Path VSAs

Question 1

What does Denosumab target

Answer 1

Receptor activator of nuclear factor kappa-B Ligand (RANKL)

Question 2

Turkish man
fever
history of recurrent chest infections
mutation in the MEFV gene

Answer 2

ME-FV = Familial MEditerranean FeVer

Question 3

mixed pattern auto-inflammatory condition over 90% heritability
sacroiliac joint

Answer 3

Ankylosing spondylitis

Question 4

hyperthyroidism Sx
low TSH and high thyroxine
NO good uptake on technetium scan

Answer 4

Viral De Quervain’s thyroiditis (virus releases thyroxine stores)

Good uptake bilaterally = Grave’s Disease
nodular = Toxic multinodular goitre
single mass uptake = toxic adenoma (Ca)

Question 5

measure the turnover of bone, and is raised in people who have Paget’s, Osteomalacia / Rickets?

Answer 5

Alkaline Phosphatase

Question 6

elderly man has a fall
no LoC
two days later confusion
where is the likely site of bleeding?

Answer 6

subdural

Question 7

clotting factor that falls most rapidly after administering warfarin

Answer 7

FVII

FVII > Protein C/S > F 9 > F 2

Question 8

blood marker MEDULLARY thyroid Ca

Answer 8

calcitonin

(and CEA - Carcinoembryonic antigen )

Question 9

Marker Papillary (commonest) & Follicular thyroid carcinoma

Answer 9

Thyroglobulin

common thyroid ca
Papillar>Follicular>Medullary
PAy FOr ME

Question 10

drug is used to treat severe falciparum malaria

Answer 10

artesunate

Question 11

massive splenomegaly
JAK2 V617F mutation leucoerythroblastic picture
tear-drop poikilocytes (dacrocytes)

Answer 11

myelofibrosis

Question 12

African man

with Burkitt’s lymphoma is given Rasburicase. Develops haematuria with irregularly contracted cells

Answer 12

G6PD

Question 13

aortic valve replaced 3 months ago
few weeks later
jaundice, Hb-urea (haemoglobinuria), and raised reticulocytes

Answer 13

MAHA

Question 14

cancer is present if keratin and intercellular bridges

Answer 14

Squamous Cell Carcinoma

Question 15

high Na+, low K+, and low renin

Answer 15

Conn’s - Primary Hyperaldosteronism

Question 16

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

Answer 16

Psoriasis

Question 17

vasculitis external carotid

Answer 17

Temporal arteritis

Question 18

Type of amyloidosis

Answer 18

reactive

Question 19

type of amyloid deposited in multiple myeloma

Answer 19

Ig light chain

Question 20

one of types/groups of drugs used to treat HIV

Answer 20

Nucleoside Reverse Transcriptase Inhibitors

Protease inhibitor

Question 21

main class of drug used to treat HIV

Answer 21

Nucleoside Reverse Transcriptase Inhibitors

Question 22

zoonotic disease does the Ixodes Tick cause

Answer 22

Lyme disease

Question 23

absence UDP gluconoryl transferase
jaundice + kernicterus 
high unconj bili
death in 1 yr of life
AR inheritance

Answer 23

Crigler-Najjar syndrome

Question 24

reduced activity UDP gluconoryl transferase
AD inheritance
harmless raised unconj bili

Answer 24

Gilbert’s

Question 25

Medical certificate of Cause of Death OR consented autopsy

Answer 25

Know the cause of death

Question 26

unsure of cause of death

Answer 26

Discuss w/ coroner about death certificate or autopsy

Question 27

unknown cause death violent death died in prison/custody/MH hospital

Answer 27

autopsy

Question 28

Cause of death unknown Not seen by Dr during last illness OR last 14 days During or within 12m of pregnancy Death in custody Death whilst detained under MHA Death due to suicide, accident/trauma (inc domestic), industrial, peri-operative, abortion, anaesthetic care, lack of medical care, murder, self-neglect or ANY DOUBT (inc if injury was years ago)

Answer 28

refer to coroner

Question 29

Person with well controlled HIV and hyperlipidaemia due to HAART medication. Deteriorated and found wedge shaped lesion on CTPA. Suffered from a cardiac arrest and died.

Answer 29

1a pulmonary infarction/MI 1b Hyperlipidaemia 2 HIV CANNOT put FAILURES (heart/liver/resp) or cardiac arrest as 1a

Question 30

Patient with HIV was recently involved in an RTA | Fill in MCCD?

Answer 30

NO

Question 31

Woman who’s daughter and husband disagree on post mortem

Answer 31

refer to coroner

Question 32

Enzyme raised in biliary obstruction

Answer 32

Gamma glutamyltransferase

Question 33

High sodium, high potassium, high serum osmolality, low urine osmolality

Answer 33

Diabetes insipidus

Question 34

euvolaemic low serum osmolality urine NA >20 normal renal, adrenal, thyroid

Answer 34

SIADH

Question 35

no particles in urine

Answer 35

urine specific gravity

Question 36

commonest cause hyperkalaemia

Answer 36

AKI

Question 37

Vegan with megaloblastic anaemia

Answer 37

B12 deficiency

Question 38

Crohn’s with Megaloblastic anaemia

Answer 38

B12 deficiency

Question 39

Deficiency associated w/ Lacking IF

Answer 39

B12 | pernicious anaemia

Question 40

Dementia, Dermatitis (scaly), Diarrhoea Pellagra

Answer 40

Niacin def

Question 41

Tx Beri Beri

Answer 41

B1 (thiamine)

Question 42

Nutritional deficiency glossitis dementia Pernicious anaemia

Answer 42

B12

Question 43

Dermatitis, anaemia, neuropathy

Answer 43

B6: Pyridoxine

Question 44

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

Answer 44

Primary Hyperparathyroidism