Last Minute Flashcards
Ankylosing Spondylitis Monoclonal
Etanercept
TNF-alpha inhibitor
Psoriasis Monoclonal
Ustekinumab
IL-12/IL-23
anti-‐proteinase 3
Wegner’s
Granulomatosis with polyangiitis
Felty’s
Rheumatoid arthritis + hepatosplenomegaly –> Neutropenia
How to monitor the activity of SLE?
C3
C4
Anti-dsDNA
Antibody useful to diagnose someone with systemic sclerosis?
Anti-Scl-70
Tocilizumab
Rheumatoid Arthritis
IL-6R
Denosumab
Osteoporosis
RANKL
IFN-gamma
Chronic granulomatous disease
Treating Wegner’s
Cyclophosphamide
Treatment of hereditary angioedema
IV C1 inhibitor
Treatment of oral allergy syndrome
Wash out mouth
oral antihistamines
Utricaria
H1-antagonist.
Neutralizing antibody in HIV
gp120
NON-Neutralizing antibody in HIV
p24
Co-receptor for entry of HIV
CCR5
Enzyme targeted by HIV treatment
protease
reverse transcriptase
C7 complement deficiency
Meningitis
CD40L deficiency
Hyper IgM syndrome
Asplenic patient vaccines
Pneumovax
Vaccine against viral haemagglutinin
Influenza
Yellow fever, MMR and BCG
Live vaccines
Avoid in immunocomprimised
Live Vaccines
Small Yellow Typhoid Chicken BOY MMR
Smallpox
Yellow fever
Typhoid
Chickenpox
BCG
Oral polio
Yellow fever
MMR
Patient gets recurrent infections with negative NBT and dihdrorrhadamine tests
Chronic granulomatous disease
Atypical granulomatous infection in previously healthy patien
IFN-y receptor deficiency
Serum sickness
Type III
Eczema
Type I
vaccinia
Small pox vaccine
Treatment of temporal arteritis
prednisolone
Azathioprine resistant Crohn’s
Anti-TNF alpha (Infliximab)
Cytokine responsible for promoting antibody synthesis
Ig4?
Promoting eosinophil growth
IL-5
AIRE gene causes
Auto-immune polyendocrine syndrome type 1 (APS1)
Auto-immune polyendocrinopathy-candidiasis-ectodermal dystrophy syndrome / APECED
Antibodies vs parathyroid and adrenal glands Hypoparathyroidism and Addison’s
Antibodies vs IL17 and IL22
Candidiasis
HIV: Uses this receptor on the cell wall to facilitate entry
gp120
b. What travel vaccine don’t you give to a person who has ankylosing spondylitis and on TNF alpha inhibitor?
Yellow fever
What vaccine do you give to girls at 12-13y?
HPV
Vaccine you give every 5 years for splenectomised patients
Pneumococcal (Pneumovax)
What is in the routine immunization programme but not given to immunocompromised children?
MMR
Ground glass appearance
PCP
Guy has urethritis, arthritis and eye problems
Reiter’s syndrome
Gram positive that gives LUT symptoms in women
Staphylococcus Saprophyticuss
Gram neg rod UTI
E.Coli
Flagellate protozoan that can cross placenta
Toxoplasmosis
STI that can cross placenta in third trimester
Syphilis
Squamous cells on microscopy
=Contamination of sample
Coliform organisms
Nitrites
Stone associated infetcion
Proteus
Struvite stones
Gas gangrene
Clostridium perfringens
Urine antigen detection
Legionella
Rust coloured sputum
Strep pneumonia
HIV: Enzyme that copies with errors
Reverse transcriptase
What is the chemokine that inhibits HIV entry into cells
Aminooxypentane (AOP)-MIP-1α
Molluscum contagiosum
pox virus
Kaposi’s sarcoma
HHV8
gram positive rod
Listeria
N. meningitis
gram negative cocci
Smoker – gram positive cocci
Strep pneumonia
Meningitis, normal glucose, raised lymphocytes, slightly raised protein
Herpes
neonatorum ophthalmia
Chlamydia trachomatis
What causes hemorrhagic cystitis in kids
Adenovirus
Mum had skin infection with a son with a sore throat
Strep pyogenes
Guy came back from afganistan with ulcer on his ring finger
cutaneous leishmaniasis
Kid had red erythemous, oedematous rash, first on face and crosses the nasal bridge and spread really quickly –
N.Meningitis
Livery cyst
antamoeba histolytica
Angular stomatitis
Folate deficiency /B12
You suspect Acute Intermittent Porphyria. What test?
Urine PBG
Jaundiced baby no dysmorphic features
Urine amino acids
hypoglycaemic neonate
Urine reducing substances
Wet Beri Beri
Pulmonary oedema
Dry Beri Beri
Neurological symptoms
Bicarb in pyloric stenosis
High
> 30
Woman with hypothyroidism, T1DM, adrenal failure
Polyendocrinopathy
–> B12 def (pernicious anaemia)
Enzymes - rate-limiting enzyme in haem synthesis?
ALA synthase
first enzyme
Deficiency leads to high urate
HGPRT
Leysch-Nyhan syndrome
How to diagnose B Thal trait
Raised HbA2
Raised amylase
Mumps
Impaired glucose tolerance
- 1-6.9 FASTING
7. 8-11.0 OGTT 2 hours
Diabetes cut-off
> 7.0 Fasting
> 11.1 OGTT 2 hours
HbA1c > 6.5% (48mmol/mol)
One that causes hepatic cirrhosis and portal hypertension in some and cardiomyopathy in others?
Haemochromatosis
CAH
Hyperkalaemia
+ salt losing crisis
Adult T-‐cell lymphoma
JC virus
INR Someone with AF?
2.0-3.0
INR: Someone with a prosthetic valve.
3.0-4.0
Monitoring: Someone on unfractionated heparin.
APTT
Normal Hb - positive sickle solubility test
Sickle trait
Low Hb - positive sickle test
Sickle cell disease
polychromasia and spherocytes
Hereditary spherocytosis
Raised ESR
Temporal arteritis
Thalassaemia patient looks tanned and has diabetes
Transfusion haemosiderosis
Patient has prolonged APTT, normal PT and normal bleeding time
Haemophilia A
Patient has menorrhagia, prolonged APTT, normal PT and prolonged bleeding time. Her mother had similar problems
vWF
Elderly Patient is asymptomatic and has generalised lymphadenopathy, with abnormal bloods
CLL
Elderly patient presents with MASSIVE splenomegaly with low platelets, red cells and normal white cells
Myelofibrosis
Pelger Huet cells, hyposegmented neutrophil
Myelodyplastic syndrome
Breast Mass. Aspirated. Brown ‘fluid’
Galactocele
Halo-sign on x-ray
Aspergillosis
CD19+
CD5+
B cells
CLL
Ritcher’s transformation
CLL
Hairy cell
—> DLBC
Smear Cells
CLL
CD5+
CLL
Or could be a mantle cell lymphoma!
Binet staging
CLL
Stage 1 <3 lymph nodes
Stage 2 >3 lymph nodes
Stage 3 >3 lymph nodes Hb<100
Protein C
Inactivates VIIa and V
Antithrombin III
Inactivates thrombin
Inactivates IX, X and XI
Tissue factor pathway inhibitor
Inhibits factor Xa and TF:VIIa complex
When the integrity of the BBB is disrupted the resultant oedema is described as
Vasogenic Oedema
Which of the following types of herniation do not involve cortex?
Tonsillar
What percentage of patents who experience a TIA will get a significant infarct within 5 years?
33%
What is the most common cause of non-traumatic intraparenchymal haemorrhages?
Hypertension
Krukenberg tumours
Secondary ovarian tumour
Bilateral metastases composed of mucin producing signet ring cells
most often of gastric origin or breast
HNPCC associated ovarian tumour
Mucinous
BRCA associated ovarian tumour
Serous cystadenocarcinoma
Most common ovarian cancer
Serous cystadenocarcinoma
Type I Ovarian Tumours
Low grade, relatively indolent, arise from well characterised precursors (BOT) and endometriosis
Usually present as large stage I tumours
Mutations in K-ras, BRAF, PI3KCA and HER2, PTEN and beta–catenin
Usually have precursors
Include low grade serous, low grade endometrioid, mucinous and tentatively CCC.
Type II Ovarian Tumours
High grade mostly of serous type
Aggressive
More than 75% have p53 mutations
No precursor lesions
Type I Endometrial Cancer
Type I: 80-85%
Endometrioid, mucinous and secretory adenocarcinomas
Younger age
Are oestrogen dependent
Often associated with atypical endometrial hyperplasia
Low grade tumours, superficially invasive
Type II Endometrial Cancer
Type II: 10-15%
Serous and clear cell carcinomas Older, postmenopausal Less oestrogen dependent Arise in atrophic endometrium High grade, deeper invasion, higher stage
Most common endometrial cancer
adenocarcinomas
C2 breast
Benign
C5 breast
Malignant
Dilated ducts
Periductal inflammation
Filled with secretions
Duct ectasia
Benign
Neutrophils (trinucleate cells)
Acute inflammation
+/- abscess
Mastitis
Degenerative fat
Foamy macrophages
Giant cells
Fat necrosis
Later fibrosis and calcification
Apocrine metaplasia
Adenosis
Epithelial and stromal hyperplasia
Fibrocytsic change
Overlapping cells
Excess glandular and stromal proliferation
Leaf-like fonds
Phyllodes tumour
Benign
Branching papillary groups
Papillary mass within duct lined by epithelium
Fibrovascular core
Intraductal papilloma
Benign
Central zone of scarring
Radiating zone of proliferating glandular tissue
Stellate mass
Radial scar
Benign
Ducts filled with atypical epithelial cells
DCIS
Infiltrating atypical epithelial cells
Invasive breast carcinoma
Most common breast cancer
Invasive ductal
Cancer staged into low grade, intermediate, high grade
DCIS
Proliferation of fibroepithelium and stromal tissue
phylloides tumour
Loss of E.cadherin
LCIS
HR PR negative
High grade DCIS
Rheumatic valvular disease
Mitral valve
Condition caused by a genetic defect in myofilament formation leading to large myocytes
Hypertrophic cardiomyopathy
Conditions caused by progressive loss of myocytes
Dilated heart failure
Condition of structural calcification causing onset of a murmur late in life
Aortic stenosis
35 yr old male presented with a 1 week history of hoarse voice, cough, headache and mild fever. His symptoms were getting worse and he was finding it harder to breathe. He also developed sinus pain.
Strep Pneumonia
A 75 year old male non-smoker presented with a cough productive of sputum and fever. He was short of breath and felt a ‘catching’ chest pain upon breathing in. Chest X-ray showed consolidation in the right lower lobe.
Strep pneumonia
An otherwise healthy 25 year old female complained of ‘flu like’ symptoms following return from Mexico. She had a headache, weakness and joint pains and had developed a dry cough. Tests detected the presence of cold agglutins.
Mycoplasma pneumonia
- 25 year HIV positive man presented with a 2 week history of a bloody cough and night sweats. He had lost weight and had a fever. 3 weeks ago he had travelled to Africa to visit family. Chest xray revealed hilar lymphadenopathy and left sided upper lobe shadowing.
TB
A 45 year old business man was previously well. One week after staying in a hotel he developed diarrhoea, nausea and weakness. He had a headache and on examination was confused and pyrexial. Tests revealed lymphopaenia and hyponatraemia.
Legionella
A 69yr old male smoker is rushed into hospital complaining of severe breathlessness when walking upstairs. He is tachycardic with a reduced pulse volume and you also note that his ankles are considerably swollen.
Cardiac failure
A 26yr old known I.V. drug user presents with fever, weakness, lassitude and night sweats. On examination you discover a heart murmur
Staph Aureus
A 7yr old girl complains of a rash on her chest and painful joints. On further questioning you discover she had recovered from a sore throat a fortnight ago
Rheumatic fever
A young fit 22yr old is rushed into A&E after complaining of a severe chest pain and breathlessness. A loud fourth heart sound is heard.
Hypertrophic cardiomyopathy
A 55yr old male presents to A&E with a sharp centralised chest pain which is relieved by sitting forwards. A pericardial rub is heard at the left sternal edge.
Pericarditis
A gram positive bacillus that produces alpha-toxin causing gas gangrene in infected wounds
Clostridium perfringens
A man punches someone in a pub brawl. The recipient then bites his hand. Later the bite wound becomes infected, with lots of pus and a foul smell. The most likely pathogen is?
Anaerobes
A gram positive B haemolytic coccus that can cause pharyngitis, erysipelas and cellulitis.
Strep pyogenes
A 65yr old male is found to have an Hb of 19g/dl on a routine blood test, EPO levels were normal. On examination he is found to have splenomegaly and engorgement of the retinal vein. Bone marrow histology showed increased cellularity of erythroid cells. What is the most likely diagnosis?
Polycythaemia rubra vera
A 30yr old female was found to have platelets>600x109/L on 3 separate occasions. Her CRP and ESR were within the normal range. She suffered a DVT 3 months ago. What is the likely diagnosis?
Essential thrombocythemia
Which drug aids in the reduction of platelet number and can cause palpitations and flushing?
Anagrolide
A peripheral blood film of a patient with polycythaemia vera shows a leucoerythroblastic picture with tear drop poikilocytes. What is the likely diagnosis?
Myelofibrosis
Imatinib can be used in the treatment for which leukaemia?
Chronic granulocytic leukaemia
What is the correct pathological term for a discontinuation in the epithelial surface?
ULCER
A 65 year old male with a long history of epigastric pain. Endoscopy reveals 3.2cm of columnar metaplasia in the lower oesophagus. What does this suggest?
Barrett’s oesophagus.
What is the technical term for a connection between two epithelial surfaces, as occurs in Crohns disease where for example there might be a connection between the bladder and the bowel?
Fistula
A 46-year old Japanese female is found to have bilateral ovarian masses on imaging of the abdomen and had both ovaries removed. Histology revealed malignant signet ring cells containing mucin in both ovaries. What is the diagnosis?
Krukenberg tumour
A 50 year-old female was found to have an ovarian mass. On its removal, histology revealed several cell types, including thyroid follicles, hair and teeth. What is the likely diagnosis?
Dermoid cyst or Cystic Teratoma
A 40 year-old female non-smoker presents with a one week history of fever, shortness of breath and a cough productive of rusty coloured sputum. Microscopy of the sputum is shown (Gram positive diplococci). What is the organism?
Streptococcus pneumoniae
A 37 year-old man presents with a headache, myalgia and a cough. He is also suffering with nausea, diarrhoea and abdominal pain. On examination he is tachypnoeic and has a pyrexia of 39ºC. Blood tests reveal lymphopenia and hyponatraemia. A gram stain from the patients sputum is shown here (Gram negative rods). CXR shows lobar consolidation. Cold agglutinins are negative. What is the organism?
Legionnaires disease or Legionella Pneumophila
A 40 year-old woman presents with malaise, muscular pains and diarrhoea with mucus and blood. On examination she has a fever and several distinctive spots on her abdomen (Rose spots). Blood cultures are positive and grow gram negative rods. What is the likely organism?
Salmonella Typhae or Typhoid fever.
genus of spiral flagellated Gram negative bacteria. Found in the stomach within the mucosa layer. It occurs in the majority of middle-aged people and causes progressive gastritis. Invariably present in duodenal ulceration and usually in gastric ulceration. What is the organism?
Helicobacter pylori.
A 4 year old girl presents to the A&E with a recurrent chest infection that will not clear. On examination, the house officer notices that she has low set ears, a cleft palate and a murmur. Investigations reveal:
Calcium 1.9 mM (NR 2.2 to 2.6);
Phosphate 1.4 mM (NR 0.8 to 1.4)
PTH 1.1 pM (NR 1.1 to 6.8)
What is the likely diagnosis?
Di George syndrome or 22q11.2 deletion syndrome.
A 40-year old lady complains of tight fingers and dysphagia, and is thought to have a syndrome associated with Raynaud’s phenomenon, and telangiectasia. What antibody should we measure to confirm this possible diagnosis?
Anti-centromere
Name the drug used for patients with type 2 diabetes which inhibits the enzyme alpha glucosidase in the brush border membrane of the small bowel.
Acarbose
Name an example of a drug that inhibits the enzyme dipeptidyl dipeptidase IV (DPP-4).
Gliptins such as alogliptin or sitagliptin
A patient presents with weakness and is found to have a potassium of 2.4mM (NR 3.5 to 5.0). What is the likely acid-base abnormality if you check the patients arterial blood gas?
Metabolic acidosis
A 67-year-old woman presented with confusion 2 days after a cholecystectomy. She had experienced some pain postoperatively, largely relieved by analgesia.
SIADH
A 51-year old man is having investigations for palliative surgery due to gastric adenocarcinoma. He is found to be anaemic, with high a reticulocyte count and fragmented red blood cells on blood smear. What is this anaemia known as?
MAHA
In a patient with Hodgkins Lymphoma, the stage of disease is given by the amount of spread, with stage 1 disease involving only one group of nodes, and stage IV disease involving extra nodal spread. What would stage III Hodgkins disease suggest?
Disease above AND below the diaphragm.
A 56 year-old male presents with fever, vomiting and seizures. Examination reveals a well- established ear infection and there is a ‘ring-enhancing’ lesion on the MRI of his brain.
Brain abscess
A 27 year old patient has a knee effusion drained. The gram stain reveals Gram negative intracellular diplococci. What is the likely organism?
Neisseria gonorrhoeae
A 40 year old man presents with weight loss, muscle aches and abdominal pain. On examination he has high BP and urine dipstick reveals blood + and protein +. The patient is thought to have a vasculitis and is p-ANCA positive.
Eosinophilic Granulomatosis with Polyangiitis. (EGPA)
A patient presents with haemoptysis and haematuria. She is thought to have Goodpastures syndrome. What antibody should you look for?
Anti glomerular basement membrane.
A four-year-old boy presents with a purpuric rash across the legs and buttocks. Two weeks previously you had seen the child about a chest infection. Further examination reveals abdominal pain and haematuria. Serum IgA levels are raised. What is the likely diagnosis?
Henoch Schonlein purpura
A patient is found to have a positive Coombes (anti-globulin) test. What is the likely diagnosis?
Auto-immune haemolytic anaemia
Etanercept
TNF-alpha inhibitor
Ankylosing Spondylitis Monoclonal
Ustekinumab
IL-12/IL-23
Psoriasis Monoclonal
Wegner’s
Granulomatosis with polyangiitis
anti-‐proteinase 3
Rheumatoid arthritis + hepatosplenomegaly –> Neutropenia
Felty’s
C3
C4
Anti-dsDNA
How to monitor the activity of SLE?
Anti-Scl-70
Antibody useful to diagnose someone with systemic sclerosis?
Rheumatoid Arthritis
IL-6R
Tocilizumab
Osteoporosis
RANKL
Denosumab
Chronic granulomatous disease
IFN-gamma
Cyclophosphamide
Treating Wegner’s
IV C1 inhibitor
Treatment of hereditary angioedema
Wash out mouth
oral antihistamines
Treatment of oral allergy syndrome
H1-antagonist.
Utricaria
gp120
Neutralizing antibody in HIV
p24
NON-Neutralizing antibody in HIV
CCR5
Co-receptor for entry of HIV
protease
reverse transcriptase
Enzyme targeted by HIV treatment
Meningitis
C7 complement deficiency
Hyper IgM syndrome
CD40L deficiency
Pneumovax
Asplenic patient vaccines
Influenza
Vaccine against viral haemagglutinin
Live vaccines
Avoid in immunocomprimised
Yellow fever, MMR and BCG
Small Yellow Typhoid Chicken BOY MMR
Smallpox
Yellow fever
Typhoid
Chickenpox
BCG
Oral polio
Yellow fever
MMR
Live Vaccines
Chronic granulomatous disease
Patient gets recurrent infections with negative NBT and dihdrorrhadamine tests
IFN-y receptor deficiency
Atypical granulomatous infection in previously healthy patien
Type III
Serum sickness
Type I
Eczema
Small pox vaccine
vaccinia
prednisolone
Treatment of temporal arteritis
Anti-TNF alpha (Infliximab)
Azathioprine resistant Crohn’s
Ig4?
Cytokine responsible for promoting antibody synthesis
IL-5
Promoting eosinophil growth
Auto-immune polyendocrine syndrome type 1 (APS1)
Auto-immune polyendocrinopathy-candidiasis-ectodermal dystrophy syndrome / APECED
Antibodies vs parathyroid and adrenal glands Hypoparathyroidism and Addison’s
Antibodies vs IL17 and IL22
Candidiasis
AIRE gene causes
gp120
HIV: Uses this receptor on the cell wall to facilitate entry
Yellow fever
b. What travel vaccine don’t you give to a person who has ankylosing spondylitis and on TNF alpha inhibitor?
HPV
What vaccine do you give to girls at 12-13y?
Pneumococcal (Pneumovax)
Vaccine you give every 5 years for splenectomised patients
MMR
What is in the routine immunization programme but not given to immunocompromised children?
PCP
Ground glass appearance
Reiter’s syndrome
Guy has urethritis, arthritis and eye problems
Staphylococcus Saprophyticuss
Gram positive that gives LUT symptoms in women
E.Coli
Gram neg rod UTI
Toxoplasmosis
Flagellate protozoan that can cross placenta
Syphilis
STI that can cross placenta in third trimester
=Contamination of sample
Squamous cells on microscopy
Nitrites
Coliform organisms
Proteus
Struvite stones
Stone associated infetcion
Clostridium perfringens
Gas gangrene
Legionella
Urine antigen detection
Strep pneumonia
Rust coloured sputum
Reverse transcriptase
HIV: Enzyme that copies with errors
Aminooxypentane (AOP)-MIP-1α
What is the chemokine that inhibits HIV entry into cells
pox virus
Molluscum contagiosum
HHV8
Kaposi’s sarcoma
Listeria
gram positive rod
gram negative cocci
N. meningitis
Strep pneumonia
Smoker – gram positive cocci
Herpes
Meningitis, normal glucose, raised lymphocytes, slightly raised protein
Chlamydia trachomatis
neonatorum ophthalmia
Adenovirus
What causes hemorrhagic cystitis in kids
Strep pyogenes
Mum had skin infection with a son with a sore throat
cutaneous leishmaniasis
Guy came back from afganistan with ulcer on his ring finger
N.Meningitis
Kid had red erythemous, oedematous rash, first on face and crosses the nasal bridge and spread really quickly –
antamoeba histolytica
Livery cyst
Folate deficiency /B12
Angular stomatitis
Urine PBG
You suspect Acute Intermittent Porphyria. What test?
Urine amino acids
Jaundiced baby no dysmorphic features
Urine reducing substances
hypoglycaemic neonate
Pulmonary oedema
Wet Beri Beri
Neurological symptoms
Dry Beri Beri
High
> 30
Bicarb in pyloric stenosis
Polyendocrinopathy
–> B12 def (pernicious anaemia)
Woman with hypothyroidism, T1DM, adrenal failure
ALA synthase
first enzyme
Enzymes - rate-limiting enzyme in haem synthesis?
HGPRT
Leysch-Nyhan syndrome
Deficiency leads to high urate
Raised HbA2
How to diagnose B Thal trait
Mumps
Raised amylase
- 1-6.9 FASTING
7. 8-11.0 OGTT 2 hours
Impaired glucose tolerance
> 7.0 Fasting
> 11.1 OGTT 2 hours
HbA1c > 6.5% (48mmol/mol)
Diabetes cut-off
Haemochromatosis
One that causes hepatic cirrhosis and portal hypertension in some and cardiomyopathy in others?
Hyperkalaemia
+ salt losing crisis
CAH
JC virus
Adult T-‐cell lymphoma
2.0-3.0
INR Someone with AF?
3.0-4.0
INR: Someone with a prosthetic valve.
APTT
Monitoring: Someone on unfractionated heparin.
Sickle trait
Normal Hb - positive sickle solubility test
Sickle cell disease
Low Hb - positive sickle test
Hereditary spherocytosis
polychromasia and spherocytes
Temporal arteritis
Raised ESR
Transfusion haemosiderosis
Thalassaemia patient looks tanned and has diabetes
Haemophilia A
Patient has prolonged APTT, normal PT and normal bleeding time
vWF
Patient has menorrhagia, prolonged APTT, normal PT and prolonged bleeding time. Her mother had similar problems
CLL
Elderly Patient is asymptomatic and has generalised lymphadenopathy, with abnormal bloods
Myelofibrosis
Elderly patient presents with MASSIVE splenomegaly with low platelets, red cells and normal white cells
Myelodyplastic syndrome
Pelger Huet cells, hyposegmented neutrophil
Galactocele
Breast Mass. Aspirated. Brown ‘fluid’
Aspergillosis
Halo-sign on x-ray
CLL
CD19+
CD5+
B cells
CLL
Hairy cell
—> DLBC
Ritcher’s transformation
CLL
Smear Cells
CLL
Or could be a mantle cell lymphoma!
CD5+
CLL
Stage 1 <3 lymph nodes
Stage 2 >3 lymph nodes
Stage 3 >3 lymph nodes Hb<100
Binet staging
Inactivates VIIa and V
Protein C
Inactivates thrombin
Inactivates IX, X and XI
Antithrombin III
Inhibits factor Xa and TF:VIIa complex
Tissue factor pathway inhibitor
Vasogenic Oedema
When the integrity of the BBB is disrupted the resultant oedema is described as
Tonsillar
Which of the following types of herniation do not involve cortex?
33%
What percentage of patents who experience a TIA will get a significant infarct within 5 years?
Hypertension
What is the most common cause of non-traumatic intraparenchymal haemorrhages?
Secondary ovarian tumour
Bilateral metastases composed of mucin producing signet ring cells
most often of gastric origin or breast
Krukenberg tumours
Mucinous
HNPCC associated ovarian tumour
Serous cystadenocarcinoma
BRCA associated ovarian tumour
Serous cystadenocarcinoma
Most common ovarian cancer
Low grade, relatively indolent, arise from well characterised precursors (BOT) and endometriosis
Usually present as large stage I tumours
Mutations in K-ras, BRAF, PI3KCA and HER2, PTEN and beta–catenin
Usually have precursors
Include low grade serous, low grade endometrioid, mucinous and tentatively CCC.
Type I Ovarian Tumours
High grade mostly of serous type
Aggressive
More than 75% have p53 mutations
No precursor lesions
Type II Ovarian Tumours
Type I: 80-85%
Endometrioid, mucinous and secretory adenocarcinomas
Younger age
Are oestrogen dependent
Often associated with atypical endometrial hyperplasia
Low grade tumours, superficially invasive
Type I Endometrial Cancer
Type II: 10-15%
Serous and clear cell carcinomas Older, postmenopausal Less oestrogen dependent Arise in atrophic endometrium High grade, deeper invasion, higher stage
Type II Endometrial Cancer
adenocarcinomas
Most common endometrial cancer
Benign
C2 breast
Malignant
C5 breast
Duct ectasia
Benign
Dilated ducts
Periductal inflammation
Filled with secretions
Mastitis
Neutrophils (trinucleate cells)
Acute inflammation
+/- abscess
Fat necrosis
Later fibrosis and calcification
Degenerative fat
Foamy macrophages
Giant cells
Fibrocytsic change
Apocrine metaplasia
Adenosis
Epithelial and stromal hyperplasia
Phyllodes tumour
Benign
Overlapping cells
Excess glandular and stromal proliferation
Leaf-like fonds
Intraductal papilloma
Benign
Branching papillary groups
Papillary mass within duct lined by epithelium
Fibrovascular core
Radial scar
Benign
Central zone of scarring
Radiating zone of proliferating glandular tissue
Stellate mass
DCIS
Ducts filled with atypical epithelial cells
Invasive breast carcinoma
Infiltrating atypical epithelial cells
Invasive ductal
Most common breast cancer
DCIS
Cancer staged into low grade, intermediate, high grade
phylloides tumour
Proliferation of fibroepithelium and stromal tissue
LCIS
Loss of E.cadherin
High grade DCIS
HR PR negative
Mitral valve
Rheumatic valvular disease
Hypertrophic cardiomyopathy
Condition caused by a genetic defect in myofilament formation leading to large myocytes
Dilated heart failure
Conditions caused by progressive loss of myocytes
Aortic stenosis
Condition of structural calcification causing onset of a murmur late in life
Strep Pneumonia
35 yr old male presented with a 1 week history of hoarse voice, cough, headache and mild fever. His symptoms were getting worse and he was finding it harder to breathe. He also developed sinus pain.
Strep pneumonia
A 75 year old male non-smoker presented with a cough productive of sputum and fever. He was short of breath and felt a ‘catching’ chest pain upon breathing in. Chest X-ray showed consolidation in the right lower lobe.
Mycoplasma pneumonia
An otherwise healthy 25 year old female complained of ‘flu like’ symptoms following return from Mexico. She had a headache, weakness and joint pains and had developed a dry cough. Tests detected the presence of cold agglutins.
TB
- 25 year HIV positive man presented with a 2 week history of a bloody cough and night sweats. He had lost weight and had a fever. 3 weeks ago he had travelled to Africa to visit family. Chest xray revealed hilar lymphadenopathy and left sided upper lobe shadowing.
Legionella
A 45 year old business man was previously well. One week after staying in a hotel he developed diarrhoea, nausea and weakness. He had a headache and on examination was confused and pyrexial. Tests revealed lymphopaenia and hyponatraemia.
Cardiac failure
A 69yr old male smoker is rushed into hospital complaining of severe breathlessness when walking upstairs. He is tachycardic with a reduced pulse volume and you also note that his ankles are considerably swollen.
Staph Aureus
A 26yr old known I.V. drug user presents with fever, weakness, lassitude and night sweats. On examination you discover a heart murmur
Rheumatic fever
A 7yr old girl complains of a rash on her chest and painful joints. On further questioning you discover she had recovered from a sore throat a fortnight ago
Hypertrophic cardiomyopathy
A young fit 22yr old is rushed into A&E after complaining of a severe chest pain and breathlessness. A loud fourth heart sound is heard.
Pericarditis
A 55yr old male presents to A&E with a sharp centralised chest pain which is relieved by sitting forwards. A pericardial rub is heard at the left sternal edge.
Clostridium perfringens
A gram positive bacillus that produces alpha-toxin causing gas gangrene in infected wounds
Anaerobes
A man punches someone in a pub brawl. The recipient then bites his hand. Later the bite wound becomes infected, with lots of pus and a foul smell. The most likely pathogen is?
Strep pyogenes
A gram positive B haemolytic coccus that can cause pharyngitis, erysipelas and cellulitis.
Polycythaemia rubra vera
A 65yr old male is found to have an Hb of 19g/dl on a routine blood test, EPO levels were normal. On examination he is found to have splenomegaly and engorgement of the retinal vein. Bone marrow histology showed increased cellularity of erythroid cells. What is the most likely diagnosis?
Essential thrombocythemia
A 30yr old female was found to have platelets>600x109/L on 3 separate occasions. Her CRP and ESR were within the normal range. She suffered a DVT 3 months ago. What is the likely diagnosis?
Anagrolide
Which drug aids in the reduction of platelet number and can cause palpitations and flushing?
Myelofibrosis
A peripheral blood film of a patient with polycythaemia vera shows a leucoerythroblastic picture with tear drop poikilocytes. What is the likely diagnosis?
Chronic granulocytic leukaemia
Imatinib can be used in the treatment for which leukaemia?
ULCER
What is the correct pathological term for a discontinuation in the epithelial surface?
Barrett’s oesophagus.
A 65 year old male with a long history of epigastric pain. Endoscopy reveals 3.2cm of columnar metaplasia in the lower oesophagus. What does this suggest?
Fistula
What is the technical term for a connection between two epithelial surfaces, as occurs in Crohns disease where for example there might be a connection between the bladder and the bowel?
Krukenberg tumour
A 46-year old Japanese female is found to have bilateral ovarian masses on imaging of the abdomen and had both ovaries removed. Histology revealed malignant signet ring cells containing mucin in both ovaries. What is the diagnosis?
Dermoid cyst or Cystic Teratoma
A 50 year-old female was found to have an ovarian mass. On its removal, histology revealed several cell types, including thyroid follicles, hair and teeth. What is the likely diagnosis?
Streptococcus pneumoniae
A 40 year-old female non-smoker presents with a one week history of fever, shortness of breath and a cough productive of rusty coloured sputum. Microscopy of the sputum is shown (Gram positive diplococci). What is the organism?
Legionnaires disease or Legionella Pneumophila
A 37 year-old man presents with a headache, myalgia and a cough. He is also suffering with nausea, diarrhoea and abdominal pain. On examination he is tachypnoeic and has a pyrexia of 39ºC. Blood tests reveal lymphopenia and hyponatraemia. A gram stain from the patients sputum is shown here (Gram negative rods). CXR shows lobar consolidation. Cold agglutinins are negative. What is the organism?
Salmonella Typhae or Typhoid fever.
A 40 year-old woman presents with malaise, muscular pains and diarrhoea with mucus and blood. On examination she has a fever and several distinctive spots on her abdomen (Rose spots). Blood cultures are positive and grow gram negative rods. What is the likely organism?
Helicobacter pylori.
genus of spiral flagellated Gram negative bacteria. Found in the stomach within the mucosa layer. It occurs in the majority of middle-aged people and causes progressive gastritis. Invariably present in duodenal ulceration and usually in gastric ulceration. What is the organism?
Di George syndrome or 22q11.2 deletion syndrome.
A 4 year old girl presents to the A&E with a recurrent chest infection that will not clear. On examination, the house officer notices that she has low set ears, a cleft palate and a murmur. Investigations reveal:
Calcium 1.9 mM (NR 2.2 to 2.6);
Phosphate 1.4 mM (NR 0.8 to 1.4)
PTH 1.1 pM (NR 1.1 to 6.8)
What is the likely diagnosis?
Anti-centromere
A 40-year old lady complains of tight fingers and dysphagia, and is thought to have a syndrome associated with Raynaud’s phenomenon, and telangiectasia. What antibody should we measure to confirm this possible diagnosis?
Acarbose
Name the drug used for patients with type 2 diabetes which inhibits the enzyme alpha glucosidase in the brush border membrane of the small bowel.
Gliptins such as alogliptin or sitagliptin
Name an example of a drug that inhibits the enzyme dipeptidyl dipeptidase IV (DPP-4).
Metabolic acidosis
A patient presents with weakness and is found to have a potassium of 2.4mM (NR 3.5 to 5.0). What is the likely acid-base abnormality if you check the patients arterial blood gas?
SIADH
A 67-year-old woman presented with confusion 2 days after a cholecystectomy. She had experienced some pain postoperatively, largely relieved by analgesia.
MAHA
A 51-year old man is having investigations for palliative surgery due to gastric adenocarcinoma. He is found to be anaemic, with high a reticulocyte count and fragmented red blood cells on blood smear. What is this anaemia known as?
Disease above AND below the diaphragm.
In a patient with Hodgkins Lymphoma, the stage of disease is given by the amount of spread, with stage 1 disease involving only one group of nodes, and stage IV disease involving extra nodal spread. What would stage III Hodgkins disease suggest?
Brain abscess
A 56 year-old male presents with fever, vomiting and seizures. Examination reveals a well- established ear infection and there is a ‘ring-enhancing’ lesion on the MRI of his brain.
Neisseria gonorrhoeae
A 27 year old patient has a knee effusion drained. The gram stain reveals Gram negative intracellular diplococci. What is the likely organism?
Eosinophilic Granulomatosis with Polyangiitis. (EGPA)
A 40 year old man presents with weight loss, muscle aches and abdominal pain. On examination he has high BP and urine dipstick reveals blood + and protein +. The patient is thought to have a vasculitis and is p-ANCA positive.
Anti glomerular basement membrane.
A patient presents with haemoptysis and haematuria. She is thought to have Goodpastures syndrome. What antibody should you look for?
Henoch Schonlein purpura
A four-year-old boy presents with a purpuric rash across the legs and buttocks. Two weeks previously you had seen the child about a chest infection. Further examination reveals abdominal pain and haematuria. Serum IgA levels are raised. What is the likely diagnosis?
Auto-immune haemolytic anaemia
A patient is found to have a positive Coombes (anti-globulin) test. What is the likely diagnosis?
