Deck 4 Flashcards
Acute inflammation def
body’s response to tissue injury characterised by red hot swollen pain
Acute inflammation stages
- vasoconstriction
- vasodilation (red/hot)
- increased permeability (swelling)
- Migration of white cells (neutrophils)
- Phagocytosis
- Resolution or progression
Complement cascade 3 pathways activation
Classic: antigen-antibody complex activation
Alternative: C3 contacting micro-organisms
Lectin: Mannose-binding lectin binds to cell membrane of pathogens
Consequences of complement cascade activation
- inflammation and activation of leucocytes
- Opsonisation of pathogens for macrophages
- formation of MAC and destruction of pathogens
Possible outcomes of inflammation
- Resolution
- Chronic inflammation
- Scar
- abscess
- Death (meningitis)
Possible outcomes of inflammation
- Resolution
- Chronic inflammation
- Scar
- abscess
- Death (meningitis)
Chronic inflammation
Active inflammation, tissue injury and healing occurring at the same time
Examples of chronic inflmmation
Infection evading host immune: TB, H pylori
Auto-immune: rheumatoid
Untreated acute inflammation: chronic osteomyelitis
Examples of chronic inflmmation
Infection evading host immune: TB, H pylori
Auto-immune: rheumatoid
Untreated acute inflammation: chronic osteomyelitis
BRCA 1 and 2 chromosomes
1 = 17 2 = 13
BRCA 1 ass with which cancers
Ovarian
Breast
BRCA 2 associated with which cancers
Breast
Pancreatic
Sentinel node biopsy procedure
- radio-isotope/dye injected into sub-dermal layer around areolar region
- During op, sentinel node identified by dye or Geiger counter
- if positive that group of nodes are excised
Complications of mastectomy
Immediate: haemorrhage
Early:
- damage to local nerves: thoraco-dorsal, long thoracic
- infection
- haematoma/seroma formation
Late:
- recurrance
Breast reconstruction
Breast mound:
- flap or implant or both
Nipple areolar complex:
- areolar region: tattoo
- nipple: flap or graft from contra-lateral side
Types of flaps in breast reconstruction
- Latissimus dorsi
- TRAM (transverse rectus abdominis)
- DIEP (deep inferior epigastric perforator)
- SGAP or IGAP (Sup/Inf gluteal aretery perforator flaps)
Local complications of radiotherapy
- permenant skin discolouration
- Lymphoedema
- Swelling of remaining breast
Oestrogen dependent breast cancer mx
Pre-menupause:
- tamoxifen (SERM)
- stops production of oestrogen at overies
Post-menupause
- anastrazole ( aromatase inhibitor)
- stops peripheral production in fat tissue
Herceptin role in breast cancer
Targets cells that over-express HER2 (transmembrane epidermal growth factor)
Reduces recurrence
HER2 over expressed in 15% of breast cancers
Poor prognostic factors for breast cancer
HER 2 positive
Young at diagnosis
High grade
Naevus definition
benign proliferation of cells of skin
Types of naevus
- melanocytic (eg congenital)
- vascular (eg port wine stain)
- Epidermal (warty naevus)
Types of cutaneous melanoma
- Superficial spreading
- Nodular
- Acral lentigenous and subungal melanoma
- lentigo maligna
Types of cutaneous melanoma
- Superficial spreading
- Nodular
- Acral lentigenous and subungal melanoma
- lentigo maligna
RFs for melanoma
Modifiable:
- UV light exposure
- CT scan in childhood
Non-modifiable:
- age
- Previous BCC, SCC
- Fitz Patrick 1
ABCDE rule to examine melanomas
Assymetry Border irregularity Colour variation Diameter >7mm Evolution eg shape/size/colour
Glasgow 7 point checklist for melanoma components
Major fx (2 points)
- change in size
- irregular shape
- irregular colour
Minor fx (1 point)
- diameter >7mm
- inflammation
- oozing
- change in sensation
Glasgow 7 point checklist interpretation
Lesions scoring 3 or more need urgent referral
What type of biopsy for melanoma
excision biopsy with 2mm excision margin
How are branchial cyst formed
Failed or incomplete involution of pharyngeal cleft during development (mostly 2nd branchial cleft)
Where are branchial cysts found
Anterior to SCM upper 1/3 in the anterior triangle
When do branchial cysts present
2-3rd decade of life
How are branchial cysts diagnosed?
USS +/- FNA (cholesterol rich fluid)
Branchial cyst rx
Mostly conservative
Surgical removal if pressure/infection
When do thyroglossal cysts present
40% in the first decade, but could present later
Where are thyroglossal cysts found
Midline or off midline,
Between chin to 2nd tracheal ring
What is a dermoid cyst
Benign tumour of ectoderm
Keratinised epithelium with hair and sweat glands
Where are dermoid cysts found
- Midline neck and trunk
- Midline nose
- Medial and lateral eyebrows
Dermoid cyst mx
Excision
What is a sebaceous cyst
Epidermoid or pilar (hair follicle) cysts that contain keratin
What is a sebaceous cyst
Epidermoid or pilar (hair follicle) cysts that contain keratin
Common sites for sebaceous cysts
Head
Scalp
Neck
Trunk
Rx for sebaceous cyst
Excised with overlying skin as contains a punctum
Ludwig’s angina
Cellulitis of floor of the mouth and neck
Spreads through submandibular space
Leads to elevation and posterior displacement of tongue
-> aiwary obstruction
Cystic hygroma cause
Congenital malformation of lymphatic system
Where are cystic hygromas found
posterior triangle of neck
When do cystic hygromas present
Majority visible at birth
90 % by 2yo
Rx for cystic hygroma
Aspiration + Injection of sclerosing agent
or
Resection
Ludwig’s angina
Cellulitis of floor of the mouth and neck
Spreads through submandibular space
Leads to elevation and posterior displacement of tongue
-> aiwary obstruction
