Potential Questions Flashcards
1
Q
Which joint is most commonly affected in gout?
A
1st Metatarsophalangeal Joint
2
Q
A 6 month old boy presents with developmental delay and hyperuricaemia. At 1 year, he begins to exhibit choreiform movements and regularly bites his lip. What is the most likely diagnosis?
A
Lesch-Nyhan Syndrome
X-Linked Recessive deficiency in HPRT
3
Q
An alcoholic presents with a painful 1st metatarsophalangeal joint. The joint is aspirated, and needle shaped crystals which are negatively birefringent are seen under polarising light. What is the most likely diagnosis, and what is the most likely chemical composition of the crystals?
A
Gout
Monosodium Urate
4
Q
A man presents with an acutely painful left knee. The joint is aspirated, and rhomboid shaped positively birefringent crystals are seen under polarising light. What is the most likely diagnosis and what is the most likely chemical composition of the crystals?
A
Pseudogout
Calcium Pyrophosphate
5
Q
List 2 drugs which may be used in acute gout management.
A
NSAIDs
Colchicine
6
Q
A man is diagnosed with gout, and is prescribed a xanthine oxidase inhibitor to aid with reducing urate synthesis. Which drug was he most likely prescribed?
A
Allopurinol
7
Q
A woman presents with corneal arcus and tendon xanthomata at a young age. Her older brother experienced similar symptoms. What is the most likely diagnosis?
A
Familial Hypercholesterolaemia
8
Q
A woman is prescribed a statin. What would be the expected effect on:
a) LDLs
b) HDLs
c) Triglycerides
A
a) Reduction
b) Increase
c) Slight Increase
9
Q
How is Gilbert’s Syndrome inherited?
A
Autosomal Recessive
10
Q
A man presents with an episode of jaundice after not eating for 12 hours. LFTs are grossly normal. Which enzyme is likely to be defective?
A
UDP glucoronyl transferase
11
Q
What is the most sensitive marker for testing liver function?
A
Prothrombin Time
12
Q
What is the most common form of liver disease in the Western World?
A
Non-Alcoholic Fatty Liver Disease
13
Q
A man presents with painless jaundice. He is later diagnosed with Pancreatic Cancer. To where is his tumour most likely to metastasise?
A
Liver
14
Q
A young boy is flagged by teachers as having difficulty with basic learning in school. On further investigation, he is found to have high serum levels of phenylalanine. What is the most likely diagnosis, and which enzyme is he deficient in?
A
Phenylketonuria
Phenylalanine Hydroxylase
15
Q
What is the most common pathogenesis behind Congenital Hypothyroidism?
A
Thyroid Agenesis
16
Q
How is Cystic Fibrosis screened for?
A
Measure serum Immune Reactive Trypsinogen levels.
17
Q
A child presents with vomiting, a respiratory alkalosis and seizures. On examination, he is found to have high serum levels of ammonia. Which class of disease is he most likely to be suffering from?
A
Urea Cycle Disorders
18
Q
A child presents with vomiting, seizures and loss of consciousness. Their medical history is unremarkable, however their Mother reports giving them 2 aspirin tablets for a headache yesterday evening. What is the most likely diagnosis?
A
Reye Syndrome
19
Q
A neonate is found to be hyponatraemic. What is the most likely cause?
A
Congenital Adrenal Hyperplasia
20
Q
Which enzyme is most likely to be deficient in a neonate presenting with congenital adrenal hyperplasisa?
A
21-Hydroxylase
21
Q
What is the most common type of Porphyria?
A
Porphyria Cutanea Tarda
22
Q
A child is diagnosed with a Porphyria. What is the most likely diagnosis?
A
Erythropoietic Protoporphyria
23
Q
A young woman presents with abdominal pain, constipation palpitations and a recent seizure. She has just returned from a holiday with her friends where she drank a lot of alcohol. Her father has experienced similar attacks. What is the most likely diagnosis?
A
Acute Intermittent Porphyria
Autosomal Dominant, only presents with neurovisceral symptoms
24
Q
A young woman presents with a potential case of acute intermittent porphyria. Which investigation may be most helpful in coming to a diagnosis?
A
Increased urinary PBG
25
How does pregnancy affect Thyroid function?
hCG levels can stimulate a slight increase in free T4
26
A woman presents with palpitations, weight loss and a tremor. She reports a viral upper respiratory tract infection 2 weeks ago. Radio-iodine uptake is low across the thyroid gland. What is the most likely diagnosis?
De Quervain's Thyroiditis
27
A patient has a total thyroidectomy for medullary thyroid cancer. List two markers that may be used to assess disease recurrence.
Calcitonin
| Carcinoembryonic Antigen
28
In which forms does calcium exist in the plasma?
Free, ionised - 50%
Bound to Albumin - 40%
Complexed - 10%
29
How is corrected calcium calculated?
Serum Calcium + (0.02 x (40 - serum albumin g/L))
30
What is the rate limiting enzyme in Vitamin D activation?
1-alpha-hydroxylase
31
A man presents with symptoms of hypercalcaemia. Non-caseating granulomas are seen on chest x-ray. What is the likely diagnosis, and pathophysiology behind the hypercalcaemia?
Sarcoidosis
| Sarcoid lung cells express 1-alpha-hydroxylase, hence lead to more production of activated Vitamin D
32
A lady presents with osteomalacia secondary to Vitamin D deficiency. Her medical history is remarkable for one, long term, well controlled condition. Which class of drugs are most likely to have contributed to her deficiency?
Anti-convulsants
33
A life-long smoker presents with a worsening history of cough, weight loss, constipation and confusion. He is found to be hypercalcaemic. What is the most likely diagnosis and pathophysiology behind the raised calcium?
Small Cell Lung Cancer
| Ectopic PTHrP release
34
A man is found to have hypercalcaemia secondary to malignancy. How would he be managed?
Lots of fluids
Bisphosphonates
Treat the underlying cause
35
A woman is found to be hyponatraemic. She is clinically hypovolaemic. List three potential causes of her electrolyte abnormality.
Diarrhoea/Vomiting
Diuretics
Salt-Losing Nephropathy
36
A woman is found to be hyponatraemic. She is clinically euvolaemic. List 3 potential causes of her electrolyte abnormality.
Adrenal Insufficiency
Hypothyroidism
SIADH
37
A woman is found to be hyponatraemic. Clinically, she is hypervolaemic. List 3 potential causes of her electrolyte abnormality.
Cirrhosis
Cardiac Failure
Nephrotic Syndrome
38
A man presents with euvolaemic hyponatraemia. All endocrine screening is normal. What is the most likely diagnosis, and how would this be investigated?
SIADH
Low plasma osmolality
High urine osmolality
39
A man complains of pain in all 4 limbs and joint pain. Soon after, he has a seizure, and falls into a coma. He was in hospital being treated for hyponatraemia secondary to SIADH. What is the most likely diagnosis?
Central Pontine Myelinolysis due to rapidly corrected hyponatraemia.
40
A man presents with hyperkalaemia. How would he be managed in the first instance?
10ml 10% Calcium Gluconate
50ml 50% Dextrose
10 U Insulin
Nebulised Salbutamol
41
How would you calculate Osmolality?
2(Na + K) + Urea + Glucose
42
A patient is found to be in a hyperglycaemic hyperosmolar state. Why must you take care in giving lots of fluids to this patient?
May lead to Cerebral Oedema
43
A man presents with hypertension, and is found to have an adrenal mass. List 3 potential diagnoses.
Conn's Syndrome
Cushing's Syndrome
Phaeochromocytoma
44
Other than blood, what may cause a urine dipstick to show positive for blood.
Myoglobin, typically from rhabdomyloysis
45
If a red blood cell is described as 'polychromatic' on blood film, what does this mean.
Bluish appearance due to taking up eosinophilic and basophilic dyes. Occurs due to the presence of reticulocytes.
46
A man has a diagnosis of Hereditary Spherocytosis. What would you expect to happen to his erythrocytes when added to a hypotonic saline?
Increased rate of lysis due to osmotic fragility
47
Which cancer is most associated with Down's Syndrome?
AML
48
What feature would you expect to see on blood film of someone with Acute Myeloid leukaemia?
Auer Rods
49
What is the most common cause of Vitamin K deficiency?
Warfarin
50
How would you distinguish between platelet disorders and coagulation factor disorders clinically?
Plt -> Small, superficial bleeding from minor scratches. Petechiae
Coagulation factor -> Deep bleeding into joints, soft tissues and muscles
51
List two treatments that may be used for Immune thrombocytopaenic Purpura.
Steroids
| IVIG (If severe)
52
What is the most common cause of Disseminated Intravascular Coagulation?
Sepsis
53
A man presents with headaches, visual disturbance and itching after having a hot shower. On examination, he has splenomegaly. What is the likely diagnosis?
Polycythaemia Vera
54
A man has a bone marrow biopsy which shows increased erythroid cellularity, slight reticulin fibrosis and megakaryocyte abnormalities. What is the most likely diagnosis?
Polycythaemia Vera
55
Which mutation is commonly associated, and can be diagnostic of, myeloproliferative disorders?
JAK2 V617F
56
A patient presents with an isolated erythrocytosis, with a low serum erythropoietin. What is the likely diagnosis, and which mutation may they have?
Idiopathic Erythrocytosis
| Exon 12 Mutation
57
A patient is incidentally found to have a low WCC and thrombocytosis. On examination, they have hepatosplenomegaly. Bone marrow biopsy shows a dry tap. What is the likely diagnosis, and what might you see on blood film?
Myelofibrosis
Leukoerythroblastic picture with 'Tear Drop' Poikilocytes
58
Which cancers are associated with secondary polycythaemias, and why?
Liver
Renal Cell
Ectopic EPO production
59
Which diagnosis must you consider in a patient presenting with Micro-angiopathic haemolytic anaemia?
Adenocarcinoma
60
A patient is found to have a mutation in the FIP1L1-PDGFRa fusion gene. Which condition are they likely susceptible to developing?
Chronic Eosinophilic Leukaemia
61
A patient presents with a rash and coryzal symptoms. They are found to have a basophilia on blood film. Which class of virus are they most likely to be infected with?
Poxviruses
62
What percentage of hospital deaths are caused by Pulmonary Emboli?
5-10%
63
A man has taken 5 times his regular dose of heparin. Which medication would you administer?
Protamine
64
You stain a sample of a patient's bone marrow with Prussian Blue stain. You observe an accumulation of iron around the nuclei of red blood cell precursors. What might the diagnosis be?
Ringed Sideroblasts, seen in myelodysplastic syndromes
65
What is the most common inherited cause of Aplastic Anaemia?
Fanconi Anaemia
66
A patient is known to have chronic H.Pylori infection. Which malignancy are they most at risk of?
Gastric MALT NHL
67
A patient is known to have Sjogren's Syndrome, and are positive for both anti-ro and anti-la antibodies. Which malignancy are they most at risk of developing?
Marginal Zone NHL of the parotid.
68
A patient has poorly controlled Coeliac disease. Which malignancies are they most at risk of developing?
Small Bowel T Cell Lymphoma
| Enteropathy-associated T Cell NHL
69
Which virus is associated with Adult T Cell Leukaemias?
HTLV1
70
Which cells of the immune system are marked by CD3 and CD5?
T Cells
71
Which cells of the immune system are marked by CD20?
B Cells
72
Which Non-Hodgkins Lymphoma is most common?
B Cell Lymphoma
73
A patient presents with a painless swollen lymph node and splenomegaly. They have also experienced weight loss and drenching night sweats. Genetic analysis reveals a (11;14) translocation. What is the most likely diagnosis?
Mantle Cell Lymphoma
74
Histology of a lymphoma reveals small lymphocytes which are CD5 and CD23 positive. These replace the entire node, with no follicles or areas of T Cell dominance visible. Which subtype is it?
Small lymphocytic Lymphoma
75
A child presents with a growing unilateral mass on their mandible. They are known to have been infected with EBV. Biopsy shows a 'Starry Sky' Appearance'. What is the likely diagnosis?
Burkitt's Lymphoma
76
A patient is diagnosed with mycosis fungoides. Which malignancy are they now at risk of?
Cutaneous T Cell Lymphoma
77
A lymphoma is shown to be positive for CD15 and CD30. Which histological subtype is it most likely to be?
Hodgkin's Lymphoma
78
A Lymphoma displays reed-Sternberg cells under histology, however is negative for CD15 and CD30, and positive for CD20. What is the most likely diagnosis?
Lymphocyte predominant Hodgkin Lymphoma
79
A patient presents with a progressive dry cough. His medical history is notable for treated Hodgkin's Lymphoma. What is the most likely diagnosis?
Pulmonary Fibrosis
80
What are the two most common types of non-Hodgkins Lymphoma?
Diffuse large B Cell
| Follicular
81
What is the most common leukaemia in the Western World?
CLL
82
A 58 year old patient is incidentally found to be anaemic and thrombocytopenic. Blood film shows the presence of smear cells. What is the most likely diagnosis?
Chronic Lymphocytic Leukaemia
83
A patient is diagnosed with cancer. He is informed that his disease will be staged by the Rai and Binet systems to guide treatment and prognosis. Which cancer does he most likely have?
Chronic Lymphocytic Leukaemia
84
List one gene mutation that is associated with a poor prognosis in CLL.
17p (Tp53) deletion
85
List one gene mutation which is associated with a good prognosis in CLL.
VH
86
A patient with a diagnosis of CLL begins to experience drenching night sweats, and finds a lump in his axilla. What pathological process has likely occurred?
Richter Transformation
87
What is the mechanism of action of Ibrutinib?
Bruton Tyrosine Kinase Inhibitor
88
A patient is diagnosed with Chronic Myeloid Leukaemia. Which genetic defect are they most likely to have?
(9;22) Translocation
89
A woman presents at 28 weeks gestation with a hot, swollen lower left leg. She is subsequently diagnosed with a DVT. How is the relative risk of thromboembolic Disease in pregnancy different to the general population?
10x higher
90
A patient undergoes a plasma transfusion and develops an acute reaction. What is the most likely mechanism?
Allergic. Plasma is frozen, hence is unlikely to harbour bacteria
91
When would a platelet transfusion be contraindicated in a patient bleeding heavily?
Heaprin-Induced Thrombocytopaenia
Thrombotic Thrombocytopaenic Purpura
92
A patient's blood film displays Howell-Jolly bodies, what is the most likely cause?
Hyposplenism
93
A patient presents with petechiae on the lower limbs, bruises and bloody blisters in the mouth. What is the most likely diagnosis?
Immune Thrombocytopaenic Purpura
94
Which feature seen on a FBC may be considered a bad prognostic feature in Leukaemia?
Very high WCC
95
Which type of T cell binds HLA Class II?
CD4 +
| Helper/Regulator
96
Which type of T Cell binds HLA Class I?
CD8+
| Killer
97
A child presents with recurrent infections. There is a positive family history for similar presentations. On further investigation, there is a complete absence of lymphoid or myeloid cells. What is the most likely diagnosis?
Reticular Dysgenesis
98
A child presents with recurrent infections with no pus. On further investigation, there is a complete absence of neutrophils. What is the likely diagnosis?
Kostmann Syndrome
99
A patient presents with recurrent infections that seem to occur once every 4-6 weeks. His FBC one month ago showed a normal neutrophil count, however his repeat FBC today shows absent neutrophils. What is the diagnosis?
Cyclic Neutropenia
100
A child presents with recurrent infections with no pus. As a neonate, there was delayed umbilical cord separation. Their FBC shows high neutrophils. What is the likely diagnosis?
Leukocyte Adhesion Deficiency
101
A child presents with recurrent infections, and is found to be positive for the Adenylate Kinase 2 mutation. What is the most likely diagnosis?
Reticular Dysgenesis
102
Which enzyme are patients with Chronic Granulomatous Disease likely to be deficient in?
NADPH Oxidase
103
A child presents with recurrent infections by atypical mycobacteria. Neutrophil count is normal and pus is present. What is the most likely diagnosis?
IL12/IL12r or IFN-gamma/IFN-gamma r deficiency
104
A patient is diagnosed with a phagocyte deficiency. List 2 treatments that may be used in their management.
Aggressive Management of infections
Haematopoietic Stem Cell Transplant
IFN-Gamma (CGD)
105
A patient presents with recurrent infections. In the past year she has cultured Neisseria meningitides, Haemophilus Influenzae and Streptococcus pneumoniae. Which type of immune deficiency may she have?
Complement
106
Which is the most common complement deficiency?
C2 Deficiency
107
A patient presents with recurrent infections. They also report regular arthralgia, chest pain, and have a bilateral erythematous rash on their face which worsens in sunlight. They test positive for Anti-dsDNA antibodies. What is the most likely cause of their recurrent infections?
Systemic Lupus Erythematosus causing C2 Deficiency.
| C3/C4 will also be low in active Lupus
108
How would you investigate function of the classical complement pathway?
CH50
109
How would you test function of the alternative complement pathway?
AP50
110
A child presents with a severe malar rash that worsens in sunlight, fever and systemic arthralgia. On further investigation, C3/C4 levels are found to be normal. What is the most likely immune deficiency?
C1q Deficiency
111
A patient undergoing chemotherapy presents with recurrent infections and low neutrophil counts. They never experienced similar issues before starting chemotherapy. What is the most likely diagnosis?
MBL Deficiency
112
A patient is found to be anaemic, and has lots of variation in the size and shape of erythrocytes on blood film. What is this sign called, and what is the likely cause of their anaemia?
Anisopoikilocytosis
| Iron Deficiency Anaemia
113
A patient has a blood film, which shows nuclear remnants present within erythrocytes. What is this called, and what may cause it?
Howell-Jolly Bodies
| Hyposplenism
114
A patient is found to be positive for HLA-DQ2 and HLA-DQ8. Which disease are they most likely to suffer from?
Coeliac Disease
115
An infant is found to have very low T Cells, very low B Cells and very low NK Cells. Which enzyme may they be deficient in?
Adenosine Deaminase (ADA), which is required by lymphocytes for cell metabolism.
116
A patient is found to have a condition in which there is a deficiency of CD4+ T Cells due to impaired T Cell selection in the thymus. What is the most likely diagnosis, and what is deficient?
Bare Lymphocyte Syndrome 2
| MHC Class II
117
What determines a) the class and b) effector function of immunoglobulins?
a) Heavy Chain
| b) Constant region of the heavy chain
118
A 2 year old boy presents with recurrent infections. Investigation reveals normal WCC, high IgM and absent IgA, IgG & IgE. What is the most likely diagnosis, and which gene may be mutated?
X-Linked Hyper IgM Syndrome
| CD40 Ligand
119
A patient with a long-term condition caused by a mutation in the MEFV gene presents with end-stage renal failure. What is the most likely cause?
AA Amyloidosis due to chronic Familial Mediterranean Fever
120
A patient presents with Hypoparathyroidism, Addison's and Hypothyroidism. They test positive for a mutation in the AIRE gene. What is the most likely diagnosis?
Autoimmune Polyendocrinopathy Candidiasis Ectodermal Dystrophy (APECED)
121
A patient, known to have Type 1 Diabetes Mellitus and Autoimmune Hypothyroidism, presents with acute dermatitis and abdominal pain. They are found to have a mutation in the FoxP3 gene, and to have impaired T-Regulator function. What is the most likely diagnosis?
Immune Dysregulation Polyendocrinopathy Enteropathy X-Linked Syndrome (IPEX)
122
Which HLA polymorphism is associated with Type 1 Diabetes Mellitus?
HLA-DR3/4
123
Which HLA Polymorphism is associated with Graves' Disease?
HLA-DR3
124
Which class of hypersensitivity does Multiple Sclerosis fall into?
Type IV - Delayed T Cell mediated
125
What is the gold standard test for diagnosing food and drug allergies?
Challenge test
126
What mediates anaphylaxis triggered by blood product transfusions?
IgG
127
What mediates anaphylaxis triggered by dialysis membranes?
Complement
128
Which organ is most commonly transplanted?
Kidney
129
Which cells express HLA Class I molecules?
All cells
130
A patient recently underwent a kidney transplant, however there is suspicion that the graft has been rejected. What is the gold standard test for diagnosis?
Biopsy
131
A biopsy of a graft is taken. It shows lymphocytic interstitial infiltration, ruptured tubular basement membrane and tubulitis. What is the likely diagnosis?
T-Cell Mediated Rejection
132
A biopsy of a graft is taken. it shows the presence of inflammatory cells within the capillaries of the graft. What is the likely diagnosis?
Antibody-mediated transplant rejection
133
A patient recently underwent a successful kidney transplant. He is now complaining of gum hypertrophy. Which medication is most likely to have caused his symptoms?
Cyclosporin, a Calcineurin inhibitor.
134
Name two drugs which may be used for transplant rejection prophylaxis.
Tacrolimus, Cyclosporin
| Both Calcineurin Inhibitors
135
Name an anti-CD20 agent which may be used in the management of lymphoma and rheumatoid arthritis.
Rituximab
136
Name an anti-CD25 agent which may be used as prophylaxis to prevent organ transplant rejection
Daclizumab
137
List two agents which may be used in the prevention of Graft vs Host Disease
Methotrexate
| Cyclosporin
138
A patient underwent a successful liver transplant 3 months ago. He now presents with a rash, nausea and vomiting, abdominal pain and bloody diarrhoea. On examination, he appears jaundiced. What is the most likely diagnosis?
Graft vs Host Disease
139
Name two examples of toxoid vaccines.
Diptheria
| Tetanus
140
List 3 examples of component/subunit vaccines
```
Hep B (HBsAg)
HPV (Capsid)
Haemophilus Influenzae (HA)
```
141
List 3 examples of conjugate vaccines
Haemophilus influenzae type B
Meningococcus
Pneumococcus
142
What is the most common form of adjuvant?
Aluminium Salts
143
A patient is found to have a TPMT polymorphism which lessens its activity. Which drug must they not be started on?
Azathioprine
144
A patient has refractory Rheumatoid Arthritis. They are JAK positive, and started on a drug which targets this. Which drug is it most likely to be?
Tofacitinib
145
A patient presents with weight gain and feeling cold all the time. They also state they have been feeling low recently. They are found to be positive for Anti-Thyroglobulin and Anti-Thyroid Peroxidase antibodies. What is the most likely diagnosis?
Hashimoto's thyroiditis
146
Which HLA polymorphisms are associated with Rheumatoid Arthritis?
HLA DR1
| HLA DR4
147
A patient presents with recurrent VTEs, multiple miscarriages and is found to be thrombocytopaenic. Which antibody are they most likely to test positive for?
Anti-Cardiolipin
148
A patient presents with a dry cough, cold, painful hands and tight, thickened skin which spreads across their whole body. What is the likely diagnosis and which antibody are they most likely to test positive for?
Diffuse Cutaneous Systemic Sclerosis
| Anti-Scl70
149
A patient presents with refractory asthma, fever and weight loss. They also have nasal polyposis and allergic rhinitis. They are later found to have hypereosinophilia. What is the likely diagnosis, and which antibody might they test positive for?
Eosinophilic Granulomatosis with Polyangiitis
| p-ANCA
150
A patient presents with tiredness, loss of appetite and arthralgia. They have depleted renal function, and have experienced one episode of haemoptysis. They test positive for p-ANCA antibodies. What is the most likely diagnosis?
Microscopic Polyangiitis
151
A patient presents with tiredness, loss of appetite and weight loss. They have experienced two episodes of haemoptysis and haematuria, and on examination seem to have a saddle nose deformity. They test positive for c-ANCA antibodies. What is the most likely diagnosis?
Granulomatosis with Polyangiitis
152
A patient presents with a headache, neck stiffness and photosensitivity. They are known to be HIV positive. CSF analysis shows clear liquid with high lymphocytes, high protein and low glucose. MRI shows leptomeningeal enhancement. What is the likely diagnosis?
Tuberculosis Meningitis
153
A patient presents with a headache, stiff neck and photosensitivity. CSF analysis shows high lymphocytes, high protein and normal glucose. List 3 potential causes of their meningitis.
Mumps
Enteroviruses
Herpes Viruses
154
A patient presents with features typical of meningitis. Culture grows a gram negative non-haemolytic diplococci. What is the most likely organism?
Neisseria Meningitides
155
A patient presents with a recent history of behavioural changes and a decreased level of consciousness. Whilst being examined they experience a seizure. Culture from a lumbar puncture grows gram positive rods. What is the most likely causative organism?
Listeria Monocytogenes
156
Gram staining of an unknown organism with India Ink reveals an orbit-like structure, with a yeast cell in the middle and a capsule around the outside. What is the most likely organism?
Cryptococcus spp.
157
A patient is diagnosed with meningitis, and culture grows Gram Positive cocci. Which treatment would most likely be initiated?
Ceftriaxone
158
A patient is diagnosed with meningitis. Culture grows Gram negative coccobacilli. What is the likely organism, and how would it be managed?
Cefotaxime
| Haemophilus Influenzae
159
A patient presents with a recent history of behavioural changes and a decreased level of consciousness. Whilst being examined they experience a seizure. Culture from a lumbar puncture grows gram positive rods. How would this patient be treated?
Ampicillin
160
A patient presents with watery, non-bloody diarrhoea a day after eating reheated rice. Culture grows Gram-positive rods which are spore forming. What is the likely causative organism?
Bacillus cereus
161
A patient has watery diarrhea and cramping abdominal pain following a recent course of clindamycin. Which antibiotic would most likely be used to treat them?
Vancomycin
162
A man who eats a lot of soft cheese presents with watery diarrhoea, headache and vomiting. Culture reveals a Gram Positive rod which is a facultative anaerobe. What is the most likely diagnosis?
Listeria monocytogenes
163
Which strand of E.Coli most commonly induces Haemolytic Uraemic Syndrome?
O157:H7
164
A man presents with non-bloody loose stools. He does not have a fever. He recently ate some chicken. Culture grows Gram Negative Rods. What is the likely causative organism?
Salmonella enteritidis
165
A patient presents with slow onset fever and constipation. On examination, he has splenomegaly and has Rose Spots on his abdomen. What would be the most likely first line treatment?
Ceftriaxone
166
Which enteric bacterium has the lowest infective dose?
Shigella
167
A patient presents with severe diarrhoea with blood and mucus in the faeces. Culture grows Gram-Negative Rods. What is the likely causative organism, and how is it treated?
Shigella
| Supportive
168
A patient presents with descending paralysis. he reports visiting a farm recently and trying their honey. What is the most likely causative organism?
Clostridium botulinum
169
A patient presents with massive diarrhoea, which he describes as being like 'rice water'. On culture, comma shaped bacteria grow. What is the likely causative organism?
Vibrio cholera
170
A man from Peru presents with fever and bloody diarrhoea. A cyst in the right lobe of his liver is detected on USS. What would be the most likely first line treatment?
Metronidazole
| Paromycin
171
A patient presents with foul-smelling, non-bloody diarrhoea with cramps, flatulence and no fever. Microscopy shows Pear-shaped trophozoites. What is the likely diagnosis, and how would it be treated?
Giardia lamblia
| Metronidazole
172
What is the most likely causative organism in an immunocompromised patient with severe diarrhoea?
Cryptosporidium parvum
173
What type of drug is zidovudine?
Nucleotide Reverse Transciptase Inhibitor
174
What type of drug is efavirenz?
Non-Nucleotide Reverse Transciptase Inhibitor
175
Which type of drug is raltegravir?
Integrase Inhibitor
176
What type of drug is lopinavir?
Protease Inhibitor
177
A patient presents with a productive cough, with desaturation on exercise. CXR shows widespread, bilateral, ground-glass shadowing. What is the likely causative organism?
Pneumocystis jirovecii
178
A patient presents with a productive cough, with desaturation on exercise. CXR shows widespread, bilateral, ground-glass shadowing. How would this patient likely be treated?
Co-trimoxazole
179
A patient has a diffusion-weighted MRI, which shows an increased signal in the cortex of the right parietal lobe. What is the most likely diagnosis?
Creutzfield-Jakob Disease
180
A patient is found to have a mutation in the PRNP gene. Which disease class are they most likely to develop?
Prion Disease
181
A patient with a catheter inserted develops a UTI. How would they be managed?
Remove Catheter
| Gentamicin
182
A patient develops an infection at the site of a recent surgery. Culture grows MRSA. How would this patient be treated?
Linezolid
183
List the 5 most common types of Hospital-Acquired-Infection in order of prevalence.
```
Pneumonia
Surgical Site Infection
UTI
Blood Stream Infection
GI Infection
```
184
A patient has a fever of 38.5 which has lasted over 3 weeks. After 10 days in hospital, doctors still have yet to come to a conclusive diagnosis. How would their condition be defined?
Pyrexia of unknown origin
185
A patient presents with scalp tenderness, jaw claudication and changes in their vision. How should they be managed?
High dose prednisolone (Giant Cell Arteritis)
186
A patient develops a macule at the the site of a cat scratch one week ago. They have a fever, and local lymphadenopathy can be palpated. What is the likely causative organism?
Bartonella henselae
187
Which organism causes Q Fever?
Coxiella burnetii
188
A man with pneumonia is shown to have a cavitating lung lesion. He had the flu a month ago. What is the most likely causative organism?
Staphylococcus aureus
189
What is the most common cause of hospital-acquired pneumonia?
Enterobacteriaciae (E.Coli, Klebsiella)
190
A patient is diagnosed with chronic wheeze, eosinophilia and bronchiectasis. CXR shows the presence of an aspergilloma. How might this patient be treated?
Amphotericin B
191
What are the two most common infectious causes of death worldwide?
1) HIV
| 2) Tuberculosis
192
How is TB Treated?
Rifampicin 6m
Isoniazid 6m
Pyrazinamide 2m
Ethambutol 2m
193
Name a drug which may be used to treat influenza, and its mechanism of action.
Oseltamavir
| Neuraminidase Inhibitor
194
Histology of a patient with a viral infection shows 'Owl's Eye inclusions'. Which virus is likely to be implicated?
Cytomegalovirus
195
How is herd immunity threshold calculated?
1-1/R0
196
List two examples of live attenuated vaccines.
MMR
| Yellow Fever
197
What type of vaccine are influenza, polio and cholera?
Inactivated
198
Name three diseases which are screened for in pregnancy?
HIV
Hepatitis B
Syphilis
199
How would early-onset sepsis in a neonate be managed?
Benzylpenicillin (GBS)
| Gentamicin (E.Coli)
200
What is the most common cause of UTI in children?
E Coli
201
What is the most common vector for Malaria?
Female Anopheles Mosquito
202
A child presents 2 weeks after a Group A Strep throat infection with chest pain, joint pain and rapid involuntary movements of their limbs. What is the most likely diagnosis?
Acute Rheumatic fever
203
A child presents 2 weeks after a Group A Strep throat infection with chest pain, joint pain and rapid involuntary movements of their limbs. Which heart valve is most likely to be affected?
Mitral
204
A patient has chest pain. Biopsy of their heart shows Beady Fibrous vegetations, Aschoff bodies and Anitschkov myocytes. What is the most likely diagnosis?
Acute Rheumatic fever
205
A patient is treated for an MI. 20 hours after onset of the chest pain, they collapse and die. What is the most likely cause?
Arrhythmia. VF
206
A patient is treated for an MI. 6 weeks later, they return, complaining of chest pain and a fever. Pericardial Effusion is seen on echocardiogram. What is the most likely diagnosis?
Dressler's Syndrome
207
A patient presents with a chronic productive cough. Biopsy shows dilatation of the airways, goblet cell hyperplasia and hypertrophy of mucous glands. What is the most likely diagnosis?
Chronic Bronchitis
208
A patient presents with recurrent episodes of cough and fever with purulent sputum production. Histology shows permanent dilatation of the bronchi. What is the likely diagnosis?
Bronchiectasis
209
A child presents with episodes of cough and wheeze, with associated dyspnoea. They have a history of eczema. Histology shows whorls of shed epithelium, eosinophils and Charcot-Leyden Crystals. What is the most likely diagnosis?
Asthma
210
A patient presents with dyspnoea and cough. Histology shows loss of the alveolar parenchyma distal to the terminal bronchiole. What is the most likely diagnosis?
Emphysema
211
A man presents with a dry cough and chronic shortness of breath. On examination, end-inspiratory crackles can be heard. CT CAP shows a honeycomb appearance. What is the most likely diagnosis?
Interstitial Lung Disease
212
A smoker presents with a short history of cough, weight loss and fevers. A tumour is found. Biopsy shows large cells with large nuclei and no evidence of glandular or squamous differentiation. What is the most likely diagnosis?
Large Cell Carcinoma
213
A patient is known to have inflammatory bowel disease. Colic biopsy shows Skip Lesions forming a cobblestone appearance and non-caseating granulomas. What is the most likely diagnosis?
Crohn's
214
A patient presents with episodes of shortness of breath, flushing and diarrhoea. Further investigation reveals a mass in the abdomen, and high serum 5-HT levels. What is the likely diagnosis?
Carcinoid Tumour of the Bowel
215
A patient presents with hyperpigmentation around their mouth, palms and soles. They are found to have a mutation in the LKB1 gene and hamartmatous polyps of the bowel. What is the most likely diagnosis?
Peutz-Jeghers Syndrome
216
What is the most common form of colorectal carcinoma?
Adenocarcinoma
217
A 32 year old woman presents with changes in bowel habit and crampy abdominal pain. She also reports fevers, and unexplained weight loss. She tests positive for a mutation in her APC gene. What is the likely diagnosis?
Adenocarcinoma secondary to Familial Adenomatous Polyposis
218
A man presents with severe epigastric pain relieved by sitting forward. What is the most common cause of the condition causing his symptoms?
Gallstones
