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Path Flashcards

1
Q

How to monitor activity of SLE?

A

C3 and C4 levels

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2
Q

How to monitor patient with HIV?

A

WCC and differential.

Viral load is determined by PCR. Used to detect viral RNA to determine if virus is replicating

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3
Q

Antibody to diagnose someone with systemic sclerosis/scleroderma?

A

anti-toposiomerase aka anti-SCL-70

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4
Q

Management of flare of ANCA-assoc. vasulitis?

ie Wengeners, PAN, microscopic polyangitis

A

Induce remission with steroids and cyclophosphamide (or rituximab)
Maintain relapse by weaning off steroids and switch CYC to AZA or MTX (or continue rituximab)
Wean off biologic

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5
Q

Management of rheumatoid arthritis?

A

Induce remission with steroids and methotrexate.
Can add in a biologic like etanercept/infliximab/tocilizumab (based on what is cheapest) if inadequate control.
Rituximab is 3rd line if other dmards fail
Initial treatment is for 6 months then wean down dose as symptoms reduce. Increase if theres another flare.

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6
Q

Monotherapy for RA?

A

can use Adalimumab, etanercept, certolizumab or tocilizumab for monotherapy if methotrexate is contraindicated eg pregnancy or not tolerated

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7
Q

Systemic management of psoriasis?

A

Methotrexate or ciclosporin are first choice non-biologic systemic drugs. Monitor for hepatotoxicity with methotrexate.

If not responding to both, consider anti-TNF (adalimumab, etanercept, infliximab 2nd line) or anti-IL12 (ustekinumab)

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8
Q

Treatment of chronic granulomatous disease?

A

prophylactic trimethoprim and itraconazole.

INF-gamma for immunomodulation

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9
Q

Biologic used in treatment of osteoporosis?

A

Denosumab

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10
Q

how to manage acute attack of swelling in C1 inhibitor deficiency?

A

IV C1 inhibitor.

Chronically reduce freq. with tranexamic acid or regular C1 injections

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11
Q

What is the difference between H1 and H2 antagonists?

A

H1 are used to treat allergic reactions examples cyclizine, loratadine, promethazine, cetirazine
H2 are used to reduce gastric acid secretions egs cimetidine, ranitidine

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12
Q

Which HIV antigen do neutralising antibodies bind to?

A

envelope glycoprotein gp120 and gp41

Very specific to a certain region on HIV1 viruses

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13
Q

Which HIV antigens are non-neutralising antibodies produced against?

A

Most Env (viral envelope protein) are non-neutralising

Anti p24 (caspid protein) are non-neutralising

NB, body can also produce non-neutralising antibodies to monoclonals eg anti-TNFs like etanercept

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14
Q

What coreceptors on T-cells are required for viral entry?

A

CXCR4 and CCR5

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15
Q

What drugs are used for HIV antiviral therapy and how do they work/what is the target?

A

Nucleoside reverse transcriptase inhibitors (nucleoside analogues so competitive inhibition)

Non-nucleoside reverse transcriptase inhibitors (non-competitive inhibition)

Integrase inhibitors inhibit integration of viral DNA into host cell DNA

Protease inhibitors block viral enzyme which cleaves proteins necessary to form mature virions

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16
Q

6 month old with failure to thrive and recurrent infections. T cells undetectable and B cells normal, reduced antibody levels.

A

X-linked SCID.

Defect of IL2 receptor means no t cells and no maturation of B cells

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17
Q

Young person with recurrent episodes of meningococcal sepsis - what is likely immunodeficiency?

A

Complement deficiency. Def of any in the terminal pathway (C3,5,6,7,8,9) predispose to meningococcus and pneumococcus

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18
Q

What is the likely deficiency if CH50 test only is abnormal?

A

C4 most likely. Could be C1 or 2

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19
Q

What is the likely deficiency if AP50 test only is abnormal?

A

Factor B, I or P

Predisposes to encapsulated bacterial infection

Hib, pneumococc, meningococc, GBS, klebsiella, salmonella, e.coli

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20
Q

What vaccines should be avoided in the immunocompromised?

A 
Live vaccines:
Smallpox
Yellow fever
Typhoid
Chickenpox
MMR (still give in HIV unless severely immunocompromised)
BCG
oral polio (sabin)
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21
Q

What vaccine is given to asplenic patients and repeated every 5 years?

A

pneumovax

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22
Q

What vaccine is part of routine schedule but avoid in immunodeficiency?

A

MMR

ok in HIV or diGeorge if no evidence of severe immunocompromise

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23
Q

Which vaccine is a component vaccine consisting of viral haemagglutinin?

A

influenza

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24
Q

What are the target INRs for warfarin therapy?

A

2.5 (2-3) for most indications eg VTE, AF, biologic prosthetic valve etc
A target of 3 (2.5-3.5) is indicated for a mechanical aortic valve
A target of 3.5 (3-4) is indicated for a VTE while on anticoagulants or a mechanical mitral valve

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25
Q

warfarin overdose, INR 5-8 with no bleeding

A

stop warfarin restart when under 5

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26
Q

Warfarin overdose INR 5-8 with minor bleed

A

Stop warfarin, slow Vit K IV. Restart warfarin when INR

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27
Q

Warfarin overdose, INR>8 with no bleed

A

Stop warfarin, seek specialist advice, Oral Vit K. Repeat in 24hr if INR still high. Restart warfarin if INR

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28
Q

Warfarin overdose, INR>8 with minor bleeding

A

Stop warfarin. Arrange admission for IV Vit K. Daily INR check. Restart warfarin when INR

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29
Q

Warfarin overdose (INR above therapeutic range) and major active bleeding

A

Stop warfarin, Urgent admission. IV Vit K and dried prothrombin complex (Factors II, VII, IX, X)

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30
Q

Immediate transfusion reaction where patient has a high fever

A

Bacterial contamination. If temp rises above 39C or by more than 2C

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31
Q

Immediate transfusion reaction where patient has anaphylaxis. Has had another transfusion years ago

A

IgA deficiency

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32
Q

Patient suffers acute sever trauma, transfused with O- blood as emergency. Then loses consciousness a few mins after transfusion

A

Most likely internal hemorrhage

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33
Q

Immediate transfusion reaction, sudden onset dyspnoea with hypotension

A

TRALI

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34
Q

Immediate transfusion, sudden onset dyspnoea. Normotensive or hypertensive. Raised JVP

A

TACO -(fluid overload)

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35
Q

Immediate transfusion reaction. Fevers, chills, pain at site of transfusion, nausea/vomiting, BP drop, dark urine.
Confusion or possibility for error in samples sent

A

ABO incompatibility - acute haemolytic reaction. STOP transfusion. IV saline and diuretics. Keep blood for testing

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36
Q

Immediate transfusion reaction. Fevers, chills. Temp rise by less than 1C

A

Febrile reaction. Give paracetamol. Dont stop transfusion

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37
Q

Most common hereditary thrombophilic disorders

A

Factor V Leiden

Prothrombin G20210A

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38
Q

Rarer hereditary thrombophilias

A

Antithrombin III deficiency,
Protein C deficiency
Protein S deficiency

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39
Q

Recurrent miscarriages, hypercoagulable, assoc with SLE

A

Antiphospholipid syndrome

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40
Q

Pregnant woman develops seizures. Shes anaemic and jaundiced. Schistocytes seen on blood film. Febrile with neuro syx. PT and APTT normal

A

TTP/HELLP syndrome.

NOT DIC b/c of neuro symptoms and normal coagluation cascade (dysregulated in DIC)

The clots in TTP are aggregated platelets cf DIC where they are fibrin clots

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41
Q

Pregnant woman. Chorioamnionitis. Becomes septic. Bruises form. PT and APTT prolonged.

A

DIC

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42
Q

30/40 pregnant lady. Antenatal care all normal. Develops nosebleeds/bleeding gums/easy bruising. Otherwise well.

A

Gestational thrombocytopenia.

Occurs in mid 2nd trimester onwards

May present asymptomatically with diagnosis on routine FBC (eg 28-week second screed)

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43
Q

Child with recurrent infection. Normal CD8 levels and absent CD4

A

Bare Lymphocyte Syndrome type 2

Type 1 is rarer. Deficient in CD8 and normal CD4

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44
Q

Boy presents at 1 yr with recurrent infections and failure to thrive. High levels of IgM. Low IgA and IgG. What is the deficiency?

A

CD40L deficiency. Causes Hyper IgM syndrome

CD40L def is X-linked recessive. Other types can be autosomal recessive

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45
Q

Person with normal Hb and positive sickle solubility test

A

Sickle cell trait

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46
Q

Patient with low Hb and positive sickle solubility test

A

Sickle cell anaemia

trait would have normal Hb

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47
Q

African man becomes jaundiced and anaemic after taking primiaquine and chloroquine for malaria

A

G6PD deficiency. X-linked. Drug trigger

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48
Q

Older man with splenomegaly, fatigue and anaemia. Peripheral film shows polychromasia and spherocytes

A

Hereditary spherocytosis

Polychromasia = reticulocytosis

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49
Q

55yr old woman. Incidental finding of isolated platelet count >600. On further questioning, she has noted gum bleeding and headaches/dizziness. She has mild splenomegaly.

A

Essential thombrocythema.

Treat with aspirin (antithrombosis) Anegrelide (inhibits platelet formation) and hydroxycarbamide (anitmetabolite and BM suppression)

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50
Q

3-month old admitted for pneumonia. White cells are up, Platelets are 510. What is the cause of the thrombocytosis?

A

Reactive (secondary) thrombocytosis

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51
Q

70 yr old man is feeling increasingly tired. Bloods show he is anaemic and has raised platelets and neutrophilia

A

CML

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52
Q

A vegetarian lady presents feeling tired. She has a low Hb and platelets are 470

A

Iron deficiency raises platelets

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53
Q

An afrocarribbean boy has anaemia and a raised platelet count and a palpable spleen

A

Sickle cell causes hyposplenism, which can cause a reactive thrombocytosis

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54
Q

A man has a routine hernia repair. After the surgery his platelets go up

A

Reactive thrombocytosis secondary to surgery

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55
Q

Infection in pregnancy: what is a flagellate protozoan that can cross the placenta?

A

Toxoplamsa gondii

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56
Q

Infection in pregnancy - what is an STI previously beleived to only cross the placenta in the third trimester?

A

syphilis

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57
Q

Infection in pregnancy that can be teratogenic if mother eats unpasteurised cheeses?

A

Listeria

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58
Q

Normal maternal commensal that can cause neonatal sepsis

A

GBS

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59
Q

STI that can cause neonatal conjunctivitis

A

Chlamydia or gonorrhoea

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60
Q

Most common UTI

A

E. Coli

61
Q

Most common UTI in young women

A

E. Coli

62
Q

What would suggest contamination of an MSU sample?

A

epithelial cells on microscopy

63
Q

What would suggest coliform organism causing UTI?

A

Nitrites

64
Q

A man presents with pyelonephritis and renal stones. What is the likely organism?

A

Proteus (increases alkalinity which causes struvite and calcium carbonate stone formation)

65
Q

A child is born with hydrocephalus, chorioretinitis and intracranial calcifications

A

congenital toxoplasmosis

66
Q

A child is born with microcephaly, retinitis and intracranial calcifications

A

congenital CMV

67
Q

Rice water stool

A

CHolera

68
Q

a 30 yr old presents with clusters of nodules and papules on his hand. He installed a fish tank in his home 3 weeks ago. It is diffucult to grow, and eventually cultured at 33C

A 
Mycobacteria marinarum (aquarium granuloma)
Classically on the elbows and knees when assoc with swimming pools. Hands for fish/pet shop owners
69
Q

a man returns from africa with a scaling ulcer on his arm. He thinks we was bitten by an insect. Diagnosis confirmed by PCR

A

cutaneous leishmaniasis. L. major or L. tropica

70
Q

RUQ pain and fever in traveler returning from thailand

A

HAV

71
Q

early onset neonatal sepsis

A
72
Q

late onset neonatal sepsis

A

> 48hrs
coag negative staph, GBS, e coli, listeria
Give fluclox and gent.
taz and vanc 2nd line

73
Q

3 month old with sepsis and irritability. LP microscopy shows gram +ve bacilli

A

Listeria monocytogenes. Amoxicillin

74
Q

Meningitis, G -ve cocci

A

meningococcus

75
Q

Smoker, Meningitis, G+ve cocci in chains

A

strep. pneumoniae

76
Q

neonate, meningitis, G -ve rods/bacilli

A

E.coli (gent)

77
Q

Commonest cause of gastroenteritis

A

Rotavirus

78
Q

What investigation would you order to confirm C diff

A

ELISA is quick but not as sensitive as culture, which takes longer and should only be done if watery diarrhoea
ELISA shows toxin A

79
Q

How to confirm salmonella/shigella in patient with diarrhoea after a barbeque?

A

Stool culture

80
Q

Commonest cause of gas gangrene?

A

Clostridium perfringens

Limb is oedematous, discoloured, necrotic bullae. Crepitations may be heard on palpation

81
Q

Commonest causes of cellulitis?

A

Group A strep (pyogenes), Staph aureus

82
Q

Red, swollen, warm, well-demarcated erythematous rash, blistering, patient feverish. ASOT positive

A

Erysepelas.

Caused by GAS (strep pyogenes)

83
Q

Soldier returns from afghanistan. Has a skin lesion

A

cutaneous leishmaniasis

84
Q

DRug regime for HepB?

A

PegINF alpha, entecavir, tenofovir

85
Q

Drug regime for HepC?

A

PegINF alpha and ribavirin

86
Q

Prophylaxis for vertical transmission of HIV?

A

Nevirapine

Given with zidovudine as well

87
Q

antiviral for CMV

A

gancivlovir or valganciclovir

88
Q

antivirals for HSV

A

Act Very Fast

acyclovir, valacyclovir, foscarnet

89
Q 
Normal Ranges for Blood gases?
pH
CO2
Bicarb(HCO3)
O2
Anion gap?
A 
pH: 7.35-7.45
CO2: 4.7-6.0 kPa
Bicarb: 22-30 mmol/l
O2: 10-13 kPa
Anion gap 14-18
90
Q

Vegan lady feels tired. Shes anaemic with normal ferritin. Whats the cause?

A

B12 deficiency

91
Q

A patient lacks intrinsic factor and feels tired. Whats the cause

A

pernicious anaemia- B12 deficieny. Anti-IF or anti-gastric parietal cell antibodies

92
Q

A woman with hypothyroidism, T1DM, and adrenal failure has a routine blood film that shows anaemia. Why?

A

B12 deficiency. Multiple autoimmune endocrinopathies means likely to be pernicious anaemia

93
Q

A patient with Crohns has a megaloblastic anaemia. Why?

A

B12 deficiency. Terminal ileum commonly affected and required for B12 absorbtion. But could be IDA or anaemia of chronic disease

94
Q

Patient has low calcium, low phosphate, high PTH and high ALP. Whats the cause?

A

Vit D deficiency causing 2nd hyperparathyroidism

95
Q

Isolated raised ALP

A

Pagets disease, pregnancy

96
Q

Raised ALP and raised GGT

A

Cholestasis eg gallstones

97
Q

Raised transferases. AST:ALT ratio 2:1, raised GGT

A

alcoholic liver disease

98
Q

Raised transferases. AST:ALT ratio 1:1

A

Viral hepatitis

99
Q

Patient with bowel cancer has raised GGT

A

Metastases

100
Q

A boy presents with intellectual disability, involuntary movements and self-harming behavours. He is found to have megaloblastic anaemia and hyperuricaemia. His mother has a history of gouty arthritis. What enzyme does he lack?

A

Hypoxathine-guanine phosphoribosyltransferase (HGPRT)

This is Lech-Nyhan syndrome. X-linked recessive disease defined by triad of neurological dysfunction, cognitive/behavioural problems and hyperuricaemia.

101
Q

What enzyme is needed for the rate-limiting step in haem synthesis?

A

ALA synthase

102
Q

What metalloprotein is raised in Beta thalassemia?

A

HbA2

103
Q

A boy presents with hyperkalemia. What enzyme defect could cause this?

A

21-alpha hydroxylase deficiency (CAH)

104
Q

What enzyme is raised in mumps infection?

A

Amylase. Also raised in pancreatitis

105
Q

A 70-yr old lady who lives alone fell and broke her hip on Saturday morning. She couldn’t get up and was found two days later when her carer came on Monday. What enzyme will be raised?

A 
Creatine Kinase (CK-MM)
Rhabdomyolysis
106
Q

What biochem results would you expect in osteomalacia?

A

low calcium, low phosphate, hight PTH, high ALP, low vit D

107
Q

What biochem results would you expect in osteoporosis?

A

Normal bone studies

108
Q

What biochem results would you expect in primary hyperparathyroidism?

A

high calcium, high or normal PTH

109
Q

What calcium results would you expect in squamous cell carcinoma?

A

High calcium, low PTH (appropriately suppressed)

110
Q

What biochem results would you expect in primary hypoparathyroidism?

A

Low calcium, Low PTH/normal PTH (PTH should be high if calcium is low)

111
Q

What potassium would you expect in untreated DKA?

A

raised potassium (>5.5)

112
Q

How do you calculate osmolarity?

A

2(Na+K)+urea+glucose

113
Q

Formula for anion gap?

A

Na+K-Cl-HCO3

114
Q

Formula to calculate GFR/creatinine clearance?

A

(urine creatinine concentration * urine output in ml/min)/plasma creatinine concentration

115
Q

What bicarb would you expect in pyloric stenosis?

A

High (>30)

116
Q

What values would indicate impaired glucose tolerance?

A

7.8-11.0 inclusive

117
Q

What values would indicate impaired fasting glucose? (WHO)

A

6.1-6.9 inclusive

118
Q

What U+Es would you expect in HONK?

A

osmolarity >320, hypernatremia, hypokalaemia, glucose high, acidotic, low bicarb

119
Q

What U+Es would you expect in DKA?

A

Na may be high bc of dehydration, low because of interference in assay by glucose and ketones or normal
K will be high if untreated, will fall with treatment

120
Q

What U+Es would you expect in diabetes insupidus?

A

High sodium.

121
Q

What U+es would you expect in Conns syndrome?

A

High sodium, low K, hyperosmolar

122
Q

Occupational lung disease leading to fibrosis. Tends to affect the upper lobes

A

Pneumoconiosis
Most types affect the upper lobe
Asbestosis tends to affect the lower lobe

123
Q

Occupational lung disease. Farmer with progressive SOB, dyspnoea, cough and weight loss. Finger clubbing noted

A

Extrinsic allergenic alveolitis

Acute form presents with fever, chills and cough hours after inhaling allergen

124
Q

Smoker with progressive cough, lethargy and neuro signs. Bloods show low sodium

A

Small cell carcinoma causing SIADH

125
Q

75 yr old ex-construction worker presents with progressive dyspnoea and weight loss. CXR shows a large right sided pleural effusion

A

Mesothelioma

Assoc w/ Asbestos exposure. 25-40yr latent period

126
Q

Indictions for colectomy in UC

A

Dysplasia or adenocarcinoma found on screening biopsy
Uncontrollable symptoms/failed medical management
Systemic complications from medication
Toxic megacolon

127
Q

What would you see on histology in Crohns disease?

A

non-caseating granuloma, transmural inflammation

128
Q

Man is investigated for longstanding diarrhoea. Continuous lesion seen on sigmoidoscopy. Whats the diagnosis?

A

UC

129
Q

In what disease is serum Copper high, causing basal ganglia toxicity?

A

Wilsons.

Can cause parkinsonism, psychosis and dementia

130
Q

What disease is ANA positive and liver biopsy shows lymphocytic infiltration?

A

autoimmune liver disease

131
Q

A patient has portal hypertension and on biopsy his liver shows micronodular cirrhosis

A

alcoholic cirrhosis

132
Q

a 40 yr old woman presents with fatigue, itching and abdominal discomfort. ALp is raised, Antimitochondrial antibody is positive, US shows no dilatation of the ducts and biopsy shows bile duct loss with granuloma formation

A

Primary biliary cirrhosis

133
Q

Man with UC presents with jaundice. Liver ultrasound shows bile duct dilatation. ERCP shows beading fo the bile ducts

A

Primary sclerosing cholangitis

134
Q

Cushingoid features. High serum cortisol with low serum ACTH. Cortisol fails to suppress after high dose dexamethason

A

Cortisol-producing adrenal tumour

135
Q

Which thyroid cancer is associated with the RET protooncogene?

A

Medullary

136
Q

What substance may be found deposited in pancreatic islets that may cause T2DM?

A

Amyloid

137
Q

A 55yr old woman with large hands presents with diarrhoea and a neck mass. FNA shows calcitonin staining

A

medullary thyroid cancer.
Mostly caused by MEN2 or familial MTC (RET mutation)
Calcitonin can be used as treatment marker. Radioidine isnt useful

138
Q

30 yr old woman presents with a single asymptomatic neck lump. FNA shows mixed papillary and follicular architecture, clearing of cytoplasmic chromaffin and pathognomic nuclear changes.

A

Papillary carcinoma. Can be difficult to differentiate from follicular as can have mixed or entirely follicular histology. Diagnosis is looking for nuclear signs like nuclear overlapping,

139
Q

Young woman with mobile breast mass

A

fibroadenoma

140
Q

Endometrial cancer that presents in perimenopausal women and is related to oestrogen excess

A

Type 1 (endometrioid) endometrial cancer

141
Q

Endometrial cancer that presents in elderly women with endometrial atrophy

A

Type2 (non-endometrioid) endometrial cancer

142
Q

40 yr old woman presents with bloody nipple discharge and no palpable mass

A

Duct papilloma

143
Q

70 yr old woman presents with a hard, craggy breast mass. On examination there is nipple retraction and peau d/orange

A

Invasive ductal carcinoma (most common invasive breast carcinoma)

144
Q

65 yr old woman presents with rough, reddened skin and a fissure on her nipple. It hasn’t responded to emollients or corticosteroids

A

Paget’s disease of the breast

Begins with eczema-like rash. May have discharge or a burning sensation. Can progress to nipple inversion and breast changes

145
Q

What would you expect to see on post-mortem of a person with alzheimers

A

Tau protein, beta-amyloid plaques

146
Q

Thunderclap headache, berry aneurisms. Assoc with PKD and ehlers-danlos

A

subarachnoid haemmorhage

147
Q

patient hit head a few days ago. Presents with fluctuating consciousness

A

subdural

148
Q

35 yr old man has a 3 month history of anxiety and paranoia. He now presents with glove and stocking numbness and ataxia. He is not a vegetarian.

A

variant CJD.
From exposure to BSE.
neuro signs include peripheral neuropathy, ataxia, chorea and dementia

Stuff (12 decks)

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