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Question

Which SIDS pathology is depicted in this histopathological slide? [1]

Answer 1

Persistent haemopoiesis in the liver

Answer 2

Unknown - lung petechiae are suggestive of SIDS

Answer 3

What is this patient presenting with, based off the ECG? Hypokalaemia **Hyperkalaemia** - tall tented T waves Hypothermia Hypocalcaemia Hypercalcaemia

Answer 4

Surina Folkes, 22, has a history of Crohn's disease. She presents to her GP with fatigue, shortness of breath on exertion in addition to pins and needles in her fingers. On examination, she is noticed to have pale conjunctiva and atrophic glossitis. As part of her work-up, you send off a set of bloods which reveal the following results: Hb 80 (g/l) MCV 120 (82-100 fl) Ferritin 100 (20-230 ng/ml) What is the most likely diagnosis? **Vitamin B12 deficiency** Crohn's disease often affects the terminal ileum where vitamin B12 is absorbed. It may, therefore, cause a deficiency which presents with macrocytic anaemia. Notably, B12 is also important in maintaining the nervous system so a deficiency may present with neurological symptoms. Iron deficiency anaemia Anaemia of chronic disease Sideroblastic anaemia Folate deficiency

Answer 5

A 32-year-old lady consults her GP because she is worried that her periods have been very heavy and painful recently. She has a past medical history of type 1 diabetes. She also states that her mood has been low recently and she has put on some weight. Which of the following blood results is most likely to be low? **T4** Hypothyroidism is a recognised cause of menorrhagia or abnormally heavy bleeding during menstruation. There is an association between autoimmune hypothyroidism (Hashimoto's thyroiditis) and other autoimmune diseases, such as this lady's Diabetes Type 1. She also has signs suggesting hypothyroidism such as low mood and weight gain. The correct answer is, therefore, T4, which would be low in hypothyroidism. Total iron binding capacity Testosterone TSH Folate

Answer 6

This 50-year-old man presents with abdominal pain. Abdominal x-ray shows small bowel dilatation. Contrast-enhanced CT is performed with selected images shown. What is the most likely diagnosis? Amyand hernia De Garengeot hernia **femoral hernia** direct inguinal hernia indirect inguinal hernia obturator hernia

Answer 7

This 50-year-old man presents with abdominal pain. Abdominal x-ray shows small bowel dilatation. Contrast-enhanced CT is performed with selected images shown. What is the most likely diagnosis? Amyand hernia De Garengeot hernia femoral hernia direct inguinal hernia **indirect inguinal hernia** obturator hernia

Answer 8

Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis? De Garengeot hernia femoral hernia direct inguinal hernia **indirect inguinal hernia** Inferior epigastric vessels medial to hernial neck (arrowhead) are visible obturator hernia

Answer 9

Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis? De Garengeot hernia femoral hernia **direct inguinal hernia** anguinal hernia (arrow), which passes medially to inferior epigastric ar tery and vein (arrowhead) indirect inguinal herni obturator hernia

Answer 10

Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis? De Garengeot hernia femoral hernia **direct inguinal hernia** T image shows par t of bladder (arrow) is contained within direct lef t inguinal hernia medial to inferior epigastric neurovascular bundle (arrowhead) indirect inguinal hernia obturator hernia

Answer 11

What type of hernia would it be if came out at the *? De Garengeot hernia **femoral hernia** direct inguinal hernia indirect inguinal hernia obturator hernia

Answer 12

A: direct hernia

Answer 13

What of the following depicts the inferior epigastric arteries Solids arrows **Open arrows** Curved arrows Arrowheads

Answer 14

What of the following depicts the deep inguinal ring Solids arrows Open arrows **Curved arrows** Arrowheads

Answer 15

What of the following depicts the deep inguinal ring Solids arrows Open arrows Curved arrows **Arrowheads**

Answer 16

What of the following depicts the inguinal ligament **Solids arrows** Open arrows Curved arrows Arrowheads

Answer 17

Sigmoid volvulus Grossly-dilated loop of large bowel has a 'coffee-bean shape' and the descending colon tapers in its inferior portion in keeping with a sigmoid volvulus. Air-fluid levels on erect projection.

Answer 18

Sigmoid volvulus Grossly-dilated loop of large bowel has a 'coffee-bean shape' and the descending colon tapers in its inferior portion in keeping with a sigmoid volvulus. Air-fluid levels on erect projection.

Answer 19

A 64-year-old lady with a BMI of 37 presents to you complaining of incontinence. She has previously had two children, both were delivered vaginally and the first required forceps due to slow progression of the second stage of labour. She takes no regular medication and has no other significant past medical history. Given her risk factors, which type of urinary incontinence is she most likely to suffer from? Overflow incontinence Mixed inctontinence Urge incontinence **Stress incontinence** Due to her previous forceps delivery, she is most likely to be suffering from stress incontinence. Stress incontinence is the loss of urine associated with a rise in intra abdominal pressure such as coughing or sneezing. Risk factors include increasing age, traumatic vaginal delivery, obesity, and previous pelvic surgery.

Answer 20

A 76-year-old gentleman with a history of primary hypothyroidism attends his GP for the first time in many years for a routine check-up. He divulges that he has not been complying fully with his levothyroxine therapy as he sometimes cannot make it to a pharmacy to refill his prescription. Which of the values below is most likely to be low in this gentleman? Mean cell volume (MCV) LDL Cholesterol **Core temperature** TSH Body mass index

Answer 21

Which of these pathologies would cause a high anion gap metabolic acidosis? Diarrhoea **Methanol poisoning** Emesis Renal tubular acidosis

Answer 22

A 55-year-old overweight man with a background of type 2 diabetes presents to the GP with tiredness. He is otherwise well and does not smoke or drink alcohol. Bloods reveal an elevated ALT and AST. The rest of his blood results are normal. An ultrasound scan of his liver is reported as 'echobright' with no focal areas of abnormality. What is the most likely diagnosis? Hepatocellular carcinoma Pancreatic cancer Gilbert's syndrome **Non-alcoholic fatty liver disease** This patient is middle aged, overweight and has type 2 diabetes. This puts him at risk of non-alcoholic fatty liver disease (NAFLD), which causes raised liver transaminases (ALT and AST) and otherwise normal bloods. The only way to distinguish this from alcoholic liver disease is the alcohol intake and, as this patient does not drink, it suggests that NAFLD is the diagnosis. Management is through risk factor modification which would include weight loss. If NAFLD is not managed, it leads to a risk of developing hepatocellular carcinoma. This gentleman's ultrasound, however, only showed the early 'echobright' stage of NAFLD and no evidence of any masses. Acute viral hepatitis

Answer 23

**gliclazide**: Gliclazide is an insulin secretagogue, increasing the amount of endogenous insulin produced. Sometimes too much Insulin can be secreted, resulting in hypoglycaemia Metformin is an insulin sensitiser and therefore makes the amount of insulin in the body more effective. While metformin reduces average blood sugars it very rarely causes hypoglycaemia. Therefore reducing the offending drug, gliclazide, is the most appropriate management option.

Answer 24

Most patients have a history of an **upper respiratory tract infection** and, either at the onset or within the first 24-48 hours, there is **gross haematuria that lasts for less than three days**. The urine is red or brown and there may also be loin pain

Answer 25

A 32-year-old male presents to the emergency department with bilateral flank pain and red coloured urine. Approximately five days ago he experienced a sore throat with nasal discharge. He has no pertinent family medical history and no chronic medical problems. He denies smoking and is an occasional alcohol drinker. Review of systems is unremarkable. His observations are as follows: Blood pressure: 125/65 mmHg Pulse: 88 BPM Temperature: 37.4 °C Respiratory rate: 15 breaths per minute On physical examination, he has bilateral mild flank tenderness but the remainder of the physical examination is normal. Laboratory investigations demonstrate a normal full blood count and chemistry panel. The urine dipstick is positive for blood and protein but shows no signs of white blood cells or nitrites. Further examination of the urine reveals red blood cell casts. A CT KUB scan of the abdomen and pelvis in the emergency department is also normal. What is the most likely diagnosis? **IgA nephropathy** Alport syndrome Minimal change disease Acute post-streptococcal glomerulonephritis Kidney stones

Answer 26

Biliary colic Ascending cholangitis Liver cirrhosis Hepatic carcinoma **Primary biliary cirrhosis** Ascending cholangitis would typically have fever and pain Malignancy would usually feature weight loss and general malaise Biliary colic would feature pain This leaves two potential diagnoses: primary biliary cirrhosis or liver cirrhosis. There are no risk factors for liver cirrhosis and her LFTs do not show a hepatitic pattern of derangement (AST, ALT, bilirubin, albumin all normal). The raised ALP and GGT suggest a cholestatic picture, making primary biliary cirrhosis (also known as primary biliary cholangitis) the most likely diagnosis

Answer 27

Pancake kidney

Answer 28

Pancake kidney

Answer 29

Horseshoe kidney

Answer 30

Polycystic kidney disease

Answer 31

Polycystin gene

Answer 32

Abdominal CT showing **polycystic kidneys**

Answer 33

A: **mesonephric bud** B: **uteric bud**

Answer 34

What type of renal pathology is depicted here? IgA neuropathy Membrane change disease Glomerulonephritis **Acute rejection from kidney transplant** Focal glomerulitis in active antibody mediated rejection-Banff score g3. Dilated glomerular capillaries are filled with swollen endothelial cells and inflammatory cells (PAS, 200×).

Answer 35

Inflammatory cells (arrows) infiltrate the intima in intimal arteritis, due to **acute cell mediated rejection**

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