marrow sba Flashcards
A 23 year old woman has been admitted to the medical assessment unit with her initial presentation of Crohn’s disease. Endoscopy reveals that she has localised ileocaecal disease. During this admission, remission has successfully been induced using corticosteroid therapy.
Which of the following best describes the first line pharmacotherapy for maintenance of remission of her disease?
Prednisolone
Infliximab
Methotrexate
Oral azathioprine
Budesonide
Oral azathioprine
- A 60 year old man comes to the clinic complaining of sudden excruciating pain and redness at his right big toe. He is currently on treatment for his hypertension, diabetes mellitus and hypercholesterolaemia. On examination, his right first metatarsal is swollen, erythematous and tender. Otherwise, he is systemically well. Which of the following medications is most likely to be contributory to his symptoms?
Amlodipine
Bendroflumethiazide
Gliclazide
Simvastatin
Metformin
Bendroflumethiazide
- A 31 year old man presents to the emergency department after experiencing a syncopal episode whilst playing football. He has no prior history of syncope but describes intermittent palpitations and chest pain for several years.
An ECG shows left ventricular hypertrophy, atrial fibrillation with occasional ventricular ectopics. An echocardiogram is consistent with a diagnosis of hypertrophic cardiomyopathy.
Which clinical feature is a risk factor for sudden cardiac death?
Chest pain
Left ventricular hypertrophy on ECG
Unexplained syncope
Premature ventricular complexes
Palpitations
Unexplained syncope
- A 76-year old gentleman on the ward has become acutely unwell and the junior doctor has been asked to review him. He has had a prolonged admission, complicated by a hospital-acquired pneumonia, for which he was treated with Cefuroxime.
He has been having non-bloody diarrhoea over the past 24 hours, and his stool sample has tested positive for Clostridium Difficile Toxin (CDT). On examination, his abdomen is soft, tender in the left-iliac fossa, with no signs of peritonism.
Which of the following antibiotics would be most appropriate for this patient?
Oral Metronidazole
IV Metronidazole + oral Vancomycin
IV Piperacillin/Tazobactam (Tazocin) + oral Vancomycin
Oral Fidaxomicin
Intravenous Vancomycin + oral Metronidazole
IV Metronidazole + oral Vancomycin
. Every year influenza is an illness that affects thousands of people. It is endemic to many countries, including the UK, during the winter months. Notably, different strains of the virus are responsible for illness each year, and novel flu vaccines are used each year to counter this.
What mechanism explains how most new strains of influenza emerge over time?
Genetic mutation - substitution
Antigenic drift
Antigenic shift
Genetic mutation - deletion
Pandemic
Antigenic drift
. An 8-year-old boy goes on holiday with family to Kenya, and suffers from excessively watery diarrhoea and dehydration. You suspect that he may have cholera. What is the mechanism of dehydration in cholera?
Reversal of the concentration gradient of ions
Increased absorption of chlorine
Blockage of the sodium-glucose transporter
Blockage of chlorine channels
Increased urinary excretion of water
Reversal of the concentration gradient of ions
- A 46-year-old woman his admitted to the surgical ward with right upper quadrant pain. The pain came on after eating a large meal and has persisted for two days. She has also felt generally unwell.
On examination, she appears jaundiced and febrile. She is tender in the right upper quadrant and Murphys sign is positive.
What is the most likely diagnosis?
Acute cholecystitis
Ascending cholangitis
Gastric ulcer
Hepatitis
Biliary colic
Ascending cholangitis
- A 45 year old woman with a history of coeliac disease presents to the GP with a 3 month history of palpitations, irregular periods, weight loss and diarrhoea. Given the most likely diagnosis which antibody would you expect to be raised in her blood tests.
anti-TPO
Auto 21-a-hydroxylase
ANA
TSH-R
pANCA
TSH-R
- What is the chromosomal translocation associated with Acute myeloid leukaemia?
t(9:22)
t(15:17)
t(12:21)
t(7:21)
t(14:21)
t(15:17)
- A 36 year old man presents with fever, abdominal pain, vague arthralgia and a purpuric rash on his legs. From initial investigations he is hypertensive, has hematuria and proteinuria. His only past medical history is hepatitis B. ESR is very elevated but CRP is normal. What is the most likely diagnosis?
Granulomatosis with polyagnitis
Systemic lupus erythmatosus
Polyarteritis nodosa
Buerger’s disease
Scleroderma
Polyarteritis nodosa
- Which Toll Like Receptor is activated by flagellated bacteria to trigger an immune response?
TLR-2
TLR-4
TLR-5
TLR-7
TLR-9
TLR-5
- What would happen to a patient taking warfarin if they started taking St John’s Wort (a P450 inducer)?
Haemoglobin will increase
Haemoglobin will decrease
INR will increase
INR will decrease
INR will stay the same
INR will decrease
- A 20 year old male patient presents to the emergency department with a syncopal episode whilst playing football. He regained consciousness on arrival at the emergency department. He has no past medical history of note. His father died suddenly 2 years ago from a ‘heart condition’, but the patient is unsure of the name.
Which of the following echocardiogram findings is consistent with the most likely diagnosis?
Regional wall motion abnormality, ejection fraction <55%
Asymmetric septal hypertrophy, normal diastolic function
Left ventricular dilation, ejection fraction <55%
Asymmetric septal hypertrophy, diastolic dysfunction
Apical ballooning of the left ventricle
Asymmetric septal hypertrophy, diastolic dysfunction
- A 34 year old woman presents with painful hands especially during the winter. She describes her fingers changing colours from white to blue to red. What medication should she avoid?
Propranolol
Nifedipine
Ramipril
IV prostacyclin
IV iloprost
Propranolol
- A 56 year old man with a background of rheumatoid arthritis is reviewed on the ward.
He was admitted with urosepsis on a Friday and started on intravenous antibiotics and he has made a good recovery so far. It is now Monday morning and the pharmacist approached you with the drug chart saying he has noticed a prescribing error from admission. This patient has been given methotrexate daily instead of once a week since he was admitted.
What adverse effect is this patient most at risk of?
Acute liver failure
Bone marrow suppression
Acute kidney injury
Pulmonary fibrosis
Encephalitits
Bone marrow suppression
