Misc Flashcards
Sarcoma:
- Def
- Types
- Pres
Cancer of connective tissue
Liposarcoma
Leimyosarcoma
Kaposi’s
Soft tissue swelling and pain
Gell and Coombs, 4 types of hypersensitivity
ABCD
Type 1
- Allergy: IgE, anaphylaxis. Minute
Type 2
- antiBody (IgG/IgM), hours (ITP or haemolysis due to ABO)
Type 3
- immune Complex: soluble antigen/antibody complexes (IgG, IgM). Days, Lupus, post-strep glomerulonephritis
Type 4
- Delayed. E.g. Graft versus host disease
Sarcoma familial syndromes
Neurofibromatosis 1
Retinoblastoma mutation (osteosarcoma)
Angiosarcoma:
- Pres
- Prog
Long term bruising at breast
Highly aggro, mets to bone/lung
Ewings sarcoma:
- Who
- Location
Bone sarcoma in young males
Pelvis/Femur
Sarcoma investigations
CT/MRI primary tumour
- Heterogenous mass
- Central necrosis
- CT chest = pulmonary mets
HIV test (Kaposi’s)
Biopsy (type and grade)
Genetic testing (NF1, RB)
Sarcoma Tx
Excision
Radiotherapy (Pre-op, adjuvant)
Chemo (not very chemosensitive)
Sarcoidosis
- Pres
SOB, cough, Erythema nodosum
Bilateral Hilar lymphandenopathy
Pulmonary infiltrates
What is Sarcoidosis
Chronic granulomatous (non-caseating) disorder characterised by accumulation of lymphocytes and macrophages in lung and other organs (any)
Sarcoidosis Organ system effects
Pulmonary
- Bilateral hilar lymphadenopathy
- Pulmonary infiltrates
- Extensive fibrosis
Cutaneous
- Plaques
- Lupus pernio (raised, purple lesion)
- Erythema nodosum
Eyes
- Anterior Uveitis
Cardia
- Heart block (fibrosis of AV node)
Neurosarcoid
- Headaches
- Seizures
Joints:
- Arthralgia
Sarcoidosis RF
20-40 yrs old
Fix Sarcoid
Non-Smoker
Sarcoidosis Pres
Lung symptoms
Cough (non-prod), dyspnoea, wheezing, rhonchi (airway hyperreactivity),
LNs
Lymphadenopathy: enlarged and non-tender, cervical and submandibular
Eye symptoms
Photophobia, red painful eye and blurred vision suggestive of uveitis, + conjunctival nodules
Skin symptoms
Erythema nodosum, lupus pernio
Joint symptoms
Arthralgia and chronic fatigue
Sarcoidosis Investigations
CXR: Bilateral hilar lymphadenopathy, upper zone infiltrates, pleural effusions
LuFT: restrictive, Obstructive or mixed (Nodules can obstruct, fibrosis = restrictive)
ECG: heart block
U&E: renal involve
LFT: Liver involve
Serum Ca: Granulomas have activated MP with disregulated Calcitriol prod (Hypercalcaemia)
Skin biopsy: Non-Caveating granulomas
Sarcoidosis management
SE of Tx
Lung:
- Oral/inhaled corticosteroids (prednisolone)
- stage 2: MTX/azathioprine ±O2
Cutaneous/opthalmic
- Topical corticosteroids
CNS
- Oral corticosteroid
Osteoporosis, LFT for cytotoxic
Amyloidosis
- Def
- Presentation
- Ix
Amyloid tissue deposition
Unexplained weight loss, fatigue, oedema resistant to diuretics
Serum and urine monoclonal light chains
Amyloidosis causes
Primary (immunoglobulin light chain amyloidosis)
NOTE: similar to multiple myeloma but less Plasma cells in BM
Secondary: seen in inflammatory arthropathy (RA, psoriatic, juvenile, Anky spondylitis
IBD
Pathology of Amyloidosis
Misfolding of alpha helix to from beta pleated sheets
Organs affected by amyloidosis
Kidney (Primary target)
- Monoclonal light chain disrupt basement membrane
Cardiac - Restrictie cardiomyopathy, conduction defects
Periorbital purpura
Amyloidosis presentation
Oedema (esp lower extremity)
Periorbital purpura
Fatigue/weight loss
Carpal tuneless
Complications Amyloidosis
Chronic renal failure
Progressive cardiomyopathy
Tx with myeloablative high dose chemo
Lymphoedema
- Def
- Loc
- Cause
- Mech
Progressiv swelling of tissue with protein rich fluid. due to disruption of lymphatic system
Extremities
Nematode infection, malignancy and Ca Tx
Mechanisms of oedema
- Inflammatory
- Lymphatic
- Hypoalbuminaemia
- Venous oedema
Inflammatory
- Inc vascular permeability
Lymphatic
- Obstruction of lymphatic drainage
Hypoalbuminaemia
- Decreased oncotic pressure e.g. liver failure (dec synth), nephrotic syndrome
Venous oedema
- Inc venous pressure (e.g. HF, venous obstruction)
Fluid drainage by lymph
Fluid leaves capillaries and drains to adjacent lymph channels
Fluid returns to circulation via thoracic duct at Left subclav
Oedema treatment
General: skin care, compression bandage, elevation, exercise, weight loss
Filariasis: diethylcarbamazine
Breast cancer
- RF
- Mets
- Symptoms
Constitutional
- Age, female, obesity, benign breast disease
Oestrogen
- Uninterupted oestrogen: no breast feed, no children
- Prolonged endogenous: early menarche, late menopause
Alcohol
FH ovarian/breast Ca
- BRCA1: risk 80%
- BRCA2: risk 40%
Liver, bone, lung, brain
4 main symptoms
- Lump (painless_
- Discharge
- Skin tethering/nipple inversion
- Skin changes (pea d’orange, pagets)
Types of Breast Ca
Ductal carcinoma (70%) Lobular Ca (10%) - normally bilateral - better prognosis Mucinous Medullary
Aim of Breast Ca screening
How often & what method
Detect DCIS
From 47-73 (3 yearly)
Using mammography
Ovarian cancer & Breast Ca mutation
BRCA 1 (40%), 2 (15%)
Breast cancer Receptors, Prognosis and Tx
ER +ve (good prognosis due to Tx)
- Oestrogen stimulated growth
- Tamoxifen ER blocker
- Anastrozole aromatase inhib
Her-2 (poor prognosis)
- Trastuzumab/herceptin to EGFR (Her-2)
Ki67: poor prognosis. Marker of proliferation
Triple negative: Poor prognosis as no Tx
Breast triple investigation
Clinical Examination
Histological/Cytology
- FNA (cytology - differentiate benign from malignant)
- Core biopsy (histology - differentiate DC from DCIS)
Radiology
- Mammography (Microcalcification = DCIS, speculated mass = carcinoma)
- USS (cystic Vs colic)
Other: LFT (mets), Ca and bone scan, Receptors (ER, Progesterone, Her-2)
Indications for mammography
Screening
Lump in over 40
Blood stained discharge
LCIS (annual until 50)
CI: no lump, under 40 (triple test with USS instead)
Breast Ca staging
1) mobile and confined to breasr
2) Breast + ipsilateral axilla
3) Over 5cm, Skin/chest wall fixation
4) contralateral Los mets (Brain, bone, Liver, lung) = Inoperable
Breast Ca surgical Tx
Mastectomy (if over 20% breast volume, multifocal, central)
Lumpectomy (under 20% volume, unifocal, peripheral)
Axillary clearance indicated if +ve SLN
± reconstruction
Radiotherapy in Breast Ca
- Who
- SE
- Why
With lumpectomy, palliates inoperable
Pneumonitis
Decrease disease recurrence
Chemo in Breast Ca
- How is used
Hormone therapy
Adjuvant
Tamoxifen (premenopausal)
- SE: affects endometrium (RF for Ca), thrombotic
Aromatase inhib (Anastrazole)
- stop peripheral androgen -> oestrogen conversion
- Risk of osteoporosis (DEXA, Ca, Vit D, Bisphosphonates)
Herceptin (Trastuzumab
DCIS
- Progression
- Tx
50% progress to Ca in 5-10 years
Wide local excision
Breast discharge
- When worrying
- Duct papilloma
- Duct ectasia
Persistent, Unilateral, Bloody
Papilloma: This is benign warty growth: Bloody/clear discharge
Ectasia: clogged lactiferous duct. Yellow/green/thick discharge
Treatment of Breast infection (lactational or abscess)
Flucloxacillin + Metronidazole in abscess
Middle age woman with lumpy, painful breasts at menstruation
Woman around menopause with tender lump and green discharge
Bloody discharge, local area of epithelial proliferation in large mammary duct (hyperplastic)
Obese woman with trauma to breast. Initially firm and round but turns hard and irregular
Lactating woman with red, hot, tender breast
Fibroadenosis
Mammary duct ectasia
Duct papilloma
Fat necrosis
Abscess
Mononucleosis
- Pres
- Causes
- Diagnosis
- Complications
Fever, pharyngitis, lymphadenopathy, hepatosplenomegaly
EBV (80%), CMV
Positive monospot test
Splenic rupture, fulminant hepatitis, haemolytic anemia, thrombocytopenia
Mononucleosis
- Transmission
- Pathology
Saliva (kissing)
DNA virus with affinity for B-cells (esp in tonsils)
B-lymphocytes spread to Liver, spleen, LNs
Mononucleosis IX
Heterophil antibody test +ve
- patient blood (with IgM to EBV) react positively to Sheep/horse blood
- Causes agglutination (clumping)
EBV antibody test
PVR EBV DNA
EBV Tx
DO NOT GIVE AMP/AMOX - rash with EBV
Supportive Tx (hydration, antipyretics, analgesics - para, NSAID)
Glandular fever prognosis + complications
2-4 weeks resolution (full function in months)
Splenic rupture at minor trauma (e.g. cough)
CT suspected and no contact sport for 8 weeks
What is arachidonic acid converted into by Cyclooxygenase (Action on)
Thromboxanes (Platelets)
Prostacyclin (endothelium)
Prostaglandins (Smooth muscle)
Action of tranexamic acid
Blocks conversion of plasminogen to plasmin
Stops plasmin action cleaving fibrin clots - stops bleeding
