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Path Key Points Bank Flashcards

1
Q

BPH

A

Lower urinary tract symptoms (frequency, urgency, nocturia, terminal dribbling, poor stream)

Mx

  • alpha reductase inhibitor - finasteride
  • alpha blocker (with HTN - prazosin; without HTN - tamsulosin)
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2
Q

Grading system for RCC

A

Furhman’s system

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3
Q

Clear cell RCC

A

Most common RCC
Golden colour due to lipid collection
Clear cytoplasm arranged in nests

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4
Q

Papillary RCC

A

Friable brown tumours

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5
Q

Chromophobe RCC

A

Variable chromosomal changes

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6
Q

Prostate cancer

A

Genes associated - PTEN, AMACR, P27, E-cadherin
Associated with eating red meats
Prognosis - Gleason score

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7
Q

Varicocele

A

Non-translucent

Dull ache with venous dilation

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8
Q

Hydrocele

A

Translucent

Due to trauma or pathology

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9
Q

Zoon’s balanitis

A

Inflammation of glans –> redness –> biopsy - can be dysplastic

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10
Q

Fournier’s gangrene

A

Necrotising fasciitis of male genitalia

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11
Q

High risk HPV

A

16 & 18

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12
Q

Low risk HPV

A

6 & 11

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13
Q

Cervical intra-epithelial neoplasia (CIN)

A

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

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14
Q

Endometrial hyperplasia

A

PCOS, anovulation, perimenopause, granulose cell tumours, unopposed oestrogen therapy, endometrial cancer
Type 1 - K-RAS, BRAF
Type 2 - P53

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15
Q

Endometrial hyperplasia prognostic factors

A 
Figo stage
1 - uterus
2 - spread to cervix
3 - pelvic spread
4 - distant spread
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16
Q

Sex cord stromal tumours

A

Benign - fibromas, thecomas

Variable - granulosa cell tumour, sertoli-leydig cell tumours

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17
Q

Lynch syndrome (hereditary non-polyposis colorectal cancer)

A

Autosomal dominant

Colorectal and endometrial tumours

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18
Q

Krukenberg tumour

A

Ovarian metastases from stomach tumour - signet ring cells

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19
Q

Dermatomyositis

A

Tender inflamed muscles - raised CK

Gottron’s papules

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20
Q

Sarcoidosis

A

Lungs - SOB + dry cough
Skin - lupus pernio, erythema nodosum
Heart - pericarditis, HF, valvular lesions
Non-caseating granulomas, hypergammaglobulinaemia, high serum ACE, hypercalcaemia

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21
Q

What causes erythema nodosum?

A

Sarcoidosis, IBD, Behcet’s disease, streptococcus, mycobacterium tuberculosis, pregnancy, OCP

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22
Q

What causes parotid enlargement?

A

Sarcoidosis, Sjogren’s disease, mumps, alcoholism, parotid cancer

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23
Q

Large vessel vasculitis

A

Takayasu arteritis

Giant cell arteritis - >50s, jaw claudication, scalp tenderness

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24
Q

Medium vessel vasculitis

A

Polyarteritis nodosa - renal/mesenteric vessels affected, beads of vessels on angiogram
Kawasaki’s disease - children, fever, erythematous rash on palsm and soles, conjunctivitis, lymphadenopathy

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25
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
26
Reactions to antibiotics
``` Renal failure - gentamicin, vancomycin Anaphylaxis - penicillin Hepatitis - meropenem Liver failure - fusidic acid + statin INR raise - warfarin + ciprofloxacin/clarithromycin ```
27
Community acquired pneumonia
Streptococcus pneumoniae Haemophilus Moraxella Mx - augmentin
28
Severe community acquired pneumonia
Legionella Mycoplasma Mx - clarithromycin + augmentin
29
Hospital acquired pneumonia
Gram -ves --> cephalosporins, ciprofloxacin, tazocin | MRSA --> vancomycin
30
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 ```
31
Community UTI
Trimethoprim
32
Iatrogenic UTI
Cephalexin/augmentin | If infected cather - change under gentamycin cover
33
C.diff enterocolitis
Stop offending agent - cephalosporin | PO metronidazole --> PO vancomycin
34
Pneumocystis carinii
HIV +ve + CD4 <200 | Oral co-trimoxazole
35
Gout
Due to drugs - thiazides, furosemide, alcohol, pyrazinamide Mx - acute - NSAID, steroid injection, colchicine - 2 weeks later - allopurinol
36
Hairy cell leukaemia
Middle aged men | Pancytopenia, splenomegaly, hepatomegaly
37
Burkitt's lymphoma
Due to latent EBV Mandibular/abdominal mass Starry sky appearance on microscopy
38
Hodgkin's lymphoma
Painless, asymmetrical lymphadenopathy that is painful on alcohol consumption Reed Sternberg cells
39
Mantle cell lymphoma
Old men | Translocation between Chr 11 and 14
40
Follicular lymphoma
Middle aged people Translocation between Chr 14 and 18 Painless, generalised lymphadenopathy Centrocytes and centroblasts
41
Diffuse large B cell lymphoma
Old people | Large lymphocytes
42
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
43
AIHA
Warm - IgG mediated - lymphoproliferative disease, drugs (penicillins), autoimmune diseases (SLE) Cold - IgM mediated - mycoplasma/EBV DAT +ve + spherocytes
44
Common variable immunodeficiency syndrome
Adults MHC III mutation Low B cells, Ig A/G/E
45
Chronic granulomatous disease
X-linked Chronic inflammation with non-caseating granuloma Niotroblue tetrazolium - colourless
46
Bare lymphocyte syndrome
Low MHC I/II | Sclerosing cholangitis + hepatomegaly + jaundice
47
Selective IgA deficiency
Mild respiratory and gastro infections | Linked to RA and SLE
48
Reticular dysgenesis
No granulocytes and lymphocytes | Sepss few days after birth
49
Interferon gamma deficiency
No granulomas | Mycobacterium and salmonella infections
50
Goodpasture's disease
Respiratory feature - haemoptysis, dyspnoea, cough Renal features - haematuria, AKI, nephrotic syndrome IgG in basement membrane
51
Di George syndrome
22q11 deletion Cardiac abnormalities + atresia + thymic aplasia + cleft palate + hypocalcaemia Low CD4, CD8, IgG, gA
52
Rabies
Progressive encephalitis + hydrophobia + muscle spasm
53
Q fever
Coxiella burnetti | Inhalation of urine/faeces of infected livestock
54
Cat scratch disease
Bartonella species Bites from cats Tender and swollen lymph nodes + headache + backache
55
Kala azar
Visceral leishmaniasis Fever + splenomegaly Hepatomegaly, hyperpigmentation, dry warty skin
56
Cutaneous leishmaniasis
Itchy papule at bite site --> ulcer with raised edges
57
Brucellosis
Brucella abortis Unsterilised milk/cheese Fever, muscle and joint pain, weight loss, fatigue, sacroilitis, depression Mx - amoxicillin and doxycycline for 6 weeks
58
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
59
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
60
Variant CJD
26 years Initially psych feature --> ataxia, dementia, myoclonus MRI - positive pulvinar sign EEG - normal
61
Sleeping sickness
Trypanosoma brucei Subcutaneous chancre at bite site Fever, weaknes, arthralgia, headache
62
Chagas disease
Trypansoma cruzi Red nodule at bite site Acute - swollen eyelids, fever, diarrhoea, vomiting, lethargy Chronic - colon/cardiac/oesophageal dilation
63
Wilson's disease
Cirrhosis, parkinsonism, seizures, dementia
64
Pemphigoid
Autimmune deep bullous | Nikolsky sign -ve
65
Pemphigus
Autoimmune bullous disease | Nikolsky sign +ve
66
Psoriasis
Salmon-pink plaque + silver white scale on extensor surfaces
67
Pityriasis rosea
Single scaly salmon-pink macule <5cm | Becomes a fir tree pattern after a few days
68
Lichen planus
Pruritic, purple, polygonal, planar, papular, plaques, pearl sheen
69
Acute tubular necrosis
Damage to tubular epithelium --> AKI | Ischaemic/toxic injury - loss of polarity, glomerular back pressure, interstitial leakage
70
IgA nephropathy
Few days after infection
71
Post-streptococcal glomerulonephritis
Few weeks after infection
72
Osteochondroma
10-30 years | Bone cancer of large joints
73
Osteoid osteoma
Dull pain Bone cancer X-ray - central nidus and sclerotic rim
74
Endochondroma
10-40 years | Bone cancer of small joints
75
Pyoderma gangrenosum
Necrotic ulcer with purple edges | Caused by UC, CD, RA, AML, CML, PRV, multiple myeloma
76
Polymyositis
Weakness, pain and swelling of proximal muscles and facial muscles, ptosis, dysphagia
77
Dermatitis herpetiformis
Symmetrical, itchy papulovesicular rash on extensor surfaces (elbows, buttocks) Associated with gluten intake in Coeliac's disease
78
Dengue fever
Abrupt onset fever, retrobulbar pain, facial flushing | Generalised maculopapular rash
79
Guttate psoriasis
Abrupt onset small salmon-pink lesions in young adults/children Strep throat infection 2/3 weeks before
80
Giardia
Bloating, flatulence From India Mx - Metronidazole PO 400mg tds for 5 days

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