Past papers + BB quizzes Flashcards
Paul Bunnel test - shows heterophilic antibodies
Glandular fever
Rash of dermatomal distribution
Shingles
Kaposi sarcoma
HHV8
Exanthem subitum
HHV6
Acute necrotising encephalitis
HSV1
Pale rigid lesions on the side of the tongue
hairy leukoplakia - tx is aciclovir
Naturally occurring cytokine that is able to inhibit HIV fusion to cd4+ t lymphocytes?
MIP-1alpha
Nucleoside analogue able to inhibit reverse transcriptase
zidovudine
drug delivered by inhalation able to treat both influenza A and B
zanamivir
Tx of severe, treatment resistant herpes
Interferon
CMV tx
Ganciclovir
Pneumonitis after a bone marrow transplant
CMV
HIV monitoring?
viral load PCR
Primary stomatitis cause?
HSV 1
Viral protein responsible for binding HIV to CD4
gp120
cardinal features of this disease - muscle spasms and rigidity
Tetanus
Tx of gram -ve anaerobes
metronidazole
Tx of VRE (vancomycin resistant enterococci)
Linezolid
Severe systemic infection before the cause has been identified
cefuroxime
Long-term prophylactic in post splenectomy patients
penicillin V
Mesenteric adenitis and necrotising granulomas
Yersinia
Rice eating and diarrhoea
Bacillus cereus
Rice water stool
Cholera
Diarrhoea and stools contain numerous cysts
Giardiasis
Nausea, vomiting, non bloody diarrhoea that resolved 3 days later
Salmonella
Desending paralysis after eating canned food
Clostridium botulinum
toxin-mediated organism that does not damage or invade gastrointestinal epithelium
Cholera
GI infection - family’s main source of water is the river
Cryptospordium parvum
Bitten by rat. 10 days later he complains of fever, malaise, headache and myalgia
Spirillum minus
Cat scratch disease
Bartonella henselae
A zoonosis associated with hepatitis, jaundice, conjunctival infection and renal impairment. Transmission by direct contact with the urine or tissues of infected animal
Leptospirosis
Raised, erythematous rash with clearing in the centre or dim centre
Lyme disease - erythema chronicum migrans
Jaundice and conjunctival haemorrhages
Leptospira interrogans
Castenada’s medium - gram negative coccobacilli
Brucella melitensis
ulcer - centra is black and necrotic. Painless round black lesions with rim of oedema
Anthrax - `bacillus anthracis
Arm pain, dysphagia, hypersalivation, agitation, generalised muscle twiching, confusion
Rabies (encephalitis)
Most common cause of nappy rash fungus?
Candida albicans
itchy, scaly rash on the soles of the feet. Fugus
Trichophytum rubrum
Fungus causing hepatocellular carcinoma
Aspergillus flavus
Hypopigmentation on the trunk. Woods lamp produces yellow fluorescence. Fungus?
Pityrosporum orbiculare
itchy sensation between the toes
Tinea pedis
itchy vaginal discharge most likely diagnosis?
Candidiasis
cavitating lesion on CXR
Aspergillosis
Loves pigeon racing has enlarged lymph node in the neck
Cryptococcus neoformans
Malaise, migratory erythematous rash, arthralgia, more forgetful recently
Lyme disease
Painful and swollen limb after having an accident on the limb (e.g. fracture)
Staphylococcal osteomyelitis
History of TB now has trouble with posture and movement
Pott’s disease
Abscess associated with chronic osteomyelitis
Brodie’s abscess
Infection of surgical site
Staph Aureus and coagulase -ve staph
Difficulty opening mouth, eyes drooped down, rigid abdomen, angles of mouth stretched outwards
Tetanus. Tx is IV tetanus antitoxin
High temp in someone in contact with animals
Brucellosis
Jaundice, fever, hepatomegaly in someone with past history of HBV
HDV - Hepatitis delta virus
MRI of brain shows ring enhancing lesion
cerebral abscess
Woman forgetful. Doesnt speak properly. Ataxia and sudden spasms of muscles. EEG shows periodic sharp waves
CJD prion disease
causes cavitating pneumonia and associated with functional or anatomical abnormalities of the renal tract
Klebsiella
Commonest cause of UTI in catheterised men
E coli
2nd commonest cause of UTI in women
Staph saprophyticus
Causes haemorrhagic cystitis in children
Adenovirus
Tx of acute pyelonephritis
Cipro
Tx of pseudomonas in CF
ceftazidime
UTI features in someone with negative culture, maybe HIV +ve
Renal TB
Sigmoidoscoy shows white plaques on the mucosal surface
C diff
Procedure of Abx prophylaxis in surgeries
Cef and Met 0-2 hours before no longer than 24 hours after surgery
Hepatosplenomegaly, lymphadenopathy, swollen eyelids
Chagas disease
Ulcer in the mouth. Also had ulcer in arm 1 year ago
Mucocutaneous leishmaniasis
Fever, dizziness, persistent cough. Splenomegaly and rough, dry skin. Dark patches on the hands. Pancytopenia
Leishmania donovani
Fever, malaise, weight loss. Hepatosplenomegaly and neck stiffness. CXR shows small, nodular opacities.
Miliary tb
Infant with swollen eyelids. Discharge
Chalmydial conjunctivitis in the neoborn
Intra-cranial calcification
Congenital toxoplasmosis
Newly born with microphthalmia, deafness, hepatosplenomegaly, rash
Congenital rubella syndrome
HepB virus
dsDNA virus
distate for cigarettes
HepA
liver problems associated with polycythaemia
Budd Chiari syndrome
Low serum copper and low caeruplasmin
Wilsons - serrum copper initially low and then becomes high?
Hyperkalaemia in someone with mechanical heart valves
Haemolysis
Urinary sodium < 20 =
Hypovolaemia
CT shows atrophy of the adrenal glands
Cushings?
Progressive tanning of the skin after having an adrenelectomy for Cushing’s
Nelson’s syndrome - patient develops macroadenomas secreting ACTH. Pigmentation, visual disturbances, headaches, high ACTH
Increased levels in the urine of people with CAH
Pregnanetriol
CYP21 deficiency = congenital adrenal hyperplasia
Hyponatraemia with hyperkalaemia
Lump in throat moves up with swallowing with thyroid symotoms
Hashimotos thyroiditis
Dark patches on back of hands with high serum cholesterol
Familial hypercholesterolaemia
Haemoptysis and haematuria
Goodpastures
Associated with Von Hippel Lindau
Renal Cell Ca
Well-circumscribed metastasis in the lungs secondary to renal cell ca, choriocarcinom, prostate cancer
Cannonball metastasis
Polyuria, polydipsia, no hypercalcaemia, no glycosuria on urine dip. Fluid deprivation test 400-600 urine osmolarity
Psychogenic polydipsia
Varies with posture when sample is taken
Albumin and renin
Varies with race and exercise
Creatinine kinase
Varies with time of sampling
Cortisol
Genital atrophy + hypokalaemia
Use of corticosteroids
Dark brown urine + proliferation of the mesangium
IgA nephropathy
Gold standard of measuring GFR
Inulin
Staging and monitoring treatment of extracapsular spread of prostatic carcinoma
Acid phosphatase
Loin to groin pain
Renal stones
Raised levels of this in sarcoidosis?
ACE
Useful marker of reinfarction MI?
CK MB
Following chemotherapy which enzyme would you expect to be elevated?
LDH
T1D antibody
anti-glutamic acid decarboxylase
liver enzyme raised after MI
AST
Test of the extrinsic pathway
PT
Antibody in macrocytic anaemia
Anti gastric parietal cell antibody
Spherocytosis test
Osmotic fragility
Vitamin deficiency someone with waddling gait
Vit D
Deficiency of —— in someone very thing but distended abdomen
Protein
Fabry’s disease - an x linked disorder of glycolipid metabolism due to deficiency of what?
Galctosidase A
SCID deficiency?
Adenosine deaminase
McArdle’s glycogen storage disease causes stiffness following exercise deficiency of?
Mycophosphorylase
Recommended therapy used in an attack of acute
intermittent porphyria
Haem arginate
drug that is contraindicated in
patients with porphyria
Diclofenac (NSAID) and Co-trimoxazole
Drug that can result in chronic porphyria
Alcohol
An 8 year old boy, showing signs of slow development,
presents with a painful right knee which on examination
was hot and swollen. Scratch marks on his face were
also observed. An aspiration of the synovial fluid from
the joint revealed crystals which were negatively
birefringent.
Lesch-Nyhan Syndrome
What is the major antagonist of serine
proteases at a site of injury?
Alpha-1-antitrypsin
A 60 year old male presents to his GP with
symptoms of tiredness, dizziness and loss of
vision. He has lymphadenopathy and
splenomegaly. Serum electrophoresis shows
an IgM spike.
Waldenstrom’s macroglobulinaemia
A 3-day-old baby presents with jaundice and has
raised levels of unconjugated bilirubin. During
examination, he is found to be irritable and has
increased muscle tone and lies with an arched
back (opisthotonus)
Kernicterus
The molecule that is formed by the gut after a meal
and is the main carrier of dietary triglycerides. This molecule is present in the fasting state in cases
of lipoprotein lipase deficiency.
Chylomicron
A 3-week-old male is seen by a paediatrician
because of severe jaundice that appeared at birth
and has been worsening ever since.
Crigler-Najjar syndrome
A young boy presents to his GP with jaundice. He is
also found to have haemoglobinuria, splenomegaly
and anaemia. His mother reveals that he was
jaundiced at birth and needed a blood transfusion.
G6PD deficiency
A post mortem diagnosis of an inborn error of
metabolism is investigated in a case of “sudden infant
death”. What deficiency is the most likely cause?
Medium chain acyl coA dehydrogenase
A neonate with a history of feeding difficulties
presents with jaundice, cataracts and sepsis. What
deficiency is the most likely cause?
Galactase-1-phosphate uridyltransferase
DM values
Fasting > 7, Random > 11.1, OGTT > 11.1
Impaired glucose tolerance values
Fasting < 7 AND OGTT 7.8 - 11.1
Impaired fasting glucose
Fasting 6.1 - 7 AND OGTT < 7.8
Diabetes - Na, K and serum osmolarity
High Na, Low K, serum osmolarity?
Potassium in DKA
High
Conn’s - Na, K and serum osmolarity
High Na, low K, and high urine osmolarity
Rule of thumb for SIADH
urine osmolality is double the plasma osmolality, it’s likely to be SIADH
Which cell sits in (it’s immature form in) the periphery, and when it matures, goes to
present things to T cells? So migrates to LN in mature form…
dendritic cells
when there is an infection, this cell produces pus
Neutrophils
increases with parasitic infections
Oesinophils
cell is inhibited by the presence of MHC1 on cells?
Natural killer cell
Sickle cell disease Hb and MCV
Low Hb, normal MCV
Girl with coeliac refused to stick to gluten free diet and now had macrocytosis
Folate deficiency (due to malabsorption)
A teenage girl who when she goes cross country running gets an erythematous rash on her legs. It is
well controlled by antihistamines
Cold urticaria
Man has an allergic reaction during surgery and who’s lips becomes swollen/oedematous when
blowing up balloons as his daughter’s birthday party
Type 1 hypersensitivity Latex allergy
Bloated after drinking milk but not IgE mediated
Lactose intolerance
Patient with high IgG paraprotein – (32 or 40) g/dl, back pain and loss of sensation in legs
Multiple myeloma
Patient with IgM paraprotein and visual disturbances
Patient with IgM paraprotein and visual disturbances
A German lady who is asymptomatic, has low neutrophils, but no abnormal cells on film
Chronic idiopathic neutropenia
An overweight individual with diabetes has longstanding bone/back pain. They are found to have
paraprotein IgA ~8g/dl, and GFR 55mls/min/1.73m^2. FBC normal and albumin normal.
Monoclonal-gammopathy-of-unknown-significance
Asymptomatic with isolated rise in unconjugated bilirubin
Gilberts
What is the most common cause of traveller’s diarrhoea?
E Coli
A ward sister gets diarrhoea, and patients on the ward have been ill recently
norovirus
Shigella
Bloody diarrhoea, vomiting with abdo pain
Cholera
Profuse watery diarrhoea, resulting in weight loss
Campylobacter
Flu like prodrome followed by crampy abdo pain. Complication is Guillian Barre
Amoebiasis
Bloody diarrhoea, abdo pain and tenderness lasting for few weeks
Diarrhoea (before 12 hours)
Staph
Diarrhoea (after 12 hours, or day after meal)
E Coli
Diarrhoea (2-3 days post-meal)
Camylobacter
Diarrhoea (after 7 or more days after meal). non-bloody
Giardiasis
Diarrhoea + (context of question e.g. Travel to Southeast Asia)
Cholera
Diarrhoea + Flu like symptoms
Campylobacter
Diarrhoea + Travel from Bangladesh
Typhoid
Listeria meningitis tx
Amoxicillin + Gentamycin or Ampicillin + Gentamycin
- IV antibiotic for Group A Strep pharyngitis/Strep Throat?
IV Benzylpenicillin
Which/What antibiotic would you use to treat/prescribe someone who has cellulitis with a Methicillin SENSITIVE strain of Staphylococcus aureus
Flucloxacillin
Abx for meningitis in over 50/60
Cefotaxime with amoxicillin
Pyloric stenosis bloods
low potassium, normal sodium and high bicarbonate
What happens to the body of the stomach in a patient with pernicious anaemia
Atrophic (gastritis)
Cancer with H pylori
Gatric Mucosa-associated lymphoid tissue (MALT)
Most common type of malignancy in the breast
Invasive ductal carcinoma (accounts for 75% of all breast cancer) > DCIS is the most common type of non-invasive breast cancer.
Which/What cancer is associated with (? the presence of?) E cadherins
E-cadherin present, answer = Invasive ductal carcinoma.
However, if it said E-Cadherin negative, answer = Invasive lobular carcinoma
Cancer which has a high, medium and low stage to it
DCIS
Fibro-epithelial tumour with abundant stromal elements
Phyllodes tumour
enzyme regulates the rate limiting step in haem biosynthesis pathway/of the blood
ALA Synthase
In Rhabdomyolysis, which biomarker is likely to be raised
CReatinine kinase raised
Anti-PCD – Anti-Purkinje cell
Paraneoplastic cerebellar degeneration disease (which also spells PCD) can be associated with any cancer – most commonly small cell lung cancer, and Hodgkin’s disease
Heterophile antibody
Infectious mononucleosis
Anti-microsomal antibodies
Chronic lymphocytic thyroiditis (Hashimoto’s thyroiditis – hypothyroidism).
Graves disease antibody
Thyroid stimulating hormone receptor antibody
Anti-Jo1
Myositis (specifically polymyositis and dermatomyositis) and Pulmonary Fibrosis (Honeycomb changes on X-ray)
Anti-ribonucleoprotein antibody (U1RNP)
Mixed connective tissue disorder (e.g. Ankylosing spondylitis).
Anti platelet antibody
ITP
dry eyes and parotid swelling?
Sjogren
Leukocyte adhesion deficiency II
Selectin deficiency – typical History: less severe than LAD1, mentally limited, short stature and depressed nasal bridge
Boy with abscesses has a positive NBT
Myeloperoxidase deficiency (NBT = Nitro Blue Tetrazolium (or as I call it NBT = Nitro Blue Test). A positive result suggests MPO (Myeloperoxidase deficiency) – an autosomal recessive disease. A negative result suggests lack of NADPH oxidase activity – i.e. NADPH is broken or absent (I.e. chronic granulomatous disease)
A man with AF (Atrial fibrillation) develops fever, nausea, vomiting and pain in his right loin/flank. What is the most likely cause?
renal infarct
- What is the most common cause of thrombocytopenia/low platelets in Pregnancy (Commonest cause of maternal thrombocytopenia)?
gestational thrombocytopenia
Which antibiotic do you use to treat viral syncytial virus (bronchiolitis) in a child
ribavirin appaz
- Man has an MI 3 years ago. Now comes into hospital feeling very unwell. Is having a sample taken from their pericardial layer and you find blood is aspirated from the pericardium
Ventricular rupture
- A girl has recently been noted by her parents to be acting strange lately. A Lumbar puncture is performed and the CSF shows high lymphocytes and a raised protein, but normal glucose (on LP)
Herpes
- A Rhesus D negative woman is having a Haematopoietic stem cell transplant (HSCT) and is CMV IgG negative. What is the most important thing to ensure in the transplant?
a. CMV IgG negative
MMR + preg
must not be given
- Which of these is a common finding in someone who has portal hypertension?
splenomegaly
- Which cancer does asbestos cause?
mesthothelioma
‘transitional cell’ cancer
bladder ca
- Man presents with ulcers on mouth following treatment with a drug
steven johnson syndrome
- Which vector transmits Trypanosoma brucei rhodesiense?
a. Tsetse Fly
Which of these ions (K, CL, Na, Mg) is most likely to be outside it’s normal range in an alkalotic picture?
Sodium
- Which cancer is most likely in a person who is a non-smoker?
Adenocarcinoma
50 year old man with Midshaft femur fracture – what would you find at the site of the break/fracture
chondrosarcoma
Which/What is the most common cause of jaundice/fever in a returning traveller with a fever?
malaria
ALL feature?
neutropenia
- Which mixed pattern auto-inflammatory condition has over 90% heritability and effects the sacroiliac joint?
Ankylosing spondylitis
- An elderly man has a fall, and doesn’t become unconscious/lose consciousness, and presents two days later with a confusion, where is the likely site of bleeding?
subdural
Which clotting factor falls most rapidly after administering warfarin?
factor VII
What drug is used to treat severe falciparum malaria?
Artesunate
- A patient has a massive splenomegaly, and JAK2 V617F mutation with a leucoerythroblastic picture and tear-drop poikilocytes. What do they have?
myelofibrosis
A patient required an aortic valve replaced 3 months ago. They have now come back a few weeks later with jaundice, Hb-urea (haemoglobinuria), and raised reticulocytes. What is the cause
mechanical haemolytic anaemia
Which vasculitis causes stenosis to the ascending external carotid
Takayasu / Giant cells
- What zoonotic disease does the Ixodes Tick cause?
Lyme disease
Disease that causes Hydrops fetalis if caught in first 20wks
Parvovirus
Disease which if transmitted to baby: they can initially be symptomless but then
come down with problems - long term sequelae. Beta herpes virus.
CMV
Broad spec, no pseudomonal activity usually given with a beta lactamase inhibitor
Amoxicillin
Wet slide microscopy
Trichomoniasis
Woman with UTI - Culture grows gram positive cocci in clusters
Staph saprophyticus
19 year old rugby player with boils, members of his team have similar boils, as do
members of his family
herpes gladitorium HSV 1
Virus that resides in pharynx and GIT - 1:100 encephalitis, 1:1000 destruction of
motor neurons
polio
Develops a grey film over the epiglottis
Diptheria
Cause of lockjaw
tetanus
mass in head of pancreas
adenocarcinoma
mass following acute pancreatitis
pseudocyst
Patient with a history of severe abdominal pain; during cholecystectomy, the
surgeons noticed white specks around and on the pancreas.
chronic pancreatitis
Patient with hypoglycaemia and pancreas mass
hypoglycaemia
sacroidosis
non caseating granulomas
On doing a patient’s nephrectomy they notice a mass in the kidney that extends into
the renal vessels and into the perinephric fat
papillary adenoma (found incidentally)
Radiosensitive cancer of the testicle in a young man with a white/smooth
appearence?
seminoma
Patient with a cancer in their bladder following chronic schistosomiasis
squamous cell carcinoma
20 year old with a lytic lesion in the diaphysis of his leg - pain alleviated by aspirin
osteoid osteoma
man goes deaf with bowed legs
pagets
Patient with HIV, raised ICP, new onset epilepsy.
toxoplasmosis
Woman with recurrent episodes of weakness and parasthesia that spontaneously
resolve
Multiple sclerosis
Pt with Lung CA - High Na, Low K
ectopic ACTH
Patient with polyuria and polydipsia- low Na, Low K, Low plasma and urine osmolarity
psychogenic polydipsia
restrictive pericarditis
Hx of systemic disease e.g. amyloidosis,
haemochromatosis, inflammatory bowel disease
optic nerve tumour excised and now lump on hand
neurofibromatosis
Depression then CNS symptoms in young person
Variant CJD
neurosings first and presents later
Sporadic CJD
HIV Tuberculoma
ring enhancing lesion
epileptic with patch on back and lumps in brain
Tuberous sclerosis
capillary loops surrounded by epithelial cells
AV malformation
INR 2.5
1 st episode DVT, PE, AF
INR 3.5
recurrent DVT, PE, mechanical vales
Familial hypocalcuric hypercalcaemia
high serum calcium, low urine calcium
paracetamol and liver
Paracetamol: VERY HIGH ALT and AST
HONK
low potassium, high glucose, high serum osmolality >320, bicarb>15
DM
high lipids create a pseudohyponatraemia with normal
osmolality
Ashkenazi Jews
Tay Sachs, lysosomal
GvHD
Donor cells attacking host
o Days-weeks, rash, N+V, bloody diarrhoea, abdo pain, jaundice
o Prophylaxis: methotrexate/cyclosporine
o Treat with steroids
Serum sickness
type III reaction
Travel vaccine not given to someone with ank spond on TNFalpha inhibitro
yellow fever
Every 5 years given to splenectomy patients
pneumococcal
Given as post exposure prophylaxis
rabies
death certificate
1a - ultimate cause of death e.g. bronchopneumonia
1b causes 1a e.g. lung cancer
1c causes 1b
Part II - other diseases related to cause of death but not related to 1a-c e.g. diabetes
mellitus for a patient who died of MI
Auer Rod and PML RARA
Acute promyelocytic leukaemia
pregnant and DIC?
Important cause if amniotic fluid embolus
Felty’s syndrome
Rheumatoid arthritis, splenomegaly and neutropenia
Pneumonia in HIV with ground glass appearance?
PCP
urethritis, arthritis and eye problems
Reiter’s syndrome
calcitonin
Calcitonin is produced by the parafollicular cells (aka C-cells) which reduce blood Ca2+, opposing the
effects of PTH.
MSSA
Methicillin-sensitive Staphylococcus aureus; treatment is penicillin
MRSA
M-resistant SA; treatment is vancomycin.
MSSA with penicillin allergy
macrolide
Meningitis prophylaxis in contacts
ciprofloxacin
scaly red lesions of the scalp with hair loss.
tinea capitis
ring worm, trunks, arms and legs, with raised red rings.
tinea corporis
ringworm, Athlete’s foot.
Tricophyton rubrum
aka Malassezia globosa/furfur; xmas tree pattern rash beginning with a Herald’s patch – spaghetti
and meatballs appearance.
Pityriasis versicolor/rosea
meningitis with insidious onset in HIV.
cryptococcus
protozoa infection in pregnancy can be passed on to baby
toxoplasmosis
snail trail oral ulcer
Secondary syphilis - T pallidum
abdo pain and headache but specifically NO diarrhoea
Salmonella typhi
small ulcer on right ring finger that won’t heal and keeps getting bigger
Leishmania
NOD2/CARD15 found in?
Chrons
Swollen joint, needle-shaped aspirate with negative birefringence, what is the enzyme responsible
xantine oxidase
What does JC virus cause?
Progressive Multifocal Leukoencephalopathy
5yr old, tetany, bone pain. Widened epiphyses + ‘Cupping’ of metaphysis shown on x-ray. What is the cause?
rickets
What is the minimum amount of time to treat a VTE?
3 months
Neonate with meningococcal sepsis. What pathogen
GBS
HIV +ve patient with v low CD4 + vascular lesions seen on trunk. What virus causes this cancer?
HHV8 - Kaposi
What enzyme to confirm cardiac failure
BNP
What liver enzyme is raised in MI
AST
White things on the oesophagus seen in OGD of an alcoholic man with recurrent bleeding varices.
Oesophageal candidiasis
type of cell does Rituximab target?
Mature B cell
HepA spread
Foecal oral
Slate grey skin
Haemochromatosis
HTLV1 Virus lymphoma
Adult t cell lymphoma/leukaemia
