Wrong Questions Flashcards
What is the type of hereditary gastric cancer? What is the gene? What is the inheritance? What other cancers are associated
Hereditary diffuse gastric cancer
CDH1
Autosomal recessive - colon, rectal, breast, prostatw
When do you screen for CDH1? Do you offer anything routinely
18 years
Prophylactic surgery - 20-25 years
Clinical criteria for CDH1
2+ family members
Diffuse gastric cancer <40, no FH
How is colorectal cancer staged
A - limited mucosa or muscularis propria
B1 - to the level of muscularis, but not beyond
B2 - penetrates through muscularis into surrounding tissue
C1 - limited to bowel wall BUT with lymph node involvement
C2 - beyond the bowel with lymph node involvement
D - distant mets
What is the pathophysiology of atherosclerosis
Endothelial injury and dysfunction
Lipoprotein infiltration
platelet adhesion > monocyte infiltration > differentiation into macrophages and formation of foam cells
Free radical damage
What are the types of germ cell tumours
Seminomatous
- seminoma
- spermatocytic seminoma
Non seminomatous tumours
- embryonal carcinoma
- yolk sac tumour
- choriocarcinoma
Sex cord stromal tumours
- leydig cell tumour
- sertoli cell tumour
Teratoma
Common ages for seminoma vs teratoma
Seminoma 30+
Teratoma 20-30
What are the boundaries of the mediastinum
Superior - thoractic inlet
Inferior - continous with inferior mediastinum at the level of the sternal angles
Anterior - manubrium
Posterior - vertebral bodies of T1-4
lateral - pleurae of lung
What are the contents of the superior mediastinum
Great vessels
- arch of aotra and it’s three branches
- SVC AND:
1. Brachiocephalic veins
2. Left superior intercostal vein
3. Supreme intercostal vein
4. Azygous vein
Nerves
- vagus
- phrenic
- cardaic nerves - from suprerior/middle/inferior cardiac ganglia, which form cardiac plexuses
- sympathetic trunk
Thymus
Traches
Oesphagus
Thoracic duct
Muscles
- sternohyoid
-sternothyroid
What are the borders of the posterior mediastinum
Lateral - mediastinal pleura
Anterior - pericardium
Posterior - T5-T12 vertebrae
Roof - imaginary line between sternal angle and T4
Floor - diaphragm
What are the contents of the posterior mediastinum
Thoractic Aorta
-Posterior intercostal arteries
-Bronchial arteries
-oesophageal arteries
- superior phrenic arteries
Oesophagus
Thoracic duct
Ayzgous system
- azygous vein - right lumbar + right subcostal
- hemiazygous vein - left lumbar and left subcostal - drains into azygous at T8
- accessory hemiazygous - 4th to 8th intercostal vein, drains into azygous at T7
Sympathetic trunk
- arising from these trunks are
Describe the structure of the sympathetic trunk
Pre-ganglionic fibres - originate in T and L divisions of spinal cord, end by synapsing with post ganglionnic fibres at peripheral ganglia
Post ganglionic fibres - begin at peripheral ganglia and carry sympathetic fibres to target organs
Where do the pre-ganglionic fibres of the sympathetic chain arise
Myelinated fibres arising from lateral horns of T1-L2
What is the course of the pre-ganglionic fibres
ventral root > ventral ramus > white ramus communicans > sympathetic chain
What is the surface anatomy of the abdominal aorta
?just below xiphisternum to line bisecting iliac crests
Surface anatomy of transpyloric plane
Halfway between jugular notch and pubic symphysis
Definition of aneurysm
Abnormal dilatation of an artery more than 1.5x original diameter
Tributeries of IVC
Common iliac veins
renal veins
Median sacral
Lumbar veins
Right gonadal
Classification of gastric cancer
WHO
BORMANN - gross morphology
Lauren - histology
Paraneoplastic syndrome definition
Symptoms that occur in cancer, not explained by local or distant spread of the cancer
Secretion of hormones causing effect on distant organ system
Paraneoplastic syndromes associated with gastric carcinoma
Acanthosis nigricans
Dermatomyositis
How does gastric carcinoma spread
Lymphatics - first
How does atherosclerosis occur
- Endothelial injury
- Endothelial permiability - increased permeability, leucocyte adhesion and monocyte emigration
- Macrophage activation and smooth muscle recruitment
- Macrophages and smooth muscle cells enguld lipid
- Smooth muscle proliferation
What is the DUKES classification
How does MI occur
- Within seconds, aerobic glycosis ceases
Drop in ATP and accumulation of noxious metabolities like lactid acid - in cardiac myocytes
Rapid loss of contractility
- Structural changes -
glycogen depletion
Myocyte swelling
(reversible until now
After 20-40 minutes of severe ischaemia
- coagulative necrosis
- death
What are the histological prognostic features of melanoma
Increased tumour thickness
Increased breslow thickness
increased depth of invasion
ulceration
Presence of lymphovascular invasion
What is HER2
Transmembrane protein
Oncogene
What is adenocarcinoma
Malignant tumour arising from glandular structure epithelial tissue
PRE AND POST MENOPAUSAL HORMONAL TREATMENT
Tamoxifen - Pre - menopausal
Aromatase inhibitors - Post menopausal
What is pathophysiology of paget disease
Extension of ductal carcinoma in situ beyond lactiferous ducts to the skin of nipple
How does herceptine work
Antibody mediated destruction of tumour cells
Surface anatomy of transpyloric plane
Halway between jugular notch and pubis symphysis
Surface anatomy of aorta
4 cm above transpyloric plane
Supracrestal line
Describe the efferent nerve supply to the heart
parasympathetic via vagus nerve
Sympathetic via cervical and upper thoracic sympathetic trunk
- cardiac plexuses are located below the arch of the aorta and transmit all of heart’s autonomic fibres
Why is the ischaemic heart pain referred as chest wall
Afferent fibres fromt he heart run with sympathetic fibres
Enter spinal cord via posterior roots of T1-4
Describe the origin of the azygous vein
FOrmed at the level of the right renal vein from either a posterior tributary of teh IVC or from the junction of the right ascending lumbar and right subcostal veins
Traverses aortic opening of the diaphragm and lies to the right of the vetebra, behind the oesophagus
Runs anteriorly over hilum of right lung into SVC
Describe the tributataries to azygous vein
Hemiazygous
- arises from left ascending lumbar, left subcostal and often left renal veins
- drains four lower left posterior intercostal veins
Accessory hemiazygous
- drains 5-8th left posterior intercostal veins
- tributaries from the bronchial and mid oesophageal veins
Differentiate between pseudocyst and pancreatic ca
CA 19-9
US/CT
Cyst fluid analysis
Investigation of choice for pancreatis necrosis
IV contrast CT abdomen with pancreatic protocols
Medical managmenet of pancreatitis
PPI
ABx
Octreotide
+- Steroids
Management of pain in pancreatitis
NSAIDs worsen
Morphine can worsen by causing sphincter
significance of ransons
0-2 2% mortality
3-4 8%
5-6 40%
7-11 100%
What tests do you order after 48h in glasgow score
Ca
LDH
Albumin
These are only ordered once
PaO2 etc on admission
