Pathology 3

Question 1

Drug for ventricular tachycardia

Answer 1

Amiodarone and lidocaine

Question 2

Drug for Wolf Parkinson White syndrome

Answer 2

Propranolol

Question 3

Drug for atrial fibrillation

Answer 3

Metoprolol or amiodarone or digoxin

Question 4

Drug for ventricular fibrillation

Answer 4

Amiodarone

Question 5

Drug for atrial flutter

Answer 5

Verapamil hydrochloride

Question 6

Drug to reverse torsades des pointes

Answer 6

Magnesium

Question 7

Osteoarthritis

Answer 7

Gradual onset joint pain, worse at end of day and with movement. Short periods of stiffness less than 30 mins in the morning.

Can affect distal phalanges and is often on load bearing joints. Swelling can be both hard and soft. Crepitus can be heard.

Characterised on imaging with thinning joint space, osteophytes, subchondral cysts, subchondral sclerosis.

Question 8

Rheumatoid arthritis

Answer 8

Connective tissue disease affecting joints within a synovium. Classically a symmetrical polyarthralgia with wide distribution and can particularly affect the hands.

Tender swollen joints. Smaller joints more likely to be affected.

RF and anti ccp can help to diagnose but some are seronegative.

Methotrexate, leflunomide or sulfasalazine

Question 9

Pseudogout

Answer 9

Acute or chronic deposition of calcium pyrophosphate instead of uric acid crystals. Tends to affect ankles, wrists, knees and shoulders.

Question 10

Treating RHA

Answer 10

DMARDs methotrexate, sulfasalazine, hydroxychloroquine, leflunomide. Bio DMARDs rituximab, etanercept, adainmumab anti TNFs.

Question 11

Ankylosis spondylitis

Answer 11

Arthritis of spine joints, occasionally pelvis, hips correct shoulder involvement. May get eye or bowel issues eg anterior uveitis.

It’s a seronegative spondyloarthropathy without RF antibodies.

Treatment includes NSAIDs and DMARDs eg sulfasalazine or TNF inhibitors.

Symptoms include dull back pain that radiates down and wakes people up.

Progressive with loss of spinal mobility and chest expansion with often weight loss, fever, fatigue.

Prepubertal knee and ankle swelling. Will show high crp and esr.
Detectable via HLA B27

Question 12

Osteoporosis

Answer 12

Progressive skeletal disorder characterised by low bone mass and micro architectural deterioration leading to increased bone fragility. Diagnosis from DEXA or fragility fractures.

If begin consolidating without achieving peak bone density will drop to osteopenia and osteoporosis faster.

Secondary causes include hyperthyroidism, hyperparathyroidism, RHA, IBD, Coeliacs, Cushing.

Drug treatments are anti resorption or stimulate bone.

Biphosphonates eg alendronate, risedronate, longer term iv zolendronate or ibondronate,

Anabolic teriparatide sc injection. Extreme treatment

SORM raloxifene for spine.

Denosumab sc per 6m if intol of biphosphonates, 2 yrs max

Question 13

Values for diabetes in glycated glycohaemoglobin A1c test

Answer 13

Prediabetes is 5.7-6.4 and diabetes is 6.5 or more.

Question 14

Systemic lupus erythematous

Answer 14

Most common in middle aged women. Triggered by factors like UV light, ebv, smoking, oestrogen.

Symptoms include fatigue, fever, uv sensitivity, butterfly rash, discoid rash, cognitive impairment, headaches, seizures, peripheral neuropathy, interstitial fibrosis leading to possible pleural effusion, pericarditis, htn, lupus nephritis, anaemia and leukopenia. Polyarthralgia.

Responds to esr, evc, crp, albumin and creatinine.

Treatment includes vitamin D, calcium, cholesterol management, myelophenalate or azathiopurine to halt B cell proliferation.

SLE increases risk of Hodgkin lymphoma.

Question 15

Poly myalgia rheumatic a

Answer 15

Inflammatory condition of severe bilateral pain and morning stiffness over 45 mins of the shoulder, neck and pelvic girdle.

Bilateral upper arm tenderness. Struggle to raise arms to head at waking hours. May have flu symptoms.

Managed with methotrexate or steroid prednisolone.

Question 16

Fibromyalgia

Answer 16

Chronic pain disorder, mostly in women between 20-50+. Believed peripheral and central hyper excitability at spinal or brain stem level resulting in altered pain perception.

Often presents alongside arthritis/osteoarthritis. Pain in multiple sites, shoulders and lower back, fatigue, sleep disturbance, morning stiffness, paraesthesia, feeling of swollen joint without swelling, headaches, anxiety and depression.

Flares when stressed, cold or humid.

Question 17

Ehlser danlos hyper mobile form

Answer 17

Soft skin, hyperextending, striae, bilateral piezogenic papules of the heels. Multiple abdominal hernias. Prolapse, mitral prolapse, aortic root dissection, dislocations and pain.

Question 18

Ehsler danlos classical

Answer 18

Autosomal dominant, skin stretching, atropic scarring, generally hyper mobile, skin splitting, soft, pseudotumours, hernias, sprains, subluxations, pain, bruising.

Question 19

Types of Alopecia

Answer 19

Areata- autoimmune round patches missing in places like head, beard, eyebrows, eyelashes.

Androgenic is all over age related loss for men and all over thinning for women.

Scarring/cicatricial- conditions that destroy the follicle. If central, starts in the centre of the scalp and slowly spreads outwards.

Frontal fibrosing- type of scarring one where follicle is destroyed and replaced by scar tissue.

In lichen planopilaris - a scarring one with patches over the head.

Telogen effluvium- having a faster hair cell cycle that sheds more often.

Tractional is from physical tension on the hair.

Trichotillomania is obsessively pulling out hair.

Question 20

vestibular neuronitis and labyrinthitis

Answer 20

Vestibular neuronitis is thought to be due to inflammation of the vestibular nerve and often occurs after a viral infection.
Labyrinthitis is a different diagnosis that involves inflammation of the labyrinth.
Hearing loss is a feature of labyrinthitis, but hearing is not affected in vestibular neuronitis.

Symptoms of vestibular neuronitis include spontaneous onset of vertigo, nausea, vomiting, and unsteadiness. Hearing loss and tinnitus are not present, and there are no focal neurological symptoms. Will often have nystagmus.

If symptoms are severe, short-term symptomatic drug treatment can be offered.
Buccal or intramuscular prochlorperazine or intramuscular cyclizine can be considered to rapidly relieve severe nausea or vomiting associated with vertigo.
A short course of oral prochlorperazine, cinnarizine, cyclizine, or promethazine teoclate can be considered to alleviate less severe nausea, vomiting, and vertigo.

Question 21

Diaphragmatic breathing

Answer 21

Diaphragmatic breathing, or “belly breathing,” involves fully engaging the stomach, abdominal muscles, and diaphragm when breathing. This means actively pulling the diaphragm down with each inward breath. In this way, diaphragmatic breathing helps the lungs fill more efficiently. used in COPD.

Question 22

Biot’s breathing

Answer 22

Biot respiratory pattern is characterized by regular deep respirations interspersed with periods of apnea. It is caused by damage to the pons due to stroke, trauma, or uncal herniation. As the insult to the pons progresses, the pattern becomes irregular. At this point, the pattern deteriorates to ataxic breathing.

It has rapid, shallow breathing. It differs from Cheyne-Stokes respiration in that it does not feature cycles of deep breathing, or gradual alternations in breathing patterns.

Question 23

Hordeolum

Answer 23

A stye (hordeolum) is a tender red bump on the edge of the eyelid. It is an infection of a gland of the eyelid. The infection is most often caused by bacteria called staph (Staphylococcus aureus). The most common symptoms are redness and swelling of the eyelid. In most cases a stye will go away on its own.

Question 24

Reactive arthritis

Answer 24

Reactive arthritis is a painful form of inflammatory arthritis (often at knees, ankle, heels, digits, lower back). It occurs in reaction to an infection by certain bacteria. Most often, these bacteria are in the genitals (Chlamydia trachomatis) or the bowel (Campylobacter, Salmonella, Shigella and Yersinia). Chlamydia most often transmits by sex. It often has no symptoms, but can cause a pus-like or watery discharge from the genitals. The bowel bacteria can cause diarrhoea. If you develop arthritis within one month of diarrhoea or a genital infection -may have reactive arthritis. Give NSAIDS, then DMARDs if not useful eg sulfasalazine or methotrexate.

Question 25

Seborrheic keratosis

Answer 25

Seborrheic keratosis is a harmless warty spot that appears during adult life as a common sign of skin ageing. Some people have hundreds of them.

Question 26

Serosa vs mucosa vs adventitia

Answer 26

Adventitia consists of ordinary connective tissue in the shape of fibers that rests around the organ that the tissue supports. The serosa is also connective tissue, but its surface consists of mesothelium. It makes up the visceral peritoneum and extends over the abdominal wall, forming the parietal peritoneum.

The mucosa consists of the epithelium itself, also innermost layer of GI organs and also includes a supporting loose connective tissue, called lamina propria, immediately beneath the epithelium. Deeper connective tissue which supports the mucosa is called the submucosa. Muscularis mucosae consists of scattered bundles of longitudinal muscle fibers. Then the serosa exists. The serosa is instead an adventitia when it covers an organ or blood vessel retroperitoneally. Intraperitoneal structures require lubricant and so need an additional layer that forms the visceral peritoneum.

Question 27

Acute intermittent porphyria

Answer 27

A rare metabolic disorder affecting the production of heme resulting from a deficiency of the porphobilinogen deaminase. It is the most common of the acute porphyrias (liver disorder of porphyrin proteins build up).

The patients are typically asymptomatic, with most gene carriers having no family history because the condition had remained latent for several generations. The syndrome marked by acute attacks affects only 10% of gene carriers. The mean age at diagnosis is 33 years old. Like other porphyrias, AIP is more likely to present in women. A distinguishing feature of AIP that separates it from other porphyrias is the absence of photosensitive cutaneous symptoms that occur in addition to acute attacks.

Acute symptoms include general abdominal colicky pain, tachycardia, possibly: vomiting, constipation, stiff or painful back and thighs that shifts to loss of tendon reflexes and paralysis. Sometimes psychiatric symptoms are present. Often show photosensitive port wine urine. Hyponaetremia also occurs, also hypomagnesemia. Most common triggers are medicines, weight loss and surgery.

During an attack, can give hematin and heme arginate. Sometimes 10% glucose infusion. Discontinuing causative medicines.

Question 28

legionella bacteria

Answer 28

Gram negative, causes legionnaires’ disease/pneumonia and pontiac fever URTI. From water and soil.

Question 29

Encephalitis vs hydrocephalus

Answer 29

Encephalitis- inflammation of the brain that is viral or autoimmune quite often.

Signs-
fever, headache, confusion, seizures, fatigue, poor appetite, stiff neck if associated with meningitis.

Hydrocephalus accumulation of CSF increases ICP and can be from neural tube defects, meningitis, tumours, haematoma, intraventricular haemorrhage.

Signs-
eyes that appear to gaze downward/hard to control, irritability, seizures, separated sutures, sleepiness, vomiting, headaches, incontinence

Question 30

TORCH neutropenia acronym

Answer 30

(toxoplasmosis, other [viruses], rubella, cytomegalovirus, herpes [simplex] viruses)

Question 31

Henoch-Schönlein purpura

Answer 31

Henoch-Schönlein purpura (HSP) is an IgA-mediated, autoimmune hypersensitivity vasculitis of childhood. The main clinical features are skin purpura, arthritis, abdominal pain, gastrointestinal bleeding, and nephritis.

The condition tends to be seasonal and there is often a history of recent infection. Infections preceding HSP include those involving group A streptococci, mycoplasma, Epstein-Barr virus, Coxsackievirus, hepatitis A and B, parvovirus B19, campylobacter, varicella and adenoviruses. Vaccination has also been described as a trigger. There is also an association with malignancy. Self resolving.

Question 32

Desmopressin

Answer 32

Desmopressin (DDAVP) is a synthetic form of vasopressin hormone, a chemical made by the pituitary gland. It works on the kidneys to decrease the amount of urine made. DDAVP can help decrease bedwetting in children.

Also sometimes for mild haemophilia A, von Willebrand disease, and high blood urea levels.

Question 33

What is a CA-125 blood test?

Answer 33

A CA-125 blood test may be used to:

Monitor treatment for ovarian cancer. If CA-125 levels go down, it usually means the treatment is working.
Check to see if cancer has come back after successful treatment.
Screen women who are at high risk for ovarian cancer.

Question 34

Alpha Fetoprotein (AFP) Tumor Marker Test

Answer 34

AFP stands for alpha-fetoprotein. It is a protein made in the liver of a developing baby. AFP levels are usually high when a baby is born, but fall to very low levels by the age of 1. Healthy adults should have very low levels of AFP.

An AFP tumor marker test may be used to:

Help confirm or rule out a diagnosis of liver cancer or cancer of the ovaries or testicles.
Monitor cancer treatment. AFP levels often go up if cancer is spreading and go down when treatment is working.
See if cancer has returned after treatment.
Monitor the health of people with cirrhosis or hepatitis.

Question 35

Noonan Syndrome

Answer 35

Congenital birth disorder.

Most infants with Noonan syndrome have characteristic craniofacial features. In many cases; a large head, widely set eyes (ocular hypertelorism) that are unusually prominent; drooping of the upper eyelids (ptosis) and/or unusually thick, “hooded” eyelids; an eye that turns in or turns out (strabismus); downwardly slanting eyelids (palpebral fissures); skin folds (epicanthal folds) that may cover the eyes’ inner corners; and/or strikingly blue or bluish green colored portions of the eyes (irides).

Many infants with Noonan syndrome also have additional craniofacial features. These may include an unusually deep vertical groove in the middle of the upper lip (philtrum); and/or a small chin. Affected infants may also have a small jaw (micrognathia); crowding of the lower teeth, low-set, posteriorly rotated external ears (pinnae); and/or distinctive abnormalities of the nose including a depressed nasal root, a wide base, and a rounded (bulbous) tip. Affected infants also often have excessive skin in the neck area (nuchal skin) and a low hairline at the back of the neck (low posterior hairline).

During older adulthood, characteristic features may include an abnormally high hairline on the forehead; wrinkled, unusually transparent skin; and unusually prominent nasolabial folds. In addition, individuals with Noonan syndrome may have wispy scalp hair during infancy that typically becomes more wooly or curly during later childhood or adolescence. Many affected individuals also have distinctive eyebrows that appear highly arched and/or “diamond shaped.”

Many newborns with Noonan syndrome attain normal birth weight. However, in some newborns, the birth weight may be increased due to subcutaneous oedema. For example, swelling of the back of the hands and top of the feet (peripheral lymphedema) is common in newborns with Noonan syndrome; in such cases, oedema affecting the fingers may result in an increased number of whorls on the fingertips (abnormal dermatoglyphics). Such oedema may be due to improper or late development of certain lymph vessels (congenital lymphatic dysplasia).

Some infants with Noonan syndrome may experience feeding problems and fail to grow and gain weight at the expected rate (failure to thrive). In addition, children with the disorder tend to be short for their age, and approximately 20 percent experience delayed bone maturation.

Skeletal and cardiac abnormalities are also common and blood vessel malformations.

Question 36

Central scotoma

Answer 36

Central scotoma is an area of depressed vision that corresponds with the point of fixation and interferes with central vision. It suggests a lesion between the optic nerve head and the chiasm. Possible causes include: multiple sclerosis, disorders of the optic nerve, choroid or retina, such as macular degeneration. Eye infections that result in a scar or strokes, tumours, and traumatic brain injuries.

Question 37

Nipple rashes

Answer 37

Eczema more so around the areola, paget’s disease of the nipple on the nipple, nipple dermatitis if breastfeeding.

Question 38

Cogwheel rigidity

Answer 38

In Parkinson’s disease muscle stiffness. The muscles become stiff and the body no longer moves smoothly. When movement becomes jerky, it is called cogwheel rigidity, and when stiffness continues, it is called lead-pipe rigidity.

Question 39

Causes: swelling supraclavicular and upper back

Answer 39

Could be lymphoma, infection, cancer, thoracic outlet syndrome.

Question 40

Male breast cancer referral 2w

Answer 40

• >50 years (mean age 65 years)
• Positive family history in 50%
• Referred with an irregular mass, possibly hard and fixed, dimpling, nipple
changes and nipple discharge

Question 41

Female breast cancer referral 2w

Answer 41

Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer if they are:

Aged 30 years and over and have an unexplained breast lump with or without pain. Have a swollen lymph node in your armpit that doesn’t go away after 2 or 3 weeks. Are over 35 and have lumpiness in your breast that doesn’t go away after 2 or 3 weeks.

Aged 50 years and over with any of the following symptoms in one nipple only:
Discharge.
Retraction.
Other changes of concern.

Question 42

Hyper parathyroidism

Answer 42

Hyperparathyroidism occurs when too much parathyroid hormone is released by the parathyroid glands in the neck. It generally leads to high levels of calcium in the blood. This can cause various symptoms, commonly tiredness, feeling sick (nausea), being sick (vomiting), kidney stones and bone pains. It can usually be treated with surgery. Can be given biphosphonates for bone density. Aim to have parathyroidectomy.

Question 43

Labetalol x with afib if have PAD

Answer 43

Betablockers contraindicated in severe PAD.