HIS 2016-2017 MCQ - Flashcards
Q1. A patient suffering from dehydration is given an infusion of isotonic saline. What effect will the introduction of this solution have on the body’s fluids?
increase ECF (extracellular fluid) volume while decreasing ECF osmolarity
increase ECF volume without altering ECF osmolarity
increase ICF (intracellular fluid) volume without altering ECF osmolarity
increase ECF volume while increasing ECF osmolarity
increase ICF volume without altering ICF osmolarity
A. Increase ECF volume without altering ECF osmolarity
Q2. A 16-year-old girl presents to the Emergency department after fainting in school. Her mother informs the doctor that she suffers from fatigue, breathlessness and menorrhagia (heavy, regular menstruation). Her physical examination is notable for pallor. Following analysis of her full blood count and blood film, the girl is diagnosed with iron deficiency anaemia. In terms of haemoglobin levels and red blood cell size, how would you best describe her anaemia?
Hyperchromic, macrocytic
Hyperchromic, microcytic
Hypochromic, microcytic
Hypochromic, normocytic
Normochromic, microcytic
C. Hypochromic, microcytic
Q3. Prior to performing a blood transfusion, blood grouping of the donor’s blood is determined. The illustration below highlights the results of this blood group analysis. What is the blood group of the donor?
A Rhesus negative
A Rhesus positive
AB Rhesus positive
B Rhesus negative
B Rhesus positive
B. A rhesus positive
Q4. A man goes to his GP after a scratch on his leg has become painful and swollen. The GP diagnoses a bacterial infection. What cells of the immune system use a process of phagocytosis to engulf bacteria?
Eosinophils
Macrophages
Mast cells
Secretory cells
T cells
B. Macrophages
Q5. Approximately 60 minutes after being bitten by an insect, a 45-year-old woman noticed localised swelling, itching and redness to the affected area. A likely contributor to this reaction is histamine, released by mast cells in an acute inflammatory response. What is the main role of histamine in this case?
It acts as a chemoattractant
It causes constriction of blood vessels
It increases the permeability of blood vessels
It activates neutrophils
It mediates direct killing of a microbe
C. It increases the permeability of blood vessels
Q6. A 26-year-old man presented to the Emergency Department of a hospital with severe swelling to his face mainly around the lips. There was no itching and no evidence of hives. The doctor suspected anaphylaxis but adrenaline failed to have a significant effect. Based on a family history of similar events, hereditary angioedema was considered more likely. What defect in the immune system contributes to this disease?
Complement disorder
Cytokine deficiency
Defects in antigen presentation
MHC deficiency
Phagocyte disorder
A. Complement disorder - hereditary angioedema - overactivation due to a lack of complement inhibitors.
Q7. Where do precursor T cells develop into fully competent but not yet activated T cells?
Bone marrow
Lymph nodes
Peripheral tissue
Spleen
Thymus
E. Thymus -
Q8. A 15-month-old girl was admitted to hospital with diarrhoea, vomiting, dehydration and abdominal pain. She was also noted to have significant weight loss, irritability and a distended stomach over the last 3 months. Clinical presentation, serologic testing and biopsy analysis confirmed coeliac disease. What antibody isotype would be highly elevated in the serology result?
IgA
IgD
IgE
IgG
IgM
D. IgG
Q9. Following a trip to East Asia, and the consumption of unwashed vegetables there, a 32-year-old man developed intestinal symptoms consistent with an extracellular helminth (worm) infection. What subset of helper T cells drives the immune response responsible for clearing worm infections?
Th0
Th1
Th2
Th17
Treg
C. Th2
Q10. It is flu season, and a media campaign has been launched to advise vulnerable groups of society to get the flu vaccine. What cytokine is primarily associated with the immune response to viral infection, via functions including the following: shutting down viral replication, activating cytotoxic T cells, activating antigen-presenting cells and up regulating Class I MHC?
Interferon alpha
Interleukin 1 beta
Interleukin 2
Interleukin 8
Tumour necrosis factor alpha
B. interleukin 1 beta
Q11. A woman presents to her general practitioner with symptoms including persistent skin rashes, joint pain, oedema and chronic fatigue. Based on a combination of physical exam, history and lab tests, the autoimmune disease systemic lupus erythematosus is diagnosed. The patient later develops severe kidney inflammation (lupus nephritis) as a consequence of immune complex deposition in the kidneys. What type of hypersensitivity reaction involves immune complex deposition in tissues or organs?
Immediate hypersensitivity
Type I
Type II
Type III
Type IV
C. Type 3
Q12. A new immunotherapy for cancer is being tested in a Phase II clinical trial in combination with the standard-of-care cytotoxic drugs. Part of the acquired (specific) immune response towards clearing tumour cells mimics the way in which virally infected cells are disposed of. What cell type and immune mediator combination is commonly used by both the anti-tumour and anti-viral immune response?
Cytotoxic T lymphocytes / perforin
Helper T lymphocytes / complement
Helper T lymphocytes / granzyme
Natural killer cells / interleukin-1 beta
Neutrophil / defensins
D. Natural Killer Cells/Interleukin 1 beta
Q14. A 40-year-old man is admitted with a chest infection, which is subsequently identified as Pneumocystis jiroveci pneumonia. He was diagnosed with HIV 8 years earlier and had been treated with a combination of a nucleoside and non-nucleoside reverse transcriptase inhibitor as well as a protease inhibitor. A decision is taken to start treatment with maraviroc.
What test must be performed before using maraviroc?
CD4+ cell count
CD8+ cell count
Liver function test
Renal function test
Viral tropism test
Viral tropism test
Q13. A surgical patient developed a methicillin-resistant Staphylococcus aureus infection and was started on a combination of linezolid and daptomycin and subsequently improved. What is the mechanism of action of daptomycin?
Cell depolarization
Inhibition of cell wall synthesis
Inhibition of DNA synthesis
Inhibition of ribosomal complex formation
Inhibition of RNA synthesis
A . Cell depolarization
Q15. A liver transplant patient is started on tacrolimus to prevent organ rejection. How does tacrolimus prevent organ rejection?
It inhibits IL-2 production
It inhibits IL-2 signalling
It inhibits lymphocyte entry to blood stream
It inhibits nucleotide synthesis
It is cytotoxic to dividing cells
It inhibits IL-2 production
Q16. A 38-year-old woman presents with a number of neurological deficits that occur sporadically. These symptoms have been occurring more frequently and with greater severity. She is diagnosed with multiple sclerosis and started on treatment with fingolimod. What is the mechanism of action of the immunosuppressant fingolimod?
Increase the levels of anti-inflammatory cytokines
Inhibition of IL-2 signalling
Inhibition of IL-2 production
Inhibition of lymphocyte entry to the blood stream
Inhibition of nucleotide synthesis
Inhibition of lymphocyte entry to the blood stream
Q17. A runner is doing multiple sprints while training. This leads to a shift in the oxygen dissociation curve to the right and therefore more oxygen delivery to the tissues. What is the major contributor to this shift in the curve?
A decrease in 2,3 bisphosphoglycerate
An increase in 2,3 bisphosphoglycerate
An increase in erythropoietin
Haem-haem interactions
The Bohr effect
B. An increase in 2,3 Bisphosphoglycerate
Q18. A patient is being treated with hydroxyurea for sickle cell anaemia. This causes an increase in expression of the foetal haemoglobin leading to a decrease in haemoglobin multimer formation, which is responsible for the sickling of erythrocytes. What haemoglobin chain is increased with hydroxyurea treatment?
Alpha chain
Beta chain
Gamma chain
Epsilon chain
Zeta chain
C. Gamma chain - b/c it induces fetal haemoglobin
Q19. A young boy arrives in the clinic in haemolytic crisis after taking an antibiotic. His mother explains that he has glucose-6-phosphate dehydrogenase deficiency. Patients with G6PD deficiency are sensitive to oxidative stress and in this case, the drug was an oxidizing agent. What are these patients unable to neutralize?
Hydrogen peroxide
Hydroxyl radical
Nitric oxide
Peroxynitrite
Superoxide
A. Hydrogen peroxide
Q20. A 25-year-old woman arrives in the emergency department with chest pain. Her creatine kinase test results reveal CKMM is elevated while CKMB and CKBB are normal. What conclusion can you draw from these results?
She has damaged her heart muscle
She has damaged her skeletal muscle
She has damaged her spleen
She has a tumour in her liver.
You can’t draw any conclusions using creatine kinase only
b.She has damaged her skeletal muscle
Q21. Maryam, an RCSI Medical student receives a paper cut to her hand while studying for her exams and begins to bleed. In normal haemostasis, which clotting factor is released from damaged tissue, and initiates a chain of clotting events?
Factor XIIa
Fibrinogen (Factor I)
Prekinninogen (PK)
Thrombin (Factor II)
Tissue factor (TF)
E.Tissue factor (TF)
Questions 22-23
A 24-year-old man with poor English, presented to the emergency department with excessive and prolonged bleeding from an accidental domestic knife cut while chopping vegetables. His poor command of English prevented any detailed family history from being taken. A coagulation screen was requested and the results, shown in the table below, demonstrated that he appeared to suffer from a bleeding disorder. What type of blood sample is used to assess blood coagulation?
A blood sample collected from the bleeding wound
A blood sample collected in a vaccutainer containing heparin as the anticoagulant
A blood sample collected in a vaccutainer containing sodium citrate as the anticoagulant
A blood sample collected in a vaccutainer containing no anticoagulant
A serum sample obtained after centrifugation of the clotted blood
Q23. What is the likely cause of the bleeding disorder in this patient?
Deficiency of Factor VIII or Factor IX
Deficiency of Factor VII
Deficiency of Prothrombin, fibrinogen or Factor X
Incorrectly synthesised Factors II, VII, IX and X
Presence of an inhibitor of Prothrombin, Fibrinogen or Factor X
c. A blood sample collected in a vaccutainer containing sodium citrate as the anticoagulant?
Q24. James, 67 years of age, was diagnosed with acute coronary syndrome (ACS) following presentation in the emergency department with severe chest pain. His initial blood analysis indicated a platelet count of 179 X 109/L (range 150-400 X 109/L). Following primary angioplasty to clear the thrombus from his cardiac artery, he was treated with a heparin infusion (800 units), aspirin (325mg) and clopidogrel (60mg). 24-hours post-procedure, routine tests showed a platelet count of 12 X 109/L. He had no signs of bleeding and all other blood results were stable and within normal ranges.
What adverse drug reaction is James likely to be experiencing?
Aspirin-induced hypersensitivity (AIH)
Clopidogrel resistance (CR)
Disseminated intravascular coagulation (DIC)
Heparin-induced thrombocytopenia (HIT)
None, as this is normal in ACS patients
D. Heparin-induced thrombocytopenia (HIT)
Q25. A 23-year-old suffering with sneezing, nasal congestion and red watery eyes is diagnosed with allergic rhinitis (hay fever). Analysis of this patient’s blood after staining with haematoxylin and eosin revealed increased levels of the leukocyte indicated by an arrow in the photomicrograph below. What is this cell type called?
Eosinophil
Erythrocyte
Lymphocyte
Monocyte
Neutrophil
E. Eosinophil
Questions 26 & 27
A 45-year-old woman with a history of rheumatoid arthritis has been treated with methotrexate for a number of years. However, recently her condition has been worsening and she presents with pain in her joints. You prescribe aspirin to provide immediate pain relief and decide to start her on a targeted therapy using etanercept.
Q26. What does aspirin inhibit?
cyclooxygenase
prostaglandin receptors
prostaglandin reductase
prostaglandin synthetase
thromboxane synthetase
Q27. What is the target of etanercept.
B7
Tumour necrosis factor alpha
Interleukin 1
Interleukin 2
Interleukin 6
- cyclooxygenase
- TNF alpha
Q28. A patient with community-acquired pneumonia is started on levofloxacin, a fluoroquinolone antibiotic. What is the mechanism of action of levofloxacin?
Cell depolarization
Inhibition of cell wall synthesis
Inhibition of DNA synthesis
Inhibition of RNA synthesis
Inhibition of ribosomal complex formation
C. Inhibition of DNA synthesis
Q29. Under normal circumstance the T cell is activated through interaction of the T-cell receptor with antigen bound to the major histocompatibility complex and by the interaction of a co-stimulatory molecule on its cell surface. What is this co-stimulatory molecule found on T cells called?
CD28
CD80
CTLA4
IL-2 receptor
LFA-1
A. CD28
Q30. A 36-year-old man presented with pain and swelling in his calf, 2 days after completing a long-haul flight from California to Dublin. After confirmation of the presence of a deep vein thrombosis by a D-Dimer test and a CT scan, he was treated first with daily heparin injections and then slowly changed to treatment with a recently approved oral anti-coagulant that did not require regular monitoring. What drug is this most likely to be?
Aspirin
Dabigatran
Fondaparinux
Low molecular weight heparin (LMWH)
Warfarin
B. Dabigatran
