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Sophia's Path > Path 2018 Past Paper > Flashcards

Path 2018 Past Paper Flashcards

1
Q

Child with hereditary spherocytosis - investigation?

A

Osmotic fragility test

or DAT?

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2
Q

Supraclavicular aspirate, swollen face, Reed Sternberg cells

A

Hodgkin Lymphoma

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3
Q

MEFV Mutation

A

Familial Mediterranean Fever

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4
Q

NOD2/CARD15

A

Crohns Disease

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5
Q

Immunodeficiency with common gamma chain problem

A

X linked SCID

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6
Q

Swollen joint, needle-shaped aspirate with negative birefringence, what is the enzyme responsible

A

Xanthins Oxidase (gout)

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7
Q

Treatment for gout (Acute)

A

NSAIDs (1st line)
Colchicine (2nd)
Glucocorticoids (3rd)

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8
Q

Treatment for gout (Non-Acute/interval)

A

Fluids
Reverse precipitating factors e.g. thiazides
Allopurinol

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9
Q

What does JC virus cause?

A

Progressive Multifocal Leukoencephalopathy

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10
Q

Reactivation of a virus following a transplant?

A

EBV

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11
Q

Bacteria causing scarlet fever?

A

Strep Pyogenes (Group A)

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12
Q

Most common virus causing aseptic meningitis?

A

Enteroviruses (Coxsackie or Echovirus)

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13
Q

Iron deficiency anaemia in male. Most important investigation?

A

Colonoscopy to rule out bleeding

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14
Q

Smear cells

A

Chronic Lymphocytic Leukaemia

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15
Q

Publican with diabetes, fatty stools, weight loss, ‘slate grey skin’ and joint pains. What is the underlying diagnosis causing this?

A

Haemachromatosis (joint pain, skin changes, pancreatitis, liver deposition)

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16
Q

5yr old, tetany, bone pain. Widened epiphyses + ‘Cupping’ of metaphysis shown on x-ray.

A

Rickets

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17
Q

What is the minimum amount of time to treat a VTE?

A

3 months

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18
Q

Female - overweight, irregular periods, flare of acne and hirsutism, LH:FSH ratio >3

A

LH:FSH ratio >3 → PCOS

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19
Q

Ovarian tumour with hair. No immature cells seen.

A

Mature teratoma

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20
Q

Mother is a donor for kidney to a child, what is the max number of mismatches possible with HLA class I?

A

Clinically most important
HLA-A
HLA-B
HLA-DR

As two alleles from each, opportunity to match 6 alleles
Maximum of 6 mismatches (MM)
6 MM= bad
0 MM = good

Sibling to sibling:
25% - 6MM
50% - 3MM
25% - 0MM

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21
Q

Neonate with sepsis

A

Group B Streptococcus

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22
Q

HLA B27 positive

A

Ankylosing Spondylitis

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23
Q

HIV +ve, very low CD4 + vascular lesions on trunk

A

HHV8 - Kaposi Sarcoma

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24
Q

Enzyme to confirm cardiac failure

A

Brain Natriuretic Peptide

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25
Q

Liver enzyme raised in MI

A

AST Aspartate aminotransferase

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26
Q

Old man who fell over, been on floor for days. Severely dehydrated. Dark urine. Not blood on microscopy.

  1. What causes the dark urine?
  2. What enzyme will be high (>5x upper limit of normal)?
A
  1. Myoglobin

2. Creatine Kinase

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27
Q

Multiple myeloma and restrictive cardiomyopathy. What will you see on heart biopsy?

A

Amyloid depositions (AL - MM)

AA - RA, ankylosing spongylitis

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28
Q

Abx for MRSA

A

Vancomycin

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29
Q

Macrocytic anaemia, atrophy of body of stomach. What substance are they deficient in that leads to B12 malabsorption?

A

Intrinsic factor (pernicious anaemia)

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30
Q

aphthous ulcers, conjunctivitis, diarrhoea & abdo pain

A

Crohns (non caseating granulomas on histo)

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31
Q

Alcoholic man with recurrent bleeding varices

A

Oesophageal Candidiasis

32
Q

Mexico and ate unpasteurized dairy. 4 weeks later unwell No diarrhoea.

A

Brucellosis - undulant fever (Peaks in evening)

Malaise, rigors, myalgia/arthralgia, tiredness
Incubation - 3-4w

33
Q

Non-Tuberculous mycobacterium, cut on his hand in a man who cleaned a fish tank?

A

Mycobacterium marinum

34
Q

Painless penile ulcer which healed in few weeks, followed by fine snail track oral ulcer

A

Treponema pallidum

35
Q

Low Hb, raised Br (i.e. haemolytic anaemia). Background of SLE. What test is best to determine the cause?

36
Q

Antibody in SLE

A

double stranded DNA

37
Q

Rituximab target

A

Anti CD20 - mature B cells

38
Q

Clostridium Diff Treatment

A

Oral metronidazole 10-14 days (two trials before moving onto vancomycin 10-14d)

39
Q

Oesophageal cancer

A

Adenocarcinoma - a/w Barrett’s, distal 1/3

SCC - a/w ETOH and smoking, middle 1/3

40
Q

Gastric cancer

A

B cell lymphoma a/w H. Pylori

41
Q

Di George

A

CATCH 22

Low T Cells

42
Q

Cancer with keratin and intercellular bridges

A

Squamous cell carcinoma

43
Q

Hep A spread

A

Faeco oral

44
Q

Reaction to penicillin. Which of these drugs will safe?

Piperacillin/tazobactam
Temocillin
Amoxicillin
Co-amoxiclav
Cephalexin
A

Cephalexin

Cephalosporins can be prescribed safely for penicillin-allergic patients.

45
Q

Treatment for CLL with p53 mutation. What is the first line treatment?

● Rituximab
● Imatinib
● Ibrutinib
● Ciclosporin

A

Ibrutinib - Bruton TK Inhibitor

46
Q 
Treatment for CML
●	Rituximab
●	Imatinib
●	Ibrutinib
●	Ciclosporin
A

Imatinib - BCR-ABL TK inhibitor

47
Q

What is the usual prophylaxis for allograft rejection?
● Mycophenolate mofetil, pred, tacrolimus
● Mycophenolate mofetil, pred, azathioprine
● Cyclosporine, tacrolimus and rafamycin

A

Mycophenolate mofetil, pred, tacrolimus???

48
Q 
Which allergy is more likely to present in child than adult? 
●	OAS 
●	Egg
●	Bee
●	Pollen
49
Q

Adalimumab

A

TNFalpha

Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, ulcerative colitis, psoriasis

SE - infection (TB, Hep B/C, lupus-like condition, demyelination, malignancy (lymphoma)

50
Q

Basiliximab

A

Anti CD25

Allograft rejection prophylaxis

51
Q

Denosumab

A

anti-RANKL
Osteoporosis, MM, bone mets
SE - infection, avascular necrosis of the jaw

52
Q

Secukinumab

A

anti-IL-17A
Psoriasis, psoriatic arthritis, ankylosing spondylitis
Infection (TB)

53
Q

Receptor and Co-Receptor

A

CD4 molecule/Ag is the Receptor for HIV-1.

Most infecting strains of HIV-1 use co-receptor molecules (CCR5 and CXCR4) in addition to CD4 to enter target cells.

54
Q

Acquired immunity – antibody

B cells

A

Anti-gp120 and anti-gp41 (Nt) antibodies are thought to be important in protective immunity
HIV remains infectious even when coated with antibodies.

55
Q

Acquired immunity: CD4+ T cells

A

Recognise processed antigen - especially Gag p24 (peptides) - in the context of class II HLA molecules.

56
Q 
What natural antibody against, which confers protective immunity against HIV?
●	HIV - GAG
●	HIV - gp120 
●	CXCR4 
●	Protease
●	Reverse transcriptase
A

Anti gp120

57
Q

What is in urine of a multiple myeloma patient?

A

Bence Jones protein

58
Q 
Which type of embolus is common in cholesterol cleft?
•	Air
●	Fat
●	Amniotic
●	Fluid
●	Atheromatous
A

Atheromatous

59
Q 
Patient with coeliac. What would you see on biopsy?
●	Intraepithelial Leukocytes
●	Intraepithelial Eosinophils
●	Intraepithelial Macrophages
●	Intraepithelial neutrophils
●	Intraepithelial Lymphocytes
A

Intraepithelial Lymphocytes

60
Q 
Newborn baby. DAT +ve, spherocytes seen. Baby jaundiced. Lady is Group A Rhesus negative, Baby is Group O Rhesus positive. Why is baby jaundiced?
●	Hereditary spherocytosis
●	G6PD
●	ABO incompatibility
●	Rhesus incompatibility
A

Rhesus incompatibility

61
Q 
Acquired MAHA. What do you see?
●	Dat +ve spherocytes
●	Dat +ve fragments
●	Dat -ve spherocytes
●	Dat -ve fragments
●	Dat +ve smear cells
A

Dat +ve fragments

62
Q 
Sickle cell patient, spleen not felt. Low reticulocytes, very anaemic.
●	Parvovirus B19
●	Splenic sequestration
●	Normal for SCD
●	Sickle cell crisis
●	???? - other spleen thing
A

Splenic sequestration

63
Q

HTLV1 Virus lymphoma

A

Adult t cell lymphoma/leukaemia

64
Q 
What causes hypertension in upper half of body?
●	Coarctation of the aorta
●	Renal \_\_\_?
●	Renal parenchymal disease
●	Renal vascular hypertension
●	Adrenal hypertension
65
Q

Low glucose, high insulin, low C peptide. High BMI.
● Factitious insulin (was called ‘surreptitious’ insulin)
● Surreptitious gliclazide
● Type 1 diabetes mellitus
● Anorexia nervosa
● Insulinoma

66
Q 
What is low during pregnancy?
●	Fibrinogen
●	Factor 7 (or 8)
●	Protein S
●	Plasminogen activator inhibitor 1
●	Von Willebrand’s factor
A

Protein S (1/2 of basal)

Fibrinogen, Factor 8, Factor 7, vWF = increase = hypercoagulable

Plasminogen activator inhibitor 1 = increase
Protein S = decrease
= hypofibrinolytic

67
Q

Person with low platelets & bruising, fever, confused. What’s going on?
● TTP
● HUS

A

TTP - MAHA, fever, renal impairment, neuro abnormalities, thrombocytopenia

ADAMST3

68
Q 
How does a melanoma spread?
●	Lymphoid
●	Haematological
●	Perineural
●	Iatrogenic
●	Transcoelomic
69
Q

Coeliac malignancy?

A

Enteropathy associated T cell lymphoma (EATL)

70
Q

cANCA Glomerulonephritis and lung changes - lung and kidney changes only?”

A

Wegener’s

Granulomatosis with polyangitis

71
Q

Patient (male) having an elective AAA repair

A

ABO cross match with all Rhesus match

72
Q

Male sickle cell patient receiving regular transfusion

A

?Group in C,E,K crossmatch/anti-CcRR Abs – extended Ab screen

73
Q

Woman who had rhesus-C negative in pregnancy having an elective cesarean (don’t think it actually specified ‘elective’)

A

Group O rhesus negative

74
Q

Lady (was younger woman like teenager) needing emergency blood

A

Group O rhesus negative

75
Q

Man who has had a previous allergic reaction (serum sickness like reaction) to transfusion

A

Washed cells

Sophia's Path (8 decks)

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