Block 12 Flashcards
What proportion of Crohn’s disease is ileocaecal?
It is the commonest site- 50%
String sign of Kantor
RIF string like strictures on barium studies
Crohn’s disease
SCLC
Bowel obstruction
Pseudo-obstruction
Autoimmune inflammation/destruction of the myenteric plexus
Which gender is most commonly affected in Hirschprung’s?
M:F
5:1
Pathophysiology of Hirschprung’s disease?
Defective neural crest cell migration resulting in a congenital absence of the ganglia that make up the Auerbach (myenteric) and Meissner (submucosal) plexus.
Biopsy in Hirschprung’s
Suction biopsy of the narrowed segment
Full-thickness rectal biopsy is required if suction biopsy is inconclusive
Pain on passive plantar flexion of the big toe but not on passive dorsiflexion
Compartment syndrome of the anterior compartment of the leg.
EHL is the muscle being stretched. This muscle is in the anterior compartment
What is the normal location of the major duodenal papilla
Descending part of the duodenum (i.e. the site where the CBD and pancreatic duct join and enter the duodenum)
Which of the following statements is true regarding familial hypocalciuric hypercalcaemia?
Hypermagnesaemia may be seen
It is AR
It is associated with increased urinary Ca excretion
It is associated with low PTH levels.
The condition responds to parathyroidectomy.
AD condition which is associated with decreased Urinary Ca excretion (<200mg/24h).
No response to parathyroidectomy
Hypermagnesaemia may be seen.
PTH levels are normal or slightly elevated
During repair of spaghetti wrist, what is the maximum torniquet time you should use?
Muscle tolerates an ischaemia time of approximately 6 hours, however in prolonged operations, surgeons will reduce the tourniquet every 2 hours for a period of 15 minutes to establish muscle perfusion
The tendons of which of the following muscles of the forearm is most vulnerable to damage in a laceration on the central palmar aspect of the rist?
FCR
FPL
Abductor PL
Supinator
FCU
FCR is one of the five superficial muscles of the flexor compartment of the forearm, it arises from the medial epicondyle and inserts radial to the carpal tunnel. It would be at risk from a palmar wrist laceration.
Abductor pollucis longus is on the dorsal aspect of the hand
FPL is in the deep compartment
Supinator is in the deep posterior compartment.
FCU sits on the most ulnar aspect of the wrist and as such is less at risk from a central laceration

At what MAP does CBF reduce?
MAP of <60.
This does not occur until there is a loss of over 40% of the circulating volume in a normal individual
When is eschar seen in burns?
Full thickness burns
Relationship between axillary clearance and survival in breast Ca
It yields prognostic information but there is no evidence that axillary clearance in itself prolongs survival
Which of the following statements regarding the mechanism of fetal wound healing is correct.
Reduced inflammatory response
Decreased synthesis of total collagen
Involves a decreased expression of transforming growth factor b3
Involves a reduction in migration of fibroblasts
Involves decrease in hyaluronic acid synthesis
Fetal wounds have reduced pro-inflammatory signals and there is thus a reduction in the inflammatory infiltrate during the early phase of healing
Jefferson fracture
Blow out fracture of the atlas caused by axial loading.
Best visualised with a peg view on plain radiography.
Unstable injuries requiring careful specialist spinal input

Hangman’s fracture
Bilateral fracture of the pars interarticularis affecting axis

By what rate does tamoxifen increase the risk of endometrial carcinoma?
From 1:1000 to 1:50
Hence it is second line in the hormonal treatment of breast cancer in post-menopausal women
What proportion of tumours in post-menopausal women are ER +ve?
2/3rds
Presentation of medullary thyroid cancer?
Thyroid mass or local lymphadenopathy
May present with diarrhoea due to calcitonin but occasionally with other paraneoplastic manifestations e.g. ectopic ACTH production
Failure rates of surgery in testicular germ cell tumours
Surgery alone: 20%
3% when Sx in combination with RTx
Adenocarcinoma and radiation
Most adenocracinomas are RTx insensitive
What is the ebb phase?
Seen in the first few hours of a traumatic insult to the body.
Decreased O2 consumption
Lactic acidosis
Increased stress hormone levels
Decreased insulin levles
Hyperglycaemia
Insulin resistance
Increased substrate consumption
Immune activation
Hepatic acute-phase response.
What is the flow phase
Days to weeks post trauma
Increased body temeprature
Increased O2 consumption
Negative nitrogen balance
Increased stress hormone levels
Hyperglycaemia
Gluconeogenesis
Lipolysis
Immunosuppresssion




























































