Medicine General 02 Flashcards
(27 cards)
Malignant Melanoma Types
- Lentigo maligna melanoma: arises from chronically sun exposed skin
- Superficial spreading MM
- Nodular MM
- Acral-lentiginous MM: arising from palm, soles & nail beds
- Ocular MM
- Mucosal MM
< 30% from pre-existing nevus
ABCDE rule for melanoma evaluation
A - asymmetric
B - borders are irregular
C - color variegation
D - diameter > 6 mm
E - evolution ie changing appearance, growing in size
Black box warning
Topical Tacrolimus & Pimecrolimus
Can cause T cell lymphoma and should be sparingly used.
Risk is more in those with HIV, iatrogenic immunosuppressive Rx, past lymphoma etc.
Inherited platelet function disorders
- Glanzman’s disease (GPIIb/IIIa deficiency)
- Bernard Soulier disease (GP deficiency)
- Chediak Higashi syndrome (abnormal platelet granules)
- Grey platelet syndrome (Alfa granule deficiency)
- Storage pool disease
- Secretion defect
Thrombocytopenia - low production
Myelosuppression:
- viral infections
- drugs, alcohol
- infiltration/failure/fibrosis
ITP, 1/3 rd of cases
B12 or folate deficiency
Inherited disorders
Thrombocytopenia- increased destruction/ consumption
Immune:
- Idiopathic, ITP
- drug induced
- SLE
- HIV related
Non Immune:
- massive transfusion
- Hypersplenism
- DIC, TTP
Koebner phenomenon
Psoriatic changes occurs at the site of skin trauma for example at a simple scratch which turns into a plaque like changes.
Obesity worsened psoriasis and good weight loss improves it.
Inverse psoriasis
Psoriasis changes only at the flexures like axilla, groin or popliteal fossa is termed inverse psoriasis( regular one favors extensor surfaces)
Nail pitting, onycholysis, koebner phenomenon seen in both.
Flare triggers - beta blockers, anti malarials, Statins, Lithium.
Causes of Lung haemorrhage and renal failure both together
- Goodpasture syndrome
- GPA (Wegner’s granulomatosis)
- Microscopic polyarteritis
- SLE
- Leptospirosis
Causes of renal failure alone due to vasculitis (without lung involvement)
- Anti GBM disease
- Small vessel vasculitis
- Secondary vasculitis
- Medium vessel vasculitis
Medications which can induce Cutaneous SLE
Subacute Cutaneous Lupus:
Anti Ro/SSA +ve
- Hydrochlorothiazide
- Calcium Channel blockers
- H2 blockers
- proton pump inhibitors
- ACE inhibitors
- TNF inhibitors
- Terbinafine
Patterns of anti-nuclear cytoplasmic antibody (ANCA) vasculitis
c-ANCA: anti neutrophil Alfa-proteinase (PR-3)
- GPA
- Microscopic polyangitis
P-ANCA: anti-myeloperoxidase MPO
- Microscopic polyangitis
- EGPA (churg-Strauss)
atypical ANCA
- UC
- sclerosing cholangitis
Myogenic Hyperuricemia
Myogenic hyperuricemia, as a result of the purine nucleotide cycle running when ATP reservoirs in muscle cells are low, is a common pathophysiologic feature of glycogenoses, such as GSD-III, which is a metabolic myopathy impairing the ability of ATP (energy) production for muscle cells. In these metabolic myopathies, myogenic hyperuricemia is exercise-induced; inosine, hypoxanthine and uric acid increase in plasma after exercise and decrease over hours with rest. Excess AMP (adenosine monophosphate) is converted into uric acid.
Porphyria cutanea tarra
Genetic,
Triggers: Estrogens, ALD, Hemochromatosis, Hepatitis C
Lesions -
= on dorsum of hand macular rash, painless on exposure to sunlight
= facial hypertrichosis
= facial hyperpigmentation
Lab test -
Urinary porphyrins
Liver function tests
Hepatitis C serology
Hemochromatosis work up
Treatment: barrier sun protection with clothing and sun screens. Wavelength of triggering light is beyond that absorbed by sunscreens SO THEY MAYNOT HELP.
Pseudo porphyria
Similar lesions on dorsum of hand on sun exposure, specially when taking medications like:
- Tetracycline
- NSAIDs: Naproxen
- Voriconazole
Histopathology of lesions same as porphyria but urinary porphyrins normal
Vasculitis presentation features
Arthralgia
Fever of unknown origin
Weight loss, malaise, fatigue
Rashes: purpura, splinter haemorrhages, nail fold infarcts, lived o reticularis, nodules
Lung disease: Haemoptysis, cough, SOB, pulmonary infiltrates
Renal: hematuria, proteinuria, new HTN, AKI
Neurological: mononeuritis multiplex, sensorimotor polyneuropathy, confusion, seizures, hemiplegia, cerebral syndrome
Primary systemic vasculitis
Large arteries: GCA, Takayasu
Medium arteries: PAN, Kawasaki
Small & Medium arteries:
EGPA(church-Strauss), GPA (Werner’s), Microscopic polyangitis
Small vessel: HSP, Hypersensitivity vasculitis
Secondary systemic vasculitis
Large arteries: aortitis secondary to RA or syphilis
Medium arteries: infectious e.g. HBV
Small & Large arteries: vasculitis secondary to RA, SLE, systemic sclerosis, drugs or HIV
**Small vessel vasculitis: drug’s, HCV, HBV
Causes of secondary Vasculitis
Infective endocarditis
Malignancy
Rheumatoid arthritis
Systemic lupus
Cryoglobulinemia, HCV associated
Drug reaction
Hirsutism
Excessive androgen levels or activity
- Polycystic ovarian syndrome
- Cushing’s syndrome
- Congenital adrenal hyperplasia
- Acromegaly
- Virilizing tumours
Causes of proximal Upper/Lower girdle stiffness or pain (proximal myopathy)
- Cervical spondylitis +_ adhesive capsulitis: CRP, ESR normal, CK normal
- Lumbar spondylitis
- Osteomalacia
- Fibromyalgia
- Hypothyroidism: CK high, ESR normal, CRP normal
- Polymyositis/ Dermatomyositis: acute phase reactants ++ CK elevated, look for neoplasms
- Inflammatory arthritis: acute phase reactants +
Cushing syndrome causes
high ACTH production from a pituitary adenoma and
ectopic ACTH (e.g. small cell lung cancer).
Primary hypercortisolaemia caused by adrenal hyperplasia,
adrenal tumour
(adenoma or carcinoma),
exogenous steroids;
ectopic CRF
production (very rare),
depression,
alcohol-induced.
When to screen Genetics in Ca Breast
if Family history of:
- Bilateral breast cancer
- Male breast cancer
- Ovarian cancer
- Jewish ancestry
- Sarcoma in a relative younger than age 45
- Glioma or childhood adrenocortical carcinomas
- Complicated patterns of multiple cancers at a young age
- Paternal history of breast cancer (2 or more relatives on the father’s side of the family.
AJCC or TNM tumor classification
T1 = 20 mm or less in diameter
T2 = 20-50 mm in diameter
T3 = at least 50 mm or more
N0 = no nodal involvement
N1 = nodal involvement
M0 = no distant metastasis
M1 = distant metastasis present
