Path Meeran Mocks '22 Flashcards
A 26 year old known I.V. drug user presents with fever, weakness, lassitude and night sweats. On examination you discover a heart murmur.
What is the diagnosis?
endocarditis
A 70 year old known teetotal patient is noted to have a heart murmur and careful examination reveals splenomegaly with an obvious notch and you can’t get above it. There are no visible veins on the anterior abdominal wall, and there is no ascites, so you conclude that there is no portal hypertension. Dipstick of the urine reveals microscopic haematuria. She is found to have a temperature of between 37.5oC and 38.5oC whenever it is checked.
What is the diagnosis?
subacute endocarditis
A liver biopsy histology is reported as showing “A “nutmeg” appearance”. What is the most likely diagnosis?
right heart failure
- A liver biopsy histology is reported as showing “Caseating granulomata”. What is the most likely diagnosis?
-TB
- When stained with a Rhodanine stain a liver biopsy reveals a golden brown colour against the blue counterstain. What is the most likely diagnosis?
Wilson’s
- An 11 year daughter of an anti-Vaxxer old presents with a fever red eyes, a runny nose and a pink rash that began on the face and then spread downwards to the rest of the body.
measles
- Name the disorder of calcium handling most commonly seen in patients with end-stage chronic renal failure, in which the plasma calcium is raised.
A. Hypoparathyroidism B. Primary Hyperparathyroidism C. Pseudohypoparathyroidism D. Secondary Hyperparathyroidism E. Tertiary Hyperparathyroidism
E. Tertiary Hyperparathyroidism
- Name the peptide hormone responsible for increasing plasma calcium in response to reduced calcium levels by stimulating osteoclast activity.
Calcitonin B. Calcitriol C. Cholecalciferol D. Ergocalciferol E. Parathyroid Hormone
E. Parathyroid Hormone
- Name the form of vitamin D produced following the action of 1alpha hydroxylase on 25-OH D3 in the kidney.
A. Calcitonin B. Calcitriol C. Cholecalciferol D. Ergocalciferol E. Vitamin D3
B. Calcitriol
- Which of the options acts to stimulate 1alpha hydroxylase activity in the kidney to increase the production of vitamin D3.
A. Calcitonin B. Calcitriol C. Cholecalciferol D. Ergocalciferol E. Parathyroid Hormone
E. Parathyroid Hormone
- A patient has a positive Coombes test (positive direct antiglobulin test). Which is the most likely diagnosis?
A. Auto-immune haemolytic anaemia (AIHA)
B. Disseminated intravascular haemolysis (DIC)
C. Hereditary spherocytosis
D. Micro-angiopathic haemolytic anaemia (MAHA)
E. Polycytheamia Rubra Vera
A. Auto-immune haemolytic anaemia (AIHA)
- Antibodies to phospholipase A2 receptor are associated with what form of glomerulonephritis?
A. Crescentic B. Goodpastures disease C. Membranous D. Minimal change E. Rapidly progressive
C. Membranous
- Which of the following cause a polycythaemia?
A. Adrenal cortical carcinoma B. Colonic carcinoma C. Prostatic carcinoma D. Renal cell carcinoma E. Transitional cell carcinoma of the bladder
D. Renal cell carcinoma
- What is the specific auto-antigen that is the target of the immune system in Goodpastures syndrome?
A. Osteoblasts B. Osteoclasts C. Skin D. Spectrin E. Type IV Collagen
-E. Type IV Collagen
- Which of the following is most diagnostic for Rheumatoid arthritis?
A. Anti-CCP (cyclic citrullinated peptide) Antibody
B. Anti-Centromere Antibody
C. Anti-GAD (glutamic acid decarboxylase) Antibody
D. Anti-Mitochondrial Antibody
E. Rheumatoid Factor
A. Anti-CCP (cyclic citrullinated peptide) Antibody
- Which of these is particularly associated with longstanding bronchiectasis?
A. E-Coli B. Pseudomonas Aeruginosa C. Staph aureus D. Strep pneumoniae E. Strep pyogenes
B. Pseudomonas Aeruginosa
- Which of these is most likely to CAUSE bronchiectasis?
A. E-coli B. Pseudomonas Aeruginosa C. Staph aureus D. Strep pneumoniae E. Strep pyogenes
C. Staph aureus
- A 40 year old woman has always known cramping pain associated with her periods – which have usually been heavy. Recently this pain has become constant throughout the month, and her periods have become more frequent. She claims never to have used oral contraception and has no children. She is abstaining from sexual intercourse as it is too painful.
A. Cervical Polyps B. Endometriosis C. Fibroids D. Herpes Virus Infection E. Polycystic Ovary Syndrome
-B. Endometriosis
- Which of these is associated with hyperkalaemia?
A. Addison’s disease B. Conn’s syndrome C. Ectopic ACTH D. Prostate cancer E. Renal artery stenosis
A. Addison’s disease
A 40 year old presents to A&E with severe hypotension and shock. He appears dehydrated and tests reveal the following: Sodium 123 mmol/L (135–146) Potassium 6.8 mmol/L (3.5–5.3) Glucose 2.9mM Rank the following diagnoses in order of likelihood: 1. Addison's disease 2. Primary hyperparathyroidism 3. Hypothyroidism 4. Gastroenteritis 5. Conn's syndrome
he correct order is:
- Addison’s disease
- Gastroenteritis
- Hypothyroidism
- Primary hyperparathyroidism
- Conn’s syndrome
What is the correct pathological term for a discontinuation in the epithelial surface?
ulcer
A 65 year old male with a long history of epigastric pain. Endoscopy reveals 3.2cm of columnar metaplasia in the lower oesophagus. What does this suggest?
Barrett’s
What is the technical term for a connection between two epithelial surfaces, as occurs in Crohns disease where for example there might be a connection between the bladder and the bowel?
fistula
A 46-year old Japanese female is found to have bilateral ovarian masses on imaging of the abdomen and had both ovaries removed. Histology revealed malignant signet ring cells containing mucin in both ovaries. What is the diagnosis?
Krukenberg
A 50 year-old female was found to have an ovarian mass. On its removal, histology revealed several cell types, including thyroid follicles, hair and teeth. What is the likely diagnosis?
mature teratoma/dermoid
40 year-old female non-smoker presents with a one week history of fever, shortness of breath and a cough productive of rusty coloured sputum. Microscopy of the sputum is shown (Gram positive diplococci). What is the organism?
streptococcus pneumoniae
37 year-old man presents with a headache, myalgia and a cough. He is also suffering with nausea, diarrhoea and abdominal pain. On examination he is tachypnoeic and has a pyrexia of 39ºC. Blood tests reveal lymphopenia and hyponatraemia. A gram stain from the patient’s sputum is shown here (Gram negative rods). CXR shows lobar consolidation. Cold agglutinins are negative. What is the organism?
Legionella pneumophilia
A 40 year-old woman presents with malaise, muscular pains and diarrhoea with mucus and blood. On examination she has a fever and several distinctive spots on her abdomen (Rose spots). Blood cultures are positive and grow gram negative rods. What is the likely organism?
salmonella typhi
A genus of spiral flagellated Gram negative bacteria. Found in the stomach within the mucosa layer. It occurs in the majority of middle-aged people and causes progressive gastritis. Invariably present in duodenal ulceration and usually in gastric ulceration. What is the organism?
Helicobacter pylori
hich tumour is caused by Human Herpes virus 8?
Kaposi’s
A 28-year old woman presents with malaise, weight loss, and abdominal pain.Both anti-tissue transglutaminase (tTG) and anti-endomyseal (EMA) antibodieswere found in the serum. What is the likely diagnosis?
Coeliac
he same28-year old woman with anti-tissue transglutaminase (tTG) and anti-endomyseal (EMA) antibodieswanted to know if she needed any further investigations. What gold standard diagnostic test should be undertaken?
distal duodenal endoscopy
A 4 year old girl presents to the A&E with a recurrent chest infection that will not clear. On examination, the house officer notices that she has low set ears, a cleft palate and a murmur. Investigations reveal:
Calcium 1.9 mM (NR 2.2 to 2.6); Phosphate 1.4 mM (NR 0.8 to 1.4)
PTH 1.1 pM (NR 1.1 to 6.8)
What is the likely diagnosis?
Di George
A 40-year old lady complains of tight fingers and dysphagia, and is thought to have a syndrome associated with Raynaud’s phenomenon, and telangiectasia. What antibody should we measure to confirm this possible diagnosis?
-anti centromere
A 32-year old woman is thought to have Graves’ disease. What antibody should you look for?
anti TSH receptor
In a patient with Hodgkins Lymphoma, the stage of disease is given by the amount of spread, with stage 1 disease involving only one group of nodes, and stage IV disease involving extra nodal spread. What would stage III Hodgkins disease suggest?
either side of diaphragm
Give one feature that would make you add the suffix “B” to the stage of the Hodgkins disease.
fever, weight loss
hat type of neutrophil is shown in the middle of this blood film, in this patient known to have pernicious anaemia?
hypersegmented
A patient is thought to have multiple myeloma. What is found in the urine that will confirm this diagnosis?
-bence jones
A 51-year old man is having investigations for palliative surgery due to gastric adenocarcinoma. He is found to be anaemic, with high a reticulocyte count and fragmented red blood cells on blood smear. What is this anaemia known as? (Remember NOT to use acronyms).
microangiopathic haemolytic anemia
A 67-year-old woman presented with confusion 2 days after a cholecystectomy. She had experienced some pain postoperatively, largely relieved by analgesia. On examination, she was disoriented, her heart rate was 66 beats per minute and her blood pressure was 162/82 mmHg. She only had minor discomfort of the abdomen. The urine sodium was 90mmol/l (NR 20-200mmol/l depending on hydration of patient). The figure below shows the colours you would see on the dipstick after it has been dipped in the urine, and it was yellow in colour, consistent with an SG of 1.030. Investigations: Haemoglobin 130 g/L (115-165) MCV 92 fL (80-96) white cell count and platelet countnormal serum sodium 120 mmol/L (137-144) serum potassium 3.7 mmol/L (3.5-4.9) serum urea 3 mmol/L (2.5-7.0) serum creatinine 90 µmol/L (60-110) serum albumin 36 g/L (37-49) random plasma glucose5 mmol/L What is the most likely cause of the low sodium (avoid acronyms)?
syndrome of inappropriate ADH
45 year old woman, presents with increasing pain in her thighs and hips.Blood results : Ca – 2.4 mmol/L (2.2 to 2.6), Phosphate – 0.9 mmol/L (0.8 to 1.4), PTH – 5.0 pmol/L (1.1 to 6.8),ALP 3900 (39-120).What is the likely diagnosis?
Pagets
A patient presents with weakness and is found to have a potassium of 2.4mM (NR 3.5 to 5.0). What is the likely acid-baseabnormality if you check the patients arterial blood gas?
metabolic alkalosis
Name the drug used for patients with type 2 diabetes which inhibits the enzyme alpha glucosidase in the brush border membrane of the small bowel.
acarbose
Namean example of a drug that inhibits the enzyme dipeptidyl dipeptidase IV (DPP-4).
gliptins
A 25-year-old woman complains of right iliac fossa pain, diarrhoea and weight loss worsening over several weeks. Laparotomy reveals an oedematous, reddened terminal ileum and a biopsy uncovers transmural inflammation with the presence of granulomas.
crohns
A 35-year-old woman presents with diarrhoea and lower abdominal pain. Examination of her stools reveals blood and mucus. A biopsy reveals a continuous superficial ulceration of the colon.
UC
60-year-old patient presents with chronic left-sided abdominal discomfort and the passage of fresh blood from the rectum. He denies weight loss and on examination has no palpable masses. However a colonoscopy reveals pouches of mucosa extruding through the muscle layer.
Diverticulitis
A 70-year-old man who has been receiving broad-spectrum antibiotic treatment develops profuse diarrhoea and frequent episodes of incontinence. A biopsy of the colon reveals a membrane like material covering the surface composed of mucin, fibrin, polymorphs and what seems to be debris of leukocytes and mucosal epithelial cells. What is the diagnosis?
c.diff - psuedomembrnaous colitis
A 68-year-old man presents with rectal bleeding and new onset constipation. Some years ago, he was diagnosed with polyps in his colon and recently has lost a lot of weight. An abdominal examination reveals a mass in the right lumbar region which is non-tender.
colon carcinoma
A 28 year-old junior doctor comes in feeling ‘pretty lousy and aching all over’. She is wearing dark glasses and complains of a stiff neck. CSF examination reveals a normal CSF/blood glucose ratio and slightly raised protein of 0.7 g/L with a lymphocyte count of 150 and no neutrophils. There were no red cells in the CSF which proved that the lumbar puncture was well carried out, and that the SHO undertaking it had not punctured any veins.
What is the likely diagnosis?
viral meningitis / aseptic meningitis
A 56 year-old male presents with fever, vomiting and seizures. Examination reveals a well- established ear infection and there is a ‘ring-enhancing’ lesion on the MRI of his brain.
cerebral abscess
A 40 year-old man complains of a stiff neck. He is the member of a cheese club and enjoys unpasteurised cheese. He has a high neutrophil count in the CSF, and gram staining reveals gram positive rods. What is the likely organism?
listeria monocytogenes
Gram staining of a blood culture reveals Gram positive diplococci. What is the likely organism?
streptococcus pneumoniae
A 27 year old patient has a knee effusion drained. The gram stain reveals Gram negative intracellular diplococci. What is the likely organism?
neisseria gonnorrhoea
A 28 year old woman presents with malaise, weight loss, an erythematous rash on the face and joint pains. Both antinuclear antibodies (ANA) and double-stranded DNA (dsDNA) antibodies were found in the serum.
SLE
40 year old man presents with weight loss, muscle aches and abdominal pain. On examination he has high BP and urine dipstick reveals blood + and protein +. The patient is thought to have a vasculitis and is p-ANCA positive.
microscopic polyangitis
A patient is found to have a very high titre of anti-mitochondrial antibody. What is the likely diagnosis?
primary biliary cholangitis
patient presents with haemoptysis and haematuria. She is thought to have Goodpastures syndrome. What antibody should you look for?
anti GBM
32yr old woman complains of fatiguability in many muscles and double vision. She is thought to be at risk of other autoimmune diseases as she has a family history of various autoimmune diseases and herself has autoimmune hypothyroidism. Her thyroid function is normal because she is well replaced with thyroxine. What might be causing her muscle weakness?
Myasthenia gravis
four-year-old boy presents with a purpuric rash across the legs and buttocks. Two weeks previously you had seen the child about a chest infection. Further examination reveals abdominal pain and haematuria. Serum IgA levels are raised. What is the likely diagnosis?
hence schonlein purpura
patient is found to have a positive Coombes (anti-globulin) test. What is the likely diagnosis?
autoimmune haemolytic anemia
A child is found to be anaemic, and molecular studies show a defect in the spectrin molecule. What is the diagnosis?
hereditary spherocytosis
A 70 year old lady presents with pallor and has the following results:
Hb 90. (NR 120-150) g/dl
MCV 125 fl (NR 76-96).
The film shows hyper-segmented neutrophils. The patient also has type 1 diabetes and hypothyroidism that are both well treated. What is the underlying cause of her low haemoglobin.
pernicious anaemia
A 70 year old man presents with pallor and has the following results:
Hb 90. (NR 120-150) g/dl
MCV 65 fl (NR 76-96).
What is the likely underlying cause of the low haemoglobin.
iron deficiency anemia
A patient presents with tiredness and is found to have a calcium of 3.0mM and a normal PTH at 3.0pM (NR 1.1 to 6.8). What is the likely diagnosis?
primary hyperparathyroidism
patient presents with tiredness and is found to have a calcium of 2.0 mM and a raised PTH at 30pM (NR 1.1 to 6.8). What is the likely diagnosis?
vitamin D deficiency
A patient presents with tiredness and notices that he is more pigmented than usual. His results reveal: Na 129 K 6.2 and his blood pressure is 80/50. What is the likely underlying diagnosis?
Addisons
Which vitamin deficiency is associated with Pellagra?
B3 - niacin
A patient presents with tiredness and has the following results:
TSH=30 (NR 0.3 to 4.7).
What is the likely diagnosis?
primary hypothyroidism
