Mock Questions Flashcards
What is the correct pathological term for a discontinuation in the epithelial surface?
Ulcer
A 65 year old male with a long history of epigastric pain. Endoscopy reveals 3.2cm of columnar metaplasia in the lower oesophagus. What does this suggest?
Barrett’s Oesophagus
What is the technical term for a connection between two epithelial surfaces, as occurs in Crohns disease where for example there might be a connection between the bladder and the bowel?
Fistula
A 46-year old Japanese female is found to have bilateral ovarian masses on imaging of the abdomen and had both ovaries removed. Histology revealed malignant signet ring cells containing mucin in both ovaries. What is the diagnosis?
Krukenberg Tumour
A 50 year-old female was found to have an ovarian mass. On its removal, histology revealed several cell types, including thyroid follicles, hair and teeth. What is the likely diagnosis?
Teratoma
A 40 year-old female non-smoker presents with a one week history of fever, shortness of breath and a cough productive of rusty coloured sputum. Microscopy of the sputum is shown (Gram positive diplococci). What is the organism?
Strep Pneumoniae
37 year-old man presents with a headache, myalgia and a cough. He is also suffering with nausea, diarrhoea and abdominal pain. On examination he is tachypnoeic and has a pyrexia of 39ºC. Blood tests reveal lymphopenia and hyponatraemia. A gram stain from the patients sputum is shown here (Gram negative rods). CXR shows lobar consolidation. Cold agglutinins are negative. What is the organism?
Legionnaires Disease
A 40 year-old woman presents with malaise, muscular pains and diarrhoea with mucus and blood. On examination she has a fever and several distinctive spots on her abdomen (Rose spots). Blood cultures are positive and grow gram negative rods. What is the likely organism?
Salmonella Typhae
A genus of spiral flagellated Gram negative bacteria. Found in the stomach within the mucosa layer. It occurs in the majority of middle-aged people and causes progressive gastritis. Invariably present in duodenal ulceration and usually in gastric ulceration.
Heliobacter Pylori
Which tumour is caused by Human Herpes virus 8?
Kaposi’s Sarcoma
A 28-year old woman presents with malaise, weight loss, and abdominal pain. Both anti-tissue transglutaminase (tTG) and anti-endomyseal (EMA) antibodies were found in the serum. What is the likely diagnosis?
Coeliac Disease
The same 28-year old woman with anti-tissue transglutaminase (tTG) and anti-endomyseal (EMA) antibodies wanted to know if she needed any further investigations. What gold standard diagnostic test should be undertaken?
Duodenal Biopsy
A 4 year old girl presents to the A&E with a recurrent chest infection that will not clear. On examination, the house officer notices that she has low set ears, a cleft palate and a murmur. Investigations reveal:
Calcium 1.9 mM (NR 2.2 to 2.6); Phosphate 1.4 mM (NR 0.8 to 1.4)
PTH 1.1 pM (NR 1.1 to 6.8)
Di George Syndrome
A 40-year old lady complains of tight fingers and dysphagia, and is thought to have a syndrome associated with Raynaud’s phenomenon, and telangiectasia. What antibody should we measure to confirm this possible diagnosis?
Anti-centromere
A 32-year old woman is thought to have Graves’ disease. What antibody should you look for?
Anti-TSH Receptor antibodies
In a patient with Hodgkins Lymphoma, the stage of disease is given by the amount of spread, with stage 1 disease involving only one group of nodes, and stage IV disease involving extra nodal spread. What would stage III Hodgkins disease suggest?
Spread to both sides of body and below diaphragm too
Give one feature that would make you add the suffix “B” to the stage of the Hodgkins disease.
Fever, night sweats or 10% weight loss
What type of neutrophil is shown in the middle of this blood film, in this patient known to have pernicious anaemia?
Hypersegmented Neutrophil
A patient is thought to have multiple myeloma. What is found in the urine that will confirm this diagnosis?
Bence Jones protein
A 51-year old man is having investigations for palliative surgery due to gastric adenocarcinoma. He is found to be anaemic, with high a reticulocyte count and fragmented red blood cells on blood smear. What is this anaemia known as?
MAHA
A 67-year-old woman presented with confusion 2 days after a cholecystectomy. She had experienced some pain postoperatively, largely relieved by analgesia. On examination, she was disoriented, her heart rate was 66 beats per minute and her blood pressure was 162/82 mmHg. She only had minor discomfort of the abdomen. The urine sodium was 90mmol/l (NR 20-200mmol/l depending on hydration of patient).
The figure below shows the colours you would see on the dipstick after it has been dipped in the urine, and it was yellow in colour, consistent with an SG of 1.030.
Investigations:
Haemoglobin 130 g/L (115-165)
MCV 92 fL (80-96)
white cell count and platelet count normal
serum sodium 120 mmol/L (137-144)
serum potassium 3.7 mmol/L (3.5-4.9)
serum urea 3 mmol/L (2.5-7.0)
serum creatinine 90 µmol/L (60-110)
serum albumin 36 g/L (37-49)
random plasma glucose 5 mmol/L
What is the most likely cause of the low sodium
SIADH
A 45 year old woman, presents with increasing pain in her thighs and hips. Blood results : Ca – 2.4 mmol/L (2.2 to 2.6), Phosphate – 0.9 mmol/L (0.8 to 1.4), PTH – 5.0 pmol/L (1.1 to 6.8), ALP 3900 (39-120).What is the likely diagnosis?
Paget’s disease
A patient presents with weakness and is found to have a potassium of 2.4mM (NR 3.5 to 5.0). What is the likely acid-base abnormality if you check the patients arterial blood gas?
Metabolic Alkalosis
Name the drug used for patients with type 2 diabetes which inhibits the enzyme alpha glucosidase in the brush border membrane of the small bowel.
Acarbose
Name an example of a drug that inhibits the enzyme dipeptidyl dipeptidase IV (DPP-4)
Sitagliptins
What is the condition in which infiltrates show characteristic green staining of the myocardium with Congo Red?
Amyloidosis
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?
Infective Endocarditis Staph Aureus
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?
Infective Endocarditis Strep Viridans
A 7 year old girl complains of a rash on her chest and painful joints. She has some nodules on her elbows and has some difficulty walking and appears clumsy with apparent random arm movements, as if she is trying to dance. On further questioning you discover she had recovered from a sore throat a fortnight ago.
What is the diagnosis?
Rheumatic Fever
A 44 year old male presents to A&E with a sharp centralised chest pain which is relieved by sitting forwards. A pericardial rub is heard at the left sternal edge.
What is the diagnosis?
Pericarditis
A 34 year old female presents with breathlessness. Investigations reveal normal renal function, but a calcium of 3.0mM and a suppressed PTH. Chest X-ray reveals bilateral hilar lymphadenopathy.
What is the diagnosis?
Sarcoidosis
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
Tertiary Hyperparathyroidism
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
PTH
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
Calcitirol
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
PTH
What is the diagnosis in a patient with a plasma calcium concentration of 2.9mmol/L (2.2-2.6),
a normal creatinine, a phosphate concentration of 0.76mmol/L (0.8-1.2), a parathyroid hormone level of 4.2pmol/L (1.1-6.8).
A. Malignant hypercalcaemia B. Primary Hyperparathyroidism C. Pseudohypoparathyroidism D. Secondary Hyperparathyroidism E. Tertiary Hyperparathyroidism
Primary Hyperparathyroidism
A 69 year old male smoker is rushed into hospital complaining of severe breathlessness when walking upstairs. He is tachycardic with a reduced pulse volume and you also note that his ankles are considerably swollen.
What is the diagnosis?
A. Cardiac Failure B. Myocardial Infarction C. Restrictive Cardiomyopathy D. Stable Angina E. Sub-acute Bacterial Endocarditis
Cardiac Failure
A young fit 22 year old is rushed into A&E after complaining of a severe chest pain and breathlessness. A loud fourth heart sound is heard.
What is the diagnosis?
A. Cardiac Failure B. Myocardial Infarction C. Restrictive Cardiomyopathy D. Stable Angina E. Sub-acute Bacterial Endocarditis
Restrictive Cardiomyopathy
A 65 year old male is found to have an Hb of 190g/l on a routine blood test, EPO levels were normal. On examination he is found to have splenomegaly and engorgement of the retinal vein. Bone marrow histology showed increased cellularity of erythroid cells.
What is the most likely diagnosis?
A. Chronic hypoxia B. Chronic lymphocytic leukemia C. Essential thrombocythaemia D. Myeloma E. Polycythaemia Vera
Polycythaemia Vera
A 30yr old female was found to have Hb 130g/l, WC 11.0 x109/L and platelets=690x109/L on three separate occasions. Her CRP and ESR were within the normal range. She suffered a DVT 3 months ago.
What is the likely diagnosis?
A. Chronic lymphocytic leukemia B. Chronic myeloid leukemia C. Essential thrombocythaemia D. Myeloma E. Polycythaemia Vera
Essential thrombocythaemia
Imatinib can be used in the treatment for which of these conditions?
A. Acute lymphoblastic leukaemia B. Acute myeloid leukaemia C. Chronic lymphocytic leukemia D. Chronic myeloid leukemia E. Myeloma
CML
Copper carrying protein with oxidase activity.
A. Alpha-1- antitrypsin B. Alpha-fetoprotein C. Bence-Jones protein D. C1-esterase inhibitor E. C3 F. CA19.9 G. Caeruloplasmin H. Carcinoembryonic antigen I. C-reactive protein J. Immunoglobulin E K. Transferrin
Caeruloplasmin
Low levels are present in Wilson’s disease (hepatolenticular degeneration)
A. Alpha-1- antitrypsin B. Alpha-fetoprotein C. Bence-Jones protein D. C1-esterase inhibitor E. C3 F. CA19.9 G. Caeruloplasmin H. Carcinoembryonic antigen I. C-reactive protein J. Immunoglobulin E K. Transferrin
Caeruloplasmin
A 40 year old man who has never smoked develops severe emphysema. Which protein may be deficient?
A. Alpha-1- antitrypsin B. Alpha-fetoprotein C. Bence-Jones protein D. C1-esterase inhibitor E. C3 F. CA19.9 G. Caeruloplasmin H. Carcinoembryonic antigen I. C-reactive protein J. Immunoglobulin E K. Transferrin
A1AT
Which protein appears in the urine in patients with myeloma?
A. Alpha-1- antitrypsin B. Alpha-fetoprotein C. Bence-Jones protein D. C1-esterase inhibitor E. C3 F. CA19.9 G. Caeruloplasmin H. Carcinoembryonic antigen I. C-reactive protein J. Immunoglobulin E K. Transferrin
Bence-Jones
Tumour marker associated with colorectal cancer.
A. Alpha-1- antitrypsin B. Alpha-fetoprotein C. Bence-Jones protein D. C1-esterase inhibitor E. C3 F. CA19.9 G. Caeruloplasmin H. Carcinoembryonic antigen I. C-reactive protein J. Immunoglobulin E K. Transferrin
CEA
15 year old male with cystic fibrosis has a chronic productive cough with green sputum. What is the likely organism?
A. Chlamydia pneumoniae B. Chlamydia psittaci C. Klebsiella pneumoniae D. Legionella pneumophila E. Mycobacterium tuberculosis F. Mycoplasma pneumoniae G. Pneumocystis carinii pneumonia H. Pseudomonas aeruginosa I. Staph aureus J. Strep. Pneumonia
H
A 75 year old male non smoker presented with a cough productive of sputum and fever. He was short of breath and felt a ‘catching’ chest pain upon breathing in. Chest X-ray showed consolidation in the right lower lobe.
A. Chlamydia pneumoniae B. Chlamydia psittaci C. Klebsiella pneumoniae D. Legionella pneumophila E. Mycobacterium tuberculosis F. Mycoplasma pneumoniae G. Pneumocystis carinii pneumonia H. Pseudomonas aeruginosa I. Staph aureus J. Strep. Pneumonia
J
An otherwise healthy 25 year old female complained of ‘flu like’ symptoms following return from Mexico. She had a headache, weakness and joint pains and had developed a dry cough. Tests detected the presence of cold agglutins.
A. Chlamydia pneumoniae B. Chlamydia psittaci C. Klebsiella pneumoniae D. Legionella pneumophila E. Mycobacterium tuberculosis F. Mycoplasma pneumoniae G. Pneumocystis carinii pneumonia H. Pseudomonas aeruginosa I. Staph aureus J. Strep. Pneumonia
F
A 25 year old HIV positive man presented with a two week history of a bloody cough and night sweats. He had lost weight and had a fever. Chest X-Ray revealed hilar lymphadenopathy and left sided upper lobe shadowing.
A. Chlamydia pneumoniae B. Chlamydia psittaci C. Klebsiella pneumoniae D. Legionella pneumophila E. Mycobacterium tuberculosis F. Mycoplasma pneumoniae G. Pneumocystis carinii pneumonia H. Pseudomonas aeruginosa I. Staph aureus J. Strep. Pneumonia
E
A 45 year old business man was previously well. One week after staying in a hotel he developed diarrhoea, nausea and weakness. He had a headache and on examination was confused and pyrexial. Tests revealed lymphopaenia and hyponatraemia.
A. Chlamydia pneumoniae B. Chlamydia psittaci C. Klebsiella pneumoniae D. Legionella pneumophila E. Mycobacterium tuberculosis F. Mycoplasma pneumoniae G. Pneumocystis carinii pneumonia H. Pseudomonas aeruginosa I. Staph aureus J. Strep. Pneumonia
D
If an unvaccinated pregnant woman became infected with this virus the baby can be born with a congenital syndrome. Features of this syndrome include mental retardation, cataracts, deafness and heart defects.
A. Cholera B. Diphtheria C. Haemophilus influenzae type B D. Hepatitis B E. Hepatitis C F. Measles G. Meningitis C H. Mumps I. Pertussis J. Polio K. Rabies L. Rubella M. Tetanus N. Tuberculosis O. Typhoid P. Varicella-zoster
L
The inactivated vaccine is highly effective in preventing this virus’ potentially devastating paralysing effects. This vaccine is given at 2, 3 and 4 months of age and two further boosters are given, one between 3-5 years of age and one between 13-18 years of age.
A. Cholera B. Diphtheria C. Haemophilus influenzae type B D. Hepatitis B E. Hepatitis C F. Measles G. Meningitis C H. Mumps I. Pertussis J. Polio K. Rabies L. Rubella M. Tetanus N. Tuberculosis O. Typhoid P. Varicella-zoster
J
The recombinant protein vaccine for this virus is given to at risk individuals. This virus can cause jaundice.
A. Cholera B. Diphtheria C. Haemophilus influenzae type B D. Hepatitis B E. Hepatitis C F. Measles G. Meningitis C H. Mumps I. Pertussis J. Polio K. Rabies L. Rubella M. Tetanus N. Tuberculosis O. Typhoid P. Varicella-zoster
D
Vaccination has reduced the incidence of meningitis caused by this organism in five year olds over the last 10 years.
A. Cholera B. Diphtheria C. Haemophilus influenzae type B D. Hepatitis B E. Hepatitis C F. Measles G. Meningitis C H. Mumps I. Pertussis J. Polio K. Rabies L. Rubella M. Tetanus N. Tuberculosis O. Typhoid P. Varicella-zoster
C
The vaccine for this virus is a diploid cell vaccine containing the inactivated form. In the later stages of infection with this virus the sight of water induces convulsions and paralysis.
A. Cholera B. Diphtheria C. Haemophilus influenzae type B D. Hepatitis B E. Hepatitis C F. Measles G. Meningitis C H. Mumps I. Pertussis J. Polio K. Rabies L. Rubella M. Tetanus N. Tuberculosis O. Typhoid P. Varicella-zoster
K
A 23 year old male, who has just commenced treatment with penicillin, presents with confusion, weakness and seizures. On examination you notice that he is pale, bruised and breathing deeply.
A. Acute Tubular Necrosis B. Acute Tubulointerstitial Nephritis C. Chronic Tubulointerstitial Nephritis D. Diabetic Retinopathy E. Focal Segmental Glomerulosclerosis F. Goodpasture's Syndrome G. Hypertensive Renal Damage H. IgA Nephropathy I. Membranous Glomerulonephritis J. Mesangiocapillary Glomerulonephritis K. Minimal Change Glomerulonephritis L. Pyelonephritis M. SLE Nephritis N. Wegener’s Granulomatosis
B
A 45 year old female presents with swelling of the ankles and abdomen. Urine dipstick shows proteinuria +++ but no blood. Light microscopy detects a thickening of the glomerular basement membrane.
A. Acute Tubular Necrosis B. Acute Tubulointerstitial Nephritis C. Chronic Tubulointerstitial Nephritis D. Diabetic Retinopathy E. Focal Segmental Glomerulosclerosis F. Goodpasture's Syndrome G. Hypertensive Renal Damage H. IgA Nephropathy I. Membranous Glomerulonephritis J. Mesangiocapillary Glomerulonephritis K. Minimal Change Glomerulonephritis L. Pyelonephritis M. SLE Nephritis N. Wegener’s Granulomatosis
I
A 7 year old boy presents with swelling of the legs and sacrum. Urine dipstick shows no haematuria but two ++ of proteinuria ++.
A. Acute Tubular Necrosis B. Acute Tubulointerstitial Nephritis C. Chronic Tubulointerstitial Nephritis D. Diabetic Retinopathy E. Focal Segmental Glomerulosclerosis F. Goodpasture's Syndrome G. Hypertensive Renal Damage H. IgA Nephropathy I. Membranous Glomerulonephritis J. Mesangiocapillary Glomerulonephritis K. Minimal Change Glomerulonephritis L. Pyelonephritis M. SLE Nephritis N. Wegener’s Granulomatosis
K
A 25 year old male notices blood in his urine. Light microscopy detects mesangial cell proliferation.
A. Acute Tubular Necrosis B. Acute Tubulointerstitial Nephritis C. Chronic Tubulointerstitial Nephritis D. Diabetic Retinopathy E. Focal Segmental Glomerulosclerosis F. Goodpasture's Syndrome G. Hypertensive Renal Damage H. IgA Nephropathy I. Membranous Glomerulonephritis J. Mesangiocapillary Glomerulonephritis K. Minimal Change Glomerulonephritis L. Pyelonephritis M. SLE Nephritis N. Wegener’s Granulomatosis
J
A 45 year old female presents with swelling of the ankles and abdomen. Urine dipstick shows proteinuria +++ but no blood. Light microscopy detects segmental scarring of the glomeruli.
A. Acute Tubular Necrosis B. Acute Tubulointerstitial Nephritis C. Chronic Tubulointerstitial Nephritis D. Diabetic Retinopathy E. Focal Segmental Glomerulosclerosis F. Goodpasture's Syndrome G. Hypertensive Renal Damage H. IgA Nephropathy I. Membranous Glomerulonephritis J. Mesangiocapillary Glomerulonephritis K. Minimal Change Glomerulonephritis L. Pyelonephritis M. SLE Nephritis N. Wegener’s Granulomatosis
E
Condition caused by progressive loss of myocytes.
A. Acute Myocardial Infarction B. Aortic Stenosis C. Atherosclerosis D. Dilated Heart Failure E. Hypertrophic obstructive Cardiomyopathy (HOCM) F. Hypothyroidism G. Infective Endocarditis H. Marfan's Syndrome I. Pericardial Effusion J. Rheumatic Valve Disease K. Ventricular Septal Defect
D
Long-standing result of previous acute inflammation of the heart.
A. Acute Myocardial Infarction B. Aortic Stenosis C. Atherosclerosis D. Dilated Heart Failure E. Hypertrophic obstructive Cardiomyopathy (HOCM) F. Hypothyroidism G. Infective Endocarditis H. Marfan's Syndrome I. Pericardial Effusion J. Rheumatic Valve Disease K. Ventricular Septal Defect
J
Condition caused by a genetic defect in myofilament formation leading to large myocytes.
A. Acute Myocardial Infarction B. Aortic Stenosis C. Atherosclerosis D. Dilated Heart Failure E. Hypertrophic obstructive Cardiomyopathy (HOCM) F. Hypothyroidism G. Infective Endocarditis H. Marfan's Syndrome I. Pericardial Effusion J. Rheumatic Valve Disease K. Ventricular Septal Defect
E
Condition of structural calcification causing onset of a murmur late in life
A. Acute Myocardial Infarction B. Aortic Stenosis C. Atherosclerosis D. Dilated Heart Failure E. Hypertrophic obstructive Cardiomyopathy (HOCM) F. Hypothyroidism G. Infective Endocarditis H. Marfan's Syndrome I. Pericardial Effusion J. Rheumatic Valve Disease K. Ventricular Septal Defect
B
Condition in which a patient develops splinter haemorrhages in the nail beds.
A. Acute Myocardial Infarction B. Aortic Stenosis C. Atherosclerosis D. Dilated Heart Failure E. Hypertrophic obstructive Cardiomyopathy (HOCM) F. Hypothyroidism G. Infective Endocarditis H. Marfan's Syndrome I. Pericardial Effusion J. Rheumatic Valve Disease K. Ventricular Septal Defect
G
The most appropriate treatment for a surgical wound from which MRSA is isolated.
A. Anaerobic bacteria B. Benzyl penicillin C. Cephalosporin D. Clostridium perfringens E. Clostridium tetanae F. Flucloxacillin G. Metronidazole H. Mycobacterium tuberculosis I. Neisseria meningitidis J. Pasterulla multocida K. Salmonella L. Shigella M. Staph. Aureus N. Strep. pyogenes O. Vancomycin
O
A gram positive bacillus that produces α-toxin causing gas gangrene in infected wounds.
A. Anaerobic bacteria B. Benzyl penicillin C. Cephalosporin D. Clostridium perfringens E. Clostridium tetanae F. Flucloxacillin G. Metronidazole H. Mycobacterium tuberculosis I. Neisseria meningitidis J. Pasterulla multocida K. Salmonella L. Shigella M. Staph. Aureus N. Strep. pyogenes O. Vancomycin
D
A man punches someone in a pub brawl. The recipient then bites his hand. Later the bite wound becomes infected, with lots of pus and a foul smell. The most likely pathogen is?
A. Anaerobic bacteria B. Benzyl penicillin C. Cephalosporin D. Clostridium perfringens E. Clostridium tetanae F. Flucloxacillin G. Metronidazole H. Mycobacterium tuberculosis I. Neisseria meningitidis J. Pasterulla multocida K. Salmonella L. Shigella M. Staph. Aureus N. Strep. pyogenes O. Vancomycin
A
The most appropriate treatment for the man in case the last case who punched someone in a pub brawl. The recipient then bites his hand. Later the bite wound becomes infected, with lots of pus and a foul smell. The most appropriate treatment is?
A. Anaerobic bacteria B. Benzyl penicillin C. Cephalosporin D. Clostridium perfringens E. Clostridium tetanae F. Flucloxacillin G. Metronidazole H. Mycobacterium tuberculosis I. Neisseria meningitidis J. Pasterulla multocida K. Salmonella L. Shigella M. Staph. Aureus N. Strep. pyogenes O. Vancomycin
G
A gram-positive β-haemolytic coccus that can cause pharyngitis, erysipelas and cellulitis.
A. Anaerobic bacteria B. Benzyl penicillin C. Cephalosporin D. Clostridium perfringens E. Clostridium tetanae F. Flucloxacillin G. Metronidazole H. Mycobacterium tuberculosis I. Neisseria meningitidis J. Pasterulla multocida K. Salmonella L. Shigella M. Staph. Aureus N. Strep. pyogenes O. Vancomycin
N
Lichen planus is an example of which type of inflammatory reaction pattern.
Lichenoid
Where in the epidermis does the bullae in pemphigus vulgaris form?
Within the epidermis
White/silvery plaques on the extensor surface are seen in which clinical dermatological condition?
Psoriasis
Which common skin cancer does NOT metastasize?
Basal cell carcinoma
A liver biopsy histology is reported as showing “Caseating granulomata”. What is the most likely diagnosis?
TB
A liver biopsy histology is reported as showing “NON Caseating granulomata”. What is the most likely diagnosis?
Sarcoidosis
A liver biopsy histology is reported as showing “A “nutmeg” appearance”. What is the most likely diagnosis?
Heart failure
When stained with a Rhodanine stain a liver biopsy reveals a golden brown colour against the blue counterstain. What is the most likely diagnosis?
Wilson’s disease
What is a rhodamine stain used for
Acid fast bacilli
What is the correct term for a ‘rodent ulcer’?
BCC
Blood biochemistry reveals: Na+ 119 mmol/l K+ 4.5 mmol/l Cl- 84 mmol/l HCO3- 25 mmol/l Urea 3.2 mmol/l Creatinine 97 micromol/l Plasma osmolality 249 mmol/kg Urine biochemistry reveals: Na+ 57 mmol/l K+ 26 mmol/l Urine osmolality 530 mmol/kg What is the most likely diagnosis? a. Conn’s syndrome b. Cushing’s syndrome c. Addison’s disease d. Cranial diabetes insipidus e. Nephregenic diabetes insipidus f. Bartter’s sundrome g. Gitelman’s syndrome h. SIADH i. Renal artery stenosis j. Psychogenic polydipsia
H
A 25-year old medical student trips and hits her head hard on the table. Shortly afterwards she finds that she is very thirsty and drinking several litres of water because she has gone more thirsty. She also wakes at night to pass urine and drinks more water whenever she awakes. Na+ 130, K+ 4, U 2.2, Cr 57 What is the diagnosis? a. Conn’s syndrome b. Cushing’s syndrome c. Addison’s disease d. Cranial diabetes insipidus e. Nephregenic diabetes insipidus f. Bartter’s sundrome g. Gitelman’s syndrome h. SIADH i. Renal artery stenosis j. Psychogenic polydipsia
J
A 40-year old man has hypertension and hypokalaemia. Renin: 6.4 (2.7-4.5) Aldosterone 1200 (140-450 pM) a. Conn’s syndrome b. Cushing’s syndrome c. Addison’s disease d. Cranial diabetes insipidus e. Nephregenic diabetes insipidus f. Bartter’s sundrome g. Gitelman’s syndrome h. SIADH i. Renal artery stenosis j. Psychogenic polydipsia
I Renal Artery Stenosis
cos renin is high
A 40-year old man has hypertension and hypokalaemia. Renin 0.4 (2.7-4.5) Aldosterone: 1300 (140-450 pM) a. Conn’s syndrome b. Cushing’s syndrome c. Addison’s disease d. Cranial diabetes insipidus e. Nephregenic diabetes insipidus f. Bartter’s sundrome g. Gitelman’s syndrome h. SIADH i. Renal artery stenosis j. Psychogenic polydipsia
A
A tired patient has the following results: Na+ 119, K+ 6.2, glucose 3.7 a. Conn’s syndrome b. Cushing’s syndrome c. Addison’s disease d. Cranial diabetes insipidus e. Nephregenic diabetes insipidus f. Bartter’s sundrome g. Gitelman’s syndrome h. SIADH i. Renal artery stenosis j. Psychogenic polydipsia
c
Regarding ACE inhibitors in patients with diabetes:
a. ACE inhibitors cause an improvement in the creatinine within days of starting
b. ACE inhibitors cause an increase (worsening) of the creatinine within days of starting
c. ACE inhibitors increase microalbuminuria
b
Regarding ACE inhibitors in patients with diabetes:
a. ACE inhibitors are useful in patients with diabetes and resultant renal artery stenosis
b. ACE inhibitors increase microalbuminuria
c. ACE inhibitors prevent end stage renal failure
d. ACE inhibitors cause hypokalaemia
c
This deadly strain of malaria causes widespread organ damage due to impaired microcirculation:
a. P.Falciparum
b. P.Malariae
c. P.Ovale
d. P.Vivax
e. Chloroquine
f. Oral quinine
g. Oral quinine + doxycycline
h. Primaquine
i. FBC
j. Thick blood film
k. Thin blood film
l. Hyponozoite
m. Sporozoite
n. Trophozoite
a
Post initial treatment, this strain of malaria requires Primaquine 30mg to eradicate liver parasites
a. P.Falciparum
b. P.Malariae
c. P.Ovale
d. P.Vivax
e. Chloroquine
f. Oral quinine
g. Oral quinine + doxycycline
h. Primaquine
i. FBC
j. Thick blood film
k. Thin blood film
l. Hyponozoite
m. Sporozoite
n. Trophozoite
d
This test is used to determine the species of malarial parasite
a. P.Falciparum
b. P.Malariae
c. P.Ovale
d. P.Vivax
e. Chloroquine
f. Oral quinine
g. Oral quinine + doxycycline
h. Primaquine
i. FBC
j. Thick blood film
k. Thin blood film
l. Hyponozoite
m. Sporozoite
n. Trophozoite
k
The malarial parasite is in this form when injected into the human host by the mosquito
a. P.Falciparum
b. P.Malariae
c. P.Ovale
d. P.Vivax
e. Chloroquine
f. Oral quinine
g. Oral quinine + doxycycline
h. Primaquine
i. FBC
j. Thick blood film
k. Thin blood film
l. Hyponozoite
m. Sporozoite
n. Trophozoite
m
This drug is the first line treatment for non-falciparum malaria
a. P.Falciparum
b. P.Malariae
c. P.Ovale
d. P.Vivax
e. Chloroquine
f. Oral quinine
g. Oral quinine + doxycycline
h. Primaquine
i. FBC
j. Thick blood film
k. Thin blood film
l. Hyponozoite
m. Sporozoite
n. Trophozoite
e
A 45-year old lady complains of ‘itchy skin’. Investigations reveal the presence of AMA positive and elevated ALP levels.
a. Acute drug-induced hepatitis
b. Alcoholic liver disease
c. Budd-Chiari syndrome
d. Chronic lymphocytic leukaemia
e. CMV infection
f. Criggler-Najjar syndrome
g. Hep A virus infection
h. Hep C virus infection
i. Hepatocellular carcinoma
j. Hereditary haemochromatosis
k. Portal vein thrombosis
l. Primary biliary cirrhosis
m. Primary sclerosing cholangitis
n. Wilson’s disease
l
Kayser- Fleischer rings
a. Acute drug-induced hepatitis
b. Alcoholic liver disease
c. Budd-Chiari syndrome
d. Chronic lymphocytic leukaemia
e. CMV infection
f. Criggler-Najjar syndrome
g. Hep A virus infection
h. Hep C virus infection
i. Hepatocellular carcinoma
j. Hereditary haemochromatosis
k. Portal vein thrombosis
l. Primary biliary cirrhosis
m. Primary sclerosing cholangitis
n. Wilson’s disease
n
A young man who had recently visited India complains of a fever, malaise and jaundice. Investigations show raised ALT levels.
a. Acute drug-induced hepatitis
b. Alcoholic liver disease
c. Budd-Chiari syndrome
d. Chronic lymphocytic leukaemia
e. CMV infection
f. Criggler-Najjar syndrome
g. Hep A virus infection
h. Hep C virus infection
i. Hepatocellular carcinoma
j. Hereditary haemochromatosis
k. Portal vein thrombosis
l. Primary biliary cirrhosis
m. Primary sclerosing cholangitis
n. Wilson’s disease
g
Clotting tests showed a prolonged PT
a. Acute drug-induced hepatitis
b. Alcoholic liver disease
c. Budd-Chiari syndrome
d. Chronic lymphocytic leukaemia
e. CMV infection
f. Criggler-Najjar syndrome
g. Hep A virus infection
h. Hep C virus infection
i. Hepatocellular carcinoma
j. Hereditary haemochromatosis
k. Portal vein thrombosis
l. Primary biliary cirrhosis
m. Primary sclerosing cholangitis
n. Wilson’s disease
b
An ERCP showed a structure with a “beaded” appearance Clotting tests showed a prolonged PT a. Acute drug-induced hepatitis b. Alcoholic liver disease c. Budd-Chiari syndrome d. Chronic lymphocytic leukaemia e. CMV infection f. Criggler-Najjar syndrome g. Hep A virus infection h. Hep C virus infection i. Hepatocellular carcinoma j. Hereditary haemochromatosis k. Portal vein thrombosis l. Primary biliary cirrhosis m. Primary sclerosing cholangitis n. Wilson’s disease
m
A 49-year old Irish lady visits her GP complaining of feeling bloated and lethargic, with abdominal pain, nausea and vomiting associated with eating. She had recently been on the Atkins diet, when her symptoms improved, but she suffered a relapse after returning to her normal diet. The GP noted a blistering rash on the patient’s elbows and knees. What is the rash called?
a. Acne vulgaris
b. Basal cell carcinoma
c. Bening melanocyctic naevus
d. Dermatitis Herpetiformis
e. Eczema
f. Erythema Multiforme
g. Erythema Nodosum
h. Rosacea
i. Pemphigoid
j. Pemphigus Vulgaris
k. Pityriasis rosea
l. Psoriasis
m. Vitiligo
d
Salmon pink scaly eruption on trunk, extending outwards. Herald patch. Viral associated.
a. Acne vulgaris
b. Basal cell carcinoma
c. Bening melanocyctic naevus
d. Dermatitis Herpetiformis
e. Eczema
f. Erythema Multiforme
g. Erythema Nodosum
h. Rosacea
i. Pemphigoid
j. Pemphigus Vulgaris
k. Pityriasis rosea
l. Psoriasis
m. Vitiligo
k
IgG binds to basement membrane. Sub-epidermal bulla with eosinophils. a. Acne vulgaris b. Basal cell carcinoma c. Bening melanocyctic naevus d. Dermatitis Herpetiformis e. Eczema f. Erythema Multiforme g. Erythema Nodosum h. Rosacea i. Pemphigoid j. Pemphigus Vulgaris k. Pityriasis rosea l. Psoriasis m. Vitiligo
i
Tense bulla that often rupture. Intradermal bullae. IgG antibodies bind to desmosomes. Nikolsky’s sign positive.
a. Acne vulgaris
b. Basal cell carcinoma
c. Bening melanocyctic naevus
d. Dermatitis Herpetiformis
e. Eczema
f. Erythema Multiforme
g. Erythema Nodosum
h. Rosacea
i. Pemphigoid
j. Pemphigus Vulgaris
k. Pityriasis rosea
l. Psoriasis
m. Vitiligo
j
Which of these looks like ‘target lesions’ and may progress to Stevens Johnson Syndrome?
a. Acne vulgaris
b. Basal cell carcinoma
c. Bening melanocyctic naevus
d. Dermatitis Herpetiformis
e. Eczema
f. Erythema Multiforme
g. Erythema Nodosum
h. Rosacea
i. Pemphigoid
j. Pemphigus Vulgaris
k. Pityriasis rosea
l. Psoriasis
m. Vitiligo
f
https://tinyurl.com/yaq7cgcw
What tissue is this?
a. Bronchus
b. Breast
c. Kidney
d. Thyroid
e. Prostate
f. Skeletal muscle
g. Liver
h. Duodenum
i. Adrenal
d
http://peir.path.uab.edu/library/_data/i/upload/2013/08/01/20130801101001-00fa2a29-me.jpg
What tissue is this?
j. Bronchus
k. Breast
l. Kidney
m. Thyroid
n. Prostate
o. Skeletal muscle
p. Liver
q. Duodenum
r. Adrenal
p
https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcT83HJh1MeXLrdHkmIem4gMbuPh07y0Iw1AV9VqykZ8Pjber8g2YQ
What tissue is this?
a. Bronchus
b. Breast
c. Kidney
d. Thyroid
e. Prostate
f. Skeletal muscle
g. Liver
h. Duodenum
i. Adrenal
c
https://tinyurl.com/y8ovkmtd
What tissue is this?
a. Bronchus
b. Breast
c. Kidney
d. Thyroid
e. Prostate
f. Skeletal muscle
g. Liver
h. Duodenum
i. Adrenal
c
http://medlib.bu.edu/histology/i/14502hoa.jpg
What tissue is this?
a. Bronchus
b. Breast
c. Kidney
d. Thyroid
e. Prostate
f. Skeletal muscle
g. Liver
h. Duodenum
i. Adrenal
i
A 36-year old IV drug user complains of fevers and night sweats. A 5th year medical student detects a new murmur
a. Monckeberg arteriosclerosis
b. Infective endocarditis
c. Right heart failure
d. Pericardial effusion
e. Rheumatic valve disease
f. Marfan’s syndrome
g. Atherosclerosis
h. Ventricular septic defect
i. Acute MI
j. Carcinoid syndrome
k. Amyloidosis
l. Aortic Stenosis
b
A 65-year old presents with fevers and night sweats. Dipstick of the urine reveals microscopic haematuria and abdominal examination reveals splenomegaly
a. Monckeberg arteriosclerosis
b. Infective endocarditis
c. Right heart failure
d. Pericardial effusion
e. Rheumatic valve disease
f. Marfan’s syndrome
g. Atherosclerosis
h. Ventricular septic defect
i. Acute MI
j. Carcinoid syndrome
k. Amyloidosis
l. Aortic Stenosis
b
This patient complained of St Vitus dance when she was 9 years old, and actually had Sydenham’s chorea. Many years later she has a murmur.
a. Monckeberg arteriosclerosis
b. Infective endocarditis
c. Right heart failure
d. Pericardial effusion
e. Rheumatic valve disease
f. Marfan’s syndrome
g. Atherosclerosis
h. Ventricular septic defect
i. Acute MI
j. Carcinoid syndrome
k. Amyloidosis
l. Aortic Stenosis
e
A 50-year old complains of weight loss and facial flushing and develops tricuspid and pulmonary stenosis and fibrosis. Examination of the abdomen reveals hepatomegaly with large nodules. Urine 5 hydroxy-indolacetic acid (5HIAA) levels are raised.
a. Monckeberg arteriosclerosis
b. Infective endocarditis
c. Right heart failure
d. Pericardial effusion
e. Rheumatic valve disease
f. Marfan’s syndrome
g. Atherosclerosis
h. Ventricular septic defect
i. Acute MI
j. Carcinoid syndrome
k. Amyloidosis
l. Aortic Stenosis
j
Post-mortem reveals nutmeg liver
a. Monckeberg arteriosclerosis
b. Infective endocarditis
c. Right heart failure
d. Pericardial effusion
e. Rheumatic valve disease
f. Marfan’s syndrome
g. Atherosclerosis
h. Ventricular septic defect
i. Acute MI
j. Carcinoid syndrome
k. Amyloidosis
l. Aortic Stenosis
c
38-year old male presents to his GP with chronic cough and copious amounts of purulent mucus production. High resolution CT scans demonstrate dilated bronchi.
a. Hyaline membrane disease
b. Small cell carcinoma
c. Extrinsic allergic alveolitis
d. Bronchiectasis
e. Non-small cell carcinoma
f. Chronic bronchitis
g. Pulmonary oedema
h. Cystic fibrosis
i. Sarcoidosis
d
A 14-year old girl is admitted to hospital after suffering her third bout of pneumonia caused by pseudomonas aeruginosa infection. She also had previous admission for pancreatitis.
a. Hyaline membrane disease
b. Small cell carcinoma
c. Extrinsic allergic alveolitis
d. Bronchiectasis
e. Non-small cell carcinoma
f. Chronic bronchitis
g. Pulmonary oedema
h. Cystic fibrosis
i. Sarcoidosis
h
A 60-year old previous heavy smoker presents with haemoptysis and weight loss. HE is referred to the oncology department for a biopsy which reveals “Oat-shaped” cells in microscopy.
a. Hyaline membrane disease
b. Small cell carcinoma
c. Extrinsic allergic alveolitis
d. Bronchiectasis
e. Non-small cell carcinoma
f. Chronic bronchitis
g. Pulmonary oedema
h. Cystic fibrosis
i. Sarcoidosis
b
Neonate with respiratory distress
a. Hyaline membrane disease
b. Small cell carcinoma
c. Extrinsic allergic alveolitis
d. Bronchiectasis
e. Non-small cell carcinoma
f. Chronic bronchitis
g. Pulmonary oedema
h. Cystic fibrosis
i. Sarcoidosis
a
A 42-year old man is found to have hypercalcaemia and a CXR reveals bilateral hilar lymphadenopathy
a. Hyaline membrane disease
b. Small cell carcinoma
c. Extrinsic allergic alveolitis
d. Bronchiectasis
e. Non-small cell carcinoma
f. Chronic bronchitis
g. Pulmonary oedema
h. Cystic fibrosis
i. Sarcoidosis
i
A 43-year old woman presents with dysphagia. Her fingers have turned pale and cold. She has tightening of the skin near her fingertips and small dilated vessels on her skin.
a. SLE
b. Sjogren’s syndrome
c. Diffuse scleroderma
d. Amyloidosis
e. Takayasu arteritis
f. Dermatomyositis
g. CREST syndrome
h. Polymyositis
i. Microscopic polyangitis
g
A 35-year old female presents with recurrent miscarriages, and joint pains. She is anti-double stranded DNA antibody positive.
a. SLE
b. Sjogren’s syndrome
c. Diffuse scleroderma
d. Amyloidosis
e. Takayasu arteritis
f. Dermatomyositis
g. CREST syndrome
h. Polymyositis
i. Microscopic polyangitis
a
A 65-year old man living at home, develops severe dyspnoea and heart failure. A tongue biopsy shows an apple-green birefringence under polarised light with the Congo red stain.
a. SLE
b. Sjogren’s syndrome
c. Diffuse scleroderma
d. Amyloidosis
e. Takayasu arteritis
f. Dermatomyositis
g. CREST syndrome
h. Polymyositis
i. Microscopic polyangitis
d
A patient presents with renal failure and is found to be p-ANCA positive
a. SLE
b. Sjogren’s syndrome
c. Diffuse scleroderma
d. Amyloidosis
e. Takayasu arteritis
f. Dermatomyositis
g. CREST syndrome
h. Polymyositis
i. Microscopic polyangitis
i
A 47-year old man complains of limb weakness and breathlessness. A distinctive rash around both eyes as well as plaques on the joints of her hands.
a. SLE
b. Sjogren’s syndrome
c. Diffuse scleroderma
d. Amyloidosis
e. Takayasu arteritis
f. Dermatomyositis
g. CREST syndrome
h. Polymyositis
i. Microscopic polyangitis
f
A 65-year old man presents complaining that he’s being left behind by the pace of life and his friends have commented that he’s quieter than he used to be and doesn’t smile as much either. He is finding it difficult to write letters as he has a tremor
a. Alzheimer’s
b. Parkinson’s
c. Huntington’s
d. Pick’s disease
e. Depression
f. Acute Haemorrhagic Leukoencephalitis
g. Multiple Sclerosis
h. Progressive multifocal Leukoencephalitis
b
A 49-year old lady presents to you with blurred vision. She also has tingling in her legs that is particularly bad after a hot bath. She is also having more trouble on her stairmaster and her wok seems to be getting heavier impeding on her stir-fry abilities. This happened a few years ago and got better but now seems to have started again.
a. Alzheimer’s
b. Parkinson’s
c. Huntington’s
d. Pick’s disease
e. Depression
f. Acute Haemorrhagic Leukoencephalitis
g. Multiple Sclerosis
h. Progressive multifocal Leukoencephalitis
g
A 70-year old woman presents to her GP accompanied by her daughter. The daughter explains that her mother’s memory has been getting worse for some time now and has difficulty retaining new information. She has difficult with what day of the week it is and is always grasping at words. The mother is quite oblivious to her problems but the daughter is more concerned.
a. Alzheimer’s
b. Parkinson’s
c. Huntington’s
d. Pick’s disease
e. Depression
f. Acute Haemorrhagic Leukoencephalitis
g. Multiple Sclerosis
h. Progressive multifocal Leukoencephalitis
a
In which disease, microscopically speaking, is there a severe neuronal loss demonstrable in the substantia Nigra, with remaining neurones often containing a distinctive intracellular inclusion, the Lewy Body.
a. Alzheimer’s
b. Parkinson’s
c. Huntington’s
d. Pick’s disease
e. Depression
f. Acute Haemorrhagic Leukoencephalitis
g. Multiple Sclerosis
h. Progressive multifocal Leukoencephalitis
b
A 60-year old gentleman presents with blurred vision and a 1-motnh history of forgetfulness and not being able to answer as many questions on the weakest link as he used to. You notice from his notes he had a kidney transplant 2 years ago.
a. Alzheimer’s
b. Parkinson’s
c. Huntington’s
d. Pick’s disease
e. Depression
f. Acute Haemorrhagic Leukoencephalitis
g. Multiple Sclerosis
h. Progressive multifocal Leukoencephalitis
h
A 53-year old T1 diabetic man presents with weight loss, weakness and depression. Full blood count is unremarkable but U&Es reveal: Na+ 129, K+ 6.2, Urea 8.4 mmol/l and Ca2+ 2.67 mmol/l a. Addison’s disease b. Adrenal adenoma c. Adrenal carcinoma d. Carney’s syndrome e. Congential adrenal Hyperplasia f. Conn’s syndrome g. Cushing’s disease h. Ectopic ACTH secretion i. Iatrogenic Addison’s disease j. Iatrogenic Cushing’s Syndrome k. Phaeochromocytoma l. Pseudo-Cushing’s Syndrome m. Thyrotoxicosis
a
A 54-year old woman presents with a one-year history of weight gain, fatigue and hirsutism. Examination reveals thin skin, easy bruising, purple abdominal striae and a supraclavicular fat pad. Plasma cortisol and ACTH levels are both raised but supress after high dose dexamethasone suppression test.
a. Addison’s disease
b. Adrenal adenoma
c. Adrenal carcinoma
d. Carney’s syndrome
e. Congential adrenal Hyperplasia
f. Conn’s syndrome
g. Cushing’s disease
h. Ectopic ACTH secretion
i. Iatrogenic Addison’s disease
j. Iatrogenic Cushing’s Syndrome
k. Phaeochromocytoma
l. Pseudo-Cushing’s Syndrome
m. Thyrotoxicosis
g
A 10-year old girl complains of hirsutism. Invetigations reveal a low cortisol, a raised ACTH and 17OHP (hydroxyprogesterone)
a. Addison’s disease
b. Adrenal adenoma
c. Adrenal carcinoma
d. Carney’s syndrome
e. Congential adrenal Hyperplasia
f. Conn’s syndrome
g. Cushing’s disease
h. Ectopic ACTH secretion
i. Iatrogenic Addison’s disease
j. Iatrogenic Cushing’s Syndrome
k. Phaeochromocytoma
l. Pseudo-Cushing’s Syndrome
m. Thyrotoxicosis
e
A 34-year old woman presents with rapid palpitations associated with chest tightness, severe headache, tremor, weight loss and sweating.
a. Addison’s disease
b. Adrenal adenoma
c. Adrenal carcinoma
d. Carney’s syndrome
e. Congential adrenal Hyperplasia
f. Conn’s syndrome
g. Cushing’s disease
h. Ectopic ACTH secretion
i. Iatrogenic Addison’s disease
j. Iatrogenic Cushing’s Syndrome
k. Phaeochromocytoma
l. Pseudo-Cushing’s Syndrome
m. Thyrotoxicosis
m
A 29-year old prison officer with a 3-month history of weight loss, and secondary amenorrhoea. Examination reveals postural hypotension, and hyperpigmentation. Serum cortisol is low and ACTH levels are elevated.
a. Addison’s disease
b. Adrenal adenoma
c. Adrenal carcinoma
d. Carney’s syndrome
e. Congential adrenal Hyperplasia
f. Conn’s syndrome
g. Cushing’s disease
h. Ectopic ACTH secretion
i. Iatrogenic Addison’s disease
j. Iatrogenic Cushing’s Syndrome
k. Phaeochromocytoma
l. Pseudo-Cushing’s Syndrome
m. Thyrotoxicosis
a
A 25-year-old woman complains of right iliac fossa pain, diarrhoea and weight loss worsening over several weeks. Laparotomy reveals an oedematous, reddened terminal ileum and a biopsy uncovers transmural inflammation with the presence of granulomas.
Crohn’s
A 35-year-old woman presents with diarrhoea and lower abdominal pain. Examination of her stools reveals blood and mucus. A biopsy reveals a continuous superficial ulceration of the colon.
UC
A 60-year-old patient presents with chronic left-sided abdominal discomfort and the passage of fresh blood from the rectum. He denies weight loss and on examination has no palpable masses. However a colonoscopy reveals pouches of mucosa extruding through the muscle layer.
Diverticular Disease
A 70-year-old man who has been receiving broad-spectrum antibiotic treatment develops profuse diarrhoea and frequent episodes of incontinence. A biopsy of the colon reveals a membrane like material covering the surface composed of mucin, fibrin, polymorphs and what seems to be debris of leukocytes and mucosal epithelial cells. What is the diagnosis?
Pseduomembranous Colitis
A 68-year-old man presents with rectal bleeding and new onset constipation. Some years ago, he was diagnosed with polyps in his colon and recently has lost a lot of weight. An abdominal examination reveals a mass in the right lumbar region which is non-tender.
Colonic Carcinoma
A 28 year-old junior doctor comes in feeling ‘pretty lousy and aching all over’. She is wearing dark glasses and complains of a stiff neck. CSF examination reveals a normal CSF/blood glucose ratio and slightly raised protein of 0.7 g/L with a lymphocyte count of 150 and no neutrophils. There were no red cells in the CSF which proved that the lumbar puncture was well carried out, and that the SHO undertaking it had not punctured any veins.
What is the likely diagnosis?
Viral meningitis
A 56 year-old male presents with fever, vomiting and seizures. Examination reveals a well- established ear infection and there is a ‘ring-enhancing’ lesion on the MRI of his brain.
Cerebral abscess
A 40 year-old man complains of a stiff neck. He is the member of a cheese club and enjoys unpasteurised cheese. He has a high neutrophil count in the CSF, and gram staining reveals gram positive rods. What is the likely organism?
Listeria Monocytogenes
Gram staining of a blood culture reveals Gram positive diplococci. What is the likely organism?
Strep Pneumoniae
A 27 year old patient has a knee effusion drained. The gram stain reveals Gram negative intracellular diplococci. What is the likely organism?
Neisseria Gonorrhoea
A 28 year old woman presents with malaise, weight loss, an erythematous rash on the face and joint pains. Both antinuclear antibodies (ANA) and double-stranded DNA (dsDNA) antibodies were found in the serum.
SLE
A 40 year old man presents with weight loss, muscle aches and abdominal pain. On examination he has high BP and urine dipstick reveals blood + and protein +. The patient is thought to have a vasculitis and is p-ANCA positive.
Microscopic Polyangitis
OR
Churg Strauss Syndrome
A patient is found to have a very high titre of anti-mitochondrial antibody. What is the likely diagnosis?
PBC
A patient presents with haemoptysis and haematuria. She is thought to have Goodpastures syndrome. What antibody should you look for?
Anti-GBM
A 32yr old woman complains of fatiguability in many muscles and double vision. She is thought to be at risk of other autoimmune diseases as she has a family history of various autoimmune diseases and herself has autoimmune hypothyroidism. Her thyroid function is normal because she is well replaced with thyroxine. What might be causing her muscle weakness?
Myasthenia Gravis
A four-year-old boy presents with a purpuric rash across the legs and buttocks. Two weeks previously you had seen the child about a chest infection. Further examination reveals abdominal pain and haematuria. Serum IgA levels are raised. What is the likely diagnosis?
Henoch Schonlein Purpura
A patient is found to have a positive Coombes (anti-globulin) test. What is the likely diagnosis?
Autoimmune HA
A child is found to be anaemic, and molecular studies show a defect in the spectrin molecule. What is the diagnosis?
Hereditary Spherocytosis
A 70 year old lady presents with pallor and has the following results:
Hb 90. (NR 120-150) g/dl
MCV 125 fl (NR 76-96).
The film shows hyper-segmented neutrophils. The patient also has type 1 diabetes and hypothyroidism that are both well treated. What is the underlying cause of her low haemoglobin.
Pernicious anaemia
A 70 year old man presents with pallor and has the following results:
Hb 90. (NR 120-150) g/dl
MCV 65 fl (NR 76-96).
What is the likely underlying cause of the low haemoglobin.
Iron deficiency anaemia
A patient presents with tiredness and is found to have a calcium of 3.0mM and a normal PTH at 3.0pM (NR 1.1 to 6.8). What is the likely diagnosis?
Primary Hyperparathyroidism
A patient presents with tiredness and is found to have a calcium of 2.0 mM and a raised PTH at 30pM (NR 1.1 to 6.8). What is the likely diagnosis?
Secondary Hyperparathyroidism
A patient presents with tiredness and notices that he is more pigmented than usual. His results reveal: Na 129 K 6.2 and his blood pressure is 80/50. What is the likely underlying diagnosis?
Addison’s
Which vitamin deficiency is associated with Pellagra?
B3
A patient presents with tiredness and has the following results:
TSH=30 (NR 0.3 to 4.7).
What is the likely diagnosis?
Primary hypothyroidism
What is increased in Paget’s disease of the bone
ALP
What is increased in a patient with osteomalacia
ALP
What liver enzyme is increased in a patient following an acute MI
AST
What is raised in Addison’s disease?
Potassium
What enzyme is raised the most in jaundice caused by a gall stone?
ALP
What enzyme is raised the most in viral hepatitis?
ALT
What enzyme is most increased in chronic alcoholic cirrhosis?
AST
What enzyme is raised in a patient with prostatic carcinoma?
PSA/Acid Phosphatase
What investigation is used to make diagnosis for Pagets?
Skeletal survey withy Technitium bisphosphonate
What is raised most in osteomalacia?
ALP, low Vit D = more PTH so increased bone turnover
A patient had an MI 3 days ago? Best enzyme?
Lactate dehydrogenase. For re-infarct, CKMB is good
What is raised in primary hyperparathyroidism?
Calcium
What may be low in serum in primary hyperparathyroidism?
Vitamin D because 1 alpha hydroxylase uses it all up
What rises most in acute renal failure where the cause is dehydration?
Urea
What rises most in chronic renal failure, caused by a fall in GFR?
Creatinine
Hyperkalaemia management?
Calcium gluconate 10ml 10%
Dextrose 50ml 50%
Nebulised salbutamol
Insulin
What is a marker of glucose control over the last three months? Last three weeks?
HbA1c
Fructosamine
A 19-year-old man returns from holiday in Spain. Four weeks later, he develops a hot, swollen, painful red knee joint, with an effusion. The knee is tapped, and 20 ml of cloudy yellow fluid is withdrawn. Microbiology reveals Gram-negative intracellular diplococci.
Neisseria Gonorrhoea
A 19-year-old student arrives in casualty, septic, pyrexial and confused with a pyrexia of 39oC. He has a stiff neck, and a lumbar puncture reveals Gram-negative intracellular diplococci.
Neisseria Meningitides
A 6-year-old boy arrives in casualty, septic, pyrexial and confused with a pyrexia of 39oC. He has a stiff neck, and a lumbar puncture reveals gram-negative rods.
Haemophilus Influenzae B
A 19-year-old student arrives in casualty, septic, pyrexial and confused with a pyrexia of 39oC and blood cultures grew Gram-positive diplococci.
Streptococcus Pneumoniae
Penicillin
A 19-year-old student arrives in casualty, septic, pyrexial and confused with a pyrexia of 39oC and blood cultures fail to culture any organisms. Cold agglutinins are positive.
Mycoplasma Pneumoniae
Clarithromycin + Amoxicillin coverage
A 19-year-old student has a boil on his leg which is 2cm in diameter, and painful. It is drained and some of the pus sent to microbiology. Eventually it grows Gram-positive cocci in clusters.
Staph Aureus
Flucloxicillin
A 19-year-old has a mild fever for several months, and no cause can be found. After 2 months, blood cultures come back positive for Gram-positive cocci.
Streptococcus Viridans
Caused by action of acid and pepsin on the mucosa linked to increased output of stomach acid. Worse when stomach is empty
Gastric ulcer
Failure to produce IF so decreased B12 absorption in the bowel
Pernicious anaemia
49 year old woman feels bloated and lethargic linked to eating. Improved with Atkins diet, but got worse straight after.
Coeliac disease
49 year old woman feels bloated and lethargic linked to eating. Improved with Atkins diet, but got worse straight after. What disease is she at increased risk of having?
Lymphoma
Enteropathy associated T cell lymphoma
49 year old woman feels bloated and lethargic linked to eating. Improved with Atkins diet, but got worse straight after. She gets a rash on her elbows and knees. What is this rash called?
Dermatitis Herpetiformis
Salmon pink scalry eruption on trunk extending outwards with a herald patch, caused by a virus.
HHV6
Pityriasis Rosea
IgG binds to basement membrane and sub epidermal bulla with eosinophils
Pemphigoid
Tense bulla that often rupture with intradermal bullae. IgG antibodies bind to desmosomes and Nikolsky’s sign positive
Pemphigus Vulgaris
Rodent Ulcer
BCC
Woman gets severe wound infection following hip replacement. MRSA is isolated from the wound. What antibiotic?
Vancomycin
An 18 year old female presents with fever, headache, neck stiffness and petechial rash. What antibiotic?
Vancomycin and Ceftriaxone
82 year old man at home gets severe dyspnoea and productive cough and fever. PaO2 has fallen below 8 and he is becoming confused. What antibiotic?
Amoxicillin and maybe add Clarithromycin
A 6 month old child whose father has been diagnosed with TB. What do you give the child?
Isoniazid
A 12 year old boy requests treatment for widespread impetigo. He developed a rash 3 years ago when he has given penicillin
Clarithromycin
Caused by staph aureus or strep pyogenes
A 32 year old IVDU presents with pyrexia, fever, jaundice and hepatomegaly. Diagnosis?
Hepatitis B
18 year old female presents with pyrexia, jaundice, lymphadenopathy and sore throat. What is the cause?
Infectious mononucleosis caused by Ebstein Barr virus
10 and 8 year old brothers present with mild illness and mild hepatomegaly without jaundice after a recent trip to Bangladesh. What is the cause?
Hepatitis A
60 year old presents with liver cirrhosis. She has never taken any drugs and has never drunk anything. She had a post partum haemorrhage requiring transfusion with her child when she was 25.
Hepatitis C
Positive Coombes test
Autoimmune Haemolytic Anaemia
New born male presents with jaundice and blood film has spherocytes and reticulocytes. DAT is negative and serum bilirubin and urinary urobiligen are raised.
Hereditary Spherocytosis
A mother of Middle Eastern origin is worried about her 2m old son. He has suddenly developed jaundice and pallor. Irregularly contracted cells are seen on the blood film.
Glucose 6 Phosphate Dehydrogenase deficiency
A four year old boy presents with a purpuric rash on his legs and buttocks. Two weeks ago he had a chest infection. He also has abdominal pain and haematuria with raised IgA levels.
Henoch-Schonlein purpura
Caused by an abnormality in the spectrin molecule
Hereditary sphecrocytosis
T1DM presents with weight loss, weakness and depression. FBC is normal but U+E show Na 129 K 6.2 Urea 8.4 Ca 2.67
Addison’s
Schmidt syndrome
37 year old presents with one year history of weight gain, fatigue and hirsutism. Examination shows thin skin,, easy bruising, purple abdominal striae and a supraclavicular fat pad. Plasma cortisol and ACTH are raised and do not suppress after a low dose dexamethasone suppression test.
Cushing’s snydomre
It would be disease if high dose dexamethasone suppression worked.
A 10 year old girl complains of hirsutism. Investigations reveal a low cortisol, raised 17 hydroxyprogresterone and raised ACTH.
Congenital Adrenal Hyperplasia
A 34 year old man presents with rapid palpitations, chest tightness, headache, tremor weight loss and sweating.
Hyperthyroidism
A 29 year old prison officers presents with a three month history of weight loss and secondary amenorrhoea. Examination reveals postural hypotension and hyperpigmentation. Serum cortisol is low and ACTH
Addison’s Disease
A 23 year old woman rapidly develops chest pain and abdominal pain soon after a transfusion. She is vomiting. Urine shows haemoglobinuria. Blood cultures are negative.
ABO Incompatibility
A 24 year old woman rapidly develops chest and abdominal pain after a transfuusion. She is vomiting and is odematous, dyspnoeic and hypotensive. SHe is later diagnosed with selective igA deficiency.
Anaphylaxis
MAYBE, probably actually.
IgA deficient patients are also predisposed to severe anaphylactic reactions to blood transfusions due to the presence of IgA in donor blood.
A 63 year old gentleman rapidly gets shortness of breath and goes into hearth failure after a transfusion. There were no white well antibodies in the donor blood.
Fluid overload
MAYBE.
A 36 year old gentleman develops a mild urticarial rash after a transfusion.
Mild allergic reaction
A 44 year old woman develops a fever eight days after a transfusion. She is also anaemic, jaundiced and has haemoglobinuira. Blood cultures are negative.
Delayed haemolytic transfusion reaction
A 30 year old woman presents with polyuria and polydipsia. Bloods show: Na 155 K 4 Glucose 4 Urea 4 Creatinine 100
Diabetes Insipidus
A 54 year old woman presents with polyuria and polydipsia. Bloods show: Na 150 K 5 Glucose 34 Urea 4 Creatinine 100
Type 2 diabetes
A 45 year old woman presents with polyuria and polydipsia and weakness. She has a history of hypertension with poorly controlled blood pressure despite 3 anti-hypertensives. Bloods show Na 145 K 3 Glucose 4 Urea 4 Cr 100
Conn’s Syndrome
A 55 year old woman presents with malaise and weakness. She has diabetes and hypertension and oedema on examination. Bloods show Na 125 K 6 Glucose 4 Urea 15 Creatinine 350
Chronic Kidney Disease
A 60 year old woman presents with left sided weakness and weight loss. Bloods show Na 126 K 4 Glucose 5 Urea 5 Creatinine 100 TFT and SST Normal Plasma osmolality 270 Urine osmolality 400
SIADH
