Path Key Points Bank Flashcards
BPH
Lower urinary tract symptoms (frequency, urgency, nocturia, terminal dribbling, poor stream)
Mx
- alpha reductase inhibitor - finasteride
- alpha blocker (with HTN - prazosin; without HTN - tamsulosin)
Grading system for RCC
Furhman’s system
Clear cell RCC
Most common RCC
Golden colour due to lipid collection
Clear cytoplasm arranged in nests
Papillary RCC
Friable brown tumours
Chromophobe RCC
Variable chromosomal changes
Prostate cancer
Genes associated - PTEN, AMACR, P27, E-cadherin
Associated with eating red meats
Prognosis - Gleason score
Varicocele
Non-translucent
Dull ache with venous dilation
Hydrocele
Translucent
Due to trauma or pathology
Zoon’s balanitis
Inflammation of glans –> redness –> biopsy - can be dysplastic
Fournier’s gangrene
Necrotising fasciitis of male genitalia
High risk HPV
16 & 18
Low risk HPV
6 & 11
Cervical intra-epithelial neoplasia (CIN)
Figo staging
CIN IA - invasive diagnosis only by microscopy - cone biopsy
CIN IB - visible lesion confined to microscopy - radical trachelectomy with lymphadenectomy if tumour <2cm otherwise radical hysterectomy with lymphadenectomy
CIN II - beyond uterus but not past the lower third of vagina or pelvic wall - chemoradiotherapy
CIN III - tumour extends to pelvic wall ± lower third of vagina ± hydronephrosis - chemoradiotherapy
CIN IVA - spread to bladder or rectum - chemoradiotherapy
CIN IVB - distant metastases - combination chemotherapy
Endometrial hyperplasia
PCOS, anovulation, perimenopause, granulose cell tumours, unopposed oestrogen therapy, endometrial cancer
Type 1 - K-RAS, BRAF
Type 2 - P53
Endometrial hyperplasia prognostic factors
Figo stage 1 - uterus 2 - spread to cervix 3 - pelvic spread 4 - distant spread
Sex cord stromal tumours
Benign - fibromas, thecomas
Variable - granulosa cell tumour, sertoli-leydig cell tumours
Lynch syndrome (hereditary non-polyposis colorectal cancer)
Autosomal dominant
Colorectal and endometrial tumours
Krukenberg tumour
Ovarian metastases from stomach tumour - signet ring cells
Dermatomyositis
Tender inflamed muscles - raised CK
Gottron’s papules
Sarcoidosis
Lungs - SOB + dry cough
Skin - lupus pernio, erythema nodosum
Heart - pericarditis, HF, valvular lesions
Non-caseating granulomas, hypergammaglobulinaemia, high serum ACE, hypercalcaemia
What causes erythema nodosum?
Sarcoidosis, IBD, Behcet’s disease, streptococcus, mycobacterium tuberculosis, pregnancy, OCP
What causes parotid enlargement?
Sarcoidosis, Sjogren’s disease, mumps, alcoholism, parotid cancer
Large vessel vasculitis
Takayasu arteritis
Giant cell arteritis - >50s, jaw claudication, scalp tenderness
Medium vessel vasculitis
Polyarteritis nodosa - renal/mesenteric vessels affected, beads of vessels on angiogram
Kawasaki’s disease - children, fever, erythematous rash on palsm and soles, conjunctivitis, lymphadenopathy
Small vessel vasculitis
Eosinophilic granulomatosis with polyangitis (Churg Strauss) - atopy + eosinophilia + vasculitis
Granulomatosis with polyangitis (Wegener’s granulomatosis) - nose bleeds, crusting, sinusitis, ear/lung problems, haemat/proteinuria
Mx
- cyclophosphamide + steroids
Reactions to antibiotics
Renal failure - gentamicin, vancomycin Anaphylaxis - penicillin Hepatitis - meropenem Liver failure - fusidic acid + statin INR raise - warfarin + ciprofloxacin/clarithromycin
Community acquired pneumonia
Streptococcus pneumoniae
Haemophilus
Moraxella
Mx - augmentin
Severe community acquired pneumonia
Legionella
Mycoplasma
Mx - clarithromycin + augmentin
Hospital acquired pneumonia
Gram -ves –> cephalosporins, ciprofloxacin, tazocin
MRSA –> vancomycin
Meningitis
Neisseria meningitidis
Streptococcus pneumoniae
Listeria - very young/old, pregnant, immunocompromised
Mx - dexamethasone 10 mg IV THEN - empirical therapy - cephalosporin - neonates - penicillin + cephalosporin - >60 or immunocompromised - penicillin + cephalosporin - listeria - amoxicillin/ampicillin - neisseria - benzylpenicillin + cephalosporin
Community UTI
Trimethoprim
Iatrogenic UTI
Cephalexin/augmentin
If infected cather - change under gentamycin cover
C.diff enterocolitis
Stop offending agent - cephalosporin
PO metronidazole –> PO vancomycin
Pneumocystis carinii
HIV +ve + CD4 <200
Oral co-trimoxazole
Gout
Due to drugs - thiazides, furosemide, alcohol, pyrazinamide
Mx
- acute - NSAID, steroid injection, colchicine
- 2 weeks later - allopurinol
Hairy cell leukaemia
Middle aged men
Pancytopenia, splenomegaly, hepatomegaly
Burkitt’s lymphoma
Due to latent EBV
Mandibular/abdominal mass
Starry sky appearance on microscopy
Hodgkin’s lymphoma
Painless, asymmetrical lymphadenopathy that is painful on alcohol consumption
Reed Sternberg cells
Mantle cell lymphoma
Old men
Translocation between Chr 11 and 14
Follicular lymphoma
Middle aged people
Translocation between Chr 14 and 18
Painless, generalised lymphadenopathy
Centrocytes and centroblasts
Diffuse large B cell lymphoma
Old people
Large lymphocytes
SIADH
2 low in blood - sodium and osmolality
2 high in urine - sodium and osmolality
3 exclusions - renal/adrenal/thyroid/cardiac cause, hypovolaemia, contributing drugs
AIHA
Warm - IgG mediated - lymphoproliferative disease, drugs (penicillins), autoimmune diseases (SLE)
Cold - IgM mediated - mycoplasma/EBV
DAT +ve + spherocytes
Common variable immunodeficiency syndrome
Adults
MHC III mutation
Low B cells, Ig A/G/E
Chronic granulomatous disease
X-linked
Chronic inflammation with non-caseating granuloma
Niotroblue tetrazolium - colourless
Bare lymphocyte syndrome
Low MHC I/II
Sclerosing cholangitis + hepatomegaly + jaundice
Selective IgA deficiency
Mild respiratory and gastro infections
Linked to RA and SLE
Reticular dysgenesis
No granulocytes and lymphocytes
Sepss few days after birth
Interferon gamma deficiency
No granulomas
Mycobacterium and salmonella infections
Goodpasture’s disease
Respiratory feature - haemoptysis, dyspnoea, cough
Renal features - haematuria, AKI, nephrotic syndrome
IgG in basement membrane
Di George syndrome
22q11 deletion
Cardiac abnormalities + atresia + thymic aplasia + cleft palate + hypocalcaemia
Low CD4, CD8, IgG, gA
Rabies
Progressive encephalitis + hydrophobia + muscle spasm
Q fever
Coxiella burnetti
Inhalation of urine/faeces of infected livestock
Cat scratch disease
Bartonella species
Bites from cats
Tender and swollen lymph nodes + headache + backache
Kala azar
Visceral leishmaniasis
Fever + splenomegaly
Hepatomegaly, hyperpigmentation, dry warty skin
Cutaneous leishmaniasis
Itchy papule at bite site –> ulcer with raised edges
Brucellosis
Brucella abortis
Unsterilised milk/cheese
Fever, muscle and joint pain, weight loss, fatigue, sacroilitis, depression
Mx - amoxicillin and doxycycline for 6 weeks
Lyme disease
Borrelia burgdorferi
Local - erythema chronicum migrans (red papule/macule –> target lesion), fever, headache
Disseminated - peripheral neuropathy, erythema chronicum migrans, cranial nerve palsies, arthritis
Late - persistent arthritis, chronic encephalitis
Mx - oral doxycycline
Sporadic CJD
Rapidly progressing dementia at 65, lower motor neuron signs, akinetic mutism, myoclonus, cortical blindness
LP for 14-3-3 protein
EEG - generalised triphasic sharp complexes
Variant CJD
26 years
Initially psych feature –> ataxia, dementia, myoclonus
MRI - positive pulvinar sign
EEG - normal
Sleeping sickness
Trypanosoma brucei
Subcutaneous chancre at bite site
Fever, weaknes, arthralgia, headache
Chagas disease
Trypansoma cruzi
Red nodule at bite site
Acute - swollen eyelids, fever, diarrhoea, vomiting, lethargy
Chronic - colon/cardiac/oesophageal dilation
Wilson’s disease
Cirrhosis, parkinsonism, seizures, dementia
Pemphigoid
Autimmune deep bullous
Nikolsky sign -ve
Pemphigus
Autoimmune bullous disease
Nikolsky sign +ve
Psoriasis
Salmon-pink plaque + silver white scale on extensor surfaces
Pityriasis rosea
Single scaly salmon-pink macule <5cm
Becomes a fir tree pattern after a few days
Lichen planus
Pruritic, purple, polygonal, planar, papular, plaques, pearl sheen
Acute tubular necrosis
Damage to tubular epithelium –> AKI
Ischaemic/toxic injury - loss of polarity, glomerular back pressure, interstitial leakage
IgA nephropathy
Few days after infection
Post-streptococcal glomerulonephritis
Few weeks after infection
Osteochondroma
10-30 years
Bone cancer of large joints
Osteoid osteoma
Dull pain
Bone cancer
X-ray - central nidus and sclerotic rim
Endochondroma
10-40 years
Bone cancer of small joints
Pyoderma gangrenosum
Necrotic ulcer with purple edges
Caused by UC, CD, RA, AML, CML, PRV, multiple myeloma
Polymyositis
Weakness, pain and swelling of proximal muscles and facial muscles, ptosis, dysphagia
Dermatitis herpetiformis
Symmetrical, itchy papulovesicular rash on extensor surfaces (elbows, buttocks)
Associated with gluten intake in Coeliac’s disease
Dengue fever
Abrupt onset fever, retrobulbar pain, facial flushing
Generalised maculopapular rash
Guttate psoriasis
Abrupt onset small salmon-pink lesions in young adults/children
Strep throat infection 2/3 weeks before
Giardia
Bloating, flatulence
From India
Mx - Metronidazole PO 400mg tds for 5 days
