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MRCS Part B - Paul Edit > Misc 6 > Flashcards

Misc 6 Flashcards

1
Q

4 examples of primary malignant bone tumours?

A

Osteosarcoma
Chondrosarcoma
Ewing’s sarcoma
Multiple myeloma

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2
Q

Give 6 examples of primairy benign bone tumours?

A 
Giant cell tumour
Non-ossifying fibroma
Simple bone cyst
Osteochondroma
Enchondroma
Fibrous dysplasia
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3
Q

Most common benign bone tumour?

A

Osteochondroma

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4
Q

Most common non-myeloma malignant bone tumour?

A

Osteosarcoma

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5
Q

Onions skin appearance on radiograph of bone?

A

Ewings sarcoma

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6
Q

Investigating bone lesions ?tumour?

A 
Bloods
Plain radiography
MRI
Bone scan
CT - staging
Consider biopsy
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7
Q

Indications for surgical removal of benign bone tumour?

A

Rapid growth
Limiting movement or causing severe pain
Impingeing on nearby structures such as nerves or blood vessels

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8
Q

Would you nail IM through a sarcoma prophylactically?

A

No

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9
Q

Describe the different subtypes of surgical resections?

A

Intralesional = tumour cut into or entered
Marginal = incision extends into reactive zone surrounding tumour
Wide local = plane of dissection doesnt breach reactive zone
Radical = entire bone/myofascial resection

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10
Q

4 required features for limb salvage surgery? How many do you need?

A 
Bone
Nerves
Vessels
Skin/soft tissue
Need at least 2
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11
Q

What are clostridia?

A

Gram positive anaerobic spore forming rods found in soil, clothing, faeces

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12
Q

4 give clostridia?

A

Difficile
Botulinum
Perfrinogens
Tetani

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13
Q

System for examining AXRs?

A 
Technical details etc
Bowels - small, large and caecum
Extraluminal gas
Organs - liver, spleen, kidenys, psoas
Bones
Additional features - catheters, clips etc
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14
Q

4 causes of large bowel obstruction?

A

Tumours
Strictures e.g. divertuicular
Adhesions
Volvulus

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15
Q

Management of descending colonic tumour causing obstruction?

A

Left hemicolectomy, +/- defunctioning colostomy or primary anastomosis

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16
Q

Layers of GI tract from internal to external?

A

Mucosa - epithelium, lamina propria, muscularis mucosa
Submucosa
Muscularis propria
Adventitia/serosa

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17
Q

In order for a GI tract cancer to be malignant what does it have to go through?

A

Mucosa - musclaris mucosa

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18
Q

What is the adenoma-carcinoma sequence e.g. in FAP?

A

Normal epithelium mutations leading to hyperproliferation, adenoma formation and eventually carcinoma - such as changes in APC, P53

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19
Q

What is an adenocarcinoma?

A

Tumour from glandular tissue

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20
Q

Define neoplasm?

A

Abnormal mass of tissue in which growth is uncoordinated, exceeds that of normal tissue and persists after cessation of stimulus

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21
Q

Surveillance post CRC resection?

A

CEA monitoring

CT surveillance

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22
Q

Right liver lobes?

A

5,6,7,8

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23
Q

Left liver lobes?

A

2,3,4

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24
Q

Differential for hepatomgaly?

A 
Tumour
Physiological e.g. pregnancy
infective 
metabolic - alcohol, acromegaly
infiltrative e.g. amyloid
vascular - budd chiari, heart failure
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25
Q

4 indications for heart transplant?

A

Advanced heart failure e.g. IHD, dilated cardiomyopathy
Severe ventricular dysfunction secondary to valve disease
Diastolic dysfunction due to restrictive/hyperrophic cardiomyopathy
Heart failure secondary to congential heart disease

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26
Q

Patient criteria for heart transplant?

A

NYHA class 4, low EF aand less than 1 year to live

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27
Q

Type 1 hypersensitivity and examples?

A

IgE/Mast cell mediated against antigen

Anaphylaxis

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28
Q

Type 2 hypersnsitivty and examples?

A

Antibody and completement mediated via MAC

e.g. transfusion reactions, autoimmune haemolytic anaemia, goodpastures, rheumatic heart disease

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29
Q

Type 3 hypersensitivty and examples?

A

Antibody-antigen immune complex deposition in e.g. kidneys, joints, vessels
e.g. SLE, extrinsic allergic alveolitis

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30
Q

Type 4 hypersensitivity and examples?

A

Delayed T cell hypersensitivty

e.g. Hashimotos, contact dermatitis, chronic transplant rejection, Mantoux

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31
Q

Mantoux test is an example of which kind of hypersensitivity reaction?

A

type 4 - delayed T cell

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32
Q

Type 5 hypersensitivty and examples?

A

Autoantibodies e.g. Graves

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33
Q

Define inflammation and its features?

A

Body’s stereotypical response to tissue injury - innate and immediate and characterised by heat pain redness swelling and loss of function

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34
Q

Stages of acute inflammation?

A

Vasoconstriction (white) then vasodilation (red)
Increased vascular permeability
Migration of neutrophils through vessel walls
Phagocytosis
Resolution or progression

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35
Q

4 kinds of chemical mediators of inflammation?

A

Substances stored and released by cells - histamine, serotonin
Produced by cells in response - interleukins, TNF etc.
Produced in plasma in response - plasmin, bradykinin
Pre-existing cascades - complement, fibrinolytic system, coagulation cascade

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36
Q

What part of the immune system is the complement cascade?

A

Innate

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37
Q

3 pathways of activation in compleemnt cascade?

A

Classic
Alternative
Lectin - MBL

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38
Q

5 outcomes from acute inflammation?

A 
Resolution
Progrsesion to chronic
Organisation and repair - scar
Death
Abscess formation/supparation
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39
Q

Define chronic inflammation?

A

Active inflammation, tissue injury and healing all at same time (simultaneous destruction and repair)

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40
Q

What is a granuloma?

A

Collection of epithelioid macrophages

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41
Q

What is granulomatous inflammation?

A

Chronic inflammation characterised by epithelioid macrophage that can fuse to form Langerhans giant cells

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42
Q

Classifications of granulomatous inflammation?

A

Non-caseating e.g. Crohns

Caseating e.g. TB

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43
Q

Immediate, early and late complications of central lines?

A

Immediate - haematoma, haemorrhage, pneumothorax, haemothorax, arrhythmia, right atrial perf, tamponade, air embolus
Early - Chylothorax, blockage, pseudoaneurysm
Late - catheter fracture, infection, thrombosis, vascular erosion, vascular stenosis

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44
Q

Where do you put IJV central line?

A

Compressible jugular vein next to incompressible pulsatile carotid, at level of C4 (upper border of thyroid cartilage)
Insert at medial border of SCM aiming towards ipsilateral nipple at 30 degree angle

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45
Q

Describe Seldinger technique?

A 
Needle into vein
Guidewire into needle
Dilator over guidewire
Dilator out
Catheter over guidewire
Guidewire out
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46
Q

Confirming position of IJV catheter?

A

Tip should be in SVC just above entry into right atrium
Confirm w US
Transduce pressure to demonstrate venous waveform
CXR

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47
Q

Site of insertion for subclavian line?

A

Middle of clavicle just underneath aiming towards jugular notch

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48
Q

Things traversed through for subclavian line insertion?

A 
Skin
Subcut tissue and fascia
Pectoralis major
Subclavius muscle
Subclavian vein
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49
Q

CVP is a measure of preload, afterload or cardiac output?

A

Preload

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50
Q

What causes shift in Starling curve to the right/down?

A

Decreased cardiac motility - e.g. failure, ischaemia

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51
Q

What causes shift in Starling curve to left and up?

A

Increased cardiac motility - e.g. inotropes or adrenaline

52
Q

Parts of the CVP trace?

A

A - wave- atrial contraction
C - wave- bulging of tricuspid into atrium at start of ventricular systole
V - wave - venous return to right atrium
X - descent - atrial relaxation during ventricular systole
Y - descent - opening of tricuspid valve

53
Q

Which side is presferred for IJV insertion and why?

A

Right IJV because more straighter and more direct into RA

54
Q

How to review a non-flushing central line?

A

Review patient, notes and insertion note
Examine line and ensure no kinking/compression
Cough and breathe deeply as you flush
Anti-thrombolytic flush

55
Q

Why would you aim to insert chest drain just anterior to mid-axillary line?

A

To avoid long thoracic nerve of Bell

56
Q

Differentials for shock in epidural post op patients?

A

Distributive shock secondary to epidural
Post op hypovolaemia/haemorrhage etc
Intrathecal injection resuling in high spinal
LA toxicity

57
Q

How are epidural and spinal anaesthetics different?

A

Epidurals produce nerve root block around the area of insertion e.g. T2-6 at T3/4 blockade
Vs Spinal which acts more like a transection

58
Q

Why may thoracic epidurals influence haemodynamics and respirationy?

A

Respiration via intercostal nerves

Haemodynamics via sympathetic blocakde

59
Q

Where is the thoracic symp innervation to the heart?

A

T1-5

60
Q

Pathology of compartment syndrome?

A

Increased compartment pressure causes increased venous pressure and obstruction of venous return, reducing AV pressure gradient, less capillary tissue perfusion and tissue necrosis

61
Q

What pressure measurment is suggestive of compartment syndrome?

A

Difference of 30mmHg or less between diastolic BP and compartment pressure

62
Q

What is the mechanism of rhabdomyolysis causing renal failure?

A

ATN - likely toxic myoglobin

63
Q

Cytological features of malignancy?

A

Increased number of mitotic figures
Abnormal mitoses
Hyperchromatism - dark nuclei due to DNA concentration
Pleomorphism - varied size/shape of cell + nucleus
Increased nuclear:cytoplasmic ratio

64
Q

Disadvantages of histology over cytology?

A

More invasive
More expesnive
Reuquires specialist analysis and takes longer to report
May seed malignant cells
May alter appearance of area for subsequent imaging

65
Q

Most common benign thyroid tumour?

A

Follicular adenoma

66
Q

Which thyroid tumour is most likely to feature haematological metastasis?

A

Follicular carcinoma

67
Q

Features of MEN 1?

A

Pituitary cancer - prolactinoma
Parathyroid hyperplasia
Pancreatic iselt cell tumour e.g. gastrinoma

68
Q

Featurse of MEN 2A?

A

Medullay thyroid carcinoma
Phaeochromocytoma
Parathyroid hyperplasia

69
Q

Features of MEN 2B?

A

Medullary thyroid cancer
Phaeochromocytoma
Muscosal neuromatosis
Marfanoid body habitus

70
Q

Define a clot?

A

Mass formed ffrom constituents of blood, in static blood

71
Q

What is the difference between a clot and a thrombus?

A

Clot is formed in stationary blood

Thrombus is formed in flowing blood

72
Q

Virchows triad contributing to thrombus formtion? Examples of each?

A

Abnormal blood flow - e.g. AF, stasis (limb or prolonged surgery) aneurysms/stens/valves
Hypercoagulable state- e.g. APLS, Protein C/S def, COCP, trauma, surgery, dehydration, malignancy, Factor V leiden
Endothelial injury e.g. dissection or other vessel wall injury

73
Q

4 cancers presenting with haematuria?

A

Renal
Ureter
Bladder
Prostate

74
Q

Most common type of renal cancer? Alternatives?

A

RCC - clear cell (most common), papillary, chromophobe)

TCC, medullary carcinoma, carcinoma of collecting ducts are rarer

75
Q

Features of Von Hippel Lindau?

A 
AD condition
Renal cell carcinoma
Phaeochromocytoma
Pancreatic neuroendocrirne
Retinal angioma
CNS haemangioblastomas
76
Q

Management of bladder carcinoma in situ?

A

Cystoscopy and biopsy +/- TURBT for any visible lesions
Intravesical BCG as its normally diffuse
Radical cystectomy is a surgical intervention

77
Q

Types of cryptorchidism?

A

True - maldescended, along usual site of descent e.g. abdominal inguinal or suprascrotal
Ectopic - prepenile, perineal, femoral etc.

78
Q

Management of post pubertal patient with cryptorchidism and contralateral normal testicle?

A

Orchidectomy - increased risk of cancer

79
Q

3 types of testicular tumours and subtpes?

A

Seminoma and NSGCT

Sex cord stromal tumours e.g. leydig/sertoli

80
Q

What is a teratoma?

A

Tumour (neoplasm) consisting of all 3 germ cell layers, able to differentiate into any tissue

81
Q

What 2 markers do teratomas commonly secrete?

A

BHCG

AFP

82
Q

What marker may seminomas secrete? What do they not secrete?

A

BHCG

Not AFP

83
Q

How does raised BHCG cause gynaecomastia?

A

Stimlulates LEydig cells like LH to produce testosterone nd oestrogen

84
Q

What is a chroiocarcinoma?

A

Carcinoma producing BHCG

Type of NSGCT in men, or seen in e.g. molar pregnancies in women

85
Q

Histological features of malignancy?

A 
Loss of normal architecture
Invasion of basement membrane
Neovascularisation
Necrosis
Haemorrahge
Lymphovascular infiltration
Cell shedding
86
Q

Layers of the scrotum to testicle?

A 
Skin
Dartos fascia and muscle
External spermatic fascia
Cremasteric fascia
Internal spermatic fascia
Tunica vaginalis
Tunica albuginea
87
Q

Most common site for ectopic ball?

A

Inguinal canal

88
Q

Management of neonatal cryptorchidism?

A

Leave til 6 months to give chance to descend

Then orchidopexy between 6-18 months old if not down by then

89
Q

Benefits of orchidopexy for cryptorchidism?

A

Makes detecting cancer easier

Possible lessens risks of cancer and infertility

90
Q

What kind of testicular tumour may radiotherapy be useful for?

A

Seminoma

91
Q

Define metastasis?

A

Survival and growth of cells at a site distant to their primary origin

92
Q

Most common kind of melanoma?

A

Superficial spreading

93
Q

Most aggressive kind of melanoma?

A

Nodular

94
Q

5 types of melanoma?

A 
Superficial spreading
Nodular
Acral lentiginous
Amelanotic
Lentigo maligna melanoma
95
Q

Which type of melanoma is more common in black/asians?

A

Acral lentiginous

96
Q

Melanoma resection margin recommendatinos by stage?

A

0 - 0.5cm
1 - 1cm
2 - 2cm

97
Q

Different types of wound healing?

A

Primary - direct opposition
Secondary - left open and not formally closed, by tissue contracction and re-epitheliasition
Tertiary - delayed primary closure

98
Q

What is Bowen’s disease?

A

Premalignant condition - SCC in situ, red asymmetrical plaque often seen on legs

99
Q

What patholgy technique may be useful in melaonma detection vs non-melaonma?

A

Immunohistochemistry - S-100

100
Q

3 word definition of DIC?

A

Pathological consumptive coagulopathy

101
Q

How much 0.9% saline stays in intravascular compartment?

A

1/3-1/4

102
Q

How much dextrose stays in intravascular compartment?

A

1/9

103
Q

What is a branchial cyst?

A

Branchial pouch remnant (failure of involution)

104
Q

Where are branchial cysts found and how do they present?

A

Anterior to upper 1/3 of SCM - anterior triangle

Usually present in 2nd-3rd decades as a firm swelling, can get infected

105
Q

What is suggesitve of branchial cyst on FNA?

A

Cholesterol rich fluid

106
Q

Management of branchial cysts?

A

Conservative
Or surgical if painful, recurrent infection, mass effect or cosmetic
Don’t operate whilst active infection

107
Q

What causes thyroglossal cyst?

A

Remnant of thyroglossal duct - embryological descent of thyroid gland from origin at base of tongue through foramen caecum, usually obliterated after this

108
Q

Are thyroglossal cysts always midline?

A

No, can be just to side

Also can rapidly enlarge if infected

109
Q

Differentials for thyroglossal cyst?

A

Thyroid lesion
Sebaceous cyst
Dermoid cyst
Lymph node

110
Q

Operation name for thyroglossal cyst excision? What is removed and why?

A

Sistrunk procedure

Cyst itself and hyoid bone (reduces recurrence rate)

111
Q

What is seen on histology of thyroglossal cyst?

A

Lymphoid tissue, occasionally ectopic thyroid tissue

112
Q

Why is pre-op US and bloods important for thyroglossal cyst?

A

Ensure there is a normally functioning thyroid - occasionally this contains the only normally functioning thyroid tissue in the body

113
Q

What is a dermoid cyst?

A

Benign tumour of mature tissue arising from ectoderm in embryonic development, with squamous keratinising epitheliumc containing skin structures such as hair/sweat glands/teeth

114
Q

Most common sites for congenital dermoid cyst?

A

Midline of nose, neck or trunk

Medial and lateral aspect of eyebrows

115
Q

Why is caution advised in congenital dermoid cyst removal?

A

May communicate with deeper structures

116
Q

What is a sebaceous cyst?

A

Epidermoid or pilar (hair follicle) cysts containing keratin

117
Q

Management of submandibular abscess?

A 
A-E assessment including airway, floor of mouth
Fibreoptic nasendoscopy to assess airway
OPG if poss (dentition)
IV antibiotics e.g. amox and met
OMFS team review
118
Q

What can submandibular abscess progress to? What is this?

A

Ludwigs angina
Spreading cellulitis of soft tissues of neck and floor of mouth causing posterior displacement of tongue and potentially airway obstruction

119
Q

What is a cystic hygroma and where is it normally found? Age?

A

Congential cystic malformation of lymphatic system
Usually in posterior triangle of neck
Usually found within first 2 years of life

120
Q

Management options for cystic hygroma?

A

Aspiration and injection with sclerosing agent

Surgical excision

121
Q

Where are pharyngeal pouches found? What is it?

A

Diverticulum through Killian’s dehiscence, which is between the upper and lower portions of the inferior constrictor muscle (between thyropharyngeus and criicopharyngeus)

122
Q

Demographics of pharyngeal pouch? Presentaiton?

A

Older men usually
May or may not have neck lump, may gurgle
Regurgitation, hallitosis, weight loss, chronic cough

123
Q

Ix of choice for pharyngeal pouch?

A

Barium swallow

124
Q

Management of pharyngeal pouch?

A

Conservative

Or endoscopic stapling/external approach excision

125
Q

General principles for assessing neck lump?

A

Full ENT exam incl LNs and direct (fibreoptic nasendoscopy) or indirect (mirror) laryngoscopy
FNA or core biopsy, under US guidance if needed

126
Q

Differentials for neck lump by location?

A

Superficial - sebaceous cyst, lipoma, abscess
Anterior triangle - branchial cyst, thyroglossal cyst, thyroid swelling, dermoid cyst, submandibular pathology, carotid body tumour, LNs
Posterior triangle - pharyngeal pouch, cystic hygroma, LNs
Within SCM - sternocleidomastoid

127
Q

Differentials for cervical LNs?

A 
Infectious - dental, tonsils, ENT, face/scalp, cat scratch etc
Viral, CMV EBV HIV etc
Toxoplasmosis
Haemo - lymph/leukamiea
Ca - primary/mets
Sarcoid

MRCS Part B - Paul Edit (29 decks)

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