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Question 1
Incorrect
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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 sustained decrease in GFR of 25% or more within 12 months
Correct Answer: A rise in serum creatinine of 30 μmol/L within 48 hours
Explanation:Urgent referral to ophthalmology is indicated if the patient with conjunctivitis has any of the following:
Suspected gonococcal or chlamydial conjunctivitis
Corneal involvement associated with soft contact lens use
Severe disease indicated by presence of a pseudomembrane
Conjunctivitis associated with rheumatoid arthritis or in immunocompromised patient. Ophthalmia neonatorum.
Possible herpes infection.
Had recent intraocular surgery. A red flag indicating a serious cause of red eye.
Suspected periorbital or orbital cellulitis.Bilateral conjunctivitis is not an indication for urgent referral to ophthalmology.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 2
Incorrect
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A 57-year-old 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:
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 3
Incorrect
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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:
Correct 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 4
Incorrect
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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:
Correct 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 5
Incorrect
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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:
Correct 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 6
Incorrect
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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:
Correct 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 7
Incorrect
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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:
Correct 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 8
Incorrect
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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:
Correct 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 9
Incorrect
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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:
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 10
Incorrect
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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:
Correct 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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