Stem2: A patient known to have hypothyroidism with a hard swelling in the inguinal region, the GP sent her for a biopsy. If the inguinal LNS was lymphoma what are the distinct types of lymphoma? SpoilerHodgkin Non-Hodgkin How malignant cells survive in LNSs SpoilerMalignant tumours release growth factors such as VEGF-C (vascular endothelial growth factor C) to induce lymphatic vessel expansion (lymph angiogenesis) in primary tumours and in draining sentinel LNs, thereby promoting LN metastasis Why is melanoma pigmented? SpoilerBecause of melanin Mention 4 types of melanoma? SpoilerLentigo maligna Superficial spreading Desmoplastic melanoma Acral melanoma Nodular melanomas A lesion under the toenail was found and the decision to amputate the toe and excise the LNs. What is the reason behind this decision? SpoilerTo prevent metastasis Safety margin Pain control What is epithelioid melanoma? SpoilerType of melanoma with cells resembling epithelium because of Abundant eosinophilic cytoplasm Enlarged round to oval shaped nuclei. Gene mutation in familial malignant melanoma? SpoilerBRAF gene Postoperatively the wound is red and swollen. Culture revealed diplococci give examples? SpoilerGram-negative diplococci Neisseria sp. Haemophilus Brucella Moraxella catarrhalis Acinetobacter Gram-positive diplococci SpoilerStreptococcus pneumoniae Enterococcus. Next the patient became toxic with rapid spread of infection what do you think the cause? SpoilerNecrotizing fasciitis

Stem 2 46-year-old man is referred by GP with a large 25 mm non-bleeding right arm skin ulcer. Punch biopsy is performed. Six months later, patient developed cervical lymphadenopathy. Excision done but not enough: What is the advantage of frozen section? SpoilerFrozen section technique shortens the time to preliminary diagnosis significantly from traditional tissue biopsy preparation. What other alternatives to frozen section? SpoilerFine Needle Aspiration Cytology (FNAC) Imprint Cytology (IC) After excision and grafting, graft became infected and sloughed. Swab shows MRSA. What will you do? See 'BCC' station & 'Breast Cancer' station Define granulation tissue? SpoilerCombination of proliferating fibroblasts, loose connective tissue, new blood vessels and scattered chronic inflammatory cells, forms a type of tissue that is unique to healing wounds and is called granulation tissue. Fate of granulation tissue? SpoilerRemodelling - The connective tissue that has been deposited by fibroblasts is reorganized to produce the stable fibrous scar. This process begins 2 to 3 weeks after injury.

New questions: Ask about complications of diverticulitis: infects perforation obstruction

Stem 2 34-year-old man with a previous history of asthma and HTN is referred with back pain. He undergoes a CT TAP which shows bilateral enlarged kidneys (measuring about 21 cm) Stem 3 A 25-year-old male underwent bilateral nephrectomy. In light of the picture given, what's the diagnosis? SpoilerPolycystic Kidney Disease (APKD) What's the mode of inheritance of polycystic kidney disease? SpoilerAutosomal dominant condition due to mutations in 2 genes: PKD1, PKD2 What other organs could be affected as well? SpoilerLiver Ovaries Pancreas Spleen Intestines Other pathology associated with PCKD? SpoilerBrain aneurysm Mitral valve prolapse Liver cysts Pancreatic cyst What complication of pathology is not seen in this picture? SpoilerInfection Hypertension Renal failure Pain What complications of pathology can lead to pain? SpoilerWeight of the organ dragging upon its pedicle or stretching of renal capsule by cysts Infection Haemorrhage What are the causes of renal failure in PCKD? SpoilerDue to replacement of normal kidney tissue by cysts with infection leading to scaring What's the type of fluid contained within the cysts? SpoilerTrans-epithelial secretion What are pathological types of transplant rejections? SpoilerHyperacute Accelerated acute Acute Chronic What are the types of matching required before transplant? SpoilerABO and HLA human leucocytic antigen (HLA-A, HLA-B, HLA-DR). Can a non-perfectly matched kidney be transplanted? SpoilerYes How to prevent transplant rejection? SpoilerUse immunosuppression Seven days after transplant, patient developed swelling at the operative site with declining renal function. What do you think is the cause is? SpoilerAcute rejection Infection Four months later he came with CBD stones, fever & sepsis. What's the diagnosis? SpoilerAscending cholangitis What is the management needed? SpoilerI will manage this patient by ABCDE approach, but most important management is to relieve the obstruction by ERCP. ERCP done, but he developed sepsis. What are the possible causes of bacterial infection in this patient? SpoilerBecause of the obstruction If the patient developed fever, jaundice and sepsis. What is the diagnosis? SpoilerAscending cholangitis Risk factors for ascending cholangitis in this patient? SpoilerImmunosuppression. Taking steroids Obstruction by stone in CBD Iatrogenic What's the cause of CBD stones in this patient? SpoilerSecondary hyperparathyroidism Cholecystectomy done & GB send for histopathological examination. What to look for? SpoilerMacroscopic for any ulcerations or gangrene Microscopic for any malignant or inflammatory cells Patient comes 6 years after transplant on immunosuppression with declined renal function. Biopsy shows lymphocytic infiltration with blast cells. What's the diagnosis? SpoilerLPD (lymphoproliferative disease) Why is it not rejection? SpoilerThe presence of blast cells its characteristic for PTLD How to treat Post transplant lymphoproliferative disorder? SpoilerDecrease immunosuppressive therapy dose Change the type of immunosuppressive therapy What are the causative factors for PTLD (Post transplant lymphoproliferative disorder)? SpoilerOpportunistic viral infection by CMV and EBV due to immunosuppression.