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Miscellaneous Flashcards

1
Q

What are sarcomas?

A

Cancers that arise from mesenchymal (connective tissue) origin

Examples malignant tumours can arise from - cancellous bone, cartilage, fat, muscle, vascular or haemopoietic tissues

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2
Q

What do soft tissue sarcomas present as?

A

Present as a painless, enlarging mass

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3
Q

What are 2 risk factors for soft tissue sarcomas

A

Neurofibromatosis type 1 (genetic condition that causes tumours to grow along your nerves)
Previous radiotherapy

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4
Q

When would you consider a sarcoma malignant?

A

> 5cm
Increasing in size
Painful

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5
Q

How would you diagnose a sarcoma?

A

MRI, followed by needle biopsy

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6
Q

What is the treatment for sarcoma?

A

Excision with wide margins, then radiotherapy

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7
Q

What is lymphoedema?

A

Build-up of lymph somewhere in the body’s tissues, due to obstruction somewhere in body’s lymphatic system

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8
Q

What is a main feature of lymphoedema?

A

Chronic non-pitting oedema due to lymphatic insufficiency

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9
Q

What is Milroy disease, and what are the genetic defects?

A

Milroy disease is a primary congenital lymphoedema, causing lower leg swelling from birth

Autosomal dominant, mutations in VEGFR3, cause lymphatic dysfunction

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10
Q

What is the treatment for Milroy disease?

A

Compression stockings/bandages

Encourage exercise

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11
Q

How is filarial infection transmitted, and what does it cause?

A

Transmitted by 5 genera of mosquito

Causes elephantiasis and hydrocoeles

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12
Q

What does an acute filarial infection cause?

A

Fever, lymphadenopathy, chyluria

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13
Q

What is amyloidosis?

A

Name of a group of rare, serious conditions, caused by a build-up of an abnormal protein called amyloid in organs and tissues throughout the body

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14
Q

What is AL amyloidosis and what is the pathway to organ failure?

A 
A = amyloidosis
L = light chain of immunoglobulin

L chain gets misfolded and deposited

Proliferation of plasma cell clone > amyloidgenic monoclonal immunoglobulins > fibrillar light chain protein desposition > organ failure > death

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15
Q

What is AL amyloidosis associated with?

A

Myeloma
Waldenstroms
Lymphoma

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16
Q

What is the pathway of AL build up for myeloma?

A

Plasma cells in BM produce more light chains than heavy chains
Excess light chains leak into blood
So many light chains, some misfold into AL proteins and build up in various tissues

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17
Q

What organs are affected in AL amyloidosis, and what does it cause in them?

A

Kidneys, glomerular lesions - proteinuria and nephrotic syndrome
Heart - angina
Nerves - peripheral and autonomic neuropathy
Macroglossia (big tongue)

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18
Q

What is the treatment for AL amyloidosis?

A

Optimise nutrition
Drugs - oral melphalen + prednisolone OR
high -dose IV melphalen + autologous peripheral blood stem cell transplant

19
Q

AA amyloidosis

A

A = serum amyloid A

Serum amyloid A is an acute ohase reactant that is secreted by the liver, and goes into the bloodstream when there is inflammation
When inflammation goes on for too long, like in RA, then there’s a lot of serum amyloid A in the blood, and a small proportion of serum amyloid A folds incorrectly into AA amyloids, which end up accumulating within tissues causing amyloidosis

20
Q

What does AA amyloidosis affect?

A

Kidneys
Liver
Spleen

21
Q

What could an AA amyloidosis patient present with?

A

May present with proteinuria, nephrotic syndrome, or hepatosplenomegaly

22
Q

What is treatment for AA amyloidosis?

A

Manage underlying condition

23
Q

What is familial amyloidosis and what is the genetic inheritance type, and defect itself?

A

Hereditary amyloidosis

Autosomal dominant - mutations in e.g. transthyretin, a transport protein produced by the liver

24
Q

What does familial amyloidosis cause?

A

Causes a sensory or autonomic neuropathy +- renal or cardiac involvement

25
Q

What is the treatment for familial amyloidosis?

A

Liver transplant is curative

26
Q

Amyloidosis, diagnosis

A

Biopsy of affected tissue
Fat pad biopsy - fat taken from abdomen, sample dyed with Congo Red Staining, makes amyloid take on pink colour, and when it is seen under polarised light, amyloid proteins appear apple green in colour

27
Q

Can you get rid of amyloid deposits?

A

Theres no way to remove amyloid deposits

If theres extensive damage, organ transplantation can be tried

28
Q

Breast Cancer, what are some risk factors?

A 
Family History
Genetics - mutations in BRCA1 or BRCA2
Obesity
Nulliparity
Age
Early Menarche
Not breastfeeding
Late menopause
29
Q

What is Ductal carcinoma in-situ (DCIS)?

A

Tumour cells that grow from wall of the ducts into lumen

If untreated, over time can cross basement membrane, becoming invasive ductal carcinoma

30
Q

What three things can cancer cells cause in DCIS?

A
  1. Migrate along lactiferous ducts, through pore, onto skin (Paget Disease of the Nipple)
  2. Inflammation, brings extracellular fluid out through breaks in skin, fluid dries, forms crust over skin surface
  3. Release mobility factor - helps cells break and settle between squamous epithelial cells
31
Q

Lobular carcinoma in-situ (LCIS)

A

Abnormal cells form in the milk glands (lobules) in the breast. LCIS isn’t cancer. But being diagnosed with LCIS indicates that you have an increased risk of developing breast cancer
Doesn’t invade ducts
Doesn’t cross basement membrane

32
Q

What factor indicates a better breast cancer prognosis?

A

60-70% of breast cancers are oestrogen recpetor +ve, better prognosis

33
Q

What factor indicates a worse breast cancer prognosis?

A

30% over express HER2 (growth factor receptor gene), aggressive disease, poorer prognosis

34
Q

What is the main differential diagnosis of breast cancer?

A

Benign breast disease

35
Q

What is the 1st symptom in breast cancer?

A

Hard painless lump or swelling, commonly upper and outer part of breast

36
Q

What are 6 symptoms for breast cancer?

A
  1. Hard painless lump, upper and outer part of breast
  2. Swelling under armpit, spread to axillary lymph nodes
  3. Breast immobile and fixed, due to infiltration, if cancer cells spread into pectoral muscles
  4. Dimpling of skin
  5. Fibrosis of lactiferous ducts and suspensory ligaments causes retraction
  6. Paget disease, itching, redness, crusting and discharge
37
Q

How do you diagnose breast cancer?

A

Triple assessment for all breast lumps,

  1. Clinical examination
  2. Histology, FNA (fine needle aspiration)
  3. Mammography/ultrasound
38
Q

What are stages 1 to 4 for breast cancer?

A

Stage 1, confined to breast, mobile

Stage 2, growth confined to breast, mobile, lymph nodes in ipsilateral axilla

Stage 3, tumour fixed to muscle (but not chest wall), ipsilateral lymph nodes matted/fixed, skin involvement larger than tumour

Stage 4, complete fixation of tumour to chest wall, distant metastases

39
Q

What is the TNM breast cancer staging system?

A

T - size of the tumour, whether it has grown in nearby areas
N - degree that cancer has spread to lymph nodes
M - degree cancer has spread to other sites or metastisized

40
Q

What are the 4 different treatment options for stage 1-2 breast cancer?

A

Surgery - wide local excision, mastectomy and breast reconstruction, axillary node sample/surgical clearance/sentinel node biopsy

Radiotherapy - after WLE
SE - pericarditis, rib fractures

Chemotherapy - adjuvant chemo improves survival and reduces recurrence
Epirubicin and CMF

Endocrine agents - aim to decrease oestrogen activity
Only used if post-menopausal - Tamoxifen, Anastrozole
Pre-menopausal and ER+ve - ovarian ablation or GnRH analogues (goserelin)

41
Q

What is the treatment for stage 3-4 breast cancer?

A

Radiotherapy (+bisphosphonates) - painful bony lesions

Tamoxifen for ER+ve

Trastuzumab for HER2+ve tumours, with chemo

42
Q

What dose could be a fatal paracetamol overdose in adults?

A

150mg/kg or 12g in adults may be fatal

43
Q

What are the signs and symptoms of paracetamol overdose?

A

None initially
OR
Vomiting and RUQ pain

Later - jaundice and encephalopathy from liver damage, and AKI

44
Q

What are the 2 management options for a paracetamol overdose?

A

G.I. decontamination if present within 4 hours - activated charcoal

N-acetylcysteine (I.V. infusion) is the antidote, depends on dose, time and symptoms

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