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Question 1
Correct
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A 45-year-old African American male presents to your clinic complaining of swelling of his feet for the past six months. On examination, there is periorbital and pedal oedema. A 24-hour urine collection is ordered, which shows 8 g of protein. The serum cholesterol is ten mmol/L. You order a renal biopsy to confirm the diagnosis.
Which one of the following findings are you most likely to see in this patient's biopsy?Your Answer: Focal segmental glomerulosclerosis
Explanation:This patient has Nephrotic Syndrome confirmed by the presence of 1. Heavy proteinuria (greater than 3-3.5 g/24 hours)
2. Hypoalbuminemia (serum albumin < 25 g/L)
3. Generalised oedema (often with periorbital involvement)
4. Severe hyperlipidaemia (total cholesterol is often > 10 mmol/L).Focal Segmental Glomerulosclerosis will be the most likely answer as it is the most common cause of Nephrotic Syndrome in African American adults.
Minimal change disease is the most common cause of nephrotic syndrome in children.
Membranous glomerulonephritis is the most common cause of Nephrotic Syndrome in Caucasian adults.
In IgA nephropathy, patients will complain of cola-coloured urine.
Mesangiocapillary glomerulonephritis presents with features of Nephritic Syndrome.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 2
Incorrect
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A 57-year-old male presents to the orthopaedic clinic complaining of pain and swelling in the left knee joint. On examination, the left knee is swollen, tender and erythematous. The patient is booked for joint aspiration, and a diagnosis of pseudogout is made following the aspiration.
Which types of crystals would be seen in the joint aspirate to lead to this diagnosis?Your Answer: Negatively birefringent needle-shaped crystals
Correct Answer: Positively birefringent brick-shaped crystals
Explanation:Gout and pseudogout are both characterised by crystal deposition in the affected joints. The deposition of urate crystals causes gout, while calcium pyrophosphate crystals cause pseudogout. The crystals can be distinguished microscopically because urate crystals are negatively birefringent needle-shaped crystals, whilst calcium pyrophosphate crystals are positively birefringent brick-shaped crystals.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 3
Correct
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The following are all examples of type III hypersensitivity EXCEPT for:
Your Answer: Goodpasture's syndrome
Explanation:Examples of type III reactions include:
Extrinsic allergic alveolitis
Systemic lupus erythematosus (SLE)
Post-streptococcal glomerulonephritis
Reactive arthritis
Rheumatoid arthritis -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 4
Incorrect
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One of the benefits of wound healing through first intention is:
Your Answer: Decreased risk of anaerobic infection
Correct Answer: Minimisation of scar tissue formation
Explanation:Primary wound healing, or healing by first intention, occurs within hours of repairing a full-thickness surgical incision. This surgical insult results in the mortality of a minimal number of cellular constituents. Healing by first intention can occur when the wound edges are opposed, the wound is clean and uninfected and there is minimal loss of cells and tissue i.e. surgical incision wound. The wound margins are joined by fibrin deposition, which is subsequently replaced by collagen and covered by epidermal growth.
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This question is part of the following fields:
- Pathology
- Wound Healing
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Question 5
Correct
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Typically, granulomatous inflammation is associated with one of the following infections:
Your Answer: Tuberculosis
Explanation:Granulomatous inflammation is typically seen when an infective agent with a digestion-resistance capsule (e.g. Mycobacterium tuberculosis) or a piece of inert foreign material (such as suture or glass) is introduced into the tissue. A transient acute inflammatory response occurs and when this is ineffective in eradicating the stimulus, chronic inflammation occurs.
Tuberculosis is the prototype of the granulomatous diseases, but sarcoidosis, cat-scratch disease, lymphogranuloma inguinale, leprosy, brucellosis, syphilis, some mycotic infections, berylliosis, reactions of irritant lipids, and some autoimmune diseases are also included
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 6
Correct
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The following are all examples of type I hypersensitivity EXCEPT for:
Your Answer: Contact dermatitis
Explanation:Examples of type I reactions include:
Allergic rhinitis
Allergic conjunctivitis
Allergic asthma
Systemic anaphylaxis
Angioedema
Urticaria
Penicillin allergy -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 7
Incorrect
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Innate, or non-specific, immunity is the immune system we are born with.
Which of the following is NOT an example of innate immunity? Select ONE answer only.Your Answer: Enzymes in tears
Correct Answer: T-lymphocytes
Explanation:Innate, or non-specific, immunity is the immune system we are born with.
There are three aspects of innate immunity:
1. Anatomical barriers, such as:
The cough reflex
Enzymes in tears and skin oils
Mucus – which traps bacteria and small particles
Skin
Stomach acid
2. Humoral barriers, such as:
The complement system
Interleukin-1
3. Cellular barriers, such as:
Neutrophils
Macrophages
Dendritic cells
Natural killer cells
Antibody production is part of the specific, or inducible immune response. T-lymphocytesare responsible for the cell mediated immune response which is part of specific, or inducible immunity. -
This question is part of the following fields:
- General Pathology
- Pathology
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Question 8
Correct
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Which of the following clotting factors is NOT vitamin K-dependent:
Your Answer: V
Explanation:Fat-soluble vitamin K is obtained from green vegetables and bacterial synthesis in the gut. Deficiency may present in the newborn (haemorrhagic disease of the newborn) or in later life. Deficiency may be caused by an inadequate diet, malabsorption or inhibition of vitamin K by drugs such as warfarin. The activity of factors II, VII, IX and X are vitamin K dependent as well as that of protein C and protein S. Both PT and APTT are prolonged.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 9
Correct
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A 15-year-old male is admitted to a rehabilitation centre with a history of multiple strokes, myopathy and learning disabilities since childhood. He is under the care of a multidisciplinary team, and his genetic testing reports show the presence of a mitochondrial disorder.
Which one of the following diseases does this patient most likely have?Your Answer: MELAS
Explanation:Mitochondrial diseases are a group of disorders caused by dysfunctional mitochondria. Most cases are maternally inherited, as we inherit our mitochondrial DNA from our mothers only, although mutations in nuclear DNA cause some cases.
Examples of Mitochondrial Diseases include:
1. Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS)
2. Mitochondrial epilepsy with ragged red fibres (MERRF)
3. Leber’s hereditary optic neuropathy (LHON)
4. Diabetes mellitus and deafness (DAD)
5. Neuropathy, ataxia, retinitis pigmentosa, and ptosis (NARP)
6. Leigh syndrome (subacute sclerosing encephalopathy).Red-green colour blindness and G6PD deficiency have an X-linked recessive pattern of inheritance.
Tay-Sachs Disease and spinal muscular atrophy have an autosomal recessive pattern of inheritance.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 10
Correct
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A 53-year-old male has presented to your clinic with the complaint of a rash on his right forearm. On examination, you discover small reddish-purple spots on the skin measuring less than 2-3 mm. They do not blanch on applying pressure.
Which one of the following best fits the description given above?Your Answer: Petechiae
Explanation:Petechiae are small red or purple spots on the skin measuring less than 3 mm, caused by minor haemorrhages which do not blanch on applying pressure.
Purpura measures between 3mm and 1 cm in diameter, while ecchymoses are greater than 1 cm in diameter. Both are caused due to haemorrhage.Erythema is the generalised redness of the skin.
A macule is a flat, discoloured area of the skin measuring less than 1 cm in diameter.
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This question is part of the following fields:
- General Pathology
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
