Random Flashcards
What causes rat bite fever? tx?
Sterptobacillus monoliformis/spirillum minus
Tx: penicillin
What is a VHF caused by ticks? rats?
Congo-Crimean haemorrhagic fever
Rats: Lassa
What is a snail track ulcer characteristic of?
Secondary syphilis
What cells are usually not seen in stomach?
Goblet = intestinal metaplasia
Layers of mucosa of stomach?
Columnar epithelium
Lamina propria
Muscularis mucosa (erosion stops here)
Layers of oesophagus?
Mucosa
Submucosa
Muscularis propria
2 types of barrett’s(CLO)?
With goblet cells (intestinal type) - higher risk
Without goblet cells (gastric type)
What is SCC of oesophagus linked to?
Alcohol and smoking
Causes of chronic gastritis?
Autoimmune
Bacteria
Chemical
What helps H pylori attach?
cag-A –> chronic (–> cancer)
2 types of gastric adenocarcinoma?
Intestinal - well-diff
Diffuse - poorly diff e.g. linitis plastica, signet ring cell carcinoma
Characteristic feature off H pylori in upper GI?
Lymphoid follicles (but crypts full of neuts = MALToma)
What infection apart from H pylori can cause duodenitis?
Tropheryma whippelii
What infection mimics Coeliac histology?
Tropical sprue
Precursor of Coeliac?
Lymphocytic duodenitis
Where is ankyrin mutation found?
Spherocytosis
Where is protein 4.2 found?
Spherocytosis
Where is alpha spectrin found?
Elliptocytosis
Inheritance of spherocytosis?
Autosomal dominant
Definitive diagnosis for spherocytosis?
Eosin-5-maleimide on flow cytometry = less binding
Cause of gout?
Monosodium urate monohydrate
Cause of pseudogout?
Calcium pyrophosphate dihydrate
Most common RF for brain tumours?
Radiation
Chemo for high grade gliomas?
Temozolomide (or biologics like EGFR, PD-1 i)
Survival with grade 2 vs 3 brain tumours?
2 = >5yrs 3 = <5yrs
NB: no staging, just TYPE + GRADE
Only brain tumour that is staged?
Medulloblastoma
Most common primary CNS tumour?
Glioma
Rosenthal fibres + granular bodies in CNS?
Pilocytic astrocytoma
Well circumscribed enhancing tumours that is cystic and cerebellar on MRI?
Pilocytic astrocytoma
Mutation in pilocytic astrocytomas?
BRAF in 70%
Supratentorial type of glioma in adults?
Diffuse astrocytoma
Positive genetic prognostic in diffuse astrocytoma?
IDH1/2
Diffuse astrocytoma on MRI?
Non-enhancing and low choline:creatinine ratio
NB: glioblastomas are HETEROGENOUS enhancing
CNS tumour with microvascular proliferation, high cellularity and high mitotic activity (+ necrosis)?
Glioblastoma multiforme
Most common CNS tumour in children?
Pilocytic astrocytoma (*not medulloblastoma)
70yo with focal neurologu, MRI with enhancing right frontal lesion?
Glioblastoma
Astrocytomas or oligodendrogliomas, better prognosis?
Oligodendrogliomas
Fried eggs appearance CNS tumours?
Oligodendrogliomas (small cells with clear cytoplasm)
Patchy/no enhancement on MRI CNS tumour?
Oligodendroglioma
IDH1/2 and co-deletion of 1p/19q present in 100% of cases of this tumour
Oligodendroglioma
2nd most common CNS tumour overall?
- Metastatic
- Meningioma
- Glioblastoma
- Astrocytoma
Extraaxial, isodense, enhancing with contrast?
Meningioma
What grade is a tumour with mitotic activity of 3 vs 21 on HPF?
<4 = grade I >20 = grade III
Which tumour shows globules on hx and pseudinvasion in Virchow-Robin space?
Meningioma
Most common sources of CNS mets in order?
Lung (>40%)
Breast (15%)
Melanoma (~9%)
CNS mets location?
Grey-white junction
Homer-Wright rosettes, small blue round cells and synaptophysin expression?
Medulloblastoma - 2nd most common tumour in children
Which CNS tumour is a candidate for resection?
Oligodendroglioma
CNS tumour responsive to steroids?
Diffuse astrocytoma?
Max number of mismatches in HLA class I between mother and child?
2 - because you inherit at least one of HLAA etc from each parent so 1 will always be a match to that parent
Tx for MRSA?
Vancomycin
Reactivation of which virus is common with Rituximab?
Hep B
Which coagulation factor decreased first with warfarin?
FVII
Which coagulation factors are not made in the liver?
III, IV and VIII
Non-Tuberculous mycobacterium , some cut on his hand in a man who cleaned a fish tank?
Mycobacterium marinum
Which vessel wall anticoagulant helps protein C activation?
Endothelial protein C receptor
What is a vessel wall anticoagulant that is a co-factor for antithrombin?
Heparan
Long term side effect of heparins?
Osteoporosis
Which anticoagulants fall with warfarin?
C and S
List the anticoagulants in order of half life from shortest to longest.
UFH - 2hrs
LMWH - 6hrs
DOAC - 8-10hrs
Warfarin - 2-3days
List the anticoagulants in order of onset.
Heparin
DOAC
Warfarin
What is the antidote to heparin?
Protamine
What type of bleeding do DOACs reduce compared to warfarin?
Intracranial
Idiopathic VTE recurrence risk in 2 yrs?
10-20%
2 most common allergens for anaphylaxis in children vs adults?
Children: milk then egg (then peanut)
Adult: shellfish, then peanut/treenut then fish
Which chr is HLA found on?
6
Most important HLA to match in order.
HLA-DR
HLA-B
HLA-A
Where does phase 2 of T mediated rejection happen?
Lymph node
Effect of ab mediated damage?
Endothelium and capillaritis –> interstitial damage
Tx for T-cell mediated rejection?
Steroids (give first), calcineurin inhibitors, cytotoxic agents, mAbs to cell surface receptors
Basiliximab target?
IL-2 receptor (anti-CD25)
Alemtuzumab MOA?
Anti-CD52 –> T cell lysis
Tx for Ab mediated rejection?
Rituximab, BAFF inhibitors, proteasome inhibitors, complement inhibitors
MOA of bortezomib?
Less ab production by plasma cells
MOA of eculizumab?
Anti-C5 blocks interaction of complement with endothelial cells
Management of cellular rejection?
Steroids
OKT3
ATG
Management of antibody mediated rejection?
IVIG
Plasmapharesis
Eculizumab (anti-CD5)
Rituximab (anti CD20)
Induction agents for transplantation?
OKT3/ATG
Alemtuzumab
Basiliximab
Baseline immunosuppression for transplants?
Tacolimus
MMF/Aza
+/- steroids
Most common HAIs?
HAP SSI UTI BSI GI
Abx which is best at preventing future C diff?
Fidaxomycin
Secukinumab target?
IL-17A
Anti-TNFalpha mAb?
Adalimumab
Absence of which cytokine increases risk of staph aureus SSI?
IL-10
Most common causes of septic arthritis? What is 2nd most common?
Staph aureus (46%)
Streptococci
Gram -ve e.g. E coli, neisseria, salmonella, Hib
CoNS
Most common causes of vertebral osteomyelitis? What is 2nd most common?
Staph aureus (48%)
CoNS
Gram -ve
Streptococci
What is Papineau technique used for?
Osteomyelitis debridement + grafting
Most common causes of prosthetic joint infections? 2nd most common ?
CoNS - send several cultures as this is common skin contaminant Staph aureus Streptococci Enetrococci Gram -ve
What is Endo Klinik?
Single stage revision for PJI
What is PJI defined as on microscopy?
> 5 neutrophils
What is the most common cause of cellulitis?
GAS
Which granulocytes are increased in pregnancy?
Neutrophils
Give an example of when hepcidin is high vs low?
Iron deficiency = high hepcidin
Haemochromatosis = low hepcidin
What is the MOA of thrombocytopenia in 3rd trimester?
Increased destruction and activation –> giant platelets
What % decrease in plt in pregnancy?
~10%
Tx for ITP in pregnancy?
IVIG + steroids
Which coagulation factors increase in pregnancy?
7, 8 , 10, vWF and fibrinogen
Which anticoagulants decrease in pregnancy?
Protein S and PAI
In a preg woman with previous DVT, how long does antenatal LMWH need to be continues?
6 weeks postpartum
How do you monitor LMWH?
Anti-Xa assay 4hrs post dose (only after 1st trimester)
Complication of warfarin in pregnancy?
Chondrodysplasia punctata
Treatment which is most beneficial to preg outcomes in women with antiphospholipid syndrome?
Aspirin and LMWH
Define PPH.
> 500ml
What is the usual blood loss in C/S?
700ml
What MCH indicated possible thal on screening?
MCH<27 (alpha thal trait if <25)
What is the HbA2 in alpha-thal trait?
Normal
What is the most common cause of DIC in pregnancy?
Acute haemorrhage
What are the layers of the skin?
“Corn Lovers Grow Several Bales”
Corneum, lucidum, granulosum, spinosum, basale
Which skin layer has melanocytes?
Stratum basale
What are the epidermal inflammation types?
Spongiotic - oedema
Lichenoid - border attack
Psoriasiform -
Vesciculobullous - epidermal attacj
What are the dermal types of inflammation?
Vasculitis, granulomatous
What are the subcutis types of inflammation?
Pannicullitis (erythema nodosum)
What group does SJS fall into?
Lichenoid
Characteristic of lichen planus?
Wickham’s striae - T cell attack the border between dermis and epidermis
Name 3 features of psoriasis (3 words).
Acanthosis
Hypogranulosis - less granular layer
Parakeratosis - retain nuclei in corneum
What immune components attack in pemphigoid?
IgG and C3
What is seen on IF in pemphigus?
Chicken wire pattern
What is the other form of pemphigus?
Foliaceous - no blisters
Mutation in BCC?
PTCH
Which skin cancer is a blue tumour?
BCC - more nucleus than cytoplasm
Where is peripheral palisading and basaloid cells seen?
BCC
What is the pre-cancerous state form of SCC?
Actinic keratosis - affects basale
SCC in situ/Bowen’s - full thickness
What are the types of naevi from superficial to deep?
Junctional
Compound
Intradermal
What is a feature of naevi the deeper they go?
They get smaller
What is pagetoid spread in malignant melanoma?
Individual cell proliferation in the upper layers of the epidermis
2 markers of melanoma on immunohisto?
Melan A
S100
HMB45
NB: BRAF mutation seen in 50% (V600E)
2nd most important factor in melanoma prognosis?
Ulceration
Where is Breslow thickness measured from?
Top of granular layer
Which syndromes predispose to sertoli-Leydig?
Peutz Jeghers
DICER1
Why is BRCA2 good?
PARP inhibitors can be used
Which cyst causes Meig’s syndrome?
Fibroma
Which cyst causes pseudomyxoma peritonei?
Mucinous cystadenoma
What does C M U B mean in breast?
C = cytological, M = clinical, U= radiological, B= biopsy
Which type of breast epithelial hyperplasia has more risk of progression to atypical ductal carcinoma?
Flat>usual
Which breast cancer is associated with BRCA and is triple negative?
Basal-like carcinoma
Which breast change occurs due to imbalances in progesterone and oestrogen?
Fibrocystic disease (may show calcification on mammogram)
Ovarian tumour strongly positive for beta catetin?
Microcystic stromal tumours
