Passmed - Random Flashcards
Multiple myeloma?
Multiple myeloma causes hypercalcaemia primarily through increased osteoclast activity in response to cytokines released by the myeloma cells
Most common age - 60-70 years
Most common symptom - bone pain or pathological fractures from the osteolytic lesions
The myelomas lead to osteolysis by releasing cytokines that increase osteoclast activity.
CRABBI?
For multiple myeloma:
Calcium (hypercalcaemia)
Renal (light chain deposition due to renal tubules, caused by monoclonal production of immunoglobulins)
Anaemia (bone marrow crowding suppresses erythropoeisis)
Bleeding (thrombocytopenia)
Bones (lytic bone lesions -> bone pain, often in back, and pathological fractures)
Infection
Multiple myeloma investigations?
Bloods - FBC (anaemia), peripheral blood film (rouleaux formation), U&E (renal failure), bone profile (hypercalcaemia)
Protein electrophoresis - raised conc. of monoclonal IgA/G proteins in serum. In urine known as Bence Jones proteins.
Imaging - X-ray - raindrop skull
Multiple myeloma diagnostic criteria?
One major and one minor, or three minor with symptoms.
Major - plasmacytoma
- 30% plasma cells in bone marrow
- elevated M protein in urine or blood
Minor - 10-30% plasma in bone marrow
- minor M protein elevation
- osteolytic lesions
- low levels antibodies in blood
Most common inherited cause of kidney disease?
Autosomal dominant polycystic kidney disease (ADPKD)
Sulfasalazine
A sulphonamide
Works by inhibiting folic acid formation. The two important enzymes involved in the formation of folic acid are dihydropteroate synthase and dihydrofolate reductase.
IL-1?
Pro-inflammatory cytokine released by activated macrophages
plays a role in the systemic inflammatory response seen in SEPSIS
induces vasodilation and increases vascular permeability -> decreased systemic vascular resistance and hypotension: hallmark of septic shock
Also stimulates the further release of cytokines, amplifying the response and the clinical manifestation of sepsis
IL-10?
anti-inflammatory properties
dampens immune response by inhibiting the production of pro-inflammatory cytokines
In sepsis, IL-10 aims to counterbalance excessive inflammation and is not directly implicated in causing hypotension or the initial inflammatory response to infection.
IL-12?
Produced by dendritic cells and macrophages
crucial for the differentiation of naive T cells into Th1 cells and activating natural killer cells, promoting a cell-mediated immune response
does not directly contribute to the vasodilation and hypotension characteristic of sepsis.
IL-3?
A growth factor that supports the proliferation of haematopoietic stem cells into various blood cells
Main function is in haematopoiesis
IL-6
Significantly upregulated in sepsis and contributes to fever and the acute phase response
IL-6 primarily signals the liver to produce acute phase proteins and aids in B cell differentiation
Fabry disease?
X-linked recessive; deficiency of alpha-galactosidase A
Features:
-burning pain/paraesthesia in childhood
-angiokeratomas
-lens opacities
-proteinuria
-early cardiovascular disease
