Path 1 Flashcards
1
Q
Inc GGT+ALP > inc AST+ALT
A
Obstructive picture
i.e. gallstones, malignancy
2
Q
Inc AST+ALT
A
Hepatocyte damage - ALT more sensitive
2AST:1ALT = ETOH
1>AST:1ALT = Viral
3
Q
Elevated GGT
A
Chronic ETOH use (confirms hepatic source of ALP)
4
Q
Gilbert’s
A
Reduced conjugation of bili.
Biochem normal apart from inc bili
5
Q
Ax - autoimmune antiglycoprotein IIb-IIIa Ab leading to thrombocytopenia (chronic)/ virus coated plts (acute)
Px - plt disorder so superficial bleeding (gums), low plts, proceeds infx, in children (acute, chronic differs slightly)
Mx - self limiting (acute)/steroids + splenectomy (chronic)
A
Autoimmune thrombocytopenic purpura
6
Q
Ax - FVIII deficiency, X-linked recessive,
Px - prolonged bleeding after surgery
Mx - FVIII concentrates lifelong
A
Haemophilia A
7
Q
Ax - FIX def, X-linked recessive
Px - like Haemophilia A
Mx - FIX concentrates lifelong
A
Haemophilia B/Christmas disease
8
Q
Ax - plt microthrombi causing MAHA
Px - Renal failure, low plts, fever, neuor signs (headache, stroke)
Mx - plasma exchange
A
(Idiopathic) Thrombotic thrombocytopenic purpura
9
Q
Ax - E.coli toxin leads to RBC damage
Px - D, renal failure, children and elfderly
A
Haemolytic uraemic syndrome (HUS)
10
Q
Ax - widespread activation of coagulation due to malignancy/sepsis/trauma/placental abruption/amniotic fluid embolus
Px - Clotting F’s + Plts consumed=bleeding, low Plts, low fibrinogen, renal failure, shock
A
Disseminated intravascular coagulation (DIC)
11
Q
Ax - vWF def, autosomal dominant, (low production of FVIII)
Px - Gum bleeding, epistaxis, prolonged bleeding after surgery
A
Von Willebrand disease
12
Q
Ax - autosomal dominant
Px - telangiectasia on skin and mucous membranes
A
Osler-Webber-Rendu/hereditary haemorrhagic telangiectasia
13
Q
Rheumatoid Arthritis AutoAb
A
Anti-CCP, rheumatoid F
14
Q
Autoimmune hepatitis autoAb
A
Anti-smooth muscle, anti-liver kidney microsomal-1 (anti-LKM1), anti-soluble liver antigen (anti-SLA)
15
Q
Dermatomyositis autoAb
A
Anti-Jo1
Px - heliotrope rash around eyes, Gottron’s papules, proximal limb weakness
16
Q
Systemic scleroderma/CREST syndrome
A
Ax - anti-centromere Ab
Px - Calcinosis, Reynaud’s, Oesophageal dysmotility, Sclerodactyly, Telangectasia
17
Q
Diffuse cutaneous scleroderma autoAb
A
Anti-topoisomerase
Px - similar to CREST but more aggressive
18
Q
Churg-Strauss syndrome/Eosinophilic granulomatosis with polyangiitis
A
pANCA
19
Q
SLE
A
Ax - anti-dsDNA
20
Q
Pernicious anaemia
A
Ax - anti-parietal cell Abs
21
Q
Graves
A
Ax - anti-TSH Abs
22
Q
Coeliac’s autoAb
A
anti-TTG, anti-endomysial Abs
23
Q
Myasthenia Gravis AutoAb
A
Anti-Ach receptor
24
Q
Primary biliary cirrhosis AutoAb
A
Anti-mitochondrial Ab
25
T1DM AutoAb
Anti-glutamate decarboxylase, Anti-pancreatic beta cells
26
Wegener's Granulomatosis/Granulomatosis with PolyAngitis (GPA)
c-ANCA
| saddle shaped nose, epistaxis, haemoptysis, haematuria, glomerulonephritis
27
Chlamydia trachomatis
Grm -ve obligate
Px:
Chlamydiosis - dysparenuia, dysuria, vaginal/penile discharge
Lymphogranuloma venerum - painless papule/ulcer, LA
28
Treponema pallidum
Syphilis
primary - painless genital ulcer
Secondary - bacteriaemic, rash, LA
Tertiary - multiple organs, neuro signs, pupils
29
Haemophlus ducreyi
Grm -ve coccobacillus, cultured on chocolate agar
| Px -tropical ulcer diseas, painful genital ulcer
30
Neiserria gonorrhoeae
Grm -ve diplococcus
Px - urethritis, dysuria, purulent discharge
Thayer-Martin VCN medium
31
Bacterial vaginosis
Ax - bacterial imbalance
Px - fishy smelling, white cream discharge
Ix - pH >4.5, clue cells
32
Trichomonas vaginalis
flagellated protozoan
| Ix - wet prep microscopy
33
Klebsiella granulomatis
Grm +ve rod
Px - donovanosis, ulcerating STI
Ix - giemsa stain=donovan bodies
34
Herpes simplex virus 2
Px - genital herpes, fluid filled painful blisters
35
Addison's disease
Def - Adrenal insufficiency
Px - fatigue, orthostatic hypotension, hyponatraemia, hyperkalaemia
Ix - synACTHen test
36
Conn's syndrome
Def: primary hyperaldosteronism
| Px - HTN, hypernatraemia, hypokalaemia
37
Prolactinoma
Def: most prevalent pituitary tumour
| Px - amenorrhoea, galactorrhoe, gynaecomastia
38
Grave's
Def: TSH receptor Abs overproduction
39
Kallman's
Def: hypogonadotrophic hypogonadism
40
FV leiden
Def: FV less easily broken down by protein c = hypercoagulable
41
Anti phospholipid syndrome
Autoimmune: anti-cardiolipin Abs, lupus anticoagulant
42
Buerger's disease
Vasculitis
| Px - Corkscrew angiogram
43
Protein S deficiency
Imparied degradation of FVa + VIIIa
| Protein S is an anticoagulant that break down FVa + FVIIIa
44
Antithrombin deficiency
Antithrombin inhibits FIIa (thrombin) and FXa
45
Sjorgren's syndrome
Anti-ro, anti-la present in 50%
Def: destruction of the epithelial cells of the exocrine glands
Px - dry eyes/mouth, parotid swelling, arthralgia, myalgia
46
Amoxicillin
Beta-lactam Abx
| Mild community aqc pneumonia
47
Flucloxacillin
Beta-lactam Abx
| S. Aureus
48
Trimethoprim
Folate metabolism inhibitor
Uncomplicated UTI's
SE: megaloblastic anaemia
49
Vancomycin
Glycopeptide Abx inhiits cell wall synthesis
MRSA
Grm +ve
SE's need to be monitored
50
Cefotaxime
3rd gen cephalosporin
| N.Men/Bacterial meningitis
51
Doxycycline
Tetracycline (30s protein synthesis)
| Chlamydia + gonorrhoea, COPD exacerbation
52
Co-amoxiclav
Amox and clavulinic acid (beta-lactamase inhibitor)
| Severe community aqc pneumonia, nosocomial UTI
53
Cirrhosis Histo
Fibrosis and nodules
54
Hameochromatosis
Def: autosomal recessive condition due to HFE mutation causing inc Fe
Ix - Perl's prussian blue stain
55
Hepatocellular carcinoma
Most common primary liver malignancy, commonly secondary to cirrhosis
Aflatoxin
56
Pagets biochem
```
Ca: N
PTH: N
ALP: Inc
PO4: N
VitD: N
```
57
Primary hyperparathyroidism
```
Ca: Inc
PTH: Inc/N
ALP: Inc/N
PO4: Dec
VitD: N
```
58
Osteomalacia
```
Ca: Dec
PTH: Inc
ALP: Inc
PO4: Dec
VitD: Dec
```
59
Primary hypoparathyroidism
```
Ca: Dec
PTH: Dec
ALP: Dec/N
PO4: Inc
VitD: N
```
60
Graft vs host disease
Ax - transfer of donor lymphocytes in immsupressed
| Px - D, macpap rash, skin necrosis
61
Transfusion related lung injury
w/in 6hrs
| px - dry cough dyspnoea and fever
62
Immediate haemolytic transfusion reaction
Ax - ABO incompatibility
| Px - Abdo pain, loin pain, vomiting, flushing, HbUria
63
Goodpasture's
Type IV collagen T2 hypersensitivity reaction
| Px - cough, haemoptysis, HbUria
64
Hepatitis B
dsDNA virus prevelant in sub-Saharan Africa
IP 2-6mnths Acute<6 mnths
20% become chronic
65
Hepatitis C
ssRNA
| 80% become chronic
66
EBV
Associated with glandular fever/infectious mononucleosis
| Monospot test+ve, atypical lymphocytes
67
Influenza
Binds to sialic acid receptor
68
Chronic myeloid leukaemia
Def: Myeloproliferative disorder
Epid: 40-60
Ax - Phili chromosome 9;22 = BCR-Abl
Px - often asymptomatic picked up on routine blds, splenomegaly massive
Ix - Ph+ve, BM biopsy shows hypercellula BM
Chronic, accelerated and blast phase
Tx - tyrosine kinase inhibitor, BMT
69
Hairy cell leukaemia
CLL subtype, B lymphocyte malignancy
Diagnosis - tartrate-resistant acid phosphatase
Px - pancytopenia, HepSplenMeg
70
Acute myeloid leukaemia
Neoplastic process of BM, immature blast cells>20% of BM
Auer rods on blood film
Px - HepSplenMeg, LA, Gum hypertrophy
Ix - morphology, immunophenotyping, cytogenetics
Tx - Chemo
71
Adult T cell leukaemia
Ax - human T-cell leukaemia virus Type 1.
Japan Caribbean
Px - HyperCa, LA, HepSplenMeg
72
Chronic lymphocytic leukaemia
B cell neoplasm lymphocyte count >4000
Epx- 65-70 males smudge cells
Px - non specific, LA
73
Acute lymphoblastic leukaemia
Most common paediatric Ca
74
Multiple sclerosis
Myelin basic protein + proteolipid protein implicated in pathogenesis of MS
Def: demyelinating disease
Ax - TIV hypersens reaction cytotixic T cells
Px - optic neuritis, urinary/bowel incontinence, weakness, dysphagia
75
Oral allergy syndrome
Type 1 hypersens reaction
| IgE cross reacts with food substance (stony fruit)
76
Zidovudine
Nucleoside reverse transcriptase inhibitor (NRTI)
| AIDS/HIV
77
Interferon-alpha
Immune system potentiation JAK-STAT pathway
| HepB
78
Oseltamivir
Neuramidase inhibitor
| Influenza
79
Gancyclovir
2-deoxyguanosine analogue
| CMV
80
Lamivudine
Nucleoside reverse transcriptase inhibitor (NRTI)
81
Efavirenz
NRTI
| HIV
82
Ritonavir
Protease inhibitor
| HIV
83
Amantidine
M2 ion channel inhibitor
84
Pemphigoid
Fluid filled blisters
| Ax - autoimmune
85
Actinic keratosis
Brown-red-warty lesion w/ rough consistency
| Hist - solar elastosis, focal parakeratosis, premalignant
86
Lichen planus
7 p's - pruritic, purple, polygonal, planar, popular, plaques, pearl sheen.
87
Vit B12 def
Pernicious anaemia, assoc w/ graves, megaloblastic anaemia
88
Vit C def
Bleeding gums, poor dentition
89
Vit E def
poor coordination, areflexia
90
B1/Thiamine
Alcholics, wernicke's encephalopathy,
91
Burkitt's
Starry sky
92
Hodgkin's lymphoma
Reed-Sternberg, pain after ETOH
93
Mantle cell lymphoma
Translocation 11;14 (BCL-1 locus +cyclin D1)
94
Follicular lymphoma
Centrocytes+centroblasts, translocation 14;18, BCL-2
95
Diffuse large B-cell lymphoma
Large B-cells +ve for EBV (or HHV8), HIV
96
Angiocentric lymphoma
NK-cell markers and EBV infx
97
Cyclophosphamide
Alkylating agent
| SLE, Wegeners/GPA
98
Abatacept
CTA4-Ig
| RA resistant to methotrexate
99
Mycophenolate mofetil
prevents guanine synth
| Pre-transplant immsup
100
Infliximab
TNF-alpha antagonist
101
Denosumab
Ab against RANK
| Osteoporosis
102
Basiliximab
Ab against IL-2alpha receptor
103
Rituximab
CD20 monoclonal Ab
| Lymphoma, RA, SLE
104
Candida albicans
Oral - creamy white patches, Tx - nystatin
| Vaginal - cottage cheese like clumps
105
Cryptococcus neoformans
India ink CSF analysis = yeast cells with halos
Immcomp pts
Subacute/chronic meningitis
106
Pityriasis versicolour
Hypo/Hyper pigmentation
| Spaghetti and meatball appearance
107
Aspergillus
Pneumonia, spherical opacity aspergilloma, immcomp
108
Sporothrix schenckii
Rose gardener's disease
109
Tinea corporis
Ringworm
110
Tinea capitis
expanding ring on scalp
111
Nephritic syndrome
Haematuria, red cell casts, white cell casts
112
Goodpasture's
Anti-glomerular basement mebrane Ab
Crescent morphology
Haemoptysis+haematuria
113
Acute tubular necrosis
Muddy casts
114
IgA nephropathy/Berger's disease
1-4 days after resp/gastro infx
| Frank/microscopichaematuria 50:50
115
Homocystinuria
Fair skin brittle hair
| Dev delay+convulsions
116
Phenylketonuria
Musty smell
| Developmental delay low IQ
117
Von Gierke's
Floppy, Hypoglycaemia, HepMeg, Renomeg
118
Maple syrup urine disease
Sweet odour+sweaty feet
119
Fabry's
Cherry red spot
120
Essential thombocythaemia
+++Plts >600
| Px - burning sensation in extremities, DVT,
121
Myelofibrosis
Dry tap on BM aspirate, tear drop cells
122
Multiple myeloma
Bence-Jones proteins in urine, lytic lesions on XR, rouleaux
123
Chronic myelo-monocytic leukaemia
Elderly, monocytosis >1000/mm3, myeloblasts <20% peripheral bld
124
Polycythaemia ruba vera
JAK2 mutation, pruritus after hot baths, low erythropoietin
125
Refractory anaemia w/ excess blasts
<5% myeloblasts in BM w/ >15%erythrocyte precursors
126
Refractory anaemia
<5% myeloblasts in BM
127
Post streptococcal glomerulonephritis
preceeding GAS pharyngitis, anti-streptolysin raised
128
Rapidly progressive glomerulonephritis
ESRF in days, needing transplant,
129
Minimal change
Commonest cause of nephrotic syndrome, triggered by recent allergic reaction
130
Brucellosis
Unpasturized dairy products, farm animals, castaneda medium
131
Lyme disease
Borrelia burgdorferi, ixodes ticks
132
Leptospirosis
Microscopic agglutination, drinking water
133
Duct ectasia
green discharge from nipple
134
Fibroadenoma
Soft, mobile, breast mouse, fluctuates cyclically
135
Ductal carcinoma in situ
Calcification
136
Phylloides tumour
Artichoke like appearance
137
Intraductal carcinoma
Invasive, peau d'orange
138
Mastitis
Breast feeding mothers
139
Phenytoin
Antiepileptic
| SE: hypotension, heart block, vent arrhythmias, ataxia
140
Lithium
```
Tx of bipolar
Monitoring essential (12hrs post dose) due to toxicity i.e. D+V, coarse tremor, dysarthria
```
141
Gentamicin toxicity
Ringing in ears - ototoxic and nephrotoxic
| Aminoglycoside Abx
142
Digoxin toxicity
Prolonged PR interval and brady
143
Theophylline
Tx of asthma + COPD
| Severe toxicity may lead to seizures
144
Methotrexate
Antifolate drug
| Toxicity - leukocytopenia, ulcerative stomatitis
145
Carbemazepine
Anti-convulsant
| Toxicity - headaches, ataxia, abdo pain
146
Cyclosporine
Immsuppressant
| Toxicity - AKI
147
Anaemia of chronic disease
Ax - RA
| His - microcytic hypochromic anaemia, inc ferritin
148
Temporal arthritis
Inc ESR
149
Secondary polycythaemia
Ax - Chronic hypoxia, renal disease, solid tumours (renal+liver)
Raised Hb, erthyrocyte, erthyropoeitin
150
Eosinophilia
Parasitic infection i.e. schistosomiasis
151
Haem effects 'Acute pancreatitis'
Neutrophilia
152
Haem effects 'EBV'
Reactive lymphocytosis
153
Western blot
HIV test
154
Kveim test
Sarcoidosis
155
Direct antiglobulin test (DAT)/direct Coombes test
Autoimmune haemolytic anaemia (AIHA)
| Ax - SLE, lymphoproliferative disorders, drugs
156
Skin prick test
T1 hypersens reactions i.e. allergic to food, inhalants or specific materials
157
Patch testing
Allergen in contact dermatitis
158
Immunofluorescence
Henoch-Schonlein purpura
159
Histocompatibility testing
Pre transplant test to assess compatibility
160
Mumps
Parotitis, amylase inc, orchitis,
161
Listeria
Meningitis <3mnths, grm +ve rod
162
Measles
Koplik's spots, rash behind ears, prodrome
163
Haemophilus influenzae
Meningitis >3mnths, grm -ve rod
164
Rubella
sub occipital+post-aruicular LN's
| Congenital rubella syndrome - sensorineural deafness, eye abnormalities, congenital heart disease
165
Syphilis
HepSplenMeg, rash, Saddle shape nose, neuro involvement (neurosyphilis)
166
Cafe-au-lait Spots
Fibrous dysplasia (McCune-Albright syndrome)
167
Pseudo-fractures/looser zones
Osteomalacia
168
DEXA<2.5
Osteoporosis
169
Recurrent chest infx, low T cells+non-functioning b cells
SCID
170
Low Neutrophil count
Kostmann's
171
Low IgA/M/G levels
Bruton's
172
Cardiac abnormalities, abnormal facies, thymus aplasia,, cleft palate, hypocalcaemia, 22q11.2 deletion
DiGeorge
173
Gomori's methanamine silver stain 'flying saucer'
Pneumocystis jirovecii
