CBL notes Flashcards
Staging system for Hodgkin Lymphoma
Ann Arbour
Hodgkin lymphoma
- reed Sternberg cells
- lymphadenopathy
- pain on alcohol consumption
Criteria for PCOS
Rotterdam criteria
1. Polycystic ovaries on USS
2. Oligomenorrhoea / anovulation
3. Hyperandrogenism features (biochemical or chemical)
Examples of two nephrotic syndromes that cause proteinuria
- Minimal change disease
- Focal glomerulonephritis
MEN 1 syndromes
- Parathyroid
- Pituitary
- Pancreatic
due to MEN 1 link gene mutation
MEN 2a syndromes
due to RET proto oncogene mutation
Pheochromocytoma
Parathyroid
Medulla
Men 2b syndromes
due to RET proto oncogene mutation
Pheochromocytoma
Mucosal neuromas
Medullary thyroid carcinoma
Features of prolactinoma
- low libido
- galactorrhoea
- fatigue
- amenorrhoea
- infertility
- erectile dysfunction
Treatment of prolactinoma
dopamine agonist
- e.g. bromocriptine
Causes of microcytic anaemia
TAILS
T-thalassaemia
A-anaemia of chronic disease
I- Iron deficiency anaemia
L- lead poisoning
S- sideroblastic anamia
Management of heavy menstrual bleeding
1st line = IUS
2nd line = COCP
3rd line = POP
Tranexamic acid - for bleeding
Mefenamic acid - for pain
**Surgical **
- endometrial ablation
- hysterectomy
Myeloproliferative disorders associated with what gene mutation
JAK 2 mutation
Features associated with myeloma
CRAB
C-high calcium
R- renal failure
A- anaemia
B - bony disease
Pepperpot skull
Normocytic anaemia causes
- anaemia of chronic disease
- renal failure
- acute bleeding
Normocytic anaemia causes
- anaemia of chronic disease
- renal failure
- acute bleeding
Macrocytic anaemia causes
Megaloblastic
- due to b12 and folate def
Non-megaloblastic
- alcohol
Causes of optic neuritis (3)
Multiple sclerosis
Diabetes
Syphilis
Features of optic neuritis
- unilateral
- decreased visual acuity
- red desaturation
High risk babies are given what for prevention of RSV causing bronchiolitis
Palvizumab
Mutations to know about in cystic fibrosis (2)
Phe(delta)508del
- abnormal protein folding
F(delta)508del
- amino acid fucks off so cannot stay in 3D shape
How does ivacaftor work?
- opens up CFTR protein channels
Important gene associated with cystic fibrosis
CYP2D6
two types of age related macular degeneration
Wet vs Dry
Wet
- WORSE PROGNOSIS
- choroidal neovascularisation
- leakage of serous fluid
- rapid visual loss
Dry
- atrophic
- drusen
- subacute
Classification used for AKI
K-DIGO classification
Otitis externa management
Management
- **Topical acidifiers **
- acetic acid (ear carlm)
**2. Topical Abx **
- ciprofloxacin
- or gentamicin and hydrocortisone
**3. Oral antiboiotics **
- flucloxacillin
- ciprofloxacillin
or metronidazole if anaerobic
Indications for dialysis
**AEIOU **
- acidosis pH < 7.1
- electrolyte abnormalities k+ > 6.5
- Intoxication (SLIME)
- Oedema (fluid overload)
- Urea
**Slime **
- salicylates
- lithium
- isopropanolol
- methanol
- ethylene glycol
Why may decreased potassium lead to hepatic encephalopathy ?
- decreased potassium
- leads to hyperammonaemia
- hepatic encephalopathy
Name of criteria for diagnosis of MS (2)
- Poser 1983
- Macdonald
Multiple sclerosis
- demyelinating lesions in the central nervous system
- disseminated in time and space
What features may you see on the MRI of someone with MS?
Dawsons fingers
3 main types of MS presentations
- Relapsing remitting
- most acute attack and then period of remission - Secondary progressive
- relapsing / remitting
- patients are deteriorating
- may have gait and bladder disturbance - Primary progressive
- progressive deteriorating from the start
Medical management for relapsing MS
5 days of 500mg Methyl prednisolone
Features of low vs high ICP
Raised
- papillodema
- valsalva may help
Low
- severe, throbbing headache
- lie down and fluids needed
UMN vs LMN
Upper motor neuron
- increased tone
- increased reflexes
- positive babinski
- disuse atrophy
Lower motor neuron
- decreased tone
- decreased reflexes
- negative babinski
- severe muscle atrophy
- fasciculations
Cerebrum functions
- vision
- hearing
- fine control
- touch
- emotions
Brainstem fuctions
- breathing
- vomiting
- swallowing
- body temp
- sleep cycles
- digestion
Cerebellum functions
- coordinate muscle movement
- posture
- balance
Epilepsy treatment: Tonic clonic
M - sodium valproate
F- Lamotrigine (VG[Na] inhibitor)
O in lamotrigine O in tonic clonic
Epilepsy treatment: Generalised tonic clonic
M - sodium valproate
F - lamotrigine / levetiracetam
Epilepsy treatment: Focal seizures
1st line - Lamotrigine or Leve
2nd line - carbamazepine
Beware carbamazepine can cause absent seizures
Epilepsy treatment: absent
1st line - Ethosuximide
2nd line:
M = sodium valproate
F = lamotrigine or Leve
Epilepsy treatment: myoclonic seizures
M - sodium valproate
F - leve
Summarise Parkinson’s treatment
1. L-Dopa + carbidopa (prevent breakdown of L-dopa before reaching BBB)
2. MAOB-i
- e.g. Rasagiline
- note selegiline lots of side effects
—-> hallucinations
—-> confusion
—-> insomnia
3. COMT-i
- e.g. entarcapone (increase dopamine getting to BBB)
4. Dopamine agonist
- bromocriptine
—-> Non-ergot
- cabergoline
—-> ERGOT based –> pulmonary fibrosis
Name a drug which prevents reuptake of dopamine at synapses
Amantidine
- increases exocytosis
and release of dopamine
3 core features of parkinsons
- tremor
- bradykinesia
- cogwheel rigidity
Summarise extrapyramidal side effects
1. Acute dystonia’s
- torticolis (lateral neck rotation)
- retrocolis (neck extension)
- trismus (fixed jaw closing)
- opisthotonus (arching of posture)
- oculogyric crisis (forceful eye deviation)
2. Tardive dyskinesia
- lip smacking
- uncontrollable movements of face
3. Akathisia (restlessness)
4. Parkinsonsism features
Key features of neuroleptic malignant syndrome
- Muscle rigidity
- Fever
- Unstable BP
- Myoglobinuria
Autonomic instability
- fever
- tachy
- diaphoresis (sweating lots)
- dilation of pupils
- elevated or unstable BP
What may cause parkinsonian type features?
1. Parkinsons disease
2. Parkinson plus syndromes
- multisystem atrophy
- progressive supranuclear palsy
- lewy body dementia
- corticobasal degeneration
3. Drug induced
- lithium
- antipyschotics
Medical prevention of tumour lysis syndrome
allopurinol
Examples of non-Hodkgin lymphoma
1. Malt lymphoma
- associated with H-pylori
2. Burkit lymphoma
- associated with EBV
- very bad
Describe features of Ann Arbour staging
Stage 1 - in one region
Stage 2 - more than one region but same side of diaphragm
Stage 3 - above and below diaphragm
Stage 4 - widespread in non lymphatic areas too
What might be found in urine with a patient with myeloma
bence jones protein
Movicol is what type of laxative
bulk forming
Constipation management
1st Line
- Senna (stimulant)
- Lactulose (osmotic)
2nd Line
- if caused by opiates give naloxogel
3rd line
- if non-opiate related then give a macrogol (osmotic) e.g. movicol
4th line
- enema
Management of pericarditis
- Ibuprofen (NSAID)
- colchicine
- PPI cover
What type of cells is chronic lymphocytic leukaemia associated with
NOT ASSOCIATED WITH BLAST CELLS
associated with –> smudge cells
worm
CLL
- more common in adults
What is the name given when chronic lymphocytic leukaemia turns into lymphoma
Richter transformation
Acute myeloid leukaemia is associated with what:
auer rods
AML
- older patients
Acute lymphocytic leukaemia is associated with what genetic condition
Downs syndrome
Most common type of leukaemia found in children
acute lymphocytic leukaemia
What biologic can be given for CML treatment
Imantinib
What is the Philadelphia chromosome
- abnormality of chromosome 22 which part of chromosome 9 is transferred to it
- often found in CML
