Past Paper Q's - 2016

Question 1

• 19 year old rugby player with boils, members of his team have similar boils, as do members of his family

Answer 1

Herpes Gladitorium cuased by HSV1

Question 2

• Virus that resides in pharynx and GIT - 1:100 encephalitis, 1:1000 destruction of motor neurons

Answer 2

Polio

Question 3

• Maculopapular rash moves from face that can cause encephalitis and pneumonitis

Answer 3

Measles (Possibly VZV)

Question 4

• Disease that causes Hydrops fetalis if caught in first 20wks

Answer 4

Parvovirus

Question 5

• Patient with a mass following acute pancreatitis

Answer 5

Pseudocyst or abscess

Question 6

• Patient with a history of severe abdominal pain; during cholecystectomy, the surgeons noticed white specks around and on the pancreas

Answer 6

Chronic Pancreatitis - Due to clacification

Question 7

• Patient with hypoglycaemia and pancreas mass

Answer 7

Insulinoma

Question 8

• What material is seen in the vessel of a patient with an MI due to burst atheroma

Answer 8

Thrombus

Question 9

• Patient had an appendectomy 1 week ago. What would you see in their scar

Answer 9

Collagen in scar

Question 10

• On doing a patient’s nephrectomy they notice a mass in the kidney that extends into the renal vessels and into the perinephric fat

Answer 10

Papilliary Adenomas are found incidentally

Question 11

• Radiosensitive cancer of the testicle in a young man with a white/smooth appearence

Answer 11

Seminoma

Question 12

• Patient with a cancer in their bladder following chronic schistosomiasis

Answer 12

Squamous Cell Carcinoma or transitional cell

Question 13

• Man goes deaf with bowed legs

Answer 13

Pagets

Question 14

• Recurrent TIAs, arteriopath risk factors. What does the patient have?

Answer 14

Atheroscleorsis

Question 15

• Sudden headache, loss of consciousness, meningism. What does the patient have?

Answer 15

SAH

Question 16

• Man dies from MI. What histopathology is likely to have caused this? (not atherosclerosis)

Answer 16

atheroma

Question 17

• Man has an MI 3 years ago. Now he comes into hospital and very unwell. Blood is aspirated from the pericardium.

Answer 17

CARDIAC TAMPONADE

Question 18

• Lady with spinal fracture due to tb (didn’t say tb but the fracture suggested it)

Answer 18

IFN-Gamma receptor deficiency - Type of cytokine deficinecy

Question 19

• Used to treat Lymphoma and RA

Answer 19

Rituximab Anti CD-20

Question 20

• Used to prevent transplant rejection, by blocking T cell proliferation and activation

Answer 20

anti thymocyte globulin or CD25 Basiliximab (Il-2)

Question 21

• Used to treat ankylosing spondylitis and NICE recommended if two other anti-inflammatories have failed

Answer 21

– Anti TNFa eg. Infliximab

Question 22

• Monocytes resident in peripheral skin cells

Answer 22

Dendritic cells

Question 23

• Responsible for the killing of cancerous cells and are inhibited by MHC-I

Answer 23

natural killer cells

Question 24

• Mentioned FAS pathway

Answer 24

Autoimmune lymphoproliferative syndrome

Question 25

• Nod2/CARD15

Answer 25

chrons

Question 26

• Can lead to development of post transplantation lymphoproliferative disease

Answer 26

EBV

Question 27

• Patient with HIV, raised ICP, new onset epilepsy.

Answer 27

cryptococcus

Question 28

• 10 year old Bangladeshi girl pale and tired - hypochromic RBCs with some pencil cells

Answer 28

Fe def anaemia

Question 29

• Pregnant patient with slightly low platelets in 3rd trimester (100 x 10^9). No other symptoms.

Answer 29

Gestational thrombocytopenia (150 is physiological lower limit)

Question 30

INR target for most people?
INR target for DVT
What does increasing warafin do to INR?

Answer 30

2.5 for most conditions and bio valves
3.5 for recurrent DVT after already being on OAC and INR is above 2 or mechanical valves
Increase warafin increases INR as you’re increasing time taken to clot

Question 31

• Patient with paraprotein - 40g/dl, back pain and loss of sensation in legs (these might have been in another question) yeah i think maybe the bcl-abl ones go with the puritis one maybe?

Answer 31

Parathesisa means amyloidosis

Question 32

• Patient with paraprotein - IgM at 32. Lymphadenopathy, angioedema?

Answer 32

Waldenstroms macroglobulinemia AKA lymphoplasmacytic lymphoma- Cos of IGM

Question 33

• Man with pancytopenia and myeloid precursors

Answer 33

AML- CML doesn’t cause pancytropaenia

Question 34

• Woman who received a transfusion before her hysterectomy who presented with bleeding gums and rash on her shins on discharge

Answer 34

Post transfusion Purpura

Question 35

• Patient with polyuria and polydipsia- low Na, Low K, Low plasma and urine osmolarity

Answer 35

psychogenic polydipsia

Question 36

• Pt with HTN - high Na, Low K, high renin,

Answer 36

high aldosterone (conns has a high aldosterone to renin ratio) renal artery stenosis high renin, high aldosterone

Question 37

• Vegan with megaloblastic anaemia

Answer 37

b12 deficiency

Question 38

• Everything normal but low TSH

Answer 38

Secondary Hypothyroid

Question 39

What are the 3 things you give in CPFT?

Answer 39

GnRH, Insulin, and TSH

Question 40

What is the rate limiting step in porphyrinogen cycle?

Answer 40

ALA synthase

Question 41

Limb girdle stiffness

Answer 41

Polymyalgia rheumatica (Check ESR and CRP) or muscular dystrophy

Question 42

Warafin Reversal/Stop
When to reverse/Stop?
Major bleed management
Non bleeding management
Warfarin above 8

Answer 42

When to reverse/Stop? - INR 5 or more OR bleeding
Major bleed - IV - PCC (Prothrombin complex concentrates) and phytomenadione (Vitamin K)
Non major bleed - IV Phytomenadione (Vit K)

Non bleeding 5 or more - Omit doses and reduce dose
Warfarin above 8 Omit dose till 5 and oral phytomenadione (Vit K)