Other diseases Flashcards
What is HIV?
HIV is caused by a retrovirus hijacking reverse transcriptase enzymes within CD4 (T) cells, resulting in immunosuppression.
What is the clinical presentation of HIV?
- Unexplained night sweats/fever > 1 month.
- Involuntary weight loss.
- Rash.
- Mouth ulcers.
- Sore throat.
- Lymphadenopathy.
- Recurrent infection.
What are the risk factors for HIV?
- Unprotected straight sex.
- Unprotected anal receiving.
- Needle sharing.
- Needle prick injuries.
- Mother > child transmission.
What are the tests used to diagnose/monitor HIV?
- ELISA/rapid HIV testing used for initial diagnosis.
- High sensitivity, low specificity so requires 2 +ve tests before diagnosis.
- Stage disease with CD4 cell count. <200 diagnoses AIDS.
What is the treatment for HIV/AIDS?
What is the caveat to this treatment?
HAART (Highly active anti-retroviral therapy):
- Uses 3+ anti-retroviral drugs to slow down the progression of HIV.
- Requires good adherence to treatment, or will not work and will risk drug resistance development.
What is an AIDS defining disease?
What are the most common AIDS defining infectious organsisms?
AIDS defining disease - When a person with HIV gets it, they are now defined as having AIDS regardless of CD4 count.
Examples of AIDS defining diseases:
- Mycobacterium tuberculosis (Bacterial).
- Pneumocystis jirovecii (fungal pneumonia).
- CMV pneumonitis (viral pneumonia).
What is the most common form of breast cancer?
- Invasive ductal carcinoma.
What is the clinical presentation of breast cancer?
- Presence of a lump (90% will be benign).
- Peau d’orange.
- Nipple discharge.
- Nipple inversion.
- Typical cancer signs (e.g. weight loss, tiredness etc.)
- Bone pain (bone is a common metastatic site of breast cancer).
What are the risk factors for breast cancer?
- Age
- Female
- FH
- BRCA1/2 mutation
- Alcohol
- Increased breast density
- Radiation
- Other breast disease
How does breast cancer screening work?
- Routinely between the ages of 50 and 70.
- Mammogram every 3 years to check for breast cancer.
How is breast cancer investigated?
- Mammogram (either screening or ordered as 1st line due to suspicion). Picks up on breast cancer.
- Breast biopsy (fine needle aspiration). Assesses the breast cancer and the type of breast cancer.
How does ductal carcinoma present in a breast core biopsy?
- Cords of tumour cells, with the presence of fibrosis.
What is the treatment for breast cancer?
1st line:
- Lumpectomy/mastectomy.
- Course of chemo (doxorubicin).
If the cancer is advanced, do chemo BEFORE surgery as this increases the chance of successful resection of the tumour.
What are the most common sites of breast cancer metastases?
- Bone (50% - most common)
- Lung
- Brain
- Liver.
What is cellulitis?
Acute infection of the skin typically presenting in the leg. Affects the dermis and underlying subcutaneous tissues.
What is the clinical presentation of cellulitis?
- Red, swollen, painful skin.
- Usually in leg.
- If severe, may bleed/ulcerate.
What are the risk factors for cellulitis?
- Diabetes.
- Immunosuppression.
- Eczema.
- Peripheral vascular disease.
What are the two main causes of cellulitis?
- Staphylococcus aureus.
- Streptococcus pyrogenes.
- Be careful as it could be MRSA.
How is cellulitis investigated?
- Usually, just a clinical diagnosis.
- If bleeding/ulcerated, consider swabbing to check for MRSA.
- If patient requires admission, take blood cultures.
How is cellulitis treated?
Normally:
- Flucloxacillin (erythromycin if there is a penicillin allergy).
If MRSA:
- Add vancomycin.
What is HZV?
- Herpes zoster virus.
- Reactivation of the chicken pox virus (Varicella zoster virus).
What is the typical presentation of HZV?
- Dermatomal pain followed by a dermatomal rash.
What is the pathophysiology of HZV?
- After the VZV infection (chicken pox) virus lies dormant in the dorsal root ganglia.
- Immunodeficiency triggers reactivation of the virus.
- Spreads up the neurons associated with the dermatome (causing pain) which eventually reaches the skin and comes out as a dermatomal rash.
What are the potential causes of immunocompromise relating to HZV reactivation?
- HIV
- Chemo
- Steroid use
What test is often indicated in HZV cases?
- A HIV test.
