Questions answered poorly Flashcards by Jonah Little

A 55 year old man with history of angina was advised to take a tablet before a long flight. After taking the pill, he suddenly finds that he has difficulty breathing, feels nauseous and is itching.

A. C1 inhibitor deficiency
B. Urticarial vasculitis
C. Allergic asthma
D. Coeliac disease
E. Idiopathic angioedema
F. Extrinsic allergic alveolitis
G. Mast cell degranulation
H. Panic attack
I. IgE mediated anaphylaxis
J. Chronic urticaria
K. Acute urticaria

Mast cell degranulation

How well did you know this?

Not at all

Perfectly

A 24 year old medical student develops worsening swelling of the hands and feet and abdominal pain before her final year medical exams. She says that similar milder episodes have occurred preciously.

A. C1 inhibitor deficiency
B. Urticarial vasculitis
C. Allergic asthma
D. Coeliac disease
E. Idiopathic angioedema
F. Extrinsic allergic alveolitis
G. Mast cell degranulation
H. Panic attack
I. IgE mediated anaphylaxis
J. Chronic urticaria
K. Acute urticaria

C1 inhibitor deficiency

How well did you know this?

Not at all

Perfectly

A. C1 inhibitor deficiency
B. Urticarial vasculitis
C. Allergic asthma
D. Coeliac disease
E. Idiopathic angioedema
F. Extrinsic allergic alveolitis
G. Mast cell degranulation
H. Panic attack
I. IgE mediated anaphylaxis
J. Chronic urticaria
K. Acute urticaria

Urticarial vasculitis

How well did you know this?

Not at all

Perfectly

A 35 year old woman presents with a two day history of a red itchy skin rash which started soon after her first scuba-diving lesson. She is otherwise well.

A. Anaphylaxis
B. Allergic asthma
C. Hereditary angioedema
D. Acute urticaria
E. Allergic conjunctivitis
F. Acute angioedema
G. Chronic urticaria
H. Contact hypersensitivity
I. Allergic rhinitis
J. Allergic bronchopulmonary aspergillosis

Acute urticaria

The temporal association with scuba diving may indicate an allergy to latex (in wet suits)

How well did you know this?

Not at all

Perfectly

This 45 year old woman presents to A&E with tongue swelling and acute respiratory tract obstruction. She has longstanding hypertension and received a renal transplant two years previously. She has no history of allergic disease. On examination her blood pressure is stable, and examination of her lung fields reveal normal breath sounds. Her current medication includes cyclosporine, azathioprine, captopril and nifedipine.

A. Anaphylaxis
B. Allergic asthma
C. Hereditary angioedema
D. Acute urticaria
E. Allergic conjunctivitis
F. Acute angioedema
G. Chronic urticaria
H. Contact hypersensitivity
I. Allergic rhinitis
J. Allergic bronchopulmonary aspergillosis

Isolated angioedema may be allergic in origin, but 94% of cases angioedema presenting to A&E are drug induced and the majority of these are associated with ACE inhibitors (eg captopril)

How well did you know this?

Not at all

Perfectly

A 40 year old man complains of loss of smell with nasal itching and discharge over 4 weeks. He also describes morning sneezing. He is otherwise in good health. On examination his nasal mucosa are swollen and hyperaemic.

A. IM adrenaline 1mL of 1:1000
B. PO antihistamines
C. IM adrenaline 0.5 mL of 1:1000
D. IV adrenaline 0.3mL of 1:1000
E. Venom immunotherapy
F. Intraarticular corticosteroids
G. None of the above
H. Inhaled corticosteroids
I. Intracardiac adrenaline
J. IM adrenaline 1mL of 1:10000
K. Inhaled antihistamines
L. IV antihistamines
M. Intranasal antihistamines

Oral antihistamines and intranasal corticosteroids are the mainstay of treatment of mild allergic rhinitis. (As intranasal corticosteroid is not an option available, the “single best” answer here is oral antihistamines.

How well did you know this?

Not at all

Perfectly

A. IM adrenaline 1mL of 1:1000
B. PO antihistamines
C. IM adrenaline 0.5 mL of 1:1000
D. IV adrenaline 0.3mL of 1:1000
E. Venom immunotherapy
F. Intraarticular corticosteroids
G. None of the above
H. Inhaled corticosteroids
I. Intracardiac adrenaline
J. IM adrenaline 1mL of 1:10000
K. Inhaled antihistamines
L. IV antihistamines
M. Intranasal antihistamines

IM adrenaline 0.5 mL of 1:1000

Intramuscular adrenalin should be used in patients with severe local angioedema with secondary acute respiratory tract obstruction. However this is not always effective in ACE inhibitor-induced angioedema, and some patients will require intubation. Always stop the causative agent!

How well did you know this?

Not at all

Perfectly

Along with IgD, is one of the first immunoglobulins expressed on B cells before they undergo antibody class switching

A. IgE
B. IgM
C. Alternative complement pathway
D. IgG
E. IL6
F. Classical complement pathway
G. Major histocompatability complex class 2
H. Interferons
I. IgA
J. Innate immune system
K. Major histocompatability complex class 1
L. CD8+

IgM

How well did you know this?

Not at all

Perfectly

Which component of the innate immune system is usually one of the first to respond to infection through a cut?

A. Mast cell
B. Neutrophil
C. Bacterial
D. MHC Class I
E. Parasitic
F. Viral
G. Complement
H. B lymphocyte
I. Fungal
J. MHC Class II
K. T lymphocyte

Neutrophil

How well did you know this?

Not at all

Perfectly

Meningococcal infections are quite common as a result of which deficiency of the component of the immune system?

A. Mast cell
B. Neutrophil
C. Bacterial
D. MHC Class I
E. Parasitic
F. Viral
G. Complement
H. B lymphocyte
I. Fungal
J. MHC Class II
K. T lymphocyte

Complement

How well did you know this?

Not at all

Perfectly

Which complement factor is an important chemotaxic agent?

A. IgG
B. Neutrophils
C. AP50
D. C1
E. NADPH oxidoase
F. IgA
G. IgM
H. C3b
I. C3a
J. MAC
K. Macrophages
L. Myeloperoxidase
M. CH50

C3a

How well did you know this?

Not at all

Perfectly

Goodpasture’s syndrome

A. Type III – T-cell mediated
B. Type IV – T-cell mediated
C. Type II – Antigen mediated
D. Type II – Antibody mediated
E. Type III – complement mediated
F. Not an autoimmune disease
G. Type III – Immune complex mediated
H. Type IV – Complement mediated

Type II – Antibody mediated

How well did you know this?

Not at all

Perfectly

A 60 year old female patient with the following blood results: neutrophils 0.4 x 109/l, platelets 19 x 109/l and reticulocytes 50 x109/l.

A. Fanconi anaemia
B. Hepatitis C infection
C. Radiation-induced
D. Drug-induced
E. Dyskeratosis congenita
F. Aplastic anaemia
G. Parvovirus B19 infection
H. Systemic lupus erythematosus
I. Acute myeloid leukaemia
J. Myelofibrosis

Aplastic anaemia

How well did you know this?

Not at all

Perfectly

A 76 year old man presents to his GP with increasing tiredness, weakness and a long-standing cold. The blood results ordered by the GP showed that the gentleman was anaemic and that increased blast cells were present.

A. Fanconi anaemia
B. Hepatitis C infection
C. Radiation-induced
D. Drug-induced
E. Dyskeratosis congenita
F. Aplastic anaemia
G. Parvovirus B19 infection
H. Systemic lupus erythematosus
I. Acute myeloid leukaemia
J. Myelofibrosis

Acute myeloid leukaemia

How well did you know this?

Not at all

Perfectly

An 83 year old woman presents to the A&E Departments with severe weakness and shortness of breath on minimal exertion. On examination, masses are felt in both left and right upper quadrants of the abdomen. Blood film show leukoerythroblastic cells and teardrop poikilocytes.

A. Fanconi anaemia
B. Hepatitis C infection
C. Radiation-induced
D. Drug-induced
E. Dyskeratosis congenita
F. Aplastic anaemia
G. Parvovirus B19 infection
H. Systemic lupus erythematosus
I. Acute myeloid leukaemia
J. Myelofibrosis

Myelofibrosis

How well did you know this?

Not at all

Perfectly

Hams test

A. Sickle-cell disease
B. Autoimmune haemolytic anaemia
C. Hereditary elliptocytosis
D. Haemolytic uraemic syndrome
E. Gaucher's disease (glucosylceramide lipidosis)
F. Cardiac haemolysis
G. Drug-induced immune haemolysis
H. Paroxysmal nocturnal haemoglobinuria
I. Hereditary spherocytosis
J. Pyruvate kinase deficiency
K. Spur cell anaemia
L. Sepsis

Paroxysmal nocturnal haemoglobinuria

How well did you know this?

Not at all

Perfectly

A 19 year old Jewish male presenting with multiple pathological fractures and hypersplenism.

B. Autoimmune haemolytic anaemia
C. Hereditary elliptocytosis
D. Haemolytic uraemic syndrome
E. Gaucher's disease (glucosylceramide lipidosis)
F. Cardiac haemolysis
G. Drug-induced immune haemolysis
H. Paroxysmal nocturnal haemoglobinuria
I. Hereditary spherocytosis
J. Pyruvate kinase deficiency
K. Spur cell anaemia
L. Sepsis

Gaucher’s disease (glucosylceramide lipidosis)

How well did you know this?

Not at all

Perfectly

Mr RX came to Fulham from Thailand last year. He has inflammatory bowel disease and is taking dapsone for his dermatitis herpetiformis. Which of the above conditions would be likely and clinically relevant?

A. Sickle cell anaemia
B. Disseminated intravascular coagulation
C. Hereditary elliptocytosis
D. Paroxysmal nocturnal haemoglobinuria
E. Hereditary spherocytosis
F. Primary autoimmune haemolytic anaemia
G. Paroxysmal cold haemoglobinuria
H. G6PD deficiency
I. Sepsis
J. Autoimmune haemolytic anaemia due to infectious mononucleosis
K. Cephalosporin-induced haemolytic anaemia

G6PD deficiency

Dapsone is used to treat dermatitis herpetiformis. Dapsone is known to cause haemolysis in G6PD deficient patients, so it is avoided. G6PD deficiency in commoner in Thai people.

How well did you know this?

Not at all

Perfectly

A 29 year old man noticed he had yellow eyes and dark urine. He was always tired, and could not take part in sports as he easily became short of breath. There was no itching, fever or bleeding, and he was not taking any drugs. On examination he was anaemic, jaundiced, afebrile and had no palpable lymphadenopathy, hepatosplenomegaly or rash. His blood tests showed Hb 5.4g/Dl and raised WCC (40 x 109/L), bilirubin (47 µmol/l), aspartate transaminase (90iu/L) and lactate dehydrogenase (5721iu/l). The blood film showed polychromic nucleated red cells and spherocytes and the reticulocyte count was 9%. Direct Coombs’ test revealed IgG and C3 on the red cell surfaces. The serum contained a warm non-specific autoantibody (i.e. it reacted with all the red cells in the test panel). Antinuclear antibodies and rheumatoid factor tests were negative and immunoglobulin levels were normal; there were no paraprotein bands in his serum. He failed to respond to high-dose corticosteroids and had a splenectomy three weeks later.

Correct F. Primary autoimmune haemolytic anaemia

How well did you know this?

Not at all

Perfectly

In which condition might a Donath-Landsteiner be positive?

Correct G. Paroxysmal cold haemoglobinuria

How well did you know this?

Not at all

Perfectly

A 44 year old male develops a pyrexia of >40 C and marked hypotension very shortly after receiving a blood transfusion. He has never had a transfusion before and there is no evidence of ABO blood group / rhesus incompatibility.

A. Iron overload
B. Delayed haemolytic transfusion reaction.
C. Bacterial contamination
D. Allergic reaction
E. TRALI
F. Graft versus host disease
G. Febrile non haemolytic transfusion reaction
H. Immediate haemolytic transfusion reaction
I. Anaphylactic reaction
J. Viral contamination
K. Fluid overload

Bacterial contamination

How well did you know this?

Not at all

Perfectly

Patient develops shortness of breath, dry cough and chills. Donors blood was found to contain anti-leucocyte antibodies with similar specificity to the patient’s white blood cell antigens.

A. TA-GVHD – Transfusion associated graft versus host disease
B. FNHTR – Febrile non-haemolytic transfusion reaction
C. ABO incompatible
D. Bacterial infection
E. Iron overload
F. Urticarial rash
G. DHTR – Delayed Haemolytic transfusion reaction
H. IgA deficiency
I. TRALI – Transfusion related acute lung injury

TRALI – Transfusion related acute lung injury

How well did you know this?

Not at all

Perfectly

A 33 year old male was brought in from a serious RTA. He was given a donor transfusion on the ward. He later developed a fever and complained of suffereing from a ‘dry cough’. The patient became increasingly breathless.

A. Guthrie test
B. Bacterial contamination of transfusion
C. Delayed haemolytic transfusion reaction (DHTR)
D. Pulmonary embolism
E. Transfusion-related acute lung injury (TRALI)
F. Kleihauer test
G. Transfusion haemosiderosis
H. Allergic reaction to forein protein in donor blood
I. Immediate haemolytic transfusion reaction
J. Viral contamination of transfusion

Transfusion-related acute lung injury (TRALI)

How well did you know this?

Not at all

Perfectly

A 6 foot 7 inch rower presents to his GP complaining of easy skin bruising. On further examination he is found to have pectus excavatum, lax joints and a high-arched palate.

A. von Willebrand deficiency
B. Haemophilia
C. Factor XII deficiency
D. Marfan syndrome
E. Ehlers-Danlos syndrome
F. Megakaryocyte
G. Factor VIII deficiency
H. Sensitised platelet
I. Prostacyclin PGI2
J. Christmas disease
K. Thromboxane A2
L. Vitamin K deficiency
M. Autoimmune thrombocytopenic purpura

Correct E. Ehlers-Danlos syndrome

How well did you know this?

Not at all

Perfectly

A 62 year old overweight woman presents to the Emergency Department following a Road Traffic Accident. A full set of investigations is carried out – which shows an increased Activated Partial Thromboplastin Time (APTT) and Prothrombin Time (PT) ``` A. von Willebrand deficiency B. Haemophilia C. Factor XII deficiency D. Marfan syndrome E. Ehlers-Danlos syndrome F. Megakaryocyte G. Factor VIII deficiency H. Sensitised platelet I. Prostacyclin PGI2 J. Christmas disease K. Thromboxane A2 L. Vitamin K deficiency M. Autoimmune thrombocytopenic purpura ```

Correct L. Vitamin K deficiency

Which protein, important in haemostasis, is vitamin K dependent but is not a serine protease? ``` A. Tissue factor pathway inhibitor B. Tissue factor C. Protein C D. Protein S E. Arichidonic acid F. Factor VII G. Cyclooxygenase H. Vascular subendothelium I. Platelets J. Vascular endothelium K. Activated factor X L. Thrombin ```

Correct D. Protein S

Which option is required as a cofactor for protein C activity? ``` A. Tissue factor pathway inhibitor B. Tissue factor C. Protein C D. Protein S E. Arichidonic acid F. Factor VII G. Cyclooxygenase H. Vascular subendothelium I. Platelets J. Vascular endothelium K. Activated factor X L. Thrombin ```

Correct D. Protein S

Which key clotting factor activates both factors V and VIII, and also activates protein C? ``` A. Tissue factor pathway inhibitor B. Tissue factor C. Protein C D. Protein S E. Arichidonic acid F. Factor VII G. Cyclooxygenase H. Vascular subendothelium I. Platelets J. Vascular endothelium K. Activated factor X L. Thrombin ```

Correct L. Thrombin

A 37 year old mother of 4 children, presents to her GP because of recurrent nose bleeds and feeling tired all the time and heavy periods. ``` A. Haemophilia A B. B-Thalassaemia C. Factor V Leiden D. Henoch – Schönlein Purpura E. Sickle cell anaemia F. Warfarin overdose G. Von Willebrand’s Disease H. Bile acid malabsorption I. Christmas Disease J. Disseminated intravascular coagulation K. Malignancy L. Vitamin K Deficiency M. Antiphospholipid antibody syndrome N. Osler-Weber-Rendu Syndrome ```

Correct N. Osler-Weber-Rendu Syndrome 1) A rare autosomal dominant disorder. Alternative name = hereditary haemorrhagic telangiectasia. There is a structural abnormality of the blood vessels, resulting in telangiectases, which are thin walled so are likely to bleed. This leads to haemorrhage and anaemia. It is more common in females, and may not present until later in life. Epistaxis is the commonest presenting symptom. This patient is feeling tired, not just because of her 4 children, but because she also has iron deficiency anaemia.

22 year old Saharawi refugee presents with anaemia, weight loss, loose stools and blood tests reveal an increased PT and slightly increased APTT, with normal thrombin time and platelet count. ``` A. Haemophilia A B. B-Thalassaemia C. Factor V Leiden D. Henoch – Schönlein Purpura E. Sickle cell anaemia F. Warfarin overdose G. Von Willebrand’s Disease H. Bile acid malabsorption I. Christmas Disease J. Disseminated intravascular coagulation K. Malignancy L. Vitamin K Deficiency M. Antiphospholipid antibody syndrome N. Osler-Weber-Rendu Syndrome ```

Correct L. Vitamin K Deficiency 3) Prevalence of coeliac disease is highest in Saharawi refugees. This patient has coeliac disease, and as a result of malabsorption is losing weight and has loose stools (steatorrhoea), and vitamin K deficiency. The blood results related to vitamin K deficiency.

Used to monitor patients undergoing warfarin therapy. ``` A. Unfractionated heparin (UFH) B. Warfarin C. Thrombin time (TT) D. LMWH and aspirin E. Streptokinase F. Pentapolysaccharide G. APTT H. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days I. Aspirin J. Clopidogrel K. Calciparone L. Dalteparin (LMWH) M. Prothrombin time (PT) N. Dipyridamole modified release (MR) and aspirin O. 10mg, 10mg, 5mg, measure on 4th day then every 2 days P. Clopidogrel and aspirin ```

Correct M. Prothrombin time (PT)

Used to monitor patients undergoing unfractionated heparin therapy. ``` A. Unfractionated heparin (UFH) B. Warfarin C. Thrombin time (TT) D. LMWH and aspirin E. Streptokinase F. Pentapolysaccharide G. APTT H. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days I. Aspirin J. Clopidogrel K. Calciparone L. Dalteparin (LMWH) M. Prothrombin time (PT) N. Dipyridamole modified release (MR) and aspirin O. 10mg, 10mg, 5mg, measure on 4th day then every 2 days P. Clopidogrel and aspirin ```

Correct G. APTT

Antiplatelet action. Licensed for secondary prophylaxis of stroke. More effective than aspirin alone. Cheap. ``` A. Unfractionated heparin (UFH) B. Warfarin C. Thrombin time (TT) D. LMWH and aspirin E. Streptokinase F. Pentapolysaccharide G. APTT H. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days I. Aspirin J. Clopidogrel K. Calciparone L. Dalteparin (LMWH) M. Prothrombin time (PT) N. Dipyridamole modified release (MR) and aspirin O. 10mg, 10mg, 5mg, measure on 4th day then every 2 days P. Clopidogrel and aspirin ```

Correct N. Dipyridamole modified release (MR) and aspirin

Dangerous combination with no added efficacy and increased GI bleed. ``` A. Unfractionated heparin (UFH) B. Warfarin C. Thrombin time (TT) D. LMWH and aspirin E. Streptokinase F. Pentapolysaccharide G. APTT H. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days I. Aspirin J. Clopidogrel K. Calciparone L. Dalteparin (LMWH) M. Prothrombin time (PT) N. Dipyridamole modified release (MR) and aspirin O. 10mg, 10mg, 5mg, measure on 4th day then every 2 days P. Clopidogrel and aspirin ```

Correct P. Clopidogrel and aspirin

Side effects include cutaneous necrosis ``` A. Unfractionated heparin (UFH) B. Warfarin C. Thrombin time (TT) D. LMWH and aspirin E. Streptokinase F. Pentapolysaccharide G. APTT H. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days I. Aspirin J. Clopidogrel K. Calciparone L. Dalteparin (LMWH) M. Prothrombin time (PT) N. Dipyridamole modified release (MR) and aspirin O. 10mg, 10mg, 5mg, measure on 4th day then every 2 days P. Clopidogrel and aspirin ```

Correct B. Warfarin

Indicated as thrombotic prophylaxis in DIC ``` A. Unfractionated heparin (UFH) B. Warfarin C. Thrombin time (TT) D. LMWH and aspirin E. Streptokinase F. Pentapolysaccharide G. APTT H. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days I. Aspirin J. Clopidogrel K. Calciparone L. Dalteparin (LMWH) M. Prothrombin time (PT) N. Dipyridamole modified release (MR) and aspirin O. 10mg, 10mg, 5mg, measure on 4th day then every 2 days P. Clopidogrel and aspirin ```

Correct L. Dalteparin (LMWH)

A 65 year old patient presents with hepatosplenomegaly. He is mildly anaemic and thrombocytompenic. A blood monocyte count of 1.2 x 109/l is observed. Bone marrow aspirate reveals ring sideroblasts at 15% of total blasts. Auer rods are observed. A. Refractory anaemia B. Chronic Myelomonocytic Anaemia C. Secondary Sideroblastic Anaemia D. Myelodysplastic syndrome associated with isolated del(5q) chromosome abnormality (5q syndrome) E. Myelodysplastic syndrome,unclassifiable F. Refractory Anaemia with excess of Blasts II G. Refractory Cytopaenia with Multilineage Dysplasia H. Acute Myeloid Leukaemia I. Refractory Anaemia with Ring Sideroblasts J. Refractory Anaemia with excess of Blasts I K. Aplastic Anaemia

Correct B. Chronic Myelomonocytic Anaemia

A 78 year old male patient with recurring infections of the face and maxillary sinuses associated with neutropenia. His bloods are: Hb 9.8 g/dl; WBC 1.3x109/l; Neutrophils 0.3x109/l; platelets 38x109/l.The lab informs you that there are Blasts approximately compromise 17% of bone marrow aspirate. A. Refractory anaemia B. Chronic Myelomonocytic Anaemia C. Secondary Sideroblastic Anaemia D. Myelodysplastic syndrome associated with isolated del(5q) chromosome abnormality (5q syndrome) E. Myelodysplastic syndrome,unclassifiable F. Refractory Anaemia with excess of Blasts II G. Refractory Cytopaenia with Multilineage Dysplasia H. Acute Myeloid Leukaemia I. Refractory Anaemia with Ring Sideroblasts J. Refractory Anaemia with excess of Blasts I K. Aplastic Anaemia

Correct F. Refractory Anaemia with excess of Blasts II

You are called to A&E to see a 65 year old man. He is complaining of fever, shortness of breath, and has lost 5Kg in the last few months. His notes say he was previously diagnosed with “Refractory Anaemia with excess Blasts in Transformation” (RAEB-t). His blast cell count is approximately 30% of all nucleated cells. A. Refractory anaemia B. Chronic Myelomonocytic Anaemia C. Secondary Sideroblastic Anaemia D. Myelodysplastic syndrome associated with isolated del(5q) chromosome abnormality (5q syndrome) E. Myelodysplastic syndrome,unclassifiable F. Refractory Anaemia with excess of Blasts II G. Refractory Cytopaenia with Multilineage Dysplasia H. Acute Myeloid Leukaemia I. Refractory Anaemia with Ring Sideroblasts J. Refractory Anaemia with excess of Blasts I K. Aplastic Anaemia

Correct H. Acute Myeloid Leukaemia

A 64 year old man complains of headaches, fatigue and itchy skin, particularly evident after a hot bath. He has a long-standing history of alcohol abuse and drug history reveals that he taking thiazide diuretics. On examination, you note that he is thin with sunken eyes. ``` A. Imitanib B. Erythropoeitin C. Venesection D. Acute myeloid leukaemia E. Microcytosis F. Haematocrit G. Polycythaemia vera H. Essential thrombocythaemia I. Melphalan J. Chronic myeloid leukaemia K. Splenomegaly L. Idiopathic myelofibrosis M. Hydroxycarbamide N. Tear drop poikilocytes O. Pseudopolycythaemia P. Chlorambucil ```

Correct O. Pseudopolycythaemia

A consultant grills you on a ward round: there is a patient with a WBC of 140 x109/L, Hb 12 g/dL, Platelet count 320 x109/L. She complains of tiredness, night sweats, fever and abdominal pain. Her spleen is markedly enlarged. Blood film shows blasts, neutrophils, basophils. How would you treat her? ``` A. Imitanib B. Erythropoeitin C. Venesection D. Acute myeloid leukaemia E. Microcytosis F. Haematocrit G. Polycythaemia vera H. Essential thrombocythaemia I. Melphalan J. Chronic myeloid leukaemia K. Splenomegaly L. Idiopathic myelofibrosis M. Hydroxycarbamide N. Tear drop poikilocytes O. Pseudopolycythaemia P. Chlorambucil ```

Imitanib

A 34 year old man with peripheral cytopenia suffers from bleeding gums. Peripheral blood shows 5% blast cells and bone marrow 42% blast cells. ``` A. 5q syndrome B. Refractory anaemia with an excess of blasts C. Secondary aplastic anaemia D. Inherited aplastic anaemia E. Acute myeloid leukaemia F. Idiopathic aplastic anaemia G. Myelofibrosis H. Juvenile myelomonocytic leukaemia I. Refractory cytopenia with multilineage dysplasia J. Refractory anaemia ```

Correct E. Acute myeloid leukaemia

A 74 year old woman with high-normal platelet count. Bone marrow aspirate shows hyperplasia of hypolobulated micromegakaryocytes. Responds well to lenalidomide. ``` A. 5q syndrome B. Refractory anaemia with an excess of blasts C. Secondary aplastic anaemia D. Inherited aplastic anaemia E. Acute myeloid leukaemia F. Idiopathic aplastic anaemia G. Myelofibrosis H. Juvenile myelomonocytic leukaemia I. Refractory cytopenia with multilineage dysplasia J. Refractory anaemia ```

Correct A. 5q syndrome

A 20 year old man with hepatitis C complains of fatigue and breathlessness and bruises very easily. ``` A. 5q syndrome B. Refractory anaemia with an excess of blasts C. Secondary aplastic anaemia D. Inherited aplastic anaemia E. Acute myeloid leukaemia F. Idiopathic aplastic anaemia G. Myelofibrosis H. Juvenile myelomonocytic leukaemia I. Refractory cytopenia with multilineage dysplasia J. Refractory anaemia ```

Correct C. Secondary aplastic anaemia

This patients blood film shows classic Pelger-Huet neutrophils and bone marrow blasts make up 15% of cells. ``` A. 5q syndrome B. Refractory anaemia with an excess of blasts C. Secondary aplastic anaemia D. Inherited aplastic anaemia E. Acute myeloid leukaemia F. Idiopathic aplastic anaemia G. Myelofibrosis H. Juvenile myelomonocytic leukaemia I. Refractory cytopenia with multilineage dysplasia J. Refractory anaemia ```

Correct B. Refractory anaemia with an excess of blasts

In this case haemoglobin is normal but there is a reduction in platelets and neutrophils ``` A. 5q syndrome B. Refractory anaemia with an excess of blasts C. Secondary aplastic anaemia D. Inherited aplastic anaemia E. Acute myeloid leukaemia F. Idiopathic aplastic anaemia G. Myelofibrosis H. Juvenile myelomonocytic leukaemia I. Refractory cytopenia with multilineage dysplasia J. Refractory anaemia ```

Correct I. Refractory cytopenia with multilineage dysplasia

A routine medical of 33-year-old footballer reveals: Hb = 9.9g/dl and WCC = 130 x 109/L. His blood film shows whole spectrum of myeloid precursors, including a few blast cells. He admits to having frequent night sweats and blurred vision. There is a presence of Ph chromosome t(9;22) on cytogenetic analysis. ``` A. Vincristine poisoning B. Hypothyroidism C. Chronic myeloid leukaemia D. Richter's syndrome E. DIC F. Chronic lymphocytic leukaemia G. Bronchial carcinoma H. Hairy cell leukaemia I. Acute myeloid leukaemia J. Tumour-lysis syndrome K. Acute promyelocytic leukaemia L. Lung fibrosis M. Acute lymphoblastic leukaemia N. Septicaemia ```

Correct C. Chronic myeloid leukaemia

A 61-year-old man with CLL presents with recurrent pneumonia and haemoptysis. On fibreoptic bronchoscopy, the patient is found to have an endobronchial mass. The biopsy shows anaplastic, large cell lymphoma. ``` A. Vincristine poisoning B. Hypothyroidism C. Chronic myeloid leukaemia D. Richter's syndrome E. DIC F. Chronic lymphocytic leukaemia G. Bronchial carcinoma H. Hairy cell leukaemia I. Acute myeloid leukaemia J. Tumour-lysis syndrome K. Acute promyelocytic leukaemia L. Lung fibrosis M. Acute lymphoblastic leukaemia N. Septicaemia ```

Correct D. Richter's syndrome

The commonest adult leukaemia. ``` All Answer Choices A. Acute myeloid leukaemia B. Ionising radiation C. Lymphocytes D. Chronic lymphocytic leukaemia E. Chronic myeloid leukaemia F. Marfan’s syndrome G. Thalassaemia H. Neutrophils I. Down’s syndrome J. Acute lymphocytic leukaemia K. Sickle cell disease L. Magnesium exposure M. Blast cells ```

Correct D. Chronic lymphocytic leukaemia

A 50yr old man presents to his GP complaining of weight loss, tiredness, easy bruising and a painful big toe. On examination his spleen is massively enlarged. Investigation shows a raised serum urate. The peripheral blood film is abnormal, showing proliferation of which type of cell? ``` A. Platelets B. Neutrophils C. Chromosome 11q23 deletion D. Spherocytes E. Reticulocytes F. Chromosome 9;22 translocation G. Eosinophils H. Blast cells I. Pelger-Huet cells J. Auer rods K. Clonal B lymphocytes ```

Correct B. Neutrophils

A 70yr old man complains of a year’s history of fatigue, weight loss and recurrent sinusitis. His white cell count is raised with a lymphocytosis of 283x109 /L. Blood film shows features of haemolysis and Coomb’s test is positive. Further investigation show the bone marrow, blood and lymph nodes are infiltrated with which cell population? ``` A. Platelets B. Neutrophils C. Chromosome 11q23 deletion D. Spherocytes E. Reticulocytes F. Chromosome 9;22 translocation G. Eosinophils H. Blast cells I. Pelger-Huet cells J. Auer rods K. Clonal B lymphocytes ```

Correct K. Clonal B lymphocytes

A 6 month old girl is brought to her GP by her Greek Cypriot parents. They complain that she looks small compared to their neighbour’s baby of the same age. They also think her face looks funny. On examination, you note pallor and jaundice, the baby’s skull appears bossed and there is maxillary prominence. There is also marked hepatosplenomegaly. Her blood film shows a microcytosis and haemoglobin analysis shows high levels of HbF and HbA2. ``` A. Haemolytic Disease of the Newborn B. Hereditary Eliptocytosis C. Thalassaemia Major D. Transient Abnormal Myelopoiesis E. Sickle Cell Trait F. Haemolytic Uraemic Syndrome G. G6PD deficiency H. Haemophillia B I. Von Willebrand’s Disease J. Thalassaemia Minor K. Sickle Cell Anaemia L. Hereditary Spherocytosis M. Haemophilia A ```

Correct C. Thalassaemia Major Persons with thalassemia minor have (at most) mild anemia (slight lowering of the hemoglobin level in the blood). This situation can very closely resemble that with mild iron-deficiency anemia. However, persons with thalassemia minor have a normal blood iron level (unless they are iron deficient for other reasons). No treatment is necessary for thalassemia minor. In particular, iron is neither necessary nor advised. Thalassemia major (Cooley's anemia): The child born with thalassemia major has two genes for beta thalassemia and no normal beta-chain gene. The child is homozygous for beta thalassemia. This causes a striking deficiency in beta chain production and in the production of Hb A. Thalassemia major is a significant illness.

A young boy is referred to you because of prolonged bleeding following circumcision. You also note some bleeding of the gums. Coagulation tests reveal a normal PT but a raised APTT and an increased Bleeding Time. Analysis of clotting factors reveals a low Factor VIII. ``` A. Haemolytic Disease of the Newborn B. Hereditary Eliptocytosis C. Thalassaemia Major D. Transient Abnormal Myelopoiesis E. Sickle Cell Trait F. Haemolytic Uraemic Syndrome G. G6PD deficiency H. Haemophillia B I. Von Willebrand’s Disease J. Thalassaemia Minor K. Sickle Cell Anaemia L. Hereditary Spherocytosis M. Haemophilia A ```

Correct I. Von Willebrand’s Disease Von Willebrand's Disease is autosomal dominant. - Remember that Haemophilia causes prolonged APTT, normal PT and normal bleeding time, with normal VWF level whereas von willebrand's disease (VWD) causes prolonged APTT AND prolonged bleeding time (very impt to remember!), with low VWF level (but normal level in VWD type 2, which is functionally abnormal) - Both Haemophilia and VWD have normal platelet count. - Remember that FVIII levels may also be low in von willebrand's disease, as von willebrand's factor (VWF) is the carrier molecule for FVIII, preventing its premature degredation in the circulation, so if VWF is low, FVIII is vulnerable to degredation and is therefore also low.

This region encodes C2, C4 and factor B ``` A. IL-2 receptor B. IFN Receptor 1 gene C. MHC Class III D. CD3 mutation E. Bruton’s tyrosine kinase (Btk) gene F. WASP gene G. Chromosome 22q11 H. CD40 Ligand gene I. Adenosine Deaminase (ADA) gene J. IL12 gene ```

Correct C. MHC Class III

Risk factor for chronic allograft rejection ``` A. Diabetes B. CD4+ T cells C. Interferon gamma D. Amino acids E. HLA DR > A > B F. CD17+ T cells G. ABO blood type H. Diuretics I. IV Immunoglobulins and Plasmapheresis J. HLA DR > B > A K. Hypotension L. CD8+ T cells M. Hypertension N. HLA type O. Antibiotics P. Hyperacute Q. HLA A > B > DR R. High dose corticosteroids S. Granzyme B T. Free radical ```

Correct M. Hypertension

Prevents DNA replication especially of T cells ``` A. Cyproterone acetate B. Dobutamine C. Metolazone D. Immunoglobulins E. Gentamicin F. Prednisolone G. Ciclosporin H. Ribavirin I. Chloramphenicol J. Mycophenolate mofetil K. Perindopril L. Cyclophosamide M. Thyroxine N. ```

Correct J. Mycophenolate mofetil

Causes a transient increase in neutrophil count ``` A. Cyproterone acetate B. Dobutamine C. Metolazone D. Immunoglobulins E. Gentamicin F. Prednisolone G. Ciclosporin H. Ribavirin I. Chloramphenicol J. Mycophenolate mofetil K. Perindopril L. Cyclophosamide M. Thyroxine N. ```

Correct F. Prednisolone

Monoclonal antibodies inhibiting the actions of cytokines ``` A. Cyproterone acetate B. Dobutamine C. Metolazone D. Immunoglobulins E. Gentamicin F. Prednisolone G. Ciclosporin H. Ribavirin I. Chloramphenicol J. Mycophenolate mofetil K. Perindopril L. Cyclophosamide M. Thyroxine N. ```

Correct N. Infliximab

Can cause gingival hypertrophy as a side effect ``` A. Cyproterone acetate B. Dobutamine C. Metolazone D. Immunoglobulins E. Gentamicin F. Prednisolone G. Ciclosporin H. Ribavirin I. Chloramphenicol J. Mycophenolate mofetil K. Perindopril L. Cyclophosamide M. Thyroxine N. ```

Correct G. Ciclosporin

Administration of this may boost the immune system ``` A. Cyproterone acetate B. Dobutamine C. Metolazone D. Immunoglobulins E. Gentamicin F. Prednisolone G. Ciclosporin H. Ribavirin I. Chloramphenicol J. Mycophenolate mofetil K. Perindopril L. Cyclophosamide M. Thyroxine N. ```

Correct D. Immunoglobulins

Plasmapheresis may be indicated in which condition? ``` A. Mycophenolate mofetil B. Atopic dermatitis C. Bone marrow suppression D. Infliximab E. Goodpasture’s syndrome F. Blocking cytokine synthesis G. Plasmapheresis H. Influenza type B vaccine I. Diptheria, Tetanus, Pertussis vaccine J. Tacrolimus K. Inhibition of DNA synthesis L. Bee/wasp venom allergy M. Polio vaccine ```

Correct E. Goodpasture’s syndrome

Prevents DNA replication especially of T cells ``` A. Gentamicin B. Perindopril C. Chloramphenicol D. Ciclosporin E. Ribavirin F. Cyproterone acetate G. Cyclophosamide H. Infliximab I. Mycophenolate mofetil J. Thyroxine K. Dobutamine L. Prednisolone M. Metolazone N. Immunoglobulins ```

Correct I. Mycophenolate mofetil

Causes a transient increase in neutrophil count ``` A. Gentamicin B. Perindopril C. Chloramphenicol D. Ciclosporin E. Ribavirin F. Cyproterone acetate G. Cyclophosamide H. Infliximab I. Mycophenolate mofetil J. Thyroxine K. Dobutamine L. Prednisolone M. Metolazone N. Immunoglobulins ```

Correct L. Prednisolone

Can cause gingival hypertrophy as a side effect ``` A. Gentamicin B. Perindopril C. Chloramphenicol D. Ciclosporin E. Ribavirin F. Cyproterone acetate G. Cyclophosamide H. Infliximab I. Mycophenolate mofetil J. Thyroxine K. Dobutamine L. Prednisolone M. Metolazone N. Immunoglobulins ```

Correct D. Ciclosporin

Prednisolone ``` A. Ototoxicity B. Hypertension and reduced GFR C. Dysrhythmias D. Lethargy E. Anorexia F. Hypertension G. Hair loss H. Anaphylaxis I. Bone marrow depression J. Pneumonitis, pulmonary fibrosis and cirrhosis ```

Correct F. Hypertension

Ciclosporin ``` A. Ototoxicity B. Hypertension and reduced GFR C. Dysrhythmias D. Lethargy E. Anorexia F. Hypertension G. Hair loss H. Anaphylaxis I. Bone marrow depression J. Pneumonitis, pulmonary fibrosis and cirrhosis ```

Correct B. Hypertension and reduced GFR

Azathioprine ``` A. Ototoxicity B. Hypertension and reduced GFR C. Dysrhythmias D. Lethargy E. Anorexia F. Hypertension G. Hair loss H. Anaphylaxis I. Bone marrow depression J. Pneumonitis, pulmonary fibrosis and cirrhosis ```

Correct I. Bone marrow depression

Methotrexate ``` A. Ototoxicity B. Hypertension and reduced GFR C. Dysrhythmias D. Lethargy E. Anorexia F. Hypertension G. Hair loss H. Anaphylaxis I. Bone marrow depression J. Pneumonitis, pulmonary fibrosis and cirrhosis ```

Correct J. Pneumonitis, pulmonary fibrosis and cirrhosis

The final metabolite of the antiviral used to treat Herpes Simplex ``` A. Oseltamivir B. Interferon-α (alpha) C. Entecevir D. Ribavirin E. Interferon-b (beta) F. Nevirapine G. Aciclovir monophosphate H. Cidofovir I. Foscarnet J. Zidovudine K. Aciclovir triphosphate L. Interferon-g (gamma) M. Ganciclovir N. Neuraminidase inhibitor O. Aciclovir ```

Correct K. Aciclovir triphosphate

Which option inhibits the action of viral DNA polymerase? ``` A. Thymidine B. Influenza C. Ribavarin D. Famciclovir E. Aciclovir diphosphate F. Varicella-zoster virus G. Aciclovir monophosphate H. Cytomegalovirus I. AIDS J. Aciclovir triphosphate K. Guanosine ```

Correct J. Aciclovir triphosphate

Valaciclovir, a prodrug of aciclovir, is used to treat patients with which viral disease in the list, above? ``` A. Thymidine B. Influenza C. Ribavarin D. Famciclovir E. Aciclovir diphosphate F. Varicella-zoster virus G. Aciclovir monophosphate H. Cytomegalovirus I. AIDS J. Aciclovir triphosphate K. Guanosine ```

Correct F. Varicella-zoster virus

The synthetic nucleoside analogue ganciclovir is the drug of choice against which infective virus? ``` A. Thymidine B. Influenza C. Ribavarin D. Famciclovir E. Aciclovir diphosphate F. Varicella-zoster virus G. Aciclovir monophosphate H. Cytomegalovirus I. AIDS J. Aciclovir triphosphate K. Guanosine ```

Correct H. Cytomegalovirus

Ribavirin, a synthetic nucleoside that acts as an RNA polymerase inhibitor, is similar in structure to which of the options given above? ``` A. Thymidine B. Influenza C. Ribavarin D. Famciclovir E. Aciclovir diphosphate F. Varicella-zoster virus G. Aciclovir monophosphate H. Cytomegalovirus I. AIDS J. Aciclovir triphosphate K. Guanosine ```

Guanosine

Used for the treatment of severe, resistant herpes infections ``` A. Doxacyclin B. Citalapram C. Adefovir D. Gancyclovir E. Aciclovir F. Loviride G. Ibuprofen H. Zidovudine I. Foscarnet J. Interferon K. Ribavarin L. Amantadine M. Abacavir ```

Foscarnet

A purine nucleoside analogue that selects specifically for thymidine kinase ``` A. Doxacyclin B. Citalapram C. Adefovir D. Gancyclovir E. Aciclovir F. Loviride G. Ibuprofen H. Zidovudine I. Foscarnet J. Interferon K. Ribavarin L. Amantadine M. Abacavir ```

Correct E. Aciclovir

The drug that is selectively toxic to virally infected cells through its selective phosphorylation using viral thymidine kinase ``` A. Ribavarin B. Indinavir C. Amantadine D. Interferon E. Human normal immunoglobulin F. Human specific immunoglobulin G. Zidovudine H. Enfuvirtide I. Efavirenz J. Aciclovir K. Nevirapine L. Ganciclovir M. Zanamivir ```

Correct J. Aciclovir

The drug which can be delivered by inhalation to treat both influenza A and B. ``` A. Ribavarin B. Indinavir C. Amantadine D. Interferon E. Human normal immunoglobulin F. Human specific immunoglobulin G. Zidovudine H. Enfuvirtide I. Efavirenz J. Aciclovir K. Nevirapine L. Ganciclovir M. Zanamivir ```

Correct M. Zanamivir

The drug mechanisms which acts by stopping post-translational cleaving of polyproteins by inhibiting proteases ``` A. Ribavarin B. Indinavir C. Amantadine D. Interferon E. Human normal immunoglobulin F. Human specific immunoglobulin G. Zidovudine H. Enfuvirtide I. Efavirenz J. Aciclovir K. Nevirapine L. Ganciclovir M. Zanamivir ```

Correct B. Indinavir

A nucleoside analogue which inhibits reverse transcriptase ``` A. Ribavarin B. Indinavir C. Amantadine D. Interferon E. Human normal immunoglobulin F. Human specific immunoglobulin G. Zidovudine H. Enfuvirtide I. Efavirenz J. Aciclovir K. Nevirapine L. Ganciclovir M. Zanamivir ```

Correct G. Zidovudine

Dry cough, new infiltrates on CXR, dyspnoea and target shaped lesions on the palms. No recent history of herpes. ``` A. [None] B. M. tuberculosis C. C. psittaci D. L. pneumophila E. K. pneumoniae F. S. aureus G. P. aeuruginosa H. B. pertussis I. S. pneumoniae J. M. pneumoniae K. C. neoformans ```

Correct J. M. pneumoniae

A 55 year old female clown, recovering from a cold, is found to have a cavitating lesion on CXR and a productive cough. ``` A. MSSA or MRSA B. H. influenzae C. Anaerobic infection D. M tuberculosis E. Chlamydia psittaci F. Burkholderia cepacia G. M. Catarrhalis H. Chlamydia pneumoniae I. S. pneumoniae J. MRSA K. MSSA L. Legionella pneumophila M. PCP/ P jiroveci ```

Correct A. MSSA or MRSA Q2: influenza is a classic precedent of S. aureus pneumonia. This is because there is transient postviral hypofunction of airway clearance mechanisms e.g. cilia

Varies with posture when sample is taken. ``` A. Glucose B. Albumin C. Urea D. Potassium E. ALP F. Triglycerides G. Cortisol H. ALT I. Creatinine Kinase ```

Correct B. Albumin

Increases during pregnancy ``` A. Glucose B. Albumin C. Urea D. Potassium E. ALP F. Triglycerides G. Cortisol H. ALT I. Creatinine Kinase ```

Correct E. ALP

Drugs are mainly excreted by which organ?

Correct G. Kidneys

Peak and trough levels of this drug should be taken ``` A. Carbamazepine B. Warfarin C. Heparin - Low molecular weight D. Phenobarbitone E. Lithium F. Ethosuximide G. Aspirin H. Digoxin I. Theophylline J. Ciclosporin K. Gentamicin L. Clonazepam M. Phenytoin N. Heparin - unfractionated ```

Correct K. Gentamicin

Requires regular monitoring of APTT ``` A. Carbamazepine B. Warfarin C. Heparin - Low molecular weight D. Phenobarbitone E. Lithium F. Ethosuximide G. Aspirin H. Digoxin I. Theophylline J. Ciclosporin K. Gentamicin L. Clonazepam M. Phenytoin N. Heparin - unfractionated ```

Correct N. Heparin - unfractionated

A man was found collapsed on the floor of his room and his breathing was found to be severely depressed. A urine test was found to be positive for 6-MAM. ``` A. Amphetamines B. Methadone C. Ethanol D. Cannabis E. Cyanide F. Organophosphate G. Strychnine H. Aspirin I. Methanol J. Police brutality K. Ecstasy L. Heroin M. Paracetamol N. Cocaine O. Benzodiazepines P. Carbon monoxide ```

Correct L. Heroin In the lectures slides it mentiones EBE and BE as breakdown products of cocaine: what are these? EME = ecgonine methyl ester BE = benzoylecgonine They are the two degredation products of cocaine produced by pseudocholinesterases and hydrolysis respectively.

A 30-year-old farmer presents to casualty complaining of diarrhoea and painful mouth ulcers. On questioning he admitted accidentally ingesting liquid paraquat ``` A. Hyperbaric oxygen B. Gastric lavage C. Glucagon D. Desferrioxamine E. Atropine F. Naloxone G. Dicobalt edentate H. Activated charcoal I. Haemodialysis J. N-acetylcysteine K. Symptomatic and Supportive treatment ```

Correct H. Activated charcoal Remember activated charcoal is NOT helpful in poisoning with: cyanide, iron, ethanol, lithium, acid or alkali, pesticides; see discussion attached.

A 15-year-old girl presents with sweats and hyperventilation indicative of a severe metabolic acidosis; after taking a large number of salicylate tablets ``` A. Hyperbaric oxygen B. Gastric lavage C. Glucagon D. Desferrioxamine E. Atropine F. Naloxone G. Dicobalt edentate H. Activated charcoal I. Haemodialysis J. N-acetylcysteine K. Symptomatic and Supportive treatment ```

Correct I. Haemodialysis

A 26-year-old woman collapses after a massive overdose of atenolol. She remains in cardogenic shock despite initial treatment with IV atropine ``` A. Hyperbaric oxygen B. Gastric lavage C. Glucagon D. Desferrioxamine E. Atropine F. Naloxone G. Dicobalt edentate H. Activated charcoal I. Haemodialysis J. N-acetylcysteine K. Symptomatic and Supportive treatment ```

Correct C. Glucagon

An 80 year old man and his 79 year old wife were brought in after a neighbour found them collapsed in their home. On questioning the neighbour it was found that the couple had not been feeling well for a few weeks and had been complaining of nausea, headaches and dizziness ``` A. Organophosphates B. Ecstasy C. Methanol D. Desferrioxamine E. Acetylcysteine F. Paracetamol G. Naloxone H. Lithium I. Salicylates J. Tricyclic antidepressants K. Carbon Monoxide ```

Correct K. Carbon Monoxide

Which of the above techniques can be used to test for benzodiazepines and various antipsychotic drugs? ``` A. Urine sample B. Immunoassay C. Benzodiazepines D. Drugs of abuse (DOA) E. Paracetamol F. Blood sample G. Stool sample H. Thin layer chromotography I. Liver sample J. Liquid chromotography K. Barbituate ```

Correct J. Liquid chromotography

Which of the above techniques can be used to analyse samples of stool, liver and also urine? ``` A. Urine sample B. Immunoassay C. Benzodiazepines D. Drugs of abuse (DOA) E. Paracetamol F. Blood sample G. Stool sample H. Thin layer chromotography I. Liver sample J. Liquid chromotography K. Barbituate ```

Correct H. Thin layer chromotography

What sample is required for use with gas chromatography mass spectroscopy? ``` A. Urine sample B. Immunoassay C. Benzodiazepines D. Drugs of abuse (DOA) E. Paracetamol F. Blood sample G. Stool sample H. Thin layer chromotography I. Liver sample J. Liquid chromotography K. Barbituate ```

Correct F. Blood sample

Which of the above techniques can be used to test for all classes of drugs of abuse (DOA)? ``` A. Urine sample B. Immunoassay C. Benzodiazepines D. Drugs of abuse (DOA) E. Paracetamol F. Blood sample G. Stool sample H. Thin layer chromotography I. Liver sample J. Liquid chromotography K. Barbituate ```

Correct B. Immunoassay

Which drug is not excreted into saliva? ``` A. Blood B. MDMA C. Paracetamol D. THC E. Toxicology F. Saliva G. Hair H. Forensics I. Urine J. Morphine K. Cocaine ```

Correct D. THC

A 28 year old sportsman presents to A&E with severe chest pain and breathlessness. He has a history of asthma. There is a systolic murmur on examination. ``` A. Pericardial effusion B. Aortic regurgitation C. Myxomatous mitral valve D. Myomalacia cordis E. Hypertrophic cardiomyopathy F. Dilated cardiomyopathy G. Infective endocarditis H. Pericarditis I. Mitral regurgitation J. Congenital septal defect K. Aortic stenosis L. Rheumatic fever ```

Correct E. Hypertrophic cardiomyopathy

A 65 year old man is in hospital after suffering an acute myocardial infarction. The house officer hears a pansystolic murmur on auscultation. ``` A. Pericardial effusion B. Aortic regurgitation C. Myxomatous mitral valve D. Myomalacia cordis E. Hypertrophic cardiomyopathy F. Dilated cardiomyopathy G. Infective endocarditis H. Pericarditis I. Mitral regurgitation J. Congenital septal defect K. Aortic stenosis L. Rheumatic fever ```

Correct D. Myomalacia cordis

A 39 year old Nepalese man presents with severe watery diarrhoea. He is found to have hypokalaemia and, surprisingly, a metabolic acidosis. A RUQ mass is detected by contrast-enhanced spiral CT scanning. Stool bicarb is high and urine anion gap is negative. ``` A. Hypercalcaemia B. Vibrio cholerae infection C. Pseudocysts D. Insulinoma E. Haemochromatosis F. Carcinoma tail of the pancreas G. Gallstone pancreatitis H. VIPoma (Werner Morrison syndrome) I. Gallstones J. Iatrogenic pancreatitis K. Chronic alcoholic pancreatitis L. Renal tubular acidosis M. Carcinoma head of the pancreas N. Cystic fibrosis ```

Correct H. VIPoma (Werner Morrison syndrome)

65 year old female with a large, cystic mass on tail of pancreas imaged using computed tomography. Further cytology reported the presence of epithelium ``` A. Scorpion Sting B. Alcoholism C. Hyperlipidaemia D. Cystic Fibrosis E. Whipples' resection F. Jaundice G. Agenesis H. Gall Bladder I. Pancreatitis J. Carcinoma of the Pancreas K. Thrombophlebitis L. Pancreas Divisum M. Type 1 Diabetes N. Pseudocyst O. Trousseau’s Syndrome P. Cystadenoma ```

Correct P. Cystadenoma

55 year old, diabetic, afro-Caribbean male presents with weight loss, poor diet and a gnawing pain in his back, which is sometimes felt ‘under his chest’ ``` A. Scorpion Sting B. Alcoholism C. Hyperlipidaemia D. Cystic Fibrosis E. Whipples' resection F. Jaundice G. Agenesis H. Gall Bladder I. Pancreatitis J. Carcinoma of the Pancreas K. Thrombophlebitis L. Pancreas Divisum M. Type 1 Diabetes N. Pseudocyst O. Trousseau’s Syndrome P. Cystadenoma ```

Correct J. Carcinoma of the Pancreas

A 38 year old female with Rheumatoid Arthritis presents with a single episode of malaena. Investigations reveal erosions through out the stomach and a neutrophilic infiltrate in the superficial mucosa ``` A. Oesophageal Adenocarcinoma B. GORD C. Coeliac Disease D. Oesophageal Varices E. Gastric Carcinoma F. Barretts Oesophagus G. Active Chronic Gastritis H. Acute Gastritis I. Pernicious Anaemia J. Duodenal Ulcer ```

Correct H. Acute Gastritis

A 66 year old man complaining of epigastric pain undergoes an endoscopy. The mucosa appears reddened in the antrum of the stomach. 13C is detected on a urea breath test. ``` A. Microsporidiosis B. Lymphoma C. Gastro-oesophageal disease D. Coeliac disease E. Carcinoma of the oesophagus F. Duodenal ulcer G. Mucosal associated lymphoid tumour H. Tropical sprue I. Hiatus hernia J. Whipple's disease K. Cryptosporidiosis L. Barrett's oesophagus M. Pernicious anaemia N. Partial villous atrophy O. Helicobacter pylori P. Gastric ulcer ```

Correct O. Helicobacter pylori

A 30-year-old woman presents with haematemesis and diarrhoea. She has recurrent peptic ulceration and is taking omeprazole. Despite this, she has persistently high serum gastrin levels. Endoscopy shows a large 3cm actively bleeding ulcer in the duodenum. ``` A. Bulbar palsy B. Gastro-oesophageal reflux disease C. Mallory-Weiss tear D. Gastric ulcer E. Adenocarcinoma F. Achalasia G. Haemorrhagic gastritis H. Pyloric stenosis I. Zollinger-Ellison syndrome J. Duodenal ulcer K. Barrett's oesophagus L. Mucosal-associated lymphoid tumour M. Gastroenteritis (Staphylococcus aureus) N. Gastroenteritis (Salmonella) ```

Correct I. Zollinger-Ellison syndrome

A 20-year-old student gives an 8 hour history of very frequent vomiting and epigastric cramping. O/E she is pale and shivering. Her serum WBC is normal. ``` A. Bulbar palsy B. Gastro-oesophageal reflux disease C. Mallory-Weiss tear D. Gastric ulcer E. Adenocarcinoma F. Achalasia G. Haemorrhagic gastritis H. Pyloric stenosis I. Zollinger-Ellison syndrome J. Duodenal ulcer K. Barrett's oesophagus L. Mucosal-associated lymphoid tumour M. Gastroenteritis (Staphylococcus aureus) N. Gastroenteritis (Salmonella) ```

Correct M. Gastroenteritis (Staphylococcus aureus)

A 40 year old man with previous hepatitis B infection presents with weight loss, muscle aches and abdominal pain. On examination he has high BP and urine dipstick reveals blood + and protein + ``` A. Temporal arteritis B. Sarcoidosis C. Scleroderma D. Renal amyloidosis E. Kawasaki's disease F. Sjorgen's syndrome G. Polyarteritis nodosa H. Mixed connective tissue disease I. Systemic lupus erythematous ```

Correct G. Polyarteritis nodosa

A 60 year old man, currently undergoing treatment for long-standing chronic renal failure, complaining of tingling in his wrist & hand when he wakes in the morning. ``` A. Hogkin’s Lymphoma B. Haemodialysis associated amyloidosis C. Myeloma associated amyloidosis D. Waldenström’s macroglobulinaemia E. Reactive amyloidosis F. Senile amyloidosis G. Bronchial carcinoma H. Hereditary amyloidosis ```

Correct B. Haemodialysis associated amyloidosis Secondary or reactive amyloidosis (AA) is secondary to inflammatory conditions including rheumatoid arthritis, crohn's disease etc. AL amyloidosis may be idiopathic/primary or "secondary to having multiple myeloma" or other monoclonal B-cell proliferative disorders. Myeloma is NOT a type of amyloidosis!! It is a type of lymphoproliferative disorder; specifically, it is a monoclonal expansion of plasma cells which MAY OR MAY NOT BE ASSOCIATED WITH AL type amyloidosis depending on whether the precursor proteins, immunoglobulin light chains, happen to be amyloidogenic or not. The term "amyloidosis" refers to deposition of insoluble abnormally folded protein fibrils. It is an umbrella term that encompasses several precursor proteins and, alone, DOES NOT imply a specific cause. Beta -2-microglobulin amyloidosis is associated with haemodialysis. This is a secondary amyloidosis due to impaired clearance of b2m across dialysis membranes that causes carpal tunnel syndrome. I thought a list of causes of splenomegaly might be useful. Whenever someone asks you for a list of causes..always try to classify your answers, instead of listing causes in a random manner (this is especially important for finals next year). Classification is always very individual...so develop your own system early on. One such classification for splenomegaly could depend on the size of the spleen ie massive, moderate, mild Massive splenomegaly: common in the UK -- CML, myelofibrosis (ie haematological) common worldwide -- malaria, kala-azar (ie infectious) Moderate splenomegaly: Portal hypertension, lymphoma, CLL, thalassaemia and metabolic diseases e.g Gaucher's Mild splenomegaly: Infection (viral e.g. EBV, hepatitis or bacterial e.g infective endocarditis, miliary TB) Connective Tissue Diseases (e..g RA, PAN, SLE, Felty's syndrome) Infiltrative disorders (amyloidosis, sarcoidosis)

A 64 year old woman with a history of chronic rheumatological disease presents to her GP complaining of abdominal discomfort – which is found to be due to hepatosplenomegaly. An ensuing liver biopsy stains positive with Congo Red stain. ``` A. Hogkin’s Lymphoma B. Haemodialysis associated amyloidosis C. Myeloma associated amyloidosis D. Waldenström’s macroglobulinaemia E. Reactive amyloidosis F. Senile amyloidosis G. Bronchial carcinoma H. Hereditary amyloidosis ```

Correct E. Reactive amyloidosis Secondary or reactive amyloidosis (AA) is secondary to inflammatory conditions including rheumatoid arthritis, crohn's disease etc. AL amyloidosis may be idiopathic/primary or "secondary to having multiple myeloma" or other monoclonal B-cell proliferative disorders. Myeloma is NOT a type of amyloidosis!! It is a type of lymphoproliferative disorder; specifically, it is a monoclonal expansion of plasma cells which MAY OR MAY NOT BE ASSOCIATED WITH AL type amyloidosis depending on whether the precursor proteins, immunoglobulin light chains, happen to be amyloidogenic or not. The term "amyloidosis" refers to deposition of insoluble abnormally folded protein fibrils. It is an umbrella term that encompasses several precursor proteins and, alone, DOES NOT imply a specific cause. Beta -2-microglobulin amyloidosis is associated with haemodialysis. This is a secondary amyloidosis due to impaired clearance of b2m across dialysis membranes that causes carpal tunnel syndrome. I thought a list of causes of splenomegaly might be useful. Whenever someone asks you for a list of causes..always try to classify your answers, instead of listing causes in a random manner (this is especially important for finals next year). Classification is always very individual...so develop your own system early on. One such classification for splenomegaly could depend on the size of the spleen ie massive, moderate, mild Massive splenomegaly: common in the UK -- CML, myelofibrosis (ie haematological) common worldwide -- malaria, kala-azar (ie infectious) Moderate splenomegaly: Portal hypertension, lymphoma, CLL, thalassaemia and metabolic diseases e.g Gaucher's Mild splenomegaly: Infection (viral e.g. EBV, hepatitis or bacterial e.g infective endocarditis, miliary TB) Connective Tissue Diseases (e..g RA, PAN, SLE, Felty's syndrome) Infiltrative disorders (amyloidosis, sarcoidosis)

Herpes Simplex Type 1 ``` A. Neonatal Infection associated with vaginal delivery B. Infectious Mononucleosis C. Primary stomatitis D. Exanthem Subitum E. Herpangina F. Infection associated with Kaposi’s sarcoma G. Shingles H. Mumps I. Measles J. Rubella K. Pneumonitis ```

Correct C. Primary stomatitis

Cytomegalovirus ``` A. Neonatal Infection associated with vaginal delivery B. Infectious Mononucleosis C. Primary stomatitis D. Exanthem Subitum E. Herpangina F. Infection associated with Kaposi’s sarcoma G. Shingles H. Mumps I. Measles J. Rubella K. Pneumonitis ```

Correct K. Pneumonitis

Pneumonitis after a bone marrow transplant ``` A. HIV B. Epstein-Barr virus (gamma) C. Cytomegalovirus (beta) D. Herpes simplex virus type 1 (alpha) E. Human herpes virus 7 F. Herpes simplex virus type 2 (alpha) G. Human herpes virus 6 (beta) H. Varicella zoster virus (alpha) I. Human herpes virus 8 (gamma) ```

Correct C. Cytomegalovirus (beta)

Acute necrotising encephalitis ``` A. HIV B. Epstein-Barr virus (gamma) C. Cytomegalovirus (beta) D. Herpes simplex virus type 1 (alpha) E. Human herpes virus 7 F. Herpes simplex virus type 2 (alpha) G. Human herpes virus 6 (beta) H. Varicella zoster virus (alpha) I. Human herpes virus 8 (gamma) ```

Correct D. Herpes simplex virus type 1 (alpha)

Which of the above is a naturally occurring cytokine that is able to inhibit HIV fusion to CD4+ T-lymphocytes? ``` A. Anti-HIV antibody (Western blot) B. CD25 C. CD4 D. Hairy leukoplakia E. CCR5/CXCR4 F. Viral load (PCR) G. Kaposi's sarcoma H. MIP-1alpha I. gp120 J. CD8 K. Reverse transcriptase L. Integrase M. Candidiasis ```

Correct H. MIP-1alpha

Haemophiliacs and patients in receipt of regular blood transfusions should be vaccinated against this virus. ``` A. MMR B. Pertussis C. BCG D. Rabies E. Varicella-Zoster F. Tetanus G. Diptheria H. Measles I. Meningococcal J. Influenza K. Hepatitis B ```

Correct K. Hepatitis B

Toxoid given as part of ‘triple’ vaccine during first year of life to prevent cardinal features of the disease: muscle spasms and rigidity. ``` A. MMR B. Pertussis C. BCG D. Rabies E. Varicella-Zoster F. Tetanus G. Diptheria H. Measles I. Meningococcal J. Influenza K. Hepatitis B ```

Correct F. Tetanus

35 year old household wife presents with an infected insect bite. In the past she has been treated with Penicillin and responded with facial swelling and acute shortness of breath. ``` A. Linezolid B. Flucloxacillin C. Ciprofloxacin D. Vancomycin E. Metronidazole F. Ceftriaxone G. Benzyl Penicillin H. Gentamicin I. Erthyromycin ```

Correct I. Erthyromycin

A 6 month old child whose father has just been diagnosed with tuberculosis. ``` A. vancomycin B. Cefalexin C. trimethoprim D. linezolid E. Flucloxacillin F. Chloramphenicol G. cefuroxime & clarithromycin H. no antibiotics required I. Amoxicillin J. Ceftriaxone K. Erythromycin L. isoniazid M. rifampicin ```

Correct L. isoniazid

A 26 year old male who has been suffering from ‘flu-like’ symptoms with fever presents to the GP after developing skin rash in the last few days. ``` A. Panic attack B. Extrinsic allergic alveolitis C. Idiopathic angioedema D. Allergic asthma E. Mast cell degranulation F. Coeliac disease G. Acute urticaria H. IgE mediated anaphylaxis I. Chronic urticaria J. C1 inhibitor deficiency K. Urticarial vasculitis ```

Correct G. Acute urticaria

A 35 year old woman presents with persistent itchy wheels for the last 2 months. She noticed that when this is at its worst, she also has a fever and feels generally unwell. After an acute attack, she has bruising and post-inflammatory residual pigmentation at the site of the itching. ``` A. Panic attack B. Extrinsic allergic alveolitis C. Idiopathic angioedema D. Allergic asthma E. Mast cell degranulation F. Coeliac disease G. Acute urticaria H. IgE mediated anaphylaxis I. Chronic urticaria J. C1 inhibitor deficiency K. Urticarial vasculitis ```

Correct K. Urticarial vasculitis

Which infection is most common as a consequence of B cell deficiency? ``` A. Bacterial B. T lymphocyte C. Mast cell D. MHC Class I E. Complement F. Viral G. Parasitic H. Neutrophil I. Fungal J. MHC Class II K. B lymphocyte ```

Bacterial

Which crucial enzyme is vital for the oxidative killing of intracellular micro-organisms? ``` A. IgA B. MAC C. IgG D. NADPH oxidoase E. Macrophages F. C1 G. Neutrophils H. C3b I. C3a J. AP50 K. IgM L. Myeloperoxidase M. CH50 ```

Correct D. NADPH oxidoase

Rheumatoid arthritis ``` A. Type II – Antigen mediated B. Type IV – T-cell mediated C. Type III – Immune complex mediated D. Type IV – Complement mediated E. Type III – T-cell mediated F. Not an autoimmune disease G. Type II – Antibody mediated H. Type III – complement mediated ```

Correct B. Type IV – T-cell mediated

Type 1 diabetes ``` A. Type II – Antigen mediated B. Type IV – T-cell mediated C. Type III – Immune complex mediated D. Type IV – Complement mediated E. Type III – T-cell mediated F. Not an autoimmune disease G. Type II – Antibody mediated H. Type III – complement mediated ```

Correct B. Type IV – T-cell mediated

The pattern of the antibody deposition in the glomerular basement membrane is typically described as what? ``` A. Mesangium B. Plasmapheresis C. Lung D. Ciclosporin E. Prednisolone F. Lumpy-bumpy pattern G. Anti-neutrophil cytoplasmic antibodies H. Type II collagen I. Blood vessels J. Smooth linear pattern K. Skin L. Glomerular basement membrane M. Type IV collagen N. Type II Hypersentivity ```

Correct J. Smooth linear pattern

This microbe affects the ileum, appendix and colon. Its peyer patch invasion leads to mesenteric lymph node enlargement with necrotising granulomas. Complication can include peritonitis, pharyngitis and pericarditis. ``` A. Salmonella B. Shigella C. Clostridium difficile D. Vibrio cholera E. Aeromonas F. Hepatitis A G. Yersinia H. Entamoeba histolytica I. Escherichia Coli ```

Correct G. Yersinia Yersinia enterocolitica undergoes multiplication in Peyer's patches following invasion of human epithelial cells and penetration of the mucosa which occurs in the ileum. Complications include diarrhoea, mesenteric adenitis, mesenteric ileitis, or acute pseudoappendicitis, reactive arthritis and erythema nodosum. Ingestion of Entamoeba histiolytica cysts is followed by excystation in the small bowel and trophozite colonisation of the small colon. The trophozyte may then encyst and be excreted in faeces or it may invade the intestinal mucosal barrier, thereby gaining access to the circulation. Complications include amoebic colitis, liver abscesses, pleuropulmonary amoebiasis and cerebral amoebiasis. For some more information, see attached file.

Following a trip to Brazil, a patient develops bloody diarrhoea, with a high fever, sweating and on examination the patient is found to have RUQ pain.

Correct C. Entamoeba Histolytica

Following a barbeque, a 41 year old develops watery diarrhoea and vomiting. On retrospect, he wondered whether he should have had that dodgy looking shish kebab... ``` A. Taenia Saginata B. Giardia Lamblia C. Entamoeba Histolytica D. E. coli E. Vibrio Cholera F. Salmonella G. Clostridium Difficile H. Yersinia Enterocolitica I. Taenia Solium J. Laxative abuse K. Shigella L. Typhoid M. Camplyobacter Jejuni ```

Correct F. Salmonella

A 40 year old homosexual man develops severe flatulence, accompanied by bloating and explosive diarrhoea. ``` A. Taenia Saginata B. Giardia Lamblia C. Entamoeba Histolytica D. E. coli E. Vibrio Cholera F. Salmonella G. Clostridium Difficile H. Yersinia Enterocolitica I. Taenia Solium J. Laxative abuse K. Shigella L. Typhoid M. Camplyobacter Jejuni ```

Correct B. Giardia Lamblia

Mrs A became ill at about midnight after eating chicken wings for lunch at a summer BBQ. Mrs A complained of nausea, vomiting and non-bloody diarrhoea. Her symptoms resolved 3 days later. ``` A. Escherichia coli B. Entamoeba histolytica C. Staphylococcus D. Bacillus cereus E. Salmonella F. Clostridium botulinum G. Shigella H. Rotavirus I. Campylobacter ```

Correct E. Salmonella

Mr S became ill with nausea, vomiting and watery diarrhoea about 4 hours after eating some ham at a conference buffet lunch. Mr B’s illness was attributed to a heat stable, preformed toxin in the ham. His symptoms resolved within 24hours. ``` A. Escherichia coli B. Entamoeba histolytica C. Staphylococcus D. Bacillus cereus E. Salmonella F. Clostridium botulinum G. Shigella H. Rotavirus I. Campylobacter ```

Correct C. Staphylococcus

Mr C complained of fever and severe (>10 bowel movements/day) diarrhoea after looking after his neighbours dogs for a few days. Laboratory analysis of Mr C’s stools found the causative organism to be a S-shaped microaerophillic bacteria. ``` A. Escherichia coli B. Entamoeba histolytica C. Staphylococcus D. Bacillus cereus E. Salmonella F. Clostridium botulinum G. Shigella H. Rotavirus I. Campylobacter ```

Campylobacter

Miss D initially complained of a dry mouth and visual disturbance a few days after ingesting some home canned produce. She sought medical attention after she began to experience bilateral descending paralysis. Miss A later died from respiratory failure. ``` A. Escherichia coli B. Entamoeba histolytica C. Staphylococcus D. Bacillus cereus E. Salmonella F. Clostridium botulinum G. Shigella H. Rotavirus I. Campylobacter ```

Correct F. Clostridium botulinum

Found in patients with Myeloma with low serum albumin and oedema. ``` A. Osteoblasts B. Amyloid C. Barry-Jane proteins D. Bence-Jones proteins E. Inflammation F. Extramedullary tumour deposits G. Paraprotein H. Osteoclasts ```

Correct B. Amyloid

Stimulated by IL-6 secreted by cells in the vicinity of the myeloma cells. Produces radiological changes resembling those of generalized osteoporosis. ``` A. Osteoblasts B. Amyloid C. Barry-Jane proteins D. Bence-Jones proteins E. Inflammation F. Extramedullary tumour deposits G. Paraprotein H. Osteoclasts ```

Correct H. Osteoclasts

Induction chemotherapy regimen with the best evidence pre autologous stem cell transplant in multiple myeloma ``` A. Lenalidomide + low dose dexamethasone B. Waldenstrom’s macroglobinaemia C. Infliximab + budesonide D. AL amyloid E. Thalidomide + high dose dexamethasone F. Anaemia & renal failure G. AA amyloid H. Rituximab I. Multiple myeloma J. Monoclonal gammopathy of undetermined significance (MGUS) K. Interferon α + ibuprofen L. IgM M. Aβ amyloid N. Bortezomib O. Melphalan + prednisolone ```

Lenalidomide + low dose dexamethasone ``` There are quite a few agents that could be used for the treatment of myeloma and I really don't think we need to worry ourselves over them. Essentially you either split patients into those that are suitable for auto-SCT and those that are not. If unsuitable for auto-SCT: Melphalan + Pred + Thalidomide = first line Melphalan + Pred + Bortezomib = Second line (can't tolerate Thalidomide) If suitable for auto-SCT use induction chemo: There are quite a few option available and I don't know which NICE endorses. I would tentatively suggest: Lenalidomide + Dex = First line Bortezomib + Dex = Second line Alkylating agents (eg Mephalan) are best avoided for induction chemo if SCT is planned as they may compromise SC reserve. ```

Proteasome inhibitor active in myeloma ``` A. Lenalidomide + low dose dexamethasone B. Waldenstrom’s macroglobinaemia C. Infliximab + budesonide D. AL amyloid E. Thalidomide + high dose dexamethasone F. Anaemia & renal failure G. AA amyloid H. Rituximab I. Multiple myeloma J. Monoclonal gammopathy of undetermined significance (MGUS) K. Interferon α + ibuprofen L. IgM M. Aβ amyloid N. Bortezomib O. Melphalan + prednisolone ```

Correct N. Bortezomib

Previously fit 35yo Afro Carribean female, sudden onset back pain, no history of trauma, 1 month history polyuria, urine specific gravity raised but dipstick negative for protein (and normal in all other respects), estimated GFR 70mL/min, vertebral fracture and bilateral femoral neck fractures on radiograph. ``` All Answer Choices A. MGUS B. Primary amyloidosis C. CLL D. Multiple myeloma E. Sarcoidosis F. Smouldering multiple myeloma G. Metastatic breast cancer H. Secondary hyperparathyroidism I. Waldenstrom's macroglobulinaemia J. Primary hyperparathyroidism K. Solitary plasmacytoma of bone (SPB) ```

Multiple myeloma

Which paraprotein is most commonly raised in patients with multiple myeloma? ``` A. IgG B. IgD C. Amyloid AA D. Waldenstrom's macroglobuliaemia E. IL-8 F. Monoclonal gammopathy of undetermined significance (MGUS) G. IgM H. IL-6 I. Amyloid AL J. IgA K. Beta2 microglobulin L. Bence-Jones protein M. Amyloid AB ```

Correct A. IgG

Which cytokine is an important growth factor in the development of myeloma? ``` A. IgG B. IgD C. Amyloid AA D. Waldenstrom's macroglobuliaemia E. IL-8 F. Monoclonal gammopathy of undetermined significance (MGUS) G. IgM H. IL-6 I. Amyloid AL J. IgA K. Beta2 microglobulin L. Bence-Jones protein M. Amyloid AB ```

Correct H. IL-6

Elevated levels imply a poor prognosis in myeloma patients. ``` A. IgG B. IgD C. Amyloid AA D. Waldenstrom's macroglobuliaemia E. IL-8 F. Monoclonal gammopathy of undetermined significance (MGUS) G. IgM H. IL-6 I. Amyloid AL J. IgA K. Beta2 microglobulin L. Bence-Jones protein M. Amyloid AB ```

Correct K. Beta2 microglobulin

A 60 yr old woman presents to her GP with shortness of breath and ankle oedema. When examined the patient has bilateral weakness and paraesthesia of her hands. Investigations revealed a monoclonal proliferation of plasma cells and the presence of Bence Jones proteins. ``` A. Monoclonal gammopathy of undetermined significance B. Primary amyloidosis C. Secondary amyloidosis D. Chronic lymphocytic leukaemia E. Multiple myeloma F. Waldenstrom's macroglobulinaemia G. Metastatic carcinoma ```

Correct B. Primary amyloidosis

A 43 year old man presents to his GP with concerns over a tender lump on the left side of his abdomen. Investigation showed a normal haemoglobin but a mildly raised white-cell count (13.2 x 109/l). On the blood film these cells were mainly small mononuclear cells resembling lymphocytes. These cells stained positively for tartrate-resistant acid phosphatase. ``` A. Benign paraproteinaemia B. Fractured vertebrae C. Hodgkin's lymphoma D. Acute leukaemia E. Hairy cell leukaemia F. Sezary syndrome G. Bone metastasis H. Sarcoidosis I. Non-Hodgkin's lymphoma J. Multiple myeloma ```

Hairy cell leukaemia

A 78 year old man is admitted to hospital after experiencing problems urinating and defecating. He also noticed numbness in some areas of his abdomen. Blood levels of calcium and ALP were raised. A bone scan confirms the diagnosis. ``` A. Benign paraproteinaemia B. Fractured vertebrae C. Hodgkin's lymphoma D. Acute leukaemia E. Hairy cell leukaemia F. Sezary syndrome G. Bone metastasis H. Sarcoidosis I. Non-Hodgkin's lymphoma J. Multiple myeloma ```

Correct G. Bone metastasis

A 69 year old man presents with a complaint of right elbow pain. Radiography shows a lytic lesion in the area of the right proximal radius. Biopsy of the lesion reveals a mono-clonal population of plasma cells consistent with a plasmacytoma. A radiographic skeletal bone survey shows other similar lesions. ``` A. Benign paraproteinaemia B. Fractured vertebrae C. Hodgkin's lymphoma D. Acute leukaemia E. Hairy cell leukaemia F. Sezary syndrome G. Bone metastasis H. Sarcoidosis I. Non-Hodgkin's lymphoma J. Multiple myeloma ```

Correct J. Multiple myeloma

Corticosteroid refractory haemolytic anaemia A. Splenectomy B. Rituximab (anti CD20) C. Lenalidomide (Revlimid) and low dose dexamethasone followed by allogeneic stem cell transplant (SCT) D. Anagrelide E. Thalidomide and dexamethasone F. Thymectomy G. Hydroxyurea H. Treatment with anti lymphocyte globulin I. Imatinib J. Campath (anti CD52, alemtuzumab) K. Bortezomib (Velcade) L. Lenalidomide (Revlimid) and low dose dexamethasone followed by autologous stem cell transplant (SCT) M. Cyclophosphamide, fludarabine and rituximab N. Melphalan O. Regular surveillance but no active treatment P. Dexamethasone alone Q. Venesection and aspirin R. Leucovorin (Folinic acid, Formyl tetrahydrofolate) S. Folate

Correct A. Splenectomy

Chronic lymphocytic leukaemia A. Splenectomy B. Rituximab (anti CD20) C. Lenalidomide (Revlimid) and low dose dexamethasone followed by allogeneic stem cell transplant (SCT) D. Anagrelide E. Thalidomide and dexamethasone F. Thymectomy G. Hydroxyurea H. Treatment with anti lymphocyte globulin I. Imatinib J. Campath (anti CD52, alemtuzumab) K. Bortezomib (Velcade) L. Lenalidomide (Revlimid) and low dose dexamethasone followed by autologous stem cell transplant (SCT) M. Cyclophosphamide, fludarabine and rituximab N. Melphalan O. Regular surveillance but no active treatment P. Dexamethasone alone Q. Venesection and aspirin R. Leucovorin (Folinic acid, Formyl tetrahydrofolate) S. Folate

Correct M. Cyclophosphamide, fludarabine and rituximab

Multiple myeloma A. Splenectomy B. Rituximab (anti CD20) C. Lenalidomide (Revlimid) and low dose dexamethasone followed by allogeneic stem cell transplant (SCT) D. Anagrelide E. Thalidomide and dexamethasone F. Thymectomy G. Hydroxyurea H. Treatment with anti lymphocyte globulin I. Imatinib J. Campath (anti CD52, alemtuzumab) K. Bortezomib (Velcade) L. Lenalidomide (Revlimid) and low dose dexamethasone followed by autologous stem cell transplant (SCT) M. Cyclophosphamide, fludarabine and rituximab N. Melphalan O. Regular surveillance but no active treatment P. Dexamethasone alone Q. Venesection and aspirin R. Leucovorin (Folinic acid, Formyl tetrahydrofolate) S. Folate

Lenalidomide (Revlimid) and low dose dexamethasone followed by autologous stem cell transplant (SCT)

Smouldering myeloma A. Splenectomy B. Rituximab (anti CD20) C. Lenalidomide (Revlimid) and low dose dexamethasone followed by allogeneic stem cell transplant (SCT) D. Anagrelide E. Thalidomide and dexamethasone F. Thymectomy G. Hydroxyurea H. Treatment with anti lymphocyte globulin I. Imatinib J. Campath (anti CD52, alemtuzumab) K. Bortezomib (Velcade) L. Lenalidomide (Revlimid) and low dose dexamethasone followed by autologous stem cell transplant (SCT) M. Cyclophosphamide, fludarabine and rituximab N. Melphalan O. Regular surveillance but no active treatment P. Dexamethasone alone Q. Venesection and aspirin R. Leucovorin (Folinic acid, Formyl tetrahydrofolate) S. Folate

Correct O. Regular surveillance but no active treatment

Used in solid organ transplantation, multiple sclerosis, NHL. Depletes lymphocytes. Side effects include ITP and Graves disease. A. Splenectomy B. Rituximab (anti CD20) C. Lenalidomide (Revlimid) and low dose dexamethasone followed by allogeneic stem cell transplant (SCT) D. Anagrelide E. Thalidomide and dexamethasone F. Thymectomy G. Hydroxyurea H. Treatment with anti lymphocyte globulin I. Imatinib J. Campath (anti CD52, alemtuzumab) K. Bortezomib (Velcade) L. Lenalidomide (Revlimid) and low dose dexamethasone followed by autologous stem cell transplant (SCT) M. Cyclophosphamide, fludarabine and rituximab N. Melphalan O. Regular surveillance but no active treatment P. Dexamethasone alone Q. Venesection and aspirin R. Leucovorin (Folinic acid, Formyl tetrahydrofolate) S. Folate

Correct J. Campath (anti CD52, alemtuzumab)

Add-on anti-proteasome drug for myeloma A. Splenectomy B. Rituximab (anti CD20) C. Lenalidomide (Revlimid) and low dose dexamethasone followed by allogeneic stem cell transplant (SCT) D. Anagrelide E. Thalidomide and dexamethasone F. Thymectomy G. Hydroxyurea H. Treatment with anti lymphocyte globulin I. Imatinib J. Campath (anti CD52, alemtuzumab) K. Bortezomib (Velcade) L. Lenalidomide (Revlimid) and low dose dexamethasone followed by autologous stem cell transplant (SCT) M. Cyclophosphamide, fludarabine and rituximab N. Melphalan O. Regular surveillance but no active treatment P. Dexamethasone alone Q. Venesection and aspirin R. Leucovorin (Folinic acid, Formyl tetrahydrofolate) S. Folate

Correct K. Bortezomib (Velcade)

Reduces platelet count in thrombocythaemia but causes palpitations, tachycardia, fluid retention A. Splenectomy B. Rituximab (anti CD20) C. Lenalidomide (Revlimid) and low dose dexamethasone followed by allogeneic stem cell transplant (SCT) D. Anagrelide E. Thalidomide and dexamethasone F. Thymectomy G. Hydroxyurea H. Treatment with anti lymphocyte globulin I. Imatinib J. Campath (anti CD52, alemtuzumab) K. Bortezomib (Velcade) L. Lenalidomide (Revlimid) and low dose dexamethasone followed by autologous stem cell transplant (SCT) M. Cyclophosphamide, fludarabine and rituximab N. Melphalan O. Regular surveillance but no active treatment P. Dexamethasone alone Q. Venesection and aspirin R. Leucovorin (Folinic acid, Formyl tetrahydrofolate) S. Folate

Correct D. Anagrelide

Standard prophylaxis accompanying a once weekly myelosuppressant when used in rheumatoid arthritis A. Splenectomy B. Rituximab (anti CD20) C. Lenalidomide (Revlimid) and low dose dexamethasone followed by allogeneic stem cell transplant (SCT) D. Anagrelide E. Thalidomide and dexamethasone F. Thymectomy G. Hydroxyurea H. Treatment with anti lymphocyte globulin I. Imatinib J. Campath (anti CD52, alemtuzumab) K. Bortezomib (Velcade) L. Lenalidomide (Revlimid) and low dose dexamethasone followed by autologous stem cell transplant (SCT) M. Cyclophosphamide, fludarabine and rituximab N. Melphalan O. Regular surveillance but no active treatment P. Dexamethasone alone Q. Venesection and aspirin R. Leucovorin (Folinic acid, Formyl tetrahydrofolate) S. Folate

Correct S. Folate

Rescue drug after high dose methotrexate is used for gestational trophoblastic disease or intrathecal ALL A. Splenectomy B. Rituximab (anti CD20) C. Lenalidomide (Revlimid) and low dose dexamethasone followed by allogeneic stem cell transplant (SCT) D. Anagrelide E. Thalidomide and dexamethasone F. Thymectomy G. Hydroxyurea H. Treatment with anti lymphocyte globulin I. Imatinib J. Campath (anti CD52, alemtuzumab) K. Bortezomib (Velcade) L. Lenalidomide (Revlimid) and low dose dexamethasone followed by autologous stem cell transplant (SCT) M. Cyclophosphamide, fludarabine and rituximab N. Melphalan O. Regular surveillance but no active treatment P. Dexamethasone alone Q. Venesection and aspirin R. Leucovorin (Folinic acid, Formyl tetrahydrofolate) S. Folate

R. Leucovorin (Folinic acid, Formyl tetrahydrofolate)

Used in solid organ transplantation, multiple sclerosis, NHL. Depletes B lymphocytes more than T lymphocytes. A. Splenectomy B. Rituximab (anti CD20) C. Lenalidomide (Revlimid) and low dose dexamethasone followed by allogeneic stem cell transplant (SCT) D. Anagrelide E. Thalidomide and dexamethasone F. Thymectomy G. Hydroxyurea H. Treatment with anti lymphocyte globulin I. Imatinib J. Campath (anti CD52, alemtuzumab) K. Bortezomib (Velcade) L. Lenalidomide (Revlimid) and low dose dexamethasone followed by autologous stem cell transplant (SCT) M. Cyclophosphamide, fludarabine and rituximab N. Melphalan O. Regular surveillance but no active treatment P. Dexamethasone alone Q. Venesection and aspirin R. Leucovorin (Folinic acid, Formyl tetrahydrofolate) S. Folate

Correct B. Rituximab (anti CD20)

Most easily curable B cell neoplasm ``` A. Indolent T cell B. Aggressive B cell C. Variable T cell D. Variable B cell E. Indolent B cell F. Aggressive T cell ```

Incorrect E. Indolent B cell

Follicular lymphoma ``` A. Indolent T cell B. Aggressive B cell C. Variable T cell D. Variable B cell E. Indolent B cell F. Aggressive T cell ```

Correct E. Indolent B cell

A classical but rare constitutional symptom of Hodgkin lymphoma. ``` A. Non-Hodgkin lymphoma B. Epstein-Barr virus C. Very aggressive D. Pruritis E. Follicular lymphoma F. Night sweats G. Stage IIIB H. Indolent I. Aggressive J. Burkitt's lymphoma K. Pel-Ebstein fever L. Stage IIA M. Diffuse large B cell lymphoma N. Hodgkin lymphoma ```

Pel-Ebstein fever

The grade of the Follicular lymphoma NHL subtype. ``` A. Non-Hodgkin lymphoma B. Epstein-Barr virus C. Very aggressive D. Pruritis E. Follicular lymphoma F. Night sweats G. Stage IIIB H. Indolent I. Aggressive J. Burkitt's lymphoma K. Pel-Ebstein fever L. Stage IIA M. Diffuse large B cell lymphoma N. Hodgkin lymphoma ```

Correct H. Indolent

A 21 year old student recently returning from India complains to his GP of cough, headache and diarrhoea. He is febrile and rose spots are present on his chest. Blood culture reveals salmonella typhi. Which immune cells out of the list are most likely to be raised? ``` A. Anaemia of chronic disease B. Eosinophils C. Leucoerythroblastic anaemia D. Monocytes E. Iron deficiency anaemia F. Neutrophils G. Rheumatoid arthritis H. Microangiopathic haemolytic anaemia I. Polymyalgia rheumatica J. Systemic lupus erythematosis K. Diverticular disease ```

Correct D. Monocytes

An elderly lady is found to suffer from Epstein-Barr virus. She is late noted to have splenic enlargement. ``` All Answer Choices A. Combination Chemotherapy B. Hodgkins Disease Stage IB C. Burkitts Lymphoma D. Primary Amyloidosis E. Acute Myeloid Leukaemia F. Hodgkins Stage IIA G. Aplastic Anaemia H. Polycythaemia Rubra Vera I. Chronic Lymphocytic Leukaemia J. Hairy Cell Leukaemia K. Multiple Myeloma L. Radiation Therapy Alone M. Myelodysplasia ```

Correct C. Burkitts Lymphoma

A 2 year old boy living in the slums who has a one day history of profuse watery diarrhoea, fever and abdominal cramps. His family’s main source of water is the river near their squatters. ``` A. Bartonella henselae B. Spirillum minus C. Borrelia burgdorferi D. Yersinia pestis E. Rickettsia prowazekii F. Brucella abortus G. Campylobacter jejuni H. Cryptosporidium parvum I. Francisella tularensis J. Trypanosoma cruzi ```

Correct H. Cryptosporidium parvum

A 25 year old Maltese man presented to his GP with lethargy for a month and headaches and fever. On examination, he had a temperature of 39°C and one fingerbreadth splenomegaly. Small Gram-negative coccobacilli were seen on culture in Casteneda’s medium. ``` A. Leishmania major. B. Bacillus anthracis C. Rickettsia typhi D. Borrelia burgdorferi E. Brucella abortus F. Brucella melitensis G. Leptospira interrogans H. Rabies I. Yersina pestis ```

Correct F. Brucella melitensis

A 22 year old student presented to her GP upon return from a biology field trip, with a lesion on her leg which was 3” in diameter and flat, with a red edge and dim centre. She also mentioned feeling tired and suffering from headaches. On examination, the GP noted a fever of 38.0°C and an irregular heartbeat. ``` A. Leishmania major. B. Bacillus anthracis C. Rickettsia typhi D. Borrelia burgdorferi E. Brucella abortus F. Brucella melitensis G. Leptospira interrogans H. Rabies I. Yersina pestis ```

Correct D. Borrelia burgdorferi

A tanner on holiday from India presented to hospital with an ulcerating papule on his hand. On inspection of the ulcer, the centre was black and necrotic. Gram-positive rods grew on blood agar culture and responded to treatment with large doses of penicillin. ``` A. Leishmania major. B. Bacillus anthracis C. Rickettsia typhi D. Borrelia burgdorferi E. Brucella abortus F. Brucella melitensis G. Leptospira interrogans H. Rabies I. Yersina pestis ```

Correct B. Bacillus anthracis

A 6 month old baby presents at his GP with nappy rash. Which is the most likely causative fungus? ``` A. Epidermophyton floccosum B. Aspergillus flavus C. Pneumocystis carinii D. Pityrosporum orbiculare E. Candida albicans F. Corynebacterium minutissimum G. Histoplasmosis capsulatum H. Trichophytum rubrum I. Cryptococcus neoforms ```

Correct E. Candida albicans

A 21 year old man presents at his GP complaining of an itchy, scaly rash on the soles of his feet. Skin scrapings are taken and sent away for microscopic examination. Which fungi might be identified? ``` A. Epidermophyton floccosum B. Aspergillus flavus C. Pneumocystis carinii D. Pityrosporum orbiculare E. Candida albicans F. Corynebacterium minutissimum G. Histoplasmosis capsulatum H. Trichophytum rubrum I. Cryptococcus neoforms ```

Correct H. Trichophytum rubrum

A 55 year old farmer is seen in the Oncology clinic with a diagnosis of hepatocellular carcinoma. He is a lifelong teetotal and his virology has all been negative. Which fungus may have indirectly been a cause of his cancer? ``` A. Epidermophyton floccosum B. Aspergillus flavus C. Pneumocystis carinii D. Pityrosporum orbiculare E. Candida albicans F. Corynebacterium minutissimum G. Histoplasmosis capsulatum H. Trichophytum rubrum I. Cryptococcus neoforms ```

Correct B. Aspergillus flavus

A 17 year old Nigerian girl presents at her GP with patches of hypopigmentation on her trunk. After an initial trial of steroid cream, the girl returns complaining that the rash is spreading. Woods lamp examination of the rash produces a yellow fluorescence. What is the causative fungus? ``` A. Epidermophyton floccosum B. Aspergillus flavus C. Pneumocystis carinii D. Pityrosporum orbiculare E. Candida albicans F. Corynebacterium minutissimum G. Histoplasmosis capsulatum H. Trichophytum rubrum I. Cryptococcus neoforms ```

Correct D. Pityrosporum orbiculare

A 19 year-old student presents to her GP with a macular rash and suboccipital lymphadenopathy. She also complains of pain on moving her hands and wrists. ``` A. Infectious mononucleosis B. Tuberculous arthritis C. Tuberculous osteomyelitis D. Lyme disease E. Gonococcal arthritis F. Staphylococcal arthritis G. Rubella H. Candidiasis I. Staphylococcal osteomyelitis J. Viral hepatitis K. Brodie's abscess ```

Correct G. Rubella

This type of bone is immature and usually pathological. ``` A. Diaphysis B. Periosteum C. Cancellous D. Osteocyte E. Lamellar F. Osteoclast G. Metaphysis H. Epiphysis I. Endosteum J. Osteoblast K. Cortical L. Woven ```

Correct L. Woven

A 24 year old police woman attends the clinic as her GP suspects she may have a parathyroid tumour. She has raised PTH and serum calcium. After a 24hr urinary collection it is noted the patient has a low urine calcium output ``` A. Cushing's syndrome B. Familial hypocalcuric hypercalcaemia C. Cushing's disease D. Paget's disease E. Osteomalacia F. Tertiary hyperparathyroidism G. Primary hypthyroidism (myxoedema) H. Secondary hyperparathyroidism with chronic renal osteodystrophy I. Osteoporosis J. Osteitis fibrosa K. Primary hyperparathyroidism ```

Correct B. Familial hypocalcuric hypercalcaemia

A 14 year old boy complains to you of a painless lump on his left thigh, just above the knee which is slowly growing. His past medical history reveals that he fractured his femur in the same location several years before. ``` A. Osteoporosis B. Osteitis C. Osteoid osteoma D. Osteoarthritis E. Metastases F. Ewing's tumour G. Osteosarcoma H. Osteoclastoma I. Echondroma J. Simple bone cyst K. Osteochondroma L. Fibrous dysplasia M. Chondrosarcoma N. Rheumatoid arthritis ```

Correct K. Osteochondroma

A 42 year old woman presents to her GP suffering from mild depression. Her thyroid function is investigated: TSH 6.5, Free T4 5.6 ``` A. Postpartum thyroiditis B. Medullary carcinoma C. Euthyroid state D. Thyroid storm E. Papillary carcinoma F. Hashimoto's thyroiditis G. Subacute thyroiditis H. De Quervain's I. Grave's disease ```

Correct F. Hashimoto's thyroiditis

An 18 year old man notices a lump on his neck and goes to his GP. As well as the lump, the GP discovers cervical lymphadenopathy. There is no family history of any endocrine disorder, nor is he suffering from any other illness. Thyroglobulin is 140. ``` A. Postpartum thyroiditis B. Medullary carcinoma C. Euthyroid state D. Thyroid storm E. Papillary carcinoma F. Hashimoto's thyroiditis G. Subacute thyroiditis H. De Quervain's I. Grave's disease ```

Correct E. Papillary carcinoma

Neoplasms found in women aged between 30 and 40 as ovarian masses, usually unilateral. They are usually benign (90%) and are often the largest ovarian neoplasm. ``` A. Endometrial Adenocarcinoma B. Serous Tumour C. Teratoma (Immature) D. Mucinous Tumour E. Endometrial Polyps F. Cervical Intraepithelial Neoplasia (CIN) G. Vaginal Squamous Cell Carcinoma H. Teratoma (Mature) I. Cervical Squamous Cell Carcinoma J. Endometrioid Tumour ```

Correct D. Mucinous Tumour Mucinous ovarian neoplasms account for 10-15% of all ovarian tumours and are rarely malignant (~10-15%). They are rarely bilateral, but can be very large. In contrast, whilst serous tumours are also usually benign (30% malignant) and common - accounting for 30% of all ovarian tumours - they have a strong tendency to be bilateral.

Squamous epithelium mixed with intestinal epithelium ``` A. Thecoma B. Serous cystadenocarcinoma C. Krukenberg tumour D. Immature teratoma E. Fibroma F. Clear cell tumour G. Dysgerminoma H. Sertoli-Leydig tumour I. Mature cystic teratoma J. Mucinous cystadenocarcinoma K. Granulosa cell tumours ```

Correct I. Mature cystic teratoma

Fibrous tissue containing spindle cells and lipid ``` A. Thecoma B. Serous cystadenocarcinoma C. Krukenberg tumour D. Immature teratoma E. Fibroma F. Clear cell tumour G. Dysgerminoma H. Sertoli-Leydig tumour I. Mature cystic teratoma J. Mucinous cystadenocarcinoma K. Granulosa cell tumours ```

Correct A. Thecoma

Very aggressive tumour producing HCG and AFP; neoplastic cells are anaplastic. ``` A. Diffuse large B cell lymphoma (DLBCL) B. Embryonal carcinoma C. Acute lymphoblastic leukaemia/lymphoma (ALL) D. Acute myeloid leukaemia (AML) E. Seminoma F. Yolk sac (endodermal sinus) tumour G. Sertoli cell tumour H. Leydig cell tumour I. Teratoma J. Choriocarcinoma ```

Correct B. Embryonal carcinoma

Nonseminomatous germ cell tumour that has elements derived from all 3 germ cell layers ``` A. Diffuse large B cell lymphoma (DLBCL) B. Embryonal carcinoma C. Acute lymphoblastic leukaemia/lymphoma (ALL) D. Acute myeloid leukaemia (AML) E. Seminoma F. Yolk sac (endodermal sinus) tumour G. Sertoli cell tumour H. Leydig cell tumour I. Teratoma J. Choriocarcinoma ```

Correct I. Teratoma

Commonest malignant cause of testicular mass in those aged under 5. ``` A. Diffuse large B cell lymphoma (DLBCL) B. Embryonal carcinoma C. Acute lymphoblastic leukaemia/lymphoma (ALL) D. Acute myeloid leukaemia (AML) E. Seminoma F. Yolk sac (endodermal sinus) tumour G. Sertoli cell tumour H. Leydig cell tumour I. Teratoma J. Choriocarcinoma ```

Correct C. Acute lymphoblastic leukaemia/lymphoma (ALL)

Commonest malignant cause of testicular mass in those aged 60 ``` A. Diffuse large B cell lymphoma (DLBCL) B. Embryonal carcinoma C. Acute lymphoblastic leukaemia/lymphoma (ALL) D. Acute myeloid leukaemia (AML) E. Seminoma F. Yolk sac (endodermal sinus) tumour G. Sertoli cell tumour H. Leydig cell tumour I. Teratoma J. Choriocarcinoma ```

Correct A. Diffuse large B cell lymphoma (DLBCL)

A 22-year-old lady presented with a vaginal discharge. Gram staining revealed “Clue cells” surrounded by rods, that were “Gram variable”. ``` A. Cervical Microglandular Hyperplasia B. Herpes zoster C. Trichomonas vaginalis D. Chlamydia E. Cervical Intraepithelial Neoplasia I F. Cervical Intraepithelial Neoplasia III G. Candida albicans H. Neisseria gonorrheae I. Group B Streptococcus J. Lymphogranuloma venereum K. Cervical Intraepithelial Neoplasia II L. Gardnerella vaginalis M. Granuloma Inguinale N. Herpes simplex O. Treponema pallidum (syphilis) P. Cervical polyps ```

Correct L. Gardnerella vaginalis

A pap smear taken from a chronic granulomatous ulcer shows a necrotic centre, periarteritis and endarteritis obliterans and an intense peripheral cellular infiltrate consisting mainly of mononuclear cells and giant cells. ``` A. Cervical Microglandular Hyperplasia B. Herpes zoster C. Trichomonas vaginalis D. Chlamydia E. Cervical Intraepithelial Neoplasia I F. Cervical Intraepithelial Neoplasia III G. Candida albicans H. Neisseria gonorrheae I. Group B Streptococcus J. Lymphogranuloma venereum K. Cervical Intraepithelial Neoplasia II L. Gardnerella vaginalis M. Granuloma Inguinale N. Herpes simplex O. Treponema pallidum (syphilis) P. Cervical polyps ```

Correct O. Treponema pallidum (syphilis)

The metaplasia that occurs in the transformation zone involves which cell-types? ``` A. 30 - 40 years B. Squamous to glandular epitheliem C. CIN II D. Glandular to squamous epithelium E. 50-60 years F. Invasive cervical cancer G. CIN I H. 45 years I. CIN III J. Ovarian cancer K. 65 years ```

Correct D. Glandular to squamous epithelium

Single most useful first-line cytological investigation of an impalpable breast lump seen on a mammogram.

Correct I. Stereotactic radiographic cytological sampling method

Single most useful first-line cytological investigation for the confirmation of the benign status of an ovarian cyst. ``` A. Cystoscopy B. Percutaneous FNA biopsy C. Endometrial tissue sampling D. Fluid cytology of alveolar washings E. Exfoliative (brush) cytology F. Core biopsy G. Cone biopsy H. Fine needle aspirate I. Stereotactic radiographic cytological sampling method ```

Correct H. Fine needle aspirate

Single most useful first-line cytological investigation of a palpable breast lump in a clinic setting. ``` A. Cystoscopy B. Percutaneous FNA biopsy C. Endometrial tissue sampling D. Fluid cytology of alveolar washings E. Exfoliative (brush) cytology F. Core biopsy G. Cone biopsy H. Fine needle aspirate I. Stereotactic radiographic cytological sampling method ```

Correct H. Fine needle aspirate

FNA A. Has an 85% positive predictive value for malignant cytopathological diagnosis. B. Requires a hospital stay, possible general anaesthetic and leads to pain and trauma to the patient. C. Leads to pain and trauma to the patient. D. Has a 10% false positive rate E. Does not allow patient counselling prior to definitive treatment. F. Has a 100% positive predictive value for malignant cytopathological diagnosis.

Correct F. Has a 100% positive predictive value for malignant cytopathological diagnosis.

A 20yr old gentleman presents to his GP with a lump in his neck. He has noticed the lump getting bigger. Examination reveals the lump to be in the thyroid gland. FNA and cytology reveals the diagnosis. ``` A. Diabetes Mellitus B. Secondary Hyperparathyroidism C. Tertiary Hyperparathyroidism D. Paget’s Disease E. Hypocalcaemia F. Multiple Myeloma G. Papillary Carcinoma H. Osteomalacia I. Hypercalcaemia J. Amyloidosis K. Medullary Carcinoma ```

Correct G. Papillary Carcinoma

Increases of what is a cardiovascular risk factor? ``` A. Pre-albumin B. Caeruloplasmin C. Albumin D. AFP E. IgM F. IgA G. CSF H. Paraprotein I. C4 J. C3 K. Alpha-1-antitrypsin L. IgE M. CRP N. Transferrin O. Myoglobin P. IgD ```

Correct M. CRP

Which can act as a source of amino acids? ``` A. Pre-albumin B. Caeruloplasmin C. Albumin D. AFP E. IgM F. IgA G. CSF H. Paraprotein I. C4 J. C3 K. Alpha-1-antitrypsin L. IgE M. CRP N. Transferrin O. Myoglobin P. IgD ```

Correct C. Albumin

A 50 year male with multiple myeloma comes to his GP complaining of ankle swelling. Urine dipstick shows proteinuria. On examination he is also noted to have macroglossia and waxy papules on his face. ``` A. Sarcoidosis B. Hodgkin's lymphoma C. Hypoalbuminaemia D. Alpha-1-antitrypsin deficiency E. Myeloma F. Pneumonia G. Acute renal failure H. Tuberculosis I. Amyloidosis J. Asthma K. Emphysema L. Waldenstrom's macroglobulinaemia M. Pollycythaemia rubra vera N. Chronic myeloid leukaemia O. Monoclonal gammopathy P. Wilson's disease ```

Correct I. Amyloidosis

How do daily requirements of water for neonates compare with those of adults? ``` A. Defect in renal hydroxylation B. Vitamin D C. Alkaline phosphatase D. Calcium E. Kernicterus F. Oesophageal atresia G. > 6 times adult requirements H. Cerebral palsy I. Kallman's syndrome J. > 3 times adult requirements K. Defect in receptor L. Phosphate M. Defect in renal phosphorylation N. Pierre-Robin sequence O. Twice adult requirements P. Nectrotising enterocolitis ```

Correct G. > 6 times adult requirements

High fluid intake in neonates during the first week of life is associated with increasing frequency of this condition. ``` A. Defect in renal hydroxylation B. Vitamin D C. Alkaline phosphatase D. Calcium E. Kernicterus F. Oesophageal atresia G. > 6 times adult requirements H. Cerebral palsy I. Kallman's syndrome J. > 3 times adult requirements K. Defect in receptor L. Phosphate M. Defect in renal phosphorylation N. Pierre-Robin sequence O. Twice adult requirements P. Nectrotising enterocolitis ```

Correct P. Nectrotising enterocolitis

Pseudo vitamin D deficiency 1 is associated with this defect. ``` A. Defect in renal hydroxylation B. Vitamin D C. Alkaline phosphatase D. Calcium E. Kernicterus F. Oesophageal atresia G. > 6 times adult requirements H. Cerebral palsy I. Kallman's syndrome J. > 3 times adult requirements K. Defect in receptor L. Phosphate M. Defect in renal phosphorylation N. Pierre-Robin sequence O. Twice adult requirements P. Nectrotising enterocolitis ```

Correct A. Defect in renal hydroxylation

A 2-month Canadian neonate presents with failure to thrive, jaundice and sepsis. You are screening for metabolic disorders, what 1st line test would you recommend? A 2-month Canadian neonate presents with failure to thrive, jaundice and sepsis. You are screening for metabolic disorders, what 1st line test would you recommend? ``` A. Amino acids (urine and plasma) B. Medium chain acyl coA dehydrogenase C. Very long chain fatty acids D. Transferrin glycoforms E. Urine organic acids F. Glucose and lactate G. Plasma lactate H. Urine sugar chromotography I. Plasma ammonia J. Galactase-1-phosphate uridyl transferase ```

Correct A. Amino acids (urine and plasma) think that a short-cut to being able to recognise these (if your mind doesn't have space for all those pathways) is to draw a Venn diagram with the various symptoms of inborn errors. 1) Plasma and urine amino acids would be in first line metabolic screen. The Canadian hint is trying to point towards Type 1 tyrosinaemia which is more common in Quebec. (plus, the overlap between jaundice and sepsis suggest either tyrosinaemia or galactosaemia, and it doesn't fit with the latter in other ways) 2) Tachypnoea with neuro signs suggests respiratory alkalosis and encephalopathy, characteristic of urea cycle defects - ie. ammonia would be raised. 3) Of the inborn errors, the 2 that produce dysmorphic signs are peroxisomal and congenital disorders of glycosylation. Of these, only the first is associated with jaundice. 5) As above jaundice suggests galactosaemia or tyrosinaemia - In this case, cataracts occur because of accumulation of galacitol, and jaundice because of excess galactose-1-phosphate in liver.

A male infant presents with failure to thrive, neurological signs (including tremor) and tachypnea. From our metabolic disorders screen, which 1st line test is likely to be abnormal? ``` A. Amino acids (urine and plasma) B. Medium chain acyl coA dehydrogenase C. Very long chain fatty acids D. Transferrin glycoforms E. Urine organic acids F. Glucose and lactate G. Plasma lactate H. Urine sugar chromotography I. Plasma ammonia J. Galactase-1-phosphate uridyl transferase ```

Correct I. Plasma ammonia think that a short-cut to being able to recognise these (if your mind doesn't have space for all those pathways) is to draw a Venn diagram with the various symptoms of inborn errors. 1) Plasma and urine amino acids would be in first line metabolic screen. The Canadian hint is trying to point towards Type 1 tyrosinaemia which is more common in Quebec. (plus, the overlap between jaundice and sepsis suggest either tyrosinaemia or galactosaemia, and it doesn't fit with the latter in other ways) 2) Tachypnoea with neuro signs suggests respiratory alkalosis and encephalopathy, characteristic of urea cycle defects - ie. ammonia would be raised. 3) Of the inborn errors, the 2 that produce dysmorphic signs are peroxisomal and congenital disorders of glycosylation. Of these, only the first is associated with jaundice. 5) As above jaundice suggests galactosaemia or tyrosinaemia - In this case, cataracts occur because of accumulation of galacitol, and jaundice because of excess galactose-1-phosphate in liver.

A neonate has seizures, conjugated hyperbilirubinaemia and the 3rd year med student’s clinical observation is that “he looks weird!” From our metabolic disorders screen, which 1st line test is likely to be abnormal? ``` A. Amino acids (urine and plasma) B. Medium chain acyl coA dehydrogenase C. Very long chain fatty acids D. Transferrin glycoforms E. Urine organic acids F. Glucose and lactate G. Plasma lactate H. Urine sugar chromotography I. Plasma ammonia J. Galactase-1-phosphate uridyl transferase ```

Correct C. Very long chain fatty acids think that a short-cut to being able to recognise these (if your mind doesn't have space for all those pathways) is to draw a Venn diagram with the various symptoms of inborn errors. 1) Plasma and urine amino acids would be in first line metabolic screen. The Canadian hint is trying to point towards Type 1 tyrosinaemia which is more common in Quebec. (plus, the overlap between jaundice and sepsis suggest either tyrosinaemia or galactosaemia, and it doesn't fit with the latter in other ways) 2) Tachypnoea with neuro signs suggests respiratory alkalosis and encephalopathy, characteristic of urea cycle defects - ie. ammonia would be raised. 3) Of the inborn errors, the 2 that produce dysmorphic signs are peroxisomal and congenital disorders of glycosylation. Of these, only the first is associated with jaundice. 5) As above jaundice suggests galactosaemia or tyrosinaemia - In this case, cataracts occur because of accumulation of galacitol, and jaundice because of excess galactose-1-phosphate in liver.

A post mortem diagnosis of an inborn error of metabolism is investigated in a case of “sudden infant death”. What deficiency is the most likely cause? ``` A. Amino acids (urine and plasma) B. Medium chain acyl coA dehydrogenase C. Very long chain fatty acids D. Transferrin glycoforms E. Urine organic acids F. Glucose and lactate G. Plasma lactate H. Urine sugar chromotography I. Plasma ammonia J. Galactase-1-phosphate uridyl transferase ```

Correct B. Medium chain acyl coA dehydrogenase think that a short-cut to being able to recognise these (if your mind doesn't have space for all those pathways) is to draw a Venn diagram with the various symptoms of inborn errors. 1) Plasma and urine amino acids would be in first line metabolic screen. The Canadian hint is trying to point towards Type 1 tyrosinaemia which is more common in Quebec. (plus, the overlap between jaundice and sepsis suggest either tyrosinaemia or galactosaemia, and it doesn't fit with the latter in other ways) 2) Tachypnoea with neuro signs suggests respiratory alkalosis and encephalopathy, characteristic of urea cycle defects - ie. ammonia would be raised. 3) Of the inborn errors, the 2 that produce dysmorphic signs are peroxisomal and congenital disorders of glycosylation. Of these, only the first is associated with jaundice. 5) As above jaundice suggests galactosaemia or tyrosinaemia - In this case, cataracts occur because of accumulation of galacitol, and jaundice because of excess galactose-1-phosphate in liver.

A neonate with a history of feeding difficulties presents with jaundice, cataracts and sepsis. What deficiency is the most likely cause? ``` A. Amino acids (urine and plasma) B. Medium chain acyl coA dehydrogenase C. Very long chain fatty acids D. Transferrin glycoforms E. Urine organic acids F. Glucose and lactate G. Plasma lactate H. Urine sugar chromotography I. Plasma ammonia J. Galactase-1-phosphate uridyl transferase ```

Correct J. Galactase-1-phosphate uridyl transferase think that a short-cut to being able to recognise these (if your mind doesn't have space for all those pathways) is to draw a Venn diagram with the various symptoms of inborn errors. 1) Plasma and urine amino acids would be in first line metabolic screen. The Canadian hint is trying to point towards Type 1 tyrosinaemia which is more common in Quebec. (plus, the overlap between jaundice and sepsis suggest either tyrosinaemia or galactosaemia, and it doesn't fit with the latter in other ways) 2) Tachypnoea with neuro signs suggests respiratory alkalosis and encephalopathy, characteristic of urea cycle defects - ie. ammonia would be raised. 3) Of the inborn errors, the 2 that produce dysmorphic signs are peroxisomal and congenital disorders of glycosylation. Of these, only the first is associated with jaundice. 5) As above jaundice suggests galactosaemia or tyrosinaemia - In this case, cataracts occur because of accumulation of galacitol, and jaundice because of excess galactose-1-phosphate in liver.

A 3-week-old male is seen by a paediatrician because of severe jaundice that appeared at birth and has been worsening ever since. ``` A. Rheumatoid arthritis B. Crigler-Najjar syndrome C. Pellagra D. Folate deficiency E. Glucose-6-phosphate dehydrogenase deficiency F. 5 alpha reductase deficiency G. Ehlers-Danlos syndrome H. Autism I. Scurvy J. 17 alpha hydroxylase deficiency K. Hereditary spherocytosis L. 21 hydroxylase deficiency M. Phenylketonuria N. Alpha 1 antitrypsin deficiency O. Lesch-Nyhan syndrome ```

Correct B. Crigler-Najjar syndrome

The smallest lipoprotein which carries cholesterol from extra-hepatic tissues to the liver for excretion. ``` A. HMG coA reductase B. Low density lipoprotein (LDL) C. Apolipoprotein A D. Apolipoprotein E. Cholesterol acyl transferase F. Gamma-glutyl transferase G. Very low density lipoprotein (VLDL) H. Intermediate density lipoprotein I. Triglyceride J. Chylomicron K. High density lipoprotein (HDL) L. Lipoprotein lipase ```

Correct K. High density lipoprotein (HDL)

This is present on capillaries of adipose tissue and skeletal muscle and it removes triglyceride from lipoproteins. ``` A. HMG coA reductase B. Low density lipoprotein (LDL) C. Apolipoprotein A D. Apolipoprotein E. Cholesterol acyl transferase F. Gamma-glutyl transferase G. Very low density lipoprotein (VLDL) H. Intermediate density lipoprotein I. Triglyceride J. Chylomicron K. High density lipoprotein (HDL) L. Lipoprotein lipase ```

Correct L. Lipoprotein lipase

The molecule that is formed by the gut after a meal and is the main carrier of dietary triglycerides ``` A. HMG coA reductase B. Low density lipoprotein (LDL) C. Apolipoprotein A D. Apolipoprotein E. Cholesterol acyl transferase F. Gamma-glutyl transferase G. Very low density lipoprotein (VLDL) H. Intermediate density lipoprotein I. Triglyceride J. Chylomicron K. High density lipoprotein (HDL) L. Lipoprotein lipase ```

Correct J. Chylomicron

In diabetics, this substance is formed in increased quantities in cells that do not require insulin for glucose uptake. It is injurious to those cells: ``` A. Lipoprotein lipase B. Sorbitol C. Ketone bodies D. Amyloid E. Insulitis F. Albumin G. LDL cholesterol H. Glucose I. HDL cholesterol J. Elevated serum osmolarity ```

Correct B. Sorbitol

50 year old male has serum glucose values of 145 and 167 mg/dL on visits to his physician last month. His body mass index is 31. He has not had any major illnesses. The islets of Langerhans in his pancreas may demonstrate: ``` A. Lipoprotein lipase B. Sorbitol C. Ketone bodies D. Amyloid E. Insulitis F. Albumin G. LDL cholesterol H. Glucose I. HDL cholesterol J. Elevated serum osmolarity ```

Correct D. Amyloid

A 35 year old woman was brought to A&E with a severe headache. She was lucid and mentioned that she suffered from frequent headaches but that this one felt like a hammer-blow. She was photophobic and nauseous with slight neck stiffness. Her pulse rate was 75bpm, and BP was 130/80. ``` A. Raised intracranial pressure B. Extradural haemorrhage C. Brain stem infarction D. Pontine haemorrhage E. Panic attack F. Opiate overdose G. Transient Ischaemic attack H. Vascular dementia I. Transient hypotension J. Cerebellar stroke K. Alzheimer’s disease L. Meningitis M. Temporal arteritis N. Cerebral embolus O. Subdural haemorrhage P. Subarachnoid haemorrhage ```

Correct P. Subarachnoid haemorrhage

An 86 year old man is admitted to A&E having collapsed at his home. He is unconscious and a couple of days later he is still deeply unconscious. His pupils are pin-point and their reaction to light is difficult to see clearly. ``` A. Raised intracranial pressure B. Extradural haemorrhage C. Brain stem infarction D. Pontine haemorrhage E. Panic attack F. Opiate overdose G. Transient Ischaemic attack H. Vascular dementia I. Transient hypotension J. Cerebellar stroke K. Alzheimer’s disease L. Meningitis M. Temporal arteritis N. Cerebral embolus O. Subdural haemorrhage P. Subarachnoid haemorrhage ```

Correct C. Brain stem infarction

A 45 year old lady is referred to the breast clinic with nipple retraction ``` A. Invasive Carcinoma B. Lobular Carcinoma in situ C. Lymphoma D. Nipple adenoma E. Duct Papilloma F. Gyaecomastia G. Fibroadenoma H. Pagets Disease of the nipple I. Ductal Carcinoma in situ ```

Correct A. Invasive Carcinoma

A 45 years old woman presents with multiple bilateral masses, each less than 10mm. FNA revealed serous, turbid fluid. ``` A. Fibroadenoma B. Paget’s disease C. Mammary duct ectasis D. Cyclic nodularity E. Invasive Carcinoma F. Breast cyst G. Lobular carcinoma in situ H. Traumatic fat necrosis I. Acute mastitis ```

Correct F. Breast cyst

Can occur in hypothyroidism due to raised TRH ``` A. fibroadenoma B. lump C. mastitis D. fibrocystic change E. intraductal papilloma F. breathlessness G. gynaecomastia H. bloody discharge I. incidental finding on mammography J. galactorrhoea K. galactocoele L. mammary duct ectasia ```

Correct J. galactorrhoea

A 50 year old Asian woman is referred to the Diabetes clinic after presenting to her GP with polyuria and polydipsia. When tested, she has a fasting whole blood glucose of 6.3 mmol/L and 6.4 mmol/L when tested again a week later. ``` A. Diabetic Ketoacidosis B. Pioglitazone (Thiazolidinedione) C. Nateglinide (Meglitinide) D. Nephrogenic Diabetes Insipidus E. Metformin (biguanide) F. Impaired Fasting Glucose G. Lactic Acidosis H. Hyperosmolar Non-Ketotic Coma I. Orlistat J. Diabetes Mellitus Type 2 K. Impaired Glucose Tolerance L. Gliclazide (sulfonylurea) M. Cranial Diabetes Insipidus N. Diabetes Mellitus Type 1 ```

Correct J. Diabetes Mellitus Type 2

A recently diagnosed 48 year old opera singer was noted by her diabetic nurse to have unacceptably high blood sugar levels, despite strict calorie control and oral metformin. Which class of drug could be added to reduce insulin resistance further? ``` All Answer Choices A. Diabetic Ketoacidosis B. Pioglitazone (Thiazolidinedione) C. Nateglinide (Meglitinide) D. Nephrogenic Diabetes Insipidus E. Metformin (biguanide) F. Impaired Fasting Glucose G. Lactic Acidosis H. Hyperosmolar Non-Ketotic Coma I. Orlistat J. Diabetes Mellitus Type 2 K. Impaired Glucose Tolerance L. Gliclazide (sulfonylurea) M. Cranial Diabetes Insipidus N. Diabetes Mellitus Type 1 O. Acarbose ```

Correct B. Pioglitazone (Thiazolidinedione)

A 45 year old female presents with fever. O/E she is pyrexial, has hepatosplenomegaly, lymphadenopathy and a severely swollen eyelid. She returned from Guatemala 2 days ago. ``` A. Tuberculosis B. Tropical sprue C. Plasmodium malariae D. Plasmodium falciparum E. Schistosomiasis F. Amoebiasis G. Chagas Disease H. Giardia lamblia I. Dengue fever J. Mucocutaneous Leishmaniasis K. Plasmodium vivax ```

Correct G. Chagas Disease

A 45 year old male presents with frequency, dysuria and haematuria. Blood tests reveal a marked eosinophilia. He arrived back to the UK 4 months ago after travelling Africa; his best memory was diving in Lake Malawi. ``` A. Tuberculosis B. Tropical sprue C. Plasmodium malariae D. Plasmodium falciparum E. Schistosomiasis F. Amoebiasis G. Chagas Disease H. Giardia lamblia I. Dengue fever J. Mucocutaneous Leishmaniasis K. Plasmodium vivax ```

Correct E. Schistosomiasis

A 35 year old male complains of a persistent ulcer in the mucosa of the mouth. When questioned further admits to remembering a small ulcer on his upper arm which healed without treatment when holidaying in Brazil one year ago. ``` A. Tuberculosis B. Tropical sprue C. Plasmodium malariae D. Plasmodium falciparum E. Schistosomiasis F. Amoebiasis G. Chagas Disease H. Giardia lamblia I. Dengue fever J. Mucocutaneous Leishmaniasis K. Plasmodium vivax ```

An African woman and her 33 year-old husband come to their doctor because she is worried that he is not as alert as he used to be. On examination, he has non-tender lymphadenopathy, hepatomegaly and marked CNS abnormalities. He is noted to be quite lethargic. ``` A. Schistosoma mansoni B. Pneumocystis carinii C. Salmonella typhi D. Trypanosoma brucei gambiense E. Mycobacterium leprae F. Plasmodium falciparum G. Leishmania donovani H. Trypanosoma brucei rhodesiense I. Hepatitis B virus J. Wuchereria bancrofti K. Schistosoma haematobium ```

Correct D. Trypanosoma brucei gambiense Wucheria bancrofti is characterised by the detection of microfilariae in peripheral blood, marked eosinophilia and symptoms affecting the lymph nodes. Leishmania donovani (visceral leishmaniasis) is an opportunistic infection in HIV leading to prolonged fever, splenomegaly, leukopenia and hypergammaglobulinaemia. Pancytopenia may also occur. Patients present with fatigue, weight loss, dizziness, cough and diarrhoea. An uncommon feature is xerosis (rough dry skin). In contrast, pneumocystis carnii infection presents with a non- productive cough, fever and dyspnoea. In the 1% of patients with extrapulmonary disease, unexplained lymphadenopathy, hepatosplenomegaly and choroid lesions in the absence of intraocular inflammation may be found. For Schistosoma mansoni vs hematobium see attached file

A thin peripheral blood film from a 59 year-old female demonstrates eosinophilia and microfilariae. On examination, the skin overlying her superficial lymph nodes is streaky red and tender. ``` A. Schistosoma mansoni B. Pneumocystis carinii C. Salmonella typhi D. Trypanosoma brucei gambiense E. Mycobacterium leprae F. Plasmodium falciparum G. Leishmania donovani H. Trypanosoma brucei rhodesiense I. Hepatitis B virus J. Wuchereria bancrofti K. Schistosoma haematobium ```

Correct J. Wuchereria bancrofti Wucheria bancrofti is characterised by the detection of microfilariae in peripheral blood, marked eosinophilia and symptoms affecting the lymph nodes. Leishmania donovani (visceral leishmaniasis) is an opportunistic infection in HIV leading to prolonged fever, splenomegaly, leukopenia and hypergammaglobulinaemia. Pancytopenia may also occur. Patients present with fatigue, weight loss, dizziness, cough and diarrhoea. An uncommon feature is xerosis (rough dry skin). In contrast, pneumocystis carnii infection presents with a non- productive cough, fever and dyspnoea. In the 1% of patients with extrapulmonary disease, unexplained lymphadenopathy, hepatosplenomegaly and choroid lesions in the absence of intraocular inflammation may be found. For Schistosoma mansoni vs hematobium see attached file

A 43 year-old Asian male with AIDS presents with a prolonged fever, dizziness and a persistent cough. On examination, he is found to have marked splenomegaly and rough, dry skin. Blood results reveal pancytopenia. ``` A. Schistosoma mansoni B. Pneumocystis carinii C. Salmonella typhi D. Trypanosoma brucei gambiense E. Mycobacterium leprae F. Plasmodium falciparum G. Leishmania donovani H. Trypanosoma brucei rhodesiense I. Hepatitis B virus J. Wuchereria bancrofti K. Schistosoma haematobium ```

Correct G. Leishmania donovani Wucheria bancrofti is characterised by the detection of microfilariae in peripheral blood, marked eosinophilia and symptoms affecting the lymph nodes. Leishmania donovani (visceral leishmaniasis) is an opportunistic infection in HIV leading to prolonged fever, splenomegaly, leukopenia and hypergammaglobulinaemia. Pancytopenia may also occur. Patients present with fatigue, weight loss, dizziness, cough and diarrhoea. An uncommon feature is xerosis (rough dry skin). In contrast, pneumocystis carnii infection presents with a non- productive cough, fever and dyspnoea. In the 1% of patients with extrapulmonary disease, unexplained lymphadenopathy, hepatosplenomegaly and choroid lesions in the absence of intraocular inflammation may be found. For Schistosoma mansoni vs hematobium see attached file

A 5 year-old girl presents unconscious and unrousable. Neck rigidity is not present and kernig’s sign is negative. She dies 3 hours after presentation. ``` A. Severe malaria B. Giadiasis C. Visceral leishmaniasis (kala-azar) D. Miliary tuberculosis E. Cutaneous leishmaniasis F. Trypanosomiasis G. Brain worm H. Trichuris trichiura I. Chagas disease J. Amoebic dysentery K. Pulmonary tuberculosis ```

Correct A. Severe malaria

A 20 year-old man presents with a persisting intermittent fever which began whilst he was travelling in South America the previous week. He has a dry cough and a massively enlarged spleen. Sandfly parasites are detected in a spleen aspirate. ``` A. Severe malaria B. Giadiasis C. Visceral leishmaniasis (kala-azar) D. Miliary tuberculosis E. Cutaneous leishmaniasis F. Trypanosomiasis G. Brain worm H. Trichuris trichiura I. Chagas disease J. Amoebic dysentery K. Pulmonary tuberculosis ```

Correct C. Visceral leishmaniasis (kala-azar)

A 16 yr old boy complains of a one week history of fever, muscle aches, nausea/vomiting/diarrhoea with general malaise following a trip to Zimbabwe visiting relatives. On further questioning he remembers developing an itchy rash on his right thigh following wading in Lake Kariba whilst on holiday. O/E He has generalised lymphadenopathy with hepatosplenomegaly. Initial blood tests reveal raised WCC with eosinophillia. ``` A. Loa-Loa B. Toxoplasma gondii C. Leishmania donovani D. Clonorchis sinensis E. Trichinella spiralis F. Schistosoma mansoni G. Enchinococcus granulosus H. Taenia saginata I. Entamoeba histolytica J. Ancylostoma duodenale K. Giardia lamblia L. Plasmodium falciparum M. Wucheria bancrofti ```

Correct F. Schistosoma mansoni

A 32 yr old female complaining of the presence of small pale bodies in her stools on a number of occasions. On further questioning she admits some occasional mild epigastric pain over the past 4/12. O/E she appears clinically well. There is no significant travel history. ``` A. Loa-Loa B. Toxoplasma gondii C. Leishmania donovani D. Clonorchis sinensis E. Trichinella spiralis F. Schistosoma mansoni G. Enchinococcus granulosus H. Taenia saginata I. Entamoeba histolytica J. Ancylostoma duodenale K. Giardia lamblia L. Plasmodium falciparum M. Wucheria bancrofti ```

Correct H. Taenia saginata

A 40 yr old Indian lady who was vacationing in the UK presented with fever which followed no particular pattern, vomiting and the production of brown-black urine. ``` A. American trypanosomiasis B. Falciparum malaria C. Vivax malaria D. Ameobiasis E. Cryptosporidiosis F. Visceral Leishmania G. Giardiasis H. Toxoplasmosis I. Trichomoniasis J. African trypanosomiasis K. Babesiosis ```

Correct B. Falciparum malaria

An 18 yr old boy presented with diarrhoea, anorexia abdominal discomfort and distension. He noted that he had been passing pale, fatty stools. He had been back-packing in North America. Both cysts and trophozoites were present on stool examination. ``` A. American trypanosomiasis B. Falciparum malaria C. Vivax malaria D. Ameobiasis E. Cryptosporidiosis F. Visceral Leishmania G. Giardiasis H. Toxoplasmosis I. Trichomoniasis J. African trypanosomiasis K. Babesiosis ```

Correct G. Giardiasis

A 10 year old girl presents with fever, hepatomegaly, splenomegaly and anaemia. She recently emigrated from the Sudan. Her mother tells you that 6 months ago the girl developed dark patches on her hands and forehead. ``` A. Trypanosoma rhodesiense B. Trypanosoma gambiense C. Cryptosporidium parvum D. Trypanosoma cruzi E. Entamoeba histolytica F. Leishmania donovani G. Naegleria fowleri H. Giardia lamblia I. Plasmodium falciparum J. Toxoplasma gondii K. Trichomonas vaginalis ```

Correct F. Leishmania donovani

An 18 month old girl from Brazil sees you whilst on a short holiday in Britain. Her parents are worried because she appears to have had fever for the last few weeks, seems more tired and out of spirits than usual, has loss of appetite, vomiting and diarrhoea and complains of pains in her legs. On examination she has general lymphadenitis and non-pitting oedema in her legs and feet. Her Machado-Guerreiro test is positive. ``` A. Trypanosoma rhodesiense B. Trypanosoma gambiense C. Cryptosporidium parvum D. Trypanosoma cruzi E. Entamoeba histolytica F. Leishmania donovani G. Naegleria fowleri H. Giardia lamblia I. Plasmodium falciparum J. Toxoplasma gondii K. Trichomonas vaginalis ```

Correct D. Trypanosoma cruzi

A prematurely born 1 week old infant presented with microcephaly, chorioretinitis and vesicular skin lesions. He also had non-specific features of fever, irritability and failure to feed. ``` A. Hepatitis B B. Viral meningitis C. Bacterial meningitis D. Neonatal HSV infection E. Chlamydial ophthalmia F. Bordetella pertussis G. Congenital rubella syndrome H. Listeria I. Congenital toxoplasmosis J. Group B streptococci K. Chickenpoc (VZV) L. E. coli ```

Correct D. Neonatal HSV infection

19 year old woman presents with cervicitis, erythema and oedema. Cultures were unable to be grown with agar but were subsequently grown using tissue medium. ``` A. Syphilis B. Bacterial vaginosis C. Hepatitis C D. Neisseria gonorrhoea E. HIV F. Trichomoniasis vaginal infection G. Chlamydia trachomatis ```

Correct G. Chlamydia trachomatis

A neonate is referred and presents with skin lesions, lymphadenopathy and failure to thrive. ``` A. Non-specific vaginosis B. HIV C. Gonorrhoea D. Tetracycline E. Metronidazole F. Trichomonas vaginalis G. Calymmatobacterium granulomatis H. Chlamydia I. Genital warts J. Haemophilus ducreyi K. Acyclovir L. Lymphogranuloma venerum M. Erythromycin N. Chancroid O. Oral fluconazole P. Syphilis ```

Correct P. Syphilis

A 22-year old male medical student is prescribed erythromycin after presenting with mucopurulent discharge. No gram negative organisms seen. ``` A. Non-specific vaginosis B. HIV C. Gonorrhoea D. Tetracycline E. Metronidazole F. Trichomonas vaginalis G. Calymmatobacterium granulomatis H. Chlamydia I. Genital warts J. Haemophilus ducreyi K. Acyclovir L. Lymphogranuloma venerum M. Erythromycin N. Chancroid O. Oral fluconazole P. Syphilis ```

Correct H. Chlamydia

Questions answered poorly Flashcards

(231 cards)