Path PPQs + Enzymes Flashcards
(249 cards)
1
Q
Full name for ALP?
A
Alkaline phosphatase
2
Q
Full name for ALT?
A
Alanine transaminase
3
Q
Full name for AST?
A
Aspartate transaminase
4
Q
Full name for GGT?
A
Gamma glutamyl transferase
5
Q
What enzyme is deficient in Gilbert’s?
A
UDP-glucuronyl transferase
6
Q
What is Richter’s transformation?
A
Transformation of CLL to diffuse large B cell lymphoma
7
Q
bWhat do you measure in dermatomyositis with polyangitis?
A
Creatinine Kinase
8
Q
What is the vegan Vit D supplement called?
A
Ergocholecalciferol (Vitamin D2)
9
Q
What is the animal source of Vitamin D
A
Cholecalciferol (Vitamin D3)
10
Q
Where is the enzyme 25-hydroxylase?
A
Liver
11
Q
Inactive form of vitamin D?
A
25-hydroxyvitamin D
12
Q
What enzymes activates vitamin D?
A
1 alpha hydroxylase
13
Q
1 alpha hydroxylase can be produced by which disease?
A
Sarcoidosis
14
Q
What is another name for 1,25 dihydroxy vitamin D?
A
Calcitriol (active form)
15
Q
Features of osteomalacia?
A
Bone and muscle pain, Looser zones, increased fracture risk, Raised ALP, low calcium, low phosphate
16
Q
What are Looser zone’s?
A
Pseudofractures
17
Q
Features of rickets?
A
Bowed legs, chostochondral swelling, widening epiphysis at the wrists, myopathy
18
Q
What drugs can cause rickets?
A
Anti-convulsants
19
Q
How can ostemalacia occur in pregnancy?
A
Baby steals calcium
20
Q
PTH stimualtes which bone cells?
A
Osteoclasts
21
Q
Which bone cells produce alkaline phosphatase?
A
Osteoblasts
22
Q
What is the effect of Cushing’s on vitamin D?
A
Vitamin D reduces and phosphate - leads to osteoporosis
23
Q
What is the first feature of osteoporosis?
A
Fracture - often NOF or Colle’s fracture
24
Q
Rash with amoxicillin is indicative of what?
A
EBV
25
Irritability = what disease?
meningitis
26
Gower's sign positive?
Duchenne's muscular dystrophy
27
Heart is boot shaped on CXR
Tetralogy of fallot (right to left shunt)
28
Port wine stain?
Sturge-Weber (epilepsy)
29
A baby is born with micrognathia, low-set ears, rocker bottom feet and overlapping of fingers - what condition?
Edward's syndrome (trisomy 18)
30
Back arching is indicative of what?
Reflux
31
Peripheral pulses absent = which condition?
Coarctation of the aorta
32
West syndrome treatment?
- vigabatrin is now considered first-line therapy
- ACTH is also used
33
EEG and CT results of west syndrome?
EEG shows hypsarrhythmia in 2/3 of infants; CT shows diffuse/localised brain disease in 70% (e.g. tuberous sclerosis)
34
How is Vesicoureteric reflux diagnosed?
MCUG
35
Osgood-Schlatter disease is caused by what?
Inflammation of the tibial tuberosity
36
Chickenpox where does rash start?
Face/trunk. Fever first
37
Measles history and signs
Prodrome: irritable, conjunctivitis, fever
confluent rash
Koplik spots: white spots ('grain of salt') on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
38
Roseola infantum cause and signs
- high fever: lasting a few days, followed later by a
- maculopapular rash.
Caused b HHV6
39
Screening in Kawasaki disease
Echocardiogram
40
USS in NEC?
Shows target sign
41
Management of Hisrschprung's disease
management:
1. bowel irrigation
2. surgery: ano-rectal pull-through
42
Sexual aggression + precocious puberty
sexual aggression = testotoxicosis
43
Small testes in precocious puberty =?
Adrenal hyperplasia
44
Diagnosis of whooping cough?
Per nasal swab.
Give erythromycin for 10 days
45
Wiskott-Aldrich syndrome
X-linked recessive
Sx: eczema, thrombocytopaenia, immune deficiency, bloody diarrhoea, petechiae
46
Cri du chat syndrome
Chr 5p deletion syndrome
Features:
- Characteristic cry due to larynx and neurological problems
- Feeding difficulties and poor weight gain
- Learning difficulties
- Microcephaly and micrognathism
- Hypertelorism
47
William's syndrome
Features:
- Short stature
- Learning difficulties
- Friendly, extrovert personality
- Transient neonatal hypercalcaemia
- Supravalvular aortic stenosis
48
Pierre-Robin syndrome?
Features:
- Micrognathia
- Posterior displacement of the tongue (may result in upper airway obstruction)
- Cleft palate
49
Noonan syndrome?
- Webbed neck
- Pectus excavatum
- Short stature
- Pulmonary stenosis
50
Edward's syndrome?
Trisomy 18
Features:
- Micrognathia
- Low-set ears
- Rocker bottom feet
- Overlapping of fingers
51
Patau syndrome signs?
Trisomy 13
Features:
- Microcephalic, small eyes
- Cleft lip/palate
- Polydactyly
- Scalp lesions
52
Fragile X syndrome
Features in males:
- learning difficulties
- large low set ears, long thin face, high arched palate
- macro-orchidism
- hypotonia
- autism is more common
- mitral valve prolapse
Diagnosis
- can be made antenatally by chorionic villus sampling or amniocentesis
- analysis of the number of CGG repeats using restriction endonuclease digestion and Southern blot analysis
53
What syndrome is associated with diabetes?
Cystic fibrosis
54
Which cancer is associated with H.Pylori infection?
Gastric MALT lymphoma
55
What happens to the body of the stomach in a patient with pernicious anaemia?
Atrophy
56
Most common type of malignancy in the breast?
Invasive ductal carcinoma
57
A 2 year old has a palpable abdominal mass when his mother picks him up. What is the most likely cause?
Wilmm's tumour
58
A lady has frank painless haematuria and a mass palpable on one side. What is the most likely cause?
Renal cell carinoma
59
Patient with hypoglycaemia and pancreas mass
Insulinoma
60
55yr old man with a painless mass in head of pancreas and jaundice
Adenocarcinoma
61
What is deposited in the kidneys in Multiple Myeloma?
AL Amyloid deposition
62
What material is seen in the vessel of a patient with an MI due to burst atheroma
Atheramatous plaque?
63
Patient presents with a craggy enlarged uneven prostate
Prostate adenocarcinoma
64
Patient with a cancer in their bladder following chronic schistosomiasis??
65
Young man, sudden severe pain in testicle following horse riding
Testicular torsion
66
Radiosensitive cancer of the testicle in a young man with a white/smooth appearance?
Seminoma??
67
Woman with recurrent episodes of weakness and paraesthesia that spontaneously resolve
TIA
68
Eczematous nipple rash caused by individual ‘malignant cells’?
Paget's disease of the breast
69
Which cancer is associated with coeliac disease?
EATL
70
Which thyroid cancer most commonly metastasises to the lymph nodes?
Papillary
71
What virus increases risk of nasopharyngeal cancer?
EBV
72
An ovarian mass is found in a Japanese woman, and histology shows signet ring cells
Krukenberg tumour
73
What liver change occurs in diabetic patients
Non-alcoholic fatty liver disease (NAFLD)
74
Both mother and grandmother had medullary thyroid carcinoma and have tested positive for MEN2. What biomarker would be raised in the blood to confirm medullary thyroid cancer?
Calcitonin
75
A patient required an aortic valve replaced 3 months ago. They have now come back a few weeks later with jaundice, Hb-urea (haemoglobinuria), and raised reticulocytes. What is the cause?
MAHA???
76
Which disease do you see in both MEN1 and MEN2a?
Parathyroid hyperplasia
77
Insulinoma. What would you find?
low free fatty acids
78
What would you see on a duodenal biopsy of a patient with Coeliac disease?
Intraeplithelial lymphocytes
79
What causes hypertension in upper half of body?
Coarctation of the aorta
80
Which cancer is associated with asbestos?
Mesothelioma
81
A lady is found to have cancer, and investigations show it is a ‘transitional cell’ cancer. Where has it metastasised from?
Colon
Liver
Bladder
Breast
Bladder
82
Which lung cancer is most likely in a non-smoker?
Adenocarcinoma
83
What is the most likely cause of nephrotic syndrome in a child?
Minimal change disease
84
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)?
Neuroblastoma
Osteosarcoma
Ewing’s sarcoma
Chondrosarcoma
Adenocarcinoma
Chondrosarcoma
85
Woman with recurrent episodes of weakness and paraesthesia that spontaneously resolve -
TIA?
86
. HIV patient who desaturates on exercise?
Pneumocystis jirovecii
87
Girl receiving chemotherapy for leukaemia with ‘Halo’ sign on CXR
Aspergillus fumigatus
88
Lower lobe pneumonia in a 22 year-old who is coughing up rusty coloured sputum
Strep pneummoniae
89
Upper lobe cavitation on CXR in an alcoholic
Klebsiella pneummoniae
90
Smoker back from holiday in Spain, also hyponatraemic and confused
Legionella pneumophilia
91
HIV patient with CD4+ count of 150 with meningitis
Cryptococcus neoformans
92
Water polo player with itchy scaly rash on lateral toe which then moved along lateral side of foot
Tricophytum rubrum
93
Pityriasis versicolor
Malassezia furfur
94
Lady came back from visiting her sister in Arizona with systemic sx - fever etc:
Coccidioides
95
A South American man presents to a doctor in the UK with fever and bloody diarrhoea, and investigations detect a cyst in the right lobe of the liver
Entamoeba histolytica
96
A Nigerian man presenting with fever and chills, has just returned from Nigeria, did not take prophylaxis, and was bitten a lot
Malaria
97
A woman returning from travel in Asia presents with abdo pain, headache, and constipation. A Gram- rod is later cultured from her blood
Salmonella typhi
98
Snail trail oral ulcer in a homosexual man
Treponema pallidum
99
A soldier returning from Afghanistan has a small ulcer on right ring finger that won’t heal and keeps getting bigger
Leishmaniasis
100
What is the treatment for MRSA?
Vancomyin
101
Which of these vaccines must not be given to a pregnant woman?
MMR
102
What is the most common cause of fever in a returning traveller?
Malaria
103
Which of these is the most likely causative organism of a hospital acquired pneumonia?
a. Haemophilus influenza
b. Streptococcus pneumonia
c. Staphylococcus aureus
d. Mycoplasma pneumonia
e. Pseudomonas aeruginosa
Pseudomonas aeruginosa
104
Which of these does not lead to chronic Hepatitis?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
E. Hepatitis E
Hepatitis A
105
Which vector transmits Trypanosoma brucei rhodesiense?
A. Anopheles mosquito
B. Sandfly
C. Tsetse Fly
D. Aedes mosquito
E. Ixodes tick
Tsete fly
106
A Girl develops a throat infection. She is given amoxicillin, and a rash develops. It is later found out that she has infectious mononucleosis, and her symptoms persist. What is the most likely cause of the rash?
A. Drug reaction
B. Penicillin allergy
C. Mastocytosis
D. Erythema nodosum
E. Pyoderma gangrenosum
Drug reaction
107
HIV DNA is formed by which error prone enzyme?
A. RNA polymerase
B. DNA polymerase
C. RNA transcriptase
D. Reverse transcriptase
E. Proteases
Reverse transcriptase
108
Which of the following is the most common cause of cellulitis?
A. S. epidermidis
B. S. saprophyticus
C. S. pyogenes
D. S. agalactiae
E. E. coli
Strep pyogenes
109
Natural antibodies against what can confer protective immunity against HIV?
A. HIV – GAG
B. HIV – gp120
C. CXCR4
D. Protease
E. Reverse transcriptase
B
110
Which would be the most useful test in confirming acute EBV infection 2 weeks after possible exposure in an immunocompetent patient
Serum IgM
111
Which vaccine-preventable organism causes cough, lymph node enlargement and has a potential to occlude the airway?
Corynebacterium diptheriae
112
What cell type is raised in the blood in schistosomiasis?
Eosinophils
113
Boy visits grandparents in Wiltshire, comes back with 5 days of diarrhoea, no vomiting, and unexplained bruises all over body, which organism has most likely triggered this?
E. Coli 0157:H7
114
Name an infectious organism that is a common cause of sepsis in a neonate
Group B streptococcus
115
Name an infectious organism which is a common cause of meningitis in a child older than 3 months
Neisseria meningitidis
116
Name the main class of drugs used to treat HIV
NRTI - nucleotide reverse transcriptase inhibitors
117
What zoonotic disease is carried by the Ixodes tick?
Lyme disease
118
Via which route does Hep A spread?
Faeco-oral route
119
What is the treatment for pseudomembranous colitis?
Metronidazole
120
Painless penile ulcer which healed in few weeks, followed by fine snail track oral ulcer
Treponema pallidum
121
Reactivation of a virus following a transplant
EBV
122
What does JC virus cause?
Progressive multifocal leukoencephalopathy
123
HIV +ve patient with v low CD4 + purple lesions seen on trunk. What virus causes this cancer?
HHV8
124
What is the most likely cause of early-onset sepsis in a neonate?
Group B streptococcus
125
What is the most common cause of viral meningitis?
Enteroviruses
126
What is the most common cause of traveller’s diarrhoea?
E. Coli
127
Which bacterial species causes scarlet fever?
Group A haemolytic streptococcus
128
Receptor/ cytokine mutation that could be protective in HIV?
CCR5 = receptor
MIP-1a is the cytokine mutation
129
Which stain would be used to confirm infection with acid-fast bacilli?
Ziehl-nielson stain
130
What is the definition of herd immunity threshold?
1-(1/R0)
131
Name 1 of the 3 characteristics of Influenza A that could cause a pandemic
Novel antigenicity
132
Alcoholic man is on ceftriaxone for meningitis, what organism is he at risk of which this does not cover for?
Listeria monocytogenes
133
Returning traveller with fever and constipation (salmonella typhi) - what abx do you give
IV ceftriaxone
134
Septic arthritis in a 56yo man - likely organism?
Staph aureus
135
What does it mean if urine MC&S sample has epithelial cells and mixed bacterial growth?
Contaminated sample
136
Develops a grey film over the back of the throat
Diptheria
137
Causes lumps on parotid and neck
Mumps virus
138
Maculopapular rash moves from face that can cause encephalitis and pneumonitis
Measles?
139
Virus that resides in pharynx and GIT - 1:100 encephalitis, 1:1000 destruction of motor neurons
Polio
140
What virus can cause Lockjaw ?
Tetanus
141
Woman with UTI - culture grows Gram positive cocci in clusters
Staph aureus
142
49 Year old with no medical problems has septic arthritis
Staph aureus
143
. 50 year old male smoker has meningitis with Gram positive diplococci
Strep pneummoniae
144
Neonate has meningitis, Gram positive organism in chains
Group B streptococcus?
145
19 year old rugby player with boils, members of his team have similar boils, as do members of his family
Staphylococcal sacrophyticus??
146
Lady with PID and positive urinary NAAT test
Chlamydia
147
Lady with discharge, no other symptoms, and causative infection found on wet slide microscopy
Trichomonas vaginalis
148
Man with discharge- Gram negative diplococci found
Neisseria gonorrhoea
149
Painless indurated ulcer, grown on dark brown medium, spiral shaped organism found
Treponema pallidum
150
A girl has been noted by her parents to be acting strange lately. A Lumbar puncture is performed and the CSF shows high lymphocytes and a raised protein, but normal glucose, what organism is the cause?
HSV
151
An 18 year old student is found to have Gram negative diplococcus causing meningitis
Neisseria meningitidis
152
A man is found to have a Gram positive diplococcus causing meningitis
Streptococcus pneummoniae
153
Gram negative rod causing sepsis in a neonat
E. coli
154
Gram positive rod causing meningitis in a 72 year-old
Liseteria monocytogenes
155
Gram positive diplococci example?
Streptococcus pneummoniae
156
Which antibiotic would you use for cellulitis with MRSA
Vancomycin
157
Which antibiotic would you use to treat someone who has cellulitis with a Methicillin SENSITIVE strain of Staphylococcus aureus
Flucloxacillin
158
Young women with cystitis and fully sensitive E-Coli
Trimethoprim
159
Antibiotic for Group A Strep pharyngitis
Benzylpenicillin
160
Included in meningitis treatment to cover Listeria monocytogenes
Amoxicillin
161
A man develops foul-smelling diarrhoea and cramping pain 5 days after eating chicken at a barbeque
Campylobacter Jejuni
162
A woman develops vomiting a few hours after eating a Chinese meal with lots of rice
Bacillus cereus
163
Women has had some surgery which required antibiotics, and now has profuse watery diarrhoea
Clostridium difficile
164
A ward sister gets diarrhoea, and patients on the ward have been ill recently with similar symptoms
Norovirus
165
Virus that may cause Hydrops fetalis if caught in first 20wks of pregnancy
Parvovirus B19
166
Immunoglobulin may be given to the mother if she is exposed to this virus in pregnancy to prevent infection
Varicella Zoster
167
Virus that require C-section if mother has an outbreak at 34wks or later due to risk of transmission vaginally
HSV 2
168
Virus that can cause baby to have cataracts, sensorineural deafness, hepatomegaly and thrombocytopenia
Rubella
169
Virus which if transmitted to baby: they can initially be symptomless but then come down with long term sequelae
CMV
170
A. 60 year old Man with abdominal pain radiating to back, collapses and dies
Acute aortic aneurysm
171
Man, ex-smoker, with history of hypertension and MI, has sudden chest pain which radiates to the neck
Left anterior descending artery thrombus
172
A 60 year old lady with a background of stepwise memory loss and hypertension is hospitalised with bronchopneumonia
Multiple cerebral infarcts
173
An elderly man with atrial fibrillation develops new right flank pain
– Renal thrombus
174
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
175
What histological finding will be seen in the kidneys in cases of post-Streptococcal glomerulonephritis?
– Immune complex deposition
176
Malignant HTN, what is the classic renal finding on histology
– Fibrinoid necrosis
177
Women has acute appendicitis, 5mm tumour found in tip when it’s remove
Neuroendocrine tumour
178
Man with H pylori, abnormal area in antrum, mitotic figures and cells with raised nuclear to cytoplasmic ratio, not invading the basement membrane
B cell lymphoma
179
What happens to the body of the stomach in a patient with pernicious anaemia
Chronic gastritis and atrophy
180
Which/What breast cancer is also known as non-specific type?
Invasive ductal carcinoma
181
Breast cancer which has a high, medium and low stage to it
Ductal carcinoma in situ
182
Fibro-epithelial tumour with abundant stromal elements
Phyllodes tumour
183
A man presents with the symptoms of a UTI and acute onset costovertebral pain. He is found to have pus cells and blood in his urine. What is the most likely cause?
Acute pyelonephritis
184
A lady with loin-to-groin pain, haematuria and pain at the end of micturition. What is the most likely cause?
Renal calculi
185
A lady has frank painless haematuria and a mass palpable on one side. What is the most likely cause?
Renal cell carcinoma
186
A 2 year old has a palpable abdominal mass when his mother picks him up. What is the most likely cause?
Nephroblastoma
187
A man with AF (Atrial fibrillation) develops fever, nausea, vomiting and pain in his right loin/flank. What is the most likely cause?
Renal infarct
188
Patient with a pancreatic mass following acute pancreatitis?
Pancreatic pseudocyst
189
Patient with a history of severe abdominal pain; during cholecystectomy the surgeons noticed grey specks around and on the pancreas?
Ductal adenocarcinoma
190
Patient with a carcinoma in their liver, what was the original carcinoma in their pancreas that caused the metastases?
Ductal adenocarcinoma
191
Appendix that is full of neutrophils and is enlarged touching the peritoneum
Inflammation
192
Patient with a cancer in their bladder following chronic schistosomiasis
Squamous cell carcinoma
193
On doing a patient’s nephrectomy they notice a mass in the kidney that extends into the the renal vessels and into the perinephric fat
Angiomyolipoma?
194
Man goes deaf with bowed legs
Paget's disease of bone
195
Sudden headache, loss of consciousness, meningism
Subarachnoid haemorrhage
196
Patient with HIV, raised ICP, new onset epilepsy
Primary CNS lymphoma
197
Woman with recurrent episodes of weakness and paraesthesia that spontaneously resolve?
TIA
198
15 year old presents with signs of ataxia. Imaging shows a brain tumour extending outwards from cerebellum and invading subarachnoid space. What is the most likely type?
Medulloblastoma
199
Publican with diabetes, fatty stools, weight loss, ‘slate grey skin’ and joint pains. What is the underlying diagnosis causing this?
Haemachromatosis
200
White plaques are seen lining the oesophagus on an OGD of an alcoholic man with recurrent bleeding varices, what are they most likely to be?
Oesophageal candidiasis
201
What type of gastric cancer is most common?
Adenocarcinoma
202
42 year old woman has a history of intermenstrual bleeding. On examination, a cervical polyp is found. What do you do next?
Remove and send for histology
203
What type of section is done for urgent diagnosis during surgery?
Intra-operative frozen section
204
How does a melanoma spread?
Lymphoid
205
Which of these is a common finding in someone who has portal hypertension?
Splenomegaly?
206
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)?
Chondrosarcoma
207
Middle aged lady. Liver biopsy, loss of bile ducts and granulomas present. Which/what disease is consistent with these findings?
PBC
208
Beta lactam with anti-pseudomonal activity
Ceftazidime
209
Broad spec, no pseudomonal activity usually given with a beta lactamase inhibitor
Amoxicillin
210
A DNA synthesis inhibitor used to treat Pseudomonal infections but poor against anaerobes?
Ciprofloxacin
211
Abx of the Macrolide/lincosamide/streptogrammin group used to treat some atypical pneumonias
Clarithromycin
212
The organism that causes tetanus
Clostridium tetanae
213
A 6 year old girl comes in with a high fever, severe headache and confusion. There is no rash present. The parents say that she is usually well but has had a sore throat in the last few weeks.
Neisseria meningitidis
214
A 7 year old boy arrives is brought into A&E by his worried parents. He has headache, fever, photophobia and neck stiffness. An LP revealed clear CSF. His parents say that they have never had to take him to the doctor, except for his immunisations as an infant.
Coxsakie B
215
A 13 year old boy is brought in with headache, fever and photophobia by his mother. She says that she usually gives him a homeopathic remedy when he is ill but it has not worked this time. The CSF collected from the lumbar puncture is clear.
Measles
216
Which immunosupressent is associated with irreversible infertility and is only used when there is no alternative?
Cyclophosphamide
217
Which immunosuppressant blocks T cell migration
Natalizumab
218
Calcineurin inhibitors act by blocking which cytokine?
IL-2
219
Which 2 immunosuppresants act to inhibit the T cell cycle?
Azathioprine and Mycophenolate mofetil
220
Contains a b-lactamase inhibitor to increase the antibiotic's efficacy
Co-amoxiclav
221
Is used to treat mild Pseudomembranous Colitis
Metronidazole
222
Is used to treat Pneumocystis Pneumonia
Co-trimoxazole
223
Acts by inhibiting bacterial folate synthesis
Co-trimoxazole
224
Binds to bacterial 30s ribosomal subunit and causes codon misreading
Gentamicin
225
Inhibits DNA Gyrase
Moxifloxacin
226
1. A homeless man dies (signs of trauma), you cannot contact his brother, what do you do about the autopsy?
This death must be referred to the coroner for autopsy as it is suspicious, so you don’t need consent from the brother.
227
2. HIV positive girl dies of cerebral toxoplasmosis, before she dies she says she doesn’t want to disclose her HIV status. What do you write on the death certificate?
You must disclose it if it contributed to the death
228
3. Woman (45y) with learning difficulties and cerebral palsy, she gets influenza, then strep pneumonia, then dies of cardiorespiratory arrest. Death certificate?
1a Streptococcal pneumonia
1b Influenza
2 Cerebral palsy
229
4. Man dies, daughter consents to autopsy, step mum (his wife) does not want autopsy - what to do?
No autopsy, step-mum outranks daughter (order is spouse/ partner, child/ parent, brother/ sister, grandparent or grandchild etc. – see section 27 (4) of Human Tissue Act)
230
5. Guy with brain mets from lung cancer, has a PE, dies of cardiorespiratory arrest. Fill out death certificate
1a: Pulmonary embolism
1b: Cerebral metastases
1c: Lung cancer
(Assuming the PE was due to increased coagulability due to cancer)
231
1. What to put on death certificate for a well-controlled HIV patient who had a PE after a long haul flight and died from cardiac arrest soon after admission to hospital?
a. 1a: PE
b. 1a: PE, 1b: HIV
c. 1a: cardiac arrest, 1b: HIV
1a: PE
232
2. Woman found at home surrounded by needles, lots of extra pathologies - PE, etc. Family are waiting for the death certificate what do you do?
a. Ask family for permission to do the autopsy in hospital
b. Call the coroner, and ask him to ask the family to do the autopsy in the hospital
c. Can’t give death certificate
d. Just give death certificate without autopsy
Can't give death certificate
233
4. Hospital Autopsy. Coroner wants a spine specimen for teaching. What do you?
a. Must ask family
b. Don’t need one as hospital and good for education (something like that)
c. Must have asked for consent previously from deceased
Must have asked for consent previously from deceased
234
1. Dad and brother of dead individual disagree over having an autopsy. The Dad was the main carer but no mention of standing order or special status assigned to dad by the dead individual.
a. Dad & Brother disagree so there can be no autopsy
b. There is a family disagreement so there can be no autopsy
c. An autopsy can be done but to settle the disagreement it goes to a special court
d. Dad’s consent is all that is needed legally speaking
Dad’s consent is all that is needed legally speaking
235
2. Next of kin is identified for a woman who is estranged from her family, and found at home unresponsive with needles, and is a drug addict. When they get her to hospital she dies before you can talk to her. They find her next of kin (her brother)
a. If police declare it a possible murder then they can ask the coroner?
b. You can refer to coroner for autopsy if the police rule it as a suspicious death provided you get consent from the next of kin first
c. Perform a post-mortem at the hospital after seeing permission from her brother
d. Refer to coroner
Refer to coroner
236
3. Random doctor following a needle stick injury, from a parent who has come back from the Philippines. Random doctor doesn’t want to take PEP unless risk is real. Asks patient (who has capacity) if they can consent to the blood test – patient refuses. The doctor then asks CT1 college if they can ask the lab to do a test on one of the patient’s old blood samples. What does the CT1 say?
a. If they decline to consent and have capacity then you cannot do the test
b. To not do the test would violate the doctor’s human’s rights under article 3 or 5 of the Human Rights acts of year XXXX
c. To not do the test would violate the patient’s human’s rights under the Human’s right’s act of year XXXX
d. If the hospital refuses to test the blood despite the person’s protests, then they are violating the doctor’s human rights.
e. They can proceed and test an old sample of blood as it is in the best interests of the doctor.
If they decline to consent and have capacity then you cannot do the test
237
4. A man presents with history of heart disease, left ventricular hypertrophy, has a facial basal cell carcinoma and type 2 diabetes. Investigations from one year ago showed critical aortic stenosis, with poor ejection fraction. Current echo shows critical aortic stenosis. They suddenly die. List the order for the coroners / How should you fill out the MCCD (Medical Certificate of Causes of Death)?
e. 1a = Aortic Stenosis, 2 = Type 2 diabetes
238
When to refer a death to the coroner?
Any trauma = NEEDS TO BE REFERRED TO THE CORONER. This includes falls in the elderly.
Suspicious circumstances
After a hospital procedure.
The death was violent or unnatural
* the cause of death is unknown, or
* the person died in prison, police custody, under section, or another type of state detention. Migration camps etc
Not seen a doctor in 28 days or in last illness
During or within 12 months of pregnancy
Death due to suicide, industrial disease, abortion, anaesthetic care, medical care, murder, self-neglect
Any allegation of medical negligence.
Don’t need to suspect a crime to refer to the coroner.
239
What should be done before discussing with the family?
Medical certificate of cause of death
240
What is Part II on a death certificate?
Other diseases related to the cause of death
241
What should be avoided in death certificates?
Modes of death eg. cardiorespiratory arrest, herniation, organ failure etc.
Congestive heart failure is the only exception
242
three types of autopsy?
Forensic, Coroner and hospital "consented"
243
What not to do on death certificate?
Abbreviations, vague notions
244
When is consent required with regards to human tissue?
Consent is necessary for taking surgical pathology specimens in the living and, of course, the performance of autopsies and dealing with the Deceased's tissue necessary for various diagnostic and other purposes.
245
What purposes of the deceased require consent?
Clinical audit, education, performance assessment, public health, quality assurance
246
When can tissue be removed without consent?
In coroner's autopsy to determine cause of death
247
What is the HTA hierarchy of consent?
Spouse/partner
Parent/child
Sibling
Grandparent/grandchild
Niece/nephew
Step parent
Half sibling
Friend of longstanding
248
Does consent for organ donation mean it will proceed?
No. A specialist nurse (SN) for organ/tissue donation should be involved for all organ donation decisions. Their role is to speak with the family, to ascertain if there is reasonable reason to believe that the person would not have given consent. This is a highly skilled role and is crucial when there is disagreement between family members or with the clinical team that consent can be deemed. The next slide s gives some potential scenarios.
249
Does confidentiality end after death?
NO!
