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1
Q

Describe the difference in onset of pre-eclampsia versus HTN of pregnancy

A

HTN presents in the first 20 weeks mother often will have history of (essential) HTN

Pre-eclampsia: de novo HTN and develops after 20 weeks (although occurs due to remodelling of spiral arteries which starts at the beginning of pregnancy)

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2
Q
A

Spiral arteries don’t dilate - causes maternal blood to enter

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3
Q

What is labelled A

Chlamdyia infection
Endometriosis
Fibroids
Gonorrhea infection
Polycysitc ovary syndrome

A

What is labelled A

Chlamdyia infection
Endometriosis
Fibroids
Gonorrhea infection
Polycysitc ovary syndrome

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4
Q

What is this image

Herpes Simplex 1
Herpes Simplex 2
HPV 6
HPV 16
HPV 18

A

Herpes Simplex 1
Herpes Simplex 2
HPV 6
HPV 16
HPV 18

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5
Q

What is this image

Herpes Simplex 1
Herpes Simplex 2
HPV 6
HPV 16
HPV 18

A

What is this image

Herpes Simplex 1
Herpes Simplex 2
HPV 6
HPV 16
HPV 18

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6
Q

What is this image

Herpes Simplex 1
Herpes Simplex 2
HPV 6
HPV 16
HPV 18

A

What is this image

Herpes Simplex 1
Herpes Simplex 2
HPV 6
HPV 16
HPV 18

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7
Q

What is this image

Herpes Simplex 1
Herpes Simplex 2
HPV 6
HPV 16
HPV 18

A

What is this image

Herpes Simplex 1
Herpes Simplex 2
HPV 6
HPV 16
HPV 18

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8
Q

What is this image

Herpes Simplex 1
Herpes Simplex 2
HPV 6
HPV 16
HPV 18

A

What is this image

Herpes Simplex 1
Herpes Simplex 2
HPV 6
HPV 16
HPV 18

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9
Q

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 6

A

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 16

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10
Q

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 6

A

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis - penile chancre
HPV 16

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11
Q

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 6

A

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis - Congenital syphilis exhibiting classic skin rash
HPV 16

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12
Q

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 6

A

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 16

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13
Q

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 6

A

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 16

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14
Q

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 6

A

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 16

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15
Q

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 6

A

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 16

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16
Q

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 6

A

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 16

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17
Q

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 6

A

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis - Congenital syphilis - Hutchinson’s teeth
HPV 16

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18
Q

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 6

A

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia - LGV lymphadenopathy
Syphilis
HPV 16

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19
Q

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 6

A

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 6

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20
Q

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 6

A

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 6

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21
Q

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 6

A

What is this image

Gonorrhoea
Herpes simplex 2
Chlamydia
Syphilis
HPV 6

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22
Q

What is the causative agent of this CSF infection? [1]

A

Group B streptococcus

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23
Q

What is the most likely cause of this neonatal pathology? [1]

A

Osteogenesis imperfecta

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24
Q

A child presents to A&E and becomes siginifcantly unwell and dies. The biopsy reveals viral antigens.

What is the most likely cause of their death? [1]

A histological biopsy from their lung is shown below.

A

RSV - most likely cause of viral pneumonia in neonates

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25
Q

Which SIDS pathology is depicted in this histopathological slide? [1]

A

Persistent haemopoiesis in the liver

26
Q

What is likely to be the cause of death from this infant? [1]

A

Unknown - lung petechiae are suggestive of SIDS

27
Q

What is this patient presenting with, based off the ECG?

Hypokalaemia
Hyperkalaemia
Hypothermia
Hypocalcaemia
Hypercalcaemia

A

What is this patient presenting with, based off the ECG?

Hypokalaemia
Hyperkalaemia - tall tented T waves
Hypothermia
Hypocalcaemia
Hypercalcaemia

28
Q

Surina Folkes, 22, has a history of Crohn’s disease. She presents to her GP with fatigue, shortness of breath on exertion in addition to pins and needles in her fingers. On examination, she is noticed to have pale conjunctiva and atrophic glossitis.

As part of her work-up, you send off a set of bloods which reveal the following results:

Hb 80 (g/l)
MCV 120 (82-100 fl)
Ferritin 100 (20-230 ng/ml)
What is the most likely diagnosis?

Vitamin B12 deficiency
Iron deficiency anaemia
Anaemia of chronic disease
Sideroblastic anaemia
Folate deficiency

A

Surina Folkes, 22, has a history of Crohn’s disease. She presents to her GP with fatigue, shortness of breath on exertion in addition to pins and needles in her fingers. On examination, she is noticed to have pale conjunctiva and atrophic glossitis.

As part of her work-up, you send off a set of bloods which reveal the following results:

Hb 80 (g/l)
MCV 120 (82-100 fl)
Ferritin 100 (20-230 ng/ml)
What is the most likely diagnosis?

Vitamin B12 deficiency
Crohn’s disease often affects the terminal ileum where vitamin B12 is absorbed. It may, therefore, cause a deficiency which presents with macrocytic anaemia. Notably, B12 is also important in maintaining the nervous system so a deficiency may present with neurological symptoms.

Iron deficiency anaemia
Anaemia of chronic disease
Sideroblastic anaemia
Folate deficiency

29
Q

A 32-year-old lady consults her GP because she is worried that her periods have been very heavy and painful recently. She has a past medical history of type 1 diabetes. She also states that her mood has been low recently and she has put on some weight.

Which of the following blood results is most likely to be low?

T4
Total iron binding capacity
Testosterone
TSH
Folate

A

A 32-year-old lady consults her GP because she is worried that her periods have been very heavy and painful recently. She has a past medical history of type 1 diabetes. She also states that her mood has been low recently and she has put on some weight.

Which of the following blood results is most likely to be low?

T4
Hypothyroidism is a recognised cause of menorrhagia or abnormally heavy bleeding during menstruation. There is an association between autoimmune hypothyroidism (Hashimoto’s thyroiditis) and other autoimmune diseases, such as this lady’s Diabetes Type 1. She also has signs suggesting hypothyroidism such as low mood and weight gain. The correct answer is, therefore, T4, which would be low in hypothyroidism.

Total iron binding capacity
Testosterone
TSH
Folate

30
Q

This 50-year-old man presents with abdominal pain. Abdominal x-ray shows small bowel dilatation. Contrast-enhanced CT is performed with selected images shown. What is the most likely diagnosis?

Amyand hernia
De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia

A

This 50-year-old man presents with abdominal pain. Abdominal x-ray shows small bowel dilatation. Contrast-enhanced CT is performed with selected images shown. What is the most likely diagnosis?

Amyand hernia
De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia

31
Q

Contrast-enhanced CT is performed with selected images shown. What is the most likely diagnosis?

Amyand hernia
De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia

A

This 50-year-old man presents with abdominal pain. Abdominal x-ray shows small bowel dilatation. Contrast-enhanced CT is performed with selected images shown. What is the most likely diagnosis?

Amyand hernia
De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia

32
Q

Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis?

De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia

A

Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis?

De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia Inferior epigastric vessels medial to hernial neck (arrowhead) are visible
obturator hernia

33
Q

Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis?

De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia

A

Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis?

De Garengeot hernia
femoral hernia
direct inguinal hernia
anguinal hernia (arrow), which passes medially to inferior epigastric ar tery and vein (arrowhead)

indirect inguinal herni
obturator hernia

34
Q

Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis?

De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia

A

Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis?

De Garengeot hernia
femoral hernia
direct inguinal hernia

T image shows par t of bladder (arrow) is contained within direct lef t inguinal hernia medial to inferior epigastric neurovascular bundle (arrowhead)

indirect inguinal hernia
obturator hernia

35
Q

What type of hernia would it be if came out at the *?

De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia

A

What type of hernia would it be if came out at the *?

De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia

36
Q

What type of hernia is A? [1]

A

A: direct hernia

37
Q

What of the following depicts the inferior epigastric arteries

Solids arrows
Open arrows
Curved arrows
Arrowheads

A

What of the following depicts the inferior epigastric arteries

Solids arrows
Open arrows
Curved arrows
Arrowheads

38
Q

What of the following depicts the deep inguinal ring

Solids arrows
Open arrows
Curved arrows
Arrowheads

A

What of the following depicts the deep inguinal ring

Solids arrows
Open arrows
Curved arrows
Arrowheads

39
Q

What of the following depicts the deep inguinal ring

Solids arrows
Open arrows
Curved arrows
Arrowheads

A

What of the following depicts the deep inguinal ring

Solids arrows
Open arrows
Curved arrows
Arrowheads

40
Q

What of the following depicts the inguinal ligament

Solids arrows
Open arrows
Curved arrows
Arrowheads

A

What of the following depicts the inguinal ligament

Solids arrows
Open arrows
Curved arrows
Arrowheads

41
Q

FYI

A
42
Q

What pathology is indicated by this imaging? [1]

A

Sigmoid volvulus

Grossly-dilated loop of large bowel has a ‘coffee-bean shape’ and the descending colon tapers in its inferior portion in keeping with a sigmoid volvulus. Air-fluid levels on erect projection.

43
Q

What pathology is indicated by this imaging? [1]

A

Sigmoid volvulus

Grossly-dilated loop of large bowel has a ‘coffee-bean shape’ and the descending colon tapers in its inferior portion in keeping with a sigmoid volvulus. Air-fluid levels on erect projection.

44
Q

A 64-year-old lady with a BMI of 37 presents to you complaining of incontinence. She has previously had two children, both were delivered vaginally and the first required forceps due to slow progression of the second stage of labour. She takes no regular medication and has no other significant past medical history.

Given her risk factors, which type of urinary incontinence is she most likely to suffer from?

Overflow incontinence
Mixed inctontinence
Urge incontinence
Stress incontinence

A

A 64-year-old lady with a BMI of 37 presents to you complaining of incontinence. She has previously had two children, both were delivered vaginally and the first required forceps due to slow progression of the second stage of labour. She takes no regular medication and has no other significant past medical history.

Given her risk factors, which type of urinary incontinence is she most likely to suffer from?

Overflow incontinence
Mixed inctontinence
Urge incontinence
Stress incontinence

Due to her previous forceps delivery, she is most likely to be suffering from stress incontinence. Stress incontinence is the loss of urine associated with a rise in intra abdominal pressure such as coughing or sneezing. Risk factors include increasing age, traumatic vaginal delivery, obesity, and previous pelvic surgery.

45
Q

A 76-year-old gentleman with a history of primary hypothyroidism attends his GP for the first time in many years for a routine check-up. He divulges that he has not been complying fully with his levothyroxine therapy as he sometimes cannot make it to a pharmacy to refill his prescription.

Which of the values below is most likely to be low in this gentleman?

Mean cell volume (MCV)
LDL Cholesterol
Core temperature
TSH
Body mass index

A

A 76-year-old gentleman with a history of primary hypothyroidism attends his GP for the first time in many years for a routine check-up. He divulges that he has not been complying fully with his levothyroxine therapy as he sometimes cannot make it to a pharmacy to refill his prescription.

Which of the values below is most likely to be low in this gentleman?

Mean cell volume (MCV)
LDL Cholesterol
Core temperature
TSH
Body mass index

46
Q

Which of these pathologies would cause a high anion gap metabolic acidosis?

Diarrhoea
Methanol poisoning
Emesis
Renal tubular acidosis

A

Which of these pathologies would cause a high anion gap metabolic acidosis?

Diarrhoea
Methanol poisoning
Emesis
Renal tubular acidosis

47
Q

A 55-year-old overweight man with a background of type 2 diabetes presents to the GP with tiredness. He is otherwise well and does not smoke or drink alcohol. Bloods reveal an elevated ALT and AST. The rest of his blood results are normal. An ultrasound scan of his liver is reported as ‘echobright’ with no focal areas of abnormality.

What is the most likely diagnosis?

Hepatocellular carcinoma
Pancreatic cancer
Gilbert’s syndrome
Non-alcoholic fatty liver disease
Acute viral hepatitis

A

A 55-year-old overweight man with a background of type 2 diabetes presents to the GP with tiredness. He is otherwise well and does not smoke or drink alcohol. Bloods reveal an elevated ALT and AST. The rest of his blood results are normal. An ultrasound scan of his liver is reported as ‘echobright’ with no focal areas of abnormality.

What is the most likely diagnosis?

Hepatocellular carcinoma
Pancreatic cancer
Gilbert’s syndrome
Non-alcoholic fatty liver disease

This patient is middle aged, overweight and has type 2 diabetes. This puts him at risk of non-alcoholic fatty liver disease (NAFLD), which causes raised liver transaminases (ALT and AST) and otherwise normal bloods. The only way to distinguish this from alcoholic liver disease is the alcohol intake and, as this patient does not drink, it suggests that NAFLD is the diagnosis. Management is through risk factor modification which would include weight loss.

If NAFLD is not managed, it leads to a risk of developing hepatocellular carcinoma. This gentleman’s ultrasound, however, only showed the early ‘echobright’ stage of NAFLD and no evidence of any masses.

Acute viral hepatitis

48
Q

Out of metformin and gliclazide, which causes hypoglycaemia and why? [2]

A

gliclazide: Gliclazide is an insulin secretagogue, increasing the amount of endogenous insulin produced. Sometimes too much Insulin can be secreted, resulting in hypoglycaemia

Metformin is an insulin sensitiser and therefore makes the amount of insulin in the body more effective. While metformin reduces average blood sugars it very rarely causes hypoglycaemia. Therefore reducing the offending drug, gliclazide, is the most appropriate management option.

49
Q

IgA nephropathy:

  • Most patients have a history of an [] infection and, either at the onset or within the first 24-48 hours.
  • There is gross [] that lasts for less than three days. The urine is red or brown and there may also be loin pain
A

Most patients have a history of an upper respiratory tract infection and, either at the onset or within the first 24-48 hours, there is gross haematuria that lasts for less than three days. The urine is red or brown and there may also be loin pain

50
Q

A 32-year-old male presents to the emergency department with bilateral flank pain and red coloured urine. Approximately five days ago he experienced a sore throat with nasal discharge. He has no pertinent family medical history and no chronic medical problems. He denies smoking and is an occasional alcohol drinker. Review of systems is unremarkable.

His observations are as follows:

Blood pressure: 125/65 mmHg
Pulse: 88 BPM
Temperature: 37.4 °C
Respiratory rate: 15 breaths per minute
On physical examination, he has bilateral mild flank tenderness but the remainder of the physical examination is normal. Laboratory investigations demonstrate a normal full blood count and chemistry panel. The urine dipstick is positive for blood and protein but shows no signs of white blood cells or nitrites. Further examination of the urine reveals red blood cell casts. A CT KUB scan of the abdomen and pelvis in the emergency department is also normal.

What is the most likely diagnosis?

IgA nephropathy
Alport syndrome
Minimal change disease
Acute post-streptococcal glomerulonephritis
Kidney stones

A

A 32-year-old male presents to the emergency department with bilateral flank pain and red coloured urine. Approximately five days ago he experienced a sore throat with nasal discharge. He has no pertinent family medical history and no chronic medical problems. He denies smoking and is an occasional alcohol drinker. Review of systems is unremarkable.

His observations are as follows:

Blood pressure: 125/65 mmHg
Pulse: 88 BPM
Temperature: 37.4 °C
Respiratory rate: 15 breaths per minute
On physical examination, he has bilateral mild flank tenderness but the remainder of the physical examination is normal. Laboratory investigations demonstrate a normal full blood count and chemistry panel. The urine dipstick is positive for blood and protein but shows no signs of white blood cells or nitrites. Further examination of the urine reveals red blood cell casts. A CT KUB scan of the abdomen and pelvis in the emergency department is also normal.

What is the most likely diagnosis?

IgA nephropathy
Alport syndrome
Minimal change disease
Acute post-streptococcal glomerulonephritis
Kidney stones

51
Q

A 50-year-old woman undergoing routine health screening is found to have the following liver function results:

ALP 210 umol/L
ALT 28 iu/L
AST 25 iu/L
Bilirubin 15 umol/L
GGT 110 u/L
Albumin 45 g/L
She mentions she has been getting increasingly tired over several years but assumed it was due to age and stress. She has no past medical history of note and drinks 6 units of alcohol a week. On examination, there are some excoriations and xanthelasma around her eyes, but nil else of note.

What is the most likely diagnosis?

Biliary colic
Ascending cholangitis
Liver cirrhosis
Hepatic carcinoma
Primary biliary cirrhosis

A

Biliary colic
Ascending cholangitis
Liver cirrhosis
Hepatic carcinoma
Primary biliary cirrhosis

Ascending cholangitis would typically have fever and pain
Malignancy would usually feature weight loss and general malaise
Biliary colic would feature pain

This leaves two potential diagnoses: primary biliary cirrhosis or liver cirrhosis. There are no risk factors for liver cirrhosis and her LFTs do not show a hepatitic pattern of derangement (AST, ALT, bilirubin, albumin all normal). The raised ALP and GGT suggest a cholestatic picture, making primary biliary cirrhosis (also known as primary biliary cholangitis) the most likely diagnosis

52
Q

What kidney pathology is depicted? [1]

A

Pancake kidney

53
Q

What kidney pathology is depicted? [1]

A

Pancake kidney

54
Q

What kidney pathology is depicted? [1]

A

Horseshoe kidney

55
Q

What kidney pathology is depicted? [1]

A

Polycystic kidney disease

56
Q

Name the gene that has a defect to cause this pathology [1]

A

Polycystin gene

57
Q

Abdominal CT showing []

A

Abdominal CT showing polycystic kidneys

58
Q

Label A & B of developing kidneys

A

A: mesonephric bud
B: uteric bud

59
Q

What type of renal pathology is depicted here?

IgA neuropathy
Membrane change disease
Glomerulonephritis
Acute rejection from kidney transplant

A

What type of renal pathology is depicted here?

IgA neuropathy
Membrane change disease
Glomerulonephritis
Acute rejection from kidney transplant
Focal glomerulitis in active antibody mediated rejection-Banff score g3. Dilated glomerular capillaries are filled with swollen endothelial cells and inflammatory cells (PAS, 200×).

60
Q

Describe what pathology is occuring at the arrow heads in this renal artery

A

Inflammatory cells (arrows) infiltrate the intima in intimal
arteritis, due to acute cell mediated rejection

HD2 (55 decks)

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