Formative Assessments 1 Flashcards
What is the name of the main effector cell in acute inflammation?
Neutrophil Polymorph
What is the name of cells that produce collagen in fibrous scarring?
Fibroblasts
Which of the following is an example of acute inflammation? A. Glandular fever B. Leprosy C. Appendicitis D. Tuberculosis
A. Glandular fever B. Leprosy = chronic inflammation *C. Appendicitis = correct * D. Tuberculosis = chronic inflammation
What crystals are deposited in joints in gout?
Uric Acid crystals
In which of the following does granulomatous inflammation occur?
*A. Crohn’s disease = correct * B. Acute appendicitis = acute inflammation C. Infectious mononucleoisis = chronic inflammation D. Lobar pneumonia = acute inflamm
Which of the following is a chronic inflammatory process from its start?
A. Appendicitis B. Cholecystitis C. Infectious mononucleosis = correct D. Lobar pneumonia
What is the name of the cells that produce antibodies
Plasma cells
Name a tumour that never metastasises?
Basal cell carcinoma of the skin
What is the name of a malignant tumour of striated muscle?
Rhabdomyosarcoma Rhabdo = striated Myo = muscle Sarcoma = malignant neoplasm of soft tissue
Which of the following tumours does not commonly metastasise to bone? A. Breast B. Lung C. Prostate D. Liposarcoma
*D. Liposarcoma = correct *
What term describes a cancer that has not invades through the basement membrane?
Carcinoma in situ (non invasive)
Which of the following is not a known carcinogen in humans? A. Hep C B. Ionising radiation C. Aromatic amines D. Aspergillus niger
*D. Aspergillus niger = correct*
What is the name of a benign tumour of fat cells?
Lipoma
What is the name of a malignant tumour of glandular epithelium?
Adenocarcinoma Adeno = glandular
True or false: A transitional cell carcinoma of the bladder is malignant?
True
True or false: A leiomyoma is a benign tumour of smooth muscle?
True
Is radon gas a cause of lung cancer?
yes
Which lifestyle factor is most likely to cause cancer? A. Drinking half a bottle of wine a day B. Being obese C. Running for 20 minutes twice a week D. Smoking 20 a day
*D. Smoking 20 a day = 26x risk *
Activation of naive T cells is best achieved by which antigen presenting cells? a) Neutrophils b) Mast cells c) Macrophages d) Dendritic cells
(d) dendritic cells Activation of naive T cells is best achieved by dendritic cells
What cell type is described below: Located exclusively in tissues, has an important role in both the innate and adaptive immune system, are antigen presenting cells and have phagocytic properties a) Macrophage b) Neutrophil c) Eosinophil d) Mast cell e) Fibroblast
(a) Macrophage Macrophages are located exclusively in tissues and they have an important role in both innate and adaptive immunity, are antigen presenting cells and have phagocytic properties
Which of the following is not involved in innate immunity? a) Anatomic barriers b) Phagocytic c) Inflammatory mechanisms d) Antibody production e) Skin
(d) Antibody production
T cells recognise antigens… a) In solution in plasma b) When presented on red blood cells c) Following presentation on antigen presenting cells d) In a 3-dimensional form e) Following presentation on pattern recognition receptors
(c) Following presentation on antigen presenting cells T cells recognise antigens following presentation on antigen presenting cells
Influenza vaccine is targeted towards ‘at risk’ groups in the UK. Which of the following are classified as ‘at risk’? a) Over 65 years b) 16 years old c) The obese of any age d) Teenagers e) Under 2 years old
(a and e) Over 65 and Under 2
Which of the following is administered as a live attenuated vaccine in the UK? a) Hepatitis A b) Measles, Mumps, Rubella c) Tetanus d) Flu e) Polio
b) Measles, Mumps, Rubella
Complements are the proteins that are involved in the clearance of antigen/bacteria. Which of the following is NOT part of the Elimination phase of complement activation? a) Opsonisation b) Target cell lysis c) Chemoattraction of leukocytes d) Production of interferons e) Phagocytosis
d) Production of interferons
Which of the following is a polysaccharide vaccine? a) anthrax vaccine b) Hib vaccine (Haemophilus influenza type c) rabies vaccine d) hepatitis A
(b) Hib vaccine
Which if the following are features of the adaptive immune response? a) Does not require prior contact with the pathogen b) It works with B and T lymphocytes c) Lacks specificity d) Distinguishes “self” from “non-self” e) Enhanced by complement
b) It works with B and T lymphocytes
What are the two types of immune response in humans? Immunological tolerance b) Immune surveillance c) Innate and acquired d) Intrinsic and extrinisic e) Overt and covert
(c) innate and acquired
Which of the following is not an organ-specific auto immune disease? a) Ulcerative colitis b) Type 1 diabetes mellitus c) Graves disease d) Hashimoto’s thyroiditis e) Sjogren’s syndrome
(a) ulcerative colitis
Which of the following is not a classical PAMP? a) peptidoglycan, found in bacterial cell walls; b) flagellin, a protein found in bacterial flagella; c) lipopolysaccharide (LPS) from the outer membrane of gram-negative bacteria; d) Interleukin 12 e) nucleic acids such as viral DNA or RNA.
(d) interleukin 12
Which of these is a gram negative bacillus that ferments lactose? A.Shigella sonnei B.Listeria monocytogenes C. Neisseria meningitidis D. Eschericia coli E. Streptococcus pyogenes
D. Eschericia coli
Which is incorrect? Haemophilus influenzae is an important cause of a). meningitis in pre-school children b). Otitis media c). Pharyngitis d). Gastroenteritis e). Exacerbations of Chronic Obstructive Pulmonary Disease (COPD)
d). Gastroenteritis
Which of the following is normally a sterile site? a). The pharynx b). The urethra c). Cerebrospinal fluid d). The lung e). Skin
c). Cerebrospinal fluid
Which of these is NOT a means by which viruses can cause disease? a).direct destruction of host cells b). cell proliferation and cell immortalisation c). inducing immune system mediated damage d). Endotoxin production e). modification of host cell structure or function
d). Endotoxin production
When diagnosing viral infections, which of the following is NOT true? a). The sample must come from a sterile site b). Electron microscopy is rarely used c). Use a green swab not a black swab d). PCR results take 1-2 days e). A detectable IgM in serum may be diagnostic
a). the sample must come from a sterile site
Which is the most accurate: the HIV virus envelope contains? a). RNA + capsid + DNA polymerase b). DNA + capsid + Reverse transcriptase c). DNA + p24 + protease d). RNA + capsid + reverse transcriptase
d). RNA + capsid + reverse transcriptase
Which pair is correct? a). Pityriasis versicolor = bacterium b). Ringworm = helminth c). Aspergillus fumigatus = mycobacterium d). Falciparum malariae = fungal e). Giardia lamblia = protozoal
e). Giardia lamblia = protozoal
Myocbacteria, which is not a feature? a). Resistance to destaining by acid and alcohol b). Cell wall contains lipoarabinomannan c). They only divide every 20 hours d). They cannot withstand phagolysosomal killing e). May cause meningitis
d). They cannot withstand phagolysosomal killing
Regarding antimicrobial resistance, which is true? a). it is spread by plasmid mediate gene transfer b). spontaneous gene mutations do not occur c). MRSA refers to vancomycin resistant S. aureus d). Only Mereopenem is effective against all gram negative bacteria
c). MRSA refers to vancomycin resistant S. aureus
Antimicrobials. Which pairing is incorrect? a). S. pyogenes : can use penicillin b). Meropenem : a carbapenem c). Glycopeptides : use for MRSA d). Co-amoxiclav : contains a Beta-lactamase inhibitor e). Cefuroxime : a macrolide
e). Cefuroxime : a macrolide
A 34 year old gay man who has had prolonged diarrhoea now presents short of breath with a dry cough and hypoxia. Which is most accurate? a). This is bacterial pneumonia caused by pneumocysitis jirovecii. b). It is too early for a 4th generation HIV test to be positive c). The CD4 T cell count will be between 500 and 750 d). Even if the HIV test is negative this man has AIDS e). With appropriate therapy he has a good prognosis
e). With appropriate therapy he has a good prognosis
Which of these does NOT feature in the definition of Sepsis? a). Temperature >38.3oC or <36oC b). Heart rate >90 c). Systolic blood pressure >130 d). White Cell count >12 e). Hypoxia
c). Systolic blood pressure >130
What is the role of the catalase test? A: identifies staph aureus B: identifies staph from non-staph C: identifies mycobacterium D: identifies fungi
B: identifies staph from non-staph
What is the role of coagulase test? A: identifies staph aureus B: identifies staph from non-staph C: identifies mycobacterium D: identifies fungi
A: identifies staph aureus
For which group of bacteria should you do an optochin test? A: alpha-haemolytic staph B: alpha-haemolytic strep C: beta-haemolytic strep D: enterococcus
B: alpha-haemolytic strep
Optochin +ve test: what is the bug? A: strep pneumoniae B: strep viridians C: strep pyogenes D: strep agalactiae
A: strep pneumoniae
Example of group A strep? A: strep pneumoniae B: strep viridians C: strep pyogenes D: strep agalactiae
C: strep pyogenes
Example of group B strep? A: strep pneumoniae B: strep viridians C: strep pyogenes D: strep agalactiae
D: strep agalactiae
Which of the following describes C. difficile? A: gram –ve bacilli B: gram –ve cocci C: gram +ve cocci D: gram +ve bacilli
D: gram +ve bacilli
Antibiotic for C. difficile A: amoxicillin B: cefotaxime C: carbapenem D: metronidazole
D: metronidazole
Which of the following is gram +ve diplococci on microscopy A: Neisseria gonorrhoea B: strep pneumoniae C: Moraxella catarrhalis D: mycobacterium tb
B: strep pneumoniae
Which of the following is gram -ve diplococci on microscopy A: Neisseria gonorrhoea B: strep pneumoniae C: Moraxella catarrhalis D: mycobacterium tb
A: Neisseria gonorrhoea
When is chocolate agar important? To culture: A: mycobacterium tb B: haemophilus influenza C: Treponema pallidum D: Not important, blood agar can be substituted
B: haemophilus influenza
MacConkey test – shows yellow, what possible bug? A: pseudomonas aeruginosa B: e.coli C: klebsiella pneumoniae
A: pseudomonas aeruginosa
MacConkey test – shows pink, what bug? A: pseudomonas aeruginosa B: staph aureus C: strep pneumoniae D: e.coli
D: e.coli
Which stain is needed for mycobacteria? A: Lowenstein-Jensen stain B: Methylene blue C: Oxidase purple D: Ziehl-Neelsen stain
D: Ziehl-Neelsen stain
Which of the following is not under the control of the pituitary gland? A. Thyroid B. Adrenal cortex C. Adrenal medulla D. Testis E. Ovary
C. Adrenal Medulla
Which of the following statements is false? A. The pituitary gland lies in the sella turcica B. The weight of the pituitary gland is around 0.5g C. ACTH is secreted from the pituitary during stress D. The pituitary regulates calcium metabolism E. The anterior and posterior pituitary are distinct on an MRI scan
D. The pituitary regulates calcium metabolism
|n men, all the following are mainly produced in the adrenal cortex except? A. DHEAS B. Testosterone C. Aldosterone D. 17-OH progesterone E. Androstenedione
B. Testosterone
Where is growth hormone’s main site of action to stimulate IGF1 release? A. Bone B. Liver C. Adrenal cortex D. Muscle E. Pancreas
B. Liver
The following are typical features of excess growth hormone secretion except? A. Polyuria B. Joint pains C. Sweating D. Hypotension E. Headaches
D. Hypotension
The following hormones all have a circadian rhythm except? A. Cortisol B. Testosterone C. DHEA D. 17OH progesterone E. Thyroxine (T4)
E. Thyroxine (T4)
Typical features of cortisol deficiency include the following features except? A. Hypotension B. Muscle aches C. Weight loss D. Hyperglycaemia E. Lethargy
D. Hyperglycaemia
A 30 year old lady presented with weight gain, menorrhagia and constipation. She is most likely to be suffering from? A. Cushing’s syndrome B. Addison’s disease C. Primary hypothyroidism D. Graves disease E. Acromegaly
C. Primary hypothyroidism
Which test would you want to perform in a patient with proximal muscle weakness, purple striae and thin skin? A. Synacthen test B. Overnight dexamethasone suppression test C. Insulin tolerance test D. Glucagon test E. Skin allergy tests
B. Overnight dexamethasone suppression test
A 24 year old girl presents with hirsutism, oligimenorrohoea and acne, what test would you likely carry out from below? A. Ultra sound adrenals B. Ultra sound ovaries C. MRI ovaries D. CT scan adrenals E. Prolactin
B. Ultrasound ovaries
A 54 year old gentleman presented with hyponatraemia. All the following conditions need excluding before confirming SIADH except? A. Hypothyroidism B. Hypervolaemia C. Euvolaemia D. Adrenal insufficiency E. Diuretic use
C. Euvolaemia
A 66 year old gentleman had a serum sodium of 124 mmol/l and a urine sodium of 52 mmol/l. What would you like to perform first? A. Chest X-ray B. CT brain C. Skin turgor and jugular venous pressure test D. Thyroid function tests E. Synacthen test
C. Skin turgor and jugular venous pressure test
All of the following are most likely causes of SIADH except? A. Multiple sclerosis B. Lung abscess C. Subdural haemorrhage D. Lymphoma E. Cerebrovascular accident
A. Multiple sclerosis
A 28 year old presented with a microprolactinoma. what is the most unlikely symptom? A. Galactorrhoea B. Oligomenorrhoea C. Decreased sexual appetite D. Headaches E. Visual field defects
E. Visual field defects
The following suppress appetite except: A. Peptide YY B. Ghrelin C. CCK D. GLP1 E. Glucose
B. Ghrelin
The main adipose signal to the brain is? A. CCK B. Neuropeptide y C. Leptin D. Agouti-related peptide E. Adiponectin
C. Leptin
A 65 year old lady is diagnosed with SIADH, her sodium is 123mmol/l. What is your first line of management? A. If she is symptomatic I will treat with fluid restriction B. If she is asymptomatic I will treat with hypertonic saline C. If she is asymptomatic I will treat with fluid restriction D. If she is asymptomatic I will repeat the sodium level the next day E. If she is asymptomatic I will give normal saline
C. If she is asymptomatic i will treat with fluid restriction
A patient with Addisons disease presents with a chest infection, what do you do? A. Omit his steroids to avoid immunosuppression B. Stop his steroids as they have precipitated a chest infection C. Double his steroid dose whilst unwell D. Keep him on his usual steroid dose E. Not of the above
C. Double is steroid dose whilst unwell
The following tests are typical of secondary hypogonadism: A. Low LH; High testosterone B. Low LH; Low testosterone C. High prolactin; high testosterone D. Low FSH; Low prolactin E. None of the above
B. Low LH, low testosterone
A patient has a noon testosteronal level below the normal range, what will you do? A. Treat with testosterone gel B. Repeat the test at 0900h and check for symptoms C. Repeat the test at noon to keep things equal D. Refer to endocrinology E. Ignore it
B. Repeat test a 0900h and check for symptoms
The first line of treatment for a patient with symptomatic prolactinoma is usually: A. Radiotherapy B. Transphenoidal surgery C. Dopamine agonists D. Transfrontal surgery E. Somatostatin analogues
C. Dopamine agonists
Typical visual field defect of a patient with a large pituitary mass is: A. Unilateral quadrantanopia B. Bitemporal hemianopia C. Complete unilateral visual field loss D. Complete bilateral visual field loss E. None of the above
B. Bitemporal hemianopia
Satiety is: A. The physiological feeling of no hunger B. Inhibited by activation of POMC neurons C. The physiological feeling of hunger D. Induced by ghrelin release E. Enhanced by Agoutirelated peptide
A. The physiological feeling of no hunger
The centres of appetite regulation in the brain are mainly found in the: A. Pituitary B. Cerebellum C. Hypothalamus D. Basal ganglia E. Brain cortex
C. Hypothalamus
Lidocaine is effective in the treatment of ventricular tachycardias because it…. A. slows conduction in healthy heart tissue B. opens sodium channels C. blocks sodium channels at rest D. blocks the activation gate of the sodium channel E. blocks the inactivation gate of the sodium channel
E. blocks the inactivation gate of the sodium channel
Digoxin can be a useful drug in the treatment of supra ventricular tachycardias because… A. stimulates the release of acetylcholine from sympathetic nerves B. is inotropic C. makes the membrane potential more positive releasing acetylcholine from parasympathetic nerves D inhibits calcium channels E. stimulates sodium/calcium exchange
C. makes the membrane potential more positive releasing acetylcholine from parasympathetic nerves
Amlodipine and verapamil are both calcium channel blockers, what property makes verapamil the more effective anti-arrhythmic agent? A. Additional sodium channel blockade B. Once daily treatment C. Lack of effect on the calcium channel at rest D. Blockade of all calcium channel types (L,N & T) E. Additional potassium channel blockade
C. Lack of effect on the calcium channel at rest
Which additional property makes propranolol the most useful beta blocker to help control the arrhythmias which occur immediately following a heart attack? A. Calcium channel block B. Potassium channel block C. Heart block D. Sodium channel block E. Parasympathetic activation
D. Sodium channel blocker
In the treatment of heart failure, which transport protein or ion channel is inhibited by the loop diuretic, furosemide? A. Na/K ATP-ase B. Epithelial Na channel C. K channel D. Na/K/2Cl transporter E. Na/Cl transporter
D. Na/K/2Cl transporter
ACE inhibitors reduce the circulating levels of which adrenal hormone? A. Aldosterone B. Adrenaline C. Cortisone D. Angiotensin II E. Atrial Natriuretic Peptide
A. Aldosterone
Which drug exerts a direct inotropic effect on the heart muscle? A. Ramipril B. Losartan C. Digoxin D. Spironolactone E. Glyceryl Trinitrate
C. Digoxin
In chronic heart failure beta blockers are…? A. Contra-indicated B. Beneficial by slowing the heart rate C. Beneficial by depressing the myocardium D. Beneficial by increasing oxygen demand E. Effective by blocking reflex sympathetic responses which stress the failing heart
E. Effects by blocking reflex sympathetic responses which stress the failing heart
For which CVS drug is bronchospasm a potential side effect? A. Morphine B. Beta blocker C. Aspirin D. Nitrate E. ACE inhibitor
B. Beta blocker .
For which CVS drug is cough a potential side effect? A. Morphine B. Beta blocker C. Aspirin D. Nitrate E. ACE inhibitor
E. ACEi
For which CVS drug is tolerance a potential side effect? A. Calcium antagonist B. Beta blocker C. Aspirin D. Nitrate E. ACE inhibitor
D. Nitrate
Which CVS drug is most likely to induce postural hypotension as a potential side effect? A. Calcium antagonist B. Beta blocker C. Aspirin D. Nitrate E. ACE inhibitor
A. Calcium antagonist
Doxazosin is an antagonist at which peripheral receptor? A. Alpha-1 adrenoceptor B. Purine receptor C. Angiotensin II receptor D. Vasopressin receptor E. Beta-1 adrenoceptor F. Dopamine receptor
A. Alpha-1 adrenoreceptor
Atenolol is an antagonist at which type of peripheral receptor? A. Alpha-1 adrenoceptor B. Purine receptor C. Angiotensin II receptor D. Vasopressin receptor E. Beta-1 adrenoceptor F. Dopamine receptor
E. Beta-1 adrenoreceptor
What enzyme does linsopril inhibit? A. Kininase II B. Renin C. Na/K ATP-ase D. Angiotensin Converting Enzyme (ACE) E. DOPA decarboxylase
D. Angiotensin Converting Enzyme
Which of the following drug side effects is less likely to be seen when treating hypertension with an angiotensin receptor blocker (ARB) rather than ACEi? A. Hyperkalaemia B. Cough C. Angioedema D. Renal failure in the presence bilateral renal E. stenosis
B. Cough
How to beta blockers work to relieve the pain from angina pectoris? A. Reduce O2 demand by slowing the heart rate B. Reduce O2 demand by reducing myocardial contractility C. Improve O2 distribution by slowing the heart rate D. Increase the O2 supply by dilating the coronary arteries E. Increase O2 supply by stimulating respiration
A. Reduce O2 demand by slowing the heart rate B. Reduce O2 demand by reducing myocardial contractility C. Improve O2 distribution by slowing the heart rate
What is the major mechanism by which glyceryl trintrate can relieve the pain of angina pectoris? A. Dilatation of veins to reduce the preload on the heart B. Dilatation of arterioles to reduce the after load on the heart C. Dilatation of coronary arteries to increase cardiac perfusion D. Opening of collateral blood vessels to improve cardiac perfusion E. A positive inotropic effect
A. Dilation of the veins to reduce preload on the heart
Which of the following drugs is likely to be more situable for the treatment of variant angina due to coronary artery vasospasm? A. Bumetanide B. Losartan C. Isosorbide D. Amlodipine E. Glyceryl trintrate
D. Amlodipine (CCB)
Which of the following drugs might be used to reduce atheromatous disease, the underlying cause of angina pectoris? A. Atenolol B. Amlodipine C. Simvastatin D. Glyceryl trinitrate E. Enalapril
C. Simvastatin
What is the characteristic genetic abnormality in Chronic Myeloid Leukemia? A. ATRA gene B. Philadelphia chromosome C. AML/ETO gene D. cMYC oncogene
B. Philidelphia chromosome First example of an isolated genetic abnormality that consistently causes cancer
What class of drug best describes Rituximab? A. Cytotoxic chemotherapy B. Disease modifying therpy C. Monoclonal antibody D. Antibiotic
C. Monoclonal antibody
Which age group is characteristically affected by Hodgkin lymphoma? A. Children B. Teens and young adults C. Middle age D. Older aged
B and D
What is the correct mechanism of action fot the anti emetic drug Ondansetron? A. Peripheral D2 antagonist B. Central D2 antagonist C. Anti-cholinergic D. 5HT3 antagonist
D. 5HT3
In sickle cell anaemia, what would you expect the reticulocyte count to be? A. Absent B. Low C. Normal D. Raised
D. Raised
Bacterial infection usually causes? A. Low lymphocytes B. Low neutrophils C. High lymphocytes D. High neutrophils
D. High neutrophils
Which best outlines the approach to the management of a patient with suspected febrile neutropaenia? A. Encourage fluids and paracetamol B. Perform cultures and wait for results before starting antibiotics C. Perform cultures and start oral antibiotics D. Perform cultures and start broad spectrum antibiotics
D. Perform cultures and start broad spectrum antibiotics E.G TAZOSIN
How does Aspirin exert its effect? A. ADP receptor antagonist B. Inhibition of cyclooxygenase enzyme C. Inhibition of glycoprotein IIb-IIIa D. Inhibition of PAR4 receptor
B. Inhibition of cyclooxygenase enzyme
What is the commonest cause of microcytic anaemia? A. Thalassemia B. Hepatitis A C. Sickle cell D. Iron deficiency
D. Iron deficiency
How is myeloma bone disease usually assessed? A. DEXA bone scan B. CT bone scan C. Plain X ray
C. Plain X ray
A 74 year old man presents with a change in bowel habit and anaemia. Colonoscopy and subsequent CT shown below, what is the Duke stage of his cancer?
A.Dukes A
B.Dukes B
C.Dukes C
D.Dukes D
D. Dukes D
Which one of the folowing is false regarding colorectal cancer?
A. Bowel cancer screening is offered to people aged 55 or over
B. The majority of cancers occur in the proximal colon
C. FAP and HNPCC are two inherited causes of colon cancer
D. Proximal cancers usually have a worse prognosis
E. Patients with PSC and UC have increased risk of developing colon cancer
B. The majority of cancers occur in the proximal colon FALSE because the majority of colorectal cancers occur in the DISTAL colon
A 50 year old man presents with dysphagia. Which one of the following suggests a benign nature of his disease?
A. Weight loss
B. Dysphagia to solids initally then to liquids
C. Dysphagia to solids and liquids from the start
D. Anaemia
E. Recent onset of the symptom
C. Dysphagia to solids and liquids from the start
A 32 year old lady complains of a 6 month history of bloating an diarrhoea. What is the most likely diagnosis based on the small bowel hisology?
A. Crohns
B. Ulcerative colitis
C. Micrscopic colitis
D. Coeliac disease
E. Irritable bowel sydrome
D. Coeliac disease
Hypertrophic villi with no crypts
A 32 year old lady complains of a 6 month history of bloating an diarrhoea. What is the most likely diagnosis based on the small bowel hisology?
A. Crohns
B. Ulcerative colitis
C. Micrscopic colitis
D. Coeliac disease
E. Irritable bowel sydrome
A. Crohns
Arrow is pointing at granuloma
A 32 year old lady complains of a 6 month history of bloating an diarrhoea. What is the most likely diagnosis based on the small bowel hisology?
A. Crohns
B. Ulcerative colitis
C. Micrscopic colitis
D. Coeliac disease
E. Irritable bowel sydrome
B. Ulcerative colitis
Arrow is pointing at crypt abcess
A 19 year old girl presents with abdominal pain and loose stool, which of the features suggest that she has irritable bowel sydrome?
A.Anaemia
B.Nocturnal diarrhoea
C.Weight loss
D.Blood in stool
E.Abdominal pain relieved by defaecation
E. Abdominal pain relieved by defaecation
Which statement about Helicobacter pylori is true?
A.It is a gram positive bacteria
B.HP prevalence is similar in developing and developed countries
C.15% of patients with a duodenal ulcer are infected with H. Pylori
D.PPIs should be stopped 1 week before a H. Pylori stool antigen test – false 2 weeks
E.It is associated with an increased risk of gastric cancer
E. It is associated with an increased risk of gastric cancer
- it is gram negative
- greater presence in developing countreis
- majority of patients with duodenal ulcers have h pylori
- PPis should be stopped 2 weeks before h pylori stool antigen test
A 56 year old man presents with abdominal distension and shortness of breath. Examination revealed fever of 38C a tense distended abdomen with shifting dullness. He also has dullness to percussion in the right lung base. Several spider naevi are sneed on his chest. What is the most important management in this patient and what is the most likely diagnosis?
A.CXR
B.Ultrasound abdomen
C.Echocardiogram
D.Ascitic tap
D. Ascitic tap
Liver cirrhosis
Which of the following features best distinguishes ulceratiive colitis from crohns?
A.Ileal involvement
B.Continuous colonic involvement on endoscopy
C.Non-caseating granuloma
D.Transmural inflammation
E.Perianal disease
B. Continous colonic involvement on endoscopy - no skip lesions
Also no granulomas, fistulas or peri-anal disease however rectal involvement is common
- A 68 year old lady presents with abdominal pain and distention. She last opened her bowels 5 days ago. She has a poor appetite and has lost some weight recently. Her PMH includes an abdominal hysterectomy and diverticulosis. She drinks 20 units of alcohol a week and smokes 5 a day. Examination reveals a distended abdomen with tympanic percussion throughout. There is a small left groin lump with a cough impulse. Which one of the following is NOT likely to be the cause of her abdominal pain and distention?
A.Colon cancer
B.Adhesions
C.Ascites
D.Diverticulitis
E.Strangulated hernia
C.Ascites = you would be able to see this
- A patient drinks 4 pints (568ml=1 pint) of beer (4%) a day, and 2 standard (175ml) glasses of red wine (13%) on Saturday and Sunday additionally. How many units of alcohol is he drinking per week? (round up to nearest whole number)
A.73 units
B.62 units
C.94 units
D.57 units
E.49 units
A. 73
(ABV x ml) / 1000 = units!
- A 71 year old man was admitted to hospital with pneumonia after he returned from a cruise holiday in the Mediterranean Sea. He was treated with a week of augmentin (co-amoxiclav) for his pneumonia. On day 7 of his admission, he started having diarrhoea 10 times a day without any blood. He feels unwell and dehydrated. He had a flexible sigmoidoscopy which showed this. What is the likely organism responsible for his diarrhoea?
A.Norovirus
B.Escherichia coli
C.Giardia lamblia
D.Clostridium difficile
E.Salmonella enteritidis
D. Clostridium difficile
A 52 year old lady presents with fatigue and itching. She noticed pale stool and dark urine naevi, and hepatomegaly. Her bloods showed Bili 150, ALP 988, ALT 80, positive AMA and a raised IgM. What is the most likely diagnosis? (and why), also what is this patient at increased risk of?
A.Simvastatin induced liver injury
B.Primary biliary cirrhosis
C.Gall stones
D.Autoimmune hepatitis
E.Primary sclerosing cholangitis
B.Primary biliary cirrhosis
positive AMA and raised IgM = blood markers
image shows = xathelasma
associated with RA and sjogrens
INCREASED RISK OF HEPATOCELLULAR CARCINOMA
A 16 year old girl is admitted with vomiting and abdominal pain. She reports taking 20 paracetamol tablets after her boyfriend split up with her. Which one of the following test results would you NOT expect to see?
A.Metabolic acidosis
B.A prolonged prothrombin time
C.A raised creatinine
D.Hyperglycaemia
E.ALT 1000
D Hyperglycaemia - you would expect HYPOGLYCAEMIA
A 68 year old unkempt and malnourished homeless man was brought to the hospital with haematemesis. Endoscopy found bleeding varices. Subsequent USS showed a coarse shrunken liver. On day 2 admission he was found to be ataxic, confused with nystagmus. What is the most likely cause of his neurological presentation?
A.Alcohol toxicity
B.Alcohol withdrawal
C.Delirium tremens
D.Wernicke’s encephalopathy
E.Korsakoff syndrome
D.Wernicke’s encephalopathy
- A 23 year old man was brought in at 2am with RIF pain and was diagnosed with acute appendicitis. He was stable and was scheduled for appendicectomy in the morning. During the ward round, he acutely deteriorated. He was immediately brought to theatre for a perforated appendix. What clinical signs would you NOT expect to see? (and what is the likley diagnosis)
A.Fever
B.Bowel sounds
C.Tachycardia
D.Rebound tenderness
E.Guarding
B.Bowel sounds
Peritonitis
