absolute nonsense

Photo

Wed, 19 Jun 2013 01:38:18 +0800

boring revision things with apologies to people on the mobile app because I don’t think it...

Wed, 19 Jun 2013 00:39:07 +0800

boring revision things

with apologies to people on the mobile app because I don’t think it deals with read mores

1. Thyroid – Surgical anatomy & pathophysiology
Normal gland weighs 20 to 25g. Consists of two lobes (right and left) with right larger and higher than left. Gland lies on the front and side of trachea and larynx (C5-7) and the lobes are connected by isthmus (2^nd to 4^th tracheal rings). Gland is invested by pretracheal fascia which binds it to larynx, cricoid cartilage and upper tracheal (ligament of Berry) – because of this ligament the thyroid elevates with larynx on swallowing.

Lobule is the functional unit – supplied by a single arteriole and consisting of 24 to 40 follicles lined with cuboid epithelium. Follicle contains colloid in which thyroglobulin is stored.

Arterial supply from superior thyroid artery (from external carotid artery), inferior thyroid artery (from thyrocervical trunk), and sometimes thyroid ima artery (from aorta/brachiocephalic artery). Venous drainage is to superior thyroid vein (to internal jugular vein), middle thyroid vein (to internal jugular vein), and inferior thyroid vein (to brachiocephalic vein). Lymphatic drainage is mainly laterally into deep cervical lymph nodes, and also into prelaryngeal, pre-isthmic and pretracheal lymph nodes. Nerve supply is by parasympathetic input from recurrent and superior laryngeal nerves (branches of laryngeal nerve, from vagus nerve).

Gland produces thyroid hormones in the forms of T3 and T4, which are bound to thyroglobulin within the colloid. Synthesis of the hormones involve trapping of inorganic iodide from the blood, oxidation of iodide to iodine, binding of iodine with tyrosine to form iodotyrosines, and coupling of monoiodotyrosines and di-iodotyrosines to form T3 and T4. When hormones are required, thyroglobulin is broken down and T3 and T4 are liberated into the blood, where they are bound by serum proteins (albumin, thyroxine-binding globulin and thyroxine-binding prealbumin.) Synthesis and release of thyroid hormones are controlled by thyroid-stimulating hormone (TSH) from the anterior pituitary which is regulated by level of circulating thyroid hormones (negative feedback). In hyperthydoidism, TSH production is suppressed. Regulation of TSH secretion also results from action of thyrotrophin-releasing hormone (TRH) from hypothalamus.

Simple (euthyroid) goitre may develop as a result of stimulation of the thyroid gland by TSH, either as a result of inappropriate secretion from a microadenoma in the anterior pituitary (rare) or in response to a chronically low level of circulating thyroid hormones. Most important factor in endemic goitre is dietary deficiency of iodine.

Toxic goitres lead to overproduction of thyroid hormones, leading to hyperthyroidism (see: symptoms of thyrotoxicosis). Diffuse toxic goitre is commonly caused by Graves’ disease, an autoimmune disease in which antibodies are produced which stimulate the thyroid to secrete excessive quantities of thyoird hormones (primary thyrotoxicosis). A toxic nodule is a solitary overactive nodule which may be part of a generalised nodularity or a true toxic adenoma.

2. Salivary gland (submandibular & parotid) – stones and tumour
Stones are the most common cause of obstruction within the submandibular gland and its associated duct system (sialothiasis). 80% of all salivary stones occur in the submandibular glands because their secretions are highly viscous. 80% of submandibular stones are radio-opaque (easily seen on x-ray). Patients usually present with acute painful swelling in the submandibular region, precipitated by eating. Swelling occurs rapidly and often spontaneously resolves in 1-2 hours after meal is completed. This occurs when the stone causes complete obstruction, usually at the opening of the submandibular duct. More frequently, the stone causes only partial obstruction when it lies within the hilum of the gland or within the duct in the floor of the mouth. In such circumstances, symptoms are more infrequent, producing minimal discomfort and swelling (not confined to mealtimes). Clinical examination reveals enlarged firm submandibular gland, tender on bimanual examination. Pus may be visible in consequence of chronic bacterial infection. Management depends on whether the stone is located distal or proximal to the point at which the submandibular duct crosses the lingual nerve. If distal, the stone can be removed by incising longitudinally over the duct. Once removed, the wall of the duct should be left open to promote free drainage to salica. Suturing the duct will lead to stricture and obstruction symptoms. When the stone is proximal to the lingual nerve, treatment is by simultaneous submandibular gland excision and removal of the stone and ligation of the submandibular duct under direct vision.

Tumours of the submandibular gland are uncommon and usually slow-growing, painless swelling within the submandibular triangle. 50% of submandibular gland tumours are benign. On clinical examination, the swelling usually cannot be differentiated from submandibular lymphadenopathy. Clinical features include facial nerve weakness, rapid enlargement(???), induration/ulceration of overlying skin, and/or cervical node enlargemnt. CT and MRI scanning are helpful for imaging the tumours. Fine-needle aspiration biopsy can be done but rarely alters surgical management. Management of the tumours is by surgical excision. If small and encased by the gland, straightforward intracapsular submandibular gland excision is appropriate. If benign tumours are large and beyond the gland, it is best served by suprahyoid neck dissection – full clearance of submandibular triangle, including dissection of periosteum along lower border and inner aspect of mandible, and delivery of gland and tumour with cuff of normal tissue. In cases of overt malignancy, modified neck dissection or radical neck dissection is appropriate.

Sialolithiasis is less common in parotid gland (20%) than in submandibular gland (80%). Parotid duct stones are usually radiolucent and rarely visible on plain radiography. Parotid gland sialography is usually required to identify the stone. A stone located in the collecting duct or within the gland requires surgical removal via parotidectomy approach. The stone is identified by palpation and, once exposed, the surrounding parotid duct is incised longitudinally to release the stone.

Parotid gland is the most common site for salivary tumours. Most arise in the superficial lobe and present as slow-growing, painless swellings below the ear, in front of the ear, or in the upper aspect of the neck. Less commonly, tumours may arise from the accessory lobe and present as persistent swellings within the cheek. Rarely, tumours may arise from the deep lobe and present as parapharyngeal masses. Symptoms include difficulty in swallowing and snoring. 80-90% of tumours in the parotid gland are benign, most commonly being pleomorphic adenoma. Malignant tumours of the gland can be divided into low-grade (clinically indistinguishable from benign) and high-grade (usuallly rapid-growing, painless swelling, either discrete mass with infiltration into overlying skin or diffuse but hard swelling of the gland with no discrete mass. Cervical lymph node metastases may be present.) CT and MRI are the most useful imaging techniques. Fine-needle aspiration biopsy may aid in obtaining a preoperative diagnosis. Management is most commonly by superficial parotidectomy or in the case of high-grade malignant tumour (eg. Squamous cell carcinoma), radical parotidectomy (removal of all parotid gland tissue and elective sectioning of facial nerve, along with removal of masseter muscle and simultaneous neck dissection.)

3. Breast – fibroadenoma, fibroadenosis, carcinoma, conservative breast surgery
Fibroadenoma usually arise in younger ages (15-25) from hyperplasia of a single lobule and usually grow up to 2-3cm in size. They are surrounded by a well-marked connective tissue capsule. They consist of: fibrous component (fibrosis) and abnormal multiplication of ducts and acini (adenoma). Clinical presentation is a highly mobile (breast mouse), well-defined, painless, smooth and firm mass with no axillary lymph node involvement. They do not require excision unless associated with suspicious cytology, is large in size, or when the patient desires its removal.

tbc

mlysza: late sketchin’ murder husbands make up your own story

Tue, 18 Jun 2013 20:18:00 +0800

mlysza:

late sketchin’ murder husbands

make up your own story

princessgarynuman: fuck

Tue, 18 Jun 2013 14:33:21 +0800

princessgarynuman:

fuck

Photo

Tue, 18 Jun 2013 14:00:21 +0800

mlysza: mlysza: Hannibal Stickers and Buttons! All stickers...

Tue, 18 Jun 2013 13:58:46 +0800

mlysza:

mlysza:

Hannibal Stickers and Buttons!

All stickers are 99 cents or under and buttons $2.25 each!

no blazers were harmed in the photoshoot.

back in stock!

lostconner: play chess

Tue, 18 Jun 2013 03:50:09 +0800

lostconner:

play chess

TAG.YOU’RE IT. The rules are to state 10 random facts about yourself. Then, go to your 10 favourite blogs and tell them they’re it. ;)

Tue, 18 Jun 2013 01:36:16 +0800

I’m 21 years old and I have no idea what I’m doing with my life
I have scoliosis and it annoys me sometimes
both my brothers have names beginning with the letter Q
I once had a full-time job as a bookstore cashier for 2 months (I miss it sometimes??)
hey look I used to draw like this (old art is so embarrassing)
I’ve had to wear glasses since I was 9
I really like kitkats hmm hmmmm
I have a 6-week hospital elective thing next year and I’d really like to spend the time working in a morgue :T
speaking of which I’m supposed to be cramming for surgery and ophthalmology right now SOBS
I have a bad attention span bye

I’m too lazy to tag anyone lol but thank you lovely anon!!

kiranwearsscienceblues: thedoctorwillsaveme: pigfarts-is-on-vul...

Tue, 18 Jun 2013 01:10:54 +0800

Hooman, wut iz dis nonsense?

R dey gay??

Stahp! Who iz dis?

I tink I'm in luv.

Dis got boring.

kiranwearsscienceblues:

thedoctorwillsaveme:

pigfarts-is-on-vulcan:

I forgot about this, but back during Christmas Break, I put Star Trek in front of my cat to see what he would do. To my surprise, he actually did watch it. However, he only seemed mildly entertained - that is, until Scotty started talking. Then my cat actually paused the episode and stared at him. He just stared at Scotty and wouldn’t let me press play for, like, four or five minutes. After that, he watched for a while, but gradually lost interest and started dozing, only looking up when he heard Scotty’s voice.

Can someone please explain to me why my cat loves Scotty so much? Was James Doohan secretly some sort of magical cat whisperer? What is this?

oh

my

god

i think your cat has a crush

jensenshackled: adorablelabrat replied to your post: suggestions for doodles? because i have too...

Tue, 18 Jun 2013 00:02:55 +0800

jensenshackled:

adorablelabrat replied to your post: suggestions for doodles? because i have too many…

kirk/spock?

I got carried away into sketch territory because the doodle just looked terrible. FFFf. ANYway, based off this image and the fact that most people (including myself) thought they were ZQ and Chris Fine.

Favourite scenes in Merlin // the almost-hug (S2, Ep.6)

Mon, 17 Jun 2013 15:58:50 +0800

Favourite scenes in Merlin // the almost-hug (S2, Ep.6)

Damn it, Jim! 10 Jim/Bones moments for camille

Mon, 17 Jun 2013 15:54:00 +0800

Damn it, Jim!

10 Jim/Bones moments for camille

Photo

Sun, 16 Jun 2013 23:49:09 +0800

-“What is this? “-“The battlefield.”-“Based on what? “-“The...

Sun, 16 Jun 2013 23:37:40 +0800

-“What is this? “
-“The battlefield.”
-“Based on what? “
-“The briefing room board at the police station.”
-“You did this from memory?”
-“Yes.”
-“You said you saw it for two minutes.”
-“Right, two whole minutes.”
-“You got problems.”

I can never spell chikungunya correctly who named this disease

Sun, 16 Jun 2013 23:36:02 +0800

I can never spell chikungunya correctly

who named this disease

thefalloutkid: “I can’t remember most of the things I’ve done....

Sun, 16 Jun 2013 22:20:29 +0800

thefalloutkid:

“I can’t remember most of the things I’ve done. but the things I’ve learned, I can’t forget” —Gabe Saporta

8. Write about the etiology and treatment of premature ejaculation. (2+3 Marks) I need to know this...

Sun, 16 Jun 2013 17:12:51 +0800

8. Write about the etiology and treatment of premature ejaculation. (2+3 Marks)

I need to know this for psychiatry??? oh mygod

trekgate: Star Trek Parallels

Sun, 16 Jun 2013 17:05:30 +0800

trekgate:

Star Trek Parallels

asix-oud: For Spicedpiano Happy Belated Birthday Dearest

Sun, 16 Jun 2013 09:52:27 +0800

asix-oud:

For Spicedpiano

Happy Belated Birthday Dearest

housemate has taken my car again because I was too nice to say no (at least she asked for permission...

Sat, 15 Jun 2013 23:57:07 +0800

housemate has taken my car again because I was too nice to say no

(at least she asked for permission this time?)