Miscellaneous Flashcards
What is AIDS?
Chronic potentially life threatening condition caused by HIV virus
How common is AIDS?
Mostly affects 15-24 year olds
1 in 4 people with HIV worldwide don’t know they are infected
1 million people die each year due to undiagnosed HIV
97% of people with HIV in UK are on ART
Number of new infections falling
100,000 people living with HIV at end of 2018
7,500 people were living with undiagnosed HIV infection
Epidemic is diverse
High prevalence in Central London, Rotherham, Sheffield, Manchester
How can you prevent HIV/AIDS?
Circumcision PEP - post-exposure prophylaxis PreP- pre-exposure prophylaxis Behavioural changes - condom usage STI control Vaccines Microbicides Diagnosis/partner notification HAART Screen blood products/needle exchange
What can increase your risk of getting HIV?
Men who have sex with men Heterosexual women Injecting drug users Commercial sex workers Truck drivers Migrant workers
What is acute HIV syndrome?
Within 2-4 weeks of infection but can be up to 10 months
Abrupt onset of non-specific symptoms
Severe symptoms
What is clinical latency in HIV?
No symptoms
May notice enlarged lymph nodes - persistent generalised lymphadenopathy
How does HIV infect cells?
Virus enters via mucosa
APCs to T cells a lymph nodes
Local infection within a mucosal macrophage or dendritic cell established and then spreads to other cells
Initially humoral and cell mediated responses
Level of HIV free in plasma very high around 3 weeks
Falls after this as immune response begins to fight it
T cells recover after primary infection
Eventually develop a viral reservoir that you cannot get rid of
CD4 cells begin to fall
AIDS when CD4 < 200
How does the virus replicate within CD4 cells?
Attachment entry Transcription Assembly of new virions Budding HIV receptors
What infections can you get when CD4 cells begin to get to moderately low levels?
Shingles Candida Oral hairy leucoplakia Molluscum contagiosum Kerion
What infections can you get with AIDS?
Pneumocystitis pneumonia
Infections, neoplasms, direct HIV effect, immunological
AIDS defining conditions
How does HIV present?
Generalised lymphadenopathy
Acute generalised rash
Glandular fever/flu-like illness
Prolonged episodes of HSV
Persistent frequently occurring candidiasis
Oral candida
Indicators of immune dysfunction
Recently developed or worsening skin conditions
Odd looking mouth lesions
Unexplained weight loss or night sweats
Persistent diarrhoea
Gradually increasing shortness of breath and dry cough
Recurrent bacterial infections - pneumococcal pneumonia
Recurrent/unexplained infections
How does acute HIV syndrome present?
Fever, sweats Sore throat Myalgia Rash Vomiting/diarrhoea Headache Lymphadenopathy Hepatosplenomagaly Mouth ulcers Myalgia/arthralgia Significant weight loss Lethargy and depression
How is HIV/AIDS diagnosed?
Venous blood sample - most accurate Salivary antibody screening Prick test Monitored via CD4 cell count HIV viral load
How is HIV/AIDS treated?
HAART
3+ antiretroviral drugs
Act on different points in HIV replication cycle to suppress virus
Significant impact on mortality and morbidity
Prevents HIV developing resistance to drugs
How common is breast cancer?
By far most common cancer in women
2nd most common cause of death in UK
Majority arise from either - epithelial lining of ducts (ductal) or from epithelium of terminal ducts of lobules (lobular)
Affects 1 in 9 women
Rare in men - 1%
Risk increases with age - less than 5% below 35
Most common histological subtype infiltrating ductal carcinoma 70%
Lobular carcinoma 10-15%
Medullary cancers 5% tend to affect younger patients
Colloid/mucoid cancers tend to affect the elderly
What does the UK breast cancer screening programme involve?
Biplanar digital mammography every 3 years in women aged 50-70 years and improvements in multi-modality treatment have increased overall survival and rates of cure
What is familial breast cancer?
5-10% breast cancers due to BRCA1 mutation (long arm chromosome 17) or BRCA2 (long arm chromosome 13)
BRCA1 higher risk
Tumour suppressor genes that act as inhibitors of cellular growth
BRAC1 65% risk
BRCA2 45%
Sronger incidence of BRCA1 than BRCA2
What can increase your risk of getting breast cancer?
Increasing age FHx in 1st degree relative BRCA1 or 2 mutation Never having borne a child/first child after 30 Not having breast fed Early menarche and late menopause Radiation to chest HRT with oestrogen and progesterone Combined OCP Obesity Past breast cancer
What are the possible symptoms of breast cancer?
Most women with symptomatic present with painless, increasing mass that may also be associated with
- Skin tethering
- Ulceration
- Nipple discharge
- In inflammatory cancer - oedema and erythema
What is a possible differential diagnosis of breast cancer?
Benign breast disease
- Fibroadenoma
- Breast cysts
- Intraductal papilloma
How is breast cancer diagnosed?
Clinical examination
Radiology - USS for < 35, mammography and USS > 35
Histology and cytology
- Fine needle aspiration - if cystic lump - clear fluid (discard and reassure), bloody fluid found (cytology)
USS guided biopsy
- If there is residual mass/solid lump - if malignant plan treatment
Ask direct questions eg past lumps, FHx, pain, changes in size related to menstrual cycle, skin changes, nipple discharge
Consider metastatic disease - weight loss, breathlessness, back pain, abdominal mass
Check oestrogen receptor, progesterone receptor and human epidermal growth factor 2 status as will affect treatment options
Expression of HER2 adverse factor for small, otherwise good prognosis tumours - tumour more likely to grow and divide
How is breast cancer staged?
CXR, MRI, CT, liver, USS, bone scan, LFTs, Ca2+
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 and may be fixed, skin involvement larger than tumour
Stage 4 - complete fixation of tumour to chest wall, distant metastases
TMN
- T1 < 2cm
- T2 2-5cm
- T3 > 5cm
- T4 fixed to chest wall
- N1 mobile, ipsilateral nodes
- N2 fixed nodes
- M1 distant metastases
