Deck1

Question 1

What is amyloidosis

Answer 1

• Rare life-threatening condition

- Deposition of abnormal fibrillar protein known as amyloid in the extracellular tissue

Question 2

Histological fx of amyloidosis

Answer 2

Apple green birefringence under polarised light

Question 3

Classifications of amyloidosis

Answer 3

AL: primary
AA: Secondary to chronic inflammation
ATTR: hereditary

Question 4

ATTR amyloid

Answer 4

Autosomal dominant mutation in transthyretin

Similar sx to AL

Question 5

AL amyloidosis cause

Answer 5

AKA immune origin

Profileration of plasma cells -> produce amyloidal immunoglobulins -> precursor t AL amyloid protein

Question 6

AL amyloid organs

Answer 6

Kidneys
Heart 
Peripheral nerves
Skin
GI

Question 7

AA amyloid cause

Answer 7

Secondary to inflammation

Macrophages produce IL, stimulating hepatocytes -> release amyloid protein A (precursor to amyloid)

Question 8

Conditions associated with amyloid AA

Answer 8

Rheumatoid
IBD
TB

Question 9

Sx of amyloid AL

Answer 9

Kidney: Proteinuria, Nephrotic syndrome
CVS: arrhythmia
NS: peripheral neuropathy
GI: bleeding, obstruction

Question 10

Sx of amyloid AA

Answer 10

Hepatosplenomegally

Protienuria

Question 11

Dx of amyloid

Answer 11

Tissue biopsy

Question 12

Amyloidosis rx

Answer 12

AL: chemo targetting plasma cells producing amyloid antibodies
AA: control the primary cause
ATTR: transplant affected organs (kidneys, liver) but tend to recurr

Question 13

Prognosis amyloid

Answer 13

1-2yrs

Question 14

Most common cause of death secondary to amyloid

Answer 14

Cardiac failure or fatal arrhythmia

Question 15

Thyroid cancer ass with amyloid

Answer 15

Medullary carcinoma

Question 15

Thyroid cancer ass with amyloid

Answer 15

Medullary carcinoma

Question 16

Causes of aneurysm

Answer 16

Atherosclerosis
Trauma
Infection
FHx (genetic disposition)

Question 17

How does atherosclerosis lead to aneurysm

Answer 17

Weakens mechanical structure and reduces recoil -> more pressure of vessel wall
Obstrucs vasa vasorum (degenerative ischaemia of the vessel wall)

Question 18

Atherosclerosis risk factors

Answer 18

Modifiable:
Smoking
High chol diet
HTN

Nonmodifiable:
Age
DM
Male

Question 19

Operative mortality of AAA repair

Answer 19

Elective: 3-5% (MI, CVA, rupture)
Emergency: 50% make it to hospital, 50% of those who make it survive an operation

Question 20

Classification of aortic dissection

Answer 20

Question 21

Complications of AAA open repair

Answer 21

Immediate: haemorrhage, trash foot
Early: Mesenteric ischaemia, Spinal ischaemia, MI, CVE
Late: Pseudoaneurysm, graft infection, Aorto-enetric fistula, impotence

Question 22

Causes of aortic stenosis

Answer 22

Calcification
Bicuspid congenital valve
Infection and damage: rheumatic fever
Autoimmune: SLE

Question 23

Which nerve initially picks up appendicitis pain

Answer 23

Lesser splanchnic (T10) 
Refers to umbilicus

Question 24

Scoring system for appendicitis

Answer 24

Alvarado

Question 25

Causes of transudate ascites

Answer 25

Raised portal pressure: Cirrhosis R sided heart failure Buddchiari Reduced oncotic pressure: Nephrotic syndrome Hypoprotienaemia (secondary to hepatic failure)

Question 26

Causes of exudate ascites

Answer 26

Inflammation (pancreatitis) Infection Malignancy Post radiation

Question 27

Pathophysiology of atherosclerosis

Answer 27

1. Endothelial dysfunction: migration of macrophages -> foam cells and lipid core 2. Migration of vascular smooth muscle : forming fibrous cap 3. stenosis of vessel, rupture of cap could lead to thrombosis

Question 28

What is a fibroadenoma of breast

Answer 28

Proliferation of epithelial and stromal cells in breast

Question 29

Causes of mastalgia

Answer 29

Cyclical Non cyclical: meds (hormone contraception, antidepressants, antipsychotics) Extramammary: chest wall/shoulder

Question 30

Mx of cyclical mastalgia

Answer 30

Better fitting bra Pain diary Flax seed oil/primrose oil Danazol (antigonadortrophin)

Question 31

Abscess def

Answer 31

Pus filled collection surrounded by granulation (macrophages) or fibrotic tissue

Question 32

Peri-ductal mastitis affects what part? which group of patients

Answer 32

Inflammation of subareolar ducts presents usually as young smokers

Question 33

Periductal mastatitis sx

Answer 33

Nipple retraction Painful tender red breast Nipple discharge Abscess

Question 34

Causes of nipple discharge

Answer 34

Benign: 1. intraductal papilloma 2. ductal ectasia 3. periductal mastitis 4. Gestational Malignant

Question 35

Commonest cause of developing cholangiocarcinoma

Answer 35

PSC Chronic liver disease HIV/Hep C

Question 36

Commonest risk factor for cholangiocarcinoma in developing world

Answer 36

parasitic liver flukes

Question 37

Primary sclerosing cholangitis (PSC) pathophysiology

Answer 37

Non infective non malignant inflammation and stricture of intra and extra hepatic ducts Associated with UC and HIV

Question 38

Primary billary cirrhosis pathophysiology

Answer 38

Progressive inflammation and dammage of the interlobular bile ducts leading to cirrhosis, cholestasis Associated with autoimmune conditions eg sjogrens or rheumatoid arthritis

Question 39

Tumour markers for Cholangiocarcinoma

Answer 39

C19-9 | CEA (carcinoembryonic antigen)

Question 40

What are different types of bone tumours

Answer 40

Benign: fibroma, osteochondroma Malignant: 1. primary: - marrow: Myeloma, Ewings - stromal tissue: Osteosarcoma, chondrosarcoma 2. Secondary: Thyroid, breast, bronchus, Kidney, prostate

Question 41

Age of Ewings

Answer 41

5 to 20

Question 42

Principles of limb salvage surgery in the setting of bone tumours

Answer 42

Every pt should be considered if the tumour could be removed with adequate margins Adequate margins: acceptable low local recurrence. Remaining limb needs to have: reasonable degree of movement and minimal pain

Question 43

What is the minimum requirement for a viable limb

Answer 43

4 components: bone, vessels. nerves, adequate soft tissue If 2/4 removed, still might be salvageable But any more needs amputation to be considered

Question 44

Risk factors for C diff

Answer 44

Periop abx use immunosuppression Old PPIs

Question 45

Dx of c diff

Answer 45

``` Acute diarrhoea (>2 stools in 24hrs) with no alternative cause Stool culture for C diff toxins A and B Pseudomembranes on colonoscopy ```

Question 46

C diff Rx

Answer 46

Depends on severity (WCC>15, rising Cr, Temp >38) Low severity: PO metronidazole High: PO vanc +/- PO metronidazole Stop the culprit abx

Question 47

Causes of gynocaomastia

Answer 47

Physiological: puberty /age Pathological: 1. Too much oestrogen Leydig tumour Obesity Liver disease 2. Too little testosterone Klinefelters Renal disease 3. Meds: digoxin, spironolactone