DPD2: Meeran- Histopathology, Addisons, TB

Question 1

What is the commonest brain tumour?

Answer 1

Mets
from Lung in men
from breast in women

Question 2

What is the most common primary benign and malignant brain tumour?

Answer 2

Benign: Meningioma
Malignant: Glioblastoma

Question 3

In decreasing order, list 4 metabolic states most likely to cause a seizure?

Answer 3

Hypocalcaemia
Hyponatraemia
Hypoglycaemia
Hypokalaemia (more likely arrhythmia)

Question 4

What measurements of 9am serum cortisol determine adrenal failure?

Answer 4

< 100 nmol/L is diagnostic

> 550 nmol/L: adrenal insufficiency unlikely

Question 5

What measurement in a Short Synacthen Testsuggests adrenal failure?

Answer 5

IM 250 mg tetrocosactrin (synthetic ACTH)

Serum cortisol < 550 nmol/L at 30 mins indicates adrenal failure

Question 6

If a biopsy of the adrenals shows multinucleated giant cells and caveating granulomata, what is the diagnosis?

Answer 6

Tuberculosis Addisons disease

Question 7

What are the most common causes of Addisons disease?

Answer 7

UK: AI
Worldwide: TB

Question 8

Name the 4 antibiotics used in treatment of tuberculosis

Answer 8

Rifampicin
Isoniazid
Pyazinamide
Ethambutol

Question 9

Explain the regimen of antibiotic use in TB

Answer 9

4 drugs for 2 months as it takes 2 months to get the culture + sensitivity back
If sensitive to all 4, stop P+E as these have the most SEs (unless sensitivity shows resistance to RI, in which case, may choose 2 others)

Question 10

What drugs are required for treating tuberculosis Addisons?

Answer 10

Prednisolone 5mg OD
Fludrocortisone 100mcg OD
Rifampicin is an enzyme inducer, so high dose pred is necessary

Question 11

Describe pulmonary oedema

Answer 11

Abnormal leakage of fluids into lung interstitium + alveoli
Usually Symmetrical
Causes: LV failure, ARDS, fluid overload, neurogenic

Question 12

What is a pleural effusion?

Answer 12

Fluid in the pleural space
Transudates: increased venous pressure
Exudates: increased leakiness of pulmonary capillaries

Question 13

What causes a transudate pleural effusion?

Answer 13

Cardiac failure
Constrictive pericarditis
Fluid overload
Hypoproteinaemia (Cirrhosis, nephrotic syndrome)

Question 14

What causes a exudate pleural effusion?

Answer 14

High protein
Infection: Pneumonia, TB
Inflammation: RA, SLE
Malignancy: Mesothelioma, Lymphoma

Question 15

What protein concentration defines transudates and exudates?

Answer 15

Transudate: < 25g/L
Exudate: > 35g/L

Question 16

What are the most likely causative organisms of a community acquired pneumonia?

Answer 16

Streptococcus pneumoniae

Haemophilus influenza

Question 17

Describe the appearance of Streptococcus pneumoniae on gram stain

Answer 17

Gram +ve diplococcus
Like “rugby balls” in pairs
Stains purple

Question 18

Describe the appearance of Haemophilus influenza on gram stain

Answer 18

Gram -ve bacilli

Poor uptake of gram stain due to thin peptidoglycan wall

Question 19

What drugs is often used to treat pneumonia?

Answer 19

Amoxicillin

covers the 2 most common causes- strep pneumoniae + haemophilus influenzae