Miscellaneous Topics

Question 1

What is the aetiology of AA amyloidosis?

Answer 1

RA, ankylosing spondylitis, Crohn’s disease, malignancy

Question 2

What is the aetiology of AL amyloidosis?

Answer 2

Myeloma, Waldenstrom’s macroglobulinaemia and non-Hodgkin’s lymphoma

Question 3

What is the pathophysiology of amyloidosis?

Answer 3

There is extracellular and/or intracellular deposition of insoluble abnormal amyloid fibrils that alter the normal function of tissues

Question 4

What are the symptoms of amyloidosis?

Answer 4

Fatigue, weight loss, easy bruising, dyspnoea, peripheral oedema, sensory change, carpal tunnel syndrome and postural hypotension

Question 5

What are the signs of amyloidosis?

Answer 5

Unexplained renal disease, marked hepatomegaly, right sided rapidly progressive heart failure, sensory glove- and stocking-type neuropathy, vitreous opacities, macroglossia, racoon eye sign

Question 6

What tests are used to diagnose amyloidosis?

Answer 6

Urinalysis - proteinuria
FBC - anaemia, blood film - Howell-Jolly bodies, U&Es (increased creatinine), LFTs (high alk phos), clotting, ESR (raised), CRP (normal)
Biopsy of an affected organ or subcutaneous aspiration of abdominal fat - stains red with Congo red stain

Question 7

What is the treatment of amyloidosis?

Answer 7

Supportive treatment e.g. diuretics for kidney failure.

Question 8

What is the immunology of HIV?

Answer 8

HIV binds to CD4 receptors on helper T lymphocytes, monocytes, macrophages and neural cells. CD4+ cells migrate to lymphoid tissue and the virus replicates to produce new virions. These are released and infect new CD4 cells. As infection progresses, depletion or impaired function of CD4+ cells leads to reduced immunity.

Question 9

What are the 5 stages of HIV infection?

Answer 9

Acute infection
Seroconversion
Persistent generalised lymphadenopathy (only 30% of patients)
AIDS-related complex (increased temp, night sweats, diarrhoea, weight loss +/- minor opportunistic infections)
AIDS

Question 10

How is HIV diagnosed?

Answer 10

Serum HIV-Ab by ELISA
HIV RNA PCR
Core p24 antigen in plasma

Question 11

What is the treatment for HIV?

Answer 11

HAART - highly active anti-retroviral therapy
1 NNRTI + 2 NRTIs -or- PI + 2 NRTIs
NNRTI - non-nucleoside reverse transcriptase inhibitor e.g. nevirapine, efavirenz
NRTI - nucleoside reverse transcriptase inhibitor e.g. tenofovir, abacavir, zidovudine, didanosine
PI - protease inhibitor e.g. indinavir, ritonavir, saquinavir

Question 12

How is HIV monitored?

Answer 12

CD4+ T cell count (per microlitre)

HIV viral load (RNA copies/ml)

Question 13

What are some AIDS-defining infections?

Answer 13

Candidiasis: oesophageal/lung
Extrapulmonary cryptococcus
Cryptosporidiosis for >1 month
CMV: any organ except liver, spleen and lymph nodes
Mycobacterium TB
Toxoplasmosis of internal organs
HSV with mucocutaneous ulcer >1 month
Pneumocystis jiroveci pneumonia (PCP)
Recurrent bacterial pneumonia

Question 14

What are some AIDS-defining neoplasms?

Answer 14

Invasive cervical carcinoma
Kaposi’s sarcoma
Primary CNS lymphoma
Non-Hodgkin’s lymphoma

Question 15

What are 2 AIDS-defining conditions that are a direct HIV effect?

Answer 15

HIV dementia/encephalopathy

HIV-associated wasting

Question 16

What are some risk factors for developing breast cancer?

Answer 16

Family history, age, uninterrupted oestrogen exposure, nulliparity, HRT, obesity, not breast feeding, BRCA genes

Question 17

What are the different types of breast cancer?

Answer 17

Non-invasive ductal carcinoma in situ
Non-invasive lobular carcinoma in situ
Invasive ductal carcinoma - most common
Invasive lobular
Medullary
Colloid/mucoid

Question 18

What are the symptoms of breast cancer?

Answer 18

Lump in the breast, breast pain, nipple change, nipple discharge, skin contour changes

Question 19

What is a sign of breast cancer?

Answer 19

Skin change - Peau d’orange

Question 20

What tests are used to diagnose breast cancer?

Answer 20

All lumps should undergo triple assessment:

• Clinical examination
• Histology/cytology
• Mammography/ultrasound

CT or MRI scan to assess extent and mets

Question 21

What is the treatment for breast cancer?

Answer 21

Surgery: wide local excision, mastectomy, sentinel node biopsy +/- sentinel node clearance
Radiotherapy
Chemotherapy: vinorelbine, docetaxel
Endocrine agents: tamoxifen, herceptin, aromatase inhibitors e.g. anastrozole

Question 22

What is the pathophysiology of paracetamol poisoning?

Answer 22

Paracetamol is well absorbed from the stomach and small intestine and reaches peak plasma concentration in 1 hour. It is inactivated in the liver.
In an overdose, the liver is inundated and so uses the alternative pathway to metabolise the paracetamol which produces a toxic metabolite leading to necrosis. Toxicity increases through drugs such as rifampicin, phenobarbital, phenytoin, carbamazepine

Question 23

What are the symptoms of paracetamol poisoning?

Answer 23

Asymptomatic for the first 24 hours or nausea and vomiting then hepatic necrosis so right upper quadrant pain

Question 24

What are the signs of paracetamol poisoning?

Answer 24

Jaundice, encephalopathy, oligouria, hypoglycaemia, lactic acidosis, renal failure

Question 25

What tests are used to diagnose paracetamol poisoning?

Answer 25

Paracetamol level (4 hours post-ingestion), U&Es, LFTs (high ALT), glucose (BM should be done hourly), clotting screen, ABG

Question 26

What is the treatment for paracetamol poisoning?

Answer 26

Lavage if >12g taken within 1 hour
Give activated charcoal if ~/< 1 hour since ingestion
N-acetylcysteine - IVI