Foundation week 2 Flashcards
Type 1 hypersensitivity
Antigen +TH2 -> TH2 releases IL-4 so Bcells produce IgE. IgE sensitises mast cells and basophils by joining.
Antigen reinfection + IgE complex -> histamines, leukotrienes and prostaglandins.
Eg anaphylaxis, asthma, atopic dermatitis, food and drug allergies.
Type 2 hypersensitivity
Cell-bound antibodies bind to foreign/abnormal cell -> activates compliment -> neutrophil degranulation, O2 radicals and MAC.
Eg Acute transfusion reaction, Goodpasture’s, Grave’s, myasthenia gravis, ITTP, Autoimmune haemolytic anaemia.
Type 3 hypersensitivity
Soluble antigens + free antibodies -> complex wedges in basement membranes of blood filtration eg Kidney, synovial joints -> activates compliment.
Eg Rheumatoid Arthritis, T1 diabetes, SLE, post strep glomerulonephritis
Type 4 hypersensitivity
Antigen processed by antigen presenting cells. Antigen+ TH1 -> THelper releases chemokines to attract macrophages -> release lysozymes and IF alpha for more. CD8 Tcells involved in organ rejection -> cell mediated cytotoxicity.
Eg contact dermatitis, drug allergies, multiple sclerosis,
Chostochondritis
Chest wall pain syndrome- inflammation of costochondal and sternocostal joints. Usually affecting multiple ribs (commonly 2-5th) on same side. Often microtrauma or infection. No swelling.
Those with persisting discomfort may have local nerve blocking corticosteroid injections. Affects teen and 50+ and more likely women.
Tietze syndrome
Chest pain and swelling of costochondral and sternocostal areas of ribs 1-4. Firm spindle swelling within the cartilage. An aching, gripping pain. Sometimes radiates to shoulders, arms and neck. Redness and warmth can happen. Pain goes after weeks but swelling stays longer. Mostly affects teenagers and younger adults.
Precordial catch syndrome
Nerve based stabbing pain in a small area of the chest. Can be psychological. Children- tweens most commonly affected.
Papillary thyroid cancer
70% of thyroid cancer. Presents 35-40. Commonly ,1cm with good prognosis. Tends to spread locally, compressing trachea and recurrent laryngeal nerve. Most metastases= lungs , bone, mediastinal nodes, pelvis, brain, liver.
Follicular thyroid cancer
10%. Occurs in areas of low iodine. Women 30-60. More likely to metastasise to lungs and bones.
Hurthle cell thyroid cancer/tumours
Up to 10%, most commonly at 50-60 years. More aggressive.
Medullary thyroid cancer
From parafollicular calcitonin producing c cells of the thyroid. 75% of cases occur sporadically. Most commonly in 20-30s then 50-60s. In men and women. Produces carcinoembryonic antigen/CEA and calcitonin.
Anaplastic thyroid cancer
Most aggressive. From the follicular cells but no resemblance. Most commonly 55-65. Is often a transformation of a well-differentiated tumour. Large mass- often has compression signs:
Dyspnoea, cough, vocal cord paralysis, dysphagia and hoarseness. %05 have distant metastases, commonly in the bones, liver and brain. Mean survival is 6 months.
Thyroid lymphomas
Almost always NHL, up to 10% of all thyroid malignancies. More common in areas of thyroiditis. Females have it 4:1. Rapidly growing neck mass that can obstruct. Much worse if disseminated.
Risk = cowden’s syndrome or familial adenomatous polyposis.
PSA test fast track referral
if 40-49 yrs- >2.5
50-59- >3.5
60-60- >4.5
70+ is >6.5
Prostate cancer hormone therapy
LHRH agonists- eg goserelin, leuprorelin, triptorelin. Lowers testosterone via anterior pituitary.
Anti-androgens inhibit androgen receptors to inhibit cancer growth. Can be steroidal = cyproterone acetate or non-steroidal = bicalutamide, nilutamide, flutamide.
Chemo would be docetaxel or cabazitaxel with prednisone or prednisolone.
Small cell lung cancers vs Non-small cell lung cancers
SCLC (15%) also called oat-cell carcinoma. Arises from kulchitsky cells. Part of the endocrine system. Rapidly growing and poor prognosis.
NSCLC- squamous is 42% of lung cancers. Most present as obstructive lesions of the bronchus leading to infection. More likely to have a local spread.
Adenocarcinoma- 39%. From mucous cells in bronchial epithelium. It is the most common bronchial carcinoma associated with asbestos and is more common in non-smokers. Invasion of pleura and mediastinal nodes= common. Often metastasises to brain and bones.
Other types include large cell (undifferentiated), bronchioalveolar and carcinoid.
2 wk referral for 40+ w/ smoked, cough, fatigue, sob, dec weight or appetite.
Rifampin side effects
Upset stomach, itching, flu symptoms, headache, dizziness, menstrual changes, temporary colour change of skin, teeth, saliva, urine, stool, sweat and tears to yellow, red or brown.
NIPE
eyes, heart and hips (+testes)
Exercise induced bronchospasm
Occurs 5-20 minutes after- trouble breathing, cough, chest pain, tightness, wheezing.
Other exercise pain- costochondritis, tietze’s, precordial catch syndrome.
Hypothermia changes
dec bicarb and potassium, inc sugar then dec after, increased urea and calcium.
Perioperative complications
DVT, PE, intracranial bleeding, sepsis, implant failure, anastomotic leak, ileus, postoperative haemorrhage, fistula.
V flutter
is extreme of ventricular tachycardia. Turns to vfib, shows no p, qrs nor t. Rate over 200. x give verapamil to svt bc leads to vfib. this requires cardioversion.
Otosclerosis
Bone based hearing loss more likely in women. Develops 15-35. Speaking softly, hears better when noisy, hears body sounds, can be dizzy and ataxic.
Doctrine of double effect
If doing something morally good = morally bad outcome, is ethically ok if side effect was not intended.
Ethical equipoise
When there is uncertainty or conflicting opinion on best diagnosis, treatment etc. It’s ok to allocate interventions to patients as to figure it out.
Thromboangiitis obliterans
Smoking related condition that results in thrombosis in small-medium arteries, commonly in hands and feet.
Pain, general claudication, cold sensitivity, diminished pulses, blue-red digit change, skin becomes thin and shiny, reduced hair growth, might complicate to ulcerations and gangrene.
Signs of PAD
leg pain whilst walking that stops at rest, skin ulcers, blue skin, cold skin, statins, ace, cilostazol. Better is dangle feet off bed.
Multiple endocrine neoplasia
Autosomal dominant. Tumours in at least 2 endocrine glands and doesn’t have to be cancerous. Types 1 (MEN1) 2 (RET) and 4 (CDKN1B).
Type 1 = parathyroid, pituitary, pancreas, hyperparathyroidism is major sign. Disrupts calcium + gives osteoporosis, vomiting, htn, weakness.
Type 2 is associated with medullary thyroid cancer. can also have pheochromocytoma with htn. Type 2B x have hyperparathyroidism.
Type 4 is like 2 but onset by different genes,
Acetylcysteine
To treat paracetamol overdose and loosen thick mucous.
STI backdating time frame
men = 1 month before symptoms. Women + asymptomatic men= 6 months before onset.
Hepatitis A
Only transmitted fecal-orally. Self-resolving within 2 months. Prodromal phase- flu and GI symptoms, RUQ pain, headache, cough, pharyngitis, itch, urticaria.
Icteric phase includes jaundice, pale stools and dark urine if there is cholestasis. Symptoms improve once jaundice appears.
Convalescent phase includes malaise and hepatic tenderness.
Diagnosis is from presentation, igM + igG or have HAV RNA, or have antiHAV igM with a confirmed hep A link.
No longer contagious after 7 days onset of jaundice or symptoms.
Spinal claudication
Narrowed spinal canal-> pressurises cauda equina. Pain, tingling, tiredness, numb or heavy legs, butt and lower back. Caused by stenosis, osteoarthritis, spondylitis, Rha, Paget’s, tumour, disc issues, scoliosis, achondroplasia.
Indications of low specific gravity
Diabetes insipidus. High would show mild dehydration or DM.
Vocal cord polyps
More red than nodules +larger. Looks like blisters with a scratchy voice. Occurs from overuse. Same with vocal nodules.
Reinke’s Oedema
Fold under the vocal cord space is swollen. It’s bilateral and symmetrical. Often from acid, smoking**! or hypothyroidism. Has a sac-like appearance to the vocal cords. Deep hoarse voice like in pharyngitis. Often dyspnoea.
Associations of perianal skin tags
External haemorrhoids (will be painful if they have a clot). Or fissures and crohns. Fissures can itch, bleed and hurt when passing stool.
Management of diabetes in palliative care
If > 15mmol/L only treat the symptomatic. eg 5 units/novorapid and check in an hour. Monitor twice a day.
If terminal- give if they have spiked 2 days on.
If asymptomatic and BM >4 stop monitoring or once a day at 1/3-2/3 previous normal dose.
If tablets- check up BM twice a week. Should ideally be glicazide. If control is slipping give insulin.
Terminal phase and declining- stop dietary restriction, monitoring and medication.
Nimodipine
With subarachnoid haemorrhage is good because improves neurological deficits due to spasm.
Acute fatty liver of pregnancy
3rd trimester issue. Vomiting, pain, polydipsia/urea, encephalopathy, >14micromol/L billirubin, <4mmol/L hypoglycaemia. > 340 micromol/L urea. Inc leukocytes, inc transaminases, inc ammonia, creatinine > 150micromol/L, inc PTT or APTT.
Coombs test
Also AGT test. Detects antibodies against surface of RBCs. Coomb’s positive babies= risk of hyperbilirubinemia. Could be positive in autoimmune haemolytic anaemia, chronic lymphocytic leukaemia, SLE, drug haemolysis. Tests Rh antibody in pregnancy.
Adrenaline dosing
For cardiopulmonary resus- 10micrograms/Kg per 3-5 mins. Max dose 1mg. Eg 100 microgram/Ml for a child. Adult is 1mg per 3-5 mins as 100micrograms/Ml solution as max dose.
For acute hypertension- neonate is 100nanograms/kg/minute, then up to 1.5 micrograms. Same for a child.
For emergency anaphylaxis- in micrograms every 5 minutes:
100 for 6m or younger, 150 for under 5 yrs, 300 for under 12 years, over 12 and under 18 is 300-500 depending on size, 500 for 18+.
Testicular seminomas
Germ cell tumour most commonly in anterior mediastinum, 45% of all testicular tumours. Most common non-haematological malignancy in males 15-49.
Risk factors = undescended testis, family history, HIV, mumps, orchitis, trauma, immunosuppression.
Shows painless-uncomfortable yellow-grey nodular testicular mass. Not associated with alpha fetoprotein.
3 types of seminomas- classic (85%) characterised by sheets of cells, lots of cytoplasm, round hyperchromatic nuclei and infrequent mitosis. Anaplastic- (10%) > mitotic figures per high power field. Spermatocytic (5%) males older than 60, rarely metastasises, well differentiated and appears like secondary spermatids.
Ultrasound diagnoses and CT stages it.
Non-seminoma testicular tumours
Choriocarcinoma(rare), embryological carcinoma, teratoma, yolk sac tumours.
Stromal tumours are benign tumours of leydig or sertoli cells and usually occurs in childhood.
Stage 1 has not spread, 2 is to nodes and 3 is beyond.
Blind loop syndrome
When food bypasses a section of the intestine, often from surgery. Can be as digested food slows or stops moving-? overgrowth of bacteria + issue absorbing nutrients. Affects bile use and vitamin B12 lvels.
Symptoms = diarrhoea, fatty stool, early saeity, loss of appetite, nausea, unintentional weight loss.
Giardiasis
Parasite from poor water sanitation. Gives smelly diarrhoea, egg burps, stomach pain and vomitign. Give metronidazole.
Lyme disease
Borrelia burgdorferi. Erythema migrans rash only occurs in lyme disease. If doesn’t have that- give an elisa test. Treat with doxycycline.
Post operative anuria
May be delayed or reduced due to fluid + blood loss, as well as inc aldosterone + ADH in 24hrs after surgery, comes with salt and water retention. Insufficient analgesia after surgery can precipitate retention or anuria. If anuric or -500ml after 24hrs, could be acute renal failure or urinary retention.
Acute cerebellar ataxia of childhood
Unsteady gait, slurred speech, ataxia, nystagmus but afebrile. Cause by drugs, infection or paraneoplastic syndrome. Most common infections are chickenpox and epstein barr. Between 2-7 commonly.
