Formative assessments Flashcards by Alzahra Kassir

Which of these is an example of acute inflammation?

a) glandular fever
b) leprosy
c) appendicitis
d) tuberculotis

appendicitis
glandular fever is primary chronic inflammation
leprosy and tuberculotis are microbacterial infections that cause primary chronic inflammation

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Which of these is an example of hyperplasia?

a) body builder’s bicep
b) enlarged left ventricle
c) benign prostate enlargement
d) wasting of quadriceps

benign prostate enlargement
body builder’s bicep has skeletal muscle and left ventricle has cardiac muscles. these types of muscles cannot replicate
wasting of quadriceps is atrophy

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Which of these is an example of granulomatous inflammation?

a) crohn’s disease
b) appendicitis
c) infectious mononucleasis
d) lobar pneumonia

crohn’s disease
appendicitis and lobar pneumonia are acute inflammations
infectious mononuleasis is primary chronic inflammation

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Which of these is not an inherited condition?

a) huntington’s disease
b) haemophilia
c) sickle cell anaemia
d) foetal alcohol syndrome

foetal alcohol syndrome

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Which of these is not associated with dementia (any decline in cognitive function)?

a) down’s
b) huntington’s syndrome
c) Alzheimer’s disease
d) cerebral palsy

cerebral palsy

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Which of these uses autosomal dominance inheritance?

a) familial adenomotous polyposis
b) colour blindness
c) cystic fibrosis
d) sickle cell disease

FAP
the other three are recessive
colour blindness is also X linked

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Which of these is not an example of apoptosis?

a) loss of cells from tip of duodenal villi
b) loss of cells in embyrogenesis
c) renal infarction
d) graft vs host disease

renal infarction (necrosis)

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which of these is a primary chronic inflammation?

a) appendicitis
b) cholecystitis
c) infectious mononucleosis
d) lobar pneumonia

infectious mononucleasis

the others are acute inflammation (with cholecystitis leading on to chronic inflammation after)

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which cells can regenerate?

a) neurons
b) myocytes
c) hepatocytes
d) nephrons

hepatocytes

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Which pathologies can end with full resolution?

a) lobar pneumonia
b) cerebral infarction
c) myocardial infarction
d) partial nephrectomy

lobar pneumonia

the others don’t have cells that can regenerate

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Which neoplasm never metastases?

a) melanoma
b) small cell carcinoma of lung
c) basal cell carcinoma of skin
d) breast cancer

basal cell carcinoma

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which neoplasm won’t metastasise to bone?

a) breast cancer
b) lung cancer
c) prostate cancer
d) liposarcoma

liposarcoma

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which type of cancer doesn’t have screening in the UK?

a) breast cancer
b) colerectal cancer
c) cervical cancer
d) lung cancer

lung cancer

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which carcinogen is not known to be a carcinogen of humans?

a) hep C virus
b) ionising radiation
c) aromatic amines
d) aspergillus niger

apergillus niger

it is a fungus that grows in showers when they are damp

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what is not a feature of a malignant tumour?

a) vascular invasion
b) metastasis
c) increased cell division
d) growth related to overall body growth

growth related to overall body growth

hamartoma is a benign tumour and it does this.

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what is most likely to cause cancer?

a) drinking 1/2 a bottle of wine per day
b) obesity
c) running
d) smoking 20 cigarettes a day

smoking 20 cigarettes a day

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which tumour has the shortest median survival time?

a) basal cell carcinoma
b) malignant melanoma
c) breast cancer
d) anaplastic carcinoma

anaplastic carcinoma

has a median survival of 6 weeks

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which of these infections are most often seen in patients with hypogammaglobulinemia?

a) cytomegalovirus retinitis
b) pneumocystis jirovecii pneumonia
c) streptococcus pneumoniae sinusitis
d) staphyloccus aureus abscesses

streptococcus pneumoniae sinusitis
(due to primary antibody deficiency)
[staphyloccus due to primary defects in phagocytic function which is less common than the first one)

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which of these is not an organ-specific autoimmune disease?

a) type 1 diabetes mellitus
b) pernicious anaemia
c) hashimoto’s thyroiditis
d) ulcerative colitis
e) multiple sclerosis

ulcerative colitis

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which of these is a classical PAMP?

a) heat shock protein
b) RIG 1
c) lipopolysaccharide
d) interleukin 1
e) TLR 2

lipopolysaccharide
(heat shock protein is DAMP)
(RIG1 and TLR2 are receptors that detect the PAMP and DAMP)
(interleukin1 released from cells to promote immunity)

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which of these functions are true for T cells?

a) t cells mature in thyroid gland
b) all t cells secrete cytotoxic material
c) t cells respond to proteins on surface of host cells
d) t cells secrete IgG when activated

T cells respond to proteins on surface of host cells

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the normal immunological control of tumours is called:

a) immunological tolerance
b) immune surveillance
c) type 3 hypersensitivity
d) immunological silence
e) superantigen recognition

immune surveillance

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which of these features are true for the adaptive immune system?

a) its efficiency is not affected by prior contact with the pathogens
b) it would not work without lymphocytes
c) it lacks specificity
d) it generally distinguishes self from non-self
d) its effectiveness is enhanced by complement

it wouldn’t work without lymphocytes

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which of these proteins is essential in inducing a cytotoxic t cell response?

a) IgG
b) complement C3
c) Mannose binding lectin
d) MHC 1
e) TLR4

MHC1

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which of these statements are false for biological therapies of autoimmune disease? a) delivered with low dose cytotoxic drug methotrexate b) have no risk of bacterial infection, unlike conventional treatment c) include adalimumab, tocilizumab, retuximan d) are immunosuppresive and are always injected e) are expensive and only prescribed in NHS once conventional therapies have failed

no risk of bacterial infection unlike conventional treatments

which of these is not part of the elimination phase of complement activation? a) phagocytosis b) target cell lysis c) chemoattraction of leukocytes d) production of interferons e) opsonisation

production of interferons

which cell is being described (located only in tissues, responds to IgE coated objects by degranulation thus releasing inflammatory mediators, proteases, histamine)? a) neutrophil b) eosinophil c) mast cell d) macrophage e) fibroblast

mast cell

Patient starts on commonly used drug, they develop an unusual ADR that you have never seen before, what should you do after stopping the drug and informing the patient? 1. report the ADR on a yellow card 2. contact the pharmaceutical company that makes the drug to inform them 3. write the case up in a case report to educate other doctors 4. contact the local pharmacy to tell them 5. stop prescribing the drug to all patients

1. report the ADR on a yellow card

woman has over-active bladder, she's given anti-cholinergic drug to help, which of these symptoms are not a side effect of anti-cholinergic drugs? 1. constipation 2. constricted pupils 3. dry mouth 4. reduced sweating 5. tachycardia

constricted pupils

a man has lower urinary tract symptoms and suffers from narrow angle glaucoma, which drug will help his lower urinary tract symptoms but will worsen his narrow angle glaucoma? 1. 5alpha reductase inhibitor 2. alpha1 receptor antagonist 3. anticholinergic 4. beta3 receptor agonist

anticholinergic

an iV abuser has reduced resp rate and pin-point pupils, which drug do you give to reverse his opioid overdose? 1. flumazenil 2. fentanyl 3. glucagon 4. naloxone 5. neostigmine

naloxone

which of these drugs does not have a narrow therapeutic index? 1. digoxin 2. gentamicin 3. lithium 4. simvastatin 5. warfarin

simvastatin

``` which side effect from morphine can contribute to hypoxia? 1. constipation 2. cough 3. neuromuscular paralysis 4. resp depression tachypnoea ```

resp depression

``` which ADR is an anaphylaxis reaction to penicillin? a b c e ```

Type B

a man says he hasnt been taking his statins as prescribed because he feels fine without them, which of the following seems the most important reason for his non-adherence? 1. capacity and resources 2. concerns about medication 3. necessity beliefs about medication 4. practical barriers to adherence 5. specific beliefs about medication

necessity beliefs about medication

a man has an anaphylactic reaction to penicillin, which antibody mediates this type of allergic reaction 1. IGA 2. IGD 3. IGE 4. IGG 5. IGM

IGE

pharmacokinetics is: 1. The study of biological & therapeutic effects of drugs. 2. The study of absorption, distribution, metabolism & excretion of drugs. 3. The study of mechanism of action of drugs. 4. The study of new drug development. 5. The study of genetic differences in drug metabolism.

the study of absorption, distribution, metabolism, excretion of drugs

what is half life? 1. the time taken for the plasma drug concentration to fall to half its original value 2. the time to metabolise half the drug into its active metabolite 3. the time to absorb half the drug 4. the time to bind half the drug to plasma proteins 5. the time to maximum plasma levels after a dose of the drug

time taken for plasma drug conc to fall to half its original value

which statement about ACh is true? 1. It acts on M1 receptors on smooth muscle to cause bronchoconstriction 2. Muscarinic receptors are the major preganglionic signalling receptor for sympathetic signalling 3. Both sympathetic and parasympathetic systems use acetylcholine in preganglionic signalling 4. It acts on beta 2 receptors to cause smooth muscle relaxation 5. It acts in the eye to cause dilatation of the pupil

Both sympathetic and parasympathetic systems use acetylcholine in preganglionic signalling

which drug would you give a patient with COPD who has atrial fibrillation? 1. Propranolol is the beta blocker of choice to slow his heart rate 2. Beta blockers are contraindicated because they can cause bronchoconstriction and dangerous wheezing 3. A muscarinic agonist is standard treatment to safely slow the heart without affecting the airways 4. A selective beta 1 blocker would be safe and effective treatment to slow the heart rate without affecting the airways 5. A muscarinic antagonist will slow the heart effectively

A selective beta 1 blocker would be safe and effective treatment to slow the heart rate without affecting the airways

``` Chains of purple cocci seen on gram film. show alpha haemolysis in blood agar, don't grow near optochin disc. they are... 1strep. pneumonia 2staph. epidermidis 3strap. viridans 4group A streptocci 5neisseria meningitidis ```

strep. pneumonia

which of these is gram neg bacillus that ferments lactose? 1. shigella sonnei 2. listeria monocytogenes 3. neisseria meningitidis 4. e. coli 5. streptococcus pyogenes

e. coli

which is wrong. haemophilus influenzae is important cause of: 1. meningitis in preschool kids 2. otitis media 3. pharyngitis 4. gastroenteritis 5. exacerbations of COPD

gastroenteritis

``` normally sterile? 1 pharynx 2 urethra 3 CSF 4 Pleural cavity 5 skin ```

CSF

``` which is not a way virus 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 ```

endotoxin production

``` when diagnosing viral infections which is false? 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 ```

sample must come from sterile site

``` HIV virus envelope has? A. RNA + capsid + DNA polymerase B. DNA + capsid + Reverse transcriptase C. DNA + p24 + protease D. RNA + capsid + reverse transcriptase ```

rna and capsid and reverse transcriptase

``` which is correct? A. Pityriasis versicolor = bacterium B. Ringworm = helminth C. Aspergillus fumigatus = mycobacterium D. Falciparum malariae = fungal E. Giardia lamblia = protozoal ```

giardia lamblia is protozoal

``` which is not a feature of mycobacteria? 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 ```

they cannot withstand phagolysosomal killing

``` which is true for antimicrobial resistance? 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 ```

it is spread by plasmid mediated gene transfer

``` which is false? A. S. pyogenes : can use penicillin B. Meropenem : a carbapenem C. Glycopeptides : use for MRSA D. Ciprofloxacin : cause C. difficile diarrhoea E. Cefuroxime : a macrolide ```

cefuroxime is a macrolide

``` 21 year old has mylagia, sore throat, tired, febrile, large spleen. which is best answer? A. He has sepsis and needs broad spectrum antimicrobial therapy with cefotaxime B. A charcoal throat swab will confirm the diagnosis C. Finding atypical lymphocytes on a blood film and a positive EBV IgM in serum would be consistent D. PCR on a viral throat swab will confirm the diagnosis E. This is a viral upper respiratory tract infection and doesn’t warrant investigation or antimicrobial therapy ```

``` 34yr old gay man prolonged diarrhoea presents with short breath with dry cough and hypoxia. which is most true? 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 | AIDS just for HIV

``` Sepsis: infection and systemic inflammatory response. which is false for systemic inflam. response? A. Temperature >38.3C or <36C B. Heart rate >90 C. Systolic blood pressure >130 D. White Cell count >12 E. Hypoxia ```

systolic blood pressure >130 | In sepsis should be below 90

``` Which is false? the give steps of hand hygiene are to wash hands? A. Before contact with patient B. Before bodily fluid exposure C. Before aseptic procedures D. After contact with patient surroundings E. After patient contact ```

before bodily fluid exposure

Which of these is not causing a reduction in transfer factor? 1) idiopathic pulmonary fibrosis 2) pulmonary hypertension 3) asthma 4) Anaemia 5) COPD

3)ASTHMA IS THE ANSWER because normal structure of alveolar, problem is moving air in and out IPF: scarring between alveolar and blood so less transfer so less transfer factor PHypertension: heart working hard, blood flow reduced to lungs so less transfer Anaemia less RBC so less O2 taking so less transfer COPD less alveolar ability from emphysema esp. so less transfer

Which is not a pathological description of findings seen in interstitial lung disease? 1) usual interstitial pneumonia 2) non-specific interstitial pneumonia 3) de-squamative interstitial pneumonia 4) obliterative bronchiolitis 5) diffuse alveolar damage

Obliterative bronchiolitis | All the others are seen in ILD

Which of these is not seen with lobar collapse? a) triangular opacity with apex at the hilum b) veil like opacity over right hemi-thorax c) sickle sign of air around aortic knuckle d) loss of right hemi-diaphragm e) sail sign

Veil like opacity over right hemi thorax | the others can be seen sometimes

which lung condition does not have an occupational component? 1) asthma 2) idiopathic pulmonary fibrosis 3) sarcoidosis 4) pigeon fancier's lung 5) COPD

pigeon fancier lung (from hobby not job)

To establish COPD which of these is not necessary? 1) substantial smoking history 2) progressive airflow obstruction 3) lack of reversibility 4) reduced FEV1/FVC ratio 5) lack of change over several months

substantial smoking history is not needed

Which is the right criteria for home O2 in COPD? 1) PACO2 less than 7.3 2) assessed while stable 3) assessed twice, 6 weeks apart 4) assessed off treatment 5) PA02 more than 7.3

Assessed while stable The others are wrong: PACO2 should be more than 7.3 and PAO2 less than 7.3 Assessed twice 3 weeks apart and assessed on treatment

Which is true? 1) 80% of lung cancer are SCLC 2) 10 year survival is 10% 3) traditional radiotherapy is as good as daily therapy 4) chemotherapy gives a 4% rise in 2year survival compared to traditional treatment 5) performance status 4 is assosciated with good one year survival

chemotherapy gives a 4% rise in 2 year survival compared to traditional treatment the others are false SCLC make up a small proportion

pick true response? a. 4.2 million people in UK have occupational illness b. most of these are respiratory c. occupation history is not worth time it takes to ask d. diagnosis of occupational lung disease can solve significant problems – cause problem because have to deal with employment or unemployment etc. e. at least 10% of asthma is thought to be occupational

at least 10% of asthma is thought to be occupational

11. which of these occupations are not associated with occupational lung disease? a. baker b. lab technician c. joiner d. metal worker e. prawn sheller f. none

NONE Lab tech- animal allergy Joiner-asbestos Prawn sheller-allergies

in pulmonary embolism which is true? a. shock is heralded by pleuritic chest pain and haemoptysis b. DVT is usually seen c. prophylaxis is over used d. idiopathic PEs usually require at least 6 months of treatment e. treatment with NOACs is better than heparin in cancer

answer; Idiopathic PE need at least 6 months treatment shock is heralded by pleuritic chest pain and haemoptysis – these steps don’t usually happen sometimes patients just collapse with PCPain without haemoptysis etc DVT rare to be seen Prophylaxis life saving heparin is best for cancer

13. Epidemic flu is: a. crosses international boundaries b. caused by antigenic drift c. 2 or more linked cases d. prevented by Tamiflu e. prevented by immunisation

Answer: caused by antigenic drift | Not prevented by these things just reduce transmission.

70 yr old woman presents with 1 month history of irritative bladder symptoms. she's on antibiotics for presumed UIT with no symptom improvement. She's complaining of a 1 week history of visible haematuria. renal ultrasound is normal and dipstick shows blood and leukocytes. what further investigations do u do? 1. flexible cystoscopy 2. MRI KUB 3. urine culture 4. Non-contrast CT KUB 5. U+E blood test

Flexible cystoscopy you're worried for bladder cancer due to no cause of UTI showing, sudden onset of irritative bladder symptoms and blood. If cancer you would then do CT contrast afterwards.

``` flexible cystoscopy reveals a 3cm papillary bladder lesions. a transurethral resection of bladder tumour occurs. what is the chance of tumour being muscule invasive in histology 50% 20% 40% 60% 80% ```

20% muscle invasive | 80% superficial

59 year old man shows with 2 day history of sudden onset left loin to groin pain with pain 9/10 severity and is intermittent pain. normally fit and on no regular medication. what investigation would most likely establish diagnosis. 1. urine dipstick 2. XR 3. renal ultrasound 4. contrast enhanced CT 5. Non-contrast CT

NON-CONTRAST CT contrast is same colour as stone XR after stone to compare and check you can also see it on XR so you can do XR follow up instead of CT follow ups

``` pharmacies offer tests for lots of STIs. what kind of public health approach is this? secondary prevention tertiary prevention health improvement primary prevention health promotion ```

secondary prevention

``` may and anderson 1987 transmission model describes how infections are spread. what is the best term relating to number of opportunities for transmission? infectivity rate partner rate over time duration of infection reproductive rate contact tracing ```

partner over time

``` asymptomatic bacteriuria should be treated in which of the following situations: men >65 pregnant women women>65 both bacteria and wbc seen on microscopy indewlling catheter is in situ ```

pregnant women

``` which of the following is a first line antibiotic for UTI nitrofurantoin tazocin fosfomycin benzylpenicillin ceftriaxone ```

nitrofurantoin

30 year old women presents with pyrexia, rigors, low BP, loin pain and renal angle tenderness. Urine WBC >10^5. what is the best diagnosis: 1. cystitis 2. diverticulitis 3. pyelonephritis 4. renal abscess 5. pelvic inflammatory disease

pyelonephritis | cystitis (bladder inflammation)

which is the most appropriate investigation to pyelonephritis abdominal exam not including vaginal exam bloods imaging abdo exam with vag exam, bloods, cultures, midstream urine, imaging

abdo exam with vag exam, bloods, cultures, midstream urine, imaging (vag exam to check doesn't have pelvic inflammatory disease)

``` the most common cause of UTI is: Klebsiella staph. aureus candida e. coli enterococcus ```

e. coli uropathogenic

``` 35 year old man in road traffic accident undergoes CT of abdo which picks up 6.5 cm left renal mass and no injuries. mass confined to renal parenchyma and no evidence of lymph or metastatic spread and its though to be a renal cell carcinoma. what is the T stage? t1a t1b t2a t2b t3 ```

T1B | T1 is 0-7cm mass. T1A is <4cm. T1B is >4cm

with urosepsis, ACEi and angiotensin receptor blockers and more likely to result in: reduced glomerular filtration pressure and worsening renal function increased glom filtration pressure and improved renal function reduced efficacy meaning the dose should be doubled reduced thirst meaning patient needs IV fluids all of above

reduced glom filtration pressure and worse renal function | acei protective in chronic renal damage but not in acute case

most common inherited cause of kidney failure is phenylketonuria autosomal dominant polycystic kidney disease auto recessive polycystic kidney disease von hippel lindau disease anderson fabry disease

auto dom polycystic kidney disease