Wrong Questions Flashcards by Michael Grant

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

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When do you screen for CDH1? Do you offer anything routinely

18 years

Prophylactic surgery - 20-25 years

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Clinical criteria for CDH1

2+ family members
Diffuse gastric cancer <40, no FH

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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

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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

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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

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Common ages for seminoma vs teratoma

Seminoma 30+

Teratoma 20-30

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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

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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

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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

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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

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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

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Where do the pre-ganglionic fibres of the sympathetic chain arise

Myelinated fibres arising from lateral horns of T1-L2

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What is the course of the pre-ganglionic fibres

ventral root > ventral ramus > white ramus communicans > sympathetic chain

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What is the surface anatomy of the abdominal aorta

?just below xiphisternum to line bisecting iliac crests

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Surface anatomy of transpyloric plane

Halfway between jugular notch and pubic symphysis

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Definition of aneurysm

Abnormal dilatation of an artery more than 1.5x original diameter

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Tributeries of IVC

Common iliac veins
renal veins
Median sacral
Lumbar veins
Right gonadal

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Classification of gastric cancer

WHO

BORMANN - gross morphology

Lauren - histology

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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

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Paraneoplastic syndromes associated with gastric carcinoma

Acanthosis nigricans
Dermatomyositis

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How does gastric carcinoma spread

Lymphatics - first

How does atherosclerosis occur

1. Endothelial injury 2. Endothelial permiability - increased permeability, leucocyte adhesion and monocyte emigration 3. Macrophage activation and smooth muscle recruitment 4. Macrophages and smooth muscle cells enguld lipid 5. Smooth muscle proliferation

What is the DUKES classification

How does MI occur

1. Within seconds, aerobic glycosis ceases Drop in ATP and accumulation of noxious metabolities like lactid acid - in cardiac myocytes Rapid loss of contractility 2. 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

What is coriocarcinoma

Highly malignant trophoblastic tumour - two cells lines, syncitiotrophoblast and cytotrophoblast

Can beta HCG be physiological

In seminal plasma Increased in spermatogenesis

What is AFP

Produced by liver and yolk sac Associated with HCC and yolk sac tumour

What is LDH in testicular cancer

LDH is a non specific marker of testicular cancer Can help track growth

How do tumours spread via lymphatics

Permeation Emobilisation

Define granulation tissue

What is the fate of granulation tissue

Why is LN large in abscess

Non specific reactive follicular hyperplasia

structure of LN

Fibrous cortex Dividing septa Cortex Medulla

What is the content of neutrophil cytoplasm

microbicidal agents - primary granule, enzymes i.e. lysozyme, collagenase

Rule of 30s

Carcinoid - 30% small bowel - 30% multiple - 30% metastasize - 30% malignant

What is immunohistochemistry

Laboratory test to measure amount of specific Antigen on surface of cancer cell Specific antibody labelled with dye which allows identification of antigen