lab med june

A patient with a documented history of type 1 hypersensitivity to penicillins is diagnosed with Escherichia coli peritonitis after a colectomy. The organism is only resistant in vitro to amoxicillin. Which one of the following antibiotics would be an appropriate choice as part of the therapeutic regimen:

Aztreonam

3 multiple choice options

What is the incubation period for measles?

7-14 days

Which one of the following antiviral drugs is often used in the management of influenza cases in hospital?

Oseltamivir

3 multiple choice options

In Ireland the most common cause of 'early onset' perinatal infection in a baby is which one of the following organisms?

Streptococcus agalactiae (Group B)

3 multiple choice options

In a child who has succumbed to a dirty puncture wound of the skin, which one of the following vaccinations would be considered the highest priority to keep up to date?

Tetanus

3 multiple choice options

In a patient who develops a significant fever while profoundly neutropenic (neutrophil count <0.1 x 109/L) which one of the following is part of the correct management approach?

Broad-spectrum antimicrobials should be given within 1 hour

3 multiple choice options

TORCH is an acronym for what organisms?

Toxoplasmosis

Others (Syphilis, Hep B)

Rubella

Cytomegalovirus

Herpes Simplex

Which one of the following sexually transmitted infections may present with a painless chancre in its primary stage?

Syphilis

3 multiple choice options

Which one of the following infections requires airborne infection control precautions, ideally in a negatively pressurised isolation room?

Pulmonary tuberculosis with acid fast bacilli in sputum

3 multiple choice options

Which one of the following diagnostic procedures is the most appropriate to screen for a latent Mycobacterium tuberculosis infection prior to commencing anti-Tumour Necrosis Factor (TNF) alpha therapy?

Interferon gamma release assay (IGRA)

3 multiple choice options

Gas gangrene is typically caused by which one of the following Clostridia species?

Clostridium perfringens

3 multiple choice options

Which one of the following transmissible spongiform encephalopathies is usually familial (inherited)?

Gerstmann-Sträussler-Scheinker syndrome (GSS)

3 multiple choice options

Which one of the following antimicrobial agents has recently become available with an indication for treatment of certain strains of Carbapenemase producing Enterobacteriales (CPE)?

Ceftazidime-Avibactam

3 multiple choice options

To which Ambler Class of beta-lactamase does OXA-48 Carbapenemase belong (choose one of the following)?

D

3 multiple choice options

Which one of the following viruses is primarily transmitted from person to person by the faecal-oral route?

Hepatitis A

3 multiple choice options

The most common medical device associated with biofilm infections is which one of the following?

Central vascular catheters

3 multiple choice options

Which one of the following would be the most rapid method for diagnosing a case of Legionnaires' Disease due to Legionella pneumophila serogroup 1?

Urinary Legionella Pneumophila antigen detection

3 multiple choice options

Which of the following antibiotic stewardship interventions is considered "restrictive"?

Selective reporting by laboratory of antibiotic susceptibilities

3 multiple choice options

t(8;14)(q24;q32) with translocation of the c-myc gene to the Immunoglobulin heavy chain gene locus is characteristic of:

Burkitt's lymphoma/leukaemia

A 72 year old man presents with recurring viral infections, enlarged lymph nodes in the neck, axilla and inguinal region, splenomegaly and fatigue. He has low IgG, IgA and IgM. What is the most likely diagnosis?

Chronic Lymphocytic Leukaemia

3 multiple choice options

A 69 year old female presents with mild jaundice and pallor and is found to have macrocytic anaemia. Which is the most likely laboratory finding?

Low B12 (megaloblastic anaemia)

3 multiple choice options

A 30 year old female presents with left upper quadrant pain and is found to have splenomegaly, an WCC >200 x10/9/L, anaemia and minimally elevated platelet count. Which is the most likely diagnosis?

Chronic myeloid leukaemia

3 multiple choice options

A 19 year old female presents following a recent upper respiratory tract infection with recent onset bleeding into the skin and mucous membranes. Her coagulation screen is normal. Which of the following is most likely to be present?

FBC confirm a low platelet count (<10 x 109/L), normal WCC and haemoglobin (immune thrombocytic purpura)

3 multiple choice options

A 70 year old male previously fit man presents with a 3 week history of progressive shortness of breath, bleeding after shaving/washing teeth, and inflamed gums and mouth ulcers. A diagnosis is made on the basis of a blood film, what is the most likely finding?

Myeloblasts

3 multiple choice options

A 70 year old male living in a hostel, who has alcohol dependence is admitted with profound anaemia. Which is the least likely cause of his anaemia?

Autoimmune Haemolytic Anaemia

3 multiple choice options

A 36 year old man presents with abdominal pain, nausea and heartburn. Endoscopy shows inflamed gastric mucosa and an area of ulceration. A CLO test is positive. Biopsy shows chronic gastritis, particularly in the antrum, and gram negative rods are seen. Which of the following is the most correct statement about this condition?

It has a known association with the development of adenocarcinoma and MALT lymphoma

3 multiple choice options

A 58 year old man presents following a fall. On examination he has a quiet voice and a 'pill-rolling' tremor which is more prominent on the right side. When asked to walk he is slow to begin movement and walks with a shuffling gait. There is notable rigidity of the limbs. Where is the primary site of neuropathology in this condition?

Substantia Nigra

A 14 year old boy presents with a bulky mass of the knee. Imaging demonstrates that the lesion arises from the medulla of the distal femur, and a Codman triangle is seen. On histology the lesion is composed of neoplastic bone-forming (osteoblastic) cells. What is the most likely diagnosis?

Osteosarcoma

Which of the following combination of clinical biochemistry tests is commonly used to classify Chronic Kidney Disease (CKD)?

Serum eGFR and Urine Albumin

3 multiple choice options

A 20 year-old male college student presented with a 4 day history of jaundice, general malaise and right hypochondrial pain. The following serum Liver Function Tests (LFTs) were reported.

ALP 94 (40 -129 IU/L)

GGT 47 (10 - 71 IU/L)

Total Bili 376 (0 - 21μmol/L),

ALT 1253 (0 - 41 IU/L)

AST 1786 (0 - 40 IU/L

What is the most likely diagnosis?

Hepatitis A

Muir Torre Syndrome is associated with which genetic mutation?

Germline DNA mismatch repair enzyme gene mutation

Kaposi Sarcoma is associated with what virus?

HHV-8

Basal Cell Naevus Syndrome (Gorlin Syndrome) is associated with what mutation?

Germline PTCH gene mutation

Verucca Vulgaris is associated with what viral infection?

Herpes Simplex Virus

Chicken Pox is associated with what virus?

Varicella Zoster Virus

A 23 year old woman experiences a significant post-partum haemorrhage requiring transfusion of 6 litres of blood. Two days later her urine output is still reduced. Her BUN and creatinine are elevated.

What is the most likely diagnosis?

Acute Tubular Injury

A 58 year old man is admitted for investigation of renal impairment. A high level of Bence-Jones protein is identified in his urine. A kidney biopsy demonstrates large casts within the tubules

What is the most likely diagnosis?

Myeloma-associated nephropathy

A 34 year old man with Tuberous Sclerosis is found to have a renal mass. He undergoes nephrectomy which reveals that the tumour is composed of a mixture of vessels, smooth muscle and fat.

What is the most likely diagnosis?

Angiomyolipoma

A 76 year old man presents with haematuria. Imaging reveals a tumour within the renal pelvis. He undergoes nephrectomy and his tumour is found to be deficient in a mismatch repair protein.

What is the most likely diagnosis?

Urothelial Carcinoma

A 39 year old man presents with pneumothorax, a chest drain is inserted, and subsequent imaging reveals cysts and blebs in the lung. The radiology report also notes bilateral renal lesions which have central stellate scars. You note numerous papules on his face, but examination is otherwise unremarkable.

What is the most likely diagnosis?

Birt-Hogg-Dubé syndrome

These clinical findings are most closely associated with what diagnosis?

This is the second most common type of breast cancer. Up to 20% can be bilateral. It is characterised histologically by non-cohesive cells which are often orientated in single file

Invasive Ductal Carcinoma

These findings best describe what pathology?

This cytogenetic abnormality is present in up to 25% of breast cancers and is associated with an aggressive behaviour. It can be detected by FISH (fluorescent in situ hybridization).

HER2

These clinical findings best describe what pathology?

Enlargement of the male breast due to hypertrophy and hyperplasia of the glands and stroma.

Gynaecomastia

These findings best describe what pathology?

Neoplastic proliferation with malignant features, confined within spaces bordered by myoepithelium and basement membrane.

Ductal carcinoma in situ

These findings best describe what pathology?

Discrete usually solid freely mobile nodule ranging in size from 1-10cm characterised by a firm tan-white macroscopic appearance. Microscopic examination reveals a loose fibroblastic stroma containing duct like epithelium lined spaces of various sizes and formation.

Fibroadenoma

Malignant rhabdoid tumours are associated with what genetic mutation?

Biallelic inactivation of SMARCB1

Chromosomal translocation (2;13), resulting in PAX3-FOXO1 fusion gene, is associated with what childhood cancer?

Alveolar rhabdomyosarcoma

What are poor prognostic markers in neuroblastoma?

Gain of 17q

MycN amplification

The following best describes what malignancy?

High grade B cell lymphoma characterised by a c-myc translocation

Burkitt's Lymphoma

The following best describes what malignancy?

Histologically the neoplastic T cells infiltrate the epidermis and upper dermis. The T cells have a characteristic marked infolding of the nuclear membrane. As the disease progresses nodal and visceral dissemination is common.

Mycosis Fungoides

The following best describes what malignancy?

The t(14,18) translocation occurs in 90% of cases. This translocation results in over expression of BCL2. On light microscopy, the normal nodal architecture is effaced by closely packed follicles containing centrocytes and centroblasts

Follicular Lymphoma

What is the most common type of Non-Hodgkin's Lymphoma?

Diffuse Large B-Cell Lymphoma

The following best describes what malignancy?

These extra nodal B cell lymphomas arise in the salivary glands, small and large bowel, lungs and breast. They are associated with auto-immune diseases including Sjogren's disease and Hashimoto's thyroiditis. Those arising in the stomach may have Helicobacter pylori as an aetiological agent.

MALT Lymphoma

The following best describes what malignancy?

There are four histological subtypes with identical immunotypic and genetic features. Histology is characterised by the presence of large cells with abundant basophilic cytoplasm and binucleate mirror nuclei (Reed Sternberg cells).

Hodgkin's Lymphoma

A 75 year old man presents with acute pain in his ribs and back. He also has urinary frequency and a poor flow with a hard prostate on digital examination.

? Metastatic Prostate Cancer

A 60 year old man has pain in his bladder on standing and difficulty in emptying his bladder with blood at the end of the stream.

? Bladder Calculus

A 65 year old man presents with a large painless bladder, overflow incontinence at night and a raised creatinine level.

? Hydronephrosis

A 30 year old man complains of pain in the rectum, groin and urinary frequency with dysuria.

? Chronic Bacterial Prostatitis

A 52 year old man has a PSA 3.9ng/dl. Biopsies show Gleason 3+3 on 1 of 12 cores, <5% of tissue involved.

? Localised prostate cancer

Squamous carcinoma of lateral border of the tongue in a 45 year old male

What is the most likely aetiologic factor?

Acquired p53 mutation secondary to smoking

What is the most likely aetiologic factor?

Carcinoma of the nasopharynx in a 54 year old female

Epstein Barr virus infection

What is the most likely aetiologic factor?

Tonsillar squamous carcinoma in 55 year old male, non-smoker

Human papilloma virus 16 infection

What is the most likely aetiologic factor?

Maxillary carcinoma in 65 year old female

Chronic sinusitis

What is the most likely aetiologic factor?

Kaposi sarcoma of the palate in a patient from the Mediterranean

Human herpes virus 8

A 57 year old man with a history of primary sclerosing cholangitis presents with jaundice and hepatomegaly. On imaging a mass is seen at the confluence of the right and left hepatic ducts.

Klatskin tumour (hilar cholangiocarcinoma)

A 41 year old man with a history of ulcerative colitis presents with jaundice and itch. pANCA, ANA and IgM are raised, while AMA is normal. Liver biopsy shows loss of bile ducts with inflammation and periductal fibrosis ('onion skinning').

Primary sclerosing cholangitis

A 50 year old woman presents with a fever, jaundice, tenderness of the right upper quadrant and coagulopathy. Blood tests show markedly raised AST and ALT, with a normal ALP. Serum ANA, anti-SM, pANCA and IgG are raised. A liver biopsy shows dense portal tract inflammation composed of lymphocytes and plasma cells, interface hepatitis, lobular inflammation and hepatocyte necrosis.

Autoimmune hepatitis

A 33 year old woman with a known history of gallstones presents with pyrexia, right upper quadrant pain, jaundice and confusion. She is hypotensive. Her white cell count and CRP are elevated.

Ascending cholangitis

A 5 week old baby is brought to the emergency department by her parents. Her parents report that her skin and eyes have become yellow in colour, her urine has become dark in colour and her stools appear pale. On examination her liver is enlarged.

Biliary atresia

A 29 year old woman presents with palpitations, weight loss and anxiety. On examination she is tachycardic. You notice that her eyes bulge outwards. Her thyroid is diffusely enlarged. TSH receptor antibodies are identified.

Grave's Disease

A 58 year old woman presents with a 3cm mass in the right lobe of the thyroid. On excision of the lesion there are papillary structures and psammoma bodies.

Papillary thyroid carcinoma

A 20 year old man presents with headache, photophobia and neck stiffness. You notice a non-blanching rash and suspect bacterial meningitis. Despite antibiotic therapy, that evening you are called to review him as he is vomiting and is profoundly hypotensive. A venous blood gas demonstrates low sodium and high potassium.

Waterhouse Friedrichsen Syndrome

A 42 year old man presents with muscle cramps and muscle weakness. His blood pressure is 185/98 mmHg. You perform some tests which reveal an elevated sodium and low potassium.

Conn's Syndrome (primary aldosteronism)

A 67 year old man presents for routine blood pressure assessment. You notice that he has large hands and coarse facial features. He tells you that his rings no longer fit.

Acromegaly

Low risk HPV subtypes associated with genital warts

HPV 6 and 11

Clinical presentation of infertility, hirsutism and amenorrhoea

Polycystic Ovary Syndrome

High-risk HPV subtypes associated with cervical cancer

HPV 16 and 18

Histologically identified by the presence of endometrial glands, endometrial stroma and haemorrhagic foci

Endometriosis

Tumour derived from all 3 germ cell layers (ectoderm, mesoderm and endoderm)

Mature teratoma

What is the most appropriate diagnostic investigation for Cryptococcus neoformans

Antigen detection on cerebrospinal fluid (CSF) using lateral flow device in a case of meningitis in a patient with AIDS (Acquired Immunodeficiency Syndrome)

What is the most appropriate diagnostic investigation for Mycobacterium tuberculosis?

Ziehl Neelsen (ZN) stain on sputum

What is the most appropriate diagnostic investigation for HACEK group organisms

Polymerase chain reaction (PCR) test on heart valve tissue targeting 16S bacterial ribosomal gene in a case of culture negative infective endocarditis

What is the most appropriate diagnostic investigation for Clostridioides difficile

PCR test on stool for bacterial exotoxin gene in a case of nosocomial diarrhoea

What is the most appropriate diagnostic investigation for Neisseria gonorrhoeae

Gram stain on microscopic preparation of urethral pus

What is the most likely pathogen in a case of community-acquired meningitis with a purpuric rash?

Neisseria meningitides

3 multiple choice options

What is the most likely pathogen in a case of acute bacterial tonsillitis?

Streptococcus pyogenes (group A streptococci)

3 multiple choice options

What is the most likely pathogen in a case of complicated or catheter-associated UTI?

Proteus mirabilis

3 multiple choice options

What is the most likely pathogen in a case of non-bacterial liver abscess?

Entamoeba histolytica

3 multiple choice options

JAK 2 mutation is associated with what blood pathology?

Polycythemia vera

What would be the suspected laboratory finding in a 24-year old female with splenomegaly, high LDH, and spherocytes?

Coomb's test positive for IgG

3 multiple choice options

What would be the suspected laboratory finding in a 49 year old male with vitamin K deficiency due to antibiotic usage?

Prolonged PT (prothrombin time) and normal APTT (activated partial thromboplastin time)

2 multiple choice options

What would be the suspected laboratory finding in a 75 year old male with recent onset low back pain?

Normochromic, normocytic anaemia, rouleaux formation and paraprotein

3 multiple choice options

What would be the suspected laboratory finding in a 56 year old female with splenomegaly due to chronic myeloid leukaemia?

White cell count 64 x109/L, 52% neutrophils, with myelocytes, eosinophils and basophils also seen (normal white cell count 4-11 x109/L)

3 multiple choice options

Monoclonal IgG band with associated IgA and IgM deficiency is associated with what haematological diagnosis?

Multiple myeloma

Reciprocal translocation generating a hybrid bcr-abl transcript is associated with what haematological diagnosis?

Chronic myeloid leukaemia

High platelet count, normal haemoglobin and positive JAK2 mutation is associated with what haematological diagnosis?

Essential thrombocythaemia

Low haemoglobin and reticulocyte count, Neutrophil count of 1 x 109/L and platelet count of 20 x 109/L is associated with what haematological diagnosis?

Severe aplastic anaemia

Intravascular haemolysis with high reticulocyte count and LDH is associated with what haematological diagnosis?

Sickle cell anaemia

Which of the following is a targetable molecular alteration in lung cancer?

EGFR mutation

3 multiple choice options

PD-L1 immunohistochemistry is used as a biomarker to select patients for one of the following:

Immune checkpoint targeted immunotherapy

3 multiple choice options