Questions Flashcards

Question

A patient has recent weight loss and anaemia. The doctor suspects a diagnosis of cancer. A CXR is undertaken and is shown below. Due to the CXR, where do you suspect this cancer might have metasised from? Bladder cancer Renal cancer Liver cancer Pancreatic cancer

Answer 1

**Renal cancer**

Answer 2

NVH: **Renal USS tract**

Answer 3

Patient with severe abdominal pain. What does the image show? **Rigler’s/ double wall sign** **Free gas (pneumoperitoneum)** can be seen on both sides of the bowel wall. This is Rigler’s sign or the double wall sign. Whenever sharp points or triangles of low density are seen adjacent to loops of bowel, pneumoperitoneum should be suspected. Note: In patients with an acute abdomen an erect chest X-ray is more sensitive for small volumes of free gas.

Answer 4

Patient with severe abdominal pain. What does the image show? Ascites Lead pipe colon Normal gas pattern Rigler’s/ double wall sign **Thumbprinting** **Inflammation of the bowel wall leads to thickening of the haustral folds.** This results in the radiological sign of thumbprinting, a **characteristic finding in patients with active ulcerative colitis.**

Answer 5

What is the cause of the abnormal calcification? **Staghorn renal calculus**

Answer 6

24-year-old patient with suspected appendicitis. What does the image show? **Small bowel obstruction** Dilated loops of bowel with valvulae conniventes – lines crossing the full width of the bowel – indicates small bowel obstruction.

Answer 7

Patient with severe abdominal pain. What is the cause of pain demonstrated on this abdominal X-ray? **Caecal volvulus** Normal appearances Pneumoperitoneum Small bowel obstruction Toxic megacolon

Answer 8

What is the artifact shown in this image? Biliary stent Colonic stent External tubing Percutaneous nephrostomy tube **Ureteric stent**

Answer 9

Patient with abdominal pain and vomiting. What is the radiological diagnosis? Caecal volvulus **Large bowel obstruction** Small bowel obstruction Bowel perforation Normal

Answer 10

What is the radiological diagnosis? Sigmoid volvulus Normal **Ascites** Small bowel obstruction Pneumoperitoneum

Answer 11

What is the cause of the abnormal calcification in this image? Calcified gallstones Calcified mesenteric lymph nodes **Pancreatic calcification** Malignant calcification Calcified uterine fibroid

Answer 12

Patient with abdominal pain, vomiting, and constipation. What is the radiological diagnosis? **Caecal volvulus** Sigmoid volvulus Small bowel obstruction Perforation Normal

Answer 13

What is the cause of the area of increased density in the pelvis? Calcified pelvic kidney Calcified abdominal lymph node **Calcified uterine fibroid** Ingested barium Calcified adrenal gland

Answer 14

History of abdominal surgery 7 years ago. Presented with a 24 hour history of severe abdominal pain and vomiting. What is the radiological diagnosis? **Small bowel obstruction** Post-operative ileus Normal Perforation Sigmoid volvulus

Answer 15

If you saw these X-ray appearances in the setting of acute abdominal pain, what would be the most appropriate course of action? Place an abdominal drain Request abdominal ultrasound Request abdominal MRI **Resuscitate the patient and inform the surgeons** Take a break ## Footnote A large volume of free gas is present under the diaphragm. In the context of acute abdominal pain this finding indicates perforation. Emergency resuscitation and informing the surgeons would be the most appropriate action.

Answer 16

Patient with abdominal pain and vomiting. Which answer best describes the X-ray appearances? Pneumoperitoneum Ascites Psoas abscess Small bowel obstruction **Normal**

Answer 17

Patient with abdominal pain and absolute constipation. Which answer best describes the X-ray appearances? Large bowel obstruction **Sigmoid volvulus** Caecal volvulus Perforation Small bowel obstruction

Answer 18

Normally **only the inner wall** of the bowel is visible If there is **pneumoperitoneum** **both** **sides** of the **bowel** **wall** may be visible

Answer 19

When **perforation** of a **duodenal** **ulcer** **occurs**, and results in a **pneumoperitoneum**: **Gas** collects in **Morison's pouch** (the hepato-renal space), and **rise on the supine film to the anterior abdominal wall outlining the edge of the liver** diagnostic of duodenal perforation.

Answer 20

**False Rigler's/double wall sign** * Be careful not to mistake the gas within two adjacent bowel segments for Rigler's sign. * Gas seen on both sides of the bowel wall is contained within adjacent bowel * There are no black triangles or sharp angles on the outside of the bowel wall

Answer 21

**Small bowel obstruction - features** **Centrally located** multiple dilated loops of gas filled bowel (arrowheads) **Valvulae conniventes** (arrow) are visible - confirming this is small bowel

Answer 22

**Large bowel obstruction** * Here the colon is dilated down to the level of the distal descending colon. There is the impression of soft tissue density at the level of obstruction (X). No gas is seen within the sigmoid colon. * Obstruction is not absolute in this patient as a small volume of gas has reached the rectum (arrow). * An obstructing colon carcinoma was confirmed on CT and at surgery.

Answer 23

**Mucosal thickening - 'thumbprinting'** This patient presented with an exacerbation of symptoms of **ulcerative colitis.**

Answer 24

**Lead pipe colon** This patient with **ulcerative** **colitis** has a featureless segment of transverse colon with loss of the normal haustral markings. This 'lead pipe' appearance is associated with longstanding ulcerative colitis.

Answer 25

**Toxic megacolon** The colon is very dilated in this patient with acute abdominal pain, sepsis, and a known history of **ulcerative colitis.** The clinical features and X-ray appearances are consistent with toxic megacolon.

Answer 26

**Bladder stones** form in the bladder as a result of **urinary stasis**, e.g. **bladder outflow obstruction** (enlarged prostate) or in **patients with a neurogenic bladder** (loss of bladder function due to spinal cord injury/disease)

Answer 27

**Vascular calcification** There is striking calcification of the aorta and iliac vessels **This is a sign of generalised atherosclerosis elsewhere in the body**

Answer 28

**Abdominal aortic aneurysm - AAA** There is calcification of the dilated aortic wall Frequently only one side of the aneurysm is visible - as in this image - the other being projected over the spine

Answer 29

What is the cause of the abnormal calcification? **Adrenal calcification** Appendicolith Gallstones Pancreatic calcification Staghorn renal calculus

Answer 30

What is the cause of the abnormal calcification? Adrenal calcification Appendicolith Gallstones **Pancreatic calcification** Staghorn renal calculus

Answer 31

**Appendicolith** Appendicoliths are highly predictive of appendicitis in patients presenting with right iliac fossa pain ## Footnote Appendicoliths are calcific masses in the appendix, formed as a result of the aggregation of faecal particulates and inorganic salts within the lumen of the appendix

Answer 32

**Inferior vena cava (IVC) filter** An IVC filter may be used to reduce the risk of large pulmonary emboli

Answer 33

**Colonic stent** Large bowel obstruction can be treated with placement of a metallic colonic stent This is often used as a temporary measure allowing a patient to recover from the effects of obstruction prior to definitive colonic resection

Answer 34

**Pig-tail (JJ) stent** A ureteric stent has been placed to relieve ureteric obstruction The catheter has loops (pig-tails) at both ends which hold it in place

Answer 35

**Naso-jejunal tube** Placed for the purpose of enteral feeding The tube passes through the stomach and forms a C-shape as it navigates the 4 parts of the duodenum (D1-4) The tube tip lies beyond the duodenojejunal flexure which lies on the left

Answer 36

**Ascites** There is generalised hazy density of the entire abdomen In the presence of ascites gas within bowel is located centrally

Answer 37

A 45-year-old man presents with symptoms of urinary colic. In the history he has suffered from recurrent episodes of frank haematuria over the past week or so. On examination he has a left loin mass and a varicocele. The most likely diagnosis is: **Renal adenocarcinoma** Renal cortical adenoma Squamous cell carcinoma of the renal pelvis Retroperitoneal fibrosis Nephroblastoma

Answer 38

**Bilateral idiopathic adrenal hyperplasia** is the most common cause of primary hyperaldosteronism

Answer 39

A transjugular intrahepatic portosystemic shunt procedure connects which two vessels? Internal jugular vein and hepatic vein Internal jugular vein and portal vein Hepatic artery and hepatic vein Hepatic artery and portal vein **Hepatic vein and portal vein**

Answer 40

Which of the following stone type appears as a stag-horn on x-ray? Urate **Magnesium ammonium phosphate** Calcium oxalate Calcium phosphate Cystine

Answer 41

A 28-year-old female presents with jaundice. The following results are available: HBsAg +ve, HBeAg +ve, HBeAb −ve, HBc IgM +ve Which of the following interpretations is most accurate? Susceptible to hepatitis B Chronic hepatitis B with low infectivity **Chronic hepatitis B with high infectivity** Previous immunisation against hepatitis B Natural immunity against hepatitis B

Answer 42

A patient with a history of abdominal surgery develops abdominal pain. A plain abdominal X-ray shows dilated bowel loops. There are lines on the dilated parts of the bowel which cross it. What is the most likely underlying cause? Gallstones Inguinal hernia **Adhesions** Caecal carcinoma Sigmoid carcinoma

Answer 43

A 25-year-old male has presented to the Emergency Department with fever, jaundice and malaise for the past three days. Initial laboratory studies show raised liver enzymes and a low platelet count. He has no recent travel history. A diagnosis of autoimmune hepatitis is being considered. Which of the following antibodies are most specific for this condition? **Anti-smooth muscle antibodies**

Answer 44

Which of the following is the most appropriate antibiotic for this patient’s infected pressure ulcer? **Flucloxacillin** The patient has an infected sacral pressure sore. The infection is likely to be superficial with no extension to the underlying bone (which would be concerning for osteomyelitis). Along with cleaning and dressing the wound, culture swabs of the fluid should be taken so antibiotics can be tailored according to microbial sensitivities. Superficial infections are typically treated with oral antibiotics such as flucloxacillin as this is likely to provide coverage for gram-positive bacteria that reside on the skin surface, such as **Staphylococcus aureus**. As the patient is bed-bound, he should also be assessed for an air mattress.

Answer 45

Gilbert’s syndrome is an **autosomal recessive condition** associated with **intermittent raised unconjugated bilirubinaemia**, resulting from a **defective glucuronyl transferase**. This is the **enzyme** involved in **conjugation** of **bilirubin**, and so the **ability** of **patients** to **conjugate bilirubin is significantly reduced.**

Answer 46

The condition is defined by the four following characteristics, necessary for diagnosis: * **unconjugated hyperbilirubinaemia** * **normal liver function** * **no haemolysis** * **no evidence of liver disease**

Answer 47

*In unaffected individuals following conjugation, conjugated bilirubin is released into the bile and is either excreted in the faeces as stercobilin or reabsorbed in the circulation and excreted by the kidneys in the urine in the form of urobilinogen* In Gilberts: there is a defective glucuronyl transferase. This is the enzyme involved in conjugation of bilirubin, and so the ability of patients to conjugate bilirubin is significantly reduced. **Unconjugated bilirubin is non-water-soluble; therefore, it cannot be excreted in the urine.**

Answer 48

A 55-year-old male alcoholic with known cirrhotic liver disease is admitted to the Gastroenterology Ward with a distended abdomen, jaundice and confusion. On examination, he is clinically jaundiced and has a massively distended abdomen with evidence of a fluid level on percussion. An aspirate of fluid is taken from his abdomen and sent for analysis. Results indicate the fluid is an exudate. Which of the following is an exudative cause of ascites? **Malignancy** Ascites is defined as an accumulation of fluid within the peritoneal cavity. The causes can be classified according to the **protein content of the fluid: < 30 g/l transudate, >30 g/l exudate**. The most common causes of an exudative ascites are infection or malignancy. The above patient scenario would be more in keeping with a malignant cause.

Answer 49

What imaging modility is first line for non-pregnant patients for suspected kidney stones? MRI XR-KUB **CT-KUB** US

Answer 50

What imaging modility is first line for pregnant patients for suspected kidney stones? MRI XR-KUB CT-KUB **US**

Answer 51

What is the first line treatment for pregnant person with stone? [1] Open surgery Percutaneous nephrolithotomy (PCNL) **Ureteroscopy (URS)** Shockwave lithotripsy (SWL)

Answer 52

What is the first line treatment for pregnant person with stone size of less than 2cm? Open surgery Percutaneous nephrolithotomy (PCNL) Ureteroscopy (URS) **Shockwave lithotripsy (SWL)** Watchful waiting

Answer 53

What is the first line treatment for pregnant person with stone size of < 5mm? Open surgery Percutaneous nephrolithotomy (PCNL) Ureteroscopy (URS) Shockwave lithotripsy (SWL) **Watchful waiting**

Answer 54

What is the first line treatment for person with stone size of 12 mm? Open surgery Percutaneous nephrolithotomy (PCNL) Ureteroscopy (URS) **Shockwave lithotripsy (SWL)** Watchful waiting

Answer 55

What is the first line treatment for person with stone size of 24 mm? Open surgery **Percutaneous nephrolithotomy (PCNL)** Ureteroscopy (URS) Shockwave lithotripsy (SWL) Watchful waiting

Answer 56

Which of the following are related to urinary tract infections Uric acid stones Cystine stones Calcium oxalate stones Calcium carbonate stones **Magnesium carbonate stones**

Answer 57

A 48-year-old women presents with recurrent loin pain and fevers. Investigation reveals a staghorn calculus of the left kidney. Infection with which of the following organisms is most likely? Staphylococcus saprophyticus **Proteus mirabilis** Klebsiella E-Coli Staphylococcus epidermidis

Answer 58

Proteus mirabilis is most likely to cause what type of stone? Uric acid stones Cystine stones Calcium oxalate stones Calcium carbonate stones **Magnesium carbonate stones**

Answer 59

Which of the following type of UTIs is most likely to have spread haematogenously? **Candida albicans** AND **Staph. aureus; M. tb**

Answer 60

Which following treatment for UTIs may cause neonatal haemolysis? Cefalexin Trimethoprim Amoxicillin Co-amoxiclav **Nitrofurantoin**

Answer 61

Which following treatment for UTIs may cause spina bifida? Cefalexin **Trimethoprim** Amoxicillin Co-amoxiclav Nitrofurantoin

Answer 62

Which following treatment for UTIs should be avoided in the third trimester of pregnancy? Cefalexin Trimethoprim Amoxicillin Co-amoxiclav **Nitrofurantoin**

Answer 63

Which following treatment for UTIs should be avoided in the first trimester of pregnancy? Cefalexin **Trimethoprim** Amoxicillin Co-amoxiclav Nitrofurantoin

Answer 64

Which following treatment for UTIs should be avoided in patients with renal impairment? Cefalexin **Trimethoprim** Amoxicillin Co-amoxiclav Nitrofurantoin

Answer 65

A 60-year-old man attends the surgical day unit for a loop ileostomy following rectal cancer surgery. He is informed that he will be left with a stoma and that the stoma nurses will explain how this is to be cared for. What are the correct features of this stoma? **Right iliac fossa, spouted appearance with liquid output** Colon has a role in the absorption of water from the gastrointestinal tract, with it being bypassed, the stool will be looser and therefore present as a liquid. As the stool is liquid and rich in digestive enzymes it is more likely to irritate the skin, therefore a spout is preferred so that it can drain directly into the stoma bag. It is often located in the right iliac fossa as the ileocecal junction (the connection between the ileum and cecum) is located in the right iliac fossa. Creating an ileostomy in this area allows for the least disruption of the natural digestive process.

Answer 66

**Loop ileostomy** The presence of two lumens in this stoma suggests that it is indeed a loop stoma; end stomas characteristically have only one lumen

Answer 67

**loop stoma**; **two lumens** **end stomas** characteristically have only **one lumen**

Answer 68

A 76-year-old woman presents to the outpatient colonoscopy department following a referral from her GP due to a positive faecal immunochemical test (FIT). Colonoscopy reveals a 3x2 cm mass at the distal end of the transverse colon near the splenic flexure. Histology from a biopsy confirms an isolated adenocarcinoma. Following a multidisciplinary team (MDT) discussion, she is scheduled for surgical resection of the tumour. What is the most likely surgery that will be performed? Hartmann's procedure **Left hemicolectomy** Total colectomy Transverse colectomy: - It is generally reserved for tumours situated centrally within the transverse colon, whereas lesions at either end are more appropriately managed with right or left hemicolectomies respectively. Wide-local excision of the tumour

Answer 69

Question 8 of 113 A 67-year-old man presents to clinic with a history of blood in the stools and weight loss. He was referred for an urgent colonoscopy, which showed a mass in the distal transverse colon. Biopsy confirmed adenocarcinoma. Further investigation reveals no lymph node involvement or distant metastasis. What surgery should be offered? Hartmann's procedure High anterior resection **Left hemicolectomy** Right hemicolectomy Total colectomy

Answer 70

A 78-year-old man presents to the emergency department with intense abdominal pain. He has not passed faeces or wind in the last 48 hours. When asked, he mentions that he has lost some weight recently and in the weeks preceding this event he has been feeling constipated. The team suspects a large bowel obstruction due to cancer and orders a CT scan, that shows a mass in the hepatic flexure. Which one of the following surgical management plans is the most appropriate for the patient? Hartmann's procedure High anterior resection Left hemicolectomy Low anterior resection **Right hemicolectomy**

Answer 71

Right hemicolectomy: - involves removal of the caecum, ascending and proximal transverse colon. Left hemicolectomy: - involves removal of the distal transverse and descending colon. High anterior resection: - involves removing the sigmoid colon (may be called a sigmoid colectomy). Low anterior resection: - involves removing the sigmoid colon and upper rectum but sparing the lower rectum and anus. Abdomino-perineal resection (APR): - involves removing the rectum and anus (plus or minus the sigmoid colon) and suturing over the anus. It leaves the patient with a permanent colostomy. Hartmann’s procedure:

Answer 72

Which of the following involves removal of the distal transverse and descending colon? Hartmann's procedure High anterior resection Left hemicolectomy Low anterior resection **Right hemicolectomy**

Answer 73

Which of the following involves removing the sigmoid colon and upper rectum but sparing the lower rectum and anus? Hartmann's procedure High anterior resection Left hemicolectomy **Low anterior resection** Right hemicolectomy

Answer 74

Which of the following involves removing the sigmoid colon? Hartmann's procedure **High anterior resection** Left hemicolectomy Low anterior resection Right hemicolectomy

Answer 75

**Cullens sign** Cullen's sign is described as superficial oedema with bruising in the subcutaneous fatty tissue around the peri-umbilical region. This is also known as peri-umbilical ecchymosis. It is most often recognised as a result of **haemorrhagic pancreatitis.**

Answer 76

**Grey-Turner's sign** Classically it correlates with **severe acute necrotizing pancreatitis**

Answer 77

A 61-year-old library assistant has an increasing frequency of episodes of intermittent abdominal discomfort and bloating. She also complains of associated episodes of diarrhoea, with mucus in the stool but no blood. The pain usually worsens after meals and improves after opening her bowels. She has not lost weight and continues to have a good appetite. She has had a knee replacement for osteoarthritis but no other significant medical history of note. Investigation of the patient’s symptoms reveals diverticular disease. Which of the following complications is this patient most at risk of developing? **Colovesical fistulae** **A colovesical fistula is an abnormal connection between the bladder and the colon. It presents with pneumaturia and other lower urinary tract symptoms.**

Answer 78

Which of the following is considered the most common underlying cause of colovesical fistula? appendicitis **diverticulitis** colorectal cancer Crohn disease radiotherapy trauma

Answer 79

A 36-year-old female with a history of ulcerative colitis (UC) for seven years seeks guidance on the frequency of colonoscopies in UC. Her UC is currently well-managed, and there is no family history of malignancy. She underwent a routine colonoscopy slightly over one year ago. What would be the most appropriate date for her next colonoscopy appointment? **In four years** National Institute for Health and Care Excellence (NICE) guidelines recommend a surveillance colonoscopy every five years. Patients at intermediate risk have a surveillance colonoscopy every three years and patients in the high-risk group annually.

Answer 80

A 74-year-old male is seen by his General Practitioner with a one-month history of pain on passing urine. His urine dip is positive for blood but negative for leukocytes and nitrites, and he is started on nitrofurantoin for suspected urinary tract infection. His urine culture is negative. Two weeks later, he continues to experience pain in passing urine. His urine dip results are unchanged; blood tests reveal a raised white cell count. **Refer to Urology on the two-week wait pathway** Referral of this patient under the suspected cancer pathway to Urology is necessary due to suspicious features suggestive of bladder cancer. According to the pathway criteria, patients aged 45 and above should be referred if they present with unexplained visible haematuria without urinary tract infection, visible haematuria that persists or reoccurs after urinary tract infection treatment, or unexplained non-visible haematuria in combination with raised serum white cell count or dysuria (for those over 60 years old). In this case, the persistent dysuria and elevated white cell count raise potential malignancy concerns.

Answer 81

A surgeon performing his first appendectomy could not identify the base of the appendix due to massive adhesions in the peritoneal cavity. The consultant suggested identifying the caecum first and then localising the base of the appendix. Which anatomical structure(s) on the caecum would he have used to find the base of the appendix? Omental appendages Haustra coli Ileal orifice Semilunar folds **Teniae coli** The Taeniae coli are three bands of longitudinal muscle on the surface of the large intestine. The large intestine does not have a continuous layer of longitudinal muscle; it has taeniae coli. **These three bands meet at the appendix, which projects from the dependent portion of the caecum.**

Answer 82

A 56-year-old male presents with a high spiking fever for the past two weeks and dull abdominal pain in the right upper quadrant. Blood cultures were negative for the growth of any organisms. The patient gives a poor history, but on imaging, there is noted to be a collection in the liver. Ultrasound-guided biopsy reveals pus, which is described as anchovy sauce. What is the most likely diagnosis? **Amoebic abscess** An amoebic liver abscess causes right upper quadrant pain, swinging fever and tenderness. This can occur following amoebic dysentery but does not always do so. Amoebic dysentery causes slowly increasing diarrhoea which can be profuse and bloody. Anchovy sauce pus in the liver is consistent with an amoebic abscess and is the key to this answer.

Answer 83

A 55-year-old female presents with a thyroid lump and you have a clinical suspicion of follicular carcinoma of the thyroid. Which of the following is the best option that fits such a case? **Spreads mainly via blood** Follicular carcinoma is a carcinoma that spreads via the haematogenous route. Papillary and medullary carcinomas spread via the lymphatic system; anaplastic cancer spreads locally.

Answer 84

What sign indicated global, rather than localised, peritonitis? **Absent bowel sounds** **Other signs of generalised peritonitis are tenderness to percussion of the abdomen and a generalised rigid, ‘board-like’ abdomen.**

Answer 85

A 60-year-old male patient is admitted complaining of severe abdominal pain. He is diagnosed with mesenteric vascular occlusion. The small bowel becomes gangrenous and resection is performed. Which of the following is a complication of this procedure? Your answer was incorrect Constipation Scurvy Weight gain **Nephrolithiasis** Achlorhydria

Answer 86

A 33-year-old female is found to have a blood pressure of 180/130 mmHg incidentally on three separate occasions. Her General Practitioner completes the rest of her cardiovascular examination, which was unremarkable. Secondary hypertension causes are investigated, and an abdominal computed tomography (CT) angiogram is performed. This shows a significantly smaller left kidney compared to the right, with the left renal artery displaying a ‘string of beads’ appearance. What would be the most appropriate management option for this patient? **Balloon angioplasty** Kidney transplantation Nephrectomy Statins Surgical revascularisation

Answer 87

A 72-year-old female with a history of diverticular disease undergoes emergency abdominal surgery. When examining this patient after her surgery, you notice she has an end colostomy. What feature would suggest that this patient has had a Hartmann’s procedure and not an abdominoperineal (AP) resection? **Presence of rectum** **Complete excision** of the **rectum** and **anus** is carried out as part of an **AP resection**. Therefore, the presence of the rectum excludes an AP resection.

Answer 88

Critical limb ischaemia

Answer 89

A patient describes pain in their lower limb. After you ask them to describe the pain more they describe a cramping in their legs after walking 300 m in distance. What is their Fontaine classification? Stage I Stage IIa Stage IIb **Stage III** Stage IV

Answer 90

A patient describes pain in their lower limb. After you ask them to describe the pain more they describe a cramping in their legs when they're resting. What is their Fontaine classification? Stage I Stage IIa Stage IIb **Stage III** Stage IV

Answer 91

A patient describes pain in their lower limb. After a clinical exam you find that they have pain walking around the room, but have no rest pain. What is their Fontaine classification? Stage I Stage IIa Stage IIb **Stage III** Stage IV

Answer 92

Buergers test for PAD

Answer 93

A patient has their ABPI measured due to suspeted PAD. The ratio is found to be 0.8. This PAD can be classified as Normal **Mild** Moderate Severe ## Footnote 0.9 – 1.3 is normal 0.6 – 0.9 indicates mild peripheral arterial disease 0.3 – 0.6 indicates moderate to severe peripheral arterial disease Less than 0.3 indicates severe disease to critical ischaemic

Answer 94

A patient has their ABPI measured due to suspeted PAD. The ratio is found to be 0.5. This PAD can be classified as Normal Mild **Moderate** Severe

Answer 95

A patient has their ABPI measured due to suspeted PAD. The ratio is found to be 0.2. This PAD can be classified as Normal Mild Moderate **Severe**

Answer 96

A patient has their ABPI measured due to suspeted PAD. The ratio is found to be 0.7. This PAD can be classified as Normal **Mild** Moderate Severe

Answer 97

A patient has their ABPI measured due to suspeted PAD. The ratio is found to be 0.4 This PAD can be classified as Normal Mild **Moderate** Severe

Answer 98

Greater than **1.3** due to **calcification**

Answer 99

Which of the following presentations is classical for an aortic dissection? * Central crushing chest pain, radiating down the left arm, with tachycardia and hypertension * **A tearing central chest pain, new onset cardiac murmur, and tachycardia** * Sudden onset dyspnoea with widespread crackles and wheeze * A burning pain, spreading from the epigastrium to the central chest, worse when lying down, normal clinical examination

Answer 100

What is the gold standard imaging modality for first line investigation of a suspected aortic dissection? ECHO CT Chest-Abdo-Pelvis CXR **CT Angiogram**

Answer 101

Type IIIa Type III – originates distal to the subclavian artery in the descending aorta Further subdivided into IIIa which extends distally to the diaphragm and IIIb which extends beyond the diaphragm into the abdominal aorta

Answer 102

What is Debakey classification for aortic dissection is this? Type I Type II **Type IIIa** Type IIIB

Answer 103

What is Debakey classification for aortic dissection is this? Type I Type II Type IIIa **Type IIIB**

Answer 104

What is Debakey classification for aortic dissection is this? **Type I** Type II Type IIIa Type IIIB

Answer 105

What is Debakey classification for aortic dissection is this? Type I **Type II** Type IIIa Type IIIB

Answer 106

A 65-year-old man attends an abdominal aortic aneurysm (AAA) screening offered by his GP. On ultrasound, it is revealed that he has a supra-renal aneurysm that is 4.9 cm in diameter. When questioned he says he has no symptoms. How should this patient be managed? 12-monthly ultrasound assessment **3-monthly ultrasound assessment** 6-monthly ultrasound assessment Referral to stop smoking services Urgent referral to vascular surgery

Answer 107

A 55-year-old lady with claudication is assessed and an ABPI is performed. Results show an ABPI value of 1.3. Which of the following conditions may lead to this abnormal result? Hypothyroidism Hypercalcaemia **Type 2 diabetes** Peripheral arterial disease Previous deep vein thrombosis

Answer 108

Open bypass graft

Answer 109

**Endovascular revascularization** Peripheral arterial disease with critical limb ischaemia: high-risk patients with short segment stenosis are more suited to endovascular revascularization

Answer 110

Acromegaly Obesity Hypothyroidism Pregnancy RA

Answer 111

Which of the following descriptions of benign or malignant focal lung opacities is correct? **benign: much wider than tall, with scalloped margins** benign: taller than wide, with rounded margins malignant: microlobulated margins, with sparse, angulated radiations malignant: polygonal margins, with indrawing of the fissure

Answer 112

thyroid transcription factor 1 (TTF-1) is expressed in most lung cancer except [] cancer **squamous cell lung cancer** small cell lung cancer large cell lung cancer lung adenocarcinoma

Answer 113

Which of the following lung cancers is NOT associated with cigarette smoking? adenocarcinoma **adenoid cystic carcinoma** adenosquamous carcnioma large-cell lung cancer small-cell lung cancer squamous cell carcinoma

Answer 114

**Trachea and main bronchi** Localized plaques associated with asbestos exposure are most frequently reported in both hemidiaphragms, the lateral chest wall and along the mediastinum.

Answer 115

Patients with proliferative diabetic retinopathy and no macular involvement should be treated with **panretinal photocoagulation.**

Answer 116

**15 x 10^9**

Answer 117

**Restless leg syndrome: IDA**

Answer 118

**Iron**: PICA Pica is the abnormal craving or appetite for non-food substances, such as soil, ice, paint, or clay. It has been reported in up to 55% of patients with IDA.[86] Ingestion of some materials, such as clay, has chelating effects, which can impair the absorption of iron. These cravings correct within 2 weeks of iron replacement.

Answer 119

Heinz bodies on a blood film would indicate which cause of anaemia **G6PD deficiency** Pernicious anaemia Hereditary spherocytosis Sickle cell anaemia

Answer 120

**G6PD deficiency** - Heinz bodies

Answer 121

According to NICE guidelines, what hemoglobin level is indicative of anemia in adult males? A. < 12 g/dL **B. < 13 g/dL** C. < 14 g/dL D. < 15 g/dL

Answer 122

In the context of macrocytic anemias, which laboratory test is crucial for differentiating between vitamin B12 deficiency and folate deficiency? **A. Methylmalonic acid (MMA)** B. Homocysteine levels C. Serum vitamin B12 D. Reticulocyte count

Answer 123

Which type of anemia is characterized by a low serum iron, low total iron-binding capacity (TIBC), and a high transferrin saturation? A. Iron deficiency anemia **B. Anemia of chronic disease** C. Sideroblastic anemia D. Thalassemia

Answer 124

According to NICE guidelines, what is the primary confirmatory test for **hereditary hemochromatosis?** A. Liver biopsy B. Serum ferritin **C. Genetic testing (HFE mutations)** D. Iron studies

Answer 125

Which form of thalassemia is characterized by a microcytic hypochromic anemia with target cells on peripheral blood smear? A. Beta-thalassemia major B. Alpha-thalassemia minor **C. Beta-thalassemia minor** D. Alpha-thalassemia major

Answer 126

In the diagnosis of aplastic anemia, which parameter is typically reduced in the peripheral blood count? A. Reticulocyte count B. White blood cell count **C. Platelet count** D. Hematocrit

Answer 127

What is the primary screening test for sickle cell anemia in newborns, as recommended by NICE guidelines? A. Hemoglobin electrophoresis B. High-performance liquid chromatography (HPLC) **C. Sickle solubility test** D. Complete blood count (CBC)

Answer 128

Which type of anemia is characterized by a triad of microangiopathic hemolytic anemia, thrombocytopenia, and renal dysfunction? A. Sickle cell anemia **B. Hemolytic-uremic syndrome** C. Aplastic anemia D. Polycythemia vera

Answer 129

According to NICE guidelines, what is the recommended initial test for suspected hemoglobinopathies in newborns? A. Complete blood count (CBC) B. High-performance liquid chromatography (HPLC) C. Osmotic fragility test **D. Hemoglobin electrophoresis**

Answer 130

**Acute myeloid leukaemia**

Answer 131

Which of the following is most associated with : exposure to certain toxins (e.g. benzene and organochlorine insecticides) **Acute myeloid leukaemia** Acute lymphoblastic leukaemia Chronic myeloid leukaemia Chronic lymphocytic leukaemia

Answer 132

**Acute myeloid leukaemia**

Answer 133

Alpha thalassemia can result from the deletion of alpha-globin genes. What is the most common alpha thalassemia genotype associated with clinical manifestations? a) αα/αα b) --/αα c) --/-- **d) α-/α-**

Answer 134

**c) Folic Acid supplementation**

Answer 135

Individuals with alpha thalassemia trait (silent carrier) typically have two affected alpha-globin genes. How does NICE recommend managing asymptomatic individuals with alpha thalassemia trait during pregnancy? a) Iron supplementation **b) Genetic counseling** c) Folate supplementation d) Regular blood transfusions

Answer 136

**b) Chorionic villus sampling (CVS)**

Answer 137

NICE recommends screening for alpha thalassemia in newborns. What is the primary screening test used for this purpose? a) Hemoglobin electrophoresis b) Complete Blood Count (CBC) **c) DNA analysis** d) Serum Ferritin

Answer 138

After the diagnosis of alpha thalassemia, what is the recommended frequency of follow-up monitoring for individuals with alpha thalassemia trait, according to NICE? a) Every 6 months **b) Annually** c) Biennially d) Only as needed based on symptoms

Answer 139

**d) Molecular genetic testing**

Answer 140

In beta thalassemia major, NICE recommends regular blood transfusions to maintain hemoglobin levels. What is the target pre-transfusion hemoglobin level, according to NICE? a) 8-9 g/dL **b) 9-10 g/dL** c) 10-11 g/dL d) 11-12 g/dL

Answer 141

Individuals with beta thalassemia major are at risk of iron overload due to frequent transfusions. How often does NICE recommend monitoring serum ferritin levels for these patients? **a) Every 3 months** b) Every 6 months c) Annually d) Biennially

Answer 142

To manage iron overload in beta thalassemia major, NICE recommends chelation therapy. Which chelator is commonly used in this setting? a) Deferoxamine b) Deferiprone c) Desferrioxamine **d) Deferasirox**

Answer 143

NICE recommends folate supplementation in beta thalassemia major. What is the purpose of folate supplementation in these patients? a) Stimulate erythropoiesis b) Prevent neural tube defects c) Enhance iron chelation **d) Reduce oxidative stress**

Answer 144

In beta thalassemia major, allogeneic bone marrow transplantation is considered a curative option. What is a key requirement for a successful bone marrow transplant? a) Age over 50 years **b) HLA-matched sibling donor** c) Presence of iron overload d) Chronic liver disease

Answer 145

NICE suggests the use of hydroxyurea in beta thalassemia intermedia to reduce transfusion requirements. What is the mechanism of action of hydroxyurea in this context? **a) Stimulation of fetal hemoglobin** b) Inhibition of iron absorption c) Prevention of bone marrow suppression d) Induction of erythropoiesis

Answer 146

Beta thalassemia major can lead to complications such as endocrine dysfunction. Which endocrine complication is commonly associated with beta thalassemia major, according to NICE? a) Thyroid dysfunction b) Diabetes mellitus **c) Growth hormone deficiency** d) Adrenal insufficiency

Answer 147

Beta thalassemia major can lead to cardiac complications. How often does NICE recommend cardiac monitoring, including echocardiography, for these patients? **a) Every 2 years** b) Every 5 years c) Annually d) Only when symptoms arise

Answer 148

According to NICE guidelines, which imaging modality is recommended for the initial staging of Hodgkin's lymphoma? a) X-ray b) Computed Tomography (CT) c) Magnetic Resonance Imaging (MRI) **d) Positron Emission Tomography (PET)**

Answer 149

**c) Excisional lymph node biopsy**

Answer 150

NICE provides guidance on follow-up monitoring for Hodgkin's lymphoma survivors. How often does NICE recommend follow-up appointments during the first two years after treatment? a) Every 3 months **b) Every 6 months** c) Annually d) Biennially

Answer 151

Hodgkin's lymphoma survivors are at risk of late effects from treatment. What is a common late effect that NICE emphasizes for monitoring? a) Osteoporosis **b) Cardiomyopathy** c) Peripheral neuropathy d) Diabetes

Answer 152

In relapsed or refractory Hodgkin's lymphoma, what is a commonly used salvage chemotherapy regimen according to NICE? a) ABVD b) BEACOPP **c) CHOP** d) EPOCH

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