Past papers Flashcards
What scan do for bony metastases
Technetium bisphsophonate scan
Also see activity where fractures
What scan do for meabolically active metastases
FDG PET scan
Septic arthritis with gram negative intracellular diplococci
Neisseria gonorrhoea
Get primary gonorrhoea then a few weeks later get septic arthritis
Most common cause of septic monoarthritis in someone aged 19-30
Neisseria gonorrhoea
Gram negative intracellular diplococci causing meningitis
Neisseria meningitidis
6 year old with gram negative rods on lumbar puncture
Haemophilus influenzae
Neonate or premature with gram negative rods on lumbar puncture
E coli
Only causes meningitis in neonates and premature babies
Gram positive diplococci on blood culture
Step pneumoniae
Gram positive in clusters
Staph aureus
Mild fever pyrexia of unknown origin (PUO), cultures come back gram positive cocci
Strep viridans
What malignancy is lambert eaton associated with
Small cell lung cancer
Which coagulation factor decreases quickest after warfarin
VII
What does a normal osmolality with hyponatraemia suggest
Pseudohyponatraemia
Caused by hyperlipidaemia or paraproteinaemia
What is needed for a true hyponatraemia
A low osmolality
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
Hypokalaemia with hypoglycaemia
Insulin OD
What causes hypokalaemia, hypotension and hypercalciuria
Bartter syndrome
Hyperkalaemia with a low aldosterone
ACEi
Reduced production of aldosterone
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
What is used to differentiate causes of metabolic acidosis
Anion gap (NR 10-18)
Brittle hair and developmental delay
Homocysteinuria
Cherry red spot
Developmental delay
Deafness and blindness
Fabrys disease (lysosomal disease)
Encephalopathy- hypotonia, lethargy, poor feeding
Sweet odour and sweaty feet
Maple syrup disease
How to tell difference between primary and tertiary hyperparathyroidism
Can be very difficult to tell difference biochemically however presence of CKD shows is tertiary
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 pentad for TTP
Microangiopathic haemolytic anaemia (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 haematocrit (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 GlpIIb/IIIa 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 polyarteritis nodosa (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 auto-immunehepatitis (AIH) as opposed to type 1
Presence of anti liver kidney microsome (anti-LKM) 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 Creutzfeldt-Jakob Disease (CJD)
MRI
Creutzfeldt-Jakob disease (CJD) is a rapidly progressive, invariably fatal neurodegenerative disorder believed to be caused by an abnormal isoform of a cellular glycoprotein known as the prion protein.
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
x3
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
RA
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
RA
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 hydrophillicand cannot be excreted in the urine.
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 GFR:ACS
What is the commonest cause of portal vein thrombosis?
Liver cirrhosis
Most common cause of nephrotic syndrome in adults
Focal Segmental Glomerulosclerosis (FSGS)
Most common cause of constrictive pericarditis in developing world
TB
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- increase in uric acid
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
Bilirubin does not reach bowel, urinary excretion of urobilinogen 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
Schwachman-Diamond syndrome (SDS) is an autosomal recessive disorder that is the second most common cause of exocrine pancreatic insufficiency after cystic fibrosis.
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
4
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
Deficiency leads to Lesch Nyan Syndrome
Rate limiting enzyme for purine metabolism
PAT
Phosphinothyricine Acetyltransferase
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
11
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
GH
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’?
TB
In which condition might you see a proliferative synovitis, with pannus formation and grimley sokoloff cells on histology?
RA
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
