Deck 7 Flashcards
Teratoma definition
a tumour composed of or able to form tissue from all germ lines (endoderm, mesoderm, ectoderm)
How does rise in bHCG lead to gynocomastia
- bHCG acts like LH on Laydig cells
- Laydig cells produce more testosterone and oestrogen (Higher oestrogen to testosterone ratio)
- higher oestrogen -> gynocomastia
What is the most common type of renal cancer
RCC 80-85% (clear cell (80%), papillary (15%), chromophobe)
TCC of kidneys rare
What is Von Hippel Lindau syndrome
autosomal dominant hereditary condition predisposes to
- RCC
- pheochromocytoma
- pancreatic tumours
- CNS haemangioblastomas
What is Von Hippel Lindau syndrome
autosomal dominant hereditary condition predisposes to
- RCC
- pheochromocytoma
- pancreatic tumours
- CNS haemangioblastomas
RFs for bladder TCC
Modifable:
- smoking
- dye or rubber industry
Non-modifiable:
- age
- male
Bladder carcinoma in situ treatment
TURBT
BCG or chemotherapy
How is urine removed post radical cystectomy
A section of ileum with its blood supply is removed and used to form a bag
Ureters are attached to this bag
A stoma is created for urine drainage
The bowel is re-anastomosed
Why not take ileum proximal to ileocaecal valve for ileal conduit formation
patients end up with B12 deficiency -> macrocytic anaemia and degeneragtion of cord
What do chief cells of stomach secrete
pepsinogen
Calcium levels and peptic ulcer?
High calcium stimulates acid secretion
Hypercalcaemia associated with PUD
PPI mech of action
Blocks H/K ATPase on parietal cells
Gastric cancer mets sites
Lymphatic: local then supraclavicular nodes (Virchow node)
Local: omenta, pancreas, diaphragm
Haem: liver, lung
Virchow’s triad of clotting
- hypercoaguable state
- abnormal blood flow
- endothelial injury
Abnormal blood flow examples for virchows triad
AF
Stasis (eg immobility)
Turbulent flow (aneurysm, stents)
Most common thyroid tumour
Follicular adenoma
Most common primary malignant thyroid tumour
Papillary carcinoma
Which cells affected in medullary carcinoma
Parafollicular c cells (calcitonin)
What type of bacteria is TB
Weakly gram positive
Non motile
Non sporulating
Examples of mycobacterium
M. avium : respiratory and GI sx
M. tuberculosis
Where does TB affect
90% lung
20 % affect also other organs: Pleura, CNS, lymphatics, GU, MSK
Pott’s disease (in relation to TB)
TB of spine
Affects lower thoracic, upper lumbar
Progressive destruction of bones and disc + abscess
Pott’s disease (in relation to TB)
TB of spine
Affects lower thoracic, upper lumbar
Progressive destruction of bones and disc + abscess
What is miliary TB
TB widely spread through haematogenous route
Multiple opacities throughout lung, liver, spleen, pancreas
Ix for active TB
- Fluid sample (sputum or bronchial lavage)
- acid-fast bacilli staining or Ziehl-Neelsen staining - PCR or gene probe to differentiate specific type of mycobacterium + test for multidrug resistance
- Imaging: CT and CXR
Tests for latent TB
- interferon gamma release assay (eg quantiferon blood test)
- more reliable - Immunological tests: Mantoux or tuberculin skin test
Small amount of tuberculin injected into forearm and presence of a delayed hypersensitivity reaction is assessed
Issues with mantoux test
Positive in pt who had BCG vaccine
Negative in immunosuppressed§§
Medical mx of TB
Chemotherapeutic regime:
eg rifampicin , isoniazid, pyrazinamide , ethambutol
2 months of 4 followed by 2 months of 2
Granuloma def
An organised collection of macrophages, some fuse to form Langerhans giant cells
Often surrounded by a rim of lymphocytes
