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Year 5 Path PPQ > PPQ Imp > Flashcards

PPQ Imp Flashcards

1
Q

What is the most common parasitic infection in the duodenum causing malabsorption?

A

Giardiasisi Duodenalis

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2
Q

40 year old,with low TSH and very high T4, what sign would you likely see in/around her eyes if you look closely?

A

Periorbital myxoedema/

If phrased differently think about Exophthalmos

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3
Q

What are the vaccines that are offered in pregnancy?

A

Influenza, Whooping cough and Covid

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4
Q

What is the method to help reduce the chances of acute ABO rejection in the transfer of an ABO incompatible kidney?

A

Plasmaphoresis

Apparently Hyperacute doesnt have a treatment?

As prevention plasmophoresis

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5
Q

Hospital is low on O- what is the most approapriate method to give blood who comes in as a casualty?

A

Give O+ if male or female who can’t get pregnant

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6
Q

If there is a patient with poorly controlled diabetes and an eye infection that is oozing, What is the most approapriate immidiate pharm Tx?

A

The diagnosis is Mucormycosis

Treated by Amphotericin B

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7
Q

Patient has joint pain and a rash. She has an autoimmune condition what is it called? Results show a reduced C1q

A

SLE (Systemic Lupus Erythematosus)

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8
Q

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?

A

Drug induced reaction

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9
Q

A woman has mouth and lip swelling following a dental procedure, and her mother reports a similar problem in the past?

A

C1 esterase inhibitor deficiency

Heridatory angiooedema

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10
Q

What is the genetic mutation in digeorge syndrome?

A

22q11.2

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11
Q

What natural antibody is protective against HIV?

A

HIV-gp120
gp41

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12
Q

What allergy is more likely to present in a child?

A

Egg

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13
Q

What is the Maintanence treatment against allograft rejection?

Induction agents are?

A

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

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14
Q

What is the mechanism of hyperacute allograft rejection?

A

This where antibodies are against HLA or ABO

These antibodies are preformed and occur within an hour of transfusion

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15
Q

What is the effect of gene mutation in Familial mediterranean fever?

A

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

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16
Q

What type of hypersensitive causes serum sickness ?

A

This is a type 3 complex mediated hypersensitivity

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17
Q

What infections are covered by conjugate vaccines?

A

Encapsulated infections.

Pneumococcal vaccines or Hib vaccines

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18
Q

What does PD-1 inhibit

A

T-cells

Nivolumab is an example and treats Malignant melanoma

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19
Q

cAnca with glomerularnephritis and lung changes what does he have

A

Wegner;s or granulamatosis with polyangitis

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20
Q

Rituximab which acts on CD 20, effects what cell type?

A

B-cells.

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21
Q

What is the max number of HLA mismatches?

What if this is between mother and son

A

So max mismatch is 6

Mother and son max is 3

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22
Q

What condition is NOD2/CARD15 associated with?

A

Crohn’s disease

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23
Q

What is the receptor /cytokine mutation that can be protective in HIV?

A

CCR5/MIP-1a or b

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24
Q

What is found in coeliac biopsy?

A

Crypt hyperplasia
Non-caseating granuloma
Intraepithelial lymphocytes

I think Villous atrophy as well

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25
Q

Chimeric antigen receptor T-cell (CART) therapy Cd19: What type of haematological malignancy foes it target?

A

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

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26
Q

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?

A

SLE (Systemic Lupus Erythematosus)

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27
Q

For the treatment of ankylosing spondyitis, NSAIDs TNF inhibitor have been tried what else can be targeted?

A

IL17

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28
Q

What is the mechanism of graft versus host disease?

presentation?

prophylaxis
Treatment

A

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

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29
Q

What virus causes progressive multifocal leukoencephalopathy?

A

John cunningham virus

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30
Q

What condition is a complication of the John Cunningham virus?

A

The JC virus causes progressive multifocal leukoencephalopathy

Diffuse large B-cell is lymphoproliferative disease caused by this virus

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31
Q

Autoimmune hypothyroidism (Hashimoto’s is associated with which antibody)

A

Anti thyroglobulin

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32
Q

What is dry eyes and parotid sweling associated with (antibody)?

Diagnosis

A

Anti-ro and anti la (Which are both Anti ENAs)

Sjrogrens syndrome

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33
Q

Swollen joinst of the hand and X-ray showing erosive changes antibody

A

Anto CCP

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34
Q

What is the treatment of Osteoperosis? (When bisphosphonates are not tolerated)

A

RanK L -> Denosumab

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35
Q

What is the treatment for Chronic granulomatous diase?

A

IFN gamma

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36
Q

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

A

Neutrophils

The APCs would be Macrophages

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37
Q

Foxp3+ And CD25+ cells, they mature in the thymus

A

Treg cells

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38
Q

What immune cells detects antigen in the periphery and moves to lymph nodes

A

Dendritic Cells

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39
Q

What immune cell detects MHC1 and kills virus infected/cancer cells. Is inhibited by MHC I

A

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

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40
Q

What immune cells is targeted by HIV

A

Memory CD4+ ccells

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41
Q

Sle with recurrant clotting
Diagnosis
Antibody

A

Phospholipid syndrome
Anti cardiolipin

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42
Q

72 year old women with stiff limb girdles. Aches all over and joint stiffness
Diagnosis
Antibody

A

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

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43
Q

CREST syndrome antibody

A

Anti-centromere

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44
Q

(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

A

Cold urticaria

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45
Q

(EMQ) Man can eat apple pie. But if he eats fresh apples and pears, he gets inflamed lips

A

Oral allergy syndrome

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46
Q

(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

A

Type 1 hypersensitivity latex allergy

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47
Q

(EMQ) Bloated after drinking milk but not IgE mediated

A

Lactose intolerance

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48
Q

(EMQ) A girl with a sore throat is given penicillin and develops a rash. She is found to have EBV

A

Drug reaction

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49
Q

(EMQ) What cells do Myasthenia gravis antibodies bind to?

A

They bind to skeletal muscle

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50
Q

(EMQ) What will be measured in a patient with well controlled HIV, who is currently on HAART?

A

Lymphocyte subset

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51
Q

A woman with known SLE presents with an exacerbation of her SLE/ worsening symptoms, what would you measure?

A

C3 and C4

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52
Q

A 60 year old lady with recurrent chest infections now has reduced total serum protein and has autoimmune thrombocytopenia

A

Common variable immunodeficiency

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53
Q

A 12 year old boy has recurrent chest infections and has an ear infection. He doesn’t have any B Cells

A

Bruton’s Agammaglobulinaemia

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54
Q

Boy with recurrent abscesses has a negative NBT test

A

Chronic granulomatous disease

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55
Q

A Girl is found to have no CD4 cells, but CD8 cells and B cells are present

A

Bare lymphocyte syndrome 2

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56
Q

A boy’s father has TB. The same boy develops a mycobacterium infection, following their BCG

What is their primary immune deficiency

A

Interferon gamma receptor deficiency

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57
Q

Young boy with normal B cell numbers and absence of CD8+ and CD4+

They have a deficiency in the common gamma chain protein

A

X-linked SCID

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58
Q

Normal B and T cells, high IgM but absence of IgA, IgE and IgG

A

Hyper IgM syndrome

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59
Q

Encampsulated bacteria infections that are recurrent suggests what primary immune deficicencys

A

Complement deficiency e.g. C7
Either the complement deficiency alternate or common

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60
Q

What is used to treat lymphoma and rheumatoid arthritis

A

Rituximab

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61
Q

What is used to prevent transplant rejection by blocking T cell activation

A

Tacrolimus or Cyclosporin

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62
Q

What is used to treat severe ankylosing spondylitis not controlled by NSAIDs.

A

etanercept (Anti-TNF alpha)

1st NSAIDS
2nd Anti TNF alpha
3rd Anti 1l 17

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63
Q

Monocytes found in the tissue are called

A

Macrophages

Liver - Kupffer cells

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64
Q

What is the name of the differentiated B cells that produce immunoglobulins

A

Plasma cells

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65
Q

What condition is associated with DR4 and CCP

A

Rheumatoid arthritis

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66
Q

What is the condition that is associated with a mutation in the FAS pathway, with lymphocytosis, lymphomas and autoimmune cytopenia

A

Autoimmune lymphoproliferative syndrome

ALPS

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67
Q

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

A

Creatine kinase (dermatomyositis)

Within muscle → perivascular CD4 T and B cells
o Immune complex mediated vasculitis – T3 response

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68
Q

What virus can lead to post traplantation lymphoproliferative disease?

A

Epstein barr virus diffuse large b cell lymphoma

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69
Q

Patient presents with clear discharge from the nose every summer. These symptoms seems very allergic like. What is the cause?

A

Allergic rhinitis

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70
Q

A diabetic patient with Hypertension is being treated, and develops angioedema.
What is the cause?

A

This is a drug reaction to ACE inhibitor?

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71
Q

What zoonotic disease does Ixodes Tick cause?

A

Lyme disease

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72
Q

What is the main class of drugs that are used to treat HIV?

A

Nucleoside reverse transcriptase inhibitor

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73
Q

What is the amyloid that is deposited in multiple myeloma and what type of amyloidosis is this?

A

Amyloid light chain amyloidosis which is a primary amyloidosis?

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74
Q

What is Behcet’s Disease?
Epi
Pres
Some of the other symptoms

A

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

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75
Q

What is Polyarteritis Nodosa?
Cause
Presentation
Ix

A

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

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76
Q

Takayasu’s Arteritis
What is it?
Presentation? (6)
Associations?
Treatment?

A
  • 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

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77
Q

Which vasculitis causes a disease in a branch of the external carotid artery?

A

This is a large vessel vasculitis and so is probably Giant cell arthritis

Takayasu arthritis is possible but more rare.

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78
Q

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?

A

SIADH secondary to small cell lung carcinoma

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79
Q

Elderly woman with C. diff colitis and profuse diarrhoea, Presents with low sodium, what type of hyponatremia will be present?

A

Hypovolaemic hyponatraemia

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80
Q

Man who has been in a car accident, raised sodium and plasma osmolality, low urine osmolality

A

Cranial Diabetes insipidus

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81
Q

There is a raised Na and a low K but there is a raised Renin, What is the cause of this presentation

A

Renal artery stenosis.

Could have been hyperaldosterone but the raised renin tells us it is renal artery stenosis.

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82
Q

What are the indications for dialysis?

A

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

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83
Q

What is described by true positives divided by the total number of people who have the disease describe?

A

Sensitivity

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84
Q

What is the true negative divided by the total number of people who don’t have the disease describing?

A

Specificity

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85
Q

What is described by the people who are true positive divided by the number of people who tested positive?

A

Postive predictive value

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86
Q

What is described by the people who are true negative divided by the the number of people who tested negative?

A

Negative predictive value

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87
Q

What ion is likely to be outside the normal range in an alkalotic picture?
K+
Na+
Ca 2+
Mg 2+

A

K+ (I think) It decreaseas

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88
Q

What is the best investigation to confirm cushings disease?

A

High dose dexamethasone

Apparently inferior pituitary petrosal sinus sampling

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89
Q

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?

A

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?

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90
Q

A person have a pituitary adenoma removed. What is the medication that needs to be provided if they are discharged?

DDAVP
Fludrocortisone
Testosterone

A

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

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91
Q

Describe the metabolic picture in the most common form of congenital adrenal hyperplasia?
Na
K
volume

A

Na+ this will be low
K+ Will be high
Hypovolaemia

Most common version is 21 hydroxylase

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92
Q

Low glucose high insulin
What needs to be measured?

A

C-peptide

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93
Q

Low glucose high insulin High C-peptide

A

Insulinoma, or Surreptitious gliclazide

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94
Q

What ion is raised in red cell lysis?

A

K+

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95
Q

What does PCSK9 inhibitor halve?

A

Evolucumab - halves LDL

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96
Q

Which molecule takes cholesterol and moves it to liver and steroidogenesis organs?

A

HDL

Look where the L is, HDL (L at the end cause to the liver)
LDL L at the start so from the liver

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97
Q

Vitamin deficiency that causes both megaloblastic anaemia and Neural tube defects>?

A

Folate

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98
Q

What hormone would be raised in the most common cause of CAH?

A

Sex Steroid hormones (Androgens)

And

ACTH

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99
Q

What hormone leads to increased levels of prolactin?

What causes a decrease in prolactin?

A

Increase- Thyroid Releasing hormone

Decrease- Dopamine

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100
Q

What is produced by a medullary carcinoma of the thyroid?

A

Calcitonin

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101
Q

A man develops signs of hyperthyroidism. Bloods show low TSH and high thyroxine. A technetium scan shows no uptake. What is the likely diagnosis?

A

Viral thyroiditis/ De Quervain’s thyroiditis

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102
Q

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?

A

Rhabdomyolysis leading to Myoglobin

Creatinine kinase

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103
Q

What liver enzyme is raised in an MI?

A

Aspartate aminotransferase

Could be ALT???

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104
Q

What enzyme is used to confirm cardiac failure?

A

B-type natriuretic peptide

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105
Q

5yr old, tetany, bone pain. Widened epiphyses + ‘Cupping’ of metaphysis shown on x-ray. What is the cause?

A

Rickets

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106
Q

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

A

Haemochromatosis (joint pain, skin changes, pancreatitis, liver deposition)

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107
Q

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

A

Xanthine oxidase

Acute: Colchicine or an NSAID
Chronic: Allopurinol or probenecid

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108
Q

T1DM with hypoglycaemia, what is the management option if no IV access?

A

IM glucagon

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109
Q

Patient with GI conditions, lack of which substance leads to B12 being malabsorbed?

A

Intrinsic factor

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110
Q

Which thyroid cancer is most commonly metastsisises to the lymph nodes?

A

Papillary

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111
Q

What is the most common cause of pancreatitis?

A

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

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112
Q

What is the best test that will help with the diagnosis of temporal arthritis?

A

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

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113
Q

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

A

Prolactinoma

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114
Q

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

A

Non-functioning pituitary macroadenoma

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115
Q

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

A

Hypopituitarism

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116
Q

Which of the following would be consistent with obstructive jaundice?

Normal ALP
Normal AST
Normal GGT
Dark stools
Increased bilirubin in the urine

A

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.

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117
Q

Which of the following is found in haemolytic jaundice?

Raised AST
Raised CK
Normal bilirubin
Pale stools
High urobilinogen in urine

A

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.

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118
Q

Calcium high, PTH low

A

Bone Mets

Could also be Sarcoid, thyrotoxicosis, High Vit D etc

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119
Q

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?

A

serum IGF then oral glucose tolerance test

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120
Q

BP 190/100, thin skin, overweight, high-normal sodium, low normal potassium, OGTT done (glucose high normal)
low dose dexamethasone suppression test then

A

inferior pituitary petrosal sinus sampling

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121
Q

Pt with low Na, High K + postural hypotension

Ix?

A

Addison’s

Therefore SyncACTH test.

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122
Q

Patient with low sodium, potassium normal, low plasma osmolality and urine osmolality was 70

A

Primary polydipsia,

fluid deprivation test

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123
Q

Women with colicky pain.

Elevated mildly elevated ALP, ALT, GGT, & Bilirubin.
GGT + Bilirubin most raised of results provided.

A

Gallstones

Acute Cholestasis

Any Post hepatic cause of jaundice probably

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124
Q

A 57 year old man presents following hematemesis and is found to have high ALT + GGT, slightly raised ALP, and low Albumin
Diagnosis

A

Cirrhosis

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125
Q

An elderly gentleman has massively elevated ALP on its own, and the other results are normal. He also reports a history of headaches.
Diagnosis

A

Paget’s

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126
Q

What is the bicarbonate level of someone with pyloric stenosis?

A

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.

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127
Q

What is the K+ level in a patient with DKA?

A

Raised K+

K+ matches H+ conc most of the time

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128
Q

Man with impaired glucose tolerance fasting value

A

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

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129
Q

Deficiency of which enzyme leads to hyperuricemia?

A

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.

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130
Q

What enzyme is raised in Mumps?

A

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

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131
Q

Baby with seizures: low Ca, low PTH

A

Primary hypoparathyroidism?

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132
Q

10 year old with seizures: low Ca, high PO4, high PTH

A

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,

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133
Q

Colour blindness is caused by which Vitamin deficiency?

A

Vit A

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134
Q

What vitamin deficieny causes pellegra?

How does thie condition present?

A

Niacin / B3

It is associated with Diarrhoea, dementia and dermatitis

DEATH if untreated

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135
Q

What vitamin deficicency is associated with beriberi?

What is the presentation of this? (Wet/Dry)

A

Vitamin B1/ thiamine.#

Wet - > heart related overload

Dry -> neurological deficits like Wernickes. Pabrinex

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136
Q

A man requires a 6 unit transfusion after a traffic collision, and two hours later becomes
breathless, feverish, and tachycardic

What is the diagnosis?

A

Transfusion related acute lung injury?

OR

Transfusion associated circulatory overload (MOST COMMON ACUTE REACTION)

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137
Q

What are causes of acute transfusion reaction under 24 hours?

A

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)

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138
Q

What are the causes of delayed transfusion reactions?

A

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

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139
Q

A thalassemia patient presents with malaise and erectile dysfunction

A

Transfusion-related
haemosiderosis

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140
Q

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

A

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.

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141
Q

Man feels itchy after transfusion, calms down with cetirizine <24 hrs

A

Allergic reaction

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142
Q

Alcoholic has an AAA repair and several days later develops a fever, low Hb, and jaundice

A

Delayed transfusion reaction

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143
Q

Rank the following in the likihood of infection?

RBC
Platelets
FFP

A

Platelets (room temperature)

RBC

FFP

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144
Q

What temperature is platelets kept in?
shelf life

A

room temp
22 degrres celc

7 days

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145
Q

What temp RBC storage?
shelf life

A

4 deg cel

35 days

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146
Q

Platelet levels in pregnancy. Normal vs ITP

A

Normal > 70 x 10^9

ITP if less than, or some other pathology

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147
Q

Protein S levels in pregnancy?

A

decreased

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148
Q

A woman after placental abruption and surgery has:

low fibrinogen, prolonged APTT,
prolonged PT

A

DIC

Bascically every clotting thing will be fkd

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149
Q

Which test is used to detect beta thalassaemia ?????

A

High performance liquid chromatography

OR

Electrophoresis (Gold standard)

there will be raised Alpha globulin because of less beta globulins being created (NOT SUREEEE)

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150
Q

What tumour is associated with Pseudomyxoma peritonei?

A

Mucinous tumour of the ovary

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151
Q

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?

A

urothelial carcinoma in situ

VERY SPECIFIC QS AND ANSWER

No invasion so it wasn’t the other option of just carcinoma.

152
Q

Monitoring Polycythaemia vera?

A

Haemotocrit

153
Q

Test for autoimmune haemolytic anaemia

A

Direct antiglobulin test

154
Q

Patient (male) having an elective AAA repair
What blood products / procedure can be used?

A

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

155
Q

Lady (was younger woman like teenager) needing emergency blood

A

O-ve

156
Q

Man who has had a previous allergic reaction
to transfusion

A

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

157
Q

Person has a blood reaction: A pregnant woman who needs anti-coagulation.

A

LMWH

158
Q

Which of the following is expressed by vessel walls in their resting state and is anti-
thrombotic?

A

Thrombomodulin

+

Heparin???

159
Q

There are 5 special drug treatments. Which drug can be used to treat some malignancies and
affects T cell activity?

A

Pembrolizumab (anti PD-1 on lymphocytes)

160
Q

What is targeted in Graft vs Host disease?

A

T-cells target HLA

161
Q

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?

A

CMV IgG negative

162
Q

How do you manage GvHD
Prophylactically?
Acutly?

A

Proph? Methotrexate or irradiate blood components for immunosuppressed

Acute? Corticosteroids

163
Q

Person with low platelets, bruisin, fever and confused. What’s going on?

A

TTP

HUS (Normally kids and after diarrhoeal disease) – Renal failure thrombocytopenia and MAHA

TTP -> ADD Fever and neurological signs

164
Q

What cancer is associated with HTLV1

A

Adult T cell lymphoma/leukaemia

165
Q

Sickle cell patient, spleen not felt. Low reticulocytes, very anaemic.

What is the diagnosis?

A

Parvovirus B19

Aplastic anaemia

166
Q

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

A

DAT -ve fragmants

167
Q

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

A

Rhesus diasease

168
Q

What is the transfusion thershold for platelets after trauma necessitating massive transfusion?

A

< 75

<10 or <20 if sepsis

<50 and bleeding in surgery

Platelet dysfunction or immune cause - if actively bleeding

169
Q

What type of hypersesnitivity is serum sickness?

A

Type 3

170
Q

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?

A

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 →

171
Q

What is the mechanism of hyperacute allograft rejection?

A

Pre-formed antibodies attach the graft

This is the humoral mediated rejection

172
Q

Bortezomib is a proteasome inhibitor, how does this work?

A

Inhibits intracellular protein degradation, build-up and amino acid shortage kills cell

Apparently used in MM or mantle lymphoma

173
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

Valve-associated haemolytic anaemia?

174
Q

An African man with Burkitt’s lymphoma is given Rasburicase. He develops haematuria with
irregularly contracted cells. What is the cause?

A

G6PD deficiency

Rasburicase is known to trigger haemolysis?

G6PD is also associated with african decent

175
Q

Which clotting factor falls most rapidly after administering warfarin?

A

factor 7

Factor 2, 7. 9 and 10 are all decreased.

176
Q

Multiple myeloma and Restrictive cardiomyopathy. What is seen on heart biopsy?

A

amyloid deposition

177
Q

what is the min time to treat a VTE?

A

3 months

178
Q

What would be the most important investigation to carry out in a 65 year old man with iron-
deficient anaemia?

A

Colonoscopy

179
Q

Which investigation would confirm a diagnosis of hereditary spherocytosis after seeing
spherocytes on a blood film?

A

eosin 5 malemide test

180
Q

What additional virus apart from HIV and HBV are screened for in platelet donations to
pregnant women?

A

CMV

181
Q

A patient with renal impairment is on low molecular weight heparin, what do you measure
to monitor this?

A

Anti - Xa assay

182
Q

56 y/o lady with SLE, has spherocytes, low Hb, raised bilirubin how do you test for diagnosis?

A

DAT

She has AIHA due to SLE

183
Q

How does being a male affect VTE recurrance risk?

A

Increases the risk

184
Q

What is done to blood donations to reduce risk of TaGvHD in immunosuppressed patients?

A

Irradiation

185
Q

What is the most common cause of thrombocytopenia/low platelets in Pregnancy

A

Gestational thrombocytpoenia

186
Q

HELLP syndrome signs

A

Haemolytic anaemia
Low platelets
Elevated LFTs

187
Q

What is a cause of neonatal thrombocytopenia?

A

Maternal idiopathic thrombocytopenia prpura can be passed on to the child

188
Q

German lady who is ASYMPTOMATTIC has low neutrophils but there are no abnormal cells on blood film

A

Chronic idiopathic neutropenia

189
Q

Patient with IgM paraprotein and visual disturbances

A

Lymphoplasmacytic lymphoma
(Waldenstrom’s macroglobulinaemia)

Multiple myeloma is probably also right (WAS aVSA)

190
Q

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?

A

Sickle cell trait

She has cloudy therefore it is probably between carrier and disease.

As no symptoms probs trait.

191
Q

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

A

sickle cell anaemia

192
Q

What is the target INR for AF

A

INR 2-3

193
Q

Pt with prosthetic valve and AF - INR

A

INR 3-4

194
Q

Continuous unfractioned heparin monitoring

A

aPTT Anti Xa assay

195
Q

How to reverse LMWH

A

Protoamine

196
Q

DOAC How to monitor?

How to reverse?

A

No monitoring

There is none

idarucizumab for dabigatran and andexanet Alfa for rivaroxaban/apixaban

197
Q

Renal failue

● Bisphosphonates
● Plasmapheresis
● Haemodialysis
● Radiotherapy
● Leukapheresis

A

haemodialysis

198
Q

Spinal cord compression

● Bisphosphonates
● Plasmapheresis
● Haemodialysis
● Radiotherapy
● Leukapheresis

A

radiotherapy

199
Q

Hyperviscousity

● Bisphosphonates
● Plasmapheresis
● Haemodialysis
● Radiotherapy
● Leukapheresis

A

Plasmaphoresis

200
Q

Prevention of pathological fractures OR hypercalcaemia

● Bisphosphonates
● Plasmapheresis
● Haemodialysis
● Radiotherapy
● Leukapheresis

A

Bisphosphonates

BUTTTT if fluids is an option for hypercalcaemia go for that,

201
Q

CMV retinititis

Aciclovir
Ganciclovir
Oseltamivir
Ribavirin

A

Gancyclovir

202
Q

HSV meningitis

Aciclovir
Ganciclovir
Oseltamivir
Ribavirin

A

Nothing if an option?

Otherwise Acycloivir
This is used if aseptic meningitis recurrant which is often the case with HSV virus

203
Q

VZV in adults

Aciclovir
Ganciclovir
Oseltamivir
Ribavirin

A

Again normally this is nothing with CHILDREN ADULTS ARE TREATED

Otherwise -> Acyclovir

204
Q

RSV

Aciclovir
Ganciclovir
Oseltamivir
Ribavirin

A

Ribavirin

205
Q

Asthmatic with flu

Aciclovir
Ganciclovir
Oseltamivir
Ribavirin

A

Oseltamivir

206
Q

HIV patients that desaturates on exercise?
What is the causative organism?

A

Pneumocystitis jirovecci

207
Q

Halo sign on CXR and is a girl recieving chemotherapy for leukaemia
What is the causative organism?

A

Aspergillus fumigatus

208
Q

Upper lobe cavitation on CXR in an alcoholic
What is the causative organism?

A

Klebsiella pneumonia

Cam also be Tuberculosis?

209
Q

Smoker back from holiday in Spain, also hyponatraemic and confused.
What is the causative organism?

A

Legionella pneumophilia

210
Q

HIV patient with CD4+ count of 150 with meningitis.
What is the causative organism?

A

Cryptococcus neoformans

211
Q

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

What is the causative organism

A

Trichophytum rubrum

This is athletes foot

212
Q

Pityriasis versicolor, is caused by what organism?

A

Malassezia furfur

213
Q

Man in his 60s with poorly controlled diabetes presents with rapidly progressing periorbital swelling, sinus pain and confusion

A

mucormycosis caused by Rhizopus species

This is treated by amphotercin B

214
Q

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?

A

Leishmaniasis

215
Q

Snail trail oral ulcer in a homosexual man

A

Treponema pallidum

AKA Syphyllis

216
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

217
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

218
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

219
Q

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

A

CMV

220
Q

What is the most common cause of travellers diarrhoea

A

Entero-toxigenic Escherichia coli

221
Q

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

A

Campylobacter jejuni

222
Q

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

A

Bacillus Cereus

223
Q

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

A

Clostridium difficile

224
Q

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

A

Norovirus

225
Q

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

A

Flucloxacillin

226
Q

Young women with cystitis and fully sensitive E-Coli

A

Trimethoprim

227
Q

Which antibiotic would you use for cellulitis with MRSA

A

Vancomycin

228
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

Change in behaviour therefor this encephalitis

HSV

229
Q

Beta lactam with anti-pseudomonal activity

A

Ceftazidime

230
Q

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

A

Amoxicillin

Given with clavulanic acid

231
Q

A glycopeptide used to treat MRSA

A

Vancomycin

232
Q

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

A

Ciprofloxacin

233
Q

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

A

Clarithromycin

234
Q

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

What is the causative organism

A

Treponema pallidum

Syphyllis

235
Q

Teenager with genital warts
What is the cause?

A

HPV 6,11

236
Q

Lockjaw

Buzzword causative organism?

A

Clostridium Tetani

237
Q

Maculopapular rash moves from face that can cause encephalitis and pneumonitis

Cause?

A

Measles

238
Q

Causes lumps on parotid and neck

A

Mumps

239
Q

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

Causative organism

A

Polio virus

240
Q

Cat scratch disease full name (genus and species) of bacteria?

A

Bartonella Henselae

241
Q

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

A

Ziehl neelson

242
Q

What is the definition of herd immunity threshold?

A

The proportion of immune healthy people needed within a population to stop a pathogen’s spread: 1- (1/R0)%

243
Q

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

A

Novel antigenicity

Efficient replication in human airway

Efficient transmission between humans

244
Q

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

A

Listeria monocytogenes

245
Q

Has contact with someone with TB, what is the lifetime risk of immunocompetent getting active TB?

A

10%

246
Q

Returning traveller with fever and constipation (salmonella typhi) - what abx do you give if she hasn’t been started on them already?

A

Ceftriaxone

247
Q

Which bacterial species causes scarlet fever?

A

Streptococcus pyoenes

248
Q

What is the most common cause of viral meningitis?

A

Enterovirus

249
Q

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

A

HHV 8

KArposi sarcoma

250
Q

Diffuse white plaques that can be easily brushed away are seen on an OGD, what is the diagnosis?

A

Oesophageal candidiasis

251
Q

What is the treatment for pseudomembranous colitis?

A

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

252
Q

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

A

IgM

(heterophile test if that is an option)
This is a MONOSPOT test

253
Q

Gram +ve cocci UTI in a young woman?

A

Staphylococcus saprophyticus

254
Q

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

A

Corynebacterium diphtheriae

255
Q

What cell type is raised in the blood in schistosomiasis?

A

Eosinophils

256
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

Escherichia coli 0157:H7

257
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

258
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

REvers transcriptase

259
Q

Which vector transmits Trypanosoma brucei rhodesiense?

A

tsetse fly

Causes sleeping sickness. High fever muscle pain and headaches?

260
Q

Which of these does not lead to chronic Hepatitis?

A

Hepatitis A and E

261
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

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%

262
Q

What is the most common cause of fever in a returning traveller?
A. Malaria
B. Hepatitis
C. HIV seroconversion
D. Typhoid
E. Dengue

A

Malaria

263
Q

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

A

PBC

264
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 -> midshaft - 40 year old

Neuroblastoma is not a bone cancer

Osteosarcoma -> Metaphysis, and less painful

Ewing sarcoma-> young painful

265
Q

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

A

Adenocarcinoma

266
Q

Which cancer is associated with asbestos?

A

Mesothelioma

267
Q

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

A

Splenomegaly

268
Q

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

A

Intra-operative frozen section

269
Q

What type of gastric cancer is most common?

A

Adenocarcinoma

270
Q

What type oesophageal cancer is most common in the UK?

A

Adenocarcinoma

If it says world then squamous cell carcinoma

271
Q

Ovarian tumour with hair. No immature cells seen.

A

Mature teratoma

272
Q

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?

A

posterior fossa tumour

Medullablastoma

273
Q

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?

A

Kruckenberg tumour – gastric or breast? metastasis

274
Q

What virus increases risk of nasopharyngeal cancer?

A

EBV

275
Q

Which thyroid cancer most commonly metastasises to the lymph nodes?

A

Papillary

276
Q

Which thyroid cancer most commonly metastasises to the lymph nodes?

A

Papillary

277
Q

Which cancer is associated with coeliac disease?

A

Enteropathy-associated T-cell lymphoma
Non-hodgkins lymphoma
Adenocarcinoma

278
Q

Eczematous nipple rash caused by individual ‘malignant cells’?

A

Paget’s disease of the breast

279
Q

Sudden headache, loss of consciousness, meningism

A

Subarachnoid haemohrage

280
Q

Patient with HIV, raised ICP, new onset epilepsy
Causes?

A

Cryptococcus neoformans or toxoplasmosis

281
Q

Old woman falls and breaks her hip

A

Osteoperosis

282
Q

20 year old with a lytic lesion in the diaphysis of his leg, pain alleviated by aspirin

A

osteoid osteoma

283
Q

Man goes deaf with bowed legs

A

Pagets disease of the bone

284
Q

Vertebral fracture, high paraprotein

A

MM

285
Q

Young woman with symmetrical joint pain

A

Rheumatoid arthritis?

286
Q

Patient with a cancer in their bladder following chronic schistosomiasis

A

Squamous cell carcinoma

287
Q

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?

A

Seminoma

288
Q

Patient presents with a craggy enlarged uneven prostate

A

Prostate cancer (adenocarcinoma)

289
Q

Patient had an appendectomy 1 week ago. What would you see in their scar?

A

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)

290
Q

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

A

Thrombus/ atheromatous plaque?

291
Q

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

A

inflammation

292
Q

What is deposited in the kidneys in Multiple Myeloma?

A

Amyloid light chain
AL amyloid

293
Q

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

A

Ductal adenocarcinoma

294
Q

Patient with a pancreatic mass following acute pancreatitis

A

Pancreatic pseudocyst

295
Q

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

A

Ductal adenocarcinoma

296
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

297
Q

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

A

Calculi

298
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 pyelenophritis

299
Q

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

A

Renal cell carcinoma

300
Q

Fibro-epithelial tumour with abundant stromal elements

Breast pathology

A

Phyllodes tumour

301
Q

Which/What cancer is also known as non-specific type? (Breast pathology)

A

Invasice ductal carcinoma

302
Q

Most common type of malignancy in the breast?

A

Invasice ductal carcinoma

303
Q

Cancer which has a high, medium and low Grade to it? Breast pathology

A

– Ductal carcinoma in situ

304
Q

Which cancer is associated with H.Pylori infection?

A

Gastric MALT

305
Q

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

A

Atrophy

306
Q

Which process takes place in the oesophagus in response to exposure to stomach acid?

A

Metaplasia

307
Q

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

A

Carcinoid tumour/ neuroendocrine tumour

308
Q

Malignant HTN, what is the classic renal finding on histology

membranous glomerulonephritis

minimal change glomerulonephritis

granulomatous changes to vessel

amyloid deposition

fibrinoid necrosis

A

Fibrinoid necrosis

309
Q

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

A

Immmune complex deposition?

310
Q

Severe UTI in the kidney in Diabetes, what do you see on biopsy

A

Kimmelstiel-Wilson nodules

311
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

312
Q

An elderly man with atrial fibrillation develops new right flank pain

A

renal thrombus

313
Q

What condition is caused by vitamin C deficiceny?

A

Scurvy?

314
Q

common cause of death ue to cancer in males is ?

A

Lung cancer

Lung
Prostated
Colon
Head and neck
Breast

315
Q

What is the most common cause of constrictive pericarditis?

A

Tuberculosis

316
Q

What 3 infections are checked in pregnancy?

A

Hep B, HIV and syphyllis

317
Q

According to the recovery study what steroid is given in covid 19 with low O2

A

Dexamethasone

318
Q

Guy with knee pain and postively bifringent crystals diagnosis?

A

Pseudogout

319
Q

What stain for amyloid?

A

Congo red stain?

320
Q

How do you monitor LMWH in renal failure?

A

Anti Xa Assay

321
Q

Pelger huet cells and Hypogranular hypolobated neutrophils?

Diagnosis

A

Myelodysplastic syndrome

322
Q

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?

A

Pneumocystitis Jirovecii

323
Q

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?

A

Nisseria meningitis

324
Q

What bone cancer is likely to develop in someone with pagets disease?

A

Osteosarcoma

325
Q

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?

A

Renal artery stenosis

326
Q

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?

A

Tumour lysis syndrome

327
Q

What drug causes Hypoglycaemia?

Quinine, Thiazide, Statin, Glucagon, prednisone

A

Quinine

328
Q

What antiviral is given in covid?

A

Remdesivir

329
Q

Which type of hyperlipidaemia causes acute pancreatitis?

A

Triglycerides

330
Q

What is the treatment for Malignant melanoma?

A

Nivolumab (anti PD1)

331
Q

What is the name of macrophages found in the skin?

A

Langerhans cells

332
Q

What is the name of the macrophages in the brain?

A

Microglial cells

333
Q

What is macrophages in the bone is called?

A

Osteoclast cells

334
Q

What are the macrophages in the lungs called?

A

Alveolar macrophages

335
Q

What is the macrophages in connective tissue called?

A

Histocytes

336
Q

List some influenza antiviral with their mechanism?

A

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

337
Q

Cell lacks e Cadherin. Found in breast
What is histopathology?

A

Lobular carcinoma in situ

338
Q

TTP pentad

A

MAHA
Thrombocytopenia
Acute renal failure
Neurological symptoms
Fever

339
Q

What is the treatmend of tSideroblastic aneanmia

A

Pyridoxine

340
Q

What disaease is routinely screened for in transfusion

A

CMV -> Pregnancy; HTLV1 for first time donor;
HIV; Hepatitis B and C + Syphyllis

341
Q

A patient has hemiangioblastoma of the cerebellum, multiple bilateral renal cell carcinoma and cysts of the pancreas and kidney is seen in what condition?

A

Von hippel lindau

342
Q

What common double stranded virus causes nephritis in transplant patients?

A

BK virus

343
Q

rank the most likely to the least likely cause of typical pneumonia

A

Strep Pneumonia
Haemophilus influenza
Moraxella Catarrhalis
Staph aureus
Klebsiella pneumonia

344
Q

What is the cytochine that is key in promoting the development and terminal differentiation of eosinophils?

A

Il-5

345
Q

What is the primary heart cancer?

A

Atrial Myxoma

346
Q

Person had an unprovoked DVT, treated with LMWH for 6 months. What long-term DVT prophylaxis should they take?

Aspirin, warfarin, DOAC, none needed

A

I think DOAC

idarucizumab for dabigatran and andexanet Alfa for rivaroxaban/apixaban

347
Q

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?

A

Warm AIHA

Spherocytosis is associated with Warm

Cold AIHA is associated with raynauds

348
Q

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?

A

Warm AIHA

Spherocytosis is associated with Warm

Cold AIHA is associated with raynauds

349
Q

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?

A

As this is Staph aureus but sesnitive to methecillin then it is Flucloxacillin

It will be vanc or Linezolid if it is MRSA

350
Q

What type of emphysema is associated with smoking?

A

Centrilobular emphysema

351
Q

Commonest primary tumour of the heart?

A

Atrial myxoma

352
Q

A dysgerminoma is a type of tumour that affects the ovary. What is the equivalent tumour type in the testes?

A

seminoma

353
Q

Intestinal metaplasia in Barrett’s (columnar-lined) oesophagus is most commonly due to the presence of which cell?

A

goblet cells

354
Q

Deficiency of which plasma protein occurs in patients with liver disease and a movement disorder?

A

ceruloplasmin –> Wilsons disaease

355
Q

Which class of antibiotics has concentration dependent killing (i.e. the goal of therapy is to maximise peak > MIC)

A

aminoglycoside

356
Q

Bleeding patient has prolonged APTT and PT, but normal platelet count and normal fibrinogen. What is the most suitable blood component for treatment?

A

d) Fresh frozen plasma

Cryoprecipitate

One of these 2 i think it is fresh frozen plasma

357
Q

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?

A

Relative polycythaemia

358
Q

Brain tumour which most commonly occurs near the surface of the brain and is frequently asymptomatic is most likely to be?

A

Meningioma

359
Q

Streptobacillus moniliformis is the causative organism of which of the following infections?

A

Rat bite fever

360
Q

Which enzyme causes hypercalcaemia in sarcoidosis?

A

1-alpha hydroxylase

361
Q

What liver cancer is associated with Alpha fetoprotein

A

Hepatocellular carcinoma

362
Q

What enzyme is specific for Pacreatitis?

A

Lipase

363
Q

What is the causative organism of Lymes’ disease?

A

Borrelia Burgforferi

364
Q

Venetoclax is a BCL2 inhibitor used for B-cell CLL. Which cellular process does this act on?

A

This acts to increase apoptosis. By binding to BCL cells.

365
Q

What pathway is associated with problems in Autoimmune lymphoproliferative syndrome?

A

FAS pathway

366
Q

What is the gene that is mutated in brutons agammaglobiaemia ?

A

BTK gene

367
Q

What is the defective protein in Hyper IgM syndrome?

A

CD40 ligand

368
Q

What animal is associated with hanta virus?

A

Rat and mice

369
Q

What is the possible cause of infection, with someone who works with bats?

Bartonella henselea
Rabies
streptobassilus moniliformis
SARS-COV2
Hanta virus

A

Hanta virus -> Rats and mice
Rabies -> Rats and dogs+ bats
Streptobacillus -> rats
SARS-COV2 none of these really
Bartonella henselea -> cat scratch disease

370
Q

Malaria treatment cut off if severity of symptoms unclear.

A

IV artensuate

Adult >=10 % parisitaemia
Children >=2% parisitaemia

371
Q

Anti SRP is associated with what condition?

A

Polymyositis

Also associated with aNti Jo 1 but apparently the jo 1 is more linked with dermatopolymyositis

372
Q

What type of vaccine is Whooping cough pertussi; Hepatitis A and Rabies and tetanus?

A

Inactivated vaccines

373
Q

What is associated with interferon gamma receptor associated deficiency?

A

Increases the likelihood of Mycobacterial diseases

374
Q

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?

A

Macrophage Giant cell

375
Q

Renal cell transplant recipients on a long term immunosuppression have an increased risk of which lymphoid cancer?

A

EBV associated diffuse large B-cell lymphoma

376
Q

What is it called when you have discontinuation of the epithelium?

A

Ulcer

377
Q

Subtotoal villous atrophy with tall crypts

A

Coeliacs disease

Year 5 Path PPQ (1 decks)

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