MedEd Mock Flashcards
MRSA gold-standard treatment
Fluclox IV
A 35-year-old HIV-positive man presents to his GP complaining of a general feeling of tiredness, weight loss and night sweats. On examination there is hepato-splenomegaly and hyperpigmentation of the skin. The most likely diagnosis is:
Visceral leishmaniasis
Cutaneous leishmaniasis
Mucocutaneous leishmaniasis
Malaria
Schistosomiasis
Visceral leishmaniasis
Returns from india, high fever flu-like symtpoms
thick and thin films show Maurer’s clefts under microscope
Plasmodium falciparum
Transplant patient - increased frequency visual floaters, diarrhoea and abdo pain
Human Cytomegalovirus
One of your patients on the labour ward gives birth to a child. You perform a newborn examination and note loss of the red reflex, microcephaly and a widespread non-blanching rash that coalesces into violaceous patches. What is the most likely causative organism of this congenital syndrome?
Varicella zoster virus
Live vaccine from list below
A) Influenza vaccine
B) Pertussis vaccine
C) Sabin vaccine
D) Salk vaccine
E) Tetanus vaccine
Salk vaccine (for polio)
Which drug DOESN’t inhibit viral nucleic acid synthesis
A) Cidofovir
B) Foscarnet
C) Ganciclovir
D) Nevirapine
E) Saquinavir
saquinavir
pneumonia w/ ground glass appearance on CXR
pneumocystis jirovecii
Painful joints, burning feeling passing urine, painful irritated eyes. Which organism?
Chlamydia trochomatis
Gas gangrene organism
Clostridium perfringens
They test positive for HBsAg and Anti-HBc; negative for IgM anti-HBc and anti-HBs. What is their HBV infection status?
Chronic infection
Rapid genetic change in influenza viruus
Antigenic shift
A vegetarian returns from holiday in Morocco and presents jaundiced. They complain about the food options available and explain that they ended up eating a lot of salad. What is the most likely diagnosis?
Hepatitis A
A patient with dark skin presents with dandruff and patches of depigmentation which appeared quite suddenly; usually their hair is impeccable. What is the most likely diagnosis?
Pityriasis versicolor (NB: pityriasis rosea is a viral illness)
A patient with diabetes who is non-compliant with their glycaemic control agents presents with pain and redness around the eye. As they wait in A&E majors they start to discharge black pus from their mouth and nose. What is the most likely diagnosis?
Mucormycosis
Which of the following is true regarding pancreatic cancer?
a) Ductal adenocarcinomas commonly arise from dysplastic precursor lesions
b) Acinar adenocarcinomas are the most common cancer
c) Pancreatic adenocarcinomas are commonly found in the tail
d) Pancreatic NETs are most commonly secretory
a) Ductal adenocarcinomas commonly arise from dysplastic precursor lesions
A 35 year old lady presents with nipple discharge. Histology shows dilated ducts with peri-ductal inflammation filled with secretions. What is the most likely diagnosis?
a) DCIS
b) ductal papilloma
c) duct ectasia
d) radial scar
Duct ectasia
Which of the following would confirm lymphocytic duodenitis?
a. Villous atrophy
b. Intraepithelial lymphocytes > 20/100
c. Crypt hyperplasia
d. Low serum B12
e. Thickened basement membrane
b. Intraepithelial lymphocytes > 20/100
What is the most common cause of chronic pancreatitis?
Alcohol
Which hepatic lobular zone is most at risk of injury?
Zone 3
A patient with alcohol related liver disease undergoes a biopsy and is found to have cirrhosis. What is the stage of his liver disease?
F4
OGD performed and an oesophageal mass biopsy reveals intercellular bridges and high-keratin content.
What is the diagnosis?
oesophageal squamous cell carcinoma
He undergoes an OGD and a biopsy of the gastric body confirms: mitotic figures, invasion of the basement membrane and signet ring cells.
diffuse adenocarcinoma (gastric)
Worldwide, what is the most common type of oesophageal malignancy?
oesophageal squamous cell carcinoma
The stomach mucosa is normally lined with which cell type?
simple columnar epithelium
A histopathologist describes a biopsy containing stratified squamous cells with mucous glands located in the submucosa. Which organ has the biopsy been taken from?
Oesophagus
A 7 year old child presents with recurrent severe bacterial meningitis. There is a family history of childhood death from meningococcal sepsis. Immunological investigations show normal levels of C3 and C4, and abnormal CH50 and AP50. What is the most likely diagnosis?
C5-9 deficiency
There is a mutation in neutrophil elastase (ELA-2). What is the diagnosis?
Cyclical neutropaenia
A 27 year old Turkish man presents with periodic abdominal pain, chest pain and arthritis. He spikes a fever every 48h. He has a known history of amyloidosis. Which of the following are first line treatment options?
Colchicine
Anakinra
Etanercept
Canakinumab
Methotrexate
Colchicine
Which of the following is a conjugate vaccine?
A. Diptheria
B. Pneumococcus
C. MMR
D. Yellow Fever
E. HPV
B. Pneumococcus – encapsulated bacteria
Ipilimumab is a licensed therapy in the treatment of metastatic melanoma, but which receptor does it bind to?
A. CD3
B. CTLA4
C. IL2
D. RANKL
E. TNF-alpha
B. CTLA4 – ipilimumab (melanoma)
Which type of rejection can be treated with plasmapheresis?
Acute antibody mediated
Acute cell mediated
Chronic
Graft versus Host Disease
Hyperacute
Acute antibody mediated
A 63 female with T2DM and poorly controlled hypertension underwent a renal transplant 10 years ago for diabetic nephropathy. She is on tacrolimus and mycofenalate mofetil and is compliant with therapy. Over the past two years her GFR has reduced from 45 to 5 and is not requiring renal replacement therapy. A biopsy is taken of her transplanted kidney showing fibrosis. What type of rejection has caused this?
Antibody mediated
Cell mediated
Chronic
Graft versus Host Disease
Hyperacute
Chronic
A 3 month old male baby presents with recurrent episodes of candidiasis and diarrhoea. There is a family history of early infant death. Investigations show:
WCC: 9
CD3: 0%
CD19: 1 (96%)
CD3+CD4+: 0%
CD3+CD8+: 0%
IgG: 2 g/L (3-9)
IgA: <0.06 (0.15-0.7)
IgM: 0.19 (0.4-1.6)
What is the most likely diagnosis?
X-linked SCID
Which MHC is most important when matching donors?
DR
DR > B > A
Which cell surface receptor does HIV use to enter cells?
CD4
What is the name given to specific dendritic cells that are present in the skin?
Langerhans Cell
Which type of rejection can be treated with plasmapheresis?
Acute antibody mediated
Which of the following lab values would be consistent with a diagnosis of SIADH
Sodium 136 (134-146)
TSH 4.6 (0.5-2.5)
Urine sodium 50 (<20)
Serum osmolality 290 (275-295)
Potassium 6.1 (3.5-5.5)
Urine sodium 50 (<20)
A patient presents with polyuria and polydipsia, which of the following is a reversible cause of nephrogenic diabetes insipidus
Head trauma
Hypernatraemia
Hyperglycaemia
Hypercalcaemia
Hypophosphataemia
Hypercalcaemia
Which of the following drugs is a cause of hyperkalaemia
Digoxin
Enalapril
Furosemide
Dalteparin
Monoxidine
Enalapril
Which of the following is an appropriate initial test for acromegaly
Combined pituitary function test
Serum IGF-1
Urine catecholamines
Oral glucose tolerance test with GH measurement
Insulin stress test with GH measurement
Serum IGF-1
Which of the following is a potentially fatal cause of neonatal jaundice
1) Crigler-Najjar syndrome
2) Gilbert’s syndrome
3) Noonan’s syndrome
4) Goldenhar syndrome
5) Kabuki syndrome
1) Crigler-Najjar syndrome
What type of hypersensitivity is graves’ disease?
1) Type I
2) Type II
3) Type III
4) Type IV
5) It is not a hypersensitivity
II
List 2 causes of hypovolaemic hyponatraemia
Diuretics, D/V, burns, ascites, salt-wasting nephropathy, Barter/Gitelman syndrome, Addisons
List 2 investigations needed for the diagnosis of SIADH (not serum sodium)
Urine sodium/osmolality, TSH/TFTs, 9am cortisol (or short synACTHen test), serum osmolality
What would you expect to happen to urine specific gravity in diabetes insipidus?
Low or <1.005 (or similar answers)
List a cause of a low serum sodium (126, normal 133-146) with a normal serum osmolality (280, normal 275-295)
Myeloma, paraprotein, lipids, alcohol (not glucose or mannitol as this will increase osmolality)
A patient on the ward is noted to have a potassium of 7.0 (3.5-5.5) and you note they have ECG changes. Which drug should be given to protect the heart immediately?
Accept calcium chloride or calcium gluconate.
Probably accept just “calcium” but not calcium carbonate
What is the diagnostic test for hypopituitarism?
Combined pituitary function test
A 25 year old male presents with a 10 year history of epistaxis and prolonged bleeding after shaving. There is no evidence of any haemarthrosis and there is no organomegaly. Which is most likely?
Haemoglobin 140g/l (135-170)
K 4.0 (3.5-5.2)
Platelets 160 (150-400)
Creatinine 70 (50-90)
White cell count 7.0 (4-11)
Prothrombin time 12seconds (11-13)
Na 140 (133-145)
Activated partial thromboplastin time 48 seconds (30-40)
Haemophilia A
Von Willebrand Disease
ITP
Haemophilia B
Factor XI deficiency
Von Willebrand Disease
this can present with a prolonged APTT due to concurrent mildly decreased levels of factor 8 (this is bound to VWF in the plasma). Haemophilia would present with a different pattern of bleeding and would be more severe. By this age they would have likely had multiple complications if they were haemophiliac. Factor XI deficiency is rarer than VWF but would similarly prolong the APTT.
A 55 year old man presents to his GP after a 2 week history of fatigue and easy bruising. Blood results show:
White cell count: 27(4-11)
Neutrophils 0.1 (1.5-5)
Lymphocytes 0.1 (1.0-2.5)
Blasts 26 (0-0.1)
Haemoglobin 90g/l (135-170)
Platelets 30 (150-400)
Blood film shows presence of blasts, with 27% blasts in marrow
Flow cytometry shows a clonal population of cells expressing CD34, CD19 and TdT.
Cytogenetic analysis shows the presence of t(9;22)
What is the most likely diagnosis?
Acute Myeloid Leukaemia
Acute Lymphoblastic Leukaemia
Mixed Phenotype Acute Leukaemia
Adult T-cell leukaemia-lymphoma
Burkitt’s lymphoma
Acute Lymphoblastic Leukaemia
Acute lymphoblastic leukaemia. t(9;22) is the BCR-ABL1 fusion gene also found in CML. However, this mutation can also be present in ALL. The case history here is of an acute leukaemia which is confirmed by the flow cytometry as being lymphocytic lineage. However, while this is a hard question, the only other differential would be blast phase CML which is not presented as an option and would be excluded by the flow cytometry results.
25 year old man presents to his GP after a 4 week history of intermittent fevers and drenching night sweats.
Blood results show:
WCC 7 Hb 120 Plt 300 Na 140 K 4.0 Creatinine 90 Calcium 2.5
Examination reveals cervical lymphadenopathy, which is biopsied.
On biopsy there are multinucleated cells:
What is the most likely diagnosis?
Mantle Cell Lymphoma
Follicular Lymphoma
Chronic Lymphocytic Leukaemia
Hodgkin’s Lymphoma
Burkitt’s Lymphoma
Hogkin’s lymphoma
Reed-sternburg cells as shown on this biopsy are multi-nucleated cells found in Hodgkins lymphoma.
A 5-year-old African American boy presents with extreme abdominal pain. He has a history of several such episodes, as well as acute episodes of extreme bone pain. What is the most likely mechanism responsible for this patient’s disorder?
a. Trinucleotide repeat expansion
b. Deletion in the gene coding for alpha-globin
c. Point mutation at the 6th position of the beta-globin chain
d. Increased levels of haemoglobin F
e. Reduced levels of folic acid
c. Point mutation at the 6th position of the beta-globin chain
A 35-year-old Caucasian female presents to the emergency room with unilateral leg swelling. She reports that she developed painful left-sided leg swelling and redness earlier in the day. She is otherwise healthy and takes no medications. She denies any recent prolonged travel. She experienced a similar episode affecting the opposite leg one year ago and was diagnosed with a thrombus in the right femoral vein. On examination, the left leg is erythematous and swollen. Passive dorsiflexion of the left ankle elicits pain in the left calf. Ultrasound of the leg reveals a thrombus in the left popliteal vein. A genetic workup reveals that she has an inherited condition. What is the most likely pathophysiology of this patient’s condition?
a. Elevated serum homocysteine
b. Thrombin inhibitor deficiency
c. Protein C deficiency
d. Auto-antibodies against phospholipids
e. Resistance to clotting factor degradation
e. Resistance to clotting factor degradation
A 27-year-old male presents to the emergency department with a one day history of progressive confusion and oliguria. The patient has had several episodes of epistaxis and bleeding gums since the onset of his illness. Past medical history is unremarkable and the patient does not take medications. Temperature is 39C, blood pressure is 100/62 mm Hg, pulse is 95/min, and respiratory rate is 18/min. Physical exam is notable for a purpuric rash in the lower extremities bilaterally. Peripheral blood smear is shows schistocytes. Which of the following is the most likely mechanism behind the patient’s illness?
a. Defect in platelet aggregation
b. Deficiency in degradation of von Willebrand factor multimers
c. Peripheral platelet destruction
d. Defect in platelet-collagen adhesion
e. Decreased levels of von Willebrand factor
b. Deficiency in degradation of von Willebrand factor multimers
A 78 year old man with MDS develops a fever 3 hours after a platelet transfusion and becomes breathless. His observations are as follows:
Temperature 38.5 degrees
Blood pressure 75/40 mmHg
Heart rate 130 bpm
Respiratory rate 32 / minute
Oxygen saturations 92% on 4 litres oxygen via nasal cannulae
What is the diagnosis?
TRALI aka transfusion related acute lung injury is an immune mediated complication which is more likely following FFP or platelet transfusion. Patients present within 6 hours and typically have fever, hypotension and acute dyspnoea.
A 3-month-old African American infant presents to the hospital with 2 days of fever, “coke”-coloured urine, and jaundice. The pregnancy was uneventful except the infant was found to have hyperbilirubinemia that was treated with phototherapy. The mother explains that she breastfeeds her child and recently was treated herself for a UTI with trimethoprim-sulfamethoxazole (TMP-SMX). What is the commonest mode of inheritance of this disorder?
X-linked recessive
What is the reversal agent for heparin?
Protamine
A 65 year old man presents with fatigue to his GP. Blood results show: WCC 7 Hb 90 MCV 80 Na 140 K 4.0 Creatinine 90 Calcium 2.5
Serum electrophoresis shows an IgG paraprotein of 37 g/l
What is the most likely diagnosis?
Multiple myeloma - paraprotein + one of the CRAB symptoms (anaemia) means a likely multiple myeloma.
