Past papers Flashcards by Owen Vineall

What scan do for bony metastases

Technetium bisphsophonate scan
Also see activity where fractures

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What scan do for meabolically active metastases

FDG PET scan

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Septic arthritis with gram negative intracellular diplococci

Neisseria gonorrhoea
Get primary gonorrhoea then a few weeks later get septic arthritis

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Most common cause of septic monoarthritis in someone aged 19-30

Neisseria gonorrhoea

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Gram negative intracellular diplococci causing meningitis

Neisseria meningitidis

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6 year old with gram negative rods on lumbar puncture

Haemophilus influenzae

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Neonate or premature with gram negative rods on lumbar puncture

E coli
Only causes meningitis in neonates and premature babies

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Gram positive diplococci on blood culture

Step pneumoniae

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Gram positive in clusters

Staph aureus

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Mild fever PUO, cultures come back gram positive cocci

Strep viridans

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What malignancy is lambert eaton associated with

Small cell lung cancer

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Which coagulation factor decreases quickest after warfarin

VII

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What does a normal osmolality with hyponatraemia suggest

Pseudohyponatraemia
Caused by hyperlipidaemia or paraproteinaemia

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What is needed for a true hyponatraemia

A low osmolality

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How to differentiate between causes of hypovolaemic hyponatraemia

Look at urinary sodium
- if over 20 then renal cause (drugs, salt losing nephropathy)
- if under 20 diarrhoea etc

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Hypokalaemia with hypoglycaemia

Insulin OD

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What causes hypokalaemia, hypotension and hypercalciuria

Bartter syndrome

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Hyperkalaemia with a low aldosterone

ACEi
Reduced production of aldosterone

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What are the types of renal tubular acidosis and their affect on potassium handling

Type 1 (distal tubule)- hypokalaemia
Type 2 (proximal tubule)- hypokalaemia
Type 3 (both DCT and PCT)- hypokalaemia
Type 4 (adrenals) - hyperkalaemia

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What is used to differentiate causes of metabolic acidosis

Anion gap (NR 10-18)

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Brittle hair and developmental delay

Homocysteinuria

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Cherry red spot
Developmental delay
Deafness and blindness

Fabrys disease (lysosomal disease)

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Encephalopathy- hypotonia, lethargy, poor feeding
Sweet odour and sweaty feet

Maple syrup disease

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How to tell difference between primary and tertiary hyperparathyroidism

Can be very difficult to tell difference biochemically however presence of CKD shows is tertiary

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If ischaemia causing a hyerkalaemia what is cause of the hyperkalaemia

Can either be due to metabolic acidosis or tissue injury Tissue injury releases K and metabolic acidosis would cause hyperkalaemia to correct acidosis If acidosis corrected is tissue injury

What does normal base excess show

Whether a resp acidosis or alkalosis is being corrected If between -2 and 2 is not compensation

How is osmolarity calculated

2(Na+K)+ glucose+urea

What is rash like in pellagra

Casals necklace- erythematous an dpigmented rash in neklace distribution

What is ALP in myeloma

Normal

How many half lifes does it take for a drug to reach a steady state

4-5

What is best measure of confirming a reinfarction a couple days after first MI

CK MB as returns to normal a couple days after

What is best measure of MI in terms of sensitivity and specificity

Troponin I

What are differences between cold and warm AIHA

Warm - haemolysis occurs in spleen - IgG - occurs at 37C in DAT Cold - intravascular peripheral haemolysis - IgM - occurs at lower temperatures

Causes of warm AIHA

Drugs CLL SLE

Causes of cold AIHA

Mycoplasma EBV

What are howell-jolly bodies

Nuclear remnants in RBCs

What is anisocytosis

Variety in size of RBC- seen in IDA, beta thalassaemia, megaloblastic anaemia

What are cabot rings and what are they seen in

Looped structures found within RBC B12 deficiency

What is pental for TTP

MAHA Renal failure Thrombocytopenia Fever Neuro signs

What is definitive test for TTP

ADAM-ST13 enzyme assay

What leukaemia is caused by HTLV-1 infection in japanese women commonly

Adult T-cell leukaemia

What presents with centrocytes and centroblasts on histology

Follicular NHL

What lymphoma is seen in HIV

Diffuse large cell lymphoma

What can cause hyposplenism

Trauma Planned splenectomy Physiological hyposplenism- coeliac, UC, SCD

Conditions where splenectomy helpful

The PIIES Thalassaemia PK deficiency Immune haemolytic anaemia Idiopathic TTP Elliptocytosis Spherocytosis

How does beta thalassaemia trait present

Normally picked up on routine blood test Have slightly microcytic anaemia Slightly increased HbA2

What is normal proportion of HbA2

1.5-3.5

Presentation of beta thalassaemia major

Failure to thrive Severe microcytic anaemia Hepatosplenomegaly Bossing of forehead

What are donath-landsteiner antibodies seen in

Paroxysmal cold haemoglobinuria

How to remember symptoms of paroxysmal nocturnal haemoglobinuria

Pancytopenia New thrombus Haemolytic anaemia

What is most sensitive antibody for pernicious anaemia

Anti-parietal cell

What are blood findings of haemochromatosis

High ferritin Low TIBC High transferrin saturation High iron

Presentation of hereditary haemochromatosis

* the liver (hepatomegaly, deranged LFTs) * joints (arthralgia, chondrocalcinosis) * pancreas (diabetes) * heart (dilated cardiomyopathy) * pituitary gland (hypogonadism and impotence) * adrenals (adrenal insufficiency) * skin (slate grey skin pigmentation)

Management of TTP

Plasma exchange

How do packed red cells and FFP transfusions cause thrombocytopenia

They contain very few platelets and have diluting effect on the blood

Physiologically what causes an increased ESR

Fibrinogen Acute phase proteins Immunoglobulins

What causes combined polycythaemia

Chronic smoking Smoking contains CO which displaces O from Haemogoblin causing raised EPO. Furthermore it is a risk factor for COPD which causes polycythaemia too Presence of COPD shows is combined

What is difference between splenomegaly and hypersplenism

Splenomegaly is when spleen enlarged- in some cases this can become hypersplenism Hypersplenism is when get splenomegaly with a reduction in a cell line

What is red cell mass

Essentially is a better measure of HCT as HCT can be increased if the patient is dehydrated

What is an absolute versus a relative erythrocytosis

Relative erythrocytosis is caused by dehydration whereas absolute is polycythaemia Red cell mass proves this

What happens to red cell mass in true polycythaemia

Increases

What is glanzmanns thrombasthenia

Inherited lack of Glp11b/111a leading to defective platelet aggregration

How to differentiate between a reactive neutrophilia and cancer

Luekocyte ALP Low in dyscrasia but normal/high in reactive

MOA of bortezomib

Proteosome inhibitor

How is von wilebrand treated

Desmopressin

What is most common cause of death in myelodysplastic syndromes

Bacterial infection

Increased susceptibility to infection following from diarrhoea

Protein-losing enteropathy

What is protein losing enteropathy

Crohns and coeliac disease can lead to hypoproteinaemia causing loss of Ig which diminishes adaptive immune response

What is defect in CVID

Mutation in MHC III

What does presence of anti-Jo suggest about dermatomyositis

Lung fibrosis

Presentation of PBC

Malaise Itching Symptoms from lack of absorption of fat soluble vitamins - Vit A blindness - Vit K bruising - vitamin D osteomalacia

Which antigen is indicated in pathogenesis of AIHA

rhesus

Which antigen is indicated in pathogenesis of PAN

Hep B surface antigen

Which antigen is indicated in pathogenesis of MS

Myelin basic protein

Biopsy of lupus nephritis

IgM, IgG and IgA deposition C3 deposition

What is used to diagnose IgA nephropathy

Immunofluoresecence showing IgA deposition in the kidney

What is the kviem test used for

Sarcoid

What is CH50 and what happens to it in SLE

An acute phase protein Raised in SLE

Which HLA is coeliac associated with

HLA-DQ2 and 8

What is the NBT test

Nitro blue tetrazolium Measures ability of neutrophils to produce NADPH Positive (normal functioning neutrophils) means turning blue Negative (aberrant function) means stays colourless/yellow

What is NBT in the different neutrophil immunodeficiencies

Kostmann and leukocyte adhesion deficiency is positive Negative in chronic granulomatous disease

What autoimmune conditions are often seen in selective IgA deficiency

RA SLE Coelaic

Which cell first encounters an allergen

Macrophage

In rejection due to ABO incompatibility what cell is responsible for reaction

B cell

What is treatment of a myasthenic crisis

Plasmapharesis

What is a hyperacute organ rejection

Occurs within minutes to hours due to preformed antigens on surface of donor organ Often occurs if mismatch on ABO

What are the 2 monoclonal anti-TNF alpha antibodies and what is difference

Infliximab- mouse human chimeric Adalimumab- human monoclonal antibody

What T1DM antibody is against tyrosine phosphate

Anti-IA-2

Which factors suggest type 2 AIH as opposed to type 1

Presence of anti liver kidney microsome antibodies Younger people (children) Resistance to steroids Low IgA

What antIbodies are seen in vitiligo

Anti-melanocyte

What are anti glutamic acid decarboxylase antibodies associated with

T1DM Stiff man syndrome

What antibodies are indicated in GBS

Anti-ganglioside LM1

Low IgA in disease with deranged liver function or symptoms

Type 2 AIH

What is the stain done for PJP

Gomori methenamine silver stain showing flying saucer shaped cysts on microscopy

When are moraxella catarrhalis infections common

In chronic lung disease often in COPD infective exacerbations

Organism causing gastroenteritis after drinking unpasteurised milk

Listeria

Which patients are listeria GI infections seen in

Immunocompromised Neonates

Beta haemolytic anaerobic organism with tumbling motility causing GI infection

Listeria monocytogenes

GI infection after swimming in a contaminated lake in UK

E coli

Severe watery diarrhoea with no leukocytes on microscopy

Vibrio cholera as produce enterotoxins which cause water loss but don't colonise the intestine

What type of organism is giardia

Pear shaped trophozyte with 4 flagella and 2 nuceli

In what people should giardia be considered

Homosexual men Hikers Travellers

Which bacteria causes diarroea by producing exotoxins which act as a superantigen

Staph aureus

What are phases to leptospirosis (weils syndrome)

Initially get non specific fever, headache and conjunctival haemorrhage Then haemolytic anaemia, meningitis and renal failure

What organism causes leptospirosis

Leptospira interrogans

Gold standard for leptospirosis

Microscopic agglutination test

What type of organism is cryptococcus

Encapsulated yeast infection

Most common cause of viral meningitis

Non-polio enteroviruses

What are examples of NRTIs

Lamivudine and zidovudine

What bacteria causes lyme disease

Borrelia burgdorferi

Main brucella complication

Granulomatous liver

What are examples of NNRTI

Efavirenz

Presentation of lyme disease

In 3 stages Local - rash and constitutional sx Disseminated - PEACH - peripheral neuropathy - erythem migrans - arthritis - cranial nerve palsy - heart block Late - arthritis - encephalitis

Most appropriate and useful test for sporadic CJD

MRI

How to remember sx of sporadic CJD

Demented LAMB Dementia LMN signs Akinetic mutism Myoclonus Blindess

Differentiating between the meningitis' on CSF - viral - bacterial - TB

Both viral and TB can have clear CSF and high lymphocytes however they have extremely high protein and low glucose Bacterial will have high neutrophils and high proteins but always be turbid and also have a low glucose

What is most significant predictor of clearing the virus in Hep C

Genotype as are a few in the UK some of which carry significantly worse prognosis

What is used to diagnose a current Hep C infection

Hep C RNA PCR

What are haemosiderin macrophages in the lung seen in

LHF

Gastric biopsy reveals signet rings and linitis plastica

Gastric adenocarcinoma

How are peptic ulcers differentiated from gastric adenocarcinomas

Carcinomas have raised and uneven borders

Which cancer is associated with exposure to alfatoxins (from aspergillus)

Hepatocellular carcinoma

Difference in identification lobular and ductal carcinoma in situ

Ductal- unilateral with calcifications Lobular- bilateral (can have many) and cant be picked up on mammogram

Breast tumour with artichoke like appearance

Phyllodes tumour

Multiple lytic zones around epiphyses

Giant cell tumours

Pains in limbs with shooting pain and SOB too

Pagets bone disease

Recurrent emboli from vegetations on mitral valve where no inflammation and blood cultures negative

Non thrombotic endocarditis

Colorectal cancers with pigmentation around the mouth

Peutz jeughers giving harmartomatous polyps

How to differentiate between emphysema and chronic bronchitis

Chronic bronchitis produces copious amounts of sputum

What is lung disease associated with burns injuries

ARDS

What presents with oral ulcers, malaise and erythema multiforme

SJS

What is eosinophiluria indicative of

Tubulointerstitial nephritis

How is beta thalassaemia diagnosed

High performance liquid chromatography

Treatment for spinal chord compression myeloma

Steroids Radiotherapy

What is standard INR target

2-3 This for first time DVT/PE, AF

What factors can raise the target INR

Prosthetic valve Second DVT/PE

If on continuous unfractionated heparin what need monitored

aPTT

If on prophylaxis LMWH for a surgery what monitoring needed

None

What is done to blood donations to reduce risk of TaGvHD in immunosuppressed patients?

Irradiation

What is mechanism behind hyperacute organ rejection

Preformed antibodies

What is VTE risk compared to women for men

How is heparin function monitored if have renal impairment

Anti-Xa assay

Chimeric antigen receptor T-cell therapy against CD19: what type of haematological malignancy does it target?

Any B cell lymphoma or leukaemia

Diagnostic test for HS

Eosin-5’-maleimide dye test

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. What is the possible cause?

Post thrombotic syndrome

Other than PCV what else can JAK2 mutations occur in

Myelofibrosis Essential thrombocythaemia

What are irregularly contracted cells seen in

G6PD

Haematuria after starting a drug what is diagnosis

G6PD

What is used for treatment of p53 mutation CLL

Ibrutinib

What thrombomodulator reduces in pregnancy

Protein S

What is targeted in Graft vs Host disease?

HLA

What drug can allopurinol not be given with

Azathioprine

Which thrombomodulators are antithrombotic

Thrombomodulin Protein S Protein C

How does renal artery stenosis cause hyperaldosteronism

Reduced perfusion which activates RAAS

What is normal response to water deprivavtion test

Urine osmolality increases over 600

What enzyme gets raised if taken cocaine

AST

Elderly gentleman with history of headaches and a raised ALP alone

Pagets

What enzyme is raised in mumps

Amylase-S

If vegan has macrocytic anaemia what is like vitamin deficiency

B12 as folate in veggies

What happens to epiphyses and metaphyses in rickets

Widened epiphyses Metaphyses become cupped

Final enzyme in uric acid production

Xanthine oxidase

What is raised in rhabdomyolysis

CK Myoglobin

Acute management of gout

NSAIDS Colchicine

Chronic management of gout

Allopurinol Probenecid in some countries

In what condition is there deficiency in HGPRT

Lesch nyan syndrome

What is main difference biochemically between osteomalacia and osteodystrophy

High phosphate in renal Low in osteomalacia

What is calcitonin raised in

Medullary thyroid cancer

Whats in MEN1

3 ps Parathyroid Pancreatic (insulinoma) Pituitary

What is in MEN2a

2Ps 1M Parathyroid Phaeo Medullary thyroid

What is in MEN 2b

1P 2MS Phaeo Medullary thyroid Mucocutaenous Associated with Marfans

Interpreting hot uptake on thyroid gland - diffuse - multinodular - single nodule

Diffuse- graves Multinodular- toxic multinodular goitre (plummers) Single nodule- toxic adenoma

Hyperthyroidism with cold uptake globally

De quervains

Which molecule takes cholesterol and moves it to liver and steroidogenesis organs?

HDL

How to interpret urine specific gravity

Normal range from 1.005-1.030 If low suggests lots of water in the urine If high implies very dehydrated

What is most common type of tumour in appendix

Neuroendocrine

Mass in pancreas after pancreatitis

Pseudocyst

Where does pancreatic cancer most commonly metastasie

Liver

Surgeons notice grey specks on the pancreas

Ductal adenocarcinoma

Symmetrical joint pain in younger woman

Which thyroid cancer metastasises to lymph nodes most commonly

Papillary

Ovarian cancer with signet ring cells

Kruckenburg tumour- gastric metastases

Which virus increases risk of nasopharyngeal cancer

EBV

Alcoholic with white stripes in oesophagus

Candidiasis

42 year old woman has a history of intermenstrual bleeding. On examination, a cervical polyp is found. What do you do next?

Remove and send for histology

What type of section is done intraoperatively if need a diagnosis

Intra-operative frozen section

Cause of HTN in upper body only

Aortic coarctation

Most common lung cancer in a non smoker

Adeno

What is method of spread of melanoma

Lymphoid

What presents with muscles aches all over and joint pain

Polymyositis (can also present with joint pain)

What would you measure in an excacerbation of SLE

C3 and C4

Which cells are Foxp3+

Treg

Which cell has oxidative and non-oxidative killing methods and dies once job is done

Neutrophils

What are antibodies for sjogrens

ENA Anti-Ro Anti-La

What is associated with increased susceptibility to mycobacterium and the BcG vaccine

IFN-gamma deficiency IL-12 deficiency

Person older than 18 with recurrent infections and evidence of B cell problems

CVID

Normal B cells and CD8 but deficient CD4

Bare lymphocyte syndrome type II

Reduced T cell and neutrophil counts but normal B cells

X-linked SCID

Normal B and T cells, high IgM but absence of IgA, IgE and IgG

Hyper IgM syndrome

What monoclonal antibody used to treat ank spond

Etanercept

What is MOA of etanercept

TNF-alpha inhibitor AND TNF-beta unlike infliximab and adalimumab which just alpha

What antibodies are used to treat melanoma

Ipilimumab Pembrolizumab Nivolumab

MOA of ipilimumab

Blocks T cell inhibitory checkpoints by binding to CTLA4

Recurrent episodes of flushed face and breathing problems with hepatomegaly

Hereditary angioedema

What type of gel and coombs HS reaction is atopic eczema

Type I

If targetting TNF-alpha doesnt work in ank spnd what can then be used

Secukinumab- Anti-IL17

Which receptor mutation is associated with better outcomes in HIV

CCR5

What immunodeficiency is associated with IL2 common gamma chain

X-liked SCID

What is maxium number of HLA mismatches in a transplant

6 Do off HLA class 1 proteins and are 2 of DR, A and B

How does nivolumab/pembrolizumab work

PD1 on regulator t cells to induce apoptosis This then in turn means more circulating T cells to destroy cancer cells

What type of hypersensivity reaction is serum sickness

III

What is adalimumab used in treatment of

Which anibody confers natural protection against HIV

gp120

What vaccine cant be given to pregnant women

MMR as a live vaccine

Which cells bind to MHC1

NK CD8+

What is used to treat a child with comorbidities who has RSV

Ribavirin

When differentiating between CMV and rubella in neonatal infection how to differentiate

The eye disease Cataracts in rubella but CMV has choroidretinitis

Most common cause of travellers diarrhoea

Entero-toxigenic E coli

Even on a ward what is most likely cause of an outbreak of gastroenteritis

Norovirus

Best antibiotic for pseudomonas

Ciprofloxacin

Outbreak of boils around someones friendship group

S aureus

Treatment for typhoid

Ceftriaxone

What is definition of herd immunity

The proportion of immune healthy people needed within a population to stop a pathogen’s spread

What are the 3 characteristics of a successful flu outbreak

Novel antigenicity Efficient replication in human airway Efficient transmission between humans

Alcoholic man is on ceftriaxone for meningitis, what organism is he at risk of which this does not cover for?

Listeria

Has contact with someone with TB, what is the lifetime risk of immunocompetent getting active TB?

10%

What are snail track oral ulcers seen in

Syphyllis

What carries borrelia burgdorferi

Ixodes tick

Which vaccine-preventable organism causes cough, lymph node enlargement and has a potential to occlude the airway?

Cornyebacterium diphteria

Which hepatitis does not cause chronic hepatitis

Hep A and E

Most common cause of cellulitis

Strep pyogenes

What infections cause aplastic anaemia

Parvovirus B19 HEPATITIS

Most common malignancy in breast

Invasive ductal carcinoma

MOA of allopurinol

Xanthine oxidase inhibitor

What is pathophysiology in hyper IgM syndrome

Mutation in CD40 on T cells which affect communication between B and T cells

Gram positive rods causing meningitis in elderly

Listeria

Why are under 12 months not able to have honey

Risk of infection with clostridium botulinum

Which hepatitis virus is associated with more severe disease if acquired in pregnancy potentially leading to fulminant hepatic failure and death?

Hep E

What can be treated with plasmapharesis

Anything with excessive type 2 mediated hypersensitivity - Myasthenic crisis - Goodpastures - Antibody mediated rejection - cryoglobulinaemia

What are the expected number of HLA matches between parent and child

3/6 50%

What is the likelihood of these matches between 2 siblings - 0 matches - 3/6 matches - 6 matches

0/6- 25% 3/6- 50% 6/6- 25%

What type of HS reaction is PAN

III

How to interpret a high prolactin

Moderately high (1000-5000) - microprolactinoma (<10mm) - non-functioning adenoma compressing stalk supplying dopamine Extremely high (over 5000) - macroprolactinoma

What happens to urinary bilirubin in haemolytic jaundice

There is not bilirubinaemia as uncnoj bilirubin hydrophillic Get urobilirubinaemia as more urobilirubin absorbed to enterohepatic recycling pathway

What happens to HDL if an alcoholic

Gets raised

Most common skin cancer

BCC

Brain tumour that occurs near top of brain and often asymptomatic

Meningioma

Which is the commonest glial cell in the CNS?

Astrocytes

Most common cause of ARDS in adults

Sepsis

What is the most common ovarian tumour?

Serous cystadenoma

Which type of necrosis is associated with a MI?

Coagulative necrosis

In obstetric practice, the maximum risk of fatal maternal thrombo-embolism occurs at which stage of pregnancy?

Post partum

Acute GvHD post-allogeneic haematopoietic stem cell transplant is mediated by which cell type?

Donor T cells

What do MDS progress to

AML As blasts

What causes relative polycythaemia

Dehydration

What is left and right shift with regards to neutrophils and its significance

Shifted to left means producing less lobes (reactive neutrophilia) Shifted to right means more lobes (megaloblastic)

What is organism in mumps

Mumps virus

Which class of antibiotics has concentration dependent killing (i.e. the goal of therapy is to maximise peak > MIC)

Aminoglycoside

Doctors should measure the level/activity of which enzyme before prescribing azathioprine?

Thiopurine methyltransferase

What hormone is produced by fat cells, and has receptors in the hypothalamus?

Leptin

What is the commonest cause of hypercalcaemia in the community?

Parathyroid adenoma

What active enzyme in sarcoidosis patients causes hypercalcaemia

1 alpha hydroxylase

Most common cause of hypocalcaemia in the community

Hypoalbuminaemia

What are adrenal zones and what produce

Zona glomerulosa- aldosterone Zona fasciculata- cortisol Zona reticularis- sex steroids Medulla- adrenaline REMEMBER AS ACS

What is the commonest cause of portal vein thrombosis?

Liver cirrhosis

Most common cause of nephrotic syndrome in adults

FSGS

Most common cause of constrictive pericarditis in developing world

Most common primary tumour of heart

Myxoma

What is a myelocyte

A neutrophil precursor

What is stain for cryptococcus

India ink- see yeast cells surrounded by halos

What is stain for chlamydia psittaci

Giemsa stain

What electrolyte abnormality can quinines cause

Hypoglycaemia

Indications for nivolumab and pembrolizumab

Melanoma Metastatic renal cancer

Which infection does cyclophosphamide make you susceptible to

PJP

What drug increases excretion of uric acid

Probenecid

What is main killer in CKD

Calcifications and subsequent atherosclerosis

How to differentiate between renal artery stenosis and conns as causing hypokalemia, hypernatraemia and hypertension

Look at aldosterone renin ratio - high aldosterone in conns - high renin in RAS as reduced perfusion

Causes of normal anion gap metabolic acidosis

ABC Addisons Bicarb loss- renal tubular acidosis, diarrhoea, laxatives Chloride gain- NaCl infusion

What is fanconi syndrome

Condition where failure of PCT to reabsorb small particles

Causes of fanconi syndrome

Congenital Wilsons Myeloma Lead poisoning Tetracyclines

Lab results of fanconi syndrome

Glucosuria Hypokalaemia Metabolic acidosis Hyperuricosuria Proteinuria

MOA of lomitapide

Lomitapide acts by inhibiting Microsomal triglyceride transfer protein (MTP)

MOA of colchicine

Inhibits tubulin polymerisation to reduce migration of neutrophils

Pseudohypoparathyroidism presentation

Resistance to PTH - low calcium - high phosophate - high PTH Short 4th and 5th metacarpals

Other name for pseudohypoparathyroidism

Albright hereditary osteodystrophy

Difference between osmolarity and osmolality

Osmolarity is what is estimation of particles in a solution is. Units =units mmol/L Osmolality is measured particles in a solution done by osmometer. Units= mmol/Kg

MOA of ezetimibe

Inhibits absorption of cholesterol

What is inside of homemade alcohol that can cause hyperuricaemia poisnoing

Lead

What presents with orange tonsils and very low HDL

Tangier disease Can also present with hepatosplenomegaly

Elevated plant sterol

Phytosterolaemia

Which brain tumour has psammoma bodies in

Meningioma

What is assocaited with epithelial casts in urine

ATN

COPD in 20 year old woman what should be investigated

Alpha 1 antitrypsin deficiency

What sign, which may be visible around the nails, is seen in Graves' disease and is due to periosteal bone growth in the nail bed?

Thyroid acropavhy

Which cancer has largest mortality in UK

Lung

Second and third most common cancer for each sex

2nd- lung 3rd- bowel

What condition is characterised by microangiopathic haemolytic anaemia, thrombocytopenia and renal failure in children?

HUS

What protein in PCKD

Polycystin-1

What is the name given to areas of regenerating mucosa which project into the lumen of the bowel, which may be visualised during a colonoscopy of a patient with ulcerative colitis?

Pseudopolyp

What structures, present in the large bowel, represent weak points in the bowel wall and allow for the formation of diverticula?

Taenia coli

What respiratory condition is characterised by airspace enlargement and alveolar wall destruction?

Emphysema

What condition is the presence of waxy casts in urine associated with?

CKD

What do delta cells from pancreas produce

Somatostatin which reduce secretion of glucagon and insulin

Which enzyme, synthesised by the pancreas, is most sensitive for the diagnosis of pancreatitis?

Lipase

Post TIA what scan do

Carotid USS

What are buffers in intracellular fluid, extracellular fluid and red blood cells

Intra- phosphate Exta- Bicarbonate RBC- haemoglobin

What is best measure of glucose over last 3 weeks

Fructosamine

What is broken down to create uric acid

Purines

Why remove whole thyroid in cancer

Thyroglobulin is marker and so can use to monitor if goes above 0

Most common cause of AKI in hospital

Reduced perfusion

What happens to urinary urinobilinogen in obstructive jaundice

Is low

What are codfish vertebrae, pepper pot skull and looser zones seen in

Osteomalacia

Why does hyperventilation cause paraesthesia?

Hyperventilation increases the pH of the blood, which increases the amount of calcium that binds to albumin in the serum. This essentially causes hypocalcaemia which causes paraesthesia.

What are the most common causes of primary and secondary hyperparathyroidism?

Primary: A parathyroid adenoma Secondary: Chronic renal failure

Which drugs decrease afferent arteriolar pressure

NSAIDS Calcineurin inhibitors

Which drugs decrease efferent arteriolar pressure

ACEi ARBs

Proportion of thyroid transported in blood

Thyroglobulin binding globulin 75 Thyroxine binding prealbumin 20 Albumin 5 Free 0.03

What causes pityraisis versicolor

Melassazia

If have a high WCC what can it be confused for

Reticulocyte count- blood film

Most common cause of IDA in world

Hookworm

What is d-dimer a measure of

Fibrinolysis

What are cigar cells seen in

IDA

After a DVT in arm what investigations do

Chest x-ray then do doppler

Reversal agent for rivaroxaban

Andexanet alpha

What triggers intrinsic pathway

Exposed collagen

What is second most common of pancreatic exocrine insufficiency in children inherited

Schwachman diamond syndrome

Which RBC are polychromatic and stain for presence of RNA

Reticulocyte

How does heparin induced thrombocytopenia present

Pro-thrombotic even though thrombocytopenia as platelets get activated by immune complexes

First line for VTE in cancer

DOAC

What lymphoma originates in the germinal zone

Burkitts

What do all myeloproliferative conditions carry risk of progressing to

AML

Which cofactor is required for synthesis of the anticoagulant proteins C and S?

Vitamin K

A 56 year old man is reviewed by his GP after his blood tests suggested a new microcytic anaemia. His ferritin and serum iron is low. His full blood count, CRP, renal function, LFTs, B12 and folate are otherwise normal. A blood film reveals the presence of hypochromic erythrocytes with pencil cells. What is the next most appropriate blood test to request, prior to an OGD and colonoscopy?

Anti-TTG

What is lymphoma in a young person

Burkitts

In a young person non child what is likely lymohoma

Hodgkins

How to quickly raise plateltes in ITP

IVIG

What are negri bodies pathognomic for

Rabies

What presents with fever worse in evening

Brucellosis

What presents with black lesions and lung problems

Anthrax

What presents with areas of hypopigmentation which under woods lamp appears orange

Pityriasis versicolor

Gold standard for leishmaniasis

Splenic aspirate

Normal B cells and CD4 cells but absent CD8

BLS I

How diagnose coxiella

Serology

What stains can be used for aspergillus and candida

Methanamine silver

What can be used to quickly diagnose nail infections

Potassium hydroxide test

What gram positive organism is associated with tumbling motility and rockets?

Listeria

Gets bitten by fish and then nodules arise

Mycobacterium marinum

How are streptoccus infections split up

Into alpha or beta haemolytic Incubate on blood agar - partial haemolysis is alpha (green) - complete haemolysis is beta (clear) Beta haemolytic then split into lancefield groups based off antigens on cell membrane

What are 2 main alpha haemolytic strep

Strep viridans and pneumoniae

Lancefield strep groups

A- no antigens (strep viridans and pneumoniae) B- (strep agalactiae) D- enterococcus

What is growth medium for differnetiating strep

Blood agar

A 34 year old man has severe Crohn's disease. His gastroenterologist wishes to start a biologic drug, infliximab. What infection should be ruled out before commencing the drug?

TB- mantoux test

What antigen is injected intradermally as part of the mantoux screening test for tuberculosis?

Tuberculin

What is main metabolite of azathioprine

6-mercatopurine

How does reticular dysgenesis present

Severe life threatening infections Profound sensorineural deafness

Blood findings of reticular dysgenesis

Deficiency of the myeloid and lymphoid cell lineages

Inheritance of reticular dysgenesis

Autosomal recessive

What immune cell releases granzyme and perforin when activated?

Killer T cells

What viral enzyme is predominantly responsible for the high mutation rate of HIV and other RNA viruses?

Reverse transcriptase

In skin prick testing, what is used as a positive control?

Histamine

Which cytokine is important in the pathogenesis of rheumatoid arthritis, anyklosing spondylitis and inflammatory bowel disease?

TNF-alpha

How long before skin prick testing must antihistamines be stopped to allow for accurate interpretation?

48 hours

A neutrophil releases preformed myeloperoxidase, defensins and neutrophil elastase. What is this process known as?

Degranulation

Which joints in the hand are classically not affected by rheumatoid arthritis?

Distal interphalangeal

What HLA allele is associated with Graves disease?

DR3

A 5 year old girl is seen by her GP. Her mother says she is unable to sleep at night as her knees, elbows and shoulders are very red and painful, especially to touch. Her mother has also noticed small bumps under her skin. She is currently pyrexic, but the mother says she is still recovering from a bad sore throat two weeks ago. What is the likely diagnosis?

Rheumatic fever

How is Latex Food Syndrome diagnosed?

Skin prick

HIV infected CD4+ cells are killed by the immune system. What cell type is responsible for this?

T killer cells

Swan neck deformity which corrects itself when putting hans together

SLE

A 31 year old accountant reports an itchy rash over the trunk and back that has been present for the last 7 weeks. On examination, there are smooth erythematous papules with evidence of excoriation. She reports no association with food, time and has changed her washing powder to a "Non-Bio" formulation. What condition is she suffering from?

Chronic urticaria

Woman with coeliac develops low albumin and immunoglobulins, what is diagnosis

Protein losing enteropathy

How to differentiate between goodpastures and microscopic polyangiitis

Goodpastures has systemic symptoms like fever and joint pain

What cell of immune systme would identify a lack of MHC on the surface and destroy it

NK cells

Which interleukins are responisble for fever

IL-1 and 6

Which antibody is associated with homogenous ANA staining

Ant-dsDNA

What gel and coombs is mantoux test

What is main immunoglobulin in breast milk

IgA

A severe asthmatic presents to their GP for the third time in three years complaining of blocked sinuses. However, over the last 6 months, she has also had unintentional weight loss and reports intermittent fevers. She also has an indistinct erythematous macular rash on both her ankles. A Full Blood Count reveals an eosinophilia (>10% of white blood cells). What rare immunological condition may be responsible for her symptoms?

Eosinophillic granulomatosis

What cell stains with CD14

Monocyte

What is the name given to the immunological process that must have occurred prior to a hyperacute transplant rejection?

Sensitisation

Immunoglobulins may bind to multiple pathogens at once in order to enhance phagocytosis. What is this process known as

Neutralisation

What is the name given to a substance that increases the effectiveness of an immune reponse to a vaccination without altering the specificity of the response?

Adjuvant

What test can be used to measure the levels of serum IgE directed against brazil nut antigens?

Radioallergosorbent test

What does RAST stand for

Radioallergosorbent tets

What is crucial enzyme in salvage pathway for purines

HGPRT

Rate limiting enzyme for purine metabolism

PAT

How to tell if something is positively birefringent or not

If positively birefringent When aligned with light filter goes blue When light filter perpendicular it goes yellow/whiteish

Which renal stone is ethylene glycol associated with

Calcium oxalate as ethylene glycol broken into oxal acid

What are hyperlobated nuclei (flower cells) seen in

Adult T cell lymphoma

What does siderosis mean

Iron accumulation

How does starry sky actually appear

Macrophages filled with apoptotic remains on a background of lymphoblasts

What are auer rods

Azurophillic crystal found in neutrophils

What technique is used to identify genetic feature of CML

FISH

Most common inherited coagulopathy

Factor 5 Leiden- normally only increased risk in presence of other RF like COCP

What clotting factor is contraindicatedlly raised in pregnancy

Where and in who does does bullous pemphigoid occur

Elderly Flexural surfaces

What is centromere pattern immunofluorescence associated with

CREST

What is nucleolar pattern immunofluorescence associated with

Diffuse systemic sclerosis

What is wire loop appearance in kidney associated with

SLE

What thyroid cancer arises from parafollicular c-cells

Medullary

2 most common pituitary adenomas

Prolatinoma 1st Non-functioning 2nd

What is somatotrophin

When is only time screening for cervical cancer may extend 64

If not had since 50 or recent abnormal results

What is most significant independant RF for CVD

Family history

If have femoral artery stenosis what change happens to skeletal muscle in legs

Atrophy

What is most damamging pathology to myocardium

Ischaemia as toxic waste products accumulate which cant be drained efficiently

What is process whereby in slowed flow, white cells are drawn to vessels walls

Margination- drawing cells to walls

How are macrophages described in granulomas

Epithelioid as develop intracellular organelle growth

Penetration through which layer of skin will lead to formation of scar

Basement membrane

If severe autoimmune haemolysis removal of which organ may help syomptoms

Spleen

Deficiency in what cell leads to recurrent viral infections

Classic NK deficiency

What is role of follicular t helper cells

Promoting germinal centre reactions and differentiation of B cells into IgG and IgA secreting plasma cells

Person with multiple autoimmune conditions presents with muscle weakness what could be cause

Myasthenia gravis

What organisms are very likely to cause bronchiectasis

Pertussis Staph aureus

What is most specific finding for IDA

Pencil cells

Rank these as cause of HAI A. Skin and soft tissue B. Surgical site C. Urinary tract D. Hospital acquired pneumonia E. Gastrointestinal system

1 - E. Gastrointestinal system 2 - C. Urinary tract 3 - D. Pneumonia/ LRTI 4 - B. Surgical site 5 - A. Skin and soft tissue

Rank as cause of PUO A. Dengue B. Viral haemorrhagic fever C. Malaria D. UTIs E. Bacterial diarrhoea

1 - C. Malaria 2 - A. Dengue 3 - E. Bacterial diarrhoea 4 - D. UTIs 5 - B. Viral haemorrhagic fever

Rank as cause of anaphylaxis A. Eggs B. Penicillin C. Banana D. Gliadin E. Peanut

1 - E. Peanut 2 - B. Penicillin 3 - A. Eggs 4 - D. Gliadin 5 - C. Banana

Rank from narrow to broad spectrum A. Meropenem B. Benzylpenicillin C. Co-amoxiclav D. Tazocin E. Amoxicillin

1 - B. Benzylpenicillin 2 - E. Amoxicillin 3 - C. Co-amoxiclav 4 - D. Tazocin 5 - A. Meropenem

Superoxide dismutase 1 is a misfolded protein associated with which condition?

MND

Best treatments for pseudomonas

Aminoglycosides are best narrow spectrum Can also give broad spectrum beta lactams like ceftazidime

Meningitis with high opening pressure

Cryptococcus

Flu like illness a few weeks after contracting HIV

HIV seroconversion illness

What infection is likely to cause positive result on heterophile test aswell as well as EBV

CMV

Most appropriate test for EBV

EBV IgM as heterophile test can also be positive in CMV

What test do before intiating a quinine

G6PD test

4 causes of massive splenomegaly

Certain haematological malignancies (e.g. myelofibrosis, CML, hairy cell leukaemia) Chronic malaria Leishmaniasis Gaucher disease

What infection are immunosuppressed kids especially at risk of

Adenovirus

Most common cause of infectious congenital hearing loss

CMV

Which causes of diarrhoea have lowest infective dose

Noroviris Shigella

Why does the influenza virus only cause respiratory disease?

The influenza virus requires activation by host cell proteases that are only expressed in the respiratory tract

What is the vector for Trypsanoma brucei rhodesiense?

Tsete fly

What is the most common cause of late onset sepsis in neonate?

Staph epidermis

What stain is used to screen TB

Auramine

What drug is given with cidofovir

Probenecid

What is rate limiting step in haem synthesis

ALA synthase

What can denosumab be used to treat other than osteoprosis

Giant cell tumours Metastases

Which test would be used to confirm a diagnosis of Cushing’s Syndrome?

High dose dexamethasone

How would you manage renal failure in a patient with Myeloma?

Haemodialysis

How would you manage spinal cord compression in a patient with myeloma?

Radiotherapy and dexamethasone

A man has spherocytes, polychromasia and reticulocytosis on blood film, what is the most likely diagnosis?

Hereditary spherocytosis

Which viruses are screened for in platelet donations intended for pregnant women?

HIV HBV CMV

How do proteasome inhibitors, such as Bortezomib, work

Inhibited protein degradation leads to amino acid build up, shortage and cell death

What is the first line biological treatment for Ankylosing Spondylitis?

Anti-TNF alpha

What would be the most likely diagnosis in a teenage girl who develops an erythematous rash after running in winter?

Cold urticaria

An HIV patient with a low CD4+ count presents with meningitis. What is the most likely causative organism?

Cryptococcus neoformans

A lady returns from a holiday in America, where she stayed in Arizona. She presents with systemic symptoms, including a fever. What is the most likely diagnosis and causative organism?

Valley fever Coccidioides

Which congenital initially presents asymptomatically

CMV

Which virus resides in the pharynx and gastrointestinal tract, causes encephalitis in 1/100, and destruction of motor neurones in 1/1000?

Polio

What is seen on urine dip of pyelonephritis

Leukocyte casts

What is renal fibrinoid necrosis seen in

Malignant HTN

A man with known H.Pylori infection has a stomach biopsy. An abnormal area is seen in the antrum, with mitotic figures and cells with a raised nuclear to cytoplasmic ratio. The mass is not invading the basement membrane. What is the most likely diagnosis?

Mucosal associated NHL

What would you prescribe a patient post-removal of a pituitary adenoma?

Desmopressin

A man presents with a midshaft femur fracture without a serious history of trauma. What may have caused this?

Chondrosarcoma

Which breast malignancy may be described as a ‘Fibro-epithelial Tumour with abundant stromal elements’?

Phyllodes tumour

What are pus cells seen in

Pyelonephritis

Which testicular cancer is radiosensitive, and typically has a white/smooth appearance?

Seminoma

A young man presents with a lytic lesion in the diaphysis of his leg. Night pains are relieved by aspirin. What is the most likely diagnosis?

Osteoid Osteoma

A man goes deaf, and on examination is noted to have bowed legs. What is the most likely diagnosis?

Pagets

A patient with HIV presents with signs of raised ICP and new onset epilepsy. What is the most likely diagnosis?

Primary CNS lymphoma

What is the main mechanism behind CMV resistance to antivirals?

Protein Kinase mutation

Post transplant in child what virus worried about

Adenovirus

Post HSCT how is CMV treated

Foscarnet as ganiciclovir it suppresses the BM

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

How would you treat Candida spp. infections not caused by Candida albicans?

Echinocandins

A patient with pneumonia has a CXR, which shows a bat wing appearance. What is the most likely causative organism?

PJP

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

In which infectious disease are ‘Purple eyelids’ a common feature?

Chagas

Which organism is the most common cause of CNS infections overall?

Cocksackie

The centre of a granuloma being diffuse red indicates what?

Caseating

At what level must skin damage be to leave a scar?

Dermis

What is the role of stellate cells in the liver?

Vitamin A stores Activate to myofibroblasts to lay down collagen

In which breast cancer are Indian Files seen?

Invasive Lobular

In which breast cancer are Empty Spaces seen?

Invasive mucinous

Which stain is used to distinguish Squamous Cell Carcinomas from Adenocarcinomas?

P40

Which breast disease shows ‘dilated, calcified ducts’ on histology

Fibrocystic disease

Breast tumour with leaf like apperance

Phyllodes tumour

Q Which breast condition shows: Cytology: Clusters of cells Histology: Dilated ducts, polypoid mass in the middle ?

Intraductal papilloma

What thyroid condition stains with amyloid

Medullary carcinoma as calcitonin broken down to amyloid

Name one mutation that is associated with Type I endometrial carcinoma.

PTEN

In which renal condition might you see ‘shrunken kidneys with granular cortices’ and ‘fibrinoid necrosis’?

Hypertensive nephropathy

What might it indicate if a lung lobe isn’t black on autopsy?

Pneumonia

In which IgG mediated skin condition might the outer layer of the stratum shear off?

Pemphigus follaceous

How does Lichen Planus present: a) on the wrists/arms b) in the mouth?

Arms- red/purplish rash Mouth- white lines

Early versus late phase of asthma

Early- Mast cell degranulation and effects Late- Tissue damage, mucous production, muscle hypertrophy

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

In which bone disease might you see ‘Langerhans-type Giant Cells with horseshoe nuclei’?

In which condition might you see a proliferative synovitis, with pannus formation and grimley sokoloff cells on histology?

What is the most common genetic predisposition to brain tumours?

Neurofibromatosis

What is the most common primary brain cancer in adults?

Glioblastoma mutliforme

What mutation is associated with pilocytic astrocytoma

BRAF

Which brain cancer displays ‘round cells with clear cytoplasm’ (fried egg appearance)

Oligodendroma

Which brain cancer shows ‘small blue round cells’ and ‘Horner-Wright Rosettes’?

Medulloblastoma

Which cytokine plays a key role in development of TH2 cell responses (and hence allergic responses)?

IL-4

What do TH1 cells release

IL-2 or IFN-gamma

What is tofacitinib

JAK inhibitor

Which immunodeficiency may be implicated in a child presenting with recurrent, severe viral infections?

NK deficiency

How to differentiate between IDA and beta thalassaemia on blood film

Basophillic stippling in beta thalassaemia

What are the gram positive bacilli

Bacillus Clostridium Diphteria Listeria

What are gram negative coco bacilli

Haemophilus Bordatella Pseudomonas Chlamydia Brucella

Which pneumonia cause shows ‘glossy colonies’ on agar?

Haemophilus influenzae

What type of organism is entamoeba histolytica

Trophozoite with 4 nuclei Flask shaped ulcer

MOA of ribavirin

Nuceloside analogue

What haem condition is associated with ADAMTS13 mutations other than TTP

MAHA

What is used as a marker of stem cells?

CD34

Which stones does renal tubular acidosis predispose to

Calcium oxalate