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V Flashcards > Path PPQs + Enzymes > Flashcards

Path PPQs + Enzymes Flashcards

1
Q

Full name for ALP?

A

Alkaline phosphatase

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2
Q

Full name for ALT?

A

Alanine transaminase

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3
Q

Full name for AST?

A

Aspartate transaminase

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4
Q

Full name for GGT?

A

Gamma glutamyl transferase

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5
Q

What enzyme is deficient in Gilbert’s?

A

UDP-glucuronyl transferase

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6
Q

What is Richter’s transformation?

A

Transformation of CLL to diffuse large B cell lymphoma

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7
Q

bWhat do you measure in dermatomyositis with polyangitis?

A

Creatinine Kinase

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8
Q

What is the vegan Vit D supplement called?

A

Ergocholecalciferol (Vitamin D2)

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9
Q

What is the animal source of Vitamin D

A

Cholecalciferol (Vitamin D3)

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10
Q

Where is the enzyme 25-hydroxylase?

A

Liver

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11
Q

Inactive form of vitamin D?

A

25-hydroxyvitamin D

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12
Q

What enzymes activates vitamin D?

A

1 alpha hydroxylase

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13
Q

1 alpha hydroxylase can be produced by which disease?

A

Sarcoidosis

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14
Q

What is another name for 1,25 dihydroxy vitamin D?

A

Calcitriol (active form)

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15
Q

Features of osteomalacia?

A

Bone and muscle pain, Looser zones, increased fracture risk, Raised ALP, low calcium, low phosphate

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16
Q

What are Looser zone’s?

A

Pseudofractures

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17
Q

Features of rickets?

A

Bowed legs, chostochondral swelling, widening epiphysis at the wrists, myopathy

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18
Q

What drugs can cause rickets?

A

Anti-convulsants

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19
Q

How can ostemalacia occur in pregnancy?

A

Baby steals calcium

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20
Q

PTH stimualtes which bone cells?

A

Osteoclasts

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21
Q

Which bone cells produce alkaline phosphatase?

A

Osteoblasts

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22
Q

What is the effect of Cushing’s on vitamin D?

A

Vitamin D reduces and phosphate - leads to osteoporosis

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23
Q

What is the first feature of osteoporosis?

A

Fracture - often NOF or Colle’s fracture

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24
Q

Rash with amoxicillin is indicative of what?

A

EBV

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25
Q

Irritability = what disease?

A

meningitis

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26
Q

Gower’s sign positive?

A

Duchenne’s muscular dystrophy

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27
Q

Heart is boot shaped on CXR

A

Tetralogy of fallot (right to left shunt)

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28
Q

Port wine stain?

A

Sturge-Weber (epilepsy)

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29
Q

A baby is born with micrognathia, low-set ears, rocker bottom feet and overlapping of fingers - what condition?

A

Edward’s syndrome (trisomy 18)

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30
Q

Back arching is indicative of what?

A

Reflux

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31
Q

Peripheral pulses absent = which condition?

A

Coarctation of the aorta

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32
Q

West syndrome treatment?

A
  • vigabatrin is now considered first-line therapy
  • ACTH is also used
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33
Q

EEG and CT results of west syndrome?

A

EEG shows hypsarrhythmia in 2/3 of infants; CT shows diffuse/localised brain disease in 70% (e.g. tuberous sclerosis)

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34
Q

How is Vesicoureteric reflux diagnosed?

A

MCUG

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35
Q

Osgood-Schlatter disease is caused by what?

A

Inflammation of the tibial tuberosity

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36
Q

Chickenpox where does rash start?

A

Face/trunk. Fever first

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37
Q

Measles history and signs

A

Prodrome: irritable, conjunctivitis, fever

confluent rash

Koplik spots: white spots (‘grain of salt’) on buccal mucosa

Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent

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38
Q

Roseola infantum cause and signs

A
  • high fever: lasting a few days,followed laterby a
  • maculopapular rash.
    Caused b HHV6
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39
Q

Screening in Kawasaki disease

A

Echocardiogram

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40
Q

USS in NEC?

A

Shows target sign

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41
Q

Management of Hisrschprung’s disease

A

management:
1. bowel irrigation
2. surgery: ano-rectal pull-through

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42
Q

Sexual aggression + precocious puberty

A

sexual aggression = testotoxicosis

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43
Q

Small testes in precocious puberty =?

A

Adrenal hyperplasia

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44
Q

Diagnosis of whooping cough?

A

Per nasal swab.
Give erythromycin for 10 days

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45
Q

Wiskott-Aldrich syndrome

A

X-linked recessive

Sx: eczema, thrombocytopaenia, immune deficiency, bloody diarrhoea, petechiae

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46
Q

Cri du chat syndrome

A

Chr 5p deletion syndrome

Features:
- Characteristic cry due to larynx and neurological problems
- Feeding difficulties and poor weight gain
- Learning difficulties
- Microcephaly and micrognathism
- Hypertelorism

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47
Q

William’s syndrome

A

Features:

  • Short stature
  • Learning difficulties
  • Friendly, extrovert personality
  • Transient neonatal hypercalcaemia
  • Supravalvular aortic stenosis
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48
Q

Pierre-Robin syndrome?

A

Features:

- Micrognathia
- Posterior displacement of the tongue (may result in upper airway obstruction)
- Cleft palate
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49
Q

Noonan syndrome?

A
  • Webbed neck
  • Pectus excavatum
  • Short stature
  • Pulmonary stenosis
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50
Q

Edward’s syndrome?

A

Trisomy 18

Features:
- Micrognathia
- Low-set ears
- Rocker bottom feet
- Overlapping of fingers

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51
Q

Patau syndrome signs?

A

Trisomy 13

Features:

  • Microcephalic, small eyes
  • Cleft lip/palate
  • Polydactyly
  • Scalp lesions
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52
Q

Fragile X syndrome

A

Features in males:

  • learning difficulties
  • large low set ears, long thin face, high arched palate
  • macro-orchidism
  • hypotonia
  • autism is more common
  • mitral valve prolapse

Diagnosis

  • can be made antenatally by chorionic villus sampling or amniocentesis
  • analysis of the number of CGG repeats using restriction endonuclease digestion and Southern blot analysis
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53
Q

What syndrome is associated with diabetes?

A

Cystic fibrosis

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54
Q

Which cancer is associated with H.Pylori infection?

A

Gastric MALT lymphoma

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55
Q

What happens to the body of the stomach in a patient with pernicious anaemia?

A

Atrophy

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56
Q

Most common type of malignancy in the breast?

A

Invasive ductal carcinoma

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57
Q

A 2 year old has a palpable abdominal mass when his mother picks him up. What is the most likely cause?

A

Wilmm’s tumour

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58
Q

A lady has frank painless haematuria and a mass palpable on one side. What is the most likely cause?

A

Renal cell carinoma

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59
Q

Patient with hypoglycaemia and pancreas mass

A

Insulinoma

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60
Q

55yr old man with a painless mass in head of pancreas and jaundice

A

Adenocarcinoma

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61
Q

What is deposited in the kidneys in Multiple Myeloma?

A

AL Amyloid deposition

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62
Q

What material is seen in the vessel of a patient with an MI due to burst atheroma

A

Atheramatous plaque?

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63
Q

Patient presents with a craggy enlarged uneven prostate

A

Prostate adenocarcinoma

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64
Q

Patient with a cancer in their bladder following chronic schistosomiasis??

A
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65
Q

Young man, sudden severe pain in testicle following horse riding

A

Testicular torsion

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66
Q

Radiosensitive cancer of the testicle in a young man with a white/smooth appearance?

A

Seminoma??

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67
Q

Woman with recurrent episodes of weakness and paraesthesia that spontaneously resolve

A

TIA

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68
Q

Eczematous nipple rash caused by individual ‘malignant cells’?

A

Paget’s disease of the breast

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69
Q

Which cancer is associated with coeliac disease?

A

EATL

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70
Q

Which thyroid cancer most commonly metastasises to the lymph nodes?

A

Papillary

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71
Q

What virus increases risk of nasopharyngeal cancer?

A

EBV

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72
Q

An ovarian mass is found in a Japanese woman, and histology shows signet ring cells

A

Krukenberg tumour

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73
Q

What liver change occurs in diabetic patients

A

Non-alcoholic fatty liver disease (NAFLD)

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74
Q

Both mother and grandmother had medullary thyroid carcinoma and have tested positive for MEN2. What biomarker would be raised in the blood to confirm medullary thyroid cancer?

A

Calcitonin

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75
Q

A patient required an aortic valve replaced 3 months ago. They have now come back a few weeks later with jaundice, Hb-urea (haemoglobinuria), and raised reticulocytes. What is the cause?

A

MAHA???

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76
Q

Which disease do you see in both MEN1 and MEN2a?

A

Parathyroid hyperplasia

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77
Q

Insulinoma. What would you find?

A

low free fatty acids

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78
Q

What would you see on a duodenal biopsy of a patient with Coeliac disease?

A

Intraeplithelial lymphocytes

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79
Q

What causes hypertension in upper half of body?

A

Coarctation of the aorta

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80
Q

Which cancer is associated with asbestos?

A

Mesothelioma

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81
Q

A lady is found to have cancer, and investigations show it is a ‘transitional cell’ cancer. Where has it metastasised from?
Colon
Liver
Bladder
Breast

A

Bladder

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82
Q

Which lung cancer is most likely in a non-smoker?

A

Adenocarcinoma

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83
Q

What is the most likely cause of nephrotic syndrome in a child?

A

Minimal change disease

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84
Q

50 year old man with Midshaft femur fracture – what would you find at the site of the break/fracture (or rather, which/what type of cancer does he have)?
Neuroblastoma
Osteosarcoma
Ewing’s sarcoma
Chondrosarcoma
Adenocarcinoma

A

Chondrosarcoma

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85
Q

Woman with recurrent episodes of weakness and paraesthesia that spontaneously resolve -

A

TIA?

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86
Q

. HIV patient who desaturates on exercise?

A

Pneumocystis jirovecii

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87
Q

Girl receiving chemotherapy for leukaemia with ‘Halo’ sign on CXR

A

Aspergillus fumigatus

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88
Q

Lower lobe pneumonia in a 22 year-old who is coughing up rusty coloured sputum

A

Strep pneummoniae

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89
Q

Upper lobe cavitation on CXR in an alcoholic

A

Klebsiella pneummoniae

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90
Q

Smoker back from holiday in Spain, also hyponatraemic and confused

A

Legionella pneumophilia

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91
Q

HIV patient with CD4+ count of 150 with meningitis

A

Cryptococcus neoformans

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92
Q

Water polo player with itchy scaly rash on lateral toe which then moved along lateral side of foot

A

Tricophytum rubrum

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93
Q

Pityriasis versicolor

A

Malassezia furfur

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94
Q

Lady came back from visiting her sister in Arizona with systemic sx - fever etc:

A

Coccidioides

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95
Q

A South American man presents to a doctor in the UK with fever and bloody diarrhoea, and investigations detect a cyst in the right lobe of the liver

A

Entamoeba histolytica

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96
Q

A Nigerian man presenting with fever and chills, has just returned from Nigeria, did not take prophylaxis, and was bitten a lot

A

Malaria

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97
Q

A woman returning from travel in Asia presents with abdo pain, headache, and constipation. A Gram- rod is later cultured from her blood

A

Salmonella typhi

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98
Q

Snail trail oral ulcer in a homosexual man

A

Treponema pallidum

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99
Q

A soldier returning from Afghanistan has a small ulcer on right ring finger that won’t heal and keeps getting bigger

A

Leishmaniasis

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100
Q

What is the treatment for MRSA?

A

Vancomyin

101
Q

Which of these vaccines must not be given to a pregnant woman?

A

MMR

102
Q

What is the most common cause of fever in a returning traveller?

A

Malaria

103
Q

Which of these is the most likely causative organism of a hospital acquired pneumonia?
a. Haemophilus influenza
b. Streptococcus pneumonia
c. Staphylococcus aureus
d. Mycoplasma pneumonia
e. Pseudomonas aeruginosa

A

Pseudomonas aeruginosa

104
Q

Which of these does not lead to chronic Hepatitis?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
E. Hepatitis E

A

Hepatitis A

105
Q

Which vector transmits Trypanosoma brucei rhodesiense?
A. Anopheles mosquito
B. Sandfly
C. Tsetse Fly
D. Aedes mosquito
E. Ixodes tick

A

Tsete fly

106
Q

A Girl develops a throat infection. She is given amoxicillin, and a rash develops. It is later found out that she has infectious mononucleosis, and her symptoms persist. What is the most likely cause of the rash?
A. Drug reaction
B. Penicillin allergy
C. Mastocytosis
D. Erythema nodosum
E. Pyoderma gangrenosum

A

Drug reaction

107
Q

HIV DNA is formed by which error prone enzyme?
A. RNA polymerase
B. DNA polymerase
C. RNA transcriptase
D. Reverse transcriptase
E. Proteases

A

Reverse transcriptase

108
Q

Which of the following is the most common cause of cellulitis?
A. S. epidermidis
B. S. saprophyticus
C. S. pyogenes
D. S. agalactiae
E. E. coli

A

Strep pyogenes

109
Q

Natural antibodies against what can confer protective immunity against HIV?
A. HIV – GAG
B. HIV – gp120
C. CXCR4
D. Protease
E. Reverse transcriptase

A

B

110
Q

Which would be the most useful test in confirming acute EBV infection 2 weeks after possible exposure in an immunocompetent patient

A

Serum IgM

111
Q

Which vaccine-preventable organism causes cough, lymph node enlargement and has a potential to occlude the airway?

A

Corynebacterium diptheriae

112
Q

What cell type is raised in the blood in schistosomiasis?

A

Eosinophils

113
Q

Boy visits grandparents in Wiltshire, comes back with 5 days of diarrhoea, no vomiting, and unexplained bruises all over body, which organism has most likely triggered this?

A

E. Coli 0157:H7

114
Q

Name an infectious organism that is a common cause of sepsis in a neonate

A

Group B streptococcus

115
Q

Name an infectious organism which is a common cause of meningitis in a child older than 3 months

A

Neisseria meningitidis

116
Q

Name the main class of drugs used to treat HIV

A

NRTI - nucleotide reverse transcriptase inhibitors

117
Q

What zoonotic disease is carried by the Ixodes tick?

A

Lyme disease

118
Q

Via which route does Hep A spread?

A

Faeco-oral route

119
Q

What is the treatment for pseudomembranous colitis?

A

Metronidazole

120
Q

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

A

Treponema pallidum

121
Q

Reactivation of a virus following a transplant

A

EBV

122
Q

What does JC virus cause?

A

Progressive multifocal leukoencephalopathy

123
Q

HIV +ve patient with v low CD4 + purple lesions seen on trunk. What virus causes this cancer?

A

HHV8

124
Q

What is the most likely cause of early-onset sepsis in a neonate?

A

Group B streptococcus

125
Q

What is the most common cause of viral meningitis?

A

Enteroviruses

126
Q

What is the most common cause of traveller’s diarrhoea?

A

E. Coli

127
Q

Which bacterial species causes scarlet fever?

A

Group A haemolytic streptococcus

128
Q

Receptor/ cytokine mutation that could be protective in HIV?

A

CCR5 = receptor
MIP-1a is the cytokine mutation

129
Q

Which stain would be used to confirm infection with acid-fast bacilli?

A

Ziehl-nielson stain

130
Q

What is the definition of herd immunity threshold?

A

1-(1/R0)

131
Q

Name 1 of the 3 characteristics of Influenza A that could cause a pandemic

A

Novel antigenicity

132
Q

Alcoholic man is on ceftriaxone for meningitis, what organism is he at risk of which this does not cover for?

A

Listeria monocytogenes

133
Q

Returning traveller with fever and constipation (salmonella typhi) - what abx do you give

A

IV ceftriaxone

134
Q

Septic arthritis in a 56yo man - likely organism?

A

Staph aureus

135
Q

What does it mean if urine MC&S sample has epithelial cells and mixed bacterial growth?

A

Contaminated sample

136
Q

Develops a grey film over the back of the throat

A

Diptheria

137
Q

Causes lumps on parotid and neck

A

Mumps virus

138
Q

Maculopapular rash moves from face that can cause encephalitis and pneumonitis

A

Measles?

139
Q

Virus that resides in pharynx and GIT - 1:100 encephalitis, 1:1000 destruction of motor neurons

A

Polio

140
Q

What virus can cause Lockjaw ?

A

Tetanus

141
Q

Woman with UTI - culture grows Gram positive cocci in clusters

A

Staph aureus

142
Q

49 Year old with no medical problems has septic arthritis

A

Staph aureus

143
Q

. 50 year old male smoker has meningitis with Gram positive diplococci

A

Strep pneummoniae

144
Q

Neonate has meningitis, Gram positive organism in chains

A

Group B streptococcus?

145
Q

19 year old rugby player with boils, members of his team have similar boils, as do members of his family

A

Staphylococcal sacrophyticus??

146
Q

Lady with PID and positive urinary NAAT test

A

Chlamydia

147
Q

Lady with discharge, no other symptoms, and causative infection found on wet slide microscopy

A

Trichomonas vaginalis

148
Q

Man with discharge- Gram negative diplococci found

A

Neisseria gonorrhoea

149
Q

Painless indurated ulcer, grown on dark brown medium, spiral shaped organism found

A

Treponema pallidum

150
Q

A girl has been noted by her parents to be acting strange lately. A Lumbar puncture is performed and the CSF shows high lymphocytes and a raised protein, but normal glucose, what organism is the cause?

A

HSV

151
Q

An 18 year old student is found to have Gram negative diplococcus causing meningitis

A

Neisseria meningitidis

152
Q

A man is found to have a Gram positive diplococcus causing meningitis

A

Streptococcus pneummoniae

153
Q

Gram negative rod causing sepsis in a neonat

A

E. coli

154
Q

Gram positive rod causing meningitis in a 72 year-old

A

Liseteria monocytogenes

155
Q

Gram positive diplococci example?

A

Streptococcus pneummoniae

156
Q

Which antibiotic would you use for cellulitis with MRSA

A

Vancomycin

157
Q

Which antibiotic would you use to treat someone who has cellulitis with a Methicillin SENSITIVE strain of Staphylococcus aureus

A

Flucloxacillin

158
Q

Young women with cystitis and fully sensitive E-Coli

A

Trimethoprim

159
Q

Antibiotic for Group A Strep pharyngitis

A

Benzylpenicillin

160
Q

Included in meningitis treatment to cover Listeria monocytogenes

A

Amoxicillin

161
Q

A man develops foul-smelling diarrhoea and cramping pain 5 days after eating chicken at a barbeque

A

Campylobacter Jejuni

162
Q

A woman develops vomiting a few hours after eating a Chinese meal with lots of rice

A

Bacillus cereus

163
Q

Women has had some surgery which required antibiotics, and now has profuse watery diarrhoea

A

Clostridium difficile

164
Q

A ward sister gets diarrhoea, and patients on the ward have been ill recently with similar symptoms

A

Norovirus

165
Q

Virus that may cause Hydrops fetalis if caught in first 20wks of pregnancy

A

Parvovirus B19

166
Q

Immunoglobulin may be given to the mother if she is exposed to this virus in pregnancy to prevent infection

A

Varicella Zoster

167
Q

Virus that require C-section if mother has an outbreak at 34wks or later due to risk of transmission vaginally

A

HSV 2

168
Q

Virus that can cause baby to have cataracts, sensorineural deafness, hepatomegaly and thrombocytopenia

A

Rubella

169
Q

Virus which if transmitted to baby: they can initially be symptomless but then come down with long term sequelae

A

CMV

170
Q

A. 60 year old Man with abdominal pain radiating to back, collapses and dies

A

Acute aortic aneurysm

171
Q

Man, ex-smoker, with history of hypertension and MI, has sudden chest pain which radiates to the neck

A

Left anterior descending artery thrombus

172
Q

A 60 year old lady with a background of stepwise memory loss and hypertension is hospitalised with bronchopneumonia

A

Multiple cerebral infarcts

173
Q

An elderly man with atrial fibrillation develops new right flank pain

A

– Renal thrombus

174
Q

Man has an MI 3 years ago. Now comes into hospital feeling very unwell. Is having a sample taken from their pericardial layer and you find blood is aspirated from the pericardium

A

Ventricular rupture

175
Q

What histological finding will be seen in the kidneys in cases of post-Streptococcal glomerulonephritis?

A

– Immune complex deposition

176
Q

Malignant HTN, what is the classic renal finding on histology

A

– Fibrinoid necrosis

177
Q

Women has acute appendicitis, 5mm tumour found in tip when it’s remove

A

Neuroendocrine tumour

178
Q

Man with H pylori, abnormal area in antrum, mitotic figures and cells with raised nuclear to cytoplasmic ratio, not invading the basement membrane

A

B cell lymphoma

179
Q

What happens to the body of the stomach in a patient with pernicious anaemia

A

Chronic gastritis and atrophy

180
Q

Which/What breast cancer is also known as non-specific type?

A

Invasive ductal carcinoma

181
Q

Breast cancer which has a high, medium and low stage to it

A

Ductal carcinoma in situ

182
Q

Fibro-epithelial tumour with abundant stromal elements

A

Phyllodes tumour

183
Q

A man presents with the symptoms of a UTI and acute onset costovertebral pain. He is found to have pus cells and blood in his urine. What is the most likely cause?

A

Acute pyelonephritis

184
Q

A lady with loin-to-groin pain, haematuria and pain at the end of micturition. What is the most likely cause?

A

Renal calculi

185
Q

A lady has frank painless haematuria and a mass palpable on one side. What is the most likely cause?

A

Renal cell carcinoma

186
Q

A 2 year old has a palpable abdominal mass when his mother picks him up. What is the most likely cause?

A

Nephroblastoma

187
Q

A man with AF (Atrial fibrillation) develops fever, nausea, vomiting and pain in his right loin/flank. What is the most likely cause?

A

Renal infarct

188
Q

Patient with a pancreatic mass following acute pancreatitis?

A

Pancreatic pseudocyst

189
Q

Patient with a history of severe abdominal pain; during cholecystectomy the surgeons noticed grey specks around and on the pancreas?

A

Ductal adenocarcinoma

190
Q

Patient with a carcinoma in their liver, what was the original carcinoma in their pancreas that caused the metastases?

A

Ductal adenocarcinoma

191
Q

Appendix that is full of neutrophils and is enlarged touching the peritoneum

A

Inflammation

192
Q

Patient with a cancer in their bladder following chronic schistosomiasis

A

Squamous cell carcinoma

193
Q

On doing a patient’s nephrectomy they notice a mass in the kidney that extends into the the renal vessels and into the perinephric fat

A

Angiomyolipoma?

194
Q

Man goes deaf with bowed legs

A

Paget’s disease of bone

195
Q

Sudden headache, loss of consciousness, meningism

A

Subarachnoid haemorrhage

196
Q

Patient with HIV, raised ICP, new onset epilepsy

A

Primary CNS lymphoma

197
Q

Woman with recurrent episodes of weakness and paraesthesia that spontaneously resolve?

A

TIA

198
Q

15 year old presents with signs of ataxia. Imaging shows a brain tumour extending outwards from cerebellum and invading subarachnoid space. What is the most likely type?

A

Medulloblastoma

199
Q

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

A

Haemachromatosis

200
Q

White plaques are seen lining the oesophagus on an OGD of an alcoholic man with recurrent bleeding varices, what are they most likely to be?

A

Oesophageal candidiasis

201
Q

What type of gastric cancer is most common?

A

Adenocarcinoma

202
Q

42 year old woman has a history of intermenstrual bleeding. On examination, a cervical polyp is found. What do you do next?

A

Remove and send for histology

203
Q

What type of section is done for urgent diagnosis during surgery?

A

Intra-operative frozen section

204
Q

How does a melanoma spread?

A

Lymphoid

205
Q

Which of these is a common finding in someone who has portal hypertension?

A

Splenomegaly?

206
Q

50 year old man with Midshaft femur fracture – what would you find at the site of the break/fracture (or rather, which/what type of cancer does he have)?

A

Chondrosarcoma

207
Q

Middle aged lady. Liver biopsy, loss of bile ducts and granulomas present. Which/what disease is consistent with these findings?

A

PBC

208
Q

Beta lactam with anti-pseudomonal activity

A

Ceftazidime

209
Q

Broad spec, no pseudomonal activity usually given with a beta lactamase inhibitor

A

Amoxicillin

210
Q

A DNA synthesis inhibitor used to treat Pseudomonal infections but poor against anaerobes?

A

Ciprofloxacin

211
Q

Abx of the Macrolide/lincosamide/streptogrammin group used to treat some atypical pneumonias

A

Clarithromycin

212
Q

The organism that causes tetanus

A

Clostridium tetanae

213
Q

A 6 year old girl comes in with a high fever, severe headache and confusion. There is no rash present. The parents say that she is usually well but has had a sore throat in the last few weeks.

A

Neisseria meningitidis

214
Q

A 7 year old boy arrives is brought into A&E by his worried parents. He has headache, fever, photophobia and neck stiffness. An LP revealed clear CSF. His parents say that they have never had to take him to the doctor, except for his immunisations as an infant.

A

Coxsakie B

215
Q

A 13 year old boy is brought in with headache, fever and photophobia by his mother. She says that she usually gives him a homeopathic remedy when he is ill but it has not worked this time. The CSF collected from the lumbar puncture is clear.

A

Measles

216
Q

Which immunosupressent is associated with irreversible infertility and is only used when there is no alternative?

A

Cyclophosphamide

217
Q

Which immunosuppressant blocks T cell migration

A

Natalizumab

218
Q

Calcineurin inhibitors act by blocking which cytokine?

A

IL-2

219
Q

Which 2 immunosuppresants act to inhibit the T cell cycle?

A

Azathioprine and Mycophenolate mofetil

220
Q

Contains a b-lactamase inhibitor to increase the antibiotic’s efficacy

A

Co-amoxiclav

221
Q

Is used to treat mild Pseudomembranous Colitis

A

Metronidazole

222
Q

Is used to treat Pneumocystis Pneumonia

A

Co-trimoxazole

223
Q

Acts by inhibiting bacterial folate synthesis

A

Co-trimoxazole

224
Q

Binds to bacterial 30s ribosomal subunit and causes codon misreading

A

Gentamicin

225
Q

Inhibits DNA Gyrase

A

Moxifloxacin

226
Q
  1. A homeless man dies (signs of trauma), you cannot contact his brother, what do you do about the autopsy?
A

This death must be referred to the coroner for autopsy as it is suspicious, so you don’t need consent from the brother.

227
Q
  1. HIV positive girl dies of cerebral toxoplasmosis, before she dies she says she doesn’t want to disclose her HIV status. What do you write on the death certificate?
A

You must disclose it if it contributed to the death

228
Q
  1. Woman (45y) with learning difficulties and cerebral palsy, she gets influenza, then strep pneumonia, then dies of cardiorespiratory arrest. Death certificate?
A

1a Streptococcal pneumonia
1b Influenza
2 Cerebral palsy

229
Q
  1. Man dies, daughter consents to autopsy, step mum (his wife) does not want autopsy - what to do?
A

No autopsy, step-mum outranks daughter (order is spouse/ partner, child/ parent, brother/ sister, grandparent or grandchild etc. – see section 27 (4) of Human Tissue Act)

230
Q
  1. Guy with brain mets from lung cancer, has a PE, dies of cardiorespiratory arrest. Fill out death certificate
A

1a: Pulmonary embolism
1b: Cerebral metastases
1c: Lung cancer
(Assuming the PE was due to increased coagulability due to cancer)

231
Q
  1. What to put on death certificate for a well-controlled HIV patient who had a PE after a long haul flight and died from cardiac arrest soon after admission to hospital?
    a. 1a: PE
    b. 1a: PE, 1b: HIV
    c. 1a: cardiac arrest, 1b: HIV
A

1a: PE

232
Q
  1. Woman found at home surrounded by needles, lots of extra pathologies - PE, etc. Family are waiting for the death certificate what do you do?
    a. Ask family for permission to do the autopsy in hospital
    b. Call the coroner, and ask him to ask the family to do the autopsy in the hospital
    c. Can’t give death certificate
    d. Just give death certificate without autopsy
A

Can’t give death certificate

233
Q
  1. Hospital Autopsy. Coroner wants a spine specimen for teaching. What do you?
    a. Must ask family
    b. Don’t need one as hospital and good for education (something like that)
    c. Must have asked for consent previously from deceased
A

Must have asked for consent previously from deceased

234
Q
  1. Dad and brother of dead individual disagree over having an autopsy. The Dad was the main carer but no mention of standing order or special status assigned to dad by the dead individual.
    a. Dad & Brother disagree so there can be no autopsy
    b. There is a family disagreement so there can be no autopsy
    c. An autopsy can be done but to settle the disagreement it goes to a special court
    d. Dad’s consent is all that is needed legally speaking
A

Dad’s consent is all that is needed legally speaking

235
Q
  1. Next of kin is identified for a woman who is estranged from her family, and found at home unresponsive with needles, and is a drug addict. When they get her to hospital she dies before you can talk to her. They find her next of kin (her brother)
    a. If police declare it a possible murder then they can ask the coroner?
    b. You can refer to coroner for autopsy if the police rule it as a suspicious death provided you get consent from the next of kin first
    c. Perform a post-mortem at the hospital after seeing permission from her brother
    d. Refer to coroner
A

Refer to coroner

236
Q
  1. Random doctor following a needle stick injury, from a parent who has come back from the Philippines. Random doctor doesn’t want to take PEP unless risk is real. Asks patient (who has capacity) if they can consent to the blood test – patient refuses. The doctor then asks CT1 college if they can ask the lab to do a test on one of the patient’s old blood samples. What does the CT1 say?
    a. If they decline to consent and have capacity then you cannot do the test
    b. To not do the test would violate the doctor’s human’s rights under article 3 or 5 of the Human Rights acts of year XXXX
    c. To not do the test would violate the patient’s human’s rights under the Human’s right’s act of year XXXX
    d. If the hospital refuses to test the blood despite the person’s protests, then they are violating the doctor’s human rights.
    e. They can proceed and test an old sample of blood as it is in the best interests of the doctor.
A

If they decline to consent and have capacity then you cannot do the test

237
Q
  1. A man presents with history of heart disease, left ventricular hypertrophy, has a facial basal cell carcinoma and type 2 diabetes. Investigations from one year ago showed critical aortic stenosis, with poor ejection fraction. Current echo shows critical aortic stenosis. They suddenly die. List the order for the coroners / How should you fill out the MCCD (Medical Certificate of Causes of Death)?
A

e. 1a = Aortic Stenosis, 2 = Type 2 diabetes

238
Q

When to refer a death to the coroner?

A

Any trauma = NEEDS TO BE REFERRED TO THE CORONER. This includes falls in the elderly.
Suspicious circumstances
After a hospital procedure.
The death was violent or unnatural
* the cause of death is unknown, or
* the person died in prison, police custody, under section, or another type of state detention. Migration camps etc
Not seen a doctor in 28 days or in last illness
During or within 12 months of pregnancy
Death due to suicide, industrial disease, abortion, anaesthetic care, medical care, murder, self-neglect
Any allegation of medical negligence.

Don’t need to suspect a crime to refer to the coroner.

239
Q

What should be done before discussing with the family?

A

Medical certificate of cause of death

240
Q

What is Part II on a death certificate?

A

Other diseases related to the cause of death

241
Q

What should be avoided in death certificates?

A

Modes of death eg. cardiorespiratory arrest, herniation, organ failure etc.
Congestive heart failure is the only exception

242
Q

three types of autopsy?

A

Forensic, Coroner and hospital “consented”

243
Q

What not to do on death certificate?

A

Abbreviations, vague notions

244
Q

When is consent required with regards to human tissue?

A

Consent is necessary for taking surgical pathology specimens in the living and, of course, the performance of autopsies and dealing with the Deceased’s tissue necessary for various diagnostic and other purposes.

245
Q

What purposes of the deceased require consent?

A

Clinical audit, education, performance assessment, public health, quality assurance

246
Q

When can tissue be removed without consent?

A

In coroner’s autopsy to determine cause of death

247
Q

What is the HTA hierarchy of consent?

A

Spouse/partner
Parent/child
Sibling
Grandparent/grandchild
Niece/nephew
Step parent
Half sibling
Friend of longstanding

248
Q

Does consent for organ donation mean it will proceed?

A

No. A specialist nurse (SN) for organ/tissue donation should be involved for all organ donation decisions. Their role is to speak with the family, to ascertain if there is reasonable reason to believe that the person would not have given consent. This is a highly skilled role and is crucial when there is disagreement between family members or with the clinical team that consent can be deemed. The next slide s gives some potential scenarios.

249
Q

Does confidentiality end after death?

A

NO!

V Flashcards (17 decks)

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