Flashcards in Revision Deck (275):
Ach receptor blocked by autoantibodies resulting in weak , but not atrophied, muscles
Pernicious anaemia is lack of absorption of what? Why?
B12 due to lack of intrinsic factor
what does ANCA stand for?
anti-neutrophil cytoplasmic antibodies
3 forms ANCA vasculitis
Granulomatosis with polyangitis
Eosinophilic granulomatosis with polyangitis
All forms of ANCA vasculitis have what? Some have what?
ANA is positive in what type of raynauds?
Skin fibrosis and tightening in fingers and face, finger ulcers, lung fibrosis=? What antibody?
What is a positive predictive value?
Proportion of people with a positive test who have the target disorder (true positive/all positives)
Type II hypersensitivity reaction called what? Which antibodies? Example?
IgM and IgG
Type III hypersensitivity reaction called what? Which antibodies? Example?
IgG/M (+ antigen = complex)
Type IV hypersensitivity reaction called? Mediated by what? Example?
In a type I hypersensitivity reaction, Th2 cells secrete what, and what stimulates them to do so?
APCs stimulate them (using the allergen)
to secrete IL4 to B cells
IL-3,5,GM-CSF to eosinophils
In a type I hypersensitivity reaction, B cells, having been activated by IL-4, do what?
Produce IgE which degranulates mast cells to stimulate the initial and late responses.
Also releases IL3 and IL5 to stimulate eosinophils
In a type I hypersensitivity reaction, eosinophils, having been activated by IL3,5,GM-CSF, do what?
Degranulate and activate the late phase response.
T cell deficient patients present with what? How to treat?
Stem cell transplant, somatic gene therapy
B cell deficient patients present with what? Treatment?
Recurrent pyogenic bacterial infection
Antibiotics then IV IgG
X linked agammaglobulinaemia is a type of?
B cell deficiency
Phagocyte deficient patients present with what?
Recurrent, prolonged infections that respond poorly to Abx.
Skin and mucous membranes
C1,2,4 deficient patients present with what?
Immune complex symptoms e.g malar rash, vasculitis
C3 deficient patients present with what?
Increased susceptibility to bacterial infection- pneumonia, sepsis, meningitis
C5-8 deficient patients present with what?
Recurrent neisserial infection (meningococcal meningitis)
Immune stimulants other than immunisation?
alpha, beta, gamma interferons
3 classes of immune suppressant
4 lymphocyte targeting therapies
IL-2 receptor MABs
What are the classical HLA antigens? What region codes for them?
A, B, C
Class I region
Class II region encodes which HLAs?
HLA-DR, DQ, DP
Class III region encodes which MHCs?
HSP70, TNF, C4a, C4b, C2, BF, CYP21
Where are all of the classical HLAs found?
All nucleated cells
What sort of expression do MHC genes have?
3 types of recognition of the foreign body in transplantation?
Direct (T cells bind directly to graft)
Indirect (graft peptides)
Semi-direct (in lymph nodes)
What is cRF/sensitisation percentage?
percentage of deceased donors that will not be a suitable match
What is the minimum inhibitory concentration of an antibacterial agent?
Minimum concentration at which visible growth is inhibited
Aminoglycosides bind to what to inhibit protein synthesis?
Macrolides etc. bind to what to inhibit protein synthesis?
Tetracyclines bind to what to inhibit protein synthesis?
Oxazolidinones bind to what to inhibit protein synthesis?
Cephalosporins treat what?
Gram negative bacilli
Action of aciclovir? Used to treat?
Oseltamivir and zanamavir
Rx Hep C and RSV
Rx Hep C and B
Ciprofloxacin is what type of antibiotic?
Co-amoxiclav is what type of antibiotic?
Which antifungal is nephrotoxic?
Which antifungals are hepatotoxic?
Allylamines and azoles- ergosterol synthesis inhibitors
Ascariasis type of pathogen
Ascariasis where in body?
Digestive system, migrates to lung (Loeffler's syndrome)
Schistosomiasis action in body?
Matures in GI blood vessels, exists in faeces after sexual reproduction
Definitive and intermediate hosts in schisto?
Definitive and intermediate hosts in hyatid?
Type of pathogen in hyatid
Platyhelminth- tape worm
4 plasmodiums in malaria and which is most common
Faeco-oral human to human
Measles type of virus
What involves cough, conjunctivitis, coryza?
What do you get prior to measles rash?
Slapped cheek syndrome caused by which virus?
'everything else' infant viral rash? Dx of exclusion
Croup is caused by what?
Respiratory virus with conjunctivitis and diarrhoea is likely to be what?
The frequency of reactions decreases with number of doses in live or inactivated vaccines?
Difference between sterilisation and disinfection?
Sterilisation is killing all micro-organisms, disinfection is just killing sufficient numbers to make an item safe to use.
Disinfection applied to the skin is what?
Decontamination method of surgical equipment
Decontamination method of syringe needle
gamma irradiation and disposal after use
Decontamination method of surgeons hands
Decontamination method of flexible endoscope
Decontamination method of catheter insertion site
Pa O2 of respiratory failure
more than 8.0kpa
Type 1 resp failure pa O2 and what is driving it?
less than 6.3kpa, hypoxic
Type 2 resp failure pa O2 and what is driving it?
more than 6.3kpa, hypercapnic drived
4 types non-small cell lung carcinoma
Undifferentiated large cell
Large cell neuroendocrine
What type of cancer can mimic pneumonia?
CD56 detects what?
Neuroendocrine lung tumours
4 features typical carcinoid tumours? (lung cancer)
No necrosis, bland
Distant mets are rare
NOT assoc with smoking
May occlude bronchioles
TTF is expressed by which 3 lung cancers?
Undifferentiated large cell
What colour asbestos is the worst?
Small plaques on parietal pleura + effusion =?
Which type of pneumonia in elderly and diabetic and alcoholic?
3 distributions of emphysema
Panlobar (alpha-1-anti trypsin)
Acute interstitial lung disease is?
Adult resp distress synd
What cellular change is seen in acute interstitial lung disease?
Type II pneumocyte hyperplasia
Appearance of chronic interstitial lung disease?
What 2 serum substrates are increased in sarcoidosis?
Calcium and ACE
Dx criteria for chronic bronchitis?
Productive cough on most days during at least 3 months of 2 successive years (with no alternative cause)
90% lobar pneumoniae is due to which pathogen?
2 pathogens that cause hospital acquired pneumonia?
2 pathogens that are spread from person to person causing community acquired pneumonia
Pathogen from the environment that might cause community acquired pneumonia
Animal derived cause of community acquired pneumonia
4 atypical pneumonias
Rare complications of Mycoplasma pneumonia?
Neuropathies, guilliane barre
Incidence of Chlamydophila pneumonia is highest in what group?
What score is used to quantify the severity of pneumonia?
Paul Bunnell Test is for what?
Rx malignant otitis externa
ceftazidime then ciprofloxacin
3 features mycobacteria
waxy cell wall (high in lipids)
combination therapy required
2 mycobacteria that cause TB
BCG is against which?
m. tuberculosis and m.bovis
Bovis is BCG
how does primary TB present?
What is another name for disseminated TB?
After the TB pathogen has multiplied, what are the 2 things that can happen?
Latency or dissemination
Rifampicin, isoniazide (4 months), pyrazinamide, ethambutol or streptomycin (2 months)
If pericarditis or meningitis then add steroids
Sites other than meninges- 6 months
Tuberculoid leprosy is what cell type response? What symptoms?
Skin plaques and nerve involvement
Lepromatous leprosy is what cell type response? Symptoms?
Subcut tissue accumulation
Earlobes and face
Rx m. leprae?
Dapsone, rifampicin, clofazimine
2 types oesophageal carcinoma?
Barrett's oesophagus leads to which cancer?
Adenocarcinoma of the oesophagus
4 types gastric carcinoma, which is most common?
CDH1/E-cadherin mutation = ?
Hereditary diffuse type gastric cancer
Pathogenesis of coeliac disease?
Gliadin in gluten induces epithelial cells to express IL-15
Causes actiation of CD8+ and IELs
These are cytotoxic
2 cancer types assoc with coeliac?
Enteropathy- associated T cell lymphoma
Small intestinal adenocarcinoma
3 investigative tests for coeliac?
IgA antibodies to TTG
IgA or G antibodies to deamidated gluten
Where in the bowel are diverticula, commonly?
Where on the circumference of the bowel are diverticula often positioned?
Between the mesenteric and antimesenteric taenia coli
Pathogenesis of diverticula?
Increased intra luminal pressure + points of relative weakness in the bowel wall
short bowel syndrome is a complication of what?
Apthoid and fissuring ulcers are in crohns or UC?
Strictures are common in crohn's or UC?
No spontaneous fistulae are present in crohns or UC?
Crypt abscesses are common and crypt distortion is severe in crohn's or UC?
Granulomas present in crohns or UC?
7 extra-intestinal manifestations of IBD?
Which hyperplastic polyps may give rise to microsatellite unstable carcinoma?
Large, right sided
What benign polyp is a CRC precursor?
2 genetic traits that increase susceptibility to colorectal cancer
FAP is due to a mutation in what?
APC tumour supressor gene
HNPCC also increases risk of which cancers?
Endometrial, ovarian, gastric, small bowel, urinary tract, biliary tract
HNPCC what mutation?
DNA mismatch repair genes
Pathogens that cause intra abdominal infection
Rx of intra abdominal infection of intestinal source
Cefuroxime and metronidazole if under 65
Piperacillin/tazobactam if over 65
Then depends on culture results
Pain in shoulder
Pleural effusion/lung collapse
Pathogens that cause gastroenteritis?
Norovirus and Rotavirus
How might you catch cryptosporidium gastroenteritis?
Waterborne- e.g. swimming pool or salad washed in infected water
Of the bacterial causes of gastroenteritis, which produce enterotoxins and which act by adherence?
C. diff and C. perfringens
EHEC/VTEC form of E.coli =?
ETEC form of E.coli =?
EIEC form of E.coli =?
Enteroinvasive dystentry like
EPEC form of E.coli =?
E Coli 0157 releases what virulence factor?
Shiga toxin mechanism?
It is the bacteria itself not the toxin.
Typhoidal strains of salmonella do what?
Affect cells outside of GI tract and spread
Avoid abx unless very young/old, campylobacter infection or it has invaded (positive blood cultures)
Abd may make e coli hus worse or increase the duration of salmonella carriage
Type of colitis in abx associated diarrhoea?
rx c diff
metronidazole or vancomycin
8 causes aseptic meningitis
Partially treated bacterial
2 main causes of viral meningitis?
Herpes virus (HSV2, VZV)
2 extra signs of viral meningitis seen in neonates/infants?
Bluging anterior fontanelle
What is Kernig's sign?
Flexing neck causes hips and knees to flex
What investigation must you do ASAP in viral meningitis (and what would contraindicate it?) What is the gold standard test?
Lumbar puncture unless raised ICP (do a CT to check)
Gold standard is viral PCR
difference in CSF between bacterial and viral meningitis?
White cell count- B very high, V high
Predominant WBC- B neutrophils, V lymphocytes
Protein- B high or very high, V normal or high
Glucose- B low, V normal
Rx viral meningitis
If risk of bacterial then abx
What is Mollaret's meningitis?
Recurrent aseptic, normally HSV2
Viral meningitis + fever, lymphadenopathy, pharyngitis, rash =?
Viral encephalitis causes that are different to meningitis?
HSV1, rubella, rabies, acute disseminated encephalomyopathy
Rx viral encephalitis
High dose aciclovir
What is ADEM?
Immune mediated CNS demyelination
Difference between onset of encephalitis and brain abscess?
Encephalitis is acute
3 causes of bacterial meninigitis?
Rx of bacterial meningitis?
Ceftraixone and cefotaxime
Rifampicin to contacts
+steroids for s. pneumoniae
3 causes neonatal meningitis
Group B strep
Rx neonatal meningitis
Ampicillin and gentamicin
Marfan syndrome is associated with what valvular heart disease?
Cyanosis in R to L or L to R shunts?
R to L
Downs syndrome is associated with which heart defect?
Which 3 heart conditions require a shunt to survive?
Transposition great arteries
Total anomalous pulmonary venous connection
Coarctation of the aorta is associated with what genetic defect?
Murmur in aortic regurg
Murmur in mitral stenosis
Opening snap and diastolic
Murmur in aortic stenosis
Murmur in mitral regurg
3 types endocarditis
Non bacterial thrombotic
Endocarditis of SLE (Libman-Sacks Disease)
What pathogen found to be causing infective endocarditis should prompt investigation for bowel cancer?
Signs of infective endocarditis
fever, roth spots, osler's nodes, murmur, janeway lesions, anaemia, nail haemorrhage, emboli
In whom does non-bacterial thrombotic endocarditis occur?
Debiliated patients in hypercoagulable state
Which valves affected in Libman-Sacks endocarditis?
Mitral and tricuspid (atrioventricular valves)
Aschoff bodies are found in what?
3 pathogens that cause infective endocarditis
5 types acute pericarditis and their causes
1. purulent (infection)
2. serous (adjacent inflammation)
3. Caseous (TB or fungal)
4. Fibrinous/serofibrinous (Dressler's syndrome post MI)
5. Haemorrhagic (trauma, neoplasm, surgery, infection)
3 types chronic pericarditis
-Adhesive mediastino pericarditis (follows pericarditis caused by infection, surgery, radiation)
4 classes of cardiomyopathies
-Arrythmogenic right ventricular
4 causes of dilated cardiomyopathy
Genetic, myocarditis, alcohol/toxin, autoimmune
Cause hypertrophic cardiomyopathy
Sign of hypertrophic cardiomyopathy on examination?
Systolic ejection murmur
Restrictive cardiomyopathies are either idiopathic or secondary to which 5 things?
Inborn errors of metabolism
Myocarditis is caused by which two infections?
Coxsackie virus A+B
Giant cell arteritis is a type of? It involves what sort of inflammation?
What type of cells are seen in giant cell arteritis?
Multi-nucleated giant cells
Rx giant cell arteritis?
Corticosteroid, anti TNF
6 types aneurysm
Micro and syphilitic
Which type of aneurysm is associated with subacute bacterial endocarditis?
3 signs nephrotic syndrome
5 signs acute nephritis
What is nephrotic syndrome?
5 causes nephrotic syndrome
minimal change disease
6 causes acute nephritis?
Henoch schonlein purpura
Myeloma can have what effect on the kidneys?
Immunoglobulins in the tubules
Major cause of CKI and 3 other causes
Haematuria + ear and eye problems = ?
Alport type hereditary nephrophathy
4 caues proteinuria
Henoch schonlein purpura
4 possible composition of renal stones?
Struvite (Mg NH4+ P)
Cause of struvite stones
Urease producing bacterial infection (urease converts urea to ammonia)
Staghorn caliculi are a sign of which type of stone?
What is the gold standard investigation for renal stones?
Majority of renal cancers are what tyoe?
Renal cancer is associated with which genetic disease?
Von Hippel-Lindau syndrome
Foamy cell renal tumours are likely to be
True or false renal cell carcinoma responds well to chemo?
Urothelial cell carcinoma is found in the?
Prostate carcinomas normally arise from which zone of the prostate?
Seminoma or teratoma is after puberty?
What serum substrates are increased in seminoma?
PLAP and hCG
True or false teratomas do not secrete tumour markers
Pain and swelling in the epididymis following a vasectomy
Inflammatory and myofibroblastic mass in the testis of unknown aetiology
Myofibroplastic pseudotumour of testis
Swollen, tender testis with flu-like illness and a granulomatous mass
Idiopathic granulomatous orchitis
Painless scrotal swelling
Caseating, granulomatous inflammation, fibrosis
Infarcted seminiferous tubules
Yellow/brown nodules and histiocytes in testis
Cefuroxime, ciprofloxacin (or pip and tazo if over 65)
3 common pathogens that cause UTIs
Staph saprophyticus (GP)
Enterococcus ssp (hospital)
What is urethral syndrome?
Symptoms UTI w/o infection
When would you treat asymptomatic bacteriuria
Prior to urological procedures
Thalassaemia leads to what type of anaemia?
Megaloblastic macrocytic anaemia can be caused by what?
B12 or folate deficiency
Pathogenesis of acute haemolytic reaction (ABO incompatibility)
Release of free Hb
Fatigue, jaundice and fever 3-14 days post blood transfusion =? Due to what?
Delayed haemolytic reaction
Due to RBC antigens other than ABO
What does coomb's test detect?
True or false febrile non haemolytic transfusion reaction is life threatening?
Prothrombin time measures which pathway?
Time from thrombin to fibrin is measured by what test?
Thrombin clotting time
4 in vivo anticoagulants
What does the fibrinolytic system involve?
Plasmin an ezyme that causes fibrin breakdown
Plasminogen cleaved by plasminogen tissue activator to plasmin
Alpha 2 anti plasmin mops up excess plasmin in plasma
Coagulation problems that are platelet/vessel wall defects give rise to what sort of symptoms?
Mucosal and skin bleeding e.g. heavy periods, nose bleeds
Coagulation problems that are coagulation defects give rise to what sort of symptoms?
Deep muscular and joint beds
VW disease affects what part of clotting?
True or false haemophilias VIII and IX have different presentations to each other
Which clotting test is abnormal in VWD and haemophilia?
What is a treatment of VWD that stimulates VWF release?
DDAVP a vasopressin/ADH analogue
Patients with liver disease invariably have what blood problem?
4 features of impaired haemostasis in liver disease?
Low and dysfunctional platelets
Reduced synthesis of all coagulation factors except VIII
Fibrin polymerisation is delayed
Excessive plasmin activity
Massive transfusion can have what 2 problems?
Dilutional depletion of platelets and coagulation factors
What chromosomes are the different Hbs found on?
Gamma, delta and beta- 11
4 acute complications of sickle cell disease
Chronic complications of sickle cell disease
Leg ulcers, osteomyelitis, gall stones, retinopathy, cardiac, respiratory
True or false sickle cell is an inflammatory condition in some ways
Alpha thalassaemia results in which 2 types of Hb?
Hb Barts and HbH
True or false alpha thalassaemia trait is clinically significant
Thalassaemia beta major has what 6 features?
Skeletal abnormalities and stunted growth
Increased BM activity so increased iron absorption
Splenomegaly (RBC pooling)
Rx thalassaemia beta major?
Transfusion to maintain Hb and suppress rbc production
And chelation with desferrioxamine to get rid of excess iron.
What do most thalassaemia maj beta patients die of?
Blood differences in pregnancy?
Fe and folic acid used
3 main areas of chronic myeloproliferative disorders
Symptoms polycythaemia vera
Redness, itching, gout, splenomegaly
Some causes of secondary polycythaemia?
Chronic lung disease
EPO producing tumours
What mutations are associated with thrombocytosis and myelofibrosis?
JAK2 and CALR
Thrombocytosis is increase in what?
Megakaryocytes and platelets
What are the two types of thrombocytosis?
What is myelofibrosis?
What are the symptoms of myelofibrosis?
Fever, weight loss, night sweats
Chronic myeloid leukaemia symptoms
Leukoerythroblastic blood picture
What chromosome is associated with CML?
Philadelphia (9 and 22 swap= cell proliferation = active tyrosine kinase. Inhibited by imatinib)
Name the two light chains of Igs
Kappa and lambda
What 2 states precede myeloma?
MGUS, asymptomatic myeloma
What are the diagnosis criteria for myeloma?
more than 10% BM plasma cells neoplastic
Lump of plasma cells found
One of more of either CRAB or MDEs
hyperCalcaemia, Renal insufficiency, Anaemia, Bone lesoins
What can myeloma go on to become?
Plasma cell leukaemia
AKI and myeloma is what?
A medical emergency! Give steroids
Non hodgkins lymphoma is what?
Too many follicles in lymph nodes, lump on neck