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Question 1
Correct
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Regarding acute myeloid leukaemia (AML), which of the following statements is CORRECT:
Your Answer: AML becomes increasingly common with age.
Explanation:Acute myeloid leukaemia (AML) is the most common form of acute leukaemia in adults and becomes increasingly common with age, with a median onset of 65 years. It forms only a minor fraction (10 – 15%) of childhood leukaemia. The clinical features of AML typically presents with clinical features secondary to leukaemic infiltration of bone marrow and extramedullary sites:
Anaemia (lethargy, pallor and breathlessness)
Thrombocytopaenia (petechiae, bruising, epistaxis, haemorrhage) – often profound
Neutropenia (infections)
Hepatosplenomegaly
Gingival infiltration
Central nervous system involvement in AML is uncommon.
Leukaemia cutis is the infiltration of neoplastic leukocytes in the skin. It occurs in approximately 10% of patients with AML.Haematological investigations reveal a normochromic normocytic anaemia with thrombocytopenia in most cases. The total white cell count is usually increased and blood film examination typically shows a variable number of blast cells. The bone marrow is hypercellular and typically contains many blast cells.. The prognosis for patients with AML has been improving steadily, particularly for those under 60 years of age, and approximately one-third of patients of this group can expect to achieve long-term cure. For the elderly, the situation is poor and less than 10% of those over 70 years of age achieve long-term remission.
CML is commonly associated with the Philadelphia chromosome. The Philadelphia chromosome is present in only 1% of adults AML cases.
Lymphadenopathy is rare in AML. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 2
Correct
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A 62-year-old woman presents with a 3-month history of lethargy and tiredness. She states that she has also felt very itchy, particularly after a hot bath and that she is often dizzy and sweaty. On examination she appears plethoric and you note the presence of splenomegaly. Her blood tests today show that her haemoglobin level is 16.9 g/dl.
What is the most likely diagnosis in this case? Select ONE answer only.Your Answer: Polycythaemia vera
Explanation:Polycythaemia vera (PCV), which is also referred to as polycythaemia rubra vera, is a clonal haematological malignancy in which the bone marrow produces too many red blood cells. It may also result in the overproduction of white blood cells and platelets. It is most commonly seen in the elderly and the mean age at diagnosis is 65-74 years.
Patients can be completely asymptomatic and it is often discovered as an incidental finding on a routine blood count. Approximately 1/3 of patients present with symptoms due to thrombosis, of these 3/4 have arterial thrombosis and 1/4 venous thrombosis. Features include stroke, myocardial infarction, deep vein thrombosis and pulmonary embolism.
The other clinical features of PCV include:
Plethoric appearance
Lethargy and tiredness
Splenomegaly (common)
Pruritis (in 40% – particularly after exposure to hot water)
Headaches, dizziness and sweating (in 30%)
Gouty arthritis (in 20%)
Budd-Chiari syndrome (in 5-10%)
Erythromyalgia (in <5% – burning pain and red/blue discolouration of hands and feet)
Increased incidence of peptic ulcer disease (possibly related to increased histamine release from mast cells)
The diagnosis of PCV requires two major criteria and one minor criterion, or the first major criterion and two minor criteria:
Major criteria:
HB > 18.5 g/dl in men, 16.5 g/dl in women
Elevated red cell mass > 25% above mean normal predicted value
Presence of JAK2 mutationMinor criteria:
Bone marrow biopsy showing hypercellularity with prominent erythroid, granulocytic and megakaryocytic proliferation
Serum erythropoietin level below normal range
Endogenous erythroid colony formation in vitro
The main aim of treatment is to normalize the full blood count and prevent complications such as thrombosis. Venesection is the treatment of choice but hydroxyurea can also be used to help control thrombocytosis. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 3
Correct
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A patient presents to your clinic with fever of unknown origin. His blood results shows a markedly elevated C-Reactive Protein (CRP) level.
Which of these is responsible for mediating the release of CRP?
Your Answer: IL-6
Explanation:C-reactive protein (CRP) is an acute phase protein produced by the liver hepatocytes. Its production is regulated by cytokines, particularly interleukin 6 (IL-6) and it can be measured in the serum as a nonspecific marker of inflammation.
Although a high CRP suggest an acute infection or inflammation, it does not identify the cause or location of infection.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 4
Correct
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Which of the following is the most common cause of megaloblastic anaemia:
Your Answer: Vitamin B12 deficiency
Explanation:Megaloblastic anemia results from inhibition of DNA synthesis during red blood cell production. When DNA synthesis is impaired, the cell cycle cannot progress from the growth stage to the mitosis stage. This leads to continuing cell growth without division, which presents as macrocytosis, with an increase in mean corpuscular volume (MCV). The defect in red cell DNA synthesis is most often due to hypovitaminosis, specifically vitamin B12 deficiency or folate deficiency.
Folate is an essential vitamin found in most foods, especially liver, green vegetables and yeast. The normal daily diet contains 200 – 250 μg, of which about 50% is absorbed. Daily adult requirements are about 100 μg. Absorption of folate is principally from the duodenum and jejunum. Stores of folate are normally only adequate for 4 months and so features of deficiency may be apparent after this time. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 5
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 6
Correct
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What is the primary function of collagen in wound healing?
Your Answer: Strength and support
Explanation:Key elements of the maturation stage include collagen cross-linking, collagen remodelling, wound contraction, and repigmentation. The tensile strength of the wound is directly proportional to the amount of collagen present. Numerous types of collagen have been identified; types I and III predominate in the skin and aponeurotic layers. Initially, a triple helix (tropocollagen) is formed by three protein chains; two are identical alpha-1 protein chains, and the third is an alpha-2 protein.
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This question is part of the following fields:
- Pathology
- Wound Healing
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Question 7
Correct
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How does dipyridamole mediate its antiplatelet effect:
Your Answer: It is a phosphodiesterase inhibitor.
Explanation:Dipyridamole inhibits both the reuptake of adenosine and phosphodiesterase, preventing the degradation of cAMP and thus blocking the platelet aggregation response to ADP.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 8
Correct
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Caseous necrosis is typically seen in which of the following:
Your Answer: Tuberculosis
Explanation:Caseous necrosis is most commonly seen in tuberculosis. Histologically, the complete loss of normal tissue architecture is replaced by amorphous, granular and eosinophilic tissue with a variable amount of fat and an appearance reminiscent of cottage cheese.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 9
Correct
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Leukaemia has been diagnosed in a 6-year-old child on your list. He comes to the ER with a complication related to this diagnosis.
Which type of leukaemia do you think this is?Your Answer: Acute lymphoblastic leukaemia
Explanation:Acute lymphoblastic leukaemia (ALL) is the most common childhood cancer that primarily affects children. ALL is most common between the ages of 2 and 4, and it is uncommon in adults.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 10
Correct
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Haemophilia B results from a deficiency in:
Your Answer: Factor IX
Explanation:Haemophilia B is a bleeding disorder caused by a deficiency of clotting factor IX. It is the second commonest form of haemophilia, and is rarer than haemophilia A. Haemophilia B tends to be similar to haemophilia A but less severe. The two disorders can only be distinguished by specific coagulation factor assays.
The incidence is one-fifth of that of haemophilia A. Laboratory findings demonstrate prolonged APTT, normal PT and low factor IX.
Haemophilia B inherited in an X-linked recessive fashion, affecting males born to carrier mothers.
There is also a variation called Leyden, in which factor IX levels are below 1% until puberty, when they rise, potentially reaching as high as 40-60% of normal. This is thought to be due to the effects of testosterone at puberty. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 11
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 12
Correct
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Common causes of exudates are infection, pericarditis, and malignancy.
Which one statement about exudates is true?Your Answer: LDH levels are usually high
Explanation:An exudate is an inflammatory fluid emanating from the intravascular space due to changes in the permeability of the surrounding microcirculation.
Exudates are cloudy. It has high LDH levels, serum protein ratio >0.5, protein content >2.9g/dl, specific gravity of >1.020 and a serum-ascites albumin gradient (SAAG) of <1.2g/dl.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 13
Correct
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A 20-year-old male has an anaphylactic reaction following a wasp sting.
What type of hypersensitivity reaction is this?
Your Answer: Type I
Explanation:Anaphylaxis is an example of a type I hypersensitivity reaction.
It is IgE mediated.
It requires a prior exposure to the antigen. The initial exposure sensitizes the body to the antigen and a second exposure to that antigen leads to an anaphylactic reaction.
Massive calcium influx into the cells leads to mast cell degranulation.
The Immunoglobulin antigen complex binds to Fc receptors on the surface of mast cells. The result is mast cell degranulation and release of histamine, proteoglycans and serum proteases from cytoplasmic granules.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 14
Correct
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You examine a 78-year-old man who has been diagnosed with chronic lymphocytic leukaemia (CLL).
What is the MAIN contributory factor in this condition's immunodeficiency?Your Answer: Hypogammaglobulinemia
Explanation:Immunodeficiency is present in all patients with chronic lymphocytic leukaemia (CLL), though it is often mild and not clinically significant. Infections are the leading cause of death in 25-50 percent of CLL patients, with respiratory tract, skin, and urinary tract infections being the most common.
Hypogammaglobulinemia is the most common cause of immunodeficiency in CLL patients, accounting for about 85 percent of all cases.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 15
Correct
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Which of the following diseases is caused by a build-up of lymphoblasts in the bone marrow?
Your Answer: Acute lymphoblastic leukaemia
Explanation:Acute lymphoblastic leukaemia (ALL) is a clonal (malignant) bone marrow disorder in which early lymphoid precursors multiply and replace the marrow’s normal hematopoietic cells. ALL is most common between the ages of 3 and 7, with 75 percent of cases occurring before the age of 6.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 16
Correct
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Fat necrosis is typically seen in which of the following:
Your Answer: Acute pancreatitis
Explanation:Fat necrosis typically occurs following either direct trauma or from enzymatic lipolysis in acute pancreatitis, where release of triglyceride elicits a rapid inflammatory response and fat is phagocytosed by neutrophils and macrophages with subsequent fibrosis.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 17
Correct
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Which of the following features of cell damage tends to be reversible:
Your Answer: Swelling of endoplasmic reticulum and some mitochondria
Explanation:Features of cell damage that tend to be reversible include: swelling of endoplasmic reticulum and some mitochondrialoss of ribosomescell stress response
Features of cell damage that tend to be irreversible include: loss of nucleolus, no ribosomes, swelling of all mitochondria, nuclear condensation, membrane blebs and holes, lysosome rupture, fragmentation of all inner membranes, nuclear breakup -
This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 18
Correct
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A six-year-old boy presents with coryzal symptoms that have persisted for more than two weeks. He was born and raised in the Middle East. His mother claims he has been tired and has complained of various 'aches and pains.' On examination, you find splenomegaly and enlarged cervical lymph nodes. His legs and arms are covered in petechiae.
In this case, what is the most likely diagnosis?Your Answer: Acute lymphoblastic leukaemia (ALL)
Explanation:ALL is the most common leukaemia in children, with a peak incidence between the ages of 2 and 5.
ALL has a wide range of clinical symptoms, but many children present with an acute illness that resembles coryza or a viral infection. ALL also has the following features:
Weakness and sluggishness all over
Muscle, joint, and bone pain that isn’t specific
Anaemia
Petechiae and unexplained bruising
Oedema
Lymphadenopathy
HepatosplenomegalyThe following are typical features of a full blood count in patients with ALL:
Anaemia (normocytic or macrocytic)
Leukopenia affects about half of the patients (WCC 4 x 109/l).
Around 25% of patients have leucocytosis (WCC > 10 x 109/l).
Around 25% of patients have hyperleukocytosis (WCC > 50 x 109/l).
Thrombocytopaenia -
This question is part of the following fields:
- Haematology
- Pathology
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Question 19
Correct
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Which of the following statements about sickle cell disease is TRUE:
Your Answer: Hand-foot syndrome is frequently a first presentation of the disease.
Explanation:Hand-foot syndrome in children is typically the first symptom of the disease, produced by infarction of the metaphysis of small bones. The disease is inherited as an autosomal recessive trait. By adulthood, the spleen has usually infarcted. Infection with the B19 parvovirus is usually followed by an aplastic crisis. Thrombocytopenia is caused by splenic sequestration.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 20
Correct
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Regarding acute lymphoblastic leukaemia (ALL), which of the following statements is CORRECT:
Your Answer: ALL is the most common malignancy of childhood.
Explanation:Acute lymphoblastic leukaemia (ALL) is caused by an accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood. The incidence of ALL is highest at 3 – 7 years, with 75% of cases occurring before the age of 6. 85% of cases are of B-cell lineage. Haematological investigations reveal a normochromic normocytic anaemia with thrombocytopenia in most cases. The total white cell count may be decreased, normal or increased. The blood film typically shows a variable number of blast cells. The bone marrow is hypercellular with >20% blast cells.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 21
Correct
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A 17-year-old male presenting in the department has a history of C3 deficiency.
C3 deficiency is associated with all of the following EXCEPT?Your Answer: Hereditary angioedema
Explanation:C1-inhibitor deficiency is the cause of hereditary angioedema not C3 deficiency,
All the other statements are correct
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 22
Correct
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A 66-year-old patient attends the Emergency Department with chest pain. His ECG and troponin are suggestive of a new myocardial infarction. You have explained the condition and the prognosis. He asks you about how the damaged area of his heart will heal following this.
Which answer best describes the process of myocardial healing following myocardial infarction? Select ONE answer only.Your Answer: The damaged myocardium will form non-contractile scar tissue
Explanation:Myocardial cells are unable to regenerate, they are unable to divide in response to tissue injury. The remain permanently in G0 and cannot progress to G1. If a segment of muscle dies, for example in myocardial infarction, this tissue will be replaced by scar tissue if the patient recovers. This scar tissue is non-contractile and therefore the remaining myocardium must work harder to maintain cardiac output. As a consequence the remaining undamaged myocardium undergoes compensatory hypertrophy without cell division.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 23
Correct
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You are asked to review the blood results on a 56-year-old man who appears to be acutely unwell. His results show that he is neutropenic.
Which ONE of the following is NOT a recognized cause of a neutropenia?Your Answer: Hyposplenism
Explanation:Neutropenia is defined as a total neutrophil count of < 2.0 x 109/l.
It can be caused by:
Viral infections
Collagen disease e.g. SLE and RA
Chemotherapy and radiotherapy
Hypersplenism
Marrow infiltration
Vitamin and folate deficiency
Drug reactions
Drugs that cause neutropenia include flecainide, phenytoin, carbimazole, indomethacin and co-trimoxazole. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 24
Correct
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Which of the following immunoglobulins is most important for mast cell degranulation:
Your Answer: IgE
Explanation:IgA is the major Ig in secretions, particularly from the gastrointestinal tract (but also in saliva, tears, sweat and breast milk).
IgE is important for mast cell degranulation in allergic and antiparasitic response. In the allergic response, the plasma cell produces IgE-antibodies, which, like antibodies of other immunoglobulin isotypes, are capable of binding a specific allergen via its Fab portion.
IgG is the most abundant in plasma (comprising 80% of normal serum immunoglobulin) and the main circulatory Ig for the secondary immune response. -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 25
Correct
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Which of the following is the most abundant peripheral blood leucocyte:
Your Answer: Neutrophils
Explanation:Neutrophils are the most abundant peripheral blood leucocyte, comprising about 50 – 70% of circulating white cells. Neutrophils have a characteristic dense nucleus consisting of between two and five lobes, and a pale cytoplasm with an irregular outline containing many fine pink-blue or grey-blue granules. The granules are divided into primary, which appear at the promyelocyte stage, and secondary, which appear at the myelocyte stage and predominate in the mature nucleus. Both types of granule are lysosomal in origin; the primary contains myeloperoxidase and other acid hydrolases; the secondary contains lactoferrin, lysozyme and other enzymes. The lifespan of neutrophils in the blood is only 6 – 10 hours. In response to tissue damage, cytokines and complement proteins, neutrophils migrate from the bloodstream to the site of insult within minutes, where they destroy pathogens by phagocytosis.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 26
Correct
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Which of the following is NOT a feature characteristic of intravascular haemolysis:
Your Answer: Bilirubinuria
Explanation:Features of intravascular haemolysis include:haemoglobinaemia, methaemalbuminaemia, haemoglobinuria (dark urine) and haemosiderinuria
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This question is part of the following fields:
- Haematology
- Pathology
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Question 27
Correct
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Which of the following best describes a natural killer cell:
Your Answer: A large granular lymphocyte that kills by inducing target cell apoptosis.
Explanation:Natural killer (NK) cells are cytotoxic CD8 positive cells that lack the T-cell receptor. They are large cells with cytoplasmic granules. NK cells are designed to kill target cells that have a low level of expression of HLA class I molecules, such as may occur during viral infection or on a malignant cell. NK cells do this by displaying several receptors for HLA molecules on their surface. When HLA is expressed on the target cell these deliver an inhibitory signal into the NK cell. When HLA molecules are absent on the target cell this inhibitory signal is lost and the NK cell can then kill its target. In addition, NK cells display antibody-dependent cell-mediated cytotoxicity. In this, antibody binds to antigen on the surface of the target cell and then NK cells bind to the Fc portion of the bound antibody and kill the target cell.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 28
Correct
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Reed-Sternberg cells are characteristic of which of the following malignancies:
Your Answer: Hodgkin lymphoma
Explanation:Lymphomas are a group of diseases caused by malignant lymphocytes that accumulate in lymph nodes and other lymphoid tissue and cause the characteristic clinical feature of lymphadenopathy. The major subdivision of lymphomas is into Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) and this is based on the histological presence of Reed-Sternberg cells present in HL. Hodgkin lymphoma can present at any age but is rare in children and has a peak incidence in young adults. There is an almost 2 : 1 male predominance. Most patients present with painless, asymmetrical, firm and discrete enlargement of superficial lymph nodes. Cervical nodes are involved in 60-70% of cases, axillary nodes in 10-15% and inguinal nodes in 6-12%. Modest splenomegaly occurs during the course of the disease in 50% of patients; the liver may also be enlarged. Bone marrow failure involvement is unusual in early disease. The prognosis depends on age, stage and histology, but overall approximately 85% of patients are cured. Alcohol‐induced pain and pruritus are two well‐known but rare symptoms in HL.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 29
Correct
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A 31-year-old man with sickle-cell disease receives a blood transfusion for symptomatic anaemia. He presents to the Emergency Department three weeks later with a rash, fever, and diarrhoea. He has pancytopenia and abnormal liver function results on blood tests.
Which of the transfusion reactions is most likely to have happened?Your Answer: Graft-vs-host disease
Explanation:Blood transfusion can be a life-saving treatment with significant clinical benefits, but it also comes with a number of risks and potential complications, including:
Immunological side effects
Errors in administration (episodes of ‘wrong blood’)
Viruses and Infections (bacterial, viral, possibly prion)
ImmunodilutionA culture of better safety procedures as well as steps to reduce the use of transfusion has emerged as a result of growing awareness of avoidable risk and improved reporting systems. Transfusion errors, on the other hand, continue to occur, and some serious adverse reactions go unreported.
Transfusion-associated graft-vs-host disease (TA-GVHD) is a rare blood transfusion complication that causes fever, rash, and diarrhoea 1-4 weeks after the transfusion. Pancytopenia and liver function abnormalities are common laboratory findings.
TA-GVHD, unlike GVHD following allogeneic marrow transplantation, causes profound marrow aplasia with a mortality rate of >90%. Survival is uncommon, with death occurring within 1-3 weeks of the onset of symptoms.
Because of immunodeficiency, severe immunosuppression, or shared HLA antigens, viable T lymphocytes in blood components are transfused, engraft, and react against the recipient’s tissues, and the recipient is unable to reject the donor lymphocytes.
The following is a list of the most common transfusion reactions and complications:1) Reaction to a febrile transfusion
The temperature rises by one degree from the baseline. Chills and malaise are also possible symptoms.
The most common response (1 in 8 transfusions).
Cytokines from leukocytes in transfused red cell or platelet components are usually to blame.
Only supportive. The use of paracetamol is beneficial.2) Acute haemolytic reaction is a type of haemolytic reaction that occurs when the
Fever, chills, pain at the transfusion site, nausea, vomiting, and dark urine are all symptoms of a transfusion reaction.
Early on, many people report a sense of ‘impending doom.’
The most serious reaction. ABO incompatibility is frequently caused by a clerical error.
STOP THE TRANSFUSION OF INFORMATION. IV fluids should be given. It’s possible that diuretics will be required.3) Haemolytic reaction that is delayed
It usually happens 4 to 8 days after a blood transfusion.
Fever, anaemia, jaundice, and haemoglobinuria are all symptoms that the patient has.
Positive Coombs test for direct antiglobulin.
Because of the low titre antibody, it is difficult to detect in a cross-match, and it is unable to cause lysis at the time of transfusion.
The majority of delayed haemolytic reactions are harmless and do not require treatment.
Anaemia and renal function should be monitored and treated as needed.4) Reaction to allergens
Foreign plasma proteins are usually to blame, but anti-IgA could also be to blame.
Urticaria, pruritus, and hives are typical allergic reactions. It’s possible that it’s linked to laryngeal oedema or bronchospasm.
Anaphylaxis is a rare occurrence.
Antihistamines can be used to treat allergic reactions symptomatically. It is not necessary to stop transfusions.
If the patient develops anaphylaxis, the transfusion should be stopped and the patient should be given adrenaline and treated according to the ALS protocol.5) TRALI (Transfusion Related Acute Lung Injury)
Within 6 hours of transfusion, there was a sudden onset of non-cardiogenic pulmonary oedema.
It’s linked to the presence of antibodies to recipient leukocyte antigens in the donor blood.
The most common cause of death from transfusion reactions is this.
STOP THE TRANSFUSION OF INFORMATION. Oxygen should be given to the patient. Around 75% of patients will require aggressive respiratory support.
The use of diuretics should be avoided.6) TACO (Transfusion Associated Circulatory Overload)
Acute or worsening respiratory distress within 6 hours of a large blood transfusion. Fluid overload and pulmonary and peripheral oedema can be seen. Rapid blood pressure rises are common. BNP is usually 1.5 times higher than it was before the transfusion. It is most common in the elderly and those who have chronic anaemia.Blood transfusions should be given slowly, over the course of 3-4 hours.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 30
Correct
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Which of the following leukaemias is most common in children in the UK:
Your Answer: Acute lymphoblastic leukaemia
Explanation:Acute lymphoblastic leukaemia (ALL) is caused by an accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood. The incidence of ALL is highest at 3 – 7 years, with 75% of cases occurring before the age of 6. There is a secondary rise after the age of 40 years. 85% of cases are of B-cell lineage and have an equal sex incidence; there is a male predominance for the 15% of T-cell lineage.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 31
Correct
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What is the average healing time for a femoral shaft fracture under normal circumstances? Choose ONE answer.
Your Answer: 12 weeks
Explanation:The process of fracture healing occurs naturally after traumatic bone disruption and begins with haemorrhage, then progresses through Inflammatory, reparative, and remodelling stages
Average healing times of common fractures are:
Femoral shaft: 12 weeks
Tibia: 10 weeks
Phalanges: 3 weeks
Metacarpals: 4-6 weeks
Distal radius: 4-6 weeks
Humerus: 6-8 weeks -
This question is part of the following fields:
- General Pathology
- Pathology
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Question 32
Correct
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A 66-year-old male was admitted from the Emergency Department due to severe pain in the left forearm and hand, refractory to pain medication along with pallor and hypothermia of the affected limb. Ultrasound doppler showed an arterial embolism. Circulation was restored after vascular surgery, but there was extensive, irreversible muscle damage.
How will the muscle heal from an injury of this type?Your Answer: Diffuse formation of fibrous tissue
Explanation:Once muscle tissue is damaged, there will be healing via diffuse formation of fibrous tissue, especially due to the widespread ischemia.
Callus formation takes place in the healing of bone, not muscle.
Organised scar formation occurs when a lacerated wound is approximated by sutures so that primary intention wound healing can occur.
Liquefaction degeneration occurs following ischemia in the brain.
Volkmann’s ischemic contracture may occur, but it is not the primary type of healing that will take place but rather the effect of the fibrous scar formation.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 33
Correct
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A patient presents with a rash for a dermatological examination. A flat circumscribed area of discoloured skin measuring 0.7 cm in diameter is seen on examination.
What is the best description of this rash that you have found on examination?
Your Answer: Macule
Explanation:A macule is a flat, well circumscribed area of discoloured skin less than 1 cm in diameter with no changes in the thickness or texture of the skin.
A vesicle is a visible collection of clear fluid measuring less than 0.5 cm in diameter.
A papule is a solid, well circumscribed, skin elevation measuring less than 0.5 cm in diameter.
A nodule is a solid, well circumscribed, raised area that lies in or under the skin and measures greater than 0.5 cm in diameter. They are usually painless.
A plaque is a palpable skin lesion that is elevated and measures >1cm in diameter.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 34
Correct
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Liquefactive necrosis is most commonly seen in which of the following conditions:
Your Answer: Ischaemic stroke
Explanation:Liquefactive necrosis results in the loss of all cellular structure and the formation of a soft, semi-solid mass. This is commonly seen in the brain after a cerebral infarction.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 35
Correct
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A 24-year-old female visits her family physician to complain of painless lumps in her neck. Her physician notes several enlarged, rubbery, non-tender cervical lymph nodes on examination. He immediately refers the patient for a lymph node biopsy, the results of which show the presence of Reed-Sternberg cells.
What is the diagnosis in this case based on the above scenario?Your Answer: Hodgkin’s lymphoma
Explanation:The presence of Reed-Sternberg cells is pathognomonic for Hodgkin’s Lymphoma, which is a disease-causing neoplastic transformation of lymphocytes. There is a bimodal age distribution with peaks in the 20s and 60s. Patients typically present with enlarged, rubbery, non-tender lymph nodes. Symptoms such as fever, night sweats and weight loss may be present.
Pain after alcohol consumption is a pathognomonic sign of Hodgkin’s lymphoma, it is, however, not a ‘B’ symptom. It is rare though, only occurring in 2-3% of patients with Hodgkin’s lymphoma.
The Ann Arbour clinical staging is as follows:
Stage I: one involved lymph node group
Stage II two involved lymph node groups on one side of the diaphragm
Stage III: lymph node groups involved on both sides of the diaphragm
Stage IV: Involvement of extra-nodal tissues, such as the liver or bone marrow
Diagnosis is made by lymph node biopsy, which should be taken from a sufficiently large specimen or excisional biopsy, as opposed to a fine needle biopsy.Multiple myeloma most commonly presents with bone pain, especially in the back and ribs.
In non-Hodgkin’s lymphoma, Reed-Sternberg cells are not present.
Acute lymphoblastic leukaemia will present with features of anaemia, thrombocytopenia and leukopenia.
The most common symptoms of chronic lymphocytic leukaemia are fatigue, night sweats and low-grade fever.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 36
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 37
Correct
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The least likely feature of anaemia is:
Your Answer: Narrow pulse pressure
Explanation:Non-specific signs of anaemia include:
1. pallor of mucous membranes or nail beds (if Hb < 90 g/L),
2. tachycardia
3. bounding pulse
4. wide pulse pressure
5. flow murmurs
6. cardiomegaly
7. signs of congestive cardiac failure (in severe cases) -
This question is part of the following fields:
- Haematology
- Pathology
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Question 38
Incorrect
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A 40-year-old female presents to the orthopaedic clinic complaining of pain and limited range of motion in the right elbow for the past two days. On examination, the right elbow is extremely tender with erythema and warmth of the overlying skin due to acute inflammation.
Which ONE of the following statements is true with regards to acute inflammation?Your Answer: Increased intravascular osmotic pressure leads to oedema
Correct Answer: Neutrophils are activated and adhere to the endothelium as a result of interaction with endothelial cell adhesion molecules
Explanation:Acute inflammation is defined as inflammation occurring within minutes to hours in response to an injury lasting for less than two weeks.
Acute inflammation
Rapid onset (minutes to hours)
Quick resolution (usually days)Chronic inflammation
May last weeks, months, or yearsThere are five cardinal signs of inflammation:
1) Pain
2) Redness
3) Warmth
4) Oedema
5) Loss of functionDuring acute inflammation, neutrophils are activated and attracted to the site of inflammation in response to various interleukins and cytokines. This process takes place via the following mechanism:
1) Margination
Neutrophils flow nearer the vessel wall rather than in the axial stream, which is referred to as margination
2) Rolling along the surface of vascular endothelium
3) Adhesion to the endothelium by interaction with adhesion molecules (ICAMS and VCAMS)
4) Diapedesis is the movement of neutrophils from the endothelial cells into the interstitial space by squeezing through the gaps between adjacent endothelial cellsBradykinin and histamine are both responsible for vasodilation which causes oedema and decreases intravascular osmotic pressure.
Neutrophils dominate early (<2 days)
– Many in the bloodstream
– Attach firmly to adhesion molecules
– Apoptosis after 24-48hrs
Monocytes/macrophages dominate late (>2 days)
– Live longer
– Replicate in tissues -
This question is part of the following fields:
- General Pathology
- Pathology
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Question 39
Correct
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Which of the following laboratory findings are indicative of von Willebrand disease (VWD):
Your Answer: Prolonged APTT
Explanation:Laboratory results often show that:
PFA-100 test results are abnormal.
Low levels of factor VIII (if a factor VIII/VWF binding assay is conducted)
APTT is Prolonged (or normal)
PT is normal
VWF values are low.
Defective Platelet aggregation
The platelet count is normal. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 40
Correct
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Regarding chronic idiopathic thrombocytopaenic purpura (ITP), which of the following statements is INCORRECT:
Your Answer: ITP is classically associated with massive splenomegaly.
Explanation:Chronic ITP is a relatively common disorder. The highest incidence is in women aged 15 – 50 years. It is the most common cause of thrombocytopaenia without anaemia or neutropaenia. It is usually idiopathic but it may been seen in association with other conditions. Platelet autoantibodies (usually IgG) result in the premature removal of platelets from the circulation by macrophages of the reticuloendothelial system. In many causes the antibody is directed against the glycoprotein IIb/IIIa or Ib complex. The normal platelet lifespan of 10 days is reduced to a few hours. Total megakaryocyte mass and platelet turnover are increased to approximately five times normal. Despite the destruction of platelets by splenic macrophages, the spleen is normally not enlarged. In fact, an enlarged spleen should lead to a search for other possible causes for the thrombocytopenia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 41
Correct
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Regarding folate requirements, which of the following statements is CORRECT:
Your Answer: Dietary folate is found particularly in leafy green vegetables and liver.
Explanation:Megaloblastic anemia results from inhibition of DNA synthesis during red blood cell production. When DNA synthesis is impaired, the cell cycle cannot progress from the growth stage to the mitosis stage. This leads to continuing cell growth without division, which presents as macrocytosis, with an increase in mean corpuscular volume (MCV). The defect in red cell DNA synthesis is most often due to hypovitaminosis, specifically vitamin B12 deficiency or folate deficiency.
Folate is an essential vitamin found in most foods, especially liver, green vegetables and yeast. The normal daily diet contains 200 – 250 μg, of which about 50% is absorbed. Daily adult requirements are about 100 μg. Absorption of folate is principally from the duodenum and jejunum. Stores of folate are normally only adequate for 4 months and so features of deficiency may be apparent after this time. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 42
Correct
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Question 43
Correct
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A 53 year old male is found to have megaloblastic anaemia secondary to folate deficiency. He has a known history of alcohol abuse. Which of the following is characteristic of this condition?
Your Answer: Increased mean corpuscular volume (MCV)
Explanation:Megaloblastic anaemia occurs when there is inhibition of DNA synthesis as red blood cells are produced. Impairment of DNA synthesis causes the cell cycle to be unable to progress from the growth stage to the mitosis stage. As a result, there is continuous cell growth without division, with an increase in mean corpuscular volume (MCV), which presents as macrocytosis. The most common cause of this defect in red cell DNA synthesis is hypovitaminosis, in particular, vitamin B12 deficiency or folate deficiency.
Folate is an essential vitamin that can be found in most foods, and is highest in liver, green vegetables and yeast. 200 – 250 μg is found in the normal daily diet, and about 50% is absorbed. The daily adult requirement is about 100 μg and its absorption is principally from the duodenum and jejunum. Folate stores are normally only adequate for 4 months and so clinical features of folate deficiency usually become evident after this time. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 44
Correct
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A 78-year-old man complains of lumps in his neck. Several large, non-tender cervical lymph nodes are discovered during your examination.
You arrange for some blood tests, and the results reveal that he has lymphocytosis with a count of 16 x 10 9 /l.
In this case, what is the most likely diagnosis?Your Answer: Chronic lymphocytic leukaemia
Explanation:The most common type of adult leukaemia is chronic lymphocytic leukaemia (CLL). It develops as a result of relatively mature lymphocytes clonally proliferating. The B-cell lineage accounts for approximately 95% of cases. CLL is primarily a disease of adult men, with men over the age of 50 accounting for more than 75% of CLL patients.
It is the most indolent form of chronic leukaemia, and it is frequently discovered by chance when blood counts are taken for other reasons, such as ‘well man’ screening tests. The patient may develop lymphadenopathy, hepatosplenomegaly, anaemia, and infections as the disease progresses.
The following are examples of CLL laboratory findings:
Clonal B cell lymphocytosis (diagnosed at greater than 5 x 109/l, but can reach 300 x 109/l)
In advanced disease, normocytic, normochromic anaemia is present.Patients with autoimmune-related haemolytic anaemias have a positive direct antiglobulin test (DAT).
Although bone marrow aspiration is not always required, it can aid in the diagnosis of CLL. If there has been rapid lymph node enlargement, a lymph node biopsy is required to rule out Richter’s syndrome. This is the transition from low-grade lymphoma to high-grade lymphoma, which is characterised by fever, weight loss, and pain.
Although there is no cure for CLL, it can be managed with chemotherapy regimens that help patients live longer. Early treatment has no benefit, and the standard treatment for early disease is to watch and wait, with examinations and blood counts every 3 to 12 months. Chemotherapy is usually reserved for patients who have a disease that is active and causing symptoms.
The following is the overall prognosis for CLL:
1/3 will not require treatment and will live a long time.
1/3 will go through an indolent phase before the disease progresses.
1/3 of patients will have an aggressive disease that requires immediate treatment. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 45
Correct
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The following are all examples of type II hypersensitivity EXCEPT for:
Your Answer: Post-streptococcal glomerulonephritis
Explanation:Examples of type II reactions include:
Incompatible blood transfusions
Haemolytic disease of the newborn
Autoimmune haemolytic anaemias
Goodpasture’s syndrome
Rheumatic heart disease
Bullous pemphigoid -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 46
Correct
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Which of the following statements is correct with regards to immunoglobulin?
Your Answer: The isotype of immunoglobulin is determined by the heavy chain.
Explanation:The composition of immunoglobulin molecules is two identical heavy and two identical light chains. These chains are linked by disulphide bridges and are each have highly variable regions which give the immunoglobulin its specificity. In addition, they have constant regions and there is virtual complete correspondence in amino acid sequence in all antibodies of a given isotype.
Five isotypes of immunoglobulin exist – these are IgG, IgA, IgM, IgE and IgD. They are determined by the heavy chain (gamma, alpha, mu, epsilon or delta respectively). The light chains are either kappa or lambda. -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 47
Correct
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A 35-year-old man suffered a severe road traffic accident and has been brought to the hospital. As part of his treatment, he requires a blood transfusion and experiences a transfusion reaction.
The most common type of transfusion reaction is which of the following?Your Answer: Febrile transfusion reaction
Explanation:During or shortly after transfusion, febrile transfusion reactions, also known as non-haemolytic transfusion reactions, present with an unexpected temperature rise (38oC or 1oC above baseline, if baseline is 37oC). This is usually a one-off occurrence. The fever is sometimes accompanied by chills.
The most common type of transfusion reaction is febrile transfusion reactions, which occur in about 1 in every 8 transfusions.
The most common event leading to symptoms of febrile transfusion reactions is cytokine accumulation during storage of cellular components (especially platelet units). White cells secrete cytokines, and pre-storage leucodepletion has reduced this risk.
Recipient antibodies (raised as a result of previous transfusions or pregnancies) reacting to donor human leukocyte antigen (HLA) or other antigens can also cause febrile transfusion reactions. Donor lymphocytes, granulocytes, and platelets all contain these antigens.
Treatment is reassuring. Other causes should be ruled out, and antipyretics like paracetamol can help with fever relief. If another cause of fever is suspected, the transfusion should be stopped; however, if other causes of fever have been ruled out, it can be restarted at a slower rate.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 48
Correct
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A patient is found to be anaemic. Which one of the following blood results would favour a diagnosis of anaemia of chronic disease rather than iron deficiency:
Your Answer: Low total iron binding capacity (TIBC)
Explanation:Anaemia of chronic disease is one of the most common causes of normocytic anaemia. The anaemia is usually mild (Hb > 90 g/L) and non-progressive. Anaemia of chronic disease is usually associated with low serum iron, low transferrin saturation, and a low total iron binding capacity (TIBC) with normal or raised ferritin which differentiates it from iron deficiency anaemia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 49
Correct
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A 62-year-old woman has reduced urine output, nausea, and confusion. Renal function tests and other investigations done leads to a diagnosis of acute kidney injury (AKI). Which one of these is consistent with a diagnosis of AKI?
Your Answer: A rise in serum creatinine of 26 μmol/L within 48 hours
Explanation:AKI is diagnosed based on an acutely rising serum creatinine and/or reduction in urine output.
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AKI can often be non-oliguric.
AKI is present if any one or more of the following criteria is met:
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A rise in serum creatinine of ≥26 micromol/L (≥0.3 mg/dL) within 48 hours
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A rise in serum creatinine to ≥1.5 times baseline, which is known or presumed to have occurred within the past 7 days (in practice you can use the lowest value from the past 3 months as the baseline for the patient)
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Urine volume <0.5 ml/kg/hour for at least 6 hours.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 50
Correct
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Which of the following cytokines is important for the maintenance of granulomatous inflammation:
Your Answer: TNF-alpha
Explanation:Granulomatous inflammation is a distinctive pattern of chronic inflammation that is encountered in a limited number of infectious and some non-infectious conditions. Briefly, a granuloma is a cellular attempt to contain an offending agent that is difficult to eradicate. In this attempt, there is often strong activation of T lymphocytes leading to macrophage activation, which can cause injury to normal tissues. IL-1 is important in initiating granuloma formation, IL-2 can cause them to enlarge and TNF-α maintains them.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 51
Correct
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Which of the following is NOT a heritable risk factor for venous thrombosis:
Your Answer: Von Willebrand disease
Explanation:Approximately one-third of patients who suffer DVT or PE have an identifiable heritable risk factor, although additional risk factors are usually present when they develop the thrombosis. The history of a spontaneous DVT in a close relative increases an individual’s risk of DVT even if no known genetic predisposition can be identified.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 52
Correct
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A 2-day-old male is referred to a tertiary care hospital by the community midwife after a home visit due to jaundice and dyspnoea. After history and examination, the relevant blood work is performed, and the baby is found to have conjugated hyperbilirubinemia. The paediatric team suspects a hepatic origin for jaundice based on the findings.
Which one of the following aetiologies is the most likely cause of jaundice in this case?Your Answer: Alpha 1-antitrypsin deficiency
Explanation:The presence of dyspnoea makes alpha-1 antitrypsin deficiency the more likely diagnosis as biliary atresia does not cause respiratory symptoms. Deficiency of the enzyme alpha-1 antitrypsin causes uninhibited elastase activity and a decrease in elastic tissue. This causes liver cirrhosis leading to an elevation of conjugated bilirubin and emphysema in the lungs.
Rhesus disease, hereditary spherocytosis and breast milk jaundice cause an elevation of unconjugated bilirubin thus ruling it out in this case. Breast milk jaundice occurs due to an inability of the newborn to metabolize the proteins in breast milk.
Rhesus disease occurs when an Rh negative mother gives birth to an Rh positive baby. The jaundice would have been accompanied by anaemia and oedema.
Hereditary spherocytosis occurs due to extravascular haemolysis as defective RBCs are removed by the spleen. The patient would present with jaundice, splenomegaly and possibly an aplastic crisis (if Parvovirus B19 infection).
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 53
Correct
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A 69-year-old man with a history of chronic anaemia is transfused. He takes bisoprolol and furosemide for his cardiac failure, and his most recent BNP was 123 pmol/l. He developed shortness of breath and his pre-existing peripheral oedema became worse 5 hours after transfusion was commenced. His BP rises to 170/105 mmHg and a repeat measurement of his BNP is 192 pmol/l.
What is the most likely transfusion reaction to have occurred?Your Answer: TACO
Explanation:Transfusion-associated circulatory overload (TACO) presents as acute or worsening respiratory distress within 6 hours of transfusion of a large volume of blood. It is common in patients with diminished cardiac reserve or chronic anaemia. Elderly patients, infants and severely anaemic patients are particularly susceptible. Typical clinical features of TACO include: Acute respiratory distress, Tachycardia, Hypertension, Acute/worsening pulmonary oedema on chest X-ray. The BNP is usually raised to at least 1.5 times the pre-transfusion baseline.
Febrile transfusion reaction presents with a 1 degree rise in temperature from baseline during transfusion. Patient may have chills and malaise. It is the most common transfusion reaction (1 in 8 transfusions) and is usually caused by cytokines released from leukocytes in transfused red cell or platelet components.
TRALI (Transfusion Related Acute Lung Injury) is a clinical syndrome with abrupt onset of non-cardiogenic pulmonary oedema within 6 hours of transfusion not explained by another risk factor. Associated with the presence of antibodies in the donor blood to recipient leukocyte antigens. patients present with dyspnoea, hypertension, hypotension, acute leukopenia.
Graft versus host disease(GVHD) is an immune mediated condition that arises from a complex interaction between donor and recipients adaptive immunity. It presents as dermatitis, hepatitis and enteritis developing within 100 days after stem cell or bone marrow transplant.
Acute haemolytic reaction aka immediate haemolytic transfusion reaction presents with fever, chills, pain at transfusion site, nausea, vomiting, dark urine and feeling of ‘impending doom’. Often, it occurs due to ABO incompatibility.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 54
Correct
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A 29-year-old female with chronic anaemia secondary to sickle cell disease is being transfused. A few minutes after starting the blood transfusion, she develops widespread itching with urticarial rash, wheezing, nausea and chest pain. Her BP reduces to 60/40 mmHg.
What is the most appropriate treatment?Your Answer: Stop the transfusion and administer adrenaline
Explanation:Anaphylaxis transfusion reaction occurs when an individual has previously been sensitized to an allergen present in the blood and, on re-exposure, releases IgE or IgG antibodies. Patients with anaphylaxis usually develop laryngospasm, bronchospasm, abdominal pain, nausea, vomiting, hypotension, shock, and loss of consciousness. The transfusion should be stopped immediately and the patient should be treated with adrenaline, oxygen, corticosteroids, and antihistamines.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 55
Correct
-
A dermatological examination on a patient presenting with a skin lesion which shows a solid, well circumscribed, lump measuring 0.8 cm in diameter. Which one of these best describes the lump you have found on examination?
Your Answer: Papule
Explanation:Macule— a small patch of skin that is altered in colour, but is not elevated.
Patch — a large area of colour change, with a smooth surface.
Papule— elevated, solid, palpable lesion that is ≤ 1 cm in diameter. They may be solitary or multiple. Papules may be:
Nodule — elevated, solid, palpable lesion > 1 cm usually located primarily in the dermis and subcutis (deeper layers of the skin). The greatest portion of the lesion may be above or beneath the skin surface.
Vesicle — a small blister. It is a circumscribed lesion ≤ 1 cm in diameter that contains liquid (clear, serous or haemorrhagic).
Cyst — papule or nodule that contains fluid or semi-fluid material so is fluctuant
Plaque — a circumscribed, palpable lesion more than 1 cm in diameter; most plaques are elevated.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 56
Correct
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A 40-year-old man with episodes of blood in urine and flank pain that are recurrent presents for management. He has a history of hypertension that is difficult to control and recurrent urinary tract infections. Other findings are: bilateral masses in his flanks and haematuria (3+ on dipstick).
What is the most likely diagnosis?Your Answer: Polycystic kidney disease
Explanation:Autosomal dominant polycystic kidney disease (ADPKD) presents with abdominal or loin discomfort due to the increasing size of the kidneys, acute loin pain with or without haematuria, hypertension, and male infertility. It is the most common cause of serious renal disease and the most common inherited cause of renal failure in adults.
Alport syndrome has hearing loss and eye abnormalities in addition to symptoms of kidney disease.
Renal cell carcinoma presents with additional features of unexplained weight loss, loss of appetite, fever of unknown origin and anaemia.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 57
Correct
-
A patient noticed ankle swelling and has passed very little urine over the past 24 hours. He also has nausea and vomiting, reduced urine output and his blood results reveal a sudden rise in his creatinine levels over the past 48 hours. You make a diagnosis of acute kidney injury (AKI).
Which one of these is a prerenal cause of AKI?
Your Answer: Cardiac failure
Explanation:The causes of AKI can be divided into pre-renal, intrinsic renal and post-renal causes. Majority of AKI developing in the community is due to a pre-renal causes (90% of cases).
Pre-renal causes: Haemorrhage, severe vomiting or diarrhoea, burns, cardiac failure, liver cirrhosis, nephrotic syndrome, hypotension, severe cardiac failure, NSAIDs, COX-2 inhibitors, ACE inhibitors or ARBs, Abdominal aortic aneurysm, renal artery stenosis, hepatorenal syndrome,
Intrinsic (renal) causes:
Eclampsia, glomerulonephritis, thrombosis, haemolytic-uraemic syndrome, acute tubular necrosis (ATN), acute interstitial nephritis, drugs ( NSAIDs), infection or autoimmune diseases, vasculitis, polyarteritis nodosa, thrombotic microangiopathy, cholesterol emboli, renal vein thrombosis, malignant hypertensionPost-renal causes: Renal stones, Blood clot, Papillary necrosis, Urethral stricture, Prostatic hypertrophy or malignancy, Bladder tumour, Radiation fibrosis, Pelvic malignancy, Retroperitoneal fibrosis
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 58
Correct
-
Which of the following statements is correct with regards to natural killer cells?
Your Answer: They are part of the innate immune system.
Explanation:Natural Killer (NK) Cells are lymphocytes in the same family as T and B cells, which come from a common progenitor. They are cytotoxic CD8 positive cells that do not have the T-cell receptor. They are very big cells with cytoplasmic granules and are designed to kill target cells with a low level of expression of HLA class I molecules.
Examples include during a viral infection or on a malignant cell. NK cells display several receptors for HLA molecules on their surface, and when HLA is expressed on the target cell, these deliver an inhibitory signal into the NK cell. Absent HLA molecules on the target cell cause this inhibitory signal to get lost and as a result, the NK cell can then kill its target. Also, NK cells display antibody-dependent cell-mediated cytotoxicity, where antibody binds to antigen on the surface of the target cell. The NK cells then bind to the Fc portion of the bound antibody and kill the target cell. -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 59
Correct
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A 6-year-old girl is brought to the nephrology clinic by her mother due to facial oedema. Her lab workup shows proteinuria of 7 g/24 hours and serum albumin levels of 15 g/L. A diagnosis of Nephrotic Syndrome is made, and corticosteroid therapy is initiated.
Which one of the following is the most likely cause of nephrotic syndrome in this patient?Your Answer: Minimal change disease
Explanation:Minimal Change Disease is the most common cause of Nephrotic Syndrome in the paediatric population. It may be caused by NSAID use. Electron microscopy shows the fusion of foot processes while light microscopy will appear normal.
Focal segmental glomerulosclerosis causes Nephrotic Syndrome in adults. It is associated with Heroin use and HIV infection. There is a limited response to steroids, and the disease progresses to end-stage renal failure in 5-10 years.
Diabetic nephropathy occurs after a long period of diabetes due to the deposition of amyloid protein leading to a decrease in glomerular filtration.
There is no history of Hepatitis B in this patient and no symptoms of liver disease such as jaundice.
Membranous glomerulonephritis would present with features of Nephritic Syndrome. These would be oedema, haematuria; red blood cell casts in the urine and hypertension.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 60
Correct
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Which of the following is the correct sequential order of the phases of healing:
Your Answer: Haemostasis, inflammation, proliferation, remodelling
Explanation:Acute wound healing has four main stages: haemostasis, inflammation, proliferation and remodelling.
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This question is part of the following fields:
- Pathology
- Wound Healing
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Question 61
Correct
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Regarding iron deficiency anaemia, which of the following statements is INCORRECT:
Your Answer: Dietary insufficiency is the most common cause of iron deficiency anaemia in adult men in the UK.
Explanation:Blood loss from the gastrointestinal (GI) tract is the most common cause of iron deficiency anaemia in adult men and postmenopausal women.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 62
Correct
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Which of the following laboratory findings are suggestive of functional hyposplenism:
Your Answer: Howell-Jolly bodies
Explanation:Functional hyposplenism is characterised by the blood film findings of Howell-Jolly bodies or siderotic granules on iron staining. The most frequent cause is surgical removal of the spleen e.g. after traumatic rupture, but hyposplenism can also occur in sickle cell anaemia, gluten-induced enteropathy, amyloidosis and other conditions.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 63
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 64
Correct
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Regarding thalassaemia, which of the following statements is CORRECT:
Your Answer: Screening for thalassaemia in pregnancy is offered to all pregnant women.
Explanation:Beta thalassemia is caused by mutations in one or both of the beta globin genes. Alpha thalassemia is caused by a deletion or mutation (less commonly) in one or more of the four alpha globin gene copies. β-thalassaemia is more common in the Mediterranean region while α-thalassaemia is more common in the Far East.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 65
Correct
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A blood transfusion is given to a 52-year-old woman. She develops chills and rigours shortly after the transfusion begins.
The following are her observations: Temperature 40°C, HR 116 bpm, BP 80/48, SaO 2 97 percent on air.
Which of the following treatments is the most appropriate?Your Answer: Stop the transfusion and administer antibiotics
Explanation:Bacterial infections are common in the following situations:
Platelet transfusions are associated with a higher risk of bacterial infection (as platelets are stored at room temperature)
Immersion in a water bath thawed previously frozen components.
Components of red blood cells that have been stored for several weeks
Gram-positive and Gram-negative bacteria have both been linked to transfusion-transmitted bacterial infection, but Gram-negative bacteria are linked to a higher rate of morbidity and mortality.
Yersinia enterocolitica is the most common bacterial organism linked to transfusion-transmitted bacterial infection. This organism can multiply at low temperatures while also utilising iron as a nutrient. As a result, it’s well-suited to proliferating in blood banks.The following are some of the most common clinical signs and symptoms of a bacterial infection transmitted through a blood transfusion. These symptoms usually appear shortly after the transfusion begins:
Fever is very high.
Rigours and chills
Vomiting and nausea
Tachycardia
Hypotension
Collapse of the circulatory systemIf a bacterial infection from a transfusion is suspected, the transfusion should be stopped right away. Blood cultures and a Gram stain should be requested, as well as broad-spectrum antibiotics. In addition, the blood pack should be returned to the blood bank for an urgent culture and Gram-stain.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 66
Correct
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A 20-year-old female presents with painful wrist following a fall while skating. X-rays shows fracture of the ulna.
The initial phase of bone healing is?
Your Answer: Haematoma at the fracture site
Explanation:Haemorrhage occurs into the fracture site from the ruptured vessels in the bone marrow and those supplying the periosteum immediately after fracture. This hematoma formation is the first phase of bone healing.
The 4 stages of bone healing are:
Haematoma at the fracture site (provides a framework for healing)
Callus formation
Lamellar bone formation
Remodelling -
This question is part of the following fields:
- General Pathology
- Pathology
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Question 67
Correct
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A 29-year-old woman with anaphylactic reaction to peanuts, had to use her EpiPen on the way to hospital.
What percentage of patients with anaphylactic reaction suffer a biphasic response?.Your Answer: 20%
Explanation:About 20% of patients that suffer an anaphylactic reaction suffer a biphasic response 4-6 hours after the initial response (sometimes up to 72 hours after).
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 68
Correct
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A 20-year-old male who is a known patient of sickle cell disease presents to the Emergency Room with a sustained erection that is extremely painful.
Out of the following clinical syndromes, which one does this patient most likely have?Your Answer: Priapism
Explanation:Sickling of red blood cells can lead to several different clinical syndromes. If the sickling occurs in the corpora cavernosa, it can lead to a sustained, painful erection of the penis, referred to as priapism. One of the complications is long-term impotence. It is important to seek a urological opinion immediately in this case, but in the interim, treat with perineal ice packs and walk up and down the stairs.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 69
Correct
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A 78-year-old male presents to the Orthopaedic clinic with lower back pain for the past month. His past medical history reveals a history of cancer. After examination, you diagnose Metastatic Spinal Cord Compression (MSCC).
Which one of the following cancers is this patient most likely to have had?Your Answer: Prostate cancer
Explanation:Compression of the thecal sac causes metastatic Spinal Cord Compression (MSCC) due to a Metastatic tumour and its components. It can cause symptoms of limb weakness, sensory disturbances and back pain depending on the extent and level of Compression.
The most common source of a tumour causing MSCC is a prostate carcinoma that metastasized to the spinal cord via the vertebral venous plexus.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 70
Correct
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A 50-year-old woman with painful joints had some blood tests done with her GP. The test showed she had anti-double stranded DNA antibodies.
Which one of these disorders is most likely to be associated with anti-double stranded DNA antibodies?Your Answer: Systemic lupus erythematosus (SLE)
Explanation:CREST syndrome is usually associated with anti-centromere antibodies.
Primary biliary cirrhosis is associated with anti-mitochondrial antibodies.
Sjogren’s syndrome is associated with anti-Ro and anti-La antibodies.
Polymyositis is associated with anti-Jo1 antibodies.
Anti-double stranded DNA antibodies are highly characteristic of systemic lupus erythematosus (SLE). They are a group of anti-nuclear antibodies (ANA) that target double stranded DNA and are implicated in the pathogenesis of lupus nephritis.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 71
Correct
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A 30-year-old male with a known allergy to natural latex rubber presents with an allergic reaction to a food he has just eaten.
Which ONE of these foods is most likely to cause an associated hypersensitivity in him?Your Answer: Banana
Explanation:About one third of patients with allergy to natural latex rubber (NRL) have an associated allergy to some plant-derived foods. It is known as the latex-fruit syndrome and occurs commonly with consumption of fresh fruits. Banana and avocado are the most implicated fruits but it can also be seen with tomato, kiwi and chestnut.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 72
Incorrect
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C3 deficiency leads to particular susceptibility of infection with which of the following:
Your Answer: Neisseria spp.
Correct Answer: Encapsulated bacteria
Explanation:Macrophages and neutrophils have C3b receptors and they phagocytose C3b-coated cells. C3 deficiency thus leads to increased susceptibility of infection with encapsulated organisms (e.g. S. pneumoniae, H. influenzae).The early stages of the complement cascade leading to coating of the cells with C3b can occur by two different pathways:The classical pathway usually activated by IgG or IgM coating of cellsThe alternative pathway which is more rapid and activated by IgA, endotoxin and other factors
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 73
Correct
-
Which of the following is NOT a characteristic of megaloblastic anaemia?
Your Answer: Raised reticulocyte count
Explanation:The LDH level is usually markedly increased in severe megaloblastic anaemia. Reticulocyte counts are inappropriately low, representing a lack of production of RBCs due to massive intramedullary haemolysis. These findings are characteristics of ineffective haematopoiesis that occurs in megaloblastic anaemia as well as in other disorders such as thalassemia major.
The common feature in megaloblastosis is a defect in DNA synthesis in rapidly dividing cells. To a lesser extent, RNA and protein synthesis are impaired. Unbalanced cell growth and impaired cell division occur since nuclear maturation is arrested. More mature RBC precursors are destroyed in the bone marrow prior to entering the bloodstream (intramedullary haemolysis). -
This question is part of the following fields:
- Haematology
- Pathology
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Question 74
Correct
-
A 30-year-old woman is transfused following a diagnosis of anaemia secondary to heavy vaginal bleeding. She complains of feeling hot and cold during transfusion of the second unit and her temperature is 38.5ºC. Prior to the transfusion, her temperature was 37ºC. She has no other symptoms.
Which of these transfusions reactions most likely occurred?Your Answer: Febrile transfusion reaction
Explanation:Febrile transfusion reactions presents with an unexpected temperature rise (≥ 38ºC or ≥ 1ºC above baseline, if baseline ≥ 37ºC) during or shortly after transfusion. It is usually an isolated finding and the fever is accompanied by chills and malaise occasionally.
Allergic reaction is commonly caused by foreign plasma proteins but may be due to anti-IgA. Allergic type reactions usually present with urticaria, pruritus, hives. Associations include laryngeal oedema or bronchospasm.
Acute haemolytic reaction aka immediate haemolytic transfusion reaction presents with fever, chills, pain at transfusion site, nausea, vomiting, dark urine and feeling of ‘impending doom’. Often, it occurs due to ABO incompatibility.
Transfusion-associated circulatory overload (TACO) presents as acute or worsening respiratory distress within 6 hours of transfusion of a large volume of blood. It is common in patients with diminished cardiac reserve or chronic anaemia. Elderly patients, infants and severely anaemic patients are particularly susceptible. Clinical features of TACO include: Acute respiratory distress, Tachycardia, Hypertension, Acute/worsening pulmonary oedema on chest X-ray. The BNP is usually raised to at least 1.5 times the pre-transfusion baseline.
Transfusion-related lung injury (TRALI) is a form of acute respiratory distress caused by the donor plasma containing antibodies against the patient’s leukocytes. It is defined as hypoxia and bilateral pulmonary oedema that occurs within 6 hours of a transfusion in the absence of other causes of acute lung injury. Clinical features include Breathlessness, cough, frothy sputum, hypertension or hypotension, hypoxia and fever. Chest X-ray shows multiple perihilar nodules with infiltration of the lower lung fields.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 75
Correct
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A 26-year-old male presents to your clinic with the complaint of recurrent fevers over the past three months. On documentation of the fever, it is noted that the fever increases and decreases in a cyclical pattern over a 1-2 week period. After the appropriate investigations, a diagnosis of Pel-Ebstein fever is made.
Which ONE of the following conditions is most likely to cause this patient's fever?Your Answer: Hodgkin lymphoma
Explanation:The release of cytokines from Reed-Sternberg cells can cause fever in patients with Hodgkin lymphoma, which increases and decreases in a cyclical pattern of 1 to 2 weeks. This is called Pel-Ebstein or Ebstein-Cardarelli fever, specifically seen in Hodgkin lymphoma. The fever is always high grade and can reach 40 degrees or higher.
Cyclical fever in other conditions is common but is not termed as Pel-Ebstein fever. This term is reserved only with Hodgkin lymphoma.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 76
Correct
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A 23-year-old male is referred to your haematology clinic after an acute attack of haemolytic anaemia. He was diagnosed with glucose-6-phosphate dehydrogenase deficiency ten years ago.
Which ONE of the following options is FALSE with regards to this disorder?Your Answer: Acute haemolysis can be triggered by cephalosporin antibiotics
Explanation:Glucose-6-phosphate dehydrogenase deficiency is an X-linked recessive disorder in which there is a deficiency of the enzyme G6PD. This causes instability of red blood cell membranes under oxidative stress leading to haemolysis.
Triggers include:
1) Fava beans
2) Sulphonamides
3) Primaquine
4) Anti-TB drugs
5) InfectionsMost individuals will be asymptomatic until exposed to one of the triggers listed above. It is the commonest human enzyme defect and affects males more than females because of the X-linked inheritance pattern. The use of penicillins and cephalosporins is generally safe.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 77
Correct
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Which of the following is NOT mainly characterised by intravascular haemolysis:
Your Answer: Beta-Thalassaemia
Explanation:Causes of intravascular haemolysis:
Haemolytic transfusion reactions
G6PD deficiency
Red cell fragmentation syndromes
Some severe autoimmune haemolytic anaemias
Some drug-and infection-induced haemolytic anaemias
Paroxysmal nocturnal haemoglobinuria -
This question is part of the following fields:
- Haematology
- Pathology
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Question 78
Correct
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Which of the following is NOT an effect of cytokine activity:
Your Answer: Opsonisation of bacteria for phagocytosis
Explanation:Cytokines are a family of chemical messengers, secreted by leucocytes, that act over short distances by binding specific receptors on target cell surfaces. They include: interleukins (act between leucocytes), interferons (inhibit replication of viruses within cells and activate macrophages and natural killer cells), growth factors, and tumour necrosis factors (kill tumour cells). Effects include: induction of fever and acute phase response, stimulation of leucocyte differentiation and maturation, leucocyte recruitment and activation and increased antibody production.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 79
Correct
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A patient presents with epistaxis. She tells you that she has a rare platelet disorder and gives you her haematology outpatient letter that contains information about it. You learn that her disorder is caused by low levels of glycoprotein IIb/IIIa.
What is the SINGLE most likely diagnosis?Your Answer: Glanzamann’s thromboasthenia
Explanation:Glanzmann’s thromboasthenia is a rare platelet disorder in which platelets contain defective or low levels of glycoprotein IIb/IIIa.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 80
Correct
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Which of the following immunoglobulin molecules is the most abundant in secretions (such as saliva and breast milk):
Your Answer: IgA
Explanation:IgA is the predominant antibody class in secretions and tremendous quantities are secreted into various body spaces and onto mucosal surfaces (the gut lumen, the pharynx and sinuses, the larger airways, although not the alveoli).
Because of its size, the majority of IgM is found in the circulation.Along with IgM, IgD is predominant among the surface receptors of mature B cells, where it plays a key role in B cells activation.
IgE has the lowest concentration in normal human serum. It plays a prominent role in immune responses to helminth parasites, and in allergic reactions.
IgG is the most abundant immunoglobulin and constitutes 75 percent of serum immunoglobulin in an adult human -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 81
Correct
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Which one of the listed cells are typically found in a granuloma?
Your Answer: Epithelioid cells
Explanation:Typically, a granuloma has Langhan’s cells (large multinucleated cells) surrounded by epithelioid cell aggregates, T lymphocytes and fibroblasts.
Antigen presenting monocytic cells are found in the skin are known as Langerhan’s cells.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 82
Correct
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A 40-year-old woman was rushed to the Emergency Department due to an anaphylactic reaction after being stung by a bee. She responded well to initial treatment but developed anaphylactic symptoms after 6 hours. Her symptoms were resolved after a further dose of adrenaline. Her family threatened legal action as they thought she had not received adequate treatment but withdrew their accusation after the attending physician explained that the woman had suffered a biphasic reaction.
What is the approximate percentage of people who suffer this type of reaction?Your Answer: 20%
Explanation:Anaphylactic reactions are Type 1 hypersensitivity reactions IgE-mediated and can be potentially life-threatening if not treated promptly. There are four well-recognized patterns of anaphylaxis:
1) Uniphasic
2) Biphasic
3) Protracted
4) RefractoryBiphasic reactions occur in 20% of the population, although their mechanism is poorly understood. The symptoms of anaphylaxis recur within 4-6 hours, although they may also recur up to 72 hours later. All patients discharged from the hospital after an anaphylactic shock must:
1) Be warned to return to the hospital immediately if symptoms recur
2) Have a treatment plan in place
3) Have a follow-up appointment
4) Be considered for an adrenaline auto-injector
5) Referred to an allergy clinic -
This question is part of the following fields:
- General Pathology
- Pathology
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Question 83
Correct
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A 12-year-old boy presents to the ED with symptoms suggesting an anaphylactic reaction.
Which of these statements about anaphylaxis is true?Your Answer: The immunoglobulin-antigen complex binds to Fc receptors on the surface of mast cells.
Explanation:Anaphylaxis is an example of a type I hypersensitivity reaction.
It is IgE mediated.
It requires a prior exposure to the antigen. The initial exposure sensitizes the body to the antigen and a second exposure to that antigen leads to an anaphylactic reaction.
Massive calcium influx into the cells leads to mast cell degranulation.
The Immunoglobulin antigen complex binds to Fc receptors on the surface of mast cells. The result is mast cell degranulation and release of histamine, proteoglycans and serum proteases from cytoplasmic granules.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 84
Correct
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A patient presents with a rash for dermatological examination. A large area of purplish discolouration of the skin that measures 2 cm in diameter and does not blanch when pressure is applied is seen .
What is the best description of this rash that you have found on examination?
Your Answer: Ecchymoses
Explanation:Ecchymosis are discolouration of the skin or mucous membranes caused by extravasation of blood. They are usually red or purple in colour and measure greater than 1 cm in diameter and do not blanch on applying pressure.
A macule is a flat, well circumscribed area of discoloured skin less than 1 cm in diameter with no changes in the thickness or texture of the skin.
Petechiae are discolouration of the skin measuring less than 3 mm in diameter
Purpura are discolouration of the skin measuring between 0.3 cm and 1 cm in diameter.
Erythema is redness of the skin or mucous membranes caused by hyperaemia of superficial capillaries caused by skin injury, infection or inflammation. Erythema blanches when pressure is applied whereas ecchymosis, purpura and petechiae do not.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 85
Correct
-
Regarding beta-thalassaemia, which of the following statements is CORRECT:
Your Answer: Beta-thalassaemia trait is associated with a raised HbA2.
Explanation:Beta-thalassaemia major is caused by a complete or almost complete failure of β-globin chain synthesis, severe imbalance of α:β-chains with deposition of α-chains in erythroblasts, ineffective erythropoiesis and extramedullary haemopoiesis. The severe anaemia becomes apparent at 3 – 6 months when the switch from γ-chain to β-chain synthesis normally occurs. Beta-thalassaemia minor is a variable syndrome, milder than thalassaemia major, with later onset and characterised by moderate hypochromic microcytic anaemia with raised haemoglobin A2. Beta-thalassaemia trait is characterised by mild hypochromic, microcytic anaemia with raised red cell count and raised haemoglobin A2.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 86
Correct
-
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 87
Correct
-
By the third day of wound healing, which sort of inflammatory cell has predominated:
Your Answer: Macrophages
Explanation:The inflammatory phase of healing is sometimes called the lag phase because wound strength does not begin to return immediately. The inflammatory phase is completed within three days except in the presence of infection or other factors associated with impaired wound healing. Mononuclear leukocytes accumulate and are transformed into macrophages. The maturation of blood-derived monocytes into macrophages is heralded by several events, including secretion of vimentin, which is a structural filament protein involved in wound healing.
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This question is part of the following fields:
- Pathology
- Wound Healing
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Question 88
Correct
-
Which type of collagen is initially laid down in early wound healing:
Your Answer: III
Explanation:Fibroblasts migrate to the wound (about 2 – 5 days after wounding), proliferate and secrete extracellular matrix comprising mainly collagen (type III) and fibronectin to plug the gap.
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This question is part of the following fields:
- Pathology
- Wound Healing
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Question 89
Incorrect
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Which of the following laboratory findings is NOT typical of Hodgkin lymphoma:
Your Answer: Eosinophilia
Correct Answer: Basophilia
Explanation:Features may include:Normochromic normocytic anaemia is most common; bone marrow failure involvement is unusual in early disease, but if it occurs bone marrow failure may develop with leucoerythroblastic anaemiaOne-third of patients have a neutrophilia; eosinophilia is frequentAdvanced disease is associated with lymphopenia and loss of cell-mediated immunityPlatelet count is normal or increased in early disease and reduced in later stagesESR and CRP are usually raised (ESR is useful in monitoring disease progress)Serum LDH is raised initially in 30-40% of casesDiagnosis is made by histological examination of an excised lymph nodeThe distinctive multinucleate polypoid RS cell is central to the diagnosis of the four classic types of HL (95% of cases)
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This question is part of the following fields:
- Haematology
- Pathology
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Question 90
Incorrect
-
Eosinophils comprise what percentage of circulating white cells:
Your Answer: 0.2
Correct Answer: 1 - 3%
Explanation:Eosinophils comprise 1 – 3% of circulating white cells. Eosinophils are similar to neutrophils, except that the cytoplasmic granules are coarser and more deeply red staining, and there are rarely more than three nuclear lobes. They are less motile, but longer lived. They enter inflammatory exudates and have a special role in allergic responses, defence against parasites and removal of fibrin formed during inflammation. Thus they play a role in local immunity and tissue repair.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 91
Correct
-
The blood test reports of a 56-year-old female are sent for your review. She seems acutely sick and has had multiple infections over the past few months. Her complete blood count report shows neutropenia.
Which one of the following options is true with regards to neutropenia?Your Answer: It can be caused by both radiotherapy and chemotherapy
Explanation:A total neutrophil count of less than 2 x 109/L is defined as neutropenia. It can be caused by the following:
1. viral infections
2. SLE
3. RA
4. hypersplenism
5. chemo- and radiotherapy
6. vitamin B12 and folate deficiency
7. drug reactions -
This question is part of the following fields:
- Haematology
- Pathology
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Question 92
Correct
-
Regarding non-Hodgkin lymphoma (NHL), which of the following statements is CORRECT:
Your Answer: There is a much greater predilection to disseminate to extranodal sites than in Hodgkin lymphoma.
Explanation:Non-Hodgkin’s lymphoma (NHL) refers to a group of lymphoproliferative malignancies (about 85% of B-cell and 15% of T or NK (natural killer) cell origin) with different behavioural patterns and treatment responses. This group of malignancies encompasses all types of lymphoma without Reed-Sternberg cells being present. The Reed-Sternberg cell is classically seen in Hodgkin’s lymphoma.
NHL is five times as common as Hodgkin’s lymphoma. The peak incidence of NHL is in the 50-70 years age group, it affects men and women equally, but affects the Caucasian population more commonly than black and Asian ethnic groups.
The following are recognised risk factors for NHL:
Chromosomal translocations and molecular rearrangements
Epstein-Barr virus infection
Human T-cell leukaemia virus type-1 (HTLV-1)
Hepatitis C
Congenital and acquired immunodeficiency states
Autoimmune disorders, e.g. Sjogren’s syndrome and Hashimoto’s thyroiditis
The most common clinical features at presentation are:
Lymphadenopathy (typically asymmetrical and painless)
Weight loss
Fatigue
Night sweats
Hepatosplenomegaly
For clinical purposes, NHL is divided into three groups: indolent, high-grade, and lymphoblastic.
Indolent (low-grade) NHL:
The cells are relatively mature
Disease follows an indolent course without treatment
Often acceptable to follow a ‘watch and wait’ strategy
Local radiotherapy often effective
Relatively good prognosis with median survival of 10 years
High-grade NHL:
Cells are immature
Disease progresses rapidly without treatment
Significant number of patients can be cured with intensive combination chemotherapy regimens
Approximately 40% cure rate
Lymphoblastic NHL:
Cells are very immature and have a propensity to involve the CNS
Treatment and progression are similar to that of acute lymphoblastic leukaemia (ALL) -
This question is part of the following fields:
- Haematology
- Pathology
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Question 93
Correct
-
While studying fluid homeostasis in the body, you encounter the term exudate. Exudate is a fluid that leaks out of the intravascular space due to changes in the permeability of the microcirculation secondary to inflammation.
Which ONE of the following conditions would not be listed among the causes of an exudate?Your Answer: Myxoedema
Explanation:An exudate is an inflammatory fluid that leaks out of the intravascular space due to increased vascular permeability and intravascular pressure. It is mostly caused by local processes and can occur in the following conditions:
1) Infection (e.g. pneumonia)
2) Malignancy
3) Pericarditis
4) Collagen vascular diseases, e.g., Rheumatoid ArthritisMyxoedema is a state of severe hypothyroidism in which deposition of mucopolysaccharides occurs in the dermis. This causes a transudative effusion, typically in the pretibial region.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 94
Correct
-
A 61-year-old woman returns to get the results of recent blood tests she had done for non-specific malaise, lethargy, and weight loss.
The only abnormality discovered during the blood tests was a 580 x 10 9 /l increase in platelets. Her platelets were also elevated on a blood test taken 6 months earlier, according to her previous results. You're aware of the recent emergence of elevated platelet levels as a cancer risk marker and decide to look into it.
Which of the following cancers is most likely to cause isolated thrombocytosis?Your Answer: Colorectal cancer
Explanation:Raised platelet levels have emerged as a cancer risk marker, according to a large population-based study published in 2017(link is external). According to the study, 12 percent of men and 6% of women with thrombocytosis were diagnosed with cancer within a year. These figures increased to 18% in men and 10% in women if a second platelet count was taken within 6 months of the first and showed an increased or stable elevated platelet count.
The researchers discovered that thrombocytosis linked to cancer is most common in colorectal and lung cancers, and it is linked to a worse prognosis. Furthermore, one-third of the cancer patients in the study had no other symptoms that would have prompted an immediate cancer referral.
The exact mechanism by which these cancers cause thrombocytosis is unknown, but one theory proposes the existence of pathogenic feedback loops between malignant cells and platelets, with a reciprocal interaction between tumour growth and metastasis, as well as thrombocytosis and platelet activation. Another hypothesis is that thrombocytosis occurs independently of cancer but aids in its spread and progression.
The findings show that routinely testing for thrombocytosis could cut the time it takes to diagnose colorectal and lung cancer by at least two months. In the UK, this could result in around 5500 earlier cancer diagnoses per year.
Because the positive predictive value of thrombocytosis in middle age for cancer (10%) is higher than the positive predictive value for a woman in her 50s presenting with a new breast lump (8.5%), this is clearly an important research paper that should be used to adjust future clinical practise. The current NICE guidelines predate these new research findings, so we’ll have to wait and see how they affect cancer referral guidelines in the UK.
Because there are so many possible cancers associated with thrombocytosis, the treating clinician should take a thorough history and perform a thorough clinical examination if a patient is diagnosed with it. Further investigation and the most appropriate referral route should be aided by this information.
It’s worth noting that the patients in the study had their blood tests done for a medical reason rather than as a random screening test.
If there are no other symptoms to guide investigation and referral (one-third of the patients in the study had no other symptoms), keep in mind that the two most common cancers encountered were colorectal and lung cancer, so a chest X-ray and a faecal immunochemical test (FIT) for faecal blood may be reasonable initial investigations.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 95
Correct
-
Coagulative necrosis is typically seen in which of the following:
Your Answer: Myocardial infarction
Explanation:Coagulative necrosis is the most common form of necrosis characterised by the loss of cell nuclei, but with general preservation of the underlying architecture. Dead tissue is macroscopically pale and firm. This is the classic pattern seen in myocardial infarction.Liquefactive necrosis leads to complete loss of cellular structure and conversion into a soft, semi-solid mass. This is typically seen in the brain following cerebral infarction.Caseous necrosis is most commonly seen in tuberculosis. Histologically, the complete loss of normal tissue architecture is replaced by amorphous, granular and eosinophilic tissue with a variable amount of fat and an appearance reminiscent of cottage cheese.Gangrenous necrosis is necrosis with putrefaction of tissues due to exposure to air (dry gangrene) or infection (wet gangrene).
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 96
Correct
-
You are about to perform a blood test on a patient suspected of having systemic lupus erythematosus. Which antibodies will indicate a positive result of systemic lupus erythematosus?
Your Answer: Anti-nuclear antibodies
Explanation:Antinuclear antibodies (ANA) are autoantibodies to the cells’ nucleus.
The ANA test is the most sensitive diagnostic test for verifying the disease’s diagnosis.
Other autoantibodies that may be found in SLE patients include rheumatoid factor, antiphospholipid antibodies, and antimitochondrial antibodies.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 97
Correct
-
Regarding the factor V Leiden gene mutation, which of the following best describes the clinical effect:
Your Answer: It results in increased levels of activated factor V.
Explanation:Factor V Leiden gene mutation is the most common inherited cause of an increased risk of venous thrombosis. Activated protein C normally breaks down activated factor V and so should slow the clotting reaction and prolong the APTT, but a mutation in the factor V gene makes factor V less susceptible to cleavage by activated protein C, resulting in increased levels of activated factor V.Heterozygotes for factor V Leiden are at an approximately five- to eight- fold increased risk of venous thrombosis compared to the general population (but only 10% of carriers will develop thrombosis in their lifetime). Homozygotes have a 30 – 140-fold increased risk. The incidence of factor V Leiden in patients with venous thrombosis is approximately 20 – 40%. It does not increase the risk of arterial thrombosis.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 98
Correct
-
Regarding anaemia, which of the following statements is INCORRECT:
Your Answer: Anaemia is usually associated with a decrease in red cell 2,3 - DPG.
Explanation:Anaemia is defined as a reduction in haemoglobin concentration below the normal range for the age and sex of the individual. Children tend to have lower haemoglobin than adults, and women tend to have lower haemoglobin than men. Anaemia may occur from an actual reduction in total circulating haemoglobin mass, or with an increase in plasma volume e.g. in pregnancy, causing a dilutional anaemia. After acute major blood loss, anaemia is not immediately apparent because total blood volume is reduced and it takes up to a day for plasma volume to be replaced and hence the degree of anaemia to become apparent. The initial clinical features in acute haemorrhage are therefore a result of reduction in blood volume rather than that of anaemia. When anaemia develops slowly, the associated symptoms are often very mild as the body has time to adapt to the fall in haemoglobin. This involves mechanisms such as an increase in red cell 2,3 -diphosphoglycerate (2,3 – DPG), which shifts the oxygen dissociation curve to the right, allowing enhanced delivery of O2 to the tissues, and an increase in stroke volume and heart rate.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 99
Correct
-
A 67-year-old female presents with a history of morning stiffness and arthritis of her hand joints. She is being investigated for rheumatoid arthritis.
Which test is most sensitive and specific for this diagnosis?
Your Answer: Anti-CCP
Explanation:Anti-cyclic citrullinated peptide (anti-CCP) is an antibody present in 60-80% of rheumatoid arthritis patients. It is measured by enzyme-linked immunosorbent assay (ELISA). It may be present years before the onset of the disease and is associated with a more severe disease course.
While most patients with anti-CCP antibodies are also positive for rheumatoid factor (RF), RF antibody is not specific for rheumatoid arthritis as it can occur in patients with other conditions such as infections and other autoimmune conditions.
ESR, antinuclear antibodies(ANA) and Synovial fluid examination are not specific for rheumatoid arthritis.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 100
Correct
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The qSOFA score is a bedside prompt designed to identify patients with suspected infection who are at greater risk for a poor outcome outside of the intensive care unit.
Which of the following is one of the criteria used in the qSOFA score? Select ONE answer only.Your Answer: Respiratory rate >22
Explanation:In February 2016 the Society of Critical Care Medicine published a JAMA article reformatting the definitions of sepsis in an attempt to overcome the shortcomings of the old definitions.
The main changes are a new definition of sepsis, the replacement of the SIRS criteria with the quick Sepsis-related Organ Failure Assessment (qSOFA), and the complete removal of “severe sepsis” as an entity.
The new definition of sepsis is that it is “life-threatening organ dysfunction caused by a dysregulated host response to infection.”
Septic shock is “a subset of sepsis in which underlying circulatory and cellular metabolism abnormalities are profound enough to increase mortality.”
In essence this means that septic shock is sepsis plus the following, despite adequate fluid resuscitation:
Vasopressors required to maintain a MAP > 65 mmHg
Serum lactate > 2 mmol/l
The qSOFA score is a bedside prompt designed to identify patients with suspected infection who are at greater risk for a poor outcome outside of the intensive care unit. It uses the following three criteria:
Hypotension (SBP < 100 mmHg)
Tachypnoea (RR > 22)
Altered mental status (GCS < 15)
The presence of 2 or more of the qSOFA criteria near the onset of infection is associated with greater risk of death or a prolonged intensive care unit stay. -
This question is part of the following fields:
- Pathology
- Pathology Of Infections
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Question 101
Correct
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A 56-year-old male with a 10-year history of Diabetes Mellitus and Hypertension was rushed to the Emergency Department due to sudden onset crushing chest pain. ECG showed an ST-elevation myocardial infarct in the left anterior descending artery territory. The patient's condition was stabilised and managed with angioplasty, but he sustained significant myocardial damage.
Which one of the following statements best agrees with the myocardial healing process?Your Answer: The left ventricle will likely hypertrophy first to maintain cardiac output
Explanation:Following a myocardial infarction scar tissue formation will take place at the site of the damaged muscle. This places increased load on the rest of the myocardium causing it to hypertrophy. The left ventricle will hypertrophy first as it is pumping blood against a greater afterload as compared to the right ventricle.
There are three types of cells in the body with regards to the cell cycle: 1. permanent
2. labile
3. stable cellsPermanent cells do not re-enter the cell cycle and remain in G0. If there is a pool of stem cells the stem cells will enter the cell cycle to form more cells. Myocardial cells are a type of permanent cell and there is no pool of stem cells in the heart muscle. The anterior wall will not hypertrophy as it is formed by the right atrium and ventricle and both of these hypertrophy after the left ventricle.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 102
Incorrect
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Which of the following is NOT a typical clinical feature of beta-thalassaemia major:
Your Answer: Increased susceptibility to infection
Correct Answer: Increased bleeding tendency
Explanation:Features include:
– severe anaemia (becoming apparent at 3 – 6 months when the switch from gamma-chain to beta-chain production takes place)
– failure to thrive
– hepatosplenomegaly (due to excessive red cell destruction, extramedullary haemopoiesis and later due to transfusion related iron overload)
– expansion of bones (due to marrow hyperplasia, resulting in bossing of the skull and cortical thinning with tendency to fracture)
– increased susceptibility to infections (due to anaemia, iron overload, transfusion and splenectomy)
– osteoporosis
– hyperbilirubinaemia and gallstones
– hyperuricaemia and gout
– other features of haemolytic anaemia
– liver damage and other features of iron overload -
This question is part of the following fields:
- Haematology
- Pathology
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Question 103
Correct
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Regarding acute idiopathic thrombocytopaenic purpura (ITP), which of the following statements is CORRECT:
Your Answer: Over 80% of children recover without treatment.
Explanation:Acute ITP is most common in children. In approximately 75% of cases, the episode follows vaccination or infection such as chicken pox or glandular fever. Most cases are caused by non-specific immune complex attachment to platelets. Acute ITP usually has a very sudden onset and the symptoms usually disappear in less than 6 months (often within a few weeks). It is usually a self-limiting condition and over 80% of children recover without treatment; in 5 – 10% of cases a chronic form of the disease develops.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 104
Correct
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Which of the following best describes the process of opsonisation:
Your Answer: The coating of foreign particles with molecules which allow easier recognition of that cell by phagocytes
Explanation:An opsonin is any molecule that enhances phagocytosis by marking an antigen for an immune response, for example, immunoglobulin or complement. Opsonisation is the molecular mechanism whereby molecules, microbes, or apoptotic cells are chemically modified to have a stronger attraction to the cell surface receptors on phagocytes and natural killer cells. With the antigen coated in opsonins, binding to immune cells is greatly enhanced. Opsonisation also mediates phagocytosis via signal cascades from cell surface receptors.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 105
Correct
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Aplastic crises in sickle cell anaemia is classically precipitated by which of the following infections:
Your Answer: Parvovirus B19
Explanation:A serious complication in sickle cell disease (SCD) is the aplastic crisis. This may be caused by infection with Parvovirus B-19 (B19V). This virus causes fifth disease, a normally benign childhood disorder associated with fever, malaise, and a mild rash. This virus infects RBC progenitors in bone marrow, resulting in impaired cell division for a few days.
Healthy people experience, at most, a slight drop in hematocrit, since the half-life of normal erythrocytes in the circulation is 40-60 days. In people with SCD, however, the RBC lifespan is greatly shortened (usually 10-20 days), and a very rapid drop in Hb occurs. The condition is self-limited, with bone marrow recovery occurring in 7-10 days, followed by brisk reticulocytosis. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 106
Correct
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What proportion of peripheral blood leukocytes are monocytes?
Your Answer: 5 - 10%
Explanation:Monocytes account for around 5 to 10% of peripheral white cells. Monocytes in peripheral blood are generally bigger than other leukocytes and feature a large central oval or indented nucleus with clumped chromatin. The abundant cytoplasm staining blue and containing numerous fine vacuoles gives the appearance of ground glass. Cytoplasmic granules are another type of granule.
Monocytes evolve from the granulocyte-macrophage progenitor to become monoblasts, promonocytes, monocytes, and tissue macrophages (in increasing order of maturity). Monocytes only stay in the bone marrow for a short time before exiting to circulate in the bloodstream for 20-40 hours before becoming macrophages.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 107
Correct
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Mast cells play a significant part in which of the following?
Your Answer: Allergic disease
Explanation:Mast cells play a central role in the response to allergen challenges. The activation of mast cells results in both an early and a delayed phase of inflammation. Mast cells have been implicated in both physiologic and pathogenic processes. Mast cells are important in defence against some bacteria and viruses and contribute to defence against parasites. They are key effector cells in both innate and acquired immunity and are capable of inducing and amplifying both types of responses. Specifically, mast cells are capable of detecting microbial products through surface pattern recognition receptors, and they are involved in the recruitment of other leukocytes, containment of bacterial infections, and tissue repair.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 108
Correct
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A patient presents to your Emergency Department with a laceration on their buttocks requiring closure with sutures.
What stage of wound healing is the first to reach completion?Your Answer: Haemostasis
Explanation:The stages of wound healing are: haemostasis, inflammatory, proliferative and remodelling (maturation) phases in that order. The first stage in the healing process of a laceration is haemostasis. Haemostasis is the process of the wound being closed by clotting.
The inflammatory phase occurs just after and up to 48 hours after injury– Blood vessels dilate to allow white blood cells, antibodies, growth factors, enzymes and nutrients to reach the wounded area leading to the characteristic signs of inflammation seen.
Epithelialisation and angiogenesis are not phases of wound healing but occur during the proliferative phase. This ia after haemolysis and inflammation phases have occurred.
The maturation phase is the final phase and occurs when the wound has closed. It involves remodelling of collagen from type III to type I. Apoptosis remove unwanted cells, cellular activity reduces and the number of blood vessels in the wounded area regresses and decreases. This can continues for up to 1 year after injury.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 109
Incorrect
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A 16-year-old male with a known case of Haemophilia A is referred to your orthopaedic clinic for evaluation and aspiration of a hemarthrosis of the left knee joint.
Out of the modes of inheritance listed below, which one is present in this disease?Your Answer: Autosomal recessive
Correct Answer: X-linked recessive
Explanation:All the Haemophilia’s have an X-linked recessive inheritance pattern, so they only manifest in male patients. Diseases with a mitochondrial inheritance pattern include MELAS syndrome, Leigh syndrome, LHON and MERRF syndrome. Autosomal dominant disorders include Huntingdon disease and Marfan syndrome. X-linked dominant diseases include Fragile X syndrome. Autosomal recessive diseases include cystic fibrosis and sickle cell disease.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 110
Correct
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Which of the following is NOT a typical clinical feature of sickle cell disease:
Your Answer: Neutropaenia
Explanation:Features of sickle cell disease include:
Anaemia (symptoms are usually mild because the O2 dissociation curve of Hb S is shifted to the right)
Vaso-occlusive crisis
Visceral sequestration crisis
Aplastic crisisIncreased susceptibility to infection
Other clinical features: Pigment gallstones with cholecystitis
Chronic leg ulcers
Avascular necrosis of the femoral and humeral heads or other bones
Cardiomyopathy
Pulmonary hypertension
Proliferative retinopathy
Priapism
Renal papillary necrosis
Stroke -
This question is part of the following fields:
- Haematology
- Pathology
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Question 111
Correct
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One of the following statements about acute lymphoblastic leukaemia(ALL) is true.
Your Answer: It is classified using the FAB classification
Explanation:ALL affects children predominantly.
The CNS is commonly involved in ALL.
The Philadelphia chromosome is present in 25% of adult ALL and 5% of childhood ALL cases.
The cure rate in children is approximately 80% in children and 50% in adults.
ALL is classified into 3 groups using the French-American-British (FAB) classification:
ALL-L1: small uniform cells
ALL-L2: large varied cells
ALL-L3: large varied cells with vacuoles. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 112
Correct
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A 58-year-old man with a traumatic brain injury is brought into the ER. A medical student asks you about the processes that occur in the brain following a traumatic injury.
One of these best describes the central nervous systems response to injury.Your Answer: Degeneration of the axon occurs proximally before it occurs distally
Explanation:Following neuronal injury, as seen in traumatic brain injury, the axon undergoes anterograde degeneration. Degradation starts from the cell body (proximally) and progresses distally. The axon becomes fragmented and degenerates.
The brain shows no reactive changes to injury is incorrect. Following major injury such as stroke, the brain undergoes a process of liquefactive degeneration, which leaves cystic spaces within the brain.
Axonal regeneration does not occur to any significant extent within the central nervous system unlike what is seen in the peripheral nervous system.
Astrocytes undergo reactive gliosis, leaving behind a firm translucent tissue around sites of damage.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 113
Correct
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A 24-year-old male presents to the Emergency Department with a three-day history of high-grade fever, headache and rash along with neck stiffness. On examination, Kernig's sign is positive, and you note a petechial rash over the trunk and limbs. Her vital signs show tachycardia and hypotension. Based on these findings, you diagnose sepsis secondary to meningitis.
Which one of the following definitions of sepsis is currently accepted?Your Answer: Life-threatening organ dysfunction caused by a dysregulated host response to infection
Explanation:In 2016 the SOFA guideline was introduced, also called the Sepsis-related Organ Failure Assessment, to make a sepsis diagnosis easier and prevent mortality.
According to this guideline, sepsis was defined as a life-threatening organ dysfunction due to a dysregulated host response to infection.
Septic shock was defined as a subset of sepsis in which the circulatory and metabolic abnormalities would lead to a greater risk of mortality than sepsis alone. Patients with septic shock would be clinically identified by a need for vasopressors to maintain MAP greater than 65 mmHg and serum lactate greater than two mmol/L.
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This question is part of the following fields:
- Pathology
- Pathology Of Infections
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Question 114
Correct
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Antinuclear antibodies (ANAs) also referred to as anti-nuclear factors (ANFs) are autoantibodies that bind to contents of the cell nucleus.
Which ONE of these statements about ANAs is true?Your Answer: They can be of any immunoglobulin class
Explanation:Anti-nuclear antibodies(ANAs) also referred to as anti-nuclear factors (ANFs) are autoantibodies that bind to contents of the cell nucleus. They can be of any immunoglobulin class.
CREST syndrome is usually associated with anti-centromere antibodies.
ELISA testing is cheaper but not the most accurate means of testing for ANAs. Indirect immunofluorescence testing is the most reliable.
Nucleolar staining is suggestive of scleroderma, while homogenous staining is suggestive of lupus.
Anti-dsDNA antibodies are found in 80 – 90% of patients with SLE
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 115
Correct
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A 30-year-old male presents with easy bruising and bleeding gums, feeling very tired lately, and recurrent chest infections over the past few months. He had glandular fever approximately 6 months ago and feels that his symptoms started after that.
His full blood count today is as follows:
Hb 6.3 g/dl (11.5-14 g/dl)
MCV 90 fl (80-100 fl)
WCC 2.0 x 10 9 /l (4-11 x 10 9 /l)
Platelets 15 x 10 9 /l (150-450 x 10 9 /l)
The SINGLE most likely diagnosis is?Your Answer: Aplastic anaemia
Explanation:Aplastic anaemia is a life-threatening failure of haemopoiesis characterised by pancytopenia and hypocellular bone marrow. It is rare and patients present with features of recurrent infections secondary to (leukocytopenia), increased bleeding tendency (secondary to thrombocytopenia) and anaemia. In aplastic anaemia, there is damage to the bone marrow and the haematopoietic stems cells leading to pancytopenia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 116
Correct
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Which of the following clinical features is NOT a typical feature of haemolytic anaemias:
Your Answer: Angular cheilitis
Explanation:Features include:
Anaemia
Jaundice (caused by unconjugated bilirubin in plasma, bilirubin is absent from urine)
Pigment gallstones
Splenomegaly
Ankle ulcers
Expansion of marrow with, in children, bone expansion e.g. frontal bossing in beta-thalassaemia major
Aplastic crisis caused by parvovirus -
This question is part of the following fields:
- Haematology
- Pathology
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Question 117
Correct
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Question 118
Correct
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The Philadelphia chromosome is a genetic abnormality associated primarily with which of the following malignancies:
Your Answer: Chronic myeloid leukaemia
Explanation:Chronic myeloid leukaemia (CML) is a clonal disorder of a pluripotent stem cell. The disease accounts for around 15% of leukaemias and may occur at any age. The diagnosis of CML is rarely difficult and is assisted by the characteristic presence of the Philadelphia (ph) chromosome. This disease occurs in either sex, most frequently between the ages of 40 and 60 years. In up to 50% of cases the diagnosis is made incidentally from a routine blood count. Leucocytosis is the main feature, with a complete spectrum of myeloid cells seen in the peripheral blood. The levels of neutrophils and myelocytes exceed those of blast cells and promyelocytes.Increased circulating basophils are a characteristic feature. Normochromic normocytic anaemia is usual. Platelet count may be increased (most frequently), normal or decreased. The clinical outlook is very good and 90% of patients can expect long-term control of disease.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 119
Correct
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Chronic myeloid leukaemia is most common in middle-aged and elderly people. It is responsible for 20% of all leukemias.
Which of the following statements about CML is NOT TRUE?Your Answer: Serum B12 is typically low
Explanation:Chronic myeloid leukaemia is most common in middle-aged and elderly people. It is responsible for 20% of all leukemias. The majority of CML patients experience fatigue, weight loss, and excessive sweating.
The Philadelphia chromosome is found in over 90% of CML cases. A balanced translocation between chromosomes 9 and 22 is known as the Philadelphia chromosome.
Because white cells produce a B12 binding protein, serum B12 levels in CML are typically high.
In CML, the neutrophil alkaline phosphatase score is usually low.
Almost all patients with CML eventually progress to blast crisis, though this can take up to ten years. If any of the following features are present in a CML patient, a blast crisis is diagnosed:
In the blood or bone marrow, there are more than 20% myeloblasts or lymphoblasts.
On a bone marrow biopsy, large clusters of blasts were discovered.CML can be treated with tyrosine kinase inhibitors like imatinib and dasatinib if a chloroma (a solid tumour made up of myeloblasts that grows outside of the bone marrow) is present.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 120
Correct
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Regarding iron handling, which of the following statements is CORRECT:
Your Answer: Iron is taken across the enterocyte apical membrane by the divalent metal transporter (DMT1).
Explanation:Dietary iron may be in the form of haem or non-haem iron. Haem iron is degraded after absorption through the cell surface to release Fe2+. Most non-haem iron is in the form Fe3+, which is reduced at the luminal surface to the more soluble Fe2+, facilitated by hydrochloric acid in gastric secretions (and enhanced by ascorbic acid). Fe2+is taken across the enterocyte apical membrane by the divalent metal transporter (DMT1). In the enterocyte, Fe2+is then either stored in enterocyte epithelial cells as ferritin, or released into portal plasma via the molecule ferroportin at the basolateral membrane.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 121
Correct
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How does aspirin mediate its antiplatelet effect:
Your Answer: It irreversibly inhibits cyclo-oxygenase
Explanation:Aspirin irreversibly inhibits cyclooxygenase and blocks the platelet production of thromboxane A2 (TXA2), thus inhibiting platelet aggregation.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 122
Correct
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Which of the following pathogens is most likely to cause an infection in a chemo patient with significant neutropenia?
Your Answer: Candida
Explanation:Chemotherapy that is too aggressive weakens your immune system, putting you at risk for a fungal and many other infection.
Neutropenia is a condition in which a person’s neutrophil count is abnormally low. Neutrophils are an infection-fighting type of white blood cell. Neutrophils fight infection by killing bacteria and fungi (yeast) that infiltrate the body.
Fungal organisms are significant pathogens in the setting of neutropenia.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 123
Correct
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Langhans giant cells, seen in granulomatous inflammation. are:
Your Answer: Multinucleated cells formed from fusion of epithelioid cells
Explanation:A granuloma is a collection of five or more epithelioid macrophages, with or without attendant lymphocytes and fibroblasts; epithelioid macrophages are altered macrophages which have turned themselves over to becoming giant phagocytosing and killing machines, they often fuse to become multinucleate (Langhans) giant cells.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 124
Correct
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You are giving a presentation on the immune system as part of your peer-to-peer teaching sessions. Yu are currently discussing phagocytes. Macrophages are derived from which of the following cells:
Your Answer: Monocytes
Explanation:Monocytes spend only a short time in the marrow and, after circulating for 20-40 hours, leave the blood to enter the tissues where they become macrophages. Macrophages form the reticuloendothelial system in the liver, spleen and lymph nodes. The lifespan of macrophages may be as long as several months or even years. In tissues the macrophages become self-replicating without replenishment from the blood. They assume specific functions in different tissues e.g. dendritic cells which are involved in antigen presentation to T-cells. Macrophages may be activated by cytokines such as IFN-gamma, contact with complement or direct contact with the target cell through leucocyte adhesion molecules.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 125
Correct
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Which of the following is NOT one of the cardinal features of acute inflammation:
Your Answer: Discharge
Explanation:Classic signs:
Rubor (redness)
Calor (heat)
Dolour (pain)
Tumour (swelling)
Functio laesa (loss of function)
These classic signs are produced by a rapid vascular response and cellular events. The main function of these events is to bring elements of the immune system to the site of injury and prevent further tissue damage. -
This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 126
Correct
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You review an 18-months-old child who seems to be having a reaction following an immunisation she took earlier in the day.
Which statement concerning immunity and vaccination is true?Your Answer: The strongest immunological response is seen with natural immunity
Explanation:Vaccination induces ACTIVE adaptive immunity. Actively acquired immunity involves the development of an immune response either due to vaccination or natural exposure to a pathogen and leads to long-lasting resistance to infection.
Immediate protection is achieved with injection of immunoglobulin. The protection is transient lasting only a few weeks and is useful as post-exposure prophylaxis.
Passively acquired immunity usually leads to short-lasting resistance to infection because it does not involve a host immune response.
With inactivated bacteria, a series of primary vaccinations is usually required to induce an adequate immune response. In most cases, boosters are required to sustain adequate immunity.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 127
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 128
Correct
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A newborn baby is referred by the community midwife who is concerned the baby is jaundiced because of the yellow appearance of his eyes and skin following a postnatal home visit. The jaundice is visible in the baby’s feet making her worried.
Jaundice are visible in the extremities of neonates at what approximate threshold bilirubin level?Your Answer: 255 μmol/L
Explanation:Newborn babies have a higher concentration of red blood cells with shorter lifespan leading to higher bilirubin levels than in adults. This condition is short-lived and harmless but with potential serious causes that need to be assessed for if present.
The most obvious physical sign of jaundice is a yellow discolouration of the sclera, skin and mucous membranes. At a bilirubin level of 35 μmol/L or higher, the eye is affected. The bilirubin level will need to be higher than 255 μmol/L for the feet and extremities to be affected.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 129
Correct
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A 40-year-old male visits his family physician with the complaint of a high-grade fever for the past five days. A complete blood count report shows the presence of neutrophilia.
Which one of the following facts regarding neutrophilia is accurate?Your Answer: It can be caused by eclampsia
Explanation:A total neutrophil count of greater than 7.5 x 109/L is called neutrophilia. Typhoid fever usually causes leukopenia or neutropenia. Both localised and generalised bacterial infections can cause neutrophilia.
Metabolic disorders such as
– gout
– eclampsia
– uraemia
can also cause neutrophilia.Acute neutrophilia, in which immature neutrophils can be seen, is referred to as a left shift and can be seen in conditions such as appendicitis.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 130
Correct
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Regarding Hodgkin lymphoma, which of the following statements is CORRECT:
Your Answer: Some patients may complain alcohol-induced nodal pain and pruritus
Explanation:Lymphomas are a group of diseases caused by malignant lymphocytes that accumulate in lymph nodes and other lymphoid tissue and cause the characteristic clinical feature of lymphadenopathy. The major subdivision of lymphomas is into Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) and this is based on the histological presence of Reed-Sternberg cells present in HL. Hodgkin lymphoma can present at any age but is rare in children and has a peak incidence in young adults. There is an almost 2 : 1 male predominance. Most patients present with painless, asymmetrical, firm and discrete enlargement of superficial lymph nodes. Cervical nodes are involved in 60-70% of cases, axillary nodes in 10-15% and inguinal nodes in 6-12%. Modest splenomegaly occurs during the course of the disease in 50% of patients; the liver may also be enlarged. Bone marrow failure involvement is unusual in early disease. The prognosis depends on age, stage and histology, but overall approximately 85% of patients are cured. Alcohol‐induced pain and pruritus are two well‐known but rare symptoms in HL.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 131
Correct
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The most common type of adult leukaemia is chronic lymphocytic leukaemia (CLL). It develops as a result of lymphocyte clonal proliferation. Which of the following statements about CLL is CORRECT?
Your Answer: It is most commonly discovered as an incidental finding
Explanation:CLL (chronic lymphocytic leukaemia) is the most common type of chronic lymphoid leukaemia, with a peak incidence between the ages of 60 and 80. It is the most common type of leukaemia in Europe and the United States, but it is less common elsewhere.
The CLL tumour cell is a mature B-cell with low immunoglobulin surface expression (IgM or IgD). The average age at diagnosis is 72 years, with only 15% of cases occurring before the age of 50.
The male-to-female ratio is about 2:1. Over 80% of cases are identified by the results of a routine blood test, which is usually performed for another reason.
Lymphocytic anaemia, thrombocytopenia, and normochromic normocytic anaemia are common laboratory findings. Aspiration of bone marrow reveals up to 95% lymphocytic replacement of normal marrow elements.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 132
Correct
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C-reactive protein (CRP) synthesis is predominantly stimulated by which of the following cytokines:
Your Answer: IL-6
Explanation:Activated leukocytes, adipocytes, and endothelial cells all release interleukin 6 (IL-6), a significant proinflammatory cytokine. The main downstream mediator of the acute phase response is C-reactive protein, which is predominantly produced by IL-6–dependent hepatic biosynthesis.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 133
Correct
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A newborn baby is rushed to the neonatal ICU 4 hours after birth due to sudden onset severe jaundice and generalised oedema. Family history reveals that this is the second baby, while blood testing shows that the mother has an Rh-negative blood group while the baby is Rh-positive. A diagnosis of haemolytic disease of the newborn is established.
Which one of the following hypersensitivity reactions have occurred in this case?Your Answer: Type II hypersensitivity reaction
Explanation:Hepatitis A usually doesn’t pose a special risk to a pregnant woman or her baby. Maternal infection doesn’t result in birth defects, and a mother typically doesn’t transmit the infection to her baby. HAV is almost always transmitted by the faecal-oral route and is usually acquired through close personal contact or via contaminated food.
When a woman has chickenpox in the first 20 weeks of pregnancy, there is a 1 in 50 chance for the baby to develop a set of birth defects. This is called the congenital varicella syndrome. It includes scars, defects of muscle and bone, malformed and paralyzed limbs, small head size, blindness, seizures, and intellectual disability.
TORCH Syndrome refers to infection of a developing foetus or newborn by any of a group of infectious agents. “TORCH” is an acronym meaning (T)oxoplasmosis, (O)ther Agents, (R)ubella (also known as German Measles), (C)ytomegalovirus, and (H)erpes Simplex.
Infection with any of these agents may cause a constellation of similar symptoms in affected newborns. These may include fever; difficulties feeding; small areas of bleeding under the skin, causing the appearance of small reddish or purplish spots; enlargement of the liver and spleen (hepatosplenomegaly); yellowish discoloration of the skin, whites of the eyes, and mucous membranes (jaundice); hearing impairment; abnormalities of the eyes; and other symptoms and findings. -
This question is part of the following fields:
- General Pathology
- Pathology
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Question 134
Correct
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Regarding disseminated intravascular coagulation (DIC), which of the following statements is INCORRECT:
Your Answer: Thrombocytosis results in widespread platelet aggregation.
Explanation:DIC is characterised by a widespread inappropriate intravascular deposition of fibrin with consumption of coagulation factors and platelets. This may occur as a consequence of many disorders that release procoagulant material into the circulation or cause widespread endothelial damage or platelet aggregation. Increased activity of thrombin in the circulation overwhelms its normal rate of removal by natural anticoagulants. In addition to causing increased deposition of fibrin in the microcirculation and widespread platelet aggregation to the vessels, intravascular thrombin formation interferes with fibrin polymerisation. Intense fibrinolysis is stimulated by thrombi on vascular walls and the release of fibrin degradation products again interferes with fibrin polymerisation. The combined action of thrombin and plasmin causes depletion of fibrinogen and all coagulation factors, compounded by thrombocytopaenia caused by platelet consumption.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 135
Correct
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A 26-year-old female cuts her hand on a knife while preparing dinner but the bleeding stops within a few minutes.
Which one of the following cells will be among the first to be present at the wound site to be involved in haemostasis?Your Answer: Platelets
Explanation:Platelets are the first cells to be attracted to the wound site due to the release of the Von Willebrand factor from the damaged endothelium. Platelets, in turn, release cytokines such as platelet-derived growth factor, which will attract other inflammatory cells to the wound site.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 136
Correct
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The following statements about leukotrienes as chemical mediators of the acute inflammatory response are all true EXCEPT?
Your Answer: They decrease vascular permeability
Explanation:Leukotrienes increases (not decrease) vascular permeability during acute inflammation.
All the other statements are correct
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 137
Correct
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Regarding acute lymphoblastic leukaemia (ALL), which of the following statements is CORRECT:
Your Answer: 75% of cases occur before the age of 6 years.
Explanation:Acute lymphoblastic leukaemia (ALL) is caused by an accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood. The incidence of ALL is highest at 3 – 7 years, with 75% of cases occurring before the age of 6. 85% of cases are of B-cell lineage. Haematological investigations reveal a normochromic normocytic anaemia with thrombocytopenia in most cases. There is great variation in the chance of individual patients achieving a long-term cure based on a number of biological variables. Approximately 25% of children relapse after first-line therapy and need further treatment but overall 90% of children can expect to be cured. The cure rate in adults drops significantly to less than 5% over the age of 70 years.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 138
Correct
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A 66-year-old male is brought to your clinic by his wife with the complaint of increasing confusion and disorientation over the past three days, along with decreased urination. She reports that he has been complaining of increasing pain in his back and ribs over the past three months.
On examination, the patient looks anaemic, is not oriented in time, place and person and has tenderness on palpation of the lumbar spine and the 10th, 11th and 12th ribs.
Blood tests show anaemia which is normocytic, normochromic, raised urea and creatinine and hypercalcemia.
Which one of the following diagnoses is most likely in this case?Your Answer: Multiple myeloma
Explanation:Multiple myeloma is a clonal abnormality affecting plasma cells in which there is an overproduction of functionless immunoglobulins. The most common patient complaint is bone pain, especially in the back and ribs. Anaemia and renal failure are common, along with hypercalcemia. Hypercalcemia may lead to an altered mental status, as in this case.
Chronic lymphocytic leukaemia occurs due to the overproduction of lymphocytes, usually B cells. CLL may present with an asymptomatic elevation of B cells. Patients are generally more than 50 years old and present with non-specific fatigue and weight loss symptoms.
There is no history of alcohol abuse in this case. Furthermore, patients with a history of alcohol abuse may have signs of liver failure, which are not present here.
Metastatic prostate cancer would most often cause lower backache as it metastasises first to the lumbar spine via the vertebral venous plexus.
A patient with Vitamin B12 deficiency would have anaemia, megaloblastic, hypersegmented neutrophils, and signs of peripheral neuropathy.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 139
Correct
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A 22-year-old man arrives at the emergency department with a sore throat, low-grade fever, and malaise. His partner has infectious mononucleosis, which was recently diagnosed. In this situation, which of the following cells is the most proliferative:
Your Answer: Lymphocytes
Explanation:Histologic findings in EBV infectious mononucleosis: Oropharyngeal epithelium demonstrates an intense lymphoproliferative response in the cells of the oropharynx. The lymph nodes and spleen show lymphocytic infiltration primarily in the periphery of a lymph node.
Relative lymphocytosis (≥ 60%) plus atypical lymphocytosis (≥ 10%) are the characteristic findings of Epstein Barr virus (EBV) infectious mononucleosis. -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 140
Correct
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A 60-year-old female presents with fatigue, easy bruising and repeated chest and skin infections for five months. She also complains about several episodes of nosebleeds over the last few days without any history of trauma.
Her complete blood count shows the following results:
Hb 9 g/dl
Total leukocyte count: 2.5x10^9/L, 1100 neutrophils/ųL
MCV 100
platelet count of 90,000/ųL.
Which one of the following conditions does this patient most likely have?Your Answer: Myelodysplastic syndrome
Explanation:Myelodysplastic syndromes are a group of clonal haematopoietic disorders which are characterised by anaemia, leukopenia and thrombocytopenia.
Patients will complain of fatigue, symptoms of thrombocytopenia such as nosebleeds and easy bleeding and a history of repeated infections due to low white blood cells (especially Neutrophils).
In Chronic lymphocytic leukaemia production of hematopoietic cells goes on for a longer time.
Folate and B12 deficiency would result in hypersegmented neutrophils and a raised MCV.
Iron deficiency anaemia would not cause neutropenia or thrombocytopenia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 141
Correct
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You see a 30-year-old man who has come to the department with a very tender right elbow. On examination, the elbow is very hot and red, and appears to be acutely inflamed.
Which SINGLE statement regarding acute inflammation is FALSE?Your Answer: Reduced extravascular osmotic pressure leads to oedema
Explanation:Inflammation can be divided intoacute inflammation, which occurs over seconds, minutes, hours, and days, andchronic inflammation, which occurs over longer periods.
Acute inflammationcommences within seconds or minutes following the injury of tissues. There are numerous potential stimuli for an acute inflammatory response including infections (bacterial, viral, fungal, parasitic), tissue necrosis, foreign bodies, and Immune reactions (hypersensitivity reactions). The chief cell type of acute inflammation is the neutrophil.
There are three main processesthat occur in the acute inflammatory response:
Increased blood flow
Increased capillary permeability
Neutrophil migration
1. Increased blood flow:
Vasoactive mediators are released, such as nitric oxide, histamine, bradykinins, and prostaglandin E2. These mediators cause vasodilatation and increased blood flow to the area (causing redness and heat).
2. Increased capillary permeability:
The vasoactive mediators also cause increased capillary permeability by causing endothelial cell contraction that widens the intercellular gaps of venules. This allows an outpouring of protein-rich fluid (exudate) into the extracellular tissues that results in a reduction of intravascular osmotic pressure and an increase in extravascular/interstitial pressure. The increased interstitial osmotic pressure leads to oedema.
3. Neutrophil migration:
Neutrophils leave the vasculature through the following sequence of events:
Margination and rolling: neutrophils flow nearer the vessel wall, rather than in the axial stream, which is referred to as margination. Following margination the neutrophils begin rolling along the surface of the vascular endothelium.
Activation and adhesion: then as a result of interaction with endothelial cell adhesion molecules (CAMs) that is mediated by selectins, the neutrophils are activated and adhere to the endothelium.
Transmigration: once bound to the endothelium, neutrophils squeeze through gaps between adjacent endothelial cells into the interstitial fluid, in a process calleddiapedesis. -
This question is part of the following fields:
- General Pathology
- Pathology
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Question 142
Correct
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Regarding red blood cell group antigens and antibodies, which of the following statements is CORRECT:
Your Answer: Anti-D antibodies are usually IgG.
Explanation:Approximately 400 red blood cell group antigens have been described. The ABO group antigens are unusual in that naturally occurring antibodies occur in the plasma of subjects who lack the corresponding antigen, even if they have not been exposed to that antigen previously. The most important of these natural antibodies are anti-A and anti-B, which are usually IgM. Anti-D antibodies don’t occur naturally, and are therefore immune antibodies that result from previous transfusions or pregnancy. Only IgG antibodies are capable of transplacental passage and the most important immune antibody is the Rh antibody, anti-D.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 143
Incorrect
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A 79-year-old male had a humeral shaft fracture during a road traffic accident and is being followed up in a fracture clinic. He complains of inability to use the limb 6 months after the injury. X-rays of that arm shows non union of his fracture.
All the following are responsible for this non-union EXCEPT?Your Answer: Movement at fracture site
Correct Answer: Osteoporosis
Explanation:An imbalance between bone resorption and formation is Osteoporosis. In normal bone, formation and resorption are roughly equal, and the density of bone matrix remains constant but there is more resorption in osteoporosis and the matrix density reduces and bones become weaker. Fractures are more likely to occur but healing is unaffected.
Non-union of a fracture occurs when the two sides of a fracture fail to unite after 6 months. Causes include: infection, movement at the fracture site, avascular necrosis, tissue interposed between the fracture and gross misalignment.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 144
Incorrect
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Approximately what proportion of lymphocytes are B-cells:
Your Answer: 0.35
Correct Answer: 0.2
Explanation:B-cells (20% of lymphocytes) mature in the bone marrow and circulate in the peripheral blood until they undergo recognition of antigen. B-cell immunoglobulin molecules synthesised in the cell are exported and bound to the surface membrane to become the B-cell receptor (BCR) which can recognise and bind to a specific antigen (either free or presented by APCs). The BCR is also important for antigen internalisation, processing and presentation to T helper cells. Most antibody responses require help from antigen-specific T helper cells (although some antigens such as polysaccharide can lead to T-cell independent B-cell antibody production). When the B-cell is activated, the receptor itself is secreted as free soluble immunoglobulin and the B-cell matures into a memory B-cell or a plasma cell (a B-cell in its high-rate immunoglobulin secreting state). Plasma cells are non-motile and are found predominantly in the bone marrow or spleen. Most plasma cells are short-lived (1 – 2 weeks) but some may survive much longer. A proportion of B-cells persist as memory cells, whose increased number and rapid response underlies the augmented secondary response of the adaptive immune system.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 145
Incorrect
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A 60-year-old female is referred to the Oncology clinic due to the presence of lumps in her neck. There is a non-tender enlargement of several groups of cervical lymph nodes on examination. She is sent for a lymph node biopsy. The results show the presence of lymphoma cells, but there are no Reed-Sternberg cells.
Which one is most appropriate for this case out of the following diagnoses?Your Answer: Chronic lymphocytic leukaemia
Correct Answer: Non-Hodgkin’s lymphoma
Explanation:Non-Hodgkin’s Lymphoma (NHL) causes neoplastic transformation of both B cell (85%) and T cell (15%) lines.
The most common presentation is with enlarged, rubbery, painless lymph nodes. The patient may also have B symptoms which consist of night sweats, weight loss and fevers. Multiple myeloma most commonly presents with bone pain, especially in the back and ribs.
The presence of Reed-Sternberg cells characterises Hodgkin’s lymphoma. Acute lymphoblastic leukaemia will present with features of anaemia, thrombocytopenia and leukopenia. The most common symptoms of chronic lymphocytic leukaemia are fatigue, night sweats and low-grade fever.
The peak incidence of NHL is in the 50-70 years age group, it affects men and women equally, but affects the Caucasian population more commonly than black and Asian ethnic groups.
The following are recognised risk factors for NHL:
Chromosomal translocations and molecular rearrangements
Epstein-Barr virus infection
Human T-cell leukaemia virus type-1 (HTLV-1)
Hepatitis C
Congenital and acquired immunodeficiency states
Autoimmune disorders, e.g. Sjogren’s syndrome and Hashimoto’s thyroiditis -
This question is part of the following fields:
- Haematology
- Pathology
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Question 146
Incorrect
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A 54-year-old man who is acutely unwell has his blood sent for test and the results come back with a CRP of 115.
Which of these statements about C-reactive protein is FALSE?
Your Answer: It can be used to monitor infections
Correct Answer: It is produced in the bone marrow
Explanation:C-reactive protein(CRP) is synthesized in the liver in response to increased interleukin-6 (IL-6) secretion by macrophages and T-cells.
Some conditions that cause CRP levels to a rise include: bacterial infection, fungal infection, severe trauma, autoimmune disease, Organ tissue necrosis, malignancy and surgery.It is useful in the clinical setting as a marker of inflammatory activity and can be used to monitor infections.
CRP levels start to rise 4-6 hours after an inflammatory trigger and reaches peak levels at 36-50 hours.
In the absence of a disease process, the normal plasma concentration is less than 5 mg/l.
CRP is useful for monitoring inflammatory conditions (e.g. rheumatoid arthritis and malignancy), can be used as a prognostic marker in acute pancreatitis, and serial measurement can be used to recognize the onset of nosocomial infections in the intensive care settling.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 147
Incorrect
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Which of the following statements about neutrophils is TRUE:
Your Answer: TNF-alpha inhibits neutrophil chemotaxis.
Correct Answer: Neutrophils are typically the first immune cell to arrive to a site of injury.
Explanation:Neutrophils are the most numerous peripheral blood leukocytes, accounting for 50-70 percent of all circulating white cells. Neutrophils have a compact nucleus with two to five lobes and a pale cytoplasm with an irregular shape containing numerous fine pink-blue or grey-blue granules. The granules are classified as primary, which emerges during the promyelocyte stage, and secondary, which develop at the myelocyte stage and predominate in the mature nucleus.
The lifespan of neutrophils in the blood is only 6 – 10 hours. In response to tissue damage, cytokines and complement proteins, neutrophils migrate from the bloodstream to the site of insult within minutes, where they destroy pathogens by phagocytosis.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 148
Correct
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The most important Complement protein for antigen opsonization is:
Your Answer: C3b
Explanation:Phagocytosis is largely responsible for depletion of cells coated with antibodies. Cells opsonized by IgG antibodies are recognized by phagocyte Fc receptors, which are specific for the Fc portions of some IgG subclasses. In addition, when IgM or IgG antibodies are deposited on the surfaces of cells, they may activate the complement system by the classical pathway. Complement activation generates by-products, mainly C3b and C4b, which are deposited on the surfaces of the cells and recognized by phagocytes that express receptors for these proteins. The net result is phagocytosis of the opsonized cells and their destruction.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 149
Incorrect
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Regarding myeloma, which of the following statements is CORRECT:
Your Answer: Myeloma is most common in Caucasian populations.
Correct Answer: Myeloma is associated with marked rouleaux formation on blood film.
Explanation:98% of cases of myeloma occur over the age of 40 years with a peak incidence between 65 and 70 years. The disease is twice as common in black individuals compared to those of white or Asian origin. Laboratory findings include presence of a paraprotein in serum/urine (the paraprotein is IgG in 60% of cases, IgA in 20% and light chain only in almost all the rest) and marked Rouleaux formation on blood film. There is no cure for myeloma. The overall median survival is now 7-10 years and in younger (less than 50 years) patients it can be over 10 years.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 150
Correct
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A 40-year-old woman presents with a red, scaly, itchy rash around her navel that occurred after contact with a nickel belt buckle. A diagnosis of allergic contact dermatitis is made. Which type of hypersensitivity reaction is this?
Your Answer: Type IV hypersensitivity reaction
Explanation:A type IV hypersensitivity reaction occurred in this patient. Allergic contact dermatitis is an inflammatory skin reaction occurring in response to an external stimulus, acting either as an allergen or an irritant, caused by a type IV or delayed hypersensitivity reaction. They usually take several days to develop.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 151
Correct
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Regarding basophils, which of the following statements is INCORRECT:
Your Answer: They are the second most common type of granulocyte.
Explanation:Basophils are only occasionally seen in normal peripheral blood comprising < 1% of circulating white cells. However, they are the largest type of granulocyte. They have many dark cytoplasmic granules which overlie the nucleus and contain heparin and histamine. They have immunoglobulin E (IgE) attachment sites and their degranulation is associated with histamine release. Basophils are very similar in both appearance and function to mast cells.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 152
Incorrect
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A 1-year-old male is brought to the paediatrician by his mother due to swelling of the right knee after a minor fall. On examination, the right knee is swollen, fluctuant and tender. Ultrasound-guided aspiration reveals a massive hemarthrosis. Family history shows that his older brother also has a bleeding disorder.
Which one of the following conditions does the patient most likely have?Your Answer: Glucose-6-phosphate dehydrogenase (G6PD) deficiency
Correct Answer: Haemophilia A
Explanation:A diagnosis of Haemophilia is supported in this patient by the family history and the presence of hemarthrosis-both characteristics of Haemophilia. Haemophilia A is caused by Factor VIII deficiency, leading to impaired coagulation. This disease typically presents after six months when the child starts crawling.
Von Willebrand disease presents with nosebleeds and hematomas. Idiopathic thrombocytopenic purpura presents with bruises that resemble a rash.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency presents with haemolytic anaemia induced by specific drugs or foods.
Factor V Leiden mutation causes blood clotting rather than bleeding.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 153
Incorrect
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A 69-year-old woman with new-onset back pain was diagnosed with osteopenia, osteolytic lesions, and vertebral collapse after undergoing a radiographic examination. Her laboratory results revealed anaemia and hypercalcemia. These findings most likely indicate what condition?
Your Answer: Acute myeloid leukaemia
Correct Answer: Myeloma
Explanation:Bone pain, pathologic fractures, weakness, anaemia, infection, hypercalcemia, spinal cord compression, and renal failure are all signs and symptoms of multiple myeloma (MM). The patient’s condition matched the signs and symptoms of myeloma.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 154
Incorrect
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Which one these is an example of a cause of an exudate?
Your Answer: Congestive cardiac failure
Correct Answer: Subphrenic abscess
Explanation:An exudate is an inflammatory fluid emanating from the intravascular space due to changes in the permeability of the surrounding microcirculation.
Some common causes of exudates are: pneumonia, empyema, lung cancer, breast cancer, cancer of the pleura, SLE, rheumatoid arthritis, pericarditis, subphrenic abscess, chylothorax.
Myxoedema, nephrotic syndrome, congestive cardiac failure, and liver cirrhosis all cause TRANSUDATE.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 155
Incorrect
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A dermatological examination on a patient presenting with a lump shows a small visible skin elevation containing an accumulation of pus.
Which one of these best describes the lump you have found on examination?Your Answer: Carbuncle
Correct Answer: Pustule
Explanation:A pustule is a small visible skin elevation containing an accumulation of pus.
A carbuncle is a collection of individual boils clustered together.
A bulla is a visible collection of clear fluid measuring greater than 0.5 cm in diameter.
A furuncle, or boil, is a pyogenic infection of the hair follicle commonly caused by infection with Staphylococcus aureus.
A vesicle is a visible collection of fluid measuring less than 0.5 cm in diameter.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 156
Incorrect
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Which of the following is the most abundant immunoglobulin in plasma:
Your Answer: IgM
Correct Answer: IgG
Explanation:IgA is the major Ig in secretions, particularly from the gastrointestinal tract (but also in saliva, tears, sweat and breast milk).
IgE is important for mast cell degranulation in allergic and antiparasitic response. In the allergic response, the plasma cell produces IgE-antibodies, which, like antibodies of other immunoglobulin isotypes, are capable of binding a specific allergen via its Fab portion.
IgG is the most abundant in plasma (comprising 80% of normal serum immunoglobulin) and the main circulatory Ig for the secondary immune response. -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 157
Incorrect
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Regarding cytotoxic T cells, which of the following statements is CORRECT:
Your Answer: They form the majority of the circulating T-cell population.
Correct Answer: They kill target cells by inducing cell apoptosis.
Explanation:CD8+ T-cells (Cytotoxic T cells)
Recognise antigen only in association with HLA Class I molecules (found on all nucleated cells; present endogenous antigens such as those found in cells infected by viruses or intracellular bacteria.)
Comprise about 25% of peripheral T-cells
Responsible for cytotoxic killing of target cells -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 158
Incorrect
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A 66-year-old male presents to his family physician with the complaint of increasing fatigue and lethargy, along with itching, especially after a hot bath. He also complains of increased sweating and dizziness. On examination, he has a plethoric appearance. Abdominal examination shows the presence of splenomegaly. A basic panel of blood tests is ordered in which her Hb comes out to be 17 g/dL.
Which one of the following treatment options will be most suitable in this case?Your Answer: No treatment is available
Correct Answer: Venesection
Explanation:The clinical and laboratory findings, in this case, support a diagnosis of polycythaemia vera. A plethoric appearance, lethargy, splenomegaly and itching are common in this disease. Patients may also have gouty arthritis, Budd-Chiari syndrome, erythromelalgia, stroke, myocardial infarction or DVT. The average age for diagnosis of Polycythaemia Vera is 65-74 years. It is a haematological malignancy in which there is overproduction of all three cell lines. Venesection is the treatment of choice as it would cause a decrease in the number of red blood cells within the body.
Erythropoietin is given in patients with chronic renal failure as they lack this hormone. Administration of erythropoietin in such patients causes stimulation of the bone marrow to produce red blood cells.
Desferrioxamine is a chelating agent for iron and is given to patients with iron overload due to repeated blood transfusions, e.g. in thalassemia patients.
Penicillamine is a chelating agent for Copper, given as treatment in Wilson’s disease.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 159
Incorrect
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Which of the following does NOT typically cause a neutrophil leucocytosis:
Your Answer: Acute appendicitis
Correct Answer: Glandular fever
Explanation:Causes of neutrophil leucocytosis:
Bacterial infection
Inflammation and tissue necrosis (e.g. cardiac infarct, trauma, vasculitis, myositis)
Metabolic disorders (e.g. uraemia, acidosis, eclampsia, gout)
Pregnancy
Acute haemorrhage or haemolysis
Neoplasms of all types
Drugs (e.g. corticosteroid therapy, lithium, tetracyclines)
Asplenia
Myeloproliferative disorders (e.g. CML, essential thrombocythaemia, polycythaemia vera, myelofibrosis)
Rare inherited disorders -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 160
Incorrect
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A patient presents with a lump for a dermatological examination. There is a circumscribed skin elevation measuring 0.3 cm in diameter seen on examination.
Which one of these best describes the lump you have found on examination?Your Answer: Pustule
Correct Answer: Papule
Explanation:A papule is a solid, well circumscribed, skin elevation measuring less than 0.5 cm in diameter.
A nodule is a solid, well circumscribed, raised area that lies in or under the skin and measures greater than 0.5 cm in diameter. They are usually painless.
A bulla is a visible collection of clear fluid measuring greater than 0.5 cm in diameter.
A furuncle, or boil, is a pyogenic infection of the hair follicle commonly caused by infection with Staphylococcus aureus.
A pustule is a small visible skin elevation containing an accumulation of pus.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 161
Incorrect
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A 18 year old male presents to the GP with painless asymmetrical cervical lymphadenopathy. Histological examination of a biopsied lymph node demonstrates Reed-Sternberg cells. What is the most likely diagnosis:
Your Answer: Multiple Myeloma
Correct Answer: Hodgkin lymphoma
Explanation:Hodgkin’s lymphoma is a malignant tumour of the lymphatic system that is characterised histologically by the presence of Reed-Sternberg cells (multinucleated giant cells). The peak incidence is in young adults aged 20-35, and there is a slight male predominance.
The following are recognised risk factors for Hodgkin’s lymphoma:
Male gender
Age 20-35
Positive family history
Epstein-Barr virus infection
Immunosuppression including HIV infection
Prolonged use of human growth hormone
Most patients present with an enlarged, but otherwise asymptomatic lymph node. The most commonly affected lymph nodes are in the supraclavicular and lower cervical areas. Other common clinical features include shortness of breath and chest discomfort secondary to mediastinal mass. Mediastinal masses are sometimes discovered as incidental findings on routine chest X-rays. Approximately 30% of patients with Hodgkin’s lymphoma develop splenomegaly.
‘B’ symptoms occur in approximately 25% of patients. The ‘B’ symptoms of Hodgkin’s lymphoma are:
Fever (>38ºC)
Night sweats
Weight loss (>10% over 6 months)
Pain after alcohol consumption is a pathognomonic sign of Hodgkin’s lymphoma, it is, however, not a ‘B’ symptom. It is rare though, only occurring in 2-3% of patients with Hodgkin’s lymphoma.The Ann Arbour clinical staging is as follows:
Stage I: one involved lymph node group
Stage II two involved lymph node groups on one side of the diaphragm
Stage III: lymph node groups involved on both sides of the diaphragm
Stage IV: Involvement of extra-nodal tissues, such as the liver or bone marrow
Diagnosis is made by lymph node biopsy, which should be taken from a sufficiently large specimen or excisional biopsy, as opposed to a fine needle biopsy. The Reed-Sternberg cell is the most useful diagnostic feature. This is a giant cell with twin mirror-image nuclei and prominent ‘owl’s eye’ nucleoli.
The Reed-Sternberg cell of Hodgkin’s Lymphoma
Histological typing depends upon the other cells within the diseased tissue. Nodular sclerosing is the most common type of Hodgkin’s lymphoma. Lymphocyte-depleted and lymphocyte-predominant are rare subtypes.
The majority of cases can be successfully treated, and unlike many other malignancies even if the first-line treatment fails, a cure can often be achieved with second-line therapies. Stage 1 Hodgkin’s lymphoma is usually treated with radiotherapy alone, but more advanced stages require combination chemotherapy. In localised disease treated with irradiation, there is a 5-year survival rate of greater than 80%. In disseminated disease treated with chemotherapy, the 5-year survival falls to around 50%. Overall, a 5-year survival of >70% should be achieved. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 162
Correct
-
Regarding haemophilia A, which of the following statements is INCORRECT:
Your Answer: In haemophilia both the APTT and PT are prolonged.
Explanation:Haemophilia A is the most common of the hereditary clotting factor deficiencies. The inheritance is sex-linked but up to one-third of patients have no family history and these cases result from recent mutation. The vast majority of cases are inherited in an X-linked recessive fashion, affecting males born to carrier mothers. Females born to affected fathers can also, rarely, be affected due to homozygosity for the gene, where there is marriage to close relatives.
The defect is an absence or low level of plasma factor VIII. The APTT is prolonged but the PT is normal. Recurrent painful haemarthroses and muscle haematomas dominate the clinical course of severely affected patients and if inadequately treated, lead to progressive joint deformity and disability. Local pressure can cause entrapment neuropathy or ischaemic necrosis. Prolonged bleeding occurs after dental extractions or post-trauma. Spontaneous haematuria and gastrointestinal haemorrhage may occur. The clinical severity of the disease correlates inversely with the factor VIII level. Operative and post-traumatic haemorrhage are life-threatening both in severely and mildly affected patients.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 163
Correct
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In all of the following conditions, lymphocytosis typically occurs except for:
Your Answer: Corticosteroid therapy
Explanation:In infants and young children, lymphocytosis often occurs in response to infections that would normally produce a neutrophil reaction in adults.
Lymphocytosis occurs in:
1. Viral infections (e.g. infectious mononucleosis, HIV, rubella, mumps, viral hepatitis, cytomegalovirus, herpes simplex or zoster)
2. Bacterial infections (e.g. pertussis, tuberculosis, toxoplasmosis, syphilis)
3. Chronic lymphoid leukaemias
4. Acute lymphoblastic leukaemias
5. Non-Hodgkin lymphoma
6. Thyrotoxicosis -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 164
Incorrect
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Regarding apoptosis, which of the following statements is INCORRECT:
Your Answer: Apoptosis leads to the formation of membrane-bound apoptotic bodies.
Correct Answer: Apoptosis leads to cell swelling and eventual cell lysis.
Explanation:Apoptosis is a controlled form of cell death in which no cellular contents are released from the dying cell, and thus no inflammatory reaction is seen. Apoptosis may occur physiologically or pathologically. Apoptosis may be induced in two main ways: by the engagement of surface death receptors e.g. TNF-alpha (extrinsic pathway) or through cellular injury (intrinsic pathway). The end result is the activation of proteases enzymes called caspases which dismantle the cell cytoplasm and nucleus. Apoptotic cells shrink down and fragment into apoptotic bodies, each of which retains an intact cell membrane; apoptotic bodies are then targeted or rapid removal by adjacent cells. Disordered apoptosis is thought to be central to a number of important disease processes, particularly carcinogenesis.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 165
Correct
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While on morning rounds in the medical ward, the attending physician asks a medical student about the differences between transudates and exudates and their causes. The student explains that a transudate is an excess fluid that leaks out of an intravascular compartment due to an imbalance between oncotic and hydrostatic pressures.
Which ONE of the following conditions will he mention as the cause of a transudate?Your Answer: Meig’s syndrome
Explanation:Transudative effusions are caused due to systemic causes leading to increased hydrostatic pressure or decreased oncotic pressure. These include:
1) Meig’s Syndrome (Ovarian tumour causing ascites and pleural effusion)
2) Congestive heart failure
3) Nephrotic Syndrome
4) Myxoedema
5) Cirrhosis
6) SarcoidosisAn exudate is caused by local inflammation and results from increased vascular permeability. Causes include:
1) Rheumatoid arthritis
2) Pneumonia leading to empyema
3) Malignancies
4) Pericarditis -
This question is part of the following fields:
- General Pathology
- Pathology
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Question 166
Incorrect
-
Fibrinoid necrosis is typically seen in which of the following:
Your Answer: Myocardial infarction
Correct Answer: Malignant hypertension
Explanation:Fibrinoid necrosis occurs in malignant hypertension where increased arterial pressure results in necrosis of smooth muscle wall. Eosinophilic and fibrinous deposits are seen.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 167
Incorrect
-
A 43 year old lady suffering with idiopathic thrombocytopenic purpura has a splenectomy. She is advised to get the Pneumococcal vaccine booster every 5 - 10 years as Streptococcus pneumoniae has which of the following properties that make her prone to infection to this organism?
Your Answer: It causes pneumonia
Correct Answer: It is encapsulated
Explanation:There is a lifelong susceptibility to increased risk of infection from a variety of organisms in patients with hyposplenism, especially in children under 5 years and those with sickle cell anaemia. Patients are most susceptible is to the encapsulated bacteria Streptococcus pneumoniae, Haemophilus influenzae type B and Neisseria meningitidis. Streptococcus pneumoniae is particular concerning as it can cause rapid and fulminant disease, which can be fatal. Malaria and animal bites that become infected also tend to be more severe.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 168
Incorrect
-
C5 - C9 deficiency increases susceptibility to infection with which of the following:
Your Answer: Candida
Correct Answer: Neisseria spp.
Explanation:If the complement sequence is completed, an active phospholipase (the membrane attack complex, MAC) is produced, which punches holes in the cell membrane and causes cell lysis. Because the MAC appears to be the sole means to destroy the Neisseria family of bacteria, C5 – C9 deficiency increases susceptibility to Neisseria infections.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 169
Incorrect
-
Which of the following is NOT a common clinical manifestation of sickle cell disease?
Your Answer: Hand-foot syndrome
Correct Answer: Iron deficiency
Explanation:Signs and symptoms of Sickle cell disease(SCD):
Acute and chronic pain: The most common clinical manifestation of SCD is vaso-occlusive crisis; pain crises are the most distinguishing clinical feature of SCD
Bone pain: Often seen in long bones of extremities, primarily due to bone marrow infarction
Anaemia: Universally present, chronic, and haemolytic in nature
Aplastic crisis: Serious complication due to infection with parvovirus B19 (B19V)
Splenic sequestration: Characterized by the onset of life-threatening anaemia with rapid enlargement of the spleen and high reticulocyte count
Infection: Organisms that pose the greatest danger include encapsulated respiratory bacteria, particularly Streptococcus pneumoniae; adult infections are predominantly with gram-negative organisms, especially Salmonella
Growth retardation, delayed sexual maturation, being underweight
Hand-foot syndrome: This is a dactylitis presenting as bilateral painful and swollen hands and/or feet in children
Acute chest syndrome: Young children present with chest pain, fever, cough, tachypnoea, leucocytosis, and pulmonary infiltrates in the upper lobes; adults are usually afebrile, dyspnoeic with severe chest pain, with multilobar/lower lobe disease
Pulmonary hypertension: Increasingly recognized as a serious complication of SCD
Avascular necrosis of the femoral or humeral head: Due to vascular occlusion
Central nervous system (CNS) involvement: Most severe manifestation is stroke
Ophthalmologic involvement: Ptosis, retinal vascular changes, proliferative retinitis
Cardiac involvement: Dilation of both ventricles and the left atrium
Gastrointestinal involvement: Cholelithiasis is common in children; liver may become involved
Genitourinary involvement: Kidneys lose concentrating capacity; priapism is a well-recognized complication of SCD
Dermatologic involvement: Leg ulcers are a chronic painful problem -
This question is part of the following fields:
- Haematology
- Pathology
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Question 170
Incorrect
-
A 57-year-old woman has presented with cough and shortness of breath. Her GP had done some blood tests recently and told her that she had a positive ANA result.
Which of these statements is true about anti-nuclear antibodies (ANAs)? Select only ONE answer.
Your Answer: Speckled staining is suggestive of lupus
Correct Answer: The presence of ANAs in rheumatoid arthritis is suggestive of Felty’s syndrome
Explanation:Anti-nuclear antibodies are auto-antibodies directed against a variety of nuclear antigens. There are different staining patterns and each pattern is suggestive of a different disorder.
Speckled staining is suggestive of mixed connective tissue disease.
Nucleolar staining is suggestive of scleroderma, while homogenous staining is suggestive of lupus.
Anti-double stranded DNA is suggestive of SLE while anti-histone antibodies are suggestive of drug-induced lupus.
ELISA testing is cheaper but not the most accurate means of testing for ANAs. Indirect immunofluorescence testing is the most accurate.
The presence of ANAs in rheumatoid arthritis is suggestive of Felty’s syndrome. Felty’s syndrome is characterized by a combination of rheumatoid arthritis, splenomegaly and neutropenia.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 171
Incorrect
-
The following are all examples of type IV hypersensitivity EXCEPT for:
Your Answer: Sarcoidosis
Correct Answer: Extrinsic allergic alveolitis
Explanation:Examples of type IV reactions includes:
Contact dermatitis
Hashimoto’s thyroiditis
Primary biliary cholangitis
Tuberculin skin test (Mantoux test)
Chronic transplant rejection
Granulomatous inflammation (e.g. sarcoidosis, Crohn’s disease) -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 172
Correct
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A 7-year-old girl is admitted to the hospital with a persistently high temperature. To help her reduce her fever, you decide to give her paracetamol and ibuprofen.
What are the effects of paracetamol and ibuprofen on fever?Your Answer: Reduction in prostaglandin synthesis
Explanation:Interleukin-1, which is released by leukocytes and acts on the thermoregulatory centre of the hypothalamus, causes fever. Because prostaglandins mediate this process, antipyretics such as NSAIDs, paracetamol, and aspirin reduce prostaglandin levels by inhibiting cyclooxygenase enzymes. Malignant disease secretes interleukins, which cause the B-symptoms seen in lymphoma, for example. Bacterial toxins can also cause interleukins to be produced.
Pyrexia of unknown origin (PUO) is defined as a fever of greater than 38.3 degrees Celsius that lasts for more than 2-3 weeks with no clear diagnosis despite extensive investigation.
Investigation necessitates a thorough understanding of the conditions that can cause febrile illness, which may be missed during an initial investigation, as well as a thorough history, examination, and investigation centred on that list.
Pyrexia of unknown origin has a wide differential diagnosis, which includes:
Infection
Bacterial
Pyogenic abscess
Tuberculosis
Infective endocarditis
Brucellosis
Lyme disease
Viral
HIV
Epstein Barr Virus
Cytomegalovirus
Parasite
Toxoplasmosis
Malignancy
Leukaemia
Lymphoma
Renal cell carcinoma
Hepatocellular carcinoma
Vasculitides
Still’s disease
Granulomatosis with polyangiitis (formerly Wegener’s)
Systemic lupus erythematosus
Giant cell arteritis
Rheumatoid arthritis
Polymyalgia rheumatica
Miscellaneous
Drug induced fevers
Familial Mediterranean fever
Thyrotoxicosis
Inflammatory bowel disease
Sarcoidosis
Factitious fever
Exaggerated normal circadian fluctuationThe patient might need to be admitted to the hospital for observation and further investigation. Because infection is still a possibility, blood cultures should be repeated on a regular basis, and inflammatory markers should be closely monitored. CT, PET, and MRI imaging have largely replaced diagnostic laparotomy as a diagnostic tool.
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This question is part of the following fields:
- Pathology
- Pathology Of Infections
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Question 173
Correct
-
Which of the following is NOT typically associated with eosinophilia:
Your Answer: Whooping cough
Explanation:An eosinophil leucocytosis is defined as an increase in blood eosinophils above 0.4 x 109/L.It is most frequently due to:
Allergic diseases (e.g. bronchial asthma, hay fever, atopic dermatitis, urticaria)
Parasites (e.g. hookworm, ascariasis, tapeworm, schistosomiasis)
Skin diseases (e.g. psoriasis, pemphigus, urticaria, angioedema)
Drug sensitivity -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 174
Incorrect
-
A 2nd-year medical student is solving an exam paper with questions about the immune system. She comes across a question regarding innate immunity. Innate immunity is the immunity naturally present within the body from birth.
Which ONE of the following is not a part of this type of immunity?Your Answer: The skin
Correct Answer: Antibody production
Explanation:Innate immunity, also called non-specific immunity, refers to the components of the immune system naturally present in the body at birth.
The components of innate immunity include:
1) Natural Killer Cells
2) Neutrophils
3) Macrophages
4) Mast Cells
5) Dendritic Cells
6) Basophils.Acquired or adaptive immunity is acquired in response to infection or vaccination. Although the response takes longer to develop, it is also a more long-lasting form of immunity.
The components of this system include:
1) T lymphocytes
2) B lymphocytes
3) Antibodies -
This question is part of the following fields:
- General Pathology
- Pathology
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Question 175
Incorrect
-
Which of the following clinical features is a feature of a chronic extravascular haemolytic anaemia:
Your Answer: Pica
Correct Answer: Gallstones
Explanation:Clinical features of haemolytic anaemia include:
Anaemia
Jaundice (caused by unconjugated bilirubin in plasma, bilirubin is absent from urine)
Pigment gallstones
Splenomegaly
Ankle ulcers
Expansion of marrow with, in children, bone expansion e.g. frontal bossing in beta-thalassaemia major
Aplastic crisis caused by parvovirus -
This question is part of the following fields:
- Haematology
- Pathology
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Question 176
Incorrect
-
A 23-year-old male presents to his family physician with the complaint of repeated episodes of abdominal pain and the passage of dark coloured urine every morning. He also reports increasing fatigue over the past several months. On examination, there are raised, painful red nodules over the skin of the back. Laboratory workup shows haemolytic anaemia, leukopenia and thrombocytopenia.
Which one of the following disorders is this patient most likely to have?Your Answer: Acute lymphoblastic leukaemia
Correct Answer: Paroxysmal nocturnal haemoglobinuria
Explanation:Paroxysmal nocturnal haemoglobinuria is an acquired genetic disorder that causes a decrease in red blood cells due to a membrane defect that allows increased complement binding to RBCs, causing haemolysis. Patients complain of dark-coloured urine first in the morning due to haemoglobinuria secondary to lysis of red blood cells overnight.
Thrombosis occurs, which affects hepatic, abdominal, cerebral and subdermal veins. Thrombosis of hepatic veins can lead to Budd-Chiari syndrome, thrombosis of subdermal veins can lead to painful nodules on the skin, and thrombosis of cerebral vessels can lead to stroke. The presence of dark urine in the morning only and at no other time differentiates this condition from other conditions.
Multiple myeloma would present with bone pain, signs of radiculopathy if there were nerve root compression and a history of repeated infections.
Patients with Non-Hodgkin Lymphoma would complain of enlarged lymph nodes, fatigue, fever, weight loss and a history of repeated infections.
Acute lymphoblastic leukaemia presents more commonly in children than in adults. The patient would complain of bone pain, and on examination, there would be hepatosplenomegaly.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 177
Incorrect
-
Which of the following is NOT a common myeloma laboratory finding:
Your Answer: Hypercalcaemia
Correct Answer: Elevated serum Bence-Jones protein
Explanation:Myeloma laboratory findings include:
– The presence of a paraprotein in serum or urine (the paraprotein is IgG in 60 percent of cases, IgA in 20 percent, and light chain only in almost all the rest),
– Increased serum immunoglobulin-free light chain proteins generated by plasma cells but not coupled with heavy chains
– Reduced IgG, IgA, and IgM levels in the blood (immune paresis)
– Anaemia, whether normochromic, normocytic, or macrocytic.
– On a blood film, a Rouleaux formation has been marked.
– In advanced illness, neutropenia and thrombocytopenia are common.
– ESR is high.
– Plasma cells in the bone marrow are overabundant, typically in aberrant forms. – Hypercalcemia
– Creatinine levels are high.
– Serum albumin levels are low in advanced illness.
60 percent of patients have osteolytic lesions, osteoporosis, or pathological fractures. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 178
Incorrect
-
Which of the following laboratory findings is NOT typical of von Willebrand disease (VWD):
Your Answer: Abnormal PFA-100
Correct Answer: Thrombocytopaenia
Explanation:Laboratory findings typically show (although this varies depending on VWD type):
Abnormal PFA-100 test
Low factor VIII levels (if low a factor VIII/VWF binding assay is performed)
Prolonged APTT (or normal)
Normal PT
Low VWF levels
Defective platelet aggregation
Normal platelet count -
This question is part of the following fields:
- Haematology
- Pathology
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Question 179
Incorrect
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In which of the following would you NOT typically see a neutropaenia:
Your Answer: Aplastic anaemia
Correct Answer: Asplenism
Explanation:Causes of neutropaenia:
Drug-induced (e.g. chemotherapy, chloramphenicol, co-trimoxazole, phenytoin, carbamazepine, carbimazole, furosemide, chloroquine, clozapine, some DMARDs)
Benign (racial or familial)
Cyclical
Immune (e.g. SLE, Felty’s syndrome, hypersensitivity and anaphylaxis)
Leukaemia
Infections (e.g. HIV, hepatitis, fulminant bacterial infection)
General Pancytopaenia
Hypersplenism, aplastic anaemia, malignant infiltration of bone marrow, megaloblastic anaemia, chemotherapy, myelodysplasia -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 180
Incorrect
-
A 13-year-old male presents to the Emergency Department with a heavy nosebleed. His medical record shows that he was diagnosed with Haemophilia B as a child.
What is the mode of inheritance of this disease?Your Answer: Autosomal dominant
Correct Answer: X-linked recessive
Explanation:Deficiency of Factor IX causes Haemophilia B, and like the other Haemophilia’s, it has an X-linked recessive pattern of inheritance, affecting males born to carrier mothers.
Haemophilia B is the second commonest form of haemophilia and is rarer than haemophilia A. Haemophilia B is similar to haemophilia A but is less severe. You can distinguish the two disorders by specific coagulation factor assays.
The incidence of Haemophilia B is one-fifth of that of haemophilia A.
In laboratory findings, you get prolonged APTT, normal PT and low factor IX for Haemophilia B.
There is also a variation called Leyden, in which factor IX levels are below 1% until puberty, when they rise, potentially reaching as high as 40-60% of normal. This is thought to be due to the effects of testosterone at puberty.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 181
Correct
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A 49-year-old woman with haemoglobin of 6 g/dL following persistent vaginal bleeding receives blood transfusion. She developed pain and burning at her cannula site and complains of a feeling of “impending doom”, nausea, and severe back pain shortly after transfusion was started. Her temperature is 38.9ºC.
What is the most appropriate treatment?Your Answer: Stop the transfusion and administer IV fluids
Explanation:Acute haemolytic transfusion reactions present with: Feeling of ‘impending doom’ as the earliest symptom, fever and chills, pain and warmth at transfusion site, nausea and vomiting, back, joint, and chest pain. Transfusion should be stopped immediately and IV fluid (usually normal saline) administered.
Supportive measures and paracetamol can be given since patient has fever but it is not the immediate first step.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 182
Incorrect
-
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: Amorphous 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 183
Incorrect
-
The most common cause of anaemia worldwide is which of the following?
Your Answer: Haemolytic anaemia
Correct Answer: Iron deficiency anaemia
Explanation:The most common cause of microcytic anaemia and of any anaemia worldwide is iron deficiency anaemia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 184
Incorrect
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Regarding T helper cells, which of the following statements is CORRECT:
Your Answer: They only recognise antigen in association with HLA class I molecules.
Correct Answer: They form the vast majority (about 75%) of the total circulating T-cell population.
Explanation:CD4+ T-cells (Helper T cells)Recognise antigen only in association with HLA class II molecules (found on antigen presenting cells (APCs) e.g. dendritic cells, B-cells; present exogenous antigens that have been phagocytosed/endocytosed into intracellular vesicles)Form most of the circulating T-cell population (about 75%)Secrete cytokines (e.g. IFN-gamma) which are required for recruitment and activation of other immune cells such as macrophages, T cytotoxic cells and NK cells and for the activation of and production of immunoglobulin from B-cells
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 185
Incorrect
-
A dermatological examination of a patient who has presented with a lump shows a collection of boils clustered together.
Which one of these best describes the lump you have found on examination?Your Answer: Bulla
Correct Answer: Carbuncle
Explanation:A furuncle, or boil, is a pyogenic infection of the hair follicle commonly caused by infection with Staphylococcus aureus.
A carbuncle is a collection of individual boils clustered together.
A bulla is a visible collection of clear fluid measuring greater than 0.5 cm in diameter.
A vesicle is a visible collection of clear fluid measuring less than 0.5 cm in diameter.
A pustule is a small visible skin elevation containing an accumulation of pus.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 186
Incorrect
-
A 66-year-old female presents to the Emergency Department with a nose bleed. She says that she has been having frequent episodes of nose bleeds over the past four months, along with increasing fatigue and some weight loss. On examination, she has a diffuse petechial rash and hypertrophy of the gingiva.
Which one of the following conditions is this patient most likely to have?Your Answer: Acute lymphocytic leukaemia (ALL)
Correct Answer: Acute myeloid leukaemia (AML)
Explanation:The history of nosebleeds and fatigue, and gingival hyperplasia presents a typical picture of acute myeloid leukaemia. Leukemic infiltrates within the gingiva cause hypertrophy and distinguish this condition from other types of leukaemia. The fatigue is secondary to anaemia, while the nosebleeds are caused by thrombocytopenia secondary to leukemic infiltration of bone marrow. Patients may also report frequent infections secondary to neutropenia and hepatosplenomegaly.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 187
Incorrect
-
A medical student is reviewing the chart of a patient who has recently been diagnosed with leukaemia. The chief resident asks him to identify ONE feature that will most support acute leukaemia diagnosis in contrast to chronic leukaemia.
Which one of the following options will he pick?Your Answer: An excess of mature, differentiated cells in the marrow
Correct Answer: The patient is a child
Explanation:Acute lymphocytic leukaemia (ALL) is more common in children than chronic leukaemias, which generally occur in adults. Bone marrow failure occurs early on in the course of the disease in acute leukaemias, and there is the massive proliferation of undifferentiated cells with functioning cells being crowded out. Hepatosplenomegaly occurs in both acute and chronic forms of leukaemia and is not a differentiating feature.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 188
Correct
-
A 27-year-old female is brought to the Emergency Department by ambulance with extensive bleeding from her upper arm following a fall from a bicycle onto a fence. On inspection her biceps brachii muscle has been lacerated.
How will the muscle heal from this injury? Select ONE answer only.Your Answer: Satellite cells will produce a small number of regenerated myocytes
Explanation:Muscle heals with fibrous tissue to form a scar. Once cut, it will never regain its previous bulk or power. Within the scar a small number of myocytes (muscle cells) may be seen, which are formed from satellite cells but they contribute little to the function of the muscle overall.
In more widespread ischaemic injury, such as critical ischaemic limb due to arterial compromise, or in compartment syndrome, damaged myocytes are replaced diffusely with fibrous tissue. This fibrous tissue contracts and reduces movement, and in extreme cases can pull the limb into abnormal positions such as in Volkmann’s ischaemic contracture of the forearm. -
This question is part of the following fields:
- General Pathology
- Pathology
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Question 189
Incorrect
-
A patient with rash is examined. He has some redness of the skin that blanches when finger pressure is applied.
What is the best description of this rash that you have found on examination?Your Answer: Macule
Correct Answer: Erythema
Explanation:Erythema is redness of the skin or mucous membranes caused by hyperaemia of superficial capillaries caused by skin injury, infection or inflammation. Erythema blanches when pressure is applied whereas ecchymosis, purpura and petechiae do not.
Ecchymosis are discolouration of the skin or mucous membranes caused by extravasation of blood. They are usually red or purple in colour and measure greater than 1 cm in diameter and do not blanch on applying pressure.
A macule is a flat, well circumscribed area of discoloured skin less than 1 cm in diameter with no changes in the thickness or texture of the skin.
Petechiae are discolouration of the skin measuring less than 3 mm in diameter
Purpura are discolouration of the skin measuring between 0.3 cm and 1 cm in diameter.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 190
Incorrect
-
A 24 year old male sustained an insect bite and presents with a red hot arm and acute cellulitis has been diagnosed. The predominant white cells in this type of acute inflammation are:
Your Answer: Macrophages
Correct Answer: Neutrophils
Explanation:Neutrophil polymorphs are the predominant type of white cells in an acute reaction. They pass between endothelial cell junctions to invade damaged tissue so that the effects of injury can be combated. Extravasation occurs with the movement of leukocytes out of the vessel lumen, and is achieved in five phases which are margination, ‘rolling’, adhesion, transmigration and chemotaxis.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 191
Correct
-
Detection of urinary Bence-Jones protein would be most suggestive of which of the following malignancies:
Your Answer: Multiple myeloma
Explanation:Bence Jones proteins are monoclonal immunoglobulin light chains found in urine (and plasma) of some patients with myeloma. Because of their relatively small size, light chains are readily excreted into the urine. The presence of significant amounts of Bence Jones proteins in urine is indicative of malignant B cell proliferation.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 192
Incorrect
-
A 40-year-old man with reduced urine output, nausea, and confusion also has a 150% rise of creatinine from baseline over the past 7 days. A diagnosis of acute kidney injury (AKI) is made after more tests are done.
His AKI stage is?Your Answer: Stage 1
Correct Answer: Stage 2
Explanation:This patient with a 150% rise of creatinine above baseline within 7 days has stage 2 Acute kidney injury (AKI).
AKI stages are as follows:
Stage 1
Creatinine rise of 26 micromole/L or more within 48 hours, or
Creatinine rise of 50-99% from baseline within 7 days (1.5-1.99 x baseline),or
Urine output <0.5 mL/kg/hour for more than 6 hours Stage 2
Creatinine rise of 100-199% from baseline within 7 days (2.0-2.99 x baseline),or
Urine output <0.5 mL/kg/hour for more than 12 hours Stage 3
Creatinine rise of 200% or more from baseline within 7 days (3.0 or more x baseline), or
Creatinine rise to 354 micromole/L or more with acute rise of 26 micromole/L or more within 48 hours or 50% or more rise within 7 days, or
Urine output <0.3 mL/kg/hour for 24 hours or anuria for 12 hours -
This question is part of the following fields:
- General Pathology
- Pathology
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Question 193
Correct
-
One of the benefits of wound healing through first intention is:
Your 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 194
Correct
-
A 20-year-old male receives a small cut over his hand while climbing a fence causing it to bleed. Upon applying pressure for a few minutes, the bleeding stops. Which one of the following physiological components of the blood is responsible for the primary haemostasis reaction, such as in this case?
Your Answer: Platelet plug formation
Explanation:Haemostasis is your body’s defence against an injury that causes bleeding. It stops bleeding in three main steps:
1) Primary haemostasis – formation of a weak platelet plug
– The primary reaction of the body is to cause local vasoconstriction at the site of injury and decrease blood flow to the affected area
– the release of cytokines and inflammatory markers lead to adhesion of platelets and aggregation at the site of injury forming a platelet plug
– the injured vessel wall has exposed subendothelial collagen that releases von Willebrand factorAny damage to the vessel wall causes the release of the Von Willebrand factor, which is necessary for platelet adhesion. Tissue Thromboplastin is also released, which activates the coagulation pathway, a component of secondary haemostasis. The coagulation cascade ultimately results in the conversion of fibrinogen to fibrin.
2) Secondary haemostasis
3) FibrinolysisFibrin (factor Ia) is a long, thin protein with branches produced at the end of the coagulation cascade when fibrinogen (factor I) is converted to fibrin, which stabilizes the blood clot.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 195
Incorrect
-
A 29-year-old female with a swollen red finger presents to your clinic and you suspect that the underlying process is of acute inflammation. You request for some bloods investigations.
Which statement about histamine as a chemical mediator of the acute inflammatory response is TRUE?Your Answer: Neutrophils are the primary source
Correct Answer: It increases vascular permeability
Explanation:Histamine increases vascular permeability in the acute inflammatory response.
Histamine causes vasodilation.
It is released from Mast cells and basophils, eosinophils and platelets.
Mast cells and basophils are its primary source
Nitric oxide (not histamine) is a major factor in endotoxic shock
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 196
Incorrect
-
A dermatological examination of a patient presenting with a lump shows a visible collection of fluid measuring 0.3 cm in diameter.
Which one of these best describes the lump you have found on examination?Your Answer: Carbuncle
Correct Answer: Vesicle
Explanation:A vesicle is a visible collection of fluid measuring less than 0.5 cm in diameter.
A furuncle, or boil, is a pyogenic infection of the hair follicle commonly caused by infection with Staphylococcus aureus.
A carbuncle is a collection of individual boils clustered together.
A bulla is a visible collection of clear fluid measuring greater than 0.5 cm in diameter.
A pustule is a small visible skin elevation containing an accumulation of pus.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 197
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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Question 198
Incorrect
-
Question 199
Correct
-
A 30-year-old female presented to the Emergency Department after a fall during a hiking expedition caused severe pain in her left arm and wrist drop. An X-ray revealed a mid-shaft fracture of the humerus, which most likely damaged the radial nerve.
Which one of the following statements best describes the healing process of peripheral nerves?Your Answer: Peripheral nerve fibres regenerate at around 1mm per day
Explanation:Peripheral nerves are nerves that lie outside the brain and spinal cord. Peripheral nerves readily regenerate, while central nervous system axonal injury does not spontaneously regenerate.
If there is damage to the axons of peripheral nerves, the nerves will regenerate at a slow rate of 1 mm per day. The slow regeneration process may lead to muscle atrophy before regeneration is complete.Each peripheral nerve has a single cell body that supplies nutrients to the growing nerve fibre. The cell body does not undergo mitosis; only the axon is regenerated.
Schwann cells of the peripheral nervous system provide support for this process, while the analogous oligodendrocytes of the central nervous system do not. Schwann cells themselves do not cause regeneration. Schwann cells provide myelin for myelinated fibres and surround non-myelinated fibres with their cytoplasm.
If an axon is completely severed, as in the case of amputation, the axonal fibres regenerating from the cell body may never find their original route back to the muscle. Instead, they may form a traumatic neuroma, a painful collection of nerve fibres and myelin.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 200
Incorrect
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How does abciximab mediate its antiplatelet effect:
Your Answer:
Correct Answer: It is a GPIIb/IIIa inhibitor.
Explanation:Abciximab, eptifibatide and tirofiban are GPIIb/IIIa inhibitors, inhibiting platelet aggregation by preventing the binding of fibrinogen, von Willebrand factor and other adhesive molecules.
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This question is part of the following fields:
- Haematology
- Pathology
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