Deck 5

Question 1

What is pharyngeal pouch

Answer 1

Diverticulum of pharynx through killian dehisence

Found betwee upper and lower parts of inferior constrictor

Question 2

Sx of pharyngeal pouch

Answer 2

Old men
halitosis
wt loss
regurgitation

Question 3

Sx of pharyngeal pouch

Answer 3

Old men
halitosis
wt loss
regurgitation

Question 4

Pharyngeal pouch Rx

Answer 4

If asymptomatic no rx

Otherwise:

• endoscopic stapling
  or
• External excision

Question 5

Differentials for superficial neck lump

Answer 5

Sebaceous cyst
Abscess
Lipoma

Question 6

Differentials for anterior triangle neck lump

Answer 6

Dermoid cyst
Thyroglossal cyst
Branchial cyst 
Carotid body tumour
Thyroid
Lymph

Question 7

Differentials for posterior triangle neck lump

Answer 7

• Cystic hygroma
• pharyngeal pouch
• lymph node

Question 8

Types of necrosis

Answer 8

1. coagulative (tissue structure preserved)
2. Liquefactive
3. Caseous (impossible to tell type of tissue as structure destroyed)
4. Fat necrosis
5. Fibrinoid

Question 9

What happens in liquefactive necrosis

Answer 9

Lipid rich tissues denaturation of fats by lysosomes

eg in brain

Question 10

Example of caseous necrosis

Answer 10

TB

Question 11

Examples of fat necrosis

Answer 11

Pancreas (lypolysis)

Breast (trauma)

Question 12

Examples of fibrinoid necrosis

Answer 12

Blood vessels:

• antigen-antibody complex and fibrin deposited in wall of vessels causing necrosis
• type 3 hypersensitivity
• SLE or vasculitis

Question 13

How are neoplasms classified based on cell type

Answer 13

1 cell type:

• Adenoma
• Sarcoma
• lymphoma

2 cell types, 1 germ line:

• Pleomorphic adenoma
• fibroadenoma

2 germ lines:
teratoma

Question 14

Physiological and pathological examples of hyperplasia

Answer 14

Physio:

• breast tissue in puberty
• thyroid in pregnancy

Pathological:

• BPH
• parathyroid hyperplasia in renal failure

Question 15

Physiological and pathological examples of hypertrophy

Answer 15

Physiological:

• skeletal muscle
• uterus in pregnancy

Pathological:

• Graves
• Cardiomyopathy

Question 16

Examples of metaplasia

Answer 16

Barrets : LES changes from stratified squamous to columnar

Cervix with HPV: changes from columnar to stratified squamous

Question 17

Carcinoma vs sarcoma spread

Answer 17

Carcinoma: lymphatics (except follicular thyroid)

Sarcoma: haematological

Question 17

Carcinoma vs sarcoma spread

Answer 17

Carcinoma: lymphatics (except follicular thyroid)

Sarcoma: haematological

Question 18

What is rheumatic fever

Answer 18

Systematic disease due to untreated pharyngeal strep pyogenes resulting in damage to heart, brain, skin and joints

Question 19

Which valve does rheumatic disease affect

Answer 19

Mitral (70%)
aortic (40%)
tricuspid (10%)

Question 20

Criteria for diagnosis of Infective endocarditis

Answer 20

Duke’s criteria (eg presence viridancs, or HACEK in culture etc)

Question 21

Criteria for dx of rheumatic disease

Answer 21

Modified Jones criteria (eg raised ESR, carditis)

Question 22

What causes Grey Turners sign

Answer 22

Release of elastase (pancreatitis) leads to breakdown of blood vessel wall leading to bleeding into retroperitoneal space

Question 23

Pancreatic severity scoring systems

Answer 23

Modified Glasgow score
Ransons
Balthazar
Apache

Question 24

Ransons score

Answer 24

estimates pancreatitis mortality based on initial and 48 hr values

Question 25

Balthazar score

Answer 25

CT based severity score for pancreatitis

Question 26

Why amylase levels might be normal in acute panc

Answer 26

Levels start to fall after 24-48hr after onset

Question 27

Why amylase levels might be normal in acute panc

Answer 27

Levels start to fall after 24-48hr after onset

Question 28

Complications of pancreatitis

Answer 28

Early: - DIC - ARDS - Electrolyte disturbance: low calcium Late: - chronic - necrosis and infection - pseudocyst

Question 29

When to CT pancreatitis

Answer 29

At least after 72 hrs to allow complications to show

Question 30

How high should amylase be for dx of pancreatitis

Answer 30

3 times upper limit (normal is 30-110)

Question 31

What other conditions lead to rise in amylase

Answer 31

Perforation Trauma Burns

Question 32

Differentials for bilat swelling of parotid

Answer 32

Infective: mumps Inflam: Sjogrens or sarcoid

Question 33

Differential for unilateral parotid swelling

Answer 33

Obstruction: - stones - external neoplasia Neoplasia of parotid Infective: mumps

Question 34

Why submandibular stone more common than other salivary glands

Answer 34

Mucous composition (as opposed to serous in parotid) Long duct to enter mouth Ascends against gravity

Question 35

Difference between submandibular and parotid stones

Answer 35

Parotid: multiple, small, within gland Submandibular: single, large, intraductal

Question 36

Parotid neoplasia

Answer 36

Benign: pleomorphic (80 %), Warthins (5%) Malignant: Mucoepidermoid (10%) and adenoid cystic carcinoma

Question 37

Complications of parotidectomy

Answer 37

Immediate: CN7, greater auricular n, haemorrhage Early: haematoma, infection Late: Freys syndrome, fistula

Question 38

Criteria to refer dyspepsia for endoscopy urgently

Answer 38

- Dysphagia - upper abdo mass - >55 + wt loss + either abdo pain, reflux, dyspepsia

Question 39

When does pain happen in relation to gastric and duodenal ulcers

Answer 39

Gastric: during meal time Duodenal: 2-3 hrs after meal

Question 40

Non surgical mx of peptic ulcer disease

Answer 40

Lifestyle : NSAIDs, steroids, alcohol PPIs and H2 receptor antagonists Antacids (gavascon) H pylori eradication

Question 41

What are billroth 1 and Billroth 2 operations

Answer 41

1: Gastroduodonostomy after partial gastrectomy 2: Gastrojejunostomy after partial gastrectomy + closure of duodenal stump

Question 42

Dumping syndrome def

Answer 42

Rapid passage of food from stomach to small intestine (secondary to gastrectomy, osoephagectomy, bypass) Results in fluid shift

Question 43

Early dumping syndrome sx

Answer 43

10-30 mins after food Bloating, fainting, dizziness

Question 44

Late dumping syndrome sx

Answer 44

Hypoglycaemia (massive release of insulin) | 1-3 hours post food