BCC

Question 1

In this station pt was going for temp art biopsy
when you noticed this leasion.

Q- Why Biopsy? Q- What’s ttt?

Answer 1

TO CONFIRM / EXCLUDE GCA
- prednisolone 60 mg

Question 2

Q- Why ttt started before biopsy?

Answer 2

to protect vision from Arteritis of Ophth a.

Question 3

Q-What from items of data you want to see in pathology
summary report regard to skin carcinoma?

Answer 3

1- Varify pf tumor type and it’s Dx
2- Tumor diameter
3-Thickness
4-Clearance to the lateral and deep margins

Question 4

Q-what features of tumor may give insight of a risk to a metastatic disease?

Answer 4

Presence or absence of lymph vascular invasion

Question 5

Q-Pt had # NOF 6 months later. What are 3 predisposing fx for that?

Answer 5

Steroids – Female pt – Postmenopausal status (age)

Question 6

Q-From bioch. Serum Ca / Ph will be in Osteoprotic having acute Osteoprotic #?

Answer 6

Both will be normal

Question 7

What’s Myloma/Plasmocytoma?

Answer 7

Neoplastic monoclonal proliferation of plasma cells

Question 8

What this tumor may secreate into serum?
(Myeloma)

Answer 8

Ig or fragmentation of Igs

Question 9

What’s Bence-Jones Ptn?

Answer 9

Light chain ptn identified in urine

Question 10

Apart from Osteoprosis why whis pt may susceptible for #?

Answer 10

Because of bone lysis directly form tumor

Question 11

Wound sepsis – 4 Fx?

Answer 11

DM –
Steroids –
Depressed immunity from plasmocytoma –
Presence of Foreign body prosthesis (DHS)

Question 12

Pt had sudden death after surgery—Two most likely causes of that?

Answer 12

Fat Embolism – Venous thromboembolism

Question 13

Q1: What are your physical findings (BCC)?

Answer 13

Pearly papule with central ulceration, and rolled edge, granulation tissue at base surrounded by telangiectasia

Question 14

Q2: What is your differential diagnosis?

Answer 14

BCC / SCC / Seborrheic keratitis

Question 15

Examiner gives you histology report.
Q3: What will you look for in the report?

Answer 15

Size / Depth / Invasion

Question 16

Q4. If unclear margins, what to do?

Answer 16

Re-Excision with Safety margins using frozen sections / Moh’s Procedure

Question 17

Q5: If there is lymph node involved, what to do?

Answer 17

FNAC

Question 18

Q6: What is frozen section?

Answer 18

FROZEN SECTION;
–the surgeon takes a small piece of fresh tissue or tumour for Analysis, – the pathologist freezes this sample and sections are immediately cut,
– the sections are stained and
– Results reported immediately by phoned back to theatre

Question 19

How do malignant cells reach lymph nodes?

Answer 19

Permeation and embolization

Question 20

Skin graft was done, and the patient had graft failure subsequently.

Q8: What is the possible causes for graft failure?

Q9: Common organisms for wound infection?

Q10: What to do to diagnose it?

Answer 20

8. Infection / Hematoma
9. Staph Aureus
10. Swab – > C&S

Question 21

Q11. What is MRSA?

Answer 21

Methicillin Resistant Staph Aureus

Question 22

Q12: What to do if swab for MRSA is positive?

Answer 22

Isolate pt / Contact Infection control team
INpt; IV Vancomycine and Clindamycin/ Rifampicin. if resistant ( Linzolids)

Question 23

Q13. Who will you involve in management?

Answer 23

My consultant / Plastic Surg / Microbiologist

Question 24

Patient developed axillary LN enlargement. LN biopsy showed large cells with bilobed nucleus with prominent eosinophilic inclusion like nuclei resembling an owl’s eye appearance.

Q14: What is your diagnosis now?

Answer 24

Hodg. Lymphoma

Question 25

Q15. Define carcinoma?

Answer 25

Malignant epithelial neoplasm

Question 26

Q16: Features of malignant cells?

Answer 26

Invasion Increase in mitotic rate Anaplasia -- > Pleomorphism / Hyperchromatism / Loss of differentiation / Loss of mitotic features / loss of architecture / high Cyt-Nuc ration