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Y3 Charis > Other cases - general > Flashcards

Other cases - general Flashcards

1
Q

Differences between open angle and closed angle glaucoma

A 
Open angle
Bilateral
Initially asymptomatic
Mild non specific symptoms
Progressive visual loss

Closed angle
Unilateral
Sudden onset
Severely painful
N+V, cloudy cornea, headache, dilated pupil
Reduced visual acuity
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2
Q

Differences between anterior uveitis and posterior uveitis

A 
Anterior uveitis
Unilateral 
Autoimmune conditions
Painful, ocular hyperaemia
Blurry vision
Increased lacrimation + photophobia

Posterior uveitis
Bilateral
infective
Painless
Blurry vision
Floaters + scotomata
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3
Q

Define conjuctivitis

A

Inflammation of the lining of the eyelids and eyeball caused by bacteria, viruses, allergic or immunological reactions, mechanical/irritative/toxic or medicines

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4
Q

Differences between bacterial and viral conjunctivitis

A 
Bacterial conjunctivitis
Unilateral
Purulent discharge
Reduced vision
might have a Hx of STD Urethritis/vaginal discharge?

Viral conjunctivitis
Bilateral
Clear discharge
Normal vision
Signs of viral infection e.g. URT infection
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5
Q

Differences between acute angle glaucoma + acute anterior uveitis + conjunctivitis

A 
Acute angle glaucoma
•	Extremely painful
•	Decreased VA
•	Photophobia 
•	Systemically unwell – acute systemic malaise
•	Semi-dilated or oval pupil
•	Hazy cornea
•	Halos around eyes
•	increased IOP

Acute anterior uveitis
•	Painful
•	VA may be reduced
•	Photophobia
•	Constricted or irregular pupils
•	Cloudy aqueous humour (presence of inflammatory cells in aqueous humour) [hypopyon, flare, keratic precipitates]
•	decreased IOP

Conjunctivitis
• Not painful
• No photophobia
• VA normal

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6
Q

What is rheumatc fever?

A

autoimmune disease that may occur 1-5 weeks after a group A β-haemolytic streptococci throat infection (URTI, may present as a sore throat)

Peak incidence – 5-15 y/o

All manifestations (joints, chorea, erythema marginatum, SC nodules) of acute rheumatic fever resolve without sequale but carditis can lead to chronic rheumatic heart disease

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7
Q

Which are the 4 stages of the HIV infection?

A 
Seroconversion illness
•	1-6 weeks after infection
•	Infectious mononucleosis – like illness – fever, night sweats, malaise, myalgia, pharyngitis, headaches, diarrhoea, neuralgia neuropathy, lymphadenopathy, maculopapular rash
•	Antibody tests are negative
•	Viral p24 + HIV RNA are elevated

Asymptomatic infection
• 18 months to 15 years
• Persistent generalised lymphadenopathy - Nodes >1cm at 2 extra-inguinal sites persisting >3 months not due to any other cause
• Progressive minor symptoms – rash, oral thrush, weight loss, malaise
• CD4 + CD8 lymphocyte levels are normal (>500 cells/mm3)
• Virus levels are low but replication continues slowly

Symptomatic infection
• Nonspecific constitutional symptoms develop – fever, night sweats, diarrhoea, weight loss
• Minor opportunistic infections – candida, oral hairy leucoplakia, herpes zoster, recurrent herpes simplex, seborrheic dermatitis, tinea infections
• This collection of symptoms + signs is referred to as AIDS-related complex (ARC) + is regarded as a prodrome to AIDS

AIDS
• CD4 count <200 cells/microlitre
• Severe immunodeficiency
• Evidence of life-threatening infections + unusual tumours
• AIDS defining conditions start to occur
o Recurrent bacterial pneumonia
o Pneumocystis pneumonia
o Fungal infections (candidiasis of oesophagus)
o Kaposi sarcoma – HHV8
o Primary lymphoma of the brain

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8
Q

Most common causes of viral tonsilitis

A

rhinovirus, coronavirus, adenovirus

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9
Q

A 47-year-old HIV positive patient presents with weakness of his right leg, headaches, fever and confusion that have been getting worse for the last week. CT head shows multiple ring-enhancing lesions.

Causative organism

A

Toxoplasma gonidii

Associated with cats
In immunocompromised - myocarditis, encephalitis, focal CNS signs, stroke, seizures
Tests - ↑IgM in acute infection, ↑IgG and toxoplasma antigen titres in acute (not useful), lymph node/CNS biopsy
CT – characteristic multiple ring-shaped contrast enhancing lesions

• HIV, neuro symptoms, multiple brain lesions with ring enhancement – toxoplasmosis

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10
Q

Commonest virus causing common cold

A

Rhinovirus

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11
Q

Human herpesviruse and the conditions they cause

HHV1
HHV2
HHV3
HHV4
HHV5
HHV8
A

HHV1 - HSV1
Respiratory, saliva
Gingivostomatitis, keratoconjuctivits, herpes labialis, Temporal lobe encephalitis

HHV2 - HSV2
Sexual contact, perinatal
Genital herpes, Neonatal herpes

HHV3 - VZV
Respiratory
Chicken pox, shingles

HHV4 - EBV
Saliva - kissing disease
Mononucleosis (associated with lymphomas, nasopharyngeal carcinoma)

HHV5 - CMV
congenital, sexual, saliva
Mononucleosis in immunocompromised

HHV8 - HHV8
Sexual contact
Causes kaposi sarcoma in immunocompromised patients

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12
Q

Complications of infectious mononucleosis

A 
•	Nasopharyngeal carcinoma
•	Hodgkin’s lymphoma
•	Non-Hodgkin’s lymphoma
o	Burkitt’s lymphoma
o	Primary central nervous system lymphoma
  • Extreme tonsillar enlargement – upper airway obstruction
  • Splenic rupture
  • Haemolytic anaemia, thrombocytopenia
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13
Q

Define anaphylaxis

A

Rapidly developing airway +/or breathing +/or circulation problems usually associated with skin + mucosal changes
Acute onset
Most involve IgE
>2 organ systems are affected [most often skin + resp system]

Although skin + mucosal changes can be dramatic + uncomfortable, without ABC problems isolated skin changes do not indicate anaphylaxis

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14
Q

Aspirin overdose

Normal tablets?
Overdose?
Severe/fatal toxicity?

A

Usually 300 mg tablets

> 150mg/kg body weight/ >6.5g – overdose

> 500mg/kg body weight – severe/fatal toxicity

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15
Q

Paracetamol overdose

Normal tablets?
Overdose?
Severe/fatal toxicity?

A

Usually 500mg tablets

Recommended dose of paracetamol – 4g or 75mg/kg in 24h for an adult patient
Single acute overdose – ingestion of >4g or >75 mg/kg in a period <1h
Staggered overdose – ingestion of multiple doses of paracetamol over a period of >1h exceeding recommended dosage

Paracetamol can cause serious fatal effects at around 150mg/kg for many adults

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16
Q

Pathophysiology of paracetamol overdose + treatment

A

Overdose - liver can’t metabolise it - paracetamol metabolised via an alternative pathway by CYP450 - toxic metabolite produced (N-acetyl-p-benzoquinone imine (NAPQI) - inactivated by glutathione to prevent harm

Depleted glutathione stores - NAPQI accumulates, reacts with cells leading to necrosis
Necrosis occurs in the liver + kidney tubules

IV acetylcysteine

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17
Q

Indication for platelet transfusion

A

Active bleeding + platelets <50*109/L

or bone marrow failure + platelets <10*109/L

(normal platelet count 150-450*109/L)

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18
Q

What is Actinic keratosis + Bowen’s disease?

A

• Actinic keratosis – precancerous lesion that can turn into squamous cell carcinoma

• Bowen’s disease/squamous cell carcinoma in situ - early stage of the squamous cell carcinoma
o Tumour can be found in the epidermis but it hasn’t broken through the basement membrane
o Atypical, large, over-pigmented cells

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19
Q

4 subtypes of BCC

A
  • Nodular [most common]
  • Superficial [flat shape]
  • Morpheic [yellow waxy plaque, scar like]
  • Pigemented [dense colour, specks of colour]

https://image.slidesharecdn.com/bcc-100906062810-phpapp02/95/basal-cell-carcinoma-9-728.jpg?cb=1283754650

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20
Q

4 subtypes of malignant melanoma

A
  • Superficial spreading [most common]
  • nodular [domed shape, rapid growth]
  • lentigo maligna [flat lesions often on face, elderly]
  • acral lentiginous [palms, soles, nail beds, often in non-caucasians]
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21
Q

Skin cancer referrals

A

Referral
• Melanoma – urgent referral
• SCC – urgent referral
• BCC – routine referral

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22
Q

What are melanocytic lesions?

A

• Melanocytic lesions = not cancer, benign neoplasms of melanocytes in epidermis

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23
Q

What type of hypersensitivity reaction is atopic eczema?

A

Type I hypersensitivity (IgE mediated)

24
Q

What type of hypersensitivity reaction is contact dermatitis?

A

Type IV hypersensitivity (delayed)

25
Define psoriasis
Auto-immune condition characterised by hyperproliferation of keratinocytes
26
Define eczema
Inflammatory skin condition which is not autoimmune
27
Define cellulitis + erysipelas
Bacterial infection of the skin (often 1) strep pyogenes or 2) staph aureus (less likely))
28
Complications of cellulitis + erysipelas
* Abscess * Sepsis * Necrotising fasciitis (surgical emergency) * Periorbital cellulitis – medical emergency, visual impairment, mx IV abx * Orbital cellulitis – medical emergency, visual impairment, mx IV abx, surgery * Chronic oedema
29
Define erythema nodosum
inflammation of the SC fat (panniculitis) – type IV hypersensitivity LOST BUSH Lymphoma (NHL), leukaemia, leprosy OCP Sarcoidosism sulphonamides, penicillin TB, toxoplasmosis Bechets UC, Croh's Salmonella, Strep, Yersinia Histoplasmosis
30
Erythema nodosum aetiology
• Infections o Streptococcal infection – most common underlying cause o TB o HIV o Gastroenteritis – Yersinia enterocolitica, Salmonella, Campylobacter • Systemic diseases o Sarcoidosis o UC, IBD o Bechet’s disease • Drugs o OCP o Sulphonamides (abx) * Pregnancy * F>M * 20-40 ``` NODOSUM No cause found in 60% Drugs OCP Sarcoidosis UC, IBD, Bechets Microbiology - TB, viral, bacterial ``` ``` LOST BUSH Leprosy, lymphoma (NHL), leukaemia Oral contraceptive, pregnancy Sarcoidosis, sulphonamides, penicillins TB, toxoplasmosis ``` Bechet’s UC, Crohn’s Salmonella, Strep, Yersinia Histoplasmosis
31
Define erythema multiforme
inflammation of the skin + mucous membranes – type IV hypersensitivity
32
Erythema multiforme aetiology
Most common - HSV - Mycoplasma pneumoniae Other • Infections – HIV, HBV, HZV, EBV CMV • Drugs – sulphonamides (abx), aminopenicillin, TNFα inhibitors, anti-malarial, anti-convulsant, lidocaine injections, barbiturates • Vaccines – HBV, HPV, smallpox, varicella, meningococcal
33
Breast cyst aspiration results + actions
Clear - discard + reassure patient Bloody - send for cytology Residual mass - core biopsy + send FNA for cytology Solid lump - triple assessment + core biopsy + histology + send FNA for cytology
34
What factors increase oestrogen exposure and therefore also increase the risk of breast cancer? + Other RF
- Early menarche (before 13) - Late menopause (after 51 years) - Nulliparity - Having a first child after the age of 30 - Not breastfeeding - HRT - COCP - Obesitiy ``` other RF FHx Alcohol consumption Fatty diet Previous chest irradiation e.g. for Hodgkin's lymphoma ```
35
Difference between a breast cyst and an abscess
An abscess will give you a fever | Palpable breast cysts are commonly bilateral
36
When do you move on to core biopsy after FNA?
If FNA positive FNA inadequate FNA discordant with imaging + clinical
37
Breast cancer tumour markers
ca125, ca153
38
What is Paget's disease of the breast?
Intradermal infiltration by malignant cells Destruction of the nipple by ductal spread of carcinoma Usually caused by DCIS May present with a red scaly lesion around the nipple (mimics eczema) Best treated by mastectomy + axillary clearance
39
Define fibroadenoma
Benign neoplasm of a lobule - arising from stroma (fibro) and glandular (adenoma) epithelium
40
Define duct ectasia
Dilation of the milk ducts due to blockage cheesy, yellow-green, blood stained discharge smoking is a key RF
41
What is an intraductal papilloma?
Benign neoplasm growing within ducts of the breast | Bloody or clear/serous discharge
42
What can untreated mastitis lead to?
Breast abscess Most common pathogen - Staph aureus
43
Most common type of breast cancer
Invasive ductal carcinoma (75%) Invasive lobular carcinoma (25%) both are adenocarcinomas
44
Difference in symptoms bn EBV and CMV infections
``` EBV sore throat tonisllar enlargement lymphadenopathy fever splenomegaly ``` CMV similar symptoms but no sore throat or tonsilar enlargement
45
Dermoid cyst description
Formed at embryological lines of fusion - would be in the midline in the neck Formed following a puncture injury (implantation dermoid, Hx would be trauma to the neck) smooth, fluctuant, non-tender, cannot be moved separately from overlying skin, mobile over deeper tissues
46
On which Chromosomes are the genes BRCA1 and BRCA2 found?
BRCA 1 - 17 | BRCA 2 - 13
47
National screening program for Breast cancer in the UK
50-70 every 3 years
48
Cystic hygroma vs branchial cyst
Cystic hygroma = benign proliferation of lymph vessels - Posterior triangle - Posterior to SCM - Transilluminates - Clear fluid Branchial cyst = Arise from the embryonic remnants of the second branchial cleft, secondary to cystic degeneration of lymphoid tissue. - Anterior triangle - Anterior border of SCM - Does not transilluminate - Creamy fluid with cholesterol crystals Commonest in males on the L May enlarge following an URTI
49
Describe the 4 different types of necrotising fasciitis
Type I – polymicrobial infection with aerobic + anaerobic bacteria Usually in patients with immunocompromise or chronic disease Type II – monomicrobial infection with Streptococcus pyogenes (group A streptococcus – GAS) Occurs in any age and in otherwise healthy people, occasionally accompanied by staphylococcal infection Type III – gram negative monomicrobial infection Marine organisms – can occur following seawater contamination of wounds, injuries involving fish fins or stings, raw seafood consumption Particularly in patients with chronic liver disease Type IV – fungal infection Zygomycetes – After traumatic wounds or burns Candida – immunocompromised
50
Difference bn necrotising fasciitis + cellulitis
In necrotising fasciitis o Margins of infection are poorly defined, tenderness extends beyond the apparent area of involvement (unlike cellulitis) o No response to abx (unlike cellulitis) o Lymphangitis is rarely seen (unlike cellulitis) o SC tissues have a wooden-hard feel (unlike cellulitis or erysipelas)
51
What is Kaposi's sarcoma?
``` Malignant tumour of the vascular endothelium Bruise like appearance Caused by HHV8 in immunocompromised Biopsy Radiotherapy ```
52
Commonest organsim resposnible for necotising fasciitis
group A beta haemolytic streptococci
53
Commonest organism responsible for cellulitis
Streptococcus pyogenes Staphylococcus aureus (less likely)
54
Define Multiorgan dysfunction syndrome
Multiple dysfunction syndrome is the presence of altered organ function in acutely ill patients such that homeostasis cannot be maintained without intervention It usually involves two or more organ systems Condition usually results from infection, injury, hypoperfusion, hypermetabolism Sepsis is the most common cause
55
Which CD4 value defines AIDS?
o CD4 count <200 cells/microlitre – defines AIDS and places the patient at high risk of most opportunistic infections – below this development of AIDS related opportunistic infections becomes highly likely likely (e.g. pneumocystis pneumonia)
56
Best prognosis indicator for malignant melanoma
Malignant melanoma – best prognosis indicator is the invasive depth measured by the Breslow thickness <0.76mm – low risk 0.76-1.5 mm – medium risk >1.5mm – high risk

Y3 Charis (35 decks)

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