Cancer, Skin, Breast and Infection Flashcards
What 4 blood tests should be done on anyone with suspected metastatic disease?
FBC - Marrow infiltration can give anaemia and thrombocytopenia
Bone profile - hypercalcemia occurs with metastatic disease
U+E
LFT
What % of breast cancers are ER+ve?
80%
What % of breast cancers are HER2+ve?
15%
What is the criteria for neutropenic sepsis according to NICE?
Temp > 38
Neutrophils < 0.5x10(9)
Recent chemo
Which chemotherapy agent, used in Hodgkin lymphoma commonly causes damage to lung tissue?
Bleomycin
What common urine side effect of doxorubicin should patients be counselled on?
Makes urine red for 24 hours following treatment
What general principle of treating side effects of monoclonal antibodies should all doctors be aware of?
As it’s boosting immune system simple SE’s like diarrhoea may need high dose steroids to control
What are the different criteria for WHO performance status?
0- Normal
1- Restricted with strenuous activity but can do light work
2- Ambulatory and can self care but unable to do work, up and about >50% of waking hours
3- Symptomatic, in chair or bed >50% of the day
4- Completely disabled, no self care
A patient has been diagnosed with a brain tumour or brain metastasis, what action should they be prompted to take regarding lifestyle?
Inform DVLA
Which cancer is the BRAF mutation most commonly associated with?
Melanoma
What drugs are used to treat hepatitis C infeciton?
Ribavirin and interferon
As a general rule of thumb , what is the first choice antibiotics for anaerobic infections?
Metronidazole
The husband of a pregnant lady has chickenpox, what action should be taken?
She should be tested for VZV IgG. If positive, no action is needed. If negative give vaccine.
Which antibiotic is used first line for cellulitis?
Flucloxacillin
Which antibiotic is most strongly associated with c.diff infection?
Clindamycin
As v.active against most gut flora but not c.diff
Which are the only animals in the UK to carry rabies?
Bats
Which antibiotic is first line to be used for those who have had cellulitis due to an animal bite?
Co-amoxiclav
more broad spectrum than fluclox
When assessing a cellulitis which has pain out of keeping with clinical signs (more intense than the signs would suggest) - what should you be considering?
Deeper soft tissue infection (abscess etc.)
What is necrotising fasciitis? What are the key clues in the history?
Medical emergency, rapid progression of tissue necrosis, often following trauma/ surgery.
Key signs: Pain out of proportion to lesions, rapid spread of lesion, systemic unwellness, RF’s such as IVDU
How should necrotising fasciitis be treated?
Surgical debridement
Antibiotics are only supportive
How does staph aureus appear on a gram stain?
Gram positive cocci in clusters
What treatment is used for severe CAP (assuming CURB score >3)?
IV Co-amoxiclav and clarithromycin
A patient has an influenza infection requiring admission to AMU. How should they be managed with regard to infection control? (5)
Single room
Surgical mask within 2m (as influenza travels in droplets which can reach 2 metres)
FFP3 Mask if aerosol generating procedures
Apron, gloves, hand hygiene
Teach patient cough etiquette
You are a GP and you see a 28yoF who is 24 weeks pregnant. She visited her father yesterday in a nursing home. She is currently fit and well, but she mentions that her father was coughing and sneezing and was on treatment for that but she can’t remember the name. Yesterday you received an email from Public Health England reporting an influenza outbreak in nursing homes, including the one where the patient’s father resides.
What would be the best approach?
Start prophylactic Oseltamivir (75mg PO for 10 days)
She is at risk of complicated influenza and should be given prophylaxis
How long does an influenza illness take to resolve?
3-7 days
How long does someone who has had an influenza infection remain potentially contagious?
Up to 14 days
What is the most common causative organism of CAP?
Streptococcus pneumonia
H.influenzae
What is the most common causative organism of HAP?
Staph aureus
HAP after 4 days from admission, before this still same as CAP
What is the most common causative organism of pneumonia in those with COPD?
H.Influenzae
What is the most common causative organism of pneumonia in those who’ve been on holiday, presenting with dry cough?
Legionella
Also hyponatremia and derranged LFT’s
What is the most common causative organism of pneumonia in alcoholics?
Klebsiella pneumoniae
What is the most common causative organism of pneumonia in CF/ bronchiectasis?
Pseudomonas aeruginosa
What is the most common causative organism of pneumonia in the immunocompromised?
Pnemocystis jiroveci pneumonia
Especially if desaturation on exertion
Which medication is used to treat cytomegalovirus infections in the immunocompromised?
IV Ganciclovir
Then oral valganciclovir
When immunosuppressed patients are on broad spectrum antibiotics they are at higher risk of developing candidaemia (fungal blood infection). What is the test for this?
Serum fungal antigen test (beta-D-glucan test; BDG)
Very sensitive
What test is used to diagnose Aspergillus infections?
Serum galactomannan (GM) test
What is the most common infection sources in candidaemia? (2)
Lines
(Cannula, central line etc.)
Gut flora translocation following damage to gut lining
How is urticaria due to an allergic reaction likely to present?
Hives is urticaria (raised, itchy, nettle rash)
Itchyness
No systemic symptoms
What are the common causes of viral gastroenteritis (2)
Rotavirus
Norovirus
What is the most common cause of bloody diarrhoea in an immunocompromised patient?
CMV
Name the 5 most common bacterial causes of bloody diarrhoea (dysentery)?
Campylobacter Shigella Salmonella E.coli O157 C.Diff
What two viruses are most commonly associated with infectious mononucelosis?
EBV
CMV (similar symptoms to EBV)
What is the most common hepatitis in a) the UK, b) the world
a) Hep C
b) Hep B
Which hepatitis is spread by fecal/oral and which are spread by blood/ body fluids?
Fecal/ oral = A + E
Blood/ fluids = B, C, D
What is the most common acute hepatits?
Hep A
What test is used to diagnose acute hepatitis A infection?
IgM antibody
Appears as soon as symptoms start, this may be up to 6 weeks post exposure
What antibody suggests previous HepA infection, how long does it last?
IgG antibody to HepA (with no IgM) suggests past infection or vaccination. It appears soon after an illness has started (or vaccination) and is present for life
Which test is used to establish current Hep B infection?
HBsAg (surface antigen)
Acute disease = there for 1-6 months
Chronic disease = still present after 6 months
What does presence of the anti-HBs antibody suggest?
Immunity
(either from infection or immunisation)
Note won’t be present in acute stage
What does presence of the anti-HBc antibody suggest?
Infection with Hep B
First 6 months: IgM
After 6 months: IgG
Either current or previous HepB infection
anti-HBc is NOT present following immunisation so can distinguish
A patient has previously had HepB and gained immunity, what two antibodies will be shown in their serum?
Anti-HBs + Anti HBc
What antigen is monitored to assess the severity of HepB?
HBeAg
If HBeAg +ve then offer 48 week course of peginterferon alfa-2a
What treatment is offered for hepatitis C?
48week course of Peginterferon alfa-2a and ribavirin for all patients with Hepatitis C