Path Past Paper 16-21 Flashcards
1) An old lady has fatigue. She is pale with slight tachycardia. Hb is low, WBC is low, platelets are low, MCV is high. Blood film shows neutrophils with reduced granularity and reduced nuclear lobules. No polychromasia present. Rank the following in order of likelihood, with (1) being the most likely and (5) being the least likely
a) Aplastic anaemia
b) Vitamin B12 deficiency
c) ITP
d) CLL
e) Myelodysplastic syndrome
-
2) Rank the following in order of reticulocyte count, with (1) being the highest and (5) being the lowest
a) Occult GI blood loss
b) ITP
c) Anaemia due to low dose oral myelosuppressive chemotherapy
d) Severe aplastic anaemia
e) Hereditary spherocytosis
-
3) Rank cancers as cause of death in UK men according to frequency with (1) being the most common
a) Lung
b) Colon
c) Head and Neck
d) Breast
e) Prostate
-
4) Rank the following stages of oesophageal adenocarcinoma progression in chronological order
a) Reactive
b) Metaplasia
c) Low grade dysplasia
d) High grade dysplasia
e) Adenocarcinoma
a) Reactive
b) Metaplasia
c) Low grade dysplasia
d) High grade dysplasia
e) Adenocarcinoma
5) 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.
a) Cushing’s syndrome
b) Phaeochromocytoma
c) Conn’s syndrome
d) Addison’s disease
e) Essential hypertension
-
6) Rank in order of potency at reducing LDL with (1) being the most potent
a) Evolocumab
b) Simvastatin
c) Atorvastatin
d) Bezafibrate
e) Prednisolone
-
7) Woman has dry mouth, severe dryness that affects her eyes. Also fatigue and arthralgia of hand.
Blood test - normal urate, high ESR, high IgG, high rheumatoid factor, normal anti-CCP antibody, ANA is high and has a speckled pattern. Rank with (1) being most likely
a) Rheumatoid arthritis
b) Osteoarthritis and keratoconjunctivitis sicca
c) Gout
d) Primary sjogren’s syndrome
e) Osteogenesis imperfecta
-
8) A young female presents with mild SLE. Rank the results of investigations in order of likelihood in this patient, with (1) being most likely
a) Positive anti-dsDNA
b) Positive ANA
c) Low C3
d) Absent IgG
e) Positive C3 nephritic factor
-
9) Young woman with dysuria, urinary frequency and suprapubic pain. Rank organisms with (1) being most likely
a) Escherichia coli
b) Staph saprophyticus
c) Proteus mirabilis
d) Candida albicans
e) Acinetobacter baumanii
a) Escherichia coli
b) Staph saprophyticus
c) Proteus mirabilis
d) Candida albicans
e) Acinetobacter baumanii
10) A neonate presents at 36 hours of life with meningitis signs. Rank the organisms with (1) being most likely
a) GBS
b) E. coli
c) Listeria
d) Pseudomonas
e) Cryptococcus
-
11) Middle aged man has pruritus, and has an emergency thrombotic cerebrovascular accident. He has a high Hb, and JAK2 V617F mutation. What is the likely diagnosis?
polycythaemia vera
12) Fatigue and mild jaundice, has spherocytes on blood film. Coombs test positive. Likely diagnosis?
warm autoimmune haemolytic anaemia
13) Which coagulation factor falls most rapidly after starting warfarin?
7
14) Young woman requires therapeutic anticoagulation during the 1st trimester of pregnancy. Which anticoagulant should be given?
LMWH
15) Imatinib is used for what leukaemia?
CML
16) Man has fatigue and back pain. Blood results show - high creatinine, low IgG, low IgM, no paraprotein detected (via electrophoresis), low serum kappa light chains, high lamda light chains, low kappa/lamda ratio. What is the likely diagnosis?
multiple myeloma
17) Woman has chest pain, SOB, persistent swelling in neck. Large mass in supraclavicular fossa is biopsied - malignant cells with reactive fibrosis and high eosinophils [exact pictures below were included in question]. What is the likely diagnosis?
lymphoma. (mainly hodgkin)
18) 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, low fibrinogen, high D-dimers. What is the most likely obstetric event?
amniotic fluid embolism
19) At what temperature can platelet transfusions be stored?
room temp (20 degrees C)
20) Pregnant women has amniocentesis, she is group O-ve. What therapeutic intervention is required?
anti D prophylaxis
21) Woman is group A-ve. She has had two previous pregnancies. What naturally occurring antibody will be present in her blood?
anti D + anti B
22) Infants with sickle cell disease (HbSS) may have splenic sequestration. Why does this not occur before 3 months of age?
HbF dampens the symptoms.
HbF synthesis decreases and HbS increases.
23) Venetoclax is a BCL2 inhibitor used in CLL. What cellular process does it affect?
blocks the anti-apoptotic B-cell lymphoma 2 protein, leading to programmed cell death of CLL cells
24) Old woman with painless lymphadenopathy. Blood results - normal Hb, normal neutrophils, normal platelets, high lymphocytes. Smear cells present. Lymphocytes are CD5+ve and CD19+ve
CLL
25) 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?
aplastic anaemia?????/?
26) Commonest primary tumour of the heart?
atrial myxoma
28) Most likely cause of mobile mass in young woman’s breast?
fibroadenoma
29) Commonest histological type of primary malignant breast cancer?
invasive carcinoma (probably ductal)
30) What type of emphysema is associated with smoking?
centrilobular damage
31) What is the commonest cause of constrictive pericarditis in the developing world?
TB
32) What is the most common cause of nephrotic syndrome in adults that is a glomerular pathology?
Focal segmental glomerulosclerosis
33) What is the commonest cause of portal vein thrombosis?
malignancy
34) Which organism that causes pneumonia and bloody sputum that is associated with alcoholics and diabetics?
klebsiella pneumonia
35) A dysgerminoma is a type of tumour that affects the ovary. What is the equivalent tumour type in the testes?
seminoma
36) What is the most common histological type of oesophageal cancer in the UK?
adenocarcinoma
37) Intestinal metaplasia in Barrett’s (columnar-lined) oesophagus is most commonly due to the presence of which cell?
goblet
38) Which vascular tumour is associated with infection by HHV8?
kaposi sarcoma
39) What is the commonest cause of myocarditis?
viral infection
40) Raised AMA antibodies are characteristic of which liver disease?
PBC - primary biliary cholangitis
41) Which virus characteristically causes encephalitis involving the temporal lobes?
herpes simplex
42) What is the most common cause of hypocalcaemia in the community?
primary hypoparathyroidism
43) Which liver enzyme can be measured in the blood and specifically suggests obstructive jaundice if levels are raised?
ALP
44) Addison’s patient is admitted in adrenal crisis. Her BP is low. What fluid should be given?
0.9% saline
45) Which adrenal zone produces cortisol?
zona fasciculata
46) 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?
viral thyroiditis
47) What condition occurs in both MEN1 and MEN2a?
parathyroid hyperplasia
48) What enzyme does allopurinol inhibit?
xanthine oxidase
49) What vitamin deficiency causes pellagra?
niacin (B3)
50) Which hormone increases urinary phosphate excretion?
PTH
51) Alcoholic has severe abdominal pain, rigid abdomen - he has acute pancreatitis. What blood test will confirm the diagnosis?
serum amylase
52) What active enzyme in sarcoidosis patients causes hypercalcaemia
1 alpha hydroxylase
53) What is the commonest cause of hypercalcaemia in the community?
primary hyperparathyroidism
54) What hormone is produced by fat cells, and has receptors in the hypothalamus?
leptin
55) Deficiency of which plasma protein occurs in patients with liver disease and a movement disorder?
caeruloplasmin
56) Patient has hypertension. Blood results - normal sodium, low potassium, normal urea, normal creatinine, raised aldosterone, renin suppressed. What is the diagnosis?
primary hyperaldosteronism (conns)
57) What is the name for a fully differentiated B-cell that produces antibody?
Plasma cell
58) What condition involves the upper and lower airways and kidneys, and is ANCA positive with cytoplasmic staining and is specific for proteinase 3?
Wegener’s granulomatosis, GPA
59) Which condition is caused by reactivation of human polyoma virus 2 (John Cunningham (JC) virus) in immunosuppressed people?
PML
progressive multifolcal leukoencephalopathy
60) Which drug should be given as an immediate IM injection to an individual presenting with acute anaphylaxis?
adrenaline
61) Patient has periodic fevers and is found to have a mutation in MEFV. What is the condition?
familial Mediterranean fever
62) A woman has Graves’ disease. What antibody should be tested?
anti TSH
63) Doctors should measure the level/activity of which enzyme before prescribing azathioprine?
TPMT
thiopurine methyl transferase
64) Child with recurrent bacterial and fungal infections. A dihydrorhodamine test shows that neutrophils fail to oxidise dihydrorhodamine. What is the likely diagnosis?
CGD (chronic granulomatous)
65) Which isotype of antibody is involved in allergies to food and insect venom?
IgE
66) 5 month baby has failure to thrive and recurrent infections. Investigations - mutation affecting IL2RG gene, which encdoes IL2 common gamma chain. What is the diagnosis?
X linked SCID
67) 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?
B cells
68) In bare lymphocyte syndrome which affects the HLA class II transactivator, which type of immune cell will be deficient?
CD4+ T cells
69) Mutation of CD40 ligand is associated with which form of primary immunodeficiency?
hyper IgM syndrome
70) Denosumab is a monoclonal antibody specific for RANKL. What condition is it used to treat?
osteoporosis
71) Woman with iron deficiency anaemia is found to have IgA antibodies specific for tissue transglutaminase. What is the underlying condition?
coeliac disease
72) Which class of antibiotics has concentration dependent killing (i.e. the goal of therapy is to maximise peak > MIC)
ahminoglycosides
73) 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?
cephalosporins (ceftriaxone)
74) What feature of the MMR vaccine makes it contra-indicated in pregnancy?
virulence possibility
75) Elderly woman has 24 hour history of headache, confusion, photophobia, fever. Gram stain of CSF shows gram+ve rods. What is the causative organism?
listeria monocytogenes
76) Which human herpes virus is associated with post transplant lymphoproliferative disorder (PTLD)
EBV
77) This vaccine preventable disease causes headache, fever, parotid swelling (unilateral or bilateral). Complications include epididymo-orchitis in postpubertal males and more rarely meningitis. What is the causative organism?
mumps
78) Woman has hot, swollen and painful left knee. Gram stain of joint aspirate - gram +ve cocci in clusters. Patient has no drug allergies and MRSA screen is -ve. What narrow spectrum antibiotic is indicated?
flucloxacillin
79) Elderly woman has type 6 stool which is green and mucoid. She is on the 6th day of IV ceftriaxone. What is the likely causative organism?
c.diff
80) 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?
most likely and aspergillosis
81) 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?
cryptococcal meningitis
82) Aid worker returns from camp in Yemen. He has profuse watery diarrhoea, which looks like water rice has been cooked in. He is very dehydrated. What is the likely cause of his diarrhoea?
cholera
83) Infection with which virus in the first 20 weeks of pregnancy causes hydrops fetalis?
parvovirus B19
84) 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?
amphotericin
mucormycosis in poorly controlled diabetes
85) 4 year old goes on school trip to petting farm, later has bloody diarrhoea and HUS. What is the causative organism?
E.coli 0157:H7
86) Young man has headache, neck stiffness and photophobia. He was not confused, did not have features of encephalitis. HSV1 was detected on PCR of CSF obtained from LP. What antiviral should be given?
acyclovir
87) What is the cause of beta-thalassaemia major?
a) Decreased production of alpha-globin chains
b) Decreased production of beta-globin chains
c) Decreased production of gamma-globin chains
d) Increased production of alpha-globin chains
e) Increased production of beta-globin chains
b) Decreased production of beta-globin chains
88) Elderly woman has fever and productive cough in GP. She has pleural rub. Spleen is not palpable, no lymphadenopathy. Her WBC is 15x10^9 with neutrophilia. The Hb concentration is slightly low and platelet count is normal. Blood film - toxic granulation, left shift. CRP is high. What is the diagnosis?
a) AML
b) Aplastic anaemia
c) CML
d) Infectious mononucleosis
e) Reactive neutrophilia
d) Infectious mononucleosis
89) Bleeding patient has prolonged APTT and PT, but normal platelet count and normal fibrinogen. What is the most suitable blood component for treatment?
a) Albumin
b) Anti-D
c) Cryoprecipitate
d) Fresh frozen plasma
e) Platelets
c) Cryoprecipitate
d) Fresh frozen plasma
???
90) Young girl has pains in her legs, and miserable for past few weeks. She is pale, has several bruises and generalised lymphadenopathy with nodes up to 2cm diameter. Investigations - low Hb, normal MCV, high WCC, low platelets. Blood film shows 80% blast cells. What is the diagnosis?
a) ALL
b) AML
c) CLL
d) CML
e) Infectious mononucleosis
a) ALL
91) 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) Polycythaemia vera
b) Primary polycythaemia
c) Secondary polycythaemia
d) Relative polycythaemia
e) High affinity haemoglobinopathy
d) Relative polycythaemia
because plasma volume low
92) 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) Development of iron deficiency
b) Development of aplastic anaemia
c) Progression to AML
d) Progression to CML
e) Progression to myelofibrosis
e) Progression to myelofibrosis
93) 55 year old man started on therapy with DOAC rivaroxaban. What advice would you give regarding monitoring whilst on treatment?
a) Platelet count
b) No monitoring required
c) INR
d) APTT
e) Anti-Xa assay
b) No monitoring required
(such a short half life)
94) Acute GvHD post-allogenic haematopoietic stem cell transplant is mediated by which cell type?
a) Donor T-cells
b) Donor B-cells
c) Recipient B-cells
d) Recipient NK cells
e) Recipient T-cells
a) Donor T-cells
95) Which of the following is NOT normally associated with a diagnosis of multiple myeloma?
a) Anaemia
b) Humoral immune dysfunction
c) Osteolytic bone lesions
d) Renal impairment
e) Splenomegaly
e) Splenomegaly
96) In obstetric practice, the maximum risk of fatal maternal thrombo-embolism occurs at which stage of pregnancy?
a) 1st trimester
b) 2nd trimester
c) 3rd trimester
d) Post partum
e) Post amniocentesis
d) Post partum
97) What is the most appropriate 1st line therapy for CML with acquired Philadelphia translocation, in chronic phase?
a) Ibrutinib, a Bruton tyrosine kinase inhibitor
b) Imatinib, an ABL1 tyrosine kinase inhibitor
c) Rituximab, an anti-CD20 monoclonal antibody
d) Thalidomide, an anti-angiogenic agent
e) Tocilizumab, an anti-IL6R monoclonal antibody
b) Imatinib, an ABL1 tyrosine kinase inhibitor
98) Which of the following decreases during pregnancy?
a) Von Willebrand factor
b) Protein S
c) Plasminogen activator inhibitor 1
d) Fibrinogen
e) Factor VIII
b) Protein S
99) 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) 1:100
b) 1:4
c) 1:2
d) 1:11000
e) 1:1
b) 1:4
100) In Hodgkin lymphoma, PET CT scan at diagnosis demonstrates disease involving the following sites only: supraclavicular fossa, mediastinum, inguinal nodes and spleen. What anatomical stage is this?
a) Stage 0
b) Stage 1
c) Stage 2
d) Stage 3
e) Stage 4
e) 3
(the spleen is not an extra nodal sites)
101) Which type of necrosis is associated with a MI?
a) Liquefactive necrosis
b) Fat necrosis
c) Coagulative necrosis
d) Caseous necrosis
e) Abscess formation
c) Coagulative necrosis
102) Palpable lymph node in the left supraclavicular fossa in a gastric cancer patient is referred to as?
a) Virchow node
b) Sister Mary Joseph node
c) Krukenberg tumour
d) Cushing’s node
e) Blumer shelf
a) Virchow node
103) What is the most common ovarian tumour?
a) Serous mucinous cystadenocarcinoma
b) Serous cystadenoma
c) Mucinous cystadenoma
d) Mucinous cystadenocarcinoma
e) Brenner tumour
b) Serous cystadenoma
104) An extradural (epidural) haemorrhage is due to damage to which blood vessel/vascular lesion?
a) Middle meningeal artery
b) Middle cerebral artery
c) Internal carotid
d) Bridging veins
e) Berry aneurysm
a) Middle meningeal artery
105) Which virus is associated with the development of nasopharyngeal carcinoma?
a) EBV
b) HBV
c) HHV-8
d) HPV-16
e) HCV
a) EBV
106) Pulmonary oedema due to liver disease is an example of which type of cause of pulmonary oedema?
a) Lymphatic obstruction
b) Indirect injury to alveolar wall
c) Increased hydrostatic pressure
d) Direct injury to alveolar wall
e) Decreased osmotic pressure
c) Increased hydrostatic pressure
107) What is the commonest cause of adult ARDS?
a) Sepsis
b) Trauma
c) Pancreatitis
d) Drug reaction
e) Aspiration
a) Sepsis
108) Which is the commonest glial cell in the CNS?
a) Oligodendrocytes
b) Microglia
c) Ependymal cells
d) Endothelial cells
e) Astrocytes
e) Astrocytes
109) What is the most common cause of mitral valve stenosis?
a) Systemic lupus
b) Rheumatic heart disease
c) Pulmonary hypertension
d) Infective endocarditis
e) Congenital
b) Rheumatic heart disease
110) Which of the following is the inheritance of genetic haemochromatosis?
a) X-linked recessive
b) X-linked dominant
c) Polygenic
d) Autosomal recessive
e) Autosomal dominant
d) Autosomal recessive
111) Which is the commonest cause of pancreatitis in adults? [Q did not specify acute or chronic]
a) Alcohol
b) Autoimmune disease
c) Cystic fibrosis
d) Drugs
e) Gallstones
a) Alcohol
or
e) Gallstones
112) Brain tumour which most commonly occurs near the surface of the brain and is frequently asymptomatic is most likely to be?
a) GBM
b) Haemangioma
c) Meningioma
d) Schwannoma
e) Oligodendroglioma
c) Meningioma
113) In IVDU, which valve is characteristically associated with infectious endocarditis?
a) Aortic valve
b) Prosthetic valve
c) Pulmonary valve
d) Mitral valve
e) Tricuspid valve
e) Tricuspid valve
114) Which is the most common skin cancer?
a) Keratoacanthoma
b) Melanoma
c) Metastatic cancer
d) Squamous cell carcinoma
e) Basal cell carcinoma
e) Basal cell carcinoma
115) 25 year man is in A&E with abdominal 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 [blood gases were also listed but can’t remember them]. What is the likely diagnosis?
a) Addison’s disease
b) Conn’s syndrome
c) Diabetic ketoacidosis
d) Acute abdomen
e) Cushing’s syndrome
a) Addison’s disease
(crisis)
116) 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 [blood gases were also listed but can’t remember them]. What is the cause of his electrolyte abnormalities?
a) Renal loss of sodium
b) Vomiting
c) Renal failure
d) Perforated appendix
e) Dehydration
e) Dehydration
(triggering an addisonian crisis)
117) 60 year old man with BMI of 28 has abdo pain. His LFTs - high total BR, high ALP, high ALT, high AST, high GGT, high creatine kinase. What is the most likely diagnosis?
a) Acute pancreatitis
b) Viral hepatitis
c) Alcoholic cirrhosis
d) Haemolytic jaundice
e) Obstructive jaundice due to gallstones
e) Obstructive jaundice due to gallstones
118) Which of the following can cause hypoglycaemia?
a) Atorvastatin
b) Bendroflumthiazide
c) Glucagon
d) Prednisolone
e) Quinine
e) Quinine
119) Increased insulin sensitivity results in low plasma glucose and occurs in which of the following?
a) PCOS
b) Phaeochromocytoma
c) Cushing’s disease
d) ACTH deficiency
e) Acromegaly
d) ACTH deficiency
120) Which one of the following is correct in a patient with moderate alcohol intake?
a) Elevated HDL
b) AST is nearly normal
c) Normal GGT
d) Normal triglycerides
e) Reduced albumin
elevated HDL
121) Clinical features of hypercalcaemia include which one of the following?
a) Polyuria and polydipsia
b) Tetany
c) Hypotension
d) Diarrhoea
e) Easy bruising
a) Polyuria and polydipsia
???
122) 40 year old woman has a headache, normal visual fields. MRI shows 4mm pituitary adenoma. Investigations - normal cortisol [upper boundary of normal], normal ACTH, high prolactin of 1400, normal TSH, normal T4. What is the likely diagnosis?
a) Acromegaly
b) Non-functioning pituitary macroadenoma
c) Prolactinoma
d) TSHoma
e) Hypopituitarism
b) Non-functioning pituitary macroadenoma / prolactinoma that hasn’t gown big enough yet to produce high levels of prolactin
123) 40 year old woman has post-partum haemorrhage, unable to breastfeed. Investigations - low cortisol, low ACTH, low prolactin, normal TSH, normal T4. What is the likely diagnosis?
a) Acromegaly
b) Non-functioning pituitary macroadenoma
c) Prolactinoma
d) TSHoma
e) Hypopituitarism
e) Hypopituitarism
125) Which of the following is found in obstructive jaundice
a) There is increased bilirubin in urine
b) The stools are dark
c) GGT is usually normal
d) AST is usually normal
e) ALP is usually normal
a) There is increased bilirubin in urine?????
126) Which of the following is found in haemolytic jaundice
a) Bilirubin is normal
b) AST is raised
c) CK is raised
d) The stools are pale
e) There is increased urobilinogen in urine
e) There is increased urobilinogen in urine
127) Which of the following binds to receptors in the adrenal and stimulates aldosterone release?
a) Angiotensin 2
b) ACTH
c) Renin
d) Sodium
e) Calcium
b) ACTH
128) 40 year old woman has a headache and bitemporal hemianopia. MRI shows 2cm pituitary macroadenoma. Investigations - normal cortisol, normal ACTH, high prolactin of 1400, normal TSH, normal T4. What is the likely diagnosis?
a) Acromegaly
b) Non-functioning pituitary macroadenoma
c) Prolactinoma
d) TSHoma
e) Hypopituitarism
b) Non-functioning pituitary macroadenoma
129) Which type of vaccine should not given to immunosuppressed individuals
a) Vaccine containing lipid adjuvant
b) Toxoid
c) Subunit
d) Live attenuated
e) Conjugate
d) Live attenuated
130) In a histology slide showing antibody mediated rejection of a renal allograft, where is the inflammatory infiltrate seen?
a) Capillaries
b) Capsule
c) Interstitium
d) Tubules
e) Adipose tissue
a) Capillaries
think its the blood vessels
131) Which of the following is a mixed pattern auto-inflammatory auto-immune disease characterised by sacroiliac joint inflammation
a) Ankylosing spondylitis
b) Osteitis condensans illi
c) Osteoarthritis
d) Rheumatoid arthritis
e) Gout
a) Ankylosing spondylitis
132) Routine of a HIV patient should include testing for which leukocyte subset?
a) CD8 T-cells
b) CD4 T-cells
c) B-cells
d) Monocytes
e) NK cells
b) CD4 T-cells
133) Conjugate vaccine of polysaccharide and protein carrier may be used to enhance B-cell immunity to which of the following?
a) HIV
b) TB
c) Rabies
d) Streptococcus pneumoniae
e) Vibrio cholerae
d) Streptococcus pneumoniae
134) 21 year old woman has joint pain, rashes, fevers, pleuritic chest pain. Blood tests - high ESR, low CRP, high ANA titre, positive dsDNA antibody, low C3 level, low C4 level. What is the likely diagnosis?
a) SLE
b) Systemic sclerosis
c) Lyme arthritis
d) Granulomatosis with polyangiitis
e) Dermatomyositis
a) SLE
135) Development of auto-antibodies specific for gastric parietal cells is associated with which disease?
a) T1D
b) Rheumatoid arthritis
c) Multiple sclerosis
d) Graves’ disease
e) Pernicious anaemia
e) Pernicious anaemia
136) Gel and Coombs type III hypersensitivity is mediated by which of the following mechanisms?
a) Activation of complement by antibody binding to cellular antigen
b) Cytotoxic T-cell mediated cell destruction
c) Activation of pre-existing IgE bound to antigen
d) Deposition of antibody-antigen complexes in blood vessel walls
e) Modulation of cell function by antibody binding to cell surface receptor
d) Deposition of antibody-antigen complexes in blood vessel walls
137) Failure to regulate cryopyrin driven activation of neutrophils is characteristic of which of the following diseases?
a) Auto-immune lymphoproliferative syndrome (ALPS)
b) Behcet’s disease
c) Familial Mediterranean fever
d) Microscopic polyangiitis
e) Ulcerative colitis
c) Familial Mediterranean fever
138) Which of the following monoclonal antibody therapies enhances T-cell immunity and is used in management of some malignancies?
a) Infliximab (anti-TNFalpha)
b) Pembrolizumab (anti-PD1)
c) Rituximab (anti-CD20)
d) Tocilizumab (anti-IL6R)
e) Ustekinumab (anti-IL12/23)
b) Pembrolizumab (anti-PD1)
139) Which one of the following agents is effective as a biological disease modifying anti-rheumatic drug (b-DMARD) as part of rheumatoid arthritis management?
a) Adalimumab (anti-TNFalpha)
b) Basiliximab (anti-CD25)
c) Denosumab (anti-RANKL)
d) Pembrolizumab (anti-PD1)
e) Secukinumab (anti-IL17A)
Adalimumab (anti-TNFalpha)
140) Which one of the following is a standard immunosuppressive regimen for patients who received an allograft?
a) Azathioprine, mycophenolate mofetil, prednisolone
b) Cyclophosphamide, methotrexate, rituximab
c) Cyclosporine, rapamycin, tacrolimus
d) Dapsone, methotrexate, prednisolone
e) Mycophenolate mofetil, prednisolone, tacrolimus
a) Azathioprine, mycophenolate mofetil, prednisolone
141) Which of the following exists in an immature form in the periphery where they recognise pathogens, and then mature and become adapted for presenting antigen to T-cells in lymph nodes
a) B-cells
b) Dendritic cells
c) Eosinophils
d) Erythrocytes
e) Plasma cells
b) Dendritic cells??
142) Which of the following immune-mediated diseases may respond to treatment with plasmapheresis?
a) Ankylosing spondylitis
b) Goodpasture syndrome
c) IgA vasculitis
d) Sjogren’s syndrome
e) Takayasu’s arteritis
b) Goodpasture syndrome
143) 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) 0.1%
b) 1%
c) 10%
d) 50%
e) 90%
c) 10%
144) 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?
a) Azithromycin
b) Amoxicillin
c) Ceftriaxone
d) Co-trimoxazole
e) Meropenem
a) Azithromycin
(macrolides for atypical cover)
145) Which hepatitis virus is associated with more severe disease if acquired in pregnancy potentially leading to fulminant hepatic failure and death?
a) Hepatitis A
b) Hepatitis B
c) Hepatitis C
d) Hepatitis D
e) Hepatitis E
e) Hepatitis E
146) Which of the following serological tests is useful in the diagnosis of invasive Candida albicans infections?
a) Beta-D-Glucan
b) Galactomannan
c) RFR
d) TPPA
e) Widal test
beta D glucan
147) Infants under 12 months should not be fed honey due to an increased risk of food poisoning caused which of the following organisms?
a) Campylobacter jejuni
b) Clostridium botulinum
c) Escherichia coli 0157
d) Salmonella typhi
e) Vibrio cholerae
b) Clostridium botulinum
148) 45 year old woman has 2-day history of fever and headache. She returned 5 days ago from a 2 week visit to Ghana. She initially thought she had a cold but her partner brought her in as she is now drowsy and confused. GCS is 11, temperature is 39.1 degrees, HR is 108 bpm, BP is 90/60. Malaria rapid diagnostic test is positive and parasitemia is 10%. Which of the following is the most appropriate initial antimalarial therapy?
a) IV artesunate
b) IV quinine
c) Oral artemether and lumefantrine
d) Oral atovaquone and proguanil
e) Oral mefloquine
a) IV artesunate
as severe
149) Which of the following antivirals is used for chronic hepatitis B treatment?
a) Aciclovir
b) Oseltamivir
c) Tenofovir
d) Zanamivir
e) Ribavirin
c) Tenofovir
150) Streptobacillus moniliformis is the causative organism of which of the following infections?
a) Bacillary angiomatosis
b) Lyme disease
c) Q fever
d) Rat bite fever
e) Syphilis
d) Rat bite fever
151) What is the commonest form of prion disease?
a) Fatal familial insomnia
b) Iatrogenic Creutzfeldt-Jakob disease
c) Kuru
d) Sporadic Creutzfeldt-Jakob disease
e) Variant Creutzfeldt-Jakob disease
d) Sporadic Creutzfeldt-Jakob disease
(80%)
152) 31 year old man is found unconscious in his flat surrounded by empty whisky bottles and recreational drugs. Shortly after arriving in the emergency department, he has a cardiac arrest and dies. His brother, his next of kin, arrives at the hospital a few hours later. He explains that his brother has alcohol related seizures but had not seen his doctor for several years. Which advice should be given to the Emergency department team regarding a post-mortem?
a) If the police suspect that the man’s death is a crime, then the team should refer to the coroner for a coroner’s post-mortem
b) In this situation, the case should be referred to the Coroner for a Coroner’s post-mortem
c) The cause of death is most likely to be related to recreational drugs and alcohol so a post-mortem is not needed
d) The cause of death is uncertain so it would be preferable to perform a post-mortem
e) The cause of death is uncertain so it would be preferable to perform a post-mortem but it can only be performed with the brother’s consent
-
153) 56 year old man admitted with a reduced conscious level, fever and seizures. His brain MRI shows gross hydrocephalus and lesions suspicious of neurocysticercosis, a parasitic disease usually contracted from eating infected pork. A shunt is inserted to relieve the hydrocephalus but he develops shunt sepsis and dies 1 week post-surgery. The patient’s wife says that they are orthodox Jews and do not want the case discussed with the coroner. She is anxious that the coroner will request a post-mortem that could confirm neurocysticercosis. Which advice should be given regarding disclosure to the coroner?
a) Explain to the wife that the right of confidentiality does not extend after death
b) In this situation, disclosure to the coroner would be a breach of the wife’s article 8 right to a private life under the Human Rights Act 1998
c) The wife has an absolute right to confidentiality so her request must be respected
d) There is a legal duty to disclose relevant medical information to the coroner in this situation irrespective of consent
e) Where non-disclosure is requested on religious grounds and the diagnosis has been confirmed, it is not necessary to discuss the case with the coroner
) There is a legal duty to disclose relevant medical information to the coroner in this situation irrespective of consent
154) 56 year old single man with known cystic fibrosis and severe learning disability (mental age of 4 years) is admitted to hospital with a severe pneumonia. He dies 5 days later. His mother died over 10 years previously. His stepfather, who has been his main carer since the mother died, has requested a post-mortem. However, his sister is deeply opposed to this. The coroner has advised that a coroner’s post-mortem is not required. How should you advise his medical team regarding the post mortem?
a) A post mortem cannot be performed if the coroner has not requested one
b) Provided one family member gives consent, the post mortem can be performed in this situation
c) Provided the stepfather was the next of kin, then the post mortem can be performed
d) The post mortem cannot be performed in the face of the sister’s refusal
e) Where there is family disagreement the post-mortem should be referred to the Court of Protection
d) The post mortem cannot be performed in the face of the sister’s refusal
unless paperwork saying otherwise
155) 17 year old boy, with no known health problems dies suddenly while playing football. Hypertrophic cardiomyopathy is diagnosed as the cause of death at the coroner’s post-mortem. The pathologist wishes to retain the heart for teaching purposes. The mother agrees but his 26 year old brother is completely opposed to this. What is the legal position regarding organ retention in this situation?
a) Following a coroner’s post-mortem, organ or tissue retention is required as evidence for the cause of death
b) Organ or tissue retention can lawfully process with the mother’s consent
c) Organ or tissue retention cannot lawfully proceed where there is family disagreement
d) Organ or tissue retention following a coroner’s autopsy does not require consent
e) Organ or tissue retention for the purpose of medical education does not required the family’s consent
-
156) 63 year old man admitted with decompensated liver failure, hepatic encephalopathy and GCS of 7. He is found to have previously diagnosed hepatitis C. His wife asks for more information. Her husband is now alert but still acutely confused. His consultant thinks it is likely that his encephalopathy will resolve in the next few days. Which advice should be given in terms of disclosure of this man’s hepatitis C status to the wife?
a) Disclosure should wait until the man has regained mental capacity to consent to disclosure
b) Disclosure should wait until the mode of transmission of hepatitis C has been confirmed
c) Failure to disclose the diagnosis of hepatitis to the wife at the earliest opportunity would be a breach of her article 2 right to life under the Human Rights Act 1998
d) The man lacks mental capacity. Therefore, provided the wife is the next of kin, she should be informed of the diagnosis
e) The wife may have contracted hepatitis C from her husband and there she should be informed of the diagnosis
-
Man with sudden onset abdo pain radiates to the back and dies: 4 years ago had a heart attack, now you aspirate blood from the pericardium
ventricular wall rupture - only because this leads to a haemopericardium
Woman with progressive memory loss and bronchopneumonia
multiple infarcts
Chest pain, radiates to neck:
carotid artery embolism
-Hypothyroidism abs
if hashimotos then anti thyroglobulin and anti thyroperoxidase
-Dry eyes etc. anti Ro, anti La
Sjogrens syndrome
- Droopy eyelid which is fatiguable.
Myasthenia gravis abs
Swollen joints of the hand, x-ray shows erosive joint changes.
rheumatoid arthritis
CMV retinitis antiviral
ganciclovir
HSV meningitis antiviral
acyclovir / valaciclovir
VZV antiviral
acyclovir
Child with RSV antiviral
ribavarin
Asthmatic with flu antiviral
oseltamivir (not sure why you couldnt give to an asthmatic)
Man with cough, SoB and wt loss. Hyponatraemia, low serum osmolality, urine Na and osmo were inappropriately normal cause
SIADH neoplastic from small cell lung cancer
Elderly woman with C. diff and profuse diarrhoea hyponatrameia cause?
hypovolaemic hyponatreamia
Low plasma sodium, low urine sodium cause
primary/psychogenic polydipsia
Man who has been in a car accident, raised sodium and plasma osmolality, low urine osmolality casue
cranial diabetes insipidus
Hyperaldosterone picture with raised Na, low K, HTN but raised renin? cause
renal artery stenosis
What enzyme is raised in Pagets?
ALP
What would be raised in obstructive jaundice due to gallstones
GGT + ALP
What would be raised in obstructive jaundice due to pancreatic adenocarcinoma?
ALP + CA19.9
What is a sign that your patient has been taking cocaine?
white powder on their nose + AST
Indication for dialysis?
AEIOU
Temporal arteritis test which will help with diagnosis?
ESR
Post strep GN - what do you see in the kidneys?
granular deposit of IgG and C3 in glomerular basement membrane
Malignant HTN, what is the classic finding on histology in kidneys
fibrinoid necrosis
A 64yo man develops renal failure after an episode of haematemesis. What do you see on his kidney biopsy?
acute tubular necrosis from hyopvolameia
• Necrosis of short segments of tubules, acute renal failure
Severe UTI in the kidney in Diabetes - what do you see on biopsy?
casts
Multiple myeloma - what would you see in kidneys?
renal failure, AL amyloid
Non functioning macroadenoma hormone profile
mildly raised proclatin,1000-5000
TSHoma hormone profile
high TSH, high T4 (and raised prolactin)
Prolactinoma hormone profile
prolactin >5000
Hypopituitarism hormone profile
low GH, low TSH,, low ACTH
- Primary hypothyroidism hormone profile
high TSH, low T4
- Woman comes in with bitemporal hemianopia, 2cm mass, and a raised prolactin 1400?
non functional macro adenoma
- Woman comes in with no visual change, 4mm mass, and raised prolactin 1400?
prolactinoma
- Raised prolactin, normal TSH, raised T4
TSHoma
- High TSH low T4
primary hypothyroid
causes of pneumonia
● Strep pneumo
● Aspergillus
● PCP
● TB
● Legionella
klebsiella
1) HIV patient -
2) Girl receiving chemotherapy for leukaemia ‘Halo’ sign on CXR-
3) Lower lobe pneumonia in a 22 year old, Gram-positive diplococci -
4) Upper lobe cavitation + alcoholic -
5) Smoker back from holiday in Spain, also hyponatraemic and confused -
HIV patient - PCP
2) Girl receiving chemotherapy for leukaemia ‘Halo’ sign on CXR- Aspergillus
3) Lower lobe pneumonia in a 22 year old, Gram-positive diplococci -Strep pneumoniae
4) Upper lobe cavitation + alcoholic - Klebsiella
5) Smoker back from holiday in Spain, also hyponatraemic and confused - Legionella
Micro: Fungi
A. Candida Albicans
B. Candida something else
C. Cryptococcus
D. Rhizopus
E. Cocciodies
F. Trichophytum rubrum
G. Malassezia furfur
H. Piedraia hortae
I. + 6 more unheard of fungi
- AIDS person with meningitis
- Water polo player with itchy scaly rash on lateral toe then moved along lateral side of foot
- Pityriasis versicolor
- Lady came back from visiting her sister in Arizona with systemic sx - fever etc:
- Man in his 60s with poorly controlled diabetes presents with rapidly progressing periorbital swelling, sinus pain, confusion and sinusitis
AIDS person with meningitis Cryptococcus
- Water polo player with itchy scaly rash on lateral toe then moved along lateral side of foot Trichophytum rubrum
- Pityriasis versicolor Malassezia furfur
- Lady came back from visiting her sister in Arizona with systemic sx - fever etc: Coccidioides https://www.cdc.gov/features/valleyfever/index.html (nice)
- Man in his 60s with poorly controlled diabetes presents with rapidly progressing periorbital swelling, sinus pain, confusion and sinusitis - apparently Rhizopus spp. causing mucormycosis
Immunology
A. Interferon gamma
B. Interferon alpha
C. TNFalpha
D. Etanercept
E. Basiliximab
F. Tocilizumab
G. Natalizumab
H. Denosumab
I. And some others
- Ankylosing spondylitis
- Resistant Psoriasis
- Chronic granulomatous disease treatment
- Osteoporosis
- Hyper IgM syndrome
- Ankylosing spondylitis Etanercept
- Resistant Psoriasis Etanercept
- Chronic granulomatous disease treatment IFN gamma
- Osteoporosis Denosumab
- Hyper IgM syndrome Human Ig
Histopathology
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Cholangiocarcinoma
D. Active gastritis
E. B cell lymphoma
F. T cell lymphoma
G. Glandular dysplasia
H. Neuroendocrine tumour
I. Other types of dysplasia/metaplasia?
J. None of the above
- Tumour in head of pancreas, invading into portal vein, mass in liver
- Man with H pylori, abnormal area in antrum, mitotic figures and cells with raised nuclear to cytoplasmic ratio, not invading the basement membrane Glandular dysplasia (?
- Tumour in oesophagus with keratin and intercellular bridges
- Women has acute appendicitis, 5mm tumour found in tip when it’s removed –
Tumour in head of pancreas, invading into portal vein, mass in liver Adenocarcinoma
- Man with H pylori, abnormal area in antrum, mitotic figures and cells with raised nuclear to cytoplasmic ratio, not invading the basement membrane Glandular dysplasia (?) B cell lymphoma
- Tumour in oesophagus with keratin and intercellular bridges Squamous cell carcinoma
- Women has acute appendicitis, 5mm tumour found in tip when it’s removed – neuroendocrine tumour?
13 Immunology - types of immune cells
- What immune cell resides in bone marrow until migrates to site of injury. Oxidative and non-oxidative killing. Dies once job’s done.
- Something Foxp3+ cells, I think it also said they mature in the thymus?
- What immune cells detects antigen in the periphery and moves to lymph nodes?
- What immune cell detects MHC1 and kills virus infected/cancer cells. Is inhibited by MHC I.
- What immune cells is targeted by HIV?
What immune cell resides in bone marrow until migrates to site of injury. Oxidative and non-oxidative killing. Dies once job’s done. Neutrophils
- Something Foxp3+ cells, I think it also said they mature in the thymus? Treg
- What immune cells detects antigen in the periphery and moves to lymph nodes? Dendritic cell
- What immune cell detects MHC1 and kills virus infected/cancer cells. Is inhibited by MHC I. NK cells
- What immune cells is targeted by HIV? CD4+
haem tests
- What would you measure to check for beta thalassaemia?
- How to monitor therapy in someone with polycythaemia vera?
- Test for autoimmune haemolytic anaemia?
- What would you measure to check for beta thalassaemia? HbA2
- How to monitor therapy in someone with polycythaemia vera? Haematocrit and haemoglobin
- Test for autoimmune haemolytic anaemia? Direct antiglobulin test
which is a naturally occurring cytokine that is able to inhibit HIV fusion to CD4+ T-lymphocytes?
MIP-1a binding to CCR5
2) What is done to blood donations to reduce GvHD?
irradiation
3) Eczematous nipple rash caused by individual ‘malignant cells’?
Pagets disease of the nipple???
4) Cat scratch disease full name (genus and species) of bacteria
bartonella henselae
7) Coeliac disease cancer:
EATL (gastric lymphoma)
8) VTE recurrence risk how does being male affect it:
slightly increases it
9) Smear cells, what is diagnosis?
CLL
10) What type of hypersensitivity (Gel and Coombs classification) is myasthenia gravis and what cell?
type II
acetylcholine receptor
11) Woman on a DOAC. Advice in pregnancy. Lady with life long DOAC, has never had problems, when becomes pregnant what should you do?
switch to LMWH
12) Most common cause of acute pancreatitis?
gallstones
13) Increased calcitonin. Type of cancer?
medullary thyroid carcinoma
MEN2 medullary thyroid adenoma. What hormone would you measure?
TSH or calcitonin
15) IPEX affects what type of immune cell?
Treg cells
16) CAH which enzyme deficiency is most common?
21 hydroxylase
17) 2 questions with low TSH, raised T3/4 following a viral infection
viral thyroiditis
23) Most common type of primary thyroid cancer to metastasise to lymph node?
papillary
24) Lady with SLE, has spherocytes, low Hb, raised bilirubin how do you test for diagnosis?
AIHA so use DAT test
25) What is the definition of herd immunity threshold
1- (1/Ro)
26) Name 1 of the 3 characteristics of Influenza A that could cause a pandemic?
antigenic shift/drift (novel antigenicity)
ability to replicate in human airway
27) Patient is on low molecular weight heparin, what do you measure to monitor this?
APTT
28) 16 year old girl has pleuritic chest pain, joint pain, positive ANA and Anti-Sm, no liver enzyme derangement, raised ESR?
SLE
29) Alcoholic man is on ceftriaxone for meningitis, what organism is he at risk of which this does not cover for?
listeria monocytogenes
31) What virus increases risk of nasopharyngeal cancer?
EBV
32) What additional virus apart from HIV and HBV are screened for in platelet donations to pregnant women?
CMV
33) Multiple questions on differentiating primary biliary cholangitis and primary sclerosing cholangitis (including which one is associated with UC and which one involves granulomas)
-
34) Chimeric antigen receptor T-cell therapy against CD19: what type of haematological malignancy does it target?
B cell
35) Kid has low calcium, cleft palate, low T cells,?
DiGeorge, 22 11q.2 deletion
36) Has contact with someone with TB, what is the risk of getting active TB?
10%
37) Ankylosing spondylitis - they’ve tried NSAID and TNF inhibitor?, what else can you target?
IL-17. (secukinumab)
38) Diffuse continuous inflammation rectal to caecal, with no granulomas
UC
39) 45yo woman with autoimmune diseases, low IgM, IgA and IgE; full blood count is normal?
CVID
40) Patient with low WCC and Plt and teardrop cells on film?
myelofibrosis??
41) Which enzyme is raised in Paget’s, Osteomalacia etc. and is caused by osteoblast activation?
ALP
42) Patient with GI conditions, lack of which substance leads to B12 being malabsorbed
intrinsic factor
43) T1DM? with hypoglycaemia, What is the management option if no IV access?
IM glucagon
44) Young guy has a fall and hits his head, presents two days later and then loses consciousness, where is the bleeding coming from?
subdural
on Ovarian mass in Japanese woman: signet ring cells
metastses from colon cancer
Krukenberg’s
46) HTLV1 virus is associated with which cancer
adult T cell leukaemia
47) Woman with constipation from abroad (sounded like salmonella typhi?) - what abx do you give if she hasn’t been started on them already
ceftriaxone
48) Patient with microcytic anaemia abdominal symptoms. Duodenal biopsy showed crypt hyperplasia and non-caseating granulomas, lymphocytes
coeliac
49) MAHA and thrombocytopenia following GI upset
HUS, E coli 1057:h7
50) Septic arthritis in a 56yo man - likely organism?
staph aureus
51) What is called when you have discontinuation of epithelium
ulcer
52) Which immunoglobulin is found in mucosa
IgA
54) What cell goes wrong in IPEX?
Treg cells
55) What does it mean if urine MC&S sample has epithelial cells and mixed bacterial growth
contaminated sample
56) Histopathological change that occurs to liver in patients with diabetes?
fatty liver
57) Patient with subtotal villous atrophy, tall crypts
-coeliac
58) Diffuse continuous inflammation rectal to caecal, with no granulomas.
UC???
59) Young guy has a fall and hits his head, presents two days later and then loses consciousness, where is the bleeding coming from
subdural
60) Histopathological change that occurs to liver in patients with diabetes?
fatty liver
- Antibody for Graves
anti TSH receptor
- Nivolumab is a PD1 inhibitor, what cells does it target?
T Cells
- PCSK9 inhibitor - evolucumab, what does it halve?
LDL
- Which molecule takes cholesterol and moves it to liver and steroidogenesis organs
HDL
- 42 year old woman has a history of intermenstrual bleeding. On examination, a cervical polyp is found. What do you do next?
removal and histology
- EBV serology 2 weeks post infection
EBV IgM
- Homeless guy dies (signs of trauma), cannot contact brother, what do you do about the autopsy?
death must be referred to coroner for autopsy
- HIV positive girl dies of cerebral toxoplasmosis, before she dies she says she doesn’t want to disclose her HIV status. What do you write on the death certificate?
must be disclosed if deemed to have contributed to her death
- Woman (45y) with learning difficulties and cerebral palsy, she gets influenza, then strep pneumonia, then dies of cardiorespiratory arrest. Death certificate
1a. streptococcal throat infection
1b. cinflueza
2. cerebral palsy
- Man dies, daughter consents to autopsy, step mum (his wife) does not want autopsy - what to do?
no autopsy as wife outranks daughter
- Guy with brain mets from lung cancer, history of PE, dies of cardiorespiratory arrest. Fill out death certificate
- 1a. PE
1b. cerebral mets
1c. lung cancer
- Which vaccine is a polysaccharide and conjugate vaccine?
pneumococcal
- Which disease do you see in both MEN1 and MEN2a?
parathyroid adenoma - primary hyperparathyroidism
- What is one of the complications of Parvovirus B19?
aplastic aneamia, hydros fetalis
- What type of section is done for urgent diagnosis during surgery?
frozen section
- ToF - what type of shunt?
right to left
- How do you initially treat Malaria falciparum; 38.9 fever, hypotension, 4% parasitaemia?
iv artesunate
- Insulinoma. What would you find?
low FFAs
- Bortezomib is a proteasome inhibitor, how does this work?
inhibits intracellular protein degradation, build up and amino acid shortage kills cells
- What is the first-line treatment for CML?
imatinib
- Woman, non-smoker, peripheral lung tumour, which type is it most likely to be?
adenocarcinoma
- Woman with periorbital purple rash and rash on legs (dermatomyositis?), which enzyme is elevated?
creatine kinase
- Vitamin deficiency that causes megaloblastic anaemia & NTD?
folic acid
- What Type Hypersensitivity causes serum sickness?
type III
- High PTH and low Ca, what can this be
osteomalacia (vitamin D deficiency)
- Young gentleman brough to A&E by friends due to confusion. CSF is clear, raised lymphocytes, high protein, normal glucose. Causative organism?
HSV - confusion suggets encephalitis
- Low sodium (124) and specific gravity of 1.000 cause?
psychogenic polydipsia
- Neonate (2 day old) has meningitis and blood cultures isolate gram negative rods, what is the organism?
e.coli
- Gram +ve cocci UTI in a woman?
staphylococcus saphrophyticus
- What would be high in most common cause of CAH
17 OH (progesterone) androgens
- What vaccine preventable organism causes cough, lymph node enlargement and has a potential to occlude the airway?
diphtheria
- Which hormone leads to release of prolactin?
TRH
- Transfusion level for platelets after trauma?
50
can be 100 if actively bleeding
- What is the effect of the gene mutation in familial mediterranean fever?
increased IL-1 production
- Man with cyanotic heart disease has a haematocrit of 54% (high) and is found to be negative for JAK2 mutation. What does he have?
secondary polycythaemia
- Man with history of PKD has a cerebral bleed - what type?
berry aneurysm - SAH
- What cell type is raised in the blood in schistosomiasis?
eosinophils
- Boy visits grandparents in Wiltshire, comes back with 5 days of diarrhoea, no vomiting, and unexplained bruises all over body
HUS e.coli 0157:h7
- Mechanism of hyperacute allograft rejection
preformed antibodies
What is common feature between MEN1 and MEN2a?
parathyroid adenoma
. A man with persistent heartburn has an Endoscopy done, which shows a mass in the oesophagus (at a depth of) 35cm (???) down. Which cancer develops in Barrett’s oesophagus?
adenocarcinoma
What is the mechanism in the oesophagus as a result of reflux (GORD) that takes place and leads to cancer?
metaplasia
What happens to the body of the stomach in a patient with pernicious anaemia?
atrophy
Which cancer do you get with H.Pylori?
antigenic stimulation - MALT
marginal zone non Hodgkins
Cancer in Coeliac disease. What would they get if they don’t follow a gluten free diet?
EATL
. 60 year old Man with abdominal pain radiating to back, collapses and dies
aortic dissection
or rupture abdo aneurysm
Man, ex-smoker, with history of hypertension and MI, has sudden chest pain which radiates to the neck
carotid artery thrombus
50 year old lady with memory issues/progressive amnesia, hypertension (?? + bronchopneumonia??)
multiple cerebral infarcts
Elderly man with atrial fibrillation with right flank pain?
renal artery thrombosis
Man has an MI 3 years ago. Now comes into hospital feeling very unwell. Is having a sample taken from their pericardial layer and you find blood is aspirated from the pericardium
ventricular wall rupture
Child had spherocytes and anaemia and it asked next investigation to do
DAT testing??
- Histology: supraclavicular aspirate, girl has swollen face? Showed reed-sternberg (poorly drawn) cells
Hodgkins lymphoma
- MEFV Mutation, what is it?
familial mediterranean fever
- NOD2/CARD15, what is it found in?
IBD
- Immunodeficiency with common gamma chain problem?
x linked SCID
- Common traveller’s diarrhoea
(ET) E.coli
- Swollen joint, needle-shaped aspirate with negative birefringence, what is the enzyme responsible
uricase
- Treatment for previous question (gout), specifically not one you should use acutely
allopurinol or probenecid
- What does JC virus cause?
progressive multifocal leukoencephalopathy
- Reactivation of a virus following a transplant.
EBV
