Sep 2014 Flashcards
(37 cards)
How are internal and external haemorrhoids differentiated?
How many grades?
Internal = proximal to dentate line External = distal to dentate line
Grades 1-4
What are risk factors for haemorrhoids?
- Increased venous pressure and drainage - cirrhosis with ascites, pregnancy, straining, squatting
- Abnormal bowel function - constipation/diarrhoea
- Collagen vascular disease
- Pelvic floor abnormalities
- Low fibre intake
- Obese / Sedentary
What is the treatment of low-grade haemorrhoids?
- Hygiene
- Bowel regulation - water and fibre
- Avoid straining
- Topical medications
If above fails - rubber-band ligation
What is the treatment of high-grade complicated haemorrhoids?
- Sclerotherapy / haemorrhoidectomy
- Thrombectomy of external haemorrhoid thrombosis
- Stapled haemorrhoidopexy
What is the 2 most common symptoms of haemorrhoids?
Haematochezia (60%)
Itching (55%)
Patient returns from West Africa and presents initially with fever and polyarthralgia with intense pain. 3 days later a maculopapular rash arises that lasting 5 days.
what is the important DDx?
Chikungunya - anthropod borne virus endemic to West Africa (RNA virus)
What are the options for diagnosing Chikungunya?
- IgM/IgG anti-chikungunya viral antibodies
2. RT-PCR for virus
What is the vector for Chikungunya transmission?
Mosquitos
What is the treatment of Chikungunya?
- Treat pain - analgesia (e.g. NSAIDS)
- No antiviral available
Which of the following 2 options improves prolonged progression-free survival in multiple myeloma:
- high dose melphalan consolidation + ASCT
- melphalan + prednisone + lenalidomide
high dose melphalan consolidation + ASCT
True/False: In the treatment of myeloma, addition of Lenalidomide maintenance significantly improves prolonged progression-free survival compared to no maintenance.
True
What is a better alternative to melphalan-prednisone-thalidomide regimen in Transplant-ineligible patients with myeloma?
lenallidomide-dexamethasone improves progression-free survival
What % of pancreatic cancers are adenocarcinomas?
85% (most)
What are the 3 most common mutations in pancreatic ductal adenocarcinomas?
KRAS (90%)
p53 (70%)
CDKN2A (50%)
Anatomically, where do most pancreatic cancers occur?
Head (70%) - most
Body/Tail (25%)
What are common clinical features of pancreatic cancers?
What other medical condition is likely to be associated?
- Abdominal pain / weight loss / asthenia / anorexia
- Jaundice (if pancreatic head implicated)
- DM in 50%
Where does pancreatic cancer metastasise to?
Obvious: liver and abdomen
Less obvious: lungs
What is the treatment of Stage 1/2 pancreatic cancer?
- Surgery (pancreaticoduodenectomy (Whipple procedure) if in head/neck
- Adjuvant chemotherapy: 6m of gemcitabine or fluorouracil
- +/- Radiation therapy - controversial
- Neoadjuvant (pre-op chemotherapy) - trials only
What is the treatment of Stage 3/4 pancreatic cancer?
- FOLFIRINOX + gemcitabine-nab-paclitaxel
- Erlotinib improves survival by 2 weeks in stage 4 disease
Which 2 genetic syndromes increase the risk of pancreatic cancer?
- Hereditary pancreatitis (PRSS1, SPINK1) - 50%
- Peutz-Jeghers syndrome (STK11[LKB1]) - 40%
What new therapy in HF-REF may reduce risk of death and hospitalisation compared to ACEi?
LCZ696 = AT2R inhibitor + neprilysin (valsartan + sacubitril)
Superior to ACEi (enalapril) in the treatment of HF-REF
Neprilysin = enzyme that degrades natriuretic peptides
What is the significance of PCR detection of AR-V7 (androgen receptor isoform encoded by splice variant 7) in castration-resistant prostate cancer?
Detection of AR-V7 in circulating tumour cells suggest resistance to enzalutamide and abiterone therapy.
AR-V7 lacks the ligand bind domain for these medications.
What is Ticagrelor?
Direct acting platelet P2Y12 receptor agonist
True/False: pre-hospital administration of ticagrelor in acute STEMI is safe and improves pre-PCI reperfusion.
False.
Safe but does NOT improve pre-PCI reperfusion.
