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Fess' Flashcards (Path & Specialties Questions) > Path Quiz > Flashcards

Path Quiz Flashcards

These are the questions given as part of the quiz in Path

1
Q

A patient who sustained a severe snakebite was given equine anti-venom gamma globulin, and responded well to treatment. Within 5 days, the patient developed a slight fever and urticaria. How would you describe this reaction?

A. Type III hypersensitivity
B. Eosinophilia
C. Type IV hypersensitivity
D. Type II hypersensitivity

A

C. Type IV hypersensitivity

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2
Q

A 21 year old female presents with severe abdominal pain, diarrhoea, blood, and mucus per rectum. Colonoscopy with histology reveals a patchy severe active colitis interspersed with normal colon. What is the likely diagnosis?

A. Colorectal cancer
B. Ulcerative colitis
C. Pseudomembranous colitis
D. Crohn’s disease

A

D. Crohn’s disease

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3
Q

Which antibody test would you send off in a patient in whom you suspected coeliac disease?

A. Anti-tissue transglutaminase antibody
B. Anti-nuclear antibody
C. Antimitochondrial antibody
D. Antigastric parietal cell antibody

A

A. Anti-tissue transglutaminase antibody

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4
Q

A 50 year old man has fever, SOB, hepatosplenomegaly, and pallor. A blood count shows that he has a white cell count of 65 x 10^9/L and a blood film shows 90% blast cells. The blast cells contain granules and occasional Auer rods. Rank the following differential diagnoses in order of likelihood, with 1 being the most likely, and 5 being the least likely.

A. Acute myeloid leukaemia
B. Chronic lymphocytic leukaemia
C. Chest infection
D. Chronic myeloid leukaemia
E. Acute lymphoblastic leukaemia
A 
1 - A. Acute myeloid leukaemia
2 - D. Chronic myeloid leukaemia
3 - E. Acute lymphoblastic leukaemia
4 - B. Chronic lymphocytic leukaemia 
5 - C. Chest infection
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5
Q

A 24 year old female presents with rapid onset of a skin rash, SOB, and loss of consciousness shortly after eating shellfish. Rank the following treatments in order of appropriateness with 1 being the most appropriate answer and 5 the least.

A. I.V. adrenaline
B. I.V. hydrocortisone
C. Nebulised salbutamol
D. I.M. adrenaline
E. I.V. saline
A 
1 - D. I.M. adrenaline
2 -  E. I.V. saline
3 - C. Nebulised salbutamol
4 - B. I.V. hydrocortisone 
5 - A. I.V. adrenaline
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6
Q

All of the conditions here re associated with a raised plasma gastrin level. Rank the following conditions in order of the likely gastrin level, with 1 being the cause of the highest, and 5 the lowest.

A. Achlorhydria
B. Post-vagotomy
C. H. pylori infection
D. Renal failure
E. Zollinger-Ellison syndrome
A 
1 - A. Achlorhydria
2 - B. Post-vagotomy
3 - C. H. pylori infection
4 - E. Zollinger-Ellison syndrome
5 - D. Renal failure
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7
Q

A 52 year old patient is admitted with unexplained hypoglycaemia. The blood glucose is 2.1mmol/L and the C-peptide is 457pmol/L. What is the most useful next step?

A. Measure insulin antibodies
B. Undertake 72 hour fast
C. Urine sulphonylurea screen
D. Check insulin concentrations

A

C. Urine sulphonylurea screen

A sulphonylurea screen is required because if raises both insulin and c-peptide, and so can mimic increased endogenous insulin production. Though this history is suggestive of an insulinoma, a negative sulphonylurea screen is required to make that diagnosis.

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8
Q

Which of the following predispose to emphysema?

A. Childhood asthma
B. Squamous cell lung cancer
C. Cystic fibrosis
D. Alpha 1 anti-trypsin deficiency

A

D. Alpha 1 anti-trypsin deficiency

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9
Q

Three of the following are well known side effects of dopamine antagonists. Which of the following is not?

A. Tremor
B. Nausea
C. Hyperprolactinaemia
D. Stiffness

A

B. Nausea

Dopamine antagonists are used as anti-emetics

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10
Q

Which of the following best describes rheumatic fever?

A. It is an autoimmune disease
B. Splenomegaly occurs in some cases
C. It is causes by S. viridans infecting the heart valves
D. Clubbing occurs in some cases

A

A. It is an autoimmune disease

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11
Q

Which of the following is the first line treatment for chronic stage CML?

A. Stem cell transplant
B. Imatinib
C. Infliximab
D. Etanercept

A

B. Imatinib

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12
Q

A patient is found to have rose spots and a fever. Which organism is most likely to be responsible?

A. Salmonella typhi
B. Neisseria gonorrhoeae
C. Streptococcus pyogenes
D. Neisseria meningitidis

A

A. Salmonella typhi

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13
Q

Which of the following predispose to diabetes?

A. Cystic fibrosis
B. Childhood asthma
C. Squamous cell lung cancer
D. Alpha 1 antitrypsin deficiency

A

A. Cystic fibrosis

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14
Q

Which of the following has the most antiviral activity?

A. Amantadine
B. Selegiline
C. Prednisolone
D. Aminophylline

A

A. Amantadine

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15
Q

Rank the following in order of the likely underlying haematological diagnosis associated with a platelet count of 1,324 x 10^9/L

A. Polycythaemia vera
B. Chronic myeloid leukaemia
C. Essential thrombocythaemia
D. Myelodysplasia
E. Acute myeloid leukaemia
A 
1 - C. Essential thrombocythaemia
2 - B. Chronic myeloid leukaemia
3 - A. Polycythaemia vera
4 - D. Myelodysplasia
5 - E. Acute myeloid leukaemia

???

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16
Q

A 26 year old female patient presents with bilateral cervical lymphadenopathy (with localised and contiguous nodal involvement) accompanied by night sweats, fever, and mild weight loss. She has a diagnostic lymph node excision and microscopy shows partial node effacement by an infiltrate composed of small lymphocytes, eosinophils, macrophages (with focal micro-granuloma formation and atypical large cells). The atypical large cells are seen singly and show binucleation with prominent nuclei. These large cells stain with CD30 stain. Rank the following in order of likelihood of diagnosis with 1 being the most likely and 5 the least.

A. Classical Hodgkin lymphoma
B. Follicular lymphoma
C. Infectious mononucleosis
D. Anaplastic large cell lymphoma
E. Nodular lymphocyte predominant Hodgkin lymphoma (non-classical)
A 
1 - A. Classical Hodgkin lymphoma
2 - D. Anaplastic large cell lymphoma
3 - E. Nodular lymphocyte predominant Hodgkin lymphoma (non-classical)
4 - C. Infectious mononucleosis
5 - B. Follicular lymphoma
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17
Q

Please rank the following in terms of which is the most convincing indication of iron deficiency, with 1 being the most convincing and 5 the least.

A. Low transferrin saturation with low serum iron
B. Pencil cells on the blood film
C. Anaemia and low MCV
D. Jaundice
E. Fatigue
A 
1 - B. Pencil cells on the blood film
2 - A. Low transferrin saturation with low serum iron
3 - C. Anaemia and low MCV
4 - E. Fatigue
5 - D. Jaundice
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18
Q

When considering the initial production of antibodies in response to the first dose of a vaccine, please rank the following in the sequence of the main immune response.

A. APCs present part of the vaccine on the cell surface
B. Production of antibodies specific for the vaccine antigen
C. Activation of B cells (with the aid of CD4+ cells) in response to the antigen
D. Proportion of activated B cells mature into plasma cells
E. Antigens presented to naive T cells by APCs

A

1 - A. APCs present part of the vaccine on the cell surface
2 - E. Antigens presented to naive T cells by APCs
3 - C. Activation of B cells (with the aid of CD4+ cells) in response to the antigen
4 - D. Proportion of activated B cells mature into plasma cells
5 - B. Production of antibodies specific for the vaccine antigen

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19
Q

In the 2006 Point Prevalence Survey of Healthcare Associated Infections, please rank the following HAI syndrome in order from most to least prevalent.

A. Skin and soft tissue
B. Surgical site
C. Urinary tract
D. Hospital acquired pneumonia
E. Gastrointestinal system
A 
1 - E. Gastrointestinal system
2 - C. Urinary tract
3 - D. Pneumonia/ LRTI
4 - B. Surgical site
5 - A. Skin and soft tissue
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20
Q

Rank the following investigations in the order they are likely to be used for HIV-1 diagnosis.

A. CD4+ count
B. Viral load PCR
C. ELISA HIV-1 antibody test
D. Confirmatory HIV test
E. HIV-1 drug resistance test
A 
C. ELISA HIV-1 antibody test
D. Confirmatory HIV test
B. Viral load PCR
A. CD4+ count
E. HIV-1 drug resistance test
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21
Q

A 50 year old woman presents to her GP with fatigue and SOB. She is found to be pale with mild jaundice. Her blood count shows a haemoglobin concentration of 88g/L with a slight macrocytosis. Her blood film shows spherocytes and polychromatic macrocytes. A direct antiglobulin test is positive and unconjugated bilirubin is increased. Rank the following differential diagnoses, with 1 being the most likely and 5 the least.

A. Hepatitis A
B. Obstructive jaundice
C. Autoimmune haemolytic anaemia
D. Microangiopathic haemolytic anaemia
E. Hereditary spherocytosis
A 
1 - C. Autoimmune haemolytic anaemia
2 - E. Hereditary spherocytosis
3 - D. Microangiopathic haemolytic anaemia
4 - A. Hepatitis A
5 - B. Obstructive jaundice
22
Q

A 28 year old woman is invited for a routine cervical smear, list the sequence of events in the order that they occur.

A. Referral to colposcopy
B. Cervical intraepithelial neoplasia 1
C. Low grade dyskaryosis on ctyology
D. High risk HPV positive molecular test
E. 360 degrees rotation, five times around the cervix, with sampling device for smear sample
A 
E. 360 degrees rotation, five times around the cervix, with sampling device for smear sample
C. Low grade dyskaryosis on ctyology
D. High risk HPV positive molecular test
A. Referral to colposcopy
B. Cervical intraepithelial neoplasia 1
23
Q

Rank the following in order of likelihood of developing an acquired autoimmune haemolytic anaemia.

A. Penicillin V (Phenoxymethylpenicillin)
B. SLE
C. Pernicious anaemia
D. G6PD deficiency
E. CLL
A 
1 - E. CLL
2 - B. SLE
3 - A. Penicillin V (Phenoxymethylpenicillin)
4 - C. Pernicious anaemia
5 - D. G6PD deficiency

While the mechanism of AID in CLL is not fully understood, we
know that the autoantibodies responsible for destroying the blood
cells are polyclonal which means they don’t come directly from
the CLL cells themselves. Rather the dysfunctional activity of the
T-cells that help regulate the immune response (regulatory Tcells or T-regs) is likely playing a role.

24
Q

Which of the following is the most sensitive marker of liver damage?

A. AST
B. Prothrombin time
C. Alkaline phosphatase
D. Bilirubin

A

B. Prothrombin time

25
Q

Superoxide dismutase 1 is a misfolded protein associated with which condition?

A. Motor neurone disease
B. Multiple sclerosis
C. Parkinson’s disease
D. Alzheimer’s disease

A

A. Motor neurone disease

26
Q

Which of these options is a Gram positive organism?

A. E. coli
B. H. influenzae
C. L. Monocytogenes
D. S. typhi

A

C. L. Monocytogenes

27
Q

Which of the following is a common cause of renal disease in children?

A. Diabetic glomerulosclerosis
B. Minimal change disease
C. Membranous glomerulonephritis
D. FOcal and segmental glomerulonephritis

A

B. Minimal change disease

28
Q

Which of the following genetic syndrome is not associated with phaeochromocytoma?

A. Neurofibromatosis type 1
B. MEN 1
C. MEN2
D. Von-Hippel Lindau

A

B. MEN 1

29
Q

Which drug can be used in the treatment of benign prostatic hyperplasia?

A. Phosphodiesterase inhibitor
B. Beta blockers
C. 5-alpha reductase inhibitor
D. Oestradiol

A

C. 5-alpha reductase inhibitor

30
Q

Which of the following drugs would cause dangerous toxicity if taken with allopurinol?

A. Phenytoin
B. Tamoxifen
C. Azathioprine
D. Aminophylline

A

C. Azathioprine

31
Q

Which term describes the number of true positives divided by the total number of people who have the disease?

A. Positive predictive value
B. Negative predictive value
C. Sensitivity
D. Specificity

A

C. Sensitivity

32
Q

Which of the following is used first in an acute attack of gout?

A. Colchicine
B. Allopurinol
C. Aspirin
D. Probenecid

A

C. Aspirin

33
Q

A 53 year old European male presents with a recent history of weight loss and sudden onset abdo pain and fever. O/E abdomen is distended and peritonitic. He undergoes emergency laparotomy and partial resection of small bowel and mesentery.
Over the next few days, the following biochemistry results become available:
LDH - 12,000
EBV IgG positive, HIV positive
Histology of resected mesenteric lymph nodes reveals large CD20 positive cells and a starry sky appearance under low power microscopy.
What is the most likely diagnosis?

A. Burkitt’s lymphoma
B. Diffuse large B-cell lymphoma
C. Enteropathy-associated T-cell lymphoma of the small bowel
D. MALT lymphoma

A

A. Burkitt’s lymphoma

34
Q

Rank the following beta lactam antibiotics in order of width of spectrum from narrow (1) to broad (5).

A. Meropenem
B. Benzylpenicillin
C. Co-amoxiclav
D. Tazocin
E. Amoxicillin
A 
1 - B. Benzylpenicillin
2 - E. Amoxicillin
3 - C. Co-amoxiclav
4 - D. Tazocin
5 - A. Meropenem
35
Q

A 49 year old man presents with haemoptysis. Imaging reveals mediastinal lymphadenopathy, and he is referred for an endobronchial ultrasound guided transbronchial fine needle aspirate of the lymph nodes. Rank the sequence of events in the order they would occur.

A. Adenocarcinoma diagnosed
B. Sample processed and cell block made
C. Rapid on site evaluation by cytopathologist of endoscopic sample
D. Targeted chemotherapy commenced
E. ECFR mutation detected
A

1 - C. Rapid on site evaluation by cytopathologist of endoscopic sample
2 - A. Adenocarcinoma diagnosed
3 - B. Sample processed and cell block made
4 - E. ECFR mutation detected
5 - D. Targeted chemotherapy commenced

36
Q

A 56 year old woman presents with hepatosplenomegaly and generalised lymphadenopathy. Rank the following in order of likelihood.

A. Chronic myeloid leukaemia
B. Acute lymphoblastic leukaemia
C. Chronic lymphocytic leukaemia
D. Hodgkin lymphoma
E. Primary myelofibrosis
A 
1 - C. Chronic lymphocytic leukaemia
2 - D. Hodgkin lymphoma
3 - A. Chronic myeloid leukaemia
4 - B. Acute lymphoblastic leukaemia
5 - E. Primary myelofibrosis

Note that the generalised
lymphadenopathy makes CML less likely than CLL. If it were ONLY massive splenomegaly, then CML would be more likely.

37
Q

A 26 year old woman presents with facial swelling and fixed elevation of the external jugular vein. She has a persistent cough and a 4 month history of drenching night sweats. The histopathology report from a mediastinal mass biopsy is most likely to show which of the following? Rank in order of likelihood

A. T-cell lymphoblastic lymphoma
B. Mycosis fungoides
C. Hodgkin lymphoma
D. Diffuse large B-cell lymphoma
E. Acute myeloid leukaemia
A 
1 - C. Hodgkin lymphoma
2 - A. T-cell lymphoblastic lymphoma
3 - D. Diffuse large B-cell lymphoma
4 - E. Acute myeloid leukaemia
5 - Mycosis fungoides
38
Q

An 80 year old woman presents with tense fluid-filled flexural bullae. Rank the following in order of most likely diagnosis.

A. Pemphigus foliaceous
B. Pemphigus vulgaris
C. Pemphigoid gestationis
D. Bullous pemphigoid
E. Traumatic blisters
A 
1 - D. Bullous pemphigoid
2 - B. Pemphigus vulgaris
3 - A. Pemphigus foliaceous
4 - E. Traumatic blisters
5 - C. Pemphigoid gestationis
39
Q

A previously healthy 65 year old develops a painful vesicular rash confined to the T8 dermatome. Rank in order of appropriateness (in terms of cost and efficacy according to NICE) which antiviral treatments are indicated.

A. Valaciclovir p.o. 1g TDS
B. Oseltamavir p.o. 75mg BDS
C. Aciclovir p.o. 800mg five times per day
D. Foscarnet i.v. infusion, 60mg/kg every 8 hours
E. Aciclovir i.v. 10mg/kg TDS

A

1 - C. Aciclovir p.o, 800mg five times per day
2 - A. Valaciclovir p.o., 1g TDS
3 - E. Aciclovir i.v., 10mg/kg TDS
4 - D. Foscarnet i.v. infusion, 60mg/kg every 8 hours
5 - B. Oseltamavir po, 75mg BDS

  1. The most likely clinical diagnosis is zoster (shingles) caused by the varicella zoster virus (VZV). Treatment is recommended for patients over the age of 50 years with zoster in order to reduce the risk of postherpetic neuralgia. Aciclovir po is effective and well tolerated, and therefore the most commonly used and most cost-effective option for this patient group who are otherwise healthy.
  2. Valaciclovir is also effective and requires less frequent administration, but is more expensive and therefore less commonly used.
  3. Intravenous aciclovir is also effective and indicated for patients with zoster who are immunocompromised (eg post-transplant), but patients need to be admitted to hospital (hence increased cost), and there are infection-risks associated with IV access.
  4. Foscarnet, although also effective against VZV, is more toxic that aciclovir and valaciclovir (nephrotoxicity), and therefore only rarely used for treatment of VZV disease.
  5. Oseltamivir is a neuraminidase inhibitor with activity against influenza viruses, but not against VZV

I.V. is indicated for opthalmic involvement, immunocompromised patients, or encephalitis.

40
Q

Rank the following in order of likelihood of being followed by further recurrent thromboses from high to low.

A. Male with idiopathic thrombosis with no clear precipitant
B. Thrombosis whilst taking COCP (afterwards discontinued)
C. Thrombosis following surgery
D. Female with idiopathic thrombosis with no clear precipitant
E. Thrombosis following 4 hour flight

A

1 - A. Male with idiopathic thrombosis with no clear precipitant
2 - D. Female with idiopathic thrombosis with no clear precipitant
3 - E. Thrombosis following 4 hour flight
4 - B. Thrombosis whilst taking COCP (afterwards discontinued)
5 - C. Thrombosis following surgery

41
Q

A 14 year-old boy presents with pain and swelling of the knee. The x-ray shows a lesion which is worrying for malignancy. Rank the following diagnoses in order of likelihood.

A. Metastatic neuroblastoma
B. Osteosarcoma
C. Metastatic lung cancer
D. Osteomyelitis
E. Ewing sarcoma
A 
1 - B. Osteosarcoma
2 -  E. Ewing sarcoma
3 - A. Metastatic neuroblastoma
4 - D. Osteomyelitis
5 - C. Metastatic lung cancer
42
Q

A 76 year old man presents with symptomatic anaemia, undergoes a bone marrow biopsy, and a diagnosis of myelodysplastic syndrome is made. With respect to the Revised International Prognostic Scoring System, rank the following findings from worst prognostic marker to least bad.

A. Platelet count of 80 x 10^9/L
B. Haemoglobin of 112g/L
C. A history of diabetes
D. An intermediate karyotype (e.g. deletion of the long arm of the 7th chromosome)
E. A bone marrow blast count of 17%
A 
1 - E. A bone marrow blast count of 17%
2 - D. An intermediate karyotype (e.g. deletion of the long arm of the 7th chromosome)
3 - A. Platelet count of 80 x 10^9/L
4 - B. Haemoglobin of 112g/L
5 - C. A history of diabetes
43
Q

A 40 year old woman with diabetes and heavy periods complains of SOB. Examination reveals bibasal creps, rank the investigations in order of the likelihood they will be useful.

A. ECG
B. Echocardiogram
C. FBC
D. CXR
E. U&Es and creatinine
A 
1 - C. FBC
2 - D. CXR
3 - B. Echocardiogram
4 - A. ECG
5 - E. U&Es and creatinine
44
Q

A 23 year old woman presents to clinic with a one year history of bloody diarrhoea associated with large amounts of mucous. Rank the most likely diagnoses.

A. Inflammatory bowel disease
B. Infection
C. Endometrial adenocarcinoma
D. Large bowel cancer
E. Nemaline rod deficiency
A 
1 - A. Inflammatory bowel disease
2 - B. Infection
3 - D. Large bowel cancer
4 - C. Endometrial adenocarcinoma
5 - E. Nemaline rod deficiency
45
Q

Anaphylaxis is most likely to occur following exposure to which of the following? Rank them in order.

A. Eggs
B. Penicillin
C. Banana
D. Gliadin
E. Peanut
A 
1 - E. Peanut
2 - B. Penicillin
3 - A. Eggs
4 - D. Gliadin
5 - C. Banana
46
Q

Rank the following factors in terms of how likely they are to indicate that recurrent episodes will follow a DVT.

A. It occurred after a 4 hour flight
B. It was idiopathic
C. It occurred shortly after an operation
D. D-dimer was elevated after completing treatment
E. The patient was taking the COCP at the time

A

1 - B. It was idiopathic
2 - D. D-dimer was elevated after completing treatment
3 - A. It occurred after a 4 hour flight
4 - E. The patient was taking the COCP at the time
5 - C. It occurred shortly after an operation

47
Q

Rank the following in terms of the percentage of thyroxine that exists in each state.

A. Bound to albumin
B. Bound to TBPA
C. Free
D. Bound to TBG
E. Bound to testosterone
A 
1 - D. Bound to TBG
2 - B. Bound to TBPA
3 - A. Bound to albumin
4 - C. Free
5 - E. Bound to testosterone
48
Q

A 39 year old woman presents with pain and stiffness in hands and
feet associated with a lump on the elbow. Rank the following diagnoses in
order of likelihood, with (1) being the most likely.

A. Infective arthritis
B. Lyme disease
C. Rheumatoid arthritis
D. Gout
E. Osteoarthritis
A 
1 - C. Rheumatoid arthritis
2 - D. Gout
3 - A. Infective arthritis
4 - B. Lyme disease
5 - E. Osteoarthritis
49
Q

Rank the following causes of PUO in a returning traveller in decreasing frequency with 1 being the most common condition and 5 the least common.

A. Dengue
B. Viral haemorrhagic fever
C. Malaria
D. UTIs
E. Bacterial diarrhoea
A 
1 - C. Malaria
2 - A. Dengue
3 - E. Bacterial diarrhoea
4 - D. UTIs
5 - B. Viral haemorrhagic fever
50
Q

A 35 year old intravenous drug user presents with a one week history of lower back pain, and 24 hours of leg weakness. A magnetic resonance scan of his back demonstrates a collection around the T12 vertebral body. Rank the following organisms which may have caused this presentation with 1 being the most likely and 5 being the least likely.

A. Streptococcus pneumoniae
B. Pseudomonas aeruginosa
C. Escherichia coli
D. Staphylococcus aureus
E. Mycobacterium tuberculosis
A 
1 - D. Staphylococcus aureus
2 - E. Mycobacterium tuberculosis
3 - A. Streptococcus pneumoniae
4 - C. Escherichia coli
5 - B. Pseudomonas aeruginosa
51
Q

A 19 year old university student with no past medical history presents with headache and neck stiffness. Lumbar puncture microscopy shows 3800 white cells, 90% of which are neutrophils. Rank the following organisms which may have caused this presentation with 1 being the most likely and 5 being the least likely.

A. Streptococcus pneumonia
B. Listeria monocytogenes
C. Neisseria meningitidis
D. Cryptococcus neoformans
E. Mycobacterium tuberculosis
A 
1 - C. Neisseria meningitidis
2 - A. Streptococcus pneumoniae
3 - B. Listeria monocytogenes
4 - E. Mycobacterium tuberculosis
5 - D. Cryptococcus neoformans

Fess' Flashcards (Path & Specialties Questions) (10 decks)

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