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1
Q

What cellular mechanism does Venetoclax (BCL2 inhibitor) affect?

A

It inhibits anti-apoptosis proteins.

Used in CLL

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2
Q

What is the most common primary tumour of the heart?

A

Atrial myxoma

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3
Q

What two types of emphysema are there?

A

Centrilobular - seen in smoking
Panacinar - seen in alpha-1 antitrypsin deficiency

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4
Q

What is the most commmon cause of constrictive pericarditis in the world?

A

TB

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5
Q

What are the buzzwords for Klebseilla pneumoniae?

A

Alcoholics, elderly

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6
Q

What is the male counterpart of dysgerminoma?

A

Seminoma

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7
Q

What is the most common cause of portal vein thrombosis?

A

Liver cirrhosis

*Other causes include malignancy and chronic liver disease

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8
Q

Presence of what cells in Barrett’s oesophagus confers to a high risk of cancer?

A

Goblet cells

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9
Q

What is the commonest cause of myocarditis?

A

Viruses e.g. enteroviruses, adenoviruses, PV19, Influenza

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10
Q

Most common cause of hypocalcaemia?

A

Hypoaluminaemia

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11
Q

What is the anatomy of an andral gland and which hormones are produced?

q

A

Cortex:
Zona glomerulosa - mineralocorticoids e.g. aldosterone
Zona fasciculata - glucocorticoids e.g. cortisol
Zona reticularis - sex hormones

Medulla - catecholamines

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12
Q

What active enzyme in sarcoidosis patients causes hypercalcaemia?

A

Ectopic 1alpha-hydroxylase

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13
Q

What is the commonest cause of hypercalcaemia in the community?

A

Parathyroid adenoma (which causes primary hyperparathyroidism)

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14
Q

What hormone is produced by fat cells, and has receptors in the hypothalamus?

A

Leptin

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15
Q

Patient has hypertension. Blood results - normal sodium, low potassium, normal urea, normal creatinine, raised aldosterone, renin suppressed. What is the diagnosis?

A

Conns

Raised aldosterone:renin ratio + low potassium

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16
Q

Deficiency of which plasma protein occurs in patients with liver disease and a movement disorder?

A

Classical Wilson’s disease picture

Mutation of ATP7B on chromosome 13 which encondes copper transporting ATPase

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17
Q

What condition is caused by the reactivation of JC virus?

A

Progressive multifocal leukoencephalopathy

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18
Q

Denosumab is a monoclonal antibody specific for RANKL. What condition is it used to treat?

A

Osteoporosis

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19
Q

Mutation of CD40 ligand is associated with which form of primary immunodeficiency?

A

Hyper IgM syndrome

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20
Q

Which class of antibiotics has concentration dependent killing (i.e. the goal of therapy is to maximise peak > minimum inhibitory concentration)?

A

Aminoglycosides include drugs such as gentamicin, tobramycin, and amikacin.

The goal of therapy with aminoglycosides is to achieve peak serum concentrations that are significantly higher than the minimum inhibitory concentration (MIC) of the target bacteria.

This high peak concentration is required to maximize the bactericidal effect of aminoglycosides.

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21
Q

What is the abx regimen for typhoid fever?

A

IV ceftriaxone then PO azithromycin

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22
Q

Which human herpes virus is associated with post transplant lymphoproliferative disorder?

A

HHV4 aka Epstein Barr Virus

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23
Q

When do you use amphotericin-B?

A

Invasive candida

Cryptococcus

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24
Q

What do cryoprecipitate and FFP contain?

A

Cryoprecipitate: Cryoprecipitate is rich in specific clotting factors, particularly fibrinogen, von Willebrand factor, and factor VIII.

Fresh Frozen Plasma (FFP): FFP contains a broad range of clotting factors, including fibrinogen, prothrombin, factors V, VII, VIII, IX, X, XI, and XIII, as well as von Willebrand factor.

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25
Q

What is relative polycythaemia?

A

Relative polycythemia is a condition characterized by an apparent increase in red blood cell count, Hb, and Hct, without an actual increase in red cell mass. It occurs due to a decrease in plasma volume relative to red cell mass.

One of the common causes of relative polycythemia is dehydration, which can be induced by various factors such as diuretic use (like frusemide), excessive sweating, inadequate fluid intake, or prolonged exposure to high altitudes.

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26
Q

What is reactive neutrophilia?

A

Reactive neutrophilia is a nonspecific response of the body characterized by an increase in the number of neutrophils in response to various underlying causes or conditions. The presence of fever, productive cough, and pleural rub suggests an ongoing respiratory infection, which can lead to an inflammatory response and subsequent neutrophilia.

The elevated white blood cell count (WBC) with neutrophilia and left shift (increased number of immature forms of neutrophils) on the blood film indicates an acute inflammatory reaction. The toxic granulation in neutrophils further supports an acute infection as the cause of the reactive neutrophilia. The slightly low Hb concentration may be due to anemia of chronic inflammation, which can occur in response to the infection and inflammatory process.

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27
Q

What are patients with myelodysplastic syndrome at risk of?

A

Acute myeloid leukaemia transformation

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28
Q

55 year old man started on therapy with DOAC rivaroxaban. What advice would you give regarding monitoring whilst on treatment?

A

No monitoring required

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29
Q

What cell type mediates acute graft vs. host disease in allogeneic stem cell transplant?

A

Donor T cells

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30
Q

What is the first-line treatment for chronic phase CML?

A

Imatinib (ABL1 tyrosine kinase inhibitor)

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31
Q

Which type of necrosis is associated with a MI?

A

Coagulative necrosis - preservation of tissue architecture and cell outlines, despite cellular death

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32
Q

Pulmonary oedema due to liver disease is an example of which type of cause of pulmonary oedema?

A

Increased hydrostatic pressure (as the primary cause) due to portal hypertension

*decreased oncotic pressure due to reduced albumin synthesis in liver disease also contributes to fluid leakage, it is generally considered a secondary factor.

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33
Q

What is the commonest cause of adult ARDS?

A

Sepsis

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34
Q

Which is the commonest glial cell in the CNS?

A

Astrocytes

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35
Q

What is the most common cause of mitral valve stenosis?

A

Rheumatic fever

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36
Q

What is the most common cause of pancreatitis in adults?

A

Overall: gallstones
Acute: gallstones
Chronic: alcohol

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37
Q

Which of brain tumour occurs near the surface of the brain and is frequently asymptomatic?

A

Meningioma

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38
Q

Which of the following can cause hypoglycaemia?
Atorvastatin
Bendrofluazide
Glucagon
Prednisolone
Quinine

A

Quinine

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39
Q

Increased insulin sensitivity causes low plasma glucose, and features in which of the following?
Acromegaly
ACTH deficiency
Cushing’s disease
Phaeochromocytoma
PCOS

A

ACTH deficiency

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40
Q

Which of the following findings is consistent with moderate alcohol intake?
Reduced albumin
Elevated HDL
Nearly normal AST
Normal GGT
Normal triglycerides

A

Elevated HDL

Studies have shown a better lipid profile with moderate alcohol intake in men and women

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41
Q

Which of the following would be consistent with obstructive jaundice?
Normal ALP
Normal AST
Normal GGT
Dark stools
Increased bilirubin in the urine

A

Increased bilirubin in the urine

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42
Q

Which of the following binds to receptors in the adrenal and stimulates aldosterone release?

a) Angiotensin 2

b) ACTH

c) Renin

d) Sodium

e) Calcium

A

Angiotensin 2

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43
Q

In renal transplant rejection, where would the following cells be observed?

Antibody-mediated
T cell-mediated

A

Antibody-mediated: capillaries (clear spaces)
T cell-mediated: tubules and interstitium.

*Ab-mediated has worst prognosis

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44
Q

Which of the following is vaccinated against with a conjugate vaccine with a polysaccharide and protein carrier?
HIV
M. tuberculosis
Rabies
S. pneumoniae
V. cholerae

A

S. pneumoniae

*And other encapsulated bacteria like N. Meningitidis and H. Influenzae

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45
Q

Failure to regulate cryopyrin-driven neutrophil activation is characteristic of which disease?

A

Familial Mediterranean fever

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46
Q

Which one of the following agents is effective as a biological disease modifying anti-rheumatic drug (b-DMARD) as part of rheumatoid arthritis management?

a) Adalimumab (anti-TNFalpha)

b) Basiliximab (anti-CD25)

c) Denosumab (anti-RANKL)

d) Pembrolizumab (anti-PD1)

e) Secukinumab (anti-IL17A)

A

Adalimumab (anti-TNFalpha)

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47
Q

Which of the following monoclonal antibody therapies enhances T-cell immunity and is used in management of some malignancies?

a) Infliximab (anti-TNFalpha)

b) Pembrolizumab (anti-PD1)

c) Rituximab (anti-CD20)

d) Tocilizumab (anti-IL6R)

e) Ustekinumab (anti-IL12/23)

A

Pembrolizumab (anti-PD1)

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48
Q

Which of the following is a standard immunosuppressive regime post-allograft?
Azathioprine, mycophenolate mofetil, prednisolone
Cyclophosphamide, methotrexate, rituximab
Cyclosporin, rapamycin, tacrolimus
Dapsone, methotrexate, prednisolone
Mycophenolate mofetil, prednisolone, tacrolimus

A

Mycophenolate mofetil, prednisolone, tacrolimus

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49
Q

Which of the following cells exists in an immature form in the periphery where they recognise pathogens, then mature and become adapted for presenting antigen to T-cells In lymph nodes?
B lymphocytes
Dendritic cells
Eosinophils
Erythrocytes
Plasma cells

A

Dendritic cells

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50
Q

A 22 y/o man is a close household contact of someone diagnosed with TB. What is his lifetime risk of developing the disease?
0.1%
1%
10%
50%
90%

A

10%

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51
Q

What is the main abx used to treat legionella?

A

Azithromycin

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52
Q

Which virus is associated with severe hepatic disease and potentially death if it infects a pregnant patient?
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E

A

Hepatitis E

While most cases of hepatitis E resolve on their own without causing severe illness, pregnant women infected with the virus are at a higher risk of developing severe liver disease, including fulminant hepatitis (acute liver failure). In pregnant women, particularly those in their third trimester, HEV infection can be associated with a high mortality rate, reaching up to 20%.

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53
Q

Which of the following serological tests is useful in the diagnosis of invasive Candida albicans infections?

a) Beta-D-Glucan

b) Galactomannan

c) RFR

d) TPPA

e) Widal test

A

Beta-D-Glucan

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54
Q

Which of the following antivirals is used for chronic hepatitis B treatment?

a) Aciclovir

b) Oseltamivir

c) Tenofovir

d) Zanamivir

e) Ribavirin

A

Tenofovir

55
Q

What parasite infection is associated with malabsorption in the duodenum?

A

Giardiasis (Giardia Lamblia)

56
Q

What sign in the eye do you see in Grave’s disease?

A

Exophthalmos

57
Q

What is the most common cause of constrictive pericarditis associated with calcifications?

A

Tuberculosis

58
Q

What medical procedure can you do to prevent hyperacute ABO rejection in the transfer of an ABO incompatible kidney?

A

Plasmapheresis

59
Q

IVDU tried to inject stuff into his femoral vein, missed and hit an artery instead. Urine dipstick positive for blood but no red cells, what is causing the haematuria?

A

Myoglobin

60
Q

Where do you see smear cells?

A

Chronic lymphocytic leukaemia

61
Q

What are the histological findings post-MI?

A
  • Under 6 hours - normal by histology (CK-MB also normal)
  • 6–24 hrs - loss of nuclei, homogenous cytoplasm, necrotic cell death
  • 1-4 days - infiltration of polymorphs then macrophages (clear up debris)
  • 5-10 days - removal of debris
  • 1-2 weeks - granulation tissue, new blood vessels, myofibroblasts, collagen synthesis
  • Weeks-months - strengthening, decellularising scar tissue.
62
Q

Where are Pelger Huet Cells (flower nuclei white cells) found?

A

Myelodysplastic syndromes

63
Q

Which hepatitis virus normally doesn’t become chronic, but dangerous for pregnant women?

A

Hepatitis E

64
Q

A Woman has a pituitary adenoma with the following biochem: TSH low T4 ACTH low IgF1 low prolactin 700 just a bit raised. What is the likely cause?

A

Non-functioning pituitary adenoma (compressing on the hypothalamus)

65
Q

What test on peripheral blood would reveal the diagnosis, results in line with multiple myeloma.

A

Serum protein electrophoresis

66
Q

What bone cancer is most likely to develop in someone with Paget’s disease?

A

Osteosarcoma

67
Q

What is the treatment of H.pylori?

A

Triple therapy - 2 abx with 1 PPI

68
Q

What is the most common primary brain tumour in adults?

A

Glioblastoma multiforme

69
Q

A poorly controlled T2DM pt has oozing infection of eyes and sinuses, ENT surgeons taking for debridement surgery, what’s the immediate pharm Tx?

A

Amphotericin B

This is Mucormycoses aka black fungus

70
Q

What are the two most common melanoma subtypes?

A

1st - superficial spreading

2nd - nodular

71
Q

What drug causes hypoglycaemia (repeat)
Quinine, Thiazide, Statin, Glucagon, prednisone

A

Quinine

72
Q

What vaccine should you avoid in immunosuppressed patients?

A

Live attenuated e.g. VZV, BCG, yellow fever, MMR

73
Q

A man with HIV, CD4 count under 50, non-compliant with HAART develops diarrhoea and abdo Sxs. Acid and alcohol fast bacilli. Which atypical mycobacterium caused this?

Fortuitum
Clodinea
Avium complex
Marinum
Ulcerans

A

Mycobacterium avium-complex

It causes disseminated infection in immunocompromised and resembles TB

74
Q

Which type of hyperlipidaemia causes acute pancreatitis?
HDL, LDL, high density LDL, cholesterol, triglycerides

A

Triglycerides

75
Q

What is the treatment for advanced malignant melanoma?

A

Nivolumab/Pembrolizumab (PD1)

Ipilimumab (CTLA4)

76
Q

What is rituximab (CD20) used for?

A

Lymphoma, rheumatoid arthritis, SLE

77
Q

What is Ibrutinib used for?

A

CLL treatment

78
Q

What is imatinib used for?

A

ALL or CML treatment (targets 9;22 translocation)

79
Q

What is the most likely complication of multiple pulmonary thromboembolism?

A

Pulmonary hypertension

80
Q

What type of cardiomyopathy is associated with amyloidosis?

A

Restrictive cardiomyopathy

81
Q

In what haemorrhage are cortical veins damaged?

A

Subdural haemorrhage

82
Q

What amyloidosis is most associated with multiple myeloma?

A

AL (light chain) amyloidosis

83
Q

Person had an unprovoked DVT, treated with LMWH for 6 months. What long-term DVT prophylaxis should they take?

Aspirin, warfarin, DOAC, none needed, LMWH?

A

DOAC

84
Q

Lady with bronchiectasis known to be colonised with fully sensitive Pseudomonas aeruginosa, what antimicrobial should be used?

Ceftazidime, Ceftriaxone, Co-trimoxazole, Cefuroxime

A

Ceftazidime

85
Q

A 19 yo boy has meningococcal Meningitis. Dad Says he is deathly allergic to penicillins and cephalosporins due to anaphylactic reactions. Which antibiotic should you use instead?

Meropenem, Amoxicillin, co amoxiclav, ceftriaxone, chloramphenicol

A

Chloramphenicol

It is useful especially in penicillin-allergic individuals

86
Q

In histology of antibody-mediated rejection of allogeneic kidney transplant, where would the inflammatory infiltrate be seen?

A

Capillaries

*Whilst in T-cell mediated rejection, this is seen in the interstitial

87
Q

What is the effect of male sex on the risk of venous thrombosis recurrence?

A

Increased risk

88
Q

A 21 year old Syrian woman who has recently moved to the UK from a refugee camp attends a haematology clinic. She has Beta Thalassaemia major and for the last six years has received regular blood transfusions as treatment for anaemia. On examination she has signs of congestive cardiac failure and gonadal failure. What is the most likely explanation for these clinical findings ?

A

Iron overload secondary to multiple blood transfusions

89
Q

Which leucocyte actively participates in an acute inflammatory reaction, contains myeloperoxidase within its primary granules and alkaline phosphatase in it secondary granules?

A

Neutrophil

90
Q

What is the most common histologic type of carcinoma involving the oral cavity?

A

Squamous cell carcinoma

91
Q

A patient with Sjogren’s syndrome has a salivary gland biopsy. What cells are the most common infiltrating cell type likely to be seen?

A

T lymphocytes

92
Q

What is Von Hippel-Lindau (VHL) syndrome?

A

Autosomal dominant inherited disorder caused by mutations in the VHL gene - predisposition to the development of various tumours, including hemangioblastomas, renal cell carcinomas, and cysts in multiple organs

93
Q

A 39 year old male farmer from Southern Africa has been exposed to mouldy grain during his working life. He has worsening abdominal pain and jaundice. There is a large mass in the right lobe of his liver. Biopsy of the mass reveals hepatocellular carcinoma, What extrinsic agent is likely to have played a role in the development of this tumour?

A

Aflatoxin

Aflatoxin is a carcinogenic substance produced by certain molds, particularly Aspergillus species, which can contaminate stored food products such as grains and nuts. Prolonged exposure to aflatoxin is a known risk factor for the development of hepatocellular carcinoma.

94
Q

Which cytokine is key in promoting the development and terminal differentiation of eosinophils?

A

IL-5

95
Q

Antibodies bind to which cell type during the effector phase of antibody mediated rejection of solid organ allografts?

A

Endothelial cells

96
Q

What are the three phases of transplant rejection?

A

Recognition –> activation –> effector function

97
Q

A young man presents with episodes of fever, pleurisy and peritonitis. Investigations: confirm a mutation of the MEFV gene encoding pyrin. Which drug inhibiting neutrophil function is regarded as the agent of choice for prophylaxis against acute febrile illness and prevention of amyloidosis?

A

Colchicine

*Other treatment options include anakinra and etarnercept

98
Q

What cytokine is targeted to improve disease control of ankylosing spondylitis?

A

Tumour necrosis factor alpha

99
Q

What double stranded DNA virus is associated with nephritis in renal transplant recipients on immunosuppresive therapy?

A

BK virus

100
Q

Which helminth is capable of autoinfection in humans via the following life cycle?

Infective filariform larvae penetrate intact skin and migrate to the small intestine where they became adults. Eggs hatch into rhabaitifom larvae which mature into filariform larvae which can autoinfect via perianal skin.

A

Strongyloides

101
Q

In optimal circumstances, for a 70kg male, transfusion of 1unit RBC and 1 unit of platelet gives a predictable increment in the Hb and platelet count. Which statement is correct?
Expected increment, Haemoglobin 10 g/L and Platelets 400 x 10^9/L.
Expected increment, Haemoglobin 20 g/L and Platelets 10 x 10^9/L.
Expected increment, Haemoglobin 50 g/L and Platelets 35 x 10^9/L
Expected increment, Haemoglobin 50 g/l and Platelets 100 x 10^9/L.
Expected increment, Haemaglobin 10 g/L and Platelets 35 x 10^9/L.

A

Expected increment, Haemaglobin 10 g/L and Platelets 35 x 10^9/L.

102
Q

In allogeneic haemopoietic stem cell transplantation for acute myeloid leukaemia. Removing all donor derived T lymphocytes (T-cell depletion) from the donor cell collection prior to infusion into the recipient has an impact on both, the incidence of acute graft, versus host disease (aGVHD) and the rate of leukaemia relapse. Which statement is true?
Abolishes aGHVD risk and removes risk of leukaemia relapse .
Increases aGVHD risk and increases leukaemia relapse rate.
Increases aGVHD risk and reduces leukaemia relapse rate.
Reduces aGVHD risk and reduces leukaemia relapse rate.
Reduces aGVHD risk and increases leukaemia relapse rate.

A

Reduces aGVHD risk and increases leukaemia relapse rate.

In allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia, removing all donor-derived T lymphocytes (T-cell depletion) from the donor cell collection prior to infusion into the recipient has the following effects:

It reduces the risk of acute graft-versus-host disease (aGVHD). By depleting T lymphocytes, which play a major role in the immune response, the incidence and severity of aGVHD can be significantly reduced.

However, it increases the risk of leukaemia relapse. T lymphocytes have an important role in the graft-versus-leukaemia (GVL) effect, where donor immune cells target and destroy residual leukaemia cells in the recipient. By removing T lymphocytes, the GVL effect is diminished, leading to an increased risk of leukaemia relapse.

103
Q

Renal transplant recipients on long term immunosuppression have an increased risk of which lymphoid cancer?
Cutaneous T cell lymphoma.
EBV associated Diffuse large B cell lymphoma (DLBCL)
Enteropathy associated T cell lymphoma
H.Pylori associated gastric marginal zone lymphoma
HTLV1 associated Adult T cell lymphoma (ATLL)

A

EBV associated Diffuse large B cell lymphoma (DLBCL)

*Post-transplant complications include viral-induced malignancies like lymphoma (EBV), Kaposi’s sarcoma (HHV8), skin cancers. There is also a risk of conventional and opportunistic infections.

104
Q

Which of the following is associated with disseminated intravascular coagulation?
Decrease in neutrophil count
Decrease in reticulocyte count
Increased plasma fibrinogen concentration
Increased platelet count
Prolonged thrombin time

A

Increased plasma fibrinogen concentration

105
Q

A 55 year old man is being discharged from hospital on long term anticoagulation with Rivaroxaban a direct acting anticoagulant. Which is the correct approach for routine monitoring of his anticoagulation?
anti Xa assay
APTT (Activated Partial Thromboplastin Time)
D-Dimers assay
INR (International normalised ratio)
Routine laboratory
Monitoring not required

A

Monitoring not required

DOACs do not require monitoring!!

106
Q

Which of these tumours is most likely to be associated with Pseudomyxoma peritonei?

Clear cell tumour of the kidney
Cystic tumour of the gallbladder
Mucinous tumour of the ovary
Serous tumour of the ovary
Smooth-muscle tumour of the uterus

A

Mucinous tumour of the ovary

Pseudomyxoma peritonei = accumulation of mucinous material within the peritoneal cavity

107
Q

A 26 year old person had silicone breast implants inserted 2 years ago. They are now asymmetrical, and one has become much harder than before. The leaking implants are removed and sent to pathology. Which inflammatory cell is most prominent on histological examination?

Eosinophil
Macrophage giant cell
Mast cell
Neutrophil
Plasma cell

A

Macrophage giant cell

Giant cells form as a response to the presence of foreign material, such as silicone. They are involved in the inflammatory reaction and can contribute to the formation of a fibrous capsule around the implant.

108
Q

A 42 year old male with alcoholism presents with signs of alcoholic hepatitis, A liver biopsy shows cytoplasmic regular eosinophilic hyaline bodies in the hepatocytes. From which substance are these inclusions formed?

Basement membrane material
Excess plasma proteins
Immunoglobulin
Lipofuscin
Pre-keratin intermediate filaments

A

Excess plasma proteins

What is described are mallory denk cells. They are formed by the aggregation of excess cytoskeletal proteins, particularly cytokeratins, within the hepatocytes. These proteins accumulate due to impaired protein degradation pathways in the liver affected by alcohol abuse.

109
Q

A 42 year old male cigarette smoker presents with urinary frequency and haematuria. Cystoscopy finds an ‘exophytic fronded lesion’ which is biopsied. Histologic examination shows fibrovascular cores covered by atypical cells. No invasive malignancy is seen. No glands are seen, and no keratin production is found. Dx for this bladder tumour?

Adenocarcinoma
Inverted papilloma
Papillary urothelial carcinoma
Squamous cell carcinoma
Urothelial carcinoma in situ

A

Papillary urothelial carcinoma

110
Q

A 29 year old male presents with bloody diarrhoea. Barium examination reveals a characteristic “string sign.” At colonoscopy, the rectum and sigmoid colon appear normal. Biopsy from the terminal ileum reveals numerous acute and chronic inflammatory cells within the lamina propria. The distal ileum is resected and examination shows a thickened wall with long mucosal fissures extending deep into the wall. Which is the correct diagnosis?

Crohn’s disease
Eosinophilic colitis
Infectious colitis
Lymphocytic colitis
Ulcerative colitis

A

Crohn’s disease

111
Q

Which of the following stimulate the release of prolactin from the pituitary gland?

Corticotrophin releasing hormone (CRH)
Dopamine
Gonadotrophin releasing hormone (GnRH)
Growth hormone releasing hormone {GHRH}
Thyrotropin releasing hormone (TRH)

A

Thyrotropin releasing hormone (TRH)

112
Q

Alum is effective as an adjuvant for vaccination. Which of the following best describes its mechanism of action?

Enhancement of CD4+ T cell response
Enhancement of the innate immune response
Promotion of B cell differentiation
Suppression of CD& T ceil response
Suppression of the T reg response

A

Enhancement of the innate immune response

Antigens are absorbed to alum so it acts as a mean of slowly releasing antigen. Activation of Gr1 cells produces IL-4 and this helps prime naïve B cells

113
Q

Nivolumab is a monoclonal antibody specific for programmed death 1 (PD-1) and may be used as part of management for metastatic melanoma. Its principle mechanism of action is to activate which cell type?

B-lymphocytes
Endothelial cells
Melanocytes
Neutrophils
T-lymphocytes

A

T-lymphocytes

114
Q

Which biologic disease modifying anti-rheumatic drug (DMARD) targeting a specific cytokine pathway would be expected to show efficacy in RA but not psoriatic arthritis?

Adalirnumab (anti-tumour necrosis factor alpha antibody)
Etanercept (tumour necrosis factor receptor - Ig fusion protein
Secukinurnab (anti-interleukin 17antibody)
Tocilizumab (anti-interleukin 6 receptor antibody)
Ustekinumab (Ab specific for p40 of interleukin 12 and interleukin 23)

A

Tocilizumab (anti-interleukin 6 receptor antibody)

115
Q

Cigarette smoking is associated with development of rheumatoid arthritis. Which is the most likely mechanism underpinning this association?

Nicotine acts as an immune checkpoint inhibitor
Nicotine as an inhibitor of T reg
Peptide from nicotine binds to the shared epitope of HLADR1 and DR4
Smoking increases citrullination of proteins in the lung
Smoking results in high levels of hydrogen cyanide which stimulated production of RF

A

Smoking increases citrullination of proteins in the lung

116
Q

What antibiotics have activity against mycoplasma?

A

Macrolides
Tetracyclines
Fluoroquinolones

117
Q

Which component of SARS CoV-2 is the antigenic target for the vaccines currently used in the UK?

Envelope (E) protein
Membrane (iM) protein
Nucleocapsid (N)protein
Spike (S) protein
Viral RNA

A

Spike (S) protein

118
Q

Which agent is an Interleukin 6 (IL-6) inhibitor, indicated for treatment of severe COVID-19 infection with hypoxia?

Anakinra
Nafamostat
Palivizumab
Ruxalitinib
Tocilizumab

A

Tocilizumab

119
Q

Which antiviral agent is used for the treatment of Influenza A?

Cidofovir
Foscarnet
Ribavirin
Tenofovir
Zanamivir

A

Zanamivir

120
Q

Streptococcus pneumoniae is resistant to penicillin, by which mechanism?

Alteration of the target that binds the antimicrobial
Bypass of the antimicrobial susceptible step in metabolism
Enhanced efflux of the antimicrobial
Enzymatic inactivation of the antimicrobial
Impaired uptake of the antimicrobial into the bacterial cell

A

Alteration of the target that binds the antimicrobial - involves mutations in penicillin-binding proteins (PBPs), which are enzymes involved in cell wall synthesis. These mutations can reduce the affinity of PBPs for penicillin, rendering the bacteria resistant to its effects.

121
Q

Blood cultures taken from a 57 year old patient on renal dialysis have grown a glycopeptide resistant Enterococcus faecium. Further susceptibilities are to follow. Which antimicrobial is an appropriate choice for initial treatment of this infection?

Co-trimoxazole
Linezolid
Meropenem
Taicopianin
Vancomycin

A

Linezolid

122
Q

A 26 year old woman presents with fever, headache and confusion. She has an HIV infection and has refused to take antiretroviral therapy for the past 4 years. What rapid test should you ask the microbiology laboratory to perform on her serum sample to confirm the likely diagnosis?

A

Cryptococcal antigen in serum/CSF + india ink staining

123
Q

Which liver enzyme can be measured in the blood and specifically suggests obstructive jaundice if levels are found to be raised?

A

GGT

124
Q

A 30 year old woman with known ITP gives birth to a healthy full term baby. Which is the correct haematological management of the newborn baby?

Check daily bilirubin levels for a minimum of five days
Check daily FBC for a minimum of five days.
Check FBC on cord blood sample and if normal no further action required
Check INK on cord blood sample and administer Vitamin K
Perform DAT (direct anti-globulin test) on both maternal and neonatal red blood cells.

A

Check FBC on cord blood sample and if normal no further action required

125
Q

What clotting time is prolonged in antiphospholipid syndrome (lupus anticoagulant)?

A

APTT

126
Q

A 75 year old male presents with dysphagia and is feu to have a 4m mass in the middle third of the oesophagus which invades into the middle third of the oesophagus which invades into the adjacent lung. Biopsy from this mass would mass likely show which histological feature?

A mass composed of benign cartilage
A mass composed of benign smooth-muscle cells
Infiltrating groups of malignant cells forming glandular structures
Infiltrating malignant single calls having intracellular mucin
Infiltrating sheets of malignant cells forming keratin

A

Infiltrating groups of malignant cells forming glandular structures

127
Q

Which one of these individuals is most likely to have a prolactin secreting tumour of the anterior pituitary?

A 23 year old female with amenorrhoea, galactorrhoea, and a negative pregnancy test
A 25 year old female with polyuria, polydipsia, and hypernatremia
A 47 year old female with coarse facial features, large hands and feet, and headaches
A 48 year old male with psychosis, ophthalmoplegia, and ataxia
A 54 year old male with central obesity, purple abdominal striae, and mental changes

A

A 23 year old female with amenorrhoea, galactorrhoea, and a negative pregnancy test

128
Q

A25 year old woman presents with a purple rash around the eyes and a raised red rash on her elbows and knees. Which enzyme would you expect to be raised?

Alkaline Phosphatase
Amylase
Aspartate Amino-transferase
Creatine kinase
Glucose-6-phasphate dehydrogenase

A

Creatine kinase

This is a picture of polymyositis and dermatomysositis which would have a raised CK!!!

129
Q

A 4 year old child presents with fever, weight loss, malaise and abdo pain. CT abdomen shows hepatosplenomegaly and retroperitoneal lymphadenopathy. Mycobacterium aviurm-intracellulare is grown from blood cultures. Which immune deficiency is most likely to explain the presentation?

Bare lymphocyte syndrome type 2
Chronic granulomatous disease
IgA deficiency
Interferon gamma receptor deficiency
Mannose binding lectin deficiency

A

Interferon gamma receptor deficiency

Cytokine deficiency that causes susceptibility to mycobacteria, BCG and salmonella.

There is an inability to form granulomas

130
Q

What is X-linked SCID associated with?

A

Very low/absent T cells and NK cells

Normal or increased B cells

*Gamma chain of IL2 receptor mutation

131
Q

45F develops weakness involving proximal muscles of arms and legs. Blood test results for FBC, renal function and LFT are all normal. Further ix below. Dx?

ESR – 25 (<20)
CRP – 4 (<5)
Creatine kinase – 3540 (25-175)
ENA (extractable nuclear antigen) screen – positive

Hypothyroidism
Myasthenia Gravis
Polymyalgia rheumatica
Polymyositis
Transverse myelitis

A

Polymyositis

If CK is raised, then polymyosisits/dermatomyositis!!

132
Q

A 45 year old man has a long history of cutaneous psoriasis and has developed features of a spondyloarthritis, with sacroiliitis and knee effusions. He has been extensively investigated, including with blood tests for anti-nuclear antibody, anti- dsDNA antibody, rheumatoid factor, anti-cyclic citrullinated peptide antibody. What would you expect results of these serological tests to show?

Negative for all
Positive anti CCP ab
Positive anti-dsDNA ab
Positive anti-nuclear ab
Positive rheumatoid factor.
A

Negative for all

133
Q

A 76 year old man with a long term indwelling urinary catheter which was changed earlier in the day becomes unwell. He is pyrexial and has been having rigors. He is tachycardic heart rate of 123 bpm, and hypotensive blood pressure 94/62 mmHg. He is known to be colonised with an ESBL producing E.coli. Which antimicrobial would be the mast appropriate empiric therapy?

Aztreonam
Ceftriaxone
Meropenem
Piperacillin/tazobactam
Trimethoprim

A

Meropenem

134
Q

What do hypogranular hypolobulated neutrophils suggest?

A

These are also known as Pelger–Huët cells which are commonly found in myelodysplasia

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