Plastic Surgery Flashcards
1
Q
what are the features of rhinoplasty procedure?
A
o incisions are made to access bones + cartilage
o bone may be removed, or grafts/synthetic filler added
o after reshaping the skin is redraped over structure of nose
o stents may be used to support
2
Q
what are the features of mentoplasty procedure?
A
o Reduction of addition of material to a patients chin
o Chin rounding = osteotomy
o Chin augmentation = implants (intraoral or submental, alloplastic implants)
3
Q
what are the features of otoplasty procedure?
A
o Cartilage splitting – incisions + repositioning of cartilage
o Cartilage sparing – avoid full thickness attempting to create more effective angles + curls
4
Q
what is botulin toxins use in plastic surgery?
A
injected into muscles under facial wrinkles
5
Q
what are facial fillers?
A
hydoronic acid, synthetic, collagen – fill up lines + hollows
6
Q
what is blepharoplasty?
A
upper lid (take ellipse of skin), lower lid (more complicated)
7
Q
what is skin rejuvenation?
A
use fat from patient = on NHS acnes scarring, hyaluronic acid
8
Q
what is a face lift?
A
removal of excess skin, tightening of underlying tissues
9
Q
how are wounds reconstructed?
A
o Primary closure – clean, simple cut
o Healing by secondary intention = treat infection, clean, debride
o Skin grafts and skin flaps
10
Q
what are is the cause of acute tonsillitis?
A
Majority viral
B lactamase producing bacteria
11
Q
what are the viral causes of acute tonsiliitis?
A
EBV, also rhinovirus, influenza, parainfluenza, enterovirus, adenovirus
12
Q
what are the bacterial causes of acute tonsillitis?
A
streptococcus pyognes, H influenza, S aureus, streptococcus pneumoniae
13
Q
what is the histology of the tonsils?
A
specialised squamous, deep crypts, lymphoid follicles and posterior capsule
14
Q
what is the pathophysiology of acute tonsillitis?
A
- Local inflammatory pathways result in oropharyngeal swelling, oedema, erythema and pain
- Rarely swelling may progress to the soft palate and uvula or inferiorly to supraglottitis
15
Q
what are the types of acute tonsillitis?
A
- Acute parenchymatous
- Acute Follicular
- Acute Catarrhal Tonsillitis
16
Q
what are the features of Acute parenchymatous tonsillitis?
A
swelling and erythema and whole tonsil
17
Q
what are the features of Acute follicular tonsillitis?
A
crypts filled with infected fibrin and often spotted appearance
18
Q
what are the clinical features of viral tonsillitis?
A
malaise, sore throat, temperature, able to undertake normal activity, possible lymphadenopathy
19
Q
what are the clinical features of bacterial tonsillitis?
A
systemic upset, fever, odynophagia, halitosis, unable to work/school, lymphadenopathy, tonsillar exudates
20
Q
how is tonsillitis diagnosed?
A
Centor Criteria
21
Q
what are the features of the centor criteria?
A
o 1 point for each – absence of cough, fever, tonsil exudates, anterior cervical adenopathy, age <15
o Subtract point for >44
22
Q
how do centor scores determine
A
o 0 or 1 point = no antibiotic
o 2 or 3 points = should receive antibiotic if symptom progress
o 4 or 5 points = treat empirically with antibiotic
23
Q
what is the management of tonsillitis?
A
- Supportive – eat&drink, rest, ibuprofen +/- paracetamol analgesia
- 1st Line – antibiotics
- 2nd Line – steroids
- Hospital – IV fluid, IV antibiotic, steroid
- Surgery - adenotonsillectomy
24
Q
what is the antibiotics given in tonsillitis?
A
penicillin 500mg qd for 10 days (clarithromycin if allergic)
25
what is the indications for surgery in tonsillitis?
o 7 episodes in a year, 5 in 2 years consecutively or 3 or more in 3 preceding years, symptoms have been occurring for at least a year, the episodes of sore throat are disabling and prevent normal functioning
26
what are the complications of tonsillitis?
Quinsy, Airway obstruction, otitis media, sinusitis, spread of infection to brain, parapharyngeal abscess, retrophargyngeal abscess, rheumatic fever, septic arthritis, post streptococcal glomerulonephritis
27
what is a peritonsillar abscess?
abscess (pus) forms in the peritonsillar space between capsule of the tonsils (superiorly) and superior constrictor muscle
28
what are the causes of peritonsillar abscesses?
complication of bacterial tonsillitis, streptococcal organisms
29
what are the clinical features of peritonsillar abscess?
* unilateral sore throat, odynophagia, headache, ipsilateral otalgia
* hot potato voice, drooling, trismus, peritonsillar swelling, downwards displacement of tonsil, bulging soft palate on one side, deviated uvula away from side, systemic unilateral cervical lymphadenopathy
30
what is the management of peritonsillar abscess?
hospital admission for drainage along with IV antibitoics (e.g.benzylpenicillin)
31
what is a parapharyngeal abscess?
spread of infection from the tonsil or quinsy through the superior constrictor muscle of the pharynx into the parapharyngeal space
32
what is the cause of a parapharyngeal abscess?
complication of tonsillitis, dental infection
33
what are the clinical features of a parapharyngeal abscess?
* sore throat, trismus, fever and malaise
* swelling lateral pharyngeal wal – cause displacement of tonsil
* erythematous upper lateral neck overlying tender swelling
34
what is the management of a parapharyngeal abscess?
referral to secondary Care
35
what are the complications of a parapharyngeal abscess?
airway obstruction, mediastinum infection, haemorrhage or carotid artery
36
what is a retropharyngeal abscess?
abscess in retropharyngeal space
37
what is the retropharyngeal space?
o space is posterior to pharynx
o bound by fascia anteriorly, paravertebral fascia posteriorly, carotid sheaths laterally
o extends inferiorly to mediastinum superiorly to base
38
what are the clinical features of retropharyngeal abscess?
* sore throat, adnophagia, dysphagia, neck stoffness, voice change, malaise and/or lump, unilateral lymphadenopathy, rigors
* neck swelling may be present
39
what is the management of retropharyngeal abscess?
emergency admission, airway care, incision and drainage + antibiotics
40
what is cause of mumps?
paramyxoviruses
41
what is the spread of infection of mumps?
virus moves from respiratory tract to parotid gland, where it replicates
Can enter CSF
42
what other organs are can be affected by mumps?
brain, pancreas, testicles and ovaries (ependymal cells)
43
what are the clinical features of mumps?
* Symptoms usually develop 14-25 days after infection
* Bilateral parotitis
* Associated orchitis
* Parotid duct may appear swollen and red
* Headache, joint pain, feeling sick, dry mouth abdo pain, feeling tired, anorexia, fever
44
how is mumps diagnosed?
clinical examination, PCR of nasal or saliva samples, raised plasma amylase
45
what is the management of mumos?
* Supportive – bed rest, fluid, pain relief, cool/warm compress
* Prevent infection
* Vaccine
46
what are the complications of mumps?
* Orchitis
* Spontaneous abortion
* Meningitis or encephalitis
* Ovarium inflame
* Brain inflame
* Hearing loss
47
what is the cause of Diptheria?
Corynebacterium dihtheriae
48
what is the pathophysiology of diptheria?
* transmission through air
| * diphtherian toxin is produced – inhibits synthesis of new proteins, neurotoxic and endotoxic
49
what are the clinical symptoms of dipetheria?
* severe sore throat (tonsillitis) + grey white membrane across the pharynx
* pseudomembrane of pharynx may become large + obstruct
* temperature
* breathing difficulty
* polyneuritis – cranial nerve palsy
* Shock can occur through myocarditis or toxaemia
50
how is diphtheria diagnosed?
swab material below grey membrane, PCR
51
how is diphtheria managed?
* Antitoxin and erythromycin
| * supportive
52
what is the age group most affected by glandular fever?
most commonly effects 15-24 year olds - "kissing disease"
53
what is the cause of glandular fever?
* Ebsetin-Bar – spread through salvia
| * Others: cytomegaly, HIV, HPV
54
what is the pathophysiology of glandular fever?
* Virus first replicates within epithelial cells in the pharynx, then primarily with B cells
* Circulating B cells spread infection through liver, spleen, lymphnodes
55
what is the triad of symptoms in glandular fever?
pharyngitis, fever and cervical lymphadenopathy
56
what is the symptoms of infective mono?
Triad of pharyngitis, fever and cervical lymphadenopathy plus lymphocytosis with atypical lymphocyte
57
what are the other clinical features of glandular fever?
* Malaise, lethargy
* Bilateral enlarged tonsils covered in exudate
* Other – rash, jaundice/hepatitis, splenomegaly, palatal petchiae, haemolytic anaemia (cold agglutins IgM)
58
how is glandular fever diagnosed?
* IgM positive (antibiotics) – Paul Bunnel or monospot
| * IgG positive – blood count + film + LFTs
59
what is the management of glandular fever?
* Bed rest
* Paracetamol
* Avoid sport for 8 weeks to avoid splenic rupture
* Antivirals not effective
60
why is penicillin avoided in glandular fever?
a maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis
61
what is the cause of hand, foot and mouth disease?
coxsackie viruses (enterovirises) – A16, EV-17
62
what is the route of spread of coxsackie virus?
* spread through close contact, coughing, faecal
* viremia develops followed invasion of skin + mucus membrane
* incubation period 5-7 days
63
what are the clinical features of hand, foot and mouth disease?
* commonly kids
* fever (without flu like symptoms)
* sore throat
* loss of appetite
* a few days later appearance of rash and papules on hand and feet and around mouth – vesicles + macerated ulcers
* ache in limbs
64
how is hand, foot and mouth disease diagnosed?
* clinically
| * PCR test of viral transport medium
65
what is the treatment of hand, foot and mouth disease?
* Good hygiene to prevent spread – take off school/work
| * Supportive – fluids, soft foods, paracetamol
66
what are the two types of herpes simplex virus?
* Type 1 – acquired in childhood, most cause of mouth ulcers
| * Type 2 – more likely to reactivate (sexual contact)
67
how is herpes simplex spread?
through saliva contact
68
what is the infection pathway of herpes simplex virus?
* Invades cells by binding to transmembrane receptors via their glycoprotein
* Travels to cell nucleus and via pore injects its DNA
* Latency Period – after primary infection an inactive form is stored in the sensory nerve cells where it can be reactivated
69
what is the cause of primary gingivostomatitis?
HSV1
70
what age group is commonly affected by primary gingivostomatitis?
pre school children
71
what are the clinical features of Primary Gingivostomatitis?
Systemic upset
Sudden onset
Vesicles + ulcers n the lips, buccal mucosa, and hard palate
Halitosis + refusal to eat/drink
72
what is the management of Primary Gingivostomatitis?
take up to 3 weeks, acyclovir
73
what is the cause of cold sores?
HSV1
74
what is the pathophysiology of cold sores?
various stimuli causes reactivation from nerves to cause active infection (stress, illness)
75
what are the clinical features of cold sores?
oral lesion
76
what is the management of cold sores?
acyclovir treatment or suppression (won’t treat latency)
77
what is the clinical features of herpetic whitlow?
lesion on finger or thumb
78
what is the management of herpetic whitlow?
self limiting, acyclovir
79
what is the pathophysiology of Herpes Simplex Encephalitis?
trigmeninal + ophthalmic nerve involvement
80
what are the clinical features of Herpes Simplex Encephalitis?
altered level of consciousness
81
what is a diagnostic feature of Herpes Simplex Encephalitis?
Increased white cell count in CSF
82
what is sialolithiasis?
Formation of calcified masses within a salivary gland
83
where does sialolithiasis occur?
Most common with submandibular (95%), parotid (5%)
84
what is the pathophysiology of sialolithiasis?
Composed of inorganic calcium and sodium phosphate salts mixed with mucous and cellular debris = calculi
85
what is the cause of sialolithiasis?
* Alteration in calcium metabolism
* Dehydration
* Reduced salivary flow rate
* Altered pH salivary
* Food debris, foreign body, bacteria – stuck in salvia glands
86
what are the clinical features of sialolithiasis?
* Pain – intermittent (worse before mealtimes)
* Swelling of gland
* Tenderness of gland
* Palpable hard lump
* Lack of salvia
* Erythema of floor of mouth
87
how is sialolithiasis diagnosed?
sialography, xray (appear radio opaque)
88
what is the management of sialolithiasis?
* Non-invasive – hydration, moist heat therapy, NSAIDs, sour foods, massage, shock wave therapy
* Small stones normally pass
* Silendoscopy
* Surgery
* Antibiotics to prevent infection
89
what is Wegeners Granulomatosis?
Granulomatosis with Polyangiitis
90
what is the cause Wegeners Granulomatosis?
* Unknown – autoimmune condition
| * Microbes and genetics implicated in pathogenesis
91
what is the pathophysiology Wegeners Granulomatosis?
* Small vessel vasculitis limited to respiratory tract and kidneys
* Inflammation and infiltration by immune cells forming granulomas
92
what is the histology of Wegeners Granulomatosis?
o Looks like granuloma (blood vessel infiltrated with neutrophils)
o Palsy immune necrotizing vasculitis
93
what is the characteristic antibody associated with Wegeners Granulomatosis?
ANCA - react with proteinase 3 – activate neutrophils, increase their adherence, induce degranulation
94
how is wegeners diagnosed?
presence of ANCA, FBC, EVC, ESR, CRP, urine casts, Xray
95
how is wegeners managed?
high dose corticosteroids, DMARDs – methotrexate, cyclophosphamide, plasma exchange
96
what are the kidney clinical features of Wegeners?
progressive glomerulonephritis – chronic kidney disease
97
what are the ENT clinical features of Wegeners?
o Nose – pain, stuffiness, nosebleed, rhinitis, crusting, saddle nose deformity (perforated septum), paranasal and sinusitis
o Ears – hearing loss, serous otits media
o Oral cavity – strawberry ginvitis, ulceration, tooth destruction
98
what are the trachea clinical features of Wegeners?
subglottal stenosis
99
what are the lungs clinical features of Wegeners?
pulmonary nodules, pneumonia, haemorrhage, pleuritis
100
what are the eye clinical features of Wegeners?
conjunctivitis, proptosis
101
what are the non-specific clinical features of Wegeners?
fever, cough, w/loss, arthritis
102
what are the skin clinical features of Wegeners?
nodules, purpura
