Onexamination 2012 - GENITOURINARY - (Www.mymrcp.blogspot.com)

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Exam Revision Scores Community Help 14

Work Smart Work Hard Group Learning Saved Tests Revision Advice Tagged Questions

Work Smart Session - MRCP Part 1

Which one of the following cutaneous lesions is associated with HIV infection?

(Please select 1 option)

Leucoplakia

Lichen planus

Lichen sclerosus

Plasma cell balanitis

Psoriasis

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Which one of the following cutaneous lesions is associated with HIV infection?


Leucoplakia Incorrect answer selected

Lichen planus

Lichen sclerosus

Plasma cell balanitis

Psoriasis This is the correct answer

It occurs in 2-4% of healthy people. If pre-existing psoriasis flares up for no apparent reason or middle-agedpeople develop psoriasis for the first time, one should exclude underlying HIV infection in those patients.

Leucoplakia is a pre-cancerous lesion whereas oral hairy leucoplakia is a sign of immunodefiency in an HIVpositive patient.

Lichen planus, lichen sclerosus and plasma cell balanitis are not associated with HIV infection.

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Related Articles(BMJ)

Balanoposthitis - Basics -Aetiology - Best Practice -English Read article

Balanoposthitis - Basics -Aetiology - Best Practice -English Read article

Cutaneous Manifestationsof Rheumatic Diseases. --BAER 56 (4): 228 --Annals of the RheumaticDiseases Read article





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Which one of the following is an AIDS defining illness?


Anal canal warts

Extra genital molluscum contagiosum

Multidermatomal shingles

Oesophageal candidiasis

Oral candidiasis


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Which one of the following is an AIDS defining illness?


Anal canal warts

Extra genital molluscum contagiosum

Multidermatomal shingles

Oesophageal candidiasis Correct

Oral candidiasis

Any opportunistic infections or opportunistic malignancies are AIDS defining illnesses.

Oesophageal candidiasis is an AIDS defining illness but oral candidiasis is not.

Anal warts are not an opportunistic infection.

Extra genital molluscum contagiosum is also not an opportunistic infection but frequently occurs in symptomaticHIV positive patients.

Multidermatomal shingles is not an opportunistic infection but if it occurs in a young person HIV infection needsto be excluded.


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A 28-year-old man with HIV presents with a five day history of feeling unwell. He is a heavy smoker.

A chest radiograph showed right upper lobe consolidation. His CD4 count was 468 cells/mm3. HIV RNA level

was 90,678 copies/ml. He is not on any antiretroviral treatment.

What is the most likely diagnosis?


Bronchial carcinoma

Invasive pulmonary aspergillosis

Pulmonary tuberculosis

Pneumocystis jiroveci pneumonia (PCP)

Streptococcal pneumonia


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A 28-year-old man with HIV presents with a five day history of feeling unwell. He is a heavy smoker.

A chest radiograph showed right upper lobe consolidation. His CD4 count was 468 cells/mm3. HIV RNA level

was 90,678 copies/ml. He is not on any antiretroviral treatment.

What is the most likely diagnosis?


Bronchial carcinoma

Invasive pulmonary aspergillosis

Pulmonary tuberculosis

Pneumocystis jiroveci pneumonia (PCP)

Streptococcal pneumonia Correct

This is typical of community-acquired pneumonia. One should think of common infections rather than anyopportunistic infections in HIV patients with good CD4 counts. (More than 400 cells/mm

3 is not

immunocompromised.)

It is not a typical history for bronchial carcinoma as the history was short and radiographic changes were nottypical of bronchial carcinoma.

Invasive pulmonary aspergillosis is unlikely in a patient with good CD4 count. Pulmonary tuberculosis typicallycauses cavitating lesions in a patient with a good CD4 count.

PCP commonly occurs in patients with CD4 count of less than 200 cells/mm3 and chest radiograph shows

bilateral infiltrates from the hila without any effusion or lymphadenopathy.


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A rare cause of empyemain a non-immunocompromised caseand successful combinedtreatment -- 80 (941): 185-- Postgraduate Medical






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Which one of the following is an oncogenic virus?


Hepatitis A

Human papilloma virus 6 (HPV 6)



Varicella zoster virus (VZV)


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Which one of the following is an oncogenic virus?


Hepatitis A



Human papilloma virus 16 (HPV 16) Correct

Varicella zoster virus (VZV)

HPV 16 is oncogenic and causes squamous cell carcinomas in the oral cavity, cervix, anus and penis.

Hepatitis A is not an oncogenic virus, as it does not cause chronic infection or cancer.

HPV 6 and 11 typically cause the majority of benign warts.

VZV causes chicken pox and herpes zoster.

Reference:Yoganathan K, Patel RN, Maitland N, McManus TJ, Calman FM, Pozniak A. Carcinoma of the penis in an HIVpositive patient. Genitourin Med.1995 Feb; 71 (1): 41-2.

Further reading:United Kingdom National Guideline on the Management of Ano-genital Warts, 2007 (pdf)


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Novel mechanism forimpaired nitrergicrelaxation in achalasia --Boeckxstaens 55 (3): 304 -- Gut Read article

Oral communications -- 58(suppl 1): A3 -- Journal ofEpidemiology CommunityHealth Read article

Recurrent conjunctivalpapilloma progressing intosquamous cell carcinomawith change of HPV-






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A 34-year-old homosexual Caucasian man developed jaundice two months after taking a combination ofantiretroviral drugs.

He admitted that he had had several episodes of unprotected sex with several casual male partners. His liverfunction showed raised bilirubin with normal transaminases and alkaline phosphatase.

What is the most likely cause of his jaundice?


Acute hepatitis B

Alcoholic hepatitis

Atazanavir

Efavirenz

Nevirapine


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A 34-year-old homosexual Caucasian man developed jaundice two months after taking a combination ofantiretroviral drugs.

He admitted that he had had several episodes of unprotected sex with several casual male partners. His liverfunction showed raised bilirubin with normal transaminases and alkaline phosphatase.

What is the most likely cause of his jaundice?


Acute hepatitis B

Alcoholic hepatitis

Atazanavir This is the correct answer

Efavirenz Incorrect answer selected

Nevirapine

Atazanavir causes hyperbilirubinaemia with normal transaminases and alkaline phosphatase (mimickingGilbert's syndrome).

Acute hepatitis B is unlikely with normal trasaminases and alkaline phosphatase.

A mild to moderate rise in trasaminases and alkaline phosphatase occurs in alcoholic hepatitis.

Efavirenz can cause acute hepatitis with raised levels of transaminases.

Nevirapine causes acute hepatitis where transaminases are raised several-fold.


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A single centre cohortexperience with a newonce daily antiretroviraldrug -- Stebbing et al. 82(967): 343 -- PostgraduateMedical Journal Read article

New drugs for treatingdrug resistant HIV-1 --Isaac and Pillay 79 (3):176 -- SexuallyTransmitted Infections Read article

Antiretroviral treatment ofHIV infected adults --






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Which of the following is a sign of immunodeficiency in the mouth?


Gingivitis

Herpes labialis

Leucoplakia

Oral hairy leucoplakia

Oral wart


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Which of the following is a sign of immunodeficiency in the mouth?


Gingivitis

Herpes labialis

Leucoplakia

Oral hairy leucoplakia Correct

Oral wart

Oral hairy leucoplakia is a sign of immunodefiency. It is due to reactivation of Epstein-Barr virus infection.

Gingivitis is not a sign of immunodefiency.

Leucoplakia is not a sign of immunodefiency but it is a precancerous lesion.

Herpes labialis is due to herpes simplex infection, which causes 'cold sores' in immunocompetent patients andchronic herpes labialis in immunocompromised patients.

Oral warts can occur in healthy people. They are due to HPV infection usually due to benign types, 6 and 11.


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A 32-year-old African woman with HIV presents with a two week history of greenish, frothy, itchy vaginaldischarge.

What is the most likely cause of her discharge?


Candida albicans infection

Chlamydia infection

Foreign body

Gonorrhoea infection

Trichomonas vaginalis infection


Score: 66.67%

Total Answered: 6

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A 32-year-old African woman with HIV presents with a two week history of greenish, frothy, itchy vaginaldischarge.

What is the most likely cause of her discharge?


Candida albicans infection

Chlamydia infection

Foreign body

Gonorrhoea infection

Trichomonas vaginalis infection Correct

Trichomonas vaginalis causes itchy, frothy, greenish vaginal discharge.

Candida albicans causes a white, curdy, itchy vaginal discharge.

Chlamydia and gonorrhoea do not cause itchy, frothy vaginal discharge and both can be asymptomatic.

Foreign body causes foul smelling vaginal discharge.

Further reading:

United Kingdom National Guideline on the Management of Trichomonas vaginalis (2007) (pdf) BASHH


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A 39-year-old Caucasian man with symptomatic HIV disease developed multiple painless umbilicated papularlesions on his face.

What is the most likely cause of his skin lesions?


Cytomegalovirus (CMV)

Epstein Barr virus (EBV)

Human herpes virus (HHV) 8

Human papilloma virus (HPV 16)

Pox virus


Score: 71.43%

Total Answered: 7

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A 39-year-old Caucasian man with symptomatic HIV disease developed multiple painless umbilicated papularlesions on his face.

What is the most likely cause of his skin lesions?


Cytomegalovirus (CMV)

Epstein Barr virus (EBV)

Human herpes virus (HHV) 8

Human papilloma virus (HPV 16)

Pox virus Correct

Multiple painless umbilicated papular lesions are typical of molluscum contagiosum and are caused by poxvirus.

CMV does not cause painless papular lesions.

EBV causes Burkitt's lymphoma, non-Hodgkin's lymphoma and primary brain lymphomas.

HHV 8 is strongly associated with Kaposi's sarcoma.

HPV 16 is associated with squamous cell carcinomas in cervix, penis, anus and oral cavity.

Reference:Bain S, Yoganathan K. Physical Signs for the General Practitioner. Case 51. Molluscum contagiosum. Dentalupdate. 2008; 68.

Yoganathan K, Patel RN, Maitland N, McManus TJ, Calman FM, Pozniak A. Carcinoma of the penis in a HIVpositive patient. Genitourin Med.1995 Feb; 71 (1): 41-2.


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The HIV-positive skinbiopsy -- Grayson 61 (7):802 -- Journal of ClinicalPathology Read article

AIDS related systemicnon-Hodgkin's lymphoma -- Powles et al. 76 (5): 335-- Sexually TransmittedInfections Read article






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A 46-year-old homosexual HIV positive man presents with a two week history of weakness of his right arm andleg.

Examination reveals right hemiparesis and left cerebellar signs. CT scan shows white matter lesions in the leftcerebellar region and left temporoparietal area. There is no midline shift or surrounding oedema.

Which one of the following is most likely to be found in his cerebrospinal fluid (CSF)?


Positive cytomegalovirus (CMV) PCR

Positive Epstein-Barr virus (EBV) PCR

Positive herpes simplex virus (HSV) PCR

Positive human herpes virus (HHV) 8 PCR

Positive JC PCR


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Total Answered: 8

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A 46-year-old homosexual HIV positive man presents with a two week history of weakness of his right arm andleg.

Examination reveals right hemiparesis and left cerebellar signs. CT scan shows white matter lesions in the leftcerebellar region and left temporoparietal area. There is no midline shift or surrounding oedema.

Which one of the following is most likely to be found in his cerebrospinal fluid (CSF)?


Positive cytomegalovirus (CMV) PCR

Positive Epstein-Barr virus (EBV) PCR Incorrect answer selected

Positive herpes simplex virus (HSV) PCR

Positive human herpes virus (HHV) 8 PCR

Positive JC PCR This is the correct answer

Multifocal lesions in left cerebellar and temporoparietal white matter areas without any mass effect orsurrounding oedema are most likely to be due to progressive multifocal leucoencephalopathy (PML).

JC virus causes PML in immunocompromised patients especially when the CD4 count is below 100 cells/mm3.

CMV polymerase chain reaction (PCR) may be found in CMV encephalitis. It is clinically not a typical feature ofCMV encephalitis.

Positive EBV PCR indicates primary brain lymphoma where CT scan often shows significant mass effect withsurrounding oedema.

HSV PCR may be found in HSV encephalitis which commonly affects temporal lobes in patients with good CD4count.

HHV 8 PCR is usually associated with Kaposi's sarcoma.


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Progressive multifocalleucoencephalopathy andimmunosuppression --Cuevas and Fuchs 63 (1):112 -- Annals of theRheumatic Diseases Read article

Community-acquiredbacterial meningitis inadults -- Schut et al. 8 (1):8 -- Practical Neurology Read article






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A 67-year-old man presents after having a urine tract infection treated and has read in a magazine that maybeit would be worth checking a PSA.

When should his PSA be checked?


Check in three days' time

Check in one week

Check in two weeks

Check on this occasion

No need to check PSA


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A 67-year-old man presents after having a urine tract infection treated and has read in a magazine that maybeit would be worth checking a PSA.

When should his PSA be checked?


Check in three days' time

Check in one week

Check in two weeks This is the correct answer

Check on this occasion Incorrect answer selected

No need to check PSA

Prostate-specific antigen ( PSA) concentrations can rise with problems of false positives after catheterisationand particularly urinary tract infections (UTI).

Therefore, if one has decided to check a PSA then it is recommended that this should be measured at leasttwo weeks after a treated UTI.


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A 56-year-old man who has presented with chest pain, has a PSA of 45 ng/ml (normal less than 4).

Which of the following statements is correct with respect to this patient's management?


An elevated PSA is a definitive test for prostate cancer

High selenium intake is related to prostate cancer

Prostate cancer is more aggressive with increasing age

Prostate cancer is typically squamous call carcinoma

The most commonly used pathological grading system is the Gleason score


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A 56-year-old man who has presented with chest pain, has a PSA of 45 ng/ml (normal less than 4).

Which of the following statements is correct with respect to this patient's management?


An elevated PSA is a definitive test for prostate cancer

High selenium intake is related to prostate cancer

Prostate cancer is more aggressive with increasing age

Prostate cancer is typically squamous call carcinoma

The most commonly used pathological grading system is the Gleason score Correct

Prostate-specific antigen (PSA) may be elevated in prostatitis, benign prostatic hyperplasia and prostatecancer.

High intake of animal fats is related to prostate cancer, as well as low intake of selenium.

As a rule, prostate cancer is more aggressive in younger men.

Prostate cancer is an adenocarcinoma.

The Gleason score is recommended by the American College of Pathologists. The most well differentiatedtumours have a Gleason score of 2, and the most poorly differentiated a Gleason score of 10.

Related Articles (BMJ)

Metastatic conventional prostatic adenocarcinoma with diffuse chromogranin A and androgen receptorpositivity -- Roudier et al. 57 (3): 321 -- Journal of Clinical Pathology Read article

Epidural compression of the cauda equina caused by vertebral osteoblastic metastasis of prostaticcarcinoma: resolution by hormonal therapy -- Susuki et al. 68 (4): 514 -- Journal of Neurology,Neurosurgery Psychiatry Read article

Acute effects of therapeutic irradiation for prostatic carcinoma on anorectal function -- Yeoh et al. 43(1): 123 -- Gut Read article


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