CP Flashcards
What 4 things present with SLE?
Photosensitive malar rash
Multiple mouth ulcers
Arthralgia - joint pain
Alopecia - hair loss
Which 3 organs are involved with SLE?
Lung - pleural effusion
Kidney - lupus nephritis
Brain - cerebral lupus
What condition uses a-inteferon as a replacement therapy?
Hep C
What condition uses B-inteferon as a replacement therapy?
MS
What condition uses y-inteferon as a replacement therapy?
CGD
IL-12 deficiency
In replacement therapy of the immune system what are the following molecules used to treat?
1) IL-2
2) alpha inteferon
3) G-CSF/GM-CSF
4) beta inteferon
5) y-inteferon
1) Stimulate T cell activation
2) Hep C treatment
3) Increase neutrophil production in bone marrow
4) MS therapy
5) CGD, IL-12 deficiency, atypical mycobacteria
What is the name of the drug that acts as a folate antagonist and has a side effect of pneumonitis?
1) Cyclophospamide
2) Basilixmab
3) Methotrexate
4) Azathioprine (AZA)
5) Myophenolate mofetil (MMF)
6) Ciclosporin A
7) Sirolimus
8) Tacrolimus
9) Daclizumab
Methotrexate
Which drugs are anti-metabolates and act by inhibiting nucleotide synthesis?
1) Cyclophospamide
2) Basilixmab
3) Methotrexate
4) Azathioprine (AZA)
5) Myophenolate mofetil (MMF)
6) Ciclosporin A
7) Sirolimus
8) Tacrolimus
9) Daclizumab
Azathioprine - AZA
Myophenolate mofetil - MMF
Which drugs are calcineurin inhibitors?
1) Cyclophospamide
2) Basilixmab
3) Methotrexate
4) Azathioprine (AZA)
5) Myophenolate mofetil (MMF)
6) Ciclosporin A
7) Sirolimus
8) Tacrolimus
9) Daclizumab
Ciclosporin A
Tacrolimus
Which drug is a macrolide antibiotic but also inhibits mTOR?
1) Cyclophospamide
2) Basilixmab
3) Methotrexate
4) Azathioprine (AZA)
5) Myophenolate mofetil (MMF)
6) Ciclosporin A
7) Sirolimus
8) Tacrolimus
9) Daclizumab
Sirolimus
Which drug cross links DNA and has a side effect of cystitis?
1) Cyclophospamide
2) Basilixmab
3) Methotrexate
4) Azathioprine (AZA)
5) Myophenolate mofetil (MMF)
6) Ciclosporin A
7) Sirolimus
8) Tacrolimus
9) Daclizumab
Cyclophosphamide
Whcih drugs inhibit IL-2 signalling?
1) Cyclophospamide
2) Basilixmab
3) Methotrexate
4) Azathioprine (AZA)
5) Myophenolate mofetil (MMF)
6) Ciclosporin A
7) Sirolimus
8) Tacrolimus
9) Daclizumab
Basiliximab
Daclizumab
Which drugs are often uses in vasculitis?
1) Cyclophospamide
2) Basilixmab
3) Methotrexate (MTX)
4) Azathioprine (AZA)
5) Myophenolate mofetil (MMF)
6) Ciclosporin A
7) Sirolimus
8) Tacrolimus
9) Daclizumab
Methotrexate (MTX)
Cyclophosphamide
What is the hormone cycle of sex hormones? [Hypothalamus] ¦ [Pituitary] ¦ [Tissue]
[Hypothalamus] GnRH ¦ ¦ [Pituitary] LH FSH ¦ ¦ [Tissue] sex hormones
What is the hormone cycle of thyroid hormones? [Hypothalamus] ¦ [Pituitary] ¦ [Tissue]
[Hypothalamus] TRH ¦ ¦ [Pituitary] TSH ¦ ¦ [Tissue] T4 T3
What is the hormone cycle of growth hormones? [Hypothalamus] ¦ [Pituitary] ¦ [Tissue]
[Hypothalamus] GHRH ¦ ¦ [Pituitary] GH ¦ ¦ [Tissue] ¦
What is the hormone cycle of cortisol? [Hypothalamus] ¦ [Pituitary] ¦ [Tissue]
[Hypothalamus] CRH ¦ ¦ [Pituitary] ACTH ¦ ¦ [Tissue] adrenal cortex ¦ cortisol
What type of diagnostic test provides a T score that reflects bone density?
DEXA scan
For the following bone conditions what are the T score ranges?
1) Osteopenia
2) Osteoporosis
Osteopenia: -1 –> -2.5
Osteoporosis:
What are the 2 hereditary genes for pancreatitis?
Which is autosomal and which is recessive?
PRSS1 - autosomal dominant
SPINK1 - autosomal recessive
What type of pain does acute pancreatitis present with?
Sharp pain in epigastric region radiating to back
Which enzymes in the blood are raised in pancreatitis?
Amylase/Lipase
What symptom makes chronic pancreatitis mimic cancer?
Weight loss
What type of pancreatic cancer is most common?
What is the pathogenesis?
Pancreatic adenocarcinoma
KRAS –> inactivates p16 (tumour suppressor)
What is Trousseau’s syndrome? When does it present?
Inflammation of veins
Pancreatic adenocarcinoma
What is Courvoisier’s sign? What condition does it suggest?
Palpable GB but no pain
Pancreatic Adenocarcinoma
From which cells do Pancreatic Neuroendocrine Tumours derive from?
Islet cells
Presentation of spider naevia, ascites and gynaecomastia suggest which condition?
Hepatic failure
What genetic inborn errors result in chronic hepatitis?
Wilson’s disease (copper)
Haematochromatosis (iron)
Alpha 1 antitrypsin deficiency
C.perfringens and S.aureus can cause which GI condition?
Gastroenteritis
Which anaerobic bacterial family is penicillin resistant?
Bacteroides fragilis
What antibiotic do you use to treat Staph Aureus?
Flucloxacillin (not MRSA)
What antibiotic do you use to treat MRSA?
Vancomycin
What antibiotic do you use to treat S.pyogenes?
Benzylpenicillin
What antibiotic do you use to treat gram -ve bacilli eg: E.coli?
Cephlasporins (avoid in elderly)
What antibiotic do you use to treat anaerobes?
Metronidazole
Name the 4 main families of B lactam antibiotics in order of narrow spectrum to broad?
Penicillins
Cephalosporins
Carbapenems
Monobactams
What does Staphylococcus contain that makes it resistant to some penicillins?
B lactamase enzyme
What are Extended spectrum β-lactamases (ESBLs) resistant to?
Penicillins and cephalosporins
What is another name for Amocixillin-clavulanate?
Augmentin
What is the special family Augmentin belongs to?
BLBLIs (Beta Lactam/Beta Lactamase Inhibitors)
What is the negative of using BLBLIs?
They are very broad spectrum so can lead to C.diff
What type of antibiotic is Vancomycin part of?
1) B lactams
2) Glycopeptides
Glycopeptides
What is the name of the fungal pathogen that is responsible for dermatophyte infections?
Trichophyton Rubrum
What are the names of the fungal pathogens that are responsible for tinea unguium?
Trichophyton Rubrum
Trichophyton Interdigitae
What are the treatments for dermatophyte infections?
Topical antifungals:
Clotrimazole
Terbinafine
What type of surfaces do candida colonise?
Mucosal
What is the treatment for candida infections?
Who cannot receive this treatment and why?
Oral azoles:
Fluconazole
Pregnant women - increases risk of tetratologies
What is the treatment for aspergillosis?
Itraconazole
Voriconazole
Amphotercin B
Which virus is a double stranded enveloped DNA virus and therefore has the ability to establish latency and reactivate?
Herpes
Match up the following viruses (numbered) with their common names (lettered):
1) HSV1
2) VZV
3) HSV2
4) Herpes Zoster
A) Genital Herpes
B) Chicken Pox
C) Cold Sores
D) Shingles
HSV1 –> cold sores
HSV2 –> genital herpes
VZV –> chicken pox
HZ –> shingles
Name the 2 mechanisms of transmission of Varicella Zoster Virus.
1) Respiratory droplets
2) Fluid from vesicles
Which virus presents with atypical lymphocytes on a blood film?
EBV
Which 2 viruses are associated with infectious mononucleosis?
EBV and CMV
What treats CMV?
1) Flucloxicillin
2) Acyclovir
3) Valacyclovir
4) Ganicyclovir
Ganicyclovir
Which virus presents with the nomenclature of H1N1?
Influenza
Which of the influenza strains mutates regularly? Influenza A Influenza B Influenza C Influenza D
Influenza A
Which virus presents with dermatomal distribution (found along dermatomes)?
Shingles
What disease is one of the most common causes of hospitalisation in children presenting as bronchiolitis?
RSV
What is targeted and therefore reduced in numbers in HIV patients?
CD4
Which hepatitis infections transmit enterically (faeco-oral)?
Hep A and E
Which hepatitis infections have parenteral transmission (blood borne/vertical)
Hep B, C, D
What does Hep D require for replication?
Hep D requires Hep B
Which of the following viruses are associated with point-source outbreaks?
1) Hep B
2) Rota virus
3) Norovirus
4) Parvovirus
Norovirus
Which virus infects erythroid progenitor cells leading to transient anaemia?
What are its other names?
Parvovirus
Slapped Cheek Syndrome or Fifth Disease
People with which condition are affected badly by parvovirus?
1) Pregnant women
2) Children
3) Sickle cell patients
4) Immunocomprised
Sickle cell - because affect those with high erythrocyte turnover –> leads to transient aplastic crisis
Which prion disease is associated with eating contaminated beef?
nvCJD
What is the histological change of prion diseases in brain tissue?
Spongiform
Which viruses replicate in the gut but have no GI symptoms?
1) Enteroviruses
2) Parvoviruses
3) Noroviruses
4) Rota viruses
Give an example of one.
Enteroviruses - Coxsackie A/B
For which condition is oseltamivir used to treat?
Influenza
Which antiviral is used as an M2 H+ channel blocker?
1) Acyclovir
2) Valacyclovir
3) Oseltamivir
4) Amantidine
5) Ganiciclovir
Amantidine
What antiviral treats RSV?
Ribavirin
In sepsis what type and how much oxygen do you give?
15L/min of high flow oxygen
In sepsis how much fluid do you give?
500ml/15 minutes
What are the commonest treatments for UTIs?
Trimethoprim
Nitrofuratonin
What is Cor Pulmonale?
(R sided) Pulmonary hypertensive heart disease
Which of the following are not causes of R sided hypertensive heart disease?
1) Pulmonary parenchyma diseases
2) Chest movement disorders
3) Disorders including pulmonary arterial compression
4) Endocarditis
5) Pulmonary vessel diseases
Endocarditis
In the RAAS system where does Renin come from?
Kidneys
In the RAAS system what converts angiotensin I into angiotensin II?
Where does it come from?
ACE
Lungs
What effect does angiotensin II have on the adrenal glands?
To produce aldosterone –> induce reabsorption of NaCl/H2O in the kidneys
In terms of layers what is the difference between a true aneurysm and a false/pseudo aneurysm?
True = all 3 layers (intima, media, adventitia) False/Pseudo = just breaks vascular wall
What is orthopnoea?
Shortness of breath lying flat
Does paroxysmal nocturnal dyspnoea (PND) present in R sided heart failure or L sided heart failure?
L sided
What do WEDGE pressure and BOXCAR nuclei indicate?
Which is used in L sided heart failure?
Which is used in R sided heart failure?
The severity of hypertrophy
L sided - WEDGE
R sided - BOXCAR nuclei
Which side of the heart is the mitral valve on?
L side
Which disease presents with a holosystolic murmur if regurg is present?
Mitral Valve Prolapse (MVP)
Between which weeks does faulty embryogenesis result in CHDs?
Weeks 3-8
Name the 4 conditions presenting with L –> R shunts.
VSD
ASD
AVSD
PDA
Name the 5 conditions presenting with R –> L shunts.
Tetralogy of Fallot Truncus arteriosus Tricuspid atresia Transportation of great arteries Total anomalous pulmonary venous connection
Which shunt presents with cyanosis and systemic venous emboli?
R –> L
Which shunt presents with no cyanosis and pulmonary hypertension?
L –> R
What's the most common CHD? ASD VSD Truncus arteriosus Patent ductus arteriosus
VSD
What is the most common R --> L shunt? Tetralogy of Fallot Truncus arteriosus Tricuspid atresia Transportation of great arteries Total anomalous pulmonary venous connection
Tetralogy of Fallot
What drug is used to treat breast cancer by blocking oestrogen receptors and is also a risk factor for uterine cancers?
Tamoxifen
Which glycoprotein receptors do platelets bind to fibrinogen via?
Glycoproteins 2b/3a
Which glycoprotein receptors do platelets bind to vWF via?
Glycoprotein 1b
Alpha globin chains are coded for in genes HBA1 and HBA2 on which chromosome?
Cr16
Beta globin chains are coded for on which chromosome?
Cr11
What criteria is used to determine whether a sore throat infection is bacterial?
What are the 4 aspects to the criteria?
CENTOR
1) Exudate
2) Temp > 38*C
3) Absence of cough
4) Tender lymph nodes
What is the cause of infectious mononucelosis (glandular fever)?
EBV
What is the triad of symptoms for glandular fever?
Cervical lymphadenopathy
Tonsillar pharyngitis
Fever
Which treatment do you avoid in glandular fever as it gives the patient a mac-pap rash?
Ampicillin
For which infection is CURB used as a severity scorer?
Pneumonia
What does CURB stand for?
C - confusion
U - urea (>7)
R - resp rate (>30)
B - blood pressure (<90/<60)
What are the 4 types of primary lung carcinomas?
Small cell
Large cell undifferentiated
Adenocarcinoma
Squamous cell carcinoma
What is the term for lymphatics within the lung being involved with a tumour?
Lymphangitis Carcinomatosa
What mutation causes Cystic Fibrosis?
Which chromosome?
What is the treatment?
F508 deletion on CFTR gene
Chromosome 7
Orkambi
If a pleural effusion presents with <2.5 protein is it a transudate or exudate?
Transudate
If a pleural effusion presents with >2.9 protein is it a transudate or exudate?
Exudate
What are the common types of malignant mesothelioma?
Which is more common?
Pleural - 92%
Peritoneal - 8%
Is malignant mesothelioma more common in men or women?
Who gets affected more severely?
Men - more common
Women - affects worse
What gene mutation is responsible for malignant mesothelioma?
BAP1
Which type of asbestos is the most oncogenic in malignant mesothelioma?
Crocidolite (blue)
What is the Cappadocian carcinogen?
Erionite
Which resp disease commonly presents with centrilobal emphysema, wheeze and mucus gland hyperplasia?
Asthma
Which chronic disease presents with fine crackles, dry cough and a honeycomb appearance?
CILD (Chronic Interstitial Lung Disease)
Who does sarcoidosis affect?
What is the chest xray key feature?
Young females
Hilar lymphadenopathy
Which disease presents with interstitial pneumonia affecting the lower lobes first?
Idiopathic Pulmonary Fibrosis
Silicosis can reactivate which serious condition?
TB
Hypersensitivity Pneumonitis is an example of which type of hypersensitivity reaction?
Type 3
Actinomyces in hay lead to which disease?
Farmers lung
Pigeon antigens lead to which disease?
Pigeon fancier’s lung
Primary ciliary dyskinesia (Kartegener’s syndrome) and CF give predisposition to which resp disease?
Bronchiectasis
What type of sputum is produced in Bronchiectasis?
Foul smelling sputum
Testicular swelling, gynaecomastia, exophthalmos and infertility is a presentation of which testicular cancer?
Seminoma
What are the infection markers of a seminoma?
hCG and PLAP
Teratomas affect the young or old?
Young - 0-20yrs
What is alpha-fetoprotein a marker for?
Yolk-sac tumours (eg: testis)
What does the Gleason scoring system test for?
Prostate cancer
Which tumour suppressor gene gives a 20x risk of prostate cancer?
BRCA2
Blood in semen, pain on ejaculation, urinary leaks and delayed urination are classical presentations of which type of cancer?
Prostate
What do androgens do in terms of cell death and proliferation of cells?
Androgens inhibit cell death and increase cellular proliferation
In Benign Prostate Hyperplasia (BPH) which zone is diffusely enlarged?
How does it present?
Transition Zone
Incomplete emptying of bladder, nocturia etc (LUTS)
Malakoplakia of testis can have granular cytoplasm high in which type of cell:
1) Neutrophil
2) Eosinophil
3) Basophil
4) Leukocyte
Eosinophil
Which side is cryptorchidism more common on?
Right side
What is a normal urine volume produced per day?
750-2000ml/24h
What is oliguria?
<400
What is anuria?
<100
What is polyuria?
> 3000
What does plasma creatinine do as GFR decreases?
Increases
What does eGFR measure?
Renal function of creatinine, age and sex
Which type of renal obstruction (uni/bilateral) is:
(i) acute?
(ii) chronic?
Acute - bilateral
Chronic - unilateral
What type of cancer is transitional cell carcinoma?
Bladder cancer
What is the pathogenesis of Von Hippel Lindau Syndrome?
Dodgy VHL gene (TS gene) (which is normally required to break down HIF-1) causes cell growth and increased survival leading to tumours
Who is at a higher risk of renal cell carcinoma:
(i) males?
(ii) females?
Males
What is the most common renal cell carcinoma?
Clear cell carcinoma
What gene is a precursor to cervical cancer (adenocarcinoma)?
CGIN
What does Gardasil protect you from?
HPV - strains 6, 11, 16, 18,
When is FIGO staging used?
Cervical cancer
What is a colposcopy and when is it used?
Examination of the cervix HPV +ve Any high grade dyskaryasis Invasive malignancies Glandular neoplasia
How do you treat cervical intraepithelial neoplasia?
Large Loop Excision of Transformation Zone (LLETZ)
In vulval intraeptihelial neoplasia (VIN) which type is graded 1-3, affects young people and is related to HPV:
(i) classic/baseloid/warty
(ii) differentiated
Classic/baseloid/warty
Which type of vulval cancer is the most common?
SCC
What is leiomyoma?
Benign smooth muscle (fibroid) tumours with oestrogen (E2) and progesterone (P4) dependent growth
What disease is caused by ectopic pregnancies?
Endometriosis
In vulval intraeptihelial neoplasia (VIN) which type is associated with lichen sclerosus, not graded, affects old people and is not related to HPV:
(i) classic/baseloid/warty
(ii) differentiated
Differentiated
Are PTEN and Kras mutations in type 1 (endometroid) or type 2 (serous) adenocarcinomas of the endometrium?
Type 1 - endometroid
What type of people are affected by serous (type 2) carcinomas?
Post-menopausal
Who does Wilm’s tumour/nephroblastoma affect?
Children
What condition is the Rotterdam criteria used in?
Polycystic Ovarian Syndrome
What is Sheehan syndrome a cause of?
Hypogonadotrophic gonadal failure
Which category of ovarian cancer is serous carcinoma from?
Surface epithelia
What is the prognostic test used in Breast Cancer?
What are the values in the range?
Nottingham
< 3.4 = good
3.4 - 5.4 = moderate
> 5.4 = poor
Which benign breast disease is common in adolescents?
Fibroadenomas
A rare fibroepithelial neoplasm which can be benign, borderline or malignant?
Phyllodes tumour
What is the key nuclear receptor used to diagnose breast cancer?
Oestrogen
HER2 is a gene commonly found in breast cancer patients - what treatment do you use against it?
Herceptin
Which antibiotics are safe to use in pregnant women?
Penicillins (amoxicillin) and Cephlasporins
Which antibiotics are unsafe to use in pregnant women?
Chloramphenicol –> grey baby syndrome
Tetracycline
Which infection is a precursor to symptomatic UTIs in pregnant women?
Asymptomatic bacteriuria
What type of infections are most common at childhood?
Respiratory
B. pertussis causes which disease?
Whooping cough
Most common causes of meningitis in:
- neonates
- children
- elderly
Neonates - Group B Strep (S. Agalactiae)
Children - Neisseria Menigitidis
Elderly - S. Pneumoniae
Most common cause of viral meningitis?
Coxsackie (Enteroviruses)
Meningococcaemia is caused by which bacteria?
What type of rash occurs?
Neisseria meningitidis
Maculopapular rash
What type of strep causes Scarlet Fever?
What is the key feature?
Group A Strep (S. Pyogenes)
Desquamation (skin peeling)
What disease presents with a pink mac pap rash?
Rubella
What does Ribavirin treat?
Hep C
RSV
Name a cause of neutropenia?
Drugs (antibiotics) or Chemotherapy
What results in basophilia?
CML
In parasitic infections what blood marker is raised?
Eosinophils
Kupffer cells in the liver and Langerhans in the skin are examples of which type of cell?
Monocytes
Monocytosis occurs in which infection?
TB
What is the effect of bone marrow transplants and glandular fever on lymphocytes?
Lymphocytosis - glandular fever
Bone marrow transplants - lymphopenia
What type of cell is further differentiated into platelets?
Megakaryocytes
MDS is a complication of chemotherapy. Which of its syndromes can be actively treated by Lenalidome
5q syndrome
What does leucodepeltion mean?
Removal of WBCs
What is the name of the only adequate fibrinogen concentrate available for IV use?
What does it treat?
Cryoprecipitate
Treats: Haemophilia, vWD, haemorrhages
Fresh frozen plasma is used when?
When can it not be used for?
Coagulopathy during bleeding/surgery
Massive haemorrhage
Warfarin reversal (PCC) Replacing a single factor deficiency
Blood group A can transfuse who?
A or AB
Blood group B can transfuse who?
B or AB
Blood group AB can transfuse who?
AB
Blood group O can transfuse who?
A, B, AB, O
Blood group A can receive blood from who?
A or O
Blood group B can receive blood from who?
B or O
Blood group O can receive blood from who?
O only
Blood group AB can receive blood from who?
A, B, AB or O
Who is the primary receiver?
AB
Who is the primary donator?
O
PTT measures which pathway of the coagulation cascade?
Extrinsice
Intrinsic pathway of coagulation cascade is measured by what?
APTT
Thrombin time measures which pathway in the coagulation cascade?
Common pathway
Meningococcal sepsis presents with what type of rash?
Non-blanching purpuric rash
What type of anti blood molecule is Clopidogrel?
Antiplatelet
What factor is von Willebrand Disease associated with?
FVIII
What does aspirin inhibit?
COX - synthesises platelets
Management of overantigoagulation?
Stop heparin –> consider protamine
Myeloproliferative disorder marked by which gene mutation?
JAK2 V617F
CALR = mutation in exon 9
What is it used as a marker for?
Myeloproliferative disorders
CML is caused by which mutation?
Philadelphia (9;22)
Hydrocarbamide treats which condition?
Thrombocytosis
Treatment of polycythaemia vera?
Aspirin
Imatinib is a tyrosine kinase inhibitor - what myeloid disease can it treat?
CML
When is blood urea raised?
UTIs
C-reactive protein
Procalcitonin
TRAIL
are markers of what?
Inflammation
What does serology specifically test for?
Antibodies
What is the treatment for C.Diff?
Metronidazole
Beta-1-3 glucan is the component of which organism’s cell wall?
Fungi (chitin)
Tetracyclines treat which propionic bacteria?
Acne
Quinolone is used in patients allergic to what?
Penicillin
What do you give for high risk penumonia?
Co-amoxiclav
Erythromycin
What do you give for low risk pneumonia patients?
Amoxicillin
What is a risk of C.diff?
Co-amoxiclav
Echinocandins, Azoles and Nystatin are part of which antimicrobial family?
Anti-fungal
Antibiotic resistance involves what different stages?
1) Absent target - antibiotics –> viruses
2) Decrease in permeability - vancomycin –> g-ve bacteria
3) Target modification - fluclox –> MRSA
4) Enzymatic degradation - penicillin –> b-lactamases
5) Drug efflux
Praziquentil treats what parasites?
Schistosomiasis
What treats ascariasis?
Albendazole
MIC = ?
minimum inhibiton concentration
- lowest concentration of antibiotics that kill all bacteria
Trichomoniasis is treated by what?
Metronidazole
Metformin treats which ovary disease?
Polycystic ovary disease
Autoantibodies of B cells act directly cytotoxic and activate what system?
Complement
Myasthenia Gravis is due to what?
What is the treatment?
Anti-Ach receptor blocking neuromuscular junctions causing muscle weakness
T: acetylcholine esterase inhibitor
Pernicious anaemia is due to what autoimmune destruction?
What is the result?
Parietal cells and intrinsic factor
B12 deficiency