general path Flashcards
1
Q
vaccinations in pregnancy
A
Vaccinations:
Flu vaccine straightaway, pertussis vaccine book for @16 weeks.
1
Q
most common cause of lobar pnuemonia
A
strep pneumonia
2
Q
which infections are checking in routine antenatal screening ?
A
hepatitis B virus, HIV, syphilis
3
Q
which psych drug can cause hyponatraemia ?
A
sertraline
4
Q
baby can be born with these if mothers gets this in pregnancy:
sensorineural deafness
congenital cataracts
congenital heart disease (e.g. patent ductus arteriosus)
growth retardation
hepatosplenomegaly
purpuric skin lesions
‘salt and pepper’ chorioretinitis
microphthalmia
cerebral palsy
A
congenital rubella
5
Q
pituitary adenoma with slightly raised prolactin ?
A
A non-functioning adenoma may crush the stalk, leading to increase prolactin levels (lower dopamine inhibition as reduced blood flow). However, the increased prolactin will be relatively small (but will be massively raised in prolactinoma)
6
Q
which hepattitis virus is very dangerous for women ?
A
hepatitis E
7
Q
what is the most specific antibody for Rheumatoid arthritis ?
A
anti cyclic citrullinated peptide
8
Q
A
9
Q
what do you see on biopsy in Hirschsprung’s disease –
A
Absence of ganglion cells in myenteric plexus (80% males).
hypertrophied nerve fibres
10
Q
A person has MEN2, underwent thyroidectomy for medullary thyroid cancer, develops palpitations and hypertension. Dx?
A
Phaeochromocytoma
11
Q
different congenital adrenal hyperplasia and what you get in them?
A
21-hydroxylase deficiency (90%)
impairs the conversion of 17-hydroxyprogesterone to 11-deoxycortisol, leading to cortisol deficiency and excess androgen production. you get salt wasting crisis
11-beta hydroxylase deficiency (5%)
results in hypertension due to excess deoxycorticosterone
17-hydroxylase deficiency (very rare)
leads to mineralocorticoid excess with low androgen and estrogen levels
12
Q
- A child with sickle cell comes in SOB, listless. Lo rbc, lo reticulocytes
A
parvovirus B19 infection causing aplastic crisis
13
Q
which resp infection in CF and why ? and how to manage ?
A
immunocompromsied
Pseudomonas aeruginosa. Assoc with worse prognosis, treat with ceftazidine
14
Q
what is Rituximab and when do you use it ?
A
Anti-CD20, depletes mature B cells (not plasma cells)
Lymphoma, rheumatoid arthritis, SLE
15
Q
first step in clincial assessment of someone with low sodium
A
clinical assessment of volume statuts
16
Q
most frequent route of pathogen entry into CNS ?
A
haematagenous spread
17
Q
what are the Myeloproliferative Disorders
A
A group of conditions characterized by clonal proliferation of one or more haemopoietic component i.e. increased production of mature cells.
“Philadelphia Chromosome positive”
Chronic Myeloid Leukaemia (CML)
“Philadelphia Chromosome negative”
- Polycythaemia vera (PV)
- Myelofibrosis (MF)
- Essential thrombocytosis (ET)
18
Q
why do you get tetany when you hyperventilate ?
A
Hyperventilation due to anxiety can result in tetany
Respiratory alkalosis happens when you’re breathing too fast or too deeply, causing your lungs to get rid of too much carbon dioxide. This causes the carbon dioxide levels in your blood to decrease, and your blood then becomes alkaline.
19
Q
put these in order of broad spectrum
pip taz
benzyl penicillin
meropenem
ceftriaxone
amoxicclin
A
benzyle pen
amoxicilin
ceftriaxone
pip taz
meropenem
20
Q
what happens to platelets in pregancy ?
A
dilutional thrombocytopaenia
21
Q
peripheral pancytopenia + qualitative abnormalities of cell maturation
A
myelodysplastic syndrome
22
Q
outline myelodysplastic syndrome
A
Heterogeneous group of progressive disorders featuring ineffective proliferation and differentiation of abnormally maturing myeloid stem cells.
* Characterised by: peripheral cytopenia; qualitative abnormalities of cell maturation; risk of AML transformation
* Typically seen in the elderly; symptoms usually develop over weeks/months (incidental)
* By definition all patients have <20% blasts (>20% blasts = acute leukaemia)
Clinical Features
* BM failure and cytopenias infection, bleeding, fatigue
* Hypercellular BM
* Defective cells:
o RBCs e.g. ring sideroblasts (abn nucleated blast surrounded by iron granule ring)
o WBCs – hypogranulation, Pseudo-Pelger-huet anomaly (hyposegmented neutro)
o Platelets – micromegakaryocytes, hypolobated nuclei
23
Q
tx for beta thalassaemia ? and what do you need to be careful of ?
A
- Minor and some intermedia forms may not need regular treatment
- Blood transfusions with iron chelation (desferrioxamine) to stop iron overload, plus folic acid
- Regular screening for iron overload in heart and liver
24
outline hypoglycaemia management for all cases
if they're conscious
1) Glucotabs – short acting simple CHO
2) Sandwich – long acting complex CHO
if not conscipus and you have IV access
- Glucose 10% 100ml IV over 10 mins
if unconscious and no IV access
IM glucagon
25
name the 3 eznymes deficient in congenital adrenal hyperplasia
21-hydroxylase deficiency (90%)
impairs the conversion of 17-hydroxyprogesterone to 11-deoxycortisol, leading to cortisol deficiency and excess androgen production
11-beta hydroxylase deficiency (5%)
results in hypertension due to excess deoxycorticosterone
17-hydroxylase deficiency (very rare)
leads to mineralocorticoid excess with low androgen and estrogen levels
26
what is HHS and who gets it ?
Hyperosmolar hyperglycaemic state (HHS) is a medical emergency that can be difficult to manage and has a significant associated mortality (up to 20%). Hyperglycaemia results in osmotic diuresis, severe dehydration, and electrolyte deficiencies. HHS typically presents in the elderly with type 2 diabetes mellitus (T2DM).
Some people who don’t realise they have type 2 diabetes don’t get diagnosed until they are very unwell with HHS
27
Hyper Igm due to a mutation in what gene ?
CD40 ligand gene
28
which cytokine for eosinophils ?
IL-5
29
Investigations: confirm a mutation of the MEFV gene encoding pyrin. whats going on... what drug .... what do you prevent ?
Familial Meditaranean Fever
Prevent amyloidosis
tx = colchicine
30
A 6 month old baby has presented with recurrent ix is being investigated for immunodeficiency. Analysis of lymphocyte subsets shows presence of B cells and CD8+ T cells but very low numbers of CD4+ T cells.
presence of IgM but low levels of IgG
Bare lymphocyte syndrome
Defect in one of the regulatory proteins involved in Class II gene expression
* Regulatory factor X or Class II transactivator
Absent expression of MHC Class II molecules
Profound deficiency of CD4+ cells
* Usually have normal number of CD8+ cells
* Normal number of B cells
* Failure to make IgG or IgA antibody (no class switching)
31
which cytokine in ankylosing spondyltitis and what is teh name of the drug?
Secukinumab
anti-IL-17A
psoriasis, psoriatic arthritis, ankylosing spondylitis
32
A 32 year old man presents with fever, abdominal pain and constipation. He has recently returned from Pakistan. He undertook no vaccinations prior to travel. Blood cultures taken on admission have grown non-lactose fermenting Gram negative bacilli in both bottles. What is the most likely causative organism? + mx?
Salmonella Typhi + Paratyphi
(Typhoid- see fever in returning traveller)
Enteric fever: constipation, fever, rose spots, splenomegaly
mx = IV ceftriaxone then PO azithromycin
33
HIV patients develops fever, confusion, headache - whats going on
immunosupression --> toxoplasmosis gondii causing encephalitis sx
34
PML/RARA fusion gene
Acute promyelocytic leukaemia (APML)
15;17– prone to DIC & bleeding
35
Chromosomal translocation involving c-myc proto oncogene
birkitt's leukaemia
36
presentation of nephortic with myeloma ?
myeloma kidney (cast nephropathy)
37
Hb fall in patient with CLL (spherocytes )
Associated with autoimmunity (Evan’s Syndrome) – AIHA, ITP
38
mother with ITP - how can you check baby?
check cord FBC
39
what monitoring for doAC
none
40
Renal transplant recipients on long term immunosuppression have an increased risk of which lymphoid cancer?
EBV associated Diffuse large B cell lymphoma (DLBCL)
41
Children with Down syndrome have an increased incidence of which type of blood cancer?
ALL
42
outline Antiphospholipid syndrome
Antiphospholipid syndrome is an acquired disorder characterised by a predisposition to both venous and arterial thromboses, recurrent fetal loss and thrombocytopenia. It may occur as a primary disorder or secondary to other conditions, most commonly systemic lupus erythematosus (SLE). Around 30% of patients with SLE have positive antiphospholipid antibodies.
A key point for the exam is to appreciate that antiphospholipid syndrome causes a paradoxical rise in the APTT. This is due to an ex-vivo reaction of the lupus anticoagulant autoantibodies with phospholipids involved in the coagulation cascade.
Associations other than SLE
other autoimmune disorders
lymphoproliferative disorders
phenothiazines (rare)
Features
venous/arterial thrombosis
recurrent miscarriages
livedo reticularis
other features: pre-eclampsia, pulmonary hypertension
Investigations
antibodies
anticardiolipin antibodies
anti-beta2 glycoprotein I (anti-beta2GPI) antibodies
lupus anticoagulant
thrombocytopenia
prolonged APTT
Management - based on EULAR guidelines
primary thromboprophylaxis
low-dose aspirin
secondary thromboprophylaxis
initial venous thromboembolic events: lifelong warfarin with a target INR of 2-3
recurrent venous thromboembolic events: lifelong warfarin; if occurred whilst taking warfarin then consider adding low-dose aspirin, increase target INR to 3-4
arterial thrombosis should be treated with lifelong warfarin with target INR 2-3
43
Which of these tumours is most likely to be associated with Pseudomyxoma peritonei?
Mucinous tumour of the ovary
44
A 21 year old Syrian woman who has recently moved to the UK from a refugee camp attends a haematology clinic. She has Beta Thalassaemia major and for the last six years has received regular blood transfusions as treatment for anaemia. On examination she has signs of congestive cardiac failure and gonadal failure
iron overload (due to blood transfusions)
45
What species of Coagulase Negative Staphylococcus is a common cause of lower urinary tract infection in young women?
2. Staphylococcus saprophyticus
46
What double stranded DNA virus is associated with nephritis in renal transplant recipients on immunosuppresive therapy?
BK polyomovirus
47
Which vaccine preventable disease presents initially with mild fever, swollen neck glands, anorexia, malaise. and cough. After 2-3 days a membrane of dead cells forms in the throat, tonsils, larynx or nose which may narrow or occlude the airway leading to respiratory distress?
diphtheria
Diphtheria is caused by the Gram positive bacterium Corynebacterium diphtheriae
Possible presentations
recent visitors to Eastern Europe/Russia/Asia
sore throat with a 'diphtheric membrane' - grey, pseudomembrane on the posterior pharyngeal wall
bulky cervical lymphadenopathy
may result in a 'bull neck' appearanace
neuritis e.g. cranial nerves
heart block
Investigations
culture of throat swab: uses tellurite agar or Loeffler's media
Management
intramuscular penicillin
diphtheria antitoxin
48
Which of these tumours is most likely to be associated with Pseudomyxoma peritonei
mucinous tumour of the ovary
48
complete mole vs partial mole pregancy
complete = diploid
partial = triploid
The presentation of a partial hydatiform mole is usually less dramatic than that of a complete mole. These patients typically present as described before with symptoms similar to a threatened or spontaneous abortion, including vaginal bleeding. Since partial hydatiform moles have fetal tissue, on examination, these patients may have fetal heart tones evident on Doppler.
On physical exam, in more than 50% of cases, uterine size discrepancy and date discrepancy usually takes place.
In a complete mole, the uterus is usually larger than the expected gestational date of the pregnancy, whereas, in partial moles, the uterus can be smaller than the suggested date.
49
what is this descirbing
cytoplasmic hyaline inclusions of hepatocytes
Pre-keratin intermediate filaments
Mallory bodies (MBs), also known as Mallory-Denk bodies (MDBs), are cytoplasmic hyaline inclusions of hepatocytes, once thought to be specific for alcohol-related steatohepatitis (ASH)
50
A 42 year old male cigarette smoker presents with urinary frequency and haematuria. Cystoscopy finds an ‘exophytic fronded lesion’ which is biopsied. Histologic examination shows fibrovascular cores covered by atypical cells
papillary urothelial carcinoma
51
what molecule transports cholesterol to the liver?
The main lipoprotein involved in this process is the HDL-c
52
what is caused by niacin deficiency ?
pellagra
53
polymyositis/dermatomyositis what enzyme would be raised ?
Creatine kinase is the muscle enzyme most widely used to diagnose polymyositis/dermatomyositis and to follow therapeutic response
54
what are the hormones released from the hypothalamus
The thyrotropin-releasing hormone (TRH), gonadotropin-releasing hormone (GnRH), growth hormone-releasing hormone (GHRH), corticotropin-releasing hormone (CRH), somatostatin, and dopamine are released from the hypothalamus into the blood and travel to the anterior pituitary.
55
Multiple Endocrine Neoplasia TYPE 1 AND TYPE 2 - FEATURES
* MEN 1= ‘PPP’ - Parathyroid hyperplasia/adenoma, Pancreatic endocrine tumour (often phaeochromocytoma), Pituitary adenoma.
* MEN 2A- Parathyroid, Thyroid, Phaeochromocytoma
* MEN 2B- Medullary Thyroid, Phaeochromocytoma, Acoustic Neuroma. Marfanoid phenotype
56
Lymphadenopathy and hepatosplenomegaly in immune deficiency question - what is it ?
chronic granulomatous disease
57
* Very low or absent T cell and NK cell numbers
* Normal or increased B cell numbers
in immune deficiencies what is this ?
X linked SCID
58
A 29 year old female has experienced three second trimester miscarriages. She has a mild livedo. reticularis rash affecting her forearms and lower legs. Which auto-antibody is most likely to be present?
anti cardiolipin
Anti phospholipid syndrome (APS) also known as Hughes syndrome presents with diverse clinical symptoms including thrombosis (arterial and venous) and recurrent miscarriage. Anti-cardiolipin is one of the many antibodies to a variety of phospholipid molecules in APS
59
anti virals for influenza
1. Oral Oseltamivir (Tamiflu)
2. Inhaled Zanamivir (Relenza – used in patients with underlying respiratory disease)
60
What is the correct pathological term for a discontinuation in the epithelial surface?
ulcer
61
What is the technical term for a connection between two epithelial surfaces, as occurs in Crohns disease where for example there might be a connection between the bladder and the bowel?
fissure
62
A 46-year old Japanese female is found to have bilateral ovarian masses on imaging of the abdomen and had both ovaries removed. Histology revealed malignant signet ring cells containing mucin in both ovaries. What is the diagnosis?
Krukenberg tumour. Signet cells are present in gastric carcinoma. This is a gastric carcinoma that has metastasised to both ovaries. If both ovaries are affected, a primary elsewhere spreading to both ovaries is more likely.
Gastric carcinoma is far more prevalent in Japan that anywhere else
63
A 50 year-old female was found to have an ovarian mass. On its removal, histology revealed several cell types, including thyroid follicles, hair and teeth. What is the likely diagnosis?
Correct answer: Dermoid cyst or Cystic Teratoma
64
A 37 year-old man presents with a headache, myalgia and a cough. He is also suffering with nausea, diarrhoea and abdominal pain. On examination he is tachypnoeic and has a pyrexia of 39ºC. Blood tests reveal lymphopenia and hyponatraemia. A gram stain from the patient’s sputum is shown here (Gram negative rods). CXR shows lobar consolidation. Cold agglutinins are negative
Legionnaires disease or Legionella Pneumophila. Klebsiella
65
if a question has a pneumonia infection and also they talk about cold agglutin test what is going on ?
this is part of the Combs (DAT) test ...
cause of +ve cold agglutin test = mycoplasma pneumonia (NB you also get this in EBV). Normally cold agglutinins suggest Mycoplasma, which does not show up on Gram stain, and is an “atypical pneumonia”
cause of -ve cold agluttin test = legionella pneumophilia / klebsiella
this will most likely be for a typical pnuemoniae
66
A 40 year-old woman presents with malaise, muscular pains and diarrhoea with mucus and blood. On examination she has a fever and several distinctive spots on her abdomen (Rose spots). Blood cultures are positive and grow gram negative rods. What is the likely organism?
Salmonella Typhae or Typhoid fever.
67
what tumour is caused by human herpes virus 8?
Kaposi's sarcoma
68
Name the drug used for patients with type 2 diabetes which inhibits the enzyme alpha glucosidase in the brush border membrane of the small bowel.
Acarbose
69
Name an example of a drug that inhibits the enzyme dipeptidyl dipeptidase IV (DPP-4)
gliptins
70
tear-drop poikilocytes
myelofibrosis
71
dry tap
myelofibrosis
72
Pelger Huet cells
myelodysplastic syndrome
73
t(15;17) translocation
acute promyelocytic leukaemia
74
PML-RARA fusion gene
acute promyelocytic leukaemia
75
What infection is associated with P1104A variant of the TYK2?
TB
76
10. What disease is associated with Kimmelsteil Wilson nodule?
diabetic nephropathy
77
11. What autoimmune condition is associated with a mutation on the “shared epiptope” on HLA-DR1 and HLA-DR4?
rheumatoid arthritis
78
whta type of sideroom for someone with a very contagious infection ?
negative pressure ventilation
79
16. What antibiotic should be used to treat mycoplasma pneumoniae in a 5 year old?
MACROLIDE
Erythromycin is the drug of choice for infants and children with Legionnaire's disease, pertussis, diphtheria, lower respiratory tract infections caused by Mycoplasma pneumoniae, Chlamydia pneumoniae and Chlamydia trachomatis and enteritis caused by Campylobacter jejuni.
80
18. Child presents with chorioretinitis, cerebral calcifications. What is the most likely causative parasite in pregnancy to cause this?
toxoplasma gondii
81
19. Other than adenocarcinoma, what is the most likely neoplasm caused by H.pylori?
19. Mucosal associated lymphoid tissue lymphoma
82
20. What virus causes progressive multifocal leukoencephalopathy in AIDS?
20. John Cunningham virus
83
What enzyme should be measured before administering azathioprine? REPEAT
Before administering azathioprine, it's essential to measure the activity of the enzyme thiopurine S-methyltransferase (TPMT). This enzyme is responsible for metabolizing azathioprine and converting it into its active metabolites
83
22. Patient has been admitted with severe influenza A pneumonia and is intubated in ITU. Given that she can’t have any oral medication, what is the most appropriate antiviral to start?
2 anti virals for influenza
· Neuraminidase inhibitors (effective against Influenza A & B):
1. Oral Oseltamivir (Tamiflu)
2. Inhaled Zanamivir (Relenza – used in patients with underlying respiratory disease)
for this question we would use zanamivir
84
25. Cystericosis is caused by taenia solium. How does a human contract cystericosis?
eating pork
85
most common primary CNS tumour in children ?
48. Pilocytic astrocytoma
86
How is LMWH monitored in a patient with renal failure?
In patients with renal failure, the monitoring of low molecular weight heparin (LMWH) is typically done using the anti-Xa activity assay. This test measures the plasma levels of
anti-factor Xa activity,
which correlates with the anticoagulant effect of LMWH. Monitoring anti-Xa levels is crucial in renal failure because the reduced renal function can lead to accumulation of LMWH, increasing the risk of bleeding complications. The goal is to ensure therapeutic levels are achieved while minimizing the risk of over-anticoagulation.
87
infection causes coryzal symptoms, a grey coating on the back of the throat followed by swallowing/breathing problems?
diptheria
88
MEFV gene
60. Familial mediterranean fever
89
1. Which exact strain of E.coli causes travelers diarrhoea?
ETEC Toxigenic diarrhoea
90
5. Most common cause for myocarditis?
a. Virus
91
7. What drug is used to treat CLL (name not used, drug class/MOAs were mentioned)
a. Bruton’s kinase inhibitor
ibrutinib
92
9. Man with diabetes has conjuncitivits and rhinitis with pus, what is the most likely causative organism?
rhizopus
93
what does FAS mutation cause?
a. Expansion of lymphocytes/ ALPS
Auto-immune lymphoproliferative syndrome (ALPS)
94
14. Anti-interferon antibody levels predict disease severity in which disease?
TB
95
22. YOUNG PERSON presenting with neurological sx followed by cognitive impairment. What is the likely diagnosis? (repeat)
variant CJD
First: psychiatric symptoms (anxiety, paranoia, hallucinations). Next: neurological symptoms (peripheral sensory symptoms, ataxia and myoclonus). Later: chorea, ataxia, dementia
96
26. Ann-Arbor staging with cervical lymph nodes, mediastinum, inguinal nodes and spleen (repeat)
a. Stage 0
b. Stage 1
c. Stage 2
d. Stage 3
e. Stage 4
stage 3
don't count spleen as an extra nodal site since it is a secondary lymphoid organ
97
IL-1 blockers used in...
Familial Mediterrannean fever, gout, adult onset Still’s disease.
mainly remmeebr gout
98
2cm pituitary mass. Prolactin level: 1400 (REPEAT). What’s the diagnosis?
Non functional macro pituitary adenoma
prolactinaemia:
Mild elevation (<1000 miu/l)
* Stress
* Recent breast examination
* Vaginal examination
* Hypothyroidism
* PCOS
Moderate elevation (>1000 miu/l, <5000 miu/l)
* Hypothalamic tumour
* Non-functioning pituitary tumour compressing the hypothalamus
* Microprolactinoma
* PCOS
* Drugs, e.g. domperidone, phenothiazines
Extreme elevation (>5000 miu/l)
* Macroprolactinoma
99
Which drug do you give patients with pseudomonas infection?
ceftazidime
100
Rituximab is a monoclonal antibody against CD20 used in the treatment of Rheumatoid Arthritis and others. What is the target cell?
B lymphocytes
101
CAR-T cell against CD19 can be used in the treatment of what disease? (Repeat?)
d. Diffuse large B cell lymphoma
102
What is the most likely thing seen with moderate alcohol consumption? (repeat)
high HDL
103
rapid correction of sodium in hyponatraemia leads to ?
central pontine myelinolysis
104
how to diagnose SIADH?
Diagnostic criteria:
* True hyponatraemia (<135) + low plasma/serum osmolality (<270) + high urine sodium (>20) + high urine osmolality (>100) + no adrenal/thyroid/renal dysfunction
(euvolaemic hyponatraemia - in the middle of the diagram)
* Clinically euvolemic
* SIADH is characterised by inappropriate ADH secretion (not in response to a stimulus)
* Increased ADH → increased water reabsorption → low plasma Osm (secondary to dilution) → less water is excreted in the urine → urine Osm is high
* Confirming the diagnosis requires a normal 9am cortisol and normal TFTs (i.e. diagnosis of exclusion)
105
SIADH tx
Treatment: Fluid restriction and treat the cause, demeclocycline (increases ADH resistance) and tolvaptan can induce a state of diabetes insipidus that may help to correct the SIADH although the cost is prohibitive.
If severe, can consider giving slow IV hypertonic 3% saline.
106
what is the only radioluscent renal stone made from ?
uric acid
107
Causes of high ALP =
BLIP
Bone
Liver
Intestine
Placenta
108
newborn heelprick test - what is its name and what is it testing for ?
UK screening via the Guthrie blood spot test at 6 days age.
* Phenylketonuria, congenital hypothyroidism, cystic fibrosis, sickle cell disease, MCAD (medium chain acylCoA dehydrogenase) deficiency
109
define specificity vs sensitivity
Specificity is the probability (in %) that someone without the disease will correctly test negative
o TN/(FP+TN)
o 85 people without CF in total, and 80 actually test negative. Specificity is 80/85=94% (much easier to think like this than memorise formulae!)
* Sensitivity is the probability that someone with the disease will correctly test positive
o TP/(TP+FN)
o 100 people with CF in total, and 90 actually test positive. Sensitivity is 90/100=90%
110
positive predictive value vs negative predictive value
* PPV is the probability that someone who tests positive actually has the disease
o TP/(TP+FP)
o 95 people tested positive, of which 90 had the disease. PPV=90/95=95%
* NPV is the probability that someone who tests negative actually doesn’t have the disease
o TN/(TN+FN)
o 90 people tested negative, of which 80 didn’t have the disease, NPV=80/90=89%
111
order of importance of tests for SLE ?
Positive ANA (Anti-nuclear Antibody): This is highly sensitive and commonly positive in patients with SLE.
Positive anti-dsDNA (Anti-double-stranded DNA): This antibody is highly specific for SLE and is often associated with active disease, but not all patients with SLE have positive anti-dsDNA.
Low C3 (Complement Component 3): Decreased levels of C3 are seen in many patients with active SLE due to complement activation and consumption.
112
top 3 causes of neonatal meningitis ?
GBS (Group B Streptococcus): This is the most common cause of early-onset neonatal meningitis, typically acquired during delivery from a colonized mother.
E. coli: This is another common cause of early-onset neonatal meningitis, often acquired during delivery or through vertical transmission from the mother.
Listeria: Less common than GBS and E. coli but still a significant cause of early-onset neonatal meningitis, particularly in mothers who are carriers or have consumed contaminated food products.
113
Which coagulation factor falls most rapidly after starting warfarin?
factor VII
114
Imatinib is used for what leukaemia?
CML
iMatinib
115
Woman has chest pain, SOB, persistent swelling in neck. Large mass in supraclavicular fossa is biopsied - malignant cells with reactive fibrosis and high eosinophils [exact pictures below were included in question]. What is the likely diagnosis?
hogdkins lymphoma
116
At what temperature can platelet transfusions be stored?
room temp
117
25) Venetoclax is a BCL2 inhibitor used in CLL. What cellular process does it affect?
apoptosis
118
Commonest primary tumour of the heart?
atrial myxoma
119
31) What type of emphysema is associated with smoking
centriacinar (centrilobular) emphysema.
120
What is the commonest cause of constrictive pericarditis in the developing world?
TB
121
klebsiella full name ?
klebsiella pneumoniae
122
36) A dysgerminoma is a type of tumour that affects the ovary. What is the equivalent tumour type in the testes?
seminoma
123
adenocarcinoma - what cells ?
columnar epithelium
124
commonest cause of myocarditis ?
viral infection
125
Which virus characteristically causes encephalitis involving the temporal lobes?
HSV1
126
Which adrenal zone produces cortisol?
zona fasciculata
127
What enzyme does allopurinol inhibit?
xanthine oxidase
128
acute pancreatitis. What blood test will confirm the diagnosis?
lipase
129
What active enzyme in sarcoidosis patients causes hypercalcaemia
1 alpha hydroxlase
130
55) What hormone is produced by fat cells, and has receptors in the hypothalamus?
leptin
131
What condition involves the upper and lower airways and kidneys, and is ANCA positive with cytoplasmic staining and is specific for proteinase 3?
Granulomatosis with Polyangiitis
(Wegner’s)
132
Which condition is caused by reactivation of human polyoma virus 2 (John Cunningham (JC) virus) in immunosuppressed people?
progressive multifocal leukoencephalopathy (PML)
133
Doctors should measure the level/activity of which enzyme before prescribing azathioprine?
Thiopurine methyltransferase
134
Mutation of gamma chain of IL2 receptor, baby has failure to thrive + recurrent infections
X linked severe combined immuno deficiency
135
Mutation of CD40 ligand is associated with which form of primary immunodeficiency?
hyperIgM syndrome
136
Denosumab which ligand what does it treat ?
anti-RANK ligand, Inhibits RANK mediated osteoclast differentiation and function
osteoporosis
137
Man has recently returned from trip to India, has high fever and abdominal pain but no diarrhoea. His blood cultures - gram-ve bacilli. Malaria rapid diagnostic test is -ve. What is the most appropriate antibiotic therapy?
he has typhoid
IV ceftriaxone followed by PO azithromycin
138
Which human herpes virus is associated with post transplant lymphoproliferative disorder
EBV
139
aspergillus full name ?
Aspergillus fumigatus
140
Infection with which virus in the first 20 weeks of pregnancy causes hydrops fetalis?
parvovirus b19
141
86) 4 year old goes on school trip to petting farm, later has bloody diarrhoea and HUS. What is the causative organism?
e coli 0157
142
89) Elderly woman has fever and productive cough in GP. She has pleural rub. Spleen is not palpable, no lymphadenopathy. Her WBC is 15x10^9 with
neutrophilia. The Hb concentration is slightly low and platelet count is normal. Blood film - toxic granulation, left shift. CRP is high. What is the diagnosis?
reactive neutrophilia
not EBV (in EBV you would get lymphadenopathy)
143
what can myelodysplastic syndrome progress to ?
AML
144
55 year old man started on therapy with DOAC rivaroxaban. What advice would you give regarding monitoring whilst on treatment?
no monitoring requireed
145
What is the most appropriate 1st line therapy for CML with acquired Philadelphia translocation, in chronic phase?
d) Imatinib, an ABL1 ton tyrosine kinase inhibitor
146
chance that a sibling is HLA identical ?
25%
147
102) Which type of necrosis is associated with a MI?
coagulative necrosis
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104) What is the most common ovarian tumour?
serous cystadenoma
149
106) Which virus is associated with the development of nasopharyngeal carcinoma?
EBV
150
109) Which is the commonest glial cell in the CNS?
astrocyte
151
113) Brain tumour which most commonly occurs near the surface of the brain and is frequently asymptomatic is most likely to be?
meningioma
152
115) Which is the most common skin cancer?
basal cell carcinoma
153
144) 72 year old man is a close household contact of someone recently diagnosed with smear positive pulmonary TB. What is his lifetime risk of developing TB?
10%
154
which abx for legionella ?
azithromycin
155
what is the commonest form of prion disease? and what is the commonest in children ?
The commonest form of prion disease in humans is sporadic Creutzfeldt-Jakob disease (sCJD).
young person with lots of different stages in hx = Variant CJD
156
ibrutinib
CLL
157
Most common lymphoma in >40 year olds
Diffuse Large B Cell Lymphoma
158
mutliple myeloma vs smouldering myeloma vs MGUS
Multiple Myeloma is a malignancy of plasma cells.
It is differentiated from the related conditions MGUS and Smouldering Myeloma by the presence of end organ damage, the so called "CRAB" symptoms. Calcium (elevated), Renal failure, Anaemia and Bone lesions.
MGUS has <10% plasma cells in the bone marrow on biopsy, where as SM and multiple myeloma have >10%.
159
most common adult leukaemia >
CLL
160
