Oliver's Quizzes Flashcards by Kitty Eichner

What translocation is characteristic of Ewing’s sarcoma and primitive neuroectodermal tumours?

a. t(9;14)
b. t(9;22)
c. t(11;14)
d. t(11;22)

= d. t(11;22)

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The bifurcate ligament consists of:

a. Calcaneonavicular ligament and calcaneocuboid ligament
b. Anterior talofibular ligament and calcaneonavicular ligament
c. Anterior talofibular ligament and tibiotalar ligament
d. Calcaneocuboid ligament and tibiotalar ligament

= a. Calcaneonavicular ligament and calcaneocuboid ligament

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What is the correct interpretation of a positive Trendelenburg sign when the patient stands on their right leg?

a. The left hip abductors are weak
b. The right hip extensors are weak
c. The left hip adductors are weak
d. The right hip abductors are weak

= d. The right hip abductors are weak

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What is the main type of collagen present in bones?

a. Type I
b. Type II
c. Type III
d. Type IV

= a. Type I

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Achondroplasia is caused by a gene mutation in:

a. COL1A1
b. EWSR1
c. FGF Receptor 3
d. GNAS1

= c. FGF Receptor 3

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What are the 8 clinical features of Paget’s Disease of Bone? (2 marks)

Most are asymptomatic
Bone pain
Bone deformities
Erythema and heat over affected bones (due to increased vascularization)
Skull enlargement
Cranial nerve deficits
Headache
Pathological fractures

(0.5 marks each, max 2 marks)

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Briefly describe the SPIKES protocol for breaking bad news.

(6 marks)

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What are the 7 complications of Osteomyelitis?

(2.5 marks)

Bone abscess formation
Septic arthritis
Sinus tract formation
Sequestrum formation
Sepsis
Chronic osteomyelitis
Pathological fractures

(0.5 marks each, max 2 marks)

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List 3 strategies for managing osteoporosis with a brief explanation of their mechanism of action?

(3 marks)

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You are on your ED rotation in fourth year and just as you are about to go for lunch the consultant asks you to tell them what is wrong with this X-ray.

(0.5 marks)

This is a right-sided Colles’ fracture.

(0.5)

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Which of the following antibodies is most specifically associated with drug induced lupus?

a. ANA
b. Anti-CCP antibodies
c. Anti-histone antibodies
d. Anti-dsDNA antibodies

= c. Anti-histone antibodies

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Rheumatoid arthritis is an example of a:

a. Type I hypersensitivity reaction
b. Type II hypersensitivity reaction
c. Type III hypersensitivity reaction
d. Type IV hypersensitivity reaction

= c. Type III hypersensitivity reaction

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Which thumb movement is demonstrated in the following picture?

a. Abduction
b. Extension
c. Reposition
d. Forward flexion

= a. Abduction

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Boutonniere’s deformity is characterised by:

a. PIP flexion and DIP flexion
b. PIP flexion and DIP hyperextension
c. PIP extension and DIP flexion
d. PIP extension and DIP hyperextension

= b. PIP flexion and DIP hyperextension

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Which of the following antibodies are most specifically associated with Sjogren’s syndrome?

a. Rheumatoid factor
b. Anti-Jo1
c. Anti-topoisomerase
d. Anti-Ro/SSA

= d. Anti-Ro/SSA

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Define Hypersensitivity.

(1 mark)

Any immune response that gives rise to an excessive or inappropriate reaction (0.5) or that is more damaging than the antigen or pathogen (0.5) that induced the response.

(0.5 marks each, max 1 mark)

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What are the 9 clinical features of fibromyalgia syndrome?

(3 marks)

Widespread pain that affects at least 6 sites → “Tender points” where tendon attach to bone
Pain is present for >3 months
Fatigue and poor sleep quality
Cognitive dysfunction “fibro fog”
Stiffness in the morning
Paraesthesia
Absence of swollen joints
Normal inflammatory markers i.e. CRP and ESR
Normal FBC

(0.5 marks each, max 3 marks)

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Outline the mechanisms of damage/dysfunction caused by type II hypersensitivity reactions.

(5 marks)

Cell-mediated damage

Antibodies coat their target antigen which facilitates:
- Antibody dependent cellular cytotoxicity (ADCC) (0.5): FcγRIII (CD16) binds to IgG that is bound to antigen which triggers degranulation of the NK cell and the killing of target cells by perforin and granzyme (0.5)
- Phagocytosis (0.5) : Antibodies opsonise the target and Fc receptors on phagocytes bind to the Fc portion of those antibodies which trigger receptor mediated phagocytosis (0.5)

Complement-mediated damage

Antibodies bound to antigen can activate the classical complement pathway (0.5)
C3a and C5a exacerbate inflammation and attract neutrophils which release ROS and proteolytic enzymes → tissue damage (0.5)
C3b and C4b opsonise the target and facilitate phagocytosis (0.5)
Formation of the membrane attack complex → cell lysis (0.5)

Functional antibodies causing cellular dysfunction

Some antibodies against receptors may act as agonists (0.5) e.g. TSH receptor antibodies in Graves’ disease
Some antibodies against receptors may act as antagonists (0.5) e.g. Anti-acetylcholine receptor antibodies in myasthenia gravis

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What are the 4 key radiological features of osteoarthritis?

(2 marks)

Joint space narrowing
Subchondral sclerosis
Subchondral cysts
Osteophytes

(0.5 marks each, max 2 marks)

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What are the muscles of the thenar compartment?

(2 marks)

Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Adductor pollicis

(0.5 marks each, max 2 marks)

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Which of the following glomerular diseases is associated with a spike and dome pattern on electron microscopy?

a. IgA Nephropathy
b. Mesangiocapillary glomerulonephritis
c. Membranous nephropathy
d. Acute Post-streptococcal glomerulonephritis

= c. Membranous nephropathy

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Primary membranous nephropathy is associated with:

a. HLA-DR7
- c. HLA-DR3
d. HLA-DQ8

= b. HLA-DQ1

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Which of the following is a cause of synpharyngitic haematuria?

a. Post-streptococcal Glomerulonephritis
b. Focal Segmental Glomerulosclerosis
c. Berger’s disease
d. Rapidly Progressive Glomerulonephritis

= c. Berger’s disease (IgA nephropathy)

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Which of the following calculi form in basic urine?

a. Urate stones
b. Cystine stones
c. Calcium oxalate stones
d. Struvite stones

= d. Struvite stones

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Autosomal dominant polycystic kidney disease is associated with: * a. Hepatic fibrosis * b. Berry aneurysms * c. Vesicoureteric Junction Reflux * d. Potter sequence

= b. Berry aneurysms

Pre-renal causes account for the majority of acute kidney injury. Briefly discuss the main pathophysiological causes of pre-renal acute kidney injury (3 marks)

Pre-renal failure is caused by decreased perfusion to the kidney as a consequence of: 1. **Hypovolaemia** - e.g. burns, bleeding, vomiting and diarrhoea (any cause of volume depletion) 2. **↓ effective circulating volume** - e.g. cirrhosis, nephrosis, CHF 3. **Hypotension** - e.g. sepsis, distributive shock, cardiogenic shock 4. **Renal artery stenosis with an acute complication** - e.g. thrombus, plaque rupture etc 5. **Iatrogenic** - e.g. NSAIDs and ACE inhibitors

What are the risk factors for renal cell carcinoma? (3 marks)

What are the clinical features of nephrotic syndrome? (2 marks)

A 19 year old male presents with haemoptysis and haematuria. The resident orders a chest X-ray, urinalysis and urea and electrolytes. In addition to these tests, what singular antibody test would you like to order and why? (1 mark)

Anti-GBM antibodies (0.5), this patient is a young male with both haematuria and haemoptysis, excluding Goodpasture’s syndrome is important (0.5)

You are sitting in on an MDT meeting with the renal physicians during your general medicine placement. The pathologist is reviewing slides and asks you to describe any pathology you see and give a diagnosis of the following histological sample from a kidney of a patient with haematuria. (1.5 marks)

Which of the following is not a rapid acting insulin? * a. Insulin Lispro * b. Insulin Aspart * c. Insulin Glulisine * d. Insulin Glargine

= d. Insulin Glargine

Amber receives a lung transplant from her identical twin sister Delilah. This type of transplant is best described as: * a. Autologous * b. Allogenic * c. Syngeneic * d. Xenogenic

= c. Syngeneic

Chronic kidney failures is defined as: * a. A GFR of \<60 mL/min/1.73m2 for ≥3 months * b. A GFR of \<15 mL/min/1.73m2 for ≥3 months * c. A GFR of \<60 mL/min/1.73m2 for ≥6 months * d. A GFR of \<15 mL/min/1.73m2 for ≥6 months

= a. A GFR of \<60 mL/min/1.73m2 for ≥3 months

David received a bone marrow transplant. 26 days later he develops a maculopapular rash involving the hands, feet and neck, nausea and vomiting and is visibly jaundiced. This is most likely due to: * a. A systemic hypersensitivity reaction caused by donor B and T cells * b. A Type II hypersensitivity reaction caused by donor T cells * c. A Type III hypersensitivity reaction caused by donor B cells * d. A Type IV hypersensitivity reaction caused by donor T cells

= d. A Type IV hypersensitivity reaction caused by donor T cells

The indirect pathway of allorecognition involves: * a. T cells recognising foreign protein antigens produced by donor cells and secreted into the serum * b. T cells recognising foreign MHC antigens that are presented by host antigen presenting cells * c. T cells recognising foreign MHC antigens that are presented by donor antigen presenting cells * d. T cell recognising foreign MHC antigens on donor APCs that drain into host lymph nodes

= b. T cells recognising foreign MHC antigens that are presented by host antigen presenting cells

What are the histological features of diabteic nephropathy? (1.5 marks)

1. Kimmelstiel-Wilson nodules 2. Diffuse uniform thickening of the GBM 3. Mesangial expansion

What are the features of diabetic symmetrical peripheral neuropathy? (2 marks)

1. Distal glove and stocking distribution 2. Sensorimotor deficits: 1. ↓ tendon reflexes 2. ↓ proprioception 3. ↓ vibration sensation 4. ↓ pain and temperature sensation 5. Motor weakness 6. Dysaesthesia of the feet

What are the clinical features of uraemia? (6.5 marks)

* **Fluid and electrolytes** 1. Dehydration 2. Oedema 3. Hyperkalaemia 4. Metabolic acidosis * **Endocrine** 1. Hyperphosphataemia 2. Hypocalcaemia 3. 2 o Hyperparathyroidism 4. Renal osteodystrophy * **Haematological system** 1. Anaemia 2. Bleeding diathesis * **Cardiovascular system** 1. Pericarditis 2. Cardiomyopathy * **Gastrointestinal system** 1. Nausea and vomiting 2. GI Bleeding 3. Oesophagitis 4. Gastritis 5. Colitis * **Neuromuscular system** 1. Myopathy 2. Peripheral neuropathy 3. Encephalopathy * **Integumentary system** 1. Sallow looking skin 2. Pruritus 3. Dermatitis

What are the risk factors for developing type II diabetes? (3 marks) = 9 answers

1. Obesity, in particular central adiposity 2. Family history 3. Ethnicity - e.g. Aboriginal Australians and Torres Strait Islanders, people of Southern Asian, Middle Eastern and North African descent 4. Hyperlipidaemia 5. HTN 6. Low birth weight 7. Female sex 8. Polycystic ovarian syndrome 9. History of gestational diabetes

Compare and contrast diabetic ketoacidosis and hyperosmolar hyperglycaemic state can be difficult to differentiate (5 marks)

Paroxysmal Nocturnal Haemoglobinuria is caused by mutations that impact the function of: * a. CD19 * b. CD20 * c. CD28 * d. CD55

= d. CD55

Which of the following terms best describes red blood cells of varying size? * a. Anisocytosis * b. Dacrocytosis * c. Poikilocytosis * d. Spherocytosis

= a. Anisocytosis

Which of the following is characterised by haemolytic crises in response to increased oxidative stress? * a. Autoimmune haemolytic anaemia * b. G6PD deficiency * c. Haemoglobin H disease * d. Sickle cell anaemia

= b. G6PD deficiency

Which of the following is not a megaloblastic anaemia? * a. B9 deficiency * b. B12 deficiency * c. Diamond-Blackfan anaemia * d. Orotic aciduria

= c. Diamond-Blackfan anaemia

Inherited forms of sideroblastic anaemia are caused by mutations in the gene that codes for: * a. δ-ALA dehydratase * b. δ-ALA synthase * c. Ferrochelatase * d. Porphobilinogen deaminase

= b. δ-ALA synthase

What are the general clinical features of anaemia? (2.5 marks) = 11

**Clinical Features of Anaemia** 1. Fatigue 2. Pallor 3. Shortness of breath 4. Dizziness 5. Tachycardia 6. Bounding pulses 7. Flow murmurs 8. New onset or worsening heart failure 9. New onset or worsening of pre-existing angina 10. New onset or worsening of claudication 11. Features of extramedullary haematopoiesis e.g. hepatosplenomegaly

What are the specific clinical features of iron deficiency leading to anaemia? (3 marks) = 6 features

**Specific Clinical Features of Iron Deficiency Anaemia** 1. Koilonychia 2. Brittle nails 3. Angular cheilitis 4. Glossitis 5. Pica 6. Dysphagia (Plummer-Vinson Syndrome)

What are the clinical features of subacute demyelination of the spinal cord? (3 marks) = 7 features

**Clinical features of subacute demyelination of the spinal cord** 1. Spastic paresis 2. Sensory ataxia → ataxic gait 3. Positive Romberg's sign 4. Impaired vibration sensation 5. Impaired proprioception 6. Paraesthesias 7. Hyperreflexia

List 4 mechanisms of generating peripheral tolerance? (2 mark) = 6 options

Myasthenia gravis, grave’s disease and autoimmune haemolytic anaemia are examples of organ specific autoimmune diseases that are caused by type II hypersensitivity reactions. Using these diseases as examples, briefly outline the 3 different functional outcomes of type II hypersensitivity reactions? (1.5 marks)

A pt has \<30g/L serum monoclonal proteins, her bone marrow has \<10% plasma cells and she has no CRAB symptoms. You diagnose her with: * a. Monoclonal gammopathy of undetermined significance * b. Multiple myeloma * c. Smouldering myeloma * d. Waldenström macroglobulinaemia

= a. Monoclonal gammopathy of undetermined significance

Most common subtype of multiple myeloma is: * a. IgAκ * b. IgGκ * c. IgGλ * d. IgMλ

Most common subtype of multiple myeloma is: * a. IgAκ * **b. IgGκ** * c. IgGλ * d. IgMλ

Daratumumab targets: * a. CD19 * b. CD28 * c. CD38 * d. CD52

Daratumumab targets: * a. CD19 * b. CD28 * **c. CD38** * d. CD52

Which of the following is a proteasome inhibitor? * a. Bortezomib * b. Imatinib * c. Lenalidomide * d. Pamidronate

Which of the following is a proteasome inhibitor? * **a. Bortezomib** * b. Imatinib * c. Lenalidomide * d. Pamidronate

The immunoglobulin heavy chain gene is located on chromosome: * a. 2 * b. 14 * c. 18 * d. 22

The immunoglobulin heavy chain gene is located on chromosome: * a. 2 * **b. 14** * c. 18 * d. 22

What are the red flags for back pain? (3 marks)

What are the causes of hypercalcaemia? (5 marks)

Your next patient, Arnold, a 48 year old retail manager, is coming to see you for his annual check up. What health checks and/or screening tests would you do? (3.5 marks)

What are the 3 important side effects of bisphosphonates? (1.5 marks)

1. **○** Osteonecrosis (particularly of the jaw) 2. ○ Atypical fractures 3. ○ Oesophagitis

What are the signs and symptoms of hypocalcemia? (3 marks) = 9

1. ○ Perioral paraesthesias 2. ○ Muscle cramps 3. ○ Muscle weakness 4. ○ Tetany 5. ○ Seizures 6. ○ Arrhythmias 7. ○ Abdominal pain 8. ○ Chvostek sign 9. ○ Trousseau sign

Which of the following is not a pyrimidine? * a. Cytosine * b. Guanine * c. Thymine * d. Uracil

Which of the following is not a pyrimidine? * a. Cytosine * **b. Guanine** * c. Thymine * d. Uracil

Which lymphoid malignancy is characterised by a starry sky appearance? * a. Burkitt’s lymphoma * b. Follicular lymphoma * c. Diffuse Large B Cell Lymphoma * d. Small Lymphocytic lymphoma

Which lymphoid malignancy is characterised by a starry sky appearance? * **a. Burkitt’s lymphoma** * b. Follicular lymphoma * c. Diffuse Large B Cell Lymphoma * d. Small Lymphocytic lymphoma

Trismus is a common clinical feature of: * a. Tonsillitis * b. Peritonsillar abscesses * c. Post-tonsillectomy bleeds * d. Epiglottitis

Trismus is a common clinical feature of: * a. Tonsillitis * **b. Peritonsillar abscesses** * c. Post-tonsillectomy bleeds * d. Epiglottitis

Polycythaemia vera is commonly associated with mutations in: * a. JAK2 * b. BRCA1 * c. p53 * d. c-Myc

Polycythaemia vera is commonly associated with mutations in: * **a. JAK2** * b. BRCA1 * c. p53 * d. c-Myc

Which cranial nerves are involved in the swallowing process? * a. V, IX, X, XII * b. VII, IX, X, XII * c. V, VII, IX, X, XI, XII * d. V, IX, X, XI, XII

Which cranial nerves are involved in the swallowing process? * a. V, IX, X, XII * b. VII, IX, X, XII * **c. V, VII, IX, X, XI, XII** * d. V, IX, X, XI, XII

What are the clinical features of tumour lysis syndrome? (3 marks)

What are the contents of the carotid triangle? (3.5 marks) = 7 important things & 5 others

**_Contents of the Carotid (Anterior) Triangle_** 1. **Common carotid artery** 2. **Internal carotid artery** 3. **External carotid artery** 4. **Internal jugular vein** 5. **CN X →** External and internal branches of the superior laryngeal nerve arising from the vagus nerve 6. **CN XI** 7. **CN XII** 8. Superior thyroid artery and vein 9. Lingual artery and vein 10. Facial artery and common facial vein 11. Occipital artery and vein 12. Ascending pharyngeal artery and vein

What are the causes of a hoarse voice? (2.5 marks)

What are the clinical features of acute gout? (2 marks)

. Briefly outline the Ann Arbor criteria for staging of lymphoma. (2 marks)

* **Stage I** - single node or extralymphatic site involved * **Stage II** - 2 or more nodes or extralymphatic sites on the same side of the diagram * **Stage III** - Involvement of nodes or extralymphatic sites on the both sides of the diagram * **Stage IV** - Diffuse extralymphatic involvement e.g. bone marrow, skin, liver, lung

What are the ABCDEs of melanoma? (2.5 marks)

Outline the role of IL-4, IL-5 and IL-13 in Type I hypersensitivity reactions? (3 marks)

What are the clinical features of anaphylaxis? (5 marks)

Outline the difference between the pathophysiology and clinical features of food intolerances and food allergies? (5 marks)

What are the clinical criteria for diagnosing contact dermatitis (exogenous dermatitis)? (2 marks)

You are examining a patient’s eye movements. They are looking directly at you and what you see is shown below. Where is the lesion?

Define Syncope. (1 mark)

What are the different types of generalised seizures? (2.5 marks)

What are the clinical features of the postictal period? = 7 (2.5 marks)

1. Confusion 2. Fatigue/exhaustion 3. Aphasia 4. Residual focal neurological deficits e.g. Todd’s paresis 5. Headache 6. Muscle soreness 7. Pain if injured during seizure

Outline first aid for seizures. (3 marks)