Things I've Learned from EMQs - Path edition Flashcards Preview

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Flashcards in Things I've Learned from EMQs - Path edition Deck (147):
1

What is the particular test for PCP?

Gomorra's methenamine silver stain, which reveals 'flying saucer' shaped cysts on microscopy

2

How does strep pneumoniae appear?

Alpha haemolytic gram positive cocci arranged in pairs (diplococci). Catalase negative.

3

Which reaction with anti serum and methylene blue will enable you to visualise Strep pneumoniae under the microscope as a result of the capsule swelling?

Quelling reaction

4

How does staph aureus appear?

Beta haemolytic gram positive cocci in grape like clusters; catalase positive

5

How does Legionella appear?

Aerobic gram negative rod; to diagnose culture respiratory secretions on buffered charcoal yeast extract agar (can also use rapid urinary antigen testing)

6

How does moraxella catarrhalis present?

Aerobic gram negative diplococci

7

Which atypical pneumonia can be diagnosed with a cold-agglutinin test?

Mycoplasma pneumonia

8

What is a rare dermatological complication of mycoplasma pneumonia?

Stevens Johnsons syndrome

9

what does E coli look like?

Gram negative rod shaped

10

What are the CSF results in TB meningitis?

Colourless CSF with high protein, low glucose and raised lymphocytes

11

Which organism causes chancroid and what kind of bacteria is it?

Haemophilus ducreyi - gram negative coccobacillus (painful genital ulcer that leads to unilateral painful swollen inguinal lymph nodes)

12

Which organism causes donovanosis and what's the test for it?

Klebsiella granulomatis - giemsa stain reveals Donovan bodies

13

Which antibiotic should you use for MRSA?

Vancomycin

14

What do you use Chloramphenicol for?

Rocky Mountain spotted fever

15

Which diseases does HHV8 cause?

Kaposi's sarcoma, primary effusion lymphoma and multi centric Castleman's disease

16

Which organism causes pityriasis versicolor?

Malassezia fur fur

17

What is sporothrix schenckii?

Fungus in soil and plants that causes sporotrichosis (Rose gardener's disease). Prick by thorns causes nodular lesions to appear on the surface of the skin. Initially small and painless but if untreated they become ulcerated and infection can spread to joints, bone and muscle. Inhalation of spores can cause pulmonary disease and systemic infection can lead to CNS involvement. Treatment options: itraconazole, fluxonazole and oral potassium iodide.

18

What is histoplasma capsulatum?

Fungus transmitted by inhaled spores; highly prevalent in Mississippi River. Mostly subclinical but a minority of infections proceed to chronic progressive lung disease.

19

What is phialophora verrucosa?

Copper coloured soil saprophyte found on rotting wood that causes chromoblastomycosis - characterised by a warty lesion resembling a cauliflower

20

How do you diagnose brucellosis?

Blood culture on Castaneda medium

21

What is a another name for leptospirosis?

Weil's disease

22

What are the features of Rickettsia infection?

Rocky Mountain Spotted fever. Gram negative. Harboured in small wild rodents and domestic animals, transmitted by ticks. Invades endothelial lining of capillaries -> vasculitis. Features: headache, fever, myalgia, vomiting and confusion. Late signs: rash that is maculopapular and/or petechial on the distal parts of the limbs which then spreads to the face and trunk. May lead to thrombocytopenia, hyponatraemia and/or elevated liver enzymes

23

What is an atypical effect of cat scratch fever?

Parinaud's oculoglandular syndrome

24

How does MTB appear on Lowenstein-Jensen medium?

Rough, tough, buff - coffee coloured (buff), granular bread crumb like colonies (rough) which often stick to the bottom of the growth plate and are hard to remove (tough)

25

What is the stain for mycobacterium leprae?

Fite stain

26

What size induration on a mantoux test indicates TB?

>15mm in anyone, >10mm if recent immigrant, IVDU, high risk place, lab personnel, people with conditions that put them at risk, children 5mm if HIV, recent contact of person with TB, X ray changes suggestive of TB, organ transplant, immunosuppressed for other reasons

27

What bacteria does optochin differentiate between?

OVeR PS - Viridans resistant, Pneumococci sensitive

28

Which bacteria causes pneumonia with redcurrant jelly sputum?

Klebsiella pneumoniae

29

How should you treat gonococcal arthritis or gram negative joint infection?

IV cefotaxime for 4-6 weeks

30

How should you treat staphylococcal septic arthritis?

IV flucloxacillin for 4-6 weeks

31

When is oral vancomycin given for 10-14 days for C diff?

Third or subsequent episodes, severe infection, infection not responding to metronidazole, or patients who cannot tolerate metronidazole

32

When is IV metronidazole needed for C diff infection?

Patient not responding to vancomycin, infection is life threatening, patients with ileum

33

What is the diagnostic test of choice in sporadic CJD?

EEG

34

What is the treatment for spontaneous bacterial peritonitis?

Cefotaxime for 5 days, or another 3rd gen ceph

35

What's the difference between trypanosoma brucei gambiense and trypanosoma brucei rhodesiense?

Gambiense - Gradual infection (takes months/years to appear, chronic) west and central Africa, 95% of cases. Rhodesiense - Rapid infection (acute with symptoms appearing in weeks or moths), south and eastern Africa,

36

Which bugs transmit trypanosoma cruzi?

Reduviid bugs

37

Which type of malaria causes quartan malaria?

P malariae

38

Which type of malaria causes tertian malaria?

Falciparum, vivax, ovale

39

Which type of malaria causes quotidian malaria

Knowlesi

40

Which kind of malaria shows Maurer's clefts?

Falciparum

41

What do you need to check before starting a patient on anti malarial treatment?

G6PD levels - can cause acute haemolysis

42

Which kind of lung cancer has 'oat cells'?

Small cell

43

Which breast cancer is indicated by an 'artichoke like appearance' on histology?

Phyllodes tumour

44

Which is the most common type of lung cancer in non smokers?

Adenocarcinoma

45

Cytokines exerting an anti-viral effect

interferons

46

Immunoglobulin dimer

IgA

47

MHC associated with Th1 cells

MHC2

48

MHC associated with cytotoxic T cells

MHC1

49

Along with IgD, is one of the first immunoglobulins expressed on B cells before they undergo antibody class switching

IgM

50

Which component of the innate immune system is usually one of the first to respond to infection through a cut?

Neutrophil

51

The antiviral which is given to untreated pregnant women with HIV to prevent vertical transmission of the virus during childbirth.

Nevirapine

52

Used for the treatment of severe, resistant herpes infections

Foscarnet

53

Mechanism of action of Indinavir

acts by stopping post-translational cleaving of polyproteins by inhibiting proteases

54

drug which can be delivered by inhalation to treat both influenza A and B.

Zanamivir

55

Macrolides are USEFUL for -

- Methicillin Sensitive Staph aureus in penicillin allergic patients (who are thus also resistant to flucloxacillin)
- Group A Strep pharyngitis in penicillin allergic patients
- Ophthalmia neonatorum prophylaxis (gonoccocus, Chlamydia)

56

A liver enzyme raised after a myocardial infarction

. Aspartate transaminase

57

An enzyme markedly raised in obstructive jaundice along with direct bilirubin

. Total bilirubin

58

Possible features of DIGOXIN TOXICITY include:

arrhythmia: the most common arrhythmias are ventricular extrasystoles, ventricular bigeminy / trigeminy and atrial tachycardia with complete heart block

anorexia, nausea and vomiting and occasionally, diarrhoea

confusion especially in the elderly

yellow vision (xanthopsia), blurred vision and photophobia

59

activated charcoal is NOT helpful in poisoning with

cyanide, iron, ethanol, lithium, acid or alkali, pesticides

60

Colorimetric can be used to test for which drug commonly taken in overdose?

Paracetamol

61

Which of the above techniques can be used to analyse samples of stool, liver and also urine?

Liquid chromatography

62

Which drug is not excreted into saliva?

THC

63

What is the major antagonist of serine proteases at a site of injury

Alpha 1 antitrypsin

64

Features of alpha 1 antitrypsin deficiency

Symptoms of alpha-1 antitrypsin deficiency include shortness of breath, wheezing, rhonchi, and rales. The patient's symptoms may resemble recurrent respiratory infections or asthma that does not respond to treatment. Individuals with A1AD may develop emphysema during their thirties or forties even without a history of significant smoking, though smoking greatly increases the risk for emphysema.[1] A1AD causes impaired liver function in some patients and may lead to cirrhosis and liver failure (15%). In newborns, alpha-1 antitrypsin deficiency has indicators that include early onset jaundice followed by prolonged jaundice. It is a leading indication for liver transplantation in newborns.

65

Useful in staging and monitoring treatment of extracapsular spread of prostatic carcinoma (not PSA)

Acid phosphatase

66

A 19 year old African boy presented with cervical lymph nodes, 3 month history of night sweats and a 3kg weight loss. Lymph node biopsy showed the presence of Reed-Sternberg cells loss. Following chemotherapy which enzyme would you expect to be elevated?

Lactate dehydrogenase

67

McArdle’s glycogen storage disease (type V) - a deficiency in an enzyme involved in glycogen metabolism. Name this enzyme.

Mycophosphorylase

68

Fabry’s disease, an X-linked disorder of glycolipid metabolism due to deficiency of?

Galctosidase A

69

Askanazy cells were noted on thyroid biopsy, what's the condition?

Hashimoto's thyroiditis (hypothyroidism)

70

Neurotoxic product(s) of heme breakdown producing neurovisceral damage in certain porphyrias

5-aminolevulinic acid

71

What is Riddle's thyroiditis?

one manifestation of a systemic disease that can affect many organ systems called IgG4-related disease. It is often a multi-organ disease affecting pancreas, liver, kidney, salivary and orbital tissues and retroperitoneum. The hallmarks of the disease are fibrosis and infiltration by IgG4 secreting plasma cells

72

How does Nelson's syndrome come about?

In the old days, patients who had pituitary Cushing's had bilateral adrenalectomy as a treatment option. This would
leave the pituitary adenoma free to grow, and the ACTH would continue to rise. In addition POMC levels (precursor
to ACTH) would rise too. This would make patients become more tanned.

The pituitary tumour would get larger, and eventually cause real local problems, originally described by Nelson as
Nelson's syndrome.

73

Levels of this steroid are raised in the serum of CAH patients

17 hydroxyprogesterone

74

The sodium and potassium pattern seen in CYP21 deficiency.

hyponatraemia with hyperkalaemia

75

Increased levels are seen in the urine of CAH patients

pregnanetriol

76

Features of acute proliferative glomerulonephritis

Hematuria:[5]
Oliguria[6]
Edema[7]
Hypertension[7]
Fever, headache, malaise, anorexia, nausea.[8], post strep infection (signs of original infection often still present)

77

How do you calculate creatinine clearance?

Creatine clearance = (creatinine's urine concentration)* (Vol) / (plasma creatinine concentration) (note: the units have to match).

78

A liver enzyme raised after a myocardial infarction

AST

79

Varies with posture when sample is taken.

Albumin

80

Symptoms of under-treatment and toxicity may be similar

Digoxin

81

A 26-year-old woman collapses after a massive overdose of atenolol. She remains in cardogenic shock despite initial treatment with IV atropine - what do you give?

Glucagon

82

What sample is required for use with gas chromatography mass spectroscopy?

Blood

83

Colorimetric can be used to test for which drug commonly taken in overdose?

Paracetamol

84

Which of the above techniques can be used to analyse samples of stool, liver and also urine?

Thin layer chromatography

85

The most important cell in the initiation of normal haemostasis.

Endothelial cell

86

The main component involved in stabilising the primary haemostatic plug.

Fibrin

87

A serine protease which assists in the break down of blood clots by binding to the clot and localising agents which break it down.

Tissue plasminogen activator

88

A potent inhibitor of plasmin in the blood.

alpha 2 macroglobulin

89

Which key clotting factor activates both factors V and VIII, and also activates protein C?

Thrombin

90

Used to monitor patients undergoing warfarin therapy.

INR/PT

91

Used to monitor patients undergoing unfractionated heparin therapy.

APTT

92

Antiplatelet action. Indicated for primary prophylaxis of stroke in a patient experiencing recurrent retinal TIAs (amaurosis fugax). Ineffective for DVT prophylaxis.

Aspirin

93

Test which Reflects the amount and activity of fibrinogen

thrombin time

94

Antiplatelet action. Licensed for primary prevention of stroke in aspirin allergic patients, secondary prevention of stroke (but expensive) and in acute myocardial infarction in addition to aspirin.

clopidogrel

95

New (recommended, Tait) model of starting warfarin

5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days

96

In patients with cancer and acute venous thromboembolism, the most effective drug at reducing the risk of recurrent VTE is __

LMWH

97

This drug when given alone initially increases the clotting risk & Side effects include cutaneous necrosis

warfarin

98

The drug most likely to cause thrombocytopaenia with paradoxical thrombosis

unfractionated heparin

99

Contra-indicated if recent sore throat, if ever used before, or in the presence of proliferative retinopathy.

Streptokinase

100

In which condition might the sucrose and Ham acid haemolysis tests be positive?

PNH

101

A monoclonal immunoglobulin which appears as a dense narrow band (M band) on electrophoresis

Paraprotein

102

Misfolded protein deposited in myeloma-associated amyloidosis

AL amyloid

103

Induction chemotherapy regimen with the best evidence pre autologous stem cell transplant in multiple myeloma

Lenalidomide + low dose dexamethasone

104

Proteasome inhibitor active in myeloma

Bortezomib

105

Which paraprotein is most commonly raised in patients with multiple myeloma?

IgG

106

Elevated levels imply a poor prognosis in myeloma patients.

Beta2 microglobulin

107

Which cytokine is an important growth factor in the development of myeloma?

IL6

108

Monocytosis but with a normal neutrophil count could be?

Brucella infection

109

Neutrophilia with visible toxic granulation and vacuoles on the blood film. The monocyte count is normal.

Acute fungal infection

110

How do you treat corticosteroid refractory haemolytic anaemia?

Splenectomy

111

How do you treat CLL?

Cyclophosphamide, fludarabine and rituximab

112

How do you treat CML?

Imatinib

113

How do you treat polycythaemia?

Venesection and aspirin

114

How do you treat multiple myeloma?

Lenalidomide + low dose dexamethasone followed by autologous SCT

115

What immunosuppressant is used in solid organ transplantation, MS, NHL which depletes lymphocytes and has side effects of ITP and Graves' disease?

Cam path (anti CD52, alemtuzumab)

116

What is an add-on proteasome drug for myeloma?

Bortezomib

117

What is an anti proliferative drug used in polycythaemia rub vera and essential thrombocythaemia?

Hydroxyurea

118

Which drug reduces platelet count in thrombocythaemia but causes palpitations, tachycardia and fluid retention?

Anagrelide

119

What is a rescue drug for after high dose methotrexate is used for gestational trophoblastic disease or intrathecal ALL?

Leucovorin (folinic acid, formyl tetrahydrofolate)

120

Which drug is used in solid organ transplantation, MS, NHL that depletes B cells mor ethan T cells?

Rituximab (anti CD0)

121

The most common cause of UTI in catheterized men

E coli

122

The 2nd commonest cause of uncomplicated UTI in young women

Staph saprophyticus

123

Can be used as monotherapy for acute pyelonephritis and should always be prescribed orally because its bioavailability is near 100% and iv dosing is 30 times more expensive.

Ciprofloxacin

124

Causes haemorrhagic cystitis in children

Adenovirus

125

A cephalosporin used for treating pseudomonal infections in cystic fibrosis

Ceftazidime

126

In combination with iv ampicillin, this drug is used iv for very sick patients with obstructed infected upper UTIs and gram negative septicaemia.

Gentamicin

127

Blood cultures and wound swabs grew gram-positive cocci in chains, which grew on MacConkey plate and was aesculin-positive. This isolate was also resistant to the conventional anti-streptococcal antibiotics.

Vancomycin resistant enterococcus

128

gram-negative bacilli that produced a green pigment and was oxidase positive - wound infection

Pseudomonas aeruginosa

129

A 46 year old women presents to A&E out of breath and with severe chest pain. On examination a mid systolic click late systolic murmur is revealed.

Myxomatous mitral valve

130

Features of VIPoma

The major clinical features are prolonged watery diarrhea (fasting stool volume > 750 to 1000 mL/day) and symptoms of hypokalemia and dehydration. Half of the patients have relatively constant diarrhea while the rest have alternating periods of severe and moderate diarrhea. One third have diarrhea

131

Whipple's disease

rare, systemic infectious disease caused by the bacterium Tropheryma whipplei. First described by George Hoyt Whipple in 1907 and commonly considered a gastrointestinal disorder, Whipple's disease primarily causes malabsorption but may affect any part of the body including the heart, brain, joints, skin, lungs and the eyes.[1] Weight loss, diarrhea, joint pain, and arthritis are common presenting symptoms, but the presentation can be highly variable and approximately 15% of patients do not have these classic signs and symptoms.[2] Whipple's disease is significantly more common in men, with 87% of the patients being male.[3] When recognized and treated, Whipple's disease can usually be cured with long-term antibiotic therapy; untreated, the disease is ultimately fatal.

132

Differentiation of this is regulated via the RANK gene product.

Osteoclasts

133

Covers cortical surface of bone and delivers blood supply

Periosteum

134

This type of bone is 80-90% calcified and its function is mainly mechanical and protective

Cortical

135

`This type of bone is immature and usually pathological.

Woven

136

An 18 year old student presents to his GP with focal pain in his left fore-arm which is tender to touch and worsens at night. The pain is relieved with aspirin. An X-ray shows a 1cm are of radio-lucency in the tibia surrounded by dense bone.

Osteoid osteoma

137

A 14 year old boy complains to you of a painless lump on his left thigh, just above the knee which is slowly growing. His past medical history reveals that he fractured his femur in the same location several years before.

Osteochondroma

138

A 15 year old girl shows you a small lump on her upper arm on routine examination. She says the lump has been present for a couple of years and has slowly moved down, away from her shoulder.

Simple bone cyst

139

An 8 year old boy is brought to his GP by his parents with pain in his hips and a fever. Blood results demonstrate a raised ESR and biopsy histology shows droplets of glycogen in the cytoplasm of small round cells in the pelvic bones.

Ewing's tumour

140

Ovarian - Squamous epithelium mixed with intestinal epithelium

Mature cystic teratoma

141

Ovarian - Fibrous tissue containing spindle cells and lipid

Thecoma

142

Ovarian - Malignant signet ring cells containing mucin

Krukenberg tumour

143

Germ cell tumour originating in testis that is radiosensitive and classically presents in the 4th decade.

Seminoma

144

Very aggressive tumour producing HCG and AFP; neoplastic cells are anaplastic.

Embryonal carcinoma

145

Very aggressive HCG-producing tumour composed of cytotrophoblast and syncytiotrophoblast cells that metastasizes early.

Choriocarcinoma

146

Commonest malignant cause of testicular mass in those aged under 5.

ALL

147

Commonest malignant cause of testicular mass in those aged 60

Diffuse large B cell lymphoma