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MRCS part B > Pathology deck > Flashcards

Pathology deck Flashcards

1
Q

Define amyloidosis

A

Improper collection of Beta pleated sheets of amyloid protein in the extracellular matrix. It is a life-threatening condition as humans lack the enzyme to break down this protein structure

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2
Q

How do you classify amyloidosis

A

Al - congenital and primary
This is caused by clonal proliferation of plasma cells producing this amyloid immunoglobulin

AA - secondary to chronic inflammation (in RA, IBD, TB, bronchiectasis, renal cell carcinoma)
Inflammation forces macrophages to secrete interleukin that then stimulates hepatocytes to produce amyloid protein A.

ATTR - autosomal dominant and most commonly affected protein is tranthyretin

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3
Q

What are the clinical features of AL amyloidosis

A

Kidneys: Proteinuria and nephrotic syndrome
Cardiac: Restrictive cardiac disease and arrythmias
Nervous system: Peripheral and central symptoms
GI: Malabsorbtion, bleeding, obstruction and perforation
Vascular: purpura

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4
Q

Clinical features of AA amyloid

A

Hepato and splenomegaly and proteinuria

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5
Q

How is amyloid diagnosed

A

Tissue biopsy
Subcut fat or rectal tissue is regarded as the best sample
Isotope scanning can also show hot spots of amyloid deposits

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6
Q

How is amyloidosis managed

A

AA can be controlled if underlying inflammation is controlled

AL needs chemo and eradicating abnormal plasma cells

Stem cellls

Supportive tx

It has poor survivial and the median survivial rate is 1-2 years

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7
Q

In the thyroid, what cancer causes amyloid deposition

A

Meduallry as amyloid is composed of calcitonin

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8
Q

Where can isolated amyloid deposits be found

A

Larynx
Anwhere in the urinary tract
Aorta
Pituitary

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9
Q

Amyloid microsopy

A

Congo red stain shows apple gree birefingence under polarized light

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10
Q

What is the pathogenesis of calcification of the aortic valve in aortic stenosis

A

Lipid accumulation, inflammation and clacification

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11
Q

What are the symptoms of aortic stenosis

A

Syncope, angina and dyspnoea. The symptoms may not present until they are life-threatening and hence patients can also present with sudden cardiac death

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12
Q

How would you investigate for aortic stenosis

A

ECG, ECHO, CT angio, cardiac CT/MRI and exercise tolerance test

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13
Q

Aortic sclerosis vs aortic stenosis

A

Sclerosis is calcification of the valve without a significant gradient across the valve, this may progress into aortic stenosis

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14
Q

Do patients that undergo routine aortic valve replacement need prophylactic abx

A

No, I would consult the nice guidelines but the only exception to this would be if a patient was having a contaminated surgery, then abx to cover for those bacteria would be considered

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15
Q

What are organisms that commonly cause IE

A

HACEK organisms Strep Viridans and groups B and D, staph auerus (most common), Candida, enterococci, Pseudomonas aueriginosa

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16
Q

What is the definition of AKI

A

Abrupt reduction in GF resulting in the reduction in the ability of the kidneys to excrete nitrogenous waste. This is reflected by a rise in serum creatinine and urea

Biochemical cutoff is an increase in serum creatinine of 1.5-2x

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17
Q

Over what timescale does AKI normally develop

A

48 hours

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18
Q

What is a normal U and Cr

A

U 2.5-7.8 mmol/L
Cr 60-110 mcrmmol/L for men and 45-90mcrmmol/L for females

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19
Q

Emergency management of pulmonary oedema

A

ABCDE approach
Stop IV fluids
Sit the patient up
Oxygen
furosemide
Consider HF
CXR

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20
Q

What is normal urine output

A

0.5ml/kg/hr for adults and 1 for child

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21
Q

Define oliguria

A

<0.5ml/kg over a 6 hour period or <400mls over a 24 hour period

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22
Q

What is the most common cause of anuria in a surgical patient

A

Blocked catheter

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23
Q

In which decade is appendicitis most common

A

Second decade of life 10-20, slightly more common in males 1.4:1

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24
Q

In what positions can appendix be found

A

Retrocaecal 75%
Pre and post ileal 5%
Pelvic 20%

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25
Q

What are the boundaries of the foregut, midgut and hindgut

A

Foregut: mouth to 2nd part of du
Midgut: 2nd part of duo to 2/3rd the way of transverse colon
Hindgut: End of midugut to rectum

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26
Q

What is the obturator sign

A

Pain on flexion and internal rotation of the hip joint, this irritates the obturator internus

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27
Q

Through which general visceral nerve does the pain of appendicitis travel

A

Lesser splanchnic nerve, T10 and T11 is the root value

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28
Q

Scoring systems used for appendicitis

A

Alvarado and Appendicitis inflammatory response score

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29
Q

What are the types of acites

A

Transudative and exudative:
Transudate is protein <25g/mL
Exudate is >25g/mL protein

SAAG
Serum albumin and ascites albumin gradient
<11 exudative low gradient §
>11 is transudative highgradient

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30
Q

Give some examples of transudates

A

Portal hypertension caused by liver cirrhosis, portal vein thrombosis, budd chiari syndrome

Low albumin production: Liver impairment, starvation and nephrotic syndrome

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31
Q

Give some examples of exudates

A

Caused by inflammation and infection resulting in protein loss
4Ps
Peritonitis
post-irradiation
peritoneal mets
pancreatitis

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32
Q

How does acites form, with respect to the starling equation

A

The starling equation represents the movement of fluid across blood vessels and the interstitium with respect to hydrostatic and oncotic pressure

Blood moves from arteries to cap and then to veins

In the artery, hydrostatic pressure is higher than oncotic pressure and hence net movement of fluid is into the interstitium
In the vein, hydrostatic pressure is lower than the oncotic pressure and hence fluid is pulled back in, rest of the fluid is carried by the lymph

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33
Q

What is Rh

A

Symmetrical autoimmune inflammation of the joints with systemic manifestations. Commonly more females are affected than males. RH+ve in 70% of cases

5th or 6th decade is the most common decade of presentation

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34
Q

What is the pathology of RH

A

Joint effusions and inflammation, increase in the number of T cells and macrophages. Formation of granulation tissue and

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35
Q

What are some extra-articular manifestations of Rh

A

Nodules
Lymphadenopathy
Vasculitis

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36
Q

What are rheumatoid nodules

A

Most commonly seen on extensor surfaces
Seen in 20% of patients with RA
Accumulation of collagen with a central area of necrosis and surrounding cells including fibroblasts and macrophages

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37
Q

What happens on a radiograph of a joint with Rh

A

Loss of joint space and erosions, joint swelling, juxta-articular osteopenia

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38
Q

Define atherosclerosis

A

It is the thickening of vasculature as a result of buildup of fatty tissue on the inside of the vessels

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39
Q

What is the pathogenesis of atherosclerosis

A

It begins due to endothelial dysfunction. Then there is macrophages that form foam cells with a lipid-rich core.

Secondly, there is migration of smooth muscle cells to form a fibrous cap

This process ultimately leads to stenosis and can lead to obstruction of the lumen of the vessel. This leads to thrombosis or possible infarction of the tissue supplied by the vessel

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40
Q

How do tamsulosin and finasteride work

A

Finasteride: 5 alpha-reductase inhibitor and prevents the conversion of testosterone to dihydrotestosterone and hence reduces the size of the gland

Tamsulosin: Alpha 1 adrenergic receptor antagonist and relaxes smooth muscles to make urinary flow better

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41
Q

What is a fibroadenoma

A

Proliferation and collection of epithelium and stromal tissue of the duct lobes
Well rounded, oval shaped and mobile
Most common site is the upper and outer quadrant of the breast
Can be multiple and bilateral

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42
Q

How do you score the breast triple assessment

A

1-5 5 being malignant and 1 besing normal

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42
Q

What are breast cysts

A

They are distended, fluid-filled involuted lobules that develop in peri-menopausal females
They can be single or multiple and often present as smooth discrete lumps that are painful
Mammography and USS to confirm diagnosis, if aspirations are blood stained then patient needs triple assessment

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43
Q

What causes true mastalgia

A

Caused by an exaggerated response of breast tissue to hormones in menstruation
First line is OTC meds and soft fitting bra while sleeping

a secondary referral is then required and a medication called danazol that is an anti-gonadotrophin agent can be used

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44
Q

What is Mondor disease

A

Thrombophlebitis of the superficial veins of the breast and chest wall. Treatment os conservative with OTC pain meds and it can take months to heal

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45
Q

When is gestational nipple discharge the most common

A

2nd trimester

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46
Q

What is the commonest malignancy of the biliary tree

A

Cholangiocarcinoma: It is an adenocarcinoma of the epithelial lining of the bile duct

Commonest cause in the west is PSC followed by Hep C, HIV and congenital liver disease

In developing worlds it is most commonly caused by liver flukes

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47
Q

What is a klatskin tumour

A

A specific tumour originating at the junction of the left and right hepatic ducts

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48
Q

Any specific tumour markers for cholangiocarcinoma

A

CEA, CA19=9

Most tumours present when they are unresectable and hence patients are offered best supportive care.
Disease recurrence rates are also very high

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49
Q

What are the most common types of bladder cancer

A

Transitional and squamous cell carcinoma
Squamous cell carcinoma is more common in Africa due to present of Schisto H

In developing countries, 70% are SCC

Others include adenocarcinoma, small cell, sarcoma and secondary met

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50
Q

What are the surgical management options for bladder cancer

A

TRansurethral resection of bladder tumour, this is the most common
partial cystectomy: rarely offered
radical cystectomy: Involved removal of the bladder and the urethra and lymph nodes. In men, prostate, seminal vesicles and vas deferens are also removed

Intravesical mitomycin C chemo or BCG immunotherapy

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51
Q

Disinfection vs sterilization

A

Disinfection removes a number of viable organisms but not all. Sterilisation removes all including spores

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52
Q
A
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53
Q

Changes for hypokalaemia

A
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54
Q

What is the scoring system for NEC FASC

A

LRINEC

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55
Q

Types of nec fasc

A
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56
Q

What is clostridium

A

Gram positive, rod shaped, spore forming, anaerobic commonly found in soil, clothing and faeces

Perfringins, tetani, botulinum, difficile

In mild to moderate disease can give oral metro or vanc
In severe: oral vanc or oral fidoxamicin

IV immunotherapy or faecal transplant may be required in very severe cases

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57
Q

How are FAP and HNPCC inherited

A

Both are autosomal dominant
FAP: APC on Ch5
HNPCC: mutations on CH 2 and 3

APC gene mutation that then causes a mutation in KRAS and DCC and finally p53 tumour suppressor gene

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58
Q

Where does colorectal cancer predominantly metastasize to

A

Brain, bone, lung and liver

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59
Q

What types of liver tumours are there

A

Benign: Hemangioma, adenoma
Malignant: HCC, Cholangiocarcinoma, angiosarcoma, hepatoblastoma
Secondary: Metastasis (This is the most common type)

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60
Q

What is H.pylori

A

Gram-negative bacterium found in the stomach
It uses flagella to move away from acidic contents in the stomach and survive

It produces the enzyme urease that converts urea to CO2 and Ammonia. The ammonia then binds to the H+ to neutralise the gastric acid

it releases certain protease and along with the ammonia, erode the gastric contents

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61
Q

What is the lifetime risk of developing a peptic ulcer with H pylori

A

10-20 %
1-2% of the time H pylori is associated with gastric mucosa

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62
Q

How can H Pylori be diagnosed

A

Carbon 13 breath test or stool antigen
CLO test on a gastric mucosa sample but this depends on the urease production

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63
Q

What is the H Pylori eradication therapy

A

Twice daily for 7 days of PPI + amox + Metro/clarithromycin
If pen allergic then PPI + Clar + met

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64
Q

FACT

A

Thymus also develops from the 3rd pharyngeal arch and hence it may drag the inferior parathyroids down with it

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65
Q

What does normal parathyroid tissue contain

A

Chief cells and oxyphil cells

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66
Q

What are the gell and coombs hypersensitivity reactions

A
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67
Q

What are the contributors to an infection

A

Infectious agent, susceptible host and a poorly perfused area

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68
Q

Name to fungi that cause abscesses and sinuses

A

Histoplasma and candida

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69
Q

What are the common factors that create a good environment for infection

A

hypoxia, hypercapnia, poor perfusion, acidosis

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70
Q

What is the qSOFA score

A

Altered mental state/ GCS
RR >22
SBP <100

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71
Q

What is Rheumatic fever

A

Disease affecting the heart, joints, skin and bones. It can develop 2-4 weeks after an unrelated pharyngeal infection A beta-haemolytic streptococci.
It is a type 2 hypersensitivity reaction
It is uncommon in the west but still common in developing countries

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72
Q

What are the properties that you look for in a drape

A

Breathable, non-inflammable, can handle cold, hot and wet stresses
accept or dissipate electrical current
Non-toxic

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73
Q

What are the risk factors of developing thyroid cancer

A

being female
radiation
FHx
Obesity
history of goitre

20-25 % of medullary is familial and papillary and follicular is more sporadic with only 5-10% being familial

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74
Q

What are the causes of hypoparathyroidism

A

Thyroid surgery
Autoimmune
Post irradiation

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75
Q

What is a nevus

A

A benign proliferation of normal constituent cells of the skin

Spitz nevus, shagreen patch, port wine stain, Strawberry neveus

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76
Q

Is melanoma more common in males or females

A

50-50

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77
Q

How can you tell a melanoma

A

Irregular shape and multicoloured
growing rapidly
Change in size or sensation

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78
Q

What is more common UC or Chrons

A

UC

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79
Q

What are the extraintestinal manifestations of UC and chrons

A

Aphthous ulcers

Pyoderma gangrenosum
Iritis
Erythema nodosum

Sclerosing cholangitis
Arthritis
Clubbing of fingertips

A PIE SAC

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80
Q

What are the different kinds of necrosis

A
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81
Q

What is the difference between apoptosis and necrosis

A
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82
Q

What are 2 pathological examples of hyperplasia

A

BPH and adrenal glands in cushings syndrome

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83
Q

What are 2 physiological and 2 pathological causes of hypertrpphy

A

Physio: Uterus in preg and skeletal muscles on exercise
Path: Thyroid in graves disease and cardiomopathy

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84
Q

What is a hamartoma

A

Tumour like malformation due to disorganised arrangement of different amounts of normal cells
Eg: Peutz Jeghers polyps, hemangiomas

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85
Q

What is the difference between carcinoma and sarcoma and their spread

A

Carcinoma is abnormal growth of epithelial tissue and sarcoma is connective tissue
Carcinoma spread through lymph and sarcoma spread through blood

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86
Q

What cancers typically spread to the bone

A

Breast, Prostate, renal, thyroid, bronchus

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87
Q

What are the stages of acute inflammation

A

Vasoconstriction initially and then vasodilation
Increased vascular permeability
Migration of white blood cells
Phagocytosis
resolution or progression to chronic inflammation

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88
Q

What is the complement cascade

A

It is a part of the innate immune response that aids in development of membrane attack complexes.

Classic activation involved antigen and antibody binding
Alternative pathway is when c3 comes in direct contact with micro-organisms
Lectin pathway

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89
Q

What is a granuloma

A

Collection of epitheloid macrophages
Granulomatous inflammation is type of chronic inflammation that is caused by the presence of above mentioned cells as they form giant cells

Caseating: TB
Non caseating: sarcoid, chrons

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90
Q

Define a clot

A

A collection of solid material formed by the constituents of bloods

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91
Q

What is an embolus

A

A collection of undissolved material that partially breaks off and is carried from one place to another

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92
Q

What leads to the development of thrombus

A

Virchows triad: Abnormal blood flow, hypercoagulable state and endothelial injury

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93
Q

What are the benefits of cytology

A

Cheap and easy with quick result
Minimally invasive procedure to get sample

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94
Q

How do you diagnose IE

A

2 major criteria or 1 major and 3 minor on the Dukes criteria

Major
2 separate + blood cultures with IE organisms
Evidence of endocardial involvement

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95
Q

How do you diagnose rheumatic fever

A

2 major criteria or 1 major and 2 minor according to the Modified Jones criteria

Major (CEPS)
Carditis
Erythema marginatum
Polyarthritis
Sydenhams chorea

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96
Q

Why is IE so hard to treat

A

The valves of the heart do not recieve specifi blood supply and hence this makes it harder for immune cells and antibiotics to get through

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97
Q

What are the possible benefits of the use of tumour markers

A

Screening
Diagnostic
Measuring response to treatment
Monitoring for reccurence

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98
Q

What is the difference between staging and grading

A

Staging is describing the extent of the tumour based on size, spread.
Grading is describing differentiation of the tumour based on histology

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99
Q

Can you name some staging methods

A

Dukes
Clarkes
Breslow
TNM

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100
Q

What is the Dukes staging

A

For Colorectal cancer

A - confined to bowel wall (95-100 survival)
B - through bowel wall (65-75)
C- lymph nodes (30-40)
D - Distant mets (5-10)

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101
Q

What is a grading system that you know if

A

Gleason score for prostate cancer
2-10

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102
Q

What is the differnece between submandibular calculi and parotid calculi

A

Parotid tend to be multiple and small and within the gland
Submandibular tend to be large and single and intraductal

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103
Q

What % of salivary glands are radio-opaque

A

80-90% of the submandibular stones and 60% of parotid

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104
Q

Parotid gland tumours

A

85% benign - pleomorphic adenoma and Warthins tumour

15% malignant: Mucoepidermoid carcinoma and adenoid cystic carcinoma

105
Q

What is actinic keratoses

A

It is a pre-malignant skin condition caused by UV exposure. It can progress to SCC

106
Q

What are the histological features of squamous cell carcinoma

A

Atypical squamous cells, keratin pearls and invasion of dermis

107
Q

When should patients have sutures removed

A

Face: 5 days
Scalp: 7 days
Trunk: 10-14 days
Limbs: 10-14 days

108
Q

What is the benefit of using lidocaine with bupivocaine

A

Lidocaine has a quick onset of action but does not last as long
Using it with bupivocaine that oes last long can have an LA that has a quick onset and also lasts long

109
Q

When would you refer a patient for an OGD with epigastric pain

A

Urgent
- dysphagia
- upper abdominal mass
Aged over 55 or over with weigth loss and any of the following: upper abdo pain, reflux and dyspepsia

Non-urgent
Haematemesis
Dyspepsia tx resistant
Upper abdo pain and low Hb
Raised platlet count
NV

110
Q

Is H.Pylori more associated with gastric or duodenal ulcers

A

Duodenal more than gastric

111
Q

What are bilroth 1 and 2 operations

A

Bilroth 1: Anastomosis with the gastric remnant and the duodenum
Bilroth 2: The Duodenum is oversewn and the gastric remnant is anastomosed with the proximal jejunum

112
Q

What is PSA

A

It is a glycoprotein ‘peptidase’ enzyme that is secreted by epithelial cells of the prostatte gland

it liquifies semen, allowing sperm to move freely and dissolve in the cervical mucus

It is elevated in certain prostatic disorders

113
Q

How frequently should you check the PSA post resection

A

6 weeks following treatment
Then every 6 months for the first 2 years and then once every year

114
Q

Is PSA is 7 6 weeks post op, what will one do?

A

PSA should fall within 2-3 days post resection.
It should be undetectable.
Raised PSA can mean disseminated prostate cancer

115
Q

What is the purpose of anti-androgen therapy in prostate cancer

A

It competitively binds to androgen receptors, preventing testosterone from further growing cancer cells

116
Q

What are mycobacterium

A

Non motile
Non sporulating
Usually aerobic
Weekly gram positive rods
Acid fast

117
Q

Name a mycobacterium other than TB

A

Mycobacterium avium

118
Q

What is Potts disease

A

Dissemination of TB into the bone causing pathological fractures.
Abscesses can also form and it can result in cord compression

119
Q

How is TB diagnosed

A

Active TB
1) Fluid sample sputum for ZN staining
2) PCT
3) CXR and CT scan

Latent
1) Quantiferon test
2) Monospot test

120
Q

How is TB treated

A

RIPE medications
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

These 4 drugs for atleast 2 months and RI for atleast 4 months

121
Q

What are the risk factors for prostate cancer

A

Age
Obestity
FHx
Ethinicity (afro-carribean)

122
Q

How do you define the Gleason score

A

Looking at histological pattern
1-5 for the first and second most common patterns
The score is out of 10

123
Q

What is the prostate utricle

A

It is the part of the prostate that he seminal vesicles open into

124
Q

How can wound healing be classified

A

Primary, secondary or tertiary intention

125
Q

What is healing by tertiary intention

A

Purposefully delayed closure of wounds, washed and debrided wound

126
Q

What are the stages of wound healing

A

Haemostasis (Immediate)
Acute inflammation (up to 3 days)
Proliferation (3 days - 3 weeks)
Maturation (3 weeks to 2 years)

127
Q

What is the most common benign thyroid tumour

A

Follicular adenoma

128
Q

What is the definition of a laparotomy

A

An incision that assesses the peritoneal region

129
Q

What layers are cut through in a laparotomy

A

Skin
Campers
Scarpas
Linea alba
Transversalis fascia
Extra peritoneal fat
Peritoneal

130
Q

What principles must be adhered to in abdominal incisions

A

Incision should allow plenty of access
It should have capacity to be extended
Muscles should be split and not cut
Nerve damage should be minimal

131
Q

What are the different kinds of incisions

A
132
Q

What is diethermy

A

Use of electricity to generate heat up to 1000 degree C. Can be used for cutting or coagulation

133
Q

What is cutting vs coagulation vs blend

A

Cutting: Continuous current and sinus wave form. Greater heat application
Coag: Pulsing current and square wave form. Heat produced is less.
Blend: Blend of the two above

134
Q

How are bone tumours classified

A

Benign or malignant
Primary or secondary

Soem benign bone tumours: Simple bone cyst, giant cell tumours

Some primary bone tumours: Ewings, Osteosarcoma, Chondrosarcoma, Multiple myeloma

135
Q

What is the most common type of benign bone tumour

A

Osteochondroma

136
Q

What is the most common type of primary and malignant bone tumour

A

Multiple myeloma
Osteosarcoma is the second most common type

137
Q

Which bone tumour has an onion skin appearance

A

Ewings sarcoma affecting the ages between 5 and 20

138
Q

What is important to take into account when doing a biopsy of a bone tumour

A

Care should be taken to take biopsies at limb salvage lines. It is the last step of the bone tumour work up and only the sugeon that is going to perform the operation should take the biopsy

139
Q

What are the 4 key components needed for a viable limb

A

Bone, blood vessels, nerves and adequate soft tissue envelope.
It 2/4 need to be taken then the limb can be salvaged, if 3/4 then salvage is not generally possible

140
Q

What are the indications for a heart transplant

A

Severely low EF
Low diastolic function
Low systolic function
Congenital abnormalities

141
Q

What are the different types of grafting

A

Auto - self
Allo - same species
Xeno - another species
Iso - identical twin

142
Q

What tumours are associated with HIV

A

Kaposi sarcoma and CNS lymphoma

143
Q

What genetic condition is associated with renal cell cancer

A

VHL

144
Q

What def can occur if ileum is resected just proximal the the IC valve

A

Vit B12 def.

145
Q

Difference between Osler nodes and Janeway lesions

A

Osler nodes are painful, tender nodules that are found primarily on the pads of the fingers and toes. Janeway lesions are painless, nontender, hemorrhagic nodular lesions seen on the palms and soles, especially on thenar and hypothenar eminences. Both lesions are rare in children with endocarditis.

146
Q

Most common valve to be affected in IVDU

A

Tricuspid valve

147
Q

What pathway does warfaring affect

A

extrinsic pathway

148
Q

What is the ross procedure

A

Borrowing healthy valve and moving it to the position of a damaged aortic valve

149
Q

What is the difference between a metallic heart valve and a normal tissue valve

A

Metallic will require warfarin and has a high risk of bleeding and thromboembolism. It is, however, easier to insert than a tissue valve

150
Q

What part of the vessel if affected in a GCA

A

Tunica media

151
Q

What is the mechanism by which corticosteroids cause osteoporosis

A

Reduced osteoblast activity
Increased osteoclast activity and bone resorbtion
Inhibition of sex steroids
Stimulation of renal calcium losses

152
Q

What is multiple myeloma

A

It is a lytic plasma cell bone tumour.
CRAB summarizes the most typical clinical manifestations of multiple myeloma, these being hypercalcemia, renal failure, anemia, and bone disease
Large amounts of IgG or IgA

153
Q

What are bence jones proteins

A

Monoclonal globulin proteins, light chains found in the urine

154
Q

What is the difference between dry gangrene and wet gangrene

A
155
Q

What is the cause for clubbing in lung cancer

A

several reasons given, however, mainly believed to be due to increased growth factors or platlets/ megakaryocytes dislodged into the nail bed

156
Q

What paraneoplastic syndrome does a Pancoast tumour costs

A

Increased ACTH leading to cushings syndrome

157
Q

How would you manage a patient that is MSRA positive

A

Mupirocin in the nose for 5 days pre-op
Hairwash with chlorohex on day 1 and day 5
Chlorohex skin and body wash for 5 days

158
Q

What are the mutations associated with insulinomas

A

MEN1, PTEN, DAXX mutations as well as mTOR signalling pathway

159
Q

What is a telomere

A

End DNA sequence on a chromosome that prevents degradation and also attachment to another chromosome

160
Q

MEN syndromes inheritance pattern

A

Autosomal dominant

161
Q

What is the appearance of pleomorphic adenoma on histology

A

Benign lesion that consists of epithelial and myoepithelial cells.

162
Q

What is anaplasia of cells

A

Lack of differentiation in the cell architechture

163
Q

What are the risk factors for developing a nasopharyngeal carcinoma

A

Gender: twice as common in males than in females
Most common ethnicity is Chinese and asian
High salt diet containing carcinogenic nitrosamines
EBV
Genetic
FH
Smoking

164
Q

What is the structure of an abscess

A

A large area of necrosis that is rimmed off by preserved neutrophils. Showing on scans as a ring enchanting lesion.

165
Q

Where are carcinoid tumours most commonly found

A

small intestine
appendix

They can also be found in the rectum, stomach and the lungs
They arise from enterochromaffin cells

Can commonly metastasize to the liver

166
Q

What do carcinoid tumours release

A

serotonin, prostaglandins, substance P, histammine

167
Q

Why does a person not really have symptoms of a carcinoid tumour unless it has metastasized to the liver

A

This is as most blood from the GI tract flows to the liver first and then to the rest of the body

168
Q

How do you diagnose a carcinoid tumour

A

5HIAA in the urine
Chromogranin in the blood

169
Q

What surgery would you offer somone with UC

A

Total colectomy as all the colon is susceptible

170
Q

What type of vit deficiencies do you have in IBD

A

ADEK

171
Q

What is the management of FAP

A

Prophylactic colectomy before the age of 25

172
Q

What is healing by secondary intention

A

Re-epithelialisation, granulation and contraction of the wound

173
Q

What is the oculocardiac reflex

A

Oculocardicac reflex (OCR; also known as the Aschner reflex or trigeminovagal reflex) is a reduction of the heart rate resulting from direct pressure placed on the extraocular muscles (EOM), globe, or conjunctiva.[1] The reflex is defined by a decrease in heart rate by greater than 20% following the exertion of the aforementioned eye pressure.[2] The reflex is mediated by the connection between the ophthalmic branch of the trigeminal nerve and the vagus nerve. Most commonly, the reflex induces bradycardia, though it has also been reported to cause arrhythmias and, in extreme cases, cardiac arrest.

174
Q

Where does GB cancer spread to first

A

The liver, commonly segments 4/5

175
Q

How do diverticula form

A

Increased intraluminal pressure due to exaggerated peristalsis secondary to low fibre diet. The nerves and blood vessels of the bowel lining are included in this outpouching

Faecal matter then gets lodged into these spaces leading to local inflammatory reaction and infection causing divertiulitis

176
Q

How does endometrial tissue get into the colon

A

Retrograde menstruation theory
Metastasis theory i.e via lymph and blood vessel channel

Look like chocolate cysts

177
Q

Can endometriosis increase the risk of cancer

A

Yes, especially ovarian (3-5 fold)

178
Q

What type of cancers can H.Pylori cause

A

Adenocarcinoma and MALT

179
Q

Why can we not use paraffin for histology

A

Paraffin takes weeks to embed into the tissues

180
Q

How do you interpret parathyroid adenoma histology

A

If there are chief cells then there is an adenoma and if there is oxyphil cells and then there is involution

181
Q

What are the different types of gastric carcinoma

A

Tubular adenocarcinoma: Made up of tubules
Papillary
Mucinous
Poorly cohesive
Mixed

182
Q

What is the lauren classification

A

Classification of gastric carcinomas
Intestinal: Slow growing and well differentiated, forms glands
Diffuse: Aggressive and invading, grows fast and can rapidly invade adjacent structures and become metastatic

183
Q

What is the borrmann classification of gastric cancers

A

It is a classification based on macroscopic appearance of the cancer
Polypoid
Fungating
Ulcerating
diffuse

184
Q

What paraneoplastic syndromes are associated with gastric cancer

A

Acanthosis nigracans and dermatomyositosis

185
Q

What is the dukes staging for colorectal cancers

A

A: Not through submucosa
B1: Not throught MP
B2: Through MP
C1: 1-3 nearby lymph nodes
C2: >4 LN
D: Distant mets

186
Q

What is the function of a thrombus

A

Healthy response to injury in order to prevent bleeding

187
Q

How do you differentiate a melanoma vs an SCC

A
188
Q

Breslow thickness chart

A

<1mm = 1cm
1-2mm = 1-2 cm
2-3mm = 2-3cm
4mm = 3cm

189
Q

What is the Virchow’s triad for thrombus formation

A

Endotheolial injury
Turbulant blood flow
Hypercoagulable state

190
Q

What is epitheliod melanoma

A

Melanoma with epitheloid and spindle cells

191
Q

What is a satellite lesion

A

Lesion of the melanoma that spreads around it. 2 cm or closer to the original lesion

192
Q

What are the genetic mutations associated with melanoma

A

BRAF, NRAS, NF1, KIT

193
Q

What are the treatment options for a BCC

A

Mohns
Excision and closure
Cryo
electrodissection

Topically you can use 5FU and imiquimod

194
Q

How would you manage MRSA

A

OP: Oral clinda, Amox, tetra
IP: Vanc, linezolid, clinda

195
Q

Define sickle cell disease

A

Sickle cell disease is a common hereditary hemoglobinopathy caused by a point mutation in β-globin that promotes the polymerization of deoxygenated hemoglobin, leading to red cell distortion, hemolytic anemia, microvascular obstruction, and ischemic tissue damage.

196
Q

What are some of the complications of sickle cell disease

A

Vaso-occlusive crisis
Sequestration crisis
Aplastic crisis
Chronic tissue hypoxia
Increased susceptibility to infections

197
Q

What is the mechanism of autosplenectomy

A

Mechanism of autosplenectomy? In early childhood, the spleen is enlarged up to 500 gm by red pulp congestion, which is caused by the trapping of sickled red cells in the cords and sinuses. With time, however, the chronic erythrostasis leads to splenic infarction, fibrosis, and progressive shrinkage, so that by adolescence or early adulthood only a small nubbin of Fibrous splenic tissue is left; this process is called autosplenectomy

Because of autosplenectomy with increased susceptibility of infection with encapsulated organisms

198
Q

What are the most common organisms affecting patients after a splenectomy

A

Streptococcus pneumoniae * Haemophilus influenzae * Neisseria meningitidis

199
Q

What is the mode of inheritance of autosomal dominant kidney disease

A

PKD1 and PKD2 genes

Pathogenesis of cyst formation? The cells of the renal tubules divide repeatedly until causing an outpocketing of the tubular wall with the formation of a saccular cyst that fills with fluid derived from glomerular filtrate that enters from the afferent tubule segment. Progressive expansion eventually causes most of the emerging cysts to separate from the parent tubule, leaving an isolated sac that fills with fluid by transepithelial secretion. This isolated cyst expands relentlessly as a result of continued proliferation of the mural epithelium together with the transepithelial secretion of sodium chloride and water into the lumen

200
Q

Why is there pain in PCKD

A

Because of the orang getting larger dragging on the pedicle as well as stretching the fibrous capsule

201
Q

What malignancy can occur in immunocompromised patients

A

Malignancy: this is 5 times greater than the normal population. Most commonly squamous cell carcinoma of skin, cervix, basal cell carcinoma’s, lymphoma and Kaposi’s sarcoma.

202
Q

Define cryptorchidism?

A

Cryptorchidism is a complete or partial failure of the intra-abdominal testes to descend into the scrotal sac and is associated with testicular dysfunction and an increased risk of testicular cancer

It can also lead to Infertility, inguinal hernia, testicular torsion

The cryptorchid testis carries a 3 to 5-fold higher risk for testicular cancer, which arises from foci of intratubular germ cell neoplasia within the atrophic tubules

203
Q

What are the risk factors for cryptorchadism

A

FH, Down syndromes, Low birth weight and premature birth and high abdominal pressure

204
Q

Types of germ cell tumors?

A
  • Seminomatous tumors
    o Seminoma
    o Spermatocytic seminoma
  • Nonseminomatous tumors
    o Embryonal carcinoma
    o Yolk sac (endodermal sinus) tumor
    o Choriocarcinoma
  • Teratoma
  • Sex Cord-Stromal tumors o Leydig cell tumor o Sertoli cell tumor
205
Q

What are the most common testicular tumours

A

Seminomas in the young and non-Hodgkins lymphoma in the old

206
Q

Why is it important to take multiple biopsies from the prostate glands

A

Prostatic cancer can be focal, so it’s important to take samples from different sites

207
Q

How to differentiate between rectum and prostate cells in a needle biopsy?

A

Using immunohistochemical marker (α-methylacyl-coenzyme A-racemase) (AMACR) * CEA (in rectal cells)

208
Q

What is the rationale in treating prostate cancer by bilateral orchidectomy?

A

Androgen deprivation

209
Q

Describe the lobes of the prostate gland

A
210
Q

What tissue is the wall of an abscess characteristically composed of?

A

Granulation tissue

211
Q

When would you give antibiotics in an abscess

A

Antibiotics are indicated if the abscess is not localised (e.g. evidence of cellulitis) or the cavity is not left open to drain freely

212
Q

What is the most common infective cause of granuloma formation

A

TB

213
Q

What is the most common cause of osteomyelitis in adults and in children

A

Exogenous from an open wound for example in adults
Haematogenous - Due to sepsis in children

214
Q

What is sequestrum

A

Dead bone that has become separated during the process of necrosis from normal or sound bone. It is a complication (sequela) of osteomyelitis

215
Q

What is an involcrum

A

Thick sheath of periosteal new bone surrounding a sequestrum

216
Q

What is the protein that is deposited in chronic OM

A

Amyloid AA

217
Q

Difference between gout and pseudogout on sampling

A
218
Q

Which thyroid cancer will not show Radioiodine update

A

Medullary thyroid cancer as its origin is from parafollicular C cells so it is not of a follicular origin

219
Q

What is the precursor of platelets

A

Megakaryocytes

220
Q

Extrinsic and intrinsic pathways

A
  • Intrinsic pathway is activated by vessel injury which will lead to activation of factor 12 * Extrinsic pathway is activated by tissue thromboplastin released by the damaged cells * APTT tests for intrinsic pathway * PT tests for extrinsic pathway and the common pathway
221
Q

What are the stages of bone healing

A

Hematoma formation (mass of clotted blood) at fracture site. Tissue in fracture site swells, very painful, obvious inflammation, and bone cells are dying.

Fibrocartilaginous callus develops over a 3 to 4-week period. This process involves * Capillary growth in the hematoma * Phagocytic cells invading and cleaning-up debris in injury site * Fibroblasts and osteoblasts migrating into site and beginning reconstruction of bone Note that the fibrocartilaginous callus serves to splint the fracture.

  1. Bony callus begins forming after 3 to 4 weeks after injury and is prominent 2 to 3 months following the injury. Continued migration and multiplying of osteoblasts and osteocytes result in the fibrocartilaginous callus turning into a bony callus.
  2. Remodeling. Any excess material of the bony callus is removed and compact bone is laid down in order to reconstruct the shaft. Remodeling is the final stage
222
Q

What is PVL staph auerus

A

Panton-Valentine leukocidin (PVL) is a cytotoxin produced by Staphylococcus aureus that causes leukocyte destruction and tissue necrosis. It is one of the β-pore-forming toxins. The presence of PVL is associated with increased virulence of certain strains (isolates) of Staphylococcus aureus. It is present in the majority of community-associated Methicillin Resistant Staphylococcus aureus

223
Q

What is the type of necrosis in HCV infection

A

Coagulative

224
Q

What is CRP and where it is produced

A

C-reactive protein (CRP) is a substance produced by the liver early in response to inflammation (acute phase reactant)
* It is not very specific, it isn’t unique to one disease * Can help to monitor disease progress and flares.

225
Q

Causes of DIC

A

Infection
Bleeding
Shock
Adenocarcinoma
Transfusion
Trauma

226
Q

When can you use protein C infusions

A

In DIC

227
Q

What are the different tests for varicose veins

A

Tap test, cough test and tourniquet test
And put the doppler at the SFJ and press the calf to hear a whoosh sound. If there is a retrograde whoosh then there is incompetence

228
Q

What is the composition of gallstones

A

Gallstones are crystallized deposits in the gallbladder or biliary tree that are made up of a mixture of cholesterol, calcium salts, proteins, mucin, and bile. The type of gallstone is determined by its main components:

Mixed pigmented stones is the most common

Cholesterol stones
These stones form when bile in the gallbladder has more cholesterol than bile salts can dissolve. They are usually found in people who have a genetic or environmental predisposition to bile that is supersaturated with cholesterol.

Black pigment stones
These stones are the result of hemolysis and are made up of calcium bilirubinate.

Brown pigment stones
These stones are associated with a bacterial infection or parasitic infestation of the biliary system

229
Q

What is a cyst and how does it differ from a pseudocyst

A

A cyst is an abnormal membraneous sac containing a gaseous, liquid or semisold substance
This differs from a pseudo cyst as pseudocysts lack epithelial or endothelial tissue

230
Q

What is a sinus

A

A sinus is a blind-ended sac lined by granulation tissue, Which abnormally connects an abscess to the skin

231
Q

What is a fistula

A

It is an abnormal connection between 2 epithelial surfaces. The most common fistula is an ear piercing

232
Q

What is a stoma

A

A surgical opening into a hollow viscus. It can be classified by anatomical site, temporary or permanent and the number of openings

233
Q

What is a diverticula

A

Abnormal outpouching of a hollow viscus

234
Q

What is the difference between a clot, a thrombus and an embolus

A

A thrombus is solid material formed by the constituents of blood in flowing blood. When formed in stationary blood, this is termed a clot
An embolus is an abnormal mass of undissolved material that is carried in the bloodstream from one place to another

235
Q

What is a hypersensitivity reaction

A

Abnormal host immune response to a particular substance

236
Q

What is a polyp

A

A mass of tissue arising from an epithelial surface

237
Q

What is metaplasia

A

Reversible change in one fully differentiated cell type into another fully differentiated cell type

238
Q

What is leukoplakia

A

It is a white plaque on the oral mucosa. Characteristically, these patches are not painful, irregularly shaped and slightly raised, can be scraped away

It is not always malignant and is classically characterised as a pre-malignant condition. . Patients are encouraged to stop smoking and reduce alcohol intake. This can progress to SCC in 5% of patients

239
Q

Where does malignancy from the tongue drain

A

The tip - submental
Anterior 2/3rd - submandibular
Posterior 1/3rd - deep cervical lymph nodes

240
Q

What is better in SCC of the head and neck region? Chemo or radio therapy

A

Radio

241
Q

What is a flap

A

It is a unit of tissue that is moved from a donor site to a recipient site and has its own blood supply

242
Q

What is your understanding of BRCA 1 and BRCA 2 genes

A

BRCA 1: Found on chromosome 17, associated with breast cancer, ovarian and fallopian tube cancer, Lifetime risk is 80%

BRCA 2: Ch13, slightly lower risk of cancer. It is also associated with pancreatic malignancy and malignant melanoma

These only account for about 2% of the breast cancer cases now

243
Q

What is the role of blue dye in sentinel node biopsies

A

Injected pre-op for detection of the lymph nodes
Tech 99 human colloid albumin
At surgery, sentinel lymph node biopsy is done either by blue dye or hand held gieger counter
Detection rate is 95% with these methods

244
Q

What are the levels of the axillary lymph nodes

A

Inferolateral to the pec minor is level 1
Post to pec minor is level 2
Superomedial to the pec minor is level 3

245
Q

Breast reconstruction

A

TRAM FLAP: Transverse rectus abdominis muscle flap, pedicled or free
DIEP - Flap baed on the deep inf epigastric perforator vessels
SGAP or IGAP: Sup and ing gluteal artery flaps

246
Q

Who should have radiotherapy post breast cancer resection

A

Positive resection margins
Tumour >5 cm
4 or more pathological lymph nodes
Nodal radiotherapy should be offered in node positive disease

This should commence within a month of the surgery

247
Q

What are the hormonal therapies in Brease Ca

A

Tamoxifen for pre-meno and anastrozole in post menopausal

248
Q

What are the major and minor criteria for infective endocarditis

A

major blood culture criteria:

  • 2 blood cultures positive for micro organisms typically
    found in patients with IE.
  • Blood cultures persistently positive for one of these
    micro organisms drawn 12 hours apart.
  • 3 or more separate blood cultures drawn at least 1 hour
    apart.
    ◌ major echocardiographic criteria:
  • Valve vegetations.
  • Myocardial abscess.
  • New partial dehiscence of a prothetic valve.

Minor criteria
◌ predisposing factor: known cardiac lesion or iv drug abuser.
◌ Fever: > 38°C.
◌ Vascular problems: Arterial emboli, Janeway lesions, conjuctival hge.
◌ Immunological proplems: Glomerulonephrits, Roth’s spots, Osler’s nodes.
◌ Positive blood cultures that doesn’t meet the criteria above.
◌ Echocardiographic findings consistent with IE that does not meet the criteria above

249
Q

Can endometriosis increase the risk of having cancer

A

Yes, by 3 fold ovarian cancer

250
Q

Which pathway will not be affected by warfarin

A

Intrinsic pathway

251
Q

What are some common sites to have a brain aneurysms

A

85% are anterior circulation

30% ACA and ACOM
30% is ICA and PCOM
20% MCA
5% basilar and 5% PCA

252
Q

Structure of a lymph node

A

capsule: A dense connective tissue capsule that encloses the lymph node and sends trabeculae into the node
Subcapsular sinus: A space between the capsule and the cortex that allows lymphatic fluid to pass through
Cortex: The outer layer of the lymph node that contains lymphoid follicles, B cells, macrophages, and follicular dendritic cells
Paracortex: The inner part of the cortex that contains T cells and dendritic cells
Medulla: The innermost layer of the lymph node that contains large blood vessels, sinuses, and medullary cords
Medullary cords: Contain antibody-secreting plasma cells, B cells, and macrophages

253
Q

What is the indication for each type of biopsy

A

Excisional for small lesion
Incisional for large lesion
Punch for flat lesion like and ulcer
Core or true cut for deep-seated lesions

254
Q

What are the histological features of malignancy

A

Invasion of other organs
Perineural invasion
Abnormal tissue architecture

255
Q

Key differences between benign and malignant lesions

A

Benign lesions: Less invasion of neighbouring structures, slow growing, well differentiated, less likely to metastasize, low angiogenesis

256
Q

Can benign lesions become significant

A

Yes, osteoblastoma/ osteochondroma

257
Q

Give some examples of neural crest tumours

A

Malignant melanoma
Med thy carc
Phaeo
Neuroblastoma

258
Q

What is VEGFc

A

Metastasize to lymph node

259
Q

What changes do you see in lymph node swelling

A

Follicular enlargement

260
Q
A

MRCS part B (10 decks)

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