Miscellaneous Topics Flashcards
What is the aetiology of AA amyloidosis?
RA, ankylosing spondylitis, Crohn’s disease, malignancy
What is the aetiology of AL amyloidosis?
Myeloma, Waldenstrom’s macroglobulinaemia and non-Hodgkin’s lymphoma
What is the pathophysiology of amyloidosis?
There is extracellular and/or intracellular deposition of insoluble abnormal amyloid fibrils that alter the normal function of tissues
What are the symptoms of amyloidosis?
Fatigue, weight loss, easy bruising, dyspnoea, peripheral oedema, sensory change, carpal tunnel syndrome and postural hypotension
What are the signs of amyloidosis?
Unexplained renal disease, marked hepatomegaly, right sided rapidly progressive heart failure, sensory glove- and stocking-type neuropathy, vitreous opacities, macroglossia, racoon eye sign
What tests are used to diagnose amyloidosis?
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
What is the treatment of amyloidosis?
Supportive treatment e.g. diuretics for kidney failure.
What is the immunology of HIV?
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.
What are the 5 stages of HIV infection?
Acute infection
Seroconversion
Persistent generalised lymphadenopathy (only 30% of patients)
AIDS-related complex (increased temp, night sweats, diarrhoea, weight loss +/- minor opportunistic infections)
AIDS
How is HIV diagnosed?
Serum HIV-Ab by ELISA
HIV RNA PCR
Core p24 antigen in plasma
What is the treatment for HIV?
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
How is HIV monitored?
CD4+ T cell count (per microlitre)
HIV viral load (RNA copies/ml)
What are some AIDS-defining infections?
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
What are some AIDS-defining neoplasms?
Invasive cervical carcinoma
Kaposi’s sarcoma
Primary CNS lymphoma
Non-Hodgkin’s lymphoma
What are 2 AIDS-defining conditions that are a direct HIV effect?
HIV dementia/encephalopathy
HIV-associated wasting
What are some risk factors for developing breast cancer?
Family history, age, uninterrupted oestrogen exposure, nulliparity, HRT, obesity, not breast feeding, BRCA genes
What are the different types of breast cancer?
Non-invasive ductal carcinoma in situ Non-invasive lobular carcinoma in situ Invasive ductal carcinoma - most common Invasive lobular Medullary Colloid/mucoid
What are the symptoms of breast cancer?
Lump in the breast, breast pain, nipple change, nipple discharge, skin contour changes
What is a sign of breast cancer?
Skin change - Peau d’orange
What tests are used to diagnose breast cancer?
All lumps should undergo triple assessment:
- Clinical examination
- Histology/cytology
- Mammography/ultrasound
CT or MRI scan to assess extent and mets
What is the treatment for breast cancer?
Surgery: wide local excision, mastectomy, sentinel node biopsy +/- sentinel node clearance
Radiotherapy
Chemotherapy: vinorelbine, docetaxel
Endocrine agents: tamoxifen, herceptin, aromatase inhibitors e.g. anastrozole
What is the pathophysiology of paracetamol poisoning?
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
What are the symptoms of paracetamol poisoning?
Asymptomatic for the first 24 hours or nausea and vomiting then hepatic necrosis so right upper quadrant pain
What are the signs of paracetamol poisoning?
Jaundice, encephalopathy, oligouria, hypoglycaemia, lactic acidosis, renal failure
What tests are used to diagnose paracetamol poisoning?
Paracetamol level (4 hours post-ingestion), U&Es, LFTs (high ALT), glucose (BM should be done hourly), clotting screen, ABG
What is the treatment for paracetamol poisoning?
Lavage if >12g taken within 1 hour
Give activated charcoal if ~/< 1 hour since ingestion
N-acetylcysteine - IVI
