Histopathology

Question 1

What is the typical chemotherapy regime used for non-resectable pancreatic cancer?

Answer 1

FOLFIRINOX

Question 2

A 60 year old man has suffered from atrial fibrillation since his early 30s. He has undergone multiple failed cardioversions, the most recent of which was 10 years ago. Since then his symptoms have been well controlled with bisoprolol 10mg OD. His heart sounds are normal.

He says he has had high blood pressure for “years”.

His ECG is normal other than an irregularly irregular rhythm and large, bifid p waves.

What is the most likely abnormality that will be found on his echocardiogram to explain his permanent atrial fibrillation and poor success at cardioversion?

Answer 2

Dilated left atrium

Question 3

What liver enzyme may also be found in the heart and may rise in acute myocardial infarction?

Answer 3

Aspartate Aminotransferase

Question 4

What sign is the name of a palpable lymph node in the left supraclavicular fossa?

Answer 4

Troisier sign

Question 5

What further imaging is indicated for a confirmed transient ischaemic attack of the anterior circulation when neurological symptoms have resolved?

Answer 5

Carotid Ultrasound (for consideration of a carotid endarterectomy)

Question 6

Long term prevention of TIA

Answer 6

Clopidogrel 75mg lifelong (replaces aspirin)
High intensity statin

Question 7

Pattern of AST:ALT in alcoholic hepatitis

Answer 7

AST > 3x ALT - highly specific for alcoholic hepatitis

Question 8

ALT> 1000 suggests what

Answer 8

toxins, drugs, viruses, ischaemia

Question 9

Chest pain + raised AST

Answer 9

Myocardial infarction

Question 10

Chest pain + raised AST

Answer 10

Myocardial infarction

Question 11

ALP>AST

Answer 11

Biliary Obstruction

Question 11

ALP>AST

Answer 11

Biliary Obstruction

Question 12

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?

Answer 12

Interstitial Lung Disease

Question 13

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?

Answer 13

Breast Abscess

Question 14

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?

Answer 14

Echocardiogram

Question 15

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

Answer 15

Benign familial haematuria

Question 16

What is the minimum random plasma glucose level (in mmol/L) that is required to diagnose diabetes in a symptomatic individual?

Answer 16

11.1

Question 17

Which class of lupus nephritis on biopsy may show complete sclerosis of nearly all glomeruli?

Answer 17

Class VI

Question 18

Most common solid organ cancers in men

Answer 18

Prostate (most common in men)
Lung
Bowel
Head and Neck
Other

Question 19

Most common solid organ cancers in women

Answer 19

Breast (most common cancer overall)
Lung
Bowel
Uterus
Other

Question 20

Comonest causes cancer mortality men

Answer 20

Lung (most deadly)
Prostate
Bowel
Oesophagus
Other

Question 21

Most common causes cancer death women

Answer 21

Lung (most deadly)
Breast
Bowel
Cancer of unknown primary
Other

Question 22

A 30 year old woman is seen in emergency department after an overdose of paracetamol.

Her blood tests reveal: ALT >12x upper limit of normal, AST >7x upper limit of normal, ALP >2x upper limit of normal, Bilirubin >8x upper limit of normal

A VBG shows a pH of 7.23 and a lactate of 10. Her blood sugar is 3.4.

She has been started on N-acetylcysteine, glucose and intravenous fluids by A+E.

What is the next most appropriate treatment for her deranged liver function?

Answer 22

Liver transplant

Question 23

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?

Answer 23

Subarachnoid haemorrhage

Question 24

What cancer is associated with the presence of “oat shaped cells” on biopsy?

Answer 24

Small Cell Lung Cancer

Question 25

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?

Answer 25

Testicular cancer

Question 26

A 67 year old man is seen by his GP with painless jaundice and weight loss of two months duration.

He has previously had two hospital admissions for pancreatitis related to alcohol.

Blood tests show he has an elevated bilirubin, elevated ALP, borderline elevated yGT, elevated CA19-9 and a normal AFP.

The GP refers him to secondary care using an urgent referral pathway.

What is the most appropriate first line investigation?

Answer 26

CT Abdomen

Question 27

What is the main hormone produced by delta cells in the pancreas?

Answer 27

Somatostatin

Question 28

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?

Answer 28

MRI Brain and Optic Nerves

Question 29

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?

Answer 29

Eschericia coli

Question 30

A 83 year old man is started on bicalutamide for treatment of his metastatic prostate cancer.

What is the method of action of bicalutamide?

Answer 30

Androgen antagonist

Question 31

A 18 year old man presenting with nephritic syndrome, cataracts and sensorineural deafness suggests what underyling diagnosis?

Answer 31

Alports syndrome