Pathology

Question 1

Ghon complex -

Answer 1

Ghon complex - primary TB and regional nodal involvement
o Macrophage internalisation
o Granulomata – epitheloid histocytes
o T4 hypersensitivity

Question 2

Cancer most common in non-smokers

Answer 2

Peripheral Adenocarcinoma – most common in non-smokers

Question 3

Organisms for Malignant otitis externa

Answer 3

Malignant otitis - Pseudomonas aeruginosa - Severe pain, headaches and granulation tissue

Diabetes (90%) or immunosuppression (illness or treatment related)
Severe, unrelenting, deep-seated otalgia
Temporal headaches
Purulent otorrhea
Possibly dysphagia, hoarseness, and/or facial nerve dysfunction

Question 4

Malignant hypertension results in

Answer 4

Malignant hypertension - Fibrinoid necrosis

Question 5

Reed Sternberg cells

Answer 5

Hodgkins lymphoma - Reed Sternberg cells

Question 6

Most favourable prognosis for Hodgkins lymphoma

Answer 6

Classical lymphocyte predominant

Question 7

Asteroid Bodies

Answer 7

Asteroid Bodies - Sarcoid

Question 8

% of sarcomas are found in the extremities.

Answer 8

40% of sarcomas are found in the extremities.

Question 9

Most common anal cancer and cause

Answer 9

Anal SCC (most common) – HPPV 16 (Less 18)

Question 10

Granulomas are…

Answer 10

Granulomas are organised collections of macrophages, different to giant cells

Question 11

nose bleed, hearing loss, face/ear pain, soft palate paralysis

Answer 11

nasoparyngeal carcinoma – nose bleed, hearing loss, face/ear pain, soft palate paralysis
- EBV risk factor

Question 12

Concentric ring of epithelial cells seen in the medulla of the thymus (pharyngeal pouch 3+4)

Answer 12

Hassall’s corpuscles

Question 13

Watercress farmer - jaundice - organism?

Answer 13

Watercress farmer – fasciola hepatica –

Jaundice and bile duct hyperechoic dilation.

Aka liver fluke, nematode.
Stool or serology, triclabendazole

Question 14

cartilage, ciliated epithelium

Answer 14

Hamartoma: CT,

Question 15

to kill tubercle bacilli

Answer 15

Autoclave to kill tubercle bacilli

Question 16

laxative abuse

Answer 16

Melanosis coli

Question 17

GVDH

Answer 17

Lymphocyte proliferation not neutrophil

Question 18

Gigantic leg

Mosquito bite in congo, Indian BL

Answer 18

Filriasis- gigantic leg Wuchereria bancrofti - nematode– treat with diethylcarbamazepine

Question 19

Ascending UTI

Answer 19

Ascending UTI – E Coli

Question 20

Fournier’s Gangrene

Answer 20

E-coli and bacteroides

Question 21

To sterilise endoscopic equipment

Answer 21

Glutaraldehyde

Question 22

Fistulae, sulphur granules, poor healing

Answer 22

Fistulae, sulphur granules, poor healing

Actinomycosis – Gram +ve anaerobes, long term penicillin

Question 23

Colon carcinoma + endocarditis

Answer 23

Streptoccus Bovis - gram +ve

Question 24

Work with sheeps and dogs – LFTs + Eosinophilia

Answer 24

Echinococcus granulosus

Hydatid cyst – calcified – work with sheeps and dogs – LFTs + Eosinophilia (liver, intestines)

Question 25

Meditarrean, Middle Eastern, Biliary cysts + Urticarial rash

Answer 25

Hydatid cysts – Echinococcus Granulosus – | T1 Hypersitivity – cysts are allergens

Question 26

Most common food borne illness (resistant to cooking) Onset is hours after eating

Answer 26

C. Perfringens

Question 27

Foodborne illness - within minutes of eating

Answer 27

Minutes with staph aureus (preformed enterotoxin)

Question 28

Associated with gas grene

Answer 28

C. Perfringens

Question 29

Waterhouse - Friderichsen syndrome - adrenal gland bleeding and failure due to severe infection - mostly commonly due to.

Answer 29

most commonly Meningococcus - Neisseria meningitidis. Waterhouse - Friderichsen syndrome - adrenal gland bleeding and failure due to severe infection -

Question 30

Osteomyelitis in Sickle

Answer 30

Osteomyelitis in Sickle: E.Coli>Staph Aureus

Question 31

Achalasia - Infective destruction of myenteric plexus ganglia, heart, CNS, spleen.

Answer 31

Achalasia – trypanosoma Cruzi destruction of myenteric plexus ganglia, heart, CNS, spleen. Only acute infection curable

Question 32

SEVERE Abdo pain with diarrhoea – more likely to be

Answer 32

SEVERE Abdo pain with diarrhoea – more likely campylobacter jejuni

Question 33

Diarrhoea in immune suppressed – renal transplant

Answer 33

cryptospirodium - cysts

Question 34

Relative bradycardia in

Answer 34

Relative bradycardia in typhoid fever

Question 35

CMV infection most common in

Answer 35

CMV infection most common in solid organ transplants

Question 36

Birds touching your milk?!

Answer 36

Birds touching your milk?! Compylobacter jejuni!

Question 37

Egypt, swimming pool, diarrhoea

Answer 37

Giardia – resistant to chlorination. | First line treatment is with metronidazole

Question 38

Group A Strep add what to flucloxacillin

Answer 38

Group A Strep – add penicillin to flucloxacillin

Question 39

Coughing, abdo discomfort, no prurois anii, Indian/Far East

Answer 39

orms and eggs on microscopy – Ascaris Lumbricoides Treatment is with mebendazole

Question 40

Management of hepatitis B

Answer 40

Pegylated interferon-alpha | lamivudine, tenofovir and entecavir

Question 41

Complications of hepatitis B infection

Answer 41

``` Chronic hepatitis (5-10%) Fulminant liver failure (1%) Hepatocellular carcinoma Glomerulonephritis Polyarteritis nodosa Cryoglobulinaemia ```

Question 42

Management of chronic Hep C

Answer 42

a combination of pegylated interferon-alpha and ribavirin are used, up to 55% of patients successfully clear the virus

Question 43

Hep C management complications

Answer 43

ribavirin - side-effects: haemolytic anaemia, cough. Women should not become pregnant within 6 months of stopping ribavirin as it is teratogenic interferon alpha - side-effects: flu-like symptoms, depression, fatigue, leukopenia, thrombocytopenia

Question 44

HIV Antigen test

Answer 44

p24 antigen test usually positive from about 1 week to 3 - 4 weeks after infection with HIV sometimes used as an additional screening test in blood banks

Question 45

The commonest organism in isolated pathogen infection in Necrotising fasciitis

Answer 45

Streptococcus

Question 46

A similar principle but the infection is more superficially sited than necrotising fasciitis and often confined to the trunk

Answer 46

Meleneys gangrene

Question 47

Who should be screened for MRSA?

Answer 47

all patients awaiting elective admissions (exceptions include day patients having terminations of pregnancy and ophthalmic surgery. Patients admitted to mental health trusts are also excluded) in the UK all emergency admissions are currently screened

Question 48

How should a patient be screened for MRSA?

Answer 48

nasal swab and skin lesions or wounds the swab should be wiped around the inside rim of a patient's nose for 5 seconds the microbiology form must be labelled 'MRSA screen'

Question 49

Suppression of MRSA from a carrier once identified

Answer 49

nose: mupirocin 2% in white soft paraffin, tds for 5 days skin: chlorhexidine gluconate, od for 5 days. Apply all over but particularly to the axilla, groin and perineum

Question 50

The following antibiotics are commonly used in the treatment of MRSA infections:

Answer 50

vancomycin teicoplanin ``` Some strains may be sensitive to the antibiotics listed below but they should not generally be used alone because resistance may develop: rifampicin macrolides tetracyclines aminoglycosides clindamycin ```

Question 51

Osteomyelitis

Answer 51

S aureus and occasionally Enterobacter or Streptococcus species

Question 52

Septic arthritis... Most common organism overall - young adults who are sexually active -

Answer 52

Most common organism overall is Staphylococcus aureus In young adults who are sexually active Neisseria gonorrhoeae should also be considered The BNF currently recommends flucloxacillin or clindamycin if penicillin allergic

Question 53

Alpha haemolytic streptococci

Answer 53

``` Streptococcus pneumoniae (pneumococcus) - pneumonia, meningitis and otitis media Streptococcus viridans ```

Question 54

Beta haemolytic streptococci

Answer 54

These can be subdivided into group A and B Group A most important organism is Streptococcus pyogenes responsible for erysipelas, impetigo, cellulitis, type 2 necrotizing fasciitis and pharyngitis/tonsillitis immunological reactions can cause rheumatic fever or post-streptococcal glomerulonephritis erythrogenic toxins cause scarlet fever Group B Streptococcus agalactiae may lead to neonatal meningitis and septicaemia

Question 55

Staphylococcus aureus

Answer 55

``` Facultative anaerobe Gram positive coccus Exo toxin -toxic shock syndrome Enterotoxin - gastroenteritis Resistance to methicillin (and other antibiotics) is mediated by the mec operon ```

Question 56

Streptococcus pyogenes

Answer 56

Gram positive, forms chain like colonies, Lancefield Group A Streptococcus beta haemolysis on blood agar plates superantigens such as pyogenic exotoxin A which results in scarlet fever

Question 57

Escherichia coli

Answer 57

Gram negative rod Facultative anaerobe, non sporing Enterotoxigenic E-Coli produces an enterotoxin (ST enterotoxin) that results in large volume fluid secretion into the gut lumen (Via cAMP activation) Enteropathogenic E-Coli binds to intestinal cells and cause structural damage

Question 58

Campylobacter jejuni

Answer 58

Curved, gram negative, non sporulating bacteria commonest causes of diarrhoea worldwide Remains a differential for right iliac fossa pain with diarrhoea Self limiting infection so antibiotics are not usually advised. However, the quinolones are often rapidly effective.

Question 59

Helicobacter pylori

Answer 59

Gram negative, helix shaped rod, microaerophillic Those carrying the cag A gene may cause ulcers colonises the gastric antrum and irritates resulting in increased gastrin release and higher levels of gastric acid These patients will develop duodenal ulcers. In patients who are colonised 10-20% risk of peptic ulcer, 1-2% risk gastric cancer, <1% risk MALT lymphoma.