Week 3 bb revision Flashcards
Monoclonal
Immunoglobulin light chain
urine or serum
Bence-Jones protein
Bence-Jones found in what conditions
Multiple Myeloma
Waldenstrom’s macroglobulinaemia
Amyloidosis
Blood serum paraprotein GREATER than 30
Multiple Myeloma
Amyloid in myeloma-associated amyloidosis
AL amyloid
Initial multiple myeloma chemo pre-autologous stem cell transplant
Lenalidomide + dexamethasone
proteasome inhibitor used for multiple myeloma
Bortezomib
Old patient with multiple myeloma not eligible for transplant. What treatment do they get?
melphalan and prednisolone
with either thalidomide or bortezomib
Which immunoglobulin is raised in macroglobulinaemia?
IgM
The most common paraprotein in multiple myeloma
IgG
Raised beta2-microglobulin
Poor prognosis in multiple myeloma
Weight loss and IgM paraprotein on electrophoresis
Waldenstrom’s macroglobulinaemia
tartrate-resistant acid phosphatase
Hairy-cell leukaemia
Gaucher’s disease
Haemolytic anaemia refractory to corticosteroids, next line treatment?
Splenectomy and rituximab
Chemo options for CLL?
FCR = Fludarabine, cyclophosphamide, Rituximab
CHOP = Cyclophosphamide, Doxorubicin, Vincristine and Prednisolone
Antiproliferative used in polycythaemia vera
Hydroxyurea
Anagrelide
Reduces platelets in thrombocythaemia
Lecuovorin
Methotrexate rescue drug
Solid organ transplant, MS, NHL
Reduces B lymphocytes more than T
Rituximab
Treatment of hodgkins
ABVD (Doxorubicin, Bleomycin, Vinblastine, Decarbazine) +/- radiotherapy
Raised ESR
History of temporal arteritis
Polymyalgia rheumatica
Schistocytes
anaemia
Microangiopathic haemolytic anaemia
Gram-negative monocytosis, urease positive
Brucella
Urease negative = salmonella
C1 inhibitor deficiency aka…
hereditary angioedema
Bubonic plague
Yersinia pestis
Dodgy water source
Profuse, non-bloody diarrhoea
Cryptosporidium parvum
Rat bite fever
sodoku
Spirillium minus
Cat-scratch disease
Bartonella henselae or Bartonella quintana
Epidemic typhus
Rickettsia prowazekii
Hunter who has been skinning animals
Tularemia
Erythema chronicum migrans
Lyme disease
A form of brucella …
Mediterranean
Goats
Easy culture
Brucella melitensis
‘m’ for mediterranean
Brucella abortus is more common in cows
Ulceration
Black and necrotic
Gram positive rods
Respond to penicillin
Bacillus anthracis
Trichophyton rubrum
Tinea pedis
Epidermophyton floccosum
Tinea pedis
Tichophyton interdigitale
Tinea pedis
Fungus associated with hepatocellular carcinoma
Aspergilllus flavus
Malassezia furfur
Pityriasis versicolor
Malassezia restricta
Seborrhoeic dermatitis
Malassezia globosa
Sebrrhoeic dermatitis
Woods lamp exam - yellow or orange
Pityriasis versicolor
Woods lamp exam - red pink fluorescence
Porphyria cutanea tarda
India ink with halo around the cell
Cryptoccus neoformans
Swollen and painful limb near a boil
Staphylococcal osteomyelitis
Female
Macular rash
Pain in wrists and hands
No respiratory symptoms
Rubella
This is common for women, more than men
Clutton’s joints
symmetrical joint swelling with congenital syphillis
Radiography: Oval, elliptical or serpentine sclerosis granulation nidus
Brodie’s abscess - subacute osteomyelitis
RANK ligand is involved with the differentiation of which bone product?
osteoclast differentiation and activation
This type of bone is 80-90% calcified and has mostly mechanical and protective functions
Cortical
bone which is haphazard in its organisation of collagen fibers and is mechanically weak
Woven/fibrous bone
Bone which has a regular parallel allignment of collagen into sheets and is mechanically strong
lamellar bone
These star shaped cells are important in the regulation of bone formation and are the most commonly found tissue in the bone marrow.
osteocytes
This part of bones has fibrous and cambium layers which are involved in fibroblast and osteoblast formation.
Periosteum
This type of bone is found towards the ends of long bones near the joints and has trabeculae aligned towards the mechanical load distribution.
Cancellous aka trabecular aka spongy bone
onion-skin on radiograph
Ewing’s sarcoma
CD99 immunostain
Ewing’s sarcoma
Bone-in-bone radiological appearance
Osteopetrosis
marble bone
osteopetrosis
Bone conditions with Codman’s triangle
Osteosarcoma
Ewing’s sarcoma
Sun burst, moth-eaten, fir-tree appearance on radiograph
Osteosarcoma
Hypercalcaemia with hypocalciuria in an otherwise well patient
Familial hypocalciuric hypercalcaemia
Condition caused by hyperparathyroidism, may see Brown’s tumours on xray
Osteitis Fibrosa cystica
Young men
Dull pain in long bone which gets worse at night
Relieved with NSAIDs
Osteoid osteoma
Anastomosing bony trabeculae
Osteoblastic rimming
Osteoid osteoma
Hard immobile painless palpable mass that is slowly growing
Teenager
osteochondroma
Cavity in bone filled with yellow fluid which grow next to epiphyseal plate until it fills the entire diaphysis.
Can lead to fractures
Simple bone cyst
Glycogen on staining cells from a bone biopsy
Ewing’s sarcoma
Rings and arcs calcification
Enchondroma
Cartilage cyst in bone
Enchondroma
Bone tumour that exhibits osteoblastic differentiation and produces malignant osteoid
Osteosarcoma
This lung cancer is often found alongside LEMS
Small-cell
anti-thyroid peroxidase antibodies
Hashimoto’s thyroiditis
Initial hyperthyroidism with neck pain
Returns to normal within a few weeks
De Quervain’s
This teratoma is often malignant and found in men
Immature
This teratoma is often benign and found in women
mature
This tumour can present as an ovarian mass. It is multi-lobular with a smooth lining of epithelium. Most often are benign.
Mucinous tumour
A neoplasm that produces oestrogen typically
Spindle cells with moderate pale cytoplasm containing lipid droplets and central nuclei
Thecoma
Ovarian neoplasm
cells surrounded by serous fluid and psammomma bodies
Seroud cystadenocarcinoma
mucin-secreting signet-ring cells in the tissue of the ovary
Krukenburg tumour
A malignancy in the ovary that has metastasized from a primary site - can show mucin-secreting signet-ring cells in the tissue of the ovary.
Krukenburg tumour
Ovarian tumour which has uniform germ cells mixed with lymphocytes
Dysgerminoma
Rises in placental alkaline phosphatase, hCG, LDH but not classically alpha fetoprotein
Seminoma
Schiller-Duval bodies
Endodermal sinus tumour
Neoplasm composed of cytotrophoblast and syncytiotrophoblase cells
Choriocarcinoma
Arise from the germinal epithelium of the seminiferous tubules
Seminona
This tumour can produce masculinisation in women with raised serum testosterone.
Sertoli-Leydig cell tumour
Metaplasia that occurs in the transformation zone which involves which cell-types?
Glandular to squamous epithelium
Breast investigation that gives histology
Core biopsy
Breast investigation that gives cytology
FNA
Common drug used for cardiovascular conditions which affects kidney’s ability to excrete uric acid
Aspirin
Which drug competes with uric acid for the organic acid transporter in the kidney thereby increasing serum urate
Thiazide diuretics
Chvostek’s and Trousseau’s indicate what biochemical state …
hypocalcaemia
What is PTH-rP?
PTH related peptide - undetectable by usual PTH test . Common cause for malignant hypercalcaemia
Short metacarpals Rounded facies Low serum calcium High phosphate High PTH
Pseudohypoparathyroidism aka Albright’s hereditary osteodystrophy
Bowing of long bones in adults
Paget’s
IgM spike
Waldenstrom’s macroglobulinaemia
young COPD patient with worsening LFTs
?Alpha-1 antitrypsin deficiency which can lead to liver cirrhosis
Micrognathia
posterior displacement of tongue
upper airway obstruction
clef palate
Pierre-Robin sequence
T and B cell lymphocyte infiltration of the islets of Langerhans leading to inflammation and destruction of the beta cells
Insulitis
The three hormones used in the combined pituitary function test
Insulin
GnRH
TRH
Overweight with central obesity Hypertension Raised triglycerides PCOS erectile dysfunction
Metabolic syndrome
Massive accumulation of chylomicrons in the plasma and severe hypertriglyceridaemia.
The plasma has a creamy appearance.
Lipoprotein lipase deficiency
This molecule is formed by the gut post-meal and carries dieatary triglycerides
Chylomicrons
The smallest lipoprotein particle which transports cholesterol to the liver
HDL
Persistent jaundice from day 1 of life which has been worsening
Crigler-Najjar syndrome
Haemoglobinuria … intra or extra vascular haemolysis?
Intravascular haemolysis
Niacin deficiency
Pellagra
Delayed motor development
Self-mutilation, e.g. biting
Sand-like crystals in nappies
Lysch-nyhan syndrome
The virus that can only propagate in the presence of HBV.
Hepatitis D virus