Difficult Past Questions Flashcards
How to monitor activity of SLE
C3 and C4 levels
Biologic in psoriasis
Ustekinemab (also anti-TNF if psoriatic arthritis)
DMARD for Wegener’s
Cyclophosphamide
Biologic for Chronic Granulomatous Disease
IFN-gamma
Non-neutralising antibodies formed against this HIV protein
p24
Deficiency in these complements increases encapsulated organisms
C5-9
Patient involved in trauma and transfused with O negative blood –> he lost consciousness a few minutes after the transfusion
Splenic Haemorrhage (NOT ABO as O-ve!!)
Antithrombin III deficiency
VTE runs in family
Normal Hb with positive sickle solubility test
Sickle trait
Diagnosis of C. diff
Toxin ELISA (not culture)
STI that can cross placenta in 3rd trimester
Syphillis
Bloody discharge from nipple –> mammogram does not show any lesions
Intraductal Papilloma
Thyroid cancer associated with Ret mutation
Medullary
Thyroid cancer associated with calcitonin staining
Medullary
Rate-limiting enzyme in haem synthesis
ALA synthase
Raised calcium and normal PTH
Primary hyperparathyroidism (inappropriately normal PTH!)
Definition of Impaired Glucose Tolerance
7.8 – 11.1mM
Stellate mass with fibrosis
Radial scar
Lump containing epithelium cells
Intraductal papilloma
Gene affected in FAP
APC gene
“Child presenting with a mass in abdomen”
Wilm’s Tumour
What are seen in Haversian lacunae?
Osteocytes
Smoker with raised parathyroid-related polypeptide
Squamous Cell
Investigation for hypotonia and hypoglycaemia in young child
Ketones
Oedema – pic shows red cell casts
Acute glomerulonephritis
Hypoglycaemia in neonates
<2.5
Hypothyroid –> confused/drowsy
Myxoedema coma (too hypothyroid)
Vitamin deficient in Beri Beri
B1
Immune cells which migrate to germinal centre
Dendritic Cells (APCs)
Biologic used in ankylosing spondylitis
Anti-TNF –> anti-IL-17
Cellular-mediated rejection vs GVHD
Cell-mediated = T cells against donor GVHD = T cells against host
Blood product to use if you want to avoid allergic reactions (e.g. donor allergic to proteins)
Washed RBCs = most of plasma, platelets and WBCs removed
Changes in pregnancy
Volume 50% increase
Red cell mass increases
Hb decreases (11 minimum)
WBC increases
Acute Promyelocytic Leukaemia key features (including translocation)
t(15;17)
Responds to all-trans retinoic acid
Gram positive showing increased resistance to vancomycin and teicoplanin
Enterococcus
Cervicitis and discharge
Chlamydia
Normal skin pathogen with low pathogenicity
Staph epidermis
Infection where baby only affected if mum infected <20 weeks (causes hydrops fetalis)
Parvovirus B19
Infection where baby can be asymptomatic initially, but then get problems
Beta herpesvirus (HHV6/7)
Also toxoplasmosis
Also HIV
Cause of aseptic meningitis
90% caused by enterovirus = Coxsackie Group B and Echovirus
Treatment of pseudomonas
Ceftazidime
Glycopeptide used to treat MRSA
Vancomycin
DNA synthesis inhibitor used to treat Pseudomonal infections but bad against anaerobes
Ciprofloxacin
Lady with discharge, no other symptoms, and causative infection found on wet slide microscopy
Bacterial Vaginosis (gardnerella vaginalis)
Positive urinary NAAT test
Chlamydia
Neonatal meningitis, Gram positive chains
Group B streptococcus
Organism targeted by vaccine: virus that resides in pharynx and GIT - 1:100 encephalitis, 1:1000 destruction of motor neurons
Poliovirus
Organism targeted by vaccine: maculopapular rash that starts on face –> can cause encephalitis and pneumonitis
Measles
Organism targeted by vaccine: lockjaw
Clostridium tetani
Mass after acute pancreatitis
Pancreatic pseudocyst
Pancreatic mass and hypoglycaemia
Insulinoma
Pancreatic cancer which metastasises to liver
Tumours in the tail and the body of the pancreas
What deposits in kidneys in Multiple Myeloma?
AL amyloid
Barrett’s changes
Stratified squamous to simple columnar
Radiosensitive testicular cancer in young man
Seminoma
Cancer associated with chronic schisto infection
SCC bladder cancer
Deaf and bowed legs
Paget’s
Post-MI: blood aspirated from pericardium
Cardiac tamponande
Treats lymphoma and rheumatoid
Anti-CD20 (rituximab)
Used to prevent transplant rejection, by blocking T cell proliferation and activation
Anti-CD25 (part of IL-2Rα) = basiliximab
Kill of cancerous cells and are inhibited by MHC-I
NK Cells
Mutation in FAS Pathway
ALPS = Autoimmune Lymphoproliferative Syndrome
-lymphocytes don’t apoptose –> HIGH lymphocytes
Philadelphia chromosome with 70% blasts
AML crisis
Tear drop poikilocytes and Jak2 mutation
Myelofibrosis
Pregnant with platelets 100 in 3rd trimester, no other problems
Gestational thrombocytopenia
INR target in AF
2.5
INR target for treatment of VTE
2.5
INR target in prosthetic heart valve
2.5
INR target in recurrent VTE/VTE whilst on anticoags
3.5
Cause of Pellagra
B3 deficiency –> dementia, diarrhoea, dermatitis
A man after a road traffic accident (Man vs Car) requires a 6 unit transfusion, and then becomes acutely breathless/SOB, with a fever and tachycardia
Transfusion related lung injury (TRALI)
A man has had (a diagnosis of) beta thalassemia since 13 months of age. (?and receives regular transfusions?). He presents to an outpatient clinic with malaise and erectile dysfunction
Transfusion associated haemosiderosis
Immunoglobulin raised in multiple myeloma
IgG paraprotein
Patient with IgM paraprotein and visual disturbances
Lymphoplasmocytic lymphoma (a.k.a. Waldenstrom’s macroglobinaemia).
An overweight individual with diabetes has longstanding bone/back pain. They are found to have paraprotein IgA ~8g/dl, and GFR 55mls/min/1.73m^2. FBC normal and albumin normal.
Monoclonal gammopathy of unknown significance
-as IgA < 30
An elderly gentleman has really really elevated ALP on it’s own, and the other results are normal. He also reports a history of headaches.
Paget’s (headaches = frontal bossing)
Used for mild CAP caused by HiB
Amoxicillin
Treatment of listeria meningitis
Amoxicillin 21 days + gentamycin 7 days
Which type of cancer develops in Barrett’s?oesophagus?
Adenocarcinoma
What happens to the body of the stomach in a patient with pernicious anaemia?
Atrophy (atrophic gastritis)
Most common type of malignancy in the breast
Invasive ductal carcinoma (75% breast cancer)
Most common type of non-invasive breast cancer
DCIS
Breast cancer with E-cadherins
Invasive ductal carcinoma
Breast cancer without E-cadherins
Invasive lobular carcinoma
Breast cancer which has a high, medium and low stage to it.
Ductal carcinoma in situ
Enzyme raised in mumps
Amylase-S (S for salivary glands)
Enzyme raised in pancreatitis
Amylase-P (P for pancreas)
Defiency in this enzyme leads to high urate/Lesch-Nyhan
HGPRT
Best antibody for Sjogren’s
Anti-La (La = “the” best)
A man presents with the symptoms of a UTI and acute onset costovertebral pain. He is found to have pus cells and blood in his urine. What is the most likely cause?
Acute Pyelonephritis
Most common cause of thrombocytopenia in pregnancy
Gestational thrombocytopenia (70% of thrombocytopenias in pregnancy)
Normal change in pregnancy
Increased fibrinogen
Man, ex-smoker, with history of hypertension and MI, has sudden chest pain which radiates to the neck
Descending internal carotid thrombus
Gram positive rod causing meningitis in a 72 year old
Listeria monocytogenes
What cancer can the Bruton tyrosine kinase inhibitor ibrutinib be used in?
Chronic lymphoblastic leukaemia (CLL)
-imatinib is used in CML!
A Rhesus D negative woman is having a Haematopoietic stem cell transplant (HSCT) and is CMV IgG negative. What is the most important thing to ensure in the transplant?
CMV IgG negative
HIV RNA forms HIV, via which error prone enzyme?
Reverse transcriptase
Which of these vaccines must not be given to a pregnant woman:
a. MMR
b. Hep B
c. DTP
MMR (as contains live Rubella virus)
Cancer cells express TdT
ALL (this trumps genetic tests i.e. t9;22 and TdT = ALL!)
Which of these is a common finding in someone who has portal hypertension?
a. Splenomegaly
b. Hepatomegaly
c. Spider Naevi in distribution of Superior vena cava (SVC)
d. Hand flapping
e. Jaundice
Splenomegaly
Itchiness of the skin is likely to be a feature of one of the following?
a. Hepatitis
b. intravascular haemolysis
Hepatitis
The wall of vessels expresses anti-thrombotic factors why is this?
a. Because it secretes Tissue factor
b. Because it secrete Thrombomodulin
c. Because it secretes Von Willebrand factor
Thrombomodulin (cofactor in the thrombin-induced activation of protein C in the anticoagulant pathway)
Which vector transmits Trypanosoma brucei rhodesiense?
Tsetse Fly
Which vector transmits Leishmaniasis?
Sandfly
What does the number of True positives divided by the total number who have the disease describe?
Sensitivity
Which of these can cause peri/neonatal illness without causing damage to the foetus if the mother is infected antenatal?
a. Cytomegalovirus (CMV)
b. Herpes Simplex Virus (HSV)
c. Enterovirus
d. Varicella Zoster Virus (VZV)
e. Rubella
Enterovirus
Most common cause of HAP
Pseudomonas
Which feature is characteristic of acute lymphoblastic anaemia (ALL) –
a. anaemia and thrombocytopenia
b. neutropenia
c. macrocytosis
d. raised lymphocytes
Neutropenia (CLL = granulocytopenia)
Name an infectious microorganism which is a common cause of meningitis in 3 months or older new-borns?
Neisseria (or strep)
Hyperthyroid - good uptake vs poor uptake
Good uptake = Graves
Poor uptake = De Quervain’s
An elderly man has a fall, and doesn’t become unconscious/lose consciousness, and presents two days later with a confusion, where is the likely site of bleeding?
Subdural (not extradural as should have loss of conscious –> lucid –> EXTRA loss of conscious)
Person who had negative direct coombs test but who has anaemia and jaundice
Paroxysmal nocturnal hemoglobinuria, MAHA, drugs
Which clotting factor falls most rapidly after administering warfarin?
Factor VII (shortest half-life, then Protein C)
Biomarker in medullary thyroid cancer
Calcitonin
A patient required an aortic valve replaced 3 months ago. They have now come back a few weeks later with jaundice, haemoglobinuria, and raised reticulocytes.
Mechanical Haemolytic Anaemia (non-immune)
Which common condition can be treated with drugs that target with TNF, IL-17 and IL-12/23?
Psoriasis
Which vasculitis cases a disease in which a branch of the external carotid is affected?
Giant Cell Arteritis (affects big vessels, like aorta)
Type of amyloidosis in multiple myeloma
AL amyloidosis
Name the main class of drug used to treat HIV
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
What zoonotic disease does the Ixodes Tick cause?
Lyme disease
Breast cancer also known as “no specific type”
Invasive ductal carcinoma
Treatment of hyperviscosity in myeloma
Plasmapheresis
Treatment of hypercalcaemia in myeloma
Bisphosphonates
How to monitor unfractionated heparin
APTT
How to monitor LMWH
None needed! (as reliable pharmacokinetics)
Soldier returning from Afghanistan has a small ulcer on right ring finger that won’t heal and keeps getting bigger
Cutaneous Leishmaniasis
“Snail-trail” oral ulcer
Treponema pallidum (syphilis)
Infection with abdo pain and headache but specifically NO diarrhoea
Salmonella typhi
Disease that requires rapid vaccination at birth/immunoglobulins if mother is highly infectious.
Hepatitis B
• Disease that require C-section if mother has an outbreak at 34wks or later due to risk of transmission vaginally
Genital Herpes Simplex (greatest risk is within 6 weeks of delivery)
Immunodeficiency with common gamma chain problem
X-linked SCID
Traveller’s Diarrhoea (full name, not abbreviated)
Enterotoxigenic E. coli
Enzyme responsible for gout
Xanthine Oxidase
Most common virus causing aseptic meningitis?
Enterovirus
15yo child with brain tumour extending outwards from cerebellum and invading subarachnoid space. Signs of ataxia.
Medulloblastoma
Publican with diabetes, fatty stools, weight loss, ‘slate grey skin’ and joint pains.
Haemachromatosis
What is the minimum amount of time to treat a VTE?
3 months
Enzyme confirms heart failure
Brain Natriuretic Peptide
Liver enzyme raised in MI
Aspartate aminotransferase
Lady with Multiple myeloma and restrictive cardiomyopathy. What will you see on heart biopsy?
AL amyloid deposition
Previous IVDU man is given Rituximab - CHOP treatment for Non-Hodgkin’s lymphoma. He later 8 months later develops fulminant liver failure and dies. Why?
Hep B reactivation from Rituximab +/- Hep D co-infection
White things on the oesophagus seen in OGD of an alcoholic man with recurrent bleeding varices.
Candidiasis
Lady who went to Mexico and ate unpasteurized dairy. 4 weeks later unwell. Which gram -ve rod caused this?
Brucella (long incubation period)
IBD with aphtous ulcers
Crohn’s
Non-Tuberculous mycobacterium on cut on hand in a man who cleaned a fish tank
Mycobacterium marinum
Test to determine cause of haemolytic anaemia
Direct Antiglobulin Test
Types of oesophageal cancer
Developed: adenocarcinoma
Developing: SCC
Most common gastric cancer type
Adenocarcinoma (90%)
Treatment for CLL with p53 mutation
Ibrutinib Bruton TKI
MAHA - DAT +ve or -ve?
-ve
Electrolyte raised in red cell lysis (Na, K, Ca, bicarb…)
Potassium
What is low during pregnancy? • Fibrinogen • Factor 7 (or 8?) • Protein S • Plasminogen activator inhibitor 1 • Von willebrand’s factor
Protein S (anticoagulant)
How does a melanoma spread? • Lymphoid • Haematological • Perineural • Iatrogenic • Transcoelomic
Lymphoid first usually
Man has just been started on allopurinol and now has ulcers of mucus membranes
Stevens-Johnsons Syndrome
Enlarging fibroepithelial mass in woman >50, potentially aggressive, can arise with pre existing fibroadenoma
o ‘Proliferation of fibroepithelium and stromal tissue’
Phyllodes Tumour
Bowel polyps not associated with increased cancer risk
Hamartomatous
“Optic nerve tumour excised and now lump on hand”
Neurofibromatosis 1 (lump = neurofibroma)
“Epileptic with patch on back and lumps in brain”
Tuberous Sclerosis
“Mass under dura mater compressing frontal lobe”
Meningioma
“Ship worker with pleural plaques”
Asbestosis
Causes Meig’s syndrome
Ovarian Fibroma
“Thalassaemia patient who looks tanned and has diabetes”
Transfusion haemosiderosis
Rheumatoid arthritis patient with mycobacterial infections
TNF antagonists
Marker of antibody mediated rejection
C4d
AIRE mutation
APS1/APECED
Hypersensitivity type in serum sickness
Type III
Hypersensitivity type in atopic dermatitis
Type I
Travel vaccine not given to someone with ank spond on anti-TNF
Yellow Fever
Amantadine targets this
M2 channel
What vaccine type is Hep B?
Conjugate
