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Final > Misc > Flashcards

Misc Flashcards

1
Q

Sarcoma:

  • Def
  • Types
  • Pres
A

Cancer of connective tissue

Liposarcoma
Leimyosarcoma
Kaposi’s

Soft tissue swelling and pain

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2
Q

Gell and Coombs, 4 types of hypersensitivity

A

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

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3
Q

Sarcoma familial syndromes

A

Neurofibromatosis 1

Retinoblastoma mutation (osteosarcoma)

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4
Q

Angiosarcoma:

  • Pres
  • Prog
A

Long term bruising at breast

Highly aggro, mets to bone/lung

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5
Q

Ewings sarcoma:

  • Who
  • Location
A

Bone sarcoma in young males

Pelvis/Femur

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6
Q

Sarcoma investigations

A

CT/MRI primary tumour

  • Heterogenous mass
  • Central necrosis
  • CT chest = pulmonary mets

HIV test (Kaposi’s)

Biopsy (type and grade)

Genetic testing (NF1, RB)

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7
Q

Sarcoma Tx

A

Excision
Radiotherapy (Pre-op, adjuvant)
Chemo (not very chemosensitive)

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8
Q

Sarcoidosis

- Pres

A

SOB, cough, Erythema nodosum

Bilateral Hilar lymphandenopathy
Pulmonary infiltrates

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9
Q

What is Sarcoidosis

A

Chronic granulomatous (non-caseating) disorder characterised by accumulation of lymphocytes and macrophages in lung and other organs (any)

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10
Q

Sarcoidosis Organ system effects

A

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

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11
Q

Sarcoidosis RF

A

20-40 yrs old
Fix Sarcoid
Non-Smoker

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12
Q

Sarcoidosis Pres

A

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

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13
Q

Sarcoidosis Investigations

A

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

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14
Q

Sarcoidosis management

SE of Tx

A

Lung:

  • Oral/inhaled corticosteroids (prednisolone)
  • stage 2: MTX/azathioprine ±O2

Cutaneous/opthalmic
- Topical corticosteroids

CNS
- Oral corticosteroid

Osteoporosis, LFT for cytotoxic

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15
Q

Amyloidosis

  • Def
  • Presentation
  • Ix
A

Amyloid tissue deposition

Unexplained weight loss, fatigue, oedema resistant to diuretics

Serum and urine monoclonal light chains

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16
Q

Amyloidosis causes

A

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

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17
Q

Pathology of Amyloidosis

A

Misfolding of alpha helix to from beta pleated sheets

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18
Q

Organs affected by amyloidosis

A

Kidney (Primary target)
- Monoclonal light chain disrupt basement membrane

Cardiac - Restrictie cardiomyopathy, conduction defects

Periorbital purpura

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19
Q

Amyloidosis presentation

A

Oedema (esp lower extremity)
Periorbital purpura
Fatigue/weight loss
Carpal tuneless

20
Q

Complications Amyloidosis

A

Chronic renal failure
Progressive cardiomyopathy

Tx with myeloablative high dose chemo

21
Q

Lymphoedema

  • Def
  • Loc
  • Cause
  • Mech
A

Progressiv swelling of tissue with protein rich fluid. due to disruption of lymphatic system

Extremities

Nematode infection, malignancy and Ca Tx

22
Q

Mechanisms of oedema

  • Inflammatory
  • Lymphatic
  • Hypoalbuminaemia
  • Venous oedema
A

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)

23
Q

Fluid drainage by lymph

A

Fluid leaves capillaries and drains to adjacent lymph channels
Fluid returns to circulation via thoracic duct at Left subclav

24
Q

Oedema treatment

A

General: skin care, compression bandage, elevation, exercise, weight loss

Filariasis: diethylcarbamazine

25
Q

Breast cancer

  • RF
  • Mets
  • Symptoms
A

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)
26
Q

Types of Breast Ca

A 
Ductal carcinoma (70%)
Lobular Ca (10%)
- normally bilateral
- better prognosis
Mucinous
Medullary
27
Q

Aim of Breast Ca screening

How often & what method

A

Detect DCIS

From 47-73 (3 yearly)
Using mammography

28
Q

Ovarian cancer & Breast Ca mutation

A

BRCA 1 (40%), 2 (15%)

29
Q

Breast cancer Receptors, Prognosis and Tx

A

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

30
Q

Breast triple investigation

A

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)

31
Q

Indications for mammography

A

Screening
Lump in over 40
Blood stained discharge
LCIS (annual until 50)

CI: no lump, under 40 (triple test with USS instead)

32
Q

Breast Ca staging

A

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

33
Q

Breast Ca surgical Tx

A

Mastectomy (if over 20% breast volume, multifocal, central)

Lumpectomy (under 20% volume, unifocal, peripheral)

Axillary clearance indicated if +ve SLN

± reconstruction

34
Q

Radiotherapy in Breast Ca

  • Who
  • SE
  • Why
A

With lumpectomy, palliates inoperable

Pneumonitis

Decrease disease recurrence

35
Q

Chemo in Breast Ca
- How is used

Hormone therapy

A

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

36
Q

DCIS

  • Progression
  • Tx
A

50% progress to Ca in 5-10 years

Wide local excision

37
Q

Breast discharge

  • When worrying
  • Duct papilloma
  • Duct ectasia
A

Persistent, Unilateral, Bloody

Papilloma: This is benign warty growth: Bloody/clear discharge

Ectasia: clogged lactiferous duct. Yellow/green/thick discharge

38
Q

Treatment of Breast infection (lactational or abscess)

A

Flucloxacillin + Metronidazole in abscess

39
Q

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

A

Fibroadenosis

Mammary duct ectasia

Duct papilloma

Fat necrosis

Abscess

40
Q

Mononucleosis

  • Pres
  • Causes
  • Diagnosis
  • Complications
A

Fever, pharyngitis, lymphadenopathy, hepatosplenomegaly

EBV (80%), CMV

Positive monospot test

Splenic rupture, fulminant hepatitis, haemolytic anemia, thrombocytopenia

41
Q

Mononucleosis

  • Transmission
  • Pathology
A

Saliva (kissing)

DNA virus with affinity for B-cells (esp in tonsils)
B-lymphocytes spread to Liver, spleen, LNs

42
Q

Mononucleosis IX

A

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

43
Q

EBV Tx

A

DO NOT GIVE AMP/AMOX - rash with EBV

Supportive Tx (hydration, antipyretics, analgesics - para, NSAID)

44
Q

Glandular fever prognosis + complications

A

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

45
Q

What is arachidonic acid converted into by Cyclooxygenase (Action on)

A

Thromboxanes (Platelets)
Prostacyclin (endothelium)
Prostaglandins (Smooth muscle)

46
Q

Action of tranexamic acid

A

Blocks conversion of plasminogen to plasmin

Stops plasmin action cleaving fibrin clots - stops bleeding

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