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Potential Questions Flashcards

1
Q

Which joint is most commonly affected in gout?

A

1st Metatarsophalangeal Joint

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2
Q

A 6 month old boy presents with developmental delay and hyperuricaemia. At 1 year, he begins to exhibit choreiform movements and regularly bites his lip. What is the most likely diagnosis?

A

Lesch-Nyhan Syndrome

X-Linked Recessive deficiency in HPRT

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3
Q

An alcoholic presents with a painful 1st metatarsophalangeal joint. The joint is aspirated, and needle shaped crystals which are negatively birefringent are seen under polarising light. What is the most likely diagnosis, and what is the most likely chemical composition of the crystals?

A

Gout

Monosodium Urate

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4
Q

A man presents with an acutely painful left knee. The joint is aspirated, and rhomboid shaped positively birefringent crystals are seen under polarising light. What is the most likely diagnosis and what is the most likely chemical composition of the crystals?

A

Pseudogout

Calcium Pyrophosphate

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5
Q

List 2 drugs which may be used in acute gout management.

A

NSAIDs

Colchicine

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6
Q

A man is diagnosed with gout, and is prescribed a xanthine oxidase inhibitor to aid with reducing urate synthesis. Which drug was he most likely prescribed?

A

Allopurinol

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7
Q

A woman presents with corneal arcus and tendon xanthomata at a young age. Her older brother experienced similar symptoms. What is the most likely diagnosis?

A

Familial Hypercholesterolaemia

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8
Q

A woman is prescribed a statin. What would be the expected effect on:

a) LDLs
b) HDLs
c) Triglycerides

A

a) Reduction
b) Increase
c) Slight Increase

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9
Q

How is Gilbert’s Syndrome inherited?

A

Autosomal Recessive

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10
Q

A man presents with an episode of jaundice after not eating for 12 hours. LFTs are grossly normal. Which enzyme is likely to be defective?

A

UDP glucoronyl transferase

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11
Q

What is the most sensitive marker for testing liver function?

A

Prothrombin Time

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12
Q

What is the most common form of liver disease in the Western World?

A

Non-Alcoholic Fatty Liver Disease

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13
Q

A man presents with painless jaundice. He is later diagnosed with Pancreatic Cancer. To where is his tumour most likely to metastasise?

A

Liver

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14
Q

A young boy is flagged by teachers as having difficulty with basic learning in school. On further investigation, he is found to have high serum levels of phenylalanine. What is the most likely diagnosis, and which enzyme is he deficient in?

A

Phenylketonuria

Phenylalanine Hydroxylase

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15
Q

What is the most common pathogenesis behind Congenital Hypothyroidism?

A

Thyroid Agenesis

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16
Q

How is Cystic Fibrosis screened for?

A

Measure serum Immune Reactive Trypsinogen levels.

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17
Q

A child presents with vomiting, a respiratory alkalosis and seizures. On examination, he is found to have high serum levels of ammonia. Which class of disease is he most likely to be suffering from?

A

Urea Cycle Disorders

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18
Q

A child presents with vomiting, seizures and loss of consciousness. Their medical history is unremarkable, however their Mother reports giving them 2 aspirin tablets for a headache yesterday evening. What is the most likely diagnosis?

A

Reye Syndrome

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19
Q

A neonate is found to be hyponatraemic. What is the most likely cause?

A

Congenital Adrenal Hyperplasia

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20
Q

Which enzyme is most likely to be deficient in a neonate presenting with congenital adrenal hyperplasisa?

A

21-Hydroxylase

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21
Q

What is the most common type of Porphyria?

A

Porphyria Cutanea Tarda

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22
Q

A child is diagnosed with a Porphyria. What is the most likely diagnosis?

A

Erythropoietic Protoporphyria

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23
Q

A young woman presents with abdominal pain, constipation palpitations and a recent seizure. She has just returned from a holiday with her friends where she drank a lot of alcohol. Her father has experienced similar attacks. What is the most likely diagnosis?

A

Acute Intermittent Porphyria

Autosomal Dominant, only presents with neurovisceral symptoms

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24
Q

A young woman presents with a potential case of acute intermittent porphyria. Which investigation may be most helpful in coming to a diagnosis?

A

Increased urinary PBG

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25
Q

How does pregnancy affect Thyroid function?

A

hCG levels can stimulate a slight increase in free T4

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26
Q

A woman presents with palpitations, weight loss and a tremor. She reports a viral upper respiratory tract infection 2 weeks ago. Radio-iodine uptake is low across the thyroid gland. What is the most likely diagnosis?

A

De Quervain’s Thyroiditis

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27
Q

A patient has a total thyroidectomy for medullary thyroid cancer. List two markers that may be used to assess disease recurrence.

A

Calcitonin

Carcinoembryonic Antigen

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28
Q

In which forms does calcium exist in the plasma?

A

Free, ionised - 50%
Bound to Albumin - 40%
Complexed - 10%

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29
Q

How is corrected calcium calculated?

A

Serum Calcium + (0.02 x (40 - serum albumin g/L))

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30
Q

What is the rate limiting enzyme in Vitamin D activation?

A

1-alpha-hydroxylase

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31
Q

A man presents with symptoms of hypercalcaemia. Non-caseating granulomas are seen on chest x-ray. What is the likely diagnosis, and pathophysiology behind the hypercalcaemia?

A

Sarcoidosis

Sarcoid lung cells express 1-alpha-hydroxylase, hence lead to more production of activated Vitamin D

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32
Q

A lady presents with osteomalacia secondary to Vitamin D deficiency. Her medical history is remarkable for one, long term, well controlled condition. Which class of drugs are most likely to have contributed to her deficiency?

A

Anti-convulsants

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33
Q

A life-long smoker presents with a worsening history of cough, weight loss, constipation and confusion. He is found to be hypercalcaemic. What is the most likely diagnosis and pathophysiology behind the raised calcium?

A

Small Cell Lung Cancer

Ectopic PTHrP release

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34
Q

A man is found to have hypercalcaemia secondary to malignancy. How would he be managed?

A

Lots of fluids
Bisphosphonates
Treat the underlying cause

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35
Q

A woman is found to be hyponatraemic. She is clinically hypovolaemic. List three potential causes of her electrolyte abnormality.

A

Diarrhoea/Vomiting
Diuretics
Salt-Losing Nephropathy

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36
Q

A woman is found to be hyponatraemic. She is clinically euvolaemic. List 3 potential causes of her electrolyte abnormality.

A

Adrenal Insufficiency
Hypothyroidism
SIADH

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37
Q

A woman is found to be hyponatraemic. Clinically, she is hypervolaemic. List 3 potential causes of her electrolyte abnormality.

A

Cirrhosis
Cardiac Failure
Nephrotic Syndrome

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38
Q

A man presents with euvolaemic hyponatraemia. All endocrine screening is normal. What is the most likely diagnosis, and how would this be investigated?

A

SIADH
Low plasma osmolality
High urine osmolality

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39
Q

A man complains of pain in all 4 limbs and joint pain. Soon after, he has a seizure, and falls into a coma. He was in hospital being treated for hyponatraemia secondary to SIADH. What is the most likely diagnosis?

A

Central Pontine Myelinolysis due to rapidly corrected hyponatraemia.

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40
Q

A man presents with hyperkalaemia. How would he be managed in the first instance?

A

10ml 10% Calcium Gluconate
50ml 50% Dextrose
10 U Insulin
Nebulised Salbutamol

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41
Q

How would you calculate Osmolality?

A

2(Na + K) + Urea + Glucose

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42
Q

A patient is found to be in a hyperglycaemic hyperosmolar state. Why must you take care in giving lots of fluids to this patient?

A

May lead to Cerebral Oedema

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43
Q

A man presents with hypertension, and is found to have an adrenal mass. List 3 potential diagnoses.

A

Conn’s Syndrome
Cushing’s Syndrome
Phaeochromocytoma

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44
Q

Other than blood, what may cause a urine dipstick to show positive for blood.

A

Myoglobin, typically from rhabdomyloysis

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45
Q

If a red blood cell is described as ‘polychromatic’ on blood film, what does this mean.

A

Bluish appearance due to taking up eosinophilic and basophilic dyes. Occurs due to the presence of reticulocytes.

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46
Q

A man has a diagnosis of Hereditary Spherocytosis. What would you expect to happen to his erythrocytes when added to a hypotonic saline?

A

Increased rate of lysis due to osmotic fragility

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47
Q

Which cancer is most associated with Down’s Syndrome?

A

AML

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48
Q

What feature would you expect to see on blood film of someone with Acute Myeloid leukaemia?

A

Auer Rods

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49
Q

What is the most common cause of Vitamin K deficiency?

A

Warfarin

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50
Q

How would you distinguish between platelet disorders and coagulation factor disorders clinically?

A

Plt -> Small, superficial bleeding from minor scratches. Petechiae

Coagulation factor -> Deep bleeding into joints, soft tissues and muscles

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51
Q

List two treatments that may be used for Immune thrombocytopaenic Purpura.

A

Steroids

IVIG (If severe)

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52
Q

What is the most common cause of Disseminated Intravascular Coagulation?

A

Sepsis

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53
Q

A man presents with headaches, visual disturbance and itching after having a hot shower. On examination, he has splenomegaly. What is the likely diagnosis?

A

Polycythaemia Vera

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54
Q

A man has a bone marrow biopsy which shows increased erythroid cellularity, slight reticulin fibrosis and megakaryocyte abnormalities. What is the most likely diagnosis?

A

Polycythaemia Vera

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55
Q

Which mutation is commonly associated, and can be diagnostic of, myeloproliferative disorders?

A

JAK2 V617F

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56
Q

A patient presents with an isolated erythrocytosis, with a low serum erythropoietin. What is the likely diagnosis, and which mutation may they have?

A

Idiopathic Erythrocytosis

Exon 12 Mutation

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57
Q

A patient is incidentally found to have a low WCC and thrombocytosis. On examination, they have hepatosplenomegaly. Bone marrow biopsy shows a dry tap. What is the likely diagnosis, and what might you see on blood film?

A

Myelofibrosis

Leukoerythroblastic picture with ‘Tear Drop’ Poikilocytes

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58
Q

Which cancers are associated with secondary polycythaemias, and why?

A

Liver
Renal Cell
Ectopic EPO production

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59
Q

Which diagnosis must you consider in a patient presenting with Micro-angiopathic haemolytic anaemia?

A

Adenocarcinoma

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60
Q

A patient is found to have a mutation in the FIP1L1-PDGFRa fusion gene. Which condition are they likely susceptible to developing?

A

Chronic Eosinophilic Leukaemia

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61
Q

A patient presents with a rash and coryzal symptoms. They are found to have a basophilia on blood film. Which class of virus are they most likely to be infected with?

A

Poxviruses

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62
Q

What percentage of hospital deaths are caused by Pulmonary Emboli?

A

5-10%

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63
Q

A man has taken 5 times his regular dose of heparin. Which medication would you administer?

A

Protamine

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64
Q

You stain a sample of a patient’s bone marrow with Prussian Blue stain. You observe an accumulation of iron around the nuclei of red blood cell precursors. What might the diagnosis be?

A

Ringed Sideroblasts, seen in myelodysplastic syndromes

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65
Q

What is the most common inherited cause of Aplastic Anaemia?

A

Fanconi Anaemia

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66
Q

A patient is known to have chronic H.Pylori infection. Which malignancy are they most at risk of?

A

Gastric MALT NHL

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67
Q

A patient is known to have Sjogren’s Syndrome, and are positive for both anti-ro and anti-la antibodies. Which malignancy are they most at risk of developing?

A

Marginal Zone NHL of the parotid.

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68
Q

A patient has poorly controlled Coeliac disease. Which malignancies are they most at risk of developing?

A

Small Bowel T Cell Lymphoma

Enteropathy-associated T Cell NHL

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69
Q

Which virus is associated with Adult T Cell Leukaemias?

A

HTLV1

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70
Q

Which cells of the immune system are marked by CD3 and CD5?

A

T Cells

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71
Q

Which cells of the immune system are marked by CD20?

A

B Cells

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72
Q

Which Non-Hodgkins Lymphoma is most common?

A

B Cell Lymphoma

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73
Q

A patient presents with a painless swollen lymph node and splenomegaly. They have also experienced weight loss and drenching night sweats. Genetic analysis reveals a (11;14) translocation. What is the most likely diagnosis?

A

Mantle Cell Lymphoma

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74
Q

Histology of a lymphoma reveals small lymphocytes which are CD5 and CD23 positive. These replace the entire node, with no follicles or areas of T Cell dominance visible. Which subtype is it?

A

Small lymphocytic Lymphoma

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75
Q

A child presents with a growing unilateral mass on their mandible. They are known to have been infected with EBV. Biopsy shows a ‘Starry Sky’ Appearance’. What is the likely diagnosis?

A

Burkitt’s Lymphoma

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76
Q

A patient is diagnosed with mycosis fungoides. Which malignancy are they now at risk of?

A

Cutaneous T Cell Lymphoma

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77
Q

A lymphoma is shown to be positive for CD15 and CD30. Which histological subtype is it most likely to be?

A

Hodgkin’s Lymphoma

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78
Q

A Lymphoma displays reed-Sternberg cells under histology, however is negative for CD15 and CD30, and positive for CD20. What is the most likely diagnosis?

A

Lymphocyte predominant Hodgkin Lymphoma

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79
Q

A patient presents with a progressive dry cough. His medical history is notable for treated Hodgkin’s Lymphoma. What is the most likely diagnosis?

A

Pulmonary Fibrosis

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80
Q

What are the two most common types of non-Hodgkins Lymphoma?

A

Diffuse large B Cell

Follicular

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81
Q

What is the most common leukaemia in the Western World?

A

CLL

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82
Q

A 58 year old patient is incidentally found to be anaemic and thrombocytopenic. Blood film shows the presence of smear cells. What is the most likely diagnosis?

A

Chronic Lymphocytic Leukaemia

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83
Q

A patient is diagnosed with cancer. He is informed that his disease will be staged by the Rai and Binet systems to guide treatment and prognosis. Which cancer does he most likely have?

A

Chronic Lymphocytic Leukaemia

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84
Q

List one gene mutation that is associated with a poor prognosis in CLL.

A

17p (Tp53) deletion

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85
Q

List one gene mutation which is associated with a good prognosis in CLL.

A

VH

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86
Q

A patient with a diagnosis of CLL begins to experience drenching night sweats, and finds a lump in his axilla. What pathological process has likely occurred?

A

Richter Transformation

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87
Q

What is the mechanism of action of Ibrutinib?

A

Bruton Tyrosine Kinase Inhibitor

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88
Q

A patient is diagnosed with Chronic Myeloid Leukaemia. Which genetic defect are they most likely to have?

A

(9;22) Translocation

89
Q

A woman presents at 28 weeks gestation with a hot, swollen lower left leg. She is subsequently diagnosed with a DVT. How is the relative risk of thromboembolic Disease in pregnancy different to the general population?

A

10x higher

90
Q

A patient undergoes a plasma transfusion and develops an acute reaction. What is the most likely mechanism?

A

Allergic. Plasma is frozen, hence is unlikely to harbour bacteria

91
Q

When would a platelet transfusion be contraindicated in a patient bleeding heavily?

A

Heaprin-Induced Thrombocytopaenia

Thrombotic Thrombocytopaenic Purpura

92
Q

A patient’s blood film displays Howell-Jolly bodies, what is the most likely cause?

A

Hyposplenism

93
Q

A patient presents with petechiae on the lower limbs, bruises and bloody blisters in the mouth. What is the most likely diagnosis?

A

Immune Thrombocytopaenic Purpura

94
Q

Which feature seen on a FBC may be considered a bad prognostic feature in Leukaemia?

A

Very high WCC

95
Q

Which type of T cell binds HLA Class II?

A

CD4 +

Helper/Regulator

96
Q

Which type of T Cell binds HLA Class I?

A

CD8+

Killer

97
Q

A child presents with recurrent infections. There is a positive family history for similar presentations. On further investigation, there is a complete absence of lymphoid or myeloid cells. What is the most likely diagnosis?

A

Reticular Dysgenesis

98
Q

A child presents with recurrent infections with no pus. On further investigation, there is a complete absence of neutrophils. What is the likely diagnosis?

A

Kostmann Syndrome

99
Q

A patient presents with recurrent infections that seem to occur once every 4-6 weeks. His FBC one month ago showed a normal neutrophil count, however his repeat FBC today shows absent neutrophils. What is the diagnosis?

A

Cyclic Neutropenia

100
Q

A child presents with recurrent infections with no pus. As a neonate, there was delayed umbilical cord separation. Their FBC shows high neutrophils. What is the likely diagnosis?

A

Leukocyte Adhesion Deficiency

101
Q

A child presents with recurrent infections, and is found to be positive for the Adenylate Kinase 2 mutation. What is the most likely diagnosis?

A

Reticular Dysgenesis

102
Q

Which enzyme are patients with Chronic Granulomatous Disease likely to be deficient in?

A

NADPH Oxidase

103
Q

A child presents with recurrent infections by atypical mycobacteria. Neutrophil count is normal and pus is present. What is the most likely diagnosis?

A

IL12/IL12r or IFN-gamma/IFN-gamma r deficiency

104
Q

A patient is diagnosed with a phagocyte deficiency. List 2 treatments that may be used in their management.

A

Aggressive Management of infections
Haematopoietic Stem Cell Transplant
IFN-Gamma (CGD)

105
Q

A patient presents with recurrent infections. In the past year she has cultured Neisseria meningitides, Haemophilus Influenzae and Streptococcus pneumoniae. Which type of immune deficiency may she have?

A

Complement

106
Q

Which is the most common complement deficiency?

A

C2 Deficiency

107
Q

A patient presents with recurrent infections. They also report regular arthralgia, chest pain, and have a bilateral erythematous rash on their face which worsens in sunlight. They test positive for Anti-dsDNA antibodies. What is the most likely cause of their recurrent infections?

A

Systemic Lupus Erythematosus causing C2 Deficiency.

C3/C4 will also be low in active Lupus

108
Q

How would you investigate function of the classical complement pathway?

A

CH50

109
Q

How would you test function of the alternative complement pathway?

A

AP50

110
Q

A child presents with a severe malar rash that worsens in sunlight, fever and systemic arthralgia. On further investigation, C3/C4 levels are found to be normal. What is the most likely immune deficiency?

A

C1q Deficiency

111
Q

A patient undergoing chemotherapy presents with recurrent infections and low neutrophil counts. They never experienced similar issues before starting chemotherapy. What is the most likely diagnosis?

A

MBL Deficiency

112
Q

A patient is found to be anaemic, and has lots of variation in the size and shape of erythrocytes on blood film. What is this sign called, and what is the likely cause of their anaemia?

A

Anisopoikilocytosis

Iron Deficiency Anaemia

113
Q

A patient has a blood film, which shows nuclear remnants present within erythrocytes. What is this called, and what may cause it?

A

Howell-Jolly Bodies

Hyposplenism

114
Q

A patient is found to be positive for HLA-DQ2 and HLA-DQ8. Which disease are they most likely to suffer from?

A

Coeliac Disease

115
Q

An infant is found to have very low T Cells, very low B Cells and very low NK Cells. Which enzyme may they be deficient in?

A

Adenosine Deaminase (ADA), which is required by lymphocytes for cell metabolism.

116
Q

A patient is found to have a condition in which there is a deficiency of CD4+ T Cells due to impaired T Cell selection in the thymus. What is the most likely diagnosis, and what is deficient?

A

Bare Lymphocyte Syndrome 2

MHC Class II

117
Q

What determines a) the class and b) effector function of immunoglobulins?

A

a) Heavy Chain

b) Constant region of the heavy chain

118
Q

A 2 year old boy presents with recurrent infections. Investigation reveals normal WCC, high IgM and absent IgA, IgG & IgE. What is the most likely diagnosis, and which gene may be mutated?

A

X-Linked Hyper IgM Syndrome

CD40 Ligand

119
Q

A patient with a long-term condition caused by a mutation in the MEFV gene presents with end-stage renal failure. What is the most likely cause?

A

AA Amyloidosis due to chronic Familial Mediterranean Fever

120
Q

A patient presents with Hypoparathyroidism, Addison’s and Hypothyroidism. They test positive for a mutation in the AIRE gene. What is the most likely diagnosis?

A

Autoimmune Polyendocrinopathy Candidiasis Ectodermal Dystrophy (APECED)

121
Q

A patient, known to have Type 1 Diabetes Mellitus and Autoimmune Hypothyroidism, presents with acute dermatitis and abdominal pain. They are found to have a mutation in the FoxP3 gene, and to have impaired T-Regulator function. What is the most likely diagnosis?

A

Immune Dysregulation Polyendocrinopathy Enteropathy X-Linked Syndrome (IPEX)

122
Q

Which HLA polymorphism is associated with Type 1 Diabetes Mellitus?

A

HLA-DR3/4

123
Q

Which HLA Polymorphism is associated with Graves’ Disease?

A

HLA-DR3

124
Q

Which class of hypersensitivity does Multiple Sclerosis fall into?

A

Type IV - Delayed T Cell mediated

125
Q

What is the gold standard test for diagnosing food and drug allergies?

A

Challenge test

126
Q

What mediates anaphylaxis triggered by blood product transfusions?

A

IgG

127
Q

What mediates anaphylaxis triggered by dialysis membranes?

A

Complement

128
Q

Which organ is most commonly transplanted?

A

Kidney

129
Q

Which cells express HLA Class I molecules?

A

All cells

130
Q

A patient recently underwent a kidney transplant, however there is suspicion that the graft has been rejected. What is the gold standard test for diagnosis?

A

Biopsy

131
Q

A biopsy of a graft is taken. It shows lymphocytic interstitial infiltration, ruptured tubular basement membrane and tubulitis. What is the likely diagnosis?

A

T-Cell Mediated Rejection

132
Q

A biopsy of a graft is taken. it shows the presence of inflammatory cells within the capillaries of the graft. What is the likely diagnosis?

A

Antibody-mediated transplant rejection

133
Q

A patient recently underwent a successful kidney transplant. He is now complaining of gum hypertrophy. Which medication is most likely to have caused his symptoms?

A

Cyclosporin, a Calcineurin inhibitor.

134
Q

Name two drugs which may be used for transplant rejection prophylaxis.

A

Tacrolimus, Cyclosporin

Both Calcineurin Inhibitors

135
Q

Name an anti-CD20 agent which may be used in the management of lymphoma and rheumatoid arthritis.

A

Rituximab

136
Q

Name an anti-CD25 agent which may be used as prophylaxis to prevent organ transplant rejection

A

Daclizumab

137
Q

List two agents which may be used in the prevention of Graft vs Host Disease

A

Methotrexate

Cyclosporin

138
Q

A patient underwent a successful liver transplant 3 months ago. He now presents with a rash, nausea and vomiting, abdominal pain and bloody diarrhoea. On examination, he appears jaundiced. What is the most likely diagnosis?

A

Graft vs Host Disease

139
Q

Name two examples of toxoid vaccines.

A

Diptheria

Tetanus

140
Q

List 3 examples of component/subunit vaccines

A 
Hep B (HBsAg)
HPV (Capsid)
Haemophilus Influenzae (HA)
141
Q

List 3 examples of conjugate vaccines

A

Haemophilus influenzae type B
Meningococcus
Pneumococcus

142
Q

What is the most common form of adjuvant?

A

Aluminium Salts

143
Q

A patient is found to have a TPMT polymorphism which lessens its activity. Which drug must they not be started on?

A

Azathioprine

144
Q

A patient has refractory Rheumatoid Arthritis. They are JAK positive, and started on a drug which targets this. Which drug is it most likely to be?

A

Tofacitinib

145
Q

A patient presents with weight gain and feeling cold all the time. They also state they have been feeling low recently. They are found to be positive for Anti-Thyroglobulin and Anti-Thyroid Peroxidase antibodies. What is the most likely diagnosis?

A

Hashimoto’s thyroiditis

146
Q

Which HLA polymorphisms are associated with Rheumatoid Arthritis?

A

HLA DR1

HLA DR4

147
Q

A patient presents with recurrent VTEs, multiple miscarriages and is found to be thrombocytopaenic. Which antibody are they most likely to test positive for?

A

Anti-Cardiolipin

148
Q

A patient presents with a dry cough, cold, painful hands and tight, thickened skin which spreads across their whole body. What is the likely diagnosis and which antibody are they most likely to test positive for?

A

Diffuse Cutaneous Systemic Sclerosis

Anti-Scl70

149
Q

A patient presents with refractory asthma, fever and weight loss. They also have nasal polyposis and allergic rhinitis. They are later found to have hypereosinophilia. What is the likely diagnosis, and which antibody might they test positive for?

A

Eosinophilic Granulomatosis with Polyangiitis

p-ANCA

150
Q

A patient presents with tiredness, loss of appetite and arthralgia. They have depleted renal function, and have experienced one episode of haemoptysis. They test positive for p-ANCA antibodies. What is the most likely diagnosis?

A

Microscopic Polyangiitis

151
Q

A patient presents with tiredness, loss of appetite and weight loss. They have experienced two episodes of haemoptysis and haematuria, and on examination seem to have a saddle nose deformity. They test positive for c-ANCA antibodies. What is the most likely diagnosis?

A

Granulomatosis with Polyangiitis

152
Q

A patient presents with a headache, neck stiffness and photosensitivity. They are known to be HIV positive. CSF analysis shows clear liquid with high lymphocytes, high protein and low glucose. MRI shows leptomeningeal enhancement. What is the likely diagnosis?

A

Tuberculosis Meningitis

153
Q

A patient presents with a headache, stiff neck and photosensitivity. CSF analysis shows high lymphocytes, high protein and normal glucose. List 3 potential causes of their meningitis.

A

Mumps
Enteroviruses
Herpes Viruses

154
Q

A patient presents with features typical of meningitis. Culture grows a gram negative non-haemolytic diplococci. What is the most likely organism?

A

Neisseria Meningitides

155
Q

A patient presents with a recent history of behavioural changes and a decreased level of consciousness. Whilst being examined they experience a seizure. Culture from a lumbar puncture grows gram positive rods. What is the most likely causative organism?

A

Listeria Monocytogenes

156
Q

Gram staining of an unknown organism with India Ink reveals an orbit-like structure, with a yeast cell in the middle and a capsule around the outside. What is the most likely organism?

A

Cryptococcus spp.

157
Q

A patient is diagnosed with meningitis, and culture grows Gram Positive cocci. Which treatment would most likely be initiated?

A

Ceftriaxone

158
Q

A patient is diagnosed with meningitis. Culture grows Gram negative coccobacilli. What is the likely organism, and how would it be managed?

A

Cefotaxime

Haemophilus Influenzae

159
Q

A patient presents with a recent history of behavioural changes and a decreased level of consciousness. Whilst being examined they experience a seizure. Culture from a lumbar puncture grows gram positive rods. How would this patient be treated?

A

Ampicillin

160
Q

A patient presents with watery, non-bloody diarrhoea a day after eating reheated rice. Culture grows Gram-positive rods which are spore forming. What is the likely causative organism?

A

Bacillus cereus

161
Q

A patient has watery diarrhea and cramping abdominal pain following a recent course of clindamycin. Which antibiotic would most likely be used to treat them?

A

Vancomycin

162
Q

A man who eats a lot of soft cheese presents with watery diarrhoea, headache and vomiting. Culture reveals a Gram Positive rod which is a facultative anaerobe. What is the most likely diagnosis?

A

Listeria monocytogenes

163
Q

Which strand of E.Coli most commonly induces Haemolytic Uraemic Syndrome?

A

O157:H7

164
Q

A man presents with non-bloody loose stools. He does not have a fever. He recently ate some chicken. Culture grows Gram Negative Rods. What is the likely causative organism?

A

Salmonella enteritidis

165
Q

A patient presents with slow onset fever and constipation. On examination, he has splenomegaly and has Rose Spots on his abdomen. What would be the most likely first line treatment?

A

Ceftriaxone

166
Q

Which enteric bacterium has the lowest infective dose?

A

Shigella

167
Q

A patient presents with severe diarrhoea with blood and mucus in the faeces. Culture grows Gram-Negative Rods. What is the likely causative organism, and how is it treated?

A

Shigella

Supportive

168
Q

A patient presents with descending paralysis. he reports visiting a farm recently and trying their honey. What is the most likely causative organism?

A

Clostridium botulinum

169
Q

A patient presents with massive diarrhoea, which he describes as being like ‘rice water’. On culture, comma shaped bacteria grow. What is the likely causative organism?

A

Vibrio cholera

170
Q

A man from Peru presents with fever and bloody diarrhoea. A cyst in the right lobe of his liver is detected on USS. What would be the most likely first line treatment?

A

Metronidazole

Paromycin

171
Q

A patient presents with foul-smelling, non-bloody diarrhoea with cramps, flatulence and no fever. Microscopy shows Pear-shaped trophozoites. What is the likely diagnosis, and how would it be treated?

A

Giardia lamblia

Metronidazole

172
Q

What is the most likely causative organism in an immunocompromised patient with severe diarrhoea?

A

Cryptosporidium parvum

173
Q

What type of drug is zidovudine?

A

Nucleotide Reverse Transciptase Inhibitor

174
Q

What type of drug is efavirenz?

A

Non-Nucleotide Reverse Transciptase Inhibitor

175
Q

Which type of drug is raltegravir?

A

Integrase Inhibitor

176
Q

What type of drug is lopinavir?

A

Protease Inhibitor

177
Q

A patient presents with a productive cough, with desaturation on exercise. CXR shows widespread, bilateral, ground-glass shadowing. What is the likely causative organism?

A

Pneumocystis jirovecii

178
Q

A patient presents with a productive cough, with desaturation on exercise. CXR shows widespread, bilateral, ground-glass shadowing. How would this patient likely be treated?

A

Co-trimoxazole

179
Q

A patient has a diffusion-weighted MRI, which shows an increased signal in the cortex of the right parietal lobe. What is the most likely diagnosis?

A

Creutzfield-Jakob Disease

180
Q

A patient is found to have a mutation in the PRNP gene. Which disease class are they most likely to develop?

A

Prion Disease

181
Q

A patient with a catheter inserted develops a UTI. How would they be managed?

A

Remove Catheter

Gentamicin

182
Q

A patient develops an infection at the site of a recent surgery. Culture grows MRSA. How would this patient be treated?

A

Linezolid

183
Q

List the 5 most common types of Hospital-Acquired-Infection in order of prevalence.

A 
Pneumonia
Surgical Site Infection
UTI
Blood Stream Infection 
GI Infection
184
Q

A patient has a fever of 38.5 which has lasted over 3 weeks. After 10 days in hospital, doctors still have yet to come to a conclusive diagnosis. How would their condition be defined?

A

Pyrexia of unknown origin

185
Q

A patient presents with scalp tenderness, jaw claudication and changes in their vision. How should they be managed?

A

High dose prednisolone (Giant Cell Arteritis)

186
Q

A patient develops a macule at the the site of a cat scratch one week ago. They have a fever, and local lymphadenopathy can be palpated. What is the likely causative organism?

A

Bartonella henselae

187
Q

Which organism causes Q Fever?

A

Coxiella burnetii

188
Q

A man with pneumonia is shown to have a cavitating lung lesion. He had the flu a month ago. What is the most likely causative organism?

A

Staphylococcus aureus

189
Q

What is the most common cause of hospital-acquired pneumonia?

A

Enterobacteriaciae (E.Coli, Klebsiella)

190
Q

A patient is diagnosed with chronic wheeze, eosinophilia and bronchiectasis. CXR shows the presence of an aspergilloma. How might this patient be treated?

A

Amphotericin B

191
Q

What are the two most common infectious causes of death worldwide?

A

1) HIV

2) Tuberculosis

192
Q

How is TB Treated?

A

Rifampicin 6m
Isoniazid 6m
Pyrazinamide 2m
Ethambutol 2m

193
Q

Name a drug which may be used to treat influenza, and its mechanism of action.

A

Oseltamavir

Neuraminidase Inhibitor

194
Q

Histology of a patient with a viral infection shows ‘Owl’s Eye inclusions’. Which virus is likely to be implicated?

A

Cytomegalovirus

195
Q

How is herd immunity threshold calculated?

A

1-1/R0

196
Q

List two examples of live attenuated vaccines.

A

MMR

Yellow Fever

197
Q

What type of vaccine are influenza, polio and cholera?

A

Inactivated

198
Q

Name three diseases which are screened for in pregnancy?

A

HIV
Hepatitis B
Syphilis

199
Q

How would early-onset sepsis in a neonate be managed?

A

Benzylpenicillin (GBS)

Gentamicin (E.Coli)

200
Q

What is the most common cause of UTI in children?

A

E Coli

201
Q

What is the most common vector for Malaria?

A

Female Anopheles Mosquito

202
Q

A child presents 2 weeks after a Group A Strep throat infection with chest pain, joint pain and rapid involuntary movements of their limbs. What is the most likely diagnosis?

A

Acute Rheumatic fever

203
Q

A child presents 2 weeks after a Group A Strep throat infection with chest pain, joint pain and rapid involuntary movements of their limbs. Which heart valve is most likely to be affected?

A

Mitral

204
Q

A patient has chest pain. Biopsy of their heart shows Beady Fibrous vegetations, Aschoff bodies and Anitschkov myocytes. What is the most likely diagnosis?

A

Acute Rheumatic fever

205
Q

A patient is treated for an MI. 20 hours after onset of the chest pain, they collapse and die. What is the most likely cause?

A

Arrhythmia. VF

206
Q

A patient is treated for an MI. 6 weeks later, they return, complaining of chest pain and a fever. Pericardial Effusion is seen on echocardiogram. What is the most likely diagnosis?

A

Dressler’s Syndrome

207
Q

A patient presents with a chronic productive cough. Biopsy shows dilatation of the airways, goblet cell hyperplasia and hypertrophy of mucous glands. What is the most likely diagnosis?

A

Chronic Bronchitis

208
Q

A patient presents with recurrent episodes of cough and fever with purulent sputum production. Histology shows permanent dilatation of the bronchi. What is the likely diagnosis?

A

Bronchiectasis

209
Q

A child presents with episodes of cough and wheeze, with associated dyspnoea. They have a history of eczema. Histology shows whorls of shed epithelium, eosinophils and Charcot-Leyden Crystals. What is the most likely diagnosis?

A

Asthma

210
Q

A patient presents with dyspnoea and cough. Histology shows loss of the alveolar parenchyma distal to the terminal bronchiole. What is the most likely diagnosis?

A

Emphysema

211
Q

A man presents with a dry cough and chronic shortness of breath. On examination, end-inspiratory crackles can be heard. CT CAP shows a honeycomb appearance. What is the most likely diagnosis?

A

Interstitial Lung Disease

212
Q

A smoker presents with a short history of cough, weight loss and fevers. A tumour is found. Biopsy shows large cells with large nuclei and no evidence of glandular or squamous differentiation. What is the most likely diagnosis?

A

Large Cell Carcinoma

213
Q

A patient is known to have inflammatory bowel disease. Colic biopsy shows Skip Lesions forming a cobblestone appearance and non-caseating granulomas. What is the most likely diagnosis?

A

Crohn’s

214
Q

A patient presents with episodes of shortness of breath, flushing and diarrhoea. Further investigation reveals a mass in the abdomen, and high serum 5-HT levels. What is the likely diagnosis?

A

Carcinoid Tumour of the Bowel

215
Q

A patient presents with hyperpigmentation around their mouth, palms and soles. They are found to have a mutation in the LKB1 gene and hamartmatous polyps of the bowel. What is the most likely diagnosis?

A

Peutz-Jeghers Syndrome

216
Q

What is the most common form of colorectal carcinoma?

A

Adenocarcinoma

217
Q

A 32 year old woman presents with changes in bowel habit and crampy abdominal pain. She also reports fevers, and unexplained weight loss. She tests positive for a mutation in her APC gene. What is the likely diagnosis?

A

Adenocarcinoma secondary to Familial Adenomatous Polyposis

218
Q

A man presents with severe epigastric pain relieved by sitting forward. What is the most common cause of the condition causing his symptoms?

A

Gallstones

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