Path PPQs Flashcards
(110 cards)
1
Q
flucloxacillin resistance in S. aureus
A
c. Alteration of the target
2
Q
mechanism is ESBL E.coli resistant to ceftriaxone
A
b. Enzymatic inactivation of antibiotic
3
Q
patient has grown a fully susceptible E.coli in their urine. Which of the following is the narrowest spectrum agent you should de-escalate to
A
a. Amoxicillin
4
Q
Most common HAI
A
HA pneumonia
5
Q
c.diff
A
Gram pos spore-forming anaerobe
6
Q
What are fungi
A
a. Eukaryotic organisms with chitinous cell walls and ergosterol containing plasma membranes
7
Q
commonest cause of fungal infections in humans
A
c. Candida spp
8
Q
cryptococcus associated with which animal
A
pigeons
9
Q
stain used for cryptococcus
A
india
10
Q
antigungals targeting cell membrane not work in PCP why?
A
PCP lacks ergosterol in cell wall
11
Q
Live vaccine should be deferred if?
A
a. Patient has received immunoglobulin in past 3 months If given antibodies already, they may not produce an immune response, so there is no point
b. Patient is receiving systemic high dose steroids They would be immunosuppressed
12
Q
Percentage of world’s popultion infected w TB
A
33%
13
Q
acid-fast bacilli found in clinical sample - what to do next?
A
start TB therapy
14
Q
lifetime risk of reveloping TB if in contact with smear positive pul TB if HIV neg
A
10%
15
Q
yearly risk of reveloping TB if in contact with smear positive pul TB if HIV pos
A
10 per year
16
Q
Most common meningeal disease in UK
A
men B
17
Q
Most common cause of death worldwide under 5 yrs
A
prematurity and pneumonia
18
Q
What on microsopy suggests poor sample
A
squamous epithelial cells
19
Q
dipstick paramemter that is a produuct of nitrate reductase and suggestive of UTI
A
nitrate
20
Q
What type of immunouppression has greatest relative risk of developing viral infection:
a. Steroids
b. Solid organ transplant
c. Allogeneic stem cell transplant
d. Monoclonal antibody therapies
e. Cytotoxic chemotherapy
A
Allogenic stem cell transplant
21
Q
Mouth ulcers post HSCT
A
Herpes simplex virus (HSV) - very common after transplant
22
Q
How long do u need to have Sx for gastroenteritis definition
A
> 1wk of symptoms
23
Q
Extraintestinal manifestation associated with salmonella infection
A
Aortitis
24
Q
Virus associted wtih outbreaks
A
Norovirus
25
What si the thoracic duct
c. Carries lymphocytes from lymph nodes back to blood circulation
26
thymus?
d. Site of deletion of T cells with inappropriately high or low affinity for HLA molecules and of maturation of T cells into CD4+ or CD8+ cells
27
germinal centre?
a. Area within secondary lymphoid tissue where B cells proliferate and undergo affinity maturation and isotope switching
28
Which of the following medications can cause antibody deficiency?
a. Metformin
b. Losartan
c. Prednisolone
d. Alendronic acid
e. Rituximab
RITUXIMAB
a. Metformin
b. Losartan
c. Prednisolone -> Could be, but antibody deficiency usually seen at higher dose (>10mg). Also usually only causes a selective antibody deficiency (IgG). It usually spares IgM and IgA.
d. Alendronic acid
e. Rituximab -> Targets B cells
29
7) Which of the following conditions are most likely to present in patients with CD4 T cell counts of >350?
a. Shingles, pulmonary TB, pneumococcal pneumonia
b. Hairy leukoplakia
c. PCP, Cryptococcus, toxoplasmosis
d. MAC disease
a. Shingles, pulmonary TB, pneumococcal pneumonia
30
Infection wiht atypical mycobacterium. normal FBC - diagnosis?
IFN gamma R deficiency
31
Meningococcus meningitis with sibling dying of same condition at same age?
C7 deficiency
32
17) Severe recurrent infections from 3 months,CD4 and CD8 T cells absent, B cell present, Igs low. Normal facial features and cardiac echocardiogram. What is the diagnosis?
X-linked SCID
33
22) Recurrent bacterial infections in a child, episode of pneumocystis pneumonia, high IgM, absent IgA and IgG. What is the diagnosis?
X-linked hyper-IgM
34
CD40 ligand mutation
HyperIgM syndrome
35
what proportion of the world has kidney disease
11%
36
5 year survival % for end stage kidney failure on dialysis
35%
37
28) A potential donor is described as being 1:1:0 MM. What does this mean?
c. 1 MM A locus, 1 MM B locus, 0 MM DR locus
38
29) The main effector cells in T-cell mediated rejection are
b. T cells and monocytes / macrophages
39
30) A patient has an episode of acute T cell-mediated rejection 2 months post transplantation. What additional drug would most commonly be administered?
Corticosteroids 3 pulses of methyl-prednisolone given 3 days in a row, followed by an oral steroid taper
40
What cell is njuryed in the effector phase of antibody-mmediated rejection
endothelial cells
41
If there is 50% match of HLA from donor and recipient, what does that mean?
Parent and son/
42
39) Which of the following is an example of Gel and Coombs type III hypersensitivity
a. Goodpasture disease
b. Eczema
c. SLE
d. Multiple sclerosis
e. Graves disease
SLE
43
45) Which of the following vaccines should NOT be given to an immunosuppressed individual?
a. BCG - bacilli Calmette-Guerin
b. Diphtheria toxoid
c. Quadrivalent inactivated influenza vaccine
d. Polio (Salk – injected)
e. Pfizer Covid mRNA vaccine
a. BCG - bacilli Calmette-Guerin
44
46) A 23 year old has metastatic melanoma. Reduce disease progression with what?
Nivolocumab - anti-PD-1
45
48) Rituximab is a monoclonal antibody specific for CD20 on B cells. It depletes B cells. For what is it effective treatment
e. Rheumatoid arthritis
46
Treatment fo psoriasis / psoriatic arthritis
Ustekinumab - IL-12 / IL-23 inhibition / TNF-alpha blocker
47
Increase or decreased protein C increases thrombosis risk?
Decreased protein C
48
3. Which agent has a delayed anticoagulant effect?
a) Vitamin K
b) Unfractionated heparin
c) Warfarin
d) Low molecular weight heparin
e) Aspirin
Warfarin
49
2. Which factor confers the highest risk of thrombosis?
a) Antithrombin deficiency
b) Factor V Leiden
c) Family history of thrombosis
d) Reduced factor 8 level
e) 3 hour plane flight
Antithrombin deficiency
50
4. How does warfarin achieve its anticoagulant effect?
a) Reduce plasma protein C and S
b) Block phospholipid synthesis
c) Reduce plasma procoagulant factors
d) Act as a cofactor for antithrombin
e) Inhibit factor 2, 7, 9 and 10
Reduced plasma procoagulants
51
5. Which patients is most likely to benefit from long-term anticoagulation after a DVT in the following circumstances?
a) 67yo man after flying from Kuala Lumpar
b) 27yo woman during pregnancy
c) 33yo woman on COCP
d) 77yo man after hip replacement
e) 30yo man after a long walk
e) 30yo man after a long walk
52
6. 33yo man has a PE. What is most appropriate 1st line treatment?
a) Compression stockings
b) Aspirin 600mg
c) Therapeutic LMWH
d) Warfarin
e) Fresh frozen plasma
c) Therapeutic LMWH
53
8. 34yo woman developed a DVT after removal of ovarian cyst. Father and brother had DVT. What should you do?
a) Test for antithrombin deficiency
b) Recommend HRT
c) Continue long term anticoagulation
a) Test for antithrombin deficiency
54
11. 22 year old male with cyanotic congenital heart disease. Hb 210g/l and Haematocrit 60%. No splenomegaly. What are the most likely labl test results?
a. JAK2 wildtype + low serum EPO
b. JAK2 V617F positive + raised serum EPO
c. JAK2 wildtype + raised EPO
d. JAK2 V617F positive + low serum EPO
c. JAK2 wildtype + raised EPO
55
10. 38yo woman who had a previous DVT while taking COCP. She then had a 2nd DVT during her 2nd pregnancy. What should you do?
a) Test for Factor V Leiden
b) HRT
c) Continue long term anticoagulation
d) Fixed low-dose warfarin
a) Test for Factor V Leiden
56
16. In certain NHL subtypes, chromosome translocations involving a proto-oncogene are seen. Which statement is NOT true?
a. Follicular NHL: IgH-BCL2
b. Mantle cell lymphoma: IgH-Cyclin D1
c. Follicular NHL: BCR-ABL1
d. Burkitt lymphoma: IgH-cMYC
57
18. 22 year old female with cHL, mediastinal mass. What is the most likely subtype?
a. Lymphocyte depleted
b. Nodular sclerosis
c. Mixed cellularity
d. Lymphocyte rich
b. Nodular sclerosis
58
Venetoclax in CLL treatment does what?
Blocks BCL protein
59
Bad progrnosis in CLL
IgHV unmutated and P53 Mutated
60
Newborn babies in contrast to adults have
a. A higher Hb
b. A lower WBC
c. Smaller red blood cells
d. The same percentage of Haemoglobin F
a. A higher Hb
61
First line Tx of actue GvHD
pred and ciclosporin
62
First line prevention of acute GvHD
Methotrexate and ciclosporin
63
Risk factor for both acuute and chronic GvDH
Incfreased recipient age
64
Platelet count rises or falls in pregnancy?
Falls
65
neutrophil count rises or falls in pregnancy?
Rises
66
Hb conc rises or falls during pregnance?
Falls
67
telomeric shortening is a feature of both idiopathic and aplasitc anaemia - true/false?
True
68
61. Which of the following statements is correct?
a. In gestational thrombocytopenia, the baby’s platelet count is usually affected
b. Thrombocytopenia is rarely found in associated with pre-eclampsia
c. Thrombotic thrombocytopenic purpura remits spontaneously following delivery
d. The platelet count may fall following delivery in baby’s born to mothers with ITP
d. The platelet count may fall following delivery in baby’s born to mothers with ITP
69
Most common pancreatic neoplasm
ductal adenocarcinoma
70
7) Which of these is not associated with fatty change in the liver?
a. Diabetes
b. Hepatitis B
c. Alcohol
hepatitis B
71
9) Lichen planus is an example of which type of inflammatory reaction pattern?
Lichenoid
72
10) Where is the epidermis does the bullae in pemphigus vulgaris form?
- Stratum spinosum
73
14) What percentage of lung cancers in the UK develop in non-smokers?
10-20%
74
19) How many parameters are included in breast tumour grading?
3
75
17) What benign lesions most commonly mimic breast cancer on radiology?
– Fat necrosis and radial scar
76
18) What is the most common malignant breast tumour?
ductal carcinoma
77
20) Impaired blood supply to the bowel most commonly causes what?
ischaemic colitis
78
22) What sort of colon polyps most commonly predispose to adenocarcinoma of the colon?
adenomatous
79
26) What type of amyloid is associated with multiple myeloma
AL
80
29) Which of the following is not a cause of chronic gastritis?
a. Auto-immunity
b. Infection
c. Drugs
d. Metabolic disease
Metabolic Disease
81
30) What is the most common brain tumour in adults?
Metastasis
82
Most common brain tumour in children
Pilocytic astrocytoma
83
32) What does tumour grade tell us?
Survival
84
33) Which mutation identifies diffuse astrocytic tumours with a better prognosis?
IDH mutation
85
36) 5 year-old boy. Had headache and vomiting in the morning for 2 weeks. Symptoms worsened and the vision became blurred. Fundoscopic exam: papilledema. MRI showing cystic cerebellar lesion. A tumour was removed. What is your diagnosis?
d) Pilocytic astrocytoma (WHO grade I)
86
35) 70 year old male. Seizure following 2 weeks of left arm and leg weakness. MRI showing heterogeneous enhancing right frontal lesion, started on steroids. Partial response to steroids with improved dexterity of the left arm and leg. A tumour was partially resected. What is your diagnosis?
a) Glioblastoma (WHO grade IV)
87
What herniation doesn't involve cerebral cortex
tonsillar
88
39) What percentage of patients who experience a TIA will get a significant infarct within 5 years?
33%
89
Most common cause of non-traumatic intraparenchymmal haemorrhage
HTN
90
43) Excluding Parkinson’s disease, which other disorder (often presenting with Parkinsonism) is associated with alpha-synuclein pathology
Multiple system atrophy
91
Most common thyroid cancer
papillary
92
cancers screened for in the uk
breast, bowel, cervical
93
most common site in female genital tract to receive metastatic tuumouurs
ovaries
94
6) Which has the lowest calcium?
a. Primary hyperparathyroidism
b. Secondary hyperparathyroidism
c. Osteoporosis
d. Paget’s disease of the bone
e. Breast cancer
Secondary hyperparathyroidism
95
10) How long does it take to see benefit from good glucose control?
15 yrs
96
11) Which study suggests that tight control increases mortality?
a. Accord
97
12) Hyperkalaemia is a side effect of which of the following drugs?
a. Furosemide
b. Bendroflumethiazide
c. Salbutamol
d. Ramipril
Ramipril
98
13) Hypokalaemia is a side-effect of which of the following drugs?
a. Spironolactone
b. Indomethacin
c. Perindopril
d. Furosemide
Furosemide
99
biggest risk factor for duct ectasia
smoking
100
Biggest predictor for portal htn
splenomegaly
101
lung malignancy associated with PTHrp
squamous cell cancer
102
mutation in familial adenomatous polyposis
APC tumour suppressor gene
103
chromosome with CFTR mutation
chromosome 7
104
c diff diagnostic test
toxin stool assay
105
21) Histology shows benign central scarring surrounded by proliferating glandular tissue. Most likely diagnosis?
radial scar
106
stage of breast cancer targetted by screening
DCIS
107
signet ring cells and ovarian tumour
Krunkenburg tumour
108
CML management
imatinib
109
globin genes located on which chromosomes?
11 and 16
110
