PPQ Imp Flashcards
What is the most common parasitic infection in the duodenum causing malabsorption?
Giardiasisi Duodenalis
40 year old,with low TSH and very high T4, what sign would you likely see in/around her eyes if you look closely?
Periorbital myxoedema/
If phrased differently think about Exophthalmos
What are the vaccines that are offered in pregnancy?
Influenza, Whooping cough and Covid
What is the method to help reduce the chances of acute ABO rejection in the transfer of an ABO incompatible kidney?
Plasmaphoresis
Apparently Hyperacute doesnt have a treatment?
As prevention plasmophoresis
Hospital is low on O- what is the most approapriate method to give blood who comes in as a casualty?
Give O+ if male or female who can’t get pregnant
If there is a patient with poorly controlled diabetes and an eye infection that is oozing, What is the most approapriate immidiate pharm Tx?
The diagnosis is Mucormycosis
Treated by Amphotericin B
Patient has joint pain and a rash. She has an autoimmune condition what is it called? Results show a reduced C1q
SLE (Systemic Lupus Erythematosus)
Man has intermittent mouth and tongue swelling for 2 years. This is unresponsie for over the counter anti-histamines. He is also on Aspirin and ACE inhibitor. what is the most likely cause?
Drug induced reaction
A woman has mouth and lip swelling following a dental procedure, and her mother reports a similar problem in the past?
C1 esterase inhibitor deficiency
Heridatory angiooedema
What is the genetic mutation in digeorge syndrome?
22q11.2
What natural antibody is protective against HIV?
HIV-gp120
gp41
What allergy is more likely to present in a child?
Egg
What is the Maintanence treatment against allograft rejection?
Induction agents are?
MAINTANENCE :Mycophenolate mofetil/Azath +pred + Tacrolimus
INDUCTION : OXT3/ATG, anti-CD52, anti-CD25
§ Given at time of transplantation or just before to prepare the patient to receive the foreign organ
What is the mechanism of hyperacute allograft rejection?
This where antibodies are against HLA or ABO
These antibodies are preformed and occur within an hour of transfusion
What is the effect of gene mutation in Familial mediterranean fever?
There is a mutation in MEFV and this causes a problem in the pyrin-marenostrin which then leads to increased IL-1, NF kappa B and apoptosis
What type of hypersensitive causes serum sickness ?
This is a type 3 complex mediated hypersensitivity
What infections are covered by conjugate vaccines?
Encapsulated infections.
Pneumococcal vaccines or Hib vaccines
What does PD-1 inhibit
T-cells
Nivolumab is an example and treats Malignant melanoma
cAnca with glomerularnephritis and lung changes what does he have
Wegner;s or granulamatosis with polyangitis
Rituximab which acts on CD 20, effects what cell type?
B-cells.
What is the max number of HLA mismatches?
What if this is between mother and son
So max mismatch is 6
Mother and son max is 3
What condition is NOD2/CARD15 associated with?
Crohn’s disease
What is the receptor /cytokine mutation that can be protective in HIV?
CCR5/MIP-1a or b
What is found in coeliac biopsy?
Crypt hyperplasia
Non-caseating granuloma
Intraepithelial lymphocytes
I think Villous atrophy as well
Chimeric antigen receptor T-cell (CART) therapy Cd19: What type of haematological malignancy foes it target?
ALL and some non-hodgkins lymphomas
Multiple myeloma
Mantle cell lymphoma
CART therapy essentially creates T-cells that search for C19 cells which are B-cells therefore targeting them
Pleuritic chest pain, joint pain, positive ANA and Anti SM but there is no abnormal liver enzyme derangement, raised ESR. what is the likely diagnosis?
SLE (Systemic Lupus Erythematosus)
For the treatment of ankylosing spondyitis, NSAIDs TNF inhibitor have been tried what else can be targeted?
IL17
What is the mechanism of graft versus host disease?
presentation?
prophylaxis
Treatment
Donor T-cells react to host cells
??CD4+ activated and assists CD8+ and B cells
Presentation is Days-weeks –> N+V, bloody diarrhoea, abdo pain and jaundice
Methotrexate /cyclosporin prophylaxis IRRADIATE BLOOD
Treated with steroids
What virus causes progressive multifocal leukoencephalopathy?
John cunningham virus
What condition is a complication of the John Cunningham virus?
The JC virus causes progressive multifocal leukoencephalopathy
Diffuse large B-cell is lymphoproliferative disease caused by this virus
Autoimmune hypothyroidism (Hashimoto’s is associated with which antibody)
Anti thyroglobulin
What is dry eyes and parotid sweling associated with (antibody)?
Diagnosis
Anti-ro and anti la (Which are both Anti ENAs)
Sjrogrens syndrome
Swollen joinst of the hand and X-ray showing erosive changes antibody
Anto CCP
What is the treatment of Osteoperosis? (When bisphosphonates are not tolerated)
RanK L -> Denosumab
What is the treatment for Chronic granulomatous diase?
IFN gamma
Which immune cell is produced in the bone marroe and then migrated to ht site of injury. It has oxidative and non-oxidative killing abilities and dies when the job is done?
What will they be if after they did their jobs they would ace as APCs
Neutrophils
The APCs would be Macrophages
Foxp3+ And CD25+ cells, they mature in the thymus
Treg cells
What immune cells detects antigen in the periphery and moves to lymph nodes
Dendritic Cells
What immune cell detects MHC1 and kills virus infected/cancer cells. Is inhibited by MHC I
NK cells or CD8+ cells
NK cells -> MHC 1 inhibition
When infected or cancerous loose some MHC 1 and so loose the inhibition
CD8+ recognise abnormal MHC1 antigen presentation leading to them attacking the cell
I think
What immune cells is targeted by HIV
Memory CD4+ ccells
Sle with recurrant clotting
Diagnosis
Antibody
Phospholipid syndrome
Anti cardiolipin
72 year old women with stiff limb girdles. Aches all over and joint stiffness
Diagnosis
Antibody
Polymyositis? - Anti Jo 1 or anti srp
Polymyalgia rheumatica -> Most representative of symptoms imo but not really associated with antibody
Rheuamtic arthritis –> AntiCCP –> More likely than polymyositis current thinking
polymyalgia rheumatica mainly refers to the shoulder girdles, not peripheral joints - if there’s peripheral joint involvement more likely RA –> BENJI
CREST syndrome antibody
Anti-centromere
(EMQ) A teenage girl who when she goes cross country running gets an erythematous rash on her legs. It is well controlled by antihistamines
Diagnosis
Cold urticaria
(EMQ) Man can eat apple pie. But if he eats fresh apples and pears, he gets inflamed lips
Oral allergy syndrome
(EMQ) Man has an allergic reaction during surgery and who’s lips becomes swollen/oedematous when blowing up balloons as his daughter’s birthday party
Type 1 hypersensitivity latex allergy
(EMQ) Bloated after drinking milk but not IgE mediated
Lactose intolerance
(EMQ) A girl with a sore throat is given penicillin and develops a rash. She is found to have EBV
Drug reaction
(EMQ) What cells do Myasthenia gravis antibodies bind to?
They bind to skeletal muscle
(EMQ) What will be measured in a patient with well controlled HIV, who is currently on HAART?
Lymphocyte subset
A woman with known SLE presents with an exacerbation of her SLE/ worsening symptoms, what would you measure?
C3 and C4
A 60 year old lady with recurrent chest infections now has reduced total serum protein and has autoimmune thrombocytopenia
Common variable immunodeficiency
A 12 year old boy has recurrent chest infections and has an ear infection. He doesn’t have any B Cells
Bruton’s Agammaglobulinaemia
Boy with recurrent abscesses has a negative NBT test
Chronic granulomatous disease
A Girl is found to have no CD4 cells, but CD8 cells and B cells are present
Bare lymphocyte syndrome 2
A boy’s father has TB. The same boy develops a mycobacterium infection, following their BCG
What is their primary immune deficiency
Interferon gamma receptor deficiency
Young boy with normal B cell numbers and absence of CD8+ and CD4+
They have a deficiency in the common gamma chain protein
X-linked SCID
Normal B and T cells, high IgM but absence of IgA, IgE and IgG
Hyper IgM syndrome
Encampsulated bacteria infections that are recurrent suggests what primary immune deficicencys
Complement deficiency e.g. C7
Either the complement deficiency alternate or common
What is used to treat lymphoma and rheumatoid arthritis
Rituximab
What is used to prevent transplant rejection by blocking T cell activation
Tacrolimus or Cyclosporin
What is used to treat severe ankylosing spondylitis not controlled by NSAIDs.
etanercept (Anti-TNF alpha)
1st NSAIDS
2nd Anti TNF alpha
3rd Anti 1l 17
Monocytes found in the tissue are called
Macrophages
Liver - Kupffer cells
What is the name of the differentiated B cells that produce immunoglobulins
Plasma cells
What condition is associated with DR4 and CCP
Rheumatoid arthritis
What is the condition that is associated with a mutation in the FAS pathway, with lymphocytosis, lymphomas and autoimmune cytopenia
Autoimmune lymphoproliferative syndrome
ALPS
A woman with periorbiital purple rash and rash on knees, which enzyme is elevated?
Grotton’s papules - Red violet bumps outside joints of the hand
Creatine kinase (dermatomyositis)
Within muscle → perivascular CD4 T and B cells
o Immune complex mediated vasculitis – T3 response
What virus can lead to post traplantation lymphoproliferative disease?
Epstein barr virus diffuse large b cell lymphoma
Patient presents with clear discharge from the nose every summer. These symptoms seems very allergic like. What is the cause?
Allergic rhinitis
A diabetic patient with Hypertension is being treated, and develops angioedema.
What is the cause?
This is a drug reaction to ACE inhibitor?
What zoonotic disease does Ixodes Tick cause?
Lyme disease
What is the main class of drugs that are used to treat HIV?
Nucleoside reverse transcriptase inhibitor
What is the amyloid that is deposited in multiple myeloma and what type of amyloidosis is this?
Amyloid light chain amyloidosis which is a primary amyloidosis?
What is Behcet’s Disease?
Epi
Pres
Some of the other symptoms
Systemic Vasculitis of unknown cause
This is a multisystem disorder of the small, medium and large sized blood vessels.
Epi- Easter Mediterranean mainly in men 20-40 yrs
PRESENTATION
Cant see, cant pee and cant eat spicy
Anterior uveirtis
Genital ulcers
Oral ulcers
What is Polyarteritis Nodosa?
Cause
Presentation
Ix
A vasculitis affecting the medium sized vessels.
Aetiology: Idiopathic / Hep B infection
Presenation:
- Renal -> HTN + Renal failure
- Abdo: Abdo pain
- Skin: Livedo reticularis
- Nerves
- Arthralgia
- Systemic Flaws
Investigations:
CTA/MRA: ROSARY SIGN
Takayasu’s Arteritis
What is it?
Presentation? (6)
Associations?
Treatment?
- Large vessel vasculitis.
- Typically occludes the aorta and questions commonly refer to an absent limb pulse.
- More common in females and Asian people.
Features
- Systemic features of a vasculitus e.g malaise, headache.
- Unequal blood pressure in upper limbs
- Carotid bruit
- Intermittent claudication
- Aortic regurg
Associated with renal artery stenosis.
Manage with Steroids
Which vasculitis causes a disease in a branch of the external carotid artery?
This is a large vessel vasculitis and so is probably Giant cell arthritis
Takayasu arthritis is possible but more rare.
Man with cough, SoB and weight loss. Hyponatraemia, low serum osmolality, urine Na and osmolality were inappropriately normal, what is the cause of the low sodium?
SIADH secondary to small cell lung carcinoma
Elderly woman with C. diff colitis and profuse diarrhoea, Presents with low sodium, what type of hyponatremia will be present?
Hypovolaemic hyponatraemia
Man who has been in a car accident, raised sodium and plasma osmolality, low urine osmolality
Cranial Diabetes insipidus
There is a raised Na and a low K but there is a raised Renin, What is the cause of this presentation
Renal artery stenosis.
Could have been hyperaldosterone but the raised renin tells us it is renal artery stenosis.
What are the indications for dialysis?
A - Acidosis pH<7.1
E - electrolytes - Refractory Hyperkalaemia
I - Intoxification/Ingestions Toxic alcohol, salicylates, lithium
O - Overload - Congestive heart failure
U - Uraemia - Uremix pericarditis and uremic encehaloppathy
What is described by true positives divided by the total number of people who have the disease describe?
Sensitivity
What is the true negative divided by the total number of people who don’t have the disease describing?
Specificity
What is described by the people who are true positive divided by the number of people who tested positive?
Postive predictive value
What is described by the people who are true negative divided by the the number of people who tested negative?
Negative predictive value
What ion is likely to be outside the normal range in an alkalotic picture?
K+
Na+
Ca 2+
Mg 2+
K+ (I think) It decreaseas
What is the best investigation to confirm cushings disease?
High dose dexamethasone
Apparently inferior pituitary petrosal sinus sampling
A man has gout and is kept up at night by it. His symptoms are relieved by ibuprofen, but when he stops taking it, the symptoms come back. His neighbour is on allopurinol, and he would like to be on it too. Which of these medications would need to be altered for them to be able to be prescribed allopurinol?
Azathioprine
Azathioprine is a powerful immunosuppressant drug used in the treatment of inflammatory bowel disease and other conditions.
{{c1::Thiopurine methyltransferase (TPMT)}} deficiency is a congenital deficiency in an enzyme used to convert 6-mercaptopurine, a breakdown product of azathioprine, into less toxic, excretable metabolites. Approximately 1 in 300 people are deficient.
There are only two ways the body can clear 6-mercaptopurine: {{c1::Thiopurine methyltransferase (TPMT}} and the {{c2::Xanthine Oxidase pathway}}.
If a patient is on both azathioprine and allopurinol AND they have {{c1::Thiopurine methyltransferase (TPMT}} deficiency - this leads to a buildup of toxic metabolites that may lead to profound leukopenia and death.
All patients starting azathioprine need {{c1::Thiopurine methyltransferase (TPMT}} levels checked
Be cautious about patients on both {{c3::allopurinol (Xanthine Oxidase inhibitor)}} + azathioprine - have their {{c1::TPMT}} levels been checked?
A person have a pituitary adenoma removed. What is the medication that needs to be provided if they are discharged?
DDAVP
Fludrocortisone
Testosterone
DDAVP
But if hydrocortisone or a a steroid is present choose that one
Ilan said he remebered something about hydrocort, thyroxine then sex steroids depending on gender?
ChatGPT said DDAVP pick whatever you want
Describe the metabolic picture in the most common form of congenital adrenal hyperplasia?
Na
K
volume
Na+ this will be low
K+ Will be high
Hypovolaemia
Most common version is 21 hydroxylase
Low glucose high insulin
What needs to be measured?
C-peptide
Low glucose high insulin High C-peptide
Insulinoma, or Surreptitious gliclazide
What ion is raised in red cell lysis?
K+
What does PCSK9 inhibitor halve?
Evolucumab - halves LDL
Which molecule takes cholesterol and moves it to liver and steroidogenesis organs?
HDL
Look where the L is, HDL (L at the end cause to the liver)
LDL L at the start so from the liver
Vitamin deficiency that causes both megaloblastic anaemia and Neural tube defects>?
Folate
What hormone would be raised in the most common cause of CAH?
Sex Steroid hormones (Androgens)
And
ACTH
What hormone leads to increased levels of prolactin?
What causes a decrease in prolactin?
Increase- Thyroid Releasing hormone
Decrease- Dopamine
What is produced by a medullary carcinoma of the thyroid?
Calcitonin
A man develops signs of hyperthyroidism. Bloods show low TSH and high thyroxine. A technetium scan shows no uptake. What is the likely diagnosis?
Viral thyroiditis/ De Quervain’s thyroiditis
An old man who fell over, been on the floor for days. Severely dehydrated. Dark urine. Not blood on microscopy. What causes dark urine?
What enzyme will be raised?
Rhabdomyolysis leading to Myoglobin
Creatinine kinase
What liver enzyme is raised in an MI?
Aspartate aminotransferase
Could be ALT???
What enzyme is used to confirm cardiac failure?
B-type natriuretic peptide
5yr old, tetany, bone pain. Widened epiphyses + ‘Cupping’ of metaphysis shown on x-ray. What is the cause?
Rickets
Publican with diabetes, fatty stools, weight loss, ‘slate grey skin’ and joint pains. What is the underlying diagnosis causing this?
Haemochromatosis (joint pain, skin changes, pancreatitis, liver deposition)
Swollen joint, needle-shaped aspirate with negative birefringence, which enzyme manufactures the material that makes up the crystals?
Treatment for previous question, specifically one you should use acutely
Xanthine oxidase
Acute: Colchicine or an NSAID
Chronic: Allopurinol or probenecid
T1DM with hypoglycaemia, what is the management option if no IV access?
IM glucagon
Patient with GI conditions, lack of which substance leads to B12 being malabsorbed?
Intrinsic factor
Which thyroid cancer is most commonly metastsisises to the lymph nodes?
Papillary
What is the most common cause of pancreatitis?
Gallstones
GET SMASHED
First three are in order
Gallstones, Alcohol and then trauma
Gallstones is likely if acute pancreatitits,
Alcohol is the answer if it is chronic pancreatitis
What is the best test that will help with the diagnosis of temporal arthritis?
ESR
If asking for gold standard this would be a biopsy. Normally however this cant get an affected part of the vessel so is not helpful
40 y/o woman presents with headache, but normal visual fields. MRI shows a 4mm pituitary adenoma. Investigations:
Cortisol 400 (high end of normal)
ACTH 30 (normal)
Prolactin 1400 (high)
TSH 3.3 (normal)
Free T4 17 (normal)
What is the most likely diagnosis?
Acromegaly
Hypopituitarism
Nonfunctioning pituitary macroadenoma
Prolactinoma
TSHoma
Prolactinoma
40 y/o woman presents with headache and a bitemporal hemianopia. MRI shows a 2cm pituitary adenoma. Investigations:
Cortisol 400 (high end of normal)
ACTH 30 (normal)
Prolactin 1400 (high)
TSH 3.3 (normal)
Free T4 17 (normal)
What is the most likely diagnosis? – same as prev question but with hemianopia?
Acromegaly
Hypopituitarism
Non-functioning pituitary macroadenoma
Prolactinoma
TSHoma
Non-functioning pituitary macroadenoma
40 y/o woman has post-partum haemorrhage and is then unable to breastfeed. Investigations:
Cortisol <50 (very low)
ACTH <10 (very low)
Prolactin <50 (very low)
TSH 0.9 (normal)
Free T4 12 (normal)
What is the most likely diagnosis?
Acromegaly
Hypopituitarism
Non-functioning macroadenoma
Prolactinoma
TSHoma
Hypopituitarism
Which of the following would be consistent with obstructive jaundice?
Normal ALP
Normal AST
Normal GGT
Dark stools
Increased bilirubin in the urine
Increased bilirubin in the urine.
Normally dark urine is because of urobillin. In obstructive jaundice the dark urine is because the bilirubin gets into the urine however.
Which of the following is found in haemolytic jaundice?
Raised AST
Raised CK
Normal bilirubin
Pale stools
High urobilinogen in urine
This is high Urobilinogen in the urine
The liver function is fine and so is the movement of bilirubin in the blood. This means that the normal process can occur leading to more urobillin in the urine.
Calcium high, PTH low
Bone Mets
Could also be Sarcoid, thyrotoxicosis, High Vit D etc
Patient can’t fit in her shoes or put on her wedding ring and has prognathism, what test do you need to do to confirm?
serum IGF then oral glucose tolerance test
BP 190/100, thin skin, overweight, high-normal sodium, low normal potassium, OGTT done (glucose high normal)
low dose dexamethasone suppression test then
inferior pituitary petrosal sinus sampling
Pt with low Na, High K + postural hypotension
Ix?
Addison’s
Therefore SyncACTH test.
Patient with low sodium, potassium normal, low plasma osmolality and urine osmolality was 70
Primary polydipsia,
fluid deprivation test
Women with colicky pain.
Elevated mildly elevated ALP, ALT, GGT, & Bilirubin.
GGT + Bilirubin most raised of results provided.
Gallstones
Acute Cholestasis
Any Post hepatic cause of jaundice probably
A 57 year old man presents following hematemesis and is found to have high ALT + GGT, slightly raised ALP, and low Albumin
Diagnosis
Cirrhosis
An elderly gentleman has massively elevated ALP on its own, and the other results are normal. He also reports a history of headaches.
Diagnosis
Paget’s
What is the bicarbonate level of someone with pyloric stenosis?
High Bicarbonate
Therefore you would expect to see a low potassium, normal sodium and high bicarbonate
PATHOPHYSIOLOGY
You would expect low CL because of vomiting of HCL from stomach.
You would expect an individual to become dehydrated from vomiting. So you would expect the kidneys to respond to dehydration by increasing water reabsorption via Vasopressin/Anti-diuretic hormone and Aldosterone.
Aldosterone allows trading of water in the renal tubules back into the blood in exchange for potassium in the blood. Just like how Insulin allows trading of water from within cells, back into the blood, in exchange for potassium to flow into the cells (from the blood). Another effect of aldosterone on the kidneys (in the renal tubules) is to allow H+ trading into the urine, in exchange for HCO3- from the urine. This results in a metabolic alkalosis (= H+ lost from the blood, and HCO3- reabsorbed into the blood).
Therefore in Pyloric stenosis, the sodium is reabsorbed to draw the water into the body, and result in a high bicarbonate.
What is the K+ level in a patient with DKA?
Raised K+
K+ matches H+ conc most of the time
Man with impaired glucose tolerance fasting value
Between 6.1 and 6.9
WHO criteria for diabetes and blood glucose impairment:
NORMAL fasting glucose (FGP): {{c1::≤6.0}} mmol/L
IMPAIRED fasting glucose (IFP): {{c1::6.1‒6.9}} mmol/L
Diabetes Mellitus: {{c1::≥7.0}} mmol/L
WHO criteria 2-hour glucose tolerance test
Impaired fasting glucose :{{c1::≥6.1 - 6.9}} mmol/L
Normal Glucose tolerance : {{c1::<7.8}}
Impaired glucose tolerance {{c1::≥7.8 -11.0}} mmol/L
Diabetes : {{c1::≥11.1}} mmol/L
Deficiency of which enzyme leads to hyperuricemia?
HGPRT ->
hypoxanthine-guanine phosphoribosyltransferase
This is Lesch Nyhan disease?
Rare inherited disorder that effects the metabolism of purines.
Developmental delay, junenille gout and self mutilation.
What enzyme is raised in Mumps?
Amylase-S or P?
Mumps is associated with Pancreatitis and so leads to an increase in amylase levels.
S stands for salivary gland so it is that one
Baby with seizures: low Ca, low PTH
Primary hypoparathyroidism?
10 year old with seizures: low Ca, high PO4, high PTH
Renal osteodystrophy
Secondary hyperparathyroidism is probably correct, but this would cause a low phosphate or high phosphate depending on the cause. In the cases where the phosphate is high there must be a problem with the kidney leading to the diagnosis of renal osteodystrophy, as opposed to a vitamin D deficiency cause,
Colour blindness is caused by which Vitamin deficiency?
Vit A
What vitamin deficieny causes pellegra?
How does thie condition present?
Niacin / B3
It is associated with Diarrhoea, dementia and dermatitis
DEATH if untreated
What vitamin deficicency is associated with beriberi?
What is the presentation of this? (Wet/Dry)
Vitamin B1/ thiamine.#
Wet - > heart related overload
Dry -> neurological deficits like Wernickes. Pabrinex
A man requires a 6 unit transfusion after a traffic collision, and two hours later becomes
breathless, feverish, and tachycardic
What is the diagnosis?
Transfusion related acute lung injury?
OR
Transfusion associated circulatory overload (MOST COMMON ACUTE REACTION)
What are causes of acute transfusion reaction under 24 hours?
o Acute haemolytic (ABO incompatible)
o Allergic/anaphylaxis –> improvves with antihistamine and hx of atopy/ Often associated with facial swelling
o Infection (bacterial)
o Febrile non-haemolytic –> Will have high temperature during transfusion
o Respiratory
▪ Transfusion associated circulatory overload (TACO)
* Often pre-existing cardiac/respiratory problems
* 1 in 100,000 mortality risk (very preventable)
* MOST COMMON ACUTE REACTION
▪ Acute lung injury (TRALI)
What are the causes of delayed transfusion reactions?
o Delayed haemolytic transfusion reaction (antibodies) – Duffy and Kidd
o Infection (viral, malaria, vCJD)
o TA-GvHD (week or 2 after transfusion)
o Post transfusion purpura
o Iron overload
A thalassemia patient presents with malaise and erectile dysfunction
Transfusion-related
haemosiderosis
A Lady with myelodysplastic syndrome requires regular monthly blood transfusions. 10
minutes after her latest transfusion she becomes tachycardic, has transfusion site pain, and
is hypotensive
ABO incompatibility
ABO incompatibility occurs when the recipient’s antibodies react with the transfused red blood cells that have different ABO antigens. This immune reaction leads to the destruction of the transfused red blood cells and subsequent release of substances that can cause symptoms such as tachycardia, transfusion site pain, and hypotension. AHTR is a serious and potentially life-threatening complication.
While anaphylactic reactions can occur during blood transfusions, they typically present with symptoms such as hives, itching, respiratory distress, wheezing, and significant hypotension. However, anaphylactic reactions are less common compared to AHTR in the context of blood transfusions.
Man feels itchy after transfusion, calms down with cetirizine <24 hrs
Allergic reaction
Alcoholic has an AAA repair and several days later develops a fever, low Hb, and jaundice
Delayed transfusion reaction
Rank the following in the likihood of infection?
RBC
Platelets
FFP
Platelets (room temperature)
RBC
FFP
What temperature is platelets kept in?
shelf life
room temp
22 degrres celc
7 days
What temp RBC storage?
shelf life
4 deg cel
35 days
Platelet levels in pregnancy. Normal vs ITP
Normal > 70 x 10^9
ITP if less than, or some other pathology
Protein S levels in pregnancy?
decreased
A woman after placental abruption and surgery has:
low fibrinogen, prolonged APTT,
prolonged PT
DIC
Bascically every clotting thing will be fkd
Which test is used to detect beta thalassaemia ?????
High performance liquid chromatography
OR
Electrophoresis (Gold standard)
there will be raised Alpha globulin because of less beta globulins being created (NOT SUREEEE)
What tumour is associated with Pseudomyxoma peritonei?
Mucinous tumour of the ovary
A 42 year old male cigarette smoker presents with increased urinary frequency and haematuria. Cystoscopy finds an exophytic fronded lesion which is biopsied. Histologic examination shows a fibrovascular core by atypical cells. No invasive malignancy is see, no glands are seen no keratin production is found.
What is the most likely diagnosis of bladder tumour?
urothelial carcinoma in situ
VERY SPECIFIC QS AND ANSWER
No invasion so it wasn’t the other option of just carcinoma.
Monitoring Polycythaemia vera?
Haemotocrit
Test for autoimmune haemolytic anaemia
Direct antiglobulin test
Patient (male) having an elective AAA repair
What blood products / procedure can be used?
Cell Salvage (I think it is this)
Group and screened if antibodies are present then crossmatch is needed.
Elective surgery with expected blood loss, may use this
Lady (was younger woman like teenager) needing emergency blood
O-ve
Man who has had a previous allergic reaction
to transfusion
Washed blood
Washed (i.e. for IgA-deficient patients)
▪ RBCs/platelets given to patients who had severe allergic reactions to some donors’ plasma proteins
▪ This takes 4 hours to happen so needs to be pre-planned
Person has a blood reaction: A pregnant woman who needs anti-coagulation.
LMWH
Which of the following is expressed by vessel walls in their resting state and is anti-
thrombotic?
Thrombomodulin
+
Heparin???
There are 5 special drug treatments. Which drug can be used to treat some malignancies and
affects T cell activity?
Pembrolizumab (anti PD-1 on lymphocytes)
What is targeted in Graft vs Host disease?
T-cells target HLA
A Rhesus D negative woman is having a haematopoietic stem cell transplant (HSCT) and is
CMV IgG negative. What is the most important thing to ensure in the transplant?
CMV IgG negative
How do you manage GvHD
Prophylactically?
Acutly?
Proph? Methotrexate or irradiate blood components for immunosuppressed
Acute? Corticosteroids
Person with low platelets, bruisin, fever and confused. What’s going on?
TTP
HUS (Normally kids and after diarrhoeal disease) – Renal failure thrombocytopenia and MAHA
TTP -> ADD Fever and neurological signs
What cancer is associated with HTLV1
Adult T cell lymphoma/leukaemia
Sickle cell patient, spleen not felt. Low reticulocytes, very anaemic.
What is the diagnosis?
Parvovirus B19
Aplastic anaemia
What is seen in Acquired MAHA?
a. Dat +ve spherocytes
b. Dat +ve fragments
c. Dat -ve spherocytes
d. Dat -ve fragments
e. Dat +ve smear cells
DAT -ve fragmants
Lady has newborn baby. Dat +ve, spherocytes seen. Baby jaundiced. Lady is Group A Rhesus
negative, Baby is Group O Rhesus positive. Why is baby jaundiced?
a. Hereditary spherocytosis
b. G6PD
c. ABO incompatibility
d. Rhesus disease
Rhesus diasease
What is the transfusion thershold for platelets after trauma necessitating massive transfusion?
< 75
<10 or <20 if sepsis
<50 and bleeding in surgery
Platelet dysfunction or immune cause - if actively bleeding
What type of hypersesnitivity is serum sickness?
Type 3
Patient with Pneumonia + SOB gets admitted for treatment. IV penecillin is given and 3 days later presents with
FEVER
ARTHRALGIA
VASCULITIC RASH
RENAL FUNCTION DECLINE
What is the diagnosis?
Serum sickness
Penicillin binds to cell surface proteins
o This acts as a “neo-antigen” and stimulates a very strong IgG antibody response
o The individual becomes “sensitised” to penicillin
o Subsequent exposure to penicillin stimulates:
▪ Immune complex formation
▪ Production of more IgG antibodies
o Immune complexes are then deposited in small vessels → small vessel vasculitis:
▪ Renal dysfunction – deposition of IgG immune complexes in glomeruli
▪ Arthralgia – deposition in joints
▪ Vasculitis with local haemorrhage – deposition in skin →
What is the mechanism of hyperacute allograft rejection?
Pre-formed antibodies attach the graft
This is the humoral mediated rejection
Bortezomib is a proteasome inhibitor, how does this work?
Inhibits intracellular protein degradation, build-up and amino acid shortage kills cell
Apparently used in MM or mantle lymphoma
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?
Valve-associated haemolytic anaemia?
An African man with Burkitt’s lymphoma is given Rasburicase. He develops haematuria with
irregularly contracted cells. What is the cause?
G6PD deficiency
Rasburicase is known to trigger haemolysis?
G6PD is also associated with african decent
Which clotting factor falls most rapidly after administering warfarin?
factor 7
Factor 2, 7. 9 and 10 are all decreased.
Multiple myeloma and Restrictive cardiomyopathy. What is seen on heart biopsy?
amyloid deposition
what is the min time to treat a VTE?
3 months
What would be the most important investigation to carry out in a 65 year old man with iron-
deficient anaemia?
Colonoscopy
Which investigation would confirm a diagnosis of hereditary spherocytosis after seeing
spherocytes on a blood film?
eosin 5 malemide test
What additional virus apart from HIV and HBV are screened for in platelet donations to
pregnant women?
CMV
A patient with renal impairment is on low molecular weight heparin, what do you measure
to monitor this?
Anti - Xa assay
56 y/o lady with SLE, has spherocytes, low Hb, raised bilirubin how do you test for diagnosis?
DAT
She has AIHA due to SLE
How does being a male affect VTE recurrance risk?
Increases the risk
What is done to blood donations to reduce risk of TaGvHD in immunosuppressed patients?
Irradiation
What is the most common cause of thrombocytopenia/low platelets in Pregnancy
Gestational thrombocytpoenia
HELLP syndrome signs
Haemolytic anaemia
Low platelets
Elevated LFTs
What is a cause of neonatal thrombocytopenia?
Maternal idiopathic thrombocytopenia prpura can be passed on to the child
German lady who is ASYMPTOMATTIC has low neutrophils but there are no abnormal cells on blood film
Chronic idiopathic neutropenia
Patient with IgM paraprotein and visual disturbances
Lymphoplasmacytic lymphoma
(Waldenstrom’s macroglobulinaemia)
Multiple myeloma is probably also right (WAS aVSA)
An African lady’s doctor requests a sickle cell solubility test, after blood tests show low Hb and
normal MCV. The test comes back positive with some clouding of the tested blood. What is the
diagnosis?
Sickle cell trait
She has cloudy therefore it is probably between carrier and disease.
As no symptoms probs trait.
An African child is found to be anaemic with a low Hb and normal MCV. The doctor in the hospital
has the child’s blood tested by electrophoresis to confirm the suspected diagnosis. Results show very
high HbS and low HbF. What is the diagnosis
sickle cell anaemia
What is the target INR for AF
INR 2-3
Pt with prosthetic valve and AF - INR
INR 3-4
Continuous unfractioned heparin monitoring
aPTT Anti Xa assay
How to reverse LMWH
Protoamine
DOAC How to monitor?
How to reverse?
No monitoring
There is none
idarucizumab for dabigatran and andexanet Alfa for rivaroxaban/apixaban
Renal failue
● Bisphosphonates
● Plasmapheresis
● Haemodialysis
● Radiotherapy
● Leukapheresis
haemodialysis
Spinal cord compression
● Bisphosphonates
● Plasmapheresis
● Haemodialysis
● Radiotherapy
● Leukapheresis
radiotherapy
Hyperviscousity
● Bisphosphonates
● Plasmapheresis
● Haemodialysis
● Radiotherapy
● Leukapheresis
Plasmaphoresis
Prevention of pathological fractures OR hypercalcaemia
● Bisphosphonates
● Plasmapheresis
● Haemodialysis
● Radiotherapy
● Leukapheresis
Bisphosphonates
BUTTTT if fluids is an option for hypercalcaemia go for that,
CMV retinititis
Aciclovir
Ganciclovir
Oseltamivir
Ribavirin
Gancyclovir
HSV meningitis
Aciclovir
Ganciclovir
Oseltamivir
Ribavirin
Nothing if an option?
Otherwise Acycloivir
This is used if aseptic meningitis recurrant which is often the case with HSV virus
VZV in adults
Aciclovir
Ganciclovir
Oseltamivir
Ribavirin
Again normally this is nothing with CHILDREN ADULTS ARE TREATED
Otherwise -> Acyclovir
RSV
Aciclovir
Ganciclovir
Oseltamivir
Ribavirin
Ribavirin
Asthmatic with flu
Aciclovir
Ganciclovir
Oseltamivir
Ribavirin
Oseltamivir
HIV patients that desaturates on exercise?
What is the causative organism?
Pneumocystitis jirovecci
Halo sign on CXR and is a girl recieving chemotherapy for leukaemia
What is the causative organism?
Aspergillus fumigatus
Upper lobe cavitation on CXR in an alcoholic
What is the causative organism?
Klebsiella pneumonia
Cam also be Tuberculosis?
Smoker back from holiday in Spain, also hyponatraemic and confused.
What is the causative organism?
Legionella pneumophilia
HIV patient with CD4+ count of 150 with meningitis.
What is the causative organism?
Cryptococcus neoformans
Water polo player with itchy scaly rash on lateral toe which then moved along lateral side of foot
What is the causative organism
Trichophytum rubrum
This is athletes foot
Pityriasis versicolor, is caused by what organism?
Malassezia furfur
Man in his 60s with poorly controlled diabetes presents with rapidly progressing periorbital swelling, sinus pain and confusion
mucormycosis caused by Rhizopus species
This is treated by amphotercin B
A soldier returning from Afghanistan has a small ulcer on right ring finger that won’t heal and keeps getting bigger
What is the cause?
Leishmaniasis
Snail trail oral ulcer in a homosexual man
Treponema pallidum
AKA Syphyllis
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
Entamoeba histolytica
A Nigerian man presenting with fever and chills, has just returned from Nigeria, did not take prophylaxis, and was bitten a lot
Malaria
A woman returning from travel in Asia presents with abdo pain, headache, and constipation. A Gram- rod is later cultured from her blood
Salmonella Typhi
Virus which if transmitted to baby: they can initially be symptomless but then come down with long term sequelae
CMV
What is the most common cause of travellers diarrhoea
Entero-toxigenic Escherichia coli
A man develops foul-smelling diarrhoea and cramping pain 5 days after eating chicken at a barbeque
Campylobacter jejuni
A woman develops vomiting a few hours after eating a Chinese meal with lots of rice
Bacillus Cereus
Women has had some surgery which required antibiotics, and now has profuse watery diarrhoea
Clostridium difficile
A ward sister gets diarrhoea, and patients on the ward have been ill recently with similar symptoms
Norovirus
Which antibiotic would you use to treat someone who has cellulitis with a Methicillin SENSITIVE strain of Staphylococcus aureus
Flucloxacillin
Young women with cystitis and fully sensitive E-Coli
Trimethoprim
Which antibiotic would you use for cellulitis with MRSA
Vancomycin
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?
Change in behaviour therefor this encephalitis
HSV
Beta lactam with anti-pseudomonal activity
Ceftazidime
Broad spec, no pseudomonal activity usually given with a beta lactamase inhibitor
Amoxicillin
Given with clavulanic acid
A glycopeptide used to treat MRSA
Vancomycin
A DNA synthesis inhibitor used to treat Pseudomonal infections but poor against anaerobes
Ciprofloxacin
Abx of the Macrolide/lincosamide/streptogrammin group used to treat some atypical pneumonias
Clarithromycin
Painless indurated ulcer, grown on dark brown medium, spiral shaped organism found
What is the causative organism
Treponema pallidum
Syphyllis
Teenager with genital warts
What is the cause?
HPV 6,11
Lockjaw
Buzzword causative organism?
Clostridium Tetani
Maculopapular rash moves from face that can cause encephalitis and pneumonitis
Cause?
Measles
Causes lumps on parotid and neck
Mumps
Virus that resides in pharynx and GIT - 1:100 encephalitis, 1:1000 destruction of motor neurons
Causative organism
Polio virus
Cat scratch disease full name (genus and species) of bacteria?
Bartonella Henselae
Which stain would be used to confirm infection with acid-fast bacilli?
Ziehl neelson
What is the definition of herd immunity threshold?
The proportion of immune healthy people needed within a population to stop a pathogen’s spread: 1- (1/R0)%
Name 1 of the 3 characteristics of Influenza A that could cause a pandemic
Novel antigenicity
Efficient replication in human airway
Efficient transmission between humans
Alcoholic man is on ceftriaxone for meningitis, what organism is he at risk of which this does not cover for?
Listeria monocytogenes
Has contact with someone with TB, what is the lifetime risk of immunocompetent getting active TB?
10%
Returning traveller with fever and constipation (salmonella typhi) - what abx do you give if she hasn’t been started on them already?
Ceftriaxone
Which bacterial species causes scarlet fever?
Streptococcus pyoenes
What is the most common cause of viral meningitis?
Enterovirus
HIV +ve patient with v low CD4 + purple lesions seen on trunk. What virus causes this cancer?
HHV 8
KArposi sarcoma
Diffuse white plaques that can be easily brushed away are seen on an OGD, what is the diagnosis?
Oesophageal candidiasis
What is the treatment for pseudomembranous colitis?
Metronidazole or Vancomycin or fidoxmacin depending on severity (if in doubt say Vancomycin)
Metro and vanc if severe
Vanc is first line
Fidaxomicin is second line
if third recurrant infection within 12 wks then fidaxomicin
Which would be the most useful test in confirming acute EBV infection 2 weeks after possible exposure in an immunocompetent patient?
IgM
(heterophile test if that is an option)
This is a MONOSPOT test
Gram +ve cocci UTI in a young woman?
Staphylococcus saprophyticus
Which vaccine-preventable organism causes cough, lymph node enlargement and has a potential to occlude the airway?
Corynebacterium diphtheriae
What cell type is raised in the blood in schistosomiasis?
Eosinophils
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?
Escherichia coli 0157:H7
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
Strep. Pyogenes
HIV DNA is formed by which error prone enzyme?
A. RNA polymerase
B. DNA polymerase
C. RNA transcriptase
D. Reverse transcriptase
E. Proteases
REvers transcriptase
Which vector transmits Trypanosoma brucei rhodesiense?
tsetse fly
Causes sleeping sickness. High fever muscle pain and headaches?
Which of these does not lead to chronic Hepatitis?
Hepatitis A and E
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
Staphylococcus aureus
Enterobacteriaciae (e.g. E. coli, K. pneumoniae) – 31%
Staphylococcus aureus – 19%
Pseudomonas spp – 17%
Haemophilus influenzae – 5%
Acinetobacter baumanii – 4%
Fungi (Candida spp) – 7%
What is the most common cause of fever in a returning traveller?
A. Malaria
B. Hepatitis
C. HIV seroconversion
D. Typhoid
E. Dengue
Malaria
Middle aged lady. Liver biopsy, loss of bile ducts and granulomas present. Which/what disease is consistent with these findings?
Mucinous carcinoma
Primary biliary cholangitis
Primary sclerosing cholangitis
PBC
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
Chondrosarcoma -> midshaft - 40 year old
Neuroblastoma is not a bone cancer
Osteosarcoma -> Metaphysis, and less painful
Ewing sarcoma-> young painful
Which lung cancer is most likely in a non-smoker?
Adenocarcinoma
Which cancer is associated with asbestos?
Mesothelioma
Which of these is a common finding in someone who has portal hypertension?
Splenomegaly
Hepatomegaly
Spider naevi in distribution of Superior Vena Cava (SVC)
Hand flapping
Jaundice
Splenomegaly
What type of section is done for urgent diagnosis during surgery?
Intra-operative frozen section
What type of gastric cancer is most common?
Adenocarcinoma
What type oesophageal cancer is most common in the UK?
Adenocarcinoma
If it says world then squamous cell carcinoma
Ovarian tumour with hair. No immature cells seen.
Mature teratoma
A 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?
posterior fossa tumour
Medullablastoma
An ovarian mass is found in a Japanese woman, and histology shows signet ring cells
What is the name of this tumour and where is it from?
Kruckenberg tumour – gastric or breast? metastasis
What virus increases risk of nasopharyngeal cancer?
EBV
Which thyroid cancer most commonly metastasises to the lymph nodes?
Papillary
Which thyroid cancer most commonly metastasises to the lymph nodes?
Papillary
Which cancer is associated with coeliac disease?
Enteropathy-associated T-cell lymphoma
Non-hodgkins lymphoma
Adenocarcinoma
Eczematous nipple rash caused by individual ‘malignant cells’?
Paget’s disease of the breast
Sudden headache, loss of consciousness, meningism
Subarachnoid haemohrage
Patient with HIV, raised ICP, new onset epilepsy
Causes?
Cryptococcus neoformans or toxoplasmosis
Old woman falls and breaks her hip
Osteoperosis
20 year old with a lytic lesion in the diaphysis of his leg, pain alleviated by aspirin
osteoid osteoma
Man goes deaf with bowed legs
Pagets disease of the bone
Vertebral fracture, high paraprotein
MM
Young woman with symmetrical joint pain
Rheumatoid arthritis?
Patient with a cancer in their bladder following chronic schistosomiasis
Squamous cell carcinoma
Radiosensitive cancer of the testicle in a young man with a white/smooth appearance?
This is a cancer that spreads through the paraaortic lymph nodes. and responds well to radiotherapy?
Seminoma
Patient presents with a craggy enlarged uneven prostate
Prostate cancer (adenocarcinoma)
Patient had an appendectomy 1 week ago. What would you see in their scar?
Granulation tissue
<6 hours: normal by histology (CK-MB also normal)
6–24 hours: coagulative necrosis, loss of nuclei and striations
1-4 days infiltration of neutrophils → macrophages
5-10 days granulation tissue
(10-14 days = collagen synthesis, angiogenesis)
What material is seen in the vessel of a patient with an MI due to burst atheroma
Thrombus/ atheromatous plaque?
Appendix that is full of neutrophils and is enlarged touching the peritoneum
inflammation
What is deposited in the kidneys in Multiple Myeloma?
Amyloid light chain
AL amyloid
Patient with a carcinoma in their liver, what was the original carcinoma in their pancreas that caused the metastases?
Ductal adenocarcinoma
Patient with a pancreatic mass following acute pancreatitis
Pancreatic pseudocyst
Patient with a history of severe abdominal pain; during cholecystectomy the surgeons noticed grey specks around and on the pancreas
Ductal adenocarcinoma
A man with AF (Atrial fibrillation) develops fever, nausea, vomiting and pain in his right loin/flank. What is the most likely cause?
Renal Infarct
A lady with loin-to-groin pain, haematuria and pain at the end of micturition. What is the most likely cause?
Calculi
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?
Acute pyelenophritis
A lady has frank painless haematuria and a mass palpable on one side. What is the most likely cause?
Renal cell carcinoma
Fibro-epithelial tumour with abundant stromal elements
Breast pathology
Phyllodes tumour
Which/What cancer is also known as non-specific type? (Breast pathology)
Invasice ductal carcinoma
Most common type of malignancy in the breast?
Invasice ductal carcinoma
Cancer which has a high, medium and low Grade to it? Breast pathology
– Ductal carcinoma in situ
Which cancer is associated with H.Pylori infection?
Gastric MALT
What happens to the body of the stomach in a patient with pernicious anaemia?
Atrophy
Which process takes place in the oesophagus in response to exposure to stomach acid?
Metaplasia
Women has acute appendicitis, 5mm tumour found in tip when it’s removed
Carcinoid tumour/ neuroendocrine tumour
Malignant HTN, what is the classic renal finding on histology
membranous glomerulonephritis
minimal change glomerulonephritis
granulomatous changes to vessel
amyloid deposition
fibrinoid necrosis
Fibrinoid necrosis
What histological finding will be seen in the kidneys in cases of post-Streptococcal glomerulonephritis?
Immmune complex deposition?
Severe UTI in the kidney in Diabetes, what do you see on biopsy
Kimmelstiel-Wilson nodules
Man, ex-smoker, with history of hypertension and MI, has sudden chest pain which radiates to the neck
Left anterior descending artery thrombus
An elderly man with atrial fibrillation develops new right flank pain
renal thrombus
What condition is caused by vitamin C deficiceny?
Scurvy?
common cause of death ue to cancer in males is ?
Lung cancer
Lung
Prostated
Colon
Head and neck
Breast
What is the most common cause of constrictive pericarditis?
Tuberculosis
What 3 infections are checked in pregnancy?
Hep B, HIV and syphyllis
According to the recovery study what steroid is given in covid 19 with low O2
Dexamethasone
Guy with knee pain and postively bifringent crystals diagnosis?
Pseudogout
What stain for amyloid?
Congo red stain?
How do you monitor LMWH in renal failure?
Anti Xa Assay
Pelger huet cells and Hypogranular hypolobated neutrophils?
Diagnosis
Myelodysplastic syndrome
Which fungus that can cause respiraatory disease in immunocomprimised cannot be used treated using a certain type of antifugal but is treated wtih co-trimoxazole?
Pneumocystitis Jirovecii
Kid gets a purpuric rash and fever too. Blood investigations show low Haemolytic complement and low alternative complement pathay. What is the likely causative organism?
Nisseria meningitis
What bone cancer is likely to develop in someone with pagets disease?
Osteosarcoma
Person with diabetes, atherosclerotic diseases, started ACE inhibitor due to
microalbuminuria, develops high creatinine and urea a week later, hasn’t passed urine in
3 days, normal Na and K. What was the underlying condition of the kidney stuff?
Renal artery stenosis
Patient with ?CML treated with cytotoxic chemotherapy. Table comparing bloods U&Es
before and after the chemo.
Pre-chemo: normal urea, normal creatinine, high leukocytes, …?
Post-chemo: high urea, high creatinine, normal leukocytes, low Ca?, high phos
What is the new diagnosis?
Tumour lysis syndrome
What drug causes Hypoglycaemia?
Quinine, Thiazide, Statin, Glucagon, prednisone
Quinine
What antiviral is given in covid?
Remdesivir
Which type of hyperlipidaemia causes acute pancreatitis?
Triglycerides
What is the treatment for Malignant melanoma?
Nivolumab (anti PD1)
What is the name of macrophages found in the skin?
Langerhans cells
What is the name of the macrophages in the brain?
Microglial cells
What is macrophages in the bone is called?
Osteoclast cells
What are the macrophages in the lungs called?
Alveolar macrophages
What is the macrophages in connective tissue called?
Histocytes
List some influenza antiviral with their mechanism?
Amantadine
(Influenza A only, experimental) – Targets M2 ion channel.
BUT single AA mutation (S31N) in M2 = resistance (now in many ‘flu A strains incl. H1N1)
Neuraminidase inhibitors:
Oseltamivir (Tamiflu) –> IF ASTHMATIC
Zanamivir (Relenza)
Effective only if given <48hrs after infection
Cell lacks e Cadherin. Found in breast
What is histopathology?
Lobular carcinoma in situ
TTP pentad
MAHA
Thrombocytopenia
Acute renal failure
Neurological symptoms
Fever
What is the treatmend of tSideroblastic aneanmia
Pyridoxine
What disaease is routinely screened for in transfusion
CMV -> Pregnancy; HTLV1 for first time donor;
HIV; Hepatitis B and C + Syphyllis
A patient has hemiangioblastoma of the cerebellum, multiple bilateral renal cell carcinoma and cysts of the pancreas and kidney is seen in what condition?
Von hippel lindau
What common double stranded virus causes nephritis in transplant patients?
BK virus
rank the most likely to the least likely cause of typical pneumonia
Strep Pneumonia
Haemophilus influenza
Moraxella Catarrhalis
Staph aureus
Klebsiella pneumonia
What is the cytochine that is key in promoting the development and terminal differentiation of eosinophils?
Il-5
What is the primary heart cancer?
Atrial Myxoma
Person had an unprovoked DVT, treated with LMWH for 6 months. What long-term DVT prophylaxis should they take?
Aspirin, warfarin, DOAC, none needed
I think DOAC
idarucizumab for dabigatran and andexanet Alfa for rivaroxaban/apixaban
A patient with fatigue and mild jaundice is found to have spherocytes on a blood film and a positive DAT test (Coombs test). What is the most likely diagnosis?
Warm AIHA
Spherocytosis is associated with Warm
Cold AIHA is associated with raynauds
A patient with fatigue and mild jaundice is found to have spherocytes on a blood film and a positive DAT test (Coombs test). What is the most likely diagnosis?
Warm AIHA
Spherocytosis is associated with Warm
Cold AIHA is associated with raynauds
37 y/o woman with hot swollen, painful left knee has Gram positive cocci in clusters on joint aspirate. NKDA and MRSA screen is negative: which narrow spectrum antibiotic is most appropriate here?
As this is Staph aureus but sesnitive to methecillin then it is Flucloxacillin
It will be vanc or Linezolid if it is MRSA
What type of emphysema is associated with smoking?
Centrilobular emphysema
Commonest primary tumour of the heart?
Atrial myxoma
A dysgerminoma is a type of tumour that affects the ovary. What is the equivalent tumour type in the testes?
seminoma
Intestinal metaplasia in Barrett’s (columnar-lined) oesophagus is most commonly due to the presence of which cell?
goblet cells
Deficiency of which plasma protein occurs in patients with liver disease and a movement disorder?
ceruloplasmin –> Wilsons disaease
Which class of antibiotics has concentration dependent killing (i.e. the goal of therapy is to maximise peak > MIC)
aminoglycoside
Bleeding patient has prolonged APTT and PT, but normal platelet count and normal fibrinogen. What is the most suitable blood component for treatment?
d) Fresh frozen plasma
Cryoprecipitate
One of these 2 i think it is fresh frozen plasma
55 year old male smoker, on long term frusemide. Investigations - high Hb, high Hct, normal red cell mass. Plasma volume is low. What is the most likely diagnosis?
Relative polycythaemia
Brain tumour which most commonly occurs near the surface of the brain and is frequently asymptomatic is most likely to be?
Meningioma
Streptobacillus moniliformis is the causative organism of which of the following infections?
Rat bite fever
Which enzyme causes hypercalcaemia in sarcoidosis?
1-alpha hydroxylase
What liver cancer is associated with Alpha fetoprotein
Hepatocellular carcinoma
What enzyme is specific for Pacreatitis?
Lipase
What is the causative organism of Lymes’ disease?
Borrelia Burgforferi
Venetoclax is a BCL2 inhibitor used for B-cell CLL. Which cellular process does this act on?
This acts to increase apoptosis. By binding to BCL cells.
What pathway is associated with problems in Autoimmune lymphoproliferative syndrome?
FAS pathway
What is the gene that is mutated in brutons agammaglobiaemia ?
BTK gene
What is the defective protein in Hyper IgM syndrome?
CD40 ligand
What animal is associated with hanta virus?
Rat and mice
What is the possible cause of infection, with someone who works with bats?
Bartonella henselea
Rabies
streptobassilus moniliformis
SARS-COV2
Hanta virus
Hanta virus -> Rats and mice
Rabies -> Rats and dogs+ bats
Streptobacillus -> rats
SARS-COV2 none of these really
Bartonella henselea -> cat scratch disease
Malaria treatment cut off if severity of symptoms unclear.
IV artensuate
Adult >=10 % parisitaemia
Children >=2% parisitaemia
Anti SRP is associated with what condition?
Polymyositis
Also associated with aNti Jo 1 but apparently the jo 1 is more linked with dermatopolymyositis
What type of vaccine is Whooping cough pertussi; Hepatitis A and Rabies and tetanus?
Inactivated vaccines
What is associated with interferon gamma receptor associated deficiency?
Increases the likelihood of Mycobacterial diseases
26 year old women with breast implants inserted 2 years ago. They are asymmetrical and have become harder. The leaking implants are sent to pathology. What inflammatory cell is most prominent in histological examination?
Macrophage Giant cell
Renal cell transplant recipients on a long term immunosuppression have an increased risk of which lymphoid cancer?
EBV associated diffuse large B-cell lymphoma
What is it called when you have discontinuation of the epithelium?
Ulcer
Subtotoal villous atrophy with tall crypts
Coeliacs disease
