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  • Question 1 - Which of the following leukaemias is most common in children in the UK:...

    Correct

    • 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.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      4.4
      Seconds

  • Question 2 - Regarding chronic idiopathic thrombocytopaenic purpura (ITP), which of the following statements is INCORRECT:...

    Correct

    • 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.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      40.5
      Seconds

  • Question 3 - Which type of collagen is initially laid down in early wound healing: ...

    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.

    • This question is part of the following fields:

      • Pathology
      • Wound Healing
      3.5
      Seconds

  • Question 4 - A 24 year old male sustained an insect bite and presents with a...

    Correct

    • 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: 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.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      7.7
      Seconds

  • Question 5 - You examine a 78-year-old man who has been diagnosed with chronic lymphocytic leukaemia...

    Correct

    • 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.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      13.8
      Seconds

  • Question 6 - Which of the following pathogens is most likely to cause an infection in...

    Incorrect

    • Which of the following pathogens is most likely to cause an infection in a chemo patient with significant neutropenia?

      Your Answer: Herpes varicella

      Correct 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.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      47.8
      Seconds

  • Question 7 - A 69-year-old man with a history of chronic anaemia is transfused. He takes...

    Correct

    • 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.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      62.4
      Seconds

  • Question 8 - Leukaemia has been diagnosed in a 6-year-old child on your list. He comes...

    Correct

    • 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.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      7.9
      Seconds

  • Question 9 - A medical student is reviewing the chart of a patient who has recently...

    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: Absence of marrow failure

      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.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      36.4
      Seconds

  • Question 10 - A 7-year-old girl is admitted to the hospital with a persistently high temperature....

    Correct

    • 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:InfectionBacterialPyogenic abscessTuberculosisInfective endocarditisBrucellosisLyme diseaseViralHIV Epstein Barr VirusCytomegalovirusParasiteToxoplasmosisMalignancy LeukaemiaLymphomaRenal cell carcinomaHepatocellular carcinomaVasculitides Still’s diseaseGranulomatosis with polyangiitis (formerly Wegener’s)Systemic lupus erythematosusGiant cell arteritisRheumatoid arthritisPolymyalgia rheumaticaMiscellaneous Drug induced fevers Familial Mediterranean feverThyrotoxicosisInflammatory bowel diseaseSarcoidosisFactitious 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.

    • This question is part of the following fields:

      • Pathology
      • Pathology Of Infections
      11.9
      Seconds

  • Question 11 - Regarding apoptosis, which of the following statements is INCORRECT: ...

    Correct

    • Regarding apoptosis, which of the following statements is INCORRECT:

      Your 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.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      12.8
      Seconds

  • Question 12 - Regarding cytotoxic T cells, which of the following statements is CORRECT: ...

    Incorrect

    • 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-cellsResponsible for cytotoxic killing of target cells

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      40.7
      Seconds

  • Question 13 - The following are all examples of type IV hypersensitivity EXCEPT for: ...

    Incorrect

    • The following are all examples of type IV hypersensitivity EXCEPT for:

      Your Answer: Mantoux test

      Correct Answer: Extrinsic allergic alveolitis

      Explanation:

      Examples of type IV reactions includes:Contact dermatitisHashimoto’s thyroiditisPrimary biliary cholangitisTuberculin skin test (Mantoux test)Chronic transplant rejectionGranulomatous inflammation (e.g. sarcoidosis, Crohn’s disease)

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      16.5
      Seconds

  • Question 14 - Which of the following statements is correct with regards to immunoglobulin? ...

    Correct

    • 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
      18.5
      Seconds

  • Question 15 - Which of the following blood groups is the least common in the UK:...

    Incorrect

    • Which of the following blood groups is the least common in the UK:

      Your Answer: B

      Correct Answer: AB

      Explanation:

      Blood group O is the most common in the UK (46 %), followed by group A (42 %), group B (9 %) and finally group AB (3 %).Blood group O has no antigens, but both anti-A and anti-B antibodies and thus is the universal donor. Blood group AB has both A and B antigens but no antibodies and thus is the universal recipient.Blood group A has A antigens and anti-B antibodies and blood group B has B antigens and anti-A antibodies.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      9
      Seconds

  • Question 16 - Regarding acute myeloid leukaemia (AML), which of the following statements is CORRECT: ...

    Incorrect

    • Regarding acute myeloid leukaemia (AML), which of the following statements is CORRECT:

      Your Answer: AML is characterised by plasma cell accumulation on the bone marrow.

      Correct 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 profoundNeutropenia (infections)HepatosplenomegalyGingival infiltrationCentral 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
      31.7
      Seconds

  • Question 17 - Regarding acute lymphoblastic leukaemia (ALL), which of the following statements is CORRECT: ...

    Correct

    • 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.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      14.3
      Seconds

  • Question 18 - Fibrinoid necrosis is typically seen in which of the following: ...

    Correct

    • Fibrinoid necrosis is typically seen in which of the following:

      Your 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.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      5.8
      Seconds

  • Question 19 - A 60-year-old female presents with fatigue, easy bruising and repeated chest and skin...

    Correct

    • 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/dlTotal leukocyte count: 2.5x10^9/L, 1100 neutrophils/ųLMCV 100platelet 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.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      52.2
      Seconds

  • Question 20 - Which of the following immunoglobulins is most important for mast cell degranulation: ...

    Incorrect

    • Which of the following immunoglobulins is most important for mast cell degranulation:

      Your Answer: IgM

      Correct 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
      55.6
      Seconds

  • Question 21 - Coagulative necrosis is typically seen in which of the following: ...

    Incorrect

    • Coagulative necrosis is typically seen in which of the following:

      Your Answer: Malignant hypertension

      Correct 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).

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      23.2
      Seconds

  • Question 22 - Regarding iron handling, which of the following statements is CORRECT: ...

    Correct

    • 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.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      5.1
      Seconds

  • Question 23 - Caseous necrosis is typically seen in which of the following: ...

    Incorrect

    • Caseous necrosis is typically seen in which of the following:

      Your Answer: Ischaemic stroke

      Correct 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.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      19
      Seconds

  • Question 24 - Which of the following does NOT typically cause a neutrophil leucocytosis: ...

    Incorrect

    • 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 infectionInflammation and tissue necrosis (e.g. cardiac infarct, trauma, vasculitis, myositis)Metabolic disorders (e.g. uraemia, acidosis, eclampsia, gout)PregnancyAcute haemorrhage or haemolysisNeoplasms of all typesDrugs (e.g. corticosteroid therapy, lithium, tetracyclines)AspleniaMyeloproliferative disorders (e.g. CML, essential thrombocythaemia, polycythaemia vera, myelofibrosis)Rare inherited disorders

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      20.8
      Seconds

  • Question 25 - C5 - C9 deficiency increases susceptibility to infection with which of the following:...

    Incorrect

    • C5 - C9 deficiency increases susceptibility to infection with which of the following:

      Your Answer: Herpesviridae

      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.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      38.2
      Seconds

  • Question 26 - Regarding acute idiopathic thrombocytopaenic purpura (ITP), which of the following statements is CORRECT:...

    Incorrect

    • Regarding acute idiopathic thrombocytopaenic purpura (ITP), which of the following statements is CORRECT:

      Your Answer: It is most common in women aged 15 - 50 years.

      Correct 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.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      7.5
      Seconds

  • Question 27 - You are giving a presentation on the immune system as part of your...

    Incorrect

    • 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: Basophils

      Correct 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.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      153.3
      Seconds

  • Question 28 - A 24-year-old male presents to the Emergency Department with a three-day history of...

    Incorrect

    • 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: Infection in the presence of tissue hypoperfusion persisting an hour after resuscitation with intravenous fluids

      Correct 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.

    • This question is part of the following fields:

      • Pathology
      • Pathology Of Infections
      2.9
      Seconds

  • Question 29 - Which of these immunoglobulin molecules can cross the placenta? ...

    Incorrect

    • Which of these immunoglobulin molecules can cross the placenta?

      Your Answer: None of the above

      Correct Answer: IgG

      Explanation:

      An important mechanism that provides protection to the foetus is placental transfer of maternal IgG antibodies while his/her humoral response is inefficient. The only antibody class that significantly crosses the human placenta is IgG.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      6.5
      Seconds

  • Question 30 - C3 deficiency leads to particular susceptibility of infection with which of the following:...

    Incorrect

    • C3 deficiency leads to particular susceptibility of infection with which of the following:

      Your Answer: Intracellular bacteria

      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

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      9.8
      Seconds

  • Question 31 - You are about to perform a blood test on a patient suspected of...

    Incorrect

    • 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: Rheumatoid factor

      Correct 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.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      197.1
      Seconds

  • Question 32 - Which of the following cytokines is important for the maintenance of granulomatous inflammation:...

    Incorrect

    • Which of the following cytokines is important for the maintenance of granulomatous inflammation:

      Your Answer: IL-4

      Correct 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.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      22.5
      Seconds

  • Question 33 - Which of the following best describes the process of opsonisation: ...

    Incorrect

    • Which of the following best describes the process of opsonisation:

      Your Answer: The coating of foreign particles with antibodies that aid cytotoxic killing

      Correct 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.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      21.8
      Seconds

  • Question 34 - A 78-year-old man complains of lumps in his neck. Several large, non-tender cervical...

    Incorrect

    • 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: Non-Hodgkin’s lymphoma

      Correct 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
      14.5
      Seconds

  • Question 35 - Which of the following is the correct sequential order of the phases of...

    Correct

    • 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.

    • This question is part of the following fields:

      • Pathology
      • Wound Healing
      21.8
      Seconds

  • Question 36 - Langhans giant cells, seen in granulomatous inflammation. are: ...

    Incorrect

    • Langhans giant cells, seen in granulomatous inflammation. are:

      Your Answer: Active antibody-producing B-cells

      Correct 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.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      17.7
      Seconds

  • Question 37 - A 35-year-old man suffered a severe road traffic accident and has been brought...

    Incorrect

    • 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: Acute haemolytic reaction

      Correct 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.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      8
      Seconds

  • Question 38 - Which of the following diseases is caused by a build-up of lymphoblasts in...

    Correct

    • 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.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      4.9
      Seconds

  • Question 39 - Fat necrosis is typically seen in which of the following: ...

    Incorrect

    • Fat necrosis is typically seen in which of the following:

      Your Answer: Ischaemic stroke

      Correct 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.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      48.1
      Seconds

  • Question 40 - Regarding red blood cell group antigens and antibodies, which of the following statements...

    Correct

    • 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.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      189.7
      Seconds

  • Question 41 - Which of the following statements is correct with regards to Hodgkin's lymphoma? ...

    Correct

    • Which of the following statements is correct with regards to Hodgkin's lymphoma?

      Your Answer: Most patients present with painless asymmetrical lymphadenopathy, with cervical nodes involved most commonly.

      Explanation:

      Lymphoma is a cancer of the lymphatic system, which is part of the body’s germ-fighting network. They are a group of diseases that are caused by malignant lymphocytes. These malignant cells accumulate in lymph nodes and other lymphoid tissue, giving rise to the characteristic clinical feature of lymphadenopathy. They can be subdivided into Hodgkin lymphoma (HL) which are characterised by the presence of Reed-Sternberg cells, and non-Hodgkin lymphoma (NHL). Characteristics of HL include:1. can present at any age but is rare in children and has a peak incidence in young adults, 2. almost 2:1 male predominance. 3. presents with painless, asymmetrical, firm and discrete enlargement of superficial lymph nodes. 4. cervical node involvement in 60-70% of cases, 5. axillary node involvement in 10-15% 6. inguinal node involvement in 6-12%. 7. modest splenomegaly during the course of the disease in 50% of patients8. may occasionally have liver enlargement9. bone marrow failure involvement is unusual in early disease. Approximately 85% of patients are cured, but the prognosis depends on age, stage and histology. Two well‐known but rare symptoms in HL are alcohol‐induced pain and pruritus.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      228
      Seconds

  • Question 42 - Which of the following is NOT typically associated with eosinophilia: ...

    Incorrect

    • Which of the following is NOT typically associated with eosinophilia:

      Your Answer: Hodgkin lymphoma

      Correct 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
      11.9
      Seconds

  • Question 43 - A 16-year-old male with a known case of Haemophilia A is referred to...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      13.1
      Seconds

  • Question 44 - Which of the following is NOT an effect of cytokine activity: ...

    Correct

    • 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.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      10.1
      Seconds

  • Question 45 - A 43 year old lady suffering with idiopathic thrombocytopenic purpura has a splenectomy....

    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 is gram positive

      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.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      4.3
      Seconds

  • Question 46 - Typically, granulomatous inflammation is associated with one of the following infections: ...

    Correct

    • 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

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      930.9
      Seconds

  • Question 47 - Which of the following best describes a natural killer cell: ...

    Incorrect

    • Which of the following best describes a natural killer cell:

      Your Answer: A professional antigen presenting cell that is important for normal T helper cell function.

      Correct 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.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      15.1
      Seconds

  • Question 48 - The following are all examples of type III hypersensitivity EXCEPT for: ...

    Incorrect

    • The following are all examples of type III hypersensitivity EXCEPT for:

      Your Answer: Systemic lupus erythematosus

      Correct Answer: Goodpasture's syndrome

      Explanation:

      Examples of type III reactions include:Extrinsic allergic alveolitisSystemic lupus erythematosus (SLE)Post-streptococcal glomerulonephritisReactive arthritisRheumatoid arthritis

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      15.1
      Seconds

  • Question 49 - Which of the following is NOT a function of antibodies: ...

    Incorrect

    • Which of the following is NOT a function of antibodies:

      Your Answer: Neutralise toxins

      Correct Answer: Act as antigen receptors on T lymphocytes

      Explanation:

      Antibodies: Neutralise toxins and prevent attachment of pathogensTarget, opsonise or agglutinate (clump together) antigens for phagocytosisActivate the complement cascade (leading to lysis or opsonisation of the pathogen)Act as antigen receptors on B lymphocytesActivate antibody-dependent cell-mediated cytotoxicity by natural killer (NK) cells or T cytotoxic cellsProvide mucosal immunity (IgA-mediated)Stimulate degranulation of mast cells (IgE and IgG mediated)Provide passive immunity to the newborn (through transplacental passage of IgG and secretion of IgA in breast milk)

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      8.9
      Seconds

  • Question 50 - Which of the following features of cell damage tends to be reversible: ...

    Incorrect

    • Which of the following features of cell damage tends to be reversible:

      Your Answer:

      Correct 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 responseFeatures 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
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Haematology (14/16) 88%
Pathology (36/49) 73%
Wound Healing (2/2) 100%
Inflammatory Responses (12/12) 100%
Immune Responses (6/17) 35%
Pathology Of Infections (2/2) 100%
Passmed
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