1. Fully Oxygenate pt 2. Hypoventilate so PCO2 reaches 6.5 3. Withdraw ventilation If no respiratory movement even when PCO2 rises by more than 1 (above 6.65), then unlikely to recover

Deck 3 Flashcards by K D

RFs for thyroid cancer

Modifiable

Obesity
Radiation in infancy or childhood

Non modifiable:

Female
FHx
Cancer syndromes : FAP

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Thyroid cancer genetic?

Medullary thyroid ~ 25% familial

Papillary and follicular ~10%

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Features of thyroid malignancy on USS

Increased vascularity
Solid appearance
Microcalcification

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Indications for removal of thyroid nodular goitre

Cancer
Pressure
Hyperthyroid resistant to meds

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Most common thyroid cancer

Papillary (80%)

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Causes of hypoparathyroidism

Post thyroidectomy
Radiotherapy to head and neck
Low Mg

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Difference between primary and secondary hyperaldosteronism

Primary: Low renin, high aldosterone
eg aldosterone producing adenocarcinoma

Secondary: high renin, high aldosterone,
eg renal vascular disease, renin secreting tumours

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Difference between primary and secondary hyperaldosteronism

Primary: Low renin, high aldosterone
eg aldosterone producing adenocarcinoma

Secondary: high renin, high aldosterone,
eg renal vascular disease, renin secreting tumours

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What is leukoplakia

White patch or plaque on the oral mucosa
Not painful, irregular shape
Cannot be scrapped

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Is leukoplakia malignant

No, pre-malignant

Improved on stopping smoking and alcohol

Progresses to SCC in 5%

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Commonest head and neck cancer

SCC

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RFs for SSC of oral cavity

Alcohol
Smoking
Working with wood dust or nickel dust
Infection: HIV, HPV, EBV

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What is radical neck dissection

Removal of SCM
Internal jugular vein
Accessory nerve
As well as lymph node levels 1-5

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Indications for heart transplant

Heart failure secondary to :

congenital heart disease
valve disease
cardiomyopathy
Ischaemic heart disease

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General transplant criteria

no active malignancy
No active HIV or sepsis
Lifestyle: no alcohol or smoking or drugs

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Criteria for being a heart organ donor

<55 yo
Normal heart investigations (ECG, echo, angio)
No hx of heart disease or chest trauma
No Hep B,C, HIV

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Criteria for being a heart organ donor

<55 yo
Normal heart investigations (ECG, echo, angio)
No hx of heart disease or chest trauma
No Hep B,C, HIV

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Criteria for brainstem dead

Known aetiology for irreversible brain damage
Exclusion of reversible causes for coma and apnoea
Absence of brainstem reflexes

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Tests of brainstem reflexes?

No response to supraorbital pain
Pupils fixed and unresponsive
No corneal reflex
No vestibulo-occular reflex (no eye movement on injecting 50mls of ice cold water in ear)
No gag reflex
No cough in response to bronchial stimulation

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Apnoea test

Study These Flashcards

Fully Oxygenate pt
Hypoventilate so PCO2 reaches 6.5
Withdraw ventilation

If no respiratory movement even when PCO2 rises by more than 1 (above 6.65), then unlikely to recover

Who can declare someone brainstem dead

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2 doctors 5 years after full GMC registration
At least 1 consultant
2 separate occasions

How to reduce allograft rejection

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blood type matching
Tissue size and type matching
Immunosuppressants

Side effects of steroids

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Skin:

bruising
thining
hirstusm

CVS:

HTN
retension

GI:

fatty liver
pancreatitis

Neuro:

psychosis
insomnia

MSK:

osteoporosis
AVN

Endocrine:
- diabetes

Tumours associated with HIV

Study These Flashcards

Kaposi sarcoma
CNS lymphoma
Hodkin’s

How does H pylori survive acidic conditions

1. detects low ph and uses its flagella to swim away 2. burrows through the mucous lining and attaches itself to cells under 3. produces urease which produces ammonia from urea. Ammonia binds H+

How does H pylori lead to ulceration

Produces enzymes protease and lipase -> damage gastric mucosa Damaged protective layer gets further damaged by the stomach acid Ulcer formation

What proportion of patients with H pylori 1. asymptomatic 2. develop ulcers or 3. cancer

1. 80-90% 2. 10% 3. 1-2%

Which gastric neoplasia associated with H pylori

Adenocarcinoma | MALT lymphoma

Embryological origin of parathyroid gland

3rd and 4th pharyngeal arch

Where are parathyroid glands found

Usually posterior to thyroid Sometimes inferior ones are pulled down along with thymus into the mediastinum (both originate from 3rd pharyngeal arch)

Where are parathyroid glands found

Usually posterior to thyroid Sometimes inferior ones are pulled down along with thymus into the mediastinum (both originate from 3rd pharyngeal arch)

Frozen section use

Intra-operative histology review: - benign or malignant - resection margins

What happens during frozen section revie

Pathologist fixes the sample using cryostat machine and a microtome before looking under microscope Quality lower than if it was formalin as the usual fixation agent

Parathyroid histology fx

Oxyphil cells | Chief cells

What happens in type 1 hypersensitivity reaction

1. Initial exposure to antigen -> sensitization of B and T cells 2. Mast cells with IgE in circulation 3. If re-exposed: release of histamine leading to inflammation

Examples of type 1 hypersensitivity

Anaphylaxis | Asthma

Pathophysiology of type 2 hypersensitivity

IgG and IgM antibodies binds to foreign cell surface antigens Activates complement pathway Membrane attach complexes (MAC) destroys the cell membrane

Examples of type 2 hypersensitivity

Autoimmune haemolytic anaemia | Rheumatic heart disease

Pathophysiology of type 3 hypersensitivity

Formation of antibody-antigen complexes in circulatory blood Forms a circulatory immune complex Deposited in vessels, joint, kidneys etc causing tissue damage

Examples of type 3 hypersensitivity

SLE | Rheumatoid arthritis

Pathophysiology of type 4 hypersensitivity

Mediated by T cells attacking the tissue | Takes 48-72hrs

Examples of type 4 hypersensitivity

Acute transplant rejection Dermatitis TB mantoux test Hashimotos thyroiditis

Pathophysiology of type 5 hypersensitivity

Stimulatory or inhibitory autoantibodies Similar to type 2 that IgG or IgM binds to cell surface Instead inhibits or stimulates the cell to produces something

Examples of type 5 hypersensitivity

Graves | Myasthenia Gravis

Sepsis definition

Organ dysfunction secondary to dysregulated host response to infection Organ dysfunction : increase of 2 or more points on SOFA (sequential organ failure assessment) score

qSOFA score use?

likelihood of sepsis in pt with a known or suspected infection

Granuloma definition

Collection of epithelioid macrophages (epithelial formation)

Types of granulomatous inflammation

Caseating (TB) or Non caseating (Sarcoid, Crohns) Infective (TB) or non infective (Rheumatoid, corhns)

Deck 3 Flashcards

(48 cards)