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Past Paper Qs Flashcards

1
Q

Rank cancers as cause of death in UK men according to frequency with (1) being the most common

A

Lung
Prostate
Colon
Head and Neck
Breast

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2
Q

Mechanism of Evolocumab?

A

Lowers LDL by inhibiting PCSK9

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3
Q

Woman has acute SOB. PMHx includes hypertension and T2D. Her medication is metformin, atorvastatin, amlodipine. Blood pressure was high. She had a third heart sound, no murmurs, and bibasal crackles. Blood tests - sodium was normal, potassium was 3.5, urea was high, creatinine was high. Rank diagnosis with (1) being most likely.

  • Phaeochromocytoma
  • Addisons
  • Cushings
  • Essential hypertension
  • Conns
A
  1. Essential htn
  2. Cushing’s
  3. Conn’s
  4. Phaeochromocytoma
  5. Addison’s
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4
Q

Rank in order of potency at reducing LDL with (1) being the most potent

  • Atorvostatin
  • Bezafibrate
  • Prednisolone
  • Simvastatin
  • Evolocumab
A
  1. Evolocumab
  2. Atorvostatin
  3. Simvastatin
  4. Bezafibrate (antilipimetic)
  5. Prednisolone
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5
Q

Moa Bezafibrate?

A

Antilipemic, lowers LDL and increases HDL

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6
Q

Which antibodies are present in Sjorgren’s syndrome?

A
  • Anti-Ro
  • Anti-La
  • RF
  • ANA
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7
Q

When will C3 and C4 be low in SLE?

A

C4 always, C3 only if it’s severe

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8
Q

Which is more sensitive for SLE: ANA or anti-dsDNA?

A

ANA (95-99%)

(ds-DNA 50-70%)

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9
Q

Young woman with dysuria, urinary frequency and suprapubic pain. Rank organisms with (1) being most likely

  • Staph saprophyticus
  • Acinetobacter baumanii
  • Candida albicans
  • Escherichia coli
  • Proteus mirabilis
A

Escherichia coli
Staph saprophyticus
Proteus mirabilis
Acinetobacter baumanii (main one for catheters)
Candida albicans

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10
Q

Fatigue and mild jaundice, has spherocytes on blood film. Coombs test positive. Likely diagnosis?

A

Autoimmune haemolytic anaemia

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11
Q

What does d-dimer detect?

A

Fibrin degredation products

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12
Q

Pregnant women given misoprostol to induce labour. She suddenly has severe shivers, clammy skin, vomiting. Observations - high HR, low BP. Blood results - INR of 1.9, high APTT, , high D-dimers. What is the most likely obstetric event?

A

Amniotic fluid embolism

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13
Q

At what temperature can platelet transfusions be stored?

A

20-24 degrees (22 degrees)

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14
Q

Infants with sickle cell disease (HbSS) may have splenic sequestration. Why malignant cells with reactive fibrosis and high eosinophils does this not occur before 3 months of age?

A

HbF (foetal haemoglobin) is present

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15
Q

Venetoclax is a BCL2 inhibitor used in CLL. What cellular process does it affect?

A

Apoptosis

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16
Q

Which cellular markers indicate CLL?

A

CD5+ CD19+

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17
Q

Man has returned from India. Whilst abroad, he has malaise and jaundice which self-resolved. He now has fatigue and easy bruising. Blood results - low Hb, normal MCV, low reticulocytes, low WCC, low neutrophils, normal lymphocytes, low platelets. What is the likely diagnosis?

A

Dengue haemorrhagic fever

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18
Q

Which mosquitos transmit Dengue fever?

A

Aedes

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19
Q

Commonest primary tumour of the heart

A

Myxoma

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20
Q

What is the commonest cause of constrictive pericarditis in the developing world?

A

Tuberculosis

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21
Q

A dysgerminoma is a type of tumour that affects the ovary. What is the equivalent tumour type in the testes?

A

Seminoma

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22
Q

What is the most common cause of nephrotic syndrome in adults that is a glomerular pathology?

A

Focal segmental glomerulosclerosis (primary)

Diabetic nephropathy (secocndary)

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23
Q

What is the commonest cause of myocarditis?

A

Viral infection - coxsackie

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24
Q

Raised AMA antibodies are characteristic of which liver disease?

A

Primary biliary cholangitis

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25
Q

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

A

Gamma glutyl transferase (more specific than ALP)

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26
Q

Woman has neck pain, which radiates to the upper neck and jaw. Pain is worse on swallowing. She has PMHx of URTI two weeks ago. Investigations - high T4, high T3, low TSH. Technetium scanning of thyroid shows low uptake. What is the likely cause of hyperthyroidism?

A

De Quervain’s thyroiditis

(Not producing excess T3/4, releasing due to apoptosis)

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27
Q

What condition occurs in both MEN1 and MEN2a?

A

Primary hyperparathyroidism

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28
Q

What is the name of vitamin B3?

A

Niacin

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29
Q

Alcoholic has severe abdominal pain, rigid abdomen - he has acute pancreatitis. What blood test will confirm the diagnosis?

A

Lipase

(more sensitive than amylase)

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30
Q

What is the commonest cause of hypercalcaemia in the community?

A

Primary hyperparathyroidism

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31
Q

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

A

Leptin

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32
Q

Where is ghrelin produced?

A

Endocrine cells of the stomach

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33
Q

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

A

Caeruloplasmin

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34
Q

What condition involves the upper and lower airways and kidneys, and is ANCA positive with cytoplasmic staining and is specific for proteinase 3?

A

Wegener’s granulomatosis/ granulomatosis with polyangiitis

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35
Q

Which condition is caused by reactivation of human polyoma virus 2 (John Cunningham (JC) virus) in immunosuppressed people?

A

Progressive multifocal leukoencephalopathy

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36
Q

Doctors should measure the level/activity of which enzyme before prescribing azathioprine?

A

Thiopurine methyltransferase

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37
Q

5-month baby has failure to thrive and recurrent infections. Investigations - mutation affecting IL2RG gene, which encodes IL2 common gamma chain. What is the diagnosis?

A

X-linked SCID

IL2RG encodes for IL2 common gamma chain

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38
Q

CAR T-cells are engineered to bind to CD19. They have immunoglobulin variable fragments to CD19 linked to cytoplasmic T-cell activation domains. They are effective in treating haem malignancies of which cell type?

A

B lymphocytes

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39
Q

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

A

Osteoporosis

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40
Q

Man has recently returned from trip to India, has high fever and abdominal pain but no diarrhoea. His blood cultures - gram-ve bacilli. Malaria rapid diagnostic test is -ve. What is the most appropriate antibiotic therapy?

A

Ceftriaxone

(Salmonella typhi)

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41
Q

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

A

EBV (HHV4)

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42
Q

Patient receiving chemotherapy for leukaemia. She has prolonged neutropenia and ongoing fever, raised inflammatory markers despite broad antibacterial therapy with meropenem and amikacin. CT scan shows multiple nodules with surrounding hypo-attenuation (halo sign). What is the most likely organism?

A

Aspergillosis

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43
Q

Young woman has severe headache, neck stiffness, fever. She is HIV+ve but is poorly compliant with medication, does not attend her appointments. She has yeasts in her CSF. What is the causative organism?

A

Cryptococcus neoformans

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44
Q

Poorly controlled person with T2DM has headache, sinus pain, periorbital oedema and orbital cellulitis. His symptoms have progressed rapidly. He has purulent discharge from his nose. ENT surgeons bring him to theatre as an emergency. What antifungal therapy should be started ASAP?

A

Amphotericin B

(Mucormycosis)

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45
Q

What does a left shift on blood film mean?

A

Increased number of immature blood cells

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46
Q

What does a right shift on blood film mean?

A

Increased number of mature neutrophils with hypersegmented nuclei

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47
Q

What does toxic granulation mean?

A

The presence of dark, coarse granules within the cytoplasm of neutrophils on a blood film

Indicates severe infection

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48
Q

What does cryopercipitate contain?

A

Fibrinogen, factor VIII, factor XIII, von Willebrand factor, and fibronectin

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49
Q

Bleeding patient has prolonged APTT and PT, but normal platelet count and normal fibrinogen. What is the most suitable blood component for treatment?

A

FFP

(Contains all the coagulation factors)

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50
Q

55-year-old male smoker, on long term frusemide. Investigations - high Hb, high Hct, normal red cell mass. Plasma volume is low. What is the most likely diagnosis?

A

Relative polycythaemia

(Occurs when there’s a decrease in plasma volume eg. long term furosemide use)

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51
Q

What is the difference between relative and secondary polycythaemia?

A

Relative = decreased plasma volume
Secondary = increased RBC production

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52
Q

75-year-old woman has neutropenic sepsis secondary to myelodysplasia. Her blood count is lower than it was 6 weeks ago, with marked panyctopaenia. Blood film shows numerous large cells of primitive appearance. What is the likely explanation?

A

Progression to AML

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53
Q

Acute GvHD post-allogenic haematopoietic stem cell transplant is mediated by which cell type?

A

Donor T cells

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54
Q

25-year-old with acute leukaemia requires an allogeneic haematopoietic stem cell transplant. She is mixed Afro-Carribean and European heritage and has one sibling. What is the chance of the sibling being HLA identical?

A

1:4

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55
Q

Which type of necrosis is associated with a MI?

A

Coagulative necrosis

(This type of necrosis is typically seen in infarcts in all solid organs except the brain)

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56
Q

What type of necrosis occurs in the brain?

A

Liquefactive necrosis

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57
Q

What is the most common ovarian tumour?

A

Serous cystadenoma

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58
Q

Which virus is associated with the development of nasopharyngeal carcinoma?

A

EBV

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59
Q

What is the commonest cause of adult ARDS?

A

Sepsis

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60
Q

Which is the commonest glial cell in the CNS?

A

Astrocytes

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61
Q

Which is the commonest cause of pancreatitis in adults?

A

Gallstones

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62
Q

25 year man is in A&E with abdo pain and having collapsed, he had a low blood pressure and was in shock. Blood results - low sodium, high potassium, low HCO3-, slightly high urea, high creatinine, slightly low glucose.

A

Renal failure - pre-renal AKI (2ndary to Addison’s)

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63
Q

What is a side effect of quinine?

A

Hypoglycaemia

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64
Q

What is the role of cortisol with insulin?

A

Cortisol has anti-insulin effects to keep blood sugar levels high, therefore ACTH deficiency will lead to increased insulin sensitivity and low plasma glucose

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65
Q

What is the criteria for macroadenoma?

A

> 10mm

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66
Q

Conjugate vaccine of polysaccharide and protein carrier may be used to enhance B-cell immunity to which of the following?

HIV
TB
Rabies
Streptococcus pneumoniae
Vibrio cholerae

A

Strep pneumoniae

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67
Q

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

Infliximab (anti-TNFalpha)
Pembrolizumab (anti-PD1)
Rituximab (anti-CD20)
Tocilizumab (anti-IL6R)
Ustekinumab (anti-IL12/23)

A

Pembrolizumab

Pembrolizumab is a checkpoint inhibitor that targets the programmed cell death protein 1 (PD-1) receptor on T cells. By blocking this receptor, pembrolizumab prevents the interaction between PD-1 and its ligands (PD-L1 and PD-L2), which are often expressed by cancer cells to evade the immune system.

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68
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?

Adalimumab (anti-TNFalpha)
Basiliximab (anti-CD25)
Denosumab (anti-RANKL)
Pembrolizumab (anti-PD1)
Secukinumab (anti-IL17A)

A

Adalimumab

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69
Q

Which one of the following is a standard immunosuppressive regimen for patients who received an allograft?

Azathioprine, mycophenolate mofetil, prednisolone
Cyclophosphamide, methotrexate, rituximab
Cyclosporine, rapamycin, tacrolimus
Mycophenolate mofetil, prednisolone, tacrolimus

A

Mycophenolate mofetil, prednisolone, tacrolimus

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70
Q

72 year old man is a close household contact of someone recently diagnosed with smear positive pulmonary TB. What is his lifetime risk of developing TB?

A

10%

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71
Q

72-year-old man has returned from a 7 day holiday in Italy. He has signs of pneumonia and Legionella urinary antigen is positive. Which of the following antibacterials is the most appropriate initial therapy?

Azithromycin
Amoxicillin
Ceftriaxone
Co-trimoxazole
Meropenem

A

Azithromycin

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72
Q

Which hepatitis virus is associated with more severe disease if acquired in pregnancy potentially leading to fulminant hepatic failure and death?

A

Hep E

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73
Q

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

Beta-D-Glucan
Galactomannan
RFR
TPPA
Widal test

A

Beta-D-glucan

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74
Q

Streptobacillus moniliformis is the causative organism of which of the following infections?

Bacillary angiomatosis
Lyme disease
Q fever
Rat bite fever
Syphilis

A

Rat bite fever

  • Bacillary angiomatosis = bartonella henselae
  • Lyme disease = borrelia burgdorferi
  • Q fever = coxiella burnetti
  • Syphilis = treponema pallidum
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75
Q

What is the commonest form of prion disease?

A

Sporadic Creutzfeldt-Jakob disease

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76
Q

Which coronary artery is most commonly occluded in MI?

A

LAD

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77
Q

What is the general range for gestational thrombocytopaenia?

A

130-150 000

Below 70 excludes GT and indicates another pathology eg. ITP

Platelets >50 preferred for delivery

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78
Q

What are the blood results for DIC?

A
  • Thrombocytopaenia
  • Elevated FDPs
  • Prolonged PT
  • Prologned aPTT
  • Low fibrinogen
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79
Q

Which antivirals:

CMV retinitis
HSV meningitis
VZV
Child with RSV
Asthmatic with flu

A

CMV retinitis: ganciclovir
HSV meningitis: aciclovir
VZV: aciclovir
Child with RSV: ribavirin
Asthmatic with flu: oseltamivir

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80
Q

What are the first signs of cocaine use?

A
  1. Dilated pupils
  2. Tachycardia
  3. Hypertension
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81
Q

What are the classic histological findings of malignant hypertension?

A

Fibrinoid necrosis and hyperplastic arteriolosclerosis

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82
Q

What are Kimmelstiel Wilson nodules?

A

Diffuse GBM thickening with mesnagial matrix nodules (diabetic nephropathy)

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83
Q

What is the causative agent of pityriasis versicolor?

A

Malassezia furfur

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84
Q

Lady came back from visiting her sister in Arizona with systemic sx - fever etc, which fungus caused her symptoms?

A

Coccidioides species

Either coccidioides immitis or coccidioides posadasii

Cause coccidioidomycosis aka. Valley fever

SW USA

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85
Q

Which fungal infections are patients with poorly controlled diabetes at risk of?

A

Mucormycosis

Causes: rhizopus, mucor or rhizomucor

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86
Q

Women has acute appendicitis, 5mm tumour found in tip when it’s removed. What is the tumour?

A

Neuroendocrine tumour

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87
Q

What immune cell detects MHC1 and kills virus infected/cancer cells. Is inhibited by MHC I?

A

Natural killer cells

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88
Q

What would you measure to check for beta thalassaemia?

A

HbA2

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89
Q

Receptor mutation that could be protective in HIV?

A

CCR5-delta 32

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90
Q

What is done to blood donations to reduce GvHD?

A

Irradiation

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91
Q

Eczematous nipple rash caused by individual ‘malignant cells’?

A

Padget’s disease of the breast

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92
Q

How does being male increase the risk of VTE recurrence?

A

2-3 times increased

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93
Q

Most common type of primary thyroid cancer to metastasise to lymph node?

A

Papillary

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94
Q

What is the definition of herd immunity threshold?

A

(R0-1)/R0

75-85% of population to be vaccinated

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95
Q

Name 1 of the 3 characteristics of Influenza A that could cause a pandemic?

A
  • Novel antigenicity
  • Efficient replication in the human airway
  • Efficient viral transmission between people
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96
Q

Patient is on low molecular weight heparin, what do you measure to monitor this?

A

Anti-Xa assay

Routine monitoring not usually required, only if there’s an increased risk of bleeding eg. renal impairment, underweight, overweight, pregnancy

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97
Q

Alcoholic man is on ceftriaxone for meningitis, what organism is he at risk of which this does not cover for?

A

Listeria monocytogenes

Alcohol increases the risk of listeria monocytogenes

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98
Q

What virus increases risk of nasopharyngeal cancer?

A

EBV

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99
Q

Chimeric antigen receptor T-cell therapy against CD19: what type of haematological malignancy does it target?

A

B-cell haematological malignancies, CD19 is a surface marker on B cells

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100
Q

Has contact with someone with TB, what is the risk of getting active TB?

A

10%

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101
Q

Ankylosing spondylitis - they’ve tried NSAID and TNF inhibitor?, what else can you target?

A

IL-17

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102
Q

45yo woman with autoimmune diseases, low IgM, IgA and IgE; full blood count is normal?

A

Common variable immunodeficiency

Associated with autoimmune diseases, normal FBC

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103
Q

What is the pattern of symptoms after extradural haematoma?

A

Initial LOC followed by lucid interval then rapid deterioration

Presentation within hours of injury

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104
Q

Young guy has a fall and hits his head, presents two days later and then loses consciousness, where is the bleeding coming from?

A

Subdural haematoma

Likely to present with a gradual worsening of symptoms

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105
Q

HTLV1 virus is associated with which cancer?

A

Adult T cell lymphoma

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106
Q

Antibiotic of choice for salmonella typhi?

A

Ciprofloxacin or ceftriaxone

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107
Q

Histopathological change that occurs to liver in patients with diabetes?

A

Steatosis (NAFLD)

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108
Q

Nivolumab is a PD1 inhibitor, what cells does it target?

A

T regulatory cells

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109
Q

What is the guidance for cervical polpys?

A

<2cm
- Remove and send for histology
- Abnormal histology, refer for colposcopy

> 2cm
- Refer to gynae clinic

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110
Q

EBV serology 2 weeks post infection

A
  • IgM viral capsid antigen (preferred)
  • IgG viral capsid antigen (higher)
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111
Q

What kind’ve vaccine is strep pneumoniae?

A

Conjugate vaccine

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112
Q

Which disease do you see in both MEN1 and MEN2a?

A

Primary hyperparathyroidism

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113
Q

What type of section is done for urgent diagnosis during surgery?

A

A frozen section

Tissue is excised and frozen to preserve

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114
Q

Which direction is the shunt in tetrology of fallot?

A

Right to left

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115
Q

What Type Hypersensitivity causes serum sickness?

A

Type III

Foreign serum triggers B cells to produce antibodies with form complexes and deposit in tissue

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116
Q

Young gentleman brough to A&E by friends due to confusion. CSF is clear, raised lymphocytes, high protein, normal glucose. Causative organism?

A

HSV, consistent with viral encephalitis (leading cause in adults)

  • Clear CSF: Typically seen in viral infections.
  • Raised Lymphocytes: Indicates a viral etiology, as bacterial infections usually present with a predominance of neutrophils.
  • High Protein: Often elevated in viral infections, though not as high as in bacterial infections.
  • Normal Glucose: Suggests viral rather than bacterial infection, as bacterial meningitis often causes low CSF glucose levels.
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117
Q

What would be high in most common cause of CAH?

A

ACTH

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118
Q

What vaccine preventable organism causes cough, lymph node enlargement and has a potential to occlude the airway?

A

Corynebacterium diphtheriae

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119
Q

Which hormones stimulate the release of prolactin?

A
  • GHRH
  • TRH
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120
Q

What is the effect of the gene mutation in familial mediterranean fever?

A

Increased IL-1 production

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121
Q

What is the mechanism of hyperacute allograft rejection?

A

Pre-existing antibodies in the host against the donor transplant (existing before the transplantation)

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122
Q

What are the features of corynebacterium diphtheriae?

A
  • Cough
  • Lymph node enlargement: bull neck (significant swelling of the lymph nodes)
  • Airway obstruction: grey pseudomembrane on the throat, tonsils, nasal passages
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123
Q

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

A

Plasmapheresis

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124
Q

What’s the most common cause of constrictive pericarditis with calcifications?

A

TB

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125
Q

What is the treatment of mucormycosis?

A

Mainly get if immunocompromised (T2DM with eye+sinus infection is classic)

Amphotericin B

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126
Q

What 3 infections are checked in pregnant women according to UK screening program?

A

HIV
Hepatitis B
Syphilis

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127
Q

According to the RECOVERY study, what steroid is given in COVID-19 with low oxygen?

A

Dexamethosone

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128
Q

What type of hypersensitivity reaction is Goodpasture’s?

A

Type II

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129
Q

What blood gas deformity does aspirin overdose usually cause?

A
  1. Respiratory alkalosis - salicyclates stimulate the respiratory centre and increase oxygen intake
  2. Metabolic acidosis (raised anion gap)

Most patients present with a mixed metabolic acidosis and respiratory alkalosis

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130
Q

Name the type of physiological cell death that occurs in embryogenesis?

A

Apoptosis

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131
Q

What are the microscopic findings over 6 hours after a transmural myocardial infarction?

A
  • Loss of nuclei
  • Homogenous cytoplasm
  • Necrotic cell death

(Macroscopic, nothing)

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132
Q

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

A

Hepatitis E

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133
Q

A no presenting complaint 56 yo man comes in for routine bloods: all normal except high IgG. BM aspirate shows 8% blast cells. What’s the diagnosis

A

Monoclonal gammopathy of uncertain significance (<10%)

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134
Q

Which antifungal class is not effective against pneumocystic jirovecii?

A

Echinocandins - Pneumocystis jirovecii doesn’t have ergosterol or beta D glucan in the cell wall

Also not effective against cryptococcus

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135
Q

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

A

Serum protein electrophoresis

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136
Q

What is the diagnosis, results showed increased IgG lambda but normal kappa lambda ratio, <30g/L

A

Suggests non-malignant polyclonal gammopathy

  • Chronic infection
  • Autoimmune disease
  • Chronic inflammation
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137
Q

How can ACE inihibtors affect GFR?

A

Angiotensin II causes vasoconstriction of the efferent arteriole increasing GFR

Lack of angiotensin II production decreases pressure gradient and decreases GFR

Starting ACE inhibitors in people with renal artery stenosis can increase the effects

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138
Q

What are the blood results for tumour lysis syndrome?

A
  • Elevated potassium
  • Elevated bicarbonate
  • Elevated urea
  • DECREASED calcium
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139
Q

What is the most common primary type of brain tumour in adults?

A

Glioblastoma multiforme

140
Q

What is the triple therapy treatment for H.pylori?

A

Amoxicillin+clarithromycin+PPI

141
Q

Which pneumonia causing organisms cause cavitating lesions?

A

Staphylococcus aureus

142
Q

What is bare lymphocyte syndrome?

A

Issues with the MHC I and/or MHC II complexes leading to reduced levels of T cells and if CD4 cells are affected, reduced circulating B cells and macrophages

143
Q

Young woman with ovarian tumour, AFP is elevated. Which type of tumour is this?

A

Yolk sac tumour

  • Malignant germ cell tumours
  • Schiller-Duval bodies on histopathology - pathognomonic for yolk sac tumours
144
Q

What is the order of commonality for the melanomas?

A
  1. Superficial spreading
  2. Nodular
  3. Lentigo maligna melanoma
  4. Acral lentiginous melanoma
  5. Desmoplastic melanoma
145
Q

Lady following COVID treated with steroids for 10 days now has striae and difficultly losing weight despite exercise and has funny cortisol results following - AM cortisol - 700nM 24:00 cortisol - 43nM suppressed with dexamethasone overnight showing <28 at 9:00 am following dev at 23:00. Imaging: CT shows bilateral adrenal lesions and upper lobe lung consolidation MRI - 3mm pituitary mass. Dx?

A

Likely Cushing’s disease (due to the suppression of cortisol with dexamethosone)

146
Q

What is the mechanism of quinines causing hypoglycaemia?

A

Stimulate insulin release from the pancreas

147
Q

What is the threshold for treatment for ITP in adults?

A

Symptomatic or platelets <30:
- Oral prednisolone
- IVIG

Severe/ life threatening bleeding:
- Platelet transfusion

148
Q

Which vaccine class should be avoided in patients taking TNF alpha inhibitors?

A

Live attenuated vaccines:
- MMR
- Varicella
- Herpes Zoster vaccine
- Yellow fever
- Polio
- Bacillus clamette guerin

149
Q

What type of vaccine is a tetanus toxoid vaccine?

A

Subunit vaccine

150
Q

What is indicated by the blood results:

Hep surface Ag -ve, core Ab +ve, surface Ab -ve

A

Past infection (core ab +ve, stays +ve for life) but no lasting immunity (surface ab -ve) , meaning they have previously recovered from Hep B, but have not developed lasting immunity

151
Q

What is the order of most sensitive antibodies for Sjogren’s?

A
  1. Anti-Ro (60-75%)
  2. Anti-La (40%, but MORE specific)
152
Q

Testicular tumour spreads through para-aortic lymph nodes. Responds well to radiotherapy. Which type is most likely?

A

Seminoma

153
Q

What is the most likely atypical mycobacterium to cause diarrhea and abdominal symptoms in a severly immunocompromised individual?

A

Mycobacterium avium complex

154
Q

What antivirals are given in covid?

A
  • Nirmatrelvir plus ritonavir
  • Molnupiravir
  • Remdesivir
155
Q

Biologic treatment for malignant melanoma?

A

PD-1 inhibitors eg. Pembrolizumab and Nivolumab

(Act on T cells)

156
Q

Which bacteria will not produce urinary nitrites?

A

Gram positive (lack nitrite reductase)

157
Q

Best urine dipstick measure for uncomplicated E coli UTI?

A

Nitrites

  • Sensitivity moderate (not all bacteria produce eg. staph saphrophyticus, but e.coli does)
  • Specificity high
158
Q

Which diseases are routinely screened for in blood transfusions?

A
  • HIV
  • Syphilis
  • Hep B
  • Hep C
  • Hep E
  • HTLV1
159
Q

Most likely complication of multiple pulmonary thromboemboli?

A

Pulmonary hypertension

160
Q

Woman hurt her back lifting something in the garden. Pain persisted for a week. Some blood abnormalities (low Hb, high Ca, high urea/creatinine? …) . What is the best test?

A

Multiple myeloma likely presentation

Serum protein electrophoresis

161
Q

What is the medication regimen for Crohn’s?

A
  1. Steroids (prednisolone)
  2. Immunosuppressants (5-ASA, azathioprine, mercaptopurine, methotrexate)
  3. Biologics (adalimumab, infliximab, vedolizumab, ustekinumab and risankizumab)
162
Q

Some type of haem malignancy with monocytes and hypogranular bassophilic cytoplasm?

A

Acute monocytic leukaemia

163
Q

What is true about skin prick testing:
~ 95% positive predictive value, 95% negative predictive values, sensitivity/ specificity, better than mast cell tryptase for checking anaphylaxis, results take >24 hours

A

95% negative predictive value

164
Q

Treatment of staph aureus infection rank the antibiotics with narrow to broad
fluclox
co amox
meropenem
pip taz
ceftriaxon

A
  1. Flucloxacillin
  2. Co-amoxiclav
  3. Ceftriaxone
  4. Pipericillin and tazobactam
  5. Meropenem
165
Q

Sort investigations for Sjogerns with 1 being most sensitive and 5 being least:
anti-Ro
ESR
CRP
?biopsy of gland infiltrates
ANA titre 1:300

A
  1. ESR
  2. ANA
  3. Anti-Ro
  4. Biopsy
  5. CRP
166
Q

A 67 year old man has been diagnosed with vertebral osteomyelitis. Rank the causative organisms below in likelihood, with (1) being the most likely and (5) being the least likely.
Staphylococcus aureus
Streptococcus anginosus
Escherichia coli
Brucella melitensis
Pseudomonas aeruginosa

A
  1. Staphylococcus aureus
  2. Escherichia coli
  3. Pseudomonas aeruginosa
  4. Streptococcus anginosus
  5. Brucella melitensis
167
Q

What infection is associated with P1104A variant of the TYK2?

A

TB

168
Q

Rank in order of occurrence:

Myocardial infarction
Myocardial fibrosis
Mural thrombus
Myocardial aneurysm
Cerebral embolism

A
  1. MI
  2. Myocardial aneurysm
  3. Mural thrombus
  4. Cerebral aneurysm
  5. Myocardial fibrosis
169
Q

Prophylactic antibiotics often used once before surgery to improve outcomes. Usually one dose is administered. Give one of the two indications for further antibiotics during surgery?

A
  • Long surgical duration
  • Blood loss
170
Q
A
171
Q

Most common renal cancer in adults?

A

Renal cell carcinoma

(Most common subtype of RCC, clear cell carcinoma)

172
Q

What type of myocytes are responsible for transmitting signals from the atria via the septum to the ventricles?

A

Purkinje fibres

173
Q

Most common primary CNS tumour in children?

A

Pilocytic astrocytoma

174
Q

Which exact strain of E.coli causes travelers diarrhoea?

ETEC Toxigenic diarrhoea
EIEC Invasive dysentery
EHEC Haemorrhagic
EPEC Infantile diarrhoea

A

Enterotoxigenic Escherichia coli

175
Q

Male tested positive for COVID 3 days ago. Emergency intubation on AMU today. What retroviral should be used assuming no contraindications or allergies?
a. Ribavirin
b. Tenofivir: Hep B
c. Remdesivir
d. Paxlovid
e. Tocilizumab

A

Remdesivir

176
Q

What is the mechanism of ibrutinib?

A

Bruton’s kinase inhibitor

177
Q

Patient in hospital eight days after a dynamic hip screw develops pneumonia. What is the most likely causative organism?
(Staph A and E.coli were not amongst the options)
a. Strep. Pneumoniae,
b. Haemiphilius influenzae
c. Pseudomonas
d. Legionella

A

Pseudomonas

178
Q

Anti-interferon antibody levels predict disease severity in which disease?

A

COVID

179
Q

Which conditions are IL-1 blockers used in?

A

Familial mediterranean fever, gout, adult onset still’s disease

180
Q

Patient is on prednisolone and mycophenolate. Which vaccine should they not have?
a. COVID
b. Quadruple influenza
c. Pneumococcal
d. Zostavax
e. Hep B

A

Zostavax (live attenuated)

181
Q

Young woman returning from australia 8 weeks ago with non-healing ulcer that has been treated with 2 antibiotics already. Culture of lesion reveals positive acid-face bacilli and Zheel-Niehlson stain. What is the most likely causative organism?

A

Mycobacterium ulcerans

182
Q

Young woman returning from australia 8 weeks ago with non-healing ulcer that has been treated with 2 antibiotics already. Culture of lesion reveals positive acid-face bacilli and Zheel-Niehlson stain. What is the most likely causative organism?

A

Mycobacterium ulcerans

183
Q

Boy had pituitary mass removed. He felt a bit dizzy and serum sodium was 129. Observations and all other U&Es showed he was fit to be discharged. What’s the most important medication for him to be prescribed to take as outpatient

Fludrocortisone
Prednisolone
Desmpopressin (DDVAP)
Growth hormone

A

Prednisolone, replace the glucocorticoids

184
Q

How is cystericosis contracted?

A

Consuming larvae in food contaminated by faeces from a person with taenia solium

185
Q

Patient has been admitted with severe influenza A pneumonia and is intubated in ITU. Given that she can’t have any oral medication, what is the most appropriate antiviral to start?

A

Zanamivir

186
Q

Blood cultures reveal Candida spp (not albicans), what antifungal should be used?

A

Echinocandins

187
Q

Which malaria drug can cause haemolysis in G6PD deficiency?

A

Primaquine

188
Q

What indicates hyperparasitaemia in plasmodium falciparum (adults)?

A

> 10%

189
Q

What indicates hyperparasitaemia in plasmodium knowlesi (adults)?

A

> 2%

190
Q

What is the management for non-severe malaria?

A

Atremesin combination therapy (Riamet - artemether & lumefantrine)

191
Q

Severe malaria mx?

A

IV artesunate

192
Q

Most common organisms causing HAP?

A
  • Enterobacteriaceae (e.g., Klebsiella pneumoniae, Escherichia coli, Enterobacter spp.)
  • Staphylococcus aureus (including MRSA)
  • Pseudomonas aeruginosa
  • Acinetobacter baumannii
  • Haemophilus influenzae
  • Streptococcus pneumoniae
193
Q

Symptoms of transfusion associated haemosiderosis?

A

Fatigue, joint pain, hepatosplenomegaly

194
Q

Does the sickle cell solubility test distinguish SCT from SCD?

A

No, both conditions will produce a turbid result

195
Q

What type of hypersensitivity reaction is the rash formed when amoxicillin is taken in EBV?

A

IV

196
Q

Which type of haemoglobin is predominant in beta thalassaemia major?

A

HbF

197
Q

Scientific name for bite cells?

A

Degmacytes

198
Q

What is multiple myeloma with IgM paraproteinaemia?

A

Waldenstorm’s gammaglobulinemia

199
Q

What is the difference between MGUS and smouldering myeloma?

A

MGUS:
- Paraprotein <3g/L
- Blast cells <10%

Smouldering:
- Paraprotein 3-30g/L
- Blast cells 10-60%

Myeloma = smoulder results with end organ damage

200
Q

What is the prodrome for campylobacter jejuni?

A

Flu like prodrome

201
Q

IV antibiotic for Group A Strep pharyngitis/Strep Throat?

A

Benzylpenicillin

202
Q

What indicates impaired OGTT?

A

7.8-<11.1

203
Q

What indicates impaired fasting glucose?

A

6.1-<7

204
Q

Equation for plasma osmolality?

A

2(Na+ + K+) + urea + glucose

205
Q

pH below 7.35 – Acidosis
K+ - high
Metabolic acidosis present

A

T1DM

206
Q

high sodium (173),
high potassium,
plasma osmolality ~400
urine osmolality ~600

A

Severe dehydration

207
Q

Which/what cell is inhibited by the presence of MHC1 on cells?

A

Natural killer cells

208
Q

Which breast cancer is known as the non-specific type?

A

Invasive ductal carcinoma

209
Q

Which breast cancer is associated with E cadherins?

A

Invasive ductal carcinoma

(invasive lobular carcinoma E-cadherin negative)

210
Q

Which breast cancer has a high, medium and low stage to it?

A

Ductal carcinoma in situ

211
Q

Breast cancer:
Fibro-epithelial tumour with abundant stromal elements

A

Phyllodes tumour

212
Q

Which/What enzyme if low, leads to hyperuricemia/rise in blood uric acid?

A

Hypoxanthine-guanine phosphoribosyl transferase

213
Q

Which/What enzyme regulates the rate limiting step in haem biosynthesis pathway/of the blood

A

5-aminolevulinate (ALA) synthase

214
Q

Which/What enzyme is raised in mumps?

A

Amylase-S

(Amylase-P is raised in pancreatitis)

215
Q

Why is the overall B cell level decreased in Bruton’s x-linked agammaglobulinaemia?

A

Mutation in the Bruton’s Tyrosine Kinase gene

Pre-B cells in the bone marrow can’t form mature B cells, meaning reduced overall level of mature B cells in the circulation

216
Q

Boy with abscesses has a positive NBT

A

Myeloperoxidase deficiency

If nitroblue tetrazolium test was negative, chronic granulomatous disease

217
Q

Why are CD4 cells not present in bare lymphocyte syndrome II?

A

MHC II complex not expressed, meaning CD4 cells can’t be activated and depleat in number

218
Q

When is CMV screened for in blood products?

A

When transfusing pregnant women

219
Q

What is the pathophysiology of graft vs host disease in a haematopoietic stem cell transplant?

A

Transfer of immunocompetent lymphocytes to an immunocompromised host

eg. CD4+ activated and assists CD8+ and B cells

220
Q

What is the mechanism of Pembrolizumab?

A

Monoclonal antibody for PD1 on regulatory T cells, blocks it from binding to PD-L1/2 on tumour cells which would induce T cell death

221
Q

What is a common finding in people with portal hypertension?

A

Splenomegaly

222
Q

What causes hypocalcaemia with decreased phosphate?

A

Vitamin D deficiency

Hypoparathyroidism

DiGeorge

Pseudohypoparathyroidism

223
Q

What causes hypocalcaemia with normal or decreased phosphate?

A

Osteomalacia (2ndary hypoparathyroidism)

Acute pancreatitis

Overhydration

Respiratory alkalosis

224
Q

Man has intermittent mouth & tongue swelling for the past 2 years, which is unresponsive to over-the-counter anti-histamines, is on aspirin and ACE inhibitor. What is the likely cause?

A

Drug induced reaction

225
Q

Man presents with ulcers on mouth following treatment with a drug

A

Steven Johnson Syndrome

  • Drugs bind to cellular proteins causing complex formation
  • Complexes are taken up by APCs and presented to CD8 cells
  • CD8 and NK cells apoptose keratinocytes
  • Widespread skin and mucous membrane detatchment (blisters, erosions, mucosal involvement)
226
Q

What is African Sleeping Sickness?

A

Trypanosoma brucei rhodesiense

227
Q

What are the indications for starting dialysis?

A

AEIOU

A - acidosis
E - electrolyte disarray (Na+, K+, Ca++)
I - intoxicants
O - fluid overload
U - uraemic symptoms eg. nausea, seizure, pericarditis, bleeding

228
Q

Which thyroid condition causing rasied thyroxine would not show good uptake on an iodine scan?

A

De Quervain’s thyroiditis

229
Q

An African man, with Burkitt’s lymphoma is given Rasburicase. He develops haematuria with irregularly contracted cells. What is the cause?

A

G6PD deficiency

Rasburicase causes oxidative stress which precipitates haemolysis in G6PD, irregularly contracted cells indicates bite cells

230
Q

What does rasburicase convert uric acid to?

A

Allantoin

231
Q

Which vasculitis cases a Disease in which a branch of the external carotid is affected?

A

Giant cell arteritis

232
Q

Where is the inflammation in Takayasu arteritis?

A

Aorta and it’s main branches

233
Q

In which conditions is serum amyloid A increased?

A

Inflammation (eg. Rheumatoid arthritis)

234
Q

In which condition is amyelin increased?

A

T2DM

Islet amyloid polypeptide

235
Q

What is most consistently decreased in ALL?

A

Neutophils

236
Q

Which CLL is more aggressive, mutated IgH variable gene or unmutated IgH variable gene?

A

Unmutated

237
Q

Rank the following diagnoses in order of expected measured serum potassium, with (1) being the highest potassium and (5) being the lowest.

Phaeo
Pneumonia
Addisons
Conns
Cushings

A
  1. Addisons
  2. Pneumonia
  3. Phae
  4. Cushings
  5. Conns
238
Q

What are the histological stages of MI?

A
  1. 0-12 hours
    - Stretched cardiomyocytes
    - Flocculent densities form in mitochondria
  2. 12-72 hours
    - Infiltration of neutrophils
    - Culmination of necrotic coagulation
  3. 1-3 weeks
    - Disintegration of necrotic myocytes
    - Formation of granulation tissue (collagenous fibres, macrophages and fibroblasts)
  4. > 1 month
    - Foramtion of fibrous scar (abundance of collagenous fibres)
239
Q

What are the most common causitive organisms of septic arthritis?

A
  1. Staph aureus (including MRSA)
  2. Strep spp
  3. Neisseria gonorrhoea
  4. Gram -ve bacilli (incuding E.coli)
  5. Haemophilus influenzae
  6. Kingella kingae
240
Q

Platelets 162 x 109/L (150-400)
CRP 34 mg/L (<5)
ESR 86 mm/hr (<20)
Complement C3 0.84 g/L (0.70-1.70)
Complement C4 0.50 g/L (0.16-0.54)
Anti-nuclear antibody: negative
Anti-nuclear cytoplasmic antibody: weak (1+) c-ANCA +ve

His renal, liver and bone profiles are normal. He has been investigated for possible infection and all results are negative, including blood film for malaria and elispot for Mycobacterium tuberculosis. Results for the anti-myeloperoxidase (MPO) and anti-proteinase 3 (PR3)
antibodies are pending.

Rank the following in order of likelihood of diagnosis, with (1) being the most likely and (5) being the least.

A

Granulomatosis with Polyangiitis (GPA)
Microscopic Polyangiitis (MPA)
Lymphoma
Chronic Granulomatous Disease (CGD)
Systemic Lupus Erythematosus (SLE)

241
Q

What is a side effect of carbimazole?

A

Agranulocytosis

242
Q

A 25 year old Greek woman who is 12 weeks pregnant attends a routine antenatal appointment, the following blood test results are obtained. Based on these results, to determine if the future health of this fetus may be at risk, what is the first action/investigation required?

Hb 114 g/L (115-165)
MCV 70 fL (80-96)
Hb A2 concentration 5.2% (2.0-3.5)
Ferritin 13ug/L (12-200)
Serum transferrin 2.4u/L (1.7-3.4)

A

Electrophoresis for the father

243
Q

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

A

Squamous cell carcinoma

244
Q

The combination of hemangioblastomas in the cerebellum and retina, multiple and bilateral renal cell carcinomas, and cysts of the pancreas and kidneys is characteristic of what neurocutaneous syndrome?

A

Von Hippel Lindau

245
Q

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

A

Lymphocytes

246
Q

Are dacrocytes (tear drop shaped poikilocytes) specific for myelofibrosis?

A

No, they just indicate bone marrow infiltration

247
Q

What are the histological findings of HOCM?

A

Thickened disorganised muscle fibres with hyperchromatic nuclei

248
Q

What is contained in the primary granules of neutrophils?

A

Myeloperoxidase

249
Q

What is contained in the secondary granules of neutrophils?

A

Alkaline phosphatase

250
Q

What kind’ve granulomas in TB?

A

Caseating

251
Q

A plain chest X-ray of a 47-year-old male reveals a 2.5 cm “coin lesion” in the upper lobe of his left lung. The lesion is removed. The pathology report describes a clear cell carcinoma. What is the most likely primary site of origin for this carcinoma?

A

Kidneys

252
Q

What is the most common cause of restrictive cardiomyopathy?

A

Amyloidosis

253
Q

What is the most common cause of constrictive pericarditis world wide?

A

TB

254
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

255
Q

A 24 year old patient with known type 1 diabetes presents having missed her insulin, and is now vomiting with Kussmaul respiration. Predict the likely bicarbonate concentration in this patient. (bicarbonate reference range 22-29 mmol/L)

A

Low ~15

256
Q

Which mutation is seen in hyper IgM syndrome?

A

CD40 ligand gene mutation

257
Q

Serology for which polysaccharide is used for diagnosis of candida albicans infection?

A

Beta-D-glucan

258
Q

What species of Coagulase Negative Staphylococcus is a common cause of lower urinary tract infection in young women?

A

Staphylococcus saprophyticus

259
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 become adults. Eggs hatch into rhabditifom larvae which mature into filariform larvae which can autoinfect via perianal skin.

A

Strongyloides

260
Q

What is the mechanism of adalimumab?

A

Anti-TNF alhpha

261
Q

A 45 year old woman has rheumatoid arthritis and is taking methotrexate and adalimumab (ab specific for TNFa) to manage her condition. Which vaccination is contraindicated?

Hepatitis B vaccine
pneumococcal polysaccharide vaccine
Quadrivalent influenza vaccine
Tetanus vaccine
Yellow fever vaccine

A

Yellow fever vaccine (live attenuated vaccine)

262
Q

What are promyelocytes specific for?

A

Acute promyelocytic leukaemia

263
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, Haemoglobin 10 g/L and Platelets 35 x 10^9/L.

A

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

264
Q

A patient who is known to have chronic lymphocytic leukaemia presents with sudden worsening of fatigue and is found to have had a fall in Hb. His FBC results are reported below. His blood film shows lymphocytosis, smear cells, spherocytes and polychromatic macrocytes. Which is the most likely cause of his fall in Hb?

AIHA
Folic acid deficiency
Hereditary spherocytosis
Progression of CLL
Vit B12 deficiency

A

AIHA

In CLL, the immune system can become dysregulated and attack erythrocytes, this is indicated by presence of spherocytes and reticulocytes which would not be seen in DLBCL transformation

265
Q

A 41-year-old woman who is 20 weeks pregnant attends a routine antenatal appointment. She has a past medical hx of venous thromboembolic disease in a previous pregnancy. BMI 31. Mx?

Apixaban therapy
Aspirin therapy
Low molecular weight heparin therapy
TED stockings and avoid dehydration
Warfarin therapy

A

LMWH

266
Q

What is a pseudomyxoma peritonei?

A

Appendiceal cancer that derives from a polyp

Ovarian cancers are a rare source of pseudomyxoma peritonei

267
Q

What does CEA stand for?

A

Carcinoembryonic antigen

268
Q

What is the histological description of Mallory Denk bodies?

A

Regular eosinophilic hyaline bodies in the hepatocytes formed from pre-keratin intermediate filaments

269
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

Promotion of B cell differentiation

270
Q

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

IX
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

271
Q

Which conditions are seronegative?

A
  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Inflammatory bowel disease- associated arthritis
  • Reactive arthritis
272
Q

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

A

Smoking increases citrullination of proteins in the lung

273
Q

Organisms causing osteomyelitis?

A
  1. Staph aureus
  2. Strep spp
  3. Enterobacteriaceae (eg. E. coli, klebsiella)
  4. Pseudomonas
  5. Anaerobes (eg. bacteroides spp)
  6. Coagulase negative staph
  7. Mycobacteria
  8. Salmonella
  9. Fungi
274
Q

Organisms causing surgical site infections?

A
  1. Staph aureus
  2. Coagulase negative staph
  3. Enterococcus spp
  4. E. coli
  5. Pseudomonas
  6. Klebsiella
  7. Enterobacter spp
  8. Proteus
  9. Strep spp
  10. Candida
275
Q

Organisms causing septic arthritis infections?

A
  1. Staph aureus (inc. MRSA)
  2. Strep spp
  3. N. gonorrhea
  4. Gram -ve bacilli (eg. E.coli, pseudomonas)
  5. H. influenzae
  6. Kingella kingae
  7. Coagulase negative staph
  8. Mycobacterium
  9. Candida
276
Q

Organisms causing prosthetic joint infections?

A
  1. Staph aureus (inc. MRSA)
  2. Coagulase negative staph
  3. Strep spp
  4. Enterococcus spp
  5. Gram -ve bacilli (e. coli, pseudomonas)
277
Q

Organisms causing HAP?

A
  1. Enterobacteriacae (inc. E.coli)
  2. Staph aureus
  3. Pseudomonas
  4. Haemophilus influenzae
  5. Klebsiella
  6. Acinetobacter spp
  7. Enterobacter spp
  8. Strep pneumoniae
278
Q

What are the blood products for someone who has had a previous allergic reaction to transfusion?

A
  1. Chlorpheniramine
  2. Washed blood products (with saline)
279
Q

What is the management for cord compression caused by mutliple myeloma?

A

Radiotherapy

280
Q

What is the management for pathological bone fracture caused by multiple myeloma?

A

Bisphosphonates

281
Q

What is the monitoring for continuous unfractunated heparin?

A

APTT

282
Q

What is the INR target for atrial fibrillation?

A

2-3

283
Q

What is the INR target for prosthetic valve?

A

2.5-3.5

284
Q

Which antibodies are included in the ENA screen?

A
  • Anti-Ro
  • Anti-La
  • Anti-Smith
  • Anti-Scl70
  • Anti-Jo1
  • Anti-centromere

Sjogren’s, SLE, Diffuse cutaneous systemic sclerosis, Limited cutaneous systemic sclerosis and dermatomyositis

285
Q

What does the JC virus cause?

A

Progressive multifocal leukoencephalopathy

286
Q

Which investigation should be done in an elderly person with IDA?

A

Colonoscopy

287
Q

Child (was a 15 yo) with brain tumour extends outwards from cerebellum and invading subarachnoid space. Signs of ataxia? What is the most likely type.

A

Medulloblastoma

288
Q

What are the features of haemochromatosis?

A
  • Joint pain
  • Skin changes (grey/ bronze skin)
  • Pancreatitis
  • Liver deposition
289
Q

Mother is a donor for kidney to a child, what is the max number of mismatches possible with HLA class I?

A

2

If it were HLA class I and II it would be 3

290
Q

White things on the oesophagus seen in OGD of an alcoholic man with recurrent bleeding varices. What are they?

A

Oesophageal candidiasis

291
Q

Lady who went to Mexico and ate unpasteurized dairy. 4 weeks later unwell (no diarrhoea mentioned?) Which gram -ve rod caused this?

A

Brucella melitensis

292
Q

What is the mutation in DiGeorge syndrome?

A

22q11.2 deletion mutation

293
Q

Which allergy is more likely to present in child than adult?

A

Eggs

294
Q

What are the most common causative organisms of cellulitis?

A
  • Group A strep (and other strep spp)
  • MRSA
  • Staph aureus
295
Q

What is a cholesterol cleft?

A

A small open space filled with cholesterol

When they form emoli, these are atheroemboli (cholesterol emboli)

296
Q

What is the main mechanism of melanoma spreading?

A

Lymphatic route

297
Q

Which brain tumour starts in the cerebellum?

A

Medulloblastoma (2nd most common brain tumour in kids)

298
Q

Disease that can cause baby to have cataracts, sensorineural deafness, hepatomegaly and thrombocytopenia

A

CMV (if they mention beta herpes virus)

Toxoplasmosis

299
Q

Which pneumonia gives ground glass appearance on x-ray?

A

Pneumocystis jirovecii

300
Q

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

A

Polio (?)

301
Q

What symptom can clostridium tetani cause?

A

Lockjaw

302
Q

Maculopapular rash moves from face that can cause encephalitis and pneumonitis

A

Measles

303
Q

Patient with a mass following acute pancreatitis

A

Pseudocyst

304
Q

Patient with hypoglycaemia and pancreas mass

A

Insulinoma

305
Q

Patient with a carcinoma in their liver, what was the original carcinoma in their pancreas that caused the metastases?

A

Pancreatic ductal adenocarcinoma

Liver is a common metastases site for PDAs due to the portal venous drainage

306
Q

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

A

Likely calcifications, often associated with chronic pancreatitis

307
Q

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

A

Granulation tissue

308
Q

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

A

Angiomyolipoma

Fat, blood vessels and muscle = angiomyolipoma

309
Q

Woman with recurrent episodes of weakness and paraesthesia that spontaneously resolve

A

Depending on the age, could be TIA could be MS

310
Q

Man dies from MI. What histopathology is likely to have caused this?

A

Depending on the question, arrhythmia or coagulative necrosis

311
Q

Young boy with normal B cells and absence of CD8+ and CD4+

A

Depending on the age:

  • Immature B cells x-linked SCID
  • Mature B cells DiGeorge
312
Q

Woman with flushed face, problems breathing that has happened multiple times with enlarged liver

A

Carcinoid syndrome

313
Q

Mechanism behind GVHD

A

Pre-formed donor antibodies

314
Q

Mechanism behind cellular rejection

A

T cell mediated

315
Q

10 year old Caucasian who had been on a holiday, presented with low platelets and profound anaemia (6g/dl + oliguria) - anaemic blood film showed ?bite cells, and schistocytes

A

Haemolytic uraemic syndrome

316
Q

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

A

Post transfusion purpura

(Alloantibodies against platelet HPA-1a)

317
Q

Sickle cell patient who came down ill with pain in his joints, dark urine, fever and headache 8 days later that then resolved, what complication of blood transfusion should you screen for?

A

Delayed haemolytic transfusion reaction

318
Q

What is the CURB65 score?

A

C - Confusion
U - urea >7mmol/L or >19mg/dL
R - resp rate >=30
B - BP <90/60
65 - >=65

> =2 inpatient
=3 ICU

319
Q

What is the antibiotic treatment for salmonella typhi?

A

IV ceftriaxone, PO azithromycin

320
Q

Name the mechanism which drives rapid genetic change in influenza virus.

A

Antigenic shift

321
Q

A vegetarian returns from holiday in Morocco and presents jaundiced. They complain about the food options available and explain that they ended up eating a lot of salad. What is the most likely diagnosis?

A

Hepatitis A

Eating raw/ uncooked or unwashed foods is a risk factor for Hep A

322
Q

Which investigation is used to confirm a diagnosis of Addison’s disease?

A

Short synACTHen test

323
Q

Which live attenuated vaccine is safe to give in HIV?

A

MMR

324
Q

Which receptor does Ipilimumab bind to and what is it used for?

A

CTLA4

Melanoma

325
Q

What happens to mean cell volume during pregnancy?

A

It increases

326
Q

Which are the following is not a laboratory feature of hemolytic anemia?

a. Raised reticulocytes
b. High LDH
c. High Haptoglobin
d. Anemia
e. High Potassium

A

High haptoglobin

In haemolytic anaemia there’s increased free haemoglobin in the blood stream, meaning more haptoglobin is used up to bind to free haemoglobin and cleared from the blood stream

327
Q

What level of lymphocytes would confirm lymphocytic duodenitis?

A

Intraepithelial lymphocytes >20/100

328
Q

A histopathologist describes a biopsy containing stratified squamous cells with mucous glands located in the submucosa. Which organ has the biopsy been taken from?

A

Oesophagus

329
Q

Which condition are maurer’s clefts on blood film characteristic of?

A

Plasmodium falciparum

330
Q

A transplant patient presents to his GP with diarrhoea and abdominal pain. He also complains of increased frequency visual floaters. What is the likely causative organism?

A

CMV

Eye symptoms = CMV retinitis
GI symptoms characteristic

331
Q

What is the Salk vaccine?

A

Polio vaccine, inactivated

332
Q

What is the sabin vaccine?

A

Oral polio vaccine

Live attenuated

333
Q

What is the vector for Chagas disease?

A

Reduviid bugs

334
Q

What does spotty necrosis on liver biopsy indicate?

A

Acute hepatitis

335
Q

What’s the most common benign liver lesion?

A

Haemangioma

336
Q

What is the score for liver cirrosis?

A

Child-Pugh scoring system

337
Q

What is the mutation in Kostmann syndrome?

A

HCLS-associated protein X-1

338
Q

What is the mutation in cyclical neutropaenia?

A

ELA-2 (neutrophil elastase)

339
Q

Which cell surface receptor does HIV use to enter cells?

A

CD4

340
Q

Which investigation is most useful for Conn’s syndrome?

A

Plasma aldosterone: renin

341
Q

Which electrolyte abnormality is a reversible cause of nephrogenic diabetes insipidus?

A

Hypercalcaemia

342
Q

What is Criger-Najjar syndrome

A

A congenital autosomal recessive inherited disorder that leads to nonhemolytic jaundice. This syndrome is caused by an absence (CN1) or profoundly decreased level (CN2) of the enzyme UDP-glucuronosyltransferase due to a genetic defect in the UGT1A1 gene

343
Q

List a cause of a low serum sodium (126, normal 133-146) with a normal serum osmolality (280, normal 275-295)

A

Myeloma, paraprotein, lipids, alcohol

344
Q

What would you see on electrophoresis for sickle cell trait?

A

Spikes at both HbA and HbS (one normal beta globin and one mutated beta globin)

345
Q

What is the reveral agent for heparin?

A

Protamine sulfate

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