Formative assessments Flashcards
what is the name of the cells that produce collagen in fibrous scarring?
fibroblasts
what is an example of acute inflammation from the following:
- glandular fever
- leprosy
- appendicitis
- tubercolosis
appendicitis
what is the main effector cell of acute inflammation?
neutrophil polymorphs
what crystals are deposited in joints in gout?
uric acid
in which one of the following does granulomatous inflammation occur?
- Chron’s disease
- acute appendicitis
- infectious mononucleosis
- lobar pneumonia
Crohn’s disease
what is the specific name of calcification in diseased (as opposed to normal) tissues?
dystrophic calcification
which one of the following is a chronic inflammatory process from its start?
- appendicitis
- cholecystitis
- infectious mononucleosis
- lobar pneumonia
infectious mononucleosis
what is the name of the cells which produce antibodies?
plasma cells
which one of the following tumours never metastasises?
- malignant melanoma
- small cell carcinoma
- 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?
rhabdomyosarcoma
which of the following tumours does not commonly metastasise to bone?
- breast cancer
- lung cancer
- prostate cancer
- liposarcoma
liposarcoma
what term describes a cancer that has not invaded through the basement membrane?
carcinoma in situ
what is the name of a benign tumour of glandular epithelium?
adenoma (adenocarcinoma is malignant)
which one of these tumours does not have a screening programme in the UK?
- breast cancer
- colorectal cancer
- cervical cancer
- lung cancer
lung cancer
which one of the following is not known to be a carcinogen in humans?
- hepatitis C virus
- ionising radiation
- aromatic amines
- aspergillus niger
aspergillus niger
what does Hepatitis C cause?
hepatocellular carcinoma
what do aromatic amines cause?
bladder cancer
what does aflatoxin cause?
hepatocellular cancer
what is the name of a benign tumour of fat cells?
lipoma
what is the name of a malignant tumour of glandular epithelium?
adenocarcinoma
which one of the following is not a feature of malignant tumours?
- vascular invasion
- metastasis
- increased cell division
- growth related to overall body growth
growth related to overall body growth
what is a benign tumour whose growth is related to overall body growth?
hamartoma
a transitional cell carcinoma of the bladder is a malignant tumour?
- true
- false
true
a leiomyoma is a benign tumour of smooth muscle?
- true
- false
true
radon gas is a cause of lung cancer?
- true
- false
true
what mechanism is the damage of radon gas to the lungs?
- produces alpha particles, which damage the DNA
asbestos is a human carcinogen?
- true
- false
true
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
smoking 20 cigarettes a day
how much does smoking 20 cigarettes a day increase the risk of cancer by?
26 times
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
- false
true
activation of naive T cells is achieved by which antigen presenting cells?
- neutrophils
- mast cells
- macrophages
- dendritic cells
dendritic cells
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
macrophage
which of the following is not involved in innate immune mechanisms?
- anatomic barriers
- phagocytic
- inflammatory mechanisms
- antibody production
- skin
antibody production
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
over 65 years and under 2 years old
which of the following is administered as a live attenuated vaccine in the UK?
- hepA
- MMR
- tetanus
- flu
- polio
MMR
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
production of interferons
which of the following is a polysaccharide vaccine?
- anthrax vaccine
- Hib vaccine (Haemophilus influenza type b)
- rabies vaccine
- hep A
Hib vaccine (Haemophilus influenza type b)
what are two types of immune response in humans?
- immunological tolerance
- immune surveillance
- innate and acquired
- intrinsic and extrinsic
- overt and covert
innate and acquired
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
ulcerative colitis
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
interleukin 12
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…
Streptococcus pneumoniae
which of these is a gram negative bacillus that ferments lactose?
- shigella sonnei
- listeria monocytogenes
- neisseria meningitidis
- eschericia coli
- streptococcus pyogenes
Eschericia coli
which is incorrect? Haemophilus influenzae is an important cause:
- meningitis in pre-school children
- otitis media
- pharyngitis
- gastroenteritis
- exacerbations of COPD
gastroenteritis
which is normally a sterile site?
- the pharynx
- the urethra
- CSF
- the lung
- 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 take 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
- RNA, capsid, reverse transcriptase
RNA, capsid, reverse transcriptase
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?
- 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
spread by plasmid mediated gene transfer
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
cefuroxime: a macrolide
which of the following is not under the control of the pituitary gland?
- thyroid
- adrenal cortex
- adrenal medulla
- testis
- ovary
adrenal medulla
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
the pituitary regulates calcium metabolism
in men all the following are mainly produced in the adrenal cortex except?
- DHEAS
- testosterone
- aldosterone
- 17-OH progesterone
- androstenedione
testosterone
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
is produced in the pituitary gland
where is growth hormone’s main site of action to stimulate IGF1 (insulin-like growth factor) release?
- bone
- liver
- adrenal cortex
- muscle
- pancreas
liver
the following are typical features of excess growth hormone secretion except?
- polyuria
- joint pains
- sweating
- hypotension
- headaches
hypotension
the following hormones all have a circadian rhythm except?
- cortisol
- testosterone
- DHEA
- 17OH progesterone
- thyroxine (T4)
thyroxine
typical features of cortisol deficiency include the following except?
- hypotension
- muscle aches
- weight loss
- hyperglycaemia
- lethargy
hyperglycaemia
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
primary hypothyroidism
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
overnight dexamethasone suppression test
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
ultrasound ovaries
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
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?
- chest x-ray
- CT brain
- skin turgor and jugular venous pressure test
- thyroid function tests
- synacthen test
skin turgor and jugular venous pressure test
what is SIADH?
syndrome of inappropriate ADH secretion
what are essential criteria for the diagnosis of SIADH?
- 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)
the following are most likely causes of SIADH except?
- multiple sclerosis
- lung abscess
- subdural haemorrhage
- lymphoma
- cerebrovascular accident
MS
what are CNS disorders that cause SIADH?
- head injury
- meningitis
- encephalitis
- brain tumour
- brain abscess
- cerebral haemorrhage/thrombosis
- Guillain-Barre syndrome
- acute intermittent porphyria
what are tumours that cause SIADH?
- carcinoma (esp. lung)
- lymphoma
- leukaemia
- thymoma
- sarcoma
- mesothelioma
what are respiratory causes of SIADH?
- pneumonia
- TB
- emphysema
- severe asthma
- pneumothorax
- positive pressure ventilation
what are drugs that can cause SIADH?
- carbamazapine
- clofibrate
- chlorpropramide
- thizides
- phenothiazides
- MAO inhibitors
- SSRIs
- cytotoxics
- desmopressin
- vasopressin
- oxytocin
a 28 year old presented with a microprolactinoma. what is the most unlikely symptom?
- galactorrhoea
- oligomenorrhoea
- decreased sexual appetite
- headaches
- visual field defects
visual field defects
the following suppress appetite except:
- peptide YY
- ghrelin
- CCK
- GLP1
- glucose
ghrelin
the main adipose signal to the brain is:
- CCK
- neuropeptide Y
- leptin
- agouti-related peptide
- adiponectin
leptin
a 65 year old lady is diagnosed with SIADH. her sodium is 123 mmol/l. what is your first line of management?
if she is asymptomatic i will treat with fluid restriction
what is the treatment of acute hyponatraemia secondary to SIADH?
24-48 hours
- 3% saline if symptomatic
- if asymptomatic, fluid restriction
what is the treatment of slow onset hyponatraemia?
> 48 hours
- severe symptoms: 3% saline
- mild symptoms/asymptomatic: fluid restriction, vaptans
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
double his steroid dose whilst unwell
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
low LH; low testosterone
typical features of hypogonadism in a male include the following except:
- decreased sweating
- joint and muscular aches
- decreased sexual appetite
- decreased hair growth
- asymptomatic
decreased sweating
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
repeat test at 0900h and check for symptoms
the first line treatment for a patient with a symptomatic prolactinoma is usually:
- radiotherapy
- transphenoidal surgery
- dopamine agonists
- transfrontal surgery
- somatostatin analogues
dopamine agonists
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
bitemporal hemianopia
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
the physiological feeling of no hunger
the centres of appetite regulation in the brain are mainly found in the:
- pituitary
- cerebellum
- hypothalamus
- basal ganglia
- brain cortex
hypothalamus
a patient presents with chest pain on exertion… diagnosis?
stable angina
ECG shows saddle-shaped ST… diagnosis?
pericarditis
name a condition in which beta-blockers are contraindicated
asthma
common side effect of ACEi?
dry cough
MRI reveals CNS disseminated in space and time… diagnosis?
MS
commonest cause of hospital acquired pneumonia?
Staph. aureus
bowel biopsy reveals transmural lesion… diagnosis?
Crohns
pain in big toe, diet of excessive red wine and cheese… diagnosis?
gout
antibiotics for treating TB?
rifampcin
painless haematuria, works in a dye factory… diagnosis?
bladder cancer
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
increased lipolysis
- you would decrease breakdown of fats to prevent further increase in glucose
why is muscle broken down in hyperglycaemia?
to increase glucose for gluconeogenesis
what hormone is produced in low glucose levels?
glucagon
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)
HbA1c of 47
what are values for diagnosis of T2DM?
- fasting plasma glucose >7mmol/L
- OGTT >11.1mmol/ol
- HbA1c >48/6.5%
- random plasma glucose + symptoms of CM >11mmol/L
give 3 risk factors for developing T2DM and 2 symptoms of it?
- obesity
- family history
- ethnicity
- diet/exercise
- medications (thiazide diuretic with beta blocker)
which of the following symptoms would align your suspected diagnosis?
- dry skin
- hair loss
- constipation
- lethargy
- clubbing
clubbing - hyperthyroidism
others indicate hypothyroidism
what is the treatment of hyperthyroidism?
- carbimazole
- radioiodine
- surgery
what is the treatment of hypothyroidism?
levothyroxine
what are signs of hyperthyroidism?
- anxiety, heat intolerance
- eyes building (exophthalmos)
- increased appetite
- goitre
- tachycardia
- tremor, clubbing, sweating (hands)
- weight loss, diarrhoea
- oligomenorrhoea (infrequent)
(think pop tarts)
what are signs of hypothyroidism?
- cold intolerance, slowing intellectual activity, hair, hearing, decreased libido
- apathy/blank expression
- decreased appetite
- bradycardia
- brittle nails, dry skin
- weight gain, constipation
- amenorrhoea/menorrhagia
abdominal pain, weight loss, drinking water, tachycardic, tachypnoeic, clammy and confused… diagnosis
- Cushing’s
- diabetes insipidus
- diabetic ketoacidosis
- hyperaldosteronism
- SIADH
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
what is the treatment of DKA?
IV fluids and insulin
what is the action of aldosterone?
increases sodium retention -> water retention -> hypertension -> increased excretion of potassium -> hypokalaemia
TSH high and T4 low. what is the appropriate diagnosis?
- sub-clinical hypothyroidism
- primary hypothyroidism
- sub-clinical hyperthyroidism
- primary hyperthyroidism
- TSH secreting tumour
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
the ______ secretes TRH?
hypothalamus; thyrotropin-releasing hormone
TRH stimulates the _______ pituitary to produce ________
anterior; thyroid stimulating hormone
TSH stimulates the production of T4 (_____) and T3 (______)
T4 = thyroxine T3 = triiodothyronine
tired, tearful, low sodium and high potassium… diagnosis?
- Addison’s
- Conn’s
- Cushing’s
- depression
- T1DM
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
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
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
why may people not gain muscle after weightlifting
- adrenal insufficiency
- Conn’s
- hypothyroidism
- hyperparathyroidism
- phaeochromocytoma
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
give three functions of parathyroid hormone?
released when calcium levels are low
- increased bone resorption
- increased Ca2+ reabsorption from kidneys
- increased 1,25dihydroxy-vitaminD
- increased Ca2+ absorption from gut
what is not a sign of high serum calcium levels?
- bone pain
- constipation
- depressions
- hypertension
- kidney stones
hypertension
what are main features of hypercalcaemia?
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
name a scan that can be used to measure bone density?
DEXA (dual energy xray absorptiometry)
true or false: bisphosphonates are a medical treatment for hypercalcaemia
true; also used for osteoporosis
- prevent bone turnover
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
t(9;22) Philadelphia chromosome
what class of drug best describes Rituximab?
- cytotoxic chemotherapy
- disease-modifying therapy
- monoclonal antibody
- antibiotic
monoclonal antibody
-mab = monoclonal antibody
which age group is characteristically affected by Hodgkin’s lymphoma?
- children
- teenagers and young adults
- middle aged (40-60yrs)
- older aged (60+)
teenagers and young adults
- also affects the elderly
- peak in late teens and early 20s and a second peak at older age
how is myeloma bone disease usually assessed?
- plain xray
- clinical assessment
- isotope bone scan
- PET scan
plain x-ray
- skeletal survey
- production of osteoclast-activating factors
- OAFs include RANKL, IL-3 and TNF-alpha
what is the correct mechanism of action for the anti-emetic drug Ondansetron?
- peripheral D2 antagonist
- central D2 antagonist
- anti-cholinergic
- 5HT3 antagonist
5HT3 antagonist
- pro-kinetics for gastrostasis
- centrally acting good for drug induced
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
- reactive vs primary
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
perform cultures and start broad spectrum antibiotics
- haematological emergency
- ABC
- perfurm cultures
- broad spectrum IV antibiotics within 1 hour
how does aspirin exert its antiplatelet effect?
- ADP receptor antagonist
- inhibition of cyclooxygenase enzyme
- inhibition of glycoprotein IIb/IIIa
- inhibition of PAR4 receptor
inhibition of cyclooxygenase enzyme
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?
D
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
the majority of cancers occur in the proximal colon - FALSE - they occur most in the distal colon
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
dysphagia to solids and liquids occurring from the start (others are red flags)
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
coeliac disease
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
abdominal pain relieved by defecation
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
associated with increased risk of gastric cancer
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
ascitic tap
which of the following features best distinguishes UC from Crohns?
- ileal involvement
- continuous colonic involvement on endoscopy
- non-caseating granuloma
- transmural inflammation
- perianal disease
continuous colonic involvement on endoscopy
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
73 units
how is an alcoholic unit calculated?
strength of drink (%) x amount of liquid in mls /1000
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
C. difficile
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
primary biliary cirrhosis
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
hyperglycaemia
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
Wernicke’s encephalopathy
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
bowel sounds
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
pain in the 1st carpometacarpal joints
which of the following is an extra-articular manifestation of RA?
- subcutaneous nodules
- episcleritis
- peripheral sensory neuropathy
- pericardial effusion
- all of the above
all of the above
which of the following is a classical features of RA on x-ray?
- peri-articular sclerosis
- subchondral cysts
- osteophytes
- periarticular erosions
- new bone formation
peri-articular erosions
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
reassured and advised to take simple analgesics and return to normal activity as soon as he can manage
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
greater than 60% bone density
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
diet rich in dairy products
which of the following is not an autoimmune connective tissue disease?
- systemic lupus erythematosus
- ehler danlos syndrome
- primary Sjorgren’s syndrome
- systemic sclerosis
- dermatomyositis
Ehler Danlos Syndrome
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
thrombocytosis
which of the following is used in the treatment of SLE?
- anti-TNF
- anti-malarials
- ustekinuab (IL12/23 blocker)
- sulfasalzine
- allopurinol
anti-malarials
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
can present with acute sight loss
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
plain X-ray right forefoot
