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MED GEMS HISTO Flashcards

1
Q

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

A

Aspartate aminotransferase

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2
Q

A 50 year old perimenopausal woman is admitted to A+E after a night out. She drank a bottle of Sauvignon Blanc and 8 shots of sambuca. She is known to have gallstones. A fever of 38.3C is recorded in the ambulance.

Her GCS is 13. She reports pain in her right upper quadrant which is reproducible on palpation

Blood tests show ALT 1.5x upper limit of normal, AST 1.2x upper limit of normal, ALP 2x upper limit of normal and bilirubin in the normal range.

What is the likely cause of her hepatic derangement?

A

Cholecystitis

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3
Q

Which histological subtype of malignancy are patients with poorly controlled ulcerative colitis at increased risk for?

A

Adenocarcinoma

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4
Q

A 38 year old woman with systemic lupus erythematosus presents to the emergency department.

She reports only passing a small volume of dark brown urine once in the last 3 days. She feels unwell.

Urine dip reveals the presence of haematuria (++) and proteinuria (++). She is hypertensive.

Blood tests reveal an elevated urea and creatinine.

What is the likely cause of the nephritic syndrome?

A

Rapidly progressive glomerulonephritits

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5
Q

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?

A

Breast abscess

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6
Q

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?

A

Benign familial haematuria

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7
Q

Classically which valve is colonised in IV drug users diagnosed with infective endocarditis?

A

Tricuspid valve

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8
Q

What tumour marker is associated with pancreatic cancer?

A

CA 19-9

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9
Q

Carcinoid syndrome is caused by an excess of what neurotransmitter?

A

Serotonin

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10
Q

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

A

11.1

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11
Q

Which enzyme, synthesised by the pancreas, is most sensitive for the diagnosis of pancreatitis?

A

Lipase

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12
Q

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

A

Class 6

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13
Q

What is the most common type of breast cancer in the UK?

A

Invasive ductal carcinoma

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14
Q

What is the most common solid organ cancer in men?

A

prostate cancer

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15
Q

A 32 year old man presents to the emergency department with frothy, cola coloured urine.

He denies pain or fever. He had a sore throat two weeks ago. He has no other medical history of note and this has not happened before.

He also is mildly hypertensive at 150/100.

What type of nephritic syndrome is this patient likely to have?

A

Post-streptococcal nephritis

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16
Q

A nephrologist is investigating an elderly gentleman with nephrotic syndrome.

A renal biopsy revealed normal histology when viewed under a light microscopy. There were no immune complexes detected in the biopsy either. There was no amyloid deposition.

Urinary Bence Jones Protein and serum electrophoresis were normal.

The patient responded well to steroids and their renal function is normal.

What is the most likely primary cause of the nephrotic syndrome?

A

Minimal change disease

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17
Q

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?

A

Chronic subarachnoid haemorrhage

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18
Q

Which valve is predominantely affected in acute rheumatic fever?

A

Mitral

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19
Q

Epigastric pain that worsens after food is a classical history of what form of peptic ulcer disease?

A

Gastric

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20
Q

Which lobe of the brain does HSV encephalitis classically affect?

A

Temporal lobe

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21
Q

What intracerebral tumour is Multiple Endocrine Neoplasia Type 1 associated with?

A

Pituitary adenoma

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22
Q

A 40 year old man has routine bloods done for yearly statin monitoring at his GP. His monitoring blood tests last year were normal

One week prior he broke his ankle falling off his bike.

Blood tests show a normal ALT, raised ALP, normal AST, normal bilirubin.

What is the likely explanation for his deranged liver function?

A

Fracture

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23
Q

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

A

Small cell lung cancer

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24
Q

Give an example of a biomarker that may be used to monitor hepatic synthetic function

A

INR

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25
Q

Which type of cell forms foam cells in the formation of atheromatous plaques?

A

Macrophages

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26
Q

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?

A

Testicular cancer

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27
Q

What is the name given to the criteria used for diagnosis of infective endocarditis?

A

Duke’s criteria

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28
Q

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?

A

CT abdomen

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29
Q

A 64 year old gentleman with hypertension and Type 2 Diabetes Mellitus presents to the emergency department with sudden onset weakness in his right arm.

Neurological examination in the emergency department is normal.

What is the most likely diagnosis?

A

Transient ischaemic attack

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30
Q

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

A

Somatostatin

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31
Q

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?

A

MRI brain and optic nerves

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32
Q

What is the inheritance pattern of alport’s syndrome?

A

X-linked recessive

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33
Q

What histochemical stain would reveal the presence of copper in a liver biopsy with a patient with Wilson’s disease?

A

Rhodanine stain

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34
Q

A 80-year-old man presents to his primary care physician with increasing shortness of breath, weight loss and a dry cough over a period of several months. Prior to his retirement, he was a plumber.

Physical examination reveals decreased breath sounds and dullness to percussion in the left lung base.

Chest X ray reveals irregular pleural thickening and a peripheral homogenous opacity in the left lower lung field.

What is the likely diagnosis?

A

Mesothelioma

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35
Q

A 80 year old man is undergoing elective bilateral knee arthroplasty. He has hypertension but no other past medical history. He is under general anaesthetic.

During the operation, he develops 4mm convex ST elevation in leads II and III. The cardiac monitor immediately alarms and alerts the anaesthetist.

A blood test for high sensitivity Troponin is taken and the anaesthetist informs the surgeon.

30 minutes later, the troponin is reported by the lab as normal.

What is the diagnosis?

A

Myocardial infarction

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36
Q

A 45 year old woman undergoes routine screening mammography for breast cancer.

There is an area of microcalcification seen at the 7 o clock position of her right breast.

The area is biopsied and is revealed to be a non invasive group of dysplastic cells which has not penetrated the basement membrane.

What is the likely histopathological diagnosis?

A

Ductal carcinoma in situ

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37
Q

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

What is the method of action of bicalutamide?

A

Androgen antagonist

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38
Q

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

A

Alport’s syndrome

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39
Q

A biopsy, taken at autopsy, reads: “There is pathological intimal thickening of the right renal artery with significant occlusion of the luminal space. Immunohistochemical staining reveals the presence of macrophages”

What pathology does the report describe?

A

Atherosclerosis

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40
Q

A biopsy sample from a patient with suspected renal cancer is reported as follows:

“There are neoplastic cells with transparent cytoplasm. Cells are arranged in nests with intervening blood vessels”

What is the specific histological type of cancer?

A

Clear cell cancer

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41
Q

Give an example of a misfolded protein implicated in the pathogenesis of alzheimer’s disease

A

Tau

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42
Q

What is the main hormone produced by of alpha cells in the pancreas?

A

Glucagon

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43
Q

What is the first line chemotherapy drug for treating prostate cancer in the UK?

A

Docetaxel

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44
Q

Damage to which artery is commonly associated with an extradural haemorrhage?

A

Middle meningeal artery

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45
Q

A fasting blood glucose value above what value (in mmol/L) on two consecutive occasions in an asymptomatic individual confirms a diagnosis of diabetes?

A

7

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46
Q

A gentleman is diagnosed with cushing syndrome. Cortisol levels do not alter with either low or high dose dexamethasone suppression test.

A chest x ray reveals a homogenous opacification in the left middle zone.

What histological type of cancer is most likely responsible for this presentation?

A

Small cell lung cancer

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47
Q

What condition is the presence of waxy casts in urine associated with?

A

CKD

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48
Q

A 42 year old woman with Type 1 Diabetes Mellitus is investigated for fatigue and pruritus.

She has an elevated serum ALP and an elevated anti mitochondrial antibody titre.

An ultrasound of the biliary tree shows no gross dilatation.

What is the likely diagnosis?

A

Primary biliary cirrhosis

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49
Q

What respiratory condition is characterised by airspace enlargement and alveolar wall destruction?

A

Emphysema

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50
Q

Schistosomiasis infection predisposes to what urological malignancy?

A

Squamous cell carcinoma of the bladder

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51
Q

What structures, present in the large bowel, represent weak points in the bowel wall and allow for the formation of diverticula?

A

Taenia coli

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52
Q

What is the typical inheritance pattern of Hereditary non-polyposis colorectal cancer/Lynch Syndrome?

A

Autosomal dominant

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53
Q

Kimmelstiel Wilson nodules found in a renal biopsy are associated with what underlying disease?

A

Diabetes

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54
Q

What finding on renal biopsy is associated with diabetes?

A

Kimmelstiel Wilson nodules

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55
Q

A nephrologist is investigating a 45 year old man with nephrotic syndrome.

His past medical history includes poorly controlled Type 2 Diabetes.

A biopsy viewed under light microscopy shows thickening of the glomerular basement membrane.

Some areas are visibly scarred.

Immunofluorescence shows the presence of antibody complexes and complement deposits. There are visible areas of scarring of the glomerular basement membrane, however, some areas appear spared.

What subtype of nephrotic syndrome does this histological pattern and history suggest?

A

Focal segmental glomerulonephritis

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56
Q

A renal biopsy is performed on a 34 year old man with significant proteinuria. He is known to have Chronic Hepatitis B.

The biopsy reads: “Thickened basement membrane with spike and dome appearance due to electron dense deposits in the subepithelial layer”

What is the likely diagnosis?

A

Membranous glomerulonephritis

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57
Q

Which glomerulonephritis is commonly associated with Hep B?

A

Membranous

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58
Q

What is the name given to dilated veins, commonly found in the oesophagus and are often associated with portal hypertension?

They are a common cause of sudden, life threatening, haematemesis in alcoholics.

A

Oesophageal varices

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59
Q

What is the commonest cause of oesophagitis in UK adults over 50?

A

GORD

60
Q

Other than zinc, what is the first line pharmacological treatment for Wilson’s disease?

A

Trientine

61
Q

Which adrenal tumour is most commonly associated with Multiple Endocrine Neoplasia?

A

Phaeochromocytoma

62
Q

How is MEN inherited?

A

Autosomal dominant

63
Q

Tumours associated with MENb?

A

mucosal neuromas, marfanoid body habitus, medullary thyroid carcinoma, phaechromocytoma

64
Q

What is the name given to areas of regenerating mucosa which project into the lumen of the bowel, which may be visualised during a colonoscopy of a patient with ulcerative colitis?

A

Pseudo polyp

65
Q

A 55 year old gentleman with newly diagnosed bipolar disorder is seen by a psychiatrist. An ECG is performed as part of the workup for starting lithium, a mood stabiliser.

His past medical history includes an anterior STEMI 4 months ago.

The ECG shows ST elevation in leads V2, V3, V4 and V5. He denies chest pain, breathlessness or any other symptoms.

What is the diagnosis?

A

Ventricular aneurysm

66
Q

Expression of what cell surface receptor may confer a good prognosis in invasive breast carcinoma?

A

Oestrogen receptor

67
Q

Expression of what cell surface receptor may confer a bad prognosis in invasive breast carcinoma?

A

HER2

68
Q

What is the most common type of lung cancer in the UK?

A

Adenocarcinoma

69
Q

A 58-year-old woman presents to her GP with a painful lump in her left breast.

There is palpable axillary lymphadenopathy and she reports recent significant weight loss and malaise.

She is assessed for breast cancer.

What histological subtype of breast cancer will this patient most likely have?

A

Invasive ductal carcinoma

70
Q

A patient undergoing investigation for lung cancer has a bronchoscopy.

He has a 40 pack year history of smoking and is currently being worked up for a suspected diagnosis of myasthenia gravis.

A tumour is visualised by the bronchoscope in the left main bronchus. A biopsy is taken.

What histological type of lung cancer is this likely to be?

A

Small cell lung cancer

71
Q

A 83 year old woman was admitted to hospital for a severe chest infection. At the time of admission, her CURB-65 was 4. Her blood pressure was 80/40

She was diagnosed as having an acute kidney injury.

What is the likely cause of the AKI?

A

Acute tubular necrosis

72
Q

In which gross anatomical section of the pancreas does pancreatic cancer typically occur?

A

Head

73
Q

What is the most common cancer in the UK?

A

Breast cancer

74
Q

Which tumour marker is used in the diagnosis of hepatocellular carcinoma?

A

Alpha feto-protein

75
Q

What is the most common cause of acute interstitial nephritis?

A

Drugs

76
Q

A 32 year old man presents to the emergency department with cola coloured urine.

He denies pain or fever. He has had a sore throat for the past five days. He has no other medical history of note and this has not happened before.

He also has a non-blanching rash over his legs.

What is the likely cause of the nephritic syndrome?

A

IgA nephropathy

77
Q

Which hepatobilary pathology is classically associated with an elevated p-ANCA?

A

Primary Sclerosing Cholangitis

78
Q

The ECG leads V1 and V2 represent which specific region of the heart?

A

Septal region

79
Q

A 45 year old man presents to their GP with a chronic cough and mild breathlessness on exertion. He has a 60 pack year history of smoking. Spirometry reveals an obstructive picture with FEV1 75% of predicted. There is no association with time of day or seasonality.

What is the most likely diagnosis?

A

COPD

80
Q

A 40 year old man is referred to cardiology clinic due to reduced exercise tolerance. He is found to have mitral stenosis.

He previously reported episodes of spontaneous, rapid, jerking movements that he could not control during a period of illness when he was a teenager. His sister had similar symptoms at that time.

What illness may he have had in his youth which has precipitated his heart murmur today?

A

Rheumatic fever

81
Q

Which neuroendocrine tumour is associated with Zollinger-Ellison syndrome?

A

Gastrinoma

82
Q

Which common medication are hepatic adenomas associated with?

A

Oral Contraceptive Pill

83
Q

A histopathologist looks at a piece of excised lung tumour under a microscope.

She notes the presence of mucin and glandular differentiation.

Which histological subtype of lung cancer is associated with mucin production?

A

Adenocarcinoma

84
Q

What is the most common chemical composition of renal stones?

A

Calcium oxalate

85
Q

What is the commonest cause of chronic renal failure in the UK?

A

Diabetes

86
Q

What condition is characterised by microangiopathic haemolytic anaemia, thrombocytopenia and stroke-like symptoms in an adult?

A

Thrombotic Thrombocytopenic Purpura

87
Q

How much glucose is given, in grams, for an oral glucose tolerance test for the diagnosis of diabetes?

A

75

88
Q

A CT-KUB from a patient with renal colic reveals the presence of a radiopaque, laminated density which conforms to the shape of the renal pelvis.

There is evidence of dilation of the renal calyces.

What is the typical chemical composition of this density?

A

Magnesium ammonium phosphate

89
Q

A CT-KUB from a patient with renal colic reveals the presence of a radiopaque, laminated density which conforms to the shape of the renal pelvis.

There is evidence of dilation of the renal calyces.

What is the typical chemical composition of this density?

A

Magnesium ammonium phosphate

90
Q

What histological type of bladder cancer is most common?

A

Transitional cell carcinoma

91
Q

What condition is the presence of fatty casts in urine associated with?

A

Nephrotic syndrome

92
Q

What is the most common histopathological subtype of pancreatic cancer?

A

Adenocarcinoma

93
Q

What histopathological description is given to cells that have lost their intercellular connections between neighbouring cells?

An example could be the loss of desmosomal connections in pemphigus vulgaris.

A

Acantholysis

94
Q

What type of kidney stone are patients on chemotherapy for chronic lymphocytic lymphoma at increased risk of?

A

Uric acid

95
Q

What monoclonal antibody therapy targets human epidermal growth factor receptor 2 and is used in the treatment of breast cancer?

A

Trastuzumab

96
Q

What kind of cancer is associated with keratin pearls?

A

Squamous cell carcinoma

97
Q

In which form of inflammatory bowel disease does smoking classically worsen symptoms?

A

Crohn’s disease

98
Q

A 5 year old boy is generally oedematous in his arms, face, legs, abdomen and feet. It started with facial swelling two days ago. His parents noted that he has particularly frothy urine.

He had a cold 5 days ago but is otherwise well with no medical history.

On examination there is generalised pitting oedema.

What is the most likely diagnosis?

A

Minimal change disease

99
Q

Classically the triad of bronchoconstriction, flushing and diarrhoea is described as what paraneoplastic syndrome?

A

Carcinoid syndrome (excess seratonin)

100
Q

What tumour marker is most commonly used in the diagnosis of colorectal cancer?

A

CEA

101
Q

What condition is characterised by microangiopathic haemolytic anaemia, thrombocytopenia and renal failure in children?

A

Haemolytic uraemic syndrome

102
Q

What is the most common histochemical stain used to visualise cells for light microscopy, such as that used for diagnosis of cancers?

A

Haematoxylin and eosin stain

103
Q

A 18 year old woman collapses after running a half marathon. She is noted to be drowsy and acting like she is drunk.

Her BMI is 28kg/m2 and she ate a sufficient breakfast prior to starting the run. She is normally fit and well.

There is a family history of Multiple Endocrine Neoplasia Type 1.

Paramedics record her blood sugar as 2.4mmol/L. They administer dextrose and she becomes more alert.

What is the probable cause of her hypogylcaemic episode?

A

Insulinoma

104
Q

Give an example of a biomarker that suggests the presence of hepatic ischaemia

A

Alanine aminotransferase

105
Q

What is the typical inheritance pattern of Maturity Onset Diabetes of the Young (MODY)?

A

Autosomal dominant

106
Q

Which hepatobiliary condition may be described as: fibrosis of bile ducts throughout the biliary tree with associated stricture formation?

A

PSC (associated with P-ANCA antibodies)

107
Q

The ECG leads II, III and aVF represent which region of the heart?

A

Inferior wall

108
Q

A 55-year-old man presents to his GP with a chronic productive cough of 6 months duration. He has had mild weight loss. He has had two hospitalisations for pneumonia in the last two years.

Spirometry in the practice was normal. Chest x ray was normal.

High resolution CT scan reveals bronchial wall thickening with a positive signet ring sign.

What is the diagnosis?

A

Bronchiectasis

109
Q

What is the typical inheritance pattern of hypertrophic obstructive cardiomyopathy (HOCM)?

A

Autosomal Dominant

110
Q

What is the cancer with the highest mortality in the UK?

A

Lung cancer

111
Q

Incidence of male cancers

A

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

112
Q

Incidence of female cancers

A

Breast (most common cancer overall)
Lung
Bowel
Uterus
Other

113
Q

Cancers by mortality?

A

Mortality

Men

Lung (most deadly)
Prostate
Bowel
Oesophagus
Other
Women

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

114
Q

Which hepatobillary condition may be described as a slow, insidious process of autoimmune destruction of intrahepatic bile ducts, associated with cholestasis?

A

Primary Biliary Cirrhosis

115
Q

A 54 year old gentleman with type 2 diabetes mellitus presents to his GP. He reports seeing blood in his urine. In addition, he has felt feverish and tired for a few weeks. He has no night sweats or weight loss and there is no family history of any medical problems.

Physical examination revealed an ejection systolic murmur and a palpable mass in the left upper quadrant of the abdomen.

Blood tests showed an elevated CRP with a normal haemoglobin.

Results of the urine dip are below:

Blood ++

Proteinuria ++

What is the cause of this constellation of symptoms?

A

Infective endocarditis

116
Q

A histopathologist looks at a piece of excised lung tumour under a microscope.

There is no evidence of glandular or squamous differentiation. The cells are poorly differentiated with large nuclei.

Which histological subtype of lung cancer has these features?

A

Large cell carcinoma

117
Q

Which hepatobiliary pathology is associated with the finding of “beading” of bile ducts during an endoscopic retrograde cholangiopancreatogram (ERCP)?

A

PSC

118
Q

What is the organism typically implicated in acute postinfectious glomerulonephritis?

A

Group A strep

119
Q

What sign, which may be visible around the nails, is seen in Graves’ disease and is due to periosteal bone growth in the nail bed?

A

Thyroid acropachy

120
Q

Which enzyme, released by neutrophils, does the compound alpha-1 antitrypsin inhibit to prevent the development of emphysema in the lungs?

A

Neutrophil elastase

121
Q

An 84 year old Asian woman presented to the ED with chest pain of 10 hours duration, which began while watching television. The pain was 9/10 and did not radiate. She reported being under extreme stress since the death of her 50 year old son a week ago.

An ECG revealed ST elevation in V2 and V3. Chest X ray was normal. Troponin and electrolytes were normal. Percutaneous Coronary Intervention was unremarkable with no occlusions and no evidence of atherosclerotic disease.

An echocardiogram showed apical akinesis with an ejection fraction of 36%. There was hypertrophy of the interventricular septum.

What is the diagnosis?

A

Takotsubo’s Cardiomyopathy/broken heart syndrome

122
Q

A nephrologist is investigating a 40 year old man with nephrotic syndrome.

A biopsy viewed under light microscopy shows thickening of the glomerular basement membrane.

Immunofluorescence shows the presence of antibody complexes and complement deposits throughout the glomerular basement membrane.

The patient’s renal function has continued to decline despite high dose pulsed IV methylprednisolone.

What is the likely primary cause of the nephrotic syndrome?

A

Membranous glomerular disease

123
Q

What condition is the presence of granular (“muddy brown”) casts seen in the urine associated with?

A

Acute tubular necrosis

124
Q

A 24 year old man with Alport’s syndrome has routine blood tests done with his GP. He takes an ACE inhibitor for CKD.

He reports that he is currently fasting as part of a diet and hasn’t eaten anything since yesterday morning.

Bloods show ALT normal, ALP normal, Bilirubin moderately elevated. Urea 2x upper limit of normal. Creatinine 3x upper limit of normal.

What is the likely explanation for his abnormal liver function tests?

A

Gilbert’s syndrome

125
Q

What type of bladder cancer is associated with chronic cystitis?

A

Squamous cell carcinoma

126
Q

A 45 year old diabetic man is investigated for heart failure.

A panel of blood tests shows an elevated serum ferritin in the absence of a fever, with a low total iron binding capacity and elevated transferrin saturation. He recalls that his brother has something wrong with iron in his body.

What is the diagnosis?

A

Hereditary haemochromatosis

127
Q

A 16 year old body is investigated for liver failure. He has markedly increased transaminases.

His mother, aunt and grandmother are all smokers and have COPD.

Blood tests show a low serum copper and low serum caeruloplasmin.

What is the likely diagnosis?

A

Wilson’s disease

128
Q

A 20-year-old man with cystic fibrosis presents to his GP with a chronic productive cough, that has been getting worse over the last two years. He is known to be colonised with pseudomonas aeruginosa.

His BMI is 18.5. Temperature in the surgery was 36.8c.

Examination revealed coarse crackles at the bases which shifted upon coughing.

Chest x ray was reported as showing tram-track opacities.

What is the diagnosis?

A

Bronchiectasis

129
Q

A 24 year old woman presents to their GP with progressive shortness of breath on exertion associated with wheezing. She also has a productive cough, present most days.

Spirometry shows an obstructive picture with FEV1 47% of predicted.

A chest X ray shows evidence of hyperinflation.

What genetic condition should she be investigated for?

A

Alpha-1-antitrypsin deficiency

130
Q

Degeneration of neurons in the substantia nigra is implicated in the pathogenesis of what synucleinopathy?

A

Idiopathic Parkinson’s disease

131
Q

Aschoff bodies found in the heart of a patient who has died of acute heart failure suggests what causative diagnosis?

A

Acute rheumatic fever

132
Q

What condition is the presence of epithelial casts in urine associated with?

A

Acute tubular necrosis

133
Q

A biopsy specimen from the gastric antrum of a patient is reported as showing evidence of acute gastritis.

What cell of the immune system is found disproportionately in biopsies of acute gastritis?

A

Neutrophils

134
Q

Severe epigastric pain associated with an elevated serum lipase is highly suggestive of what diagnosis?

A

Pancreatitis

135
Q

A 84 year old man with atrial fibrillation presents to the emergency department with increasing disorientation and headache. He has been having frequent falls at home over the last few months.

CT head reveals a unilateral, hypodense, crescent shaped mass underlying the left parietal bone.

What is the likely diagnosis?

A

Chronic subdural haematoma

136
Q

A 64 year old lady with osteoarthritis of the hip presents to her GP reporting fevers and bilateral joint pain. She suffers from heart failure and gout. She thinks her symptoms started after a recent course of amoxicillin for a chest infection. Her usual medications are furosemide, naproxen, omeprazole and allopurinol.

Blood tests show a Stage 1 AKI and mild eosinophilia. Her blood pressure is 142/90 and her urine dip shows leucocytes +1.

Urine microscopy shows the presence of white cell casts.

What is the likely underlying diagnosis?

A

Acute interstitial nephritis (associated with new medications)

137
Q

What is chronic interstitial nephritis associated with?

A

Chronic analgesic use

138
Q

Staghorn calculi are typically formed when there is the presence of certain pathogenic bacteria.

Which enzyme, produced by these bacteria, is responsible for the formation of staghorn calculi?

A

Urease

139
Q

What are staghorn calculi composed of?

A

Struvite

140
Q

What malignancy is Lambert Eaton Myasthenic Syndrome associated with?

A

small cell lung cancer

141
Q

What is the most common type of lung cancer in the UK?

A

Non small cell lung cancer

142
Q

What hormone is produced by small cell lung cancer and is responsible for paraneoplastic Cushing’s Syndrome?

A

ACTH

143
Q

What is the second most common type of non small cell lung cancer in the UK?

A

Squamous cell carcinoma

144
Q

What is the most common paraneoplastic syndrome associated with Small Cell Lung Cancer?

A

SIADH

145
Q

What is the most common type of non small cell lung cancer in the UK?

A

Adenocarcinoma

146
Q

What is the most appropriate treatment for non-small cell lung cancer that is present in both lungs?

A

Palliative care

V Flashcards (17 decks)

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