Joseph Hall Flashcards
What is the glass test used for?
Push a glass against the rash, if you can see the rash through the glass the test is positive for a petechial rash.
What is the relationship between appetite and sickness?
Release of IL-18 cytokine
Binds to receptors on the BST-LH (bed nucleus of the stria terminalis- lateral hypothalamus) neuronal pathway, which interferes with GABA and glutamate release.
This means that the lateral hypothalamus isn’t stimulated enough, so we do not feel as hungry.
Bacteria need glucose, by not eating we reduce availability for them
At what age is the liver palpable till in children?
Should be palpable in newborns for 2cm, >3.5cm is cause for concern
Gap gradually decreases
10-16 under 1cm can be felt
How to classify non-blanching and petechial rashes?
Non-blanching rashes are caused by bleeding under the skin. Petechiae are small (< 3mm), non blanching, red spots on the skin caused by burst capillaries.
Purpura are larger (3 – 10mm) non-blanching, red-purple, macules or papules created by leaking of blood from vessels under the skins.
5 ddx for petechial rashes
meningococcal septicaemia HSP ITP Acute leukaemia HUS mechanical traumatic viral illness e.g influenza
5 causes of lymphadenopathy (MIAMI)
Malignancy Infection Autoimmune Miscellaneous Iatrogenic
3 types of anaemia?
microcytic
normocytic
macrocytic
5 ddx for macrocytic anaemia
acute GI bleeding trauma iron, B12, folate deficiency leukaemia pregnancy
5 causes of hepatomegaly
inflammation infiltration obstruction storage abnormalities vascular congestion
5 causes of splenomegaly
• Alcohol induced • Hepatic steatosis • Tumours • Haemolytic anaemia • SCA • Acute anaemia • Malaria • TB • Viral hepatitis • Infective endocarditis • Leukaemia • Lymphoma •
4 emergencies associated with childhood malignancy
o SVC syndrome- caused by compression or obstruction of the SVC usually as a result of a thrombosis or mass
o Spinal cord compression- mass or tumour pressing on the spinal cord, weakness, gait abnormalities, numbness etc.
o Tumour lysis syndrome- when a tumour cell dies and releases potassium, phosphates and nucleic acids into the blood stream. This leads to hyperuricemia and hypocalcaemia. Usually seen in ALL and high-grade lymphomas. Symptoms include decreased urine output, respiratory distress, oedema, nausea and vomiting, muscle cramps and twitching, cardiac arrhythmias.
o Septic shock
what is myeloma?
tumour comprised of plasma cells
2 proteins detectable in myeloma?
paraprotein
Bence-Jones proteins
why do you get renal failure in myeloma?
proteins get stuck in the kidneys
4 symptoms of myeloma
pain, fatigue, recurring infections, kidney damage, peripheral neuropathy
5 symptoms of lymphoma
fatigue, lumps in neck, armpits or groin, fever, night sweats, SOB, unexplained weight loss, itchy skin
5 symptoms of AML
fever, SOB, bruising, bleeding, petechiae, weakness, loss of appetite, weight loss.
5 symptoms of ALL
fever, bruising, bleeding, petechiae, bone/joint pain, painless lumps in the neck, armpits and groin, pain or feeling of fullness below the ribs- hepatomegaly caused by infiltration of leukaemic cells, weakness, anaemia, loss of appetite
5 symptoms of CML
exhaustion, fever, drenching night sweats, unexplained weight loss and pain or a feeling of fullness below the ribs- sometimes asymptomatic
5 symptoms of CLL
painless lumps in the lymph nodes, weakness, feeling tired, pain or feeling of fullness below the ribs, fever and infection, bleeding, petechiae, night sweats, unexplained weight loss
What is DIC
o Overactive clotting
o Clotting factors are used up which can lead to bleeding
role of the spleen x3
o Clearance of microorganisms and particulate antigens from the blood stream.
o Synthesis of immunoglobulin G (IgG), properdin (an essential component of the alternate pathway of complement activation), and tuftsin (an immunostimulatory tetrapeptide)
o Removal of abnormal red blood cells (RBCs)
What are CD2 and CD10 what are they markers for?
CD2 is a glycoprotein receptor found on NK cells and T cells. It plays an important role in the activation of helper T cells. It is shown that T cell lymphoid malignancies have a low CD2 markers and AML may have an increased CD2 expression
CD10 is a marker for B-ALL, various other cancers including breast, hepatocellular carcinoma vs non-hepatocellular carcinoma, Burkitt lymphoma, follicular lymphoma.
Why is potassium low in leukemia?
- Inadequate intake
- Caused by the treatment vomiting, nausea
- Antibiotics and steroids can increase renal losses
- Damage to renal tubule cells via leukemic cells
- Blast crisis
CI, cautions, side effect and MOA of vincristine
o CI: intrathecal injection- severe neurotoxicity and death
o Cautions: irritant to tissues, ileus, neuromuscular disease
o Side effects: hypersensitivity, rash, SIADH, abdominal cramps, adrenal disorder, anaemia, decreased appetite, alopecia, constipation, coronary artery disease, diarrhoea, dizziness, headache, hypotension, bronchospasm following administration, neurotoxicity
o MOA: vinca alkaloid- inhibits mitosis at metaphase by interacting with tubulin
CI, cautions, side effect and MOA of aspariginase
o CI: history of pancreatitis, serious haemorrhage, serious thrombosis, pre-existing coagulopathy
o Cautions: diabetes- may raise blood glucose, hypersensitivity reactions, hypertriglyceridaemia (severe), increased risk of acute pancreatitis.
o Side effects: abdominal pain, agitation, anaemia, decreased appetite, back pain, bronchospasm, diarrhea, DIC, dizziness, drowsiness, embolism and thrombosis, haemorrhage, hallucination, hyperglycaemia, hypersensitivity
o MOA: breaks down L-asparagine to aspartic acid and ammonia, which interrupts protein synthesis in tumour cells.
CI, cautions, side effect and MOA of dexamethasone
o CI: avoid live virus vaccines, systemic infection, injections containing benzyl alcohol in neonates.
o Cautions: congestive heart failure, diverticulitis, epilepsy, glaucoma, hypertension, hypothyroidism, recent MI
o Side effects: anxiety, fluid retention, GI discomfort, headache, impaired healing, increased risk of infection, menstrual cycle irregularities, nausea, skin reactions, weight gain.
o MOA: reduces leukocyte migration to sites of inflammation, inhibit NFk-b and promote anti-inflammatory genes like IL-10.
distinguish between 1y and 2y immunodeficiencies
- Primary immunodeficiency- inherited immune disorders resulting from genetic mutations, usually present at birth and diagnosed in childhood.
- Secondary immunodeficiency- acquired as a result of disease or environmental factors e.g. chemotherapy, HIV infection, malnutrition. These are more common than PID.
Prophylaxis of TLS
can give fluids and allopurinol
rasburicase if intermediate risk
DO NOT GIVE RASBIURICASE AND ALLOPURINOL
Tx of established TLS
o Hydration- NOT POTASSIUM BASED
o Give rasburicase at 0.2mg/kg as long as no CIs. Duration is determined by clinical response.
o don’t treat asymptomatic hypoCa
o Symptommatic hypocalcaemia can be treated with a short infusion of calcium gluconate.
o K>6mmol/L or an increase in 25% over baseline should have cardiac monitoring
o Fluid overload that is hard to control, hyperK, hyperuricaemia, hyperphosphataemia of hypoCa are indications for renal dialysis -Peritoneal dialysis not recommended, Should continue until adequate recovery
MOA of calcium gluconate
Oral calcium salt
Prevents arrhythmias by raising the depolarization requirements, thereby reducing contractility
MOA of ametop cream
Contains tetracaine
Blocks sodium ion channels involved in initiation and conduction of neuronal impulses
what is piptazobactam and MOA
combination of piperacillin and tazobactam- broadens the spectrum it can be used for. Interferes with cell wall synthesis. Binds to specific penicillin binding proteins. Cell lysis then occurs by cell wall autolytic enzymes. May also interfere with autolysin inhibitors.
MOA of gentamicin
aminoglycoside, binds irreversibly to 30S subunit proteins and 16S rRNA, interfering with protein synthesis. Interferes with the initiation complex resulting in the misreading of mRNA therefore incorrect AAs are inserted into the polypeptide.
MOA of methotrexate
Inhibits enzymes responsible for nucleotide synthesis, thus preventing cell division.
what is the philadelphia chromosome
Gene that codes for a tyrosine kinase with increased enzymatic activity.
Fusion of 2 chromosomes leading to the production of a BCR-ABL oncogene- abnormal tyrosine kinase activity.
MOA of allopurinol
inhibits xanthine oxidase, which converts hypoxanthine to xanthine to uric acid.
Rasburicase MOA
catalyses enzymatic oxidation of uric acid into inactive and soluble metabolites- allantoin
