MCQ deck

Question 1

Pituitary Apoplexy

Answer 1

Acute Hemorrhage or Ischemic infarction of a pituitary adenoma, presenting with sudden onset severe headache, visual field defects, ophthalmoplegia and life threatening secondary adrenal insufficiency

Question 2

MEN1

Answer 2

The three P’s, Parathyroid tumors, Pancreatic neuroendocrine tumors, Pituitary tumors.
Menin - which is a tumor suppressor gene, autosomal Dominat mutation
Parathyroid adenoma, Pituitary adenoma and Pancreatic neuroendocrine tumors, Gastronome, insulinoma, VIPoma and Glucagonoma

Question 3

MEN2A

Answer 3

MTC-
Produces Calcitonin
Pheochromoytoma
Hyperparathyoridism

Question 4

MEN2B

Answer 4

Rare autosomal dominant mutation of the RET gene (Proto-oncogene)

Question 5

DiGeorge Syndrome

Answer 5

DiGeorge Syndrome is due to 22q11 deletion and causes parathyroid and thymic hypolasia, leading to hypocalcemia, hyperphosphatemia, T cell deficiency with normal B cell numbers.

Question 6

Hemochromatosis

Answer 6

Autosomal Recessive, Mutations in the HFE gene, located on chromosome 6, leads to abnormally low Hepcidin production, increased intestinal absorption. Iron accumulates, Liver, Pancreas, Skin, Heart, Joints.
Arthopathy, Calcium pyrohosphate crystals Calcium pyrophosphate crystals.

Question 7

VHL (Tumor suppressor gene),
Autosomal Dominant

Answer 7

Chromosome 3, VHL gene, codes for proteins that degrade Hypoxia inducible transcription factor PDGF, HIF, VEGF increases risk of tumor formation
1. Hemangioblastoma
2. Benign Cysts
RCC, PTEN. Pheochromocytoma, Hemagioblastoma, Retinal Hemangioblastomas.
Bilateral RCC, pancreatic neuroendocrine tumor

Question 8

RCC

Answer 8

Clear cell carcinoma is the most common variant of RCC, can secrete PTHrp and EPO.

Question 9

Acromegaly

Answer 9

Acromegaly results from GH excess after Growth plate closure, causing progressive soft tissue, skeletal and metabolic changes. Common features include CTS, Skeletal Deformities. Diagnosis is confirmed by serum IGF-1 and treatment involves somatostatin analogues like Octreotide to suppress GH secretion.

Question 10

Pituitary Tumors

Answer 10

Trans-sphenoidal Pituitary surgery performed via a nasal approach proceeds through, the sphenoid gives access to the pituitary while avoiding major brain retraction.

Question 11

Cricothyroid muscle

Answer 11

External branch of the Superior Laryngeal Nerve, innervates the Cricothyroid muscle which is, acts to tense the vocal cords

Question 12

Evolocumab

Answer 12

PCSK9 inhibitor used to lower high LDL, and used to reused the risk of stroke and heart attacks in adults. Is a serine protease that regulates the concentration of LDL on hepatocyte cell surface,

Question 13

Acanthosis Nigricans

Answer 13

Is characterized by a hyperinsuliemic state, can be associated with PCOS

Question 14

SIADH

Answer 14

Certain medication like SSRIs, Carbamezapine and Cyclophosphamide.

Question 15

Papillary Carcinoma

Answer 15

Radiation Increases the risk of Papillary Thyroid Carcinoma, Empty appearing nucleus with central clearing,”Orphan Annie eyes” Psammoma bodies, nuclear clearing, nuclear grooves, intranucear psudoinclsuions and psammoma bodies.
RET/PTC and BRAF mutations/

Question 16

Follicular Carcinoma

Answer 16

Microfollicles with nuclear enlargement, overlapping and crowding,
overlapping follicular cells and microacinar architecture,
Vascular invasion; locally invasive, invades thyroid capsule
Hurtle cells, Invades into the local blood vessels, RAS and PAx8-PPAR-gamma, Invasive type cancer always think, Follicular carcinoma.

Question 17

Anaplastic Carcinoma

Answer 17

RAS and P53 mutations, Very aggressive and has a poor prognosis, infiltration into local structure specially soft tissue of the neck, do not take up radio iodine –

Question 18

Medullary thyroid carcinoma

Answer 18

C cell carcinoma, sheets of polygonal cells in an Amyloid storm.
Neuroendocrine appearance, “Packet” of uniform cells; Stroma made of amyloid, Derived from parafollicular cells or C cells; produce calcitonin.
Associated with MEN2 A and B and RET mutations, produces Calcintonin, RET mutations

Question 19

Subacute thyroiditis

Answer 19

Granulomatous thyroiditis or De Quervains thyroiditis, often follows viral infection, Tender painful thyroid, pain in the Jaw, increased ESR

Question 20

Fibrous Thyoriditis

Answer 20

Riedels thyroiditis, rare in patients in there 40s, normal thyroid tissue replaced by dense fibrosis, thyroid will be rock hard and fixed, can be associated with IgG 4 related systemic disease.

Question 21

QT prolongation

Answer 21

Hypocalcemia and prolonged QT interval,

Question 22

Hypospadias

Answer 22

Non-fusion of the urethral folds will result in this and it is the most common, in complete fusion of the urethral folds, an abnormal opening of the urethra proximal to the glands along the ventral shaft of the penis.

Question 23

Trichomoniasis Vaginalis

Answer 23

Frothy Green vaginal discharge, flagellated protozoa, single celled parasite, pear or round shaped. Single- Celled parasite. Strawberry cervix. Can be seen on wet mount microscopy of vaginal discharge.

Question 24

Metronidazole

Answer 24

Forms free radical metabolites in anaerobic organisms causing DNA breakage, inhibits nucleic acid synthesis and causes cell death

Question 25

Adenomyosis

Answer 25

Adenomyosis, is the abnormal presence of endometrial glands and stroma within the uterine myometrium, affected patients are typically multiparous women with dysmenorrhea, heavy menses and a uniformly enlarged uterus.

Question 26

Testicular Torsion

Answer 26

Sudden, Unilateral Scrotal pain and a high riding testicle, nausea and vomiting, high riding testicle. ABSENT CREMESTERIC REFLEX. Immediate, surgical detorsion, if necrotic Orchiplexy. "Bell-Clapper deformity. (PAIN DOES NOT IMPROVE UPON TESTICULAR ELEVATION).

Question 27

Epididymitis

Answer 27

relief upon elevation of the testicle,

Question 28

Isotretinoin

Answer 28

Used to treat sever acne with significant scarring, Pregnancy is absolutely contraindicated due to risk of teratogenicity. Sexually active women should be advised to use two forms of contraception, and take monthly pregnancy test.

Question 29

Acyclovir

Answer 29

Phosphorylation of viral Thymidine Kinase, Inhibits viral DNA polymerase. Guanosine analogue, antiviral guanosine analogue. Inhibits viral DNA and causes DNA chain termination.

Question 30

Turner syndrome

Answer 30

XO complete, Sporadic non-disjunction of sex chromosomes, resulting in complete monosomy, Low hairline, low set ears, high arched palate, wide, web like neck cystic hygroma, shielded neck, broad chest wide spaced nipples, -Low hairline -Low set ears -Small lower jaw -Shielded neck -Aortic coartation/Dissectiom -Short fingers and toes -Osteoperosis -Bicuspid aortic valves -SOX gene on X chromosome/ Short stature -Hashimotos - type 2 DM -Delayed Puberty and

Question 31

Molar pregnancy

Answer 31

Partial and Complete mole Partial Mole: Triploid XXY/XXX Complete Mole: Diploid Gestational Chriocarcinoma, is seen as a bulky intrauterine mass that is usually soft yellow white with extensive necrosis and hemorrhage, there is abnormal proliferation of

Question 32

Gardnerella Vaginalis

Answer 32

facultative, Anaerobic Gram Variable Rod, clue cells are seen on wet mount microscopy and cytology. Thin, fishy white odor, positive amine whiff test,

Question 33

Seminoma

Answer 33

Most Common type of

Question 34

Bacterial Vaginosis

Answer 34

Gardrenella Vaginalis overgrowth, reduce Lactobacilli, foul smelling discharge on KOH prep. Characteristic clue cells. Maladourorus smelly vaginal discharge. thin white or grey color. New or multiple sexual partners. Copper IUD. Mixed vaginitis, Trichomoniasis, atrophic vaginitis, candida vulvovaginitis positive amine or whiff test. Treatment is with Oral metronidazole

Question 35

Para-aortic lymph nodes

Answer 35

Testes, Ovaries, Fallopian tube, supra-renal glands. Lymph from the testes drains through lymph channels directly back to the para-aortic lymph nodes. In contrast lymph from the scrotum drains into the superficial inguinal lymph nodes.

Question 36

Prostate Cancer

Answer 36

Transrectal approach, involves taking multiple small biopsies from the transrectal approach.

Question 37

Anti-coagulant factors

Answer 37

Protein C and S act like anti-coagulant factors

Question 38

Trazadone

Answer 38

Sedating anti depressant used to treat insomnia, priapism is a rare but serious adverse effect

Question 39

Fertilization

Answer 39

Prior to fertilization, secondary oocytes are arrested at metaphase 2 of meiosis

Question 40

Endometrial Carcinoma

Answer 40

PCOS can present with irregular menstruation, increased LH and increased androgens and estrogen

Question 41

Neuroendocrine Tumors

Answer 41

NETs, glucagon producing alpha cells associated with MEN 1, ALPHA cells that produce Glucagon, Glucagons main function is Gluconeogenesis (formation of new glucose), Glycogenolysis both of these methods will increase or cause a rise in the Blood glucose levels. 1.Necrotizing migratory erythema, 2.Burning, prutitis and itching 3. Depression 4. Diarrhea Associated with MEN 1

Question 42

Molar pregnancy

Answer 42

Swollen Chorionic Villi and focal trophoblastic proliferation, Partial Mole contain 69XXY or 69XYY

Question 43

Alpha 1 antagonist (prazosins) or Alpha Blockers

Answer 43

Decreased BP, fluid retention, Miosis, decreased bladder sphincter tone

Question 44

Cystic Fibrosis

Answer 44

CFTR, Expressed in Exocrine glands, Exocrine, Chromosome 7. Inherited defect in CFTR gene, that results in impaired ability to produce normal body secretions (CBAVD), patients will have azoospermia and infertility and normal levels of FSH, LH and testosterone.

Question 45

Theca cells Granulosa cells

Answer 45

Cholesterol to Androgens Androgens to Estrogens

Question 46

Ebstein's anomaly

Answer 46

Lithium is commonly used to treat Bipolar disorder, Its use during pregnancy, is associated with Ebstein anomaly, which is characterized by apical displacement of tricuspid valve leaflets, decreased right ventricular volume and atrialization of the right ventricle.

Question 47

PCOS

Answer 47

Irregular menses, Hyperandrogenism (acne, Hirsuitism) and anovulatory inferility. Patients are at increased risk of endometrial hyperplasia and carcinoma, due to increased estrogen production and chronic anovulation.

Question 48

VHL gene

Answer 48

Renal Cell carcinoma (RCC), Clear cell subtype, cerebral hemangioblastoma. - Hemangioblastoma - Clear cell Carcinoma (RCC) -Pheochromocytoma Activation of multiple angiogenic and tumrogenic factors (VEGF,PDGF)

Question 49

HSP (Henoch Schonlein Purpura)

Answer 49

IgA vasculitis, kidney impairment, abdominal pain and joint pain and palpable purport, 1. Palpable purpura 2.Arthalgias and arthritis 3. Abdominal pain 4. Renal involvement Hemorrhage, Intussusception and bowel Infarction, IgA nephritis this can lead to microscopic or macroscopic Hematuria, Proteinuria, Nephrotic syndrome,

Question 50

Acute bacterial Prostatitis

Answer 50

Reflux of urine and organisms from the bladder and urthera, Mostly gram negative bacilli. Systemic symptoms, fever chills, lower urinary tract symptoms, dysuria, urinary retention. Swollen and tender prostate.

Question 51

Allopurinol

Answer 51

Xanthine oxidase inhibitors

Question 52

Febuxostat

Answer 52

Xanthine oxidase inhibitors

Question 53

Probenecid

Answer 53

Inhibits reabsorption of uric acid in the PCT. Can precipitate uric acid calculi or lead to sulfa allergies

Question 54

Colchicine

Answer 54

Binds to and stabilizes tubular to inhibit microtubule polymerization, Impaired neutrophil chemotaxis and degranulation.

Question 55

Adalimumab and infliximab

Answer 55

Anti-TNF alpha monoclonal antibodies

Question 56

Hereditary Cystinuria

Answer 56

Defective transporter of Cystine amino acids, results in reduced reabsorption of Cysteine, ornithine, lysine and Arginine. autosomal recessive disorder, Stones found inside the persons urinary tract that are made of cystine. Positive sodium nitroprusside test.

Question 57

ANP and BNP

Answer 57

Promote naturisis, diuresis, induced vasodilation, causes a reduction in Blood pressure. these are produced in response to stress.

Question 58

Bladder cancer

Question 59

Schistosome Haematobium

Answer 59

This causes SCC of the bladder, smoking an industrial dyes cause TCC of the bladder

Question 60

Lupus Nephritis

Answer 60

Kidney Biopsy is Essential Lupus patients presenting with signs of nephritis to accurately classify disease severity and guide appropriate immunosuppressive therapy. Clinical and lab data are insufficient, making biopsy a critical diagnostic step before initiating treatment.

Question 61

Infundibulopelvic ligament

Answer 61

Suspensory ligament of the ovary, also known as the infundibulopelvic liagment, connects the lateral ovary to the pelvic side wall contains the ovarian ligaments.

Question 62

Renal Cell Carcinoma

Answer 62

Hematuria, flank pain and a palpable flank mass. Associated with smoking, Polycythemia (produces EPO) and hypercalcemia, PTHrP as a paraneoplastic syndrome.

Question 63

Struvite

Answer 63

Magnesium ammonium phosphate stones are strongly associated with urease producing bacteria

Question 64

Myobacterial TB Granuloma

Answer 64

Th1 subtype of cells release Interferon Gamma, Activated macrophages IL-12 and INF gamma

Question 65

CFTR

Answer 65

Cystic fibrosis is most common due to 3 base pair deletion in CF transmembrane conductance regulator (CFTR) gene at amino acid position 508, this mutation impairs post- translational modification of CFTR, with complete absence of the proteins on the cell surface, elevated sweat chloride concentrations are found in most patients with CF.

Question 66

H influenze a

Answer 66

Gram negative coccobacilli

Question 67

Epistaxis

Answer 67

Anterioinferior part of the nasal septum, 1.Anterior and posterior ethmoidal artery 2.Greater palatine and sphenopalatine artery 3.Superior Labial artery

Question 68

Elastin

Answer 68

The rubber like properties of elastin are due to high lipid content of non polar amino acids and extensive cross-linking between elastin monomers facilitated by lysyl Oxidase,

Question 69

Acute Pulmonary Edema

Answer 69

Common Consequence of Acute Pulmonary edema, is a common consequence of acute MI affecting the left ventricle, elevated hydrostatic pressure in the pulmonary vasculature or pulmonary venous system. The airway epithelium changes to ciliated simple cuboidal by the level of the terminal bronchiole. Ciliated epithelium persists up to the respiratory bronchioles.

Question 70

Type 1 HS reaction

Answer 70

IL-4 and IL-13 cause class switching between antigens, degranulation of Mast cells. Type 1 HS reactions are mediated by interaction of allergens with pre-existing IgE bound to basophils and mast cells. This facilitates the cross-linking of surface IgE molecules signals the cells to degranulate, these cause immediate signs of anaphylaxis, which is life threatening.

Question 71

Idiopathic Pulmonary Fibrosis (IPF)

Answer 71

Histologic findings of IPF include, heterogenous Mixture of chronic inflammation and patch interstitial Fibrosis, Focal Fibroblast Proliferation, formation of Fibrotic cysts in a honeycomb pattern

Question 72

Lung Adenocarcinoma

Answer 72

The most Common cause of Hypertrophic osteoarthopathy, a paraneoplastic syndrome characterized by digital clubbing and joint pain. Peripheral lung nodule in smokers

Question 73

Idiopathic Pulmonary Fibrosis

Answer 73

Interstitial lung disease, Chest X ray shows reticular reticulonodular pattern or honey combing. Spirometry will be restrictive, where FEV1/FVC is normal or increased. We can treat this condition with prednisone and fibrinolytic.

Question 74

Posterior Urethral Valves

Answer 74

A persistently enlarged bladder on prenatal ultrasound with associated oligohydroamnios is most common cause of lower urinary tract obstruction in male fetuses. This leads to impaired fetal urine excretion, causing potter sequence.

Question 75

Kaposi Sarcoma

Answer 75

Kaposi Sarcoma (KS), a vascular tumor associated with Human Herpes Virus (HHV-8), often arises in immunosuppressed patients with HIV infections. KS typically involves the skin but can also affect the viscera, including the GI tract, and Pulmonary system. Biopsy shows spindle-shaped endothelial cells forming slit-like vascular space, extravasated red blood cells and inflammation.

Question 76

Strep Pneumonia

Answer 76

Strept pneumoniae vaccination reduces the risk of invasive disease and is recommended for young patients and elderly. The Pneumococcal Polysaccharide vaccine is an unconjugated vaccine the induces a T cell independent humor immune response. In contrast, Pneumococcal conjugated vaccine contains polysaccharide material attached to a protein antigen, which creates a robust T cell mediated Robust humoral immune response.

Question 77

Acute Exacerbation of COPD

Answer 77

Non-typeable H influenza, Morexalla Catarrhalis, and strep pneumoniae. Rhinovirus, RSV and influenza

Question 78

CYP450 Inhibitors

Answer 78

Alcohol, Amiodarone, Azole (-fluconazole), Cimetidine, DV diltaizem and Verapamil, Grapefruit juice, Isoniazid, macrolides, Quinolones, Protease inhibitors, SSRIs (fluoxetine)

Question 79

B Pertussis (Gi) Cholera Toxin (Gs)

Answer 79

Blocks ADP- ribosylation of alpha subunit of Gi proteins, impaired phagocytosis

Question 80

B Pertussis

Answer 80

Azithromycin, is the drug of choice and also provides, post exposure prophylaxis to close contacts. Pertussis should be treated empirically with azithromycin.

Question 81

Asthma

Answer 81

Asthma is a chronic inflammatory airway disorder, with reversible bronchoconstriction triggered by HS to environmental triggers. It involves IgE mediated mast cell response, followed by late phase, eosinophilic infiltrates. Leukotriene D4 is a key mediator driving sustained bronco spasms, Mucus Production and vascular permeability.

Question 82

EBV infection

Answer 82

"Starry sky appearance", seen in Burkitt's Lymphoma is one of the most distinctive histopathologist patterns in pathology. Sheets of monomorphic, c-myc Oncogene (8:14), High rate of apoptosis in Burkitts lymphoma, Classically presents as a jaw lesion or mass. This Process is a hallmark of the high mitotic and apoptotic activity characteristics of this lymphoma.

Question 83

ALA synthase

Answer 83

X-linked defect in ALA Synthase, resulting in Sideroblastic Anemia, Basophilic stippling of RBCs, Isoniazid and Linezolid.

Question 84

Anemia of Chronic Disease

Answer 84

Renal Failure is one of the most High yield causes of anemia of Chronic disease. The mechanism is Cytokine mediated EPO deficiency. Serum Iron is low, and ferritin is normal or slightly high in ACD.

Question 85

Hereditary Spherocytosis

Answer 85

Hereditary spherocytosis is most often caused by a heterozygous mutation in the ANK1 gene encoding ankyrin, inherited in an Autosomal Dominant Pattern. Defective RBC membrane anchoring leads to spherocyte formation, splenic sequestration and extravascular hemolysis, presenting with normocytic anemia, reticulocytosis, Jaundice and splenomegaly.

Question 86

Hydroxyurea

Answer 86

Hydroxyurea inhibits ribonucleated reductase and increase HbF in sickle cell disease. Splenectomy is reserved for refractory cases after both medical therapies have failed