Questions Flashcards

Question 1

Q

As part of the treatment for NAFLD, NICE recommends the prescription of Vitamin E following due to increased clinical outcomes. Which drug is this often given with and why? [1]

Answer

A

Vitamin E and pioglitazone

Question 2

Q

Which atypical pneumonia is most likely to cause erythema multiforme?

Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella pneumonia
Chlamydia psittaci
Q fever pneumonia

Answer

A

Which atypical pneumonia is most likely to cause erythema multiforme?

Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella pneumonia
Chlamydia psittaci
Q fever pneumonia

Question 3

Q

Which type of gangrene occurs most commonly in healthy patients?

Type I
Type II
Type III
Type IV

Answer

A

Which type of gangrene occurs most commonly in healthy patients?

Type I
Type II
Type III
Type IV

Question 4

Q

Which type of gangrene occurs most commonly due to streptococcus infection?

Type I
Type II
Type III
Type IV

Answer

A

Type II

Question 5

Q

Hepatitis D requires a co-infection with

Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis E
Hepatitis F

Answer

A

Hepatitis D requires a co-infection with

Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis E
Hepatitis F

Question 6

Q

Which type of NSTI is associated with toxic shock syndrome?

Type 1
Type 2
Type 3
Type 4

Answer

A

Which type of NSTI is associated with toxic shock syndrome?

Type 1
Type 2
Type 3
Type 4

Question 7

Q

Which HBV marker is indicative of infection but not immunisation? [1]

Answer

A

Hepatitis B core antigen (HBcAg)
- expressed by infected hepatocytes, not used in the vaccination

Core antigen = Caught

Question 8

Q

Describe the skin colour change in a patient with early compared to later presenting haemochromatosis [1]

Answer

A

Bronzed to slate grey pigmentation

Question 9

Q

There is inappropriately low production of the hormone hepcidin.

Answer

A

There is inappropriately low production of the hormone hepcidin.

Question 10

Q

Which pathology would these nails indicate? [1]

Answer

A

Wilsons disease

Question 11

Q

Which tumour marker indicates HCC? [1]

Question 12

Q

Which of the following is associated with alcoholic liver disease? [1]

IgA
IgE
IgD
IgM
IgG

Answer

A

Which of the following is associated with alcoholic liver disease? [1]

IgA:
IgE
IgD
IgM
IgG

Question 13

Q

Which of the following is associated with primary biliary cholangitis?? [1]

IgA:
IgE
IgD
IgM
IgG

Answer

A

Which of the following is associated with primary biliary cholangitis?? [1]

IgA:
IgE
IgD
IgM
IgG

Question 14

Q

Which of the following is associated with autoimmune hepatitis? [1]

IgA:
IgE
IgD
IgM
IgG

Answer

A

Which of the following is associated with autoimmune hepatitis? [1]

IgA:
IgE
IgD
IgM
IgG

Question 15

Q

Anti nuclear antibodies (ANA) are associated with which of the following?

autoimmune hepatitis
primary biliary cholangitis
alcoholic liver disease
primary sclerosing cholangitis

Answer

A

Anti nuclear antibodies (ANA) are associated with which of the following?

autoimmune hepatitis
primary biliary cholangitis
alcoholic liver disease
primary sclerosing cholangitis

Question 16

Q

Anti mitochondrial antibodies are associated with which of the following?

autoimmune hepatitis
primary biliary cholangitis
alcoholic liver disease
primary sclerosing cholangitis

Answer

A

Anti mitochondrial antibodies are associated with which of the following?

autoimmune hepatitis
primary biliary cholangitis
alcoholic liver disease
primary sclerosing cholangitis

Question 17

Q

Antineutrophilic cytoplasmic antibodies (ANCA) are associated with which of the following?

autoimmune hepatitis
primary biliary cholangitis
alcoholic liver disease
primary sclerosing cholangitis

Answer

A

Antineutrophilic cytoplasmic antibodies (ANCA) are associated with which of the following?

autoimmune hepatitis
primary biliary cholangitis
alcoholic liver disease
primary sclerosing cholangitis

Question 18

Q

Soluble liver antigens are associated with which of the following?

autoimmune hepatitis
primary biliary cholangitis
alcoholic liver disease
primary sclerosing cholangitis

Answer

A

Soluble liver antigens are associated with which of the following?

autoimmune hepatitis
primary biliary cholangitis
alcoholic liver disease
primary sclerosing cholangitis

Question 19

Q

Smooth muscle antigens are associated with which of the following?

autoimmune hepatitis
primary biliary cholangitis
alcoholic liver disease
primary sclerosing cholangitis

Answer

A

Smooth muscle antigens are associated with which of the following?

autoimmune hepatitis
primary biliary cholangitis
alcoholic liver disease
primary sclerosing cholangitis

Question 20

Q

Question 21

Q

Which of the following treatments for prostate cancer works as an non-steroidal anti-androgen?

Cytoproterone acetate
Degarelix
Goserelin
Bicalutamide
Abiraterone

Answer

A

Which of the following treatments for prostate cancer works as an non-steroidal anti-androgen?

Cytoproterone acetate
Degarelix
Goserelin
Bicalutamide
Abiraterone

Question 22

Q

Which of the following treatments for prostate cancer works is an steroidal anti-androgen?

Cytoproterone acetate
Degarelix
Goserelin
Bicalutamide
Abiraterone

Answer

A

Which of the following treatments for prostate cancer works is an steroidal anti-androgen?

Cytoproterone acetate
Degarelix
Goserelin
Bicalutamide
Abiraterone

Question 23

Q

Which of the following treatments for prostate cancer works is an androgen synthesis inhibitor?

Cytoproterone acetate
Degarelix
Goserelin
Bicalutamide
Abiraterone

Answer

A

Which of the following treatments for prostate cancer works is an androgen synthesis inhibitor?

Cytoproterone acetate
Degarelix
Goserelin
Bicalutamide
Abiraterone

Question 24

Q

Which of the following treatments for prostate cancer works is an GnRH antagonist?

Cytoproterone acetate
Degarelix
Goserelin
Bicalutamide
Abiraterone

Answer

A

Which of the following treatments for prostate cancer works is an GnRH antagonist?

Cytoproterone acetate
Degarelix
Goserelin
Bicalutamide
Abiraterone

Question 25

Q

Which of the following treatments for prostate cancer works is an GnRH agonist?

Cytoproterone acetate
Degarelix
Goserelin
Bicalutamide
Abiraterone

Answer

A

Which of the following treatments for prostate cancer works is an GnRH agonist?

Cytoproterone acetate
Degarelix
Goserelin
Bicalutamide
Abiraterone

Question 26

Q

Which of the following treatments for prostate cancer is normally the option for the treatment of hormone-relapsed metastatic prostate cancer in patients who have no or mild symptoms after androgen deprivation therapy has failed, and before chemotherapy is indicated?

Cytoproterone acetate
Degarelix
Goserelin
Bicalutamide
Abiraterone

Answer

A

Which of the following treatments for prostate cancer is normally the option for the treatment of hormone-relapsed metastatic prostate cancer in patients who have no or mild symptoms after androgen deprivation therapy has failed, and before chemotherapy is indicated?

Cytoproterone acetate
Degarelix
Goserelin
Bicalutamide
Abiraterone

Question 27

Q

Which of the following treatments for prostate cancer works by preventing DHT binding from intracytoplasmic protein complexes?

Cytoproterone acetate
Degarelix
Goserelin
Bicalutamide
Abiraterone

Answer

A

Which of the following treatments for prostate cancer works by preventing DHT binding from intracytoplasmic protein complexes?

Cytoproterone acetate
Degarelix
Goserelin
Bicalutamide
Abiraterone

Question 28

Q

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

A

Renal cancer

Question 29

Q

A patient has suspected bladder cancer. They have demonstrated visibile haematuria despite UTI treatment. The junior doctor is considering a cytoscope. What would be the next best investigation after this?

Renal USS tract
CT
MRI
PET

Answer

A

NVH: Renal USS tract

Question 30

Q

Patient with severe abdominal pain. What does the image show?

Ascites
Lead pipe colon
Normal gas pattern
Rigler’s/ double wall sign
Thumbprinting

Answer

A

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.

Question 31

Q

Patient with severe abdominal pain. What does the image show?

What is the likely pathology?

Ascites
Lead pipe colon
Normal gas pattern
Rigler’s/ double wall sign
Thumbprinting

Answer

A

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.

Question 32

Q

What is the cause of the abnormal calcification?

Adrenal calcification
Appendicolith
Gallstones
Pancreatic calcification
Staghorn renal calculus

Answer

A

What is the cause of the abnormal calcification?

Staghorn renal calculus

Question 33

Q

24-year-old patient with suspected appendicitis. What does the image show?

Caecal volvulus
Normal appearances
Pneumoperitoneum
Small bowel obstruction
Toxic megacolon

Answer

A

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.

Question 34

Q

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

A

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

Question 35

Q

What is the artifact shown in this image?

Biliary stent
Colonic stent
External tubing
Percutaneous nephrostomy tube
Ureteric stent

Answer

A

What is the artifact shown in this image?

Biliary stent
Colonic stent
External tubing
Percutaneous nephrostomy tube
Ureteric stent

Question 36

Q

Patient with abdominal pain and vomiting. What is the radiological diagnosis?

Caecal volvulus
Large bowel obstruction
Small bowel obstruction
Bowel perforation
Normal

Answer

A

Patient with abdominal pain and vomiting. What is the radiological diagnosis?

Caecal volvulus
Large bowel obstruction
Small bowel obstruction
Bowel perforation
Normal

Question 37

Q

What is the radiological diagnosis?

Sigmoid volvulus
Normal
Ascites
Small bowel obstruction
Pneumoperitoneum

Answer

A

What is the radiological diagnosis?

Sigmoid volvulus
Normal
Ascites
Small bowel obstruction
Pneumoperitoneum

Question 38

Q

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

A

What is the cause of the abnormal calcification in this image?

Calcified gallstones
Calcified mesenteric lymph nodes
Pancreatic calcification
Malignant calcification
Calcified uterine fibroid

Question 39

Q

Patient with abdominal pain, vomiting, and constipation. What is the radiological diagnosis?

Caecal volvulus
Sigmoid volvulus
Small bowel obstruction
Perforation
Normal

Answer

A

Patient with abdominal pain, vomiting, and constipation. What is the radiological diagnosis?

Caecal volvulus
Sigmoid volvulus
Small bowel obstruction
Perforation
Normal

Question 40

Q

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

A

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

Question 41

Q

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

A

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

Question 42

Q

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

Answer

A

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

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.

Question 43

Q

Patient with abdominal pain and vomiting. Which answer best describes the X-ray appearances?

Pneumoperitoneum
Ascites
Psoas abscess
Small bowel obstruction
Normal

Answer

A

Patient with abdominal pain and vomiting. Which answer best describes the X-ray appearances?

Pneumoperitoneum
Ascites
Psoas abscess
Small bowel obstruction
Normal

Question 44

Q

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

A

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

Question 45

Q

Describe what Rigler’s double wall sign appears like [1]
What does this indicate?

Answer

A

Normally only the inner wall of the bowel is visible

If there is pneumoperitoneum both sides of the bowel wall may be visible

Question 46

Q

What may a liver edge silhouette indicate on an AXR? [1]

Answer

A

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.

Question 47

Q

What pathology is indicated in this AXR? [1]

Answer

A

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

Question 48

Q

Describe what is seen in this AXR [3]

Answer

A

Small bowel obstruction - features

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

Question 49

Q

Describe what is depicted in this AXR [1]

Answer

A

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.

Question 50

Q

Which of the following is a caecal and sigmoid volvulus? [2]

Question 51

Q

What sign does this AXR show? [1]
What pathology does this indicate? [1]

Answer

A

Mucosal thickening - ‘thumbprinting’
This patient presented with an exacerbation of symptoms of ulcerative colitis.

Question 52

Q

What sign does this AXR show? [1]
What pathology does this indicate? [1]

Answer

A

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.

Question 53

Q

What sign does this AXR show? [1]
What pathology does this indicate? [1]

Answer

A

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.

Question 54

Q

Where is the ureteric stone in this AXR? [1]

Question 55

Q

What is depicted here? [1]
State a cause of this [1]

Answer

A

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)

Question 56

Q

What is depicted in this AXR? [1]
What does this indicate? [1]

Answer

A

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

Question 57

Q

What is depicted in this AXR? [1]
What does this indicate? [1]

Answer

A

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

Question 58

Q

What is the cause of the abnormal calcification?

Adrenal calcification
Appendicolith
Gallstones
Pancreatic calcification
Staghorn renal calculus

Answer

A

What is the cause of the abnormal calcification?

Adrenal calcification
Appendicolith
Gallstones
Pancreatic calcification
Staghorn renal calculus

Question 59

Q

What is the cause of the abnormal calcification?

Adrenal calcification
Appendicolith
Gallstones
Pancreatic calcification
Staghorn renal calculus

Answer

A

What is the cause of the abnormal calcification?

Adrenal calcification
Appendicolith
Gallstones
Pancreatic calcification
Staghorn renal calculus

Question 60

Q

What is depicted in this AXR? [1]
What does this indicate? [1]

Answer

A

Appendicolith
Appendicoliths are highly predictive of appendicitis in patients presenting with right iliac fossa pain

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

Question 61

Q

What is the artifact shown in this image?
What pathology does it reduce the risk of?

Naso-jejunal tube
Colonic stent
Pig-tail (JJ) stent
Percutaneous nephrostomy tube
Inferior vena cava (IVC) filter

Answer

A

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

Question 62

Q

What is the artifact shown in this image?
What pathology does it reduce the risk of?

Naso-jejunal tube
Colonic stent
Pig-tail (JJ) stent
Percutaneous nephrostomy tube
Inferior vena cava (IVC) filter

Answer

A

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

Question 63

Q

What is the artifact shown in this image?

Naso-jejunal tube
Colonic stent
Pig-tail (JJ) stent
Percutaneous nephrostomy tube
Inferior vena cava (IVC) filter

Answer

A

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

Question 64

Q

What is the artifact shown in this image?

Naso-jejunal tube
Colonic stent
Pig-tail (JJ) stent
Percutaneous nephrostomy tube
Inferior vena cava (IVC) filter

Answer

A

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 61

A

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

Answer 62

A

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 63

A

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

Answer 64

A

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 65

A

Which of the following stone type appears as a stag-horn on x-ray?

Urate
Magnesium ammonium phosphate
Calcium oxalate
Calcium phosphate
Cystine

Answer 66

A

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 67

A

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 68

A

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 69

A

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 70

A

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 71

A

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 72

A

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 73

A

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 74

A

What imaging modility is first line for non-pregnant patients for suspected kidney stones?

MRI
XR-KUB
CT-KUB
US

Answer 75

A

What imaging modility is first line for pregnant patients for suspected kidney stones?

MRI
XR-KUB
CT-KUB
US

Answer 76

A

What is the first line treatment for pregnant person with stone? [1]

Open surgery
Percutaneous nephrolithotomy (PCNL)
Ureteroscopy (URS)
Shockwave lithotripsy (SWL)

Answer 77

A

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 78

A

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 79

A

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 80

A

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 81

A

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 82

A

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 83

A

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 84

A

Which of the following type of UTIs is most likely to have spread haematogenously?

Candida albicans
AND
Staph. aureus; M. tb

Answer 85

A

Which following treatment for UTIs may cause neonatal haemolysis?

Cefalexin
Trimethoprim
Amoxicillin
Co-amoxiclav
Nitrofurantoin

Answer 86

A

Which following treatment for UTIs may cause spina bifida?

Cefalexin
Trimethoprim
Amoxicillin
Co-amoxiclav
Nitrofurantoin

Answer 87

A

Which following treatment for UTIs should be avoided in the third trimester of pregnancy?

Cefalexin
Trimethoprim
Amoxicillin
Co-amoxiclav
Nitrofurantoin

Answer 88

A

Which following treatment for UTIs should be avoided in the first trimester of pregnancy?

Cefalexin
Trimethoprim
Amoxicillin
Co-amoxiclav
Nitrofurantoin

Answer 89

A

Which following treatment for UTIs should be avoided in patients with renal impairment?

Cefalexin
Trimethoprim
Amoxicillin
Co-amoxiclav
Nitrofurantoin

Answer 90

A

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 91

A

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 92

A

loop stoma; two lumens

end stomas characteristically have only one lumen

Answer 93

A

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 94

A

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 95

A

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 96

A

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 97

A

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 98

A

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 99

A

Which of the following involves removing the sigmoid colon?

Hartmann’s procedure
High anterior resection
Left hemicolectomy
Low anterior resection
Right hemicolectomy

Answer 100

A

Which of his medications could lead to a reduced awareness of the symptoms of a hypoglycemic event following his insulin use?

Beta-blocker
Hypotension
Bradycardia
HYPOGLYCEMIA
Hypothermia

Answer 101

A

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 102

A

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

Answer 103

A

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 104

A

Which of the following is considered the most common underlying cause of colovesical fistula?

appendicitis
diverticulitis
colorectal cancer
Crohn disease
radiotherapy
trauma

Answer 105

A

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 106

A

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 107

A

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 108

A

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 109

A

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 110

A

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 111

A

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 112

A

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 113

A

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 114

A

Critical limb ischaemia

Answer 115

A

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 116

A

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 117

A

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 118

A

Buergers test for PAD

Answer 119

A

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

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 120

A

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 121

A

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 122

A

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 123

A

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 124

A

Greater than 1.3 due to calcification

Answer 125

A

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 126

A

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 127

A

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 128

A

What is Debakey classification for aortic dissection is this?

Type I
Type II
Type IIIa
Type IIIB

Answer 129

A

What is Debakey classification for aortic dissection is this?

Type I
Type II
Type IIIa
Type IIIB

Answer 130

A

What is Debakey classification for aortic dissection is this?

Type I
Type II
Type IIIa
Type IIIB

Answer 131

A

What is Debakey classification for aortic dissection is this?

Type I
Type II
Type IIIa
Type IIIB

Answer 132

A

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 133

A

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 134

A

Open bypass graft

Answer 135

A

Endovascular revascularization

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

Answer 136

A

Acromegaly
Obesity
Hypothyroidism
Pregnancy
RA

Answer 137

A

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 138

A

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 139

A

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 140

A

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 141

A

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

Answer 142

A

15 x 10^9

Answer 143

A

Restless leg syndrome: IDA

Answer 144

A

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 145

A

Heinz bodies on a blood film would indicate which cause of anaemia

G6PD deficiency
Pernicious anaemia
Hereditary spherocytosis
Sickle cell anaemia

Answer 146

A

G6PD deficiency - Heinz bodies

Answer 147

A

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 148

A

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 149

A

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 150

A

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 151

A

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 152

A

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 153

A

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 154

A

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 155

A

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 156

A

Acute myeloid leukaemia

Answer 157

A

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 158

A

Acute myeloid leukaemia

Answer 159

A

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 160

A

c) Folic Acid supplementation

Answer 161

A

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 162

A

b) Chorionic villus sampling (CVS)

Answer 163

A

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 164

A

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 165

A

d) Molecular genetic testing

Answer 166

A

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 167

A

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 168

A

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 169

A

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 170

A

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 171

A

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 172

A

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 173

A

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 174

A

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 175

A

c) Excisional lymph node biopsy

Answer 176

A

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 177

A

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 178

A

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

Answer 179

A

As part of the treatment for NAFLD, NICE recommends the prescription of which following vitamin, due to increased clinical outcomes?

Vitamin A
Vitamin B
Vitamin C
Vitamin D
Vitamin E

Answer 180

A

Which of the following best describes

occurs when a person develops angina when lying down (not necessarily only at night) and is without any apparent cause

St Vincent’s angina
Stable angina
Decubitus angina
Prinztmetal angina

Answer 181

A

Which of the following best describes

results from a spasm of one of the large coronary arteries on the surface of the heart.

St Vincent’s angina
Stable angina
Decubitus angina
Prinztmetal / variant angina

Answer 182

A

Which of the following has a risk of GI ulceration?

Ivabradine
Nicorandil
Digoxin
Amlodopine
Verapamil

Answer 183

A

severe coronary artery spasm is which type of MI

Type I
Type II
Type III
Type IV

Answer 184

A

Myocardial infarction associated with percutaneous coronary intervention (PCI) or stent thrombosis would be classified as:
Type I
Type II
Type III
Type IV

Answer 185

A

Myocardial infarction associated with tachyarrhythmias would be classified as:
Type I
Type II
Type III
Type IV

Answer 186

A

Myocardial infarction associated with hypotension would be classified as:
Type I
Type II
Type III
Type IV

Answer 187

A

which of these findings would be consistent with a ventricular septal defect?

Pulsus paradoxus
Early diastolic murmur
Displaced apex beat
Split S1
Pansystolic murmur

Answer 188

A

Burkitt’s lymphoma is associated with which one of the following genetic changes:

Cyclin D1-IGH gene translocation
TEL-JAK2 gene translocation
Bcl-2 gene translocation
C-myc gene translocation
BCR-Abl1 gene translocation

Answer 189

A

chronic myeloid leukaemia (CML) is associated with which one of the following genetic changes:

Cyclin D1-IGH gene translocation
TEL-JAK2 gene translocation
Bcl-2 gene translocation
C-myc gene translocation
BCR-Abl1 gene translocation

Answer 190

A

myelofibrosis is associated with which one of the following genetic changes:

Cyclin D1-IGH gene translocation
TEL-JAK2 gene translocation
Bcl-2 gene translocation
C-myc gene translocation
BCR-Abl1 gene translocation

Answer 191

A

follicular lymphoma is associated with which one of the following genetic changes:

Cyclin D1-IGH gene translocation
TEL-JAK2 gene translocation
Bcl-2 gene translocation
C-myc gene translocation
BCR-Abl1 gene translocation

Answer 192

A

Which of the following medications are known to cause QTc prolongation?

Bisoprolol
Diazepam
Salbutamol
Sotalol
Carvedilol

Answer 193

A

M - Methadone
E - Erythromycin
T - Terfenadine
H - Haloperidol
C - Chloroquine / Citalopram
A - Amiodarone
T - Tricyclics
S - Sotalol

Answer 194

A

Which of the following is the most cause of endocarditis in patients following prosthetic valve surgery?

Staphylococcus epidermidis
Streptococcus viridans
Staphylococcus aureus
Streptococcus bovis
Streptococcus sanguinis

Answer 195

A

Which of the following is the most cause of endocarditis in patients with colorectal cancer?

Staphylococcus epidermidis
Streptococcus viridans
Staphylococcus aureus
Streptococcus bovis
Streptococcus sanguinis

Answer 196

A

Which of the following is associated most with poor dental hygiene / following a dental procedure?

Staphylococcus epidermidis
Streptococcus viridans
Staphylococcus aureus
Streptococcus bovis
Streptococcus sanguinis

Answer 197

A

Which of the following is associated most with patients with no prior past medical history?

Staphylococcus epidermidis
Streptococcus viridans
Staphylococcus aureus
Streptococcus bovis
Streptococcus sanguinis

Answer 198

A

Which of the following is associated most with IVDU who present acutely?

Staphylococcus epidermidis
Streptococcus viridans
Staphylococcus aureus
Streptococcus bovis
Streptococcus sanguinis

Answer 199

A

Which of the following is associated most with IE in the first 2 months following prosthetic valve surgery

Staphylococcus epidermidis
Streptococcus viridans
Staphylococcus aureus
Streptococcus bovis
Streptococcus sanguinis

Answer 200

A

Is the most appropriate first-line anti-anginal for stable angina in a patient with known heart failure, if there are no contraindications?

A. Verapamil
B. Amlodipine
C. Nifedipine
D. Bisoprolol
E. Nicorandil
F. Isosorbide mononitrate

Answer 201

A

Patients may develop tolerance to this medication necessitating a change in dosing regime

A. Verapamil
B. Amlodipine
C. Nifedipine
D. Bisoprolol
E. Nicorandil
F. Isosorbide mononitrate

Answer 202

A

Acute endocarditis is most commonly caused by Staphylococcus
Subacute cases are most commonly caused by Streptococcus species.

Answer 203

A

Native valve endocarditis

Answer 204

A

vancomycin + meropenem is the treatment for:

native valve endocarditis with severe sepsis, penicillin allergy or suspected methicillin-resistent staphylococcus aureus (MRSA)
Native valve endocarditis
Prosthetic valve endocarditis
NVE with severe sepsis and risk factors gram negative infection

Answer 205

A

Prosthetic valve endocarditis

Answer 206

A

vancomycin + gentamicin is the treatment for

native valve endocarditis with severe sepsis, penicillin allergy or suspected methicillin-resistent staphylococcus aureus (MRSA)
Native valve endocarditis
Prosthetic valve endocarditis
NVE with severe sepsis and risk factors gram negative infection

Answer 207

A

Which of the following would you use to treat native valve endocarditis?

vancomycin + gentamicin
vancomycin + meropenem
vancomycin, gentamicin + rifampacin
amoxicillin + gentamicin

Answer 208

A

Which of the following would you use to treat MRSA +ve endocarditis?

vancomycin + gentamicin
vancomycin + meropenem
vancomycin, gentamicin + rifampacin
amoxicillin + gentamicin

Answer 209

A

Which of the following would you use to treat NVE with severe sepsis and risk factors gram negative infection?

vancomycin + gentamicin
vancomycin + meropenem
vancomycin, gentamicin + rifampacin
amoxicillin + gentamicin

Answer 210

A

Which of the following would you use to treat prosethetic valve endocarditis?

vancomycin + gentamicin
vancomycin + meropenem
vancomycin, gentamicin + rifampacin
amoxicillin + gentamicin

Answer 211

A

Ivabradine

sacubitril-valsartan

digoxin

hydralazine in combination with nitrate

cardiac resynchronisation therapy

Answer 212

A

Hydralazine and nitrate

Answer 213

A

Ivabradine
- sinus rhythm > 75/min and a left ventricular fraction < 35%

sacubitril-valsartan:
- criteria: left ventricular fraction < 35%
- is considered in heart failure with reduced ejection fraction who are symptomatic on ACE inhibitors or ARBs

digoxin

hydralazine in combination with nitrate
- this may be particularly indicated in Afro-Caribbean patients

cardiac resynchronisation therapy
- indications include a widened QRS (e.g. left bundle branch block) complex on ECG

Answer 214

A

hydralazine in combination with nitrate

Answer 215

A

A patient has chronic heart failure.

You iniate an ACEin and a BB as first line treatment. This does not resolve their EF.

You next trial and aldosterone antagonist. This does also not help.

They have a widened QRS on their ECG.

What is the appropriate third line treatment?

Ivabradine
sacubitril-valsartan
digoxin
hydralazine in combination with nitrate
cardiac resynchronisation therapy

Answer 216

A

A patient has chronic heart failure.

You iniate an ACEin and a BB as first line treatment. This does not resolve their EF.

You next trial and aldosterone antagonist. This does also not help.

They have LVEF < 35% and symptomatic

What is the appropriate third line treatment?

sacubitril-valsartan

Answer 217

A

A patient has chronic heart failure.

You iniate an ACEin and a BB as first line treatment. This does not resolve their EF.

You next trial and aldosterone antagonist. This does also not help.

They have LVEF < 35% and a sinus rhythm of 90bpm

What is the appropriate third line treatment?

Ivabradine

Answer 218

A

Which of the following requires 0 bridging time after LMWH treatment for PE?

Warfarin
Edoxaban
Rivaroxaban
Dabigatran

Answer 219

A

A pregnant patient suffers a PE.
What treatment would you give them?

Warfarin - teratogenic
Edoxaban
LMWH
Rivaroxaban
Dabigatran

Answer 220

A

A pregnant patient suffers from anti-phospholipid syndrome
What treatment would you give them?

Warfarin
Edoxaban
LMWH
Rivaroxaban
Dabigatran

Answer 221

A

.
A 35-year-old woman visits her general practitioner (GP) complaining of a productive cough of 6 weeks duration. On further questioning she has a history of fever and night sweats and lost about 10 kg in weight during this time. She lived in Nigeria until she was 16 years old.

Which investigation should the GP request first?

Bronchoscopy

Full blood count

Mantoux test

Serum interferon-gamma release assay

Sputum for acid fast bacillus

Answer 222

A

Pulmonary HTN

Answer 223

A

Modification of the bacterial RNA polymerase, the target of the drug

Answer 224

A

Aminoglycosides

Answer 225

A

Blocking epinephrine, serotonin reuptake pumps

Answer 226

A

A patient has recently started a new medication that has caused them to have decreased free T3/4 levels.

What medication could it be?

Interaction with calcium carbonate

Interaction with amlodipine
Iodine deficiency
Interaction with aspirin
Poor adherence to levothyroxine

Answer 227

A

What is the most common endogenous cause of this Cushings?

Adrenal adenoma
- adrenal adenoma (5-10%)

Adrenal carcinoma

Glucocorticoid therapy

Micronodular adrenal dysplasia

Pituitary adenoma

Answer 228

A

A 34 year old woman presents with weight loss, irregular menstrual cycles and anxiety. On examination she has a fine tremor, a diffuse goitre, and mild proptosis. On examination, she has a skin condition.

Which is the most likely skin condition be present?

Acanthosis nigricans

Erythema nodosum

Granuloma annulare

Pyoderma gangrenosum

Vitiligo

Answer 229

A

A 25 year old man is admitted with severe headache, and is noted to have a blood pressure of 204/110 mmHg, with a pulse rate of 120 BPM, regular. He mentions about getting episodes of headache, anxiety and sweating 3-4 times per month, which last around 30 minutes. His GP has commenced him on propranolol, but his symptoms have worsened. He is now being commenced on another treatment from the list of bendroflumethiazide, doxazosin, losartan, moxonidine and ramipril.

Which treatment should be the most appropriate one to commence initially?

Bendroflumethiazide

Doxazosin - alpha blocker

Losartan

Moxonidine

Cross
Ramipril

Answer 230

A

A 67 year old man is admitted with confusion and severe dehydration. Urgent blood tests show an acute kidney injury, but normal liver function and full blood count.

Corrected serum calcium is 3.45 mmol/L (2.3-2.7).

Serum parathyroid hormone is 1.0 pmol/l (5-12).

Chest x-ray is normal.

He has undergone several investigations including CT chest abdomen and pelvis, X ray lumbar spine, serum lactate dehydrogenase, serum parathyroid hormone related peptide and serum vitamin D.

Which investigation is most likely to help determine the cause of his serum calcium result?

CT chest abdomen and pelvis

X ray Lumbar spine

Serum lactate dehydrogenase

Serum parathyroid hormone related peptide

Serum vitamin D

Answer 231

A

A patient presents with these changes to their nails.

You find they are suffering from micocytic anaemia.

What is the most likely cause?

Thalassemia
Anemia of chronic disease
Iron deficiency
Lead poisoning
Sideroblastic anemia.

Answer 232

A

A patient presents with hypoalbuminemia.
Which nail changes are you likely to see

Clubbing
Koilonychia
Leuconychia
Mees’ lines
Onycholysis

Answer 233

A

A patient has stage 4 CKD.

What nail change might you expect to see

Clubbing
Koilonychia
Leuconychia
Mees’ lines
Onycholysis

Answer 234

A

Koilonychia refers to spoon-shaped nails. Can be caused by:
* Iron deficiency anaemia (e.g. Crohn’s disease)
* Lichen planus
* Rheumatic fever: therefore Streptococcus pyogenes

Answer 235

A

A patient has been diagnosed with lung cancer and are recieving chemotherapy. .

What nail change might you expect to see

Clubbing
Koilonychia
Leuconychia - chemotherapy can cause
Mees’ lines
Onycholysis

Answer 236

A

Routine blood tests are unnecessary

Answer 237

A

A 23 year old woman has a 2-day history of headache. She has multiple symptoms including visual aura, intermittent tingling sensation in the legs, stiff neck, ongoing rash on the face and an episode of loss of vision in the right eye 10 years ago. She is otherwise well. She is diagnosed as having migraine.

Which symptom is most supportive of the diagnosis of migraine?

Loss of vision in the right eye

Neck stiffness

Rash on the face

Tingling in both legs

Visual aura

Answer 238

A

After a first episode

Answer 239

A

What is the treatment for large, external haemorrhoids?

stapled haemorroidopexy
botulinum toxin
lateral internal sphincterotomy
topical GTN or diltiazem
Milligan Morgan style conventional haemorroidectomy

Answer 240

A

What is the definitive treatment for fissure in ano?

stapled haemorroidopexy
botulinum toxin
lateral internal sphincterotomy
topical GTN or diltiazem
Milligan Morgan style conventional haemorroidectomy

Answer 241

A

What is the usual first line therapy for fissure in ano?

stapled haemorroidopexy
botulinum toxin
lateral internal sphincterotomy
topical GTN or diltiazem
Milligan Morgan style conventional haemorroidectomy

Answer 242

A

What is the usual third line therapy for fissure in ano?

stapled haemorroidopexy
botulinum toxin
lateral internal sphincterotomy
topical GTN or diltiazem
Milligan Morgan style conventional haemorroidectomy

Answer 243

A

What is the usual second line therapy for haemorrhoids?

stapled haemorroidopexy
botulinum toxin
lateral internal sphincterotomy
topical GTN or diltiazem
Milligan Morgan style conventional haemorroidectomy

Answer 244

A

Treatment failures which fail topical therapy will usually go on to have what treatment fpr fissure in ano?

stapled haemorroidopexy
botulinum toxin
lateral internal sphincterotomy
topical GTN or diltiazem
Milligan Morgan style conventional haemorroidectomy

Answer 245

A

Which of the following is associated with a risk of change in libido

Beta blocker
Spironolactone
ACEin
Digoxin
SGLT-2 in

Answer 246

A

Which of the following is associated with a risk of blurred vision?

Beta blocker
Spironolactone
ACEin
Digoxin
SGLT-2 in

Answer 247

A

Imatinib

Answer 248

A

Biological agents:

Which of the following is used when treating renal transplants?

Basiliximab
Etanercept
Bevacizumab
Adalimumab
Cetuximab

Answer 249

A

Biological agents:

Which of the following is used when treating EGF positive colorectal cancers?

Basiliximab
Etanercept
Bevacizumab
Adalimumab
Cetuximab

C for Colorectal

Answer 250

A

Biological agents:

Which of the following is used intreating Crohns?

Basiliximab
Etanercept
Bevacizumab
Adalimumab
Cetuximab

Answer 251

A

Basiliximab is used to treat renal transplants

What is it’s MoA?

Tyrosine kinase inhibitor
TNF alpha inhibitor
Anti VEGF
Epidermal growth factor inhibitor
IL2 binding site

Answer 252

A

Cetuximab is used to treat EGF +ve colorectal cancers.

What is it’s MoA?

Tyrosine kinase inhibitor
TNF alpha inhibitor
Anti VEGF
Epidermal growth factor inhibitor
IL2 binding site

Answer 253

A

Bevacizumab is used to treat colorectal cancer and renal and glioblastomas.

What is it’s MoA?

Tyrosine kinase inhibitor
TNF alpha inhibitor
Anti VEGF
Epidermal growth factor inhibitor
IL2 binding site

Answer 254

A

A 48-year-old man notices that he is becoming increasingly dizzy when he plays squash, in addition he has also developed cramping pain in his left arm. One day he is inflating his car tyre with a hand held pump, he collapses and is brought to hospital.

Subclavian steal syndrome

Due to proximal stenotic lesion of the subclavian artery
Results in retrograte flow through vertebral or internal thoracic arteries
The result is that decrease in cerebral blood flow may occur and produce syncopal symptoms
A duplex scan and/ or angiogram will delineate the lesion and allow treatment to be planned

Answer 255

A

A 24-year-old lady from Western India presents with symptoms of lethargy and dizziness, worse on turning her head. On examination her systolic blood pressure is 176/128. Her pulses are impalpable at all peripheral sites. Auscultation of her chest reveals a systolic heart murmur.

Takayasu’s arteritis
- Takayasu’s arteritis most commonly affects young Asian females.** Pulseless peripheries are a classical finding**. The CNS symptoms may be variable.

Answer 256

A

A 25-year-old junior doctor has a chest x-ray performed as part of a routine insurance medical examination. The x-ray shows evidence of rib notching. Auscultation of his chest reveals a systolic murmur which is loudest at the posterior aspect of the fourth intercostal space.

Subclavian steal syndrome
Takayasu’s arteritis
Cervical rib
Aortic coarctation
Patent ductus arteriosus
- Untreated patients develop symptoms of congestive cardiac failure

Answer 257

A

Out of the following, which disease is most associated with anal fistula formation?

Anal fissure

Rectal prolapse

Anal abscess

Lichen sclerosus

Answer 258

A

Which of the following is NOT a major risk factor for anal fistula?

History of radiation therapy to the anal region

Crohn’s disease

History of trauma to the anal region

Constipation

Answer 259

A

What is the most common type of perianal fistula?

Intersphincteric

Transsphincteric

Suprasphincteric

Extrasphincteric

Answer 260

A

Mutations in ABL gene are associated with

AML
CML - BCR-ABL (9:22)
ALL
CLL

Answer 261

A

Philadelphia chromosome is associated with

AML
CML - BCR-ABL (9:22)
ALL
CLL

TS - Im feeling 22

Answer 262

A

This symptom is most likely associated with

AML
CML
ALL
CLL

Answer 263

A

electroylte disturbances seen in TLS

Hypocalcaemia
- Low Ca2+; High K; P; Uric acid

Answer 264

A

Which is most associated with Richter transformation to a lymphoma?

AML
CML
ALL
CLL

Answer 265

A

Anaemia

Answer 266

A

BCR-ABL fusion protein

The Philadelphia chromosome is present in more than 95% of patients with chronic myeloid leukaemia (CML). It is due to a translocation between the long arm of chromosome 9 and 22 - t(9:22)(q34; q11). This results in part of the ABL proto-oncogene from chromosome 9 being fused with the BCR gene from chromosome 22. The resulting BCR-ABL gene codes for a fusion protein that has tyrosine kinase activity in excess of normal.

Answer 267

A

t(9:22)

Answer 268

A

Decreased leukocyte alkaline phosphatase

Answer 269

A

inhibitor of the tyrosine kinase associated with the BCR-ABL defect

Answer 270

A

hypogammaglobulinaemia

Answer 271

A

What is the first line therapy for patients with CML?

Hydroxyurea
FCR
Imatinib
R-CHOP
Ibrutinib

Answer 272

A

R-CHOP

Answer 273

A

Which of the following is used in HL?

FOLFOX
FOLFIRI
FOLFIRINOX
ABVD
R-CHOP

Answer 274

A

A 55 yr old is having chemotherapy for her NHL.

Days after treatment, she notices blood in her urine.

Which treatment is most likely to have caused this?

Doxorubicin
Vincristine
Cyclophosphomide - causes haemorrhagic cystitis
Cisplatin
Bleomcyin

Answer 275

A

A patient is diagnosed with CML

What is the first line treatment?

Infliximab
- Imatinib
Vincristine
Ritixumab

Answer 276

A

most common genetic change is the deletion in chromosome 13
TP53 mutation
Trisomy 12: presence of an extra 12th chromosome
Overexpression of BCL2 proto-oncogene: suppresses programmed cell death (i.e. increases cell survival)

Answer 277

A

What is the most common cytogenetic feature seen in ALL?

t(4;11)
t(12;21)
t(9;22)
Hypodiploid karyotype
Hypodiploid karyotype

Answer 278

A

a. Regular monitoring of which parameter is crucial for assessing the response to treatment and detecting relapse in CML?

A. Hemoglobin levels
B. Platelet count
C. BCR-ABL transcript levels
D. Liver function tests

Answer 279

A

a. What is the characteristic molecular marker for CML?

A. BCR-ABL fusion gene
B. FLT3-ITD mutation
C. JAK2 mutation
D. MPL mutation

Answer 280

A

Chronic lymphocytic leukaemia

Answer 281

A

Which of the following is most associated with warm haemolytic anaemia

Chronic lymphocytic leukaemia

Warm hemolytic anemia is a type of autoimmune hemolytic anemia (AIHA), which is a condition where the body’s immune system attacks and destroys its own red blood cells123. Warm hemolytic anemia is caused by IgG antibodies that bind red blood cells at normal body temperature12. The diagnosis is confirmed by the direct antiglobulin (direct Coombs) test1.

Answer 282

A

Which of the following is most associated with Downs syndrome

Acute myeloid leukaemia
Acute lymphoblastic leukaemia
Chronic myeloid leukaemia
Chronic lymphocytic leukaemia

Answer 283

A

Which of the following is most associated with the Philadelphia chromosome

Acute myeloid leukaemia
Acute lymphoblastic leukaemia
Chronic myeloid leukaemia
Chronic lymphocytic leukaemia

Answer 284

A

Which of the following is most associated with three phases

Acute myeloid leukaemia
Acute lymphoblastic leukaemia
Chronic myeloid leukaemia
Chronic lymphocytic leukaemia

Answer 285

A

Which of the following is most associated with Auer rods

Acute myeloid leukaemia
Acute lymphoblastic leukaemia
Chronic myeloid leukaemia
Chronic lymphocytic leukaemia

Answer 286

A

Auer rods

Acute myeloid leukaemia
Acute lymphoblastic leukaemia
Chronic myeloid leukaemia
Chronic lymphocytic leukaemia

Answer 287

A

Chronic lymphocytic leukaemia = Richter’s transformation

Answer 288

A

Acute myeloid leukaemia

Answer 289

A

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 290

A

Acute myeloid leukaemia

Answer 291

A

Congenital disorders:
- Congenital neutropenia
- Fanconi anaemia

Radiation exposure

Myeloproliferative disorders:
- polycythaemia ruby vera
- myelofibrosis

Previous chemotherapy:
- Alkylating agents
- topoisomerase-II inhibitors

Toxins
- Insecticides

Answer 292

A

Features are largely related to bone marrow failure:

anaemia (fatigue; pallor; angina)
fever (due to infections)
splenomegaly & hepatomegaly
recurrent infections (neutropenia)
thrombocytopenia (petechiae; nose bleeds; bruising; ecchymosis; gingivial bleeding)
bone pain (sternal discomfort; aching in extremities)
leukaemia cutis (nodular, violaceous lesions on the skin)
gingivial hypertrophy
CNS involvement: headaches; visual changes; nerve palsies

Answer 293

A

Lymphadenopathy
Hepatosplenomegaly
Bone pain
Gum hypertrophy
Violaceous skin deposits
Testicular enlargement

Answer 294

A

Bone marrow aspirate and biopsy is required for formal diagnosis of AML

≥ 20% myeloblasts in the bone marrow confirm the diagnosis

Answer 295

A

LDH a non-specific marker of increased cell turnover may be raised in leukaemia.

Answer 296

A

Auer rods

Answer 297

A

According to NICE, what is the standard induction chemotherapy regimen for adults under 60 years old with AML who are fit for intensive treatment?
a) Azacitidine
b) Decitabine
c) Daunorubicin and Cytarabine
d) Midostaurin

Answer 298

A

According to NICE, what is the recommended duration of thromboprophylaxis in AML patients receiving intensive chemotherapy?
a) 7 days
b) 14 days
c) 21 days
d) Until complete remission is achieved

Answer 299

A

A patient presents with these changes to their nails.

You find they are suffering from micocytic anaemia.

What is the most likely cause?

Thalassemia
Anemia of chronic disease
Iron deficiency
Lead poisoning
Sideroblastic anemia.

Answer 300

A

A patient presents with hypoalbuminemia.
Which nail changes are you likely to see

Clubbing
Koilonychia
Leuconychia
Mees’ lines
Onycholysis

Answer 301

A

A patient has stage 4 CKD.

What nail change might you expect to see

Clubbing
Koilonychia
Leuconychia
Mees’ lines
Onycholysis

Answer 302

A

Psoriasis

Answer 303

A

Koilonychia refers to spoon-shaped nails. Can be caused by:
* Iron deficiency anaemia (e.g. Crohn’s disease)
* Lichen planus
* Rheumatic fever: therefore Streptococcus pyogenes

Answer 304

A

A patient has been diagnosed with lung cancer and are recieving chemotherapy. .

What nail change might you expect to see

Clubbing
Koilonychia
Leuconychia - chemotherapy can cause
Mees’ lines
Onycholysis

Answer 305

A

A patient has C. diff

They have their WCC measured - it’s 13 x10^9

What is their level of C. diff?

Mild
Moderate < 15 x10^9
Severe - > 15
Life threatening

Answer 306

A

Aspirational pneumonia in a COPD patient is most likely to be

Streptococcus pneumoniae
Staphylococcus aureus
Haemophilus influenzae
Pseudomonas aeruginosa
Klebsiella

Not specific to COPD - just that not an alcoholic

Answer 307

A

Imatinib

Answer 308

A

Biological agents:

Which of the following is used when treating renal transplants?

Basiliximab
Etanercept
Bevacizumab
Adalimumab
Cetuximab

Answer 309

A

Biological agents:

Which of the following is used when treating EGF positive colorectal cancers?

Basiliximab
Etanercept
Bevacizumab
Adalimumab
Cetuximab

C for Colorectal

Answer 310

A

Biological agents:

Which of the following is used intreating Crohns?

Basiliximab
Etanercept
Bevacizumab
Adalimumab
Cetuximab

Answer 311

A

Basiliximab is used to treat renal transplants

What is it’s MoA?

Tyrosine kinase inhibitor
TNF alpha inhibitor
Anti VEGF
Epidermal growth factor inhibitor
IL2 binding site

Answer 312

A

Cetuximab is used to treat EGF +ve colorectal cancers.

What is it’s MoA?

Tyrosine kinase inhibitor
TNF alpha inhibitor
Anti VEGF
Epidermal growth factor inhibitor
IL2 binding site

Answer 313

A

Bevacizumab is used to treat colorectal cancer and renal and glioblastomas.

What is it’s MoA?

Tyrosine kinase inhibitor
TNF alpha inhibitor
Anti VEGF
Epidermal growth factor inhibitor
IL2 binding site

Answer 314

A

fluid resuscitation
* aggressive early hydration with crystalloids. In severe cases 3-6 litres of third space fluid loss may occur
aim for a urine output of > 0.5mls/kg/hr

intravenous opioids are normally required to adequately control the pain

patients should not routinely be made ‘nil-by-mouth’ unless there is a clear reason e.g. the patient is vomiting
- enteral nutrition should be offered to anyone with moderately severe or severe acute pancreatitis within 72 hours of presentation

NICE state the following: ‘Do not offer prophylactic antimicrobials to people with acute pancreatitis’:
- Even though they present with raised WCC

Surgery if indicated

Answer 315

A

A patient has suspected acute pancreatitis.

Imaging reveals they have gallstones.
What surgery is indicated

ERCP
Early cholecystectomy
Radiological drainage or surgical necrosectomy
Debridement

Answer 316

A

A patient has suspected acute pancreatitis.

Imaging reveals they an obstructed biliary tree.
What surgery is indicated?

ERCP
Early cholecystectomy
Radiological drainage or surgical necrosectomy
Debridement

Answer 317

A

Which of the following drug for transplantation immunosuppression is a risk factor for hyperlipidaemia?

Tacrolimus
Ciclosporin
Mycophenolate mofetil (MMF)
Sirolimus (rapamycin)

Answer 318

A

Which drug is a risk factor for NODAT?

Tacrolimus & (ciclosporin, but less)
Prednisilone
Mycophenolate mofetil (MMF)
Sirolimus (rapamycin)

Answer 319

A

Which drug used in kidney transplant. inhibits proliferation of B and T cells?

Tacrolimus
Ciclosporin
Pred.
Mycophenolate mofetil (MMF)
Sirolimus (rapamycin)

Answer 320

A

A patient has HCV. Which drug class is the choice for treatment?

Integrase inhibitor
Protease inhibitor
NRTI
NNRTI

Answer 321

A

The doctor thinks that another medication he is taking might be reducing the effectiveness of clopidogrel.

What medication would that be?

Allopurinol
Amiodarone
Metronidazole
Omeprazole
Trimethoprim

Answer 322

A

Inhibits DC maturation and enhance Tregs

Answer 323

A

Which drug / drug class works by the following mechanism to prevent graft rejection?

Inhibits purine synthesis and clonal expansion of lymphocytes

Aziothropine
Corticosteroids
Calcineurin inhibitors
Rapamycin
MMF

Answer 324

A

Which drug / drug class works by the following mechanism to prevent graft rejection?

inhibits DC maturation

Aziothropine
Corticosteroids
Calcineurin inhibitors
Rapamycin
MMF

Answer 325

A

Which drug / drug class works by the following mechanism to prevent graft rejection?

inhibits macrophages

Aziothropine
Corticosteroids
Calcineurin inhibitors
Rapamycin
MMF

Answer 326

A

Which drug / drug class works by the following mechanism to prevent graft rejection?

kills rapidly dividing cells

Aziothropine
Corticosteroids
Calcineurin inhibitors
Rapamycin
MMF

Answer 327

A

A patient is diagnosed with alcoholic liver disease. What Ig would you expect to be raised?

IgA
IgG
IgM
IgD
IgE

Alcoholic = IgA

Answer 328

A

A patient is diagnosed with autoimmune hepatitis What Ig would you expect to be raised?

IgA
IgG
IgM
IgD
IgE

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