Tag: classification

Classification of receptors-Based on adaptation


Classification of receptors-Based on adaptation


The receptors of cells are divided into the following based on adaptation:

1. Rapidly Adapting Receptors (RAR’s)

o Adapts quickly to stimulus

o Ex: Corpuscles – Meissner’s & Pacinian Corpuscles

2. Slowly Adapting Receptors (SAR’s)

o Adapts slowly to stimulus

o Ex: Merkel’s Cells, Ruffini’s endings, Free nerve endings.

Classification of hormones-Based on chemical structure


Classification of hormones-Based on chemical structure


The hormones are classified into the following based on chemical structure

1. Amino Acid Derivative

• SINGLE amino acid

• TYROSINE = (T3, T4) & Catecholamines (Epinephrine, Norepinephrine, Dopamine)

• TRYPTOPHAN -5-HT (Serotonin) & Melatonin

• ARGININE (Nitric Oxide)

2. Protein / Peptide

 MULTIPLE amino acid

 Acts on “EXTRACELLULAR RECEPTORS

 INSULIN (51 amino acids), PARATHORMONE (84 amino acids)

3. Cholesterol derivatives

• Crosses cell Membrane

• Acts on “INTRACELLULAR RECEPTORS”

• STEROID HORMONES (Aldosterone, Cortisol, Estrogen, Progesterone, Testosterone)

4. Vitamins

 VITAMIN A & D

 Acts on “INTRACELLULAR RECEPTORS

Psychiatric Disease-Classification


Psychiatric Disease-Classification


Psychiatric diseases are classified as following:

ICD – 10 [International Classification of Disease, 10th Edition]

  • Published by WHO and provides classification for all medical disease
  • Psychiatric Ds has been classified in Chapter V (F)

DSM-5 [Diagnostic and statistical manual of mental disorders]

  • Published by American Psychiatric disorders, 5th Edition in 2013

Organic Vs Functional Mental Disorders

Psychosis Vs Neuroses [Insight or awareness of illness]

Buerger Disease

BUERGER DISEASE


BUERGER’S DISEASE (THROMBOANGITIS OBLITERANS)

  • Buerger’s disease is a non- atherosclerotic, progressive, segmental, occlusive inflammatory disorder involving small and medium sized arteries with cell mediated sensitivity to Type I and Type II collage in upper and lower extremities.
  • Inflammatory process does involve adjacent nerves and veins.
  • Triad of thromboangitis obliterans- occlusion of small and medium sized vessels, superficial thrombophelbitis, Raynaud’s phenomenon.

ETIOLOGY-

  • Mainly seen in smokers and tobacco users.
  • Common in Jewish people
  • Hormonal influence
  • Familial nature
  • Poor hygiene

PATHOLOGY-

  • Smoke → vasospasm & hyperplasia initma → thrombus & obliteration medium sized vessels → Panarteritis → Artery, vein & nerve are involved  → Blockage leads to collateral open up → Blood supply to ishchaemic areas → Compensatory peripheral vascular disease
  • Microabscesses, giant cells are found.

CLASSIFICATION-

  • Type I- upper limb TAO (rare)
  • Type II- involving legs & infrapopliteal
  • Type III- femoropopliteal
  • Type IV- aortoiliofemoral
  • Type V- generalised

CLINICAL FEATURES-

  • Common in male smokers between 20- 40 years
  • Intermittent claudication in foot & calf progressing to rest pain, ulceration & gangrene.
  • Absence of atheromas.
  • Small & medium sized vessels such as dorsalis, pedis, posterior tibial, popliteal are commonly involved.

INVESTIGATIONS-

1. Arterial Doppler & Duplex scan

2. Transformed retrograde angiogram-

  • Shows blockage
  • Cork screw appearance of the vessel
  • Inverted tree/ spider leg collaterals
  • Severe vasospasm causing rippled artery

3. Transbranchial angiogram- if femorals are not felt then transbranchial angiogram is done.

4. USG abdomen- shows abdominal aorta for block 

TREATMENT-

  • Stop smoking
  • Vasodilators- nifedipine, xanthinol nicotinate
  • Antithrombin activity- low dose of aspirin
  • Analgesics
  • Lumbar sympathectomy- for rest pain and ulcerations
  • Omentoplasty, profundoplasty
  • Amputation in gangrene

Exam Important

PATHOLOGY-

  • Smoke → vasospasm & hyperplasia initma → thrombus & obliteration medium sized vessels → Panarteritis → Artery, vein & nerve are involved  → Blockage leads to collateral open up → Blood supply to ishchaemic areas → Compensatory peripheral vascular disease
  • Microabscesses, giant cells are found.

ETIOLOGY-

  • Mainly seen in smokers and tobacco users.
  • Common in Jewish people
  • Hormonal influence
  • Familial nature
  • Poor hygiene

CLINICAL FEATURES-

  • Common in male smokers between 20- 40 years
  • Intermittent claudication in foot & calf progressing to rest pain, ulceration & gangrene.
  • Absence of atheromas.
  • Small & medium sized vessels such as dorsalis, pedis, posterior tibial, popliteal are commonly involved.
Don’t Forget to Solve all the previous Year Question asked on BUERGER DISEASE

Module Below Start Quiz

Buerger Disease

Buerger Disease

Q. 1

All of the following are the clinical feature of thromboangitis obliterans except :

 A Raynaud’s phenomenon

 B

Claudication of extremeties

 C

Absence of popliteal pulse

 D

Migratory superficial thrombophlabitis

Q. 1

All of the following are the clinical feature of thromboangitis obliterans except :

 A

Raynaud’s phenomenon

 B

Claudication of extremeties

 C

Absence of popliteal pulse

 D

Migratory superficial thrombophlabitis

Ans. C

Explanation:

Ans. is ‘c’ i.e., Absence of popliteal pulse


Q. 2

Commonest site of thromboangitis obliterans is 

 A

Femoral artery

 B

Popiteal artery

 C

iliac artery

 D

None

Q. 2

Commonest site of thromboangitis obliterans is 

 A

Femoral artery

 B

Popiteal artery

 C

iliac artery

 D

None

Ans. D

Explanation:

Ans. is ‘None’ 
Distal circulation is involved in Buerger’s disease, usually distal to popliteal and brachial artery.


Q. 3

Thromboangitis obliterans is associated with

 A

HLA B27

 B

HLA – DR4

 C

HLA – B5

 D

HLA – DR2

Q. 3

Thromboangitis obliterans is associated with

 A

HLA B27

 B

HLA – DR4

 C

HLA – B5

 D

HLA – DR2

Ans. C

Explanation:

Ans. is ‘c’ i.e., HLA – B5 

Thromboangitis obliterans (Berger disease)

  • Thrombangitis obliterans is a distinctive disease that is characterized by segmental, thrombosing acute and chronic inflammation of medium sized and small sized arteries, and sometimes secondarily extending to veins and nerves.
  • Thromboangitis obliterans occurs almost exclusively among heavy-cigarrete-smoking persons.
  • It is more common in men but incidence is increasing in women because of increasing smoking habit in women. o Buerger disease is associated with HLA B-5 and HLA-A9.
  • In thrombongitis obliterans there is acute and chronic segmental inflammation of vessels with accompanied thrombosis in the lumen.
  • Typically, the thrombus contains microabscesses with a central focus of neutrophils surrounded by gran u lomatous inflammation.
  • Later, the inflammatory process extends into contiguous veins and nerves and in time all three structures (arteries, veins and nerves) become encased in fibrous tissue, a characterstic that is very rare with other form of vasculitis.
  • Clinical manifestations
  • Thrombangitis obliterans affects vessels of upper and lower extremities.
  • Symptoms are due to vascular insufficiency, i.e. Ischemia of toes, feet and fingers that can lead to ulcer and frank gangrene.
  • Due to neural involvement, there may be severe pain, even at rest.

Q. 4 True about Buerger disease

 A

Affects larger artery only

 B

Younger males are more commonly affected

 C

Phlebitis migrans is characteristic

 D

Cold intolerance

Q. 4

True about Buerger disease

 A

Affects larger artery only

 B

Younger males are more commonly affected

 C

Phlebitis migrans is characteristic

 D

Cold intolerance

Ans. B:C:E

Explanation:

Answer- B,Younger males are more commonly affected C,Phlebitis migrans is characteristic E,Veins may involved
Also called as Thromboangiitis Obliterans
It is a inflammatory occlusive vascular disorder involving small and medium sized arteries and veins in upper and lower extremities.
It involves tibial and radial arteries and sometimes secondarily extending to veins and nerves of extremities.
The clinical features of thromboangiitis obliterans includes a triad of claudication of the affected extremity, Raynaud’s phenomenon, and migratory superficial vein thrombophlebitis.

Quiz In Between



Malignant Melanoma

MALIGNANT MELANOMA


MALIGNANT MELANOMA (MELANOCARCINOMA)

  • Malignant melanoma is a malignant tumour arising from epidermal melanocyte derived from neural crest.
  • Most aggressive cutaneous malignant tumour.
  • DOPA REACTION-

SITES FOR MALIGNANT MELANOMA-

  • Head & neck
  • Lower extremity
  • Trunk
  • Upper limb
  • Choroid of the eye
  • Genetalia
  • MC site for men- front or back of the trunk
  • MC site for female- leg
  • More common in whites than black

 ETIOLOGY-

  • UV rays
  • Albinism
  • Xeroderma pigmentosa- AR (Chromosome 9q)
  • Genetic factors-

i) Tumour suppressor gene mutation 9q 21

ii) Deletion or rearrangement of chromosome 10 & 8p

iii) Dysplastic naevus syndrome

  • Pre- existing mole
  • Immunocompromised- HIV, Hodgkin’s disease

CLASSIFICATION-

I) Breslow classification-

  • According to maximum thickness at the centre of the lesion-

a) Stage I- thickness less than 0. 75 mm

b) Stage II- 0.75 mm to 1.5 mm

c) Stage III- 1.5 mm to 3.0 mm

d) Stage IV- more than 3 mm

II) Clark’s Classification-

  • According to the basis of the depth of the invasion

a) Stage I- Melanoma restricting to epidermis and appendages

b) Stage II- invading papillary dermis without filling it

c) Stage III- reach interface of papillary and reticular dermis

d) Stage IV- invading reticular dermis

e) Stage V- invading subcutaneous tissue

III) According to clinical types-

a) Lentigo malignant melanoma-

  • Benign
  • MC- face

b) Superficial spreading-

  • MC type
  • MC site- torso

c) Nodular-

  • Most malignant
  • MC site- head, neck, trunk

d) Acral lentiginous-

  • Least common with worst prognosis
  • MC site- sole, mucosa

CLINICAL FEATURES-

  • Can spread from mother to foetus
  • Asymmetry, border irregularity, color variation and diameter >6mm (ABCD)
  • Microsatellites (0.05mm)- separated from main body tumour by normal dermal collagen or subcutaneous fat
  • Macrosatellites associated with increase risk of regional LN
  • MC site of systemic metastasis- liver
  • Choroidal melanoma is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma in the body and may produce  exudative retinal detachment.
  • In melanoma cells, numbers of mutations and/or dysregulated expression of B-Rof N-Ras, CDK2A, MDM2, PTEN, p53 have been recognized”

SPREAD-

  • Through lymphatics (MC)
  • In- transit or satellite nodules
  • Through blood 

INVESTIGATIONS-

  • Chest X-ray- cannonball secondaries
  • USG abdomen- secondary in liver
  • FNAC- detects spreading & stages of the disease
  • Serum LDH levels- indicate metastatic disease
  • HHB- 4S- premelanosomal protein is specific immunohistochemical marker for melanoma
  • Full thickness excisional biopsy- confirms MM

TREATMENT-

  • Surgical excision with sentinel LN biopsy
  • Block dissection to be done when sentinel node is involved

Exam Important

According to clinical types-

a) Lentigo malignant melanoma-

  • Benign
  • MC- face

b) Superficial spreading-

  • MC type
  • MC site- torso

c) Nodular-

  • Most malignant
  • MC site- head, neck, trunk

d) Acral lentiginous-

  • Least common with worst prognosis
  • MC site- sole

CLINICAL FEATURES-

  • Can spread from mother to foetus
  • Asymmetry, border irregularity, color variation and diameter >6mm (ABCD)
  • Microsatellites (0.05mm)- separated from main body tumour by normal dermal collagen or subcutaneous fat
  • Macrosatellites associated with increase risk of regional LN
  • MC site of systemic metastasis- liver
  • Choroidal melanoma is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma in the body and may produce  exudative retinal detachment.
  • In melanoma cells, numbers of mutations and/or dysregulated expression of B-Rof N-Ras, CDK2A, MDM2, PTEN, p53 have been recognized”

SPREAD-

  • Through lymphatics (MC)
  • In- transit or satellite nodules
  • Through blood

INVESTIGATIONS-

  • Chest X-ray- cannonball secondaries
  • USG abdomen- secondary in liver
  • FNAC- detects spreading & stages of the disease
  • Serum LDH levels- indicate metastatic disease
  • HHB- 4S- premelanosomal protein is specific immunohistochemical marker for melanoma
  • Full thickness excisional biopsy- confirms MM

TREATMENT-

  • Surgical excision with sentinel LN biopsy
  • Block dissection to be done when sentinel node is involved
Don’t Forget to Solve all the previous Year Question asked on MALIGNANT MELANOMA

Module Below Start Quiz

Malignant Melanoma

Malignant melanoma

Q. 1 Skin biopsy of a patient shows evidence of malignant melanoma. Which is the common type of malignant melanoma?

 A

Superficial spreading

 B

Lentigo maligna melanoma

 C

Nodular

 D

Acral lentiginous

Q. 1

Skin biopsy of a patient shows evidence of malignant melanoma. Which is the common type of malignant melanoma?

 A

Superficial spreading

 B

Lentigo maligna melanoma

 C

Nodular

 D

Acral lentiginous

Ans. A

Explanation:

Superficial spreading melanoma comprises approximately 60% to 70% of melanomas and represents the most common melanoma subtype.
They often arise in a preexisting nevus and typically develop as a spreading pigmented plaque with irregular borders and variation in color and surface contour.
They often exhibit the classic clinical features of melanoma.
Areas of regression may result in pink to white areas within the black or brown tumor.
They may progress to a vertical growth phase faster than lentigo maligna.

 
Ref: Ludgate M.W., Wang T.S. (2009). Chapter 100. Skin Cancer. In J.B. Halter, J.G. Ouslander, M.E. Tinetti, S. Studenski, K.P. High, S. Asthana (Eds), Hazzard’s Geriatric Medicine and Gerontology, 6e.

 


Q. 2

Marker of malignant melanoma is?

 A

HMB 45               

 B

S-100

 C

Synaptophysin

 D

Both A and B

Q. 2

Marker of malignant melanoma is?

 A

HMB 45               

 B

S-100

 C

Synaptophysin

 D

Both A and B

Ans. D

Explanation:

Ans. is ‘a’ i.e., HMB 45 & ‘b’ i.e., S-100


Q. 3

Marker for malignant melanoma is –

 A

Cytokeratin

 B

MBN- 45

 C

Alpha FP

 D

S 100

Q. 3

Marker for malignant melanoma is –

 A

Cytokeratin

 B

MBN- 45

 C

Alpha FP

 D

S 100

Ans. D

Explanation:

Ans. is ‘d i.e., S-100

Tumor markers for malignant melanoma —4 S – 100, TA – 90.

These two markers can be used to look for the spread of melanoma.

Quiz In Between


Q. 4 Most common malignant melanoma is

 A

Superficial spreading

 B

Lentigo maligna melanoma

 C

Nodular

 D

Acral lentiginous

Q. 4

Most common malignant melanoma is

 A

Superficial spreading

 B

Lentigo maligna melanoma

 C

Nodular

 D

Acral lentiginous

Ans. A

Explanation:

Ans. is ‘a’ i.e. Superficial spreading type 

  • There are 4 common type of melanoma (these are in order of decreasing frequency)

a)      Superficial spreading type (most common)

b)         Nodular

c)         Lentigo maligna

d)         Acral lentiginous (least common)

  • Also remember:
  • MC type in dark skinned people —> Acral lentiginous type

Q. 5 The most malignant form of malignant melanoma is ‑

 A

Nodular

 B

Hutchinson’s melanotic freckle

 C

Acral lentiginous type

 D

Superficial spreading

Q. 5

The most malignant form of malignant melanoma is ‑

 A

Nodular

 B

Hutchinson’s melanotic freckle

 C

Acral lentiginous type

 D

Superficial spreading

Ans. A

Explanation:

Ans. is ‘a’ i.e. Nodular

Schwartz 9/e p415 writes that- “In general, there is no significant difference between different histologic tumor types in terms of prognosis, when matched for tumor thickness, gender, age, or other. Nodular melanomas have the same prognosis as superficial spreading types when lesions are matched for depth of invasion. Lentigo maligna types, however, have a better prognosis even after correcting for thickness, and acral lentiginous lesions have a worse prognosis.”


Q. 6 All of the following statements about malignant melanoma are true except:

 A

prognosis is better in female than in male

 B

Acral lentiginous melanoma carries a good prognosis

 C

Stage II A shows satelite deposits

 D

A and b

Q. 6

All of the following statements about malignant melanoma are true except:

 A

prognosis is better in female than in male

 B

Acral lentiginous melanoma carries a good prognosis

 C

Stage II A shows satelite deposits

 D

A and b

Ans. D

Explanation:

Ans. is ‘b’ i.e. acral lentiginous melanoma carries a good prognosis & ‘c’ i.e. stage II A shows satellite deposits

Acral lentignous melanoma has the worst prognosis

  • Satellite deposits are foci of tumor adajent but separate from the primary melanoma also k/a in-transit metastasis. In the original staging system, satellite deposits or lesions were classified as stage II ds.

Conventional staging of melanoma

  • Stage I Primary tumor
  • Stage II Presence of satellites or regional lymph nodes
  • Stage III –> Spread beyond regional lymph nodes
  • But according to latest AJCC classification (2002) presence of satellite lesions is classified as stage III.

More facts about melanoma

  • Most of the melanomas develop in benign nevus.
  • ABCD of melanoma – Lesions that are suspicions of melanoma can be identified by their clinical characteristic often referred to as ABCD.
  • Some books also have an ‘E’. E stands for ‘evolution of lesion’ or ‘elevation’.
  • The treatment is primary surgical
  • Diagnosis is confirmed by biopsy

Quiz In Between


Q. 7 True about malignant melanoma:

 A

Lymphatic spread

 B

Lymph node biopsy is done always

 C

Block dissection to be done when sentinel node is involved

 D

All

Q. 7

True about malignant melanoma:

 A

Lymphatic spread

 B

Lymph node biopsy is done always

 C

Block dissection to be done when sentinel node is involved

 D

All

Ans. D

Explanation:

Ans. is all 

Management of Malignant Melanoma

  • Wide local excision of the primary tumor is the management of choice. The recommended margin of resection depends on the thickness of the tumor.

Recommended Margins for Surgical Resection of Primary Melanoma

Tumor thickness

Margin Radius

< 1.0 mm

1.0 cm

 

1-4 mm

2.0 cm

 

>4 mm

3.0 cm

(Schwartz)

 Sabiston (18/e p773) and Harrison (I7/e p547) differ somewhat from Schwartz. According to Sabiston‑

Recommended Margins for Surgical Resection of Primary Melanoma

Tumor thickness

Margin Radius

In situ

0.5 cm

 

< 1.0 mm

1.0 cm

 

1-2 mm

1.0 – 2.0 cm

 

> 2.0 mm

> 2.0 cm

(Sabiston)

 According to Harrison —

Recommended Margins for Surgical Resection of Primary Melanom:

Tumor thickness

Margin Radius

 

In situ

0.5 cm

 

< 1.0 mm

1.0 cm

 

> 1.0 mm

2.0 cm

(Harrison)

 

  • Sentinel lymph node biopsy is done for tumors more than 1 mm thick. If biopsy is positive complete lymph node dissection is done.

Also know

Treatment of subungual melanoma — amputation of the distal digit to provide a 1 cm margin from the tumor. For fingers, amputation commonly involves only the distal phalanx; ray amputation is not required. (Sabiston 18/e p775) About option ‘d’ i.e. Microsatellitism

[Ref: http://www.moffitt.org/CCIRoot/v12n4/pdf/223.pdf http://www.pubmedcentranih.gov/articlerenderfcgi?artid=1250595 Ann Surg. 1984 December; 200(6): 759-763. http://archderm.ama-assn.org/cgi/reprint/141/6/739.pdf%5D

  • Microsatellites are discrete tumor nests greater than 0.05 mm in diameter that are separated from the main body of the tumor by normal reticular dermal collagen or subcutaneous fat.
  • Microsatellites constitute a risk factor for local recurrence. Melanomas with microsatellites are associated with a greater frequency of local clinical metastasis than those without.
  • Microsatellites are different from Satellite lesions. Satellite lesions are macroscopic finding whereas microsatellites are histopathological findings. Satellite lesions are foci of tumor adajacent to but separate from the primary melanoma. They are also called in-transit metastases, implying that secondary melanomas have grown in the skin on their way to spreading to local lymph nodes.

Q. 8

All are true statement about malignant melanoma except –

 A Clark’s classification used for prognosis

 B

Women have better prognosis

 C

Acral lentigenous have better prognosis

 D

Limb perfusion is used for local treatment

Q. 8

All are true statement about malignant melanoma except –

 A

Clark’s classification used for prognosis

 B

Women have better prognosis

 C

Acral lentigenous have better prognosis

 D

Limb perfusion is used for local treatment

Ans. C

Explanation:

Ans. is ‘c’ i.e., Acral lentigenous have better prognosis 


Q. 9

Prognosis of malignant melanoma depends on

 A

Grade of tumor

 B

Spread of tumor

 C

Depth of invasion

 D

Metastasis

Q. 9

Prognosis of malignant melanoma depends on

 A

Grade of tumor

 B

Spread of tumor

 C

Depth of invasion

 D

Metastasis

Ans. C

Explanation:

Ans. is ‘c’ i.e., Depth of invasion 

Quiz In Between


Q. 10

Least malignant melanoma is

 A

 Lentigo malignant melanoma

 B

Superifcial spreading

 C

Nodular

 D

Amelanotic

Q. 10

Least malignant melanoma is

 A

 Lentigo malignant melanoma

 B

Superifcial spreading

 C

Nodular

 D

Amelanotic

Ans. A

Explanation:

Ans. is ‘a’ i.e., Lentigo maligna 


Q. 11

Malignant melanoma of the choroid will produce:
September 2012

 A

Retinal dialysis

 B

Exudative retinal detachment

 C

Traction retinal detachment

 D

Rhegmatogenous retinal detachment

Q. 11

Malignant melanoma of the choroid will produce:
September 2012

 A

Retinal dialysis

 B

Exudative retinal detachment

 C

Traction retinal detachment

 D

Rhegmatogenous retinal detachment

Ans. B

Explanation:

Ans. B i.e. Exudative retinal detachment


Q. 12

Prognosis of malignant melanoma depends upon:
March 2011, March 2013

 A

Grade of tumour

 B

Age of the patient

 C

Invasion of nearby nodes

 D

Site of lesion

Q. 12

Prognosis of malignant melanoma depends upon:
March 2011, March 2013

 A

Grade of tumour

 B

Age of the patient

 C

Invasion of nearby nodes

 D

Site of lesion

Ans. C

Explanation:

Ans. C: Invasion of nearby nodes

The presence of lymph node metastases is the single most important prognostic index in melanoma, outweighing both tumour and host factors

Melanoma:

  • May be familial
  • Originate from melanocytes
  • Cutaneous melanoma arises from epidermal melanocytes
  • Spread by the lymphatic channels or the bloodstream
  • Lentigo maligna (least common) involves face commonly
  • Superficial spreading is the MC type
  • Nodular melanoma is the most malignant type

Quiz In Between


Q. 13

Most common site of distant metastasis inintraorbital malignant melanoma is‑

 A Brain

 B

Lung

 C

Liver

 D

Lymph nodes

Q. 13

Most common site of distant metastasis inintraorbital malignant melanoma is‑

 A

Brain

 B

Lung

 C

Liver

 D

Lymph nodes

Ans. C

Explanation:

Ans. is `c i.e., Liver

  • Malignant melanoma mostly arise in uvea and uveal malignant melanoma is the most common primary intraocular tumor.
  • The most common site for distant metastasis of uveal melanoma is liver.
  • The liver is the most common site of metastasis of uveal melanoma”                   — Clinical oncology
  • The liver is the most common site of metastatis from primary ocular melanoma”   — Smith & Nesi’s

Uveal melanoma

  • Uveal melanoma is the most common primary intraocular tumor in adults.
  • Most of the (85%) uveal melanomas arise in the choroid.
  • So, choroidal melanoma is the most common primary intraocular tumor in adults.
  • Tumor arises from dendritic melanocytes (neural crest, neuroectodermal origin).
  • Histologically choroidal melanoma can be divided into: –

Spindle cell melanomas : – These melanomas contain predominantly spindle cells.

  • These melanomas are further subdivided into Spindle A or Spindle B depending upon the type of cells.

Epitheloid cell melanomas : – Contain epitheloid like cells.

Mixed cell melanomas : – Contain both spindle cells and epitheloid cells.

  • Choroidal melanoma presents as a sessile or dome shaped mass located deep to the sensory retina.
  • A secondary non-rheugmatogenous retinal detachment frequently occurs.

Involvement of vortex vein by tumor results in glaucoma.

  • With continued growth, a choroidal melanoma can rupture Bruch’s membane and assume a mushroom shape.
  •  When that occurs, tumor has a tendency to bleed, and vitreal or subretinal hemorrhage may occur.

Q. 14 Risk factor for malignant melanoma all the following are risk factors fore malignant melanoma except

 A

Giant congenital nevi

 B

Family history melanoma

 C

Exposure to UV light

 D

HPV infection

Q. 14

Risk factor for malignant melanoma all the following are risk factors fore malignant melanoma except

 A

Giant congenital nevi

 B

Family history melanoma

 C

Exposure to UV light

 D

HPV infection

Ans. D

Explanation:

Answer- D. HPV infection
risk factor for malignant melanoma is exposure to (UV radiation)

  1. Dysplastic nevus (DN) syndrome; 5-10% risk of forming superficial spreading mil*o^u.
  2. Xeroderma pigmentosum
  3. Historyon nonmelanoma skin cancer (NMSC)
  4. Family history of melanoma (high risk)
  5. Congenital nevi

Quiz In Between



Hanging: Introduction,classification, causes of death

Hanging: Introduction,classification, causes of death

Q. 1

Hanging is established by :

 A

Fracture of hyoid cartilage

 B

Fracture of thyroid cartilage

 C

Staining of saliva

 D

All

Q. 1

Hanging is established by :

 A

Fracture of hyoid cartilage

 B

Fracture of thyroid cartilage

 C

Staining of saliva

 D

All

Ans. C

Explanation:

C i.e. Staining of saliva


Q. 2

Hanging causes large amount of injury to:

 A

Vertebral artery

 B

Carotid A

 C

Trachea

 D

Oesophagus

Q. 2

Hanging causes large amount of injury to:

 A

Vertebral artery

 B

Carotid A

 C

Trachea

 D

Oesophagus

Ans. B

Explanation:

B i.e. Carotid artery

Reddy’s Essentials of forensic medicine & toxicology 23/e P-287 – Injury to trachea is unusual & intima of carotid artery show transverse splits with extravasation of blood.

Parikh 6/e P-3.40 – Jugular veins are occluded by 2 kg tension, carotids by 3.5 kg, trachea by 15 kg, vertebral arteries by 16.6 kg. So amount & chances of injury is also in same order


Q. 3

Hanging with the feet touching the ground is seen in:

 A

Partial hanging

 B

Complete hanging

 C

Homicidal hanging

 D

Suicidal hanging

Q. 3

Hanging with the feet touching the ground is seen in:

 A

Partial hanging

 B

Complete hanging

 C

Homicidal hanging

 D

Suicidal hanging

Ans. A

Explanation:

A i.e. Partial hanging

Quiz In Between


Q. 4

Hanging is defined as :

 A

Suspension of body a ligature, body weight acting as constricting force

 B

Suspension of body by ligature after death

 C

Obliteration of air passages by external compression

 D

Mechanical interference to respiration

Q. 4

Hanging is defined as :

 A

Suspension of body a ligature, body weight acting as constricting force

 B

Suspension of body by ligature after death

 C

Obliteration of air passages by external compression

 D

Mechanical interference to respiration

Ans. A

Explanation:

A i.e. Suspension of body, body weight acting as constricting force


Q. 5

When a person has suspended himself by applying ligature around neck so that the point of suspension (knot) is situated in the region of the occiput. Such a hanging is called as:

 A

Typical

 B

Atypical

 C

Partial

 D

Incomplete

Q. 5

When a person has suspended himself by applying ligature around neck so that the point of suspension (knot) is situated in the region of the occiput. Such a hanging is called as:

 A

Typical

 B

Atypical

 C

Partial

 D

Incomplete

Ans. A

Explanation:

A i.e. Typical Hanging


Q. 6

The “Knot” in judicial hanging is placed at

 A

The back of the neck

 B

The side of the neck

 C

Below the chin

 D

Choice of hangman

Q. 6

The “Knot” in judicial hanging is placed at

 A

The back of the neck

 B

The side of the neck

 C

Below the chin

 D

Choice of hangman

Ans. B

Explanation:

B i.e. Side of the neck

Quiz In Between


Q. 7

Transverse tear in intima of carotid arteries may be seen in:

March 2003

 A

Partial hanging

 B

Judicial hanging

 C

Bansdola

 D

Garroting

Q. 7

Transverse tear in intima of carotid arteries may be seen in:

March 2003

 A

Partial hanging

 B

Judicial hanging

 C

Bansdola

 D

Garroting

Ans. B

Explanation:

Ans. B i.e. Judicial hangin


Q. 8

In simple hanging, the knot comes to rest at the:

September 2009

 

 A

Occiput

 B

Chin

 C

Angle of mandible

 D

Below the cheek

Q. 8

In simple hanging, the knot comes to rest at the:

September 2009

 

 A

Occiput

 B

Chin

 C

Angle of mandible

 D

Below the cheek

Ans. C

Explanation:

Ans. C: Angle of mandible

In most hanging deaths, the ligature and ligature mark lie above the thyroid prominence, with a point of suspension usually behind one ear.

Frontal knots are unusual.

The appearance of the ligature mark varies with the type of ligature used and with the physical characteristics of the individual neck. Soft broad ligatures may not leave any recognizable marks. In most cases, the ligature does not completely encii le the neck.

Quiz In Between



Hanging: Introduction,classification, causes of death

Hanging: Introduction,classification, causes of death


Introduction

Hanging is that form of violent asphyxial deaths, which is caused by the suspension of the  body by a ligature which  encircles the neck, the constricting force being the weight of the body.

Classification:

Depending on the degree of suspension:

Complete hanging: 

  • When the whole body is suspended from the ligature material and no portion of the body is touching the ground.

Partial hanging: 

  • As the name suggests, the body is partially suspended, the toe or feet or either part of the body touching the ground. 
  • The deceased may be in kneeling down position, sitting position etc.
  • the weight of the head is where the constricting force comes from.

Depending on position of the knot of ligature:

Typical hanging: 

  • Where the ligature runs from the midline, above the thyroid cartilage.
  • symmetrically upwards on both sides of the neck(judicial hanging), to the occipital region.
  • The knot is placed over the central part of the back of neck.

Atypical hanging:  The knot is anywhere other than the central part of the back of neck. Most common

site of knot is near one side of mastoid process or angle of mandible.

 Types of knot: Knot tied may be :
1) Fixed noose: Rope is knotted to form fixed knot. This is the most cotnmon pattern. ligature mark is in inverted V shape.

2) Running  noose: One  end  of  the  rope  is  passed  through  the  loop  made from  the  other end, ligature  mark is  horizontal.

Depending on the manner of hanging:

  • Suicidal hanging.
  • Homicidal hanging.
  • Accidental hanging for e.g. autoerotic asphyxia.
  • Judicial hanging.

Causes  of death

Death  may occur  from  :

  • Cerebral ischemia and anoxia due to compression of carotid artery.
  • It require 3-5 kg weight of suspension-
  • Tear in  intima  of carotid  artery  is  known  as  Amussat’s sign.
  • Cerebral  congestion  due to  compression  of jugular veins.  It  requires  only 2 kg weight.
  • Asphyxia due to  compression  of  airways  (larynx  and  trachea).  It  requires  15 kg weight.
  • Neurogenic shock/vagal  inhibition (due  to  pressure  on  vagus  nerve  or carotid  sinuses)
  • Fracture  dislocation  of upper  cervical  vertebrae with damage  to  spinal  cord  and brainstem :  especially in  judicial hanging.
  • Any  combination  of  the  above.

* Combined asphyxia  and cerebral  venous  congestion  is  the  most  common  cause  of death.

Exam Important

Complete hanging: 

  • When the whole body is suspended from the ligature material and no portion of the body is touching the ground.

Partial hanging: 

  • As the name suggests, the body is partially suspended, the toe or feet or either part of the body touching the ground. 
  • The deceased may be in kneeling down position, sitting position etc.
  • the weight of the head is where the constricting force comes from.

Depending on position of the knot:

Typical hanging: 

  • Where the ligature runs from the midline, above the thyroid cartilage.
  • symmetrically upwards on both sides of the neck(judicial hanging), to the occipital region.
  • The knot is placed over the central part of the back of neck.

Atypical hanging:  The knot is anywhere other than the central part of the back of neck.

Death  may occur  from  :

  • Cerebral ischemia and anoxia due to compression of carotid artery.
  • It require 3-5 kg weight of suspension-
  • Tear in  intima  of carotid  artery  is  known  as  Amussat’s sign.
  • Cerebral  congestion  due to  compression  of jugular veins.  It  requires  only 2 kg weight.
  • Asphyxia due to  compression  of  airways  (larynx  and  trachea).  It  requires  15 kg weight.
  • Neurogenic shock/vagal  inhibition (due  to  pressure  on  vagus  nerve  or carotid  sinuses)
  • Fracture  dislocation  of upper  cervical  vertebrae with damage  to  spinal  cord  and brainstem :  especially in  judicial hanging.
  • Any  combination  of  the  above.

* Combined asphyxia  and cerebral  venous  congestion  is  the  most  common  cause  of death.

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