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Phase 4 - GR > extra > Flashcards

extra Flashcards

1
Q

What is a sarcoma

A

a cancer of the connective tissue

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2
Q

How does an angiosarcoma present?

A 
long term bruising at breast - 
highly aggressive (bone and lung mets)
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3
Q

Name of bone sarcoma in young males - usually femus/pelvis?

A

ewing’s

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4
Q

Sarcoma Ix

Name 3

A

CT/MRI primary tumour
Heterogenous mass, central necrosis, patchy contrast enhancement

CT chest - pulmonary mets

HIV test

Biopsy for histology - grade and type

Genetic testing - Eg NF1

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5
Q

Mx of sarcoma

A

Excision
+radio
(chemo - but they not very chemosensitive

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6
Q

Key organs affected in sarcoidosis

A

Lungs (+LNs affected in 90%)

skin, eyes

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7
Q

What are the things in sarcoidosis?

A

Non-caseating granulomas with multinucleated giant cells

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8
Q

Extra thoracic sx of sarcoidosis

A

Erythema nodosum
chronic uveitis
hypercalcaemia neuro - headache / seizure
arthralgia

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9
Q

Sarcoidosis usual age

A

20-40

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10
Q

Name 3 sarcoid Ix and what you’d expect to see

A

CXR - bilateral hilar lymphadenopathy, bilateral upper zone infiltrates, pleural effusions, egg-shell calcifications

LuFT - restrictive, obstructive or mixed

ECG - conduction defect

FBC - bone marrow involvement - anaemia (20%), leukopenia (40%)

Urea and creatanine - renal involvement

Liver enzymes - liver involvement

Serum calcium - disregulated production of calcitriol by activated MP and granulomas leads to hypercalcaemia

Skin biopsy - non caseating granulomas

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11
Q

Name 2 DDx of sarcoidosis

A

TB
lymphoma
non-small cell Lung Ca

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12
Q

Mx of lung disease in sarcoidosis

A

1 -
Oral or inhaled corticosteroid (stage 1) - prednisolone, budesonide

2
(stage 2, 3, 4) + Cytotoxics - methotrexate (PO once per week)/azathioprine ±O2

3
Lung transplant

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13
Q

Mx of cutaneous sx of sarcoidosis

A

corticosteroids topical ± oral

Basically corticosteroids for all of the other tings as well

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14
Q

Common presentation of amyloidosis

A

unexplained weight loss, fatigue and oedema resistant to diuretics (kidney)

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15
Q

Whats seen in serum and urin in amyloidosis

A

monoclonal light chains

can mimic atypical multiple myeloma

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16
Q

Name 2 DdX of amyloidosis

A

Atypical myeloma, cardiomyopathy, nephrotic syndrome, carpal tunnel, MGUS

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17
Q

What dye for amyloid tissue ? whats seen\/

A

congo red dye and demonstrates green birefringence

18
Q

Name 3 parts of pres of amyloidosis

A

Lower extremity oedema (hypoalbuminaemia)

Jugular venous distension (high right side filling pressure with restrictive cardiomyopathy @50%)

Periorbital purpura (highly specific amyloid)

Fatigue, weight loss (cardiac), dyspnoea on exertion (cardiac amyloidosis)

Carpal tunnel

Large tongue

19
Q

Name 3 Ix in amyloidosis

A

Serum immunofixation -> +ve in 60% AL (presence monoclonal protein)

Urine immunofixation -> +ve in 80% AL (presence monoclonal protein)

Immunoglobulin free light chain assay - abnormal kappa to lambda

Bone marrow biopsy -> clonal plasma cells

Tissue biopsy -> positive green birefringence congo red

24hr urine -> high protein

ECG (conduction ab), echo (diastolic dysfunction, thickened septum), troponin (raised)

20
Q

Mx of amyloidosis

A

myeloablative high dose chemotherapy (melphalan) with stem cell reconstitution or chemotherapy

21
Q

2 key comps of amyloidosis

A

Chronic renal failure (use lisinopril)

Progressive cardiomyopathy

22
Q

name 2 different mech of lymphoedem a

A

Inflammatory - increased vascular permeability

Lymphatic - obstruction of lymphatic drainage

Hypoalbuminaemia - decreased oncotic pressure plasma e.g. liver failure (reduced protein synth), nephrotic syndrome

Venous oedema - due to increased venous pressure e.g. HF or venous obstruction

23
Q

Which parasite can cause lympoedema ? ix?

mx?

A

filarial

test with blood smear

diethylcarbamazine

24
Q

General mx of lympedema

A

Skin care, compression bandage, elevation, exercise, wt loss + psych support

25
Q

Name 4 Rfs of breast Ca

A

Constitutional
female, increasing age, obesity, high breast density, high SE status, benign breast disease

Oestrogen
uninterrupted oestrogen (no breast feeding, 0 children)
prolonged endogenous oestrogen (early menarche, late menopause)

Alcohol

*Family history - ovarian and breast Ca -> age and onset and number
BRCA1 -> Ch. 17 -> early: ER-ve, PR-ve - lifetime risk 80%
BRCA2 -> Ch. 13 -> AD -> male breast Ca - lifetime risk 40%

26
Q

2 key receptors of breast Ca and drug you can use

A

ER +ve - tamoxifen

HER-2 +ve - trastuzumab/herceptin

27
Q

Tripple breast assessment is?

A

Clinical

Hystology

  • fine needle aspiriation for cytology
  • core biopsy for histology

Radiology
-mammography -uss

28
Q

Bar triple assessment what other Ix might you do in breast ca ? name 2

A

LFT/liver USS (mets),
Ca + bone scan (bone),
CXR (lung) +
TEST RECEPTORS (ER, PR, HER2)

29
Q

3 types of breast surgery

A

Mastectomy
> 20% breast volume, multifocal, central

Lumpectomy (conservation + margin) + radiotherapy
<20% breast volume, unifocal, peripheral

± reconstruction (gold standard = tram flap)

30
Q

When is chemo used in breast Ca

A

younger patients or for more aggressive cancer

31
Q

Mx of lactational infection

A

flucloxacillin or erythromycin

32
Q

Mx of breast abscess

A

flucloxacillin + metronidazole

33
Q

Middle age woman with lumpy, painful breasts at menstruation

A

Fibroadenosis

34
Q

Woman around menopause with tender lump and green discharge

A

Mammary duct ectasia

35
Q

Bloody discharge, local area of epithelial proliferation in large mammary duct (hyperplastic)

A

Duct papilloma

36
Q

Obese woman with trauma to breast. Initially firm and round but turns hard and irregular

A

Fat necrosis

37
Q

Lactating woman with red, hot, tender breast

A

Abscess

38
Q

Test for EBV

A

Positive heterophile antibody test

39
Q

2 KEY comps of EBV

A

splenic rupture

haemolytic anaemia

40
Q

Sx of glandular fever

A

Cervical or generalised lymphadenopathy (tender)

pharyngitis

fever

malaise

splenomegaly

hepatomegaly

41
Q

What can’t you give to EBV? why?

A

NO AMP/AMOX as severe rash with EBV

Phase 4 - GR (22 decks)

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