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Phase 2A > Formative assessments > Flashcards

Formative assessments Flashcards

1
Q

what is the name of the cells that produce collagen in fibrous scarring?

A

fibroblasts

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2
Q

what is an example of acute inflammation from the following:

  • glandular fever
  • leprosy
  • appendicitis
  • tubercolosis
A

appendicitis

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3
Q

what is the main effector cell of acute inflammation?

A

neutrophil polymorphs

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4
Q

what crystals are deposited in joints in gout?

A

uric acid

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5
Q

in which one of the following does granulomatous inflammation occur?

  • Chron’s disease
  • acute appendicitis
  • infectious mononucleosis
  • lobar pneumonia
A

Crohn’s disease

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6
Q

what is the specific name of calcification in diseased (as opposed to normal) tissues?

A

dystrophic calcification

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7
Q

which one of the following is a chronic inflammatory process from its start?

  • appendicitis
  • cholecystitis
  • infectious mononucleosis
  • lobar pneumonia
A

infectious mononucleosis

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8
Q

what is the name of the cells which produce antibodies?

A

plasma cells

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9
Q

which one of the following tumours never metastasises?

  • malignant melanoma
  • small cell carcinoma
  • basal cell carcinoma of the skin
  • breast cancer
A

basal cell carcinoma of the skin

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10
Q

what is the name of a malignant tumour of striated muscle?

A

rhabdomyosarcoma

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11
Q

which of the following tumours does not commonly metastasise to bone?

  • breast cancer
  • lung cancer
  • prostate cancer
  • liposarcoma
A

liposarcoma

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12
Q

what term describes a cancer that has not invaded through the basement membrane?

A

carcinoma in situ

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13
Q

what is the name of a benign tumour of glandular epithelium?

A

adenoma (adenocarcinoma is malignant)

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14
Q

which one of these tumours does not have a screening programme in the UK?

  • breast cancer
  • colorectal cancer
  • cervical cancer
  • lung cancer
A

lung cancer

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15
Q

which one of the following is not known to be a carcinogen in humans?

  • hepatitis C virus
  • ionising radiation
  • aromatic amines
  • aspergillus niger
A

aspergillus niger

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16
Q

what does Hepatitis C cause?

A

hepatocellular carcinoma

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17
Q

what do aromatic amines cause?

A

bladder cancer

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18
Q

what does aflatoxin cause?

A

hepatocellular cancer

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19
Q

what is the name of a benign tumour of fat cells?

A

lipoma

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20
Q

what is the name of a malignant tumour of glandular epithelium?

A

adenocarcinoma

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21
Q

which one of the following is not a feature of malignant tumours?

  • vascular invasion
  • metastasis
  • increased cell division
  • growth related to overall body growth
A

growth related to overall body growth

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22
Q

what is a benign tumour whose growth is related to overall body growth?

A

hamartoma

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23
Q

a transitional cell carcinoma of the bladder is a malignant tumour?

  • true
  • false
A

true

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24
Q

a leiomyoma is a benign tumour of smooth muscle?

  • true
  • false
A

true

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25
Q

radon gas is a cause of lung cancer?

  • true
  • false
A

true

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26
Q

what mechanism is the damage of radon gas to the lungs?

A
  • produces alpha particles, which damage the DNA
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27
Q

asbestos is a human carcinogen?

  • true
  • false
A

true

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28
Q

which lifestyle factor is most likely to cause cancer?

  • drinking half a bottle of wine a day
  • being obese
  • running for 20 minutes twice a week
  • smoking 20 cigarettes a day
A

smoking 20 cigarettes a day

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29
Q

how much does smoking 20 cigarettes a day increase the risk of cancer by?

A

26 times

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30
Q

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
A

anaplastic carcinoma of the thyroid

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31
Q

ovarian cancer commonly spreads in the peritoneum?

  • true
  • false
A

true

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32
Q

activation of naive T cells is achieved by which antigen presenting cells?

  • neutrophils
  • mast cells
  • macrophages
  • dendritic cells
A

dendritic cells

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33
Q

what type of cell 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”

  • macrophage
  • neutrophil
  • eosinophil
  • mast cell
  • fibroblast
A

macrophage

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34
Q

which of the following is not involved in innate immune mechanisms?

  • anatomic barriers
  • phagocytic
  • inflammatory mechanisms
  • antibody production
  • skin
A

antibody production

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35
Q

influenza vaccine is targeted towards ‘at risk’ groups in the UK. which of the following are classified ‘at risk’?

  • over 65 years
  • 16 years old
  • the obese at any age
  • teenagers
  • under 2 years old
A

over 65 years and under 2 years old

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36
Q

which of the following is administered as a live attenuated vaccine in the UK?

  • hepA
  • MMR
  • tetanus
  • flu
  • polio
A

MMR

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37
Q

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?

  • opsonisation
  • target cell lysis
  • chemoattraction of leukocytes
  • production of interferons
  • phagocytosis
A

production of interferons

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38
Q

which of the following is a polysaccharide vaccine?

  • anthrax vaccine
  • Hib vaccine (Haemophilus influenza type b)
  • rabies vaccine
  • hep A
A

Hib vaccine (Haemophilus influenza type b)

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39
Q

what are two types of immune response in humans?

  • immunological tolerance
  • immune surveillance
  • innate and acquired
  • intrinsic and extrinsic
  • overt and covert
A

innate and acquired

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40
Q

which of the following is not an organ-specific auto-immune disease?

  • ulcerative colitis
  • type 1 diabetes mellitus
  • Graves disease
  • Hashimoto’s thyroidtitis
  • Sjogren’s syndrome
A

ulcerative colitis

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41
Q

which of the following is not a classical PAMP?

  • peptidoglycan, found in bacterial walls
  • flagellin, a protein found in bacterial flagella
  • lipopolysaccharide (LPS) from the outer membrane of gram-negative bacteria
  • interleukin 12
  • nucleic acids such as viral DNA or RNA
A

interleukin 12

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42
Q

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. this is probably…

A

Streptococcus pneumoniae

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43
Q

which of these is a gram negative bacillus that ferments lactose?

  • shigella sonnei
  • listeria monocytogenes
  • neisseria meningitidis
  • eschericia coli
  • streptococcus pyogenes
A

Eschericia coli

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44
Q

which is incorrect? Haemophilus influenzae is an important cause:

  • meningitis in pre-school children
  • otitis media
  • pharyngitis
  • gastroenteritis
  • exacerbations of COPD
A

gastroenteritis

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45
Q

which is normally a sterile site?

  • the pharynx
  • the urethra
  • CSF
  • the lung
  • skin
A

CSF

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46
Q

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
A

endotoxin production

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47
Q

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 take 1-2 days
  • a detectable IgM in serum may be diagnostic
A

the sample must come from a sterile site

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48
Q

which is most accurate? the HIV virus envelope contains

  • RNA, capsid, DNA polymerase
  • DNA, capsid, reverse transcriptase
  • RNA, capsid, reverse transcriptase
A

RNA, capsid, reverse transcriptase

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49
Q

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

A

they cannot withstand phagolysosomal killing

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50
Q

regarding antimicrobial resistance, which is true?

  • 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
A

spread by plasmid mediated gene transfer

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51
Q

antimicrobials. which pairing is incorrect?
- S. pyogenes: can use penicillin
- meropenem: a carbapenem
- glycopeptides: used for MRSA
- coamoxiclav: contains a beta-lactamase inhibitor
- cefuroxime: a macrolide

A

cefuroxime: a macrolide

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52
Q

which of the following is not under the control of the pituitary gland?

  • thyroid
  • adrenal cortex
  • adrenal medulla
  • testis
  • ovary
A

adrenal medulla

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53
Q

which of the following statements is false?

  • the pituitary gland lies in the sella turcica
  • the weight of the pituitary gland is around 0.5g
  • ACTH is secreted from the pituitary during stress
  • the pituitary regulates calcium metabolism
  • the anterior and posterior pituitary are distinct on an MRI scan
A

the pituitary regulates calcium metabolism

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54
Q

in men all the following are mainly produced in the adrenal cortex except?

  • DHEAS
  • testosterone
  • aldosterone
  • 17-OH progesterone
  • androstenedione
A

testosterone

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55
Q

which of the following regarding AVP (vasopressin) 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
A

is produced in the pituitary gland

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56
Q

where is growth hormone’s main site of action to stimulate IGF1 (insulin-like growth factor) release?

  • bone
  • liver
  • adrenal cortex
  • muscle
  • pancreas
A

liver

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57
Q

the following are typical features of excess growth hormone secretion except?

  • polyuria
  • joint pains
  • sweating
  • hypotension
  • headaches
A

hypotension

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58
Q

the following hormones all have a circadian rhythm except?

  • cortisol
  • testosterone
  • DHEA
  • 17OH progesterone
  • thyroxine (T4)
A

thyroxine

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59
Q

typical features of cortisol deficiency include the following except?

  • hypotension
  • muscle aches
  • weight loss
  • hyperglycaemia
  • lethargy
A

hyperglycaemia

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60
Q

a 38 year old lady presented with weight gain, menorrhagia and constipation. she is most likely to be suffering from?

  • Cushing’s syndrome
  • Addison’s disease
  • primary hypothyroidism
  • Graves disease
  • acromegaly
A

primary hypothyroidism

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61
Q

which test would you likely want to perform in a patient with proximal muscle weakness, purple striae and thin skin?

  • synacthen test
  • overnight dexamethasone suppression test
  • insulin tolerance test
  • glucagon test
  • skin allergy tests
A

overnight dexamethasone suppression test

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62
Q

a 24 year old woman presented with hirsutism, oligomenorrhoea and acne. what test would you perform?

  • ultrasound adrenals
  • ultrasound ovaries
  • MRI ovaries
  • CT scan adrenals
  • prolactin
A

ultrasound ovaries

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63
Q

a 54 year old gentlemen presented with hyponatraemia. all the following conditions need to be excluded before confirming SIADH except?

  • hypothyroidism
  • hypervolaemia
  • euvolaemia
  • adrenal insufficiency
  • diuretic use
A

euvolaemia

64
Q

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?

  • chest x-ray
  • CT brain
  • skin turgor and jugular venous pressure test
  • thyroid function tests
  • synacthen test
A

skin turgor and jugular venous pressure test

65
Q

what is SIADH?

A

syndrome of inappropriate ADH secretion

66
Q

what are essential criteria for the diagnosis of SIADH?

A
  • hyponatraemia <135 mmol/L
  • plasma hypoosmolality <275 mOsm/Kg
  • urine osmolality > 100 mmOsm/Kg
  • clinical euvolaemia (no clinical signs of hypovolaemia or hypervolaemia)
  • increased urinary sodium excretion >30 mmol/L with normal salt and water intake (recent diuretic use, renal disease, hypothyroidism and hypocortisolism)
67
Q

the following are most likely causes of SIADH except?

  • multiple sclerosis
  • lung abscess
  • subdural haemorrhage
  • lymphoma
  • cerebrovascular accident
A

MS

68
Q

what are CNS disorders that cause SIADH?

A
  • head injury
  • meningitis
  • encephalitis
  • brain tumour
  • brain abscess
  • cerebral haemorrhage/thrombosis
  • Guillain-Barre syndrome
  • acute intermittent porphyria
69
Q

what are tumours that cause SIADH?

A
  • carcinoma (esp. lung)
  • lymphoma
  • leukaemia
  • thymoma
  • sarcoma
  • mesothelioma
70
Q

what are respiratory causes of SIADH?

A
  • pneumonia
  • TB
  • emphysema
  • severe asthma
  • pneumothorax
  • positive pressure ventilation
71
Q

what are drugs that can cause SIADH?

A
  • carbamazapine
  • clofibrate
  • chlorpropramide
  • thizides
  • phenothiazides
  • MAO inhibitors
  • SSRIs
  • cytotoxics
  • desmopressin
  • vasopressin
  • oxytocin
72
Q

a 28 year old presented with a microprolactinoma. what is the most unlikely symptom?

  • galactorrhoea
  • oligomenorrhoea
  • decreased sexual appetite
  • headaches
  • visual field defects
A

visual field defects

73
Q

the following suppress appetite except:

  • peptide YY
  • ghrelin
  • CCK
  • GLP1
  • glucose
A

ghrelin

74
Q

the main adipose signal to the brain is:

  • CCK
  • neuropeptide Y
  • leptin
  • agouti-related peptide
  • adiponectin
A

leptin

75
Q

a 65 year old lady is diagnosed with SIADH. her sodium is 123 mmol/l. what is your first line of management?

A

if she is asymptomatic i will treat with fluid restriction

76
Q

what is the treatment of acute hyponatraemia secondary to SIADH?

A

24-48 hours

  • 3% saline if symptomatic
  • if asymptomatic, fluid restriction
77
Q

what is the treatment of slow onset hyponatraemia?

A

> 48 hours

  • severe symptoms: 3% saline
  • mild symptoms/asymptomatic: fluid restriction, vaptans
78
Q

a patient with Addison’s disease presents with a chest infection. what do you do?

  • omit his steroids to avoid immunosuppression
  • stop his steroids as they have precipitated a chest infection
  • double his steroid dose whilst unwell
  • keep him on his usual steroid dose
  • none of the above
A

double his steroid dose whilst unwell

79
Q

the following tests are typical of secondary hypogonadism:

  • low LH; high testosterone
  • low LH; low testosterone
  • high prolactin; high testosterone
  • low FSH; low prolactin
  • none of the above
A

low LH; low testosterone

80
Q

typical features of hypogonadism in a male include the following except:

  • decreased sweating
  • joint and muscular aches
  • decreased sexual appetite
  • decreased hair growth
  • asymptomatic
A

decreased sweating

81
Q

a patient has a noon testosterone level below the normal range. what will you do?

  • treat with testosterone gel
  • repeat the test at 0900h and check for symptoms
  • repeat the test at noon to keep things equal
  • refer to endocrinology
  • none of the above
A

repeat test at 0900h and check for symptoms

82
Q

the first line treatment for a patient with a symptomatic prolactinoma is usually:

  • radiotherapy
  • transphenoidal surgery
  • dopamine agonists
  • transfrontal surgery
  • somatostatin analogues
A

dopamine agonists

83
Q

typical visual field defect of a patient with a large pituitary mass is:

  • unilateral quadrantanopia
  • bitemporal hemianopia
  • complete unilateral visual field loss
  • complete bilateral visual field loss
  • none of the above
A

bitemporal hemianopia

84
Q

satiety is:

  • the physiological feeling of no hunger
  • inhibited by activation of POMC neurons
  • the physiological feeling of hunger
  • induced by ghrelin release
  • enhanced by agouti related peptide
A

the physiological feeling of no hunger

85
Q

the centres of appetite regulation in the brain are mainly found in the:

  • pituitary
  • cerebellum
  • hypothalamus
  • basal ganglia
  • brain cortex
A

hypothalamus

86
Q

a patient presents with chest pain on exertion… diagnosis?

A

stable angina

87
Q

ECG shows saddle-shaped ST… diagnosis?

A

pericarditis

88
Q

name a condition in which beta-blockers are contraindicated

A

asthma

89
Q

common side effect of ACEi?

A

dry cough

90
Q

MRI reveals CNS disseminated in space and time… diagnosis?

A

MS

91
Q

commonest cause of hospital acquired pneumonia?

A

Staph. aureus

92
Q

bowel biopsy reveals transmural lesion… diagnosis?

A

Crohns

93
Q

pain in big toe, diet of excessive red wine and cheese… diagnosis?

A

gout

94
Q

antibiotics for treating TB?

A

rifampcin

95
Q

painless haematuria, works in a dye factory… diagnosis?

A

bladder cancer

96
Q

which of the following is not a physiological response to increased blood glucose?

  • decreased breakdown of muscle
  • glycogenesis
  • increased lipolysis
  • increased glucose uptake
  • production of insulin from the pancreas
A

increased lipolysis

- you would decrease breakdown of fats to prevent further increase in glucose

97
Q

why is muscle broken down in hyperglycaemia?

A

to increase glucose for gluconeogenesis

98
Q

what hormone is produced in low glucose levels?

A

glucagon

99
Q

what result does not suggest a diagnosis of type 2 diabetes mellitus?

  • fasting plasma glucose 10mmol/L
  • fasting plasma glucose 8mmol/L
  • oral glucose tolerance test 25mmol/mol
  • HbA1c of 47
  • random plasma glucose of 13mmol/L (with other symptoms of DM)
A

HbA1c of 47

100
Q

what are values for diagnosis of T2DM?

A
  • fasting plasma glucose >7mmol/L
  • OGTT >11.1mmol/ol
  • HbA1c >48/6.5%
  • random plasma glucose + symptoms of CM >11mmol/L
101
Q

give 3 risk factors for developing T2DM and 2 symptoms of it?

A
  • obesity
  • family history
  • ethnicity
  • diet/exercise
  • medications (thiazide diuretic with beta blocker)
102
Q

which of the following symptoms would align your suspected diagnosis?

  • dry skin
  • hair loss
  • constipation
  • lethargy
  • clubbing
A

clubbing - hyperthyroidism

others indicate hypothyroidism

103
Q

what is the treatment of hyperthyroidism?

A
  • carbimazole
  • radioiodine
  • surgery
104
Q

what is the treatment of hypothyroidism?

A

levothyroxine

105
Q

what are signs of hyperthyroidism?

A
  • anxiety, heat intolerance
  • eyes building (exophthalmos)
  • increased appetite
  • goitre
  • tachycardia
  • tremor, clubbing, sweating (hands)
  • weight loss, diarrhoea
  • oligomenorrhoea (infrequent)

(think pop tarts)

106
Q

what are signs of hypothyroidism?

A
  • cold intolerance, slowing intellectual activity, hair, hearing, decreased libido
  • apathy/blank expression
  • decreased appetite
  • bradycardia
  • brittle nails, dry skin
  • weight gain, constipation
  • amenorrhoea/menorrhagia
107
Q

abdominal pain, weight loss, drinking water, tachycardic, tachypnoeic, clammy and confused… diagnosis

  • Cushing’s
  • diabetes insipidus
  • diabetic ketoacidosis
  • hyperaldosteronism
  • SIADH
A

diabetic ketoacidosis

  • Cushings: weight gain not loss; no drinking symptoms; no acute crisis
  • DI: does cause polydipsia, not weight loss, less likely to cause profound dehydration/shock
  • hyperaldosteronism: polydipsia, polyuria
  • hyperthyroidism: weight loss but no thirst or polydipsia
108
Q

what is the treatment of DKA?

A

IV fluids and insulin

109
Q

what is the action of aldosterone?

A

increases sodium retention -> water retention -> hypertension -> increased excretion of potassium -> hypokalaemia

110
Q

TSH high and T4 low. what is the appropriate diagnosis?

  • sub-clinical hypothyroidism
  • primary hypothyroidism
  • sub-clinical hyperthyroidism
  • primary hyperthyroidism
  • TSH secreting tumour
A

TSH high and high T4 = pituitary problem e.g. TSH secreting tumour
TSH high and low T4 = thyroid problem e.g. primary hypothyroidism

TSH low and high T4 = thyroid problem e.g. primary hyperthyroidism
TSH low and low T4 = pituitary problem

111
Q

the ______ secretes TRH?

A

hypothalamus; thyrotropin-releasing hormone

112
Q

TRH stimulates the _______ pituitary to produce ________

A

anterior; thyroid stimulating hormone

113
Q

TSH stimulates the production of T4 (_____) and T3 (______)

A 
T4 = thyroxine
T3 = triiodothyronine
114
Q

tired, tearful, low sodium and high potassium… diagnosis?

  • Addison’s
  • Conn’s
  • Cushing’s
  • depression
  • T1DM
A

Addison’s

Addison's: tanned, tired, tearful
Conn's: high aldosterone -> low potassium and high sodium
Cushing's: high cortisol
depression: does not affect electrolytes
T1DM: history not compliant
115
Q

lost sex drive, skin thinning, easy bruising on lower arms, mood swings, 160/105 BP… which investigation would be performed?

  • ABG
  • 24hr urine cortisol collection
  • CT head
  • thyroid function tests
  • liver functional tests
A

24hr urine cortisol collection; features of Cushing’s

ABG = more acute, e.g. DKA
CT head = would be beneficial
thyroid function tests = not really relevant
liver function tests = potentially by low platelets

116
Q

why may people not gain muscle after weightlifting

  • adrenal insufficiency
  • Conn’s
  • hypothyroidism
  • hyperparathyroidism
  • phaeochromocytoma
A

adrenal insufficiency: caused by Addison’s disease (primary) and steroids (secondary)

Conn’s: caused by adrenal adenoma (80%)

hypothyroidism: caused by AI (Hashimotos thyroiditis, iatrogenic, iodine deficiency, drugs e.g. lithium)
hyperparathyroidism: caused by parathyroid gland adenoma
phaeochromocytoma: caused by tumour of chromaffin of adrenal medulla

117
Q

give three functions of parathyroid hormone?

A

released when calcium levels are low

  • increased bone resorption
  • increased Ca2+ reabsorption from kidneys
  • increased 1,25dihydroxy-vitaminD
  • increased Ca2+ absorption from gut
118
Q

what is not a sign of high serum calcium levels?

  • bone pain
  • constipation
  • depressions
  • hypertension
  • kidney stones
A

hypertension

119
Q

what are main features of hypercalcaemia?

A

bones, groans, stones, psychiatric overtones

  • abnormal bone remodelling and fracture risk
  • increased risk for kidney stones
  • abdominal cramping, nausea, ileus, constipation
  • lethargy, depressed mood, psychosis, cognitive dysfunction
120
Q

name a scan that can be used to measure bone density?

A

DEXA (dual energy xray absorptiometry)

121
Q

true or false: bisphosphonates are a medical treatment for hypercalcaemia

A

true; also used for osteoporosis

- prevent bone turnover

122
Q

what is the characteristic genetic abnormality in CML?

  • t(15;17) ATRA gene
  • t(9;22) Philadelphia chromosome
  • t(8;21) AML/ETO gene
  • t(8;14) cMYC oncogene
A

t(9;22) Philadelphia chromosome

123
Q

what class of drug best describes Rituximab?

  • cytotoxic chemotherapy
  • disease-modifying therapy
  • monoclonal antibody
  • antibiotic
A

monoclonal antibody

-mab = monoclonal antibody

124
Q

which age group is characteristically affected by Hodgkin’s lymphoma?

  • children
  • teenagers and young adults
  • middle aged (40-60yrs)
  • older aged (60+)
A

teenagers and young adults

  • also affects the elderly
  • peak in late teens and early 20s and a second peak at older age
125
Q

how is myeloma bone disease usually assessed?

  • plain xray
  • clinical assessment
  • isotope bone scan
  • PET scan
A

plain x-ray

  • skeletal survey
  • production of osteoclast-activating factors
  • OAFs include RANKL, IL-3 and TNF-alpha
126
Q

what is the correct mechanism of action for the anti-emetic drug Ondansetron?

  • peripheral D2 antagonist
  • central D2 antagonist
  • anti-cholinergic
  • 5HT3 antagonist
A

5HT3 antagonist

  • pro-kinetics for gastrostasis
  • centrally acting good for drug induced
127
Q

what is the commonest cause of microcytic anaemia?

  • B12 deficiency
  • iron deficiency
  • haematologic malignancy
  • hereditary spherocytosis
A

iron deficiency

128
Q

in sickle cell anaemia what would you expect to see the reticulocyte count?

  • absent
  • low
  • normal
  • raised
A

raised

129
Q

bacterial infection usually causes

  • low lymphocytes
  • low neutrophils
  • high lymphocytes
  • high neutrophils
A

high neutrophils

- reactive vs primary

130
Q

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 starting antibiotics
  • perform cultures and start oral antibiotics
  • perform cultures and start broad spectrum antibiotics
A

perform cultures and start broad spectrum antibiotics

  • haematological emergency
  • ABC
  • perfurm cultures
  • broad spectrum IV antibiotics within 1 hour
131
Q

how does aspirin exert its antiplatelet effect?

  • ADP receptor antagonist
  • inhibition of cyclooxygenase enzyme
  • inhibition of glycoprotein IIb/IIIa
  • inhibition of PAR4 receptor
A

inhibition of cyclooxygenase enzyme

132
Q

a 74 year old man presents with a change in bowel habit and anaemia. colonoscopy and subsequent CT showed below. what is the Duke stage of his cancer?

A

D

133
Q

which one of the following is false regarding colorectal cancer?

  • bowel cancer screening offered to people aged 55 or over
  • majority of cancers occur in the proximal colon
  • FAP and HNPCC are two inherited causes of colon cancer
  • proximal cancers usually have a worse prognosis
  • patients with PSC and UC have an increased risk of developing colon cancer
A

the majority of cancers occur in the proximal colon - FALSE - they occur most in the distal colon

134
Q

a 50 year old 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 symptom
A

dysphagia to solids and liquids occurring from the start (others are red flags)

135
Q

a 32 year old lady complains of a 6 month history of bloating and diarrhoea/ what is the most likely diagnosis on the small bowel histology?

  • Crohns
  • UC
  • microscopic colitis
  • coeliac disease
  • irritable bowel syndrome
A

coeliac disease

136
Q

a 19 year old presents with abdominal pain and loose stool. which of the following features suggest that she has IBS?

  • anaemia
  • nocturnal diarrhoea
  • blood in stool
  • abdominal pain relieved by defectaion
A

abdominal pain relieved by defecation

137
Q

which statement is true regarding Helicobacter pylori?

  • gram positive
  • HP prevalence is similar in developing and developed countries
  • 15% of patients with a duodenal ulcer are infected with H. pylori
  • PPIs should be stopped 1 week before a H. pylori stool antigen test
  • associated with an increased risk of gastric cancer
A

associated with increased risk of gastric cancer

138
Q

a 56 year old man presents with abdominal distension and SOB. examination revealed fever of 38C, tense distended abdomen with shifting dullness. he also has dullness to percussion in the right lung base. spider naevi are seen. what is the most important test?

  • CXR
  • ultrasound abdomen
  • echocardiogram
  • ascitic tap
A

ascitic tap

139
Q

which of the following features best distinguishes UC from Crohns?

  • ileal involvement
  • continuous colonic involvement on endoscopy
  • non-caseating granuloma
  • transmural inflammation
  • perianal disease
A

continuous colonic involvement on endoscopy

140
Q

a patient drinks 4 pints of beer a day, and 2 standard glasses of red wine on Saturday and Sunday additionally. how many units of alcohol is he drinking per week?

  • 73 units
  • 62 units
  • 94 units
  • 57 units
  • 49 units
A

73 units

141
Q

how is an alcoholic unit calculated?

A

strength of drink (%) x amount of liquid in mls /1000

142
Q

pneumonia, treated with coamoxiclav, on day 7 diarrhoea 10 times a day no blood, feels unwell and dehydrated, flexible signmoidoscopy showing this. what is the likely organism responsible for diarrhoea?

  • norovirus
  • E. coli
  • giardia lamblia
  • C. difficile
  • Salmonella
A

C. difficile

143
Q

pale stool and dark urine, fatigue and itching, hypercholesterolaemia and rheumatoid arthritis, simvastain and cocodamol, jaundice, xanthelasma, spider naevi and hepatomegaly. bloods showed bili 150, ALP 988, ALT 80, positive AMA and raised IgM. what is the likely diagnosis?

  • simvastain induced liver injury
  • primary biliary cirrhosis
  • gall stones
  • autoimmune hepatitis
  • primary sclerosing cholangitis
A

primary biliary cirrhosis

144
Q

vomiting and abdominal pain, overdose of paracetamol. which of the following test results would you not expect to see?

  • metabolic acidosis
  • PPT
  • raised creatinine
  • hyperglycaemia
  • ALT 1000
A

hyperglycaemia

145
Q

unkempt and malnourished man, haematemesis, bleeding varices, coarse shrunken liver, ataxic, confused, nystagmus. what is the most likely cause of his neurological presentation?

  • alcohol toxicity
  • alcohol withdrawal
  • delirium tremens
  • Wernicke’s encephalopathy
  • Korsakoff syndrome
A

Wernicke’s encephalopathy

146
Q

RIF pain, acute appendicitis, stable and scheduled for appendicectomy, deteriorated in ward round, brought to theatre for a perforated appendix. what clinical signs would you not expect to see?

  • fever
  • bowel sounds
  • tachycardia
  • rebound tenderness
  • guarding
A

bowel sounds

147
Q

which of the following clinical features is typical of OA?

  • 60mins of early morning stiffness
  • painful swelling across MCP joints and proximal interphalangeal joints
  • pain in 1st CMC joints
  • mobile subcutaneous nodules at points of pressure
  • alternating buttock pain
A

pain in the 1st carpometacarpal joints

148
Q

which of the following is an extra-articular manifestation of RA?

  • subcutaneous nodules
  • episcleritis
  • peripheral sensory neuropathy
  • pericardial effusion
  • all of the above
A

all of the above

149
Q

which of the following is a classical features of RA on x-ray?

  • peri-articular sclerosis
  • subchondral cysts
  • osteophytes
  • periarticular erosions
  • new bone formation
A

peri-articular erosions

150
Q

3 day history of pain in lower back. started spontaneously and noticed it at work (builder). slightly overweight with BMI of 29, no neurological deficits or spinal deformity and pain not easily localised on examination. which of the following describes the best management?

  • given age, should be referred to specialist
  • sent for an X-ray to look for pathological changes in spine
  • should not be given a sick note and advise to return to work
  • reassured and advised to take simple analgesics and return to normal activity as soon as he can manage
  • should be advised to seek other employment
A

reassured and advised to take simple analgesics and return to normal activity as soon as he can manage

151
Q

for a lytic tumour to be visible on X-ray, it must have lost:

  • greater than 6% bone density
  • greater than 16% bone density
  • greater than 60% bone density
  • greater than 90% bone density
  • 100% bone density
A

greater than 60% bone density

152
Q

57 yr old man presents with 3 day history of painful 1st MTP joint. area is red and very warm. BMI of 32 and hypertension, and has had identical episodes before. which dietary changes would reduce risk of future similar episodes?

  • diet with high red meat content
  • diet rich in dairy products
  • drinking >5 cans of non-diet fizzy drinks per day
  • diet rich in sugary foodstuffs
  • switching from drinking beer to drinking lager
A

diet rich in dairy products

153
Q

which of the following is not an autoimmune connective tissue disease?

  • systemic lupus erythematosus
  • ehler danlos syndrome
  • primary Sjorgren’s syndrome
  • systemic sclerosis
  • dermatomyositis
A

Ehler Danlos Syndrome

154
Q

23 year old woman presents with mouth ulcers, fever, painful white fingers and pleuritic chest pain. antinuclear antibody (AMA) positive, ESR is 52, WCC low. which of the features would you not expect to be associated with her illness?

  • deforming arthritis
  • photosensitive rash
  • seizures
  • PE
  • thrombocytosis
A

thrombocytosis

155
Q

which of the following is used in the treatment of SLE?

  • anti-TNF
  • anti-malarials
  • ustekinuab (IL12/23 blocker)
  • sulfasalzine
  • allopurinol
A

anti-malarials

156
Q

adult male presents with 6 week history of right sided headache, general malaise, early morning stiffness, pain in jaw when eating. CRP is 63, ESR 78. which of the following is true about his underlying disease?

  • associated with ANCA positivity
  • affects those 50-60yrs
  • present with acute sight loss
  • rarely responds to corticosteroids
  • vasculitis affecting small blood vessels
A

can present with acute sight loss

157
Q

64 year old with T2DM, cellulitis of right forefoot for 4 weeks/ no progress with oral antibiotics, has had 14 days of IV flucloxacillin and co-amoxiclavulanic acid but pain and erythema persist and CRP only fallen to 47 from its peak of 91. what is the next most appropriate investigation?

  • blood cultures
  • MRI right forefoot
  • plain X-ray right forefoots
  • skin biopsy of right forefoot
  • ultrasound scan of right forefoot
A

plain X-ray right forefoot

Phase 2A (28 decks)

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