Histopathology Flashcards
1
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. Mitral Stenosis B. Aortic Dissection C. Transient Ischaemic Attack D. Dressler’s Syndrome E. Aortic Stenosis F. Pericarditis G. Decubitus Angina H. Restrictive cardiomyopathy I. Stable Angina J. Acute Coronary Syndrome K. Coarctation of the Aorta L. Acute Myocardial Infarction M. Pulmonary embolus N. Cerebrovascular Accident O. Ventricular Tachycardia
A
I. Stable Angina
2
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. Mitral Stenosis B. Aortic Dissection C. Transient Ischaemic Attack D. Dressler’s Syndrome E. Aortic Stenosis F. Pericarditis G. Decubitus Angina H. Restrictive cardiomyopathy I. Stable Angina J. Acute Coronary Syndrome K. Coarctation of the Aorta L. Acute Myocardial Infarction M. Pulmonary embolus N. Cerebrovascular Accident O. Ventricular Tachycardia
A
L. Acute Myocardial Infarction
3
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. Mitral Stenosis B. Aortic Dissection C. Transient Ischaemic Attack D. Dressler’s Syndrome E. Aortic Stenosis F. Pericarditis G. Decubitus Angina H. Restrictive cardiomyopathy I. Stable Angina J. Acute Coronary Syndrome K. Coarctation of the Aorta L. Acute Myocardial Infarction M. Pulmonary embolus N. Cerebrovascular Accident O. Ventricular Tachycardia
A
J - Acute coronary syndrome (unstable angina) is defined as recurrent episodes of angina on minimal effort or at rest and persists for longer than stable angina.
4
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. Mitral Stenosis B. Aortic Dissection C. Transient Ischaemic Attack D. Dressler’s Syndrome E. Aortic Stenosis F. Pericarditis G. Decubitus Angina H. Restrictive cardiomyopathy I. Stable Angina J. Acute Coronary Syndrome K. Coarctation of the Aorta L. Acute Myocardial Infarction M. Pulmonary embolus N. Cerebrovascular Accident O. Ventricular Tachycardia
A
B. Aortic Dissection
5
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. Mitral Stenosis B. Aortic Dissection C. Transient Ischaemic Attack D. Dressler’s Syndrome E. Aortic Stenosis F. Pericarditis G. Decubitus Angina H. Restrictive cardiomyopathy I. Stable Angina J. Acute Coronary Syndrome K. Coarctation of the Aorta L. Acute Myocardial Infarction M. Pulmonary embolus N. Cerebrovascular Accident O. Ventricular Tachycardia
A
C. Transient Ischaemic Attack
6
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. Hypertrophic cardiomyopathy B. Aortic stenosis C. Dilated cardiomyopathy D. Infective endocarditis E. Rheumatic fever F. Myomalacia cordis G. Congenital septal defect H. Pericardial effusion I. Myxomatous mitral valve J. Pericarditis K. Mitral regurgitation L. Aortic regurgitation
A
F. Myomalacia cordis
7
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. Hypertrophic cardiomyopathy B. Aortic stenosis C. Dilated cardiomyopathy D. Infective endocarditis E. Rheumatic fever F. Myomalacia cordis G. Congenital septal defect H. Pericardial effusion I. Myxomatous mitral valve J. Pericarditis K. Mitral regurgitation L. Aortic regurgitation
A
A. Hypertrophic cardiomyopathy
8
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. Hypertrophic cardiomyopathy B. Aortic stenosis C. Dilated cardiomyopathy D. Infective endocarditis E. Rheumatic fever F. Myomalacia cordis G. Congenital septal defect H. Pericardial effusion I. Myxomatous mitral valve J. Pericarditis K. Mitral regurgitation L. Aortic regurgitation
A
J. Pericarditis
9
Q
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. Hypertrophic cardiomyopathy B. Aortic stenosis C. Dilated cardiomyopathy D. Infective endocarditis E. Rheumatic fever F. Myomalacia cordis G. Congenital septal defect H. Pericardial effusion I. Myxomatous mitral valve J. Pericarditis K. Mitral regurgitation L. Aortic regurgitation
A
B. Aortic stenosis
10
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. Hypertrophic cardiomyopathy B. Aortic stenosis C. Dilated cardiomyopathy D. Infective endocarditis E. Rheumatic fever F. Myomalacia cordis G. Congenital septal defect H. Pericardial effusion I. Myxomatous mitral valve J. Pericarditis K. Mitral regurgitation L. Aortic regurgitation
A
I. Myxomatous mitral valve
11
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. Acute bacterial endocarditis B. Cardiomyopathy (Hypertrophic) C. Cardiomyopathy (Dilated) D. Acute rheumatic fever E. Subacute bacterial endocarditis F. Aortic stenosis - Degenerative G. Chronic rheumatic valvular disease H. Pericarditis I. Cardiomyopathy (Restrictive J. Aortic stenosis – acquired K. Non infective endocarditis L. Cardiac Failure M. Cardiomyopathy (Obliterative)
A
D. Acute rheumatic fever
12
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. Acute bacterial endocarditis B. Cardiomyopathy (Hypertrophic) C. Cardiomyopathy (Dilated) D. Acute rheumatic fever E. Subacute bacterial endocarditis F. Aortic stenosis - Degenerative G. Chronic rheumatic valvular disease H. Pericarditis I. Cardiomyopathy (Restrictive J. Aortic stenosis – acquired K. Non infective endocarditis L. Cardiac Failure M. Cardiomyopathy (Obliterative)
A
A. Acute bacterial endocarditis
13
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. Acute bacterial endocarditis B. Cardiomyopathy (Hypertrophic) C. Cardiomyopathy (Dilated) D. Acute rheumatic fever E. Subacute bacterial endocarditis F. Aortic stenosis - Degenerative G. Chronic rheumatic valvular disease H. Pericarditis I. Cardiomyopathy (Restrictive J. Aortic stenosis – acquired K. Non infective endocarditis L. Cardiac Failure M. Cardiomyopathy (Obliterative)
A
H. Pericarditis
14
Q
A 25 year old man presents with palpitations. Chest X-ray shows an enlarged heart and echocardiogram shows thickening of the septum. A. Acute bacterial endocarditis B. Cardiomyopathy (Hypertrophic) C. Cardiomyopathy (Dilated) D. Acute rheumatic fever E. Subacute bacterial endocarditis F. Aortic stenosis - Degenerative G. Chronic rheumatic valvular disease H. Pericarditis I. Cardiomyopathy (Restrictive J. Aortic stenosis – acquired K. Non infective endocarditis L. Cardiac Failure M. Cardiomyopathy (Obliterative)
A
B. Cardiomyopathy (Hypertrophic)
15
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. Acute bacterial endocarditis B. Cardiomyopathy (Hypertrophic) C. Cardiomyopathy (Dilated) D. Acute rheumatic fever E. Subacute bacterial endocarditis F. Aortic stenosis - Degenerative G. Chronic rheumatic valvular disease H. Pericarditis I. Cardiomyopathy (Restrictive J. Aortic stenosis – acquired K. Non infective endocarditis L. Cardiac Failure M. Cardiomyopathy (Obliterative)
A
L. Cardiac Failure
16
Q
A 19 year old American student with bronchiectasis is on inhaled tobramycin for chronic Pseudomonal infection. The mutation delta F508 is identified. A. Renal tubular acidosis B. Carcinoma tail of the pancreas C. Gallstones D. Vibrio cholerae infection E. Iatrogenic pancreatitis F. Hypercalcaemia G. Haemochromatosis H. Chronic alcoholic pancreatitis I. Pseudocysts J. Gallstone pancreatitis K. Insulinoma L. Cystic fibrosis M. Carcinoma head of the pancreas N. VIPoma (Werner Morrison syndrome)
A
L. Cystic fibrosis
17
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. Renal tubular acidosis B. Carcinoma tail of the pancreas C. Gallstones D. Vibrio cholerae infection E. Iatrogenic pancreatitis F. Hypercalcaemia G. Haemochromatosis H. Chronic alcoholic pancreatitis I. Pseudocysts J. Gallstone pancreatitis K. Insulinoma L. Cystic fibrosis M. Carcinoma head of the pancreas N. VIPoma (Werner Morrison syndrome)
A
M. Carcinoma head of the pancreas - Carcinoma of the head of the pancreas causes obstructive jaundice, whereas that of the tail does not.
18
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. Renal tubular acidosis B. Carcinoma tail of the pancreas C. Gallstones D. Vibrio cholerae infection E. Iatrogenic pancreatitis F. Hypercalcaemia G. Haemochromatosis H. Chronic alcoholic pancreatitis I. Pseudocysts J. Gallstone pancreatitis K. Insulinoma L. Cystic fibrosis M. Carcinoma head of the pancreas N. VIPoma (Werner Morrison syndrome)
A
N. VIPoma (Werner Morrison syndrome)
19
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. Renal tubular acidosis B. Carcinoma tail of the pancreas C. Gallstones D. Vibrio cholerae infection E. Iatrogenic pancreatitis F. Hypercalcaemia G. Haemochromatosis H. Chronic alcoholic pancreatitis I. Pseudocysts J. Gallstone pancreatitis K. Insulinoma L. Cystic fibrosis M. Carcinoma head of the pancreas N. VIPoma (Werner Morrison syndrome)
A
B. Carcinoma tail of the pancreas - Carcinoma of the head of the pancreas causes obstructive jaundice, whereas that of the tail does not.
20
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. Renal tubular acidosis B. Carcinoma tail of the pancreas C. Gallstones D. Vibrio cholerae infection E. Iatrogenic pancreatitis F. Hypercalcaemia G. Haemochromatosis H. Chronic alcoholic pancreatitis I. Pseudocysts J. Gallstone pancreatitis K. Insulinoma L. Cystic fibrosis M. Carcinoma head of the pancreas N. VIPoma (Werner Morrison syndrome)
A
H. Chronic alcoholic pancreatitis
21
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. Thrombophlebitis C. Whipples' resection D. Gall Bladder E. Hyperlipidaemia F. Agenesis G. Trousseau’s Syndrome H. Type 1 Diabetes I. Pseudocyst J. Carcinoma of the Pancreas K. Pancreatitis L. Cystic Fibrosis M. Cystadenoma N. Alcoholism O. Pancreas Divisum P. Jaundice
A
M. Cystadenoma - A cystadenoma has an epithelial wall or capsule that contains a fluid collection.
22
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. Thrombophlebitis C. Whipples' resection D. Gall Bladder E. Hyperlipidaemia F. Agenesis G. Trousseau’s Syndrome H. Type 1 Diabetes I. Pseudocyst J. Carcinoma of the Pancreas K. Pancreatitis L. Cystic Fibrosis M. Cystadenoma N. Alcoholism O. Pancreas Divisum P. Jaundice
A
J. Carcinoma of the Pancreas
23
Q
The commonest cause of acute pancreatitis in the UK. A. Scorpion Sting B. Thrombophlebitis C. Whipples' resection D. Gall Bladder E. Hyperlipidaemia F. Agenesis G. Trousseau’s Syndrome H. Type 1 Diabetes I. Pseudocyst J. Carcinoma of the Pancreas K. Pancreatitis L. Cystic Fibrosis M. Cystadenoma N. Alcoholism O. Pancreas Divisum P. Jaundice
A
N. Alcoholism
24
Q
Inflammatory condition of the exocrine pancreas that results in injury to acinar cells. A. Scorpion Sting B. Thrombophlebitis C. Whipples' resection D. Gall Bladder E. Hyperlipidaemia F. Agenesis G. Trousseau’s Syndrome H. Type 1 Diabetes I. Pseudocyst J. Carcinoma of the Pancreas K. Pancreatitis L. Cystic Fibrosis M. Cystadenoma N. Alcoholism O. Pancreas Divisum P. Jaundice
A
K. Pancreatitis
25
Q
ERCP finding due to incomplete fusing of pancreatic buds. A. Scorpion Sting B. Thrombophlebitis C. Whipples' resection D. Gall Bladder E. Hyperlipidaemia F. Agenesis G. Trousseau’s Syndrome H. Type 1 Diabetes I. Pseudocyst J. Carcinoma of the Pancreas K. Pancreatitis L. Cystic Fibrosis M. Cystadenoma N. Alcoholism O. Pancreas Divisum P. Jaundice
A
O. Pancreas Divisum
26
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 Gastric cancer B. Intestinal metaplasia C. Squamous carcinoma D. Oesophageal varices E. Reflux oesophagitis F. Campylobacter jejuni G. Barrett’s oesophagus H. Helicobacter pylori I. Adenocarcinoma J. Gastric ulcer K. Duodenal ulceration L. Pernicious anaemia
A
G. Barrett’s oesophagus
27
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 Gastric cancer B. Intestinal metaplasia C. Squamous carcinoma D. Oesophageal varices E. Reflux oesophagitis F. Campylobacter jejuni G. Barrett’s oesophagus H. Helicobacter pylori I. Adenocarcinoma J. Gastric ulcer K. Duodenal ulceration L. Pernicious anaemia
A
K. Duodenal ulceration
28
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 Gastric cancer B. Intestinal metaplasia C. Squamous carcinoma D. Oesophageal varices E. Reflux oesophagitis F. Campylobacter jejuni G. Barrett’s oesophagus H. Helicobacter pylori I. Adenocarcinoma J. Gastric ulcer K. Duodenal ulceration L. Pernicious anaemia
A
L. Pernicious anaemia
29
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 Gastric cancer B. Intestinal metaplasia C. Squamous carcinoma D. Oesophageal varices E. Reflux oesophagitis F. Campylobacter jejuni G. Barrett’s oesophagus H. Helicobacter pylori I. Adenocarcinoma J. Gastric ulcer K. Duodenal ulceration L. Pernicious anaemia
A
D. Oesophageal varices
30
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 Gastric cancer B. Intestinal metaplasia C. Squamous carcinoma D. Oesophageal varices E. Reflux oesophagitis F. Campylobacter jejuni G. Barrett’s oesophagus H. Helicobacter pylori I. Adenocarcinoma J. Gastric ulcer K. Duodenal ulceration L. Pernicious anaemia
A
H. Helicobacter pylori
31
Q
A breach in mucosa which extends through muscularis mucosa into submucosa or deeper A. Normal oesophagus B. H. pylori infection C. Intestinal metaplasia D. Coeliac disease E. Barrett’s oesophagus F. Peptic ulcer G. Normal stomach H. Chronic gastritis I. Partial villus atrophy J. GORD K. Pernicious anaemia
A
F. Peptic ulcer
32
Q
Present in almost all patients with duodenal ulcer and 70 % with gastric ulcer. A. Normal oesophagus B. H. pylori infection C. Intestinal metaplasia D. Coeliac disease E. Barrett’s oesophagus F. Peptic ulcer G. Normal stomach H. Chronic gastritis I. Partial villus atrophy J. GORD K. Pernicious anaemia
A
B. H. pylori infection
33
Q
Around 10 % eventually get primary lymphoma (less often, carcinoma) of the gut if not properly treated. HLA B8 is linked with this. A. Normal oesophagus B. H. pylori infection C. Intestinal metaplasia D. Coeliac disease E. Barrett’s oesophagus F. Peptic ulcer G. Normal stomach H. Chronic gastritis I. Partial villus atrophy J. GORD K. Pernicious anaemia
A
D. Coeliac disease
34
Q
The commonest cause of oesophagitis. A. Normal oesophagus B. H. pylori infection C. Intestinal metaplasia D. Coeliac disease E. Barrett’s oesophagus F. Peptic ulcer G. Normal stomach H. Chronic gastritis I. Partial villus atrophy J. GORD K. Pernicious anaemia
A
J. GORD
35
Q
Re-epithelialisation by metaplastic columnar epithelium with goblet cells A. Normal oesophagus B. H. pylori infection C. Intestinal metaplasia D. Coeliac disease E. Barrett’s oesophagus F. Peptic ulcer G. Normal stomach H. Chronic gastritis I. Partial villus atrophy J. GORD K. Pernicious anaemia
A
E. Barrett’s oesophagus
36
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. Duodenal Ulcer B. Gastric Carcinoma C. GORD D. Coeliac Disease E. Barretts Oesophagus F. Oesophageal Adenocarcinoma G. Active Chronic Gastritis H. Acute Gastritis I. Pernicious Anaemia J. Oesophageal Varices
A
C. GORD
37
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. Duodenal Ulcer B. Gastric Carcinoma C. GORD D. Coeliac Disease E. Barretts Oesophagus F. Oesophageal Adenocarcinoma G. Active Chronic Gastritis H. Acute Gastritis I. Pernicious Anaemia J. Oesophageal Varices
A
H. Acute Gastritis
38
Q
A 30 year old female complaining of diarhorrea and weight loss. Biopsy of duodenum shows increased intraepithelial cytotoxic T cells. A. Duodenal Ulcer B. Gastric Carcinoma C. GORD D. Coeliac Disease E. Barretts Oesophagus F. Oesophageal Adenocarcinoma G. Active Chronic Gastritis H. Acute Gastritis I. Pernicious Anaemia J. Oesophageal Varices
A
D. Coeliac Disease
39
Q
A 60 year old male complaining of epigastric pain relieved by antacids and meals. He has a positive CLO test. A. Duodenal Ulcer B. Gastric Carcinoma C. GORD D. Coeliac Disease E. Barretts Oesophagus F. Oesophageal Adenocarcinoma G. Active Chronic Gastritis H. Acute Gastritis I. Pernicious Anaemia J. Oesophageal Varices
A
A. Duodenal Ulcer
40
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. Duodenal Ulcer B. Gastric Carcinoma C. GORD D. Coeliac Disease E. Barretts Oesophagus F. Oesophageal Adenocarcinoma G. Active Chronic Gastritis H. Acute Gastritis I. Pernicious Anaemia J. Oesophageal Varices
A
E. Barretts Oesophagus
41
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. Gastric ulcer B. Cryptosporidiosis C. Helicobacter pylori D. Lymphoma E. Gastro-oesophageal disease F. Carcinoma of the oesophagus G. Pernicious anaemia H. Tropical sprue I. Coeliac disease J. Partial villous atrophy K. Microsporidiosis L. Duodenal ulcer M. Barrett's oesophagus N. Hiatus hernia O. Mucosal associated lymphoid tumour P. Whipple's disease
A
L. Duodenal ulcer
42
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. Gastric ulcer B. Cryptosporidiosis C. Helicobacter pylori D. Lymphoma E. Gastro-oesophageal disease F. Carcinoma of the oesophagus G. Pernicious anaemia H. Tropical sprue I. Coeliac disease J. Partial villous atrophy K. Microsporidiosis L. Duodenal ulcer M. Barrett's oesophagus N. Hiatus hernia O. Mucosal associated lymphoid tumour P. Whipple's disease
A
F. Carcinoma of the oesophagus
43
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. Gastric ulcer B. Cryptosporidiosis C. Helicobacter pylori D. Lymphoma E. Gastro-oesophageal disease F. Carcinoma of the oesophagus G. Pernicious anaemia H. Tropical sprue I. Coeliac disease J. Partial villous atrophy K. Microsporidiosis L. Duodenal ulcer M. Barrett's oesophagus N. Hiatus hernia O. Mucosal associated lymphoid tumour P. Whipple's disease
A
B. Cryptosporidiosis
44
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. Gastric ulcer B. Cryptosporidiosis C. Helicobacter pylori D. Lymphoma E. Gastro-oesophageal disease F. Carcinoma of the oesophagus G. Pernicious anaemia H. Tropical sprue I. Coeliac disease J. Partial villous atrophy K. Microsporidiosis L. Duodenal ulcer M. Barrett's oesophagus N. Hiatus hernia O. Mucosal associated lymphoid tumour P. Whipple's disease
A
C. Helicobacter pylori
45
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. Gastric ulcer B. Cryptosporidiosis C. Helicobacter pylori D. Lymphoma E. Gastro-oesophageal disease F. Carcinoma of the oesophagus G. Pernicious anaemia H. Tropical sprue I. Coeliac disease J. Partial villous atrophy K. Microsporidiosis L. Duodenal ulcer M. Barrett's oesophagus N. Hiatus hernia O. Mucosal associated lymphoid tumour P. Whipple's disease
A
P. Whipple’s disease
46
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. Bulbar palsy B. Gastroenteritis (Staphylococcus aureus) C. Gastro-oesophageal reflux disease D. Mucosal-associated lymphoid tumour E. Zollinger-Ellison syndrome F. Achalasia G. Duodenal ulcer H. Pyloric stenosis I. Mallory-Weiss tear J. Haemorrhagic gastritis K. Barrett's oesophagus L. Adenocarcinoma M. Gastroenteritis (Salmonella) N. Gastric ulcer
A
C. Gastro-oesophageal reflux disease
47
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. Bulbar palsy B. Gastroenteritis (Staphylococcus aureus) C. Gastro-oesophageal reflux disease D. Mucosal-associated lymphoid tumour E. Zollinger-Ellison syndrome F. Achalasia G. Duodenal ulcer H. Pyloric stenosis I. Mallory-Weiss tear J. Haemorrhagic gastritis K. Barrett's oesophagus L. Adenocarcinoma M. Gastroenteritis (Salmonella) N. Gastric ulcer
A
B. Gastroenteritis (Staphylococcus aureus)
48
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. Bulbar palsy B. Gastroenteritis (Staphylococcus aureus) C. Gastro-oesophageal reflux disease D. Mucosal-associated lymphoid tumour E. Zollinger-Ellison syndrome F. Achalasia G. Duodenal ulcer H. Pyloric stenosis I. Mallory-Weiss tear J. Haemorrhagic gastritis K. Barrett's oesophagus L. Adenocarcinoma M. Gastroenteritis (Salmonella) N. Gastric ulcer
A
E. Zollinger-Ellison syndrome
49
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. Bulbar palsy B. Gastroenteritis (Staphylococcus aureus) C. Gastro-oesophageal reflux disease D. Mucosal-associated lymphoid tumour E. Zollinger-Ellison syndrome F. Achalasia G. Duodenal ulcer H. Pyloric stenosis I. Mallory-Weiss tear J. Haemorrhagic gastritis K. Barrett's oesophagus L. Adenocarcinoma M. Gastroenteritis (Salmonella) N. Gastric ulcer
A
F. Achalasia
50
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. Bulbar palsy B. Gastroenteritis (Staphylococcus aureus) C. Gastro-oesophageal reflux disease D. Mucosal-associated lymphoid tumour E. Zollinger-Ellison syndrome F. Achalasia G. Duodenal ulcer H. Pyloric stenosis I. Mallory-Weiss tear J. Haemorrhagic gastritis K. Barrett's oesophagus L. Adenocarcinoma M. Gastroenteritis (Salmonella) N. Gastric ulcer
A
L. Adenocarcinoma
51
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. Sarcoidosis B. Systemic lupus erythematous C. Sjorgen's syndrome D. Polyarteritis nodosa E. Temporal arteritis F. Renal amyloidosis G. Mixed connective tissue disease H. Scleroderma I. Kawasaki's disease
A
F. Renal amyloidosis
52
Q
A 28 year old woman presents with malaise, weight loss, an erythematous rash on the face and joint pains. Both antinuclear antibodies (ANA) and double-stranded DNA (dsDNA) antibodies were found in the serum. A. Sarcoidosis B. Systemic lupus erythematous C. Sjorgen's syndrome D. Polyarteritis nodosa E. Temporal arteritis F. Renal A. Sarcoidosis G. Mixed connective tissue disease H. Scleroderma I. Kawasaki's disease
A
B. Systemic lupus erythematous
53
Q
A 55 year old woman presents with severe, unremitting headache with scalp tenderness. Her ESR and CRP are raised. A biopsy reveals giant cells.A. Sarcoidosis B. Systemic lupus erythematous C. Sjorgen's syndrome D. Polyarteritis nodosa E. Temporal arteritis F. Renal amyloidosis G. Mixed connective tissue disease H. Scleroderma I. Kawasaki's disease
A
E. Temporal arteritis
54
Q
A 40 year old man with previous hepatitis B infection presents with weight loss, muscle aches and abdominal pain. On examination he has high BP and urine dipstick reveals blood + and protein + A. Sarcoidosis B. Systemic lupus erythematous C. Sjorgen's syndrome D. Polyarteritis nodosa E. Temporal arteritis F. Renal amyloidosis G. Mixed connective tissue disease H. Scleroderma I. Kawasaki's disease
A
D. Polyarteritis nodosa - Polyarteritis nodosa is characterised by necrotizing inflammation of medium and small ARTERIES. It is sometimes associated with hepatitis B or hepatitis C. Because of the size of the arteries involved, it can cause aneurysms. Other key features are renal involvement, peripheral neuropathies, livedo recticularis.
55
Q
A 30 year old Afrocaribbean woman presents with tender red nodules on the shins and legs. She also has joint pains in her feet and hands. Her blood test reveals a raised angiotensin converting enzyme (ACE) and Ca2+ level A. Sarcoidosis B. Systemic lupus erythematous C. Sjorgen's syndrome D. Polyarteritis nodosa E. Temporal arteritis F. Renal amyloidosis G. Mixed connective tissue disease H. Scleroderma I. Kawasaki's disease
A
A. Sarcoidosis
56
Q
A 35 year old female presents to her GP with unsightly, red, tender lesions on her shins. A subsequent CT scan shows evidence of enlarged glands in the lung hilar region, and nodular shadowing in the right middle lobe. A. Hereditary amyloidosis B. Myeloma associated amyloidosis C. Bronchial carcinoma D. Waldenström’s macroglobulinaemia E. Hogkin’s Lymphoma F. Reactive amyloidosis G. Senile amyloidosis H. Sarcoidosis I. Haemodialysis associated amyloidosis
A
H. Sarcoidosis
57
Q
A 60 year old man, currently undergoing treatment for long-standing chronic renal failure, complaining of tingling in his wrist & hand when he wakes in the morning. A. Hereditary amyloidosis B. Myeloma associated amyloidosis C. Bronchial carcinoma D. Waldenström’s macroglobulinaemia E. Hogkin’s Lymphoma F. Reactive amyloidosis G. Senile amyloidosis H. Sarcoidosis I. Haemodialysis associated amyloidosis
A
I. Haemodialysis associated amyloidosis - This is a secondary amyloidosis due to impaired clearance of b2m across dialysis membranes that causes carpal tunnel syndrome.
58
Q
A 70 year old woman is referred to hospital with signs of peripheral oedema and hepatosplenomegaly. Hospital investigations demonstrate a degree of bone erosion and high levels of circulating kappa uniform light chain A. Hereditary amyloidosis B. Myeloma associated amyloidosis C. Bronchial carcinoma D. Waldenström’s macroglobulinaemia E. Hogkin’s Lymphoma F. Reactive amyloidosis G. Senile amyloidosis H. Sarcoidosis I. Haemodialysis associated amyloidosis
A
B. Myeloma associated amyloidosis
59
Q
A 32 year old man presents with a painless, enlarged axillary lymph node. Slight hepatosplenomegaly is noted on examination. Whilst the patient denies experiencing any night sweats, weight loss or fevers, bloods on admission show a raised ESR and abnormal liver biochemistry. A. Hereditary amyloidosis B. Myeloma associated amyloidosis C. Bronchial carcinoma D. Waldenström’s macroglobulinaemia E. Hogkin’s Lymphoma F. Reactive amyloidosis G. Senile amyloidosis H. Sarcoidosis I. Haemodialysis associated amyloidosis
A
E. Hogkin’s Lymphoma
60
Q
A 64 year old woman with a history of chronic rheumatological disease presents to her GP complaining of abdominal discomfort – which is found to be due to hepatosplenomegaly. An ensuing liver biopsy stains positive with Congo Red stain. A. Hereditary amyloidosis B. Myeloma associated amyloidosis C. Bronchial carcinoma D. Waldenström’s macroglobulinaemia E. Hogkin’s Lymphoma F. Reactive amyloidosis G. Senile amyloidosis H. Sarcoidosis I. Haemodialysis associated amyloidosis
A
F. Reactive amyloidosis
