Histopath Flashcards
1
Q
What protein is defective in adult polycystic kidney disease?
A
Polycystin-1
2
Q
What sign, which may be visible around the nails, is seen in Graves’ disease and is due to periosteal bone growth in the nail bed?
A
Thyroid acropachy
3
Q
What cancer is associated with the presence of “oat shaped cells” on biopsy?
A
Small Cell Lung Cancer
4
Q
Which class of lupus nephritis on biopsy may show complete sclerosis of nearly all glomeruli?
A
Class VI
5
Q
What structures, present in the large bowel, represent weak points in the bowel wall and allow for the formation of diverticula?
A
Taenia Coli
Taenia coli are where blood vessels penetrate the mucosa and hence represent weak points in the muscular wall of the colon. These weak points may allow diverticula to form.
Haustra, on the other hand, represent sacculations in the wall of the colon. They are not typically where diverticula form as there is continuous, thick mucosa over the entire surface of the haustral outpouching.
6
Q
A 18 year old man presenting with nephritic syndrome, cataracts and sensorineural deafness suggests what underyling diagnosis?
A
Alport’s syndrome
7
Q
Which common medication are hepatic adenomas associated with?
A
Oral Contraceptive Pill
8
Q
What histopathological description is given to cells that have lost their intercellular connections between neighbouring cells?
An example could be the loss of desmosomal connections in pemphigus vulgaris.
A
Acantholysis
9
Q
What is the name of the clinical criteria, which include erythema marginatum and sydenham’s chorea, classically used to diagnose Acute Rheumatic Fever?
A
Jones Criteria
10
Q
A 24 year old with Ehlers Danlos syndrome presents to the emergency department with a sudden onset severe headache.
She lost consciousness at the onset of the headache and has vomited twice since.
CT Head non contrast reveals hyperdense enhancement adjacent to the circle of willis.
What is the likely diagnosis?
A
Subarachnoid haemorrhage
11
Q
Which tumour marker is used in the diagnosis of hepatocellular carcinoma?
A
Alpha-fetoprotein
12
Q
Other than zinc, what is the first line pharmacological treatment for Wilson’s disease?
A
Trientine
13
Q
Which enzyme, released by neutrophils, does the compound alpha-1 antitrypsin inhibit to prevent the development of emphysema in the lungs?
A
Neutrophil elastase
14
Q
A 30 year old woman has experienced a week of progressive retro ocular pain with a loss of visual acuity in the right eye. She does not wear glasses. There is a family history of Type 1 Diabetes.
On examination, there is a right relative afferent pupillary defect with reduced visual acuity. Fundoscopy and intraocular pressure is normal.
What investigation would be diagnostic?
A
MRI Brain and Optic Nerves
15
Q
What stain is used to visualise amyloid on histological specimins?
A
Congo Red
16
Q
A nephrologist is investigating an elderly gentleman with nephrotic syndrome.
A renal biopsy revealed normal histology when viewed under a light microscopy. There were no immune complexes detected in the biopsy either. There was no amyloid deposition.
Urinary Bence Jones Protein and serum electrophoresis were normal.
The patient responded well to steroids and their renal function is normal.
What is the most likely primary cause of the nephrotic syndrome?
A
Minimal Change Disease
17
Q
What type of kidney stone are patients on chemotherapy for chronic lymphocytic lymphoma at increased risk of?
A
Uric acid
18
Q
Classically the triad of bronchoconstriction, flushing and diarrhoea is described as what paraneoplastic syndrome?
A
Carcinoid syndrome
19
Q
A 60 year old with longstanding alcoholism, weight loss and epigastric pain undergoes a pancreatic biopsy.
The biopsy shows evidence of destruction of exocrine tissue, associated with fibrosis and calcification. Duct dilatation is noted.
There is no elevation in CA-19-9.
What is the likely diagnosis?
A
Chronic pancreatitis
20
Q
A histopathologist looks at a piece of excised lung tumour under a microscope.
There is no evidence of glandular or squamous differentiation. The cells are poorly differentiated with large nuclei.
Which histological subtype of lung cancer has these features?
A
Large Cell Carcinoma
21
Q
A 67 year old woman with CKD stage 4 is seen in the emergency department. She reports chest pain and a cough which has worsened over the last week. The chest pain is worse when she coughs.
Her partner had a cold two weeks ago.
On examination of the chest wall there is point tenderness adjacent to the sternum bilaterally.
An ECG is normal.
Bloods reveal the following: eGFR 25ml/min Creatinine 160 Urea 12 Troponin I 20 <14
What is the diagnosis?
A
Costochondritis
22
Q
A 45 year old diabetic man is investigated for heart failure.
A panel of blood tests shows an elevated serum ferritin in the absence of a fever, with a low total iron binding capacity and elevated transferrin saturation. He recalls that his brother has something wrong with iron in his body.
What is the diagnosis?
A
Hereditary Haemochromatosis
23
Q
Kayser Fleischer rings represent the deposition of what substance in the cornea?
A
Copper
24
Q
A 20 year old man with liver failure and parkinsonism is a classical history of what condition?
A
Wilson’s disease
25
What is the name given to the criteria used for diagnosis of infective endocarditis?
Duke's Criteria
26
Infection by what organism classically precipitates acute rheumatic fever?
Streptococcal infection
27
Which neuroendocrine tumour is associated with Zollinger-Ellison syndrome?
Gastrinoma
28
A nephrologist is investigating a 40 year old man with nephrotic syndrome.
A biopsy viewed under light microscopy shows thickening of the glomerular basement membrane.
Immunofluorescence shows the presence of antibody complexes and complement deposits throughout the glomerular basement membrane.
The patient's renal function has continued to decline despite high dose pulsed IV methylprednisolone.
What is the likely primary cause of the nephrotic syndrome?
Membranous Glomerular Disease
29
A 18 year old man has his urine dipped as part of a pre employment health check.
He has no past medical history and denies any symptoms.
The urine dip shows the presence of microscopic haematuria (+). He says that his father also always has blood in his urine.
What is the likely diagnosis?
Benign familial haematuria
30
What histochemical stain would reveal the presence of copper in a liver biopsy with a patient with Wilson's disease?
Rhodanine
31
A HbA1c value of above what value (in mmol/mol) is considered diagnostic for diabetes?
48
32
A 80 year old man is undergoing elective bilateral knee arthroplasty. He has hypertension but no other past medical history.
During the operation, he develops 2mm ST elevation in leads II and III. The cardiac monitor immediately alarms and alerts the anaesthetist.
A blood test for high sensitivity Troponin is taken and the anaesthetist informs the surgeon.
30 minutes later, the troponin is reported by the lab as normal.
What is the diagnosis?
Myocardial Infarction
33
Which histological subtype of malignancy are patients with poorly controlled ulcerative colitis at increased risk for?
Adenocarcinoma
34
Carcinoid syndrome is caused by an excess of what neurotransmitter?
Serotonin
35
A 68-year-old woman presents to her GP with a non-tender, hard lump with irregular borders in her left breast. She denies any nipple discharge, weight loss or malaise.
She was in a car accident 6 months ago and sustained significant bruising to the chest wall.
She undergoes triple assessment. Ultrasound shows a solid mass with indistinct margins.
The biopsy report is lost however the system recorded that the specimen was benign.
What condition may explain the lump?
Fat necrosis
36
A 38 year old woman with systemic lupus erythematosus presents to the emergency department.
She reports only passing a small volume of dark brown urine once in the last 3 days. She feels unwell.
Urine dip reveals the presence of haematuria (++) and proteinuria (++). She is hypertensive.
Blood tests reveal an elevated urea and creatinine.
What is the likely cause of the nephritic syndrome?
Rapidly progressive glomerulonephritits
37
A biopsy sample from a patient with suspected renal cancer is reported as follows:
"There are neoplastic cells with transparent cytoplasm. Cells are arranged in nests with intervening blood vessels"
What is the specific histological type of cancer?
Clear cell cancer
38
A 42 year old woman with Type 1 Diabetes Mellitus is investigated for fatigue and pruritus.
She has an elevated serum ALP and an elevated anti mitochondrial antibody titre.
An ultrasound of the biliary tree shows no gross dilatation.
What is the likely diagnosis?
Primary Biliary Cirrhosis
39
Which adrenal tumour is most commonly associated with Multiple Endocrine Neoplasia?
Phaeochromocytoma
The Multiple Endocrine Neoplasias (MEN) describe syndromes of associated neoplasias which are inherited in an autosomal dominant fashion.
MEN 1 Pituitary adenoma Parathyroid hyperplasia Pancreatic tumours
Think MEN 1 = PPP
MEN 2A Parathyroid hyperplasia Medullary thyroid carcinoma Phaeochromocytoma Think all the Cs: Calcitonin (medullary thyroid cancer), Calcium (Parathyroid hyperplasia) and Catecholamines (Phaeo)
MEN 2B Medullary thyroid carcinoma Phaeochromocytoma Marfanoid body habitus Mucosal neuromas Think B is for Big (marfanoid) and Belly problems (mucosal neuromas)
40
Kimmelstiel Wilson nodules found in a renal biopsy are associated with what underlying disease?
Diabetes
41
What tumour marker is most commonly used in the diagnosis of colorectal cancer?
Carcinoembryonic antigen
42
Which hepatobiliary condition may be described as: fibrosis of bile ducts throughout the biliary tree with associated stricture formation?
Primary Sclerosing Cholangitis
43
A 16 year old boy is investigated for liver failure. He has markedly increased transaminases.
His mother, aunt and grandmother are all smokers and have COPD.
Blood tests show a low serum copper and low serum caeruloplasmin.
What is the likely diagnosis?
Wilson's disease
44
An immune response directed against myelin basic protein and proteo-lipoprotein results in what autoimmune condition?
Multiple Sclerosis
45
What is the most common histological type of prostate cancer?
Adenocarcinoma
46
A 64 year old gentleman with hypertension and Type 2 Diabetes Mellitus presents to the emergency department with sudden onset weakness in his right arm.
Neurological examination in the emergency department is normal.
What is the most likely diagnosis?
Transient Ischaemic Attack
47
Which protein, detected in the stool of patients with inflammatory bowel disease, reflects the presence of intraluminal neutrophils and hence the presence of intestinal inflammation?
Calprotectin
48
What tumour marker is associated with pancreatic cancer?
Carbohydrate Antigen 19-9
49
A CT report for a 74 year old gentleman with shortness of breath and a dry cough mentions the presence of "a honeycomb lung".
What condition does the gentleman likely have?
Interstitial Lung Disease
50
A CT-KUB from a patient with renal colic reveals the presence of a radiopaque, laminated density which conforms to the shape of the renal pelvis.
There is evidence of dilation of the renal calyces.
What is the typical chemical composition of this density?
Magnesium Ammonium Phosphate
51
A 40 year old man is referred to cardiology clinic due to reduced exercise tolerance. He is found to have mitral stenosis.
He previously reported episodes of spontaneous, rapid, jerking movements that he could not control during a period of illness when he was a teenager. His sister had similar symptoms at that time.
What illness may he have had in his youth which has precipitated his heart murmur today?
Acute Rheumatic Fever
52
An 84 year old woman is seen in the emergency department feeling unwell and with crampy left iliac fossa pain.
The pain started in the midline 3 days ago and has now moved to the left iliac fossa. She has also felt progressively unwell over this time. She reports intermittent haematochezia and constipation.
On examination there is localised guarding and tenderness in the left iliac fossa.
What is the diagnosis?
Diverticulitis
53
What type of bladder cancer is associated with chronic cystitis?
Squamous Cell Carcinoma
54
Which organism is classically associated with haemolytic uraemic syndrome?
Escherichia coli
55
What kind of cancer is associated with keratin pearls?
Squamous Cell Carcinoma
56
Clinical Assessment and Imaging are two parts of the "Triple Assessment" for suspected breast malignancy.
What is the final component of Triple Assessment?
Histology
57
What is the name given to dilated veins, commonly found in the oesophagus and are often associated with portal hypertension?
They are a common cause of sudden, life threatening, haematemesis in alcoholics.
Varices
58
What is the most common histochemical stain used to visualise cells for light microscopy, such as that used for diagnosis of cancers?
Haematoxylin and eosin stain
59
A 73 year old man presents to his GP with progressive exertional dyspnoea and a dry cough.
On examination there is bilateral digital clubbing and fine end inspiratory crackles on auscultation of the chest.
Chest X ray is normal and spirometry reveals a decreased FEV1, decreased FVC and increased FEV1/FVC ratio.
What specific further investigation would be diagnostic?
High Resolution Lung CT Scan
Investigation of pulmonary fibrosis essentially comprises two things - lung function tests and CT.
Lung Function Tests will typically reveal a restrictive pattern (decreased FEV1, decreased FVC and increased FEV1/FVC ratio)
Chest X rays are typically normal and even normal chest CTs aren't sensitive enough.
This is because the changes are so small, a very high resolution is needed to identify them.
Hence, the diagnostic investigation of choice is a High Resolution CT Chest.
A HR CT Chest will show honeycombing and ground glass opacities.
60
What is the typical inheritance pattern of Hereditary non-polyposis colorectal cancer/Lynch Syndrome?
Autosomal Dominant
61
An elderly woman who lives alone is brought into hospital after being found lying on the ground at home by her daughter this morning. She says she collapsed the previous evening and was unable to reach the phone. You suspect she has a fractured hip. Her bloods show a raised potassium and very high levels of serum creatine kinase. She is found to have very dark urine. What protein is responsible for the dark urine?
Myoglobin
Rhabdomyolysis describes necrosis of muscle and release of intracellular components. It may be caused by traumatic crush injuries. A serum creatine kinase measurement greater than 5 times the upper limit of normal is considered diagnostic. Myoglobin is a protein normally present in urine in small amounts. The muscle breakdown in rhabdomyolysis causes raised serum myoglobin which leads to myoglobinuria. The high levels of myoglobin in the urine are responsible for the dark brown colour. It may occur after vigorous exercise. A urine dipstick test measures the peroxidase activity of erythrocytes and therefore will be positive for blood if myoglobin is present.
62
What is the typical inheritance pattern of hereditary haemochromatosis?
Autosomal recessive
63
A histopathologist looks at a piece of excised lung tumour under a microscope.
She notes the presence of mucin and glandular differentiation.
Which histological subtype of lung cancer is associated with mucin production?
Adenocarcinoma
64
What is the most common histological type of renal malignancy?
Renal cell carcinoma
65
How many stages, classified by glomerular filtration rate, of chronic kidney disease are there?
5
66
How much glucose is given, in grams, for an oral glucose tolerance test for the diagnosis of diabetes?
75
67
What condition is characterised by microangiopathic haemolytic anaemia, thrombocytopenia and renal failure in children?
Haemolytic Uraemic Syndrome
68
What is the name of the clinical criteria are used to diagnose infective endocarditis?
Modified Duke Criteria
69
What is the inheritance pattern of benign familial haematuria?
Autosomal dominant
70
What is the minimum required plasma glucose level to diagnose diabetes in a person undergoing an oral glucose tolerance test?
11.1
71
Head trauma causing loss of consciousness followed by a lucid interval before the patient deteriorates is a classical history of what cerebral pathology?
Extradural haemorrhage
72
A 67 year old woman presents to her GP feeling generally unwell.
Her past medical history is significant for a myocardial infarction three weeks ago.
She feels feverish and reports some sharp chest pain on inspiration.
An ECG performed at the practice shows ST elevation throughout limb and chest leads.
What is the diagnosis?
Dressler's syndrome
73
In which gross anatomical section of the pancreas does pancreatic cancer typically occur?
Head
74
What sign is the name of a palpable lymph node in the left supraclavicular fossa?
Troisier sign
75
The ECG leads V1 and V2 represent which specific region of the heart?
Septal region
76
What is the main hormone produced by of alpha cells in the pancreas?
Glucagon
In the pancreas, there are three main cell types which produce endocrine hormones.
Alpha cells: Produce glucagon. Glucagon raises blood sugar levels
Beta cells: Produce Insulin. Insulin lowers blood sugar levels
Delta cells: Produce somatostatin. Exhiibts a paracrine effect on alpha and beta cells, reducing secretion of glucagon and insulin
77
What is the commonest cause of oesophagitis in UK adults over 50?
Gastro oesophageal reflux disease
78
Classically which valve is colonised in IV drug users diagnosed with infective endocarditis?
Tricuspid valve
79
Which lobe of the brain does HSV encephalitis classically affect?
Temporal lobe
80
What further imaging is indicated for a transient ischaemic attack when neurological symptoms have resolved?
Carotid Ultrasound
81
Which enzyme, synthesised by the pancreas, is most sensitive for the diagnosis of pancreatitis?
Lipase
82
Give an example of a misfolded protein implicated in the pathogenesis of alzheimer's disease
Tau
83
What histological type of bladder cancer is most common?
Transitional Cell Carcinoma
84
A liver biopsy from a patient with chronic hepatitis B shows areas of fibrosis and hepatocyte necrosis. There are visible nodules of regenerating hepatocytes.
An upper GI endoscopy reveals the presence of large, dilated veins in the oesophagus.
What diagnosis is likely responsible for the increase in portal venous pressure?
Cirrhosis
85
Which renal syndrome is characterised by proteinuria, oliguria and haematuria?
Nephritic Syndrome
86
A 55 year old gentleman with newly bipolar disorder is seen by a psychiatrist. An ECG is performed as part of the workup for starting lithium, a mood stabiliser.
His past medical history includes an anterior STEMI 4 months ago.
The ECG shows ST elevation in leads V2, V3, V4 and V5. He denies chest pain, breathlessness or any other symptoms.
What is the diagnosis?
Ventricular aneurysm
87
What type of fluid motion produces low sheer stress and is hence protective against the development of atherosclerotic disease?
Laminar Flow
88
What condition is characterised by microangiopathic haemolytic anaemia, thrombocytopenia and stroke-like symptoms in an adult?
Thrombotic Thrombocytopenic Purpura
89
A 5 year old boy is generally oedematous in his arms, face, legs, abdomen and feet. It started with facial swelling two days ago. His parents noted that he has particularly frothy urine.
He had a cold 5 days ago but is otherwise well with no medical history.
On examination there is generalised pitting oedema.
What is the most likely diagnosis?
Minimal Change Disease
90
A 72-year-old woman presents to her GP.
She has become progressively confused over the past 2 years. She reports she has trouble shopping and paying with coins. She is becoming progressively more forgetful.
At night, she sees children playing in her house and has called the police on several occasions despite her husband trying to calm her down.
For the last few months she has had difficulty getting out of chairs and began walking with a shuffling gait.
What is the likely diagnosis?
Lewy Body Dementia
91
What surgical procedure may be used to treat pancreatic cancer affecting the head, neck and body of the pancreas?
Whipple's procedure
92
A 32 year old man presents to the emergency department with frothy, cola coloured urine.
He denies pain or fever. He had a sore throat two weeks ago. He has no other medical history of note and this has not happened before.
He also has a non-blanching rash over his legs and is mildly hypertensive at 150/100.
What is the likely cause of the nephritic syndrome?
Acute Postinfectious Glomerulonephtitis
93
A 18 year old university student collapses 1 hour into a game of rugby. He regains consciousness after bystanders perform CPR. There is a family history of sudden cardiac death.
He has an ejection systolic murmur and an ECG shows ST depression in the anterior leads with giant T wave inversion. QRS complexes are noted to be tall.
What diagnostic investigation is most appropriate?
Echocardiogram
94
A 80-year-old man presents to his primary care physician with increasing shortness of breath, weight loss and a dry cough over a period of several months. Prior to his retirement, he was a plumber.
Physical examination reveals decreased breath sounds and dullness to percussion in the left lung base.
Chest X ray reveals irregular pleural thickening and a peripheral homogenous opacity in the left lower lung field.
What is the likely diagnosis?
Mesothelioma
95
A 20-year-old man with cystic fibrosis presents to his GP with a chronic productive cough, that has been getting worse over the last two years. He is known to be colonised with pseudomonas aeruginosa.
His BMI is 18.5. Temperature in the surgery was 36.8c.
Examination revealed coarse crackles at the bases which shifted upon coughing.
Chest x ray was reported as showing tram-track opacities.
What is the diagnosis?
Bronchiectasis
96
A 55-year-old man presents to his GP with a chronic productive cough of 6 months duration. He has had mild weight loss. He has had two hospitalisations for pneumonia in the last two years.
Spirometry in the practice was normal. Chest x ray was normal.
High resolution CT scan reveals bronchial wall thickening with a positive signet ring sign.
What is the diagnosis?
Bronchiectasis
97
Which form of inflammatory bowel disease may, on biopsy, show evidence of transmural inflammation?
Crohn's disease
98
Which hepatobillary condition may be described as a slow, insidious process of autoimmune destruction of intrahepatic bile ducts, associated with cholestasis?
Primary Biliary Cirrhosis
99
A 32 year old breastfeeding woman presents to her GP with a sore, inflamed left breast. She reports symptoms are worsening. She feels unwell.
Her temperature is 38.5c. She is not tachycardic.
On examination there is a diffusely tender left breast with a firm, fluctuant mass located 2cm medial to the nipple. It is approximately 1cm in size. There is no nipple retraction.
What is the diagnosis?
Breast Abscess
100
A 64-year-old man is brought to the accident and emergency due to a collapse while shopping.
On examination an ejection systolic murmur is heard in the aortic region and there is radiation of the murmur to the carotids.
What is the most likely diagnosis?
Aortic Stenosis
101
What is the inheritance pattern of Wilson's disease?
Autosomal recessive
102
A 75 year old man has a resting tremor in his right hand. On examination there is cogwheel rigidity of the right arm only. The tremor is made worse on distraction.
In addition, he walks with small steps and "shuffles" his feet across the floor. He reports loss of his sense of smell.
What is the diagnosis?
Idiopathic Parkinson's disease
103
A 55 year old woman presents to her GP with a number of painful fluid filled blisters in her mouth and on her body. They are relatively large, approximately 2-3cm on the body. She says they itch intermittently.
She feels well in herself and her type 1 diabetes is well controlled.
When you run your finger over the surface of one of the blisters on her arm, the roof of the blister easily comes away.
A biopsy reveals acantholytic cells, however the basal keratinocytes remain attached to the basement membrane.
What is the diagnosis?
Pemphigus vulgaris
104
What syndrome is characterised by the quartet of hypoalbuminemia, oedema, hyperlipidaemia and proteinuria?
Nephrotic Syndrome
105
A GFR of less than what value is considered reflecting End Stage Renal Failure in chronic kidney disesease?
<15mL/min
106
What scoring system is used to grade prostate tumours?
Gleason Score
107
Epigastric pain that worsens after food is a classical history of what form of peptic ulcer disease?
Gastric
108
A positive Courvoisier's sign - painless jaundice in the presence of a palpable gallbladder - is most commonly caused by of what diagnosis?
Pancreatic cancer
109
A 84 year old man with atrial fibrillation presents to the emergency department with increasing disorientation and headache. He has been having frequent falls at home over the last few months.
CT head reveals a unilateral, hypodense, crescent shaped mass underlying the left parietal bone.
What is the likely diagnosis?
Subdural Haemorrhage
110
What is the inheritance pattern of adult polycystic kidney disease?
Autosomal dominant
111
A nephrologist is investigating a 45 year old man with nephrotic syndrome.
His past medical history includes poorly controlled Type 2 Diabetes.
A biopsy viewed under light microscopy shows thickening of the glomerular basement membrane.
Some areas are visibly scarred.
Immunofluorescence shows the presence of antibody complexes and complement deposits. There are visible areas of scarring of the glomerular basement membrane, however, some areas appear spared.
What subtype of nephrotic syndrome does this histological pattern and history suggest?
Focal Segmental Glomerulosclerosis
112
What is the most common histopathological type of colorectal cancer?
Adenocarcinoma
113
A 23 year old man visits their GP with a positive pregnancy test, which he did for a joke. A repeat pregnancy test in the surgery is also positive.
He denies any sexual activity in the last year.
What is the possible underlying diagnosis?
Testicular cancer
114
Which form of inflammatory bowel disease is associated with Primary Sclerosing Cholangitis?
Ulcerative colitis
115
In the emergency department what imaging is required in the initial workup of a suspected stroke?
CT Head Non Contrast
116
The ECG leads II, III and aVF represent which region of the heart?
Inferior wall
117
Damage to what muscle within the heart may result in mitral regurgitation?
Papillary Muscle
118
A 32 year old man presents to the emergency department with cola coloured urine.
He denies pain or fever. He has had a sore throat for the past five days. He has no other medical history of note and this has not happened before.
He also has a non-blanching rash over his legs.
What is the likely cause of the nephritic syndrome?
IgA Nephropathy
119
A 58-year-old woman presents to her GP with a painful lump in her left breast.
There is palpable axillary lymphadenopathy and she reports recent significant weight loss and malaise.
She is assessed for breast cancer.
What histological subtype of breast cancer will this patient most likely have?
Invasive Ductal Carcinoma
120
What is the most common pattern of disease progression in Multiple Sclerosis?
Relapsing Remitting
121
A 83 year old woman was admitted to hospital for a severe chest infection. At the time of admission, her CURB-65 was 4. Her blood pressure was 80/40
She was diagnosed as having an acute kidney injury.
What is the likely cause of the AKI?
Acute Tubular Necrosis
122
A 5 day old baby (born three weeks premature) is admitted to the special care baby unit for suspected sepsis.
Blood cultures reveal a gram negative rod.
What is the likely organism responsible?
Eschericia coli
123
Barrett's oesophagus is a premalignant change associated with what histological malignancy of the oesophagus?
Adenocarcinoma
124
A 62-year-old man presents with a 3 months of right-sided flank discomfort.
He reports 5 days of gross haematuria with some clot formation.
On examination, his blood pressure is 157/95 mmHg. There is a palpable right sided mass in the lower abdomen.
What is the likely underlying diagnosis?
Renal cell cancer
125
A fasting blood glucose value above what value (in mmol/L) on two consecutive occasions in an asymptomatic individual confirms a diagnosis of diabetes?
7
126
What sign describes painless jaundice in the presence of a palpable gallbladder?
Courvoisier's sign
127
Degeneration of neurons in the substantia nigra is implicated in the pathogenesis of what synucleinopathy?
Idiopathic Parkinson's disease
128
What is the typical inheritance pattern of hypertrophic obstructive cardiomyopathy (HOCM)?
Autosomal Dominant
129
A 45 year old man presents to their GP with a chronic cough and mild breathlessness on exertion. He has a 60 pack year history of smoking. Spirometry reveals an obstructive picture with FEV1 75% of predicted. There is no association with time of day or seasonality.
What is the most likely diagnosis?
Chronic Obstructive Pulmonary Disease
130
A 18 year old woman was stabbed in the groin at a party. Arterial blood flow was observed from the wound on scene. Haemostasis was achieved by bystanders.
She was stabilised on scene and transferred to hospital by air ambulance.
She lost an estimated 6 units of blood, however the air ambulance transfused one unit on scene and bolused two litres of 0.9% sodium chloride.
You perform an A-E assessment in the emergency department 30 minutes later. She is unconscious but tachypneic. You note the presence of a new, soft, systolic murmur.
Given the history, what type of murmur is this likely to be?
Flow murmur
Flow murmurs are typically soft, systolic murmurs heard best at the left lower sternal edge.
They are often found in hyperdynamic circulations - pregnancy, anaemia or severe blood loss.
131
What is the inheritance pattern of alport's syndrome?
X linked recessive
132
What is the histological term which describes the change from one cell type to another, such as in Barrett's oesophagus?
Metaplasia
133
What is the minimum random plasma glucose level (in mmol/L) that is required to diagnose diabetes in a symptomatic individual?
11.1
134
A patient undergoing investigation for lung cancer has a bronchoscopy.
He has a 40 pack year history of smoking and is currently being worked up for a suspected diagnosis of myasthenia gravis.
A tumour is visualised by the bronchoscope in the left main bronchus. A biopsy is taken.
What histological type of lung cancer is this likely to be?
Small Cell Carcinoma
135
What histochemical stain would reveal the presence of iron in a liver biopsy with a patient with haemachromatosis?
Prussian blue
136
In which form of inflammatory bowel disease does smoking classically worsen symptoms?
Crohn's Disease
137
In which form of inflammatory bowel disease may non-caseating granulomas be seen on biopsy?
Crohn's Disease
138
Which strain of Escheriscia coli is classically associated with haemolytic uraemic syndrome in children who have spent time around farmyard animals?
0157:H7
139
What respiratory condition is characterised by airspace enlargement and alveolar wall destruction?
Emphysema
140
Staghorn calculi are typically formed when there is the presence of certain pathogenic bacteria.
Which enzyme, produced by these bacteria, is responsible for the formation of staghorn calculi?
Urease
141
Damage to which artery is commonly associated with an extradural haemorrhage?
Middle Meningeal Artery
142
What is the other condition that, together with emphysema, makes up COPD?
Chronic Bronchitis
143
What is the typical inheritance pattern of Maturity Onset Diabetes of the Young (MODY)?
Autosomal Dominant
144
What is the commonest cause of chronic renal failure in the UK?
Diabetes
145
Which hepatobiliary pathology, associated with a positive antimitochondrial antibody, may show the presence of granulomas on biopsy?
Primary Biliary Cirrhosis
146
What is the main hormone produced by beta cells in the pancreas?
Insulin
In the pancreas, there are three main cell types which produce endocrine hormones.
Alpha cells: Produce glucagon. Glucagon raises blood sugar levels
Beta cells: Produce Insulin. Insulin lowers blood sugar levels
Delta cells: Produce somatostatin. Exhiibts a paracrine effect on alpha and beta cells, reducing secretion of glucagon and insulin
147
Which valve is predominantely affected in acute rheumatic fever?
Mitral
148
A 54 year old gentleman with type 2 diabetes mellitus presents to his GP. He reports seeing blood in his urine. In addition, he has felt feverish and tired for a few weeks. He has no night sweats or weight loss and there is no family history of any medical problems.
Physical examination revealed an ejection systolic murmur and a palpable mass in the left upper quadrant of the abdomen.
Blood tests showed an elevated CRP with a normal haemoglobin.
Results of the urine dip are below:
Blood ++
Proteinuria ++
What is the cause of this constellation of symptoms?
Infective endocarditis
149
An 84 year old Asian woman presented to the ED with chest pain of 10 hours duration, which began while watching television. The pain was 9/10 and did not radiate. She reported being under extreme stress since the death of her 50 year old son a week ago.
An ECG revealed ST elevation in V2 and V3. Chest X ray was normal. Troponin and electrolytes were normal. Percutaneous Coronary Intervention was unremarkable with no occlusions and no evidence of atherosclerotic disease.
An echocardiogram showed apical akinesis with an ejection fraction of 36%. There was hypertrophy of the interventricular septum.
What is the diagnosis?
Takotsubo's Cardiomyopathy
150
What spirometry pattern is characterised by a normal FEV1, reduced FVC and an increased FEV1/FVC ratio?
Restrictive
151
What intracerebral tumour is Multiple Endocrine Neoplasia Type 1 associated with?
Pituitary Adenoma
152
A gentleman is diagnosed with cushing syndrome. Cortisol levels do not alter with either low or high dose dexamethasone suppression test.
A chest x ray reveals a homogenous opacification in the left middle zone.
What histological type of cancer is most likely responsible for this presentation?
Small Cell Lung Cancer
153
What is the main hormone produced by delta cells in the pancreas?
Somatostatin
In the pancreas, there are three main cell types which produce endocrine hormones.
Alpha cells: Produce glucagon. Glucagon raises blood sugar levels
Beta cells: Produce Insulin. Insulin lowers blood sugar levels
Delta cells: Produce somatostatin. Exhiibts a paracrine effect on alpha and beta cells, reducing secretion of glucagon and insulin
154
A biopsy, taken at autopsy, reads: "There is pathological intimal thickening of the right renal artery with significant occlusion of the luminal space. Immunohistochemical staining reveals the presence of macrophages"
What disease does the report describe?
Atherosclerosis
155
What is the most common cause of a pulmonary embolus?
Deep Vein Thrombosis
156
What tumour marker is associated with prostate cancer?
Prostate Specific Antigen
157
A biopsy specimen from the gastric antrum of a patient is reported as showing evidence of acute gastritis.
What cell of the immune system is found disproportionately in biopsies of acute gastritis?
Neutrophils
158
In which liver condition will cytoplasmic Mallory Denk Bodies most commonly be found on biopsy?
Alcoholic hepatitis
159
A 3 year old girl has progressive abdominal distension.
On examination there is a firm, smooth, non tender mass in the upper left quadrant of the abdomen.
A urine dip shows microscopic haematuria.
What is the likely diagnosis?
Nephroblastoma
160
Which hepatobiliary pathology is associated with the finding of "beading" of bile ducts during an endoscopic retrograde cholangiopancreatogram (ERCP)?
Primary Sclerosing Cholangitis
161
What is the organism typically implicated in acute postinfectious glomerulonephritis?
Group A Strep
162
What is the name given to areas of regenerating mucosa which project into the lumen of the bowel, which may be visualised during a colonoscopy of a patient with ulcerative colitis?
Pseudopolyp
163
Severe epigastric pain associated with an elevated serum lipase is highly suggestive of what diagnosis?
Pancreatitis
164
What is the commonest type of dementia in over 60 year olds?
Alzheimer's Disease
165
What is the most common chemical composition of renal stones?
Calcium oxalate
166
What is the first line treatment for severe haemachromatosis?
Therapeutic phlebotomy
167
A 24 year old woman presents to their GP with progressive shortness of breath on exertion associated with wheezing. She also has a productive cough, present most days.
Spirometry shows an obstructive picture with FEV1 47% of predicted.
A chest X ray shows evidence of hyperinflation.
What genetic condition should she be investigated for?
Alpha 1 Antitrypsin deficiency
168
Which hepatobilary pathology is classically associated with an elevated p-ANCA?
Primary Sclerosing Cholangitis
169
What is the most common type of lung cancer in the UK?
Squamous Cell Carcinoma
170
A fasting blood glucose value above what value (in mmol/L) will confirm a diagnosis of diabetes in an individual with polyuria and polydipsia?
7
171
A 80 year old presents to the emergency department with severe shortness of breath. She is visibly breathless at rest with a respiratory rate of 25 and oxygen saturations of 89%. Her JVP is elevated and she has pitting oedema to the level of the knee.
She reports she has been coughing up pink, frothy sputum for the last 3 days.
What is the most likely reason for her shortness of breath?
Pulmonary Oedema
