meded qs Flashcards
1
Q
Most common Gm -ve cause of UTIs?
Pseudomonas Aeruginosa Enterococcus Escherichia Coli Staphylococcus Saprophyticus Klebsiella
A
Escherichia Coli
2
Q
Which medication is gold standard for the treatment of MSSA?
Vancomycin IV Vancomycin PO Flucloxacillin IV Daptomycin IV Co-Amoxiclav IV
A
Flucloxacillin IV
3
Q
A 27 year old man presents to his GP with a rash on his palms and soles, and on asking for a full history states that he had also noticed an ulcer on his penis which had now healed. Which organism is the most likely cause?
Neisseria Gonorrhoea Chlamydia Trochomatis Herpes Simplex Treponema Pallidum Haemophilus Ducreyi
A
Treponema Pallidum
4
Q
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
A
Visceral leishmaniasis
5
Q
A 55-year-old housewife returns from visiting her relatives in India, with a high fever and with flu-like symptoms. thick and thin films are requested, and Maurer’s clefts are seen under the microscope. The diagnosis is:
Plasmodium falciparum Plasmodium vivax Plasmodium ovale Plasmodium malariae Plasmodium knowlesi
A
Plasmodium falciparum
6
Q
A transplant patient presents to his GP with diarrhoea and abdominal pain. He also complains of increased frequency visual floaters. What is the likely causative organism?
A) Clostridium difficile B) Human Cytomegalovirus C) JC virus D) Rotavirus E) Toxoplasma gondii
A
Human Cytomegalovirus
7
Q
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?
A) Herpes simplex virus B) Human cytomegalovirus C) Rubella virus D) Varicella zoster virus E) Zika virus
A
Varicella zoster virus
8
Q
Select the only drug in the list below that does not inhibit viral nucleic acid synthesis:
A) Cidofovir B) Foscarnet C) Ganciclovir D) Nevirapine E) Saquinavir
A
Saquinavir
9
Q
Which fungus most commonly causes respiratory disease in patients with cystic fibrosis?
A) Aspergillus fumigatus B) Candida albicans C) Cryptococcus neoformans D) Histoplasma capsulatum E) Pseudomonas aeruginosa
A
Aspergillus fumigatus
10
Q
Which organism typically causes a pneumonia with a ground glass appearance on CXR?
A
Pneumocystis jirovecii
11
Q
A man presents to clinic with painful joints, a burning feeling when passing urine and has recently had painful and irritated eyes. Which organism is most likely responsible?
A
Chlamydia Trochomatis
12
Q
Which organism is responsible for gas gangrene?
A
Clostridium Perfrignens
13
Q
A 46-year-old Ethiopian woman presents to her GP with a dry cough and weight loss of 6kg over 3 weeks. A chest x-ray reveals cavitating lung lesions. Which medications should she be prescribed?
A
Rifampicin, Isonizaid, Pyrazinimide, Ethambutol
14
Q
A 20-year-old student seeks medical attention due to recent difficulty in swallowing, and severe weight loss. He has a history of travel in Brazil, where during his trip he was ill with fever, diarrhoea, and vomiting, and swollen purple eyelids. This resolved over 3 weeks with no treatment being necessary. A chest x-ray is ordered as one of his investigations, and this reveals marked dilatation of his oesophagus. Which vector is responsible for transmitting this disease?
A
A 20-year-old student seeks medical attention due to recent difficulty in swallowing, and severe weight loss. He has a history of travel in Brazil, where during his trip he was ill with fever, diarrhoea, and vomiting, and swollen purple eyelids. This resolved over 3 weeks with no treatment being necessary. A chest x-ray is ordered as one of his investigations, and this reveals marked dilatation of his oesophagus. Which vector is responsible for transmitting this disease?
Reduviid Kissing bugs
Chagas
15
Q
A medical student undergoes blood-borne virus screening before starting clinical placements. They test positive for HBsAg and Anti-HBc; negative for IgM anti-HBc and anti-HBs. What is their HBV infection status?
A
Chronic infection
16
Q
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?
A
Hepatitis A
17
Q
Name the mechanism which drives rapid genetic change in influenza virus.
A
Antigenic shift
18
Q
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?
A
Pityriasis versicolor (NB: pityriasis rosea is a viral illness)
19
Q
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?
A
Mucormycosis
20
Q
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
a) Ductal adenocarcinomas commonly arise from
21
Q
A young patient with visual hallucinations and seizures is admitted to the hospital. His routine bloods show a deranged clotting and abnormal LFTs. Which of the following stains would be most useful to identify the underlying cause of his symptoms?
a) congo red
b) giesma
c) rhodanine
d) prussian blue
A
c) rhodanine
Suspecting Wilson’s disease
*stains for copper
22
Q
A young gentleman who works for a catering company presents with jaundice and deranged LFTs. A liver biopsy shows spotty necrosis. What does this likely represent?
a) chronic hepatitis
b) alcoholic hepatitis
c) cirrhosis
d) acute hepatitis
A
acute hepatitis
*spotty necrosis
23
Q
A 50 year old has a breast lump. Biopsy shows atypical cells within the ducts but a regular lumen. What does this likely represent?
a) Invasive ductal carcinoma
b) ductal carcinoma in situ
c) phyllodes tumour
d) ductal papilloma
A
ductal carcinoma in situ
*atypical cells within the ducts but a regular lumen
24
Q
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
A
c) duct ectasia
25
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
Intraepithelial lymphocytes > 20/100
26
What is likely to be seen on biopsy of a child with Hirschsprung’s disease?
a. Absent nerve fibres
b. Increased chromatin and number of nuclei
c. Normal biopsy
d. Absent myenteric ganglia
e. Increase mitotic figures with evidence of basement membrane disruption
d. Absent myenteric ganglia
27
65 year old gentlemen presents to his GP after complaining of a change of bowel habit and some fresh blood in the stools. He goes on to have a colonoscopy which shows some polyps. Which of the following indicates a higher risk of malignant transformation?
a. Higher villous component
b. Higher tubular component
c. Polyp size of 2cm
d. Solitary polyp on background of normal mucosa
e. Degree of anaemia
Higher villous component
28
What is the most common type of renal stone?
a. Uric acid stone
b. Magnesium ammonium phosphate (struvite)
c. Calcium pigment stones
d. Calcium oxalate
e. Sodium oxalate
d. Calcium oxalate
29
What is the most common type of malignant renal cell carcinoma?
a. Papillary cell
b. Transitional cell
c. Clear cell
d. Chromophobe cell
e. Squamous cell
c. Clear cell
30
What is the most common cause of chronic pancreatitis?
Alcohol
31
What is the most common benign liver lesion?
Haemangioma
32
Mallory-denk bodies are seen in what liver condition?
Alcoholic hepatitis
33
Which hepatic lobular zone is most at risk of injury?
Zone 3
34
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
35
A 65 year old male presents to your GP surgery and complains of progressive dysphagia. He reports a 20 pack-year smoking history and previously owned a pub for 35 years.
OGD performed and an oesophageal mass biopsy reveals intercellular bridges and high-keratin content.
What is the diagnosis?
oesophageal squamous cell carcinoma
* intercellular bridges and high-keratin content.
36
Worldwide, what is the most common type of oesophageal malignancy?
oesophageal squamous cell carcinoma
37
A 72 year old male presents to your GP surgery and complains of intermittent pain around the epigastrium. The patient looks slim with obviously loose clothing. He reports a 25 pack-year smoking history.
He undergoes an OGD and a biopsy of the gastric body confirms: mitotic figures, invasion of the basement membrane and signet ring cells.
What is the diagnosis?
diffuse adenocarcinoma (gastric)
38
The stomach mucosa is normally lined with which cell type?
simple columnar epithelium
39
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
40
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?
```
C1q deficiency
Factor B deficiency
SLE
Mannose binding lectin deficiency
C7 deficiency
```
C7 deficiency
C5-7 deficient:
Recurrent severe bacterial meningitis
FHx: meningoccal sepsis
41
A 3 year old child with recurrent infections has been found to be neutropenic on two occasions. There is a mutation in neutrophil elastase (ELA-2). What is the diagnosis?
```
Reticular dysgenesis
Kostmann syndrome
Chronic granulomatous disease
Cyclical neutropenia
Leukocyte adhesion deficiency
```
Cyclical neutropenia
*ELA-2
42
A child presents with recurrent skin abscesses, lymphadenopathy and splenomegaly. An NBT test is negative. The white cell counts and immunoglobulin levels are normal. What is the treatment for this condition?
```
Haematopoietic stem cell transplant
Interferon-gamma
Granulocyte colony stimulating factor
Interferon-alpha
Thymic transplantation
```
Interferon-gamma
*M/BT -ve = chronic granulomatous disease
Tx: IFN gamma
43
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
```
*Familial Mediterranean fever
Painful inflammation of abdo, chest or joints
+ fever
Sometimes rash and headache
MEFV gene
```
44
A 2 year old presents with chronic mucocutaneous candidiasis, hypothyroidism and hypoadrenalism. There is a mutation in transcription factor AIRE. Which of the following is the diagnosis?
```
APECED
APS-1
APLS-1
IPEX
Familial Mediterranean Fever
```
APECED
(Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy)
*chronic mucocutaneous candiasis
45
A 35-year-old man develops diarrhoea with fever and malaise 24 hours after eating a take-away meal. Stool cultures reveal the source of the infection is Salmonella spp. Which antibody is responsible for protecting against gastrointestinal infections?
```
IgA
IgD
IgE
IgG
IgM
```
IgA
46
Which of the following is a conjugate vaccine?
```
A. Diptheria
B. Pneumococcus
C. MMR
D. Yellow Fever
E. HPV
```
B. Pneumococcus – encapsulated bacteria
47
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)
48
Which type of rejection can be treated with plasmapheresis?
```
Acute antibody mediated
Acute cell mediated
Chronic
Graft versus Host Disease
Hyperacute
```
Acute antibody mediated
49
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
50
A 2 year old child with recurrent skin infections, but no pus formation. There is a history of delayed umbilical cord separation at birth. Her investigations show a high neutrophil count, normal immunoglobulin levels and a positive NBT. What is the most likely diagnosis?
Leukocyte adhesion deficiency
*delayed umbilical separation at birth
High neutrophil count
no pus formation
51
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
52
A 6 year old child presents with recurrent infections. He has a past history of cleft palate repair, congenital heart disease and abnormal facies (low set ears). Blood tests show hypocalcaemia and reduced numbers of T cells. What is the most likely diagnosis?
DiGeorge syndrome
53
A young adult presents to clinic with chronic Mycobacterium marinum infection. An NBT test is positive. What is the most likely diagnosis?
Cytokine or cytokine receptor deficiency e.g. IL12 or IFN-gamma or their receptors
54
A six month old baby presents with two recent serious bacterial infections. Blood tests show that CD8+ T cells are present, but not CD4+ T cells. There are normal levels of IgM but IgG levels are low. What is the most likely diagnosis?
Bare lymphocyte syndrome type II
55
Which MHC is most important when matching donors?
DR
DR > B > A
56
Which cell surface receptor does HIV use to enter cells?
CD4
57
What is the name given to differentiated B cells responsible for producing immunoglobulins?
Plasma cells
58
What is the name given to specific dendritic cells that are present in the skin?
Langerhans Cell
59
Which type of rejection can be treated with plasmapheresis?
Acute antibody mediated
60
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
| NR <20
61
Which of the following investigations is most useful for the diagnosis of Conn’s syndrome?
```
Serum cortisol
Plasma Aldosterone
Serum Potassium
Plasma aldosterone:renin ratio
CT abdomen and pelvis
```
Plasma aldosterone:renin ratio
62
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
63
Which of the following drugs is a cause of hyperkalaemia
```
Digoxin
Enalapril
Furosemide
Dalteparin
Monoxidine
```
Enalapril
64
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
65
Which of the following shows a partially compensated metabolic acidosis?
1) pH 7.27 pCO2 3.0 pO2 15.1 HCO3- 9.2
2) pH 7.39 pCO2 2.1 pO2 13.2 HCO3- 12.3
3) pH 7.55 pCO2 2.1 pO2 14.5 HCO3- 29.1
4) pH 7.11 pCO2 5.2 pO2 11.0 HCO3- 6.2
5) pH 7.11 pCO2 9.9 pO2 11.0 HCO3- 16.2
1) pH 7.27 pCO2 3.0 pO2 15.1 HCO3- 9.2
66
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
nonhaemolytic jaundice resulting in high levels of unconjugated bilirubin = brain damage to infants
67
Hyperglycaemic hyperosmolar state is defined by:
1) A glucose of >30 and a serum osmolality of <290
2) A glucose of <30 and a serum osmolality of <290
3) A glucose of <30 and a serum osmolality of >320
4) A glucose of >30 and a serum osmolality of >320
5) A glucose of <30 and serum osmolality of <320
4) A glucose of >30 and a serum osmolality of >320
68
Which of the following is NOT a treatment option for a pituitary mass?
1) Bromocriptine
2) Cabergoline
3) Octreotide
4) Radiotherapy
5) Carbimazole
5) Carbimazole
69
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
2) Type II
70
List 2 causes of hypovolaemic hyponatraemia
```
Diuretics
D/V
burns
ascites
salt-wasting nephropathy
Barter/Gitelman syndrome
Addisons
```
71
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
72
What would you expect to happen to urine specific gravity in diabetes insipidus?
Low or <1.005 (or similar answers)
73
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)
74
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.
75
What is the diagnostic test for hypopituitarism?
Combined pituitary function test
76
What visual field defect is a pituitary macroadenoma most likely to cause?
Bitemporal hemianopia
77
What is the most common cause of addison's worldwide?
Tuberculosis of the adrenals
78
What specific blood test is diagnostic of conns syndrome?
plasma aldosterone renin ratio
79
What is the most common cause of primary hyperparathyroidism?
Parathyroid adenoma
80
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
```
VWD - 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.
81
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.
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.
* CD34, CD19 and TdT.
* *t(9;22)
82
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 multi-nucleated cells:
```
What is the most likely diagnosis?
Mantle Cell Lymphoma
Follicular Lymphoma
Chronic Lymphocytic Leukaemia
Hodgkin’s Lymphoma
Burkitt’s Lymphoma
```
Reed-sternburg cells as shown on this biopsy are multi-nucleated cells found in Hodgkins lymphoma.
83
A 60 year old lady presents to her GP with tiredness. Examination reveals a mass in the left side of the abdomen.
FISH for BCR-ABL1 is negative.
Blood tests show: WCC 3.0 Hb 70 Platelets 50 Neuts 1.5
Blood film shows poikilocytes
```
What is the most likely diagnosis?
Myelodysplastic syndrome
Acute Myeloid Leukaemia
Acute Lymphocytic Leukaemia
Chronic Myeloid Leukaemia
Myelofibrosis
```
While the blood film is helpful in this case (showing tear drop poikilocytes) this can be answered without looking at it.
Massive splenomegaly has a limited number of causes and the only other cause on the list of options is CML.
Negative fish for BCR-ABL1 points us away from this and towards myelofibrosis.
Myelofibrosis can present with JAK2 mutation and MPL mutation.
84
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
Suspect sickle cell disease
85
A 7-year-old male is brought to his pediatrician for an annual physical. Routine blood work demonstrates hematocrit of 35% and a mean corpuscular volume of 72 fL. Red cell distribution width (RDW) is within normal limits. Electrophoresis demonstrates slightly diminished HbA1, elevated HbA2 and and normal HbF.
Of the following, which is the most appropriate next step in management?
a. Splenectomy
b. Folic acid supplementation
c. Iron supplementation
d. Blood transfusion
e. No treatment necessary
e. No treatment necessary
86
A 48-year-old woman is admitted to the hospital and requires anticoagulation. She is administered a drug that binds tightly to antithrombin III. Which of the following drugs was administered?
a. Enoxaparin
b. Aspirin
c. Warfarin
d. Rivaroxaban
e. Dabigatran
a. Enoxaparin
87
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
Resistance to clotting factor degradation
88
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
89
A 60 year old man presents to the GP with tiredness and pallor. He occasionally drinks alcohol and eats a normal diet. Examination is unremarkable. He has a past medical history of hypertension and ischaemic heart disease. He is taking aspirin, clopidogrel, ramipril and bisoprolol. Bloods show:
Haemoglobin 84g/l (135-170)
MCV 65fl (80-100)
White cell count 5.2 (4.0-11.0)
Platelet count 200 (150-400)
Blood film: microcytic, hypochromic cells. Pencil cells present.
What is the diagnosis?
Answer: Iron deficiency anaemia - microcyctic anaemia is typical. Pencil cells are specific for iron deficiency.
90
```
A 30 year old woman presents to A&E with acute unprovoked intracranial haemorrhage. Blood results done on admission are abnormal:
White cell count 17 (4-11)
Neutrophils 2.0 (1.5-5.5)
Lymphocytes 0.8 (1.0-2.5)
Haemoglobin 80g/l (115-155)
Platelets 12 (150-400)
PT 30 seconds (11-13)
APTT 67 seconds (30-40)
```
A blood film shows the presence of blast cells and auer rods. Urgent FISH for t(15;17) is positive.
What is the diagnosis?
Answer: APML / APL (acute promyelocytic leukaemia).
This is a clinically important subtype of acute myeloid leukaemia (which is also a correct answer, just not as specific) which often presents with DIC. It is essential to pick up early as it can be treated with all-trans retinoic acid - vitamin A.
91
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?
Answer: 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.
92
A 25 year old African man presents with a painful growing lump under the jaw. This is biopsied and histology shows a “starry sky appearance”. What is the diagnosis?
Answer: Burkitt’s lymphoma
93
A 28-year-old male is found to have 93% HbA, 2% HbF, and 5% HbA2 on hemoglobin electrophoresis. Which of the following is the most likely diagnosis?
Beta-thalassaemia minor
94
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
95
What is the reversal agent for heparin?
Protamine
96
A 5-year-old boy presents to the emergency room with rapid onset swelling of his right knee after falling while playing. Upon further questioning his mother states, that while he has no other significant past medical history, he has always bruised easily. The patient also had an uncle who died from blood loss after a benign surgical procedure. On physical exam the patient has multiple ecchymoses on his arms, legs and abdomen, in various stages of healing. His right knee is swollen, erythematous and tender. Arthrocentesis yields bloody aspirate with 1000 white blood cells (WBCs). Laboratory analysis is significant for a bleeding time of 4 minutes (normal: 3-10 minutes) and a aPTT of 67 seconds (normal: 30-40 seconds) What medical condition is the likely underlying cause to his knee swelling?
Either haemophilia A or haemophilia B
97
An 82-year-old woman is brought to the emergency room after her neighbour saw her fall in the hallway. She lives alone and remarks that she has been feeling weak lately. Neurological examination is unremarkable. Her diet consists of packaged foods and canned meats. Laboratory studies are ordered as seen below. Haemoglobin = 91 g/L, MCV = 110 fL. What is the most likely vitamin deficiency?
Either folic acid or folate or vitamin B9
98
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?
Answer: Multiple myeloma
- paraprotein + one of the CRAB symptoms (anaemia) means a likely multiple myeloma.
99
A 26 year old known I.V. drug user presents with fever, weakness, lassitude and night sweats. On examination you discover a heart murmur.
What is the diagnosis?
Possible responses: acute endocarditis, endocarditis
100
A 70 year old known teetotal patient is noted to have a heart murmur and careful examination reveals splenomegaly with an obvious notch and you can’t get above it. There are no visible veins on the anterior abdominal wall, and there is no ascites, so you conclude that there is no portal hypertension. Dipstick of the urine reveals microscopic haematuria. She is found to have a temperature of between 37.5oC and 38.5oC whenever it is checked.
What is the diagnosis?
Possible responses: endocarditis, subacute bacterial endocarditis
101
A liver biopsy histology is reported as showing “A "nutmeg" appearance”. What is the most likely diagnosis?
Possible responses: Cardiac failure, Comgestive cardiac failure, Congeative cardiac failure, Congestive cardiac failure, Congestive cardiac failure/right heart failure, Congestive heart failure, Congestive hepatopathy, Congestive right heart failure, Heart failure, Heart failure (right side or both sides), Heart failure (right sided or congestive), Liver Congestion (heart failure), Right-sided heart failure, Right heart failure, Right sided cardiac failure, Right sided heart failure, cardiac failure (Right sided or congestive), congestive heart failure
102
When stained with Congo red stain, an apple green birefringence is seen in a liver biopsy. What is the most likely diagnosis?
Possible responses: AA amyloidosis, Ameyloidosis, Amylodosis, Amyloid, AmyloidOsis, Amyloid deposition, Amyloidoisis, Amyloidosis, amyloidosis
103
A liver biopsy histology is reported as showing “NON Caseating granulomata”. What is the most likely diagnosis?
Possible responses: Sacoidosis, Sarcoid, Sarcoidosis, Sarcoidosis of the liver, Sarcoisosis, Satcoidosis, sarcoidosis
104
A liver biopsy histology is reported as showing “Caseating granulomata”. What is the most likely diagnosis?
Possible responses: Liver tuberculosis, Microbacterium tuberculosis, Miliary tb, Mycobacterium tuberculosis, TB, TB Infection, TUberculosis, Tb, Tubeculosis, Tubercullosis, Tuberculosis, Tuberculosis (miliary), Tuberculosis infection, Tuberculosis of the liver, tb, tuberculosis
105
When stained with a Rhodanine stain a liver biopsy reveals a golden brown colour against the blue counterstain. What is the most likely diagnosis?
Possible responses: Copper, Copper deposits, Wilson's, Wilson's Disease, Wilson's disease , Wilson disease, Wilsons, Wilsons Disease, Wilsons diseAse, Wilsons disease, wilsons disease
106
An 11 year daughter of an anti-Vaxxer old presents with a fever red eyes, a runny nose and a pink rash that began on the face and then spread downwards to the rest of the body.
What is the most likely diagnosis?
Possible responses: German measles, Rubella
107
Name the disorder of calcium handling most commonly seen in patients with end-stage chronic renal failure, in which the plasma calcium is raised.
```
A. Hypoparathyroidism
B. Primary Hyperparathyroidism
C. Pseudohypoparathyroidism
D. Secondary Hyperparathyroidism
E. Tertiary Hyperparathyroidism
```
E. Tertiary Hyperparathyroidism
108
Name the peptide hormone responsible for increasing plasma calcium in response to reduced calcium levels by stimulating osteoclast activity.
```
A. Calcitonin
B. Calcitriol
C. Cholecalciferol
D. Ergocalciferol
E. Parathyroid Hormone
```
E. Parathyroid Hormone
109
Name the form of vitamin D produced following the action of 1alpha hydroxylase on 25-OH D3 in the kidney.
```
A. Calcitonin
B. Calcitriol
C. Cholecalciferol
D. Ergocalciferol
E. Vitamin D3
```
B. Calcitriol
110
```
Which of the options acts to stimulate 1alpha hydroxylase activity in the kidney to increase the production of vitamin D3.
A. Calcitonin
B. Calcitriol
C. Cholecalciferol
D. Ergocalciferol
E. Parathyroid Hormone
```
E. Parathyroid Hormone
111
A patient has a positive Coombes test (positive direct antiglobulin test). Which is the most likely diagnosis?
A. Auto-immune haemolytic anaemia (AIHA)
B. Disseminated intravascular haemolysis (DIC)
C. Hereditary spherocytosis
D. Micro-angiopathic haemolytic anaemia (MAHA)
E. Polycytheamia Rubra Vera
A. Auto-immune haemolytic anaemia (AIHA)
112
18. Antibodies to phospholipase A2 receptor are associated with what form of glomerulonephritis?
```
A. Crescentic
B. Goodpastures disease
C. Membranous
D. Minimal change
E. Rapidly progressive
```
C. Membranous
113
19. Which of the following cause a polycythaemia?
```
A. Adrenal cortical carcinoma
B. Colonic carcinoma
C. Prostatic carcinoma
D. Renal cell carcinoma
E. Transitional cell carcinoma of the bladder
```
D. Renal cell carcinoma CORRECT ANSWER
114
```
20. What is the specific auto-antigen that is the target of the immune system in Goodpastures syndrome?
A. Osteoblasts
B. Osteoclasts
C. Skin
D. Spectrin
E. Type IV Collagen
```
E. Type IV Collagen
115
21. Which of the following is most diagnostic for Rheumatoid arthritis?
A. Anti-CCP (cyclic citrullinated peptide) Antibody
B. Anti-Centromere Antibody
C. Anti-GAD (glutamic acid decarboxylase) Antibody
D. Anti-Mitochondrial Antibody
E. Rheumatoid Factor
A. Anti-CCP (cyclic citrullinated peptide) Antibody
116
22. Which of these is particularly associated with longstanding bronchiectasis?
```
A. E-Coli
B. Pseudomonas Aeruginosa
C. Staph aureus
D. Strep pneumoniae
E. Strep pyogenes
```
B. Pseudomonas Aeruginosa
117
```
23. Which of these is most likely to CAUSE bronchiectasis?
A. E-coli
B. Pseudomonas Aeruginosa
C. Staph aureus
D. Strep pneumoniae
E. Strep pyogenes
```
C. Staph aureus
118
24. A 40 year old woman has always known cramping pain associated with her periods – which have usually been heavy. Recently this pain has become constant throughout the month, and her periods have become more frequent. She claims never to have used oral contraception and has no children. She is abstaining from sexual intercourse as it is too painful.
What is the likely diagnosis?
```
A. Cervical Polyps
B. Endometriosis
C. Fibroids
D. Herpes Virus Infection
E. Polycystic Ovary Syndrome
```
B. Endometriosis
119
25. Which of these is associated with hyperkalaemia?
```
A. Addison’s disease
B. Conn’s syndrome
C. Ectopic ACTH
D. Prostate cancer
E. Renal artery stenosis
```
A. Addison’s disease
