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