Difficult Past Questions Flashcards
1
Q
How to monitor activity of SLE
A
C3 and C4 levels
2
Q
Biologic in psoriasis
A
Ustekinemab (also anti-TNF if psoriatic arthritis)
3
Q
DMARD for Wegener’s
A
Cyclophosphamide
4
Q
Biologic for Chronic Granulomatous Disease
A
IFN-gamma
5
Q
Non-neutralising antibodies formed against this HIV protein
A
p24
6
Q
Deficiency in these complements increases encapsulated organisms
A
C5-9
7
Q
Patient involved in trauma and transfused with O negative blood –> he lost consciousness a few minutes after the transfusion
A
Splenic Haemorrhage (NOT ABO as O-ve!!)
8
Q
Antithrombin III deficiency
A
VTE runs in family
9
Q
Normal Hb with positive sickle solubility test
A
Sickle trait
10
Q
Diagnosis of C. diff
A
Toxin ELISA (not culture)
11
Q
STI that can cross placenta in 3rd trimester
A
Syphillis
12
Q
Bloody discharge from nipple –> mammogram does not show any lesions
A
Intraductal Papilloma
13
Q
Thyroid cancer associated with Ret mutation
A
Medullary
14
Q
Thyroid cancer associated with calcitonin staining
A
Medullary
15
Q
Rate-limiting enzyme in haem synthesis
A
ALA synthase
16
Q
Raised calcium and normal PTH
A
Primary hyperparathyroidism (inappropriately normal PTH!)
17
Q
Definition of Impaired Glucose Tolerance
A
7.8 – 11.1mM
18
Q
Stellate mass with fibrosis
A
Radial scar
19
Q
Lump containing epithelium cells
A
Intraductal papilloma
20
Q
Gene affected in FAP
A
APC gene
21
Q
“Child presenting with a mass in abdomen”
A
Wilm’s Tumour
22
Q
What are seen in Haversian lacunae?
A
Osteocytes
23
Q
Smoker with raised parathyroid-related polypeptide
A
Squamous Cell
24
Q
Investigation for hypotonia and hypoglycaemia in young child
A
Ketones
25
Oedema -- pic shows red cell casts
Acute glomerulonephritis
26
Hypoglycaemia in neonates
<2.5
27
Hypothyroid --> confused/drowsy
Myxoedema coma (too hypothyroid)
28
Vitamin deficient in Beri Beri
B1
29
Immune cells which migrate to germinal centre
Dendritic Cells (APCs)
30
Biologic used in ankylosing spondylitis
Anti-TNF --> anti-IL-17
31
Cellular-mediated rejection vs GVHD
```
Cell-mediated = T cells against donor
GVHD = T cells against host
```
32
Blood product to use if you want to avoid allergic reactions (e.g. donor allergic to proteins)
Washed RBCs = most of plasma, platelets and WBCs removed
33
Changes in pregnancy
Volume 50% increase
Red cell mass increases
Hb decreases (11 minimum)
WBC increases
34
Acute Promyelocytic Leukaemia key features (including translocation)
t(15;17)
| Responds to all-trans retinoic acid
35
Gram positive showing increased resistance to vancomycin and teicoplanin
Enterococcus
36
Cervicitis and discharge
Chlamydia
37
Normal skin pathogen with low pathogenicity
Staph epidermis
38
Infection where baby only affected if mum infected <20 weeks (causes hydrops fetalis)
Parvovirus B19
39
Infection where baby can be asymptomatic initially, but then get problems
Beta herpesvirus (HHV6/7)
Also toxoplasmosis
Also HIV
40
Cause of aseptic meningitis
90% caused by enterovirus = Coxsackie Group B and Echovirus
41
Treatment of pseudomonas
Ceftazidime
42
Glycopeptide used to treat MRSA
Vancomycin
43
DNA synthesis inhibitor used to treat Pseudomonal infections but bad against anaerobes
Ciprofloxacin
44
Lady with discharge, no other symptoms, and causative infection found on wet slide microscopy
Bacterial Vaginosis (gardnerella vaginalis)
45
Positive urinary NAAT test
Chlamydia
46
Neonatal meningitis, Gram positive chains
Group B streptococcus
47
Organism targeted by vaccine: virus that resides in pharynx and GIT - 1:100 encephalitis, 1:1000 destruction of motor neurons
Poliovirus
48
Organism targeted by vaccine: maculopapular rash that starts on face --> can cause encephalitis and pneumonitis
Measles
49
Organism targeted by vaccine: lockjaw
Clostridium tetani
50
Mass after acute pancreatitis
Pancreatic pseudocyst
51
Pancreatic mass and hypoglycaemia
Insulinoma
52
Pancreatic cancer which metastasises to liver
Tumours in the tail and the body of the pancreas
53
What deposits in kidneys in Multiple Myeloma?
AL amyloid
54
Barrett's changes
Stratified squamous to simple columnar
55
Radiosensitive testicular cancer in young man
Seminoma
56
Cancer associated with chronic schisto infection
SCC bladder cancer
57
Deaf and bowed legs
Paget's
58
Post-MI: blood aspirated from pericardium
Cardiac tamponande
59
Treats lymphoma and rheumatoid
Anti-CD20 (rituximab)
60
Used to prevent transplant rejection, by blocking T cell proliferation and activation
Anti-CD25 (part of IL-2Rα) = basiliximab
61
Kill of cancerous cells and are inhibited by MHC-I
NK Cells
62
Mutation in FAS Pathway
ALPS = Autoimmune Lymphoproliferative Syndrome
| -lymphocytes don't apoptose --> HIGH lymphocytes
63
Philadelphia chromosome with 70% blasts
AML crisis
64
Tear drop poikilocytes and Jak2 mutation
Myelofibrosis
65
Pregnant with platelets 100 in 3rd trimester, no other problems
Gestational thrombocytopenia
66
INR target in AF
2.5
67
INR target for treatment of VTE
2.5
68
INR target in prosthetic heart valve
2.5
69
INR target in recurrent VTE/VTE whilst on anticoags
3.5
70
Cause of Pellagra
B3 deficiency --> dementia, diarrhoea, dermatitis
71
A man after a road traffic accident (Man vs Car) requires a 6 unit transfusion, and then becomes acutely breathless/SOB, with a fever and tachycardia
Transfusion related lung injury (TRALI)
72
A man has had (a diagnosis of) beta thalassemia since 13 months of age. (?and receives regular transfusions?). He presents to an outpatient clinic with malaise and erectile dysfunction
Transfusion associated haemosiderosis
73
Immunoglobulin raised in multiple myeloma
IgG paraprotein
74
Patient with IgM paraprotein and visual disturbances
Lymphoplasmocytic lymphoma (a.k.a. Waldenstrom’s macroglobinaemia).
75
An overweight individual with diabetes has longstanding bone/back pain. They are found to have paraprotein IgA ~8g/dl, and GFR 55mls/min/1.73m^2. FBC normal and albumin normal.
Monoclonal gammopathy of unknown significance
| -as IgA < 30
76
An elderly gentleman has really really elevated ALP on it’s own, and the other results are normal. He also reports a history of headaches.
Paget’s (headaches = frontal bossing)
77
Used for mild CAP caused by HiB
Amoxicillin
78
Treatment of listeria meningitis
Amoxicillin 21 days + gentamycin 7 days
79
Which type of cancer develops in Barrett’s?oesophagus?
Adenocarcinoma
80
What happens to the body of the stomach in a patient with pernicious anaemia?
Atrophy (atrophic gastritis)
81
Most common type of malignancy in the breast
Invasive ductal carcinoma (75% breast cancer)
82
Most common type of non-invasive breast cancer
DCIS
83
Breast cancer with E-cadherins
Invasive ductal carcinoma
84
Breast cancer without E-cadherins
Invasive lobular carcinoma
85
Breast cancer which has a high, medium and low stage to it.
Ductal carcinoma in situ
86
Enzyme raised in mumps
Amylase-S (S for salivary glands)
87
Enzyme raised in pancreatitis
Amylase-P (P for pancreas)
88
Defiency in this enzyme leads to high urate/Lesch-Nyhan
HGPRT
89
Best antibody for Sjogren's
Anti-La (La = "the" best)
90
A man presents with the symptoms of a UTI and acute onset costovertebral pain. He is found to have pus cells and blood in his urine. What is the most likely cause?
Acute Pyelonephritis
91
Most common cause of thrombocytopenia in pregnancy
Gestational thrombocytopenia (70% of thrombocytopenias in pregnancy)
92
Normal change in pregnancy
Increased fibrinogen
93
Man, ex-smoker, with history of hypertension and MI, has sudden chest pain which radiates to the neck
Descending internal carotid thrombus
94
Gram positive rod causing meningitis in a 72 year old
Listeria monocytogenes
95
What cancer can the Bruton tyrosine kinase inhibitor ibrutinib be used in?
Chronic lymphoblastic leukaemia (CLL)
| -imatinib is used in CML!
96
A Rhesus D negative woman is having a Haematopoietic stem cell transplant (HSCT) and is CMV IgG negative. What is the most important thing to ensure in the transplant?
CMV IgG negative
97
HIV RNA forms HIV, via which error prone enzyme?
Reverse transcriptase
98
Which of these vaccines must not be given to a pregnant woman:
a. MMR
b. Hep B
c. DTP
MMR (as contains live Rubella virus)
99
Cancer cells express TdT
ALL (this trumps genetic tests i.e. t9;22 and TdT = ALL!)
100
Which of these is a common finding in someone who has portal hypertension?
a. Splenomegaly
b. Hepatomegaly
c. Spider Naevi in distribution of Superior vena cava (SVC)
d. Hand flapping
e. Jaundice
Splenomegaly
101
Itchiness of the skin is likely to be a feature of one of the following?
a. Hepatitis
b. intravascular haemolysis
Hepatitis
102
The wall of vessels expresses anti-thrombotic factors why is this?
a. Because it secretes Tissue factor
b. Because it secrete Thrombomodulin
c. Because it secretes Von Willebrand factor
Thrombomodulin (cofactor in the thrombin-induced activation of protein C in the anticoagulant pathway)
103
Which vector transmits Trypanosoma brucei rhodesiense?
Tsetse Fly
104
Which vector transmits Leishmaniasis?
Sandfly
105
What does the number of True positives divided by the total number who have the disease describe?
Sensitivity
106
Which of these can cause peri/neonatal illness without causing damage to the foetus if the mother is infected antenatal?
a. Cytomegalovirus (CMV)
b. Herpes Simplex Virus (HSV)
c. Enterovirus
d. Varicella Zoster Virus (VZV)
e. Rubella
Enterovirus
107
Most common cause of HAP
Pseudomonas
108
Which feature is characteristic of acute lymphoblastic anaemia (ALL) –
a. anaemia and thrombocytopenia
b. neutropenia
c. macrocytosis
d. raised lymphocytes
Neutropenia (CLL = granulocytopenia)
109
Name an infectious microorganism which is a common cause of meningitis in 3 months or older new-borns?
Neisseria (or strep)
110
Hyperthyroid - good uptake vs poor uptake
Good uptake = Graves
| Poor uptake = De Quervain's
111
An elderly man has a fall, and doesn’t become unconscious/lose consciousness, and presents two days later with a confusion, where is the likely site of bleeding?
Subdural (not extradural as should have loss of conscious --> lucid --> EXTRA loss of conscious)
112
Person who had negative direct coombs test but who has anaemia and jaundice
Paroxysmal nocturnal hemoglobinuria, MAHA, drugs
113
Which clotting factor falls most rapidly after administering warfarin?
Factor VII (shortest half-life, then Protein C)
114
Biomarker in medullary thyroid cancer
Calcitonin
115
A patient required an aortic valve replaced 3 months ago. They have now come back a few weeks later with jaundice, haemoglobinuria, and raised reticulocytes.
Mechanical Haemolytic Anaemia (non-immune)
116
Which common condition can be treated with drugs that target with TNF, IL-17 and IL-12/23?
Psoriasis
117
Which vasculitis cases a disease in which a branch of the external carotid is affected?
Giant Cell Arteritis (affects big vessels, like aorta)
118
Type of amyloidosis in multiple myeloma
AL amyloidosis
119
Name the main class of drug used to treat HIV
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
120
What zoonotic disease does the Ixodes Tick cause?
Lyme disease
121
Breast cancer also known as "no specific type"
Invasive ductal carcinoma
122
Treatment of hyperviscosity in myeloma
Plasmapheresis
123
Treatment of hypercalcaemia in myeloma
Bisphosphonates
124
How to monitor unfractionated heparin
APTT
125
How to monitor LMWH
None needed! (as reliable pharmacokinetics)
126
Soldier returning from Afghanistan has a small ulcer on right ring finger that won’t heal and keeps getting bigger
Cutaneous Leishmaniasis
127
"Snail-trail" oral ulcer
Treponema pallidum (syphilis)
128
Infection with abdo pain and headache but specifically NO diarrhoea
Salmonella typhi
129
Disease that requires rapid vaccination at birth/immunoglobulins if mother is highly infectious.
Hepatitis B
130
• Disease that require C-section if mother has an outbreak at 34wks or later due to risk of transmission vaginally
Genital Herpes Simplex (greatest risk is within 6 weeks of delivery)
131
Immunodeficiency with common gamma chain problem
X-linked SCID
132
Traveller's Diarrhoea (full name, not abbreviated)
Enterotoxigenic E. coli
133
Enzyme responsible for gout
Xanthine Oxidase
134
Most common virus causing aseptic meningitis?
Enterovirus
135
15yo child with brain tumour extending outwards from cerebellum and invading subarachnoid space. Signs of ataxia.
Medulloblastoma
136
Publican with diabetes, fatty stools, weight loss, ‘slate grey skin’ and joint pains.
Haemachromatosis
137
What is the minimum amount of time to treat a VTE?
3 months
138
Enzyme confirms heart failure
Brain Natriuretic Peptide
139
Liver enzyme raised in MI
Aspartate aminotransferase
140
Lady with Multiple myeloma and restrictive cardiomyopathy. What will you see on heart biopsy?
AL amyloid deposition
141
Previous IVDU man is given Rituximab - CHOP treatment for Non-Hodgkin’s lymphoma. He later 8 months later develops fulminant liver failure and dies. Why?
Hep B reactivation from Rituximab +/- Hep D co-infection
142
White things on the oesophagus seen in OGD of an alcoholic man with recurrent bleeding varices.
Candidiasis
143
Lady who went to Mexico and ate unpasteurized dairy. 4 weeks later unwell. Which gram -ve rod caused this?
Brucella (long incubation period)
144
IBD with aphtous ulcers
Crohn's
145
Non-Tuberculous mycobacterium on cut on hand in a man who cleaned a fish tank
Mycobacterium marinum
146
Test to determine cause of haemolytic anaemia
Direct Antiglobulin Test
147
Types of oesophageal cancer
Developed: adenocarcinoma
Developing: SCC
148
Most common gastric cancer type
Adenocarcinoma (90%)
149
Treatment for CLL with p53 mutation
Ibrutinib Bruton TKI
150
MAHA - DAT +ve or -ve?
-ve
151
Electrolyte raised in red cell lysis (Na, K, Ca, bicarb...)
Potassium
152
```
What is low during pregnancy?
• Fibrinogen
• Factor 7 (or 8?)
• Protein S
• Plasminogen activator inhibitor 1
• Von willebrand’s factor
```
Protein S (anticoagulant)
153
```
How does a melanoma spread?
• Lymphoid
• Haematological
• Perineural
• Iatrogenic
• Transcoelomic
```
Lymphoid first usually
154
Man has just been started on allopurinol and now has ulcers of mucus membranes
Stevens-Johnsons Syndrome
155
Enlarging fibroepithelial mass in woman >50, potentially aggressive, can arise with pre existing fibroadenoma
o ‘Proliferation of fibroepithelium and stromal tissue’
Phyllodes Tumour
156
Bowel polyps not associated with increased cancer risk
Hamartomatous
157
"Optic nerve tumour excised and now lump on hand"
Neurofibromatosis 1 (lump = neurofibroma)
158
"Epileptic with patch on back and lumps in brain"
Tuberous Sclerosis
159
"Mass under dura mater compressing frontal lobe"
Meningioma
160
"Ship worker with pleural plaques"
Asbestosis
161
Causes Meig’s syndrome
Ovarian Fibroma
162
"Thalassaemia patient who looks tanned and has diabetes"
Transfusion haemosiderosis
163
Rheumatoid arthritis patient with mycobacterial infections
TNF antagonists
164
Marker of antibody mediated rejection
C4d
165
AIRE mutation
APS1/APECED
166
Hypersensitivity type in serum sickness
Type III
167
Hypersensitivity type in atopic dermatitis
Type I
168
Travel vaccine not given to someone with ank spond on anti-TNF
Yellow Fever
169
Amantadine targets this
M2 channel
170
What vaccine type is Hep B?
Conjugate
