QNA 3

Question 1

Pathophys diverticulosis

Answer 1

1. Low fibre diet -> chronic constipation -> increased pressure
2. Connective tissue disorders

1 + 2 ->muscular hypertrophy
herniation of mucosa through wall

Question 2

Why no diverticularis within small intestine

Answer 2

As neurovascular bundle enters the muscularis propria, points of weakness are created

These are re-enforced with a longitudinal layer of muscle in small intestine

In large intestine, these longitudinal muscles form 3 bands only (taeniae coli)

Could herniate through between these bands

Question 3

Why endometriosis cause pain

Answer 3

intrapelvic bleed
Peri-uterine adhesions

Question 4

Endometriosis cancer risk

Answer 4

3times risk of ovarian cancer

Question 5

Types of graft rejection

Answer 5

Hyperacute: Immediate

Acute:
- Accelerated acute: within 7 days
- within 100 days
- treated with high-dose steroids

Chronic:
- T cell
- months-years

Question 6

3 separate gene mutations for insulinoma

Answer 6

1. MEN 1
2. PTEN/TSC2 tumour suppressor genes
3. ATRX and DAXX ->maintenance of telomere

Question 7

MRSA decol

Answer 7

Mupirucin nasal cream
Chlorhexadine body wash

Question 8

Causative agents for osteomyelitis

Answer 8

G +:
Staph aureus
Strep pneumonia

G -:
E coli
H influenza

Question 9

Pathogenesis of osteomyelitis

Answer 9

1. Inflammation
   - microbial invasion -> inflammation ->increased interosseus pressure -> pain and obstruction of
2. Suppuration
   - Pus appears in the medulla and spread along Volkmanns canal
   - Lifts periosteum, spreads along the shaft, and forms subperiosteal abscess
   - pus could re-enter at a different point
3. Necrosis
   - raised pressure, vascular stasis, infective thrombosis comprises blood supply to bone, resulting in death and formation of SEQUESTREUM
4. New bone formation
   - 10-14 d after
   - deep layer of periosteum forms new bone becoming INVOLUCRUM (enclosing infected tissue and sequestra)
5. a : Resolution
   - if infection is controlled, intraosseus pressure decreases and bone will heal

5.b. Chronic OM
- if not controlled, pus may break through the involucrum, and track by sinus to skin surface

Question 10

MEN I

Answer 10

• pancreas insulinoma
• parathyroid hyperplasia
• pituitary adenoma

Question 11

MEN II

Answer 11

Phaeochromo
Parathyroid hyperplasia
Thyroid medullary carcinoma

Question 12

MEN IIb

Answer 12

MEN II + Marfinoid habitus + Mucosal neuroma

Question 13

MEN 1 vs MEN2 mutation

Answer 13

Autosomal dominant
MEN 1:
- Menin gene
MEN 2:
- RET protoconcogene

Question 14

Where is carcinoid tumour commonly found

Answer 14

Small intestine
Appendix

Question 15

Origin cells of carcinoid

Answer 15

Enterochromaffin cells

Question 16

Secretion of carcinoid

Answer 16

serotonin

Question 17

Sx of carcinoid tumour

Answer 17

Flushing
Diarrhoea

Cadiac: valvular abnormality, fibrosis of endocardium

Wheeze (bronchial constriction)

Question 18

Met site of carcinoid

Answer 18

Liver

Question 19

Why carcinoid present after met to liver

Answer 19

Seretonin produced by bowel passes through liver and gets broken down before spreading

But when produced by liver, enters the systemic circulation

Question 20

Dx of carcinoid

Answer 20

Chromagranin A blood

5HIAA 24hr urinary test

Question 21

Haemorrhoids def

Answer 21

swollen anal cushions

Question 22

Pathogenesis of haemorroids

Answer 22

Anal cushions fixed by fibromuscular ligaments

Repeated strained defecation -> downward stress tears the fibromuscular ligaments

Can become engorged with blood/prolapse

Question 23

What is TNF

Answer 23

a cytokine in systemic inflammation

Question 24

Anti TNF drugs

Answer 24

IgG antibodies against TNF
Infliximab
Adalimumab

Question 25

Difference between proto-oncogene and oncogene

Answer 25

Proto-oncogene: normal genes promoting cellular proliferation

Oncogene: mutated or over expressed protooncogenes resulting in abnormal proliferation