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