Clinical relevance Flashcards
A 31 year old woman presents with a 6 week history of asymmetrical additive polyarthritis with some remitting joints. She describes needing to get going in the morning and better in the afternoons, but night times are bad. She is well in herself but has been more tired recently. She has a viral infection and sore throat about a month before the onset of joint pain, but this settled fairly quickly without treatment. She also has some back pain. Ibuprofen helps.
What 2 things would you look for on examination and why?
- pattern of joints - we are more likely to see an assymetrical pattern of joint involvement in someone with PsA, and a symmetrical small joint involvement in someone with RA
- soft tissues - tenosynovitis, inflammation around a tendon indicative of inflammatory. Rheumatoid nodules form on pressure points in RA.
A 31 year old woman presents with a 6 week history of asymmetrical additive polyarthritis with some remitting joints. She describes needing to get going in the morning and better in the afternoons, but night times are bad. She is well in herself but has been more tired recently. She has a viral infection and sore throat about a month before the onset of joint pain, but this settled fairly quickly without treatment. She also has some back pain. Ibuprofen helps.
Which investigations will help and why?
- FBC; someone is more likely to be anaemic if they have a chronic inflammatory disease due to the affects of systemic inflammation
- U&Es and LFT; check renal and liver function as these may be damaged in some autoimmune diseases. Important to check before prescribing
- RhF and Anti-CCP; anti-CCP specific for rheumatoid arthritis
- HLA-B27; sponydyloarthropathies and reactive arthritis
- blood culture; if you suspect infection
- ultrasound; synovitis or tenosynovitis in inflammatory joint disease
Which 3 medications used to treat rheumatoid arthritis have shared care?
- methotrexate
- sulphasalazine
- leflunomide
Which 5 people are involved in the shared care of rheumatoid arthritis?
- rheumatologist
- GP
- pain management clinic
- occupational therapist - as per NICE clinical guidelines (conserving energy, splints etc)
- physiotherapist - as per NICE clinical environment (assess ROM, muscle wasting. hydrotherapy etc.)
A 65 year old male with a history of hypertension, smoking and type 2 diabetes had a myocardial infarct diagnosed 6 months previously. He was hit by an articulated truck while crossing the road after attending his 6 month cardiology check up and died from a head injury. At autopsy, the pathologist examines the site of the previous myocardial infarct and the image shows what the pathologist sees on naked eye examination. What are they most likely to see under the microscope?
- myocyte fibre eosinophilia
- a dense infiltrate of macrophages and myocyte necrosis
- necrotic myocytes with an infiltrate of neutrophils
- loss of myocytes with a dense collagenous scar
- normal myocytes
loss of myocytes
in myocardial infarction, the myocytes undergo coagulative necrosis. collagen is deposited from day 10 onwards
A 36 year old female presents to a gastoenterologist with intermittent attacks of mild diarrhoea and abdominal pain. The gastoenterologist sends a colonoscopic biopsy series to the pathologist, who issues this report:
“Large bowel mucosal biopsies which show focal mild acute cryptitis with a patchy increase in the number of chronic inflammatory cells present within the lamina propria. The inflamed regions are separated by non-inflamed areas and a single small non-caseating granuloma is present within the lamina propria away from the inflamed crypts”
What is the most likely diagnosis here?
- Ischaemic colitis
- Colonic carcinoma
- Radiation Colitis
- Helicobacter infection
- Crohns disease
chrons disease
A 36 year old female presents to a gastoenterologist with intermittent attacks of mild diarrhoea and abdominal pain. The gastoenterologist sends a colonoscopic biopsy series to the pathologist, who issues this report:
“Large bowel mucosal biopsies which show focal mild acute cryptitis with a patchy increase in the number of chronic inflammatory cells present within the lamina propria. The inflamed regions are separated by non-inflamed areas and a single small non-caseating granuloma is present within the lamina propria away from the inflamed crypts”
What is the most likely diagnosis here?
- Ischaemic colitis
- Colonic carcinoma
- Radiation Colitis
- Helicobacter infection
- Crohns disease
chrons disease
Describe the 4 stages of wound healing, in the correct time sequence
Activation of coagulation system
- a wound damages blood vessels, so the coagulation system is activated first to preserve life
Recruitment of neutrophils and macrophages
- Damage to cells release Damage Associated Molecular Patterns (DAMPS) which recruit neurtophils and macrophages to the site of injury.
Granulation tissue formation
- The new scar needs a blood supply and oxygen to support the repair process
- therefore vascular endothelial growth factor causes new vessels to proliferate to form granulation tissue
Fibrous scar tissue formation with collagen deposition
- fibroblasts secrete collagen, forming scar tissue
Which inflammatory cell is present at the arrow on this blood film, indicated by the arrow
- Plasma cell
- Neutrophil
- Eosinophil
- Macrophage
- Lymphocyte
Lymphocyte
A 24 year old male smoker presents to the accident and emergency department with a 2 day history of increasing breathlessness, associated with fever and a raised CRP. A chest X ray shows consolidation of the right lower lobe with a right pleural effusion which relieves the mans breathlessness somewhat. The fluid is sent to cytology. What is the cytologist likely to find when she examines some centrifuged fluid under the microscope?
- a monotous lymphoid population with some reactive mesothelial cells
- blood and malignant epithelial cells, containing vacuoles indicative of metastatic adenocarcinoma
- frequent papillary clusters of atypical mesothelial cells and red blood cells, consistent with malignant mesothelialoma
- an acellular fluid
- frequent neutrophil polymorphs consistent with a parapneumonic effusion
frequent neutrophil polymorphs consistent with a parapneumonic effusion
What are the functions of the complement system? (3)
- formation of anaphylotoxins
- enables cell lysis by forming a terminal membrane attack complex
- removes immune complexes from the circulation
