M1 CA1 QBI Revision Zoom

M1 CA1 QBI Revision Zoom

16th Oct 2024

Introduction

• Each question: maximum of 30s for answering

  • you will likely have longer than this for exams

• We will briefly explain each question right after

  • Feel free to unmute to ask questions - if you send via the chat, we may not be able to see and address it on time

• Refrain from discussing with one another - this is for your learning!

• Disclaimer: we strive to be as accurate as possible, but always refer back to official slides and textbooks!!!

Immunology

General Pathology

General Pharmacology

Microbiology

Multiple Choice

A 32-year-old man has had dysphagia, nausea, and epigastric pain for 6 months. He was previously diagnosed with peptic ulcer disease and prescribed a proton pump inhibitor. Which of the following statements is most accurate?

• His symptoms are consistent with cholera

• His symptoms are consistent with typhus

• He should take naproxen for pain relief

• Bethanechol would help relieve his nausea

• Oral pilocarpine could worsen his symptoms

Multiple Choice

The patient with peptic ulcer disease visits the doctor due to recent worsening of his symptoms. He is afebrile, and his abdomen is soft and non-tender. A laboratory workup is negative for stool ova and parasites, including Giardia and Entamoeba. Based on these findings, which statement is most accurate?

• Salmonella causes peptic ulcer disease

• He should take cisplatin to prevent stomach cancer

• He is likely experiencing Type I hypersensitivity reaction

• His symptoms are consistent with H. pylori infection

• He should be treated with oral metronidazole

Multiple Choice

After some investigations, he is diagnosed with H. pylori infections. Which statement about diagnosis of H. pylori is most accurate?

• H. pylori can be detected through a urine test

• H. pylori is diagnosed by abdominal X-ray

• Serology for H. pylori stays positive for life

• H. pylori must be cultured in Thayer-Martin agar

• H. pylori is a gram-negative coccus

Multiple Choice

Treatment for H. pylori is initiated. A commonly adopted first-line option is triple therapy, comprising clarithromycin, amoxicillin/metronidazole, and a proton pump inhibitor (e.g., omeprazole) for 14 days. Which statement is most accurate?

• Clarithromycin inhibits polypeptide synthesis

• Using metronidazole increases risk of C. diff infection

• Amoxicillin contains beta-lactamase inhibitor

• Clarithromycin is used as H. pylori is an “atypical”

• Clarithromycin is used as H. pylori is an anaerobe

Multiple Choice

He undergoes gastroscopy and biopsy of stomach tissue to check malignancy. Which of the following complications is LEAST likely to be associated with H. pylori?

• Duodenal ulcers

• Gastric adenocarcinoma

• MALT lymphoma

• Squamous cell carcinoma

• Chronic gastritis

Multiple Choice

Here is a histological section of his biopsied stomach tissue. His stomach lining shows the presence of goblet cells, which are normally only present in the intestines. Which statement is LEAST accurate?

• This may be related to his H. pylori infection

• This is an example of metaplasia

• Metaplasia can be a precursor to dysplasia

• Metaplasia is considered to be carcinoma-in-situ

• Goblet cells are epithelial tissue

Multiple Choice

The patient is worried that he will get stomach cancer in the future. You reassure him that with proper compliance to triple therapy, the risk of malignant transformation is low. However, he wants to learn more about anti-cancer drugs. Which statement is most accurate?

• Paclitaxel is a platinating agent

• Microtubule inhibitors are non-cell cycle specific

• Alkylating agents are cell cycle specific

• Doxorubicin is highly cardiotoxic

• Vinblastine inhibits topoisomerase

Multiple Choice

The man is thus reminded to adhere to his triple therapy (clarithromycin, amoxicillin, and omeprazole). One day he experiences heart palpitations, and an ECG is conducted. He is shown to be having QT prolongation. What is the most likely cause?

• Clarithromycin

• Amoxicillin

• Complication of H. pylori infection

• Drug allergy

Multiple Choice

A 30-year-old woman presents with a 1-week history of severe right upper quadrant abdominal pain, fever, and chills. She has been sexually active with three partners during the past year. Which of the following pathogens is LEAST associated with STD?

• Candida albicans

• Neisseria gonorrhoeae

• Chlamydia trachomatis

• Treponema pallidum

• Trichomonas vaginalis

Multiple Choice

Upon examination, the patient is febrile, with elevated heart rate and breathing rate. PCR tests were ordered for chlamydia and gonorrhoea, as well as an RPR (rapid plasma reagin) test. Which of the following is most accurate about the RPR test?

• It is a test for Chlamydia trachomatis

• It stays positive for a long time after recovery

• It is a test for Mycobacterium tuberculosis

• It is a test for Treponema pallidum

• It is an ELISA for viral STDs

Multiple Choice

To investigate her right upper quadrant abdominal pain, a contrast CT scan of the patient’s abdomen and pelvis is performed. It reveals increased perihepatic enhancement that raises concern of perihepatitis (inflammation of the liver’s lining). What is this complication most likely to be?

• Jarisch-Herxheimer reaction

• Hepatic amoebiasis

• Proctitis

• Waterhouse-Friderichsen syndrome

• Fitz-Hugh-Curtis syndrome

Multiple Choice

The patient is started on empirical antibiotic therapy to cover both Chlamydia trachomatis and Neisseria gonorrhoea. Select the best statement.

• Treat with ceftriaxone and vancomycin

• Azithromycin is effective against “atypicals” like Neisseria

• Co-amoxiclav covers both pathogens

• Nitrofurantoin is indicated as this is a UTI

• Ceftriaxone effectively eliminates Neisseria

Multiple Choice

One last question about Neisseria! Select the best statement

• Neisseria meningitidis has a protein capsule

• Gonorrhoea causes a non-blanching rash

• Blood culture can be used to diagnose N. meningitidis

• Neisseria is resistant to all penicillins

• N. meningitidis is a leading cause of neonatal meningitis

Multiple Choice

A 5-year-old boy presents with a rash around his mouth, with pustules and papules on a background of reddish plaques. Some pustules have ruptured, leaving honey-coloured crusts. The rash started 4 days ago.

• This condition is called erysipelas

• Debridement is necessary, as the dermis is infected

• A culture would grow gram positive cocci in clusters

• This is acute herpetic gingivostomatitis

• This condition is caused by alpha-haemolytic streptococci

Multiple Choice

The patient has impetigo caused by Staphylococcus aureus.  Select the most accurate statement:

• Topical clindamycin can treat MRSA skin infections

• This presentation is caused by enterotoxin

• This skin infection is caused by coagulase-negative staph

• Rheumatic heart disease is a known complication

• TSST-1 can cause toxic epidermal necrolysis

Multiple Choice

The boy complains that the rash is itchy. Which medicine is LEAST likely to be effective in relieving his itch?

• Triprolidine

• Cetirizine

• Loratadine

• Promethazine

• Pseudoephedrine

Multiple Choice

He is given an oral antihistamine. The doctor advises that this antihistamine will not cause dry mouth, tachycardia, or urinary retention, but it might be slightly sedating. What is its most likely identity?

• Loratadine

• Promethazine

• Fexofenadine

• Chlorpheniramine

• Cetirizine

Multiple Choice

A 40-year-old Singaporean man who lives in a dengue red zone presents to his GP with abrupt onset of 39.3 degrees fever, myalgia, and retro-orbital pain. Select the FALSE statement:

• NSAIDs are contraindicated

• The dengue rash may blanch

• Retro-orbital pain is a warning sign of shock

• The dengue virus replicates in macrophages

• A serological test for dengue virus is NS1 antigen

Multiple Choice

The man is prescribed paracetamol for his fever and myalgia. In which of the following conditions is paracetamol NOT indicated?

• To reduce inflammation in rheumatoid arthritis

• To lower fever associated with Covid-19

• To relieve mild abdominal cramps during pregnancy

• In all elderly above 80 y/o

• In patients with renal impairment

Multiple Choice

Paracetamol is normally processed hepatically into nontoxic metabolites. If the patient has hepatic impairment, which parameter of paracetamol will be decreased?

• Bioavailability

• AUC

• Half-life

• Distribution volume

• Clearance

Cancer Biology

Multiple Choice

Mr Tan (60 years old) came to your clinic for vague abdominal pain which lasted for 6 months. Investigations were done to find out the cause.

A biopsy was done and shown here. MOST likely histological diagnosis?

• Squamous cell carcinoma

• Liposarcoma

• Adenocarcinoma

• Leiomyosarcoma

• Angiosarcoma

Multiple Choice

Mr Tan (60 years old) came to your clinic for vague abdominal pain which lasted for 6 months. He was diagnosed to have colorectal cancer.

Which of the following signs or symptoms is Mr Tan LEAST likely to have?

• Change in bowel habits

• Shortness of breath

• Melena (black tarry stools)

• Jaundice

• Hematemesis

Multiple Choice

Which of the following is NOT an established risk factor for colorectal cancer?

• Male gender

• Irritable bowel syndrome

• Alcohol intake

• Sedentary lifestyle

• Diet high in processed meat

Multiple Choice

Mr Tan has been diagnosed with colorectal cancer. Which of the following tests would you order?

• Alpha fetoprotein

• CA-125

• Calcitonin

• Human chorionic gonadotropin

• Carcinoembryonic antigen

Multiple Choice

The pathologist has prepared a series of histological slides for a presentation. Which of the following MOST likely describes the images above?

• The staging increases from left to right.

• The grading decreases from left to right.

• The mitotic index decreases from left to right.

• The grading increases from left to right.

• The staging decreases from left to right.

Multiple Choice

Another patient with colorectal cancer presents with bilateral lower limb weakness and numbness, together with altered mental status. What is the MOST likely phenomenon occuring in this patient?

• Paraneoplastic syndrome

• Cancer cachexia

• Neural metastasis

• Sciatic nerve compression by tumour

• Warburg effect

Multiple Choice

At the clinic, Mr Tan recalled that many of his family members and relatives also had colorectal cancer. You drew a family tree based on what he told you. Which of the genes, among the following, is MOST likely mutated?

• KRAS

• HER2

• PMS2

• PNAS

• BRAF

Multiple Choice

How may cancer cells evade destruction by the immune system?

• Expression of multiple neo-antigens

• Promoting activation of CD28 receptors

• Activate apoptosis of regulatory T cells

• Degradation of TGF-beta molecules

• Downregulation of MHC-I expression

Multiple Choice

The patient was started on anti-cancer drugs. Which of the following drugs is cell cycle non-specific?

• Doxorubicin

• 5-fluorouracil

• Etoposide

• Paclitaxel

• Methotrexate

Multiple Choice

As chemotherapy was not effective in controlling his condition, the patient agreed to try out CAR-T cell immunotherapy. Which of the following steps is NOT part of the process involved in this treatment?

• Extraction of T cells from the patient

• Insertion of chimeric antigen receptors on the surface of T cells

• Lowering the patient’s white blood cell count with chemotherapy

• In-vitro proliferation of CAR T cells

• Infusion of CAR T cells into the patient’s blood

Multiple Choice

Mr Tan shows you one of the radiological images he had recently taken.

What is the view and abnormality in this X-ray?

• Coronal view, Missing pedicle

• AP view, Loss of disc space

• Lateral view, Presence of syndesmophytes

• AP view, Missing pedicle

• Sagittal view, Abnormal alignment of vertebral bodies

Multiple Choice

MOST likely significance of this radiological finding in this patient?

• Osteoporotic fracture of the spine

• Cancer cachexia

• Vertebral metastasis

• Increased risk of prolapsed intervertebral disc

• Kyphosis of lumbar spine

Multiple Choice

What is the modality and view used in this radiological image?

• MRI, T1-weighted, sagittal view

• MRI, T2-weighted, coronal view

• CT scan, axial view

• MRI, T2-weighted, sagittal view

• CT scan, sagittal view

Multiple Choice

Which vertebral body is affected in this radiological image?

• S1

• L4

• L3

• L5

• T12

Multiple Choice

With reference to all of the previous information, what is the MOST likely stage of cancer and treatment for Mr Tan?

• Stage III, neoadjuvant chemotherapy with colectomy

• Stage IV, total colectomy

• Stage III, palliative radiotherapy

• Stage II, adjuvant chemotherapy and radiotherapy

• Stage IV, palliative chemotherapy

Feedback!
(anonymous)

https://tinyurl.com/m1ca1zoom

Your feedback is important and is greatly appreciated :)