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Last minute > Chem path, haem and 1/2 micro > Flashcards

Chem path, haem and 1/2 micro Flashcards

1
Q

What is difference in units osmolarity vs osmolality

A

Osmolarity (calculated)- units=mmol/L
Osmolality- mmol/kg

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2
Q

Causes of raised anion gap met acidosis

A

Uraemia
Metformin
Ethylene glycol
Aspirin
Lactate
DKA

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3
Q

What class of drug is metformin

A

Biguanide

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4
Q

Causes of normal anion gap met acidosis

A

A- adidsons- renal tubular ACIDOSIS
B- bicarb loss from high output stoma, pancreatic fistula, diarrhoea
C- chloride ingestion
D- drugs such as acetazolamide

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5
Q

Causes of resp acidosis

A

From HYPOventilation- chronic lung disease, opiods, sedatives, NM weakness

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6
Q

Causes of resp alkalosis

A

From HYPERventilation- panic attack, PE, salicylates, altitude, anything which increases resp rate

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7
Q

What causes extremely high ALP in a child

A

Osteopenia of prematurity

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8
Q

Causes of hypernatraemia in a neonate

A

Very common in first 2 weeks
Can be sign of dehydration or overconcentrated formula

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9
Q

Causes of hyponatraemia in a neonate between first 5 days and then after

A

Overhydration
SIADH from infection orIVH
CAH

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10
Q

What does AST:ALT over 2:1 suggest

A

Alcoholic liver disease

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11
Q

What is urobilinogen in each of types of jaundice

A

Elevated in pre
Elevated in hepatic
Absent in post

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12
Q

What is urinary bilirubin in each type of jaundice

A

Absent in pre- as unconjugated is lipophillic
Present in post and hepatic

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13
Q

What causes a low urea

A

Pregnancy
Liver disease
Malnutrition

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14
Q

What causes a low albumin

A

Liver disease
Sepsis
Chronic illness
Malnutrition

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15
Q

What are 2 ways of making purines

A

De novo= from scratch but very energy taxing (RL= PAT)
Salvage pathway= HPRT creates purines from recycled catabolism pathways

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16
Q

What is main enzyme in purines salvage pathway

A

HPRT

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17
Q

What is rate limiting enzyme in purine de novo pathway

A

PAT

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18
Q

In subclinical hypo/hyperthyroidism what is first marker to go

A

TSH
For example in subclinical hypo- T4 will be normal but TSH will be raised

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19
Q

What ovarian cancer are ciliated cells seen in

A

Serous cystadenoma

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20
Q

Which thyroid hormone is active

A

T4 peripherally activated to T3 which has effects

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21
Q

Metabolic association of hypothyroidism

A

High cholesterol

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22
Q

When is only time treat subclinical hypothyroidism

A

If hypercholesterolaemia present

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23
Q

Histology of anaplastic thyroid cancer

A

Pleomorphic cells
Spindle cells with sarcomatous appearance

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24
Q

Thyroid tumour with sheets of dark cells

A

Medullary

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25
Q

Which thyroid cancer spreads by blood most commonly

A

Follicular

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26
Q

Which thyroid cancer is well differentiated

A

Follicular

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27
Q

Most common cause of hypopituitarism

A

Non functioning adenoma

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28
Q

Histology of thyroid adenoma

A

Encapsulated in fibrous cap

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29
Q

What used to diagnose thyroid cancer

A

Fine needle aspiration

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30
Q

Histology of papillary thyroid cancer

A

Psammoma bodies
Orphan annie eyes (optically clear nuclei)

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31
Q

What happens to adrenal tissue in different causes of cushings

A

Pituitary adenoma and ectopic ACTH-> adrenal hyperplasia
Exogenous steroids-> atrophy of adrenals

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32
Q

What do adrenal carcinomas produce

A

Androgens

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33
Q

When use demecycline and tolvaptan

A

Fluid restriction not successful

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34
Q

When can use hypertonic saline (3%) for hyponatraemia

A

If very severe like coma or seizures

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35
Q

Management of hypernatraemia

A

To replace water deficit- 5% dextrose
To replace extracellular depletion- NaCl 0.9%

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36
Q

Differentiating cause of hypervolaemia hyponatraemia

A

Urine sodium just like hypovolaemia
Over 20 then renal cause

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37
Q

How do thiazide diuretics work

A

Block sodium-chloride transporter in distal tubule

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38
Q

Management of hyperkalaemia

A

Calcium gluconate 10%-> 50% dextrose with insulin-> salbutamol

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39
Q

ECG changes hyperkalaemia

A

Absent P waves
Tented T waves
Widened QRS

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40
Q

What is caused by vitamin E deficiency

A

Neuropathy- cerebellar symptoms
Anaemia
IHD

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41
Q

Best test for iodine

A

TFTs

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42
Q

Names for vitamines
- B1
- B2
- B3
- B6
- A
- E
- K

A

Thiamine
Riboflavin
Niacin
Pyridoxine
Retinol
Tocopherol
Phytomeniadone

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43
Q

Fluoride deficiency and excess

A

Dental caries- deficiency
Fluorosis- excess

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44
Q

What does excess vitamin C cause

A

Calcium oxalate stones

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45
Q

What is only vitamin measure plasma level

A

C

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46
Q

What is used to calculate eGFR

A

Creatinine in practise however inulin the gold standard

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47
Q

What is Km (michaelis menten)

A

Substate velocity at which reaction speed is 50% of maximum

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48
Q

Cardiac complication of CKD

A

Uraemic cardiomyopathy

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49
Q

What can define stage 1 AKI

A

Creatinine rise over 26
Over 50% increase in creatininte
Urine out put less than 0.5ml/kg in 12 hours

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50
Q

Grades for CKD

A

1- kidney damage with GFR>90
2- 60-90
3- 30-59
4- 15-29
5- <15

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51
Q

What is the definition of clearance and equation

A

The volume of plasma that can be completely cleared of a substance in a certain amount of time
Clearnace =(urine concentration x urine rate flow)/plasma concentration

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52
Q

How does low dose dexamethasone test work

A

Give 0.5mg dexamethasone every 6 hours for 48 hours

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53
Q

Management of conns

A

Spironolactone
If over 4cm can consider surgery

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54
Q

How does short synACTHen test work

A

Measure ACTH and cortisol then give IM ACTH 250mg
Then measure cortisol after 30 and 60mins

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55
Q

In combined pituitary testing what hormones are used and what do they stimulate

A

TRH-> prolactin, TSH
LHRH-> LH/FSH
Insulin-> GH, ACTH

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56
Q

Blood findings of acromegaly

A

Raised GH, IGF-1 and prolactin
Hyperglycaemic

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57
Q

Management for prolactinoma

A

Cabergoline/bromocriptine
Replacement of other pituitary hormones affected
Consider surgery if compressive or eye symptoms unresponsive to medical management

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58
Q

Combined pituitary function test results for non-functioning adenoma

A

Baseline raised prolactin
Will be failure to increase other hormones

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59
Q

Management of non-functioning pituitary adenoma

A

Depends on presentation
High prolactin= cabergoline
Panhypopituitarism= replacement of other hormones
Nothing wrong=monitor

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60
Q

Management of acromegaly

A

1st line= transsphenoidal surgery
2nd line= radiotherapy and octreotide
3rd line= pegvisomat

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61
Q

What medications can be used for acromegaly

A

Octreotide= somatostatin analogues
Dopamine antagonists= cabergoline/bromocriptine
Pegvisomat= GH antagonist

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62
Q

First step in vitamin D synthesis

A

7 dehydroxycholesterol to cholecalciferol under influence of UV

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63
Q

In primary hyperparathyroidism, which out of calcium and PTH can be normal

A

PTH

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64
Q

Causes of hypoparathyoidism including most common

A

Post surgical- most common
Post radiation
Autoimmune
Magnesium abnormalities
DiGeorge

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65
Q

Management of hypocalcaemia

A

If symptomatic or less than 1.9- IV calcium gluconate
If asymptomatic or mild- oral calcium (sandocal)

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66
Q

Porphyria cutanea
- presentation
- enzyme affected
- test

A
  • skin blistering and desquamation after liver inducer
  • uroprophyrinogen decarboxylase
  • urinary uroporhyrins and coproporphyrins
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67
Q

Acute intermittent porphyria
- presentation
- enxyme affected
- test

A
  • pain in stomach, psychosis, peripheral neuropathy after liver inducers
  • HMB synthase
  • urinary porphobilinogen and
    aminolevulinic acid
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68
Q

What are the acute porphyrias and how differentiate

A

Acute intermitten porphyria
Hereditary coproporphyria
Vareigate porphyria
HCP and VP have skin lesions vs pain, port wine and psychosis AIP presentation of acute intermitten porphyria
HCP and VP can be investigated using stool coporphyrinogen

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69
Q

What is MOA of DM drugs
- acarbose
- metformin
- empaglifizon
- liraglutide
- gliptins
- sulphonylureas

A
  • acarbose inhibits alpha glucosidase on brush border to reduce absorption
  • metformin is a biguanide which increases insulin sensitivty and reduces gluconeogenesis
  • empaglifizon is SGLT2i to increase glucose excretion
  • liraglutide is an incretin mimetic
  • gliptins inhibit DD4 to increase incretins
  • sulphonylureas increases insulin secretion in islet cells
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70
Q

MOA of cholesterol lowering drugs
- statins
- ezetimibe
- cholestyramine
- evolocumab
- fibrates

A
  • HMG CoA reductase inhibitor which reduces hepatic lipid synthesis
  • ezetimibe blocks absorption of cholesterol
  • cholestyramine binds to bile salts to reduce cholesterol absorption
  • evolocumab is PCSK9i which increases hepatic cholesterol clearing
  • fibrates reduce triglyceride generation
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71
Q

What are the 2 types of creatine kinase

A

CK-MB- cardiac muscle
CK-MM- skeletal muscle

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72
Q

What bone diseases causes an extremely high ALP comapred to others

A

Pagets

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73
Q

Niche causes of hypoglycaemia

A

Autoimmune insulin syndrome in japanese women
Big IGF2 paraneoplastic syndrome against IGF-1 causing hypoketotic, hypo FFA
Post meal
- post gastric bypass
- early DM
- hereditary fructose intolerance

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74
Q

In bile acid synthesis Acyl-CoA cholesterol acyltransferase (ACAT) is the enzyme that converts cholesterol into what?

A

Cholesterol ester

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75
Q

A patient is hypocalcaemic, has an elevated serum phosphate and has an elevated parathyroid hormone (PTH). Upon examination you notice they have short 4th and 5th metacarpals

A

Albright hereditary osteodystrophy

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76
Q

How does aspirin OD present

A

Ringing in ears
N&V
Dizziness

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77
Q

What is transporter affected by ezetimibe

A

NPC 1L1

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78
Q

What does lead poisoning lead to and what caused by

A

Drinking moonshine
Acute gout as lead reduces urate excretion

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79
Q

Symptoms and signs of fanconi syndrome

A

Symptoms
- polyuria
- polydipsia
- failure to thrive in kids
Signs
- hypokalaemia
- hypouricaemia
- hypoglycaemia
- proteinuria

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80
Q

How is osmolar gap calculated

A

Osmolality- osmolarity

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81
Q

What is normal osmolar gap

A

Less than 10

82
Q

What causes a raised anion gap and osmolar gap

A

Methanol
Mannitol
Glycol

83
Q

What is pathophysiology of familial benign hyperclacaemia

A

Mutation is CASR gene leading to defective calcium sensing receptor

84
Q

Presntation of hypoglycaemia

A

Sweating
Fine tremor
Seemed drunk

85
Q

High urinary calcium with hypokalaemia

A

Bartter syndrome

86
Q

What causes mildly elevated liver enzymes with high GGT

A

Alcohol abuse

87
Q

How to differentiate addisons from secondary disease

A

Long synACTHen test- if pituitary problem will see increase in cortisol

88
Q

What drug causes B6 deficiency and what is result

A

Isoniazid
- anaemia
- seborrheic dermatitis

89
Q

How does rasburicase work

A

Recombinant urate oxidase to prevent hyperuricaemia

90
Q

Inheritance of thalassaemia and SCD

A

Autosomal recessive
Beta chain on Chr 11
- SCD point mutation of glutamate to valine Alpha chain on Chr 16

91
Q

Frontal bossing and hair on ends x ray appearance

A

Beta thalassaemia

92
Q

How to differentiate thalassaemia trait from IDA on FBC and then blood film

A

RBC increased in thalassaemia
On blood film will see basophilic stippling

93
Q

How are thalassaemia and SCD diagnosed

A

Hb electrophoresis

94
Q

What is inheritance of PK deficiency and what are cells seen in it

A

Autosomal recessive
RBC with short projections

95
Q

What is seen in G6PD blood film

A

Heinz bodies- blue bits in RBC from oxidised Hb
Bite cells- erythrocytes with an irregular membrane which result from splenic macrophage-mediated removal of denatured hemoglobin molecules
Irreguarly contracted cells- uneven cell membrane

96
Q

What are spherocytes

A

Sphere shaped RBC often a little smaller

97
Q

How does ACD work

A

IL1and interferons reduce EPO production
IL-6 reduces hepcidin production which blocks iron absorption and sequesters it in macrophages

98
Q

Differentiating IDA and ACD

A

ACD has increased transferrin saturation and reduced TIBC

99
Q

Symptoms of paroxysmal nocturnial haemoglobinuria

A

Pancytopenia
New thrombosis- budd chiari very commonly
Haemolysis

100
Q

What is test for paoroxysmal nocturnal haemoglobinuria

101
Q

Most common cause of autoimmune haemolysis

A

Idiopathic

102
Q

Acquired causes of haemolysis

A

Malaria
Adenocarcinoma
TTP
HUS
DIC
Autoimmune

103
Q

What can be specialised treatments for ALL

A

CD20- rituximab
Phil Chr- imatinib

104
Q

Specialised treatments for AML

A

CD33 -gemtuzumab

105
Q

What surface marker is on all immature WCC

106
Q

What is mutation in APML and the special treatments

A

PML-RARA (15;17)
All trans retinoic acid and A203

107
Q

What is poor genetic prognostic marker for CLL

A

TP53 (deletion on chromosome 17)

108
Q

Hpw is TP53 mutation assessed in CLL

A

FISH- detects loss on Chr 17

109
Q

What is MOA of venetoclax

A

BCL2- promotes apoptosis

110
Q

Difference in flow cytometry of T cells, B cells and CLL B-cells

A

T-cells - CD5 positive
B- cells- CD19 positive
CLL B cells- both CD5 and CD19 positive

111
Q

How is AML treated

A

Cytarabine and danorubicin
To maintain remission- cytarabine

112
Q

Staging of CLL

A

Rai and binet

113
Q

What is evans syndrome and what seen in

A

Get AIHA and ITP
CLL

114
Q

How is philadelphia chromosome detected

115
Q

What is the protein formed from Ph chromosome and how detected

A

BCR-ABL
PCR

116
Q

Blood findings of CML

A

Very high neutrophils and basophils

117
Q

What is associated with good prognosis in CLL

A

Ig mutation

118
Q

What is associated with good prognosis in CLL

A

Ig mutation

119
Q

What is name for IgM producing leukaemia

A

Waldenstroms macroglobinaemia
Lymphoplasmacytoid leukaemia

120
Q

Staging for myeloma and MGUS

A

Salmon Durie for myeloma
MAYO for MGUS

121
Q

Management plan for myeloma

A

Induce remission - bortezomib and immune modulators- dexamethasone and lenalidomide
If in remission then ideally auto-SCT
If not then daratumumab (CD-38) and bortezomib

122
Q

CD stainging for the lymphoma

A

Follicular- CD10
bURKITTS- DC20
Classical Hodgkins- CD15 AND 30
lYMPHOCYTE PREDOMINANT- CD20

123
Q

Managementof T cell lymphomas

A

Can use alemtuzumab- CD52

124
Q

Management of burkitts lymphoma

125
Q

Management of burkitts lymphoma

126
Q

Management of MDS

A

Supportive – transfusions, EPO, G-CSF, ABx
* Biological modifiers – immunosuppressive drugs, lenalidomide, azacytidine
* Chemotherapy – similar to AML
* Allogeneic SCT

127
Q

Prognosis predictor in MDS and what are outcomes

A

IPSS
1/3 bleeding
1/3 infection
1/3 leukaemia

128
Q

What is in schwachman diamond

A

Neutropenia
Pancreatic exocrine function lost
Short

129
Q

What is diamond black fan syndrome

A

Anaemia
Presents at 1 year old with severe physical dysmorphology

130
Q

What is associated with aplastic anaemia

A

PNH
Acute leukaemia

131
Q

What is ruloxitinib used in

A

Myelofibrosis (JAK inhibitor)

132
Q

What is management of essential thrombocytosis

A

Aspirin
Hydroxycarbamide
Anagreiide

133
Q

Blood results for polycythaemia rubra vera

A

High HCT, RBC, red cell mass, low EPO

134
Q

Blood film and BM findings of essential thrombocytosis

A

Blood film- megakaryocytes
BM- megakaryocyte hyperplasia

135
Q

Mutations assoc with myeloproliferative disorders

A

JAK2
Calreticulin
MPL

136
Q

Management of polycythaemia rubra vera

A

Venesection
Aspirin
Hydroxycarbamide

137
Q

What is d-dimer

A

A degredation product of fibrinolysis

137
Q

What is d-dimer

A

A degredation product of fibrinolysis

138
Q

What is Andexanet alfa the reversal agent for

A

Apixaban
Rivaroxaban

139
Q

What description is given to red blood cells stain heavily for the presence of RNA?

A

Reticulocytes

140
Q

What is most common lymphoma in over 40s

141
Q

When see spherocytes, what are the 2 differentials

A

Hereditary spherocytosis
AIHA

142
Q

What clotting factor has the shortest half life?

143
Q

MOst common lymphoma in a child

144
Q

What can cause an acquired reduction in platelet function

A

Aspirin
Uraemia

145
Q

Blood findings of liver diease causing

A

Reduced synthesis of II, V, VII, IX, X, XI and fibrinogen
High AST
Elevated VIII and VWB

146
Q

How manage vitamin K deficiency

A

IV Vitamin K
If bleeding then FFP

147
Q

What happens in protein S deficiency

A

Reduced breakdown of factor 5 and 8

148
Q

How is factor V leiden diagnosed

A

Protein C functionality

149
Q

Reversal agents for blood thinners

A

Heparin- protamine sulphate
Warfarin- vitamin k or ffp
Rivaroxaban- andexanet alfa
Dabigatran- idracizumab

150
Q

Management of vit K OD

A

5-8, no bleeding Withhold few doses, reduce maintenance. Restart when INR<5.

5 – 8, minor bleeding Stop warfarin. Vit K slow IV. Restart when INR <5.

> 8, no bleed/minor bleed Stop warfarin. Vitamin K (oral/IV) no bleeding/if risk factors for bleeding or minor bleeding. Check INR daily.

Major bleeding, (including
intracranial haemorrhage)- Stop warfarin. Give prothrombin complex concentrate. If
unavailable, give FFP.
Also give vitamin K IV

151
Q

MOA of the blood thinners

A

Warfarin- vitamin k epoxide reductase
Heparin- antithrombin III potentiator which inactivates thrombin and F9-11
Apixaban- anti-Xa
Dabigatran- anti-IIa

152
Q

Lead poisoning anaemia

A

Microcytic
Basophillic stippling

153
Q

What are Howell Jolly bodies

A

Inclusions of DNA

154
Q

What is IgA deficiency a risk factor for with transfusions

A

Anaphylaxis

155
Q

What are unique features to adult T cell leukaemia

A

Hypercalcaemia
Hepatosplenomegaly
Skin lesions

156
Q

What lymphoma are centrocytes seen in

A

Follicular

157
Q

What are target cells seen in

A

3 Hs
- hepatic disease
- haemoglobinopathies
- hyposplenism

158
Q

How is VWB disease treated

A

Desmopressin

159
Q

What are methods of resistance to
- carbapenems
- cephalosporins
- penicillins
- macrolides
- tetracyclines
- rifamycins

A
  • carbapenemase
  • ESBL
  • BL
  • methylate ribosome
  • prevent accumulation of drug
  • rapid resistance from mutations of beta unit in RNA polymerase
160
Q

How does strep pneumoniae become resistant

A

Stepwise mutations in penicillin binding protein

161
Q

Side effects of aminoglycosides vs oxazolidinones

A

Aminoglycosides- ototoxic and nephrotoxic
Oxazolidinones- thrombocytopenia and optic neuritis

162
Q

Making diagnosis of UTI

A

> 10^4 colony forming units
10^3 colony forming units if E coli, staphylococcus sabrophyticus

163
Q

Organism if recurrent UTIs

A

Pseudomonas

164
Q

Ecoli method of resistance

165
Q

What are beefy red ulcers seen in

A

Dononvaonisis

166
Q

Management of leishmanisias

A

Amphotericin B

167
Q

Onset of symptoms from eating staph areus vs salmonella enterica

A

S. aureus- 1-2 hrs
Salmonella- 12 hours

168
Q

Staining of candida, aspergillus, cryptococcus and pneumocystis

A

Candida- periodic acid schiff or methanemine silver
Aspergillus- methanemine silver
Cryptococcus- india ink
Pneumocystis- silver and peridoc acid schiff

169
Q

Name some spirochaetes

A

Leptospirosis
Borrelia
Treponema

170
Q

What is used on nails for fungal infections

A

Potassium hydroxide

171
Q

Features of legionella pneumonia

A

Plumber
Recent hotel travel
Hyponatraemia
LFTs affected

172
Q

Visceral leishmaniasis presentation

A

Massive hepatoslpenomegaly
Skin hyperpigmentation

173
Q

What activates influenza

A

hUMAN AIRWAY TRYPTASE

174
Q

Problem of cidofovir and foscarnet

A

Nephrotoxic

175
Q

Examination finding of rubella infection

A

Rash which started on face and quickly spread
Pre auricular and occipital lymphadeopathy
Forchmeicher spots

176
Q

How can Zika virus present congenitally

A

Severe microcephaly and craniofacial disproportion
Deafness and retinopathy
Talipes
Hypertonia

177
Q

What are 3 levels of surgical site infection

A

Superficial incisionial- skin and subcut
Deep incisional- affects muscle and fascial
Organ/space infection- any part of anatomy other than incision

178
Q

What is associated with fulminant septic arthritis

A

Strains producing rhe PVL (panton valentine leucocidin) cytotoxin

179
Q

What is surgical method for chronic osteomyelitis

A

Masquelet technique

180
Q

Management of toxplasmosis

A

Spiramycin
Pyrimethanine

181
Q

Investigation and management of rabies

A

Serology
Brain biopsy
Management- IG, vaccine

182
Q

Organisms for rate bite fever

A

Streptobacillus moniliforms
Spirillum minus

183
Q

Investigation and management of rat bite fever

A

Joint fluid mc&s
Penicillins

184
Q

What is the MOA of aciclovir, ganiciclovir and valganiciclovir

A

Competitive guanosine analogue which inactivates DNA polymerase (nucleoside analogue)

185
Q

MOA of cidofovir

A

Cytidine analogue terminator

186
Q

MOA of foscarnet

A

Non-competitive inhibitor of viral DNA polymerase

187
Q

What is ramsay hunt syndrome and what causes it

A

Varicella
Facial nerve palsy with vesicles in the ear

188
Q

How is Hep B treated

A

Interferon alpha
Lamivudine
Entecavir and tenofovir

189
Q

MOA of lamivudine

A

NRTI
Nucleoside analogue

190
Q

What does PJP show on methanemine silver stain

A

Flying saucer cysts
Boat shaped on histology

191
Q

What is associated with tumbling motility and rockets

A

Listeria as flagellated

192
Q

Which pneumonia shows glossy colonies

193
Q

Giardia vs entamoeba histolytica

A

Giardia- 2 nuclei, pear shaped
Entamoeba- 4 nuclei, flask shaped nuclei

194
Q

Gold standard for leptospirosis

A

Microscopic agglutination

195
Q

India ink showing halo

A

Cryptococcus

196
Q

Addition of potassium hydroxide leads to spaghetti and meatballs appearance of skin

A

Melassazia furfur

197
Q

What is seen on biopsy of rabies cells

A

Negri (inclusion) bodies

198
Q

What are the gram negative diplococcus

A

Moraxella cattarhalis
Neiserria meningitidis

199
Q

What causes culture negative endocarditis

A

HACEK
Parahaemophilus influenzae
Aggregobacterum
Cardiobacterum
Eikinella
Kingella

Last minute (11 decks)

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