Past Papers ChemPath Flashcards
24 y/o asymptomatic man
isolated rise in unconjugated bilirubin
other results (ALT, ALP etc normal)
Gilbert’s
22 year old student
two weeks anorexia, fever and malaise – raised ALT
normal/super mildly raised ALP + GGT
Viral Hepatitis
Women,colicky abdominal pain.
mildly elevated ALP, ALT, GGT, & Bilirubin.
GGT + Bilirubin most raised
Post hepatic cause
- gallstones/acute cholestasis
- head of pancreas Ca
57 y/o man presents hematemesis High ALT + GGT slightly raised ALP Low Albumin.
Alcohol induced hepatitis
elderly man
v high ALP
headache
Paget’s
disorder bone remodelling
Increased AST > Increased ALT (2:1)
> Increased GGT + ALP
Alcoholic liver disease (aSt wavy - drunk)
NAFLD
Increased ALT > Increased AST (1:<1)
> Increased GGT + ALP
Viral hepatitis
Raised Bilirubin - unconjugated
haemolysis
Raised Bilirubin - conjugated
damage to the liver or the gallbladder/bileduct
high ALP and GGT
raised conj bilirubin
cholestasis
Normal GGT + Raised ALP
Paget’s
or placenta
Bicarbonate in a pyloric stenosis patient
high bicarb
low K, N Na
oral glucose tolerance test
impaired glucose tolerance reading
OGTT 7.8 - 11.1
Calculate plasma osmolality
2(Na + K) + Urea + Glucose
Normal fasting blood glucose
<6.1
and >4
OGTT normal glucose
<7.8 (at 2hr reading)
Impaired fasting glucose
Fasting glucose 6.1 - 6.9
OGTT 7.8 - 11.1
Diabetes random blood glucose
> 11.1
HbA1c:
normal
pre-diabetes
diabetes
Normal <6.0%
Prediabetes - 6.0% to 6.4%
Diabetes > 6.5%
Low sodium, all else (K+, CL-) normal
Glucose before OGTT is 4.9, 2 hours later is 10
Impaired OGTT
teen
polyuria and polydipsia
wt loss
T1DM
high Na
low K
high urine osmolality
Conn’s
K in DKA metabolic acidosis
high
as no insulin
high sodium
high potassium
plasma osmolality ~400
urine osmolality ~600
SIADH
60 y/o
abdominal pain radiating to back, collapses and dies
AAA
ex-smoker
hypertension and MI
sudden chest pain which radiates to the neck
Descending internal carotid thrombus
50 y/o F,
memory issues/progressive amnesia, hypertension
Multiple cerebral/(?cortical) infarcts
man with atrial fibrillation with right flank pain
Renal infarct
MI 3 years ago
unwell
sample from pericardial layer -blood
Ventricular rupture
Itchiness of the skin more likely in hepatitis or intravascular haemolysis
hepatitis
ulcers on mouth following treatment with a drug
- Steven-Johnson Syndrome
which ion low if pt urinating a lot?
Na
Na 119 K 4.5
Plasma osmolality 249
Urine Na 54
Urine osmolality 530
Diagnosis?
SIADH
Pt hits head, polyuria and polydipsia
Na 130 K 4 U 2.2 Cr 57
Diagnosis?
psychogenic polydipsia
diabetes insipidus if high Na (as no ADH to reabsorb water)
40 y/o renin 6.4 (high) aldosterone 1200 (high)
renal artery stenosis (high renin plus Ald)
NB Conn’s has just high Ald
ACEi improve/worsen Creatinine within days of starting?
worsen
Plasmodium species treated with Primaquine
P. vivax
Form malaria injected into host
Sporozoite
First line non-falciparum malaria
Chloroquine
In multiple myeloma, how would you manage: hypercalcaemia
fluid + BISPHOSPHONATES
In multiple myeloma, Mx of spinal cord compression
Dexamethasone
In multiple myeloma, Mx of hyperviscosity
Venesection
INR of pt with AF
INR 2-3
Pt with prosthetic valve and AF
INR 2.5-3.5
Blood monitoring of Old lady who had cancer having aspirin and clopidogrel
not needed
Which organism?
returning from Afghanistan has a small ulcer on right ring finger that won’t heal and keeps getting bigger
Leishmania
Liver cyst, travel to South America
Entamoeba histolytica
HIV, pneumonia
Ground glass CXR
PCP
Renal transplant CXR halo sign
Organism?
Aspergillosis
mechanism in the oesophagus as a result of reflux (GORD) that takes place and leads to cancer?
dysplasia
mucous producing cancer in lungs
Mucinous adenocarcinoma
NOD2/CARD15, what is it found in?
Crohn’s
Immunodeficiency with common gamma chain problem?
X-linked SCID
Swollen joint, needle-shaped aspirate with negative birefringence, what is the enzyme responsible
Xanthine Oxidase
Long term Tx for gout
Colchicine
JC virus cause?
Progressive Multifocal Leukoencephalopathy
Reactivation of a virus following a transplant
Epstein Barr Virus
Most common virus causing aseptic meningitis
Coxsackie or echovirus
Smear cells
Chronic LYMPHOCYTIC leukaemia
15 yo with brain tumour extends outwards from cerebellum and invading subarachnoid space. Signs of ataxia
medulloblastoma
cerebral low grade /commonest in kids = pilocytic astrocytoma
Diabetes, fatty stools, weight loss, ‘slate grey skin’ and joint pains
Haemachromatosis (joint pain, skin changes, pancreatitis, liver deposition
5yr old, tetany, bone pain. Widened epiphyses + ‘Cupping’ of metaphysis shown on x-ray. What is the cause?
Rickets
minimum amount of time to treat a VTE?
3 months
Mother is a donor for kidney to a child, what is the max number of mismatches possible with HLA class I?
3 out of 6
- Ovarian tumour with hair. No immature cells seen
Mature teratoma
liver enzyme is raised in MI
AST Aspartate aminotransferase
Old man who fell over, been on floor for days. Severely dehydrated. Dark urine. Not blood on microscopy. What causes the dark urine?
Myoglobin
Creatine Kinase MM will be HIGH
Multiple myeloma and restrictive cardiomyopathy. What will you see on heart biopsy?
Amyloid depositions AL (light chain)
macrocytic anaemia, atrophy of body of stomach. What substance are they deficient in that leads to B12 malabsorption?
Intrinsic Factor
IVDU man is given Rituximab - CHOP treatment for Non-Hodgkin’s lymphoma. He later 8 months later develops fulminant liver failure and dies. Why?
Hep B reactivation
coagulation factor is decreased first on administration of warfarin?
Factor VII
White things on the oesophagus seen in OGD of an alcoholic man with recurrent bleeding varices.
Oesophageal Candidiasis
Mexico and ate unpasteurized dairy + diarrhoea?
Brucellosis
apthous ulcers
Crohn’s
Which type of cell does Rituximab target?
Mature B cells
How does HepA spread
Faeco oral
CLL with p53 mutation Tx
Ibrutinib (TK mutation)
less aggressive CLL (no p53 mutation) = watch and wait
Prophylaxis for allograft rejection
BASILIXIMAB (anti-CD25)
Tacrolimus/Cyclosporin (calcineurin inhibitor)
Which allergy is more likely to present in child than adult? • OAS • Egg • Bee • Pollen
Egg
natural antibody that confers protective immunity against HIV
gp120 and anti gp41 +
Common cause of cellulitis
Staph Aureus
B haemolytic Strep - Strep PYOGENES
Ion raised in red cell lysis
Potassium
HTLV1 Virus lymphoma
Adult t cell lymphoma/leukaemia
Lower in pregnancy
Protein S
Factor XI
Plt, Hct, Hb all lower too
How does melanoma spread?
LN
Metabolic disturbance of CAH
No Aldosterone - LOW Na, HIGH K
No Cortisol - low Glucose
Causes DIC in pregnancy
Amniotic fluid embolism
placental abruption
retained dead fetus
pre-eclampsia (severe)