Other Path Flashcards
What is the main mechanism behind HSV resistance to antivirals?
Thymidine Kinase mutation
What is the main mechanism behind CMV resistance to antivirals?
Protein Kinase mutation
Which virus is most commonly implicated in infection post-transplant in paediatric populations?
Adenovirus
How is post-transplant adenovirus treated?
Brincidofovir
How is RSV infection treated?
Ribavarin
Which virus is implicated in post-transplant lymphoproliferative disease?
EBV
When would you not give Ganciclovir to treat CMV?
Post HCST, use Foscarnet
A patient who has recently been on a cruise in Japan, where they ate lots of raw seafood, presents with diarrhoea. What is the most likely causative organism?
Vibrio parahaemolyiticus
Give an example of an antibiotic class that is affected by altered target resistance.
Macrolides
Give an example of an antibiotic that is affected by bypass resistance.
Trimethoprim
What is a fungal eye infection most commonly found to be?
Candida endopthalmitis
How would you treat Candida spp. infections not caused by Candida albicans?
Echinocandin
Which Cryptococcus species infects immunocompetent hosts?
Cryptococcus gattii
Which Cryptococcus species infects immunosuppressed hosts?
Cryptococcus neoformans
A patient with pneumonia has a CXR, which shows a bat wing appearance. What is the most likely causative organism?
Pneumocystis jirovecii
How is Hepatitis C treated?
Interferon
Ribavarin
How are infected prosthetic joints managed?
Removal and debridement before Abx
A patient returns from a city break in Bangkok complaining of a new, sunburn like rash, a retro-orbital headache and myalgia. What is the most likely diagnosis?
Dengue Fever
In which infectious disease are ‘Purple eyelids’ a common feature?
Chagas Disease
In which infectious disease are ‘Negri Bodies’ seen?
Rabies
Name two classes of drug which may be used to treat Benign prostatic Hyperplasia.
5-alpha reductase inhibitor
Alpha Blocker
In which disease might there be a mutation affecting Superoxide Dismutase 1?
Motor Neurone Disease
How would you manage a Pseudomonas aeruginosa infection?
Gentamicin
Ceftazadine
Which disease’s severity would be assessed using the Breslow Score?
Melanoma
Which organism is the most common cause of bronchopneumonia?
Haemophilus influenzae
Which organism is the most common cause of CNS infections overall?
Coxsackie virus
Which organism most commonly causes lung disease in patients with Cystic Fibrosis?
Pseudomonas aeruginosa
Which tapeworm species is found in pigs?
Taenia solium
Which tapeworm species is found in cows?
Taenia saginata
Which type of worm’s life cycle involves migrating from the skin to the bowel, laying eggs, hatching as rhabitiform larvae and maturing into filariform larvae?
Strongyloide (Pinworm), type of Nematode (soil-based)
Which type of worm’s life cycle involves being eaten, living in the intestines, forming a cyst and the cyst releasing a tapeworm, which grows and releases more eggs?
Cestodes (Tapeworm)
Which type of worm’s life cycle involves cercariae invading the skin after being released by freshwater snails, worms developing in the liver, migrating to the mesenteric venules/venous plexus of bladder, laying eggs which become miricidia and reinfecting freshwater snails?
Trematode (Schistosomiasis)
How would you treat strongyloide infection?
Ivermectin
Which medication is most widely used for parasitic infection?
Praziquantel
The centre of a granuloma being diffuse red indicates what?
Necrosis
Caseation
At what level must skin damage be to leave a scar?
Dermis
Where is the dermis in relation to the basement membrane?
Sits below it
Which virus is associated with Nasopharyngeal Carcinoma?
EBV
Which toxins are associated with Hepatocellular Carcinoma?
Aflatoxins
What is the role of stellate cells in the liver?
Vitamin A stores
Activate to myofibroblasts to lay down collagen
What does ‘Grade’ mean with regards to Chronic Hepatits?
Severity of inflammation
What does ‘Stage’ mean with regards to Chronic Hepatitis?
Severity of Fibrosis
What is the most common form of carcinoma that arises from CIN changes?
Squamous Cell Carcinoma
In which breast cancer are large, pleomorphic cells seen?
Invasive Ductal
In which breast cancer are Indian Files seen?
Invasive Lobular
In which breast cancer are Elongated Tubules seen?
Invasive Tubular
In which breast cancer are Empty Spaces seen?
Invasive Mucinous
What is the most important prognostic factor for Breast Cancer?
Spread to axillary lymph nodes
Which stain is used to distinguish Squamous Cell Carcinomas from Adenocarcinomas?
P40
In which condition would you see ‘Soap Bubble Osteolysis’ on x-ray, with ‘Chinese Letters and Shepherd’s Crook’ Signs?
Fibrous Dysplasia
In which syndrome would you see polyostotic fibrous dysplasia and rough border Cafe au Lait spots?
McCune Albright Syndrome
Which benign bone tumour typically affects teenage boys and occurs at the end of long bones?
Osteochondroma
Which benign bone tumour occurs in hands and feet and shows ‘popcorn calcification’ on x ray?
Enchondroma
Which benign bone tumour mainly affects young women and occurs at the epiphyses of long bones? On histology, there are osteoclasts on a background of spindle/ovoid cells.
Giant Cell tumour
What is the most common bone sarcoma?
Osteosarcoma
Which malignant bone tumour shows ‘Codman’s Triangle and a sunburst appearance’ on x-ray and malignant mesenchymal cells on histology?
Osteosarcoma
Which malignant bone tumour produces cartilage, and on histology shows ‘Malignant chondrocytes with or without chondroid matrix’?
Chondrosarcoma
Which malignant bone tumour shows ‘onion skinning of the periosteum’ on x-ray, and ‘sheets of small round cells’ on histology?
Ewing’s Sarcoma
Which tumour is associated with t(11;22)(q24;q12)?
Ewing’s Sarcoma
How are cytopathological samples of Breast cancers graded?
C1-5
1: Inadequate
2: benign
3: Atypia, probably benign
4: Atypia, probably malignant
5: malignant
Which disease shows proteinaceous material and neutrophils on cytology, and duct distension with proteinaceous material and ‘foamy macrophages’ on histology?
Duct Ectasia
Which breast disease shows neutrophils on cytology, and is usually caused by Staphylococcus aureus?
Acute Mastitis
Which breast disease shows ‘fat cells surrounded by macrophages’ on cytology?
Fat Necrosis
Which breast disease shows ‘dilated, calcified ducts’ on histology.
Fibrocystic Disease
Which breast disease shows ‘glandular and stromal cells’ on histology, and presents as a mobile, well circumscribed lump?
Fibroadenoma
Which breast condition shows ‘overlapping cells’ on histology, and is benign? It is sometimes described as having a ‘leaf-like’ appearance.
Phyllode’s Tumour
Which benign breast tumour may present with bloody nipple discharge?
Central Intraductal Papilloma
Which breast condition shows:
Cytology: Clusters of cells
Histology: Dilated ducts, polypoid mass in the middle
?
Intraductal Papilloma
Which breast condition may show ‘a central stellate area’ and a ‘proliferation of ducts and acini’ on histology?
Radial Scar
List 3 types of proliferative breast disease.
Usual Epithelial Hyperplasia
Flat Epithelial Atypia/Ductal Carcinoma
In situ lobular neoplasia
Which breast condition shows ‘cribiform, punched out;’ appearance on histology, with compact lumens, calcification and overlapping cells?
Low grade Ductal carcinoma in situ
Which breast condition shows a ‘central lumen of necrotic tissue’ with large cells, pleiomorphic cells which occlude a duct, and few lumens?
High grade ductal carcinoma in situ
Which breast cancer shows ‘pleiomorphic cells with large nuclei’ on histology and is E-cadherin +ve?
Invasive Ductal Carcinoma
Which breast cancer shows a ‘linear, Indian File pattern’ on histology, with a monomorphic appearance?
Invasive Lobular Carcinoma
Which breast cancer shows ‘elongated tubules invading the stroma’ on histology?
Invasive tubular carcinoma
Which breast cancer shows ‘empty spaces with lots of mucin’ on histology?
Invasive mucinous carcinoma
Which breast cancer shows ‘sheets of markedly atypical cells, with prominent lymphocytic infiltrates and central necrosis’ on histology?
Basal-Like Carcinoma
Which gene mutation is a poor prognostic indicator for breast cancer?
Her2
Which gene mutation is a good prognostic indicator for breast cancer?
ER/PR
In which thyroid condition might you see calcifications (psammoma bodies) and clear nuclei (Orphan’s Annie Eyes)?
Papillary Thyroid Cancer
In which thyroid condition might you see amyloid deposition with Congo Red staining, and why?
Medullary Carcinoma
Calcitonin breaks down to Amyloid
What effect does PTH have?
1-alpha Hydroxylase activation
Osteoclast activation
Renal calcium resorption
Renal potassium excretion
What is secreted in the Zona Glomerulosa?
Aldosterone
What is secreted in the Zona Fasciculata?
Glucocorticoids
What is secreted in the Zona Reticularis?
Androgens & Glucocorticoids
What is secreted in the Zona Medulla?
Noradrenaline
Adrenaline
What is Waterhouse Friederichson Syndrome?
Haemorrhage into adrenals due to septic DIC = acute adrenal insufficiency
Non-infective endocarditis caused by SLE?
Libman-Sacks Endocarditis
Which vasculitis characteristically shows a ‘rosary beads’ appearance on angiogram due to multiple aneurysms?
Polyarteritis Nodosa
What is c-ANCA directed against?
Proteinase 3
What is p-ANCA directed against?
Myeloperoxidase
Which vasculitis shows ‘narrowing of the lumen and lymphocytic infiltration of the tunica media’ on biopsy?
Temporal Arteritis
Which staging system is used for Cervical Cancer?
FIGO
Name one mutation that is associated with Type I endometrial carcinoma.
PTEN
Which mutation is associated with serous endometrial carcinoma?
p53
Which cancer is most strongly associated with endometriosis?
Ovarian clear cell carcinoma
How does an artheroma form?
Endothelial Injury -> LDL Aggregation
Monocyte Adhesion
Monocyte migration into intima
Platelet Adhesion
Lipid Accumulation
What does MI histology show in the first 6 hours?
Normal
What does MI histology show between 6-24 hours?
Coagulative Necrosis
Loss of Nuclei
Striations
What does MI histology show 1-4 days?
Infiltration of neutrophils & macrophages
What does MI histology show 5-10 days?
Macrophages
What does MI histology show 10-14 days?
Granulation, Angiogenesis, Collagen Synthesis
Myofibroblasts, Macrophages, Angioblasts
What is the most common cause of aortic stenosis?
Calcification
Which disease in children shows ‘effacement of foot processes’ on electron microscopy?
Minimal Change Disease
Which renal disease shows ‘partially scarred glomeruli’ and ‘thickened GBM’?
Focal Segmental Glomerulosclerosis
Which renal disease shows immune deposits on the outside of the glomerular basement membrane and thickening of the BM?
Membranous Glomerulonephritis
Which antibody is associated with membranous glomerulonephritis?
Anti-phospholipase A2 type M receptor
How is Alport’s Syndrome inherited, and what does the mutation affect?
X-linked dominant
alpha 5 subunit of type iv collagen
In which renal condition might you see ‘shrunken kidneys with granular cortices’ and ‘fibrinoid necrosis’?
Hypertensive Nephropathy
Poisoning with which chemical may predispose to Calcium Oxalate crystal formation?
Ethylene Glycol
In which syndrome might you see Renal Oncocytomas?
Birt-Hogg-Dube Syndrome
Which benign renal tumour is epithelial in origin and composed of papules and tubules?
Papillary Adenoma
Which benign renal tumour is epithelial in origin and composed of oncocytic cells?
Renal Oncocytoma
Which benign renal tumour is mesenchymal in origin and composed of thick walled blood vessels, smooth muscle and fat?
Angiomyolipoma
Which malignant renal tumour appears grossly as a ‘golden yellow tumour’ with ‘haemorrhagic areas’?
Clear Cell Carcinoma
Which malignant renal tumour is associated with long-term dialysis and appears as a ‘fragile, friable, brown tumour’?
Papillary Renal Cell Carcinoma
Which malignant kidney tumour appears as a well circumscribed solid brown tumour?
Chromophobe Renal Cell Carcinoma
Which renal tumour appears as ‘small, round, blue cells’ on histology?
Nephroblastoma
How is prognosis for Prostatic Adenocarcinoma calculated?
Gleason Score
What might it indicate if a lung lobe isn’t black on autopsy?
Pneumonia
When would you refer a death to the coroner?
Unknown COD Sudden death (<24h in hospital) Suspicious Self-Neglect/Suicide Related to detainment/Medical care Related to job
Which antibody is implicated in Bullous Pemphigoid?
Anti-Hemidesmosome, attacking basememnt membrane
Where is the site of disease in Pemphigus Vulgaris?
Dermal-epidermal junction
IgG attacks between keratin layers
In which IgG mediated skin condition might the outer layer of the stratum shear off?
Pemphigus follaceous
Which skin condition is characterised pathologically by thickened epidermis, parakeratosis layers, disappeared stratum granulosum and Munro’s microabscesses?
Psoriasis
How does Lichen Planus present:
a) on the wrists/arms
b) in the mouth?
a) Purplish/red rash
b) White Lines (Wickham Striae)
In which condition might you see ‘horn cysts’, which are areas where the epidermis entraps keratin?
Seborrhoeic Dermatitis
What occurs in the immediate phase of asthma?
Mast cell degranulation and effects
What occurs in the late phase of asthma?
Tissue damage, mucous production, muscle hypertrophy
In which lung condition might you find ‘iron-laden macrophages’ on histology?
Pulmonary Oedema
From the heart
What are the stages of lobar pneumonia?
Congestion
Red Hepatisation
Grey Hepatisation
Resolution
What is the key feature of grey hepatisation in pneumonia?
Intra-alveolar neutrophils
What are the stages of fracture repair?
Haematoma
Fibrocartilaginous callus
Mineralisation of callus
Remodelling
In which bone disease might you see ‘Langerhans-type Giant Cells with horseshoe nuclei’?
TB
In which condition might you see a proliferative synovitis, with pannus formation and grimley sokoloff cells on histology?
Rheumatoid Arthritis
Which cells are present in MALTomas related to H Pylori?
B Cells
Which cells are present in Duodenal Lymphomas?
T Cells
What is the most common genetic predisposition to brain tumours?
Neurofibromatosis
What is the most common paediatric brain cancer?
Pilocytic Astrocytoma
Which brain tumour is cerebellar and well circumscribed on MRI, and shows hairy piloid cells and rosenthal fibres on histology?
Pilocytic Astrocytoma
Which mutation is associated with Pilocytic Astrocytoma?
BRAF mutation
What is the most common primary brain cancer in adults?
Glioblastoma Multiforme
How do astrocytomas progress?
Become Glioblastomas
Which brain cancers are associated with IDH1/2 mutations?
Diffuse Astrocytoma
Oligodendroglioma
Which brain cancer displays ‘round cells with clear cytoplasm’ (fried egg appearance)
Oligodendroglioma
Which brain cancer shows ‘small blue round cells’ and ‘Horner-Wright Rosettes’?
Medulloblastoma
How is tau spread staged in Alzheimer’s?
Braak Staging
Which three enzymes are involved in oxidative killing by granulocytes?
NADPH Oxidase
Superoxide Dismutase
Myeloperoxidase
Which antigen is found on all T Cells?
CD3
Which T Cells play a key role in germinal centre reactions and Plasma Cell class switching?
T Follicular Helper Cells
Which T Cells express FoxP3 and CD25?
T Regulatory
Which T Cells express CD4 and secrete IFN-y and IL-2
T Helper 1
Which chemokines help direct dendritic cells to lymph nodes?
CCL19 CCL21
ligands for CCR7
Which agent used in FMF binds to tubulin in neutrophils?
Colchicine
Which HLA is seen in Goodpasture’s Syndrome?
HLA DR15
Which cytokine plays a key role in development of TH2 cell responses (and hence allergic responses)?
IL-4
Which cell type does Azathioprine target?
T
Which cell type does Cyclophosphamide target?
B
Which cell type does mycophenolate motefil target?
T
Which enzyme’s activity must be checked before starting Azathioprine?
TPMT
Name a JAK inhibitor.
Tofacitinab
What does Secukinumab target?
IL-17
What does Guselkumab target?
IL-23
What does Ustekinumab target?
IL12 IL23
What does Abatacept target?
CTLA4-Ig fusion gene
RA if Anti-tnf alpha ineffective
What is the max number of HLA mismatches between a parent and child?
3
What is the max number of mismatches between siblings?
3
What are the 3 phases of antibody mediated transplant rejection?
1: exposure to antigen
2: B Cell proliferation and maturation
3: Effector = antibodies bind to graft epithelium
What are the phases of T cell-mediated graft rejection?
1: Activate alloreactive T Cells
2: Normal T Cell functions vs graft
Effector: T cells tether graft endothelium and attack tubular epithelium.
What are the histological features of T-cell mediated graft rejection?
Lymphocytic interstitial infiltration
Ruptured tubular basement membrane
Tubulitis
Macrophages
What are the cardinal features of antibody-mediated rejection?
Capillaritis
Inflammatory cells in the capillaries
What is there a deficiency of in Leukocyte Adhesion Deficiency?
CD18
Which immunodeficiency may be implicated in a child presenting with recurrent, severe viral infections?
NK Deficiency
A patient has: Low/Absent T Low/Absent NK Normal/High B Low Ig What is the likely cause?
X-linked SCID
A patient has: Low/Absent T Low/Absent NK Low/Absent B Low Ig Normal Neutrophils What is the likely cause?
ADA Deficiency
A patient has: Low CD4 Normal CD8 Normal B Low IgG/IgA What is the likely cuase?
Bare Lymphocyte Syndrome II
How might you differentiate between IDA and Beta Thalassaemia trait on blood film?
Basophilic Stippling = BT
How is anaphylaxis managed?
ABC Mask O2 IM Adrenaline IV Antihistamine Nebulised Bronchodilators IV Corticosteroids IV Fluids
What does normal levels of C3/4, but absent CH50/AP50 represent?
Deficiency in common pathway
Which Staph is coagulase positive?
Staph aureus
Which Staph is coagulase negative?
epidermidis
Which bacteria are gram positive bacilli?
ABCDL Actinomyces Bacillus Clostridium Diptheria Listeria
Which bacteria are gram negative cocci?
Neisseria spp
Moraxella
Which bacteria are gram negative cocobacilli?
Haemophilus Bordatella Pseudomonas Chlamydia Brucella
Which antibiotics are considered broad-spectrum?
'These meds can cover' Tazocin Meropenem Co-amoxicvlax Ciprofloxacin
Which pneumonia cause shows ‘glossy colonies’ on agar?
Haemophilus influenzae
Which cause of pneumonia is cold agglutinin +ve?
Mycoplasma pneumoniae
Trophozoite with 4 nuclei, flask-shaped ulcer?
Entamoeba Histolytica
Trophozoite with 2 nuclei, pear-shaped ulcer?
Giardia Lamblia
What is the mechanism of action of aciclovir and ribavarin?
Nucleoside Analogue
Which disease is transmitted by the Tsetse Fly?
Trypanasoma
Which disease is transmitted by the Sand Fly?
Lesihmania
Which mutation is associated with MAHA and TTP?
ADAMTS13 = VWF cleaving protease deficiency
What are the three main causes of MAHA?
Adenocarcinoma
HUS
TTP
What effect does Protein C have?
Anti-thrombotic
What is the mechanism of action of warfarin?
Vitamin K epoxide reductase inhibitor
How is warfarin monitored?
INR
How is LMWH monitored in patients with renal failure/extremes of weight?
Anti-Xa assay
In which order do factors drop after commencing warfarin?
7, C, 9, 10, 2
Which type of patient might benefit most from long term anticoagulation after a DVT?
M>F
Idiopathic
Which factor falls in pregnancy?
S
Rank B-Cell NHLs from most to least aggressive.
Burkitt's Mantle Diffuse large B Cell Marginal Zone Small Lymphocytic Follicular
Which diagnostic markers are used for Hodgkin’s Lymphoma?
CD30
CD15
Which cancer is likely to be present if B Cells expressing CD5 but not CD19 are found in the peripheral blood?
CLL
When would you treat CLL?
Progressive disease
Massive splenomegaly
Massive Lymphadenopathy
B Symptoms
What might cause psuedopolycythaemia?
Alcohol
Obesity
Diuretics
What might cause a polycythaemia with an appropriately high EPO?
Altitude
Hypoxic Lung Disease
What might cause a polycythaemia with an inappropriately high EPO?
Renal Disease
Which pharmacological agent might be used in the treatment of polycythaemia vera?
Hydroxycarbimide
A patient presents with an isolated mild thrombocythaemia. They regularly suffer from headaches, What is the most likely diagnosis?
Essential thrombocythaemia
A man with CML is found to have between 10-19% blasts on blood film. Which stage of disease is he said to be in?
Accelerated Phase
A man with CML is found to have over 20% blasts on blood film. Which stage of disease is he said to be in?
Blast Crisis
In which group of conditions might you see ringed sideroblasts and bi-lobed neutrophils?
Myelodysplastic Syndromes
How might you treat myelodysplastic syndromes?
Allogenic Stem cell Transplant
Chemo
How do people with myelodysplastic syndrome die?
Third each
Infection
Bleeding
Acute Leukaemia
What is the most common cause of Aplastic Anaemia?
Idiopathic
What might cause congenital Aplastic Anaemia?
Fanconi Anaemia
Dyskeratosis Congenita
What is aplastic anaemia?
Failure of pleuipotent stem cells -> Pancytopaenia
What does the bone marrow look like in aplastic anaemia?
Hypocellular
Fatty
What shortens in dyskeratosis congenita?
Telomere
When is a red cell transplant indicated?
If >30% blood lost
Hb below 70 peri-operatively
Symptomatically
When might you transfuse washed cells?
If patients have severe allergic reactions to blood products
What does blood irradiation do?
Destroys donor lymphocytes to prevent GvHD in immunosuppressed people
When is fresh frozen plasma indicated?
Massive blood loss (>150ml/min)
DIC with bleeding
Liver disease with PT 1.5x normal
A patient develops chills, rigors and fever of 37.8 degrees during a blood transfusion. Your consultant says a reaction has taken place due to the release of cytokines by white cells in blood storage. Which reaction has taken place?
Febrile non-haemolytic transfusion reaction
A patient develops a mild itchy rash and a wheeze during a fresh frozen plasma transfusion. What is the likely diagnosis?
Allergic reaction
A patient develops pulmonary oedema shortly after undergoing a blood transfusion. What is the most likely diagnosis?
Transfusion-associated circulatory overload
A patient develops SOB, low sats and tachycardia 4 hours after undergoing a transfusion. CXR shows pulmonary infiltrates. What is the most likely diagnosis?
Transfusion-associated acute lung injury
A patient who regularly undergoes blood transfusions for Beta-Thalassaemia becomes jaundiced and anaemic 2 days after their most recent treatment. They also notice dark urine. What is the most likely diagnosis?
Delayed Haemolytic Transfusion Reaction
What is the mechanism behind delayed haemolytic transfusion reactions?
Develop new antibodies vs RBCs (Alloimunisation)
What is the prognosis of GVHD?
Mostly fatal
What is used as a marker of stem cells?
CD34
How does chronic GVHD present?
Similarly to Sjogren’s
What disease causes HbSC?
Sickle Cell/Haemoglobin C disease, which causes milder sickling than HbSS
Which disease might cause anaemia via a glycolytic pathway enzyme deficiency?
Pyruvate Kinase Deficiency
In which leukaemia might you see an abundance of promyelocytes with auer rods on blood film?
Acute Promyelocytic Leukaemia
How would you conclusively distinguish between acute leukaemias?
Immunophenotyping
What is the normal range for potassium?
3.5-5.5 mmol/L
What is the normal range for sodium?
135-145 mmol/L
What is the normal range for haemoglobin in men?
130-180 g/L
What is the normal range for haemoglobin in women?
115-160 g/L
What is the normal range for calcium?
2.2-2.6 mmol/L
A patient presents with metabolic acidosis, an isolated hypokalaemia and renal stones. What is the likely diagnosis?
Type 1 Renal Tubular Acidosis
Which drug, used in chronic management of gout, increases the fractional excretion of uric acid?
Probenecid
What causes a raised anion gap metabolic acidosis?
GOLDMARK Glycols Oxoproline L-lactate D-lactate Methanol Aspirin Renal Failure Ketoacidosis
What condition describes inadequate function of the proximal renal tubules of the kidney and is associated with glucosuria, hypophosphataemia and hyperuricosuria?
Fanconi Syndrome
Which enzyme converts Cholesterol into Cholesterol ester?
ACAT
Which agent is best at reducing LDL levels in the blood?
Evolocumab
What may cause a gout attack in the knee?
Saturnine Gout - Lead Poisoning
Which condition might cause hypocholesterolaemia and orange tonsils in children?
Tangier Disease
How might you distinguish between true and pseudo hyponatraemias?
Serum osmolality - should be low
Which sign, often seen in hypocalcaemia, involves tapping the facial nerve and visualising ipsilateral contraction of the facial muscles?
Chvostek’s Sign
What might cause an unexplained metabolic acidosis with both a raised anion gap and osmolar gap?
Glycol, Ethanol, Mannitol, Methanol Poisoning
Which enzyme is the rate limiting step in de novo purine synthesis?
PAT
Which autosomal recessive disorder leads to an increase in blood plant sterols?
Phytosterolaemia
What might cause a normal anion gap metabolic acidosis?
Addisons
Bicarbonate Loss
NaCl infusion
Drugs
What might cause a false lymphocytosis to show on FBC?
Presence of reticulocytes
What might cause p-wave flattening, hyperacute t waves and a broad QRS in a patient undergoing chemotherapy?
Hyperkalaemia due to tumour lysis syndrome
Does haemophilia affect the bleeding time?
No
Which blood film finding is caused by paraproteinaemia in MM?
Rouleaux formation
What complication are patients with essential thrombocytosis at risk of?
Stroke
Which syndrome is characterised by neutropenia, pancreatic dysfunction and short stature?
Shwachmann Diamond Syndrome
Which bone marrow failure syndrome is characterised by an isolated failure of red cell production, presenting as a macrocytic anaemia and low reticulocytes?
Diamond-Blackfan Syndrome
What is the most sensitive marker for iron deficiency anaemia?
Low Serum Ferritin
Which anticoagulant would you use in a patient with DVT and renal failure?
Warfarin
Which medication may be used as prophylaxis for tumour lysis syndrome?
Rasburicase
Which drug can be used to treat M3 AML (Acute promyeloytic leukaemia)?
All Trans Retinoic Acid
Which condition causes progressively falling platelet counts in a patient started on heparin (enoxaparin)?
Heparin induced Thrombocytopaenia
Why does tumour lysis syndrome cause hypocalcaemia?
Released phosphate binds free calcium in the serum
In which cell type are auer rods seen?
Neutrophil
Which oncogene is found in Burkitt’s, and is formed by a t(8;14) mutation?
C-MYC
Which lobe is most commonly affected in HSV encephalitis?
Temporal
Which cancer shows ‘oat-shaped cells’ on biopsy?
Small cell lung cancer
How many stages of CKD are there?
5
What do delta cells of the pancreas secrete?
Somatostatin
What is Von Hippel Lindau Syndrome?
Brain Haemangiomas Renal Cysts Neuroendocrine tumours Clear Cell Tumours Phaeochromocytomas
A patient with a recent history of head trauma causing LOC experiences a lucid interval followed by deterioration. Which pathology is this most likely to represent?
Extradural Haemorrhage
Which syndrome is characterised by nephritic syndrome, cataracts and sensironeural deafness?
Alport’s
What is the first line chemotherapy for prostate cancer?
Docetaxel
What condition may be present if ‘waxy casts’ are found in urine?
CKD
Kimmelstiel Wilson nodules found in a renal biopsy are associated with what underlying disease?
Diabetes
A renal biopsy reads “Thickened basement membrane with spike and dome appearance due to electron dense deposits in the subepithelial layer”. What is the most likely diagnosis?
Membranous Glomerulonephritis
Name the first line treatments for Wilson’s Disease.
Zinc
Trientine
In which gross anatomical section of the pancreas does pancreatic cancer typically occur?
Head
What are the most common cancers in the UK in men/women?
Men:
Prostate (most common in men)
Lung
Bowel
Head and Neck
Women:
Breast (most common cancer overall)
Lung
Bowel
Uterus
The ECG leads V1 and V2 represent which specific region of the heart?
Septal
What might cause AST to be over 3x higher than ALT?
Alcoholic Hepatits
What might cause ALT to be in the thousands?
Paracetamol/Toxins
Viruses
Ischaemia
What might cause a mildly elevated ALT?
Fatty Liver
Which medication might cause hepatic adenomas?
COCP
Which condition is associated with the presence of fatty casts in urine?
Nephrotic Syndrome
Which protein is defective in Polycystic Kidney Disease?
Polycystein-1
What is the name of the criteria used to diagnose rheumatic fever?
Jones’
What is the triad seen in carcinoid syndrome?
Bronchoconstriction
Flushing
Diarrhoea
The ECG leads II, III and aVF represent which region of the heart?
Inferior
An immune response directed against myelin basic protein and proteo-lipoprotein results in what autoimmune condition?
Multiple Sclerosis
Which cause of nephrotic syndrome doesn’t respond to high dose steroids?
Membranous Glomerulonephritis
What condition is the presence of granular (“muddy brown”) casts in the urine associated with?
Acute Tubular Necrosis
What condition is the presence of epithelial casts in urine associated with?
Acute Tubular Necrosis
What is the diagnostic criteria for common variable immunodeficiency?
Decrease in IgG and one of IgA/M
Lack of antibody response to antigens or immunisation
What protein is defective in X linked Severe Combined Immunodeficiency?
Common gamma chain of IL2 receptor
Which autoantibody is associated with ITP?
Anti-glycoprotein IIb
What gene is defective in Bruton’s agammagobulinaemia?
BTK
Which cytokine is predominantly responsible for T cell proliferation and survival?
IL-2
CD14 is typically a marker of what type of immune cell?
Monocytes/Macrophages
What is the likely cause of a rapidly progressive glomerulonephritis and nosebleeds/haemoptysis?
Granulomatosis with Polyangiitis
Which organisms are people with chronic granulomatous disease susceptible to?
Catalase positive E Coli Staph a Listeria Klebsiella Candida
Which stain is used for Pneumocystis?
Silver/Periodic acid-Schiff
Which stains are used for Candida?
Periodic Acid Schiff or Methenamine Silver
Which stains are used for Aspergillus?
Methenamine Silver
PAS
What might Q Fever progress to?
Atypical Pneumonia
ARDS
Endocarditis
How is Lyme Disease treated?
Doxycycline
How is Leishmaniasis treated?
Amphotericin B
Antibiotics - what does ceph- indicate?
Cephalosporin
ABx - what does -floxacin indicate?
Quinolone
Which malaria species causes fevers every 3 days?
Plasmodium malariae
Which organism causes Q Fever?
Coxiella Burnetti
Which antibiotic is used to treat BV?
Metronidazole
Which species causes Lyme Disease?
Borellia Burgdoreffi
Rash after fish bite organism?
Mycoplasma marinum
What is the gold standard investigation for Leishmaniasis?
Splenic Aspirate
The presence of galactomannan in the serum of a septic patient suggests the presence of what organism?
Aspergillus
Which organism causes Chancroid?
Haemophilus ducreyi
What can you mix toenails with to test for Tinea/Trichophytum presence?
Potassium Hydroxide
A sexually active homosexual man received treatment two hours ago for genital primary syphilis. He was given a single of dose of IM benzylpenicillin. He presents to the emergency department reporting he has become unwell, with a fever, headache and muscle aches. He is concerned he is having an allergic reaction. He is pyrexial at 38C and his blood pressure is 98/76.
What syndrome is he suffering from?
Jarisch Herxeimer Syndrome
What type of Hypersensitivity is Mixed Essential Cryoglobulinaemia, and which disease is it associated with?
Hepatitis C
III
What is Evan’s Syndrome?
Type II HS
Autoimmune Haemolytic Anaemia + ITP
Which antigen is targeted in Autoimune Thrombocytopaenic Purpura?
Glycoprotein IIb/IIIa on Platelets
Which antigen is targeted in Pemphigus Vulgaris?
Epidermal Cadherin
Which syndrome causes Hepatic Jaundice and is caused by a mutation in the UGT1A1 gene?
Criggler-Najjar Syndrome
What is Turcot Syndrome?
Gliobastoma Multiforme
Medulloblastoma
Pineoblastoma
What is Li-Fraumeni Syndrome?
Astrocytoma, PNET, Sarcomas, Breast Cancer, Leukaemia
Which condition is associated with optic gliomas, neurofibromas and astrocytomas?
Neurofibromatosis Type I
Which condition is associated with vestibular schwannomas, meningiomas, ependyomas and astrocytomas?
Neurofibromatosis Type II
Which condition is associated with Giant Cell Astrocytomas, Cortical Tubers, Superendymal Nodules and calcifications on CT?
Tubular Sclerosis
Which syndrome presents with parkinsonism, dystonia, apraxia and ‘alien limbs’ phenomenon?
Corticobasal Syndrome
Which Parkinson Plus Syndrome presents with early autonomic dysfunction?
Multiple System Atrophy
Which Parkinson Plus syndrome is associated with early falls, axial rigidity, akinesia, dysarthria and dysphagia?
Progressive Supranuclear Palsy
Which chromosome is Frontotemporal Dementia associated with?
17
Which condition describes behavioural changes associated with spherical inclusion bodies found in the cytoplasm on autopsy?
Pick’s Disease
What is Aphasia?
Language disorder
What is Apraxia?
Loss of ability to carry out learned purposeful tasks
What is Agnosia?
Loss of ability to recognise objects/people etc
Which tumour is ventricular, and associated with hydrocephalus?
Ependyoma
Which brain tumour is indolent, and common in children?
Pilocytic Astrocytoma
Which brain tumour is soft, gelatinous and calcified?
Oligodendroma
Which cause of pneumonia is associated with birds?
Chlamydia psittaci
How do you distinguish between GBS and Botulism?
Descending paralysis in botulism
Which bacteria is caught through reheated meats, causes diarrhoea and cramps and may cause gas gangrene?
Clostridium perfringens
Which bacteria commonly causes infantile diarrhoea?
EPEC
Which lysosomal disorder occurs due to a defect in Hexoaminidase A, and leads to lipid accumulation, nervous damage and death at a young age?
Tay-Sachs Disease
Which disorder occurs due to a buildup in Gal-1-phosphate, and leads to cataracts, hypoglycaemia, and neonatal conjugated jaundice?
Galactossaemia
Which group of disorders (and name 1 example) cause hypoglycaemia, lactic acidosis, hepatomegaly and developmental delay?
Glycogen Storage Disorders
Von Gierke’s
Name two examples of aminoacidopathies, which present with mental retardation, blue eyes and fair hair/skin.
Phenylketonuria
Maple Syrup Disease
How does the classical pathway work?
C1 binds to antibody-antigen complex
How does the mannose binding pathway work?
MBL binds to microbial cell surface carbohydrates, which stimulates C2/4 of the classical pathway
How does the alternate pathway work?
C3 binds straight to the bacterial cell wall
Complement: Normal C3, C4, CH50, low AP50?
Factor B Deficiency
Complement: Normal C3/C4, Low CH50, normal AP50?
C2/C1q deficiency
Complement: Normal C3/C4, Low CH50/AP50?
C9 Deficiency
Complement: Low C3/C4, Low CH50, Normal AP50?
SLE
Monogenic Autoinflammatory?
FMF
TRAPS
Polygenic Autoinflammatory?
IBD
Osteoarthritis
GCA
Takasayu’s
Mixed Pattern Diseases?
Ankylosing Spondylitis
Psoriatic Arthritis
Behcet’s Syndrome
Polygenic Autoimmune Diseases?
RA MG PA Graves' SLE PBC Vasculitides Goodpasture's
Monogenic Auto-immune Disease?
APS-1
APECED
IPEX
ALPS
What do you do to assess allergies if a patient cannot stop anti-histamines or has a history of anaphylaxis?
RAST testing
What are component resolved diagnostics?
Assessment of individual allergen, eg. peanuts have 5 allergens in, this would assess just one of the compounds
Which antibody is implicated in Autoimmune Haemolytic Anaemia?
Anti-Rh Blood group Antigen
Why doesn’t vaccination work properly in the elderly?
Immune Senescence
Nutrition
Which cells may have potential to be utilised as cancer vaccines?
Dendritic Cells
For which diseases might you use Interferon Alpha?
Hep B/C
CML
For which disease might you use Interferon Beta?
Behcet’s
How does cyclophosphamide work?
Alkylates guanine in B cells, preventing replication. Used for vasculitides.
How does Azathioprine work?
Antimetabolite T>B cells. Prevents cell replication
How does Methotrexate work?
Anti-folate = anti-proliferation.
How does Mycophenolate Motefil work?
Anti Metabolite T>B
Used in transplantation prophylaxis
How do Tacrolimus/Cyclosporin work?
Calcineurin Inhibition = no cell signalling.
T
Rejection prophylaxis
What does Sirolimus target?
IL-2
Transplant
What does Basiliximab target?
CD-25
Transplant
What does Natalizumab target?
Anti-alpha4 integrin
MS
What does Tocilizumab Target?
IL-6
How does transplantation affect the risk of MI?
20x increase
How does transplantation affect the risk of viral associated cancers?
100x increase
How does transplantation affect the risk of skin cancer?
20x increase
What do T Helper 1 cells do?
Help CD8/Macrophages
What do T Helper 2 cells do?
Humoral Response
What do T Helper 17 cells do?
Help Neutrophils
Give an example of a passive vaccination.
Varicella Zoster Immunoglobulin
Which immunohisto stain targets lymphoid cells?
CD45
Which immunohisto stain targets epithelial cells?
Cytokeratin
Which cells form the fibrous cap in the process of artherosclerosis?
Vascular smooth muscle
Which condition shows ‘myocyte loss with fibrofatty replacement typically affecting the right ventricle’?
Arrhythmogenic Right Ventricular Cardiomyopathy
Why does Rheumatic Fever occur?
Antigenic Mimicry
What are Jones’ major Criteria for Rheumatic Fever?
Carditis Arthritis Sydenham's Chorea Erythema Marginatum Subcutaneous Nodules
A middle-aged woman presents with shortness of breath and chest pains. O/E she has a mid systolic click with a late systolic murmur. What is the most likely diagnosis?
Mitral Valve Prolapse
What is the most common cause of Aortic Stenosis?
Calcification
What is the most common cause of Mitral Stenosis?
Rheumatic Fever
In which condition might you see ‘Smiling Face’ cells with ‘fish mouths’?
Hereditary Stomatocytosis
Which type of anaemia is commonly seen in Sideroblastic Anaemia?
Microcytic
What causes anaemia of chronic disease?
Cytokine driven inhibition of red cell production, with increased ferritin.
What causes anaemia of chronic disease in renal failure?
EPO Deficiency
When is TIBC raised?
Pregnancy
Iron Deficiency Anaemia
How is transferrin saturation calculated, and what can it indicate?
Iron/TIBC
<20% may indicate IDA
What does the combination of pancytopaenia and splenomegaly imply?
Myelofibrosis
Which leukaemia most commonly causes pancytopaenias?
Hairy Cell
What is the key feature of extravascular haemolytic anaemia?
Splenomegaly
Which complication commonly occurs in Hereditary Spherocytosis?
Gallstones
Name one serious complication of Hereditary Elliptocytosis.
Hydrops Foetalis
What can precipitate an acute G6PD attack, presenting with jaundice, anaemia and heinz bodies and bite cells on blood film?
Drugs
Broad Beans
In which condition are target cells commonly seen?
Sickle Cell Disease
How are the types of vWD characterised?
1: Low
2: Dysfunctional
3: Absent
What is Factor V Leiden?
Resistance to Protein C = Thrombosis
What would be the target INR for a patient after their first DVT/PE?
2.5
What would be the target INR for a patient after recurrent DVTs?
3.5
What do you do if a patient on warfarin presents with an INR of 6?
Withhold doses until below 5
Which blood components decrease in pregnancy?
Hb HCT Plt Factor XI Protein S
How does Binet Staging work?
A = <3 lymph nodes B = >3 lymph nodes C = Anaemia/Thrombocytopaenia
Which type of Burkitt’s lymphoma affects the jaw?
Endemic
Which disease is associated with Mycosis Fungoides?
Cutaneous T-Cell Lymphoma
How would you treat Essential Thrombocytopaenia?
Anagrelide
How would you distinguish Circulatory Overload from Acute Lung Injury (Post transplant)?
Signs of Cardiac Failure (Raised JVP/PCWP) in acute lung injury
A patient presents with skin depigmentation, nodules, trophic ulcers and nerve thickening. What is the likely diagnosis?
Hanson’s Disease
Mycobacterium leprae
An immunocompromised patient presents with disseminated TB. What is the most likely diagnosis?
Mycobacterium Avium Intracellulare Complex
A man from Australia presents with painless nodules which are beginning to ulcer, scar and contract. What is the most likely diagnosis?
Mycobacterium ulcerans
Name a gram negative cocci that can cause typical Pneumonia.
Moraxella cattarrhalis
Which bacteria are included in the HACEK group?
Haemophilus Acinetobacter Cardiobacterium Eikinella Kingella
What is the most likely cause of secretory diarrhoea in an under 6 year old?
Rotavirus
How many copies of an organism must be present in urine to diagnose a UTI?
> 10^4/ml
What is the most common cause of infection in a prosthetic joint?
Coagulase negative Staph ie. epidermidis
How would a brain abscess present?
Signs of SOL
Swinging fevers
How is Chlamydia diagnosed?
NAAT from urethral swab
What is Lympho-Granuloma Venereum?
Chlamydia infecting lymph nodes
What can cause painful inguinal buboes and genital elephantosis?
Lympho-Granuloma Venereum
What is the role of Haemagglutinin in Influenza?
Viral Entry
What is the role of Neuraminidase in Influenza?
Cleaves sialic acid for exit of infected cells
What is the third line treatment for CMV?
Cidofovir
Which antivirals can be used for Hep C?
N33/4 Protease Inhibitors
Which virus causes Measles?
Morbillivirus
A man who drank some untreated milk presents with an undulant fever that peaks in the evening. What is the most likely diagnosis?
Brucellosis
A patient presents with a fever and conjunctival haemorrhages a day after going swimming in a river. What is the most likely diagnosis?
Leptospirosis
L.interrogans
A man presents with painless round black lesions with a rim of oedema, and a mediastinal haemorrhage. What is the most likely diagnosis?
Anthrax
Which type of drug is Amphotericin?
Polyene
Which gene is mostly implicated in CJD?
129 codon MM
What are the different types of Renal Tubular Acidosis?
1 = Can't excrete H+ 2 = Can't reabsorb bicarbonate 4 = Resistant to aldosterone
What are the key features of hypokalaemia?
Muscle Weakness
Cardiac Arrhythmias
Polyuria
Polydipsia
What can cause a sine wave on ECG?
Severe Hyperkalaemia
Why is ALP normal in Myeloma?
Plasma Cells suppress osteoblasts
When is Urobilinogen raised?
Pre-Hepatic Jaundice
Which porphyria presents with urine colour change (Port Wine) with abdominal pain?
Acute Intermittent Porphyria
Which porphyria presents with both neurovisceral and cutaneous lesions?
Variegate
HCP
What is the deficiency causing Acute Intermittent Porphyria?
HMB Synthase
What do skin lesions look like in porphyrias?
Blisters on the back of hands that worsen in the sun.
What size does a tumour have to be to be considered a macroprolactinoma?
> 10mm
What is the mainstay of management for Acromegaly?
Transphenoidal Surgery
Which Thyroid Disease might display ‘Hurthle Cells’?
Hashimoto’s Thyroiditis
What is the most likely diagnosis if a patient has a ‘stony hard thyroid’?
Riedel’s Thyroiditis
Which tumours are seen in MEN1?
Pituitary Adenoma
Parathyroid Hyperplasia
Pancreatic Neuroendocrine Tumours
Which tumours are seen in MEN2a?
Parathyroid Hyperplasia
Phaeochromocytoma
Medullary Thyroid Carcinoma
Which tumours are seen in MEN2b?
Phaeochromocytoma
Medullary Thyroid Carcinoma
Neuromas
‘Marfinoid’
A patient with AF presents with confusion and states they are ‘seeing yellow’. What is the likely diagnosis?
Digoxin Toxicity
What is the most common radiolucent cause of nephrolithiasis?
Uric Acid
What is the most specific enzyme for Acute Pancreatitis?
Lipase
Which enzyme is raised in Duchenne’s?
Creatine Kinase
How long does Troponin remain raised for after an MI?
Up to 10 days
Which vitamins are commonly deficient in patients with malabsorption syndromes?
Fat soluble (ADEK)
What causes Farmer’s Lung?
Saccharopolyspora rectivirgula
What causes Pigeon fancier’s lung?
Proteins in excreta/feathers
What is the most common cause of IDA in developing countries?
Hookworm
What is hereditary Pyropikilocytosis?
AR condition where erythrocytes are abnormally sensitive to lysis by heat
What does Hyxroxycarbimide do?
Used in SCD/Myeloproliferative disorders to increase foetal haemoglobin levels
In which scenario is transfusion a better treatment for iron deficiency than oral iron?
Sepsis and severe infection, as oral iron won’t absorb well.
How is Pyridoxine (B6) used as a medication?
It promotes RBC production, can be used in disorders with ineffective erythropoiesis such as Sideroblastic Anaemia
What would you see on iron studies of a pregnant lady?
High Iron
High TIBC
Normal Ferritin
Which investigation is most likely to provide a definitive diagnosis in a patient with pancytopaenia?
Bone Marrow Biopsy
How is B12 deficiency treated?
Hydroxocobalamin
When must folic acid replacement not be given?
If the cause of the deficiency is unknown, as this may exacerbate the neuropathy of B12 deficiency
Which enzyme might be raised in Haemolytic Anaemias?
Lactate Dehydrogenase
When might haptoglobin be low, and why?
Intravascular Haemolytic Anaemia, since it binds free haemoglobin
Which enzyme deficiencies might cause a Haemolytic Anaemia?
Glucose-6-Phosphate Dehydrogenase Deficiency
Pyruvate Kinase Deficiency
How is G6PD Deficiency inherited?
X-Linked
When would you investigate G6PD Deficiency?
2-3m after a crisis with an enzyme assay
How is Pyruvate Kinase Deficiency inherited?
Autosomal Recessive
How is Sickle Cell Disease inherited?
Autosomal Recessive
How is HbA made up?
2x Alpha
2x Beta
How is HbA2 made up?
2x Alpha
2x Gamma
How is HbF made up?
2x Alpha
2x Delta
in which condition might you see a classical ‘hairs on end’ skull X-Ray?
Beta-Thalassaemia
What is Paroxysmal Cold Haemoglobulinaemia?
Hb in the urine caused by a viral infection. Donath-Landsteiner Antibodies stick to Abs in the cold, and complement attacks RBCs as you warm up, leading to haemolysis.
How are warm autoimmune haemolytic anaemia and cold agglutinin disease distinguished?
Warm: IgG, Spherocytes
Cold: Raynaud’s, IgM
How is TTP treated?
Emergency plasma exchange
What is the pentad of TTP?
MAHA Fever Renal Impairment Neurological Abnormalities Thrombocytopaenia
What is paroxysmal nocturnal haemoglobulinuria?
Chronic intravascular haemolysis at night due to complement-mediated lysis. Cause morninghaematuria and thrombosis
How do you diagnose Paroxysmal Nocturnal haemoglobulinuria?
Ham’s Test
What is the difference between Acute and Chronic ITP?
Acute = Children, self limiting Chronic = Adults, long-term
Which factor is low in vWD?
Factor 8
Why might you continue LMWH when starting warfarin?
Warfarin is initially procoagulant due to Protein C/S deficiency
What does Heparin potentiate?
Antithrombin III
When is Vitamin K indicated?
INR over 5 and bleeding
INR over 8 and not bleeding
When is prothrombin complex concentrate indicated?
Major bleeding
Intracranial haemorrhage
When should Anti-D be given to Rh-ve mothers?
28 weeks
Sensitising Events
At delivery if baby is Rh+ve
In which CML phase are there <5% blasts?
Chronic
What is the difference between CLL and SLL?
SLL = LNs CLL = BM
Which NHLs are B Cell Lymphomas?
Burkitt's Mantle Cell MALT DLBC Follicular
In which lymphoma might you see a ‘nodular/follicular appearance’?
Follicular
In which lymphoma might you see ‘angular/clefted nuclei’?
Mantle Cell
Which T Cell lymphoma is most aggressive?
Anaplastic
Which agent can be used in the management of T Cell Lymphomas/
Alemtuzumab
What is smouldering myeloma?
> 10% clonal plasma cells, but no CRAB symptoms
How are AML and myelodysplastic syndromes distinguished?
<20% blasts in Myelodysplastic syndromes
What are Pelger-Huet Cells?
Right shifted hyposegmented neutrophils seen in MDS
What is Dyskeratosis Congenita?
X-Linked Aplastic Anaemia
Triad of skin pigmentation, nail dystrophy and oral leukoplakia
What causes Psuedopolycythaemia?
Normal Hb, reduced plasma volume, often due to burns, dehydration and diarrhoea
Which conditions are associated with Massive Splenomegaly?
Myelofibrosis
CML
What is Essential Thrombocytosis?
MPD where megakaryocytes dominate the bone marroow
What might increase the risk of a patient experiencing anaphylaxis due to a transfusion?
IgA Deficiency
What mediates ABO incompatiblity?
IgM
What is a Gohn Focus?
Primary latent TB lesion
What does BCG stand for?
Bacille-Calmette-Guerin
Name a gram negative rod that causes typical pneumonia.
Klebsiella pneumoniae
Name a gram +ve diplococci that causes pneumonia
Streptococcus pneumoniae
Name a gram -ve cocco-bacilli that causes typical pneumonia.
Haemophilus influenzae
Name a gram +ve cocci that grows in ‘grape-bunch clusters’ that causes pneumonia.
Staphylococcus aureus
What is the CURB 65 score?
Pneumonia Severity Confusion Urea >7 RR >30 BP <90/60 >65yo
What is more likely to be seen in subacute than acute IE?
Signs O/E such as Osler’s Nodes, Roth spots, janeway lesions and splinter haemorrhages
What are the major criteria of the Duke’s Score?
New Murmur
2x blood cultures
What might cause cellulitis in shellfish handlers?
Vibrio vulnificus
Which antibiotics most commonly cause pseudomembranous colitis?
Ciprofloxacin
Cephalosporins
Clindamycin
What is secondary syphylis?
Rash and genital warts 1-6m after infection
What is tertiary syphylis?
2-3y after infection
Granulomas
Dementia
Cardiac Disease
How is syphylis investigated?
Dark-ground microscopy
What causes beefy red ulcers and donovan bodies?
Donovanosis (Granuloma Inguinale)
Which condition is associated with a whiff test and clue cells?
BV
What causes Molluscum Contagiousm?
Poxvirus
Which antibiotic classes target Cell Walls?
Beta Lactams
Glycopeptides
Which antibiotic classes target protein synthesis?
Aminoglycosides Tetracyclines Macrolides Chloramphenicol Oxazolidinones
Which antibiotic classes target DNA synthesis?
Fluoroquinolones
Nitroimidazoles
Which antibiotics target RNSA Synthesis?
Rifamycin
Which antibiotics are cell membrane toxins?
Polymyxin
Cyclic Lipopeptides
Which Antibiotics target folate metabolism?
Sulfonamides
Diaminopyrimidines
What are the BEAT mechanisms of antibiotic resistance?
Bypass antibiotic-sensitive step (MRSA) Enzyme-mediated inactivation (Beta Lactamase) Accumulation impairment (Tetracycline) Target Modification (Quinolone)
What causes Kaposi’s Sarcoma?
HHV8
Which viruses aren’t dsDNA viruses?
Hepatitis
MMR
Parvovirus B19
Which hepatitis is always a coinfection?
Hep D
with B
Which Hepatitis is usually a self-limiting, mild infeciton, but may cause severe disease in pregnancy?
Hepatitis A
Which virus, when caught antenatally, may lead to severe congenital microcephaly and skull deformities?
Zika
Which antibodies are positive in Hep B vaccination?
Anti-HBs
Which antibodies are present in previous Hep B infection?
Anti-HBs
Anti-HBc
Which antibodies are present in chronic Hep B infection?
HBsAg
Anti-HBc
How is Dengue spread?
Flavivirus by Aedes Mosquito
Which disease might cause dry gangrene, swollen lymph nodes and is spread by fleas?
Plague (Yersinia Pestis)
Which disease causes disfiguirng dermal disease in a malnourished child?
Visceral Lesihamania (Kala Azar)
What does a high Osmolar gap imply?
Unmeasured solutes in the serum (toxins etc)
What does ALP stand for?
Alkaline Phosphatase
What does AST stand for?
Aspartate Aminotransferase
What does ALT stand for?
Alanine Aminotransferase
Which LFT result is characteristic of Alcoholic Liver Disease?
2:1 AST:ALT
Which LFT result is characteristic of Viral hepatitis?
1:1 AST:ALT
Which LFT result is characteristic of Chronic Liver Disease?
ALT>AST
What might cause a urea 10x higher than usual?
Upper GI Bleed
AKI (urea secreted renally)
When are pale stools/dark urine seen?
Post-hepatic jaundice
What stimulates ACTH release?
CRH
Which hormones are given in a combined pituitary test?
Insulin TRH LHRH Normal = Adequate increase in related hormones. Abnormal = Hypopituitarism
In which condition might you have a raised Aldosterone:Renin ratio?
Conn’s
What is activated vitamin D called?
Calcitriol
What are the types of activated vitamin D used as medication?
Ergocalciferol (Plants, C2)
Cholecalciferol (Animals, C3)
Which form of Vitamin D is stored and measured?
25-hydroxy-cholecalciferol
Inactive
Liver
When might ALP be pathologically less than 5x higher than normal?
Bone Tumours
PPV vs Sensitivity
PPV = probability it's a true positive Sensitivity = Probability someone with the disease will.test positive
NPV vs Specificty
NNV = Probability it's a true negative Specificity = Probability someone without the disease will correctly test negative
Normal GFR?
120ml/hr
What is Wiskott-Aldrich Syndrome?
Eczema
High IgA/IgE
Low IgM
WAS gene mutation
What does IPEX (FoxP3) stand for?
Immune dysregulation, polyendocrinopathy, enteropathy
What does APS 1 (AIRE) stand for?
Auto-immune polyendocrine syndrome type 1
What does APECED (AIRE) stand for?
Auto-immune polyendocrinopathy candidiasis ectodermal dystrophy syndrome
What does ALPS (FAS) stand for?
Auto-Immune Lymphoproliferative Syndrome
What happens in APECED/APS1?
Abnormality in T Cell tolerance = multiple autoimmune diseases
What happens in ALPS?
Abnormality in lymphocyte apoptosis = High WCC and lymphomas
What happens in IPEX?
Abnormality in T Regulatory Cells leads to diarrhoea, dermatitis and dementia
Name two genetic polymorphisms associated with polygenic auto-immune diseases.
PTPN22 = RA, SLE, T1DM CTLA4 = SLE/T1DM/Autoimmune Thyroiditis
Which HLA is associated with Pernicious Anaemia and Hashimoto’s Thyroiditis?
DR5
Which HLA is associated with Haemochromatosis?
A3
What is serum sickness?
Reaction to proteins in penicillin
T3HS
Which hypersensitivity type is Chronic urticaria?
Type 2
Which antibody is associated with mixed connective tissue diseases?
Anti-U1RNP (speckled pattern)
What does Anti-jo1 target?
t-RNA synthetase
What is direct transplant recognition?
Donor APC presents antigen to recipient T Cells
What is indirect transplant recognition?
Recipient APCs present antigens to recipient t Cells
What would a typical HAART regimen be?
2x NRTI + PI
What is injected in the mantoux test?
Tuberculin
What size induration indicates a positive mantoux test?
10mm
How many Duke’s minor criteria are needed for diagnosis?
5
or 3 if one major
Which histological pattern is required for diagnosis of Cryptogenic Fibrosing Alveolitis/Idiopathic Pulmonary Fibrosis?
Usual Interstitial Pneumonia (sub-plural honeycomb change in periphery)
What is Extrinsic Allergic Alveolitis?
Inhaled organic antigens leading to immune-mediated alveolar inflammation
Polypoid Plugs of loose connective tissue
What are found in both Juvenile Polyposis and Peutz-Jegher’s Synrome?
Hamartomatous Polyps of the Bowel (Non-neoplastic)
What is Gardner’s Syndrome?
Familial Adenomatous Polyps (APC AD) with extra-GI features (Dental caries, osteomas)
What is Lynch Syndrome/HNPCC?
Carcinomas in right colon, associated with gynae cancers
What stimulates pancreatic exocrine function?
Secretin
CCK
What is metabolic syndrome?
Hyperglycaemia HTN Obesity Dyslipidaemia Microalbuminaemia
What is Acinar Cell Carcinoma?
Cancer of exocrine cells of pancreas
Positive for lipase, trypsin and chymotrypsin
What are the zones of a liver lobule?
1 = periportal hepatocytes 2 = mid 3 = Perivenular Hepatocytes (liver enzymes)
When might you see spotty necrosis?
Acute Hepatitis
When might you see ‘Piecemeal Necrosis’?
Chronic hepatitis
What is the critical histological stage linking chronic hepatitis to cirrhosis?
Bridging from portal vein to central vein
Describe the histopathology of a cirrhotic liver.
Hepatocyte Necrosis
Fibrosis
Nodules of regenerating Hepatocytes
Disturbance of vascular architecture
How is prognosis calculated in cirrhosis?
Modified Child’s Pugh Score
What are the factors assessed in the Modified Child Pugh Score?
Albumin Bilirubin Clotting Distension Encepalopathy
How is cirrhosis classified?
Micronodular = <3mm = Alcohol/Bile Macronodular = >3mm = Viral/Wilson's/A1At
Which form of NAFLD sis benign and shows mild fatty infiltration?
Simple Steatosis
Which form of NAFLD shows Steatosis and Hepatitis?
NASH
Which antibodies are associated with Autoimmune Hepatitis?
ANA/Anti-SM
Anti-LKM
Which biliary disease shows ‘Onion-Skinning fibrosis’?
PSC
How is HCC monitored?
Alpha-fetoprotein
Which stain is used for Alpha-1-antitrypsin deficiency?
Periodic Acid Schiff
Which procedure may be used to treat Benign Prostatic Hyperplasia?
TURP
Which testicular tumours don’t arise from Germ Cells?
Sertoli cell (Sex Cord) Leydig Cell (Stroma)
Which Renal Cancers have:
a) Nests of epithelium
b) Papillary/Tubulopapillary growth
c) Sheets of large cells with distinct border?
a) Clear Cell
b) Papillary
c) Chromophobe
Which tumour of the bladder has frond-like growths projecting from the bladder wall which are lined by epithelium?
Non-Invasive Papillary Transitional cell carcinoma
Which bladder cancer has the most invasive behaviour?
Invasive Urothelial Transitional Cell carcinoma
What is benign familial haematuria?
Thin basement membrane disease = TypeIV collagen, asymptomatic haematuria
What does loss of podocyte foot processes indicate?
Nephrotic Syndrome
What causes Nephrotic Syndrome?
Primary = FSGS, MG, MCD Secondary = Diabetes, Amyloidosis
What causes Nephritic Syndrome?
Post-Strep IgA Nephropathy Rapidly Progressive (Crescentic) Alport's Syndrome Thin basement Membrane Disease
What might cause Rapidly Progressive Glomerulonephriritis?
Goodpastures
Immune complex (SLE, Alport’s)
ANCA (Polyangiitis)
Which cause of nephritic syndome shows linear deposition of IgG in the glomerular basement membrane?
Goodpasture’s
Which cause of nephritic syndromes shows ‘granular IgG deposition’?
Immune-Complex mediated
which cause of nephritic syndrome shows ‘a lack of immune complex deposition’?
Polyangitides
What might cause asymptomatic haematuria?
Thin basement membrane disease
IgA Nephropathy
Alport Syndrome
Which IG is deposited in post-strep glomerulonephritis?
IgG
A man presents with a fever, rash, haematuria and proteinuira/ He is found to have an eosinophila, and a renal biopsy shows inflammatory infiltrate with tubular injury and granulomas. He recently started a course of NSAIDs. What is the most likely diagnosis?
Acute Interstitial Nephritis
What is the triad of HUS?
MAHA
Thrombocytopaenia
Renal Failure
Why might you get a murmur in Polycystic Kidney Disease?
Mitral Valve Prolapse
In which condition might you see ‘wire-loop capillaries’ and ‘lumpy bumpy granular deposition in the GBM’ on a renal biopsy?
Lupus Nephritis
In which cancers might you see Psammoma Bodies?
Papillary Thyroid
Serous Cystadenoma
Which cell type is seen in serous cystadenomas?
Columnar Epithelium
Which morphology is seen in endometroid ovarian cancer?
Tubular Glands
Which cancer has a ‘hobnail appearance’?
Clear Cell Ovarian
Which ovarian cancers secrete B-HCG?
Choriocarcinoma
Which tumour is associated with Meig’s Syndrome?
Fibroma
Which ovarian cancer produces Oestrogen?
Granulosa-Theca Cell tumour
Which ovarian cancer secretes androgens?
Sertoli-Leydig Cell
How is FIGO staging done?
1 = Ovaries 2= Pelvis 3 = Abdomen 4 = Distant
How does CIN staging work?
1 = lower 1/3 epithelium 2 = Lower 2/3 3 = Full thickness
How is Lobular carcinoma in situ identified?
Incidentally on Biopsy
What are the forms of breast carcinoma in situ?
Lobular
Ductal (microcalcification of mammogram)
On breast biopsy, you see ducts filled with atypical epithelial cells. What is the likely diagnosis?
Carcinoma in situ
Which medication targets HER2 in breast cancer?
Herceptin
Which medication targets ER in breast cancer?
Tamoxifen
Which breast cancer is associated with BRCA?
Basal-Like carcinoma
Which territory is most likely occluded if a stroke presents with contralateral leg paresis?
ACA
Which territory is most likely occluded if a stroke presents with contralateral weakness of face and arm?
MCA
Which territory is most likely occluded if a stroke presents with contralateral hemianopia/quadrantanopia?
PCA
Which territory is most likely occluded if a stroke presents with ipsilateral ataxia and horner’s?
PICA
How does Lewy Body Dementia (ASyn) present?
Parkinsonism, fluctuations in cognitive ability and hallucinations
What is the main component of Lewy Bodies?
Alpha-Synuclein
Which proteins are targeted in Multiple Sclerosis?
Myelin Basic protein
Proteo-Lipid protein
XR features of osteoporosis?
None
Crystal colours to polarised parallel light?
Gout = Yellow Pseudogout = Blue
In which condition are ‘Brown Tumours’ seen?
Primary Hyperparathyroidism
What causes osteomyelitis in SCD patients?
Salmonella spp
What causes osteomyelitis in children?
Haemophilus influenzae
Group B strep
How does osteomyelitis present?
Fever, malaise, pain, swelling and tenderness
In which condition might you see Heberden’s Nodes and Bouchard’s Nodes?
Osteoarthritis
What are the x-ray features of Osteoarthritis?
LOSS Loss of joint space Osteophytes Subchondral Sclerosis Subchondral Cysts
Which joints are spared in Rheumatoid Arthritis?
Distal Interphalanegal Joints
Which skin condition has ‘saw-toothing of rete ridges’ on histology?
Lichen Planus
Which skin condition is IgA mediated?
Dermatitis Herpetiformis
Which skin condition has a ‘Buckshot Appearance’ on histology?
melanoma
What is Bowen’s Disease?
Flat, red, scaly patches on sun-exposed areas
How does Actinic Keratosis look on histology?
SPAIN Solar elastosis Parakeratosis Atypia Inflammation Not full thickness
What does Bowen’s Disease progress to?
Squamous Cell Carcinoma
Which skin lesions have a ‘waxy, stuck on appearance’?
Seborrhoeic Keratosis
A patient presents with sheets of skin detachment, with a positive Nikolsky sign. They recently started a new anti-convulsant. What is the most likely diagnosis?
Stevens-Johnson Syndrome
How does Pityriasis Rosea present?
Salmon pink rash (herald patch) followed by oval macules in a Christmas Tree formation
Which disease is associated with a ‘Corkscrew Appearance’ on angiogram?
Buerger’s Disease
What is the triad of Granulomatosis with Polyangiitis?
Saddle Nose
Haemoptysis
Glomerulonephritis
Which vasculitis presents with an absent pulse?
Takasayu’s Arteritis
What can cause AA amyloidosis?
RA (and other autoimmune)
TB
Renal Cell carcinoma
Which enzyme might be raised in Sarcoidosis?
ACE
Which blood group is universal for fresh frozen plasma?
AB
Which tumour is associated with pseudomyxoma peritonei?
Mucinous cystadenoma
How does ALUM work?
Promotes B Cell differentiation
Which component of COVID does the vaccine target?
Spike Protein
Which IL-6 Inhibitor can be used in hypoxic COVID?
Tocilizumab
What is zanamivir used for?
Hepatitis A
Which broad spectrum antibiotic is typically given in penicillin-allergic patients?
Clarithromycin
