Science deck Flashcards

Question

Intraductal papilloma

Answer 1

Commoner in younger patients May cause blood stained discharge There is usually no palpable lump

Answer 2

Rectal and oesophageal surgery have some of the highest rates of anastomotic leakage. Small bowel anastomosis are generally technically more forgiving

Answer 3

sphenopalatine artery

Answer 4

Non compression bandaging

Answer 5

Psoriasis Vitiligo Warts Lichen planus Lichen sclerosus Molluscum contagiosum

Answer 6

Inhibition of the thyroid peroxidase enzyme

Answer 7

Nodular lymphocyte predominant

Answer 8

Cysteine stones

Answer 9

It is a cytotoxic agent that causes DNA intercalation

Answer 10

5 FU S Phase specific drug, mimics uracil and is incorporated into RNA Doxorubicin Inhibits DNA and RNA synthesis by intercalating base pairs Etoposide Inhibits topoisomerase II, prevents efficient DNA coiling Cisplatin Crosslinks DNA, this then distorts molecules and induces apoptosis (similar to alkylating agents) Cyclophosphamide Phosphoramide mustard forms DNA crosslinks and then cell death Docetaxal Disrupts microtubule formation

Answer 11

Nasal injuries can be challenging to manage and where there is tissue loss, it can be difficult to primarily close them and still obtain a satisfactory aesthetic result. Debridement together with a rotational flap would obtain the best results here.

Answer 12

Elevated serum Calcium > 1mg/dL above normal Hypercalciuria > 400mg/day Creatinine clearance < 30% compared with normal Episode of life-threatening hypercalcaemia Nephrolithiasis Age < 50 years Neuromuscular symptoms Reduction in bone mineral density of the femoral neck, lumbar spine, or distal radius of more than 2.5 standard deviations below peak bone mass (T score lower than -2.5)

Answer 13

S2, 3, 4 Keeps the poo off the floor

Answer 14

Thyroid lymphoma (Non Hodgkin's B cell lymphoma) is rare. It should be considered in patients with a background of Hashimoto's thyroiditis and a rapid growth in size of the thyroid gland. Diagnosis can be made with core needle biopsy; however an incisional biopsy may be needed. Radiotherapy is the main treatment option.

Answer 15

Anatomical dead space is measured by Fowlers method.

Answer 16

Loose areolar tissue

Answer 17

Villous adenomas carry the highest risk of malignant transformation

Answer 18

Metastatic malignancy

Answer 19

Primary hyperparathyroidism

Answer 20

Hypovolaemic shock is likely to compromise renal blood flow especially if blood pressure falls below the range at which the kidney is able to autoregulate its blood flow. The result of this will be an increase of the specific gravity as water retention occurs in an attempt to maintain circulating volume.

Answer 21

Etomidate it inhibits adrenal mitochondrial 11-β hydroxylase, the enzyme responsible for the final conversion of 11-deoxycortisol to cortisol

Answer 22

Perianal - Most common and very superficial Ischioanal abscess - Second most common cause of anal sepsis and lies lateral to the levetor ani Horshoe - Basically IA but on both sides Intersphincteric - between the sphincters Supralevetor - As the name suggests, can happen from abdominal infections such as appendicitis tracking down

Answer 23

Adrenal cortex

Answer 24

Superficial spreading is the most common and nodular is second. Legs and trunk are more affected in these two.

Answer 25

Cleft lip/palate Congenital HD Inguinal hernia Undescended testes

Answer 26

Liquefaction necrosis

Answer 27

Acid pH and pre-existing pepsinogen

Answer 28

It initially increases and then decreases

Answer 29

Perthes disease: Avascular necrosis of the femoral head.

Answer 30

Borchardt's triad: Epigastric pain, retching without vomiting and inability to pass NG tube

Answer 31

Increased capillary permiability Interstitial and alveolar fibrosis and oedema Fibrin exudation Hyaline formation

Answer 32

Parasitic infections can cause Type 1 hypersensitivity reactions and liver flukes are parasites

Answer 33

2mg per kg

Answer 34

Poperdin will be absent and it is produced by the spleen

Answer 35

It is a B cell lymphoma marker

Answer 36

Adductor canal compression syndrome most commonly presents in young males and is an important differential diagnosis in men presenting with symptoms of acute limb ischaemia on exertion. It is caused by compression of the femoral artery by the musculotendinous band from adductor magnus muscle. The treatment consists of the division of the abnormal band and restoration of the arterial circulation. Popliteal fossa entrapment is the main differential diagnosis, however the pulse disappears when the knee is fully extended.

Answer 37

Dysphagia lusoria is caused by compression of the esophagus from any of several congenital vascular abnormalities. The vascular abnormality is usually an aberrant right subclavian artery arising from the left side of the aortic arch, a double aortic arch, or a right aortic arch with left ligamentum arteriosum. The dysphagia may develop in childhood or later in life as a result of arteriosclerotic changes in the aberrant vessel. Barium swallow shows the extrinsic compression, but arteriography is necessary for absolute diagnosis.

Answer 38

Atenolol inhibits insulin release

Answer 39

Key points in management of fractures Immobilise the fracture including the proximal and distal joints Carefully monitor and document neurovascular status, particularly following reduction and immobilisation Manage infection including tetanus prophylaxis IV broad spectrum antibiotics for open injuries As a general principle all open fractures should be thoroughly debrided ( and internal fixation devices avoided or used with extreme caution) Open fractures constitute an emergency and should be debrided and lavaged within 6 hours of injury

Answer 40

Chronic Cholecystitis sign on histology

Answer 41

Desmoid tumours are fibrous neoplasms arising from musculoaponeurotic structures. They are usually treated (regardless of site) by radical surgical resection, in some patients radiotherapy and chemotherapy may be considered. High tendency for local recurrence

Answer 42

Work of breathing is decreased which is one of the reasons it is a popular option for weaning ventilated patients

Answer 43

Amyloidosis = apple green birefringence with polarised light

Answer 44

Double stranded DNA virus

Answer 45

W. Bancrofti is the commonest cause of filariasis leading to lymphatic obstruction

Answer 46

Medullary breast cancer is a breast cancer of special type. Histologically, it is characterised by a marked lymphocytic infiltrate. Very good prognosis

Answer 47

Hoomans operation: excision of the subcutaneous tissue beneath the affected skin and covering the defect with skin flaps or a full or split-thickness grafts

Answer 48

D iabetes I nfection, irradiation D rugs eg steroids, chemotherapy N utritional deficiencies (vitamin A, C & zinc, manganese), Neoplasia O bject (foreign material) T issue necrosis H ypoxia E xcess tension on wound A nother wound L ow temperature, Liver jaundice

Answer 49

Carotid body tumours are the commonest type of head and neck paraganglionoma.

Answer 50

Meckels diverticulum is the number one cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years.

Answer 51

The argon plasma coagulation system is very good for managing splenic bleeding.

Answer 52

Pressures lower than 7mm Hg are not usually compatible with satisfactory views. Pressures >15mm Hg are usually associated with decreased venous return and hypotension. 10 is good

Answer 53

Skew and Burgess flaps

Answer 54

Serum albumin levels. It is also a negative acute phase reactant and levels decrease in sepsis and inflammation

Answer 55

Serum albumin levels. It is also a negative acute phase reactant and levels decrease in sepsis and inflammation

Answer 56

Left more common than the right and B/L

Answer 57

Liquid nitrogen or 5FU

Answer 58

1 - Non expanding subcapsular haematoma 2 - Superficial laceration <1 cm not involving the collecting system 3 - >1cm and no collecting system or vessel involvements 4 - Urinary extravasation 5 - Shattered kidney and avulsion of renal vessels

Answer 59

The method by which DNA errors are corrected. It detects base pair mismatch

Answer 60

Extradural haematoma

Answer 61

Operation for an MI carried out within the last 3-6 months carries re-infarction risk of 10%

Answer 62

Can cause demyelination of peripheral nerves (neuropraxia is most common)

Answer 63

Thoracoscopy and decortication for stage 3 empyema. VATS for stage 2 and chest drain for stage 1/ early stage 2. Indications for thoracoscopy are: Resp disability, Thich fibrous peel, multiloculated stage 3 empyema.

Answer 64

A rare complication of sinusitis. Subperiosteal abscess present. Frontal sinus most commonly affected and presents with swelling of the forehead. HI can sometimes cause ot but most commonly staph and strep. MRI or CT to diagnose and treat with IV ABx.

Answer 65

Initially, pupils constrict due to sympathetic nerve fibres being squashed, but then dilate when the optic nerve is blocked. Complete third nerve palsy can also occur.

Answer 66

Strep pyo is the most common causative agent.

Answer 67

Meconium plugs

Answer 68

The mesonephric duct

Answer 69

Proteus mirabilis

Answer 70

Alpha granules. GPS is very rare but forms abnormally large, agranular platelets causing splenomegaly and myelofibrosis

Answer 71

Hypochromic microcytic

Answer 72

CEA can be elevated in smokers, UC, pancreatitis and liver cirrhosis

Answer 73

Contaminated Surgery; Clean-contaminated surgery; Placement of prosthesis and hip implants

Answer 74

Hypercalcaemia

Answer 75

Signet ring cells are features of poorly differentiated gastric cancer associated with a increased risk of metastatic disease.

Answer 76

Redo fundoplication surgery carries with it a risk of damaging the vagus nerves. If both are damaged, there will be delay to gastric emptying

Answer 77

T tube drain that is latex as it helps in forming a tract

Answer 78

Less than 30 mins

Answer 79

Rifampicin, phenytoin, levodopa, methyldopa, and quinine all cause pseudohaematuria.

Answer 80

50% may be non diagnostic

Answer 81

Right sided live donor transplants are extremely rare. This is because the vena cava precludes mobilisation of the right renal artery. The short right renal artery that is produced therefore presents a major challenge

Answer 82

Takayasu's arteritis most commonly affects young Asian females. Pulseless peripheries are a classical finding.

Answer 83

Perineal approaches include the Delormes operation, this avoids resection and is relatively safe but is associated with high recurrence rates. An Altmeirs operation involves a perineal excision of the sigmoid colon and rectum, it may be a more effective procedure than a Delormes but carries the risk of anastomotic leak. Rectopexy - this is an abdominal procedure. The rectum is mobilised and fixed onto the sacral promontary. A prosthetic mesh may be inserted. The recurrence rates are low and the procedure is well tolerated (particularly if performed laparoscopically). Risks with ventral mesh rectopexy include chronic pain and visceral mesh erosions. Thirsch tape- this is a largely historical procedure and involves encircling the rectum with tape or wire. It may be of use in a palliative setting.

Answer 84

A Bankart lesion is an injury of the anterior (inferior) glenoid labrum of the shoulder due to anterior shoulder dislocation. When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it.

Answer 85

The most likely explanation for this is that the thoracodorsal nerve has been injured. This will result in atrophy of latissimus dorsi and this will become evident with repetitive arm movements where the arm is elevated and moving up and down (such as in painting). Injury to the pectoral nerves may produce a similar picture but this pattern of injury is very rare and the pectoral nerves are seldom injured in breast surgery.

Answer 86

It's cardiac effects are mediated via β 1 receptors. The coronary arteries which have β 2 receptors are unaffected by adrenaline

Answer 87

The Bolam test defines if a decision made by a doctor is in agreement with the professional standard of medical practise.

Answer 88

The recurrence of symptoms following medical therapy attracts a recommendation for definitive treatment. Since radio-iodine can worsen eye signs, this is not a wise choice. Surgery in the form of a total thyroidectomy would be curative.

Answer 89

Median arcuate ligament syndrome is largely a diagnosis of exclusion. The classic signs of epigastric pain with an audible bruit are only found in a minority. Where the condition is suspected, the diagnosis is usually apparent on duplex scanning (in thin patients) or with CT angiography.

Answer 90

Cajal cells

Answer 91

1 Suture sizes are assessed on the French gauge scale. 1/0 is thicker than 6/0. Note though that 1 is thicker than 1/0 and 5 is thicker than 1. When the /0 is removed they become thicker with ascending numerical value

Answer 92

ATN and kidney injury do not respond to IV fluids as the injury is inside the kidney already and not pre-renal

Answer 93

Stones becoming impacted in the Hartmans pouch causing fistulation. This can make delineating the anatomy of the calots triangle really challenging

Answer 94

Achalasia is a rare condition. However, even once treated there is an increased risk of malignancy. When it does occur it is most likely to be of squamous cell type.

Answer 95

Hyperlipidaemia and multiple myeloma are known to cause a pseudo hyponatraemia, this is due to raised protein and oncotic pressure that causes dilution

Answer 96

4 Types of opioid receptor: δ (located in CNS)- Accounts for analgesic and antidepressant effects k (mainly CNS)- analgesic and dissociative effects µ (central and peripheral) - causes analgesia, miosis, decreased gut motility Nociceptin receptor (CNS)- Affect of appetite and tolerance to µ agonists.

Answer 97

The annual probability of strangulation is up to 3% and is more common in indirect hernias

Answer 98

Ileum, only 10% is absorbed in the Colon.

Answer 99

In young children, laparotomy is performed via transverse supra umbilical incision. Access via midline incisions is very poor and they should not be used.

Answer 100

Lineorenal ligament

Answer 101

Young females at very high risk of breast cancer should undergo annual MRI.

Answer 102

Pes anserinus: GOOSE'S FOOT Combination of sartorius, gracilis and semitendinous tendons inserting into the anteromedial proximal tibia. Pes Anserinus Bursitis is common in sportsmen due to overuse injuries. The main sign is of pain in the medial proximal tibia. As the McMurray test is negative, medial meniscal injury is excluded.

Answer 103

Food: spinach, cheese, wine, caffeine, tomatoes Drugs: Naproxen, Monoamine oxidase inhibitors Recent surgery

Answer 104

99% of males with cystic fibrosis will have absent vas

Answer 105

painful mucocutaneous defect in the posterior midline (90% cases). Anterior is 10% and should be investigated for the source

Answer 106

Type A - Reduced tissue ATP due to poor oxygenation Type B1 - systemic disease B2 - Drugs B3 - Abnormalities in metabolism

Answer 107

Fibular flap is a very vascular piece of bone and is commonly used for mandibular reconstruction

Answer 108

Mnemonic for the causes of hypercalcaemia: CHIMPANZEES C alcium supplementation H yperparathyroidism I atrogentic (Drugs: Thiazides) M ilk Alkali syndrome P aget disease of the bone A cromegaly and Addison's Disease N eoplasia Z olinger-Ellison Syndrome (MEN Type I) E xcessive Vitamin D E xcessive Vitamin A S arcoidosis

Answer 109

These are usually superficially sited and are best managed with shave biopsy and cautery. These can also be irregular and multi-coloured

Answer 110

Organisms causing post splenectomy sepsis: Streptococcus pneumoniae Haemophilus influenzae Meningococci

Answer 111

Sudden anaemia and a LOW reticulocyte count indicate parvovirus. High reticulocyte count can be seen in sequestration and haemolysis

Answer 112

Pyramidal tract

Answer 113

Pyrexia is the most common adverse event in transfusing packed red cells Urticaria is the most common adverse event following infusion of FFP

Answer 114

Diaphragm disease of the small intestine is caused by NSAIDS in most cases and treated by surgical resection.

Answer 115

Saturated Steam (Autoclaving): Hold time is 3 minutes under 134C and 15 mins under 121C.

Answer 116

Hill Sach - Posterior-lateral humeral head dislocation causing lesion in the back Bankart - Opposite https://www.youtube.com/watch?v=a6BWiufgmsc

Answer 117

VATS procedure

Answer 118

T cells as they can only be activated by HLA

Answer 119

Infarction causes liquefactive necrosis. Coagulative necrosis is more common where there is fatty tissue and hence very uncommon in the brain. Caseous necrosis is most commonly seen in TB infections Because MRCS prep, turns your brain into liquid, hence, liquifactive (colliquative) necrosis

Answer 120

That being the case, the correct answer is small cell lung cancer as they are nearly always disseminated at diagnosis.

Answer 121

Features cerebellar haemangiomas retinal haemangiomas: vitreous haemorrhage renal cysts (premalignant) phaeochromocytoma extra-renal cysts: epididymal, pancreatic, hepatic endolymphatic sac tumours

Answer 122

Low Mg also results in Low Ca Absorption

Answer 123

Suxamethonium may induce hyperkalaemia as it induces generalised muscular contractions. In patients with likely extensive tissue necrosis this may be sufficient to produce cardiac arrest.

Answer 124

Paranasal sinus cancer is strongly associated with wood work.

Answer 125

Rare cancer and crepitus is felt Ameloblastoma is a rare, noncancerous (benign) tumor that develops most often in the jaw near the molars. Ameloblastoma begins in the cells that form the protective enamel lining on your teeth. The most common type of ameloblastoma is aggressive, forming a large tumor and growing into the jawbone.

Answer 126

Flow volume loop is the investigation of choice for upper airway compression.

Answer 127

Significant necrosis is more commonly seen with glioblastomas than with other CNS tumours.

Answer 128

Oncological orchidectomy is routinely performed via an inguinal approach to avoid contamination of another lymphatic field.

Answer 129

Macrophages

Answer 130

Staph Auerus

Answer 131

They are typically seen following a sub total colectomy where the distal sigmoid colon is deemed too friable to close and it then brought onto the skin as a mucous fistula.

Answer 132

Mnemonic for drugs causing gynaecomastia: DISCO D igitalis I soniazid S pironolactone C imetidine O estrogen Mnemonic for causes of gynaecomastia: METOCLOPRAMIDE M etoclopramide E ctopic oestrogen T rauma skull/tumour breast, testes O rchitis C imetidine, Cushings L iver cirrhosis O besity P araplegia R A A cromegaly M ethyldopa I soniazid D igoxin E thionamide

Answer 133

Excision biopsy of the lymph node

Answer 134

Glottic as the vocal cords themselves have no lyphatic drainage and hence acts as a watershed region

Answer 135

Bipolar as the diathermy is contained between the electrodes and this reduces damage to the recurrent laryngeal nerve

Answer 136

Muscle contractions

Answer 137

About 2-3 weeks

Answer 138

Internal vertebral venous plexus. This is also called the Batson's plexus and it is clinically relevant as the vein is valveless and hence a route for metastatic spread

Answer 139

Adenoma is the most common (80-90%) -> Hyperplasia (10-15%) next and then carcinoma (<1%)

Answer 140

Other breast may also be involved. It does not have any preceeding symptoms

Answer 141

Aids in the maturation process

Answer 142

Used to measure PAOP

Answer 143

Is like a fibroadenoma, fast growing and present in women with large breasts.

Answer 144

Rule of thirds: 1/3 multiple 1/3 small bowel 1/3 metastasize 1/3 second tumor Liver metastases need to be present in order to have carcinoid syndrome

Answer 145

Amylase as the pancreatic head of often times damaged and amylase will drain into the splenic bed via the pancreatic duct

Answer 146

Psammoma bodies consist of clusters of microcalcification. They are most commonly seen in papillary carcinomas.

Answer 147

Used to treat duct ectasia as there are multiple ducts involved Single duct pathology= microdochectomy

Answer 148

Neutrophils are the main cells of acute inflammation, important action against gram -ve and +ve bacteria Appearance of segmented nucleus and granulated cytoplasm Have a lifespan of 1-3 days (shorter when consumed during septic process, though 9 hours is unusual) Actions include: movement, opsonise microorganisms, phagocytosis & intracellular killing of microorganisms via aerobic (produce HYDROGEN PEROXIDE) & anaerobic mechanisms. Neutrophil disorders include chronic granulomatous diseases: rare AIDS associated with T cell deficiency

Answer 149

Kocher's 'WIFE' is: WCC >12 Inability to weight bear Fever ESR >40 = >90 chance of septic arthritis

Answer 150

Staph epidermis. Makes a biofilm and is usually very difficult to eradicate. Treatment usually involves removal of the implant

Answer 151

Ependymoma account for up to 33% of CNS tumours in those under age of 3. They commonly arise in the 4th ventricle and can grow through the foramina of Luschka and Magendie

Answer 152

Portacaths are very good for children as they only need to be looked at when accessing

Answer 153

In patients with major cardiac co-morbidities the safest option is to choose an axillo-bifemoral bypass graft. The long term patency rates are less good than with aorto-bifemoral bypass grafts, however, the operation is less major.

Answer 154

Methyline blue Prilocaine is a recognised cause of methaemoglobinaemia, this is characterised by the development of cyanosis and dyspnoea. This disorder occurs because of the change haemoglobin to a ferric subtype rather than ferrous (Fe2+). This type of change shifts the oxygen dissociation curve to the left and tissue hypoxia occurs. Methylene blue will revert the haemoglobin to the ferrous type and reverse this effect.

Answer 155

Many umbilical hernias will close in the first year of life. Defer surgery until the child is 3 years or older.

Answer 156

Parietal cells: secrete HCl, Ca, Na, Mg and intrinsic factor Chief cells: secrete pepsinogen Surface mucosal cells: secrete mucus and bicarbonate

Answer 157

1 <1cm injury 2 >icm injury with moderate soft tissue injury 3 10cm or more with soft tissue damage 3a Adequate soft tissue coverage 3b inadequate soft tissue coverage 3c Associated arterial injury

Answer 158

The diffuse lung injury, which is associated with loss of surfactant and increased elastase release from neutrophils, results in fluid accumulation. This leads to reduced diffusion, which is the main reason for hypoxemia.

Answer 159

The use of a pedicled latissimus dorsi flap is a common method of providing breast reconstruction over an implant. Free flaps do not heal as reliably as pedicled ones and these would therefore be used in preference in this particular setting.

Answer 160

Stored blood has less 2,3 DPG and therefore has a higher affinity for oxygen, this reduces its ability to release it at metabolising tissues.

Answer 161

As part of the enhanced recovery principles oral intake in this setting should resume soon after surgery (within 24 hours). Administration of a liquid and even light diet does not increase the risk of anastomotic leak. Also administration of carbohydrate-rich drink 3 hours before op is common

Answer 162

Dextrans are branched polysaccharide molecules. Dextran 40 and 70 are available. The higher molecular weight dextran 70 may persist for up to 8 hours. They inhibit platelet aggregation and leucocyte plugging in the microcirculation. Thereby improving flow through the microcirculation, primarily of use in sepsis. Unlike many other intravenous fluids Dextrans are a recognised cause of anaphylaxis.

Answer 163

Heaped or raised borders should raise suspicion of a marjolins ulcer.

Answer 164

Embryological origin stapes = 2nd pharyngeal arch

Answer 165

Thrombosis is more commonly seen in the hyperacute phase. neo intimal hyperplasia is more commonly seen in the chronic setting

Answer 166

JVP 3 Upward deflections and 2 downward deflections Upward deflections a wave = atrial contraction c wave = ventricular contraction v wave = atrial venous filling Downward deflections x wave = atrium relaxes and tricuspid valve moves down y wave = ventricular filling

Answer 167

MRI will show subtle changes in blood supply

Answer 168

Insulin producing tumours of the pancreatic β cells Incidence of 1 per 1,000,000 per year 90% of lesions are benign Most tumours less than 2cm in size Between 5 and 10% have MEN type 1 75% of patients with MEN 1 will develop pancreatic islet cell tumours Treatment is enucleation of the lesion

Answer 169

The rectum can contain high levels of potassium

Answer 170

Damage to the nerve in the bony canal may result in impaired innervation to stapedius and therefore sounds are no longer dampened. Another cause of hyperacusis is increased activity in the tensor tympani muscle, this is innervated by the trigeminal nerve.

Answer 171

The presence of chronic sinuses together with gram positive organisms and sulphur granules is highly suggestive of Actinomycosis.

Answer 172

As a rule most vascular surgeons will administer approximately 3,000 units of systemic heparin 3-5 minutes prior to cross clamping to help prevent further intra arterial thromboses. A dose of 30,000 units is given prior to going on cardiopulmonary bypass. Heparin given at induction will cause bleeding during routine dissection.

Answer 173

Proximally sited disease greater than 5-10cm from the OG junction may be treated by sub total gastrectomy Total gastrectomy if tumour is <5cm from OG junction For type 2 junctional tumours (extending into oesophagus) oesophagogastrectomy is usual

Answer 174

LHRH analogues may cause flare of metastatic disease and anti androgens should be administered to counter this

Answer 175

The pancreas develops from a ventral and dorsal endodermal outgrowth of the duodenum.

Answer 176

Diverticular strictures have a high complication rate with stent insertion. Where patients present with large bowel obstruction, the best option is to resect the affected area. Given the fact that there is underlying colonic obstruction, a primary anastomosis would be unwise. Diverticular strictures should not be dilated. Perform Hartmann's

Answer 177

Staph auerus

Answer 178

B Blockers reduce the secretion of renin

Answer 179

A benign neoplasm that is comprised of tissue structures normally found within that site or organ. The lung is one of the commonest site of hamartoma formation and they comprise around 5% of all lung lesions. They generally have a good prognosis and do not require excision unless symptomatic.

Answer 180

Goodsals rule: Anterior fistulae will tend to have an internal opening opposite the external opening. (straight) Posterior fistulae will tend to have a curved track that passes towards the midline. (curved)

Answer 181

The intercostobrachial nerves traverse the axilla and innervate the overlying skin. These can be injured or divided during axillary surgery and the result is anaesthesia of the overlying skin.

Answer 182

Leriche syndrome Classically, it is described in male patients as a triad of symptoms (Claudication, atrophy and impotence): 1. Claudication of the buttocks and thighs 2. Atrophy of the musculature of the legs 3. Impotence (due to paralysis of the L1 nerve) Leriche syndrome, is atherosclerotic occlusive disease involving the abdominal aorta and/or both of the iliac arteries. Management involves correcting underlying risk factors such as hypercholesterolaemia and stopping smoking. Investigation is usually with angiography. Can be treated with angioplasty and or stent insertion

Answer 183

Obesity hormones leptin decreases appetite ghrelin increases appetite (sounds like an animal is growling because of hunger)

Answer 184

Mnemonic for Rockall score ABCDE A: Age B: Blood pressure drop (Shock) C: Co-morbidity D: Diagnosis E: Evidence of bleeding

Answer 185

The prevalence of a condition is equal to pre test probability

Answer 186

Mnemonic of the drugs causing hyperuricaemia as a result of reduced excretion of urate 'Can't leap' C iclosporin A lcohol N icotinic acid T hiazides L oop diuretics E thambutol A spirin P yrazinamide

Answer 187

Birds are a recognised reservoir of campylobacter.

Answer 188

The trachea commences at C6. It terminates at the level of T5

Answer 189

First time hernias may be treated by performing an open inguinal hernia repair; the inguinal canal is opened, the hernia reduced and the defect repaired. A prosthetic mesh may be placed posterior to the cord structures to re-enforce the repair and reduce the risk of recurrence. Recurrent hernias and those which are bilateral are generally managed with a laparoscopic approach. This may be via an intra or extra peritoneal route. As in open surgery a mesh is deployed. However, it will typically lie posterior to the deep ring. Inguinal hernias in children are almost always of an indirect type and therefore are usually dealt with by herniotomy, rather than herniorraphy. Neonatal hernias especially in those children born prematurely are at highest risk of strangulation and should be repaired urgently. Other hernias may be repaired on an elective basis.

Answer 190

ventricular septal defect (VSD) right ventricular hypertrophy right ventricular outflow tract obstruction, pulmonary stenosis overriding aorta Shunting is from right to left Management: cyanotic episodes may be helped by beta-blockers to reduce infundibular spasm

Answer 191

Prolapsed haemorroids are best managed surgically if symptomatic. Note that phenol injections are usually only used for minor internal haemorroids. Where phenol is used, low concentration phenol in oil is the correct agent,

Answer 192

VACTERL, which is a combination of Vertebral, Ano-rectal, Cardiac, Tracheo-oesophageal, Renal and Radial limb anomalies. Half of babies with oesophageal atresia will have VACTERL. Problems that occur during feeding are more suggestive of proximal pathology.

Answer 193

The median lobe is usually enlarged in BPH

Answer 194

Inflammatory breast cancers have an aggressive nature. Dissemination occurs early and is more resistant to adjuvant treatments than other types of breast cancer. Often occurs in pregnancy or lactation.

Answer 195

Any advanced right iliac fossa pathology can result in a positive Rovsings sign. However, in retrocaecal appendicitis, it may be absent and this fact can contribute to a delayed diagnosis if undue weight is placed on the presence of the sign in making the diagnosis.

Answer 196

Patients with duodenal ulcers will usually have a history of epigastric pain that occurs several hours after eating. The pain is often improved by eating food. They are most frequently located in the first part of the duodenum. Anteriorly sited ulcers may perforate and result in peritonitis, posteriorly sited ulcers may erode the gastroduodenal artery and present with haematemesis and/ or malaena

Answer 197

Individuals with small carcinoids can be discharged (<2cm and limited to the appendix). Larger tumours should have a radioisotope scan. Where the resection margin is positive or where the isotope scan suggests lymphatic metastasis a right hemicolectomy should be performed.

Answer 198

Patients with electrolyte disturbance and previous surgery may develop colonic pseudo-obstruction (Ogilvies syndrome). The diagnosis is made using a contrast enema and treatment is usually directed at the underlying cause with colonic decompression if indicated.

Answer 199

1:1:1 rule of FFP, platelets and packed cells

Answer 200

Apex of the lung

Answer 201

sequential organ failure assessment (SOFA) tool PaO2, BP, Platelets, bilirubin, creatinine, GCS and urine output. A SOFA score of 2 or more reflects an overall mortality risk of approximately 10% in a general hospital population with suspected infection

Answer 202

In hernia repair, the mesh procedure is called an open Lichtenstein repair and suturing the defect shut with no mesh is a bassini repair

Answer 203

DIC Will tend to consume factors five and eight intially (and platelets)

Answer 204

Contraindications to lung cancer surgery include SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis

Answer 205

Bipolar. Any other method will carry a risk of damage to end vessels

Answer 206

35% Infection risk may still be very high despite giving abx. Surgeons in this case may not close the skin.

Answer 207

Third nerve palsy and headache: Posterior communicating artery anuresym

Answer 208

Haemachromatosis can cause pseudogout and hence if you have suspicion of pseudo gout, order transferrin levels Risk factors hyperparathyroidism hypothyroidism haemochromatosis acromegaly low magnesium, low phosphate Wilson's disease

Answer 209

Desmopressin

Answer 210

Rima Glottis

Answer 211

Risk factors Family history Female sex Increasing age Deficient diet Sedentary lifestyle Smoking Premature menopause Low body weight Caucasians and Asians

Answer 212

In Catterall stage I disease there may be no radiological abnormality at all. In Stage II disease there may be sclerosis of the femoral head. Indication for treatment (aide memoire):Half a dozen, half a head Those aged greater than 6 years with >50% involvement of the femoral head should almost always be treated.

Answer 213

Dexamethasone

Answer 214

In NF type1, children may have one limb longer than the other as the fibrous tissue growing around nerves accelerates growth

Answer 215

Waldeyers fascia- Posterior ano-rectum Sibsons fascia- Lung apex Bucks fascia- Base of penis Gerotas fascia- Surrounding kidney Denonvilliers fascia- Between rectum and prostate

Answer 216

The birth defect is diagnosed by the presence of a combination of these symptoms: One or more distinctive port-wine stains with sharp borders Varicose veins Hypertrophy of bony and soft tissues, that may lead to local gigantism or shrinking. An improperly developed lymphatic system

Answer 217

Li-Fraumeni Syndrome Autosomal dominant Consists of germline mutations to p53 tumour suppressor gene High incidence of malignancies particularly sarcomas and leukaemias Diagnosed when: *Individual develops sarcoma under 45 years *First degree relative diagnosed with any cancer below age 45 years and another family member develops malignancy under 45 years or sarcoma at any age

Answer 218

Lynch Syndrome Autosomal dominant Develop colonic cancer and endometrial cancer at young age 80% of affected individuals will get colonic and/ or endometrial cancer High risk individuals may be identified using the Amsterdam criteria Amsterdam criteria 3 or more relatives with an associated cancer (colorectal cancer, or cancer of the endometrium, small intestine, ureter or renal pelvis); 2 or more successive generations were affected; 1 or more relatives diagnosed before the age of 50 years; 1 should be a first-degree relative of the other two; Familial adenomatous polyposis (FAP) should be excluded in cases of colorectal carcinoma; Tumors should be verified by pathologic examination.[4]

Answer 219

Post transplant complications CMV: 4 weeks to 6 months post transplant EBV: post transplant lymphoproliferative disease. > 6 months post transplant

Answer 220

Signature fractures are synonymous with depressed skull fractures, they are usually low velocity injuries where the fracture impression resembles the injurious source.

Answer 221

The penis takes autonomic nerves from the nervi erigentes that lie near the seminal vesicles. These may be compromised by direct surgical trauma (such as use of diathermy in this area) and also by radiotherapy that is used in these patients pre operatively. The result is that up to 50% of patients may develop impotence following rectal cancer surgery.

Answer 222

Post gastrectomy syndrome Rapid emptying of food from stomach into the duodenum: diarrhoea, abdominal pain, hypoglycaemia Complications: Vitamin B12 and iron malabsorption, osteoporosis Treatment: High protein, low carbohydrate diet. Replace B12/Fe/Ca

Answer 223

Schistosomiasis is the most common cause of bladder calcification worldwide. Schistosoma mansoni typically resided in the colon from where it is excreted. Schistosoma haematobium causes haematuria

Answer 224

Because it is excreted by renal tubular cells a MAG 3 renogram provides excellent imaging of renal function and is often used in investigating failing transplants.

Answer 225

The most likely diagnosis here is meconium ileus. The first line treatment for uncomplicated cases is enemas of either dilute gastrograffin or N-acetyl cysteine. It's important to ensure the child is adequately hydrated first. They are contra indicated if there is a suspected underlying perforation.

Answer 226

Carbohydrate loading is one of the enhanced recovery principles. Hence, carbohydrate rich diet should be given after colonic surgery. High protein and low carb diet may be used post gastrectomy

Answer 227

Most renal tumours are yellow or brown in colour. TCC's are one of the few tumours to appear pink.

Answer 228

Hypospadias most commonly occurs as an isolated disorder. Associated urological abnormalities may be seen in up to 40% of infants, of these cryptorchidism is the most frequent (10%).

Answer 229

CXR changes Widened mediastinum Trachea/Oesophagus to right Depression of left main stem bronchus Widened paratracheal stripe/paraspinal interfaces Space between aorta and pulmonary artery obliterated Rib fracture/left haemothorax

Answer 230

A McEvedy incision is traditionally used to approach incarcerated femoral hernias. The disadvantage of the Lotheissen approach is that it weakens the inguinal canal and predisposes to inguinal hernia formation. The other incisions would not usually address femoral hernias. Given the features of bowel obstruction, a low approach would be inappropriate.

Answer 231

1. Left main stem stenosis or equivalent (proximal LAD and proximal circumflex) 2. Triple vessel disease 3. Diffuse disease unsuitable for PCI

Answer 232

ECG changes for thrombolysis or percutaneous intervention: ST elevation of > 2mm (2 small squares) in 2 or more consecutive anterior leads (V1-V6) OR ST elevation of greater than 1mm (1 small square) in greater than 2 consecutive inferior leads (II, III, avF, avL) OR New Left bundle branch block

Answer 233

Heparin can cause hyperkalaemia

Answer 234

Young females at very high risk of breast cancer should undergo annual MRI.

Answer 235

Got a bad unit G raft vs. Host disease O verload T hrombocytopaenia A lloimmunization B lood pressure unstable A cute haemolytic reaction D elayed haemolytic reaction U rticaria N eutrophilia I nfection T ransfusion associated lung injury

Answer 236

A Klatskin tumor (or hilar cholangiocarcinoma) is a cholangiocarcinoma (cancer of the biliary tree) occurring at the confluence of the right and left hepatic bile ducts.

Answer 237

Thrombosis of the splenic vein may complicate pancreatitis, pancreatic carcinoma, iatrogenic trauma and hypercoagulable diseases. The condition may predispose to the development of gastric varices, oesophageal varices are uncommon in splenic vein thrombosis alone. Diagnosis is made by CT angiography. Treatment is with splenectomy.

Answer 238

Rhabdomyosarcomas as one of the more common malignant solid tumours in children (though all are rare). They have an aggressive behavior pattern and metastases are common. Teratomas are nearly always benign in younger children. Seminomas are very rare indeed. Malignant fibrous histiocytomas are almost never found in this location.

Answer 239

For humeral fractures, fracture through the anatomical neck is rare and needs to be replaced as there is a very high risk of avascular necrosis

Answer 240

The secretions of the proximal small bowel are hugely and directly affected by lumenal content osmolality. This can contribute to some of the symptoms of dumping syndrome that can be seen following gastric surgery. Jejunum in particular

Answer 241

Menisci have no nerve or blood supply and thus heal poorly. Established tears with associated symptoms are best managed by arthroscopic menisectomy.

Answer 242

If there are clear cells in the histology, then the metastatic disease origin is from the kidneys

Answer 243

Between 500 mL and 1.5 L of bile enters the small bowel daily. Most bile salts are recycled by the enterohepatic circulation. When the gallbladder contracts the lumenal pressure is approximately 25cm water, which is why biliary colic may be so painful.

Answer 244

Linitis plastica produces a diffuse infiltrating lesion, the stomach is fibrotic and rigid and will not typically distend. This may be described as a 'leather bottle stomach'. Diagnosis is made with a combination of pathology examination with endoscopy, radiological or surgical assessment. Pathologically signet-ring cell proliferation occurs.

Answer 245

Median arcuate ligament syndrome (MALS) occurs when the arc-shaped band of tissue in the chest area (median arcuate ligament) presses on the artery that sends blood to the upper abdomen. The artery is called the celiac artery. MALS can cause stomach pain in some people

Answer 246

Food: spinach, cheese, wine, caffeine, tomatoes Drugs: Naproxen, Monoamine oxidase inhibitors Recent surgery

Answer 247

Pain out of proportion to the injury. There is also pain on passive stretching of the muscle groups

Answer 248

Multiple lesions along with cytokeratin positive cells are a sign of mets. Raised ALP also

Answer 249

Medullary thyroid carcinoma is sporadic in 80% of cases and familial in 20% of cases

Answer 250

Stimulate the production of testosterone

Answer 251

Thyroid Ima artery, 5%

Answer 252

Ileum as it has the most payers patches and salmonella typhi accumulates in the payers patches

Answer 253

Anaplastic: 60-70 and aggressive Lymphomas: 40-50 Papillary 30-40 Hurtle cell carcinoma 80-90

Answer 254

Cervicofascial

Answer 255

D-Penicillamine is used to help. Alkalising urine can also help as acidic urine causes it. 1-2% of stones and is less common

Answer 256

Produce hypotonic solutions with more potassium than that in the plasma and also contains amylase and lipase. 1-2 L per day

Answer 257

If it is muscle invasive then cystectomy. If not then mitomycin or BCG is good

Answer 258

Without adrenaline is 3mg/kg and with adrenaline is 7mg/kg

Answer 259

Preserve the pylorus

Answer 260

Temp above 38 or below 36 Resprate above 20 with pCO2 <32 Wcc >12 or <4 HR >90 Only 2 of these conditions have to be met

Answer 261

Clinically detectable at 30u/L and obvious at 60

Answer 262

The ventromedial nucleus of the thalamus is responsible for satiety. If this is destroyed then it will lead to overeating

Answer 263

1: only those inferio-lateral to the pectoralis minor 2: posterior to pec minor 3: Superio-medial to pec minor

Answer 264

Normal Gap Acidosis: HARDUP H - Hyperalimentation/hyperventilation A - Acetazolamide R - Renal tubular acidosis D - Diarrhoea U - Ureteral diversion P - Pancreatic fistula/parenteral saline

Answer 265

Steroids are associated with Na and water retention

Answer 266

The term DALM lesion refers to a Dysplasia Associated Lesion or Mass. They may complicate dysplasia occurring in patients with longstanding ulcerative colitis. They have a high incidence of invasive foci. When they complicate longstanding ulcerative colitis, they should be treated by panproctocolectomy.

Answer 267

Accessory spleens - 10% population - 1 cm size - locations: hilum of the spleen, tail of the pancreas, along the splenic vessels, in the gastrosplenic ligament, the splenorenal ligament, the walls of the stomach or intestines, the greater omentum, the mesentery, the gonads

Answer 268

Drugs causing SIADH: ABCD A nalgesics: opioids, NSAIDs B arbiturates C yclophosphamide/ Chlorpromazine/ Carbamazepine D iuretic (thiazides)

Answer 269

Penile fractures are a rare type of urological trauma that may be encountered. The injury is usually in the proximal part of the penile shaft and may involve the urethra. A classically history of a snapping sensation followed by immediate pain is usually given by the patient (usually during vigorous intercourse). On examination there is usually a tense haematoma and blood may be seen at the meatus if the urethra is injured. When there is a a strong suspicion of the diagnosis the correct management is surgical and a circumferential incision made immediately inferior to the glans. The skin and superficial tissues are stripped back and the penile shaft inspected. Injuries are usually sutured and the urethra repaired over a catheter.

Answer 270

Cystic medial necrosis ( or cystic medial degeneration) occurs when basophils and mucoid material lie in between the intimal elastic fibres of the aorta. It is typically found in the aortic degeneration of Marfans syndrome, but may also be seen in aortic degeneration in older adults.

Answer 271

Catheter TPA

Answer 272

Beta 2 transferrin is a carbohydrate free form of transferrin that is almost exclusively found in the CSF. Although lab stix testing for glucose is traditional it is associated with false positive results secondary to contamination with other glucose containing bodily secretions.

Answer 273

Gritti - Stokes amputation. During a Gritti - Stokes operation the patella is conserved and swung posteriorly to cover the distal femoral surface.

Answer 274

Seminoma is the commonest type of testicular tumour and is more common in males aged between 30-40 years. Classical seminoma is the commonest subtype and histology shows lymphocytic stromal infiltrate. Other subtypes include: 1. Spermatocytic: tumour cells resemble spermatocytes. Excellent prognosis. 2. Anaplastic 3. Syncytiotrophoblast giant cells: β HCG present in cells A teratoma is more common in males aged 20-30 years.

Answer 275

Merkel cell tumours and pyoderma gangrenosum are similar under histology

Answer 276

Reduction in Ca ionised as it alkalises the blood

Answer 277

The ductular epithelium

Answer 278

Seminoma: 50%, AFP normal and HCG raised, older age Non seminoma: 50% and AFP and HCG both raised. Younger. Occasional ectopic tissue such as hair Leydig cell tumour associated with hormone imbalance

Answer 279

Allis technique for relocation

Answer 280

Thrombocytosis

Answer 281

Squamous cell lung cancer

Answer 282

2 feet from the IC juntion 2 inches long 2% of population 2:1 male to female ratio 1 in 2 will contain ectopic gastric tissue 2% will be symptomatic Rectal bleeding in under 2s

Answer 283

Class 1 laser: Printer Class 2: BArcode scanners (eyes are naturally protected) Class 3R: May sometimes cause eye injury eg some laser pointers Class 3B: Sufficient to cause eye injury Class 4: Very dangerous (cataract surgery)

Answer 284

<1% is pre renal 2-4% is intra >4% is post BUN creatinine ratio Prerenal >20:1 Intra >10:1 Post renal or normal is 10-20:1

Answer 285

Increased by 4 times

Answer 286

Majority of CO2 in the body is transported as bicarbonate

Answer 287

Decolonisation is attempted first before surgery and side room is not always needed. Marked decline in morbidity and mortality since 2006 There is insufficient evidence to support in widespread use of systemic and topical antimicrobial therapy. Severe infections can be treated with Vancomycin or teicoplanin

Answer 288

Particular Tumours Love Killing Bone P Prostate T Thyroid L Lung K Kidney B Breast

Answer 289

Mast cells and basophils

Answer 290

Cytoplasmic proteins

Answer 291

Ascending contrast venogram

Answer 292

There is a risk of developing secondary leukemia. 22% increase in relative risk

Answer 293

It is a cause of post menopausal bleeding as it is an agonist to the oestrogen receptors in the uterus as opposed to antagonist in the breast 5-10% have shown tamoxifen to be effective despite no oestrogen positive receptors

Answer 294

Chromosome 17

Answer 295

Presents with pain 5-10% increased risk in smokers Is a more severe form of AAA ESR is higher here and infected AAA will have a higher procalcitonin

Answer 296

Paediatric CO is usually dependent more on HR rather than SV. This is as they cannot increase their contractility as much as adults due to presence of fibrous tissue

Answer 297

Ends at L1 and L2 in adults and L3 in neonates Average male spinal cord is 18 inches long

Answer 298

Eccrine sweat glands occur over most of the body and open directly onto the skin's surface. Apocrine glands open into the hair follicle, leading to the surface of the skin. Apocrine glands develop in areas with many hair follicles, such as on the scalp, armpits and groin. Hidradenitis is inflammation of the apocrine glands

Answer 299

Bregma: Is formed by closure of the anterior fontanelle Pterion and lambda are known Asterion: Behind the ear (transverse and sigmoid sinuses are here)

Answer 300

ECTO: CNS (surface ecto gives rise to hair, skin and nails) ENDO: GI tract and resp tract as well as organs of the abdomen Intermediate meso: Urogenital Lateral plate meso: skeleton

Answer 301

Gilbert: Is common and autosomal recessive. Bilirubin is unconjugated and hence there is no bilirubin in the urine Dubin Johnson and rotor: Have conjugated high bili and this is why it is present in the urine. Liver will be black in dubin

Answer 302

The mucociliary escilator travels 1mm/min in LRT and 5-10mm/min in URT 10-100 ml mucus is generated per day Bronchioles are 1mm in diameter

Answer 303

The tetanus immunoglobulin or prophylaxis is not required if the patient has had tetanus vaccine in the last 10 years

Answer 304

Most common benign bone tumour and around 80% are noted in patients under thhe age of 21

Answer 305

Occurs due to C1 esterase inhibitors. FFP can be given to treat. It does not respond to adrenaline or anti-histamine treatement

Answer 306

Innate - Complement system, acute phase proteins, NK cells Acquired - From previous exposure Active - Whole immune system is activated Passive - From fetus for eg Humoral Cellular

Answer 307

Leukaemia and solid tumors occur at an increased rate following ionising radiation.

Answer 308

Brain 15% Kidneys 20% Liver 25% Muscles 20% Heart 5% Skin 5% other 10%

Answer 309

Type 1: Stable fracture and impaction Type 2: Complete fracture but non displaced Type 3: Partially displaced Type 4: Completely displaced

Answer 310

Anatomic anomalies of the adrenal gland may occur. Because the development of the adrenals is closely associated with that of the kidneys, agenesis of an adrenal gland is usually associated with ipsilateral agenesis of the kidney, and fused adrenal glands (whereby the 2 glands join across the midline posterior to the aorta) are also associated with a fused kidney. IF the kidney is ectopic then the adrenal glads will develop in its usual position

Answer 311

Recurrence following attempted resection of thyroglossal cysts is very common. Complete excision of the cyst and its track and origin is mandatory (Sistrunks procedure).

Answer 312

Hepatocellular adenomas in males have a greater risk of malignant transformation and resection should be considered.

Answer 313

If a lady has had a wide local excision and it shows ILC, send for completion mastectomy as ILC is multifocal and can reccur

Answer 314

Staph viridans Vir Dance in the heart!

Answer 315

Most asymptomatic Meckels diverticulum will be lined by ileal mucosa. Those which present with bleeding are more likely to contain gastric type mucosa.

Answer 316

Mesenteric vein thrombosis may complicate severe intra abdominal sepsis and when it progresses may impair bowel perfusion. The serosa is quite resistant to ischaemia so in this case the appearances are usually patchy.

Answer 317

This is a peripheral neuropathy that may complicate viral illnesses and usually resolves spontaneously. Parsonage-Turner syndrome causes sudden, intense pain in your shoulder and upper arm followed by muscle weakness.

Answer 318

Peritrochanteric lesions have the greatest risks of fracture (due to loading). The lesions from breast cancer are usually lytic and therefore at higher risk rather than the sclerotic lesions from prostate cancer.

Answer 319

A fistula is an abnormal connection between two epithelial lined surfaces, in the case of a fistula in ano it will be lined by squamous cells.

Answer 320

Nerve injury There are 3 types of nerve injury: Neuropraxia Nerve intact but electrical conduction is affected Full recovery Autonomic function preserved Wallerian degeneration does not occur Axonotmesis Axon is damaged and the myelin sheath is preserved. The connective tissue framework is not affected. Wallerian degeneration occurs. Neurotmesis Disruption of the axon, myelin sheath and surrounding connective tissue. Wallerian degeneration occurs. Wallerian Degeneration Axonal degeneration distal to the site of injury. Typically begins 24-36 hours following injury. Axons are excitable prior to degeneration occurring. Myelin sheath degenerates and is phagocytosed by tissue macrophages. Nerve repair Neuronal repair may only occur physiologically where nerves are in direct contact. Where a large defect is present, the process of nerve regeneration is hampered. It may not occur at all or result in the formation of a neuroma. Where nerve regrowth occurs it is typically at a rate of 1mm per day.

Answer 321

BASCOM: This procedure is usually performed if a pilonidal abscess has failed to heal. The operation involves removing the infected tissue which is often more extensive than it appears on the surface. The operation should take about 45 minutes and is done under a general anaesthetic.

Answer 322

The granulocyte (the eosinophil component is seldom raised) and platelet count are the first to be affected following splenectomy. Then reticulocytes increase. Although a lymphocytosis and monocytosis are reported, these take several weeks to develop.

Answer 323

Beta blockers should not be stopped acutely prior to surgery as there may be a rebound effect associated with increased complications. Brain natriuretic peptide is a neurohormone synthesized in the cardiac ventricles. Levels have been used to assess prognosis in heart failure and acute coronary syndromes. Preoperative elevated brain natriuretic peptide levels identify patients undergoing non cardiac surgery at high risk of cardiac mortality and all cause mortality. All patients with peripheral vascular disease should take statins prior to vascular surgery as studies have shown a 50% risk reduction and a reduction in perioperative cardiac events. Hypoalbumaenemia is associated with increased mortality

Answer 324

1 - systematic review or meta-analysis 2 - RCT 3 - pseudo RCT 4 - case reports 5 - expert opinion

Answer 325

Some of the more commonly occurring genetic conditions occurring in surgical patients are presented here. Li-Fraumeni Syndrome Autosomal dominant Consists of germline mutations to p53 tumour suppressor gene High incidence of malignancies particularly sarcomas and leukaemias Diagnosed when: *Individual develops sarcoma under 45 years *First degree relative diagnosed with any cancer below age 45 years and another family member develops malignancy under 45 years or sarcoma at any age BRCA 1 and 2 Carried on chromosome 17 (BRCA 1) and Chromosome 13 (BRCA 2) Linked to developing breast cancer (60%) risk. Associated risk of developing ovarian cancer (55% with BRCA 1 and 25% with BRCA 2). Lynch Syndrome Autosomal dominant Develop colonic cancer and endometrial cancer at young age 80% of affected individuals will get colonic and/ or endometrial cancer High risk individuals may be identified using the Amsterdam criteria Amsterdam criteria Three or more family members with a confirmed diagnosis of colorectal cancer, one of whom is a first degree (parent, child, sibling) relative of the other two. Two successive affected generations. One or more colon cancers diagnosed under age 50 years. Familial adenomatous polyposis (FAP) has been excluded. Gardners syndrome Autosomal dominant familial colorectal polyposis Multiple colonic polyps Extra colonic diseases include: skull osteoma, thyroid cancer and epidermoid cysts Desmoid tumours are seen in 15% Mutation of APC gene located on chromosome 5 Due to colonic polyps most patients will undergo colectomy to reduce risk of colorectal cancer Now considered a variant of familial adenomatous polyposis coli

Answer 326

Overview Also known as marble bone disease Rare disorder of defective osteoclast function resulting in failure of normal bone resorption Stem cell transplant and interferon-gamma have been used for treatment

Answer 327

Once a malignant diagnosis is made patients with colonic cancer will be staged using chest / abdomen and pelvic CT. Patients with rectal cancer will also undergo evaluation of the mesorectum with pelvic MRI scanning. For examination purposes the Dukes and TNM systems are preferred.

Answer 328

Some rules relating to fistula management: They will heal provided there is no underlying inflammatory bowel disease and no distal obstruction, so conservative measures may be the best option Where there is skin involvement, protect the overlying skin, often using a well fitted stoma bag- skin damage is difficult to treat A high output fistula may be rendered more easily managed by the use of octreotide, this will tend to reduce the volume of pancreatic secretions. Nutritional complications are common especially with high fistula (e.g. high jejunal or duodenal) these may necessitate the use of TPN to provide nutritional support together with the concomitant use of octreotide to reduce volume and protect skin. When managing perianal fistulae surgeons should avoid probing the fistula where acute inflammation is present, this almost always worsens outcomes. When perianal fistulae occur secondary to Crohn's disease the best management option is often to drain acute sepsis and maintain that drainage through the judicious use of setons whilst medical management is implemented. Always attempt to delineate the fistula anatomy, for abscesses and fistulae that have an intra abdominal source the use of barium and CT studies should show a track. For perianal fistulae surgeons should recall Goodsall's rule in relation to internal and external openings.

Answer 329

LEARN THIS! Mnemonic for the assessment of the severity of pancreatitis: PANCREAS (Ann R Coll Surg Engl 2000; 82: 16-17 P a02 < 60 mmHg A ge > 55 years N eutrophils > 15 x 10/l C alcium < 2 mmol/l R aised urea > 16 mmol/l E nzyme (lactate dehydrogenase) > 600 units/l A lbumin < 32 g/l S ugar (glucose) > 10 mmol/l > 3 positive criteria indicates severe pancreatitis.

Answer 330

Concussion with no skull fracture - oriented - 1 in 6000 Concussion with no frac - no oriented - 1 in 120 Concussion + frac - oriented - 1 in 32 concussion + frac - non oriented - 1 in 4

Answer 331

Anomalies of the connection of the SVC are recognised. In some individuals a persistent left sided SVC drains into the right atrium via an enlarged orifice of the coronary sinus.

Answer 332

About 68.27% of the values lie within 1 standard deviation of the mean. Similarly, about 95.45% of the values lie within 2 standard deviations of the mean. Nearly all (99.73%) of the values lie within 3 standard deviations of the mean

Answer 333

25% of people with aneurysms also have aneurysms elsewhere

Answer 334

Most likely cause of death is dysphagia related aspiration Like most carcinomas, it is sensitive to radiotherapy More common in men More common in anterior 2/3rd of the tongue

Answer 335

Lingual lipase digests 10-30% of the overall TGs, the rest is done by pancreatic lipase

Answer 336

The aim of a FAST scan is to detect intraperitoneal fluid. Hence, it is bad at identifying injury to retroperitoneal structures such as the liver

Answer 337

Spina bifida: Has overlying skin Meningocele: Has only CSF and no cord Myelomeningocele: Has CSF and cord

Answer 338

Low inflammatory reaction at the site

Answer 339

Metabolic alkalosis, hyponat and hypokal

Answer 340

Secondary fibrocartlage

Answer 341

Membranous urethra: 2 cm long and most commonly injured because of attachment with the puboprostatic ligaments. Goes into the retro pubic space Bulbous: Over the perineum Penile: Around the penis and scrotum VUJ: Urine will flow retrograde into the retroperitoneal space Bladder: Bladder will be collapsed on imaging if it has ruptured

Answer 342

Codmans triangle is the most common feature peak is 10-25 years and >65 due to paget's Bone develops and grows towards medulla and cortex and breaks through forming a starry appearance.

Answer 343

Bovis: Less common and causes GI TB Hominis: Most common and infects humans

Answer 344

initially GTN or diltiazem then EUA and BOTOX if secondary cause or paeds Sphincterotomy is the last option

Answer 345

Classification stage 0: clinical: mild clinical diverticulitis CT finding: diverticula with colonic wall thickening stage Ia: clinical: confined pericolic inflammation or phlegmon CT finding: pericolic soft tissue changes stage Ib: clinical: pericolic or mesocolic abscess CT finding: Ia changes and pericolic or mesocolic abscess stage II: clinical: pelvic, distant intra-abdominal or retroperitoneal abscess CT finding: Ia changes and distant abscess, usually deep pelvic stage III: clinical: generalized purulent peritonitis CT finding: localized or generalized ascites, pneumoperitoneum, peritoneal thickening stage IV: clinical: generalized fecal peritonitis CT finding: same as stage III

Answer 346

Lung compliance remains unchanged

Answer 347

1: <10% of one lobe and on surface 2: 10-50% 3: >50% and surface 4: 25-75% and associated parenchymal injury 5: >75% 6: Vascular involvement

Answer 348

Kohler disease is a rare bone disorder of the foot in children that may be the result of stress-related compression at a critical time during the period of growth. It is characterized by limping caused by pain and swelling in the foot. Affects 3-5 year olds Main pathology is avascular necrosis

Answer 349

The cell cycle is a four-stage process in which the cell increases in size (gap 1, or G1, stage), copies its DNA (synthesis, or S, stage), prepares to divide (gap 2, or G2, stage), and divides (mitosis, or M, stage)

Answer 350

Anasarca is a medical condition in which there is a severe generalized accumulation of fluid or edema in the interstitial space. This accumulation of fluid occurs when capillary filtration exceeds the amount of fluid removed via lymphatic drainage or a change in the oncotic pressure from low protein states.

Answer 351

Merantic is non bacterial thrombotic endocarditis. Can me mets Carcinoid: Carcinoid tumours

Answer 352

Ileostomies can cause high output of magnesium and hence hypomagnesemia. This makes

Answer 353

Phase 0: Rapid Na influx Phase 1: Small efflux of potassium Phase 2: Slow influx of calcium Phase 3: Efflux of potassium Phase 4: Na, Ca and K efflux

Answer 354

Sirolimus (Rapamycin)

Answer 355

Post central gyrus receives sensory information and precentral is the motor strip

Answer 356

Hypertrophic payers patches will lead to intussusception in 90% of cases

Answer 357

Ewing sarcoma

Answer 358

In minor the defect is <4cm

Answer 359

Mimics achalasia and is caused by Tryp cruzi. Causes destruction of ganglionic cells in the myenteric plexus. Can also cause myopathy and mimic malignancy

Answer 360

IL6 is secreted by muscles and macrophages and is very important in activation of the coagulation cascade

Answer 361

E coli secreting verotoxin

Answer 362

Max lidocaine dose is 200mg and hence if you do 3mg per kg and it is higher than this then do not give more

Answer 363

1: Simple 2: Thin septae non enhancing and non calcium 2F: Thick septae and some calcifications 3: 55% malignant 4: Malignant

Answer 364

Staph, strep and salmonella

Answer 365

Initially spread through the fascial planes and can mets throught blood most commonly to the lung

Answer 366

Orphan annie nuclei are seen

Answer 367

Antibodies to ABO are IgM and rhesus are IgG

Answer 368

CD8 and NK cells.

Answer 369

PCO2 receptors are more sensitive in pregnancy due to the hight amount of circulating progesterone. This makes preg women hyperventilate and reduce pCO2

Answer 370

CA and PO4 are co-transported in the same direction. Thus, calcitonin will decrease Ca and PO4 absorbtion

Answer 371

Can be found in the superficial inguinal pouch as the most common site. Can also be found at the base of the penis but this is less common

Answer 372

Right bundle branch block occurs in 5% of patients in the first 24hrs

Answer 373

Cortisol rises intra and post op, apart from CPBypass where it initially decreases and then increases CP bypass is also associated with thrombocytosis

Answer 374

Glasgow is for prognosis APACHE is for ITU patients Balthazaar is for CT scan and acute pancreatitis

Answer 375

When testicular torsion is repaired, there is a risk of cancer developing in both testes. The reason for this is unclear

Answer 376

Acid are more painful but in alkali the pain is delayed and hence more tissue damage occurs before seeking aid. HF burns needs wash with water and topical CA gluconate due to impending systemic toxicity

Answer 377

150mls/min or >50% blood volume loss in the first 3h

Answer 378

1: Incomplete 2: Complete and non-displaced 3: Complete and partially displaced 4: Complete and full displacement

Answer 379

Ipsilateral loss of fine touch and reflexes and muscle wasting Contralateral loss of pain and temperature

Answer 380

Wavelength defines penetration and depth of effect

Answer 381

Anti-TPO, Anti-thyroglobulin and anti microsomal

Answer 382

Intussusception is more common in males and in the winter as there are more viruses FACT: Post op MI is likely to occur at day 1

Answer 383

Klebsiella and e coli are the most common

Answer 384

Outside the BBB and on the floor of the 4th ventricle

Answer 385

Commonly can occur after excision of adrenal glands for Cushings syndrome Nelson syndrome is a disorder characterized by abnormal hormone secretion, enlargement of the pituitary gland (hypophysis), and the development of large and invasive growths known as adenomas. It occurs in an estimated 15 to 25 percent of people who undergo surgical removal of the adrenal glands for Cushing disease.

Answer 386

Zinc is essential for DNA and RNA synthesis

Answer 387

Liver metastases are necessary for the presence of carcinoid syndrome.

Answer 388

Facial artery, Marginal mandibular of the facial nerve, Hypoglossal and lingual nerve Retromandibular vein

Answer 389

50mmHg over arterial and ovver 1 hour. Above 2 hours there is risk of injury

Answer 390

Branchial cysts contain cholesterol

Answer 391

The classical complement pathway typically requires antigen-antibody complexes (immune complexes) for activation (specific immune response), whereas the alternative pathway can be activated by C3 hydrolysis, foreign material, pathogens, or damaged cells

Answer 392

It goes down and then normalises a few days later

Answer 393

The appendix testis is a remnant of the Müllerian duct, meaning that it's a leftover part of something that previously existed. The appendix testis is also called testicular appendix or hydatid of Morgagn It is found in 90% of men and does not affect the functioning of the testes. However, it can be torsion and hence surgery may be required for symptomatic relief. Typically presents with a blue dot on testicular examination

Answer 394

Only HCG in seminoma and LDH AFP and HCG in teratoma (teratoma terrorizes and hence it has both present in it)

Answer 395

0-8 mmHg Compartment syndrome symptoms start to show >30

Answer 396

Anterior single spinal artery and paired posterior

Answer 397

Autoclaving at 134C, Ethylene oxide, low temp steam, hot air ovens, formaldehyde, irradiation

Answer 398

Iodine based is bacteriocidal and hence used in DFI Alginate is wet and used in dry necrosis.

Answer 399

Identifying the first and only one node. Blue dye is now contraindicated in pregnancy

Answer 400

Large veins

Answer 401

Dihydrotestosterone

Answer 402

For rectum, resection followed by radiotherapy, for others of the intestine, it is resection followed by chemo

Answer 403

4-6 weeks post op and then every 5 years

Answer 404

Low current with high frequency and low voltage

Answer 405

Between cricoid cartilage and the sternal notch. 3-4 cm transverse incision is made into the platysma and the pre-tracheal fascia and this is supposed to be a relatively avascular area

Answer 406

Most cases will settle with conservative management with NG decompression and appropriate support. Laparotomy should be undertaken in patients do not who progress despite conservative management or in whom compelling indications for surgery exist

Answer 407

Bacteroides fragilis.

Answer 408

Brownes tube

Answer 409

Pes cavus is a descriptive term for a foot morphology characterized by high arch of the foot that does not flatten with weightbearing. No specific radiographic definition of pes cavus exists. The deformity can be located in the forefoot, the midfoot, the hindfoot, or a combination of these sites. Clawing of the toes may be seen

Answer 410

Colorectal cancer

Answer 411

F VIII and fibrinogen

Answer 412

Most local anaesthetics are of the amino- amide types, these have a more favorable side effect profile and are more stable in solution. PROCAINE and BENZOCAINE have amino - ester groups, these are metabolised by pseudocholinesterases.

Answer 413

Prilocaine without adrenaline

Answer 414

Exomphalos and diaphragmatic herniae are commonly associated with malrotation.

Answer 415

Hyperchloraemic ACIDOSIS

Answer 416

Squamous cell carcinomas are reported to be more slow growing and are typically centrally located. Small cell carcinomas are usually centrally located. However, small cell carcinomas would seldom be associated with a survival of a year without treatment.

Answer 417

Verapamil should never be given to a patient with a broad complex tachycardia as it may precipitate ventricular fibrillation in patients with ventricular tachycardia. Adenosine is sometimes given in this situation as a 'trial' if there is a strong suspicion the underlying rhythm is a supraventricular tachycardia with aberrant conduction

Answer 418

Lesser omentum

Answer 419

The seepage of pink serosanguineous fluid through a closed abdominal wound is an early sign of abdominal wound dehiscence with possible evisceration. If this occurs, you should remove one or two sutures in the skin and explore the wound manually, using a sterile glove. If there is separation of the rectus fascia, the patient should be taken to the operating room for primary closure.

Answer 420

Circular smooth muscle contracts behind the food bolus and longitudinal smooth muscle propels the food through the oesophagus Primary peristalsis spontaneously moves the food from the oesophagus into the stomach (9 seconds) Secondary peristalsis occurs when food, which doesn't enter the stomach, stimulates stretch receptors to cause peristalsis In the small intestine each peristalsis waves slows to a few seconds and causes mixture of chyme In the colon three main types of peristaltic activity are recognised (see below) Colonic peristalsis Segmentation contractions Localised contractions in which the bolus is subjected to local forces to maximise mucosal absorption Antiperistaltic contractions towards ileum Localised reverse peristaltic waves to slow entry into colon and maximise absorption Mass movements Waves migratory peristaltic waves along the entire colon to empty the organ prior to the next ingestion of food bolus

Answer 421

Anterior is mylohyoid nerve and posterior is facial

Answer 422

There are 4 collateral venous systems: Azygos venous system Internal mammary venous pathway Long thoracic venous system with connections to the femoral and vertebral veins (2 pathways)

Answer 423

Lateral is level 1, level 2 is posterior and level 3 is medial to the pec minor

Answer 424

At this point continue with ultrasound surveillance. USS surveillance of AAA: 3cm- 4.4cm - 1 year 4.5-5.4cm- 3 monthly

Answer 425

The patient is most likely to have a malignant lesion within the parotid. Of the malignancies listed; adenoid cystic carcinoma has the greatest tendency to perineural invasion.

Answer 426

Caudal block

Answer 427

Bruising of the flank is described as Grey Turners sign

Answer 428

Carbimazole is used to treat hyperthyroidism. Carbimazole is a pro-drug as after absorption it is converted to the active form, methimazole. Methimazole prevents thyroid peroxidase enzyme from iodinating and coupling the tyrosine residues on thyroglobulin, hence reducing the production of the thyroid hormones T3 and T4. Clinical effects take some months to occur as thyroid globulin stores remain for some time after treatment commences.

Answer 429

Unilateral isolated cleft lip represents a failure of nasolabial ring fusion. It is not related to branchial arch fusion. Arch disorders have a far more profound phenotype and malformation sequences.

Answer 430

PTH increases the activity of 1-α-hydroxylase enzyme, which converts 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol, the active form of vitamin D. Osteoclasts do not have a PTH receptor and effects are mediated via osteoblasts.

Answer 431

Serotonin normally is a vasodilator but in acute inflammation it is a vasocontrictor

Answer 432

Atracurium

Answer 433

Opiates typically affect the medullary respiratory centre to depress respiratory activity.

Answer 434

Elevated thyroglobulin levels

Answer 435

Round body knife as this would minimise damage to adjacent tissues

Answer 436

Lingual nerve is related to the duct and the MMN of the facial nerve is the most superficial and is hence implicated during the incision

Answer 437

Achilles tendon

Answer 438

Hista release and vasodil

Answer 439

Cap refill and pulse

Answer 440

Kidney - lytic Prostate - sclerotic Lung - mix Breast - mix Thyroid - Lytic

Answer 441

30 degrees

Answer 442

White spots in the lips that are commonly mistaken for disease

Answer 443

Should be completely excised on first surgery

Answer 444

Non therapeutic irradiation of the neck is most closely linked to papillary gland cancer.

Answer 445

Mucinous carcinomas: Mucinous carcinomas comprise 2-3% of all breast cancers. They are one of the special type of carcinomas. These have a better prognosis than is associated with tumours of Non Special Type (NST) and axillary nodal disease is rare in this group.

Answer 446

Will drain into the coronary sinuses. Persistent left superior vena cava is the most common anomaly of the thoracic venous system. It is prevalent in 0.3% of the population and is a benign entity of failed involution during embryogenesis.

Answer 447

Calcitonin is released from the thyroid gland

Answer 448

Ascaris lumbricoides

Answer 449

Most superficial structure on the parotid gland = facial nerve

Answer 450

Intraoperative frozen section

Answer 451

Adjuvant chemo to the breast can lead to secondary leukaemia

Answer 452

TPN can cause hypokalaemia

Answer 453

Osler nodes are normally described as tender, purple/red raised lesions with a pale centre. These lesions occur as a result of immune complex deposition. These occur most often in association with endocarditis. However, other causes include SLE, gonorrhoea, typhoid and haemolytic anaemia.

Answer 454

Give aspirin and Ibuprofen

Answer 455

21 - Hydroxylase

Answer 456

3 and 7 rule but also remember that max is 500 with adrenaline and 200 without

Answer 457

women aged 50 that have a triple neg breast cancer.. Negative for oestrogen, progesterone and HER

Answer 458

100ml/kg in the first 10kg 50ml/5kg in 10-20 20ml./kg for all weight above 20

Answer 459

Can be caused by smoking, ESR will be high and there will be weight loss as well as fever. They are more common in men and there is also an association with takatsubo Procalcitonin is high in infective AAA

Answer 460

Partial 21- Hydroxylase causes partial symptoms as there is still an ability to produce cortisol and aldosterone In complete there is complete incompetence

Answer 461

It connects the cricoid to the thyroid and has important implications as it contains the recurrent laryngeal nerve

Answer 462

XR for late and US for early symptoms

Answer 463

It is more common in boys and it is more common in the winter as viruses pre-dispose them to developing this condition

Answer 464

Asteroid bodies

Answer 465

Transfer factor raised: asthma, haemorrhage, left-to-right shunts, polycythaemia low: everything else

Answer 466

Anterior interosseous lesions occur due to fracture, or rarely due to compression. The Gantzer muscle is an aberrant accessory of the flexor pollicis longus and is a risk factor for anterior interosseous nerve compression. Remember loss of pincer grip and normal sensation indicates an interosseous nerve lesion.

Answer 467

Long term catheters can cause SCC of the bladder

Answer 468

Ca gluconate gel in the wound and lavage with water is required, however, systemic Ca may also be needed due to the fact that HF binds to Ca and hence reduces it plasma volume

Answer 469

It increases 6 fold

Answer 470

Shows widened mediastinum

Answer 471

Liver cirrhosis as there is increased activity of aromatase enzyme that converts stuff to oestrogen, thus tipping the balance

Answer 472

Haemolysin

Answer 473

Unpaired T test is for 2 groups at the same point in time Paired T-test is for one group at 2 different points in time Pearson correlation co-efficient is to judge how strong the relationship between 2 things is Friedmans is 3 or more groups Analysis of variance is between 3 or more groups

Answer 474

Lung and breast

Answer 475

Endocervical polyps or micro glandular hyperplasia is common after COCP use. They are usually reddish pink and are barely malignant

Answer 476

Occurs in the PCT and is actively co-transported with Na. Absorbtion is inhibited by PTH

Answer 477

1 in 2000 risk of getting a serious type of cancer

Answer 478

0.5 - 1 of nitrogen 35ml/kg/day of water

Answer 479

Marantic, It is most commonly diagnosed at autopsy

Answer 480

Rectal cancers with threatened resection margins are managed with radiotherapy and chemotherapy initially. This is not the case with colonic cancers which are usually primarily resected.

Answer 481

SCC of the kidney usually arises in an area of chronic inflammation such as a staghorn calculus. They are rare.

Answer 482

Diuretics increase the risk of re-feeding syndrome through a process of increasing the risk of depletion of key electrolytes.

Answer 483

Early reduction of the fracture is the best. It is also associated with retinal petechia

Answer 484

Narrow resection margins are fine as it is a premalignant lesion and can be treated with liquid nitrogen

Answer 485

Causes adrenal suppression but has a good cardiac safety profile

Answer 486

Left atrium

Answer 487

In Type IIIc injuries, the mangled extremity scoring system (MESS) can help to predict the need for primary amputation.

Answer 488

Be careful not to damage the tail of the pancreas, if you do then this will need to be formally removed and the pancreatic duct closed.

Answer 489

Single oral dose of praziquantel

Answer 490

Warfarin interferes with fibrin formation by affecting carboxylation of glutamic acid residues in factors 2,7,9 and 10. Factor 2 has the longest half life of approximately 60 hours, therefore it can take up to 3 days for warfarin to be fully effective. Warfarin has a small volume of distribution as it is protein bound.

Answer 491

Hurthle cell Hurthle cell tumours are a variant of follicular neoplasms in which oxyphil cells predominate. They have a poorer prognosis than conventional follicular neoplasms.

Answer 492

metastatic bone pain may respond to NSAIDs, bisphosphonates or radiotherapy

Answer 493

Jugular venous pressure Absent a waves = Atrial fibrillation Large a waves = Any cause of right ventricular hypertrophy, tricuspid stenosis Cannon waves (extra large a waves) = Complete heart block Prominent v waves = Tricuspid regurgitation Slow y descent = Tricuspid stenosis, right atrial myxoma Steep y descent = Right ventricular failure, constrictive pericarditis, tricuspid regurgitation

Answer 494

If the gastric cancer has signet rings, this means that the cancer is poorly differentiated and hence has a higher risk of metastatic spread

Answer 495

The Amsterdam criteria (Box 3‐4) requires the presence of at least three family members with colorectal cancer, extending over at least two generations, with at least one person diagnosed before the age of 50 years, and one affected person a first‐degree relative of the other two. 3-2-1 rule

Answer 496

Li-Fraumeni Syndrome Autosomal dominant Consists of germline mutations to p53 tumour suppressor gene High incidence of malignancies particularly sarcomas and leukaemias Diagnosed when: *Individual develops sarcoma under 45 years *First-degree relative diagnosed with any cancer below age 45 years and another family member develops malignancy under 45 years or sarcoma at any age. BRCA 1 and 2 Carried on chromosome 17 (BRCA 1) and Chromosome 13 (BRCA 2) Linked to developing breast cancer (60%) risk. Associated risk of developing ovarian cancer (55% with BRCA 1 and 25% with BRCA 2). Lynch Syndrome Autosomal dominant Develop colonic cancer and endometrial cancer at young age 80% of affected individuals will get colonic and/ or endometrial cancer High risk individuals may be identified using the Amsterdam criteria Gardners syndrome Autosomal dominant familial colorectal polyposis Multiple colonic polyps Extra colonic diseases include: skull osteoma, thyroid cancer and epidermoid cysts Desmoid tumours are seen in 15% Mutation of APC gene located on chromosome 5 Due to colonic polyps most patients will undergo colectomy to reduce risk of colorectal cancer Now considered a variant of familial adenomatous polyposis coli

Answer 497

MEN 1 = MENIN gene on chromosome 11 MEN 2a and 2b = RET and chromosome 10

Answer 498

COWDEN = PTEN (MACROCEPHALY and multiple colonic polyps) FAP = APC MYH = MYH 1p Peutz Jegers syndrome = STK11 on c19 Lynch syndrome = Germline mutations of DNA mismatch repair genes

Answer 499

No corneal, vestibulo ocular reeflex, no resp effort 5 mins after turning of ventilator, no change when supraorbital pressure is applied. PaCO2 up to 6 after turning off ventilator (6.5 if retainer). Adequate oxygenation given before hand The test should be undertaken by two appropriately experienced doctors on two separate occasions. Both should be experienced in performing brain stem death testing and have at least 5 years post graduate experience. One of them must be a consultant. Neither can be a member of the transplant team (if organ donation contemplated)

Answer 500

There is a decreased level of 2,3 BPG and hence there will be more affinity for oxygen

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