MISC

Question 1

what 3 main cell types are infected in HIV?

Answer 1

CD4+ T helper cells
macrophages
Dendritic cells

Question 2

where is HIV2 localised to?

Answer 2

west africa

Question 3

how may cases are the approx of HIV worldwide?

Answer 3

40 million

Question 4

what age range is the majority of new HIV infections found in?

Answer 4

15-24 years

Question 5

what are the 3 modes of transmission for HIV?

Answer 5

sexual - most frequent
parenteral - needles
vertical - breastfeeding/vaginal delivery

Question 6

what are 3 risk factors for HIV?

Answer 6

sex worker/frequent intercourse with multiple partners
needle sharing - IVDU
vertical transmission

Question 7

what kind of virus is HIV?

Answer 7

RNA retrovirus

Question 8

what 3 things does the HIV envelope contain?

Answer 8

RNA
capsid
reverse transcriptase

Question 9

what two things does HIV need to bind to in order to get inside the cell?

Answer 9

CD4 receptor

a co-receptor (CXCR4 or CCR5)

Question 10

why are there many strains of HIV virus?

Answer 10

because transcription is error prone

Question 11

what are the 3 phases of HIV infection?

Answer 11

Acute infection
chronic infection (latency)
Late stage HIV/AIDS

Question 12

what kind of symptoms does acute HIV infection cause?

Answer 12

3-6 weeks after infection

flu like illness - fever, malaise, lymphadenopathy, sore throat, maculopapular rash, diarrhoea, ulcers

Question 13

what kind of symptoms does latent HIV cause?

Answer 13

opportunistic infection

Question 14

what is the CD4 count like in AIDS?

Answer 14

<200 mm3

Question 15

what are 4 opportunistic infections in HIV?

Answer 15

oral candida
hairy leukoplakia
shingles
aspergillosis - resp fungal infection

Question 16

how do you diagnose HIV?

Answer 16

HIV antibody and p24 antigen test - if negative repeat at 12 weeks

western blot test

Question 17

what 2 measurements are used to monitor HIV?

Answer 17

CD4 T cell count

viral load

Question 18

what is the management for HIV?

Answer 18

anti-retroviral therapy

2 nucleoside reverse transcriptase inhibitors

Question 19

what is the prophylactic treatment of HIV?

Answer 19

co-trimoxazole - protects agains pneumocystis jirovecii pneumonia in those with AIDS
PrEP

Question 20

what is the most common malignancy in women?

Answer 20

breast cancer

Question 21

what chromosome is BRCA1 on?

Answer 21

chromosome 17

Question 22

what chromosome is BRCA2 on?

Answer 22

chromosome 13

Question 23

what hormone increases risk of breast cancer?

Answer 23

oestrogen

Question 24

what gene mutation causes HER2?

Answer 24

ERBB2 gene mutation

Question 25

no

Answer 25

no

Question 26

what is the most common invasive breast cancer?

Answer 26

invasive ductal carcinoma invasive lobular - 2nd

Question 27

what are the 3 different classes of breast cancer by hormone receptor type?

Answer 27

ER +ve and HER2 -ve HER2 +ve and ER +/-ve ER -ve and HER2 -ve

Question 28

what are 5 manifestations of breast cancer?

Answer 28

lump breast pain skin changes - tethering, oedema, peau d'orange nipple changes - inversion, discharge, dilated veins, Paget's disease of the breast metastatic features - bone pain, fatigue, SOB, confusion

Question 29

between what ages in breast cancer screened for?

Answer 29

50-71

Question 30

what are 3 local complications of radiotherapy?

Answer 30

fibrosis of breast tissue soreness changes in skin tone

Question 31

what chemotherapy is used in HER2 +ve breast cancer?

Answer 31

trastuzumab (Herceptin)

Question 32

what is the first line endocrine therapy given in breast cancer for men and pre-menopausal women?

Answer 32

tamoxifen - oestrogen receptor modulator for ER/PR +ve patients

Question 33

what are 4 complications of tamoxifen?

Answer 33

blood clots endometrial cancer osteoporosis DO NOT GIVE IN PREGNANCY

Question 34

what is the first line endocrine therapy given in breast cancer for post-menopausal women?

Answer 34

aromatase inhibitors. - anastrozole

Question 35

what are 3 side effects of anastrozole?

Answer 35

menopausal symptoms osteoporosis MSK pain

Question 36

what are denosumab and bisphosphonates given for in breast cancer?

Answer 36

to prevent lytic bone lesions and reduce bone pain/fracture

Question 37

what are 4 differentials for breast cancer?

Answer 37

fibroadenoma breast cyst fat necrosis lipoma

Question 38

what are 4 complications of breast cancer?

Answer 38

local inflammation booked lymphatics invasion of tissue metastasis

Question 39

what is amyloidosis?

Answer 39

The disease state caused by abnormal amyloid protein deposits in organs.

Question 40

what are the 2 types of amyloidosis?

Answer 40

systemic and localised

Question 41

what are 5 manifestations of systemic amyloidosis?

Answer 41

``` nephrotic syndromes congestive heart failure and arrhythmia malabsorption peripheral neuropathies spleen, liver or tongue enlargement ```

Question 42

what are 4 localised manifestations of amyloidosis?

Answer 42

alzheimer's familial amyloid cardiomyopathy senile cardiac amyloidosis T2DM

Question 43

what are 2 investigations for amyloidosis?

Answer 43

fat pad biopsy - apple green birefringence under polarised microscopy with Congo red stain SAP scan - about and location of amyloid

Question 44

what is the management of amyloidosis?

Answer 44

organ transplant optimise nutrition alkylating agent + corticosteroid stem cell transplant

Question 45

what is the prognosis for amyloidosis?

Answer 45

1 - 2 year median survival

Question 46

what is lymphadenopathy?

Answer 46

progressive swelling of body parts due to developmental or acquired disruption of lymphatic system resulting in lymph accumulation in the interstitial space

Question 47

where tends to be affected by lymphadenopathy?

Answer 47

legs

Question 48

what can lymphadenopathy lead to?

Answer 48

fibrosis

Question 49

what is the management for lymphadenopathy?

Answer 49

``` massage compression bandages exercises oral diethycarbamazine prophylactic oral phenoxymethylpenicillin ```

Question 50

what percentage of sarcomas are soft tissue?

Answer 50

80%

Question 51

what percentage of sarcomas are bone?

Answer 51

20%

Question 52

what are 5 manifestations of bone sarcoma?

Answer 52

``` non-mechanical bone pain swelling feeling tired pyrexia weight loss ```

Question 53

what are 4 manifestations of soft tissue sarcomas?

Answer 53

lump - painless at first pain and soreness as lump grows spotting and bleeding - leiomyosarcoma in womb metastasis

Question 54

what is Gilick competence?

Answer 54

<16 can give consent if assessed to be competent