Path Past Paper 16-20 Flashcards by J Akoro

1) An old lady has fatigue. She is pale with slight tachycardia. Hb is low, WBC is low, platelets are low, MCV is high. Blood film shows neutrophils with reduced granularity and reduced nuclear lobules. No polychromasia present. Rank the following in order of likelihood, with (1) being the most likely and (5) being the least likely
a) Aplastic anaemia
b) Vitamin B12 deficiency
c) ITP
d) CLL
e) Myelodysplastic syndrome

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2) 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

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3) 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

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4) 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

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5) 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

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6) Rank in order of potency at reducing LDL with (1) being the most potent
a) Evolocumab
b) Simvastatin
c) Atorvastatin
d) Bezafibrate
e) Prednisolone

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7) 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

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8) 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

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9) 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

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10) 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

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11) 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?

polycythaemia vera

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12) Fatigue and mild jaundice, has spherocytes on blood film. Coombs test positive. Likely diagnosis?

warm autoimmune haemolytic anaemia

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13) Which coagulation factor falls most rapidly after starting warfarin?

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14) Young woman requires therapeutic anticoagulation during the 1st trimester of pregnancy. Which anticoagulant should be given?

LMWH

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15) Imatinib is used for what leukaemia?

AML

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16) 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?

multiple myeloma

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17) 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?

T cell lymphoma

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18) 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, low fibrinogen, high D-dimers. What is the most likely obstetric event?

amniotic fluid embolism

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19) At what temperature can platelet transfusions be stored?

room temp (20 degrees C)

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20) Pregnant women has amniocentesis, she is group O-ve. What therapeutic intervention is required?

anti D prophylaxis

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21) Woman is group A-ve. She has had two previous pregnancies. What naturally occurring antibody will be present in her blood?

anti D + anti B

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22) Infants with sickle cell disease (HbSS) may have splenic sequestration. Why does this not occur before 3 months of age?

HbF dampens the symptoms.

HbF synthesis decreases and HbS increases.

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23) Venetoclax is a BCL2 inhibitor used in CLL. What cellular process does it affect?

blocks the anti-apoptotic B-cell lymphoma 2 protein, leading to programmed cell death of CLL cells

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24) 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

CLL

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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?

aplastic anaemia

26) Commonest primary tumour of the heart?

atrial myxoma

28) Most likely cause of mobile mass in young woman’s breast?

fibroadenoma

29) Commonest histological type of primary malignant breast cancer?

invasive carcinoma (probably ductal)

30) What type of emphysema is associated with smoking?

centrilobular damage

31) What is the commonest cause of constrictive pericarditis in the developing world?

32) What is the most common cause of nephrotic syndrome in adults that is a glomerular pathology?

Focal segmental glomerulosclerosis

33) What is the commonest cause of portal vein thrombosis?

malignancy

34) Which organism that causes pneumonia and bloody sputum that is associated with alcoholics and diabetics?

klebsiella pneumonia

35) A dysgerminoma is a type of tumour that affects the ovary. What is the equivalent tumour type in the testes?

seminoma

36) What is the most common histological type of oesophageal cancer in the UK?

adenocarcinoma

37) Intestinal metaplasia in Barrett’s (columnar-lined) oesophagus is most commonly due to the presence of which cell?

goblet

38) Which vascular tumour is associated with infection by HHV8?

kaposi sarcoma

39) What is the commonest cause of myocarditis?

viral infection

40) Raised AMA antibodies are characteristic of which liver disease?

PBC

41) Which virus characteristically causes encephalitis involving the temporal lobes?

herpes simplex

42) What is the most common cause of hypocalcaemia in the community?

primary hypoparathyroidism

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

ALP

44) Addison’s patient is admitted in adrenal crisis. Her BP is low. What fluid should be given?

dextrose

45) Which adrenal zone produces cortisol?

zona fasciculata

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?

viral thyroiditis

47) What condition occurs in both MEN1 and MEN2a?

parathyroid hyperplasia

48) What enzyme does allopurinol inhibit?

xanthine oxidase

49) What vitamin deficiency causes pellagra?

niacin (B3)

50) Which hormone increases urinary phosphate excretion?

PTH

51) Alcoholic has severe abdominal pain, rigid abdomen - he has acute pancreatitis. What blood test will confirm the diagnosis?

serum amylase

52) What active enzyme in sarcoidosis patients causes hypercalcaemia

1 alpha hydroxylase

53) What is the commonest cause of hypercalcaemia in the community?

primary hyperparathyroidism

54) What hormone is produced by fat cells, and has receptors in the hypothalamus?

leptin

55) Deficiency of which plasma protein occurs in patients with liver disease and a movement disorder?

albumin

56) Patient has hypertension. Blood results - normal sodium, low potassium, normal urea, normal creatinine, raised aldosterone, renin suppressed. What is the diagnosis?

primary hyperaldosteronism (conns)

57) What is the name for a fully differentiated B-cell that produces antibody?

Plasma cell

58) What condition involves the upper and lower airways and kidneys, and is ANCA positive with cytoplasmic staining and is specific for proteinase 3?

vasculitis

59) Which condition is caused by reactivation of human polyoma virus 2 (John Cunningham (JC) virus) in immunosuppressed people?

PML

60) Which drug should be given as an immediate IM injection to an individual presenting with acute anaphylaxis?

adrenaline

61) Patient has periodic fevers and is found to have a mutation in MEFV. What is the condition?

familial Mediterranean fever

62) A woman has Graves’ disease. What antibody should be tested?

anti TSH

63) Doctors should measure the level/activity of which enzyme before prescribing azathioprine?

TPMT

64) Child with recurrent bacterial and fungal infections. A dihydrorhodamine test shows that neutrophils fail to oxidise dihydrorhodamine. What is the likely diagnosis?

CGD (chronic granulomatous)

65) Which isotype of antibody is involved in allergies to food and insect venom?

IgE

66) 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

67) 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 cells

68) In bare lymphocyte syndrome which affects the HLA class II transactivator, which type of immune cell will be deficient?

CD4+ T cells

69) Mutation of CD40 ligand is associated with which form of primary immunodeficiency?

hyper IgM syndrome

70) Denosumab is a monoclonal antibody specific for RANKL. What condition is it used to treat?

osteoporosis

71) Woman with iron deficiency anaemia is found to have IgA antibodies specific for tissue transglutaminase. What is the underlying condition?

coeliac disease

72) Which class of antibiotics has concentration dependent killing (i.e. the goal of therapy is to maximise peak > MIC)

ahminoglycosides

73) 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?

cephalosporins

74) What feature of the MMR vaccine makes it contra-indicated in pregnancy?

virulence possibility

75) 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

76) Which human herpes virus is associated with post transplant lymphoproliferative disorder (PTLD)

EBV

77) 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

78) 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

79) 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?

c.diff

80) 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?

most likely and aspergillosis

81) 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?

cryptococcal meningitis

82) 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?

cholera

83) Infection with which virus in the first 20 weeks of pregnancy causes hydrops fetalis?

parvovirus B19

84) 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 | mucormycosis in poorly controlled diabetes

85) 4 year old goes on school trip to petting farm, later has bloody diarrhoea and HUS. What is the causative organism?

E.coli

86) 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?

acyclovir

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

b) Decreased production of beta-globin chains

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

d) Infectious mononucleosis

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

c) Cryoprecipitate d) Fresh frozen plasma ???

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

a) ALL

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

d) Relative polycythaemia | because plasma volume low

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

e) Progression to myelofibrosis

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

b) No monitoring required | such a short half life

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

a) Donor T-cells

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

e) Splenomegaly

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

d) Post partum

97) What is the most appropriate 1st line therapy for CML with acquired Philadelphia translocation, in chronic phase? a) Ibrutinib, a Bruton tyrosine kinase inhibitor b) Imatinib, an ABL1 tyrosine kinase inhibitor c) Rituximab, an anti-CD20 monoclonal antibody d) Thalidomide, an anti-angiogenic agent e) Tocilizumab, an anti-IL6R monoclonal antibody

b) Imatinib, an ABL1 tyrosine kinase inhibitor

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

b) Protein S

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

b) 1:4

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

e) 4 | extra nodal sites

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

c) Coagulative necrosis

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

a) Virchow node

103) What is the most common ovarian tumour? a) Serous mucinous cystadenocarcinoma b) Serous cystadenoma c) Mucinous cystadenoma d) Mucinous cystadenocarcinoma e) Brenner tumour

b) Serous cystadenoma

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

a) Middle meningeal artery

105) Which virus is associated with the development of nasopharyngeal carcinoma? a) EBV b) HBV c) HHV-8 d) HPV-16 e) HCV

a) EBV

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

c) Increased hydrostatic pressure

107) What is the commonest cause of adult ARDS? a) Sepsis b) Trauma c) Pancreatitis d) Drug reaction e) Aspiration

a) Sepsis

108) Which is the commonest glial cell in the CNS? a) Oligodendrocytes b) Microglia c) Ependymal cells d) Endothelial cells e) Astrocytes

e) Astrocytes

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

b) Rheumatic heart disease

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

d) Autosomal recessive

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

a) Alcohol or e) Gallstones

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

c) Meningioma

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

e) Tricuspid valve

114) Which is the most common skin cancer? a) Keratoacanthoma b) Melanoma c) Metastatic cancer d) Squamous cell carcinoma e) Basal cell carcinoma

e) Basal cell carcinoma

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

a) Addison’s disease | crisis

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

e) Dehydration | triggering an addisonian crisis

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? a) Acute pancreatitis b) Viral hepatitis c) Alcoholic cirrhosis d) Haemolytic jaundice e) Obstructive jaundice due to gallstones

e) Obstructive jaundice due to gallstones

118) Which of the following can cause hypoglycaemia? a) Atorvastatin b) Bendroflumthiazide c) Glucagon d) Prednisolone e) Quinine

e) Quinine

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

d) ACTH deficiency | most likely???

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

121) Clinical features of hypercalcaemia include which one of the following? a) Polyuria and polydipsia b) Tetany c) Hypotension d) Diarrhoea e) Easy bruising

a) Polyuria and polydipsia | ???

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

b) Non-functioning pituitary macroadenoma

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

e) Hypopituitarism

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

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

a) There is increased bilirubin in urine?????

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

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

b) ACTH

128) 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

b) Non-functioning pituitary macroadenoma

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) Live attenuated

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

a) Capillaries | think its the blood vessels

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

a) Ankylosing spondylitis

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

b) CD4 T-cells

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

d) Streptococcus pneumoniae

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

a) SLE

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

e) Pernicious anaemia

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

d) Deposition of antibody-antigen complexes in blood vessel walls

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

c) Familial Mediterranean fever

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)

b) Pembrolizumab (anti-PD1)

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) Adalimumab (anti-TNFalpha) b) Basiliximab (anti-CD25) c) Denosumab (anti-RANKL) d) Pembrolizumab (anti-PD1) e) Secukinumab (anti-IL17A)

c) Denosumab (anti-RANKL)

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) Dapsone, methotrexate, prednisolone e) Mycophenolate mofetil, prednisolone, tacrolimus

a) Azathioprine, mycophenolate mofetil, prednisolone

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

b) Dendritic cells??

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

b) Goodpasture syndrome

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%

c) 10%

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

a) Azithromycin | macrolides for atypical cover

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

e) Hepatitis E

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

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

b) Clostridium botulinum

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

a) IV artesunate | as severe

149) Which of the following antivirals is used for chronic hepatitis B treatment? a) Aciclovir b) Oseltamivir c) Tenofovir d) Zanamivir e) Ribavirin

c) Tenofovir

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

d) Rat bite fever

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

d) Sporadic Creutzfeldt-Jakob disease | 80%

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

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

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

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

156) 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

Man with sudden onset abdo pain radiates to the back and dies: 4 years ago had a heart attack, now you aspirate blood from the pericardium

ventricular wall rupture - only because this leads to a haemopericardium

Woman with progressive memory loss and bronchopneumonia

suggesting aspiration pneumonia???

Chest pain, radiates to neck:

myocardial infarction

-Hypothyroidism abs

if hashimotos then anti thyroglobulin and anti thyroperoxidase

-Dry eyes etc. anti Ro, anti La

Sjogrens syndrome

- Droopy eyelid which is fatiguable. Myasthenia gravis abs

Myasthenia gravis abs

Swollen joints of the hand, x-ray shows erosive joint changes.

rheumatoid arthritis

CMV retinitis antiviral

ganciclovir

HSV meningitis antiviral

acyclovir / valaciclovir

VZV antiviral

acyclovir

Child with RSV antiviral

ribavarin

Asthmatic with flu antiviral

oseltamivir (not sure why you couldnt give to an asthmatic)

Man with cough, SoB and wt loss. Hyponatraemia, low serum osmolality, urine Na and osmo were inappropriately normal cause

SIADH

Elderly woman with C. diff and profuse diarrhoea hyponatrameia cause?

diarrhoea, hypovolaemic

Low plasma sodium, low urine sodium cause

hypovolaemic hyponatreamia (non-renal cause)

Man who has been in a car accident, raised sodium and plasma osmolality, low urine osmolality casue

trauma and not drinking

Hyperaldosterone picture with raised Na, low K, HTN but raised renin? cause

Conns

What enzyme is raised in Pagets?

ALP

What would be raised in obstructive jaundice due to gallstones

GGT + ALP

What would be raised in obstructive jaundice due to pancreatic adenocarcinoma?

ALP + CA19.9

What is a sign that your patient has been taking cocaine?

white powder on their nose

Indication for dialysis?

AEIOU

Temporal arteritis test which will help with diagnosis?

ESR

Post strep GN - what do you see in the kidneys?

Malignant HTN, what is the classic finding on histology

ibrous endarteritis in the interlobular arteries of the kidney and fibrinoid necrosis in the walls of a proportion of the efferent glomerular arterioles.

A 64yo man develops renal failure after an episode of haematemesis. What do you see on his kidney biopsy?

Severe UTI in the kidney in Diabetes - what do you see on biopsy?

Multiple myeloma - what would you see in kidneys?

renal failure, amyloid

Non functioning macroadenoma hormone profile

mildly raised proclatin,1000-5000

TSHoma hormone profile

high TSH, high T4

Prolactinoma hormone profile

prolactin >5000

Hypopituitarism hormone profile

low GH, low TSH,, low ACTH

- Primary hypothyroidism hormone profile

high TSH, low T4

- Woman comes in with bitemporal hemianopia, 2cm mass, and a raised prolactin 1400?

macro adenoma

- Woman comes in with no visual change, 4mm mass, and raised prolactin 1400?

micro adenoma

- Raised prolactin, normal TSH, raised T4

- High TSH low T4

primary hypothyroid

causes of pneumonia ● Strep pneumo ● Aspergillus ● PCP ● TB ● Legionella 1) HIV patient - 2) Girl receiving chemotherapy for leukaemia ‘Halo’ sign on CXR- 3) Lower lobe pneumonia in a 22 year old, Gram-positive diplococci - 4) Upper lobe cavitation + alcoholic - 5) Smoker back from holiday in Spain, also hyponatraemic and confused -

HIV patient - PCP 2) Girl receiving chemotherapy for leukaemia ‘Halo’ sign on CXR- Aspergillus 3) Lower lobe pneumonia in a 22 year old, Gram-positive diplococci -Strep pneumoniae 4) Upper lobe cavitation + alcoholic - Klebsiella 5) Smoker back from holiday in Spain, also hyponatraemic and confused - Legionella

``` Micro: Fungi A. Candida Albicans B. Candida something else C. Cryptococcus D. Rhizopus E. Cocciodies F. Trichophytum rubrum G. Malassezia furfur H. Piedraia hortae I. + 6 more unheard of fungi - AIDS person with meningitis - Water polo player with itchy scaly rash on lateral toe then moved along lateral side of foot - Pityriasis versicolor - Lady came back from visiting her sister in Arizona with systemic sx - fever etc: Coccidioides - Man in his 60s with poorly controlled diabetes presents with rapidly progressing periorbital swelling, sinus pain, confusion and sinusitis ```

AIDS person with meningitis Cryptococcus - Water polo player with itchy scaly rash on lateral toe then moved along lateral side of foot Trichophytum rubrum - Pityriasis versicolor Malassezia furfur - Lady came back from visiting her sister in Arizona with systemic sx - fever etc: Coccidioides https://www.cdc.gov/features/valleyfever/index.html (nice) - Man in his 60s with poorly controlled diabetes presents with rapidly progressing periorbital swelling, sinus pain, confusion and sinusitis - apparently Rhizopus spp. causing mucormycosis

``` Immunology A. Interferon gamma B. Interferon alpha C. TNFalpha D. Etanercept E. Basiliximab F. Tocilizumab G. Natalizumab H. Denosumab I. And some others - Ankylosing spondylitis - Resistant Psoriasis - Chronic granulomatous disease treatment - Osteoporosis - Hyper IgM syndrome ```

- Ankylosing spondylitis Etanercept - Resistant Psoriasis Etanercept - Chronic granulomatous disease treatment IFN gamma - Osteoporosis Denosumab - Hyper IgM syndrome Human Ig

``` Histopathology A. Adenocarcinoma B. Squamous cell carcinoma C. Cholangiocarcinoma D. Active gastritis E. B cell lymphoma F. T cell lymphoma G. Glandular dysplasia H. Neuroendocrine tumour I. Other types of dysplasia/metaplasia? J. None of the above ``` - Tumour in head of pancreas, invading into portal vein, mass in liver - Man with H pylori, abnormal area in antrum, mitotic figures and cells with raised nuclear to cytoplasmic ratio, not invading the basement membrane Glandular dysplasia (? - Tumour in oesophagus with keratin and intercellular bridges - Women has acute appendicitis, 5mm tumour found in tip when it’s removed --

Tumour in head of pancreas, invading into portal vein, mass in liver Adenocarcinoma - Man with H pylori, abnormal area in antrum, mitotic figures and cells with raised nuclear to cytoplasmic ratio, not invading the basement membrane Glandular dysplasia (?) B cell lymphoma - Tumour in oesophagus with keratin and intercellular bridges Squamous cell carcinoma - Women has acute appendicitis, 5mm tumour found in tip when it’s removed -- neuroendocrine tumour?

13 Immunology - types of immune cells - What immune cell resides in bone marrow until migrates to site of injury. Oxidative and non-oxidative killing. Dies once job’s done. - Something Foxp3+ cells, I think it also said they mature in the thymus? - What immune cells detects antigen in the periphery and moves to lymph nodes? - What immune cell detects MHC1 and kills virus infected/cancer cells. Is inhibited by MHC I. - What immune cells is targeted by HIV?

What immune cell resides in bone marrow until migrates to site of injury. Oxidative and non-oxidative killing. Dies once job’s done. Neutrophils - Something Foxp3+ cells, I think it also said they mature in the thymus? Treg - What immune cells detects antigen in the periphery and moves to lymph nodes? Dendritic cell - What immune cell detects MHC1 and kills virus infected/cancer cells. Is inhibited by MHC I. NK cells - What immune cells is targeted by HIV? CD4+

haem tests - What would you measure to check for beta thalassaemia? - How to monitor therapy in someone with polycythaemia vera? - Test for autoimmune haemolytic anaemia?

- What would you measure to check for beta thalassaemia? HbA2 - How to monitor therapy in someone with polycythaemia vera? Haematocrit and haemoglobin - Test for autoimmune haemolytic anaemia? Direct antiglobulin test

which is a naturally occurring cytokine that is able to inhibit HIV fusion to CD4+ T-lymphocytes?

MIP-1a binding to CCR5

2) What is done to blood donations to reduce GvHD?

irradiation

3) Eczematous nipple rash caused by individual ‘malignant cells’?

Pagets disease of the nipple???

4) Cat scratch disease full name (genus and species) of bacteria

bartonella henselae

7) Coeliac disease cancer:

EATL (gastric lymphoma)

8) VTE recurrence risk how does being male affect it:

slightly increases it

9) Smear cells, what is diagnosis?

CLL

10) What type of hypersensitivity (Gel and Coombs classification) is myasthenia gravis and what cell?

type II

11) Woman on a DOAC. Advice in pregnancy. Lady with life long DOAC, has never had problems, when becomes pregnant what should you do?

switch to LMWH

12) Most common cause of acute pancreatitis?

alcohol

13) Increased calcitonin. Type of cancer?

medullary thyroid carcinoma

MEN2 medullary thyroid adenoma. What hormone would you measure?

TSH

15) IPEX affects what type of immune cell?

T cells

16) CAH which enzyme deficiency is most common?

21 hydroxylase

17) 2 questions with low TSH, raised T3/4 following a viral infection

viral thyroiditis

23) Most common type of primary thyroid cancer to metastasise to lymph node?

anaplastic????

24) Lady with SLE, has spherocytes, low Hb, raised bilirubin how do you test for diagnosis?

25) What is the definition of herd immunity threshold

something to do with R number

26) Name 1 of the 3 characteristics of Influenza A that could cause a pandemic?

antigenic shift

27) Patient is on low molecular weight heparin, what do you measure to monitor this?

APTT

28) 16 year old girl has pleuritic chest pain, joint pain, positive ANA and Anti-Sm, no liver enzyme derangement, raised ESR?

SLE

29) Alcoholic man is on ceftriaxone for meningitis, what organism is he at risk of which this does not cover for?

31) What virus increases risk of nasopharyngeal cancer?

EBV

32) What additional virus apart from HIV and HBV are screened for in platelet donations to pregnant women?

CMV

33) Multiple questions on differentiating primary biliary cholangitis and primary sclerosing cholangitis (including which one is associated with UC and which one involves granulomas)

34) Chimeric antigen receptor T-cell therapy against CD19: what type of haematological malignancy does it target?

B cell

35) Kid has low calcium, cleft palate, low T cells,?

DiGeorge, 22 11q.2 deletion

36) Has contact with someone with TB, what is the risk of getting active TB?

10%

37) Ankylosing spondylitis - they’ve tried NSAID and TNF inhibitor?, what else can you target?

IL-17

38) Diffuse continuous inflammation rectal to caecal, with no granulomas

39) 45yo woman with autoimmune diseases, low IgM, IgA and IgE; full blood count is normal?

CVID

40) Patient with low WCC and Plt and teardrop cells on film?

leucoerythroblastic anaemia

41) Which enzyme is raised in Paget’s, Osteomalacia etc. and is caused by osteoblast activation?

ALP

42) Patient with GI conditions, lack of which substance leads to B12 being malabsorbed

intrinsic factor

43) T1DM? with hypoglycaemia, What is the management option if no IV access?

IM glucagon

44) Young guy has a fall and hits his head, presents two days later and then loses consciousness, where is the bleeding coming from?

extradural - veins?

on Ovarian mass in Japanese woman: signet ring cells

metastses from colon cancer

46) HTLV1 virus is associated with which cancer

adult T cell leukaemia

47) Woman with constipation from abroad (sounded like salmonella typhi?) - what abx do you give if she hasn’t been started on them already

ceftriaxone

48) Patient with microcytic anaemia abdominal symptoms. Duodenal biopsy showed crypt hyperplasia and non-caseating granulomas, lymphocytes

coeliac

49) MAHA and thrombocytopenia following GI upset

HUS, E coli 1057:h7

50) Septic arthritis in a 56yo man - likely organism?

staph aureus

51) What is called when you have discontinuation of epithelium

ulcer

52) Which immunoglobulin is found in mucosa

IgA

54) What cell goes wrong in IPEX?

T reg cells

55) What does it mean if urine MC&S sample has epithelial cells and mixed bacterial growth

contaminated sample

56) Histopathological change that occurs to liver in patients with diabetes?

fatty liver

57) Patient with subtotal villous atrophy, tall crypts

-coeliac

58) Diffuse continuous inflammation rectal to caecal, with no granulomas.

UC???

59) Young guy has a fall and hits his head, presents two days later and then loses consciousness, where is the bleeding coming from

extradural - veins?

60) Histopathological change that occurs to liver in patients with diabetes?

fatty liver

1. Antibody for Graves

anti TSH receptor

2. Nivolumab is a PD1 inhibitor, what cells does it target?

T Cells

3. PCSK9 inhibitor - evolucumab, what does it halve?

LDL

4. Which molecule takes cholesterol and moves it to liver and steroidogenesis organs

HDL

5. 42 year old woman has a history of intermenstrual bleeding. On examination, a cervical polyp is found. What do you do next?

Remove it and send it for histology

6. EBV serology 2 weeks post infection

EBV IgM

8. Homeless guy dies (signs of trauma), cannot contact brother, what do you do about the autopsy?

9. HIV positive girl dies of cerebral toxoplasmosis, before she dies she says she doesn’t want to disclose her HIV status. What do you write on the death certificate?

10. Woman (45y) with learning difficulties and cerebral palsy, she gets influenza, then strep pneumonia, then dies of cardiorespiratory arrest. Death certificate

11. Man dies, daughter consents to autopsy, step mum (his wife) does not want autopsy - what to do?

12. Guy with brain mets from lung cancer, history of PE, dies of cardiorespiratory arrest. Fill out death certificate

13. Which vaccine is a polysaccharide and conjugate vaccine?

14. Which disease do you see in both MEN1 and MEN2a?

parathyroid adenoma - primary hyperparathyroidism

15. What is one of the complications of Parvovirus B19?

aplastic aneamia, hydros fetalis

16. What type of section is done for urgent diagnosis during surgery?

frozen section

17. ToF - what type of shunt?

right to left

18. How do you initially treat Malaria falciparum; 38.9 fever, hypotension, 4% parasitaemia?

iv artesunate

19. Insulinoma. What would you find?

low FFAs

20. Bortezomib is a proteasome inhibitor, how does this work?

21. What is the first-line treatment for CML?

imatinib

22. Woman, non-smoker, peripheral lung tumour, which type is it most likely to be?

adenocarcinoma

23. Woman with periorbital purple rash and rash on legs (dermatomyositis?), which enzyme is elevated?

creatine kinase

24. Vitamin deficiency that causes megaloblastic anaemia & NTD?

folic acid

25. What Type Hypersensitivity causes serum sickness?

type III

26. High PTH and low Ca, what can this be

osteomalacia

27. Young gentleman brough to A&E by friends due to confusion. CSF is clear, raised lymphocytes, high protein, normal glucose. Causative organism?

HSV - confusion suggets encephalitis

28. Low sodium (124) and specific gravity of 1.000 cause?

psychogenic polydipsia

29. Neonate (2 day old) has meningitis and blood cultures isolate gram negative rods, what is the organism?

e.coli

31. Gram +ve cocci UTI in a woman?

staphylococcus saphrophyticus

32. What would be high in most common cause of CAH

ACTH

33. What vaccine preventable organism causes cough, lymph node enlargement and has a potential to occlude the airway?

diphtheria

34. Which hormone leads to release of prolactin?

TRH

35. Transfusion level for platelets after trauma?

36. What is the effect of the gene mutation in familial mediterranean fever?

increased IL-1 production

37. Man with cyanotic heart disease has a haematocrit of 54% (high) and is found to be negative for JAK2 mutation. What does he have?

secondary polycythaemia

38. Man with history of PKD has a cerebral bleed - what type?

berry aneurysm - SAH

39. What cell type is raised in the blood in schistosomiasis?

eosinophils

40. Boy visits grandparents in Wiltshire, comes back with 5 days of diarrhoea, no vomiting, and unexplained bruises all over body

HUS e.coli 0157:h7

41. Mechanism of hyperacute allograft rejection

preformed antibodies

What is common feature between MEN1 and MEN2a?

parathyroid adenoma

. A man with persistent heartburn has an Endoscopy done, which shows a mass in the oesophagus (at a depth of) 35cm (???) down. Which cancer develops in Barrett’s oesophagus?

adenocarcinoma

What is the mechanism in the oesophagus as a result of reflux (GORD) that takes place and leads to cancer?

dysplasia

What happens to the body of the stomach in a patient with pernicious anaemia?

hypotrophy

Which cancer do you get with H.Pylori?

antigenic stimulation - MALT

Cancer in Coeliac disease. What would they get if they don’t follow a gluten free diet?

EATL

. 60 year old Man with abdominal pain radiating to back, collapses and dies

aortic dissection | or rupture abdo aneurysm

Man, ex-smoker, with history of hypertension and MI, has sudden chest pain which radiates to the neck

carotid artery thrombus

50 year old lady with memory issues/progressive amnesia, hypertension (?? + bronchopneumonia??)

multiple cerebral infarcts

Elderly man with atrial fibrillation with right flank pain?

renal artery stenosis

Man has an MI 3 years ago. Now comes into hospital feeling very unwell. Is having a sample taken from their pericardial layer and you find blood is aspirated from the pericardium

ventricular wall rupture

Child had spherocytes and anaemia and it asked next investigation to do

DAT testing??

2. Histology: supraclavicular aspirate, girl has swollen face? Showed reed-sternberg (poorly drawn) cells

Hodgkins lymphoma

3. MEFV Mutation, what is it?

familial mediterranean fever

4. NOD2/CARD15, what is it found in?

IBD

5. Immunodeficiency with common gamma chain problem?

6. Common traveller’s diarrhoea

E.coli

7. Swollen joint, needle-shaped aspirate with negative birefringence, what is the enzyme responsible

xanthine oxidase

8. Treatment for previous question (gout), specifically not one you should use acutely

9. What does JC virus cause?

progressive multifocal leukoencephalopathy

10. Reactivation of a virus following a transplant.

EBV or CMV?

11. Bacteria causing scarlet fever?

group A streptococcus (strep pyogenes)

12. Most common virus causing aseptic meningitis?

13. Old man with iron deficiency anaemia, what’s the mo st important investigation to do.

colonoscopy

14. Smear cells.

CLL

15. Child (was a 15 yo) with brain tumour extends outwards from cerebellum and invading subarachnoid space. Signs of ataxia? What is the most likely type.

16. Publican with diabetes, fatty stools, weight loss, ‘slate grey skin’ and joint pains. What is the underlying diagnosis causing this?

17. 5yr old, tetany, bone pain. Widened epiphyses + ‘Cupping’ of metaphysis shown on x-ray. What is the cause?

rickets????/

18. What is the minimum amount of time to treat a VTE?

3 months

19. A girl comes, overweight, irregular periods, flare of acne and hirsutism

PCOS

20. Mother is a donor for kidney to a child, what is the max number of mismatches possible with HLA class I?

21. Ovarian tumour with hair. No immature cells seen.

teratoma (mature)

Neonate with meningococcal sepsis. What pathogen

GBS

23. Sacroiliitis, HLA B27 positive-

ankylosing spondylitis

24. HIV +ve patient with v low CD4 + vascular lesions seen on trunk. What virus causes this cancer?

HHV8 - kaposis sarcoma

25. What enzyme to confirm cardiac failurxe?

BNP

26. What liver enzyme is raised in MI

ALP

27. Old man who fell over, been on floor for days. Severely dehydrated. Dark urine. Not blood on microscopy. What causes the dark urine?

myoglobin

28. Same man (Old man who fell over, been on floor for days. Severely dehydrated. Dark urine. Not blood on microscopy.), what enzyme will be high (>5x upper limit of normal)?

creatine kinase???

29. Lady with Multiple myeloma and restrictive cardiomyopathy. What will you see on heart biopsy?

amyloid deposits

30. Treatment for MRSA.

vancomycin

31. Man with macrocytic anaemia, atrophy of body of stomach. What substance are they deficient in that leads to B12 malabsorption?

intrinsic factor

32. Previous IVDU man is given Rituximab - CHOP treatment for Non-Hodgkin’s lymphoma. He later 8 months later develops fulminant liver failure and dies. Why?

33. Someone with aphthous ulcers, conjunctivitis, diarrhoea & abdo pain

34. Which coagulation factor is decreased first on administration of warfarin?

protein S and shortest half life

35. White things on the oesophagus seen in OGD of an alcoholic man with recurrent bleeding varices. What are they?

36. Lady who went to ?Mexico and ate unpasteurized dairy. 4 weeks later unwell (no diarrhoea mentioned?) Which gram -ve rod caused this?

38. Non-Tuberculous mycobacterium , some cut on his hand in a man who cleaned a fish tank?

marinarum???

39. painless penile ulcer which healed in few weeks, followed by fine snail track oral ulcer

syphillis

40. Lady with low Hb, raised Br (i.e. haemolytic anaemia) background of SLE. What test is best to determine the cause?

dat

42. Which type of cell does Rituximab target?

B cells

43. What is the treatment for c diff?

vancomycin / metronidazole (check guidelines)

44. What type of cancer is oesophageal

adenocarcinoma

45. What type of cancer is gastric

lymphoma?

46. Child born with abnormal facies and congenital cardiac abnormalities also has normal B cells but abnormal T cells, what genetic mutation would you see. Or they said the mutation and what condition it is.

DeGeorge 22q 11.2 deletion

Cancer with keratin and intercellular bridges

-squamous

48. cANCA positive man with glomerulonephritis and lung changes, what does he have?

GPA???

49. How does HepA spread

faecal oral

Someone gets reactions when being given penicillin. Which of these drugs will be ok to give them? Options: piperacillin/tazobactam, temocillin, amoxicillin, co-amoxiclav, cefalexine

``` Treatment for CLL with p53 mutation. What is the first line treatment? Ibrutinib BTK inhibitor ● Rituximab ● Imatinib ● Ibrutinib ● Ciclosporin ```

Ibrutinib

Treatment for CML:

imatinib

What is the usual prophylaxis for allograft rejection ● Mycophenolate mofetil, pred, tacrolimus ● Mycophenolate mofetil, pred, azathioprine ● Cyclosporine, tacrolimus and rafamycin

``` Think there was for treatment with Rheumatoid arthritis? It gave names and mechanisms ● Adalimumab - TNFalpha ● Basiliximab - Anti CD25 ● Denosumab - anti-RANKL ● Secukinumab ```

TNF alpha

``` HIV - what natural antibody against, which confers protective immunity against HIV? Or something similar ● HIV - GAG ● HIV - gp120 ● CXCR4 ● Protease ● Reverse transcriptase ```

What is in urine of a multiple myeloma patient?

bence jones

Common cause of cellulitis in this list? S. epidermidis B. S. saprophyticus C. S. pyogenes D. S. agalactiae E. E. coli

C. S. pyogenes

Which type of embolus is common in cholesterol cleft?

Patient with coeliac. What would you see on biopsy? ● Intraepithelial? Leukocytes ● Intraepithelial? Eosinophils ● Intraepithelial? Macrophages ● Intraepithelial neutrophils ● Intraepithelial Lymphocytes ● All answers were the same but with a different cell on the end

Intraepithelial Lymphocytes

``` Lady has newborn baby. Dat +ve, spherocytes seen. Baby jaundiced. Lady is Group A Rhesus negative, Baby is Group O Rhesus positive. Why is baby jaundiced? ● Hereditary spherocytosis ● G6PD ● ABO incompatibility ● Rhesus incompatibility ```

Rhesus incompatibility | HDN

``` Acquired MAHA. What do you see? ● Dat +ve spherocytes ● Dat +ve fragments ● Dat -ve spherocytes ● Dat -ve fragments ● Dat +ve smear cells ```

● Dat -ve fragments

``` Red cell lysis, what ion is raised: ● Potassium ● Sodium ● Calcium ● Bicarbonate ● Other things…. ```

-potassium?

``` Sickle cell patient, spleen not felt. Low reticulocytes, very anaemic. ● Parvovirus B19 ● Splenic sequestration ● Normal for SCD ● Sickle cell crisis ● ???? - other spleen thing ```

aplastic?????

``` What causes hypertension in upper half of body? ● Coarctation of the aorta ● Renal ___? ● Renal parenchymal disease ● Renal vascular hypertension ● Adrenal hypertension ```

HTLV1 Virus lymphoma

adult T cell

Woman presents worried because she has low glucose when she tests using daughter’s meter (her daughter has DM1), but denies taking any drugs. Low glucose, high insulin, low C peptide Think they also stated she had a high BMI? ● Factitious insulin (was called ‘surreptitious’ insulin) ● Surreptitious gliclazide ● Type 1 diabetes mellitus ● Anorexia nervosa ● Insulinoma

Factitious insulin (was called ‘surreptitious’ insulin)

``` What is low during pregnancy? ● Fibrinogen ● Factor 7 (or 8?) ● Protein S ● Plasminogen activator inhibitor 1 ● Von willebrand’s factor ```

-protein S

Person with low platelets & bruising, fever, confused. What’s going on?

``` How does a melanoma spread? ● Lymphoid ● Haematological ● Perineural ● Iatrogenic ● Transcoelomic ```

-lymphoid?

What malignancy is someone with coeliac/some other condition that causes a lymphoma likely to get

EATL

What to put on death certificate for a well-controlled HIV patient who had a PE after a long haul flight and died from cardiac arrest soon after admission to hospital.

Woman found at home surrounded by needles, lots of extra pathologies - PE, etc. Family are waiting for the death certificate what do you do? ● Ask family for permission to do the autopsy in hospital ● Call the coroner, and ask him to ask the family to do the autopsy in the hospital ● Can’t give death certificate ● Just give death certificate without autopsy

Can’t give death certificate

Homeless man dies, no next of kin consultant says you need to do an autopsy, what are your options ● Consent not needed- human tissue act doesn’t apply ● Court must give permission ● At least 2 consultants must give permission for autopsy to go ahead ● No autopsy required ● ?Wasn’t there an answer like autopsy is in best interests so do one?

Hospital Autopsy. Coroner wants a spine specimen for teaching. What do you? ● Must ask family ● Don’t need one as hospital and good for education (something like that)

1. After a lady receives a blood transfusion and platelets, she goes home and develops a rash all over [‘several hours later’]

transfusion purpura

2. A man after a road traffic accident (Man vs Car) requires a 6 unit transfusion, and then becomes acutely breathless/SOB, with a fever and tachycardia

3. A Man has had (a diagnosis of) beta thalassemia since 13 months of age. (?and receives regular transfusions?). He presents to an outpatient clinic with malaise and erectile dysfunction

iron overload

4. Alcoholic has an AAA repair, and several days later develops a fever, with low Hb, and jaundice

5. A Lady with myelodysplastic syndrome (MDS) requires regular monthly blood transfusions. 10 minutes after another transfusion (her latest transfusion), she becomes tachycardic, has transfusion site pain, and [hypotensive/hypertensive], what is the cause?

hyperacute reaction

1. An African lady’s doctor requests a sickle cell solubility test, [?after blood tests show low Hb and normal MCV?]. The test comes back positive with some clouding of the tested blood. What is the diagnosis?

2. An African child is found to be anaemic with a low Hb and normal MCV. The doctor in the hospital has the child’s blood tested by Electrophoresis to confirm the suspected diagnosis. Results show very high HbS and low HbF. What is the diagnosis?

sickle cell anaemia

3. Haemolysis after antimalarials / malaria treatment.

g6pd

4. A man has spherocytes, polychromasia and reticulocytosis on blood film.

5. Girl with coeliac disease, refuses to stick with a gluten free diet and now has macrocytosis. Why has this happened?

malabsorption | b12 deficiency

1. A teenage girl who when she goes cross country running gets an erythematous rash on her legs. It is well controlled by antihistamines

2. Man can eat apple pie. But if he eats fresh apples and pears, he gets inflamed lips

3. Man has an allergic reaction during surgery and who’s lips becomes swollen/oedematous when blowing up balloons as his daughter’s birthday party

latex allergy

4. Bloated after drinking milk but not IgE mediated

intolerance, lactase deficiency

5. A girl with a sore throat is given penicillin and develops a rash. She is found to have EBV.

1. Patient with high IgG paraprotein – (32 or 40) g/dl, back pain and loss of sensation in legs

cauda equine from multiple myeloma

2. Patient with IgM paraprotein and visual disturbances

3. A German lady who is asymptomatic, has low neutrophils, but no abnormal cells on film

4. A man is injured playing sports. He is found to have pancytopenia and immature myeloid cells on blood film. WCC normal

5. An overweight individual with diabetes has longstanding bone/back pain. They are found to have paraprotein IgA ~8g/dl, and GFR 55mls/min/1.73m^2. FBC normal and albumin normal.

1. 24 year old asymptomatic man with isolated rise in unconjugated bilirubin (all other results (ALT, ALP etc normal)

Gilberts

2. 22 year old student with two weeks anorexia, fever and malaise – raised ALT, normal/super mildly raised ALP + GGT

3. Women with colicky abdominal pain. Elevated mildly elevated ALP, ALT, GGT, & Bilirubin. GGT + Bilirubin most raised of results provided.

4. A 57 year old man presents following hematemesis and is found to have: a. High ALT + GGT, and slightly raised ALP. Low Albumin.

alcoholic hepatitis - cirrhosis

5. An elderly gentleman has really really elevated ALP on it’s own, and the other results are normal. He also reports a history of headaches.

-Pagets

1. What is the most common cause of traveller’s diarrhoea?

e.coli

2. Microbiology - Food poisoning question – guy develops foul-smelling diarrhoea and cramping pain 5 days after eating chicken at a barbeque

campylobacter jejuni

3. Microbiology - Food poisoning question - after Chinese/rice based dinner.

bacilus cereus

4. Women has had some surgery which required antibiotics, and now has profuse watery diarrhoea

c.diff (pseudomembranous colitis)

5. A ward sister gets diarrhoea, and patients on the ward have been ill recently (?with same thing?)

norovirus

a. Treatment (?of choice?) for Listeria meningitis

ampicillin

b. Used for mild CAP (Community acquired pneumonia) caused by Hib (Haemophilus influenza type B)

amoxicillin

2. IV antibiotic for Group A Strep pharyngitis/Strep Throat?

penicillins

3. Young women with cystitis and fully sensitive E-Coli.

nitrofuration or trimethoprim

4. Which/What antibiotic would you use for cellulitis with MRSA (question specifies it HAD to be IV).

1. Low sodium, all else (K+, CL-?) normal. Glucose before OGTT is 4.9, 2 hours later is 10 ish.

2. A (?teenager?) presents with a history of several weeks of increased thirst (polydipsia), increased urination (polyuria) / High urinary output and weight loss:

type 1 diabetes

high [Na+ / Sodium] low [K+ / Potassium] high (Urine osmolality)

conns

pH below 7.35 – Acidosis K+ - high Metabolic acidosis present

``` high sodium (173), high potassium, plasma osmolality ~400 urine osmolality ~600 ```

1. Which/What cell sits in (it’s immature form in) the periphery, and when it matures, goes to present things to T cells?

monocyte

2. Which/what cell is inhibited by the presence of MHC1 on cells?

3. Which/What cell is increased in cases of a parasitic infection.

eosinophils

4. Which/What cell undergoes positive and negative selection in the thymus.

t cell

5. When there is an infection. This cell is responsible for the production of pus (when it dies).

neutrophil

1. A man with persistent heartburn has an Endoscopy done, which shows a mass in the oesophagus (at a depth of) 35cm (???) down. Which cancer develops in Barrett’s oesophagus?

adenocarcinoma

2. What is the mechanism in the oesophagus as a result of reflux (GORD) that takes place and leads to cancer?

epithelium metaplasia and dysplasia

3. What happens to the body of the stomach in a patient with pernicious anaemia?

hypotrophy

4. Which cancer do you get with H.Pylori?

MALT - marginal cell non Hodgkins lymphoma

5. Cancer in Coeliac disease. What would they get if they don’t follow a gluten free diet?

EALT

1. Most common type of malignancy in the breast?

invasie ductal carcinoma

2. Which/What cancer is also known as non-specific type?

3. Which/What cancer is associated with (? the presence of?) E cadherins?

4. Cancer which has a high, medium and low stage to it.

5. Fibro-epithelial tumour with abundant stromal elements.

1. Which/What enzyme if low, leads to hyperuricemia/rise in blood uric acid?

xanthine oxidase

2. Which/What enzyme regulates the rate limiting step in haem biosynthesis pathway/of the blood

ALA -S

3. Which/what enzyme is raised in osteomalacia?

ALP

4. Which/What enzyme is raised in mumps?

amylase

5. In Rhabdomyolysis, which biomarker is likely to be raised?

creatine kinase

1. Woman presents with aches all over, (diffuse swelling), and joint stiffness? which ab

2. Woman with dry eyes and parotid swelling? | which ab

anti Ro and anti La

3. Man with weakness in the gym and ptosis. | which ab

anti acetylcholine receptor

4. A patient with well controlled HIV, who is currently on HAART. What would you measure?

CD4 and viral load

5. A women with known SLE presents with an exacerbation of her SLE/worsening symptoms. What do you measure?

complement levels

1. A 60 year old lady with recurrent chest infections now has reduced total serum protein and has autoimmune thrombocytopenia

2. A 12 year old boy has recurrent chest infections, and has an ear infection. He doesn’t have any B Cells

brutons

3. Boy with abscesses has a positive NBT

IL12 /IFN gamme deficiency

4. A Girl is found to have no CD4 cells, but CD8 cells and B cells are present.

BLS type II

1. A man presents with the symptoms of a UTI and acute onset costovertebral pain. He is found to have pus cells and blood in his urine. What is the most likely cause?

pyelonephritis

2. A lady with loin-to-groin pain, haematuria and pain at the end of micturition. What is the most likely cause?

stones or pyelonephritis

3. A lady has frank (visible) painless haematuria and a mass palpable on one side. What is the most likely cause?

4. A 2 year old has a palpable abdominal mass when his mother picks him up. What is the most likely cause?

Wilms (nephroblastoma)

5. A man with AF (Atrial fibrillation) develops fever, nausea, vomiting and pain in his right loin/flank. What is the most likely cause?

renal thrombosis

1. What is the most common cause of thrombocytopenia/low platelets in Pregnancy (Commonest cause of maternal thrombocytopenia)?

-google says - Gestational thrombocytopenia (70%) Preeclampsia (21%) Immune thrombocytopenic purpura (3%)

causes DIC (in pregnancy)?

amniotic fluid embolism

4. Normal change in pregnancy

decreased Hb, increased clotting

5. Cause of Neonatal thrombocytopenia?

maternal history of thrombocytopenia due to autoimmune disease (eg, immune thrombocytopenic purpura [ITP] or systemic lupus erythematous [SLE]), previous affected sibling (eg, neonatal alloimmune thrombocytopenia [NAIT]), or specific disorders associated with thrombocytopenia that may be identified by characteristic physical findings. These include genetic and chromosomal disorders (eg, trisomies 21, 18, and 13) and congenital infections such as cytomegalovirus (CMV) and rubella (table 1).

1. Which drug do you give to a woman who is infected with herpes simplex/ HSV1 encephalitis?

IV acyclovir

2. Which drug do you give to a woman who is infected with herpes zoster in pregnancy?

IVIG

3. What drug do you give to treat a Neonate with Cytomegalovirus Retinitis?

ganciclovir

4. Which antibiotic do you use to treat viral syncytial virus (bronchiolitis) in a child?

not an Abx - palivizumab

5. In a 19 year old asthmatic. What drug do you use to treat influenza A?

oseltamivir

1. 60 year old Man with abdominal pain radiating to back, collapses and dies

dissection or AAA???

2. Man, ex-smoker, with history of hypertension and MI, has sudden chest pain which radiates to the neck

carotid artery embolism

3. 50 year old lady with memory issues/progressive amnesia, hypertension (?? + bronchopneumonia??)

4. Elderly man with atrial fibrillation with right flank pain

renal thrombosis

5. Man has an MI 3 years ago. Now comes into hospital feeling very unwell. Is having a sample taken from their pericardial layer and you find blood is aspirated from the pericardium

-ventricular wall rupture

1. A girl has recently been noted by her parents to be acting strange lately. A Lumbar puncture is performed and the CSF shows high lymphocytes and a raised protein, but normal glucose (on LP)

2. An 18 year old students is found to have Gram Negative diplococci causing meningitis. Which microorganism is the most likely cause?

-neisseria meningitidis

3. A smoker (?middle aged?) is found to have a Gram Positive diplococci causing meningitis. Which microorganism is the most likely cause?

-streptococcus

4. Gram negative rod causing sepsis in a neonate?

e.coli

5. Gram positive rod causing meningitis in a 72 year old?

listeria monocytogenes

Which/What cancer can the Bruton Tyrosine kinase inhibitor ibrutinib be used in? a. Bruton’s b. Chronic myeloid leukaemia (CML) c. Acute myeloid leukaemia (AML) d. Acute lymphoblastic leukaemia (ALL) e. Chronic lymphoblastic leukaemia (CLL)

e. Chronic lymphoblastic leukaemia (CLL)

2. A Rhesus D negative woman is having a Haematopoietic stem cell transplant (HSCT) and is CMV IgG negative. What is the most important thing to ensure in the transplant? a. HLA of donor and recipient identical b. Related to recipient and HLA identical c. HLA haploidentical d. CMV IgG negative e. Donor not Rhesus match

. CMV IgG negative

3. Graft(?-verus host?) disease pathophysiology in (?a Haematopoietic stem cell transplant (HSCT) gone wrong?) a. CD4 + activated and assists CD8+ & B cells b. HLA c. pre-existing antibodies in the recipient d. mast cell degranulation e. ischaemia of the donated organ

4. HIV RNA forms HIV, via which error prone enzyme? a. RNA polymerase b. DNA polymerase c. RNA transcriptase d. Reverse transcriptase

d. Reverse transcriptase

5. Person is discharged after surgery, who had a bilateral hemianopia, with removal of pituitary adenoma. Consultant says it is alright to discharge them. What do you prescribe the patient on discharge? a. DDAVP b. Fludocortisone c. Testosterone

6. Which of these vaccines must not be given to a pregnant woman: a. MMR b. Hep B c. DTP

MMR

7. What cell in the body is likely to bind to MHC1 presenting cells (or something like that) – a. Natural killer cells – aka. NK Cells b. CD4+ cells c. CD8+ cells (- aka: Killer T cells, T-killer cells, Cytotoxic T cells, CD8+ T cells)

CD8+ cells

8. There are 5 special drug treatments. Which drug can be used to treat some malignancies and affects T cell activity? a. Infliximab b. Pembrolizumab c. Rituximab

9. Large mass on right side and has blood in the urine? a. Renal Carcinoma b. Wilm’s tumour

kidney tumour - depends on age

10. 10 year old Nigerian boy with a neck swelling. You use a rudimentary staining kit (for some reason I think this was at a missionary). Stained with H and E. Starry Sky (below picture provided in exam)

burkitts non-hodgkins lymphoma

11. Which of these is a common finding in someone who has portal hypertension? a. Splenomegaly b. Hepatomegaly c. Spider Naevi in distribution of Superior vena cava (SVC) d. Hand flapping e. Jaundice

Splenomegaly

12. A man has gout and is kept up at night by it. His symptoms are relieved by ibuprofen, but when he stops taking it, the symptoms come back. His neighbour is on allopurinol, and he would like to be on it too. Which of these medications would need to be altered for them to be able to be prescribed allopurinol?

azathioprine

13. Which cancer does asbestos cause?

mesothelioma

``` 14. Interpret blood gas (ranges were given): pH 7.1, PCO2 low (2.2 or 3 or something) a. metabolic acidosis b. metabolic alkalosis c. respiratory acidosis d. respiratory alkalosis ```

15. Second interpret blood gases or something like that (I think this second question is immediately after the above interpret blood gas question in the exam, as first one gave you some ranges to help you) Person presents with Hypocalcaemia, and a seizure following something?????? We are given his biochemistry. What is the likely cause? a. SIADH b. Cranial DI c. Nephrogenic DI

16. A Girl develops a throat infection. She is given amoxicillin, and a rash develops. It is later found out that she has infectious mononucleosis, and her symptoms persist (?despite the treatment with amoxicillin mentioned earlier in the question?). (???What is the likely cause??? a. Drug reaction b. Penicillin allergy c. Mastocytosis

17. Woman who has mouth/lip swelling following a dental procedure, and her mother reports a similar history in the past a. Serum like reaction b. C1 inhibitor deficiency

18. Man has intermittent mouth & tongue swelling for the past 2 years, which is unresponsive to over-the-counter anti-histamines, is on aspirin and ACE inhibitor. What is the likely cause? a. Irritant dermatitis b. Drug induced reaction c. Serum like reaction d. C1 inhibitor deficiency e. Carcinoid Tumour

Drug induced reaction | acei induced angioedema

19. A lady is found to have cancer, and investigations show it is a ‘transitional cell’ cancer. Where has it metastasised from? a. Colon b. Liver c. Bladder d. Breast

c. Bladder IDK this is where it starts

20. What is the most specific marker for Rheumatoid arthritis: a. Anti-nuclear antibodies b. Anti-cyclic citrullinated protein c. Rheumatoid factor d. Tissue-transglutaminase antibody

b. Anti-cyclic citrullinated protein

22. Woman over 25 years of age. In theatres you overhear a surgeon who says they have just found one of the most common ovarian tumours: a. Serous adenocarcinoma b. Teratoma c. Psammoma bodies

a. Serous adenocarcinoma

23. Man presents with ulcers on mouth following treatment with a drug

24. The wall of vessels expresses anti-thrombotic factors why is this? a. Because it secretes Tissue factor b. Because it secrete Thrombomodulin c. Because it secretes Von Willebrand factor

25. Cushing disease person – Which is the best investigation to confirm the suspected diagnosis? a. High dose dexamethasone suppression test b. Low dose dexamethasone suppression test c. Long synacthen test d. Short synacthen test

27. What does the number of True positives divided by the total number who have the disease describe? a. Positive predictive value b. NPV (What does this mean?) c. Sensitivity d. Specificity e. Z score

-positive predictive value

28. Which of these does not lead to/cause Chronic Hepatitis? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis D e. Hepatitis E

e. Hepatitis E

29. Which type of cell is matured in the Thymus?

a. T cells

30. Which of these ions (K, CL, Na, Mg, ,,,,,) is most likely to be outside it’s normal range in an alkalotic picture (& if person is urinating a lot????)? a. Potassium b. Calcium c. Sodium d. Magnesium

31. Person has a blood reaction: A pregnant woman who needs anti-coagulation. a. LMW heparin b. Frozen Fresh Plasma

LMWH

32. How would you treat methicillin resistance streptococcus aureus?

-vancomycin

33. Which cancer is most likely in a person who is a non-smoker? a. Small cell carcinoma b. Adenocarcinoma

adenocarcinoma

35. Which of these can cause peri/neonatal illness without causing damage to the foetus if the mother is infected antenatal? a. Cytomegalovirus (CMV) b. Herpes Simplex Virus (HSV) Splenomegaly d. Varicella Zoster Virus (VZV) e. Rubella

Splenomegaly

36. Child/Infant – nephrotic syndrome – (What is the most likely diagnosis)? a. Minimal change disease b. Membranous glomerulonephritis c. Focal Segmental glomerulosclerosis

Minimal change disease

37. 50 year old man with Midshaft femur fracture – what would you find at the site of the break/fracture (or rather, which/what type of cancer does he have)? a. Neuroblastoma, b. Osteosarcoma c. Ewing’s sarcoma d. Chondrosarcoma e. Adenocarcinoma

38. Lady with Diarrhoea and weight-loss - There are patches of inflammation on endoscopy, with biopsy showing a granulomata (I remember it was a group of granules or some latin word for that) a. Crohn’s disease b. Ulcerative Colitis

crohns

39. (I think the point of this question was to realise this was a hospital-acquired-infection, (so it didn’t explicitly say it was a hospital acquired pneumonia) but I could be totally wrong) Which of these is the most likely causative organism of a hospital acquired pneumonia? a. Haemophilus influenza b. Steptococcus pneumonia - Most common community acquired pneumonia c. Staphylococcus aureus d. Microplasma meunomia e. Pseudomonas aregenosa f. Aspergillus

. Staphylococcus aureus

40. Which/What is the most common cause of jaundice/fever in a returning traveller with a fever? a. Malaria b. Hepatitis c. HIV seroconversion d. Typhoid e. Dengue

42. Middle aged lady. Liver biopsy, loss of bile ducts and granulomas present. Which/what disease is consistent with these findings? a. Mucinous carcinoma b. Primary biliary cholangitis c. Primary sclerosing cholangitis

PBC

43. Which feature is characteristic of acute lymphoblastic anaemia (ALL) – a. anaemia and thrombocytopenia b. neutropenia c. macrocytosis d. raised lymphocytes

a. anaemia and thrombocytopenia

44. A pregnant lady is in her first trimester, and is found to have a High MCV, and a low Hb. She informs you that she hasn’t started taking any multivitamins, or supplements, since finding out she is pregnant. a. Iron deficiency anaemia b. Pernicious anaemia

folate deificiency

46. Dad and brother of dead individual disagree over having an autopsy. The Dad was the main carer but no mention of Standing order or special status assigned to dad by the dead individual. a. Dad & Brother disagree so there can be no autopsy b. There is a family disagreement so there can be no autopsy c. An autopsy can be done but to settle the disagreement it goes to a special court

47. Next of kin is identified for a woman who is estranged from her family, and found at home unresponsive with needles, and is a drug addict. When they get her to hospital she dies (or she is dead before you can talk to her? Can’t remember) They find her next of kin (her brother) a. If police declare it a possible murder then they can ask the coroner? b. You can refer to coroner for autopsy if the police rule it as a suspicious death provided you get consent from the next of kin first c. Perform a post-mortem at the hospital after seeing permission from her brother d. Refer to coroner (for advice) as cause of death is unknown

49. Random doctor following a needle stick injury, from a patient who has come back from the Philippines. Random doctor doesn’t want to take PPE unless risk is real. Asks patient if they can consent to the blood test – patient too ill to consent/unconscious. The doctor then asks CT1 college if they can ask the lab to do a test on one of the patient’s old blood samples. What does the CT1 say? a. You can’t do it b. To not do the test would violate the doctor’s human’s rights under article 3 or 5 under the Human Rights acts of year XXXX c. If the hospital refuses to test the blood despite the person’s protests, then they are violating the doctor’s human rights. d. Wait until the patient is conscious to take consent. e. The classic, ‘it’s okay if you can get a next of kin to consent on their behalf’

50. A man presents with history of heart disease, left ventricular hypertrophy, has a facial basal cell carcinoma and type 2 diabetes. Investigations from one year ago showed critical aortic stenosis, with poor ejection fraction. Current (Investigations/ECHO) shows (severe/critical) aortic stenosis. They suddenly die. List the order for the coroners / How should you fill out the MCCD (Medical Certificate of Causes of Death)? a. 1a = Acute left ventricular heart failure, 1b = Type 2 Diabetes b. 1a = Aortic Stenosis, 1b = Type 2 Diabetes c. 1a = Aortic Stenosis, 1b = Basal Cell Carcinoma d. 1a = Aortic Stenosis, 1b = Basal Cell Carcinoma, Type 2 Diabetes e. 1a = Aortic Stenosis

1. Name an infectious microorganism which is a common cause of sepsis in newborns?

group B streptococcus

2. Name an infectious microorganism which is a common cause of meningitis in 3 months or older new-borns?

GEL acronym

3. What does Denosumab target?

RANK ligand

4. A Turkish man has a fever (and has a history of recurrent chest infections). Tests show a mutation in the MEFV gene. What does he have?

familial Mediterranean fever

5. Person who had a DVT many years ago (or recurrent DVTs), presents with recurrent dark bruising, and swelling over the course of 5 years, and now had pain in their leg. What is the possible cause? –

myeloproliferation leading to malignancy

6. Which mixed pattern auto-inflammatory condition has over 90% heritability and effects the sacroiliac joint?

ankylosing spondylitis

7. Which enzyme would you expect to be raised in obstructive jaundice/biliary obstruction?

ALP???

8. A [woman or man] develops signs of hyperthyroidism. Bloods show low TSH and high thyroxine. Does not have good uptake on technetium scan. What is the likely diagnosis?

Graves

9. What can be used to measure the turnover of bone, and is raised in people who have Paget’s, Osteomalacia / Rickets?

ALP

10. An elderly man has a fall, and doesn’t become unconscious/lose consciousness, and presents two days later with a confusion, where is the likely site of bleeding?

veins, subdural

11. Person who had negative direct coombs test but who has anaemia (low Hb), and jaundice

hereditary spherocytosis

12. Which clotting factor falls most rapidly after administering warfarin?

protein C (although not a clotting factor)

13. Both mother and grandmother had medullary thyroid carcinoma, and have tested positive for MEN2. What [biomarker/protein] would be raised in the blood to confirm medullary thyroid cancer?

calcitonin and carcinoembryonic antigen

14. What drug is used to treat severe falciparum malaria?

IV artesunate

15. A patient has a massive splenomegaly, and JAK2 V617F mutation with a leucoerythroblastic picture and tear-drop poikilocytes. What do they have?

polycythaemia vera

16. An African man, with Burkitt’s lymphoma is given Rasburicase. He develops haematuria with irregularly contracted cells. What is the cause?

haemolysis, not sure the cause ...

17. A patient required an aortic valve replaced 3 months ago. They have now come back a few weeks later with jaundice, Hb-urea (haemoglobinuria), and raised reticulocytes. What is the cause?

haemolytic anaemia - from the valve.....

18. What cancer is present if keratin and intercellular bridges are present?

SCC

19. A patient is found to have a high Na+, low K+, and low renin. What is the likely cause?

Conns

20. Which common condition can be treated with drugs that target with TNF, IL-17 and IL-12/23?

crohns

25. What zoonotic disease does the Ixodes Tick cause?

Lyme disease

b. A non-smoker gets lung cancer on/in the peripheries – what will the histology show?

adenocarcinoma - glandular differentiation

a. Name one type of amyloidosis

AA or AL

b. What type of amyloid is deposited in multiple myeloma

AL amyloid

c. A man has multiple myeloma, and get amyloidosis. Which type of amyloidosis would it be?

AL amyloid

a. In HIV different drug groups are used to manage the condition. Name one of types/groups of drugs used to treat HIV:

nucleoside reverse transcriptase inhibitors

b. Name the main class of drug used to treat HIV

nucleoside reverse transcriptase inhibitors

● Disease that causes Hydrops fetalis if caught in first 20wks

parvovirus b19

● Disease that requires rapid vaccination at birth/immunoglobulins if mother is highly infectious.

HepB

● Disease that require C-section if mother has an outbreak at 34wks or later due to risk of transmission vaginally

herpes ........

● Disease that can cause baby to have cataracts, sensoineurial deafness, hepatomegaly and thrombocytopenia.

rubella

● Disease which if transmitted to baby: they can initially be symptomless but then come down with problems - long term sequelae.

Beta herpes virus.

● Old lady with Gram + bacilli - meningism

listeria monocytogenes

● Bog standard man with meningitis Gram + diplococci

streptococcus pneumoniae

● Young woman with aseptic meningitis, normal glucose, raised lymphocytes, slightly raised protein

● Baby with gram negative rods

E. coli

● Young guy with meningitis and Gram negative diplococci

-neisseria meningitidis

● Pt from south america with weight loss, haemoptysis and weight loss, upper lobe pneumonia

TB???

● Man goes to wedding in Devon, comes back with pneumonia + confusion (hyponatraemia)

legionella pneumophilia

● Transplant patient on immunosuppressives has pneumonia - halo sign (multiple) on Xray

aspergillosis

● 22 years old, no other problems and lower lobe pneumonia

streptococcus pneumonae

● IVDU patient with Ground glass on xray

● Beta lactam with anti-pseudomonal activity

meropenem

● Broad spec, no pseudomonal activity usually given with a beta lactamase inhibitor

● A glycopeptide used to treat MRSA

vancomycin

● A DNA synthesis inhibitor used to treat Pseudomonal infections but bad against anaerobes

ciprofloxacin

● Abx of the Macrolide/lincosamide/streptogrammin group used to treat some atypical pneumonias

-erythromycin

● Painless indurated ulcer, grown on dark brown medium, spiral shaped organism found

syphillis

● Teenager with genital warts

ew HPV 6 or 11

● Lady with discharge, no other symptoms, and causative infection found on wet slide microscopy

trichomonas vaginalis

● Lady with PID and positive urinary NAAT test

chlaymdia trachomatis

● Man with discharge- Gram negative diplococci found

-neisseria gonorrhoea

● Woman with UTI - Culture grows gram positive cocci in clusters

staphylococcus aureus

● 49 Year old with no medical problems has septic arthritis

● 19 year old rugby player with boils, members of his team have similar boils, as do members of his family

plague

● Neonate has meningitis, gram positive organism in chains

group B streptococcus

● 50 year old male smoker has meningitis with gram positive diplococci

streptococcus pneumonia

● Virus that resides in pharynx and GIT - 1:100 encephalitis, 1:1000 destruction of motor neurons

-adenovrius????

● Develops a grey film over the epiglottis

-diptheria

● Causes lumps on parotid and neck

mumps

● Maculopapular rash moves from face that can cause encephalitis and pneumonitis

● 55yr old man with mass in head of pancreas

pancreatic carcinoma

● Patient with a mass following acute pancreatitis

??????

● Patient with a history of severe abdominal pain; during cholecystectomy, the surgeons noticed white specks around and on the pancreas.

● Patient with hypoglycaemia and pancreas mass

functional neuroendocrine mass

● Patient with a carcinoma in their liver, what was the original carcinoma in their pancreas that caused the metastases?

ductal adenocarcinoma

● Sarcoidosis changes in the lymph nodes

● What is deposited in the kidneys in MM?

amyloid?

● Appendix that is full of neutrophils and is enlarged touching the peritoneum

appendicitis

● What material is seen in the vessel of a patient with an MI due to burst atheroma

debris, foam cells??/

● Patient had an appendectomy 1 week ago. What would you see in their scar

granulation tissue

● Cancer due to longstanding reflux, endoscopy shows a mass 30cm down.

oesophageal adenocarcinoma

● Cell changes in GORD

metaplasia

● What happens to the body of the stomach in a patient with pernicious anaemia

hypotrophy

● Cancer due to Coeliac disease

EATL

● Carcinoma due to H. Pylori infection

MALT - marginal zone NHL

● On doing a patient’s nephrectomy they notice a mass in the kidney that extends into the the renal vessels and into the perinephric fat

● Patient presents with a craggy enlarged uneven prostate

prostate carcinoma

● Radiosensitive cancer of the testicle in a young man with a white/smooth appearence? (something like that)

● Patient with a cancer in their bladder following chronic schistosomiasis

squamous cell

● Young man, severe pain in testicle following horse riding

torsion

● 20 year old with a lytic lesion in the diaphysis of his leg - pain alleviated by aspirin

● Man goes deaf with bowed legs

osteomalacia

● Vertebral fracture, high paraprotein

multiple myeloma

● Young woman with symmetrical joint pain

● Recurrent TIAs, arteriopath risk factors. What does the patient have?

vascular dementia

● Sudden headache, loss of consciousness, meningism. What does the patient have?

encephalitis?????????

● Patient with HIV, raised ICP, new onset epilepsy.

encephalitis

● Young man with fever,leucocytosis and a petechial rash after URTI

● Woman with recurrent episodes of weakness and parasthesia that spontaneously resolve

● Man dies from MI. What histopathology is likely to have caused this? (not atherosclerosis)

ischaemia and necrosis

● Patient has abdominal pain radiating to his back and collapses and dies

ruptured AAA

● Man has an MI 3 years ago. Now he comes into hospital and very unwell. Blood is aspirated from the pericardium.

heamopericardium due to ventricular wall rupture

● Woman with progressive amnesia who has developed bronchopneumonia

● Young girl with normal B cells, normal CD8+ but absence of CD4+

bare lymphocyte II

● Young boy with normal B cells and absence of CD8+ and CD4+

digeorge

● Normal B and T cells, high IgM but absence of IgA, IgE and IgG

hyper IgM

● Lady with spinal fracture due to tb (didn't say tb but the fracture suggested it)

● Patient with recurrent pneumococcal infections and meningitis

● Used to treat osteoporosis, when the patient cannot tolerate bisphosphonates

denosumab (RANKL)

● Used to treat malignant melanoma, involved in T cell checkpoints

ipilumab or pembrolizumab

● Used to treat Lymphoma and RA

TNf alpha inhibitor?

● Used to prevent transplant rejection, by blocking T cell proliferation and activation

azathioprine

● Used to treat ankylosing spondylitis and NICE recommended if two other anti-inflammatories have failed

-etanercept or secukinumab

● In its immature form it is specialised to phagocytose pathogens, and in its mature form it is specialised to present to other cells.

monocyte/macrophage

● Monocytes resident in peripheral skin cells

langerhans

● Cells that express Foxp3 and CD25

Treg

● Differentiated B cells that produce immunoglobulins

plasma

● Responsible for the killing of cancerous cells and are inhibited by MHC-I

● Mentioned MEFV gene, periodic abdominal pain and ascites

familial Mediterranean fever

● Nod2/CARD15

IBD

● DR4 and CCP

● HLA-B27 associated with ???sacroilitis????

ankylosing spondylitis

● When they eat cherries, apples, pears and hazelnuts, they get itchy mouths

type I hypersensitivity

● Hypertensive and diabetic, with angioedema

kidneyyyysysysys

● Kid with rash on extensor surfaces, IgE mediated

atopic dermatitis

● Woman with flushed face, problems breathing that has happened multiple times with enlarged liver

polycythaemia

● Patient wondering why they get allergic symptoms every summer, clear discharge from the nose

seasonal allergic rhinitis hay fever

● Anti-centromere and raynauds

CREST

● Patient with dry eyes and anti Ro

sjogrens

● Anti dsDNA

SLE

● Anti CCP

rheumatoid arthritis

● Anti-endomysial

coeliac

● Can lead to development of post transplantation lymphoproliferative disease

EBV

● Causes progressive multifocal leukoencephalopathy

John Cunningham virus

● Mechanism behind GVHD

donor cells attacking host

● Mechanism behind antibody mediated rejection-

preformed antibodies activating complement and attacking vessels

● Mechanism behind cellular rejection

type IV rection-

● 10 year old with recurrent episodes of jaundice + mild anaemia - blood film shows NO central pallor, RBCs are spherical

hereditary spherocystosis

● 10 year old afro-caribbean girl, history of chest crises and dactylitis - sickle cells on film

sickle cell disease

● Girl with low HB from Western Africa | ○ Elliptocytes on blood film

sickle cell trait??/

● 10 year old caucasian who had been on a holiday, presented with low platelets and profound anaemia (6g/dl + oliguria) - anaemic blood film showed ?bite cells, and schistocytes

MAHA

● 10 year old Bangladeshi girl pale and tired - hypochromic RBCs with some pencil cells

hereditary elliptocystosis

● Philadelphia 9,22 BCR ABL present, TdT was expressed on cells - 22yr old, 70% blasts! No hepatosplenomegaly. No myelocytes or basophilia.

AML

● Smear cells-

CLL

● Philadelphia 9,22 BCR ABL present. Middle aged person - 3% blasts

CML - chronic phase

● Patient with puritis + raised haemoglobin following showering and Jak 2 Mutation

polycytheamia vera

● Patient with tear drop poikilocytes and a Jak2 mutation

polycythaemia vera leading to myelofibrosis

● Pregnant woman with low platelets, schistocytes and neuro symptoms (headaches + seizures), BP 100/60

eclampsialol?

● Recurrent miscarriages, all within 8 weeks gestation

anti phospholipid syndrome

● Pregnant Greek Patient with father who is on warfarin and a sister had a dvt.-

● Pregnant woman having an elective c-section due to fetal distress secondary to pre-eclampsia. Bloods show low platelets and deranged coagulation.

HELLP syndrome

● Pregnant patient with slightly low platelets in 3rd trimester (100 x 10^9). No other symptoms.

physiological?

``` INRs in warfarin: stop dose, increase, decrease? ● Pt with AF - 2.5 ● Pt with prosthetic valve - 2.5 ● Pt with prosthetic valve - 3.5 ● Pt with previous DVT - 4 ● Pt with previous DVT - 1.5 ```

``` Pt with AF - 2.5 - fine ● Pt with prosthetic valve - 2.5 - increase ● Pt with prosthetic valve - 3.5 - fine ● Pt with previous DVT - 4 - decrease ● Pt with previous DVT - 1.5 - increase ```

● Patient with paraprotein - 40g/dl, back pain and loss of sensation in legs (these might have been in another question)

cauda equina

● Patient with paraprotein - IgM at 32. Lymphadenopathy, angioedema?

● 70-something year old, overweight patient with diabetes presents with chronic back pain and mildly raised creatinine. GFR was 55? Paraprotein at 12g/dl

● Man with pancytopenia and myeloid precursors

AML

● German woman with recurrent URTIs + UTIs w/ low neutrophils

● Woman with O rh+ given A rh-, what happens?

ABO incompatibility

● Lady who received a blood transfusion and platelets and went home and developed a rash all over and “some shortness of breath”

● Elderly patient after a road traffic collision who required a massive transfusion - What is the most serious complication that could happen

TACO

● Woman who received a transfusion before her hysterectomy who presented with bleeding gums and rash on her shins on discharge

graft vs host

● Sickle cell patient who came down ill with pain in his joints, dark urine, fever and headache 8 days later that then resolved, what complication of blood transfusion should you screen for?

ABO incompatibility

● Haemolytic anaemia - how to test whether it was autoimmune in origin

dat

● Diagnosis of thalassaemia

haemoglobin electrophoresis

● Important in diagnosing temporal arteritis

ESR

● Polycythaemia monitoring

● Bone marrow response to haemolytic anaemia - measure in blood

erythropoiesis - reticulocyte count

● High Calcium,normal phos, Low PTH, High ALP - pt feels tired

● 72 year old with headache - High CA, normal phos, normal PTH, High ALP

Pagets

● Baby with seizures - Low Ca, , Low PTH,

hypoparathyroidism - congenitally no parathyroid glands

● Pt presents with low mood after renal transplant following longstanding renal disease - High Ca, High PTH

tertiray hyperparathyroisism

● 10 year old with seizures- Low Ca, High PO4 , High PTH,

psuedohyperparathyroidism

● Pt with Lung CA - High Na, Low K,

conns?? hyperalsodteronism ectopically?

● Patient with polyuria and polydipsia- low Na, Low K, Low plasma and urine osmolarity

diabetes inspidus

● Pt becomes drowsy 24 hours after RTA - high Na

hypernatraemia confusion - not consuming fluids

● Pt with HTN - high Na, Low K, high renin, high aldosterone

conns

● Patient can’t fit in her shoes or put on her wedding ring and has prognathism, what test do you need to do to confirm?

OGTT

● Cushing-like woman, BP 190/100, thin skin, overweight, high-normal sodium, low normal potassium, OGTT done (glucose high normal)

● Pt with low Na, High K + postural hypotension

Addisons

● Patient with low sodium, potassium normal, low plasma osmolality and urine osmolality was 70

high urine sodium implies renal loss

● Everything normal but low TSH

subclinical hyperthyroid

● Everything normal but high TSH and high prolactin (but less than 1000)

TSHoma

● Everything low but prolactin at 1300

non functioning pituitary adenoma

● 20 year old student with two weeks anorexia, fever and malaise - raised ALT, normal ALP and GGT

vial hepatitis

● Raised unconjugated bilirubin - all else normal

haemolytic anaemia

● Woman with colicky abdominal pain, raised ALP markedly, others might have been deranged, unsure.

primary hyperparathyroidism | abdo pain from hyerpcalcaemia

● Isolated raised ALP

pagets

● Man following haematemesis with Raised GGT and ALT?

alcoholic hepatitis - varices

● Vegan with megaloblastic anaemia

folate / b12 deficiency

● Person with crohns with megaloblastic anaemia

b12 deficiency

● Patient with Pellagra

niacin deficiency (B3)

● Young patient with bowed legs

rickets

``` 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 Thalassemia trait Normal pregnancy Auto-immune thrombocytopenic purpura ```

``` 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 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 B, is having a panic attack, is hyperventilating and complains of tetany Patient E, has a cardiac arrest and has blood gases show a low p02 and a high pC02 Patient C, a 17 year old with type 1 diabetes who omits his insulin. ```

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

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) . 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 Flocculent densities form within mitochondria Collagen is deposited, forming a fibrous scar

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 Cushing's disease Phaeochromocytoma Conn's syndrome

``` 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 ```

``` 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 ```

``` 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 ```

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

``` 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 Ceftriaxone Amoxicillin Piperacillin/tazobactam Meropenem ```

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)

physiological thrombocytopenia

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?

hodgkins lymphoma

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)

CML | high basophils

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?

agranulocytosis from carbimazole

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 III Hodgkin Lymphoma suggest?

nodes either side of the diaphragm

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

neural tube defects

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

carbimazole causing agranulocytosis

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, to determine if the future health of this fetus may be at risk, what is the first action/investigation required ? Hb 114 g/L (115-165) MCV 70 fL (80-96) Hb A2 concentration 5.2% (2.0-3.5) Ferritin 13ug/L (12-200) Serum transferrin 2.4u/L (1.7-3.4)

Hb electrophoresis

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? Hb 91 g/L (130-175) MCV 92 fL (80-96) WBC 3.4 x 10°/L (3.0-10.0) Neutrophils 0.8 x 10°/L (2.0-7.5) Lymphocytes 2.8 x 10°/L (1.5-4.0) Platelets 95 × 109/L (150-400)

A 47 year old male with a history of alcoholism and chronic liver disease presents with weight loss and ascites. A CT scan of the abdomen reveals a solitary mass in the left lobe of the liver. No other lesions are seen. Peripheral blood a-fetoprotein levels are raised. What is the likely diagnosis of the liver mass?

hepatocellular carcinoma

A 71 year a old male 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 histopathological diagnosis of this lesion?

squamous cell carcinoma

A patient is admitted to The Emergency Department after severe trauma and blood loss. Without time for blood ABO grouping, he required emergency resuscitation with red cells and fresh frozen plasma. What blood group plasma should be used?

O negative

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 disease

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

squamous cell

The combination of hemangioblastomas in the cerebellum and retina, multiple and bilateral renal cell carcinomas, and cysts of the pancreas and kidneys is characteristic of what neurocutaneous syndrome ?

von hippel lindau

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

T cells

A 21 year old patient with type 1 diabetes collapses. His capillary blood glucose is 0.7mM and a repeat confirms this. He is unrousable with a GCS of 3. He has no visible veins. What is the best emergency reatment for hypoglycaemia in an unconscious patient with no intravenous access?

buccal dextrose

A 24 year old woman with known type 1 diabetes accidentaly missed an insulin dose. She presents with vomiting and Kussmaul respiration. Predict in kPa the likely pCO2 reading that you will find on the Arterial Blood Gas sample. pCO2 normal range (4.6-6.4 kPa)

drops

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? 35 Bilirubin (<17) ALP 70 IU/L (25- 115) ALT 24 IU/L (10-50) AST 17 IU/L (10-40) GGT 30 IU/L (9-40)

Gilbert's

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 osteoblast activity?

ALP

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 clot. What is the likely diagnosis?

polycystic kidney disease

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

mature teratoma

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

psuedogout

An 18 year old student collapses and dies whilst playing football. A postmortem finds asymmetric hypertrophy of the interventricular septum. Microscopic examination shows thickened and disorganized muscle fibres with hyperchromatic nuclei. What is the most likely diagnosis?

HOCM

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

neutrophils

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

GGT and ALP

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?

TB???

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 pathology report describes a clear cell carcinoma. What is the most likely primary site of origin for this carcinoma?

kidneys, renal cell carcinoma

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?

cardiac amyloid

An asymptomatic 58 year old man undergoes a routine insurance medical. The FBC results are reported below. The blood film comment notes, no immature cells seen, smear cells present. What is the most likely diagnosis ?

CLL

A 5 year old has a 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?

nephroblastoma (Wilm's)

An 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 anemia. On examination she has signs of congestive cardiac failure and gonadal failure. What is the most likely explanation for these clinical findings ?

iron overload

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

increase

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 m/mol/L. Reference range 22-29 mmol/L) Na 134 mmol/L (135-146) K 2.8 mmol/L (3.5-5.3) Urea 5.7 mmol/L (2.5-7.8) Creatinine 70 umol/L (60- 120)

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

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? Bilirubin 12 umol/L (<17) ALT 25 IU/L (10-50) AST 19 IU/L (10-40) GGT 38 IU/L (9-40) Alkaline Phosphatase 500 IU/L (25- 115)

bone related - Pagets?

A 32 year old, female physiotherapist has overweight with excess facial hair she also exeriences recurrent acne. Over the past nine months her menstrual periods have been infrequent. Testosterone 3.7 nmol/L (0.2-2.9). What is the likely diagnosis?

PCOS

A 30 year old man comes to the Emergency Department having take a drug overdose. His arterial blood gases are shown below. What drug is he likely to have taken? pH 7.4 (7.35-7.45 pcO2 1.8 kPa (4.6-6.4) pO2 15 kPa (11-15)

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

low

A 50 year old man has tetany. Investigations: Calcium 1.95 mmol/L (2.2-2.6) Phosphate 0.7 mmol/L (0.8-1.5) PTH 27.2 pmol/L (1.6-8.5) Creatinine 90 mol/L (60-120) What is the likely diagnosis?

osteomalacia

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?

overdose of thyroxine

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

osteoporosis

A young child presents with recurrent infections and hepatosplenomegaly. In a dihydrorhodamine (DHR) assay the neutrophils remain negative for HR fluorescence after activation. What is the likely diagnosis?

chronic granulomatous

A patient who is blood group O is on the waiting list for kidney transplantation. A potential donor should have which blood group?

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 hydroxyls

A young man presents with episodes of fever, pleurisy and peritonitis. Investigations confirm a mutation a of the MEFV gene encoding pyrin. Which drug inhibiting neutrophil function is regarded as the agent of choice for prophylaxis against acute febrile illness and prevention of amyloidosis?

colchicine

A 24 year old female presents with weight loss, heat intolerance and palpitations. She has bilateral exopthalmus. Results of thyroid function tests are shown below. TSH 0.1 mU/L (0.3-4.2) Free T4 32 pmol/L (9-25) She has developed auto-antibodies specific for which surface protein?

thyroid stimualting hormone receptor

A 23 year old female presents with a facial rash, arthralgias, mouth ulcers, hair fall and pleuritic chest pain. What is the most likely diagnosis?

SLE?

What is the maximum number of HLA class I mismatches that may occur if a parent acts as a kidney donor for a child?

A 7 month old male child presents with pneumococcal pneumonia. He has a history of cellulitis and recurrent otitis media. A full blood count showed neutrophilia. Flow cytometry confirmed presence of CD19+ B cells and CD3+ T cells, including both CD8+ and CD4+ T cells. Serum immunoglobulin levels are shown below. IgA <0.1 g/L (0-0.83) IgG 0.02 g/L (2.3-14.0) IgM 1.84 g/L (0-1.45) Mutation of which gene is most likely to explain the presentation?

Hyper IgM syndrome - mutation in CD40L

A 38 year old male develops fluctuating muscle weakness and ptosis. His symptoms improve following an injection of tensilon. Which autoantibody plays a role in the pathogenesis of this condition?

anti acetycholinerecptor antibodies | myasthenia gravis

A 6 month old baby has presented with recurrent infections and is being investigated for immunodeficiency. Analysis of lymphocyte subsets shows presence of B cells and CD8+ T cells but very low numbers of CD4+ T cells. Analysis of immunoglobulin subsets shows presence of IgM but low levels of IgG. Which is the most likely diagnosis?

bare lymphocyte syndrome II

A 25 year old man has a 10 year history of low back pain and stiffness, with symptoms being worse at night and in the early mornings. An MRI scan has shown bone marrow oedema at the sacroiliac joints. Blood tests confirm an acute phase response with C- reactive protein 18 mg/L (<5). He has shown a partial response to non-steroidal anti- inflammatory drugs. Which cytokine could be targeted to improve disease control?

TNF alpha

A 49 year old male presents with haemoptysis and acute renal failure. Invesigations confirm pulmonary hemorrhage and glomerulonephritis. The renal biopsy is sent for immunofluoresence and this shows a linear deposition of antibody along the glomerular basement membrane. The effector mechanism for immunopathology in this condition is typical of which type of Gel and Coombs hypersensitivity reaction?

type III | IgG and complement deposits - membranous glomreular disease

Antibodies bind to which cell type during the effector phase of antibody mediated rejection of solid organ allografts?

endothelium?????

A baby is born with tetralogy of Fallot and is also noted to have features of hypoparathyroidism including low serum calcium. He develops recurrent infections after 3 months of age, including with viruses and bacteria. Which immune cell type is deficient?

T cells | DiGeorge

Serology for what polysaccharide is used for the diagnosis of invasive Aspergillus infection?

galactomannan

A 26 year old woman presents with fever, headache and confusion. She has an HIV infection and has refused to take antiretroviral therapy for the past four years. What rapid test should you ask the microbiology laboratory to perform on her serum sample to confirm the likely diagnosis?

CD4 count?

Urinary antigen tests are useful in the diagnosis of community acquired pneumonia. State one organism that the commonly available tests can detect?

legionella pneumophilia

Which cytokine is key in promoting the development and terminal differentiation of eosinophils

IL-5

A 35 year old person who injects drugs (PWID) is admitted with fever, shortness of breath and haemoptysis. Her chest x-ray has been reported as showing multiple pulmonary infiltrates compatible with pulmonary emboli. Which ONE microbiology investigation should you send before commencing empiric antibiotics?

blood cultures

A 72 year old woman is refered from the Emergency Department with signs and symptoms consistent with meningitis. She is known to have hypertension and type 2 diabetes mellitus. She is not confused and has no features suggestive of encephalitis. A lumbar puncture has been performed and she has been commenced her on ceftriaxone 2g i.v. twice daily. There are no known drug allergies. Given this clinical picture what one antimicrobial should be be given in addition?

Ampicillin / amoxicillin for listeria cover

A 2-day-old neonate develops meningitis. The microbiology laboratory telephone to report that a Gram stain of her CSF shows Gram-negative bacilli. What is the most likely causative organism?

E.coli

What species of Coagulase Negative Staphylococcus is a common cause of lower urinary tract infection in young women?

staphylococcus saphrophyticus

What double stranded DNA virus is associated with nephritis in renal transplant recipients immunosuppresive therapy?

BK virus

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?

Diptheria

A 32 year old man presents with fever, abdominal pain and constipation. He has recently returned from Pakistan. He undertook no vaccinations prior to travel. Blood cultures taken on admission have grown non-lactose fermenting Gram negative bacilli in both bottles. What is the most likely causative organism?

salmonella typhi

Which helminth is capable of autoinfection in humans via the following life cycle? Infective filariform larvae penetrate intact skin and migrate to the small intestine where they become adults. Eggs hatch into rhabditifom larvae which mature into filariform larvae which can autoinfect via perianal skin.

Roundworm

Exposure of the foetus to which vaccine-preventable infection during the first trimester of pregnancy is associated with a high probability of developing a syndrome characterised by the presence at birth of sensorineural deafness, eye abnormalities ( including cataract, microphthalmia and retinopathy), and congenital heart disease (including patent ductus arteriosus)?

Rubella

A 32 year old woman has been diagnosed with a superficial infection of a caesarean section wound. The preliminary report from a wound swab states Staphylococcus aureus isolated with susceptibilities to follow. The pre-operative MRSA screen was negative and there are no known drug allergies. She is breast feeding her new daughter. What narrow spectrum antimicrobial would you prescribe to treat his infection?

flucloxacillin

A 67-year-old woman presents with a chronic cough, haemoptysis and fevers particularly at night. She states she has lost 10 kg of weight over the past 3 months and her chest X-ray shows left upper zone shadowing. Her son reports she has a history of excess alcohol consumption. What is the most likely causative organism?

Klebsiella pneumoniae

What Hepatitis virus typically causes a brief, self-limiting infection but is associated with more severe disease and mortality in pregnant women and can cause chronic infection in immunocomromised patients?

Path Past Paper 16-20 Flashcards

(774 cards)