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
2
Q
Causes of raised anion gap met acidosis
A
Uraemia
Metformin
Ethylene glycol
Aspirin
Lactate
DKA
3
Q
What class of drug is metformin
A
Biguanide
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
5
Q
Causes of resp acidosis
A
From HYPOventilation- chronic lung disease, opiods, sedatives, NM weakness
6
Q
Causes of resp alkalosis
A
From HYPERventilation- panic attack, PE, salicylates, altitude, anything which increases resp rate
7
Q
What causes extremely high ALP in a child
A
Osteopenia of prematurity
8
Q
Causes of hypernatraemia in a neonate
A
Very common in first 2 weeks
Can be sign of dehydration or overconcentrated formula
9
Q
Causes of hyponatraemia in a neonate between first 5 days and then after
A
Overhydration
SIADH from infection orIVH
CAH
10
Q
What does AST:ALT over 2:1 suggest
A
Alcoholic liver disease
11
Q
What is urobilinogen in each of types of jaundice
A
Elevated in pre
Elevated in hepatic
Absent in post
12
Q
What is urinary bilirubin in each type of jaundice
A
Absent in pre- as unconjugated is lipophillic
Present in post and hepatic
13
Q
What causes a low urea
A
Pregnancy
Liver disease
Malnutrition
14
Q
What causes a low albumin
A
Liver disease
Sepsis
Chronic illness
Malnutrition
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
16
Q
What is main enzyme in purines salvage pathway
A
HPRT
17
Q
What is rate limiting enzyme in purine de novo pathway
A
PAT
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
19
Q
What ovarian cancer are ciliated cells seen in
A
Serous cystadenoma
20
Q
Which thyroid hormone is active
A
T4 peripherally activated to T3 which has effects
21
Q
Metabolic association of hypothyroidism
A
High cholesterol
22
Q
When is only time treat subclinical hypothyroidism
A
If hypercholesterolaemia present
23
Q
Histology of anaplastic thyroid cancer
A
Pleomorphic cells
Spindle cells with sarcomatous appearance
24
Q
Thyroid tumour with sheets of dark cells
A
Medullary
25
Which thyroid cancer spreads by blood most commonly
Follicular
26
Which thyroid cancer is well differentiated
Follicular
27
Most common cause of hypopituitarism
Non functioning adenoma
28
Histology of thyroid adenoma
Encapsulated in fibrous cap
29
What used to diagnose thyroid cancer
Fine needle aspiration
30
Histology of papillary thyroid cancer
Psammoma bodies
Orphan annie eyes (optically clear nuclei)
31
What happens to adrenal tissue in different causes of cushings
Pituitary adenoma and ectopic ACTH-> adrenal hyperplasia
Exogenous steroids-> atrophy of adrenals
32
What do adrenal carcinomas produce
Androgens
33
When use demecycline and tolvaptan
Fluid restriction not successful
34
When can use hypertonic saline (3%) for hyponatraemia
If very severe like coma or seizures
35
Management of hypernatraemia
To replace water deficit- 5% dextrose
To replace extracellular depletion- NaCl 0.9%
36
Differentiating cause of hypervolaemia hyponatraemia
Urine sodium just like hypovolaemia
Over 20 then renal cause
37
How do thiazide diuretics work
Block sodium-chloride transporter in distal tubule
38
Management of hyperkalaemia
Calcium gluconate 10%-> 50% dextrose with insulin-> salbutamol
39
ECG changes hyperkalaemia
Absent P waves
Tented T waves
Widened QRS
40
What is caused by vitamin E deficiency
Neuropathy- cerebellar symptoms
Anaemia
IHD
41
Best test for iodine
TFTs
42
Names for vitamines
- B1
- B2
- B3
- B6
- A
- E
- K
Thiamine
Riboflavin
Niacin
Pyridoxine
Retinol
Tocopherol
Phytomeniadone
43
Fluoride deficiency and excess
Dental caries- deficiency
Fluorosis- excess
44
What does excess vitamin C cause
Calcium oxalate stones
45
What is only vitamin measure plasma level
C
46
What is used to calculate eGFR
Creatinine in practise however inulin the gold standard
47
What is Km (michaelis menten)
Substate velocity at which reaction speed is 50% of maximum
48
Cardiac complication of CKD
Uraemic cardiomyopathy
49
What can define stage 1 AKI
Creatinine rise over 26
Over 50% increase in creatininte
Urine out put less than 0.5ml/kg in 12 hours
50
Grades for CKD
1- kidney damage with GFR>90
2- 60-90
3- 30-59
4- 15-29
5- <15
51
What is the definition of clearance and equation
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
52
How does low dose dexamethasone test work
Give 0.5mg dexamethasone every 6 hours for 48 hours
53
Management of conns
Spironolactone
If over 4cm can consider surgery
54
How does short synACTHen test work
Measure ACTH and cortisol then give IM ACTH 250mg
Then measure cortisol after 30 and 60mins
55
In combined pituitary testing what hormones are used and what do they stimulate
TRH-> prolactin, TSH
LHRH-> LH/FSH
Insulin-> GH, ACTH
56
Blood findings of acromegaly
Raised GH, IGF-1 and prolactin
Hyperglycaemic
57
Management for prolactinoma
Cabergoline/bromocriptine
Replacement of other pituitary hormones affected
Consider surgery if compressive or eye symptoms unresponsive to medical management
58
Combined pituitary function test results for non-functioning adenoma
Baseline raised prolactin
Will be failure to increase other hormones
59
Management of non-functioning pituitary adenoma
Depends on presentation
High prolactin= cabergoline
Panhypopituitarism= replacement of other hormones
Nothing wrong=monitor
60
Management of acromegaly
1st line= transsphenoidal surgery
2nd line= radiotherapy and octreotide
3rd line= pegvisomat
61
What medications can be used for acromegaly
Octreotide= somatostatin analogues
Dopamine antagonists= cabergoline/bromocriptine
Pegvisomat= GH antagonist
62
First step in vitamin D synthesis
7 dehydroxycholesterol to cholecalciferol under influence of UV
63
In primary hyperparathyroidism, which out of calcium and PTH can be normal
PTH
64
Causes of hypoparathyoidism including most common
Post surgical- most common
Post radiation
Autoimmune
Magnesium abnormalities
DiGeorge
65
Management of hypocalcaemia
If symptomatic or less than 1.9- IV calcium gluconate
If asymptomatic or mild- oral calcium (sandocal)
66
Porphyria cutanea
- presentation
- enzyme affected
- test
- skin blistering and desquamation after liver inducer
- uroprophyrinogen decarboxylase
- urinary uroporhyrins and coproporphyrins
67
Acute intermittent porphyria
- presentation
- enxyme affected
- test
- pain in stomach, psychosis, peripheral neuropathy after liver inducers
- HMB synthase
- urinary porphobilinogen and
aminolevulinic acid
68
What are the acute porphyrias and how differentiate
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
69
What is MOA of DM drugs
- acarbose
- metformin
- empaglifizon
- liraglutide
- gliptins
- sulphonylureas
- 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
70
MOA of cholesterol lowering drugs
- statins
- ezetimibe
- cholestyramine
- evolocumab
- fibrates
- 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
71
What are the 2 types of creatine kinase
CK-MB- cardiac muscle
CK-MM- skeletal muscle
72
What bone diseases causes an extremely high ALP comapred to others
Pagets
73
Niche causes of hypoglycaemia
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
74
In bile acid synthesis Acyl-CoA cholesterol acyltransferase (ACAT) is the enzyme that converts cholesterol into what?
Cholesterol ester
75
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
Albright hereditary osteodystrophy
76
How does aspirin OD present
Ringing in ears
N&V
Dizziness
77
What is transporter affected by ezetimibe
NPC 1L1
78
What does lead poisoning lead to and what caused by
Drinking moonshine
Acute gout as lead reduces urate excretion
79
Symptoms and signs of fanconi syndrome
Symptoms
- polyuria
- polydipsia
- failure to thrive in kids
Signs
- hypokalaemia
- hypouricaemia
- hypoglycaemia
- proteinuria
80
How is osmolar gap calculated
Osmolality- osmolarity
81
What is normal osmolar gap
Less than 10
82
What causes a raised anion gap and osmolar gap
Methanol
Mannitol
Glycol
83
What is pathophysiology of familial benign hyperclacaemia
Mutation is CASR gene leading to defective calcium sensing receptor
84
Presntation of hypoglycaemia
Sweating
Fine tremor
Seemed drunk
85
High urinary calcium with hypokalaemia
Bartter syndrome
86
What causes mildly elevated liver enzymes with high GGT
Alcohol abuse
87
How to differentiate addisons from secondary disease
Long synACTHen test- if pituitary problem will see increase in cortisol
88
What drug causes B6 deficiency and what is result
Isoniazid
- anaemia
- seborrheic dermatitis
89
How does rasburicase work
Recombinant urate oxidase to prevent hyperuricaemia
90
Inheritance of thalassaemia and SCD
Autosomal recessive
Beta chain on Chr 11
- SCD point mutation of glutamate to valine Alpha chain on Chr 16
91
Frontal bossing and hair on ends x ray appearance
Beta thalassaemia
92
How to differentiate thalassaemia trait from IDA on FBC and then blood film
RBC increased in thalassaemia
On blood film will see basophilic stippling
93
How are thalassaemia and SCD diagnosed
Hb electrophoresis
94
What is inheritance of PK deficiency and what are cells seen in it
Autosomal recessive
RBC with short projections
95
What is seen in G6PD blood film
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
What are spherocytes
Sphere shaped RBC often a little smaller
97
How does ACD work
IL1and interferons reduce EPO production
IL-6 reduces hepcidin production which blocks iron absorption and sequesters it in macrophages
98
Differentiating IDA and ACD
ACD has increased transferrin saturation and reduced TIBC
99
Symptoms of paroxysmal nocturnial haemoglobinuria
Pancytopenia
New thrombosis- budd chiari very commonly
Haemolysis
100
What is test for paoroxysmal nocturnal haemoglobinuria
Hams
101
Most common cause of autoimmune haemolysis
Idiopathic
102
Acquired causes of haemolysis
Malaria
Adenocarcinoma
TTP
HUS
DIC
Autoimmune
103
What can be specialised treatments for ALL
CD20- rituximab
Phil Chr- imatinib
104
Specialised treatments for AML
CD33 -gemtuzumab
105
What surface marker is on all immature WCC
CD34
106
What is mutation in APML and the special treatments
PML-RARA (15;17)
All trans retinoic acid and A203
107
What is poor genetic prognostic marker for CLL
TP53 (deletion on chromosome 17)
108
Hpw is TP53 mutation assessed in CLL
FISH- detects loss on Chr 17
109
What is MOA of venetoclax
BCL2- promotes apoptosis
110
Difference in flow cytometry of T cells, B cells and CLL B-cells
T-cells - CD5 positive
B- cells- CD19 positive
CLL B cells- both CD5 and CD19 positive
111
How is AML treated
Cytarabine and danorubicin
To maintain remission- cytarabine
112
Staging of CLL
Rai and binet
113
What is evans syndrome and what seen in
Get AIHA and ITP
CLL
114
How is philadelphia chromosome detected
FISH
115
What is the protein formed from Ph chromosome and how detected
BCR-ABL
PCR
116
Blood findings of CML
Very high neutrophils and basophils
117
What is associated with good prognosis in CLL
Ig mutation
118
What is associated with good prognosis in CLL
Ig mutation
119
What is name for IgM producing leukaemia
Waldenstroms macroglobinaemia
Lymphoplasmacytoid leukaemia
120
Staging for myeloma and MGUS
Salmon Durie for myeloma
MAYO for MGUS
121
Management plan for myeloma
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
CD stainging for the lymphoma
Follicular- CD10
bURKITTS- DC20
Classical Hodgkins- CD15 AND 30
lYMPHOCYTE PREDOMINANT- CD20
123
Managementof T cell lymphomas
Can use alemtuzumab- CD52
124
Management of burkitts lymphoma
Rituximab
125
Management of burkitts lymphoma
Rituximab
126
Management of MDS
Supportive – transfusions, EPO, G-CSF, ABx
* Biological modifiers – immunosuppressive drugs, lenalidomide, azacytidine
* Chemotherapy – similar to AML
* Allogeneic SCT
127
Prognosis predictor in MDS and what are outcomes
IPSS
1/3 bleeding
1/3 infection
1/3 leukaemia
128
What is in schwachman diamond
Neutropenia
Pancreatic exocrine function lost
Short
129
What is diamond black fan syndrome
Anaemia
Presents at 1 year old with severe physical dysmorphology
130
What is associated with aplastic anaemia
PNH
Acute leukaemia
131
What is ruloxitinib used in
Myelofibrosis (JAK inhibitor)
132
What is management of essential thrombocytosis
Aspirin
Hydroxycarbamide
Anagreiide
133
Blood results for polycythaemia rubra vera
High HCT, RBC, red cell mass, low EPO
134
Blood film and BM findings of essential thrombocytosis
Blood film- megakaryocytes
BM- megakaryocyte hyperplasia
135
Mutations assoc with myeloproliferative disorders
JAK2
Calreticulin
MPL
136
Management of polycythaemia rubra vera
Venesection
Aspirin
Hydroxycarbamide
137
What is d-dimer
A degredation product of fibrinolysis
137
What is d-dimer
A degredation product of fibrinolysis
138
What is Andexanet alfa the reversal agent for
Apixaban
Rivaroxaban
139
What description is given to red blood cells stain heavily for the presence of RNA?
Reticulocytes
140
What is most common lymphoma in over 40s
DLBC
141
When see spherocytes, what are the 2 differentials
Hereditary spherocytosis
AIHA
142
What clotting factor has the shortest half life?
7
143
MOst common lymphoma in a child
Burkitts
144
What can cause an acquired reduction in platelet function
Aspirin
Uraemia
145
Blood findings of liver diease causing
Reduced synthesis of II, V, VII, IX, X, XI and fibrinogen
High AST
Elevated VIII and VWB
146
How manage vitamin K deficiency
IV Vitamin K
If bleeding then FFP
147
What happens in protein S deficiency
Reduced breakdown of factor 5 and 8
148
How is factor V leiden diagnosed
Protein C functionality
149
Reversal agents for blood thinners
Heparin- protamine sulphate
Warfarin- vitamin k or ffp
Rivaroxaban- andexanet alfa
Dabigatran- idracizumab
150
Management of vit K OD
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
MOA of the blood thinners
Warfarin- vitamin k epoxide reductase
Heparin- antithrombin III potentiator which inactivates thrombin and F9-11
Apixaban- anti-Xa
Dabigatran- anti-IIa
152
Lead poisoning anaemia
Microcytic
Basophillic stippling
153
What are Howell Jolly bodies
Inclusions of DNA
154
What is IgA deficiency a risk factor for with transfusions
Anaphylaxis
155
What are unique features to adult T cell leukaemia
Hypercalcaemia
Hepatosplenomegaly
Skin lesions
156
What lymphoma are centrocytes seen in
Follicular
157
What are target cells seen in
3 Hs
- hepatic disease
- haemoglobinopathies
- hyposplenism
158
How is VWB disease treated
Desmopressin
159
What are methods of resistance to
- carbapenems
- cephalosporins
- penicillins
- macrolides
- tetracyclines
- rifamycins
- carbapenemase
- ESBL
- BL
- methylate ribosome
- prevent accumulation of drug
- rapid resistance from mutations of beta unit in RNA polymerase
160
How does strep pneumoniae become resistant
Stepwise mutations in penicillin binding protein
161
Side effects of aminoglycosides vs oxazolidinones
Aminoglycosides- ototoxic and nephrotoxic
Oxazolidinones- thrombocytopenia and optic neuritis
162
Making diagnosis of UTI
>10^4 colony forming units
>10^3 colony forming units if E coli, staphylococcus sabrophyticus
163
Organism if recurrent UTIs
Pseudomonas
164
Ecoli method of resistance
ESBL
165
What are beefy red ulcers seen in
Dononvaonisis
166
Management of leishmanisias
Amphotericin B
167
Onset of symptoms from eating staph areus vs salmonella enterica
S. aureus- 1-2 hrs
Salmonella- 12 hours
168
Staining of candida, aspergillus, cryptococcus and pneumocystis
Candida- periodic acid schiff or methanemine silver
Aspergillus- methanemine silver
Cryptococcus- india ink
Pneumocystis- silver and peridoc acid schiff
169
Name some spirochaetes
Leptospirosis
Borrelia
Treponema
170
What is used on nails for fungal infections
Potassium hydroxide
171
Features of legionella pneumonia
Plumber
Recent hotel travel
Hyponatraemia
LFTs affected
172
Visceral leishmaniasis presentation
Massive hepatoslpenomegaly
Skin hyperpigmentation
173
What activates influenza
hUMAN AIRWAY TRYPTASE
174
Problem of cidofovir and foscarnet
Nephrotoxic
175
Examination finding of rubella infection
Rash which started on face and quickly spread
Pre auricular and occipital lymphadeopathy
Forchmeicher spots
176
How can Zika virus present congenitally
Severe microcephaly and craniofacial disproportion
Deafness and retinopathy
Talipes
Hypertonia
177
What are 3 levels of surgical site infection
Superficial incisionial- skin and subcut
Deep incisional- affects muscle and fascial
Organ/space infection- any part of anatomy other than incision
178
What is associated with fulminant septic arthritis
Strains producing rhe PVL (panton valentine leucocidin) cytotoxin
179
What is surgical method for chronic osteomyelitis
Masquelet technique
180
Management of toxplasmosis
Spiramycin
Pyrimethanine
181
Investigation and management of rabies
Serology
Brain biopsy
Management- IG, vaccine
182
Organisms for rate bite fever
Streptobacillus moniliforms
Spirillum minus
183
Investigation and management of rat bite fever
Joint fluid mc&s
Penicillins
184
What is the MOA of aciclovir, ganiciclovir and valganiciclovir
Competitive guanosine analogue which inactivates DNA polymerase (nucleoside analogue)
185
MOA of cidofovir
Cytidine analogue terminator
186
MOA of foscarnet
Non-competitive inhibitor of viral DNA polymerase
187
What is ramsay hunt syndrome and what causes it
Varicella
Facial nerve palsy with vesicles in the ear
188
How is Hep B treated
Interferon alpha
Lamivudine
Entecavir and tenofovir
189
MOA of lamivudine
NRTI
Nucleoside analogue
190
What does PJP show on methanemine silver stain
Flying saucer cysts
Boat shaped on histology
191
What is associated with tumbling motility and rockets
Listeria as flagellated
192
Which pneumonia shows glossy colonies
HIB
193
Giardia vs entamoeba histolytica
Giardia- 2 nuclei, pear shaped
Entamoeba- 4 nuclei, flask shaped nuclei
194
Gold standard for leptospirosis
Microscopic agglutination
195
India ink showing halo
Cryptococcus
196
Addition of potassium hydroxide leads to spaghetti and meatballs appearance of skin
Melassazia furfur
197
What is seen on biopsy of rabies cells
Negri (inclusion) bodies
198
What are the gram negative diplococcus
Moraxella cattarhalis
Neiserria meningitidis
199
What causes culture negative endocarditis
HACEK
Parahaemophilus influenzae
Aggregobacterum
Cardiobacterum
Eikinella
Kingella
