HistoPath Flashcards
Questions from textbook and blackboard
1
Q
A 36-year-old man presents to accident and emergency with a 1-day history of a fever of 39.2 C and night sweats. A new heart murmur is detected by the on- call cardiologist. The patient admits to being an intravenous drug user. A Monckeberg arteriosclerosis B Infective endocarditis C Dressler’s syndrome D Dilated cardiomyopathy E Rheumatic heart disease F Left heart failure G Hypertrophic obstructive cardiomyopathy H Aortic stenosis I Carcinoid syndrome
A
B Infective endocarditis
2
Q
A 64-year-old man presents to accident and emergency due to a collapse at home. An ejection systolic murmur is heard at the upper-left sternal edge. A Monckeberg arteriosclerosis B Infective endocarditis C Dressler’s syndrome D Dilated cardiomyopathy E Rheumatic heart disease F Left heart failure G Hypertrophic obstructive cardiomyopathy H Aortic stenosis I Carcinoid syndrome
A
H Aortic stenosis
3
Q
A widowed 72-year-old woman who has passed away at home is sent for autopsy due to unknown cause of death. Post-mortem examination reveals a nutmeg liver and haemosiderin-laden macrophages in the lungs. A Monckeberg arteriosclerosis B Infective endocarditis C Dressler’s syndrome D Dilated cardiomyopathy E Rheumatic heart disease F Left heart failure G Hypertrophic obstructive cardiomyopathy H Aortic stenosis I Carcinoid syndrome
A
F Left heart failure
Pulmonary congestion with dilated capillaries and leakage of blood into alveolar spaces leads to an increase in hemosiderin-laden macrophages
4
Q
A 54-year-old man presents to accident and emergency with fever and pleuritic chest pain. It is noted that the patient suffered a myocardial infarction 4 weeks previously A Monckeberg arteriosclerosis B Infective endocarditis C Dressler’s syndrome D Dilated cardiomyopathy E Rheumatic heart disease F Left heart failure G Hypertrophic obstructive cardiomyopathy H Aortic stenosis I Carcinoid syndrome
A
C Dressler’s syndrome
5
Q
A 46-year-old man is referred to the cardiology outpatient clinic. On investiga- tion he is found to have mitral regurgitation and has a past history of St Vitus Dance when he was in school and a mild pericarditis. A Monckeberg arteriosclerosis B Infective endocarditis C Dressler’s syndrome D Dilated cardiomyopathy E Rheumatic heart disease F Left heart failure G Hypertrophic obstructive cardiomyopathy H Aortic stenosis I Carcinoid syndrome
A
E Rheumatic heart disease
6
Q
A 40-year-old male presents to his GP with chronic cough with copious amounts of purulent mucus production. High resolution CT scans demonstrate dilated bronchi. A Hyaline membrane disease B Small cell carcinoma C Extrinsic allergic alveolitis D Bronchiectasis E Non-small cell carcinoma F Chronic bronchitis G Pulmonary oedema H Cystic fibrosis I Sarcoidosis
A
D Bronchiectasis
7
Q
A 14-year-old girl is admitted to hospital after suffering her third bout of pneumonia caused by Pseudomonas aeruginosa infection. She also has a previous admission for pancreatitis. A Hyaline membrane disease B Small cell carcinoma C Extrinsic allergic alveolitis D Bronchiectasis E Non-small cell carcinoma F Chronic bronchitis G Pulmonary oedema H Cystic fibrosis I Sarcoidosis
A
H Cystic fibrosis
8
Q
A 58-year-old man presents to his GP with haemoptysis and weight loss. He has a 30 pack–year history of smoking. He is referred to the oncologist for a biopsy, who determines ‘oat-shaped’ cells on microscopy. A Hyaline membrane disease B Small cell carcinoma C Extrinsic allergic alveolitis D Bronchiectasis E Non-small cell carcinoma F Chronic bronchitis G Pulmonary oedema H Cystic fibrosis I Sarcoidosis
A
B Small cell carcinoma
9
Q
A 62-year-old man presents to his GP with shortness of breath, lethargy and weight loss. The patient’s chest X-ray reveals a peripheral focal lesion in the left lung field. A Hyaline membrane disease B Small cell carcinoma C Extrinsic allergic alveolitis D Bronchiectasis E Non-small cell carcinoma F Chronic bronchitis G Pulmonary oedema H Cystic fibrosis I Sarcoidosis
A
E Non-small cell carcinoma
10
Q
A 53-year-old woman with a history of rheumatic fever presents to accident and emergency with severe shortness of breath, and has been coughing up pink frothy sputum for the past 2 days. A Hyaline membrane disease B Small cell carcinoma C Extrinsic allergic alveolitis D Bronchiectasis E Non-small cell carcinoma F Chronic bronchitis G Pulmonary oedema H Cystic fibrosis I Sarcoidosis
A
G Pulmonary oedema
11
Q
A 35-year-old woman is referred to the rheumatology clinic due to recent onset dysphagia. The patient also reports that her fingers have turned very pale and cold. One examination she is found to have tightening of the skin near her fin- ger tips and small dilated vessels on her skin. A Systemic lupus erythematosus B Sjögren’s syndrome C Diffuse scleroderma D Amyloidosis E Takayasu arteritis F Dermatomyositis G CREST syndrome H Polymyositis I Microscopic polyangitis
A
G CREST syndrome
12
Q
A 35-year-old woman with a history of recurrent miscarriages presents to her GP with joint pains. Blood tests reveal she is anti-double stranded DNA antibody positive. A Systemic lupus erythematosus B Sjögren’s syndrome C Diffuse scleroderma D Amyloidosis E Takayasu arteritis F Dermatomyositis G CREST syndrome H Polymyositis I Microscopic polyangitis
A
A Systemic lupus
13
Q
A 68-year-old man presents to accident and emergency with symptoms sugges- tive of heart failure. All initial investigations do not determine an underlying cause. However, a tongue biopsy sample gains an apple-green birefringence under polarized light using Congo red stain. A Systemic lupus erythematosus B Sjögren’s syndrome C Diffuse scleroderma D Amyloidosis E Takayasu arteritis F Dermatomyositis G CREST syndrome H Polymyositis I Microscopic polyangitis
A
D Amyloidosis
14
Q
A 45-year-old woman presents to accident and emergency with signs suggestive of renal failure. She is found to be p-ANCA positive. A Systemic lupus erythematosus B Sjögren’s syndrome C Diffuse scleroderma D Amyloidosis E Takayasu arteritis F Dermatomyositis G CREST syndrome H Polymyositis I Microscopic polyangitis
A
I Microscopic polyangitis
15
Q
A 52-year-old man presents to his GP with limb weakness and shortness of breath. A distinctive rash is noted around both eyes as well as plaques on the joints of his hands. A Systemic lupus erythematosus B Sjögren’s syndrome C Diffuse scleroderma D Amyloidosis E Takayasu arteritis F Dermatomyositis G CREST syndrome H Polymyositis I Microscopic polyangitis
A
F Dermatomyositis
16
Q
A 54-year-old man is seen in the neurology clinic due to tremor and rigidity. A DAT scan reveals reduced uptake in the substantia nigra. A Subarachnoid haemorrhage B Parkinson’s disease C Extradural haemorrhage D Vascular dementia E Subdural haemorrhage F Intracerebral haemorrhage G Multiple sclerosis H Duret haemorrhage I Alzheimer’s disease
A
B Parkinson’s disease
17
Q
A 74-year-old man presents to accident and emergency with increasing head- ache and confusion. The man’s wife suggests her husband may have tripped and fallen 3 days previously. A Subarachnoid haemorrhage B Parkinson’s disease C Extradural haemorrhage D Vascular dementia E Subdural haemorrhage F Intracerebral haemorrhage G Multiple sclerosis H Duret haemorrhage I Alzheimer’s disease
A
E Subdural haemorrhage
18
Q
A 45-year-old woman presents to accident and emergency with the worst head- ache she has ever experienced. She is noted to have polycystic kidney disease. A Subarachnoid haemorrhage B Parkinson’s disease C Extradural haemorrhage D Vascular dementia E Subdural haemorrhage F Intracerebral haemorrhage G Multiple sclerosis H Duret haemorrhage I Alzheimer’s disease
A
A Subarachnoid haemorrhage
19
Q
A 35-year-old woman presents to the neurology clinic with weakness of her left side. On examination she is found to have nystagmus and an intention tremor. The patient complains of blurred vision for the past month. A Subarachnoid haemorrhage B Parkinson’s disease C Extradural haemorrhage D Vascular dementia E Subdural haemorrhage F Intracerebral haemorrhage G Multiple sclerosis H Duret haemorrhage I Alzheimer’s disease
A
G Multiple sclerosis
20
Q
A 42-year-old man who suffers from Down syndrome is brought to see his GP by his carer. The carer describes how the patient has been wandering out of the house with increased frequency as well as becoming uncharacteristically aggres- sive, especially in the evening. A Subarachnoid haemorrhage B Parkinson’s disease C Extradural haemorrhage D Vascular dementia E Subdural haemorrhage F Intracerebral haemorrhage G Multiple sclerosis H Duret haemorrhage I Alzheimer’s disease
A
I Alzheimer’s disease
21
Q
A 35-year-old man has a 3-week history of bloody stools without mucus with associated weight loss. A biopsy of the gastrointestinal tract reveals non- caseating granulomas with transmural inflammation. A Ulcerative colitis B Chronic gastritis C Oesophageal cancer D Coeliac disease E Gastric carcinoma F Barrett’s oesophagus G Gardener’s syndrome H Crohn’s disease I Peptic ulcer disease
A
H Crohn’s disease
22
Q
A 24-year-old woman presents to her GP with a 2-week history of diarrhoea, weight loss and fatigue. Biopsy of the gastrointestinal tract reveals villous atro- phy with crypt hyperplasia. A Ulcerative colitis B Chronic gastritis C Oesophageal cancer D Coeliac disease E Gastric carcinoma F Barrett’s oesophagus G Gardener’s syndrome H Crohn’s disease I Peptic ulcer disease
A
D Coeliac disease
23
Q
A 54-year-old man presents to his GP with a 2-week history of worsening dys- phagia. The patient’s past medical history reveals severe gastro-oesophageal reflux disease. A duodenoscopy suggests metaplastic transformation of the lower oesophageal region. A Ulcerative colitis B Chronic gastritis C Oesophageal cancer D Coeliac disease E Gastric carcinoma F Barrett’s oesophagus G Gardener’s syndrome H Crohn’s disease I Peptic ulcer disease
A
F Barrett’s oesophagus
24
Q
A 45-year-old man is referred to the gastroenterology outpatient clinic due to severe epigastric pain and an episode of haematemesis. Further testing reveals he is Helicobacter pylori positive and has a 20 pack–year history of smoking. A Ulcerative colitis B Chronic gastritis C Oesophageal cancer D Coeliac disease E Gastric carcinoma F Barrett’s oesophagus G Gardener’s syndrome H Crohn’s disease I Peptic ulcer disease
A
I Peptic ulcer disease
25
Q
A 56-year-old man presents to his GP with abdominal pain, weight loss and fatigue. A duodenoscopy allows a biopsy of a gastric lesion to be taken, which demonstrates signet ring cells and linitis plastica. A Ulcerative colitis B Chronic gastritis C Oesophageal cancer D Coeliac disease E Gastric carcinoma F Barrett’s oesophagus G Gardener’s syndrome H Crohn’s disease I Peptic ulcer disease
A
E Gastric carcinoma
26
Q
A 56-year-old man with previous history of hepatitis C infection presents to accident and emergency with jaundice. His wife notes that he has recently been bruising very easily. Ultrasound of the patient’s liver reveals irregular echo- genicity demonstrating nodules. A Cholangiocarcinoma B Cirrhosis C 1-Antitrypsin deficiency D Haemosiderosis E Primary biliary cirrhosis F Haemochromatosis G Hepatocellular carcinoma H Primary sclerosing cholangitis I Wilson’s disease
A
B Cirrhosis
27
Q
A 35-year-old man presents to his GP with his mother with signs of Parkinsonism (tremor, rigidity and slow movement) as well as recent changes in his behaviour. A Cholangiocarcinoma B Cirrhosis C 1-Antitrypsin deficiency D Haemosiderosis E Primary biliary cirrhosis F Haemochromatosis G Hepatocellular carcinoma H Primary sclerosing cholangitis I Wilson’s disease
A
I Wilson’s disease
28
Q
A 56-year-old woman is investigated by the hepatology team for decompensat- ed liver disease. A liver biopsy sample stains blue with Perl’s Prussian blue stain. A Cholangiocarcinoma B Cirrhosis C 1-Antitrypsin deficiency D Haemosiderosis E Primary biliary cirrhosis F Haemochromatosis G Hepatocellular carcinoma H Primary sclerosing cholangitis I Wilson’s disease
A
F Haemochromatosis
29
Q
A 53-year-old man who has recently emigrated from sub-Saharan Africa is referred to the hepatology department due to recent onset weight loss, jaundice and ascites. There is history of previous aflatoxin exposure. A Cholangiocarcinoma B Cirrhosis C 1-Antitrypsin deficiency D Haemosiderosis E Primary biliary cirrhosis F Haemochromatosis G Hepatocellular carcinoma H Primary sclerosing cholangitis I Wilson’s disease
A
G Hepatocellular carcinoma
30
Q
A 45-year-old woman presents to accident and emergency with jaundice and pruritis. Xanthelasma are noted on examination. The patient is found to be anti- mitochondrial antibody positive. A Cholangiocarcinoma B Cirrhosis C 1-Antitrypsin deficiency D Haemosiderosis E Primary biliary cirrhosis F Haemochromatosis G Hepatocellular carcinoma H Primary sclerosing cholangitis I Wilson’s disease
A
E Primary biliary cirrhosis
31
Q
A 65-year-old man presents to his GP with blisters along his left arm that are about 1.0 cm in diameter. Gentle rubbing of the affected area does not lead to skin exfoliation. A Pemphigoid B Bowen’s disease C Pityriasis rosea D Lichen planus E Actinic keratosis F Psoriasis G Basal cell carcinoma H Erythema multiforme I Malignant melanoma J Pemphigus
A
A Pemphigoid
32
Q
A 38-year-old man on the respiratory ward has been diagnosed with Mycoplasma pneumoniae and develops a number of target shaped rashes on his body. A Pemphigoid B Bowen’s disease C Pityriasis rosea D Lichen planus E Actinic keratosis F Psoriasis G Basal cell carcinoma H Erythema multiforme I Malignant melanoma J Pemphigus
A
H Erythema multiforme
33
Q
A 45-year-old woman presents to her GP with salmon-pink plaques with a silver–white scale on the extensor surfaces of her elbows. A Pemphigoid B Bowen’s disease C Pityriasis rosea D Lichen planus E Actinic keratosis F Psoriasis G Basal cell carcinoma H Erythema multiforme I Malignant melanoma J Pemphigus
A
F Psoriasis
34
Q
A 54-year-old man is referred to the dermatologist with a brown warty lesion on his nose which has a rough consistency. Biopsy of the lesion reveals solar elastosis. A Pemphigoid B Bowen’s disease C Pityriasis rosea D Lichen planus E Actinic keratosis F Psoriasis G Basal cell carcinoma H Erythema multiforme I Malignant melanoma J Pemphigus
A
E Actinic keratosis
35
Q
A 59-year-old woman presents to her dermatologist with a 3 cm black irregular lesion on her cheek. Over the next month the lesion spreads to cover 6 cm with new onset pain. A Pemphigoid B Bowen’s disease C Pityriasis rosea D Lichen planus E Actinic keratosis F Psoriasis G Basal cell carcinoma H Erythema multiforme I Malignant melanoma J Pemphigus
A
I Malignant melanoma
36
Q
A 45-year-old man presents to accident and emergency with haematuria and admits to passing less urine than previously. He is found to be hypertensive. Microscopy of the patient’s urine reveals red and white cell casts. A Nephritic syndrome B Wegener’s granulomatosis C Membranous glomerulonephritis D Acute tubular necrosis E Minimal change glomerulo- nephritis F Goodpasture’s syndrome G IgA nephropathy H Nephrotic syndrome I Focal segmental glomerulo- nephritis
A
A Nephritic syndrome
37
Q
A 42-year-old man presents to accident and emergency with an episode of haemoptysis and haematuria. Blood tests reveal he is in acute renal failure. Once the patient is stable a renal biopsy demonstrates a crescent morphology on immunofluorescence. A Nephritic syndrome B Wegener’s granulomatosis C Membranous glomerulonephritis D Acute tubular necrosis E Minimal change glomerulo- nephritis F Goodpasture’s syndrome G IgA nephropathy H Nephrotic syndrome I Focal segmental glomerulo- nephritis
A
F Goodpasture’s syndrome
38
Q
A 64-year-old man on the Care of the Elderly ward is found to be in acute renal failure secondary to statin-related rhabdomyolysis. Urinalysis reveals the pres- ence of ‘muddy’ casts. A Nephritic syndrome B Wegener’s granulomatosis C Membranous glomerulonephritis D Acute tubular necrosis E Minimal change glomerulo- nephritis F Goodpasture’s syndrome G IgA nephropathy H Nephrotic syndrome I Focal segmental glomerulo- nephritis
A
D Acute tubular necrosis
39
Q
An 8-year-old girl presents to accident and emergency with frank haematuria. Her parents state that she had just recovered from a throat infection 2 days previously. A Nephritic syndrome B Wegener’s granulomatosis C Membranous glomerulonephritis D Acute tubular necrosis E Minimal change glomerulo- nephritis F Goodpasture’s syndrome G IgA nephropathy H Nephrotic syndrome I Focal segmental glomerulo- nephritis
A
G IgA nephropathy
40
Q
A 62-year-old woman on the Care of the Elderly ward is found to have new onset ankle swelling. A urine dipstick demonstrates proteinuria and the only blood abnormality is a low albumin level. A Nephritic syndrome B Wegener’s granulomatosis C Membranous glomerulonephritis D Acute tubular necrosis E Minimal change glomerulo- nephritis F Goodpasture’s syndrome G IgA nephropathy H Nephrotic syndrome I Focal segmental glomerulo- nephritis
A
H Nephrotic syndrome
41
Q
A 55-year-old parous woman presents to her GP with a 2-week history of green discharge from her right nipple. A Mastitis B Phylloides tumour C Fibroadenoma D Duct ectasia E Ductal carcinoma in situ F Gynaecomastia G Fibrocystic disease H Fat necrosis I Infiltrating ductal carcinoma
A
D Duct ectasia
42
Q
A 35-year-old woman presents to her GP with a soft 3 cm mobile mass in her left breast. The patient suggests the size of the lump fluctuates with her men- strual cycle. A Mastitis B Phylloides tumour C Fibroadenoma D Duct ectasia E Ductal carcinoma in situ F Gynaecomastia G Fibrocystic disease H Fat necrosis I Infiltrating ductal carcinoma
A
C Fibroadenoma
43
Q
A 54-year-old woman presents to her GP with a single lump in her left breast. A mammogram reveals a focal area of calcification. A Mastitis B Phylloides tumour C Fibroadenoma D Duct ectasia E Ductal carcinoma in situ F Gynaecomastia G Fibrocystic disease H Fat necrosis I Infiltrating ductal carcinoma
A
E Ductal carcinoma in situ
44
Q
A 60-year-old woman presents to her GP with a 5.5 cm mobile lump in her right breast. Biopsy reveals an ‘artichoke-like’ appearance. A Mastitis B Phylloides tumour C Fibroadenoma D Duct ectasia E Ductal carcinoma in situ F Gynaecomastia G Fibrocystic disease H Fat necrosis I Infiltrating ductal carcinoma
A
B Phylloides tumour
45
Q
A 58-year-old woman presents to her GP with a painful lump in her right breast. On examination there is also evidence of peau d’orange. A Mastitis B Phylloides tumour C Fibroadenoma D Duct ectasia E Ductal carcinoma in situ F Gynaecomastia G Fibrocystic disease H Fat necrosis I Infiltrating ductal carcinoma
A
I Infiltrating ductal carcinoma
46
Q
A 35-year-old man with pain and difficulty bending his left knee. X-ray reveals many lytic lesions in the epiphysis of the patient’s left knee. A Osteoporosis B Fibrous dysplasia C Paget’s disease D Osteomalacia E Osteochondroma F Osteoid osteoma G Renal osteodytrophy H Enchondroma I Giant cell tumour
A
I Giant cell tumour
47
Q
A 38-year-old woman presents to her GP with generalized bone pain. X-ray reveals areas of pseudofracture, especially in the ribs. A Osteoporosis B Fibrous dysplasia C Paget’s disease D Osteomalacia E Osteochondroma F Osteoid osteoma G Renal osteodytrophy H Enchondroma I Giant cell tumour
A
D Osteomalacia
48
Q
A 65-year-old woman is referred to the rheumatologist after suffering recurrent falls. Blood tests are all unremarkable but a DEXA scan reveals a T-score of 2.8. A Osteoporosis B Fibrous dysplasia C Paget’s disease D Osteomalacia E Osteochondroma F Osteoid osteoma G Renal osteodytrophy H Enchondroma I Giant cell tumour
A
A Osteoporosis
49
Q
An 8-year-old boy has been diagnosed with precocious puberty. A routine examination by the paediatrician reveals café-au-lait spots on the child’s back. The boy has had numerous fractures of his femur and tibia bilaterally after falls. A Osteoporosis B Fibrous dysplasia C Paget’s disease D Osteomalacia E Osteochondroma F Osteoid osteoma G Renal osteodytrophy H Enchondroma I Giant cell tumour
A
B Fibrous dysplasia
50
Q
A 50-year-old man presents to his GP with pain in his arms and legs. The patient also complains of shooting pains down his left leg as well as worsening shortness of breath. A Osteoporosis B Fibrous dysplasia C Paget’s disease D Osteomalacia E Osteochondroma F Osteoid osteoma G Renal osteodytrophy H Enchondroma I Giant cell tumour
A
C Paget’s disease
51
Q
A 65-year-old patient with advanced breast malignancy and a history of multi- ple systemic emboli suffers a stroke. On examination, there are no cardiac mur- murs but an echocardiogram reveals small bland vegetations on the mitral valve. Blood cultures are negative. What is the most likely diagnosis? A Infective endocarditis B Acute rheumatic fever C Non-bacterial thrombotic endocarditis D Chronic rheumatic valvular disease E Libman–Sacks endocarditis
A
C Non-bacterial thrombotic endocarditis
When I google- Libman Sacks endocarditis is the same as non bacterial thrombotic endocarditis….So i guess either is correct?
52
Q
A 41-year-old man presents with severe central chest pain which he describes as ‘tearing’ in nature and radiating to the back. He is tall, with long limbs and long thin fingers. He also has an aortic regurgitation murmur. Histologically there is cystic medial necrosis in the aortic wall. In which syndrome are these findings most likely? A Ortner’s syndrome B Ehlers–Danlos syndrome C Down syndrome D Turner syndrome E Marfan syndrome
A
E Marfan syndrome
53
Q
A 57-year-old overweight patient suffers an acute myocardial infarction and subsequently dies. A post-morterm examination of the infarcted area shows extensive cell infiltration including polymorphs and macrophages. There is also extensive debris post necrosis and the cytoplasm is homogeneous making it difficult to see the outlines of the myocardial fibres. There is no evidence of collagenization or a scar. How long after the initial attack did the patient die?
A At the time of the attack (0–6 hours)
B Hours after the attack (6–24 hours)
C Days after the attack (1–4 days)
D Within the first 2 weeks of the attack (4–14 days)
E Weeks and months after (14 days +)
A
C Days after the attack (1–4 days)
<6hours = normal histology
6-24 hours = loss of nuclei, homogenous cytoplasm, necrotic cell death
1-4 days = infiltration of polymorphs then macrophages
5-10 days = removal or debris
1-2 weeks = granulation tissue, new blood vessels, myofibroblasts, collagen synthesis
Weeks-months = strengthening, decellularising scar
54
Q
A 35-year-old woman presents to accident and emergency with nausea, severe malaise, swelling and stiffness of the fingers. On examination, her blood pressure is 155/95mmHg and she has Raynaud’s phenomenon. Blood tests reveal positive anti-topoisomerase antibodies and deranged serum creatinine and urea. A biopsy result of her small arteries reveals an onion skin appearance. What is the most likely diagnosis? A Systemic lupus erythematosus B Diffuse scleroderma C Kawasaki’s disease D Polyarteritis nodosa E Limited scleroderma/CREST
A
B Diffuse scleroderma
55
Q
A 46-year-old woman presents with gradual muscle weakness in her neck and upper arms over the past 3 weeks. She is also said to have a purple ‘heliotrope’ rash on her upper eyelids, an erythematous scaling rash on her face and red patches on the knees. She has also experienced some weight loss. Blood tests reveal elevated skeletal muscle enzymes but electromyogram results were nega- tive. What is the most likely diagnosis? A Polymyositis B Henoch–Schönlein purpura C Dermatomyositis D Kawasaki disease E Sarcoidosis
A
C Dermatomyositis
56
Q
A 43-year-old man presents with a rest tremor, slowness of voluntary movement and rigidity. It is reported that he has a mutation of the alpha-synuclein protein and he is free of Lewy bodies on histological examination. What is the most likely diagnosis? A Familial Parkinson’s disease B Alzheimer’s disease C Multiple system atrophy D Multiple sclerosis E Idiopathic Parkinson’s disease
A
A Familial Parkinson’s disease
57
Q
The activity of the plaques in a 25-year-old multiple sclerosis patient is described with the presence of oedema and macrophages, and some myelin breakdown. Which ICDNS (International Classification of Diseases of the Nervous System) plaque type classification best fits the description? A Acute plaque B Early chronic active plaque C Late chronic active plaque D Chronic inactive plaque E Shadow plaque
A
B Early chronic active plaque
Acute plaque: Minor changes (e.g. oedema) and often difficult to recognize
Early chronic active plaque: Oedema and macrophages, indicative of an inflammatory disorder of the central nervous system, with some myelin breakdown. Reactive astrocytosis is present
Late chronic active plaque: Complete loss of myelin. Some macrophages will contain myelin debris and there will be often very mild perivascular inflammation at this stage with enlarged perivascular spaces
Chronic inactive plaque: Complete loss of myelin with the absence of macrophages
Shadow plaque: Nearly complete remyelination as a thin myelin with some scattered macrophages and a mild microglial up-regulation.
58
Q
A 72-year-old woman is diagnosed with a disease that accounts for 50–75 per cent of all cases of dementia. The four characteristic pathological features for her diagnosis are severe brain atrophy, loss of neurons, senile plaques and neuro- fibllirary tangles. What is the most likely diagnosis? A Huntington’s disease B Alzheimer’s disease C Multiple system atrophy D Dementia with Lewy bodies E Parkinson’s disease
A
B Alzheimer’s disease
59
Q
A 32-year-old man has a past medical history of severe gastro-oesophageal reflux disease. His most recent oesophageal biopsy shows a columnar epithelium with goblet cells suggestive of a diagnosis of Barrett’s oesophagus. What form of cell change is this also known as? A Anaplasia B Hyperplasia C Metaplasia D Dysplasia E Neoplasia
A
C Metaplasia
60
Q
A 38-year-old man is a known gastritis patient. The most recent endoscopy and biopsy has detected that the area most severely affected is the pyloric antrum. He also has susceptibility for developing a gastric MALT lymphoma in the future. What is the most likely diagnosis?
A Menetrier’s disease (hyperplastic hypersecretory gastropathy)
B Acute gastritis
C Helicobacter-associated chronic gastritis
D Autoimmune chronic gastritis
E Reactive/reflux chronic gastritis
A
C Helicobacter-associated chronic gastritis
61
Q
A 50-year-old known alcoholic man has persistent severe epigastric pain radiat- ing to the back and has experienced weight loss of 5kg in 2 months. On initial presentation, the patient is not jaundiced. On contrast enhanced CT scan there are multiple calcific densities along the line of the main pancreatic duct. On histological examination, there is evidence of parenchymal fibrosis and large ducts containing insipissated secretions. What is the most likely diagnosis? A Chronic pancreatitis B Carcinoma in the head of the pancreas C Diabetes mellitus type 2 D Acute pancreatitis E Pseudocysts
A
A. Chronic pancreatitis
62
Q
A 22-year-old man presents with polyuria and polydipsia. His fasting plasma glucose is 7.3mmol/L. He is Glutamic Acid Decarboxylase (GAD) antibody positive. What is the most likely diagnosis? A Diabetes mellitus type 1 B Diabetes insipidus C Psychogenic polydipsia D Diabetes mellitus type 2 E Zollinger–Ellison syndrome
A
A Diabetes mellitus type 1
63
Q
A 37-year-old man, while abroad, was involved in a road traffic accident and required a blood transfusion. He had an episode of acute hepatitis with the con- traction of a DNA virus of the Hepadna group. There is a small chance this may progress to chronic hepatitis. What is the most likely viral hepatitis type? A Hepatitis A B Hepatitis B C Hepatitis C D Hepatitis D E Hepatitis E
A
B Hepatitis B
64
Q
A 42-year-old woman, who has a history of joint and skin symptoms, presents with jaundice. Anti-mitochondrial antibodies are present and histologically there is evidence of a progressive, chronic granulomatous inflammation of the bile duct. What is the most likely diagnosis? A Primary sclerosing cholangitis B Autoimmune hepatitis C Primary biliary cirrhosis D -1 Antitrypsin deficiency E Alcoholic liver disease
A
C Primary biliary cirrhosis
65
Q
A 23-year-old patient has an autosomal recessive disorder. The patient has demonstrated parkinsonian symptoms such as a hand tremor and has developed chronic hepatitis. On examination, he is found to have Kayser–Fleischer
rings. Blood levels of serum ceruloplasmin are low. What is the most likely diagnosis?
A Wilson’s disease
B Genetic haemochromatosis
C -1 Antitrypsin deficiency
D Reye’s syndrome
E Budd–Chiari syndrome
A
A Wilson’s disease
66
Q
An 8-year-old Down syndrome boy presents with constipation, distended abdo- men, vomiting and overflow diarrhoea. The cause is believed to be absence of ganglion cells in the myenteric plexus causing the failure of the dilation of the distal colon. What is the most likely diagnosis? A Stenosis B Hirschsprung’s disease C Atresia D Intussusception E Volvulus
A
B Hirschsprung’s disease
67
Q
A 25-year-old white man is experiencing bloody diarrhoea and mucous discharge. Macroscopic analysis shows abnormality in the colon and rectum only and is continuous with a normal bowel wall thickness. The pattern of inflammation isconfined to the mucosa of the bowel wall and no evidence of granulomas exists. What is the most likely diagnosis? A Crohn’s disease B Ulcerative colitis C Ischaemic colitis D Pseudomembranous colitis E Viral gastroenteritis
A
B Ulcerative colitis
68
Q
A 39-year-old man is diagnosed with a colon cancer proximal to the splenic flexure that is poorly differentiated and highly aggressive. There are no associ- ated adenomata. It is an autosomal dominant condition that involves gene muta- tions of DNA mismatch repair genes. What is the most likely diagnosis?
A Familial adenomatous polyposis
B Gardner’s syndrome
C Colorectal carcinoma
D Hereditary non-polyposis colorectal cancer
E Hamartomatous polyps
A
D Hereditary non-polyposis colorectal cancer
69
Q
A 25-year-old woman presents to clinic with an inability to conceive and a past history of Chlamydia trachomatis infection. On ultrasonography, she is diagnosed with hydrosalpinx. Hydrosalpinx is the most likely complication of which of the below options? A Endometriosis B Adenomyosis C Cervical intraepithelial neoplasia D Salpingitis E Human papillomavirus
A
D Salpingitis
70
Q
A 42-year-old Afro-Caribbean woman is nulliparous and trying to conceive. She has been experiencing dysmenorrhoea. Ultrasound scan shows multiple rounded nodules within the myometrium. What is the most likely diagnosis?
A Cervical intraepithelial neoplasia
B Vulval carcinoma
C Leiomyoma
D Endometrial carcinoma
E CGIN (endocervical glandular dysplasia)
A
C Leiomyoma
71
Q
A 20-year-old woman presents to accident and emergency with a distended abdomen resembling a pregnancy. She later develops acute onset of severe abdominal pain. An ultrasound identified a mass in her right ovary. Her abdomen is rigid and she is admitted for emergency surgery. It is believed that three embryonic germ cell layers are present. What is the most likely diagnosis? A Teratoma of the ovary B Serous tumour of the ovary C Mucinous tumour of the ovary D Endometrioid tumour of the ovary E Clear cell carcinoma
A
A Teratoma of the ovary
72
Q
A 32-year-old woman presents with generalized fatigue. Full blood count shows a reduced haemoglobin level and reduced mean corpuscular volume. A peripheral blood film has revealed iron deficiency anaemia. What features are most likely to be seen on her peripheral blood film?
A Hypochromic and microcytic red blood cells with anisopoikilocytosis and acanthocytes
B Hypochromic and microcytic red blood cells with hypersegmented neutrophils
C Hypochromic and microcytic red blood cells with anisopoikilocytosis and no evidence of basophilic stippling
D Hypochromic and microcytic red blood cells with Howell–Jolly bodies and basophilic stippling
E Hypochromic and macrocytic red blood cells with target cells, acanthocytes and Howell–Jolly bodies
A
C Hypochromic and microcytic red blood cells with anisopoikilocytosis and no evidence of basophilic stippling
73
Q
A 26-year-old woman presents with fatigue ‘all the time’. She has a family his- tory of coeliac disease and blood tests reveal hypochromic, microcytic anaemia. She is referred to the gastroenterology clinic for tests. The gold standard investi- gation is the duodenal biopsy, which is carried out after positive serological test- ing. Which current serological testing and histopathology findings in the options below are most consistent with a coeliac disease diagnosis?
A Anti-reticulin antibodies only/villous atrophy, crypt hyperplasia, increased intraepithelial lymphocytes
B Anti-gliadin antibodies only/no villous atrophy, crypt hyperplasia, decreased intraepithelial lymphocytes
C Anti-endomysial antibodies only/villous atrophy, crypt hyperplasia, increased intraepithelial lymphocytes
D Anti-endomysial antibodies and anti-tissue transglutaminase antibodies/ villous atrophy, crypt hyperplasia, increased intraepithelial lymphocytes
E Anti-endomysial antibodies and anti-tissue transglutaminase antibodies/villous atrophy, no evidence of crypt hyperplasia, increased intraepithelial lymphocytes
A
D Anti-endomysial antibodies and anti-tissue transglutaminase antibodies/ villous atrophy, crypt hyperplasia, increased intraepithelial lymphocytes
74
Q
A 27-year-old woman has developed pain in her right proximal femur. She has
a history of intermittent hip pain since childhood. An X-ray has demonstrated a ‘soap bubble’ appearance indicative of osteolysis and a characteristic shepherd’s crook deformity. The biopsy would show irregular trabeculae of woven bone said to resemble Chinese letters. What is the most likely diagnosis?
A Non-ossifying fibroma
B Fibrous dysplasia
C Giant cell reparative granuloma
D Ossifying fibroma
E Simple bone cyst
A
B Fibrous dysplasia
75
Q
A 36-year-old man presents with swelling of his middle finger and subsequently a fracture. His X-ray shows cotton wool calcification and histopathology shows evidence of a tumour composed of benign hyaline cartilage. It is believed that he has only a very slight risk of malignant transformation. What is the most likely diagnosis? A Osteochondroma B Multiple myeloma C Osteoid osteoma D Giant cell tumour E Enchondroma
A
E Enchondroma
76
Q
An 18-year-old man presents with pain and a mass in his right knee. His X-ray shows an ill defined mass in the metaphyseal region of the distal femur that is sclerotic and lytic. There is also an elevated periosteum (known as a Codman’s tri- angle). Prognosis is said to be poor and the treatment required is multi-disciplinary involving intensive chemotherapy and surgery. In cytology, these tumour cells will be positive for alkaline phosphatase. What is the most likely diagnosis? A Osteosarcoma B Chondrosarcoma C Fibrosarcoma D Malignant fibrous histiocytoma E Ewing’s sarcoma
A
A Osteosarcoma
77
Q
A 25-year-old woman is due for her cervical smear test. Which method of cyto- pathology is going to be used? A FNA B Ultrasound guided FNA C Washings D Brushings E Liquid based cytology
A
E Liquid based cytology
78
Q
A 57-year-old man who is a heavy smoker presents to his GP with gradually worsening dyspnoea and cough productive of green sputum. On examination, he is cyanosed, tachypnoeic and wheezing. What is the most likely diagnosis? A Chronic bronchitis B Pulmonary embolus C Asthma D Bronchiolitis E Emphysema
A
A Chronic bronchitis
79
Q
A 57-year-old man presents to accident and emergency with dyspnoea, fever, cough and purulent sputum. Histopathology confirms widespread fibrinosup- purative consolidation on the left lower lobe and the top differential diagnosis is lobar pneumonia. Which organism is the most likely cause? A Streptococcus pneumoniae B Staphylococcus aureus C Haemophilus influenzae D Streptococcus pyogenes E Mycobacterium tuberculosis
A
A Streptococcus pneumoniae
80
Q
A 27-year-old man with severe second degree burns is admitted to the ITU and develops severe shortness of breath and tachypnoea the next day. Diffuse alveolar damage is indicated in the histopathology report. What is the most likely diagnosis? A Pulmonary oedema B Acute respiratory distress syndrome C Cryptogenic fibrosing alveolitis D Bronchiectasis E Chronic bronchitis
A
B Acute respiratory distress syndrome
81
Q
A 47-year-old construction worker presents with a 6-month history of cough, haemoptysis and 5kg weight loss. He is a heavy smoker and a centrally located lesion is found on his chest X-ray. Histology showed keratinization and intercel- lular ‘prickles’. What is the most likely diagnosis? A Tuberculosis B Squamous cell carcinoma C Mesothelioma D Emphysema E Large cell carcinoma
A
B Squamous cell carcinoma
82
Q
A 55-year-old non-smoking woman presents to her GP with a 6-month history of cough, haemoptysis and 5kg weight loss. A chest X-ray showed the lesion is in the periphery and histopathology showed evidence of glandular differentiation and cytology showed mucin vacuoles. Mode of treatment most suitable is surgi- cal. What is the most likely diagnosis? A Small cell carcinoma B Adenocarcinoma C Large cell carcinoma D Sarcoidosis E Pneuomoconiosis
A
B Adenocarcinoma
83
Q
A 27-year-old man presents with fever, fatigue and a rash. He has also noted a few painful ulcers in his mouth. The rash is described as numerous round lesions about an inch in diameter on the face, trunk, arms and legs, diagnosed as erythema multiforme. What is the most likely diagnosis for this patient? A Systemic lupus erythematosus B Stevens–Johnson syndrome C Pemphigoid D Pityriasis rosea E Contact dermatitis
A
B Stevens–Johnson syndrome
84
Q
A 55-year-old Australian man presents with a flat black lesion on his back that appears asymmetrical with an irregular border and 6mm in diameter. Breslow’s depth is 0.4mm. What is the most likely diagnosis? A Malignant melanoma B Basal cell carcinoma C Squamous cell carcinoma D Keratoacanthoma E Bowen’s disease
A
A Malignant melanoma
85
Q
A 23-year-old Irish man presents with an itchy blistering eruption on his but- tocks and elbows. He also has diarrhoea and abdominal pain. Histopathology reveals papillary microabscesses and a neutrophilic infiltrate. He has a family history of gluten sensitivity. Which rash is most often associated with his presentation? A Psoriasis B Atopic eczema C Dermatitis herpetiformis D Lichen planus E Seborrhoeic dermatitis
A
C Dermatitis herpetiformis
86
Q
A 26-year-old man presents to accident and emergency having fallen off his skateboard and landed with a big impact on his right side. His X-ray shows a fracture in the midshaft of his right humerus that appears splintered although the soft tissue is intact. What type of fracture is this? A Greenstick fracture B Transverse fracture C Compound fracture D Impacted fracture E Comminuted fracture
A
E Comminuted fracture
87
Q
An 80-year-old woman presents complaining of pain on movement and stiff- ness after inactivity in her legs, most notably in her hips and knees. She also complains of pain in her hands and marked symmetrical swelling is noted in her distal interphalangeal joints. The X-ray of her right knee shows subchondral sclerosis, subchondral cyst formation, joint space narrowing and osteophytes. What is the most likely diagnosis? A Osteoarthritis B Rheumatoid arthritis C Ankylosing spondylitis D Psoriatic arthritis E Osteoporosis
A
A Osteoarthritis
88
Q
A 59-year-old man presents to accident and emergency with a painful, swollen and hot big toe. The joint aspirate shows negatively birefringent crystals under polarized red light. The crystals are needle shaped. What is the most likely diagnosis? A Pseudogout B Lyme disease C Reiter’s sydrome D Gout E Osteomyelitis
A
D Gout
89
Q
A 23-year-old man presents to accident and emergency with a 2-day history of left-sided loin pain, fever, rigors and vomiting. Urine analysis reveals microscop- ic haematuria and white cell casts. What is the most likely diagnosis? A Cystitis B Prostatitis C Urolithiasis D Acute pyelonephritis E Hydronephrosis
A
D Acute pyelonephritis
90
Q
A 4-year-old boy presents with a large abdominal mass and haematuria. His blood pressure is 165/120mmHg. The mass has a large necrotic solid tumour with extrarenal invasion. Microscopically, there are immature-looking glomerular structures. Aggressive therapy with surgery, chemotherapy and radiotherapy is indicated. What is the most likely diagnosis? A Teratoma B Wilm’s tumour C Oncocytoma D Spermatocytic seminoma E Bowen’s disease
A
B Wilm’s tumour
91
Q
A 79-year-old man has hesitancy and terminal dribbling urinary symptoms secondary to a tumour growth. No other symptoms are present. On rectal exami- nation, the prostate is reported as hard and craggy. The patient has been given
a Gleason’s score of 8; a primary grade of 3, describing that the tissue has rec- ognizable glands and these cells are beginning to invade the surrounding tissue. There is also a secondary grade of pattern 5 suggesting poorly differentiated cells. What is the most likely diagnosis?
A Prostatic adenocarcinoma
B Seminoma
C Prostatic intraepithelial neoplasia
D Benign prostatic hyperplasia
E Transitional cell carcinoma
A
A Prostatic adenocarcinoma
92
Q
A 27-year-old lactating mother presents with a painful red left breast. On closer examination, there are cracks and fissures on the left nipple. What is the most likely diagnosis? A Fat necrosis B Acute mastitis C Duct ectasia D Simple fibrocystic change E Epithelial hyperplasia
A
B Acute mastitis
93
Q
A 56-year-old woman presents with blood stained nipple discharge and a soli- tary mass located just superior to the nipple in her left breast. A histopathology analysis shows that a papillary mass is lined by epithelium and myoepithelium. It is believed that there is no increased risk of malignancy. What is the most likely diagnosis? A Intraductal papilloma B Phylloides tumour C Fibroadenoma D Radial scar E Ductal carcinoma in situ
A
A Intraductal papilloma
94
Q
A 53-year-old overweight woman with a positive family history of breast cancer attends her appointment for the NHS Breast Screening Programme. She is oneof the 5 per cent of women who have an abnormal mammogram and are called for a core biopsy. She has been given a B code of B5b. What is the most likely diagnosis?
A Benign abnormality
B Lesion of uncertain malignant potential
C Ductal carcinoma in situ
D Invasive carcinoma
E Suspicious of malignancy
A
D Invasive carcinoma
95
Q
A 44-year-old man has developed end stage renal failure over the past 5 years with numerous episodes of macroscopic haematuria. He was asymptomatic previ- ously. Ultrasound scan has shown numerous asymmetrical large cysts bilaterally. The patient’s mother had a similar condition. What is the most likely diagnosis? A Acquired cystic disease B Medullary sponge disease C Adult polycystic kidney disease D Cystic renal dysplasia E Simple renal cysts
A
C Adult polycystic kidney disease
96
Q
A 48-year-old man presents with oliguria and a vasculitic rash on his legs. Investigations indicate that he has a reduced glomerular filtration rate and uri- nalysis finds urine casts containing red and white blood cells. Histopathology shows scanty deposits of immunoglobulins and complement present with associ- ated anti-neutrophil cytoplasm antibodies (ANCA). What is the most likely diagnosis?
A IgA nephropathy
B Thrombotic microangiopathy
C Anti-GBM crescentic glomerulonephritis disease
D Pauci-immune crescentic glomerulonephritis disease
E Amyloidosis
A
D Pauci-immune crescentic
A type of acute crescentic glomerulonephritis with the presence of ANCA. It is rapidly progressive
97
Q
A 35-year-old oedematous woman is found to have urinary protein loss of 5.1g daily. Further tests show a low albumin level and significant interference with podocyte function. No glomerular crescents were detected. What is the most likely diagnosis? A Acute glomerulonephritis B Nephritic syndrome C Nephrotic syndrome D Acute tubular necrosis E Acquired cystic disease
A
C Nephrotic syndrome
98
Q
A 58-year-old woman is known to have a Berry aneurysm in the basilar artery. She develops sudden onset severe headache, nausea and loss of consciousness. There was evidence of a ‘warning bleed’ but no history of brain trauma. What is the most likely fatal diagnosis caused by the ruptured Berry aneurysm? A Intracerebral haemorrhage B Subarachnoid haemorrhage C ‘Watershed’ strokes D Transient ischaemic attack E Tonsillar brain herniation
A
B Subarachnoid haemorrhage
99
Q
A 9-year-old boy presents with fever, headache, stiff neck and altered men- tal state. His cerebrospinal fluid is turbid and contains mostly neutrophils. The meninges appear congested and there is purulent material in the subarachnoid space. What is the most likely causative organism? A Coxsackie virus B Treponema pallidum C Staphylococcus aureus D Streptococcus pneumoniae E Haemophilus influenzae
A
D Streptococcus pneumoniae
100
Q
A 22-year-old HIV-infected woman is pregnant with her second child. HIV has been transmitted perinatally to her first child. One of the most successful inter- ventions to reduce vertical transmission of HIV during pregnancy to less than 1 per cent is the use of combination anti-retroviral treatment, which ideally should reduce the viral load to? A 50 copies/mL B 800 copies/mL C 1000 copies/mL D 5000 copies/mL E 10 000 copies/mL
A
A 50 copies/mL
101
Q
A 70 year old lady presents to her GP complaining of tight chest pain, which radiated to her left arm and was relieved by rest. Her ECG revealed some st depression A. Aortic Dissection B. Coarctation of the Aorta C. Dressler’s Syndrome D. Restrictive cardiomyopathy E. Pulmonary embolus F. Decubitus Angina G. Acute Coronary Syndrome H. Transient Ischaemic Attack I. Aortic Stenosis J. Cerebrovascular Accident K. Acute Myocardial Infarction L. Mitral Stenosis M. Stable Angina N. Pericarditis O. Ventricular Tachycardia
A
M. Stable Angina
102
Q
A 50 year old male smoker, with a history of hypertension presents to the A and E department with continuous, central, crushing chest pain radiating to the left arm. The ECG showed st elevation. A. Aortic Dissection B. Coarctation of the Aorta C. Dressler’s Syndrome D. Restrictive cardiomyopathy E. Pulmonary embolus F. Decubitus Angina G. Acute Coronary Syndrome H. Transient Ischaemic Attack I. Aortic Stenosis J. Cerebrovascular Accident K. Acute Myocardial Infarction L. Mitral Stenosis M. Stable Angina N. Pericarditis O. Ventricular Tachycardia
A
K. Acute Myocardial Infarction
103
Q
A 63 year old obese, diabetic male presents to A and E with tight chest pain at rest, which radiated to the left arm and lasted for less than 20 minutes. The CK was not raised. A. Aortic Dissection B. Coarctation of the Aorta C. Dressler’s Syndrome D. Restrictive cardiomyopathy E. Pulmonary embolus F. Decubitus Angina G. Acute Coronary Syndrome H. Transient Ischaemic Attack I. Aortic Stenosis J. Cerebrovascular Accident K. Acute Myocardial Infarction L. Mitral Stenosis M. Stable Angina N. Pericarditis O. Ventricular Tachycardia
A
G. Acute Coronary Syndrome
104
Q
A 68 year old man presents with sudden onset chest pain, which radiated to the back. On examination the patient was shocked, with a hemiplegia and the chest X-ray showed mediastinal enlargement. A. Aortic Dissection B. Coarctation of the Aorta C. Dressler’s Syndrome D. Restrictive cardiomyopathy E. Pulmonary embolus F. Decubitus Angina G. Acute Coronary Syndrome H. Transient Ischaemic Attack I. Aortic Stenosis J. Cerebrovascular Accident K. Acute Myocardial Infarction L. Mitral Stenosis M. Stable Angina N. Pericarditis O. Ventricular Tachycardia
A
A. Aortic Dissection
105
Q
A 73 year old man with a known history of peripheral vascular disease presents to the A and E department with a sudden onset hemiplegia which resolved within 24 hours. A. Aortic Dissection B. Coarctation of the Aorta C. Dressler’s Syndrome D. Restrictive cardiomyopathy E. Pulmonary embolus F. Decubitus Angina G. Acute Coronary Syndrome H. Transient Ischaemic Attack I. Aortic Stenosis J. Cerebrovascular Accident K. Acute Myocardial Infarction L. Mitral Stenosis M. Stable Angina N. Pericarditis O. Ventricular Tachycardia
A
H. Transient Ischaemic Attack
106
Q
A 65 year old man is in hospital after suffering an acute myocardial infarction. The house officer hears a pansystolic murmur on auscultation. A. Rheumatic fever B. Hypertrophic cardiomyopathy C. Infective endocarditis D. Aortic regurgitation E. Pericarditis F. Myomalacia cordis G. Dilated cardiomyopathy H. Mitral regurgitation I. Myxomatous mitral valve J. Pericardial effusion K. Aortic stenosis L. Congenital septal defect
A
F. Myomalacia cordis
There is softening of dead muscle which eventually leads to rupture and death.
107
Q
A 28 year old sportsman presents to A&E with severe chest pain and breathlessness. He has a history of asthma. There is a systolic murmur on examination. A. Rheumatic fever B. Hypertrophic cardiomyopathy C. Infective endocarditis D. Aortic regurgitation E. Pericarditis F. Myomalacia cordis G. Dilated cardiomyopathy H. Mitral regurgitation I. Myxomatous mitral valve J. Pericardial effusion K. Aortic stenosis L. Congenital septal defect
A
B. Hypertrophic cardiomyopathy
108
Q
39 year old lady suffers a sharp retrosternal chest pain which is worse on inspiration. The finding on auscultation is typical of this presentation. A. Rheumatic fever B. Hypertrophic cardiomyopathy C. Infective endocarditis D. Aortic regurgitation E. Pericarditis F. Myomalacia cordis G. Dilated cardiomyopathy H. Mitral regurgitation I. Myxomatous mitral valve J. Pericardial effusion K. Aortic stenosis L. Congenital septal defect
A
E. Pericarditis
109
Q
A middle aged women is in hospital after fainting at the gym. She has a severe headache and feels generally unwell. There is a systolic ejection murmur on examination A. Rheumatic fever B. Hypertrophic cardiomyopathy C. Infective endocarditis D. Aortic regurgitation E. Pericarditis F. Myomalacia cordis G. Dilated cardiomyopathy H. Mitral regurgitation I. Myxomatous mitral valve J. Pericardial effusion K. Aortic stenosis L. Congenital septal defect
A
K. Aortic stenosis
110
Q
A 46 year old women presents to A&E out of breath and with severe chest pain. On examination a mid systolic click late systolic murmur is revealed. A. Rheumatic fever B. Hypertrophic cardiomyopathy C. Infective endocarditis D. Aortic regurgitation E. Pericarditis F. Myomalacia cordis G. Dilated cardiomyopathy H. Mitral regurgitation I. Myxomatous mitral valve J. Pericardial effusion K. Aortic stenosis L. Congenital septal defect
A
I. Myxomatous mitral valve
Mitral valve prolapse
111
Q
A 10 year old boy presents with skin rash and joint pain in his elbows and knees. His mother tells you that he recently had a sore throat. On examination he is found to have an ejection systolic murmur and a friction rub. A. Aortic stenosis - Degenerative B. Cardiomyopathy (Obliterative) C. Chronic rheumatic valvular disease D. Cardiac Failure E. Acute rheumatic fever F. Pericarditis G. Subacute bacterial endocarditis H. Cardiomyopathy (Hypertrophic) I. Cardiomyopathy (Restrictive J. Acute bacterial endocarditis K. Non infective endocarditis L. Cardiomyopathy (Dilated) M. Aortic stenosis – acquired
A
E. Acute rheumatic fever
112
Q
A 69 year old woman is suffering from sudden onset fever and malaise. There is no previous history of heart disease. Auscultation reveals a heart murmur. She later develops sepsis. A. Aortic stenosis - Degenerative B. Cardiomyopathy (Obliterative) C. Chronic rheumatic valvular disease D. Cardiac Failure E. Acute rheumatic fever F. Pericarditis G. Subacute bacterial endocarditis H. Cardiomyopathy (Hypertrophic) I. Cardiomyopathy (Restrictive J. Acute bacterial endocarditis K. Non infective endocarditis L. Cardiomyopathy (Dilated) M. Aortic stenosis – acquired
A
J. Acute bacterial endocarditis
113
Q
A 40 year old man presents with a sharp chest pain. He has a pericardial friction rub, diminished heart sounds and a raised JVP. A. Aortic stenosis - Degenerative B. Cardiomyopathy (Obliterative) C. Chronic rheumatic valvular disease D. Cardiac Failure E. Acute rheumatic fever F. Pericarditis G. Subacute bacterial endocarditis H. Cardiomyopathy (Hypertrophic) I. Cardiomyopathy (Restrictive J. Acute bacterial endocarditis K. Non infective endocarditis L. Cardiomyopathy (Dilated) M. Aortic stenosis – acquired
A
F. Pericarditis
114
Q
A 25 year old man presents with palpitations. Chest X-ray shows an enlarged heart and echocardiogram shows thickening of the septum. A. Aortic stenosis - Degenerative B. Cardiomyopathy (Obliterative) C. Chronic rheumatic valvular disease D. Cardiac Failure E. Acute rheumatic fever F. Pericarditis G. Subacute bacterial endocarditis H. Cardiomyopathy (Hypertrophic) I. Cardiomyopathy (Restrictive J. Acute bacterial endocarditis K. Non infective endocarditis L. Cardiomyopathy (Dilated) M. Aortic stenosis – acquired
A
H. Cardiomyopathy (Hypertrophic)
115
Q
A 75 year old diabetic female with a history of 4 myocardial infarctions presents with shortness of breath and ankle swelling. She was found to have an enlarged liver and echocardiogram demonstrated a dilated heart. A. Aortic stenosis - Degenerative B. Cardiomyopathy (Obliterative) C. Chronic rheumatic valvular disease D. Cardiac Failure E. Acute rheumatic fever F. Pericarditis G. Subacute bacterial endocarditis H. Cardiomyopathy (Hypertrophic) I. Cardiomyopathy (Restrictive J. Acute bacterial endocarditis K. Non infective endocarditis L. Cardiomyopathy (Dilated) M. Aortic stenosis – acquired
A
D. Cardiac Failure
116
Q
A 19 year old American student with bronchiectasis is on inhaled tobramycin for chronic Pseudomonal infection. The mutation delta F508 is identified. A. Chronic alcoholic pancreatitis B. Renal tubular acidosis C. Insulinoma D. Gallstones E. Hypercalcaemia F. Vibrio cholerae infection G. Carcinoma head of the pancreas H. Gallstone pancreatitis I. Pseudocysts J. VIPoma (Werner Morrison syndrome) K. Iatrogenic pancreatitis L. Cystic fibrosis M. Carcinoma tail of the pancreas N. Haemochromatosis
A
L. Cystic fibrosis
117
Q
A 68 year old smoker presents with jaundice and worsening abdominal and back pain. Scratch marks are seen on his arms and legs. He has lost 5kg in 2 months. Ultrasound shows dilated intrahepatic bile ducts A. Chronic alcoholic pancreatitis B. Renal tubular acidosis C. Insulinoma D. Gallstones E. Hypercalcaemia F. Vibrio cholerae infection G. Carcinoma head of the pancreas H. Gallstone pancreatitis I. Pseudocysts J. VIPoma (Werner Morrison syndrome) K. Iatrogenic pancreatitis L. Cystic fibrosis M. Carcinoma tail of the pancreas N. Haemochromatosis
A
G. Carcinoma head of the pancreas
118
Q
A 39 year old Nepalese man presents with severe watery diarrhoea. He is found to have hypokalaemia and, surprisingly, a metabolic acidosis. A RUQ mass is detected by contrast-enhanced spiral CT scanning. Stool bicarb is high and urine anion gap is negative. A. Chronic alcoholic pancreatitis B. Renal tubular acidosis C. Insulinoma D. Gallstones E. Hypercalcaemia F. Vibrio cholerae infection G. Carcinoma head of the pancreas H. Gallstone pancreatitis I. Pseudocysts J. VIPoma (Werner Morrison syndrome) K. Iatrogenic pancreatitis L. Cystic fibrosis M. Carcinoma tail of the pancreas N. Haemochromatosis
A
J. VIPoma (Werner Morrison syndrome)
A vipoma is a non-beta pancreatic islet cell tumor secreting vasoactive intestinal peptide (VIP), resulting in a syndrome of watery diarrhea, hypokalemia, and achlorhydria (WDHA syndrome).
119
Q
A 59 year old widow complains of persistent back pain, loss of appetite and that she has dropped from dress size 18 to a size 14 in just 2 months. She was recently diagnosed with diabetes. A large central mass is palpable as well hepatosplenomegaly. A. Chronic alcoholic pancreatitis B. Renal tubular acidosis C. Insulinoma D. Gallstones E. Hypercalcaemia F. Vibrio cholerae infection G. Carcinoma head of the pancreas H. Gallstone pancreatitis I. Pseudocysts J. VIPoma (Werner Morrison syndrome) K. Iatrogenic pancreatitis L. Cystic fibrosis M. Carcinoma tail of the pancreas N. Haemochromatosis
A
M. Carcinoma tail of the pancreas
120
Q
A 47 year old lecturer is referred to hospital clinic from his GP with worsening abdominal pain. He has a poor diet and weight loss. He has previously been prescribed Thiamine. A. Chronic alcoholic pancreatitis B. Renal tubular acidosis C. Insulinoma D. Gallstones E. Hypercalcaemia F. Vibrio cholerae infection G. Carcinoma head of the pancreas H. Gallstone pancreatitis I. Pseudocysts J. VIPoma (Werner Morrison syndrome) K. Iatrogenic pancreatitis L. Cystic fibrosis M. Carcinoma tail of the pancreas N. Haemochromatosis
A
A. Chronic alcoholic pancreatitis
121
Q
65 year old female with a large, cystic mass on tail of pancreas imaged using computed tomography. Further cytology reported the presence of epithelium A. Scorpion Sting B. Jaundice C. Trousseau’s Syndrome D. Thrombophlebitis E. Agenesis F. Alcoholism G. Type 1 Diabetes H. Pseudocyst I. Pancreatitis J. Cystadenoma K. Whipples' resection L. Cystic Fibrosis M. Carcinoma of the Pancreas N. Pancreas Divisum O. Hyperlipidaemia P. Gall Bladder
A
J. Cystadenoma
122
Q
55 year old, diabetic, afro-Caribbean male presents with weight loss, poor diet and a gnawing pain in his back, which is sometimes felt ‘under his chest’ A. Scorpion Sting B. Jaundice C. Trousseau’s Syndrome D. Thrombophlebitis E. Agenesis F. Alcoholism G. Type 1 Diabetes H. Pseudocyst I. Pancreatitis J. Cystadenoma K. Whipples' resection L. Cystic Fibrosis M. Carcinoma of the Pancreas N. Pancreas Divisum O. Hyperlipidaemia P. Gall Bladder
A
M. Carcinoma of the Pancreas
123
Q
The commonest cause of acute pancreatitis in the UK A. Scorpion Sting B. Jaundice C. Trousseau’s Syndrome D. Thrombophlebitis E. Agenesis F. Alcoholism G. Type 1 Diabetes H. Pseudocyst I. Pancreatitis J. Cystadenoma K. Whipples' resection L. Cystic Fibrosis M. Carcinoma of the Pancreas N. Pancreas Divisum O. Hyperlipidaemia P. Gall Bladder
A
F. Alcoholism
124
Q
Inflammatory condition of the exocrine pancreas that results in injury to acinar cells. A. Scorpion Sting B. Jaundice C. Trousseau’s Syndrome D. Thrombophlebitis E. Agenesis F. Alcoholism G. Type 1 Diabetes H. Pseudocyst I. Pancreatitis J. Cystadenoma K. Whipples' resection L. Cystic Fibrosis M. Carcinoma of the Pancreas N. Pancreas Divisum O. Hyperlipidaemia P. Gall Bladder
A
I. Pancreatitis
125
Q
ERCP finding due to incomplete fusing of pancreatic buds A. Scorpion Sting B. Jaundice C. Trousseau’s Syndrome D. Thrombophlebitis E. Agenesis F. Alcoholism G. Type 1 Diabetes H. Pseudocyst I. Pancreatitis J. Cystadenoma K. Whipples' resection L. Cystic Fibrosis M. Carcinoma of the Pancreas N. Pancreas Divisum O. Hyperlipidaemia P. Gall Bladder
A
N. Pancreas Divisum
126
Q
A condition in which the normal squamous epithelial lining of the oesophagus is replaced by columnar epithelium because of damage caused by gastro –oesophageal reflux or oesophagitis. The condition may be associated with an ulcer, and the epithelium has an abnormally high likelihood of undergoing malignant change. A. Barrett’s oesophagus B. Pernicious anaemia C. Squamous carcinoma D. Gastric ulcer E. Gastric cancer F. Intestinal metaplasia G. Reflux oesophagitis H. Helicobacter pylori I. Oesophageal varices J. Adenocarcinoma K. Duodenal ulceration L. Campylobacter jejuni
A
A. Barrett’s oesophagus
127
Q
Caused by the action of acid and pepsin on the duodenal mucosa. Associated with increased output of stomach acid. Symptoms include pain in the upper abdomen, especially when the stomach is empty. A. Barrett’s oesophagus B. Pernicious anaemia C. Squamous carcinoma D. Gastric ulcer E. Gastric cancer F. Intestinal metaplasia G. Reflux oesophagitis H. Helicobacter pylori I. Oesophageal varices J. Adenocarcinoma K. Duodenal ulceration L. Campylobacter jejuni
A
K. Duodenal ulceration
128
Q
The result of failure to produce intrinsic factor, and the subsequent reduction in the absorption of B12 from the bowel. Characterised by the defective production of red blood cells and the presence of megaloblasts in the bone marrow. A. Barrett’s oesophagus B. Pernicious anaemia C. Squamous carcinoma D. Gastric ulcer E. Gastric cancer F. Intestinal metaplasia G. Reflux oesophagitis H. Helicobacter pylori I. Oesophageal varices J. Adenocarcinoma K. Duodenal ulceration L. Campylobacter jejuni
A
B. Pernicious anaemia
129
Q
Dilated veins in the lower oesophagus due to portal hypertension. These may rupture, leading to life threatening haematemesis. Bleeding may be stopped by a compression balloon, sclerotherapy, or applying elastic bands via an endoscope. A. Barrett’s oesophagus B. Pernicious anaemia C. Squamous carcinoma D. Gastric ulcer E. Gastric cancer F. Intestinal metaplasia G. Reflux oesophagitis H. Helicobacter pylori I. Oesophageal varices J. Adenocarcinoma K. Duodenal ulceration L. Campylobacter jejuni
A
I. Oesophageal varices
130
Q
A genus of spiral flagellated Gram negative bacteria. Found in the stomach within the mucosa layer. It occurs in the majority of middle-aged people and causes progressive gastritis. Invariably present in duodenal ulceration and usually in gastric ulceration A. Barrett’s oesophagus B. Pernicious anaemia C. Squamous carcinoma D. Gastric ulcer E. Gastric cancer F. Intestinal metaplasia G. Reflux oesophagitis H. Helicobacter pylori I. Oesophageal varices J. Adenocarcinoma K. Duodenal ulceration L. Campylobacter jejuni
A
H. Helicobacter pylori
131
Q
A breach in mucosa which extends through muscularis mucosa into submucosa or deeper A. Peptic ulcer B. Coeliac disease C. Chronic gastritis D. Intestinal metaplasia E. Normal oesophagus F. Pernicious anaemia G. GORD H. Barrett’s oesophagus I. Normal stomach J. Partial villus atrophy K. H. pylori infection
A
A. Peptic ulcer
132
Q
Present in almost all patients with duodenal ulcer and 70 % with gastric ulcer. A. Peptic ulcer B. Coeliac disease C. Chronic gastritis D. Intestinal metaplasia E. Normal oesophagus F. Pernicious anaemia G. GORD H. Barrett’s oesophagus I. Normal stomach J. Partial villus atrophy K. H. pylori infection
A
K. H. pylori infection
133
Q
Around 10 % eventually get primary lymphoma (less often, carcinoma) of the gut if not properly treated. HLA B8 is linked with this. A. Peptic ulcer B. Coeliac disease C. Chronic gastritis D. Intestinal metaplasia E. Normal oesophagus F. Pernicious anaemia G. GORD H. Barrett’s oesophagus I. Normal stomach J. Partial villus atrophy K. H. pylori infection
A
B. Coeliac disease
134
Q
The commonest cause of oesophagitis. A. Peptic ulcer B. Coeliac disease C. Chronic gastritis D. Intestinal metaplasia E. Normal oesophagus F. Pernicious anaemia G. GORD H. Barrett’s oesophagus I. Normal stomach J. Partial villus atrophy K. H. pylori infection
A
G. GORD
135
Q
Re-epithelialisation by metaplastic columnar epithelium with goblet cells A. Peptic ulcer B. Coeliac disease C. Chronic gastritis D. Intestinal metaplasia E. Normal oesophagus F. Pernicious anaemia G. GORD H. Barrett’s oesophagus I. Normal stomach J. Partial villus atrophy K. H. pylori infection
A
H. Barrett’s oesophagus
136
Q
A 40 year old male complaining of a long history of burning epigastric pain, worse on lying flat. Endoscopy and biopsy reveals inflamed squamous lining and increased basal cell proliferation A. Oesophageal Adenocarcinoma B. Duodenal Ulcer C. Barretts Oesophagus D. GORD E. Oesophageal Varices F. Active Chronic Gastritis G. Acute Gastritis H. Coeliac Disease I. Pernicious Anaemia J. Gastric Carcinoma
A
D. GORD
137
Q
A 38 year old female with Rheumatoid Arthritis presents with a single episode of malaena. Investigations reveal erosions through out the stomach and a neutrophilic infiltrate in the superficial mucosa A. Oesophageal Adenocarcinoma B. Duodenal Ulcer C. Barretts Oesophagus D. GORD E. Oesophageal Varices F. Active Chronic Gastritis G. Acute Gastritis H. Coeliac Disease I. Pernicious Anaemia J. Gastric Carcinoma
A
G. Acute Gastritis
138
Q
A 30 year old female complaining of diarhorrea and weight loss. Biopsy of duodenum shows increased intraepithelial cytotoxic T cells. A. Oesophageal Adenocarcinoma B. Duodenal Ulcer C. Barretts Oesophagus D. GORD E. Oesophageal Varices F. Active Chronic Gastritis G. Acute Gastritis H. Coeliac Disease I. Pernicious Anaemia J. Gastric Carcinoma
A
H. Coeliac Disease
139
Q
A 60 year old male complaining of epigastric pain relieved by antacids and meals. He has a positive CLO test. A. Oesophageal Adenocarcinoma B. Duodenal Ulcer C. Barretts Oesophagus D. GORD E. Oesophageal Varices F. Active Chronic Gastritis G. Acute Gastritis H. Coeliac Disease I. Pernicious Anaemia J. Gastric Carcinoma
A
B. Duodenal Ulcer
140
Q
A 65 year old male with a long history of epigastric pain. Endoscopy reveals 3.2cm of columnar metaplasia in the lower oesophagus. Goblet cells are seen A. Oesophageal Adenocarcinoma B. Duodenal Ulcer C. Barretts Oesophagus D. GORD E. Oesophageal Varices F. Active Chronic Gastritis G. Acute Gastritis H. Coeliac Disease I. Pernicious Anaemia J. Gastric Carcinoma
A
C. Barretts Oesophagus
141
Q
A 63 year old man presents with epigastric pain associated with dyspepsia. The pain gets worse at night and when he is hungry. He complains of nausea and flatulence. This patient is on NSAIDs. A. Whipple's disease B. Microsporidiosis C. Tropical sprue D. Barrett's oesophagus E. Coeliac disease F. Cryptosporidiosis G. Lymphoma H. Gastric ulcer I. Duodenal ulcer J. Helicobacter pylori K. Pernicious anaemia L. Gastro-oesophageal disease M. Partial villous atrophy N. Carcinoma of the oesophagus O. Mucosal associated lymphoid tumour P. Hiatus hernia
A
I. Duodenal ulcer
142
Q
A 70 year old woman has progressive low retrosternal dysphagia, initially to solids and now also to liquids. She complains of chest pain and weight loss over the last 3 months. A social history reveals that she has been a heavy smoker for many years and drinks around 20 units of alcohol a week A. Whipple's disease B. Microsporidiosis C. Tropical sprue D. Barrett's oesophagus E. Coeliac disease F. Cryptosporidiosis G. Lymphoma H. Gastric ulcer I. Duodenal ulcer J. Helicobacter pylori K. Pernicious anaemia L. Gastro-oesophageal disease M. Partial villous atrophy N. Carcinoma of the oesophagus O. Mucosal associated lymphoid tumour P. Hiatus hernia
A
N. Carcinoma of the oesophagus
143
Q
A 26 year old man presents with watery diarrhoea, abdominal cramps, nausea, vomiting and a low grade fever. It started 3 days after eating some undercooked meat at a barbecue. A. Whipple's disease B. Microsporidiosis C. Tropical sprue D. Barrett's oesophagus E. Coeliac disease F. Cryptosporidiosis G. Lymphoma H. Gastric ulcer I. Duodenal ulcer J. Helicobacter pylori K. Pernicious anaemia L. Gastro-oesophageal disease M. Partial villous atrophy N. Carcinoma of the oesophagus O. Mucosal associated lymphoid tumour P. Hiatus hernia
A
F. Cryptosporidiosis
144
Q
A 66 year old man complaining of epigastric pain undergoes an endoscopy. The mucosa appears reddened in the antrum of the stomach. 13C is detected on a urea breath test. A. Whipple's disease B. Microsporidiosis C. Tropical sprue D. Barrett's oesophagus E. Coeliac disease F. Cryptosporidiosis G. Lymphoma H. Gastric ulcer I. Duodenal ulcer J. Helicobacter pylori K. Pernicious anaemia L. Gastro-oesophageal disease M. Partial villous atrophy N. Carcinoma of the oesophagus O. Mucosal associated lymphoid tumour P. Hiatus hernia
A
J. Helicobacter pylori
145
Q
A 58 year old female presents with malnutrition. She complains of abdominal pain, weight loss and arthritis. She has steatorrhoea. A jejunal biopsy showed periodic acid-Schiff (PAS)-positive macrophages A. Whipple's disease B. Microsporidiosis C. Tropical sprue D. Barrett's oesophagus E. Coeliac disease F. Cryptosporidiosis G. Lymphoma H. Gastric ulcer I. Duodenal ulcer J. Helicobacter pylori K. Pernicious anaemia L. Gastro-oesophageal disease M. Partial villous atrophy N. Carcinoma of the oesophagus O. Mucosal associated lymphoid tumour P. Hiatus hernia
A
A. Whipple’s disease
146
Q
A 35-year-old man presents with a long history of epigastric burning pain, made worse at night and when drinking hot liquids. Recently he has had difficulty swallowing solids. Endoscopy shows lower oesophageal erosions and strictures and pH demonstrates acidity. A. Adenocarcinoma B. Achalasia C. Zollinger-Ellison syndrome D. Bulbar palsy E. Gastro-oesophageal reflux disease F. Gastric ulcer G. Mallory-Weiss tear H. Barrett's oesophagus I. Duodenal ulcer J. Haemorrhagic gastritis K. Gastroenteritis (Staphylococcus aureus) L. Mucosal-associated lymphoid tumour M. Gastroenteritis (Salmonella) N. Pyloric stenosis
A
E. Gastro-oesophageal reflux disease
147
Q
A 20-year-old student gives an 8 hour history of very frequent vomiting and epigastric cramping. O/E she is pale and shivering. Her serum WBC is normal. A. Adenocarcinoma B. Achalasia C. Zollinger-Ellison syndrome D. Bulbar palsy E. Gastro-oesophageal reflux disease F. Gastric ulcer G. Mallory-Weiss tear H. Barrett's oesophagus I. Duodenal ulcer J. Haemorrhagic gastritis K. Gastroenteritis (Staphylococcus aureus) L. Mucosal-associated lymphoid tumour M. Gastroenteritis (Salmonella) N. Pyloric stenosis
A
K. Gastroenteritis (Staphylococcus aureus)
148
Q
A 30-year-old woman presents with haematemesis and diarrhoea. She has recurrent peptic ulceration and is taking omeprazole. Despite this, she has persistently high serum gastrin levels. Endoscopy shows a large 3cm actively bleeding ulcer in the duodenum. A. Adenocarcinoma B. Achalasia C. Zollinger-Ellison syndrome D. Bulbar palsy E. Gastro-oesophageal reflux disease F. Gastric ulcer G. Mallory-Weiss tear H. Barrett's oesophagus I. Duodenal ulcer J. Haemorrhagic gastritis K. Gastroenteritis (Staphylococcus aureus) L. Mucosal-associated lymphoid tumour M. Gastroenteritis (Salmonella) N. Pyloric stenosis
A
C. Zollinger-Ellison syndrome
149
Q
A 50-year-old women presents with chest pain associated with regurgitation of solids and liquids equally, both occurring after swallowing. Diagnosis is confirmed by a characteristic ‘beak like’ tapering of the lower oesophagus on barium swallow and manometry shows failure of relaxation of the LOS. A. Adenocarcinoma B. Achalasia C. Zollinger-Ellison syndrome D. Bulbar palsy E. Gastro-oesophageal reflux disease F. Gastric ulcer G. Mallory-Weiss tear H. Barrett's oesophagus I. Duodenal ulcer J. Haemorrhagic gastritis K. Gastroenteritis (Staphylococcus aureus) L. Mucosal-associated lymphoid tumour M. Gastroenteritis (Salmonella) N. Pyloric stenosis
A
B. Achalasia
If you have achalasia, your LES (lower oesophageal sphincter) fails to open up during swallowing, which it’s supposed to do. This leads to a backup of food within your esophagus.
150
Q
A 65-year-old woman presents with a 3 month history of anorexia, weight loss and epigastric pain. Blood tests reveal an iron deficiency anaemia. Endoscopy shows a thickened rigid gastric wall known as ‘leather bottle stomach’ indicating infiltration into all layers of the gastric wall. Numerous signet ring cells on biopsy diffusely infiltrate the mucosa. A. Adenocarcinoma B. Achalasia C. Zollinger-Ellison syndrome D. Bulbar palsy E. Gastro-oesophageal reflux disease F. Gastric ulcer G. Mallory-Weiss tear H. Barrett's oesophagus I. Duodenal ulcer J. Haemorrhagic gastritis K. Gastroenteritis (Staphylococcus aureus) L. Mucosal-associated lymphoid tumour M. Gastroenteritis (Salmonella) N. Pyloric stenosis
A
A. Adenocarcinoma
151
Q
A 45 year old woman presents with large tongue and swelling of the legs. She has a high BP and urine dipstick reveals protein +++.The tissue from renal biopsy stains with Congo red dye and shows apple green birefringence under polarised light A. Polyarteritis nodosa B. Sarcoidosis C. Scleroderma D. Renal amyloidosis E. Mixed connective tissue disease F. Kawasaki's disease G. Sjorgen's syndrome H. Temporal arteritis I. Systemic lupus erythematous
A
D. Renal amyloidosis
