Random Facts from past Papers Flashcards
(115 cards)
1
Q
What is the inheritance pattern for all Multiple Endocrine Neoplasia (MEN) subgroups?
A
All are autosomal domiant
2
Q
What gene is affected in MEN 1?
A
MEN1 gene on chromomsome 11
Leads to altered expression of Mening (usually TSG)
3
Q
What malignancies are associated with MEN1?
A
MEN 1= 3 Ps
- Parathyroid (parathyroid adenoma)
- Pancreas (endocrine pancreatic tumours e.g. insulinoma, gastrinoma)
- Pituitary adenoma (most commonly prolactin)
4
Q
What gene is affected in MEN 2?
A
Altered expression of the RET proto-oncogene → elevated tyrosine kinase activity
MEN 2 has 2 subtypes. Both share 2 of the 3 neoplasms, but one is different (they also have different body habitus)
5
Q
What malignancies is MEN 2a associated with?
A
MEN 2a =2P and one M
For all MEN 2
- Medullary Thyroid carcinoma
- Phaeochromocytoma
For Men 2a
- above +
- Primary hyperparathyroisim
6
Q
What malignancies are associated with MEN2b?
A
MEN 2b = 2M and one P
For all MEN 2
- Medullary Thyroid carcinoma
- Phaeochromocytoma
For MEN2b
- above +
- Multiple neurinomas (+ marfanoid features)
7
Q
What sub-types of thyroid cancers are there?
A
- Derived from Thyrocytes
- Papillary
- Follicular
- Anaplasitc
- Derived from parafollicular C cells (calcitonin)
- Medullary
8
Q
What is the most common sub-type of thyroid cancer?
What is the typical epidemiology and prognosis?
A
Papillary thyroid cancer
usually in women 20-40, associated with irradiation
Overall has excellent prognosis
9
Q
What are the histological charactreistics of papillary thyroid cancer?
A
- Psamoma bodies
- empty appearing nuclei with central clearing (orphan annie eyes)
10
Q
Where does papillary thyroid cancer usually metastasise?
A
Usually Lymph nodes + lungs (often presents as painless cervical lymphadenopathy)
11
Q
What type of thyroid cancer is assocaited with MEN2?
What cells is it derived from?
A
Medullary thyroid cancer (5% of all thyroid cancers)
–> Derived from parafollicular C cells
20% of people with medullary thyroid cancer have MEN2
12
Q
What tumour markers can be used in the diagnosis of medullary thyroid cancers?
A
- CEA
- calcitonin
13
Q
What is the histological appearance of medullary thyroid cancer?
What other features might hint you towards a medullary thyroid cancer in an SBA?
A
Sheets of dark cells
With amyloid depositions (arrows pointing to fibrous bands ) with high vascularity within tumour
- Association with MEN2 (aka phaeos)
- high calcitonin
14
Q
What is follicular thyroid cancer?
What is the epiodemiology?
Where does it usually metastasise?
What is the histopathological appearnace?
A
2nd most common thyroid cancer (10-20%), usually in 40-60 years and metastasises early
Usually metastasises into **Blood ** first+
Histology
- uniform cells forming small follicles and reminiscent of normal thyroid
15
Q
What is the most agressive form of thyroid cancer?
What is the epidemiolgoy and histological appearance?
A
Anaplasic Thyroid cancer (only 1-2% of cases)
usually in elderly and prognosis <1 year
Histology: undifferentiated follicular, large pleomorphic giant cells, spindle cells
16
Q
What is the most common type of pancreatic cancer?
What is the histological appearance
A
Ductal adenocarinoma (95%) with
- altered ductal structures
- cellular infiltration
Other subtypes (acinar adenocarcinoma, mucinous cystadenocarcinoma) are less common, but also exocrine
- There are also pancreatic endocrine tumours
17
Q
What antiviral medicaiton is used for treatment of CMV?
A
Ganciclovir
18
Q
What antiviral medication can be used in the managment of RSV?
A
Ribavirn
19
Q
50 year old female presents to the ENT clinic following a recent admission of hypercalcaemia. Primary hyperparathyroidism secondary to adenoma is suspected.
What investigation is most useful in determining location and functional status of the adenomas?
A
Technetium 99 scan
20
Q
What are the traunsfusion threshold for platelet transfusions?
A
<10 : Leukaemias
<20 : Sepsis
<50 : Surgery (prevent bleeding in surgery, might be higher depending on site)
<75: if big RBC transfusion to balance
NO transfusion if activel bledding or any cunsumption diorders (e.g. TTP; DIC; HIT)
21
Q
What Breast cancer is also known as No specific type?
A
Invasice ductal carcinoma (NST) –> most common breast cancer
22
Q
What breast cancer is associated with E cadherin loss?
A
Lobular carcinoma
23
Q
Which common condition can be treated with drugs that target TNF, IL-17 and Il-12/23?
A
Psoriasis
24
Q
What viral diseases do you use Ribavirin against?
A
RSV
Hepatitis C
25
What medication is used to treat Herpes infections (HSV, CMV, EBV) in immunocompromised patients or in patients with CMV infection pre-transplant?
Foscarnet
Foscarnet is principally used for the treatment of ganciclovir-resistant cytomegalovirus (CMV) infections in patients with the acquired immunodeficiency syndrome (AIDS) or in transplant recipients.
26
What antiviral treatment must be administered with probenecid?
Cidofovir
--> off-label use of probenecid (usually gout medication) to limit nephrotoxic effects of cidofovir
27
What is an important differential to Multtiple myeloma when you see overproduction of IgM?
Waldenstrom’s macroglobulinaemia
A type of non-Hodgekin lymphoma leading to monoconal overproduction of IgM
Often presents due to hyperviscocoity (IgM overproduction) + fatigue
28
What is the most common cause of hypercalcaemia in the community?
hyperparathyroidism --> primary? (parathyroid adenoma)
29
Venetoclax is a BCL2 inhibitor used in CLL. What cellular process does it affect?
Apoptosis
30
What is the most common cause of contrictive pericarditis in developing countries?
??????
TB?
31
Wha is the most common cause of nephrotic syndrome in aduls that is glomerular pathology?
Focal segmental glomerularnephritis
32
What is the most common cause of portal vein thrombosis?
Hypercoaguability --> Polycythemia vera
33
What is the microscopic appearnace of the pathogen causing hamoptysis in eldery patients and alcoholics?
-ve rod, enterobacter
Klebsiella
34
What is the commonest cause of myocarditis?
Viral: expecially coxacie B
Most commonly implicated: coxsackie B1-B5 (picornavirus), parvovirus B19, human herpesvirus 6 (HHV-6), adenovirus, HCV, HIV
35
Which virus characteristically causes encephalitis involving the temporal lobes?
Herpes simplex virus
36
Recall the Zones of the adrenal and in which zones
1. Glococorticoids
2. Mineralcorticoids
3. Androgens
4. Epineohrine are produced
Has Medulla (inside) and Cortex (outside)
Medulla = Cetecholamines (Epinephrine)
Then from inside out:
1. Zone reticularis (androgens)
2. Zona fasciculata: glucocorticoids (cortisone)
3. Zone glomerulosa: Aldosterone (Mineralcorticoids)
37
What condition occurs in both MEN1 and MEN2a?
Hyperparathyroidism
38
What active enzyme in sarcoidosis patients causes hypercalcaemia
**1-alpha hydroxylase**
ctivated pulmonary alveolar macrophages → ↑ 1-alpha hydroxylase expression and activity → ↑ 1,25-dihydroxyvitamin D (calcitriol) → hypervitaminosis D → hyperphosphatemia, hypercalcemia, and, possibly, renal failure [6]
39
Deficiency of which plasma protein occurs in patients with liver disease and a movement disorder?
ceruloplasmin
--> Wilson's disease
40
Doctors should measure the level/activity of which enzyme before prescribing azathioprine?
TPMT
Thiopurine methyltransferas
enzmyme needed in metabolism of azathioprine. If congenital deficiency of TPMT --> built up of toxic metabolit of azathioprine leading to severe BM failure
41
What gene is defected in X-linked severe combined immune deficiency?
What does it result in?
mutations in the gene encoding the common gamma chain → defective IL-2R gamma chain receptor linked to JAK3 (most common SCID mutation)
42
Mutation of CD40 ligand is associated with which form of primary immunodeficiency?
Hyper-IgM syndrome
A group of syndromes characterized by impaired interaction between Th cells and B cells that results in a B cell class-switching defect
CD40 ligand deficiency is most common form
43
Which class of antibiotics has concentration dependent killing (i.e. the goal of therapy is to maximise peak > MIC)
Aminoglycosides
44
What is the treatment of samonella typhi?
**Cefotaxime (or ceftriaxone)**
azithromycin may be an alternative in mild or moderate disease caused by multiple-antibacterial-resistant organisms.
Alternative if micro-organism sensitive, ciprofloxacin
45
What antifungalis used in the treatment of cryptococcal meningitis + invasive fungal infection?
Amphotericin B
46
What type of necrosis is seen after an acute Myocaridal infarction?
The pathological hallmark of acute MI is **coagulative necrosis** of the myocardiu
47
What is the most common glia cell in the CNS?
Astrocyte
48
What is the inheritance pattern of haemochromatosis?
Autosomal recessive (with incomplete penetrance)
(Wilson's disease is also autosomal recessive)
49
Explain the pathophysiology and how a mutation in MEFV gene leads to diase?
Causes familial mediterranean fever
--> Failure to regulate cryopyrin driven activation of neutrophils
50
What drug regime is usually started post-transplant?
1. Signal transduction blockade, usually a CNI (calcineurin) inhibitor: Tacrolimus or Cyclosporin; sometimes mTOR inhibitor (Rapamycin) –> inhibits activation of T cells
2. Antiproliferative agent: MMF or Azathioprine (T-cell antiproliferative)
3. Corticosteroids
51
What is the most common form of prion disease?
Sporadic --> Either somatic PRNP mutation OR spontaneous conversion of PrPc to PRPSC and subsequent seeding
52
What is the most common parasitic infectio, often resides in the duodenuman and can cause malabsorbtion?
Gardiasis: infection with Giardia lamblia
Giardia live in two states: as active trophozoites in the human body and as infectious cysts surviving in various environments. Following the ingestion of the cyst, individuals may experience abdominal cramps and frothy, greasy diarrhea. Diagnosis of giardiasis involves analyzing stool for microscopic confirmation of cysts or trophozoites, and possibly immunoassays to detect antigens. Treatment is indicated in nonpregnant symptomatic individuals and usually consists of tinidazole.
Diagnsis is usually made with visualisation of cysts in stool sample
53
What are the 5 most common cancers on women?
1. Breast
2. Lung
3. Bowel
4. Uterus
5. Malignant Melanoma
54
What arer the 5 most common cancers in men?
1. Prostate
2. Lung
3. Bowel
4. Head and Neck
5. Kidney
55
What are the 5 leading causees of cancer mortality in men?
1. Lung
2. Prostate
3. Bowel
4. Oesophagus
5. Pancreas
56
What are the 5 leading causes of cancer deaths in Females?
1. Lung
2. Breast
3. Bowel
4. Unknown primary
5. Pancreas
6. Ovary
57
What are the routine vaccinations offered in pregnancy ?
Influenza
Pertussis
COVID
58
What viruses are routinely screened for in pregnancy?
HIV, syphilis, hep B,
59
What antifungal is used for invasive fungal infections and cryptococcal meningitis?
Amphotericin B
60
What organism causes athelete's foot?
How do you call it based in the location?
Fungal infection, most commonly with T. rubrum, Trichophyton interdigitale
Tinea pedis = foot
Tinea manuum = hands
61
What pathogen causes hypopigmentation of the affected area?
Usually Malassezia globosa/furfur causugin Tinea vesiculor
62
What are the two scoring systems used for
1. stageing
2. grading
of prostate cancer?
1. Stageing: TNM
2. Grading: Gleason score
63
What is the expected electrolytte imbalance in congenital andrenal hyperplaia?
No production of aldosterrone --> Low NA+ + high K+
64
What pathogen is Leishmaniasis caused by? How is it transmitted?
Leishmania donovani (protozoan)
lots of different types --> transmitted by Sandflies
65
What is the clinical presentation of cutaenous leishmaniasis?
## Footnote
What is the treatment?
solitary or multiple reddish macules/papules around the sandfly bite that quickly increase in size and develop central ulceration
## Footnote
If uncomplicated: usually local treatment (incl. thermotherapy)
66
What is the clinical presentation of visceral leishmaniasis?
What is the treatment?
Management: Amphotericin B
Presentation
* many are asymptomatic, but otherwise present with
* Kala - azar ="blackfever"
* Flue like symptoms, feverr spikes, lymphadenopathy, hepatosplenomegaly, pancytopemia
67
What is the treatment for human tapeworms in adults?
Praziquantel
Human tapeworms are part of the cestodes and can be asymputomatic in many cases, but might present with GI symtptoms, inclduing N&V, abdominaal lpain, weight loss
68
35) A 39 year old male farmer from Southern Africa has been exposed to mouldy grain during his working life. He has worsening abdominal pain and jaundice. There is a large mass in the right lobe of his liver. Biopsy of the mass reveals hepatocellular carcinoma. What extrinsic agent is likely to have played a role in the development of this tumour?
Alflatoxin
(mould produced by aspergillus flavus and associated with increased risk in hepatocellular carcinoma)
69
What is the management of Familial Mediterranean Fever?
Colchicine 500ug bd - binds to tubulin in neutrophils and disrupts neutrophil functions
including migration and chemokine secretion
* Anakinra (Interleukin 1 receptor antagonist)
* Etanercept (TNF alpha inhibitor)
70
What primary immunodeficiency is associated with
- normal B cell numbers
- nomal CD8+ T cells + NK cells
- reduction in CD4+ T-cells
- reduction in IgA and IgG antibodies?
Bare lymohocyte syndrome II
Defect in one of the regulatory proteins involved in Class II gene expression * Regulatory factor X or Class II transactivator
→Absent expression of MHC Class II molecules →Profound deficiency of CD4+ cells
71
What type of hearing loss can Paget's disease cause?
Both nerve and conductive!
Conductive: due to ossicleinvolvement
Sensorineural: Compress 8th nerve
If pagets of the skull could have either
72
Which enzyme increases after an acutet Myocardial infarction?
Mainly 4 enzymes
1. Troponin (quickest)
**2. AST** --> typical after cardiac event
3. CK (MB) --> cardiac form of creatinine kinase
4. LDH
Potassium can increase slightly but usually decreases due to adrenaline
73
What liver enzyme is usually highest in a patient with viral hepatitis?
Both transaminases high, but usually
**ALT **> AST
74
Which transaminse is usually higher in patients with jaundice caused by chronic alcohol hepaitis?
Usually **AST**> ALT
75
What two tumourmarkers / biochemical investigations can be done in the diagnosis of prostate carcinoma?
1. Acid phosphatase
2. Now usually replaced by PSA (prostate specific antigen) measurements
76
What happens to the the levels of Vitamin D in primary hyperparathyroidism?
decreases --> due to increased activation by 1-alpha- hydroxylase --> used up
77
What marker of renal function increases rapidly in patients with dehydration?
What marker of renal function increases more in patients with chronic renal failure?
Urea increases more rapidly than Creatinine in dehydration
in chronic renal failure --> increase in Creatinine
78
What are the best markers of glucose control
1. Over the last 3 months?
2. Over the last 3 weeks?
1. HBA1c
2. Fructosamine
79
What is Lesch - Nyhan syndrome?
What other clinical conditon is associated with it?
Inheritance pattern?
What enzyme is mutated?
1. Lesh - Nyhan = inherited genetic disorder characterized by impaired purine salvage pathway, resulting in an overproduction of uric
acid (due to defect in HGPTR)
--> Clinical presentaiton of gout! (+ self-harming behaviour + failure to thrive)
It is X-linked recessive
80
What is Leptospirosis? How does it present?
zoonotic disease caused by gram-negative **Leptospira bacteria**
Direct transmission to humans occurs when broken skin and mucous membranes come into contact with the urine of infected animals such as rodents --> oftenwater
1. Early phase:
* mild witth nonspecific symptoms (e.g., fever, headache, and myalgia)
* 90% resolvespontaneouly within 7 days
But 10% progress to
* severe form (icterohemorrhagic leptospirosis, or Weil disease)
* triad of jaundice, bleeding manifestations, and acute kidney injury
81
What organ is this?
Thyroid
82
What organ is this?
Liver
83
What organ is this?
Kidney
84
What organ is this?
Breast
85
what organ is this?
Adrenal
86
What tissue is this?
Lymph node with germinal centre
1. Germinal centre =centeroblasts and centerocytes
2. The periphery/ darker mantle zone = mature B cells
87
How couly you biochemically differentiate between Diabetes insipidus and psychogenic polydipsia?
Usually Serum Sodium/ plasma osmolality
in DI= high
in psychogenic polydipsia = low
88
What drugs prevent end-stage renal failure in diabetic patients?
1. ACEi (reduced renal perfusion pressure and result in reduced microalbuminuria)
2. SGLT2 inhibiotrs
89
post initial treatment this strain of malaria requires primaquine 30mg to eradicate liver parasites
plamodium vivax
90
this test is determined to determine the species of malria parasite
Thin film
91
A patient was admitted afer a fall. Investigations showed a leukocytosis with increased bilirubin levels. Albumin, folate and 12 were found tto be low. Wha tis he most likely diagnosis?
alcoholic liver disease
92
What vitamin deficiency causes pellagra?
Vitamin B3
Pellagra presents with Dermatitis, Diarrhea, and Dementia
--> usually due to Heavy drinking or malnuttrition
93
What virus is associated with the development of nasopharyngeal carcinoma?
EBV
94
122) Which of the following is found in haemolytic jaundice
a) Bilirubin is normal
b) AST is raised
c) CK is raised
d) The stools are pale
e) There is increased urobilinogen in urine
Increase in urobilinogen
--> as a marker of increased haemolysis
Typical biochemical findings in hemolysis include ↓ haptoglobin, ↑ LDH concentration, ↑ indirect bilirubin concentration, peripheral blood smear abnormalities (e.g., ↑ reticulocytes, schistocytes, spherocytes, polychromasia), and urinalysis abnormalities (e.g., hemoglobinuria, hemosiderinuria, and urobilinogen).
95
What drugs can be used in the treatment of Hepatitis B?
1. Nucleotide reverse transcriptase inhibitors (NtRTIs), e.g., tenofovir
2. Nucleoside reverse transcriptase inhibitors (NRTIs), e.g., entecavir (ETV
3. Pegylated interferon alfa (PEG-IFN-α) --> usually not done anymoredue to side-effects
96
What is the different between sporadic and variant prion disease?
How is each of them diagnosed?
Sporadic = Creitzfeld- Jacob disease, usually diagnosed with CSF analysis and increase in 14-3-3, s100 and Tau protein, no known cause
Variant = due to ingestion of prion protein, diagnosed with tonsillar biopsy (100% sensitive + specific)
97
What cauases UTIs in young women?
1. E.coli
2. Staphylococcus saprophyticus
98
A heavily pregnant (34+3) lady is newly diagnosed with HIV. Her viral load is 2,000 copies per mL of blood.
What medication should be given intrapartum to reduce the likelihood that her child will be infected by HIV?
Zidovudine
99
What 3 fungal antigens can you test for and what fungus do they respond to?
100
What pathogen causes athlete's foot?
trycophyton ruburm
101
Spot diagnsosis: discolourattion of superficial skin
Pityriasis versicolor
102
What monoclonal antibody can be used in the ttreatment of crohn's?
Vedulizumab (antit alpha 4 beta 7)
+ Natalizumab (anti alpha 4 beta 1)
103
What are the different pathways that can be targeted in the treatment of Rheumatoid arhtirits?
1. JAK1/3 inhibitor (inhibits production of inflammatory molecules)
2. Anti- CTLA4 (reduces co-stimmulation of T-cells)
3. Anti-CD20 (reduced antibody prouction)
4. Anti - IL6 (reduced macrophage, lymphocyte, neutrophil activation)
5. Anti TNF-alpha
+ Methotrexate
+
104
What are the different pathways that can be targeted in the treatment of psoriasis/psoriatic arthritis?
1. Calcineurin inhibitors (decreased T-cell activation)
2. JAK 1/2 inhibitors ( inhibits production of inflammatory molecules)
3. Anti - TNF alpha
4. **Anti IL-12/23
5. ANti-IL 17A**
+ Methotrexate
105
What are the different targets that can be used in treatment of ankylsosing spondylitis?
1. JAK1/3 inhibiotrs (reduce production of inflammatory molecules)
2. anti-TNF alpha
3. Anti TNF alpha/TNF beta
4. ANti IL17
106
What is the target of a potential monoclonal antibody that can be used in eosinophil-associated disease (asthma, eczema,)
IL4/5/13 blockade
107
What parasite is capeable of auto-reinfection via penetration of the GI tract or perianal skin?
Strongyloides
108
Name the drug used for patients with type 2 diabetes which inhibits the enzyme alpha glucosidase in the brush border membrane of the small bowel.
Arcabose
109
Name a sulphonylurea
Gliclazide
110
Name a DDP4 inhibittorr
Gliptins
Sitagliptin, Linagliptin
111
Name a GLP-1 agonist
Incretin (GLP-1 analogue –> peptide increasing insulin secretion )
(-atide/- glutide)
112
Recall he differentials for
1. Prolacinaemia <1000
2. Prolactinaemia 1000-5000
3. Prolactinaemia >5000
113
Match the lipid lowering drugs with the mechanism of action
1. Atrovastatin
2. PCSK9 inhibitors
3. Bile acid sequestrants
4. Ezetimibe
5. Niacin
6. Fibrates
a. Inhibits the enzyme that causes internalisation of LDL receptors
b. Inhibits cholesterone absorbtion at the brush border of enterocytes
c. Activation of the peroxisome proliferator-activated receptor alpha (PPAR–α)
d. Bind bile acid in intestine -->reduced bile acid resorbtion
e. Competitive inhibition of HMG-CoA reductase
f. Inhibits lipolysis and fatty acid release in adipose tissue by blockading hormone-sensitive lipase
1- e
2- a
3 - d
4- b
5 - f
6- c
114
What are some differentiating features between Myeloma kidney (cast nephropathy) and AL amyloiud renal damage?
Different pathopysiologieybut
1. Myeloma kidney usually presents with
* Ligh chain dominant proteinuria
* AKI
2. Amyloidosis
* Albumnin dominant proteiuria
115
Which agent is an Interleukin 6 (IL-6) inhibitor, indicated for treatment of severe COVID-19 infection with hypoxia?
Anakinra
Nafamostat
Palivizumab
Ruxalitinib
Tocilizumab
Tocilizumab
