QNA 2

Question 1

Hypothalamo-pituitary-adrenal axis for corticosteroids

Answer 1

CRH -> ACTH -> cortisol

Question 2

Hypothalamus hormones

Answer 2

GnRH
GHRH
CRH
TRH
PRH

Question 3

Anterior pituitary hormones

Answer 3

FSH/LH
TSH
Prolactin
ACTH
GH

Question 4

Posterior pituitary hormones

Answer 4

ADH
Oxytocin

Question 5

How does adenosian crisis affect glucose levels

Answer 5

too little cortisol
Hypoglycaemia (insulin sensitivity)

Question 6

Where to check for melanoma

Answer 6

Back of legs and back
Soles of hand and feet
Nailbeds

Question 7

How to identify what phenotype of cancer cells

Answer 7

immunohystochemistry/immunocystochemistry

Question 8

How does immunohistochemistry work

Answer 8

adding various antibodies and visualising antibody-antigen formation

Visualisation either by an enzyme like peroxidase attached to antibody changing colour of the solution or immunofluorescence where antibody tagged by fluorecine

Question 9

How does immunohistochemistry work

Answer 9

adding various antibodies and visualising antibody-antigen formation

Visualisation either by an enzyme like peroxidase attached to antibody changing colour of the solution or immunofluorescence where antibody tagged by fluorecine

Question 10

Differential for foreing traveller with lymph node in neck

Answer 10

Lymphoma (hodgkin vs non hodgkin)

TB

Question 11

What to do if suspected TB

Answer 11

Put in a category 3 biohazard bag

Inform public health england

Contact tracing

Question 12

Adult polycystic kidney disease genetics

Answer 12

Autosomal dominant
PKD1 and PKD2 mutations

Question 13

APKD cyst formation pathophysiology

Answer 13

Tubular cells relentlessy divide, lead to formation of outpouching that slowly cuts itself off the main tubule, but keeps filling with the secretions of other tubules

Question 14

Complications of APKD

Answer 14

Renal failure
Infection
HTN
Associated with cerebral aneurysm

Question 15

How does CLO test work

Answer 15

Based on H pylori producing urease urea- >ammonia

Biopsy placed in urea medium

Add an indicator eg phenol red

If H pylori present, produces ammonia, increasing pH changing colour to red

Question 16

Causes of PUD

Answer 16

H pylori
Smoking
High calcium (hyperparathyroid)

Question 17

How to investigate parathyroid issues

Answer 17

PTH assay

Sestamibi scan (giving radionucleotide sestamibi and image with gamma camera to identify hyperfunctioning parathyroid adenoma)

Question 18

Commonest histology of gallbladder carcinoma

Answer 18

Adenocarcinoma

Question 19

Commonest cause of gallbladder cancer

Answer 19

Chronic inflammation from cholecystitis

Question 20

Where does gallbladder cancer spread to first

Answer 20

Segment V of liver

Lymphatic spread to cystic and pericholedochal lymph nodes

Question 20

Where does gallbladder cancer spread to first

Answer 20

Segment V of liver

Lymphatic spread to cystic and pericholedochal lymph nodes

Question 21

Patient treated for nec fascitis. Develops bloody diarrhoea. What’s the cause

Answer 21

Pseudomembranous colitis
Ischaemic colitis
Infective enterocolitis
Stress ulcer

Question 22

Pathophysiology of Pseudomembranes caused by c diff

Answer 22

Exudative fibrin deposition as bacteria secrete proteases to damage the bowel mucosa

Question 23

Antibiotic treatment for abscess drainage

Answer 23

Recent evidence has shown that antibiotics reduce the risk of recurrence by 5% at 1 month and 8% at 3 months

Question 23

Antibiotic treatment for abscess drainage

Answer 23

Recent evidence has shown that antibiotics reduce the risk of recurrence by 5% at 1 month and 8% at 3 months

Question 24

What is sickle cell disease

Answer 24

Hereditary haemoglobinopathy Mutation in B globin leading to HbS formation Forms abnormally shaped RBC, less flexible, more likely to be broken down

Question 25

Surgical complications of sickle cell

Answer 25

Gallstones Autosplenectomy -> immunosuppression AVN of bone

Question 26

Most common brain tumour

Answer 26

High grade: Glioblastomas Low grade: Meningioma Metastatic disease

Question 27

Common bacteria causing skin infection

Answer 27

Staph aureus Group A strep (pyogenes)

Question 28

Pheochromocytoma testing

Answer 28

Urine: Vanillyl mandelic acid (metabolite of catecholamines) Plama: catecholamines and metanephrine

Question 29

What malignancy occurs in immunosupressed patients

Answer 29

SCC, BCC Lymphoma Kaposi sarcoma

Question 30

How do neutrophils migrate towards site of infection

Answer 30

Marginisation and rolling along the vessel wall Transfer between endothelial cells Migrate towards chemostatic stimulus

Question 31

How does endometriosis migrate to colon?

Answer 31

3 theories Regurgitation: retrograde flow of menstrual endometrium Vascular/lymphatic Metaplastic: arises directly from coelomic epithelium of pelvis

Question 32

Which thyroid cancer will not show response to iodine uptake (not picked up by dionuclide scan)

Answer 32

Parafollicular C cells (medullary carcinoma) Dont pick of up iodine

Question 32

Which thyroid cancer will not show response to iodine uptake (not picked up by dionuclide scan)

Answer 32

Parafollicular C cells (medullary carcinoma) Dont pick of up iodine

Question 33

Classification of lung cancer

Answer 33

Small cell Non small cell (adeno, SCC, large cell)

Question 34

Which lung cancer in smoker/nonsmoker

Answer 34

Smoker: squamous (male) Non smoker: adeno (female)