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YEAR 5: Chemical Pathology SM > past paper qs unknowns > Flashcards

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

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2
Q

Fe overload - affected organs

A

Liver
Bronze skin
Pancreas –>DM

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3
Q

Immediate haemolytic transfusion reaction

  • cause?
  • tell tale fx
A

ABO incompatibility

Haemoglobinuria

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4
Q

BP in bacterial infection from blood transfusion?

A

Hypotension

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5
Q

BP in TRALI

A

low

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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
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7
Q

Which form of Hb is highest % in b-thalassemia major?

A

HbF (alpha + gamma)

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8
Q

IgM paraprotein levels high + visual disturbance

A

Lymphoplasmacytoid lymphoma

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9
Q

Tx of Lymphoplasmacytoid lymphoma

A

plasmapheresis + chlorambucil + cyclophosphamide

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10
Q

1ary vs 2ndary amyloidosis

A 
1ary = AL
2ndary = AA - secondary to infections/inflammation
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11
Q

2 most common features of amyloidosis

A

Nephrotic syndrome + macroglossia

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12
Q

Waldenstrom aka

A

Lymphoplasmacytoid lymphoma

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13
Q

MGUS vs smouldering myeloma

A

Smouldering myeloma is >30g/dL of paraprotein

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14
Q

Best , curative tx of myeloma in younger patients

A

autologous SCT

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15
Q

proteasome inhibitor used for multiple myeloma treatment?

A

Bortezomib

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16
Q

Evolocumab

A

PCSK9 inhibitor

  • increases LDL uptake from blood
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17
Q

Homosexual man with bloody diarrheoa and liver abscess

A

Entamoeba histolytica

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18
Q

Vomiting within 6 hours of ingestion

A

S. aureus or B cereus

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19
Q

Bloody diarrhoea with later presentation (few days)

A

Entamoeba

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20
Q

Campylobacter - appearance? bloody or non-bloody?

A

Curved/s-shaped

Bloody diarrhoea

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21
Q

HIV patient with severe diarrhoea. oocysts seen in stool

A

Cryptosporidium parvum

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22
Q

Which penicillin antibiotic is NOT broken down by beta-lactamases

A

Fluclox

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23
Q

Which penicillin abx is used for pseudomonas? is it combined with anything?

A

Piperacillin + tazobactam

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24
Q

Ciprofloxacin - MOA and group

A

DNA gyrase inhibitor (a quinolone)

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25
Q

Ciprofloxacin - use?

A

against gram -ves, inc pseudomonas

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26
Q

Which cell type is increased in parasitic infection

A

Eosinophils

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27
Q

Coeliac disease with wild diet. What cancer are they at risk of?

A

Enteropathy associated T-cell lymphoma

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28
Q

Breast cancer associated with +ve E-cadherins?

A

ductal carcinoma

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29
Q

Lesch Nyhan sydnrome?

A

HGPRT deficiency –> urate accumulation

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30
Q

AIRE mutation

A

Autoimmune polyendocrinopathy syndrome Type I

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31
Q

FAS pathway mutation

A

ALPS = autoimmune lymphoproliferative syndrome

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32
Q

Mycobacterium infection following BCG vaccine. Immunodeficiency?

A

IFNgamma or IL12 deficiency

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33
Q

Antibody against myeloperoxidase

A

p-ANCA

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34
Q

Ix results in SCID vs bruton’s

A

In Bruton’s, B-cells are reduced but T cells normal.

In SCID, all lymphocytes are reduced

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35
Q

A lady with loin-to-groin pain, haematuria and pain at the end of micturition. What is the most likely cause?

A

Renal stone

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36
Q

Recurrent N. meningitides infection. Cause?

A

Complement deficiency

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37
Q

Top 2 common causes of DIC in pregnancy

A

Placental abruption

Amniotic fluid embolism

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38
Q

Which procoagulant factors are increase din pregnancy?

A

vWF + factor 8 (the most)
Fibrinogen
Factor 7

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39
Q

Top 3 causes of low platelets in pregnancy

A

Gestational
PET
ITP

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40
Q

at what point post-MI does VF usually develop?

A

first 24 hours

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41
Q

wtf is dressers? when does it occur

A

chest pain
fever
effusion

wks - months post-MI

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42
Q

which valve issue is common post MI and why?

A

mitral regurgitation due to papillary muscle rupture

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43
Q

Persistent ST elevation at >4 weeks post -MI

^ cause?

A

ventricular aneurysm

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44
Q

BIG atria - which cardiomyopathy?

A

restrictive

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45
Q

Jones major criteria of acute rheumatic fever

A 
Carditis
Arthritis
Sydenham's chorea
Erythema marginatum
Subcutaneous nodules
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46
Q

Use of Ibrutinib

A

CLL

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47
Q

Which ix is best to confirm a suspected diagnosis of CUshing’s disease

A

i.e. pituitary tumour –> ACTH release

High dose dexamethasone suppression test

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48
Q

In a pt with confirmed Cushing’s SYNDROME from low dose dex suppression test, what’s the next Ix you should do and why

A

pituitary MRI, because cushion’s disease is the most common cause

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49
Q

1st line treatment of hospital acquired pneumonia

A

Ciprofloxacin +/- vanc

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50
Q

Middle aged lady. Liver biopsy, loss of bile ducts and granulomas present. Which/what disease is consistent with these findings?

A

PBC

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51
Q

signs of hyperthyroidism. Bloods show low TSH and high thyroxine. Does not have good uptake on technetium scan. What is the likely diagnosis?

A

DeQuiervain’s thyroiditis

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52
Q

Tx of non-severe P. falciparum?

A

Doxy + quinine for 7 days

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53
Q

3 thyroid cancers in order of most to least common

A

Papillary
Follicular
Medullary

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54
Q

An African man, with Burkitt’s lymphoma is given Rasburicase. He develops haematuria with irregularly contracted cells. What is the cause?

A

G6PD deficiency

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55
Q

treated with drugs that target with TNF, IL-17 and IL-12/23

A

Psoriasis

Infliximab
Ustekinumab
Secukinumab

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56
Q

Anti-IL17 antibody

A

Secukinumab

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57
Q

Vasculitis affecting the external carotid

A

Giant cell arteritis

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58
Q

Absent pulse + bruits + claudication

A

Takayasu’s arteritis

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59
Q

Micro aneurysms on angiography

-chronic Hep B infection

A

Polyarteritis nodosa

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60
Q

Vasculitis which affects mesenteric arteries

A

PAN = polyarteritis nodosa

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61
Q

Diff btw Wegener’s and microscopic polyangitis

A

Wegener’s = histology shows granulomas + Upper rest tract involvement. c-ANCA

Microscopic polyangiits = no granulomas + no URT involvement. pANCA

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62
Q

alpha glucosidase inhibitor

A

acarbose

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63
Q

dipeptidyl dipeptidase IV inhibitor

64
Q

NPC1L1 inhibitor

65
Q

PCSK9 inhibitor

A

evolocumab

66
Q

Ring enhancing lesion on MRI with known established ear infection

A

Brain abscess

67
Q

Defect in spectrin molecule + anaemia

A

Hereditary spherocytosis

68
Q

Rhodanine vs rhodamine stain

A 
Rhodanine = copper
Rhodamine = acid fast bacilli
69
Q

1st line tx of non falciparum malaria

A

chloroquine

70
Q

Which malaria subtypes require another medication to remove liver parasites?

A

Vivax and ovale –> need primaquine

71
Q

Massive splenomegaly

72
Q

High 5-HIAA and hepatomegaly

A

Carcinoid syndrome

73
Q

Weight loss + SOB

muscle weakness which improves with testing

A

SCLC –> Lambert Eaton Syndrome

74
Q

Carcinoid syndrome - heart problems?

A

Often restrictive: tricuspid + pulmonary stenosis

75
Q

Tumour of enterochromaffin cell origin

76
Q

High Calcium, low PTH - cause?

A

Malignancy

Sarcoid

77
Q

Calcium: osteoid ratio in normal patient?

osteoporosis? Osteomalacia?

A

Normal 2:1
Osteoporosis 2:1
Osteomalacia 1:2

78
Q

4 Causes of primary hypoparathyroidism

A

Post surgery

  • Autoimmune
  • Di George
  • Mg deficiency
79
Q

Osteoporosis circumscripta

Picture frame vertebrae

A

Paget’s disease

80
Q

Histology shows multinucleate osteoclasts - give 2 potential Ddx?

A

Paget’s disease

Giant cell bone tumour

81
Q

If a high dose dexamethasone suppression test –> doesn’t suppress cortisol levels (and ACTH level is high)

A

ectopic ACTh

82
Q

If high dose dexamethasone suppression test –> suppression of cortisol levels

A

Cushing’s disease

83
Q

which isoform of CK is measured for ?Rhabdomyolysis

84
Q

Best level to measure for reinfarction

85
Q

effect of primary hypothyroidism on the HPA axis

A

leads to increased TSH and increased prolactin levels

86
Q

Hashimoto’s thyroiditis

A

anti-TPO –> primary hypothyroidism

87
Q

Normal T4 + high TSH

A

Treated hypothyroidism OR

Subclinical hypothyroidism

88
Q

No hypothyroid sx but High TSH and low T3 and T4

A

Sick euthyroidism

89
Q

Cause of low uptake hyperthyroidism

A

Dequiervain’s thyroiditis

90
Q

Tx of DeQuiervain’s

A

NSAIDs and beta-blockers

91
Q

Tx of high uptake hyperthyroidism

A

CBZ/PTU or surgery

92
Q

Pt has normal T4 and high TSH. What do ya do

A

Subclinical hypothyroidism. Measure anti-TPO

93
Q

Psammoma bodies

A

Papillary thyroid cancer

94
Q

Type of calculi seen in proteus infection + stag horn calculi?

A

Mg Ammonium Sulphate

95
Q

MEN1

A

3 Ps:
PTH
Phaeo
Pituitary

96
Q

CML - chronic vs accelerated phase

A 
Chronic = <5% blasts
Accelerated = 10-19% blasts
97
Q

PML-RARA gene

98
Q

Richters transformation

A

Diffuse Large B Cell lymphoma

99
Q

t(14;18) –>?

A

follicular B cell lymphoma

100
Q

PML-RARA gene - which translocation is this?

101
Q

which chromosomal Loss is associated with AML

A

5/5q and 7/7q

102
Q

Which trisomies are associated with AML

A

Trisomy 21 and 8

103
Q

Anaplastic Large Cell lymphoma - which cells are affected? Which protein is implicated?
what’s the transolcation

A
  • T cell lymphoma
  • Alk1 protein is affected
  • t(2;5)
104
Q

Idiopathic Aplastic anaemia tx in an >35yo

A

Anti-thymocyte globulin (to reduce CD8 cell attack)

Cyclosporin

105
Q

3 inherited causes of aplastic anaemia

A

Fanconi - Cafe au lait. Present 5-10yrs

Dykeratosis Congenita - oral leukoplakia/nail dystrophy.

Diamond Blackfan = ONLY RBCs are low.

106
Q

Aplastic anaemia + cafe au lait + normal at birth

107
Q

Oral leukoplakia, nail abnormalities. one parent has some shitty Blood marrow issue

A

Dyskeratosis congenita (autosomal dominant )

108
Q

Pelger Huet cells

109
Q

Type of amyloid deposited in multiple myeloma

110
Q

Amyloid A is deposited in…?

A

Chronic infection - this is an acute phase protein!

111
Q

TRALI triad

A

fever
hypotension
SOB

112
Q

What do you see in kidney of DM patient

113
Q

Breast lump - aspirate shows proteinaceous material + inflammatory cells

A

Duct ectasia

114
Q

Presentation of duct ectasia

A

Periareolar mass + thick white nipple secretions

115
Q

Benign sclerosing lesion of the breast. Found incidentally on mammogram

A

Radial scar

116
Q

Carcinoma in situ with lack of E-cadherin

117
Q

Her2 +ve breast cancer. Tx?

118
Q

Breast cancer that is commonly HER/ER/PR -ve

A

Basal like carcinoma

119
Q

common mutations in SCLC

A

p53 and RB1

120
Q

Most common cause of bronchiectasis

121
Q

Pleural plaques

A

asbestosis

122
Q

cells assoc with how ship lacunae

A

osteoclasts

123
Q

WTF is Gardner’s

A

FAP with osteomas + dental probs + load of other shi

124
Q

Types of non-neoplastic colon polyps

A

Hamartomatous - juvenile, Peutz Jegher’s syndrome

Hyperplastic

125
Q

Most common precursor lesion to colon adenocarcinoma

A

Adenoma (polyp)

  • either tubular, villous or tubulovillous
126
Q

Dukes staging of colon adenocarcinoma - ABCD

A

A: confined to bowel wall
B: through bowel wall
C: LNs
D: distant mets

127
Q

Major specific complication of UC

A

toxic megacolon

128
Q

Histology in Crohns - state 3 features

A

Granuloma
Thick rubber hose like wall
Cobblestone appearance

129
Q

watershed areas at risk of ischemic colitis

A

splenic flexure

rectosigmoid

130
Q

signet ring cell

A

gastric carcinoma

131
Q

Malignant melanoma treatment

A

Ipilimumab (CTLA4 inhibitor) + Pembrolizumab (PD1 inhibitor)

132
Q

HyperIgM - cause

A

CD40L defect

133
Q

Mechanism behind antibody mediated transplant rejection? which cells are involved? how is this treated?

A

B-cell mediated
Antibodies against the vascular endothelium of the graft will bind

  • Tx: Antibody removal and + B-cell suppression
134
Q

Cause of hereditary angioedema

A

Deficiency of C1 esterase inhibitor

135
Q

How do measure degree of mast cell degranulation

A

Mast cell tryptase levels

136
Q

IL5

A

promotes eosinophil growth + maturation

137
Q

IFNgamma and IL2 is released by these T cells

138
Q

Which T cell subset aims to aid Ig class switch

A

Th2 - T helper cells

139
Q

. Cell dependent on the presence of CD4 T cell help for generation.

A

IgG secreting plasma cell

140
Q

Area within secondary lymphoid tissue where B cells proliferate and undergo affinity maturation and isotope switching

A

Germinal centre

141
Q

Carries lymphocytes from lymph nodes back to the blood circulation

A

thoracic duct

142
Q

Alternative pathway of complement - components?

A

Protein B, I and P

143
Q

Binds to microbial surface carbohydrates to activate the complement cascade in an immune complex independent manner

A

mannose binding lectin

144
Q

Important signalling ligands for directing Dendritic cells to lymph nodes?

A

CCL19 and 21

145
Q

Non-neutralising antibodies for HIV

146
Q

Why do you get Anti-CCP in rheumatoid arthritis?

A

PADI ENZYMES: pm type 2 and 4 lead to higher activity and more citrullination of residues

147
Q

Mx of post transplant lymphoproliferative syndrome

A

Reduce immunosuppression (so the boyd can try to fight off EBV)

RItuximab (anti-CD20 and depletes B cells)

148
Q

2RFs for progressive multifocal leukoencephalopathy

A

JC virus

Mycophenylate mofetil

149
Q

Important SE of calcineurin inhibitors (cyclosporin + tarolimus)

A

hypertension

150
Q

V important Se of all anti proliferative agnets

A

Bone marrow suppression

151
Q

Interesting SEs of cyclophosphamide

A

Sterility
Haemorrhagic cystitis

(and also BM suppression as with all anti proliferative agents)

152
Q

WTF are nephritic factors? when are they at high levels?

A

autoantibodies against components of complement pathway

–> increased C3 activation + consumption

–> high levels of nephritic factors in membranoproliferative glomerulonephritis

153
Q

Chemo pt
Low neutrophils
interstitial shadowing

A

Aspergillus

154
Q

HIV pt with raised ICP - 2 causes

A

Toxoplasmosis = ring enhanced lesions

Cryptococcus = india ink stain

155
Q

· A DNA synthesis inhibitor used to treat Pseudomonal infections but bad against anaerobes

A

Ciprofloxacin

156
Q

Vector for leishamniasis

YEAR 5: Chemical Pathology SM (29 decks)

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