Path bits + frequent Qs Flashcards
(645 cards)
1
Q
Hx of systemic disease e.g. amyloidosis,
haemochromatosis, inflammatory bowel disease
What cardiology illness?
A
Restrictive pericarditis
2
Q
Endocrine tumour - rare, normally bod or tail, can be functional (Sx due to
hormone secretion) or non functional
enzyme production (e.g. lipase -> fat necrosis), rare, older adults
A
Acinar cell
3
Q
Endocrine tumour - rare, mainly childhood, presents with abdo pain, emesis,
jaundice
A
Pancreatoblastoma
4
Q
Usually complication of chronic pancreatitis, or in children after abdo trauma;
presents with abdo discomfort, difficult digestion
A
Pseudocyst
5
Q
Head of pancreas
85% of pancreatic malignancies; RUQ + back pain,
weight loss, ascites, usual suspects
A
Ductal adenocarcinoma
6
Q
Type of pancreatic cancer that doesn’t arise from pancreas
A
Squamous cell
7
Q
Inflammation and dilatation of breast ducts, presents with nipple discharge
○ Inflammation, proteinaceous material, benign + no risk of malignancy
A
● Duct ectasia
8
Q
benign, mobile lump in breast, multinodular composed of expanded intralobular stroma, compressed ‘slit like’ ducts, branching sheets of epithelium
A
● Fibrocystic
9
Q
Breast - hormone responsive, lumpiness, ⅓ of premenopausal women, can be cysts, apocrine metaplasia, adenosis, epithelial hyperplasia and stromal hyperplasia
○ No increased risk of malignancy
A
● Fibrocystic
10
Q
‘benign sclerosing lesion characterised by a central zone of scarring surrounded by a radiating zone of proliferating glandular tissue’
○ Stellate mass on mammogram (resembles carcinoma), central elastotic nidus surrounded by proliferative corona
A
● Radial scar
11
Q
red breast, lactating, cracked skin - continue expressing + antibiotics
A
● Mastitis
12
Q
nipple discharge or mass, 40-60, papillary, excision of involved duct is curative
A
● Duct papilloma
13
Q
breast lump, may be firm, Hx of breast trauma
A
● Fat necrosis
14
Q
enlarging fibroepithelial mass in woman >50, potentially aggressive, can arise with pre existing fibroadenoma
○ ‘Proliferation of fibroepithelium and stromal tissue’
A
● Phyllodes tumour
15
Q
Neoplastic, 85% found on mammography, ducts with atypical epithelial cells
○ Most common so pick this if in doubt
○ Staged into low, intermediate, and high grade
A
● DCIS
16
Q
oestrogen factors, 5% inherited, firm breast mass, atypical epithelial cells
○ Low grade - ER, PR positive and Her2 non amplified
○ High grade - ER, PR negative and Her2 amplified
○ Invasive ductal carcinoma - nipple retraction
○ Invasive lobular - loss of E-cadherin
A
● Invasive breast carcinoma
17
Q
● Invasive breast carcinoma
nipple retraction
A
○ Invasive ductal carcinoma
18
Q
● Invasive breast carcinoma
loss of E-cadherin
A
○ Invasive lobular
19
Q
benign enlargement of male breast around puberty or over 50, idiopathic or associated with drugs
A
● Gynaecomastia
20
Q
○ Branching ducts end in terminal duct lobular units
○ Ductal lobular system lined by inner glandular epithelium and outer myoepithelium
A
● Normal breast
21
Q
old, rectal bleeding, fever, LIF
A
● Diverticulitis
22
Q
obstruction, elderly
A
● Sigmoid volvulus
23
Q
continuous, superficial, more likely to have blood
A
UC
24
Q
metaplasia, columnar epithelium, goblet cells (intestinal)
A
● Barrett’s
25
alcohol, smoking, mid/lower oesophagus, invasion into submucosa
SCC
26
patients after lung transplant are more likely to get adenocarcinoma of colon
● CF
27
Pernicious anaemia, H pylori associated carcinoma
MALT
28
Inflammation associated with pernicious anaemia and gastric ulcer
Chronic gastritis
29
95% adenocarcinoma
○ Intestinal - well differentiated
○ Diffuse - poorly differentiated (linitis plastica, signet ring cell)
○ Signet ring cell - contains mucin which pushes nucleus to cell periphery
● Gastric cancer
30
most common Lower GI cancer - male with change in bowel habit, weight loss, bleeding PR
○ Adenocarcinoma
31
hyperplastic polyps
Familial adenomatous polyposis
32
○ Polyps not associated with increased cancer risk
hamartomatous
33
ring enhancing lesion
| CVD
● HIV Tuberculoma
34
relapsing remitting or primary progressive, vision problems
MS
35
thunderclap
● Subarachnoid Haemorrhage
36
elderly person with insidious onset of neuro problems, ‘collapse at home’
● Subdural - elderly person with insidious onset of neuro problems, ‘collapse at home’
37
hit on side of head and lucid interval
● Middle meningeal/extradural bleed - hit on side of head and lucid interval
38
Depression then CNS symptoms in young person
● Variant CJD - Depression then CNS symptoms in young person
39
neurosigns first and presents later
| Which prion?
● Sporadic CJD - neurosigns first and presents later
40
most common cause of dementia, neurofibrillary tangles (tau), senile plaques (beta amyloid)
● Alzheimer’s
41
optic nerve tumour excised and now lump on hand
● Neurofibromatosis type 1 - optic nerve tumour excised and now lump on hand
42
capillary loops surrounded by epithelial cells
CVD
● AV malformation - capillary loops surrounded by epithelial cells
43
epileptic with patch on back and lumps in brain
● Tuberous sclerosis - epileptic with patch on back and lumps in brain
44
raised ICP symptoms for a while then became obtunded
● Herniation - raised ICP symptoms for a while then became obtunded
45
mass under dura mater compressing frontal lobe (usually)
● Meningioma - mass under dura mater compressing frontal lobe (usually)
46
massive abdo mass in child, might have high BP, or haematuria
● Wilms - massive abdo mass in child, might have high BP, or haematuria
47
high EPO, high Hb, renal masses, painless haematuria
● RCC - high EPO, high Hb, renal masses, painless haematuria
48
fat person with CVS risk factors, will hurt, SO loin pain
● Renal Infarct - fat person with CVS risk factors, will hurt
49
vomiting, white cell casts
Renal
● Pyelonephritis - vomiting, white cell casts
50
pain, haematuria
● Calculus - pain, haematuria
51
Drug associated with focal glomerulonephritis
● Heroin use - associated with focal glomerulonephritis
52
oncogene, poor prognosis, squamous and small cell
KRAS
53
peripheral lesion, Asian non smokers, glandular, women
● Adenocarcinoma - peripheral lesion, Asian non smokers, glandular, women
54
prickles, keratinisation, PTHrp secretion, smokers, central but not so much anymore
● Squamous Carcinoma - prickles, keratinisation, PTHrp secretion, smokers, central but not so much anymore
55
aggressive, responds to chemo, oat cells
| ○ Can have hyponatraemia
● Small cell - aggressive, responds to chemo, oat cells
| ○ Can have hyponatraemia
56
good prognosis extremely good fucking response, lung Ca
EGFR +ve
57
plumber, thickened pleura on CT
● Mesothelioma
58
Cough after working on farm with mouldy hay
● Extrinsic allergic alveolitis - Cough after working on farm with mouldy hay
59
rusty red sputum
● Strep pneumonia - rusty red sputum
60
⅓ due to infection, also CF, immunodeficiency, ABPA, aspiration
● Bronchiectasis - ⅓ due to infection, also CF, immunodeficiency, ABPA, aspiration
61
pattern of lung injury associated with asthma
● Eosinophilic inflammation - pattern of lung injury associated with asthma
62
ship worker with pleural plaques
● Asbestosis - ship worker with pleural plaques
63
pattern of lung injury associated with alpha 1 antitrypsin deficiency
● Emphysema - pattern of lung injury associated with alpha 1 antitrypsin deficiency
64
anti Ro, anti La
● Sjogren’s - anti Ro, anti La
65
anti centromere
● CREST - anti centromere
66
anti CCP
● RA - anti CCP
67
anti Scl-70, topoisomerase
● Diffuse scleroderma - anti Scl-70, topoisomerase
68
anti mitochondrial
● Pruritus (PBC) - anti mitochondrial
69
3 miscarriages
● 3 miscarriages - anti cardiolipin
70
● Chest and renal symptoms
| What conditions
● Chest and renal symptoms - c-ANCA for Wegener’s, anti GBM for Goodpasture’s (type 4 collagen)
71
perimenopausal, oestrogen sensitive, good prognosis
○ Endometrioid endometrial cancer - perimenopausal, oestrogen sensitive, good prognosis
72
clear cell, older, bad, hobnail
| What gynaecologist cancer?
○ Non endometrioid - clear cell, older, bad, hobnail
73
most common ovarian tumour type in post menopausal women
○ Ovarian sex cord tumours most common in post menopausal women
74
Ovarian tumour that converts androgens to oestrogen
■ Granulosa-theca cells (& therefore tumours) convert androgens to oestrogen
75
Androgen producing ovarian tumour
■ Sertoli-Leydig - androgen
76
Meig’s syndrome (ascites + pleural effusion)
Fibroma
77
teratoma, dysgerminoma, choriocarcinoma (secrete hCG)
What tumour type?
○ Germ cell: teratoma, dysgerminoma, choriocarcinoma (secrete hCG)
78
○ Epithelial - most ovarian tumours
most common, psammoma bodies
■ Serous - most common, psammoma bodies
79
○ Epithelial - most ovarian tumours
mucin secreting cells
■ Mucinous - mucin secreting cells
80
○ Epithelial - most ovarian tumours
tubular glands
■ Endometrioid - tubular glands
81
○ Epithelial - most ovarian tumours
hobnail
■ Clear cell - hobnail
82
Testicular tumours
secretes AFP
● Yolk sac - secretes AFP
83
Testicular tumours
granulomatous lesion
● TB - granulomatous lesion
84
Testicular tumours
lesions on penis that were excised but returned
● Condylomata - lesions on penis that were excised but returned
85
painless ulcer which healed but now snail track ulcers in mouth
● Syphilis - painless ulcer which healed but now snail track ulcers in mouth
86
Testicular tumours
radiosensitive, most common type of germinal tumour
● Seminoma - radiosensitive, most common type of germinal tumour
87
Testicular tumours
any age, malignant if post-pubertal; AFP, HCG, LDH are markers
● Teratoma - any age, malignant if post-pubertal; AFP, HCG, LDH are markers
88
● Amyloid
myeloma type
○ AL in myeloma
89
● Amyloid
if inflammatory
○ AA if inflammatory
90
● Amyloid
Alzheimer’s
○ Abeta - Alzheimer’s
91
● Amyloid
islet amyloid polypeptide in T2DM
○ Amylin - islet amyloid polypeptide in T2DM
92
A/I condition is associated with IBD
PSC
93
Transfusion reactions
>24 hours with extravascular haemolysis (jaundice, haemoglobinuria)
● Delayed: >24 hours with extravascular haemolysis (jaundice, haemoglobinuria)
94
Transfusion reactions
wrong blood, anaphylaxis (often goes with IgA) if managed poorly
● Immediate death: wrong blood, anaphylaxis (often goes with IgA) if managed poorly
95
Transfusion reactions
urticarial rash
● Allergy: urticarial rash
96
Transfusion reactions
HLP1A
● Post transfusion purpura: HLP1A
97
Transfusion reactions
maculopapular rash, diarrhoea
● GVHD: maculopapular rash, diarrhoea
98
Transfusion reactions
dry cough, fever, low JVP, anti leucocyte antigens, acute SOB, low sats
● TRALI: dry cough, fever, low JVP, anti leucocyte antigens, acute SOB, low sats
99
Transfusion reactions
cough, high JVP, acute SOB, low sats
● TACO
100
Transfusion reactions
high fever (>40), shock, rigors
● Bacterial: high fever (>40), shock, rigors
101
Transfusion reactions
thalassaemia patient who looks tanned and has diabetes
● Transfusion haemosiderosis - thalassaemia patient who looks tanned and has diabetes
102
Transfusion choices
● Woman with anti D before C section
● Woman with anti D before C section - CMV neg, cross match
103
Transfusion choices
● Man with AAA repair (elective)
● Man with AAA repair (elective) - cross match, you’ve got time as it’s elective
104
Transfusion choices
● Woman in emergency
● Woman in emergency - O neg
105
Transfusion choices
● Immunocompromise
● Immunocompromise - irradiate
106
Transfusion choices
● Previous severe allergic reaction
● Previous severe allergic reaction - washed red cell and platelets
107
Transfusion choices
● Aplastic anaemia needs monthly transfusion
● Aplastic anaemia needs monthly transfusion - irradiated and filtered, platelets if <10,000 and if bleeding, leucodepleted
108
Transfusion choices
● Quick
● Quick - Group and save (not as good as cross match)
109
Hyperviscosity & blue toes
Igs precipitate at low temps (secondary to connective tissue diseases, lymphoproliferative disease) leading to complement activation, neutrophil recruitment and vascular damage
● Cryoglobulinaemia (in Meeran’s book) - Igs precipitate at low temps (secondary to connective tissue diseases, lymphoproliferative disease) leading to complement activation, neutrophil recruitment and vascular damage
110
Hyperviscosity & blue toes
associated with cryoglobulinaemia - type III hypersensitivity
● Hepatitis C - associated with cryoglobulinaemia - type III hypersensitivity
111
Hyperviscosity & blue toes
associated with Hep B/C
● Polyarteritis nodosa - associated with Hep B/C
112
Hyperviscosity & blue toes
Platelets >600, treat with anagrelide, aspirin, hydroxycarbamide
● Essential thrombocythaemia - Platelets >600, treat with anagrelide, aspirin, hydroxycarbamide
113
Hyperviscosity & blue toes
● Cold haemolytic anaemia antibody type
● Cold haemolytic anaemia: IgM
114
Hyperviscosity & blue toes
● Warm haemolytic anaemia antibody type
● Warm haemolytic anaemia: IgG
115
Hyperviscosity & blue toes
low platelets, MARCH: MAHA, a fever, renal failure, CNS (headaches, hallucinations), haemogobinuria
● TTP: low platelets, MARCH: MAHA, a fever, renal failure, CNS (headaches, hallucinations), haemogobinuria
116
Hyperviscosity & blue toes
kids
low plts
● ITP: kids
117
Hyperviscosity & blue toes
JAK2, itching after a bath, myelodysplastic disorder
● Polycythaemia vera: JAK2, itching after a bath, myelodysplastic disorder
118
Hyperviscosity & blue toes
>20% blasts, Auer rods, Down’s
● AML: >20% blasts, Auer rods, Down’s
119
Hyperviscosity & blue toes
9;22, myeloid cells
● CML: 9;22, myeloid cells
120
Hyperviscosity & blue toes
○ Adults: due to lymphoproliferative disease, infection, Waldenstrom’s macroglobulinaemia
● Secondary cold agglutinin disease
121
Hyperviscosity & blue toes
○ Children: due to infection, e.g. Mycoplasma, mononucleosis, HIV
● Secondary cold agglutinin disease
122
Lymphoma/leukaemia
Alk1
● Anaplastic - Alk1
123
Lymphoma/leukaemia
starry sky, EBV, jaw in African children
● Burkitt’s - starry sky, EBV, jaw in African children
124
Lymphoma/leukaemia
MALT, treated with triple therapy
○ Can also get MALT from Sjogren’s (parotid)
● H pylori - MALT, treated with triple therapy
| ○ Can also get MALT from Sjogren’s (parotid)
125
Lymphoma/leukaemia
EBV
Burkitt’s or Hodgkin’s
126
Lymphoma/leukaemia
smear cells, elderly asymptomatic patients, generalised lymphadenopathy
● CLL - smear cells, elderly asymptomatic patients, generalised lymphadenopathy
127
Lymphoma/leukaemia
9;22
● CML - 9;22
128
Lymphoma/leukaemia
Auer rods
● AML - Auer rods
129
Lymphoma/leukaemia
children
● ALL - children
130
Lymphoma/leukaemia
raised Ig no symptoms, <10% bast cells, <30g/dl paraprotein
○ MGUS - raised Ig no symptoms, <10% bast cells, <30g/dl paraprotein
131
Lymphoma/leukaemia
more cells than MGUS but no symptoms
○ Smouldering - more cells than MGUS but no symptoms
132
Lymphoma/leukaemia
bone pain bence
● Myeloma - bone pain; as soon as they have symptoms it’s myeloma
133
Lymphoma/leukaemia
elderly, massive splenomegaly, low platelets, red cells, normal white cells
● Myelofibrosis - elderly, massive splenomegaly, low platelets, red cells, normal white cells
134
Lymphoma/leukaemia
associated with DIC
● Acute promyelocytic leukaemia - associated with DIC
M3 AML
135
Lymphoma/leukaemia
collection of B cells in the bone, like multiple myeloma but not multiple
○ <5% plasma cells, no paraprotein
○ Lump on clavicle and lytic lesion on X-ray; raised IgA but no other lesions/abnormal calcium/anaemia
● Solitary plasmacytoma - collection of B cells in the bone, like multiple myeloma but not multiple
○ <5% plasma cells, no paraprotein
○ Lump on clavicle and lytic lesion on X-ray; raised IgA but no other lesions/abnormal calcium/anaemia
136
Anaemia
high ferritin (acute phase protein)
● Bacterial infection - high ferritin (acute phase protein)
137
Anaemia
menstruating woman or bleeding, low ferritin, high transferrin, high TIBC
○ High transferrin also in haemochromatosis with high saturation
● IDA - menstruating woman or bleeding, low ferritin, high transferrin, high TIBC
○ High transferrin also in haemochromatosis with high saturation
138
Anaemia
○ Raised: clotting factors, platelets (raised by the end but can drop in early pregnancy), neutrophils
○ Dilutional anaemia
○ Macrocytosis
● Values in pregnancy
○ Raised: clotting factors, platelets (raised by the end but can drop in early pregnancy), neutrophils
○ Dilutional anaemia
○ Macrocytosis
139
Anaemia
raised reticulocytes, do direct antiglobulin test
● Haemolytic anaemia: raised reticulocytes, do direct antiglobulin test
140
Anaemia
HbA2 up
B thalassaemia
141
Coagulation monitoring
1st episode DVT or PE, atrial fibrillation, caridomyopathy, symptomatic inherited thrombophilia, mural thrombus, cardioversion
What INR?
○ 2.5 if: 1st episode DVT or PE, atrial fibrillation (2-3), caridomyopathy, symptomatic inherited thrombophilia, mural thrombus, cardioversion
142
Coagulation monitoring
recurrent DVT or PE, mechanical prosthetic valve, coronary artery graft thrombosis, antiphospholipid syndrome
What INR?
○ 3.5 if: recurrent DVT or PE, mechanical prosthetic valve (2.5-3.5), coronary artery graft thrombosis, antiphospholipid syndrome
143
Coagulation monitoring
rivaroxaban, fondaparinux
What do you monitor?
● Anti Xa assay - rivaroxaban, fondaparinux (they have X’s in them)
144
Coagulation monitoring
low in liver disease and in DIC, high in pregnancy
● Fibrinogen - low in liver disease and in DIC, high in pregnancy
145
Coagulation monitoring
breakdown product of fibrin
● D dimers - breakdown product of fibrin
146
Coagulation monitoring
monitor APTT
● Unfractionated heparin: monitor APTT
147
Coagulation monitoring
doesn’t need monitoring except late pregnancy and renal failure
● LMWH: doesn’t need monitoring except late pregnancy and renal failure
148
Clotting
most common prothrombotic mutation, AD
● Carrier of Factor V Leiden - 3-5x population risk
| ○ Factor V Leiden is the most common prothrombotic mutation, AD
149
Clotting
■ Thrombocytopenia (bruising/purpura)
■ Microangiopathic haemolytic anaemia (anaemia, jaundice, RBC fragments)
■ Neuro symptoms (fluctuating) e.g. hallucinations, bizarre behaviour, delirium, stroke, headache
■ Kidney failure
■ Fever
TTP pentad is as follows:
■ Thrombocytopenia (bruising/purpura)
■ Microangiopathic haemolytic anaemia (anaemia, jaundice, RBC fragments)
■ Neuro symptoms (fluctuating) e.g. hallucinations, bizarre behaviour, delirium, stroke, headache
■ Kidney failure
■ Fever
150
Clotting
● Headache and seizure
● Headache and seizure - TTP (MAHA)
151
Clotting
● Massive splenomegaly, dry/bloody tap, tear drop cells
● Massive splenomegaly, dry/bloody tap, tear drop cells - myelofibrosis
152
Clotting
● Pelger Huet cells
● Pelger Huet cells - MDS
153
Clotting
● 10w pregnant, sister had DVT aged 33, father on long term anticoagulant
● 10w pregnant, sister had DVT aged 33, father on long term anticoagulant - antithrombin deficiency
154
Calcium
everything normal but decreased bone mineralisation; ALP can be raised if recent fracture
● Osteoporosis - everything normal but decreased bone mineralisation; ALP can be raised if recent fracture
155
Calcium
low calcium and phosphate, high ALP and PTH
● Osteomalacia - low calcium and phosphate, high ALP and PTH
156
Calcium
high calcium, low phosphate, high ALP and PTH
● Primary hyperparathyroidism - high calcium, low phosphate, high ALP and PTH
157
Calcium
high calcium, low phosphate, high ALP and PTH
low urine calcium
○ Familial hypercalcaemia - same but low calcium in urine
158
Calcium
low calcium, high phosphate, ALP and PTH
● Chronic kidney disease (secondary hyperparathyroidism) - low calcium, high phosphate, ALP and PTH
159
Calcium
no longer sensitive to PTH so high PTH despite high calcium
high phosphate, ALP and PTH
● Tertiary hyperparathyroidism - no longer sensitive to PTH so high PTH despite high calcium
160
Calcium
everything is normal but raised ALP
● Paget’s disease - everything is normal but raised ALP
161
Liver
bilirubin <100, raised ALT, AST and GGT, bile salts >10
● Intrahepatic cholestasis (pregnancy): bilirubin <100, raised ALT, AST and GGT, bile salts >10
162
Liver
raised ALT and AST
● Cirrhosis: raised ALT and AST
163
Liver
isolated ALP rise
● Pagets: isolated ALP rise
164
Liver
elevated unconjugated bilirubin
● Gilberts: elevated unconjugated bilirubin
165
Liver
raised ALT and AST, AST
● Viral hepatitis: raised ALT and AST, ALT>AST
2:1
166
Liver
VERY HIGH ALT and AST
● Paracetamol: VERY HIGH ALT and AST
167
Acid-Base
low electrolytes, high bicarb, alkalotic
○ Hypochloraemic hypokalaemic metabolic acidosis
● Pyloric stenosis - low electrolytes, high bicarb, alkalotic
○ Hypochloraemic hypokalaemic metabolic acidosis
168
Sodium/osmolality
high potassium, low sodium, normal osmolality, +/-nauseous patient if crisis or because of chemo and chemo is making them nauseous
● Addisons - high potassium, low sodium, normal osmolality, +/-nauseous patient if crisis or if Addison’s because of chemo and chemo is making them nauseous
169
Sodium/osmolality
low potassium, high sodium
● Conns - low potassium, high sodium
170
Sodium/osmolality
high urinary Na+, high urine osmolality, plasma osmolality low
○ Causes: intracerebral, alveolar, drugs, hormones
● SIADH - high urinary Na+, high urine osmolality, plasma osmolality low
○ Causes: intracerebral, alveolar, drugs, hormones
171
Sodium/osmolality
high sodium, low urine osmolality, euvolaemic
urine concentrates after desmopressin
● Diabetes insipidus - high sodium, low urine osmolality, euvolaemic
○ Cranial - urine concentrates after desmopressin
172
Sodium/osmolality
high sodium, low urine osmolality, euvolaemic
no change in urine after desmopressin
● Diabetes insipidus - high sodium, low urine osmolality, euvolaemic
○ Nephrogenic - no change in urine after desmopressin
173
Sodium/osmolality
low potassium, high glucose, high serum osmolality >320, high bicarb
● HONK - low potassium, high glucose, high serum osmolality >320, high bicarb
Hyperglycaemic Hyperosmolar Nonketotic Coma (HONK)
174
Sodium/osmolality
high lipids create a pseudohyponatraemia with normal osmolality
● Diabetes mellitus - high lipids create a pseudohyponatraemia with normal osmolality
175
Sodium/osmolality
low sodium, normal potassium, normal volume
● Post prostatectomy - low sodium, normal potassium, normal volume
○ 3 days post prostatectomy with low sodium and everything else normal - fluid overload (they give plain water in TURP)
176
Sodium/osmolality
● Potassium in DKA without treatment
● Potassium in DKA without treatment - metabolic acidosis, raised
177
Sodium/osmolality
hyponatraemia, hyperkalaemia, inadequate aldosterone synthesis, hyperandrogenism
● Congenital adrenal hyperplasia: hyponatraemia, hyperkalaemia, inadequate aldosterone synthesis, hyperandrogenism
178
Vitamins
give B1
● Wernicke’s - give B1
| Hyper G
179
Vitamins
B1 deficiency
● Beri beri - B1 deficiency
180
Vitamins
● High PTH
● High PTH - vit D deficiency
181
Vitamins
● Cystic fibrosis
What is deficient
● Cystic fibrosis - ADEK deficiencies (fat soluble - as would coeliac/Crohn’s)
182
Vitamins
● Indian lady who is vegan with tiredness and macrocytic anaemia
● Indian lady who is vegan with tiredness and macrocytic anaemia - B12
183
Vitamins
● Coeliac disease with swollen tongue and macrocytic anaemia
● Coeliac disease with swollen tongue and macrocytic anaemia - B12
184
Vitamins
● Dementia/dermatitis/Casal’s necklace/diarrhoea
● Dementia/dermatitis/Casal’s necklace/diarrhoea - niacin (=pellagra)
185
Vitamins
● Rickets
● Rickets - vit D
186
Vitamins
● Crohn’s and macrocytic anaemia
● Crohn’s and macrocytic anaemia - could be methotrexate causing folate deficiency
187
Vitamins
the combination of autoimmune adrenal insufficiency (Addison’s) with autoimmune hypothyroidism and/or T1DM
○ Part of a larger syndrome known as autoimmune polyendocrine syndrome type II or polyglandular autoimmune syndrome type II (PAS II)
● Schmidt’s disease - the combination of autoimmune adrenal insufficiency (Addison’s) with autoimmune hypothyroidism and/or T1DM
○ Part of a larger syndrome known as autoimmune polyendocrine syndrome type II or polyglandular autoimmune syndrome type II (PAS II)
○ APS Type I: childhood, very rare, Addison’s, diminished parathyroid function, delayed or slow sexual development, B12 malabsorption/deficiency, candidasis, hepatitis
○ APS Type II: young adults, Addison’s, under or overactive thyroid, delayed or slow sexual development, diabetes, vitiligo, coeliac disease
188
Vitamins
childhood, very rare, Addison’s, diminished parathyroid function, delayed or slow sexual development, B12 malabsorption/deficiency, candidasis, hepatitis
○ APS Type I: childhood, very rare, Addison’s, diminished parathyroid function, delayed or slow sexual development, B12 malabsorption/deficiency, candidasis, hepatitis
○ Part of a larger syndrome known as autoimmune polyendocrine syndrome type II or polyglandular autoimmune syndrome type II (PAS II)
189
Vitamins
young adults, Addison’s, under or overactive thyroid, delayed or slow sexual development, diabetes, vitiligo, coeliac disease
○ APS Type II: young adults, Addison’s, under or overactive thyroid, delayed or slow sexual development, diabetes, vitiligo, coeliac disease
○ Part of a larger syndrome known as autoimmune polyendocrine syndrome type II or polyglandular autoimmune syndrome type II (PAS II)
190
Pituitary hormones
● High LH, FSH, everything else normal
● High LH, FSH, everything else normal - POF
191
Pituitary hormones
● Everything normal except (slightly) high prolactin
● Everything normal except (slightly) high prolactin - panhypopituitarism
192
Pituitary hormones
● Very high prolactin and everything else suppressed
● Very high prolactin and everything else suppressed - prolactinoma
193
Pituitary hormones
● High GH, everything else suppressed
● High GH, everything else suppressed - acromegaly
194
Pituitary hormones
● High TSH, low T3 + T4, everything else normal
● High TSH, low T3 + T4, everything else normal - primary hypothyroidism
195
Endocrine tests
● Thin skin, proximal myopathy, impaired fasting glucose -> Cushing’s
● Thin skin, proximal myopathy, impaired fasting glucose -> Cushing’s -> dexamethasone suppression test
○ If it suppresses with high dose = Cushing’s disease; if not = ectopic ACTH secretion
196
Endocrine tests
● Polyuria, polydipsia, hyponatraemia and high ish serum osmolality
● Polyuria, polydipsia, hyponatraemia and high ish serum osmolality -> blood glucose, as high lipids can cause pseudohyponatraemia
○ If not diabetic, can do water deprivation test
197
Endocrine tests
● Acromegalic symptoms
● Acromegalic symptoms - OGTT
198
Endocrine tests
● Addison’s
● Addison’s - short synACTHen test
199
Endocrine tests
● Monitoring T2DM
● Monitoring T2DM - HbA1c
200
Endocrine tests
● Hypoglycaemia
● Hypoglycaemia - test C peptide (which is secreted in equimolar amounts to insulin)
○ C peptide levels are high in insulinoma, normal or low with exogenous insulin, and elevated with oral sulfonylureas
○ Non islet cell tumour hypoglycaemia - low glucose, insulin, C peptide, FFA and ketones
201
Endocrine tests
○ C peptide levels are high + insulin is
○ C peptide levels are high in insulinoma
202
Endocrine tests
○ C peptide levels are normal or low
low with exogenous insulin
203
Endocrine tests
○ C peptide levels are high but not super high
Elevated with oral sulfonylureas
204
Endocrine tests
low glucose, insulin, C peptide, FFA and ketones
○ Non islet cell tumour hypoglycaemia - low glucose, insulin, C peptide, FFA and ketones
205
Endocrine tests
○ Neonates:
■ Ketones present:
○ Neonates:
■ Ketones present: premature, IUGR
■ Ketones absent: inherited metabolic disorder
206
Endocrine tests
○ Neonates:
■ Ketones absent
○ Neonates:
■ Ketones present: premature, IUGR
■ Ketones absent: inherited metabolic disorder
207
Endocrine tests
elevated (but not super high) prolactin -> low dopamine and high prolactin
● Non functioning pituitary adenoma - high prolactin as it presses on the stalk causing pituitary failure -> low dopamine and high prolactin
208
Sugars
6.1-6.9 fasting
● Impaired fasting glucose - 6.1-6.9
209
Sugars
2 hours post glucose ≥7.8 and <11.1
● Impaired glucose tolerance - 2 hours post glucose ≥7.8 and <11.1
210
Sugars
fasting glucose ≥7.0, or 2 hour glucose ≥11.1
○ Need symptoms + one of these tests OR
○ Both of these tests
● Diabetes - fasting glucose ≥7.0, or 2 hour glucose ≥11.1
○ Need symptoms + one of these tests OR
○ Both of these tests
○ WHO also recommends HbA1c ≥48
211
Enzymes
● Rate limiting enzmye in Haem synthesis
● Rate limiting enzmye in Haem synthesis - ALA deficiency
212
Enzymes
● Deficiency resulting in urate overproduction - HGPRT
● Deficiency resulting in urate overproduction - HGPRT = Lesch Nyhan (self mutilating, choreiform movements, mentally retarded, gout)
213
Enzymes
● Raised in rhabdomyolysis
● Raised in rhabdomyolysis - CK
214
Enzymes
● Seen in the kidney of someone with T1DM
● Seen in the kidney of someone with T1DM - renal sclerosis
○ Type 2 - Amyloid AA
○ Myeloma - amyloid AL
215
Enzymes
● Emphysema in someone who hasn’t smoked
● Emphysema in someone who hasn’t smoked - A1AT deficiency
216
Enzymes
● Raised in someone with mumps
● Raised in someone with mumps - amylase
amylase-S
(NB P = in pancreatitis)
217
Metabolic disorders
● Hypoglycaemic neonate, which condition do you want to rule out first?
○ Galactosaemia - commonest is Gal-1-PUT and is also the most severe
■ Liver and kidney problems: presents with conjugated hyperbilirubinaemia, hepatomegaly, sepsis, hypoglycaemia, cataract formation
■ Urine reducing substances - shows huge preponderance of galactose, and red cell gal-1-put
218
Metabolic disorders
■ Liver and kidney problems: presents with conjugated hyperbilirubinaemia, hepatomegaly, sepsis, hypoglycaemia, cataract formation
■ Urine reducing substances
○ Galactosaemia - commonest is Gal-1-PUT and is also the most severe
■ Liver and kidney problems: presents with conjugated hyperbilirubinaemia, hepatomegaly, sepsis, hypoglycaemia, cataract formation
■ Urine reducing substances - shows huge preponderance of galactose, and red cell gal-1-put
219
Metabolic disorders
● Jaundice + sepsis
○ Can only be tyrosinaemia or galactosaemia
220
Metabolic disorders
kidney and liver disturbances, mental retardation, fatal if untreated
■ Diarrhoea and bloody stools, vomiting, poor weight gain, extreme sleepiness, irritability, ‘cabbage like odour’ to skin or urine, liver issues including jaundice and easy bruising, rickets, weakness/pain, seizures
○ Tyrosinaemia - can’t break down tyrosine: kidney and liver disturbances, mental retardation, fatal if untreated
■ Diarrhoea and bloody stools, vomiting, poor weight gain, extreme sleepiness, irritability, ‘cabbage like odour’ to skin or urine, liver issues including jaundice and easy bruising, rickets, weakness/pain, seizures
■ Type 1 Tyrosinaemia - Canada
221
Metabolic disorders
disorders in metabolism of very long chain fatty acids and the biosynthesis of complex phospholipids
■ Neonates: Muscular hypotonia, seizures, hepatic dysfunction, dysmorphia
■ Infants: retinopathy often leading to early blindness, sensorineural deafness, hepatic dysfunction, mental deficiency, often FTT, dysmorphic signs
■ Bony changes: large fontanelle, osteopaenia of long bones, often with calcified stippling in the patellar region
■ Very long chain fatty acid profile
○ Perioxisomal - disorders in metabolism of very long chain fatty acids and the biosynthesis of complex phospholipids
■ Neonates: Muscular hypotonia, seizures, hepatic dysfunction, dysmorphia
■ Infants: retinopathy often leading to early blindness, sensorineural deafness, hepatic dysfunction, mental deficiency, often FTT, dysmorphic signs
■ Bony changes: large fontanelle, osteopaenia of long bones, often with calcified stippling in the patellar region
■ Very long chain fatty acid profile
222
Metabolic disorders
commonly ataxia, seizures, retinopathy, liver fibrosis, coagulopathies, FTT, dysmorphic features (e.g. inverted nipples and subcutaneous fat pads), strabismus, +/- ocular abnormalities, congenital hyperinsulinism with hyperinsulinaemic hypoglycaemia in infancy
○ Glycosylation - commonly ataxia, seizures, retinopathy, liver fibrosis, coagulopathies, FTT, dysmorphic features (e.g. inverted nipples and subcutaneous fat pads), strabismus, +/- ocular abnormalities, congenital hyperinsulinism with hyperinsulinaemic hypoglycaemia in infancy
223
Metabolic disorders
● Ashkenazi Jews
○ Tay Sachs - cell membrane components (gangliosides - kind of sphingolipid) accumulate in nerve cells
○ Lysosomal - substrate accumulation within the organelles leading to organomegaly (connective tissue, solid organs, cartilage, bone, above all - nervous tissue)
224
Metabolic disorders
cell membrane components (gangliosides - kind of sphingolipid) accumulate in nerve cells
■ Months after birth: deterioration of mental and physical abilities, cherry red spot on retina, death before the age of 4
■ Can also present in older children with skill deterioration or as adults when effects can stop progressing
○ Tay Sachs - cell membrane components (gangliosides - kind of sphingolipid) accumulate in nerve cells
■ Months after birth: deterioration of mental and physical abilities, cherry red spot on retina, death before the age of 4
■ Can also present in older children with skill deterioration or as adults when effects can stop progressing
225
Metabolic disorders
substrate accumulation within the organelles leading to organomegaly (connective tissue, solid organs, cartilage, bone, above all - nervous tissue)
■ Urine mucopolysaccharides, oligosaccharides, leucocyte enzyme activities
○ Lysosomal - substrate accumulation within the organelles leading to organomegaly (connective tissue, solid organs, cartilage, bone, above all - nervous tissue)
■ Urine mucopolysaccharides, oligosaccharides, leucocyte enzyme activities
226
Metabolic disorders
○ Encephalopathy, respiratory alkalosis and irreversible neurological damage
○ High ammonia
○ Free flowing venous sample delivered to lab stat on ice, plasma amino acids, urine amino and organic acids (+urine orotic acid)
● Urea cycle
○ Encephalopathy, respiratory alkalosis and irreversible neurological damage
○ High ammonia
○ Free flowing venous sample delivered to lab stat on ice, plasma amino acids, urine amino and organic acids (+urine orotic acid)
227
Metabolic disorders
○ Most important involve metabolism of leucine, isoleucine and valine
○ Truncal hypotonia/limb hypertonia, myoclonic jerks, unusual odour
○ Metabolic acidosis with high anion gap (not lactate): hypo/hypercalcaemia, hypoglycaemia, hyperammonaemia
○ Neutropenia, thrombopenia, pancytopenia
○ Plasma amino acids, urine organic acids (ideally while symptomatic), blood spot for acylcarnitine profile
○ Maple syrup urine disease: sweet smelling urine, also smell of ear wax, seem healthy at birth but quickly deteriorate with severe brain damage during times of metabolic crisis & can die of cerebral oedema
● Organic acidurias
○ Most important involve metabolism of leucine, isoleucine and valine
○ Truncal hypotonia/limb hypertonia, myoclonic jerks, unusual odour
○ Metabolic acidosis with high anion gap (not lactate): hypo/hypercalcaemia, hypoglycaemia, hyperammonaemia
○ Neutropenia, thrombopenia, pancytopenia
○ Plasma amino acids, urine organic acids (ideally while symptomatic), blood spot for acylcarnitine profile
○ Maple syrup urine disease: sweet smelling urine, also smell of ear wax, seem healthy at birth but quickly deteriorate with severe brain damage during times of metabolic crisis & can die of cerebral oedema
228
Metabolic disorders
○ Failure of beta oxidation leads to hypoketotic hypoglycaemia often with hepatomegaly and cardiomyopathy
○ Urine organic acids whilst symptomatic and blood spot for acylcarnitine profile
○ MCADD: presents in early childhood, some remain completely asymptomatic; presents with metabolism is stressed
● Fatty acid oxidation defects
○ Failure of beta oxidation leads to hypoketotic hypoglycaemia often with hepatomegaly and cardiomyopathy
○ Urine organic acids whilst symptomatic and blood spot for acylcarnitine profile
○ MCADD: presents in early childhood, some remain completely asymptomatic; presents with metabolism is stressed
229
Metabolic disorders
○ Presents 3-6 months with hypoglycaemia with lactic acidosis, neutropenia, raised triglyceride, urate and transaminases
○ Muscle biopsy for enzyme studies
● Glycogen storage disease
○ Glucose 6 phosphatase = Von Gierke’s; excessive glycogen storage and prevents glucose export from gluocneogenetic organs
○ Presents 3-6 months with hypoglycaemia with lactic acidosis, neutropenia, raised triglyceride, urate and transaminases
○ Muscle biopsy for enzyme studies
230
Metabolic disorders
○ Elevated lactate after periods of fasting (overnight), elevated CK, CSF protein is raise
Onset before 20 years, ptosis and ophthalmoplegia, retinopathy, cardiac conduction abnormalities, cerebellar ataxia, proximal muscle weakness, deafness, diabetes, GH deficiency, hypoPTH etc
Mitochrondrial DNA analysis, muscle biopsy/ragged red fibres and OXPHOS (oxidative phosphorylation) complex activities
Mitochondrial disorders
○ Elevated lactate after periods of fasting (overnight), elevated CK, CSF protein is raised in Kearns-Sayre
■ Kearns Sayre: onset before 20 years, ptosis and ophthalmoplegia, retinopathy, cardiac conduction abnormalities, cerebellar ataxia, proximal muscle weakness, deafness, diabetes, GH deficiency, hypoPTH etc
○ Mitochrondrial DNA analysis, muscle biopsy/ragged red fibres and OXPHOS (oxidative phosphorylation) complex activities
231
Metabolic disorders
○ Multisystem disorders: cardiomyopathy, osteopaenia, hepatomegaly, and (in some cases) facial dysmorphia, abnormal fat distribution
○ Transferrin glycoforms (serum)
● Congenital disorders of glycosylation
○ Multisystem disorders: cardiomyopathy, osteopaenia, hepatomegaly, and (in some cases) facial dysmorphia, abnormal fat distribution
○ Transferrin glycoforms (serum)
232
2(Na + K) + urea + glucose
Calculate osmolality: 2(Na + K) + urea + glucose
233
(Na + K) - (HCO3 + Cl)
Calculate anion gap: (Na + K) - (HCO3 + Cl)
234
Immunodeficiency
○ CD4 deficiency, less IgA and IgG made
○ Unwell by 3 months
● Bare lymphocyte 2
○ CD4 deficiency, less IgA and IgG made
○ Unwell by 3 months
235
Immunodeficiency
```
○ CD40
○ X-linked; can’t class switch so no IgA and IgG
```
● Hyper IgM
○ CD40
○ X-linked; can’t class switch so no IgA and IgG
236
Immunodeficiency
● Atypical granulomatous infection in previously healthy patient
● Atypical granulomatous infection in previously healthy patient
○ IFN gamma, IFNgamma receptor deficiency, IL-12, IL-12 receptor
237
Immunodeficiency
○ 6 days every 3 weeks; give G-CSF
ELA-2 mutation
● Cyclic neutropenia
| ○ 6 days every 3 weeks; give G-CSF
238
Immunodeficiency
○ Absolute deficiency of everything, will die without BMT
● SCID
○ Reticular dysgenesis is most severe type; 45% X linked (AK2)
○ Absolute deficiency of everything, will die without BMT
239
Immunodeficiency
○ X linked tyrosine kinase - BTK gene
○ Failed production of mature B cells, no antibodies, symptoms 3-6 months
● Brutons agammaglobulinaemia
○ X linked tyrosine kinase - BTK gene
○ Failed production of mature B cells, no antibodies, symptoms 3-6 months
240
Immunodeficiency
congenital neutropenia
● Kostmann’s (HAX1) syndrome - congenital neutropenia
241
Immunodeficiency
● Rheumatoid arthritis patient with mycobacterial infections
● Rheumatoid arthritis patient with mycobacterial infections
| ○ Iatrogenic - TNF antagonists
242
Immunodeficiency
○ Complement deficiency - C5-C9
● Recurrent pneumococcal disease and meningitis
| ○ Complement deficiency - C5-C9
243
Immunodeficiency
● Recurrent infections with negative NBT and dihidrorhodamine tests
● Recurrent infections with negative NBT and dihidrorhodamine tests
○ Chronic granulomatous disease
244
Immunodeficiency
● Immune deficiency that has improved with age but not mum is concerned about delayed speaking and language
● Immune deficiency that has improved with age but not mum is concerned about delayed speaking and language
○ Di George
245
Transplant monitoring
● Marker of antibody mediated rejection
● Marker of antibody mediated rejection
| ○ C4d
246
Transplant monitoring
● Most important to match for rejection
● Most important to match for rejection
| ○ HLA: DR>B>A
247
Transplant monitoring
○ Preformed Ab activates complement
○ Thrombosis and necrosis, prevented by cross matching properly
● Hyperacute rejection
○ Preformed Ab activates complement
○ Thrombosis and necrosis, prevented by cross matching properly
248
Transplant monitoring
○ T cells, type IV reaction
○ TReat with T cell suppressors
● Acute cellular mediated rejection
○ T cells, type IV reaction
○ TReat with T cell suppressors
249
Transplant monitoring
○ Antibodies attack vessels
○ Exposure -> proliferation + maturation of B cells -> effector phase - antibodies bind to graft endothelium (->vasculitis)
● Acute antibody mediated reaction
○ Antibodies attack vessels
○ Exposure -> proliferation + maturation of B cells -> effector phase - antibodies bind to graft endothelium (->vasculitis)
250
Transplant monitoring
○ Donor cells attacking host
○ Days-weeks, rash, N+V, bloody diarrhoea, abdo pain, jaundice
○ Prophylaxis: methotrexate/cyclosporine
○ Treat with steroids
```
● GvHD
○ Donor cells attacking host
○ Days-weeks, rash, N+V, bloody diarrhoea, abdo pain, jaundice
○ Prophylaxis: methotrexate/cyclosporine
○ Treat with steroids
```
251
Antibodies + autoimmunity
● Diffuse systemic scleroderma
● Diffuse systemic scleroderma - scl-70 topoisomerase
252
Antibodies + autoimmunity
● Anti phospholipid syndrome
● Anti phospholipid syndrome - anti-cardiolipin, lupus anticoagulant, anti-b2 glycoprotein
253
Antibodies + autoimmunity
● Wegener’s granulomatosis (epistaxis and haematuria)
● Wegener’s granulomatosis (epistaxis and haematuria) - c-ANCA
254
Antibodies + autoimmunity
● Autoimmune Polyendocrinopathy Syndrome Type 1 - mutation
● Autoimmune Polyendocrinopathy Syndrome Type 1 - AIRE mutation
255
Antibodies + autoimmunity
● Graves - what type of reaction
● Graves - Type II reaction
256
Antibodies + autoimmunity
● Serum sickness what type of reaction
● Serum sickness - Type III reaction
257
Antibodies + autoimmunity
● Atopic Eczema - what type of reaction
● Atopic Eczema - Type I reaction
258
Antibodies + autoimmunity
dry eyes and mouth
● Sjogren’s - dry eyes and mouth
259
Antibodies + autoimmunity
weight loss, anti TTG antibodies, anti endomysial antibodies, steatorrhoea
● Coeliac - weight loss, anti TTG antibodies, anti endomysial antibodies, steatorrhoea
260
Antibodies + autoimmunity
Calcinosis, Raynaud’s, Esophageal dysmotility, Sclerodactyly, Telangiectasia
● CREST - Calcinosis, Raynaud’s, Esophageal dysmotility, Sclerodactyly, Telangiectasia
261
Antibodies + autoimmunity
anti ds DNA
● SLE - anti ds DNA
262
Antibodies + autoimmunity
anti parietal cell > anti intrinsic factor
● Pernicious anaemia - anti parietal cell > anti intrinsic factor
263
Allergy
○ Stony fruit
● Oral allergy
| ○ Stony fruit
264
Allergy
○ Bluish mucosa
○ Seasonal - allergen desensitisation
○ Nasal corticosteroid or oral antihistamine
● Allergic rhinitis
○ Bluish mucosa
○ Seasonal - allergen desensitisation
○ Nasal corticosteroid or oral antihistamine
265
Allergy
ACE, diabetic
● Drug induced angioedema
266
Allergy
○ C1q esterase
● Hereditary angioedema
| ○ C1q esterase needed
267
Allergy
○ Flushing, diarrhoea
● Carcinoid
| ○ Flushing, diarrhoea
268
Allergy
● Urticaria e.g. exercise induced Rx
● Urticaria e.g. exercise induced
| ○ H1 receptor antagonist
269
Allergy
○ Hypotension and respiratory difficulty
○ IM adrenalin
Anaphylaxis
| Ara H 2 = bad peanutzzz
270
Allergy
● Cytokine responsible for promoting antibody synthesis
● Cytokine responsible for promoting antibody synthesis
| ○ IgE
271
Allergy
● Main cellular source of histamine
● Main cellular source of histamine
| ○ Mast cell
272
Allergy
● How do you measure mast cell degranulation
● How do you measure mast cell degranulation
| ○ Mast cell tryptase levels
273
Allergy
● Chemokine responsible for promoting eosinophil growth
● Chemokine responsible for promoting eosinophil growth
| ○ IL5
274
Immune cells
○ Engulf debris
● Macrophage
| ○ Engulf debris
275
Immune cells
○ Secrete Igs, cytokines, present antigens
● B cells
| ○ Secrete Igs, cytokines, present antigens
276
Immune cells
○ Present antigens; migrate to lymph nodes when activated
● Dendritic
| ○ Present antigens; migrate to lymph nodes when activated
277
Immune cells
○ Cytotoxic - MHC I
● CD8+
| ○ Cytotoxic - MHC I
278
Immune cells
● HIV
○ Co receptor
● HIV
○ Co receptor = CXCR4/CCR5
○ Receptor on cell wall which facilitates entry - gp120
○ Antigen for non-neutralising antibodies - p24 gag IgG
○ Target for drugs that inhibit an enzyme that breaks down proteins - protease
279
Immune cells
● HIV
○ Receptor on HIV cell wall which facilitates entry
● HIV
○ Co receptor = CXCR4/CCR5
○ Receptor on HIV cell wall which facilitates entry - gp120
○ Antigen for non-neutralising antibodies - p24 gag IgG
○ Target for drugs that inhibit an enzyme that breaks down proteins - protease
280
Immune cells
● HIV
○ Antigen for non-neutralising antibodies
● HIV
○ Co receptor = CXCR4/CCR5
○ Receptor on cell wall which facilitates entry - gp120
○ Antigen for non-neutralising antibodies - p24 gag IgG
○ Target for drugs that inhibit an enzyme that breaks down proteins - protease
281
Immune cells
● HIV
○ Target for drugs that inhibit an enzyme that breaks down proteins
● HIV
○ Co receptor = CXCR4/CCR5
○ Receptor on cell wall which facilitates entry - gp120
○ Antigen for non-neutralising antibodies - p24 gag IgG
○ Target for drugs that inhibit an enzyme that breaks down proteins - protease
282
Immunomodulators
○ For ank spond (with methotrexate), antiTNFalpha receptor
● Etanercept
| ○ For ank spond (with methotrexate), antiTNFalpha receptor
283
Immunomodulators
Anti B cell
○ Can be used for RA
● Rituximab
| ○ Can be used for RA
284
Immunomodulators
○ For ank spond (with methotrexate), antiTNFalpha receptor
● Etanercept
| ○ For ank spond (with methotrexate), antiTNFalpha receptor
285
Immunomodulators
● Pooled Ig
● Pooled Ig
| ○ CVID
286
Immunomodulators
○ Prophylaxis of allograft rejection, IV before + after
● Basiliximab
○ Antibody against IL-2Ralpha chain of CD25
○ Prophylaxis of allograft rejection, IV before + after
287
Immunomodulators
○ Used in caslteman’s, RA if not responding to methotrexate, sulfasalazine
○ IV every 4 weeks: reduces macrophage/T cell/B cell/neutrophil activation
● Tocilizumab
○ Antibody against IL6 receptor
○ Used in caslteman’s, RA if not responding to methotrexate, sulfasalazine
○ IV every 4 weeks: reduces macrophage/T cell/B cell/neutrophil activation
288
Immunomodulators
○ Antibody to p40 subunit of IL12 and IL23
○ Psoriasis, psoriatic arthritis, subcut every 12 weeks
● Ustekinumab
○ Antibody to p40 subunit of IL12 and IL23
○ Psoriasis, psoriatic arthritis, subcut every 12 weeks
289
Immunomodulators
○ Antibody against RANK ligand inhibiting RANK mediated osteoclast differentiation and function
○ Osteoporosis if not responding to bsiphosphonate - subcut every 6 months
● Denosumab
○ Antibody against RANK ligand inhibiting RANK mediated osteoclast differentiation and function
○ Osteoporosis if not responding to bsiphosphonate - subcut every 6 months
290
Immunomodulators
○ Wegener’s/vasculitis with prednisolone
○ Antiproliferative agent - B>T cells affected
● Cyclophosphamide
○ Wegener’s/vasculitis with prednisolone
○ Antiproliferative agent - B>T cells affected
291
Immunomodulators
○ Chronic granulomatous disease
● IFNgamma
| ○ Chronic granulomatous disease
292
Immunomodulators
● Worsening Crohn’s, already taking prednisolone and azathioprine
● Worsening Crohn’s, already taking prednisolone and azathioprine - infliximab?
293
Immunomodulators
● Temporal arteritis with high ESR
● Temporal arteritis with high ESR - prednisolone
294
Vaccines
● Routine but not given to immunocompromised children
● Routine but not given to immunocompromised children
| ○ MMR
295
Vaccines
● Travel vaccine not given to someone with ank spond on TNFalpha inhibitor or HIV
● Travel vaccine not given to someone with ank spond on TNFalpha inhibitro
○ Yellow fever
296
Vaccines
● 12-13 year old girls
● 12-13 year old girls
| ○ HPV
297
Vaccines
● Every 5 years given to splenectomy patients
● Every 5 years given to splenectomy patients
| ○ Pneumococcal
298
Vaccines
influenza A only, targets M2 channel
● Targets neuraminidase/haemogglutinin
○ Amantadine - influenza A only, targets M2 channel
○ Oseltamivir, zanamivir, sialic acid - NA inhibitors
299
Vaccines
NA inhibitors
● Targets neuraminidase/haemogglutinin
○ Amantadine - influenza A only, targets M2 channel
○ Oseltamivir, zanamivir, sialic acid - NA inhibitors
300
Vaccines
● Given as post exposure prophylaxis
● Given as post exposure prophylaxis
| ○ Rabies/HIV now
301
Vaccines
● Structure varies yearly
● Structure varies yearly
| ○ Influenza
302
Vaccines
● Vaccine that eradicated small pox
● Vaccine that eradicated small pox
| ○ Vaccinia
303
Vaccines
○ Conjugate vaccine
● Hep B
| ○ Conjugate vaccine
304
STIs
○ Loads of different forms; VDRL
○ Ulcer on penis which healed then rash on palms and soles
○ BenPen single dose IM
○ Loads of different forms; VDRL tells you if ever syphilis, can also do RPR
○ Ulcer on penis which healed then rash on palms and soles
○ BenPen single dose IM
305
STIs
○ Painful ulcer on penis
○ Haemophilus ducreyi - chocolate agar
● Chancroid
306
STIs
○ Needs a swab
○ Disseminated - think complement deficiency
○ Urethrtitis
○ Ceftriaxone or cefixime (spectinomycin if resistant)
● Gonorrhoea
○ Needs a swab
○ Disseminated - think complement deficiency
○ Urethrtitis
○ Ceftriaxone or cefixime (spectinomycin if resistant)
307
STIs
○ Thin white discharge, itchy - Swab
○ Metronidazole
● Trichomonas
○ Thin white discharge, itchy - Swab
○ Metronidazole
308
STIs
○ Swab + NAAT + azithromycin
○ LGV - lymphadenopathy weeks after primary infection, rectal symptoms in MSM, needs doxycycline
● Chlamydia
○ Swab + NAAT + azithromycin
○ LGV - lymphadenopathy weeks after primary infection, rectal symptoms in MSM, needs doxycycline
309
STIs
○ Cheesy white discharge
○ Clotrimazole, fluconazole
● Candida
○ Cheesy white discharge
○ Clotrimazole, fluconazole
310
Resp
● Non smoker, well, rusty coloured sputum, lobar
● Non smoker, well, rusty coloured sputum, lobar
| ○ Strep pneumonia
311
Resp
● Homeless with dry cough and weight loss
Ziehl Neelson staining
● Homeless with dry cough and weight loss
| ○ TB - Ziehl Neelson staining
312
Resp
● IVDU with dry cough
silver stain, flying saucers/boats
● IVDU with dry cough
| ○ PCP - silver stain, flying saucers/boats
313
Resp
● Diabetes
● Diabetes
| ○ Staph most common but need more info
314
Resp
Post intubation / flu
○ Staph most common but need more info
315
Resp
○ Smoking, COPD, gram negative coccobacilli
● H influenza
| ○ Smoking, COPD, gram negative coccobacilli
316
Resp
○ Smoking, gram negative coccus
● M catarrhalis
| ○ Smoking, gram negative coccus
317
Resp
○ Recent viral infection, cavitation on CXR, gram positive cocci in grape bunch clusters
● Staph aureus
| ○ Recent viral infection, cavitation on CXR, gram positive cocci in grape bunch clusters
318
Resp
○ Alcoholism, elderly, redcurrant jelly haemoptysis, gram negative rod enterobacter
● K pneumonia
| ○ Alcoholism, elderly, redcurrant jelly haemoptysis, gram negative rod enterobacter
319
Resp
○ Mild - amoxicillin or macrolide
○ Moderate to severe - clari and coamoxiclav/cefuroxime
○ Atypical - macrolide or tetracycline
● CAP:
○ Mild - amoxicillin or macrolide
○ Moderate to severe - clari and coamoxiclav/cefuroxime
○ Atypical - macrolide or tetracycline
320
GI infections
○ Outbreaks of D+V, hospitals, cruise ships
● Norovirus
| ○ Outbreaks of D+V, hospitals, cruise ships
321
GI infections
○ Abdo pain and fever but no diarrhoea
○ Rose spots if S. typhi along with abdo distension, bradycardia, cough and constipation
○ Ceftriaxone or ciprofloxacin
● Salmonella
○ Abdo pain and fever but no diarrhoea
○ Rose spots if S. typhi along with abdo distension, bradycardia, cough and constipation
○ Ceftriaxone or ciprofloxacin
322
GI infections
○ Food poisoning +/- bloody diarrhoea
○ Avoid Abx but cipro if needed
● Shigella
○ Food poisoning +/- bloody diarrhoea
○ Avoid Abx but cipro if needed
323
GI infections
○ S shaped
○ Erythromycin or cipro if first 4-5/7
Chicken/poultry
● Campylobacter
○ S shaped
○ Erythromycin or cipro if first 4-5/7
324
GI infections
○ A + B toxin, antibiotic associated
○ Diagnosis depends on toxins in stool
○ Metronidazole, vancomycin second line
● C diff
○ A + B toxin, antibiotic associated
○ Diagnosis depends on detection of C diff or toxins in stool
○ Metronidazole, vancomycin second line
325
GI infections
○ Flatulence, smelly, bloated
○ Pear shaped
○ Metronidazole
● Giardia
○ Flatulence, smelly, bloated
○ Pear shaped
○ Metronidazole
326
GI infections
○ Comma shaped, watery diarrhoea
○ Supportive; other vibrio need doxycycline
● Cholera
○ Comma shaped, watery diarrhoea
○ Supportive; other vibrio need doxycycline
327
GI infections
○ 0157 - HUS
○ Self limiting but can give cipro
E-coli
328
GI infections
○ Peyer’s patches, gram negative non lactose fermenter
○ Reactive arthritis, erythema nodosum, enterocolitis
● Yersinia
○ Peyer’s patches, gram negative non lactose fermenter
○ Reactive arthritis, erythema nodosum, enterocolitis
329
Antibiotics
● Ceftazidime
● Ceftazidime
| ○ Pseudomonas
330
Antibiotics
○ Mild CAP
● Amoxicillin
| ○ Mild CAP
331
Antibiotics
○ S aureus skin infections
● Flucloxacillin
| ○ S aureus skin infections
332
Antibiotics
○ C diff colitis
● Metronidazole
| ○ C diff colitis
333
Antibiotics
○ Gram negatives
● Ciprofloxacin
| ○ Gram negatives
334
Antibiotics
○ MSSA
○ Gram positive + penicillin allergy
● Erythromycin
○ MSSA
○ Gram positive + penicillin allergy
335
Antibiotics
○ MRSA, 3rd episode of C diff or not tolerating/responding to met
● Vancomycin
| ○ MRSA, 3rd episode of C diff or not tolerating/responding to met
336
Skin/Joint infections
○ Probably staph aureus, could be E coli, pseudomonas, haemolytic strep
○ Fluclox
● Wound contamination
○ Probably staph aureus, could be E coli, pseudomonas, haemolytic strep
○ Fluclox
337
Skin/Joint infections
● Trauma, open wound, gas gangrene
● Trauma, open wound, gas gangrene
| ○ Clostridium perfringens
338
Skin/Joint infections
○ Staph aureus, strep
○ Cephalosporin or fluclox, drain, IV
● Septic arthritis
○ Staph aureus, strep
○ Cephalosporin or fluclox, drain, IV
339
Skin/Joint infections
● Mum with skin infection, son has sore throat
● Mum with skin infection, son has sore throat
| ○ Strep pyogenes
340
Skin/Joint infections
● Child with red rash oedematous, first on face and crosses nasal bridge and spreads quickly
● Child with red rash oedematous, first on face and crosses nasal bridge and spreads quickly
○ Erysepylis - strep cellulitis
341
Skin/Joint infections
● Fish and dog as pets, rash
● Fish and dog as pets, rash
| ○ M. marinarum
342
Skin/Joint infections
● Back from Afghanistan with ulcer on ring finger
● Back from Afghanistan with ulcer on ring finger
| ○ Leishmaniasis
343
Travellers’ infections
● Prodrome
● Prodrome
| ○ Acute viral hepatitis
344
Travellers’ infections
● RUQ abscess/cyst
- flask shaped cysts in liver
● RUQ abscess/cyst
| ○ Entamoeba histolytica - flask shaped cysts in liver
345
Travellers’ infections
● Back from holiday with fever, headache, confused, low sodium
- urine antigen detection
● Back from holiday with fever, headache, confused, low sodium
○ Legionella - urine antigen detection
346
Fungi
○ Vulva (cottage cheese discharge), mouth if immunocompromised e.g. HIV
● Candida
| ○ Vulva (cottage cheese discharge), mouth if immunocompromised e.g. HIV
347
Fungi
○ Tinea capitis and corporis
● Microsporum canis
| ○ Tinea capitis and corporis
348
Fungi
○ Pulmonary infection, immunocompromised, found in soil assoc/ with bat or bird droppings
● Histoplasmosis
| ○ Pulmonary infection, immunocompromised, found in soil assoc/ with bat or bird droppings
349
Fungi
○ Opportunistic, really bad, rapidly spreads, brain, lungs, black discharge from nose
○ Needs amphotericin B
● Mucor indicus
○ Opportunistic, really bad, rapidly spreads, brain, lungs, black discharge from nose
○ Needs amphotericin B
350
Fungi
○ Meningitis in HIV
● Cryptococcus
| ○ Meningitis in HIV
351
Viruses
○ Nigeria, rats, haemorrhagic, arenaviridae
● Lassa fever
| ○ Nigeria, rats, haemorrhagic, arenaviridae
352
Viruses
○ Arbovirus, America, mosquitoes, polio-like
● West Nile
| ○ Arbovirus, America, mosquitoes, polio-like
353
Viruses
○ Progressive multifocal leucoencephalopathy
○ Mycopehnolate, immunosuppressants
● John Cunningham
○ Progressive multifocal leucoencephalopathy
○ Mycopehnolate, immunosuppressants
354
Viruses
○ Pox virus - giant lesions if immunocompromised
● Molluscum contagiosum
| ○ Pox virus - giant lesions if immunocompromised
355
Viruses
● Cervical cancer
● Cervical cancer
○ HPV 16/18
(6/11 = warts)
356
Viruses
MIP1 + rantes
○ Chemokine that inhibits HIV entry into cells
357
Meningitis
● 72 year old, gram positive rod, tumbling motility and rockets
● 72 year old, gram positive rod, tumbling motility and rockets
○ Listeria
358
Meningitis
● Baby, gram negative rod
● Baby, gram negative rod
| ○ E coli, or Hib if unvaccinated
359
Meningitis
● Child, gram negative cocci
● Child, gram negative cocci
| ○ N meningitidis
360
Meningitis
● Smoker, gram positive cocci
● Smoker, gram positive cocci
| ○ Strep pneumo
361
Meningitis
● Young person, normal glucose, lots of lymphocytes in CSF, high protein
● Young person, normal glucose, lots of lymphocytes in CSF
| ○ Herpes
362
Childhood infections
● Neonatorum ophthalmia
● Neonatorum ophthalmia
| ○ Chlamydia trachomatis
363
Childhood infections
● Can transmit via placenta especially in late pregnancy
● Can transmit via placenta especially in late pregnancy
| ○ Syphilis
364
Childhood infections
● Haemorrhagic cystitis, virus
● Haemorrhagic cystitis, virus
| ○ Adenovirus
365
Childhood infections
● Protozoan infection which can be passed on to baby
● Protozoan infection which can be passed on to baby
| ○ Toxoplasma - french people
366
Childhood infections
● Sepsis/meningitis in newborn
● Sepsis/meningitis in newborn
| ○ GBS
367
UTI
● Most common cause
● Most common cause
| ○ E coli
368
UTI
● 2nd most common in young women
● 2nd most common in young women
| ○ Staph saprophyticus (associated with catheters as well)
369
UTI
● Associated with renal calculus
● Associated with renal calculus
| ○ Proteus - breaks urea down
370
UTI
● What on a culture shows contamination?
● What on a culture shows contamination?
| ○ Squamous cells (epithelium)
371
UTI
● Non-culture signs of infection with choliform
● Non-culture signs of infection with choliform
| ○ Nitrite on dipstick
372
Misc + Zoonoses
○ Rat bite with lymphadenopathy (could also be streptobacillus moniliformis)
● Spirillum minus
| ○ Rat bite with lymphadenopathy (could also be streptobacillus moniliformis)
373
Misc + Zoonoses
● Hyatid disease
○ Cysts in brain and liver, sheep related, rugby player bursts cyst -L> anaphylaxis type reaction
● Hyatid disease - ecinococcus granulosus
| ○ Cysts in brain and liver, sheep related, rugby player bursts cyst -L> anaphylaxis type reaction
374
Misc + Zoonoses
● Hyatid disease
○ Cysts in brain and liver, sheep related, rugby player bursts cyst -L> anaphylaxis type reaction
● Hyatid disease - ecinococcus granulosus
| ○ Cysts in brain and liver, sheep related, rugby player bursts cyst -L> anaphylaxis type reaction
375
β haemolytic anaerobe
Gm +ve
Watery diarrhoea, cramps, headaches, Fever, minimal vomiting
Tumbling motility
Mx: ampicillin, ceftriaxone, cotrimoxazole
Listeria monocytogenes
376
Gm –ve Rod
Contaminated food, water or lakes ETEC: toxigenic, traveller’s
EHEC: Haemorrhagic
HUS: anaemia, thrombocytopenia, renal failure
Mx: Ciprofloxacin
E. coli
377
Pear-shaped trophozoite
Travellers, hikers and homosexual men Foul-smelling, non-bloody steatorrhoea Cysts on microscopy
Mx: Metronidazole
Giardia lamblia
378
β haemolytic Gm +ve cocci, grape-like clusters
Superantigen
Vomiting and diarrhoea 12-24h after food No abx needed
Staph. aureus
379
Slow-onset fever, constipation, splenomegaly Rose spots
| Mx: ceftriaxone or ciprofloxacin
Slow-onset fever, constipation, splenomegaly Rose spots
| Mx: ceftriaxone or ciprofloxacin
380
Non-motile, non-hydrogen sulphide producers Bloody diarrhoea. No abx needed
Shigellae
381
Oxidase positive, non-motile
Dog faeces
Watery, foul smelling, bloody stool Assoc. with GBS + Reiter’s
Mx: erythromycin or ciprofloxacin
Campylobacter jejuni
382
```
Motile trophozoite
Flask-shaped ulcer
Liver abscess formation
Wet prep, microscopy
Mx: Metronidazole + paromomycin
```
Entamoeba Histolytica
383
Severe diarrhoea in immunocompromised Oocysts on modified Kinyoun acid fast stain Mx: Paromomycin
Cryptosporidium Parvum
384
Canned/vacuum packed foods Preformed toxin
Descending paralysis
Mx: antitoxin
Clostridium botulinum
385
Reheated meals
SuperAg
Watery diarrhoea + cramps Gas gangrene
Mx: antitoxin
Clostridium perfringens
386
Exotoxin A and B Pseudomembranous colitis Post abx in hospital
Mx: 10-14/7 PO metronidazole PO vancomycin
Clostridium difficile
387
Reheated rice, gm +ve rods, spore-forming No abx required
Bacillus cereus
388
Non-lactose fermenter
| Poultry, eggs and meat Self-limiting non bloody diarrhoea Mx: ceftriaxone or ciprofloxacin
Salomella enteritides
389
Entercolitis w mesenteric adenitis Necrotising granulomas
Reactive arthritis
Erythema nodosum
Cold enrichment
Yersinia enterocolitis
390
Rice water stool
| Diarrhoea without inflammation Mx: supportive
Vibrio cholera
391
Raw seafood, Japan
| 3/7 diarrhoea, self-limiting Mx: doxycycline
Vibrio parahaemolyticus
392
Cellulitis, shellfish handler Septicaemia in HIV pt Mx: doxycycline
Vibrio vulnificus
393
Yeast-like fungus
HIV +ve
Fever, non-productive cough, night sweats, weight loss
Bilateral pulmonary infiltrates on CXR Gomori’s methenamine silver stain = ‘flying saucer’ cysts/ boat shaped organisms
Pneumocystis jirovecii
394
Alpha haemolytic gm+ve diplococcic Rusty sputum
Optichin sensitive, catalase -ve Quelling reaction, +ve urine Ag Lobar pneumonia
Mx: Amoxicillin or macrolide (mild-mod) Clarithromycin + co-amoxiclav or 2-3/52 cefuroxime (mod-severe)
If HAP: 1st: Ciprofloxacin + vancomycin 2nd: Piptazobactam + vancomycin Aspiration: cefuroxime + metronidazole
Strep. pneumoniae
395
Beta haemolytic gm +ve cocci, grape-like Catalase +ve
Consolidation, cavitation or empyema Post-viral infection
Mx: If CAP: Flucloxacillin If MRSA: Vancomycin
S. aureus
396
Fever, cough, weight loss, night sweats HIV+
Bihilar LNopathy
Ziehl-Neelson staining, acid-fast bacilli Auramine-rhodamine staining
MTB
397
Aerobic, gm –ve rod
Air conditioning units
Myalgia, confusion, rhabdomyolysis, abdominal pain
Hyponatraemia
Buffered charcoal yeast extract agar Urinary antigen +ve
Mx: Macrolide + Rifampicin
Legionella pneumophila
398
Gm –ve diploccoci, aerobic
Chronic lung disease/COPD exac.
Can affect ears, eyes and CNS
Mx: Amoxicillin or macrolide (mild-mod) Clarithromycin + co-amoxiclav or 2-3/52 cefuroxime (mod-severe)
If HAP: 1st: Ciprofloxacin + vancomycin 2nd: Piptazobactam + vancomycin Aspiration: cefuroxime + metronidazole
Moraxella catarrhalis
399
Gm –ve bacilli
Chocolate agar
Oxidase and catalase +ve COPD/smoking
Mx: Amoxicillin or macrolide (mild-mod) Clarithromycin + co-amoxiclav or 2-3/52 cefuroxime (mod-severe)
If HAP: 1st: Ciprofloxacin + vancomycin 2nd: Piptazobactam + vancomycin Aspiration: cefuroxime + metronidazole
Haemophilus influenza
400
Obligate intracellular bacteria Cold-agglutinin test
SJS
Mx: macrolide/tetracycline
Mycoplasma pneumoniae
401
Obligate intracellular bacteria Meningoencephalitis, arthritis, myocarditis, GBS
Mx: macrolide/tetracycline
Chlamydia pneumoniae
402
Bird handler
| Mx: macrolide/tetracycline
Chlamydia psittaci
403
Whooping cough in unvaccinated Travellers
| Mx: macrolide/tetracycline
Bortadella pertussis
404
Alcoholism, elderly
Haemoptysis
Gm -ve rod, enterobacter
Mx: Amoxicillin or macrolide (mild-mod) Clarithromycin + co-amoxiclav or 2-3/52 cefuroxime (mod-severe)
If HAP: 1st: Ciprofloxacin + vancomycin 2nd: Piptazobactam + vancomycin Aspiration: cefuroxime + metronidazole
Klebsiella pneumoniae
405
CF
| Mx: piperacillin + tazobactam (tazocin) Ciprofloxacin + gentamicin
Pseudomonas aerugenosa
406
Subacute/chronic meningitis
Cerebral tuberculous granuloma – Rich focus Colourless CSF
High protein, low glucose, high lymphocyte
MTB
407
Leptospirosis (Weil’s syndrome)
Aerobic spirochaetes
Fever, headache, malaise, photophobia Meningitis, liver dmage and renal failure Raised WCC
Microscopic agglutination test
Leptospira interrogans
408
Classic presentation of meningitis
6m-2y, university students
Thayer-Martin VCN media
Mx: IM benpen, 3rd generation cephalosporin If <1m, amipicillin + cefoxatime/aminoglycoside
Neisseria meningitides
409
Subacute or chronic meninigitis
HIV +ve
India ink staining yeast cells with halo Cryptococcal Ag test
Arthritis, peripheral neuropathy and encephalopathy
Cryptococcus neoformans
410
Skin-skin contact or maternal transmission Colourless CSF, high lymphocytes, raised protein and normal glucose
Mollaret’s meningitis = recurrent aseptic meningitis, caused by HSV 1 or 2
Herpes simplex
411
Meningitis in neonates
E. Coli
412
Neonates, elderly, immunocompromised
Listeria Monocytogenes
413
Gm –ve, zoonotic spirochaete Lyme disease, Ixodes tick
Borellia burgdorferi
414
GM –ve, intracellular
L1, L2, L3 cause LGV
A, B, C cause trachoma (eye)
D-K genital + opthalmia neonatorum Mostly asymptomatic, can PID
Dx: NAAT
Mx: azithromycin (1g stat) + doxycycline 100mg BD 7/7
Chlamydia trachomatis
415
Syphilis
Painless chancre gumma later
Dx: non-treponemal tests e.g. VDRL Treponemal: antigens (TPHA, TP=PA)
Mx: Single dose IM BenPen (doxy if allergic
Treponema pallidum
416
Gm –ve coccobacilllus
| Tropical ulcer disease (chancroid) Unilateral inguinal LN swelling Chocolate agar
Haemophilus ducreyi
417
IC gm –ve diplococcic
Urethritis and PID/epididymitis
Gm stain
Thayer martin VCN medium
PCR
Most common cause of septic arthritis in young, sexually active
Mx: ceftriaxone 250mg single dose IM Cefixime PO 400mg
Spectinomycin 2g IM (resistant)
For septic arthritis: IV cefotaxime 4-6 weeks
Neisseria gonorrhoea
418
Fishy, white-cream discharge Litmus test: loss of acidity, pH >4.5 Whiff test
Clue cells
BV
419
```
Gm +ve rod
Donovanosis – large, expanding ulcers Beefy red appearance
Giemsa stain
Donovan bodies
Mx: azithromycin
```
Klebsiella granulomatis
420
Flagellate protozoan
Vaginal discharge and urethritis Wet prep microscopy
Mx: metronidazole
Trichomonas vaginalis
421
Candidiasis
Itchy, cottage cheese discharge
Mx: topical clotrimazole, PO fluconazole
Candida albicans
422
Fluid filled blisters over genital area Mx: aciclovir
HSV 1/2
423
Candidiasis
Itchy, cottage cheese discharge Candidaemia flu-like illness
Mx: topical clotrimazole, PO fluconazole Oral thrush: Nystatin wash
Candida albicans
424
Subacute or chronic meninigitis
HIV +ve
India ink staining yeast cells with halo Cryptococcal Ag test
Cryptococcus neoformans
425
Chronic fungal infection, Malassezia furfur Hypopigmentation or hyperpigmentation Potassium hydroxide: spaghetti with meatballs appearance
Woods light: orange fluorescence
Mx: topical clotrimazole, ketoconazole wash
Pityriasis versicolor
426
Grows on stored grains
| Allergic bronchopulmonary aspergillosis Aspergilloma
Aspergillus flavus
427
Rose gardener’s disease
Causes sporotrichosis
Nodular lesions ulceration
Mx: itraconazole, fluconazole or oral potassium iodide
Sporothrix schenckii
428
Inhaled spores
Mississippi river region
Can progress to chronic pulmonary disease
Histoplasma capsulatum
429
Copper coloured soil saprophyte Rotting wood
| Warty lesion – cauliflower-like
Phialophora verrucosa
430
Cutaneous dermatophyte
| Scalp – red, scaly lesions with hair loss Expanding ring on scalp
Tinea Capitis
431
Ringworm
| Cutaneous dermatophyte Trunk, arms and legs Raised, red rings
Tinea corporis
432
Brucellosis
Unpasteurised milk/dairy
Fever, myalgia, arthralgia
Blood culture on Castaneda medium Granulomatous hepatitis
Brucella spp.
433
Rocky Mountain Spotted Fever
Ticks
Gm –ve
Headache, fever, myalgia, confusion Maculopapular or petechial rash, spreading from limbs to trunk and face
Rickettsia
434
Lyssavirus
| Progressive and incurable encephalitis, hydrophobia and muscle spasm Cerebral negri bodies
Rabies
435
Q fever
Inhalation of urine, faeces or amniotic fluid from livestock
Fever, dry cough, pleural effusion, diarrhoea
Coxiella burnetti
436
Fish
| Transmitted by bite or injury Nodules on elbow, knees and feet
Mycobacterium marinarum
437
Cat scratch disease
Tender and swollen lymph nodes Headache and backache
Parinaud’s oculoglandular syndrome
Bartonella spp.
438
Tyrpanosomiasis = Sleeping Sickness Tsetse fly
Gambiense = west and central Africa Rhodesiense = south and eastern Africa
R = rapid infection
G = gradual infection
Subcut chancre fever, weakness, arthralgia headache
Winterbottom’s sign = posterior chain LNopathy in Gambiense
Crosses BBB disturbance of sleep cycle Mx: pentamidine and suramin
Trypanosoma brucei
439
Chagas disease
Reduviid (‘Kissing’) bugs, Brazil
Red nodule = chagoma
Acute: purple swelling of eyelids (Romana’s sign)
Chronic: affects heart and GIT dilatation and dysfunction
Mx: bennzimidazole or nifurtimox
Trypanosoma cruzi
440
Protozoa
Cutaneous: bite of sandfly, skin ulcer (L. major, L. tropica)
Itchy, scaly papule at bite siteheals to form oriental sore (depigmented)
Diffuse cutaneous: immunodeficiency, multiple nodules with no ulcers Mucocutaneous = ulcers in nose and mouth, L. braziliensis
Kala azar: abdo discomfort, anorexia (L. donovani, L. infantum [L. chagasis in S Amr]) invasion of reticulo-endothelial system Then disfiguring dermal disease (PKDL) Giemsa staining of slit skin smears
Cultured on Novy-Macneal-Nicolle medium
Leishmania
441
```
Anthrax
Cutaneous: painless, round, black lesions Pulmonary = woolsorter’s disease Massive lymphadenomathy
Mediastinal haemorrhage
Pleural effusion
Respiratory failure
```
Bacillus anthracis
442
Snails
‘Swimmer’s itch’ Katayama fever
Fever, rash, myalgia, hepatosplenomegaly GI or urinary schisto
Schistosomiasis
443
Protozoa
Contamination with cat faeces
Trophozoites in gut brain, eyes, lungs Cranial nerve palsy, meningoencephalitis, SOL Ring-enhancing lesions on CT
Toxoplasma gondii
444
Plasmodium falciparum: 7-14 days incubation, most severe, tertian (fever every 3 days), Maurer’s clefts
Plasmodium vivax: 12-17 days, benign tertian, relapse as can reside in liver, Schuffner’s dots Plasmodium ovale: 15-18 days, benign tertian, Schuffner’s dots
Plasmodium malariae: 18-40 days, benign quartan
Plasmodium knowlesi, 12 days, quotidian – SE Asia
Sporozoites merozites (signet ring) schizonts (oval shapes containing merozites) erythrocytic phase gametocytes fuse to form oocytes and then sporozoites
Malaria
445
```
T and B cell defect
X linked (IL-2) or AR (adenosine deaminase) Thyroid and MALT hypoplasia/atrophy Diarrhoea, FTT, GVHD
Mx: BMT in early life
```
SCID
446
Most severe form of SCID
| Mut of AK2 (Mitochondrial metabolism) Unable to differentiate from BMSCs
Reticular Dysgenesis
447
X linked, WASp gene
Lymphoma, thrombocytopenia, eczema Easy bruising, nose bleeds and GI bleeds Thrombocytopenia, low IgM, raised IgA/E IgG normal, reduced or elevated
Wiskott-Aldrich Syndrome
448
Abnormality of 3rd/4th branchial arches 22q11
Absent/hypoplastic thymus
T cell deficiency
Decreased IgG and IgA
CATCH-22: Cardiac abnormalities, atresia of oesophagus, thymic aplasia, cleft palate, hypocalcaemia
Di George Syndrome
449
Absence of HLA (I & II) expression in thymus BLS 2 (CD4) > BLS 1 (CD8)
Low CD4, Low B cell activation, Low IgA, IgG Assoc. with sclerosing cholangitis, hepatomegaly and jaundice early infant death. Mild, but chronic diarrhoea.
Bare Lymphocyte Syndrome
450
Defect in oxidative killing Mycobacterial infection Unable to form granulomas
Cytokine deficiency
451
X linked, BTK gene
Inhibits B cell maturation
Normal T cells, low B cells and Ig Absent plasma cells
Bruton’s agammaglobulinaemia
452
```
CD40-L mutation
Inability of B cell class switching
Only produce IgM (deficient in G, A & E)
```
HyperIgM
453
Defect in B cell maturation
FTT, recurrent infections, AI & granulomatous disease. End-organ damage
MHC III aberrant class switching Bronchiectasis, sinusitis
Low B cells, normal/low IgM, Low IgA, IgG, IgE
Common Variable Immune Deficiency
454
2/3 asymptomatic, 1 in 6000 caucasians Recurrent GI and RT infections
Risk of anaphylaxis in transfusion (donor IgA)
Selective IgA Deficiency
455
```
Severe congenital neutropenia Failed maturation
Low count (<500) and no pus Nitro-blue-tetrazolium test +ve
```
Kostmann Syndrome
456
Neutrophils formed, unable to exit blood V high neutrophil count
Leukocyte Adhesion Deficiency
457
NBT +ve Mx: BMT
Failure of oxidative killing (NADPH oxidase) CD18: LAD-1
Chronic inflammation with granulomas Recurrent skin infections
LAD-2 = severe, mental retardation, FTT Catalase +ve organisms: PLACESS Pseudomonas, Listeria, Aspergillus, Candida, E. Coli, S. aureus, Serratia
Chronic Granulomatous Disease
458
Autosomal dominant
ELA2 mutation
Occurs every 3 weeks for 6 days
Cyclic Neutropenia
459
Reduced macrophage activation
No granuloma formation
Increased MTB and salmonella infection
IFN-Y Deficiency
460
Removes immune complexes Lack of C1q/r/s, C2 and C4 C2 deficiency assoc. with SLE CH50 test abnormal
Classical Pathway
461
Kills bacteria
Lack of factors B, I, P
Pneumococcus, haemophilus, meningococcus AP50 test abnormal
Alternative Pathway
462
Cannot form MAC
Lack of C3, 5-9
Increased meningococcus and pneumonae Assoc. with membranoproliferative GN CH50 and AP50 abnormal
Common Pathway
463
Variation in size of erythrocytes Iron deficiency anaemia
| Raised RBC distribution width
Anisocytosis
464
Nuclear DNA fragments in erythrocytes Purple spheres- haematoxylin and eosin stain Splenectomy secondary to trauma or SCD
Howell-Jolly Bodies
465
```
Dacrocytes
Caused by myelofibrosis
PCRV or essential thrombocytosis Extramedullary haematopoieisis hepatosplenomegaly
Dry and bloody tap
Also leukoerythroblasts + megakaryocytes
```
Tear Drop Cells
466
```
G6PD Deficiency
Neonates with prolonged jaundice = NADPH deficiency
Chronic liver disease
Alpha thalassaemia
Bite cells
```
Heinz Bodies
467
Loops in erythrocytes Megaloblastic anaemia B12 deficiency
Cabot Rings
468
High plasma protein states (MM)
| Stacks RBCs
Rouleaux
469
Hereditary spherocytosis
Spherocytes
470
Thalassaemia, asplenia, liver disease
Target Cells
471
Spike/spur cells Abetalipoproteinaemia Liver disease Hyposplenism
Acanthocytes
472
Echinocyte
| Irregularly shaped cells Uraemia, GI bleeds, gastric Ca
Burr Cells
473
Hypersegmented neutrophil
Congenital (lamin B receptor)
Acquired in myelogenous leukaemia and myelodysplastic syndromes
Pelger Huet Cells
474
Differing colour of erythrocytes Premature release from BM
Polychromasia
475
Immature RBC
| Methylene blue stain ribosomal RNA Increased in haemolytic anaemia Decreased in aplastic anaemia and chemo
Reticulocytes
476
Immature white cells Hyposegmented polymorphs (<5 lobes) Megaloblastic anaemia
Uraemia and liver disease
Right Shift
477
Fragments of RBC
| Microangiopathic anaemia e.g. DIC, HUS, TTP Pre-eclampsia
Schistocytes
478
Central pallor is rod-like Smiling faces/fish mouth Hereditary stomacytosis Alcoholism and liver diseas
Stomatocytes
479
Platelet microthrombi
Microangiopathic haemolytic anaemia Renal failure, thrombocytopenia, fever, neurological signs (hallucinations, stroke) ADAMST-1 gene vWF multimers
Idiopathic thrombotic thrombocytopenic purpura (ITTP)
480
Gm –ve sepsis, malignancy, trauma, placental abruption, amniotic fluid embolus Microthrombi renal/neural signs
Low platelets, low CFs and increased fibrinolysis
DIC
481
```
AD, chromosome 12
Platelet adhesion and F8 production
Defect in platelet plug formation
Gum bleeding, epistaxis, prolonged bleeding High/normal APTT, normal PTT
Poor ristocetin aggregation
```
vWD
482
GLP-2b/3a mutation Failed platelet coagulation
Glanzmann’s Thrombasthenia
483
Hereditary haeomorrhagic telangiectasia
Nose and GI bleeds
Telangiectasia on skin and mucus membranes
Osler-Weber-Rendu
484
Mutation of Glp-1b Receptor for vWF
Bernard-Soulier Syndrome
485
Recurrent DVTs
Substitution mutation
Amplification of prothrombin production 5% Caucasians
Prothrombin G20210A mut
486
AD thronbophiliac
| Protein C inhibits F5 normally DVT and miscarriage
Factor V Leiden
487
Arterial and venous thrombosis
Recurrent miscarriage
Associated with AI disease (SLE) Anti-cardiolipin + Lupus anticoagulant Abs
Antiphospholipid Syndrome
488
Thromboangitis obliterans
Smoking
Intermittent claudication
Recurrent A/V thrombosis of UL and LL Corkscrew appearance on angiogram
Buerger’s Disease
489
Impaired degradation of F Va and VIIIa Type I: quantitative
Type II/III: qualitative
Vit K dependent anticoagulant
Protein S Deficiency
490
Inherited cause of VTE
| Normally inhibits thrombin and 10a
Antithrombin Deficiency
491
Elderly
Raised granulocytes
Myeloid cells at different stages of mat.
Philadelphia chr: BCR-ABL, (9;22) Imatinib
CML
492
B lymphocytes
Subtype of CLL
Middle-aged men Hepatosplenomegaly, pancytopenia CD25, CD11
Presence of TRAP (tartrate-resistant acid phosphatase)
Hairy Cell Leukaemia
493
```
Auer rods
>20% myeloblasts in B,
FTL3 gene and t(8;21)
Down’s syndrome
Anaemia, thrombocytopenia, low neutrophils
```
AML
494
Rare, HTLV-1
Japan and Caribbean
Cloverleaf appearance
LNopathy, HSmegaly, skin lesions, high Ca
Adult T-cell Leukaemia
495
B cell neoplasm
Lymphocytes >4000
Smudge cells Hypogammaglobulinaemia
Can transform to diffuse-large B cell lymphoma (Richter’s syndrome)
CLL
496
Paediatric leukaemia Lymphoblastic BM
ALL
497
Subtype of AML PML-RAR translocation
APML
498
Aggressive T-cell leukaemia Inv 14(q11;q32)
T Cell prolymphocytic leukaemia (T-PLL)
499
t(15;17)
APML
500
t(8;21) EPO
AML with maturation (M2)
501
t(8;14) c-myc
Burkitt’s
502
t(11;14) cyclin-D1 (Bcl-1)
Mantle Zone Lymphome
503
t(11;18)
Marginal Zone Lymphoma
| MALToma
504
t(14;18) Bcl2
Follicular Lymphoma
505
t(2;5)
Anaplastic Large Cell Lymphoma
506
t(11;22)
Ewing’s Sarcoma
507
ATP7B on Chr13
Wilson’s / Hepatolenticular degeneration
508
HFE on Chr6
Hereditary haemohromatosis
509
403 Arg -> Gln in MHC
HOCM
510
Trisomy 18
Edward’s
511
Trisomy 13
Patau’s
512
Monosomy 5p
Cri du Chat
513
Del 7q21
William’s
514
CGG repeat on Chr X
Fragile X
515
CAG repeat on Chr 4
Huntington’s
516
Smooth muscle
Liver Kidney Microsomal
Soluble Liver Antigen
Actin
Autoimmune hepatitis
517
SCL-70 (Topoisomerase) (Nucleolar)
RNA Pol 1,2,3 (Nucleolar)
Fibrillarin (Nucleolar)
Diffuse Systemic sclerosis
518
GBM (NC α3 COL4)
Goodpastures
519
Voltage gated Ca channels
Lambert-Eaton
520
Desmosomes (cadherins)
Pemphigus
521
Hemidesomosomes (collagen XVII)
Pemphigoid
522
HLA-DRB1
| HLA-DQB1
Sarcoidosis
523
A protein which assists in the breakdown of blood clots by binding to the clot and localising agents which break it down
Protein C
524
Vit K dependant and cofactor Protein C
Protein S
525
Enzyme that degrades blood plasma proteins (inc fibrin)
| Activated from plasminogen
Plasmin
526
A single chain glycoprotein, synthesised by the liver and endothelium which has strongly anticoagulant action and is important in the mode of action of heparin
Antithrombin III
527
Serine protease. Breaks down clots by binding to them and localising agents which break it down
Catalyses plasminogenplasmin
Used to treat stroke
T-PA
528
Produces cyclic endoperoxidases through COX
Mediates and modulates inflammatory responses
Procoagulant
Arachdionic acid
529
A potent inhibitor of plasmin in the blood
Product of cyclic endoperoxidases (from AA) which induces platelet aggregation
Others include prostaglandins and prostacyclins
Procoagulant
Thromboxane A2
530
Formed from fibrinogen by thrombin
Forms haemostatic plug (clot) on wound site
Platelet activation
Fibrinogen activity is measured through TT
Procoagulant
Fibrin
531
Serine protease which activates fibrin, factors V and VIII and protein C
Formed from prothrombin
Procoagulant
Thrombin
532
Attracts circulating platelets to the site of damage
Binds to coagulation factor VIII preventing its clearance from plasma
Also binds to collagen, gplb and other platelet receptors
Procoagulant
vWF
533
Enzyme involved in platelet aggregation
What aspirin works on
Produces prostaglandins, prostacyclins and thromboxane
COX
Procoagulant
534
Initiates coagulation and synthesises vWf, TF, prostacyclin, plasminogen activator, antithrombin III and thrombomodulin
Procoagulant
Endothelium
535
Inhibits plasmin in the blood
A2 macroglobin
536
Thrombin time represents deficiency of
fibrin
537
Rare inherited condition with disruption of the integrity of structural proteins (collagen) in skin, ligaments, cartilage and blood vessels leading to fragility of connective tissues.
Clinical presentation- bruising/bleeting from GIT, dissectiong aortic aneurysm, wide scars, laxity of joints, hernia, hyperelasticity of skin, pectus excavatum
Classification- Villefranche classification- Type I-TypeVII- share features of fragile skin and laxitiy of joints and ligaments
Treatment- treat CVS issues with B blockers
Ehlers-Danlos
538
Vascular dysplasia due to mutation at 9q34.1, leading to telangiectasia, AVM of skin, mucosa and viscera, epistaxis and GI bleeding
Clinical presentation- >teenage years, Recurrent nosebleeds, fatigue and menorrhagia, red-purplae macules, papules or spider lesions, dyspnoea, cyanosis, cirrhosis, cavernous aneurysms.
F>M, later presentation (IDA)
Ix- capillary microscopy, CT, MRI
Tx- blood transfusion in acute haemorrhage, surgery or laser ablation, E2 therapy
Osler-weber-rendu syndrome (Hereditary, haemorrhagic telangiectasia)
539
AD Mutated factor V that causes hypercoagulability (N factor V is cofactor to Xa to activate thrombin)
Leiden mutation cannot be switched off by protein C
Presents with excessive clotting, DVT and PE
Factor V Leiden
540
Iv
Potentiates antithrombin
Can be reversed
Se- thrombocytopaenia with paradoxical thrombosis
Unfractionated heparin
541
Sc
Potentiates antithrombin III
Used in pts with cancer and acute VTE and as prophylaxis in DIC
Se inc osteoporosis and hyperkalaemia
Dalteparin (LMWH)
542
Inhibit vit K epoxide reductase (which recycles vit K)Target INR 2-3
Starting dose 5mg, 5mg, 5mg, 5mg, measures on 5th day, 8ths day and every 4 days- initially increases clotting risk when first given as proteins C and S have shorter half-lives and disappear from the blood faster that FII, VII, IX and X
Used with prosthetic heart valves
Se- cutaneous necrosis
Warfarin
543
Prodrug requiring CYP2C19 for activation. Acts on ADP R (which activates platelets and crosslinks fibrin)
Prevention of stroke and MI
Not used with aspirin
Clopidogrel
544
Fibrinolytic
Activates plasminogen to plasmin through bond cleavage
Contraindicitve in proliferative retinopathy, sore throat or ever used before
Streptokinase
545
Inhibits phosphodiesterase that normally breaks down cAMP and inhibits reuptake of adenosine into plt RBC and endothelial cells leading to increased extracellular conc of adenosine
Used with aspirin to prevent stroke and TIA (2nd line)
expensive
Dipyridamole modified release
546
Serine protease. Breaks down clots by binding to them and localising agents which break it down
Catalyses plasminogenplasmin
Used to treat stroke
t-PA
547
TK inhibitor preventing BCR-ABl from phophorylating subsequent proteins in cancer development
Death of cancer cells by apoptosis
Used in treatment of CML
Imitanib
548
Decreases number and growth of cells
| Used in MDS syndromes eg- polycythemia rubra vera, MF and ET
Hydroxycarbamide
549
softening of dead muscle, usually after infarct
Myomalacia cordis
550
haemodialysis, impaired clearance across dialysis membranes that causes carpal tunnel syndrome
B2 microglobin amyloidosis
551
5. An overweight individual with diabetes has longstanding bone/back pain. They are found to have paraprotein IgA ~8g/dl, and GFR 55mls/min/1.73m^2. FBC normal and albumin normal.
Monoclonal-gammopathy-of-unknown-significance
552
1. What is the most common cause of thrombocytopenia/low platelets in Pregnancy (Commonest cause of maternal thrombocytopenia)?
Gestational thrombocytopenia (70% of thrombocytopenias in pregnancy) > Pre-eclampsia (21%) > Maternal idiopathic thrombocytopenia purpura (3%)
553
Relieve bone pain in myeloma
Radiotherapy
554
Management of hyperviscosity in myeloma
Plasmapheresis
555
2. Which/What cancer is also known as non-specific type?
Invasive ductal carcinoma
556
2. Man, ex-smoker, with history of hypertension and MI, has sudden chest pain which radiates to the neck.
Descending internal carotid thrombus
557
5. Man has an MI 3 years ago. Now comes into hospital feeling very unwell. Is having a sample taken from their pericardial layer and you find blood is aspirated from the pericardium.
Ventricular rupture
558
Which cell are inhibited by MHC I
NK cells
559
5. A girl with a sore throat is given penicillin and develops a rash. She is found to have EBV.
Drug Reaction
560
4. What condition is the NOD2/CARD15 gene mutation found in?
Crohn’s Disease
561
5. What immunodeficiency has a mutation in the common gamma chain?
X-linked SCID
562
7. Swollen joint, needle-shaped aspirate with negative birefringence, what is the enzyme responsible?
Xanthine Oxidase – causes gout
563
8. Treatment for acute gout?
Colchicine or an NSAID (i.e. not allopurinol)
564
9. What does JC virus cause?
Progressive Multifocal Leukoencephalopathy
565
10. What virus can get reactivated following a transplant?
Epstein Barr Virus
566
12. What is the commonest virus causing aseptic meningitis?
Echovirus (or coxsackie)
| Enterovirus
567
15. 15 year old with brain tumour extends outwards from cerebellum and invading subarachnoid space. Signs of ataxia. What is the most likely type?
medulloblastoma
568
16. Man with diabetes, fatty stools, weight loss, ‘slate grey skin’, joint pains. What is the cause?
Haemachromatosis (joint pain, skin changes, pancreatitis, liver deposition)
569
Neonate with meningococcal sepsis. What pathogen is likely?
Group B Streptococcus
570
2018: what is a pathogen causing meningitis in babies >3 months?
Neisseria meningitis
571
25. HIV +ve patient with v low CD4 + vascular lesions seen on trunk. What virus causes this cancer?
HHV8 - Kaposi (Human Herpes Virus)
572
27. What liver enzyme is raised in MI?
Aspartate aminotransferase (AST)
573
26. What enzyme to confirm cardiac failure?
brain natriuretic Peptide
574
28. Old man who fell over, been on floor for days. Severely dehydrated. Dark urine. Not blood on microscopy. What causes the dark urine?
Myoglobin
575
30. Lady with multiple myeloma and restrictive cardiomyopathy. What will you see on heart biopsy?
Amyloid depositions (AL)
576
33. Previous IVDU man is given rituximab-CHOP treatment for non-Hodkin’s lymphoma. He later develops liver failure and dies 8 months later. Why?
Hep B reactivation
577
35. Which coagulation factor is falls first on administration of warfarin?
Factor VII
578
36. On OGD of the oesophagus, white things are seen in an alcoholic man with recurrent oesophageal bleeding varices. What are these?
Oesophageal candidiasis
579
47. Cancer with keratin and intercellular bridges?
Squamous cell carcinoma
580
48. cANCA positive man with glomerulonephritis and lung changes. Which disease typically has lung and kidney changes only?
Granulomatosis with polyangiitis (Wegener’s)
581
1. Someone gets reactions when being given penicillin. Which of these drugs will be ok to give them? Options: piperacillin/tazobactam, temocillin, amoxicillin, co-amoxiclav, cefalexine, cephalexin
cephalexin
582
2. Treatment for CLL with p53 mutation. What is the first line treatment?
● Rituximab
● Imatinib
● Ibrutinib Bruton tyrosine kinase inhibitor
● Ciclosporin
Ibrutinib Bruton tyrosine kinase inhibitor
583
5. What is the usual prophylaxis for allograft rejection?
| ● Mycophenolate mofetil,
Immunosuppressants post-transplant to reduce rejection eg: Ciclosporin + MMF/Aza +/- steroids
584
```
6. Which allergy is more likely to present in child than adult?
● Oral allergy syndrome
● Egg
● Bee
● Pollen
```
Egg
585
```
7. Treatment of Rheumatoid arthritis? It gave names and mechanisms
● Adalimumab - TNFalpha
● Basiliximab - Anti CD25
● Denosumab - anti-RANKL
● Secukinumab
```
● Adalimumab - TNFalpha
586
8. HIV what natural antibody against, which confers protective immunity against HIV?
Neutralising antibodies: anti-gp120 and anti-gp41
587
```
11. Which type of embolus is common in cholesterol cleft?
Air
● Fat
● Ambiotic
● Fluid
● Atheromatous
```
Atheromatous
588
```
15. Red cell lysis, what ion is raised:
● Potassium
● Sodium
● Calcium
● Bicarbonate
● Other things….
```
Potassium
589
```
17. What causes hypertension in upper half of body?
● Coarctation of the aorta
● Renal ___?
● Renal parenchymal disease
● Renal vascular hypertension
● Adrenal hypertension
```
● Coarctation of the aorta
590
18. HTLV1 Virus lymphoma =
Adult T-cell lymphoma/leukaemia
591
19. Woman is worried because her daughter has T1DM and has low glucose. Daughter denies taking any drugs. Low glucose, high insulin, low C-peptide. What is the likely cause
● Factitious insulin (was called ‘surreptitious’ insulin)
592
```
20. What is low during pregnancy?
● Fibrinogen
● Factor 7 (or 8?)
● Protein S
● Plasminogen activator inhibitor 1
● Von willebrand’s factor
```
● Protein S
593
```
22. How does a melanoma spread?
● Lymphoid
● Haematological
● Perineural
● Iatrogenic
● Transcoelomic
```
Haematological
594
2. Graft verus host disease pathophysiology in a Haematopoietic stem cell transplant (HSCT)
HLA
595
4. Person is discharged after surgery, who had a bilateral hemianopia, with removal of pituitary adenoma. Consultant says it is alright to discharge them. What do you prescribe the patient on discharge?
Hydrocortisone
596
5. Which of these vaccines must not be given to a pregnant woman:
a. MMR (as contains live Rubella virus)
b. Hep B
c. DTP
a. MMR (as contains live Rubella virus)
597
11. A man has gout and is kept up at night by it. His symptoms are relieved by ibuprofen, but when he stops taking it, the symptoms come back. His neighbour is on allopurinol, and he would like to be on it too. Which of these medications would need to be altered for them to be able to be prescribed allopurinol?
Azothioprine - if you give allopurinol with either azothioprine or 6-mercaptopurine it causes overdose of either drug (slows down their metabolism)
598
19. Why do walls of vessels express anti-thrombotic factors?
They secrete thrombomodulin
599
21. Which vector transmits Trypanosoma brucei rhodesiense?
c. Tsetse Fly
a. Anopheles mosquitoes – causes Malaria. Females carry the disease.
b. Sandfly – causes Leishmaniasis (also known as Kala Azar)
c. Tsetse Fly
d. Aedes – causes Aedes aegypti (Yellow Fever - pyramids in Egypt and pyramids are yellow)
600
25. Which of the ions (K, Ca2+, Na+, Mg) is most likely to be outside of its normal range with alkalosis (e.g. if the person is urinating a lot)
a. Potassium
b. Calcium
c. Sodium
d. Magnesium
Potassium
601
29. Which of these won’t cause damage to the foetus if the mother is infected antenatally?
a. Cytomegalovirus (CMV)
b. Herpes Simplex Virus (HSV)
c. Enterovirus
d. Varicella Zoster Virus (VZV)
e. Rubella
Enterovirus
602
31. 50-year-old man with midshaft femur fracture – what would you find at the site of the break/fracture (or rather, which/what type of cancer does he have)?
a. Neuroblastoma
b. Osteosarcoma
c. Ewing’s sarcoma
d. Chondrosarcoma
e. Adenocarcinoma
Chondrosarcoma
603
33. Which of these is the most likely causative organism of a hospital acquired pneumonia?
a. Haemophilus influenza
b. Steptococcus pneumonia - Most common community acquired pneumonia
c. Staphylococcus aureus
d. Mycoplasma pneumonia
e. Pseudomonas auregenosa
f. Aspergillus
c. Staphylococcus aureus
604
35. Middle aged lady with a liver biopsy showing the loss of bile ducts and granulomas present. What disease is present with this?
Primary biliary cholangitis
605
41. What enzyme do you expect to be raised in obstructive jaundice/biliary obstruction?
Gamma-glutamyl transpeptidase (GGT) – do not use acronyms!
606
42. A person develops signs of hyperthyroidism. Bloods show low TSH and high thyroxine, with low uptake on technetium scan. What is the likely diagnosis?
Viral De Quervain’s thyroiditis. Good uptake bilaterally = Grave’s disease.
607
43. What can be used to measure the turnover of bone, and is raised in people with Paget’s, and osteomalacia?
Alkaline phosphatase
608
46. Both mother and grandmother had medullary thyroid carcinoma and are positive for MEN2. What biomarker/protein would be raised in the blood to confirm medullary thyroid cancer?
Calcitonin
609
49. An African man with Burkitt’s lymphoma is given Rasburicase. He develops haematuria with irregularly contracted cells. What is the cause?
Glucose-6-phosphate dehydrogenase deficiency (no acronyms!)
610
51. Which common condition can be treated with drugs that target with TNF, IL-17 and IL-12/23?
Psoriasis
611
54. What is the main class of drug used to treat HIV?
Nucleoside reverse transcriptase inhibitors (NRTIs)
612
- Seizures in newborn (<24hrs) cause
- Seizures in newborn (<24hrs) = hypoglycaemia; in 24 hours = congenital toxoplasmosis
613
3. Lady with malignancy; epistaxis, anaemia thrombocytopoenia, something up with clotting (DIC?) and blasts somewhere?
Acute promyelocytic leukaemia
614
5. Cancer with desmosomes - SBA with cell types e.g. Squamous cell columnar cells
Squamous cell columnar cells
615
3. Disease that needs C-section if the mother has an outbreak at 34weeks/later, due to the risk of transmission vaginally
herpes simplex virus
616
Meningitis
| 6. Gram +ve rods
Meningitis
6. Gram +ve rods = Listeria
7. Gram +ve diplococci = streptococcus pneumoniae
8. Normal glucose, raised lymphocytes, normal/high protein – viral meninigitis
9. Gram -ve rods = Escherichia coli
10. Gram -ve diploccoci = Neisseria meningitis
617
Meningitis
7. Gram +ve diplococci =
Meningitis
6. Gram +ve rods = Listeria
7. Gram +ve diplococci = streptococcus pneumoniae
8. Normal glucose, raised lymphocytes, normal/high protein – viral meninigitis
9. Gram -ve rods = Escherichia coli
10. Gram -ve diploccoci = Neisseria meningitis
618
Meningitis
8. Normal glucose, raised lymphocytes, normal/high protein
Meningitis
6. Gram +ve rods = Listeria
7. Gram +ve diplococci = streptococcus pneumoniae
8. Normal glucose, raised lymphocytes, normal/high protein – viral meninigitis
9. Gram -ve rods = Escherichia coli
10. Gram -ve diploccoci = Neisseria meningitis
619
Meningitis
9. Gram -ve rods = Escherichia coli
Meningitis
6. Gram +ve rods = Listeria
7. Gram +ve diplococci = streptococcus pneumoniae
8. Normal glucose, raised lymphocytes, normal/high protein – viral meninigitis
9. Gram -ve rods = Escherichia coli
10. Gram -ve diploccoci = Neisseria meningitis
620
Meningitis
10. Gram -ve diploccoci = Neisseria meningitis
Meningitis
6. Gram +ve rods = Listeria
7. Gram +ve diplococci = streptococcus pneumoniae
8. Normal glucose, raised lymphocytes, normal/high protein – viral meninigitis
9. Gram -ve rods = Escherichia coli
10. Gram -ve diploccoci = Neisseria meningitis
621
16. B-lactam vs Pseudomonas –
meropenem (carbapenem), ceftazidime (cephalosporin)
622
19. DNA synthesis inhibitor used to treat Pseudomonas but not active against anaerobes
Polymyxin B
623
26. Woman with UTI with culture of gram +ve cocci in clusters
Staph saprophyticus
624
28. 19 year old rugby player with boils, members of his team have similar boils and members of his family. What is the cause
herpes simplex virus 1 (gladitorium)
625
31. Develops a grey film over the epiglottis
diphtheria
626
30. Virus that resides in pharynx and GIT, can cause encephalitis and destruction of motor neurones –
polio
627
34. Lockjaw –
tetanus
628
39. Patient with carcinoma in the liver, what was the original carcinoma in their pancreas that caused the metastases –
adenocarcinoma
629
40. Sarcoidosis changes in the lymph nodes –
non-caseating granulomas
630
46. Cell changes in GORD –
squamous cell to columnar epithelium
631
50. Mass in kidney that extends into renal vessels and into perinephric fat –
angiomyolipoma
632
56. 20 year old with a lytic lesion in leg diaphysis, pain alleviated by aspirin –
osteoid osteoma
633
85. FAS pathway mutation –
autoimmune lymphoproliferative syndrome (ALPS)
634
105. Philadelphia 9;22 BCR ABL present, TdT+ve, 70% blasts. No hepatosplenomegaly. No myelocytes or basophilia
Philadelphia +ve ALL
635
111. Pregnant Greek patient with father who is on warfarin, sister had a DVT –
anti-thrombin deficiency
636
124. What blood transfusion complication should be screened for in SCA if the patient 8 days post-transfusion gets painful joints, dark urine, fever and headache?
Delayed haemolytic transfusion reaction
637
125. How is thalassaemia diagnosed?
Electrophoresis
638
127. What is measured to monitor polycthaemia vera?
Hct and Hb
639
133. 10 year old with seizures, low calcium, high phosphate, high PTH –
pseudohypoparathyroidism PTH is not working properly = high phosphate
Or alports?
640
135. Patient with polyuria and polydipsia, low sodium, low potassium, low plasma and urine osmolarity –
psychogenic polydipsia
641
- What immunotherapy is used for Wegener’s disease alongside prednisolone?
Cyclophosphamide
Think c-ANCA Cyclophosphamide
642
- Protozoa that can cause infection in late pregnancy?
Toxoplasma gondii
643
- What virus causes haemorrhagic cystitis post-transplant?
BK virus
644
- What on urine culture may suggest a badly collected sample?
Squamous epithelial cells
645
Which salmonella can cause splenomegaly
Salmonella typhi can cause splenomegaly
