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Flashcards in Path Quiz Deck (51)
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1

A patient who sustained a severe snakebite was given equine anti-venom gamma globulin, and responded well to treatment. Within 5 days, the patient developed a slight fever and urticaria. How would you describe this reaction?

A. Type III hypersensitivity
B. Eosinophilia
C. Type IV hypersensitivity
D. Type II hypersensitivity

C. Type IV hypersensitivity

2

A 21 year old female presents with severe abdominal pain, diarrhoea, blood, and mucus per rectum. Colonoscopy with histology reveals a patchy severe active colitis interspersed with normal colon. What is the likely diagnosis?

A. Colorectal cancer
B. Ulcerative colitis
C. Pseudomembranous colitis
D. Crohn's disease

D. Crohn's disease

3

Which antibody test would you send off in a patient in whom you suspected coeliac disease?

A. Anti-tissue transglutaminase antibody
B. Anti-nuclear antibody
C. Antimitochondrial antibody
D. Antigastric parietal cell antibody

A. Anti-tissue transglutaminase antibody

4

A 50 year old man has fever, SOB, hepatosplenomegaly, and pallor. A blood count shows that he has a white cell count of 65 x 10^9/L and a blood film shows 90% blast cells. The blast cells contain granules and occasional Auer rods. Rank the following differential diagnoses in order of likelihood, with 1 being the most likely, and 5 being the least likely.

A. Acute myeloid leukaemia
B. Chronic lymphocytic leukaemia
C. Chest infection
D. Chronic myeloid leukaemia
E. Acute lymphoblastic leukaemia

1 - A. Acute myeloid leukaemia
2 - D. Chronic myeloid leukaemia
3 - E. Acute lymphoblastic leukaemia
4 - B. Chronic lymphocytic leukaemia
5 - C. Chest infection

5

A 24 year old female presents with rapid onset of a skin rash, SOB, and loss of consciousness shortly after eating shellfish. Rank the following treatments in order of appropriateness with 1 being the most appropriate answer and 5 the least.

A. I.V. adrenaline
B. I.V. hydrocortisone
C. Nebulised salbutamol
D. I.M. adrenaline
E. I.V. saline

1 - D. I.M. adrenaline
2 - E. I.V. saline
3 - C. Nebulised salbutamol
4 - B. I.V. hydrocortisone
5 - A. I.V. adrenaline

6

All of the conditions here re associated with a raised plasma gastrin level. Rank the following conditions in order of the likely gastrin level, with 1 being the cause of the highest, and 5 the lowest.

A. Achlorhydria
B. Post-vagotomy
C. H. pylori infection
D. Renal failure
E. Zollinger-Ellison syndrome

1 - A. Achlorhydria
2 - B. Post-vagotomy
3 - C. H. pylori infection
4 - E. Zollinger-Ellison syndrome
5 - D. Renal failure

7

A 52 year old patient is admitted with unexplained hypoglycaemia. The blood glucose is 2.1mmol/L and the C-peptide is 457pmol/L. What is the most useful next step?

A. Measure insulin antibodies
B. Undertake 72 hour fast
C. Urine sulphonylurea screen
D. Check insulin concentrations

C. Urine sulphonylurea screen

A sulphonylurea screen is required because if raises both insulin and c-peptide, and so can mimic increased endogenous insulin production. Though this history is suggestive of an insulinoma, a negative sulphonylurea screen is required to make that diagnosis.

8

Which of the following predispose to emphysema?

A. Childhood asthma
B. Squamous cell lung cancer
C. Cystic fibrosis
D. Alpha 1 anti-trypsin deficiency

D. Alpha 1 anti-trypsin deficiency

9

Three of the following are well known side effects of dopamine antagonists. Which of the following is not?

A. Tremor
B. Nausea
C. Hyperprolactinaemia
D. Stiffness

B. Nausea

Dopamine antagonists are used as anti-emetics

10

Which of the following best describes rheumatic fever?

A. It is an autoimmune disease
B. Splenomegaly occurs in some cases
C. It is causes by S. viridans infecting the heart valves
D. Clubbing occurs in some cases

A. It is an autoimmune disease

11

Which of the following is the first line treatment for chronic stage CML?

A. Stem cell transplant
B. Imatinib
C. Infliximab
D. Etanercept

B. Imatinib

12

A patient is found to have rose spots and a fever. Which organism is most likely to be responsible?

A. Salmonella typhi
B. Neisseria gonorrhoeae
C. Streptococcus pyogenes
D. Neisseria meningitidis

A. Salmonella typhi

13

Which of the following predispose to diabetes?

A. Cystic fibrosis
B. Childhood asthma
C. Squamous cell lung cancer
D. Alpha 1 antitrypsin deficiency

A. Cystic fibrosis

14

Which of the following has the most antiviral activity?

A. Amantadine
B. Selegiline
C. Prednisolone
D. Aminophylline

A. Amantadine

15

Rank the following in order of the likely underlying haematological diagnosis associated with a platelet count of 1,324 x 10^9/L

A. Polycythaemia vera
B. Chronic myeloid leukaemia
C. Essential thrombocythaemia
D. Myelodysplasia
E. Acute myeloid leukaemia

1 - C. Essential thrombocythaemia
2 - B. Chronic myeloid leukaemia
3 - A. Polycythaemia vera
4 - D. Myelodysplasia
5 - E. Acute myeloid leukaemia

???

16

A 26 year old female patient presents with bilateral cervical lymphadenopathy (with localised and contiguous nodal involvement) accompanied by night sweats, fever, and mild weight loss. She has a diagnostic lymph node excision and microscopy shows partial node effacement by an infiltrate composed of small lymphocytes, eosinophils, macrophages (with focal micro-granuloma formation and atypical large cells). The atypical large cells are seen singly and show binucleation with prominent nuclei. These large cells stain with CD30 stain. Rank the following in order of likelihood of diagnosis with 1 being the most likely and 5 the least.

A. Classical Hodgkin lymphoma
B. Follicular lymphoma
C. Infectious mononucleosis
D. Anaplastic large cell lymphoma
E. Nodular lymphocyte predominant Hodgkin lymphoma (non-classical)

1 - A. Classical Hodgkin lymphoma
2 - D. Anaplastic large cell lymphoma
3 - E. Nodular lymphocyte predominant Hodgkin lymphoma (non-classical)
4 - C. Infectious mononucleosis
5 - B. Follicular lymphoma

17

Please rank the following in terms of which is the most convincing indication of iron deficiency, with 1 being the most convincing and 5 the least.

A. Low transferrin saturation with low serum iron
B. Pencil cells on the blood film
C. Anaemia and low MCV
D. Jaundice
E. Fatigue

1 - B. Pencil cells on the blood film
2 - A. Low transferrin saturation with low serum iron
3 - C. Anaemia and low MCV
4 - E. Fatigue
5 - D. Jaundice

18

When considering the initial production of antibodies in response to the first dose of a vaccine, please rank the following in the sequence of the main immune response.

A. APCs present part of the vaccine on the cell surface
B. Production of antibodies specific for the vaccine antigen
C. Activation of B cells (with the aid of CD4+ cells) in response to the antigen
D. Proportion of activated B cells mature into plasma cells
E. Antigens presented to naive T cells by APCs

1 - A. APCs present part of the vaccine on the cell surface
2 - E. Antigens presented to naive T cells by APCs
3 - C. Activation of B cells (with the aid of CD4+ cells) in response to the antigen
4 - D. Proportion of activated B cells mature into plasma cells
5 - B. Production of antibodies specific for the vaccine antigen

19

In the 2006 Point Prevalence Survey of Healthcare Associated Infections, please rank the following HAI syndrome in order from most to least prevalent.

A. Skin and soft tissue
B. Surgical site
C. Urinary tract
D. Hospital acquired pneumonia
E. Gastrointestinal system

1 - E. Gastrointestinal system
2 - C. Urinary tract
3 - D. Pneumonia/ LRTI
4 - B. Surgical site
5 - A. Skin and soft tissue

20

Rank the following investigations in the order they are likely to be used for HIV-1 diagnosis.

A. CD4+ count
B. Viral load PCR
C. ELISA HIV-1 antibody test
D. Confirmatory HIV test
E. HIV-1 drug resistance test

C. ELISA HIV-1 antibody test
D. Confirmatory HIV test
B. Viral load PCR
A. CD4+ count
E. HIV-1 drug resistance test

21

A 50 year old woman presents to her GP with fatigue and SOB. She is found to be pale with mild jaundice. Her blood count shows a haemoglobin concentration of 88g/L with a slight macrocytosis. Her blood film shows spherocytes and polychromatic macrocytes. A direct antiglobulin test is positive and unconjugated bilirubin is increased. Rank the following differential diagnoses, with 1 being the most likely and 5 the least.

A. Hepatitis A
B. Obstructive jaundice
C. Autoimmune haemolytic anaemia
D. Microangiopathic haemolytic anaemia
E. Hereditary spherocytosis

1 - C. Autoimmune haemolytic anaemia
2 - E. Hereditary spherocytosis
3 - D. Microangiopathic haemolytic anaemia
4 - A. Hepatitis A
5 - B. Obstructive jaundice

22

A 28 year old woman is invited for a routine cervical smear, list the sequence of events in the order that they occur.

A. Referral to colposcopy
B. Cervical intraepithelial neoplasia 1
C. Low grade dyskaryosis on ctyology
D. High risk HPV positive molecular test
E. 360 degrees rotation, five times around the cervix, with sampling device for smear sample

E. 360 degrees rotation, five times around the cervix, with sampling device for smear sample
C. Low grade dyskaryosis on ctyology
D. High risk HPV positive molecular test
A. Referral to colposcopy
B. Cervical intraepithelial neoplasia 1

23

Rank the following in order of likelihood of developing an acquired autoimmune haemolytic anaemia.

A. Penicillin V (Phenoxymethylpenicillin)
B. SLE
C. Pernicious anaemia
D. G6PD deficiency
E. CLL

1 - E. CLL
2 - B. SLE
3 - A. Penicillin V (Phenoxymethylpenicillin)
4 - C. Pernicious anaemia
5 - D. G6PD deficiency

While the mechanism of AID in CLL is not fully understood, we
know that the autoantibodies responsible for destroying the blood
cells are polyclonal which means they don’t come directly from
the CLL cells themselves. Rather the dysfunctional activity of the
T-cells that help regulate the immune response (regulatory Tcells or T-regs) is likely playing a role.

24

Which of the following is the most sensitive marker of liver damage?

A. AST
B. Prothrombin time
C. Alkaline phosphatase
D. Bilirubin

B. Prothrombin time

25

Superoxide dismutase 1 is a misfolded protein associated with which condition?

A. Motor neurone disease
B. Multiple sclerosis
C. Parkinson's disease
D. Alzheimer's disease

A. Motor neurone disease

26

Which of these options is a Gram positive organism?

A. E. coli
B. H. influenzae
C. L. Monocytogenes
D. S. typhi

C. L. Monocytogenes

27

Which of the following is a common cause of renal disease in children?

A. Diabetic glomerulosclerosis
B. Minimal change disease
C. Membranous glomerulonephritis
D. FOcal and segmental glomerulonephritis

B. Minimal change disease

28

Which of the following genetic syndrome is not associated with phaeochromocytoma?

A. Neurofibromatosis type 1
B. MEN 1
C. MEN2
D. Von-Hippel Lindau

B. MEN 1

29

Which drug can be used in the treatment of benign prostatic hyperplasia?

A. Phosphodiesterase inhibitor
B. Beta blockers
C. 5-alpha reductase inhibitor
D. Oestradiol

C. 5-alpha reductase inhibitor

30

Which of the following drugs would cause dangerous toxicity if taken with allopurinol?

A. Phenytoin
B. Tamoxifen
C. Azathioprine
D. Aminophylline

C. Azathioprine