Acute Medicine Exam Flashcards
Spinal Mets - Surgery vs Radiotherapy
The main indications for surgical decompression are uncertain cause with no histology, radioresistant tumour e.g. sarcoma/melanoma, unstable spine, previous RT, major structural compression, cervical cord lesion, solitary vertebral metastasis.
Indications for radiotherapy: radiosensitive tumour, several levels of compression, unfit for major surgery, patient choice.
The real extra benefit of surgical decompression would seem to be for the non-ambulant patient with a single site of cord compression and a prognosis of >3 months
Ilio-femoral DVT Rx options
Catheter-directed thrombolytic therapy should be considered in those patients who have symptomatic iliofemoral DVT if they have had symptoms for <14 days, have good functional status, >1 year to live, and low bleeding risk. An IVC filter would be considered if the patient was unable to be anticoagulated (e.g. recent intracranial bleed) or if they had recurrent VTEs despite adequate anticoagulation therapy.
HIV Associated Kaposi Rx
Kaposi’s sarcoma is caused by human herpesvirus-8. The majority of cases of Kaposi’s sarcoma associated with HIV infection respond to HAART. In the minority that does not respond to HAART, treatment with chemotherapy or radiotherapy can be offered. HIV-associated KS typically occurs in patients who have low CD4+ T-cell counts (10,000 copies/mL).
Biphosphanates
These drugs are pyrophosphate analogues that bind to hydroxyapatite crystals in bone matrix and inhibit osteoclastic bone resorption. They have no effect on parathyroid hormone or parathyroid-related protein.
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