Miscellaneous Conditions A

Question 1

Acquired Immunodeficiency Syndrome - Description

Answer 1

progressive immune system dysfunction due to CD4+ cell infection

Question 2

Acquired Immunodeficiency Syndrome - Causes (1)

Answer 2

1) HIV

Question 3

Acquired Immunodeficiency Syndrome - Risk Factors (6)

Answer 3

1) 19-24 years old
2) IV drug abuse
3) needle stick injury
4) unprotected sex (inc. anal)
5) mother to child transmission
6) herpes simplex 2 infection

Question 4

Acquired Immunodeficiency Syndrome - Symptoms (3)

Answer 4

2-4 weeks post-exposure

1) fever (inc. night sweats)
2) myalgia
3) sore throat

Question 5

Acquired Immunodeficiency Syndrome - Signs (4)

Answer 5

2-4 weeks post-exposure

1) erythematous/maculopapular rash
2) oral ulcers
3) angular cheilitis
4) lymphadenopathy (persists)

Question 6

Acquired Immunodeficiency Syndrome - Complications (5)

Answer 6

1) tuberculosis
2) immunocompromised pneumonia (Pneunocystic jirovecii)
3) hepatitis
4) Kaposi’s sarcoma (human herpes 8)
5) lymphoma

Question 7

Acquired Immunodeficiency Syndrome - Opportunistic Pathogen (6)

Answer 7

1) Pneumocystis jirovecii
2) Candidiasis
3) Cryptococcus neoformans
4) Toxoplasma gondii
5) Cytomegalovirus
6) Cryptosporidium

Question 8

Acquired Immunodeficiency Syndrome - Investigations (5/0)

Answer 8

initial

1) saliva/serum HIV rapid test
2) serum HIV ELISA
3) serum HIV RNA viral load
4) serum HIV DNA PCR
5) CD4+ count (monitor) (<200 cells/μL)

Question 9

Acquired Immunodeficiency Syndrome - Management (4/4/0)

Answer 9

conservative
1) monitor serum HIV RNA viral load (antiretroviral therapy)
2) monitor CD4+ count
3) risk education
4) vaccinations
medical
1) prophylactic antiretroviral therapy (postexposure, pregnant mother)
2) antiretroviral therapy (e.g. tenofovir)
3) opportunistic infection prophylaxis (e.g. trimethoprim for PCP)
4) multivitamin + multimineral

Question 10

Breast Carcinoma - Description

Answer 10

malignant proliferation of breast cells

Question 11

Breast Carcinoma - Risk Factors (11)

Answer 11

1) age (~2x every 10 years)
2) female
3) family history
4) genetics (BRCA1, BRCA2, TP53)
5) childless/>30 years old pregnancy
6) not breastfeeding
7) early menarche
8) late menopause
9) combined oral contraceptive
10) hormone replacement therapy
11) radiation exposure

Question 12

Breast Carcinoma - Types (6)

Answer 12

1) invasive ductal carcinoma (70%)
2) invasive lobular carcinoma (10-15%)
3) non-invasive ductal carcinoma
4) non-invasive lobular carcinoma
5) oestrogen receptor positive (70%, better prognosis)
6) HER2 positive (30%, worse prognosis)

Question 13

Breast Carcinoma - Signs (3)

Answer 13

1) tender breast mass
2) nipple discharge (watery, serous, milky or bloody)
3) axillary lymphadenopathy

Question 14

Breast Carcinoma - Complications (1)

Answer 14

1) lympoedema

2) metastasis (esp. bone, brain, liver, lungs)

Question 15

Breast Carcinoma - Investigations (1/4)

Answer 15

initial
1) mammogram (screening, 50-70 years old)
consider
1) fine needle aspiration breast biopsy
2) breast ultrasound
3) OR testing
4) HER2 testing

Question 16

Breast Carcinoma - Stages (4)

Answer 16

1) breast confined, mobile
2) breast confined, mobile, mobile ipsilateral axillary lymph node
3) skin involvement, muscle fixed, fixed ipsilateral axillary lymph node
4) distant metastasis, chest wall fixed

Question 17

Breast Carcinoma - Management (1/6/1)

Answer 17

conservative
1) screening (mammogram, 50-70 years old)
medical
1) chemotherapy (post-op) (cyclophosphamide, methotrexate, fluorouracil)
2) radiotherapy (post-op)
3) oestrogen receptor blocker (e.g. tamoxifen) (OR+, premenopausal)
4) GnRH analogue (OR+, premenopausal)
5) aromatase inhibitors (e.g. anastrozole) (OR+, postmenopausal)
6) HER2 monoclonal antibodies (e.g. trastuzumab - Herceptin) (HER2+)
surgery
1) local resection —> radical mastectomy (1st line)

Question 18

Paracetamol Overdose - Description

Answer 18

ingestion of a large amount of paracetamol (>4g/<1hr)

Question 19

Paracetamol Overdose - Risk Factors (4)

Answer 19

1) self-harm history
2) pain-relief dependance
3) cytochrome P450 inducers (e.g. alcohol)
4) glutathione deficiency

Question 20

Paracetamol Overdose - Symptoms (6)

Answer 20

1) asymptomatic (<24 hours)
2) abdominal pain
3) nausea
4) vomiting
5) confusion (fulminant hepatic failure)
6) loss of consciousness (fulminant hepatic failure)

Question 21

Paracetamol Overdose - Signs (2)

Answer 21

1) jaundice (late)

2) asterixis (fulminant hepatic failure)

Question 22

Paracetamol Overdose - Complications (1)

Answer 22

1) fulminant hepatic failure

Question 23

Paracetamol Overdose - Investigations (4/1)

Answer 23

initial
1) serum paracetamol 
2) LFT (high)
3) U+E
4) ABG (low pH, high lactate)
consider
1) urine drug screen

Question 24

Paracetamol Overdose - Management (0/3/1)

Answer 24

medical
1) acetylcysteine
2) activated charcoal
3) antiemetic
surgery
1) liver transplant (severe)