Past papers Flashcards
1
Q
What scan do for bony metastases
A
Technetium bisphsophonate scan
Also see activity where fractures
2
Q
What scan do for meabolically active metastases
A
FDG PET scan
3
Q
Septic arthritis with gram negative intracellular diplococci
A
Neisseria gonorrhoea
Get primary gonorrhoea then a few weeks later get septic arthritis
4
Q
Most common cause of septic monoarthritis in someone aged 19-30
A
Neisseria gonorrhoea
5
Q
Gram negative intracellular diplococci causing meningitis
A
Neisseria meningitidis
6
Q
6 year old with gram negative rods on lumbar puncture
A
Haemophilus influenzae
7
Q
Neonate or premature with gram negative rods on lumbar puncture
A
E coli
Only causes meningitis in neonates and premature babies
8
Q
Gram positive diplococci on blood culture
A
Step pneumoniae
9
Q
Gram positive in clusters
A
Staph aureus
10
Q
Mild fever PUO, cultures come back gram positive cocci
A
Strep viridans
11
Q
What malignancy is lambert eaton associated with
A
Small cell lung cancer
12
Q
Which coagulation factor decreases quickest after warfarin
A
VII
13
Q
What does a normal osmolality with hyponatraemia suggest
A
Pseudohyponatraemia
Caused by hyperlipidaemia or paraproteinaemia
14
Q
What is needed for a true hyponatraemia
A
A low osmolality
15
Q
How to differentiate between causes of hypovolaemic hyponatraemia
A
Look at urinary sodium
- if over 20 then renal cause (drugs, salt losing nephropathy)
- if under 20 diarrhoea etc
16
Q
Hypokalaemia with hypoglycaemia
A
Insulin OD
17
Q
What causes hypokalaemia, hypotension and hypercalciuria
A
Bartter syndrome
Bartter syndrome (BS) is a rare inherited disease characterised by a defect in the thick ascending limb of the loop of Henle, which results in low potassium levels (hypokalemia),[2] increased blood pH (alkalosis), and normal to low blood pressure.
Closely related to Gitelmann’s
Specifically, mutations directly or indirectly involving the Na-K-2Cl cotransporter are key. The Na-K-2Cl cotransporter is involved in electroneutral transport of one sodium, one potassium, and two chloride ions across the apical membrane of the tubule. The basolateral calcium-sensing receptor has the ability to downregulate the activity of this transporter upon activation.
18
Q
Hyperkalaemia with a low aldosterone
A
ACEi
Reduced production of aldosterone
19
Q
What are the types of renal tubular acidosis and their affect on potassium handling
A
Type 1 (distal tubule)- hypokalaemia
Type 2 (proximal tubule)- hypokalaemia
Type 3 (both DCT and PCT)- hypokalaemia
Type 4 (adrenals) - hyperkalaemia
Highest number has hyperK+
Eg of cause of type 4= addisons
20
Q
What is used to differentiate causes of metabolic acidosis
A
Anion gap (NR 10-18)
21
Q
Brittle hair and developmental delay
A
Homocysteinuria
Homocystinuria is a genetic disorder that affects the metabolism of the amino acid methionine
22
Q
Cherry red spot
Developmental delay
Deafness and blindness
A
Fabrys disease (lysosomal disease)
The genetic mutation that causes Fabry disease interferes with the function of an enzyme that processes biomolecules known as sphingolipids, leading to these substances building up in the walls of blood vessels and other organs. It is inherited in an X-linked manner.
23
Q
Encephalopathy- hypotonia, lethargy, poor feeding
Sweet odour and sweaty feet
A
Maple syrup disease
(MSUD- Maple syrup urine disease)
The condition gets its name from the distinctive sweet odor of affected infants’ urine and earwax, particularly prior to diagnosis and during times of acute illness
24
Q
How to tell difference between primary and tertiary hyperparathyroidism
A
Can be very difficult to tell difference biochemically however presence of CKD shows is tertiary
25
If ischaemia causing a hyerkalaemia what is cause of the hyperkalaemia
Can either be due to metabolic acidosis or tissue injury
Tissue injury releases K and metabolic acidosis would cause hyperkalaemia to correct acidosis
If acidosis corrected is tissue injury
26
What does normal base excess show
Whether a resp acidosis or alkalosis is being corrected
If between -2 and 2 is not compensation
27
How is osmolarity calculated
2(Na+K)+ glucose+urea
28
What is rash like in pellagra
Casals necklace- erythematous an dpigmented rash in neklace distribution
Pellagra = niacin deficiency (vit D3)
29
What is ALP in myeloma
Normal
Released by osteoblasts (myeloma stimulates osteoclasts + cancer cells damage BM)
30
How many half lifes does it take for a drug to reach a steady state
4-5
31
What is best measure of confirming a reinfarction a couple days after first MI
CK MB as returns to normal a couple days after
32
What is best measure of MI in terms of sensitivity and specificity
Troponin I
33
What are differences between cold and warm AIHA
Warm
- haemolysis occurs in spleen
- IgG
- occurs at 37C in DAT
Cold
- intravascular peripheral haemolysis
- IgM
- occurs at lower temperatures
34
Causes of warm AIHA
Drugs
CLL
SLE
35
Causes of cold AIHA
Mycoplasma
EBV
36
What are howell-jolly bodies
Nuclear remnants in RBCs
They are normally removed by the spleen. Their presence in red blood cells can indicate either a lack of proper splenic function or asplenia (absence of a spleen). This finding can be associated with certain conditions such as sickle cell disease
37
What is anisocytosis
Variety in size of RBC- seen in IDA, beta thalassaemia, megaloblastic anaemia
38
What are cabot rings and what are they seen in
Looped structures found within RBC
B12 deficiency
39
What is pental for TTP
MAHA
Renal failure
Thrombocytopenia
Fever
Neuro signs
FAT RN
(HUS triad is without first letter (F) and last letter (N))
40
What is definitive test for TTP
ADAMTS13 enzyme assay
Enzyme that cleaves VWF multimeters (which are very sticky)
41
What leukaemia is caused by HTLV-1 infection in japanese women commonly
Adult T-cell leukaemia
42
What presents with centrocytes and centroblasts on histology
Follicular NHL
Good pics on Wikipedia
A centroblast generally refers to an activated B cell that is enlarged (12–18 micrometer) and is rapidly proliferating in the germinal center of a lymphoid follicle.[1] They are specifically located in the dark zone of the germinal center.[2] Centroblasts form from naive B cells being exposed to follicular dendritic cell cytokines
43
What lymphoma is seen in HIV
Diffuse large cell lymphoma
44
What can cause hyposplenism
Trauma
Planned splenectomy
Physiological hyposplenism- coeliac, UC, SCD
FH accompanying celiac disease and inflammatory bowel disease is thought to be caused by excessive loss of lymphocytes through the inflamed enteric mucosa, leading to spleen's reticuloendothelial atrophy
45
Conditions where splenectomy helpful
The PIIES
Thalassaemia
PK deficiency (RBC breakdown faster than normal)
Immune haemolytic anaemia
Idiopathic TTP
Elliptocytosis
Spherocytosis
Spleen is normal place where damaged RBCs are removed ro will worsen anaemia etc in these conditions
46
How does beta thalassaemia trait present
Normally picked up on routine blood test
Have slightly microcytic anaemia
Slightly increased HbA2
47
What is normal proportion of HbA2
1.5-3.5
48
Presentation of beta thalassaemia major
Failure to thrive
Severe microcytic anaemia
Hepatosplenomegaly
Bossing of forehead
Last 2 due to extramedullary haematopoiesis
49
What are donath-landsteiner antibodies seen in
Paroxysmal cold haemoglobinuria
RBCs in urine after a cold
50
How to remember symptoms of paroxysmal nocturnal haemoglobinuria
Pancytopenia
New thrombus
Haemolytic anaemia
Ie PNH
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired,[1] life-threatening disease of the blood characterized by destruction of red blood cells by the complement system, a part of the body's innate immune system.
51
What is most sensitive antibody for pernicious anaemia
Anti-parietal cell
Not anti-IF
52
What are blood findings of haemochromatosis
High ferritin
Low TIBC
High transferrin saturation
High iron
53
Presentation of hereditary haemochromatosis
* the liver (hepatomegaly, deranged LFTs)
* joints (arthralgia, chondrocalcinosis)
* pancreas (diabetes)- bronze diabetes
* heart (dilated cardiomyopathy)
* pituitary gland (hypogonadism and impotence)
* adrenals (adrenal insufficiency)
* skin (slate grey skin pigmentation)
Later in women as menstruation reducing iron monthly
54
Management of TTP
Plasma exchange
(+ corticosteroids)
Plasma exchange removes plasma with dysfunctional ADAMTS13. Replaces it with albumin/donor plasma
ADAMTS13 deficieny is caused by auto-ABs against it (usually form after infection) so exchange removes these ABs too
55
How do packed red cells and FFP transfusions cause thrombocytopenia
They contain very few platelets and have diluting effect on the blood
## Footnote
main FFP content is CFs- FFP is typically used to replace specific blood components in patients with clotting factor deficiencies or to manage coagulopathy e.g. DIC, liver disease
56
Physiologically what causes an increased ESR
Fibrinogen
Acute phase proteins
Immunoglobulins
## Footnote
It measures the rate at which red blood cells settle in a tube of blood over time- all of these make RBCs stick together.
remember ESR marker of inflammation but not very specific.
57
What causes combined polycythaemia
Chronic smoking
Smoking contains CO which displaces O from Haemogoblin causing raised EPO. Furthermore it is a risk factor for COPD which causes polycythaemia too
Presence of COPD shows is combined
## Footnote
combined PC = secondary PC
58
What is difference between splenomegaly and hypersplenism
Splenomegaly is when spleen enlarged- in some cases this can become hypersplenism
Hypersplenism is when get splenomegaly with a reduction in a cell line- ie spleen overractive and removes blood cells from cifculation too fast
59
What is red cell mass
Essentially is a better measure of HCT as HCT can be increased if the patient is dehydrated
## Footnote
Red cell mass refers to the total volume of red blood cells (RBCs) in the body. It is a measure of the total amount of oxygen-carrying capacity available in the bloodstream.
60
What is an absolute versus a relative erythrocytosis
Relative erythrocytosis is caused by dehydration whereas absolute is polycythaemia
Red cell mass proves this
61
What happens to red cell mass in true polycythaemia
Increases
62
What is glanzmanns thrombasthenia
Inherited lack of GlpIIb/IIIa leading to defective platelet aggregration
## Footnote
Glanzmanns and Glp
63
How to differentiate between a reactive neutrophilia and cancer
Luekocyte ALP (LAP)
Low in dyscrasia but normal/high in reactive
## Footnote
In CML, the LAP score is low because the abnormal granulocytes have reduced alkaline phosphatase activity.
64
MOA of bortezomib
Proteosome inhibitor
## Footnote
stops degredation of pro-apoptotic factors. Used in MM
65
How is von wilebrand treated
Desmopressin
## Footnote
management-
tranexamic acid for mild bleeding
desmopressin (DDAVP): raises levels of vWF by inducing release of vWF from Weibel-Palade bodies in endothelial cells
factor VIII concentrate
66
What is most common cause of death in myelodysplastic syndromes
Bacterial infection
67
Increased susceptibility to infection following from diarrhoea
Protein-losing enteropathy
## Footnote
Normally, only a small amount of protein is lost through the intestines, but in PLE, there is a significant increase in the amount of protein lost, leading to hypoalbuminemia (low levels of albumin, a protein in the blood) and other associated symptoms.
68
What is protein losing enteropathy
**Crohns and coeliac** disease can lead to hypoproteinaemia causing loss of Ig which diminishes adaptive immune response
## Footnote
also loss of albumin etc
69
What is defect in CVID
Mutation in MHC III
## Footnote
mechanism unknown apparently
70
What does presence of anti-Jo suggest about dermatomyositis
Lung fibrosis
71
Presentation of PBC
Malaise
Itching
Symptoms from lack of absorption of fat soluble vitamins
- Vit A blindness
- Vit K bruising
- vitamin D osteomalacia
## Footnote
* Autoimmune inflammatory destruction of small/medium sized intrahepatic bile ducts → cholestasis → SLOW development of cirrhosis over many years
72
Which antigen is indicated in pathogenesis of AIHA
rhesus
73
Which antigen is indicated in pathogenesis of PAN
Hep B surface antigen
## Footnote
30% have underlying Hep B
74
Which antigen is indicated in pathogenesis of MS
Myelin basic protein
75
Biopsy of lupus nephritis
IgM, IgG and IgA deposition
C3 deposition
76
What is used to diagnose IgA nephropathy
Immunofluoresecence showing IgA deposition in the kidney
77
What is the kviem test used for
Sarcoid
78
What is CH50 and what happens to it in SLE
An acute phase protein
Raised in SLE (internet says it’s decreased as complement used up)
79
Which HLA is coeliac associated with
HLA-DQ2 and 8
80
What is the NBT test
Nitro blue tetrazolium
Measures ability of neutrophils to produce NADPH
Positive (normal functioning neutrophils) means turning blue
Negative (aberrant function) means stays colourless/yellow- CGD
81
What is NBT in the different neutrophil immunodeficiencies
Kostmann and leukocyte adhesion deficiency is positive
Negative in chronic granulomatous disease
82
What autoimmune conditions are often seen in selective IgA deficiency
RA
SLE
Coelaic
83
Which cell first encounters an allergen
Macrophage
84
In rejection due to ABO incompatibility what cell is responsible for reaction
B cell
85
What is treatment of a myasthenic crisis
Plasmapharesis
86
What is a hyperacute organ rejection
Occurs within minutes to hours due to preformed antigens on surface of donor organ
Often occurs if mismatch on ABO
87
What are the 2 monoclonal anti-TNF alpha antibodies and what is difference
Infliximab- mouse human chimeric
Adalimumab- human monoclonal antibody
‘Imab’ vs ‘umab’
Umab is human
88
What T1DM antibody is against tyrosine phosphate
Anti-IA-2
89
Which factors suggest type 2 AIH as opposed to type 1
Presence of anti liver kidney microsome antibodies
Younger people (children)
Resistance to steroids
Low IgA
90
What antIbodies are seen in vitiligo
Anti-melanocyte
91
What are anti glutamic acid decarboxylase antibodies associated with
T1DM
Stiff man syndrome
Anti-GAD
92
What antibodies are indicated in GBS
Anti-ganglioside LM1
93
Low IgA in disease with deranged liver function or symptoms
Type 2 AIH
94
What is the stain done for PJP
Gomori methenamine silver stain showing flying saucer shaped cysts on microscopy
95
When are moraxella catarrhalis infections common
In chronic lung disease often in COPD infective exacerbations
96
Organism causing gastroenteritis after drinking unpasteurised milk
Listeria
97
Which patients are listeria GI infections seen in
Immunocompromised
Neonates
98
Beta haemolytic anaerobic organism with tumbling motility causing GI infection
Listeria monocytogenes
99
GI infection after swimming in a contaminated lake in UK
E coli
100
Severe watery diarrhoea with no leukocytes on microscopy
Vibrio cholera as produce enterotoxins which cause water loss but don't colonise the intestine
101
What type of organism is giardia
Pear shaped trophozyte with 4 flagella and 2 nuceli
102
In what people should giardia be considered
Homosexual men
Hikers
Travellers
103
Which bacteria causes diarroea by producing exotoxins which act as a superantigen
Staph aureus
104
What are phases to leptospirosis (weils syndrome)
Initially get non specific fever, headache and conjunctival haemorrhage
Then haemolytic anaemia, meningitis and renal failure
105
What organism causes leptospirosis
Leptospira interrogans
106
Gold standard for leptospirosis
Microscopic agglutination test
107
What type of organism is cryptococcus
Encapsulated yeast infection
108
Most common cause of viral meningitis
Non-polio enteroviruses (eg coxsackie virus and echovirus)
Also HSV-2! (HSV-1 is encephalitis tracking up from nasopharynx)
109
What are examples of NRTIs
Lamivudine and zidovudine
110
What bacteria causes lyme disease
Borrelia burgdorferi
111
Main brucella complication
Granulomatous liver
112
What are examples of NNRTI
Efavirenz
113
Presentation of lyme disease
In 3 stages
Local
- rash and constitutional sx
Disseminated
- PEACH
- peripheral neuropathy
- erythem migrans
- arthritis
- cranial nerve palsy
- heart block
Late
- arthritis
- encephalitis
114
Most appropriate and useful test for sporadic CJD
MRI
115
How to remember sx of sporadic CJD
Demented LAMB
Dementia
LMN signs
Akinetic mutism
Myoclonus
Blindess
116
Differentiating between the meningitis' on CSF
- viral
- bacterial
- TB
Both viral and TB can have clear CSF and high lymphocytes however they have extremely high protein and low glucose
Bacterial will have high neutrophils and high proteins but always be turbid and also have a low glucose
117
What is most significant predictor of clearing the virus in Hep C
Genotype as are a few in the UK some of which carry significantly worse prognosis
118
What is used to diagnose a current Hep C infection
Hep C RNA PCR
119
What are haemosiderin macrophages in the lung seen in
LHF
120
Gastric biopsy reveals signet rings and linitis plastica
Gastric adenocarcinoma
121
How are peptic ulcers differentiated from gastric adenocarcinomas
Carcinomas have raised and uneven borders
122
Which cancer is associated with exposure to alfatoxins (from aspergillus)
Hepatocellular carcinoma
123
Difference in identification lobular and ductal carcinoma in situ
Ductal- unilateral with calcifications
Lobular- bilateral (can have many) and cant be picked up on mammogram
124
Breast tumour with artichoke like appearance
Phyllodes tumour
125
Multiple lytic zones around epiphyses
Giant cell tumours
126
Pains in limbs with shooting pain and SOB too
Pagets bone disease
(SOB as HO cardiac failure?)
127
Recurrent emboli from vegetations on mitral valve where no inflammation and blood cultures negative
Non thrombotic endocarditis
Non-bacterial thrombotic endocarditis (NBTE) is a disease characterised by the presence of vegetations on cardiac valves, which consist of fibrin and platelet aggregates and devoid of inflammation or bacteria.
128
Colorectal cancers with pigmentation around the mouth
Peutz jeughers giving harmartomatous polyps
129
How to differentiate between emphysema and chronic bronchitis
Chronic bronchitis produces copious amounts of sputum
Blue bloaters (CB) and pink puffers (emphysema)
130
What is lung disease associated with burns injuries
ARDS
131
What presents with oral ulcers, malaise and erythema multiforme
SJS
132
What is eosinophiluria indicative of
Tubulointerstitial nephritis
133
How is beta thalassaemia diagnosed
High performance liquid chromatography
Detecting high HbA2
134
Treatment for spinal chord compression myeloma
Steroids (dex)
Radiotherapy
(Surgery?)
135
What is standard INR target
2-3
This for first time DVT/PE, AF
136
What factors can raise the target INR
Prosthetic valve
Second DVT/PE
137
If on continuous unfractionated heparin what need monitored
aPTT
138
If on prophylaxis LMWH for a surgery what monitoring needed
None
139
What is done to blood donations to reduce risk of TaGvHD (transfusion associated GvHD) in immunosuppressed patients?
Irradiation
140
What is mechanism behind hyperacute organ rejection
Preformed antibodies
It is caused by the presence of pre-existing antibodies (usually ABO ABs) in the recipient that recognize antigens in the donor organ.[5] These antigens are located on the endothelial lining of blood vessels within the transplanted organ and, once antibodies bind, will lead to the rapid activation of the complement system.[6] Irreversible damage via thrombosis and subsequent graft necrosis is to be expected.
141
What is VTE risk compared to women for men
x3
142
How is heparin function monitored if have renal impairment
Anti-Xa assay
143
Chimeric antigen receptor T-cell therapy against CD19: what type of haematological malignancy does it target?
Any B cell lymphoma or leukaemia
144
Diagnostic test for HS (hereditary spherocytosis)
Eosin-5’-maleimide dye test
145
Person who had a DVT many years ago (or recurrent DVTs), presents with recurrent dark bruising, and swelling over the course of 5 years, and now had pain in their leg. What is the possible cause?
Post thrombotic syndrome
146
Other than PCV what else can JAK2 mutations occur in
Myelofibrosis
Essential thrombocythaemia
147
What are irregularly contracted cells seen in
G6PD
(Heinz bodies, bite cells, ghost and hemighost cells)- oxidative damage
148
Haematuria after starting a drug what is diagnosis
G6PD
149
What is used for treatment of p53 mutation CLL
Ibrutinib
150
What thrombomodulator reduces in pregnancy
Protein S
(Co-factor to protein C)
151
What is targeted in Graft vs Host disease?
HLA
152
What drug can allopurinol not be given with
Azathioprine
153
Which thrombomodulators are antithrombotic
Thrombomodulin
Protein S
Protein C
154
How does renal artery stenosis cause hyperaldosteronism
Reduced perfusion which activates RAAS
155
What is normal response to water deprivavtion test
Urine osmolality increases over 600
156
What enzyme gets raised if taken cocaine
AST
157
Elderly gentleman with history of headaches and a raised ALP alone
Pagets
158
What enzyme is raised in mumps
Amylase-S
159
If vegan has macrocytic anaemia what is like vitamin deficiency
B12 as folate in veggies
160
What happens to epiphyses and metaphyses in rickets
Widened epiphyses
Metaphyses become cupped
161
Final enzyme in uric acid production
Xanthine oxidase
162
What is raised in rhabdomyolysis
CK
Myoglobin
163
Acute management of gout
NSAIDS
Colchicine
164
Chronic management of gout
Allopurinol
Probenecid in some countries
165
In what condition is there deficiency in HGPRT
Lesch nyan syndrome
166
What is main difference biochemically between osteomalacia and osteodystrophy
High phosphate in renal
Low in osteomalacia
167
What is calcitonin raised in
Medullary thyroid cancer
168
Whats in MEN1
3 ps
Parathyroid
Pancreatic (insulinoma)
Pituitary
169
What is in MEN2a
2Ps 1M
Parathyroid
Phaeo
Medullary thyroid
170
What is in MEN 2b
1P 2MS
Phaeo
Medullary thyroid
Mucocutaenous
Associated with Marfans
171
Interpreting hot uptake on thyroid gland
- diffuse
- multinodular
- single nodule
Diffuse- graves
Multinodular- toxic multinodular goitre (plummers)
Single nodule- toxic adenoma
172
Hyperthyroidism with cold uptake globally
De quervains
173
Which molecule takes cholesterol and moves it to liver and steroidogenesis organs?
HDL
174
How to interpret urine specific gravity
Normal range from 1.005-1.030
If low suggests lots of water in the urine
If high implies very dehydrated
175
What is most common type of tumour in appendix
Neuroendocrine
176
Mass in pancreas after pancreatitis
Pseudocyst
177
Where does pancreatic cancer most commonly metastasie
Liver
178
Surgeons notice grey specks on the pancreas
Ductal adenocarcinoma
179
Symmetrical joint pain in younger woman
RA
180
Which thyroid cancer metastasises to lymph nodes most commonly
Papillary
181
Ovarian cancer with signet ring cells
Kruckenburg tumour- gastric metastases
182
Which virus increases risk of nasopharyngeal cancer
EBV
183
Alcoholic with white stripes in oesophagus
Candidiasis
184
42 year old woman has a history of intermenstrual bleeding. On examination, a cervical polyp is found. What do you do next?
Remove and send for histology
185
What type of section is done intraoperatively if need a diagnosis
Intra-operative frozen section
186
Cause of HTN in upper body only
Aortic coarctation
187
Most common lung cancer in a non smoker
Adeno
188
What is method of spread of melanoma
Lymphoid
189
What presents with muscles aches all over and joint pain
Polymyositis (can also present with joint pain)
190
What would you measure in an excacerbation of SLE
C3 and C4
191
Which cells are Foxp3+
Treg
192
Which cell has oxidative and non-oxidative killing methods and dies once job is done
Neutrophils
193
What are antibodies for sjogrens
ENA
Anti-Ro
Anti-La
194
What is associated with increased susceptibility to mycobacterium and the BcG vaccine
IFN-gamma deficiency
IL-12 deficiency
195
Person older than 18 with recurrent infections and evidence of B cell problems
CVID
196
Normal B cells and CD8 but deficient CD4
Bare lymphocyte syndrome type II
197
Reduced T cell and neutrophil counts but normal B cells
X-linked SCID
198
Normal B and T cells, high IgM but absence of IgA, IgE and IgG
Hyper IgM syndrome
199
What monoclonal antibody used to treat ank spond
Etanercept
200
What is MOA of etanercept
TNF-alpha inhibitor AND TNF-beta unlike infliximab and adalimumab which just alpha
201
What antibodies are used to treat melanoma
Ipilimumab
Pembrolizumab
Nivolumab
202
MOA of ipilimumab
Blocks T cell inhibitory checkpoints by binding to CTLA4
203
Recurrent episodes of flushed face and breathing problems with hepatomegaly
Hereditary angioedema
204
What type of gel and coombs HS reaction is atopic eczema
Type I
205
If targetting TNF-alpha doesnt work in ank spnd what can then be used
Secukinumab- Anti-IL17
206
Which receptor mutation is associated with better outcomes in HIV
CCR5
207
What immunodeficiency is associated with IL2 common gamma chain
X-liked SCID
208
What is maxium number of HLA mismatches in a transplant
6
Do off HLA class 1 proteins and are 2 of DR, A and B
209
How does nivolumab/pembrolizumab work
PD1 on regulator t cells to induce apoptosis
This then in turn means more circulating T cells to destroy cancer cells
210
What type of hypersensivity reaction is serum sickness
III
211
What is adalimumab used in treatment of
RA
212
Which anibody confers natural protection against HIV
gp120
213
What vaccine cant be given to pregnant women
MMR as a live vaccine
214
Which cells bind to MHC1
NK
CD8+
215
What is used to treat a child with comorbidities who has RSV
Ribavirin
216
When differentiating between CMV and rubella in neonatal infection how to differentiate
The eye disease
Cataracts in rubella but CMV has choroidretinitis
217
Most common cause of travellers diarrhoea
Entero-toxigenic E coli
218
Even on a ward what is most likely cause of an outbreak of gastroenteritis
Norovirus
219
Best antibiotic for pseudomonas
Ciprofloxacin
220
Outbreak of boils around someones friendship group
S aureus
221
Treatment for typhoid
Ceftriaxone
222
What is definition of herd immunity
The proportion of immune healthy people needed within a population to stop a pathogen’s spread
223
What are the 3 characteristics of a successful flu outbreak
Novel antigenicity
Efficient replication in human airway
Efficient transmission between humans
224
Alcoholic man is on ceftriaxone for meningitis, what organism is he at risk of which this does not cover for?
Listeria
225
Has contact with someone with TB, what is the lifetime risk of immunocompetent getting active TB?
10%
226
What are snail track oral ulcers seen in
Syphyllis
227
What carries borrelia burgdorferi
Ixodes tick
228
Which vaccine-preventable organism causes cough, lymph node enlargement and has a potential to occlude the airway?
Cornyebacterium diphteria
229
Which hepatitis does not cause chronic hepatitis
Hep A and E
230
Most common cause of cellulitis
Strep pyogenes
231
What infections cause aplastic anaemia
Parvovirus B19
HEPATITIS
232
Most common malignancy in breast
Invasive ductal carcinoma
233
MOA of allopurinol
Xanthine oxidase inhibitor
234
What is pathophysiology in hyper IgM syndrome
Mutation in CD40 on T cells which affect communication between B and T cells
235
Gram positive rods causing meningitis in elderly
Listeria
236
Why are under 12 months not able to have honey
Risk of infection with clostridium botulinum
237
Which hepatitis virus is associated with more severe disease if acquired in pregnancy potentially leading to fulminant hepatic failure and death?
Hep E
238
What can be treated with plasmapharesis
Anything with excessive type 2 mediated hypersensitivity
- Myasthenic crisis
- Goodpastures
- Antibody mediated rejection
- cryoglobulinaemia
239
What are the expected number of HLA matches between parent and child
3/6
50%
240
What is the likelihood of these matches between 2 siblings
- 0 matches
- 3/6 matches
- 6 matches
0/6- 25%
3/6- 50%
6/6- 25%
241
What type of HS reaction is PAN
III
242
How to interpret a high prolactin
Moderately high (1000-5000)
- microprolactinoma (<10mm)
- non-functioning adenoma compressing stalk supplying dopamine
Extremely high (over 5000)
- macroprolactinoma
243
What happens to urinary bilirubin in haemolytic jaundice
There is not bilirubinaemia as uncnoj bilirubin hydrophillic
Get urobilirubinaemia as more urobilirubin absorbed to enterohepatic recycling pathway
244
What happens to HDL if an alcoholic
Gets raised
245
Most common skin cancer
BCC
246
Brain tumour that occurs near top of brain and often asymptomatic
Meningioma
247
Which is the commonest glial cell in the CNS?
Astrocytes
248
Most common cause of ARDS in adults
Sepsis
249
What is the most common ovarian tumour?
Serous cystadenoma
250
Which type of necrosis is associated with a MI?
Coagulative necrosis
251
In obstetric practice, the maximum risk of fatal maternal thrombo-embolism occurs at which stage of pregnancy?
Post partum
252
Acute GvHD post-allogeneic haematopoietic stem cell transplant is mediated by which cell type?
Donor T cells
253
What do MDS progress to
AML
As blasts
254
What causes relative polycythaemia
Dehydration
255
What is left and right shift with regards to neutrophils and its significance
Shifted to left means producing less lobes (reactive neutrophilia)
Shifted to right means more lobes (megaloblastic)
256
What is organism in mumps
Mumps virus
257
Which class of antibiotics has concentration dependent killing (i.e. the goal of therapy is to maximise peak > MIC)
Aminoglycoside
258
Doctors should measure the level/activity of which enzyme before prescribing azathioprine?
Thiopurine methyltransferase
259
What hormone is produced by fat cells, and has receptors in the hypothalamus?
Leptin
260
What is the commonest cause of hypercalcaemia in the community?
Parathyroid adenoma
261
What active enzyme in sarcoidosis patients causes hypercalcaemia
1 alpha hydroxylase
262
Most common cause of hypocalcaemia in the community
Hypoalbuminaemia
263
What are adrenal zones and what produce
Zona glomerulosa- aldosterone
Zona fasciculata- cortisol
Zona reticularis- sex steroids
Medulla- adrenaline
REMEMBER AS ACS
264
What is the commonest cause of portal vein thrombosis?
Liver cirrhosis
265
Most common cause of nephrotic syndrome in adults
FSGS
266
Most common cause of constrictive pericarditis in developing world
TB
267
Most common primary tumour of heart
Myxoma
268
What is a myelocyte
A neutrophil precursor
269
What is stain for cryptococcus
India ink- see yeast cells surrounded by halos
270
What is stain for chlamydia psittaci
Giemsa stain
271
What electrolyte abnormality can quinines cause
Hypoglycaemia
272
Indications for nivolumab and pembrolizumab
Melanoma
Metastatic renal cancer
273
Which infection does cyclophosphamide make you susceptible to
PJP
274
What drug increases excretion of uric acid
Probenecid
275
What is main killer in CKD
Calcifications and subsequent atherosclerosis
276
How to differentiate between renal artery stenosis and conns as causing hypokalemia, hypernatraemia and hypertension
Look at aldosterone renin ratio
- high aldosterone in conns
- high renin in RAS as reduced perfusion
277
Causes of normal anion gap metabolic acidosis
ABC
Addisons
Bicarb loss- renal tubular acidosis, diarrhoea, laxatives
Chloride gain- NaCl infusion
278
What is fanconi syndrome
Condition where failure of PCT to reabsorb small particles
279
Causes of fanconi syndrome
Congenital
Wilsons
Myeloma
Lead poisoning
Tetracyclines
280
Lab results of fanconi syndrome
Glucosuria
Hypokalaemia
Metabolic acidosis
Hyperuricosuria
Proteinuria
281
MOA of lomitapide
Lomitapide acts by inhibiting Microsomal triglyceride transfer protein (MTP)
282
MOA of colchicine
Inhibits tubulin polymerisation to reduce migration of neutrophils
283
Pseudohypoparathyroidism presentation
Resistance to PTH
- low calcium
- high phosophate
- high PTH
Short 4th and 5th metacarpals
284
Other name for pseudohypoparathyroidism
Albright hereditary osteodystrophy
285
Difference between osmolarity and osmolality
Osmolarity is what is estimation of particles in a solution is. Units =units mmol/L
Osmolality is measured particles in a solution done by osmometer. Units= mmol/Kg
286
MOA of ezetimibe
Inhibits absorption of cholesterol
287
What is inside of homemade alcohol that can cause hyperuricaemia poisnoing
Lead
288
What presents with orange tonsils and very low HDL
Tangier disease
Can also present with hepatosplenomegaly
289
Elevated plant sterol
Phytosterolaemia
290
Which brain tumour has psammoma bodies in
Meningioma
291
What is assocaited with epithelial casts in urine
ATN
292
COPD in 20 year old woman what should be investigated
Alpha 1 antitrypsin deficiency
293
What sign, which may be visible around the nails, is seen in Graves' disease and is due to periosteal bone growth in the nail bed?
Thyroid acropavhy
294
Which cancer has largest mortality in UK
Lung
295
Second and third most common cancer for each sex
2nd- lung
3rd- bowel
296
What condition is characterised by microangiopathic haemolytic anaemia, thrombocytopenia and renal failure in children?
HUS
297
What protein in PCKD
Polycystin-1
298
What is the name given to areas of regenerating mucosa which project into the lumen of the bowel, which may be visualised during a colonoscopy of a patient with ulcerative colitis?
Pseudopolyp
299
What structures, present in the large bowel, represent weak points in the bowel wall and allow for the formation of diverticula?
Taenia coli
300
What respiratory condition is characterised by airspace enlargement and alveolar wall destruction?
Emphysema
301
What condition is the presence of waxy casts in urine associated with?
CKD
302
What do delta cells from pancreas produce
Somatostatin which reduce secretion of glucagon and insulin
303
Which enzyme, synthesised by the pancreas, is most sensitive for the diagnosis of pancreatitis?
Lipase
304
Post TIA what scan do
Carotid USS
305
What are buffers in intracellular fluid, extracellular fluid and red blood cells
Intra- phosphate
Exta- Bicarbonate
RBC- haemoglobin
306
What is best measure of glucose over last 3 weeks
Fructosamine
307
What is broken down to create uric acid
Purines
308
Why remove whole thyroid in cancer
Thyroglobulin is marker and so can use to monitor if goes above 0
309
Most common cause of AKI in hospital
Reduced perfusion
310
What happens to urinary urinobilinogen in obstructive jaundice
Is low
311
What are codfish vertebrae, pepper pot skull and looser zones seen in
Osteomalacia
312
Why does hyperventilation cause paraesthesia?
Hyperventilation increases the pH of the blood, which increases the amount of calcium that binds to albumin in the serum. This essentially causes hypocalcaemia which causes paraesthesia.
313
What are the most common causes of primary and secondary hyperparathyroidism?
Primary: A parathyroid adenoma
Secondary: Chronic renal failure
314
Which drugs decrease afferent arteriolar pressure
NSAIDS
Calcineurin inhibitors
315
Which drugs decrease efferent arteriolar pressure
ACEi
ARBs
316
Proportion of thyroid transported in blood
Thyroglobulin binding globulin 75
Thyroxine binding prealbumin 20
Albumin 5
Free 0.03
317
What causes pityraisis versicolor
Melassazia
318
If have a high WCC what can it be confused for
Reticulocyte count- blood film
319
Most common cause of IDA in world
Hookworm
320
What is d-dimer a measure of
Fibrinolysis
321
What are cigar cells seen in
IDA
322
After a DVT in arm what investigations do
Chest x-ray then do doppler
323
Reversal agent for rivaroxaban
Andexanet alpha
324
What triggers intrinsic pathway
Exposed collagen
325
What is second most common of pancreatic exocrine insufficiency in children inherited
Schwachman diamond syndrome
326
Which RBC are polychromatic and stain for presence of RNA
Reticulocyte
327
How does heparin induced thrombocytopenia present
Pro-thrombotic even though thrombocytopenia as platelets get activated by immune complexes
328
First line for VTE in cancer
DOAC
329
What lymphoma originates in the germinal zone
Burkitts
330
What do all myeloproliferative conditions carry risk of progressing to
AML
331
Which cofactor is required for synthesis of the anticoagulant proteins C and S?
Vitamin K
332
A 56 year old man is reviewed by his GP after his blood tests suggested a new microcytic anaemia.
His ferritin and serum iron is low. His full blood count, CRP, renal function, LFTs, B12 and folate are otherwise normal.
A blood film reveals the presence of hypochromic erythrocytes with pencil cells.
What is the next most appropriate blood test to request, prior to an OGD and colonoscopy?
Anti-TTG
333
What is lymphoma in a young person
Burkitts
334
In a young person non child what is likely lymohoma
Hodgkins
335
How to quickly raise plateltes in ITP
IVIG
336
What are negri bodies pathognomic for
Rabies
337
What presents with fever worse in evening
Brucellosis
338
What presents with black lesions and lung problems
Anthrax
339
What presents with areas of hypopigmentation which under woods lamp appears orange
Pityriasis versicolor
340
Gold standard for leishmaniasis
Splenic aspirate
341
Normal B cells and CD4 cells but absent CD8
BLS I
342
How diagnose coxiella
Serology
343
What stains can be used for aspergillus and candida
Methanamine silver
344
What can be used to quickly diagnose nail infections
Potassium hydroxide test
345
What gram positive organism is associated with tumbling motility and rockets?
Listeria
346
Gets bitten by fish and then nodules arise
Mycobacterium marinum
347
How are streptoccus infections split up
Into alpha or beta haemolytic
Incubate on blood agar
- partial haemolysis is alpha (green)
- complete haemolysis is beta (clear)
Beta haemolytic then split into lancefield groups based off antigens on cell membrane
348
What are 2 main alpha haemolytic strep
Strep viridans and pneumoniae
349
Lancefield strep groups
A- no antigens (strep viridans and pneumoniae)
B- (strep agalactiae)
D- enterococcus
350
What is growth medium for differnetiating strep
Blood agar
351
A 34 year old man has severe Crohn's disease. His gastroenterologist wishes to start a biologic drug, infliximab. What infection should be ruled out before commencing the drug?
TB- mantoux test
352
What antigen is injected intradermally as part of the mantoux screening test for tuberculosis?
Tuberculin
353
What is main metabolite of azathioprine
6-mercatopurine
354
How does reticular dysgenesis present
Severe life threatening infections
Profound sensorineural deafness
355
Blood findings of reticular dysgenesis
Deficiency of the myeloid and lymphoid cell lineages
356
Inheritance of reticular dysgenesis
Autosomal recessive
357
What immune cell releases granzyme and perforin when activated?
Killer T cells
358
What viral enzyme is predominantly responsible for the high mutation rate of HIV and other RNA viruses?
Reverse transcriptase
359
In skin prick testing, what is used as a positive control?
Histamine
360
Which cytokine is important in the pathogenesis of rheumatoid arthritis, anyklosing spondylitis and inflammatory bowel disease?
TNF-alpha
361
How long before skin prick testing must antihistamines be stopped to allow for accurate interpretation?
48 hours
362
A neutrophil releases preformed myeloperoxidase, defensins and neutrophil elastase. What is this process known as?
Degranulation
363
Which joints in the hand are classically not affected by rheumatoid arthritis?
Distal interphalangeal
364
What HLA allele is associated with Graves disease?
DR3
365
A 5 year old girl is seen by her GP. Her mother says she is unable to sleep at night as her knees, elbows and shoulders are very red and painful, especially to touch. Her mother has also noticed small bumps under her skin. She is currently pyrexic, but the mother says she is still recovering from a bad sore throat two weeks ago.
What is the likely diagnosis?
Rheumatic fever
366
How is Latex Food Syndrome diagnosed?
Skin prick
367
HIV infected CD4+ cells are killed by the immune system. What cell type is responsible for this?
T killer cells
368
Swan neck deformity which corrects itself when putting hans together
SLE
369
A 31 year old accountant reports an itchy rash over the trunk and back that has been present for the last 7 weeks. On examination, there are smooth erythematous papules with evidence of excoriation. She reports no association with food, time and has changed her washing powder to a "Non-Bio" formulation.
What condition is she suffering from?
Chronic urticaria
370
Woman with coeliac develops low albumin and immunoglobulins, what is diagnosis
Protein losing enteropathy
371
How to differentiate between goodpastures and microscopic polyangiitis
Goodpastures has systemic symptoms like fever and joint pain
372
What cell of immune systme would identify a lack of MHC on the surface and destroy it
NK cells
373
Which interleukins are responisble for fever
IL-1 and 6
374
Which antibody is associated with homogenous ANA staining
Ant-dsDNA
375
What gel and coombs is mantoux test
4
376
What is main immunoglobulin in breast milk
IgA
377
A severe asthmatic presents to their GP for the third time in three years complaining of blocked sinuses. However, over the last 6 months, she has also had unintentional weight loss and reports intermittent fevers. She also has an indistinct erythematous macular rash on both her ankles.
A Full Blood Count reveals an eosinophilia (>10% of white blood cells). What rare immunological condition may be responsible for her symptoms?
Eosinophillic granulomatosis
378
What cell stains with CD14
Monocyte
379
What is the name given to the immunological process that must have occurred prior to a hyperacute transplant rejection?
Sensitisation
380
Immunoglobulins may bind to multiple pathogens at once in order to enhance phagocytosis. What is this process known as
Neutralisation
381
What is the name given to a substance that increases the effectiveness of an immune reponse to a vaccination without altering the specificity of the response?
Adjuvant
382
What test can be used to measure the levels of serum IgE directed against brazil nut antigens?
Radioallergosorbent test
383
What does RAST stand for
Radioallergosorbent tets
384
What is crucial enzyme in salvage pathway for purines
HGPRT
385
Rate limiting enzyme for purine metabolism
PAT
386
How to tell if something is positively birefringent or not
If positively birefringent
When aligned with light filter goes blue
When light filter perpendicular it goes yellow/whiteish
387
Which renal stone is ethylene glycol associated with
Calcium oxalate as ethylene glycol broken into oxal acid
388
What are hyperlobated nuclei (flower cells) seen in
Adult T cell lymphoma
389
What does siderosis mean
Iron accumulation
390
How does starry sky actually appear
Macrophages filled with apoptotic remains on a background of lymphoblasts
391
What are auer rods
Azurophillic crystal found in neutrophils
392
What technique is used to identify genetic feature of CML
FISH
393
Most common inherited coagulopathy
Factor 5 Leiden- normally only increased risk in presence of other RF like COCP
394
What clotting factor is contraindicatedlly raised in pregnancy
11
395
Where and in who does does bullous pemphigoid occur
Elderly
Flexural surfaces
396
What is centromere pattern immunofluorescence associated with
CREST
397
What is nucleolar pattern immunofluorescence associated with
Diffuse systemic sclerosis
398
What is wire loop appearance in kidney associated with
SLE
399
What thyroid cancer arises from parafollicular c-cells
Medullary
400
2 most common pituitary adenomas
Prolatinoma 1st
Non-functioning 2nd
401
What is somatotrophin
GH
402
When is only time screening for cervical cancer may extend 64
If not had since 50 or recent abnormal results
403
What is most significant independant RF for CVD
Family history
404
If have femoral artery stenosis what change happens to skeletal muscle in legs
Atrophy
405
What is most damamging pathology to myocardium
Ischaemia as toxic waste products accumulate which cant be drained efficiently
406
What is process whereby in slowed flow, white cells are drawn to vessels walls
Margination- drawing cells to walls
407
How are macrophages described in granulomas
Epithelioid as develop intracellular organelle growth
408
Penetration through which layer of skin will lead to formation of scar
Basement membrane
409
If severe autoimmune haemolysis removal of which organ may help syomptoms
Spleen
410
Deficiency in what cell leads to recurrent viral infections
Classic NK deficiency
411
What is role of follicular t helper cells
Promoting germinal centre reactions and differentiation of B cells into IgG and IgA secreting plasma cells
412
Person with multiple autoimmune conditions presents with muscle weakness what could be cause
Myasthenia gravis
413
What organisms are very likely to cause bronchiectasis
Pertussis
Staph aureus
414
What is most specific finding for IDA
Pencil cells
415
Rank these as cause of HAI
A. Skin and soft tissue
B. Surgical site
C. Urinary tract
D. Hospital acquired pneumonia
E. Gastrointestinal system
1 - E. Gastrointestinal system
2 - C. Urinary tract
3 - D. Pneumonia/ LRTI
4 - B. Surgical site
5 - A. Skin and soft tissue
416
Rank as cause of PUO
A. Dengue
B. Viral haemorrhagic fever
C. Malaria
D. UTIs
E. Bacterial diarrhoea
1 - C. Malaria
2 - A. Dengue
3 - E. Bacterial diarrhoea
4 - D. UTIs
5 - B. Viral haemorrhagic fever
417
Rank as cause of anaphylaxis
A. Eggs
B. Penicillin
C. Banana
D. Gliadin
E. Peanut
1 - E. Peanut
2 - B. Penicillin
3 - A. Eggs
4 - D. Gliadin
5 - C. Banana
418
Rank from narrow to broad spectrum
A. Meropenem
B. Benzylpenicillin
C. Co-amoxiclav
D. Tazocin
E. Amoxicillin
1 - B. Benzylpenicillin
2 - E. Amoxicillin
3 - C. Co-amoxiclav
4 - D. Tazocin
5 - A. Meropenem
419
Superoxide dismutase 1 is a misfolded protein associated with which condition?
MND
420
Best treatments for pseudomonas
Aminoglycosides are best narrow spectrum
Can also give broad spectrum beta lactams like ceftazidime
421
Meningitis with high opening pressure
Cryptococcus
422
Flu like illness a few weeks after contracting HIV
HIV seroconversion illness
423
What infection is likely to cause positive result on heterophile test aswell as well as EBV
CMV
424
Most appropriate test for EBV
EBV IgM as heterophile test can also be positive in CMV
425
What test do before intiating a quinine
G6PD test
426
4 causes of massive splenomegaly
Certain haematological malignancies (e.g. myelofibrosis, CML, hairy cell leukaemia)
Chronic malaria
Leishmaniasis
Gaucher disease
427
What infection are immunosuppressed kids especially at risk of
Adenovirus
428
Most common cause of infectious congenital hearing loss
CMV
429
Which causes of diarrhoea have lowest infective dose
Noroviris
Shigella
430
Why does the influenza virus only cause respiratory disease?
The influenza virus requires activation by host cell proteases that are only expressed in the respiratory tract
431
What is the vector for Trypsanoma brucei rhodesiense?
Tsete fly
432
What is the most common cause of late onset sepsis in neonate?
Staph epidermis
433
What stain is used to screen TB
Auramine
434
What drug is given with cidofovir
Probenecid
435
What is rate limiting step in haem synthesis
ALA synthase
436
What can denosumab be used to treat other than osteoprosis
Giant cell tumours
Metastases
437
Which test would be used to confirm a diagnosis of Cushing’s Syndrome?
High dose dexamethasone
438
How would you manage renal failure in a patient with Myeloma?
Haemodialysis
439
How would you manage spinal cord compression in a patient with myeloma?
Radiotherapy and dexamethasone
440
A man has spherocytes, polychromasia and reticulocytosis on blood film, what is the most likely diagnosis?
Hereditary spherocytosis
441
Which viruses are screened for in platelet donations intended for pregnant women?
HIV
HBV
CMV
442
How do proteasome inhibitors, such as Bortezomib, work
Inhibited protein degradation leads to amino acid build up, shortage and cell death
443
What is the first line biological treatment for Ankylosing Spondylitis?
Anti-TNF alpha
444
What would be the most likely diagnosis in a teenage girl who develops an erythematous rash after running in winter?
Cold urticaria
445
An HIV patient with a low CD4+ count presents with meningitis. What is the most likely causative organism?
Cryptococcus neoformans
446
A lady returns from a holiday in America, where she stayed in Arizona. She presents with systemic symptoms, including a fever. What is the most likely diagnosis and causative organism?
Valley fever
Coccidioides
447
Which congenital initially presents asymptomatically
CMV
448
Which virus resides in the pharynx and gastrointestinal tract, causes encephalitis in 1/100, and destruction of motor neurones in 1/1000?
Polio
449
What is seen on urine dip of pyelonephritis
Leukocyte casts
450
What is renal fibrinoid necrosis seen in
Malignant HTN
451
A man with known H.Pylori infection has a stomach biopsy. An abnormal area is seen in the antrum, with mitotic figures and cells with a raised nuclear to cytoplasmic ratio. The mass is not invading the basement membrane. What is the most likely diagnosis?
Mucosal associated NHL
452
What would you prescribe a patient post-removal of a pituitary adenoma?
Desmopressin
453
A man presents with a midshaft femur fracture without a serious history of trauma. What may have caused this?
Chondrosarcoma
454
Which breast malignancy may be described as a ‘Fibro-epithelial Tumour with abundant stromal elements’?
Phyllodes tumour
455
What are pus cells seen in
Pyelonephritis
456
Which testicular cancer is radiosensitive, and typically has a white/smooth appearance?
Seminoma
457
A young man presents with a lytic lesion in the diaphysis of his leg. Night pains are relieved by aspirin. What is the most likely diagnosis?
Osteoid Osteoma
458
A man goes deaf, and on examination is noted to have bowed legs. What is the most likely diagnosis?
Pagets
459
A patient with HIV presents with signs of raised ICP and new onset epilepsy. What is the most likely diagnosis?
Primary CNS lymphoma
460
What is the main mechanism behind CMV resistance to antivirals?
Protein Kinase mutation
461
Post transplant in child what virus worried about
Adenovirus
462
Post HSCT how is CMV treated
Foscarnet as ganiciclovir it suppresses the BM
463
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?
Vibrio parahaemolyiticus
464
How would you treat Candida spp. infections not caused by Candida albicans?
Echinocandins
465
A patient with pneumonia has a CXR, which shows a bat wing appearance. What is the most likely causative organism?
PJP
466
How are infected prosthetic joints managed?
Removal and debridement before Abx
467
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?
Dengue
468
In which infectious disease are ‘Purple eyelids’ a common feature?
Chagas
469
Which organism is the most common cause of CNS infections overall?
Cocksackie
470
The centre of a granuloma being diffuse red indicates what?
Caseating
471
At what level must skin damage be to leave a scar?
Dermis
472
What is the role of stellate cells in the liver?
Vitamin A stores
Activate to myofibroblasts to lay down collagen
473
In which breast cancer are Indian Files seen?
Invasive Lobular
474
In which breast cancer are Empty Spaces seen?
Invasive mucinous
475
Which stain is used to distinguish Squamous Cell Carcinomas from Adenocarcinomas?
P40
476
Which breast disease shows ‘dilated, calcified ducts’ on histology
Fibrocystic disease
477
Breast tumour with leaf like apperance
Phyllodes tumour
478
Q
Which breast condition shows:
Cytology: Clusters of cells
Histology: Dilated ducts, polypoid mass in the middle
?
Intraductal papilloma
479
What thyroid condition stains with amyloid
Medullary carcinoma as calcitonin broken down to amyloid
480
Name one mutation that is associated with Type I endometrial carcinoma.
PTEN
481
In which renal condition might you see ‘shrunken kidneys with granular cortices’ and ‘fibrinoid necrosis’?
Hypertensive nephropathy
482
What might it indicate if a lung lobe isn’t black on autopsy?
Pneumonia
483
In which IgG mediated skin condition might the outer layer of the stratum shear off?
Pemphigus follaceous
484
How does Lichen Planus present:
a) on the wrists/arms
b) in the mouth?
Arms- red/purplish rash
Mouth- white lines
485
Early versus late phase of asthma
Early- Mast cell degranulation and effects
Late- Tissue damage, mucous production, muscle hypertrophy
486
What are the stages of lobar pneumonia?
Congestion
Red Hepatisation
Grey Hepatisation
Resolution
487
What is the key feature of grey hepatisation in pneumonia?
Intra-alveolar neutrophils
488
In which bone disease might you see ‘Langerhans-type Giant Cells with horseshoe nuclei’?
TB
489
In which condition might you see a proliferative synovitis, with pannus formation and grimley sokoloff cells on histology?
RA
490
What is the most common genetic predisposition to brain tumours?
Neurofibromatosis
491
What is the most common primary brain cancer in adults?
Glioblastoma mutliforme
492
What mutation is associated with pilocytic astrocytoma
BRAF
493
Which brain cancer displays ‘round cells with clear cytoplasm’ (fried egg appearance)
Oligodendroma
494
Which brain cancer shows ‘small blue round cells’ and ‘Horner-Wright Rosettes’?
Medulloblastoma
495
Which cytokine plays a key role in development of TH2 cell responses (and hence allergic responses)?
IL-4
496
What do TH1 cells release
IL-2 or IFN-gamma
497
What is tofacitinib
JAK inhibitor
498
Which immunodeficiency may be implicated in a child presenting with recurrent, severe viral infections?
NK deficiency
499
How to differentiate between IDA and beta thalassaemia on blood film
Basophillic stippling in beta thalassaemia
500
What are the gram positive bacilli
Bacillus
Clostridium
Diphteria
Listeria
501
What are gram negative coco bacilli
Haemophilus
Bordatella
Pseudomonas
Chlamydia
Brucella
502
Which pneumonia cause shows ‘glossy colonies’ on agar?
Haemophilus influenzae
503
What type of organism is entamoeba histolytica
Trophozoite with 4 nuclei
Flask shaped ulcer
504
MOA of ribavirin
Nuceloside analogue
505
What haem condition is associated with ADAMTS13 mutations other than TTP
MAHA
506
What is used as a marker of stem cells?
CD34
507
Which stones does renal tubular acidosis predispose to
Calcium oxalate
