Formative Assessments Flashcards
Give an example of acute inflammation.
Appendicitis, lobar pneumonia
Which of the following is an example of hyperplasia?
benign prostate enlargement or bodybuilders biceps?
Benign prostate enlargement.
Biceps are made of striated muscles which increase in size not number.
Give examples of granulomatous inflammation.
Crohn’s disease, sarcoidosis, leprosy.
Which of the following is not an inherited condition?
Haemophilia
Sickle cell disease
Huntington’s
Foetal alcohol syndrome
Foetal alcohol syndrome
Which of the following is not associated with dementia?
Down’s syndrome
Alzheimer’s disease
Huntington’s
Cerebral palsy
Cerebral palsy
Which of the following has autosomal dominant inheritance?
Familial adenomatous polyposis
Colour blindness
Cystic fibrosis
Sickle cell disease
Familial adenomatous polyposis
CB- usually X-linked
CF- autosomal recessive
SCD- autosomal recessive
Which of the following is not an example of apoptosis?
loss of cells from tips of duodenal villi
loss of cells during embryogenesis
renal infarction
graft versus host disease
renal infarction (example of necrosis)
Which of the following is a chronic inflammatory process from the start?
Appendicitis
Cholecystitis
Infectious mononucleosis
Lobar pneumonia
Infective mononucleosis
Aka glandular fever, usually caused by Epstein-Barr virus or herpesvirus 4. Hence lymphocytes react not neutrophils. Acute disease but chronic inflammation.
Cholecystitis starts acute but becomes chronic later.
Which of the following can regenerate?
hepatocytes
myocytes
nephrons
neurones
Hepatocytes
Which of these pathologies can end in resolution?
Lobar pneumonia
Cerebral infarction
Myocardial infarction
Partial nephrectomy
Lobar pneumonia because pneumocytes in alveoli can regenerate.
Which one of the following tumours never metastasises?
malignant melanoma
small cell carcinoma of the lung
basal cell carcinoma of the skin
breast cancer
basal cell carcinoma of the skin
What is the name of a malignant tumour of striated muscle?
lipoma
rhabdomyosarcoma
adenoma
rhabdomyoma
rhabdomyosarcoma
Which of the following tumours does not commonly metastasise to bone?
breast cancer lung cancer prostate cancer liposarcoma renal cell carcinoma thyroid cancer
liposarcoma
What is the name of a benign tumour of glandular epithelium?
adenoma
adenocarcinoma
papilloma
lipoma
adenoma
Which one these tumours does not have a screening programme in the UK?
breast
colorectal
cervical
lung
lung
Which one the following is not a known carcinogen in humans?
Hepatitis C virus
Ionising radiation
Aromatic amines
Aspergillus niger
Aspergillus niger
What is the name of a benign tumour of fat?
sarcoma
lipoma
adenoma
liposarcoma
lipoma
What is the name of a malignant tumour of glandular epithelium?
adenocarcinoma
adenoma
squamous cell epithelium
transitional cell epithelium
adenocarcinoma
Which of the following is not a feature of malignant tumours?
vascular invasion
metastasis
increasing cell division
growth rate matches that of body growth
growth rate matches that of body growth
A hamartoma is a mostly benign, focal malformation that resembles a neoplasm in the tissue of its origin. This is not a malignant tumour; it grows at the same rate as the surrounding tissue. Usually seen as coin lesions in the lung.
A transitional cell carcinoma of the bladder is a malignant tumour.
true or false
true
A leiomyoma is a benign tumour of smooth muscle.
true or false
true
Radon gas is a cause of lung cancer.
true or false
true
Asbestos is a human carcinogen.
true or false
true
Leads to mesothelioma which is a malignant tumour of the pleura with a latency period of 30 to 40 years which explains the currently steady rate of mesotheliomas.
Which lifestyle factor is most likely to cause cancer?
drinking half a bottle of wine daily
being obese
running for 20 mins twice a week
smoking 20 cigarettes a day
smoking 20 cigarettes a day
being obese is a risk factor for renal cell carcinoma, breast cancer and colon cancer.
Which tumour has the shortest median survival?
basal cell carcinoma of the skin
malignant melanoma of the skin
breast cancer
anaplastic carcinoma of the thyroid
anaplastic carcinoma of the thyroid
Ovarian cancer commonly spreads in the peritoneum.
true or false
true
What word best describes a malignant tumour of glandular epithelium?
adenocarcinoma
Which of the following infections is most often seen in patients with hypogammaglobulinaemia?
Cytomegalovirus retinitis Pneumocystis jirovecii pneumonia (PCP) Invasive Aspergillus fumigatus infection Streptococcus pneumoniae sinusitis Staphylococcus aureus abscesses
Streptococcus pneumoniae sinusitis
Which of the following is not an organ-specific auto-immune disease?
Type 1 diabetes mellitus Pernicious anaemia Hashimoto's thyroiditis Ulcerative colitis Multiple sclerosis
Ulcerative colitis
Which of the following is a classical PAMP?
Heat shock protein 60 RIG-I Lipopolysaccharide Interleukin 1 Toll-like receptor 2
Lipopolysaccharide
Regarding the functions of T lymphocytes, which is true?
T lymphocytes mature in the thyroid gland
All T cells secrete cytotoxic materials
T cells respond to proteins on the surface of host cells
T cells secrete IgG when they are activated
T cells respond to proteins on the surface of host cells
The normal immunological control of tumours is referred to as:
immunological tolerance immune surveillance Type III hypersensitivity Immunological silence Superantigen recognition
Immunological tolerance
Which of the following are features of the adaptive immune response?
Its efficiency is not affected by prior contact with the pathogen
It would not work without lymphocytes
It lacks specificity
It generally distinguishes “self” from “non-self”
Its effectiveness is enhanced by complement
It would not work without lymphocytes
Which of the following proteins would be essential in the induction of a cytotoxic T cell response?
IgG Complement component C3 Mannose binding lectin MHC class I Toll-like receptor 4
MHC class I
Which of the following answers is not true?
Biological therapies for autoimmune diseases:
are usually delivered with a low dose of the cytotoxic drug methotrexate
have no risk of bacterial infection, unlike conventional treatments
include adalimumab, tocilizumab and rituximab
are immunosuppressive and are always injected
are comparatively very expensive and only prescribed in the NHS once conventional therapies have failed
Have no risk of bacterial infection, unlike conventional treatments
Which one of the following is not a part of the Elimination phase of complement activation?
phagocytosis target cell lysis chemoattraction of leucocytes production of interferons opsonisation
Production of interferons
What cell type is described below?
Located exclusively in tissues, this cell responds to IgE-coated objects by degranulating, releasing inflammatory mediators, proteases and histamine.
Neutrophil Eosinophil Mast cell Macrophage Fibroblast
Mast cell
Which of the following is not involved in innate immune mechanisms?
Anatomic barriers Phagocytic Inflammatory mechanisms Antibody production Skin
Antibody production
What are the two types of immune response in humans?
Immunological tolerance Immune surveillance Intrinsic and extrinsic Overt and covert Innate and acquired
Innate and acquired
Polio can be eradicated by which of the following?
Attention to sewage control and hygiene
Killed polio vaccine
Live polio vaccine
Combination of killed and live polio vaccine
Combination of killed and live polio vaccine
Influenza vaccine is targeted towards ‘at risk’ groups in the UK. Which of the following are classified as ‘at risk’?
13 years old Elderly above 65 yrs Obese people Teenagers Very young below 2 yrs
Elderly and very young
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.
Eosinophil Neutrophil Basophil Mast cell Macrophage Fibroblast
Macrophage
You start a patient on a new commonly used medication. Unfortunately they develop an unusual ADR that you have never seen before which results in their hospitalisation. Which of the following is the correct course of action after stopping the drug and informing the patient?
- report the adverse drug event on a “yellow card”
- contact the pharmaceutical company that makes the drug to inform them of the ADR
- write the case up as a case report to ensure that other doctors are educated
- contact the local pharmacist to inform them of the ADR
- stop prescribing the drug for all patients
Report the adverse drug event on a “yellow card” because patient has been hospitalised
A 53yo woman presents to her GP with symptoms of an over-active bladder, she is given an anti-cholinergic drug to help with her symptoms. Which of these is NOT a side effect of the anti-cholinergic drug she has been prescribed?
- constipation
- constricted pupils
- dry mouth
- reduction in sweating
- tachycardia
constricted pupils
A 65yo man has lower urinary tract symptoms and also suffers from narrow angle glaucoma. Which of the following drugs may help his LUT symptoms but would be contra-indicated due to his narrow angle glaucoma?
- 5-alpha-reductase inhibitor
- alpha-1 receptor antagonist
- anticholinergic
- beta-3 receptor agonist
- intra-vesical botulinum toxin
anticholinergics
An 18yo man who is known to be an IV drug abuser is admitted to A&E unconscious with reduced resp rate and pin-point pupils. Which one fo the following drugs is most appropriate to reverse his opioid overdose?
- IV flumazenil
- IV fentanyl
- IV glucagon
- IV naloxone
- IV neostigmine
IV naloxone (to reverse opioid overdose)
Flumazenil will reverse benzodiazepine overdose.
Fentanyl is an opioid so would compound situation.
Glucagon is used in hypoglycaemia.
Neostigmine will reverse effects of non-depolarising muscle relaxants.
Which of the following drugs does NOT have a narrow therapeutic index?
- digoxin
- gentamicin
- lithium
- simvastatin
- warfarin
simvastatin
An 80yo lady with metastatic cancer has been taking oral morphine for pain at home. She is admitted to hospital as an emergency as she has accidentally taken a large overdose and si confused and hypoxic. Which of the following is the side effect that may be contributing to her hypoxia?
- constipation
- cough
- neuromuscular paralysis
- respiratory depression
- tachypnoea
respiratory depression
opiates do not cause tachypnoea or neuromuscular paralysis in overdose. They suppress cough. Although they do cause constipation, it would not cause hypoxia.
A 22yo woman is prescribed oral penicillin, an hour later she develops a rash, facial swelling and difficulty breathing. A diagnosis of anaphylaxis is made and she is treated appropriately. Which type of adverse drug reaction is an anaphylactic reaction to penicillin?
- type A
- type B
- type C
- type D
- type E
Type B- bizarre or idiosyncratic
A 50yo male patient found to be at increased risk CVD mentions at a routine GP check-up that he has not been taking the statin prescribed at his last visit. He comments that he is not “anti-medication” but he “feels fine without it”. Which of the following seems to be the most pertinent reason for his non-adherence?
- capacity and resources
- concerns about medication
- necessity beliefs about medication
- practical barriers to adherence
- specific beliefs about medication
necessity beliefs about medication
he answers relate to various potential reasons for non adherence
a. Capacity and resources – a practical rather than perceptual barrier
b. Concerns about medication – perceptual barrier to adherence that relates to worries about a potential adverse consequences
c. Necessity beliefs about medication - relates to perceptions of personal need for treatment, in this case to reduce risk rather than make him feel better
d. Practical barriers to adherence - capacity and resource to adhere to treatment
e. Specific beliefs about medication – relates to beliefs about the specific treatment (statin), in this example it is implied that the patient doesn’t fully understand that this is not a treatment to make him ‘feel better’ at present.
A 44 yo man receives penicillin V from his GP for tonsillitis. He becomes very unwell with a rash, flushing, wheezing and he collapses. He is told that he has had an anaphylactic reaction to penicillin. This type of allergic reaction is mediated by which one of the following antibodies?
- IgA
- IgD
- IgE
- IgG
- IgM
IgE
IgA is found in mucosal areas, such as the gut, respiratory tract and urogenital tract, and prevents colonization by pathogens, it is also found in saliva, tears, and breast milk. IgD is found on B cells that have not been exposed to antigens. IgG is the most abundant antibody and responsible for the secondary response. IgM is the most primitive antibody and eliminates pathogens in the early stages of B cell-mediated (humoral) immunity (primary response) before there are sufficient IgG. IgE is in response to parasites and is responsible for anaphylaxis.
Pharmacokinetics is:
- the study of biological and therapeutic effects of drugs
- the study of absorption, distribution, metabolism and excretion of drugs
- the study of mechanism of action of drugs
- the study of new drug development
- the study of genetic differences in drug metabolism
the study of absorption, distribution, metabolism and excretion of drugs
A 70kg woman is prescribed digoxin for atrial fibrillation. The digoxin has a half life of 42 hours. The half life is:
- the time taken for the plasma drug conc to fall to half its original value
- the time to metabolise half the drug to its active metabolite
- the time to absorb half the drug
- the time to bind half the drug to plasma proteins
- the time to maximum plasma levels after a dose of the drug
the time taken for the plasma conc to fall to half its original value
Which of the following is not under the control of the pituitary gland?
Thyroid Adrenal medulla Adrenal cortex Testis Ovary
Adrenal medulla
Cells in the adrenal medulla secrete catecholamines in response to stimulation by sympathetic preganglionic neurons
Which of the following statements is false?
The pituitary gland sits in the sella turcica.
The weight of the pituitary gland is around 0.5g.
ACTH is secreted from the pituitary during stress.
The pituitary helps regulate calcium metabolism.
The anterior and posterior pituitary are distinct on an MRI scan.
The pituitary helps regulate calcium metabolism.
In men, all the following are mainly produced in the adrenal cortex except?
DHEAS Testosterone Aldosterone 17-OH progesterone Androstenedione
testosterone
secreted by testis
Which of the following regarding AVP is false?
- AVP levels have a linear relationship with serum osmolality.
- is produced in the pituitary gland
- stimulates reabsorption of water in the collecting duct of the nephron
- in hypotension, baroreceptors predominantly activate ADH production and secretion
- further AVP production is no longer effective once urine osmolality has reached a plateau
- is produced in the pituitary gland
AVP is produced in the hypothalamus and stored in the pituitary from which it is releaseSecre
Secretion of the following hormones is stimulated by hypothalamic hormones except?
ACTH GH TSH PRL LH
PRL
The predominant effect is for dopamine to inhibit prolactin release; there is some stimulatory effect from TRH and prolactin releasing factor
Where is growth hormone’s main site of action to stimulate IGF-1 release?
bone liver adrenal cortex muscle pancreas
liver
The following are typical features of excess growth hormone secretion except?
sweating headaches joint pain polyuria hypotension
hypotension
The following hormones all have a circadian rhythm except?
cortisol testosterone DHEA 17-OH progesterone thyroxine
thyroxine
Typical features of cortisol deficiency include the following except?
A. Hypotension B. Muscle aches C. Weight loss D. Hyperglycaemia E. Lethargy
Hyperglycaemia
Cortisol deficiency may result in hypoglycaemia; cortisol, GH, adrenaline and glucagon are the 4 main stress hormones secreted to counteract hypoglycaemia in normal physiology
A 38 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
Primary hypothyroidism
Which test would you likely 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
Overnight dexamethasone suppression test
The ONDST is a screening test for Cushing’s syndrome, synacthen test for adrenal insufficiency, insulin tolerance test for adrenal insufficiency and GH deficiency, glucagon test for growth hormone deficiency
A 24 year old girl presented with hirsutism, oligomenorrhoea and acne. What test would you likely carry out from the ones below?
A. Ultra sound adrenals B. Ultra sound ovaries C. MRI ovaries D. CT scan adrenals E. Prolactin
Ultrasound ovaries
The girl is suffering from PCOS; the diagnosis besides clinical features and radiological findings includes hormonal changes such as high testosterone and/or an increased LH:FSH ratio
The following may cause nephrogenic diabetes insipidus except?
A. Lithium B. Myeloma C. Amyloidosis D. Hyperkalaemia E. Hypercalcaemia
Hyperkalaemia
hypokalaemia will cause nephrogenic DI
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
Euvolaemia
A 66 year old gentleman had a serum sodium of 124 mmol/l, serum osmolality 265 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
Skin turgor and jugular venous pressure test
Clinical chemistry suggests SIADH
plasma hypo-osmolality <275
hyponatraemia <135
increased urinary sodium >30
Urine osmolality > 100 mOsm/Kg
• Clinical euvolaemia
- No clinical signs of hypovolaemia (orthostatic decreases in blood pressure, tachycardia, decreased skin turgor, dry mucous membranes)
- No clinical signs of hypervolaemia (oedema, ascites)
- Increased urinary sodium excretion > 30 mmol/L with normal salt and water intake
- Exclude recent diuretic use, renal disease, hypothyroidism, and hypocortisolism
The following are most likely causes of SIADH except?
A. Multiple sclerosis B. Lung abscess C. Subdural haemorrhage D. Lymphoma E. Cerebrovascular accident
MS
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
Visual field defects
Macroprolactinoma causes visual field defects due to optic chiasm compression
The following suppress appetite except:
A. Peptide YY B. Ghrelin C. CCK D. GLP1 E. Glucose
Ghrelin
Ghrelin stimulates eating during hunger; high when fasting and fall on refeeding
The main adipose signal to the brain is
A. CCK B. Neuropeptide y C. Leptin D. Agouti-related peptide E. Adiponectin
Leptin
It regulates satiety based on size of fat stores
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 Addison’s 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
Double his steroid dose whilst unwell
In normals, during infection the HPA axis is stimulated to release more cortisol to overcome the stressful episode; this is not possible in patients with adrenal insufficiency or in patients on chronic steroid treatment and therefore steroid doses need to be increased to compensate for this
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
Low LH, low testosterone
Typical features of hypogonadism in a male include the following except:
A. Decreased sweating B. Joint and muscular aches C. Decreased sexual appetite D. Decreased hair growth E. Asymptomatic
Decreased sweating
Hypogonadism causes increased sweating and flushes
A patient has a noon testosterone 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
Repeat the test at 0900h and check for symptoms
Testosterone has a circadian rhythm with a peak in the morning and therefore should be tested between 0800 and 0900h; two positive tests on separate days are essential for diagnosis
Osmoreceptors are found in the:
A. Subfornical organ B. Organum vasculosum of the lamina terminalis C. Hypothalamus D. All of the above E. None of these
all of the above
The first line treatment for a patient with a symptomatic prolactinoma is usually:
A. Radiotherapy B. Transphenoidal surgery C. Dopamine agonists D. Transfrontal surgery E. Somatostatin analogues
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
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
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
hypothalamus
Which of the following is not a sign of hyperthyroidism?
A. Palpitations B. Tachycardia C. Tremor D. Goitre E. Proximal muscle weakness
Palpitations
Palpitation is a typical SYMPTOM of hyperthyroidism!!
Chains of purple cocci are seen on a gram film. They show alpha haemolysis when grown on blood agar. They don’t grow near the optochin disc. These are probably…
- streptococcus pneumoniae
- staphylococcus epidermidis
- streptococcus viridans
- Group A streptococci (S. pyogenes)
- Neisseria meningitidis
Streptococcus pneumoniae
Which of these is a gram negative bacillus that ferments lactose?
- Shigella sonnei
- Listeria monocytogenes
- Neisseria meningitidis
- Eschericia coli
- Streptococcus pyogenes
E coli
Which is incorrect? Heamophilus influenzae is an important cause of …
- meningitis in pre-school children
- otitis media
- pharyngitis
- gastroenteritis
- exacerbations of COPD
gastroenteritis
Which is a normally sterile site?
- the pharynx
- the urethra
- CSF
- pleural cavity
- skin
CSF
Which of these is not a means by which viruses cause disease?
- direct destruction of host cells
- cell proliferation and cell immortalisation
- inducing immune system mediated damage
- endotoxin production
- modification of host cell structure or function
endotoxin production
When diagnosing viral infections which is not true?
- the sample must come from a sterile site
- electron microscopy is rarely used
- use a green swab not a black swab
- PCR results takes 1-2 days
- a detectable IgM in serum may be diagnostic
The sample must come from a sterile site
Which is most accurate? The HIV virus envelope contains
- RNA + capsid + DNA polymerase
- DNA + capsid + reverse transcriptase
- DNA + p24 + protease
- RNA + capsid + reverse transcriptase
RNA + capsid + reverse transcriptase
Which pair is correct?
- pityriasis versicolor = bacterium
- ringworm = helminth
- aspergillus fumigatus = mycobacterium
- falciparum malariae = fungal
- giardia lamblia = protozoal
Giardia lamblia = protozoal
Mycobacteria. Which is not a feature?
- resistance to destaining by acid and alcohol
- cell wall contains lipoarabinomannan
- they only divide every 20 hours
- they cannot withstand phagolysosomal killing
- may cause meningitis
they cannot withstand phagolysosomal killing
Regarding antimicrobial resistance, which is true?
- it is spread by plasmid mediated gene transfer
- spontaneous gene mutations do not occur
- MRSA refers to vancomycin resistant S. aureus
- Only Mereopenem is effective against all gram negative bacteria
It is spread by plasmid mediated gene transfer
Antimicrobials. Which pairing is incorrect?
- S. pyogenes: can use penicillin
- Mereopenem: a carbapenem
- glycopeptides: use for MRSA
- Ciprofloxacin: cause C. difficile diarrhoea
- Cefuroxime: a macrolide
Cefuroxime: a macrolide
A 21 yo complains of myalgia, sore throat and tiredness. He is febrile and has an enlarged spleen. Which is the best answer?
- he has sepsis and needs broad spectrum antimicrobial therapy with cefotaxime
- a charcoal throat swab will confirm the diagnosis
- finding atypical lymphocytes on a blood film and a positive EBV IgM in serum would be consistent
- PCR on a viral throat swab will confirm the diagnosis
- This is a viral URTI and doesn’t warrant investigation or antimicrobial therapy
finding atypical lymphocytes on a blood film and a positive EBV IgM in serum would be consistent
A 34yo gay man who has had prolonged diarrhoea now presents with shortness of breath with a dry cough and hypoxia. Which is most accurate?
- This is bacterial pneumonia caused by pneumocystis jirovecii
- it is too early for a 4th generation HIV test to be positive
- the CD4 T cell count will be between 500 and 750
- Even if the HIV test is negative, this man has AIDS
- with appropriate therapy he has a good prognosis
With appropriate therapy, he has a good prognosis
Sepsis is infection + the systemic inflammatory response (SIRS). Which of these does NOT feature in the definition of SIRS?
- temperature >38.3 or <36
- heart rate >90
- systolic blood pressure >130
- white cell count >12
- hypoxia
systolic blood pressure >130
Infection control: which is false? The five steps of hand hygiene are to wash hands
- before contact with patient
- before bodily fluid exposure
- before aseptic procedures
- after contact with patient surroundings
- after patient contact
before bodily fluid exposure
Which class of drug best describes rituximab?
cytotoxic chemotherapy
disease-modifying therapy
monoclonal antibody
antibiotic
monoclonal antibody
Which age group is characteristically affected by Hodgkin’s lymphoma?
children
teenagers and young adults
middle aged (40-60)
older aged (>60)
teenagers and young adults
What is the characteristic genetic abnormality in chronic myeloid leukaemia?
ATRA gene
Philadelphia chromosome
AML/ETO gene
cMYC oncogene
philadelphia chromosome
How is myeloma bone disease usually assessed?
plain X-ray
Clinical assessment
Isotope bone scan
PET scan
plain X-ray
What is the current mechanism of action for the anti-emetic drug Ondansetron?
peripheral D2 antagonist
central D2 antagonist
Anti-cholinergic
5HT3 antagonist
5HT3 antagonist
What is the commonest cause of microcytic anaemia?
B12 deficiency
Iron deficiency
haematologic malignancy
hereditary spherocytosis
iron deficiency
In sickle cell anaemia what would you expect to see the reticulocyte count?
absent
low
normal
raised
raised
Bacterial infection usually causes…
low lymphocytes
low neutrophils
high lymphocytes
high neutrophils
high neutrophils
Which best outlines the approach to the management of a patient with suspected febrile neutropenia?
encourage fluids and paracetamol
perform cultures and wait for results before staring antibiotics
perform cultures and start oral antibiotics
perform cultures and start broad spectrum iv antibiotics
perform cultures and start broad spectrum iv antibiotics
Malignant spinal cord compression usually presents with?
back pain, ataxia and sensory neuropathy
back pain, spastic paresis and a sensory level
perianal numbness and urinary incontinence
weak legs impaired joint position sense
back pain, spastic paresis and a sensory level
How does aspirin exert is antiplatelet effect?
ADP receptor antagonist
Inhibition of cyclooxygenase enzyme
inhibition of glycoprotein IIb-IIIa
inhibition of PAR4 receptor
inhibition of COX enzyme
A 74 yo man presents with a change in bowel habit and anaemia. Colonoscopy and subsequent CT show inflamed colon and liver metastases. What is the Dukes stage of his cancer?
A
B
C
D
Dukes D (liver metastases)
Dukes’ A: Invasion into but not through the bowel wall
Dukes’ B: Invasion through the bowel wall penetrating the muscle layer but not involvinglymph nodes
Dukes’ C: Involvement of lymph nodes
Dukes’ D: Widespreadmetastases[7]
Which one of the following is false regarding colorectal cancer?
- bowel cancer screening is offered to people aged 55 or over
- the majority of cancers occur in the proximal colon
- FAP and HNPCC (lynch syndrome) are two inherited causes of colon cancer
- Proximal cancers usually have a worse prognosis
- Patients with PSC and UC have a increased risk of developing colon cancer
Majority of cancers occur in the proximal colon
A 50yo man presents with dysphagia. Which one of the following suggests a benign nature of his disease?
- weight loss
- dysphagia to solids initially then both solids and liquids
- dysphagia to solids and liquids occurring from the start
- anaemia
- recent onset of symptoms
dysphagia to solids and liquids occurring from the start
A 32yo lday complains of a 6 month history of bloating and diarrhoea. What is the most likely diagnosis based on the small bowel histology (shows villous atrophy)?
- Crohn’s
- Ulcerative colitis
- Microscopic colitis
- Coeliac disease
- IBS
Coeliac disease
A 19yo girl presents with abdo pain and loose stool. Which of the features suggest that she has irritable bowel syndrome?
- Anaemia
- Nocturnal diarrhoea
- weight loss
- blood in stool
- abdo pain relieved by defaecation
abdo pain relieved by defaecation
Which statement is true regarding H. pylori?
- it is a gram positive bacteria
- HP prevalence is similar in developing and developed countries
- 15% of patients with a duodenal ulcer are infected with HP
- PPIs should be stopped 1 week before a HP stool antigen test
- It is associated with an increased risk of gastric cancer
it is associated with an increased risk of gastric cancer
A 56yo 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 seen on his chest. Which is the most important test in the management of this patient?
- CXR
- US abdo
- Echo
- Ascitic tap
Ascitic tap
Which of the following features best distinguishes ulcerative colitis from Crohn’s disease?
- ileal involvement
- continuous colonic involvement on endoscopy
- non-caseating granuloma
- transmural inflammation
- perianal disease
continuous colonic involvement on endoscopy
A 68yo lady presents with abdo pain and distension. She last opened her bowels 5 days ago. She has a poor appetite and has lost some weight recently. Her past medical history 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 distension?
- colon cancer
- adhesions
- ascites
- diverticulitis
- strangulated hernia
ascites
A patient drinks 4 pints (568 ml = 1 pint) of beer (4%) a day, and 2 standard (175 ml) glasses of red wine (13%) on Saturday and Sunday additionally. How many units of alcohol is he drinking per week?
- 73
- 62
- 94
- 57
- 49
73 units
% x ml / 1000
alcohol unit = strength of drink (%) x amount of liquid in ml divided by 1000
beer: 4 x 568 x 4 x 7 /1000 = 63.6
wine: 13 x 175 x 2 x 2 / 1000 = 9.1
total no. of units per week = 72.7
A 71 yo man was admitted to hospital with pneumonia after he returned from a cruise holiday in the Mediterranean. 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 yellow raised patches. What is the likely organism responsible for his diarrhoea?
- norovirus
- e.coli
- giardia lamblia
- c. diff
- salmonella enteritidis
clostridium difficile
following antibiotic course and hospital stay
A 52 yo lady presents with fatigue and itching. She noticed pale stool and dark urine. She suffers from hypercholesterolaemia and rheumatoid arthritis. She takes simvastatin and cocodamol. Examination revealed jaundice, xanthelasma, spider naevi, and hepatomegaly. Her bloods showed bilirubin 150, ALP 98, ALT 80, positive AMA and a raised IgM. What is the most likely diagnosis?
- simvastatin induced liver injury
- primary biliary cholangitis
- gall stones
- autoimmune hepatitis
- primary sclerosing cholangitis
primary biliary cholangitis
if it was autoimmune hep, it would have been raised IgG and positive ANA.
A 16yo girl is admitted with comiting and abdo 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?
- metabolic acidosis
- a prolonged prothrombin time
- a raised creatinine
- hyperglycaemia
- ALT 100
hyperglycaemia as a loss of liver function due to overdose would lead to hypoglycaemia
treatment: N acetyl cysteine
A 68yo unkempt and malnourished and homeless man was brought to the hospital with haematemesis. Endoscopy found bledding varices. Subsequent ultrasound showed a coarse shrunken liver. On day 2 of his admission, he was found to be ataxic and confused with nystagmus. What is the most likely cause of his neurological presentation?
- alcohol toxicity
- alcohol withdrawal
- delirium tremens
- Wernicke’s encephalopathy
- Korsakoff syndrome
Wernicke’s encephalopathy
classical triad of ataxia, nystagmus/opthalmoplegia, confusion
acute and reversible with IV thiamine
Korsakoff - secondary to WE, memory impairment, chronic and irreversible (type of dementia)
A 23 yo 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?
- fever
- bowel sounds
- tachycardia
- rebound tenderness
- guarding
bowel sounds
Which of the following clinical features is typical of osteoarthritis?
A. 60 minutes of early morning stiffness
B. painful, swelling across the metacarpophalangeal joints and proximal interphalangeal joints
C. Pain in the 1st carpo-metacarpal joints
D. mobile, subcutaneous nodules at points of pressure
E. Alternating buttock pain
C. pain in 1st carpo-metacarpal joints
base of the thumb - squaring of thumb
10-15 mins of stiffness is normal but beyond 30 mins indicates inflammatory cause
Which of the following is an extra-articular manifestation of rheumatoid arthritis?
A. Subcutaneous nodules B. Episcleritis C. Peripheral sensory neuropathy D. Pericardial effusion E. All of the above
E. all of the above
Which of the following is a classical feature of rheumatoid arthritis on X-ray?
A. Peri-articular sclerosis B. Sub-chondral cysts C. Osteophytes D. Peri-articular erosions E. New bone formation
D. Peri-articular erosions
peri-articular osteopenia in rheumatoid
sclerosis is increased density so osteoarthritis
all the other options indicate increasing bone density which is a sign of osteoarthritis
A 53 yo man presents to you with a 3 day history of pain in his lower back. The pain started spontaneously and he first noticed it at work. He works as a builder and has been unable to go to work for the last 3 days and is keen to have a “sick note”. Physical examination reveals him to be slightly overweight with a BMI of 29, but there are no neurological deficits or spinal deformities and the pain is not easily localised on examination.
Which of the following describes the best management for this gentleman?
A. Given his age, he should be referred to a specialist
B. He should be sent for an X-ray to look for any pathological changes in his spine
C. He should not be given a sick note and be advised to return to work straight away
D. He should be reassured and advised to take simple analgesics and return to normal activity as soon as he can manage
E. He should be advised to seek other employment
D. He should be reassured and advised to take simple analgesics and return to normal activity as soon as he can manage
short history, usually fit and well hence simple mechanical backpain. do not encourage time away from work as immobilisation can worsen pain
For a lytic tumour to be visible on X-ray, it must have lost:
A. greater than 6% bone density B. greater than 16% bone density C. greater than 60% bone density D. greater than 90% bone density E. 100% bone density
C. greater than 60% bone density
loss of bone density in a malignant lesion- persisitent night time pain - i.e. x ray not great as investigation, if clinical picture suggests malignancy, do other tests
A 57 yo man presents with a 3 day history of a painful 1st MTP joint. On examination the area is red and very warm. He has a BMI of 32 and hypertension, and has had identical episodes before. Which of the following dietary changes would reduce his risk of future similar episodes?
A. A diet with high red meat content
B. A diet rich in dairy products
C. Drinking >5 cans of non-diet fizzy drinks per day
D. A diet rich in sugary foodstuffs
E. Switching from drinking beer to drinking lager
B. A diet rich in dairy products
Which of the following is not an autoimmune connective tissue disease?
- systemic lupus erythematosus
- Ehler Danlos Syndrome
- Primary Sjogren’s syndrome
- Systemic sclerosis
- Dermatomyositis
- Ehler Danlos Syndrome
AI- positive ANA
EDS- heritable disorder of collagen
A 23 yo woman presents with mouth ulcers, fever, painful white fingers and pleuritic chest pain. She is antinuclear antibody positive, her ESR is 52 (0-15) and her WCC is low (leucopenic). Which of the following features would you not expect to be associated with her illness?
A. Deforming arthritis B. Photosensitive rash C. Seizures D. Pulmonary embolism E. Thrombocytosis
diagnosis: SLE- with raynaud’s
lupus- non-erosive arthritis but still deforming
lupus in brain leads to seizures
thrombocytosis is associated with rheumatoid not lupus
you get thrombocytopenia
Which of the following is used in the treatment of SLE?
A. Anti-TNF B. Anti-malarials C. Ustekinuab (IL12/23 blocker) D. Sulfasalzine E. Allopurinol
B. Anti-malarials
Anti-TNF: IBD, skin psoriasis, rhuematoid arthritis, ankylosing spondylitis, psoriatic arthritis . can induce lupus.
Anti-malarials: hydroxychloroquine- arthritis and ucosal probelnss, mouth ulcer and skin disease
IL12/23: spondyloarthritis, IBD, skin psoriasis
sulfasalzine- DMARD, rheumatoid arthritis, lupus inducing
allopurinol- xanthine oxidase inhibitor- prophylactic treatment in gout
An adul male presents with 6 week hisotry of right sided headache, general malaise, early morning stiffness, and pain in his jaw when eating. His CRP is 63 (0-5), ESR 78 (0-15). Which of the following is true about his underlying condition?
A. It is associated with ANCA positivity
B. It typically affects those between 50 and 60 yo
C. It can present with acute sight loss
D. It rarely responds to corticosteroids
E. It is a vasculitis affecting small blood vessels
C. It can present with acute sight loss
early monring stifness- inflammatory
jaw claudication
inflam
giant cell arteritis, temporal arteritis- medical emergency , start steroids immediately
responds very well to steroids hence that statement is false
The experience of amaurosis fugax is classically described as a temporary loss of vision in one or both eyes that appears as a black “curtain coming down vertically into the field of vision in one eye.”
transient doublevision
6th nerve palsy
large vessel vasculitis
Which o the following is now a rare cause for joint infection in infants, due to the standard childhood immunisation schedule in the UK?
A. Staphyloccocus aureus B. Gp A (beta haemolytic) streptococcus C. Varicella Zoster D. Rubella E. Haemophilus influenzae
E. Haemophilus influenzae
A 64 yo woman with type 2 diabetes mellitus has been struggling with cellulitis of her right forefoot for 4 weeks. After making no progress with oral antibiotics, she has now had 14 days of IV flucloxacillin and co-amoxiclavulanic acid but the pain and erythema persist and her CRP has only fallen to 47 from its peak of 91. What is the next most appropriate investigation?
A. Blood cultures B. MRI right forefoot C. Plain X-ray right forefoot D. Skin biopsy of right forefoot E. Ultrasound scan of right forefoot
C. plain X-ray of right forefoot
no blood cultures as she has already been on antibiotics
MRI if plain film x ray normal
x ray because 4 week hisotry means bone has time to show changes on xray (oedema)
Which of the following is the most frequent infecting organism ater hip replacement?
A. Methicillin resistant staphylococcus aureus B. Coagulase negative staphylococcus C. Salmonella D. Enterococcus faecalis E. Propionibacterium acne
coagulase negative staph
A 37 yo man with a 10 yr history of back pain presents with a “flare” of symptoms- pain in his lower back radiating out over his buttocks and down the back of his thighs , and pain between the shoulder blades. Ibuprofen has been helping significantly. He finds it very difficult to get moving in the mornings.
Which of the following features would support a diagnosis of inflammatory back pain?
A. worsening pain on bending forwards B. worsening pain on bending backwards C. pain shooting down his leg to the ankle D. pain across the costochondral joints E. improved pain whilst sitting at work
pain across costochondral joints - ankylosing spondylitis can affect rib cage so ask about rib cage pain or difficulty breathing
pain bend forward- intervertebral disc problem
bacwards- facet joint pain
shooting- sciatica neural impingement electric shock
constant mid buttock or hip to knee pain sacroileitis
inflam gets better with work not rest
Mrs A Vrige (23 years old) has been complaining of dysuria, urgency and frequency passing urine. Similar urinary symptoms over the last few months were treated with 3 days of Cephalexin by another GP. She is in a stable relationship with her husband and takes the oral contraceptive pill. Using the BIA urinalysis algorithm to help you, you decide to treat empirically for UTI.
Which antibiotic do you use whilst awaiting results?
A. Ciprofloxacin B. Trimethoprim C. Nitrofurantoin D. Tazocin E. No antibiotic needed
Nitrofurantoin
Mrs A Vrige (23 years old) has been complaining of dysuria, urgency and frequency passing urine. Similar urinary symptoms over the last few months were treated with 3 days of Cephalexin by another GP. She is in a stable relationship with her husband and takes the oral contraceptive pill.
After 24 hours, yellow colonies are growing on the agar plate. A Gram film is made and round purple clusters are seen. Describe what you see.
A. Gram negative bacilli
B. Gram negative cocci
C. Gram positive bacilli
D. Gram positive cocci
Gram positive cocci (staph saprophyticus)
Mrs A Vrige (23 years old) has been complaining of dysuria, urgency and frequency passing urine. Similar urinary symptoms over the last few months were treated with 3 days of Cephalexin by another GP. She is in a stable relationship with her husband and takes the oral contraceptive pill. There are yellow colonies on agar plate and Gram positive cocci on film.
Which organism from the list is it most likely to be?
A. E. coli B. Pseudomonas aeruginosa C. Proteus mirabilis D. Staphylococcus saprophyticus E. Klebsiella pneumoniae
Staphylococcus saprophyticus
Mr C Docalot is a 65 year old man with benign prostatic hyperplasia for which he has been prescribed tamsulosin for several years. He presents with 3 days of increased urinary frequency and lower back pain. On examination he is unwell and agitated: T 390C and BP 90/50 and there is right renal angle tenderness.
What key samples should be taken?
A. MSU and blood culture B. Sputum and MSU C. CSU D. Blood culture E. All of the above
MSU and blood culture
A patient presents with sudden onset very severe headache.
What is the likely medical emergency?
What is the treatment?
What could be a complication?
subarachnoid haemorrhage
seen as hyperdense basal cisterns in CT scan
extra-ventricular device to drain CSF and reduce ICP
hydrocephalus
A young woman presents with bilateral leg weakness and numbness that has developed over 4 days. She complains of difficulty passing urine and constipation.
Give 3 differentials for this history.
MS cauda equina syndrome spinal cord compression conus medullaris syndrome spinal tumour like a lymphoma
spinal cord lesion due to bilateral and bladder/bowel symptoms
A young woman presents with bilateral leg weakness and numbness that has developed over 4 days. She complains of difficulty passing urine and constipation.
What investigations would you do?
MRI spine
A young woman presents with bilateral leg weakness and numbness that has developed over 4 days. She complains of difficulty passing urine and constipation.
On further questioning the patient reports that she had blurred vision for 4 weeks 2 years ago. She recently moved to Sheffield after living in Chile all her life.
LP showed 2 WCC 3 RBC protein of 0.56 and Oligoclonal bands
VEP showed slowing of signal transmission
What is the diagnosis?
What is the initial treatment?
What would be the treatment after this initial phase?
bilateral symptoms so lesion is not in the brain
bladder and bowel symptoms point to spinal cord lesion
blurred vision is a sign of optic neuritis which can be an early presentation of MS
incidence of MS increases with distance from the equator
oligoclonal bands in LP is a diagnostic feature of MS
visually evoked potentials tell us about the conduction speed of the optic nerve
diagnosis = multiple sclerosis
initial tx = treat acute episode- corticosteroids like methylprednisolone
disease modifying tx = Natalizumab or beta interferon to reduce disease progression
Symptomatic treatments also
A 44 year old marathon runner presents with difficultly running the same route he has done for the last 2 years. When he rests he gets twitching in his arms. He also tells you that last week when he went out for a meal he choked on his wine, this has happened before.
On examination the patient had reduced reflexes in his right arm but increased reflexes in his legs
Power 4/5 in both his arms and his legs.
When you examine his tongue it shows fasciculations.
What is the likely diagnosis?
What supportive treatments are available for this patient?
What is his life expectancy?
MND – probably ALS as UMN and LMN lesions and bulbar involvement
Supportive treatment = Riluzole only progession effecting treatment
Supportive includes treating spasms i.e. baclofen
Hyosine for drooling
Opioids for choking sensation
Modifications etc. etc.
MND = 3 year life expectancy
A 30 year old woman presents with an episode of collapse. She doesn’t remember the event, but recalls beforehand experiencing a rising sensation, and a feeling of déjà vu. Her husband who was also present reports that she went blank, fell to the floor and then went very stiff. After this she shook for 30 seconds, bit the side of her tongue and was incontinent. She now feels very tired and has achy muscles.
Which of the following is an appropriate investigation to perform? Serum prolactin CK EEG CT Brain Serum Lactate Blood Glucose ECG CXR
EEG
A 30 year old woman presents with an episode of collapse. She doesn’t remember the event, but recalls beforehand experiencing a rising sensation, and a feeling of déjà vu. Her husband who was also present reports that she went blank, fell to the floor and then went very stiff. After this she shook for 30 seconds, bit the side of her tongue and was incontinent. She now feels very tired and has achy muscles.
This person has a CT scan which shows an abnormality, in which lobe do you think this is likely to be? Frontal Temporal Parietal Occipital
Temporal (deja vu)
A 30 year old woman presents with an episode of collapse. She doesn’t remember the event, but recalls beforehand experiencing a rising sensation, and a feeling of déjà vu. Her husband who was also present reports that she went blank, fell to the floor and then went very stiff. After this she shook for 30 seconds, bit the side of her tongue and was incontinent. She now feels very tired and has achy muscles.
What would you advise this patient about driving?
Notify DVLA
Do not drive until seizure free for a year
A 30 year old woman presents with an episode of collapse. She doesn’t remember the event, but recalls beforehand experiencing a rising sensation, and a feeling of déjà vu. Her husband who was also present reports that she went blank, fell to the floor and then went very stiff. After this she shook for 30 seconds, bit the side of her tongue and was incontinent. She now feels very tired and has achy muscles.
What AED would you not use in this situation?
AED to avoid = sodium valproate – teratogenic
Which blood gas result demonstrates type 1 respiratory failure? (pO2, pCO2, pH)
A. 10.3, 5.4, 7.41 B. 14.1, 3.6, 7.46 C. 7.5, 6.5, 7.36 D. 7.3, 4.5, 7.43 E. 6.5, 7.8, 7.30
D
A pneumothorax is:
A. a pocket of air within the lung tissue
B. a collection of infected fluid in the pleural cavity
C. always life-threatening
D. an accumulation of air in the pleural cavity
E. an accumulation of air around the heart
D
A- bullous emphysema or pneumatocele
E- pneumomediastinum
B- empyema
The severity of stable COPD is assessed by:
A. FEV1/FVC B. FVC (% predicted) C. FEV1 (% predicted) D. 6 minute walk distance E. Peripheral blood oxygen saturation
C
Acute asthma severity is initially assessed by:
A. questionnaire B. clinical examination C. peak expiratory flow D. taking a detailed history E. FEV1/FVC
B
check: tachycardia silent chest sounds SpO2 respiratory rate
for chronic stable asthma: RCP3 questions
