Pathology

Question 1

think about:

ADAMTS13
LDH
Haptoglobin
DAT

Answer 1

This is acquired immune haemolytic anaemia

LDH : always high in haemolysis
ADAMTST13: Low in TTP
Haptoglobin: low free haptoglobin as it is bound to the free Hb released during haemolysis
DAT : positive in immune mediated

Question 2

Answer 2

Blood film: most useful initial diagnostic test in haemolytic uraemic syndrome (SHISCTOCYTES)

Question 3

A 63-year-old man presents to his general practitioner complaining of increased tiredness and shortness of breath over the last 3 months. He has a past medical history of type two diabetes mellitus, mitral valve prolapse for which he has had a valve replacement, and heart failure.

On examination, the patient appears pale and visibly jaundiced. He has a respiratory rate of 21 breaths/min and a clear chest on auscultation. His abdomen is soft and non-tender. There is no peripheral oedema.

What is the most likely cause of this presentation?

Answer 3

Haemolytic anaemia:

Prosthetic heart valves may result in haemolytic anaemia

Question 4

A 22-year-old man presents with crampy abdominal pain diarrhoea and bloating. He has just returned from a holiday in Egypt. He had been swimming in the local pool three weeks ago. He reports that he is opening his bowels 5 times a day. The stool floats in the toilet water, but there is no blood. What is the most likely cause?

Answer 4

Giarda

Question 5

glycaemia and cholera?

Answer 5

hypoglycaemia

Question 6

Answer 6

A negative HBsAg suggests there is no active HBV infection. Positive anti-HBs suggests there is immunity to HBV and negative anti-HBc means there is no previous infection. Therefore, immunity to HBV is secondary to previous vaccination. Negative HCV RNA means there is no current HCV infection and positive anti-HCV antibodies means there has been a previously cleared HCV infection. There is no vaccination for HCV and therefore infection is the only cause of antibodies. Therefore, the correct answer is previous HBV vaccination, cleared HCV infection.

Question 7

1st line management for kids under 5 with asthma symptoms

Answer 7

try inhaled steroid first

offer a twice-daily paediatric low-dose inhaled corticosteroid (ICS) for 8-12 weeks and review the response. If following treatment no respiratory symptoms present anymore, stop ICS and review after a while again. If symptoms re-occur, then regular ICS should be re-started and continued until objective testing is possible.

Question 9

Pancreatitis and hypercalcaemia?

Answer 9

Hypercalcaemia can cause acute pancreatitis

need to consider amylase levels in a patient with hyperC symptoms and epigastric pain

Question 10

She has neck imaging which confirms a solitary parathyroid adenoma and she is listed for a parathyroidectomy.

What is the commonest complication of this procedure?

Answer 10

Hypocalcaemia

Question 11

A low calcium level (hypocalcaemia) can result in prolonged QT interval and increase the risk of life-threatening arrhythmias such as torsades de pointes, requiring ??

Answer 11

IV calcium gluconate

Question 12

Smoking, alcohol, low bmi, - which one is the biggest risk factor for osteoporosis development?

Answer 12

Low BMI

Question 13

How does parathyroid hormone act on the bone to increase serum calcium levels?

Answer 13

Binds to osteoblasts, which stimulate osteoclasts via paracrine signalling

Question 14

Proper way of taking bisphosphonate?

Answer 14