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Arjun's Copy- Owen's Path > Past papers > Flashcards

Past papers Flashcards

1
Q

What scan do for bony metastases

A

Technetium bisphsophonate scan
Also see activity where fractures

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2
Q

What scan do for meabolically active metastases

A

FDG PET scan

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3
Q

Septic arthritis with gram negative intracellular diplococci

A

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

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4
Q

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

A

Neisseria gonorrhoea

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5
Q

Gram negative intracellular diplococci causing meningitis

A

Neisseria meningitidis

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6
Q

6 year old with gram negative rods on lumbar puncture

A

Haemophilus influenzae

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7
Q

Neonate or premature with gram negative rods on lumbar puncture

A

E coli
Only causes meningitis in neonates and premature babies

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8
Q

Gram positive diplococci on blood culture

A

Step pneumoniae

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9
Q

Gram positive in clusters

A

Staph aureus

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10
Q

Mild fever PUO, cultures come back gram positive cocci

A

Strep viridans

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11
Q

What malignancy is lambert eaton associated with

A

Small cell lung cancer

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12
Q

Which coagulation factor decreases quickest after warfarin

A

VII

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13
Q

What does a normal osmolality with hyponatraemia suggest

A

Pseudohyponatraemia
Caused by hyperlipidaemia or paraproteinaemia

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14
Q

What is needed for a true hyponatraemia

A

A low osmolality

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15
Q

How to differentiate between causes of hypovolaemic hyponatraemia

A

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

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16
Q

Hypokalaemia with hypoglycaemia

A

Insulin OD

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17
Q

What causes hypokalaemia, hypotension and hypercalciuria

A

Bartter syndrome

Bartter syndrome (BS) is a rare inherited disease characterised by a defect in the thick ascending limb of the loop of Henle, which results in low potassium levels (hypokalemia),[2] increased blood pH (alkalosis), and normal to low blood pressure.

Closely related to Gitelmann’s

Specifically, mutations directly or indirectly involving the Na-K-2Cl cotransporter are key. The Na-K-2Cl cotransporter is involved in electroneutral transport of one sodium, one potassium, and two chloride ions across the apical membrane of the tubule. The basolateral calcium-sensing receptor has the ability to downregulate the activity of this transporter upon activation.

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18
Q

Hyperkalaemia with a low aldosterone

A

ACEi
Reduced production of aldosterone

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19
Q

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

A

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

Highest number has hyperK+
Eg of cause of type 4= addisons

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20
Q

What is used to differentiate causes of metabolic acidosis

A

Anion gap (NR 10-18)

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21
Q

Brittle hair and developmental delay

A

Homocysteinuria

Homocystinuria is a genetic disorder that affects the metabolism of the amino acid methionine

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22
Q

Cherry red spot
Developmental delay
Deafness and blindness

A

Fabrys disease (lysosomal disease)

The genetic mutation that causes Fabry disease interferes with the function of an enzyme that processes biomolecules known as sphingolipids, leading to these substances building up in the walls of blood vessels and other organs. It is inherited in an X-linked manner.

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23
Q

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

A

Maple syrup disease

(MSUD- Maple syrup urine disease)

The condition gets its name from the distinctive sweet odor of affected infants’ urine and earwax, particularly prior to diagnosis and during times of acute illness

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24
Q

How to tell difference between primary and tertiary hyperparathyroidism

A

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

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25
Q

If ischaemia causing a hyerkalaemia what is cause of the hyperkalaemia

A

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

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26
Q

What does normal base excess show

A

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

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27
Q

How is osmolarity calculated

A

2(Na+K)+ glucose+urea

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28
Q

What is rash like in pellagra

A

Casals necklace- erythematous an dpigmented rash in neklace distribution

Pellagra = niacin deficiency (vit D3)

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29
Q

What is ALP in myeloma

A

Normal

Released by osteoblasts (myeloma stimulates osteoclasts + cancer cells damage BM)

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30
Q

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

A

4-5

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31
Q

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

A

CK MB as returns to normal a couple days after

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32
Q

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

A

Troponin I

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33
Q

What are differences between cold and warm AIHA

A

Warm
- haemolysis occurs in spleen
- IgG
- occurs at 37C in DAT

Cold
- intravascular peripheral haemolysis
- IgM
- occurs at lower temperatures

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34
Q

Causes of warm AIHA

A

Drugs
CLL
SLE

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35
Q

Causes of cold AIHA

A

Mycoplasma
EBV

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36
Q

What are howell-jolly bodies

A

Nuclear remnants in RBCs

They are normally removed by the spleen. Their presence in red blood cells can indicate either a lack of proper splenic function or asplenia (absence of a spleen). This finding can be associated with certain conditions such as sickle cell disease

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37
Q

What is anisocytosis

A

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

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38
Q

What are cabot rings and what are they seen in

A

Looped structures found within RBC
B12 deficiency

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39
Q

What is pental for TTP

A

MAHA
Renal failure
Thrombocytopenia
Fever
Neuro signs

FAT RN
(HUS triad is without first letter (F) and last letter (N))

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40
Q

What is definitive test for TTP

A

ADAMTS13 enzyme assay

Enzyme that cleaves VWF multimeters (which are very sticky)

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41
Q

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

A

Adult T-cell leukaemia

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42
Q

What presents with centrocytes and centroblasts on histology

A

Follicular NHL

Good pics on Wikipedia

A centroblast generally refers to an activated B cell that is enlarged (12–18 micrometer) and is rapidly proliferating in the germinal center of a lymphoid follicle.[1] They are specifically located in the dark zone of the germinal center.[2] Centroblasts form from naive B cells being exposed to follicular dendritic cell cytokines

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43
Q

What lymphoma is seen in HIV

A

Diffuse large cell lymphoma

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44
Q

What can cause hyposplenism

A

Trauma
Planned splenectomy
Physiological hyposplenism- coeliac, UC, SCD

FH accompanying celiac disease and inflammatory bowel disease is thought to be caused by excessive loss of lymphocytes through the inflamed enteric mucosa, leading to spleen’s reticuloendothelial atrophy

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45
Q

Conditions where splenectomy helpful

A

The PIIES
Thalassaemia
PK deficiency (RBC breakdown faster than normal)
Immune haemolytic anaemia
Idiopathic TTP
Elliptocytosis
Spherocytosis

Spleen is normal place where damaged RBCs are removed ro will worsen anaemia etc in these conditions

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46
Q

How does beta thalassaemia trait present

A

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

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47
Q

What is normal proportion of HbA2

A

1.5-3.5

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48
Q

Presentation of beta thalassaemia major

A

Failure to thrive
Severe microcytic anaemia
Hepatosplenomegaly
Bossing of forehead

Last 2 due to extramedullary haematopoiesis

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49
Q

What are donath-landsteiner antibodies seen in

A

Paroxysmal cold haemoglobinuria

RBCs in urine after a cold

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50
Q

How to remember symptoms of paroxysmal nocturnal haemoglobinuria

A

Pancytopenia
New thrombus
Haemolytic anaemia

Ie PNH

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired,[1] life-threatening disease of the blood characterized by destruction of red blood cells by the complement system, a part of the body’s innate immune system.

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51
Q

What is most sensitive antibody for pernicious anaemia

A

Anti-parietal cell

Not anti-IF

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52
Q

What are blood findings of haemochromatosis

A

High ferritin
Low TIBC
High transferrin saturation
High iron

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53
Q

Presentation of hereditary haemochromatosis

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

Later in women as menstruation reducing iron monthly

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54
Q

Management of TTP

A

Plasma exchange
(+ corticosteroids)

Plasma exchange removes plasma with dysfunctional ADAMTS13. Replaces it with albumin/donor plasma

ADAMTS13 deficieny is caused by auto-ABs against it (usually form after infection) so exchange removes these ABs too

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55
Q

How do packed red cells and FFP transfusions cause thrombocytopenia

A

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

main FFP content is CFs- FFP is typically used to replace specific blood components in patients with clotting factor deficiencies or to manage coagulopathy e.g. DIC, liver disease

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56
Q

Physiologically what causes an increased ESR

A

Fibrinogen
Acute phase proteins
Immunoglobulins

It measures the rate at which red blood cells settle in a tube of blood over time- all of these make RBCs stick together.

remember ESR marker of inflammation but not very specific.

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57
Q

What causes combined polycythaemia

A

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

combined PC = secondary PC

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58
Q

What is difference between splenomegaly and hypersplenism

A

Splenomegaly is when spleen enlarged- in some cases this can become hypersplenism
Hypersplenism is when get splenomegaly with a reduction in a cell line- ie spleen overractive and removes blood cells from cifculation too fast

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59
Q

What is red cell mass

A

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

Red cell mass refers to the total volume of red blood cells (RBCs) in the body. It is a measure of the total amount of oxygen-carrying capacity available in the bloodstream.

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60
Q

What is an absolute versus a relative erythrocytosis

A

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

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61
Q

What happens to red cell mass in true polycythaemia

A

Increases

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62
Q

What is glanzmanns thrombasthenia

A

Inherited lack of GlpIIb/IIIa leading to defective platelet aggregration

Glanzmanns and Glp

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63
Q

How to differentiate between a reactive neutrophilia and cancer

A

Luekocyte ALP (LAP)
Low in dyscrasia but normal/high in reactive

In CML, the LAP score is low because the abnormal granulocytes have reduced alkaline phosphatase activity.

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64
Q

MOA of bortezomib

A

Proteosome inhibitor

stops degredation of pro-apoptotic factors. Used in MM

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65
Q

How is von wilebrand treated

A

Desmopressin

management-
tranexamic acid for mild bleeding
desmopressin (DDAVP): raises levels of vWF by inducing release of vWF from Weibel-Palade bodies in endothelial cells
factor VIII concentrate

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66
Q

What is most common cause of death in myelodysplastic syndromes

A

Bacterial infection

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67
Q

Increased susceptibility to infection following from diarrhoea

A

Protein-losing enteropathy

Normally, only a small amount of protein is lost through the intestines, but in PLE, there is a significant increase in the amount of protein lost, leading to hypoalbuminemia (low levels of albumin, a protein in the blood) and other associated symptoms.

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68
Q

What is protein losing enteropathy

A

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

also loss of albumin etc

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69
Q

What is defect in CVID

A

Mutation in MHC III

mechanism unknown apparently

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70
Q

What does presence of anti-Jo suggest about dermatomyositis

A

Lung fibrosis

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71
Q

Presentation of PBC

A

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

  • Autoimmune inflammatory destruction of small/medium sized intrahepatic bile ducts → cholestasis → SLOW development of cirrhosis over many years
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72
Q

Which antigen is indicated in pathogenesis of AIHA

A

rhesus

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73
Q

Which antigen is indicated in pathogenesis of PAN

A

Hep B surface antigen

30% have underlying Hep B

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74
Q

Which antigen is indicated in pathogenesis of MS

A

Myelin basic protein

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75
Q

Biopsy of lupus nephritis

A

IgM, IgG and IgA deposition
C3 deposition

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76
Q

What is used to diagnose IgA nephropathy

A

Immunofluoresecence showing IgA deposition in the kidney

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77
Q

What is the kviem test used for

A

Sarcoid

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78
Q

What is CH50 and what happens to it in SLE

A

An acute phase protein
Raised in SLE (internet says it’s decreased as complement used up)

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79
Q

Which HLA is coeliac associated with

A

HLA-DQ2 and 8

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80
Q

What is the NBT test

A

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

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81
Q

What is NBT in the different neutrophil immunodeficiencies

A

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

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82
Q

What autoimmune conditions are often seen in selective IgA deficiency

A

RA
SLE
Coelaic

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83
Q

Which cell first encounters an allergen

A

Macrophage

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84
Q

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

A

B cell

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85
Q

What is treatment of a myasthenic crisis

A

Plasmapharesis

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86
Q

What is a hyperacute organ rejection

A

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

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87
Q

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

A

Infliximab- mouse human chimeric
Adalimumab- human monoclonal antibody

‘Imab’ vs ‘umab’
Umab is human

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88
Q

What T1DM antibody is against tyrosine phosphate

A

Anti-IA-2

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89
Q

Which factors suggest type 2 AIH as opposed to type 1

A

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

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90
Q

What antIbodies are seen in vitiligo

A

Anti-melanocyte

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91
Q

What are anti glutamic acid decarboxylase antibodies associated with

A

T1DM
Stiff man syndrome

Anti-GAD

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92
Q

What antibodies are indicated in GBS

A

Anti-ganglioside LM1

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93
Q

Low IgA in disease with deranged liver function or symptoms

A

Type 2 AIH

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94
Q

What is the stain done for PJP

A

Gomori methenamine silver stain showing flying saucer shaped cysts on microscopy

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95
Q

When are moraxella catarrhalis infections common

A

In chronic lung disease often in COPD infective exacerbations

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96
Q

Organism causing gastroenteritis after drinking unpasteurised milk

A

Listeria

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97
Q

Which patients are listeria GI infections seen in

A

Immunocompromised
Neonates

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98
Q

Beta haemolytic anaerobic organism with tumbling motility causing GI infection

A

Listeria monocytogenes

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99
Q

GI infection after swimming in a contaminated lake in UK

A

E coli

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100
Q

Severe watery diarrhoea with no leukocytes on microscopy

A

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

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101
Q

What type of organism is giardia

A

Pear shaped trophozyte with 4 flagella and 2 nuceli

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102
Q

In what people should giardia be considered

A

Homosexual men
Hikers
Travellers

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103
Q

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

A

Staph aureus

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104
Q

What are phases to leptospirosis (weils syndrome)

A

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

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105
Q

What organism causes leptospirosis

A

Leptospira interrogans

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106
Q

Gold standard for leptospirosis

A

Microscopic agglutination test

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107
Q

What type of organism is cryptococcus

A

Encapsulated yeast infection

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108
Q

Most common cause of viral meningitis

A

Non-polio enteroviruses (eg coxsackie virus and echovirus)

Also HSV-2! (HSV-1 is encephalitis tracking up from nasopharynx)

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109
Q

What are examples of NRTIs

A

Lamivudine and zidovudine

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110
Q

What bacteria causes lyme disease

A

Borrelia burgdorferi

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111
Q

Main brucella complication

A

Granulomatous liver

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112
Q

What are examples of NNRTI

A

Efavirenz

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113
Q

Presentation of lyme disease

A

In 3 stages
Local
- rash and constitutional sx

Disseminated
- PEACH
- peripheral neuropathy
- erythem migrans
- arthritis
- cranial nerve palsy
- heart block

Late
- arthritis
- encephalitis

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114
Q

Most appropriate and useful test for sporadic CJD

A

MRI

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115
Q

How to remember sx of sporadic CJD

A

Demented LAMB
Dementia
LMN signs
Akinetic mutism
Myoclonus
Blindess

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116
Q

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

A

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

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117
Q

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

A

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

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118
Q

What is used to diagnose a current Hep C infection

A

Hep C RNA PCR

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119
Q

What are haemosiderin macrophages in the lung seen in

A

LHF

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120
Q

Gastric biopsy reveals signet rings and linitis plastica

A

Gastric adenocarcinoma

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121
Q

How are peptic ulcers differentiated from gastric adenocarcinomas

A

Carcinomas have raised and uneven borders

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122
Q

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

A

Hepatocellular carcinoma

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123
Q

Difference in identification lobular and ductal carcinoma in situ

A

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

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124
Q

Breast tumour with artichoke like appearance

A

Phyllodes tumour

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125
Q

Multiple lytic zones around epiphyses

A

Giant cell tumours

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126
Q

Pains in limbs with shooting pain and SOB too

A

Pagets bone disease

(SOB as HO cardiac failure?)

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127
Q

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

A

Non thrombotic endocarditis

Non-bacterial thrombotic endocarditis (NBTE) is a disease characterised by the presence of vegetations on cardiac valves, which consist of fibrin and platelet aggregates and devoid of inflammation or bacteria.

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128
Q

Colorectal cancers with pigmentation around the mouth

A

Peutz jeughers giving harmartomatous polyps

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129
Q

How to differentiate between emphysema and chronic bronchitis

A

Chronic bronchitis produces copious amounts of sputum

Blue bloaters (CB) and pink puffers (emphysema)

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130
Q

What is lung disease associated with burns injuries

A

ARDS

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131
Q

What presents with oral ulcers, malaise and erythema multiforme

A

SJS

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132
Q

What is eosinophiluria indicative of

A

Tubulointerstitial nephritis

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133
Q

How is beta thalassaemia diagnosed

A

High performance liquid chromatography

Detecting high HbA2

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134
Q

Treatment for spinal chord compression myeloma

A

Steroids (dex)
Radiotherapy

(Surgery?)

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135
Q

What is standard INR target

A

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

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136
Q

What factors can raise the target INR

A

Prosthetic valve
Second DVT/PE

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137
Q

If on continuous unfractionated heparin what need monitored

A

aPTT

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138
Q

If on prophylaxis LMWH for a surgery what monitoring needed

A

None

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139
Q

What is done to blood donations to reduce risk of TaGvHD (transfusion associated GvHD) in immunosuppressed patients?

A

Irradiation

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140
Q

What is mechanism behind hyperacute organ rejection

A

Preformed antibodies

It is caused by the presence of pre-existing antibodies (usually ABO ABs) in the recipient that recognize antigens in the donor organ.[5] These antigens are located on the endothelial lining of blood vessels within the transplanted organ and, once antibodies bind, will lead to the rapid activation of the complement system.[6] Irreversible damage via thrombosis and subsequent graft necrosis is to be expected.

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141
Q

What is VTE risk compared to women for men

A

x3

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142
Q

How is heparin function monitored if have renal impairment

A

Anti-Xa assay

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143
Q

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

A

Any B cell lymphoma or leukaemia

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144
Q

Diagnostic test for HS (hereditary spherocytosis)

A

Eosin-5’-maleimide dye test

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145
Q

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?

A

Post thrombotic syndrome

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146
Q

Other than PCV what else can JAK2 mutations occur in

A

Myelofibrosis
Essential thrombocythaemia

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147
Q

What are irregularly contracted cells seen in

A

G6PD

(Heinz bodies, bite cells, ghost and hemighost cells)- oxidative damage

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148
Q

Haematuria after starting a drug what is diagnosis

A

G6PD

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149
Q

What is used for treatment of p53 mutation CLL

A

Ibrutinib

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150
Q

What thrombomodulator reduces in pregnancy

A

Protein S

(Co-factor to protein C)

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151
Q

What is targeted in Graft vs Host disease?

A

HLA

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152
Q

What drug can allopurinol not be given with

A

Azathioprine

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153
Q

Which thrombomodulators are antithrombotic

A

Thrombomodulin
Protein S
Protein C

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154
Q

How does renal artery stenosis cause hyperaldosteronism

A

Reduced perfusion which activates RAAS

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155
Q

What is normal response to water deprivavtion test

A

Urine osmolality increases over 600

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156
Q

What enzyme gets raised if taken cocaine

A

AST

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157
Q

Elderly gentleman with history of headaches and a raised ALP alone

A

Pagets

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158
Q

What enzyme is raised in mumps

A

Amylase-S

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159
Q

If vegan has macrocytic anaemia what is like vitamin deficiency

A

B12 as folate in veggies

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160
Q

What happens to epiphyses and metaphyses in rickets

A

Widened epiphyses
Metaphyses become cupped

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161
Q

Final enzyme in uric acid production

A

Xanthine oxidase

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162
Q

What is raised in rhabdomyolysis

A

CK
Myoglobin

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163
Q

Acute management of gout

A

NSAIDS
Colchicine

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164
Q

Chronic management of gout

A

Allopurinol
Probenecid in some countries

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165
Q

In what condition is there deficiency in HGPRT

A

Lesch nyan syndrome

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166
Q

What is main difference biochemically between osteomalacia and osteodystrophy

A

High phosphate in renal
Low in osteomalacia

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167
Q

What is calcitonin raised in

A

Medullary thyroid cancer

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168
Q

Whats in MEN1

A

3 ps
Parathyroid
Pancreatic (insulinoma)
Pituitary

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169
Q

What is in MEN2a

A

2Ps 1M
Parathyroid
Phaeo
Medullary thyroid

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170
Q

What is in MEN 2b

A

1P 2MS
Phaeo
Medullary thyroid
Mucocutaenous
Associated with Marfans

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171
Q

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

A

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

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172
Q

Hyperthyroidism with cold uptake globally

A

De quervains

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173
Q

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

A

HDL

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174
Q

How to interpret urine specific gravity

A

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

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175
Q

What is most common type of tumour in appendix

A

Neuroendocrine

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176
Q

Mass in pancreas after pancreatitis

A

Pseudocyst

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177
Q

Where does pancreatic cancer most commonly metastasie

A

Liver

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178
Q

Surgeons notice grey specks on the pancreas

A

Ductal adenocarcinoma

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179
Q

Symmetrical joint pain in younger woman

A

RA

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180
Q

Which thyroid cancer metastasises to lymph nodes most commonly

A

Papillary

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181
Q

Ovarian cancer with signet ring cells

A

Kruckenburg tumour- gastric metastases

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182
Q

Which virus increases risk of nasopharyngeal cancer

A

EBV

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183
Q

Alcoholic with white stripes in oesophagus

A

Candidiasis

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184
Q

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

A

Remove and send for histology

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185
Q

What type of section is done intraoperatively if need a diagnosis

A

Intra-operative frozen section

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186
Q

Cause of HTN in upper body only

A

Aortic coarctation

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187
Q

Most common lung cancer in a non smoker

A

Adeno

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188
Q

What is method of spread of melanoma

A

Lymphoid

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189
Q

What presents with muscles aches all over and joint pain

A

Polymyositis (can also present with joint pain)

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190
Q

What would you measure in an excacerbation of SLE

A

C3 and C4

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191
Q

Which cells are Foxp3+

A

Treg

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192
Q

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

A

Neutrophils

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193
Q

What are antibodies for sjogrens

A

ENA
Anti-Ro
Anti-La

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194
Q

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

A

IFN-gamma deficiency
IL-12 deficiency

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195
Q

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

A

CVID

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196
Q

Normal B cells and CD8 but deficient CD4

A

Bare lymphocyte syndrome type II

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197
Q

Reduced T cell and neutrophil counts but normal B cells

A

X-linked SCID

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198
Q

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

A

Hyper IgM syndrome

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199
Q

What monoclonal antibody used to treat ank spond

A

Etanercept

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200
Q

What is MOA of etanercept

A

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

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201
Q

What antibodies are used to treat melanoma

A

Ipilimumab
Pembrolizumab
Nivolumab

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202
Q

MOA of ipilimumab

A

Blocks T cell inhibitory checkpoints by binding to CTLA4

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203
Q

Recurrent episodes of flushed face and breathing problems with hepatomegaly

A

Hereditary angioedema

204
Q

What type of gel and coombs HS reaction is atopic eczema

A

Type I

205
Q

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

A

Secukinumab- Anti-IL17

206
Q

Which receptor mutation is associated with better outcomes in HIV

A

CCR5

207
Q

What immunodeficiency is associated with IL2 common gamma chain

A

X-liked SCID

208
Q

What is maxium number of HLA mismatches in a transplant

A

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

209
Q

How does nivolumab/pembrolizumab work

A

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

210
Q

What type of hypersensivity reaction is serum sickness

A

III

211
Q

What is adalimumab used in treatment of

A

RA

212
Q

Which anibody confers natural protection against HIV

A

gp120

213
Q

What vaccine cant be given to pregnant women

A

MMR as a live vaccine

214
Q

Which cells bind to MHC1

A

NK
CD8+

215
Q

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

A

Ribavirin

216
Q

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

A

The eye disease
Cataracts in rubella but CMV has choroidretinitis

217
Q

Most common cause of travellers diarrhoea

A

Entero-toxigenic E coli

218
Q

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

A

Norovirus

219
Q

Best antibiotic for pseudomonas

A

Ciprofloxacin

220
Q

Outbreak of boils around someones friendship group

A

S aureus

221
Q

Treatment for typhoid

A

Ceftriaxone

222
Q

What is definition of herd immunity

A

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

223
Q

What are the 3 characteristics of a successful flu outbreak

A

Novel antigenicity
Efficient replication in human airway
Efficient transmission between humans

224
Q

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

A

Listeria

225
Q

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

A

10%

226
Q

What are snail track oral ulcers seen in

A

Syphyllis

227
Q

What carries borrelia burgdorferi

A

Ixodes tick

228
Q

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

A

Cornyebacterium diphteria

229
Q

Which hepatitis does not cause chronic hepatitis

A

Hep A and E

230
Q

Most common cause of cellulitis

A

Strep pyogenes

231
Q

What infections cause aplastic anaemia

A

Parvovirus B19
HEPATITIS

232
Q

Most common malignancy in breast

A

Invasive ductal carcinoma

233
Q

MOA of allopurinol

A

Xanthine oxidase inhibitor

234
Q

What is pathophysiology in hyper IgM syndrome

A

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

235
Q

Gram positive rods causing meningitis in elderly

A

Listeria

236
Q

Why are under 12 months not able to have honey

A

Risk of infection with clostridium botulinum

237
Q

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

A

Hep E

238
Q

What can be treated with plasmapharesis

A

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

239
Q

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

A

3/6
50%

240
Q

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

A

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

241
Q

What type of HS reaction is PAN

A

III

242
Q

How to interpret a high prolactin

A

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

Extremely high (over 5000)
- macroprolactinoma

243
Q

What happens to urinary bilirubin in haemolytic jaundice

A

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

244
Q

What happens to HDL if an alcoholic

A

Gets raised

245
Q

Most common skin cancer

A

BCC

246
Q

Brain tumour that occurs near top of brain and often asymptomatic

A

Meningioma

247
Q

Which is the commonest glial cell in the CNS?

A

Astrocytes

248
Q

Most common cause of ARDS in adults

A

Sepsis

249
Q

What is the most common ovarian tumour?

A

Serous cystadenoma

250
Q

Which type of necrosis is associated with a MI?

A

Coagulative necrosis

251
Q

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

A

Post partum

252
Q

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

A

Donor T cells

253
Q

What do MDS progress to

A

AML
As blasts

254
Q

What causes relative polycythaemia

A

Dehydration

255
Q

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

A

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

256
Q

What is organism in mumps

A

Mumps virus

257
Q

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

A

Aminoglycoside

258
Q

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

A

Thiopurine methyltransferase

259
Q

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

A

Leptin

260
Q

What is the commonest cause of hypercalcaemia in the community?

A

Parathyroid adenoma

261
Q

What active enzyme in sarcoidosis patients causes hypercalcaemia

A

1 alpha hydroxylase

262
Q

Most common cause of hypocalcaemia in the community

A

Hypoalbuminaemia

263
Q

What are adrenal zones and what produce

A

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

264
Q

What is the commonest cause of portal vein thrombosis?

A

Liver cirrhosis

265
Q

Most common cause of nephrotic syndrome in adults

A

FSGS

266
Q

Most common cause of constrictive pericarditis in developing world

A

TB

267
Q

Most common primary tumour of heart

A

Myxoma

268
Q

What is a myelocyte

A

A neutrophil precursor

269
Q

What is stain for cryptococcus

A

India ink- see yeast cells surrounded by halos

270
Q

What is stain for chlamydia psittaci

A

Giemsa stain

271
Q

What electrolyte abnormality can quinines cause

A

Hypoglycaemia

272
Q

Indications for nivolumab and pembrolizumab

A

Melanoma
Metastatic renal cancer

273
Q

Which infection does cyclophosphamide make you susceptible to

A

PJP

274
Q

What drug increases excretion of uric acid

A

Probenecid

275
Q

What is main killer in CKD

A

Calcifications and subsequent atherosclerosis

276
Q

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

A

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

277
Q

Causes of normal anion gap metabolic acidosis

A

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

278
Q

What is fanconi syndrome

A

Condition where failure of PCT to reabsorb small particles

279
Q

Causes of fanconi syndrome

A

Congenital
Wilsons
Myeloma
Lead poisoning
Tetracyclines

280
Q

Lab results of fanconi syndrome

A

Glucosuria
Hypokalaemia
Metabolic acidosis
Hyperuricosuria
Proteinuria

281
Q

MOA of lomitapide

A

Lomitapide acts by inhibiting Microsomal triglyceride transfer protein (MTP)

282
Q

MOA of colchicine

A

Inhibits tubulin polymerisation to reduce migration of neutrophils

283
Q

Pseudohypoparathyroidism presentation

A

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

284
Q

Other name for pseudohypoparathyroidism

A

Albright hereditary osteodystrophy

285
Q

Difference between osmolarity and osmolality

A

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

286
Q

MOA of ezetimibe

A

Inhibits absorption of cholesterol

287
Q

What is inside of homemade alcohol that can cause hyperuricaemia poisnoing

A

Lead

288
Q

What presents with orange tonsils and very low HDL

A

Tangier disease
Can also present with hepatosplenomegaly

289
Q

Elevated plant sterol

A

Phytosterolaemia

290
Q

Which brain tumour has psammoma bodies in

A

Meningioma

291
Q

What is assocaited with epithelial casts in urine

A

ATN

292
Q

COPD in 20 year old woman what should be investigated

A

Alpha 1 antitrypsin deficiency

293
Q

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?

A

Thyroid acropavhy

294
Q

Which cancer has largest mortality in UK

A

Lung

295
Q

Second and third most common cancer for each sex

A

2nd- lung
3rd- bowel

296
Q

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

A

HUS

297
Q

What protein in PCKD

A

Polycystin-1

298
Q

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?

A

Pseudopolyp

299
Q

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

A

Taenia coli

300
Q

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

A

Emphysema

301
Q

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

A

CKD

302
Q

What do delta cells from pancreas produce

A

Somatostatin which reduce secretion of glucagon and insulin

303
Q

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

A

Lipase

304
Q

Post TIA what scan do

A

Carotid USS

305
Q

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

A

Intra- phosphate
Exta- Bicarbonate
RBC- haemoglobin

306
Q

What is best measure of glucose over last 3 weeks

A

Fructosamine

307
Q

What is broken down to create uric acid

A

Purines

308
Q

Why remove whole thyroid in cancer

A

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

309
Q

Most common cause of AKI in hospital

A

Reduced perfusion

310
Q

What happens to urinary urinobilinogen in obstructive jaundice

A

Is low

311
Q

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

A

Osteomalacia

312
Q

Why does hyperventilation cause paraesthesia?

A

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.

313
Q

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

A

Primary: A parathyroid adenoma
Secondary: Chronic renal failure

314
Q

Which drugs decrease afferent arteriolar pressure

A

NSAIDS
Calcineurin inhibitors

315
Q

Which drugs decrease efferent arteriolar pressure

A

ACEi
ARBs

316
Q

Proportion of thyroid transported in blood

A

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

317
Q

What causes pityraisis versicolor

A

Melassazia

318
Q

If have a high WCC what can it be confused for

A

Reticulocyte count- blood film

319
Q

Most common cause of IDA in world

A

Hookworm

320
Q

What is d-dimer a measure of

A

Fibrinolysis

321
Q

What are cigar cells seen in

A

IDA

322
Q

After a DVT in arm what investigations do

A

Chest x-ray then do doppler

323
Q

Reversal agent for rivaroxaban

A

Andexanet alpha

324
Q

What triggers intrinsic pathway

A

Exposed collagen

325
Q

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

A

Schwachman diamond syndrome

326
Q

Which RBC are polychromatic and stain for presence of RNA

A

Reticulocyte

327
Q

How does heparin induced thrombocytopenia present

A

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

328
Q

First line for VTE in cancer

A

DOAC

329
Q

What lymphoma originates in the germinal zone

A

Burkitts

330
Q

What do all myeloproliferative conditions carry risk of progressing to

A

AML

331
Q

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

A

Vitamin K

332
Q

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?

A

Anti-TTG

333
Q

What is lymphoma in a young person

A

Burkitts

334
Q

In a young person non child what is likely lymohoma

A

Hodgkins

335
Q

How to quickly raise plateltes in ITP

A

IVIG

336
Q

What are negri bodies pathognomic for

A

Rabies

337
Q

What presents with fever worse in evening

A

Brucellosis

338
Q

What presents with black lesions and lung problems

A

Anthrax

339
Q

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

A

Pityriasis versicolor

340
Q

Gold standard for leishmaniasis

A

Splenic aspirate

341
Q

Normal B cells and CD4 cells but absent CD8

A

BLS I

342
Q

How diagnose coxiella

A

Serology

343
Q

What stains can be used for aspergillus and candida

A

Methanamine silver

344
Q

What can be used to quickly diagnose nail infections

A

Potassium hydroxide test

345
Q

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

A

Listeria

346
Q

Gets bitten by fish and then nodules arise

A

Mycobacterium marinum

347
Q

How are streptoccus infections split up

A

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

348
Q

What are 2 main alpha haemolytic strep

A

Strep viridans and pneumoniae

349
Q

Lancefield strep groups

A

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

350
Q

What is growth medium for differnetiating strep

A

Blood agar

351
Q

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?

A

TB- mantoux test

352
Q

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

A

Tuberculin

353
Q

What is main metabolite of azathioprine

A

6-mercatopurine

354
Q

How does reticular dysgenesis present

A

Severe life threatening infections
Profound sensorineural deafness

355
Q

Blood findings of reticular dysgenesis

A

Deficiency of the myeloid and lymphoid cell lineages

356
Q

Inheritance of reticular dysgenesis

A

Autosomal recessive

357
Q

What immune cell releases granzyme and perforin when activated?

A

Killer T cells

358
Q

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

A

Reverse transcriptase

359
Q

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

A

Histamine

360
Q

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

A

TNF-alpha

361
Q

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

A

48 hours

362
Q

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

A

Degranulation

363
Q

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

A

Distal interphalangeal

364
Q

What HLA allele is associated with Graves disease?

A

DR3

365
Q

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?

A

Rheumatic fever

366
Q

How is Latex Food Syndrome diagnosed?

A

Skin prick

367
Q

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

A

T killer cells

368
Q

Swan neck deformity which corrects itself when putting hans together

A

SLE

369
Q

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?

A

Chronic urticaria

370
Q

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

A

Protein losing enteropathy

371
Q

How to differentiate between goodpastures and microscopic polyangiitis

A

Goodpastures has systemic symptoms like fever and joint pain

372
Q

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

A

NK cells

373
Q

Which interleukins are responisble for fever

A

IL-1 and 6

374
Q

Which antibody is associated with homogenous ANA staining

A

Ant-dsDNA

375
Q

What gel and coombs is mantoux test

A

4

376
Q

What is main immunoglobulin in breast milk

A

IgA

377
Q

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?

A

Eosinophillic granulomatosis

378
Q

What cell stains with CD14

A

Monocyte

379
Q

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

A

Sensitisation

380
Q

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

A

Neutralisation

381
Q

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?

A

Adjuvant

382
Q

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

A

Radioallergosorbent test

383
Q

What does RAST stand for

A

Radioallergosorbent tets

384
Q

What is crucial enzyme in salvage pathway for purines

A

HGPRT

385
Q

Rate limiting enzyme for purine metabolism

A

PAT

386
Q

How to tell if something is positively birefringent or not

A

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

387
Q

Which renal stone is ethylene glycol associated with

A

Calcium oxalate as ethylene glycol broken into oxal acid

388
Q

What are hyperlobated nuclei (flower cells) seen in

A

Adult T cell lymphoma

389
Q

What does siderosis mean

A

Iron accumulation

390
Q

How does starry sky actually appear

A

Macrophages filled with apoptotic remains on a background of lymphoblasts

391
Q

What are auer rods

A

Azurophillic crystal found in neutrophils

392
Q

What technique is used to identify genetic feature of CML

A

FISH

393
Q

Most common inherited coagulopathy

A

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

394
Q

What clotting factor is contraindicatedlly raised in pregnancy

A

11

395
Q

Where and in who does does bullous pemphigoid occur

A

Elderly
Flexural surfaces

396
Q

What is centromere pattern immunofluorescence associated with

A

CREST

397
Q

What is nucleolar pattern immunofluorescence associated with

A

Diffuse systemic sclerosis

398
Q

What is wire loop appearance in kidney associated with

A

SLE

399
Q

What thyroid cancer arises from parafollicular c-cells

A

Medullary

400
Q

2 most common pituitary adenomas

A

Prolatinoma 1st
Non-functioning 2nd

401
Q

What is somatotrophin

A

GH

402
Q

When is only time screening for cervical cancer may extend 64

A

If not had since 50 or recent abnormal results

403
Q

What is most significant independant RF for CVD

A

Family history

404
Q

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

A

Atrophy

405
Q

What is most damamging pathology to myocardium

A

Ischaemia as toxic waste products accumulate which cant be drained efficiently

406
Q

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

A

Margination- drawing cells to walls

407
Q

How are macrophages described in granulomas

A

Epithelioid as develop intracellular organelle growth

408
Q

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

A

Basement membrane

409
Q

If severe autoimmune haemolysis removal of which organ may help syomptoms

A

Spleen

410
Q

Deficiency in what cell leads to recurrent viral infections

A

Classic NK deficiency

411
Q

What is role of follicular t helper cells

A

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

412
Q

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

A

Myasthenia gravis

413
Q

What organisms are very likely to cause bronchiectasis

A

Pertussis
Staph aureus

414
Q

What is most specific finding for IDA

A

Pencil cells

415
Q

Rank these as cause of HAI

A. Skin and soft tissue
B. Surgical site
C. Urinary tract
D. Hospital acquired pneumonia
E. Gastrointestinal system

A

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

416
Q

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

A

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

417
Q

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

A

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

418
Q

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

A

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

419
Q

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

A

MND

420
Q

Best treatments for pseudomonas

A

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

421
Q

Meningitis with high opening pressure

A

Cryptococcus

422
Q

Flu like illness a few weeks after contracting HIV

A

HIV seroconversion illness

423
Q

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

A

CMV

424
Q

Most appropriate test for EBV

A

EBV IgM as heterophile test can also be positive in CMV

425
Q

What test do before intiating a quinine

A

G6PD test

426
Q

4 causes of massive splenomegaly

A

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

427
Q

What infection are immunosuppressed kids especially at risk of

A

Adenovirus

428
Q

Most common cause of infectious congenital hearing loss

A

CMV

429
Q

Which causes of diarrhoea have lowest infective dose

A

Noroviris
Shigella

430
Q

Why does the influenza virus only cause respiratory disease?

A

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

431
Q

What is the vector for Trypsanoma brucei rhodesiense?

A

Tsete fly

432
Q

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

A

Staph epidermis

433
Q

What stain is used to screen TB

A

Auramine

434
Q

What drug is given with cidofovir

A

Probenecid

435
Q

What is rate limiting step in haem synthesis

A

ALA synthase

436
Q

What can denosumab be used to treat other than osteoprosis

A

Giant cell tumours
Metastases

437
Q

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

A

High dose dexamethasone

438
Q

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

A

Haemodialysis

439
Q

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

A

Radiotherapy and dexamethasone

440
Q

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

A

Hereditary spherocytosis

441
Q

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

A

HIV
HBV
CMV

442
Q

How do proteasome inhibitors, such as Bortezomib, work

A

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

443
Q

What is the first line biological treatment for Ankylosing Spondylitis?

A

Anti-TNF alpha

444
Q

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

A

Cold urticaria

445
Q

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

A

Cryptococcus neoformans

446
Q

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?

A

Valley fever

Coccidioides

447
Q

Which congenital initially presents asymptomatically

A

CMV

448
Q

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

A

Polio

449
Q

What is seen on urine dip of pyelonephritis

A

Leukocyte casts

450
Q

What is renal fibrinoid necrosis seen in

A

Malignant HTN

451
Q

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?

A

Mucosal associated NHL

452
Q

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

A

Desmopressin

453
Q

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

A

Chondrosarcoma

454
Q

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

A

Phyllodes tumour

455
Q

What are pus cells seen in

A

Pyelonephritis

456
Q

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

A

Seminoma

457
Q

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?

A

Osteoid Osteoma

458
Q

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

A

Pagets

459
Q

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

A

Primary CNS lymphoma

460
Q

What is the main mechanism behind CMV resistance to antivirals?

A

Protein Kinase mutation

461
Q

Post transplant in child what virus worried about

A

Adenovirus

462
Q

Post HSCT how is CMV treated

A

Foscarnet as ganiciclovir it suppresses the BM

463
Q

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?

A

Vibrio parahaemolyiticus

464
Q

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

A

Echinocandins

465
Q

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

A

PJP

466
Q

How are infected prosthetic joints managed?

A

Removal and debridement before Abx

467
Q

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?

A

Dengue

468
Q

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

A

Chagas

469
Q

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

A

Cocksackie

470
Q

The centre of a granuloma being diffuse red indicates what?

A

Caseating

471
Q

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

A

Dermis

472
Q

What is the role of stellate cells in the liver?

A

Vitamin A stores
Activate to myofibroblasts to lay down collagen

473
Q

In which breast cancer are Indian Files seen?

A

Invasive Lobular

474
Q

In which breast cancer are Empty Spaces seen?

A

Invasive mucinous

475
Q

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

A

P40

476
Q

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

A

Fibrocystic disease

477
Q

Breast tumour with leaf like apperance

A

Phyllodes tumour

478
Q

Q
Which breast condition shows:

Cytology: Clusters of cells

Histology: Dilated ducts, polypoid mass in the middle
?

A

Intraductal papilloma

479
Q

What thyroid condition stains with amyloid

A

Medullary carcinoma as calcitonin broken down to amyloid

480
Q

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

A

PTEN

481
Q

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

A

Hypertensive nephropathy

482
Q

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

A

Pneumonia

483
Q

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

A

Pemphigus follaceous

484
Q

How does Lichen Planus present:

a) on the wrists/arms
b) in the mouth?

A

Arms- red/purplish rash
Mouth- white lines

485
Q

Early versus late phase of asthma

A

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

486
Q

What are the stages of lobar pneumonia?

A

Congestion
Red Hepatisation
Grey Hepatisation
Resolution

487
Q

What is the key feature of grey hepatisation in pneumonia?

A

Intra-alveolar neutrophils

488
Q

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

A

TB

489
Q

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

A

RA

490
Q

What is the most common genetic predisposition to brain tumours?

A

Neurofibromatosis

491
Q

What is the most common primary brain cancer in adults?

A

Glioblastoma mutliforme

492
Q

What mutation is associated with pilocytic astrocytoma

A

BRAF

493
Q

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

A

Oligodendroma

494
Q

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

A

Medulloblastoma

495
Q

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

A

IL-4

496
Q

What do TH1 cells release

A

IL-2 or IFN-gamma

497
Q

What is tofacitinib

A

JAK inhibitor

498
Q

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

A

NK deficiency

499
Q

How to differentiate between IDA and beta thalassaemia on blood film

A

Basophillic stippling in beta thalassaemia

500
Q

What are the gram positive bacilli

A

Bacillus
Clostridium
Diphteria
Listeria

501
Q

What are gram negative coco bacilli

A

Haemophilus
Bordatella
Pseudomonas
Chlamydia
Brucella

502
Q

Which pneumonia cause shows ‘glossy colonies’ on agar?

A

Haemophilus influenzae

503
Q

What type of organism is entamoeba histolytica

A

Trophozoite with 4 nuclei
Flask shaped ulcer

504
Q

MOA of ribavirin

A

Nuceloside analogue

505
Q

What haem condition is associated with ADAMTS13 mutations other than TTP

A

MAHA

506
Q

What is used as a marker of stem cells?

A

CD34

507
Q

Which stones does renal tubular acidosis predispose to

A

Calcium oxalate

Arjun's Copy- Owen's Path (8 decks)

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