1
Q
Enzyme raised in mumps
A
Amylase
2
Q
Impaired oxidative killing is in what condition
A
Chronic Granulomatous Disease
3
Q
What test? Low aldosterone
A
SynACTHen test
4
Q
What test? Raised plasma glucose
A
Fasting glucose, oral glucose tolerance test
5
Q
- Primary Hyperparathyroidism
- Secondary Hyperparathyroidism
- Tertiary Hyperparathyroidism
- Hypoparathyroidism
- Osteomalacia
- Paget’s
- Osteoporosis
- Pseudohypoparathyroidism
- Pseudopseudohypoparathyroidism
- Familial Hypocalciuric Hypercalcaemia
A
- Raised PTH due to an adenoma
- Secondary to low calcium (kidney disease)
- Chronic secondary hyperparathyroidism causes hyperplasia of the parathyroid gland
- Primary is due to parathyroid gland defect so not enough PTH secreted. Can be secondary to surgery
- Vit D deficiency, so raised PTH and ALP
- Raised ALP, defective bone mineralisation
- Normal, due to reduced bone density
- Resistance to PTH, so PTH levels are up and calcium is low
- Normal bone biochehmistry
- Raised calcium because of mutation which means calcium level estimation is inaccurate so PTH is released more
6
Q
- Raised TSH, Low T4
- Raised TSH Normal T4
- Raised TSH, Raised T4
- Low TSH, Raised T4
- Low TSH, Low T4
- Raised TSH, Normal T4 in severely sick patient
A
- Primary hypothyroidism
- Subclinical hypothyroidism
- Secondary hyperthyroidism (TSH tumour OR thyroid hormone resistance)
- Primary hyperthyroidisim
- Secondary hypothyroidism
- Sick euthyroid
7
Q
Conn’s Syndrome aldosterone:renin ratio
A
High
8
Q
Mechanism of non functioning adenoma
A
Stalk obstructed, so dopamine can’t inhibit prolactin function. Symptoms are amenorrhoea, galactorrhoea and gynaecomastia
9
Q
Macroadenoma signs and symptoms
A
Low levels of TSH, GH, ACTH and bitemporal hemianopia
10
Q
Calcitonin is produced by…and is elevated in what tumour
A
Parafollcular cells and acts on reducing Ca levels in the blood. Elevated in medullary thyroid tumour. Congo red stain can be used because of deposition
11
Q
Vitamin A deficiency
A
Night blindness
12
Q
Vitamin E deficiency
A
Neuropathy, anaemia, ataxia
13
Q
Vitamin D deficiency
A
Osteomalacia
14
Q
Vitamin K deficiency
A
Defective clotting
15
Q
Beri Beri or Wernicke’s
A
Thiamine, B1, red cell transketolase
16
Q
Glossitis, Angular Stomatitis, corneal ulceration
A
Riboflavin, B2, glutathione reductase
17
Q
Dementia, Diarrhoea, Dermatitis (Casal’s necklace)
A
Niacin, B3
18
Q
Dermatitis and anaemia, neuropathy if high
A
Pyridoxine, B6, red cell AST activation
19
Q
megaloblastic anaemia
A
B12, serum b12
20
Q
Bleeding gums, if high, causes stones
A
Vitamin C
21
Q
hypothyroidism and goitre, deficiency
A
Iodine
22
Q
Wilson’s disease
A
raised copper, low ceruloplasmin
23
Q
dental caries
A
fluoride
24
Q
Hypoinsulinaemia and hypoglycaemia without ketones
A
inerhited metabolic disorder
25
Enzyme raised in rhabdomyolysis
Creatinine kinase
26
A condition that causes hepatic cirrhosis and portal hypertension in some and cardiomyopathy in others
Haemochromatosis
27
present with joint pain, splenomegaly, skin rash, nerve and kidney involvement – Ig precipitate at low temperatures.
Hepatitis C Cryoglublinaemia
28
megakarycotes dominate BM, 50% JAK-2, platelet count > 600 x 109, see DVT or PEs or haemorrhage (as platelets dysfunctional), erythromelalgia, splenomegaly, dizziness, headache, visual disturbances
Essential Thrombocythaemia
29
– where haemoglobin in urine due to viral infection then on rewarming they get complement mediated haemolysis – see Donath-Landsteiner antibodies, it is self-limiting, transfusion if severe anaemia.
Paroxysmal Cold Haemoglobinuria
30
TTP
```
MAHA
Fever
Renal failure
CNS signs
Haematuria
Low platelets
```
31
antibodies against GpIIb/IIIa on platelets; self-limiting in children, chronic in adults
ITP
32
<37*C, IgM, positive DAT, spherocytes, often with Raynaud’s, causes = primary idiopathic, lymphoma, infections – EBV and mycoplasma, treat underlying condition, avoid cold and give chlorambucil.
Cold Agglutinins Cold AIHA
33
Low ferritin anaemia
IDA
34
Raised ferritin anaemia
Anaemia of chronic disease
35
Normal ferritin anaemia
Thalassaemia
36
When is TIBC low rather than high?
Haemochromatosis and chronic haemolysis
37
Anti-Xa assay
Monitor heparin
38
Fibrinogen is low in
Liver disease and DIC
39
D-dimer is to rule out
PE
40
Physiological changes in pregnancy
```
Mild anaemia but RBC mass rises
Plasma volume also rises so net dilution
Macrocytosis
Neutrophilia
Less platelets, but bigger size
```
41
Pre-eclampsia, low platelet + abnormal clotting
DIC
42
Haedache and Seizures, signs of MAHA
TTP
43
After transfusion, temperature is over 40
Bacterial infection
44
Recurrent hypoglycaemic attacks
Insulinoma
45
Recurrent ulcers
Zollinger Ellison Syndrome
46
Prolonged watery diarrhoea tumour of pancreas
VIPoma
47
Tumour of alpha cells of pancreas, necrolytic migratory erythema, raised glucose, lots of gluconeogenesis
Glucagonoma
48
fat necrosis tumour, lots of non specific symptoms
Acinar cell carcinoma
49
multiparous, poorly defined palpable periareolar mass with thick, white nipple secretions, may cause pain and nipple retraction and little blood, granulomatous inflammation and dilation of large breast ducts as acini secretions
Duct ectasia
50
mobile lump
fibroadenoma
51
bloody discharge, lump not seen
duct papilloma
52
Non-smokers cancer
Adenocarcinoma
53
Responds to chemo lung cancer
small lung cell carcinoma
54
Guy being hit on the side of his head + lucid interval, which artery did her burst
middle meningeal for extradural
55
CATCH 22
```
cardiac problems
atresia
thymus aplasia
cleft palate
hypocalcaemia
22q11 deletion
```
56
E Coli 0157, anaemia, thrombocytopenia and renal damage
HUS
57
Tinea capitis
scalp affected
58
Tinea corporis
ring worm on rest of body
59
Tricophyton Rubrum
Athletes foot
60
old people meningitis gram positive rod or bacilli
Listeria
61
What sexually transmitted bacteria can transmit to baby via placenta, esp in late pregnancy
Syphillis
62
What protozoa infection in pregnancy can be passed on to baby
Toxoplasmosis
63
Neonatal conjunctivitis
Chlamydia trachomatis
64
Causes hydrops fetalis if caught in first 20 weeks
Parvovirus B19
65
Disease that require C-section if mother has an outbreak at 34wks or later due to risk of transmission vaginally
Genital Herpes
66
Disease which if transmitted to baby: they can initially be symptomless but then come down with problems - long term sequelae.
CMV maybe
67
Broad spec, no pseudomonal activity usually given with a beta lactamase inhibitor
Amoxicillin
68
DNA synthesis inhibitor used to treat Pseudomonal infections but bad against anaerobes
Ciprofloxacin
69
Macrolide/lincosamide/streptogrammin group used to treat some atypical pneumonias
Erythromycin
70
Vaccine prevents Lockjaw symptom
Tetanus
71
Appendix that is full of neutrophils and is enlarged touching the peritoneum
Inflammation
72
What material is seen in the vessel of a patient with an MI due to burst atheroma
plaque
73
Patient had an appendectomy 1 week ago. What would you see in their scar
Granulation tissue
74
Radiosensitive cancer of the testicle in a young man with a white/smooth appearence?
Seminoma
75
Patient with a cancer in their bladder following chronic
Squamous cell carcinoma
76
Myeloma like patient but has lymphadenopathy, hyperviscosity and hepatosplenomegaly IgM involved
Waldenstroms Macroglobulinaemia
77
70-something year old, overweight patient with diabetes presents with chronic back pain and mildly raised creatinine. GFR was 55? Paraprotein at 12g/dl
MGUS consider possible Amyloidosis
Path Past
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