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Last minute > 1/2 micro, immuno and histo > Flashcards

1/2 micro, immuno and histo Flashcards

1
Q

MOA of tenofovir

A

Nucleotide analogue

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2
Q

MOA of ritonavir

A

Protease inhibitor

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3
Q

MOA of entecavir

A

Nucleoside analogue

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4
Q

Telaprevir MOA

A

NS3/4 protease inhibtor

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5
Q

Ledipasvir MOA

A

NS5 protease inhibitor

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6
Q

Investigations for sporadic CJD

A

EEG- periodic triphasic complexes
MRI- basal ganglia and cortical increased signal
CSF- 14-3-3 protein, S100
DIAGNOSIS CONFIRMED ON BRAIN BIOPSY showing spongiform vaculoation and PrP amyloid plaques

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7
Q

What are familial prion disease

A

Fatal familial insomnia
Gerstmann-straussler strackman

All will present with family history of someone dying of MS, dementia etc

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8
Q

Live vaccines

A

Influenza under 18s
Yellow fiver
MMR
BCG

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9
Q

Heyerotypic vaccine

A

BCG- bacille calmette guerin

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10
Q

Toxoid vaccines

A

Diphteria
Tetanus

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11
Q

Conjugated vaccines

A

HIB
Pneumococcus
Meningococcal

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12
Q

Example of inactivated vaccines

A

Pertussis
Cholera
Hep A
Polio
Influenza for vulnerable populations

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13
Q

Examples of subunit vaccines

A

HPV
Hep B

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14
Q

Examples of viral vectored vaccines

A

Ebola
AZ COVID vaccine

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15
Q

Examples of M-RNA vaccines

A

Pfizer
Moderna

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16
Q

Complication of viral vectored vaccines

A

Vaccine induced thrombocytopenia and thrombosis
Capillary leak syndrome
Seen in AZ covid vaccine

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17
Q

Complication of pfizer vaccine

A

Myocarditis

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18
Q

Viral, bacterial, parasitic and amoebic cause of encephalitis

A

Viral- HSV, enteroviruses and western nile
Bacterial- listeria
Amoebic- naegleri fowleri
Parasitic- toxoplasmosis

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19
Q

What activates aciclovir by phosphorylating it and is responsible for the susceptibilty to resistance

A

Thymidine kinase

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20
Q

What is mechanism of resistance to antivirals in CMV

A

Protein kinase mutation

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21
Q

Second line for HSV

A

Foscarnet and cidofovir

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22
Q

Management of adenovir

A

Cidofovir

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23
Q

Treatment for different candida infections

A

Oral thrush- topical nystatin
Vulvovaginitis- topical clotrimazole or oral fluconazole
Localised cutaneous- topical clotrimazole
Oesophagitis- oral fluconazole

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24
Q

Management of cryptococcus

A

Flucytisine and amphotericin B

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25
Q

What measure serologically in candida

A

Beta d glucan

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26
Q

Management of aspergillus

A

Voriconazole

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27
Q

Why do typical antifungals not work on PJP

A

Lack ergosterol in cell membrane

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28
Q

How do the antifungals work

A

Polyenes- bind sterols in cell membranes (affects function)
Azoles- Inhibit lanosterol 14 alpha demethylase which converts lanosterol to ergosterol (affects synthesis)
Pyrimidine analogues (flucytisine)- affects DNA synthesis
Echinocandins- Inhibit beta d glucan

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29
Q

Bacterial UTI caused by indwelling catheter

A

Klebsiella

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30
Q

What bacteria appears comma like

A

Cholera

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31
Q

Leishmaniasis species causing cutaneous vs mucocutaneous leishmaniasis

A

Cutaneous- L. tropica, L. major
Mucocutaenous- L. braziliensis

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32
Q

Management of c diff

A

1st line- oral vancomycin
If life threatening- vancomycin PO and metronidazole IV

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33
Q

What is pulvinar sign

A

Increased nuclei in thalamus

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34
Q

What causes chagas disease and what is presentation

A

Trypanosoma cruzi
- GI and cardiac symptoms
- purple eyelids
Cardiomyopathy most sinister symptom which must be investigated

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35
Q

What are the two types of african trypanosoma

A

Trypanosoma brucei rhodiense- acute from east and south
Trypanosoma brucei gambiense- gradual onset from west and central africa

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36
Q

How does trypanosoma brucei present

A

Fever
Painless ulcer at site of infectoin
Encephalitis- poor sleep, mood changes
Rhodiense- acute
Gambiense- common and gradual

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37
Q

How do mucous membranes prevent infections

A

Contain lactoferrin which starves bacteria of oxygen
IgA
Lysozome which breaks down cell walls

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38
Q

How is acute GVHD prevented

A

Ciclosporin
Methotrexate
Corticosteroids

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39
Q

What defines refractory anaphylaxis

A

No improvement in resp and cardio symptoms in response to 2 doses of IM adrenaline

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40
Q

Failed return to normal of tryptase

A

Systemic mastocytosis
Hereditary alpha tryptassaemia

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41
Q

What can give delayed food induced anaphylaxis

A

Occur 3-6 hours after eating red meat
IgE antibody to alpha-1,3-galactose

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42
Q

What is mechanism in oral allergy syndrome

A

When have haye fever, get cross reaction to some homologous proteins in apples, pears, carrots and nuts but not cooked

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43
Q

What is in goods syndrome and what is presentation

A

Thymoma with lack of T and B cell lineages
Susceptibiliy to opportunistic infections- PJP, CMV, candida

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44
Q

What tests are done which can determine HIV treatment

A

Test for HLAB5701 to avoid prescribing abacavir as severe risk of SJS
Tropism test for CCR5 to determine if CCR5 antagonist therapy would work

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45
Q

What is genetic defect in cyclic neutropenia

A

Neutrophil elastase

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46
Q

What is genetic defect of Kostmann syndrome

A

Autosomal recessive- HCLS-1 associated protein X-1 which prevents maturation of neutrophils

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47
Q

Pathophysiology and presentation of leukocyte adhesion deficiency

A

CD18 which is involved in clearance of neutrophils
delayed separation of umbilical cord
very high neutrophil counts in blood (20-100 x106/L)
Absence of pus formation

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48
Q

Presentation of chronic granulomatous disease

A

Granulomas
Hepatomegaly and lymphadenopathy
Recurrent infections from PLACESS often affecting skin
Pseudomonas
Listeria
Aspergillosis
Candida
Ecoli
S aureus
Serratia

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49
Q

Treatment of chronic granulomatous disease

A

Intereron gamma

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50
Q

Presentation of each of the complement pathway defects

A

Classical- severe skin disease, SLE and susceptibility to encapsulated bacteria
Alternative- encapsulated bacteria susceptibility
Mannose binding- encapsulated bacteria susceptibility but is cocontaminant immunodeficiency

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51
Q

Presentation of SCID

A

Opportunistic- candida, PJP, CMV
Viral chest and GI infections- adenovirus, parainfluenza
RARELY BACTERIAL
Skin disease
Presents by 3 months

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52
Q

What is defect in CVID

A

MHC III

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53
Q

Presentation of x-linked agammaglobulinaemia

A

Encapsulated infections of ENT, GI and RESP
By age 5
Blood findings
- neutropenia
- low B cells
- low Ig

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54
Q

Pathophysiology of IPEX

A

Mutations in Foxp3 which is needed for the development of CD25+ T reg cells. Menas is failure to negatively regulate T cell responses
Increased prevalence of autoimmune diseases
- DM
- Hypothyrodism
- enteropathy
- eczema
(Diarrhoea, DM, dermatitis)

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55
Q

Management of ank spond

A

NSAIDS
Anti-TNF alpha
Anti- IL17- secukinumab

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56
Q

What is the genetic HLA association of
- goodpasture syndrome
- RA
- coeliac
- graves
- SLE
- haemochromatosis

A

GP= DR15
RA= DR1 and DR4
Coeliac- DQ2 and DQ8
Graves= DR3
SLE- DR3
Haemochromatosis- A3

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57
Q

What are 2 examples of genetic polymorphisms seen in polygenic autoimmune disease

A

Protein tyrosine phosphatase non-receptor 22
Cytotoxic t lymphocyte associated protein 4

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58
Q

What is Protein tyrosine phosphatase non-receptor 22 polymorphism associated with

A

SLE
RA
T1DM

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59
Q

What is Cytotoxic t lymphocyte associated protein 4 polymorphism associated with

A

Hashimotos
SLE
T1DM

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60
Q

Genetic predispositions to RA

A

HLA DR4
Peptidyl arginine deaminase as increases citrullination of proteins

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61
Q

What is predominant cell infiltrated in T1DM

A

CD8 T-cell

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62
Q

Antibodies in optic neuritis vs neuromyelitis optica spectra disorders

A

Optic neuritis- ant- oligodendrocyte myelin
Neuromyelitis optica spectra disorders- anti aquaporin 4

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63
Q

Antibody for homogenous staining

A

DS-DNA

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64
Q

Antibodies for speckled staining

A

Ro
La
U1RNP
Smith

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65
Q

What do anti ….. represent
- SCL70
- p-anca
- c-anca
- anti Jo

A
  • topoisomerase
  • myeloperoxidase
  • proteinase 3
  • anti t-RNA synthetase
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66
Q

After positive ANA what do

A

Check staining under microscope
Then ELISA for specific antibodies
Then stain on crithidia lucillae to confirm DS DNA

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67
Q

What stain can be used to confirm DS-DNA

A

Crithia lucillae

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68
Q

What tests do for HIV

A

4th gen ELISA then to confirm use western blot
Rapid point of care tests (saliva or blood sample) available which provide answer in 20 minutes however less sensitive than 4th gen test

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69
Q

What are the phases of T cell mediated transplant rejection

A

Phase 1- presentation of donor HLA by an APC
Phase 2- T cell activation and inflammatory cell recruitment
Phase 3- effector phase with organ damage

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70
Q

What are phases of B cell mediated transplnat rejection

A

Phase 1- B cells recognise foreign HLA
Phase 2- proliferation and maturation of B cells with anti HLA antibodies
Phase 3- effector phase where antibodies bind to graft endothelium

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71
Q

Graft biopsy findings T cell vs B cell

A

B-cell= complement and antibody deposition in the endothelium
T-cell= tubulitis, arteritis

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72
Q

Prior to transplant how screen for rejection

A

HLA tissue typing
Screening for anti-HLA or A/B antibodies

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73
Q

What induction agents are given for baseline suppression in prevention of graft rejection

A

Anti CD52- alemtuzumab
OKT3- muronomab-CD3
Anti-CD25 (IL2-R)- daclizumab

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74
Q

As well as induction agents which baseline immunosuppression agents are given to prevent SOT rejection

A

Calcineurin inhibitor
Mycophenolate or azathioprine
+/- steroids

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75
Q

How is B vs T cell mediated rejection treated

A

T-cell= steroids and OKT3- muronomab-CD3
B-cell= rituximab, IVIG, plasma exchange

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76
Q

MOA of the antiproliferative agents
- cyclophosphamide
- ciclosporin
- azathioprine
- mycophenolate motefil
- methotrexate

A

Cyclophosphamide- alkylates guanine
Ciclosporin- calcineurin inhibitor which reduces IL-2 production
Azathioprine- broken down to 6-mercatopurine which prevents purine synthesis
Mycophenolate- inhibits inoside monophosphate dehydrogenase which prevents guanine synthesis
Methotrexate- Inhibits dihydrofolate reductase which so is anti folate

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77
Q

What is difference between a mature and immature dendritic cell

A

Immature- phagocyte
Mature- antigen presenting cell

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78
Q

Which antigen confers immunity to Influenza vaccine

A

Haemoagglutinin

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79
Q

When is IL-2 given to stimulate T cell response

A

Renal cell cancer

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80
Q

MOA of
- alemtuzumab
- toclilizumab
- basilixumab/daclizumab
- rituximab

A

Alemtuzumab- CD52
Toclizumab- IL6
Basilixumab- IL2R= CD25
Rituximab- CD20 which depletes B cells but not plasma cells

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81
Q

Which organisms are bloods for IVIG screened for

A

HIV
Hep B and C

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82
Q

Define atopy and anaphylaxis

A

Atopy- tendancy to produce IgE
Anaphylaxis- allergic reaction with an A,B o

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83
Q

Which cell is most affected by steroids

A

CD4+

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84
Q

What is MOA of rapamycin/sirolimus

A

mTOR which prevents T cell proliferation

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85
Q

MOA of tofacitinab

A

Inhibits JAK-STAT signalling which prevents cytokine production

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86
Q

What are JAKinibs used in

A

RA principally
Ank spond
Psoriasis arthritisp

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87
Q

MOA of apremilast

A

PDE4 inhibitor which modulates cytokine release

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88
Q

Use of apremilast

A

Psoriasis
Psoratic arthritis

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89
Q

MOA and uses of vedolizumab and natalizumab

A

Vedolizumab- alpha4beta 7 integrin inhibitor, IBD
Natalizumab- alpha4 integrin inhibitor, crohns and MS

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90
Q

Use of abatecept and MOA

A

Alpha CTLA4 fusion gene which inhibits CD28 which reduces costimulation of T cells
RA

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91
Q

What is anti-IL23

A

Guselkumab

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92
Q

What is anti-IL12 and 23

A

Ustekinumab

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93
Q

Use of ustekinumab and guselkumab

A

Psoriasis

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94
Q

What is MOA and use of mepolizumab

A

Anti-IL5
Eosinophilic asthma

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95
Q

What are the mixed pattern disease

A

Ank spond
Psoriasis
Behcets

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96
Q

What are polygenic autoinflammatory diseases

A

Takayasus
IBD
Osteoarthritis
GCA

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97
Q

Comparing X-linked SCID to adenosine deaminase deficiency

A

MOA
- X-linked SCID= gamma chain of IL2R
- ADA= adenosine deaminase deficiency which involved in development of leukocytes
Blood findings
- X-linked= low T cells but B Cells normal however these are immature so noIgG
- ADA= all low

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98
Q

Inheritance and pathophysiology hyper IgM

A

CD40 mutation
X-linked

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99
Q

What gel and coombs in RA

A

4
3 if RF positive

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100
Q

What is example of integrase inhibitor

A

Dolutegravir

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101
Q

What is the maximum number of viral capsids that a molecule of IgM, IgA and IgG may bind to?

A

IgM- 10
IgA- 4
IgG- 2

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102
Q

Respiratory burst cell

A

Neutrophil

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103
Q

Antibodies in diffuse systemic sclerosis

A

Topoisomerase (Scl70)
Fibrillarin

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104
Q

Reticular dysgenesis presentation

A

Neutropenia
Hearing loss
Lymphopenia

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105
Q

Interleukin responsible for T cell proliferation

A

IL-2

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106
Q

What type of drug is abacavir

A

NRTI

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107
Q

Immunodeficiency with only T cells lacking

A

Digeorge

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108
Q

Immunoglobulins may bind to multiple pathogens at once in order to enhance phagocytosis. What is this process known as?

A

Agglutination

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109
Q

Do you stop transfusion in an allergic reaction

A

If just itching then give antihistamines
If headache or widespread rash then stop

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110
Q

What is JAK

A

Tyrosine kinase

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111
Q

What is secreted by t reg cells to dampen inhibit other T cells

A

IL-10

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112
Q

What is difference between abatecept and ipilimumab

A

T reg cells express CTLA4 which directly inhibits other T cells
Ipilimumab inhibits CTLA4 to prevent inhibtion of T cells
Abatecept enhances CTLA4 to promote inhibtion

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113
Q

What cells express CD25

A

T reg cells

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114
Q

Wiskoff aldrich syndrome blood findings

A

Low IgM and high IgA and IgE
Get recurrent ear and lung infections with nose bleeds

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115
Q

In nephrotic syndrome what infections are susceptible to

A

Encapsulated bacteria

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116
Q

What has defect in MHC 1 and MHC 2

A

Bare lymphocyte syndrome

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117
Q

How do mycophenolate and cyclophosphamide affect guanine

A

Mycophenolate affects synthesis of guanine
Cyclophosphamide affects use in replication

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118
Q

Management of SLE

A

Steroids
Then cyclophosophamide

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119
Q

What is it when get crescents in kidney

A

Rapidly progressive glomerulonephritis

120
Q

Difference of C3/Ig staining between causes of rapidly progressive glomerulonephritis

A

Basement membrane disease- linear
Immune complex- granular
Pauci immune- scanty

121
Q

Parakeratosis, acanthosis and hyperkeratosis meaning

A

Parakeratosis- increased nuclei in stratum corneum
Acanthosis- increase stratum spinosum
Hyperkeratosis- increases keratin and size of stratum corneum

122
Q

What skin pathology is described as sandpaper like texture

A

Actinic keratosis

123
Q

What is protein in acute phase protein and dialysis associated amyloidosis

A

AA amyloidosis- serum amyloid A
Dialysis associated amyloidosis- beta-microglobulin 2

124
Q

Chronic dermatitis histology

A

Acanthosis
Crusting
Hyperparakeratosis
T cells and eosinophil infiltrate

125
Q

What HS is psoriasis

A

4

126
Q

Location and appearance of pustular psoriasis

A

Hands and feet
Red skin with white elevations of pus

127
Q

What is difference in bullae between pemphigus vulgaris and bullous pemphigoid

A

Bullae in bullous pemphigoid are tense on erythematous base- DO NOT rupture
Bullae in pemphigus vulagris are easily ruptured which leads to a raw red surface
Nikolsky positive in pemphigus vulgaris

128
Q

Histopathology difference between bullous pemphigoid and pemphigus vulgaris

A

Bullous pemphigoid- Subepidermal bulla with eosinophils, linear deposition of IgG along basement membrane
Pemphigus vulgaris- acantholysis, intradermal bulla
netlike pattern of IgG, complement deposition

129
Q

Histology of dermatitis herpetiformis

A

Microabscesses which coalesce to form subepidermal bullae
Neutrophil and IgA deposits at tips of dermal papillae

130
Q

Erythema multiforme lesions

A

annular target lesions on extensor surfaces of hands and feet

131
Q

How does herald patch appear

A

Erythematous patch with white centre seen in pityriasis rosea

132
Q

What causes persistent ST elevation post MI

A

Ventricular aneurysm which can develop for over a month after

133
Q

Histology post MI
- under 6 hours
- 6-24 hours
- 1-4 days
- 5-10 days
- 1-2wks
- weeks-months

A
  • Normal by histology, CK also normal
  • Loss of nuclei, necrotic cell death, homogenous cytoplasm
  • Infiltration of polymorphs then macrophages
  • removal of debris
  • granulation tissue, new blood vessels, collagen synthesis, myofibroblasts
  • decullarising scar tissue
134
Q

Histology of the 3 RCC

A

Clear- nests of epithelium with clear cytoplasm
Papillary- papillary tubulo growth under 5mm
Chromophobe- large cells with distinct borders

135
Q

Types of renal transitional cell carcinomas

A

Non-invasive papillary
Infiltrating urothelial carcinoma
Flat urothelial carcinoma in situ

136
Q

Macroscopic appearance of the renal transitional cell carcinomas

A

Non-invasive papillary- frond like projections multifocal
Infiltrating urothelial carcinoma- stuck on tumour
Flat urothelial carcinoma- red area or not visible

137
Q

Histology of 3 benign renal tumours

A

Papillary- less than 5mm papillary structure tumour
Oncoctoma- oncocytes which have eosinophiliv cytoplasm
Angiomyolipoma- made up of blood, muscles and fat

138
Q

Management of IE

A

Subacute
- benzylpenicillin and gentamicin
Acute
- fluclox if MSSA
- rifampicin, gentamicin and vancomycin is MRSA

139
Q

Presentation of glucagonoma

A

Necrolytic migrating erythema

140
Q

What colour are the different parts of oesophagus

A

Top 2/3rds- squamous white
Bottom 1/3rd- columnar pink

141
Q

How is chronic hepatits staged and graded

A

Stage= fibrosis
Grade= inflammation

142
Q

Histopathology of chronic hepatitis

A

Portal inflammation
Lobular inflammation
Interface hepatitis (piecemeal necrosis)
Bridging from portal vein to central vein

143
Q

What is peacemeal necrosis/ interface hepatitis

A

Where can’t see border between portal tract and parenchyma due to inflammation

144
Q

What is critical stage in hepatitis to cirrhosis interface

A

Bridging from portal vein to central vein

145
Q

Intrahepatic vs extrahepatic shunting

A

Extra- When blood backlogs into sites of portosystemic anastamoses
Intra- When blood goes through the liver but does not contact hepatocytes/not filtered

146
Q

Mutations of haemochromatosis and wilsons

A

Haemochromatosis- HFE chromosome 6
Wilsons- ATP7b chromosome 13

147
Q

What is stain for collagen

A

Trichome- positive= blue

148
Q

USS difference between PBC and PSC

A

Dilation of ducts in PSC

149
Q

What is the main stain for NE tumours

A

Chromogranin
Can also do synaptophysin, CD56
Then can do individual hormones

150
Q

How are NE tumours graded

A

Ki-67 index

151
Q

Supra vs infra tentorial brain tumour presentation

A

Supra
- focal neurology
- seziures
- personality

Infra
- cranial nerve
- cerebellar

152
Q

MRI and histology findings of pilocytic astrocytoma

A

MRI
- well circumscribed
- in cerebellum
- cystic

Histology
- piloid hair cells
- rosenthal fibres

153
Q

What tumours are IDH1 mutation seen

A

Astrocytoma
Oligodendroma

154
Q

Most common site of brain intra-parenchymal haemorrhage

A

Basal ganglia

155
Q

What are the traumatic brain injuries pathophysiology

A

Contusion- where brain hits skull and get bruising
Diffuse axonal injury- get shearing in trauma leading to coma
Chronic traumatic encephalopathy- effects of repeated trauma to head
Laceration- contusion where pia mater is torn

156
Q

Long term imaging finding of AD

A

Cortical atorphy
Widening of ventricles
Narrowed gyri
Widened sulci

157
Q

Histology of LBD

A

Lewy bodies
- alpha synuclein
- ubiquitin

158
Q

How does mutiple system atrophy differ to parksinsons

A

Alpha synuclein in the glial cells not neurones histologically

159
Q

Histology of picks disease

A

Fronto-temporal atrophy
Marked gliosis and neuronal loss
Balloon neurones
Hyperphosphorylated tau positive pick bodies

160
Q

What parkinsons plus syndromes stain positively for tau

A

Corticobasal syndrome
Progressive supranuclear palsy

161
Q

Main history features of the parkinson plus syndromes

A

Corticobasal- alien limb and unilateral parkinsonism
Multiple system atrophy- alpha synuclein in the glial cells and early autonomic dysfunction
Progressive supranuclear palsy- impaired upwards gaze

162
Q

What gene is linked to picks disease

A

Progranulin

163
Q

Chronic gastritis causes

A

Autoimmune- pernicious anemia
Bacteria- h pylori in antrum
Chemical- NSAIDS, bile reflux in antrum

164
Q

Difference between gastritis and ulcer

A

Ulcers breach through muscularis mucosa into submucosa

165
Q

Histology of gastric epithelial dysplasia

A

Cytological and histological features of malignancy but doesnt invade through BM

166
Q

How are gastric adenocarcinomas classifed

A

Intestinal- well differentiated
Diffuse- poorly differentiated

167
Q

What are signet ring cells seen in

A

Diffuse gastric adenocarcinomas

168
Q

Biopsies of coeliac

A

Villous atrophy
Crypt hyperplasia
See flattened villi
Increased intraepithelial lymphocytes- normal range less than 20 lymphocytes/100 enterocytes

169
Q

Pathophysiology of alpha-1-antitrypsin

A

Failure to secrete it
Intra cytoplasmic inclusions due to misfolded protein
Causes hepatitis and pneumonitis

170
Q

Causes of hepatic granulomas

A

PBC
Drugs
TB
Sarcoid

171
Q

Pathogens other than H pylori causing duodenal ulcer

A

CMV
Giardia lamblia- most important
Tropheryma whippeli

172
Q

What is signifcance of anti-histone autoantibodies in SLE

A

That it is drug induced lupus from hydralazine etc

173
Q

Most specific antibodie for SLE

A

Anti-smith (ribonucleoproteins)

174
Q

What is mixed connective tissue disease

A

Where have features of more than 1 connective tissue disorder

175
Q

Antibody in mixed connective tissue disease and staining pattern

A

Ant-U1RNP
Speckled

176
Q

Histology of GCA

A

Granulomatous transmural inflammation + giant cells +
skip lesions

177
Q

What is the classfifcation of vasculitidies

A

Large vessel
- takayasu
- GCA

Medium vessel
- polyarteritis nodosa
- kawasakis
- thromboangiitis obliterans

Small vessel
- microscopic polyangiitis
- granluomatosis with polyangiitis
- IgA nephropathy
- eosinophillic granluomatosis with polyangiitis

178
Q

Histology of polyarteritis nodosa

A

fibrinoid necrosis & neutrophil infiltration

179
Q

Presentation of eosinophilic polyangiitis with granulomatosis

A

Asthma
Eosinophilia
Allergic rhinits
Vasculitis evidence

180
Q

What is difference in name of tumour of large vs small nerve tumour

A

Small- neurofibroma
Larger (spinal cranial nerve)- schwannoma

181
Q

How does wilsons present

A

Liver cirrhosis- often in kids
Neuro- dementia, seizures and parkinsons

Also seen in eyes, kidneys and heart

182
Q

How can haemochromatosis present

A

Liver- cirrhosis
Heart- cardiomyopathy
Pancreas- DM
Gonads- atrophy and impotence
Joint pain

183
Q

Causes of acute pancreatitis

A

Obstrucrive
- gallstones
- tumours
- trauma
Metabolic
- alcohol
- hypercalcaemia
- hyperlipidaemia
- drugs (thiazides)
Poor blood supply
- shock
- hypothermia
Infection
- mumps

184
Q

How does alcohol cause pancreatitis

A

Spasm of sphincter of oddi and protein rich pancreatic fluid which less viscous

185
Q

Causes and histology of chronic pancreatitis+ which cells lose first

A

Metabolic
- Alcohol
- Haemochromatosis
Duct obstruction
- cystic fibrosis as thick mucin
- tumours

Parenchymal fibrosis with loss of parenchyma
Duct stricture with calcified stones
Lose acinar cells first

186
Q

Characterisitcs of autoimmune pancreatitis

A

IgG4 positive plasma cells

187
Q

Pathological precursors to pancreatic ductal carcinomas

A

Pancreatic Intraductal Neoplasm
Intraducal Mucinous Papillary Neoplasm
K-ras mutations majority of time

188
Q

Histology and macroscopic appearance of pancreatic carcinomas

A

Adenocarcinomas with mucin producing glands set in desmoplastic stroma
Gritty and grey macroscopically

189
Q

Most common cause of colitis- viral, bacterial, protozoal, fungal

A

Viral- CMV
Bacterial- salmonella
Protozoa- entamoeba histolytica
Fungal- candida

190
Q

Who is CMV colitis seen in

A

Immunosuppressed
Often IBD as treatment is immunosuppresant

191
Q

What are types of polyps in the bowel

A

Hyperplastic and sessile serrated lesions
Inflammatory
Hamartomatous (Peutz-jeughers)

192
Q

Differnece between sessile serrated lesions and hyperplastic polyps

A

Dysplasia in sessile serrated

193
Q

Differences between FAP and HNPCC

A

Both autosomal dominant
FAP
- hundreds of polyps
- rectosigmoid tumours
- tumour suppressor gene mutation
HNPCC
- handful of polyps
- proximal to splenic flexure
- DNA repair genes errors

194
Q

What are 3 types of renal stones and their risk factors

A

Caclium oxalate
- hypercalcaemia
- impaired renal absorption of Ca

Magnesium ammonium phosphate
- proteus infection

Uric acid
- gout
- cancer

195
Q

Causes of acquired cysts on kidney

A

Renal failure patients on dialysis

196
Q

What conditions can be cause of acute tubular injury

A

Acute tubular necrosis
- ischaemia
- toxins
- drugs
Acute tubular interstitial nephritis
- abx
- PPIs
- NSAIDs
- diuretics

197
Q

What is seen on histology when acute glomerulonephritis is bad enough to cause acute renal failure

A

Crescents from proliferation of cells in bowmans space

198
Q

Histology of pauci-immune glomerulonephritis

A

Scanty glomerular immunoglobulin deposits
Necrosis everywhere as neutrophils activated

199
Q

Aetiology of thrombotic microangiopathy

A

HUS
MAHA
- TTP
-DIC
Anti-phosopholipid syndrome

200
Q

Histology of thrombotic microangiopathy

A

Damage to endothelium, glomeruli, arterioles and thrombosis

201
Q

Causes of nephrotic syndrome

A

Primary disease non immune complex related
- minimal change disease
- FSGS
Primary disease immune complex related
- Membranous glomerulonephritis
Systemic disease
- amyloid
- DM
- SLE

202
Q

Histology of membranous glomerulonephritis

A

Subepithelial deposition of immune deposits

203
Q

What mutation causes pilocytic astrocytoma

A

BRAF

204
Q

What mutation in serous ovarian cystadenoma

A

p53

205
Q

Mutation in mucinous ovarian cystadenoma

A

KRAS

206
Q

What is associated with waxy, fatty casts

A

Waxy- CKD
Fatty- nephrotic syndrome

207
Q

Histopathology of HTN nephropathy

A

Arterial hyalination
Ischaemic glomerular changes
Segmental and global glomerulosclerosis

208
Q

Pericarditis causes

A

Fibrinous
- MI
Granulomatous
- TB
Prurulent
- staphylococcus

209
Q

Causes of microscopic haematuria

A

IgA nephropathy
Thin basement mebrane disease

210
Q

Aetiolgy of thin basement membrane

A

Genetic defect in Type IV collagen synthesis causing BM thickness under 250nm

211
Q

Inheritance of alport

A

X-linked dominant

212
Q

What is hereditary angioedema

A

Where ger recurrent bouts of facial swelling from C1 esterase inhibitor

213
Q

What comes under HLA 3

A

Complements components

214
Q

Features of APECED

A

Dysfunctional parathyroid/adrenal gland
Immune deficiency
Gonadal failure
Alpecia and vitiligo

215
Q

Where is error in APECED

A

AIRE gene- responsible for expression of self antigens in thymus which prevents production of autoreactive T cells

216
Q

What componenets are involved in classical vs alternative pathway

A

Classical- C1,C2, C4
Alternative- B, D, P

217
Q

What hypersensitivity is hyperacute transplant rejection

A

2

218
Q

What chemical messenger is key in pathogenesis of systemic sclerosis

A

TNF-beta

219
Q

Difference between pathophysiology in pemphigus vulgaris vs pemphigus follaceous

A

Anti-desmoglein 1= foliaceous
Anti-desmoglein 3= vulgaris

220
Q

Sterile vegetations on heart valves which cause systemic emboli

A

Non-bacterial thrombotic endocarditis

221
Q

Most common cause of bacterial meningitis in children

A

Strep pneumoniae

222
Q

Cytology of fibroadenoma

A

Branching sheets of epithelium in antler horn or honeycomb sheets
Bare nuclei and stroma
Basically a ball of fibrous and glandular tissue

223
Q

Histology and cytology of intraductal papillomas

A

Histo- Papillary mass with dilated duct lined by epithelium
Cytology of discharge- branching papillary epithelium

224
Q

Histology of radial scar

A

Central fibrous stellate area
If over 1cm is called complex sclerosing lesion

225
Q

What can appear as stellate area on mammogram

A

Stellate area

226
Q

How do phyllodes tumours present

A

Masses in over 50s

227
Q

Histology of fibrocystic breast disease

A

Fibrous tissue containing cysts with flattened and cuboidal epithelium which can be calcified

228
Q

What is the histology of 3 proliferative breast diseases

A

Usual type- growth of epithelial and glandular tissue protruding into lumen in fronds
Flat atypia- multiple layers forming a smaller but regular circular lumen
Intralobular neoplasia- solid proliferation of aplastic cells where can just see the lumen

229
Q

Buzzwords for phyllodes tumour

A

Anything plant like
- srtichoke
- leaf-like pronds
- branching
Arise from stroma
Fibro-epithelial Tumour with abundant stromal elements

230
Q

Presentation of duct ectasia

A

Firm thick, yellow discharge- can easily become infected with proceeding abscesses
Subareolar mass with nipple inversion

231
Q

Cytology of duct ectasia

A

Proteinaceous material with macrophages

232
Q

Histology of duct ectasia

A

Ductal dilation with proteinaceous material inside

233
Q

Problem of trastuzumab

A

Firstly poor progonsis
But also cardiotoxic so must monitor LVF

234
Q

What do basal cell carcinomas stain for

A

Triple negative- ER/PR/HER negative
CK5/6/14

235
Q

Histology of basal cell breast carcinomas

A

Sheets of atypical cells with lymphocytic infiltrates

236
Q

Histology of the 4 invasive breast tumours

A

Ductal- not classified otherwise but big pleiomrophic cells
Lobular- cells aligned in single file/cains
Tubular- well formed tubules
Mucinous- abundant mucin which dissects tissues

237
Q

How are ductal vs lobular carcinoma in situ picked up

A

Invasive- incidental as no microcalcifications
Ductal- microcalcifications
TO NOTE- they do not invade the BM

238
Q

Features of lobular carcinoma in situ

A

Lack cadherin E
Dont invade BM
Picked up incidentally

239
Q

Histology of melanoma

A

Pagetoid cells
Buckshot apperance

240
Q

Most common type of melanoma

A

Superficial spreading

241
Q

Which breast cancer does pagets develop from

A

Ductal

242
Q

Histology of ductal carcinoma in situ

A

Ducts filled with atypical epithelial cells

243
Q

2 Most common breast lesions that presents with discharge

A

Papilloma
2nd- duct ectasia

244
Q

How are aspirates of breast lumps coded

A

C1- inadequate
C2- benign
C3- atypia, probably benign
C4- suspicion of malignancy
C5- malignant

245
Q

Histology of fat necrosis

A

Central focus of necrotic fat cells surrounded by lipid filled macrophages and neutrophilic infiltrates

246
Q

How to diagnose bone tumours

A

Jamshidi needle

247
Q

Xray and histology of fibrous dysplasia

A

X ray- shepherds crook deformity and soap bubble osteolysis of ribs and gemur
Histology- chinese letters

248
Q

How do endchondromas appear histologically

A

Normal cartilage

249
Q

What appears with cotton wool or popcorn calcifcation

A

Endochondromas

250
Q

Histology of giant cell tumours

A

Sheets of multi-nucleate giant cells (osteoclasts) on background of spindle and ovioid cells
Soap bubble appearance

251
Q

What is most common malignant bone tumour

A

Metases however not at below elbow and knee

252
Q

What are malignant mesenchymal cells seen in

A

Osteosarcomas

253
Q

X-ray and histology of chondrosarcoma

A

Xray- fluffy calcification
Histology- Malignant chondrocytes

254
Q

X-ray and histology differences between ewings sarcoma and osteosarcoma

A

X ray
- Ewings sarcoma = onion skinning of periosteum
- osteosarcoma = elevated perisoteum(codmans triangle) and suburst appearance
Histology
- osteosarcoma= ALP, malignant mesenchymal cells, trabecular bone replaced
- ewings sarcoma= CD99 stain, small round cells and T(11;22)

255
Q

Bony pain at night relieved by aspirin

A

Osteoid osteoma

256
Q

X-ray and histology of osteoid osteoma

A

X-ray= central nodus with sclerotic ring(bulls- eye)
Histology- normal bone from osteoblasts

257
Q

Bone disease with lots of lytic lesions around the joint

A

Giant cell tumour

258
Q

Which infection of genital tract is associated with spontaneous abortion and chorioamnionitis

A

Mycoplasma

259
Q

Pathogenesis of staph, strep, coliform bacteria and clostridium causing PID

A

Secondary to abortion
Start in lymphatics then spread by blood and lymph upwards

260
Q

How does HPV transform cells

A

Produces 2 proteins- E6 and E7 which inactivate tumour suppressor genes
E6- p53
E7- Rb

261
Q

Serous cystadenocarcinoma histology

A

Columnar epithelium
Psammoma bodies
Ciliated epithelium

262
Q

Histology endometrioid and then clear cell ovarian tumours

A

Endometrioid= Tubular glands mimicking the endometrium
Clear= hobnail appearance, clear cells with clear cytoplasm
BOTH ASSOCIATED WITH ENDOMETRIOSIS

263
Q

Difference between immature and mature teratomas in ovaries

A

Mature
- cystic
- differentiation into mature tissues like skin teeth etc

Immature
- solid
- embryonal tissue
- secrete AFP

264
Q

What are the ovarian tumours and what in each class

A

Epithelial
- serous
- mucinous
- clear
- endometrioid
Sex-chord stromal
- fibroma
- sertoli leydig
- granulosa theca
Germ
- teratoma
- choriocarcinoma
- dysgerminoma

265
Q

What are hormone secreting ovarian tumours

A

Granulosa theca- E2
Sertoli leydig- Progesterone
Dysgerminoma- HCG
CHoriocarcinoma- HCG

266
Q

What are cal exner bodies seen in

A

Sertoli leydig

267
Q

Mutations in the gynae cancers

A

p53- serous cystadenocarcinoma, and seroud T2 endometrioid
KRAS- mucinous cystadenocarcinoma

268
Q

What do dysgerminomas secrete

A

LDH
HCG

269
Q

What complement molecules in mannose binding pathway

A

C2,C4

270
Q

What triggers MBL vs alternative complement pathway

A

MBL- cell surface carbohydrates
Alternative- bacterial cell wall

271
Q

Which cells mastermind the transition from innate to adaptive immunity?

A

Dendritic

272
Q

What is receptor in CD4 activating B cells

A

CD40

273
Q

Inheritance of kosmann vs cyclic neutropenia

A

Kostmann- autosomal recessive
Cyclic neutropenia- autosomal dominant

274
Q

What is DHR test

A

Add hydrogen peroxide and positive test is FHR becoming fluorescent rhodamine

275
Q

Other than mycobacterium, what infectoin can IL12/ IFN-gamma make susceptible to

A

Salmonella

276
Q

What is most common complement deficiency and what is result

A

C2
Have SLE and severe skin disease

277
Q

What are non primary complement deficiencies

A

Nephritis factor- Antibodies against complement components
SLE- uses up C3 and C4

278
Q

What is associated with nephritic factor

A

Glomerulonephritis and partial lipodystrophy (abnormal fat distribution)

279
Q

What causes a decrease in CH50 and AP50

A

Deficiencies in terminal pathwayeg- C9

280
Q

Blood findings of C9 deficiency

A

Low AP50 and CH50

281
Q

What happens inf have reduction in factor B

A

Low AP50

282
Q

If have deficiency in C1 or C2 what happens blood wise

A

Low CH50

283
Q

A 10 year old female patient presents with photosensitive skin rash and mouth ulcers. Investigations show:

C4 levels normal
AP50 normal
CH50 abnormal

What is the most likely diagnosis

A

C2 deficiency

284
Q

Treatment of Digeorge immunodeficiency

A

Thymic transplant- often to quadriceps

285
Q

How can T cell counts affect IgG

A

If defective CD4 lack IgG production ability

286
Q

Differences between selective IgA and CVID

A

CVID- lack of Ig E, A and G with recurrent GI and resp infections
Selective IgA deficiency- recurrent resp infections

287
Q

What is name of IL1 R blocker

A

Anakinra

288
Q

What cell are PTPN22 and CTLA4 mutations of

A

T cell regulator

289
Q

What does APECED stand for

A

Autoimmune
Polyendocrinopathy
Candidiasis
Ectodermal
Dystrophy

290
Q

What conditions seen in APECED

A

Hypoparathyroidism, Addisons, Hypothyroidism, Diabetes, Vitiligo, Enteropathy

291
Q

How does serum sickness present

A

Given penicillin and develop skin rash, joint aches and fever

292
Q

A 12 year old boy presents with haematuria and proteinuria. He has recently been discharged following severe meningococcal septicaemia. There is abnormal fat distribution.
C3 levels are low, and C4 levels are normal.

A

Nephritic factor

293
Q

How does LSD use present

A

Phsically similar to concaine however hallucinations common

294
Q

How to manage wanting a termination but is pain

A

Must redo HCG in 48 hours
If increase of over 63% then intrauterine pregnancy likely but need USS in 7 days to confirm
If decrease miscarraig likely
If plateau or slight increase then potential ectopic

295
Q

What do if evidence of recent FGM on a woman over 18

A

Report to police

296
Q

What do about police in women with FGM over 18

A

Offer to call police but do not have to

Last minute (11 decks)

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