vsa_mock_2_flashcards (1)
A 40 year old presents to A&E with severe hypotension and shock. He appears dehydrated and tests reveal the following:
Sodium 123 mmol/L (135–146)
Potassium 6.8 mmol/L (3.5–5.3)
Glucose 2.9mM
Rank the following diagnoses in order of likelihood: Gastroenteritis, primary hyperparathyroidism, hypothyroidism, Conn’s syndrome, Addison’s disease
1.The correct order is:
1. Addison’s disease
2. Gastroenteritis
3. Hypothyroidism
4. Primary hyperparathyroidism
5. Conn’s syndrome
What is the correct pathological term for a discontinuation in the epithelial surface?
Ulcer
A 65 year old male with a long history of epigastric pain. Endoscopy reveals 3.2cm of columnar metaplasia in the lower oesophagus. What does this suggest?
Barrett’s oesophagus
What is the technical term for a connection between two epithelial surfaces, as occurs in Crohns disease where for example there might be a connection between the bladder and the bowel?
Fistula
A 46-year old Japanese female is found to have bilateral ovarian masses on imaging of the abdomen and had both ovaries removed. Histology revealed malignant signet ring cells containing mucin in both ovaries. What is the diagnosis?
Krukenberg tumour
A 50 year-old female was found to have an ovarian mass. On its removal, histology revealed several cell types, including thyroid follicles, hair and teeth. What is the likely diagnosis?
Dermoid cyst / Cystic Teratoma
A 40 year-old female non-smoker presents with a one week history of fever, shortness of breath and a cough productive of rusty coloured sputum. Microscopy of the sputum is shown (Gram positive diplococci). What is the organism?
Streptococcus pneumoniae
A 37 year-old man presents with a headache, myalgia and a cough. He is also suffering with nausea, diarrhoea and abdominal pain. On examination he is tachypnoeic and has a pyrexia of 39ºC. Blood tests reveal lymphopenia and hyponatraemia. A gram stain from the patient’s sputum is shown here (Gram negative rods). CXR shows lobar consolidation. Cold agglutinins are negative. What is the organism?
Legionnaires disease / Legionella Pneumophila
A 40 year-old woman presents with malaise, muscular pains and diarrhoea with mucus and blood. On examination she has a fever and several distinctive spots on her abdomen (Rose spots). Blood cultures are positive and grow gram negative rods. What is the likely organism?
Salmonella Typhae or Typhoid fever
A genus of spiral flagellated Gram negative bacteria. Found in the stomach within the mucosa layer. It occurs in the majority of middle-aged people and causes progressive gastritis. Invariably present in duodenal ulceration and usually in gastric ulceration. What is the organism?
Helicobacter pylori
Which tumour is caused by Human Herpes virus 8?
Kaposi’s sarcoma
A 28-year old woman presents with malaise, weight loss, and abdominal pain. Both anti-tissue transglutaminase (tTG) and anti-endomyseal (EMA) antibodies were found in the serum. What is the likely diagnosis?
Coeliac disease
The same 28-year old woman with anti-tissue transglutaminase (tTG) and anti-endomyseal (EMA) antibodies wanted to know if she needed any further investigations. What gold standard diagnostic test should be undertaken?
Duodenal or jejunal biopsy
A 4 year old girl presents to the A&E with a recurrent chest infection that will not clear. On examination, the house officer notices that she has low set ears, a cleft palate and a murmur. Investigations reveal:
Calcium 1.9 mM (NR 2.2 to 2.6); Phosphate 1.4 mM (NR 0.8 to 1.4), PTH 1.1 pM (NR 1.1 to 6.8)
What is the likely diagnosis?
Di George syndrome / 22q11.2 deletion syndrome
A 40-year old lady complains of tight fingers and dysphagia, and is thought to have a syndrome associated with Raynaud’s phenomenon, and telangiectasia. What antibody should we measure to confirm this possible diagnosis?
Anti-centromere
A 32-year old woman is thought to have Graves’ disease. What antibody should you look for?
Anti TSH receptor antibodies
In a patient with Hodgkins Lymphoma, the stage of disease is given by the amount of spread, with stage 1 disease involving only one group of nodes, and stage IV disease involving extra nodal spread. What would stage III Hodgkins disease suggest?
Disease above AND below the diaphragm
Give one feature that would make you add the suffix “B” to the stage of the Hodgkins disease.
Fever, Night sweats, Unexplained weight loss of more than 10%
What type of neutrophil is shown in the middle of this blood film, in this patient known to have pernicious anaemia?
Hypersegmented Neutrophil
A patient is thought to have multiple myeloma. What is found in the urine that will confirm this diagnosis?
Bence Jones protein
A 51-year old man is having investigations for palliative surgery due to gastric adenocarcinoma. He is found to be anaemic, with high a reticulocyte count and fragmented red blood cells on blood smear. What is this anaemia known as?
Micro-Angiopathic Haemolytic Anaemia
A 67-year-old woman presented with confusion 2 days after a cholecystectomy. She had experienced some pain postoperatively, largely relieved by analgesia. On examination, she was disoriented, her heart rate was 66 beats per minute and her blood pressure was 162/82 mmHg. She only had minor discomfort of the abdomen. The urine sodium was 90mmol/l (NR 20-200mmol/l depending on hydration of patient).
Investigations:
Haemoglobin 130 g/L (115-165)
MCV 92 fL (80-96)
White cell count and platelet count normal
serum sodium 120 mmol/L (137-144)
serum potassium 3.7 mmol/L (3.5-4.9)
serum urea 3 mmol/L (2.5-7.0)
serum creatinine 90 µmol/L (60-110)
serum albumin 36 g/L (37-49)
random plasma glucose 5 mmol/L
What is the most likely cause of the low sodium?
Syndrome of inappropriate ADH
A 45 year old woman, presents with increasing pain in her thighs and hips. Blood results : Ca – 2.4 mmol/L (2.2 to 2.6), Phosphate – 0.9 mmol/L (0.8 to 1.4), PTH – 5.0 pmol/L (1.1 to 6.8), ALP 3900 (39-120).What is the likely diagnosis?
Paget’s disease of the bone
A patient presents with weakness and is found to have a potassium of 2.4mM (NR 3.5 to 5.0). What is the likely acid-base abnormality if you check the patients arterial blood gas?
Metabolic alkalosis
Name the drug used for patients with type 2 diabetes which inhibits the enzyme alpha glucosidase in the brush border membrane of the small bowel.
Acarbose
Name an example of a drug that inhibits the enzyme dipeptidyl dipeptidase IV (DPP-4).
Gliptins such as alogliptin or sitagliptin
