Pathology Flashcards
(340 cards)
1
Q
Halo sign on chest x-ray.
A
Aspergillosis.
2
Q
Crohn’s mutations.
A
Chromosome 16 - NOD2/CARD15.
3
Q
Gout treatment (long-term).
A
Allopurinol (Xanthine Oxidase Inhibitor)
4
Q
Gout attack treatment (acute).
A
NSAIDs (preferred), colchicine.
5
Q
HLA-B27.
A
Ankylosing Spondylitis.
6
Q
Cardiac failure enzyme.
A
Brain Natriuretic Peptide.
7
Q
Aphthous ulcers.
A
Crohn’s disease.
8
Q
CLL with p53 mutation. What is the treatment?
3 drugs
A
Ibrutinib (TKi), alemtuzumab (anti-CD52), idalalisib
9
Q
Multiple myeloma patient - what is seen in the urine?
A
Bence Jones Protein.
10
Q
Discontinuation in epithelial surface - technical name
A
Ulcer
11
Q
Connection between two epithelial surfaces - technical name
A
fistula
12
Q
Signet ring cells
A
Gastric carcinoma
13
Q
Rose spots on torso, recent travel history.
A
Salmonella typhi - typhoid fever.
14
Q
Gold standard for coeliac Dx
A
Duodenal/jejunal biopsy
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).
16
Q
CREST antibodies
A
Anti-centromere
17
Q
What antibodies are involved in Grave’s disease?
A
Anti-TSH-R (thyroid stimulating hormone receptor).
18
Q
Type of neutrophil is seen in pernicious anaemia.
A
Hypersegmented neutrophil.
19
Q
Alpha Glucosidase inhibitor (in brush border membrane).
A
Acarbose.
20
Q
Dipeptidyl dipeptidase inhibitor examples
A
Gliptins - Sitagliptin/Alogliptin
21
Q
Ring-enhancing lesion on CT or MRI.
A
Cerebral abscess.
22
Q
Gram-positive diplococcus.
A
Streptococcus pneumoniae.
23
Q
Gram negative intracellular diplococci.
A
Neisseria gonorrhoea.
24
Q
What condition is anti-mitochondrial antibody associated with?
A
Primary Biliary Cirrhosis/Cholangitis.
25
What 4 conditions is P-ANCA associated with?
Eosinophilic Granulomatosis with Polyangiitis, Microscopic Polyangiitis, PSC, Type 3 Crescentic/Rapidly Progressive glomerulonephritis.
26
Goodpasture's syndrome antibody
Anti-glomerular basement membrane (type IV collagen).
27
Anaemia plus spectrin molecule abnormality.
Hereditary elliptocytosis or hereditary spherocytosis.
28
Ca high
| PTH normal
Primary hyperparathyroidism (PTH is INAPPROPRIATELY normal). Most commonly caused by parathyroid adenoma.
29
Calcium low
| PTH high
Secondary hyperparathyroidism (due to CKD, osteomalacia or vitamin D deficiency).
30
What vitamin deficiency is associated with pellagra?
Niacin deficiency/vitamin B3.
31
Snail track oral ulcer.
Syphilis.
32
What organism causes syphilis?
Treponema pallidum.
33
Reed-Sternberg cells.
Hodgkin's Lymphoma.
34
What organism causes scarlet fever?
Streptococcus pyogenes.
35
What antibodies are present in Sjogren's syndrome?
Anti-Ro and Anti-La.
| Speckled pattern - RF can be present.
36
Liver enzyme in MI
AST
37
What is seen on heart biopsy in multiple myeloma?
Amyloid deposits (AL amyloidosis).
38
What is the mechanism of action of warfarin? Which factor is effected first?
It is a Vitamin K inhibitor, therefore decreasing factors 2, 7, 9, 10.
Factor 7/VII is effected first.
39
Test for autoimmune haemolytic anaemia.
Direct antiglobulin test (DAT).
Also known as the Coombs test.
40
Cancer with keratin and intercellular bridges.
Squamous cell carcinoma.
41
Chocolate cysts.
Endometriomas (endometriosis)
42
Most common type of carcinoma seen in the liver.
Metastatic adenocarcinoma (from the gut, via the hepatic portal vein).
43
Hyponatraemia is most commonly caused by…
… decreased serum osmolality (more water/in older people this can be caused by SIADH).
44
Most common type of brain cancer in adults. 
Metastatic deposit.
45
Most common type of brain cancer in children. 
Astrocytoma.
46
What electrolyte abnormality commonly presents with depression?
Hypercalcaemia.
47
Caseating granuloma.
Tuberculosis (mycobacterium tuberculosis). 
48
Non-caseating granuloma.
Sarcoidosis.
49
Tuberculosis treatment.
RIPE - rifampacin, isoniazid, pyrzinamide, ethambutol.
50
Pneumonia-like symptoms, failure to respond to antibiotics.
Abscess/empyema.
51
'Rice water stool'.
Vibrio cholerae.
52
Bloody diarrhoea after eating chicken at a barbecue.
Campylobacter jejuni.
53
Gradual onset enteric fever and constipation in a returning traveller.
Salmonella typhi.
54
Flask shaped ulcer on histology of a homosexual man presenting with dysentery and flatulence.
Entamoeba histolytica.
55
Pear-shaped trophozoite (with 2 nuclei), foul smelling non-bloody diarrhoea.
Giardia lamblia.
56
Patient with kidney stones and UTI. What is the causative organism?
Proteus mirabalis (high affinity for kidney stones).
57
UTI in a young healthy woman. Causative organism?
1. Escheria coli
| 2. Staphylococcus saprophyticus
58
Patient comes in to ED with pyelonephritis. What is your management?
1. admit
| 2. IV co-amoxiclav and gentamycin
59
What antibiotic would you prescribe for a staphylococcus aureus wound, bone or joint infection?
IV flucoxacillin
60
Clostridium difficile management?
Oral metronidazole or vancomycin (severe).
61
What antibiotic is associated with clostridium difficile?
Ceftriaxone.
62
Tear drop poikilocytes on blood film
Primary myelofibrosis.
63
What ECG changes are associated with hyperkalaemia?
1. loss of p waves
2. tall tented T waves
3. broadened QRS complex
64
What is the treatment for mild hypokalaemia (3.0-3.5 mmol/l)?
Oral KCl (2 SandoK tablets TDS for 48 hours).
65
What is the treatment for severe hypokalaemia (<3.0 mmol/l)?
IV KCl
66
What can cause an elevated anion gap metabolic acidosis?
Ketoacidosis
Uraemia
Lactic acidosis
Toxins
67
What is the best marker of acute liver injury?
Prothrombin time.
68
What does raised AST and ALT indicate?
Hepatocellular damage e.g. hepatitis, alcoholic liver disease (AST:ALT = 2:1)
69
What does raised ALP and GGT indicate?
Cholestatic/obstructive picture.
Note: GGT is raised in chronic alcoholism, isolated raised ALP can be due to Paget's or osteomalacia (bone).
70
What is the most common type of renal cell carcinoma?
Clear cell carcinoma.
71
What is the most common type of thyroid neoplasm?
Papillary (75-85%).
72
What tumour markers is indicative of each thyroid neoplasm?
Thyroglobulin - papillary, follicular.
| CEA, calcitonin - medullary.
73
What is the investigation for Addison's disease?
SynACTHen test.
74
What adrenal condition is associated with increased skin pigmentation?
Addison's disease.
75
Uncontrollable hypertension, hypernatraemia, hypokalaemia.
Conn's syndrome (raised aldosterone:renin ratio).
76
Hypertension, arrythmias, death if left untreated.
Phaeochromocytoma - adrenal medulla tumor leading to raised adrenaline.
77
What conditions are primarily caused by a vitamin D deficiency?
Rickets (children) and osteomalacia (adults).
78
Raised ALP, Ca/PO4/PTH/Vit D all normal.
Paget's disease (bone re-modelling defect).
79
What is the most common type of renal stone?
Calcium oxalate.
80
What enzymes are raised in acute pancreatitis?
Serum amylase and lipase (>3 times the reference is highly indicative).
81
What conditions is raised creatinine kinase associated with?
Myocardial infarction, Duchenne muscular dystrophy, rhabdomyolysis.
Note: CK it is a marker of muscle damage.
82
What protein is a marker of acute myocardial infarction?
Troponin - a myocardial infarction biomarker.
83
What is vitamin B12 deficiency associated with?
Pernicious anaemia.
Note: hypersegmented neutrophils.
84
What two things is folate deficiency associated with?
Megaloblastic anaemia and neural tube defects.
85
Diabetes mellitus glucose threshold values.
Random glucose >11.1, fasting glucose >7.0.
86
IGTT >7.8 but <11.1.
Impaired glucose tolerance.
87
Fasting glucose >6.1 but <7.0.
Impaired fasting glucose.
88
Fluid resuscitation quantities.
0.9% NaCl saline solution.
Systolic <90 = give 500ml in 15 minutes.
Systolic >90 = give 1000ml in 1 hour.
89
Hypoglycaemia: low C-peptide, low insulin. What are the causes?
Fasting, strenuous exercise, critical illness, anorexia nervosa etc.
90
Hypoglycaemia: high insulin, low C-peptide. What are the causes?
Poor patient understanding/administration, factitious hypoglycaemia (intentional).
91
What deficiency is associated with leukocyte adhesion deficiency?
Deficiency of CD18 (b2 integrin sub-unit) in LAD1 - leukocytes can't migrate to the site of infection.
92
What classical pathways are asssociated with SLE?
C2 and C1q.
93
What classical pathways are asssociated with mannose binding lectin deficiency?
C2 and C4.
94
A mutation in what gene is associated with Familial Mediterranean Fever?
MEFV gene.
95
What is the inheritance pattern of Familial Mediterranean Fever?
Autosomal recessive.
96
What HLA subtypes are associated with coeliac disease?
DQ2/DQ8.
"TWO eat, or not to EIGHT"
97
What HLA subtypes are associated with Rheumatoid Arthritis?
DR4.
"there are 4 walls in a rheum"
98
What HLA subtypes are associated with Pernicious Anaemia?
DR5.
99
What is HLA subtype DR2 associated with?
Multiple sclerosis, SLE, hay fever, Goodpastures syndrome.
"Multiple hay pastures have DiRt"
100
What HLA subtypes are associated with SLE?
DR2 and DR3.
"DR2 and 3 = SLE'
101
What is a type I hypersensitivity disorder?
Allergy - IgE mediated.
102
What is a type II hypersensitivity reaction?
IgG or IgM ANTIBODY mediated.
103
What is a type III hypersensitivity reaction?
IgG or IgM IMMUNE COMPLEX mediated.
104
What is the treatment for Graves' disease?
Carbimazole and propylthiouracil.
105
What is anti-platelet antibody associated with?
Autoimmune Thrombocytopenic Purpura.
106
What is anti-ACh-R associated with?
Myaesthenia gravis.
107
What is anti-gastric parietal cell antibody associated with?
Pernicious anaemia - impaired vitamin B12 absorption.
108
What is a type IV hypersensitivity disorder? Give min. 2 examples
Delayed hypersensitivity - T cell mediated.
e.g., T1DM, MS, Rheumatoid Arthritis, Crohn's Disease
109
What do you measure in a patient on LMWH?
Activated partial thromboplastin time (aPTT).
110
What do you measure in a patient on warfarin?
INR. (PT/control PT)
111
What cancer is associated with coeliac disease?
Enteropathy associated T cell lymphoma (EATL).
112
Heart attack, progressive memory loss, bronchopneumonia. What is the diagnosis?
Multiple cerebral infarcts.
113
What antiviral is used in HSV meningitis?
Acyclovir.
114
What antiviral is used in VZV?
Acyclovir.
115
What antiviral is used in CMV retinitis?
Ganciclovir.
116
What test would you request to diagnose temporal arteritis?
ESR.
117
In post-streptococcal glomerulonephritis, what changes are seen in the kidney?
Immune complex depositions.
118
What is the classic renal histological finding of malignant hypertension?
Glomerular fibronecrosis.
119
A diabetic patient with severe UTI. What is seen on the kidney?
Diffuse Glomerular Basement Membrane Thickening
120
What is the management for osteoporosis?
Denusomab. (RANK Ligand inhibitor)
121
What type of cancer can helicobacter pylori predispose?
Mucosa-associated lymphoid tissue (MALT) lymphoma.
122
What immune cell resides in the bone marrow and migrates to the site of injury, and is involved with oxidative and non-oxidative killing?
Neutrophils.
123
What receptor mutation could be protective in HIV?
CCR5 co-receptor.
124
What is done to blood donations to reduce graft vs host disease?
Irradiation.
125
What organism causes 'cat scratch' disease?
Bartonella henselae.
126
What type of cells is associated with CLL?
| 2 types
Smear cells and smudge cells.
127
What is the most common cause of acute pancreatitis?
Gallstones.
128
IPEX affects what time of immune cell?
T regulatory cell.
129
What is the marker of medullary thyroid adenoma?
Calcitonin and CEA
130
What is the definition of herd immunity threshold?
1-1/R0
131
What viral increases the risk of nasopharyngeal cancer?
Epstein barr virus.
132
What 3 viruses are screened for in platelet donations to pregnant women?
CMV, HIV and HBV.
133
What gastric carcinoma spreads bilaterally to the ovaries and is commonly seen in Japanese women?
Krukenberg tumour.
134
What type of lymphoma is HTLV1 virus associated with?
T cell lymphoma.
135
What do epithelial cells in a urine MC&S sample mean?
Poorly taken sample.
136
What is the management for severe malaria?
Artesunate.
137
What is the first-line treatment for CML? +MoA
Imanitib (tyrosine kinase inhibitor).
138
What is the most common lung cancer in non-smokers?
Adenocarcinoma.
139
What is the common feature between MEN1 and MEN2a?
Parathyroid hyperplasia.
140
What are the common features between MEN2a and MEN2b?
Phaechromocytoma and medullary thyroid cancers.
141
What cancers are associated with multiple endocrine neoplasia?
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
What autoantibodies are involved with coeliac disease?
Anti-tissue transglutaminase antibody (IgA) and anti-endomysial antibody.
Anti-TTG and anti-EMA.
143
What vaccinations are included in the 6-in-1 vaccine?
Diptheria, tetanus, whooping cough, polio, hepatitis b, and Hib.
144
What vaccines are live attenuated?
*MMR-VBOY*
MMR, VZV, BCG (TB), Oral (polio, typhoid), Yellow Fever.
145
What vaccines are conjugate vaccines?
*NHS*
Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae.
146
What conditions is interferon alpha used for?
*ABC*
Interferon Alpha for Hepatitis B, C and CML.
147
What condition is interferon B used for?
B for Bechet's... also for relapsing MS.
148
What condition is interferon gamma used for?
G for granulomatous disease.
149
What is the immune cell target of pembrolizumab and nivolumab?
T cells (via PDL-1).
150
What is the immune cell target of ipilimumab?
T cells (blocks CTLA4, such that more APCs can present to T cells).
151
What is the mechanism of action of steroids?
Inhibit phospholipase A2.
152
What is the order of importance of HLA classes in transplantation?
HLA DR > HLA B > HLA A
153
What monoclonal antibody targets RANKL?
Denusomab
154
What condition is associated with anti-glycoprotein IIb antibodies and pinprick petechiae on the lower limbs?
Autoimmune Thrombocytopenic Purpura
155
What type of tumour/cancer forms glandular epithelium and glands that can secrete substances?
Adenocarcinomas.
156
What valve diseases is infective endocarditis most associated with?
Mitral and aortic regurgitation.
157
What valve disease is rheumatic fever most associated with?
Mitral stenosis.
158
What is the most common cause of aortic stenosis?
Calcification (occurs naturally due to ageing).
| Congenital bicuspid valve.
159
What valve abnormality is classically described as a mid-systolic click and late-systolic murmur? Clinically associated with middle-aged women.
Mitral valve proplapse.
160
Honeycomb change on lung histology.
Cryptogenic fibrosing alveolitis or idiopathic pulmonary fibrosis.
161
What type of cancer can Barrett's oesophagus progress to?
Oesophageal adenocarcinoma (metaplasia → dysplasia → cancer).
162
What type of GI ulcer is WORSE with food?
Gastric ulcer.
163
What type of GI ulcer is BETTER with food?
Dueodenal ulcer.
164
'Cobblestone appearance, patchy, aphthous ulcers, rosethorn ulcers, non-caseating granulomas and transmural inflammation.'
Crohn's disease.
165
Continuous inflammation that extends proximally from the rectum.
Ulcerative colitis.
166
What is a major complication of ulcerative colitis?
Toxic megacolon.
167
What is the most common type of pancreatic cancer?
Ductal adenocarcinoma of the pancreas (85% malignancies, normally occurs at the head of the pancreas).
168
What type of tumour occurs in the body or tail of the pancreas?
Neuroendocrine tumour.
169
Liver histopathology: spotty necrosis.
Acute hepatitis.
170
Liver histopathology: piecemeal necrosis.
Chronic hepatitis.
171
Liver histopathology: Mallory Denk bodies and hepatocyte ballooning.
Alcoholic hepatitis.
172
Liver histopathology: micronodular cirrhosis i.e., small nodules and bands of fibrous tissue.
Alcoholic cirrhosis.
173
What antibodies are associated with primary biliary cirrhosis?
Anti-mitochondrial antibodies (anti-AMA).
174
Liver histopathology: nutmeg liver.
Hepatic cirrhosis (commonly seen in heart failure).
175
What condition presents with periorbital swelling and frothy urine?
Frothy urine = proteinuria, periorbital swelling = oedema.
Proteinuria + oedema + hypoalbuminaemia = NEPHROTIC SYNDROME.
176
Apple green bifringence with Congo stain.
Amyloidosis.
177
What are the symptoms of nephritic syndrome?
*PHAROH*
Proteinuria, haematuria, azootemia (high urea and creatinine), red cell casts, oliguria, hypertension.
178
What is the most common cause of ovarian cancer?
Epithelial cell cancer.
179
Traumatic brain injury, rapid arterial bleed.
Extradural haemhorrage.
180
Delayed brain bleed, fluctuating consciousness, previous history of minor trauma.
Subdural haemorrhage.
181
Thunderclap headache.
Subarachnoid haemorrhage.
'subOWachnoid'
182
Most common cause of viral meningitis in adults?
Enteroviruses (Coxsackie A and B, Echovirus)
| Herpes simplex virus (HSV).
183
Most common cause of viral meningitis in children?
Enteroviruses e.g., Cocksackie B, echovirus.
184
What pathological protein is seen in dementia with Lewy bodies?
Alpha-synuclein.
185
What pathological protein is seen in Alzheimer's disease?
Tau and beta-amyloid.
186
Where is the most common originating site of metastatic tumours?
Lung (small cell) and breast.
187
Looser's zones (pseudo-fractures).
Osteomalacia and rickets.
188
What are Brown's tumours and what are they caused by
A collection of osteoclasts caused by Primary hyperparathyroidism. They are not a neoplasm
189
Purple, pruritic plaques with mother-of-pearl sheen.
Lichen planus.
190
Annular target lesions on skin
Erythema multiforme.
191
Bilateral hilar lymphadenopathy on CXR.
Sarcoidosis.
192
Megaloblastic anaemia peripheral blood film finding
Right shift on peripheral blood film (hypermature neutrophils)
193
Shistocytes on peripheral blood film (fragmented RBCs).
Disseminated intravascular coagulation (DIC), haemolytic uraemic syndrome (HUS), thrombotic thrombocytopaenic purpura (TTP), pre-eclampsia.
194
Heinz bodies on blood film.
G6PD deficiency.
195
Lack of what factor leads to vitamin B12 deficiency.
Intrinsic factor → leading to pernicious anaemia.
196
What can occur in males with liver disease?
Gynaecomastia.
197
What 3 main factors can precipitate acute intermittent porphyria?
ALA synthase inducers (steroids, ethanol, barbiturates)
Stress (infection, surgery)
Reduced caloric intake and endocrine factors (e.g. premenstrual)
198
What deficiency cause acute porphyria? and inheritance pattern?
Hydroxymethylbilane synthase deficiency (autosomal dominant).
199
What is the recommended therapy used in an attack of acute intermittent porphyria?
IV haem arginate.
200
What is the most common type of skin cancer?
Basal cell carcinoma.
201
In IVDU, what valve is most commonly associated with infective endocarditis?
Tricuspid valve.
202
What is the most common type of primary breast cancer (histologically)?
Invasive ductal breast carcinoma.
203
What treatment targets BCR-ABL tyrosine kinase?
Imatinib (CML Tx)
204
What are the main symptoms of Multiple myeloma
```
CRAB -
(high) calcium
Renal impairment
Anaemia
Bone disease
```
205
Most common form of prostate Ca
Adenocarcinoma
206
Prostate Ca grading
Gleason scoring (based on glandular patterns and degree of differentiation
207
Essential thrombocytosis mutations
50% - JAK2
| Others: MPL and CALR
208
Drug that causes RBC production. Used to treat sideroblastic anemia
Pyridoxine
209
Hyposegmented neutrophils.
Myelodysplastic syndromes.
210
What is the most common primary tumour of the heart?
Myxoma.
211
What vascular tumour is associated with human herpesvirus 8 (HHV-8) infection?
Kaposi’s sarcoma.
212
Oesophageal cancer type in Barrett’s oesophagus?
Adenocarcinoma.
213
immunosuppressant causing irreversible infertility and is somewhat of a last line
Cyclophosphamide
214
Anti-CD20 on B cells
Rituximab
215
Immunosuppressant blocking T cell migration
Natalizumab
216
2 immunosuppressants blocking T cell cycle
Azathioprine and Mycophenolate mofetil
217
Pneumocystis pneumonia (PCP) treatment.
Co-trimoxazole (inhibits bacterial folate synthesis).
218
What happens in the presence of high prolactin
Galactorrhoea
219
Most common benign breast mass
Fibroadenoma
220
DKA effect on acid base status.
Increased H+ production = acidosis.
221
Meningitis prophylaxis?
Rifampicin.
222
Syphilis Tx
Benzylpenicillin
223
Which IBD is smoking protective against (and vice versa)
UC
224
Blood disorder associated with Down's
AML (&ALL)
225
woman with SLE - hasn't passed much urine in 3 days - what she has passed has been brown
Rapidly Progressive glomerulonephritis
226
Criteria used for infective endocariditis
Duke's criteria
227
Pancreatic tumour marker
CA 19.9 (carbohydrate antigen)
228
Which factor is lost in the urine with Nephrotic syndrome
Antithrombin 3 - therefore increased VTE risk
229
Neoplasm with "oat shaped cells"
Small cell lung carcinoma
230
Statins MOA
HMG CoA reductase inhibitor therefore decrease in hepatic cholesterol production
231
PCSK9 antibodies MOA
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
Ezetimibe MOA
Inhibits cholesterol absorption from the gut (Acarbose but for cholesterol)
233
What did the DCCT conclude
Good control = better outcomes (T1DM)
234
What did the UKPDS conclude?
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
What did the ACCORD and ADVANCE studies show?
ACCORD - Bad control to sudden good control led to earlier mortality
ADVANCE - Bad control to reasonable control led to reduced mortality
236
SGLT2 inhibitors - give examples and MOA
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
GLP1 analogue MOA
GLP1 acts to increase insulin and decrease glucagon. Therefore mimics that effect
-glutides - Liraglutide, Dulaglutide
238
DPP4 inhibitors MOA
DPP4 usually breaks down GLP1 therefore prevents this (not as good as DLP1 and SGLT2)
-gliptins - Sitagliptin, saxagliptin
239
Causes of high anion gap
```
Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde
Iron, isoniazid
Lactic acidosis
Ethanol, ethyleen glycol
Salicylate
```
240
FMF Tx (and MoAs)
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
Pt presents with recurrent infections and Hepatosplenomegaly
What is Dx?
What is the two tests used?
What organisms is this patient susceptible to?
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
What is Schmidt's syndrome? What is it more commonly known nowadays?
Modern name: Autoimmune Polyendocrine Syndrome Type 2
Addison's and hypothyroid occur together more frequently than would otherwise be suggested by chance alone
243
What is the vector for Dengue?
ADES Mosquito
244
Vector for Malaria
Female ANOPHOLES mosquito.
245
Treatment of benign prostatic hyperplasia.
TURP (trans-urethral resection of the prostate) and 5-alpha reductase inhibitors (finasteride - anti-androgen)
246
What factor is deficient in Haemophilia A?
Factor VIII (eight - ei like A).
247
What factor is deficient in Haemophilia B?
Factor IX.
248
What is the treatment for coagulation disorders?
IV vitamin K and fixed frozen plasma.
249
What haematological changes occur in pregnancy?
Decreased HHPF: haemoglobin, haematocrit, protein s, factor 11/XI.
(dilutional anaemia because plasma is ++)
250
What chromosome translocation is associated with CML?
Philadelphia chromosome translocation.
251
What is Behcet's disease? What HLA? Symptoms?
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
How does Takayasu's present
A large cell vasculitis
"Pulseless disease"
No pulse, low BP in arms, cold hands, bruits, claudication
Higher in Japanese women
253
Presentation of temporal giant cell arteritis.
Eldlerly, scalp pain, jaw claudication, blurred vision, non-palpable temporal pulse.
"pain when brushing hair"
254
How would you investigate temporal giant cell arteritis?
Temporal artery biopsy, ESR.
Would see granulomatous transmural inflammation, skip lesions, and giant cells. ESR typically elevated.
255
Mx of temporal giant cell arteritis?
Oral high-dose glucocorticoid - prednisolone.
256
Kawasaki's - who does it affect, what are the symptoms and what can it lead to?
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
Polyarteritis nodosa - what are the features and what is seen on histology?
Renal impairment, spares lungs, "string of pearls", "rosary beads", 30% have hepatitis B.
Histological findings: fibroid necrosis, neutrophil infiltration.
258
Heavy smoker < 35 year old with tibial and radial pain,
| ulcers on feet, toes and fingers, and corkscrew appearance on angiogram.
Beurger's disease (thrombangitis obliterans).
259
cANCA
Saddle nose
Pulmonary Haemorrhage
Crescentic glomerulonephritis
Wegner's Syndrome - granulomatosis with polyangiitis (GPA).
260
Asthma
Eosinophilia
pANCA
Churg Strauss Syndrome - eosinophilic granulomatosis with polyangiitis (EGPA).
261
Pulmonary Renal syndrome:
Pulmonary haemorrhage
Glomerulonephritis
pANCA
Microscopic Polyangiitis
262
Child<10
Palpable rash on buttocks
URTI last week
Has glomerulonephritis, arthritis, orchitis
Henoch Schonlein Purpura (IgA mediated)
263
First line chemo for treating Prostate Ca
Docetaxel
264
Waxy casts in urine
CKD
265
Haemochromatosis treatment.
Phlebotomy.
266
Wilsons Tx
Zinc and Treintine
267
Cancer marker for HCC
Alpha-fetoprotein
268
Medication asso with HCC
COCP
269
Term for tube shaped microscopic particles in urine
Urinary casts
270
Most common form of bladder Ca
Transitional cell
271
What separates Lewy Body
Hallucinations
| Parkinsons like Sx - shiffling gate
272
IBD - non-caseating granulomas
Crohn's
273
Presence of fatty casts in urine
Nephrotic syndrome
274
Tx of HER2 positive breast Ca
Herceptin (trastuzumab) - Monoclonal Ig
275
Defect is Polycystic kidney
Polycystin-1
276
Criteria for diagnosing Rheumatic fever
Jones Criteria
277
Paraneoplastic syndrome that causes Diarrhoea, bronchoconstriction, Flushing?
Carcinoid syndrome - usually serotonin secreted (Serotonin syndrome like symptoms)
278
tumour marker for colorectal Ca
CEA - Carcinoembryonic antigen
279
Antibodies in Bullous pemphigoid
Anti-hemidesmosomes
280
Contraindication to Infliximab
Infliximab is anti-TNF alpha. Suppression of this is associated with TB reactivation
281
What does p-ANCA taget?
Myeloperoxidase
282
Complement deficiency leads to susceptibility of what types of organisms?
Encapsulated
| NHS organisms
283
'Starry sky' appearance on histology? Haematological condition.
Burkitt's lymphoma (non-hodgkins).
284
Treatment for febrile non-haemolytic transfusion reaction
Paracetamol
285
What immune cell releases granzyme and perforin?
CD8+ T cells
286
Anti-RSV medications
Paluvizimab
287
What does cyclosporine inhibit
It is a calcineurin inhibitor and therefore blocks T cell proliferation
288
Normal IgA
Low IgG
Low IgM
Common variable immunodeficiency
289
Antigen targeted in AITP
Glycoprotein 2b/3a
290
SLE pregnant woman - what is her child at risk of?
Congenital Heart Block
291
Which cell surface receptor allows cells of the innate immune system to bind to immunoglobulins?
Fc Receptors
292
What is a haematological side effect of the use of isoniazid in treatment of tuberculosis?
Sideroblastic anaemia.
293
Hereditary Haemochromatosis gene and inheritance pattern
HFe on chromosome 6 (AR)
294
Haemochromatosis Tx
Venesection
| Desferrioxamine
295
Wilson's Gene and inheritance pattern
ATP7B (AR)
296
Alpha 1 antitrypsin deficiency inheritance pattern
AD
297
Wilson's copper stain
Rhodanine
298
Haemochromatosis stain
Prussian blue
299
Alpha 1 antitrypsin aetiology in adults and kids
Kids - Neonatal jaundice
| Adults - Emphysema and chronic liver disease
300
Gout investigations
Urate crystals
Needle shaped
NEGATIVELY birefringent
301
Pseudogout investigations
Calcium pyrophosphate crystals
Rhomboid shaped
POSITIVELY birefringent
302
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
CURB-65 score - 2
Therefore consider admission
Give Amoxicillin and clarithromycin 5-7d PO
303
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?
CURB 65 score - 3
| Therefore admit, give Co-amox with erythromycin 7d IV
304
What is the most common cause of nephrotic syndrome in children?
Minimal change disease - idiopathic, frothy urine, periorbital and perhipheral oedema, treated with corticosteroids.
305
What is the most common cause of nephrotic syndrome in patients of African and Hispanic descent?
Focal Segmental Glomerulosclerosis - mixed response to corticosteroids, can progress to CKD.
306
Wilson's first line treatment
Trientine and zinc
307
Waxy casts in urine
CKD
308
ST elevation in V2/3/4/5 no chest pain
Ventricular aneurysm
309
What stone are CLL patients on chemo at risk of
Uric acid
310
Colorectal cancer tumour marker
CEA
311
Signet ring sign on CT
Bronchiectasis
312
Sign seen in graves due to periosteal bone growth around nail bed
Thyroid acropachy
313
What does Alpha 1 antitryptsin normally break down, preventing emphysema
Neutrophil elastase
314
Enzyme with reduced activity in Gilbert's
UDP Glucoronyltransferase
315
Persistent hypokalaemia
Renal Tubular Acidosis
316
Overdose of a medication with ringing in ears
| Metabolic acidosis with Respiratory alkalosis mix
Aspirin
317
Orange tonsils on a kid
| Very low HDL
Tangier disease
318
Increased bone density name and causes
Osteoslerosis
Excess Vit D
Hypoparathyroidism
Pagets
319
Boy eating his own fingers
Lesch Nyhan syndrome (X-linked)
Deficiency of HGPRT
impaired kidney function
acute gouty arthritis
320
Large numbers of lymphocytes with macrophages containing ingested lymphocytes
What type of lymphoma
Burkitt's
321
Most common cause of iron deficiency anaemia worldwide
Hookworm
322
What is a measure of anticoagulation?
D-Dimer
323
Blood film finding of MM (non-white cells related finding)
Rouleaux
324
Rivaroxaban reversal agent
Adexanet alfa
325
Bleeding from cannula
DIC
326
What are inclusions of denatured haemoglobin within erythrocytes commonly called when seen in a peripheral blood film?
Heinz bodies
327
Woman diagnosed ITP. Has no bleeding. Platelets slightly low.
Treatment?
No treatment
If symptoms, then IVIG or Steroids
328
Renal tubular acidosis Type 1 pathophysiology
Distal failure of H+ secretion -> Acidaemia -> Metabolic acidosis
K+ excretion to maintain electrochemical gradient in kidney -> hypokalaemia
329
Renal tubular acidosis Type 2 pathophysiology
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
Renal tubular acidosis Type 4 pathophysiology
Deficiency of(Addison's)/Resistance to Aldosterone (ARBs) -> the normal stuff -> hyperkalaemia and acidosis
331
Polycythaemia Rubra Vera Tx
Venesection
| Hydroxycarbamide
332
Bullous Pemphigoid - Antibodies, Description of bullae
IgG anti-hemidesmosomes, Subepidemal (Deep)
333
Pemphigus Vulgaris - Antibodies, Description of bullae
IgG anti-desmoglein 1 and 3, Intraepidermal (Superficial), easily ruptures
334
GvHD symptoms
Diarrhoea, Liver Failure, Skin Desquamation, BM failure
335
What monoclonal antibody targets IL-17 and is involved in the treatment of psoriasis, psoriatic arthritis and ankylosing spondylitis?
Secukinumab
336
Black pus discharging from nose and mouth in a diabetic patient?
Murcomycosis - a serious but rare fungal infection.
337
What antiretroviral drug is given as IV monotherapy during labour to prevent vertical transmission of HIV-1?
Zidovudine
338
What monoclonal antibody targets CD20 and is used in the treatment of lymphomas?
Rituximab
339
What lymphocyte lineage does azathioprine predominantly inhibit?
T lymphocytes
340
What test is the ability of a patient's serum to lyse sheep erythrocytes coated with rabbit anti-sheep antibodies?
CH50
