Pathology 2017-2019 Flashcards
1
Q
HIV man with pneumonia severe dyspnoea and dry cough on exertion (but no FLAWS that indicated TB) and ground glass on imaging.
A
Pneumocystis Pneumonia
2
Q
Woman with renal transplant and a CXR showing halo sign
A
→ Aspergillus
3
Q
A man with persistent heartburn has an Endoscopy done, which shows a mass in the oesophagus (at a depth of) 35cm down. Which cancer develops in Barrett’s oesophagus?
A
Adenocarcinoma
4
Q
Antibodies:
Patient with Sjogren’s (dry mucous membranes)
A
–> anti ro & anti la
Anti-ro more specific
5
Q
Antibodies:
SLE with recurrent clotting
A
–> anticardiolipin
6
Q
Publican with diabetes, fatty stools, weight loss, ‘slate grey skin’ and joint pains. What is the underlying diagnosis causing this?
A
Haemochromatosis
7
Q
MEFV Mutation, what is it?
A
Familial Mediterranean Fever
8
Q
NOD2/CARD15, what is it found in?
A
Crohn’s disease
9
Q
Immunodeficiency with common gamma chain problem
A
X-linked SCID
10
Q
Swollen joint, needle-shaped aspirate with negative birefringence, what is the enzyme responsible
A
xanthine oxidase
11
Q
Gout - acute treatment
A
Colchine
12
Q
Gout - non acute treatment
A
Allopurinol
13
Q
Bacteria causing scarlet fever?
A
Streptococcus pyogenes
14
Q
Child (was a 15 yo) with brain tumour extends outwards from cerebellum and invading subarachnoid space. Signs of ataxia? What is the most likely type.
A
Astrocytoma
15
Q
Sacroiliitis, HLA B27 positive
A
Ankylosying spondylitis
16
Q
HIV +ve patient with v low CD4 + vascular lesions seen on trunk. What virus causes this cancer?
A
HHV8
17
Q
What enzyme to confirm cardiac failure?
A
BNP
18
Q
What liver enzyme is raised in MI
A
Aspartate aminotransferase (AST)
19
Q
Rhabdomyolysis what enzyme will be high?
A
ALP
20
Q
Lady with Multiple myeloma and restrictive cardiomyopathy. What will you see on heart biopsy
A
Amyloid deposition
21
Q
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?
A
→ Hep B virus reactivation
22
Q
Which type of cell does Rituximab target?
A
Mature B cells (CD20)
23
Q
Cancer with keratin and intercellular bridges
A
squamous cell carcinoma
24
Q
What type of cancer is gastric
A
adenocarcinoma
25
cANCA positive man with glomerulonephritis and lung changes, what does he have?
Granluomatosis with polyoangiitis
26
Treatment for CLL with p53 mutation. What is the first-line treatment?
Ibrutinib
27
Athlete's foot
Trichophyton rubrum
28
What is the usual prophylaxis for allograft rejection
Mycophenolate mofetil/azathioprine, pred, tacrolimus (calcineurin inhibitor)
29
Treatment with Rheumatoid arthritis? Something TNFa? It gave names and mechanisms
Adalimumab TNFalpha
Basiliximab - Anti CD25
Denosumab - anti-RANKL
Secukinumab
Adalimumab TNFalpha
30
HIV - what natural antibody against, which confers protective immunity against HIV? Or something similar
HIV - GAG
HIV - gp120
CXCR4
Protease
Reverse transcriptase
HIV - gp120
or CCR5
31
Which type of embolus is common in cholesterol cleft?
Atheromatous
32
Patient with coeliac. What would you see on biopsy?
Intraepithelial Lymphocytes
33
Acquired MAHA. What do you see?
Dat +ve spherocytes
Dat +ve fragments
Dat -ve spherocytes
Dat -ve fragments
Dat +ve smear cells
Dat -ve fragments
34
HTLV1 Virus lymphoma
Adult t cell lymphoma/leukaemia
35
How does a melanoma spread?
Lymphoid
36
22 year old student with two weeks anorexia, fever and malaise – raised ALT, normal/super mildly raised ALP + GGT
Viral hepatitis
37
Women with colicky abdominal pain.
Elevated mildly elevated ALP, ALT, GGT, & Bilirubin.
GGT + Bilirubin most raised of results provided.
Acute cholecystitis
38
Used for mild CAP (Community acquired pneumonia) caused by Hib (Haemophilus influenza type B)
→ amoxicillin
39
Which/What antibiotic would you use to treat/prescribe someone who has cellulitis with a Methicillin SENSITIVE strain of Staphylococcus aureus?
Flucloxacillin
40
Which/What cancer is associated with (? the presence of?) E cadherins?
Invasive ductal
41
Fibro-epithelial tumour with abundant stromal elements.
Phyllodes
42
What enzyme if low, leads to hyperuricemia/rise in blood uric acid?
HGPRT
43
What enzyme regulates the rate limiting step in haem biosynthesis pathway/of the blood?
ALA Synthase
44
Which/What enzyme is raised in mumps?
Amylase S
45
Woman with dry eyes and parotid swelling?
Sjogren syndrome → anti-ro
46
A 12-year-old boy has recurrent chest infections, and has an ear infection. He doesn’t have any B Cells.
Bruton’s
47
A Girl is found to have no CD4 cells, but CD8 cells and B cells are present.
Bare lymphocyte syndrome
48
A boy’s father has TB. The same boy develops a mycobacterium infection, following their BCG
IFN gamma receptor deficiency
49
In a 19 year old asthmatic. What drug do you use to treat influenza A?
Oseltamivir
50
Graft(?-verus host?) disease pathophysiology
- CD4 + activated and assists CD8+ & B cells
- HLA
- Pre-existing antibodies in the recipient
- mast cell degranulation
- ischaemia of the donated organ
CD4 + activated and assists CD8+ & B cells
51
HIV RNA forms HIV, via which error-prone enzyme?
Reverse transcriptase
52
Person is discharged after surgery, who had a bilateral hemianopia, with removal of pituitary adenoma. Consultant says it is alright to discharge them. What do you prescribe the patient on discharge?
DDAVP --> or hydrocortisone if it is an option
53
Which of these is a common finding in someone who has portal hypertension?
Splenomegaly
54
What is the most specific marker for Rheumatoid arthritis:
Anti-cyclic citrullinated protein
55
The wall of vessels expresses anti-thrombotic factors why is this?
Because it secrete Thrombomodulin
56
Cushing disease person – Which is the best investigation to confirm the suspected diagnosis?
High dose dexamethasone suppression test
57
What does the number of True positives divided by the total number who have the disease describe?
Sensitivity
58
Child/Infant – nephrotic syndrome – (What is the most likely diagnosis)?
Minimal change disease
59
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)?
Chondrosarcoma
60
Middle aged lady. Liver biopsy, loss of bile ducts and granulomas present. Which/what disease is consistent with these findings?
Primary biliary cholangitis
61
What would be raised in obstructive jaundice due to gallstones?
ALP
62
What would be raised in obstructive jaundice due to pancreatic adenocarcinoma?
ALP
63
What is a sign that your patient has been taking cocaine?
Raised AST
64
Post strep GN - what do you see in the kidneys?
– immune complex deposition
65
Malignant HTN, what is the classic finding on renal histology
fibrinoid necrosis
66
Multiple myeloma - what would you see in kidneys?
amyloid deposition
67
Pityriasis versicolor
Malassezia furfur
68
Man in his 60s with poorly controlled diabetes pr\esents with rapidly progressing periorbital swelling, sinus pain, confusion and sinusitis
apparently Rhizopus spp. causing mucormycosis
69
Resistant Psoriasis treatment
Etanercept (TNF antagonist)
70
Chronic granulomatous disease treatment
IFN gamma
71
Osteoporosis treatmenet
Denosumab
72
What immune cell detects MHC1 and kills virus infected/cancer cells. Is inhibited by MHC I
NK cells
73
What is done to blood donations to reduce GvHD?
– Irradiated blood components (leukapheresis)
74
Most common cause of acute pancreatitis?
Gallstones
75
Increased calcitonin. Type of cancer?
Medullary thyroid cancer
76
MEN2 medullary thyroid adenoma. What hormone would you measure?
– calcitonin
77
IPEX affects what type of immune cell?
- T reg
78
low TSH, raised T3/4 following a viral infection
– De Quervain’s thyroiditis
79
Most common type of primary thyroid cancer to metastasise to lymph node?
Papillary
80
Patient is on low molecular weight heparin, what do you measure to monitor this?
anti-Xa
81
16 year old girl has pleuritic chest pain, joint pain, positive ANA and Anti-Sm, no liver enzyme derangement, raised ESR?
- SLE
82
What virus increases risk of nasopharyngeal cancer
– EBV
83
Chimeric antigen receptor T-cell therapy against CD19: what type of haematological malignancy does it target?
ALL
84
45yo woman with autoimmune diseases, low IgM, IgA and IgE; full blood count is normal?
– common variable immune deficiency
85
Young guy has a fall and hits his head, presents two days later and then loses consciousness, where is the bleeding coming from?
Cortical vein
86
Ovarian mass in Japanese woman: signet ring cells
Krukenburg tumour
87
What is called when you have discontinuation of epithelium
Ulcer
88
Which immunoglobulin is found in mucosa
IgA
89
Histopathological change that occurs to liver in patients with diabetes?
hepatic steatosis
90
Nivolumab is a PD1 inhibitor, what cells does it target?
- T reg cells
91
PCSK9 inhibitor - evolucumab, what does it halve?
LDL
92
Which molecule takes cholesterol and moves it to liver and steroidogenesis organs?
HDL
93
Which disease do you see in both MEN1 and MEN2a?
primary hyperparathyroidism,
94
What type of section is done for urgent diagnosis during surgery?
frozen section
95
Tetralogy of Fallot type of shunt
Right to left
96
Insulinoma. What would you find? Low cortisol, low FFAs, low pro-insulin, low glucagon, low c-peptide
low pro-insulin
97
Bortezomib is a proteasome inhibitor, how does this work?
First line for treating multiple myeloma. Accumulation of misfolded protein -> induction of cell death
98
What Type Hypersensitivity causes serum sickness?
Type 3
99
Low sodium (124) and specific gravity of 1.000 cause?
psychogenic polydipsia
100
Neonate (2 day old) has meningitis and blood cultures isolate gram negative rods, what is the organism?
E coli
101
What vaccine preventable organism causes cough, lymph node enlargement and has a potential to occlude the airway?
Diptheria
102
What is the effect of the gene mutation in familial mediterranean fever?
– reduce pyrin marenostrin -> lack of -ve feedback for neutrophil
103
Man with history of PKD has a cerebral bleed - what type? Subarachnoid (berry aneurysm?)
Subarachnoid (berry aneurysm?)
104
What cell type is raised in the blood in schistosomiasis?
Eosinophils (because it’s protozoan infection)
105
What is the specific auto-antigen that is the target of the immune system in Goodpastures syndrome?
Type IV Collagen
106
Which of these is particularly associated with longstanding bronchiectasis?
A. E-Coli
B. Pseudomonas Aeruginosa
C. Staph aureus
D. Strep pneumoniae
E. Strep pyogenes
B. Pseudomonas Aeruginosa
107
Which of these is most likely to CAUSE bronchiectasis?
A. E-coli
B. Pseudomonas Aeruginosa
C. Staph aureus
D. Strep pneumoniae
E. Strep pyogenes
C. Staph aureus CORRECT ANSWER
108
Which of these is associated with hyperkalaemia?
A. Addison’s disease
B. Conn’s syndrome
C. Ectopic ACTH
D. Prostate cancer
E. Renal artery stenosis
A. Addison’s disease CORRECT ANSWER
109
Antibodies to phospholipase A2 receptor are associated with what form of glomerulonephritis?
A. Crescentic
B. Goodpastures disease
C. Membranous
D. Minimal change
E. Rapidly progressive
C. Membranous CORRECT ANSWER
110
Which of the options acts to stimulate 1alpha hydroxylase activity in the kidney to increase the production of vitamin D3.
A. Calcitonin
B. Calcitriol
C. Cholecalciferol
D. Ergocalciferol
E. Parathyroid Hormone
E. Parathyroid Hormone
111
Name the form of vitamin D produced following the action of 1alpha hydroxylase on 25-OH D3 in the kidney.
A. Calcitonin
B. Calcitriol
C. Cholecalciferol
D. Ergocalciferol
E. Vitamin D3
. Calcitriol CORRECT ANSWER
112
Name the peptide hormone responsible for increasing plasma calcium in response to reduced calcium levels by stimulating osteoclast activity.
A. Calcitonin
B. Calcitriol
C. Cholecalciferol
D. Ergocalciferol
E. Parathyroid Hormone
E. Parathyroid Hormone
113
When stained with a Rhodanine stain a liver biopsy reveals a golden brown colour against the blue counterstain. What is the most likely diagnosis?
Wilsons Disease
114
A liver biopsy histology is reported as showing “Caseating granulomata”. What is the most likely diagnosis?
Tuberculosis
115
A liver biopsy histology is reported as showing “NON Caseating granulomata”. What is the most likely diagnosis?
Sarcoidosis
116
A liver biopsy histology is reported as showing “A "nutmeg" appearance”. What is the most likely diagnosis?
Hepatic congestion secondary to right heart failure
117
A 70 year old known teetotal patient is noted to have a heart murmur and careful examination reveals splenomegaly with an obvious notch and you can’t get above it. There are no visible veins on the anterior abdominal wall, and there is no ascites, so you conclude that there is no portal hypertension. Dipstick of the urine reveals microscopic haematuria. She is found to have a temperature of between 37.5oC and 38.5oC whenever it is checked.
What is the diagnosis?
Endocarditis
118
What is the technical term for a connection between two epithelial surfaces, as occurs in Crohns disease where for example there might be a connection between the bladder and the bowel?
Fistula
119
A 32-year old woman is thought to have Graves’ disease. What antibody should you look for?
anti TSH receptor antibodies
120
. A patient presents with weakness and is found to have a potassium of 2.4mM (NR 3.5 to 5.0). What is the likely acid-base abnormality if you check the patients arterial blood gas?
Metabolic alkalosis
121
Name the drug used for patients with type 2 diabetes which inhibits the enzyme alpha glucosidase in the brush border membrane of the small bowel.
Acarbose
