Past Paper Questions Flashcards
Conn’s like picture ( low k, high na), but with markedly raised renin?
Renal Artery Stenosis
A patient presents with both low urine and serum sodium?
Psychogenic Polydipsia
Which enzyme would be raised in a patient who has been taking cocaine?
AST
List three indications for dialysis.
Refractory Hyperkalaemia
Metabolic Acidosis
Uraemic Encepalopathy
Low calcium, high PTH
Osteomalacia (Vitamin D deficiency)
High Calcium, Low PTH
Bone metastases
High Calcium, High PTH
Hyperparathyroidism
Low Calcium, Low PTH
Hypoparathyroidism
Normal calcium, normal pth
Osteoporosis
Which enzyme is the rate limiting step in the haem biosynthesis pathway?
ALA synthase
How do you calculate anion gap?
Na + K - Cl - Bicarb
How do you calculate plasma osmolality?
2(Na+K) + urea + glucose
Vitamin deficiency defined by dermatitis, diarrhoea and mental disturbance
Pellagra (B3, Niacin)
Isolated rise in unconjugated bilirubin with all other parameters normal
Gilbert’s
Which enzyme works to 30% capacity in Gilbert’s?
UDP glucorynyl transferase
Raised ALT, ALP, GGT in a young patient with a short history of coryzal symptoms and jaundice
Viral Hepatitis
High ALT, GGT, low Albumin, signs of chronic liver disease including haematemesis, spider naevi, dupuytren’s contracture and gynaecomastia
Cirrhosis
Which enzyme is raised in Mumps?
Amylase - S
Which enzyme is raised in Vitamin D deficiency?
ALP
Which enzyme is raised in rhabdomyolysis?
Creatine Kinase
What may be deficient in a child with frontal bossing, bowed legs, cupping of metaphysis and widened epiphyses on x ray?
Vitamin D
Which enzyme manufactures monosodium urate, the substance implicated in gout?
Xanthine Oxidase
Which drugs may be used in an acute attack of gout?
Cochicine
NSAIDs
Steroids
Patient presents with diabetes, steatorrhoea, weight loss, slate grey skin and joint pains. What is causing this?
Haemochromatosis
Which enzyme would you use to confirm cardiac failure?
Brain Natriuretic Peptide
Which liver enzyme may be raised in acute Myocardial infarction?
Aspartate aminotransferase
Which substance may cause dark urine in a patient suffering from rhabdomyolysis?
Myoglobin
What does the drug Denosumab target?
RANK Ligand
Which drug may be used to treat osteoporosis, bone metastases or Giant cell tumours of the bone?
Denosumab, a RANK Ligand targeting monoclonal antibody
Pt presents with hyperthyroidism, but a technetium scan shows low to no uptake. What is the likely diagnosis?
De Quervain’s Thyroiditis
What would you test if a patient was found to have a Low K, but High Na, and why?
Renin, as high renin may indicate renal artery stenosis, whilst low renin may indicate Conn’s Syndrome
Which substance does Evolucumab, a PCSK9 inhibitor halve?
LDL
Which molecule binds cholesterol for transport to the liver/other steroidogenesis organs?
HDL
Which hormone stimulates prolactin release?
TRH
Which ion abnormality may be attributed to erythrocyte haemolysis?
Potassium
What must be tested for if factitious hypoglycaemia is suspected, but C-peptide levels are normal?
Sulfonylureas
Describe the metabolic disturbance that may be seen in a neonate with congenital adrenal hyperplasia
Hyponatraemia
Hyperkalaemia
Hypovolaemia
Which medication would have to be stopped if a patient is prescribed allopurinol?
Azathioprine
Which sign is commonly seen on examination of a patient with portal hypertension?
Splenomegaly
Which test would be used to confirm a diagnosis of Cushing’s Syndrome?
High Dose Dexamethasone Suppression test
What does the number of true positives divided by the total of cases represent?
Sensitivity
Which ion is likely to be deranged in an alkalotic patient?
Potassium
How is response to therapy monitored in Polycythaemia?
Haematocrit
Which test is used to detect Beta Thalassaemia?
High performance liquid chromatography
A patient feels itchy after a transfusion. This calms down after taking an anti-histamine. What is the most likely diagnosis?
Allergic Reaction
A man requires a tranfusion after a traffic collision, and 2 hours later becomes breathless, feverish and tachycardic. What is the most likely diagnosis?
Transfusion-associated lung injury
A patient with thalassaemia presents with malaise and erectile dysfunction. What is the most likely diagnosis?
Transfusion-related haemosiderosis
A lady who undergoes regular transfusions for myelodysplastic syndrome becomes tachycardic, has site pain and is hypotensive 10 minutes after her latest transfusion. What is the most likely diagnosis?
ABO incompatability
An alcoholic undergoes a transfusion during surgery for repair of an Aortic Aneurysm. 2 Days later he develops a fever, becomes anaemic and jaundiced. What is the likely diagnosis?
Delayed haemolytic transfusion reaction
A women undergoes surgery after a placental abruption, and is found to have low fibrinogen and prolonged APTT and PT. What is the most likely cause?
Disseminated Intravascular Coagulation
A woman presents in the first trimester with significant thrombocytopaenia. What is the most likely cause?
ITP
A woman presents in the third trimester with a slightly reduced platelet count. What is the most likely cause?
Gestational Thrombocytopaenia
How would you manage renal failure in a patient with Myeloma?
Haemodialysis
How would you manage spinal cord compression in a patient with myeloma?
Radiotherapy
How would you prevent pathological bone fractures in a patient with myeloma?
Bisphosphonates
How would you manage hyperviscosity in a patient with myeloma?
Plasmapheresis
How would you manage hypercalcaemia in a patient with myeloma?
Bisphosphonates
What would you monitor in a patient on long-term unfractionated heparin?
aPTT
A man has spherocytes, polychromasia and reticulocytosis on blood film, what is the most likely diagnosis?
Hereditary Spherocytosis
A patient experiences a haemolytic anaemia after undergoing antimalarial treatment. What is the most likely diagnosis?
G6PD Deficiency
A patient presents with high IgG paraprotein, back pain and loss of sensation down her legs. What is the most likely diagnosis?
Multiple Myeloma
A patient presents with high IgM paraprotein and visual disturbances. What is the most likely diagnosis?
Lymphoplasmacytic Lymphoma (Waldenstrom’s Macroglobulinaemia)
An asymptomatic patient presents with low neutrophils, but normal blood film. What is the most likely diagnosis?
Chronic idiopathic neutropenia
A man is found to have pancytopenia and immature myeloid cells on blood film. What is the most likely diagnosis?
Acute Myeloid Leukaemia
A patient presents with longstanding bone and back pain. He has a high paraprotein IgA and a low GFR. FBC and albumin are both normal. What is the most likely diagnosis?
Multiple Myeloma
Which haematological complication may occur as a result of amniotic fluid embolism?
Disseminated Intravascular Coagulation
How should you manage a patient who becomes pregnant whilst on life-long DOAC treatment?
Switch to LMWH
What may cause neonatal thrombocytopaenia?
Maternal idiopathic thrombocytopaenia purpura
What would be the most likely diagnosis if you saw Smear Cells on a blood film?
CLL
How much more likely are males to experience a recurrence of a VTE?
3x
What type of hypersensitivity reaction is Myasthenia Gravis?
Type II
When would you test for direct antiglobulins as opposed to osmotic fragility in a patient with a haemolytic anaemia?
When there are indications to suggest it may be autoimmune, such as pre-existing diagnoses (SLE etc.)
Which viruses are screened for in platelet donations intended for pregnant women?
HIV
HBV
Cytomegalovirus
What does Chimeric receptor T-Cell Therapy against CD19 target?
B Cell Lymphoma/Leukaemia
A patient presents with low WCC, thrombocytopaenia and tear drop poikilocytes on blood film. What is the most likely diagnosis?
Myelofibrosis
Which cancer is HTLV1 virus associated with?
Adult T Cell Lymphoma
Which test would be used to diagnose hereditary spherocytosis after seeing spherocytes on blood film?
Eosin-5’-maleimide dye test
Which investigation would be important to carry out in an elderly patient with an iron deficiency anaemia?
OGD
What is the minimum length of time needed for treatment of a VTE?
3 Months
Which cell type does Rituximab target?
B Cells
Which coagulation factor decreases first upon administration of warfarin?
Factor VII
How does Myeloma cause cardiomyopathy?
Amyloid deposition
Which mutation is commonly implicated in Polycythaemia and myelodysplastic diseases?
JAK2 V617F
What may cause a non-autoimmune haemolytic anaemia?
MAHA
Valve-associated haemolysis
Sickle Cell Anaemia
How do proteasome inhibitors, such as Bortezomib, work?
Inhibited protein degradation leads to amino acid build up, shortage and cell death
Which agent is the first line treatment for CML?
Imatinib
Describe the mechanism of action of Imatinib.
BCR-ABL Tyrosine Kinase Inhibitor
What is the most likely diagnosis in a man found to have a high haematocrit on a background of chronic heart disease? He is negative for JAK2 mutations.
Secondary Polycythaemia
What is the first line treatment for a patient with CLL and a confirmed p53 mutation?
Ibrutininb, a Bruton Tyrosine Kinase inhibitor
What is the mechanism behind hyperacute allograft rejection?
Pre-formed antibodies attack the graft
Which coagulation factor is most commonly low in pregnancy?
Protein S
What is the likely diagnosis and trigger in a sickle cell patient presenting with low reticulocytes, a severe anaemia and no splenomegaly?
Aplastic crisis triggered by Parvovirus B19
What is targeted in graft vs host disease?
HLA
Which cells does Pembrolizumab target?
T Cells, targets antiPD-1
Which molecule is expressed by vessel walls in their resting state, and has anti-thrombotic activity?
Thrombomodulin
Which antibody may be positive in a patient with Autoimmune hypothyroidism?
Anti-Thyroglobulin
Which antibody may be positive in a patient with Sjogren’s Syndrome?
Anti-Ro Anti-La
Which antibody may be positive in a patient with Myasthenia Gravis?
Anti-Acetylcholine Receptor
Which antibody may be positive in a patient presenting with Calcinosis, Raynaud’s, Esophageal Dysmotility, Sclerodactyly and telangiectasia?
Anti-Centromere
What is the first line biological treatment for Ankylosing Spondylitis?
Anti-TNF Alpha
Etanercept, Adalimumab, Infliximab
What is the treatment for resistant psoriasis?
Anti-TNF alpha
Etanercept, Adalimumab, Infliximab
What is the treatment for chronic granulomatous disease?
IFN-Gamma
Which cells are FOXP3 +ve and mature in the Thymus?
T regulatory Cells
CD4+ve
Which immune cell detects antigens peripherally, and moves to the lymph nodes for presentation?
Dendritic Cells
Which immune cell detects inactivated MHC1 and kills virus infected cells and cancer cells?
Natural Killer Cells
Which immune cells are targeted by HIV?
Memory CD4+
Which antibodies might be positive in a patient with polymyositis, presenting with aches and joint stiffness all over?
Anti-Jo1
What would be the most likely diagnosis in a teenage girl who develops an erythematous rash after running in winter?
Cold urticaria
What would be the likely diagnosis in a man who gets swollen lips when eating fresh apples, but is able to eat apple pie with no problem?
Oral food allergy
A patient presents with recurrent infections. They are found to have reduced total serum protein, and an autoimmune thrombocytopaenia. What is the most likely diagnosis?
Common variable immunodeficiency
A child presents with recurrent chest infections and has an ongoing ear infection. He is found to have no mature B cells. What is the most likely diagnosis?
Bruton’s Agammaglobulinaemia
A patient presents with recurrent infections. Both a DHR and Nitrazolium Blue test return negative results. What is the most likely diagnosis?
Chronic Granulomatous Disease
A child is found to have no CD4 cells, but CD8 cells and B cells are present. What is the most likely diagnosis?
Bare Lymphocyte Syndrome 2
A boy’s father has TB. The same boy develops a mycobacterial infection after receiving his BCG vaccine. What is the most likely diagnosis?
IFN-Gamma deficiency.
A young boy presents with recurrent infections, and is found to have normal B cells but a complete absence of CD4+ and CD8+ cells. What is the most likely diagnosis?
X-Linked Severe Combined Immunodeficiency.
A patient presents with recurrent pneumococcal infections and meningitis. What is the most likely underlying diagnosis?
Complement Deficiency.
Name two drugs which may be used in malignant melanoma that target T-Cell Checkpoints.
Ipilimumab
Nivolumab
Name an immune therapy which may be used to treat Lymphoma or Rheumatoid Arthritis.
Rituximab
List 2 drugs which may be used to prevent transplant rejection by blocking T cell activation.
Tacrolimus
Cyclosporin
List 2 drugs which may be used to treat NSAID-resistant Ankylosing Spondylitis.
Etanercept
Infliximab
A patient is found to have high lymphocyte numbers with a large spleen and lymph nodes. They also have auto-immune cytopenias, and were treated for a lymphoma in the past. They were found to have a mutation within the FAS pathway of lymphocyte apoptosis. What is the most likely diagnosis?
Auto-Immune lymphoproliferative syndrome (ALPS)
A patient presents with periodic fevers, abdominal pain and chest pain. They were found to have a mutation in the MEFV gene. What is the most likely diagnosis?
Familial Mediterranean Fever
A patient was found to have mutations in their NOD2 and CARD15 genes. Which condition are they most likely to suffer from?
Crohn’s Disease
Which HLA is Ankylosing Spondylitis associated with?
HLA-B27
A child presents with an IgE-mediated rash on their extensor surfaces. What is the most likely diagnosis?
Atopic Dermatitis/Eczema
A patient is found to be positive for anti-endomysial antibodies. Which condition are they most likely to suffer from?
Coeliac Disease
Which virus may lead to the development of post transplantation lymphoproliferative disease?
Ebstein-Barr Virus
Which virus may cause progressive multifocal leukoencepalopathy?
John Cunningham Virus
What is the mechanism behind graft vs host disease?
Donor white blood cells attack host tissues.
Which cell type mediates antibody-mediated rejection?
B Cells
Which cell type mediates cellular graft rejection?
T Cells
Which receptor mutation may be protective in HIV?
CCR5
Which cell type is affected by Immune Dysregulation, Polyendocrinopathy, Enteropathy (IPEX)?
Regulatory T Cells
A patient presents with pleuritic chest pain and joint pain and is found to have a raised ESR and positive Anti nuclear, anti smooth-muscle and anti double stranded dna antibodies. What is the most likely diagnosis?
Systemic Lupus Erythematosus
What type of malignancy does Chimeric antigen receptor T-Cell therapy against CD19 target?
Acute Lymphoblastic Leukaemia
A child presents with hypocalcaemia, cleft palate, low-set ears and a low T-Cell count. What is the most likely diagnosis?
DiGeorge Syndrome
Which molecule may be targeted in a patient with Ankylosing Spondylitis who didn’t respond to NSAIDs or Anti-TNF alpha agents?
IL-17
A woman with a normal FBC and a history of autoimmune disease is found to have low IgM, IgA and IgE levels. What is the most likely diagnosis?
Common variable immunodeficiency
A deficiency in which molecule may lead to malabsorption of B12?
Intrinsic factor
A patient presents with a microcytic anaemia. Distal Duodenal Biopsy shows crypt hyperplasia and non-caseating granulomas. What is the most likely diagnosis?
Crohn’s Disease
A patient has a duodenal biopsy, which shows villous atrophy and crypt hyperplasia. What is the most likely diagnosis?
Coeliac Disease
Which immunodeficiency is characterised by an issue with common gamma chains?
X-Linked SCID
What is the maximum number of HLA mismatches possible?
6
A man presents with glomerulonephritis and lung changes. he is found to be c-ANCA positive. What is the most likely diagnosis?
Granulomatosis with Polyangiitis
A woman presents with a purple, periorbital rash (heliotrope rash), and a rash on her knees. What is the most likely diagnosis, and which enzyme is likely to be elevated?
Dermatomyositis
Creatine Kinase
What does Nivolumab target?
PD1 on T Cells
What type of hypersensitivity causes serum sickness?
Type III
What is the effect of the MEFV gene mutation in Familial Mediterranean Fever?
Increased IL-1 production
What is the mechanism behind hyperacute allograft rejection?
Preformed antibodies against HLA/ABO
List 3 drugs which may be used for prophylaxis against allograft rejection?
Mycophenolate Motefil
Predinsolone
Tacromilus
Which natural antibody may confer protective immunity against HIV?
gp120
In which disease might you see intraepithelial lymphocytes on biopsy?
Coeliac
Which genetic mutation is characteristic for DiGeorge Syndrome?
22q11.2 deletion
Describe the pathophysiology of hereditary angioedema.
Acquired C1-inhibitor deficiency
Which antiviral agent can be used to treat Cytolomegalovirus retinitis?
Ganciclovir
Which antiviral agent may be used to treat Herpes-Simplex Meningitis?
Aciclovir
Which antiviral agent may be used to treat Varicella-Zoster infection in an adult?
Aciclovir
An asthmatic presents with severe flu. Which antiviral may be useful in their treatment?
Oseltamivir
A child with multiple co-morbidities presents with RSV infection. Which antiviral agent may be used?
Ribavarin
An HIV patient presents with pneumonia. When walking around the ward, they rapidly desaturate. What is the most likely causative organism?
Pneumocystis jirovecii
A girl receiving chemotherapy for leukaemia develops pneumonia. A ‘halo sign’ is seen on chest x ray. What is the most likely causative organism?
Aspergillus fumigatus
A patient presents with a lower lobe pneumonia and is coughing up rusty coloured sputum, what is the most likely causative organism?
Streptococcus pneumoniae
An alcoholic presents with pneumonia. On cxr, upper lobe cavitation is seen. What is the most likely causative organism?
Klebsiella Pneumoniae
A smoker returns from a trip abroad. He presents with pneumonia, and is also hyponatraemic and confused. What is the most likely causative organism?
Legionella pneumophilia
An HIV patient with a low CD4+ count presents with meningitis. What is the most likely causative organism?
Cryptococcus neoformans
A water polo player presents with an itchy scaly rash on lateral toe which then moved along the lateral side of their foot. What is the most likely causative organism?
Trichophytum rubrum
A lady returns from a holiday in America, where she stayed in Arizona. She presents with systemic symptoms, including a fever. What is the most likely diagnosis and causative organism?
Valley fever
Coccidioides
A man in his 60s with poorly controlled diabetes presents with rapidly progressing periorbital swelling, sinus pain and confusion. Black discharge can be seen in his nasal cavity. What is the likely diagnosis, and causative organism?
Mucormycosis, caused by Rhizopus spp.
A man returning from travelling in the middle east presents with a small ulcer on his finger that won’t heal and is growing in size. What is the likely diagnosis?
Leishmaniasis
A homosexual man presents with a painless oral ‘snail trail’ ulcer. What is the most likely diagnosis and causative organism?
Primary Syphylis
Treponema Pallidum
A man from Peru presents with fever and bloody diarrhoea. A cyst in the right lobe of his liver is detected on USS. What is the most likely diagnosis?
Entamoeba Histolytica
A woman who has just returned from travelling in Asia presents with abdominal pain, headache and constipation. A gram negative rod is later cultured from her blood. What is the most likely diagnosis?
Salmonella typhi
Which virus may cause Hydrops Fetalis if caught in the first trimester?
Parvovirus
Which virus, if active at >34wks gestation, causes a c-section to be indicated?
HSV
Which virus can cause babies to have cataracts, sensironeural deafness, hepatomgely and thrombocytopaenia?
Rubella
Which virus, if transmitted antenatally, may be symptomless at first, but may later present with jaundice, rash, hearing loss, development delay and microcephaly?
Cytomegalovirus
What is the most common cause of traveller’s diarrhoea?
Entero-toxigenic Escherichia Coli
A man presents with cramping pain and foul-smelling diarrhoea. He attended a barbeque 5 days prior. What is the likely causative organism?
Campylobacter jejuni
A woman develops vomiting a few hours after eating lots of rice. What is the likely diagnosis?
Bacillus cereus
A woman has developed watery diarrhoea after recently finishing a course of antibiotics. What is the likely causative organism?
Clostridium difficile
Multiple patients on the same ward get diarrhoea. What is the likely causative organism?
Norovirus
Which antibiotic may be added to meningitis treatment to cover for Listeria monocytogenes?
Amoxicillin
Which antibiotic is first line for Group A Strep pharyngitis?
Benzylpenicilin
Which antibiotic is indicated to treat cystitis in a young woman. The causative organism is fully sensitive E coli
Trimethoprim
Which antibiotic is used to treat MRSA?
Vancomycin
Which antibiotic is used to treat methicillin-sensitive Staphylococcus aureus
Flucloxacilin
A student presents with meningitis. The causative organism is found to be a gram negative diplococcus, what is it most likely to be?
Neisseria meningitides
A man is found to have meningitis caused by a gram positive diplococcus. What is it most likely to be?
Streptococcus pneumoniae
Which organism is a gram negative rod, and may cause sepsis in a neonate?
Escherichia Coli
Which organism is a gram negative rod which may cause meningitis in immunocompromised patients?
Listeria monocytogenes
Name a beta-lactam antibiotic that may be used for Pseudomonas spp.
Ceftazidime
Name a broad spectrum beta-lactam with no pseudomonal activity. it is typically given with a beta lactamase inhibitor
Amoxicillin
Name a glycopeptide antibiotic which may be used to treat MRSA.
Vancomycin
Name an antibiotic which is a DNA synthesis inhibitor which may be used to treat Pseudomonal infections. It is, however, poor against anaerobes.
Ciprofloxacin
Name a macrolide which may be used to treat some atypical pneumonias.
Clarithromycin
A woman presents with a UTI. Culture grows gram positive cocci in clusters. What is the most likely causative organism?
Staphylococcus saprophyticus
A middle aged man with no medical problems develops septic arthritis. What is the most likely causative organism?
Staphylococcus aureus
A teenage rugby player presents with boils. Members of his team, and his family, all have similar boils. What is the most likely causative organism?
Staphylococcus aureus
A neonate presents with meningitis. Culture grows a Gram Positive organism in chains. What is the most likely causative organism?
Group B Streptococcus
Which virus resides in the pharynx and gastrointestinal tract, causes encephalitis in 1/100, and destruction of motor neurones in 1/1000?
Poliovirus
A patient presents with coryzal symptoms and a grey film on the back of his throat. What is the most likely causative organism?
Diptheria
Which organism causes lockjaw?
Tetanus
Which organism causes cat scratch disease?
Bartonella henselae
Which stain is used to confirm infection with acid-fast bacili?
Ziehl-Neelsen
What are the 3 characteristics of influenza A that could cause a pandemic?
Novel Antigenicity
Efficient replication in human airways
Efficient Transmission between humans
What is the lifetime risk of an immunocompetent person developing active TB after contact with someone with TB?
10%
What does it mean if urine MC&S has epithelial cells and mixed bacterial growth?
The sample has not been properly taken.
Which antibiotic is used for Salmonella typhi?
Ceftriaxone
Which organism causes scarlet fever?
Streptococcus pyogenes
What is the most common cause of viral meningitis?
Non polioviruses
Echo/Coxsackie Viruses
Which virus causes Kaposi Sarcoma?
HHV8
How does Hepatitis A spread?
Faeco-orally
What is the treatment for Pseudomembranous Colitis
Metronidazole
Vancomycin
Which drug is used to treat severe falciparum malaria?
IV Artesunate
Name the main class of drugs used to treat HIV
Nucleoside reverse transcriptase inhibitors
Which disease is carried by the Ixodes tick?
Borrelia burgdorferi
Lyme Disease
Which test would be most useful in confirming EBV infection in an immunocompetent individual 2 weeks after exposure?
IgM
Name a polysaccharide and conjugate vaccine.
Pneumococcal vaccine (Prenevar)
What is, overall, the most common cause of cellulitis?
Streptococcus pyogenes
Name a vaccine-preventable organism which causes cough, lymph node enlargement and may occlude the airway.
Corynebacterium diptheriae
Haemophilus influenzae?
Which vector transmits Trypanasoma brucei rhodesiense?
Tsetse Fly
Which strain of Hepatitis does not lead to chronic infection?
Hepatitis A
What is the most common cause of Fever in a returning traveller?
Malaria
A man presents with abdominal pain radiating to the back. He then collapses and dies. What is the most likely diagnosis?
Acute Aortic Aneurysm
A 60 year old lady with a background of stepwise memory loss and hypertension is hospitalised. What is the most likely cause of her memory decline?
Multiple Cerebral Infarcts (Vascular Dementia)
An elderly man with atrial fibrillation presents with new onset right flank pain. What is the most likely diagnosis?
Renal Thrombus
What histological finding would be seen in the kidneys in a case of post-streptococcal glomerulonephritis?
Immune Complex Deposition
What is the classic renal finding on histology of a patient with Malignant Hypertension?
Fibrinoid Necrosis
What would be seen on histology of a patient with pyelonephritis?
Leukocyte casts
What finding may be seen on kidney histology of a man with Multiple Myeloma?
Amyloid Deposition
A man is found to have a tumour in the head of his pancreas that has invaded into his portal vein. There is a palpable mass in the liver. What is the likely diagnosis?
Adenocarcinoma
A man with known H.Pylori infection has a stomach biopsy. An abnormal area is seen in the antrum, with mitotic figures and cells with a raised nuclear to cytoplasmic ratio. The mass is not invading the basement membrane. What is the most likely diagnosis?
B Cell Lymphoma
A woman presents with appendicitis. A 5mm tumour is found during removal. What is the most likely histological subtype?
Neuroendocrine Tumour
Which cancer develops in Barrett’s Oesophagus?
Adenocarcinoma
Which process takes place in response to exposure to stomach acid?
Metaplasia
What happens to the body of the stomach in a patient with pernicious anaemia?
Chronic Gastritis
Atrophy
Which cancer is associated with H Pylori Infection?
Gastric MALT Lymphoma
Which cancer is associated with poorly controlled coeliac disease?
Enteropathy-associated T-cell Lymphoma
What is the most common type of malignancy in the breast?
Invasive Ductal Carcinoma
Which breast malignancy is also known as ‘non-specific type’?
Invasive Ductal Carcinoma
Which breast malignancy may be described as a ‘Fibro-epithelial Tumour with abundant stromal elements’?
Phyllode’s Tumour
A man presents with UTI symptoms and costovertebral pain. He has pus cells and blood in his urine. What is the most likely diagnosis?
Acute Pyelonephritis
A woman presents with loin-to-groin pain, haematuria and pain at the end of micturition. What is the most likely diagnosis?
Calculi
A man presents with painless haematuria and a mass palpable on one side. What is the most likely diagnosis?
Renal Cell Carcinoma
An infant has a palpable unilateral abdominal mass when his mother picks him up. What is the most likely diagnosis?
Wilm’s Tumour/Nephroblastoma
A man presents with a pancreatic mass following an episode of acute pancreatitis. What is the most likely diagnosis?
Pancreatic Pseudocyst
A patient presents with severe abdominal pain, and undergoes a cholecystectomy. During the procedure, the surgeons notice grey specks around the pancreas. What is the most likely diagnosis?
Ductal Adenocarcinoma
Which pancreatic tumour most classically metastasises to the liver?
Ductal Adenocarcinoma
A patient presents with a pancreatic mass and hypoglycaemia. What is the most likely diagnosis?
Insulinoma
On histology of a kidney mass, it is noted that it extends into the renal vessels and into the perinephric fat. What is the most likely diagnosis?
Angiomyolipoma
A patient presents with a craggy, enlarged, uneven prostate. What is the most likely diagnosis?
Adenocarcinoma
Which testicular cancer is radiosensitive, and typically has a white/smooth appearance?
Seminoma
Which cancer is associated with schistosomiasis?
Squamous Cell Carcinoma of the bladder
A young man presents with a lytic lesion in the diaphysis of his leg. Night pains are relieved by aspirin. What is the most likely diagnosis?
Osteoid Osteoma
A man goes deaf, and on examination is noted to have bowed legs. What is the most likely diagnosis?
Paget’s Disease
A patient presents with a sudden onset severe headache, and shows signs of meningism. What is the most likely diagnosis?
Subarachnoid Haemorrhage
A patient with HIV presents with signs of raised ICP and new onset epilepsy. What is the most likely diagnosis?
Primary CNS Lymphoma
A woman presents with an eczematous nipple rash caused by ‘individual malignant cells’ What is the most likely diagnosis?
Paget’s Disease of the Breast
How many cusps does the pulmonary valve typically have?
3
What is the most common cause of Acute Pancreatitis?
Gallstones
Which cancer typically causes an increase in Calcitonin?
Medullary Thyroid Carcinoma
Which thyroid cancer most commonly metastasises to the lymph nodes?
Papillary
How do you distinguish between PBC and PSC?
PBC = Intrahepatic only, F>M, Anti-mitcohondrial PSC = Extra/Intrahepatic, M>F, p-ANCA
A young man falls and hits his head. 2 days later he loses consciousness. What is the most likely diagnosis?
Subdural Haemorrhage
An ovarian mass is found in a Japanese woman. Histology shows signet ring cells. What is the most likely diagnosis?
Krukenberg Tumour
Which liver change characteristically occurs in diabetic patients?
Non-alcoholic fatty liver disease
A teenage boy presents with ataxia. Imaging shows a brain tumour extending outwards from the cerebellum and invading the subarachnoid space. What is the most likely type?
Medulloblastoma
What is the most common type of oesophageal cancer in the UK?
Adenocarcinoma
What is the most common type of oesophageal cancer worldwide?
Squamous Cell Carcinoma
What is the most common type of gastric cancer?
Adenocarcinoma
A biopsy of a cancerous lesion shows large amounts of keratin and intercellular bridges, what type of cancer is this?
Squamous Cell Carcinoma
Which disease is seen in MEN 1 and 2a?
Parathyroid Hyperplasia
What would happen to free fatty acid levels in a patient with an Insulinoma?
Low
What procedure is performed for urgent diagnosis of a specimen during sugery?
Intra-operative Frozen Section
A man with a history of Polycystic Kidney Disease has a cerebral haemorrhage. Which type is it most likely to be?
Subarachnoid Haemorrhage
A non-smoker presents with a peripheral lung tumour. What is it most likely to be?
Adenocarcinoma
Which condition causes hypertension limited to the upper half of the body?
Coarctation of the aorta
A man presents with a midshaft femur fracture without a serious history of trauma. What may have caused this?
Chondrosarcoma
A middle aged lady has a liver biopsy. It shows loss of bile ducts and the presence of granulomas. What is the most likely diagnosis?
Primary Biliary Cholangitis
Which electrolyte abnormality might be seen in a patient with pseudomembranous colitis?
Hypovolaemic Hyponatraemia
A man with a recent history of head trauma presents with raised sodium, raised plasma osmolality and low urine osmolality. What is the likely diagnosis?
Cranial Diabetes Insipidus
Which test, when raised, may be useful in diagnosis of Giant Cell Arteritis?
ESR
How are ACTH levels measured?
Inferior Petrosal Sinus Sampling
A patient presents with hyperuricaemia. Name one enzyme which they may be deficient in.
HGPRT
List two signs which may be seen on x-ray of a patient with Rickets.
Widened Epiphyses
Metaphysis Cupping
What is the most common cause of congenital adrenal hyperplasia?
21-Hydroxylase Deficiency
Which hormones would be high in 21-Hydroxylase Deficiency?
Sex Steroid Hormones
ACTH
What would you prescribe a patient post-removal of a pituitary adenoma?
Desmopressin (DDAVP)
How are relations ranked with regards to giving consent for autopsy according to the Human Tissue Act?
Spouse Parent/Child Sibling Grand-relation Niece/Nephew Stepparent Half-Sibling Friend
