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MRCS-Pathology > Deck 5 > Flashcards

Deck 5 Flashcards

1
Q

What is pharyngeal pouch

A

Diverticulum of pharynx through killian dehisence

Found betwee upper and lower parts of inferior constrictor

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2
Q

Sx of pharyngeal pouch

A

Old men
halitosis
wt loss
regurgitation

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3
Q

Sx of pharyngeal pouch

A

Old men
halitosis
wt loss
regurgitation

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4
Q

Pharyngeal pouch Rx

A

If asymptomatic no rx

Otherwise:

  • endoscopic stapling
    or
  • External excision
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5
Q

Differentials for superficial neck lump

A

Sebaceous cyst
Abscess
Lipoma

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6
Q

Differentials for anterior triangle neck lump

A 
Dermoid cyst
Thyroglossal cyst
Branchial cyst 
Carotid body tumour
Thyroid
Lymph
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7
Q

Differentials for posterior triangle neck lump

A
  • Cystic hygroma
  • pharyngeal pouch
  • lymph node
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8
Q

Types of necrosis

A
  1. coagulative (tissue structure preserved)
  2. Liquefactive
  3. Caseous (impossible to tell type of tissue as structure destroyed)
  4. Fat necrosis
  5. Fibrinoid
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9
Q

What happens in liquefactive necrosis

A

Lipid rich tissues denaturation of fats by lysosomes

eg in brain

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10
Q

Example of caseous necrosis

A

TB

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11
Q

Examples of fat necrosis

A

Pancreas (lypolysis)

Breast (trauma)

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12
Q

Examples of fibrinoid necrosis

A

Blood vessels:

  • antigen-antibody complex and fibrin deposited in wall of vessels causing necrosis
  • type 3 hypersensitivity
  • SLE or vasculitis
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13
Q

How are neoplasms classified based on cell type

A

1 cell type:

  • Adenoma
  • Sarcoma
  • lymphoma

2 cell types, 1 germ line:

  • Pleomorphic adenoma
  • fibroadenoma

2 germ lines:
teratoma

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14
Q

Physiological and pathological examples of hyperplasia

A

Physio:

  • breast tissue in puberty
  • thyroid in pregnancy

Pathological:

  • BPH
  • parathyroid hyperplasia in renal failure
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15
Q

Physiological and pathological examples of hypertrophy

A

Physiological:

  • skeletal muscle
  • uterus in pregnancy

Pathological:

  • Graves
  • Cardiomyopathy
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16
Q

Examples of metaplasia

A

Barrets : LES changes from stratified squamous to columnar

Cervix with HPV: changes from columnar to stratified squamous

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17
Q

Carcinoma vs sarcoma spread

A

Carcinoma: lymphatics (except follicular thyroid)

Sarcoma: haematological

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17
Q

Carcinoma vs sarcoma spread

A

Carcinoma: lymphatics (except follicular thyroid)

Sarcoma: haematological

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18
Q

What is rheumatic fever

A

Systematic disease due to untreated pharyngeal strep pyogenes resulting in damage to heart, brain, skin and joints

19
Q

Which valve does rheumatic disease affect

A

Mitral (70%)
aortic (40%)
tricuspid (10%)

20
Q

Criteria for diagnosis of Infective endocarditis

A

Duke’s criteria (eg presence viridancs, or HACEK in culture etc)

21
Q

Criteria for dx of rheumatic disease

A

Modified Jones criteria (eg raised ESR, carditis)

22
Q

What causes Grey Turners sign

A

Release of elastase (pancreatitis) leads to breakdown of blood vessel wall leading to bleeding into retroperitoneal space

23
Q

Pancreatic severity scoring systems

A

Modified Glasgow score
Ransons
Balthazar
Apache

24
Q

Ransons score

A

estimates pancreatitis mortality based on initial and 48 hr values

25
Q

Balthazar score

A

CT based severity score for pancreatitis

26
Q

Why amylase levels might be normal in acute panc

A

Levels start to fall after 24-48hr after onset

27
Q

Why amylase levels might be normal in acute panc

A

Levels start to fall after 24-48hr after onset

28
Q

Complications of pancreatitis

A

Early:

  • DIC
  • ARDS
  • Electrolyte disturbance: low calcium

Late:

  • chronic
  • necrosis and infection
  • pseudocyst
29
Q

When to CT pancreatitis

A

At least after 72 hrs to allow complications to show

30
Q

How high should amylase be for dx of pancreatitis

A

3 times upper limit (normal is 30-110)

31
Q

What other conditions lead to rise in amylase

A

Perforation
Trauma
Burns

32
Q

Differentials for bilat swelling of parotid

A

Infective: mumps
Inflam: Sjogrens or sarcoid

33
Q

Differential for unilateral parotid swelling

A

Obstruction:

  • stones
  • external neoplasia

Neoplasia of parotid

Infective: mumps

34
Q

Why submandibular stone more common than other salivary glands

A

Mucous composition (as opposed to serous in parotid)
Long duct to enter mouth
Ascends against gravity

35
Q

Difference between submandibular and parotid stones

A

Parotid: multiple, small, within gland

Submandibular: single, large, intraductal

36
Q

Parotid neoplasia

A

Benign: pleomorphic (80 %), Warthins (5%)

Malignant: Mucoepidermoid (10%) and adenoid cystic carcinoma

37
Q

Complications of parotidectomy

A

Immediate: CN7, greater auricular n, haemorrhage
Early: haematoma, infection
Late: Freys syndrome, fistula

38
Q

Criteria to refer dyspepsia for endoscopy urgently

A
  • Dysphagia
  • upper abdo mass
  • > 55 + wt loss + either abdo pain, reflux, dyspepsia
39
Q

When does pain happen in relation to gastric and duodenal ulcers

A

Gastric: during meal time

Duodenal: 2-3 hrs after meal

40
Q

Non surgical mx of peptic ulcer disease

A

Lifestyle : NSAIDs, steroids, alcohol
PPIs and H2 receptor antagonists
Antacids (gavascon)
H pylori eradication

41
Q

What are billroth 1 and Billroth 2 operations

A

1: Gastroduodonostomy after partial gastrectomy
2: Gastrojejunostomy after partial gastrectomy + closure of duodenal stump

42
Q

Dumping syndrome def

A

Rapid passage of food from stomach to small intestine (secondary to gastrectomy, osoephagectomy, bypass)
Results in fluid shift

43
Q

Early dumping syndrome sx

A

10-30 mins after food

Bloating, fainting, dizziness

44
Q

Late dumping syndrome sx

A

Hypoglycaemia (massive release of insulin)

1-3 hours post food

MRCS-Pathology (11 decks)

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