Past paper Flashcards
Man has an MI 3 years ago. Now comes into hospital feeling very unwell. Is having a sample taken from their pericardial layer and you find blood is aspirated from the pericardium
Left ventricular rupture
IV antibiotic for Group A Strep pharyngitis/Strep Throat?
Benzylpenicillin
Vitamin deficiency: C (ascorbate)
Scurvy
Vitamin deficiency: B6 (pyridoxine)
Dermatitis, anaemia, neuropathy
Rate limiting step in haem biosynthesis pathway:
ALA synthase (aminolevulinic acid)
MEN2b associations:
Phaeo, medullary thyroid, mucocutaneous syndromes, marfans
Which/What cell is increased in cases of a parasitic infection
Eosinophils
57 year old man presents following hematemesis and is found to have: High ALT + GGT, and slightly raised ALP. Low Albumin
Alcohol induced hepatitis
Pneumonia: transplant patient on immunosuppressive. Halo sign on X-ray
Aspergillus
Autoimmune and auto-inflammatory disease: MEFV gene, abdominal pain and ascites
Familial Mediterranean Fever
SBA: drug can be used to treat some malignancies and affects T cell activity
Pembrolizumab (treat inoperable or metastatic melanoma, metastatic NSCLC)
Bicarbonate in a pyloric stenosis patient
High
A man after a road traffic accident (Man vs Car) requires a 6 unit transfusion, and then becomes acutely breathless/SOB, with a fever and tachycardia
TRALI
Management of acute angioedema:
IM adrenaline 0.5ml of 1:1000
Meningitis: gram positive diplococci
Strep pneumoniae
Pancreatic mass + hypoglycaemia
Pancreatic insulinoma (Islet cell tumour)
Vitamin deficiency: Folate
Macrocytic anaemia, neural tube defects
Liver Function Tests: Woman with colicky abdo pain, raised ALP
Gallstones
SBA: Characteristic of ALL
Anaemia, thrombocytopenia and neutropenia
AI disease markers: anti-centromere antibody
Limited cutaneous scleroderma (CREST syndrome)
German woman with recurrent URTIs + UTIs. She has low neutrophils.
Chronic idiopathic neutropenia
Gram positive rod causing meningitis in a 72-year-old?
Listeria
AI disease markers: Anti-endomysial
Coeliac disease
Drowsy teenage girl with CSF: raised protein + raised lymphocytes
Viral meningitis
Man with weakness in the gym and ptosis
MG. Anti-ACh receptor
A smoker is found to have a Gram Positive diplococci causing meningitis. Which microorganism is the most likely cause?
Streptococcus pneumoniae
Autoimmune and auto-inflammatory disease: due to mutations in the FAS pathway
Autoimmune lymphoproliferative syndrome (ALPS)
What lab test would you use for: diagnosing temporal arteritis
Initally ESR then temporal artery biopsy
Obstetric haematology: slightly reduced platelet count in 3rd trimester (100 x 10^9)
Gestational thrombocytopenia
Sodium handling: patient with lung cancer. High sodium, low potassium
Ectopic ACTH secretion, due to lung cancer
Lump that moves around
Fibroadenoma
Mab Used to treat Lymphoma and RA
Rituximab (anti-CD20)
SBA: Middle aged lady, loss of bile ducts and granulomas present
Primary Biliary cirrhosis
Woman presents with aches all over, (diffuse swelling), and joint stiffness?
Rheumatoid arthritis. Anti-CCP
VSA: Name an infectious microorganism which is a common cause of meningitis in 3 months or older new-borns?
Strep. pneumonia
VSA: infectious microorganism which is a common cause of sepsis in newborns
GBS (E.coli)
Meningitis: gram negative diplococcus
Neisseria meningitides
A German lady who is asymptomatic, has low neutrophils, but no abnormal cells on film
Chronic idiopathic neutropenia
Define impaired glucose tolerance (After 2hr OGTT)
BG: 7.8 – 11.1mmol/LImpaired fasting glucose = 6.1-7
Hyperuricaemia/uric acid excess is caused by:
Xanthine oxidase
Vaccine for splenectomised patients:
Pneumococcal vaccine
Treatment for Listeria meningitis
Amoxicillin
STI causing neonatal conjunctivitis
Gonorrhoea, chlamydia
Causes of hydrops fetalis < 20 weeks gestation
Parvovirus B19 (erythrovirus), CMV, HSV, toxoplasma gondii, treponema pallidum
Woman with UTI: gram positive cocci in clusters
Staph saprophyticus
SBA: Most likely cause of HAP?
Staphylococcus aureus (closely followed by Pseudomonas)
Cause of Karposi’s sarcoma
HHV8
VSA: mixed pattern auto-inflammatory condition has over 90% heritability and effects the sacroiliac joint
Ankylosing Spondylitis
Known breast cancer + red/rough nipple
Pagets disease of the breast, or DCIS
10 year old with seizures. Low calcium, high phosphate, high PTH
Secondary hyperparathyroidism, due to renal osteodystrophy. (Low calcium can cause seizures)
Protozoa causing infection in pregnancy
Toxoplasma gondii
A glycopeptide used to treat MRSA
Vancomycin or teicoplanin
What is the mass that can for following acute pancreatitis:
Pancreatic pseudocyst
Tx for Young women with cystitis and fully sensitive E-Coli.
Trimethoprim
Most common type of malignancy in the breast?
Invasive ductal carcinoma
VSA: used to measure the turnover of bone, and is raised in people who have Paget’s orOsteomalacia
ALP
Which of these options causes DIC (in pregnancy)?
Amniotic fluid embolism
Breast Cancer which has a high, medium and low stage to it
DCIS
VSA: raised in obstructive jaundice/biliary obstruction
ALP
SBA: Which Hepatitis does not lead to/cause Chronic Hepatitis
Hepatitis A
By what mechanism does GORD cause cancer?
dysplasia
Sodium handling: Patient becomes drowsy after Road traffic accident
Cranial Diabetes Insipidus (Due to trauma)
Pneumonia: weight loss, haemoptysis, upper lobe cavitation
TB
What is the most common cause of traveller’s diarrhoea?
E Coli
SBA: Cancer with transitional cells on histology. Where is the primary?
Bladder
What drug do you use to treat influenza A?
Oseltamivir
Pathogen found in badly collected urine sample
Staph A
Vaccine preventable disease: causes lumps in parotid and neck
Mumps
Patient with JAK2 mutation has raised haemoglobin, and gets pruritus following showering.
Polycythaemia Rubra Vera
Material seen in the vessel of a burst atheroma in a patient with an MI
Atheromatous plaque
SBA: Diarrhoea and weight loss + patchy inflammation and granuloma
Crohn’s disease
20 year old rugby player with boils. Rest of his team have them, and so do his family
Herpes gladiatorum (Type of HSV-1)
Rash on penis, soles, hands
Syphilis
SBA: Gout medication contraindicated with Allopurinol
Azothioprine
Requires C-section if mu has outbreak >34 weeks
Primary HSV infection
A man with Atrial fibrillation develops fever, nausea, vomiting and pain in his right loin/flank. What is the most likely cause?
Renal infarct
AI disease markers: anti-Ro. Patient has dry eyes
Sjogrens syndrome
Bloated after drinking milk but not IgE mediated
Lactose intolerance
Leukaemia: Middle aged person. t(9:22) present, BCR-ABL. Blood film shows 3% blasts
CML
An 18 year old students is found to have Gram Negative diplococci causing meningitis. Which microorganism is the most likely cause?
Neisseria meningitides
In Rhabdomyolysis, which biomarker is likely to be raised?
Creatinine Kinase
Woman with progressive amnesia dies from bronchopneumonia
Dementia (Alzheimers?)
24 year old asymptomatic man with isolated rise in unconjugated bilirubin (all other results (ALT, ALP etc normal)
Gilberts
Old woman falls and breaks her hip. What condition does she have?
Osteoperosis
Cause of molluscum contagiosum
Poxvirus
Elderly man with atrial fibrillation with right flank pain?
Renal infarcts
Vitamins: Young patient with bowed legs
Vit D deficiency (Ricketts)
ChemPath investigations: Diabetic visiting GP for routine appointment
HbA1c
A lady has frank (visible) painless haematuria and a mass palpable on one side. What is the most likely cause?
Renal cell carcinoma
VSA: massive splenomegaly, and JAK2 V617F mutation with a leucoerythroblastic picture and tear-drop poikilocytes
Myelofibrosis
Metabolic acidosis. High potassium.
T1DM
What happens to the body of the stomach in a patient with pernicious anaemia?
Atrophic body gastritis
VSA: Which common condition can be treated with drugs that target with TNF, IL-17 and IL-12/23?
Psoriasis
Sudden headache, loss of consciousness and meningism
Sub-arachnoid haemorrhage
Core biopsy coding: B5
B5 = malignant. B5a = DCIS, B5b = invasive carcinoma
Cause of haemorrhagic cystitis post-transplant
BK virus
Patient with recurrent pneumococcal infections and meningitis
C3 deficiency (or alternative pathway deficiency)
An elderly gentleman has really elevated ALP on it’s own, and the other results are normal. He also reports a history of headaches
Paget’s disease
Broad spectrum antibiotic with no pseudomonal activity. Usually given with a beta lactamase inhibitor
Amoxicillin (given with clavulanic acid = co-amoxiclav)
High sodium, low potassium, high urine osmolarity
Conns syndrome
Carcinoma due to H. Pylori infection
Gastric adenocarcinoma
22 year old student with two weeks anorexia, fever and malaise – raised ALT, normal ALP + GGT
Viral hepatitis
Patient with high IgG paraprotein – (32 or 40) g/dl, back pain and loss of sensation in legs
Multiple myeloma
Most common cause of UTI: in general
E. coli
Vitamins: Patient with Pellagra
B3 deficiency (3Ds- Dementia, diarrhoea, dermatitis {necklace rash})
SBA: Vector of Trypansoma brucei?
Tsetse Fly
What cancer can the Bruton Tyrosine kinase inhibitor ibrutinib be used in?
CLL
Sodium handling: HTN, High Na, Low K, high renin
Renal artery stenosis (Renin low in Conns)
Meningitis: aseptic (unable to culture), raised lymphocytes, raised protein, normal glucose
Viral meningitis
Cell of immune system: differentiated B cell that produces immunoglobulins
Plasma B cell
Wegener’s immunotherapy:
Cyclophosphamide (+ corticosteroids)
Obstetric haematology: recurrent first trimester miscarriage
Antiphospholipid syndrome
ChemPath investigations: Pt can’t fit on shoes or put on wedding ring and has prognathism. Which test to confirm?
OGTT (measure GH- should be suppressed) {Can also measure IGF-1 levels}
A man is injured playing sports. He is found to have pancytopenia and immature myeloid cells on blood film. WCC normal.
AML
What enzyme regulates the rate limiting step in haem biosynthesis pathway/of the blood?
ALA synthase
What lab test would you use for: diagnosing thalassaemia
Hb electrophoresis
A (?teenager?) presents with a history of several weeks of increased thirst (polydipsia), increased urination (polyuria) / High urinary output and weight loss:
T1DM
Autoimmune and auto-inflammatory disease: associated with Nod2/CARD15
Crohn’s disease
INRs and appropriate management: patient with a previous DVT, INR 4
Decrease dose of warfarin to aim for target INR of 2.5 (2-3)
Young boy has normal B cells, but no CD4+ or CD8+ cells
X-linked Severe combined immunodeficiency
AI disease markers: anti-CCP
Rheumatoid arthritis
50 year old lady with memory issues/progressive amnesia, hypertension (?? + bronchopneumonia??)
Multiple cerebral infarcts
SBA: Dad and brother of dead individual disagree over having an autopsy. The Dad was the main carer but no mention of Standing order or special status assigned to dad by the dead individual.
An autopsy can be done but to settle the disagreement it goes to a special court
Allergy: patient gets allergy symptoms every summer, with a runny nose
Allergic rhinitis
Cause of positive NAAT test + PID
Chlamydia trachomatis
Vaccine preventable disease: maculopapular rash starts on face. Can cause encephalitis and pneumonitis
Measles
Bitten woman in nigeria in with chills
Malaria
SBA: Why do the walls of vessels expresses anti-thrombotic factors
Thrombomodulin
A girl with a sore throat is given penicillin and develops a rash. She is found to have EBV.
Drug reaction
Blood transfusions: woman received a transfusion before her hysterectomy, presents with bleeding gums and rash on her shins on discharge
Post-transfusion purpura (presents 5-12 days after transfusion. Associated with thrombocytopenia)
Young man with fever, leucocytosis and petechial rash after URTI
Henoch–Schönlein purpura
A 2 year old has a palpable abdominal mass when his mother picks him up. What is the most likely cause?
Wilms tumour
SBA: Mouth/lip swelling following a dental procedure with a family history
C1 inhibitor deficiency
What lab test would you use for: bone marrow response to haemolytic anaemia
Reticulocytes
ChemPath investigations: Cushing-like woman, BP 109/100, thin skin, Overweight, high-normal sodium, low-normal potassium, OGTT (glucose high-normal)
Low dose dex suppression
Allergy: itchy mouth after eating certain fruits
Food allergy or anaphylaxis or oral allergy syndrome. IgE mediated
Vitamins: Person with Crohn’s and megaloblastic anaemia
Folate deficiency
Impaired glucose tolerance in OGTT
7.8-11.1
what enzyme is raised in osteomalacia?
ALP
Blood transfusions: what is most serious complication of blood transfusion
TRALI is the number 1 cause of transfusion mortality
A ward sister gets diarrhoea, and patients on the ward have been ill recently
Norovirus
Cell of immune system: responsible for the killing of cancerous cells, and is inhibited by MHC-1
NK cell
Which drug do you give to a woman who is infected with herpes simplex/ HSV1 encephalitis?
Aciclovir
Patient with raised IgM paraprotein (32)
Waldenstroms macroglobinaemia
Macrolide used to treat atypical pneumonias
Clarithromycin
VSA: Which clotting factor falls most rapidly after administering warfarin
Protein C
VSA: What zoonotic disease does the Ixodes Tick cause
Lyme disease (Borelia burgdorferi)
What cell sits in (it’s immature form in) the periphery, and when it matures, goes to present things to T cells?
Dendritic cell
SBA: Cause of rash in amoxicillin + IM
Drug reaction
Which/What enzyme is raised in mumps?
Amylase-S
SBA: Which cancer does asbestos cause?
Mesothelioma
Liver Function Tests: 20 year old with 2 weeks of anorexia, fever and malaise – raised ALT, normal ALP and GGT
Viral Hepatitis
