Path past papers Flashcards
What presents with centrocytes and centroblasts on histology
Follicular NHL
Physiologically what causes an increased ESR
Fibrinogen
Acute phase proteins
Immunoglobulins
What is glanzmanns thrombasthenia
Inherited lack of Glp11b/111a leading to defective platelet aggregration
What is most common cause of death in myelodysplastic syndromes
Bacterial infection
What antibodies are indicated in GBS
Anti-ganglioside LM1
Recurrent episodes of flushed face and breathing problems with hepatomegaly
Hereditary angioedema
Acute GvHD post-allogeneic haematopoietic stem cell transplant is mediated by which cell type?
Donor T cells
Which class of antibiotics has concentration dependent killing (i.e. the goal of therapy is to maximise peak > MIC)
Aminoglycoside and fluoroquinolines
What is the commonest cause of portal vein thrombosis?
Liver cirrhosis
What is stain for cryptococcus
India ink- see yeast cells surrounded by halos
Stain for chlamydia
Giemsa stain
Causes of fanconi syndrome
Congenital
Wilsons
Myeloma
Lead poisoning
Tetracyclines
Pseudohypoparathyroidism/albright hereditary osteodystrophy presentation
Resistance to PTH
- low calcium
- high phosophate
- high PTH
Short 4th and 5th metacarpals
Which brain tumour has psammoma bodies in
Meningioma
What respiratory condition is characterised by airspace enlargement and alveolar wall destruction?
Emphysema
What are codfish vertebrae, pepper pot skull and looser zones seen in
Osteomalacia
Proportion of thyroid transported in blood
Thyroglobulin binding globulin 75
Thyroxine binding prealbumin 20
Albumin 5
Free 0.03
How are streptoccus infections split up
Into alpha or beta haemolytic
Incubate on blood agar
- partial haemolysis is alpha (green)
- complete haemolysis is beta (clear)
Beta haemolytic then split into lancefield groups based off antigens on cell membrane
How does reticular dysgenesis present
Severe life threatening infections
Profound sensorineural deafness
What are hyperlobated nuclei (flower cells) seen in
Adult T cell lymphoma
What is nucleolar pattern immunofluorescence associated with
Diffuse systemic sclerosis
What is somatotrophin
GH
How are macrophages described in granulomas
Epithelioid as develop intracellular organelle growth
Rank these as cause of HAI
A. Skin and soft tissue
B. Surgical site
C. Urinary tract
D. Hospital acquired pneumonia
E. Gastrointestinal system
1 - E. Gastrointestinal system
2 - C. Urinary tract
3 - D. Pneumonia/ LRTI
4 - B. Surgical site
5 - A. Skin and soft tissue
Rank as cause of anaphylaxis
A. Eggs
B. Penicillin
C. Banana
D. Gliadin
E. Peanut
1 - E. Peanut
2 - B. Penicillin
3 - A. Eggs
4 - D. Gliadin
5 - C. Banana
Rank from narrow to broad spectrum
A. Meropenem
B. Benzylpenicillin
C. Co-amoxiclav
D. Tazocin
E. Amoxicillin
1 - B. Benzylpenicillin
2 - E. Amoxicillin
3 - C. Co-amoxiclav
4 - D. Tazocin
5 - A. Meropenem
How would you manage renal failure in a patient with Myeloma?
Haemodialysis
A man presents with a midshaft femur fracture without a serious history of trauma. What may have caused this?
Likely metastases
A patient with HIV presents with signs of raised ICP and new onset epilepsy. What is the most likely diagnosis?
Primary CNS lymphoma
A patient with pneumonia has a CXR, which shows a bat wing appearance. What is the most likely causative organism?
PJP
In which breast cancer are Indian Files seen?
Invasive Lobular
In which breast cancer are empty spaces seen?
Mucinous invasive
Which stain is used to distinguish Squamous Cell Carcinomas from Adenocarcinomas?
P40
Name one mutation that is associated with Type I endometrial carcinoma.
PTEN
What are the stages of lobar pneumonia?
Congestion- fluid everywhere
Red hepatisation- neutrophils
Grey hepatisation- fibrosis
Resolution- macrophages
In which condition might you see a proliferative synovitis, with pannus formation and grimley sokoloff cells on histology?
RA
What is the most common genetic predisposition to brain tumours?
Neurofibromatosis
Which brain cancer displays ‘round cells with clear cytoplasm’ (fried egg appearance)
Oligodendroma
Which brain cancer shows ‘small blue round cells’ and ‘Horner-Wright Rosettes’?
Medulloblastoma
What do TH1 cells release
IL-2
IFN-Gamma
How to differentiate between IDA and beta thalassaemia on blood film
Basophillic stippling in beta thalassaemia
What are gram negative coco bacilli
Haemophilus
Bordatella
Pseudomonas
Chlamydia
Brucella
Ribavirin MOA
Nuceloside analogue
What haem condition is associated with ADAMTS13 mutations other than TTP
MAHA
If have gout in knee, poisoning with what leads to it
Lead
Difference between NF1 and NF2
NF 1- astrocytomas, neurofibromas and optic gliomas
NF2 - vestibular schwannomas, meningiomas, ependymomas and astrocytomas
Which Parkinson Plus syndrome is associated with early falls, axial rigidity, akinesia, dysarthria and dysphagia?
Progressive supranuclear palsy
Which tumour is ventricular, and associated with hydrocephalus?
Ependyoma
Which brain tumour is soft, gelatinous and calcified?
Oligodendroma
Which bacteria is caught through reheated meats, causes diarrhoea and cramps and may cause gas gangrene?
Clostridium perfringens
How does the mannose binding pathway work?
MBL binds to microbial cell surface carbohydrates, which stimulates C2/4 of the classical pathway
Role ofTH17 cells
Help neutrophils
Which immunohisto stain targets epithelial cells?
Cytokeratin
How do renal tubular acidosis type 1 and 2 cause acidosis
T1- Can’t excrete H+
T2- can’t reabsorb bicarb
When is Urobilinogen raised
Pre-hepatic
What is the most common radiolucent cause of nephrolithiasis?
Uric acid
What does Hyxroxycarbimide do?
Increase foetal Hb
When is Vitamin K indicated?
INR over 5 and bleeding
INR over 8 and not bleeding
Which T Cell lymphoma is most aggressive?
Anaplastic
Which hypersensitivity type is Chronic urticaria?
T2
Which stain is used for Alpha-1-antitrypsin deficiency?
Periodic acid schiff
A patient presents with a rash and coryzal symptoms. They are found to have a basophilia on blood film. Which class of virus are they most likely to be infected with?
Poxvirus
What is mutation in reticular dysgenesis
Adenylate kinase 2
A patient presents with descending paralysis. he reports visiting a farm recently and trying their honey. What is the most likely causative organism?
Clostridium botulinum
A patient presents with a chronic productive cough. Biopsy shows dilatation of the airways, goblet cell hyperplasia and hypertrophy of mucous glands. What is the most likely diagnosis?
Chronic bronchitis
A child presents with episodes of cough and wheeze, with associated dyspnoea. They have a history of eczema. Histology shows whorls of shed epithelium, eosinophils and Charcot-Leyden Crystals. What is the most likely diagnosis?
Asthma
How is Campylobacter treated?
Erythomycin/ciprofloxacin
How might Myasthenia Gravis be treated?
Neostigmine and plasmapharesis
Which inherited disorder of metabolism can lead to recurrent E coli infections
Galactossaemia
What is cerebral salt wasting syndrome and result
In context of intracranial pathology get impaired sodium loss from kidney with depletion of extracellular volume
Urinary sodium HIGH
Preferred drug for resistant SIADH
Tolvaptan
Euvolaemic hyponatraemia with low urinary sodium
Psychogenic polydipsia
Effect of high glucose on osmolality in hyponatraemia
Hyperosmolar
When investigating sodium imbalances what investigation order for diagnosing SIADH
Paired serum and urinary osmolalites
First investigation if hypokalaemia
Serum magnesium
When interpreting hyperkalaemia what is important thing to consider
Is it spurios- does it fit with clinical picture
Rank these as hypercalcaemia
Osteoporosis
Parathyroid carcinoma
Osteomalacia
Primary hyperparathyroidism
Secondary hyperparathyroidism
Secondary hyperparathyroidism
Osteomalacia
Osteoporosis
Primary hyperparathyroidism
Parathyroid carcinoma- extremely high as autonomous PTH
Differentiating atrophic hypothyroidism from hashimotos
No goitre in atrophic
Antibodies present in hashimotos
What is given in a myxoedema coma
Liothyronine which is active T3
What is sick euthyroid
In severe illness body tries to shut down the thyroid to conserve energy
Get low T4 and high TSH but then TSH drops too
What is a pituitary macroadenoma most likely
Non functional
Microadenomas tend to be functional
What cancer associated with acromegaly
Colorectal
What is used to treat ectopic cushings
Ketoconazole or metyrapone
CYP450 inhibitors
What is nelsons syndrome
If remove adrenals and pituitary tumour is cause then it will grow uncontrollably
Most common cause of conns
Bilateral adrenal hyperplasia
What is difference between what produced between neuroblastoma and phaeochromocytoma
Neuroblastomas produce noradrenaline
Phaeos produce adrenaline
What is liraglutide
Incretin/ GLP-1 inhibitor
Management of HHS
NaCl 0.9%
Only add insulin if ketones present
What is visual defect with pituitary tumours
Bitemporal inferior quadrantopia
Best invstigation for suspected parathyroid adenoma
Technetium 99 scan
When can not do skin prick tests
History of recent anaphylaxis
Skin conditions like eczema
Cant stop taking antihistamines
Bleeding pattern of VWB vs haemophilia
VWB- epistaxis and easy bleeding
Haemophilia- deep bleeding in joints in particular
When is Ph chromosome present
ALL
CML
What is ecluzimab
Antibody against C5
Severe childhood SLE symptoms with normal C3 and C4 levels, what is diagnosis
C1q deficiency/C2 deficiency
Which breast cancer associated with pagets disease of the breast
Ductal
Rashes in secondary syphilis
Condyloma acuminate
Rash on soles and palms
What beta lactam has anti-pseudomonal activity
Carbapenems
Tazocin
Ceftazidine
Do tazocin or co-amoxiclav anti-pseudomonal abilities
Tazocin yes
Co-amoxiclav no
What happens to the body of the stomach in a patient with pernicious anaemia
Atrophy
Patient with HIV, raised ICP, new onset epilepsy
CNS lymphoma
Patient with HIV, raised ICP, new onset epilepsy
CNS lymphoma
Hypertensive and diabetic, with angioedema
Think that they are on ACEi so get hereditary angioedema
Jaundice rash and diarrhoea post transfusion
GVHD
What is screening test for SCD
Sickle solubility
If goes cloudy then sickle cells present
Man gets swollen lips when blowing up balloons
Latex hypersensitivity
Incubation periods of the gastroenteritis causes
1-6 hrs: Staphylococcus aureus, Bacillus cereus*
12-48 hrs: Salmonella, Escherichia coli (watery camper)
48-72 hrs: Shigella (bloody), Campylobacter (hayfever campylo (flu prodrome) + (diarrhoea can be bloody))
7 days: Amoebiasis (Bloody), Giardiasis (Non-bloody diarrhoea)
Diarrhoea and flu like symptoms
Campylobacter
What amylase is raised in mumps vs pancreatitis
Mumps- amylase S
Pancreatitis- amylase P
What are blood results of pseudohypoparathyroidism
Same as secondary hyperparathyroidism
Low Ca
High ALP
High phosphate
Caused by failure of kidney to recongise PTH
Management of lupus nephritis
Mycophenolate
Differentiating primary hyperparathyroidism and familial hypercalcaemia
Low urinary calcium in familial hypercalcaemia
- Which of these can cause peri/neonatal illness without causing damage to the foetus if the mother is infected antenatal?
a. Cytomegalovirus (CMV)
b. Herpes Simplex Virus (HSV)
c. Enterovirus
d. Varicella Zoster Virus (VZV)
e. Rubella
Enterovirus
What does RANKL stand for
Receptor activator of nuclear factor kappa-B Ligand
What is the amyloid in alzheimers vs T2DM
Alzheimers= amyloid B
T2DM= amyelin
What are burr cells (echinocytes) seen in
Renal disease
What is in von hippel lindau syndrome
Haemangiomas
- brain
- kidney
- retina
- adrenals
- Man with macrocytic anaemia, atrophy of body of stomach. What substance are they deficient in that leads to B12 malabsorption?
Intrinsic factor
- Previous IVDU man is given Rituximab - CHOP treatment for Non-Hodgkin’s lymphoma. He later 8 months later develops fulminant liver failure and dies. Why?
Hepatitis B
Starts a drug then get oral ulcers
Stephen johnsons syndrome
What are the neutralising antibodies in HIV
Anti-gp41 (IgM)
Anti-gp120 (IgG)
What are non-neutralising antibodies in HIV
Anti-p24 GAG
What are GAG and gp41
GAG- provides HIV structural support
gp41- provides conformational change after gp120 initial binding
Which macrophage produces chemokines neutralise HIV
MIP-1a
MIP-1b
RANTES
Most common cause of acute pancreatitis?
Gallstones
What is the definition of herd immunity threshold
1-(1/R0)
R0= basic reproduction number
- Insulinoma. What would you find?
Low cortisol, low FFAs, low pro-insulin, low glucagon, low c-peptide
Low FFAs
What level of platelets aim for to prevent bleeding in surgery
Over 50
Over 100 if critical location like eye or CNS
What level of platelets give transfusion if bleeding
30
Definitive host of toxoplasmosis
Cats
Sore throat with exudate and elevated liver enzymes
EBV
What are 4 types of viruses
DNA
- herpes and polyomaviridae
Reverse RNA
- Hep b anf HIV
Positive sense RNA
- coronaviridae
- picornoviridae- hep a and polio
- flaviviridae- hep c, dengue, rubella, zika
Negative sense RNA
- measles, mumps, RSV and flu
What is nystatin
Polyene like amphotericin B
What is histology of pseudosac
Collection of fluid in FIBRINOUS sac
Renal mass with classic brown mahogany lesion with central scar
Oncocytoma
Ovarian mass with Coffee bean nuclei
Brenner tumour
What are features of leydig cell tumours in males
Precocious puberty
Reinke crystals
DIGGING FOR CRYSTALS
Features of yolksac tumours
Secretes AFP
Schillder duval bodies
What is first line for taking swab for chlamydia
If doing speculum then endocervical
If not then vulvovaginal
If partner comes back as saying has tested positive for chlamydia what do
Treat and get tested simultaneosuly
WHich macrolide use in pregnancy
Erythomycin
What is main component of cryoprecipitate
Factor 8
What are the 2 types of brain oedema
Vasogenic- breakdown in blood-brain barrier
Cytotoxic- from cellular injury
WHich chronic hepatitis will cause fatty changes
C
Which drug can cause post transplant lymphoproliferative disease
Ciclosporin
Which drug reduces IgG
Rituximab
MOA of remdesivir
Nucleoside analogue used to inhibit RNA polymerase
What is test for latent TB
IGRA- interferon gamma release assay
Diagnostic test for mycoplasma
Serology or cold agglutin
How can staphylococcal toxic shock rash present
Desquamating in particular on hands
Hepatitis after eating seafood
Hepatitis E
Management of non typhoid salmonella and shigellosis
Ciprofloxacin
Management of acute heamolytic reaction
Stop transfusion
IV fluids
Take bloods for coombs
What causes white patches on tongue in immunosuppressed patient
Oral hairy leukoplakia caused by EBV
Rank the following in order of highest to lowest reticulocyte count
Anaemia secondary to low dose myelosuppressive chemotherapy
Hereditary spherocytosis
ITP
Occult GI blood loss
Severe aplastic anaemia
Anaemia secondary to low dose myelosuppressive chemotherapy – 4
Hereditary spherocytosis – 1
ITP – 3
Occult GI blood loss – 2
Severe aplastic anaemia- 5
62 y/o woman attends GP with tachycardia and fatigue. FBC chows macrocytic anaemia, thrombocytopenia, and neutropenia. The blood film shows neutrophils have reduced granularity and lobation, and there is no polychromasia. Rank the following in likelihood of being the diagnosis:
Aplastic anaemia
Autoimmune thrombocytopenic purpura
B12 deficiency
Chronic lymphocytic leukaemia
Myelodysplastic syndrome
Aplastic anaemia – 2
Autoimmune thrombocytopenic purpura – 4
B12 deficiency – 5
Chronic lymphocytic leukaemia – 3
Myelodysplastic syndrome - 1
Rank the cancers below from most to frequent as a cause of death of men in the UK
Breast
Colon
Head and neck
Lung
Prostate
Breast – 5
Colon – 3
Head and neck – 4
Lung – 1
Prostate – 2
72 y/o Afro-Caribbean woman is admitted with acute SOB. PMHx includes hypertension and T2DM. She takes Metformin, Atorvastatin, and Amlodipine. O/E BP is 148/96. Auscultation reveals a 3rd heart sound and bibasal crackles, but no murmurs.
Investigations:
Sodium 142
Potassium 3.5
Urea 12.4
Creatinine 126
Rank the following diagnoses from most to least likely:
Essential hypertension
Cushing’s syndrome
Conn’s syndrome
Phaeochromocytoma
Addison’s disease
Essential hypertension - 1
Cushing’s syndrome - 3
Conn’s syndrome - 2
Phaeochromocytoma - 4
Addison’s disease - 5
Rank the following in order of efficacy at reducing LDL:
Atorvastatin
Bezafibrate
Evolocumab
Prednisolone
Simvastatin
Atorvastatin – 2
Bezafibrate – 4
Evolocumab – 1
Prednisolone – 5
Simvastatin – 3
55 y/o woman develops dry mouth and eyes alongside fatigue and arthralgia of the small joints in her hands. Investigations:
Urate normal
ESR 64 (raised)
IgG 22 (raised)
Rheumatoid factor 120 (raised)
Anti-CCP antibody 0.9 (negative)
Speckled anti-nuclear antibody titre 1:640 (raised)
Rank the following diagnoses by likelihood:
Gout
Osteoarthritis and keratoconjunctivitis sicca
Osteogenesis imperfecta
Primary Sjogren’s syndrome
Rheumatoid arthritis
Gout – 4
Osteoarthritis and keratoconjunctivitis sicca – 2
Osteogenesis imperfecta – 5
Primary Sjogren’s syndrome – 1
Rheumatoid arthritis – 3
22 y/o woman presents with mild SLE. Rank the following test results by likelihood of appearing in this case:
Absent IgG
Low complement C3
Positive ANA
Positive C3 nephritic factor
Positive ds-DNA
Absent IgG – 5
Low complement C3 – 3
Positive ANA – 1
Positive C3 nephritic factor – 4
Positive ds-DNA – 2
A 20 y/o woman presents w 2 days of dysuria, increased urinary frequency, and suprapubic pain. Rank the organisms by likelihood of being causative:
Proteus mirabilis
Acinetobacter baumanii
Candida albicans
Escherichia coli
Staphylococcus saprophyticus
Proteus mirabilis – 4
Acinetobacter baumanii – 5
Candida albicans – 3
Escherichia coli – 1
Staphylococcus saprophyticus – 2
A neonate develops meningitis at 36 hours old. Rank the organisms by likelihood of being causative:
Escherichia coli
Group B Strep
Cryptococcus neoformans
Pseudomonas aeruginosa
Listeria monocytogenes
Escherichia coli – 2
Group B Strep – 1
Cryptococcus neoformans – 5
Pseudomonas aeruginosa – 4
Listeria monocytogenes – 3
Most common causes of late onset neonatal sepsis
Staphlococcus epidermis= most common
Staph aureus
Strep
Pseudomonas
What naturally occurring antibody will be in the serum of an A negative person?
Anti-B IgM
Which organism causes pneumonia with ‘red currant jelly sputum’
Klebsiella
What is associated with C3 deficiency
Membranoproliferative glomerulonephritis
What type of emphysema is associated with smoking and chronic bronchitis?
Centrilobular
What type of emphysema seen in alpha-1-antitrypsin
Panlobular
What is the most common cause of hypocalcaemia in the community?
Vitamin D deficiency
Deficiency of which plasma protein occurs in patients with movement disorder and liver disease?
Caeruloplasmin
What disease present in both MEN 1 and MEN 2a
Parathyroid hyperplasia
What fluid given in addisons
IV 0.9% saline
Spelling of adrenal cortex zones
Glomerulosa
Fasiculata
Reticularis
Specific organism for HUS
Esherichia coli O157:H7
What do grafes of brain tumours indicate
Grade 1 – benign – long-term survival
Grade 2 – more than 5 yrs
Grade 3 – less than 5 yrs
Grade 4 – less than 1 yr
MRI of pilocytic astrocytoma, meningioma and glioblastoma multiforme
Pilocytic astrocytoma- Well circumscribed, cystic
Glioblastoma multiforme- heterogenous, enhancing post contrast
Meningioma- extra axial
What can be used to identify cell type in brain tumours
Methylome profile
What promotes hyperkalaemia in addisons
Renal loss of sodium
What happens to urobilinogen in haemolytic anaemia
Up
Baseline immunosuppression during transplant
Steroids
Mycophenolate/azathioprine
CNI
What toxin associated with hepatocellular carcinoma
Aflatoxins
Rank from narrow to broad
Benzylpenicillin
Amoxicillin
Ceftriaxone
Piperaciilin/tazobactam
Meropenem
Benzylpenicillin
Amoxicillin
Ceftriaxone
Piperaciilin/tazobactam
Meropenem
rank the causative organisms below in order of likelihood, with (1) being the most likely and 5 the least likely.
Staphylococcus aureus
Streptococcus pyogenes
E coli
Staphylococcus epidermidis
Brucella melitensis
Staphylococcus aureus
Streptococcus pyogenes
E coli
Staphylococcus epidermidis
Brucella melitensis
How much does Hb and platelet increase by after transfusion of respective parts
Hb= 10g/L
Plt- 35x10^9/L
What can IFN beta be given in
MS
Behcets
What vaccines can HIV patients not receive
BCG
Yellow fever
What cell is involved in attacking prosthetic implants
Macrophage
What causes haemorrhagic infarctions
Venous occlusion
What are mallory denk bodies
cytoplasmic regular eosinophilic hyaline bodies which develop from pre-keratin intermediate filaments
What is rubor
Flushing and reddening in inflammatino
Alum is-effective as an adjuvant for vaccination. Which of the following best describes its mechanism of action?
Promotion of B cell differentiation
Which organisms are becoming resistant to carbapenems
Klebsiella
What separates fluclox from other penicillins
Resists beta lactamase
Most common causes of HAP
Enterobacteriae- E coli, klebsiella
Staph aureus
Pseudomonas
Painless genital pustule → ulcer → painful inguinal lymphadenopathy → proctocolitis
LGV
What type of AIHA is idiopathic
Intravascular
What is the most common cancer cause of mortality in men and women
For both is lung
What is seen on biopsy of hirschprung
Absence of ganglia in myenteric plexus
What investigation do on peripheral blood for myeloma
Serum electrophoresis
What is dose used in low vs high dose dex test
Low-0.5mg
High- 2mg
How are strep infections split up
Alpha haemolytic = green as partially haemolyse= s.pneumoniae, s.viridans
Beta haemolytic= clear as full haemolysis- group A= pyogenes, Group B = agalactiae
Gamma haemolytic no haemolysis= enterococcus faecalis
What is the gamma haemolytic strep
Enterococcus faecalis
What is used to differentiate beta haemolytic strep
Bacitracin
Bacitrscin sensitive= pyogenes
CURB 65 treatments
0-1= outpt with amoxicillin
2= amox and clari, consider admission
3-5= admit with co amox and clari IV
What is used to treat resistant TB
Amikacin
Linezolid
What are the 3 types of GI infection
Secretory= toxin produced and get no fever + watery diarrhoea
Inflammatory= fever and diarrhoea from invasion
Enteric fever= fever and unwell with few GI symptoms
Causes of secretory vs inflammatory diarrhoea
Secretory- Cholera, enterotoxigenic e coli
Inflammatory- campylobacter, shigella, salmonella
Which bacteria is associated with bloody diarrhoea in MSM
Shigella
What are the types of E.coli and there associations
Entero toxigenic = travellers diarrhoea
Entero invasive= bloody diarrhoea
Entero pathogenic= in children P for paeds
Enterohaemorrhagic= HUS
Which HSV causes meningitis vs encephalitis
Mening= HSV 2
Enceph= HSV 1
