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Year 2 Medicine Leeds > Clinical Pathology > Flashcards

Clinical Pathology Flashcards

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1
Q

Name the 3 gram positive cocci and 2 gram negative cocci

A 
Positive|:
Staph aureus 
Staph pyogenes 
Streptococcus agalaitae
Negative:
Neisseria meningitides 
Neisseria gonorrhoeae
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2
Q

Name the gram positive (5) and negative (5) bacilli

A 
Positive:
Bacillus anthracis
Clostridium difficile 
Listeria monocytogenes
Corynebacterium 
Diptheriae
Negative:
Salmonella Typhi 
Shingella spp
Escherichia Coli 
Proteus spp
Yersinia pestis
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3
Q

Name the 4 gram positive coccobacilli

A

Haemophilus
Bordetella
Brucella
Pasteurella

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4
Q

Name the 5 spiral bacteria

A 
Helicobacter 
Campylobacter 
Borrielia 
Leptospira 
Treponema Pallidium
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5
Q

What does staphylococcus aureus cause?

A

Skin, soft tissue, bone infections and endocarditis

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6
Q

What does coagulase negative staphylococci cause?

A

Prosthetic device infection

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7
Q

What does streptococcus pyogenes cause?

A

Scarlet fever, sore throat, necrotising fasciitis, puerperal sepsis

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8
Q

What does streptococcus pneumoniae cause?

A

Pneumonia, meningitis

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9
Q

What does escherichia coli cause?

A

UTI’s, sepsis, intra-abdominal infections

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10
Q

What does pseudomonas aeruginosa cause?

A

Ventilator associated pneumoniae

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11
Q

What does Neisseria meningitidis cause?

A

Meningococcal sepsis, meningitis

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12
Q

What does Neisseria gonorrhoeae cause?

A

Gonorrhoea, ophthalmia neonatorum

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13
Q

What does haemophilia influenzae cause?

A

Respiratory tract infections, meningitis, epiglottitis

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14
Q

What does chlamydia trachomatis cause?

A

Chlamydia

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15
Q

What does clostridium difficile cause?

A

Pseudomembranous colitis

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16
Q

What does mycobacterium tuberculosis cause?

A

TB - pulmonary and extra pulmonary

Meningitis

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17
Q

What are the 6 stages of virus life cycle?

A
  1. Adsorption
  2. Penetration
  3. Uncoating
  4. Synthesis
  5. Assembly
  6. Release
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18
Q

Describe the herpes virus (5 Strains)

A 
Simplex 1 - coldsores 
Simplex 2 - genital 
Varicella zoster - chickenpox/shingles 
Epstein-Barr - EBV
Cytomegalovirus - CMV
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19
Q

Describe respiratory viruses (4)

A

Rhinovirus - common cold
Influenza - Flu
Covid
Respiratory syncytial virus- bronchiolitis

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20
Q

Describe hepatitis viruses mode of transmission (4)

A

Hep A +E - faeco-oral

Hep B + C - Sexual, vertical, parenteral

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21
Q

Describe GI tract transmitted viruses (3)

A

Norovirus
Rotavirus
Enteroviruses - polio, fever rash syndromes

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22
Q

Describe the 4 “childhood” viruses

A

Mumps - parotids, orchitis
Measles - encephalitis SSPE
Rubella
Parvovirus - erythema infectious

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23
Q

Describe prions viruses

A

CJD
nvCID
Both show spongiform encephalopathy
Mad Cow disease

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24
Q

Describe dermatophytes

A

originate in soil/animals or humans
Geophilic
Zoophilic
Anthropophilic

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25
Describe the 5 common fungal diseases
``` Tinea pedis - athletes foot Tinea unguinum - fungal nail disease Tinea curries - jock itch Tinea corporis - ringworm Tinea capitis - scalp ringworm ```
26
What is the treatment for tines capitis?
Systematic oral antifungals depending on cause - griseofulvin, terbinafine, itraconazole
27
What is malassezia?
Genus of yeasts Part of normal skin flora Causes pityriasis vesicolor
28
What are the 5 malaria species?
``` Plasmodium falciparum Plasmodium Vivax Plasmodium Ovale Plasmodium Malariae Plasmodium Knowlesi ```
29
What is the atopic triad?
Eczema, asthma and rhinitis
30
What is auto inflammation?
Spontaneous attacks of systematic inflammation, no specific source of infection and an absence of high titre autoantibodies and antigen specific auto reactive T cells
31
What are the histamine producing cells?
Mast cells Basophils Eosinophils
32
Describe autoimmunity
- T cells recognition of self antigens - B cells and plasma cells that make autoantibodies - Inflammation in target cells, tissues and organs is secondary to actions of T cells, B cells and autoantibodies
33
What are the three mechanisms of autoimmunity?
1. Failure of central tolerance - T cell and B cell selection in the thymus and bone marrow retrospectively 2. Genetic predisposition - HLA types selected for certain self antigens 3. Antigenic factors - infections that trigger autoimmune response, environmental triggers ie. UV light, smoking etc
34
What does a non functional FoxP3 gene indicate?
Gene for immune system, lack of functionality indicates no functional T cells present within the immune system
35
What are the two types of autoimmune thyroid disease?
Hashimotos Thyroiditis - under active | Graves - overactive
36
Describe SLE (Systematic lupus erythematous)
Autoantibodies form against different molecules in the cell nucleus: ddDNA, dsDNA, ribosomes, histones
37
Describe sequestered antigens involved in cell death and failed clearance of nuclear antigens
- Nuclear self antigens are intracellular (shielded from immune system) - Apoptosis clears nuclear material - Necrosis cell death, nuclear antigens may not be cleared and may act as antigens to the immune system
38
Describe ANA - antinuclear antibodies
Antibodies that bind to the cell nucleus, can be more specific and identify subtypes of antibody that bind to parts of the nucleus - Target nucleus of cell
39
Describe anti-CCP antibody (ACPA)
Specific 95%, useful as a prognostic marker. Positive ACPA indicate more severe and erosive disease - Usually used for rheumatoid arthritis
40
Describe ANCA testing
Pattern of autoantibody | - Suggests clinical diagnosis specifically for vasculitis
41
Describe autoantibodies in type 1 diabetes
- Non pathogenic - Several types: islet cell antibodies, antiGAD65, antiGAD67, antiinsulinoma antigen 2 and insulin autoantibodies - Disappear with progression of disease and total destruction of beta islet cells Disease confirmation
42
Describe Pernicious Anaemia in relation to antibodies
Antigen: H+, K+ ATPase located in the gastric parietal cells of rodent stomach - Clinical antibody present in more than 90% of patients with pernicious anaemia - Autoimmune gastritis leads to pernicious anaemia which is characterised by antibodies to GPC and intrinsic factor
43
Describe defects in innate immunity
- Neutrophils and macrophages - Pathogen recognition receptors recognise conserved pathogen associated molecular patterns (PAMPs) - Liposaccharide = PAMP - Phagocytes use PRRs to detect pathogens
44
Describe complement deficiencies
- C2,C4 - SLE infections and myositis | - C5-C9 form membrane attack complex, present with repeated bacterial meningitis - Neisseria
45
Describe chronic granulomatous disease
- Recurrent abscesses: lung, liver, bone, skin and gut - Unusual organisms e.g. staphylococcus, klebsiella, serretia, aspergillum, fungi Diagnosis: rely on reduction neutrophil function test or nitro blue tetrazolium dye
46
Describe defects in the adaptive immunity
- Antibody production - B cell defects: CVID, IgA deficiency , x linked hyper IgM syndrome transient hypoglobulinaemia of infancy - Loss of antibody secretion - lead to recurrent bacterial infections
47
What is the treatment for antibody deficiency?
Antibiotics and immunoglobulin G replacement from blood donors
48
Describe SCID
Severe combined immunodeficiency disease - No T cells + suggestive history - Paediatric emergency with haemopoietic stem cell transplant as only cure - Antibiotics, antivirals and antifungals given as treatment - Causes: absence of critical T cell molecule TCR common gamma chain, loss of communication MHC2 deficiency, metabolic adenosine deaminase deficiency
49
Describe adoptive immunotherapy
Bone marrow transplant | Stem cell transplant, replacement of the immune system
50
Describe the drugs targeting lymphocytes
Antimetabolites - azathioprine, mycophenolate mofetil (MMF) Calcineurin Inhibitors - cyclosporin A, tacrolimus M-TOR inhibitors - sirolimus IL-2 receptor mABs - Basiliximab, daclizumab
51
What are JAK inhibitors?
Newest treatment for RA working by blocking the signalling pathways, slow down the immune system and therefore reduce RA symptoms
52
Describe HLA typing
- Inherit HLA type from parents - Each couple have 4 possible types - Class 1 and A antigens are the most important in relation to transplant matches - Serological cell based
53
Describe Complement dependent Cytotoxicity Test CDC
Detects complement fixing IgG/IgM HLA and non-HLAs - Limited sensitivity - Non-HLA interference
54
Describe antibody detection in transplantation
- Prevents hyper acute rejection - Specific against donor - pre-transplant crossmatch living or cadaveric - Avoid aborted transplants - Sensitising events - previous transplant, pregnancy and blood transfusions
55
Describe acute cellular rejection (ACR)
- T cell dependent, T cell immunosuppression - Directed against foreign HLA molecules effect of HLA mismatch - Typically 7-10 days after transplant
56
Describe hypogammaglobulinemias
- Antibody problems - Congenital X linked Acquired - multiple myeloma, burns - Usually encapsulated bacteria pneumoniae - Gardia lambila - Treatment typically with immunoglobulins
57
What are qualitative and quantitative neutrophil defects?
Qualitative - chemotaxis - rare congenital inadequate signalling Quantitative - killing power, inherited at risk of staph aureus infections - chronic granulomatous disease
58
Describe empirical therapy - neutropenic patients
Treatment: broad spectrum antibiotics 1st line - antipseudomonal penicillin +/- gentamicin 2nd line - carbapenem - Often normal flora - coagulase negative staph - Fungal infections - Viruses - Granulocyte stimulation factors
59
What is immunomodulation?
The therapeutic effect that may lead to immunopotentiation, immunosuppression or induction of immunological tolerance
60
What are 4 common acute RNA viruses?
Influenza, measles, mumps and hepatitis A
61
What viral syndromes have vesicular rashes?
Chicken pox Herpes simplex 1/2 Enterovirus
62
What viral syndromes have non vesicular rashes?
Measles Rubella Parvovirus HHV6
63
What is the baseline treatment for herpes simplex virus?
Aciclovir
64
What is the treatment of hepatitis B?
Lamivudine and Tenofovir
65
Describe HAART Therapy
Highly Active Antiviral Therapy - 2 Nucleoside reverse transcriptase inhibitors and NNRTI's - Require life long treatment
66
What are the beta lactams?
Penecillins Cephalosporins - can Carbapenems Monobactams
67
What beta lactam antibiotic can patients with penicillin allergies also react to?
Cephalosporins
68
What are the 3 groups of anti fungal cell membrane agents? + an example for each
Azoles - itraconazole Polyenes - Amphotericin B and Nystatin Allylamine - terbinafine
69
What antibiotics are best to avoid in pregnant women and why?
Quinolones - damage to cartilage Trimethoprim - folic acid antagonist Tetracyclins - stains bones/teeth + affects bone growth
70
What is the antibiotic treatment typically used for Meningitis?
IV Ceftriaxone
71
What is the antibiotic typically used to treat cellulitis?
Flucloxacillin
72
What is the typical antibiotic for treatment for necrotising fasciitis?
Meropenem and clindamycin
73
What are the two methods of antibiotic resistance transfer?
Horizontal transfer via transposons | Vertical transfer - passed via daughter cells in bacterial division
74
What is canton Valentine leucocidin staph aureus?
PVL - toxin produced by less than 2% of staph aureus | - Causes recurrent skin and soft tissue infections including necrotising haemorrhaging pneumonia
75
What blood test should be run for investigation of specific infections?
``` Immunity Detection - IgG - previous infection - IgM - current infection or reactivation Blood cultures M, C and S PCR and microscopy ```
76
Describe renal cell carcinoma + gene mutation
Two types - clear cell and papillary - Typical in 60+ males - VHL gene mutation - Common paraneoplastic syndrome
77
Describe wilm's tumour
Nephroblastoma - arises from nephroblasts Typical in children under 5 WT1 gene Abdominal swelling and pain
78
Describe urolithiasis
Kidney stones - form obstruction, urinary stasis and local trauma
79
Describe vesicoureteral reflux
Urine flows backwards from bladder to ureter - Typical in under 2's - Only seen those with symptoms - UTI due to renal stasis
80
Describe urothelial carcinoma
Transitional cell carcinoma arising from urothelium - Typically in adults over 60 and mainly males - Exposure to chemicals
81
Describe Neurogenic bladder
Inability to empty bladder - Spastic - if damage to brain or spinal cord - Flaccid - if damage to peripheral nerves Stroke, MS, pregnancy, diabetes - Lack of bladder control
82
Describe benign prostatic hyperplasia
Increased stroll and glandular cells - enlarged prostate - Older men 70% by age 60 Lower urinary tract symptoms
83
Describe prostatic adenocarcinoma and its gene association
Cancer of prostatic epithelium | - BRCA1/2 association
84
Describe cryptorchidism
Undescended testis - typical in newborns | - seen more in downs syndrome and kelinfelter syndrome
85
Describe seminoma
Malignant neoplasm of the testis arising from germ cells in seminiferous tubules - Young men 25-45 - Pain, changes in testis shape - Can cause gynecomastia
86
What is the typical treatment for pyelonephritis?
Cefuroxime, azteonam, ciprofloxacin, gentamicin
87
What is the typical treatment for prostatitis?
Piperacillintazobactam, ciprofloxacin and cotrimoxazole
88
Describe the common causes of chronic kidney disease
Diabetes and hypertension
89
Describe minimal change disease
Children with nephrotic and little/no decrease in renal function
90
Describe IgA nephropathy (Berger's Disease)
Autoimmune - teens with nephritic syndrome, build up of IgA in the glomeruli causing glomerulonephritis if secondary may have PMH of cirrhosis or coeliac
91
Describe Membranous nephropathy
Autoimmune | - Adults with nephrotic, if secondary may have PMH of hepatitis B or cancer
92
Describe focal segmental glomerulosclerosis
Scar tissue develops on the glomeruli | Adults with nephrotic, if secondary may have PMH of HIV or anabolic steroid use
93
Describe lupus nephritis
Autoimmune - Young woman with molar rash and other signs of lupus - variable types of renal presentations
94
Describe post infectious glomerulonephritis
Type 3 hypersensitivity reaction | - Children with impetigo or strep throat then develop nephritic syndrome
95
Describe Granulomatosis with polyangilitis - wegners
Autoimmune small vessel vasculitis - Haematuria and rapid fall in eGFR - Nasal and lung symptoms
96
Describe good pastures disease
Type 2 hypersensitivity reaction - Haematuria and rapid fall in eGFR - Haemoptysis due to lung involvement
97
What are 5 diseases with renal manifestations?
``` Hypertension Diabetes Vasculitis Myeloma Amyloidosis ```
98
Describe autosomal dominant polycystic kidney disease, mutation and presentation
PCKD - adults - Caused by PKD1/2 mutation Presents - ESRD, liver cysts, berry aneurysms, heart valve problems
99
Describe Autosomal recessive polycystic kidney disease
PCKD - children - PKHD 1 mutation Presents - underdeveloped lungs at birth, 1/3 die in the first month of life
100
Describe neurocrine
Secretion of hormones into the blood stream by neurones
101
Describe pituitary tumours
- Benign adenomas | - Hormone producing cells, prolactinoma, growth hormone
102
Describe hypothyroidism
- More common in women - Iodine deficiency Hashimoto's - Goitre Insufficiency of Thyroid hormones
103
Describe hyperthyroidism
``` Peak age - young women 30-40 yrs - Excess thyroid hormone Graves disease - wide eyed stare - Toxic nodular goitre - most patients euthyroid ```
104
Describe thyroid follicular carcinoma and tumour marker
Well differentiated malignant tumour - Middle Aged onset typically - 90% secrete thyroglobulin which can be used as tumour marker - Thyroid nodules
105
Describe papillary thyroid carcinoma
- Younger females - Thyroglobulin can be used as tumour marker Invasion of lymphatics
106
Describe primary hyperparathyroidism
Aetiology - Parathyroid adenoma Post menopausal women - Renal stones, muscle weakness
107
Describe Cushing's syndrome
- 25-40 years - Common cause is oral steroids - ACTH dependent increase bilateral adrenal hyperplasia - Excess cortisol - Moon face, weight gain, obesity, purple striae
108
Describe conn's syndrome
More prevalent in 30-50 yrs - Adrenal cortisol hyperplasia, adenoma, carcinoma and familial hyperaldosteronism - increased blood pressure, headaches, muscular weakness, muscle spasms, excessive urination
109
Describe Addison's disease | - Triad
- Adrenal insufficiency - Primary adrenal cortical insufficiency - Secondary due to failure of ACTH secretion - Triad of hyperpigmentation, postural hypotension and hyponatraemia - Lethargy, depression, low mood, anorexia etc
110
Describe pheochromocytoma and neuroblastoma
``` Pheochromocytoma - adults Neuroblastoma - children - Adrenal medullary tumour of neuroendocrine chromaffin cells - Episodic release of catecholamines - Hypertension, sweating, pallor ```
111
Describe insulinoma
More common in 40-60yrs - tumour arising from islets of langerhan - test for hypoglycaemia to confirm - Weakness, fatigue, vision problems
112
What are the function of osteoblasts?
Create and repair new bone, make osteoid, become osteocytes
113
What is the function of osteoclasts?
- Breakdown of old bone | - Large and found in bone pits
114
What is the function of osteocytes?
- Communication between osteoblasts and osteoclasts | - Crucial for bone remodelling
115
Describe investigations for bone disease
DEXA - bone density scan - ALP - Bone resorption - Bone formation - Osteoclast enzymes
116
Describe P1NP - pro collagen type 1 propeptides
- Synthesised by osteoblasts - Precursor molecule of type 1 collagen - Serum concentration not affected by food intake
117
Describe osteoporosis
- Decreased bone mass - Deranged bone micro architecture | - FRAX calculation tool for fracture risk calculations
118
Describe Paget's disease
- Rapid bone turnover and abnormal bone remodelling - Males over 50 - Commonly affects pelvis, femur and lower lumbar vertebrae
119
Describe osteomalacia
- Lack of mineralisation of bone - Widened osteoid seams with lack of mineralisation in adults - Widened epiphysis and poor skeletal growth in children - Insufficient calcium absorption from intestine and renal phosphate excretion
120
Describe bisphosphonates
Help to reduce bone thinning - Mimic pyrophosphate structure - Taken up by skeleton Ingested by osteoclasts
121
Describe hypocalcaemia indicates
- EDTA contamination - Vitamin D deficiency - Inadequate dietary calcium intake
122
What can hypercalcaemia indicate (4)
- Hyperparathyroidism - Malignancy - Medications - Vitamin D excess
123
Describe hypomagnesaemia
- Prevalent in hospitalised patients - Associated with hypokalaemia, hyponatraemia, hypophosphatemia and hypocalcaemia - Due to inadequate intake, renal loss, GI loss, redistribution into cells
124
Describe fibrocystic disease
- Ages 20-45 - Benign hormonally mediated breast changes - Mild epithelial hyperplasia - Premenstrual painful breasts
125
Describe fibroadenoma
- Common 20-30 yrs - Mobile painless well defined breast lesion - Asymptomatic unless infarction occurs
126
Describe breast cancer
- Late menopausal women - Arises anywhere in breast parenchyma or accessory breast tissue - Linked to oestrogens as cause - Palpable lump
127
Describe DCIS (Ductal Carcinoma in situ)
Malignant clonal proliferation of cells within breast parenchyma - Precursor of invasive carcinoma
128
What is the most and least common breast cancer?
Ductal - most common Lobular - relatively common Metaplastic and mucinous - rare
129
What markers are used for invasive tumours?
ER, PR and Her 2
130
Describe endometriosis
- Ectopic endometrial tissue - 30-40 years - Bleeding into tissues, fibrosis, NSAIDs
131
Describe endometrial polyps
- Sessile/polypoid endometrial overgrowths - 40-50 years - Risk increases with age - asymptomatic, intramenstrual/postmenopausal bleeding, menorrhagia, dysmenorrhoea
132
Describe endometrial hyperplasia
- Hyperplasia of the endometrium - >40 years - Situations of oestrogens and low progesterone - Abnormal bleeding, IMB, PMB and amenorrhea
133
Describe endometrial cancer
- Adenocarcinomas - Endometrioid - pre/post menopausal or serous - postmenopausal - Most common cancer of female genital tract - Features of advanced metastatic disease
134
Describe myometrial tumours
- Smooth muscle tumour of myometrium - Commonest gynaecological condition - benign monoclonal proliferation of smooth muscle cells - Later reproductive life, irregular bleeding
135
Describe PCOS
- Endocrine disorder characterised by hyperandrogenism, ovulatory dysfunction, menstrual regularities, insulin resistance - 6-10% of women reproductive age - Hirsutusm - hair on chin - Male pattern baldness - Lack of ovulation - Infertility
136
Describe Lynch syndrome in relation to women health
- Hereditary non polyposis colorectal cancer | - Women with Lynch syndrome have a higher lifetime risk of endometrial cancer
137
Describe insulin resistance
Insulin receptors in theca cells respond to insulinaemia in T2DM - making them bigger, driving more LH receptors on the theca cells Hypothalamus responds by producing more GnRh from pituitary
138
What are the two main intra-amniotic infections?
Chorioamnionitis - inflammation of umbilical cord, amniotic membranes/fluid/placenta Puerperal Endometriosis - infection of the uterine lining
139
What are the main infections in children?
- Neonatal sepsis - Respiratory tract infections - cold, tonsillitis, pneumonia, acute otitis media - Meningitis - UTI - Rashes associated with infections - scarlet fever, impetigo etc
140
What are the different cells in myeloid and lymphoid lineages?
Myeloid: granulocytes, erythrocytes and platelets Lymphoid: B and T lymphocytes
141
Describe the granulocytes - leukocytes
``` Neutrophils: - Phagocytes - most common WBC - Increased Number = neutrophilia - Decreased Number = neutropenia - Live for a few hours in blood Eosinophils - Increased - eosinophilia - parasitic infection and allergic reactions ```
142
Describe monocytes
- Phagocytic antigen presenting cells - Migrate to tissues and are identified as macrophages or histocytes - Kupffer cells in liver - Langerhan cells in skin
143
Describe the lymphocytes
``` T cells - adaptive immunity B cells - Rearrange immunoglobulin genes to enable antigen specific antibody production - Can indicate infection and myeloma if high numbers NK Cells - Innate immune system - Large granular lymphocytes - Recognise non-self cells and viruses ```
144
What is microcytic hypochromic anaemia and its causes?
MCV<80 fl MCH <27 Iron deficiency, thalassaemia, anaemia of chronic disease, Lead poisoning
145
What is normocytic normochromic anaemia and its causes?
MCV 80-95 fl MCH >27 - Normal haemoglobin in RBC but low amount of RBc Many haemolytic anaemia - Anaemia of chronic disease, after acute blood loss, renal disease, mixed deficiencies, bone marrow failure
146
Describe macrocytic anaemia and its causes?
MCV>95 Megaloblastic:vitamin B12 or folate deficiency Non-megaloblastic: alcohol, liver disease, myelodysplasia, aplastic anaemia
147
What is tested in a full blood count?
``` Hb MCV MCH Reticulocyte count WCC Plt ```
148
Describe 1 unit of RBC transfusion
- Raises Hb by 10g/L - 200-250mg iron - Stored at 4 degrees for up to 35 days - 280 ml - Dose 10-20ml per 1kg
149
Describe FFP
- Contains all clotting factors at physiological levels - 12-15ml/kg - 4 units - 1 unit = 300ml - Stored at -30 degrees
150
What is cryoprecipitate?
- Extracted from FFP during thawing process Contains: fibrinogen, von Willebrand factor VII and XII - 10-15ml/kg - 10 units typically
151
Describe platelets used for transfusions
- Raise count by 20-60x10^9/L - 1 unit platelets from 1 unit whole blood - 4-6 units pooled together into a single pack - can be from different donors - Stored at room temp for up to 5 days on an agitator
152
What is TRALI?
``` Transfusion related acute lung injury - serious complication of transfusion - Due to antibodies in the transfused unit against antigen expressed on recipients leukocytes - Acute lung injury Plasma used from male donors only in uk ```
153
What is Von Willebrand disease?
- Most common heritable bleeding disorder - Autosomal dominant inheritance - Reduction in factor VII Treatment - antifibrinolytics - transexamic acid
154
Describe haemophilia A and B and treatment
A = Factor VIII deficiency B = Factor IX - expressed in males and carried by females (Typically) Treatment - replacement of missing clotting factor
155
What is emicizumab (hemlibra)?
- Monoclonal antibody - Replace the action of missing FVIII in the clotting cascade - Binds to Factor IXa and X forming a link between the factors - Factor IXa activates FX allowing clotting cascade to continue
156
What is the main difference between low molecular weight heparin and unfractionated heparin ?
LMWH - switches off factor Xa | Unfractionated - switches off factor Xa and thrombin
157
What is vitamin K deficiency caused by and treatment?
- Obstructive jaundice - Prolonged nutritional deficiency - Broad spectrum antibiotics - Neonates Treatment: IV/oral vitamin k 10mg for 3-5 days
158
What is HIT and treatment?
Heparin induced thrombocytopenia - Dropped platelet count >50% from baseline - usually 5-10 days after starting heparin - stop heparin treatment and start argatroban
159
What is fondaparinux?
- Synthetic pentassaccharide given subcutaneously | - Binds antithrombin and inhibits Xa activity
160
What is aspirin?
Antiplatelet - inactivates platelet cyclooxyrgenase reducing thromboxane A2 - Irreversible affects lasting 4-5 days
161
What are the 3 P2Y 12 antagonists, their effect time, half life and action? (Antiplatelets)
``` Clopidogrel - 4-8 hours for effect - 0.5 hours half life - 5-7 days action Prasugrel - 2-4 hours for effect - 7 hours half life - 5-7 days action Ticagrelor - 2-4 hours for effect - 8-12 hours half life - 3-5 days action ```
162
What is the major haemorrhage protocol?
- HR>110, systolic BP<90mmHg - Transfusion of a volume equal to then patients total volume in less than 24 hours - Transexamic acid 1g bolus over 10 mins followed by IV 1g over 8 hours
163
What is disseminated intravascular coagulation + treatment?
- Clinicopathological syndrome complicating a range of illnesses - Systematic activation of pathways leading to and regulating coagulation which can result in the generation of fibrin clots that may cause organ failure - Consumption of platelets can lead to increased bleeding risk Treatment: Antibiotics Obstetric Intervention Maintain tissue perfusion
164
Describe physiological anaemia and macrocytosis in relation to pregnancy
Anaemia 1st and 3rd Trimester Hb<110g/L 2nd Trimester Hb<105 - Gestational thrombocytopenia
165
What are the differences in RBC mass and plasma volume during pregnancy?
RBC - increases by 25% | Plasma - 50% increase in volume
166
What is sickle cell trait?
- Heterozygous - Normal blood count - Clinically no problems except when extreme hypoxia/dehydration - Long fibrils distort red cell membrane - short lifespan
167
What is sickle cell disease and treatment?
``` - Homozygote Blood count - anaemia Hb 60-80g/L - Presentation occurs in infancy as foetal haemoglobin decreases Treatment: Penicillin from 6 months Transfusions, Hydroxycarbamide Bone marrow transplant ```
168
What are the three types of thalassaemia and treatment?
Alpha - most serious, both Hb A and F have alpha chains Beta - reduced rate of production of beta-globin chains Total Hb level normal or only slightly low Intermedia - no requirement for regular transfusions in first 3-5 years of life - Bone changes and osteoporosis Treatment: - Transfusion - Suppression of marrow red cell production and prevention skeletal deformity and liver/spleen enlargement - Iron chelators - promote excretion of iron in urine
169
Describe haemoglobin in each trimester of pregnancy
1st - gamma and Portland 2nd - Foetal Hb 3rd - more adult Hb A2 and some foetal
170
What are the primary and secondary immune disorders causing acquired bleeding and bruising in children?
``` Primary - Thrombocytopenia - TTP Secondary - SLE - ALPS - autoimmune lymphoproliferative syndrome ```
171
What is pernicious anaemia?
- Caused by B12 deficiency | - Parietal cells of stomach
172
What is subacute combined degeneration of the cord, presentation and treatment? (SACDC)
``` Myelin sheath deteriorates on spinal cord due to B12 deficiency Any cause of B12 deficiency - Anaemia not an absolute requirement Presentation: - Peripheral neuropathy - Numbness and distal weakness - Unsteady walking - Dementia Treatment: B12 and folate, folic acid ```
173
What is immune thrombocytopenia purpura (ITP) presentation and treatment?
- Immune disorder that occurs on its own or as part of another immune disorder - decreased platelets in the blood - Can be acute, chronic or relapsing Presentation: - Bruising, petechiae, bleeding Treatment - Steroid - IV immunoglobulins - New thrombocytopenia-mimetics
174
What is May Thurner syndrome?
Anatomical variant in which the right common iliac artery overlies and compresses the left common iliac vein against lumber spine - Rare cause of iliofemoral DVT
175
What are the inherited forms of hyper coagulability? (4)
- Factor 5 Leiden - Prothrombin gene mutation - Protein C and S deficiency - Antithrombin deficiency
176
Describe acute leukaemia
- Results of accumulation of early myeloid (AML) or lymphoid (ALL) precursors in the bone marrow, blood and other tissues - Somatic single cell mutation within a progenitor cell population
177
What is acute myeloid leukaemia (AML)?
``` Most common acute leukaemia in adults FLT3 mutation Median age 69 years Presentation: - anaemia, infections, fatigue, haemorrhage Treatment: Intensive chemotherapy Relapse - typical within 18 months of chemotherapy stopping ```
178
What is intensive chemotherapy?
Immediate treatment | Critically ill patients with rapidly progressive disease
179
What is acute lymphoblastic leukaemia (ALL)?
- Most common blood cancer typically in children - Philadelphia chromosome association Presentation: fatigue, bruising, bleeding, weight loss, night sweats 4 treatment components 1. Induction 8 weeks 2. Intensification 4 weeks 3. Consolidation 20 weeks 4. Maintenance 2 years
180
What is neutropenic sepsis?
Life threatening complication of chemotherapy Fever, hypotension, organ impairment Treatment - broad spectrum antibiotics
181
What is myelodysplasia (MDS)?
- Several related disorders with common features - Clonal bone marrow stem cell disorders that result in ineffective haematopoiesis with reduced production of one or more of peripheral blood cell lineages
182
What is polycythaemia vera?
Type of blood cancer - bone marrow makes too many RBC All ages - peak 50-70 yrs - Itching, plethoric face, headaches - JAK2 mutation - EPO receptor switched on continuously Treatment - blood withdrawals
183
What are the three chronic myeloproliferative disorders?
Polycythaemia Vera Essential Thrombocytosis Idiopathic Myelofibrosis
184
What is chronic myeloid leukaemia?
- Very high white cell count - Median age 55-60 - Increase leukocytosis - Philadelphia chromosome - Weight loss, fever, fatigue, bleeding, bruising
185
Describe myeloma pathophysiology etc
- Malignant disorder of clonal plasma cells - 70 years - Presentation - confusion, poor appetite, thirst, bone pain, nausea - CRAB features - Management of acute kidney injury - Management of acute kidney injury, steroids, individualised therapy
186
Describe Hodgkin lymphoma pathophysiology etc
Presence of Hodgkin reed-stern berg cells within a cellular infiltrate of non-malignant inflammatory cells - Age 20-40 and over 75 - Breathlessness, night sweats, itching - Chemo and radiotherapy
187
Describe non-hodgkin lymphoma pathophysiology etc
Follicular lymphoma, neoplastic disorder of lymphoid tissue - Arises with age - Slowly enlarging lymph nodes - chemotherapy
188
Describe chronic lymphocytic leukaemia pathophysiology etc
Malignant disorder of mature B cells Most common Leukaemia in UK - Age - over 60's - Lymphocytosis, lymphadenopathy, splenomegaly - Monitoring if caught early, chemotherapy Binet staging A + B = normal levels of platelets and Haemoglobin C = low levels of haemoglobin and platelets
189
What are CRAB features?
C - hypercalcaemia R - renal insufficiency A - anaemia B - bone lesions
190
Describe lymphomas
- Caused by malignant proliferations of lymphocytes B or T cells - Lymph nodes predominantly affected
191
What is thrombotic thrombocytopenia purpura (TTP)?
- Microangiopathic haemolytic anaemia - Red cells torn apart during circulation Reduced activity of ADAMTS13 enzyme - accumulation of ultra large von willebrand factor molecules - intravascular thrombosis - Confusion, seizures, strokes, fever, renal failure Treatment: urgent plasma exchange, suppress antibody production - steroids
192
Describe spinal cord compression in relation to haematology
- Steroids to reduce tumour size | - Likely cause is myeloma
193
Describe superior vena cava obstruction haematological emergency
- Pressure from mass obstructing the superior vena cava Causes - face and upper limb swelling, breathlessness, headaches etc - Steroids to reduce swelling - Likely cause is Hodgkin lymphoma
194
What is CAR-T therapy?
- Genetically modifying patients own T cells - Activates T cells and redirects them towards cancer cells - Current treatment for leukaemia and lymphomas
195
What is tumour lysis syndrome?
- Rapid breakdown of tumour cells - release of potassium and phosphate, elevated uric acid - leads to renal failure, cardiac arrhythmia Treatment: IV fluids, dialysis
196
What is cytokine release syndrome?
- Exaggerated physiological response to immune therapies in release of inflammatory cytokines - High fever, hypotension, hypoxia Treatment: broad spectrum antibiotics, IV fluids, oxygen
197
What is immune cell related neurological toxicity?
- Occurs at the same time or just after cytokine release - Wide range of neurological symptoms including confusion, seizures and coma - Steroids to suppress immune cells - Neurological assessments using the ICE and ICANS scores
198
What is the definition, aetiology, epidemiology, pathogenesis, morphology and clinical features of asthma?
1. Reversible intermittent narrowing of conducting airways 2. Allergens, drugs (NSAIDs), cold exercise 3. Children and young adults - atopic Adults - non atopic 4. Sensitisation to trigger followed by re-exposure to trigger 5. wall = thick contracted lumen mucus 6. SOB, wheeze, cough, hyperinflation
199
What is the definition, aetiology, epidemiology, pathogenesis, morphology and clinical features of COPD?
1. Combination of chronic bronchitis and emphysema 2. Tobacco smoke 3. Long standing cigarette smokers 4. Chemicals and heat trigger inflammation in bronchi and lung parenchyma - persistent inflammation and scarring 5. Bronchitis emphysema alveolar wall loss especially around bronchioles 6. SOB, inflammation of mucus secretion, coughing, mucus production
200
What is the definition, aetiology, epidemiology, pathogenesis, morphology and clinical features of bronchiectasis?
1. Permanent dilation of bronchi and bronchioles due to wall damage, secondary to necrotising infection 2. Mainly obstructive or infective 3. Dependent on cause 4. Obstruction causes infection, inflammation damages wall tissues, walls dilate but contain inflammatory debris and mucus 5. Dilated inflamed airway walls 6. Productive cough, obstructive ventilatory defects, repeated infections
201
What is the definition, aetiology, epidemiology, pathogenesis, morphology and clinical features of idiopathic pulmonary fibrosis?
1. Progressively patchy scarring especially in lower zones of both lungs that is fatal 2. Idiopathic 3. >60 years 4. Speculated is repeat epithelial injury leading to inflammation and fibrosis 5. Patchy interstitial fibrosis especially lung bases at periphery 6. Insidious dry cough and progressive SOB
202
What is the definition, aetiology, epidemiology, pathogenesis, morphology and clinical features of pneumoconiosis?
1. Lung damage secondary to particle inhalation commonest = coal dust/silica from mining, asbestos 2. Chronic particle inhalation 3. More male due to occupational exposures as does dependent often older 4. Particles ingested by macrophages, trigger fibrosis 5. Dust accumulation and fibrosis often centred on smaller conducting airways 6. Slowly increasing SOB
203
What is the definition, aetiology, epidemiology, pathogenesis, morphology and clinical features of sarcoid ILD (Interstitial lung disease) ?
1. Multisystem granulomatous disease that most commonly involves lymph nodes and lungs 2. Idiopathic 3. All ages 20-60 4. Granulomatous inflammation leads to fibrosis 5. Non-caseating granulomas in multiple sites often scarring 6. Nodal enlargement respiratory symptoms
204
What is the definition, aetiology, epidemiology, pathogenesis, morphology and clinical features of hypersensitivity pneumonia?
1. Inflammatory and fibrotic bronchiolar response to inhaled antigens 2. Inhaled 3. Dependent on trigger 4. Hypersensitivity response to antigen in wall of bronchioles, inflammation triggering fibrosis if antigen not removed 5. Chronic inflammation around bronchioles spilling out into interstitium - interstitial fibrosis 6. Respiratory symptoms
205
What is the definition, aetiology, epidemiology, pathogenesis, morphology and clinical features of cystic fibrosis?
1. Disease from abnormally thickened mucus 2. Chloride channel recessive gene 3. 1 in 2500 4. Reduced sodium and chloride in lumen of respiratory tract, GI and seminiferous tubules - causes dehydrated mucus which is thicker and blocks lumina 5. Lung infections, bronchitis, pancreatic exocrine atrophy 6. Depends on predominant organ involvement
206
What are the 4 chronic interstitial lung diseases?
Idiopathic pulmonary fibrosis Pneumoconiosis Sarcoid Hypersensitivity pneumonia
207
Describe the epidemiology, aetiology, pathogenesis, clinical features and non specific effects of lung cancer
1. Most common cause of cancer death in UK, 40-70 years 2. Tobacco smoking, lung fibrosis, EGFR, KRAS, ALK, ROS1 3. Oncogenic drivers, squamous cell carcinoma 4. Local effects of tumour, distant metastases 5. Usually metabolic effects, weight loss lethargy, electrolyte disturbances, clubbing
208
What are 4 possible causes of acute sore throat and a brief description of each?
Pharyngitis - inflammation of the back throat resulting in sore throat and fever Acute tonsillar pharyngitis - symmetrically inflamed tonsils and pharynx Infectious Mononucleosis - symmetrically inflamed tonsils/soft palate inflammation and posterior cervical lymphadenopathy Epiglottitis - sudden onset of sore throat and fever, inflammation of the epiglottis and surrounding tissue leading to airway obstruction
209
What is the cause of infectious mononucleosis/glandular fever?
Epstein Barr virus
210
What is otitis externa, subtypes and management?
- Inflammation of the external ear canal - Topical agents for mild/moderate and topical plus systematic antibiotic such as flucloxacillin for severe Malignant - external otitis spreading to the skull base Chronic - Often bilateral, canal wall thickening narrowing external ear canal - allergic contact dermatitis
211
What is otitis media?
Middle ear inflammation Fluid in middle ear Common in children Caused by - streptococcus, pneumonia, haemophilia influenza Possible complications with the mastoid bone and air cells
212
What is pinna cellulitis + antibiotics used for treatment?
- Acute ear injury/ soft tissue - Associated with trauma, surgery or burns - Infective agents:pseudomonas aeruginosa/ staph aureus - Treat with ciprofloxacin and flucloxacillin
213
What is aspergillosis?
- Infection caused by common mould - Immunocompromised patients and those with lung disease are at higher risk of developing health issues related to mould - Allergic reactions, infections
214
What is nocardia asteroides + antibiotic treatment?
- Nocardia is a genus of bacteria found in the environment - Pulmonary nocardiasis is acquired through inhalation - More common in the immunosuppressed and those with pre-existing lung disease - Development of lung abscess Treatment: supportive Rx(ABC), antibiotics - co-trimoxazole
215
What is a pulmonary aspergilloma ?
- Mobile mass of aspergilus within a pre existing lung cavity - Cough, haemoptysis, wright loss, wheeze and clubbing Treatment: 10% cases resolve spontaneously, surgical resection, antifungals
216
What is mycobacterium tuberculosis?
- Infection acquired by inhalation of infected respiratory droplets, bacilli lodge in alveoli and multiply resulting in ghon focus - Pulmonary tuberculosis is the most common presentation - Can disseminate or affect almost any other organ - Diagnosis: clinical features, supportive radiology, detection of acid-fast bacilli or culture of M.tuberculosis from specimen Treatment: combined chemotherapy for several months Prevention: BCG to infants and children in high prevalence areas
217
Describe normal mesothelium
A single layer of mesothelial cells lining the pleural cavity, secrete hyaluronic acid rich mucinous pleural fluid that lubricates the fluid
218
Describe pleural fibrosis
- Usually secondary to pleural inflammation - Unilateral or bilateral - Widespread thick fibrosis preventing normal expansion and compression of the lung causing breathlessness
219
Describe parietal pleural fibrous plaques
- Associated with low levels of asbestos dust exposure - Usually bilateral - Asymptomatic - May be visible on chest radiographs - Dense poor cellular collagen
220
Describe diffuse pleural fibrosis
- Associated with high levels of asbestos - Usually bilateral - Dense cellular collagen not extending into interlobular fissures - Prevents normal expansion of the lung
221
Describe pleural effusions and the two main types
Build up of fluid between pleura: Transudates - - Low capillary oncotic pressure and/or high hydrostatic pressure - Intact capillaries - low amount of protein and lactate dehydrogenase Exudates - Capillaries lose semipermeability - Normal oncotic pressure and vascular hydrostatic pressure - High protein and lactate dehydrogenase - Inflammation without infection Symptoms - Breathlessness - Little/no pleuritic pain Signs - Dull percussion - Reduced breath sounds on auscultations Treatment - Treat the breathlessness by removing fluid - Identify and treat underlying cause
222
What are the types of pneumothorax, causes, diagnosis and treatment?
Open - Chest wall perforation usually traumatic - External air drawn into pleural cavity Closed - Ruptured emphysematous bull - Common inflammatory lung disease - Can be traumatic - lung tears from fractured ribs Tension - Perforation into pleural cavity allowing air into the cavity but not out - Pressure rises and can compress mediastinal structures Diagnosis - Signs - cyanosis, tachycardia, contralateral tracheal deviation in tension pneumothorax Treatment - May resolve spontaneously - Decompression via needle aspiration - Chest tube
223
Describe malignant mesothelioma
Neoplasm of mesothelial cells that line serous cavity - Tend not to metastasise widely - Mixed tubulopapillary epithelioid and spindle cell sarcomatous morphology Causes: - Asbestos - Thoracic irradiation - BAP1 mutations - gremlin mutations in familial cancer syndrome with uveal melanomas and mesotheliomas
224
What is left sided hypertensive heart disease?
- Left ventricular concentric hypertrophy | - History or pathological evidence for hypertension
225
What is right sided hypertensive disease - Cor Pulmonale?
- Right ventricular hypertrophy, dilation and potentially heart failure secondary to pulmonary artery hypertension caused by disorders of the lung or pulmonary vasculature
226
What are true and false aneurysms?
True - when bounded by arterial wall components or the attenuated wall of the heart False - Breach in the vascular wall leading to an extravascular haematoma that freely communicated with intravascular space
227
Describe the definition, epidemiology, aetiology, pathogenesis and clinical features of left sided heart failure
1. Syndrome resulting from insufficient left ventricular output 2. 1% above 75 3. Ischaemic, hypertensive and valvular heart disease 4. Low CO - low BP sympathetic overdrive and renin angiotensin activated 5. Dyspnoea, fatigue and palpitations, peripheral oedema and ascites, - Poor prognosis - 3 years
228
Describe the definition, epidemiology, aetiology, pathogenesis and clinical features of right sided heart failure
1. Insufficient right ventricular output 2. uncommon 3. Lung diseases, ischaemic heart disease 4. Pulmonary hypertension - increased workload of right ventricular hypertrophy 5. SOB, peripheral oedema
229
What are the 4 valvular heart diseases?
Aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation
230
Describe the definition, epidemiology, aetiology, pathogenesis and clinical features of aortic stenosis
1. Narrowing of aorta 2. Most common VHD 3. Senile calcific aortic stenosis, congenital bicuspid valve, chronic rheumatic disease 4. 5. Chest pain, syncope, SOB
231
Describe the definition, epidemiology, aetiology, pathogenesis and clinical features of aortic regurgitation
1. Dilation of root of aorta 2. Common secondary to rheumatic heart disease + bacterial endocarditis 3. 4. Marfans syndrome, ankylosing spondylitis, congenital leaflet abnormalities
232
Describe the definition, epidemiology, aetiology, pathogenesis and clinical features of Mitral stenosis
1. Narrowing of mitral valve 4. Reduced blood flow increases pressure in left atrium - pulmonary oedema and dyspnoea 5. Increased risk of atrial fibrillation
233
Describe the definition, epidemiology, aetiology, pathogenesis and clinical features of mitral regurgitation
2. Common due to mitral valve prolapse or ischaemic heart disease or infective endocarditis 4. One leaflet prolapses into the left atrium during systole 5. Patients may remain asymptomatic but eventually left ventricular failure occurs
234
Describe the definition, epidemiology, aetiology, pathogenesis and clinical features of ASD
1. Abnormal hole in atrial septum - most common away from valve - foramen ovale 2. Mainly paediatric 5. causes left to right shunt, SOB
235
Describe the definition, epidemiology, and clinical features of VSD
1. Most common hole in inter ventricular septum mostly in upper part 2. Paediatric 5. Risk of endocarditis - causes left to right shunting
236
Describe the definition, epidemiology, aetiology, pathogenesis and clinical features of coarctation of the aorta
1. Narrowing of the aorta - birth defect 2. Paediatric and adult 3. Child - allows cardiac output to body via ductus arteriosus Adult - delayed pulse in lower limbs 4. Cyanosis in lower half of body
237
Describe the definition, epidemiology, aetiology, pathogenesis and clinical features of tetralogy of fallot
1. Congenital heart defects affecting normal blood flow 3. Pulmonary stenosis, VSD, right ventricular hypertrophy, displacement of aorta over VSD 5. causes right to left shunting
238
Describe the definition, epidemiology, aetiology, pathogenesis and clinical features of giant cell arteritis
1. Vasculitis of large arteries in head 2. Caucasian women > 50 3. Type 4 hypersensitivity 4. Inflammatory infiltrate narrow vessels - ischaemia 5. Jaw claudication, blindness, flu like symptoms
239
Describe the definition, epidemiology, aetiology, pathogenesis and clinical features of rheumatic fever
1. Complications of strep throat mainly affecting heart especially the mitral valve 2. Children in developing countries 3. Strep A pyrogens 4. Antibody cross reactivity between bacterial M protein and host tissues 5. Mitral stenosis, erythema marginatum sydenhams chorea, arthritis, fever
240
What is the aetiology and diagnosis of infective endocarditis?
Staph aureus + epidermidis, strep viridian's + bovis | Diagnosis - echocardiography + 3 sets of blood cultures at different times
241
What are the 4 cardiomyopathies, epidemiology and their pathogenesis?
``` Dilated - Males 20-50 - Pump failure to empty Hypertrophic - All ages and genders - Pump failure to empty or fill Restrictive - Dependent on cause - Pump failure to fill Arrhythmogenic - Most common in young males - Pump failure to empty ```
242
What are the 6 Ps in Acute Peripheral vascular disease?
1. Pale 2. Pulseless 3. Painful 4. Paralysed 5. Paraesthetic 6. Perishingly cold
243
What are the common bacteria causing bacterial meningitis for <1 month, 1-23 months, 2-50 years and >50 years of age?
<1 month - strep agalicitae, e.coli, listeria monocytogenes 1-23 - strep pneumoniae, neisseria meningitis 2-50 - strep pneumoniae, N . meningitides >50 years - strep pneumoniae, N. meningitis's, listeria monocytogenes
244
What are the common causative agents and presentation for viral meningitis?
Enteroviruses - echo, coxsackie A, B Herpes simplex, varicella zoster Respiratory or intestinal infection - CSF shows raised lymphocyte count
245
What are the bacteria typically causing brain abscesses?
``` Streptococci Staph aureus - most common post surgery Bactericides Pseudomonas E.coli ```
246
What are the 4 phases of rabies infection and their associated symptoms/presentation?
1. Prodromal Phase - fever, nausea, vomiting, headache 2. Furious Phase - agitation, disorientation, seizures 3. Dumb Phase - paralysed, stuporous 4. Coma Phase - death
247
What is the main class of antibiotics to treat meningitis and what bacterial meningitis does it not treat?
Cephalosporins | Does not treat listeria causing meningitis
248
What are the three classifications of meningitis?
Acute pyogenic - usually bacterial Aseptic - usually viral with lymphocytic pleocytosis Chronic - mycobacterium tuberculosis, spirochetes, cryptococcus neoformans
249
What medication is given to suspected meningitis patients prior to antibiotic treatment?
Steroids - dexamethasone | Given for 4 days with pneumococcal meningitis specifically
250
What are the 4 mechanisms of spread of meningitis?
Haematogenous Direct implantation Local extension Along peripheral nerves
251
What is the definition, epidemiology, aetiology, pathogenesis, clinical features and treatment for oral lichen planus?
1. Non infectious inflammatory condition 2. Females 3. Immune 4. Cell mediated immune response 5. Erythmatous, erosive Wickham striae - intercalating what striae Itchy skin 6. Topical steroids
252
What is the definition, epidemiology, aetiology, pathogenesis, clinical features and treatment for epiglottitis?
1. Swelling of the epiglottis 2. Anyone 3. Capsulated form of haemophilus influenzae B 4. Leads to airway obstruction 5. Sore throat, breathing difficulties, dysphagia 6. Intubation, tracheostomy, antibiotics
253
What is the definition, epidemiology, aetiology, pathogenesis, clinical features and treatment for Allergic laryngitis?
1. Inflammation of the larynx 2. Anyone 3. Inhalation of allergens/irritants 4. 5. Sore throat, hoarseness Can lead to obstruction of the larynx 6. Intubation, antibiotics, tracheostomy
254
What is the definition, epidemiology, aetiology, pathogenesis, clinical features and treatment for vocal nodules?
1. Non neoplastic nodules on the vocal cord 2. Singers 3. Voice abuse, smoking, alcohol 4. single or bilateral polyps 5. Hoarseness or change in voice 6. Laser surgery, voice therapy
255
What is the definition, epidemiology, aetiology, pathogenesis, clinical features and treatment for sialadenitis?
1. Salivary gland infection 2. Bacterial uncommon Viral - mumps 3. 4. Stones can cause duct obstruction, atrophy and fibrosis of salivary glands 5. Enlargement, redness and tenderness of glands 6. Antibiotics if bacterial Fluids, massaging of glands Consumption of salivary stimulating foods
256
What is the definition, aetiology, pathogenesis, clinical features and treatment for Ranula?
1. Mucous filled cyst in the mouth 2. Inflammation or trauma to the oral cavity 3. Partial or total excretory duct obstruction 4. Blueish/translucent growth on the floor of the mouth, swelling confined to the sublingual glands 5. Aspiration and drainage
257
What is the definition, epidemiology, aetiology, pathogenesis, clinical features and treatment for Salivary adenoma?
1. Benign tumour of salivary glands 2. 80% in parotid gland 3. Small proportion can become malignant 4. 5. Swelling near jaw/neck Facial numbness, muscle weakness 6. Tend to reoccur Surgical removal
258
What is the definition, epidemiology, aetiology, pathogenesis, clinical features and treatment for oral squamous cell carcinoma?
1. Cancer of the mouth 2. 50 + males 3. Tobacco, alcohol, UV 4. Lower lip, tongue and floor of mouth are most common areas 5. Ulceration, leukoplakia, erythroplakia, pain, dysphagia 6. Surgery + radiation
259
What is the definition, epidemiology, aetiology, pathogenesis, clinical features and treatment for Laryngeal cancer?
1. Cancer of the larynx 2. Males 60+ 3. Smoking, alcohol, asbestos workers 4. Unilateral lesion typically 5. Hoarseness, leukoplakia, erythroplakia or speckled leukoplakia 6. Radiotherapy, laser excision, laryngectomy
260
What is the definition, epidemiology, aetiology, pathogenesis, clinical features for eczema?
1. Irritation of the skin 2. 5% children 3. Family history, associated with asthma + hay fever 4. Type 1 hypersensitivity 5. Hot, red, itchy rash, sometimes vesicles Chronic - leathery skin
261
What is the definition, epidemiology, aetiology, pathogenesis, clinical features of psoriasis?
1. Dermatosis characterised by regular elongation of the rate ridges 2. 1-2% of the population 3. Genetic and environmental 4. Massive cell turnover, possibly autoimmune, trigger factor leading to dysfunctional immune reaction 5. Red oval plaques on extensor surfaces - fine silvery scale
262
What is the definition, epidemiology, aetiology, pathogenesis, clinical features of lichen planus?
1. Inflammation of the skin 2. Adults 3. Viral hepatitis, HIV, drugs association 4. Type 4 hypersensitivity 5. Shiny raised purple-red blotches Bald patches on scalp
263
What is the definition, epidemiology, aetiology, pathogenesis, clinical features of Lupus erythematous?
1. Autoimmune disease affecting tissues of the body 2. 3. Discoid - skin association only Systemic - visceral disease +/- skin involvement 4. 5. Red scalp patches on sun exposed skin +/- scalp involvement
264
What is the epidemiology and clinical features of dermatomyositis?
25% associated with underlying visceral cancer | - Heliocotropic rash + proximal muscle weakness
265
What is the definition, epidemiology, aetiology, pathogenesis, clinical features of pemphigus?
1. Autoimmune skin condition causing blisters on the skin 2. 3. Immunoglobulin deposition 4. Autoantibodies directed against intercellular material 5. Fragile blisters which rupture easily
266
What is the definition and clinical features of bullous pemphigoid?
Sub epidermal blisters under the skin
267
What is the definition, epidemiology, aetiology, pathogenesis, clinical features of dermatitis herpetiformis?
1. Itchy blistering skin due to gluten intolerance 2. Coeliac disease 3. 4. IgA deposition in dermal papillae 5. Small itchy blisters on extensor surfaces
268
What is the definition, epidemiology, aetiology, pathogenesis, clinical features of basal cell carcinoma?
1. Commonest malignant skin tumour 2. 3. Sun exposure 4. Likely to spread along nerves 5. Nodule to ulcers Locally destructive
269
What is the definition, epidemiology, aetiology, pathogenesis, clinical features of squamous cell carcinoma?
1. Skin cancer 2. Immunosuppressed at higher risk 3. UV exposure, chronic scars and ulcers 4. Pre cursor lesion - actinic keratosis 5. Nodule with ulcerated crusted surface
270
What is the definition, epidemiology, aetiology, pathogenesis, clinical features of Melanoma?
1. Nodular, Lentigo maligna and acral lentiginous 2. Lentigo - elderly 3. P16 encoding gene mutation , BRAF gene mutation in 60% 4. 5. Nodular - pigmented nodule +/- ulceration highly invasive Lentigo - flat pigmented Acral lentiginous - Palms of hands, feet and under nails
271
What is the definition, epidemiology, aetiology, pathogenesis, clinical features of systematic sclerosis?
1. Multi system disease with skin and raynauds 2. Females 30-50 3. Exposure to vinyl chloride, silica dust 4. Wide spread vascular damage involving small arteries 5. Raynaud's, beak like nose and small mouth, spider veins
272
What is the definition, epidemiology, aetiology, pathogenesis, clinical features of Polymyalgia rheumatica?
1. Muscle weakness and fatigue Large vessel vasculitis 2. 50 + Females 3. 4. Unknown 5. Stiffness in shoulders, lumbar spine and neck Fatigue, weight loss and fever
273
What is the definition, epidemiology, aetiology, pathogenesis, clinical features of Muscular dystrophy?
1. Muscle weakness 2. Begins in childhood 3. Genetic 23rd or X chromosome for protein dystrophin 4. 5. Progressive muscle weakness and wasting
274
What is the definition, epidemiology, aetiology, pathogenesis, clinical features of Rhabdomyolysis?
1. Destruction of skeletal muscles 2. Mainly adults - drug users 3. Trauma, crush injury, drugs, extreme temperature 4. 5. Acute renal failure - complication Muscle cramps, dark brown urine
275
What is the definition, epidemiology, aetiology, pathogenesis, clinical features of osteoarthritis?
1. Common joint disease - degenerative 2. Increases with age 3. Obesity can have a significant factor 4. Erosion of articular cartilage 5. Bony spurs, cysts in margins of joints Knees and hands in women, hips in men
276
What is the definition, epidemiology, aetiology, pathogenesis, clinical features and treatment of rheumatoid arthritis?
1. Autoimmune inflammatory arthritis 2. 30-50 years - females 3. genetic factors HLA-DR4 & HLA-DRB1 4. Synovial disease, overproduction of TNF-alpha leading to joint destruction 5. Swollen painful and stiff joints, neuropathies, subcutaneous nodules 6. NSAIDs, DMARDs, corticosteroids
277
What is the definition, epidemiology, aetiology, pathogenesis, clinical features and treatment of gout?
1. Inflammatory arthritis associated with hyperuricaemia and intra articular monosodium rate crystals 2. Common adult males 3. Alcohol intake, diet, family history 4. Purines broken into uric acid but excretion via kidneys is not efficient 5. Hyperuricaemia, pain, swelling and redness in joints 6. Weight management, anti-inflammatory meds Uloric and zyloprim as preventatives
278
What is the definition, epidemiology, aetiology, pathogenesis, clinical features and treatment of pyogenic osteomyelitis?
1. Bone marrow inflammation 2. Children 3. Staph A and coagulase negative staph 4. Pathogen into bone in many routes, direct inoculation, contiguous spread, haematogenous seeding 5. Dull pain at site, fever, sweats, rigors and malaise, swelling 6. Antimicrobial therapy
279
What is the definition, epidemiology, aetiology, pathogenesis, clinical features and treatment of osteoporosis?
1. Skeletal disease - low bone mass and micro architectural deterioration of bone tissues 2. Over 50s, Females 3. Family history 4. Increased bone breakdown 5. Fractures 6. Bisphosphonates
280
What is the definition, epidemiology, aetiology, pathogenesis, clinical features and treatment of Paget's disease?
1. Focal disorder of bone remodelling 2. Incidence increases with age - rare under 40 - females 3. Latent viral infection, family history 4. Increases osteoclastic bone resorption 5. Pelvis, lumbar spine, femur, thoracic spine, skull and tibia Bone and joint pain, deformities, neurological complications 6. Bisphosphonates + NSAIDs
281
What is the definition, epidemiology, aetiology, pathogenesis, clinical features and treatment of Osteomalacia?
1. Poor bone mineralisation due to lack of Ca2+ 2. Vitamin deficiency 3. Hypophosphatemia due to hyperparathyroidism, vitamin D and Ca2+ deficiency 4. 5. Muscle weakness, waddling gait, widespread bone pain 6. Vitamin replacement
282
What is the definition, epidemiology, aetiology, pathogenesis, clinical features of osteosarcoma?
1. Most common primary bone cancer 2. Paget's disease association 15-19 years 3. 4. Metaphysis of long bones, knees and proximal humerus 5. Painless tumour, rapid metastasis to lung
283
What is the definition, epidemiology, aetiology, pathogenesis, clinical features of chondrosarcoma?
1. Cancer of cartilage 2. common adult non sarcoma 3. 4. Pelvis, femur, humerus, scapula and ribs 5. Dull deep pain in affected area - swollen and tender
284
What is the definition, epidemiology, aetiology, pathogenesis, clinical features of Ewing's sarcoma?
1. Very rare bone cancer 2. 15 years 3. 4. Mesenchymal stem cells 5. Massive swelling commonly in long bones of arms, legs, pelvis and chest Weight loss, fever, paralysis, incontinence
285
What is the definition, aetiology, pathogenesis, clinical features and treatment of viral warts?
1. Small asymptomatic growths of skin 2. HPV 3. Cause proliferation and thickening of the stratum corneum, granulosum and spinousum 4. Asymptomatic mechanical cervical cancer 5. Topical - salicylic acid, silver nitrate, cryosurgery
286
What is the definition, aetiology, pathogenesis, clinical features and treatment of pilonidal abscess?
1. Cysts or abscesses in natal cleft 2. Ingrown hair 3. Discharge to form sinus 4. Pain, swelling and pus 5. Hot compress, analgesia, antibiotics, surgical excision
287
What is the definition, aetiology, pathogenesis, clinical features and treatment of impetigo?
1. Crusting around nares or corners of mouth 2. Superficial skin - staph A 3. 4. Itchy sores that break open and leak clear fluid or pus 5. Topical antiseptics, oral antibiotics
288
What is the definition, aetiology, pathogenesis, clinical features and treatment of cellulitis?
1. Infection affecting the inner layers of the skin 2. bacterial - staph A, group A strep, B haemolytic strep 3. Bugs enter through breaks in the skin 4. Rubor, calor, dollar, tumour, loss of skin creases, blistering, pus exudate and fever 5. Elevation, rest, antibiotics, pus drainage
289
What is the definition, aetiology, pathogenesis, clinical features and treatment of orbital cellulitis?
1. Infection of soft tissue around and behind the eye 2. Bacterial - staph A, group A strep 3. From skin or sinuses or haematogenous or trauma 4. Erythema, swelling 5. IV antibiotics
290
What is the definition, aetiology, pathogenesis, clinical features and treatment of necrotising fasciitis?
1. Flesh eating bacteria 2. Type 1 - synergistic, host impairment gram negatives - obese, immune suppressed Type 2 - Group A strep - young 3. 1 ischaemic tissue colonisation then infection 2 - infection toxin release disruption in blood supply 4. Swelling, erythema, pain, crepitus, sepsis, necrosis 5. Surgical debridement, antibiotics
291
What is the definition, aetiology, pathogenesis, clinical features and treatment of gangrene?
1. Necrosis caused by inadequate blood supply 2. Atherosclerosis, smoking, autoimmune 3. Poor blood flow leading to tissue necrosis 4. Dry - auto amputate Wet - boggy, swollen, exudate Gas - crepitus 5. Surgical - source control, revascularisation, antibiotics
292
What is the definition, aetiology, pathogenesis, clinical features and treatment of diabetic foot infections?
1. 2. Staph aureus, streps, corneybacterium 3. Damage to blood vessels, ischaemia, impaired immunity and poor wound healing 4. Holes in feet 5. Surgical debridement, revascularisation, antibiotics
293
What is the definition, aetiology, pathogenesis, clinical features and treatment of septic arthritis?
1. Infection of the joint 2. S aureus, streps, haemophilus 3. Haematogenous spread, local spread or penetrating 4. Pain swelling, erythema, reduced movement, sepsis 5. Antibiotics, surgical source control - joint washout
294
What is the definition, aetiology, pathogenesis, clinical features and treatment of prosthetic joint infection?
1. Infection of tissue and bone 2. Staph A, epidermidis 3. Bugs get into surface of foreign body and immune system cannot establish biofilm 4. Pain, instability, swelling, erythema 5. Antibiotics, debridement
295
What is the definition, aetiology, pathogenesis, clinical features and treatment of syphilis?
1. STI 2. Spirochete, treponema palladium 3. Primary, secondary tertiary 4. 1 - painless firm non itchy ulcer - 3-6 weeks 2 - maculopapulae 4-10 weeks 3 - large inflammatory swellings, gummatous, chronic gummas 3-15 years 5. Antibiotics - penicillin
296
Describe liver adenomas
Benign proliferation of liver cells May be multiple - Driven by exogenous steroids, oral contraception
297
Describe adenomas of the bile duct
Von Meyenberg complex Benign proliferation of bile duct cells Tiny white nodules
298
Describe Cholangiocarcinoma
Malignant tumour of bile duct cells - may be due to chronic inflammation - primary sclerosis cholangitis, liver fluke Can be central/hilar or peripheral
299
Describe hepatocellular carcinoma
Arise in cirrhosis Increasing incidence worldwide Composed of malignant liver cells Secrete AFP which can be used as a tumour marker
300
What are the aetiology, risk factors, clinical features and complications of gallstones?
Aetiology - cholesterol, bile salts, bacterial growth and calcification Risk - female, middle aged and overweight Clinical Features - 80% asymptomatic Cramy pain - biliary colic Complications - obstruction at neck or common bile duct - Chronic cholecystitis - Perforation - Obstruction at pancreatic level
301
What is peutz-jeghers syndrome?
Autosomal dominant condition STK11 gene chromosome 19 - Present clinically in teens or 20s with abdominal pain, GI bleeding and anaemia - Multiple gastric polyps - Mucocutaneous pigmentation
302
What are the definition, epidemiology, aetiology, pathogenesis and clinical features of oesophagitis?
1. Inflammation of the oesophagus 2. More common in hiatus hernia 3. Infectious and chemical 4. Basal cell hyperplasia 5. Ulceration, haemorrhage, perforation, Barretts oesophagus
303
What are the definition, epidemiology, aetiology, barrett's oesophagus?
1. Premalignant condition with an increased risk of developing adenocarcinoma 2. Obesity 3. Longstanding gastro-oesophageal reflux 4. Squamous lining replaced with columnar mucosa 5. Longterm indigestion and heart burn
304
What are the definition, epidemiology, aetiology, pathogenesis and clinical features of oesophageal cancer?
1. Cancer of the oesophagus 2. 8th most common cancer - more common in males, obese, caucasian 3. Squamous cell - more common in eastern population - tobacco, HPV, thermal injury Adenocarcinoma - seen more in Barrett's oesophagus
305
What are the definition, epidemiology, aetiology, pathogenesis and clinical features of acute gastritis?
1. Inflammation of the stomach lining 2. 3. Chemical injury - NSAIDs or alcohol Helicobacter pylori 4. 5. Effects dependent on severity - can form erosions and haemorrhage
306
What are the definition, epidemiology, aetiology, pathogenesis and clinical features of chronic gastritis?
1. Recurring gastritis 2. 3. Autoimmune, bacterial, chemical 4. Risk factor for gastric neoplasia 5. Nausea, heart burn, vomiting
307
What are the definition, epidemiology, aetiology, pathogenesis and clinical features of peptic ulceration?
1. Localised defect extending at least into submucosa 2. Gastric - increases with age - lesser curvature of stomach, antrum Duodenal - increases up to 35 - more common than gastric -= bulbus 3. Helicobacter pylori, hyperacidity, NSAIDs 4. First part of duodenum, junction of antral body mucosa, distal oesophagus 5. Haemorrhage, perforation, penetration into adjacent organ, stricturing
308
What are the definition, epidemiology, aetiology, pathogenesis and clinical features of Gastric carcinoma?
1. Cancer of the stomach 2. 5th common cancer in the world 3. Diet, H.Pylori, bile reflux, hereditary GOJ- white mass Body/antrum - diet association, high salt, low fruits+veg 4. Intestinal type - Well or moderately differentiated Diffuse Type - poorly differentiated, scattered growth - cadherin loss/mutation Adenocarcinoma 5. Pain
309
What are the definition, epidemiology, aetiology, pathogenesis and clinical features of coeliac disease?
1. Gluten sensitivity 2. 30-60 years 3. Immune mediated, associated with dermatitis herpetiformis - 10% of patients 4. Reaction to gliadin, increased CD8+ intraepithelial lymphocytes 5. Diarrhoea, abdominal pain, steatorrhoea, bloating
310
What are the definition, epidemiology, aetiology, pathogenesis and clinical features of diverticular disease?
1. Protrusions of mucosa and submucosa through the bowel wall 2. Relationship with fibre content of diet 3. Mesenteric and anti mesenteric Tania coli -commonly sigmoid colon 4. Increases intra- luminal pressure 5. 90% asymptomatic Cramping/abdominal pain Alternating constipation/diarrhoea
311
What are the definition, epidemiology, aetiology, pathogenesis and clinical features of ulcerative colitis?
1. Inflammation of colon 2. 20-40, increased incidence in urban areas, smoking, oral contraception, X8 familial clustering 3. Mucosal Inflammation occasionally transmural 4. Acute - infective campylobacter, shigella, drug induced, antibiotic associated Chronic - idiopathic inflammatory bowel disease 5. Diarrhoea, constipation, rectal bleeding, pain
312
What are the epidemiology, aetiology, pathogenesis, clinical features and complications of crohns disease?
2. 20-40, females, smokers 3. 30-55% ileocolic 25-35% small bowel 15-25% colonic 4. 5. Chronic relapsing disease, pain, weight loss, Complications - toxic megacolon, perforation, fistula, short bowel
313
What are the definition, epidemiology, aetiology, pathogenesis and clinical features of ischaemic bowel disease?
1. Colonic injury secondary to an acute or chronic reduction in blood flow 2. Vascular disease association 3. Occlusive or non-occlusive 3 forms a. Transient b. Chronic segmental ulcerating c. Acute fulminant and gangrenous 4. Arterial embolism, arterial thrombus 5. Cramping, abdominal pain, urge to defecate, rectal bleeding
314
What are the definition, epidemiology, aetiology, pathogenesis and clinical features of colorectal polyps?
1. Mucosa protrusion 2. 3. Pedunculated, sessile, neoplastic, haemartomatous, inflammatory or reactive 4. Hyperplastic - 1-5mm found in rectum and sigmoid colon 5. No specific symptoms
315
What are the definition, epidemiology, aetiology, pathogenesis and clinical features of colorectal cancer?
1. Cancer of the colon/rectum 2. 2/3rd commonest cancer diet, obesity, alcohol, NSAIDs 3. Familial adenomatous polyposis, Lynch syndrome 4. Adenocarcinoma, spread - lymph 5. Change in bowel habits, diarrhoea, constipation, PR bleeding, pain
316
What are the definition, epidemiology, aetiology, pathogenesis and clinical features of acute pancreatitis?
1. Gland reverts to normal if underlying cause is removed 2. Alcohol 3. Gallstones 50%, idiopathic Hereditary PRSS1, SPINK 1 gene 4. Leakage and activation of pancreatic enzymes 5. Severe abdominal pain, nausea and vomiting, raised serum amylase/lipase MEDICAL EMERGENCY
317
What are the definition, epidemiology, aetiology, pathogenesis and clinical features of chronic pancreatitis?
1. Irreversible loss of the pancreatic tissue - destruction of the exocrine tissue followed by destruction of the endocrine 3. Toxic- alcohol, cigarette smoke, drugs Genetic - GFTR, PRSS 1, SPINK 1, Autoimmune 4. Ductal obstruction 5. Abdominal pain, weight loss, diabetes
318
What are the definition, epidemiology, aetiology, pathogenesis and clinical features of pancreatic adenocarcinoma?
1. 2. 60-80 years, rare below 40 smoking, family history, alcohol, nutritional and dietary factors 3. 60-70% head of pancreas, 5-15% body, 10-15% tail 5. Non specific symptoms Courvoisier's sign - palpable gallbladder without pain
319
What are the definition, epidemiology, aetiology, pathogenesis and clinical features of pancreatic neuroendocrine tumours?
1. Rare pancreatic neoplasms 2. 20-60, smoking, family history of cancer, alcohol, obesity 3. Islet cell derived can either be malignant or benign 4. MEN1, NF-1, VHL genes 5. Dependent on cells in neoplasm Insulinoma - hypoglycaemia Glucagonoma - stomatitis, rash, diabetes Gastrinoma - peptic ulcer, diarrhoea Somatostatinoma - diabetes, cholelithiasis, hypochorhydria VIPoma - diarrhoea, hypokalaemia, achlorydria
320
What are the definition, aetiology, pathogenesis and clinical features of jaundice?
1. Yellowing of the skin 2. Bilirubin >40 mol/L - commonest sign of liver disease 3. Pre-hepatic - too much bilirubin, haemolytic anaemia - unconjugated Hepatic - too few functioning liver cells - mainly conjugated Post hepatic - bile duct obstruction by stone stricture - conjugated 4. Yellow colour of the whites of eyes and skin
321
What are the definition, aetiology, pathogenesis and clinical features of acute hepatitis?
1. Liver enzymes raised - any cause, acute liver injury caused by something that goes away 2. Damage to hepatocytes inflammatory injury, viral drugs, seronegative 3. Toxic/metabolic injury 4. Asymptomatic, malaise, jaundice, coagulopathy, encephalophathy, death
322
What are the definition, aetiology, pathogenesis and clinical features of Chronic hepatitis?
1. Liver enzymes raised Caused by something that does not go away - balance of damage and attempts repair 2. Immunological injury - virus, autoimmune, drugs Fatty liver disease - alcoholic or non alcoholic Genetic inborn errors - iron, copper, alpha 1 antitrypsin, biliary disease, vascular disease 3. Toxic/metabolic injury 4. Malaise, jaundice, coagulopathy, encephalopathy, death
323
What are the definition, aetiology and clinical features of viral hepatitis?
1. Hepatitis A, B, C 2. EBV, CMV, HSV usually immunocompromised host Same symptoms as for chronic/acute liver hepatitis
324
What is the pathogenesis and clinical features of drug induced liver disease?
Intrinsic - every time the drug is taken - predictable Idiosyncratic - rare, unpredictable, metabolic or immunological Clinical features - hepatocellular damage, cholestatic, mixed liver function tests
325
What are the definition, aetiology, pathogenesis and treatment of inherited haemochromatosis?
1. Inborn errors of iron metabolism - bronzed diabetes 2. Inherited haemochromatosis iron accumulation Liver - cirrhosis Skin - pigmented Pancreas - diabetes Joints - arthritis Heart - cardiomyopathy Treatment - Venesection to deplete iron stores
326
What are the definition, epidemiology, aetiology, and diagnostic test and treatment of Wilsons disease?
1. Inborn error of copper metabolism 2. Younger ages 3. Liver - cirrhosis Eyes - kaiser-fleischer rings Brain - Ataxia 4. Test for caeruloplasmine, urine copper, plasma copper and liver biopsy 5. Chelate copper and enhance excretion - penicillamine
327
What are the definition and aetiology of alpha-1 antitrypsin deficiency?
1. Abnormal anti-protease which cannot be exported from hepatocytes 2. Alpha-1 antitrypsin deficiency - Anti-protease accumulated in the liver cells and injures them - Insufficient in blood failure to inactivate neutrophil enzymes - emphysema
328
What are the definition, pathogenesis, clinical features and treatment of autoimmune liver disease?
1. Autoimmune response to the liver 2. Autoantibodies, raised IgG, ALT, other autoimmune diseases 3. Can cause severe acute liver failure or chronic disease 4. Immune suppression
329
What are the definition, aetiology, pathogenesis and clinical features of liver cirrhosis?
1. Disease affecting the liver characterised by scarring or fibrosis and conversion of the normal liver architecture into structurally abnormal nodules 2. Fewer liver cells, end point of liver disease 3. Pressure inside the lower increases - encircles nodules Liver cell failure - blood bypasses the sinusoids, reticuloendothelial cells vulnerable to infection 4. Portal hypertension
330
What are the definition, pathogenesis and clinical features of hepatic failure ?
1. Acute - rare severe rapid liver injury Chronic - end stage of chronic liver disease 2. Portal hypertension, structural changes, liver cell failure 3. Chronic Ascites Muscle wasting Bruising Gynaecomastia Spider nave Varices
331
What is primary biliary cholangitis - PBC?
- Anti-mitochondrial antibodies - Elevated alkaline phosphatase - Bile duct granulomas at early stage - Ductopenia and cirrhosis
332
What is primary sclerosis cholangitis?
- Associated with ulcerative colitis - high alk phosphate - Pruned tree on biliary imaging - Periductal onion skin fibrosis - Ductopenia and cirrhosis
333
What are the sterile and non sterile sites?
Sterile - peritoneal space, pancreas, gall bladder, liver | Non-Sterile - Mouth, oesophagus, stomach, small and large bowel
334
Give a brief description of Angular cheilitis, oral herpes simplex and oral hairy leukoplakia
Angular Cheilitis - mild infection of the corner of the mouth caused by S.aureus or candida treated with topical anti fungals Oral HSV - cold sores mainly via HSV-1 Oral Hairy Leukoplakia -white lesions on the tongue commonly only seen in HIV, caused by EBV
335
Give a brief description of Periodontal infection, peritonsillar abscess and parotitis
Periodontal infection - infection of the soft tissue surrounding the teeth, can be mild (gingivitis), moderate (periodontitis) and severe (necrotising gingivitis) Peritonsillar Abscess - quinsy, normally caused by streptococcus progenes Parotitis - caused by staph aureus, swelling from cheek to jaw angle which can cause bacteraemia
336
Give a brief description of Mucositis and helicobacter pylori
Mucositis - inflammation of the mucous membrane of the GI tract after chemotherapy - can cause streptococcal bacteraemia Helicobacter Pylori - infects the gastric/duodenal mucosa causing GI symptoms +/- perforation - treatment = triple antibiotic therapy + PPI for 7-14 days
337
Give a brief description of Cholangitis, cholecystitis and liver abscesses
Cholangitis - Infection of the biliary tree mainly caused by coliforms Cholecystitis - infection of the gallbladder mainly caused by coliforms Liver Abscess - bacteria from the colon - streptococcus, anaerobes and coliforms ascend into the liver and cause an abscess - treated with prolonged antibiotics and surgical drainage
338
Describe the metabolic changes after trauma
Phase 1 - Shock - Within 4 hours of trauma - Blood loss, poor blood flow, low oxygen supply Phase 2 - Hypercatabolism 24-48 hours after trauma - Increase in basal metabolic rate - Anaerobic metabolism - Excessive metabolic breakdown of fat and protein - Cytokine storm increases muscle breakdown Phase 3 - anabolic phase 3-8 days after trauma - Macromolecule synthesis - Onset of recovery - Improved appetite
339
What is refeeding syndrome?
Fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding - Moitoring of electrolytes during artificial feeding
340
Describe wernicke-korsakoff syndrome
- Thiamine B1 deficiency - Co factor form transketolase, RDH, alpha-KGDH - Results in mitochondrial damage, cellular necrosis, oxidative stress - Confusion, encephalopathy
341
What are the routine LFTs?
``` Alkaline phosphatase -ALP ALT - alanine aminotransferase Bilirubin Albumin Total protein GGT - gamma glutamyl transferase ```
342
What are the biochemical markers of fibrosis?
ELF score PIINP TIMP-1 Hyaluronic acid
343
What are the blood tests for jaundice?
AST/ALT elevated and normal ALP - 90% have hepatitis | AST/ALT normal and elevated ALP - 90% have obstructive jaundice
344
Describe direct and indirect pancreatic function tests
Direct - Invasive - Intubation to collect aspirates in the duodenum - Sectetin, CCK, Lundh tests Indirect - non-invasive - Pancreatic enzyme analysis in stools elastase - Trypsinogen measured in blood in CF screening - Pancreolauryl and NBT-PBA tests
345
What is the clinical history, aetiology, diagnosis and antimicrobial management of salmonella gastroenteritis?
1. Cramps, diarrhoea, fever, myalgia, nausea, vomiting 2. S.Enteridis - from poultry, birds and some reptiles High infective dose 3. 6-8 hours after eating XLD agar 4. Ciprofloxacin 500mg twice a day for one day
346
What is the clinical history, aetiology, diagnosis and antimicrobial management of shigella gastroenteritis?
1. Watery, bloody, mucoid stool, abdominal pain, fluid and electrolyte loss 2. S. dysenteries, S. flexneri, S. sonnei - from guts of humans, primates and faecal oral route Low infective dose 3. 36-72 hours incubation DCA 4. Ciprofloxacin 500mg twice a day for 1 day
347
What is the clinical history, aetiology, diagnosis and antimicrobial management of campylobacter gastroenteritis?
1. Watery diarrhoea, nausea, vomiting, malaise 2. Heat labile toxin, poultry, birds, faecal oral route 3. Isolate on charcoal agar 2-5 days incubation 4. Erythromycin 250mg-500mg four times a day for 5-7 days
348
What is the clinical history, aetiology, diagnosis and antimicrobial management of Ecoli 0157?
1. Watery diarrhoea then bloody diarrhoea 2. Shiga toxin, cattle and meat 3. MAC agar 2-5 days incubation 4. Do not prescribe antibiotics and avoid anti motility drugs
349
What is the clinical history, aetiology, diagnosis and antimicrobial management of Clostridiodes?
1. Foul smelling, watery diarrhoea, cramps, low grade fever 2. Toxin mediated inflammation, spores aid transmission, antibiotic associated 3. Demonstrating toxin and organism 4. Stop predisposing antibiotic and prescribe vancomycin
350
What are the 4 common viral gastroenteritis's and their incubation periods?
Rotavirus - 5-7 days - children Adenovirus - 5-7 days Norvovirus - 1-2 days Astrovirus - 2-3 days - children

Year 2 Medicine Leeds (4 decks)

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