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DEFNE Extra Buzzwords > Path PPQs > Flashcards

Path PPQs Flashcards

1
Q

flucloxacillin resistance in S. aureus

A

c. Alteration of the target

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2
Q

mechanism is ESBL E.coli resistant to ceftriaxone

A

b. Enzymatic inactivation of antibiotic

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3
Q

patient has grown a fully susceptible E.coli in their urine. Which of the following is the narrowest spectrum agent you should de-escalate to

A

a. Amoxicillin

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4
Q

Most common HAI

A

HA pneumonia

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5
Q

c.diff

A

Gram pos spore-forming anaerobe

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6
Q

What are fungi

A

a. Eukaryotic organisms with chitinous cell walls and ergosterol containing plasma membranes

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7
Q

commonest cause of fungal infections in humans

A

c. Candida spp

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8
Q

cryptococcus associated with which animal

A

pigeons

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9
Q

stain used for cryptococcus

A

india

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10
Q

antigungals targeting cell membrane not work in PCP why?

A

PCP lacks ergosterol in cell wall

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11
Q

Live vaccine should be deferred if?

A

a. Patient has received immunoglobulin in past 3 months  If given antibodies already, they may not produce an immune response, so there is no point
b. Patient is receiving systemic high dose steroids  They would be immunosuppressed

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12
Q

Percentage of world’s popultion infected w TB

A

33%

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13
Q

acid-fast bacilli found in clinical sample - what to do next?

A

start TB therapy

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14
Q

lifetime risk of reveloping TB if in contact with smear positive pul TB if HIV neg

A

10%

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15
Q

yearly risk of reveloping TB if in contact with smear positive pul TB if HIV pos

A

10 per year

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16
Q

Most common meningeal disease in UK

A

men B

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17
Q

Most common cause of death worldwide under 5 yrs

A

prematurity and pneumonia

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18
Q

What on microsopy suggests poor sample

A

squamous epithelial cells

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19
Q

dipstick paramemter that is a produuct of nitrate reductase and suggestive of UTI

A

nitrate

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20
Q

What type of immunouppression has greatest relative risk of developing viral infection:
a. Steroids
b. Solid organ transplant
c. Allogeneic stem cell transplant
d. Monoclonal antibody therapies
e. Cytotoxic chemotherapy

A

Allogenic stem cell transplant

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21
Q

Mouth ulcers post HSCT

A

Herpes simplex virus (HSV) - very common after transplant

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22
Q

How long do u need to have Sx for gastroenteritis definition

A

> 1wk of symptoms

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23
Q

Extraintestinal manifestation associated with salmonella infection

A

Aortitis

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24
Q

Virus associted wtih outbreaks

A

Norovirus

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25
Q

What si the thoracic duct

A

c. Carries lymphocytes from lymph nodes back to blood circulation

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26
Q

thymus?

A

d. Site of deletion of T cells with inappropriately high or low affinity for HLA molecules and of maturation of T cells into CD4+ or CD8+ cells

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27
Q

germinal centre?

A

a. Area within secondary lymphoid tissue where B cells proliferate and undergo affinity maturation and isotope switching

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28
Q

Which of the following medications can cause antibody deficiency?

a. Metformin
b. Losartan
c. Prednisolone
d. Alendronic acid
e. Rituximab

A

RITUXIMAB

a. Metformin
b. Losartan
c. Prednisolone -> Could be, but antibody deficiency usually seen at higher dose (>10mg). Also usually only causes a selective antibody deficiency (IgG). It usually spares IgM and IgA.
d. Alendronic acid
e. Rituximab -> Targets B cells

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29
Q

7) Which of the following conditions are most likely to present in patients with CD4 T cell counts of >350?
a. Shingles, pulmonary TB, pneumococcal pneumonia
b. Hairy leukoplakia
c. PCP, Cryptococcus, toxoplasmosis
d. MAC disease

A

a. Shingles, pulmonary TB, pneumococcal pneumonia

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30
Q

Infection wiht atypical mycobacterium. normal FBC - diagnosis?

A

IFN gamma R deficiency

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31
Q

Meningococcus meningitis with sibling dying of same condition at same age?

A

C7 deficiency

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32
Q

17) Severe recurrent infections from 3 months,CD4 and CD8 T cells absent, B cell present, Igs low. Normal facial features and cardiac echocardiogram. What is the diagnosis?

A

X-linked SCID

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33
Q

22) Recurrent bacterial infections in a child, episode of pneumocystis pneumonia, high IgM, absent IgA and IgG. What is the diagnosis?

A

X-linked hyper-IgM

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34
Q

CD40 ligand mutation

A

HyperIgM syndrome

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35
Q

what proportion of the world has kidney disease

A

11%

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36
Q

5 year survival % for end stage kidney failure on dialysis

A

35%

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37
Q

28) A potential donor is described as being 1:1:0 MM. What does this mean?

A

c. 1 MM A locus, 1 MM B locus, 0 MM DR locus

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38
Q

29) The main effector cells in T-cell mediated rejection are

A

b. T cells and monocytes / macrophages

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39
Q

30) A patient has an episode of acute T cell-mediated rejection 2 months post transplantation. What additional drug would most commonly be administered?

A

Corticosteroids  3 pulses of methyl-prednisolone given 3 days in a row, followed by an oral steroid taper

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40
Q

What cell is njuryed in the effector phase of antibody-mmediated rejection

A

endothelial cells

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41
Q

If there is 50% match of HLA from donor and recipient, what does that mean?

A

Parent and son/

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42
Q

39) Which of the following is an example of Gel and Coombs type III hypersensitivity
a. Goodpasture disease
b. Eczema
c. SLE
d. Multiple sclerosis
e. Graves disease

A

SLE

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43
Q

45) Which of the following vaccines should NOT be given to an immunosuppressed individual?
a. BCG - bacilli Calmette-Guerin
b. Diphtheria toxoid
c. Quadrivalent inactivated influenza vaccine
d. Polio (Salk – injected)
e. Pfizer Covid mRNA vaccine

A

a. BCG - bacilli Calmette-Guerin

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44
Q

46) A 23 year old has metastatic melanoma. Reduce disease progression with what?

A

Nivolocumab - anti-PD-1

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45
Q

48) Rituximab is a monoclonal antibody specific for CD20 on B cells. It depletes B cells. For what is it effective treatment

A

e. Rheumatoid arthritis

46
Q

Treatment fo psoriasis / psoriatic arthritis

A

Ustekinumab - IL-12 / IL-23 inhibition / TNF-alpha blocker

47
Q

Increase or decreased protein C increases thrombosis risk?

A

Decreased protein C

48
Q
  1. Which agent has a delayed anticoagulant effect?
    a) Vitamin K
    b) Unfractionated heparin
    c) Warfarin
    d) Low molecular weight heparin
    e) Aspirin
A

Warfarin

49
Q
  1. Which factor confers the highest risk of thrombosis?
    a) Antithrombin deficiency
    b) Factor V Leiden
    c) Family history of thrombosis
    d) Reduced factor 8 level
    e) 3 hour plane flight
A

Antithrombin deficiency

50
Q
  1. How does warfarin achieve its anticoagulant effect?
    a) Reduce plasma protein C and S
    b) Block phospholipid synthesis
    c) Reduce plasma procoagulant factors
    d) Act as a cofactor for antithrombin
    e) Inhibit factor 2, 7, 9 and 10
A

Reduced plasma procoagulants

51
Q
  1. Which patients is most likely to benefit from long-term anticoagulation after a DVT in the following circumstances?
    a) 67yo man after flying from Kuala Lumpar
    b) 27yo woman during pregnancy
    c) 33yo woman on COCP
    d) 77yo man after hip replacement
    e) 30yo man after a long walk
A

e) 30yo man after a long walk

52
Q
  1. 33yo man has a PE. What is most appropriate 1st line treatment?
    a) Compression stockings
    b) Aspirin 600mg
    c) Therapeutic LMWH
    d) Warfarin
    e) Fresh frozen plasma
A

c) Therapeutic LMWH

53
Q
  1. 34yo woman developed a DVT after removal of ovarian cyst. Father and brother had DVT. What should you do?
    a) Test for antithrombin deficiency
    b) Recommend HRT
    c) Continue long term anticoagulation
A

a) Test for antithrombin deficiency

54
Q
  1. 22 year old male with cyanotic congenital heart disease. Hb 210g/l and Haematocrit 60%. No splenomegaly. What are the most likely labl test results?
    a. JAK2 wildtype + low serum EPO
    b. JAK2 V617F positive + raised serum EPO
    c. JAK2 wildtype + raised EPO
    d. JAK2 V617F positive + low serum EPO
A

c. JAK2 wildtype + raised EPO

55
Q
  1. 38yo woman who had a previous DVT while taking COCP. She then had a 2nd DVT during her 2nd pregnancy. What should you do?
    a) Test for Factor V Leiden
    b) HRT
    c) Continue long term anticoagulation
    d) Fixed low-dose warfarin
A

a) Test for Factor V Leiden

56
Q
  1. In certain NHL subtypes, chromosome translocations involving a proto-oncogene are seen. Which statement is NOT true?
A

a. Follicular NHL: IgH-BCL2
b. Mantle cell lymphoma: IgH-Cyclin D1
c. Follicular NHL: BCR-ABL1
d. Burkitt lymphoma: IgH-cMYC

57
Q
  1. 22 year old female with cHL, mediastinal mass. What is the most likely subtype?
    a. Lymphocyte depleted
    b. Nodular sclerosis
    c. Mixed cellularity
    d. Lymphocyte rich
A

b. Nodular sclerosis

58
Q

Venetoclax in CLL treatment does what?

A

Blocks BCL protein

59
Q

Bad progrnosis in CLL

A

IgHV unmutated and P53 Mutated

60
Q

Newborn babies in contrast to adults have
a. A higher Hb
b. A lower WBC
c. Smaller red blood cells
d. The same percentage of Haemoglobin F

A

a. A higher Hb

61
Q

First line Tx of actue GvHD

A

pred and ciclosporin

62
Q

First line prevention of acute GvHD

A

Methotrexate and ciclosporin

63
Q

Risk factor for both acuute and chronic GvDH

A

Incfreased recipient age

64
Q

Platelet count rises or falls in pregnancy?

A

Falls

65
Q

neutrophil count rises or falls in pregnancy?

A

Rises

66
Q

Hb conc rises or falls during pregnance?

A

Falls

67
Q

telomeric shortening is a feature of both idiopathic and aplasitc anaemia - true/false?

A

True

68
Q
  1. Which of the following statements is correct?
    a. In gestational thrombocytopenia, the baby’s platelet count is usually affected
    b. Thrombocytopenia is rarely found in associated with pre-eclampsia
    c. Thrombotic thrombocytopenic purpura remits spontaneously following delivery
    d. The platelet count may fall following delivery in baby’s born to mothers with ITP
A

d. The platelet count may fall following delivery in baby’s born to mothers with ITP

69
Q

Most common pancreatic neoplasm

A

ductal adenocarcinoma

70
Q

7) Which of these is not associated with fatty change in the liver?
a. Diabetes
b. Hepatitis B
c. Alcohol

A

hepatitis B

71
Q

9) Lichen planus is an example of which type of inflammatory reaction pattern?

A

Lichenoid

72
Q

10) Where is the epidermis does the bullae in pemphigus vulgaris form?

A
  • Stratum spinosum
73
Q

14) What percentage of lung cancers in the UK develop in non-smokers?

A

10-20%

74
Q

19) How many parameters are included in breast tumour grading?

A

3

75
Q

17) What benign lesions most commonly mimic breast cancer on radiology?

A

– Fat necrosis and radial scar

76
Q

18) What is the most common malignant breast tumour?

A

ductal carcinoma

77
Q

20) Impaired blood supply to the bowel most commonly causes what?

A

ischaemic colitis

78
Q

22) What sort of colon polyps most commonly predispose to adenocarcinoma of the colon?

A

adenomatous

79
Q

26) What type of amyloid is associated with multiple myeloma

A

AL

80
Q

29) Which of the following is not a cause of chronic gastritis?
a. Auto-immunity
b. Infection
c. Drugs
d. Metabolic disease

A

Metabolic Disease

81
Q

30) What is the most common brain tumour in adults?

A

Metastasis

82
Q

Most common brain tumour in children

A

Pilocytic astrocytoma

83
Q

32) What does tumour grade tell us?

A

Survival

84
Q

33) Which mutation identifies diffuse astrocytic tumours with a better prognosis?

A

IDH mutation

85
Q

36) 5 year-old boy. Had headache and vomiting in the morning for 2 weeks. Symptoms worsened and the vision became blurred. Fundoscopic exam: papilledema. MRI showing cystic cerebellar lesion. A tumour was removed. What is your diagnosis?

A

d) Pilocytic astrocytoma (WHO grade I)

86
Q

35) 70 year old male. Seizure following 2 weeks of left arm and leg weakness. MRI showing heterogeneous enhancing right frontal lesion, started on steroids. Partial response to steroids with improved dexterity of the left arm and leg. A tumour was partially resected. What is your diagnosis?

A

a) Glioblastoma (WHO grade IV)

87
Q

What herniation doesn’t involve cerebral cortex

A

tonsillar

88
Q

39) What percentage of patients who experience a TIA will get a significant infarct within 5 years?

A

33%

89
Q

Most common cause of non-traumatic intraparenchymmal haemorrhage

A

HTN

90
Q

43) Excluding Parkinson’s disease, which other disorder (often presenting with Parkinsonism) is associated with alpha-synuclein pathology

A

Multiple system atrophy

91
Q

Most common thyroid cancer

A

papillary

92
Q

cancers screened for in the uk

A

breast, bowel, cervical

93
Q

most common site in female genital tract to receive metastatic tuumouurs

A

ovaries

94
Q

6) Which has the lowest calcium?
a. Primary hyperparathyroidism
b. Secondary hyperparathyroidism
c. Osteoporosis
d. Paget’s disease of the bone
e. Breast cancer

A

Secondary hyperparathyroidism

95
Q

10) How long does it take to see benefit from good glucose control?

A

15 yrs

96
Q

11) Which study suggests that tight control increases mortality?

A

a. Accord

97
Q

12) Hyperkalaemia is a side effect of which of the following drugs?
a. Furosemide
b. Bendroflumethiazide
c. Salbutamol
d. Ramipril

A

Ramipril

98
Q

13) Hypokalaemia is a side-effect of which of the following drugs?
a. Spironolactone
b. Indomethacin
c. Perindopril
d. Furosemide

A

Furosemide

99
Q

biggest risk factor for duct ectasia

A

smoking

100
Q

Biggest predictor for portal htn

A

splenomegaly

101
Q

lung malignancy associated with PTHrp

A

squamous cell cancer

102
Q

mutation in familial adenomatous polyposis

A

APC tumour suppressor gene

103
Q

chromosome with CFTR mutation

A

chromosome 7

104
Q

c diff diagnostic test

A

toxin stool assay

105
Q

21) Histology shows benign central scarring surrounded by proliferating glandular tissue. Most likely diagnosis?

A

radial scar

106
Q

stage of breast cancer targetted by screening

A

DCIS

107
Q

signet ring cells and ovarian tumour

A

Krunkenburg tumour

108
Q

CML management

A

imatinib

109
Q

globin genes located on which chromosomes?

A

11 and 16

110
Q
A

DEFNE Extra Buzzwords (15 decks)

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