past paper qs unknowns Flashcards
1
Q
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
What is it? what is the mechanism behind it?
A
TRALI
Typically: FEVER + SOB + DRY cough
(n. b. fluid overload does not cause fever + does cause frothy pink sputum)
- Donor antibodies attack the recipient’s WBCs. Often a previous transfusion = sensitising event
2
Q
Fe overload - affected organs
A
Liver
Bronze skin
Pancreas –>DM
3
Q
Immediate haemolytic transfusion reaction
- cause?
- tell tale fx
A
ABO incompatibility
Haemoglobinuria
4
Q
BP in bacterial infection from blood transfusion?
A
Hypotension
5
Q
BP in TRALI
A
low
6
Q
BP in febrile non-haemolytic transfusion reaction? Who is often affected by this?
A
BP doesn’t change!! (non-haemolytic therefore no attack of RBCs)
- Woman who has had several chlidren
7
Q
Which form of Hb is highest % in b-thalassemia major?
A
HbF (alpha + gamma)
8
Q
IgM paraprotein levels high + visual disturbance
A
Lymphoplasmacytoid lymphoma
9
Q
Tx of Lymphoplasmacytoid lymphoma
A
plasmapheresis + chlorambucil + cyclophosphamide
10
Q
1ary vs 2ndary amyloidosis
A
1ary = AL 2ndary = AA - secondary to infections/inflammation
11
Q
2 most common features of amyloidosis
A
Nephrotic syndrome + macroglossia
12
Q
Waldenstrom aka
A
Lymphoplasmacytoid lymphoma
13
Q
MGUS vs smouldering myeloma
A
Smouldering myeloma is >30g/dL of paraprotein
14
Q
Best , curative tx of myeloma in younger patients
A
autologous SCT
15
Q
proteasome inhibitor used for multiple myeloma treatment?
A
Bortezomib
16
Q
Evolocumab
A
PCSK9 inhibitor
- increases LDL uptake from blood
17
Q
Homosexual man with bloody diarrheoa and liver abscess
A
Entamoeba histolytica
18
Q
Vomiting within 6 hours of ingestion
A
S. aureus or B cereus
19
Q
Bloody diarrhoea with later presentation (few days)
A
Entamoeba
20
Q
Campylobacter - appearance? bloody or non-bloody?
A
Curved/s-shaped
Bloody diarrhoea
21
Q
HIV patient with severe diarrhoea. oocysts seen in stool
A
Cryptosporidium parvum
22
Q
Which penicillin antibiotic is NOT broken down by beta-lactamases
A
Fluclox
23
Q
Which penicillin abx is used for pseudomonas? is it combined with anything?
A
Piperacillin + tazobactam
24
Q
Ciprofloxacin - MOA and group
A
DNA gyrase inhibitor (a quinolone)
25
Ciprofloxacin - use?
against gram -ves, inc pseudomonas
26
Which cell type is increased in parasitic infection
Eosinophils
27
Coeliac disease with wild diet. What cancer are they at risk of?
Enteropathy associated T-cell lymphoma
28
Breast cancer associated with +ve E-cadherins?
ductal carcinoma
29
Lesch Nyhan sydnrome?
HGPRT deficiency --> urate accumulation
30
AIRE mutation
Autoimmune polyendocrinopathy syndrome Type I
31
FAS pathway mutation
ALPS = autoimmune lymphoproliferative syndrome
32
Mycobacterium infection following BCG vaccine. Immunodeficiency?
IFNgamma or IL12 deficiency
33
Antibody against myeloperoxidase
p-ANCA
34
Ix results in SCID vs bruton's
In Bruton's, B-cells are reduced but T cells normal.
| In SCID, all lymphocytes are reduced
35
A lady with loin-to-groin pain, haematuria and pain at the end of micturition. What is the most likely cause?
Renal stone
36
Recurrent N. meningitides infection. Cause?
Complement deficiency
37
Top 2 common causes of DIC in pregnancy
Placental abruption
| Amniotic fluid embolism
38
Which procoagulant factors are increase din pregnancy?
vWF + factor 8 (the most)
Fibrinogen
Factor 7
39
Top 3 causes of low platelets in pregnancy
Gestational
PET
ITP
40
at what point post-MI does VF usually develop?
first 24 hours
41
wtf is dressers? when does it occur
chest pain
fever
effusion
wks - months post-MI
42
which valve issue is common post MI and why?
mitral regurgitation due to papillary muscle rupture
43
Persistent ST elevation at >4 weeks post -MI
^ cause?
ventricular aneurysm
44
BIG atria - which cardiomyopathy?
restrictive
45
Jones major criteria of acute rheumatic fever
```
Carditis
Arthritis
Sydenham's chorea
Erythema marginatum
Subcutaneous nodules
```
46
Use of Ibrutinib
CLL
47
Which ix is best to confirm a suspected diagnosis of CUshing's disease
i.e. pituitary tumour --> ACTH release
High dose dexamethasone suppression test
48
In a pt with confirmed Cushing's SYNDROME from low dose dex suppression test, what's the next Ix you should do and why
pituitary MRI, because cushion's disease is the most common cause
49
1st line treatment of hospital acquired pneumonia
Ciprofloxacin +/- vanc
50
Middle aged lady. Liver biopsy, loss of bile ducts and granulomas present. Which/what disease is consistent with these findings?
PBC
51
signs of hyperthyroidism. Bloods show low TSH and high thyroxine. Does not have good uptake on technetium scan. What is the likely diagnosis?
DeQuiervain's thyroiditis
52
Tx of non-severe P. falciparum?
Doxy + quinine for 7 days
53
3 thyroid cancers in order of most to least common
Papillary
Follicular
Medullary
54
An African man, with Burkitt’s lymphoma is given Rasburicase. He develops haematuria with irregularly contracted cells. What is the cause?
G6PD deficiency
55
treated with drugs that target with TNF, IL-17 and IL-12/23
Psoriasis
Infliximab
Ustekinumab
Secukinumab
56
Anti-IL17 antibody
Secukinumab
57
Vasculitis affecting the external carotid
Giant cell arteritis
58
Absent pulse + bruits + claudication
Takayasu's arteritis
59
Micro aneurysms on angiography
| -chronic Hep B infection
Polyarteritis nodosa
60
Vasculitis which affects mesenteric arteries
PAN = polyarteritis nodosa
61
Diff btw Wegener's and microscopic polyangitis
Wegener's = histology shows granulomas + Upper rest tract involvement. c-ANCA
Microscopic polyangiits = no granulomas + no URT involvement. pANCA
62
alpha glucosidase inhibitor
acarbose
63
dipeptidyl dipeptidase IV inhibitor
Gliptin
64
NPC1L1 inhibitor
ezetimibe
65
PCSK9 inhibitor
evolocumab
66
Ring enhancing lesion on MRI with known established ear infection
Brain abscess
67
Defect in spectrin molecule + anaemia
Hereditary spherocytosis
68
Rhodanine vs rhodamine stain
```
Rhodanine = copper
Rhodamine = acid fast bacilli
```
69
1st line tx of non falciparum malaria
chloroquine
70
Which malaria subtypes require another medication to remove liver parasites?
Vivax and ovale --> need primaquine
71
Massive splenomegaly
CML
72
High 5-HIAA and hepatomegaly
Carcinoid syndrome
73
Weight loss + SOB
| muscle weakness which improves with testing
SCLC --> Lambert Eaton Syndrome
74
Carcinoid syndrome - heart problems?
Often restrictive: tricuspid + pulmonary stenosis
75
Tumour of enterochromaffin cell origin
Carcinoid
76
High Calcium, low PTH - cause?
Malignancy
| Sarcoid
77
Calcium: osteoid ratio in normal patient?
| osteoporosis? Osteomalacia?
Normal 2:1
Osteoporosis 2:1
Osteomalacia 1:2
78
4 Causes of primary hypoparathyroidism
Post surgery
- Autoimmune
- Di George
- Mg deficiency
79
Osteoporosis circumscripta
| Picture frame vertebrae
Paget's disease
80
Histology shows multinucleate osteoclasts - give 2 potential Ddx?
Paget's disease
| Giant cell bone tumour
81
If a high dose dexamethasone suppression test --> doesn't suppress cortisol levels (and ACTH level is high)
ectopic ACTh
82
If high dose dexamethasone suppression test --> suppression of cortisol levels
Cushing's disease
83
which isoform of CK is measured for ?Rhabdomyolysis
MM
84
Best level to measure for reinfarction
CK-MB
85
effect of primary hypothyroidism on the HPA axis
leads to increased TSH and increased prolactin levels
86
Hashimoto's thyroiditis
anti-TPO --> primary hypothyroidism
87
Normal T4 + high TSH
Treated hypothyroidism OR
| Subclinical hypothyroidism
88
No hypothyroid sx but High TSH and low T3 and T4
Sick euthyroidism
89
Cause of low uptake hyperthyroidism
Dequiervain's thyroiditis
90
Tx of DeQuiervain's
NSAIDs and beta-blockers
91
Tx of high uptake hyperthyroidism
CBZ/PTU or surgery
92
Pt has normal T4 and high TSH. What do ya do
Subclinical hypothyroidism. Measure anti-TPO
93
Psammoma bodies
Papillary thyroid cancer
94
Type of calculi seen in proteus infection + stag horn calculi?
Mg Ammonium Sulphate
95
MEN1
3 Ps:
PTH
Phaeo
Pituitary
96
CML - chronic vs accelerated phase
```
Chronic = <5% blasts
Accelerated = 10-19% blasts
```
97
PML-RARA gene
APML
98
Richters transformation
Diffuse Large B Cell lymphoma
99
t(14;18) -->?
follicular B cell lymphoma
100
PML-RARA gene - which translocation is this?
t(15;17)
101
which chromosomal Loss is associated with AML
5/5q and 7/7q
102
Which trisomies are associated with AML
Trisomy 21 and 8
103
Anaplastic Large Cell lymphoma - which cells are affected? Which protein is implicated?
what's the transolcation
- T cell lymphoma
- Alk1 protein is affected
- t(2;5)
104
Idiopathic Aplastic anaemia tx in an >35yo
Anti-thymocyte globulin (to reduce CD8 cell attack)
| Cyclosporin
105
3 inherited causes of aplastic anaemia
Fanconi - Cafe au lait. Present 5-10yrs
Dykeratosis Congenita - oral leukoplakia/nail dystrophy.
Diamond Blackfan = ONLY RBCs are low.
106
Aplastic anaemia + cafe au lait + normal at birth
Falcon
107
Oral leukoplakia, nail abnormalities. one parent has some shitty Blood marrow issue
Dyskeratosis congenita (autosomal dominant )
108
Pelger Huet cells
MDS
109
Type of amyloid deposited in multiple myeloma
Amyloid L
110
Amyloid A is deposited in...?
Chronic infection - this is an acute phase protein!
111
TRALI triad
fever
hypotension
SOB
112
What do you see in kidney of DM patient
Sclerosis
113
Breast lump - aspirate shows proteinaceous material + inflammatory cells
Duct ectasia
114
Presentation of duct ectasia
Periareolar mass + thick white nipple secretions
115
Benign sclerosing lesion of the breast. Found incidentally on mammogram
Radial scar
116
Carcinoma in situ with lack of E-cadherin
Lobular
117
Her2 +ve breast cancer. Tx?
Herceptin
118
Breast cancer that is commonly HER/ER/PR -ve
Basal like carcinoma
119
common mutations in SCLC
p53 and RB1
120
Most common cause of bronchiectasis
infection
121
Pleural plaques
asbestosis
122
cells assoc with how ship lacunae
osteoclasts
123
WTF is Gardner's
FAP with osteomas + dental probs + load of other shi
124
Types of non-neoplastic colon polyps
Hamartomatous - juvenile, Peutz Jegher's syndrome
| Hyperplastic
125
Most common precursor lesion to colon adenocarcinoma
Adenoma (polyp)
- either tubular, villous or tubulovillous
126
Dukes staging of colon adenocarcinoma - ABCD
A: confined to bowel wall
B: through bowel wall
C: LNs
D: distant mets
127
Major specific complication of UC
toxic megacolon
128
Histology in Crohns - state 3 features
Granuloma
Thick rubber hose like wall
Cobblestone appearance
129
watershed areas at risk of ischemic colitis
splenic flexure
| rectosigmoid
130
signet ring cell
gastric carcinoma
131
Malignant melanoma treatment
Ipilimumab (CTLA4 inhibitor) + Pembrolizumab (PD1 inhibitor)
132
HyperIgM - cause
CD40L defect
133
Mechanism behind antibody mediated transplant rejection? which cells are involved? how is this treated?
B-cell mediated
Antibodies against the vascular endothelium of the graft will bind
- Tx: Antibody removal and + B-cell suppression
134
Cause of hereditary angioedema
Deficiency of C1 esterase inhibitor
135
How do measure degree of mast cell degranulation
Mast cell tryptase levels
136
IL5
promotes eosinophil growth + maturation
137
IFNgamma and IL2 is released by these T cells
Th1
138
Which T cell subset aims to aid Ig class switch
Th2 - T helper cells
139
. Cell dependent on the presence of CD4 T cell help for generation.
IgG secreting plasma cell
140
Area within secondary lymphoid tissue where B cells proliferate and undergo affinity maturation and isotope switching
Germinal centre
141
Carries lymphocytes from lymph nodes back to the blood circulation
thoracic duct
142
Alternative pathway of complement - components?
Protein B, I and P
143
Binds to microbial surface carbohydrates to activate the complement cascade in an immune complex independent manner
mannose binding lectin
144
Important signalling ligands for directing Dendritic cells to lymph nodes?
CCL19 and 21
145
Non-neutralising antibodies for HIV
p24
146
Why do you get Anti-CCP in rheumatoid arthritis?
PADI ENZYMES: pm type 2 and 4 lead to higher activity and more citrullination of residues
147
Mx of post transplant lymphoproliferative syndrome
Reduce immunosuppression (so the boyd can try to fight off EBV)
RItuximab (anti-CD20 and depletes B cells)
148
2RFs for progressive multifocal leukoencephalopathy
JC virus
| Mycophenylate mofetil
149
Important SE of calcineurin inhibitors (cyclosporin + tarolimus)
hypertension
150
V important Se of all anti proliferative agnets
Bone marrow suppression
151
Interesting SEs of cyclophosphamide
Sterility
Haemorrhagic cystitis
(and also BM suppression as with all anti proliferative agents)
152
WTF are nephritic factors? when are they at high levels?
autoantibodies against components of complement pathway
--> increased C3 activation + consumption
--> high levels of nephritic factors in membranoproliferative glomerulonephritis
153
Chemo pt
Low neutrophils
interstitial shadowing
Aspergillus
154
HIV pt with raised ICP - 2 causes
Toxoplasmosis = ring enhanced lesions
Cryptococcus = india ink stain
155
· A DNA synthesis inhibitor used to treat Pseudomonal infections but bad against anaerobes
Ciprofloxacin
156
Vector for leishamniasis
sandfly
