Path Flashcards
Which medication is gold standard for the treatment of MSSA?
Flucloxacillin IV
A transplant patient presents to his GP with diarrhoea and abdominal pain. He also complains of increased frequency visual floaters. What is the likely causative organism?
Human Cytomegalovirus
One of your patients on the labour ward gives birth to a child. You perform a newborn examination and note loss of the red reflex, microcephaly and a widespread non-blanching rash that coalesces into violaceous patches. What is the most likely causative organism of this congenital syndrome?
Varicella zoster virus
Select the only drug in the list below that does not inhibit viral nucleic acid synthesis: A) Cidofovir B) Foscarnet C) Ganciclovir D) Nevirapine E) Saquinavir
saquinavir
A 20-year-old student seeks medical attention due to recent difficulty in swallowing, and severe weight loss. He has a history of travel in Brazil, where during his trip he was ill with fever, diarrhoea, and vomiting, and swollen purple eyelids. This resolved over 3 weeks with no treatment being necessary. A chest x-ray is ordered as one of his investigations, and this reveals marked dilatation of his oesophagus. Which vector is responsible for transmitting this disease?
Reduviid bugs
A young patient with visual hallucinations and seizures is admitted to the hospital. His routine bloods show a deranged clotting and abnormal LFTs. Which of the following stains would be most useful to identify the underlying cause of his symptoms?
rhodanine
What is the most common cause of chronic pancreatitis?
alcohol
most common benign liver lesion
haemangioma
A patient with alcohol related liver disease undergoes a biopsy and is found to have cirrhosis. What is the stage of his liver disease?
F4
A 7 year old child presents with recurrent severe bacterial meningitis. There is a family history of childhood death from meningococcal sepsis. Immunological investigations show normal levels of C3 and C4, and abnormal CH50 and AP50. What is the most likely diagnosis? C1q deficiency Factor B deficiency SLE Mannose binding lectin deficiency C7 deficiency
C7 deficiency
A 3 year old child with recurrent infections has been found to be neutropenic on two occasions. There is a mutation in neutrophil elastase (ELA-2). What is the diagnosis?
cyclic neutropenia
young adult presents to clinic with chronic Mycobacterium marinum infection. An NBT test is positive. What is the most likely diagnosis?
deficiency of IL12 or IFN gamma or their receptors
dendritic cells that are present in skin
langerhans cells
reversible cause of nephrogenic DI
hypercalcaemia
causes of hypovolaemic hyponatraemia
diuretics, D/V, burns, ascites, Barter syndrome, Addisons
low serum sodium, normal serum osmolality
myeloma, paraprotein, lipids, alcohol
most common cause of addison’s worldwide
TB of the adrenals
t(9;22) is present in
CML and ALL
how does APML present
like AML but also with DIC.
how is APML treated
all-trans retinoic acid (metabolite of vitamin A)
criteria for smouldering myeloma and multiple myeloma
monoclonal antibody > 30g/l, clonal plasma cells >10%
What monoclonal antibody targets IL-17 and is involved in the treatment of psoriasis, psoriatic arthritis and ankylosing spondylitis?
secukinumab
Which joints in the hand are classically not affected by rheumatoid arthritis?
distal interphalangeal joints
What protein is defective in X linked Severe Combined Immunodeficiency?
common gamma chain in IL-2 receptor (needed for T cell proliferation)
A mutation in what protein is the most common cause of Hyper IgM syndrome?
CD40 class switching requires activation of CD40 on surface of B lymphocytes to occur
What enzyme, deficient or defective in chronic granulomatous disease, is responsible for the “respiratory burst” that may kill phagocytosed pathogens?
NADPH oxidase
Which subtype of T helper cells are implicated in the development of allergic diseases, such as asthma or eczema
T helper 2 cells
What monoclonal antibody targets IL-23 and IL-12 and is used in the treatment of psoriasis or psoriatic arthritis?
ustekinumab
What lymphocyte lineage does cyclophosphamide predominantly inhibit?
B cells
CD3 is typically a marker of what immune cell?
T cells
CD14 is typically a marker of what type of immune cell?
macrophages
When evaluating patients for coeliac disease, in addition to serology for anti-TTG and anti-endomyseal antibodies.
What other blood test should be performed to correctly interpret these serological tests?
serum IgA
What monoclonal antibody targets CD25 and is used in the prophylaxis and treatment of allograft rejection?
basiliximab
CD25 is a component of IL-2 receptor
peptide found on surface of all B and T lymphocytes
CD52
What monoclonal antibody targets CD52 and causes depletion of all lymphocyte subsets?
alemtuzumab
what does AST stand for
aspartate aminotransferase
Troisier’s sign
when you find Virchow’s node
basophilic stippling is found in…
beta thalassemia trait
lead poisoning
What happens in renal tubular acidosis
damage to kidneys –> defect in hydrogen ion secretion in renal tubule –> more potassium excretion to balance out increased sodium reabsorption –> hypokalaemia, acidosis
most common type of malignancy in breast
invasive ductal carcinoma
fibroadenoma in breast
mobile, well circumscribed lump
size fluctuates with menstrual cycles and grows rapidly in pregnancy
African sleeping sickness is transmitted by…
tsetse fly
Organisms responsible for acute and chronic infections of Human African trypanosomiasis
acute infection = trypanosoma brucei rhodesiense (r for rapid) chronic infection (takes months/years for sx to appear) = trypanosoma brucei gambiense
Von Gierke’s disease
glycogen storage disorder
unable to convert glycogen into glucose
hypoglycaemia, hepatomegaly, kidney enlargement, floppy
subdural haemorrhage
hx of trauma
haematoma is slow to form so takes around 48h for sx of raised ICP to appear –> increasing headache, confusion
galactossaemia
newborn with cataracts, poor feeding, lethargy, conjugated hyperbilirubinaemia, reducing sugars in urine
homocysteinuria
amino acid disorder, resulting in build up of homocysteine –> fair skin, brittle hair, learning difficulties, convulsions, thrombotic episodes
Fabry’s disease
cherry red spot
glucagon
stimulates gluconeogenesis in liver
carcinoid syndrome
collection of sx due to release of serotonin from neuroendocrine tumour
flushing, palpitations, tachycardia, diarrhoea, loss of appetite
RAISED URINE 5IHAA
Microscopic polyangitis
pulmonary haemorrhage + glomerulonephritis
pANCA
JCV is associated with
progressive multifocal leukoencephalitis
Herald patch
pityriasis rosacea
enzyme that is raised in chronic alcohol cirrhosis
AST
S for smirnoff
antigen test for candida/aspergillus/pcp looks for?
beta d glucan
antigen test for aspergillus looks for?
beta d glucan + galactomannan
diagnostic test for tinea / trichophyton
potassium hydroxide mixed with nail/skin clippings
tx for mucocutaneous / visceral leishmaniasis
amphotericin B
gold standard dx test for visceral leishmaniasis
splenic / bone marrow aspirate
Jarisch Herxheimer reaction
antibiotic tx damages bacterial cell membranes –> release of endotoxins –> systemic inflammatory reaction –> significant drop in BP + acute end organ injury
life threatening!
stain for melanin
fontana stain
predominant cells in acute inflammation
neutrophils
predominant cells in chronic inflammation
lymphocytes
Layers of epidermis
corn lovers grow some bales stratum corneum stratum lucidum stratum granulosum stratum spinosum stratum basale
pre malignant condition for skin sqcc
Bowen’s disease
portal triad includes:
portal vein, hepatic artery, bile duct
zones in sinusoid
zone 3 = periportal
zone 2 = midzone
zone 1 = periventricular
drains into central vein
acute hepatitis histology
spotty necrosis
chronic hepatitis histology
fibrosis (F4=cirrhosis)
interface hepatitis
cirrhosis features + histology
features - fibrosis, necrosis, nodules of regenerating hepatocytes, distortion of vascular architecture, intrahepatic + extrahepatic shunting
histology - deposition of ECM in space of disse, stellate transformation, kupffer cell activation
alcoholic liver disease includes:
hepatic steatosis
alcoholic hepatitis
alcoholic cirrhosis
alcoholic cirrhosis histology
micronodular cirrhosis
shrunken brown organ
alcoholic hepatitis histology
fibrosis
mallory denk bodies
hepatocyte ballooning
main cause of non-alcoholic fatty liver disease
insulin resistance, therefore assoc. with high BMI + diabetes
primary sclerosing cholangitis histology
assoc. with UC pANCA periductal bile duct fibrosis --> strictures beading of bile ducts on ERCP assoc. w/cholangiocarcinoma
primary biliary cirrhosis histology
assoc. with female, autoimmune conditions
anti-mitochondrial antibodies
progressive autoimmune destruction of bile ducts –> chronic inflammation with granulomas + cholestasis –> build up of toxins + bile –> xanthelasma, jaundice, pruritis
A1AT deficiency histology
hepatocytes are unable to secrete a1at in blood (usually leave liver cells to blood to protect lungs + other organs)
misfolded proteins build up in hepatocytes –> CHRONIC HEPATITIS + PERIPORTAL RED HYALINE GLOBULES on PAS stain
benign liver conditions
haemangioma
liver cell adenoma (assoc. w/ COCP)
bile duct adenoma
liver malignancies + associations
hepatocellular carcinoma (assoc. w/ viral hepatitis, alcoholic cirrhosis, haemochromatosis, NAFLD, aflatoxin) cholangiocarcinoma (assoc. w/ PSC)
C. difficile 3 C’s
ciprofloxacin, cephalosporins, clindamycin
extra intestinal sx of IBD
anterior uveitis stomatitis arthritis erythema nodosum pyoderma gangrenosum
non-neoplastic polyps in colon
hyperplastic polyps
inflammatory pseudopolyps
hamartomatous polyps
what features of colonic polyps would increase risk of cancer
many polyps
larger polyps
HIGHER VILLOUS COMPONENT
dysplastic features
neoplastic polyps in colon
tubular adenoma
tubulovillous adenoma
villous adenoma
Duke’s staging for colorectal cancer
A - confined to mucosa
B1 - extending into muscularis propria
B2 - extending through bowel wall
C1 - extending into muscularis propria WITH LN involvement
C2 - extending through bowel wall WITH LN involvement
D - distant metastases
Familial adenomatous polyposis
autosomal dominant
mutation in APC tumour suppressor gene
lots of polyps (>100 needed for dx)
cancer within 10-15 years
Mx of inherited colon conditions
monitoring + total colectomy
Gardner’s syndrome
autosomal dominant
subtype of FAP + extraintestinal features (skull/mandibular osteomas, dental caries)
HNPCC / Lynch syndrome
autosomal dominant
mutations in DNA mismatch repair genes
colon cancer + concurrent extra-colonic cancer (eg ovarian, endometrial, small bowel, stomach carcinoma)
stain for goblet cells
methylene blue
stomach body & fundus histology
columnar epithelium parietal cells (intrinsic factor, acid) chief cells (pepsin)
stomach pylorus histology
columnar epithelium neuroendocrine cells (gastrin)
ulcers vs erosion
ulcers - loss of tissue goes beyond mucosa & into submucosa
mucosa - loss of tissue is limited to mucosa (basement membrane intact)
types of gastric cancer
intestinal adenocarcinoma
diffuse adenocarcinoma
MALT lymphoma
intestinal adenocarcinoma histology (gastric malignancy)
well differentiated
mucin production
gland formation
diffuse gastric adenocarcinoma histology
single cell architecture
signet ring cells
no glands formed
duodenum histology
columnar epithelium with goblet cells
2:1 villous to crypt ratio
duodenal ulcers:
1) anterior ulcers lead to…
2) posterior ulcers lead to…
1) performation –> peritonitis
2) erosion of gastroduodenal artery –> haemorrhage –> malaena + hypotension
what is lymphocytic duodenitis
what happens before Coeliac’s
increased intraepithelial lymphocytes but w/o structural changes
pancreatic cells + function
acinar cells (secrete digestive enzymes) exocrine cells (secrete pancreatic juice) islet cells (secrete hormones) duct cells (line ducts)
complications of acute pancreatitis
pancreatic –> pseudocyst, abscess
systemic –> hypoglycaemia, hypocalcaemia, shock
acute pancreatitis histology
duct obstruction + direct acinar injury –> inflammation, leaking of pancreatic enzymes
chronic pancreatitis histology
chronic inflammation
fibrosis
duct strictures
loss of parenchyma
tumours of pancreas
ductal carcinoma (85%) acinar carcinoma neuroendocrine tumours
marker of neuroendocrine tumours
chromogranin
most common site of pancreatic ductal carcinoma
head of pancreas
asthma histology
charcot leyden crystals airway remodelling smooth muscle hypertrophy goblet cell hyperplasia eosinophilia
COPD histology
neutrophil infiltration into airways
loss of alveoli, elastic fibres, lung parenchyma
bronchiectasis histology
dilated fibrotic airways with mucous plugging
diffuse alveolar damage due to adult/neonatal RDS
1) histology
2) CXR
1) exudative inflammatory reaction
2) white out of all lung fields on CXR
pulmonary oedema histology
1) acute
2) chronic
1) intra alveolar fluid
2) IRON LADEN MACROPHAGES (indicated heart failure), fibrosis
small cell lung cancer histology
oat cells
found centrally near bronchi
paraneoplastic syndrome assoc. w/ lung sqcc
hypercalcaemia of malignancy
papillary thyroid cancer histology
psammoma bodies
orphan annie eyes
optically clear nuclei
intranuclear bodies
medullary thyroid cancer cells
parafollicular C cells
osteosarcoma histology
found in adolescence
“sarcastic fisherman’s son”
elevated periosteum –> codman’s triangle + sunburst appearance
Ewing’s sarcoma histology
found in children
in long bones + pelvis
sheets of small round cells –> onion skin appearance of periosteum
chondrosarcoma histology
malignant chondrocytes (cartilage formation) fluffy calcification
giant cell histology (in bone malignancy)
20-40yo female
osteoclast-type multinucleate giant cells
lytic lesions
enchondroma
cotton wool calcification
osteoid osteoma
adolescent males
proximal femur
Bull’s eye sign on XR
bone pain at night, relieved by aspirin
osteochondroma
cartilage capped bony outgrowth –> mushroom like appearance on XR
Albright syndrome
fibrous dysplasia
precocious puberty
cafe au lait spots
fibrous dysplasia
chinese letters
soap bubble ostolysis
shepherd’s crook deformity
mucinous cystadenocarcinoma
pseudomyxoma peritonei
serous cystadenocarcinoma
psammoma bodies
brenner tumour
benign
coffee bean nuclei
endometrial cancer type 1 vs type 2
type 1 - more common, oestrogen dependent, younger patients, assoc. w/ atypical endometrial hyperplasia
type 2 - oestrogen independent, older patients, assoc. w/ atrophic endometrium
granulosa cell tumour
produces oestrogen, causing precocious puberty / endometrial hyperplasia
cal exner bodies
yolk sac tumour
produces AFP
schiller duval bodies
dysgerminoma
assoc. w/ Turner’s
secretes HCG + LDH
what is duct ectasia
perimenopausal women
benign
milk ducts dilate + are inflamed + walls thicken –> ducts blocked –> fluid build up
nipple discharge, pain, mass
duct ectasia discharge cytology
proteinaceous material + inflammatory cells
intraductal papilloma
bloody discharge
benign
what gives good/bad prognosis in breast cancer
ER/PR +ve = good prognosis as responds to tamoxifen
HER2 +ve = poor prognosis
invasive breast ductal carcinoma histology
big, pleomorphic cells that move into stroma
invasive breast lobular carcinoma histology
cells in single file chains
prinzmetal angina cause
coronary artery spasm
uncommon!
complications of MI
DARTH VADER Death Arrhythmia Rupture Tamponade Heart failure
Valve disease Aneurysm Dressler syndrome Embolism Recurrence
dilated cardiomyopathy histology
loss of myocytes
MI histology <6h
normal histology
MI histology 6-24h
loss of nuclei, homogenous cytopasm, cell necrosis
MI histology 1-4d
polymorphs + macrophages clear debris
MI histology 5-10d
further removal of debris
MI histology 1-2 weeks
rebuilding - granulatino tissue, new blood vessels, collagen synthesis
MI histology weeks-months
scar tissue formation
Which enzyme, synthesised by the pancreas, is most sensitive for the diagnosis of pancreatitis?
lipase
most common malignancies in women
breast lung bowel uterus other
most common malignancies in men
prostate lung bowel head and neck other
flow murmur
soft, sytolic murmur heard best at left lower sternal edge
found in hyperdynamic circulations - pregnancy, anaemia, severe blood loss
Kimmelstiel Wilson nodules
found in kidneys
associated with diabetes
benign familial haematuria inheritance pattern
autosomal dominant
most common cancer in UK
breast cancer
most common renal tumour
renal cell carcinoma (clear cell, papillary, chromophobe)
biomarker for hepatic ischaemia
raised ALT
What is the cancer with the highest mortality in the UK?
lung cancer
aschoff bodies
acute rheumatic fever
most common type of small cell lung cancer in UK
+ 2nd most common
most common = adenocarcinoma, then sqcc
gleason scoring system for prostate cancer
first number = most common cell type seen
second number = most aggressive cell type seen
crescent shaped mass underlying the left parietal bone on CT
subdural haemorrhage
waxy casts
chronic kidney disease
muddy casts + epithelial casts
acute tubular necrosis
white cell casts
acute interstitial nephritis
tx for human tapeworms
praziquantel
sinusitis abx
phenoxymethylpenicillin
haemophilus ducreyi
causes multiple painful necrotising genital ulcers + inguinal lymphadenopathy
argyll robertson pupil
pupil accmmodates but does not react to light
found in late stage syphillis
malaria species with tertian fevers vs quartan fevers
tertian fever (every 2 days) = P. falciparum, P. vivax, P. ovale quartan fever = P. malariae
halo sign
on CT = aspergillus
on CSF = cryptococcus
sx of severe malaria
parasitaemia > 2%, altered consciousness, met acidosis, organ failure, resp distress, circulatory collapse
infectious mononucleosis on blood film
atypical lymphocytes
Maurer’s clefts
p. falciparum invades RBCs + forms disc like granulations that can be seen on thin blood film
Takotsubo’s cardiomyopathy
triggered by intense emotional/physical stress
looks like MI
extradural haemorrhage
middle meningeal artery
alport’s syndrome inheritance pattern
X-linked
alport’s triad
nephritic syndrome
sensorineural hearing loss
cataracts
adult polycystic kidney disease mutation
defect in polycystin 1
high anion gap suggests…
presence of ketones
antifungal groups
polyenes azoles allylamines echinocandin pyrimidine analogue
polyenes function + eg
inhibits ergosterol function
(polly says, “I just can’t function, B!” cos she just saw the guy with the nice smile)
e.g., amphotericin B, nyastatin
azoles function + eg
inhibits ergosterol synthesis, e.g., fluconazole
echocandins function + eg
inhibits cell wall synthesis, e.g., caspofungin
allylamines function + eg
inhibits ergosterol synthesis, e.g., terbinafine
pyrimidine analogue function + eg
inhibits DNA/RNA synthesis, e.g., flucytosine
metabolic acidosis, high anion gap but low glucose + no ketones?
think lactic acidosis
14-3-3 protein indiciates…
rapid neuro degeneration
what should diabetics do when ill
continue insulin regimen as usual
more regular monitoring of blood glucose + urinary ketone levels
if struggling to eat, may need sugary drinks
diabetic drug that can help with weight loss
sulphonylureas (eg gliclazide)
examples of the following antidiabetic drugs: GLP-1 mimetics DPP4 inhibitors SGLT2 inhibitors sulphonylureas Thiazolidinediones
GLP-1 mimetics = -tide DPP4 inhibitors = -gliptin SGLT2 inhibitors = -flozin sulphonylureas = gliclazide Thiazolidinediones = pioglitazone
Brucella ix
blood/pus culture on castenada medium
toxoplasmosis ix
sabin feldman dye test
negri bodies on neural cells
rabies
gold standard test for leptospirosis
microscopic agglutinnation test
hantavirus
acquired from contact with mice/rat urine/droppings
causes hantavirus pulmonary syndrome / renal failure or bleeding
hypoglycaemia, low insulin, low c peptide, low FFAs, low ketones
non-pancreatic neoplastic tumours (e.g., mesothelioma, fibroblastoma, carcinoma) producing IGF-1 that is binding to insulin receptors + triggering glucose uptake
hypoglycaemia, low c peptide, high FFAs, low ketones
inborn errors of metabolism
nesidioblastosis
excessive function of pancreatic beta cells –> hyperinsulinaemic hypoglycaemia
Waterhouse Frierichsen syndrome
meningococcal infection –> bleeding into adrenal gland –> adrenal failure
HAP tx
ciprofloxacin + vancomycin
HAP examples
staph aureus
klebsiella
pseudomonas
e coli
hospital acquired UTI tx
cefalexin/augmentin
Hashimoto’s
herthle cells
alpha glucosidase inhibitors
inhibit absorption of glucose in small bowel
e.g., acarbose
raised reticulocytes indicates…
reticulocytes = immature RBCs
there is an increased demand for bone marrow to produce RBCs so it sends RBCs out before they are mature
CMV retinitis
seeing small specks / visual floaters
Familial mediterranean fever Mx
1) colchicine
2) anakinra (IL-2 inhibitor)
3) etanercept (TNF alpha inhibitor)
Kostmann’s mutation
HAX1 mutation
cyclical neutropenia mutation
mutation in neutrophil elastase
Chagas disease
spread by reduviid bugs
in South America
causes general flu sx, swollen eyelids, enlarged spleen/liver/lymph nodes
acute phase proteins that cause fever
IL-1
IL-6
polyarteritis nodosa is assoc. w/ which virus?
hep B
chronic granulomatous disease - increased susceptibility to…
infection due to catalase positive organisms, e.g., e coli, staph aureus, listeria, klebsiella
SIADH tx
fluid restrict tx cause demeclocycline (increases ADH resistance) tolvaptan (ADH receptor antagonist)
nephrogenic DI tx
thiazide diuretics
why does taking loop diuretics/Bartter’s syndrome lead to hypokalaemia?
inhibits Na/K/Cl transporter so less Na is reabsorbed + therefore more Na is delivered distally + then reabsorbed –> negative charge in lumen –> K is excreted via ROMK channels to balance out charge –> hypokalaemia
why does taking thiazide diuretics lead to hypokalaemia
inhibits Na/Cl symporter in DCT –> less Na reabsorbed, more Na delivered distally, more Na reabsorption –> negative charge in tubule –> more K excretion from ROMK channels
Schmidt’s
hypothyroidism + addison’s
DEXA score for osteoporosis
< -2.5
DEXA score for osteomalacia
between -1 and -2.5
Gilbert’s syndrome defect
deficiency in UDP glucoronyl transferase (enzyme that is needed to conjugate bilirubin)
familial benign hypercalcaemia
defective calcium sensing receptor on parathyroid glands –> parathyroid cannot detect calcium –> release lots of PTH even though Ca is normal
how to differentiate between primary PTH and FBH
calcium : creatinine clearance ratio is lower in FBH
micronodular cirrhosis
alcoholic cause
biliary tract disease
indications for dialysis
metabolic acidosis uraemia sx (encephalopathy, nausea, malaise, pruritis), fluid overload, hyperkalaemia, CKD stage 5
Peutz jegher syndome
freckling around mouth
hyperpigmentation of mucosa
multiple hamartous polyps
bisphosphonates MoA
cause apoptosis of osteoclasts
pseudohypoparathyoidism biochemical results
resistance to PTH
high PTH, low Ca, high phosphate
pseudopseudohypoparathydoism
features of Albright’s syndrome but normal biochemical results + no PTH resistance
macrophages in liver
kupffer cells
macrophages in kidney
mesangial cells
macrophages in bone
osteoclasts
macrophages in neural tissue
microglia
macrophages in skin
langerhans cells
all T cells express…
CD3
what kind of receptor do dendritic cells and polymorphs express to bind to immune complexes
Fc receptors which bind to antigens that are bound to antibodies
what is deficient in leukocyte adhesion deficiency
CD18
required to bind to ICAM1 via LFA-1 (CD11a, CD18
deficiency of IL-12 or interferon gamma increases your susceptibility to…
mycobacteria
deficiency of this complement can result in SLE…
C2
Wiskott aldrich syndrome sx + biochemical results
eczema + immunodeficiency + thrombocytopenia
defect in WAS gene
low IgM, high IgA, high IgE
complement deficiency makes you susceptible to…
encapsulated bacteria, unable to make MAC!
ADA deficiency
enzymes in lymphocytes required for cell metabolism –> unable to respond to cytokines –> early arrest of T cells, NK cells, B cells!
X linked SCID biochemical results
low T cells + NK cells
but NORMAL/HIGH B cells
salmonella typhi tx
IV ceftriaxone + PO azithromycin
cryoprecipitate vs FFP
FFP = equal concentration of clotting factors to blood, contains all factors cryoprecipitate = more concentrated source, contains vwf, VIII, XIII, fibrinogen
relative polycythaemia
raised red cell mass but reduced plasma volume
eg burns, dehydration, diarrhoea, vomiting, smoking, diuretics
rivaroxaban, apixaban, edoxaban
DOACs
anti-Xa
multiple myeloma sx
Calcium high
Renal failure (+ amyloidosis, nephrotic syndrome)
Anaemia (+ pancytopenia)
Bones (pain, fractures, osteolytic lesions)
Hyperviscosity syndrome
Ann arbor staging
stage 1 = 1 LN group
stage 2 = 2 LN groups on the same side of the diaphragm
stage 3 = 2 LN groups on opposite sides of diaphragm
stage 4 = extranodal spread
type of necrosis assoc. w/ MI
coagulating necrosis
most common ovarian tumour
serous cystadenoma
nasopharyngeal carcinoma is assoc. w/ which virus?
EBV
most common type of glial cell in CNS
astrocyte
most common skin cancer
basal cell carcinoma
hormone released by adipose tissue + sends signals to hypothalamus
leptin
hepatitis B tx
interferon alpha nuceloside analogues (-vudines, -avirs, -ovirs), e.g., lamivudine, telbivudine, tenofovir, entacevir)
hepatitis c tx
interferon alpha
NS3/4 inhibitors (-previrs)
NS5a inhibitors (-asvirs)
direct polymerase inhibitors (-buvirs)
most common type of CJD
sporadic
pyrin
found in neutrophils
major role in regulating inflammation
defect –> unregulated activation of neutrophils
how does colchicine work in familial mediterranean fever
colchicine binds to tubulin in neutrophils + disrupts function
nikolsky sign
when bullae rupture easily, as seen in pemphigus vulgaris
globin chain composition in HbA, HbA2, HbF
HbA - 2 alpha, 2 beta
HbA2 - 2 alpha, 2 gamma
HbF - 2 alpha, delta
beta thalassemia sx
skull bossing
maxillary hypertrophy
hairs on end on skull XR
paroxysmal cold haemoglobinuria
viral illness –> donath landsteiner antibodies which bind + hemolyse RBCs when it is cold –> haemoglobinuria + DAT +ve
complement mediated haemolysis on rewarming
paroxysmal nocturnal haemoglobinuria
DAT -ve
complemented haemolysis of RBCs, happens usually at night
what is activated protein C complex made up of
protein C + thrombomodulin + thrombin
what happens after platelets bind to collagen/vwf
release ADP / thromboxane A2 –> platelet aggregation
what happens after platelets bind to collagen/vwf
platelets release ADP / thromboxane A2 –> triggers expression of glp2b/3a on surface of platelets –> allows binding to fibrinogen –> platelet aggregation + activation
Tx after splenectomy
vaccinations
daily penicillin lifelong
rapidly progressive glomerulonephritis on light microscopy
crescents
types of rapidly progressive glomerulonephritis
Type 1 - Goodpasture’s, linear deposition
Type 2 - immune complex mediated, granular deposition, eg SLE
Type 3 - pauci immune, scanty deposition, eg wegener’s, microscopic granulomatosis
ergocalciferol
inactivated vit D obtained from diet
cholecalciferol
inactivated vit D obstained from sunlight
calcitriol
activated vit D
ix in haem malignancies
immunophenotyping to identify antigens + differentiate between myeloid/lymphoid
FISH/cytogenetic analysis/molecular genetic analysis to identify mutations
APML features + fusion gene
basically AML + DIC features (eg low fibrinogen)
Auer rods + myeloid blast cells
PML-RARA fusion gene t(15;17)
sx of hyposplenism on blood flm
Howell jolly bodies
target cells
pseudomonas tx
ciprofloxacin + gentamicin
human rights - article 2
right to life - absolute, eg right to life saving tx, right to withdraw futile tx
human rights - article 3
prohibition to torture - absolute, eg excessive restraint, failure to stop suffering, non-consensual tx
human rights - article 5
right to liberty - relative, eg detention only lawful under MHA/DoLs + patient must be able to appeal
human rights - article 8
right to a private life - relative, eg right to confidentiality, right to refuse tx
PUO definition
temp > 38.3 for >3 weeks
ethics - what happens after someone dies
doctors verifies death, notifies consultant, fills in death certificate. Doctor then discusses cause of death with medical examiner.
If they are in agreement, they can either complete medical certificate of cause of death (MCCD) or complete a consented autopsy if family request it.
If cause of death is uncertain, refer to coroner, who will either complete MCCD or request an autopsy without familial consent.
effect of C botulinum on body
blocks Ach from peripheral nerves –> descending paralysis
CAR-T cell therapy indicated in…
Non-Hodgkin’s lymphoma
ALL
how does ipilimumab work
T cells have stimulatory receptors CD28 + inhibitory receptors CTLA4. which compete with one another to bind to CD80/86 on APCs. Ipilimumab binds to CTLA4 + blocks them from binding to CD80/86 –> only stimulatory receptors can bind –> activation + proliferation of T cells = IMMUNE BOOST!
how do pembrolizumab/nivolumab work
PD-1 = receptor on T regulatory cells. PD-1 binds to its ligands PDL-1 & PDL-2, which are found on surface of tumour cells + NK cells. Binding inhibits + inactivates T cells.
HOWEVER, pembrolizumab/novolumab binds + blocks PD-1, stopping binding to its ligands –> prevents inhibition + inactivation of T cells –> IMMUNE BOOST!
cyclophosphamide MoA
antiproliferative agent
alkylates guanine
mycophenolate MoA
antiproliferative agent
inhibits de novo guanosine synthesis
azathioprine MoA
antiproliferative agent
inhibits de novo purine synthesis
test for paroxysmal noctural haemoglobinuria
HAM test
what does protein C do
binds to protein S + inhibits factors 5 & 8
Ethics death - When is consent required from family for an autopsy
when autopsy is done for research/educational purposes or when the cause of death has been agreed between doctor + medical examiner but family requests an autopsy anyway
Ethics death - When is consent not required from family for an autopsy
when cause of death is uncertain/suspicious/sudden/suicide/violent/not seen by doctor in last 28d/death under custody or MHA
human tissue act - who has priority when consenting to examination/removal/storage of dead body
1) patient before death
2) nominated rep
3) someone of qualifying relationship to patient (partner>parent>children>sibling>grandparent/grandchild>niece/nephew>step parents>half sibling>longstanding friend
human tissue act - who has priority when consenting to examination/removal/storage of dead body
1) patient before death
2) nominated rep
3) someone of qualifying relationship to patient (partner>parent>children>sibling>grandparent/grandchild>niece/nephew>step parents>half sibling>longstanding friend
how do PCSK9 inhibitors work?
PCSK9 normally degrades + downregulates the LDL receptors –> reduced uptake of LDL by the liver
inhibition of PCSK9 –> more LDL uptake + removal from blood
eg evolocumab
what happens when T cells + APCs bind
calcineurin is released –> stimulates release of IL-2 (important in activation of naive T cells + proliferation)
sirolimus
mTOr inhibitor –> inhibits IL-2 pathway –> inhibits activation of naive T cells + proliferation following binding to APCs
tofacitinib
JAK1/3 inhibitor –> inhibits production of inflammatory molecules
abatacept
opposite of ipilimumab
= CTLA4 analogue which binds to CD80/86 on APCs –> induces inhibitory effect –> suppression of T cells
used in rheumatoid arthritis
osteoprotegrin
osteoprotegrin is usually produced by osteoblasts to bind to RANKL –> prevents binding of RANKL to RANK receptor on osteoblasts
MGUS
basically what happens before multiple myeloma
NO CRAB Sx
<10% clonal plasma cells, <30g/l M spike
Multiple myeloma tx
1) alkylating agents (cyclophosphamide)
2) proteasome inhibitors (inhibits proteasome which is an enzyme that is able to degrade abnormal proteins in plasma cells; inhibition allows accumulation of abnormal proteins + cell death)
3) immune modulators
4) monoclonal antibodies
Pre-renal causes of AKI
sepsis hypotension dehydration (D+V) haemorrhage oedema renal artery stenosis drugs (NSAIDs, ACEi, diuretics, calcineurin inhibitors)
Castleman’s disease
excess IL-6 produced –> lots of proliferation of B and T cells in lymph nodes
Mucormycosis
fungal infection found in immunocompromised + poorly controlled diabetes
DUE TO RHIZOPUS SPECIES
sx = blackened skin, blisters, fever, ulcers, swelling, redness
sideroblastic anaemia
excess iron in the body but unable to incorporate the iron into Hb to produce RBCs
high iron, high ferritin, normal/high transferrin, normal TIBC
washed blood
washing blood to get rid of plasma/platelets/wbcs in patients who have had a severe allergic reaction before
cell salvage
collecting blood that is lost during a major surgery, filtering, then reinfusing back into patient
emergency blood transfusion blood group
O- (no antigens available for recipient to have an immune response)
reactivation of virus following transplant
EBV
scarlet fever causative organism
group A strep (streptoccocus pyogenes)
CLL tx
ibrutinib
what organism is likely to cause bronchiectasis + what is assoc. w/ longstanding bronchiectasis
1) staph aureus
2) pseudomonas aeruginosa
Pretransplant immunosuppressants
alemtuzumab
basiliximab (anti-CD25)
ATG (anti-thymocyte globulin)
Posttransplant immunosuppressants
steroids
anti-proliferatives (eg mycophenelate, azathioprine)
calcineurin inhibitors (eg tacrolimus, cyclosporin)
acute cellular rejection of transplant tx
steroids
ATG
acute antibody-mediated rejection of transplant tx
IVIG
plasmapheresis
rate limiting step in heme biosynthesis pathway
ALA synthase
rate limiting step in salvage pathway for purine synthesis
HGPRT
Lesch Nyhan syndrome
deficiency in HGPRT –> hyperuricaemia –> severe childhood gout, renal impairment, self mutilating behaviour
P-amylase
pancreatic amylase
S-amylase
salivary amylase
high aldosterone + high renin
renal artery stenosis
which liver enzyme is raised in cocaine use
AST
what stimulates + inhibits prolactin
TRH stimulates
dopamine inhibits
what to give after pituitary adenoma removal surgery
replace cortisol –> give hydrocortisone
may give desmopressin if resulting central DI
most common type of CAH
21 hydroxylase deficiency
beta lactam with anti-pseudomonal activity
ceftazidime
diphtheria
highly contagious
affects nose, throat, skin, fever, swollen LNs
thick grey film over throat –> sore throat, breathing difficulties
tetanus
lock jaw
painful muscle spasms
salmonella typhi tx
IV ceftriaxone + PO azithromycin
herd immunity threshold definition
the proportion of immune people in a population that is needed to stop spread of pathogen
characteristics of influenza A that could cause pandemic
novel antigenicity
efficient transmission between people
efficient replication within airway
most common cause of cellulitis
streptococcus pneumoniae
etanercept
TNF alpha inhibitor
used in rheumatoid arthritis, ank spond, psoriasis
causes of hypovolaemic hyponatremia
dehydration
burns
salt losing nephropathy
Bartter’s
low serum Na but normal osmolality
alcohol, lipids, paraproteins also present in serum
dabigatran
inhibits thrombin
ddx of anaphylaxis
urticaria
hereditary angioedema
ACEi induced angioedema
acute anxiety
heparin MoA
potentiates antithrombin
sudden chest pain radiating to neck
left anterior descending artery thrombus
secondary causes of nephrotic syndrome
diabetes
amyloidosis
abdo pain radiating to back, collapse + death
acute aortic aneurysm
causes of raised anion gap metabolic acidosis
Ketones (DKA)
Uraemic (renal failure)
Lactic acidosis (metformin)
Toxins (ethylene glycol, methanol, salicylates)
why is LDH raised in haemolytic anaemia
LDH is found intracellularly so is released when RBCs are haemolysed
giving a baby with RDS too much O2 can lead to…
retinopathy
acute intermittent porphyria
autosomal dominant
neurovisceral sx only (peripheral neuropathy, painful abdomen, seizures)
deficiency of HMB synthase
porphyria cutanea tarda
cutaneous sx only
deficiency of uroporphyrinogen decarboxylase
most common cause of hypothyroidism in UK
primary atrophic hypothyroidism
how does papillary thyroid cancer spread
via lymph nodes
how to prevent gvhd
irradiation to remove donor lymphocytes
post-thrombotic syndrome
swelling and chronic pain in the same location in the weeks-months following DVT
where is thrombomodulin found + what does it do
found on endothelium
binds to thrombin + protein C to form activated protein C complex, which then binds to protein S to then inhibit factors 5 + 8
virus assoc. w/ adult T cell lymphoma
HTLV1
Waldenstrom’s macroglobinaemia (lymphoplasmacytoid lymphoma)
elderly men
increased monoclonal IgM
weight loss, fatigue, hyperviscosity
transfusion reactions - immediate within mins
anaphylaxis
transfusion reactions - mins to hrs
bacterial contamination
ABO incompatibility
febrile non-hemolytic transufsion reaction
transfusion reactions - within several hrs (<6h)
TRALI
TACO
transfusion reactions - delayed >24h
delayed haemolytic transfusion reaction
GvHD
haemostasis process
1) endothelial injury
2) von williebrand monomers bind + catch platelets
3) platelets bind + aggregate
4) platelets held together by fibrinogen
5) coagulation cascade to produce thrombin, which then activates fibrinogen + converts it into fibrin
6) fibrin stabilises platelet plug –> clot formation
regulators of coagulation
tissue factor pathway inhibitor
antithrombin
protein C/S
vwd mx
desmopressin
factor 8 + vwf concentrates
vwd types
Type 1 - quantitative defect
Type 2 - qualitative defect
Type 3 - complete absence
glanzmann’s thrombasthenia
defect in glp2b/3a –> no platelet aggregation
why is there an initial procoagulant state with warfarin
first inhibits protein C/S so initially causes a procoagulant state due to less inhibition by protein C/S
factor V Leiden
resistance to protein C/S –> less inhibition of factor 5 + 10 –> excess factor 5 –> more prone to thrombosis
most common prothrombotic disorder
which disorder of thrombosis carries the highest risk of thrombosis
antithrombin deficiency
most common thrombotic disorder
factor V Leiden
anaemia definition in men + women
<135 in men
<115 in women
iron studies in iron deficiency anaemia
low iron
low ferritin
high transferrin
high TIBC
iron studies in sideroblastic anaemia
high iron
high ferritin
high transferrin
normal TIBC
iron studies in anaemia of chronic disease
high iron
high ferritin
low transferrin
low TIBC
sx of intravascular haemolysis
high serum LDH
low haptoglobin
dark urine
sx of extravascular haemolysis
increased splenic consumption therefore:
spherocytes
splenomegaly
urobilinogen in urine
G6PD on blood film
bite cells
Heinz bodies
anaemia of chronic disease
longstanding inflammation –> inflammatory cytokines inhibits hepcidin –> inhibits ferroportin in liver + Fe absorption in gut –> less Fe released from stores –> body is unable to use iron + make RBCs
autoimmune haemolytic anaemia mx
tx underlying cause
steroids
rituximab
how many genes for alpha globin and beta globin synthesis
4 genes for alpha globin
2 genes for beta globin (homozygous, heterozygous, intermedia)
Hb Barts
no alpha globin chains
incompatible with life –> hydrops fetalis + death in utero
HbH
1 alpha gobin chain out of 4
severe anaemia in childhood
alpha thalassemia trait
mild anaemia
HbAS
sickle cell trait
HbSS
sickle cell anaemia
key features in sickle cell anaemia (4)
haemolytic crisis
aplastic crises
sequestration crises
infection
sickle cell anaemia mx
vaccinations
daily penicillin
when is a pregnant woman most at risk of VTE
post-partum
gvhd tx + prevention
tx - steroids + ciclosporin (calcienruin inhibitor)
prevention - methotrexate + ciclosporin
bone marrow failure dx
hypocellular + fatty bone marrow biopsy
beta globin gene
Chr 11
alpha globin gene
Chr 16
why do you get splenomegaly in sickle cell anaemia
vessels in spleen occluded repetitively over time –> fibrosis + calcification –> pooling of blood in spleen –> spleen gets bigger
hand-foot syndrome
red bone marrow exists not only in axial skeleton in kids but also in hands + feets –> may have sequestration of sickle cells in small vessels in hands/feet –> occlusion –> necrosis
warm autoimmune hemolytic anaemia
antibodies activated in room temp
IgG mediated (warm in Greece)
SLE, CLL
cold autoimmune hemolytic anaemia
antibodies activated in cooler temp
IgM mediated (cold in Moscow)
EBV, mycoplasma, hep C
ANA vs anti-dsDNA in SLE
ANA is more sensitive but less specific than anti-dsDNA
most common primary tumour of heart
myxoma
most common cause of constrictive pericarditis in developing world
tuberculosis
what enzyme does allopurinol inhibit
xanthine oxidase
cause of hypercalcaemia in sarcoidosis
lung macrophages produces 1 alpha hydroxylase
mumps causative organism
mumps orthorubulavirus
Which hepatitis virus is associated with more severe disease if acquired in pregnancy potentially leading to fulminant hepatic failure and death?
hepatitis E
anti thymocyte globulin
thymocyte (lymphocytes from thymus) isolated
injected into rabbit
rabbit forms antibodies against human lymphocytes
antibodies extracted + infused into human –> non-specific immune response against lymphocytes
(given as a pretransplant immunosuppressant)
anti thymocyte globulin
thymocyte (lymphocytes from thymus) isolated
injected into rabbit
rabbit forms antibodies against human lymphocytes
antibodies extracted + infused into human –> non-specific immune response against lymphocytes
(given as a pretransplant immunosuppressant)
muscle weakness, ptosis, sx get worse with exercise, sx improve with tensilon injection
myasthenia gravis
features of myelodysplastic syndrome
cancer where blood cells in bone marrow are poorly formed / don’t work properly, risk of AML transformation
1) BM failure + cytopenia (= infection, bleeding, fatigue)
2) hypercellular BM
3) DEFECTIVE CELLS:
ringed sideroblasts, hypogranular WBC, hyposegmented neutrophils (Pseudo pelger Huet anomaly), micromegakaryocytes
<20% blasts
what do all T cells express
CD3+
Fanconi anaemia
pancytopenia
cafe au lait spots
abnormal thumbs
short stature
Diamond-Blackfan anaemia
red cell cytopenia
Shwachman-Diamond syndrome
neutropenia
pancreatic dysfunction
Dyskeratosis congenita
pancytopenia
nail dystrophy
skin hyperpigmentation
oral leukoplakia
most sensitive biomarker for IDA
ferritin but will be falsely raised in inflammation
tx of DVT
DOAC
warfarin preferred in profound renal failure (as it is not renally cleared)
richter’s transformation
CLL to high grade lymphoma
tumour lysis syndrome
when chemotherapy is started –> rapid lysis of tumour cells –> release of intracellular contents –> renal failure, arrhythmia, death
mx to reduce risk of tumour lysis syndrome
IV allopurinol or rasburicase to reduce hyperuricaemia
heparin induced thrombocytopenia
body has an immune response to heparin. antibodies are formed against heparin when it is bound to platelet factor 4 –> activates platelets & forms clots, + splenic removal of complexes –> thrombocytopenia
tumour lysis syndrome changes in electrolytes
drop in Ca
rise in urea, PO4, K
Burkitt’s Lymphoma translocation
t(8;14) cmyc
14 for lymphoma, 8 for the age when Burkitt’s lymphoma is more common
Mantle cell lymphoma translocation
t(11;14)
14 for lymphoma
follicular lymphoma translocation
t(14;18)
14 for lymphoma
BCL2
protein that inhibits cell apoptosis
most common cause of B12 deficieny in UK
pernicious anaemia
Burkitt’s lymphoma presentation in sporadic UK form vs endemic African form
sporadic UK form = abdominal/inguinal lymphadenopathy
endemic African form = massive submandibular swelling, cervical lymphadenopathy
deranged LFTs + acidosis
acidosis is late sign + generally indicates need for liver transplant
tuberous sclerosis
autosomal dominant
ash leaf spots on skin
tumours + cysts growing in multiple organs, especially CNS, kidney, eg rhabdomyoma, angiomyolipoma, retinal harmatoma
infantile spasms
what has better prognosis IgH mutated or IgH unmutated CLL
IgH mutated as it means the B cells have undergone somatic hypermutation + more mature and developed –> better prognosis
A patient is admitted to The Emergency Department after severe trauma and blood loss. Without time for blood ABO grouping, he required emergency resuscitation with red cells and fresh frozen plasma. What blood group plasma should be used?
AB
von hippel lindau
hemangioblastoma of cerebellum, brainstem and spinal cord, retina;
renal cysts, pheochromocytomas
isolated raised bilirubin with no other complications
Gilbert’s syndrome
normal pH, low pCO2, low bicarb
mixed resp alkalosis + met acodisos –> aminosalicylate overdose
What is the maximum number of HLA class I mismatches that may occur if a parent acts as a kidney donor for a child?
parent + child always have at least 3 matches so can only have mismatches in max 3
Which cytokine could be targeted to improve disease control in ank spond?
tnf alpha
cryptococcus antigen test
glucuronoxylomannan
Which cytokine is key in promoting the development and terminal differentiation of eosinophils
IL-5
which helminth is able to undergo autoinfection in the intestines
Strongyloidiasis stercoralialis
normal anion gap
14-18
carbimazole side effects
carbimazole used in hyperthyroidism
agranulocytosis + neutropenia
hereditary angioedema
autosomal dominant
C1 esterase inhibitor deficiency –> recurrent attacks of oedema –> resp distress, abdo pain
causes of microcytic anaemia
TAILS Thalassemia trait anaemic of chronic disease iron deficiency anaemia lead poisoning sideroblastic anaemia
toxic left shift
immature neutrophils released from bone marrow, typically due to severe infection/inflammation
Superoxide dismutase 1 is a misfolded protein associated with which condition?
motor neuron disease
most common causative organism of bronchial pneumonia
haemophilus influenzae
most common causative organism of lobar pneumonia
strep pneumoniae
what does a neutrophil look like
multilobed nucleus (looks like it has 3 parts to it)
most common liver malignancy
secondary cancer!! metastatic adenocarcinoma
zollinger ellison tumour
gastrin secreting tumour
what does the following indicate:
Flow cytometry is carried out and reveals 82% of the proliferated lymphocytes express kappa chains, and 0% express lambda chains.
light chain restriction which indicates monoclonal B cell proliferation –> malignancy
polycythaemia rubra vera tx
hydroxycarbamide –> reduces bone marrow activity
aetiology of febrile non-haemolytic transfusion reactio
cytokines in donor plasma cause inflammatory reaction
A kidney biopsy shows thickened glomerular capillary loops (a wire loop appearance)
Which disease is this suggestive of?
SLE
immune complex deposition –> thickening
endoemtrial cancer FIGO staging
stages
1) confined to uterus
2) + cervix
3) + spread to fallopian tubes/ovaries/vagina/local lymph nodes
4) distant spread
Tazobactam
beta lactamase inhibitor given alongside piperacillin
beta lactam that is not sensitive to beta lactamase
flucloxacillin
(Benzylpenicillin, piperacillin, and amoxicillin are all antibiotics of the penicillin class which are sensitive to beta-lactamase)
EPO in polycythaemia vera vs secondary polycythaemia
polycythemia vera = EPO low due to suppression
secondary polycythaemia = EPO high
fibrinogen in dic
low
mallory denk bodies
= intracytoplasmic inclusions in hepatocytes made up of damaged intermediate filaments
barium examination string sign
Corhn’s
biochemistry for renal failure (secondary hyperparathyroidism)
low Ca
high PTH
high phosphate due to excretion failure
why is there a drop in Hb in CLL
folate / B12 deficiency
1 unit of RBCs causes an increment of what in Hb
Hb 10
1 unit of platelet gives an increase of what in platelets
platelets 35
how does removing donor T lymphocytes in allogeneic haematopoietic SCT have an impact on incidence of GvHD + rate of leukaemia relapse
reduces risk of GvHD
increases risk of leukaemia relapse (donor lymphocytes fight tumour cells + have anti-tumour effect)
haemorrhagic testicular infarction process
venous occlusion
exophytic fronded lesion on cystoscopy
papillary urothelial carcinoma
why should you not give ACEi in renal artery stenosis
causes constriction of efferent arteriole + makes renal artery stenosis worse
which enzyme do you expect to be raised in dermatomyositis
CK
Alum MoA as an adjuvant for vaccination
promotes B cell differentiation
antibodies in ank spond
NONE
bacillus cereus mx
none, supportive
fibrinogen in DIC
low
streptobacillus moniliformis
rat bite fever
atypical pneumonias
legionella
chlamydia pneumoniae
chlamydia psittica
mycoplasma pneumoniae
what does covid target
ACE2
which component of the covid virus do vaccines target
spike proteins
rheumatoid arthritis tx
TNF alpha inhibitors (infliximab, adalimumab, certolizumab, golimumab)
Tocolizumab (anti IL 6)
Tofacitinib (JAK1/3 inhibitor)
psoriatic arthritis tx
secukinumab (anti IL 17)
ustekinumab (anti IL 12/23)
ank spond tx
secukinumab (anti IL 17)
ustekinumab (anti IL 12/23)
TNF alpha inhibitors
organism that causes diphtheria
corynebacterium diphtheriae
fibrinoid necrosis
vascular damage that occurs due to infection/immune complex deposition/autoimmunity
schistosomiasis causes what cancer
squamous cell carcinoma in bladder
osteoarthritis
Degenerative joint disease mainly affecting vertebrae, hips and knees. May see Heberden’s nodes
(DIPJ) and Bouchard’s nodes (PIPJ)
X-Ray features = LOSS = loss of joint space, osteophytes, subchondral sclerosis, subchondral cysts
rheumatoid arthritis
symmetrical arthritis
Used to treat severe ankylosing spondylitis not controlled by NSAIDs
Etanercept
