Path - Mock VSAs and SBAs Flashcards
These questions are a combination of mock questions given in Path week, and as part of the faculty mocks in March and May
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.
What is the most likely diagnosis?
Crohn’s disease
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.
What is the most likely diagnosis?
Ulcerative colitis
A 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.
What is the most likely diagnosis?
Diverticular disease
Accept:
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 most likely diagnosis?
Pseudomembranous colitis
Accept:
Clostridium difficile infection
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.
What is the most likely diagnosis?
Colonic 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 most likely diagnosis?
Viral meningitis
Accept:
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.
What is the most likely diagnosis?
Cerebral abscess
Accept:
Tuberculoma
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 most likely causative 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 gonorrhoea
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.
What is the most likely diagnosis?
Systemic Lupus Erythematosus
A 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.
What is the most likely diagnosis?
Microscopic polyangitis
Accept: Primary sclerosing cholangitis Eosinophilic Granulomatosis with Polyangiitis Ulcerative Colitis Glomerulonephritis
A patient is found to have a very high titre of anti-mitochondrial antibody.
What is the likely diagnosis?
Primary biliary cirrhosis/ primary biliary cholangitis (same thing)
A patient presents with haemoptysis and haematuria. She is thought to have Goodpasture’s syndrome.
What antibody should you look for?
Anti-glomerular basement membrane
A 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
A 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?
Henoch-Schonlein purpura
A patient is found to have a positive Coombes (anti-globulin) test.
What is the likely diagnosis?
Autoimmune haemolytic anaemia
A child is found to be anaemic, and molecular studies show a defect in the spectrin molecule.
What is the diagnosis?
Hereditary spherocytosis
Hereditary elliptocytosis is also acceptable
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
Accept:
B12 deficiency
Folate deficiency
Megaloblastic 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 anaemia
Accept:
Chronic GI blood loss
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
A 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
Accept:
Osteomalacia
Primary hyperparathyroidism
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?
Addison’s disease
Accept:
Primary hypoadrenalism
Which vitamin deficiency is associated with Pellagra?
Niacin deficiency
Accept:
B3 deficiency
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
Accept:
Myxoedema
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?
Acute endocarditis
Accept:
Bacterial endocarditis
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 bacterial endocarditis
Accept:
Endocarditis
What feature would you expect to see on a blood film in the neutrophils of a patient with pernicious anaemia?
Hypersegmented neutrophils
A liver biopsy histology is reported as showing “a nutmeg appearance”.
What is the most likely diagnosis?
Right heart failure
Accept:
Congestive cardiac failure
Liver congestion
When stained with Congo red stain, an apple green birefringence is seen in a liver biopsy.
What is the most likely diagnosis?
Amyloidosis
A liver biopsy histology is reported as showing “NON Caseating granulomata”.
What is the most likely diagnosis?
Sarcoidosis
A liver biopsy histology is reported as showing “Caseating granulomata”.
What is the most likely diagnosis?
Tuberculosis
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 disease
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
Tertiary hyperparathyroidism (HPT) appears similarly to primary HPT, but on a background of secondary HPT. The chronically low calcium causes hyperplasia in the parathyroid glands, which persist when the calcium is corrected, causing a tertiary HPT.
Name the peptide hormone responsible for increasing plasma calcium in response to reduced calcium levels by stimulating osteoclast activity.
A. 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.
What is the likely diagnosis?
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
What is the technical term for a connection between two epithelial surfaces, as occurs in Crohn’s disease where for example there might be a connection between the bladder and the bowel?
Fistula
A 65 year old male with a long history of epigastric pain. Endoscopy reveals 3.2cm of columnar metaplasia in the lower oesophagus. What is this called?
Barrett’s oesophagus
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/ Cystic teratoma/ Dermoid cyst (all the same thing)
A 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 reveals Gram positive cocci in chains. What is the organism?
Streptococcus pneumoniae
A 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 fever of 39. Blood tests reveal lymphopenia and hyponatraemia. A Gram stain from the patient’s sputum shows Gram negative bacilli, and a 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 mucous 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 mucosal 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
Which tumour is caused by Human Herpes Virus 8?
Kaposi’s sarcoma
A 28 year old woman presents with malaise, weight loss, and abdominal pain. Both anti-tTG and anti-EMA antibodies are positive. What is the likely diagnosis?
Coeliac disease
The same 28 year old woman with anti-tTG and anti-EMA antibodies wants to know if she needs any further investigations. What gold standard diagnostic test should be undertaken?
A distal duodenal or jejunal biopsy
A 4 year old presents to A&E with a recurrent chest infection that will not clear. O/E the house officer notices she has low set ears, a cleft palate, and a murmur. Investigations reveal primary hypoparathyroidism. What is the likely diagnosis?
DiGeorge syndrome
A 40 year old lady complains of tight fingers and dysphagia, and is thought to have a syndrome associated with Raynaud’s phenomenon and telangectasia. Which antibody should be measured to confirm the possible diagnosis?
Anti-centromere
A 32 year old woman is thought to have Graves’ disease. Which antibody should you look for?
Anti-TSH receptor
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 count normal
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 glucose 5 mmol/L
What is the most likely cause of the low sodium?
Syndrome of inappropriate anti-diuretic hormone
Hodgkin’s lymphoma is staged depending on spread through the lymph nodes and beyond. What would stage 3 suggest?
Involvement of lymph nodes above and below the diaphragm (but no extra-nodal spread)
Give one feature for which you would add the ‘B’ suffix to the Hodgkin’s stage
Night sweats
Unintentional/ unexplained weight loss of >10% in 6 months
Fever
What abnormality of neutrophils is associated with pernicious anaemia?
Hypersegmentation
A patient is thought to have multiple myeloma. What would be found in the urine that would confirm the diagnosis?
Bence-Jones proteins
A 45 year old woman presents with increasing pain in her thighs and hips. Her blood results show normal calcium and PTH, but an ALP of 3900. What is the likely diagnosis?
Paget’s disease of bone
What is the correct term for a discontinuation of the epithelial surface?
Ulcer
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 tumour
Signet cells are present in gastric carcinoma. This is a gastric carcinoma that has metastasised to both ovaries. If both ovaries are affected, a primary elsewhere spreading to both ovaries is more likely. Gastric carcinoma is far more prevalent in Japan that anywhere else.
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
*Leaves undigested sugar in the bowel giving wind as a side effect
Name an example of a drug that inhibits the enzyme dipeptidyl dipeptidase IV (DPP-4)
Gliptins such as alogliptin or sitagliptin
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-base abnormality if you check the patients arterial blood gas?
Metabolic alkalosis.
Remember hypokalaemic alkalosis. They go together, hypokalaemia causing alkalosis and alkalosis causing hypokalaemia
A 40 year old presents to A&E with sever 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:
A. Primary hyperparathyroidism B. Hypothyroidism C. Conn's syndrome D. Addison's disease E. Gastroenteritis
D. Addison's disease E. Gastroenteritis B. Hypothyroidism A. Primary hyperparathyroidism C. Conn's syndrome
Addison’s disease typically presents with shock, and causes a low sodium and a high potassium, and the lack of glucocorticoid also can cause a lower than average glucose (1). Gastroenteritis also can present with a low sodium and dehydration (2), although this is less likely as patients usually lose both sodium and potassium, although renal failure that results from severe dehydration can also cause hyperkalaemia.
Hypothyroidism (3) does not cause a low blood pressure, but can cause hyponatraemia when severe. Primary hyperparathyroidism (4) does not present like this, although if the high calcium causes renal failure, that could possibly cause the high potassium. Conn’s syndrome (5) is completely wrong, as those patients have a high blood pressure not a low one, and also a lot potassium.
