Exam QNA Flashcards
How much margin does melanoma excision require?
In situ: 0.5cm
Breslow<2mm: 1CM
Breslow>2mm: 2cm
Gene responsible for melanoma
CDKN2A, CKD4
Retinoblastoma 1 (RB1)
Poor prognostic factors for melanoma
Male
Old age
Nodular
Thicker breslow thickness
What skin condition associated with melanoma?
Xeroderma pigmentosum
What is xeroderma pigmentosum
Autosomal recessive
DNA repair disorder
Damaged skin cells post UV exposure cannot be repaired
How to ensure margins are included in a re-excision of melanoma
Mohs microscopic surgery (takes longer, 100% of margins are examined under microscope)
Frozen section
DVT mx
- Rx dose enox + 6mo of anticoagulation
- Catheter directed thrombolysis
- tPA (plasminogen activator)
- SVC filter
Indications for catheter-directed thrombolysis for DVT
Clots less than 14 days old
Acute phegmasia cerulea dolens with no contraindications
Indications for IVC/SVC filter
Failure of treatment of DVT
CI to anticoagulation
Presurgical prophylaxis for pt with high risk of VTE
Treatment options for BCC
Curettage and cautery
Excision with margin of 4 mm (or Mohs micrographic)
Topical fluorouracil 5%
Treatment of MRSA
Outpatient: Clindamycin
Inpatient: IV vancomycin 7-14 days
Treatment of MRSA
Outpatient: Clindamycin
Inpatient: IV vancomycin 7-14 days
Reedstenberg cells
Hogdkin lymphoma
Sx of Aortic stenosis
Syncope
Dyspnoea
Angina
Heart failure later on
Commonest bacterial cause of infective endocarditis
Staph aurus
sterp viridans
Janeway lesions vs Osler nodes
Janeway = palm, painless
Oslers = painful, pulp of fingers
Pathophysiology of Janeway lesion and Osler nodes
Janeway: immunocomplex deposition
Osler: septic microemboli (painless)
Both signs of infective endocarditis
How does bicuspid valve cause aortic stenosis
Doesnt cause narrowing of flow in itself
Causes turbulent flow which lead to continuous trauma leading to fibrosis, rigidity and calcification
Why bicuspid aortic valve could lead to sudden death
Increased risk of
MI
Aortic dissection
Surgical options for aortic stenosis
TAVI (transcatheter AV implant)
Open operation
Why metalic valves increase risk of clotting
Risk of clot formation even when blood not flowing through the valve (eg around the hinges, etc) as it captures the blood and keeps it
Branching hyphae seen on the valve in histology. What does it indicate?
Fungal infection eg candida
What is a vegetation on heart valve usually made off
Fibrin-platelet thrombus with bacteria deep inside it
Why antibiotics might not be effective against valvular vegetation
Avascular area
Deep position of bacteria within the fibrin-platelet complex
Fibrin network stops the leucocyte migration
Why prosthetic valves more prone to infective endocarditis
Organisms attach themselves and form a biofilm
How do steroids cause immunosuppression
Sequestration (removal) of CD4 T cells
Mech of action of immunosuppressants
Complication of immunosupprassants
Infection
Hepato-renal toxicity
Anaphylaxis
Cancer (biologics)
Treatment of infective endocarditis
- abx
- valve replacement
- heart transplant
Consequence of long term steroid use
Malignancy:
leukaemia
lymphoma
Features of temporal artery biopsy
Intimal thickening
Luminal stenosis
Tunica media changes:
- Giant cells
- necrosis
Why get visual disturbance in giant cell arteritis
Ophthalmic artery affected
Risk factors for oesteoprosis
Female
Post-menupause
Age >60
Steroids
Blood test for giant cell arteritis
ESR
Blood test for rheumatic heart disease monitoring
ESR
Pathophysiology of osteoprosis
Metabolic bone disease:
a. low bone mass
b. microarchitecutural
Osteomalacia vs osteoprosis
M: reduced bone mineral to matrix ratio
P: reduced bone mass. normal ratio
Why tumours cause hypercoaguable state
Produce procoagualnts and inflammatory cytokines
Activate coagulation cascade
Stimulate tissue factor production
Which enzyme converts fibringoen to fibrin
Thrombin
Which enzyme converts fibringoen to fibrin
Thrombin
Complications of cryptorchidism
Infertility
Cancer
Torsion
Type of testicular cancer in elderly
lymphoma
TNM staging of colorectal ca
Tis- in situ
T1- submucosa
T2- muscularis propria
T3- Subserosa
T4- Directly invading other organs or structures
Giant cells def
fusion of multiple cells especially macrophages form giant cells of langerhans
sign of chronic inflammation
Pathophysiology of IBD
unknown/idiopathic
IBD extra-intestinal manifestations
Shared:
- Uveitis
- Episcleritis
- Arthritis
Crohns specific:
- erythema nodosum
- perianal disease (fistula/abscess)
UC specific:
- PSC
Crons vs UC histological findings
Crohns:
- transmural inflammaition
- granulomas
UC:
- Crypt abscess
- Inflammatory cells in lamina propria
Endoscopic appearance of crohns vs UC
Crohns:
- skip lesion
- strictures
- copplestoning
UC:
- continues inflammation of rectum +colon
- contact bleeding
