Past paper Flashcards
Man has an MI 3 years ago. Now comes into hospital feeling very unwell. Is having a sample taken from their pericardial layer and you find blood is aspirated from the pericardium
Left ventricular rupture
IV antibiotic for Group A Strep pharyngitis/Strep Throat?
Benzylpenicillin
Vitamin deficiency: C (ascorbate)
Scurvy
Vitamin deficiency: B6 (pyridoxine)
Dermatitis, anaemia, neuropathy
Rate limiting step in haem biosynthesis pathway:
ALA synthase (aminolevulinic acid)
MEN2b associations:
Phaeo, medullary thyroid, mucocutaneous syndromes, marfans
Which/What cell is increased in cases of a parasitic infection
Eosinophils
57 year old man presents following hematemesis and is found to have: High ALT + GGT, and slightly raised ALP. Low Albumin
Alcohol induced hepatitis
Pneumonia: transplant patient on immunosuppressive. Halo sign on X-ray
Aspergillus
Autoimmune and auto-inflammatory disease: MEFV gene, abdominal pain and ascites
Familial Mediterranean Fever
SBA: drug can be used to treat some malignancies and affects T cell activity
Pembrolizumab (treat inoperable or metastatic melanoma, metastatic NSCLC)
Bicarbonate in a pyloric stenosis patient
High
A man after a road traffic accident (Man vs Car) requires a 6 unit transfusion, and then becomes acutely breathless/SOB, with a fever and tachycardia
TRALI
Management of acute angioedema:
IM adrenaline 0.5ml of 1:1000
Meningitis: gram positive diplococci
Strep pneumoniae
Pancreatic mass + hypoglycaemia
Pancreatic insulinoma (Islet cell tumour)
Vitamin deficiency: Folate
Macrocytic anaemia, neural tube defects
Liver Function Tests: Woman with colicky abdo pain, raised ALP
Gallstones
SBA: Characteristic of ALL
Anaemia, thrombocytopenia and neutropenia
AI disease markers: anti-centromere antibody
Limited cutaneous scleroderma (CREST syndrome)
German woman with recurrent URTIs + UTIs. She has low neutrophils.
Chronic idiopathic neutropenia
Gram positive rod causing meningitis in a 72-year-old?
Listeria
AI disease markers: Anti-endomysial
Coeliac disease
Drowsy teenage girl with CSF: raised protein + raised lymphocytes
Viral meningitis
Man with weakness in the gym and ptosis
MG. Anti-ACh receptor
A smoker is found to have a Gram Positive diplococci causing meningitis. Which microorganism is the most likely cause?
Streptococcus pneumoniae
Autoimmune and auto-inflammatory disease: due to mutations in the FAS pathway
Autoimmune lymphoproliferative syndrome (ALPS)
What lab test would you use for: diagnosing temporal arteritis
Initally ESR then temporal artery biopsy
Obstetric haematology: slightly reduced platelet count in 3rd trimester (100 x 10^9)
Gestational thrombocytopenia
Sodium handling: patient with lung cancer. High sodium, low potassium
Ectopic ACTH secretion, due to lung cancer
Lump that moves around
Fibroadenoma
Mab Used to treat Lymphoma and RA
Rituximab (anti-CD20)
SBA: Middle aged lady, loss of bile ducts and granulomas present
Primary Biliary cirrhosis
Woman presents with aches all over, (diffuse swelling), and joint stiffness?
Rheumatoid arthritis. Anti-CCP
VSA: Name an infectious microorganism which is a common cause of meningitis in 3 months or older new-borns?
Strep. pneumonia
VSA: infectious microorganism which is a common cause of sepsis in newborns
GBS (E.coli)
Meningitis: gram negative diplococcus
Neisseria meningitides
A German lady who is asymptomatic, has low neutrophils, but no abnormal cells on film
Chronic idiopathic neutropenia
Define impaired glucose tolerance (After 2hr OGTT)
BG: 7.8 – 11.1mmol/LImpaired fasting glucose = 6.1-7
Hyperuricaemia/uric acid excess is caused by:
Xanthine oxidase
Vaccine for splenectomised patients:
Pneumococcal vaccine
Treatment for Listeria meningitis
Amoxicillin
STI causing neonatal conjunctivitis
Gonorrhoea, chlamydia
Causes of hydrops fetalis < 20 weeks gestation
Parvovirus B19 (erythrovirus), CMV, HSV, toxoplasma gondii, treponema pallidum
Woman with UTI: gram positive cocci in clusters
Staph saprophyticus
SBA: Most likely cause of HAP?
Staphylococcus aureus (closely followed by Pseudomonas)
Cause of Karposi’s sarcoma
HHV8
VSA: mixed pattern auto-inflammatory condition has over 90% heritability and effects the sacroiliac joint
Ankylosing Spondylitis
Known breast cancer + red/rough nipple
Pagets disease of the breast, or DCIS
10 year old with seizures. Low calcium, high phosphate, high PTH
Secondary hyperparathyroidism, due to renal osteodystrophy. (Low calcium can cause seizures)
Protozoa causing infection in pregnancy
Toxoplasma gondii
A glycopeptide used to treat MRSA
Vancomycin or teicoplanin
What is the mass that can for following acute pancreatitis:
Pancreatic pseudocyst
Tx for Young women with cystitis and fully sensitive E-Coli.
Trimethoprim
Most common type of malignancy in the breast?
Invasive ductal carcinoma
VSA: used to measure the turnover of bone, and is raised in people who have Paget’s orOsteomalacia
ALP
Which of these options causes DIC (in pregnancy)?
Amniotic fluid embolism
Breast Cancer which has a high, medium and low stage to it
DCIS
VSA: raised in obstructive jaundice/biliary obstruction
ALP
SBA: Which Hepatitis does not lead to/cause Chronic Hepatitis
Hepatitis A
By what mechanism does GORD cause cancer?
dysplasia
Sodium handling: Patient becomes drowsy after Road traffic accident
Cranial Diabetes Insipidus (Due to trauma)
Pneumonia: weight loss, haemoptysis, upper lobe cavitation
TB
What is the most common cause of traveller’s diarrhoea?
E Coli
SBA: Cancer with transitional cells on histology. Where is the primary?
Bladder
What drug do you use to treat influenza A?
Oseltamivir
Pathogen found in badly collected urine sample
Staph A
Vaccine preventable disease: causes lumps in parotid and neck
Mumps
Patient with JAK2 mutation has raised haemoglobin, and gets pruritus following showering.
Polycythaemia Rubra Vera
Material seen in the vessel of a burst atheroma in a patient with an MI
Atheromatous plaque
SBA: Diarrhoea and weight loss + patchy inflammation and granuloma
Crohn’s disease
20 year old rugby player with boils. Rest of his team have them, and so do his family
Herpes gladiatorum (Type of HSV-1)
Rash on penis, soles, hands
Syphilis
SBA: Gout medication contraindicated with Allopurinol
Azothioprine
Requires C-section if mu has outbreak >34 weeks
Primary HSV infection
A man with Atrial fibrillation develops fever, nausea, vomiting and pain in his right loin/flank. What is the most likely cause?
Renal infarct
AI disease markers: anti-Ro. Patient has dry eyes
Sjogrens syndrome
Bloated after drinking milk but not IgE mediated
Lactose intolerance
Leukaemia: Middle aged person. t(9:22) present, BCR-ABL. Blood film shows 3% blasts
CML
An 18 year old students is found to have Gram Negative diplococci causing meningitis. Which microorganism is the most likely cause?
Neisseria meningitides
In Rhabdomyolysis, which biomarker is likely to be raised?
Creatinine Kinase
Woman with progressive amnesia dies from bronchopneumonia
Dementia (Alzheimers?)
24 year old asymptomatic man with isolated rise in unconjugated bilirubin (all other results (ALT, ALP etc normal)
Gilberts
Old woman falls and breaks her hip. What condition does she have?
Osteoperosis
Cause of molluscum contagiosum
Poxvirus
Elderly man with atrial fibrillation with right flank pain?
Renal infarcts
Vitamins: Young patient with bowed legs
Vit D deficiency (Ricketts)
ChemPath investigations: Diabetic visiting GP for routine appointment
HbA1c
A lady has frank (visible) painless haematuria and a mass palpable on one side. What is the most likely cause?
Renal cell carcinoma
VSA: massive splenomegaly, and JAK2 V617F mutation with a leucoerythroblastic picture and tear-drop poikilocytes
Myelofibrosis
Metabolic acidosis. High potassium.
T1DM
What happens to the body of the stomach in a patient with pernicious anaemia?
Atrophic body gastritis
VSA: Which common condition can be treated with drugs that target with TNF, IL-17 and IL-12/23?
Psoriasis
Sudden headache, loss of consciousness and meningism
Sub-arachnoid haemorrhage
Core biopsy coding: B5
B5 = malignant. B5a = DCIS, B5b = invasive carcinoma
Cause of haemorrhagic cystitis post-transplant
BK virus
Patient with recurrent pneumococcal infections and meningitis
C3 deficiency (or alternative pathway deficiency)
An elderly gentleman has really elevated ALP on it’s own, and the other results are normal. He also reports a history of headaches
Paget’s disease
Broad spectrum antibiotic with no pseudomonal activity. Usually given with a beta lactamase inhibitor
Amoxicillin (given with clavulanic acid = co-amoxiclav)
High sodium, low potassium, high urine osmolarity
Conns syndrome
Carcinoma due to H. Pylori infection
Gastric adenocarcinoma
22 year old student with two weeks anorexia, fever and malaise – raised ALT, normal ALP + GGT
Viral hepatitis
Patient with high IgG paraprotein – (32 or 40) g/dl, back pain and loss of sensation in legs
Multiple myeloma
Most common cause of UTI: in general
E. coli
Vitamins: Patient with Pellagra
B3 deficiency (3Ds- Dementia, diarrhoea, dermatitis {necklace rash})
SBA: Vector of Trypansoma brucei?
Tsetse Fly
What cancer can the Bruton Tyrosine kinase inhibitor ibrutinib be used in?
CLL
Sodium handling: HTN, High Na, Low K, high renin
Renal artery stenosis (Renin low in Conns)
Meningitis: aseptic (unable to culture), raised lymphocytes, raised protein, normal glucose
Viral meningitis
Cell of immune system: differentiated B cell that produces immunoglobulins
Plasma B cell
Wegener’s immunotherapy:
Cyclophosphamide (+ corticosteroids)
Obstetric haematology: recurrent first trimester miscarriage
Antiphospholipid syndrome
ChemPath investigations: Pt can’t fit on shoes or put on wedding ring and has prognathism. Which test to confirm?
OGTT (measure GH- should be suppressed) {Can also measure IGF-1 levels}
A man is injured playing sports. He is found to have pancytopenia and immature myeloid cells on blood film. WCC normal.
AML
What enzyme regulates the rate limiting step in haem biosynthesis pathway/of the blood?
ALA synthase
What lab test would you use for: diagnosing thalassaemia
Hb electrophoresis
A (?teenager?) presents with a history of several weeks of increased thirst (polydipsia), increased urination (polyuria) / High urinary output and weight loss:
T1DM
Autoimmune and auto-inflammatory disease: associated with Nod2/CARD15
Crohn’s disease
INRs and appropriate management: patient with a previous DVT, INR 4
Decrease dose of warfarin to aim for target INR of 2.5 (2-3)
Young boy has normal B cells, but no CD4+ or CD8+ cells
X-linked Severe combined immunodeficiency
AI disease markers: anti-CCP
Rheumatoid arthritis
50 year old lady with memory issues/progressive amnesia, hypertension (?? + bronchopneumonia??)
Multiple cerebral infarcts
SBA: Dad and brother of dead individual disagree over having an autopsy. The Dad was the main carer but no mention of Standing order or special status assigned to dad by the dead individual.
An autopsy can be done but to settle the disagreement it goes to a special court
Allergy: patient gets allergy symptoms every summer, with a runny nose
Allergic rhinitis
Cause of positive NAAT test + PID
Chlamydia trachomatis
Vaccine preventable disease: maculopapular rash starts on face. Can cause encephalitis and pneumonitis
Measles
Bitten woman in nigeria in with chills
Malaria
SBA: Why do the walls of vessels expresses anti-thrombotic factors
Thrombomodulin
A girl with a sore throat is given penicillin and develops a rash. She is found to have EBV.
Drug reaction
Blood transfusions: woman received a transfusion before her hysterectomy, presents with bleeding gums and rash on her shins on discharge
Post-transfusion purpura (presents 5-12 days after transfusion. Associated with thrombocytopenia)
Young man with fever, leucocytosis and petechial rash after URTI
Henoch–Schönlein purpura
A 2 year old has a palpable abdominal mass when his mother picks him up. What is the most likely cause?
Wilms tumour
SBA: Mouth/lip swelling following a dental procedure with a family history
C1 inhibitor deficiency
What lab test would you use for: bone marrow response to haemolytic anaemia
Reticulocytes
ChemPath investigations: Cushing-like woman, BP 109/100, thin skin, Overweight, high-normal sodium, low-normal potassium, OGTT (glucose high-normal)
Low dose dex suppression
Allergy: itchy mouth after eating certain fruits
Food allergy or anaphylaxis or oral allergy syndrome. IgE mediated
Vitamins: Person with Crohn’s and megaloblastic anaemia
Folate deficiency
Impaired glucose tolerance in OGTT
7.8-11.1
what enzyme is raised in osteomalacia?
ALP
Blood transfusions: what is most serious complication of blood transfusion
TRALI is the number 1 cause of transfusion mortality
A ward sister gets diarrhoea, and patients on the ward have been ill recently
Norovirus
Cell of immune system: responsible for the killing of cancerous cells, and is inhibited by MHC-1
NK cell
Which drug do you give to a woman who is infected with herpes simplex/ HSV1 encephalitis?
Aciclovir
Patient with raised IgM paraprotein (32)
Waldenstroms macroglobinaemia
Macrolide used to treat atypical pneumonias
Clarithromycin
VSA: Which clotting factor falls most rapidly after administering warfarin
Protein C
VSA: What zoonotic disease does the Ixodes Tick cause
Lyme disease (Borelia burgdorferi)
What cell sits in (it’s immature form in) the periphery, and when it matures, goes to present things to T cells?
Dendritic cell
SBA: Cause of rash in amoxicillin + IM
Drug reaction
Which/What enzyme is raised in mumps?
Amylase-S
SBA: Which cancer does asbestos cause?
Mesothelioma
Liver Function Tests: 20 year old with 2 weeks of anorexia, fever and malaise – raised ALT, normal ALP and GGT
Viral Hepatitis
SIADH related cancer
Small cell lung cancer
Which drug do you use to treat viral syncytial virus (bronchiolitis) in a child?
Ribavirin
Young girl from Bangladesh is pale and tired. Her blood film shows hypochromic RBCs and pencil cells
Pencil cells = IDA
Man with vertebral fracture and high paraprotein
Multiple myeloma
A women with known SLE presents with an exacerbation of her SLE/worsening symptoms. What do you measure?
C3, C4 (C4 drops first, then C3 in severe disease)
Man with penile discharge + gram negative diplococci
Neisseria gonorrhoea
SBA: Intermittent mouth and tongue swelling for past 2 years unresponsive to anti-histamines. Taking aspirin and ACEi
Drug induced reaction
GVHD disease pathophysiology i
pre-existing antibodies in the recipientpre-exisiting WBCs & their Abs in the graft i think - ollie
Organism in50 year old with septic arthritis
Staph aureus (46%), strep (22%), E.coli (rare)
Which cancer develops in Barrett’s oesophagus?
Oesophageal adenocarcinoma
Cancer in Coeliac disease. What would they get if they don’t follow a gluten free diet?
Lymphoma (EATL)
AI disease markers: anti-dsDNA
SLE
VSA: African man, with Burkitt’s lymphoma is given Rasburicase. He develops haematuria with irregularly contracted cells. What is the cause?
G6PD deficiency
Beta Lactam antibiotic with anti-pseudomonas activity
Carbapenem e.g. meropenem, enteropenem
Women has had some surgery which required antibiotics, and now has profuse watery diarrhoea
C. diff
Normal B and T cells, high IgM, absence of IgA, IgE and IgG
Hyper IgM syndrome
Which/What antibiotic would you use for cellulitis with MRSA (question specifies it HAD to be IV).
Vancomycin
Man has an allergic reaction during surgery and who’s lips becomes swollen/oedematous when blowing up balloons as his daughter’s birthday party
Type I / 1 hypersensitivity latex allergy
Postassium level in DKA is:
Raised (hyperkalaemia)
Obstetric haematology: woman has low platelets, schistocytes, headaches and seizures. Her blood pressure is 100/60
TTP
Craggy, enlarged prostate
Prostate adenocarcinoma
SBA: most common cause of jaundice + fever in traveller with fever
Malaria
Cell changes seen in GORD
Barret’s oesophagus/ metaplasia
What cancer is associated with chronic schistosomiasis
Bladder squamous cell carcinoma
When there is an infection, this cell is responsible for the production of pus when it dies
Neutrophils
Calculate osmolarity:
2(Na + K) + U + G
Boy with abscesses has a positive NBT
Myeloperoxidase deficiency if positive NBT (turns blue). Chronic Granulomatous disease if NBT negative (turns yellow)
Requires rapid vaccination at birth if mum is infectious
Hep B, TB
Cause of Neonatal thrombocytopenia?
Maternal ITP
Transplant complications: mechanism behind antibody mediated rejection
B-cell activation: antibody attacks vessels
Food poisoning question - after Chinese/rice based dinner
Bacillus cereus
Transplant complications: mechanism behind cellular reaction
CD4 activating a type IV reaction
Patient with JAK2 mutation has tear drop poikilocytes on blood film
Myelofibrosis
Blood transfusions: woman with O Rh+ blood is given A Rh- blood, what happens?
ABO immediate haemolytic reaction. Occurs immediately after transfusion. Sx: restlessness, fever, vomiting, loin/chest pain, collapse, haemoglobinuria
Pancreatic cancer: cancer is found in head of pancreas
Pancreatic ductal adenocarcinoma
Cause of genital warts
HPV 6 & 11
cause of UTI associated with renal calculi:
E coli, proteus
Vitamin deficiency: B3 (niacin)
Pellagra (dementia, diarrhoea, dermatitis – necklace rash)
Vaccine preventable disease: virus resides in pharynx & GIT. Can cause encephalitis and destruction of motor neurons
Polio
INRs and appropriate management: patient with AF, INR: 2.5
No change in medication required, target INR is 2.5
Neonate with meningitis: gram positive organism in chains
GBS
SBA: 10 year old Nigerian boy with a neck swelling + Starry sky
Burkitt’s lymphoma
Cancer due to coeliac disease
Enteropathy-associated T-cell lymphoma (EATL)
Lady who receives blood transfusion goes home, then develops rash all over and shortness of breath
Probably post transfusion purpura - usually presents 5–12 days after transfusion.
Possibly GVHD - usually fever, rash which progresses to T.E.N., also D & V.
Possibly allergic/anaphylaxis reaction.
Patient with IgM paraprotein and visual disturbances
Waldenstroms gammaglobulinaemia (lymphoblastic lymphoma)
Vitamin deficiency: B2 (riboflavin)
Glossitis, normocytic anaemia, dry mucous membranes
Potassium DKA
High
VSA: An elderly man has a fall, and doesn’t become unconscious/lose consciousness, and presents two days later with a confusion, where is the likely site of bleeding
Subdural haemotoma
SBA: True positive/Total with disease
Sensitivity
Young girl has been on holiday. She has low platelets, profound anaemia, oliguria. Blood film shows bite cells and schistocytes
G6PD deficiency or HUS
Vitamin deficiency: D (cholecalciferol)
Rickets, osteomalacia
Pneumonia: young patient with lower lobe consolidation
Strep pneumoniae
SBA: 50 y/o with Midshaft femur fracture. What most likely type of cancer?
Chondrosarcoma?
Which cancer is associated is E-cadherin positive?
Invasive ductal carcinoma
(Negative is invasive lobular Ca)
Subtypes of thyroid cancer:
· 60% Papillary – young. Psammoma bodies, 25% Follicular – middle age. 5% Medullary – MEN2, 5% Lymphoma – MALT origin, Anaplastic
Cell of immune system: expresses Foxp3 and CD25
T-reg cell
VSA: Name the main class of drug used to treat HIV
Nucleoside Reverse transcriptase inhibitors
What is deposited in the kidneys in multiple myeloma?
AL amyloid protein
SBA: Most specific marker for RA
Anti-cyclic citrullinated protein
Leukaemia: blood film shows smear cells
CLL
VSA: What type of amyloid is deposited in multiple myeloma
AL amyloidosis
Gram Negative diplocci - meningitis
Neiserria meningitidis
SBA: Woman found at home unresponsive with needles. Dies on way to hospital and they find next of kin, her brother. What do you do next?
Refer to coroner (for advice) as cause of death is unknown
A patient with well controlled HIV, who is currently on HAART. What would you measure?
Lymphocyte subsets. CD4
Sodium handling: patient with polyuria and polydipsia. Low sodium low potassium, low plasma and urine osmolarity
Psychogenic polydipsia
Normal change in pregnancy
rise in fibrinogen + F(VII, VIII, X), decreased fibrinolysis
MEN2a associations:
Parathyroid, phaeo, medullary thyroid
VSA: Denosumab target
RankL inhibitor
guy develops foul-smelling diarrhoea and cramping pain 5 days after eating chicken at a barbeque
Campylobacter
Vitamins: Patient with high PTH
Vit D deficiency (osteomalacia)
STI that can pass through placenta
Syphilis, HIV
High sodium, plasma osmolality 400, urine osmolality 600
Dehydration
Which enzyme if low, leads to hyperuricemia?
HGPRT in juvenile gout (lesch-nyhan syndrome)
Gram + rod (bacilli) that can pass through placenta
Listeria monocytogenes
A man has spherocytes, polychromasia and reticulocytosis on blood film
Hereditary spherocytosis
Mab Used to treat Ankylosing spondylitis
Etanercept (anti-TNF receptor antibody) or Secukinumab (anti-IL-17a antibody)
VSA: Histology of Lung CA in non-smoker
Mucin
Management of contact hypersensitivity:
nothing
DNA synthesis inhibitor used to treat pseudomonas infections, but not effective against anaerobes
Ciprofloxacin
Patient had an appendectomy a week ago. What would you see in their scar?
Granulation tissue
Vaccine preventable disease: develops a grey film over the epiglottis
Diptheria
What cell in the body is likely to bind to MHC1 presenting cells:
CD8+
VSA: high Na+, low K+, and low renin
Conn’ syndrome
Meningitis: old lady with gram positive bacilli
Listeria monocytogenes
Man has an MI 2-3 weeks ago. Now he comes into hospital and blood is aspirated from the pericardium
Left ventricular rupture
Blood transfusions: sickle cell patient has pain in his joints, dark urine, fever and headache. They have a blood transfusion. What complication of a blood transfusion should you screen for?
Iron overload
VSA: Which vasculitis cases a Disease in which a branch of the external carotid is affected
GCA
Man with bowed legs becomes deaf
Paget’s disease
SBA: Ulcers on mouth following treatment with a drug
Steven-Johnson Syndrome
An African lady’s doctor requests a sickle cell solubility test, [?after blood tests show low Hb and normal MCV?]. The test comes back positive with some clouding of the tested blood. What is the diagnosis?
Sickle cell trait
Calculate anion gap:
(Na + K) – (Cl + HCO3)
SBA: Reason for immediate dialysis
Uraemia
Management of hay fever:
PO antihistamine
VSA: Both mother and grandmother had medullary thyroid carcinoma, and have tested positive for MEN2. What [biomarker/protein] would be raised in the blood to confirm medullary thyroid cancer?
Calcitonin
HIV RNA forms HIV, via which error prone enzyme?
Reverse transcriptase
Woman with dry eyes and parotid swelling?
Sjogren’s syndrome. Anti-La
Fibro-epithelial tumour with abundant stromal elements
Phyllodes tumour
During cholecystectomy, the surgeon notices white spots on the pancreas
Pancreatic acinar cell carcinoma (or maybe pancreatic cyst)or Chronic pancreatitis??
Endocrine: Raised TSH and prolactin <1000
Hypothyroidism
Meningitis: gram positive organism in chains
Strep pneumoniae
Non-healing ulcer Afghanistan
Cutaneous leishmaniosis (Leishmania major)
SBA: Which ion is most likely to be abnormal in an alkalosis?
Potassium
What lab test would you use for: polcythaemia monitoring
Hb & Hct
SBA: Which of these can cause peri/neonatal illness without causing damage to the foetus if the mother is infected antenatally
Herpes Simplex Virus
Obstetric haematology: patient has pre-eclampsia, low platelets and deranged coagulation
DIC
Woman with discharge. Infection is diagnosed on wet slide microscopy
Bacterial vaginosis (shows clue cells)
SBA: Pregnant lady In first trimester with high MCV and low Hb. Has not started taking any multivitamins or supplements.
Folate (pernicious anaemia)
Young girls has normal B cells, normal CD8+, but zero CD4+ cells
Bare lymphocyte syndrome type 2
Haemolysis after antimalarials / malaria treatment.
G6PD deficiency
VSA: aortic valve replaced 3 months ago. They have now come back a few weeks later with jaundice, Hb-urea (haemoglobinuria), and raised reticulocytes
Mechanical haemolysis
During a nephrectomy procedure, the surgeon notices a mass in the kidney that extends into the renal vessels and into the perineal fat
Renal cell carcinoma or renal angiomyolipoma
A lady with loin-to-groin pain, haematuria and pain at the end of micturition. What is the most likely cause?
Renal calculi
Pneumonia: IVDU with ground glass on xray
Pneumocystis jirovecci (carinii)
Vitamin deficiency: B12 (cobalamine)
Pernicious anaemia
Which/what cell is inhibited by the presence of MHC1 on cells?
NK cells
Used for mild CAP (Community acquired pneumonia) caused by Hib (Haemophilus influenza type B)
Amoxicillin
INRs and appropriate management: patient with a prosthetic valve, INR: 3.5
Decrease dose of warfarin to aim for target INR 3 (2.5-3.5)
Patient presents with low mood after renal transplant, following longstanding renal disease. Raised calcium, high PTH
Tertiary hyperparathyroidism
Which of these vaccines must not be given to a pregnant woman:
MMR
Person is discharged after surgery, who had a bilateral hemianopia, with removal of pituitary adenoma. Consultant says it is alright to discharge them. What do you prescribe the patient on discharge?
Glucocorticoid e.g. hydrocortisone
Allergy: young child has rash on extensor surfaces. The pathology is IgE mediated
Atopic dermatitis (or acute urticaria?)
Calcium and bone handling: raised calcium, normal phosphate, low PTH, high ALP. Patient is lethargic
Malignancy
A Lady with myelodysplastic syndrome requires regular monthly blood transfusions. 10 minutes after another transfusion (her latest transfusion), she becomes tachycardic, has transfusion site pain, and hypotensive, what is the cause?
ABO incompatibility
Transplant complications: can lead to post-transplant lymphoproliferative disease
EBV
A girl has recently been noted by her parents to be acting strange lately. A Lumbar puncture is performed and the CSF shows high lymphocytes and a raised protein, but normal glucose (on LP)
Viral e.g. Herpes
A man presents with the symptoms of a UTI and acute onset costovertebral pain. He is found to have pus cells and blood in his urine. What is the most likely cause?
Pyelonephritis
Hyperuricaemia is caused by deficiency in:
Urate oxidase
VSA: What drug is used to treat severe falciparum malaria
Artensunate
SBA: Large mass on right side and has blood in the urine
Renal Carcinoma, Wilm’s tumour
Gam Positive diplococci - meningitis
Strep pneumoniae
Management of acute uriticaria:
PO antihistamine
ChemPath investigations: Patient with low sodium ?normal potassium, low plasma osmolality and urine osmolality of 70
SIADH (urine osmolality >100)
a cause of UTI in hospitalised/young boys
Proteus mirabilis
Liver Function Tests: Man following haematemesis with raised GGT and ALT
Oesophageal varices
SBA: most common Lung CA in a non-smoker
Adenocarcinoma
SBA: Doctor with needlestick injury and patient refuses blood test. Asks CT1 if lab can test one of old blood samples. What does CT1 say?
If they decline to consent and have capacity then you cannot do the test
Man, ex-smoker, with history of hypertension and MI, has sudden chest pain which radiates to the neck
Anterior MI (blockage of LAD)
SBA: common finding in someone who has portal hypertension
Splenomegaly
60 year old Man with abdominal pain radiating to back, collapses and dies
AAA
A teenage girl who when she goes cross country running gets an erythematous rash on her legs. It is well controlled by antihistamines
Cold urticaria? Or allergy. Not sure
Radiosensitive cancer of the testicle in a young man with a white smooth appearance
Seminoma
Women with colicky abdominal pain. Elevated ALP, ALT, GGT, & Bilirubin
Acute cholestasis
Vitamin deficiency: A (retinol)
Colour blindness
What cancer does H. Pylori cause?
MALT
Allergy: hypertensive and diabetic, with angioedema
Angioedema (possible caused by ACE inhibitors)
20 year old man with leukaemia: t(9:22). BCR-ABL present. TdT was expressed on cells. Blood film shows 70% blasts
ALL (TdT is an immature marker)
(note, you can get t(9:22) in ALL, and CML also)
Transplant complications: mechanism behind GVHD
Donor cells attack host cells (APC mediated destruction,)
What changes do you get in the lymph nodes with sarcoidosis?
Granuoma
After a lady receives a blood transfusion and platelets, she goes home and develops a rash all over
Post transfusion purpura, usually presents 5–12 days after transfusion
Possibly GVHD - usually fever, rash which progresses to T.E.N., also D & V.
Malignancy due to longstanding reflux. Endoscopy shows a mass 30cm down
Oesophageal adenocarcinoma
SBA: A man presents with history of heart disease, left ventricular hypertrophy, has a facial basal cell carcinoma and type 2 diabetes. Investigations from one year ago showed critical aortic stenosis, with poor ejection fraction. Current (Investigations/ECHO) shows (severe/critical) aortic stenosis. They suddenly die. List the order for the coroners / How should you fill out the MCCD (Medical Certificate of Causes of Death)?
1a = Aortic Stenosis
What lab test would you use for: testing whether a haemolytic anaemia is autoimmune in origin
DAT test
INRs and appropriate management: patient with a previous DVT, INR 1.5
Increase dose of warfarin to aim for target INR of 3.5 (2.5-3.5)
Which breast cancer is also known as non-specific type?
Invasive ductal carcinoma
Most common cause of UTI: catheter
- E Coli, 2. Staph saprophyticus 3. klebsiella
Which drug do you give to a woman who is infected with herpes zoster in pregnancy?
Aciclovir
Cell of immune system: monocytes resident in peripheral skin cells
Langerhans cells
An overweight individual with diabetes has longstanding bone/back pain. They are found to have paraprotein IgA ~8g/dl, and GFR 55mls/min/1.73m^2. FBC normal and albumin normal
MGUS
Pneumonia: hyponatraemia, confusion
Legionella pneumophillia
Breast: blood, discharge, benign change
Duct Papilloma
Low sodium, all else (K+, CL-?) normal. Glucose before OGTT is 4.9, 2 hours later is 10 ish
Impaired glucose tolerance
Alcoholic has an AAA repair, and several days later develops a fever, with low Hb, and jaundice
Delayed haemolytic transfusion reaction
Mab Used to treat osteoporosis
Denosummab (anti-RANK ligand antibody)
Causes cataracts, sensoneural deafness, hepatomegaly, thrombocytopenia
CMV
SBA: Diagnosis of Cushing disease
Head scan (MRI)
SBA: Nephrotic syndrome in child
Minimal change disease
Vitamins: Vegan with megaloblastic anaemia
B12 deficiency
Transplant complications: causes progressive multifocal leukoencephalopathy
JC virus
Vitamin deficiency: E (tocopherol)
Haeolytic anaemia, SCD, neuropathy
If taking infliximab and travelling to Africa/ S. America:
Can’t have live vaccine: e.g. BCG, typhoid, polio, yellow fever, MMR, varicella, influenza
Autoimmune and auto-inflammatory disease: associated with HLA-DR4 and cyclic citrullinated peptide (CCP)
Rheumatoid arthritis
What drug do you give to treat a Neonate with Cytomegalovirus Retinitis?
Ganciclovir
VSA: Person who had negative direct coombs test but who has anaemia (low Hb), and jaundice
MAHA, haemoglobinopathy, mechanical haemolysis
20-year-old man with a lytic lesion in the diaphysis of his leg, which is relieved by aspirin
Osteoid osteoma
Which/What cell undergoes positive and negative selection in the thymus
T-cells
A 12 year old boy has recurrent chest infections, and has an ear infection. He doesn’t have any B Cells
Bruton’s
Pyloric stenosis bicarb is:
Raised (metabolic alkalosis)
Baby with seizures. Low Ca, Low PTH
Hypoparathyroidism. May be due to DeGeorge syndrome.
Appendix that is full of neutrophils and is enlarged, touching the peritoneum
Inflammation?
Allergy: lady has flushed face, difficulty breathing and an enlarged liver. This has happened to her several times
Hereditary angioedema (C1 esterase inhibitor deficiency)
VSA: Signs of hyperthyroidism. Bloods show low TSH and high thyroxine. Does not have good uptake on technetium scan.
De Quervain’s thyroiditis
SBA: Most common Ovarian CA (<25)
Teratoma
A Girl is found to have no CD4 cells, but CD8 cells and B cells are present
Bare lymphocyte syndrome Type 2
Which/What antibiotic would you use to treat/prescribe someone who has cellulitis with a Methicillin SENSITIVE strain of Staphylococcus aureus?
Flucloxacillin
Gram negative rod - meningitis
E. coli
Man has abdominal pain radiating to the back. He then collapses and dies
Abdominal aortic aneurysm
SBA: Most common Ovarian CA (>25)
Serous adenoma
A Rhesus D negative woman is having a Haematopoietic stem cell transplant (HSCT) and is CMV IgG negative. What is the most important thing to ensure in the transplant?
HLA of donor and recipient identical
INRs and appropriate management: patient with a prosthetic valve, INR: 2.5
Increase dose of warfarin to aim for target INR 3 (2.5-3.5)
Gram negative rod causing sepsis in a neonate?
E. Coli
What happens to the body of the stomach in a patient with pernicious anaemia?
Atrophy
Obstetric haematology: dad is on warfarin, and sister had a DVT
Antitrhrombin deficiency
Raised in rhadommyolysis:
Creatine Kinase (CK)
72 year old with headache. Raised calcium, normal phosphate, normal PTH, high ALP
Primary hyperparathyroidism
Liver Function Tests: Raised unconjugated bilirubin with normal LFTs
Gilbert’s syndrome
A Man has) beta thalassemia since 13 months of age. He presents to an outpatient clinic with malaise and erectile dysfunction
Transfusion associated haemosiderosis
An African child is found to be anaemic with a low Hb and normal MCV. The doctor in the hospital has the child’s blood tested by Electrophoresis to confirm the suspected diagnosis. Results show very high HbS and low HbF. What is the diagnosis?
Sickle cell anaemia
Best marker of UTI on urine dip
Nitrites
A boy’s father has TB. The same boy develops a mycobacterium infection, following their BCG
IFN gamma receptor deficiency
Recurrent episodes of weakness and paraesthesia that spontaneously resolve
Relapsing-remitting MS
Autoimmune and auto-inflammatory disease: associated with HLA-B27
Ankylosing spondylitis
Cell of immune system: immature form is responsible for phagocytosis, mature form is an APC
Dendritic cell
Child with recurrent episodes of jaundice and anaemia. Blood film shows spherocytosis without central pallor
Hereditary spherocytosis
Girl with coeliac disease, refuses to stick with a gluten free diet and now has macrocytosis. Why has this happened?
B12 deficiency
Vitamin deficiency: B1 (thiamine)
Wernicke’s encephalopathy, Beri-Beri neuropathy
VSA: Person who had a DVT many years ago (or recurrent DVTs), presents with recurrent dark bruising, and swelling over the course of 5 years, and now had pain in their leg.
Superficial thrombophlebitis
Cause of post-transplant lymphoproliferative disease
EBV
Man can eat apple pie. But if he eats fresh apples and pears, he gets inflamed lips
Oral allergy syndrome
Management of anaphylaxis:
IM adrenaline 0.5ml of 1:1000
What is the most common cause of thrombocytopenia in Pregnancy
Gestational thrombocytopenia
Child from western Africa with low Hb. Blood film shows elliptocytes
Hereditary elliptocytosis
Patient with paraprotein, back pain and loss of sensation in legs
Multiple myeloma (raised IgG, IgA, light chains or IgD paraprotein)
Alzheimer’s pathology
Atrophy of brain & neuronal loss, widened sulci, narrowed gyri, enlarged ventricles, plaques of beta-amyloid protein, neurofibrillary tangles of tau protein
Increased risk of mycobacterial or salmonella infections e.g. fracture due to TB?
Cytokine deficiency e.g. IL12, IL12 receptor, IL-gamma, IL-gamma receptor
Cause of progressive multifocal leukoencephalopathy
JC virus
MEN1 associations:
Pituitary, pancreas, parathyroid
Painless indurated ulcer. Grown on dark ground microscopy medium. Spiral shaped bacterium
Treponema pallidium (syphilis)
ChemPath investigations: Pt with low sodium, high potassium and postural hypotension
Short SynACTHen test
Define impaired fasting glucose
BG: 6.1 – 6.9 mmol/L
VSA: What cancer is present if keratin and intercellular bridges are present
Squamous cell carcinoma
SBA: Anti-coagulation in pregnant woman
LMW heparin
Young man with severe pain in testicle following horse riding
Testicular torsion
Blood disorder seen in HELLP
MAHA
VSA: A Turkish man has a fever (and has a history of recurrent chest infections). Tests show a mutation in the MEFV gene.
Familial Mediterranean Fever
Patient with HIV, raised ICP and new onset epilepsy
HIV encephalitis?
Man has an MI 3 years ago. Now he comes into hospital and blood is aspirated from the pericardium
Cardiac tamponade
Vitamin deficiency: K (phytomenadione)
Defective clotting
Vaccine preventable disease: lockjaw
Clostridium tetani (tetanus)
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