Misc Flashcards by francois prinsloo

Sarcoma:

Def
Types
Pres

Cancer of connective tissue

Liposarcoma
Leimyosarcoma
Kaposi’s

Soft tissue swelling and pain

How well did you know this?

Not at all

Perfectly

Gell and Coombs, 4 types of hypersensitivity

ABCD

Type 1
- Allergy: IgE, anaphylaxis. Minute

Type 2
- antiBody (IgG/IgM), hours (ITP or haemolysis due to ABO)

Type 3
- immune Complex: soluble antigen/antibody complexes (IgG, IgM). Days, Lupus, post-strep glomerulonephritis

Type 4
- Delayed. E.g. Graft versus host disease

How well did you know this?

Not at all

Perfectly

Sarcoma familial syndromes

Neurofibromatosis 1

Retinoblastoma mutation (osteosarcoma)

How well did you know this?

Not at all

Perfectly

Angiosarcoma:

Pres
Prog

Long term bruising at breast

Highly aggro, mets to bone/lung

How well did you know this?

Not at all

Perfectly

Ewings sarcoma:

Who
Location

Bone sarcoma in young males

Pelvis/Femur

How well did you know this?

Not at all

Perfectly

Sarcoma investigations

CT/MRI primary tumour

Heterogenous mass
Central necrosis
CT chest = pulmonary mets

HIV test (Kaposi’s)

Biopsy (type and grade)

Genetic testing (NF1, RB)

How well did you know this?

Not at all

Perfectly

Sarcoma Tx

Excision
Radiotherapy (Pre-op, adjuvant)
Chemo (not very chemosensitive)

How well did you know this?

Not at all

Perfectly

Sarcoidosis

- Pres

SOB, cough, Erythema nodosum

Bilateral Hilar lymphandenopathy
Pulmonary infiltrates

How well did you know this?

Not at all

Perfectly

What is Sarcoidosis

Chronic granulomatous (non-caseating) disorder characterised by accumulation of lymphocytes and macrophages in lung and other organs (any)

How well did you know this?

Not at all

Perfectly

Sarcoidosis Organ system effects

Pulmonary

Bilateral hilar lymphadenopathy
Pulmonary infiltrates
Extensive fibrosis

Cutaneous

Plaques
Lupus pernio (raised, purple lesion)
Erythema nodosum

Eyes
- Anterior Uveitis

Cardia
- Heart block (fibrosis of AV node)

Neurosarcoid

Headaches
Seizures

Joints:
- Arthralgia

How well did you know this?

Not at all

Perfectly

Sarcoidosis RF

20-40 yrs old
Fix Sarcoid
Non-Smoker

How well did you know this?

Not at all

Perfectly

Sarcoidosis Pres

Lung symptoms
Cough (non-prod), dyspnoea, wheezing, rhonchi (airway hyperreactivity),

LNs
Lymphadenopathy: enlarged and non-tender, cervical and submandibular

Eye symptoms
Photophobia, red painful eye and blurred vision suggestive of uveitis, + conjunctival nodules

Skin symptoms
Erythema nodosum, lupus pernio

Joint symptoms
Arthralgia and chronic fatigue

How well did you know this?

Not at all

Perfectly

Sarcoidosis Investigations

CXR: Bilateral hilar lymphadenopathy, upper zone infiltrates, pleural effusions

LuFT: restrictive, Obstructive or mixed (Nodules can obstruct, fibrosis = restrictive)

ECG: heart block

U&E: renal involve
LFT: Liver involve
Serum Ca: Granulomas have activated MP with disregulated Calcitriol prod (Hypercalcaemia)

Skin biopsy: Non-Caveating granulomas

How well did you know this?

Not at all

Perfectly

Sarcoidosis management

SE of Tx

Lung:

Oral/inhaled corticosteroids (prednisolone)
stage 2: MTX/azathioprine ±O2

Cutaneous/opthalmic
- Topical corticosteroids

CNS
- Oral corticosteroid

Osteoporosis, LFT for cytotoxic

How well did you know this?

Not at all

Perfectly

Amyloidosis

Def
Presentation
Ix

Amyloid tissue deposition

Unexplained weight loss, fatigue, oedema resistant to diuretics

Serum and urine monoclonal light chains

How well did you know this?

Not at all

Perfectly

Amyloidosis causes

Primary (immunoglobulin light chain amyloidosis)
NOTE: similar to multiple myeloma but less Plasma cells in BM

Secondary: seen in inflammatory arthropathy (RA, psoriatic, juvenile, Anky spondylitis
IBD

How well did you know this?

Not at all

Perfectly

Pathology of Amyloidosis

Misfolding of alpha helix to from beta pleated sheets

How well did you know this?

Not at all

Perfectly

Organs affected by amyloidosis

Kidney (Primary target)
- Monoclonal light chain disrupt basement membrane

Cardiac - Restrictie cardiomyopathy, conduction defects

Periorbital purpura

How well did you know this?

Not at all

Perfectly

Amyloidosis presentation

Oedema (esp lower extremity)
Periorbital purpura
Fatigue/weight loss
Carpal tuneless

Complications Amyloidosis

Chronic renal failure
Progressive cardiomyopathy

Tx with myeloablative high dose chemo

Lymphoedema

Def
Loc
Cause
Mech

Progressiv swelling of tissue with protein rich fluid. due to disruption of lymphatic system

Extremities

Nematode infection, malignancy and Ca Tx

Mechanisms of oedema

Inflammatory
Lymphatic
Hypoalbuminaemia
Venous oedema

Inflammatory
- Inc vascular permeability

Lymphatic
- Obstruction of lymphatic drainage

Hypoalbuminaemia
- Decreased oncotic pressure e.g. liver failure (dec synth), nephrotic syndrome

Venous oedema
- Inc venous pressure (e.g. HF, venous obstruction)

Fluid drainage by lymph

Fluid leaves capillaries and drains to adjacent lymph channels
Fluid returns to circulation via thoracic duct at Left subclav

Oedema treatment

General: skin care, compression bandage, elevation, exercise, weight loss

Filariasis: diethylcarbamazine

Breast cancer - RF - Mets - Symptoms

Constitutional - Age, female, obesity, benign breast disease Oestrogen - Uninterupted oestrogen: no breast feed, no children - Prolonged endogenous: early menarche, late menopause Alcohol FH ovarian/breast Ca - BRCA1: risk 80% - BRCA2: risk 40% Liver, bone, lung, brain 4 main symptoms - Lump (painless_ - Discharge - Skin tethering/nipple inversion - Skin changes (pea d'orange, pagets)

Types of Breast Ca

``` Ductal carcinoma (70%) Lobular Ca (10%) - normally bilateral - better prognosis Mucinous Medullary ```

Aim of Breast Ca screening How often & what method

Detect DCIS From 47-73 (3 yearly) Using mammography

Ovarian cancer & Breast Ca mutation

BRCA 1 (40%), 2 (15%)

Breast cancer Receptors, Prognosis and Tx

ER +ve (good prognosis due to Tx) - Oestrogen stimulated growth - Tamoxifen ER blocker - Anastrozole aromatase inhib Her-2 (poor prognosis) - Trastuzumab/herceptin to EGFR (Her-2) Ki67: poor prognosis. Marker of proliferation Triple negative: Poor prognosis as no Tx

Breast triple investigation

Clinical Examination Histological/Cytology - FNA (cytology - differentiate benign from malignant) - Core biopsy (histology - differentiate DC from DCIS) Radiology - Mammography (Microcalcification = DCIS, speculated mass = carcinoma) - USS (cystic Vs colic) Other: LFT (mets), Ca and bone scan, Receptors (ER, Progesterone, Her-2)

Indications for mammography

Screening Lump in over 40 Blood stained discharge LCIS (annual until 50) CI: no lump, under 40 (triple test with USS instead)

Breast Ca staging

1) mobile and confined to breasr 2) Breast + ipsilateral axilla 3) Over 5cm, Skin/chest wall fixation 4) contralateral Los mets (Brain, bone, Liver, lung) = Inoperable

Breast Ca surgical Tx

Mastectomy (if over 20% breast volume, multifocal, central) Lumpectomy (under 20% volume, unifocal, peripheral) Axillary clearance indicated if +ve SLN ± reconstruction

Radiotherapy in Breast Ca - Who - SE - Why

With lumpectomy, palliates inoperable Pneumonitis Decrease disease recurrence

Chemo in Breast Ca - How is used Hormone therapy

Adjuvant Tamoxifen (premenopausal) - SE: affects endometrium (RF for Ca), thrombotic Aromatase inhib (Anastrazole) - stop peripheral androgen -> oestrogen conversion - Risk of osteoporosis (DEXA, Ca, Vit D, Bisphosphonates) Herceptin (Trastuzumab

DCIS - Progression - Tx

50% progress to Ca in 5-10 years Wide local excision

Breast discharge - When worrying - Duct papilloma - Duct ectasia

Persistent, Unilateral, Bloody Papilloma: This is benign warty growth: Bloody/clear discharge Ectasia: clogged lactiferous duct. Yellow/green/thick discharge

Treatment of Breast infection (lactational or abscess)

Flucloxacillin + Metronidazole in abscess

Middle age woman with lumpy, painful breasts at menstruation Woman around menopause with tender lump and green discharge Bloody discharge, local area of epithelial proliferation in large mammary duct (hyperplastic) Obese woman with trauma to breast. Initially firm and round but turns hard and irregular Lactating woman with red, hot, tender breast

Fibroadenosis Mammary duct ectasia Duct papilloma Fat necrosis Abscess

Mononucleosis - Pres - Causes - Diagnosis - Complications

Fever, pharyngitis, lymphadenopathy, hepatosplenomegaly EBV (80%), CMV Positive monospot test Splenic rupture, fulminant hepatitis, haemolytic anemia, thrombocytopenia

Mononucleosis - Transmission - Pathology

Saliva (kissing) DNA virus with affinity for B-cells (esp in tonsils) B-lymphocytes spread to Liver, spleen, LNs

Mononucleosis IX

Heterophil antibody test +ve - patient blood (with IgM to EBV) react positively to Sheep/horse blood - Causes agglutination (clumping) EBV antibody test PVR EBV DNA

EBV Tx

DO NOT GIVE AMP/AMOX - rash with EBV Supportive Tx (hydration, antipyretics, analgesics - para, NSAID)

Glandular fever prognosis + complications

2-4 weeks resolution (full function in months) Splenic rupture at minor trauma (e.g. cough) CT suspected and no contact sport for 8 weeks

What is arachidonic acid converted into by Cyclooxygenase (Action on)

Thromboxanes (Platelets) Prostacyclin (endothelium) Prostaglandins (Smooth muscle)

Action of tranexamic acid

Blocks conversion of plasminogen to plasmin | Stops plasmin action cleaving fibrin clots - stops bleeding