Path Flashcards
1
Q
Diagnostic criteria of SIADH
A
Low plasma sodium (< 135)
* Low plasma osmolality (< 270)
* High urinary sodium (> 20)
* High urinary osmolality (> 100)
* No adrenal/thyroid/renal dysfunction
2
Q
Sodium in DI?
A
High
3
Q
Treatment for high potassium?
A
- IV calcium gluconate
- IV insulin with dextrose
4
Q
If potassium is low, remember to check what?
A
Magnesium level
5
Q
What to do if high potassium level?
A
Check again before treating
6
Q
A patient has had hypertension at a young age and the following blood test results on his U&Es: Na 147, K 3.2, urea 5.0, Cr 70.
What is the next best investigation to confirm the likely diagnosis?
A
Aldosterone renin ration
7
Q
Effect of calcitonin?
A
Less bone reabsorption by osteoclasts
Decreased Ca reabsorption at
DCT
8
Q
Severe low calcium treatment
A
IV calcium gluconate
9
Q
What has lowest calcium: osteomalacia or secondary hyperparathyroidism?
A
Osteomalacia
10
Q
Management of hypercalcaemia in the acute setting is?
A
Fluids, fluids, fluids
11
Q
Commonest cancers that can metastasise to the bone are?
A
Prostate, breast, lung
12
Q
Normal anion gap level?
A
14-18
13
Q
Normal plasma osmolality?
A
275-295
14
Q
Marker of acute liver dysfunction?
A
INR/PT
15
Q
Should urobilinogen be in urine?
A
YES
16
Q
Raised AST:ALT > 2:1?
A
Alcoholic hepatitis
17
Q
Raised AST:ALT < 1:1
A
Viral hepatitis
18
Q
ALT/AST in the 1000s
A
Acute viral hepatitis, ischaemic hit, toxins
19
Q
Antibodies in Hashimoto’s disease
A
Anti-thyroid peroxidase, anti thyroglobulin
20
Q
Primary atrophic - goitre or no goitre?
A
No goitre
21
Q
Treatment for myxoedema coma
A
I.V Liothyronine
22
Q
Subclinical hypothyroidism results?
A
Pre-hypothyroid
Pituitary gland can compensate
High TSH, normal T3/4
If positive anti TPO Ig then higher risk of hypothyroidism later
23
Q
Radiolabelled iodine uptake scan.
Multiple nodules?
A
Toxic goitre
24
Q
Radiolabelled iodine uptake scan.
Generalised increase
A
Grave’s disease
25
Radiolabelled iodine uptake scan.
De Quervain's sign?
Cold thyroid
26
Radiolabelled iodine uptake scan. What is seen with adenomas??
Focal lesions
27
Graves’ specific signs and symptoms?
Pretibial myxoedema (soft tissue growth at the shins and skin changes), graves’ orbitopathy is also another specific sign (caused by retrobulbar soft tissue growth), and is characterised by lid lag, exopthalmos and opthalmoplegia.
28
Medical management of hyperthyroidism
include carbimazole and propylthiouracil.
29
There are five indications for a thyroidectomy (either full or partial) - name them
)Treatment resistant graves, suspicion of malignancy, cosmetic, or co-existing hyper-parathyroidism.
It is important to ensure patients are euthyroid before radio-iodine or surgery because the treatment / operation can both induce thyroid storm.
30
Acromegaly Ix
Oral glucose tolerance test
Measurement of GH
Plasma IGF-1
31
Hashimoto’s can cause which thyroid tumour?
Lymphoma
32
Psammoma bodies in which thyroid cancer?
Papillary
33
What stimulates prolactin?
TRH
34
CPFT: combined pituitary function test - what is given?
GnRH, TRH and insulin
35
Which blood marker is monitored to check for recurrence of papillary thyroid carcinoma post resection?
Thyroglobulin
36
Which medication is used for hyperthyroidism?
Carbimazole
37
Commonest cause of hypothyroidism in the UK?
Hashimoto’s
38
Reticularis secretes what?
Sex hormones
39
What does the adrenal medulla produce?
Catecholamines
39
What does the adrenal medulla produce?
Catecholamines
40
Purpose of high dose dexamethasone test?
Helps to determine Cushing’s syndrome from disease
41
What is Cushing's disease?
Cushing disease occurs when Cushing syndrome is caused by an ACTH-producing pituitary tumour, whereas Cushing syndrome is the set of symptoms that results when there is a surplus of cortisol in the body.
42
Treatment of Conn's syndrome?
Spironolactone
43
Sulphonylurea
gliclazide
44
DPP-4 agonists
Sitagliptin
45
SGLT-2 inhibitors
Empagliflozin.
46
Add GLP-1 antagonist
Liraglutide
47
DKA criteria:
Ketones >3
pH <7.3
BM >15
48
A patient presents with new-onset type 2 diabetes, an enlarged jaw and forehead and carpal-tunnel syndrome. Which investigation would be most useful to diagnose the likely cause?
Short SynACTHen test
Combined pituitary function test
Measurement of plasma [growth hormone]
Low-dose dexamethasone suppression test
Oral glucose tolerance test
c)
49
Sign of AML?
Auer rods
50
Acute Promyelocytic Leukaemia
T(15;17)
Presents with DIC. Good prognosis
All-Trans Retinoic Acid (ATRA)
Forces cells to differentiate, stops proliferation
51
Ruloxitnib is what?
- JAK inhibitor
52
CML association?
Philadelphia chromosome - treat with imatinib
53
How is 9:22 dected?
FISH
54
Blast phase of CML?
>20% blasts in bone marrow
Behaves like an acute leukaemia
55
Accelerated of CML?
>10% blasts in bone marrow
56
Sign of CLL?
Smudge cells
57
Richters syndrome:
Transformation of CLL to aggressive disease (ALL / high grade lymphoma)
58
Staging of CLL?
A – no cytopenia, <3 areas of lymphoid involvement
B – no cytopenia, 3+ areas of lymphoid involvement
C – cytopenias
A – watch and wait
B – consider treatment
C – treat
59
Treatment for CLL?
Venetoclax (BCL2)
Obinutuzumab (CD20)
Ibrutinib (Brutons TK inhibitor)
FCR (fludarabine, cyclophosphamide, rituximab)
60
>20% blasts = What?
AML
61
Most common Hodgkin lymphoma?
Nodular sclerosing is the most common type
62
MGUS
Serum monoclonal protein <30g/l
Plasma cells <10% on Bone Marrow
63
Smouldering myeloma
Serum monoclonal protein (IgG / IgA) >30g/l or Bence Jones Protein
And/or
Clonal bone marrow plasma cells 10%-60% in the marrow
64
waldenstrom’s
lymphadenopathy, weight loss, splenomegaly
IgM paraproteins
65
55 year old man presents to his GP with lethargy, fatigue and lymphadenopathy. Blood results show: WCC 7 Hb 90 MCV 80 Na 140 K 4.0 Creatinine 90 Calcium 2.5
Serum electrophoresis shows an IgM paraprotein of 37 g/l
What is the most likely diagnosis?
Acute leukaemia
Multiple Myeloma
Smouldering Myeloma
MGUS
Waldenstrom’s Macroglobulinaemia
E)
66
55 year old man presents to his GP after a 2 week history of fatigue and easy bruising. Blood results show:
WCC 27 Hb 90 Plt 30
Na 140 K 4.0 Creatinine 90 Calcium 2.5
Blood film shows presence of blasts (see below) with 55% blasts in marrow. Flow cytometry shows a clonal population of cells expressing CD34, MPO, CD13, CD33.
AML
67
ALL has which cells?
Hand-mirror cells
Do flow cytometry
68
TREMATODA- flukes?
Schistosoma spp.
Fasciola hepatica
69
CESTODA- tapeworms
Taenia solium
70
APICOMPLEXA
Toxoplasma gondii
Plasmodia spp
71
Complication of taenia solim?
Cysterciocisis (in the brain)
72
Treatment of neurocysticercosis
Steroids
Anti-convulsants
Anti-parasitics
Surgery
73
How does hookworm infect?
Penetrates skin
74
Schistoma affects what organ?
Liver
75
Treatment for schistomiasis?
Praziquantel
76
Name the process by which a strain of influenza may rapidly modify whole segments of its genome?
Antigenic shift
77
What step in the influenza replication cycle does tamiflu inhibit?
Cell exit
78
Which Plasmodium species causes cerebral malaria?
Plasmodium ovale
Plasmodium knowlesi
Plasmodium falciparum
Plasmodium vivax
Plasmodium malariae
Plasmodium falciparum
79
What is Toxoplasma gondii's definitive host?
Domestic cat
80
Which organism is the leading cause of adult onset seizures in the developing world?
Taenia solim?
81
Gram positive bacteria stain what colour?
Purple
82
Gram negative stain what colour?
Red/pink
83
8-16hrs after reheated meat, watery diarrhoea lasts 24hrs
Gas gangrene
Clostridium perfringens
84
Descending paralysis after canned foods/honey
Clostridium botulinum
85
Treatment of typhoid?
IV ceftriaxone
86
Treatment for mild malaria?
Mild: artemisin combination therapy (Riamet – artemether + lumefantrine)
87
What are Negri bodies associated with?
Rabies
Treatment - Rabies IgG post-exposure (passive vaccination)
88
Cause of Q fever?
Coxiella burnetii, from cattle/sheep
89
Signs of Q fever?
Atypical pneumonia symptoms: fever, dry cough, pleural effusion
90
Mixed growth, squamous epithelium - MC&S?
Contaminated sample
91
Upper UTI management?
Upper: admit, IV co-amox + gent
92
Chlamydia Serovars L1, L2, L3 cause what?
lympho-granuloma venereum (LGV)
93
Serovars A, B, C: trachoma can cause what?
Blindness
94
Treatment for chlamydia infection
Treatment:
Azithromycin 1g stat, or
Doxycycline 100mg BD 7d
95
Male urethral discharge?
Gonorrhoea
96
Treatment for gonorrhoea?
Treatment:
Ceftriaxone 250mg IM STAT
97
Secondary syphilis?
Bacteraemia after 1-6 months fever, lymphadenopathy
Rash on palms and soles
Condyloma acuminate (genital warts)
98
Signs of tertiary syphilis:
30yrs later 3 different syndromes:
Gummatous: skin/bone/mucosal granulomas
Cardiovascular: mimics any cardiac disease; aortic root dilatation
Neurosyphilis: dementia, tabes dorsalis, Argyll-Robertson pupil
99
Treatment for syphillis
Treatment: IM benzathine penicillin STAT
100
TB meningitis findings on LP?
Clear / turbid
Low
High - mononuclear
101
Bacterial meningitis findings on LP?
Bacterial
Turbid
Low
High - polymorphs
102
Hospital acquired pneumonia?
S. aureus, Klebsiella, Pseudomonas, Haemophilus
103
ABx cause of pseudomembranous colitis
3Cs (clindamycin, cephalosporins, ciprofloxacin)
104
Small non-tender nodules in IE?
Janeway lesions
105
Painful nodules in IE?
Osler's nodes
106
Example of glycopeptide?
Vancomycin
107
Example of aminoglycoside?
Gentamicin
108
Example of macrolide?
Erythromycin
109
Example of fluoroquinolone?
Ciproflaxin
110
Which antibiotic inhibits DNA synthesis?
Fluoroquinolones - Ciprofloaxin
111
Treatment for pharyngitis?
Benzylpenicillin
112
MRSA resistance mechanism?
Bypass antibiotic-sensitive step in the pathway
113
Beta-lactam resistance mechanism?
Enzyme-mediated drug inactivation
114
Tetracycline resistance mechanism?
Impairment of accumulation of the drug
115
Modification of the drug target is the mechanism for which resistance?
Quinolone
116
Signs of late LGV?
Inguinal lymphadenopathy, genital elephantiasis
117
Treatment for syphillis?
Single dose IM benzathine penicillin
118
Jarisch-herxheimer reaction is seen with which disease?
Syphilis
119
Donovanosis associated with what?
Large, beefy red ulcers. Donovan bodies.
120
Duke's criteria for IE?
2 major, 1 major + 3 minor, 5 minor
121
What organism causes the plague?
Yersinia pestis
122
What organism causes the plague?
Yersinia pestis
123
What causes anthrax?
Bacillus anthracis
124
Signs of anthrax?
Painless round black lesions + rim of oedema
Massive lymphadenopathy + mediastinal haemorrhage
125
Visceral leishmania is also known as what?
Kala Azar
126
Treatment for aspergillus?
voriconazole
127
What does terbinafine target?
Mould cell membrane
128
Echinocandin eg. caspfungin inhibits what?
Cell wall yeast (less toxic SEs)
129
How can varian CJD be diagnosed?
Tonsillar biopsy
130
Protein in sporadic CJD?
14-3-3
131
Most cases of CJD affect which codon?
129 codon MM
132
Which CJD has an earlier age of onset?
Variant
133
First symptom of variant cJD?
Dementia
134
First symptoms of sporadic cJD?
Rapid, progressive dementia with myoclonus
135
What is the fontana stain for?
melanin
136
Cytokeratin is a marker of what?
Epithelial cells
137
Unstable occlusion is what level of sclerosis?
>90%
138
Arrythmia after MI?
Ventricular fibrillation - occurs in the first 24 hours
139
Common causes of heart failure?
Ischaemic heart disease, myocarditis, hypertension, cardiomyopathy
140
Mutation in Kostmann syndrome?
Mutation in HAX1 protein
141
Treatment of Kostmann syndrome?
G-CSF
142
What has absent pus formation?
Leucocyte adhesion deficiency. High neutrophil count
143
What is deficient in leukocyte adhesion deficiency?
Deficient CD11a/18
144
What is the deficiency in chronic granulomatous disease?
Deficiency of NADPH oxidase complex
145
Nitroblue tetrazolium test negative?
Yellow
146
Cytokine deficiency
Mycobacterial infection
Salmonella infection
147
Membrane attack complex deficiency - what organisms at risk of?
NHS
N. meningitidis
S. pneumoniae
H. influenzae
148
Alternative complement deficiencies - at risk of what?
Infections with encapsulated bacteria
149
Ix classical pathway activity?
CH50
150
Ix alternative pathway activity?
AP50
151
A 5 month old baby girl presents with recurrent fungal infections and diarrhoea, with failure to thrive. There is a family history of early infant death. Blood tests show:
Absent B cells
Absent T cells
Absent NK cells
What is the diagnosis?
ADA deficiency
152
Reticular dysgenesis mutation?
Mutation of adenylate kinase 2 (AK2)
153
Mutation in X-linked SCID?
γ-chain of IL-2 receptor
154
ADA deficiency
Adenosine deaminase deficiency
Required for lymphocyte metabolism
Low B, T, and NK cells
155
Treatment of Bruton’s X-linked a-gammaglobulinaemia?
IVIG
156
Bruton’s X-linked a-gammaglobulinaemia
X-linked
Defective B cell tyrosine kinase gene
Pre B cells cannot develop into mature B cells
No circulating Ig after 3 months
Absent lymph nodes and tonsils
157
What cells does SCID have?
B cells
158
2 year old girl
Recent episode of severe staph aureus sepsis
Background: delayed separation of umbilical cord and severe skin infections
WCC normal, lymphocytes normal
Neutrophils high
Ig normal
NBT normal
Diagnosis?
Leucocyte adhesion deficiency
159
HLA association Goodpasture's
HLA -DR15
160
HLA association SLE?
HLA-DR3
161
HLA association Grave's disease?
HLA-DR3
162
What is libman-Sacks endocarditis associated with?
associated with SLE andanti-phospholipid syndrome
163
Central tolerance breakdown: APECED
Mutation of transcription factor AIRE: responsible for expression of self antigens in thymus to enable –ve selection of autoreactive T cells
164
ALPS
Mutation in Fas pathway
T cells NOT killed in thymus enter periphery untolerised
Autoimmune
Lymphoproliferative
Syndrome
Large spleen and lymph nodes
Autoimmune cytopenia
Lymphoma
165
IPEX signs?
Immune dysregulation
Polyendocinopathy
Enteropathy
X-linked syndrome
Diarrhoea, diabetes and dermatitis
166
15 year old with recurrent candidiasis, nail pitting and hypoparathyroidism. Name the causative mutation.
Mutation in TF AIRE
167
10 year old with abdominal fullness and splenomegaly. FBC reveals high lymphocytes. History of autoimmune thrombocytopenia. Diagnosis?
ALPS
168
Gel and coombs classification of T1DM?
Type 4
169
Patient develops skin rash, joint aches and fever after being given penicillin for a chest infection - gel coombs classification?
Type 3
170
A 12 year old boy presents with haematuria and proteinuria. He has recently been discharged following severe meningococcal septicaemia. There is abnormal fat distribution.
C3 levels are low, and C4 levels are normal.
What is the underlying diagnosis?
Nephritic factor deficiency
171
Examples of conjugate vaccines?
NHS
172
Adjuvant
= a substance which enhances the body's immune response to an antigen
173
brown fluid aspirated from a lump, which then resolved spontaneously
Benign cyst
174
Stellate mass with fibrosis
Radial scar – benign sclerosing lesion, glandular tissue
175
Biopsy of a lump showing epithelial cells
Phyllodes (fibroepithelial and stromal) >50y
176
-Man with AF who presented with loin pain and fevers
Renal infarct
177
smoker with raised parathyroid-related polypeptide
Squamous cell carcinoma
178
-Decreased Na+ in newborn
(CAH 17-OH progesterone)
179
Swelling of lower limbs with cANCA positive
Wegener’s (against proteinase-3)
180
-Oedema + have to look at picture provided which shows a red cell cast
181
Guy with IHD placed on an ACE inhibitor and develops renal failure
Renal artery stenosis
182
Guy post prostatectomy with normal urine osmolality and hyponatraemia
TURP syndrome
183
Deficiency in beri beri syndrome?
B1
184
Causes PML
JC virus
185
Cellular mediated rejection
T cells
186
Body cavity lymphoma
HHV8
187
Blast cells are seen in AML?
Yes
188
Normal skin pathogen with low pathogenicity
Staph epidermidis
189
Pneumonia in smoker
Moraxella catarrhalis
190
● Enzyme raised in rhabdomyolysis
Creatinine kinase
191
- Chronic liver failure sign?
Low albumin
192
Enzyme in mumps
> Amylase
193
8. High TSH, low T3 and 4
myxoedema
194
1. Impaired glucose tolerance
7.8-11.0?
195
Impaired fasting glucose?
6.1-6.9
196
2. High TSH, high T4, low t3
TSH producing pituitary adenoma
197
– hashimoto’s
(anti-Thyroid peroxidase), anti-thyroblobulin
198
1. Rate limiting haem synthesis
ALA synthase
199
MI markers
Troponin, CK(MB), LDH, AST
200
Types of renal stone
● Renal stones: Calcium oxalate (radiopaque, struvit) mg ammonium phosphate (Proteus, Staghorn), Uric acid (radiolucent)
201
● Patient with IgM paraprotein
Waldenstrom's Macroglobulinaemia
202
1. Greek, anaemic, frontal bossing, HSM, hair on end appearance
Thalassaemia
203
Woman who received a transfusion before her hysterectomy who presented with bleeding gums and rash on her shins on discharge
Post transfusion purpura
204
c) Transfusion in past, allergy plasma proteins
Washed red cells
205
2. Acute SOB, dry cough, and Hypoxia >
Transfusion associated lung injury
206
Coeliac disease cancer?
EATL
207
● Fibroepithelial tumour with abundant stromal elements
Phyllodes tumour
208
Patient with a cancer in their bladder following chronic schistosomiasis
Squamous cell carcinoma
209
loss of E-cadherin in breast cancer?
Lobular carcinoma in situ
210
2. PTH secreting lung tumour?
Squamous cell carcinoma
211
GORD cell changes
Metaplasia squamous to columnar
212
6. Polyps not associated with cancer risk
Hamartomatous
213
2. Raised amylase and abdo pain
Acute pancreatitis
214
Patient with a mass following acute pancreatitis
Pseudocyst
215
8. Mass under dura mater compressing parietal lobe
Meningioma
216
1. Tumour which secretes oestrogen
Theca or Granulosa tumour
217
2. Most common malighant gynae cancer
Endometrial carcinoma
218
Man has an MI 3 years ago. Now he comes into hospital and very unwell. Blood is aspirated from the pericardium
Myocardial rupture
219
Cell of the immune system that makes pus when it dies
Neutrophils
220
● Cell whose activity is inhibited by MHC Class 1
NK cells
221
● When they eat cherries, apples, pears and hazelnuts, they get itchy mouths but are fine when they eat apple pie
Oral allergy syndrome
222
lammatory syndrome which is 90% inheritable and associated with sacroilitis
Ankylosing spondylitis???
223
Used to treat osteoporosis, when the patient cannot tolerate bisphosphonates
Denosumab, RANKL inhibitor
224
Causes progressive multifocal leukoencephalopathy
John Cunningham Virus
225
5. Chemokine promoting eosinophil growth
IL-5
226
6. Recurrent meningitis
C7 deficiency
227
Monocytes resident in peripheral skin cells
Langerhans?
228
Mentioned FAS pathway
- ALPS (Auto-immune Lymphoproliferative Syndrome)
229
4. TPMT levels should be checked before giving what?
Azathioprine
230
8. In RA high anti CCP levels due to what?
PADI enzymes
231
18. TH1 cells
subset of cells that express CD4 and secrete IFN gamma and IL2
232
39. CTLA4 receptor for CD80/CD86 on t cells
asx with autoimmune conditions like diabetes and thyroid disease
233
58. Anti Jo association?
dermatomyositis and polymyositis
234
62. ANti scl-70
diffuse systemic sclerosis
235
hep C treatment?
IFN alpha
236
x linker hyper IgM syndrome tx?
66. Human normal immunoglobulin
237
71. Basiliximab (anti il2 receptor)
antibody specific for CD25 which inhibits T cell activation and is used to prevent rejection
238
IMMUNE modulation SEs
a. Cyclophosphamide - infertility
b. Prednisolne - osteoporosis
c. Azathioprine neutropenia particulary if TPMT is low
d. Cyclosporin - hypertension
e. Mycophenoloate mofetil - progressive multifocal leakuencephalopathy
239
Man goes to wedding in Devon, comes back with pneumonia + confusion
Legionella
240
6. Urethritis, arthritis, eye problems
Reiter's syndrome (can't see, pee climb a tree)
241
6. MSM, severe flatulence, steatorrhoea, Cysts
Giardia lamblia
242
2. Haemorrhagic cystitis in kids
Adenovirus?
243
4. Molluscum contagiosum cause?
Pox virus
244
ring enhancing lesion
● HIV Tuberculoma
245
mass under dura mater compressing frontal lobe (usually)
Meningioma
246
Interferon beta treats what?
Behcet’s
Relapsing Multiple Sclerosis
247
Pembrolizumab (PD1)
Metastatic Melanoma
248
Ipilimumab (CTLA4)
advanced melanoma
249
Nivolumab (PD1)
Hodgkin’s Lymphoma
250
Atezolizumab (PDL1)
Metastatic Bladder Cancer
251
A 35-year-old man develops diarrhoea with fever and malaise 24 hours after eating a take-away meal. Stool cultures reveal the source of the infection is Salmonella spp. Which antibody is responsible for protecting against gastrointestinal infections?
IgA
252
Conjugate vaccine?
Pneumococcus
253
Which of the following is not safe in patients with HIV?
Yellow fever
254
Mycophenolate
Infection, particular risk of HSV reactivation and
progressive multifocal leukoencephalopathy (PML) (reactivated JC virus)
Progressive neural demyelination condition
255
Replace what with methotrexate?
Folate
256
mTor inhibitor MOA?
Inhibits IL2 signaling pathways
257
TTP
ADAMST13 enzyme
pentad of symptoms including confusino
258
How do you manage TTP?
Plasma exchange
259
Serum methylmalonic acid
Elevated in vitamin B12 deficiency
