Path 2018 Past Paper Flashcards by Sophia von Widekind

Child with hereditary spherocytosis - investigation?

Osmotic fragility test

or DAT?

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Supraclavicular aspirate, swollen face, Reed Sternberg cells

Hodgkin Lymphoma

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MEFV Mutation

Familial Mediterranean Fever

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NOD2/CARD15

Crohns Disease

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Immunodeficiency with common gamma chain problem

X linked SCID

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Swollen joint, needle-shaped aspirate with negative birefringence, what is the enzyme responsible

Xanthins Oxidase (gout)

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Treatment for gout (Acute)

NSAIDs (1st line)
Colchicine (2nd)
Glucocorticoids (3rd)

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Treatment for gout (Non-Acute/interval)

Fluids
Reverse precipitating factors e.g. thiazides
Allopurinol

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What does JC virus cause?

Progressive Multifocal Leukoencephalopathy

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Reactivation of a virus following a transplant?

EBV

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Bacteria causing scarlet fever?

Strep Pyogenes (Group A)

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Most common virus causing aseptic meningitis?

Enteroviruses (Coxsackie or Echovirus)

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Iron deficiency anaemia in male. Most important investigation?

Colonoscopy to rule out bleeding

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Smear cells

Chronic Lymphocytic Leukaemia

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Publican with diabetes, fatty stools, weight loss, ‘slate grey skin’ and joint pains. What is the underlying diagnosis causing this?

Haemachromatosis (joint pain, skin changes, pancreatitis, liver deposition)

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5yr old, tetany, bone pain. Widened epiphyses + ‘Cupping’ of metaphysis shown on x-ray.

Rickets

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What is the minimum amount of time to treat a VTE?

3 months

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Female - overweight, irregular periods, flare of acne and hirsutism, LH:FSH ratio >3

LH:FSH ratio >3 → PCOS

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Ovarian tumour with hair. No immature cells seen.

Mature teratoma

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Mother is a donor for kidney to a child, what is the max number of mismatches possible with HLA class I?

Clinically most important
HLA-A
HLA-B
HLA-DR

As two alleles from each, opportunity to match 6 alleles
Maximum of 6 mismatches (MM)
6 MM= bad
0 MM = good

Sibling to sibling:
25% - 6MM
50% - 3MM
25% - 0MM

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Neonate with sepsis

Group B Streptococcus

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HLA B27 positive

Ankylosing Spondylitis

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HIV +ve, very low CD4 + vascular lesions on trunk

HHV8 - Kaposi Sarcoma

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Enzyme to confirm cardiac failure

Brain Natriuretic Peptide

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Liver enzyme raised in MI

AST Aspartate aminotransferase

Old man who fell over, been on floor for days. Severely dehydrated. Dark urine. Not blood on microscopy. 1. What causes the dark urine? 2. What enzyme will be high (>5x upper limit of normal)?

1. Myoglobin | 2. Creatine Kinase

Multiple myeloma and restrictive cardiomyopathy. What will you see on heart biopsy?

Amyloid depositions (AL - MM) AA - RA, ankylosing spongylitis

Abx for MRSA

Vancomycin

Macrocytic anaemia, atrophy of body of stomach. What substance are they deficient in that leads to B12 malabsorption?

Intrinsic factor (pernicious anaemia)

aphthous ulcers, conjunctivitis, diarrhoea & abdo pain

Crohns (non caseating granulomas on histo)

Alcoholic man with recurrent bleeding varices

Oesophageal Candidiasis

Mexico and ate unpasteurized dairy. 4 weeks later unwell No diarrhoea.

Brucellosis - undulant fever (Peaks in evening) Malaise, rigors, myalgia/arthralgia, tiredness Incubation - 3-4w

Non-Tuberculous mycobacterium, cut on his hand in a man who cleaned a fish tank?

Mycobacterium marinum

Painless penile ulcer which healed in few weeks, followed by fine snail track oral ulcer

Treponema pallidum

Low Hb, raised Br (i.e. haemolytic anaemia). Background of SLE. What test is best to determine the cause?

DAT

Antibody in SLE

double stranded DNA

Rituximab target

Anti CD20 - mature B cells

Clostridium Diff Treatment

Oral metronidazole 10-14 days (two trials before moving onto vancomycin 10-14d)

Oesophageal cancer

Adenocarcinoma - a/w Barrett's, distal 1/3 | SCC - a/w ETOH and smoking, middle 1/3

Gastric cancer

B cell lymphoma a/w H. Pylori

Di George

CATCH 22 | Low T Cells

Cancer with keratin and intercellular bridges

Squamous cell carcinoma

Hep A spread

Faeco oral

Reaction to penicillin. Which of these drugs will safe? ``` Piperacillin/tazobactam Temocillin Amoxicillin Co-amoxiclav Cephalexin ```

Cephalexin Cephalosporins can be prescribed safely for penicillin-allergic patients.

Treatment for CLL with p53 mutation. What is the first line treatment? ● Rituximab ● Imatinib ● Ibrutinib ● Ciclosporin

Ibrutinib - Bruton TK Inhibitor

``` Treatment for CML ● Rituximab ● Imatinib ● Ibrutinib ● Ciclosporin ```

Imatinib - BCR-ABL TK inhibitor

What is the usual prophylaxis for allograft rejection? ● Mycophenolate mofetil, pred, tacrolimus ● Mycophenolate mofetil, pred, azathioprine ● Cyclosporine, tacrolimus and rafamycin

Mycophenolate mofetil, pred, tacrolimus???

``` Which allergy is more likely to present in child than adult? ● OAS ● Egg ● Bee ● Pollen ```

Egg

Adalimumab

TNFalpha Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, psoriasis SE - infection (TB, Hep B/C, lupus-like condition, demyelination, malignancy (lymphoma)

Basiliximab

Anti CD25 | Allograft rejection prophylaxis

Denosumab

anti-RANKL Osteoporosis, MM, bone mets SE - infection, avascular necrosis of the jaw

Secukinumab

anti-IL-17A Psoriasis, psoriatic arthritis, ankylosing spondylitis Infection (TB)

Receptor and Co-Receptor

CD4 molecule/Ag is the Receptor for HIV-1. | Most infecting strains of HIV-1 use co-receptor molecules (CCR5 and CXCR4) in addition to CD4 to enter target cells.

Acquired immunity – antibody | B cells

Anti-gp120 and anti-gp41 (Nt) antibodies are thought to be important in protective immunity HIV remains infectious even when coated with antibodies.

Acquired immunity: CD4+ T cells

Recognise processed antigen - especially Gag p24 (peptides) - in the context of class II HLA molecules.

``` What natural antibody against, which confers protective immunity against HIV? ● HIV - GAG ● HIV - gp120 ● CXCR4 ● Protease ● Reverse transcriptase ```

Anti gp120

What is in urine of a multiple myeloma patient?

Bence Jones protein

``` Which type of embolus is common in cholesterol cleft? • Air ● Fat ● Amniotic ● Fluid ● Atheromatous ```

Atheromatous

``` Patient with coeliac. What would you see on biopsy? ● Intraepithelial Leukocytes ● Intraepithelial Eosinophils ● Intraepithelial Macrophages ● Intraepithelial neutrophils ● Intraepithelial Lymphocytes ```

Intraepithelial Lymphocytes

``` Newborn baby. DAT +ve, spherocytes seen. Baby jaundiced. Lady is Group A Rhesus negative, Baby is Group O Rhesus positive. Why is baby jaundiced? ● Hereditary spherocytosis ● G6PD ● ABO incompatibility ● Rhesus incompatibility ```

Rhesus incompatibility

``` Acquired MAHA. What do you see? ● Dat +ve spherocytes ● Dat +ve fragments ● Dat -ve spherocytes ● Dat -ve fragments ● Dat +ve smear cells ```

Dat +ve fragments

``` Sickle cell patient, spleen not felt. Low reticulocytes, very anaemic. ● Parvovirus B19 ● Splenic sequestration ● Normal for SCD ● Sickle cell crisis ● ???? - other spleen thing ```

Splenic sequestration

HTLV1 Virus lymphoma

Adult t cell lymphoma/leukaemia

``` What causes hypertension in upper half of body? ● Coarctation of the aorta ● Renal ___? ● Renal parenchymal disease ● Renal vascular hypertension ● Adrenal hypertension ```

????

Low glucose, high insulin, low C peptide. High BMI. ● Factitious insulin (was called ‘surreptitious’ insulin) ● Surreptitious gliclazide ● Type 1 diabetes mellitus ● Anorexia nervosa ● Insulinoma

????

``` What is low during pregnancy? ● Fibrinogen ● Factor 7 (or 8) ● Protein S ● Plasminogen activator inhibitor 1 ● Von Willebrand’s factor ```

Protein S (1/2 of basal) Fibrinogen, Factor 8, Factor 7, vWF = increase = hypercoagulable Plasminogen activator inhibitor 1 = increase Protein S = decrease = hypofibrinolytic

Person with low platelets & bruising, fever, confused. What’s going on? ● TTP ● HUS

TTP - MAHA, fever, renal impairment, neuro abnormalities, thrombocytopenia ADAMST3

``` How does a melanoma spread? ● Lymphoid ● Haematological ● Perineural ● Iatrogenic ● Transcoelomic ```

Lymphoid

Coeliac malignancy?

Enteropathy associated T cell lymphoma (EATL)

cANCA Glomerulonephritis and lung changes - lung and kidney changes only?”

Wegener's | Granulomatosis with polyangitis

Patient (male) having an elective AAA repair

ABO cross match with all Rhesus match

Male sickle cell patient receiving regular transfusion

?Group in C,E,K crossmatch/anti-CcRR Abs – extended Ab screen

Woman who had rhesus-C negative in pregnancy having an elective cesarean (don’t think it actually specified ‘elective’)

Group O rhesus negative

Lady (was younger woman like teenager) needing emergency blood

Group O rhesus negative

Man who has had a previous allergic reaction (serum sickness like reaction) to transfusion

Washed cells

Path 2018 Past Paper Flashcards

(75 cards)