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1
Q

What causes rat bite fever? tx?

A

Sterptobacillus monoliformis/spirillum minus

Tx: penicillin

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2
Q

What is a VHF caused by ticks? rats?

A

Congo-Crimean haemorrhagic fever

Rats: Lassa

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3
Q

What is a snail track ulcer characteristic of?

A

Secondary syphilis

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4
Q

What cells are usually not seen in stomach?

A

Goblet = intestinal metaplasia

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5
Q

Layers of mucosa of stomach?

A

Columnar epithelium
Lamina propria
Muscularis mucosa (erosion stops here)

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6
Q

Layers of oesophagus?

A

Mucosa
Submucosa
Muscularis propria

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7
Q

2 types of barrett’s(CLO)?

A

With goblet cells (intestinal type) - higher risk

Without goblet cells (gastric type)

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8
Q

What is SCC of oesophagus linked to?

A

Alcohol and smoking

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9
Q

Causes of chronic gastritis?

A

Autoimmune
Bacteria
Chemical

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10
Q

What helps H pylori attach?

A

cag-A –> chronic (–> cancer)

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11
Q

2 types of gastric adenocarcinoma?

A

Intestinal - well-diff

Diffuse - poorly diff e.g. linitis plastica, signet ring cell carcinoma

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12
Q

Characteristic feature off H pylori in upper GI?

A 
Lymphoid follicles 
(but crypts full of neuts = MALToma)
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13
Q

What infection apart from H pylori can cause duodenitis?

A

Tropheryma whippelii

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14
Q

What infection mimics Coeliac histology?

A

Tropical sprue

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15
Q

Precursor of Coeliac?

A

Lymphocytic duodenitis

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16
Q

Where is ankyrin mutation found?

A

Spherocytosis

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17
Q

Where is protein 4.2 found?

A

Spherocytosis

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18
Q

Where is alpha spectrin found?

A

Elliptocytosis

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19
Q

Inheritance of spherocytosis?

A

Autosomal dominant

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20
Q

Definitive diagnosis for spherocytosis?

A

Eosin-5-maleimide on flow cytometry = less binding

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21
Q

Cause of gout?

A

Monosodium urate monohydrate

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22
Q

Cause of pseudogout?

A

Calcium pyrophosphate dihydrate

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23
Q

Most common RF for brain tumours?

A

Radiation

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24
Q

Chemo for high grade gliomas?

A

Temozolomide (or biologics like EGFR, PD-1 i)

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25
Q

Survival with grade 2 vs 3 brain tumours?

A 
2 = >5yrs 
3 = <5yrs

NB: no staging, just TYPE + GRADE

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26
Q

Only brain tumour that is staged?

A

Medulloblastoma

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27
Q

Most common primary CNS tumour?

A

Glioma

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28
Q

Rosenthal fibres + granular bodies in CNS?

A

Pilocytic astrocytoma

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29
Q

Well circumscribed enhancing tumours that is cystic and cerebellar on MRI?

A

Pilocytic astrocytoma

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30
Q

Mutation in pilocytic astrocytomas?

A

BRAF in 70%

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31
Q

Supratentorial type of glioma in adults?

A

Diffuse astrocytoma

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32
Q

Positive genetic prognostic in diffuse astrocytoma?

A

IDH1/2

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33
Q

Diffuse astrocytoma on MRI?

A

Non-enhancing and low choline:creatinine ratio

NB: glioblastomas are HETEROGENOUS enhancing

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34
Q

CNS tumour with microvascular proliferation, high cellularity and high mitotic activity (+ necrosis)?

A

Glioblastoma multiforme

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35
Q

Most common CNS tumour in children?

A

Pilocytic astrocytoma (*not medulloblastoma)

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36
Q

70yo with focal neurologu, MRI with enhancing right frontal lesion?

A

Glioblastoma

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37
Q

Astrocytomas or oligodendrogliomas, better prognosis?

A

Oligodendrogliomas

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38
Q

Fried eggs appearance CNS tumours?

A

Oligodendrogliomas (small cells with clear cytoplasm)

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39
Q

Patchy/no enhancement on MRI CNS tumour?

A

Oligodendroglioma

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40
Q

IDH1/2 and co-deletion of 1p/19q present in 100% of cases of this tumour

A

Oligodendroglioma

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41
Q

2nd most common CNS tumour overall?

A
  1. Metastatic
  2. Meningioma
  3. Glioblastoma
  4. Astrocytoma
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42
Q

Extraaxial, isodense, enhancing with contrast?

A

Meningioma

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43
Q

What grade is a tumour with mitotic activity of 3 vs 21 on HPF?

A 
<4 = grade I 
>20 = grade III
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44
Q

Which tumour shows globules on hx and pseudinvasion in Virchow-Robin space?

A

Meningioma

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45
Q

Most common sources of CNS mets in order?

A

Lung (>40%)
Breast (15%)
Melanoma (~9%)

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46
Q

CNS mets location?

A

Grey-white junction

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47
Q

Homer-Wright rosettes, small blue round cells and synaptophysin expression?

A

Medulloblastoma - 2nd most common tumour in children

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48
Q

Which CNS tumour is a candidate for resection?

A

Oligodendroglioma

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49
Q

CNS tumour responsive to steroids?

A

Diffuse astrocytoma?

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50
Q

Max number of mismatches in HLA class I between mother and child?

A

2 - because you inherit at least one of HLAA etc from each parent so 1 will always be a match to that parent

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51
Q

Tx for MRSA?

A

Vancomycin

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52
Q

Reactivation of which virus is common with Rituximab?

A

Hep B

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53
Q

Which coagulation factor decreased first with warfarin?

A

FVII

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54
Q

Which coagulation factors are not made in the liver?

A

III, IV and VIII

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55
Q

Non-Tuberculous mycobacterium , some cut on his hand in a man who cleaned a fish tank?

A

Mycobacterium marinum

56
Q

Which vessel wall anticoagulant helps protein C activation?

A

Endothelial protein C receptor

57
Q

What is a vessel wall anticoagulant that is a co-factor for antithrombin?

A

Heparan

58
Q

Long term side effect of heparins?

A

Osteoporosis

59
Q

Which anticoagulants fall with warfarin?

A

C and S

60
Q

List the anticoagulants in order of half life from shortest to longest.

A

UFH - 2hrs
LMWH - 6hrs
DOAC - 8-10hrs
Warfarin - 2-3days

61
Q

List the anticoagulants in order of onset.

A

Heparin
DOAC
Warfarin

62
Q

What is the antidote to heparin?

A

Protamine

63
Q

What type of bleeding do DOACs reduce compared to warfarin?

A

Intracranial

64
Q

Idiopathic VTE recurrence risk in 2 yrs?

A

10-20%

65
Q

2 most common allergens for anaphylaxis in children vs adults?

A

Children: milk then egg (then peanut)
Adult: shellfish, then peanut/treenut then fish

66
Q

Which chr is HLA found on?

A

6

67
Q

Most important HLA to match in order.

A

HLA-DR
HLA-B
HLA-A

68
Q

Where does phase 2 of T mediated rejection happen?

A

Lymph node

69
Q

Effect of ab mediated damage?

A

Endothelium and capillaritis –> interstitial damage

70
Q

Tx for T-cell mediated rejection?

A

Steroids (give first), calcineurin inhibitors, cytotoxic agents, mAbs to cell surface receptors

71
Q

Basiliximab target?

A

IL-2 receptor (anti-CD25)

72
Q

Alemtuzumab MOA?

A

Anti-CD52 –> T cell lysis

73
Q

Tx for Ab mediated rejection?

A

Rituximab, BAFF inhibitors, proteasome inhibitors, complement inhibitors

74
Q

MOA of bortezomib?

A

Less ab production by plasma cells

75
Q

MOA of eculizumab?

A

Anti-C5 blocks interaction of complement with endothelial cells

76
Q

Management of cellular rejection?

A

Steroids
OKT3
ATG

77
Q

Management of antibody mediated rejection?

A

IVIG
Plasmapharesis
Eculizumab (anti-CD5)
Rituximab (anti CD20)

78
Q

Induction agents for transplantation?

A

OKT3/ATG
Alemtuzumab
Basiliximab

79
Q

Baseline immunosuppression for transplants?

A

Tacolimus
MMF/Aza
+/- steroids

80
Q

Most common HAIs?

A 
HAP
SSI
UTI
BSI
GI
81
Q

Abx which is best at preventing future C diff?

A

Fidaxomycin

82
Q

Secukinumab target?

A

IL-17A

83
Q

Anti-TNFalpha mAb?

A

Adalimumab

84
Q

Absence of which cytokine increases risk of staph aureus SSI?

A

IL-10

85
Q

Most common causes of septic arthritis? What is 2nd most common?

A

Staph aureus (46%)
Streptococci
Gram -ve e.g. E coli, neisseria, salmonella, Hib
CoNS

86
Q

Most common causes of vertebral osteomyelitis? What is 2nd most common?

A

Staph aureus (48%)
CoNS
Gram -ve
Streptococci

87
Q

What is Papineau technique used for?

A

Osteomyelitis debridement + grafting

88
Q

Most common causes of prosthetic joint infections? 2nd most common ?

A 
CoNS - send several cultures as this is common skin contaminant 
Staph aureus
Streptococci
Enetrococci
Gram -ve
89
Q

What is Endo Klinik?

A

Single stage revision for PJI

90
Q

What is PJI defined as on microscopy?

A

> 5 neutrophils

91
Q

What is the most common cause of cellulitis?

A

GAS

92
Q

Which granulocytes are increased in pregnancy?

A

Neutrophils

93
Q

Give an example of when hepcidin is high vs low?

A

Iron deficiency = high hepcidin

Haemochromatosis = low hepcidin

94
Q

What is the MOA of thrombocytopenia in 3rd trimester?

A

Increased destruction and activation –> giant platelets

95
Q

What % decrease in plt in pregnancy?

A

~10%

96
Q

Tx for ITP in pregnancy?

A

IVIG + steroids

97
Q

Which coagulation factors increase in pregnancy?

A

7, 8 , 10, vWF and fibrinogen

98
Q

Which anticoagulants decrease in pregnancy?

A

Protein S and PAI

99
Q

In a preg woman with previous DVT, how long does antenatal LMWH need to be continues?

A

6 weeks postpartum

100
Q

How do you monitor LMWH?

A

Anti-Xa assay 4hrs post dose (only after 1st trimester)

101
Q

Complication of warfarin in pregnancy?

A

Chondrodysplasia punctata

102
Q

Treatment which is most beneficial to preg outcomes in women with antiphospholipid syndrome?

A

Aspirin and LMWH

103
Q

Define PPH.

A

> 500ml

104
Q

What is the usual blood loss in C/S?

A

700ml

105
Q

What MCH indicated possible thal on screening?

A

MCH<27 (alpha thal trait if <25)

106
Q

What is the HbA2 in alpha-thal trait?

A

Normal

107
Q

What is the most common cause of DIC in pregnancy?

A

Acute haemorrhage

108
Q

What are the layers of the skin?

A

“Corn Lovers Grow Several Bales”

Corneum, lucidum, granulosum, spinosum, basale

109
Q

Which skin layer has melanocytes?

A

Stratum basale

110
Q

What are the epidermal inflammation types?

A

Spongiotic - oedema
Lichenoid - border attack
Psoriasiform -
Vesciculobullous - epidermal attacj

111
Q

What are the dermal types of inflammation?

A

Vasculitis, granulomatous

112
Q

What are the subcutis types of inflammation?

A

Pannicullitis (erythema nodosum)

113
Q

What group does SJS fall into?

A

Lichenoid

114
Q

Characteristic of lichen planus?

A

Wickham’s striae - T cell attack the border between dermis and epidermis

115
Q

Name 3 features of psoriasis (3 words).

A

Acanthosis
Hypogranulosis - less granular layer
Parakeratosis - retain nuclei in corneum

116
Q

What immune components attack in pemphigoid?

A

IgG and C3

117
Q

What is seen on IF in pemphigus?

A

Chicken wire pattern

118
Q

What is the other form of pemphigus?

A

Foliaceous - no blisters

119
Q

Mutation in BCC?

A

PTCH

120
Q

Which skin cancer is a blue tumour?

A

BCC - more nucleus than cytoplasm

121
Q

Where is peripheral palisading and basaloid cells seen?

A

BCC

122
Q

What is the pre-cancerous state form of SCC?

A

Actinic keratosis - affects basale

SCC in situ/Bowen’s - full thickness

123
Q

What are the types of naevi from superficial to deep?

A

Junctional
Compound
Intradermal

124
Q

What is a feature of naevi the deeper they go?

A

They get smaller

125
Q

What is pagetoid spread in malignant melanoma?

A

Individual cell proliferation in the upper layers of the epidermis

126
Q

2 markers of melanoma on immunohisto?

A

Melan A
S100
HMB45
NB: BRAF mutation seen in 50% (V600E)

127
Q

2nd most important factor in melanoma prognosis?

A

Ulceration

128
Q

Where is Breslow thickness measured from?

A

Top of granular layer

129
Q

Which syndromes predispose to sertoli-Leydig?

A

Peutz Jeghers

DICER1

130
Q

Why is BRCA2 good?

A

PARP inhibitors can be used

131
Q

Which cyst causes Meig’s syndrome?

A

Fibroma

132
Q

Which cyst causes pseudomyxoma peritonei?

A

Mucinous cystadenoma

133
Q

What does C M U B mean in breast?

A

C = cytological, M = clinical, U= radiological, B= biopsy

134
Q

Which type of breast epithelial hyperplasia has more risk of progression to atypical ductal carcinoma?

A

Flat>usual

135
Q

Which breast cancer is associated with BRCA and is triple negative?

A

Basal-like carcinoma

136
Q

Which breast change occurs due to imbalances in progesterone and oestrogen?

A

Fibrocystic disease (may show calcification on mammogram)

137
Q

Ovarian tumour strongly positive for beta catetin?

A

Microcystic stromal tumours

Pathology Summaries (23 decks)

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