Deck 3 Flashcards
RFs for thyroid cancer
Modifiable
- Obesity
- Radiation in infancy or childhood
Non modifiable:
- Female
- FHx
- Cancer syndromes : FAP
Thyroid cancer genetic?
Medullary thyroid ~ 25% familial
Papillary and follicular ~10%
Features of thyroid malignancy on USS
Increased vascularity
Solid appearance
Microcalcification
Indications for removal of thyroid nodular goitre
- Cancer
- Pressure
- Hyperthyroid resistant to meds
Most common thyroid cancer
Papillary (80%)
Causes of hypoparathyroidism
Post thyroidectomy
Radiotherapy to head and neck
Low Mg
Difference between primary and secondary hyperaldosteronism
Primary: Low renin, high aldosterone
eg aldosterone producing adenocarcinoma
Secondary: high renin, high aldosterone,
eg renal vascular disease, renin secreting tumours
Difference between primary and secondary hyperaldosteronism
Primary: Low renin, high aldosterone
eg aldosterone producing adenocarcinoma
Secondary: high renin, high aldosterone,
eg renal vascular disease, renin secreting tumours
What is leukoplakia
White patch or plaque on the oral mucosa
Not painful, irregular shape
Cannot be scrapped
Is leukoplakia malignant
No, pre-malignant
Improved on stopping smoking and alcohol
Progresses to SCC in 5%
Commonest head and neck cancer
SCC
RFs for SSC of oral cavity
Alcohol
Smoking
Working with wood dust or nickel dust
Infection: HIV, HPV, EBV
What is radical neck dissection
Removal of SCM
Internal jugular vein
Accessory nerve
As well as lymph node levels 1-5
Indications for heart transplant
Heart failure secondary to :
- congenital heart disease
- valve disease
- cardiomyopathy
- Ischaemic heart disease
General transplant criteria
- no active malignancy
- No active HIV or sepsis
- Lifestyle: no alcohol or smoking or drugs
Criteria for being a heart organ donor
<55 yo
Normal heart investigations (ECG, echo, angio)
No hx of heart disease or chest trauma
No Hep B,C, HIV
Criteria for being a heart organ donor
<55 yo
Normal heart investigations (ECG, echo, angio)
No hx of heart disease or chest trauma
No Hep B,C, HIV
Criteria for brainstem dead
Known aetiology for irreversible brain damage
Exclusion of reversible causes for coma and apnoea
Absence of brainstem reflexes
Tests of brainstem reflexes?
- No response to supraorbital pain
- Pupils fixed and unresponsive
- No corneal reflex
- No vestibulo-occular reflex (no eye movement on injecting 50mls of ice cold water in ear)
- No gag reflex
- No cough in response to bronchial stimulation
Apnoea test
- Fully Oxygenate pt
- Hypoventilate so PCO2 reaches 6.5
- Withdraw ventilation
If no respiratory movement even when PCO2 rises by more than 1 (above 6.65), then unlikely to recover
Who can declare someone brainstem dead
2 doctors 5 years after full GMC registration
At least 1 consultant
2 separate occasions
How to reduce allograft rejection
- blood type matching
- Tissue size and type matching
- Immunosuppressants
Side effects of steroids
Skin:
- bruising
- thining
- hirstusm
CVS:
- HTN
- retension
GI:
- fatty liver
- pancreatitis
Neuro:
- psychosis
- insomnia
MSK:
- osteoporosis
- AVN
Endocrine:
- diabetes
Tumours associated with HIV
Kaposi sarcoma
CNS lymphoma
Hodkin’s
How does H pylori survive acidic conditions
- detects low ph and uses its flagella to swim away
- burrows through the mucous lining and attaches itself to cells under
- produces urease which produces ammonia from urea. Ammonia binds H+
How does H pylori lead to ulceration
Produces enzymes protease and lipase -> damage gastric mucosa
Damaged protective layer gets further damaged by the stomach acid
Ulcer formation
What proportion of patients with H pylori 1. asymptomatic 2. develop ulcers or 3. cancer
- 80-90%
- 10%
- 1-2%
Which gastric neoplasia associated with H pylori
Adenocarcinoma
MALT lymphoma
Embryological origin of parathyroid gland
3rd and 4th pharyngeal arch
Where are parathyroid glands found
Usually posterior to thyroid
Sometimes inferior ones are pulled down along with thymus into the mediastinum (both originate from 3rd pharyngeal arch)
Where are parathyroid glands found
Usually posterior to thyroid
Sometimes inferior ones are pulled down along with thymus into the mediastinum (both originate from 3rd pharyngeal arch)
Frozen section use
Intra-operative histology review:
- benign or malignant
- resection margins
What happens during frozen section revie
Pathologist fixes the sample using cryostat machine and a microtome before looking under microscope
Quality lower than if it was formalin as the usual fixation agent
Parathyroid histology fx
Oxyphil cells
Chief cells
What happens in type 1 hypersensitivity reaction
- Initial exposure to antigen -> sensitization of B and T cells
- Mast cells with IgE in circulation
- If re-exposed: release of histamine leading to inflammation
Examples of type 1 hypersensitivity
Anaphylaxis
Asthma
Pathophysiology of type 2 hypersensitivity
IgG and IgM antibodies binds to foreign cell surface antigens
Activates complement pathway
Membrane attach complexes (MAC) destroys the cell membrane
Examples of type 2 hypersensitivity
Autoimmune haemolytic anaemia
Rheumatic heart disease
Pathophysiology of type 3 hypersensitivity
Formation of antibody-antigen complexes in circulatory blood
Forms a circulatory immune complex
Deposited in vessels, joint, kidneys etc causing tissue damage
Examples of type 3 hypersensitivity
SLE
Rheumatoid arthritis
Pathophysiology of type 4 hypersensitivity
Mediated by T cells attacking the tissue
Takes 48-72hrs
Examples of type 4 hypersensitivity
Acute transplant rejection
Dermatitis
TB mantoux test
Hashimotos thyroiditis
Pathophysiology of type 5 hypersensitivity
Stimulatory or inhibitory autoantibodies
Similar to type 2 that IgG or IgM binds to cell surface
Instead inhibits or stimulates the cell to produces something
Examples of type 5 hypersensitivity
Graves
Myasthenia Gravis
Sepsis definition
Organ dysfunction secondary to dysregulated host response to infection
Organ dysfunction : increase of 2 or more points on SOFA (sequential organ failure assessment) score
qSOFA score use?
likelihood of sepsis in pt with a known or suspected infection
Granuloma definition
Collection of epithelioid macrophages (epithelial formation)
Types of granulomatous inflammation
Caseating (TB) or Non caseating (Sarcoid, Crohns)
Infective (TB) or non infective (Rheumatoid, corhns)
