extra Flashcards
What is a sarcoma
a cancer of the connective tissue
How does an angiosarcoma present?
long term bruising at breast - highly aggressive (bone and lung mets)
Name of bone sarcoma in young males - usually femus/pelvis?
ewing’s
Sarcoma Ix
Name 3
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
Mx of sarcoma
Excision
+radio
(chemo - but they not very chemosensitive
Key organs affected in sarcoidosis
Lungs (+LNs affected in 90%)
skin, eyes
What are the things in sarcoidosis?
Non-caseating granulomas with multinucleated giant cells
Extra thoracic sx of sarcoidosis
Erythema nodosum
chronic uveitis
hypercalcaemia neuro - headache / seizure
arthralgia
Sarcoidosis usual age
20-40
Name 3 sarcoid Ix and what you’d expect to see
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
Name 2 DDx of sarcoidosis
TB
lymphoma
non-small cell Lung Ca
Mx of lung disease in sarcoidosis
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
Mx of cutaneous sx of sarcoidosis
corticosteroids topical ± oral
Basically corticosteroids for all of the other tings as well
Common presentation of amyloidosis
unexplained weight loss, fatigue and oedema resistant to diuretics (kidney)
Whats seen in serum and urin in amyloidosis
monoclonal light chains
can mimic atypical multiple myeloma
Name 2 DdX of amyloidosis
Atypical myeloma, cardiomyopathy, nephrotic syndrome, carpal tunnel, MGUS
What dye for amyloid tissue ? whats seen\/
congo red dye and demonstrates green birefringence
Name 3 parts of pres of amyloidosis
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
Name 3 Ix in amyloidosis
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)
Mx of amyloidosis
myeloablative high dose chemotherapy (melphalan) with stem cell reconstitution or chemotherapy
2 key comps of amyloidosis
Chronic renal failure (use lisinopril)
Progressive cardiomyopathy
name 2 different mech of lymphoedem 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
Which parasite can cause lympoedema ? ix?
mx?
filarial
test with blood smear
diethylcarbamazine
General mx of lympedema
Skin care, compression bandage, elevation, exercise, wt loss + psych support
Name 4 Rfs of breast Ca
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%
2 key receptors of breast Ca and drug you can use
ER +ve - tamoxifen
HER-2 +ve - trastuzumab/herceptin
Tripple breast assessment is?
Clinical
Hystology
- fine needle aspiriation for cytology
- core biopsy for histology
Radiology
-mammography -uss
Bar triple assessment what other Ix might you do in breast ca ? name 2
LFT/liver USS (mets),
Ca + bone scan (bone),
CXR (lung) +
TEST RECEPTORS (ER, PR, HER2)
3 types of breast surgery
Mastectomy
> 20% breast volume, multifocal, central
Lumpectomy (conservation + margin) + radiotherapy
<20% breast volume, unifocal, peripheral
± reconstruction (gold standard = tram flap)
When is chemo used in breast Ca
younger patients or for more aggressive cancer
Mx of lactational infection
flucloxacillin or erythromycin
Mx of breast abscess
flucloxacillin + metronidazole
Middle age woman with lumpy, painful breasts at menstruation
Fibroadenosis
Woman around menopause with tender lump and green discharge
Mammary duct ectasia
Bloody discharge, local area of epithelial proliferation in large mammary duct (hyperplastic)
Duct papilloma
Obese woman with trauma to breast. Initially firm and round but turns hard and irregular
Fat necrosis
Lactating woman with red, hot, tender breast
Abscess
Test for EBV
Positive heterophile antibody test
2 KEY comps of EBV
splenic rupture
haemolytic anaemia
Sx of glandular fever
Cervical or generalised lymphadenopathy (tender)
pharyngitis
fever
malaise
splenomegaly
hepatomegaly
What can’t you give to EBV? why?
NO AMP/AMOX as severe rash with EBV
