Path Flashcards
(485 cards)
1
Q
Which medication is gold standard for the treatment of MSSA?
A
Flucloxacillin IV
2
Q
A transplant patient presents to his GP with diarrhoea and abdominal pain. He also complains of increased frequency visual floaters. What is the likely causative organism?
A
Human Cytomegalovirus
3
Q
One of your patients on the labour ward gives birth to a child. You perform a newborn examination and note loss of the red reflex, microcephaly and a widespread non-blanching rash that coalesces into violaceous patches. What is the most likely causative organism of this congenital syndrome?
A
Varicella zoster virus
4
Q
Select the only drug in the list below that does not inhibit viral nucleic acid synthesis: A) Cidofovir B) Foscarnet C) Ganciclovir D) Nevirapine E) Saquinavir
A
saquinavir
5
Q
A 20-year-old student seeks medical attention due to recent difficulty in swallowing, and severe weight loss. He has a history of travel in Brazil, where during his trip he was ill with fever, diarrhoea, and vomiting, and swollen purple eyelids. This resolved over 3 weeks with no treatment being necessary. A chest x-ray is ordered as one of his investigations, and this reveals marked dilatation of his oesophagus. Which vector is responsible for transmitting this disease?
A
Reduviid bugs
6
Q
A young patient with visual hallucinations and seizures is admitted to the hospital. His routine bloods show a deranged clotting and abnormal LFTs. Which of the following stains would be most useful to identify the underlying cause of his symptoms?
A
rhodanine
7
Q
What is the most common cause of chronic pancreatitis?
A
alcohol
8
Q
most common benign liver lesion
A
haemangioma
9
Q
A patient with alcohol related liver disease undergoes a biopsy and is found to have cirrhosis. What is the stage of his liver disease?
A
F4
10
Q
A 7 year old child presents with recurrent severe bacterial meningitis. There is a family history of childhood death from meningococcal sepsis. Immunological investigations show normal levels of C3 and C4, and abnormal CH50 and AP50. What is the most likely diagnosis? C1q deficiency Factor B deficiency SLE Mannose binding lectin deficiency C7 deficiency
A
C7 deficiency
11
Q
A 3 year old child with recurrent infections has been found to be neutropenic on two occasions. There is a mutation in neutrophil elastase (ELA-2). What is the diagnosis?
A
cyclic neutropenia
12
Q
young adult presents to clinic with chronic Mycobacterium marinum infection. An NBT test is positive. What is the most likely diagnosis?
A
deficiency of IL12 or IFN gamma or their receptors
13
Q
dendritic cells that are present in skin
A
langerhans cells
14
Q
reversible cause of nephrogenic DI
A
hypercalcaemia
15
Q
causes of hypovolaemic hyponatraemia
A
diuretics, D/V, burns, ascites, Barter syndrome, Addisons
16
Q
low serum sodium, normal serum osmolality
A
myeloma, paraprotein, lipids, alcohol
17
Q
most common cause of addison’s worldwide
A
TB of the adrenals
18
Q
t(9;22) is present in
A
CML and ALL
19
Q
how does APML present
A
like AML but also with DIC.
20
Q
how is APML treated
A
all-trans retinoic acid (metabolite of vitamin A)
21
Q
criteria for smouldering myeloma and multiple myeloma
A
monoclonal antibody > 30g/l, clonal plasma cells >10%
22
Q
What monoclonal antibody targets IL-17 and is involved in the treatment of psoriasis, psoriatic arthritis and ankylosing spondylitis?
A
secukinumab
23
Q
Which joints in the hand are classically not affected by rheumatoid arthritis?
A
distal interphalangeal joints
24
Q
What protein is defective in X linked Severe Combined Immunodeficiency?
A
common gamma chain in IL-2 receptor (needed for T cell proliferation)
25
A mutation in what protein is the most common cause of Hyper IgM syndrome?
```
CD40
class switching requires activation of CD40 on surface of B lymphocytes to occur
```
26
What enzyme, deficient or defective in chronic granulomatous disease, is responsible for the "respiratory burst" that may kill phagocytosed pathogens?
NADPH oxidase
27
Which subtype of T helper cells are implicated in the development of allergic diseases, such as asthma or eczema
T helper 2 cells
28
What monoclonal antibody targets IL-23 and IL-12 and is used in the treatment of psoriasis or psoriatic arthritis?
ustekinumab
29
What lymphocyte lineage does cyclophosphamide predominantly inhibit?
B cells
30
CD3 is typically a marker of what immune cell?
T cells
31
CD14 is typically a marker of what type of immune cell?
macrophages
32
When evaluating patients for coeliac disease, in addition to serology for anti-TTG and anti-endomyseal antibodies.
What other blood test should be performed to correctly interpret these serological tests?
serum IgA
33
What monoclonal antibody targets CD25 and is used in the prophylaxis and treatment of allograft rejection?
basiliximab
| CD25 is a component of IL-2 receptor
34
peptide found on surface of all B and T lymphocytes
CD52
35
What monoclonal antibody targets CD52 and causes depletion of all lymphocyte subsets?
alemtuzumab
36
what does AST stand for
aspartate aminotransferase
37
Troisier's sign
when you find Virchow's node
38
basophilic stippling is found in...
beta thalassemia trait
| lead poisoning
39
What happens in renal tubular acidosis
damage to kidneys --> defect in hydrogen ion secretion in renal tubule --> more potassium excretion to balance out increased sodium reabsorption --> hypokalaemia, acidosis
40
most common type of malignancy in breast
invasive ductal carcinoma
41
fibroadenoma in breast
mobile, well circumscribed lump
| size fluctuates with menstrual cycles and grows rapidly in pregnancy
42
African sleeping sickness is transmitted by...
tsetse fly
43
Organisms responsible for acute and chronic infections of Human African trypanosomiasis
```
acute infection = trypanosoma brucei rhodesiense (r for rapid)
chronic infection (takes months/years for sx to appear) = trypanosoma brucei gambiense
```
44
Von Gierke's disease
glycogen storage disorder
unable to convert glycogen into glucose
hypoglycaemia, hepatomegaly, kidney enlargement, floppy
45
subdural haemorrhage
hx of trauma
| haematoma is slow to form so takes around 48h for sx of raised ICP to appear --> increasing headache, confusion
46
galactossaemia
newborn with cataracts, poor feeding, lethargy, conjugated hyperbilirubinaemia, reducing sugars in urine
47
homocysteinuria
amino acid disorder, resulting in build up of homocysteine --> fair skin, brittle hair, learning difficulties, convulsions, thrombotic episodes
48
Fabry's disease
cherry red spot
49
glucagon
stimulates gluconeogenesis in liver
50
carcinoid syndrome
collection of sx due to release of serotonin from neuroendocrine tumour
flushing, palpitations, tachycardia, diarrhoea, loss of appetite
RAISED URINE 5IHAA
51
Microscopic polyangitis
pulmonary haemorrhage + glomerulonephritis
| pANCA
52
JCV is associated with
progressive multifocal leukoencephalitis
53
Herald patch
pityriasis rosacea
54
enzyme that is raised in chronic alcohol cirrhosis
AST
| S for smirnoff
55
antigen test for candida/aspergillus/pcp looks for?
beta d glucan
56
antigen test for aspergillus looks for?
beta d glucan + galactomannan
57
diagnostic test for tinea / trichophyton
potassium hydroxide mixed with nail/skin clippings
58
tx for mucocutaneous / visceral leishmaniasis
amphotericin B
59
gold standard dx test for visceral leishmaniasis
splenic / bone marrow aspirate
60
Jarisch Herxheimer reaction
antibiotic tx damages bacterial cell membranes --> release of endotoxins --> systemic inflammatory reaction --> significant drop in BP + acute end organ injury
life threatening!
61
stain for melanin
fontana stain
62
predominant cells in acute inflammation
neutrophils
63
predominant cells in chronic inflammation
lymphocytes
64
Layers of epidermis
```
corn lovers grow some bales
stratum corneum
stratum lucidum
stratum granulosum
stratum spinosum
stratum basale
```
65
pre malignant condition for skin sqcc
Bowen's disease
66
portal triad includes:
portal vein, hepatic artery, bile duct
67
zones in sinusoid
zone 3 = periportal
zone 2 = midzone
zone 1 = periventricular
drains into central vein
68
acute hepatitis histology
spotty necrosis
69
chronic hepatitis histology
fibrosis (F4=cirrhosis)
| interface hepatitis
70
cirrhosis features + histology
features - fibrosis, necrosis, nodules of regenerating hepatocytes, distortion of vascular architecture, intrahepatic + extrahepatic shunting
histology - deposition of ECM in space of disse, stellate transformation, kupffer cell activation
71
alcoholic liver disease includes:
hepatic steatosis
alcoholic hepatitis
alcoholic cirrhosis
72
alcoholic cirrhosis histology
micronodular cirrhosis
| shrunken brown organ
73
alcoholic hepatitis histology
fibrosis
mallory denk bodies
hepatocyte ballooning
74
main cause of non-alcoholic fatty liver disease
insulin resistance, therefore assoc. with high BMI + diabetes
75
primary sclerosing cholangitis histology
```
assoc. with UC
pANCA
periductal bile duct fibrosis --> strictures
beading of bile ducts on ERCP
assoc. w/cholangiocarcinoma
```
76
primary biliary cirrhosis histology
assoc. with female, autoimmune conditions
anti-mitochondrial antibodies
progressive autoimmune destruction of bile ducts --> chronic inflammation with granulomas + cholestasis --> build up of toxins + bile --> xanthelasma, jaundice, pruritis
77
A1AT deficiency histology
hepatocytes are unable to secrete a1at in blood (usually leave liver cells to blood to protect lungs + other organs)
misfolded proteins build up in hepatocytes --> CHRONIC HEPATITIS + PERIPORTAL RED HYALINE GLOBULES on PAS stain
78
benign liver conditions
haemangioma
liver cell adenoma (assoc. w/ COCP)
bile duct adenoma
79
liver malignancies + associations
```
hepatocellular carcinoma (assoc. w/ viral hepatitis, alcoholic cirrhosis, haemochromatosis, NAFLD, aflatoxin)
cholangiocarcinoma (assoc. w/ PSC)
```
80
C. difficile 3 C's
ciprofloxacin, cephalosporins, clindamycin
81
extra intestinal sx of IBD
```
anterior uveitis
stomatitis
arthritis
erythema nodosum
pyoderma gangrenosum
```
82
non-neoplastic polyps in colon
hyperplastic polyps
inflammatory pseudopolyps
hamartomatous polyps
83
what features of colonic polyps would increase risk of cancer
many polyps
larger polyps
HIGHER VILLOUS COMPONENT
dysplastic features
84
neoplastic polyps in colon
tubular adenoma
tubulovillous adenoma
villous adenoma
85
Duke's staging for colorectal cancer
A - confined to mucosa
B1 - extending into muscularis propria
B2 - extending through bowel wall
C1 - extending into muscularis propria WITH LN involvement
C2 - extending through bowel wall WITH LN involvement
D - distant metastases
86
Familial adenomatous polyposis
autosomal dominant
mutation in APC tumour suppressor gene
lots of polyps (>100 needed for dx)
cancer within 10-15 years
87
Mx of inherited colon conditions
monitoring + total colectomy
88
Gardner's syndrome
autosomal dominant
| subtype of FAP + extraintestinal features (skull/mandibular osteomas, dental caries)
89
HNPCC / Lynch syndrome
autosomal dominant
mutations in DNA mismatch repair genes
colon cancer + concurrent extra-colonic cancer (eg ovarian, endometrial, small bowel, stomach carcinoma)
90
stain for goblet cells
methylene blue
91
stomach body & fundus histology
```
columnar epithelium
parietal cells (intrinsic factor, acid)
chief cells (pepsin)
```
92
stomach pylorus histology
```
columnar epithelium
neuroendocrine cells (gastrin)
```
93
ulcers vs erosion
ulcers - loss of tissue goes beyond mucosa & into submucosa
| mucosa - loss of tissue is limited to mucosa (basement membrane intact)
94
types of gastric cancer
intestinal adenocarcinoma
diffuse adenocarcinoma
MALT lymphoma
95
intestinal adenocarcinoma histology (gastric malignancy)
well differentiated
mucin production
gland formation
96
diffuse gastric adenocarcinoma histology
single cell architecture
signet ring cells
no glands formed
97
duodenum histology
columnar epithelium with goblet cells
| 2:1 villous to crypt ratio
98
duodenal ulcers:
1) anterior ulcers lead to...
2) posterior ulcers lead to...
1) performation --> peritonitis
| 2) erosion of gastroduodenal artery --> haemorrhage --> malaena + hypotension
99
what is lymphocytic duodenitis
what happens before Coeliac's
| increased intraepithelial lymphocytes but w/o structural changes
100
pancreatic cells + function
```
acinar cells (secrete digestive enzymes)
exocrine cells (secrete pancreatic juice)
islet cells (secrete hormones)
duct cells (line ducts)
```
101
complications of acute pancreatitis
pancreatic --> pseudocyst, abscess
| systemic --> hypoglycaemia, hypocalcaemia, shock
102
acute pancreatitis histology
duct obstruction + direct acinar injury --> inflammation, leaking of pancreatic enzymes
103
chronic pancreatitis histology
chronic inflammation
fibrosis
duct strictures
loss of parenchyma
104
tumours of pancreas
```
ductal carcinoma (85%)
acinar carcinoma
neuroendocrine tumours
```
105
marker of neuroendocrine tumours
chromogranin
106
most common site of pancreatic ductal carcinoma
head of pancreas
107
asthma histology
```
charcot leyden crystals
airway remodelling
smooth muscle hypertrophy
goblet cell hyperplasia
eosinophilia
```
108
COPD histology
neutrophil infiltration into airways
| loss of alveoli, elastic fibres, lung parenchyma
109
bronchiectasis histology
dilated fibrotic airways with mucous plugging
110
diffuse alveolar damage due to adult/neonatal RDS
1) histology
2) CXR
1) exudative inflammatory reaction
| 2) white out of all lung fields on CXR
111
pulmonary oedema histology
1) acute
2) chronic
1) intra alveolar fluid
| 2) IRON LADEN MACROPHAGES (indicated heart failure), fibrosis
112
small cell lung cancer histology
oat cells
| found centrally near bronchi
113
paraneoplastic syndrome assoc. w/ lung sqcc
hypercalcaemia of malignancy
114
papillary thyroid cancer histology
psammoma bodies
orphan annie eyes
optically clear nuclei
intranuclear bodies
115
medullary thyroid cancer cells
parafollicular C cells
116
osteosarcoma histology
found in adolescence
"sarcastic fisherman's son"
elevated periosteum --> codman's triangle + sunburst appearance
117
Ewing's sarcoma histology
found in children
in long bones + pelvis
sheets of small round cells --> onion skin appearance of periosteum
118
chondrosarcoma histology
```
malignant chondrocytes (cartilage formation)
fluffy calcification
```
119
giant cell histology (in bone malignancy)
20-40yo female
osteoclast-type multinucleate giant cells
lytic lesions
120
enchondroma
cotton wool calcification
121
osteoid osteoma
adolescent males
proximal femur
Bull's eye sign on XR
bone pain at night, relieved by aspirin
122
osteochondroma
cartilage capped bony outgrowth --> mushroom like appearance on XR
123
Albright syndrome
fibrous dysplasia
precocious puberty
cafe au lait spots
124
fibrous dysplasia
chinese letters
soap bubble ostolysis
shepherd's crook deformity
125
mucinous cystadenocarcinoma
pseudomyxoma peritonei
126
serous cystadenocarcinoma
psammoma bodies
127
brenner tumour
benign
| coffee bean nuclei
128
endometrial cancer type 1 vs type 2
type 1 - more common, oestrogen dependent, younger patients, assoc. w/ atypical endometrial hyperplasia
type 2 - oestrogen independent, older patients, assoc. w/ atrophic endometrium
129
granulosa cell tumour
produces oestrogen, causing precocious puberty / endometrial hyperplasia
cal exner bodies
130
yolk sac tumour
produces AFP
| schiller duval bodies
131
dysgerminoma
assoc. w/ Turner's
| secretes HCG + LDH
132
what is duct ectasia
perimenopausal women
benign
milk ducts dilate + are inflamed + walls thicken --> ducts blocked --> fluid build up
nipple discharge, pain, mass
133
duct ectasia discharge cytology
proteinaceous material + inflammatory cells
134
intraductal papilloma
bloody discharge
| benign
135
what gives good/bad prognosis in breast cancer
ER/PR +ve = good prognosis as responds to tamoxifen
| HER2 +ve = poor prognosis
136
invasive breast ductal carcinoma histology
big, pleomorphic cells that move into stroma
137
invasive breast lobular carcinoma histology
cells in single file chains
138
prinzmetal angina cause
coronary artery spasm
| uncommon!
139
complications of MI
```
DARTH VADER
Death
Arrhythmia
Rupture
Tamponade
Heart failure
```
```
Valve disease
Aneurysm
Dressler syndrome
Embolism
Recurrence
```
140
dilated cardiomyopathy histology
loss of myocytes
141
MI histology <6h
normal histology
142
MI histology 6-24h
loss of nuclei, homogenous cytopasm, cell necrosis
143
MI histology 1-4d
polymorphs + macrophages clear debris
144
MI histology 5-10d
further removal of debris
145
MI histology 1-2 weeks
rebuilding - granulatino tissue, new blood vessels, collagen synthesis
146
MI histology weeks-months
scar tissue formation
147
Which enzyme, synthesised by the pancreas, is most sensitive for the diagnosis of pancreatitis?
lipase
148
most common malignancies in women
```
breast
lung
bowel
uterus
other
```
149
most common malignancies in men
```
prostate
lung
bowel
head and neck
other
```
150
flow murmur
soft, sytolic murmur heard best at left lower sternal edge
| found in hyperdynamic circulations - pregnancy, anaemia, severe blood loss
151
Kimmelstiel Wilson nodules
found in kidneys
| associated with diabetes
152
benign familial haematuria inheritance pattern
autosomal dominant
153
most common cancer in UK
breast cancer
154
most common renal tumour
renal cell carcinoma (clear cell, papillary, chromophobe)
155
biomarker for hepatic ischaemia
raised ALT
156
What is the cancer with the highest mortality in the UK?
lung cancer
157
aschoff bodies
acute rheumatic fever
158
most common type of small cell lung cancer in UK
| + 2nd most common
most common = adenocarcinoma, then sqcc
159
gleason scoring system for prostate cancer
first number = most common cell type seen
| second number = most aggressive cell type seen
160
crescent shaped mass underlying the left parietal bone on CT
subdural haemorrhage
161
waxy casts
chronic kidney disease
162
muddy casts + epithelial casts
acute tubular necrosis
163
white cell casts
acute interstitial nephritis
164
tx for human tapeworms
praziquantel
165
sinusitis abx
phenoxymethylpenicillin
166
haemophilus ducreyi
causes multiple painful necrotising genital ulcers + inguinal lymphadenopathy
167
argyll robertson pupil
pupil accmmodates but does not react to light
| found in late stage syphillis
168
malaria species with tertian fevers vs quartan fevers
```
tertian fever (every 2 days) = P. falciparum, P. vivax, P. ovale
quartan fever = P. malariae
```
169
halo sign
on CT = aspergillus
| on CSF = cryptococcus
170
sx of severe malaria
parasitaemia > 2%, altered consciousness, met acidosis, organ failure, resp distress, circulatory collapse
171
infectious mononucleosis on blood film
atypical lymphocytes
172
Maurer's clefts
p. falciparum invades RBCs + forms disc like granulations that can be seen on thin blood film
173
Takotsubo's cardiomyopathy
triggered by intense emotional/physical stress
| looks like MI
174
extradural haemorrhage
middle meningeal artery
175
alport's syndrome inheritance pattern
X-linked
176
alport's triad
nephritic syndrome
sensorineural hearing loss
cataracts
177
adult polycystic kidney disease mutation
defect in polycystin 1
178
high anion gap suggests...
presence of ketones
179
antifungal groups
```
polyenes
azoles
allylamines
echinocandin
pyrimidine analogue
```
180
polyenes function + eg
inhibits ergosterol function
(polly says, "I just can't function, B!" cos she just saw the guy with the nice smile)
e.g., amphotericin B, nyastatin
181
azoles function + eg
inhibits ergosterol synthesis, e.g., fluconazole
182
echocandins function + eg
inhibits cell wall synthesis, e.g., caspofungin
183
allylamines function + eg
inhibits ergosterol synthesis, e.g., terbinafine
184
pyrimidine analogue function + eg
inhibits DNA/RNA synthesis, e.g., flucytosine
185
metabolic acidosis, high anion gap but low glucose + no ketones?
think lactic acidosis
186
14-3-3 protein indiciates...
rapid neuro degeneration
187
what should diabetics do when ill
continue insulin regimen as usual
more regular monitoring of blood glucose + urinary ketone levels
if struggling to eat, may need sugary drinks
188
diabetic drug that can help with weight loss
sulphonylureas (eg gliclazide)
189
```
examples of the following antidiabetic drugs:
GLP-1 mimetics
DPP4 inhibitors
SGLT2 inhibitors
sulphonylureas
Thiazolidinediones
```
```
GLP-1 mimetics = -tide
DPP4 inhibitors = -gliptin
SGLT2 inhibitors = -flozin
sulphonylureas = gliclazide
Thiazolidinediones = pioglitazone
```
190
Brucella ix
blood/pus culture on castenada medium
191
toxoplasmosis ix
sabin feldman dye test
192
negri bodies on neural cells
rabies
193
gold standard test for leptospirosis
microscopic agglutinnation test
194
hantavirus
acquired from contact with mice/rat urine/droppings
| causes hantavirus pulmonary syndrome / renal failure or bleeding
195
hypoglycaemia, low insulin, low c peptide, low FFAs, low ketones
non-pancreatic neoplastic tumours (e.g., mesothelioma, fibroblastoma, carcinoma) producing IGF-1 that is binding to insulin receptors + triggering glucose uptake
196
hypoglycaemia, low c peptide, high FFAs, low ketones
inborn errors of metabolism
197
nesidioblastosis
excessive function of pancreatic beta cells --> hyperinsulinaemic hypoglycaemia
198
Waterhouse Frierichsen syndrome
meningococcal infection --> bleeding into adrenal gland --> adrenal failure
199
HAP tx
ciprofloxacin + vancomycin
200
HAP examples
staph aureus
klebsiella
pseudomonas
e coli
201
hospital acquired UTI tx
cefalexin/augmentin
202
Hashimoto's
herthle cells
203
alpha glucosidase inhibitors
inhibit absorption of glucose in small bowel
| e.g., acarbose
204
raised reticulocytes indicates...
reticulocytes = immature RBCs
| there is an increased demand for bone marrow to produce RBCs so it sends RBCs out before they are mature
205
CMV retinitis
seeing small specks / visual floaters
206
Familial mediterranean fever Mx
1) colchicine
2) anakinra (IL-2 inhibitor)
3) etanercept (TNF alpha inhibitor)
207
Kostmann's mutation
HAX1 mutation
208
cyclical neutropenia mutation
mutation in neutrophil elastase
209
Chagas disease
spread by reduviid bugs
in South America
causes general flu sx, swollen eyelids, enlarged spleen/liver/lymph nodes
210
acute phase proteins that cause fever
IL-1
| IL-6
211
polyarteritis nodosa is assoc. w/ which virus?
hep B
212
chronic granulomatous disease - increased susceptibility to...
infection due to catalase positive organisms, e.g., e coli, staph aureus, listeria, klebsiella
213
SIADH tx
```
fluid restrict
tx cause
demeclocycline
(increases ADH resistance)
tolvaptan (ADH receptor antagonist)
```
214
nephrogenic DI tx
thiazide diuretics
215
why does taking loop diuretics/Bartter's syndrome lead to hypokalaemia?
inhibits Na/K/Cl transporter so less Na is reabsorbed + therefore more Na is delivered distally + then reabsorbed --> negative charge in lumen --> K is excreted via ROMK channels to balance out charge --> hypokalaemia
216
why does taking thiazide diuretics lead to hypokalaemia
inhibits Na/Cl symporter in DCT --> less Na reabsorbed, more Na delivered distally, more Na reabsorption --> negative charge in tubule --> more K excretion from ROMK channels
217
Schmidt's
hypothyroidism + addison's
218
DEXA score for osteoporosis
< -2.5
219
DEXA score for osteomalacia
between -1 and -2.5
220
Gilbert's syndrome defect
deficiency in UDP glucoronyl transferase (enzyme that is needed to conjugate bilirubin)
221
familial benign hypercalcaemia
defective calcium sensing receptor on parathyroid glands --> parathyroid cannot detect calcium --> release lots of PTH even though Ca is normal
222
how to differentiate between primary PTH and FBH
calcium : creatinine clearance ratio is lower in FBH
223
micronodular cirrhosis
alcoholic cause
| biliary tract disease
224
indications for dialysis
```
metabolic acidosis
uraemia sx (encephalopathy, nausea, malaise, pruritis), fluid overload, hyperkalaemia, CKD stage 5
```
225
Peutz jegher syndome
freckling around mouth
hyperpigmentation of mucosa
multiple hamartous polyps
226
bisphosphonates MoA
cause apoptosis of osteoclasts
227
pseudohypoparathyoidism biochemical results
resistance to PTH
| high PTH, low Ca, high phosphate
228
pseudopseudohypoparathydoism
features of Albright's syndrome but normal biochemical results + no PTH resistance
229
macrophages in liver
kupffer cells
230
macrophages in kidney
mesangial cells
231
macrophages in bone
osteoclasts
232
macrophages in neural tissue
microglia
233
macrophages in skin
langerhans cells
234
all T cells express...
CD3
235
what kind of receptor do dendritic cells and polymorphs express to bind to immune complexes
Fc receptors which bind to antigens that are bound to antibodies
236
what is deficient in leukocyte adhesion deficiency
CD18
| required to bind to ICAM1 via LFA-1 (CD11a, CD18
237
deficiency of IL-12 or interferon gamma increases your susceptibility to...
mycobacteria
238
deficiency of this complement can result in SLE...
C2
239
Wiskott aldrich syndrome sx + biochemical results
eczema + immunodeficiency + thrombocytopenia
defect in WAS gene
low IgM, high IgA, high IgE
240
complement deficiency makes you susceptible to...
encapsulated bacteria, unable to make MAC!
241
ADA deficiency
enzymes in lymphocytes required for cell metabolism --> unable to respond to cytokines --> early arrest of T cells, NK cells, B cells!
242
X linked SCID biochemical results
low T cells + NK cells
| but NORMAL/HIGH B cells
243
salmonella typhi tx
IV ceftriaxone + PO azithromycin
244
cryoprecipitate vs FFP
```
FFP = equal concentration of clotting factors to blood, contains all factors
cryoprecipitate = more concentrated source, contains vwf, VIII, XIII, fibrinogen
```
245
relative polycythaemia
raised red cell mass but reduced plasma volume
| eg burns, dehydration, diarrhoea, vomiting, smoking, diuretics
246
rivaroxaban, apixaban, edoxaban
DOACs
| anti-Xa
247
multiple myeloma sx
Calcium high
Renal failure (+ amyloidosis, nephrotic syndrome)
Anaemia (+ pancytopenia)
Bones (pain, fractures, osteolytic lesions)
Hyperviscosity syndrome
248
Ann arbor staging
stage 1 = 1 LN group
stage 2 = 2 LN groups on the same side of the diaphragm
stage 3 = 2 LN groups on opposite sides of diaphragm
stage 4 = extranodal spread
249
type of necrosis assoc. w/ MI
coagulating necrosis
250
most common ovarian tumour
serous cystadenoma
251
nasopharyngeal carcinoma is assoc. w/ which virus?
EBV
252
most common type of glial cell in CNS
astrocyte
253
most common skin cancer
basal cell carcinoma
254
hormone released by adipose tissue + sends signals to hypothalamus
leptin
255
hepatitis B tx
```
interferon alpha
nuceloside analogues (-vudines, -avirs, -ovirs), e.g., lamivudine, telbivudine, tenofovir, entacevir)
```
256
hepatitis c tx
interferon alpha
NS3/4 inhibitors (-previrs)
NS5a inhibitors (-asvirs)
direct polymerase inhibitors (-buvirs)
257
most common type of CJD
sporadic
258
pyrin
found in neutrophils
major role in regulating inflammation
defect --> unregulated activation of neutrophils
259
how does colchicine work in familial mediterranean fever
colchicine binds to tubulin in neutrophils + disrupts function
260
nikolsky sign
when bullae rupture easily, as seen in pemphigus vulgaris
261
globin chain composition in HbA, HbA2, HbF
HbA - 2 alpha, 2 beta
HbA2 - 2 alpha, 2 gamma
HbF - 2 alpha, delta
262
beta thalassemia sx
skull bossing
maxillary hypertrophy
hairs on end on skull XR
263
paroxysmal cold haemoglobinuria
viral illness --> donath landsteiner antibodies which bind + hemolyse RBCs when it is cold --> haemoglobinuria + DAT +ve
complement mediated haemolysis on rewarming
264
paroxysmal nocturnal haemoglobinuria
DAT -ve
| complemented haemolysis of RBCs, happens usually at night
265
what is activated protein C complex made up of
protein C + thrombomodulin + thrombin
266
what happens after platelets bind to collagen/vwf
release ADP / thromboxane A2 --> platelet aggregation
267
what happens after platelets bind to collagen/vwf
platelets release ADP / thromboxane A2 --> triggers expression of glp2b/3a on surface of platelets --> allows binding to fibrinogen --> platelet aggregation + activation
268
Tx after splenectomy
vaccinations
| daily penicillin lifelong
269
rapidly progressive glomerulonephritis on light microscopy
crescents
270
types of rapidly progressive glomerulonephritis
Type 1 - Goodpasture's, linear deposition
Type 2 - immune complex mediated, granular deposition, eg SLE
Type 3 - pauci immune, scanty deposition, eg wegener's, microscopic granulomatosis
271
ergocalciferol
inactivated vit D obtained from diet
272
cholecalciferol
inactivated vit D obstained from sunlight
273
calcitriol
activated vit D
274
ix in haem malignancies
immunophenotyping to identify antigens + differentiate between myeloid/lymphoid
FISH/cytogenetic analysis/molecular genetic analysis to identify mutations
275
APML features + fusion gene
basically AML + DIC features (eg low fibrinogen)
Auer rods + myeloid blast cells
PML-RARA fusion gene t(15;17)
276
sx of hyposplenism on blood flm
Howell jolly bodies
| target cells
277
pseudomonas tx
ciprofloxacin + gentamicin
278
human rights - article 2
right to life - absolute, eg right to life saving tx, right to withdraw futile tx
279
human rights - article 3
prohibition to torture - absolute, eg excessive restraint, failure to stop suffering, non-consensual tx
280
human rights - article 5
right to liberty - relative, eg detention only lawful under MHA/DoLs + patient must be able to appeal
281
human rights - article 8
right to a private life - relative, eg right to confidentiality, right to refuse tx
282
PUO definition
temp > 38.3 for >3 weeks
283
ethics - what happens after someone dies
doctors verifies death, notifies consultant, fills in death certificate. Doctor then discusses cause of death with medical examiner.
If they are in agreement, they can either complete medical certificate of cause of death (MCCD) or complete a consented autopsy if family request it.
If cause of death is uncertain, refer to coroner, who will either complete MCCD or request an autopsy without familial consent.
284
effect of C botulinum on body
blocks Ach from peripheral nerves --> descending paralysis
285
CAR-T cell therapy indicated in...
Non-Hodgkin's lymphoma
| ALL
286
how does ipilimumab work
T cells have stimulatory receptors CD28 + inhibitory receptors CTLA4. which compete with one another to bind to CD80/86 on APCs. Ipilimumab binds to CTLA4 + blocks them from binding to CD80/86 --> only stimulatory receptors can bind --> activation + proliferation of T cells = IMMUNE BOOST!
287
how do pembrolizumab/nivolumab work
PD-1 = receptor on T regulatory cells. PD-1 binds to its ligands PDL-1 & PDL-2, which are found on surface of tumour cells + NK cells. Binding inhibits + inactivates T cells.
HOWEVER, pembrolizumab/novolumab binds + blocks PD-1, stopping binding to its ligands --> prevents inhibition + inactivation of T cells --> IMMUNE BOOST!
288
cyclophosphamide MoA
antiproliferative agent
| alkylates guanine
289
mycophenolate MoA
antiproliferative agent
| inhibits de novo guanosine synthesis
290
azathioprine MoA
antiproliferative agent
| inhibits de novo purine synthesis
291
test for paroxysmal noctural haemoglobinuria
HAM test
292
what does protein C do
binds to protein S + inhibits factors 5 & 8
293
Ethics death - When is consent required from family for an autopsy
when autopsy is done for research/educational purposes or when the cause of death has been agreed between doctor + medical examiner but family requests an autopsy anyway
294
Ethics death - When is consent not required from family for an autopsy
when cause of death is uncertain/suspicious/sudden/suicide/violent/not seen by doctor in last 28d/death under custody or MHA
295
human tissue act - who has priority when consenting to examination/removal/storage of dead body
1) patient before death
2) nominated rep
3) someone of qualifying relationship to patient (partner>parent>children>sibling>grandparent/grandchild>niece/nephew>step parents>half sibling>longstanding friend
296
human tissue act - who has priority when consenting to examination/removal/storage of dead body
1) patient before death
2) nominated rep
3) someone of qualifying relationship to patient (partner>parent>children>sibling>grandparent/grandchild>niece/nephew>step parents>half sibling>longstanding friend
297
how do PCSK9 inhibitors work?
PCSK9 normally degrades + downregulates the LDL receptors --> reduced uptake of LDL by the liver
inhibition of PCSK9 --> more LDL uptake + removal from blood
eg evolocumab
298
what happens when T cells + APCs bind
calcineurin is released --> stimulates release of IL-2 (important in activation of naive T cells + proliferation)
299
sirolimus
mTOr inhibitor --> inhibits IL-2 pathway --> inhibits activation of naive T cells + proliferation following binding to APCs
300
tofacitinib
JAK1/3 inhibitor --> inhibits production of inflammatory molecules
301
abatacept
opposite of ipilimumab
= CTLA4 analogue which binds to CD80/86 on APCs --> induces inhibitory effect --> suppression of T cells
used in rheumatoid arthritis
302
osteoprotegrin
osteoprotegrin is usually produced by osteoblasts to bind to RANKL --> prevents binding of RANKL to RANK receptor on osteoblasts
303
MGUS
basically what happens before multiple myeloma
NO CRAB Sx
<10% clonal plasma cells, <30g/l M spike
304
Multiple myeloma tx
1) alkylating agents (cyclophosphamide)
2) proteasome inhibitors (inhibits proteasome which is an enzyme that is able to degrade abnormal proteins in plasma cells; inhibition allows accumulation of abnormal proteins + cell death)
3) immune modulators
4) monoclonal antibodies
305
Pre-renal causes of AKI
```
sepsis
hypotension
dehydration (D+V)
haemorrhage
oedema
renal artery stenosis
drugs (NSAIDs, ACEi, diuretics, calcineurin inhibitors)
```
306
Castleman's disease
excess IL-6 produced --> lots of proliferation of B and T cells in lymph nodes
307
Mucormycosis
fungal infection found in immunocompromised + poorly controlled diabetes
DUE TO RHIZOPUS SPECIES
sx = blackened skin, blisters, fever, ulcers, swelling, redness
308
sideroblastic anaemia
excess iron in the body but unable to incorporate the iron into Hb to produce RBCs
high iron, high ferritin, normal/high transferrin, normal TIBC
309
washed blood
washing blood to get rid of plasma/platelets/wbcs in patients who have had a severe allergic reaction before
310
cell salvage
collecting blood that is lost during a major surgery, filtering, then reinfusing back into patient
311
emergency blood transfusion blood group
O- (no antigens available for recipient to have an immune response)
312
reactivation of virus following transplant
EBV
313
scarlet fever causative organism
group A strep (streptoccocus pyogenes)
314
CLL tx
ibrutinib
315
what organism is likely to cause bronchiectasis + what is assoc. w/ longstanding bronchiectasis
1) staph aureus
| 2) pseudomonas aeruginosa
316
Pretransplant immunosuppressants
alemtuzumab
basiliximab (anti-CD25)
ATG (anti-thymocyte globulin)
317
Posttransplant immunosuppressants
steroids
anti-proliferatives (eg mycophenelate, azathioprine)
calcineurin inhibitors (eg tacrolimus, cyclosporin)
318
acute cellular rejection of transplant tx
steroids
| ATG
319
acute antibody-mediated rejection of transplant tx
IVIG
| plasmapheresis
320
rate limiting step in heme biosynthesis pathway
ALA synthase
321
rate limiting step in salvage pathway for purine synthesis
HGPRT
322
Lesch Nyhan syndrome
deficiency in HGPRT --> hyperuricaemia --> severe childhood gout, renal impairment, self mutilating behaviour
323
P-amylase
pancreatic amylase
324
S-amylase
salivary amylase
325
high aldosterone + high renin
renal artery stenosis
326
which liver enzyme is raised in cocaine use
AST
327
what stimulates + inhibits prolactin
TRH stimulates
| dopamine inhibits
328
what to give after pituitary adenoma removal surgery
replace cortisol --> give hydrocortisone
| may give desmopressin if resulting central DI
329
most common type of CAH
21 hydroxylase deficiency
330
beta lactam with anti-pseudomonal activity
ceftazidime
331
diphtheria
highly contagious
affects nose, throat, skin, fever, swollen LNs
thick grey film over throat --> sore throat, breathing difficulties
332
tetanus
lock jaw
| painful muscle spasms
333
salmonella typhi tx
IV ceftriaxone + PO azithromycin
334
herd immunity threshold definition
the proportion of immune people in a population that is needed to stop spread of pathogen
335
characteristics of influenza A that could cause pandemic
novel antigenicity
efficient transmission between people
efficient replication within airway
336
most common cause of cellulitis
streptococcus pneumoniae
337
etanercept
TNF alpha inhibitor
| used in rheumatoid arthritis, ank spond, psoriasis
338
causes of hypovolaemic hyponatremia
dehydration
burns
salt losing nephropathy
Bartter's
339
low serum Na but normal osmolality
alcohol, lipids, paraproteins also present in serum
340
dabigatran
inhibits thrombin
341
ddx of anaphylaxis
urticaria
hereditary angioedema
ACEi induced angioedema
acute anxiety
342
heparin MoA
potentiates antithrombin
343
sudden chest pain radiating to neck
left anterior descending artery thrombus
344
secondary causes of nephrotic syndrome
diabetes
| amyloidosis
345
abdo pain radiating to back, collapse + death
acute aortic aneurysm
346
causes of raised anion gap metabolic acidosis
Ketones (DKA)
Uraemic (renal failure)
Lactic acidosis (metformin)
Toxins (ethylene glycol, methanol, salicylates)
347
why is LDH raised in haemolytic anaemia
LDH is found intracellularly so is released when RBCs are haemolysed
348
giving a baby with RDS too much O2 can lead to...
retinopathy
349
acute intermittent porphyria
autosomal dominant
neurovisceral sx only (peripheral neuropathy, painful abdomen, seizures)
deficiency of HMB synthase
350
porphyria cutanea tarda
cutaneous sx only
| deficiency of uroporphyrinogen decarboxylase
351
most common cause of hypothyroidism in UK
primary atrophic hypothyroidism
352
how does papillary thyroid cancer spread
via lymph nodes
353
how to prevent gvhd
irradiation to remove donor lymphocytes
354
post-thrombotic syndrome
swelling and chronic pain in the same location in the weeks-months following DVT
355
where is thrombomodulin found + what does it do
found on endothelium
binds to thrombin + protein C to form activated protein C complex, which then binds to protein S to then inhibit factors 5 + 8
356
virus assoc. w/ adult T cell lymphoma
HTLV1
357
Waldenstrom's macroglobinaemia (lymphoplasmacytoid lymphoma)
elderly men
increased monoclonal IgM
weight loss, fatigue, hyperviscosity
358
transfusion reactions - immediate within mins
anaphylaxis
359
transfusion reactions - mins to hrs
bacterial contamination
ABO incompatibility
febrile non-hemolytic transufsion reaction
360
transfusion reactions - within several hrs (<6h)
TRALI
| TACO
361
transfusion reactions - delayed >24h
delayed haemolytic transfusion reaction
| GvHD
362
haemostasis process
1) endothelial injury
2) von williebrand monomers bind + catch platelets
3) platelets bind + aggregate
4) platelets held together by fibrinogen
5) coagulation cascade to produce thrombin, which then activates fibrinogen + converts it into fibrin
6) fibrin stabilises platelet plug --> clot formation
363
regulators of coagulation
tissue factor pathway inhibitor
antithrombin
protein C/S
364
vwd mx
desmopressin
| factor 8 + vwf concentrates
365
vwd types
Type 1 - quantitative defect
Type 2 - qualitative defect
Type 3 - complete absence
366
glanzmann's thrombasthenia
defect in glp2b/3a --> no platelet aggregation
367
why is there an initial procoagulant state with warfarin
first inhibits protein C/S so initially causes a procoagulant state due to less inhibition by protein C/S
368
factor V Leiden
resistance to protein C/S --> less inhibition of factor 5 + 10 --> excess factor 5 --> more prone to thrombosis
most common prothrombotic disorder
369
which disorder of thrombosis carries the highest risk of thrombosis
antithrombin deficiency
370
most common thrombotic disorder
factor V Leiden
371
anaemia definition in men + women
<135 in men
| <115 in women
372
iron studies in iron deficiency anaemia
low iron
low ferritin
high transferrin
high TIBC
373
iron studies in sideroblastic anaemia
high iron
high ferritin
high transferrin
normal TIBC
374
iron studies in anaemia of chronic disease
high iron
high ferritin
low transferrin
low TIBC
375
sx of intravascular haemolysis
high serum LDH
low haptoglobin
dark urine
376
sx of extravascular haemolysis
increased splenic consumption therefore:
spherocytes
splenomegaly
urobilinogen in urine
377
G6PD on blood film
bite cells
| Heinz bodies
378
anaemia of chronic disease
longstanding inflammation --> inflammatory cytokines inhibits hepcidin --> inhibits ferroportin in liver + Fe absorption in gut --> less Fe released from stores --> body is unable to use iron + make RBCs
379
autoimmune haemolytic anaemia mx
tx underlying cause
steroids
rituximab
380
how many genes for alpha globin and beta globin synthesis
4 genes for alpha globin
| 2 genes for beta globin (homozygous, heterozygous, intermedia)
381
Hb Barts
no alpha globin chains
| incompatible with life --> hydrops fetalis + death in utero
382
HbH
1 alpha gobin chain out of 4
| severe anaemia in childhood
383
alpha thalassemia trait
mild anaemia
384
HbAS
sickle cell trait
385
HbSS
sickle cell anaemia
386
key features in sickle cell anaemia (4)
haemolytic crisis
aplastic crises
sequestration crises
infection
387
sickle cell anaemia mx
vaccinations
| daily penicillin
388
when is a pregnant woman most at risk of VTE
post-partum
389
gvhd tx + prevention
tx - steroids + ciclosporin (calcienruin inhibitor)
| prevention - methotrexate + ciclosporin
390
bone marrow failure dx
hypocellular + fatty bone marrow biopsy
391
beta globin gene
Chr 11
392
alpha globin gene
Chr 16
393
why do you get splenomegaly in sickle cell anaemia
vessels in spleen occluded repetitively over time --> fibrosis + calcification --> pooling of blood in spleen --> spleen gets bigger
394
hand-foot syndrome
red bone marrow exists not only in axial skeleton in kids but also in hands + feets --> may have sequestration of sickle cells in small vessels in hands/feet --> occlusion --> necrosis
395
warm autoimmune hemolytic anaemia
antibodies activated in room temp
IgG mediated (warm in Greece)
SLE, CLL
396
cold autoimmune hemolytic anaemia
antibodies activated in cooler temp
IgM mediated (cold in Moscow)
EBV, mycoplasma, hep C
397
ANA vs anti-dsDNA in SLE
ANA is more sensitive but less specific than anti-dsDNA
398
most common primary tumour of heart
myxoma
399
most common cause of constrictive pericarditis in developing world
tuberculosis
400
what enzyme does allopurinol inhibit
xanthine oxidase
401
cause of hypercalcaemia in sarcoidosis
lung macrophages produces 1 alpha hydroxylase
402
mumps causative organism
mumps orthorubulavirus
403
Which hepatitis virus is associated with more severe disease if acquired in pregnancy potentially leading to fulminant hepatic failure and death?
hepatitis E
404
anti thymocyte globulin
thymocyte (lymphocytes from thymus) isolated
injected into rabbit
rabbit forms antibodies against human lymphocytes
antibodies extracted + infused into human --> non-specific immune response against lymphocytes
(given as a pretransplant immunosuppressant)
405
anti thymocyte globulin
thymocyte (lymphocytes from thymus) isolated
injected into rabbit
rabbit forms antibodies against human lymphocytes
antibodies extracted + infused into human --> non-specific immune response against lymphocytes
(given as a pretransplant immunosuppressant)
406
muscle weakness, ptosis, sx get worse with exercise, sx improve with tensilon injection
myasthenia gravis
407
features of myelodysplastic syndrome
cancer where blood cells in bone marrow are poorly formed / don't work properly, risk of AML transformation
1) BM failure + cytopenia (= infection, bleeding, fatigue)
2) hypercellular BM
3) DEFECTIVE CELLS:
ringed sideroblasts, hypogranular WBC, hyposegmented neutrophils (Pseudo pelger Huet anomaly), micromegakaryocytes
<20% blasts
408
what do all T cells express
CD3+
409
Fanconi anaemia
pancytopenia
cafe au lait spots
abnormal thumbs
short stature
410
Diamond-Blackfan anaemia
red cell cytopenia
411
Shwachman-Diamond syndrome
neutropenia
| pancreatic dysfunction
412
Dyskeratosis congenita
pancytopenia
nail dystrophy
skin hyperpigmentation
oral leukoplakia
413
most sensitive biomarker for IDA
ferritin but will be falsely raised in inflammation
414
tx of DVT
DOAC
| warfarin preferred in profound renal failure (as it is not renally cleared)
415
richter's transformation
CLL to high grade lymphoma
416
tumour lysis syndrome
when chemotherapy is started --> rapid lysis of tumour cells --> release of intracellular contents --> renal failure, arrhythmia, death
417
mx to reduce risk of tumour lysis syndrome
IV allopurinol or rasburicase to reduce hyperuricaemia
418
heparin induced thrombocytopenia
body has an immune response to heparin. antibodies are formed against heparin when it is bound to platelet factor 4 --> activates platelets & forms clots, + splenic removal of complexes --> thrombocytopenia
419
tumour lysis syndrome changes in electrolytes
drop in Ca
| rise in urea, PO4, K
420
Burkitt's Lymphoma translocation
t(8;14) cmyc
| 14 for lymphoma, 8 for the age when Burkitt's lymphoma is more common
421
Mantle cell lymphoma translocation
t(11;14)
| 14 for lymphoma
422
follicular lymphoma translocation
t(14;18)
| 14 for lymphoma
423
BCL2
protein that inhibits cell apoptosis
424
most common cause of B12 deficieny in UK
pernicious anaemia
425
Burkitt's lymphoma presentation in sporadic UK form vs endemic African form
sporadic UK form = abdominal/inguinal lymphadenopathy
| endemic African form = massive submandibular swelling, cervical lymphadenopathy
426
deranged LFTs + acidosis
acidosis is late sign + generally indicates need for liver transplant
427
tuberous sclerosis
autosomal dominant
ash leaf spots on skin
tumours + cysts growing in multiple organs, especially CNS, kidney, eg rhabdomyoma, angiomyolipoma, retinal harmatoma
infantile spasms
428
what has better prognosis IgH mutated or IgH unmutated CLL
IgH mutated as it means the B cells have undergone somatic hypermutation + more mature and developed --> better prognosis
429
A patient is admitted to The Emergency Department after severe trauma and blood loss. Without time for blood ABO grouping, he required emergency resuscitation with red cells and fresh frozen plasma. What blood group plasma should be used?
AB
430
von hippel lindau
hemangioblastoma of cerebellum, brainstem and spinal cord, retina;
renal cysts, pheochromocytomas
431
isolated raised bilirubin with no other complications
Gilbert's syndrome
432
normal pH, low pCO2, low bicarb
mixed resp alkalosis + met acodisos --> aminosalicylate overdose
433
What is the maximum number of HLA class I mismatches that may occur if a parent acts as a kidney donor for a child?
parent + child always have at least 3 matches so can only have mismatches in max 3
434
Which cytokine could be targeted to improve disease control in ank spond?
tnf alpha
435
cryptococcus antigen test
glucuronoxylomannan
436
Which cytokine is key in promoting the development and terminal differentiation of eosinophils
IL-5
437
which helminth is able to undergo autoinfection in the intestines
Strongyloidiasis stercoralialis
438
normal anion gap
14-18
439
carbimazole side effects
carbimazole used in hyperthyroidism
| agranulocytosis + neutropenia
440
hereditary angioedema
autosomal dominant
| C1 esterase inhibitor deficiency --> recurrent attacks of oedema --> resp distress, abdo pain
441
causes of microcytic anaemia
```
TAILS
Thalassemia trait
anaemic of chronic disease
iron deficiency anaemia
lead poisoning
sideroblastic anaemia
```
442
toxic left shift
immature neutrophils released from bone marrow, typically due to severe infection/inflammation
443
Superoxide dismutase 1 is a misfolded protein associated with which condition?
motor neuron disease
444
most common causative organism of bronchial pneumonia
haemophilus influenzae
445
most common causative organism of lobar pneumonia
strep pneumoniae
446
what does a neutrophil look like
multilobed nucleus (looks like it has 3 parts to it)
447
most common liver malignancy
secondary cancer!! metastatic adenocarcinoma
448
zollinger ellison tumour
gastrin secreting tumour
449
what does the following indicate:
Flow cytometry is carried out and reveals 82% of the proliferated lymphocytes express kappa chains, and 0% express lambda chains.
light chain restriction which indicates monoclonal B cell proliferation --> malignancy
450
polycythaemia rubra vera tx
hydroxycarbamide --> reduces bone marrow activity
451
aetiology of febrile non-haemolytic transfusion reactio
cytokines in donor plasma cause inflammatory reaction
452
A kidney biopsy shows thickened glomerular capillary loops (a wire loop appearance)
Which disease is this suggestive of?
SLE
| immune complex deposition --> thickening
453
endoemtrial cancer FIGO staging
stages
1) confined to uterus
2) + cervix
3) + spread to fallopian tubes/ovaries/vagina/local lymph nodes
4) distant spread
454
Tazobactam
beta lactamase inhibitor given alongside piperacillin
455
beta lactam that is not sensitive to beta lactamase
flucloxacillin
(Benzylpenicillin, piperacillin, and amoxicillin are all antibiotics of the penicillin class which are sensitive to beta-lactamase)
456
EPO in polycythaemia vera vs secondary polycythaemia
polycythemia vera = EPO low due to suppression
| secondary polycythaemia = EPO high
457
fibrinogen in dic
low
458
mallory denk bodies
= intracytoplasmic inclusions in hepatocytes made up of damaged intermediate filaments
459
barium examination string sign
Corhn's
460
biochemistry for renal failure (secondary hyperparathyroidism)
low Ca
high PTH
high phosphate due to excretion failure
461
why is there a drop in Hb in CLL
folate / B12 deficiency
462
1 unit of RBCs causes an increment of what in Hb
Hb 10
463
1 unit of platelet gives an increase of what in platelets
platelets 35
464
how does removing donor T lymphocytes in allogeneic haematopoietic SCT have an impact on incidence of GvHD + rate of leukaemia relapse
reduces risk of GvHD
| increases risk of leukaemia relapse (donor lymphocytes fight tumour cells + have anti-tumour effect)
465
haemorrhagic testicular infarction process
venous occlusion
466
exophytic fronded lesion on cystoscopy
papillary urothelial carcinoma
467
why should you not give ACEi in renal artery stenosis
causes constriction of efferent arteriole + makes renal artery stenosis worse
468
which enzyme do you expect to be raised in dermatomyositis
CK
469
Alum MoA as an adjuvant for vaccination
promotes B cell differentiation
470
antibodies in ank spond
NONE
471
bacillus cereus mx
none, supportive
472
fibrinogen in DIC
low
473
streptobacillus moniliformis
rat bite fever
474
atypical pneumonias
legionella
chlamydia pneumoniae
chlamydia psittica
mycoplasma pneumoniae
475
what does covid target
ACE2
476
which component of the covid virus do vaccines target
spike proteins
477
rheumatoid arthritis tx
TNF alpha inhibitors (infliximab, adalimumab, certolizumab, golimumab)
Tocolizumab (anti IL 6)
Tofacitinib (JAK1/3 inhibitor)
478
psoriatic arthritis tx
secukinumab (anti IL 17)
| ustekinumab (anti IL 12/23)
479
ank spond tx
secukinumab (anti IL 17)
ustekinumab (anti IL 12/23)
TNF alpha inhibitors
480
organism that causes diphtheria
corynebacterium diphtheriae
481
fibrinoid necrosis
vascular damage that occurs due to infection/immune complex deposition/autoimmunity
482
schistosomiasis causes what cancer
squamous cell carcinoma in bladder
483
osteoarthritis
Degenerative joint disease mainly affecting vertebrae, hips and knees. May see Heberden’s nodes
(DIPJ) and Bouchard’s nodes (PIPJ)
X-Ray features = LOSS = loss of joint space, osteophytes, subchondral sclerosis, subchondral cysts
484
rheumatoid arthritis
symmetrical arthritis
485
Used to treat severe ankylosing spondylitis not controlled by NSAIDs
Etanercept
