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year 5 pathology nuggets > MIscellaneous > Flashcards

MIscellaneous Flashcards

1
Q

What are the 2 high-risk HPV subtypes that cause about 70% of cervical cancers?

A

HPV 16 and HPV 18

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2
Q

What is the screening program for cervical cancer?

A

Women aged 25-65 invited for screening every 3-5 years

Sample sent for cytology and examined for cervical intraepithelial neoplasia (CIN)

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3
Q

What are the 3 HLA subtypes used for tissue typing?

A

HLA A, B and DR

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4
Q

What are the 2 mechanisms of graft rejection?

A
  1. T-cell mediated

2. Antibody-mediated

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5
Q

What is the cardinal feature of antibody-mediated graft rejection?

A

Presence of antibodies and inflammatory infiltrate in microvasculature of graft organ

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6
Q

Treating acute rejection: T cell mediated and antibody-mediated. For which do you use:

  • Steroids
  • IVIG, plasma exchange?
A

T cell mediated: steroids + T cell depleting agents

Antibody-mediated:

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7
Q

What is the time period for early onset sepsis in the neonate? What are the top 2 causative organisms?

A

Within 48h after birth. Group B Strep (S. agalactiae) is by far the most common, from the vaginal canal, followed by E. coli.

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8
Q

What is the time period for late onset sepsis in the neonate? What are the top 2 causative organisms?

A

After 72h after birth. Top is Staph aureus followed by Group B strep.

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9
Q

What is the current pathogen screening for pregnant women?

A

Hep B
HIV
Rubella
Syphillis

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10
Q

What is the classic triad for rubella of the newborn?

A

Deafness, eye problems (cataracts, micropthalmia), cardiac problems (PDA, pulm artery stenosis)

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11
Q

What are the three classes of selective targets for antibiotics?

A
  1. Peptidoglycan cell wall
  2. Ribosomal subunits
  3. DNA gyrase
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12
Q

What are the 2 classes of antibiotic that target peptidoglycan synthesis?

A
  1. Beta-lactams (penicillins, cephalosporins, carbapenems)

2. Glycopeptides

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13
Q

What is the preferred penicillin for S. aureus and why?

A

S. aureus produces beta-lactamase. Flucloxacillin is stable to S. aureus-produced beta-lactamase and is thus used first-line.

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14
Q

What is Virchow’s triad?

A
  1. Haemostasis / turbulent blood flow
  2. Endothelial damage
  3. Hypercoagulability
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15
Q

What cancer is associated with EGFR mutations? And what are the tyrosine kinase inhibitors used to treat it?

A

Adenocarcinoma of the lung (esp in non-smokers). Erlotinib and gefitinib.

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16
Q

Which 2 lung cancers are strongly associated with smoking?

A

Small cell lung cancer and squamous cell carcinoma

17
Q

Why do defects in the synthesis of α and β globin chains present at different ages?

A

α-globin is synthesised early in the fetus, so presents earlier; β globin is synthesised later, and presents later after HbF is reduced.

18
Q

Management of sickle-cell anaemia?

A

Vaccination (pneumococcus, meningococcus, H. influenzae)
Prophylactic penicillin
Folate supplementation

19
Q

Why are females less likely to have G6PD deficiency?

A

X-linked

20
Q

What is the immediate treatment of anaphylactic shock?

A

Stabilise airway: oxygen, bronchodilators
IM adrenaline
IV: antihistamine (chlorphen), corticosteroids, fluids

21
Q

What specific immunological defect is associated with recurrent meningococcal / pneumococcal / H. influenzae infections? What specific investigations would you do?

A

Complement deficiency, especially in alternative and common pathways.

Specific investigations: Serum C3 / C4 levels, CH50 (common pathway), AP50 (alternative pathway)

22
Q

What 3 tests are used to assess SLE disease activity?

A

Complement (C3 and C4) levels
ESR
Anti-dsDNA Ig levels

23
Q

Which is the most specific blood test for rheumatoid arthritis?

A 
Anti-CCP antibodies (95% specific)
Rheumatoid factor (anti-IgM) is only 70% specific.

Note that both are only 60-70% sensitive.

24
Q

Typical microscopy indicative of gout

A

Needle-shaped crystals (of urate) that are negatively birefringent under polarised light`

25
Q

What investigations would you consider in a patient with suspected diabetes insipidus?

A

Serum glucose (exclude DM)
Serum calcium and potassium (exclude hypercalcaemia / hyperkalaemia, which can both cause DI)
Serum and urine osmolality
Water deprivation test (urine will not concentrate)

26
Q

What should you suspect in a patient presenting with low-grade pyrexia of unknown origin and microscopic haematuria?

A

Endocarditis

27
Q

Ddx for hypercalcaemia

A

Malignancy
Primary hyperPTH
Sarcoidosis

28
Q

What are the enzymes involved in each step of Vitamin D activation and where are they located?

A

UV light in skin –> Cholecalciferol
25-hydroxlyase in liver –> 25-hydroxycholecalciferol
1α-hydroxylase in kidney –> calcitriol

29
Q

What is band keratopathy and what is it a sign of?

A

Calcium deposition in a band across the cornea.
A sign of chronic hypercalcaemia, most likely due to longstanding undiagnosed primary hyperparathyroidism.

(Other causes of hyperCa, such as malignancy and sarcoidosis, tend to present with complications much earlier, so band keratopathy does not have time to develop)

30
Q

Thiazides and loop diuretics - which causes Ca retention, and which increases renal Ca excretion?

A

Thiazides work on the distal convoluted tubule to increase Na+ excretion, which promotes Ca retention. Loop diuretics act on the loop of Henle and reduce reabsorption of Na, K and Ca excretion.

31
Q

GI upset after eating ham - caused by heat stable bacterial toxin. Which organism?

A

Bacillus cereus

32
Q

S shaped GI pathogen

A

Campylobacter

33
Q

MEN1 and MEN2: associated tumours

A

MEN1: parathyroid, pituitary, pancreatic
MEN2: phaeochromocytoma, medullary thyroid carcinoma

34
Q

What are the steps in treatment for a patient with clinically symptomatic or severe hypercalcaemia?
(Ca >3.0mmol/L, or dehydration / confusion / seizure / renal failure)

A

Ca is osmotic diuretic. Patients are dehydrated and need rapid rehydration with normal saline (1L/1h first and then several more litres more slowly). To avoid causing fluid overload and pulm oedema, also give furosemide to make space by inducing diuresis of Ca-rich body fluids.

  1. IV access and catheter, rehydrate with 0.9% NaCl
  2. Give furosemide
  3. Can give bisphosphonates if cause known to be malignancy
35
Q

What is the causative organism of progressive multifocal leukoencephalopathy?

A

JC virus

36
Q

What viruses cause Kaposi’s sarcoma and Burkitt’s lymphoma?

A

Kaposi’s sarcoma: HHV-8

Burkitt’s lymphoma: EBV

year 5 pathology nuggets (2 decks)

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