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Essie Year 5 > Path > Flashcards

Path Flashcards

1
Q

Which medication is gold standard for the treatment of MSSA?

A

Flucloxacillin IV

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2
Q

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?

A

Human Cytomegalovirus

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3
Q

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?

A

Varicella zoster virus

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4
Q 
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
A

saquinavir

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5
Q

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?

A

Reduviid bugs

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6
Q

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?

A

rhodanine

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7
Q

What is the most common cause of chronic pancreatitis?

A

alcohol

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8
Q

most common benign liver lesion

A

haemangioma

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9
Q

A patient with alcohol related liver disease undergoes a biopsy and is found to have cirrhosis. What is the stage of his liver disease?

A

F4

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10
Q 
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
A

C7 deficiency

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11
Q

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?

A

cyclic neutropenia

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12
Q

young adult presents to clinic with chronic Mycobacterium marinum infection. An NBT test is positive. What is the most likely diagnosis?

A

deficiency of IL12 or IFN gamma or their receptors

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13
Q

dendritic cells that are present in skin

A

langerhans cells

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14
Q

reversible cause of nephrogenic DI

A

hypercalcaemia

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15
Q

causes of hypovolaemic hyponatraemia

A

diuretics, D/V, burns, ascites, Barter syndrome, Addisons

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16
Q

low serum sodium, normal serum osmolality

A

myeloma, paraprotein, lipids, alcohol

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17
Q

most common cause of addison’s worldwide

A

TB of the adrenals

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18
Q

t(9;22) is present in

A

CML and ALL

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19
Q

how does APML present

A

like AML but also with DIC.

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20
Q

how is APML treated

A

all-trans retinoic acid (metabolite of vitamin A)

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21
Q

criteria for smouldering myeloma and multiple myeloma

A

monoclonal antibody > 30g/l, clonal plasma cells >10%

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22
Q

What monoclonal antibody targets IL-17 and is involved in the treatment of psoriasis, psoriatic arthritis and ankylosing spondylitis?

A

secukinumab

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23
Q

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

A

distal interphalangeal joints

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24
Q

What protein is defective in X linked Severe Combined Immunodeficiency?

A

common gamma chain in IL-2 receptor (needed for T cell proliferation)

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25
Q

A mutation in what protein is the most common cause of Hyper IgM syndrome?

A 
CD40
class switching requires activation of CD40 on surface of B lymphocytes to occur
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26
Q

What enzyme, deficient or defective in chronic granulomatous disease, is responsible for the “respiratory burst” that may kill phagocytosed pathogens?

A

NADPH oxidase

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27
Q

Which subtype of T helper cells are implicated in the development of allergic diseases, such as asthma or eczema

A

T helper 2 cells

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28
Q

What monoclonal antibody targets IL-23 and IL-12 and is used in the treatment of psoriasis or psoriatic arthritis?

A

ustekinumab

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29
Q

What lymphocyte lineage does cyclophosphamide predominantly inhibit?

A

B cells

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30
Q

CD3 is typically a marker of what immune cell?

A

T cells

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31
Q

CD14 is typically a marker of what type of immune cell?

A

macrophages

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32
Q

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?

A

serum IgA

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33
Q

What monoclonal antibody targets CD25 and is used in the prophylaxis and treatment of allograft rejection?

A

basiliximab

CD25 is a component of IL-2 receptor

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34
Q

peptide found on surface of all B and T lymphocytes

A

CD52

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35
Q

What monoclonal antibody targets CD52 and causes depletion of all lymphocyte subsets?

A

alemtuzumab

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36
Q

what does AST stand for

A

aspartate aminotransferase

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37
Q

Troisier’s sign

A

when you find Virchow’s node

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38
Q

basophilic stippling is found in…

A

beta thalassemia trait

lead poisoning

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39
Q

What happens in renal tubular acidosis

A

damage to kidneys –> defect in hydrogen ion secretion in renal tubule –> more potassium excretion to balance out increased sodium reabsorption –> hypokalaemia, acidosis

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40
Q

most common type of malignancy in breast

A

invasive ductal carcinoma

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41
Q

fibroadenoma in breast

A

mobile, well circumscribed lump

size fluctuates with menstrual cycles and grows rapidly in pregnancy

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42
Q

African sleeping sickness is transmitted by…

A

tsetse fly

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43
Q

Organisms responsible for acute and chronic infections of Human African trypanosomiasis

A 
acute infection = trypanosoma brucei rhodesiense (r for rapid)
chronic infection (takes months/years for sx to appear) = trypanosoma brucei gambiense
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44
Q

Von Gierke’s disease

A

glycogen storage disorder
unable to convert glycogen into glucose
hypoglycaemia, hepatomegaly, kidney enlargement, floppy

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45
Q

subdural haemorrhage

A

hx of trauma

haematoma is slow to form so takes around 48h for sx of raised ICP to appear –> increasing headache, confusion

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46
Q

galactossaemia

A

newborn with cataracts, poor feeding, lethargy, conjugated hyperbilirubinaemia, reducing sugars in urine

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47
Q

homocysteinuria

A

amino acid disorder, resulting in build up of homocysteine –> fair skin, brittle hair, learning difficulties, convulsions, thrombotic episodes

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48
Q

Fabry’s disease

A

cherry red spot

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49
Q

glucagon

A

stimulates gluconeogenesis in liver

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50
Q

carcinoid syndrome

A

collection of sx due to release of serotonin from neuroendocrine tumour
flushing, palpitations, tachycardia, diarrhoea, loss of appetite
RAISED URINE 5IHAA

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51
Q

Microscopic polyangitis

A

pulmonary haemorrhage + glomerulonephritis

pANCA

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52
Q

JCV is associated with

A

progressive multifocal leukoencephalitis

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53
Q

Herald patch

A

pityriasis rosacea

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54
Q

enzyme that is raised in chronic alcohol cirrhosis

A

AST

S for smirnoff

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55
Q

antigen test for candida/aspergillus/pcp looks for?

A

beta d glucan

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56
Q

antigen test for aspergillus looks for?

A

beta d glucan + galactomannan

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57
Q

diagnostic test for tinea / trichophyton

A

potassium hydroxide mixed with nail/skin clippings

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58
Q

tx for mucocutaneous / visceral leishmaniasis

A

amphotericin B

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59
Q

gold standard dx test for visceral leishmaniasis

A

splenic / bone marrow aspirate

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60
Q

Jarisch Herxheimer reaction

A

antibiotic tx damages bacterial cell membranes –> release of endotoxins –> systemic inflammatory reaction –> significant drop in BP + acute end organ injury
life threatening!

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61
Q

stain for melanin

A

fontana stain

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62
Q

predominant cells in acute inflammation

A

neutrophils

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63
Q

predominant cells in chronic inflammation

A

lymphocytes

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64
Q

Layers of epidermis

A 
corn lovers grow some bales
stratum corneum
stratum lucidum
stratum granulosum
stratum spinosum
stratum basale
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65
Q

pre malignant condition for skin sqcc

A

Bowen’s disease

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66
Q

portal triad includes:

A

portal vein, hepatic artery, bile duct

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67
Q

zones in sinusoid

A

zone 3 = periportal
zone 2 = midzone
zone 1 = periventricular
drains into central vein

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68
Q

acute hepatitis histology

A

spotty necrosis

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69
Q

chronic hepatitis histology

A

fibrosis (F4=cirrhosis)

interface hepatitis

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70
Q

cirrhosis features + histology

A

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

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71
Q

alcoholic liver disease includes:

A

hepatic steatosis
alcoholic hepatitis
alcoholic cirrhosis

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72
Q

alcoholic cirrhosis histology

A

micronodular cirrhosis

shrunken brown organ

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73
Q

alcoholic hepatitis histology

A

fibrosis
mallory denk bodies
hepatocyte ballooning

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74
Q

main cause of non-alcoholic fatty liver disease

A

insulin resistance, therefore assoc. with high BMI + diabetes

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75
Q

primary sclerosing cholangitis histology

A 
assoc. with UC
pANCA
periductal bile duct fibrosis --> strictures 
beading of bile ducts on ERCP 
assoc. w/cholangiocarcinoma
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76
Q

primary biliary cirrhosis histology

A

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

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77
Q

A1AT deficiency histology

A

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

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78
Q

benign liver conditions

A

haemangioma
liver cell adenoma (assoc. w/ COCP)
bile duct adenoma

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79
Q

liver malignancies + associations

A 
hepatocellular carcinoma (assoc. w/ viral hepatitis, alcoholic cirrhosis, haemochromatosis, NAFLD, aflatoxin)
cholangiocarcinoma (assoc. w/ PSC)
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80
Q

C. difficile 3 C’s

A

ciprofloxacin, cephalosporins, clindamycin

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81
Q

extra intestinal sx of IBD

A 
anterior uveitis
stomatitis
arthritis
erythema nodosum
pyoderma gangrenosum
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82
Q

non-neoplastic polyps in colon

A

hyperplastic polyps
inflammatory pseudopolyps
hamartomatous polyps

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83
Q

what features of colonic polyps would increase risk of cancer

A

many polyps
larger polyps
HIGHER VILLOUS COMPONENT
dysplastic features

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84
Q

neoplastic polyps in colon

A

tubular adenoma
tubulovillous adenoma
villous adenoma

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85
Q

Duke’s staging for colorectal cancer

A

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

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86
Q

Familial adenomatous polyposis

A

autosomal dominant
mutation in APC tumour suppressor gene
lots of polyps (>100 needed for dx)
cancer within 10-15 years

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87
Q

Mx of inherited colon conditions

A

monitoring + total colectomy

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88
Q

Gardner’s syndrome

A

autosomal dominant

subtype of FAP + extraintestinal features (skull/mandibular osteomas, dental caries)

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89
Q

HNPCC / Lynch syndrome

A

autosomal dominant
mutations in DNA mismatch repair genes
colon cancer + concurrent extra-colonic cancer (eg ovarian, endometrial, small bowel, stomach carcinoma)

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90
Q

stain for goblet cells

A

methylene blue

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91
Q

stomach body & fundus histology

A 
columnar epithelium 
parietal cells (intrinsic factor, acid)
chief cells (pepsin)
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92
Q

stomach pylorus histology

A 
columnar epithelium 
neuroendocrine cells (gastrin)
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93
Q

ulcers vs erosion

A

ulcers - loss of tissue goes beyond mucosa & into submucosa

mucosa - loss of tissue is limited to mucosa (basement membrane intact)

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94
Q

types of gastric cancer

A

intestinal adenocarcinoma
diffuse adenocarcinoma
MALT lymphoma

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95
Q

intestinal adenocarcinoma histology (gastric malignancy)

A

well differentiated
mucin production
gland formation

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96
Q

diffuse gastric adenocarcinoma histology

A

single cell architecture
signet ring cells
no glands formed

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97
Q

duodenum histology

A

columnar epithelium with goblet cells

2:1 villous to crypt ratio

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98
Q

duodenal ulcers:

1) anterior ulcers lead to…
2) posterior ulcers lead to…

A

1) performation –> peritonitis

2) erosion of gastroduodenal artery –> haemorrhage –> malaena + hypotension

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99
Q

what is lymphocytic duodenitis

A

what happens before Coeliac’s

increased intraepithelial lymphocytes but w/o structural changes

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100
Q

pancreatic cells + function

A 
acinar cells (secrete digestive enzymes)
exocrine cells (secrete pancreatic juice)
islet cells (secrete hormones)
duct cells (line ducts)
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101
Q

complications of acute pancreatitis

A

pancreatic –> pseudocyst, abscess

systemic –> hypoglycaemia, hypocalcaemia, shock

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102
Q

acute pancreatitis histology

A

duct obstruction + direct acinar injury –> inflammation, leaking of pancreatic enzymes

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103
Q

chronic pancreatitis histology

A

chronic inflammation
fibrosis
duct strictures
loss of parenchyma

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104
Q

tumours of pancreas

A 
ductal carcinoma (85%)
acinar carcinoma 
neuroendocrine tumours
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105
Q

marker of neuroendocrine tumours

A

chromogranin

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106
Q

most common site of pancreatic ductal carcinoma

A

head of pancreas

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107
Q

asthma histology

A 
charcot leyden crystals
airway remodelling
smooth muscle hypertrophy
goblet cell hyperplasia
eosinophilia
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108
Q

COPD histology

A

neutrophil infiltration into airways

loss of alveoli, elastic fibres, lung parenchyma

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109
Q

bronchiectasis histology

A

dilated fibrotic airways with mucous plugging

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110
Q

diffuse alveolar damage due to adult/neonatal RDS

1) histology
2) CXR

A

1) exudative inflammatory reaction

2) white out of all lung fields on CXR

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111
Q

pulmonary oedema histology

1) acute
2) chronic

A

1) intra alveolar fluid

2) IRON LADEN MACROPHAGES (indicated heart failure), fibrosis

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112
Q

small cell lung cancer histology

A

oat cells

found centrally near bronchi

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113
Q

paraneoplastic syndrome assoc. w/ lung sqcc

A

hypercalcaemia of malignancy

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114
Q

papillary thyroid cancer histology

A

psammoma bodies
orphan annie eyes
optically clear nuclei
intranuclear bodies

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115
Q

medullary thyroid cancer cells

A

parafollicular C cells

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116
Q

osteosarcoma histology

A

found in adolescence

“sarcastic fisherman’s son”
elevated periosteum –> codman’s triangle + sunburst appearance

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117
Q

Ewing’s sarcoma histology

A

found in children
in long bones + pelvis
sheets of small round cells –> onion skin appearance of periosteum

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118
Q

chondrosarcoma histology

A 
malignant chondrocytes (cartilage formation)
fluffy calcification
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119
Q

giant cell histology (in bone malignancy)

A

20-40yo female
osteoclast-type multinucleate giant cells
lytic lesions

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120
Q

enchondroma

A

cotton wool calcification

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121
Q

osteoid osteoma

A

adolescent males
proximal femur
Bull’s eye sign on XR
bone pain at night, relieved by aspirin

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122
Q

osteochondroma

A

cartilage capped bony outgrowth –> mushroom like appearance on XR

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123
Q

Albright syndrome

A

fibrous dysplasia
precocious puberty
cafe au lait spots

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124
Q

fibrous dysplasia

A

chinese letters
soap bubble ostolysis
shepherd’s crook deformity

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125
Q

mucinous cystadenocarcinoma

A

pseudomyxoma peritonei

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126
Q

serous cystadenocarcinoma

A

psammoma bodies

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127
Q

brenner tumour

A

benign

coffee bean nuclei

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128
Q

endometrial cancer type 1 vs type 2

A

type 1 - more common, oestrogen dependent, younger patients, assoc. w/ atypical endometrial hyperplasia
type 2 - oestrogen independent, older patients, assoc. w/ atrophic endometrium

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129
Q

granulosa cell tumour

A

produces oestrogen, causing precocious puberty / endometrial hyperplasia
cal exner bodies

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130
Q

yolk sac tumour

A

produces AFP

schiller duval bodies

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131
Q

dysgerminoma

A

assoc. w/ Turner’s

secretes HCG + LDH

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132
Q

what is duct ectasia

A

perimenopausal women
benign
milk ducts dilate + are inflamed + walls thicken –> ducts blocked –> fluid build up
nipple discharge, pain, mass

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133
Q

duct ectasia discharge cytology

A

proteinaceous material + inflammatory cells

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134
Q

intraductal papilloma

A

bloody discharge

benign

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135
Q

what gives good/bad prognosis in breast cancer

A

ER/PR +ve = good prognosis as responds to tamoxifen

HER2 +ve = poor prognosis

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136
Q

invasive breast ductal carcinoma histology

A

big, pleomorphic cells that move into stroma

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137
Q

invasive breast lobular carcinoma histology

A

cells in single file chains

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138
Q

prinzmetal angina cause

A

coronary artery spasm

uncommon!

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139
Q

complications of MI

A 
DARTH VADER
Death
Arrhythmia 
Rupture
Tamponade
Heart failure
Valve disease
Aneurysm
Dressler syndrome
Embolism
Recurrence
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140
Q

dilated cardiomyopathy histology

A

loss of myocytes

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141
Q

MI histology <6h

A

normal histology

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142
Q

MI histology 6-24h

A

loss of nuclei, homogenous cytopasm, cell necrosis

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143
Q

MI histology 1-4d

A

polymorphs + macrophages clear debris

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144
Q

MI histology 5-10d

A

further removal of debris

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145
Q

MI histology 1-2 weeks

A

rebuilding - granulatino tissue, new blood vessels, collagen synthesis

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146
Q

MI histology weeks-months

A

scar tissue formation

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147
Q

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

A

lipase

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148
Q

most common malignancies in women

A 
breast
lung
bowel
uterus 
other
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149
Q

most common malignancies in men

A 
prostate
lung
bowel
head and neck
other
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150
Q

flow murmur

A

soft, sytolic murmur heard best at left lower sternal edge

found in hyperdynamic circulations - pregnancy, anaemia, severe blood loss

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151
Q

Kimmelstiel Wilson nodules

A

found in kidneys

associated with diabetes

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152
Q

benign familial haematuria inheritance pattern

A

autosomal dominant

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153
Q

most common cancer in UK

A

breast cancer

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154
Q

most common renal tumour

A

renal cell carcinoma (clear cell, papillary, chromophobe)

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155
Q

biomarker for hepatic ischaemia

A

raised ALT

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156
Q

What is the cancer with the highest mortality in the UK?

A

lung cancer

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157
Q

aschoff bodies

A

acute rheumatic fever

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158
Q

most common type of small cell lung cancer in UK

+ 2nd most common

A

most common = adenocarcinoma, then sqcc

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159
Q

gleason scoring system for prostate cancer

A

first number = most common cell type seen

second number = most aggressive cell type seen

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160
Q

crescent shaped mass underlying the left parietal bone on CT

A

subdural haemorrhage

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161
Q

waxy casts

A

chronic kidney disease

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162
Q

muddy casts + epithelial casts

A

acute tubular necrosis

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163
Q

white cell casts

A

acute interstitial nephritis

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164
Q

tx for human tapeworms

A

praziquantel

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165
Q

sinusitis abx

A

phenoxymethylpenicillin

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166
Q

haemophilus ducreyi

A

causes multiple painful necrotising genital ulcers + inguinal lymphadenopathy

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167
Q

argyll robertson pupil

A

pupil accmmodates but does not react to light

found in late stage syphillis

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168
Q

malaria species with tertian fevers vs quartan fevers

A 
tertian fever (every 2 days) = P. falciparum, P. vivax, P. ovale 
quartan fever = P. malariae
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169
Q

halo sign

A

on CT = aspergillus

on CSF = cryptococcus

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170
Q

sx of severe malaria

A

parasitaemia > 2%, altered consciousness, met acidosis, organ failure, resp distress, circulatory collapse

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171
Q

infectious mononucleosis on blood film

A

atypical lymphocytes

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172
Q

Maurer’s clefts

A

p. falciparum invades RBCs + forms disc like granulations that can be seen on thin blood film

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173
Q

Takotsubo’s cardiomyopathy

A

triggered by intense emotional/physical stress

looks like MI

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174
Q

extradural haemorrhage

A

middle meningeal artery

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175
Q

alport’s syndrome inheritance pattern

A

X-linked

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176
Q

alport’s triad

A

nephritic syndrome
sensorineural hearing loss
cataracts

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177
Q

adult polycystic kidney disease mutation

A

defect in polycystin 1

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178
Q

high anion gap suggests…

A

presence of ketones

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179
Q

antifungal groups

A 
polyenes
azoles
allylamines
echinocandin
pyrimidine analogue
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180
Q

polyenes function + eg

A

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

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181
Q

azoles function + eg

A

inhibits ergosterol synthesis, e.g., fluconazole

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182
Q

echocandins function + eg

A

inhibits cell wall synthesis, e.g., caspofungin

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183
Q

allylamines function + eg

A

inhibits ergosterol synthesis, e.g., terbinafine

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184
Q

pyrimidine analogue function + eg

A

inhibits DNA/RNA synthesis, e.g., flucytosine

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185
Q

metabolic acidosis, high anion gap but low glucose + no ketones?

A

think lactic acidosis

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186
Q

14-3-3 protein indiciates…

A

rapid neuro degeneration

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187
Q

what should diabetics do when ill

A

continue insulin regimen as usual
more regular monitoring of blood glucose + urinary ketone levels
if struggling to eat, may need sugary drinks

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188
Q

diabetic drug that can help with weight loss

A

sulphonylureas (eg gliclazide)

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189
Q 
examples of the following antidiabetic drugs: 
GLP-1 mimetics
DPP4 inhibitors
SGLT2 inhibitors
sulphonylureas
Thiazolidinediones
A 
GLP-1 mimetics = -tide
DPP4 inhibitors = -gliptin
SGLT2 inhibitors = -flozin
sulphonylureas = gliclazide
Thiazolidinediones = pioglitazone
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190
Q

Brucella ix

A

blood/pus culture on castenada medium

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191
Q

toxoplasmosis ix

A

sabin feldman dye test

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192
Q

negri bodies on neural cells

A

rabies

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193
Q

gold standard test for leptospirosis

A

microscopic agglutinnation test

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194
Q

hantavirus

A

acquired from contact with mice/rat urine/droppings

causes hantavirus pulmonary syndrome / renal failure or bleeding

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195
Q

hypoglycaemia, low insulin, low c peptide, low FFAs, low ketones

A

non-pancreatic neoplastic tumours (e.g., mesothelioma, fibroblastoma, carcinoma) producing IGF-1 that is binding to insulin receptors + triggering glucose uptake

196
Q

hypoglycaemia, low c peptide, high FFAs, low ketones

A

inborn errors of metabolism

197
Q

nesidioblastosis

A

excessive function of pancreatic beta cells –> hyperinsulinaemic hypoglycaemia

198
Q

Waterhouse Frierichsen syndrome

A

meningococcal infection –> bleeding into adrenal gland –> adrenal failure

199
Q

HAP tx

A

ciprofloxacin + vancomycin

200
Q

HAP examples

A

staph aureus
klebsiella
pseudomonas
e coli

201
Q

hospital acquired UTI tx

A

cefalexin/augmentin

202
Q

Hashimoto’s

A

herthle cells

203
Q

alpha glucosidase inhibitors

A

inhibit absorption of glucose in small bowel

e.g., acarbose

204
Q

raised reticulocytes indicates…

A

reticulocytes = immature RBCs

there is an increased demand for bone marrow to produce RBCs so it sends RBCs out before they are mature

205
Q

CMV retinitis

A

seeing small specks / visual floaters

206
Q

Familial mediterranean fever Mx

A

1) colchicine
2) anakinra (IL-2 inhibitor)
3) etanercept (TNF alpha inhibitor)

207
Q

Kostmann’s mutation

A

HAX1 mutation

208
Q

cyclical neutropenia mutation

A

mutation in neutrophil elastase

209
Q

Chagas disease

A

spread by reduviid bugs
in South America
causes general flu sx, swollen eyelids, enlarged spleen/liver/lymph nodes

210
Q

acute phase proteins that cause fever

A

IL-1

IL-6

211
Q

polyarteritis nodosa is assoc. w/ which virus?

A

hep B

212
Q

chronic granulomatous disease - increased susceptibility to…

A

infection due to catalase positive organisms, e.g., e coli, staph aureus, listeria, klebsiella

213
Q

SIADH tx

A 
fluid restrict
tx cause 
demeclocycline 
(increases ADH resistance)
tolvaptan (ADH receptor antagonist)
214
Q

nephrogenic DI tx

A

thiazide diuretics

215
Q

why does taking loop diuretics/Bartter’s syndrome lead to hypokalaemia?

A

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

216
Q

why does taking thiazide diuretics lead to hypokalaemia

A

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

217
Q

Schmidt’s

A

hypothyroidism + addison’s

218
Q

DEXA score for osteoporosis

A

< -2.5

219
Q

DEXA score for osteomalacia

A

between -1 and -2.5

220
Q

Gilbert’s syndrome defect

A

deficiency in UDP glucoronyl transferase (enzyme that is needed to conjugate bilirubin)

221
Q

familial benign hypercalcaemia

A

defective calcium sensing receptor on parathyroid glands –> parathyroid cannot detect calcium –> release lots of PTH even though Ca is normal

222
Q

how to differentiate between primary PTH and FBH

A

calcium : creatinine clearance ratio is lower in FBH

223
Q

micronodular cirrhosis

A

alcoholic cause

biliary tract disease

224
Q

indications for dialysis

A 
metabolic acidosis
uraemia sx (encephalopathy, nausea, malaise, pruritis), fluid overload, hyperkalaemia, CKD stage 5
225
Q

Peutz jegher syndome

A

freckling around mouth
hyperpigmentation of mucosa
multiple hamartous polyps

226
Q

bisphosphonates MoA

A

cause apoptosis of osteoclasts

227
Q

pseudohypoparathyoidism biochemical results

A

resistance to PTH

high PTH, low Ca, high phosphate

228
Q

pseudopseudohypoparathydoism

A

features of Albright’s syndrome but normal biochemical results + no PTH resistance

229
Q

macrophages in liver

A

kupffer cells

230
Q

macrophages in kidney

A

mesangial cells

231
Q

macrophages in bone

A

osteoclasts

232
Q

macrophages in neural tissue

A

microglia

233
Q

macrophages in skin

A

langerhans cells

234
Q

all T cells express…

A

CD3

235
Q

what kind of receptor do dendritic cells and polymorphs express to bind to immune complexes

A

Fc receptors which bind to antigens that are bound to antibodies

236
Q

what is deficient in leukocyte adhesion deficiency

A

CD18

required to bind to ICAM1 via LFA-1 (CD11a, CD18

237
Q

deficiency of IL-12 or interferon gamma increases your susceptibility to…

A

mycobacteria

238
Q

deficiency of this complement can result in SLE…

A

C2

239
Q

Wiskott aldrich syndrome sx + biochemical results

A

eczema + immunodeficiency + thrombocytopenia
defect in WAS gene
low IgM, high IgA, high IgE

240
Q

complement deficiency makes you susceptible to…

A

encapsulated bacteria, unable to make MAC!

241
Q

ADA deficiency

A

enzymes in lymphocytes required for cell metabolism –> unable to respond to cytokines –> early arrest of T cells, NK cells, B cells!

242
Q

X linked SCID biochemical results

A

low T cells + NK cells

but NORMAL/HIGH B cells

243
Q

salmonella typhi tx

A

IV ceftriaxone + PO azithromycin

244
Q

cryoprecipitate vs FFP

A 
FFP = equal concentration of clotting factors to blood, contains all factors
cryoprecipitate = more concentrated source, contains vwf, VIII, XIII, fibrinogen
245
Q

relative polycythaemia

A

raised red cell mass but reduced plasma volume

eg burns, dehydration, diarrhoea, vomiting, smoking, diuretics

246
Q

rivaroxaban, apixaban, edoxaban

A

DOACs

anti-Xa

247
Q

multiple myeloma sx

A

Calcium high
Renal failure (+ amyloidosis, nephrotic syndrome)
Anaemia (+ pancytopenia)
Bones (pain, fractures, osteolytic lesions)

Hyperviscosity syndrome

248
Q

Ann arbor staging

A

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

249
Q

type of necrosis assoc. w/ MI

A

coagulating necrosis

250
Q

most common ovarian tumour

A

serous cystadenoma

251
Q

nasopharyngeal carcinoma is assoc. w/ which virus?

A

EBV

252
Q

most common type of glial cell in CNS

A

astrocyte

253
Q

most common skin cancer

A

basal cell carcinoma

254
Q

hormone released by adipose tissue + sends signals to hypothalamus

A

leptin

255
Q

hepatitis B tx

A 
interferon alpha
nuceloside analogues (-vudines, -avirs, -ovirs), e.g., lamivudine, telbivudine, tenofovir, entacevir)
256
Q

hepatitis c tx

A

interferon alpha
NS3/4 inhibitors (-previrs)
NS5a inhibitors (-asvirs)
direct polymerase inhibitors (-buvirs)

257
Q

most common type of CJD

A

sporadic

258
Q

pyrin

A

found in neutrophils
major role in regulating inflammation
defect –> unregulated activation of neutrophils

259
Q

how does colchicine work in familial mediterranean fever

A

colchicine binds to tubulin in neutrophils + disrupts function

260
Q

nikolsky sign

A

when bullae rupture easily, as seen in pemphigus vulgaris

261
Q

globin chain composition in HbA, HbA2, HbF

A

HbA - 2 alpha, 2 beta
HbA2 - 2 alpha, 2 gamma
HbF - 2 alpha, delta

262
Q

beta thalassemia sx

A

skull bossing
maxillary hypertrophy
hairs on end on skull XR

263
Q

paroxysmal cold haemoglobinuria

A

viral illness –> donath landsteiner antibodies which bind + hemolyse RBCs when it is cold –> haemoglobinuria + DAT +ve
complement mediated haemolysis on rewarming

264
Q

paroxysmal nocturnal haemoglobinuria

A

DAT -ve

complemented haemolysis of RBCs, happens usually at night

265
Q

what is activated protein C complex made up of

A

protein C + thrombomodulin + thrombin

266
Q

what happens after platelets bind to collagen/vwf

A

release ADP / thromboxane A2 –> platelet aggregation

267
Q

what happens after platelets bind to collagen/vwf

A

platelets release ADP / thromboxane A2 –> triggers expression of glp2b/3a on surface of platelets –> allows binding to fibrinogen –> platelet aggregation + activation

268
Q

Tx after splenectomy

A

vaccinations

daily penicillin lifelong

269
Q

rapidly progressive glomerulonephritis on light microscopy

A

crescents

270
Q

types of rapidly progressive glomerulonephritis

A

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

271
Q

ergocalciferol

A

inactivated vit D obtained from diet

272
Q

cholecalciferol

A

inactivated vit D obstained from sunlight

273
Q

calcitriol

A

activated vit D

274
Q

ix in haem malignancies

A

immunophenotyping to identify antigens + differentiate between myeloid/lymphoid

FISH/cytogenetic analysis/molecular genetic analysis to identify mutations

275
Q

APML features + fusion gene

A

basically AML + DIC features (eg low fibrinogen)
Auer rods + myeloid blast cells
PML-RARA fusion gene t(15;17)

276
Q

sx of hyposplenism on blood flm

A

Howell jolly bodies

target cells

277
Q

pseudomonas tx

A

ciprofloxacin + gentamicin

278
Q

human rights - article 2

A

right to life - absolute, eg right to life saving tx, right to withdraw futile tx

279
Q

human rights - article 3

A

prohibition to torture - absolute, eg excessive restraint, failure to stop suffering, non-consensual tx

280
Q

human rights - article 5

A

right to liberty - relative, eg detention only lawful under MHA/DoLs + patient must be able to appeal

281
Q

human rights - article 8

A

right to a private life - relative, eg right to confidentiality, right to refuse tx

282
Q

PUO definition

A

temp > 38.3 for >3 weeks

283
Q

ethics - what happens after someone dies

A

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.

284
Q

effect of C botulinum on body

A

blocks Ach from peripheral nerves –> descending paralysis

285
Q

CAR-T cell therapy indicated in…

A

Non-Hodgkin’s lymphoma

ALL

286
Q

how does ipilimumab work

A

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!

287
Q

how do pembrolizumab/nivolumab work

A

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!

288
Q

cyclophosphamide MoA

A

antiproliferative agent

alkylates guanine

289
Q

mycophenolate MoA

A

antiproliferative agent

inhibits de novo guanosine synthesis

290
Q

azathioprine MoA

A

antiproliferative agent

inhibits de novo purine synthesis

291
Q

test for paroxysmal noctural haemoglobinuria

A

HAM test

292
Q

what does protein C do

A

binds to protein S + inhibits factors 5 & 8

293
Q

Ethics death - When is consent required from family for an autopsy

A

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

294
Q

Ethics death - When is consent not required from family for an autopsy

A

when cause of death is uncertain/suspicious/sudden/suicide/violent/not seen by doctor in last 28d/death under custody or MHA

295
Q

human tissue act - who has priority when consenting to examination/removal/storage of dead body

A

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

296
Q

human tissue act - who has priority when consenting to examination/removal/storage of dead body

A

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

297
Q

how do PCSK9 inhibitors work?

A

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

298
Q

what happens when T cells + APCs bind

A

calcineurin is released –> stimulates release of IL-2 (important in activation of naive T cells + proliferation)

299
Q

sirolimus

A

mTOr inhibitor –> inhibits IL-2 pathway –> inhibits activation of naive T cells + proliferation following binding to APCs

300
Q

tofacitinib

A

JAK1/3 inhibitor –> inhibits production of inflammatory molecules

301
Q

abatacept

A

opposite of ipilimumab
= CTLA4 analogue which binds to CD80/86 on APCs –> induces inhibitory effect –> suppression of T cells
used in rheumatoid arthritis

302
Q

osteoprotegrin

A

osteoprotegrin is usually produced by osteoblasts to bind to RANKL –> prevents binding of RANKL to RANK receptor on osteoblasts

303
Q

MGUS

A

basically what happens before multiple myeloma
NO CRAB Sx
<10% clonal plasma cells, <30g/l M spike

304
Q

Multiple myeloma tx

A

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

305
Q

Pre-renal causes of AKI

A 
sepsis
hypotension
dehydration (D+V)
haemorrhage
oedema
renal artery stenosis
drugs (NSAIDs, ACEi, diuretics, calcineurin inhibitors)
306
Q

Castleman’s disease

A

excess IL-6 produced –> lots of proliferation of B and T cells in lymph nodes

307
Q

Mucormycosis

A

fungal infection found in immunocompromised + poorly controlled diabetes
DUE TO RHIZOPUS SPECIES
sx = blackened skin, blisters, fever, ulcers, swelling, redness

308
Q

sideroblastic anaemia

A

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

309
Q

washed blood

A

washing blood to get rid of plasma/platelets/wbcs in patients who have had a severe allergic reaction before

310
Q

cell salvage

A

collecting blood that is lost during a major surgery, filtering, then reinfusing back into patient

311
Q

emergency blood transfusion blood group

A

O- (no antigens available for recipient to have an immune response)

312
Q

reactivation of virus following transplant

A

EBV

313
Q

scarlet fever causative organism

A

group A strep (streptoccocus pyogenes)

314
Q

CLL tx

A

ibrutinib

315
Q

what organism is likely to cause bronchiectasis + what is assoc. w/ longstanding bronchiectasis

A

1) staph aureus

2) pseudomonas aeruginosa

316
Q

Pretransplant immunosuppressants

A

alemtuzumab
basiliximab (anti-CD25)
ATG (anti-thymocyte globulin)

317
Q

Posttransplant immunosuppressants

A

steroids
anti-proliferatives (eg mycophenelate, azathioprine)
calcineurin inhibitors (eg tacrolimus, cyclosporin)

318
Q

acute cellular rejection of transplant tx

A

steroids

ATG

319
Q

acute antibody-mediated rejection of transplant tx

A

IVIG

plasmapheresis

320
Q

rate limiting step in heme biosynthesis pathway

A

ALA synthase

321
Q

rate limiting step in salvage pathway for purine synthesis

A

HGPRT

322
Q

Lesch Nyhan syndrome

A

deficiency in HGPRT –> hyperuricaemia –> severe childhood gout, renal impairment, self mutilating behaviour

323
Q

P-amylase

A

pancreatic amylase

324
Q

S-amylase

A

salivary amylase

325
Q

high aldosterone + high renin

A

renal artery stenosis

326
Q

which liver enzyme is raised in cocaine use

A

AST

327
Q

what stimulates + inhibits prolactin

A

TRH stimulates

dopamine inhibits

328
Q

what to give after pituitary adenoma removal surgery

A

replace cortisol –> give hydrocortisone

may give desmopressin if resulting central DI

329
Q

most common type of CAH

A

21 hydroxylase deficiency

330
Q

beta lactam with anti-pseudomonal activity

A

ceftazidime

331
Q

diphtheria

A

highly contagious
affects nose, throat, skin, fever, swollen LNs
thick grey film over throat –> sore throat, breathing difficulties

332
Q

tetanus

A

lock jaw

painful muscle spasms

333
Q

salmonella typhi tx

A

IV ceftriaxone + PO azithromycin

334
Q

herd immunity threshold definition

A

the proportion of immune people in a population that is needed to stop spread of pathogen

335
Q

characteristics of influenza A that could cause pandemic

A

novel antigenicity
efficient transmission between people
efficient replication within airway

336
Q

most common cause of cellulitis

A

streptococcus pneumoniae

337
Q

etanercept

A

TNF alpha inhibitor

used in rheumatoid arthritis, ank spond, psoriasis

338
Q

causes of hypovolaemic hyponatremia

A

dehydration
burns
salt losing nephropathy
Bartter’s

339
Q

low serum Na but normal osmolality

A

alcohol, lipids, paraproteins also present in serum

340
Q

dabigatran

A

inhibits thrombin

341
Q

ddx of anaphylaxis

A

urticaria
hereditary angioedema
ACEi induced angioedema
acute anxiety

342
Q

heparin MoA

A

potentiates antithrombin

343
Q

sudden chest pain radiating to neck

A

left anterior descending artery thrombus

344
Q

secondary causes of nephrotic syndrome

A

diabetes

amyloidosis

345
Q

abdo pain radiating to back, collapse + death

A

acute aortic aneurysm

346
Q

causes of raised anion gap metabolic acidosis

A

Ketones (DKA)
Uraemic (renal failure)
Lactic acidosis (metformin)
Toxins (ethylene glycol, methanol, salicylates)

347
Q

why is LDH raised in haemolytic anaemia

A

LDH is found intracellularly so is released when RBCs are haemolysed

348
Q

giving a baby with RDS too much O2 can lead to…

A

retinopathy

349
Q

acute intermittent porphyria

A

autosomal dominant
neurovisceral sx only (peripheral neuropathy, painful abdomen, seizures)
deficiency of HMB synthase

350
Q

porphyria cutanea tarda

A

cutaneous sx only

deficiency of uroporphyrinogen decarboxylase

351
Q

most common cause of hypothyroidism in UK

A

primary atrophic hypothyroidism

352
Q

how does papillary thyroid cancer spread

A

via lymph nodes

353
Q

how to prevent gvhd

A

irradiation to remove donor lymphocytes

354
Q

post-thrombotic syndrome

A

swelling and chronic pain in the same location in the weeks-months following DVT

355
Q

where is thrombomodulin found + what does it do

A

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

356
Q

virus assoc. w/ adult T cell lymphoma

A

HTLV1

357
Q

Waldenstrom’s macroglobinaemia (lymphoplasmacytoid lymphoma)

A

elderly men
increased monoclonal IgM
weight loss, fatigue, hyperviscosity

358
Q

transfusion reactions - immediate within mins

A

anaphylaxis

359
Q

transfusion reactions - mins to hrs

A

bacterial contamination
ABO incompatibility
febrile non-hemolytic transufsion reaction

360
Q

transfusion reactions - within several hrs (<6h)

A

TRALI

TACO

361
Q

transfusion reactions - delayed >24h

A

delayed haemolytic transfusion reaction

GvHD

362
Q

haemostasis process

A

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

363
Q

regulators of coagulation

A

tissue factor pathway inhibitor
antithrombin
protein C/S

364
Q

vwd mx

A

desmopressin

factor 8 + vwf concentrates

365
Q

vwd types

A

Type 1 - quantitative defect
Type 2 - qualitative defect
Type 3 - complete absence

366
Q

glanzmann’s thrombasthenia

A

defect in glp2b/3a –> no platelet aggregation

367
Q

why is there an initial procoagulant state with warfarin

A

first inhibits protein C/S so initially causes a procoagulant state due to less inhibition by protein C/S

368
Q

factor V Leiden

A

resistance to protein C/S –> less inhibition of factor 5 + 10 –> excess factor 5 –> more prone to thrombosis
most common prothrombotic disorder

369
Q

which disorder of thrombosis carries the highest risk of thrombosis

A

antithrombin deficiency

370
Q

most common thrombotic disorder

A

factor V Leiden

371
Q

anaemia definition in men + women

A

<135 in men

<115 in women

372
Q

iron studies in iron deficiency anaemia

A

low iron
low ferritin
high transferrin
high TIBC

373
Q

iron studies in sideroblastic anaemia

A

high iron
high ferritin
high transferrin
normal TIBC

374
Q

iron studies in anaemia of chronic disease

A

high iron
high ferritin
low transferrin
low TIBC

375
Q

sx of intravascular haemolysis

A

high serum LDH
low haptoglobin
dark urine

376
Q

sx of extravascular haemolysis

A

increased splenic consumption therefore:
spherocytes
splenomegaly
urobilinogen in urine

377
Q

G6PD on blood film

A

bite cells

Heinz bodies

378
Q

anaemia of chronic disease

A

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

379
Q

autoimmune haemolytic anaemia mx

A

tx underlying cause
steroids
rituximab

380
Q

how many genes for alpha globin and beta globin synthesis

A

4 genes for alpha globin

2 genes for beta globin (homozygous, heterozygous, intermedia)

381
Q

Hb Barts

A

no alpha globin chains

incompatible with life –> hydrops fetalis + death in utero

382
Q

HbH

A

1 alpha gobin chain out of 4

severe anaemia in childhood

383
Q

alpha thalassemia trait

A

mild anaemia

384
Q

HbAS

A

sickle cell trait

385
Q

HbSS

A

sickle cell anaemia

386
Q

key features in sickle cell anaemia (4)

A

haemolytic crisis
aplastic crises
sequestration crises
infection

387
Q

sickle cell anaemia mx

A

vaccinations

daily penicillin

388
Q

when is a pregnant woman most at risk of VTE

A

post-partum

389
Q

gvhd tx + prevention

A

tx - steroids + ciclosporin (calcienruin inhibitor)

prevention - methotrexate + ciclosporin

390
Q

bone marrow failure dx

A

hypocellular + fatty bone marrow biopsy

391
Q

beta globin gene

A

Chr 11

392
Q

alpha globin gene

A

Chr 16

393
Q

why do you get splenomegaly in sickle cell anaemia

A

vessels in spleen occluded repetitively over time –> fibrosis + calcification –> pooling of blood in spleen –> spleen gets bigger

394
Q

hand-foot syndrome

A

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

395
Q

warm autoimmune hemolytic anaemia

A

antibodies activated in room temp
IgG mediated (warm in Greece)
SLE, CLL

396
Q

cold autoimmune hemolytic anaemia

A

antibodies activated in cooler temp
IgM mediated (cold in Moscow)
EBV, mycoplasma, hep C

397
Q

ANA vs anti-dsDNA in SLE

A

ANA is more sensitive but less specific than anti-dsDNA

398
Q

most common primary tumour of heart

A

myxoma

399
Q

most common cause of constrictive pericarditis in developing world

A

tuberculosis

400
Q

what enzyme does allopurinol inhibit

A

xanthine oxidase

401
Q

cause of hypercalcaemia in sarcoidosis

A

lung macrophages produces 1 alpha hydroxylase

402
Q

mumps causative organism

A

mumps orthorubulavirus

403
Q

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

A

hepatitis E

404
Q

anti thymocyte globulin

A

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)

405
Q

anti thymocyte globulin

A

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)

406
Q

muscle weakness, ptosis, sx get worse with exercise, sx improve with tensilon injection

A

myasthenia gravis

407
Q

features of myelodysplastic syndrome

A

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

408
Q

what do all T cells express

A

CD3+

409
Q

Fanconi anaemia

A

pancytopenia
cafe au lait spots
abnormal thumbs
short stature

410
Q

Diamond-Blackfan anaemia

A

red cell cytopenia

411
Q

Shwachman-Diamond syndrome

A

neutropenia

pancreatic dysfunction

412
Q

Dyskeratosis congenita

A

pancytopenia
nail dystrophy
skin hyperpigmentation
oral leukoplakia

413
Q

most sensitive biomarker for IDA

A

ferritin but will be falsely raised in inflammation

414
Q

tx of DVT

A

DOAC

warfarin preferred in profound renal failure (as it is not renally cleared)

415
Q

richter’s transformation

A

CLL to high grade lymphoma

416
Q

tumour lysis syndrome

A

when chemotherapy is started –> rapid lysis of tumour cells –> release of intracellular contents –> renal failure, arrhythmia, death

417
Q

mx to reduce risk of tumour lysis syndrome

A

IV allopurinol or rasburicase to reduce hyperuricaemia

418
Q

heparin induced thrombocytopenia

A

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

419
Q

tumour lysis syndrome changes in electrolytes

A

drop in Ca

rise in urea, PO4, K

420
Q

Burkitt’s Lymphoma translocation

A

t(8;14) cmyc

14 for lymphoma, 8 for the age when Burkitt’s lymphoma is more common

421
Q

Mantle cell lymphoma translocation

A

t(11;14)

14 for lymphoma

422
Q

follicular lymphoma translocation

A

t(14;18)

14 for lymphoma

423
Q

BCL2

A

protein that inhibits cell apoptosis

424
Q

most common cause of B12 deficieny in UK

A

pernicious anaemia

425
Q

Burkitt’s lymphoma presentation in sporadic UK form vs endemic African form

A

sporadic UK form = abdominal/inguinal lymphadenopathy

endemic African form = massive submandibular swelling, cervical lymphadenopathy

426
Q

deranged LFTs + acidosis

A

acidosis is late sign + generally indicates need for liver transplant

427
Q

tuberous sclerosis

A

autosomal dominant
ash leaf spots on skin
tumours + cysts growing in multiple organs, especially CNS, kidney, eg rhabdomyoma, angiomyolipoma, retinal harmatoma
infantile spasms

428
Q

what has better prognosis IgH mutated or IgH unmutated CLL

A

IgH mutated as it means the B cells have undergone somatic hypermutation + more mature and developed –> better prognosis

429
Q

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?

A

AB

430
Q

von hippel lindau

A

hemangioblastoma of cerebellum, brainstem and spinal cord, retina;
renal cysts, pheochromocytomas

431
Q

isolated raised bilirubin with no other complications

A

Gilbert’s syndrome

432
Q

normal pH, low pCO2, low bicarb

A

mixed resp alkalosis + met acodisos –> aminosalicylate overdose

433
Q

What is the maximum number of HLA class I mismatches that may occur if a parent acts as a kidney donor for a child?

A

parent + child always have at least 3 matches so can only have mismatches in max 3

434
Q

Which cytokine could be targeted to improve disease control in ank spond?

A

tnf alpha

435
Q

cryptococcus antigen test

A

glucuronoxylomannan

436
Q

Which cytokine is key in promoting the development and terminal differentiation of eosinophils

A

IL-5

437
Q

which helminth is able to undergo autoinfection in the intestines

A

Strongyloidiasis stercoralialis

438
Q

normal anion gap

A

14-18

439
Q

carbimazole side effects

A

carbimazole used in hyperthyroidism

agranulocytosis + neutropenia

440
Q

hereditary angioedema

A

autosomal dominant

C1 esterase inhibitor deficiency –> recurrent attacks of oedema –> resp distress, abdo pain

441
Q

causes of microcytic anaemia

A 
TAILS
Thalassemia trait
anaemic of chronic disease
iron deficiency anaemia
lead poisoning
sideroblastic anaemia
442
Q

toxic left shift

A

immature neutrophils released from bone marrow, typically due to severe infection/inflammation

443
Q

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

A

motor neuron disease

444
Q

most common causative organism of bronchial pneumonia

A

haemophilus influenzae

445
Q

most common causative organism of lobar pneumonia

A

strep pneumoniae

446
Q

what does a neutrophil look like

A

multilobed nucleus (looks like it has 3 parts to it)

447
Q

most common liver malignancy

A

secondary cancer!! metastatic adenocarcinoma

448
Q

zollinger ellison tumour

A

gastrin secreting tumour

449
Q

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.

A

light chain restriction which indicates monoclonal B cell proliferation –> malignancy

450
Q

polycythaemia rubra vera tx

A

hydroxycarbamide –> reduces bone marrow activity

451
Q

aetiology of febrile non-haemolytic transfusion reactio

A

cytokines in donor plasma cause inflammatory reaction

452
Q

A kidney biopsy shows thickened glomerular capillary loops (a wire loop appearance)

Which disease is this suggestive of?

A

SLE

immune complex deposition –> thickening

453
Q

endoemtrial cancer FIGO staging

A

stages

1) confined to uterus
2) + cervix
3) + spread to fallopian tubes/ovaries/vagina/local lymph nodes
4) distant spread

454
Q

Tazobactam

A

beta lactamase inhibitor given alongside piperacillin

455
Q

beta lactam that is not sensitive to beta lactamase

A

flucloxacillin

(Benzylpenicillin, piperacillin, and amoxicillin are all antibiotics of the penicillin class which are sensitive to beta-lactamase)

456
Q

EPO in polycythaemia vera vs secondary polycythaemia

A

polycythemia vera = EPO low due to suppression

secondary polycythaemia = EPO high

457
Q

fibrinogen in dic

A

low

458
Q

mallory denk bodies

A

= intracytoplasmic inclusions in hepatocytes made up of damaged intermediate filaments

459
Q

barium examination string sign

A

Corhn’s

460
Q

biochemistry for renal failure (secondary hyperparathyroidism)

A

low Ca
high PTH
high phosphate due to excretion failure

461
Q

why is there a drop in Hb in CLL

A

folate / B12 deficiency

462
Q

1 unit of RBCs causes an increment of what in Hb

A

Hb 10

463
Q

1 unit of platelet gives an increase of what in platelets

A

platelets 35

464
Q

how does removing donor T lymphocytes in allogeneic haematopoietic SCT have an impact on incidence of GvHD + rate of leukaemia relapse

A

reduces risk of GvHD

increases risk of leukaemia relapse (donor lymphocytes fight tumour cells + have anti-tumour effect)

465
Q

haemorrhagic testicular infarction process

A

venous occlusion

466
Q

exophytic fronded lesion on cystoscopy

A

papillary urothelial carcinoma

467
Q

why should you not give ACEi in renal artery stenosis

A

causes constriction of efferent arteriole + makes renal artery stenosis worse

468
Q

which enzyme do you expect to be raised in dermatomyositis

A

CK

469
Q

Alum MoA as an adjuvant for vaccination

A

promotes B cell differentiation

470
Q

antibodies in ank spond

A

NONE

471
Q

bacillus cereus mx

A

none, supportive

472
Q

fibrinogen in DIC

A

low

473
Q

streptobacillus moniliformis

A

rat bite fever

474
Q

atypical pneumonias

A

legionella
chlamydia pneumoniae
chlamydia psittica
mycoplasma pneumoniae

475
Q

what does covid target

A

ACE2

476
Q

which component of the covid virus do vaccines target

A

spike proteins

477
Q

rheumatoid arthritis tx

A

TNF alpha inhibitors (infliximab, adalimumab, certolizumab, golimumab)
Tocolizumab (anti IL 6)
Tofacitinib (JAK1/3 inhibitor)

478
Q

psoriatic arthritis tx

A

secukinumab (anti IL 17)

ustekinumab (anti IL 12/23)

479
Q

ank spond tx

A

secukinumab (anti IL 17)
ustekinumab (anti IL 12/23)
TNF alpha inhibitors

480
Q

organism that causes diphtheria

A

corynebacterium diphtheriae

481
Q

fibrinoid necrosis

A

vascular damage that occurs due to infection/immune complex deposition/autoimmunity

482
Q

schistosomiasis causes what cancer

A

squamous cell carcinoma in bladder

483
Q

osteoarthritis

A

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

484
Q

rheumatoid arthritis

A

symmetrical arthritis

485
Q

Used to treat severe ankylosing spondylitis not controlled by NSAIDs

A

Etanercept

Essie Year 5 (4 decks)

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