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Family Medicine > Extra 2 > Flashcards

Extra 2 Flashcards

1
Q

Most common thyroid cancer

A

Papillary - can be caused by radiation

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2
Q

Types of non functional thyroid cancer

A

Papillary
Follicular - due to low iodine
Hurthe - seen in inflammation

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3
Q

Describe medullary thyroid cancer

A

Arise from parafollicular cells
Associated with MEN 2a or 2b
Spindle cells produce calcitonin + serotonin causing diarrhea

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4
Q

Describe anaplastic thyroid cancer

A

Altered cells unlike normal ells
Pleomorphic giant cells
Most aggressive

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5
Q

Dx of thyroid cancer

A

US
Increased calcitonin
Radioiodine scan
FNA

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6
Q

Mechanism of neuroblastoma

A

common in <5 y/o
Arises from neural crest cells - don’t differentiate
Arise in adrenal gland
3 types: undifferentiated (small blue cells), poorly differentiated + differentiated (Schwannian stroma)

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7
Q

S+S of neuroblastoma

A

Fever, wt loss, sweating, fatigue
Large, painful abdo mass
Mets causing basal skull fractures = racoon eyes

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8
Q

Dx of neuroblastoma

A

HMA + VMA increased

CT

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9
Q

Tx of neuroblastoma

A

Surgery + chemo

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10
Q

Describe PNETS

A

Linked to MEN 1
Non functional - cause jaundice, asymptomatic
Functional - insulinoma or gastrinoma

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11
Q

Describe a gastrinoma

A

Increased gastrin = Zollinger Ellison syndrome

Peptic ulcers + steatorrhea

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12
Q

Mechansim of carcinoid syndrome

A

Cancers arising from neuroendocrine cells - tumors in GI tract, lung + ovaries + liver mets
Produce serotonin, histamine, bradykinin + prostaglandins

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13
Q

S+S of carcinoid syndrome

A 
Itching
Diarrhea
Flushing 
SOB 
Pulmonary stenosis 
Serotonin = pellagra + bronchoconstriction

WORSENED by alcohol or stress

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14
Q

Dx + Tx of carcinoid syndrome

A

CT or octreoscan

Surgery or chemo

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15
Q

Describe MEN 1

A

Parathyroid, pancreatic + pituitary tumors
Parathyroid = increased calcium
Pancreatic = increased gastrin (ulcers), insulin (hypoglycaemia) or glucagon (hyperglycaemia)
Pituitary adenomas

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16
Q

Describe MEN 2a

A

Thyroid medullary, pheochromocytoma, parathyroid adenoma

Thyroid = increased calcitonin
Pheo = increased adrenaline
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17
Q

Describe MEN 2b

A

Thyroid medullary, pheochromocytoma + neuromas

Neuromas = skin, mouth, tongue, lips etc

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18
Q

What is Whipple’s triad?

A

Hypoglycaemia with fasting or exercise
Reversal of S+S with glucose
Low BM

Means there is an insulinoma

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19
Q

Dx of Zollinger Ellison

A

Increased gastrin after secretin

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20
Q

Describe Peutz Jeghers syndrome

A

Auto dominant
Polyps in GI tract can lead to colon cancer + increased risk of breast, pancreatic, lung, ovaries + testes
Also causes melanotic macules on mouth, lips + gentials

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21
Q

Describe juvenile polyposis syndrome

A

Develop hamartomas - sessile or pedunculated

Also causes hypotonia + macrocephaly

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22
Q

Mechanism of primary sclerosing cholangitis

A 
Inflammation causing fibrosis + dilation of bile ducts
Looks like beading 
Onion skin on histology
Associated with IBD 
Increased IgM + pANCA
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23
Q

S+S of primary sclerosing cholangitis

A

Bile in blood causing pruritis, increased conjugated bilirubin + increased ALP + GGT

24
Q

Dx + Tx of primary sclerosing cholangitis

A

ERCP + liver transplant

25
Q

Mechanism of haemochromatosis

A 
Primary = hereditary 
Secondary = too many transfusions

Too much iron absorbed, causing iron deposits in liver that produce free radicals

Cause fibrosis + cirrhosis, T1DM, malabsorption, cardiomyopathy, joint disease, bronzed skin + gonadal dysfunction

26
Q

Lab results for haemochromotosis

A

High ferritin, transferrin + iron

Low TIBC

27
Q

Dx of haemochromotosis

A

Liver biopsy

28
Q

Tx of haemochromotosis

A

Phlebotomy + deferoxamine

29
Q

Mechanism of Wilsons disease

A

Failure to excrete excess copper in bile or urine
Causes deposits in tissues;
Brain = basal ganglia causing movement disorder or in cerebral cortex causing dementia
Cornea = Kaiser Fleischer rings
Liver - hepatitis / cirrhosis (1st presentation in kids)

30
Q

Dx + Tx of Wilsons

A

Dx = reduced ceruloplasmin, increased copper in urine

Tx with copper chelators (penicillamine, trientine, zinc)

31
Q

Mechanism of sideroblastic anemia

A

Build up of iron in RBC causing increase in immature rbc
Congenital is X linked
Acquired due to excess alcohol, lead poisoning or low B6 (due to isoniazid use)
Pappenheimer bodies in mitochondria

32
Q

S+S of sideroblastic anemia

A

Fatigue, diarrhea, ckd, cirrhosis, heart disease

33
Q

Dx + tx of sideroblastic anemia

A

Dx = pappenheimer bodies on smear
high iron, high ferritin, low TIBC
Tx = pyridoxine, thiamine, folic acid, defuroxamine

34
Q

Mechanism of aplastic anemia

A

Autoimmune destruction of haematopoitic stem cells causing pancytopenia due to chemo, radiation, toxins, EBV, HIV
Also due to Fanconi’s anemia

35
Q

Dx + Tx of aplastic anemia

A 
Dx = increased EPO, decreased reticulocytes, bone marrow biopsy 
Tx = stem cell transplant or ciclosporin
36
Q

Mechanism of G6PD deficiency

A

Destruction of RBC due to defective G6PD enzymes
X linked recessive
Protective against malaria due to reduced half life
causes hemolytic anemia which is worsened by free radical production from infections, fava beans, soy, quinines

37
Q

S+S of G6PD deficiency

A

Asymptomatic until times of stress

then jaundice + anemia

38
Q

Dx + Tx of G6PD def

A

Dx = reduced RBC, increased reticulocytes, increased LDH + bilirubin, decreased haptoglobin
Coombs test negative
Enzyme assay
Tx = hydration + transfusion

39
Q

Describe factor V leidin

A

Auto dominant, causes vte

dx = PTT shortened or protein C functional assay

40
Q

Mechanism of antiphospholipid syndrome

A

Autoimmune, associated with SLE
Hypercoagulable state causing arterial thrombosis + Libman Sachs endocarditis
Also causes CKD, livedo reticularis, miscarriage, neuro S+S

41
Q

Dx + tx of antiphospholipid syndrome

A

Dx = 1 clinical (hx of thrombosis or pregnancy complications) + 1 lab (presence of anticardiolipin, anti-beta 2 glycoprotein ab or lupus anticoagulant)

Tx = aspirin/ warfarin/ heparin

42
Q

Mechanism of ITP

A

Autoimmune - spleen produces IgG Ab
Acute = affects kids after viral infection
Chronic = affects women, triggered by hep C, HIV or lupus

43
Q

Tx of ITP

A

Steroids or IVIG

44
Q

Mechanism of SLE

A

ANA +

Ag + Ab complex deposits

45
Q

Dx of SLE

A

4 of 11 criteria:

1) malar rash
2) discoid rash
3) photosensitivity
4) ulcers in mouth/ nose
5) serositis (pleuritis, pericarditis)
6) arthritis
7) renal disease
8) seizures or psychosis
9) haem disease (pancytopenia)
10) ANA +
11) Anti smith, anti-dsDNA, anti-phospholipid

46
Q

S+S of polymyositis

A

Photosensitive macular rash
Mechanics hands
Gottron’s papules (rough red papules on fingers)
Respiratory muscle weakness

47
Q

Dx of polymyositis

A

ANA +
Jo +
Anti Mi2 +

48
Q

mechanism of pagets disease of bone

A

Increased bone remodelling leads to deformities

Can be triggered by measles

49
Q

S+S of Pagets disease of bone

A

Skull; hearing loss, vision loss

Lumbar spine, pelvis + femur = nerve pain, kyphosis, osteosarcoma

50
Q

Describe osteochondroma

A

Males <25
Benign
Arises from growth plate, forms exostosis
Typically metaphysis of long bones

51
Q

Describe giant cell tumor of bone

A

RF: trauma + radiation
Epiphyses of long bones
Benign

52
Q

Describe osteoblastoma

A

Benign

Forms a nidus (collection of vessels, trabeculae, osteoid)

53
Q

Describe osteoid osteoma

A

Benign
Worse at night
Produces prostaglandins and causes pain

54
Q

Describe osteosarcoma

A

Pleomorphic osteoblasts form increased osteoid tissue in metaphyses
Common in teens
Linked to retinoblastoma + Li-Fraumeni
Malignant

55
Q

Describe Ewing’s sarcoma

A

10-20 y/o
Malignant
Arise from small round blue cells
Commonly affects femur and sacrum

56
Q

Describe chondrosarcoma

A

Malignant
Affects elderly
Affects pelvis + long bones
causes bone pain, swelling and fractures

57
Q

X ray findings for osteochondroma, giant cell tumors, osteosarcoma, ewings sarcoma + chondrosarcoma

A 
osteochondroma = exostosis 
giant cell tumors = soap bubbles
osteosarcoma = sun burst + codmans triangle 
ewings sarcoma = onion skin 
chondrosarcoma = moth eaten

Family Medicine (10 decks)

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