Other Path Flashcards
1
Q
What is the main mechanism behind HSV resistance to antivirals?
A
Thymidine Kinase mutation
2
Q
What is the main mechanism behind CMV resistance to antivirals?
A
Protein Kinase mutation
3
Q
Which virus is most commonly implicated in infection post-transplant in paediatric populations?
A
Adenovirus
4
Q
How is post-transplant adenovirus treated?
A
Brincidofovir
5
Q
How is RSV infection treated?
A
Ribavarin
6
Q
Which virus is implicated in post-transplant lymphoproliferative disease?
A
EBV
7
Q
When would you not give Ganciclovir to treat CMV?
A
Post HCST, use Foscarnet
8
Q
A patient who has recently been on a cruise in Japan, where they ate lots of raw seafood, presents with diarrhoea. What is the most likely causative organism?
A
Vibrio parahaemolyiticus
9
Q
Give an example of an antibiotic class that is affected by altered target resistance.
A
Macrolides
10
Q
Give an example of an antibiotic that is affected by bypass resistance.
A
Trimethoprim
11
Q
What is a fungal eye infection most commonly found to be?
A
Candida endopthalmitis
12
Q
How would you treat Candida spp. infections not caused by Candida albicans?
A
Echinocandin
13
Q
Which Cryptococcus species infects immunocompetent hosts?
A
Cryptococcus gattii
14
Q
Which Cryptococcus species infects immunosuppressed hosts?
A
Cryptococcus neoformans
15
Q
A patient with pneumonia has a CXR, which shows a bat wing appearance. What is the most likely causative organism?
A
Pneumocystis jirovecii
16
Q
How is Hepatitis C treated?
A
Interferon
Ribavarin
17
Q
How are infected prosthetic joints managed?
A
Removal and debridement before Abx
18
Q
A patient returns from a city break in Bangkok complaining of a new, sunburn like rash, a retro-orbital headache and myalgia. What is the most likely diagnosis?
A
Dengue Fever
19
Q
In which infectious disease are ‘Purple eyelids’ a common feature?
A
Chagas Disease
20
Q
In which infectious disease are ‘Negri Bodies’ seen?
A
Rabies
21
Q
Name two classes of drug which may be used to treat Benign prostatic Hyperplasia.
A
5-alpha reductase inhibitor
Alpha Blocker
22
Q
In which disease might there be a mutation affecting Superoxide Dismutase 1?
A
Motor Neurone Disease
23
Q
How would you manage a Pseudomonas aeruginosa infection?
A
Gentamicin
Ceftazadine
24
Q
Which disease’s severity would be assessed using the Breslow Score?
A
Melanoma
25
Which organism is the most common cause of bronchopneumonia?
Haemophilus influenzae
26
Which organism is the most common cause of CNS infections overall?
Coxsackie virus
27
Which organism most commonly causes lung disease in patients with Cystic Fibrosis?
Pseudomonas aeruginosa
28
Which tapeworm species is found in pigs?
Taenia solium
29
Which tapeworm species is found in cows?
Taenia saginata
30
Which type of worm's life cycle involves migrating from the skin to the bowel, laying eggs, hatching as rhabitiform larvae and maturing into filariform larvae?
Strongyloide (Pinworm), type of Nematode (soil-based)
31
Which type of worm's life cycle involves being eaten, living in the intestines, forming a cyst and the cyst releasing a tapeworm, which grows and releases more eggs?
Cestodes (Tapeworm)
32
Which type of worm's life cycle involves cercariae invading the skin after being released by freshwater snails, worms developing in the liver, migrating to the mesenteric venules/venous plexus of bladder, laying eggs which become miricidia and reinfecting freshwater snails?
Trematode (Schistosomiasis)
33
How would you treat strongyloide infection?
Ivermectin
34
Which medication is most widely used for parasitic infection?
Praziquantel
35
The centre of a granuloma being diffuse red indicates what?
Necrosis
| Caseation
36
At what level must skin damage be to leave a scar?
Dermis
37
Where is the dermis in relation to the basement membrane?
Sits below it
38
Which virus is associated with Nasopharyngeal Carcinoma?
EBV
39
Which toxins are associated with Hepatocellular Carcinoma?
Aflatoxins
40
What is the role of stellate cells in the liver?
Vitamin A stores
| Activate to myofibroblasts to lay down collagen
41
What does 'Grade' mean with regards to Chronic Hepatits?
Severity of inflammation
42
What does 'Stage' mean with regards to Chronic Hepatitis?
Severity of Fibrosis
43
What is the most common form of carcinoma that arises from CIN changes?
Squamous Cell Carcinoma
44
In which breast cancer are large, pleomorphic cells seen?
Invasive Ductal
45
In which breast cancer are Indian Files seen?
Invasive Lobular
46
In which breast cancer are Elongated Tubules seen?
Invasive Tubular
47
In which breast cancer are Empty Spaces seen?
Invasive Mucinous
48
What is the most important prognostic factor for Breast Cancer?
Spread to axillary lymph nodes
49
Which stain is used to distinguish Squamous Cell Carcinomas from Adenocarcinomas?
P40
50
In which condition would you see 'Soap Bubble Osteolysis' on x-ray, with 'Chinese Letters and Shepherd's Crook' Signs?
Fibrous Dysplasia
51
In which syndrome would you see polyostotic fibrous dysplasia and rough border Cafe au Lait spots?
McCune Albright Syndrome
52
Which benign bone tumour typically affects teenage boys and occurs at the end of long bones?
Osteochondroma
53
Which benign bone tumour occurs in hands and feet and shows 'popcorn calcification' on x ray?
Enchondroma
54
Which benign bone tumour mainly affects young women and occurs at the epiphyses of long bones? On histology, there are osteoclasts on a background of spindle/ovoid cells.
Giant Cell tumour
55
What is the most common bone sarcoma?
Osteosarcoma
56
Which malignant bone tumour shows 'Codman's Triangle and a sunburst appearance' on x-ray and malignant mesenchymal cells on histology?
Osteosarcoma
57
Which malignant bone tumour produces cartilage, and on histology shows 'Malignant chondrocytes with or without chondroid matrix'?
Chondrosarcoma
58
Which malignant bone tumour shows 'onion skinning of the periosteum' on x-ray, and 'sheets of small round cells' on histology?
Ewing's Sarcoma
59
Which tumour is associated with t(11;22)(q24;q12)?
Ewing's Sarcoma
60
How are cytopathological samples of Breast cancers graded?
C1-5
1: Inadequate
2: benign
3: Atypia, probably benign
4: Atypia, probably malignant
5: malignant
61
Which disease shows proteinaceous material and neutrophils on cytology, and duct distension with proteinaceous material and 'foamy macrophages' on histology?
Duct Ectasia
62
Which breast disease shows neutrophils on cytology, and is usually caused by Staphylococcus aureus?
Acute Mastitis
63
Which breast disease shows 'fat cells surrounded by macrophages' on cytology?
Fat Necrosis
64
Which breast disease shows 'dilated, calcified ducts' on histology.
Fibrocystic Disease
65
Which breast disease shows 'glandular and stromal cells' on histology, and presents as a mobile, well circumscribed lump?
Fibroadenoma
66
Which breast condition shows 'overlapping cells' on histology, and is benign? It is sometimes described as having a 'leaf-like' appearance.
Phyllode's Tumour
67
Which benign breast tumour may present with bloody nipple discharge?
Central Intraductal Papilloma
68
Which breast condition shows:
Cytology: Clusters of cells
Histology: Dilated ducts, polypoid mass in the middle
?
Intraductal Papilloma
69
Which breast condition may show 'a central stellate area' and a 'proliferation of ducts and acini' on histology?
Radial Scar
70
List 3 types of proliferative breast disease.
Usual Epithelial Hyperplasia
Flat Epithelial Atypia/Ductal Carcinoma
In situ lobular neoplasia
71
Which breast condition shows 'cribiform, punched out;' appearance on histology, with compact lumens, calcification and overlapping cells?
Low grade Ductal carcinoma in situ
72
Which breast condition shows a 'central lumen of necrotic tissue' with large cells, pleiomorphic cells which occlude a duct, and few lumens?
High grade ductal carcinoma in situ
73
Which breast cancer shows 'pleiomorphic cells with large nuclei' on histology and is E-cadherin +ve?
Invasive Ductal Carcinoma
74
Which breast cancer shows a 'linear, Indian File pattern' on histology, with a monomorphic appearance?
Invasive Lobular Carcinoma
75
Which breast cancer shows 'elongated tubules invading the stroma' on histology?
Invasive tubular carcinoma
76
Which breast cancer shows 'empty spaces with lots of mucin' on histology?
Invasive mucinous carcinoma
77
Which breast cancer shows 'sheets of markedly atypical cells, with prominent lymphocytic infiltrates and central necrosis' on histology?
Basal-Like Carcinoma
78
Which gene mutation is a poor prognostic indicator for breast cancer?
Her2
79
Which gene mutation is a good prognostic indicator for breast cancer?
ER/PR
80
In which thyroid condition might you see calcifications (psammoma bodies) and clear nuclei (Orphan's Annie Eyes)?
Papillary Thyroid Cancer
81
In which thyroid condition might you see amyloid deposition with Congo Red staining, and why?
Medullary Carcinoma
| Calcitonin breaks down to Amyloid
82
What effect does PTH have?
1-alpha Hydroxylase activation
Osteoclast activation
Renal calcium resorption
Renal potassium excretion
83
What is secreted in the Zona Glomerulosa?
Aldosterone
84
What is secreted in the Zona Fasciculata?
Glucocorticoids
85
What is secreted in the Zona Reticularis?
Androgens & Glucocorticoids
86
What is secreted in the Zona Medulla?
Noradrenaline
| Adrenaline
87
What is Waterhouse Friederichson Syndrome?
Haemorrhage into adrenals due to septic DIC = acute adrenal insufficiency
88
Non-infective endocarditis caused by SLE?
Libman-Sacks Endocarditis
89
Which vasculitis characteristically shows a 'rosary beads' appearance on angiogram due to multiple aneurysms?
Polyarteritis Nodosa
90
What is c-ANCA directed against?
Proteinase 3
91
What is p-ANCA directed against?
Myeloperoxidase
92
Which vasculitis shows 'narrowing of the lumen and lymphocytic infiltration of the tunica media' on biopsy?
Temporal Arteritis
93
Which staging system is used for Cervical Cancer?
FIGO
94
Name one mutation that is associated with Type I endometrial carcinoma.
PTEN
95
Which mutation is associated with serous endometrial carcinoma?
p53
96
Which cancer is most strongly associated with endometriosis?
Ovarian clear cell carcinoma
97
How does an artheroma form?
Endothelial Injury -> LDL Aggregation
Monocyte Adhesion
Monocyte migration into intima
Platelet Adhesion
Lipid Accumulation
98
What does MI histology show in the first 6 hours?
Normal
99
What does MI histology show between 6-24 hours?
Coagulative Necrosis
Loss of Nuclei
Striations
100
What does MI histology show 1-4 days?
Infiltration of neutrophils & macrophages
101
What does MI histology show 5-10 days?
Macrophages
102
What does MI histology show 10-14 days?
Granulation, Angiogenesis, Collagen Synthesis
| Myofibroblasts, Macrophages, Angioblasts
103
What is the most common cause of aortic stenosis?
Calcification
104
Which disease in children shows 'effacement of foot processes' on electron microscopy?
Minimal Change Disease
105
Which renal disease shows 'partially scarred glomeruli' and 'thickened GBM'?
Focal Segmental Glomerulosclerosis
106
Which renal disease shows immune deposits on the outside of the glomerular basement membrane and thickening of the BM?
Membranous Glomerulonephritis
107
Which antibody is associated with membranous glomerulonephritis?
Anti-phospholipase A2 type M receptor
108
How is Alport's Syndrome inherited, and what does the mutation affect?
X-linked dominant
| alpha 5 subunit of type iv collagen
109
In which renal condition might you see 'shrunken kidneys with granular cortices' and 'fibrinoid necrosis'?
Hypertensive Nephropathy
110
Poisoning with which chemical may predispose to Calcium Oxalate crystal formation?
Ethylene Glycol
111
In which syndrome might you see Renal Oncocytomas?
Birt-Hogg-Dube Syndrome
112
Which benign renal tumour is epithelial in origin and composed of papules and tubules?
Papillary Adenoma
113
Which benign renal tumour is epithelial in origin and composed of oncocytic cells?
Renal Oncocytoma
114
Which benign renal tumour is mesenchymal in origin and composed of thick walled blood vessels, smooth muscle and fat?
Angiomyolipoma
115
Which malignant renal tumour appears grossly as a 'golden yellow tumour' with 'haemorrhagic areas'?
Clear Cell Carcinoma
116
Which malignant renal tumour is associated with long-term dialysis and appears as a 'fragile, friable, brown tumour'?
Papillary Renal Cell Carcinoma
117
Which malignant kidney tumour appears as a well circumscribed solid brown tumour?
Chromophobe Renal Cell Carcinoma
118
Which renal tumour appears as 'small, round, blue cells' on histology?
Nephroblastoma
119
How is prognosis for Prostatic Adenocarcinoma calculated?
Gleason Score
120
What might it indicate if a lung lobe isn't black on autopsy?
Pneumonia
121
When would you refer a death to the coroner?
```
Unknown COD
Sudden death (<24h in hospital)
Suspicious
Self-Neglect/Suicide
Related to detainment/Medical care
Related to job
```
122
Which antibody is implicated in Bullous Pemphigoid?
Anti-Hemidesmosome, attacking basememnt membrane
123
Where is the site of disease in Pemphigus Vulgaris?
Dermal-epidermal junction
| IgG attacks between keratin layers
124
In which IgG mediated skin condition might the outer layer of the stratum shear off?
Pemphigus follaceous
125
Which skin condition is characterised pathologically by thickened epidermis, parakeratosis layers, disappeared stratum granulosum and Munro's microabscesses?
Psoriasis
126
How does Lichen Planus present:
a) on the wrists/arms
b) in the mouth?
a) Purplish/red rash
| b) White Lines (Wickham Striae)
127
In which condition might you see 'horn cysts', which are areas where the epidermis entraps keratin?
Seborrhoeic Dermatitis
128
What occurs in the immediate phase of asthma?
Mast cell degranulation and effects
129
What occurs in the late phase of asthma?
Tissue damage, mucous production, muscle hypertrophy
130
In which lung condition might you find 'iron-laden macrophages' on histology?
Pulmonary Oedema
| From the heart
131
What are the stages of lobar pneumonia?
Congestion
Red Hepatisation
Grey Hepatisation
Resolution
132
What is the key feature of grey hepatisation in pneumonia?
Intra-alveolar neutrophils
133
What are the stages of fracture repair?
Haematoma
Fibrocartilaginous callus
Mineralisation of callus
Remodelling
134
In which bone disease might you see 'Langerhans-type Giant Cells with horseshoe nuclei'?
TB
135
In which condition might you see a proliferative synovitis, with pannus formation and grimley sokoloff cells on histology?
Rheumatoid Arthritis
136
Which cells are present in MALTomas related to H Pylori?
B Cells
137
Which cells are present in Duodenal Lymphomas?
T Cells
138
What is the most common genetic predisposition to brain tumours?
Neurofibromatosis
139
What is the most common paediatric brain cancer?
Pilocytic Astrocytoma
140
Which brain tumour is cerebellar and well circumscribed on MRI, and shows hairy piloid cells and rosenthal fibres on histology?
Pilocytic Astrocytoma
141
Which mutation is associated with Pilocytic Astrocytoma?
BRAF mutation
142
What is the most common primary brain cancer in adults?
Glioblastoma Multiforme
143
How do astrocytomas progress?
Become Glioblastomas
144
Which brain cancers are associated with IDH1/2 mutations?
Diffuse Astrocytoma
| Oligodendroglioma
145
Which brain cancer displays 'round cells with clear cytoplasm' (fried egg appearance)
Oligodendroglioma
146
Which brain cancer shows 'small blue round cells' and 'Horner-Wright Rosettes'?
Medulloblastoma
147
How is tau spread staged in Alzheimer's?
Braak Staging
148
Which three enzymes are involved in oxidative killing by granulocytes?
NADPH Oxidase
Superoxide Dismutase
Myeloperoxidase
149
Which antigen is found on all T Cells?
CD3
150
Which T Cells play a key role in germinal centre reactions and Plasma Cell class switching?
T Follicular Helper Cells
151
Which T Cells express FoxP3 and CD25?
T Regulatory
152
Which T Cells express CD4 and secrete IFN-y and IL-2
T Helper 1
153
Which chemokines help direct dendritic cells to lymph nodes?
CCL19 CCL21
| ligands for CCR7
154
Which agent used in FMF binds to tubulin in neutrophils?
Colchicine
155
Which HLA is seen in Goodpasture's Syndrome?
HLA DR15
156
Which cytokine plays a key role in development of TH2 cell responses (and hence allergic responses)?
IL-4
157
Which cell type does Azathioprine target?
T
158
Which cell type does Cyclophosphamide target?
B
159
Which cell type does mycophenolate motefil target?
T
160
Which enzyme's activity must be checked before starting Azathioprine?
TPMT
161
Name a JAK inhibitor.
Tofacitinab
162
What does Secukinumab target?
IL-17
163
What does Guselkumab target?
IL-23
164
What does Ustekinumab target?
IL12 IL23
165
What does Abatacept target?
CTLA4-Ig fusion gene
| RA if Anti-tnf alpha ineffective
166
What is the max number of HLA mismatches between a parent and child?
3
167
What is the max number of mismatches between siblings?
3
168
What are the 3 phases of antibody mediated transplant rejection?
1: exposure to antigen
2: B Cell proliferation and maturation
3: Effector = antibodies bind to graft epithelium
169
What are the phases of T cell-mediated graft rejection?
1: Activate alloreactive T Cells
2: Normal T Cell functions vs graft
Effector: T cells tether graft endothelium and attack tubular epithelium.
170
What are the histological features of T-cell mediated graft rejection?
Lymphocytic interstitial infiltration
Ruptured tubular basement membrane
Tubulitis
Macrophages
171
What are the cardinal features of antibody-mediated rejection?
Capillaritis
| Inflammatory cells in the capillaries
172
What is there a deficiency of in Leukocyte Adhesion Deficiency?
CD18
173
Which immunodeficiency may be implicated in a child presenting with recurrent, severe viral infections?
NK Deficiency
174
```
A patient has:
Low/Absent T
Low/Absent NK
Normal/High B
Low Ig
What is the likely cause?
```
X-linked SCID
175
```
A patient has:
Low/Absent T
Low/Absent NK
Low/Absent B
Low Ig
Normal Neutrophils
What is the likely cause?
```
ADA Deficiency
176
```
A patient has:
Low CD4
Normal CD8
Normal B
Low IgG/IgA
What is the likely cuase?
```
Bare Lymphocyte Syndrome II
177
How might you differentiate between IDA and Beta Thalassaemia trait on blood film?
Basophilic Stippling = BT
178
How is anaphylaxis managed?
```
ABC
Mask O2
IM Adrenaline
IV Antihistamine
Nebulised Bronchodilators
IV Corticosteroids
IV Fluids
```
179
What does normal levels of C3/4, but absent CH50/AP50 represent?
Deficiency in common pathway
180
Which Staph is coagulase positive?
Staph aureus
181
Which Staph is coagulase negative?
epidermidis
182
Which bacteria are gram positive bacilli?
```
ABCDL
Actinomyces
Bacillus
Clostridium
Diptheria
Listeria
```
183
Which bacteria are gram negative cocci?
Neisseria spp
| Moraxella
184
Which bacteria are gram negative cocobacilli?
```
Haemophilus
Bordatella
Pseudomonas
Chlamydia
Brucella
```
185
Which antibiotics are considered broad-spectrum?
```
'These meds can cover'
Tazocin
Meropenem
Co-amoxicvlax
Ciprofloxacin
```
186
Which pneumonia cause shows 'glossy colonies' on agar?
Haemophilus influenzae
187
Which cause of pneumonia is cold agglutinin +ve?
Mycoplasma pneumoniae
188
Trophozoite with 4 nuclei, flask-shaped ulcer?
Entamoeba Histolytica
189
Trophozoite with 2 nuclei, pear-shaped ulcer?
Giardia Lamblia
190
What is the mechanism of action of aciclovir and ribavarin?
Nucleoside Analogue
191
Which disease is transmitted by the Tsetse Fly?
Trypanasoma
192
Which disease is transmitted by the Sand Fly?
Lesihmania
193
Which mutation is associated with MAHA and TTP?
ADAMTS13 = VWF cleaving protease deficiency
194
What are the three main causes of MAHA?
Adenocarcinoma
HUS
TTP
195
What effect does Protein C have?
Anti-thrombotic
196
What is the mechanism of action of warfarin?
Vitamin K epoxide reductase inhibitor
197
How is warfarin monitored?
INR
198
How is LMWH monitored in patients with renal failure/extremes of weight?
Anti-Xa assay
199
In which order do factors drop after commencing warfarin?
7, C, 9, 10, 2
200
Which type of patient might benefit most from long term anticoagulation after a DVT?
M>F
| Idiopathic
201
Which factor falls in pregnancy?
S
202
Rank B-Cell NHLs from most to least aggressive.
```
Burkitt's
Mantle
Diffuse large B Cell
Marginal Zone
Small Lymphocytic
Follicular
```
203
Which diagnostic markers are used for Hodgkin's Lymphoma?
CD30
| CD15
204
Which cancer is likely to be present if B Cells expressing CD5 but not CD19 are found in the peripheral blood?
CLL
205
When would you treat CLL?
Progressive disease
Massive splenomegaly
Massive Lymphadenopathy
B Symptoms
206
What might cause psuedopolycythaemia?
Alcohol
Obesity
Diuretics
207
What might cause a polycythaemia with an appropriately high EPO?
Altitude
| Hypoxic Lung Disease
208
What might cause a polycythaemia with an inappropriately high EPO?
Renal Disease
209
Which pharmacological agent might be used in the treatment of polycythaemia vera?
Hydroxycarbimide
210
A patient presents with an isolated mild thrombocythaemia. They regularly suffer from headaches, What is the most likely diagnosis?
Essential thrombocythaemia
211
A man with CML is found to have between 10-19% blasts on blood film. Which stage of disease is he said to be in?
Accelerated Phase
212
A man with CML is found to have over 20% blasts on blood film. Which stage of disease is he said to be in?
Blast Crisis
213
In which group of conditions might you see ringed sideroblasts and bi-lobed neutrophils?
Myelodysplastic Syndromes
214
How might you treat myelodysplastic syndromes?
Allogenic Stem cell Transplant
| Chemo
215
How do people with myelodysplastic syndrome die?
Third each
Infection
Bleeding
Acute Leukaemia
216
What is the most common cause of Aplastic Anaemia?
Idiopathic
217
What might cause congenital Aplastic Anaemia?
Fanconi Anaemia
| Dyskeratosis Congenita
218
What is aplastic anaemia?
Failure of pleuipotent stem cells -> Pancytopaenia
219
What does the bone marrow look like in aplastic anaemia?
Hypocellular
| Fatty
220
What shortens in dyskeratosis congenita?
Telomere
221
When is a red cell transplant indicated?
If >30% blood lost
Hb below 70 peri-operatively
Symptomatically
222
When might you transfuse washed cells?
If patients have severe allergic reactions to blood products
223
What does blood irradiation do?
Destroys donor lymphocytes to prevent GvHD in immunosuppressed people
224
When is fresh frozen plasma indicated?
Massive blood loss (>150ml/min)
DIC with bleeding
Liver disease with PT 1.5x normal
225
A patient develops chills, rigors and fever of 37.8 degrees during a blood transfusion. Your consultant says a reaction has taken place due to the release of cytokines by white cells in blood storage. Which reaction has taken place?
Febrile non-haemolytic transfusion reaction
226
A patient develops a mild itchy rash and a wheeze during a fresh frozen plasma transfusion. What is the likely diagnosis?
Allergic reaction
227
A patient develops pulmonary oedema shortly after undergoing a blood transfusion. What is the most likely diagnosis?
Transfusion-associated circulatory overload
228
A patient develops SOB, low sats and tachycardia 4 hours after undergoing a transfusion. CXR shows pulmonary infiltrates. What is the most likely diagnosis?
Transfusion-associated acute lung injury
229
A patient who regularly undergoes blood transfusions for Beta-Thalassaemia becomes jaundiced and anaemic 2 days after their most recent treatment. They also notice dark urine. What is the most likely diagnosis?
Delayed Haemolytic Transfusion Reaction
230
What is the mechanism behind delayed haemolytic transfusion reactions?
Develop new antibodies vs RBCs (Alloimunisation)
231
What is the prognosis of GVHD?
Mostly fatal
232
What is used as a marker of stem cells?
CD34
233
How does chronic GVHD present?
Similarly to Sjogren's
234
What disease causes HbSC?
Sickle Cell/Haemoglobin C disease, which causes milder sickling than HbSS
235
Which disease might cause anaemia via a glycolytic pathway enzyme deficiency?
Pyruvate Kinase Deficiency
236
In which leukaemia might you see an abundance of promyelocytes with auer rods on blood film?
Acute Promyelocytic Leukaemia
237
How would you conclusively distinguish between acute leukaemias?
Immunophenotyping
238
What is the normal range for potassium?
3.5-5.5 mmol/L
239
What is the normal range for sodium?
135-145 mmol/L
240
What is the normal range for haemoglobin in men?
130-180 g/L
241
What is the normal range for haemoglobin in women?
115-160 g/L
242
What is the normal range for calcium?
2.2-2.6 mmol/L
243
A patient presents with metabolic acidosis, an isolated hypokalaemia and renal stones. What is the likely diagnosis?
Type 1 Renal Tubular Acidosis
244
Which drug, used in chronic management of gout, increases the fractional excretion of uric acid?
Probenecid
245
What causes a raised anion gap metabolic acidosis?
```
GOLDMARK
Glycols
Oxoproline
L-lactate
D-lactate
Methanol
Aspirin
Renal Failure
Ketoacidosis
```
246
What condition describes inadequate function of the proximal renal tubules of the kidney and is associated with glucosuria, hypophosphataemia and hyperuricosuria?
Fanconi Syndrome
247
Which enzyme converts Cholesterol into Cholesterol ester?
ACAT
248
Which agent is best at reducing LDL levels in the blood?
Evolocumab
249
What may cause a gout attack in the knee?
Saturnine Gout - Lead Poisoning
250
Which condition might cause hypocholesterolaemia and orange tonsils in children?
Tangier Disease
251
How might you distinguish between true and pseudo hyponatraemias?
Serum osmolality - should be low
252
Which sign, often seen in hypocalcaemia, involves tapping the facial nerve and visualising ipsilateral contraction of the facial muscles?
Chvostek's Sign
253
What might cause an unexplained metabolic acidosis with both a raised anion gap and osmolar gap?
Glycol, Ethanol, Mannitol, Methanol Poisoning
254
Which enzyme is the rate limiting step in de novo purine synthesis?
PAT
255
Which autosomal recessive disorder leads to an increase in blood plant sterols?
Phytosterolaemia
256
What might cause a normal anion gap metabolic acidosis?
Addisons
Bicarbonate Loss
NaCl infusion
Drugs
257
What might cause a false lymphocytosis to show on FBC?
Presence of reticulocytes
258
What might cause p-wave flattening, hyperacute t waves and a broad QRS in a patient undergoing chemotherapy?
Hyperkalaemia due to tumour lysis syndrome
259
Does haemophilia affect the bleeding time?
No
260
Which blood film finding is caused by paraproteinaemia in MM?
Rouleaux formation
261
What complication are patients with essential thrombocytosis at risk of?
Stroke
262
Which syndrome is characterised by neutropenia, pancreatic dysfunction and short stature?
Shwachmann Diamond Syndrome
263
Which bone marrow failure syndrome is characterised by an isolated failure of red cell production, presenting as a macrocytic anaemia and low reticulocytes?
Diamond-Blackfan Syndrome
264
What is the most sensitive marker for iron deficiency anaemia?
Low Serum Ferritin
265
Which anticoagulant would you use in a patient with DVT and renal failure?
Warfarin
266
Which medication may be used as prophylaxis for tumour lysis syndrome?
Rasburicase
267
Which drug can be used to treat M3 AML (Acute promyeloytic leukaemia)?
All Trans Retinoic Acid
268
Which condition causes progressively falling platelet counts in a patient started on heparin (enoxaparin)?
Heparin induced Thrombocytopaenia
269
Why does tumour lysis syndrome cause hypocalcaemia?
Released phosphate binds free calcium in the serum
270
In which cell type are auer rods seen?
Neutrophil
271
Which oncogene is found in Burkitt's, and is formed by a t(8;14) mutation?
C-MYC
272
Which lobe is most commonly affected in HSV encephalitis?
Temporal
273
Which cancer shows 'oat-shaped cells' on biopsy?
Small cell lung cancer
274
How many stages of CKD are there?
5
275
What do delta cells of the pancreas secrete?
Somatostatin
276
What is Von Hippel Lindau Syndrome?
```
Brain Haemangiomas
Renal Cysts
Neuroendocrine tumours
Clear Cell Tumours
Phaeochromocytomas
```
277
A patient with a recent history of head trauma causing LOC experiences a lucid interval followed by deterioration. Which pathology is this most likely to represent?
Extradural Haemorrhage
278
Which syndrome is characterised by nephritic syndrome, cataracts and sensironeural deafness?
Alport's
279
What is the first line chemotherapy for prostate cancer?
Docetaxel
280
What condition may be present if 'waxy casts' are found in urine?
CKD
281
Kimmelstiel Wilson nodules found in a renal biopsy are associated with what underlying disease?
Diabetes
282
A renal biopsy reads "Thickened basement membrane with spike and dome appearance due to electron dense deposits in the subepithelial layer". What is the most likely diagnosis?
Membranous Glomerulonephritis
283
Name the first line treatments for Wilson's Disease.
Zinc
| Trientine
284
In which gross anatomical section of the pancreas does pancreatic cancer typically occur?
Head
285
What are the most common cancers in the UK in men/women?
Men:
Prostate (most common in men)
Lung
Bowel
Head and Neck
Women:
Breast (most common cancer overall)
Lung
Bowel
Uterus
286
The ECG leads V1 and V2 represent which specific region of the heart?
Septal
287
What might cause AST to be over 3x higher than ALT?
Alcoholic Hepatits
288
What might cause ALT to be in the thousands?
Paracetamol/Toxins
Viruses
Ischaemia
289
What might cause a mildly elevated ALT?
Fatty Liver
290
Which medication might cause hepatic adenomas?
COCP
291
Which condition is associated with the presence of fatty casts in urine?
Nephrotic Syndrome
292
Which protein is defective in Polycystic Kidney Disease?
Polycystein-1
293
What is the name of the criteria used to diagnose rheumatic fever?
Jones'
294
What is the triad seen in carcinoid syndrome?
Bronchoconstriction
Flushing
Diarrhoea
295
The ECG leads II, III and aVF represent which region of the heart?
Inferior
296
An immune response directed against myelin basic protein and proteo-lipoprotein results in what autoimmune condition?
Multiple Sclerosis
297
Which cause of nephrotic syndrome doesn't respond to high dose steroids?
Membranous Glomerulonephritis
298
What condition is the presence of granular ("muddy brown") casts in the urine associated with?
Acute Tubular Necrosis
299
What condition is the presence of epithelial casts in urine associated with?
Acute Tubular Necrosis
300
What is the diagnostic criteria for common variable immunodeficiency?
Decrease in IgG and one of IgA/M
| Lack of antibody response to antigens or immunisation
301
What protein is defective in X linked Severe Combined Immunodeficiency?
Common gamma chain of IL2 receptor
302
Which autoantibody is associated with ITP?
Anti-glycoprotein IIb
303
What gene is defective in Bruton's agammagobulinaemia?
BTK
304
Which cytokine is predominantly responsible for T cell proliferation and survival?
IL-2
305
CD14 is typically a marker of what type of immune cell?
Monocytes/Macrophages
306
What is the likely cause of a rapidly progressive glomerulonephritis and nosebleeds/haemoptysis?
Granulomatosis with Polyangiitis
307
Which organisms are people with chronic granulomatous disease susceptible to?
```
Catalase positive
E Coli
Staph a
Listeria
Klebsiella
Candida
```
308
Which stain is used for Pneumocystis?
Silver/Periodic acid-Schiff
309
Which stains are used for Candida?
Periodic Acid Schiff or Methenamine Silver
310
Which stains are used for Aspergillus?
Methenamine Silver
| PAS
311
What might Q Fever progress to?
Atypical Pneumonia
ARDS
Endocarditis
312
How is Lyme Disease treated?
Doxycycline
313
How is Leishmaniasis treated?
Amphotericin B
314
Antibiotics - what does ceph- indicate?
Cephalosporin
315
ABx - what does -floxacin indicate?
Quinolone
316
Which malaria species causes fevers every 3 days?
Plasmodium malariae
317
Which organism causes Q Fever?
Coxiella Burnetti
318
Which antibiotic is used to treat BV?
Metronidazole
319
Which species causes Lyme Disease?
Borellia Burgdoreffi
320
Rash after fish bite organism?
Mycoplasma marinum
321
What is the gold standard investigation for Leishmaniasis?
Splenic Aspirate
322
The presence of galactomannan in the serum of a septic patient suggests the presence of what organism?
Aspergillus
323
Which organism causes Chancroid?
Haemophilus ducreyi
324
What can you mix toenails with to test for Tinea/Trichophytum presence?
Potassium Hydroxide
325
A sexually active homosexual man received treatment two hours ago for genital primary syphilis. He was given a single of dose of IM benzylpenicillin. He presents to the emergency department reporting he has become unwell, with a fever, headache and muscle aches. He is concerned he is having an allergic reaction. He is pyrexial at 38C and his blood pressure is 98/76.
What syndrome is he suffering from?
Jarisch Herxeimer Syndrome
326
What type of Hypersensitivity is Mixed Essential Cryoglobulinaemia, and which disease is it associated with?
Hepatitis C
| III
327
What is Evan's Syndrome?
Type II HS
| Autoimmune Haemolytic Anaemia + ITP
328
Which antigen is targeted in Autoimune Thrombocytopaenic Purpura?
Glycoprotein IIb/IIIa on Platelets
329
Which antigen is targeted in Pemphigus Vulgaris?
Epidermal Cadherin
330
Which syndrome causes Hepatic Jaundice and is caused by a mutation in the UGT1A1 gene?
Criggler-Najjar Syndrome
331
What is Turcot Syndrome?
Gliobastoma Multiforme
Medulloblastoma
Pineoblastoma
332
What is Li-Fraumeni Syndrome?
Astrocytoma, PNET, Sarcomas, Breast Cancer, Leukaemia
333
Which condition is associated with optic gliomas, neurofibromas and astrocytomas?
Neurofibromatosis Type I
334
Which condition is associated with vestibular schwannomas, meningiomas, ependyomas and astrocytomas?
Neurofibromatosis Type II
335
Which condition is associated with Giant Cell Astrocytomas, Cortical Tubers, Superendymal Nodules and calcifications on CT?
Tubular Sclerosis
336
Which syndrome presents with parkinsonism, dystonia, apraxia and 'alien limbs' phenomenon?
Corticobasal Syndrome
337
Which Parkinson Plus Syndrome presents with early autonomic dysfunction?
Multiple System Atrophy
338
Which Parkinson Plus syndrome is associated with early falls, axial rigidity, akinesia, dysarthria and dysphagia?
Progressive Supranuclear Palsy
339
Which chromosome is Frontotemporal Dementia associated with?
17
340
Which condition describes behavioural changes associated with spherical inclusion bodies found in the cytoplasm on autopsy?
Pick's Disease
341
What is Aphasia?
Language disorder
342
What is Apraxia?
Loss of ability to carry out learned purposeful tasks
343
What is Agnosia?
Loss of ability to recognise objects/people etc
344
Which tumour is ventricular, and associated with hydrocephalus?
Ependyoma
345
Which brain tumour is indolent, and common in children?
Pilocytic Astrocytoma
346
Which brain tumour is soft, gelatinous and calcified?
Oligodendroma
347
Which cause of pneumonia is associated with birds?
Chlamydia psittaci
348
How do you distinguish between GBS and Botulism?
Descending paralysis in botulism
349
Which bacteria is caught through reheated meats, causes diarrhoea and cramps and may cause gas gangrene?
Clostridium perfringens
350
Which bacteria commonly causes infantile diarrhoea?
EPEC
351
Which lysosomal disorder occurs due to a defect in Hexoaminidase A, and leads to lipid accumulation, nervous damage and death at a young age?
Tay-Sachs Disease
352
Which disorder occurs due to a buildup in Gal-1-phosphate, and leads to cataracts, hypoglycaemia, and neonatal conjugated jaundice?
Galactossaemia
353
Which group of disorders (and name 1 example) cause hypoglycaemia, lactic acidosis, hepatomegaly and developmental delay?
Glycogen Storage Disorders
| Von Gierke's
354
Name two examples of aminoacidopathies, which present with mental retardation, blue eyes and fair hair/skin.
Phenylketonuria
| Maple Syrup Disease
355
How does the classical pathway work?
C1 binds to antibody-antigen complex
356
How does the mannose binding pathway work?
MBL binds to microbial cell surface carbohydrates, which stimulates C2/4 of the classical pathway
357
How does the alternate pathway work?
C3 binds straight to the bacterial cell wall
358
Complement: Normal C3, C4, CH50, low AP50?
Factor B Deficiency
359
Complement: Normal C3/C4, Low CH50, normal AP50?
C2/C1q deficiency
360
Complement: Normal C3/C4, Low CH50/AP50?
C9 Deficiency
361
Complement: Low C3/C4, Low CH50, Normal AP50?
SLE
362
Monogenic Autoinflammatory?
FMF
| TRAPS
363
Polygenic Autoinflammatory?
IBD
Osteoarthritis
GCA
Takasayu's
364
Mixed Pattern Diseases?
Ankylosing Spondylitis
Psoriatic Arthritis
Behcet's Syndrome
365
Polygenic Autoimmune Diseases?
```
RA
MG
PA
Graves'
SLE
PBC
Vasculitides
Goodpasture's
```
366
Monogenic Auto-immune Disease?
APS-1
APECED
IPEX
ALPS
367
What do you do to assess allergies if a patient cannot stop anti-histamines or has a history of anaphylaxis?
RAST testing
368
What are component resolved diagnostics?
Assessment of individual allergen, eg. peanuts have 5 allergens in, this would assess just one of the compounds
369
Which antibody is implicated in Autoimmune Haemolytic Anaemia?
Anti-Rh Blood group Antigen
370
Why doesn't vaccination work properly in the elderly?
Immune Senescence
| Nutrition
371
Which cells may have potential to be utilised as cancer vaccines?
Dendritic Cells
372
For which diseases might you use Interferon Alpha?
Hep B/C
| CML
373
For which disease might you use Interferon Beta?
Behcet's
374
How does cyclophosphamide work?
Alkylates guanine in B cells, preventing replication. Used for vasculitides.
375
How does Azathioprine work?
Antimetabolite T>B cells. Prevents cell replication
376
How does Methotrexate work?
Anti-folate = anti-proliferation.
377
How does Mycophenolate Motefil work?
Anti Metabolite T>B
| Used in transplantation prophylaxis
378
How do Tacrolimus/Cyclosporin work?
Calcineurin Inhibition = no cell signalling.
T
Rejection prophylaxis
379
What does Sirolimus target?
IL-2
| Transplant
380
What does Basiliximab target?
CD-25
| Transplant
381
What does Natalizumab target?
Anti-alpha4 integrin
| MS
382
What does Tocilizumab Target?
IL-6
383
How does transplantation affect the risk of MI?
20x increase
384
How does transplantation affect the risk of viral associated cancers?
100x increase
385
How does transplantation affect the risk of skin cancer?
20x increase
386
What do T Helper 1 cells do?
Help CD8/Macrophages
387
What do T Helper 2 cells do?
Humoral Response
388
What do T Helper 17 cells do?
Help Neutrophils
389
Give an example of a passive vaccination.
Varicella Zoster Immunoglobulin
390
Which immunohisto stain targets lymphoid cells?
CD45
391
Which immunohisto stain targets epithelial cells?
Cytokeratin
392
Which cells form the fibrous cap in the process of artherosclerosis?
Vascular smooth muscle
393
Which condition shows 'myocyte loss with fibrofatty replacement typically affecting the right ventricle'?
Arrhythmogenic Right Ventricular Cardiomyopathy
394
Why does Rheumatic Fever occur?
Antigenic Mimicry
395
What are Jones' major Criteria for Rheumatic Fever?
```
Carditis
Arthritis
Sydenham's Chorea
Erythema Marginatum
Subcutaneous Nodules
```
396
A middle-aged woman presents with shortness of breath and chest pains. O/E she has a mid systolic click with a late systolic murmur. What is the most likely diagnosis?
Mitral Valve Prolapse
397
What is the most common cause of Aortic Stenosis?
Calcification
398
What is the most common cause of Mitral Stenosis?
Rheumatic Fever
399
In which condition might you see 'Smiling Face' cells with 'fish mouths'?
Hereditary Stomatocytosis
400
Which type of anaemia is commonly seen in Sideroblastic Anaemia?
Microcytic
401
What causes anaemia of chronic disease?
Cytokine driven inhibition of red cell production, with increased ferritin.
402
What causes anaemia of chronic disease in renal failure?
EPO Deficiency
403
When is TIBC raised?
Pregnancy
| Iron Deficiency Anaemia
404
How is transferrin saturation calculated, and what can it indicate?
Iron/TIBC
| <20% may indicate IDA
405
What does the combination of pancytopaenia and splenomegaly imply?
Myelofibrosis
406
Which leukaemia most commonly causes pancytopaenias?
Hairy Cell
407
What is the key feature of extravascular haemolytic anaemia?
Splenomegaly
408
Which complication commonly occurs in Hereditary Spherocytosis?
Gallstones
409
Name one serious complication of Hereditary Elliptocytosis.
Hydrops Foetalis
410
What can precipitate an acute G6PD attack, presenting with jaundice, anaemia and heinz bodies and bite cells on blood film?
Drugs
| Broad Beans
411
In which condition are target cells commonly seen?
Sickle Cell Disease
412
How are the types of vWD characterised?
1: Low
2: Dysfunctional
3: Absent
413
What is Factor V Leiden?
Resistance to Protein C = Thrombosis
414
What would be the target INR for a patient after their first DVT/PE?
2.5
415
What would be the target INR for a patient after recurrent DVTs?
3.5
416
What do you do if a patient on warfarin presents with an INR of 6?
Withhold doses until below 5
417
Which blood components decrease in pregnancy?
```
Hb
HCT
Plt
Factor XI
Protein S
```
418
How does Binet Staging work?
```
A = <3 lymph nodes
B = >3 lymph nodes
C = Anaemia/Thrombocytopaenia
```
419
Which type of Burkitt's lymphoma affects the jaw?
Endemic
420
Which disease is associated with Mycosis Fungoides?
Cutaneous T-Cell Lymphoma
421
How would you treat Essential Thrombocytopaenia?
Anagrelide
422
How would you distinguish Circulatory Overload from Acute Lung Injury (Post transplant)?
Signs of Cardiac Failure (Raised JVP/PCWP) in acute lung injury
423
A patient presents with skin depigmentation, nodules, trophic ulcers and nerve thickening. What is the likely diagnosis?
Hanson's Disease
| Mycobacterium leprae
424
An immunocompromised patient presents with disseminated TB. What is the most likely diagnosis?
Mycobacterium Avium Intracellulare Complex
425
A man from Australia presents with painless nodules which are beginning to ulcer, scar and contract. What is the most likely diagnosis?
Mycobacterium ulcerans
426
Name a gram negative cocci that can cause typical Pneumonia.
Moraxella cattarrhalis
427
Which bacteria are included in the HACEK group?
```
Haemophilus
Acinetobacter
Cardiobacterium
Eikinella
Kingella
```
428
What is the most likely cause of secretory diarrhoea in an under 6 year old?
Rotavirus
429
How many copies of an organism must be present in urine to diagnose a UTI?
>10^4/ml
430
What is the most common cause of infection in a prosthetic joint?
Coagulase negative Staph ie. epidermidis
431
How would a brain abscess present?
Signs of SOL
| Swinging fevers
432
How is Chlamydia diagnosed?
NAAT from urethral swab
433
What is Lympho-Granuloma Venereum?
Chlamydia infecting lymph nodes
434
What can cause painful inguinal buboes and genital elephantosis?
Lympho-Granuloma Venereum
435
What is the role of Haemagglutinin in Influenza?
Viral Entry
436
What is the role of Neuraminidase in Influenza?
Cleaves sialic acid for exit of infected cells
437
What is the third line treatment for CMV?
Cidofovir
438
Which antivirals can be used for Hep C?
N33/4 Protease Inhibitors
439
Which virus causes Measles?
Morbillivirus
440
A man who drank some untreated milk presents with an undulant fever that peaks in the evening. What is the most likely diagnosis?
Brucellosis
441
A patient presents with a fever and conjunctival haemorrhages a day after going swimming in a river. What is the most likely diagnosis?
Leptospirosis
| L.interrogans
442
A man presents with painless round black lesions with a rim of oedema, and a mediastinal haemorrhage. What is the most likely diagnosis?
Anthrax
443
Which type of drug is Amphotericin?
Polyene
444
Which gene is mostly implicated in CJD?
129 codon MM
445
What are the different types of Renal Tubular Acidosis?
```
1 = Can't excrete H+
2 = Can't reabsorb bicarbonate
4 = Resistant to aldosterone
```
446
What are the key features of hypokalaemia?
Muscle Weakness
Cardiac Arrhythmias
Polyuria
Polydipsia
447
What can cause a sine wave on ECG?
Severe Hyperkalaemia
448
Why is ALP normal in Myeloma?
Plasma Cells suppress osteoblasts
449
When is Urobilinogen raised?
Pre-Hepatic Jaundice
450
Which porphyria presents with urine colour change (Port Wine) with abdominal pain?
Acute Intermittent Porphyria
451
Which porphyria presents with both neurovisceral and cutaneous lesions?
Variegate
| HCP
452
What is the deficiency causing Acute Intermittent Porphyria?
HMB Synthase
453
What do skin lesions look like in porphyrias?
Blisters on the back of hands that worsen in the sun.
454
What size does a tumour have to be to be considered a macroprolactinoma?
>10mm
455
What is the mainstay of management for Acromegaly?
Transphenoidal Surgery
456
Which Thyroid Disease might display 'Hurthle Cells'?
Hashimoto's Thyroiditis
457
What is the most likely diagnosis if a patient has a 'stony hard thyroid'?
Riedel's Thyroiditis
458
Which tumours are seen in MEN1?
Pituitary Adenoma
Parathyroid Hyperplasia
Pancreatic Neuroendocrine Tumours
459
Which tumours are seen in MEN2a?
Parathyroid Hyperplasia
Phaeochromocytoma
Medullary Thyroid Carcinoma
460
Which tumours are seen in MEN2b?
Phaeochromocytoma
Medullary Thyroid Carcinoma
Neuromas
'Marfinoid'
461
A patient with AF presents with confusion and states they are 'seeing yellow'. What is the likely diagnosis?
Digoxin Toxicity
462
What is the most common radiolucent cause of nephrolithiasis?
Uric Acid
463
What is the most specific enzyme for Acute Pancreatitis?
Lipase
464
Which enzyme is raised in Duchenne's?
Creatine Kinase
465
How long does Troponin remain raised for after an MI?
Up to 10 days
466
Which vitamins are commonly deficient in patients with malabsorption syndromes?
Fat soluble (ADEK)
467
What causes Farmer's Lung?
Saccharopolyspora rectivirgula
468
What causes Pigeon fancier's lung?
Proteins in excreta/feathers
469
What is the most common cause of IDA in developing countries?
Hookworm
470
What is hereditary Pyropikilocytosis?
AR condition where erythrocytes are abnormally sensitive to lysis by heat
471
What does Hyxroxycarbimide do?
Used in SCD/Myeloproliferative disorders to increase foetal haemoglobin levels
472
In which scenario is transfusion a better treatment for iron deficiency than oral iron?
Sepsis and severe infection, as oral iron won't absorb well.
473
How is Pyridoxine (B6) used as a medication?
It promotes RBC production, can be used in disorders with ineffective erythropoiesis such as Sideroblastic Anaemia
474
What would you see on iron studies of a pregnant lady?
High Iron
High TIBC
Normal Ferritin
475
Which investigation is most likely to provide a definitive diagnosis in a patient with pancytopaenia?
Bone Marrow Biopsy
476
How is B12 deficiency treated?
Hydroxocobalamin
477
When must folic acid replacement not be given?
If the cause of the deficiency is unknown, as this may exacerbate the neuropathy of B12 deficiency
478
Which enzyme might be raised in Haemolytic Anaemias?
Lactate Dehydrogenase
479
When might haptoglobin be low, and why?
Intravascular Haemolytic Anaemia, since it binds free haemoglobin
480
Which enzyme deficiencies might cause a Haemolytic Anaemia?
Glucose-6-Phosphate Dehydrogenase Deficiency
Pyruvate Kinase Deficiency
481
How is G6PD Deficiency inherited?
X-Linked
482
When would you investigate G6PD Deficiency?
2-3m after a crisis with an enzyme assay
483
How is Pyruvate Kinase Deficiency inherited?
Autosomal Recessive
484
How is Sickle Cell Disease inherited?
Autosomal Recessive
485
How is HbA made up?
2x Alpha
| 2x Beta
486
How is HbA2 made up?
2x Alpha
| 2x Gamma
487
How is HbF made up?
2x Alpha
| 2x Delta
488
in which condition might you see a classical 'hairs on end' skull X-Ray?
Beta-Thalassaemia
489
What is Paroxysmal Cold Haemoglobulinaemia?
Hb in the urine caused by a viral infection. Donath-Landsteiner Antibodies stick to Abs in the cold, and complement attacks RBCs as you warm up, leading to haemolysis.
490
How are warm autoimmune haemolytic anaemia and cold agglutinin disease distinguished?
Warm: IgG, Spherocytes
Cold: Raynaud's, IgM
491
How is TTP treated?
Emergency plasma exchange
492
What is the pentad of TTP?
```
MAHA
Fever
Renal Impairment
Neurological Abnormalities
Thrombocytopaenia
```
493
What is paroxysmal nocturnal haemoglobulinuria?
Chronic intravascular haemolysis at night due to complement-mediated lysis. Cause morninghaematuria and thrombosis
494
How do you diagnose Paroxysmal Nocturnal haemoglobulinuria?
Ham's Test
495
What is the difference between Acute and Chronic ITP?
```
Acute = Children, self limiting
Chronic = Adults, long-term
```
496
Which factor is low in vWD?
Factor 8
497
Why might you continue LMWH when starting warfarin?
Warfarin is initially procoagulant due to Protein C/S deficiency
498
What does Heparin potentiate?
Antithrombin III
499
When is Vitamin K indicated?
INR over 5 and bleeding
| INR over 8 and not bleeding
500
When is prothrombin complex concentrate indicated?
Major bleeding
| Intracranial haemorrhage
501
When should Anti-D be given to Rh-ve mothers?
28 weeks
Sensitising Events
At delivery if baby is Rh+ve
502
In which CML phase are there <5% blasts?
Chronic
503
What is the difference between CLL and SLL?
```
SLL = LNs
CLL = BM
```
504
Which NHLs are B Cell Lymphomas?
```
Burkitt's
Mantle Cell
MALT
DLBC
Follicular
```
505
In which lymphoma might you see a 'nodular/follicular appearance'?
Follicular
506
In which lymphoma might you see 'angular/clefted nuclei'?
Mantle Cell
507
Which T Cell lymphoma is most aggressive?
Anaplastic
508
Which agent can be used in the management of T Cell Lymphomas/
Alemtuzumab
509
What is smouldering myeloma?
>10% clonal plasma cells, but no CRAB symptoms
510
How are AML and myelodysplastic syndromes distinguished?
<20% blasts in Myelodysplastic syndromes
511
What are Pelger-Huet Cells?
Right shifted hyposegmented neutrophils seen in MDS
512
What is Dyskeratosis Congenita?
X-Linked Aplastic Anaemia
| Triad of skin pigmentation, nail dystrophy and oral leukoplakia
513
What causes Psuedopolycythaemia?
Normal Hb, reduced plasma volume, often due to burns, dehydration and diarrhoea
514
Which conditions are associated with Massive Splenomegaly?
Myelofibrosis
| CML
515
What is Essential Thrombocytosis?
MPD where megakaryocytes dominate the bone marroow
516
What might increase the risk of a patient experiencing anaphylaxis due to a transfusion?
IgA Deficiency
517
What mediates ABO incompatiblity?
IgM
518
What is a Gohn Focus?
Primary latent TB lesion
519
What does BCG stand for?
Bacille-Calmette-Guerin
520
Name a gram negative rod that causes typical pneumonia.
Klebsiella pneumoniae
521
Name a gram +ve diplococci that causes pneumonia
Streptococcus pneumoniae
522
Name a gram -ve cocco-bacilli that causes typical pneumonia.
Haemophilus influenzae
523
Name a gram +ve cocci that grows in 'grape-bunch clusters' that causes pneumonia.
Staphylococcus aureus
524
What is the CURB 65 score?
```
Pneumonia Severity
Confusion
Urea >7
RR >30
BP <90/60
>65yo
```
525
What is more likely to be seen in subacute than acute IE?
Signs O/E such as Osler's Nodes, Roth spots, janeway lesions and splinter haemorrhages
526
What are the major criteria of the Duke's Score?
New Murmur
| 2x blood cultures
527
What might cause cellulitis in shellfish handlers?
Vibrio vulnificus
528
Which antibiotics most commonly cause pseudomembranous colitis?
Ciprofloxacin
Cephalosporins
Clindamycin
529
What is secondary syphylis?
Rash and genital warts 1-6m after infection
530
What is tertiary syphylis?
2-3y after infection
Granulomas
Dementia
Cardiac Disease
531
How is syphylis investigated?
Dark-ground microscopy
532
What causes beefy red ulcers and donovan bodies?
Donovanosis (Granuloma Inguinale)
533
Which condition is associated with a whiff test and clue cells?
BV
534
What causes Molluscum Contagiousm?
Poxvirus
535
Which antibiotic classes target Cell Walls?
Beta Lactams
| Glycopeptides
536
Which antibiotic classes target protein synthesis?
```
Aminoglycosides
Tetracyclines
Macrolides
Chloramphenicol
Oxazolidinones
```
537
Which antibiotic classes target DNA synthesis?
Fluoroquinolones
| Nitroimidazoles
538
Which antibiotics target RNSA Synthesis?
Rifamycin
539
Which antibiotics are cell membrane toxins?
Polymyxin
| Cyclic Lipopeptides
540
Which Antibiotics target folate metabolism?
Sulfonamides
| Diaminopyrimidines
541
What are the BEAT mechanisms of antibiotic resistance?
```
Bypass antibiotic-sensitive step (MRSA)
Enzyme-mediated inactivation (Beta Lactamase)
Accumulation impairment (Tetracycline)
Target Modification (Quinolone)
```
542
What causes Kaposi's Sarcoma?
HHV8
543
Which viruses aren't dsDNA viruses?
Hepatitis
MMR
Parvovirus B19
544
Which hepatitis is always a coinfection?
Hep D
| with B
545
Which Hepatitis is usually a self-limiting, mild infeciton, but may cause severe disease in pregnancy?
Hepatitis A
546
Which virus, when caught antenatally, may lead to severe congenital microcephaly and skull deformities?
Zika
547
Which antibodies are positive in Hep B vaccination?
Anti-HBs
548
Which antibodies are present in previous Hep B infection?
Anti-HBs
| Anti-HBc
549
Which antibodies are present in chronic Hep B infection?
HBsAg
| Anti-HBc
550
How is Dengue spread?
Flavivirus by Aedes Mosquito
551
Which disease might cause dry gangrene, swollen lymph nodes and is spread by fleas?
Plague (Yersinia Pestis)
552
Which disease causes disfiguirng dermal disease in a malnourished child?
Visceral Lesihamania (Kala Azar)
553
What does a high Osmolar gap imply?
Unmeasured solutes in the serum (toxins etc)
554
What does ALP stand for?
Alkaline Phosphatase
555
What does AST stand for?
Aspartate Aminotransferase
556
What does ALT stand for?
Alanine Aminotransferase
557
Which LFT result is characteristic of Alcoholic Liver Disease?
2:1 AST:ALT
558
Which LFT result is characteristic of Viral hepatitis?
1:1 AST:ALT
559
Which LFT result is characteristic of Chronic Liver Disease?
ALT>AST
560
What might cause a urea 10x higher than usual?
Upper GI Bleed
| AKI (urea secreted renally)
561
When are pale stools/dark urine seen?
Post-hepatic jaundice
562
What stimulates ACTH release?
CRH
563
Which hormones are given in a combined pituitary test?
```
Insulin
TRH
LHRH
Normal = Adequate increase in related hormones.
Abnormal = Hypopituitarism
```
564
In which condition might you have a raised Aldosterone:Renin ratio?
Conn's
565
What is activated vitamin D called?
Calcitriol
566
What are the types of activated vitamin D used as medication?
Ergocalciferol (Plants, C2)
| Cholecalciferol (Animals, C3)
567
Which form of Vitamin D is stored and measured?
25-hydroxy-cholecalciferol
Inactive
Liver
568
When might ALP be pathologically less than 5x higher than normal?
Bone Tumours
569
PPV vs Sensitivity
```
PPV = probability it's a true positive
Sensitivity = Probability someone with the disease will.test positive
```
570
NPV vs Specificty
```
NNV = Probability it's a true negative
Specificity = Probability someone without the disease will correctly test negative
```
571
Normal GFR?
120ml/hr
572
What is Wiskott-Aldrich Syndrome?
Eczema
High IgA/IgE
Low IgM
WAS gene mutation
573
What does IPEX (FoxP3) stand for?
Immune dysregulation, polyendocrinopathy, enteropathy
574
What does APS 1 (AIRE) stand for?
Auto-immune polyendocrine syndrome type 1
575
What does APECED (AIRE) stand for?
Auto-immune polyendocrinopathy candidiasis ectodermal dystrophy syndrome
576
What does ALPS (FAS) stand for?
Auto-Immune Lymphoproliferative Syndrome
577
What happens in APECED/APS1?
Abnormality in T Cell tolerance = multiple autoimmune diseases
578
What happens in ALPS?
Abnormality in lymphocyte apoptosis = High WCC and lymphomas
579
What happens in IPEX?
Abnormality in T Regulatory Cells leads to diarrhoea, dermatitis and dementia
580
Name two genetic polymorphisms associated with polygenic auto-immune diseases.
```
PTPN22 = RA, SLE, T1DM
CTLA4 = SLE/T1DM/Autoimmune Thyroiditis
```
581
Which HLA is associated with Pernicious Anaemia and Hashimoto's Thyroiditis?
DR5
582
Which HLA is associated with Haemochromatosis?
A3
583
What is serum sickness?
Reaction to proteins in penicillin
| T3HS
584
Which hypersensitivity type is Chronic urticaria?
Type 2
585
Which antibody is associated with mixed connective tissue diseases?
Anti-U1RNP (speckled pattern)
586
What does Anti-jo1 target?
t-RNA synthetase
587
What is direct transplant recognition?
Donor APC presents antigen to recipient T Cells
588
What is indirect transplant recognition?
Recipient APCs present antigens to recipient t Cells
589
What would a typical HAART regimen be?
2x NRTI + PI
590
What is injected in the mantoux test?
Tuberculin
591
What size induration indicates a positive mantoux test?
10mm
592
How many Duke's minor criteria are needed for diagnosis?
5
| or 3 if one major
593
Which histological pattern is required for diagnosis of Cryptogenic Fibrosing Alveolitis/Idiopathic Pulmonary Fibrosis?
Usual Interstitial Pneumonia (sub-plural honeycomb change in periphery)
594
What is Extrinsic Allergic Alveolitis?
Inhaled organic antigens leading to immune-mediated alveolar inflammation
Polypoid Plugs of loose connective tissue
595
What are found in both Juvenile Polyposis and Peutz-Jegher's Synrome?
Hamartomatous Polyps of the Bowel (Non-neoplastic)
596
What is Gardner's Syndrome?
Familial Adenomatous Polyps (APC AD) with extra-GI features (Dental caries, osteomas)
597
What is Lynch Syndrome/HNPCC?
Carcinomas in right colon, associated with gynae cancers
598
What stimulates pancreatic exocrine function?
Secretin
| CCK
599
What is metabolic syndrome?
```
Hyperglycaemia
HTN
Obesity
Dyslipidaemia
Microalbuminaemia
```
600
What is Acinar Cell Carcinoma?
Cancer of exocrine cells of pancreas
| Positive for lipase, trypsin and chymotrypsin
601
What are the zones of a liver lobule?
```
1 = periportal hepatocytes
2 = mid
3 = Perivenular Hepatocytes (liver enzymes)
```
602
When might you see spotty necrosis?
Acute Hepatitis
603
When might you see 'Piecemeal Necrosis'?
Chronic hepatitis
604
What is the critical histological stage linking chronic hepatitis to cirrhosis?
Bridging from portal vein to central vein
605
Describe the histopathology of a cirrhotic liver.
Hepatocyte Necrosis
Fibrosis
Nodules of regenerating Hepatocytes
Disturbance of vascular architecture
606
How is prognosis calculated in cirrhosis?
Modified Child's Pugh Score
607
What are the factors assessed in the Modified Child Pugh Score?
```
Albumin
Bilirubin
Clotting
Distension
Encepalopathy
```
608
How is cirrhosis classified?
```
Micronodular = <3mm = Alcohol/Bile
Macronodular = >3mm = Viral/Wilson's/A1At
```
609
Which form of NAFLD sis benign and shows mild fatty infiltration?
Simple Steatosis
610
Which form of NAFLD shows Steatosis and Hepatitis?
NASH
611
Which antibodies are associated with Autoimmune Hepatitis?
ANA/Anti-SM
| Anti-LKM
612
Which biliary disease shows 'Onion-Skinning fibrosis'?
PSC
613
How is HCC monitored?
Alpha-fetoprotein
614
Which stain is used for Alpha-1-antitrypsin deficiency?
Periodic Acid Schiff
615
Which procedure may be used to treat Benign Prostatic Hyperplasia?
TURP
616
Which testicular tumours don't arise from Germ Cells?
```
Sertoli cell (Sex Cord)
Leydig Cell (Stroma)
```
617
Which Renal Cancers have:
a) Nests of epithelium
b) Papillary/Tubulopapillary growth
c) Sheets of large cells with distinct border?
a) Clear Cell
b) Papillary
c) Chromophobe
618
Which tumour of the bladder has frond-like growths projecting from the bladder wall which are lined by epithelium?
Non-Invasive Papillary Transitional cell carcinoma
619
Which bladder cancer has the most invasive behaviour?
Invasive Urothelial Transitional Cell carcinoma
620
What is benign familial haematuria?
Thin basement membrane disease = TypeIV collagen, asymptomatic haematuria
621
What does loss of podocyte foot processes indicate?
Nephrotic Syndrome
622
What causes Nephrotic Syndrome?
```
Primary = FSGS, MG, MCD
Secondary = Diabetes, Amyloidosis
```
623
What causes Nephritic Syndrome?
```
Post-Strep
IgA Nephropathy
Rapidly Progressive (Crescentic)
Alport's Syndrome
Thin basement Membrane Disease
```
624
What might cause Rapidly Progressive Glomerulonephriritis?
Goodpastures
Immune complex (SLE, Alport's)
ANCA (Polyangiitis)
625
Which cause of nephritic syndome shows linear deposition of IgG in the glomerular basement membrane?
Goodpasture's
626
Which cause of nephritic syndromes shows 'granular IgG deposition'?
Immune-Complex mediated
627
which cause of nephritic syndrome shows 'a lack of immune complex deposition'?
Polyangitides
628
What might cause asymptomatic haematuria?
Thin basement membrane disease
IgA Nephropathy
Alport Syndrome
629
Which IG is deposited in post-strep glomerulonephritis?
IgG
630
A man presents with a fever, rash, haematuria and proteinuira/ He is found to have an eosinophila, and a renal biopsy shows inflammatory infiltrate with tubular injury and granulomas. He recently started a course of NSAIDs. What is the most likely diagnosis?
Acute Interstitial Nephritis
631
What is the triad of HUS?
MAHA
Thrombocytopaenia
Renal Failure
632
Why might you get a murmur in Polycystic Kidney Disease?
Mitral Valve Prolapse
633
In which condition might you see 'wire-loop capillaries' and 'lumpy bumpy granular deposition in the GBM' on a renal biopsy?
Lupus Nephritis
634
In which cancers might you see Psammoma Bodies?
Papillary Thyroid
| Serous Cystadenoma
635
Which cell type is seen in serous cystadenomas?
Columnar Epithelium
636
Which morphology is seen in endometroid ovarian cancer?
Tubular Glands
637
Which cancer has a 'hobnail appearance'?
Clear Cell Ovarian
638
Which ovarian cancers secrete B-HCG?
Choriocarcinoma
639
Which tumour is associated with Meig's Syndrome?
Fibroma
640
Which ovarian cancer produces Oestrogen?
Granulosa-Theca Cell tumour
641
Which ovarian cancer secretes androgens?
Sertoli-Leydig Cell
642
How is FIGO staging done?
```
1 = Ovaries
2= Pelvis
3 = Abdomen
4 = Distant
```
643
How does CIN staging work?
```
1 = lower 1/3 epithelium
2 = Lower 2/3
3 = Full thickness
```
644
How is Lobular carcinoma in situ identified?
Incidentally on Biopsy
645
What are the forms of breast carcinoma in situ?
Lobular
| Ductal (microcalcification of mammogram)
646
On breast biopsy, you see ducts filled with atypical epithelial cells. What is the likely diagnosis?
Carcinoma in situ
647
Which medication targets HER2 in breast cancer?
Herceptin
648
Which medication targets ER in breast cancer?
Tamoxifen
649
Which breast cancer is associated with BRCA?
Basal-Like carcinoma
650
Which territory is most likely occluded if a stroke presents with contralateral leg paresis?
ACA
651
Which territory is most likely occluded if a stroke presents with contralateral weakness of face and arm?
MCA
652
Which territory is most likely occluded if a stroke presents with contralateral hemianopia/quadrantanopia?
PCA
653
Which territory is most likely occluded if a stroke presents with ipsilateral ataxia and horner's?
PICA
654
How does Lewy Body Dementia (ASyn) present?
Parkinsonism, fluctuations in cognitive ability and hallucinations
655
What is the main component of Lewy Bodies?
Alpha-Synuclein
656
Which proteins are targeted in Multiple Sclerosis?
Myelin Basic protein
| Proteo-Lipid protein
657
XR features of osteoporosis?
None
658
Crystal colours to polarised parallel light?
```
Gout = Yellow
Pseudogout = Blue
```
659
In which condition are 'Brown Tumours' seen?
Primary Hyperparathyroidism
660
What causes osteomyelitis in SCD patients?
Salmonella spp
661
What causes osteomyelitis in children?
Haemophilus influenzae
| Group B strep
662
How does osteomyelitis present?
Fever, malaise, pain, swelling and tenderness
663
In which condition might you see Heberden's Nodes and Bouchard's Nodes?
Osteoarthritis
664
What are the x-ray features of Osteoarthritis?
```
LOSS
Loss of joint space
Osteophytes
Subchondral Sclerosis
Subchondral Cysts
```
665
Which joints are spared in Rheumatoid Arthritis?
Distal Interphalanegal Joints
666
Which skin condition has 'saw-toothing of rete ridges' on histology?
Lichen Planus
667
Which skin condition is IgA mediated?
Dermatitis Herpetiformis
668
Which skin condition has a 'Buckshot Appearance' on histology?
melanoma
669
What is Bowen's Disease?
Flat, red, scaly patches on sun-exposed areas
670
How does Actinic Keratosis look on histology?
```
SPAIN
Solar elastosis
Parakeratosis
Atypia
Inflammation
Not full thickness
```
671
What does Bowen's Disease progress to?
Squamous Cell Carcinoma
672
Which skin lesions have a 'waxy, stuck on appearance'?
Seborrhoeic Keratosis
673
A patient presents with sheets of skin detachment, with a positive Nikolsky sign. They recently started a new anti-convulsant. What is the most likely diagnosis?
Stevens-Johnson Syndrome
674
How does Pityriasis Rosea present?
Salmon pink rash (herald patch) followed by oval macules in a Christmas Tree formation
675
Which disease is associated with a 'Corkscrew Appearance' on angiogram?
Buerger's Disease
676
What is the triad of Granulomatosis with Polyangiitis?
Saddle Nose
Haemoptysis
Glomerulonephritis
677
Which vasculitis presents with an absent pulse?
Takasayu's Arteritis
678
What can cause AA amyloidosis?
RA (and other autoimmune)
TB
Renal Cell carcinoma
679
Which enzyme might be raised in Sarcoidosis?
ACE
680
Which blood group is universal for fresh frozen plasma?
AB
681
Which tumour is associated with pseudomyxoma peritonei?
Mucinous cystadenoma
682
How does ALUM work?
Promotes B Cell differentiation
683
Which component of COVID does the vaccine target?
Spike Protein
684
Which IL-6 Inhibitor can be used in hypoxic COVID?
Tocilizumab
685
What is zanamivir used for?
Hepatitis A
686
Which broad spectrum antibiotic is typically given in penicillin-allergic patients?
Clarithromycin
