Last Minute Flashcards
1
Q
Ankylosing Spondylitis Monoclonal
A
Etanercept
TNF-alpha inhibitor
2
Q
Psoriasis Monoclonal
A
Ustekinumab
IL-12/IL-23
3
Q
anti-‐proteinase 3
A
Wegner’s
Granulomatosis with polyangiitis
4
Q
Felty’s
A
Rheumatoid arthritis + hepatosplenomegaly –> Neutropenia
5
Q
How to monitor the activity of SLE?
A
C3
C4
Anti-dsDNA
6
Q
Antibody useful to diagnose someone with systemic sclerosis?
A
Anti-Scl-70
7
Q
Tocilizumab
A
Rheumatoid Arthritis
IL-6R
8
Q
Denosumab
A
Osteoporosis
RANKL
9
Q
IFN-gamma
A
Chronic granulomatous disease
10
Q
Treating Wegner’s
A
Cyclophosphamide
11
Q
Treatment of hereditary angioedema
A
IV C1 inhibitor
12
Q
Treatment of oral allergy syndrome
A
Wash out mouth
oral antihistamines
13
Q
Utricaria
A
H1-antagonist.
14
Q
Neutralizing antibody in HIV
A
gp120
15
Q
NON-Neutralizing antibody in HIV
A
p24
16
Q
Co-receptor for entry of HIV
A
CCR5
17
Q
Enzyme targeted by HIV treatment
A
protease
reverse transcriptase
18
Q
C7 complement deficiency
A
Meningitis
19
Q
CD40L deficiency
A
Hyper IgM syndrome
20
Q
Asplenic patient vaccines
A
Pneumovax
21
Q
Vaccine against viral haemagglutinin
A
Influenza
22
Q
Yellow fever, MMR and BCG
A
Live vaccines
Avoid in immunocomprimised
23
Q
Live Vaccines
A
Small Yellow Typhoid Chicken BOY MMR
Smallpox
Yellow fever
Typhoid
Chickenpox
BCG
Oral polio
Yellow fever
MMR
24
Q
Patient gets recurrent infections with negative NBT and dihdrorrhadamine tests
A
Chronic granulomatous disease
25
Atypical granulomatous infection in previously healthy patien
IFN-y receptor deficiency
26
Serum sickness
Type III
27
Eczema
Type I
28
vaccinia
Small pox vaccine
29
Treatment of temporal arteritis
prednisolone
30
Azathioprine resistant Crohn's
Anti-TNF alpha (Infliximab)
31
Cytokine responsible for promoting antibody synthesis
Ig4?
32
Promoting eosinophil growth
IL-5
33
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
34
HIV: Uses this receptor on the cell wall to facilitate entry
gp120
35
b. What travel vaccine don’t you give to a person who has ankylosing spondylitis and on TNF alpha inhibitor?
Yellow fever
36
What vaccine do you give to girls at 12-13y?
HPV
37
Vaccine you give every 5 years for splenectomised patients
Pneumococcal (Pneumovax)
38
What is in the routine immunization programme but not given to immunocompromised children?
MMR
39
Ground glass appearance
PCP
40
Guy has urethritis, arthritis and eye problems
Reiter's syndrome
41
Gram positive that gives LUT symptoms in women
Staphylococcus Saprophyticuss
42
Gram neg rod UTI
E.Coli
43
Flagellate protozoan that can cross placenta
Toxoplasmosis
44
STI that can cross placenta in third trimester
Syphilis
45
Squamous cells on microscopy
=Contamination of sample
46
Coliform organisms
Nitrites
47
Stone associated infetcion
Proteus
Struvite stones
48
Gas gangrene
Clostridium perfringens
49
Urine antigen detection
Legionella
50
Rust coloured sputum
Strep pneumonia
51
HIV: Enzyme that copies with errors
Reverse transcriptase
52
What is the chemokine that inhibits HIV entry into cells
Aminooxypentane (AOP)-MIP-1α
53
Molluscum contagiosum
pox virus
54
Kaposi's sarcoma
HHV8
55
gram positive rod
Listeria
56
N. meningitis
gram negative cocci
57
Smoker – gram positive cocci
Strep pneumonia
58
Meningitis, normal glucose, raised lymphocytes, slightly raised protein
Herpes
59
neonatorum ophthalmia
Chlamydia trachomatis
60
What causes hemorrhagic cystitis in kids
Adenovirus
61
Mum had skin infection with a son with a sore throat
Strep pyogenes
62
Guy came back from afganistan with ulcer on his ring finger
cutaneous leishmaniasis
63
Kid had red erythemous, oedematous rash, first on face and crosses the nasal bridge and spread really quickly –
N.Meningitis
64
Livery cyst
antamoeba histolytica
65
Angular stomatitis
Folate deficiency /B12
66
You suspect Acute Intermittent Porphyria. What test?
Urine PBG
67
Jaundiced baby no dysmorphic features
Urine amino acids
68
hypoglycaemic neonate
Urine reducing substances
69
Wet Beri Beri
Pulmonary oedema
70
Dry Beri Beri
Neurological symptoms
71
Bicarb in pyloric stenosis
High
>30
72
Woman with hypothyroidism, T1DM, adrenal failure
Polyendocrinopathy
--> B12 def (pernicious anaemia)
73
Enzymes - rate-limiting enzyme in haem synthesis?
ALA synthase
| first enzyme
74
Deficiency leads to high urate
HGPRT
Leysch-Nyhan syndrome
75
How to diagnose B Thal trait
Raised HbA2
76
Raised amylase
Mumps
77
Impaired glucose tolerance
6. 1-6.9 FASTING
| 7. 8-11.0 OGTT 2 hours
78
Diabetes cut-off
>7.0 Fasting
>11.1 OGTT 2 hours
HbA1c > 6.5% (48mmol/mol)
79
One that causes hepatic cirrhosis and portal hypertension in some and cardiomyopathy in others?
Haemochromatosis
80
CAH
Hyperkalaemia
+ salt losing crisis
81
Adult T-‐cell lymphoma
JC virus
82
INR Someone with AF?
2.0-3.0
83
INR: Someone with a prosthetic valve.
3.0-4.0
84
Monitoring: Someone on unfractionated heparin.
APTT
85
Normal Hb - positive sickle solubility test
Sickle trait
86
Low Hb - positive sickle test
Sickle cell disease
87
polychromasia and spherocytes
Hereditary spherocytosis
88
Raised ESR
Temporal arteritis
89
Thalassaemia patient looks tanned and has diabetes
Transfusion haemosiderosis
90
Patient has prolonged APTT, normal PT and normal bleeding time
Haemophilia A
91
Patient has menorrhagia, prolonged APTT, normal PT and prolonged bleeding time. Her mother had similar problems
vWF
92
Elderly Patient is asymptomatic and has generalised lymphadenopathy, with abnormal bloods
CLL
93
Elderly patient presents with MASSIVE splenomegaly with low platelets, red cells and normal white cells
Myelofibrosis
94
Pelger Huet cells, hyposegmented neutrophil
Myelodyplastic syndrome
95
Breast Mass. Aspirated. Brown ‘fluid’
Galactocele
96
Halo-sign on x-ray
Aspergillosis
97
CD19+
CD5+
B cells
CLL
98
Ritcher's transformation
CLL
Hairy cell
---> DLBC
99
Smear Cells
CLL
100
CD5+
CLL
Or could be a mantle cell lymphoma!
101
Binet staging
CLL
Stage 1 <3 lymph nodes
Stage 2 >3 lymph nodes
Stage 3 >3 lymph nodes Hb<100
102
Protein C
Inactivates VIIa and V
103
Antithrombin III
Inactivates thrombin
Inactivates IX, X and XI
104
Tissue factor pathway inhibitor
Inhibits factor Xa and TF:VIIa complex
105
When the integrity of the BBB is disrupted the resultant oedema is described as
Vasogenic Oedema
106
Which of the following types of herniation do not involve cortex?
Tonsillar
107
What percentage of patents who experience a TIA will get a significant infarct within 5 years?
33%
108
What is the most common cause of non-traumatic intraparenchymal haemorrhages?
Hypertension
109
Krukenberg tumours
Secondary ovarian tumour
Bilateral metastases composed of mucin producing signet ring cells
most often of gastric origin or breast
110
HNPCC associated ovarian tumour
Mucinous
111
BRCA associated ovarian tumour
Serous cystadenocarcinoma
112
Most common ovarian cancer
Serous cystadenocarcinoma
113
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.
114
Type II Ovarian Tumours
High grade mostly of serous type
Aggressive
More than 75% have p53 mutations
No precursor lesions
115
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
116
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
```
117
Most common endometrial cancer
adenocarcinomas
118
C2 breast
Benign
119
C5 breast
Malignant
120
Dilated ducts
Periductal inflammation
Filled with secretions
Duct ectasia
Benign
121
Neutrophils (trinucleate cells)
Acute inflammation
+/- abscess
Mastitis
122
Degenerative fat
Foamy macrophages
Giant cells
Fat necrosis
Later fibrosis and calcification
123
Apocrine metaplasia
Adenosis
Epithelial and stromal hyperplasia
Fibrocytsic change
124
Overlapping cells
Excess glandular and stromal proliferation
Leaf-like fonds
Phyllodes tumour
Benign
125
Branching papillary groups
Papillary mass within duct lined by epithelium
Fibrovascular core
Intraductal papilloma
Benign
126
Central zone of scarring
Radiating zone of proliferating glandular tissue
Stellate mass
Radial scar
Benign
127
Ducts filled with atypical epithelial cells
DCIS
128
Infiltrating atypical epithelial cells
Invasive breast carcinoma
129
Most common breast cancer
Invasive ductal
130
Cancer staged into low grade, intermediate, high grade
DCIS
131
Proliferation of fibroepithelium and stromal tissue
phylloides tumour
132
Loss of E.cadherin
LCIS
133
HR PR negative
High grade DCIS
134
Rheumatic valvular disease
Mitral valve
135
Condition caused by a genetic defect in myofilament formation leading to large myocytes
Hypertrophic cardiomyopathy
136
Conditions caused by progressive loss of myocytes
Dilated heart failure
137
Condition of structural calcification causing onset of a murmur late in life
Aortic stenosis
138
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
139
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
140
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
141
4. 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
142
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
143
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
144
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
145
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
146
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
147
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
148
A gram positive bacillus that produces alpha-toxin causing gas gangrene in infected wounds
Clostridium perfringens
149
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
150
A gram positive B haemolytic coccus that can cause pharyngitis, erysipelas and cellulitis.
Strep pyogenes
151
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
152
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
153
Which drug aids in the reduction of platelet number and can cause palpitations and flushing?
Anagrolide
154
A peripheral blood film of a patient with polycythaemia vera shows a leucoerythroblastic picture with tear drop poikilocytes. What is the likely diagnosis?
Myelofibrosis
155
Imatinib can be used in the treatment for which leukaemia?
Chronic granulocytic leukaemia
156
What is the correct pathological term for a discontinuation in the epithelial surface?
ULCER
157
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.
158
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
159
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
160
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
161
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
162
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
163
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.
164
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.
165
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.
166
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
167
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
168
Name an example of a drug that inhibits the enzyme dipeptidyl dipeptidase IV (DPP-4).
Gliptins such as alogliptin or sitagliptin
169
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
170
A 67-year-old woman presented with confusion 2 days after a cholecystectomy. She had experienced some pain postoperatively, largely relieved by analgesia.
SIADH
171
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
172
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.
173
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
174
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
175
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)
176
A patient presents with haemoptysis and haematuria. She is thought to have Goodpastures syndrome. What antibody should you look for?
Anti glomerular basement membrane.
177
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
178
A patient is found to have a positive Coombes (anti-globulin) test. What is the likely diagnosis?
Auto-immune haemolytic anaemia
