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General Surgery Miscellaneous Important Notes

Composition of Local Anaesthesia

General surgery miscellaneous question and answers

General Surgery Miscellaneous Short Essays

Question 1. Local anaesthesia
Answer:

Local Anaesthesia Definition: It is loss of sensation in a circumscribed area of the body characterized by depression or excitation of nerve endings and inhibition of the conduction process of peripheral nerve

Local Anaesthesia Composition:

1. Local anesthetic- ester or amide
2. Vasoconstrictor- Epinephrine
3. Antioxidant- Sodium metabisulphite
4. Preservative- Methyl paraben
5. Fungicide-Thymol
6. Salt- sodium chloride
7. Vehicle- Distilled water or Ringers lactate solution

Local Anaesthesia Ideal Properties:

1. Nonirritant
2. No permanent damage to nerve
3. Low systemic toxicity
4. Effective
5. Short onset of action
6. Long-lasting effect
7. Potent
8. Free of allergens
9. Stable and biocompatible
10. Able to sterilize it

Question 2. Complications of local anesthesia
Answer:

Local Anaesthesia Complications:

1. Needle Breakage:

• Due To Sudden Movement Of The Patient
  • Narrow gauge needle
  • Broken needle
  • Bonded needle
• Local Anaesthesia Management:
  • Radiograph to locate it
  • Expose the site and remove it

2. Facial Nerve Paralysis:

• Facial Nerve Paralysis Causes: Insertion of needle into the parotid capsule
• Facial Nerve Paralysis Management:
  • Self-curing
  • Eye can be protected with the help of an eye pad
• Paraesthesia:

• • Paraesthesia Cause: Injury to the nerve
  • Paraesthesia Management: Self-recovery by regeneration of nerve

Important general surgery questions with answers

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3. Trismus:

• Trismus Cause: Trauma to medial pterygoid muscle, Contaminated needle
• Trismus Management:
  • Analgesic
  • Muscle relaxants
  • Mot fomentation
  • Physiotherapy

4. Pain On Injection:

• Pain On Injection Cause: Blunt needle, Broader gauge needle
• Pain On Injection Management: Use of short, narrow-gauge needle

5. Burning On Injection:

• Burning On Injection Cause:
  • An acidic solution of LA
  • Contaminated needle
• Burning On Injection Management:
  • Isotonic solution by addition of bicarbonate
  • Use of disposable needle

6. Soft Tissue Injury:

• Soft Tissue Injury Cause: Due to being unaware of numbness of lips patient tries to do lip-biting
• Management:
  • Explain to the patient about the numbness
  • Use of lifeguards in children
• Soft Tissue Injury Hematoma:

• • Hematoma Cause: Injury to blood vessels
  • Hematoma Management:
    • Assure of proper anatomy of landmarks and nerve
    • Massage the area
    • Antibiotics
    • Hot fomentation

7. Infection:

• Local Anaesthesia Infection Causes: Contaminated needle
• Local Anaesthesia Infection Management:
  • Use of disposable needle
  • Antibiotics
  • Drainage of space involved
  • Physiotherapy

8. Necrosis Of Tissues Causes :

• Seen in palatal injection
• This region is tightly bound to the underlying bone
• Thus excessive pressure is required for the insertion of the needle
• This leads to the blanching of the area
• Vasoconstriction and localized necrosis

9. Edema Causes:

• Injury to nerve
• Contaminated needle

10. Edema Management:

• Subsidies on their own
• Avoid application of hot fomentation
• Application of cold fomentation
• As it acts as a vasoconstrictor and analgesic

11. Post-anesthetic lesions

• Ulcers
• Allergic reactions

Post-Anesthetic Lesions Causes:

• Trauma
• Allergy to LA agent

Common general surgery viva questions

Systemic Complications Local Anaesthesia :

Overdose:

1. Overdose Causes:
   • Excessive dose of LA
   • Systemic disorders of metabolism
2. Overdose Features
   • Nausea
   • Vomiting
   • Diplopia
   • Tremors
   • Acidosis
   • Respiratory distress
   • Chest pain
   • Bradycardia
   • Hypotension
   • Dizziness
3. Overdose Management:
   • Reassure the patient
   • Maintain patient’s airway
   • Intubate if necessary
   • Cardiac life support given
   • 4 fluids and vasopressors given for hypotension
4. Hypersensitivity:
   1. Hypersensitivity Causes:
      • Allergy to LA
      • Allergy to the preservative used
   2. Hypersensitivity Features:
      • Pruritis
      • Utricaria
      • Dyspnoea
      • Wheezing
      • Nausea, vomiting
      • Erythema
   3. Hypersensitivity Management:
      • Stop the procedure
      • Mild allergy-corticosteroids
      • Severe allergy- epinephrine 1:1000 of 0.3-0. ml SC
      • If symptoms continue 5 ml of 1:10000 epi nephrite given 4

Question 3. FNAC
Answer:

FNAC Method:

• 23-26 gauge needle is inserted into the tissues
• Aspirate the needle
• Cystic fluid is collected in it
• Examine the fluid

FNAC Indication:

• Cystic cavity
• OKC

General surgery FAQs for students

Question 4. Anaphylaxis
Answer:

Anaphylaxis Features:

• Severe dyspnoea
• Hoarseness of voice
• Hypotension
• Nausea
• Cyanosis
• Abdominal cramps
• Tachycardia
• Bronchospasm
• Chest tightness

Anaphylaxis Management:

• The upright position of the patient
• Elevate the legs
• Basic life support
• Administer adrenaline 1:1000 0.3 mg IM
• Administer oxygen
• Recovery of patient
• Give antihistamine IM
• Continue basic life support
• Transfer the patient to the hospital

Question 5. Oral submucous fibrosis
Answer:

Oral Submucous Fibrosis

• Oral Submucous Fibrosis is a pre-cancerous condition
• It is characterized by juxta epithelial inflammatory reaction in the oral mucosa followed by a fibro elastic transformation of the lamina propria loading to mucosal atrophy, rigidity, and trismus

Oral Submucous Fibrosis Etiology:

• Consumption of red chilies
• Consumption of areca nuts
• Nutritional deficiencies
• Immunological factors
• Genetic factors

Oral Submucous Fibrosis Features:

• Burning sensation
• Difficulty in mastication
• Referred pain in the ear
• Depapillation of longue
• Restricted movement of floor of mouth
• Shrunken uvula
• Fibrous bands
• Restricted mouth opening
• Stiffness of buccal mucosa

Oral Submucous Fibrosis Management:

• Quit the habit
• Antioxidant- Oxyacc-1 capsule/ day
• Multivitamin therapy
• Steroid- Betnovate 0.12%
• Tumeric application
• Intralesional injection of Hyaluronidase-1500 U
• Physiotherapy
• Splitting of fibrous bands
• Laser

General surgery exam questions and answers

Question 6. Mechanism of action of LA
Answer:

Mechanism Of Action Of LA

• Displacement of calcium ions from sodium channel receptor site which permits
• The binding of LA molecule to this site produces
• Blockade of the sodium channel and a
• Decrease in sodium conductance, which leads to
• Depression of rate of electrical depolarization
• Failure to achieve the threshold potential level along with a
• Lack of development of propagated action potential which is called
• Conduction blockade

Question 7. Mandibular nerve block
Answer:

Mandibular Nerve Block

• Nerves Anaesthesized: inferior alveolar nerve and its branches
  • Areas To Be Anesthetized: mandibular teeth and its supporting tissues

Mandibular Nerve Block Landmarks:

• Mucobuccal fold
• Anterior border of coronoid process
• Coronoid notch
• Pterygomandibular raphe
• Retromolar pad
• Retromolar triangle
• External oblique ridge

Mandibular Nerve Block Technique:

• Position the patient in a semi-reclined position
• Move your index finger over the mesiobuccal fold up to the external oblique ridge
• Move it up and down to obtain depression
• This is a coronoid notch
• Retract the cheek
• Support the mandible
• Insert 1 5/8 inch 25 gauge needle from the lingual side
• Aspirate and Slowly deposit the solution

Positive Aspiration: 10-15%

Question 8. Paget’s disease of bone
Answer:

Paget’s Disease Of Bone

Paget’s Disease Of Bone is bone disorder characterized by an excessive uncoordinated phase of bone resorption and subsequent deposition of bone in the same area

Paget’s Disease Of Bone Clinical Features

• Age-old people are usually affected
• Sex – common in males
• Site – Weight-Bearing Areas
  • Skull
  • Pelvis
  • Sternum
  • In jaws, common in the maxilla than in the mandible
• Presentation
  • Pain is always present
  • Bilateral swelling
  • Waddling gait
  • Involvement of facial bone causes leontiasis ossa
  • Headache
  • Enlargement of skull

Paget’s Disease Of Bone Radiological Features

• Haphazardly arranged radiolucent and radiopaque areas representing new bone deposition and resorption in the involved area
• This gives cotton wool appearance
• In jaw, it shows
  • Prognathic mandible
  • Hypercementosis
  • Obliteration of periodontal ligament space
  • Root resorption
  • Loss of lamina dura

Paget’s Disease Of Bone Complication: Osteosarcoma

General surgery question bank with answers

Question 9. Causes and complications of chronic otitis media
Answer:

Chronic Otitis Media Causes:

• Inflammation of the middle ear
• Resistant bacterial infection
• Risk factors
  • Traumatic perforation of tympanic membrane
  • Insertion of grommets
  • Craniofacial abnormalities

Chronic Otitis Media Complications

• Meningitis
• Intracranial abscess
• Facial paralysis
• Conductive hearing loss
• Scarring of tympanic membrane
• White calcified plaques in tympanic membrane

Question 10. Causes of inflammation
Answer:

Causes Of Inflammation

• Infection
• Injury
• Autoimmune disorders
• Long-term exposure to irritants
• Contributing factors are
  • Smoking
  • Alcohol
  • Stress
  • Obesity

General Surgery Miscellaneous Short Answers

Question 1. Pain
Answer:

Pain

• Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage
• It is considered as part of the body’s defense system

Pain Management

• Acute pain- by analgesics and antibiotics
• Chronic pain
  • Analgesics
  • Sedatives
  • Physiotherapy

Question 2. Adenoid
Answer:

Adenoid

• Adenoid is mass of soft tissue present behind the nasal cavity.
• Adenoid is part of immune system
• Adenoid is formed by lymphoid tissue.
• Adenoid is present at birth and disappears in adolescence.

Adenoid Causes:

• Bacterial infections
• Viral infections
• Pollutants

Adenoid Disorders:

• Adenoiditis
• Obstructive sleep apnoea
• Middle ear infections

Adenoid Treatment:

• Adenoidectomy
• Antibiotics to treat infection

General surgery short and long questions with answers

Question 3. Otitis media
Answer:

Otitis media

• In middle ear infections, the middle ear gets inflamed and is filled with fluid
• This is called Otitis media

Otitis Media Clinical Features:

• In Infants
  • Irritability
  • Pulling and stretching of the ear
  • vomiting
  • Drainage from ear
  • Fever
• In Adults
  • Earache
  • Hearing problems
  • Fever
  • Pressure sensation in the ear
  • Dizziness
  • Nausea
  • Vomiting

Question 4. Chemotherapy
Answer:

Chemotherapy

Chemotherapy refers to the use of chemicals in infectious diseases to destroy microorganisms without damaging the host tissues

Chemotherapy Drugs:

• Alkylating agents
• Antimetabolites
• Anthracyclines
• Plant alkaloids
• Topoisomerase inhibitors
• Anti-tumor agents

Chemotherapy Adverse Effects:

• Immunosuppression
• Myelosuppression
• Fatigue
• Gastrointestinal distress
• Nausea
• Vomiting
• Diarrheoa
• Apolecia
• Damage to specific organs
• Cardiotoxicity
• Hepatotoxicity
• Nephrotoxicity
• Ototoxicity

Question 5. Insulin
Answer:

Insulin

Insulin is stored in granules in the beta islet cells of the pancreas

Insulin Actions

• Stimulates uptake and metabolism of glucose in the peripheral tissues
• Inhibits lipolysis
• Facilitates amino acid uptake

Insulin Side Effects

• Hypoglycaemia
• Allergy
• Lipodystrophy
• Edema

Insulin Classification

• Conventional Insulins
  • Short and long-lasting
  • Intermediate-acting
  • Long-acting
• Highly purified insulin
• Human insulin
• Insulin analogs
• Insulin mixtures

Previous year general surgery questions with solutions

Question 6. Penicillin
Answer:

Penicillin

β Lactum antibiotic Mechanism:

• Inhibit cell wall synthesis
• Inhibit transpeptidase thus inhibiting synthesis of peptidoglycan

Penicillin Classification:

• Natural- Penicillin G
• Semisynthetic
  • Acid resistant – Penicillin V
  • Penicillin resistant- Methicillin
  • Aminopenicillin- Ampicillin
  • Antipseudomonal penicillin- Carbenicillin

Penicillin Uses:

• Orodental infections
• Syphilis
• Gonorrhea
• Streptococcal infections
• Tetanus
• Prophylactic
• Gangrene

Penicillin Adverse Reaction:

• Hypersensitivity
• Anaphylaxis
• Local pain at the site of injection
• Suprainfection
• Farish Herxheimer reaction

Question 7. Antioxidant
Answer:

Antioxidant

Antioxidant is a molecule capable of inhibiting the oxidation of other molecules

Antioxidant Uses:

• Inhibit oxidation reactions
• Used as ingredients in dietary supplements
• Prevents cancer, coronary heart disease
• Industrial use as preservatives in food and cosmetics
• Prevents degradation of rubber and gasoline

Antioxidant Agents:

• Thiols
• Ascorbic acid
• Polyphenols
• Glutathione
• Superoxide dismutase

Question 8. Spinal anesthesia
Answer:

Spinal Anesthesia

• Local anesthetic solution is injected into the subarachnoid space between L2-3 or L3-4 below the end of the spinal cord
• The lower abdomen and lower limbs are anesthetized and paralyzed

Spinal Anesthesia Advantages

• Safe
• Affords good analgesic
• Muscle relaxant
• No loss of consciousness

Spinal Anesthesia Uses:

• Surgical procedures on the
  • lower limb
  • Pelvis
  • Lower abdomen
  • Obstetric procedures
  • Cesarean section

Spinal Anesthesia Complications:

• Hypotension
• Bradycardia
• Respiratory paralysis
• Headache
• Cauda equine syndrome
• Sepsis
• Nausea
• Vomiting

Emergency surgery questions and answers

Question 9. Topical anaesthesia
(or)
Surface acting anaesthesia
Answer:

Topical Anaesthesia

Anesthesia of mucous membrane of the eye, nose, mouth, tracheobronchial tree, esophagus, and genitourinary tract can be produced by direct application of the anesthetic solution

Topical Anaesthesia Actions:

• Produces vasoconstriction
• Prolongs duration of action
• Anaesthesia is superficial

Topical Anaesthesia Agents Used:

• Tetracaine
• Lignocaine
• Phenylephrine

Question 10. Prophylactic antibiotics
Answer:

Prophylactic Antibiotics

Question 11. Drugs used in general anesthesia
Answer:

Drugs Used In General Anaesthesia

1. Volatile Anaesthetics
   • Ether
   • Trichloroethylene
   • Halothane
   • Enflurane
   • Isoflurane
   • Sevoflurane
2. Gaseous Anaesthetics
   • Nitrous oxide
   • Cyclopropane
3. Intravenous Anaesthetics
   • Thiopentone
   • Methohexitone sodium
   • Propanidid
   • Ketamine
   • Propofol
   • Fentanyl
4. Oxygen

Question 12. Signs of inflammation
Answer:

Signs Of Inflammation

1. Rubor – redness
   • Cause – vasodilatation in the area of inflammation
2. Tumor – swelling
   • Cause
     • Increased local hydrostatic pressure
     • Transudation of fluid into extracellular space
3. Calor – heat
   • Cause – vasodilatation
4. Dolor – pain
5. Function Laesa – loss of function

Postoperative complications questions and answers

Question 13. Paronychia
Answer:

Paronychia

• Paronychia is a common hand infection

1s. Acute paronychia

• Occurs in the subcuticular area under eponychia
• Cause – mild injury to finger
• Causative organisms – staphylococcus aureus and streptococcus pyogenes

Paronychia Features

• Suppuration occurs
• It spreads around the skin margin and under the nail causing hanging or floating nail
• Severe throbbing pain and tenderness with pus under the nail root
• Nail is tender to touch

Paronychia Treatment

• Antibiotics
• Analgesics
• Drainage of pus
• Removal of the floating nail

Chronic Paronychia: Occurs due to fungal infection

Chronic Paronychia Features: 

• Itching in the-nailbed
• Recurrent pain
• Discharge

Chronic Paronychia Treatment

• Long-term antifungal therapy
• Antibiotics
• Removal of nails in severe infection

Short answer questions in general surgery

General Surgery Miscellaneous Viva Voce

1. The primary site of action of the local anesthesia is nerve membrane
2. Maxillary first molar is the most difficult tooth to Anaesthesize by infiltration alone
3. Cocaine increases the vasoconstrictive action of adrenaline
4. Succinylcholine prevents laryngospasm due to GA
5. Most common cause of death occurring during GA administration is due to airway obstruction with improper ventilation.

Diseases Of Thyroid And Parathyroid Glands Important Notes

1. Hyperthyroidism And Hypothyroidism
2. Goitre
   • It is the enlargement of the thyroid gland irrespective of its cause
   • Goitre Classification
     • Simple goitre
       • Diffuse hyperplastic goitre
       • Nodular goitre
       • Colloid goitre
     • Toxic goitre
       • Diffuse toxic goitre
       • Toxic nodular goitre
       • Toxic nodule
     • Neoplastic goitre
       • Benign tumours
       • Malignant tumours
     • Thyroiditis
       • Autoimmune
       • Subacute
       • Reidel’s thyroiditis
     • Other rare causes
   • Goitre Treatment
     • Addition of iodide
     • Discontinuation of offending drug
     • Administration of thyroxin
     • Surgical treatment for cosmetic purposes
3. Retrosternal Goitre
   • Mainly derived from the lower pole of the multinodular goitre
   • Retrosternal Goitre Classification
     • Substernal
     • Plunging
     • Intra-thoracic
   • Retrosternal Goitre Treatment – resection
4. Thyrotoxicosis Or Toxic Goitre
   • Thyrotoxicosis Or Toxic Goitre Causes
     • Grave’s disease
     • Toxic multinodular goitre
     • Toxic adenoma
     • Other rare causes
   • Thyrotoxicosis Or Toxic Goitre Types
     • Primary toxic goitre / Grave’s diseases
     • Secondary toxic goiter
5. Thyroid Carcinoma

Diseases of thyroid and parathyroid question and answers

Diseases Of Thyroid And Parathyroid Glands Long Essays

Question 1. Describe clinical features, diagnosis and management of carcinoma of the thyroid.
Answer:

Thyroid Carcinoma is classified into four types:

1. Follicular Carcinoma:
   • Follicular Carcinoma Clinical Features:
     • Occurs in old age
     • Common in females
     • An asymptomatic slow-enlarging thyroid nodule is present
     • Regional lymph nodes are involved
     • Pain is present
     • It invades adjacent structures
     • Distant metastasis occurs
   • Follicular Carcinoma Treatment:
     • Low-grade carcinoma- treated by thyroid lobectomy
     • If regional lymph nodes are involved- Dissection of lymph nodes
     • Suppressive thyroid hormone therapy
     • Aggressive follicular carcinoma- Treated by near-total thyroidectomy and postoperative radiotherapy
2. Papillary Carcinoma
   • Papillary Carcinoma Clinical Features:
     • Occurs at any age
     • Common in females
     • Slow growing tumour
     • Tends to become malignant
     • Asymptomatic nodules appear within the thyroid gland
     • Regional lymph nodes are enlarged
   • Papillary Carcinoma Treatment:
     • Surgical excision
     • Near Total thyroidectomy
     • Suppressive dose of thyroid hormone post-operatively
3. Medullary Carcinoma:
   • Arises from parafollicular C cells
   • Medullary Carcinoma Types:
     • Sporadic
     • Familial variety
   • Medullary Carcinoma Clinical Features:
     • Associated with mucocutaneous neuroma
     • It is present as a solid, hard, nodular tumour
   • Medullary Carcinoma Treatment:
     • Near total thyroidectomy
     • Radical block dissection of lymph nodes
4. Anaplastic Carcinoma:
   • Age- Over 50 years of age o Enlarged thyroid occurs
   • Gland is fixed
   • Consistency is hard to firm
     • Anaplastic Carcinoma Treatment:
       • Total thyroidectomy with modified neck dissection
       • Tracheostomy
       • External irradiation

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Question 2. Describe clinical features, diagnosis and management of primary thyrotoxicosis.
Answer:

Primary Thyrotoxicosis Clinical Features:

• Common in females a Loss of weight
• Increased smooth muscle activity
• Intolerance to heat
• Fine tremors
• Excitability
• Hyperkinetic movements
• Excessive sweating
• Raised pulse rate
• Diarrhoea
• Polyuria
• Hot moist palms
• Systolic hypertension
• Exophthalmos
• Moebius sign- loss of convergence of eyeball
• Stell Wag’s sign- infrequent blinking
• Von Giraffe’s sign-lid lag sign

Primary Thyrotoxicosis Diagnosis:

• Thyroid function tests- elevation of T₃, T₄ and decrease in TSH levels
• Thyroid scan
• Ultrasound- for the search of cysts

Primary Thyrotoxicosis Management:

1. To restore the patient to the euthyroid state
   • Antithyroid drugs
     • Carbimazole-10 mg 6th hourly for 2-3 weeks
     • Propranolol-10-20 mg, two-three times a day
     • Lugol’s iodine-10-12 drops three times a day
   • Potassium perchlorate- 20 mg three times a day
2. To reduce the functioning of thyroid mass
   • Subtotal thyroidectomy
   • Radio-iodine therapy
3. To minimize complications
   • Proper anaesthetic measures
   • Good post-operative care

Important thyroid gland questions for exams

Question 3. Discuss Grave’s disease in detail.
Answer:

Grave’s Disease: It is a diffuse goitre affecting the whole functioning thyroid tissue, causing hypertrophy and hyperplasia due to abnormal thyroid stimulants

Grave’s Disease Etiology

• It is a systemic autoimmune disease
• It is hereditary
• Another causative factor is emotional disturbances

Grave’s Disease Clinical Features: It consists of a classical triad

1. Grave’s Disease Goitre
   • Characterised by an enlarged thyroid gland
   • On palpation, the gland is smooth and irregular
   • Bruit is heard
   • Extreme vascularity is present.
2. Grave’s Disease Thyrotoxicosis
   • Common in females
   • Loss of weight
   • Increased smooth muscle activity
   • Intolerance to heat
   • Fine tremors
   • Excitability
   • Hyperkinetic movements
   • Excessive sweating
   • Raised pulse rate
   • Diarrhoea
   • Polyuria
   • Hot moist calms
   • Systolic hypertension
3. Grave’s Disease Exophthalmos
   • It means oro tarsi on of eyeball
   • Spasm of the upper eyelid
   • Proptosis with the widening of the palpebral fissure
   • Supraorbital and infraorbital fissure
   • Congestion and edema of the conjunctive
   • Corneal ulceration

Grave’s Disease Investigations:

1. Thyroid function tests
   • T₃ T₄ levels are high
   • TSH levels are low
2. Presence of thyroid autoantibodies

Grave’s Disease Management

1. To restore the patient to the euthyroid state
   • Antithyroid drugs
     • Carbimazole- 10 mg 6th hourly for 2-3 weeks
     • Propranolol-10-20 mg two-three times a day
     • Lugol s iodine- 10-12 drops three times a day
   • Potassium perchlorate- 20 mg three times a day
2. To reduce the functioning of thyroid mass
   • Subtotal thyroidectomy
   • Radio-iodine therapy
3. To minimize complications
   • Proper anaesthetic measures
   • Good post-operative care

Question 4. Classify thyroid tumours. Discuss etiopathology.

Answer:

Thyroid Tumours Classification

1. Benign tumours
   • Adenoma
     • Follicular adenoma
     • Papillary adenoma
2. Malignant tumours
   • Follicular cell origin
     • Differentiated tumours
       • Papillary carcinoma
       • Follicular carcinoma
       • Mixed papillary and follicular carcinoma
     • Undifferentiated tumours
       • Anaplastic carcinoma
   • Parafollicular cell origin
     • Medullary carcinoma
   • Non-thyroid cell origin
     • Malignant lymphoma
     • Sarcoma
     • Metastatic carcinoma

Differentiated Thyroid Tumours:

• Differentiated thyroid tumours are:
  • Papillary carcinoma
  • Follicular carcinoma

Thyroid Tumours  Etiology:

• Iodide deficiency
• External irradiation
• Ionizing radiation
• Autoimmune thyroiditis

Thyroid and parathyroid disorders solved questions

Question 5. Describe the etiopathology, clinical features and treatment of solitary nodules in the thyroid gland.
Answer:

Solitary Nodule In Thyroid Gland: It can be classified into benign and malignant nodules

Solitary Nodule In Thyroid Gland Etiopathogenesis:

• Thyroiditis
• Follicular adenoma
• Carcinoma
• Thyroid cyst
• Colloid nodules

Solitary Nodule In Thyroid Gland Clinical Features:

• Age-20-40 Years of age
• Sex- common in females
• Stridor
• Tracheal deviation
• Neck vein engorgement
• Dyspnoea
• Dysphagia
• The solitary nodule is present

Solitary Nodule In Thyroid Gland Treatment:

• Excision of solitary nodule along with a margin of normal thyroid tissue
• If the nodule is present at the junction of the isthmus and lobe- hemithyroidectomy is done
• In the presence of malignancy- immediate total thyroidectomy is done

Question 6. Discuss clinical features and treatment of multinodular goitre. Mention four complications of it.
Answer:

Multinodular Goitre: Multinodular goitre is the end-stage result of diffuse hyperplastic goitre

Multinodular Goitre Clinical Features:

• Age- 40-60 years of age
• Sex- common in females
• Exophthalmos rarely occurs
• The presence of long-standing swelling in front of the neck
• Dyspnoea
• Dysphagia
• The gland is firm and irregular

Multinodular Goitre Treatment:

1. Total or near-total thyroidectomy
   • It is widely used to
     • Avoid nerve injury
     • Avoid recurrence
   • Subtotal thyroidectomy
     • In it, parts of the right and left lobes are removed along with the isthmus
     • It avoids right laryngeal nerve paralysis and hypothyroidism

Multinodular Goitre Complications:

• Calcification
• Sudden haemorrhage
• Dyspnoea
• Secondary thyrotoxicosis with CVS involvement- called Plummer’s disease
• Development of follicular carcinoma

hyroid and parathyroid viva questions

Question 8. Discuss clinical features and management of toxic goitre.

Answer:

Toxic Goitre Or Thyrotoxicosis: It refers to an accumulation of clinical manifestations which are due to excess secretion of acute thyroid hormones.

Toxic Goitre Or Thyrotoxicosis Causes:

• Grave’s disease
• Toxic multinodular goitre
• Toxic adenoma
• The early stage of thyroiditis
• Neonatal thyrotoxicosis
• Iatrogenic hyperthyroidism

Toxic Goitre Or Thyrotoxicosis Types:

• Primary toxic goitre- Grave’s disease
• Secondary toxic goitre

Toxic Goitre Or Thyrotoxicosis Clinical Features:

1. Primary Toxic Goitre
   • It consists of a classical triad
     • Goitre
       • Characterised by an enlarged thyroid gland
       • On palpation, the gland is smooth and irregular
       • Bruit is heard
       • Extreme vascularity is present
     • Thyrotoxicosis
       • Common in females
       • Loss of weight
       • Increased smooth muscle activity
       • Intolerance to heat
       • Fine tremors
       • Excitability
       • Hyperkinetic movements
       • Excessive sweating
       • Raised pulse rate
       • Diarrhoea
       • Polyuria
       • Hot moist palms
       • Systolic hypertension
   • Exophthalmos
     • It means protrusion of the eyeball
     • Spasm of the upper eyelid
     • Proptosis with the widening of the palpebral fissure
     • Supraorbital and infraorbital swelling
     • Congestion and edema of the conjunctiva
     • Corneal ulceration
2. Secondary Toxic Goitre
   • Toxic multinodular goitre
     • Age- 40-60 years of age
     • Sex- common in females
     • Exophthalmos rarely occurs
     • The presence of long-standing swelling in front of the neck
     • Dyspnoea
     • Dysphagia
     • The gland is firm and irregular
   • Toxic nodule
     • Occurs at a young age
     • Females are commonly affected
     • Thyroid swelling occurs
     • Presence of hyperthyroidism
     • There is a sudden increase in the size of swelling due to necrosis and intraglandular haemorrhage

Toxic Goitre Or Thyrotoxicosis Treatment:

1. Toxic Multinodular Goitre
   • To restore the patient to the euthyroid state
     • Antithyroid drugs
       • Carbimazole-10 mg 6th hourly for 2-3 weeks
       • Propranolol-10-20 mg, two-three times a day
       • Lugol’s iodine-10-12 drops three times a day
     • Potassium perchlorate- 20 mg three times a day
   • To reduce the functioning of thyroid mass
     • Subtotal thyroidectomy
     • Radio-iodine therapy
   • To minimize complications
     • Proper anaesthetic measures
     • Good post-operative care
2. Toxic Nodule
   • Anti-thyroid drugs
   • Radiotherapy
   • Subtotal thyroidectomy

Thyroid and parathyroid disorders solved questions

Question 9. What is toxic goitre? What are the differences between primary and secondary goitre? Outline the treatment of primary toxic goitre of the thyroid gland.
Answer:

Toxic Goitre Or Thyrotoxicosis: It refers to an accumulation of clinical manifestations which are due to an excess section of acute thyroid hormones.

Difference Between Primary and Secondary Goitre:

Question 10. Define goitre. Classify various types of goitre.
Answer:

Goitre Definition: Goitre refers to as enlargement of the thyroid gland irrespective of the cause

Goitre Classification

• Simple Goitre
  • Diffuse hyperplastic goitre
  • Nodular goitre
  • Colloid goitre
• Toxic Goitre
  • Diffuse toxic goitre
  • Toxic nodular goitre
  • Toxic nodule
• Neoplastic Goitre
  • Benign tumours
  • Malignant tumours
• Thyroiditis
  • Autoimmune thyroiditis
  • Subacute thyroiditis
  • Reidel’s thyroiditis
• Other Rare Causes

Diseases Of Thyroid And Parathyroid Glands Short Essays

Question 1. Hypocalcaemia Or Tetany
Answer:

Hypocalcaemia Or Tetany

Hypocalcaemia is defined as the presence of low calcium levels in the blood

Hypocalcaemia Or Tetany Causes:

• Acute pancreatitis
• Acute and chronic renal failure
• Pancreatic and small intestinal fistulae
• Hypoparathyroidism
• Transient hypocalcaemia

Hypocalcaemia Or Tetany Clinical Features:

• Numbness and tingling sensation in the circumoral region and the tips of the fingers and toes
• Hyperactive tendon jerks
• Muscle cramps
• Carpopedal spasms
• Positive Chvostek’s sign

Hypocalcaemia Or Tetany Treatment:

• Intravenous administration of calcium gluconate or chloride
• Oral administration of calcium lactate along with vitamin D

Parathyroid hormone disorder questions

Question 2. Thyroid crisis Or Thyroid storm

Answer:

Thyroid Crisis Or Thyroid storm

• It is a severe thyrotoxic reaction
• It appears suddenly within 3-4 days after the operation
• It is an acute exacerbation of hyperthyroidism

Thyroid Crisis Or Thyroid Storm Clinical Features:

• Tachycardia
• Fever
• Restlessness
• Delirium

Thyroid Crisis Or Thyroid storm Treatment:

• Sedatives- morphine or pethidine
• Control of hyperpyrexia- by use of ice bag, tepid sponging, hypothermic blanket
• Oxygen administration
• Potassium administration
• Use of 100 mg cortisone
• Lugol’s iodine is given intravenously
• 20-40 mg propranolol
• Digitalis to treat atrial fibrillation

Question 3. Adenoma Thyroid
Answer:

Adenoma Thyroid

All benign tumours of the thyroid gland arise from glandular tissues and are called adenomas

Adenoma Thyroid Types:

• Follicular adenoma
• Papillary adenoma

Adenoma Thyroid Clinical Features:

• Gradual swelling of the thyroid gland
• Swelling is palpable
• Bleeding in the tumour causes pain and a rapid increase in the size of the swelling

Adenoma Thyroid Investigations:

X-ray of the neck- for swelling

Adenoma Thyroid Treatment:

• Excisional biopsy
• Lobectomy and removal of adenoma with surrounding healthy tissue
• Replacement doses of L-thyroxine

Question 4. Hashimoto’s thyroiditis
(or)
Autoimmune thyroiditis
Answer:

Autoimmune Thyroiditis

Autoimmune Thyroiditis is also called Hashimoto’s disease or lymphedema- noid goitre

Hashimoto’s Thyroiditis Etiology:

• It is an autoimmune disease
• Four antigens are detected
  • Thyroid cell microsomes
  • Thyroid cell nuclear component
  • Thyroglobulin
  • Nonthyroglobulin colloid

Hashimoto’s Thyroiditis Clinical Features:

• Females are commonly affected the Onset is insidious
• Thyroid enlargement with slight pain
• Tenderness in the region of the thyroid
• Mild hyperthyroidism
• Shortness of breath
• Fatigue
• Increase in weight
• Thyroid gland examination
  • Diffuse swelling
    • Nodular
    • Firm or rubbery in consistency
• Increased incidence of rheumatoid arthritis, hemo- Iyitc anaemia, myasthenia gravis and pernicious anaemia

Hashimoto’s Thyroiditis  Treatment: Surgical excision

Thyroid disorders short answer questions

Question 5. Solitary nodule of thyroid
(or)
Thyroid nodule
Answer:

Solitary Nodule Of Thyroid

Solitary Nodule Of Thyroid can be classified into benign and malignant nodules

Thyroid Nodule Etiopathogenesis:

• Thyroiditis
• Follicular adenoma
• Carcinoma
• Thyroid cyst
• Colloid nodules

Thyroid Nodule Clinical Features:

• Age- 20-40 Years of age
• Sex- common in females
• Stridor
• Tracheal deviation
• Neck vein engorgement
• Dyspnoea
• Dysphagia
• The solitary nodule is present

Thyroid Nodule Treatment:

• Excision of solitary nodule along with a margin of normal thyroid tissue
• If the nodule is present at the junction of the isthmus and lobe- hemithyroidectomy is done
• In the presence of malignancy- immediate total thyroidectomy is done

Question 6. Retrosternal Goitre
Answer:

Retrosternal Goitre

Retrosternal goitre is derived from the lower pole of the multinodular goitre

Retrosternal Goitre Clinical Features:

• Usually asymptomatic
• Symptoms occur as obstruction
  • Obstruction of trachea- Dyspnoea
  • Obstruction of the oesophagus- Dysphagia
  • Obstruction to the major veins in the thorax- Engorgement of neck veins

Retrosternal Goitre Investigations:

• Thyroid scan
• Thyroid function tests
• Barium swallow
• Chest X-ray

Retrosternal Goitre Treatment: Resection of retrosternal goitre

Hypothyroidism and hyperthyroidism questions

Question 7. Gasification of goitre.
Answer:

Gasification Of Goitre

Goitre refers to the enlargement of the thyroid gland irrespective of the cause

Gasification Of Goitre Classification:

1. Simple Goitre
   • Diffuse hyperplastic goitre
   • Nodular goitre
   • Colloid goitre
2. Toxic Goitre
   • Diffuse toxic goitre
   • Toxic nodular goitre
   • Toxic nodule
3. Neoplastic Goitre
   • Benign tumours
   • Malignant tumours
4. Thyroiditis
   • Autoimmune thyroiditis
   • Subacute thyroiditis
   • Reidel’s thyroiditis
5. Other Rare Causes

Question 8. Thyroglossal Fistula
Answer:

Thyroglossal Fistula

• A Thyroglossal cyst may rupture unexpectedly resulting in a draining sinus known as a Thyroglossal fistula
• It can develop when the removal of the cyst has not been fully completed
• It is usually noticed when bleeding in the neck occurs causing swelling and fluid ejection around the original wound of removal
• It is lined by columnar epithelium

Thyroglossal Fistula Types

• Congenital
  • Thyroglossal fistula is a disorder of the Thyroglossal duct which develops from the thyroid primordium in the floor of the primitive pharynx at the site of foramen caecum
  • If involution of the Thyroglossal duct is incomplete, the Thyroglossal fistula may develop
• Acquired
  • Incomplete removal of Thyroglossal cyst
  • Rupture of Thyroglossal cyst

Thyroglossal Fistula Treatment: Sistrunk operation

Diseases Of Thyroid And Parathyroid Glands Short Answers

Question 1. TSH
Answer:

TSH

• Thyroid stimulating hormone is a peptide hormone synthesized and secreted by thyrotrope cells in the anterior pituitary gland
• It regulates the endocrine function of the thyroid gland
• It controls the rate of secretion of thyroxine and triiodothyronine by the thyroid gland
• It controls the rates of most intracellular chemical reactions in the body
• TSH secretion is regulated via a negative feedback loop by T4 and T3, when their levels are low, the production of TSH is increased
• When their levels are high, TSH production is decreased

Question 2. Goitre
Answer:

Goitre

Goitre refers to the enlargement of the thyroid gland

Goitre Clinical Features:

• Hoarseness of voice
• Coughing
• Dysphagia
• Dyspnoea

GoitreTreatment:

• Use of antithyroid drugs
• Use of Levothyroxine in euthyroid patients
• Thyroidectomy

Question 3. Thyroid scan I131
Answer:

Thyroid Scan I131

I131 is obtained at 24 hours

Thyroid Scan I131 Indications:

• When a solitary nodule is palpated
• In retrosternal goitre
• In ectopic thyroid tissue
• In toxic nodular goitre

Thyroid Scan I131 Uses:

• To distinguish functioning and non-functioning thyroid nodules
• To diagnose pathology of the thyroid gland
• To assess the nature of the nodule
• Detect areas of abnormality
• Determine the spread of thyroid cancer
• Evaluate changes in the gland

Question 4. Exophthalmos
Answer:

Exophthalmos

• It means protrusion of the eyeball
• Spasm of the upper eyelid
• Proptosis with the widening of the palpebral fissure
• Supraorbital and infraorbital swelling
• Congestion and edema of the conjunctiva
• Corneal ulceration

Question 5. Hoarseness of voice
Answer:

Hoarseness Of Voice

Hoarseness Of Voice is an abnormal change in voice

Hoarseness Of Voice Causes:

• Acid reflux
• Smoking
• Alcohol
• Screaming
• Allergies
• Inhaling toxic substances
• Coughing
• Polyps on the vocal cords
• Throat, thyroid or lung cancer
• Damage to the throat
• Aortic aneurysm

Hoarseness Of Voice Treatment:

• Rest your voice for a few days
• Avoid talking and shouting B Drink plenty of fluids
• Take hot showers and Use lozenges Avoid smoking
• Eliminate allergens

Question 6. Causes of dyspnoea in goitre
Answer:

Causes Of Dyspnoea In Goitre

• Pressure due to enlarged thyroid gland
• Formation of haematoma
• Tracheomalacia
• Bilateral recurrent laryngeal nerve injury
• Hypocalcaemia

Hypothyroidism and hyperthyroidism questions

Question 7. Metastasis in papillary carcinoma of the thyroid.
Answer:

Metastasis In Papillary Carcinoma Of The Thyroid

• Papillary carcinoma of the thyroid invades the lymphatic’s and spreads to other sites
• Vascular invasion is rare
• If occurs, it occurs through the lungs and bones
• Direct extension into soft tissues of the neck occurs in approx. 25% of cases

Question 8. Post-operative complications of thyroid surgery.
Answer:

Thyroid Surgery Complications:

1. Minor Complications
   • Seromas
   • Poor scar formation
2. Rare Complications
   • Damage to the sympathetic trunk
3. Major Complications
   • Bleeding
   • Injury to recurrent laryngeal nerve
   • Hypoparathyroidism
   • Thyrotoxic storm
   • Injury to the superior laryngeal nerve
   • Infection

Question 9. Thyroglossal cyst
Answer:

Thyroglossal Cyst: It is a cystic swelling developed in the remnant of the thyroglossal tract

Thyroglossal Cyst Etiology: Develops from the ventral portion of the endoderm between the first and second branchial arch

Thyroglossal Cyst Clinical Features:

• Age- common between 15-30 years of age n Sex- common in women h Pain in cyst
• Size: 0.5 cm to 5 cm in diameter
• Shape: spherical or oval
• Cysfbecomes tender
• It may develop anywhere along the thyroglossal tract
• Firm or hard in consistency
• Cyst moves with deglutition

Thyroglossal Cyst Management: Excision of the cyst

Question 10. Plunging goitre
Answer:

Plunging Goitre

• Plunging goitre is also called wandering goitre or diving goitre
• Plunging goitre is freely movable above or below the sternal notch
• Plunging goitre is usually not palpable
• Plunging goitre is palpable during coughing, and sneezing due to increased intrathoracic pressure

Question 11. Hypercalcaemia
Answer:

Hypercalcaemia

Hypercalcaemia is a condition in which the calcium level in the blood is above normal

Hypercalcaemia Causes:

• Overactive parathyroid glands
• Cancer
• Calcium and vitamin D supplements

Hypercalcaemia Clinical features

1. Excessive thirst and frequent urination
2. Nausea, vomiting, constipation
3. Bone pain. Muscular weakness
4. Confusion, lethargy, depression
5. Palpitation, cardiac arrhythmia

Hypothyroidism and hyperthyroidism questions

Question 12. Gynaecomastia
Answer:

Gynaecomastia

Gynaecomastia is an endocrine disorder in which a noncancerous increase in size of male breast tissue occurs

Gynaecomastia Causes:

• Altered ratio of Estrogen to androgen
• Diseases like liver disease, kidney failure, low testosterone
• Certain medications

Gynaecomastia Clinical features

• Male breast enlargement with soft, compressible and mobile subcutaneous chest tissue
• Enlargement may occur on one side or both
• Asymmetry of chest tissue occurs

Diseases Of Thyroid And Parathyroid Glands Viva Voce

Among simple goitre, nodular goitre is more prone to malignant transformation

Infections And Diseases Of The Larynx And Nasopharynx Important Notes

1. Arteries Supplying Tonsils
   • Anterior tonsillar
   • Posterior tonsillar
   • Ascending pharyngeal
   • Superior tonsillar
   • Inferior tonsillar
2. Acute Tonsillitis
   • It is generalised inflammation of the tonsils
   • Causative Organisms
     • Viral
     • Bacterial
   • Acute Tonsillitis Types
     • Acute catarrhal tonsillitis
     • Acute follicular tonsillitis
     • Acute parenchymatous tonsillitis
     • Acute membranous tonsillitis
   • Acute Tonsillitis Clinical features
     • Sore throat
     • Difficulty or painful swallowing
     • Earache
     • Enlai’ged and congested tonsils
     • Cervical lymphadenopathy
3. Quinsy
   • Collection of pus in peritonsillar space is called quinsy
   • Causative Organisms
     • Streptococcus pyogenes
     • Staphylococcus aureus
     • Anaerobes
   • Quinsy Clinical Features
     • Severe pain in throat
     • High temperature
     • Dysphagia
     • Dribbling of saliva
     • Trismus
     • Torticollis
     • Bulging of tonsillar, peritonsillar, and palatal region
     • Cervical lymph nodes are tender and enlarged
4. Ryle’s Tube
   • Ryle’s Tube is one meter long tube made up of red rubber or plastic
   • Ryle’s Tube has got markings at different levels
5. Obstructive Lesions Of Oesophagus
   • Oesophageal stricture
   • Oesophageal cancer
   • Lower oesophageal ring
   • Dysphagia
   • Scleroderma
   • Achalasia

Laryngeal infections and diseases Q&A

Infections And Diseases Of The Larynx And Nasopharynx Long Essays

Question 1. Describe signs, symptoms, and treatment of carcinoma of larynx
Answer:

Carcinoma Of Larynx: Carcinoma Of Larynx is a malignancy involving true vocal cords and anterior and posterior commissures

Carcinoma Of Larynx Clinical Features:

• Carcinoma Of Larynx Types
  • Supraglottic
    • Throat pain
    • Dysphagia
    • Referred ear pain
    • Lump in the neck
    • Hoarseness of voice
    • Weight loss
    • Respiratory obstruction
    • Persistent cough
    • Haemoptysis
    • Halitosis

Read And Learn More: General Surgery Question and Answers

• • Glottic
    • Hoarseness of voice
    • Stridor
  • Subglottic
    • Stridor
    • Hoarseness of voice

Carcinoma Of Larynx Investigations:

• Chest X-ray- to rule out lung disease
• Lateral veiw of the neck- to detect extension of tumor
• CT scan- to detect
  • Extension of tumour
  • Cartilage invasion
  • Nodal metastasis
• Direct laryngoscopy
  • For staging of tumour
• Microlaryngoscopy
• Biopsy- to confirm diagnosis

Carcinoma Of Larynx Treatment:

• Radiotherapy
  • Indicated in early lesions when the vocal cords are not involved
• Surgery
  • Done to
    • Preserve voice
    • Prevent permanent tracheostoma
    • Allow adequate resection of tumour
  • Total laryngectomy
    • Structures removed are
      • Entire larynx
      • Hyoid bone
      • Pre-glottic space
      • Strap muscles
      • Tracheal rings
• Combined Therapy

Nasopharyngeal diseases questions and answers

Question 2. Discuss the differential diagnosis of obstructive lesions in the oesophagus
Answer:

Various differential diagnoses of obstructive lesions in the oesophagus are as follows:

• Oesophageal Structure
  • It is a complication of acid reflux
  • Oesophagus Causes
    • GERD
    • Zollinger- Ellison syndrome
    • Trauma from nasogastric tube placement
    • Chronic acid exposure
  • Oesophagus Features
    • Progressive dysphagia
• Oesophageal Cancer
  • Oesophageal Cancer Clinical features
    • Progressive dysphagia
    • Insidious in onset
    • Retrosternal discomfort
    • Indigestion
    • Weight loss
    • Mild anaemia
    • Hoarseness of voice
  • Oesophageal Cancer Treatment
    • Radiotherapy
    • Surgery
      • Resection
      • Intubation
      • Laser photocoagulation
      • Diathermy
• Lower oesophageal Ring
  • Schatzki’s ring
  • Lower oesophageal Ring is an oesophageal web in its lowermost part
  • Lower oesophageal Ring contains only mucosa and submucosa
  • Covered by squamous epithelium- above and columnar epithelium- below
  • Appears at the Squamocolumnar junction
  • Lower oesophageal Ring is asymptomatic
• Dysphagia lusoria
  • Dysphagia lusoria is caused by compression of the esophagus from any congenital vascular abnormality
  • The abnormality may be in
    • Aberrant right subclavian artery
    • Double aortic arch
    • Right aortic arch with left ligament- martyrium
• Scleroderma
  • Scleroderma is a collagen vascular disease of unknown etiology
  • Scleroderma Features
    • Induration of skin
    • Fibrous replacement of the smooth muscle of internal organs
    • Dysphagia
    • Severe heartburn
  • Scleroderma Treatment
  • Treat gastro-oesophageal reflux disorder
  • Use of H₂ inhibitors like cimetidine or ranitidine
• Achalasia
  • In it peristalsis is absent
  • Lower oesophageal sphincter fails to relax during swallowing
  • Achalasia Features
    • Dysphagia
    • Regurgitation
    • Weight loss
  • Achalasia Treatment
    • Use of calcium channel antagonist
    • Mechanical dilatation
    • Oesophago cardiomyotomy

Question 3. Mention the indications for tracheostomy. Describe the steps of the operation
Answer:

Tracheostomy: Tracheostomy is a procedure of making an opening in anterior wall of trachea and converting it into a stoma on skin surface

Tracheostomy Indications:

• To bypass obstructions
  • Infections
  • Trauma to larynx
  • Tumour
  • Foreign body
  • Laryngeal edema
  • Congenital anomaly
  • Supraglottic or glottic pathologic condition
• Retained secretions
  • Comatose patient
  • Respiratory muscle paralysis
  • Painful cough
  • Aspiration of pharyngeal secretions
• Respiratory insufficiency
  • Emphysema
  • Chronic bronchitis
• Facial fractures
• To provide a long-term route for mechanical ventilation
• Prophylactic
• Severe sleep apnoea

Tracheostomy Steps:

• Position the unconscious patient in a supine position with the neck extended
• Vertical skin incision is given n Veins are ligated n Muscles are separated
• Subcutaneous fat is removed with electrocautery to aid in exposure
• Thyroid gland is retracted upwards n Trachea is exposed
• 4% xylocaine is infiltrated into the trachea
• Suction secretions and blood out of the lumen
• n Place appropriate size tracheostomy tube with an inflated cuff
• Secure it to the skin with 4-0 permanent sutures
• Attach a tracheostomy collar
• Place a sponge soaked in iodine between the skin and the flange for 24 hours

Short questions on larynx and nasopharynx infections

Question 4. Discuss the types, postoperative management, and complication of tracheostomy.
Answer:

Tracheostomy Types:

• Emergency
• Elective
• Permanent

Tracheostomy Postoperative Management:

• The site should be kept clean and dry to minimize infection
• Monitor
  • Bleeding
  • Breathing difficulty
  • Displacement of tube
  • Subcutaneous emphysema
• Irrigate with normal saline regularly
• Suctioning done regularly in every Vi hour
• Use of humified oxygen
• Use of mucolytic agents
• Deflate cuff every hour for 5 minutes

Tracheostomy Complications:

• Immediate complications
  • Bleeding
  • Apnoea
  • Pneumothorax
  • Injury to adjacent structures- recurrent laryngeal nerve, vessels, and oesophagus
  • Postobstructive pulmonary edema
  • Endotracheal tube ignition
• Early complication
  • Bleeding- due to increased blood pressure
  • Plugging of mucus
  • Tracheitis
  • Cellulitis
  • Displacement of tube
  • Subcutaneous emphysema
• Intermediate complications
  • Secondary infection
  • Blockage of tube
• Late complications
  • Tracheal stenosis
  • Scar
  • Tracheomalacia
  • Tracheoesophageal fistula
  • Tracheocutaneous fistula
  • Granulation

Infections And Diseases Of The Larynx And Nasopharynx Short Essays

Question 1. Retropharyngeal abscess
(or)
Chronic retropharyngeal abscess
Answer:

Retropharyngeal Abscess: The collection of pus in retropharyngeal space is called a retropharyngeal abscess

Retropharyngeal Abscess Types:

Question 2. Peritonsillar abscess
(or)
Quinsy
Answer:

Peritonsillar Abscess

The collection of pus in peritonsillar space is called quinsy

Peritonsillar Abscess Etiology:

• Acute tonsilitis
• De novo
• Causative organisms
  • Streptococcus pyrogens
  • Staphylococcus aureus
  • Anaerobic organisms

Peritonsillar Abscess Clinical Features:

• High-grade fever with chills
• Malaise
• Headache
• Neck pain
• Throat pain
• Dysphagia
• Change in voice
• Oralgia
• Odynophagia
• Nausea
• Constipation
• Trismus
• Halitosis
• Ipsilateral earache

Peritonsillar Abscess Treatment:

• Conservative
  • 4 fluids
  • Systemic antibiotics
  • Analgesics
  • Antipyretics
• Surgical treatment
  • Needle aspiration- to drain the abscess
  • Incision and drainage for larger abscess
  • Tonsillectomy

Peritonsillar Abscess Complications:

• Parapharyngeal abscess
• Laryngeal oedema
• Septicaemia
• Endocarditis
• Lung abscess
• Nephritis
• Brain abscess
• Jugular vein thrombosis

Infections of upper respiratory tract Q&A

Question 3. Acute tonsilitis
Answer:

Acute Tonsilitis

Acute Tonsilitis is inflammation of the tonsil

Acute Tonsilitis Types:

• Acute catarrhal tonsillitis
  • Seen in viral infections
• Acute follicular tonsilitis
  • Crypts are filled with purulent material
• Acute parenchymal tonsilitis
  • Tonsils are inflamed and enlarged
• Acute membranous tonsilitis
  • Exudates from crypts form a membrane over the surface

Acute Tonsilitis Etiology:

• Hemolytic streptococci
• Staphylococci
• Pneumococci

Acute Tonsilitis Clinical Features:

• Sore throat
• Dysphagia
• Fever
• Earache
• Headache
• Abdominal pain
• Body ache
• Malaise
• Fetid breath
• Coated tongue

Acute tonsilitis Treatment

• Bed rest
• Increased fluid intake
• Analgesics
• Antibiotics

Infections And Diseases Of The Larynx And Nasopharynx Short Answers

Question 1. Quinsy
(or)
Peritonsillar abscess
Answer:

Quinsy

The collection of pus in peritonsillar space is called quinsy

Peritonsillar Abscess Etiology:

• Acute tonsilitis
• De novo
• Causative organisms
  • Streptococcus pyrogens
  • Staphylococcus aureus
  • Anaerobic organisms

Peritonsillar Abscess Clinical Features:

• High-grade fever with chills
• Malaise
• Headache
• Neck pain
• Throat pain
• Dysphagia
• Change in voice
• Oralgia
• Odynophagia
• Nausea
• Constipation
• Trismus
• Halitosis
• Ipsilateral earache

MCQs on laryngeal diseases

Question 2. Tracheitis
Answer:

Tracheitis

Tracheitis is the inflammation of the trachea

Tracheitis Causative Organism:

• Staphylococcus aureus
• Clinical Features:
• Fever
• Stridor
• Tachypnoea
• Respiratory distress
• High WBC count
• Cough

Tracheitis Treatment:

Systemic antibiotics

Question 3. Pharyngitis
Answer:

Pharyngitis

Pharyngitis is an infection of the pharynx

Pharyngitis Etiology:

• Infections
• Allergy
• Trauma
• Toxins
• Neoplasia

Pharyngitis Clinical Features:

• Pharyngitis can be acute or chronic
• Enlarged tonsils
• Difficulty in swallowing and breathing
• Cough
• Fever

Question 4. Arterial supply to tonsils
Answer:

Arterial Supply To Tonsils

Viva questions on nasopharyngeal conditions

Question 5. Collar stud abscess
Answer:

Arterial Supply To Tonsils

• Arterial Supply To Tonsils is an acute suppurative infection of a digit presenting as a stud-like blister
• Arterial Supply To Tonsils results when a cold abscess which is deep to deep fascia ruptures through the deep fascia and forms another swelling in the subcutaneous plane which is fluctuant

Collar Stud abscess Treatment:

• Simple incision does not resolve the case
• Nondependent aspiration avoids the formation of sinus
• Systemic antibiotics are preferred

Question 6. Pharyngocele
Answer:

Pharyngocele

• Pharyngocele refers to the lateral pharyngeal wall herniation

Pharyngocele Clinical features

• Dysphagia
• Lateral cervical mass
• Valsalva maneuver
• It is diagnosed by pharyngoesophageal swallow

Question 7. Endotracheal intubation
Answer:

Endotracheal Intubation

• Endotracheal intubation secures the airway by placing a tube into the trachea either via nose, mouth, or tracheostomy
• This tube has an inflatable cuff
• Once the tube is placed into the trachea, the cuff is inflated
• This prevents the aspiration of debris
• This tube is connected to an anesthetic machine to allow the delivery of oxygen, nitrous oxide, and inhalation anesthesia
• A throat pack is used as a supplement to the cuff to prevent aspiration of blood, saliva, and debris

Question 8. Nasogastric intubation
Answer:

Nasogastric Intubation

• Nasogastric intubation refers to the insertion of a nasogastric tube through the nose into the stomach

Nasogastric intubation Uses:

• In acute gastric dilatation
• To aspirate gastric contents in intestinal obstruction
• To diagnose GI bleeding
• To provide enteral feeding in comatose patients

Question 9. Acute glottic edema
Answer:

Acute Glottic Edema

• Acute glottic emdema a rare condition when not associated with an infectious disease or other clinical symptoms
• Acute Glottic Edema is one of the complication of prolonged orotracheal intubation

Acute Glottic Edema Clinical Features:

• Hoarseness of voice
• Cough
• Short expiration
• Swelling in the throat

Acute Glottic Edema Treatment:

• Application of ice externally
• Holding small pieces of ice in the back part of mouth and frequently swallowing a small piece
• Alternate hot and cold application

Question 10. Ryle’s tube
Answer:

Ryle’s Tube

• Ryle’s Tube is also called nasogastric tube
• At the end of this tube there are lead shots
• After introducing within the stomach its position is confirmed by pushing 5-10 ml of air and auscultating in the epigastrium
• Ryle’s Tube is a long tube having 3 marks
• When the tube is passed upto 1st mark it enters stomach
• Usually it is passed upto 2nd mark

Ryle’s Tube Uses:

• In acute gastric dilatation
• To aspirate gastric contents in intestinal obstruction
• To diagnose GI bleeding
• To provide enteral feeding in comatose patients

Questions on acute and chronic laryngitis

Question 11. Signs and symptoms of acute pharyngitis
Answer:

Signs And Symptoms Of Acute Pharyngitis

• Acute pharyngitis is related to sore throat
• Symptoms Are:
  • Sore throat
  • Running nose
  • Sneezing
  • Cough
  • Headache
  • Body aches
  • Muscle pain
  • Fever
  • Malaise
  • Fatigue
  • Nausea
  • Loss of appetite

Question 12. Causes of acute tonsillitis
Answer:

Causes Of Acute Tonsillitis

• Bacteria causing acute tonsillitis are
  • Haemolytic streptococci
  • Staphylococci
  • Pneumococci

Question 13. Singer’s nodule
Answer:

Singer’s Nodule

• Singer’s Nodule is vocal cord nodule
• Results from repetitive overuse or misuse of the voice
• This causes irritation of vocal cords
• They are hard, rough, callous-like growth
• They can small as pinhead size or large as pea
• Site: midpoint of vocal folds
• Occasionally associated with abnormal blood vessels
• Women between 20-50 years of age are more prone to develop

Singer’s Nodule Clinical features

• Hoarseness of voice
• Shooting pain in ears
• Coughing
• Tiredness

Singer’s Nodule Treatment: Vocal rest

Common infections of the nasopharynx Q&A

Infections And Diseases Of The Larynx And Nasopharynx Viva Voce

1. Tonsils drains into jugulodigastric lymph nodes
2. High tracheostomy can cause tracheal stenosis
3. Mid-tracheostomy is ideal
4. Low tracheostomy impinges the suprasternal notch
5. Tracheostomy is ideal for intermittent positive pressure ventilation

Ulcers Importance Notes

1. Different Ulcers

2. Painless And Painful Ulcer

3. Edge of ulcer in different ulcers

Types of ulcers Q&A

Ulcers Short Essays

Question 1. Nonhealing ulcers

Answer:

Nonhealing Ulcers Are

1. Venous Ulcer: Venous Ulcer is commenest ulcer of the leg
   • Venous Ulcer Etiology:
     • Abnormal venous hypertension in the lower third of the leg, ankle, and dorsum of foot
   • Venous Ulcer Treatment:
     • Elevation of affected limb
     • Passive movement of limb
     • Active movement of calf muscles
     • Application of blue line bandage
     • Systemic antibiotics
2. Diabetic Ulcer:
   • Diabetic Ulcer Etiology:
     • Slight injury in glucose-laden tissues
     • Ischaemia
     • Infection
     • Peripheral neuritis
   • Diabetic Ulcer Sites:
     • Toes and feet
     • Sole
     • Leg
   • Diabetic Ulcer Feature:
     • Ulcer is deep and spreading
   • Diabetic Ulcer Treatment:
     • Diabetic control
     • Antibiotics- to control infection
     • Excision of ulcer
3. Tuberculous Ulcer:
   • Tuberculous Ulcer Etiology:
     • Bursting of cold abscess
   • Tuberculous Ulcer Features:
     • Oval in shape
     • Multiple in number
     • Has thin reddish blue and undermined edge
     • It is usually shallow
     • Mild pain occurs
     • Presence of slight induration
   • Tuberculous Ulcer Treatment
     • Antitubercular treatment
     • Excision and grafting

Read And Learn More: General Surgery Question and Answers

Question 2. Define and classify ulcers.
Answer

Ulcers Definition: Ulcer is a break in the continuity of the covering epithelium

Ulcers Classification

1. Clinical Classification

2. Pathological Classification

• Nonspecific
  • Traumatic
    • Mechanical – dental ulcer of tongue
    • Physical – x-ray of bum
    • Chemical – application of caustics
  • Arterial
    • Atherosclerosis, Raynaud’s disease, Buerger’s disease
  • Venous – in post phlebitis limb
    • Neurogenic
    • Infective – pyogenic
    • Tropical – in people living in tropical countries
    • Crvopathic – due to cold injur)
    • Martorell’s ulcer – hypertensive
    • Bazin’s ulcer
    • Diabetic ulcer
    • Miscellaneous
• Specific ulcers
  • Tubercular ulcer
  • Syphilitic ulcer
  • Actinomycosis
  • Meleney’s ulcer
• Malignant
  • Epithelioma
  • Rodent ulcer
  • Malignant melanoma

Oral ulcers questions and answers

Question 3. Tubercular ulcer
Answer:

Tubercular Ulcer

• Such ulcer develops due to bursting of cold abscess
• Clinical features
• Shape – oval in shape
• Border – irregular crescentic
• Number – multiple in number
• Edge – thin reddish blue and undermined
• Pain – slight pain is present
• Floor – pale granulation tissue seen on the floor
• Base – slight induration is present

Tubercular Ulcer Treatment

• Antitubercular drugs
• Excision and skin grafting in nonhealing ulcer

Question 4. Rodent Ulcer
Answer:

Rodent Ulcer

• Basal cell carcinoma is called rodent ulcer
• Common sites are inner and outer canthus of the eye, the eyelids bridge of the nose, and around the nasolabial fold.
• Most common pattern is a nodule-ulcerative lesion a slow-growing small nodule that undergoes central with pearly, rolled margins.
• Tumour enlarges in size by burrowing and by destroying the tissues locally like a rodent and hence the name “rodent ulcer”.

Question 5. Marjolin’s ulcer
Answer:

Marjolin’s Ulcer

• Marjolin’s Ulcer is a squamous carcinoma arising in a chronic benign ulcer or scar
• Marjolin’s Ulcer is a long-standing venous ulcer

Marjolin’s Ulcer Features:

• Slow-growing malignant lesion
• Edges may be everted and raised
• It is a painless ulcer
• There is no lymphatic metastasis

Marjolin’s Ulcer Treatment:

Wide excision of the lesion along with a margin of at least 1 cm

Question 6. Diabetic ulcer
Answer:

Diabetic Ulcer Etiology:

• Slight injury in glucose-laden tissues
• Ischaemia
• Infection
• Peripheral neuritis

Diabetic Ulcer Sites:

• foes and feet
• Sole Leg Feature:
• An ulcer is deep and spreading

Diabetic Ulcer Treatment:

• Diabetic control
• Antibiotics- to control infection
• Excision of ulcer

Question 7. Tropical ulcer
Answer:

Tropical Ulcer

• These ulcers occur in the legs and feet of persons living in tropical countries
• Caused by Vincent’s organisms

Tropical Ulcer Etiology:

• Malnutrition
• Anaemia
• Avitaminosis
• Rheumatoid arthritis

Tropical Ulcer Features:

• Edges are slightly raised
• Presence of discharge
• Remains of the same size for many months and years
• It destroys the surrounding tissues
• Pustule develops
• This burst forms painful ulcers
• The ulcer heals leaving a scar

Peptic ulcer disease Q&A

Question 8. Snail track ulcer
Answer:

Snail Track Ulcer

• Snail track ulcers are oral ulcers in syphilitic patients
• They appear in 3-6 weeks after the development of chancre
• These are small, round, and superficial erosions
• These coalesce to form ulcers
• Ulcers are narrow, curved, and shallow

Short notes on ulcers with answers

Question 9. Arterial ulcer
Answer:

Arterial Ulcer

• Arterial ulcers are caused due to
  • Peripheral arterial disease
  • Inadequate circulation
  • Atherosclerosis
  • Trauma
  • Infection
• It is a painful ulcer
• Ulcers tend to be punched out
• It destroys the whole skin and deep fascia
• Expose the tendons on the floor of the ulcer
• Sites Involved Are
  • Anterior and lateral aspects of leg
  • On the toe
  • Dorsum of the foot
  • Heel

Ulcers Viva Voce

1. Marked induration of the edge is a characteristic feature of carcinoma.
2. A leather slough on the floor of the ulcer is seen in the Gummatous ulcer.
3. The black mass on the floor suggests malignant melanoma.
4. Callous ulcer shows no tendency toward healing.

Tumour Cyst And Neck Swelling Long Essays

Question 1. Describe the various types of cysts of mandible and discuss in detail about their management.
Answer:

Types Of Cysts Of Mandible Classification:

Epithelial Cyst:

1. Odontogenic Cysts
   • Developmental cysts
     • Primordial cyst
     • Gingival cysts of infants
     • Dentigerous cyst
     • CEOC
   • Inflammatory cysts
     • Radicular cyst
     • Residual cyst
     • Paradental cyst
2. Nonodontogenic Cysts
   • Naso palatine cyst
   • Globulomaxillary cyst
   • Nasolabial cyst

Non-Epithelial Cyst:

• Simple bone cyst
• Traumatic bone cyst
• Solitary bone cyst
• Aneurysmal bone cyst

Read And Learn More: General Surgery Question and Answers

Tumour cyst and neck swelling Q&A

Question 2. Describe clinical features, diagnosis, and management of the tumor of the maxilla.
Answer:

Tumour Of Maxilla: Tumour of Maxilla is a relatively uncommon, well-circumscribed, odontogenic neoplasm characterized by the formation of multiple duct-like structures by the neoplastic epithelial cells

Tumour Of Maxilla Clinical Features:

• Age- common in young age
• Sex: females are commonly affected
• Site- commonly occurs in the maxillary anterior region
• It is slow enlarging tumour
• Small, bony hard swelling is present in the maxillary anterior region
• Causes elevation of the upper lip on the involved side
• Displacement of regional teeth
• Mild pain and expansion of the cortical plates
• Severe expansion of bone in severe cases
• Associated with unerupted teeth
• It also has extra osseous involvement in the anterior maxillary gingiva
• Produces solitary painless, asymptomatic nodular swelling on the gingiva

Tumour Of Maxilla Diagnosis:

• Clinically- slow enlarging bony hard swelling present in the maxillary anterior region
• Radiographically
  • Shows well-circumscribed, unilocular, radiolucent area with few small radiopaque foci
• Microscopically
  • Spindle-shaped, neoplastic odontogenic epithelial cells appears to proliferate in multiple duct-like patterns
  • These ducts are lined by tall columnar cells
  • The central lumen is filled with eosinophilic coagulum

Tumour Of Maxilla Management

• Tumour Of Maxilla is treated by surgical enucleation
• The associated tooth is removed

Question 3. What are the different types of haemangiomas? Describe the treatment of each type.

Answer:

Haemangioma is a developmental malformation of blood vessels

Haemangioma Types:

1. Capillary haemangioma
   • Arises from capillaries
   • Mainly there are three varieties of it
     • Strawberry angioma
     • Port wine stain
     • Salmon patch
   • Management:
     • Most of the lesions disappears on its own
     • If it persists following measures are undertaken
       • Excision of the lesion with skin grafting
       • Carbon dioxide snow application
       • Injection of hot water or hypertonic saline
       • Radiotherapy
       • Injection of steroid
2. Venous Haemangioma:
   • Also called cavernous haemangioma
   • Arises from veins
   • Venous Haemangioma consists of multiple dilated venous channels
   • Venous Haemangioma is a spongy swelling
   • Management:
     • Conservative treatment
       • Injection of sclerosing agent
       • Cautery
     • Surgery
       • Ligation of feeding vessels
       • Excision of the esion
       • Diathermy to control hemorrhage
3. Arterial Haemangioma:
   • Also called plexiform haemangioma
   • Arises from arteries
   • It is a type of congenital arteriovenous fistula
   • There is pulsatile swelling of arteries and the veins become arterialized
     • Management:
       • Ligation of feeding vessels
       • Therapeutic embolization of the feeding arteries
       • Excision of lesion with diathermy

Question 4. Describe the methods of spread of carcinoma, grading, and staging of carcinoma in general.
Answer:

Spread of Tumours: Spread of Tumours is by 2 ways.

1. Local Invasion/Direct Spread:
   • Benign Tumors:
     • Form encapsulated/circumscribed masses
     • These expand and push aside the surrounding normal tissues without actually invading, infiltrating/metastasizing.
     • Malignant tumours: They also enlarge by expansion.
     • These tumours invade via the route of least resistance
     • Often cancers extend through tissue spaces, via lymphatics, blood vessels, and perineural spaces and may penetrate bone.
     • More commonly, tumours invade thin-walled capillaries and veins than thick-walled arteries.
2. Metastasis/Distant Spread:

• • Metastasis is defined as spread of tumor by invasion in such a way that discontinuous secondary tumour mass/masses are formed at the site of lodgement.
  • Benign tumours do not metastasise while all malignant tumours with a few exceptions like gliomas of the CNS and basal cell carcinoma of skin can metastasize.

Routes Of Metastasis:

1. Lymphatic Spread: In general, carcinomas metastasise by lymphatic route

• The involvement of lymph nodes by malignant cells may be of two forms.

2. Haemategenous Spread:

• Sarcomas spread through hematogenous spread
• Common site for blood borne metastasis are
  • Lung,
  • Breast,
  • Thyroid,
  • Kidney,
  • Liver
  • Prostrate and
  • Ovary.
  • spread

3. Various Other Routes:

• TNM STAGING:
  • T- size of tumour
  • N- lymph node involvement
  • M- distant metastasis

• T0- No tumour present
• Tis- Carcinoma in situ
• T1 – Tumour 2 cm or less
• T2- Tumour between 2-4 cm
• T3- Tumour more than 4 cm
• T4- Tumour invading adjacent structures
• NO- No node involvement
• Nl- ipsilateral lymph node involvement of 3 cm or less
• N2- ipsilateral lymph node involvement of more than 3 cm or less than 6 cm
• N3- Contralateral node involvement
• MO- no metastasis
• Ml- metastasis present

Questions on neck swellings and tumors

Question 5. What are the epidermal malignant lesions of skin? Describe the clinical features and outline management of squamous cell cacinoma What are the premalignant conditions of the skin?

Answer:

Epidermal Malignant Lesions Of Skin?

• Epidermal malignant lesions of skin are
  • Basal cell carcinoma
  • Squamous cell carcinoma
  • Verrucous carcinoma
  • Malignant melanoma
  • Spindle cell carcinoma
  • Primary intra-alveolar carcinoma

Squamous Cell Carcinoma:

Squamous Cell Carcinoma is the most common epidermal malignant neoplasm derived from the stratified squamous epithelium

Squamous Cell Carcinoma Clinical Features:

• Age: common in old age
• Sex: Common in males
• Sites involved are:
  • Lower lip
  • Lateral border of tongue
  • Floor of the mouth
  • Soft palate
  • Gingiva or alveolar ridge
  • Buccal mucosa
• Associated with oral leukoplakia and erythroplakia
• Initial Symptoms Are
  • Asymptomatic
  • White or red, varigated patch
  • Nodule or fissure over oral mucosa
  • Painless
• Later Symptoms
  • Fast enlarging
  • Exophytic or invasive ulcer
  • Persistent induration around periphery
  • Presence of superadded candidal infections
  • Painful lesions due to secondary infections
  • Fixation to the underlying tissues
  • Trismus
  • Invasion of the alveolar bone
  • Enlarged regional lymph nodes
  • Pathological fractures of the jaw bone

Squamous Cell Carcinoma Management:

• Surgical excision
• Radiotherapy
• Chemotherapy

Premalignant Conditions:

• Premalignant Conditions is defined as the generalized state of the body which is associated with a significantly increased risk of cancer
• They are
  • Oral submucous fibrosis
  • Sideropenic dysphagia
  • Syphilis
  • Oral lichen planus

Question 6. Discuss in detail about etiology, pathology, clinical features, investigations, and management of basal cell carcinoma.
Answer:

Basal cell carcinoma

• Also called as rodent ulcer. Most common tumor.
• Basal cell carcinoma is locally invasive, slow-growing tumor of middle-aged individuals which rarely metastasizes.

Basal Cell Carcinoma Etiology:

• Prolonged exposure to strong sunlight
• UV rays
• Arsenic used in skin ointments.
• Dysregulation of PTCH pathway.
• Inherited effects of PTCH gene causing BCC, Gorlin syndrome.

Basal Cell Carcinoma Pathology:

• It is characterized by neoplastic proliferation of basaloid epithelial cells in the form of multiple solid islands or strands
• These cells arises from the basal cell layer of the epidermis
• Cells in the periphery are columnar in shape
• Central cells may be polyhedral, oval, round, or even spindle-shaped
• Fibrous connective tissue contains large number of elastic fibres

Basal Cell Carcinoma Clinical Features:

• Majority of lesions occur on the face, usually above a line joining lobe of the ear and the angle of the mouth.
• Common sites are inner and outer canthus of the eye, the eyelids bridge of the nose, and around nasolabial fold.
• Most common pattern is a nodule-ulcerative lesion a slow-growing small nodule that undergoes central with pearly, rolled margins.
• Tumour enlarges in size by burrowing and by destroying the tissues locally like a rodent and hence the name “rodent ulcer”.

Basal Cell Carcinoma Investigations:

• Histopathological examination of the lesion

Basal Cell Carcinoma Treatment:

• Tumours are usually treated with complete local excision.
• BCC responds well to radiation. Radiation is indicated in elderly patients with extensive lesions, does – 4000 – 6000 gy units.
• Cryosurgery
• Local chemotherapy
• Laser beam destruction of the tumour.

Question 7. Discuss clinical features and management of jaw tumours.
(or)
Classify the tumours of the alveolar bone and describe its clinical features and management of it.
Answer:

Tumours Classification:

1. Benign Tumours:

1. Epithelial origin
   • Ameloblastoma
   • CEOT
   • AOT
2. With mesenchymal origin
   • Ameloblastic fibroma
   • CEOC
   • Odontoma
3. With epithelial and mesenchymal origin:
   • Odontogenic fibroma
   • Myxoma

2. Malignant Tumours:

1. Odontogenic carcinoma
   • Malignant ameloblastoma
   • Primary intraosseous carcinoma
2. Odontogenic sarcoma
   • Ameloblastic fibro asrcoma
   • Ameloblastic fibro dentinosarcoma
3. Odontogenic carcinosarcoma

Jaw Tumours Clinical Features:

• Commonly occurs in the mandible
• Slow enlarging, painless mass occurs
• Bony hard swelling of the jaw
• Expansion and distortion of the cortical plates
• Pain
• Paresthesia
• Mobility of the regional teeth
• Presence of cyst
• Pathological fractures may occur
• The overlying mucosa appears normal
• Larger lesions may perforate the cortical plates

Jaw Tumours Management:

• Enucleation

Jaw Tumours Technique:

• Currettagc

Question 8. Describe the classification, clinical features, and treatment of odontoma.
Answer:

Odontoma

Odontomes are common hamartomatous odontogenic lesions with limited growth potential

Odontoma Types:

1. Complex odontome:
   • Consists of a massof haphazardly arranged enamel, dentin, and cementum
2. Compound odontoma:
   • Consists of collections of numerous small, discrete, tooth-like structures

Odontome Clinical Features:

• Age: Children and young adults
• Sex: Both
• Site: Compound- in maxilla
• Complex- mandible

Odontome Presentation:

• Small asymptomatic lesion
• Expansion of cortical plates
• Displacement of teeth
• Impacted or retained deciduous teeth
• Pain, inflammation
• Ulceration
• Fistula formation

Radiographic Features:

• Compound- A bag of teeth appearance
• Complex- sunburst appearance

Radiographic Treatment:

• Surgical enucleation

Cystic neck swellings questions and answers

Question 9. Describe clinical features, diagnosis, and treatment of ameloblastoma.
Answer:

Ameloblastoma Clinical Features

• Sex: Both sex
• Age- 1st to 7th decade

Ameloblastoma Types:

1. Solid or multicystic ameloblastoma
   • Slow-growing locally invasive tumours
   • High recurrence rate
2. Unicystic type
   • Lesion can be enucleated
   • Rarely seen in maxilla
   • Recurrence rate is low
3. Peripheral ameloblastoma
   • Does not invade bone
   • Treated in the early stages of development

Ameloblastoma Features:

• Swelling and pain in the region
• Inflammation
• Tension
• Dental trauma
• Ulceration of mucosa
• Loosening of teeth
• Epistaxis
• Nasal obstruction

Radiological Features:

• Unilocular or multi locular radiolucency
• Soap bubble appearance of the lesion
• Border is clear
• Resorption of the teeth

Radiological Management:

• Forintraosseous- marginal resection
• Segmental resection
• Aggressive resection

Jackson’s Guidelines:

• Tumour confined to maxilla without orbit floor involvement- Partial maxillectomy
• Tumour involving orbital floor- Total maxillectomy
• Tumour involving orbital contents- Total max-lobectomy.
• Tumour involving skull bone- Neurological procedure

Question 10. Describe the pathology, clinical features, and management of adamantinoma.
Answer:

Adamantinoma: Adamantinoma is a relatively uncommon, well-circumscribed, odontogenic neoplasm characterized by the formation of multiple duct-like structures by the neoplastic epithelial cells

Adamantinoma Clinical Features:

• Age- common in young age
• Sex: females are commonly affected
• Site- commonly occurs in the maxillary anterior region
• It is slow enlarging tumour
• Small, bony hard swelling is present in the maxillary anterior region
• Causes elevation of the upper lip on the involved side
• Displacement of regional teeth
• Mild pain and expansion of the cortical plates
• Severe expansion of bone in severe cases
• Associated with unerupted teeth
• It also has extra osseous involvement in the anterior maxillary gingiva
• Produces solitary painless, asymptomatic nodular swelling on the gingiva

Adamantinoma Pathology:

• Spindle-shaped, neoplastic odontogenic epithelial cells appears to proliferate in multiple duct-like patterns
• These ducts are lined by tall columnar cells
• Central lumen is filled with eosinophilic coagulum

Adamantinoma Management

• Adamantinoma Management is treated by surgical enucleation
• The associated tooth is removed

Oral and neck tumors short questions

Question 11. Discuss the clinical features and management of cysts of the jaw.
Answer:

Cysts Of The Jaw: Cysts of The Jaw is pathological cavity containing fluid, semi-fluid or, gas, which is usually lined by epithelium and is not formed by the accumulation of pus

Cysts Of The Jaw Management:

Enucleation Of cyst:

• • Smaller single cyst through intraoral approach
  • Unilocular lesions through marginal excision
  • Large multilocular lesions

Cysts of The Jaw Marsupialization:

• It refers to creating a surgical window in the wall of the cyst and evacuation of the cystic contents

Question 12. Name the swellings arising from the jaw. Describe clinical features, diagnosis, and treatment of dentigerous cyst.
Answer:

Dentigerous Cyst Clinical Features

• Sex: Common in males
• Age: 1st and 3rd decade
• Site: Mandibular 3rd molar, maxillary canines, maxillary 3rd molar
• Expansion of bone
• Facial asymmetry
• Displacement of adjacent teeth
• Resorption of adjacent teeth

Radiological Features:

• The unilocular, well-defined radiolucency
• Margins- sclerotic

Radiological Types:

• Central- covering the crown of an unerupted tooth
• Circumferential- covering the crown from all the sides
• Lateral- covering crown from side

Radiological Management:

• Marsupialization- in children
• Enucleation – in adults

Question 13. Describe the midline swellings of neck. Discuss etiology, clinical features, and management of thyroglossal cyst.
Answer:

Midline Swellings Of The Neck:

• Ludwig’s angina
• Enlarged submental lymph nodes
• Sublingual dermoid
• Thyroglossal cyst
• Subhyoid bursitis
• Goitre
• Lipoma
• Retrosternal goitre
• Thymic swellings
• Bony swelling arising from manubrium sterni

Thyroglossal Cyst:

Thyroglossal Cyst is a cystic swelling developed in the remnant of the thyroglossal tract

Thyroglossal Cyst Etiology:

Develops from the ventral portion of the endoderm between the first and second branchial arch

Thyroglossal Cyst Clinical Features:

• Age- common between 15-30 years of age
• Sex- common in women
• Pain in cyst
• Size: 0.5 cm to 5 cm in diameter
• Shape: spherical or oval
• Cyst becomes tender
• It may develop anywhere along the thyroglossal tract
• Firm or hard in consistency
• Cyst moves with deglutition

Thyroglossal Cyst Management:

Excision of the cyst

Neck swelling differential diagnosis Q&A

Tumour Cyst And Neck Swelling Short Essays

Question 1. Dermoid cyst
Answer:

Dermoid Cyst

• Dermoid cyst is a cyst that lies deep to the skin and is lined by the skin
• Dermoid cyst is lined by squamous epithelium and contains toothpaste-like material

Dermoid Cyst Types:

• Sequestration dermoid
• Implantation dermoid
• Tubule-dermoid
• Teratomatousdermoid

Question 2. Sublingual dermoid
Answer:

Sublingual Dermoid

• Sublingual dermoid is a congenital swelling
• Sublingual Dermoid is formed at the point of fusion of the two mandibular arches
• Sublingual Dermoid develops from the secretion of the sequestrated surface ectoderm at the fusion site

Sublingual Dermoid Clinical Features:

• Present below or above the hyoid bone
• Causes swelling of the floor of the mouth
• Color- whitish in color
• It is opaque
• Age: 10-25 years of age
• Sex: both sex are equally affected
• It is painless swelling
• Rarely the contents become infected and the cyst becomes painful and tense

Sublingual Dermoid Types:

• Median variety
  • Supramylohyoid variety
    • Midline swelling on the floor of the mouth
  • Inframylohyoid variety
    • Swelling is present in the submental region resulting in double chin appearance
• Lateral variety
  • Supramylohyoid variety
    • Opaque cystic swelling in the floor of the mouth
  • Inframylohyoid variety
    • Cystic swelling present in the submandibular region

Sublingual Dermoid Treatment:

• Total excision
  • Supramy lohyoidvarities- approached through floor of the mouth
  • Infra mylohyoid varieties approached through the neck by curved incision

Question 3. Preauricular dermoid
Answer:

Preauricular Dermoid

Preauricular dermoid is type of sequestration dermoid

Preauricular Dermoid Etiology:

• Imperfect fusion of 1st and 2ndbranchial arches in formation of the auricle communicating with an ear pit on the surface

Preauricular Dermoid Clinical Features:

• Painless swelling
• Slow growing
• Size- more than 2 cm in diameter
• Ovoid or spherical in shape
• Soft in consistency
• Has smooth surface

Preauricular Dermoid Complications

• Infection
• Suppuration
• Ulceration
• Pressure symptoms to the surrounding structures

Preauricular Dermoid Treatment

• Surgical excision

Common neck swellings MCQs

Question 4. Postauricular dermoid and External angular dermoid
Answer:

Postauricular Dermoid

• Postauricular Dermoid is type of sequestration dermoid
• Site: behind the ear- at the site of fusion of the mesodermal hillocks

External Angular Dermoid

• External angular dermoid is type of sequestration dermoid
• External angular dermoid is present above the outer canthus of the eye- at the line of fusion of the frontonasal and maxillary processes

Question 5. Lipoma
Answer:

• Lipoma is a benign neoplasm of adipose tissue
• Lipoma is composed of mature fat cells

Lipoma Clinical Features:

• Age: above 40 years of age
• Sex: both sex are equally affected
• Lipoma is soft, well-defined, movable mass
• Smooth-surfaced
• Nodular, pedunculated or sessile lesion
• These are painless swelling
• Color
  • Superficial lesions- yellow in color
  • Deep lesions- pink in color
• Size: less than 3 cm in diameter
• It floats in aqueous solution

Lipoma Pathology:

• Lipoma presents well-circumscribed areas of proliferating mature fat cells within loose areolar tissue stroma
• Cells has round, vacuolated clear cytoplasm
• Lobules of cells are separated by fibrous tissue septa
• May contain benign lip blasts which results in soap bubble appearance

Lipoma Treatment: Surgical excision

Question 6. Basal cell carcinoma
Answer:

Basal Cell Carcinoma Etiology:

• Prolonged exposure to strong sunlight
• UV rays
• Arsenic used in skin ointments.
• Dysregulation of PTCH pathway.
• Inherited effects of PTCH gene causing BCC, gorlin syndrome.

Basal Cell Carcinoma Clinical Features:

• Majority of lesions occur on the face, usually abore a line joining lobe of the ear and the angle of the mouth.
• Common sites are the inner and outer canthus of the eye, eyelids bridge of the nose, and around the nasolabial fold.
• Most common pattern is a nodule-ulcerative lesion a slow-growing small nodule that undergoes central with pearly, rolled margins.
• Tumour enlarges in size by burrowing and by destroying the tissues locally like a rodent and hence the name “rodent ulcer”.

Basal Cell Carcinoma Investigations

• Histopathological examination of the lesion

Basal Cell Carcinoma Treatment:

• Tumors are usually treated with complete local excision.
• BCC responds well to radiation. Radiation is indicated in elderly patients with extensive lesions, does – 4000 – 6000 gy units.
• Cryosurgery
• Local chemotherapy
• Laser beam destruction of the tumour

Question 7. Premalignant lesions of the oral cavity
Answer:

Premalignant Lesions Of The Oral Cavity

• Premalignant lesions of the oral cavity is defined as morphologically altered tissue in which cancer is more likely to occur than its apparently normal counterpart.
• They are
  • Leukoplakia
    • Leukoplakia is a white patch or plaque which cannot be scrapped off or stripped off easily and cannot be characterized clinically or pathologically as any other disease
    • They can be nonpalpable, faintly translucent, white areas
    • Many lesions are thick, fissured, indurated
    • Size is variable
    • The surface may be smooth or finely wrinkled
    • Color- white or grayish or yellowish-white in color
  • Erythroplakia
    • Erythroplakia is red patch or plaque which cannot be characterized clinically or pathologically as any other condition and which has no apparent cause
    • Erythroplakia has clearly defined margins
    • Types
      • Homogenous erythroplakia
      • Erythroplakia interspersed with patches of leukoplakia
      • Speckled erythroplakia
  • Stomatitis nicotine
    • Stomatitis nicotine is tobacco-related keratosis
    • Stomatitis nicotine affects both hard and soft palate
    • There is hyperkeratosis of the epithelium and inflammatory swelling of the palatal mucous glands
    • Surface has elevated keratotic rings
  • Chronic candidiasis
    • It is fungal infection
    • Seen in the palatal mucosa of the denture-wearing persons
    • Common in females
    • Appears as bright red, edematous, velvety area

Benign and malignant tumors Q&A

Question 8. Epulis
Answer:

Epulis

• Epulis is a swelling situated on the gum
• It arises from the alveolar margin of the jaw

Epulis Types:

• Fibrous epulis
  • Arises from the periosteum at the neck of an incisor or premolar tooth
  • V is a firm nodule at the junction of the gum and tooth
  • Polypoid in shape
  • Slow growing tumour
  • Adjacent teeth are slightly separated and loosen

Epulis Complications:

Fibrosarcoma

Epulis Treatment:

• Excision
• Granulomatous epulis
• Epulis is a mass of granulation tissue around a carious tooth
• Epulis looks bright red in color
• Epulis is soft to firm in consistency
• Epulis easily bleeds on touch
• Associated with carious teeth
• Regional lymph nodes are enlarged and tender
  • Extraction of the carious tooth
  • Replacement of ill-fitted denture
  • Maintenance of oral hygiene
  • Removal of granulation tissue
  • Diathermy of granulation tissue
  • Myeloid epulis
    • It is an osteoclastoma and arises from the underlying bone
    • Overlying mucosa becomes hyperaemic, edematous and soft to touch
    • It is sessile
    • Rapidly growing
    • Plum colored
    • Adjoining teeth are loosen and separated

Epulis Complication:

• Ulceration
• Serious haemorrhage

Epulis Treatment:

• Currettage of small swelling
• Radical excision of large swellings
• Carcinomatous epulis
  • It is epithelioma of the gum
  • Present as lump or ulcer
  • Painful lesion
  • Invades bone
  • Regional lymph nodes are involved
  • Adequate resection of the lesio
  • Radiotherapy

Question 9. Burkitt’s tumour
Answer:

Burkitt’s Tumour

• Burkitt’s Tumour is a distinctive type of B-cell lymphoma caused by Epstein-Barr virus (EBV) infection.
• 3 sub-groups of Burkitt’s lymphoma are:
  • African endemic
  • Sporadic
  • Immunodeficiency associated.
• Etiology – EBV infection and immune suppression.

Burkitt’s Tumour Features:

• The disease affects children and adolescents
• Involves extranodal sites, particularly the jaw, gastrointestinal tract, and gonads.

Histological Appearances:

Tightly packed lymphoblasts interspersed with phagocytic macrophages which impart a starry-sky appearance in histological sections.

Question 10. Adamantium
Answer:

Adamantium

Adamantium is relatively uncommon, well-circumscribed, odontogenic neoplasm characterized by the formation of multiple duct-like structures by the neoplastic epithelial cells

Adamantium Clinical Features

• Age- common in young age
• Sex: females are commonly affected
• Site- commonly occurs in maxillary anterior region
• It is slow enlarging tumour
• Small, bony hard swelling is present in maxillary anterior region
• Causes elevation of the upper lip on the involved side
• Displacement of regional teeth
• Mild pain and expansion of the cortical plates
• Severe expansion of bone in severe cases
• Associated with un erupted teeth
• Adamantium also has extra osseous involvement in the anterior maxillary gingiva
• Produces solitary painless, asymptomatic nodular swelling on the gingiva

Adamantium Management:

• Adamantium is treated by surgical enucleation
• The associated tooth is removed

Question 11. Epidermoid cyst
Answer:

Epidermoid Cyst

These are small, hard lumps that develop under the skin

Epidermoid Cyst Causes:

• Excessive keratin production Acne
• Excessive sun exposure

Epidermoid Cyst Clinical Features:

• Site involved
  • Face
  • Head
  • Neck
  • Back
  • Genitals
• Slow growing
• Painless swelling a Size- 1/2 -2 inch in diameter
• Color- tan to yellow in color
• Filled with thick smelly matter

Epidermoid Cyst Treatment:

• Epidermoid cyst heals on its own
• In case of infection- antibiotics and steroid injection is used
• Rarely removed for cosmetic purposes

Epidermoid Cyst Prognosis: If drained it recurs again

Questions on cystic lesions of head and neck

Question 12. Adenoma
Answer:

Adenoma

• Adenoma is benign tumour of glandular tissue
• Adenoma consists of dense mass of acini lined by exuberant epithelium which may be columnar or cuboidal

Adenoma Types:

• Fibroadenoma
  • Fibroadenoma occurs in breast
  • The specialised connective tissue surrounding the glandular epithelium is involved
  • Fibroadenoma occurs due to excessive stromal reaction
  • Fibroadenoma is further divided into two types
    • Hard pericanalicula rfibroadenoma
    • The ducts are surrounded by dense connective tissue
  • Soft intracanlicular fibroadenoma
    • Loose connective tissue is impinged into the ducts
  • The connective tissue shows rapid growth and enlarges to a great extent
• Cystadenoma
  • Adenoma forms cystic spaces into which papillary in the growth of neoplastic epithelium occurs
  • Cystadenoma is called cystadenoma
  • Sites involved
    • Ovary
    • Pancreas
    • Parotid gland
    • Kidney
• Adenoma Types
  • Serous cystadenoma- serous-producing adenoma
  • Pseudomucinous cystadenoma- mucin-producing adenoma

Question 13. Sequestration dermoid
Answer:

Sequestration Dermoid

• Sequestration dermoid is congenital type of dermoid cyst formed by inclusion of epithelium at the line of embryonic fusions

Sequestration Dermoid Common Sites:

• At the midline of the body
• External angular
• Post auricular
• On the skull at the fusion of skull bones
• At the midline of face

Sequestration Dermoid Clinical Features:

• Sequestration dermoid is congenital variety
• Painless swelling
• Slow growing
• Size- more than 2 cm in diameter
• Ovoid or spherical in shape
• Soft in consistency
• Has mooth surface

Sequestration Dermoid Complications:

• Infection
• Suppuration
• Ulceration
• Pressure to the surrounding structures

Sequestration dermoid Treatment:

• Complete excision of the cyst

Question 14. Implantation dermoid
Answer:

Implantation Dermoid

• Implantation dermoid is acquired dermoid
• Implantation dermoid arises from indriven epithelium beneath the skin due to puncture injury

Implantation Dermoid Common Sites:

• Palm of the hand
• Any part of finger
• Sole

Implantation Dermoid Clinical Features:

• Swelling in the finger or palm n Painful cyst
• Cyst is tensed n Consistency is firm to hard
• There may be scar over the skin

Implantation Dermoid Complication:

• Infection
• Suppuration
• Bursting

Implantation Dermoid Treatment:

Complete excision of the cyst

Question 15. Sternomastoid tumour
Answer:

Sternomastoid Tumour

• Sternomastoid tumour is also called congenital torticollis

Sternomastoid Tumour Etiology:

• Infarction of the central portion of one sternomastoid muscle
• Congenital anomaly
• Infarction of the sternomastoid branch of the superior thyroid artery
• Trauma

Sternomastoid Tumour Clinical Features:

• Age- several days to several months after birth
• A lump is produced
• Site: in the middle of the sternomastoid muscle
• Torticolis- head is turned to one side
• It is painful lesion
• Size: 1-2 cm in diameter
• It is fusiform in shape
• Surface is smooth
• It is firm in consistency
• Regional lymph nodes are normal

Sternomastoid Tumour Treatment:

• At birth
  • Manipulation of head of the child
• After the development of torticollis
  • Use of brace
  • Sternomastoid muscle is divided
  • Subcutaneous tenotomy
    • Deep fascia or neighboring muscles are divided

Short notes on neck tumors and swellings

Tumour Cyst And Neck Swelling Short Answers

Question 1. Nasopalatine cyst
Answer:

Nasopalatine Cyst

• A nasopalatine duct cyst is a relatively common, nonodontogenic intraosseous, cystic lesion arising within the nasopalatine duct or incisive canal

Nasopalatine Cyst Clinical Features:

• Age- fourth, fifth and sixth decade of life
• Sex: Males are commonly affected
• It is small, painful, fluctuant swelling present in the midline of the anterior part of the hard palate near the opening of the incisive foramen
• Causes pressure sensation on the floor of the nose and displacement of the upper central incisors
• There may be purulent discharge
• Swelling in the soft tissue between upper central incisors occurs
• The regional teeth are vital

Nasopalatine Cyst Treatment:

Surgical excision

Question 2. Neurofibroma
Answer:

Neurofibroma

• Neurofibroma is the tumour arising from the connective tissue of the nerve sheath

Neurofibroma Types:

• Local or solitary neurofibroma
  • Found in the subcutaneous tissue
  • Usually seen in the extremities
  • Cranial nerves may be involved
• Generalised neurofibromatosis/ Von Recklinghausen’s disease
  • In it there are multiple neurofibromas arising from the cranial, spinal, and peripheral nerves
  • It comprises of two types
    • Type 1- Von Recklinghausen’s disease
    • Type 2- acoustic neurofibromatosis
• Plexiform neurofibromatosis
  • Plexiform neurofibromatosis is an excessive overgrowth of neural tissue in the subcutaneous fat
  • Common in branches of trigeminal nerve
• Elephantiasis neurofibromarosa
  • Severe form of plexiform neurofibromatosis affecting subcutaneous nerves of the limbs
• Cutaneous neurofibromatosis
  • These are multiple subcutaneous nodules, sessile or pedunculated over the chest, abdomen, or back

Question 3. Spread of malignant tumors
Answer:

1. Lymphatic Spread: In general, carcinomas metastasize by the lymphatic route

• Involvement of lymph nodes by malignant cells may be of two forms.

2. Haemategenous Spread:

• Sarcomas spread through hematogenous spread
• Common sites for blood-borne metastasis are
  • Lung
  • Breast
  • Thyroid
  • Kidney
  • Liver
  • Prostrate and
  • Ovary.

Question 4. Glomus tumour
Answer:

Glomus Tumour

• Glomus tumour is rare, benign, and painful tumour of the skin and subcutaneous tissue
• Occurs in the extremities
• It is circumscribed
• Blue or reddish in color
• Size- not more than 1 cm in diameter
• Pain occurs spontaneously or with pressure or trauma
• Pain is stabbing and burning type
• Pain is caused by dilated glomus vessels pressing on the numerous nerve endings

Glomus Tumour Treatment:

Surgical excision of the lesion

Question 5. Carcinoid tumour
Answer:

Carcinoid Tumour

They are rare tumors of the neuroendocrine system

Carcinoid Tumour Causes:

• Hereditary
• Neurofibromatosis
• Tuberous sclerosis
• Lymphoma

Carcinoid Tumour Risk Factors:

• Diabetes
• Gastritis
• Smoking
• Obesity

Carcinoid Tumour Clinical Features:

• Slow growing
• Patient remains asymptomatic for many years
• Individuals above 60 years are affected
• Sites involved are
  • GIT
  • Lung
  • Pancreas
  • Kidney
  • Ovaries
  • Testicles
• Spread to liver, lymph nodes, and bone
• Carcinoids of lung cause
  • Cough
  • Breathlessness
  • Chest pain
  • Wheezing
  • Tiredness
  • Weight gain
• Carcinoid of stomach
  • Weight loss
  • Pain
  • Fatigue

Oral pathology tumors and cysts questions

Question 6. Malignant melonoma
Answer:

Malignant Melonoma

Malignant melanomal is a tumour arising from pigment-forming cells i.e., melanoblast which are desired from the neural crest.

Malignant Melonoma Etiology: Unknown but there is role of excessive exposure of white skin to sunlight.

Malignant Melonoma Common Site:

• Oral and anagenital mucosa,
• Oesophagus,
• Conjuctiva,
• Orbit,
• Leptomeninges.

Malignant Melanoma Clinical Features:

• Flat/slightly elevated nerves which has variegated pigmentation, and irregular borders and has undergone secondary changes of ulceration, bleeding and increase in size.
• Depending upon clinical course and prognosis, cutaneous malignant melanomas are of 4 types.
  • Lentigo maligna melanoma
  • Superficial spreading melanoma
  • Aeralcontigenous melanoma
  • Nodular melanoma.
• Spread: Metastatic spread in very common via lymphatics.

Malignant Melanoma Treatment: 

• Surgery – main modality.
• Palliative and supportive – other modalities.

Question 7. Potato tumour
Answer:

Potato Tumour

• Carotid body tumour is called potato tumour because
  • It looks yellow or orange on cut surface
  • It is firm, homogenous, and compact tumor
  • Well capsulated
• Potato Tumour is adherent to the carotid artery

Potato tumour Clinical Features:

• Age- 40-60 years of age
• Sex: Both sex are equally affected
• There is slow growing painless swelling at the bifurcation of common carotid artery
• Horner’s syndrome may be present
• Patient may suffer from transient cerebral ischaemia

Potato tumour Treatment: Surgical excision

Question 8. Osteoclastoma
Answer:

Osteoclastoma

Osteoclastoma is rare tumour of jaw

Osteoclastoma Clinical Features:

• Age- 25-40 years of age
• Sex: males are commonly affected
• Osteoclastoma is rapidly growing tumour
• Mandible is commonly affected
• There is an expansion of cortical plates
• Osteoclastoma is painless lesion

Osteoclastoma Differential Diagnosis:

• Giant cell reparative granuloma
• Adamantionoma

Question 9. Cavernous haemangioma
Answer:

Cavernous Haemangioma

• Arises from veins
• Cavernous haemangioma consists of multiple dilated venous channels
• Cavernous haemangioma is a spongy swelling

Cavernous Haemangioma Management: Conservative treatment

1. Injection of sclerosing agent
2. Cautery
   • Surgery
     • Ligation of feeding vessels
     • Excision of the lesion
     • Diathermy to control haemorrhage

Question 10. Clarke’s level of invasion of malignant melonoma
Answer:

Clarke’s Level Of Invasion Of Malignant Melonoma

• Malignant melanoma can be staged according to Clarke’s level of invasion
  • Level 1- all tumour cells are above the basement membrane
  • Level 2- Tumour extends into the papillary but not the reticular dermis
  • Level 3- Tumour cells reach the interface between the papillary and reticular dermis
  • Level 4- tumour cells reaches the reticular dermis
  • Level 5- tumour cells invade the subcutaneous fat

Question 11. Microscopic picture of squamous cell carcinoma
Answer:

Microscopic Picture Of Squamous Cell Carcinoma

Microscopic picture of squamous cell carcinoma is characterised by malignant cells

• These cells show variable degree of differentiation
• Cells invade through the basement membrane into the dermis

Squamous Cell Carcinoma Arrangement:

• Cells are arranged in concentric layers called epithelial pearls
• They contain keratin material in the center of the cell masses
• Cells are separated by lymphocytes

Question 12. Hamartoma
Answer:

Hamartoma

• Hamartoma is a developmental malformation consisting of a tumor-like overgrowth in which tissues of a particular part of the body are arranged haphazardly
• Hamartoma is present since birth
• Growth is co-ordinated
• Hamartoma may regress on its own
• Hamartoma may be multiple- like neurofibroma
• Hamartoma grows along with its surrounding
• Hamartoma is associated with a chromosomal abnormality

Hamartoma Examples

• Vascular hamartoma- haemangioma
• Benign nevus
• Angiomatous syndromes
• Glomus tumour
• Lymphangioma
• Neurofibroma
• Skeletal hamartoma
• Adenoma sebaceous

Thyroglossal cyst short questions

Question 13. Osteoid osteoma
Answer:

Osteoid Osteoma

Osteoid osteoma are benign intraosseous neoplasms

Osteoid Osteoma Clinical Features:

• Occurs among young individuals
• Males are commonly affected
• Develop in long bones
• Causes bony expansion
• Lesion is painful
• Size: 1 cm in diameter
• It don’t grow further

Osteoid Osteoma Treatment:

• Surgical excision
• Curettage

Question 14. Fibrous epulis
Answer:

Fibrous Epulis

• Fibrous epulis is common type of epulis
• Fibrous Epulis arises from the periosteum at the neck of an incisor or premolar tooth
• Fibrous Epulis is a firm nodule at the junction of the gum and tooth
• Polypoid in shape
• Slow growing tumour
• Adjacent teeth are slightly separated and loosen

Fibrous Epulis Complications: Fibrosarcoma

Fibrous Epulis Treatment: Excision

Question 15. Branchial Cyst
Answer:

Branchial Cyst

Branchial cyst is congenital cyst

Branchial Cyst Clinical Features:

• Age- symptoms appears at the age between 20-25 years
• Sex: equal in both sex
• Appears as painless swelling
• Site- upper and lateral part of the neck deep to the upper third of the sternocleidomastoid
• Branchial cyst is round or oval in shape
• Size– 5-10 cm in diameter
• Soft in consistency
• Regional lymph nodes are not palpable

Branchial Cyst Complications:

• Recurrent infections
• Branchial fistula

Branchial Cyst Treatment: Excision

Question 16. Digastric Triangle
Answer:

Digastric Triangle

• Boundaries
• Anteroinferior – anterior belly of digastric
• Posteroinferior – posterior belly of digastric
• Superior or base
  • Base of mandible
  • The line joining angle of the mandible to the mastoid process
  • Roof
    • Skin
    • Superficial fascia containing
  • Platysma
  • Cervical branch of the facial nerve
  • Ascending branch of the transverse cutaneous nerve of neck
    • Deep fascia
  • Floor
    • Anterior – mylohyoid muscle
    • Posterior – Hyoglossus muscle
    • Floor – middle constrictor of the pharynx

Question 17. Types of neck dissections
Answer:

Types Of Neck Dissections

• Neck dissection is a major surgery done to remove lymph nodes that contain cancer
• Types: based on the amount of tissue and lymph nodes removed
  • Radical neck dissection
    • AI the tissues on the side of the neck from the jawbone to the collarbone is removed
    • The muscles, nerve, salivary gland, and major blood vessel in this area are all removed
  • Modified radical neck dissection
• Types Of Neck Dissections is most common type
  • All lymph nodes are removed
  • Less tissue is removed
  • Nerves, blood vessels, or muscles are spared
• Selective neck dissection
  • Fewer lymph nodes are removed
  • Muscles, nerves, and blood vessels are saved

Tumour cyst and neck swelling Q&A

Question 18. Ganglion Cyst
Answer:

Ganglion Cyst

• Ganglion cyst is a cystic swelling occurring in relation to tendon sheath or synovial sheath or joint capsule
• Contains clear gel-like fluid

Ganglion Cyst Common Sites

• Dorsum of wrist
• Flexor aspect of wrist
• Around ankle joint

Ganglion Cyst Clinical Features

• Well-localized, smooth, soft, cystic swelling
• Ganglion cyst is non-tender, mobile and transilluminate
• Often pain, tenderness, and restricted joint movements may be present

Ganglion Cyst Treatment: Excision

Tumour Cyst And Neck Swelling Viva Voce

1. Infection is the most common complication of cyst
2. Multiple cysts is a characteristic feature of sebaceous cyst