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Year 4 TCDs > Cancer, Skin and Infection > Flashcards

Cancer, Skin and Infection Flashcards

1
Q

Name the 2 lactogenic hormones

A
  1. Prolactin - secreted by the anterior pituitary

2. Human placental lactogen (hpL) - secreted by the placenta

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2
Q

What are the 3 components of the ‘triple assessment’ diagnostic method for breast cancer?

A
  1. Clinical assessment
  2. Imaging assessment
  3. Needle biopsy
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3
Q

What is a common consequence/ side effect of axillary node clearance?

A

Lymphedema of the arm

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4
Q

What are the 2 views used in a standard mammogram?

A
  1. Mediolateral oblique

2. Craniocaudal

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5
Q

Define Karyorrhexis

A

Breakdown of the cell nucleus

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6
Q

Name the 2 principle groups of lymph nodes that drain the breast

A
  1. Axillary nodes

2. Internal mammary nodes

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7
Q

Define the 3 surgical levels of axillary lymph nodes

A

Level 1 - Inferior to the pectoralis major
Level 2 - Posterior to pectoralis major
Level 3 - Superior to pectoralis major

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8
Q

What is the principle reason for the use of the mediolateral oblique view in a standard mammogram?

A

To ensure good visualisation of the axillary tail

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9
Q

In what area of the breast to cancers most commonly occur?

A

~ 50 % of cancers are found in the upper out quadrant of the breast

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10
Q

What 3 factors are taken in to consideration for a pathological grading of a tumour sample?

A
  1. Amount of gland formation
  2. Nuclear features
  3. Mitotic activity
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11
Q

Name an example of anti-oestrogen therapy

A

Tamoxifen

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12
Q

Name an example of monoclonal anti-HER2 therapy

A

Trastuzumab (Herceptin)

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13
Q

What is the most common form of breast cancer?

A

Invasive ductal carcinoma

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14
Q

What is the second most common form of breast cancer?

A

Invasive lobular carcinoma

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15
Q

Give 3 clinical indications for mastectomy

A
  1. Multifocality
  2. Local recurrence
  3. DCIS or invasion >4cm
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16
Q

Suggest 4 factors to consider when assessing a patient with breast cancer for adjuvant chemotherapy

A
  1. Stage of tumour
  2. Tumour phenotype
  3. Age
  4. Co-morbidities
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17
Q

What is the PREDICT online tool?

A

Decision algorithm used to estimate the breast cancer survival rate of a patient and the potential benefits of hormone therapy, chemotherapy and trastuzumab

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18
Q

Give 4 potential side effects of tamoxifen

A
  1. Endometrial thickening
  2. Cataracts
  3. DVT
  4. Vaginal dryness and other menopausal symptoms
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19
Q

How does breast density affect an individuals risk of developing breast cancer?

A

Women with dense breast has a risk of breast cancer ~ 5 times that of women with fatty breasts

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20
Q

What is lactational mastitis?

A

A women’s breast become painful, swollen and red - this is most common in the first 3 months of breast feeding

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21
Q

Name a complication associated with lactational mastitis

A

Breast abscess

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22
Q

What is the primary cause of mastitis in lactating women?

A

Milk stasis

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23
Q

What is the most common organism associated with infectious mastitis in lactating women?

A

Staph Aureus

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24
Q

Give 5 clinical conditions that have an association with peripheral mastitis

A
  1. Diabetes
  2. Rheumatoid arthritis
  3. Trauma
  4. Corticosteroid treatment
  5. Granulomatous lobular mastitis
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25
Q

What are the most common organisms associated with infective mastitis in non lactating women? (3)

A
  1. S Aureus
  2. Enterococci
  3. Anaerobic bacteria
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26
Q

What are the 3 principle clinical characteristics associated with mastitis?

A
  1. Painful breast
  2. Fever and/or general malaise
  3. Tender, red and swollen area of breast (usually witha wedge shaped distribution)
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27
Q

What histological changes would you expect to see during pregnancy and lactation? (2)

A
  1. Enlargement of lobules

2. Increased luminal distension

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28
Q

Name the important differential to always consider when assessing a patient with apparent mastitis

A

Inflammatory breast cancer

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29
Q

Give 4 risk factors for the development of a breast abscess in a non lactating women

A
  1. Smoking
  2. Diabetes
  3. Nipple piercings
  4. Immunocompromised
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30
Q

Define a fibroadenoma histologically

A

Benign fibroepithelial lesion of the breast that is composed of both stromal and epithelial components

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31
Q

What is the follow up regime for a women treated for DCIS?

A

Annual mammogram and clinical examination for 5 years

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32
Q

What is the normal function of the BRCA genes?

A

Produce tumour suppressor proteins which help repair damaged DNA

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33
Q

Which gene mutation is associated with Li-Fraumeni syndrome?

A

TP53 mutation

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34
Q

BRCA mutations show what form of inheritance pattern?

A

Autosomal dominant

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35
Q

Where are the BRCA genes located?

A

BRCA 1 - Long arm of chromosome 17

BRCA 2 - Long arm of chromosome 13

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36
Q

Prophylactic mastectomy for a BRCA gene carrier has what affect on the individuals lifetime breast cancer risk?

A

Reduces the risk of breast cancer by 90%

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37
Q

Which agent may be used for chemoprevention in women with BRCA gene mutations?

A

Tamoxifen

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38
Q

What does the term ‘over-diagnosis’ refer to with regards to the breast cancer screening program

A

The detection of cancers on screening which would not have become clinically apparent in a women’s lifetime in the absence of screening

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39
Q

What are the 5 main categories of chemotherapy agents?

A
  1. Alkylating agents
  2. Anti-metabolites
  3. Mitotic inhibitors
  4. Antibiotics
  5. Others
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40
Q

Which category of chemotherapy agents specifically targets the DNA synthesis section of the cell cycle?

A

Anti-metabolites

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41
Q

Which category of chemotherapy agents specifically targets the mitosis section of the cell cycle

A

Mitotic inhibitors

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42
Q

What is the mechanism of action of alkylating agents in chemotherapy?

A

Directly bind DNA leading to DNA cross-linking. Resultant abnormal base pairing prevents further cell division

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43
Q

What is the mechanism of action of Anthracycline antibiotics as chemotherapy agents?

A

Intercalation of base pairs leads to free radical formation which in turn inibits the enzyme topoisomerase

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44
Q

Which enzyme is targeted by anthracycline antibiotics?

A

Topoisomerase

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45
Q

What is the function of the enzyme topoisomerase?

A

Catalyses the unwinding of DNA which is required for both replication and repair

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46
Q

Name 2 non-anthracycline antibiotics

A
  1. Bleomycin

2. Actinomycin D

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47
Q

Name an antimetabolite chemotherapy agent

A

Methotrexate

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48
Q

Name 3 Topoisomerase inhibitors

A
  1. Doxorubicin
  2. Irinotecan
  3. Etoposide
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49
Q

Name 2 taxanes used as chemotherapy agents

A
  1. Paclitaxel

2. Docetaxel

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50
Q

Name 3 vinca alkaloids that are used as chemotherapy agents

A
  1. Vincristine
  2. Vinblastine
  3. Vinorelbine
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51
Q

What are the 4 principle roles of chemotherapy in clinical practise?

A
  1. Curative
  2. Adjuvant
  3. Radio-sensitise
  4. Palliation
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52
Q

What are the 3 main chemotherapy emergencies?

A
  1. Febrile neutropenia/ neutropenic sepsis
  2. Thrombocytopnenic haemorrhage
  3. Tumour lysis syndrome
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53
Q

Rituximab is a monoclonal antibody used to treat what form of cancer?

A

Lymphoma

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54
Q

Trastuzumab is a monoclonal antibody agent used to treat what form of cancer

A

Breast cancer - Trastuzumab is otherwise known as Herceptin

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55
Q

Recall the ECOG scale of performance status used in the assessment of oncology patients

A

0 - Fully active and able to carry out all pre-disease performance without restriction
1 - Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 - Ambulatory and capable of all self-care but unable to carry out any work activities. Up and about > 50 % waking hours
3 - Capable of only limited self care. Confined to bed/chair > 50% waking hours
4 - Completely disabled and confined to bed/ chair. No self care
5 - Deceased

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56
Q

Recall the red flags for back pain used the mneumonic ‘REDFLAGS’

A

R - Referred pain that is mulitsegmental or band like
E - Escalating pain that is poorly responsive to treatment
D - Different character or site to previous symptoms
F - ‘Funny’ sensations / heavy legs
L - Lying flat increases pain (also worse on coughing)
A - Agonising pain
G - Gait disturbance or unsteadiness - particularly on stairs
S - Sleep grossly disturbed due to pain being worse at night

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57
Q

What is the most common area of the back for metastatic spinal cord compression to occur?

A

Thoracic spine - unusual site for any other form of back pain

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58
Q

What is the pharmacological management of metastatic spinal cord compression?

A

High dose steroids - Dexamethasone 16 mg stat followed by 8 mg BD

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59
Q

If a patient with hypercalcaemia is found to be refractory to treatment with bisphosphonates what alternative medication can be used?

A

Denosumab

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60
Q

What are the 3 main mechanisms by which hypercalcemia may occur in patients with malignancy?

A
  1. Tumour osteolytic effect on bone
  2. Humoral PTHrP
  3. Overproduction of vitamin D
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61
Q

What are the 3 principle gene types that contribute to cancer formation?

A
  1. Proto-oncogenes
  2. Tumour suppressor genes
  3. DNA repair genes
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62
Q

Recall the 8 red flag symptoms associated with lung cancer

A
  1. Persistent cough (dry/productive)
  2. Haemoptysis
  3. Dyspnoea
  4. Hoarse voice
  5. Chest pain
  6. Fatigue
  7. Appetite loss
  8. Weight loss
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63
Q

An urgent CXR should be performed on any patient aged > 40 presenting with any of which 5 symptoms in order to rule out lung cancer?

A
  1. Persistent or recurrent chest infections
  2. Finger clubbing
  3. Supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
  4. Chest signs consistent with lung cancer
  5. Thrombocytosis
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64
Q

What is the most common type of mesothelioma diagnosed in the UK?

A

Pleural mesothelioma

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65
Q

Outline the ‘T’ stages of TNM staging for lung cancer (4)

A

T1 - < 3cm
T2 - 3-5 cm or involves main bronchus (but not the carina)
T3 - 5-7cm or invades the chest wall or separate nodule in the same lobe
T4 - >7cm or invading local structures e.g. mediastinum/heart/trachea. (Inoperable)

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66
Q

What is the 1 year survival rate for patients diagnosed with lung cancer in the UK?

A

~30%

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67
Q

Classify the drug Letrozole

A

Aromatase inhibitor used in the treatment of hormone responsive breast cancers

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68
Q

Name a potential adverse affect of Letrozole

A

Osteoporosis

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69
Q

Give an example of a bisphosphonate used in the treatment of hypercalcemia

A

Zoledronic acid

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70
Q

Classify the drug Denosumab

A

RANK ligand inhibitor

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71
Q

What is the current first line treatment regime for metastatic Her2 positive breast cancer? (3)

A
  1. Trastuzumab
  2. Pertuzumab
  3. Docetaxel (chemotherapy)
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72
Q

What is the mechanism of action of Trastuzumab?

A

Interacts with the Her2 receptor and prevents its stimulation by growth factors

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73
Q

What is the mechanism of action of Pertuzumab?

A

Prevents dimerisation of HER2 receptors with other receptors in the group

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74
Q

What is a MUGA scan?

A

Multiple gated acquisition scan - radionucleotide scan used to assess ventricular output. Used as an alternative test to an echocardiogram in such instances

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75
Q

What is the dose of Denosumab used in the treatment of cancer compared to osteoporosis?

A

Cancer - 120 mg once every 4 weeks by subcutaneous injection
Osteoporosis - 60 mg once every 6 months

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76
Q

Give 2 important side effects associated with Denosumab

A
  1. Hypocalcaemia

2. Ostenecrosis of the jaw

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77
Q

With regards to potential side effects, give 2 advantages of Denosumab over Zoledronic acid

A
  1. Less likely to induce renal toxic effects

2. Less likely to induce acute phase reactions

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78
Q

What is Bicalutamide?

A

Anti-androgen commonly used in the treatment of prostate cancer

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79
Q

What are the most common side effects associated with CTLA-4 inhibitors? (2)

A
  1. Skin symptoms e.g. rashes and itching

2. GI symptoms e.g. diarrhoea

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80
Q

What are the most common side effects associated with PD-1/PD-L1 inhibitors? (3)

A
  1. Skin symptoms e.g. rashes and itching
  2. Lung symptoms
  3. Thyroid dysfunction
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81
Q

Give an example of a CTLA-4 inhibitor

A

Ipilumumab

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82
Q

Give 2 examples of a PD-1 inhibitor

A
  1. Nivolumab

2. Pembrolizumab

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83
Q

Give 2 examples of PD-l1 inhibitors

A
  1. Atelolizumab

2. Avelumab

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84
Q

Give 7 possible immune related toxicities which may occur as a result of immunotherapy

A
  1. Exacerbation of existing autoimmune conditions
  2. Diarrhoea
  3. Endocrinopathies
  4. Pneumonitis
  5. Nephritis
  6. Uveitis
  7. Paraesthesia and neuropathy
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85
Q

Recall the toxicity gradings of immunotherapy side effects according to ‘ Common Terminology Criteria’ CTC for adverse events

A

Grade 1 - Asymptomatic or mild symptoms
Grade 2 - Moderate symptoms limiting age appropriate instrumental ADL
Grade 3 - Severe or medically significant but not immediately life threatening. Usually requires hospital admission
Grade 4 - Life threatening consequences - urgent intervention required
Grade 5 - Death caused by treatment toxicity

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86
Q

Give an example of a targeted immunotherapy agent that can be used in the treatment of some forms of melanoma

A

BRAF inhibitors e.g. Vemurafenib or Dabrafenib

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87
Q

What is the mechanism of action of the monoclonal antibody Ipilimumab?

A

Blocks the checkpoint inhibitor: CTLA-4 . This prevents T cells from being ‘switched off’ thereby ensuring they attack local cancer cells

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88
Q

What is the mechanism of action of the monoclonal antibody Nivolumab?

A

Prevents the interaction of PD-L1 and PD-1 thus preventing T cell apoptosis

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89
Q

What is the overall mechanism of action of checkpoint inhibitors in immunotherapy?

A

They target signalling proteins that allow cancer cells to otherwise ‘hide’ from the immune system

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90
Q

Give 4 toxicities associated with cisplatin therapy

A
  1. Hearing impairment
  2. Bone marrow suppression
  3. Peripheral neuropathy
  4. Renal impairment
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91
Q

The HPV vaccine Gardasil protects against which 4 types of HPV?

A
  1. 18
  2. 16
  3. 6
  4. 11
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92
Q

Chemotherapy is typically dosed according to which body metric?

A

Body surface area

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93
Q

What is the classical presentation of Hodgkin’s lymphoma?

A

Painless cervical and/or supraclavicular lymphadenopathy in a young adult

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94
Q

Name 3 complications associated with Hodgkin’s lymphoma

A
  1. Secondary malignancies
  2. Heart disease
  3. Decreased pulmonary function
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95
Q

The presence of which 2 cell types is characteristic of Hodgkin’s lymphoma?

A
  1. Hodgkin cells

2. Reed - Sternberg cells

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96
Q

What is the appropriate form of lymph node biopsy for the investigation of lymphoma?

A

Excisional lymph node biopsy

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97
Q

Describe the Lugano classification for PET-CT reporting of lymphoma

A

I - One node or group of adjacent nodes
II - Two or more nodal groups on the same side of the diaphragm
III - Nodes on both sides of the diaphragm or nodes above the diaphragm + spleen involvement
IV - Additional non contagious extra-nodal involvement

A Suffix if no B symptoms present. B suffix in the present of B symptoms

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98
Q

What 2 components make up the NICE definition of neutropenic sepsis?

A
  1. Temperature > 38

2. Neutrophil count < 0.5 *10^9/L

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99
Q

Which chemotherapy agents are involved in the ABVD regime for the treatment of lymphoma?

A

A - Doxorubicin
B - Bleomycin
V - Vinblastine
D - Dacarbazine

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100
Q

What is the name given to the thin protective outer layer of the skin?

A

Stratum Corneum

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101
Q

Which protein deficiency is noted in ~ 56% of people with moderate to severe eczema

A

Filaggrin deficiency

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102
Q

Which organisms are associated with adult seborrhoeic dermatitis?

A

Species of Malassezia yeasts

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103
Q

Name the 2 subtypes of contact dermatitis

A
  1. Irritant

2. Allergic

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104
Q

Define the term ‘macule’

A

An area of skin with a distinct change in colour without any elevation above the surface of the surrounding skin

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105
Q

What is another term for a vascular papule?

A

Haemangioma

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106
Q

Define the term ‘papule’

A

Circumscribed, raised lesion of epidermal or dermal origin that is 0.5 - 1cm in diameter

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107
Q

Define the term ‘nodule’

A

Circumscribed, raised lesion of epidermal or dermal origin that is >1 cm in diameter

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108
Q

Define the term ‘plaque’

A

Circumscribed, superficial elevated plateau area 1 - 2 cm in diameter

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109
Q

Define the term ‘vesicle’ in reference to a dermatological examination

A

Raised lesion that contains clear fluid (blisters)

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110
Q

Define the term ‘bullae’

A

Vesicle that is larger than 0.5cm

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111
Q

What is Lichenification?

A

Hard thickening of the skin with accentuated skin markings commonly as a result of chronic inflammation or rubbing of the skin

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112
Q

What is a discoid lesion?

A

Coin shaped skin lesion

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113
Q

Name 4 endogenous types of eczema

A
  1. Discoid
  2. Atopic
  3. Varicose
  4. Seborrhoeic dermatitis
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114
Q

Suggest 5 signs of atopic eczema that has become complicated by bacterial infection

A
  1. Weeping/ pustules
  2. Failure to respond to therapy
  3. Rapidly worsening eczema
  4. Crusting
  5. Fever and malaise
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115
Q

Give 4 clinical signs associated with eczema herpeticum

A
  1. Area of rapidly worsening painful eczema
  2. Clustered blisters consistent with early stage cold sores
  3. Punched out erosions usually 1-3mm that are uniform in appearance
  4. Possibly fever, lethargy or distress
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116
Q

What is the first line antibiotic treatment for S.aureus and streptococcal infections?

A

Flucloxacillin

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117
Q

What are the 2 most common infective organisms known to complicate atopic eczema?

A
  1. S. Aureus

2. Streptococcal species

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118
Q

What is eczema herpeticum?

A

Atopic eczema that has been infected by Herpes simplex virus

119
Q

Name 3 potential complications associated with eczema herpeticum

A
  1. Encephalitis
  2. Hepatitis
  3. Pneumonitis
120
Q

Recall 3 factors implicated in the pathogenesis of atopic eczema

A
  1. Breakdown of skin barrier function
  2. Inflammatory cascade that has predominantly Th2 cells
  3. Decreased expression of fillagrin in the epidermis
121
Q

Name a class of drugs that can be used as alternatives to topical corticosteroids in the treatment of asthma

A

Topical calcineurin inhibitors

122
Q

Give 2 examples of topical calcineurin inhibitors

A
  1. Tacrolimus

2. Primecrolimus

123
Q

What is Dupilimab?

A

Human monoclonal antibody which inhibits signalling of cytokines IL4 and IL13

124
Q

Suggest 4 possible causes of an erythrodermic eczema flare

A
  1. Withdrawal of systemic steroids
  2. Secondary bacterial infection (or viral)
  3. Psychological stress
  4. Development of contact dermatitis
125
Q

In dermatology, what is the Kobner phenomenon?

A

Psoriasis lesion that develops following damage (i.e. cut or scratch) to a section of skin

126
Q

Name a vitamin A analogue that can be used in the treatment of psoriasis

A

Tazarotene

127
Q

Give 4 clinical features of Psoriatic nails

A
  1. Periungal erythema
  2. Pitting
  3. Subungal keratosis
  4. Onycholysis
128
Q

What is the most common form of psoriasis seen?

A

Chronic plaque psoriasis

129
Q

Which form of psoriasis can be triggered by the withdrawal of systemic corticosteroid therapy/ inappropriate use of superpotent topical steroids of a large body area?

A

Generalised Pustula psoriasis

130
Q

Recall the 5 distinct patterns of Psoriatic Arthropathy

A
  1. Distal interphalangeal alone
  2. Symmetrical polyarthritis (most common)
  3. Asymetrical oligoarthritis
  4. Arthritis mutilans
  5. Spondyloarthropathy
131
Q

Where are the 3 classical areas in which Psoriatic plaques may be found?

A
  1. Elbows
  2. Knees
  3. Scalp
132
Q

Guttate psoriasis has an association with which illness in adolescence?

A

Sore throat with associated group B-haemolytic streptococcus

133
Q

Name 6 potential triggers for the development of medically emergent erythrodermic psoriasis

A
  1. Withdrawal of systemic steroids
  2. Infections
  3. Excessive alcohol intake
  4. Antimalarials
  5. Lithium
  6. Hypocalcemia
134
Q

Outline the genetic characteristics of type 1 and type 2 psoriasis

A

Type 1 - Initial presentation <40 yrs. Genetically linked to HLA- CW6 mutation
Type 2 - Initial presentation between 55-60 yrs. No association with HLA-CW6

135
Q

Which 2 forms of psoriasis warrant direct secondary referral to dermatology ?

A
  1. Acute guttate psoriasis

2. Nail psoriasis with significant effect on quality of life

136
Q

What 2 red flags warrant emergency referral to on call dermatologist when assessing a patient with psoriasis?

A
  1. Erythrodermic patients

2. Generalised pustular psoriasis

137
Q

Outline the 4 first line treatments for localised stable psoriatic plaques

A
  1. Tar preparations
  2. Vitamin D analogues
  3. Salicylic acid preparations
  4. Topical steroids
138
Q

Give 4 advantages associated with topical treatments for dermatological conditions

A
  1. Local effects only
  2. Self-application
  3. Safe for long term use
  4. Relatively cheap
139
Q

Give 5 disadvantages associated with topical treatments for dermatological conditions

A
  1. Time consuming in cases of extensive disease
  2. Poor compliance
  3. Messy and may affect clothing/bedding/hair
  4. No benefit for associated joint disease
  5. Tachyphylaxis - i.e. treatment may become less effective with prolonged use
140
Q

Give 4 examples of photosensitive diseases

A
  1. Lupus
  2. Porphyria
  3. Albinism
  4. Xeroderma pigmentosum
141
Q

What is the function of the PASI scoring system?

A

Psoriasis Area Severity Index - objective clinical measure of the severity of the patient’s disease state

142
Q

Recall the categories of the Psoriasis Area Severity Index

A

Mild: 0-5 PASI
Moderate: 5-12 PASI
Severe: 12-20 PASI
Very Severe: >20 PASI

143
Q

What is the function of the DLQI scoring system in dermatology?

A

Dermatology of Life Index - subjective patient measure of the impact of the disease state on the patient’s quality of life

144
Q

Name 5 systemic agents sometimes used in the management of severe psoriasis

A
  1. Ciclosporin
  2. Methotrexate
  3. Acitretin
  4. Fumaric acids
  5. Apremilast
145
Q

Give 3 examples of TNF inhibitors

A
  1. Infliximab
  2. Etanercept
  3. Adalimumab
146
Q

Name an IL12/23 inhibitor

A

Ustekinumab

147
Q

Give an example of an IL-17 inhibitor

A

Ixekiaumab

148
Q

Name 3 types of biologics that can be used in the treatment of severe psoriasis

A
  1. TNF inhibitors
  2. IL 12/23 inhibitors
  3. IL-17 inhibitors
149
Q

Erythrodermic psoriasis is defined as erythema covering what proportion of total body area?

A

> 90%

150
Q

Name 4 medical conditions for which a patient with psoriasis is at a greater risk of developing as a result of their condition

A
  1. Myocardial infarction
  2. Type 2 diabetes
  3. Hyperlipidaemia
  4. Metabolic syndrome
151
Q

What treatment would you prescribe for stable plaque psoriasis of the trunk

A

Dovobet gel every 24 hrs for 4 weeks

152
Q

What is the principle clinical feature that helps distinguish between acne Vulgaris and Rosacae?

A

Absense of comedones (black heads) in Acne Rosacae

153
Q

What is the first line medical treatment for Acne Rosacae?

A

Topical metronidazole 0.75% applied twice daily

154
Q

Name a system used to grade the severity of acne vulgaris on clinical assessment

A

The Leeds scoring system - counting + categorisation of inflammatory and non inflammatory lesions

155
Q

Recall the 5 indications for the prescription of oral retinoids (e.g. isotretinoin) for acne vulgaris

A
  1. Moderate acne - unresponsive to conventional therapy or relapsing after conventional therapy
  2. Severe acne
  3. Acne scarring
  4. Psychological effects resulting from acne and/or scarring
  5. Unusual form of acne
156
Q

What is the standard dose of isotretinoin used in the treatment of severe acne vulgaris?

A

Once daily (0.5mg/kg to 1mg/kg) for 4 months

157
Q

Name 2 drug categories that can be utilised to inhibit sebaceous gland function for the treatment of acne

A
  1. Anti-androgens (e.g. spironolactone = androgen receptor blocker)
  2. Oestrogens
158
Q

What is the mechanism of action of oral retinoids e.g. isotretinoin?

A

Normalise the pattern of follicular keratinisation. They are also indirectly antibacterial.

159
Q

What is the most common form of skin cancer?

A

Basal cell carcinoma

160
Q

What is Gorlin Syndrome?

A

Autosomal dominant syndrome associated with a higher incidence (and multiple) basal cell carcinomas alongside other clinical sequelae e.g. craniofacial abnormalities and neoplasms

161
Q

What is a Marjolin’s ulcer?

A

An aggressive form ulcerating of squamous cell carcinoma that develops in an area of previous skin trauma, chronic inflammation or scarring

162
Q

Smoking is a risk factor specific to which form of skin cancer?

A

Squamous cell carcinoma

163
Q

Name a genetic syndrome associated with squamous cell carcinoma

A

Xeroderma Pigmentosum

164
Q

Which form of keratinocyte cancers is associated with chronic ulcers?

A

Squamous cell carcinoma

165
Q

Gorlin’s syndrome is associated with which gene mutation?

A

Mutation of the tumour suppressor gene: PTCH 1

166
Q

A ‘rodent ulcer’ refers to what form of skin cancer?

A

Basal cell carcinoma

167
Q

When performing a full dermatological examination, it is important to examine which 2 additional areas for completion if a malignant lesion is suspected?

A
  1. Draining lymph nodes

2. Abdominal examination for hepatomegaly

168
Q

Recall the 6 categories of the Fitzpatrick skin type classification system

A

I - Pale white skin, blue/green eyes, blonde/red hair –> Always burns, does not tan
II - Fair skin, blue eyes –> Burns easily, tans poorly
III - Darker white skin –> Tans after initial burn
IV - Light brown skin –> Burns minimally, tans easily
V - Brown skin –> Rarely burns, tans darkly easily
VI - Dark brown/ black skin –> Never burns, always tans darkly

169
Q

What is the scientific word for a mole?

A

Melanocytic naevus

170
Q

For a lesion that is suspicious for malignant melanoma what is the immediate treatment?

A

Excision with a narrow margin at the earliest opportunity - ideally same day as positive examination

171
Q

What is considered to be a large number of moles (and therefore a risk factor for melanoma) in young and old people respectively?

A

Young - More than 100

Old - More than 50

172
Q

Name 3 major clinical signs associated with malignant melanoma

A
  1. Existing or new mole that is changing rapidly over a period of weeks/ months
  2. Mole with an irregular outline
  3. Mole with a mixture of different shades of black and brown
173
Q

Give 2 medical conditions that have an associated with melanoma

A
  1. Inflammatory bowel disease

2. Immunosuppression for any reason e.g. viral or iatrogenic

174
Q

The ‘Breslow thickness’ of a melanoma measures the distance between which sections of the skin?

A

Distance in mm from the granular layer in the epidermis to the deepest level of invasion of the dermis

175
Q

Which 5 characteristics define the TNM staging of a melanoma?

A
  1. Breslow Thickness
  2. Evidence of mitosis
  3. Ulceration
  4. Lymph node involvement
  5. Evidence of distant metastases
176
Q

Give 4 recognised risk factors for the development of melanoma

A
  1. > 100 melanocytic naevi
  2. UV A radiation
  3. Family Hx of melanoma in a first degree relative
  4. Immunosuppresion
177
Q

What is the most common site for a women to develop a melanoma?

A

Lower limb

178
Q

Define pruritus

A

Itching without a rash

179
Q

Define Prurigo

A

Intensely itchy papules and nodules

180
Q

Define chronic pruritus

A

Itching that lasts > 6 weeks

181
Q

Give 3 characteristic secondary skin lesions that are often seen in a presentation of chronic pruritus

A
  1. Excoriations
  2. Lichenification
  3. Hyper/ hypo pigmentation
182
Q

Acanthosis nigrans can be associated with what form of internal malignancy?

A

Gastric adenocarcinoma

183
Q

Figurate erythemas can be associated with what form of internal malignancy?

A

Bronchial/oesophageal/ breast carcinoma

184
Q

Pruritus can be associated with what form of internal malignancy?

A

Lymphoma

185
Q

Dermatomyositis has associations with which 4 carcinomas?

A
  1. Lung
  2. Breast
  3. Ovarian
  4. Testicular
186
Q

Acquired ichthyosis can be associated with which 3 types of internal malignancy?

A
  1. Hodgkin’s disease
  2. Sarcoma
  3. Lymphoma
187
Q

What are the 2 requirements prior to performing a HIV test on a patient?

A
  1. Assessment of patients capacity

2. Attain verbal informed consent for the procedure

188
Q

Give 3 neurological causes of a persistent itch

A
  1. Peripheral neuropathy
  2. Post-herpetic neuropathy
  3. Multiple sclerosis
189
Q

Give 3 psychogenic causes of persistent itch

A
  1. Parasitophobia
  2. Obsessive compulsive disorder
  3. Depression/ Anxiety
190
Q

Suggest 3 metabolic causes of persistent itch

A
  1. Hyperthyroidism
  2. Chronic kidney disease
  3. Diabetes
191
Q

What are the 2 means by which chronic kidney disease may cause a persistent itch in a patient?

A
  1. Secondary hyperparathyroidism

2. Uraemic pruritus

192
Q

Give 2 haematological causes of a persistent itch

A
  1. Polycythaemia rubra vera

2. Myeloid dysplasia

193
Q

Candidiasis of the submammary fold can be a systemic indication of which medical condition?

A

Diabetes Mellitus

194
Q

Give 3 cutaneous signs associated with tuberous sclerosis

A
  1. Periugal fibroma
  2. Adenoma sebaceum
  3. Ash leaf ‘spots’
195
Q

What is the most appropriate test for the initial investigation of Erythema Nodosum ?

A

ASOT titre for potential streptococcal throat infection

196
Q

Which 5 diseases account for the vast majority of invasive fungal infections?

A
  1. Aspergillosis
  2. Candidiasis
  3. Cryptococcosis
  4. Mucormycosis
  5. Pneumocytosis
197
Q

Name the 4 main truly pathogenic (dimorphic) fungal diseases

A
  1. Blastomycosis
  2. Coccidioidomycosis
  3. Histoplasmosis
  4. Paracoccidioidomycosis
198
Q

Which candida species has increasing prevelence worldwide and is often seen in the intensive care setting?

A

Candida Auris

199
Q

ABPA (Allergic bronchopulmonary aspergillosis) is caused by what 2 types of hypersensitivity reaction?

A

Type II and III hypersensitivity reaction to aspergillus antigens

200
Q

Suggest 5 previous disease states which may leave residual lung cavities after resolution

A
  1. Tuberculosis
  2. Sarcoidosis
  3. Bronchiectasis
  4. Pneumoconiosis
  5. Ankylosing spondylitis
201
Q

What is the most common symptoms associated with chronic pulmonary aspergillosis?

A

Haemoptysis - occurs in ~ 50% of cases

202
Q

Suggest 2 patient cohorts in which Tracheobronchitis may be seen in

A
  1. HIV positive patients

2. Lung transplant recipients

203
Q

Acute invasive sinusitis is most commonly associated with which aspergillosis species?

A

Aspergillus flavus

204
Q

What is the treatment of choice for chronic pulmonary aspergillosis?

A

Long term itraconazole or Voriconazole therapy

205
Q

What is the treatment regime for Cryptococcal meningitis?

A

Amphotericin B + Flucytosine 25mg/kg every 6 hrs for 2 weeks followed by Fluconazole 400 mg/day for a minimum of 8 weeks

206
Q

What are the 2 classical clinical features associated with a Mucormycosis infection?

A

Rapid onset necrosis accompanied by fever

207
Q

What is the most common form of pneumonia seen in patients with AIDS?

A

Pneumocystis Jiroveci pneumonia

208
Q

Define the term prion

A

Infectious particles composed entirely of proteins

209
Q

What is the mechanism of action of metronidazole?

A

Inhibits/ interferes with nucleic acid synthesis

210
Q

Name 2 antibiotics that function by interrupting folic acid metabolism in the bacterial cells

A
  1. Trimethoprim

2. Sulphonamides

211
Q

Quinolones target which bacterial intracellular organelle?

A

DNA gyrase

212
Q

Macrolides target which bacterial intracellular organelle?

A

Ribosome 50S inhibitors

213
Q

Give 4 organisms that are associated with hospital acquired infections

A
  1. MRSA
  2. Carbapenem resistant E.Coli
  3. Norovirus
  4. C. Difficile
214
Q

Give 3 infections that can be acquired through the injection of illegal drugs

A
  1. Candida endopthalmitis
  2. Infective endocarditis
  3. Hepatitis C
215
Q

What are the 5 stages of the gram staining process?

A
  1. Fixation
  2. Crystal violet
  3. Iodine treatment
  4. Decolouration
  5. Counter stain - Safranin
216
Q

Name a stain appropriate for Mycobacteria analysis

A

Ziehl-Neelson staining

217
Q

Give 2 examples of ‘spiral’ shaped bacteria as well as the disease states that they cause

A
  1. Treponema Pallidum - Syphilis

2. Borrelia Burgdorferi - Lyme disease

218
Q

Which antibiotic class has the broadest species cover for a gram positive infection?

A

IV Glycopeptides

219
Q

Name 2 glycopeptide antibiotics

A
  1. Vancomycin

2. Teicoplanin

220
Q

Which macrolide antibiotic offers a degree of cover to some anaerobic bacteria?

A

Clindamycin

221
Q

What is the most common source for candidaemia ?

A

Gut flora

222
Q

What are the 3 broad classification categories for clinically significant fungal infections?

A
  1. Superficial
  2. Subcutaneous
  3. Deep mycoses
223
Q

Which blood test has a high sensitivity for fungal infection?

A

Beta D-glucan test (a fungal cell wall antigen).

224
Q

Name 4 risk factors for the development of varicella pneumonitis

A
  1. Smoking
  2. Pregnancy
  3. Immuno-compromise
  4. Chronic lung disease
225
Q

Name 3 types of Herpes virus known to infect humans

A
  1. Herpes simplex virus (1 and 2)
  2. Epstein -Barr Virus
  3. Cytomegalovirus
226
Q

Koplik spots on the buccal mucosa are indicative of which pathogen?

A

Measles

227
Q

Name 3 clinical complications associated with Measles

A
  1. Bacterial pneumonia
  2. Otitis media
  3. Acute encephalitis
228
Q

What are the 3 clinical components of the syndrome associated with glandular fever?

A
  1. Fever
  2. Sore throat
  3. Lymphadenopathy
229
Q

What is the most common cause for a raised eosinophil count seen in general practise in the UK?

A

Atopic diseases e.g. asthma and hayfever

230
Q

Suggest 4 possible causes of an eosinophilia

A
  1. Atopic disease e.g. asthma or eczema
  2. Haematological malignancy
  3. Parasites
  4. Drug allergies
231
Q

Define the 2 subdivisions of endoparasites

A
  1. Helminths - Worm like parasites that are mostly visible to the naked eye
  2. Protozoan parasites - Single celled, eukaryotic organisms that are usually motile
232
Q

What is the ‘definitive’ host of a parasite?

A

The animal that hosts the adult stage of the parasite

233
Q

What is the recommend agent for malarial chemoprophylaxis?

A

Doxycycline

234
Q

Name the parasite that is thought to be responsible for ‘elephantiasis’

A

Filariasis

235
Q

What is the most common causative pathogen for bacterial endocarditis?

A

Strep Viridans

236
Q

Which pathogen is associated with infective endocarditis following a dental procedure?

A

Strep Mitis

237
Q

What is Libman-Sacks endocarditis?

A

A form of non-bacterial thrombotic endocarditis caused by systemic lupus erythematosus

238
Q

Recall the organisms referred to in the HACEK mnemonic that are recognised to cause culture negative infective endocarditis

A 
H - Haemophilus aphrophilus 
A - Actinobacillus Actinomycetemitans 
C - Cardiobacterium hominis
E - Eikenella Corrodens 
K - Kingella kingae
239
Q

What is the first line antibiotic choice for the empirical treatment of septic arthritis?

A

IV Flucloxacillin

240
Q

What is the first line treatment for uncomplicated cellulitis in a patient with no allergies?

A

Flucloxacillin

241
Q

Give 2 reasons why it is best practise to give an antibiotic that is targeted to the sensitivity of the bacteria as much as possible ( i.e. targeted narrow spectrum antibiotic where possible)

A
  1. Reduce the chance of developing resistance

2. Reduce the incidence antibiotic related diarrhoea

242
Q

Which topical treatment is often used in the treatment of impetigo?

A

Fusidic acid ointment

243
Q

Name the mammals in the UK that carry the rabies virus

A

Bats are the only mammals in the UK that carry the rabies virus

244
Q

What is the antibiotic of choice for the treatment of uncomplicated cellulitis in a patient with a Penicillin allergy?

A

Clarithromycin

245
Q

What is the first line antibiotic treatment for mammal bites in the UK?

A

Co-Amoxiclav

246
Q

Name 4 antibiotics that are active against MRSA

A
  1. Doxycycline
  2. Vancomycin
  3. Linezolid
  4. Teicoplanin
247
Q

What are the 2 most common bacteria implicated in skin and soft tissue infections?

A
  1. Staph Aureus

2. Strep Pygogenes

248
Q

How would Staph. Aureus typically appear on gram staining?

A

Gram positive cocci in clusters

249
Q

What is the typical appearance of streptococcal species on gram staining?

A

Gram positive cocci in chains

250
Q

Which bacteria is commonly associated with chronic wounds e.g. chronic leg ulcers or diabetic foot ulcers?

A

Pseudomonas aeruginosa

251
Q

Give 4 clinical differentials for cellulitis

A
  1. DVT
  2. Lymphedema
  3. Venous insufficiency
  4. Venous eczema
252
Q

Recall the two modalities by which the influenza virus family is capable of mutating

A

1, Antigenic shift

2. Antigenic drift

253
Q

Define antigenic drift

A

Gradual accumulation of mutations that change the surface antigens and make the virus less susceptible to the antibodies produced during previous infections

254
Q

Define antigenic shift

A

Two or more strains combine to form a new subtype with surface antigens that humans have not encountered previously

255
Q

Suggest 6 risk factors associated with complicated influenza infection i.e. severe influenza requiring hospital admission

A
  1. Neurological, renal, hepatic, pulmonary and chronic cardiac disease
  2. Diabetes
  3. Immunocompromise
  4. Age > 65
  5. Pregnancy (including 2 weeks post partum)
  6. Morbid obesity
256
Q

Give 4 clinical complications associated with severe influenza

A
  1. Primary viral pneumonia
  2. Secondary bacterial pneumonia
  3. Myositis and Rhabdomyolysis
  4. CNS complications including: GBS, encephalitis and transverse myelitis
257
Q

Name the 3 organisms most commonly implicated in superimposed bacterial infections of the lungs

A
  1. Strep pneumoniae
  2. Staph Aureus
  3. Haemophilus influenza
258
Q

What is the mean incubation period of COVID-19?

A

5 days (2-14 day range)

259
Q

What are the 3 most commonly reported symptoms associated with COVID-19 infection?

A
  1. Persistent cough
  2. Loss of smell and taste
  3. Fever
260
Q

Define Neyman Bias

A

Tendency of initial reports of a novel infectious disease to overestimate prevalence and severity of symptoms

261
Q

Name 2 Neuraminidase inhibitors

A
  1. Oseltamivir

2. Zanamivir

262
Q

What are the 3 most common causes of diarrhoea in transplant recipients?

A

Infection due to immunosuppression. Causative organisms:

  1. C. Diff
  2. Cytomegalovirus
  3. Norovirus
263
Q

Suggest 3 potential consequences of diarrhoea in a transplant recipient

A
  1. Severe dehydration
  2. Medication toxicity
  3. Transplant organ rejection
264
Q

What is the incubation period for acute hepatitis infection?

A

Ranges from 2 weeks to 6 months

265
Q

What is the causative pathogen of Amebic liver abscesses?

A

Entamoeba Histolytica

266
Q

Amebic liver lesions are most commonly found in which lobe of the liver?

A

Right lobe

267
Q

What is the typical treatment regime for Amebic liver cysts?

A

Tissue agent - Metronidazole : 500-750mg IV/PO every 8 hours for 7-10 days

Luminal agent - Paromycin : 25-30 mg/kg PO per day in 3 divided doses over the course of 7 days

268
Q

A serological test showing antibodies to Hepatitis B surface antigens (anti-HBs) indicates what?

A

Immunity to hepatitis B virus

269
Q

A serological test showing antibodies to Hepatitis B core antigens (anti-HBc) indicates what?

A

Exposure to hepatitis B virus

270
Q

Suggest 4 causes of increased bilirubin production

A
  1. Haemolysis
  2. Ineffective erythropoiesis
  3. Blood transfusion
  4. Resorption of haematoma
271
Q

Name a drug that reduces the hepatic uptake of bilirubin

A

Rifampicin

272
Q

Name the 2 characteristic biomarkers associated with type 1 autoimmune hepatitis

A
  1. Antinuclear antibody

2. Smooth muscle (actin) antibodies

273
Q

Name the biomarker associated with type 2 autoimmune hepatitis

A

Anti-LKM1

274
Q

Which genetic mutation is associated with the majority of the cases of haemochromatosis seen?

A

HFE mutation on the short arm of chromosome 6

275
Q

What are the 2 most common strains of hepatitis C found in the UK?

A

Genotypes 1 and 3

276
Q

Outline the pathogenesis of an infection with E .Histolytica

A

Once ingested, trophozoites colonise the small intestine and invade the colonic mucosa. These can then spread via the portal circulation to the liver, the most common extra-intestinal site, or other sites

277
Q

Which form of hepatitis infection has an association with hepatocellular carcinoma?

A

Hepatitis C

278
Q

Define a ‘late’ diagnosis of HIV

A

Patient has a CD4 count < 350 cells/mm3 within 3 months of diagnosis

279
Q

PCP infections occur in the HIV patient population below what CD4 count?

A

< 200 cells/mm3

280
Q

What is the first line treatment for PCP prophylaxis in HIV patients with a CD4 count < 200 cells/mm3?

A

Co-trimozazole 96mg OD

281
Q

Recall the 6 main classes of drugs used to treat HIV

A
  1. NRTIs - Nucleotide reverse transcriptase inhibitors
  2. NNRTIs - Non-nucleotide reverse transcriptase inhibitors
  3. Protease inhibitors
  4. Integrase inhibitors
  5. CCR5 inhibitors
  6. Fusion inhibitors
282
Q

Give 3 examples of Protease inhibitors

A
  1. Indinavir
  2. Ritonavir
  3. Saquinavir
283
Q

Give 2 examples of NNRTIs

A
  1. Nevirapine

2. Efavirenez

284
Q

What resource should be used when checking potential interactions between new medications and a patient’s HAART?

A

Liverpool University HIV drug interaction website - BNF only has limited information on antiretroviral therapy interactions

285
Q

Which 2 medications are used in combination to provide Pre-exposure prophylaxis to individuals identified as being at a high risk of contracting HIV?

A
  1. Tenofovir

2. Emtricitabine

286
Q

Name 4 types of viral haemorrhagic fever

A
  1. Lassa fever
  2. Crimean -Congo haemorrhagic fever
  3. Marburg
  4. Ebola
287
Q

Suggest 4 risk factors for the development of invasive amoebiasis

A
  1. Malnutrition
  2. Vitamin deficiency
  3. Alcoholism
  4. Immunosuppression
288
Q

What is the most common infectious diagnoses made in febrile returning travellers to the UK?

A

Malaria

289
Q

How is the malarial parasite tested for in clinical practise?

A

Peripheral blood smear

290
Q

Give 6 clinical presentations in which it would be necessary to observe contact infection control precautions when treating a febrile patient

A
  1. Diarrhoea and/or vomiting
  2. Acute respiratory symptoms
  3. Rash
  4. Wound or skin infections
  5. Travel to a region where viral haemorrhagic fever is endemic in the last 21 days
  6. Recent hospitalisation overseas
291
Q

Define brachytherapy

A

A form of internal radiotherapy e.g. in the treatment of prostate cancer or cervical cancer

292
Q

Suggest 4 indications for the use of palliative radiotherapy

A
  1. Pain management
  2. Breathlessness
  3. Bleeding
  4. Obstruction
293
Q

What is the starting dose for palliative pain management for a patient with no comorbidities according to NICE?

A

23-30mg oral modified release morphine (two divided doses) with 5 mg morphine for breakout pain

Year 4 TCDs (16 decks)

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