Past Paper Questions Flashcards
neutrophils in myelodysplastic syndrome
hypogranulation and hyposegmented neutrophils
Smear cells on blood film
CLL
neutrophils in megaloblastic anaemia
hypersegmented neutrophils
rank cancers as cause of death in men
1 lung
2 prostate
3 colon
(breast least likely)
5 stages of eosophageal adenocarcinoma progression
Reactive metaplasia low grade dysplasia high grade dysplasia adenocarcinoma
Na and K in Conns
(high aldosterone) high sodium low patassium (high BP)
Evolocumab
PCSK9 antibody reduces LDL
Dry mouth, dry eyes, anti ro, anti la, speckled pattern
Sjogrens
JAK2 V617F mutation
Polycythaemia Vera
Spherocytes on blood film, coombs +ve
Autoimmune haemolytic anaemia
Which coag factor falls most rapidly after starting warfarin
(CR) 7 > 9 > 10 > 2
therapeutic anticoagulation during pregnancy
LMWH
Imatinib
CML - in chronic phase
ALL if 9;22 translocation
kappa and lambda light chains
Multiple myeloma
Reed sternberg cells
Hodgkins lymphoma
temp for platelet storage
room temp
Venetoclax
BCL2 inhibitor induces apoptosis (used in CLL)
smear cells CD5 and CD18 +ve
B cell CLL
commonest primary tumour of the heart
atrial myxoma
most likely cause of mobile mass in breast
fibroadenoma
commonest malignant breast cancer
invasive ductal carcinoma
What type of emphysema is associated with smoking?
centriobular
what type of emphysema is associated with alpha 1 antitrypsin deficiency
Panacinar
most common primary cause of nephrotic syndrome in adults
Focal segmental glomerulosclerosis
most common secondary cause of nephrotic syndrome in adults
diabetes
most common cause of portal vein thrombosis
malignancy
organism causing pneumonia with blood sputum in alcoholic and diabetics
Klebsiella Pneumoniae
male version of ovarian dysgeminoma
Seminoma
most common histological type of oesophageal cancer in UK
adenocarcinoma
goblet cells present in barret’s
intestinal metaplasia
goblet cells NOT present in barett’s
gastric metaplasia
vascular tumour associated with HHV8 infection
Kaposi Sarcoma
commonest cause of myocarditis
viral infection
raised AMA in what liver disease
Primary Biliary Cirrhosis
temporal encephalitis
Herpes Simplex Virus
most common cause of hypocalcaemia in community
Vit D def
liver enz specifically suggesting obstructive jaundice
ALP
liver enz specifically suggesting hepatic jaundice
AST and ALT
which adrenal zone produces aldosterone?
Zona glomerulosa
which adrenal zone produces cortisol?
zona fasciculata
which adrenal zone produces androgens?
zona reticularis
which adrenal zone produces noradrenaline
medulla
What condition occurs in both MEN1 and MEN2A
Parathyroid hyperplasia
What conditions occur in both MEN2A and MEN2B
Phaeo
Medullary thyroid carcinoma
Conditions in MEN1
PPP
Pituitary adenoma
Parathyroid hyperplasia
Pancreatic tumours
Conditions in MEN2A
PPM
Parathyroid hyperplasia
Pheaochromocytoma
Medullary thyroid carcinoma
Conditions in MEN2B
PMMM
Pheaochromocytoma
Medullary Thyroid Carcinoma
Marfanoid body
Mucosal neuromas
what enz does allopurinol inhibit?
Xanathine oxidase
What vit def causes pellagra?
Niacin
What vit def causes anaemia and neuropathy?
Vit E
What vit def causes clotting abnormalities=
Vit K
What vit def causes dermatitis and anaemia?
Vit B6
which hormone increases urinary phosphate excretion?
PTH
confirm pancreatitis
serum lipase
hypercalcaemia in sarcoidosis
1 alpha hydroxylase release by activated macrophages
commonest cause of hypercalcaemia in community
Primary hyperparathyroidism
hormone produced by fat cells with receptors in hypothalamus
leptin
deficiency of what plasma protein in liver disease and mvmnt disorder
Ceruloplasmin
fully differentiated b cell that produces antibodies
Plasma cell
what condition invloves upper and lower airways, kidneys, ANCA positive with cytoplasmic staining for proteinase 3?
Wegener’s Granulomatosis (GPA)
ANCA positive with perinuclear staining for myeloperoxidase
Microscopic Polyangitis
reactivation of human polyoma virus t (john cunningham virus)
Progressive Multifocal Leukoencephalopathy
MEFV gene mutation
Familial mediteranian fever
measure what before azathioprine use?
Thiopurine Methyltransferase (TPMT)
neutrophils fail to oxidise dihydrorhodamine (DHR)
Chronic granulomatous disease
antibody isotype for food allergy
IgE
antibody isotype in secretions
IgA
Antibody isotype in primary response
IgM
Antibody isotype in secondary response
IgG
IL2RG mutation encoding IL2 common gamma chain
X linked SCID
CAR-T cell for what cancer cell type?
B cells
Bare lymphocyte syndrome affecting HLA class II - what def?
CD4+ T cells (T helper cells)
Bare lymphocyte syndrome affecting HLA class I - what def?
CD8+ T cells (cytotoxic T cells)
mutation of CD40 ligand
Hyper IgM syndrome
Denosumab
monoclonal antibody for RANKL used to treat Osteoporosis
IgA specific for TTG
coeliac
class of abx - conc dependent killing
aminoglycosides
gram -ve bacilli causing fever and abdo pain after trip to india, Malaria neg, what abx?
Salmonella? Ceftriaxone
gram +ve rods in CSF of elderly woman
Listeria monocytogenes
which human herpes virus is associated with post transplant lymphoproliferative disorder ?
EBV (Human herpes virus 4)
yeasts in CSF of HIV patient
cryptococcus neoformans
Rice water stool
Vibrio Cholera
which virus in first 20 weeks of pregnancy causes hydrops fetalis
Parvovirus B19 (slapped cheek)
mucomycosis antifungal therapy
amphotericin B
4 year old with bloody diarrhoea and HUS
E coli 0157:H7
what is the cause of beta thalassaemia major
decreased production of beta globin chains
auer rods on blood film
AML
left shift
increase of immature cells
toxic granulation
bacterial infection
factors in cryprecipitate
8 ,13 and vWF
factos in FFP
Fibrinogen and all coag factors
young girl with leg pains, palor, bruising, lymphadenopathy and blood film shows 80% blast cells
ALL
smoker with high Hb, normal RBC mass, low plasma volume
relative polycythemia
neutropenic sepsis secondary to myelodysplasia presents with pancytopenia, and blood film with numerous large primitive cells
Progression to myelofibrosis
DOAC monitoring
none
LMWH monitoring
none
Warfarin monitoring
INR
Unfractionated heparin monitoring
APTT or Anti Xa assay
acute graft v host disease mediated by which cell type
donor t cells
symptoms of multiple myeloma
CRAB
Calcium
Renal failure
Anaemia
Bone lesions
therapy for CML with philadelphia translocationin chronic phase
imatinib (ABL1 tyrosine kinase inhibitor)
which blood stuff decrease in pregnancy
Hb Hct Plt Factor 2 Protein S
Ann arbor stage 1
hodgkins
one LN region
Ann arbor stage 2
Hodgkins
2 or more LN on same sid eof diaphragm
Ann arbor stage 3
hodgkins
2 or more LN on either side of diaphragm
Ann arbor stage 4
hodgkins
2 or more LN on either side of diaphragm and organ mets
what type of necrosis is associated with MI?
coagulative necrosis
most common ovarian tumour
serous cystadenoma
most common testicular cancer
germ cell testicular cancer (seminoma)
extradural haemorrhage blood vessel
middle meningeal artery
subdural haemorrhage blood vessel
bridging veins
subarachnoid haemorrhage blood vessel
berry aneurysm at carotid bifurcation
virus associated with nasopharyngeal carcinoma
EBV
pulmonary oedema due to liver disease
decreased osmotic pressure (low albumin)
commonest cause of ARDS in adults
sepsis
commonest glial cell in CNS
astrocytes
commonest cause of mitral valve stenosis
Rheumatic heart disease
inheritance of haemochromatosis
autosomal recessive
inheritance of Wilsons
Autosomal recessive
Inheritance of alpha 1 antitrypsin deficicency
Autosomal dominant
commonest cause of pancreatitis
gallstones
brain tumor at surface asymptomatic
meningioma
commonest skin cancer
basal cell carcinoma
low Na, high K, low bicarb,, lowish glucose
addisons –> renal loss of Na causing H retention –> metabolic acidosis
AST:ALT alcoholic cirrhosis
2:1
AST:ALT viral hep
1:1
Quinine glucose effect
hypoglycaemia
glucagon
release glucose into blood
clinical features of hypercalcaemia
Stones
Bones
Groans
Moans
macro vs micros pit adenoma
micro <10mm
Macro >10mm
mild prolactin elevation
<1000
stress recent breast exam vaginal exam hypothyroidism PCOS
moderate prolactin elevation >1000 <5000
hypothalamic tumour non-functioning pituitary adenoma microprolactinoma PCOS drugs
extreme prolactin elevation
>5000
macroprolactinoma
PPH low pit hormones
Sheehan syndrome (hypopituitarism)
Obstructive jaundice
incr conj bili
red urobili
pale stool
dark urine
haemolytic jaundice
raised LDH
red haptoglobin
raised urobili
raised unconj bili
what binds receptors in adrenal and stimulates aldosterone release
Ang II
what convertes Ang I to ang II
ACE produced by lungs
what converts angiotensinogen to ang I
Renin
where is angiotensinogen produced
liver
in ab mediated rejection of renal allograft where is inflmmatory infiltrate seen?
Capilaries
cells infected by HIV
CD4 t cells
HIV gp120
initial binding
HIV gp41
conformational change
conjugate vaccines
N meningitidis
H influenzae
Strep pneumonia
high ANA, +ve dsDNA antibody, low C3 and C4
SLE
gastric parietl cell abs
pernicious anaemia
coombs type 1 hypersensitivity rxn
igE mediated mast cell histamine release
coombs type 2 hypersensitivity rxn
igG/IgM to cell/matrix antigen
coombs type 3 hypersensitivity rxn
igG/IgM to soluble antigen
coombs type 4 hypersensitivity rxn
T cell mediated
failure to regulate cryopyrin driven activation of neutrophils
Familial mediteranean fever
Pembrolizumab (anti-PD1)
Keytruda
enhances T-cell immunity and used in mx of some cancers (NSCLC, melanoma, bladder cancer, Hodgkins lymphoma)
Rituximab (anti-CD20)
depletes mature B-cells
b-DMARD for RA mx
Adalimumab (anti-TNFalpha)
standard immunosuppressive regimen for transplant pts
CNI + MMF/aza +/- steroid
CNI
Tacrolimus
Cyclosporin
MMF
Mycophenolate mofetil
blocks T>B cell prolif
via blocking nucleotide synthesis
Azathioprine
prevents T>Bcell activation/prolif
via blocking purine synthesis
measure TPMT before starting
what chemokine receptor promotes dendritic cell migration to LNs
CCR7
Plasmapheresis
severe type 2 disease
Goodpastures (anti GBM)
Myasthenia Gravis (anti AchR)
Vascular rejection
Ab mediated rejection
close contact with TB - what is lifetime risk?
10%
what % of world have TB
33%
Legionella abx
Macrolides (Azithromycin)
Quinolones (ciprofloxacin)
hep worse in pregnancy
Hep E
seroogical test for candida
Beta-D-glucan
serological test for aspergillus
galactomannan
serological test for syphilis
TPPA (treponema pallidum particle agglutination)
Widal test
typhoid paratyphoid
food poisoning organism in honey or canned beans
clostridium botulinim
enteric fever constipation and rose spots
salmonella typhi
undercooked chicken and bloody diarrhoea
campylobacter jejuni
severe malaria tx
IV artesunate
mild malaria tx
Riamet = artemether + lumefantrine
Hep B antiviral
tenofovir
Rat bite fever
Streptobacillis moniliformis
Q fever
coxiella burnetti
syphilis
treponema pallidum
Lyme disease
borrelia birgdoferi
bacillary angiomatosis
bartonella henselae
commonest form of prion disease
sporadic CJD
refer to coroner if
unknown cause of death
not seen by dr in last illness or last 28 days
death in custody
detained under MHA
hierarchy of consent (family)
Partner/spouse Parent/child Sibling Grandparent/grandchild Nephew/neice step parent half sibling friend of long standing
p ANCA anti myeloperoxidase
Microscopic polyangitis
c ANCA anti proteinase 3
Granulomatosis with Polyangitis
routine test shows raised WCC, Neutrophils and Basophils
CML
Carbimazole side effect
agranulocytosis
Spleen in Ann Arbor staging for hodgkins lymphoma
= Lymphoid (so if theres mets then still considered stage 3)
hypogranular hypolobulated neutrophils
myelodysplastic syndrome
raised Hb A2
Beta thalassaemia
globins that make up Ab A2
2 alpha and 2 gamma globins
pancytopaenia
Tear drop poikilocytes
primitive cells
Myelofibrosis
liver mass with raised AFP
hepatocellular carcinoma
lesion with eosinophilic cytoplasm, intercellular bridges, intracellular keratin formation
squamous cell carcinoma
Pt without ABO grouping need plasma of what group?
AB (so no anti A or B abs are present)
villous atrophy, lymphocyte infiltrate, crypt hyperplasia
coeliac disease
haemangioblastomas in cerebellum and retina, renal cell carcinomas, cysts of pancreas and kidneys
Von Hippel Lindau
giant cell astrocytoma; cortical tuber; supependymal nodules and calcifications on CT
Tuberous Sclerosis
Sjögrens salivary gland bx
CD4 +ve T cells
hypoglycaemia tx with no IV access
IM/SC glucagon
asymptomatic hyperbilirubinaemia
Gilberts
Positively birefrinent crystals in knee
Pseuogout
18 yo died with hypertrophy of interventricular septum
hypertrophic obstructive cardiomyopathy
which WBC has granulers with myeloperoxidase and ALP
Neutrophils
clear cell carcinoma origin
Kidney
congo red +ve with apple green birefringence
Amyloid
mouldy grain + hepatocellular carcinoma
Afla toxin from aspergillus flavus
ALP > 500 in bone disease
Osteomalacia, pagets
ALP < 500 in bone disease
cancer
overdose with respiratory alkalosis
Aspirin
low calcium, low phosphate, high PTH
secondary hyperparathyroidism
dihydrorhodamine test
chronic granulomatous disease
congenital adrenal hyperplasia enz deficiency
21 hydroxylase
FMF tx
Colchicine
max number of HLA mismatches in parent to child organ donation
3
chance of perfect HLA match from sibling donor
25%
chance of HLA mm of 3 from sibling donor
50%
chance of HLA mm of 6 from sibling donor
25%
mutation in hyper IgM
CD40L
low Cd4+ve cells and no class switching
bare lymphocyte syndrome type 2
low Cd8+ve cells and normal IgG levels
bare lymphocyte syndrome type 1
cytokine in ankylosing spondylitis
TNF alpha
IL 17
linear deposits of ab along glomerular basement membrane
goodpastures
immune cell type deficient in DiGeorge
Tcells
CSF test for cryptococcus neoformans
India ink stain
urinary antigen test
legionella
strep pneumoniae
cytokine promoting terminal differentiation of eosinphils
IL5
Meningitis tx with cover
Ceftriazone + ampicillin cover for Listeria +/- acyclovir for encephalitis
2 day old CSF gram -ve bacilli
e coli
CoNs causing UTI
staph saprophyticus
dsDNA virus in transplant pts causing nephritis
BK virus
fever, abdo pain, constipation, gram -ve rod
salmonella typhi
helminth
strongoloidies
fetus exposure -> sensorineural deafness, eye abnormalities, congenital heart disease
rubella
