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Benign Neoplasms 80% of all salivary gland tumours arise in the parotid gland. Of these, ~80% are benign. Growth rate ≠ malignancy: rapid growth doesn't always imply malignancy. Facial nerve involvement = red flag for malignancy. Benign tumors are more common in women (except Warthin's). Median age: 5th decade. Benign Tumour Types Tumour Features Pleomorphic adenoma (benign mixed tumour) Most common (~80%). Involves epithelial + myoepithelial cells. Lobulated, slow-growing, not well-encapsulated. Risk of malignant transformation (2–10%) and recurrence if capsule is violated. Warthin tumour 2nd most common benign tumour (5%). Occurs in older males, often bilateral or multicentric. Cystic with lymphoid tissue. Rare malignant change. Monomorphic adenoma <5% of tumours. Single cell type. Includes oncocytoma, basal cell adenoma, canalicular adenoma, myoepithelioma. Slow-growing. Haemangioma Commonest parotid tumour in in...

📊 Epidemiology Incidence in the UK: 12.4–29 per 100,000 Most common in young males after fall on outstretched hand (FOOSH) 🧠 Anatomical Considerations Forms the floor of the anatomical snuffbox >80% of surface covered with articular cartilage , limiting vascular entry Blood supply enters distally → proximal fractures at high risk of avascular necrosis ⚠️ Mechanism of Injury Typical mechanism: FOOSH Fracture sites: Tubercle Distal pole Waist (most common) Proximal pole 📸 Diagnosis Initial imaging: 4-view scaphoid series: Posteroanterior (PA) Pronated oblique Ziter view (PA with ulnar deviation + 20° beam angle) Lateral view Sensitivity in 1st week: ~80% If initial X-ray is negative but suspicion remains: Immobilize in thumb spica Repeat imaging after 10 days MRI if diagnosis remains uncertain 🧩 Classification (by location) Tubercle Dist...

A 13-year-old boy falls onto an outstretched hand and is assessed in the emergency department. No fracture is identified at the time, and he is discharged. He returns a week later with persistent pain in his hand. What is the most likely underlying injury? A. Fracture of the distal radius B. Fracture of the scaphoid C. Dislocation of the lunate D. Rupture of the flexor pollicis longus tendon E. Bennett’s fracture ✅ Correct answer: Fracture of the scaphoid 📌 Explanation: A scaphoid fracture is a common occult injury in adolescents and young adults following a fall on an outstretched hand (FOOSH) . It may not be visible on initial X-rays , especially if non-displaced, and pain may be mild early on , leading to it being missed clinically. 🩺 Clues pointing to scaphoid fracture: Delayed presentation : The child re-presents a week later due to persistent pain. Classic mechanism : FOOSH is the classic injury mechanism. Often missed : Initial X-rays can be falsely negative. ...

A 53-year-old man presents with a mass located just below the tragus of his right ear. Ultrasound and fine-needle aspiration (FNA) confirm a 2 cm pleomorphic adenoma. What is the most appropriate next step in management? A. USS-guided core biopsy B. Radical parotidectomy C. Superficial parotidectomy D. Discharge E. MRI of the region ✅ Correct answer: C. Superficial parotidectomy 📌 Explanation: A pleomorphic adenoma is the most common benign salivary gland tumor, typically arising from the superficial lobe of the parotid gland . Even though it is benign, it has potential for malignant transformation and local recurrence if not completely excised. 🩺 Management: Superficial parotidectomy is the treatment of choice for small, well-circumscribed tumors confined to the superficial lobe. It ensures complete tumor excision with preservation of the facial nerve , which runs through the gland. Enucleation is avoided due to high recurrence risk. ❌ Why not the others? A. U...

🧾 Purpose: To quantify organ dysfunction in critically ill patients (e.g. sepsis) and predict mortality. 📌 Used in: ICU admissions Sepsis diagnosis (Sepsis = suspected infection + SOFA ↑ by ≥2) 🧪 SOFA Scoring System (0–4 points per organ) Total score: 0–24 Organ System Parameter Criteria 🧠 Neurologic Glasgow Coma Scale (GCS) ↓ GCS → ↑ score 🫁 Respiratory PaO₂/FiO₂ ratio <400 to <100 → Score 0–4 🩸 Coagulation Platelet count <150 → ↑ score 🩺 Cardiovascular Hypotension/Vasopressors MAP <70 or need for pressors 🧬 Liver Bilirubin >1.2 mg/dL → ↑ score 🧪 Renal Creatinine or urine output >1.2 mg/dL or ↓ urine output ⚠️ Interpretation SOFA ↑ by ≥2 = organ dysfunction → consider sepsis Higher scores = greater mortality risk