Pathology EMQ template.

Name: Capildeo, Lucy

Candidate number:

Theme: Chemical Pathology

 

OPTION LIST

 

A

Autoimmune hepatitis

I

Sclerosing cholangitis

B

Carcinoma of the head of the pancreas

J

Wilson’s Disease

C

Epstein Barr Virus

K

 

D

Gallstones

L

 

E

Haemochromatosis

M

 

F

Hepatitis A

N

 

G

Hepatitis B

O

 

H

Primary Biliary Cirrhosis

P

 

 

 

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

 

1. A 40 year old man, presents to GP with increasing polydipsia. On examination he appears slightly “suntanned” despite not having been on holiday in the last 6 months. He has spider naevi, gynaecomastia, 3cm heptomegaly below the right costal margin. BM stix is 17.9mmol/l. Routine investigations reveal FBC: Hb 8.7g/dl, MCV 101 fl, WCC 3.9 x 109/l; Random Blood Glucose 23.2mmol/l; LFTs: Tbil 27, AST 65, Alk Phos 555, Alb 31; ferritin 12 770.

 

 

2. A 30 year old woman, seen in outpatients with a 2 month history of weight loss associated with recent onset of jaundice. On examination, she has spider naevi, Dupytren’s contracture and 4cm hepatomegaly below the right costal margin.The diagnosis is confirmed by the presence of anti-smooth muscle and anti-LKM-1 antibodies. She improves rapidly with corticosteroids.

 

 

3. A 20 year old woman with poorly controlled sickle cell disease is admitted to hospital with severe abdominal pain, pyrexia, vomiting. On examination she is jaundiced, has generalised abdominal pain with some more localised tenderness in the right upper quadrant. Initial investigations reveal FBC: Hb 5.5, MCV 87, WCC 23.9, Plt 411; U&Es: Na 141, K 4.7, Urea 12.9, Cr 112. LFTs: Tbil 47, AST 72, ALT 66, Alk Phos 871, Alb 34.

 

 

4. Previously fit and well 35 year old man returns from India with a week’s history of worsening abdominal pains, diarrhoea, vomiting and fever. Over the last 72 hours he has become jaundiced. Investigations reveal LFTs: Tbil 38, AST 332, ALT 219, Alk Phos 238, Alb 32 and an acute phase IgM response confirming the presence of an RNA virus.

 

 

5. A 30 year old man with known ulcerative colitis is seen in the gastroenterology clinic for his 6 month check up. He reports he has been well with no recent acute exacerbations of colitis. However, in the last few months he has had occasional upper abdominal pains associated with pruritis and more recently an episode of jaundice. Routine investigations LFTs: Tbil 18, AST 22, ALT 19, Alk Phos 438, Alb 39. Diagnosis is confirmed on ERCP which shows “occasional bleeding of the biliary tree”.

 

 

 

ANSWERS

1. E

2. A

3. D

4. F

5. I