Pathology 4 Flashcards
(36 cards)
Leukaemia: common features
Common features include diffuse replacement of normal bone marrow by leukaemic cells with variable accumulation of abnormal cells in the peripheral blood.
Infiltration of liver, spleen, lymph nodes, meninges and gonads.
Bone marrow failure with anaemia, neutropenia and thrombocytopenia.
Leukaemia can be stimulated by ankylosing spondylitis, alkylating agents for lymphomas, benzene exposure, Down syndrome, viruses.
Acute lymphoblastic leukaemia
Most common between 2-4 years. For some the mutations occur in uterus with further mutations following birth. Majority of them derive from B cell precursors. Antibodies give indication of their maturity. Includes Philadelphia chromosome. Med neg means less likely to relapse.
Acute lymphocytic leukaemia
Mostly B lymphocytes. Is 80% of leukaemias in children. A small number of over 50s. Shows rapid deterioration, fatigue, dizziness, palpitations, severe bone and joint pain, recurrent and severe infections, fevers, splenomegaly, dyspnoea, abdominal mass, testicular enlargement, gum hypertrophy, cranial nerve palsy 3,6 and 8 if disease is mature as Burkitts leukaemia.
Regime vincristine, methotrexate and athracycline, maybe cyclophosphamide
Acute myeloblastic leukaemia
Often accumulates in liver and spleen from failed apoptosis. Raised WBC’s, neutropenia, fever, bleeding or dic from thrombocytopenia. If WBC’s too low can get respiratory distress.
Includes bone pain, liver, spleen, gingivitis. Treatment includes cytarabine and daunorubicin. Post remission give daunorubicin, mitoxantrane or arabinosylcytosine. Sometimes use ATRA with chemo if APC AML.
Children are more likely to achieve remission than adults.
Chronic myeloid leukaemia
Median survival 5 yrs without stem cell transplant. Occurs in all age groups. Healthy marrow is replaced by stem cells of erythoid, megakaryotic, granulocyte and Bcell lineage. Can go into an aggressive phase called blast crisis.
Fatigue, night sweats, weight loss, luq pain from splenic infarction, splenomegaly, hepatomegaly, anaemia, easy bruising, gout, fever, hyper viscosity syndrome. Treat with imatinib and stem cell transplant.
Scts can risk graft vs host disease, venoocclusion, infection, secondary malignancies.
Chronic lymphocytic leukaemia
Accumulation of Bcells. Usually less aggressive and affects the elderly. Median survival is 25 yrs and often doesn’t require treatment. Can get an aggressive form shortening it to 8/9. Anemia and thrombocytopenia are late developments. Advanced NHL can look like CLL. Nodes, liver and spleen can be affected = small cell lymphocytic lymphoma.
1/4 of all leukaemia, symmetrical lymphadenopathy, pneumonia and herpes common. Spleno/hepatomegaly and abdominal pain, pallor and tonsillar enlargement.
Chemo is cyclophosphamide or chlorambucil. Could pair cyclophosphamide with fludarabine and add rituximab sometimes. Stage A survival 10 yrs, stage C is 18 months. If have p53 deletion, prognosis is worse.
Chlamydia Trachomatis
Infects urethra, endocervix, rectum, pharynx, conjunctiva. Contact/fluid transmission. Up to 80% women and 50% men can be asymptomatic. Can complicate to pelvic inflammatory disease that can give tubal infertility, ectopic pregnancy and chronic pelvic pain.
Incubation period 7-21 days. Men = anterior urethritis with mucal discharge worse on waking with crusting at meatus and dysuria. If goes along vas deferens can lead to epididymorchitis.
Women show endocervical symptoms, vaginal discharge, dysuria, postcoital bleeding and lower abdominal pain. Examination of the cervix may reveal mucopurulent cevicitis and/or contact bleeding. Ascending infection into uterus and Fallopian tubes leading to endometriosis and acute salpingitis (PID).
In pregnancy, associated with preterm birth, postpartum infection, neonatal mucopurulent conjunctivitis and pneumonia via vaginal delivery. Vertical transmission.
Rectal infection via anal sex and be asymptomatic or proctitis. Reactive arthritis if hla b27 positive.
One ceftriaxone 500mg IM with doxycycline twice daily and metronidazole twice daily for two weeks. No sex.
Epididymo-orchitis
Pain and swelling of epididymis via extension of urethral or bladder infection. Can be c trachomatis, n gonorrhoeae or a UTI. Most common differential is spermatic cord torsion.
Subacute onset of unilateral scrotal pain and swelling. May be urethral discharge or dysuria. Tender and palpable swelling of epididymis and maybe testicle and erythema of scrotum.
If STI give eg ceftriaxone and doxycycline. UTI ofloxacin x2 daily for 2 weeks.
Bacterial vaginosis
Lactobacillus dominant flora replaced by other bacteria like gardnerella vaginalis, anaerobes, mycoplasmas and mobilunous. Not an std.
In pregnancy associated with risk of miscarriage and preterm birth. Increases risk of getting and spreading HIV.
Fishy odour and increased discharge. Creamy white with froth, can adhere to vaginal walls. No vaginal inflammation.
Diagnose with microscopy of gram stained discharge must have ph > 4.5. Treat with metronidazole x2 daily for a week. Cream for five nights if pregnant.
Candidiasis
Candida albicans. Not an STI. Higher risk of infection if pregnant or diabetic. 75% women have it at least once. Can increase risk with broad spectrum antibiotics and corticosteroids. Men can contract via sex and have a rash.
Vulval itching/burning, thick white discharge, external dysuria and superficial dyspareunia. May see vulval erythema, fissuring and oedema.
Itraconazole twice in a day, or one dose fluconazole with clotrimazole cream.
Trachomoniasis vaginalis
Most common global STI. Flagellates protozoan. In women it infects vagina and urethra. Men urethra and supraprepubital sac. Men are often asymptomatic. In pregnancy there’s risk of preterm birth and low birth weight. Increased risk of HIV acquisition.
Vaginal purilent smelling discharge with possible vulval pruritus/dysuria and dyspareunia. May be erythema, discharge is yellow or grey, frothy and profuse. Cervix might have small haemorrhages - strawberry cervix.
Treat with metronidazole twice a day for a week.
Gonorrhoea
STI of neisseria gonorrhoeae. Spread via discharge with sex etc. It can infect the cervix, urethra, rectum and facial orifices. Can be transferred to a baby in utero and cause permanent blindness.
Thick yellow or green discharge, painful urination and intermenstrual bleeding.
Treat with one time ceftriaxone and azithromycin.
Human papilloma virus/ anogenital warts.
HPV 6 and 11. Painless benign epithelial tumours. Skin contact transmission. Neonates may get HPV from infected birth canal = anogenital warts or laryngeal papillomatosis.
Incubation period 3 months and appears at site of sexual contact first. Prepuce, glans then to urethra, penile shaft. forchette to vulva and perineum.
Warts on mucous membranes tend to be soft and non keratinised. On hair bearing skin likely to be firm and keratinised.
Treating non keratinised = topical podophyllotoxin. Keratinised gets ablation via cryotherapy or electrocautery. Imiquimod helps for both types. If pregnant, hiv or immunosuppressive just ablaze.
Vaccinations at 12= 1 dose for 16 and 18 then another for 6, 11, 16 and 18.
Molluscum contagiosum
Large DNA virus leading to 2-5mm diameter benign smooth papules with central umbilication. Spread via skin contact. When sexual, lesions are multiple, on labia majora, penile shaft, pubic region, lower abdomen and upper inner thighs.
Often self limiting and resolves naturally, can treat with same as HPV anogenital warts.
Herpes Simplex/Genital herpes
Most universal cause of genital ulcers. Transmission is via mucous membrane of a person who is shedding the virus and can be asymptomatic. Genital herpes is usually due to HSV1 or 2. Can be both.
During primary infection the virus ascends peripheral sensory nerves and establishes latency in the dorsal root ganglia.
Multiple sore shallow ulcers, inguinal lymphadenopathy and systemic symptoms of viraemia, eg fever, myalgia and headache. Women can have dysuria and vulval pain. Ulcers on cervix can look like malignancy. Rectal ulcers can lead to proctitis, pain and bleeding. Can complicate to aseptic meningitis.
Reactivation makes tingling, itchy or pain in area. Treat with salt water bathing and aciclovir.
Syphilis
Via motile spirochaete treponema palidium. Spread via direct contact with lesion and enters new host via breaches in skin or mucosa, usually during sex. Can be maternally transmitted in utero so can be congenital or acquired. Latter is divided into primary and secondary.
Primary= ~21 days past exposure a papule develops at site and ulcerated to a firm chancre with painless regional lymphadenopathy that heals within 2-6 weeks.
Secondary= 6-10 weeks after primary lesion. Fever, sore throat, malaise and arthralgia. Widespread rash- coppery and maculopapular on palms and soles too. Condylomata lata = wart like plaques in the perianal area and moist body sites. Can become latent. If untreated can come back granulomatous and is destructive to skin and bones, heart, cns.
Treat with benzathine penicillin G or doxycycline. Often experience reactive flu symptoms = jarisch herxheimer reaction.
Perthe’s Disease
Rare childhood condition affecting the hip. Occurs when the blood supply to the head of femur is temporarily disrupted leading to some avascular necrosis, weakening the bone over years until it collapses. Over time, the blood supply returns and the bone begins to grow back.
Your child may limp, have limited motion, or develop a peculiar running style, all due to irritability within the hip joint. Other common symptoms include:
Pain in the hip or groin, or in other parts of the leg, such as the thigh or knee (referred pain).
Pain that worsens with activity and is relieved with rest.
Painful muscle spasms that may be caused by irritation around the hip.
Erythema infectosum/slapped cheek syndrome/fifth disease
Erythema infectosum is caused by an erythrovirus, EVB19 or Parvovirus B19. It is a single-stranded DNA virus that targets red cells in the bone marrow. It spreads via respiratory droplets, and has an incubation period of 7–10 days.
Parvovirus B19 infection causes nonspecific viral symptoms such as mild fever and headache at first. The rash, erythema infectosum, appears a few days later with firm red cheeks, which feel burning hot. This lasts 2 to 4 days, and is followed by a pink rash on the limbs and sometimes the trunk. This develops a lace-like or network pattern.
Although most prominent in the first few days, the rash can persist for up to six weeks at least intermittently, and is most obvious when warm.
VDRL and FTA (and FTA ABS) tests
Used to detect antibodies to the bacteria Treponema pallidum, which causes syphilis
What is Bence Jones protein?
A Bence Jones protein is a monoclonal globulin protein or immunoglobulin light chain found in the urine, with a molecular weight of 22–24 kDa. Detection of Bence Jones protein may be suggestive of multiple myeloma or Waldenström’s macroglobulinemia.
Hirschsprung disease/congenital megacolon
Hirschsprung disease (HSCR) is a birth defect. This disorder is characterized by the absence of particular nerve ganglions in a segment of the bowel in an infant. The absence of ganglion cells causes the muscles in the bowels to lose peristalsis. Affected individuals can develop constipation and partial or total obstruction of the bowels. Pain and discomfort can result. If not treated, a potentially serious bacterial infection may develop. Requires bowel resection.
Symptoms in the newborn period include failure to pass the meconium within a short time after birth. Failure to pass a first stool for 24-48 hours is suggestive of HSCR.
Infants with HSCR will very often have abdominal swelling (distention), abdominal pain, and vomiting. Affected infants have constipation and often exhibit poor weight gain, and slow growth.
HSCR can sometimes lead to a condition called enterocolitis, which is inflammation of the small intestines and colon. This is often referred to as Hirschsprung-associated enterocolitis.
Hirschsprung-associated enterocolitis often presents with fever, explosive diarrhoea, abdominal swelling, lethargy, and vomiting. Some individuals with either severe or untreated Hirschsprung-associated enterocolitis may develop sepsis.
Superior sagittal sinus thrombosis
Superior sagittal sinus thrombosis (SSST) is the most common type of dural venous sinus thrombosis and is potentially devastating.
Risk factors include pregnancy, dehydration, hypercoagulable states, pancreatitis.
Clinical presentation
As with all cerebral venous thrombosis, the presentation is highly variable, ranging from completely asymptomatic to a rapid fulminant course with cerebral haemorrhage and death.
Presentation includes: headache: 53% seizures: 48% hemi-, quadri-, or paraplegia: 48% visual disturbances: 25% nuchal rigidity: 18%
Might see a cord sign on CT, haemorrhage, cerebral oedema.
Antibiotics for Bites
Dog = amoxicillin-clavulanate (or clindamycin and fluoroquinolone/trimethoprim-sulfamethoxazole)
Cat = amoxicillin-clavulanate (or cefuroxime/doxycycline)
Human = amoxicillin-clavulanate (or clindamycin and ciprofloxacin/ trimethoprim-sulfamethoxazole)
Haloperidol
Haloperidol is an antipsychotic medicine that is used to treat schizophrenia. Haloperidol is also used to control motor and speech tics in people with Tourette’s syndrome.
Side effects include dry mouth. increased saliva. blurred vision. loss of appetite. constipation. diarrhoea. heartburn. nausea.
