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Buzzwords Specialty Exam > Pathology > Flashcards

Pathology Flashcards

1
Q

Halo sign on chest x-ray.

A

Aspergillosis.

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2
Q

Crohn’s mutations.

A

Chromosome 16 - NOD2/CARD15.

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3
Q

Gout treatment (long-term).

A

Allopurinol (Xanthine Oxidase Inhibitor)

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4
Q

Gout attack treatment (acute).

A

NSAIDs (preferred), colchicine.

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5
Q

HLA-B27.

A

Ankylosing Spondylitis.

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6
Q

Cardiac failure enzyme.

A

Brain Natriuretic Peptide.

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7
Q

Aphthous ulcers.

A

Crohn’s disease.

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8
Q

CLL with p53 mutation. What is the treatment?

3 drugs

A

Ibrutinib (TKi), alemtuzumab (anti-CD52), idalalisib

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9
Q

Multiple myeloma patient - what is seen in the urine?

A

Bence Jones Protein.

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10
Q

Discontinuation in epithelial surface - technical name

A

Ulcer

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11
Q

Connection between two epithelial surfaces - technical name

A

fistula

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12
Q

Signet ring cells

A

Gastric carcinoma

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13
Q

Rose spots on torso, recent travel history.

A

Salmonella typhi - typhoid fever.

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14
Q

Gold standard for coeliac Dx

A

Duodenal/jejunal biopsy

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15
Q

Recurrent chest infections, low set ears, cleft palate,

cardiac murmur, low Ca. What is the condition and associated mutation.

A

DiGeorge (22q11.2).

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16
Q

CREST antibodies

A

Anti-centromere

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17
Q

What antibodies are involved in Grave’s disease?

A

Anti-TSH-R (thyroid stimulating hormone receptor).

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18
Q

Type of neutrophil is seen in pernicious anaemia.

A

Hypersegmented neutrophil.

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19
Q

Alpha Glucosidase inhibitor (in brush border membrane).

A

Acarbose.

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20
Q

Dipeptidyl dipeptidase inhibitor examples

A

Gliptins - Sitagliptin/Alogliptin

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21
Q

Ring-enhancing lesion on CT or MRI.

A

Cerebral abscess.

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22
Q

Gram-positive diplococcus.

A

Streptococcus pneumoniae.

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23
Q

Gram negative intracellular diplococci.

A

Neisseria gonorrhoea.

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24
Q

What condition is anti-mitochondrial antibody associated with?

A

Primary Biliary Cirrhosis/Cholangitis.

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25
Q

What 4 conditions is P-ANCA associated with?

A

Eosinophilic Granulomatosis with Polyangiitis, Microscopic Polyangiitis, PSC, Type 3 Crescentic/Rapidly Progressive glomerulonephritis.

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26
Q

Goodpasture’s syndrome antibody

A

Anti-glomerular basement membrane (type IV collagen).

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27
Q

Anaemia plus spectrin molecule abnormality.

A

Hereditary elliptocytosis or hereditary spherocytosis.

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28
Q

Ca high

PTH normal

A

Primary hyperparathyroidism (PTH is INAPPROPRIATELY normal). Most commonly caused by parathyroid adenoma.

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29
Q

Calcium low

PTH high

A

Secondary hyperparathyroidism (due to CKD, osteomalacia or vitamin D deficiency).

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30
Q

What vitamin deficiency is associated with pellagra?

A

Niacin deficiency/vitamin B3.

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31
Q

Snail track oral ulcer.

A

Syphilis.

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32
Q

What organism causes syphilis?

A

Treponema pallidum.

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33
Q

Reed-Sternberg cells.

A

Hodgkin’s Lymphoma.

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34
Q

What organism causes scarlet fever?

A

Streptococcus pyogenes.

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35
Q

What antibodies are present in Sjogren’s syndrome?

A

Anti-Ro and Anti-La.

Speckled pattern - RF can be present.

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36
Q

Liver enzyme in MI

A

AST

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37
Q

What is seen on heart biopsy in multiple myeloma?

A

Amyloid deposits (AL amyloidosis).

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38
Q

What is the mechanism of action of warfarin? Which factor is effected first?

A

It is a Vitamin K inhibitor, therefore decreasing factors 2, 7, 9, 10.

Factor 7/VII is effected first.

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39
Q

Test for autoimmune haemolytic anaemia.

A

Direct antiglobulin test (DAT).

Also known as the Coombs test.

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40
Q

Cancer with keratin and intercellular bridges.

A

Squamous cell carcinoma.

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41
Q

Chocolate cysts.

A

Endometriomas (endometriosis)

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42
Q

Most common type of carcinoma seen in the liver.

A

Metastatic adenocarcinoma (from the gut, via the hepatic portal vein).

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43
Q

Hyponatraemia is most commonly caused by…

A

… decreased serum osmolality (more water/in older people this can be caused by SIADH).

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44
Q

Most common type of brain cancer in adults. 

A

Metastatic deposit.

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45
Q

Most common type of brain cancer in children. 

A

Astrocytoma.

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46
Q

What electrolyte abnormality commonly presents with depression?

A

Hypercalcaemia.

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47
Q

Caseating granuloma.

A

Tuberculosis (mycobacterium tuberculosis). 

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48
Q

Non-caseating granuloma.

A

Sarcoidosis.

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49
Q

Tuberculosis treatment.

A

RIPE - rifampacin, isoniazid, pyrzinamide, ethambutol.

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50
Q

Pneumonia-like symptoms, failure to respond to antibiotics.

A

Abscess/empyema.

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51
Q

‘Rice water stool’.

A

Vibrio cholerae.

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52
Q

Bloody diarrhoea after eating chicken at a barbecue.

A

Campylobacter jejuni.

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53
Q

Gradual onset enteric fever and constipation in a returning traveller.

A

Salmonella typhi.

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54
Q

Flask shaped ulcer on histology of a homosexual man presenting with dysentery and flatulence.

A

Entamoeba histolytica.

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55
Q

Pear-shaped trophozoite (with 2 nuclei), foul smelling non-bloody diarrhoea.

A

Giardia lamblia.

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56
Q

Patient with kidney stones and UTI. What is the causative organism?

A

Proteus mirabalis (high affinity for kidney stones).

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57
Q

UTI in a young healthy woman. Causative organism?

A
  1. Escheria coli

2. Staphylococcus saprophyticus

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58
Q

Patient comes in to ED with pyelonephritis. What is your management?

A
  1. admit

2. IV co-amoxiclav and gentamycin

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59
Q

What antibiotic would you prescribe for a staphylococcus aureus wound, bone or joint infection?

A

IV flucoxacillin

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60
Q

Clostridium difficile management?

A

Oral metronidazole or vancomycin (severe).

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61
Q

What antibiotic is associated with clostridium difficile?

A

Ceftriaxone.

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62
Q

Tear drop poikilocytes on blood film

A

Primary myelofibrosis.

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63
Q

What ECG changes are associated with hyperkalaemia?

A
  1. loss of p waves
  2. tall tented T waves
  3. broadened QRS complex
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64
Q

What is the treatment for mild hypokalaemia (3.0-3.5 mmol/l)?

A

Oral KCl (2 SandoK tablets TDS for 48 hours).

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65
Q

What is the treatment for severe hypokalaemia (<3.0 mmol/l)?

A

IV KCl

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66
Q

What can cause an elevated anion gap metabolic acidosis?

A

Ketoacidosis
Uraemia
Lactic acidosis
Toxins

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67
Q

What is the best marker of acute liver injury?

A

Prothrombin time.

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68
Q

What does raised AST and ALT indicate?

A

Hepatocellular damage e.g. hepatitis, alcoholic liver disease (AST:ALT = 2:1)

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69
Q

What does raised ALP and GGT indicate?

A

Cholestatic/obstructive picture.

Note: GGT is raised in chronic alcoholism, isolated raised ALP can be due to Paget’s or osteomalacia (bone).

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70
Q

What is the most common type of renal cell carcinoma?

A

Clear cell carcinoma.

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71
Q

What is the most common type of thyroid neoplasm?

A

Papillary (75-85%).

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72
Q

What tumour markers is indicative of each thyroid neoplasm?

A

Thyroglobulin - papillary, follicular.

CEA, calcitonin - medullary.

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73
Q

What is the investigation for Addison’s disease?

A

SynACTHen test.

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74
Q

What adrenal condition is associated with increased skin pigmentation?

A

Addison’s disease.

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75
Q

Uncontrollable hypertension, hypernatraemia, hypokalaemia.

A

Conn’s syndrome (raised aldosterone:renin ratio).

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76
Q

Hypertension, arrythmias, death if left untreated.

A

Phaeochromocytoma - adrenal medulla tumor leading to raised adrenaline.

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77
Q

What conditions are primarily caused by a vitamin D deficiency?

A

Rickets (children) and osteomalacia (adults).

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78
Q

Raised ALP, Ca/PO4/PTH/Vit D all normal.

A

Paget’s disease (bone re-modelling defect).

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79
Q

What is the most common type of renal stone?

A

Calcium oxalate.

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80
Q

What enzymes are raised in acute pancreatitis?

A

Serum amylase and lipase (>3 times the reference is highly indicative).

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81
Q

What conditions is raised creatinine kinase associated with?

A

Myocardial infarction, Duchenne muscular dystrophy, rhabdomyolysis.

Note: CK it is a marker of muscle damage.

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82
Q

What protein is a marker of acute myocardial infarction?

A

Troponin - a myocardial infarction biomarker.

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83
Q

What is vitamin B12 deficiency associated with?

A

Pernicious anaemia.

Note: hypersegmented neutrophils.

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84
Q

What two things is folate deficiency associated with?

A

Megaloblastic anaemia and neural tube defects.

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85
Q

Diabetes mellitus glucose threshold values.

A

Random glucose >11.1, fasting glucose >7.0.

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86
Q

IGTT >7.8 but <11.1.

A

Impaired glucose tolerance.

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87
Q

Fasting glucose >6.1 but <7.0.

A

Impaired fasting glucose.

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88
Q

Fluid resuscitation quantities.

A

0.9% NaCl saline solution.
Systolic <90 = give 500ml in 15 minutes.
Systolic >90 = give 1000ml in 1 hour.

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89
Q

Hypoglycaemia: low C-peptide, low insulin. What are the causes?

A

Fasting, strenuous exercise, critical illness, anorexia nervosa etc.

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90
Q

Hypoglycaemia: high insulin, low C-peptide. What are the causes?

A

Poor patient understanding/administration, factitious hypoglycaemia (intentional).

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91
Q

What deficiency is associated with leukocyte adhesion deficiency?

A

Deficiency of CD18 (b2 integrin sub-unit) in LAD1 - leukocytes can’t migrate to the site of infection.

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92
Q

What classical pathways are asssociated with SLE?

A

C2 and C1q.

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93
Q

What classical pathways are asssociated with mannose binding lectin deficiency?

A

C2 and C4.

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94
Q

A mutation in what gene is associated with Familial Mediterranean Fever?

A

MEFV gene.

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95
Q

What is the inheritance pattern of Familial Mediterranean Fever?

A

Autosomal recessive.

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96
Q

What HLA subtypes are associated with coeliac disease?

A

DQ2/DQ8.

“TWO eat, or not to EIGHT”

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97
Q

What HLA subtypes are associated with Rheumatoid Arthritis?

A

DR4.

“there are 4 walls in a rheum”

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98
Q

What HLA subtypes are associated with Pernicious Anaemia?

A

DR5.

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99
Q

What is HLA subtype DR2 associated with?

A

Multiple sclerosis, SLE, hay fever, Goodpastures syndrome.

“Multiple hay pastures have DiRt”

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100
Q

What HLA subtypes are associated with SLE?

A

DR2 and DR3.

“DR2 and 3 = SLE’

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101
Q

What is a type I hypersensitivity disorder?

A

Allergy - IgE mediated.

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102
Q

What is a type II hypersensitivity reaction?

A

IgG or IgM ANTIBODY mediated.

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103
Q

What is a type III hypersensitivity reaction?

A

IgG or IgM IMMUNE COMPLEX mediated.

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104
Q

What is the treatment for Graves’ disease?

A

Carbimazole and propylthiouracil.

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105
Q

What is anti-platelet antibody associated with?

A

Autoimmune Thrombocytopenic Purpura.

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106
Q

What is anti-ACh-R associated with?

A

Myaesthenia gravis.

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107
Q

What is anti-gastric parietal cell antibody associated with?

A

Pernicious anaemia - impaired vitamin B12 absorption.

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108
Q

What is a type IV hypersensitivity disorder? Give min. 2 examples

A

Delayed hypersensitivity - T cell mediated.

e.g., T1DM, MS, Rheumatoid Arthritis, Crohn’s Disease

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109
Q

What do you measure in a patient on LMWH?

A

Activated partial thromboplastin time (aPTT).

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110
Q

What do you measure in a patient on warfarin?

A

INR. (PT/control PT)

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111
Q

What cancer is associated with coeliac disease?

A

Enteropathy associated T cell lymphoma (EATL).

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112
Q

Heart attack, progressive memory loss, bronchopneumonia. What is the diagnosis?

A

Multiple cerebral infarcts.

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113
Q

What antiviral is used in HSV meningitis?

A

Acyclovir.

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114
Q

What antiviral is used in VZV?

A

Acyclovir.

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115
Q

What antiviral is used in CMV retinitis?

A

Ganciclovir.

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116
Q

What test would you request to diagnose temporal arteritis?

A

ESR.

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117
Q

In post-streptococcal glomerulonephritis, what changes are seen in the kidney?

A

Immune complex depositions.

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118
Q

What is the classic renal histological finding of malignant hypertension?

A

Glomerular fibronecrosis.

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119
Q

A diabetic patient with severe UTI. What is seen on the kidney?

A

Diffuse Glomerular Basement Membrane Thickening

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120
Q

What is the management for osteoporosis?

A

Denusomab. (RANK Ligand inhibitor)

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121
Q

What type of cancer can helicobacter pylori predispose?

A

Mucosa-associated lymphoid tissue (MALT) lymphoma.

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122
Q

What immune cell resides in the bone marrow and migrates to the site of injury, and is involved with oxidative and non-oxidative killing?

A

Neutrophils.

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123
Q

What receptor mutation could be protective in HIV?

A

CCR5 co-receptor.

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124
Q

What is done to blood donations to reduce graft vs host disease?

A

Irradiation.

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125
Q

What organism causes ‘cat scratch’ disease?

A

Bartonella henselae.

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126
Q

What type of cells is associated with CLL?

2 types

A

Smear cells and smudge cells.

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127
Q

What is the most common cause of acute pancreatitis?

A

Gallstones.

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128
Q

IPEX affects what time of immune cell?

A

T regulatory cell.

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129
Q

What is the marker of medullary thyroid adenoma?

A

Calcitonin and CEA

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130
Q

What is the definition of herd immunity threshold?

A

1-1/R0

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131
Q

What viral increases the risk of nasopharyngeal cancer?

A

Epstein barr virus.

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132
Q

What 3 viruses are screened for in platelet donations to pregnant women?

A

CMV, HIV and HBV.

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133
Q

What gastric carcinoma spreads bilaterally to the ovaries and is commonly seen in Japanese women?

A

Krukenberg tumour.

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134
Q

What type of lymphoma is HTLV1 virus associated with?

A

T cell lymphoma.

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135
Q

What do epithelial cells in a urine MC&S sample mean?

A

Poorly taken sample.

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136
Q

What is the management for severe malaria?

A

Artesunate.

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137
Q

What is the first-line treatment for CML? +MoA

A

Imanitib (tyrosine kinase inhibitor).

138
Q

What is the most common lung cancer in non-smokers?

A

Adenocarcinoma.

139
Q

What is the common feature between MEN1 and MEN2a?

A

Parathyroid hyperplasia.

140
Q

What are the common features between MEN2a and MEN2b?

A

Phaechromocytoma and medullary thyroid cancers.

141
Q

What cancers are associated with multiple endocrine neoplasia?

A

MEN1 (3Ps): Pituitary, Pancreatic (e.g. insulinoma), Parathyroid (hyperparathyroidism)
MEN2a (2Ps, 1M): Parathyroid, Phaeochromocytoma, Medullary thyroid
MEN2b (1P, 2Ms): Phaeochromocytoma, Medullary thyroid, Mucocutaneous neuromas (& Marfanoid).

142
Q

What autoantibodies are involved with coeliac disease?

A

Anti-tissue transglutaminase antibody (IgA) and anti-endomysial antibody.

Anti-TTG and anti-EMA.

143
Q

What vaccinations are included in the 6-in-1 vaccine?

A

Diptheria, tetanus, whooping cough, polio, hepatitis b, and Hib.

144
Q

What vaccines are live attenuated?

A

MMR-VBOY

MMR, VZV, BCG (TB), Oral (polio, typhoid), Yellow Fever.

145
Q

What vaccines are conjugate vaccines?

A

NHS

Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae.

146
Q

What conditions is interferon alpha used for?

A

ABC

Interferon Alpha for Hepatitis B, C and CML.

147
Q

What condition is interferon B used for?

A

B for Bechet’s… also for relapsing MS.

148
Q

What condition is interferon gamma used for?

A

G for granulomatous disease.

149
Q

What is the immune cell target of pembrolizumab and nivolumab?

A

T cells (via PDL-1).

150
Q

What is the immune cell target of ipilimumab?

A

T cells (blocks CTLA4, such that more APCs can present to T cells).

151
Q

What is the mechanism of action of steroids?

A

Inhibit phospholipase A2.

152
Q

What is the order of importance of HLA classes in transplantation?

A

HLA DR > HLA B > HLA A

153
Q

What monoclonal antibody targets RANKL?

A

Denusomab

154
Q

What condition is associated with anti-glycoprotein IIb antibodies and pinprick petechiae on the lower limbs?

A

Autoimmune Thrombocytopenic Purpura

155
Q

What type of tumour/cancer forms glandular epithelium and glands that can secrete substances?

A

Adenocarcinomas.

156
Q

What valve diseases is infective endocarditis most associated with?

A

Mitral and aortic regurgitation.

157
Q

What valve disease is rheumatic fever most associated with?

A

Mitral stenosis.

158
Q

What is the most common cause of aortic stenosis?

A

Calcification (occurs naturally due to ageing).

Congenital bicuspid valve.

159
Q

What valve abnormality is classically described as a mid-systolic click and late-systolic murmur? Clinically associated with middle-aged women.

A

Mitral valve proplapse.

160
Q

Honeycomb change on lung histology.

A

Cryptogenic fibrosing alveolitis or idiopathic pulmonary fibrosis.

161
Q

What type of cancer can Barrett’s oesophagus progress to?

A

Oesophageal adenocarcinoma (metaplasia → dysplasia → cancer).

162
Q

What type of GI ulcer is WORSE with food?

A

Gastric ulcer.

163
Q

What type of GI ulcer is BETTER with food?

A

Dueodenal ulcer.

164
Q

‘Cobblestone appearance, patchy, aphthous ulcers, rosethorn ulcers, non-caseating granulomas and transmural inflammation.’

A

Crohn’s disease.

165
Q

Continuous inflammation that extends proximally from the rectum.

A

Ulcerative colitis.

166
Q

What is a major complication of ulcerative colitis?

A

Toxic megacolon.

167
Q

What is the most common type of pancreatic cancer?

A

Ductal adenocarcinoma of the pancreas (85% malignancies, normally occurs at the head of the pancreas).

168
Q

What type of tumour occurs in the body or tail of the pancreas?

A

Neuroendocrine tumour.

169
Q

Liver histopathology: spotty necrosis.

A

Acute hepatitis.

170
Q

Liver histopathology: piecemeal necrosis.

A

Chronic hepatitis.

171
Q

Liver histopathology: Mallory Denk bodies and hepatocyte ballooning.

A

Alcoholic hepatitis.

172
Q

Liver histopathology: micronodular cirrhosis i.e., small nodules and bands of fibrous tissue.

A

Alcoholic cirrhosis.

173
Q

What antibodies are associated with primary biliary cirrhosis?

A

Anti-mitochondrial antibodies (anti-AMA).

174
Q

Liver histopathology: nutmeg liver.

A

Hepatic cirrhosis (commonly seen in heart failure).

175
Q

What condition presents with periorbital swelling and frothy urine?

A

Frothy urine = proteinuria, periorbital swelling = oedema.

Proteinuria + oedema + hypoalbuminaemia = NEPHROTIC SYNDROME.

176
Q

Apple green bifringence with Congo stain.

A

Amyloidosis.

177
Q

What are the symptoms of nephritic syndrome?

A

PHAROH

Proteinuria, haematuria, azootemia (high urea and creatinine), red cell casts, oliguria, hypertension.

178
Q

What is the most common cause of ovarian cancer?

A

Epithelial cell cancer.

179
Q

Traumatic brain injury, rapid arterial bleed.

A

Extradural haemhorrage.

180
Q

Delayed brain bleed, fluctuating consciousness, previous history of minor trauma.

A

Subdural haemorrhage.

181
Q

Thunderclap headache.

A

Subarachnoid haemorrhage.

‘subOWachnoid’

182
Q

Most common cause of viral meningitis in adults?

A

Enteroviruses (Coxsackie A and B, Echovirus)

Herpes simplex virus (HSV).

183
Q

Most common cause of viral meningitis in children?

A

Enteroviruses e.g., Cocksackie B, echovirus.

184
Q

What pathological protein is seen in dementia with Lewy bodies?

A

Alpha-synuclein.

185
Q

What pathological protein is seen in Alzheimer’s disease?

A

Tau and beta-amyloid.

186
Q

Where is the most common originating site of metastatic tumours?

A

Lung (small cell) and breast.

187
Q

Looser’s zones (pseudo-fractures).

A

Osteomalacia and rickets.

188
Q

What are Brown’s tumours and what are they caused by

A

A collection of osteoclasts caused by Primary hyperparathyroidism. They are not a neoplasm

189
Q

Purple, pruritic plaques with mother-of-pearl sheen.

A

Lichen planus.

190
Q

Annular target lesions on skin

A

Erythema multiforme.

191
Q

Bilateral hilar lymphadenopathy on CXR.

A

Sarcoidosis.

192
Q

Megaloblastic anaemia peripheral blood film finding

A

Right shift on peripheral blood film (hypermature neutrophils)

193
Q

Shistocytes on peripheral blood film (fragmented RBCs).

A

Disseminated intravascular coagulation (DIC), haemolytic uraemic syndrome (HUS), thrombotic thrombocytopaenic purpura (TTP), pre-eclampsia.

194
Q

Heinz bodies on blood film.

A

G6PD deficiency.

195
Q

Lack of what factor leads to vitamin B12 deficiency.

A

Intrinsic factor → leading to pernicious anaemia.

196
Q

What can occur in males with liver disease?

A

Gynaecomastia.

197
Q

What 3 main factors can precipitate acute intermittent porphyria?

A

ALA synthase inducers (steroids, ethanol, barbiturates)
Stress (infection, surgery)
Reduced caloric intake and endocrine factors (e.g. premenstrual)

198
Q

What deficiency cause acute porphyria? and inheritance pattern?

A

Hydroxymethylbilane synthase deficiency (autosomal dominant).

199
Q

What is the recommended therapy used in an attack of acute intermittent porphyria?

A

IV haem arginate.

200
Q

What is the most common type of skin cancer?

A

Basal cell carcinoma.

201
Q

In IVDU, what valve is most commonly associated with infective endocarditis?

A

Tricuspid valve.

202
Q

What is the most common type of primary breast cancer (histologically)?

A

Invasive ductal breast carcinoma.

203
Q

What treatment targets BCR-ABL tyrosine kinase?

A

Imatinib (CML Tx)

204
Q

What are the main symptoms of Multiple myeloma

A 
CRAB - 
(high) calcium
Renal impairment
Anaemia
Bone disease
205
Q

Most common form of prostate Ca

A

Adenocarcinoma

206
Q

Prostate Ca grading

A

Gleason scoring (based on glandular patterns and degree of differentiation

207
Q

Essential thrombocytosis mutations

A

50% - JAK2

Others: MPL and CALR

208
Q

Drug that causes RBC production. Used to treat sideroblastic anemia

A

Pyridoxine

209
Q

Hyposegmented neutrophils.

A

Myelodysplastic syndromes.

210
Q

What is the most common primary tumour of the heart?

A

Myxoma.

211
Q

What vascular tumour is associated with human herpesvirus 8 (HHV-8) infection?

A

Kaposi’s sarcoma.

212
Q

Oesophageal cancer type in Barrett’s oesophagus?

A

Adenocarcinoma.

213
Q

immunosuppressant causing irreversible infertility and is somewhat of a last line

A

Cyclophosphamide

214
Q

Anti-CD20 on B cells

A

Rituximab

215
Q

Immunosuppressant blocking T cell migration

A

Natalizumab

216
Q

2 immunosuppressants blocking T cell cycle

A

Azathioprine and Mycophenolate mofetil

217
Q

Pneumocystis pneumonia (PCP) treatment.

A

Co-trimoxazole (inhibits bacterial folate synthesis).

218
Q

What happens in the presence of high prolactin

A

Galactorrhoea

219
Q

Most common benign breast mass

A

Fibroadenoma

220
Q

DKA effect on acid base status.

A

Increased H+ production = acidosis.

221
Q

Meningitis prophylaxis?

A

Rifampicin.

222
Q

Syphilis Tx

A

Benzylpenicillin

223
Q

Which IBD is smoking protective against (and vice versa)

A

UC

224
Q

Blood disorder associated with Down’s

A

AML (&ALL)

225
Q

woman with SLE - hasn’t passed much urine in 3 days - what she has passed has been brown

A

Rapidly Progressive glomerulonephritis

226
Q

Criteria used for infective endocariditis

A

Duke’s criteria

227
Q

Pancreatic tumour marker

A

CA 19.9 (carbohydrate antigen)

228
Q

Which factor is lost in the urine with Nephrotic syndrome

A

Antithrombin 3 - therefore increased VTE risk

229
Q

Neoplasm with “oat shaped cells”

A

Small cell lung carcinoma

230
Q

Statins MOA

A

HMG CoA reductase inhibitor therefore decrease in hepatic cholesterol production

231
Q

PCSK9 antibodies MOA

A

Antibody anti-PCSK9 therefore increased LDL-R expression, increasing liver uptake of LDL, decreasing LDL in the blood (no effect on mortality - use for high risk patients)

232
Q

Ezetimibe MOA

A

Inhibits cholesterol absorption from the gut (Acarbose but for cholesterol)

233
Q

What did the DCCT conclude

A

Good control = better outcomes (T1DM)

234
Q

What did the UKPDS conclude?

A

Good control early on has good outcomes after 15 years

(Legacy effect)

“Good control for 7 years and bad control for 6 years better than 15 years bad control”

235
Q

What did the ACCORD and ADVANCE studies show?

A

ACCORD - Bad control to sudden good control led to earlier mortality

ADVANCE - Bad control to reasonable control led to reduced mortality

236
Q

SGLT2 inhibitors - give examples and MOA

A

MOA - decreased reabsorption of glucose in the PCT leads to loss of glucose in urine - also lose Na, and thus lose water, therefore good for BP.

e.g., -flozins = Empaglifozins

(Note: increased risk of UTI)

237
Q

GLP1 analogue MOA

A

GLP1 acts to increase insulin and decrease glucagon. Therefore mimics that effect

-glutides - Liraglutide, Dulaglutide

238
Q

DPP4 inhibitors MOA

A

DPP4 usually breaks down GLP1 therefore prevents this (not as good as DLP1 and SGLT2)

-gliptins - Sitagliptin, saxagliptin

239
Q

Causes of high anion gap

A 
Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde
Iron, isoniazid
Lactic acidosis
Ethanol, ethyleen glycol
Salicylate
240
Q

FMF Tx (and MoAs)

A

Colchicine (binds to tubulin in neutrophils and disrupts neutrophil functions including migration and chemokine secretion).

Anakinra (IL-1 receptor antagonist).

Etanercept (TNF alpha inhibitor).

241
Q

Pt presents with recurrent infections and Hepatosplenomegaly

What is Dx?

What is the two tests used?

What organisms is this patient susceptible to?

A

Chronic Granulomatous Disease

  1. Nitro Blue Tetrazolium (Yellow to Blue is normal)
  2. Dihydrorhodamine

PLACESS organisms (Pseudomonas, Listeria, Aspergilosis, Candida, E. Coli, Staph, Serratia

242
Q

What is Schmidt’s syndrome? What is it more commonly known nowadays?

A

Modern name: Autoimmune Polyendocrine Syndrome Type 2

Addison’s and hypothyroid occur together more frequently than would otherwise be suggested by chance alone

243
Q

What is the vector for Dengue?

A

ADES Mosquito

244
Q

Vector for Malaria

A

Female ANOPHOLES mosquito.

245
Q

Treatment of benign prostatic hyperplasia.

A

TURP (trans-urethral resection of the prostate) and 5-alpha reductase inhibitors (finasteride - anti-androgen)

246
Q

What factor is deficient in Haemophilia A?

A

Factor VIII (eight - ei like A).

247
Q

What factor is deficient in Haemophilia B?

A

Factor IX.

248
Q

What is the treatment for coagulation disorders?

A

IV vitamin K and fixed frozen plasma.

249
Q

What haematological changes occur in pregnancy?

A

Decreased HHPF: haemoglobin, haematocrit, protein s, factor 11/XI.

(dilutional anaemia because plasma is ++)

250
Q

What chromosome translocation is associated with CML?

A

Philadelphia chromosome translocation.

251
Q

What is Behcet’s disease? What HLA? Symptoms?

A

Behcet’s disease is characterised by inflammation of blood vessels, associated with HLA B51.

Symptoms: mouth sores, uveitits (anterior and posterior), genital sores, rashes.

252
Q

How does Takayasu’s present

A

A large cell vasculitis

“Pulseless disease”
No pulse, low BP in arms, cold hands, bruits, claudication

Higher in Japanese women

253
Q

Presentation of temporal giant cell arteritis.

A

Eldlerly, scalp pain, jaw claudication, blurred vision, non-palpable temporal pulse.

“pain when brushing hair”

254
Q

How would you investigate temporal giant cell arteritis?

A

Temporal artery biopsy, ESR.

Would see granulomatous transmural inflammation, skip lesions, and giant cells. ESR typically elevated.

255
Q

Mx of temporal giant cell arteritis?

A

Oral high-dose glucocorticoid - prednisolone.

256
Q

Kawasaki’s - who does it affect, what are the symptoms and what can it lead to?

A

Affects children < 5 years old.

Symptoms: CRASH and BURN - fever > 5 days, conjunctivitis, rash, adenopathy, strawberry tongue, hands.

Complication: coronary artery aneurysm, leading to myocardial infarction.

257
Q

Polyarteritis nodosa - what are the features and what is seen on histology?

A

Renal impairment, spares lungs, “string of pearls”, “rosary beads”, 30% have hepatitis B.

Histological findings: fibroid necrosis, neutrophil infiltration.

258
Q

Heavy smoker < 35 year old with tibial and radial pain,

ulcers on feet, toes and fingers, and corkscrew appearance on angiogram.

A

Beurger’s disease (thrombangitis obliterans).

259
Q

cANCA
Saddle nose
Pulmonary Haemorrhage
Crescentic glomerulonephritis

A

Wegner’s Syndrome - granulomatosis with polyangiitis (GPA).

260
Q

Asthma
Eosinophilia
pANCA

A

Churg Strauss Syndrome - eosinophilic granulomatosis with polyangiitis (EGPA).

261
Q

Pulmonary Renal syndrome:

Pulmonary haemorrhage
Glomerulonephritis

pANCA

A

Microscopic Polyangiitis

262
Q

Child<10
Palpable rash on buttocks
URTI last week
Has glomerulonephritis, arthritis, orchitis

A

Henoch Schonlein Purpura (IgA mediated)

263
Q

First line chemo for treating Prostate Ca

A

Docetaxel

264
Q

Waxy casts in urine

A

CKD

265
Q

Haemochromatosis treatment.

A

Phlebotomy.

266
Q

Wilsons Tx

A

Zinc and Treintine

267
Q

Cancer marker for HCC

A

Alpha-fetoprotein

268
Q

Medication asso with HCC

A

COCP

269
Q

Term for tube shaped microscopic particles in urine

A

Urinary casts

270
Q

Most common form of bladder Ca

A

Transitional cell

271
Q

What separates Lewy Body

A

Hallucinations

Parkinsons like Sx - shiffling gate

272
Q

IBD - non-caseating granulomas

A

Crohn’s

273
Q

Presence of fatty casts in urine

A

Nephrotic syndrome

274
Q

Tx of HER2 positive breast Ca

A

Herceptin (trastuzumab) - Monoclonal Ig

275
Q

Defect is Polycystic kidney

A

Polycystin-1

276
Q

Criteria for diagnosing Rheumatic fever

A

Jones Criteria

277
Q

Paraneoplastic syndrome that causes Diarrhoea, bronchoconstriction, Flushing?

A

Carcinoid syndrome - usually serotonin secreted (Serotonin syndrome like symptoms)

278
Q

tumour marker for colorectal Ca

A

CEA - Carcinoembryonic antigen

279
Q

Antibodies in Bullous pemphigoid

A

Anti-hemidesmosomes

280
Q

Contraindication to Infliximab

A

Infliximab is anti-TNF alpha. Suppression of this is associated with TB reactivation

281
Q

What does p-ANCA taget?

A

Myeloperoxidase

282
Q

Complement deficiency leads to susceptibility of what types of organisms?

A

Encapsulated

NHS organisms

283
Q

‘Starry sky’ appearance on histology? Haematological condition.

A

Burkitt’s lymphoma (non-hodgkins).

284
Q

Treatment for febrile non-haemolytic transfusion reaction

A

Paracetamol

285
Q

What immune cell releases granzyme and perforin?

A

CD8+ T cells

286
Q

Anti-RSV medications

A

Paluvizimab

287
Q

What does cyclosporine inhibit

A

It is a calcineurin inhibitor and therefore blocks T cell proliferation

288
Q

Normal IgA
Low IgG
Low IgM

A

Common variable immunodeficiency

289
Q

Antigen targeted in AITP

A

Glycoprotein 2b/3a

290
Q

SLE pregnant woman - what is her child at risk of?

A

Congenital Heart Block

291
Q

Which cell surface receptor allows cells of the innate immune system to bind to immunoglobulins?

A

Fc Receptors

292
Q

What is a haematological side effect of the use of isoniazid in treatment of tuberculosis?

A

Sideroblastic anaemia.

293
Q

Hereditary Haemochromatosis gene and inheritance pattern

A

HFe on chromosome 6 (AR)

294
Q

Haemochromatosis Tx

A

Venesection

Desferrioxamine

295
Q

Wilson’s Gene and inheritance pattern

A

ATP7B (AR)

296
Q

Alpha 1 antitrypsin deficiency inheritance pattern

A

AD

297
Q

Wilson’s copper stain

A

Rhodanine

298
Q

Haemochromatosis stain

A

Prussian blue

299
Q

Alpha 1 antitrypsin aetiology in adults and kids

A

Kids - Neonatal jaundice

Adults - Emphysema and chronic liver disease

300
Q

Gout investigations

A

Urate crystals
Needle shaped
NEGATIVELY birefringent

301
Q

Pseudogout investigations

A

Calcium pyrophosphate crystals
Rhomboid shaped
POSITIVELY birefringent

302
Q

64yo woman with Confusion and SOB, RR 27, Urea 7.2, Creatinine 170, BP 110/70.

What is CURB-65 score
What is next action

A

CURB-65 score - 2
Therefore consider admission
Give Amoxicillin and clarithromycin 5-7d PO

303
Q

82yo man with SOB, RR 31, Urea 6.9, Temp 38.2, HR 102, BP 89/69

What is CURB 65 score?
What is next step?

A

CURB 65 score - 3

Therefore admit, give Co-amox with erythromycin 7d IV

304
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease - idiopathic, frothy urine, periorbital and perhipheral oedema, treated with corticosteroids.

305
Q

What is the most common cause of nephrotic syndrome in patients of African and Hispanic descent?

A

Focal Segmental Glomerulosclerosis - mixed response to corticosteroids, can progress to CKD.

306
Q

Wilson’s first line treatment

A

Trientine and zinc

307
Q

Waxy casts in urine

A

CKD

308
Q

ST elevation in V2/3/4/5 no chest pain

A

Ventricular aneurysm

309
Q

What stone are CLL patients on chemo at risk of

A

Uric acid

310
Q

Colorectal cancer tumour marker

A

CEA

311
Q

Signet ring sign on CT

A

Bronchiectasis

312
Q

Sign seen in graves due to periosteal bone growth around nail bed

A

Thyroid acropachy

313
Q

What does Alpha 1 antitryptsin normally break down, preventing emphysema

A

Neutrophil elastase

314
Q

Enzyme with reduced activity in Gilbert’s

A

UDP Glucoronyltransferase

315
Q

Persistent hypokalaemia

A

Renal Tubular Acidosis

316
Q

Overdose of a medication with ringing in ears

Metabolic acidosis with Respiratory alkalosis mix

A

Aspirin

317
Q

Orange tonsils on a kid

Very low HDL

A

Tangier disease

318
Q

Increased bone density name and causes

A

Osteoslerosis

Excess Vit D
Hypoparathyroidism
Pagets

319
Q

Boy eating his own fingers

A

Lesch Nyhan syndrome (X-linked)
Deficiency of HGPRT

impaired kidney function
acute gouty arthritis

320
Q

Large numbers of lymphocytes with macrophages containing ingested lymphocytes

What type of lymphoma

A

Burkitt’s

321
Q

Most common cause of iron deficiency anaemia worldwide

A

Hookworm

322
Q

What is a measure of anticoagulation?

A

D-Dimer

323
Q

Blood film finding of MM (non-white cells related finding)

A

Rouleaux

324
Q

Rivaroxaban reversal agent

A

Adexanet alfa

325
Q

Bleeding from cannula

A

DIC

326
Q

What are inclusions of denatured haemoglobin within erythrocytes commonly called when seen in a peripheral blood film?

A

Heinz bodies

327
Q

Woman diagnosed ITP. Has no bleeding. Platelets slightly low.

Treatment?

A

No treatment

If symptoms, then IVIG or Steroids

328
Q

Renal tubular acidosis Type 1 pathophysiology

A

Distal failure of H+ secretion -> Acidaemia -> Metabolic acidosis

K+ excretion to maintain electrochemical gradient in kidney -> hypokalaemia

329
Q

Renal tubular acidosis Type 2 pathophysiology

A

Failure to reabsorb bicarb in proximal tubule -> acidaemia -> metabolic acidosis

High urine bicarb -> osmotic diuresis -> hypovolaemia -> RAAS activation -> Aldosterone -> Increased Na resorption + decreased K resorption -> hypokalaemia

330
Q

Renal tubular acidosis Type 4 pathophysiology

A

Deficiency of(Addison’s)/Resistance to Aldosterone (ARBs) -> the normal stuff -> hyperkalaemia and acidosis

331
Q

Polycythaemia Rubra Vera Tx

A

Venesection

Hydroxycarbamide

332
Q

Bullous Pemphigoid - Antibodies, Description of bullae

A

IgG anti-hemidesmosomes, Subepidemal (Deep)

333
Q

Pemphigus Vulgaris - Antibodies, Description of bullae

A

IgG anti-desmoglein 1 and 3, Intraepidermal (Superficial), easily ruptures

334
Q

GvHD symptoms

A

Diarrhoea, Liver Failure, Skin Desquamation, BM failure

335
Q

What monoclonal antibody targets IL-17 and is involved in the treatment of psoriasis, psoriatic arthritis and ankylosing spondylitis?

A

Secukinumab

336
Q

Black pus discharging from nose and mouth in a diabetic patient?

A

Murcomycosis - a serious but rare fungal infection.

337
Q

What antiretroviral drug is given as IV monotherapy during labour to prevent vertical transmission of HIV-1?

A

Zidovudine

338
Q

What monoclonal antibody targets CD20 and is used in the treatment of lymphomas?

A

Rituximab

339
Q

What lymphocyte lineage does azathioprine predominantly inhibit?

A

T lymphocytes

340
Q

What test is the ability of a patient’s serum to lyse sheep erythrocytes coated with rabbit anti-sheep antibodies?

A

CH50

Buzzwords Specialty Exam (4 decks)

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