Mcq Of Pass Medicine Flashcards
Each one of the following is associated with hyposplenism, except: 1-Sickle-cell anaemia 2-Liver cirrhosis 3-Systemic lupus erythematous 4-Coeliac disease 5-Splenectomy
Liver cirrhosis
A 30-year-old man is investigated for enlarged, painless cervical lymph nodes. A biopsy is taken and a diagnosis of Hodgkin's lymphoma is made. Which one of the following types of Hodgkin's lymphoma carries the best prognosis? Lymphocyte predominant Mixed cellularity Nodular sclerosing Hairy cell Lymphocyte depleted
Hodgkin’s lymphoma - best prognosis = lymphocyte predominant
Which one of the following cytotoxic agents acts by inhibiting dihydrofolate reductase and thymidylate synthesis? Methotrexate Vincristine Bleomycin Cyclophosphamide Doxorubicin
Methotrexate
A 4-year-old boy is admitted after developing a haemarthrosis in his right knee whilst playing in the garden. The following blood results are obtained: Platelets 220 * 109 /l PT 11 secs APTT 76 secs Factor VIIIc activity Normal What is the most likely diagnosis? Antithrombin III deficiency Von Willebrand's disease Antiphospholipid syndrome Haemophilia A Haemophilia B
Haemophilia B
A 45-year-old woman is diagnosed with non-Hodgkin’s lymphoma. She is a recovering alcoholic and
has been left with significant alcohol-related peripheral neuropathy. Which one of the following
chemotherapy agents should be avoided if possible, given her past history?
Doxorubicin
Vincristine
Chlorambucil
Docetaxel
Cyclophosphamide
Vincristine
A patient is investigated for leukocytosis. Cytogenetic analysis shows the presence of the following translocation: t(9;22)(q34;q11). Which hematological malignancy is most strongly associated with this translocation? Chronic myeloid leukaemia Acute promyelocytic leukaemia Acute lymphoblastic leukaemia Burkitt's lymphoma Mantle cell lymphoma
Chronic myeloid leukaemia
50-year-old man with a history of ulcerative colitis comes for review. Six years ago he had an
ileostomy formed which has been functioning well until now. Unfortunately he is currently suffering
significant pain around the stoma site. On examination a deep erythematous ulcer is noted with a
ragged edge. The surrounding skin is erythematous and swollen. What is the most likely diagnosis?
Munchausen’s syndrome
Irritant contact dermatitis
Pyoderma gangrenosum
Dermatitis artefacta
Stomal granuloma
Pyoderma gangrenosum is associated with inflammatory bowel disease and may be seen around the
stoma site. Treatment is usually with immunosuppressants as surgery may worsen the problem
A differential diagnosis would be malignancy and hence lesions should be referred for specialist
opinion to evaluate the need for a biopsy. Irritant contact dermatitis is common but would not be
expected to cause such a deep ulcer.
Which one of the following is least likely to cause a warm autoimmune haemolytic anaemia? Mycoplasma infection Methyldopa Chronic lymphocytic leukaemia Lymphoma Systemic lupus erythematous
Mycoplasma infection
A 64-year-old man with a history of depression and lumbar spinal stenosis presents with a swollen and
painful left calf. He is seen in the DVT clinic and found to have a raised D-dimer. He therefore
undergoes a Doppler scan which shows a proximal deep vein thrombosis. The patient reports being
active and otherwise well. He has not recently had any surgery or been immobile for any prolonged
period. He is started on low-molecular weight heparin and referred to the warfarin clinic. What is the
most appropriate duration of warfarin treatment?
6 week
3 months
6 months
12 months
Lifelong
6 months
A 33-year-old male patient with a history of recurrent nose bleeds, iron-deficiency anaemia and dyspnoea is found to have a pulmonary AV malformation on pulmonary angiography. What is the likely underlying diagnosis? Haemophilia A Hereditary haemorrhagic telangiectasia Mantle cell lymphoma Wegener's granulomatosis Down's syndrome
Hereditary haemorrhagic telangiectasia
blood film is reported as follows: Howell-Jolly bodies, target cells and occasional Pappenheimer bodies are seen What is the most likely underlying cause? Iron-deficiency anaemia Lead poisoning Myelofibrosis Sideroblastic anaemia Post-splenectomy
Post-splenectomy
You are asked to review a 60-year-old Greek man with known glucose-6-phosphate dehydrogenase
(G6PD) deficiency who was admitted with malaria and a chest infection. He has developed jaundice
and haemolytic anaemia after starting some medications this morning.
Which of these medications are most likely to have precipitated his crisis?
Clarithromycin
Amoxicillin
Artesunate
Primaquine
Salbutamol
.
Primaquine
is a well known cause of haemolysis in G6PD deficiency and is used in the treatment of
malaria. Artesunate is generally considered safe to use in G6PD deficiency. Penicillins and macrolides
are safe antibiotics to use in G6PD deficiency.
42-year-old woman presented with sudden onset gait ataxia, intention tremor and nystagmus. CT
head demonstrated a 4cm left cerebellar haematoma. She is discussed with the local neurosurgical unit
and urgently transferred for intervention. She is repatriated a week later for further rehabilitation.
Routine blood tests are notable for a platelet count of 1,700 * 109
/l . Initially, you attribute this to a
post-surgical rise. However, on closer examination of her results you realise that on initial presentation
her platelet count was 1,300 * 109
/l. What gene mutation is likely to be discovered in this lady?
JAK2
HFE
CFTR
WASP
BCR-ABL
JAK2
This lady has presented with a stroke at a young age, on a background of raised platelets. This is very
suggestive of essential thrombocythaemia which is known to be a rare cause of stroke and is
associated with a mutation in the JAK2 gene.
HFE mutation is seen in haemochromatosis, CFTR in cystic fibrosis and WASP in Wiskott-Aldrich.
Mutations in BCR-ABL are associated with chronic myeloid leukaemia, and is known as the
Philadelphia translocation.
22-year-old man with sickle cell anaemia presents with pallor, lethargy and a headache. Blood results are as follows Hb 4.6 g/dl Reticulocytes 3% Infection with a parvovirus is suspected. What is the likely diagnosis? Thrombotic crisis Sequestration crisis Transformation to myelodysplasia Haemolytic crisis Aplastic crisis
Aplastic crisis
The sudden fall in haemoglobin without an appropriate reticulocytosis (3% is just above the normal
range) is typical of an aplastic crisis, usually secondary to parvovirus infection
Which one of the following factors is most associated with an increased risk of developing bladder cancer? Strongyloides stercoralis infection Beryllium salt exposure Aniline dye exposure Aflatoxin exposure Long term phenytoin use
Aniline dye exposure
Which one of the following is not a feature of paroxysmal nocturnal haemoglobinuria? Haemolytic anaemia Positive Ham test Haemoglobinuria Aplastic anaemia Haemarthrosis
Haemarthrosis
A 21-year-old man comes for review. He recently had an abdominal ultrasound for episodic right upper quadrant pain which demonstrated gallstones. A full blood count was also ordered which was reported as follows: Hb 9.8 g/dl MCV 91 fl Plt 177 * 109 /l WBC 5.3 * 109 /l The patient also mentions that his father had a splenectomy at the age of 30 years. Which one of the following tests is most likely to be diagnostic? Ham's test PAS staining of erythrocytes Glucose-6-phoshate dehydrogenase levels Osmotic fragility test Direct Coombs' test
Osmotic fragility test
This patient has hereditary spherocytosis as evidenced by the normocytic anaemia, gallstones and
family histor
A 21-year-old man comes for review. He recently had an abdominal ultrasound for episodic right upper quadrant pain which demonstrated gallstones. A full blood count was also ordered which was reported as follows: Hb 9.8 g/dl MCV 91 fl Plt 177 * 109 /l WBC 5.3 * 109 /l The patient also mentions that his father had a splenectomy at the age of 30 years. Which one of the following tests is most likely to be diagnostic? Ham's test PAS staining of erythrocytes Glucose-6-phoshate dehydrogenase levels Osmotic fragility test Direct Coombs' test
Osmotic fragility test
This patient has hereditary spherocytosis as evidenced by the normocytic anaemia, gallstones and
family histor
42-year-old female is noted to have a Hb of 17.8 g/dL. Which one of the following is least likely to be the cause? Polycythaemia rubra vera Chronic obstructive pulmonary disease Hypernephroma Haemochromatosis Dehydration
Haemochromatosis
is not associated with polycythaemia. Blood tests typically reveal a raised ferritin
and iron, associated with a transferrin saturation of greater than 60% and a low total iron binding
capacit
patient is diagnosed with acute lymphoblastic leukaemia after presenting with lethargy and easy bruising. Which one of the following is a marker of a bad prognosis in acute lymphoblastic leukaemia? Pre-B phenotype Presentation in childhood Initial white cell count of 18 * 109 /l Female sex Philadelphia chromosome positive
Philadelphia translocation, t(9;22) - good prognosis in CML, poor prognosis in AML + ALL
patient is diagnosed with acute lymphoblastic leukaemia after presenting with lethargy and easy bruising. Which one of the following is a marker of a bad prognosis in acute lymphoblastic leukaemia? Pre-B phenotype Presentation in childhood Initial white cell count of 18 * 109 /l Female sex Philadelphia chromosome positive
Philadelphia translocation, t(9;22) - good prognosis in CML, poor prognosis in AML + ALL
A 34-year-old man who is HIV positive is starting treatment for Burkitt’s lymphoma. His
chemotherapy regime includes cyclophosphamide, vincristine, methotrexate and prednisolone. Around
24 hours after starting chemotherapy he becomes confused and complains of muscle cramps in his
legs. Which one of the following is most likely to have occurred?
Prednisolone-induced psychosis
Hypercalcaemia
Methotrexate pneumonitis leading to hypoxia
Haemorrhagic cystitis leading to acute renal failure
Tumour lysis syndrome
Tumour lysis syndrome
Burkitt’s lymphoma is a common cause of tumour lysis syndrome
Tumour lysis syndrome occurs as a result of cell breakdown following chemotherapy. This releases a
large quantity of intracellular components such as potassium, phosphate and uric acid.
Which one of the following may be used to monitor patients with colorectal cancer? CA-125 Carcinoembryonic antigen Alpha-fetoprotein CA 19-9 CA 15-3
Carcinoembryonic antigen may be used to monitor for recurrence in patients post-operatively or to
assess response to treatment in patients with metastatic disease
66-year-old woman with a history of chronic kidney disease stage disease 4 metastatic breast cancer
is admitted with a swollen right calf. Investigations confirm a deep vein thrombosis and she is started
on treatment dose dalteparin. As she has a significant degree of renal impairment it is decided to
monitor her response to dalteparin. What is the most appropriate blood test to perform?
Anti-Factor Xa levels
Antithrombin III levels
Anti-Factor VIIIa levels
Protrombin time (PT)
Activated Partial Thromboplastin Time (APTT)
Anti-Factor Xa levels
A 52-year-old man with a history of anaemia and abdominal discomfort is diagnosed as having
chronic myeloid leukaemia. What is the mechanism of action of imatinib?
EGF receptor antagonist
Tyrosine kinase inhibitor
Anti-CD52 monoclonal antibody
Anti-CD23 monoclonal antibody
p53 inhibitor
Chronic myeloid leukaemia - imatinib = tyrosine kinase inhibitor
Imatinib is an inhibitor of the tyrosine kinase associated with the BCR-ABL defec
67-year-old man with a 10-year history of gastro-oesophageal reflux disease is investigated for dysphagia. An endoscopy shows an obstructive lesion highly suspicious of oesophageal cancer. What is the biopsy most likely to show? Squamous cell carcinoma Normal squamous epithelium Adenocarcinoma Leiomyoma Metaplastic columnar epithelium
Oesophageal adenocarcinoma
is associated with GORD or Barrett’s
Metaplastic columnar epithelium would be seen with Barrett’s but this is not consistent with the
obstructive lesion seen on endoscopy
72-year-old woman is found to have a marked lymphocytosis associated with smudge cells on the blood film. A diagnosis of chronic lymphocytic leukaemia is suspected. Which one of the following is the investigation of choice? Immunophenotyping Bone marrow aspiration Protein electrophoresis White cell scan Bone marrow trephine
CLL - immunophenotyping is investigation of choice
72-year-old lady develops sudden onset shortness of breath. She has a heavy smoking history and
has been losing weight recently. She undergoes a CT pulmonary angiogram to exclude pulmonary
embolism, but this demonstrates obstruction of the superior vena cava (SVC) secondary to a large,
poorly defined mass. What is the most likely cause of her superior vena cava obstruction?
Small cell lung cancer
Non-small cell lung cancer
Non-Hodgkin lymphoma
Breast cancer
Thymoma
Non-small cell lung cancer
A 30-year-old female presents to the Emergency Department with epistaxis, which has now terminated. Her boyfriend reports she has a recent history of mucosal bleeding and has at times been very disorientated. On examination, she has a low-grade fever and appears confused and jaundiced. There is bruising over her legs and arms. A urine pregnancy test is negative. You receive the following blood results from the laboratory: Hb 85 g/l Platelets 8 * 109 /l WBC 4.5 * 109 /l MCV 92 fl Na+ 138 mmol/l K+ 4.9 mmol/l Urea 10.2 mmol/l Creatinine 182 µmol/l Clotting studies are normal. Given the most likely diagnosis, what is the most appropriate management of this patient? Platelet transfusion Intravenous immunoglobulin Plasma exchange Intravenous methylprednisolone Intravenous argatroban
Plasma exchange..
the haematological emergency and be aware of the
correct management.
thrombocytopenia, microvascular haemolysis, fluctuating neurological signs, renal impairment and
fever.
rombocytopenia is immune thrombocytopenic purpura
(ITP). ITP is more common than TTP however would not present with the range of symptoms seen in
this scenario.
a
life saving intervention. Platelet transfusion in TTP is only indicated if there is an on-going life-
threatening bleed. Intravenous methylprednisolone is indicated after treatment with PEX has been
completed.
mmunoglobulin in the routine management of TTP, however
there have been reports of its successful use in PEX- and steroid-refractory case
A 12-year-old boy is noted to bleed excessively during an elective dental extraction. Following the procedure, examination reveals petechial skin haemorrhages. Blood results show: Hb 12.3 g/dl Plt 255 * 109 /l WBC 7.9 * 109 /l PT 13.3 secs APTT 39 secs Factor VIII activity 87% What is the most likely diagnosis? Disseminated intravascular coagulation Idiopathic thrombocytopenic purpura Von Willebrand's disease Haemophilia A Haemophilia B
Von Willebrand’s disease
A 52-year-old woman with a history of hypothyroidism presents with lethargy and a sore tongue.
Blood tests are reported as follows:
Hb 10.7 g/dl
MCV 121 fl
Plt 177 * 109
/l
WBC 5.4 * 109
/l
Further tests are ordered:
Vitamin B12 64 ng/l (200-900 ng/l)
Folic acid 7.2 nmol/l (> 3.0 nmol/l)
What is the most appropriate management?
1 mg of IM hydroxocobalamin once every 3 months
1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3
months
1 mg of IM hydroxocobalamin once every 2 months + folic acid 5mg od
Give folic acid 5mg od one week then recheck bloods
1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months
+ folic acid 5mg od
1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3
months
54-year-old man is diagnosed as having acute myeloid leukaemia. What is the single most
important test in determining his prognosis?
Gene-expression profiling
White cell count at diagnosis
Immunophenotyping
Lactate dehydrogenase
Cytogenetics
Cytogenetics
