroidism that are both well treated.

What is the underlying cause of her low haemoglobin?

Pernicious anaemia

Accept:
B12 deficiency
Folate deficiency
Megaloblastic anaemia

20

A 70 year old man presents with pallor and has the following results:

Hb 90. (NR 120-150) g/dl
MCV 65 fl (NR 76-96).

What is the likely underlying cause of the low haemoglobin?

Iron deficiency anaemia

Accept:
Chronic GI blood loss

21

A patient presents with tiredness and is found to have a calcium of 3.0mM and a normal PTH at 3.0pM (NR 1.1 to 6.8).

What is the likely diagnosis?

Primary hyperparathyroidism

22

A patient presents with tiredness and is found to have a calcium of 2.0 mM and a raised PTH at 30pM (NR 1.1 to 6.8).

What is the likely diagnosis?

Vitamin D deficiency

Accept:
Osteomalacia
Primary hyperparathyroidism

23

A patient presents with tiredness and notices that he is more pigmented than usual. His results reveal: Na 129 K 6.2 and his blood pressure is 80/50.

What is the likely underlying diagnosis?

Addison's disease

Accept:
Primary hypoadrenalism

24

Which vitamin deficiency is associated with Pellagra?

Niacin deficiency

Accept:
B3 deficiency

25

A patient presents with tiredness and has the following results:

TSH=30 (NR 0.3 to 4.7).

What is the likely diagnosis?

Primary hypothyroidism

Accept:
Myxoedema

26

A 26 year old known I.V. drug user presents with fever, weakness, lassitude and night sweats. On examination you discover a heart murmur.

What is the diagnosis?

Acute endocarditis

Accept:
Bacterial endocarditis
Endocarditis

27

A 70 year old known teetotal patient is noted to have a heart murmur and careful examination reveals splenomegaly with an obvious notch and you can’t get above it. There are no visible veins on the anterior abdominal wall, and there is no ascites, so you conclude that there is no portal hypertension. Dipstick of the urine reveals microscopic haematuria. She is found to have a temperature of between 37.5oC and 38.5oC whenever it is checked.

What is the diagnosis?

Subacute bacterial endocarditis

Accept:
Endocarditis

28

What feature would you expect to see on a blood film in the neutrophils of a patient with pernicious anaemia?

Hypersegmented neutrophils

29

A liver biopsy histology is reported as showing "a nutmeg appearance".

What is the most likely diagnosis?

Right heart failure

Accept:
Congestive cardiac failure
Liver congestion

30

When stained with Congo red stain, an apple green birefringence is seen in a liver biopsy.

What is the most likely diagnosis?

Amyloidosis